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Laporan Rekap Dokter Tanggal: 01/04/2019 s/d 30/04/2019
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
Dokter:
1 LUVITA SARI YUNANI 201904001237 05/04/2019 IGD
- CLOZAPINE 25 MG 4,00 10.780
RISPERIDONE 2 MG 8,00
201904001682 08/04/2019 Ruangan RISPERIDONE 2 MG 15,00 21.143
CLOZAPINE 25 MG 8,00
201904002041 10/04/2019 Ruangan TABLET TAMBAH 30,00 19.876
DULCOLAX 5MG 4,00
FOLIC ACID 1 MG 10,00
201904003075 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 18.865
CLOZAPINE 25 MG 7,00
2 ABADI KRISNA JAYA 201904000682 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.800
CPZ 100 MG 60,00
HALOPERIDOL 5 MG 60,00
3 ABBAS 201904002963 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 15,00 6.255
201904003041 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 15,00 6.255
4 ABD SHOMAD 201904000398 01/04/2019 Ruangan Gelatik THD 2 MG 7,00 6.496
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904000518 02/04/2019 Ruangan Gelatik PEHACHAIN INJ 2,00 13.266
AMOXYCILLIN 500 10,00
ASAM MEFENAMAT 10,00
201904000919 04/04/2019 Ruangan Gelatik LORATADIN 10 MG 8,00 4.824
BETAMETASON 1,00
201904001746 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
5 ABD. AZIZ 201904004064 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 60,00 266.280
TFP 5 MG 60,00
THD 2 MG 60,00
6 ABD. KARIM 201904000356 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 38.472
RISPERIDONE 2 MG 28,00
7 ABD. MUIN 201904002461 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
8 ABD. QODIR JAILANI 201904000341 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
201904002940 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
9 ABD. ROCHIM 201904002908 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
10 ABD.CHALIM ROESIDI 201904005227 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 78.270
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
10 ABD.CHALIM ROESIDI 201904005227 26/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
11 ABDUL AMSORI 201904000269 01/04/2019 Ruangan Wijaya IKANEURON INJ 5000 3,00 25.701
SPUIT 3 CC 3,00
201904000981 04/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 16.852
RISPERIDONE 3 MG 14,00
201904001589 08/04/2019 Ruangan Wijaya THD 2 MG 12,00 6.807
CLOZAPINE 25 MG 3,00
201904001758 08/04/2019 Ruangan Wijaya PARACETAMOL 500 10,00 32.593
SPUIT 3 CC 3,00
NORAGES INJEKSI 3,00
DEXAMETASON 0,5 10,00
201904002633 12/04/2019 Ruangan Gelatik INFUS SET ANAK 1,00 76.542
ALKOHOL SWAB 2,00
SPUIT 5 CC 1,00
IV CANULLA NO.20 1,00
201904002634 12/04/2019 Ruangan Gelatik CURCUMA 200 MG 10,00 26.510
SALBUTAMOL 4 MG 5,00
CETIRIZINE TABLET 10,00
KAPSUL NO 2 20,00
CODEIN 20 MG 5,00
RACIKAN KAPSUL 20,00
AMBROXOL 30 MG 10,00
201904003139 15/04/2019 Ruangan Gelatik THD 2 MG 7,00 11.077
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 7,00
201904003424 16/04/2019 Ruangan Gelatik THD 2 MG 16,00 12.412
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 8,00
12 ABDUL HAFIDZ 201904001286 07/04/2019 IGD LODOMER 2 MG/ML 0,00 3.278
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 4,00
201904003128 15/04/2019 Ruangan Gelatik THD 2 MG 15,00 35.700
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 15,00
201904003172 15/04/2019 Ruangan Gelatik TFP 5 MG 10,00 3.230
201904004333 23/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 35.700
THD 2 MG 15,00
CLOZAPINE 25 MG 15,00
13 ABDUL KHOLID 201904000268 01/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 8,00 5.736
CPZ 100 MG 2,00
201904000916 04/04/2019 Ruangan Gelatik THD 2 MG 5,00 510
201904003155 15/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 2,00 1.344
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
13 ABDUL KHOLID 201904003180 15/04/2019 Ruangan
- Gelatik RISPERIDONE 3 MG 14,00 10.842
THD 2 MG 7,00
CPZ 100 MG 4,00
201904004320 23/04/2019 Ruangan Gelatik CPZ 100 MG 2,00 11.256
RISPERIDONE 3 MG 15,00
THD 2 MG 8,00
201904004566 23/04/2019 Ruangan Gelatik THD 2 MG 5,00 510
14 ABDUL LATIF 201904003948 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 45.375
CLOBAZAM 10 MG 15,00
15 ABDUL MUNIF 201904001559 08/04/2019 Poli Jiwa Dewasa VIT B COMPLEX 10,00 47.440
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
16 ABDUL MUNIP 201904002930 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 137.160
CLOZAPINE 25 MG 60,00
TFP 5 MG 60,00
17 ABDUL RACHMAN 201904001572 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 53.220
CPZ 100 MG 15,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
18 ABDUL ROCHIM 201904005547 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 153.570
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
19 ABDUL ROHMAN 201904003009 15/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904004233 23/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
20 ABDUL ROKHIM 201904002655 13/04/2019 Ruangan Kenari THD 2 MG 7,00 34.643
CLOZAPINE 100 MG 7,00
RISPERIDONE 2 MG 14,00
201904004020 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 100.515
RISPERIDONE 3 MG 60,00
21 ABDUL ROSID 201904003980 22/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 39.855
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
22 ABDUL ROSYID 201904001932 09/04/2019 Ruangan Kenari SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
201904003380 16/04/2019 Ruangan Kenari CPZ 100 MG 7,00 162.456
SEROQUEL XR 400 7,00
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904004272 23/04/2019 Ruangan Kenari THD 2 MG 14,00 161.196
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
22 ABDUL ROSYID 201904004272 23/04/2019 Ruangan
- Kenari SEROQUEL XR 400 7,00 161.196
RISPERIDONE 3 MG 14,00
201904004641 24/04/2019 Ruangan Kenari AMOXYCILLIN 500 10,00 17.448
METHYLPREDNISOL 16,00
AMBROXOL 30 MG 10,00
DEMACOLIN 10,00
201904005700 29/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 162.456
THD 2 MG 14,00
CPZ 100 MG 7,00
SEROQUEL XR 400 7,00
23 ABDUL WAHID 201904002180 10/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 158.100
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
24 ABDUS SALAM 201904003003 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904004282 23/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904004725 24/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
25 ABU BAKAR SIDIK 201904002550 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 99.210
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
26 ACH SYAUDI 201904001960 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
27 ACH. BUKORI 201904004218 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.500
THD 2 MG 60,00
28 ACHMAD FAUZAN 201904003020 15/04/2019 Ruangan Kenari THD 2 MG 14,00 26.888
CLOZAPINE 100 MG 4,00
RISPERIDONE 3 MG 14,00
201904004247 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 71.031
THD 2 MG 14,00
CLOZAPINE 100 MG 15,00
201904005719 29/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 16.852
CLOZAPINE 25 MG 4,00
29 ACHMAD ISA IDRIS 201904000096 01/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 7,00 30.163
HALOPERIDOL 5 MG 14,00
201904003129 15/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 8,00 35.656
HALOPERIDOL 5 MG 24,00
201904003166 15/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 2,00 4.309
CLOZAPINE 100 MG 1,00
201904003490 18/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 7,00 30.163
HALOPERIDOL 5 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
30 ACHMAD ISNAINI 201904001579 08/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 60,00 107.299
THD 2 MG 60,00
CLOZAPINE 100 MG 23,00
31 ACHMAD NUR 201904002482 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 85.215
CLOZAPINE 100 MG 15,00
32 ACHMAD RAMADHAN 201904001115 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 315.216
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 45,00
THD 2 MG 60,00
33 ACHMAD SIDIQ HELMI 201904000315 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 178.782
PEHACHAIN INJ 2,00
AMOXYCILLIN 500 15,00
CATAFLAM 50 MG 10,00
CURCUMA 200 MG 42,00
NUZIP 25 14,00
201904002933 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 52.850
CLOZAPINE 25 MG 14,00
CURCUMA 200 MG 0,00
201904004174 22/04/2019 Ruangan Napza NUZIP 25 6,00 76.818
CURCUMA 200 MG 40,00
SERTRALINE 50 MG 12,00
34 ACHMAD SYAIFUL FARID 201904005535 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 748.260
RISPERIDONE 3 MG 60,00
SEROQUEL XR 400 30,00
SERTRALINE 50 MG 30,00
35 ACMAT ROKMAN 201904002511 12/04/2019 Ruangan Wijaya ZYPREXA INJ 1,00 188.217
AQUA PRO INJEKSI 1,00
RISPERIDONE 2 MG 14,00
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 7,00
THD 2 MG 7,00
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 14,00
201904002951 15/04/2019 Puri Mitra (Laki- CLOZAPINE 25 MG 7,00 15.813
HALOPERIDOL 5 MG 14,00
THD 2 MG 7,00
201904004159 22/04/2019 Puri Mitra (Laki- CLOZAPINE 25 MG 7,00 15.813
HALOPERIDOL 5 MG 14,00
THD 2 MG 7,00
201904005678 29/04/2019 Puri Mitra (Laki- HALOPERIDOL 5 MG 14,00 15.813
THD 2 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
35 ACMAT ROKMAN 201904005678 29/04/2019 Puri Mitra
- (Laki- CLOZAPINE 25 MG 7,00 15.813
36 ADE IRMA NASUTION 201904000425 01/04/2019 Ruangan Puri OLANZPINE 10mg 4,00 30.420
RISPERIDONE 3 MG 10,00
THD 2 MG 10,00
37 ADE WINTONO 201904004055 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 59.055
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
38 ADEK 201904004765 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
39 ADI JAYA 201904000760 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 110.715
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
40 ADI SUSANTO 201904000331 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 33.726
VIT C 100 MG 42,00
201904002938 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
41 ADITYA PUTU 201904004363 23/04/2019 IGD DIPHENHYDRAMINE 2,00 5.314
SPUIT 3 CC 1,00
42 ADNAN 201904003006 15/04/2019 Ruangan Kenari CPZ 100 MG 7,00 4.760
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
201904003728 21/04/2019 Ruangan Kenari THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
43 AFLAHAH 201904000589 02/04/2019 IGD CLOZAPINE 25 MG 2,00 5.660
TFP 5 MG 6,00
201904001769 08/04/2019 Puri Mitra CLOZAPINE 25 MG 7,00 17.549
TFP 5 MG 14,00
201904002650 13/04/2019 Puri Mitra CLOZAPINE 25 MG 4,00 10.028
TFP 5 MG 8,00
201904003546 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
44 AGNES ABON KERANSZ 201904002630 12/04/2019 Ruangan Puri THD 2 MG 14,00 59.249
CLOZAPINE 25 MG 7,00
ADALAT OROS 30 MG 7,00
DIAZEPAM inj 1,00
RISPERIDONE 3 MG 14,00
SPUIT 3 CC 1,00
201904003663 18/04/2019 Ruangan Puri CLOZAPINE 25 MG 7,00 23.863
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904005262 26/04/2019 Ruangan Puri RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
44 AGNES ABON KERANSZ 201904005262 26/04/2019 Ruangan
- Puri CLOZAPINE 25 MG 7,00 23.863
45 AGUNG BUDIANTO 201904001748 08/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 18.879
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
TFP 5 MG 21,00
201904003165 15/04/2019 Ruangan Gelatik CPZ 100 MG 2,00 4.425
TFP 5 MG 3,00
RISPERIDONE 3 MG 4,00
THD 2 MG 4,00
201904003177 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 18.879
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
TFP 5 MG 21,00
46 AGUNG MEDIO 201904000519 02/04/2019 Ruangan Gelatik LORATADIN 10 MG 5,00 2.010
BETAMETASON 0,00
201904001204 05/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904004199 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
47 AGUNG PRIYO UTOMO 201904005501 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 160.710
CLOZAPINE 100 MG 30,00
48 AGUNG SASMITA 201904003503 18/04/2019 Poli Jiwa Dewasa PHENYTOIN CAP 100 30,00 66.750
CARBAMAZEPINE 60,00
CLOBAZAM 10 MG 30,00
49 AGUNG SETIA BUDI 201904001921 09/04/2019 IGD CLOZAPINE 25 MG 1,00 3.937
RISPERIDONE 2 MG 4,00
THD 2 MG 4,00
201904002582 12/04/2019 Ruangan Kenari CLOZAPINE 25 MG 8,00 17.472
TFP 5 MG 8,00
201904003402 16/04/2019 Ruangan Kenari THD 2 MG 14,00 32.004
CLOZAPINE 25 MG 14,00
TFP 5 MG 14,00
201904004359 23/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 32.004
TFP 5 MG 14,00
THD 2 MG 14,00
50 AGUS HARIANTO 201904005502 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 81.146
SIKZONOATE 1,00
SPUIT 3 CC 1,00
51 AGUS SRI PURWANTO 201904002590 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 60,00 30.180
TFP 5 MG 60,00
52 AGUS BUDIANTO 201904002313 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 115.530
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
52 AGUS BUDIANTO 201904002313 11/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 115.530
RISPERIDONE 3 MG 60,00
53 AGUS JUMANTORO 201904003867 22/04/2019 Poli Syaraf THD 2 MG 30,00 3.060
54 AGUS KECIL 201904005578 29/04/2019 Ruangan Kenari TFP 5 MG 10,00 5.150
THD 2 MG 10,00
CPZ 100 MG 5,00
55 AGUS PN 201904004202 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 57.420
56 AGUS PRASETIO 201904000104 01/04/2019 IGD CLOZAPINE 25 MG 11,00 20.471
57 AGUS SALIM FAHMI 201904000920 04/04/2019 IGD TFP 5 MG 14,00 6.538
KAPSUL NO 2 14,00
THD 2 MG 14,00
RACIKAN KAPSUL 14,00
58 AGUS SETIAWAN 201904001103 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 137.160
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
59 AGUS SETIYO 201904002377 12/04/2019 Ruangan Gelatik SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
201904003181 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 17.549
TFP 5 MG 14,00
201904003433 16/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 17.549
TFP 5 MG 14,00
60 AGUS SUPRIYANTO 201904002704 15/04/2019 Poli Psikiater CLOBAZAM 10 MG 40,00 46.560
61 AGUS SURYANTO 201904003942 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.180
LORAZEPAM 2 MG 10,00
62 AGUS WIJAYA 201904001538 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
63 AGUS ZAENAL 201904005529 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 115.530
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
64 AGUSTIN LISDA 201904001676 08/04/2019 Ruangan TFP 5 MG 21,00 8.211
THD 2 MG 14,00
201904003096 15/04/2019 Ruangan TFP 5 MG 21,00 8.211
THD 2 MG 14,00
201904004252 23/04/2019 Ruangan THD 2 MG 14,00 8.211
TFP 5 MG 21,00
65 AGUSTINA 201904005768 29/04/2019 Ruangan TFP 5 MG 14,00 22.210
CPZ 100 MG 4,00
THD 2 MG 14,00
CURCUMA 200 MG 14,00
66 AHMAD MUJAHID 201904003938 22/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 315.990
TFP 5 MG 60,00
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
66 AHMAD MUJAHID 201904003938 22/04/2019 Poli Jiwa- Dewasa CLOZAPINE 100 MG 30,00 315.990
67 AHMAD CHOLIB 201904002187 10/04/2019 IGD THD 2 MG 4,00 3.712
CPZ 100 MG 4,00
TFP 5 MG 8,00
201904002974 15/04/2019 Puri Mitra (Laki- THD 2 MG 7,00 6.496
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904003659 18/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 12.992
CPZ 100 MG 14,00
TFP 5 MG 28,00
201904004166 22/04/2019 Puri Mitra (Laki- TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904005669 29/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
68 AHMAD HUSEN ASHARI 201904001033 05/04/2019 Ruangan Kenari MELOXICAM 15 MG 8,00 10.840
ASAM MEFENAMAT 8,00
201904003384 16/04/2019 Ruangan Kenari ANTASIDA DOEN 8,00 19.255
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
69 AHMAD KHOIRUL 201904005210 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
70 AHMAD NIRI 201904005557 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 176.520
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
71 AHMAD SYAFRIZA 201904005904 30/04/2019 Poli Jiwa Anak CLOZAPINE 25 MG 16,00 143.356
THD 2 MG 60,00
RISPERIDONE 2 MG 120,00
SERTRALINE 50 MG 30,00
72 AHMAD TAUFIQ 201904005287 27/04/2019 Poli Psikiater BAMGETOL 200 MG 30,00 42.780
73 AHMAD UMARUL FARUQ 201904000308 01/04/2019 Puri Mitra (Laki- RISPERIDONE 3 MG 14,00 50.406
CLOZAPINE 25 MG 14,00
THD 2 MG 14,00
DIPHENHYDRAMINE 4,00
SPUIT 3 CC 2,00
201904001211 05/04/2019 Puri Mitra (Laki- DIAZEPAM 2 MG 10,00 6.110
NA DICLOFENAC 50 10,00
201904001765 08/04/2019 Puri Mitra (Laki- CLOZAPINE 25 MG 14,00 36.890
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
73 AHMAD UMARUL FARUQ 201904002978 15/04/2019 Puri Mitra
- (Laki- CLOZAPINE 25 MG 14,00 36.890
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904004160 22/04/2019 Puri Mitra (Laki- CLOZAPINE 25 MG 14,00 36.890
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
74 AHMAD YAHDILLAH 201904005610 29/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 955.950
RISPERIDONE 3 MG 60,00
ABILIFY DISCMELT 10 30,00
75 AJAK / AJAI 201904003146 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 9.471
TFP 5 MG 21,00
THD 2 MG 14,00
201904004352 23/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
76 AJI 201904002979 15/04/2019 Ruangan Kenari CPZ 100 MG 4,00 10.128
RISPERIDONE 3 MG 14,00
201904003422 16/04/2019 Ruangan Kenari SCABIMITE 10mg 1,00 58.200
201904004341 23/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 4.020
201904004357 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 10.128
CPZ 100 MG 4,00
77 AKBAR RAHMA 201904001202 05/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904004198 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
78 AKH. ARIS MUNDIR 201904001299 08/04/2019 Poli Psikiater CPZ 100 MG 30,00 24.180
TFP 5 MG 30,00
AMITRIPTILIN 25 MG 30,00
THD 2 MG 30,00
79 AKHMAD BAYU 201904003385 16/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 12,00 17.394
THD 2 MG 12,00
CLOZAPINE 25 MG 6,00
201904003629 18/04/2019 Ruangan Gelatik METFORMIN 500 MG 10,00 4.920
RAMIPRIL 5 MG 10,00
201904005821 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
80 AKHMAD YAHYA 201904001514 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
81 ALDY PRADANA DIPTYA 201904002190 10/04/2019 Poli Psikiater THD 2 MG 7,00 70.161
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
81 ALDY PRADANA DIPTYA 201904002190 10/04/2019 Poli Psikiater
- RACIKAN KAPSUL 7,00 70.161
RISPERIDONE 2 MG 7,00
KAPSUL NO 3 7,00
NOPRES 20 MG 7,00
RACIKAN KAPSUL 7,00
THD 2 MG 7,00
KAPSUL NO 3 7,00
RIKLONA 2 MG 7,00
RISPERIDONE 2 MG 7,00
201904004607 23/04/2019 Poli Psikiater KAPSUL NO.00 7,00 17.780
THD 2 MG 7,00
RACIKAN KAPSUL 7,00
ELIZAC 20 MG 7,00
RISPERIDONE 2 MG 7,00
201904005845 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 7,00 64.314
KAPSUL NO 2 2,00
ELIZAC 20 MG 2,00
RACIKAN KAPSUL 7,00
THD 2 MG 2,00
KAPSUL NO 2 7,00
RIKLONA 2 MG 7,00
RISPERIDONE 2 MG 2,00
THD 2 MG 7,00
RACIKAN KAPSUL 2,00
82 ALFAN 201904001395 08/04/2019 Poli VCT LANSOPRAZOLE 20,00 105.440
SERBION 5000 20,00
CURCUMA 200 MG 40,00
201904002791 15/04/2019 Poli Syaraf CANDESARTAN 8 MG 30,00 343.620
KUTOIN 90,00
CLOBAZAM 10 MG 15,00
LEVOPAR 90,00
THD 2 MG 60,00
83 ALFI RAHMADTUL IZZAH 201904000956 04/04/2019 Poli Jiwa Anak HALOPERIDOL 5 MG 2,00 53.062
RACIKAN KAPSUL 20,00
KAPSUL NO 2 20,00
SERTRALINE 50 MG 4,00
FOLIC ACID 1 MG 10,00
LORAZEPAM 2 MG 10,00
DEPAKOTE ER 250 10,00
84 ALFIAN SINE 201904004010 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
85 ALI MUHSIN 201904000917 04/04/2019 Ruangan Gelatik AMITRIPTILIN 25 MG 10,00 2.250
201904001976 09/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 1,00 8.280
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
85 ALI MUHSIN 201904001976 09/04/2019 Ruangan
- Gelatik TFP 5 MG 11,00 8.280
THD 2 MG 7,00
201904003150 15/04/2019 Ruangan Gelatik AMITRIPTILIN 25 MG 1,00 1.374
TFP 5 MG 3,00
THD 2 MG 2,00
201904003175 15/04/2019 Ruangan Gelatik THD 2 MG 15,00 44.078
CLOZAPINE 100 MG 8,00
TFP 5 MG 23,00
AMITRIPTILIN 25 MG 15,00
201904004342 23/04/2019 Ruangan Gelatik TFP 5 MG 21,00 27.077
AMITRIPTILIN 25 MG 14,00
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
201904005310 28/04/2019 Ruangan Gelatik TFP 5 MG 21,00 27.077
AMITRIPTILIN 25 MG 14,00
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
86 ALIF MUSTAJAB 201904001773 08/04/2019 IGD CPZ 100 MG 2,00 166.766
SPUIT 3 CC 1,00
TFP 5 MG 4,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
201904001941 09/04/2019 Ruangan Kenari CPZ 100 MG 6,00 4.956
TFP 5 MG 12,00
201904003004 15/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904004277 23/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
87 ALVIN ONGKO WIJOYO 201904000413 01/04/2019 Ruangan Puri OLANZPINE 10mg 15,00 135.710
CLOZAPINE 25 MG 20,00
RISPERIDONE 3 MG 20,00
201904001702 08/04/2019 Ruangan Puri PROPANOLOL 40 MG 10,00 85.970
OLANZPINE 10mg 15,00
201904002174 10/04/2019 Ruangan Puri SIKZONOATE 1,00 119.471
CLOZAPINE 25 MG 20,00
RISPERIDONE 3 MG 20,00
SPUIT 3 CC 1,00
201904003667 18/04/2019 Ruangan Puri PROPANOLOL 40 MG 10,00 85.970
OLANZPINE 10mg 15,00
201904004112 22/04/2019 Ruangan Puri PROPANOLOL 40 MG 7,00 85.449
RISPERIDONE 3 MG 14,00
CLOZAPINE 25 MG 7,00
OLANZPINE 10mg 11,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
87 ALVIN ONGKO WIJOYO 201904005299 27/04/2019 Ruangan
- Puri PROPANOLOL 40 MG 4,00 42.795
RISPERIDONE 3 MG 10,00
CLOZAPINE 25 MG 7,00
OLANZPINE 10mg 4,00
88 ALWI FAHRUDIN 201904001974 09/04/2019 Ruangan Gelatik THD 2 MG 14,00 1.428
201904003163 15/04/2019 Ruangan Gelatik THD 2 MG 15,00 1.530
201904003178 15/04/2019 Ruangan Gelatik THD 2 MG 14,00 30.590
CLOZAPINE 25 MG 14,00
HALOPERIDOL 5 MG 21,00
89 AMI FITRIA 201904003204 16/04/2019 Poli Jiwa Dewasa KAPSUL NO.0 30,00 65.736
AMITRIPTILIN 25 MG 30,00
RACIKAN KAPSUL 30,00
DIAZEPAM 5 MG 6,00
SERTRALINE 50 MG 30,00
90 AMIN JAKFAR SODIKIN 201904000355 01/04/2019 Ruangan Napza CLOZAPINE 25 MG 14,00 49.630
THD 2 MG 28,00
RISPERIDONE 2 MG 28,00
TFP 5 MG 28,00
91 AMIR NUDIN 201904003002 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
201904004307 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
92 ANA ISTIANANINGSIH 201904000596 02/04/2019 IGD TFP 5 MG 6,00 4.743
LORAZEPAM 2 MG 3,00
201904001201 05/04/2019 Ruangan Wijaya LORAZEPAM 2 MG 7,00 11.067
TFP 5 MG 14,00
201904003080 15/04/2019 Ruangan LORAZEPAM 2 MG 7,00 11.067
TFP 5 MG 14,00
201904003521 18/04/2019 Ruangan TFP 5 MG 14,00 12.495
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
93 ANANDA FATIKAH 201904000414 01/04/2019 Ruangan Puri LORAZEPAM 2 MG 4,00 32.132
THD 2 MG 14,00
HALOPERIDOL 5 MG 21,00
DEPAKOTE ER 250 7,00
94 ANANG KHOIRONI 201904003706 19/04/2019 IGD TFP 5 MG 6,00 180.282
AQUA PRO INJEKSI 1,00
THD 2 MG 6,00
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 6,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
201904004251 23/04/2019 Ruangan Kenari THD 2 MG 14,00 32.327
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
94 ANANG KHOIRONI 201904004251 23/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 14,00 32.327
TFP 5 MG 15,00
201904004637 24/04/2019 Ruangan Kenari SPUIT 3 CC 1,00 71.456
SIKZONOATE 1,00
201904005706 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 31.290
THD 2 MG 7,00
CLOZAPINE 25 MG 14,00
95 ANANG WINARKO 201904003501 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 135.390
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
96 ANAS ILHAM RAMADHAN 201904001213 05/04/2019 Ruangan Kenari NORAGES INJEKSI 3,00 40.573
DEXAMETASON 0,5 10,00
SPUIT 3 CC 3,00
PARACETAMOL 500 10,00
CEFADROXIL 500 MG 10,00
201904002946 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 14.308
CPZ 100 MG 14,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
97 ANDHIKA PURBASETYA 201904003974 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 180.855
LORAZEPAM 2 MG 15,00
RISPERIDONE 3 MG 60,00
CLOZAPINE 100 MG 30,00
98 ANDI DWI RUFIANTO 201904001894 09/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 10,00 7.995
THD 2 MG 10,00
LORAZEPAM 2 MG 3,00
99 ANDI ISWANTO 201904002330 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 27.720
RISPERIDONE 2 MG 60,00
100 ANDIK 201904000758 04/04/2019 Ruangan Puri SERTRALINE 50 MG 7,00 216.293
ABILIFY DISCMELT 10 7,00
RISPERIDONE 3 MG 14,00
101 ANDIK SULISWANTO 201904001223 05/04/2019 Ruangan Puri SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
201904001987 09/04/2019 Ruangan Puri ABILIFY DISCMELT 10 7,00 216.293
RISPERIDONE 3 MG 14,00
SERTRALINE 50 MG 7,00
201904003415 16/04/2019 Ruangan Puri ABILIFY DISCMELT 10 7,00 216.293
RISPERIDONE 3 MG 14,00
SERTRALINE 50 MG 7,00
201904003661 18/04/2019 Ruangan Puri ALLOPURINOL 100 7,00 1.120
201904004708 24/04/2019 Ruangan Puri NEURODEK 10,00 111.510
TENSOCRAPE 10 CM 1,00
NA DICLOFENAC 50 10,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
101 ANDIK SULISWANTO 201904004771 24/04/2019 Ruangan
- Puri RISPERIDONE 3 MG 14,00 217.413
SERTRALINE 50 MG 7,00
ALLOPURINOL 100 7,00
ABILIFY DISCMELT 10 7,00
102 ANDIKA LIDYA MURNI 201904005238 26/04/2019 Ruangan Wijaya CENDO XITROL E D 1,00 36.470
CPZ 100 MG 2,00
TFP 5 MG 6,00
201904005308 28/04/2019 Ruangan PEN NEEDLE 30 0,00 0
201904005776 29/04/2019 Ruangan TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
103 ANDIKA LUIS 201904003612 18/04/2019 Poli Jiwa Anak SERTRALINE 50 MG 12,00 56.946
CLOBAZAM 10 MG 18,00
RACIKAN KAPSUL 60,00
VIT B6 10 MG 30,00
FOLIC ACID 1 MG 24,00
RISPERIDONE 3 MG 10,00
KAPSUL NO 2 60,00
104 ANDREA 201904002958 15/04/2019 Poli Gigi (Jiwa) THD 2 MG 7,00 5.236
TFP 5 MG 14,00
201904003017 15/04/2019 Poli Gigi (Jiwa) THD 2 MG 7,00 5.236
TFP 5 MG 14,00
105 ANDREW WIJAYA 201904002683 14/04/2019 IGD RISPERIDONE 2 MG 4,00 12.834
CLOZAPINE 25 MG 6,00
201904003033 15/04/2019 Ruangan Puri RIZODAL 2 MG 20,00 68.360
THD 2 MG 20,00
NUZIP 25 20,00
201904003657 18/04/2019 Ruangan Puri DEPTRAL 50 MG 10,00 120.520
201904004104 22/04/2019 Ruangan Puri LORATADIN 10 MG 5,00 6.195
DOXYCICLIN 100 MG 5,00
RACIKAN KAPSUL 5,00
KAPSUL NO.1 5,00
201904004978 25/04/2019 Ruangan Puri RIZODAL 2 MG 20,00 52.610
THD 2 MG 20,00
NUZIP 25 10,00
201904005664 29/04/2019 Ruangan Puri DEPTRAL 50 MG 10,00 120.520
106 ANDRI PRASTIAWAN 201904004006 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
107 ANDRI PURNOMO 201904003183 15/04/2019 IGD CLOZAPINE 25 MG 4,00 9.946
RISPERIDONE 2 MG 6,00
108 ANDRIYANTO 201904001259 06/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
109 ANDY OCTABIANTO 201904000634 03/04/2019 IGD
- CENDO XITROL E D 1,00 34.172
110 ANGGER PRASEDIA 201904004783 24/04/2019 IGD RISPERIDONE 3 MG 10,00 6.720
201904005266 26/04/2019 Ruangan Puri CURCUMA 200 MG 30,00 66.105
PROBENID 500 MG 15,00
201904005661 29/04/2019 Ruangan Puri CLOZAPINE 25 MG 7,00 23.863
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
111 ANGGITA AYU F.A 201904003098 15/04/2019 IGD CIPROFLOXACIN 500 10,00 8.760
DEXAMETASON 0,5 10,00
DEMACOLIN 10,00
112 ANI MARTINI 201904005251 26/04/2019 Ruangan TFP 5 MG 2,00 1.006
CPZ 100 MG 2,00
201904005775 29/04/2019 Ruangan CPZ 100 MG 14,00 11.212
TFP 5 MG 14,00
CURCUMA 200 MG 3,00
FOLIC ACID 1 MG 10,00
113 ANI SETYAWATI, SE 201904003959 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
114 ANIK INDRAWATI 201904000189 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
115 ANIK MUJAYANTI 201904000292 01/04/2019 Puri Mitra RISPERIDONE 2 MG 14,00 31.892
CLOZAPINE 25 MG 14,00
201904001771 08/04/2019 Puri Mitra CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904002360 11/04/2019 Puri Mitra TFP 5 MG 8,00 2.584
201904002987 15/04/2019 Puri Mitra CLOZAPINE 25 MG 7,00 86.360
TFP 5 MG 14,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
201904003968 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
116 ANIK SETYOWATI 201904001574 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
117 ANIS SUHERMANTO 201904004026 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 159.690
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
118 ANITA WIJAYA 201904004795 25/04/2019 Ruangan Wijaya THD 2 MG 4,00 9.562
SPUIT 3 CC 1,00
LODOMER 2 MG/ML 1,00
RISPERIDONE 2 MG 4,00
119 ANSORI 201904000404 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 18.977
CLOZAPINE 25 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
119 ANSORI 201904000404 01/04/2019 Ruangan
- Gelatik TFP 5 MG 14,00 18.977
201904000685 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 18.150
TFP 5 MG 30,00
THD 2 MG 30,00
201904001505 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
120 ANTON 201904004711 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 1,00 826
TFP 5 MG 2,00
201904004969 25/04/2019 Ruangan Gelatik CPZ 100 MG 5,00 5.070
RISPERIDONE 2 MG 10,00
201904005731 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
121 APIN HARYONO 201904003537 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 115.530
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
122 ARDI ZULKARNAIN 201904003031 15/04/2019 Ruangan Puri CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904004148 22/04/2019 Ruangan Puri CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904005662 29/04/2019 Ruangan Puri SERTRALINE 50 MG 14,00 26.796
123 ARDIANY HURIATI 201904000301 01/04/2019 Puri Mitra LORAZEPAM 2 MG 4,00 136.586
SEROQUEL XR 300 7,00
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904001759 08/04/2019 Puri Mitra RISPERIDONE 2 MG 14,00 139.391
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
SEROQUEL XR 300 7,00
201904002981 15/04/2019 Puri Mitra THD 2 MG 14,00 139.391
LORAZEPAM 2 MG 7,00
SEROQUEL XR 300 7,00
RISPERIDONE 2 MG 14,00
201904004156 22/04/2019 Puri Mitra LORAZEPAM 2 MG 7,00 132.125
SEROQUEL XR 300 7,00
124 ARI AKBAR ROSY 201904003976 22/04/2019 Poli Jiwa Anak THD 2 MG 60,00 98.415
CLOZAPINE 25 MG 30,00
ASAM VALPROAT 1,00
HALOPERIDOL 5 MG 60,00
125 ARI KRISTIANTI PUTRI 201904005316 28/04/2019 IGD THIAMPHENICOL 500 10,00 55.376
ANTASIDA DOEN 10,00
PARACETAMOL 500 10,00
IV CANULLA NO.20 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
125 ARI KRISTIANTI PUTRI 201904005316 28/04/2019 IGD
- NORAGES INJEKSI 1,00 55.376
DEXAMETASON INJ 5 1,00
RANITIDIN INJEKSI 1,00
SPUIT 3 CC 4,00
ONDANSETRON 4 2,00
126 ARI KURNIAWAN 201904005211 26/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 594.030
CLOZAPINE 25 MG 30,00
127 ARI SETIAWAN 201904002460 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
128 ARIF 201904004704 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 2,00 1.006
TFP 5 MG 2,00
201904004962 25/04/2019 Ruangan Kenari CPZ 100 MG 10,00 5.030
TFP 5 MG 10,00
201904005690 29/04/2019 Ruangan Kenari KAPSUL NO.00 10,00 14.464
RACIKAN KAPSUL 10,00
KETOKONAZOL 200 20,00
SALEP 2-4 1,00
LORATADIN 10 MG 10,00
201904005698 29/04/2019 Ruangan Kenari SPUIT 3 CC 3,00 173.726
THD 2 MG 6,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
DIPHENHYDRAMINE 2,00
201904005703 29/04/2019 Ruangan Kenari CPZ 100 MG 14,00 7.042
TFP 5 MG 14,00
129 ARIF BUDI WAHONO 201904004137 22/04/2019 Ruangan Wijaya SERTRALINE 50 MG 7,00 35.833
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
201904005794 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 32.263
SERTRALINE 50 MG 7,00
CLOZAPINE 25 MG 7,00
130 ARIF MARDIANTO 201904003941 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
131 ARIFIN 201904003996 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 60.420
CLOBAZAM 10 MG 30,00
TFP 5 MG 60,00
132 ARIFIN ILHAM 201904003987 22/04/2019 Poli Jiwa Anak KAPSUL NO 2 30,00 165.909
ABILIFY DISCMELT 15 4,00
CLOBAZAM 10 MG 6,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
133 ARINA FITRIYAH 201904003721 20/04/2019 IGD
- SPUIT 3 CC 1,00 4.768
DIAZEPAM inj 1,00
201904004131 22/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 14,00 16.527
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904004779 24/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 6,00 341.394
SPUIT 3 CC 2,00
ZYPREXA INJ 2,00
AQUA PRO INJEKSI 2,00
201904005247 26/04/2019 Ruangan Wijaya SPUIT 3 CC 6,00 18.372
LODOMER 2 MG/ML 6,00
201904005604 29/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 14,00 42.411
SPUIT 3 CC 4,00
LODOMER 2 MG/ML 4,00
CLOZAPINE 100 MG 7,00
201904006038 30/04/2019 Ruangan Wijaya DIPHENHYDRAMINE 4,00 10.628
SPUIT 3 CC 2,00
201904006062 30/04/2019 Ruangan Wijaya HIDROKORTISON 4,00 11.880
134 ARIS NUGRAHADI 201904001055 05/04/2019 Poli Psikiater SPUIT 3 CC 1,00 99.951
SIKZONOATE 1,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
135 ARKHASUL ZIDAN 201904003983 22/04/2019 Poli Jiwa Dewasa KAPSUL NO.0 30,00 30.912
SERTRALINE 50 MG 8,00
RACIKAN KAPSUL 30,00
VIT B1 50 MG 30,00
FOLIC ACID 1 MG 30,00
RISPERIDONE 3 MG 10,00
136 ARSA FITRI WIDA 201904003943 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 1.234.360
THD 2 MG 30,00
LORAZEPAM 2 MG 8,00
ABILIFY DISCMELT 15 30,00
137 ARSAT AFANDI 201904003383 16/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
201904004354 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 22.435
CLOZAPINE 25 MG 7,00
201904005841 29/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 15,00 32.836
SERTRALINE 50 MG 8,00
CLOZAPINE 25 MG 4,00
138 ARSHAVIN DWIKI S.R. 201904003991 22/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 12,00 172.845
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
KAPSUL NO.0 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
138 ARSHAVIN DWIKI S.R. 201904003991 22/04/2019 Poli Jiwa
- Anak RACIKAN KAPSUL 30,00 172.845
CLOBAZAM 10 MG 8,00
ABILIFY DISCMELT 15 4,00
KAPSUL NO.1 30,00
RISPERIDONE 3 MG 5,00
139 ARYA PANDEGA 201904003978 22/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 10,00 71.838
FOLIC ACID 1 MG 24,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 30,00
VIT B6 10 MG 30,00
KAPSUL NO.0 30,00
RACIKAN KAPSUL 30,00
CLOZAPINE 25 MG 12,00
KAPSUL NO.1 60,00
140 ARYADI PRIHATMOKO 201904005215 26/04/2019 IGD TFP 5 MG 6,00 8.133
THD 2 MG 6,00
CLOZAPINE 25 MG 3,00
201904005750 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 18.977
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
141 ASEMAN 201904005588 29/04/2019 Psiko Geriatri CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
142 ASEP SAEPUDIN 201904005523 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 606.780
SEROQUEL XR 200 15,00
THD 2 MG 60,00
CLOBAZAM 10 MG 60,00
DEPAKOTE ER 500 30,00
143 ASIA 201904005249 26/04/2019 Ruangan TFP 5 MG 8,00 4.024
CPZ 100 MG 8,00
201904005817 29/04/2019 Ruangan THD 2 MG 14,00 8.470
CPZ 100 MG 14,00
TFP 5 MG 14,00
144 ASMAD SUHADI 201904002944 15/04/2019 Ruangan Kenari TABLET TAMBAH 14,00 9.396
FOLIC ACID 1 MG 8,00
PYRANTEL 125 MG 8,00
201904003022 15/04/2019 Ruangan Kenari SERTRALINE 50 MG 7,00 19.236
RISPERIDONE 2 MG 14,00
201904004245 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 19.236
SERTRALINE 50 MG 7,00
201904005716 29/04/2019 Ruangan Kenari SERTRALINE 50 MG 7,00 19.236
RISPERIDONE 2 MG 14,00
145 ASMUDI 201904001704 08/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 4,00 26.132
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
145 ASMUDI 201904001704 08/04/2019 Ruangan
- Gelatik RISPERIDONE 3 MG 15,00 26.132
201904002952 15/04/2019 Poli Gigi (Jiwa) CLOZAPINE 100 MG 4,00 26.132
RISPERIDONE 3 MG 15,00
146 ASNGARI 201904001290 08/04/2019 IGD SPUIT 3 CC 1,00 207.491
TFP 5 MG 6,00
CIPROFLOXACIN 500 10,00
KASA STERIL ISI 16 1,00
NA CL 0,9 % 100 ML 1,00
AQUA PRO INJEKSI 1,00
THD 2 MG 4,00
CLOZAPINE 25 MG 1,00
NEEDLE 23 G 1,00
RISPERIDONE 3 MG 4,00
ASAM MEFENAMAT 10,00
ZYPREXA INJ 1,00
GENTAMYCIN SALEP 1,00
201904001734 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 28.385
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
CLOZAPINE 25 MG 7,00
201904003137 15/04/2019 Ruangan Gelatik THD 2 MG 14,00 31.410
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
CLOZAPINE 100 MG 4,00
201904004351 23/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 4,00 32.507
THD 2 MG 15,00
RISPERIDONE 3 MG 15,00
TFP 5 MG 15,00
201904005809 29/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 4,00 31.410
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
147 ASNOTO 201904003703 19/04/2019 IGD CPZ 100 MG 6,00 169.146
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 6,00
AQUA PRO INJEKSI 1,00
THD 2 MG 6,00
NEEDLE 23 G 1,00
201904004129 22/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 10,00 4.300
THD 2 MG 10,00
CPZ 100 MG 10,00
201904005834 29/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 15,00 4.476
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
147 ASNOTO 201904005834 29/04/2019 Ruangan
- Gelatik THD 2 MG 8,00 4.476
CPZ 100 MG 8,00
148 ASPIYAH 201904002416 12/04/2019 Psiko Geriatri THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
149 ASRORI 201904001028 05/04/2019 Ruangan Kenari SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
201904001233 05/04/2019 Ruangan Kenari TFP 5 MG 14,00 8.470
THD 2 MG 14,00
CPZ 100 MG 14,00
201904002552 12/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 93.728
RISPERIDONE 2 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
DIPHENHYDRAMINE 2,00
150 ASTRIANY PUSPITA SARI 201904001019 04/04/2019 Ruangan Puri CLOZAPINE 25 MG 7,00 16.660
RISPERIDONE 2 MG 7,00
THD 2 MG 7,00
201904001184 05/04/2019 Ruangan Puri THD 2 MG 60,00 142.800
CLOZAPINE 25 MG 60,00
RISPERIDONE 2 MG 60,00
151 ASTRID NUR GUPITA 201904002688 14/04/2019 IGD RISPERIDONE 1 MG 4,00 22.432
ESILGAN 1 MG 2,00
THD 2 MG 2,00
DEPTRAL 50 MG 1,00
201904003032 15/04/2019 Ruangan Puri RISPERIDONE 2 MG 15,00 37.545
THD 2 MG 7,00
ESILGAN 1 MG 7,00
201904004147 22/04/2019 Ruangan Puri CLOZAPINE 25 MG 8,00 14.888
152 ASTUTIK 201904003068 15/04/2019 Ruangan THD 2 MG 14,00 18.977
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
201904004230 23/04/2019 Ruangan TFP 5 MG 14,00 18.977
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
153 ASTUTIK SITI AMINAH 201904000053 01/04/2019 Poli Psikiater HALOPERIDOL 1,5 180,00 322.535
BAMGETOL 200 MG 140,00
LORAZEPAM 2 MG 45,00
KUTOIN 105,00
THD 2 MG 5,00
154 ATIE HASTUTI Z 201904000271 01/04/2019 Ruangan Wijaya TABLET TAMBAH 14,00 5.964
201904000378 01/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 3,00 45.273
OLANZPINE 10mg 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
154 ATIE HASTUTI Z 201904000642 03/04/2019 Ruangan
- Wijaya PEN NEEDLE 32,5 G 5,00 11.990
201904001713 08/04/2019 Ruangan Puri ASAM MEFENAMAT 10,00 11.260
CIPROFLOXACIN 500 20,00
201904001715 08/04/2019 Ruangan Puri APIDRA SOLOSTAR 1,00 164.757
CLOZAPINE 25 MG 7,00
PEN NEEDLE 32,5 G 5,00
OLANZPINE 10mg 7,00
201904001986 09/04/2019 Ruangan Puri ASAM MEFENAMAT 6,00 1.656
201904001988 09/04/2019 Ruangan Puri NA CL 0,9 % 500 ML 2,00 196.614
LOMATUELL 5,00
HANDSCHOEN DISP 1,00
VERBAN 10 CM 2,00
KASA STERIL ISI 16 5,00
201904002675 14/04/2019 Ruangan Puri OLANZPINE 10mg 7,00 52.717
CLOZAPINE 25 MG 7,00
155 ATIK 201904000608 02/04/2019 Psiko Geriatri METFORMIN 500 MG 30,00 28.620
RAMIPRIL 5 MG 30,00
GLIMEPIRIDE 2 MG 30,00
156 ATTHAYA SEISHA ALIKA 201904003518 18/04/2019 Poli Jiwa Anak CLOBAZAM 10 MG 1,00 57.363
VIT B6 10 MG 7,00
FOLIC ACID 1 MG 6,00
ABILIFY DISCMELT 10 2,00
RACIKAN PUYER 20,00
157 AVIN 201904003133 15/04/2019 Ruangan Gelatik THD 2 MG 15,00 7.815
CPZ 100 MG 8,00
TFP 5 MG 15,00
201904004188 22/04/2019 Ruangan Gelatik TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904005286 27/04/2019 Ruangan Gelatik HALDOL DECANOAS 1,00 124.246
SPUIT 3 CC 1,00
201904005686 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904005820 29/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
158 AYIK FACRUDI 201904000721 04/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 630.540
SEROQUEL XR 300 30,00
CLOBAZAM 10 MG 30,00
159 AZIMATUN NI.MAH 201904005223 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
160 BADRUL QOMAR 201904003970 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.900
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
160 BADRUL QOMAR 201904003970 22/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 12.900
HALOPERIDOL 5 MG 30,00
161 BADRUS SALEH 201904005169 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 67.770
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
162 BAGUS SAIFULLAH 201904002170 10/04/2019 IGD THD 2 MG 4,00 14.288
CLOZAPINE 25 MG 4,00
DIAZEPAM inj 1,00
RISPERIDONE 2 MG 4,00
SPUIT 3 CC 1,00
201904002618 12/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 14,00 33.320
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904002957 15/04/2019 Puri Mitra (Laki- TFP 5 MG 15,00 40.545
CLOZAPINE 25 MG 15,00
THD 2 MG 15,00
RISPERIDONE 2 MG 15,00
201904004155 22/04/2019 Puri Mitra (Laki- RISPERIDONE 2 MG 14,00 33.320
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904005668 29/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 33.320
CLOZAPINE 25 MG 14,00
RISPERIDONE 2 MG 14,00
163 BAGUS TIRTA HANDIKA 201904003962 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 87.990
HALOPERIDOL 5 MG 30,00
RISPERIDONE 1 MG 60,00
CLOZAPINE 25 MG 30,00
164 BAGUS WISNU 201904004028 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
165 BAMBANG 201904000762 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
166 BAMBANG SRIWAHYUDI 201904003377 16/04/2019 Ruangan Kenari TFP 5 MG 14,00 74.047
THD 2 MG 7,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
201904004239 23/04/2019 Ruangan Kenari THD 2 MG 7,00 33.327
CLOZAPINE 100 MG 7,00
TFP 5 MG 14,00
201904005699 29/04/2019 Ruangan Kenari SPUIT 3 CC 1,00 89.005
SIKZONOATE 1,00
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
167 BAMBANG SUBAGIO 201904001100 05/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 170.580
RISPERIDONE 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
167 BAMBANG SUBAGIO 201904001100 05/04/2019 Psiko Geriatri
- DEPAKOTE ER 250 30,00 170.580
168 BAMBANG SUBAR 201904003430 16/04/2019 Ruangan Wijaya LORAZEPAM 2 MG 2,00 140.238
VENTOLIN NEBULES 8,00
MASKER NEBULIZER 1,00
NA CL 0,9 % 100 ML 1,00
CEFIXIME 200 MG 10,00
RISPERIDONE 1 MG 4,00
201904003585 19/04/2019 Ruangan Gelatik SALBUTAMOL 4 MG 5,00 2.800
KAPSUL NO 3 20,00
RACIKAN KAPSUL 20,00
CODEIN 20 MG 1,00
201904003626 18/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 17.693
LORAZEPAM 2 MG 3,00
201904004322 23/04/2019 Ruangan Gelatik LORAZEPAM 2 MG 4,00 9.995
RISPERIDONE 2 MG 15,00
201904005827 29/04/2019 Ruangan Gelatik LORAZEPAM 2 MG 4,00 9.995
RISPERIDONE 2 MG 15,00
169 BENZA 201904004193 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
170 BERTINUS BUDI 201904003541 18/04/2019 Psiko Geriatri VIT B COMPLEX 10,00 886.060
ABILIFY DISCMELT 10 30,00
CLOZAPINE 25 MG 30,00
171 BETA SUPRIYANA 201904003688 19/04/2019 IGD AQUA PRO INJEKSI 1,00 165.114
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
201904003691 19/04/2019 Ruangan Wijaya TFP 5 MG 8,00 17.472
CLOZAPINE 25 MG 8,00
201904004253 23/04/2019 Ruangan Kenari THD 2 MG 14,00 32.004
CLOZAPINE 25 MG 14,00
TFP 5 MG 14,00
201904004640 24/04/2019 Ruangan Kenari TFP 5 MG 20,00 26.525
CLOZAPINE 100 MG 5,00
201904005683 29/04/2019 Ruangan Kenari RACIKAN KAPSUL 14,00 67.830
CLOZAPINE 100 MG 14,00
TFP 5 MG 28,00
KAPSUL NO.00 14,00
THD 2 MG 14,00
172 BILAL FABRIANTO 201904001563 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 61.230
CPZ 100 MG 30,00
173 BINTANG HERLAMBANG 201904000636 03/04/2019 IGD THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
174 BISMA FERRYANSYAH 201904003107 15/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 8.823
CPZ 100 MG 8,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
174 BISMA FERRYANSYAH 201904003107 15/04/2019 Ruangan
- Gelatik DIAZEPAM 5 MG 8,00 8.823
201904003435 17/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.803
DIAZEPAM 5 MG 5,00
RISPERIDONE 2 MG 14,00
175 BISMA PUTRA A 201904000024 01/04/2019 Poli Jiwa Anak VIT B6 10 MG 30,00 93.450
METHYLPHENIDATE 60,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 30,00
VIT B12 50 MG 30,00
KAPSUL NO 2 60,00
176 BISU OMAN 201904002304 11/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 15.450
CPZ 100 MG 15,00
TFP 5 MG 30,00
177 BISU RUHUT 201904001199 05/04/2019 Ruangan Gelatik TABLET TAMBAH 14,00 14.674
CIPROFLOXACIN 500 14,00
PYRANTEL 125 MG 8,00
201904002956 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904003103 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 14.205
CPZ 100 MG 8,00
THD 2 MG 15,00
TABLET TAMBAH 15,00
178 BISU WAWAH 201904001656 08/04/2019 Ruangan THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904002036 10/04/2019 Ruangan HALOPERIDOL 1,5 10,00 740
201904002831 15/04/2019 Ruangan CPZ 100 MG 7,00 8.394
THD 2 MG 14,00
HALOPERIDOL 1,5 16,00
TFP 5 MG 14,00
179 BISU YULIANA 201904000216 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
180 BUDI ANTON 201904004710 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 2,00 1.660
CPZ 100 MG 1,00
RISPERIDONE 2 MG 2,00
201904004960 25/04/2019 Ruangan Kenari CPZ 100 MG 2,00 3.696
RISPERIDONE 2 MG 8,00
181 BUDI DAUD SULAIMAN 201904000435 01/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 10.836
THD 2 MG 14,00
182 BUDI RAHARJO 201904004608 23/04/2019 IGD ASAM MEFENAMAT 10,00 10.845
CLOZAPINE 25 MG 3,00
RISPERIDONE 2 MG 6,00
201904004778 24/04/2019 Ruangan Kenari CLOZAPINE 100 MG 3,00 13.707
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
182 BUDI RAHARJO 201904004778 24/04/2019 Ruangan
- Kenari RISPERIDONE 2 MG 4,00 13.707
201904005721 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 21.890
CLOZAPINE 100 MG 4,00
183 BUDI RIDO . H 201904000651 03/04/2019 Poli Psikiater THD 2 MG 30,00 98.940
CLOBAZAM 10 MG 15,00
NOPRES 20 MG 60,00
TFP 5 MG 60,00
184 BUDI SANTOSO 201904003504 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 5.760
THD 2 MG 30,00
185 BUDIANTO HALIM 201904001776 09/04/2019 Poli Psikiater MERLOPAM 2 MG 5,00 40.165
SIZORIL 25 MG 5,00
FRIMANIA 200 MG 10,00
201904002669 14/04/2019 Poli Psikiater SIZORIL 25 MG 5,00 40.165
FRIMANIA 200 MG 10,00
MERLOPAM 2 MG 5,00
201904003450 18/04/2019 Poli Psikiater SIZORIL 25 MG 5,00 40.165
FRIMANIA 200 MG 10,00
MERLOPAM 2 MG 5,00
201904003710 20/04/2019 Poli Psikiater FRIMANIA 200 MG 10,00 40.165
MERLOPAM 2 MG 5,00
SIZORIL 25 MG 5,00
186 BUDIONO 201904003111 15/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 8.526
THD 2 MG 14,00
CPZ 100 MG 7,00
201904003148 15/04/2019 Ruangan Gelatik CPZ 100 MG 1,00 1.218
RISPERIDONE 2 MG 2,00
THD 2 MG 2,00
201904003186 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 8.526
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
187 CANDRA SETIAWAN 201904001552 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
188 CHAIRIL FATONI 201904004071 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
189 CHELVIN SHEVA ARIF 201904001561 08/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 347.931
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 8,00
CLOBAZAM 10 MG 15,00
SERTRALINE 50 MG 9,00
KAPSUL NO.1 30,00
190 CHOIRI 201904003506 18/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 10,00 4.170
201904004183 22/04/2019 Ruangan Gelatik SCABIMITE 10mg 1,00 62.220
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
190 CHOIRI 201904004183 22/04/2019 Ruangan
- Gelatik LORATADIN 10 MG 10,00 62.220
201904004346 23/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 5.838
201904004587 23/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 3,00 5.583
201904005692 29/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 4,00 13.282
RISPERIDONE 2 MG 14,00
201904005720 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 13.282
CLOZAPINE 25 MG 4,00
191 CHOIRUL ANAM MAKSUM 201904003763 22/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 10.200
THD 2 MG 30,00
CPZ 100 MG 15,00
192 CHOIRUL ANAM.ST 201904002639 12/04/2019 Poli Psikiater ELXION 15,00 196.020
193 CHRISTHIO RIONARDO 201904001288 07/04/2019 IGD ZYPREXA INJ 1,00 169.728
NEEDLE 23 G 1,00
LORAZEPAM 2 MG 2,00
SPUIT 3 CC 1,00
TFP 5 MG 4,00
AQUA PRO INJEKSI 1,00
201904001724 08/04/2019 Ruangan Puri NOPRES 20 MG 7,00 11.410
TFP 5 MG 14,00
201904002171 10/04/2019 Ruangan Puri DEPAKOTE ER 250 5,00 17.040
201904002985 15/04/2019 Ruangan Puri NOPRES 20 MG 7,00 35.266
TFP 5 MG 14,00
DEPAKOTE ER 250 7,00
194 CHUSNUL CHOTIMAH 201904004078 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 110.355
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
195 CINDY ISTIKA RINI 201904004167 22/04/2019 Ruangan TFP 5 MG 14,00 13.447
CPZ 100 MG 7,00
LORAZEPAM 2 MG 7,00
ALLOPURINOL 100 7,00
201904005302 27/04/2019 Puri Mitra SPUIT 3 CC 3,00 15.942
DIPHENHYDRAMINE 6,00
201904005674 29/04/2019 Puri Mitra CPZ 100 MG 7,00 13.755
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
TFP 5 MG 14,00
201904006041 30/04/2019 Puri Mitra DIPHENHYDRAMINE 6,00 15.942
SPUIT 3 CC 3,00
196 CRIHARTONO LOEKITO 201904000653 04/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 4,00 18.925
DIAZEPAM inj 1,00
CLOZAPINE 25 MG 4,00
SPUIT 3 CC 1,00
PARACETAMOL 500 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
196 CRIHARTONO LOEKITO 201904000653 04/04/2019 Ruangan
- Wijaya CIPROFLOXACIN 500 10,00 18.925
201904000991 04/04/2019 Ruangan Wijaya THD 2 MG 8,00 21.080
CLOZAPINE 25 MG 8,00
RISPERIDONE 3 MG 8,00
201904001590 08/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 14,00 36.890
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904002158 10/04/2019 Ruangan Wijaya BETAMETASON 1,00 5.628
LORATADIN 10 MG 10,00
201904002354 11/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 13.636
RISPERIDONE 3 MG 8,00
THD 2 MG 8,00
201904002617 12/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 7.444
201904002968 15/04/2019 Puri Mitra (Laki- THD 2 MG 16,00 16.520
CLOZAPINE 25 MG 8,00
197 CUCU 201904000210 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 44.400
RISPERIDONE 2 MG 60,00
198 DAMIRAH 201904000644 03/04/2019 Ruangan THD 2 MG 14,00 23.863
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
199 DANDDY IGNATIUS S 201904000486 02/04/2019 Poli Jiwa Anak THD 2 MG 30,00 55.995
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
200 DANI ASMAWAN 201904005333 29/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 141.956
RISPERIDONE 3 MG 60,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CPZ 100 MG 60,00
201 DANUARTA TRI 201904003994 22/04/2019 Poli Jiwa Anak KAPSUL NO.0 30,00 45.825
PROHIPER 10 8,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
202 DARI 201904002879 15/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 6.255
201904004182 22/04/2019 Ruangan Gelatik LORATADIN 10 MG 10,00 62.220
SCABIMITE 10mg 1,00
201904004350 23/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 122.655
SCABIMITE 10mg 2,00
201904005837 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 6.255
201904006064 30/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 5.838
203 DARSANI 201904004788 24/04/2019 IGD RISPERIDONE 2 MG 10,00 6.090
THD 2 MG 10,00
CPZ 100 MG 5,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
203 DARSANI 201904005796 29/04/2019 Ruangan
- Gelatik RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
204 DEBBY LAURENSIA, SE 201904003043 15/04/2019 Poli Psikiater SEROQUEL XR 200 90,00 1.544.400
205 DEDE NONIK TARTAN 201904000901 04/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 15,00 20.812
THD 2 MG 15,00
CLOZAPINE 25 MG 7,00
201904001875 09/04/2019 Ruangan TABLET TAMBAH 14,00 14.674
CIPROFLOXACIN 500 14,00
PYRANTEL 125 MG 8,00
201904003092 15/04/2019 Ruangan THD 2 MG 14,00 14.710
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 14,00
206 DEDIK SUPRIYADI 201904003005 15/04/2019 Ruangan Kenari CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
201904004262 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904004723 24/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.242
CPZ 100 MG 4,00
207 DEFI EKA WIYANTO 201904004613 24/04/2019 Poli Psikiater SEROQUEL XR 400 2,00 76.886
RACIKAN KAPSUL 30,00
ALPRAZOLAM 1 MG 23,00
SERTRALINE 50 MG 15,00
KAPSUL NO 2 30,00
208 DENDRA RIBUT 201904000338 01/04/2019 Ruangan Napza SIMVASTATIN 20 MG 14,00 43.267
CLOZAPINE 25 MG 7,00
SERTRALINE 50 MG 14,00
201904001997 09/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 43.267
SIMVASTATIN 20 MG 14,00
CLOZAPINE 25 MG 7,00
201904003692 19/04/2019 Ruangan Napza NA DICLOFENAC 50 6,00 5.856
CIPROFLOXACIN 500 6,00
201904004171 22/04/2019 Ruangan Napza SIMVASTATIN 20 MG 11,00 9.006
NUZIP 25 4,00
209 DENDY WAHYU DWI 201904001390 08/04/2019 Poli Umum AMOXYCILLIN 500 15,00 8.320
PARACETAMOL 500 10,00
210 DENI SETYAWAN 201904001503 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 143.250
CLOZAPINE 100 MG 15,00
SERTRALINE 50 MG 15,00
LORAZEPAM 2 MG 15,00
211 DENTRI AGENG 201904000274 01/04/2019 Ruangan Wijaya THD 2 MG 14,00 13.811
LORAZEPAM 2 MG 7,00
RISPERIDONE 2 MG 14,00
201904000959 04/04/2019 Ruangan Wijaya OMEPRAZOLE 20 MG 10,00 19.128
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
211 DENTRI AGENG 201904000959 04/04/2019 Ruangan
- Wijaya ONDANSETRON 8 6,00 19.128
SUKRALFAT SIRUP 1,00
201904000977 04/04/2019 Ruangan Wijaya RACIKAN KAPSUL 20,00 34.950
CURCUMA 200 MG 20,00
SALBUTAMOL 4 MG 5,00
CETIRIZINE TABLET 10,00
KAPSUL NO.0 20,00
CODEIN 20 MG 5,00
201904001591 08/04/2019 Ruangan Wijaya THD 2 MG 14,00 9.366
VIT B COMPLEX 21,00
RISPERIDONE 2 MG 14,00
201904001593 08/04/2019 Ruangan Wijaya OMEPRAZOLE 20 MG 10,00 10.776
ONDANSETRON 8 12,00
201904002983 15/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 12.075
THD 2 MG 14,00
VIT B6 10 MG 21,00
201904004224 23/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 11.234
KAPSUL NO.00 10,00
RACIKAN KAPSUL 10,00
KETOKONAZOL 200 10,00
SALEP 2-4 1,00
201904004332 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 11.662
THD 2 MG 14,00
VIT B6 10 MG 14,00
212 DENY HUSEN 201904002378 12/04/2019 Ruangan Kenari RACIKAN KAPSUL 10,00 66.500
KETOKONAZOL 10,00
KAPSUL NO 3 10,00
LORATADIN 10 MG 10,00
KETOKONAZOL 1,00
201904002995 15/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 18.865
CLOZAPINE 25 MG 7,00
201904004284 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 18.865
CLOZAPINE 25 MG 7,00
201904004330 23/04/2019 Ruangan Kenari KETOKONAZOL 2,00 19.920
GRISEOFULVIN 125 30,00
201904006070 30/04/2019 Ruangan Kenari SERTRALINE 50 MG 7,00 35.833
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
213 DESI WINDA HARIYANTI 201904004244 23/04/2019 IGD CLOZAPINE 25 MG 2,00 5.798
RISPERIDONE 2 MG 4,00
THD 2 MG 4,00
201904004578 23/04/2019 Ruangan Wijaya THD 2 MG 4,00 5.798
CLOZAPINE 25 MG 2,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
213 DESI WINDA HARIYANTI 201904004578 23/04/2019 Ruangan
- Wijaya RISPERIDONE 2 MG 4,00 5.798
201904005799 29/04/2019 Ruangan FOLIC ACID 1 MG 8,00 26.892
TABLET TAMBAH 14,00
PYRANTEL 125 MG 8,00
THD 2 MG 13,00
CLOZAPINE 25 MG 6,00
RISPERIDONE 2 MG 12,00
214 DESSY WIDJAYANTI 201904005542 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 111.881
SPUIT 3 CC 1,00
SIKZONOATE 1,00
CLOZAPINE 25 MG 15,00
215 DEWI NUR AYU P.S 201904002059 10/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 8,00 355.758
CLOBAZAM 10 MG 15,00
SERTRALINE 50 MG 12,00
KAPSUL NO 2 60,00
VIT B6 10 MG 30,00
RACIKAN KAPSUL 60,00
216 DHEA OCTA AKALILI 201904001669 08/04/2019 Ruangan TFP 5 MG 21,00 21.359
LORAZEPAM 2 MG 4,00
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
217 DHYN SAKHDYATULLAH 201904000540 02/04/2019 Poli Psikiater DEPTRAL 50 MG 30,00 361.560
218 DIAH AMANI 201904003064 15/04/2019 Ruangan CLOZAPINE 100 MG 14,00 146.986
DEPAKOTE ER 500 7,00
THD 2 MG 7,00
OLANZPINE 10mg 7,00
201904004241 23/04/2019 Ruangan THD 2 MG 7,00 146.986
OLANZPINE 10mg 7,00
CLOZAPINE 100 MG 14,00
DEPAKOTE ER 500 7,00
219 DIAN 201904001912 09/04/2019 Ruangan Gelatik CPZ 100 MG 3,00 2.155
TFP 5 MG 5,00
201904002949 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 8,00 3.304
CPZ 100 MG 4,00
201904003116 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 8,00 3.304
CPZ 100 MG 4,00
201904003161 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 1,00 323
220 DIAN KUSWANDANI 201904000423 01/04/2019 Ruangan Puri CPZ 100 MG 21,00 160.076
HALOPERIDOL 5 MG 14,00
CARBAMAZEPINE 14,00
SEROQUEL XR 400 7,00
201904001721 08/04/2019 Ruangan Puri HALOPERIDOL 5 MG 21,00 491.340
CARBAMAZEPINE 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
220 DIAN KUSWANDANI 201904001721 08/04/2019 Ruangan
- Puri SEROQUEL XR 400 7,00 491.340
SPUIT 3 CC 2,00
CPZ 100 MG 21,00
ZYPREXA INJ 2,00
AQUA PRO INJEKSI 2,00
201904002364 11/04/2019 Ruangan Puri HALOPERIDOL 5 MG 4,00 592
201904003029 15/04/2019 Ruangan Puri HALOPERIDOL 5 MG 28,00 9.982
RISPERIDONE 2 MG 14,00
201904004119 22/04/2019 Ruangan Puri HALOPERIDOL 5 MG 28,00 21.196
CARBAMAZEPINE 14,00
RISPERIDONE 3 MG 14,00
CPZ 100 MG 21,00
221 DIAN FARIANTO 201904002373 11/04/2019 Poli Psikiater NOPRES 20 MG 15,00 670.194
CLOZAPINE 100 MG 18,00
ABILIFY DISCMELT 15 15,00
222 DIAN IRAWATY 201904001020 04/04/2019 Ruangan THD 2 MG 14,00 77.595
KAPSUL NO 2 7,00
RACIKAN KAPSUL 7,00
CLOZAPINE 25 MG 7,00
ADALAT OROS 30 MG 7,00
KAPSUL NO.0 7,00
RISPERIDONE 2 MG 14,00
CLOZAPINE 25 MG 14,00
RACIKAN KAPSUL 7,00
223 DIAN KRISNAWATI 201904002680 14/04/2019 IGD SPUIT 3 CC 1,00 168.422
TFP 5 MG 4,00
AQUA PRO INJEKSI 1,00
THD 2 MG 2,00
NEEDLE 23 G 1,00
CPZ 100 MG 2,00
ZYPREXA INJ 1,00
201904003067 15/04/2019 Ruangan CPZ 100 MG 8,00 6.999
TFP 5 MG 15,00
THD 2 MG 7,00
201904004250 23/04/2019 Ruangan THD 2 MG 7,00 16.215
CPZ 100 MG 7,00
TABLET TAMBAH 14,00
FOLIC ACID 1 MG 8,00
TFP 5 MG 15,00
PYRANTEL 125 MG 8,00
201904005779 29/04/2019 Ruangan CPZ 100 MG 7,00 6.496
TFP 5 MG 14,00
THD 2 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
224 DIAN S 201904000411 01/04/2019 Poli Psikiater
- ABILIFY DISCMELT 15 0,00 0
201904003441 17/04/2019 Poli Psikiater RISPERIDONE 2 MG 10,00 399.690
RISPERIDONE 3 MG 10,00
ABILIFY DISCMELT 15 10,00
201904004781 24/04/2019 Poli Psikiater ABILIFY DISCMELT 15 10,00 399.690
RISPERIDONE 2 MG 10,00
RISPERIDONE 3 MG 10,00
225 DIAN SUGIONO 201904004205 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
226 DIAN SUKMA PRAMONO 201904002849 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 7,00 18.586
TFP 5 MG 15,00
THD 2 MG 7,00
201904003510 18/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 2,00 5.422
TFP 5 MG 4,00
THD 2 MG 4,00
201904003513 18/04/2019 Ruangan Gelatik CATAFLAM 50 MG 10,00 194.624
CLINDAMYCIN 300 10,00
KASA STERIL ISI 16 3,00
NA CL 0,9 % 500 ML 1,00
PLESTERIN ROLL 1,00
201904004184 22/04/2019 Ruangan Gelatik BETAMETASON 1,00 1.608
201904004187 22/04/2019 Ruangan Gelatik PUSPALIN 500mg 7,00 43.673
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
201904005728 29/04/2019 Ruangan Gelatik TFP 5 MG 14,00 18.977
CITICOLINE 500 MG 0,00
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
227 DIAN TRI ASMORO 201904005525 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.940
CLOBAZAM 10 MG 30,00
228 DIANA CHOLIDAH 201904004044 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
229 DIDIK ADRIYANTO 201904003498 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 106.635
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
230 DIKI SISWANTO 201904004204 23/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.750
TFP 5 MG 30,00
231 DIKKI BASTIAR 201904005243 26/04/2019 IGD CPZ 100 MG 5,00 6.090
RISPERIDONE 2 MG 10,00
THD 2 MG 10,00
232 DILA LESTARI 201904004049 22/04/2019 Poli Jiwa Dewasa KAPSUL NO.00 30,00 168.660
SEROQUEL XR 200 4,00
ALPRAZOLAM 1 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
232 DILA LESTARI 201904004049 22/04/2019 Poli Jiwa- Dewasa RACIKAN KAPSUL 30,00 168.660
CLOBAZAM 10 MG 30,00
SERTRALINE 50 MG 30,00
233 DIMAS ARI WIBOWO 201904002415 12/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 221.790
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
234 DINAYAH CHOLIDAH 201904004786 24/04/2019 IGD THD 2 MG 5,00 16.841
LORAZEPAM 2 MG 5,00
LODOMER 2 MG/ML 1,00
RISPERIDONE 2 MG 10,00
SPUIT 3 CC 1,00
201904004979 25/04/2019 Ruangan Wijaya SPUIT 3 CC 3,00 107.472
SEROQUEL XR 200 4,00
CLONAZEPAM 2 MG 4,00
DIAZEPAM inj 3,00
THD 2 MG 8,00
201904005626 29/04/2019 Ruangan Wijaya CLONAZEPAM 2 MG 7,00 162.330
THD 2 MG 7,00
SEROQUEL XR 200 7,00
201904006049 30/04/2019 Ruangan Wijaya CIPROFLOXACIN 500 14,00 8.890
RAMIPRIL 5 MG 10,00
235 DINDA AGRE SELINDA 201904003170 15/04/2019 Poli Psikiater TFP 5 MG 3,00 969
236 DIYAH ARTA FIDAYANTI 201904003705 19/04/2019 IGD AQUA PRO INJEKSI 1,00 180.282
THD 2 MG 6,00
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 6,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
TFP 5 MG 6,00
201904004300 23/04/2019 Ruangan THD 2 MG 16,00 36.576
CLOZAPINE 25 MG 16,00
TFP 5 MG 16,00
201904004542 23/04/2019 Ruangan CLOZAPINE 100 MG 7,00 351.455
ZYPREXA INJ 2,00
SPUIT 3 CC 2,00
201904005763 29/04/2019 Ruangan THD 2 MG 14,00 105.497
TFP 5 MG 14,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
CLOZAPINE 100 MG 7,00
237 DJAINURI 201904000768 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
237 DJAINURI 201904001587 08/04/2019 Ruangan
- Wijaya THD 2 MG 7,00 31.290
CLOZAPINE 25 MG 14,00
TFP 5 MG 14,00
201904001948 09/04/2019 Ruangan Wijaya CLOZAPINE 100 MG 7,00 28.091
201904002160 10/04/2019 Ruangan Wijaya SPUIT 3 CC 1,00 165.114
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
201904003125 15/04/2019 Ruangan Gelatik TFP 5 MG 23,00 36.874
THD 2 MG 15,00
CLOZAPINE 25 MG 15,00
201904005836 29/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 11,00 29.107
TFP 5 MG 22,00
THD 2 MG 15,00
238 DJONI KARTOLO 201904003011 15/04/2019 Ruangan Kenari THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904004270 23/04/2019 Ruangan Kenari THD 2 MG 7,00 23.149
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
239 DJUM SISWANTO 201904005303 27/04/2019 IGD HALOPERIDOL 1,5 2,00 5.640
SPUIT 3 CC 1,00
LORAZEPAM 2 MG 2,00
AMLODIPIN 10 5,00
LODOMER 2 MG/ML 1,00
201904006035 30/04/2019 Ruangan Wijaya SIMVASTATIN 20 MG 10,00 24.330
PROBENID 500 MG 10,00
240 DJUMAIL 201904004047 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
241 DODY BAGUS PRASOJO 201904002004 09/04/2019 IGD AQUA PRO INJEKSI 1,00 179.198
ZYPREXA INJ 1,00
NEEDLE 23 G 1,00
TFP 5 MG 4,00
SPUIT 3 CC 1,00
OLANZPINE 10mg 2,00
201904002177 10/04/2019 Ruangan Puri SPUIT 3 CC 1,00 113.023
SIKZONOATE 1,00
TFP 5 MG 14,00
OLANZPINE 10mg 7,00
201904003414 16/04/2019 Ruangan Puri OLANZPINE 10mg 7,00 44.212
TFP 5 MG 14,00
201904004772 24/04/2019 Ruangan Puri TFP 5 MG 14,00 83.902
OLANZPINE 10mg 14,00
242 DONA 201904001111 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
242 DONA 201904001111 05/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 20.400
HALOPERIDOL 5 MG 60,00
243 DONA WICAKSANA 201904001212 05/04/2019 Ruangan Kenari GENTAMYCIN SALEP 1,00 4.820
201904001943 09/04/2019 IGD TFP 5 MG 14,00 32.004
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904002648 13/04/2019 IGD RISPERIDONE 2 MG 4,00 13.242
THD 2 MG 4,00
CLOZAPINE 25 MG 6,00
201904002954 15/04/2019 Ruangan Wijaya THD 2 MG 16,00 25.411
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 16,00
201904003641 18/04/2019 Ruangan Wijaya BETAMETASON 1,00 1.608
201904005832 29/04/2019 Ruangan Gelatik THD 2 MG 15,00 26.498
CLOZAPINE 25 MG 8,00
RISPERIDONE 3 MG 15,00
244 DONI YULIANTO 201904004065 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
245 DONY EKA KRISTIAWAN 201904004361 23/04/2019 IGD THD 2 MG 2,00 15.074
CLOZAPINE 25 MG 2,00
FRIMANIA 200 MG 8,00
RISPERIDONE 2 MG 4,00
201904005009 25/04/2019 Puri Mitra (Laki- THD 2 MG 6,00 16.782
CLOZAPINE 25 MG 6,00
RISPERIDONE 2 MG 12,00
201904005676 29/04/2019 Puri Mitra (Laki- THD 2 MG 7,00 19.579
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
246 DR. IVANA SAJOGO 201904000617 02/04/2019 Poli Napza ALPRAZOLAM 0.5 MG 15,00 13.085
MELOXICAM 15 MG 10,00
201904000793 04/04/2019 Poli Napza METHYLPREDNISOL 20,00 19.260
PIROXICAM 10 MG 60,00
201904001038 05/04/2019 Poli Napza ATORVASTATIN 20 30,00 28.620
201904003655 18/04/2019 Poli Napza ALPRAZOLAM 1 MG 30,00 51.495
SIZORIL 25 MG 15,00
201904004113 22/04/2019 Poli Napza ALGANAX 1 MG 10,00 55.440
247 DR. RIFATUL HASNA 201904003733 21/04/2019 Medical Check Up SERBION 5000 20,00 65.810
CODEIN 15 MG 15,00
RANITIDIN TAB 150 10,00
248 DRS. HERMAN 201904002189 10/04/2019 IGD THIAMPHENICOL 500 10,00 52.380
IV CANULLA NO.20 1,00
DEXAMETASON INJ 5 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
248 DRS. HERMAN 201904002189 10/04/2019 IGD
- IKANEURON INJ 5000 1,00 52.380
SPUIT 3 CC 3,00
PARACETAMOL 500 10,00
NORAGES INJEKSI 1,00
DEXAMETASON 0,5 10,00
249 DUWI ASTUTI 201904001092 05/04/2019 Ruangan CPZ 100 MG 2,00 360
201904002632 12/04/2019 Ruangan AQUA PRO INJEKSI 1,00 165.834
CPZ 100 MG 4,00
SPUIT 3 CC 1,00
ZYPREXA INJ 1,00
201904003073 15/04/2019 Ruangan CPZ 100 MG 14,00 9.303
TFP 5 MG 21,00
201904004246 23/04/2019 Ruangan CPZ 100 MG 7,00 8.043
TFP 5 MG 21,00
201904005778 29/04/2019 Ruangan TFP 5 MG 14,00 13.048
CPZ 100 MG 7,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
250 DWI AGUNTONO 201904003993 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 6.765
THD 2 MG 10,00
CPZ 100 MG 5,00
201904004576 23/04/2019 Ruangan Wijaya LODOMER 2 MG/ML 1,00 20.201
TFP 5 MG 12,00
SPUIT 3 CC 1,00
THD 2 MG 12,00
CLOZAPINE 100 MG 3,00
251 DWI ANISAH FITRIAWATI 201904003950 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 61.230
RISPERIDONE 1 MG 15,00
252 DWI HADI SUSWANTO 201904002422 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
253 DWI INDAH MULYANI 201904000731 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
254 DWI LULUK 201904004190 22/04/2019 Poli Psikiater TFP 5 MG 30,00 9.690
255 DWI PRAHASTUTI 201904001252 06/04/2019 Ruangan CLOZAPINE 25 MG 14,00 33.320
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
256 DWI RIANAWATI 201904003499 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 62.760
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
257 DWI SETYA IRAWAN 201904000296 01/04/2019 Puri Mitra (Laki- RISPERIDONE 2 MG 15,00 38.096
CLOZAPINE 100 MG 7,00
THD 2 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
257 DWI SETYA IRAWAN 201904000296 01/04/2019 Puri Mitra
- (Laki- HALOPERIDOL 5 MG 15,00 38.096
258 DWI SUSANTI 201904005255 26/04/2019 Ruangan CLOZAPINE 25 MG 1,00 2.899
RISPERIDONE 2 MG 2,00
THD 2 MG 2,00
201904005757 29/04/2019 Ruangan ASAM MEFENAMAT 5,00 22.493
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
VIT B1 50 MG 5,00
RISPERIDONE 2 MG 14,00
259 DWI SUSANTO 201904006092 30/04/2019 IGD THD 2 MG 6,00 4.305
HALOPERIDOL 5 MG 6,00
LORAZEPAM 2 MG 3,00
260 DWI YULI SURYANINGSIH 201904005181 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 14.040
THD 2 MG 15,00
261 EDDY PURWANTO 201904005175 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 75.765
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 30,00
262 EDI GUERERO 201904002328 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
263 EDI SUPRAYITNO 201904004201 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
264 EDI SUSANTO 201904005311 28/04/2019 IGD SPUIT 3 CC 1,00 12.088
THD 2 MG 4,00
CLOZAPINE 100 MG 2,00
LODOMER 2 MG/ML 1,00
HALOPERIDOL 5 MG 4,00
201904005801 29/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 30.163
CLOZAPINE 100 MG 7,00
201904006086 30/04/2019 Ruangan Gelatik SPUIT 3 CC 4,00 12.248
LODOMER 2 MG/ML 4,00
265 EDI WAHYUDI 201904005598 29/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 14,00 9.072
THD 2 MG 7,00
CPZ 100 MG 14,00
266 EDY WAHYUDI 201904000272 01/04/2019 Ruangan Wijaya CPZ 100 MG 14,00 8.470
TFP 5 MG 14,00
THD 2 MG 14,00
201904001939 09/04/2019 Ruangan Kenari CPZ 100 MG 14,00 8.470
TFP 5 MG 14,00
THD 2 MG 14,00
201904003390 16/04/2019 Ruangan Kenari CPZ 100 MG 14,00 8.470
TFP 5 MG 14,00
THD 2 MG 14,00
201904003425 16/04/2019 Ruangan Kenari SCABIMITE 10mg 1,00 67.410
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
266 EDY WAHYUDI 201904003425 16/04/2019 Ruangan
- Kenari RACIKAN KAPSUL 10,00 67.410
DOXYCICLIN 100 MG 10,00
CTM 4 MG 10,00
KAPSUL NO.0 10,00
201904004275 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 8.470
THD 2 MG 14,00
CPZ 100 MG 14,00
201904004340 23/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 4.020
267 EFFENDI 201904000298 01/04/2019 Puri Mitra (Laki- CLOZAPINE 100 MG 7,00 33.929
RISPERIDONE 2 MG 14,00
201904001768 08/04/2019 Puri Mitra (Laki- RISPERIDONE 2 MG 14,00 21.890
CLOZAPINE 100 MG 4,00
201904002652 13/04/2019 Puri Mitra (Laki- RISPERIDONE 2 MG 5,00 10.111
CLOZAPINE 100 MG 2,00
268 EGI PANRUB 201904002945 15/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 9.578
LORAZEPAM 2 MG 4,00
201904004324 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 15.953
LORAZEPAM 2 MG 7,00
201904006058 30/04/2019 Psiko Geriatri LORAZEPAM 2 MG 4,00 13.148
RISPERIDONE 3 MG 14,00
269 EKO AGUS PURWANTO 201904005765 29/04/2019 IGD RISPERIDONE 2 MG 4,00 2.076
THD 2 MG 4,00
201904006033 30/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 4,00 15.486
KAPSUL NO.00 12,00
SERTRALINE 50 MG 6,00
RACIKAN KAPSUL 12,00
THD 2 MG 3,00
270 EKO CAHYONO 201904003999 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
271 EKO PRAMONO 201904003534 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
272 EKO WIJAYA KUSUMA 201904000437 01/04/2019 Poli Psikiater METHYLPREDNISOL 60,00 37.200
273 ELISA DELA ANJARSARI 201904003083 15/04/2019 Ruangan DEPAKOTE ER 250 7,00 42.721
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904004281 23/04/2019 Ruangan CLOZAPINE 25 MG 5,00 34.757
RISPERIDONE 2 MG 12,00
DEPAKOTE ER 250 6,00
201904004605 23/04/2019 Ruangan RISPERIDONE 2 MG 14,00 42.721
DEPAKOTE ER 250 7,00
CLOZAPINE 25 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
274 ELLA ROSDIANA 201904003028 15/04/2019 Ruangan
- Puri OLANZPINE 10mg 15,00 122.800
CLOZAPINE 25 MG 10,00
SERTRALINE 50 MG 10,00
275 ELLY SPING 201904003085 15/04/2019 Ruangan SERTRALINE 50 MG 7,00 39.578
CPZ 100 MG 14,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
DEPAKOTE 250 MG 14,00
201904003716 20/04/2019 Ruangan SERTRALINE 50 MG 7,00 39.578
CPZ 100 MG 14,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
DEPAKOTE 250 MG 14,00
276 ELVI RAHMA WATI 201904002843 15/04/2019 Poli Jiwa Anak THD 2 MG 15,00 34.375
RACIKAN KAPSUL 30,00
KAPSUL NO 2 30,00
RISPERIDONE 3 MG 15,00
LORAZEPAM 2 MG 23,00
277 ELVIANA 201904004690 24/04/2019 Ruangan THD 2 MG 10,00 4.790
CPZ 100 MG 3,00
TFP 5 MG 10,00
201904005769 29/04/2019 Ruangan THD 2 MG 14,00 12.620
CIPROFLOXACIN 500 14,00
TFP 5 MG 14,00
CPZ 100 MG 4,00
278 ELVIANA LESTARI 201904005596 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 167.171
RISPERIDONE 3 MG 40,00
KAPSUL NO 2 60,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
RACIKAN KAPSUL 60,00
SIKZONOATE 1,00
279 ENCAH 201904000998 04/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
201904001642 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
201904003065 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
201904004228 23/04/2019 Ruangan THD 2 MG 14,00 13.811
LORAZEPAM 2 MG 7,00
RISPERIDONE 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
280 ENDANG 201904004141 22/04/2019 IGD
- CPZ 100 MG 2,00 2.028
RISPERIDONE 2 MG 4,00
201904004582 23/04/2019 Ruangan Wijaya CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904004777 24/04/2019 Ruangan Wijaya HALDOL DECANOAS 1,00 124.246
SPUIT 3 CC 1,00
201904005753 29/04/2019 Ruangan CPZ 100 MG 7,00 11.118
LORATADIN 10 MG 10,00
RISPERIDONE 2 MG 14,00
281 ENDANG RUKMAWATI 201904003493 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.995
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
282 ENDANG SISWATI 201904004003 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 100.230
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
283 ENDIK HERMAWAN 201904002702 15/04/2019 Poli Psikiater CLORILEX 25 MG 15,00 67.205
RIZODAL 2 MG 5,00
THD 2 MG 30,00
284 ENI 201904004701 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 14,00 6.958
CPZ 100 MG 7,00
FOLIC ACID 1 MG 14,00
201904005783 29/04/2019 Ruangan FOLIC ACID 1 MG 7,00 6.370
TFP 5 MG 14,00
CPZ 100 MG 7,00
285 ENI ARIANTI 201904001755 08/04/2019 IGD CPZ 100 MG 6,00 3.018
TFP 5 MG 6,00
201904002161 10/04/2019 Ruangan Wijaya ZYPREXA INJ 2,00 330.228
SPUIT 3 CC 2,00
AQUA PRO INJEKSI 2,00
201904002370 11/04/2019 Ruangan Wijaya AQUA PRO INJEKSI 2,00 71.962
IKANEURON INJ 5000 2,00
IV CANULLA NO.20 1,00
CEFTRIAXONE 1 2,00
DEXTROSE 5% 1,00
SPUIT 3 CC 2,00
RINGER LACTAT 2,00
INFUS SET DEWASA 1,00
201904002621 12/04/2019 Ruangan Wijaya THD 2 MG 6,00 612
201904002624 12/04/2019 Ruangan Wijaya STOMACH TUBE 16 1,00 211.422
IV CANULLA NO.24 1,00
SPUIT 50 CC LUBANG 1,00
DEXTROSE 5% 4,00
CEFTRIAXONE 1 8,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
285 ENI ARIANTI 201904002624 12/04/2019 Ruangan
- Wijaya IV CANULLA NO.20 1,00 211.422
SPUIT 3 CC 4,00
INFUS SET DEWASA 1,00
IKANEURON INJ 5000 4,00
SPUIT 5 CC 8,00
201904002969 15/04/2019 Ruangan Wijaya THD 2 MG 14,00 45.640
OLANZPINE 10mg 7,00
TFP 5 MG 14,00
201904003039 15/04/2019 Ruangan Wijaya THD 2 MG 14,00 45.640
OLANZPINE 10mg 7,00
TFP 5 MG 14,00
201904003389 16/04/2019 Ruangan Wijaya DEMACOLIN 14,00 169.265
SPUIT 5 CC 8,00
CEFTRIAXONE 1 8,00
INFUS SET DEWASA 1,00
IKANEURON INJ 5000 3,00
SPUIT 3 CC 3,00
RINGER LACTAT 4,00
IV CANULLA NO.20 1,00
AQUA PRO INJEKSI 4,00
DEXTROSE 5% 3,00
201904004132 22/04/2019 Ruangan Wijaya SERTRALINE 50 MG 7,00 61.299
OLANZPINE 10mg 7,00
TFP 5 MG 21,00
THD 2 MG 14,00
201904004135 22/04/2019 Ruangan Wijaya CURCUMA 200 MG 20,00 22.200
201904005245 26/04/2019 Ruangan Wijaya SPUIT 3 CC 6,00 18.372
LODOMER 2 MG/ML 6,00
201904005609 29/04/2019 Ruangan Wijaya LODOMER 2 MG/ML 4,00 113.237
SPUIT 3 CC 4,00
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
OLANZPINE 10mg 14,00
TFP 5 MG 21,00
286 ENOL 201904001731 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 5.950
TFP 5 MG 14,00
287 ERIK ARDIANZA 201904004074 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 162.791
SIKZONOATE 1,00
RISPERIDONE 2 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
288 ERVINDA ARIESKA 201904002006 09/04/2019 IGD NA DICLOFENAC 50 10,00 46.102
AMBROXOL 30 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
288 ERVINDA ARIESKA 201904002006 09/04/2019 IGD
- NEURODEK 10,00 46.102
DIPHENHYDRAMINE 1,00
RACIKAN KAPSUL 15,00
CEFIXIME 100 MG 10,00
NORAGES INJEKSI 1,00
KAPSUL NO.00 15,00
SPUIT 3 CC 1,00
CTM 4 MG 8,00
DEXAMETASON 0,5 15,00
201904003184 15/04/2019 IGD PARACETAMOL 500 10,00 4.890
VIT B COMPLEX 10,00
ANTASIDA DOEN 10,00
289 ERWANTO 201904000765 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 15.090
TFP 5 MG 30,00
290 ERWIN 201904002302 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 21.600
201904003427 16/04/2019 Poli Psikiater RISPERIDONE 1 MG 30,00 218.160
NOPRES 20 MG 30,00
CLONAZEPAM 2 MG 30,00
291 ESTI 201904005551 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 106.635
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
292 EVI MARGARETTA KIHA 201904003256 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 18.270
THD 2 MG 30,00
CPZ 100 MG 15,00
293 FA'UZUL 201904004206 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
294 FADILA LA IDU 201904002679 14/04/2019 IGD AQUA PRO INJEKSI 1,00 169.556
ZYPREXA INJ 1,00
TFP 5 MG 4,00
SPUIT 3 CC 1,00
NUZIP 25 2,00
201904003037 15/04/2019 Ruangan Puri NUZIP 25 7,00 15.547
TFP 5 MG 14,00
201904004102 22/04/2019 Ruangan Puri TFP 5 MG 21,00 17.808
NUZIP 25 7,00
201904005265 26/04/2019 Ruangan Puri NUZIP 25 3,00 32.055
IKALEP 250 MG 6,00
201904005655 29/04/2019 Ruangan Puri CPZ 100 MG 14,00 88.445
IKALEP 250 MG 14,00
STELAZINE 5 MG 21,00
201904005658 29/04/2019 Ruangan Puri IKALEP 250 MG 14,00 73.073
CPZ 100 MG 14,00
TFP 5 MG 21,00
295 FAHRUDDIN 201904000273 01/04/2019 IGD NORAGES INJEKSI 1,00 56.709
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
295 FAHRUDDIN 201904000273 01/04/2019 IGD
- OLANZPINE 10mg 2,00 56.709
SPUIT 3 CC 2,00
BUSCOPAN INJ 1,00
CLOBAZAM 10 MG 6,00
201904001740 08/04/2019 Ruangan Gelatik CLOBAZAM 10 MG 4,00 4.656
201904001980 09/04/2019 Ruangan Gelatik CLOBAZAM 10 MG 2,00 2.328
201904003038 15/04/2019 Ruangan Gelatik CLOBAZAM 10 MG 8,00 9.312
201904003159 15/04/2019 Ruangan Gelatik CLOBAZAM 10 MG 4,00 4.656
201904004063 22/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 60.420
TFP 5 MG 60,00
THD 2 MG 60,00
296 FAISOL 201904000432 01/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904001248 06/04/2019 Ruangan Puri THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
297 FAIZAL GOZALI 201904000732 04/04/2019 Poli VCT SALBUTAMOL 4 MG 4,00 54.096
KAPSUL NO 2 30,00
CTM 4 MG 15,00
CODEIN 20 MG 12,00
RACIKAN KAPSUL 30,00
CURCUMA 200 MG 30,00
298 FAJAR FAUZAN 201904003401 16/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.242
CPZ 100 MG 4,00
201904004226 23/04/2019 Ruangan Kenari CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
201904004639 24/04/2019 Ruangan Kenari CPZ 100 MG 3,00 540
299 FAKHRUL HUDA 201904005179 26/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 215.820
CPZ 100 MG 30,00
RISPERIDONE 3 MG 60,00
300 FANEL EFENDY / 201904003447 17/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 6,00 15.198
RISPERIDONE 3 MG 6,00
201904003632 18/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 10.780
RISPERIDONE 2 MG 8,00
201904004124 22/04/2019 Ruangan Wijaya LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
201904004125 22/04/2019 Ruangan Wijaya SERTRALINE 50 MG 7,00 32.263
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904005842 29/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 36.455
RISPERIDONE 2 MG 15,00
SERTRALINE 50 MG 8,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
301 FARDANI ARI BASYAR 201904001586 08/04/2019 Poli Interna
- NEURODEK 10,00 59.148
CEFIXIME 200 MG 14,00
LANSOPRAZOLE 10,00
BISOPROLOL 5 MG 10,00
302 FARHAN 201904000426 01/04/2019 Ruangan Puri IKALEP 250 MG 14,00 113.225
THD 2 MG 14,00
STELAZINE 5 MG 21,00
CLORILEX 25 MG 7,00
201904000428 01/04/2019 Ruangan Puri MASKER OKSIGEN 1,00 22.800
201904001695 08/04/2019 Ruangan Puri CLORILEX 25 MG 6,00 109.529
IKALEP 250 MG 14,00
THD 2 MG 14,00
STELAZINE 5 MG 21,00
201904003436 17/04/2019 IGD TFP 5 MG 18,00 60.474
IKALEP 250 MG 12,00
303 FARID NOVANDI 201904000652 03/04/2019 Poli Psikiater SIZORIL 100 MG 10,00 188.120
201904003432 16/04/2019 Poli Psikiater SIZORIL 100 MG 5,00 94.060
201904004606 23/04/2019 Poli Psikiater SIZORIL 100 MG 5,00 94.060
304 FARIDA 201904003681 19/04/2019 Psiko Geriatri THD 2 MG 15,00 157.483
ALPRAZOLAM 1 MG 4,00
NOPRES 20 MG 60,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 30,00
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
ALPRAZOLAM 0.5 MG 45,00
OLANZPINE 10mg 15,00
KAPSUL NO 2 30,00
305 FARIS HERMANSYAH 201904005743 29/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
306 FATDHEKUL FERRI 201904001010 04/04/2019 Puri Mitra (Laki- NOPRES 20 MG 3,00 2.952
201904005178 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
201904005312 28/04/2019 IGD ZYPREXA INJ 1,00 182.080
SPUIT 3 CC 2,00
RISPERIDONE 2 MG 6,00
AQUA PRO INJEKSI 1,00
THD 2 MG 6,00
CLOZAPINE 25 MG 6,00
201904005593 29/04/2019 Ruangan Wijaya CLOZAPINE 100 MG 7,00 37.627
DIAZEPAM inj 2,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
306 FATDHEKUL FERRI 201904005593 29/04/2019 Ruangan
- Wijaya SPUIT 3 CC 2,00 37.627
201904006037 30/04/2019 Ruangan Wijaya CURCUMA 200 MG 0,00 0
201904006039 30/04/2019 Ruangan Wijaya DIAZEPAM 5 MG 14,00 58.156
CLOZAPINE 100 MG 14,00
201904006061 30/04/2019 Ruangan Wijaya DIAZEPAM inj 2,00 9.536
SPUIT 3 CC 2,00
307 FATIMATUH ZUHROH 201904005495 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
308 FATURAHMA 201904003982 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
309 FAUZIAH 201904005561 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 62.760
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
310 FEBRI HARIANTO 201904001112 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
311 FEBRIAN DWI PUTRA 201904000335 01/04/2019 Ruangan Napza NUZIP 25 14,00 131.082
THD 2 MG 28,00
OLANZPINE 10mg 14,00
SERTRALINE 50 MG 14,00
201904002927 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 135.086
THD 2 MG 28,00
CLOZAPINE 25 MG 14,00
OLANZPINE 10mg 14,00
201904004169 22/04/2019 Ruangan Napza SERTRALINE 50 MG 21,00 200.487
THD 2 MG 21,00
CLOZAPINE 25 MG 21,00
OLANZPINE 10mg 21,00
312 FEBRYANTO NANLOHY 201904002224 11/04/2019 Poli VCT LORATADIN 10 MG 14,00 5.628
313 FELSI 201904003062 15/04/2019 Ruangan THD 2 MG 14,00 10.836
RISPERIDONE 3 MG 14,00
201904004234 23/04/2019 Ruangan RISPERIDONE 3 MG 14,00 10.836
THD 2 MG 14,00
314 FENDI ACHMAD 201904000436 01/04/2019 Puri Mitra (Laki- RISPERIDONE 3 MG 14,00 27.132
THD 2 MG 14,00
CLOBAZAM 10 MG 14,00
201904000647 03/04/2019 Puri Mitra (Laki- THD 2 MG 4,00 7.752
CLOBAZAM 10 MG 4,00
RISPERIDONE 3 MG 4,00
315 FENDI NIRWANTO 201904004040 22/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 63.330
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
316 FENDI WICAKSONO 201904005524 29/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 165.975
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
316 FENDI WICAKSONO 201904005524 29/04/2019 Poli Jiwa- Dewasa CLOZAPINE 100 MG 15,00 165.975
TFP 5 MG 60,00
317 FENNY NILAMSARI 201904000344 01/04/2019 IGD CLOBAZAM 10 MG 2,00 4.364
PHENYTOIN CAP 100 4,00
201904001002 04/04/2019 Ruangan CLOBAZAM 10 MG 7,00 15.274
PHENYTOIN CAP 100 14,00
201904001652 08/04/2019 Ruangan CLOBAZAM 10 MG 7,00 17.080
KUTOIN 14,00
201904002480 12/04/2019 Ruangan PHENYTOIN CAP 100 14,00 15.274
CLOBAZAM 10 MG 7,00
318 FERI SETIAWAN JAYA. S 201904000418 01/04/2019 Poli Psikiater THD 2 MG 60,00 56.130
RISPERIDONE 3 MG 60,00
TFP 5 MG 30,00
319 FERMI AVISSA 201904001577 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 514.800
320 FIKRA/FITRA 201904002993 15/04/2019 Ruangan Kenari THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904004297 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904004337 23/04/2019 Ruangan Kenari PYRANTEL 125 MG 8,00 12.120
TABLET TAMBAH 20,00
FOLIC ACID 1 MG 10,00
201904005191 26/04/2019 Ruangan Kenari FOLIC ACID 1 MG 10,00 840
201904006057 30/04/2019 Poli Jiwa Dewasa THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
321 FIKRI YOMA ROSYIDAN 201904005086 26/04/2019 Poli Jiwa Anak CLOZAPINE 25 MG 60,00 1.846.080
THD 2 MG 60,00
CLOBAZAM 10 MG 60,00
ABILIFY DISCMELT 10 60,00
322 FIKRIE A.M 201904000650 03/04/2019 Poli Psikiater OLANZPINE 10mg 14,00 79.380
323 FIRDAUS 201904001545 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 35.415
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
324 FIRMAN HIDAYAT 201904006030 30/04/2019 IGD CETIRIZINE TABLET 10,00 11.450
GENTAMYCIN SALEP 1,00
ASAM MEFENAMAT 10,00
325 FITRI NURHAYATI 201904003625 18/04/2019 Poli Psikiater CPZ 100 MG 60,00 45.990
TFP 5 MG 90,00
THD 2 MG 60,00
326 FITRIANA 201904005793 29/04/2019 Ruangan SEROQUEL XR 300 7,00 147.168
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
326 FITRIANA 201904005793 29/04/2019 Ruangan
- DEPAKOTE 250 MG 14,00 147.168
327 FITRIANI 201904003722 20/04/2019 IGD NA CL 0,9 % 500 ML 3,00 113.548
VERBAN 10 CM 4,00
TFP 5 MG 5,00
KASA STERIL ISI 16 5,00
LORAZEPAM 2 MG 3,00
THD 2 MG 5,00
LOMATUELL 4,00
201904003735 21/04/2019 Ruangan Wijaya OMEPRAZOLE 20 MG 10,00 10.490
CIPROFLOXACIN 500 10,00
PYRANTEL 125 MG 4,00
FOLIC ACID 1 MG 5,00
201904003737 21/04/2019 Ruangan Wijaya ASAM MEFENAMAT 6,00 1.656
201904004126 22/04/2019 Ruangan Wijaya TFP 5 MG 7,00 9.520
THD 2 MG 7,00
LORAZEPAM 2 MG 7,00
201904004133 22/04/2019 Ruangan Wijaya PYRANTEL 125 MG 8,00 14.674
TABLET TAMBAH 14,00
CIPROFLOXACIN 500 14,00
201904004179 22/04/2019 Ruangan Wijaya NA DICLOFENAC 50 6,00 3.306
201904004584 23/04/2019 Ruangan Wijaya TABLET TAMBAH 20,00 9.360
FOLIC ACID 1 MG 10,00
328 FONI ANDRIANI 201904000996 04/04/2019 Ruangan CLOZAPINE 25 MG 10,00 18.610
201904001687 08/04/2019 Ruangan CLOZAPINE 25 MG 14,00 32.004
TFP 5 MG 14,00
THD 2 MG 14,00
201904001876 09/04/2019 Ruangan RAMIPRIL 5 MG 10,00 17.040
CURCUMA 200 MG 10,00
METFORMIN 500 MG 10,00
201904003056 15/04/2019 Ruangan CLOZAPINE 25 MG 14,00 30.576
TFP 5 MG 14,00
329 FRANSISKA YUNI K 201904004885 25/04/2019 Poli Umum PARACETAMOL 500 10,00 10.630
CEFADROXIL 500 MG 10,00
330 FRASMI SANDY 201904001101 05/04/2019 Ruangan Kenari CLOZAPINE 100 MG 4,00 35.029
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
331 FUAD ROHMAN 201904005741 29/04/2019 Ruangan Kenari TFP 5 MG 6,00 26.628
THD 2 MG 6,00
CLOZAPINE 100 MG 6,00
332 FUJIONO KURNIAWAN 201904005290 27/04/2019 IGD NOPRES 20 MG 5,00 27.750
CLOBAZAM 10 MG 5,00
OLANZPINE 10mg 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
333 GALIH ANDHIKA 201904000637 03/04/2019 Ruangan
- Puri TFP 5 MG 20,00 204.831
SIKZONOATE 1,00
THD 2 MG 20,00
SPUIT 3 CC 1,00
CLORILEX 100 MG 10,00
334 GANDA SASMITA 201904003990 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
335 GANDUK 201904002315 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
336 GEORGE ANDREAS 201904005546 29/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 688.020
SEROQUEL XR 400 30,00
RISPERIDONE 2 MG 30,00
THD 2 MG 30,00
337 GESANG HENDRASTO 201904005198 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 51.840
THD 2 MG 60,00
CPZ 100 MG 30,00
338 GIYEM 201904003093 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
201904004289 23/04/2019 Ruangan RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
339 GUNADI 201904004355 23/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 7.272
THD 2 MG 7,00
CPZ 100 MG 4,00
201904005726 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 7.986
THD 2 MG 14,00
CPZ 100 MG 4,00
201904006063 30/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 7.986
THD 2 MG 14,00
CPZ 100 MG 4,00
340 GURITNO ANGGA 201904004146 22/04/2019 Ruangan Puri RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904005660 29/04/2019 Ruangan Puri RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
341 H UMAR 201904000795 04/04/2019 IGD RISPERIDONE 1 MG 10,00 13.925
THD 2 MG 10,00
CLOZAPINE 25 MG 5,00
201904003740 21/04/2019 Ruangan Puri LORAZEPAM 2 MG 1,00 2.796
CLOZAPINE 25 MG 1,00
201904004108 22/04/2019 Ruangan Puri LORAZEPAM 2 MG 4,00 14.418
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
341 H UMAR 201904004108 22/04/2019 Ruangan
- Puri RISPERIDONE 1 MG 7,00 14.418
CLOZAPINE 25 MG 4,00
THD 2 MG 7,00
201904004603 23/04/2019 Ruangan Puri RAMIPRIL 5 MG 15,00 5.940
201904004976 25/04/2019 Ruangan Puri IV CANULLA NO.20 1,00 117.840
DEXTROSE 5% 8,00
RINGER LACTAT 4,00
INFUS SET DEWASA 1,00
IKANEURON INJ 5000 4,00
342 H. ACHMAD JUNAIDI 201904000673 04/04/2019 Poli Jiwa Dewasa KAPSUL NO 2 30,00 44.370
SERTRALINE 50 MG 15,00
ALPRAZOLAM 1 MG 30,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 30,00
RISPERIDONE 3 MG 10,00
343 HABIB 201904002380 12/04/2019 Ruangan Kenari CTM 4 MG 3,00 66.810
KAPSUL NO 3 10,00
SCABIMITE 10mg 1,00
RACIKAN KAPSUL 10,00
DOXYCICLIN 100 MG 10,00
201904003019 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904004260 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904005737 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
344 HABIB SHALEH 201904003528 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 103.575
RISPERIDONE 3 MG 60,00
THD 2 MG 30,00
345 HALIMATUS SA'DIYAH 201904003615 18/04/2019 Poli Psikiater NOPRES 20 MG 90,00 135.270
RISPERIDONE 2 MG 90,00
THD 2 MG 90,00
346 HAMIYAH 201904005616 29/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
347 HANDRI ARDIAN LIPUTO 201904004977 25/04/2019 Ruangan Puri THD 2 MG 14,00 28.385
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
201904005267 26/04/2019 Ruangan Puri CIPROFLOXACIN 500 14,00 5.950
201904005438 29/04/2019 Ruangan Puri RISPERIDONE 3 MG 14,00 28.385
TFP 5 MG 14,00
CLOZAPINE 25 MG 7,00
THD 2 MG 14,00
348 HARDI MUNIB 201904002882 15/04/2019 Ruangan Kenari THD 2 MG 15,00 7.635
CPZ 100 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
348 HARDI MUNIB 201904002882 15/04/2019 Ruangan
- Kenari TFP 5 MG 15,00 7.635
201904004227 23/04/2019 Ruangan Kenari THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904005694 29/04/2019 Ruangan Kenari THD 2 MG 7,00 6.496
CPZ 100 MG 7,00
TFP 5 MG 14,00
349 HARDINATA RACHMAD 201904000007 01/04/2019 Poli Jiwa Dewasa KAPSUL NO.00 60,00 511.995
ABILIFY DISCMELT 10 15,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 30,00
SERTRALINE 50 MG 30,00
350 HARI SANTOSO 201904003972 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
351 HARI SETIAWAN 201904005214 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
352 HARI WIRANTO 201904002990 15/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 31.017
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
TFP 5 MG 21,00
201904004301 23/04/2019 Ruangan Kenari SERTRALINE 50 MG 7,00 31.017
TFP 5 MG 21,00
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
353 HARIS PRIA 201904003986 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 243.630
THD 2 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 30,00
TFP 5 MG 60,00
354 HARIYANTO 201904002308 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.180
THD 2 MG 60,00
FOLIC ACID 1 MG 60,00
355 HARIYONO 201904005201 26/04/2019 Poli Interna THYROZOL 10 MG 14,00 38.026
TABLET TAMBAH 10,00
VIT B COMPLEX 10,00
METHYLPREDNISOL 30,00
356 HARRY MUSDIYANTO 201904005228 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 152.786
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
SIKZONOATE 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
357 HASAN BUSRI 201904005208 26/04/2019 Poli Jiwa- Dewasa CLOZAPINE 100 MG 15,00 85.695
TFP 5 MG 60,00
THD 2 MG 60,00
358 HASAN BASRIE 201904004061 22/04/2019 Psiko Geriatri THD 2 MG 60,00 87.970
CLOZAPINE 25 MG 30,00
VIT B COMPLEX 10,00
RISPERIDONE 2 MG 60,00
359 HAYAT AMIN 201904001527 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 83.910
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
360 HELMAWATI 201904001247 06/04/2019 Poli Psikiater RIZODAL 2 MG-UM 45,00 117.675
THD 2 MG 30,00
NUZIP 25 23,00
201904004083 22/04/2019 Poli Psikiater NUZIP 25 20,00 31.500
361 HENDRA ALIANA 201904004177 22/04/2019 IGD TFP 5 MG 4,00 167.126
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
CPZ 100 MG 4,00
SPUIT 3 CC 1,00
201904004579 23/04/2019 Ruangan Wijaya CPZ 100 MG 4,00 166.834
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 4,00
AQUA PRO INJEKSI 1,00
THD 2 MG 4,00
201904004965 25/04/2019 Ruangan Kenari CPZ 100 MG 10,00 4.300
HALOPERIDOL 5 MG 10,00
THD 2 MG 10,00
201904005713 29/04/2019 Ruangan Kenari THD 2 MG 14,00 6.020
CPZ 100 MG 14,00
HALOPERIDOL 5 MG 14,00
362 HENDRA RINALDI 201904000416 01/04/2019 Ruangan Puri THD 2 MG 14,00 53.235
CLOZAPINE 25 MG 21,00
NOPRES 20 MG 7,00
RISPERIDONE 2 MG 14,00
201904001710 08/04/2019 Ruangan Puri CLOPIDOGREL 75 10,00 111.400
ADALAT OROS 30 MG 10,00
METFORMIN 500 MG 20,00
CANDESARTAN 16 10,00
SIMVASTATIN 20 MG 20,00
201904001716 08/04/2019 Ruangan Puri CLOZAPINE 25 MG 6,00 12.834
RISPERIDONE 2 MG 4,00
201904002173 10/04/2019 Ruangan Puri THD 2 MG 14,00 38.232
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
362 HENDRA RINALDI 201904002173 10/04/2019 Ruangan
- Puri CLOZAPINE 100 MG 6,00 38.232
NOPRES 20 MG 7,00
RISPERIDONE 2 MG 14,00
363 HENDRIK EDY WANTORO 201904005217 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 699.720
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
SEROQUEL XR 400 30,00
364 HENIK ASNIATI 201904003538 18/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 291.195
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
365 HENINGPRABOWO 201904000353 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
201904001752 08/04/2019 Ruangan Napza METFORMIN 500 MG 60,00 30.060
SIMVASTATIN 20 MG 30,00
GLIMEPIRIDE 2 MG 30,00
201904002355 11/04/2019 Ruangan Napza DOXYCICLIN 100 MG 10,00 14.030
RACIKAN KAPSUL 10,00
GENTAMYCIN SALEP 1,00
CTM 4 MG 10,00
KAPSUL NO.0 10,00
201904002356 11/04/2019 Ruangan Napza NA DICLOFENAC 50 5,00 2.755
201904002657 13/04/2019 Ruangan Napza NA DICLOFENAC 50 10,00 5.510
201904002939 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
201904004175 22/04/2019 Ruangan Napza SERTRALINE 50 MG 1,00 1.914
366 HENY MULATSIH 201904000160 01/04/2019 Ruangan SERTRALINE 50 MG 7,00 24.234
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
201904001672 08/04/2019 Ruangan RISPERIDONE 3 MG 14,00 24.234
SERTRALINE 50 MG 7,00
THD 2 MG 14,00
367 HENY PURWANINGSIH 201904002616 12/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 8,00 14.888
201904003047 15/04/2019 Ruangan THD 2 MG 14,00 34.041
CLOZAPINE 100 MG 7,00
TFP 5 MG 14,00
201904004266 23/04/2019 Ruangan TFP 5 MG 14,00 34.041
THD 2 MG 14,00
CLOZAPINE 100 MG 7,00
201904005786 29/04/2019 Ruangan CLOZAPINE 100 MG 7,00 34.041
TFP 5 MG 14,00
THD 2 MG 14,00
368 HERI SETIAWAN 201904004042 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 12.570
VIT B6 10 MG 30,00
369 HERU HARIYANTO 201904003417 16/04/2019 Ruangan Gelatik KAPSUL NO.00 15,00 92.610
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
369 HERU HARIYANTO 201904003417 16/04/2019 Ruangan
- Gelatik SCABIMITE 10mg 2,00 92.610
RACIKAN KAPSUL 15,00
AMOXYCILLIN 500 15,00
CTM 4 MG 15,00
201904003508 18/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 5,00 16.025
RISPERIDONE 3 MG 10,00
201904004802 25/04/2019 Ruangan Gelatik SCABIMITE 10mg 1,00 42.240
201904005689 29/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 22.435
RISPERIDONE 3 MG 14,00
201904005791 29/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 22.435
CLOZAPINE 25 MG 7,00
370 HERU PURWANTONO 201904003998 22/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 156.506
OLANZPINE 10mg 15,00
SIKZONOATE 1,00
371 HERY ISKANDAR 201904000635 03/04/2019 IGD THD 2 MG 6,00 16.767
CLOZAPINE 25 MG 3,00
AMOXYCILLIN 500 10,00
RISPERIDONE 3 MG 6,00
ASAM MEFENAMAT 10,00
201904003114 15/04/2019 Ruangan Gelatik THD 2 MG 16,00 27.272
CLOZAPINE 25 MG 8,00
RISPERIDONE 3 MG 16,00
201904003140 15/04/2019 Ruangan Gelatik METFORMIN 500 MG 10,00 1.980
372 HERY SUSILOWANTO 201904002663 13/04/2019 Medical Check Up VENTOLIN NEBULES 3,00 14.400
373 HIEM KIEN LAN / LANI 201904001108 05/04/2019 Poli Jiwa Dewasa FRIMANIA 200 MG 60,00 1.072.200
THD 2 MG 60,00
SEROQUEL XR 300 30,00
DEPAKOTE ER 500 30,00
CLOZAPINE 100 MG 60,00
374 HINDUN MASLICHA 201904005553 29/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 71.456
SIKZONOATE 1,00
375 HJ.FAUZIYAH 201904000770 04/04/2019 Poli Interna HERBESER CD 200 20,00 154.800
GLUCOSAMINE 30,00
376 HOJIN 201904000270 01/04/2019 Ruangan Wijaya THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904000433 01/04/2019 Ruangan Wijaya RACIKAN KAPSUL 20,00 31.592
CURCUMA 200 MG 20,00
SALBUTAMOL 4 MG 3,00
KAPSUL NO 2 20,00
CTM 4 MG 10,00
CODEIN 20 MG 5,00
201904000622 02/04/2019 Ruangan Wijaya CURCUMA 200 MG 12,00 13.320
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
376 HOJIN 201904000953 04/04/2019 Ruangan
- Wijaya ONDANSETRON 4 3,00 88.600
IV CANULLA NO.20 1,00
ASERING 500CC 2,00
OMEPRAZOLE 1,00
INFUS SET DEWASA 1,00
201904000979 04/04/2019 Ruangan Wijaya ONDANSETRON 8 6,00 3.168
201904001601 08/04/2019 Ruangan Wijaya SPUIT 3 CC 4,00 91.016
RINGER LACTAT 1,00
OMEPRAZOLE 1,00
ASERING 500CC 2,00
INFUS SET DEWASA 1,00
ONDANSETRON 4 3,00
201904001958 09/04/2019 Ruangan Wijaya OMEPRAZOLE 20 MG 12,00 8.496
ONDANSETRON 8 6,00
201904002646 13/04/2019 Ruangan Wijaya ONDANSETRON 8 10,00 26.790
CURCUMA 200 MG 1,00
SUKRALFAT SIRUP 1,00
OMEPRAZOLE 20 MG 20,00
201904002961 15/04/2019 Ruangan Wijaya ONDANSETRON 8 6,00 8.496
CURCUMA 200 MG 0,00
OMEPRAZOLE 20 MG 12,00
201904003633 18/04/2019 Ruangan Wijaya CURCUMA 200 MG 21,00 23.310
377 HOWO 201904004364 23/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 8,00 64.900
SERTRALINE 50 MG 30,00
378 HUSNUL FATHIYYA 201904000372 01/04/2019 IGD CIPROFLOXACIN 500 10,00 11.300
DEMACOLIN 10,00
DEXAMETASON 0,5 10,00
ANTASIDA DOEN 10,00
GLYSERIL 10,00
379 I WAYAN N 201904000772 04/04/2019 Poli VCT ALPRAZOLAM 1 MG 30,00 5.160
380 I'ANATUL MUALIMAH 201904001684 08/04/2019 Ruangan DEPAKOTE ER 250 7,00 54.446
HALOPERIDOL 5 MG 21,00
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
381 IBNU HANY S 201904003122 15/04/2019 Ruangan Gelatik CPZ 100 MG 15,00 8.955
RISPERIDONE 2 MG 15,00
201904003416 16/04/2019 Ruangan Gelatik KETOKONAZOL 200 10,00 11.234
SALEP 2-4 1,00
LORATADIN 10 MG 10,00
KAPSUL NO.00 10,00
RACIKAN KAPSUL 10,00
382 ICHSAN ACHMADI 201904006080 30/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 281.760
OLANZPINE 10mg 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
383 ILHAM MIDYA ISMAIL 201904001285 07/04/2019 Poli Psikiater
- CLOZAPINE 25 MG 8,00 42.158
RISPERIDONE 2 MG 30,00
NOPRES 20 MG 15,00
201904005305 27/04/2019 Poli Psikiater NOPRES 20 MG 25,00 69.643
CLOZAPINE 25 MG 13,00
RISPERIDONE 2 MG 50,00
384 IMAH 201904002593 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 49.140
THD 2 MG 60,00
CPZ 100 MG 15,00
385 IMAM HAMBALI 201904000454 02/04/2019 Poli Psikiater CPZ 100 MG 45,00 46.350
TFP 5 MG 90,00
THD 2 MG 90,00
386 IMAM KASDA'I/ IMAM 201904002682 14/04/2019 IGD CLOZAPINE 100 MG 3,00 16.427
THD 2 MG 4,00
RISPERIDONE 3 MG 4,00
TFP 5 MG 4,00
201904002955 15/04/2019 Puri Mitra TFP 5 MG 15,00 56.585
CLOZAPINE 100 MG 10,00
THD 2 MG 15,00
RISPERIDONE 3 MG 15,00
201904004157 22/04/2019 Puri Mitra (Laki- TFP 5 MG 14,00 116.461
CODEIN 15 MG 15,00
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
CLOZAPINE 100 MG 21,00
201904005602 29/04/2019 Puri Mitra (Laki- THD 2 MG 15,00 16.455
RISPERIDONE 3 MG 15,00
TFP 5 MG 15,00
387 IMAM TAUHID 201904002148 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 49.800
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
388 IMRON 201904000399 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 12.495
LORAZEPAM 2 MG 7,00
TFP 5 MG 14,00
389 IMRON WAHYUDI 201904001039 05/04/2019 Poli Psikiater RISPERIDONE 3 MG 40,00 54.900
KAPSUL NO 2 60,00
TFP 5 MG 60,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
390 INA 201904004700 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 2,00 834
201904005760 29/04/2019 Ruangan CIPROFLOXACIN 500 14,00 11.788
RISPERIDONE 2 MG 14,00
391 INDAH CHOIRUNNISA 201904004222 23/04/2019 IGD TFP 5 MG 4,00 175.710
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
391 INDAH CHOIRUNNISA 201904004222 23/04/2019 IGD
- AQUA PRO INJEKSI 1,00 175.710
THD 2 MG 4,00
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 4,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
201904004773 24/04/2019 Ruangan Puri THD 2 MG 6,00 13.716
CLOZAPINE 25 MG 6,00
TFP 5 MG 6,00
201904005264 26/04/2019 Ruangan Puri CLOZAPINE 100 MG 10,00 55.462
DEPAKOTE ER 250 4,00
TFP 5 MG 4,00
THD 2 MG 4,00
392 INDAH NUR MUFIDA 201904000645 03/04/2019 Ruangan HALOPERIDOL 5 MG 21,00 5.796
THD 2 MG 14,00
CPZ 100 MG 7,00
201904003261 16/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.900
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 30,00
393 INDAH SANJAYA 201904004077 22/04/2019 Poli Jiwa Dewasa PHENYTOIN CAP 100 90,00 58.320
RISPERIDONE 2 MG 30,00
394 INDRA KUSWANTO 201904005592 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 189.210
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
DEPAKOTE ER 250 30,00
395 INDRA RUDYANTO 201904005555 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 186.210
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 30,00
396 INDRA SUGIARTONO 201904000352 01/04/2019 Ruangan Napza THD 2 MG 28,00 14.532
RISPERIDONE 2 MG 28,00
201904000640 03/04/2019 Ruangan Napza RAMIPRIL 5 MG 10,00 19.710
NUZIP 25 10,00
201904002919 15/04/2019 Ruangan Napza RAMIPRIL 5 MG 10,00 3.960
201904003646 18/04/2019 Ruangan Napza NA DICLOFENAC 50 10,00 5.510
201904004172 22/04/2019 Ruangan Napza RAMIPRIL 5 MG 10,00 3.960
397 INDRAJID 201904001029 05/04/2019 Ruangan Kenari DOXYCICLIN 100 MG 14,00 11.102
201904001214 05/04/2019 Ruangan Kenari CENDO XITROL E D 1,00 34.172
201904001972 09/04/2019 Ruangan Kenari CPZ 100 MG 4,00 5.956
TFP 5 MG 14,00
THD 2 MG 7,00
398 INTAN M. RAMBU ANA H 201904001497 08/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 324.900
KAPSUL NO.00 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
398 INTAN M. RAMBU ANA H 201904001497 08/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 324.900
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
399 INTAN NURSINI HAPSARI 201904001021 04/04/2019 Poli Psikiater FRIMANIA 400 MG 45,00 93.915
400 IRA APRIALA 201904005756 29/04/2019 Ruangan RAMIPRIL 5 MG 10,00 17.120
CPZ 100 MG 7,00
TFP 5 MG 14,00
CIPROFLOXACIN 500 14,00
THD 2 MG 14,00
401 IRFAN 201904003119 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 35.462
RISPERIDONE 3 MG 14,00
201904003174 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 3,00 7.599
RISPERIDONE 3 MG 3,00
201904003515 18/04/2019 Ruangan Gelatik CURCUMA 200 MG 21,00 23.310
201904004181 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 15,00 37.995
RISPERIDONE 3 MG 15,00
402 IRI/H.SAMSUL 201904001384 08/04/2019 Poli Psikiater CPZ 100 MG 60,00 61.800
TFP 5 MG 120,00
THD 2 MG 120,00
403 IRIASTONO 201904005605 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 99.371
SIKZONOATE 1,00
SPUIT 3 CC 1,00
404 IRVAN S 201904000340 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
201904002931 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
405 ISA 201904005203 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 942.480
ABILIFY DISCMELT 10 30,00
CLOZAPINE 25 MG 30,00
406 ISA'I 201904003963 22/04/2019 Psiko Geriatri TFP 5 MG 60,00 36.300
THD 2 MG 60,00
CPZ 100 MG 60,00
407 ISABELLE CALOE 201904004569 23/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 28.050
408 ISMAIDATUL 201904003949 22/04/2019 Poli Jiwa Anak CLOZAPINE 25 MG 18,00 33.498
201904005510 29/04/2019 Poli Jiwa Anak KAPSUL NO 2 30,00 298.335
RISPERIDONE 3 MG 10,00
CLOZAPINE 25 MG 30,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 15,00
THD 2 MG 15,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 15 5,00
RACIKAN KAPSUL 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
408 ISMAIDATUL 201904005510 29/04/2019 Poli Jiwa
- Anak CLOBAZAM 10 MG 15,00 298.335
THD 2 MG 15,00
409 ISMAIL KOLIL 201904003382 16/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.950
THD 2 MG 14,00
201904004305 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.950
THD 2 MG 14,00
201904004638 24/04/2019 Ruangan Kenari SIKZONOATE 1,00 70.065
CPZ 100 MG 3,00
THD 2 MG 7,00
SPUIT 3 CC 1,00
201904004718 24/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.956
THD 2 MG 7,00
CPZ 100 MG 4,00
410 ISMAIL MARJUKI/CIRI 201904004216 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
411 ISMAIL SHOLEH 201904002531 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
412 ISMAWATUL 201904001865 09/04/2019 Ruangan TABLET TAMBAH 20,00 17.020
CIPROFLOXACIN 500 20,00
201904003072 15/04/2019 Ruangan CLOZAPINE 100 MG 4,00 20.574
TFP 5 MG 14,00
413 ISMOYO 201904001736 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904003143 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 33.320
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904003514 18/04/2019 Ruangan Gelatik CENDO XITROL E D 2,00 68.344
201904004310 23/04/2019 Ruangan Gelatik THD 2 MG 15,00 35.700
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 15,00
201904005811 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 33.320
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
414 ISNADI ISKAK 201904002314 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
415 ISTIYANI 201904003935 22/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 15,00 414.615
416 ITAM M .DJUNAIDY 201904000598 02/04/2019 Poli Psikiater SIZORIL 25 MG 5,00 23.185
RISPERIDONE 3 MG 10,00
THD 2 MG 10,00
417 IVA ERMAWATI 201904002371 11/04/2019 Ruangan Wijaya INFUS SET DEWASA 1,00 48.966
IKANEURON INJ 5000 2,00
IV CANULLA NO.20 1,00
DEXTROSE 5% 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
417 IVA ERMAWATI 201904002371 11/04/2019 Ruangan
- Wijaya RINGER LACTAT 2,00 48.966
201904002623 12/04/2019 Ruangan Wijaya IKANEURON INJ 5000 4,00 169.590
SPUIT 3 CC 4,00
DEXTROSE 5% 4,00
IV CANULLA NO.20 1,00
STOMACH TUBE 16 1,00
INFUS SET DEWASA 1,00
SPUIT 50 CC LUBANG 2,00
IV CANULLA NO.24 1,00
201904002967 15/04/2019 Ruangan Wijaya THD 2 MG 14,00 152.468
CLOZAPINE 100 MG 4,00
SEROQUEL XR 300 7,00
RISPERIDONE 3 MG 14,00
201904003392 16/04/2019 Ruangan Wijaya IKANEURON INJ 5000 2,00 240.292
IV CANULLA NO.20 1,00
STOMACH TUBE 16 2,00
DEXTROSE 5% 4,00
PROBENID 500 MG 10,00
SPUIT 5 CC 2,00
RINGER LACTAT 8,00
INFUS SET DEWASA 1,00
SPUIT 50 CC LUBANG 2,00
201904003581 18/04/2019 Ruangan PROBENID 500 MG 10,00 33.330
RAMIPRIL 5 MG 10,00
TABLET TAMBAH 20,00
201904003608 18/04/2019 Ruangan PROBENID 500 MG 10,00 33.330
RAMIPRIL 5 MG 10,00
TABLET TAMBAH 20,00
201904004544 23/04/2019 Ruangan RISPERIDONE 3 MG 14,00 56.911
CARBAMAZEPINE 7,00
THD 2 MG 14,00
CLOZAPINE 100 MG 11,00
201904005798 29/04/2019 Ruangan THD 2 MG 14,00 52.226
CLOZAPINE 100 MG 10,00
RISPERIDONE 3 MG 13,00
CARBAMAZEPINE 7,00
201904006053 30/04/2019 Ruangan TFP 5 MG 14,00 4.522
418 IVAN NUR SOCHIB 201904002456 12/04/2019 Psiko Geriatri RACIKAN KAPSUL 30,00 19.082
CLOZAPINE 100 MG 4,00
VIT B6 10 MG 30,00
KAPSUL NO 2 30,00
419 IVANTI KURNIAWAN 201904000005 01/04/2019 Poli Psikiater REMITAL 10 MG 120,00 3.100.860
ALGANAX 0,5 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
419 IVANTI KURNIAWAN 201904000005 01/04/2019 Poli Psikiater
- SIZORIL 25 MG 180,00 3.100.860
DEPAKOTE 250 MG 120,00
THD 2 MG 120,00
420 IWAN 201904002128 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
201904004189 22/04/2019 Ruangan Gelatik TFP 5 MG 14,00 132.002
CPZ 100 MG 14,00
THD 2 MG 7,00
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
201904005807 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 8.470
CPZ 100 MG 14,00
TFP 5 MG 14,00
421 JAIDI 201904005549 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 26.460
CPZ 100 MG 8,00
422 JAJUK SETYANINGSIH 201904003532 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 105.750
CLOBAZAM 10 MG 30,00
PHENYTOIN CAP 100 90,00
423 JANAKA 201904000912 05/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 12,00 22.332
201904000922 04/04/2019 Ruangan Gelatik LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
201904001735 08/04/2019 Ruangan Gelatik THD 2 MG 15,00 34.466
CLOZAPINE 100 MG 7,00
TFP 5 MG 15,00
201904002953 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 7,00 34.466
TFP 5 MG 15,00
THD 2 MG 15,00
424 JANIYEM 201904004689 24/04/2019 Ruangan Puri THD 2 MG 15,00 21.810
LORAZEPAM 2 MG 15,00
RISPERIDONE 2 MG 15,00
425 JATMIKO 201904003423 16/04/2019 Ruangan Kenari SCABIMITE 10mg 1,00 67.410
RACIKAN KAPSUL 10,00
DOXYCICLIN 100 MG 10,00
CTM 4 MG 10,00
KAPSUL NO.0 10,00
201904004280 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 5.838
201904004338 26/04/2019 Ruangan Kenari LORATADIN 10 MG 5,00 2.010
201904006056 30/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 5.838
426 JEFRI PRANATA 201904005163 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 82.920
SERTRALINE 50 MG 30,00
TFP 5 MG 60,00
427 JEPAN PRANSINO 201904002878 15/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 15.099
CLOZAPINE 25 MG 7,00
201904003440 17/04/2019 Ruangan Kenari DIPHENHYDRAMINE 2,00 15.232
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
427 JEPAN PRANSINO 201904003440 17/04/2019 Ruangan
- Kenari DIAZEPAM inj 1,00 15.232
THD 2 MG 10,00
SPUIT 3 CC 3,00
201904004299 23/04/2019 Ruangan Kenari THD 2 MG 7,00 13.741
CLOZAPINE 25 MG 7,00
201904006071 30/04/2019 Ruangan Kenari CLOZAPINE 25 MG 4,00 7.444
428 JOHAN ARIANSAH 201904004793 24/04/2019 IGD RISPERIDONE 2 MG 4,00 2.436
THD 2 MG 4,00
CPZ 100 MG 2,00
201904004980 25/04/2019 Ruangan Wijaya SPUIT 3 CC 8,00 36.192
THD 2 MG 8,00
CPZ 100 MG 4,00
LODOMER 2 MG/ML 4,00
DIAZEPAM inj 4,00
RISPERIDONE 2 MG 8,00
201904005246 26/04/2019 Ruangan Wijaya LODOMER 2 MG/ML 2,00 15.660
DIAZEPAM inj 2,00
SPUIT 3 CC 4,00
201904005745 29/04/2019 Ruangan Kenari THD 2 MG 14,00 8.526
CPZ 100 MG 7,00
RISPERIDONE 2 MG 14,00
429 JOHANES KURNIAWAN 201904000421 01/04/2019 Ruangan Puri THD 2 MG 14,00 15.981
HALOPERIDOL 5 MG 28,00
LORAZEPAM 2 MG 7,00
CARBAMAZEPINE 14,00
201904001575 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 51.840
CPZ 100 MG 30,00
RISPERIDONE 3 MG 60,00
201904001588 08/04/2019 Poli Jiwa Dewasa CARBAMAZEPINE 60,00 132.861
THD 2 MG 60,00
HALOPERIDOL 5 MG 90,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
LORAZEPAM 2 MG 30,00
430 JOKO 201904002998 15/04/2019 Ruangan Kenari PROBENID 500 MG 10,00 26.970
FOLIC ACID 1 MG 10,00
TABLET TAMBAH 10,00
201904003001 15/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 14.710
THD 2 MG 14,00
CLOZAPINE 25 MG 4,00
201904004304 23/04/2019 Ruangan Kenari CLOZAPINE 25 MG 4,00 14.710
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
430 JOKO 201904004731 24/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 4,00 14.710
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
431 JOKO PRASETYO 201904005707 29/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
432 JOKO SUSANTO 201904003257 16/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 27.840
TFP 5 MG 60,00
THD 2 MG 30,00
433 JOKO UTOMO 201904003627 18/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 4,00 8.628
HALOPERIDOL 5 MG 8,00
201904004343 23/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 17.108
HALOPERIDOL 5 MG 15,00
201904005843 29/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 17.108
HALOPERIDOL 5 MG 15,00
434 JONATHAN WIDJAJA 201904002178 10/04/2019 Ruangan Puri CLOZAPINE 100 MG 20,00 275.980
DEPAKOTE ER 500 20,00
RISPERIDONE 3 MG 20,00
SERTRALINE 50 MG 20,00
201904004110 22/04/2019 Ruangan Puri DEPAKOTE ER 500 14,00 193.186
RISPERIDONE 3 MG 14,00
SERTRALINE 50 MG 14,00
CLOZAPINE 100 MG 14,00
201904005666 29/04/2019 Ruangan Puri SERTRALINE 50 MG 30,00 281.680
DEPAKOTE ER 500 20,00
CLOZAPINE 100 MG 20,00
435 JONI SISWANTO 201904002368 11/04/2019 IGD RISPERIDONE 3 MG 10,00 16.025
CLOZAPINE 25 MG 5,00
201904002971 15/04/2019 IGD CLOZAPINE 25 MG 7,00 22.435
RISPERIDONE 3 MG 14,00
201904003662 18/04/2019 Ruangan Puri SERTRALINE 50 MG 5,00 9.570
201904004120 22/04/2019 Ruangan Puri CLOZAPINE 25 MG 5,00 25.595
RISPERIDONE 3 MG 10,00
SERTRALINE 50 MG 5,00
436 JUARISEH 201904004290 23/04/2019 Ruangan CLOZAPINE 25 MG 7,00 78.181
RAMIPRIL 5 MG 10,00
CLOBAZAM 10 MG 7,00
GLUCOSAMINE 22,00
CLOBAZAM 10 MG 10,00
MELOXICAM 15 MG 10,00
201904005284 27/04/2019 Ruangan CLOZAPINE 25 MG 5,00 15.125
CLOBAZAM 10 MG 5,00
437 JULSIE 201904005759 29/04/2019 Ruangan TFP 5 MG 14,00 19.202
CLOZAPINE 25 MG 4,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
437 JULSIE 201904005759 29/04/2019 Ruangan
- LORATADIN 10 MG 10,00 19.202
BETAMETASON 2,00
438 JUMAH 201904004950 25/04/2019 Psiko Geriatri LORAZEPAM 2 MG 20,00 37.076
DIAZEPAM 5 MG 16,00
RACIKAN KAPSUL 80,00
KAPSUL NO 2 80,00
VIT B6 10 MG 80,00
AMITRIPTILIN 25 MG 40,00
439 JUMAROH 201904000684 04/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 92.340
SERTRALINE 50 MG 30,00
440 JUMHUR 201904005681 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 66.374
CLOZAPINE 25 MG 14,00
441 JUNAWATI 201904000417 01/04/2019 Ruangan Puri DEPAKOTE ER 500 4,00 28.800
201904001017 04/04/2019 Ruangan Puri FRIMANIA 400 MG 20,00 145.535
THD 2 MG 20,00
CLOZAPINE 100 MG 5,00
DEPAKOTE ER 500 10,00
TFP 5 MG 30,00
442 JUS HAJATI 201904000162 01/04/2019 Ruangan TFP 5 MG 14,00 12.508
CPZ 100 MG 4,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
201904001095 05/04/2019 Ruangan NOPRES 20 MG 4,00 7.968
RISPERIDONE 3 MG 6,00
201904003071 15/04/2019 Ruangan CPZ 100 MG 4,00 18.444
NOPRES 20 MG 7,00
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904004237 26/04/2019 Ruangan RISPERIDONE 3 MG 14,00 27.635
METFORMIN 500 MG 10,00
ELIZAC 20 MG 3,00
AMLODIPIN 5 10,00
RAMIPRIL 5 MG 10,00
NOPRES 20 MG 4,00
CPZ 100 MG 3,00
201904005764 29/04/2019 Ruangan RISPERIDONE 3 MG 14,00 17.730
THD 2 MG 7,00
CPZ 100 MG 4,00
NOPRES 20 MG 7,00
443 KADARJONO 201904003182 15/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 6,00 10.558
THD 2 MG 6,00
CLOZAPINE 25 MG 4,00
201904003405 16/04/2019 Ruangan Kenari THD 2 MG 15,00 23.837
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
443 KADARJONO 201904003405 16/04/2019 Ruangan
- Kenari CLOZAPINE 100 MG 4,00 23.837
RISPERIDONE 2 MG 15,00
201904004229 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 23.318
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
201904005725 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 23.318
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
444 KALIMAH 201904004082 22/04/2019 Poli Jiwa Dewasa AMITRIPTILIN 25 MG 15,00 12.557
TFP 5 MG 12,00
KAPSUL NO 2 60,00
VIT B6 10 MG 30,00
ALPRAZOLAM 1 MG 8,00
RACIKAN KAPSUL 60,00
445 KARNIYAH / PRETTY 201904003076 15/04/2019 Ruangan CPZ 100 MG 4,00 6.558
RISPERIDONE 2 MG 14,00
446 KARNO 201904000391 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 4.522
447 KARTIKA ROSALINE REPI 201904003712 20/04/2019 IGD ALPRAZOLAM 0.5 MG 8,00 10.794
SERTRALINE 50 MG 5,00
448 KARTIKA 201904001511 08/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 1 MG 30,00 600.780
SERTRALINE 50 MG 30,00
SEROQUEL XR 300 30,00
449 KARTONO 201904002307 11/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 67.770
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
450 KASDI 201904000628 02/04/2019 Poli Gigi (Jiwa) CPZ 100 MG 7,00 9.471
TFP 5 MG 21,00
THD 2 MG 14,00
201904004197 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
451 KASIANI 201904003115 15/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004353 23/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004588 23/04/2019 Ruangan Gelatik IV CANULLA NO.20 2,00 61.320
CEFTRIAXONE 1 6,00
201904005833 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 8,00 3.336
201904006059 30/04/2019 Ruangan Gelatik THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
452 KASMINTO 201904001971 09/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 7,00 20.293
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
453 KASMURI 201904002659 13/04/2019 IGD THD 2 MG 4,00 6.848
CPZ 100 MG 6,00
DIAZEPAM inj 1,00
HALOPERIDOL 5 MG 4,00
SPUIT 3 CC 1,00
201904002986 16/04/2019 Puri Mitra (Laki- CLOZAPINE 100 MG 4,00 42.612
THD 2 MG 15,00
SPUIT 3 CC 1,00
DIPHENHYDRAMINE 2,00
CLOZAPINE 100 MG 4,00
HALOPERIDOL 5 MG 15,00
201904004158 22/04/2019 Puri Mitra (Laki- HALOPERIDOL 5 MG 14,00 19.552
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
201904005667 29/04/2019 Puri Mitra (Laki- CLOZAPINE 25 MG 7,00 16.527
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
454 KASTO 201904002312 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
455 KATENO 201904004794 25/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 2,00 5.798
RISPERIDONE 2 MG 4,00
THD 2 MG 4,00
201904004959 25/04/2019 Ruangan Wijaya THD 2 MG 4,00 9.036
CLOZAPINE 25 MG 4,00
HALOPERIDOL 5 MG 8,00
201904005687 29/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 17.193
HALOPERIDOL 5 MG 14,00
ASAM MEFENAMAT 5,00
THD 2 MG 7,00
201904005697 29/04/2019 Ruangan Kenari SCABICID CREAM 0,00 0
201904006067 30/04/2019 Ruangan Kenari SALEP 2-4 1,00 11.234
LORATADIN 10 MG 10,00
KAPSUL NO.00 10,00
RACIKAN KAPSUL 10,00
KETOKONAZOL 200 10,00
201904006075 30/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 6,00 888
456 KENSIWI NARASWATI 201904004268 23/04/2019 Ruangan CPZ 100 MG 7,00 22.750
THD 2 MG 14,00
CURCUMA 200 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
456 KENSIWI NARASWATI 201904004268 23/04/2019 Ruangan
- TFP 5 MG 14,00 22.750
201904004589 23/04/2019 Ruangan RISPERIDONE 2 MG 14,00 5.838
201904005762 29/04/2019 Ruangan ASAM MEFENAMAT 15,00 148.558
GENTAMYCIN SALEP 2,00
Plesteri rol 15 cm x 1,00
CIPROFLOXACIN 500 15,00
NA CL 0,9 % 500 ML 2,00
KASA STERIL ISI 16 2,00
DEXAMETASON 0,5 15,00
BETADINE SOL 30 ML 1,00
201904005771 29/04/2019 Ruangan TFP 5 MG 14,00 12.334
CPZ 100 MG 7,00
THD 2 MG 7,00
RISPERIDONE 2 MG 14,00
457 KHENNEDY TAPIKAP 201904002549 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
458 KHOFIFA 201904000830 04/04/2019 Poli Jiwa Anak VIT B6 10 MG 30,00 100.254
RACIKAN KAPSUL 6,00
CLOBAZAM 10 MG 30,00
ASAM VALPROAT 1,00
KAPSUL NO 2 60,00
RACIKAN KAPSUL 60,00
CLOZAPINE 100 MG 3,00
VIT B12 50 MG 30,00
KAPSUL NO 2 60,00
RISPERIDONE 3 MG 20,00
FOLIC ACID 1 MG 30,00
459 KHOIRUDIN 201904000323 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 31.962
SIMVASTATIN 20 MG 21,00
201904000639 03/04/2019 Ruangan Napza AMOXYCILLIN 500 15,00 8.430
ASAM MEFENAMAT 10,00
201904002924 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 40.152
ATORVASTATIN 20 14,00
201904004149 22/04/2019 Ruangan Napza PEHACHAIN INJ 2,00 19.008
AMOXYCILLIN 500 15,00
NA DICLOFENAC 50 12,00
460 KHOIRUL SALEH 201904001534 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 158.100
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
461 KHORNIAWAN 201904003187 16/04/2019 Poli Psikiater THD 2 MG 60,00 38.625
NUZIP 25 15,00
HALOPERIDOL 5 MG 60,00
462 KHOTIJAH 201904001265 07/04/2019 Psiko Geriatri LORAZEPAM 2 MG 15,00 60.360
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
462 KHOTIJAH 201904001265 07/04/2019 Psiko Geriatri
- SIZORIL 25 MG 15,00 60.360
463 KHOTIMAH KURNIATI 201904005248 26/04/2019 Ruangan HALOPERIDOL 5 MG 2,00 4.498
CARBAMAZEPINE 1,00
THD 2 MG 2,00
CLOZAPINE 25 MG 2,00
201904005795 29/04/2019 Ruangan CLOZAPINE 25 MG 14,00 31.486
HALOPERIDOL 5 MG 14,00
CARBAMAZEPINE 7,00
THD 2 MG 14,00
464 KLIWON 201904002324 11/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 88.560
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
465 KOIRON 201904004004 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 142.800
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
466 KOJI 201904000407 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.950
THD 2 MG 14,00
467 KRISTIANA 201904004007 22/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 45,00 357.390
DEPAKOTE ER 250 30,00
468 KRISTIN SUSILOWATI 201904000422 01/04/2019 Ruangan Puri THD 2 MG 14,00 23.863
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
201904001722 08/04/2019 Ruangan Puri SPUIT 3 CC 1,00 92.674
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 14,00
201904003483 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 204.510
DEPAKOTE ER 250 30,00
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
469 KUMA 201904000627 02/04/2019 Ruangan Gelatik TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004712 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 1,00 826
TFP 5 MG 2,00
201904004963 25/04/2019 Ruangan Kenari TFP 5 MG 10,00 4.130
CPZ 100 MG 5,00
201904005702 29/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
470 KURDI 201904000658 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 12.390
TFP 5 MG 30,00
471 KURNIA BASKORO (DRS) 201904002661 13/04/2019 IGD CPZ 100 MG 10,00 1.800
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
472 KUS INDRAYANI 201904005860 30/04/2019 Poli Psikiater
- RISPERIDONE 3 MG 60,00 167.790
TFP 5 MG 30,00
CLOZAPINE 25 MG 60,00
THD 2 MG 60,00
473 KUSNADI 201904002007 10/04/2019 Ruang Observasi NEEDLE 23 G 1,00 166.566
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
AQUA PRO INJEKSI 1,00
201904002664 13/04/2019 Ruangan Kenari TFP 5 MG 6,00 182.706
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 4,00
ZYPREXA INJ 1,00
SPUIT 3 CC 2,00
DIPHENHYDRAMINE 2,00
AQUA PRO INJEKSI 1,00
201904003373 16/04/2019 Ruangan Kenari AQUA PRO INJEKSI 1,00 356.339
NEEDLE 23 G 1,00
CLOZAPINE 100 MG 7,00
SPUIT 3 CC 2,00
ZYPREXA INJ 2,00
201904003386 16/04/2019 Ruangan Kenari TFP 5 MG 14,00 32.004
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904004288 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 22.002
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
201904004635 24/04/2019 Ruangan Kenari LODOMER 2 MG/ML 2,00 126.558
SPUIT 3 CC 3,00
SIKZONOATE 1,00
CLOZAPINE 100 MG 10,00
201904005705 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 62.132
THD 2 MG 14,00
CLOZAPINE 100 MG 14,00
474 KUSNO 201904000401 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 3.500
HALOPERIDOL 5 MG 14,00
201904001747 08/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 3.500
THD 2 MG 14,00
201904001978 09/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 8,00 2.000
THD 2 MG 8,00
201904003144 15/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 3.500
THD 2 MG 14,00
201904003160 15/04/2019 Ruangan Gelatik THD 2 MG 2,00 500
HALOPERIDOL 5 MG 2,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
475 KUSTANTINA 201904002179 10/04/2019 Ruangan
- Puri THD 2 MG 7,00 154.385
SEROQUEL XR 300 7,00
CLOZAPINE 100 MG 7,00
201904002866 15/04/2019 IGD SEROQUEL XR 300 5,00 102.596
CLOZAPINE 100 MG 5,00
THD 2 MG 3,00
201904004106 22/04/2019 Ruangan Puri THD 2 MG 7,00 143.920
SEROQUEL XR 300 7,00
CLOZAPINE 100 MG 7,00
201904004974 25/04/2019 Ruangan Puri PEDITOX 4,00 26.400
201904005657 29/04/2019 Ruangan Puri CLOZAPINE 100 MG 10,00 220.550
THD 2 MG 10,00
SEROQUEL XR 300 10,00
476 LA DHALA 201904004194 22/04/2019 Psiko Geriatri FOLIC ACID 1 MG 60,00 30.060
RISPERIDONE 2 MG 60,00
477 LANI 201904005173 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 50.520
TFP 5 MG 60,00
THD 2 MG 60,00
478 LASIKAH 201904004664 24/04/2019 Psiko Geriatri RISPERIDONE 2 MG 20,00 228.380
RIKLONA 2 MG 20,00
SIZORIL 25 MG 20,00
479 LENI /NOWNEM 201904001674 08/04/2019 Ruangan RISPERIDONE 3 MG 14,00 9.408
201904001869 09/04/2019 Ruangan METHYLPREDNISOL 10,00 15.510
PYRANTEL 125 MG 8,00
TABLET TAMBAH 20,00
201904003077 15/04/2019 Ruangan RISPERIDONE 3 MG 14,00 13.930
TFP 5 MG 14,00
201904004232 23/04/2019 Ruangan RISPERIDONE 3 MG 14,00 16.191
TFP 5 MG 21,00
201904005780 29/04/2019 Ruangan RISPERIDONE 3 MG 14,00 16.191
TFP 5 MG 21,00
480 LENI TRI 201904003977 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 38.715
RISPERIDONE 1 MG 30,00
481 LENNY AGUSTINE 201904004056 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 111.075
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
HALOPERIDOL 5 MG 30,00
482 LEONARDO KOHANSEN 201904003981 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 91.710
RISPERIDONE 3 MG 40,00
KAPSUL NO.0 60,00
THD 2 MG 60,00
RACIKAN KAPSUL 60,00
483 LIDWINA PARAMITA 201904001188 05/04/2019 Poli Psikiater ALGANAX 1 MG 50,00 277.200
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
483 LIDWINA PARAMITA 201904001189 05/04/2019 Poli Psikiater
- ALGANAX 1 MG 50,00 277.200
201904001190 05/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 50,00 8.600
201904001191 05/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 50,00 8.600
201904003697 19/04/2019 Poli Psikiater RACIKAN KAPSUL 5,00 89.544
NIFEDIPIN 10 MG 3,00
ADALAT OROS 30 MG 20,00
ONDANSETRON 4 1,00
KAPSUL NO.00 5,00
201904003698 19/04/2019 Poli Psikiater IRBERSARTAN 300 10,00 17.040
BISOPROLOL 5 MG 20,00
201904003745 22/04/2019 Poli Psikiater RIKLONA 2 MG 50,00 329.700
484 LILA DIAN FIRLIANSYAH 201904000766 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 100.515
RISPERIDONE 3 MG 60,00
485 LINDA MURTI 201904005331 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 75.315
THD 2 MG 30,00
AMITRIPTILIN 25 MG 60,00
486 LIUNIWATI MURIANI A 201904003984 22/04/2019 Poli Interna GLUCOSAMINE 10,00 21.760
OMEPRAZOLE 20 MG 10,00
VIT B12 50 MG 30,00
487 LUCKY DWI KURNIAWAN 201904001749 08/04/2019 Poli Napza NOPRES 20 MG 30,00 29.520
488 LUDIA 201904000623 02/04/2019 Ruangan BETAMETASON 1,00 1.608
201904000992 04/04/2019 Ruangan TFP 5 MG 5,00 1.615
201904001665 08/04/2019 Ruangan THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
201904002040 10/04/2019 Ruangan RISPERIDONE 2 MG 10,00 4.170
201904003063 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 15.309
TFP 5 MG 21,00
CPZ 100 MG 7,00
THD 2 MG 14,00
201904004231 23/04/2019 Ruangan THD 2 MG 14,00 13.048
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
CPZ 100 MG 7,00
489 LUKI SUGIYONO 201904002181 10/04/2019 Poli Psikiater RISPERIDONE 3 MG 30,00 112.830
SIZORIL 25 MG 30,00
490 LUKITO 201904006090 30/04/2019 Ruangan Wijaya SALEP 2-4 2,00 9.518
KETOKONAZOL 200 10,00
491 LUKITO DODIK 201904003104 15/04/2019 IGD DIAZEPAM inj 1,00 17.602
RISPERIDONE 2 MG 4,00
SPUIT 3 CC 1,00
CLOZAPINE 25 MG 6,00
492 LUKMANUL KARIM 201904005517 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
492 LUKMANUL KARIM 201904005517 29/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 81.330
TFP 5 MG 60,00
493 LULUK KURNIAWATI 201904003767 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 85.695
CLOZAPINE 100 MG 15,00
TFP 5 MG 60,00
494 LUQMAN AGUNG 201904001430 08/04/2019 Poli VCT OMEPRAZOLE 20 MG 14,00 57.884
CEFIXIME 200 MG 14,00
GENTAMYCIN SALEP 2,00
495 LUTFI IFFANDHI 201904003018 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904004264 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904005740 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
496 LUTHFI ANDRY ARIESTA 201904004143 22/04/2019 Ruangan Puri HALOPERIDOL 5 MG 7,00 2.464
THD 2 MG 14,00
201904005260 26/04/2019 Ruangan Puri SPUIT 3 CC 1,00 124.246
HALDOL DECANOAS 1,00
201904005653 29/04/2019 Ruangan Puri SPUIT 3 CC 1,00 135.082
THD 2 MG 14,00
HALDOL DECANOAS 1,00
RISPERIDONE 3 MG 14,00
201904006046 30/04/2019 Ruangan Puri LORAZEPAM 2 MG 4,00 14.576
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
497 Lani 201904001838 09/04/2019 Psiko Geriatri ABILIFY DISCMELT 15 2,00 273.723
VIT B12 50 MG 15,00
CIPRALEX 20 MG 4,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
498 M ANWAR 201904004081 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 62.100
CLOZAPINE 25 MG 15,00
LORAZEPAM 2 MG 15,00
499 M HAMBALI 201904002147 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 133.410
TFP 5 MG 60,00
SCABIMITE 10mg 1,00
500 M JAWAD HADUN 201904000412 01/04/2019 Ruangan Puri DEPAKOTE ER 500 10,00 72.000
201904002176 10/04/2019 Ruangan Puri DEPAKOTE ER 500 10,00 72.000
201904004031 22/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 316.515
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
501 M ROFI'I 201904004791 24/04/2019 IGD BUSCOPAN PLUS 6,00 50.556
PARACETAMOL 500 10,00
NORAGES INJEKSI 1,00
SPUIT 3 CC 2,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
501 M ROFI'I 201904004791 24/04/2019 IGD
- RANITIDIN INJEKSI 1,00 50.556
ANTASIDA DOEN 10,00
502 M TAUFIK 201904003656 18/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 0.5 MG 60,00 68.220
NOPRES 20 MG 60,00
503 M. ADHI PERMANA 201904003548 18/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 53.310
HALOPERIDOL 1,5 60,00
PHENYTOIN CAP 100 90,00
504 M. ADI 201904001277 07/04/2019 IGD RISPERIDONE 1 MG 2,00 2.940
SERTRALINE 50 MG 1,00
ALPRAZOLAM 0.5 MG 2,00
201904003108 15/04/2019 Ruangan Gelatik RISPERIDONE 1 MG 7,00 16.989
SERTRALINE 50 MG 7,00
ALPRAZOLAM 0.5 MG 7,00
201904004315 23/04/2019 Ruangan Gelatik RISPERIDONE 1 MG 7,00 11.400
SERTRALINE 50 MG 4,00
ALPRAZOLAM 0.5 MG 8,00
505 M. ALI 201904006066 30/04/2019 Ruangan Kenari SCABIMITE 10 GR 1,00 57.552
RACIKAN KAPSUL 16,00
DOXYCICLIN 100 MG 16,00
CTM 4 MG 16,00
KAPSUL NO.00 16,00
506 M. ARFA MALAZI 201904001567 08/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 401.697
KAPSUL NO.0 30,00
ABILIFY DISCMELT 15 10,00
CLOBAZAM 10 MG 8,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
507 M. ARIS ARIFIN 201904004139 22/04/2019 IGD THD 2 MG 4,00 2.420
CPZ 100 MG 4,00
TFP 5 MG 4,00
201904004586 23/04/2019 Ruangan Gelatik TFP 5 MG 14,00 8.470
THD 2 MG 14,00
CPZ 100 MG 14,00
201904005724 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
508 M. BASUKI 201904005829 29/04/2019 Ruangan Gelatik CPZ 100 MG 8,00 6.285
TFP 5 MG 15,00
509 M. CHANAPI 201904003957 22/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 272.340
DEPAKOTE ER 250 30,00
510 M. CHOIRUL UMAM 201904003540 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 14.040
THD 2 MG 15,00
511 M. DILFAN KAMIL 201904000152 01/04/2019 Poli Jiwa Anak DEPTRAL 50 MG 2,00 141.174
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
511 M. DILFAN KAMIL 201904000152 01/04/2019 Poli Jiwa
- Anak FOLIC ACID 1 MG 15,00 141.174
VIT B6 10 MG 10,00
CLOBAZAM 10 MG 2,00
RACIKAN PUYER 20,00
ABILIFY DISCMELT 10 4,00
CLOBAZAM 10 MG 2,00
RACIKAN PUYER 20,00
512 M. GHUFRON 201904004019 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
513 M. LAZZUARDHI ILMI 201904003284 16/04/2019 Poli Umum DEMACOLIN 10,00 12.100
CEFADROXIL 500 MG 10,00
514 M. MUHAIMIN 201904002037 10/04/2019 Poli Psikiater CLOZAPINE 25 MG 20,00 77.540
RISPERIDONE 3 MG 60,00
515 M. NAIM 201904002999 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 6.670
THD 2 MG 14,00
CPZ 100 MG 4,00
201904004225 23/04/2019 Ruangan Kenari THD 2 MG 14,00 6.670
CPZ 100 MG 4,00
TFP 5 MG 14,00
516 M. NASIHIN 201904001606 08/04/2019 Ruangan Wijaya AQUA PRO INJEKSI 1,00 199.580
THD 2 MG 15,00
CLOZAPINE 100 MG 7,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
TFP 5 MG 15,00
201904001945 09/04/2019 Ruangan Wijaya AQUA PRO INJEKSI 1,00 165.114
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
201904002157 10/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 12,00 1.776
201904003118 15/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 36.113
TFP 5 MG 14,00
CLOZAPINE 100 MG 7,00
THD 2 MG 14,00
201904003176 15/04/2019 Ruangan Gelatik TFP 5 MG 1,00 4.734
CLOZAPINE 100 MG 1,00
THD 2 MG 1,00
HALOPERIDOL 5 MG 2,00
201904005814 29/04/2019 Ruangan Gelatik TFP 5 MG 14,00 52.165
CLOZAPINE 100 MG 11,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
517 M. RAKHA RANGGA .R 201904003281 16/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 20,00 36.720
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
517 M. RAKHA RANGGA .R 201904003281 16/04/2019 Poli Jiwa
- Anak KAPSUL NO 2 60,00 36.720
THD 2 MG 15,00
RACIKAN KAPSUL 60,00
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 15,00
518 M. RIKKY ILHAM SYAH 201904005512 29/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 10.833
CLOBAZAM 10 MG 6,00
KAPSUL NO 2 30,00
FOLIC ACID 1 MG 15,00
RACIKAN KAPSUL 30,00
HALOPERIDOL 5 MG 3,00
519 M. RIZALDI PUTRA 201904005496 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 60,00 249.240
DEPAKOTE ER 500 30,00
TFP 5 MG 60,00
THD 2 MG 30,00
520 M. SAHID ABDILAH 201904003497 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
521 M. ZAED FAUZI 201904004255 23/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
201904004570 23/04/2019 Ruangan Kenari THD 2 MG 14,00 1.428
201904005715 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 14.710
THD 2 MG 14,00
CLOZAPINE 25 MG 4,00
522 M. ZAENAL ABIDIN 201904005526 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
523 M.HARIYANTO 201904005185 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 103.575
THD 2 MG 30,00
CLOZAPINE 100 MG 15,00
524 M.IQBAL SYA'RANI 201904001733 08/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 20,00 55.610
THD 2 MG 20,00
CLOZAPINE 100 MG 10,00
201904002204 11/04/2019 Poli Gigi (Jiwa) CLOZAPINE 100 MG 4,00 26.888
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
525 M.KOMARUDIN 201904002996 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 17.549
CLOZAPINE 25 MG 7,00
201904004295 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 17.549
CLOZAPINE 25 MG 7,00
201904005696 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 17.549
CLOZAPINE 25 MG 7,00
526 M.SIDIK 201904003971 22/04/2019 Psiko Geriatri TFP 5 MG 30,00 23.070
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
526 M.SIDIK 201904003971 22/04/2019 Psiko Geriatri
- CPZ 100 MG 30,00 23.070
VIT B1 50 MG 30,00
527 M.UFI ISBAR 201904003947 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 115.530
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
528 MACHMOEDAH 201904003496 18/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 30.930
AMITRIPTILIN 25 MG 15,00
529 MAHFUD 201904000167 01/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 194.910
DEPAKOTE ER 250 30,00
201904002326 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
530 MAIMUNAH 201904003079 15/04/2019 Ruangan CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
531 MALA 201904001637 08/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904003070 15/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
532 MALIKA 201904000777 04/04/2019 Poli Jiwa Dewasa KAPSUL NO.00 30,00 126.000
SEROQUEL XR 200 4,00
ALPRAZOLAM 1 MG 30,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 30,00
NOPRES 20 MG 15,00
533 MAMAT URIP 201904004072 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
534 MANSYUR 201904000913 04/04/2019 Ruangan Gelatik LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
201904003171 15/04/2019 Ruangan Gelatik THD 2 MG 14,00 15.358
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
201904004345 23/04/2019 Ruangan Gelatik TFP 5 MG 14,00 15.358
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
535 MARDI SANTOSO 201904004140 22/04/2019 IGD ASAM MEFENAMAT 10,00 3.150
DEXAMETASON 0,5 10,00
536 MARDIAH 201904001760 08/04/2019 Puri Mitra SERTRALINE 50 MG 7,00 36.078
OLANZPINE 10mg 4,00
201904002947 15/04/2019 Puri Mitra SERTRALINE 50 MG 7,00 36.078
OLANZPINE 10mg 4,00
537 MARDIANTO 201904001364 08/04/2019 Poli VCT ALPRAZOLAM 1 MG 30,00 5.160
538 MARDIYATIM 201904000722 04/04/2019 Psiko Geriatri VIT B6 10 MG 30,00 1.104.030
ALPRAZOLAM 1 MG 30,00
FOLIC ACID 1 MG 30,00
SEROQUEL XR 200 60,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
538 MARDIYATIM 201904000722 04/04/2019 Psiko Geriatri
- VIT B1 50 MG 30,00 1.104.030
DIAZEPAM 5 MG 30,00
539 MARHAWI, MM. 201904000420 01/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 33.320
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904001242 06/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 33.320
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
540 MARIA KRISTIANI 201904001973 09/04/2019 Ruangan TFP 5 MG 10,00 17.725
CLOZAPINE 25 MG 5,00
THD 2 MG 10,00
RISPERIDONE 2 MG 10,00
201904003074 15/04/2019 Ruangan CLOZAPINE 25 MG 7,00 24.815
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
201904004592 23/04/2019 Ruangan CLOZAPINE 25 MG 7,00 24.815
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
201904005790 29/04/2019 Ruangan TFP 5 MG 14,00 24.815
CLOZAPINE 25 MG 7,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
541 MARIA MAGDALENA 201904004070 22/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 15 5,00 331.350
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 30,00
SEROQUEL XR 300 2,00
KAPSUL NO 2 30,00
SERTRALINE 50 MG 15,00
CLOBAZAM 10 MG 30,00
RACIKAN KAPSUL 30,00
542 MARIA RINANING MEGA 201904004784 24/04/2019 IGD NERIPROS ORAL 1,00 275.935
543 MARIADI 201904001737 08/04/2019 Ruangan Gelatik THD 2 MG 7,00 5.236
TFP 5 MG 14,00
544 MARPUAH 201904003099 15/04/2019 Ruangan THD 2 MG 14,00 23.863
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
201904005770 29/04/2019 Ruangan THD 2 MG 14,00 12.849
CLOZAPINE 25 MG 3,00
RISPERIDONE 2 MG 14,00
545 MARULLI TAMPUBOLON 201904001744 08/04/2019 Ruangan Gelatik TABLET TAMBAH 30,00 16.620
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
545 MARULLI TAMPUBOLON 201904001744 08/04/2019 Ruangan
- Gelatik VIT B COMPLEX 30,00 16.620
FOLIC ACID 1 MG 10,00
201904002948 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
201904003130 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 8,00 7.695
RISPERIDONE 2 MG 15,00
201904003162 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 1,00 1.014
RISPERIDONE 2 MG 2,00
546 MARYATI 201904005257 26/04/2019 Ruangan RISPERIDONE 1 MG 2,00 1.124
THD 2 MG 2,00
VIT B COMPLEX 2,00
201904005766 29/04/2019 Ruangan RISPERIDONE 1 MG 14,00 7.868
THD 2 MG 14,00
VIT B COMPLEX 14,00
547 MAS HAMZAH MUSLIC 201904005932 30/04/2019 Poli VCT ALPRAZOLAM 1 MG 30,00 5.160
548 MAS'ULA NUR FARIKHA 201904005511 29/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 18,00 26.490
RISPERIDONE 3 MG 10,00
KAPSUL NO 2 60,00
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 12,00
RACIKAN KAPSUL 60,00
549 MASDUKI 201904005017 26/04/2019 Ruangan Wijaya CPZ 100 MG 3,00 2.632
HALOPERIDOL 5 MG 10,00
THD 2 MG 6,00
201904005195 26/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 6,00 2.016
THD 2 MG 4,00
CPZ 100 MG 4,00
201904005695 29/04/2019 Ruangan Kenari THD 2 MG 14,00 11.006
HALOPERIDOL 5 MG 21,00
LODOMER 2 MG/ML 1,00
SPUIT 3 CC 1,00
THD 2 MG 14,00
CPZ 100 MG 11,00
201904006072 30/04/2019 Ruangan Kenari CPZ 100 MG 4,00 9.360
DEPAKOTE 250 MG 6,00
550 MASLACHAH 201904003485 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
551 MASRIKIN 201904001491 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 78.270
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
552 MAT 201904001950 09/04/2019 Ruangan Kenari THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
552 MAT 201904001950 09/04/2019 Ruangan
- Kenari TFP 5 MG 14,00 7.210
201904003374 16/04/2019 Ruangan Kenari TFP 5 MG 14,00 76.021
SPUIT 3 CC 1,00
THD 2 MG 14,00
CPZ 100 MG 7,00
SIKZONOATE 1,00
201904004269 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
553 MAT BAKAR 201904005559 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 15.000
HALOPERIDOL 5 MG 60,00
554 MAT MADURA 201904001034 05/04/2019 Ruangan Kenari RISPERIDONE 1 MG 10,00 3.600
201904001935 09/04/2019 Ruangan Kenari RISPERIDONE 2 MG 15,00 7.785
THD 2 MG 15,00
201904003042 15/04/2019 Ruangan Kenari CLOZAPINE 100 MG 7,00 28.091
201904004274 23/04/2019 Ruangan Kenari CLOZAPINE 100 MG 7,00 28.091
555 MATSUNI 201904003717 20/04/2019 IGD THD 2 MG 6,00 3.630
CPZ 100 MG 6,00
TFP 5 MG 6,00
201904003719 20/04/2019 Ruangan Wijaya NA DICLOFENAC 50 10,00 5.510
201904004136 22/04/2019 Ruangan Wijaya THD 2 MG 14,00 8.470
CPZ 100 MG 14,00
TFP 5 MG 14,00
201904006083 30/04/2019 Ruangan Gelatik THD 2 MG 14,00 8.470
CPZ 100 MG 14,00
TFP 5 MG 14,00
556 MAU'IDAH 201904003492 18/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
557 MAVI WIDYA NINGRAT 201904003677 18/04/2019 IGD RISPERIDONE 1 MG 10,00 3.600
558 MAYA NOVITASARI 201904003451 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 854.250
ABILIFY DISCMELT 10 30,00
559 MAYDA DAHARIJJA, 201904003729 21/04/2019 Poli Napza THD 2 MG 15,00 7.670
KAPSUL NO.0 60,00
FOLIC ACID 1 MG 30,00
RACIKAN KAPSUL 60,00
HALOPERIDOL 5 MG 5,00
560 MAZZIKH MUKTAFI 201904000441 01/04/2019 IGD NA DICLOFENAC 50 10,00 26.720
RANITIDIN TAB 150 10,00
OMEPRAZOLE 20 MG 10,00
NORAGES INJEKSI 1,00
SPUIT 3 CC 2,00
RANITIDIN INJEKSI 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
561 MENTIK NUNGKI 201904004273 23/04/2019 Ruangan
- CLOZAPINE 100 MG 7,00 28.091
201904005313 28/04/2019 Ruangan CLOZAPINE 100 MG 7,00 28.091
562 MILA SARI 201904002607 12/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 85.470
SERTRALINE 50 MG 30,00
563 MILDA ANGGRAINI 201904004043 22/04/2019 IGD OMEPRAZOLE 20 MG 10,00 8.950
DEMACOLIN 10,00
DEXAMETASON 0,5 10,00
564 MINARSIH 201904005520 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 103.575
THD 2 MG 30,00
CLOZAPINE 100 MG 15,00
565 MINATUN 201904005258 26/04/2019 Ruangan CLOZAPINE 100 MG 5,00 23.295
TFP 5 MG 10,00
201904005803 29/04/2019 Ruangan CLOZAPINE 100 MG 3,00 23.197
TFP 5 MG 14,00
FOLIC ACID 1 MG 8,00
TABLET TAMBAH 14,00
566 MINHAJUN NIAMY ZADA 201904001239 06/04/2019 IGD LODOMER 2 MG/ML 1,00 37.687
SPUIT 3 CC 1,00
201904003126 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 21.263
TFP 5 MG 15,00
THD 2 MG 15,00
201904003419 16/04/2019 Ruangan Gelatik SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
201904003731 21/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 18.977
TFP 5 MG 14,00
THD 2 MG 14,00
567 MINTO 201904000586 02/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 16.198
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
AMITRIPTILIN 25 MG 14,00
TFP 5 MG 14,00
201904003106 15/04/2019 Ruangan Gelatik THD 2 MG 14,00 15.862
RISPERIDONE 2 MG 14,00
AMITRIPTILIN 25 MG 14,00
TFP 5 MG 14,00
CPZ 100 MG 7,00
568 MIQDAD JUARI EFFENDI 201904004121 22/04/2019 Poli Psikiater SIZORIL 25 MG 120,00 370.680
569 MIS BINTARI 201904005332 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 128.280
RISPERIDONE 3 MG 60,00
TFP 5 MG 90,00
CLOZAPINE 25 MG 30,00
570 MISBACHUL MUNIR 201904003117 15/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
570 MISBACHUL MUNIR 201904003117 15/04/2019 Ruangan
- Gelatik CPZ 100 MG 7,00 9.471
201904003149 15/04/2019 Ruangan Gelatik TFP 5 MG 2,00 748
THD 2 MG 1,00
201904004338 23/04/2019 Ruangan Gelatik TFP 5 MG 21,00 13.611
THD 2 MG 14,00
CPZ 100 MG 30,00
201904005733 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
571 MISBAH HANIF RAHMAT 201904001260 06/04/2019 IGD SERTRALINE 50 MG 2,00 50.299
AMBROXOL 30 MG 10,00
THD 2 MG 2,00
RACIKAN KAPSUL 3,00
SERTRALINE 50 MG 2,00
KAPSUL NO 2 3,00
THD 2 MG 2,00
RACIKAN KAPSUL 3,00
TFP 5 MG 1,00
KAPSUL NO 2 3,00
ABILIFY DISCMELT 15 1,00
572 MISBAHUDIN 201904005738 29/04/2019 Ruangan Kenari RISPERIDONE 1 MG 14,00 5.040
573 MISPAN 201904000618 02/04/2019 IGD CEFIXIME 200 MG 14,00 83.510
CODEIN 20 MG 20,00
AMBROXOL 30 MG 20,00
METHYLPREDNISOL 14,00
574 MOCH ALVAN NI'AM 201904002588 12/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 45,00 21.825
THD 2 MG 30,00
575 MOCH CHASAN 201904000725 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 106.635
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
576 MOCH LUTFI 201904003010 15/04/2019 Ruangan Kenari THD 2 MG 7,00 4.046
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
201904004238 23/04/2019 Ruangan Kenari THD 2 MG 7,00 4.046
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
201904005896 30/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 17.700
THD 2 MG 60,00
CPZ 100 MG 15,00
577 MOCH SYARIF 201904000083 01/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 15.444
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
CLOZAPINE 100 MG 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
577 MOCH SYARIF 201904000083 01/04/2019 Poli Jiwa
- Anak RACIKAN KAPSUL 30,00 15.444
578 MOCH. AHYAN 201904004059 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 126.690
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
KAPSUL NO.00 60,00
TFP 5 MG 60,00
RACIKAN KAPSUL 60,00
579 MOCH. ARIFIN 201904003016 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004291 23/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904004728 24/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
580 MOCH. FADLI 201904000520 02/04/2019 Ruangan Gelatik THD 2 MG 10,00 6.765
CPZ 100 MG 5,00
TFP 5 MG 15,00
201904000921 04/04/2019 Ruangan Gelatik KAPSUL NO 2 10,00 18.950
LORATADIN 10 MG 10,00
KETOKONAZOL 200 10,00
RACIKAN KAPSUL 10,00
KETOKONAZOL 2,00
201904001738 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
201904001982 09/04/2019 Ruangan Gelatik THD 2 MG 4,00 1.880
CPZ 100 MG 1,00
TFP 5 MG 4,00
201904003135 15/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
581 MOCH. FARIET 201904001287 07/04/2019 IGD RINGER LACTAT 1,00 17.462
ONDANSETRON 4 1,00
NORAGES INJEKSI 1,00
RANITIDIN INJEKSI 1,00
201904001292 08/04/2019 IGD NA DICLOFENAC 50 10,00 31.480
CEFIXIME 100 MG 10,00
RANITIDIN TAB 150 10,00
METOCLOPRAMIDE 5 10,00
RINGER LACTAT 1,00
582 MOCH. FONDRA IRAWAN 201904003267 16/04/2019 Poli Psikiater IKALEP 250 MG 30,00 216.225
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
582 MOCH. FONDRA IRAWAN 201904003267 16/04/2019 Poli Psikiater
- CLOZAPINE 100 MG 15,00 216.225
TFP 5 MG 60,00
583 MOCH. MUKLAS 201904005206 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
584 MOCH. MUNIP 201904003044 15/04/2019 Ruangan Kenari THD 2 MG 14,00 16.527
CLOZAPINE 25 MG 7,00
HALOPERIDOL 5 MG 14,00
201904004242 23/04/2019 Ruangan Kenari THD 2 MG 14,00 29.554
CLOZAPINE 25 MG 14,00
HALOPERIDOL 5 MG 14,00
201904004721 24/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 29.554
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
585 MOCH. SAIFULLOH 201904001325 08/04/2019 Ruangan Kenari KAPSUL NO 2 7,00 84.138
THD 2 MG 7,00
SPUIT 3 CC 1,00
RACIKAN KAPSUL 7,00
SIKZONOATE 1,00
CLOZAPINE 25 MG 7,00
TFP 5 MG 4,00
201904003679 18/04/2019 IGD DIPHENHYDRAMINE 2,00 14.610
SPUIT 3 CC 1,00
THD 2 MG 4,00
CLOZAPINE 25 MG 4,00
201904003680 18/04/2019 IGD CLOZAPINE 25 MG 4,00 8.056
THD 2 MG 6,00
586 MOCHAMAD FAISAL 201904002936 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 26.796
201904004168 22/04/2019 Ruangan Napza SERTRALINE 50 MG 5,00 9.570
587 MOCHAMAD ILHAM 201904005220 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 414.480
CLOBAZAM 10 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 60,00
THD 2 MG 60,00
588 MOCHAMAD NASIR 201904002463 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 83.910
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
589 MOCHAMAD SOLEH 201904000923 04/04/2019 Ruangan Gelatik SCABIMITE 10mg 1,00 44.250
LORATADIN 10 MG 5,00
201904001730 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904003169 15/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 10.836
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
589 MOCHAMAD SOLEH 201904003173 15/04/2019 Ruangan
- Gelatik RISPERIDONE 2 MG 2,00 2.899
THD 2 MG 2,00
CLOZAPINE 25 MG 1,00
201904004311 23/04/2019 Ruangan Gelatik SCABIMITE 10mg 2,00 95.316
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904005804 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 10.836
RISPERIDONE 3 MG 14,00
590 MOCHAMAD SUHADAK, 201904003488 18/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 114.480
DEPAKOTE 250 MG 60,00
RISPERIDONE 2 MG 60,00
591 MOCHAMMAD FATCHUR 201904003008 15/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 6.020
THD 2 MG 14,00
CPZ 100 MG 14,00
201904004236 23/04/2019 Ruangan Kenari CPZ 100 MG 14,00 6.020
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
592 MOCHAMMAD RIFA'I 201904000321 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 52.850
CLOZAPINE 25 MG 14,00
201904002168 10/04/2019 Ruangan Napza RAMIPRIL 5 MG 12,00 5.982
SIMVASTATIN 20 MG 5,00
201904002922 15/04/2019 Ruangan Napza RAMIPRIL 5 MG 14,00 71.750
ATORVASTATIN 20 14,00
SERTRALINE 50 MG 14,00
CLOZAPINE 25 MG 14,00
201904003439 17/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 52.850
CLOZAPINE 25 MG 14,00
593 MOCHAMMAD SOLIKHIN 201904004060 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 45,00 108.765
RISPERIDONE 2 MG 60,00
594 MOCHAMMAD YUSUF 201904004105 22/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 18.865
CLOZAPINE 25 MG 7,00
595 MOH HADI IRWANTO 201904006031 30/04/2019 Ruangan Puri THD 2 MG 6,00 34.632
OLANZPINE 10mg 6,00
596 MOH ZAINUDIN HANIF 201904004037 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 103.860
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
597 MOH. ASIPUDIN 201904001246 06/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 18.263
TFP 5 MG 14,00
THD 2 MG 7,00
598 MOH. IDRIS 201904000334 01/04/2019 Ruangan Napza METFORMIN 500 MG 45,00 17.700
SIMVASTATIN 20 MG 15,00
GLIMEPIRIDE 3 MG 15,00
201904000354 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 39.823
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
598 MOH. IDRIS 201904000354 01/04/2019 Ruangan
- Napza CLOZAPINE 25 MG 7,00 39.823
599 MOH. ISWAHYUDI 201904003449 17/04/2019 IGD NA CL 0,9 % 100 ML 1,00 200.870
KASA STERIL ISI 16 1,00
CLOZAPINE 25 MG 4,00
TFP 5 MG 4,00
SPUIT 3 CC 1,00
GENTAMYCIN SALEP 1,00
ZYPREXA INJ 1,00
AQUA PRO INJEKSI 1,00
201904003639 18/04/2019 Ruangan Wijaya TFP 5 MG 8,00 17.472
CLOZAPINE 25 MG 8,00
201904004249 23/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 30.576
TFP 5 MG 14,00
201904005712 29/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 31.290
TFP 5 MG 14,00
THD 2 MG 7,00
600 MOH. MANNAN 201904002641 13/04/2019 Poli Psikiater HALOPERIDOL 5 MG 120,00 1.540.080
THD 2 MG 120,00
KAPSUL NO 3 120,00
ARINIA 15 MG 40,00
RACIKAN KAPSUL 120,00
601 MOH. NUR YASIN 201904001013 04/04/2019 IGD THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
602 MOH. ROIB 201904002494 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 93.450
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
DIAZEPAM 5 MG 15,00
603 MOH. SOLEH 201904006076 30/04/2019 Poli Psikiater CPZ 100 MG 30,00 15.090
TFP 5 MG 30,00
201904006078 30/04/2019 Poli Psikiater TFP 5 MG 30,00 15.090
CPZ 100 MG 30,00
604 MOH. WAHYUDI 201904001027 05/04/2019 Ruangan Kenari BETAMETASON 1,00 5.628
LORATADIN 10 MG 10,00
201904002997 15/04/2019 Ruangan Kenari THD 2 MG 7,00 19.579
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904004292 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 19.579
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
201904004571 23/04/2019 Ruangan Kenari THD 2 MG 14,00 1.428
605 MOH. ZAINAL ABIDIN 201904004073 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
606 MOHAMAD 201904000299 01/04/2019 Puri Mitra
- (Laki- CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904001754 08/04/2019 Puri Mitra (Laki- VIT B COMPLEX 22,00 49.732
CODEIN 20 MG 22,00
OMEPRAZOLE 20 MG 14,00
AMOXYCILLIN 500 22,00
201904001764 08/04/2019 Puri Mitra (Laki- CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904002374 11/04/2019 Poli Psikiater SIKZONOATE 2,00 132.250
607 MOHAMMAD AZIS 201904004538 23/04/2019 Poli Psikiater THD 2 MG 60,00 91.350
RACIKAN KAPSUL 60,00
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 40,00
KAPSUL NO 2 60,00
608 MOHAMMAD FIRMAN 201904005205 26/04/2019 IGD TFP 5 MG 14,00 18.977
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
609 MOHAMMAD KISBIANTO 201904003397 16/04/2019 Ruangan Kenari CPZ 100 MG 4,00 4.890
RISPERIDONE 2 MG 10,00
201904004279 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 6.558
CPZ 100 MG 4,00
201904005688 29/04/2019 IGD LORAZEPAM 2 MG 4,00 13.148
RISPERIDONE 3 MG 14,00
610 MOHAMMAD. ALIM 201904005213 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
611 MOKH SUUD 201904002644 13/04/2019 Poli Jiwa Dewasa THD 2 MG 50,00 5.100
201904003711 20/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 120,00 30.000
THD 2 MG 120,00
612 MOKH WAGITO 201904005165 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 85.215
CLOZAPINE 100 MG 15,00
613 MOKH. ARIF 201904005532 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 75.210
CLOZAPINE 25 MG 30,00
614 MOKH. SHOLEH 201904003783 22/04/2019 Poli Psikiater RISPERIDONE 3 MG 180,00 146.340
THD 2 MG 90,00
CPZ 100 MG 90,00
615 MOKH. SOBI 201904004001 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 153.570
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
616 MOKH. ULUM ISKANDAR 201904005317 28/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 4,00 5.798
THD 2 MG 4,00
CLOZAPINE 25 MG 2,00
201904005654 29/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 14,00 33.320
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
616 MOKH. ULUM ISKANDAR 201904005654 29/04/2019 Ruangan
- Wijaya THD 2 MG 14,00 33.320
CLOZAPINE 25 MG 14,00
617 MOKH.HAMDI 201904005318 29/04/2019 Psiko Geriatri CPZ 100 MG 15,00 15.450
TFP 5 MG 30,00
THD 2 MG 30,00
618 MOKH.KHOIRUL 201904003956 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 172.650
CLOZAPINE 100 MG 30,00
THD 2 MG 30,00
HALOPERIDOL 5 MG 60,00
619 MOKHAMAD TAKHSINUL I 201904004785 24/04/2019 Poli Psikiater TFP 5 MG 80,00 41.200
THD 2 MG 80,00
CPZ 100 MG 40,00
620 MR-X/ ABDULLAH 201904000393 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 4.522
201904001207 05/04/2019 Ruangan Gelatik TFP 5 MG 14,00 4.522
621 MR. X 201904003147 15/04/2019 Ruangan Gelatik CPZ 100 MG 8,00 6.285
TFP 5 MG 15,00
201904003167 15/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 35.462
CLOZAPINE 25 MG 14,00
201904003168 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 6.105
TFP 5 MG 15,00
201904004312 23/04/2019 Ruangan Gelatik CPZ 100 MG 8,00 6.285
TFP 5 MG 15,00
201904005840 29/04/2019 Ruangan Gelatik CPZ 100 MG 8,00 6.285
TFP 5 MG 15,00
622 MR. X (SYAIFUL ARIF) 201904000267 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 13.048
CPZ 100 MG 7,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
623 MR.X/ARIEL 201904005014 25/04/2019 Ruangan Gelatik SCABIMITE 10 GR 1,00 42.240
201904005797 29/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904005799 29/04/2019 Ruangan Gelatik TABLET TAMBAH 14,00 9.396
FOLIC ACID 1 MG 8,00
PYRANTEL 125 MG 8,00
201904006085 30/04/2019 Ruangan Gelatik SCABIMITE 10 GR 2,00 84.480
624 MRS X /RIPKA 201904005612 29/04/2019 Ruangan Wijaya TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
625 MRS.X (TUMINI) 201904002375 11/04/2019 Ruangan Wijaya TFP 5 MG 4,00 2.060
THD 2 MG 4,00
CPZ 100 MG 2,00
201904002619 12/04/2019 Ruangan Wijaya CPZ 100 MG 5,00 5.150
TFP 5 MG 10,00
THD 2 MG 10,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
625 MRS.X (TUMINI) 201904003642 18/04/2019 Ruangan
- Wijaya THD 2 MG 10,00 74.607
CPZ 100 MG 5,00
SIKZONOATE 1,00
TFP 5 MG 12,00
SPUIT 3 CC 1,00
201904004294 23/04/2019 Ruangan TFP 5 MG 17,00 7.411
THD 2 MG 10,00
CPZ 100 MG 5,00
201904004590 23/04/2019 Ruangan RISPERIDONE 2 MG 14,00 5.838
201904005815 29/04/2019 Ruangan THD 2 MG 14,00 15.309
RISPERIDONE 2 MG 14,00
TFP 5 MG 21,00
CPZ 100 MG 7,00
626 MU'IN 201904002241 11/04/2019 Poli Psikiater CLOZAPINE 25 MG 15,00 53.415
TFP 5 MG 60,00
THD 2 MG 60,00
627 MU'IZZAHTUL ROHMAH 201904001547 08/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 7,00 200.032
LORAZEPAM 2 MG 7,00
201904002034 10/04/2019 Ruangan DOXYCICLIN 100 MG 10,00 31.930
GENTAMYCIN SALEP 1,00
KASA STERIL ISI 16 1,00
NA CL 0,9 % 500 ML 2,00
201904003084 15/04/2019 Ruangan LORAZEPAM 2 MG 7,00 278.705
ABILIFY DISCMELT 15 7,00
201904004116 22/04/2019 Ruangan LORAZEPAM 2 MG 7,00 278.705
ABILIFY DISCMELT 15 7,00
201904004278 23/04/2019 Ruangan LORAZEPAM 2 MG 7,00 278.705
ABILIFY DISCMELT 15 7,00
201904005563 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 1.193.175
LORAZEPAM 2 MG 15,00
ABILIFY DISCMELT 15 30,00
TFP 5 MG 30,00
628 MUALIMAH 201904005536 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 121.650
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
629 MUCHAMMAD GUFRON 201904000001 01/04/2019 IGD CLOZAPINE 25 MG 4,00 8.239
PARACETAMOL 500 3,00
201904000914 04/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 13.027
201904001757 08/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 4,00 23.837
RISPERIDONE 2 MG 15,00
THD 2 MG 15,00
630 MUH.AGUS ROFIK 201904003951 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
630 MUH.AGUS ROFIK 201904003951 22/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
631 MUHAMAD HAFIZ 201904000439 01/04/2019 Poli Psikiater DEPAKOTE 250 MG 6,00 33.306
SERTRALINE 50 MG 3,00
CLOZAPINE 25 MG 9,00
KAPSUL NO 2 6,00
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
RACIKAN KAPSUL 6,00
HALOPERIDOL 5 MG 6,00
201904001022 04/04/2019 Poli Psikiater DEPAKOTE 250 MG 6,00 33.342
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 25 MG 9,00
KAPSUL NO.0 6,00
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
RACIKAN KAPSUL 6,00
201904002182 10/04/2019 Poli Psikiater KAPSUL NO.0 6,00 33.342
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
RACIKAN KAPSUL 6,00
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 25 MG 9,00
201904002665 13/04/2019 Poli Psikiater THD 2 MG 6,00 33.342
DIAZEPAM 5 MG 3,00
RACIKAN KAPSUL 6,00
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 25 MG 9,00
KAPSUL NO.0 6,00
201904003702 19/04/2019 Poli Psikiater THD 2 MG 6,00 28.632
DIAZEPAM 5 MG 3,00
RACIKAN KAPSUL 6,00
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 100 MG 3,00
KAPSUL NO.0 6,00
201904004114 22/04/2019 Poli Psikiater THD 2 MG 8,00 38.176
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
631 MUHAMAD HAFIZ 201904004114 22/04/2019 Poli Psikiater
- DIAZEPAM 5 MG 4,00 38.176
RACIKAN KAPSUL 8,00
DEPAKOTE 250 MG 8,00
HALOPERIDOL 5 MG 8,00
SERTRALINE 50 MG 4,00
CLOZAPINE 100 MG 4,00
KAPSUL NO.0 8,00
201904005723 29/04/2019 Poli Psikiater RACIKAN KAPSUL 6,00 28.632
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 100 MG 3,00
KAPSUL NO.0 6,00
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
632 MUHAMMAD CAHYONO 201904001009 04/04/2019 Puri Mitra (Laki- THD 2 MG 4,00 11.188
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 8,00
201904001999 09/04/2019 Puri Mitra (Laki- RISPERIDONE 3 MG 7,00 19.441
KAPSUL NO.00 7,00
THD 2 MG 11,00
RACIKAN KAPSUL 7,00
CLOZAPINE 25 MG 7,00
201904003431 16/04/2019 Puri Mitra (Laki- KAPSUL NO.00 6,00 16.620
THD 2 MG 9,00
RACIKAN KAPSUL 6,00
CLOZAPINE 25 MG 6,00
RISPERIDONE 3 MG 6,00
201904003693 19/04/2019 Puri Mitra (Laki- SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
201904003694 19/04/2019 Puri Mitra (Laki- NERIPROS ORAL 1,00 275.935
633 MUHAMMAD FIO DZIKRI 201904002591 12/04/2019 Poli Jiwa Anak RACIKAN PUYER 60,00 14.502
CLOBAZAM 10 MG 3,00
RISPERIDONE 3 MG 10,00
FOLIC ACID 1 MG 30,00
VIT B6 10 MG 30,00
634 MUHAMMAD IBRHAIM 201904004062 22/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 597.678
KAPSUL NO.00 30,00
RISPERIDONE 2 MG 4,00
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 15,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
634 MUHAMMAD IBRHAIM 201904004062 22/04/2019 Poli Jiwa
- Anak KAPSUL NO.0 30,00 597.678
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 5,00
635 MUHAMMAD 201904000850 04/04/2019 Poli VCT GENTAMYCIN SALEP 2,00 16.100
KETOKONAZOL 200 20,00
636 MUHAMMAD NURFAQIH 201904003152 15/04/2019 IGD DIAZEPAM inj 1,00 12.212
SPUIT 3 CC 1,00
CLOZAPINE 25 MG 4,00
201904003185 15/04/2019 Ruangan Wijaya ASAM MEFENAMAT 10,00 37.322
DEXAMETASON 0,5 10,00
CENDO XITROL E D 1,00
201904003396 16/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 7.444
201904003623 18/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 16.688
RISPERIDONE 1 MG 5,00
201904004567 23/04/2019 Ruangan Gelatik RISPERIDONE 1 MG 14,00 5.040
201904005413 29/04/2019 IGD CLOZAPINE 25 MG 20,00 46.420
RISPERIDONE 1 MG 20,00
VIT B COMPLEX 20,00
637 MUHAMMAD RAFI 201904005167 26/04/2019 Poli Jiwa Anak SERTRALINE 50 MG 3,00 60.771
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 1,00
RACIKAN KAPSUL 30,00
SERTRALINE 50 MG 6,00
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
638 MUHAMMAD SAHLUL 201904004080 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 85.995
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
CLOBAZAM 10 MG 10,00
639 MUHAMMAD WARSO 201904006079 30/04/2019 Poli Psikiater THD 2 MG 15,00 14.040
RISPERIDONE 2 MG 30,00
640 MUIS AFANDI 201904005186 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.580
TFP 5 MG 30,00
THD 2 MG 30,00
641 MUJAYANAH 201904000995 04/04/2019 Ruangan THD 2 MG 10,00 19.630
CLOZAPINE 25 MG 10,00
642 MUKHKIS IMAM 201904001882 09/04/2019 Poli VCT AMLODIPIN 10 30,00 60.960
GLUCOSAMINE 40,00
643 MUKLIS 201904001032 05/04/2019 Ruangan Kenari KETOKONAZOL 1,00 8.870
KETOKONAZOL 200 10,00
201904001969 09/04/2019 Ruangan Kenari THD 2 MG 7,00 11.781
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
643 MUKLIS 201904001969 09/04/2019 Ruangan
- Kenari LORAZEPAM 2 MG 7,00 11.781
TFP 5 MG 14,00
644 MUKODAM 201904002012 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 59.700
TFP 5 MG 60,00
645 MUKROJI/WARJI 201904004215 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
646 MULIAH 201904001564 08/04/2019 Poli Psikiater THD 2 MG 50,00 41.900
CPZ 100 MG 25,00
TFP 5 MG 100,00
647 MULIF 201904002175 10/04/2019 IGD THD 2 MG 6,00 5.919
LORAZEPAM 2 MG 3,00
RISPERIDONE 2 MG 6,00
648 MULYANI 201904000781 04/04/2019 Poli Interna CANDESARTAN 8 MG 30,00 150.946
LEVEMIR FLEX PEN 1,00
GLUCOSAMINE 10,00
NEURODEK 10,00
AMLODIPIN 5 30,00
DULCOLAX 5MG 4,00
649 MULYONO 201904004265 23/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 30.576
TFP 5 MG 14,00
201904005710 29/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 26.054
650 MUNADI 201904001251 06/04/2019 Poli Umum GLIMEPIRIDE 2 MG 100,00 36.000
651 MUNAWAN 201904002660 13/04/2019 Ruangan Kenari THD 2 MG 15,00 229.363
CLOZAPINE 100 MG 7,00
ABILIFY DISCMELT 10 7,00
RISPERIDONE 2 MG 15,00
652 MUNDIK ATUS SHOLIKAH 201904000294 01/04/2019 Puri Mitra THD 2 MG 14,00 33.320
CLOZAPINE 25 MG 14,00
RISPERIDONE 2 MG 14,00
201904001011 04/04/2019 Puri Mitra TFP 5 MG 10,00 3.230
201904001012 04/04/2019 Puri Mitra KETOKONAZOL 200 10,00 8.870
KETOKONAZOL 1,00
201904001766 08/04/2019 Puri Mitra THD 2 MG 14,00 32.004
CLOZAPINE 25 MG 14,00
TFP 5 MG 14,00
201904002361 11/04/2019 Puri Mitra SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
201904002673 14/04/2019 Puri Mitra CLOZAPINE 25 MG 14,00 32.004
TFP 5 MG 14,00
THD 2 MG 14,00
201904004017 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 40.590
TFP 5 MG 90,00
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
653 MUNTIANA 201904000203 01/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
654 MUNTINGAH 201904000427 01/04/2019 Poli Psikiater SERTRALINE 50 MG 15,00 55.065
LORAZEPAM 2 MG 15,00
THD 2 MG 15,00
RISPERIDONE 1 MG 30,00
655 MURIYEH 201904005283 27/04/2019 IGD THD 2 MG 3,00 5.127
LORAZEPAM 2 MG 3,00
RISPERIDONE 3 MG 3,00
201904005773 29/04/2019 Ruangan THD 2 MG 7,00 9.357
LORAZEPAM 2 MG 3,00
RISPERIDONE 2 MG 14,00
656 MURNAJIANTONO 201904003014 15/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 29.617
FRIMANIA 200 MG 14,00
201904004326 23/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 29.617
FRIMANIA 200 MG 14,00
201904004726 24/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 29.617
FRIMANIA 200 MG 14,00
657 MUSAHRI 201904002469 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 63.330
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
658 MUSINI 201904005500 29/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 138.270
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
659 MUSTAGHFIROH 201904005320 29/04/2019 Poli Psikiater CIPRALEX 10 MG 30,00 664.050
CLOBAZAM 10 MG 30,00
LORAZEPAM 2 MG 30,00
660 MUSTOFA 201904003045 15/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 16.450
TFP 5 MG 14,00
CPZ 100 MG 14,00
201904004321 23/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 17.437
CPZ 100 MG 14,00
TFP 5 MG 14,00
DIAZEPAM 5 MG 7,00
201904004323 23/04/2019 Ruangan Kenari CPZ 100 MG 14,00 17.437
TFP 5 MG 14,00
DIAZEPAM 5 MG 7,00
RISPERIDONE 3 MG 14,00
661 MUSTOFA HARIS 201904003936 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 76.500
CARBAMAZEPINE 60,00
FOLIC ACID 1 MG 30,00
662 MUTMAINAH 201904001522 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 1.290.135
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
662 MUTMAINAH 201904001522 08/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 1.290.135
CLOZAPINE 100 MG 15,00
ABILIFY DISCMELT 15 30,00
663 MUTTAQIN 201904001268 07/04/2019 Ruangan Gelatik TFP 5 MG 14,00 34.041
THD 2 MG 14,00
CLOZAPINE 100 MG 7,00
664 NADHIM AHMAD 201904002166 10/04/2019 IGD CPZ 100 MG 2,00 244.866
KASA STERIL ISI 16 3,00
THD 2 MG 4,00
AQUA PRO INJEKSI 1,00
HALOPERIDOL 5 MG 4,00
PLESTERIN ROLL 0,00
CATAFLAM 50 MG 6,00
CEFIXIME 100 MG 6,00
NA CL 0,9 % 500 ML 1,00
SPUIT 3 CC 1,00
ZYPREXA INJ 1,00
201904002970 15/04/2019 Puri Mitra (Laki- HALOPERIDOL 5 MG 15,00 7.530
THD 2 MG 15,00
CPZ 100 MG 21,00
201904003609 18/04/2019 Puri Mitra (Laki- NA DICLOFENAC 50 10,00 5.510
201904004162 22/04/2019 Puri Mitra (Laki- HALOPERIDOL 5 MG 14,00 6.020
THD 2 MG 14,00
CPZ 100 MG 14,00
201904005671 29/04/2019 Puri Mitra (Laki- HALOPERIDOL 5 MG 14,00 4.760
THD 2 MG 14,00
CPZ 100 MG 7,00
201904006060 30/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
665 NADIROH 201904001528 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 157.230
CLOZAPINE 25 MG 30,00
DEPAKOTE 250 MG 60,00
HALOPERIDOL 5 MG 60,00
666 NAJWA ARIMBI 201904002611 12/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 110.109
KAPSUL NO 2 30,00
SERTRALINE 50 MG 3,00
CLOBAZAM 10 MG 15,00
ABILIFY DISCMELT 15 2,00
RACIKAN KAPSUL 30,00
SERTRALINE 50 MG 3,00
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
667 NANANG 201904004210 23/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
668 NANANG AROHMAN 201904001583 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.500
TFP 5 MG 60,00
669 NANANG KRISBIANTORO 201904001964 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.180
CPZ 100 MG 60,00
670 NANANG PRASETYA 201904002604 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
671 NANANG SUGIARDI 201904003939 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 144.390
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
672 NANANG TUA 201904004703 24/04/2019 Ruangan Wijaya CPZ 100 MG 1,00 928
TFP 5 MG 2,00
THD 2 MG 1,00
201904004971 25/04/2019 Ruangan Wijaya CPZ 100 MG 4,00 3.712
TFP 5 MG 8,00
THD 2 MG 4,00
201904005730 29/04/2019 Ruangan Gelatik TFP 5 MG 14,00 6.496
THD 2 MG 7,00
CPZ 100 MG 7,00
673 NAPSIAH 201904005253 26/04/2019 Ruangan CPZ 100 MG 1,00 826
TFP 5 MG 2,00
201904005774 29/04/2019 Ruangan TABLET TAMBAH 14,00 12.418
CPZ 100 MG 7,00
TFP 5 MG 14,00
FOLIC ACID 1 MG 8,00
674 NARSIH 201904000621 02/04/2019 IGD AMITRIPTILIN 25 MG 6,00 7.890
AMOXYCILLIN 500 10,00
ASAM MEFENAMAT 10,00
201904001767 08/04/2019 Puri Mitra VIT B6 10 MG 14,00 10.185
AMITRIPTILIN 25 MG 14,00
LORAZEPAM 2 MG 7,00
201904002984 15/04/2019 Puri Mitra VIT B COMPLEX 14,00 10.759
AMITRIPTILIN 25 MG 14,00
LORAZEPAM 2 MG 7,00
201904004163 22/04/2019 Puri Mitra AMITRIPTILIN 25 MG 14,00 10.759
LORAZEPAM 2 MG 7,00
VIT B COMPLEX 14,00
675 NAUFAL AYUM MA'ARIF 201904002595 12/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 2,00 61.719
MERSITROPIL 1,00
FOLIC ACID 1 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
675 NAUFAL AYUM MA'ARIF 201904002595 12/04/2019 Poli Jiwa
- Anak VIT B12 50 MG 15,00 61.719
RACIKAN PUYER 30,00
VIT B6 10 MG 15,00
676 NAZMI ALLAMIK 201904003992 22/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 120.045
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 15 3,00
RACIKAN KAPSUL 30,00
677 NELI 201904001003 04/04/2019 Ruangan CLOZAPINE 25 MG 7,00 19.282
RISPERIDONE 2 MG 15,00
201904001867 09/04/2019 Ruangan METFORMIN 500 MG 10,00 10.500
TABLET TAMBAH 20,00
201904003101 15/04/2019 Ruangan CLOZAPINE 100 MG 4,00 21.890
RISPERIDONE 2 MG 14,00
201904004261 23/04/2019 Ruangan RISPERIDONE 2 MG 13,00 17.460
CLOZAPINE 100 MG 3,00
678 NENENG 201904005785 29/04/2019 Ruangan TFP 5 MG 16,00 5.984
THD 2 MG 8,00
201904006050 30/04/2019 Ruangan BETAMETASON 1,00 1.608
679 NGATIMEN 201904001035 05/04/2019 Ruangan Kenari CLOZAPINE 100 MG 3,00 12.039
201904001209 05/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 35.876
CLOZAPINE 100 MG 7,00
RISPERIDONE 2 MG 15,00
680 NIDA ZULFA FIRDIANA 201904005291 27/04/2019 IGD CLOZAPINE 25 MG 2,00 199.127
ASAM VALPROAT 1,00
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 6,00
ZYPREXA INJ 1,00
AQUA PRO INJEKSI 1,00
THD 2 MG 2,00
681 NINIK KUSYANTI 201904000903 04/04/2019 Ruangan Wijaya CLOZAPINE 100 MG 4,00 20.897
TFP 5 MG 15,00
201904003069 15/04/2019 Ruangan CLOZAPINE 100 MG 4,00 20.574
TFP 5 MG 14,00
201904004235 23/04/2019 Ruangan CLOZAPINE 100 MG 3,00 16.561
TFP 5 MG 14,00
682 NITA MEGAWATI 201904004033 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
683 NOPIAN AINUL ROFIK 201904005595 29/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 15,00 85.050
684 NORHAYATI 201904000103 01/04/2019 Poli Psikiater CIPRALEX 10 MG 11,00 220.396
685 NORI PURWANTO 201904001915 09/04/2019 Ruangan Wijaya CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
685 NORI PURWANTO 201904003388 16/04/2019 Ruangan
- Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904004328 23/04/2019 Ruangan Kenari BETAMETASON 2,00 11.812
TFP 5 MG 14,00
CPZ 100 MG 7,00
LORATADIN 10 MG 7,00
686 NOVAL DICKY IRAWAN 201904001570 08/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 36.135
VIT B12 50 MG 15,00
KAPSUL NO 3 30,00
METHYLPHENIDATE 23,00
RACIKAN KAPSUL 30,00
687 NUNUK/NUNUNG 201904001001 04/04/2019 Ruangan RISPERIDONE 1 MG 15,00 5.400
201904001005 04/04/2019 Ruangan SPUIT 3 CC 1,00 14.948
PHENYTOIN CAP 100 20,00
DIAZEPAM inj 1,00
201904001661 08/04/2019 Ruangan RISPERIDONE 1 MG 15,00 18.427
CLOZAPINE 25 MG 7,00
201904002379 12/04/2019 Ruangan PHENYTOIN CAP 100 14,00 7.126
201904003090 15/04/2019 Ruangan CLOZAPINE 25 MG 7,00 26.825
PHENYTOIN CAP 100 14,00
RISPERIDONE 2 MG 16,00
688 NUNUK/ROMSINA 201904005758 29/04/2019 Ruangan THD 2 MG 14,00 67.266
CIPROFLOXACIN 500 14,00
RISPERIDONE 3 MG 14,00
PROBENID 500 MG 10,00
CLOZAPINE 100 MG 6,00
SIMVASTATIN 20 MG 10,00
HALOPERIDOL 5 MG 14,00
689 NUR AFITRI 201904004464 23/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 20,00 51.750
DEPAKOTE ER 250 10,00
CLOBAZAM 10 MG 10,00
RISPERIDONE 2 MG 10,00
KAPSUL NO 2 20,00
THD 2 MG 10,00
690 NUR AIDA ENI HERMANI 201904002008 10/04/2019 Poli Psikiater SIZORIL 25 MG 70,00 216.230
691 NUR CAHYONO 201904002658 13/04/2019 IGD THD 2 MG 4,00 7.283
CLOZAPINE 25 MG 3,00
TFP 5 MG 4,00
201904002972 15/04/2019 Puri Mitra (Laki- TFP 5 MG 15,00 26.846
THD 2 MG 15,00
CLOZAPINE 25 MG 11,00
201904004164 22/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 26.421
CLOZAPINE 25 MG 11,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
691 NUR CAHYONO 201904004164 22/04/2019 Puri Mitra
- (Laki- TFP 5 MG 14,00 26.421
201904005670 29/04/2019 Puri Mitra (Laki- TFP 5 MG 14,00 18.977
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
692 NUR HADI 201904004209 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.540
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
693 NUR HAYATI 201904000194 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 17.340
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
694 NUR WIYANTO 201904003500 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
695 NURBI / NURWI 201904004214 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
696 NURENI 201904000873 04/04/2019 Poli Jiwa Anak THD 2 MG 15,00 18.155
LORAZEPAM 2 MG 7,00
RISPERIDONE 3 MG 15,00
697 NURFA 201904004595 23/04/2019 IGD DEXAMETASON 0,5 10,00 5.160
LORATADIN 10 MG 5,00
ASAM MEFENAMAT 10,00
698 NURHAYATI 201904000631 02/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 6,00 13.668
CLOZAPINE 25 MG 6,00
201904001763 08/04/2019 Puri Mitra VIT B6 10 MG 14,00 19.691
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904002975 15/04/2019 Puri Mitra VIT B6 10 MG 14,00 19.691
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904003491 18/04/2019 Puri Mitra VIT B6 10 MG 14,00 19.691
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904004790 24/04/2019 IGD THD 2 MG 10,00 13.555
CLOZAPINE 25 MG 5,00
TFP 5 MG 10,00
201904005254 26/04/2019 Ruangan TFP 5 MG 2,00 2.711
THD 2 MG 2,00
CLOZAPINE 25 MG 1,00
201904005777 29/04/2019 Ruangan THD 2 MG 14,00 18.977
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
699 NURIS NUR AFIYAH 201904001653 08/04/2019 Ruangan CLOZAPINE 25 MG 7,00 24.101
THD 2 MG 7,00
RISPERIDONE 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
699 NURIS NUR AFIYAH 201904001653 08/04/2019 Ruangan
- TFP 5 MG 14,00 24.101
700 NURUL 201904005752 29/04/2019 Ruangan TFP 5 MG 14,00 11.900
THD 2 MG 14,00
CIPROFLOXACIN 500 14,00
701 NURUL KOMARIYAH 201904002631 12/04/2019 Ruangan RISPERIDONE 3 MG 4,00 10.132
CLOZAPINE 25 MG 4,00
201904003091 15/04/2019 Ruangan THD 2 MG 14,00 38.751
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 14,00
201904005209 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 55.920
CPZ 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
702 NURUL UMI 201904003960 22/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 443.025
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
CLOZAPINE 100 MG 45,00
703 NURWANTO ARIWIBOWO 201904002687 14/04/2019 IGD SPUIT 3 CC 2,00 14.573
DIPHENHYDRAMINE 1,00
NORAGES INJEKSI 1,00
704 OEY WEE LIANG 201904001726 08/04/2019 Ruangan Puri DIAMICRON MR 60 10,00 42.810
GLIMEPIRIDE 3 MG 10,00
METFORMIN 500 MG 20,00
201904002365 11/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 23.318
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
201904003024 15/04/2019 Ruangan Puri METFORMIN 500 MG 20,00 43.110
DIAMICRON MR 60 10,00
GLIMEPIRIDE 4 MG 10,00
201904003025 15/04/2019 Ruangan Puri DIAMICRON MR 60 2,00 8.478
GLIMEPIRIDE 4 MG 4,00
201904003438 17/04/2019 Ruangan Puri THD 2 MG 8,00 12.595
CLOZAPINE 100 MG 2,00
RISPERIDONE 2 MG 9,00
705 OKI SUHERMAN YANTO 201904001208 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 15,00 39.701
THD 2 MG 15,00
CLOZAPINE 100 MG 7,00
706 OLIVIA TRISETIANI 201904001680 08/04/2019 Ruangan RISPERIDONE 2 MG 15,00 23.837
THD 2 MG 15,00
CLOZAPINE 100 MG 4,00
201904002837 15/04/2019 Ruangan CLOZAPINE 100 MG 2,00 8.026
201904003078 15/04/2019 Ruangan THD 2 MG 14,00 35.357
CLOZAPINE 100 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
706 OLIVIA TRISETIANI 201904003078 15/04/2019 Ruangan
- RISPERIDONE 2 MG 14,00 35.357
201904004002 22/04/2019 Ruangan THD 2 MG 15,00 146.440
CLOZAPINE 100 MG 7,00
ABILIFY DISCMELT 10 4,00
RISPERIDONE 2 MG 15,00
201904004276 23/04/2019 Ruangan ABILIFY DISCMELT 10 4,00 146.440
RISPERIDONE 2 MG 15,00
THD 2 MG 15,00
CLOZAPINE 100 MG 7,00
201904005522 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 82.440
RISPERIDONE 2 MG 60,00
707 ONG YOHANES 201904002649 13/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 118.350
SERTRALINE 50 MG 30,00
ATIVAN 1 MG 5,00
708 OSEN 201904006034 30/04/2019 Ruangan Wijaya RACIKAN KAPSUL 12,00 18.786
CLOZAPINE 25 MG 6,00
THD 2 MG 6,00
KAPSUL NO.00 12,00
TFP 5 MG 6,00
FOLIC ACID 1 MG 6,00
THD 2 MG 6,00
RACIKAN KAPSUL 12,00
TFP 5 MG 6,00
KAPSUL NO.00 12,00
709 PAIJO 201904005589 29/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
710 PAIKIN 201904001205 05/04/2019 Ruangan Gelatik CPZ 100 MG 14,00 7.042
TFP 5 MG 14,00
711 PAIRIN 201904005189 26/04/2019 Psiko Geriatri ABILIFY DISCMELT 10 30,00 886.650
SERTRALINE 50 MG 30,00
712 PANDU RAHARTO 201904002150 10/04/2019 Poli Jiwa Anak REMITAL 10 MG 15,00 242.055
THD 2 MG 15,00
713 PANJI SAPUTRA 201904005298 27/04/2019 IGD CLOZAPINE 25 MG 3,00 10.145
LODOMER 2 MG/ML 1,00
HALOPERIDOL 5 MG 6,00
SPUIT 3 CC 1,00
THD 2 MG 6,00
201904005619 29/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 6,00 18.494
LODOMER 2 MG/ML 2,00
HALOPERIDOL 5 MG 4,00
SPUIT 3 CC 2,00
THD 2 MG 6,00
714 PARJO 201904002320 11/04/2019 Psiko Geriatri THD 2 MG 60,00 97.928
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
714 PARJO 201904002320 11/04/2019 Psiko Geriatri
- SPUIT 3 CC 1,00 97.928
OLANZPINE 10mg 15,00
DIPHENHYDRAMINE 2,00
715 PAULUS ROBIN 201904001273 07/04/2019 Puri Mitra (Laki- SPUIT 3 CC 1,00 169.974
RISPERIDONE 3 MG 4,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
NEEDLE 23 G 1,00
CPZ 100 MG 4,00
201904001762 08/04/2019 Puri Mitra (Laki- CPZ 100 MG 14,00 11.928
RISPERIDONE 3 MG 14,00
201904002982 15/04/2019 Puri Mitra (Laki- CPZ 100 MG 14,00 11.928
RISPERIDONE 3 MG 14,00
201904003611 18/04/2019 Puri Mitra (Laki- KETOKONAZOL 1,00 5.640
201904004038 22/04/2019 Puri Mitra (Laki- CPZ 100 MG 14,00 11.928
RISPERIDONE 3 MG 14,00
716 PENI MAYANG SARI 201904005174 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
717 PETER 201904000915 04/04/2019 Ruangan Gelatik PYRANTEL 125 MG 8,00 13.280
TABLET TAMBAH 20,00
VIT B COMPLEX 20,00
201904001719 08/04/2019 Ruangan Gelatik ASAM MEFENAMAT 10,00 15.156
PEHACHAIN INJ 2,00
AMOXYCILLIN 500 15,00
201904004041 22/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 15,00 6.450
THD 2 MG 15,00
CPZ 100 MG 15,00
201904004766 24/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
718 PETER KUSNO 201904005184 26/04/2019 Poli Jiwa Dewasa PROPANOLOL 10 MG 60,00 1.379.610
CLONAZEPAM 2 MG 15,00
ABILIFY DISCMELT 15 30,00
CLOZAPINE 100 MG 30,00
719 PETRONELLA OKTORINI 201904004178 22/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 4,00 2.028
CPZ 100 MG 2,00
720 PINTO LEGOWO 201904004477 23/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 73.924
VIT B6 10 MG 30,00
FOLIC ACID 1 MG 12,00
RISPERIDONE 3 MG 15,00
ELIZAC 20 MG 20,00
KAPSUL NO 2 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
720 PINTO LEGOWO 201904004477 23/04/2019 Poli Jiwa
- Anak THD 2 MG 23,00 73.924
CLOBAZAM 10 MG 15,00
721 PIPIT RIYANI 201904001076 05/04/2019 Ruangan CLOZAPINE 25 MG 7,00 19.402
TFP 5 MG 15,00
THD 2 MG 15,00
722 POERJADI 201904004012 22/04/2019 Poli Interna METRONIDAZOLE 10,00 484.710
LANSOPRAZOLE 10,00
CONCOR 2,5 MG 30,00
Coralan 5 mg Tablet 30,00
LISINOPRIL 10 MG 30,00
HARNAL OCAS 30,00
DOMPERIDONE 10,00
723 PONTJO MARTO 201904003535 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 45,00 51.270
THD 2 MG 45,00
CLOZAPINE 25 MG 15,00
724 PRAMONO 201904003000 15/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904004302 23/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
725 PRANUDIAN 201904003444 17/04/2019 IGD CLOZAPINE 25 MG 3,00 10.227
RISPERIDONE 3 MG 6,00
THD 2 MG 6,00
201904003645 18/04/2019 Ruangan Puri CLOZAPINE 25 MG 7,00 23.863
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904005263 26/04/2019 Ruangan Puri CLOZAPINE 25 MG 15,00 51.135
RISPERIDONE 3 MG 30,00
THD 2 MG 30,00
201904005663 29/04/2019 Ruangan Puri CLOZAPINE 25 MG 10,00 34.090
RISPERIDONE 3 MG 20,00
THD 2 MG 20,00
726 PRASTIONO 201904003958 22/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 90,00 171.390
DEPAKOTE ER 250 30,00
CLOZAPINE 25 MG 30,00
727 PRIHARYATI 201904003481 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 106.635
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
728 PRIYO UTOMO 201904005306 28/04/2019 Ruangan Wijaya ZYPREXA INJ 1,00 175.710
SPUIT 3 CC 1,00
TFP 5 MG 4,00
AQUA PRO INJEKSI 1,00
THD 2 MG 4,00
NEEDLE 23 G 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
728 PRIYO UTOMO 201904005306 28/04/2019 Ruangan
- Wijaya CLOZAPINE 25 MG 4,00 175.710
201904005744 29/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 32.004
TFP 5 MG 14,00
THD 2 MG 14,00
729 PUGUH SUMARTONO 201904002848 15/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 6.255
201904005691 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 6.255
201904005736 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 5.838
730 PUPUT 201904000180 01/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
731 PURBOWATI 201904000763 04/04/2019 Psiko Geriatri RISPERIDONE 2 MG 30,00 12.510
732 PURWATI 201904000610 02/04/2019 Ruangan Puri THD 2 MG 14,00 32.004
CLOZAPINE 25 MG 14,00
TFP 5 MG 14,00
201904001708 08/04/2019 Ruangan Puri SPUIT 3 CC 1,00 87.074
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
SIKZONOATE 1,00
TFP 5 MG 14,00
201904003026 15/04/2019 Ruangan Puri THD 2 MG 4,00 7.852
CLOZAPINE 25 MG 4,00
201904004117 22/04/2019 Ruangan Puri THD 2 MG 7,00 32.305
RACIKAN KAPSUL 7,00
TFP 5 MG 7,00
KAPSUL NO.0 7,00
RACIKAN KAPSUL 7,00
TFP 5 MG 7,00
KAPSUL NO.1 7,00
SERTRALINE 50 MG 7,00
CLOZAPINE 25 MG 7,00
733 QUITO HAMDAWAN 201904004069 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
734 R BAGUS DP 201904005121 26/04/2019 Poli VCT ALPRAZOLAM 1 MG 30,00 5.160
735 R.DWI AGUNG 201904004191 22/04/2019 IGD CLOZAPINE 25 MG 2,00 5.390
RISPERIDONE 2 MG 4,00
201904004577 23/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 19.282
RISPERIDONE 2 MG 15,00
201904005825 29/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
736 RACHMAT HIDAYAT 201904004067 22/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 253.230
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
737 RADEN ARTO MORO 201904005171 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 74.355
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
737 RADEN ARTO MORO 201904005171 26/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 74.355
CLOZAPINE 25 MG 15,00
738 RAFAN HANIF FERNANDI 201904001085 05/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 12,00 175.983
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 10 6,00
CLOBAZAM 10 MG 6,00
RACIKAN KAPSUL 30,00
739 RAHADIAN ARIF Y. 201904000068 01/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 18.717
SERTRALINE 50 MG 8,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
740 RAHMAD HATI 201904003013 15/04/2019 Ruangan Kenari THD 2 MG 14,00 20.608
SERTRALINE 50 MG 7,00
TFP 5 MG 14,00
CPZ 100 MG 7,00
201904004358 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 20.608
CPZ 100 MG 7,00
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
201904004730 24/04/2019 Ruangan Kenari TFP 5 MG 14,00 20.608
CPZ 100 MG 7,00
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
741 RAHMAD JAMIK 201904001250 06/04/2019 Poli Psikiater THD 2 MG 150,00 20.700
CPZ 100 MG 30,00
742 RAHMAD NUR HIDAYAT 201904000350 01/04/2019 Poli Psikiater THD 2 MG 120,00 51.600
CPZ 100 MG 120,00
HALOPERIDOL 5 MG 120,00
743 RAHMAD SULAIMAN 201904001402 08/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 105.420
TFP 5 MG 30,00
THD 2 MG 30,00
744 RAHMAT ELLIYANTO 201904003141 15/04/2019 Ruangan Gelatik TFP 5 MG 14,00 4.522
201904004349 23/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904005015 25/04/2019 Ruangan Gelatik HIDROKORTISON 1,00 9.760
KETOKONAZOL 1,00
POT PLASTIK 50 CC 1,00
201904005805 29/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
745 RAHMAT HIDAYAT 201904000641 03/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 6,00 13.668
RISPERIDONE 2 MG 6,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
745 RAHMAT HIDAYAT 201904000986 04/04/2019 Ruangan
- Wijaya CLOZAPINE 25 MG 4,00 30.124
OLANZPINE 10mg 4,00
201904000987 04/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 30.124
OLANZPINE 10mg 4,00
201904003105 15/04/2019 Ruangan Gelatik OLANZPINE 10mg 8,00 60.248
CLOZAPINE 25 MG 8,00
201904004000 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 52.717
OLANZPINE 10mg 7,00
201904004344 23/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 52.717
OLANZPINE 10mg 7,00
746 RANDY HERMAWAN 201904000667 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 258.031
CLOZAPINE 25 MG 60,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
HALDOL DECANOAS 1,00
CARBAMAZEPINE 60,00
747 RANDY IRAWAN 201904002192 10/04/2019 Poli Psikiater RISPERIDONE 3 MG 30,00 51.135
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
748 RASYA ABID A. 201904003484 18/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 2,00 80.142
VIT B12 50 MG 8,00
FOLIC ACID 1 MG 12,00
VIT B6 10 MG 10,00
RACIKAN PUYER 30,00
201904005925 30/04/2019 Poli Jiwa Anak RIZODAL 2 MG 3,00 8.944
VIT B12 50 MG 13,00
FOLIC ACID 1 MG 20,00
VIT B6 10 MG 13,00
RACIKAN PUYER 50,00
749 RATIH APSYARI 201904004076 22/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 245.372
RACIKAN KAPSUL 60,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 12,00
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
SPUIT 3 CC 1,00
750 RATIH SUSANTI KUSUMA 201904001492 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 212.190
FRIMANIA 400 MG 60,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
751 RAVA FIREZHA GANI 201904002603 12/04/2019 Poli Jiwa Anak SERTRALINE 50 MG 6,00 222.645
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
751 RAVA FIREZHA GANI 201904002603 12/04/2019 Poli Jiwa
- Anak KAPSUL NO 3 30,00 222.645
VIT B6 10 MG 15,00
METHYLPHENIDATE 30,00
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 10 6,00
FOLIC ACID 1 MG 15,00
752 REDITA APRILINI 201904002637 12/04/2019 Poli Psikiater NOPRES 20 MG 30,00 29.520
753 REFVI YULIANTO 201904002592 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 45,00 108.765
RISPERIDONE 2 MG 60,00
754 REKAMANA 201904000406 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904000626 02/04/2019 Ruangan Gelatik TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
755 RENDA STARY ANJANI 201904000055 01/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 2,00 9.082
DIAZEPAM inj 1,00
HALOPERIDOL 5 MG 4,00
SPUIT 3 CC 1,00
201904000984 04/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 14.710
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904003066 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904003695 19/04/2019 Ruangan RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
756 RENDI SETIAWAN 201904003987 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.995
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
757 RENDRA MOCH AZKA 201904002057 10/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 79.905
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 2,00
RACIKAN PUYER 30,00
758 RESA MAHENDRA 201904003708 20/04/2019 IGD ZYPREXA INJ 1,00 180.282
SPUIT 3 CC 1,00
TFP 5 MG 6,00
AQUA PRO INJEKSI 1,00
THD 2 MG 6,00
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 6,00
201904004309 23/04/2019 Ruangan Kenari SIZORIL 25 MG 14,00 43.246
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
758 RESA MAHENDRA 201904005708 29/04/2019 Ruangan
- Kenari TFP 5 MG 14,00 30.576
CLOZAPINE 25 MG 14,00
759 RETNO WULANDARI 201904003944 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
760 RETNOWATI 201904003495 18/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
201904003736 21/04/2019 IGD CLOZAPINE 100 MG 2,00 15.100
THD 2 MG 4,00
RISPERIDONE 3 MG 4,00
SPUIT 3 CC 1,00
TFP 5 MG 4,00
201904004306 23/04/2019 Ruangan TFP 5 MG 14,00 31.410
CLOZAPINE 100 MG 4,00
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
201904005808 29/04/2019 Ruangan RISPERIDONE 3 MG 14,00 23.384
TFP 5 MG 14,00
CLOZAPINE 100 MG 2,00
THD 2 MG 14,00
761 RIAMAH 201904006048 30/04/2019 Ruangan Wijaya THD 2 MG 14,00 33.320
CLOZAPINE 25 MG 14,00
RISPERIDONE 2 MG 14,00
762 RIANY RIKO 201904003668 18/04/2019 IGD MASKER OKSIGEN 1,00 24.520
ALPRAZOLAM 1 MG 10,00
201904003671 18/04/2019 IGD DIPHENHYDRAMINE 1,00 11.887
NORAGES INJEKSI 1,00
SPUIT 3 CC 1,00
201904003672 18/04/2019 IGD DIPHENHYDRAMINE 1,00 4.722
SPUIT 3 CC 1,00
201904003673 18/04/2019 IGD RINGER LACTAT 2,00 33.858
INFUS SET DEWASA 1,00
IV CANULLA NO.24 1,00
201904003674 18/04/2019 Ruangan Puri NA CL 0,9 % 500 ML 4,00 25.640
201904003676 18/04/2019 Ruangan Puri CLOBAZAM 10 MG 10,00 37.690
THD 2 MG 5,00
CLOZAPINE 25 MG 10,00
CARBAMAZEPINE 10,00
RISPERIDONE 2 MG 10,00
201904003690 19/04/2019 Ruangan Puri PARACETAMOL 500 6,00 3.126
ALPRAZOLAM 1 MG 6,00
RACIKAN KAPSUL 6,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
762 RIANY RIKO 201904003690 19/04/2019 Ruangan
- Puri KAPSUL NO.00 6,00 3.126
763 RICHARD RAY 201904004864 25/04/2019 Poli Jiwa Anak KAPSUL NO 2 30,00 257.125
CLOBAZAM 10 MG 2,00
SERTRALINE 50 MG 1,00
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 4,00
RACIKAN KAPSUL 10,00
CLOBAZAM 10 MG 6,00
SERTRALINE 50 MG 6,00
KAPSUL NO 2 10,00
ARINIA 15 MG 2,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 5,00
VIT B6 10 MG 5,00
764 RICKY ARDHANI 201904003756 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 45,00 124.065
RISPERIDONE 3 MG 60,00
765 RICKY ARFANI 201904005494 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 45,00 96.495
TFP 5 MG 30,00
THD 2 MG 30,00
766 RICKY JONY FAISOL 201904000327 01/04/2019 Ruangan Napza NUZIP 25 14,00 60.522
RISPERIDONE 2 MG 28,00
SERTRALINE 50 MG 14,00
767 RICO FIRMANSYAH 201904000266 01/04/2019 Ruangan Wijaya THD 2 MG 8,00 2.720
CPZ 100 MG 4,00
HALOPERIDOL 5 MG 8,00
201904000376 01/04/2019 Ruangan Wijaya SPUIT 3 CC 2,00 11.934
DIPHENHYDRAMINE 2,00
DIAZEPAM inj 1,00
THD 2 MG 4,00
201904001739 08/04/2019 Ruangan Gelatik LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
201904001977 09/04/2019 Ruangan Gelatik THD 2 MG 6,00 2.040
CPZ 100 MG 3,00
HALOPERIDOL 5 MG 6,00
201904002662 13/04/2019 Ruangan Gelatik THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
201904003965 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
768 RIDUAN 201904002932 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 45,00 376.185
OLANZPINE 10mg 30,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
768 RIDUAN 201904002932 15/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 376.185
769 RIDWAN ARIFANDI 201904001026 05/04/2019 Ruangan Kenari KETOKONAZOL 200 10,00 8.870
KETOKONAZOL 1,00
770 RIFAI 201904001968 09/04/2019 Ruangan Kenari CPZ 100 MG 4,00 6.670
TFP 5 MG 14,00
THD 2 MG 14,00
201904002609 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 121.650
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
771 RIFAN DWI RIFAI 201904004050 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
CPZ 100 MG 30,00
772 RIFAN HAFIFI 201904006043 30/04/2019 Ruangan Wijaya INFUS SET DEWASA 1,00 147.088
CIPROFLOXACIN 500 10,00
NORAGES INJEKSI 6,00
IV CANULLA NO.20 2,00
PARACETAMOL 500 10,00
DERMAFIX -S UK 1,00
SPUIT 3 CC 7,00
RINGER LACTAT 7,00
773 RIMONA 201904003732 21/04/2019 IGD CLOZAPINE 25 MG 6,00 13.104
TFP 5 MG 6,00
774 RINA 201904004984 25/04/2019 Ruangan SCABIMITE 10 GR 1,00 42.240
201904005787 29/04/2019 Ruangan CPZ 100 MG 4,00 6.558
RISPERIDONE 2 MG 14,00
201904006054 30/04/2019 Ruangan ASAM MEFENAMAT 6,00 3.084
THD 2 MG 14,00
775 RINA GABRELA 201904000632 02/04/2019 IGD RISPERIDONE 3 MG 6,00 15.357
SERTRALINE 50 MG 3,00
CLOZAPINE 25 MG 3,00
201904000973 04/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 4,00 6.410
CLOZAPINE 25 MG 2,00
201904001015 04/04/2019 Ruangan Wijaya IV CANULA NO. 18 1,00 141.864
SPUIT 3 CC 3,00
IV CANULLA NO.20 2,00
RINGER LACTAT 8,00
INFUS SET DEWASA 3,00
SPUIT 5 CC 3,00
PROBENID 500 MG 10,00
201904002622 12/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 2,00 168.836
SPUIT 3 CC 1,00
ZYPREXA INJ 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
775 RINA GABRELA 201904002622 12/04/2019 Ruangan
- Wijaya AQUA PRO INJEKSI 1,00 168.836
201904002950 15/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 14,00 53.735
DEPAKOTE ER 250 7,00
CLOZAPINE 25 MG 11,00
201904003387 16/04/2019 Ruangan Wijaya TFP 5 MG 6,00 6.272
THD 2 MG 6,00
CLOZAPINE 25 MG 2,00
201904003638 18/04/2019 Ruangan Wijaya TFP 5 MG 4,00 1.700
THD 2 MG 4,00
201904004303 23/04/2019 Ruangan TFP 5 MG 16,00 36.576
THD 2 MG 16,00
CLOZAPINE 25 MG 16,00
201904004596 23/04/2019 Ruangan PROBENID 500 MG 10,00 21.870
201904005516 29/04/2019 Ruangan SIKZONOATE 1,00 100.815
TFP 5 MG 14,00
SPUIT 3 CC 1,00
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
776 RINAL SUBIANTORO 201904003967 22/04/2019 Poli Jiwa Dewasa CLONAZEPAM 2 MG 30,00 546.000
DEPAKOTE 250 MG 60,00
CLOZAPINE 25 MG 60,00
OLANZPINE 10mg 30,00
777 RINI HERMIYATI / 201904001000 04/04/2019 Ruangan DEMACOLIN 9,00 3.708
201904003087 15/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
778 RIONO 201904000911 04/04/2019 Ruangan Gelatik BETAMETASON 3,00 4.824
201904003109 15/04/2019 Ruangan Gelatik TFP 5 MG 14,00 18.977
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904003157 15/04/2019 Ruangan Gelatik TFP 5 MG 9,00 3.111
THD 2 MG 2,00
201904004325 23/04/2019 Ruangan Gelatik THD 2 MG 14,00 13.394
CLOZAPINE 25 MG 4,00
TFP 5 MG 14,00
779 RISKI DEMAH SASMITA 201904002529 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
780 RISTIONO ADI 201904001499 08/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 833.270
SEROQUEL XR 300 30,00
GABAPENTIN 300 MG 10,00
SERTRALINE 50 MG 30,00
KAPSUL NO.0 30,00
DEPAKOTE ER 500 30,00
ALPRAZOLAM 1 MG 30,00
781 RITA HAMIMA 201904005781 29/04/2019 Ruangan CLOZAPINE 25 MG 14,00 26.054
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
782 RIZA ALFIAN 201904006088 30/04/2019 Ruangan
- Wijaya THD 2 MG 12,00 30.494
CLOZAPINE 25 MG 12,00
LODOMER 2 MG/ML 1,00
TFP 5 MG 12,00
SPUIT 3 CC 1,00
783 RIZKI LAILI ULFA 201904000221 01/04/2019 Poli Syaraf RISPERIDONE 2 MG 30,00 69.930
KUTOIN 90,00
784 RIZKY FAUZIA 201904001513 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 33.840
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
785 RIZKY PERDANA PUTRA 201904001998 09/04/2019 Ruangan Napza CLOZAPINE 25 MG 14,00 44.870
RISPERIDONE 3 MG 28,00
201904004150 22/04/2019 Ruangan Napza CATAFLAM 50 MG 10,00 70.920
201904004151 22/04/2019 Ruangan Napza RISPERIDONE 3 MG 26,00 39.804
CLOZAPINE 25 MG 12,00
786 RIZQI ARDENI 201904001694 08/04/2019 Ruangan Puri FOLIC ACID 1 MG 14,00 5.698
TFP 5 MG 14,00
201904002809 15/04/2019 Poli Psikiater TFP 5 MG 14,00 5.698
FOLIC ACID 1 MG 14,00
787 ROCHMAN PRIYANTO 201904002467 12/04/2019 Poli Jiwa Dewasa PHENYTOIN CAP 100 90,00 106.080
CLOZAPINE 25 MG 30,00
HALOPERIDOL 1,5 60,00
788 RODANU 201904005581 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 15,00 7.785
THD 2 MG 15,00
201904006069 30/04/2019 Ruangan Kenari BETAMETASON 2,00 3.216
789 ROFIQ 201904003945 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 106.635
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
790 ROHAINI 201904003131 15/04/2019 IGD RISPERIDONE 2 MG 6,00 2.502
201904003376 16/04/2019 Ruangan THD 2 MG 15,00 20.812
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 15,00
201904004271 23/04/2019 Ruangan CURCUMA 200 MG 7,00 28.795
VIT B6 10 MG 7,00
RISPERIDONE 2 MG 8,00
CLOZAPINE 100 MG 4,00
THD 2 MG 12,00
201904005767 29/04/2019 Ruangan RISPERIDONE 3 MG 14,00 31.058
CLOZAPINE 100 MG 3,00
THD 2 MG 14,00
CURCUMA 200 MG 7,00
VIT B6 10 MG 7,00
791 ROHANI 201904004707 24/04/2019 Ruangan CPZ 100 MG 3,00 7.770
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
791 ROHANI 201904004707 24/04/2019 Ruangan
- RISPERIDONE 3 MG 10,00 7.770
THD 2 MG 5,00
201904005754 29/04/2019 Ruangan RISPERIDONE 3 MG 14,00 16.792
CPZ 100 MG 4,00
THD 2 MG 7,00
CIPROFLOXACIN 500 14,00
201904006052 30/04/2019 Ruangan KETOKONAZOL 200 10,00 6.374
SALEP 2-4 1,00
792 ROHENDRO PUTRO 201904000614 02/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 3,00 9.615
RISPERIDONE 3 MG 6,00
201904000909 04/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 22.435
CLOZAPINE 25 MG 7,00
201904003132 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 8,00 24.968
RISPERIDONE 3 MG 15,00
201904004186 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
201904005824 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 18.865
CLOZAPINE 25 MG 7,00
793 ROHMAD 201904003741 22/04/2019 IGD THD 2 MG 4,00 2.060
CPZ 100 MG 2,00
TFP 5 MG 4,00
794 ROHMAN 201904004219 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 20.400
THD 2 MG 60,00
CPZ 100 MG 30,00
795 ROKIMAH 201904005994 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
796 ROLAN 201904003113 15/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
797 ROMI ARTA 201904004799 25/04/2019 IGD LODOMER 2 MG/ML 1,00 26.983
RISPERIDONE 2 MG 6,00
SPUIT 3 CC 1,00
THD 2 MG 6,00
CLOZAPINE 25 MG 3,00
798 RONAL TANDAJU 201904001549 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 85.455
THD 2 MG 30,00
RISPERIDONE 2 MG 30,00
TFP 5 MG 30,00
799 RONALD RAMBA 201904005187 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
800 RONALD SAMANTA 201904003121 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 42.546
THD 2 MG 14,00
CLOZAPINE 100 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
800 RONALD SAMANTA 201904003154 15/04/2019 Ruangan
- Gelatik TFP 5 MG 5,00 2.125
THD 2 MG 5,00
201904004331 23/04/2019 Ruangan Gelatik TFP 5 MG 14,00 42.067
THD 2 MG 14,00
CLOZAPINE 100 MG 9,00
201904005734 29/04/2019 Ruangan Gelatik TFP 5 MG 14,00 47.068
CLOZAPINE 100 MG 7,00
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
801 ROSIDAH 201904005275 27/04/2019 Poli Psikiater CLOZAPINE 25 MG 4,00 14.658
LODOMER 2 MG/ML 1,00
RISPERIDONE 2 MG 8,00
SPUIT 3 CC 1,00
THD 2 MG 8,00
802 ROSIHAN AMARUDIN 201904000590 02/04/2019 Ruangan Puri RISPERIDONE 3 MG 20,00 22.745
CLOZAPINE 25 MG 5,00
803 RUDI HARIONO 201904005498 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 73.155
VIT B1 50 MG 30,00
CLOZAPINE 25 MG 15,00
804 RUDI SETIYAWAN 201904000633 02/04/2019 Ruangan Wijaya CPZ 100 MG 3,00 4.162
RISPERIDONE 2 MG 6,00
AMLODIPIN 10 10,00
201904000970 04/04/2019 Ruangan Wijaya THD 2 MG 10,00 6.050
CPZ 100 MG 10,00
TFP 5 MG 10,00
201904001761 08/04/2019 Puri Mitra (Laki- CPZ 100 MG 14,00 8.470
TFP 5 MG 14,00
THD 2 MG 14,00
201904002980 15/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 8.470
CPZ 100 MG 14,00
TFP 5 MG 14,00
201904004165 22/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 10.731
CPZ 100 MG 14,00
TFP 5 MG 21,00
201904005677 29/04/2019 Puri Mitra (Laki- TFP 5 MG 21,00 10.731
THD 2 MG 14,00
CPZ 100 MG 14,00
805 RUDI SIANTURI 201904003494 18/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 98.820
CARBAMAZEPINE 105,00
806 RUDI SISWANTO 201904000415 01/04/2019 Ruangan Puri CLOZAPINE 25 MG 7,00 20.293
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904000592 02/04/2019 Ruangan Puri NOPRES 20 MG 7,00 6.888
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
806 RUDI SISWANTO 201904000604 02/04/2019 Ruangan
- Puri ASAM MEFENAMAT 10,00 2.760
201904001718 08/04/2019 Ruangan Puri CLOZAPINE 25 MG 7,00 27.181
NOPRES 20 MG 7,00
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
807 RUDY MULYADI 201904002685 14/04/2019 IGD CLOZAPINE 100 MG 3,00 16.807
DIAZEPAM inj 1,00
SPUIT 3 CC 1,00
201904002966 15/04/2019 Puri Mitra (Laki- CLOZAPINE 100 MG 12,00 98.556
DEPAKOTE ER 500 7,00
201904004161 22/04/2019 Puri Mitra (Laki- NA CL 0,9 % 500 ML 1,00 117.812
CLOZAPINE 100 MG 14,00
DEPAKOTE ER 500 7,00
GENTAMYCIN SALEP 1,00
201904005010 25/04/2019 Puri Mitra (Laki- SPUIT 3 CC 12,00 46.980
LODOMER 2 MG/ML 6,00
DIAZEPAM inj 6,00
201904005672 29/04/2019 Puri Mitra (Laki- DEPAKOTE ER 500 7,00 106.582
CLOZAPINE 100 MG 14,00
808 RUKMINI MARTONO 201904001244 06/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 60,00 10.320
809 RUKMIYAH 201904002163 10/04/2019 IGD TFP 5 MG 4,00 2.060
THD 2 MG 4,00
CPZ 100 MG 2,00
201904003094 15/04/2019 Ruangan TFP 5 MG 15,00 9.255
THD 2 MG 15,00
CPZ 100 MG 16,00
201904003378 16/04/2019 Ruangan ASAM MEFENAMAT 10,00 9.486
PEHACHAIN INJ 2,00
201904004287 23/04/2019 Ruangan RISPERIDONE 2 MG 16,00 11.082
THD 2 MG 15,00
CPZ 100 MG 16,00
201904005805 29/04/2019 Poli Gigi (Jiwa) THD 2 MG 14,00 8.346
CPZ 100 MG 6,00
RISPERIDONE 2 MG 14,00
810 RUSDI 201904005636 29/04/2019 IGD RACIKAN KAPSUL 15,00 2.456
HALOPERIDOL 5 MG 2,00
THD 2 MG 15,00
KAPSUL NO 2 15,00
811 RUSLI 201904004196 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 47.295
TFP 5 MG 60,00
812 RUSTAM 201904002129 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
813 SABAR MUDA 201904005569 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 5.838
814 SADIMAN 201904004211 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 27.915
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
815 SADIQIN 201904001206 05/04/2019 Ruangan
- Gelatik FOLIC ACID 1 MG 14,00 8.442
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
816 SAFIRA ADELIA 201904003550 18/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 18.885
FOLIC ACID 1 MG 15,00
RACIKAN PUYER 30,00
METHYLPHENIDATE 12,00
817 SAFITRI HANDAYANTI 201904000348 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 48.846
NUZIP 25 14,00
201904002018 10/04/2019 Ruangan Napza BETAHISTINE 6-IF 10,00 10.460
RANITIDIN TAB 150 10,00
201904002937 15/04/2019 Ruangan Napza CLOZAPINE 25 MG 14,00 52.850
SERTRALINE 50 MG 14,00
201904004152 22/04/2019 Ruangan Napza RANITIDIN TAB 150 20,00 2.920
201904004789 24/04/2019 Ruangan Napza GENTAMYCIN SALEP 1,00 4.820
818 SAFRULLAH 201904001990 09/04/2019 Poli Psikiater THD 2 MG 60,00 36.540
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
819 SAHAB 201904002994 15/04/2019 Ruangan Kenari THD 2 MG 14,00 7.854
FOLIC ACID 1 MG 7,00
RISPERIDONE 2 MG 14,00
201904004313 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 11.594
FOLIC ACID 1 MG 7,00
THD 2 MG 14,00
LORAZEPAM 2 MG 4,00
820 SAHDILA ARDIANI PUTRI 201904005304 27/04/2019 IGD THD 2 MG 2,00 2.808
CLOBAZAM 10 MG 1,00
RISPERIDONE 1 MG 4,00
821 SAHIDIN 201904003720 20/04/2019 IGD BETAHISTINE 6-IF 10,00 11.730
DIMENHIDRINAT 10,00
822 SAIFUL BAKRI 201904002055 10/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
201904002992 15/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 9.408
201904004316 23/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
823 SAIFUL HADI 201904000625 02/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
824 SAIFUL RAHMAN 201904003713 20/04/2019 IGD DIAZEPAM inj 1,00 21.122
RISPERIDONE 2 MG 6,00
SPUIT 3 CC 2,00
CLOZAPINE 25 MG 6,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
824 SAIFUL RAHMAN 201904004127 22/04/2019 Ruangan
- Wijaya RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904004583 23/04/2019 Ruangan Wijaya THD 2 MG 6,00 3.762
NUZIP 25 2,00
201904006044 30/04/2019 Ruangan Napza SIMVASTATIN 20 MG 15,00 3.690
825 SAIFULLOH NUH RIZAL 201904005513 29/04/2019 Poli Jiwa Anak KAPSUL NO 2 60,00 26.994
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 12,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 24,00
RISPERIDONE 3 MG 10,00
826 SAINI 201904005850 30/04/2019 Poli Psikiater OLANZPINE 10mg 30,00 283.350
CLOZAPINE 25 MG 30,00
SERTRALINE 50 MG 30,00
827 SAKTI RACHMAD 201904005527 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 185.145
CLOZAPINE 25 MG 45,00
DEPAKOTE 250 MG 60,00
HALOPERIDOL 5 MG 60,00
828 SAMSUL BISU 201904004213 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
829 SAMSUL HADI 201904004212 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 111.660
830 SAMSUL HIDAYAT 201904001264 07/04/2019 Poli Psikiater THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
831 SANA BARBARA 201904001542 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 89.884
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 4,00
832 SANIDI 201904001255 06/04/2019 IGD LOMATUELL 1,00 46.662
LIDOCAIN INJ 2,00
SPUIT 1 CC INSULIN 0,00
NA CL 0,9 % 500 ML 2,00
KASA STERIL ISI 16 2,00
GENTAMYCIN SALEP 1,00
201904001594 08/04/2019 Ruangan Wijaya LORAZEPAM 2 MG 4,00 5.812
HALOPERIDOL 5 MG 14,00
201904002960 15/04/2019 IGD HALOPERIDOL 5 MG 14,00 5.812
LORAZEPAM 2 MG 4,00
201904002988 15/04/2019 IGD HALOPERIDOL 5 MG 14,00 5.812
LORAZEPAM 2 MG 4,00
833 SANIK SUYATI 201904000521 02/04/2019 Psiko Geriatri THD 2 MG 8,00 197.536
RACIKAN KAPSUL 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
833 SANIK SUYATI 201904000521 02/04/2019 Psiko Geriatri
- TFP 5 MG 15,00 197.536
KAPSUL NO 2 30,00
THD 2 MG 8,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 30,00
TFP 5 MG 15,00
LORAZEPAM 2 MG 30,00
RIKLONA 2 MG 8,00
SERTRALINE 50 MG 30,00
KAPSUL NO 2 30,00
834 SANTIKA 201904001014 04/04/2019 Ruangan ZYPREXA INJ 1,00 165.114
SPUIT 3 CC 1,00
AQUA PRO INJEKSI 1,00
201904002039 10/04/2019 Ruangan LORAZEPAM 2 MG 6,00 5.610
201904002381 12/04/2019 Ruangan PHENYTOIN CAP 100 14,00 7.126
201904003050 15/04/2019 Ruangan CLOZAPINE 100 MG 7,00 63.458
RISPERIDONE 1 MG 15,00
LORAZEPAM 2 MG 7,00
CLOBAZAM 10 MG 14,00
PHENYTOIN CAP 100 14,00
201904004256 23/04/2019 Ruangan CLOBAZAM 10 MG 14,00 63.896
PHENYTOIN CAP 100 14,00
CLOZAPINE 100 MG 7,00
RISPERIDONE 2 MG 14,00
LORAZEPAM 2 MG 7,00
835 SANTOSO 201904001400 08/04/2019 Poli Psikiater FOLIC ACID 1 MG 40,00 197.840
RISPERIDONE 2 MG 80,00
CLOZAPINE 25 MG 80,00
THD 2 MG 120,00
836 SARDILA PUTRI 201904005469 29/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 20,00 33.090
MERLOPAM 2 MG 5,00
CLOBAZAM 10 MG 10,00
RISPERIDONE 3 MG 10,00
KAPSUL NO 2 20,00
THD 2 MG 10,00
837 SARI 201904001291 08/04/2019 IGD HALOPERIDOL 5 MG 2,00 10.630
SPUIT 3 CC 1,00
THD 2 MG 2,00
CLOZAPINE 25 MG 4,00
LODOMER 2 MG/ML 0,00
201904001678 08/04/2019 Ruangan THD 2 MG 8,00 31.776
CLOZAPINE 25 MG 16,00
HALOPERIDOL 5 MG 8,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
837 SARI 201904001868 09/04/2019 Ruangan
- HALOPERIDOL 5 MG 7,00 1.750
THD 2 MG 7,00
201904003054 15/04/2019 Ruangan THD 2 MG 14,00 29.554
CLOZAPINE 25 MG 14,00
HALOPERIDOL 5 MG 14,00
201904004248 23/04/2019 Ruangan CLOZAPINE 25 MG 14,00 29.554
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
838 SARI MURNI 201904001535 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
839 SAYATI 201904005188 26/04/2019 Ruangan KAPSUL NO 2 6,00 12.890
VIT B6 10 MG 6,00
FOLIC ACID 1 MG 6,00
RACIKAN KAPSUL 6,00
HALOPERIDOL 5 MG 2,00
SERTRALINE 50 MG 6,00
201904005747 29/04/2019 Ruangan KAPSUL NO 2 14,00 6.985
VIT B6 10 MG 7,00
FOLIC ACID 1 MG 7,00
RACIKAN KAPSUL 14,00
HALOPERIDOL 0,5 14,00
SERTRALINE 50 MG 2,00
201904006051 30/04/2019 Ruangan LORATADIN 10 MG 10,00 46.260
SCABIMITE 10 GR 1,00
840 SEKAR ASRI 201904001245 06/04/2019 Poli Syaraf FOLIC ACID 1 MG 30,00 346.680
TOPAMAX 100 MG 30,00
841 SELAMET WAHYUDI 201904000847 04/04/2019 Poli Psikiater THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
842 SELVY RIFINOVA 201904004079 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 996.060
CLOZAPINE 100 MG 30,00
ABILIFY DISCMELT 10 30,00
RISPERIDONE 3 MG 60,00
843 SENDANG HADI 201904000767 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 52.860
THD 2 MG 30,00
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
844 SENEN 201904003058 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
201904004254 23/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
845 SENO AJI 201904002626 12/04/2019 IGD ASAM MEFENAMAT 10,00 33.639
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
845 SENO AJI 201904002626 12/04/2019 IGD
- RISPERIDONE 2 MG 6,00 33.639
VERBAN 10 CM 1,00
CPZ 100 MG 3,00
AMOXYCILLIN 500 10,00
NA CL 0,9 % 100 ML 1,00
KASA STERIL ISI 16 1,00
201904002959 15/04/2019 Puri Mitra (Laki- CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904004153 22/04/2019 Puri Mitra (Laki- KASA STERIL ISI 16 1,00 19.868
RISPERIDONE 2 MG 14,00
CPZ 100 MG 7,00
NA CL 0,9 % 500 ML 1,00
201904005675 29/04/2019 Puri Mitra (Laki- RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
201904006055 30/04/2019 Puri Mitra (Laki- CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
846 SETYA ASTU WIRAWAN 201904000022 01/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
847 SHOLIKHIN 201904001774 09/04/2019 Medical Check Up LEVOPAR 24,00 65.808
THD 2 MG 24,00
848 SIAK 201904002159 10/04/2019 Ruangan Wijaya SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
201904003395 16/04/2019 Ruangan Kenari CPZ 100 MG 7,00 4.452
HALOPERIDOL 5 MG 14,00
ALLOPURINOL 100 7,00
201904004334 23/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 4.452
ALLOPURINOL 100 7,00
CPZ 100 MG 7,00
849 SIFAK ALFIYAH 201904005005 25/04/2019 IGD LODOMER 2 MG/ML 1,00 15.698
CLOZAPINE 25 MG 6,00
RAMIPRIL 5 MG 5,00
SPUIT 3 CC 1,00
201904005278 27/04/2019 Ruangan Wijaya THD 2 MG 14,00 13.811
LORAZEPAM 2 MG 7,00
RISPERIDONE 2 MG 14,00
201904005751 29/04/2019 Ruangan LORAZEPAM 2 MG 4,00 12.173
RISPERIDONE 2 MG 5,00
METFORMIN 500 MG 10,00
THD 2 MG 14,00
RAMIPRIL 5 MG 10,00
850 SIGIT 201904000818 04/04/2019 IGD ASAM MEFENAMAT 10,00 13.290
KASA STERIL ISI 16 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
850 SIGIT 201904000818 04/04/2019 IGD
- DEXAMETASON 0,5 10,00 13.290
AMOXYCILLIN 500 10,00
201904001210 05/04/2019 Ruangan Gelatik TFP 5 MG 15,00 4.845
201904001742 08/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904003110 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904003151 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 6.105
TFP 5 MG 15,00
201904004335 23/04/2019 Ruangan Gelatik CPZ 100 MG 8,00 6.285
TFP 5 MG 15,00
201904005732 29/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
851 SIH WINARNI (SE) 201904003699 19/04/2019 Ruangan Puri THD 2 MG 6,00 172.176
SPUIT 3 CC 1,00
METFORMIN 500 MG 10,00
ZYPREXA INJ 1,00
AQUA PRO INJEKSI 1,00
TFP 5 MG 6,00
NEEDLE 23 G 1,00
CPZ 100 MG 6,00
201904004118 22/04/2019 Ruangan Puri THD 2 MG 14,00 7.882
RACIKAN KAPSUL 14,00
CPZ 100 MG 7,00
TFP 5 MG 14,00
KAPSUL NO.0 14,00
201904004604 23/04/2019 Ruangan Puri METFORMIN 500 MG 20,00 52.540
DIAMICRON MR 60 10,00
SIMVASTATIN 20 MG 10,00
CIPROFLOXACIN 500 14,00
TABLET TAMBAH 10,00
852 SIMAH 201904003882 22/04/2019 Poli Psikiater THD 2 MG 20,00 2.040
853 SINAWATI 201904005277 27/04/2019 Poli Psikiater SIKZONOATE 1,00 258.800
SPUIT 3 CC 1,00
THD 2 MG 90,00
AMLODIPIN 10 47,00
NUZIP 25 93,00
TFP 5 MG 90,00
854 SIPON 201904002921 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
855 SIRO 201904005573 29/04/2019 Ruangan Kenari THD 2 MG 15,00 7.785
RISPERIDONE 2 MG 15,00
856 SISWANTO 201904000163 01/04/2019 Poli Umum ATORVASTATIN 20 30,00 94.230
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
856 SISWANTO 201904000163 01/04/2019 Poli Umum
- PROBENID 500 MG 30,00 94.230
857 SISWO UTOMO 201904004142 22/04/2019 IGD CPZ 100 MG 2,00 2.028
RISPERIDONE 2 MG 4,00
201904004581 23/04/2019 Ruangan Wijaya CPZ 100 MG 14,00 8.358
RISPERIDONE 2 MG 14,00
201904005693 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 132.604
CPZ 100 MG 14,00
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
858 SISWONO 201904004022 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
859 SITI A'ISYAH 201904003203 16/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 97.500
SERTRALINE 50 MG 30,00
ALPRAZOLAM 1 MG 30,00
860 SITI AMIATI 201904003757 22/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 116.295
THD 2 MG 60,00
LORAZEPAM 2 MG 15,00
RISPERIDONE 3 MG 60,00
861 SITI AMIDAH 201904001510 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
862 SITI FATIMAH 201904000491 02/04/2019 Ruangan KAPSUL NO 2 6,00 33.638
THD 2 MG 6,00
CLOZAPINE 100 MG 6,00
RACIKAN KAPSUL 6,00
DIPHENHYDRAMINE 2,00
TFP 5 MG 6,00
SPUIT 3 CC 1,00
201904000997 04/04/2019 Ruangan FRIMANIA 200 MG 5,00 5.925
201904001200 05/04/2019 Ruangan THD 2 MG 8,00 35.888
RACIKAN KAPSUL 8,00
CLOZAPINE 100 MG 8,00
TFP 5 MG 8,00
KAPSUL NO.0 8,00
201904001689 08/04/2019 Ruangan THD 2 MG 14,00 39.739
RACIKAN KAPSUL 14,00
CLOZAPINE 100 MG 7,00
TFP 5 MG 28,00
KAPSUL NO.00 14,00
201904003055 15/04/2019 Ruangan RACIKAN KAPSUL 14,00 39.739
CLOZAPINE 100 MG 7,00
TFP 5 MG 28,00
KAPSUL NO.00 14,00
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
862 SITI FATIMAH 201904003644 18/04/2019 Ruangan
- Puri METHYLPREDNISOL 3,00 126.580
SPUIT 5 CC 4,00
IKANEURON INJ 5000 4,00
SPUIT 3 CC 4,00
201904004103 22/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 5.838
201904004223 23/04/2019 Ruangan TFP 5 MG 14,00 40.727
KAPSUL NO.00 7,00
RACIKAN KAPSUL 7,00
CLOZAPINE 100 MG 4,00
THD 2 MG 7,00
KAPSUL NO.00 7,00
TFP 5 MG 14,00
CLOZAPINE 25 MG 7,00
THD 2 MG 7,00
RACIKAN KAPSUL 7,00
201904004601 23/04/2019 Ruangan Puri FOLIC ACID 1 MG 15,00 14.040
TABLET TAMBAH 30,00
201904004775 24/04/2019 Ruangan Puri IKANEURON INJ 5000 2,00 55.342
IV CANULLA NO.20 1,00
DEXTROSE 5% 2,00
RINGER LACTAT 2,00
INFUS SET DEWASA 1,00
201904004975 25/04/2019 Ruangan Puri DEXTROSE 5% 4,00 128.040
SPUIT 3 CC 4,00
INFUS SET DEWASA 1,00
RINGER LACTAT 8,00
IV CANULLA NO.20 1,00
IKANEURON INJ 5000 4,00
201904005656 29/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
201904005746 29/04/2019 Ruangan RACIKAN KAPSUL 7,00 40.139
TFP 5 MG 14,00
KAPSUL NO 2 7,00
RACIKAN KAPSUL 7,00
CLOZAPINE 100 MG 4,00
THD 2 MG 7,00
KAPSUL NO 2 7,00
TFP 5 MG 14,00
CLOZAPINE 25 MG 7,00
THD 2 MG 7,00
863 SITI HORRIYAH (MRS. X) 201904000156 01/04/2019 Ruangan TFP 5 MG 14,00 6.496
THD 2 MG 7,00
CPZ 100 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
863 SITI HORRIYAH (MRS. X) 201904001097 05/04/2019 Ruangan
- TFP 5 MG 4,00 1.292
201904001649 08/04/2019 Ruangan THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
201904003051 15/04/2019 Ruangan TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004258 23/04/2019 Ruangan THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
201904005819 29/04/2019 Ruangan TFP 5 MG 21,00 15.309
CPZ 100 MG 7,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
864 SITI KHODIJAH 201904002352 11/04/2019 Ruangan Puri NUZIP 25 14,00 73.654
RIZODAL 2 MG 28,00
THD 2 MG 28,00
865 SITI KHUSNUL 201904003933 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
866 SITI MA'RUFAH 201904003224 16/04/2019 IGD RISPERIDONE 1 MG 6,00 4.030
LORAZEPAM 2 MG 2,00
201904003636 18/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 5,00 16.025
RISPERIDONE 3 MG 10,00
201904004122 22/04/2019 Ruangan Wijaya SERTRALINE 50 MG 5,00 28.329
CLOZAPINE 100 MG 3,00
RISPERIDONE 3 MG 10,00
201904004575 23/04/2019 Ruangan Wijaya TABLET TAMBAH 14,00 17.836
CIPROFLOXACIN 500 14,00
METHYLPREDNISOL 14,00
201904004889 25/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 4,00 280.948
CRIPSA 2,5 MG 14,00
201904005812 29/04/2019 Ruangan CLOZAPINE 25 MG 7,00 35.833
RISPERIDONE 3 MG 14,00
SERTRALINE 50 MG 7,00
867 SITI MUALIFAH 201904003689 19/04/2019 IGD THD 2 MG 6,00 365.948
AQUA PRO INJEKSI 2,00
OLANZPINE 10mg 5,00
DIPHENHYDRAMINE 2,00
ZYPREXA INJ 2,00
SPUIT 3 CC 3,00
201904004130 22/04/2019 Ruangan Wijaya TFP 5 MG 14,00 23.178
KAPSUL NO.00 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
867 SITI MUALIFAH 201904004130 22/04/2019 Ruangan
- Wijaya THD 2 MG 14,00 23.178
RACIKAN KAPSUL 14,00
CLOZAPINE 100 MG 4,00
201904005007 25/04/2019 Ruangan Wijaya SPUIT 3 CC 2,00 330.228
AQUA PRO INJEKSI 2,00
ZYPREXA INJ 2,00
201904005628 29/04/2019 Ruangan Wijaya RACIKAN KAPSUL 14,00 105.497
THD 2 MG 14,00
SPUIT 3 CC 1,00
RACIKAN KAPSUL 14,00
SIKZONOATE 1,00
CLOZAPINE 100 MG 7,00
TFP 5 MG 14,00
868 SITI MUAWANAH 201904000593 02/04/2019 Ruangan Puri THD 2 MG 14,00 12.096
CPZ 100 MG 7,00
RISPERIDONE 3 MG 14,00
201904001249 06/04/2019 Ruangan Puri RISPERIDONE 3 MG 60,00 51.840
THD 2 MG 60,00
CPZ 100 MG 30,00
869 SITI NUR ALIFAH 201904003687 19/04/2019 Medical Check Up DEXAMETASON 0,5 15,00 8.145
METRONIDAZOLE 15,00
ASAM MEFENAMAT 15,00
870 SITI NURIFAH 201904003635 18/04/2019 Ruangan Wijaya THD 2 MG 10,00 5.150
CPZ 100 MG 5,00
TFP 5 MG 10,00
201904004296 23/04/2019 Ruangan THD 2 MG 12,00 6.180
CPZ 100 MG 6,00
TFP 5 MG 12,00
201904005813 30/04/2019 Ruangan CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
871 SITI NURYATI 201904000724 04/04/2019 Poli Jiwa Dewasa PHENYTOIN CAP 100 90,00 151.290
CARBAMAZEPINE 90,00
RISPERIDONE 1 MG 30,00
CLOBAZAM 10 MG 60,00
872 SITI ROHMAH 201904005281 27/04/2019 IGD THD 2 MG 10,00 2.130
HALOPERIDOL 1,5 15,00
873 SITI USWATUN 201904003040 15/04/2019 Ruangan CPZ 100 MG 21,00 30.723
TFP 5 MG 21,00
DEPAKOTE 250 MG 14,00
201904003097 15/04/2019 Ruangan TFP 5 MG 21,00 74.333
IKALEP 250 MG 14,00
CPZ 100 MG 21,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
874 SLAMET PURNOMO 201904001581 08/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 78.270
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
875 SLAMET HARIYANTO 201904003985 22/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 30,00 74.670
RISPERIDONE 3 MG 20,00
KAPSUL NO.0 60,00
CLOZAPINE 25 MG 30,00
RACIKAN KAPSUL 60,00
876 SLAMET NURWINADI 201904001284 07/04/2019 IGD CPZ 100 MG 2,00 1.652
TFP 5 MG 4,00
201904003138 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904004314 23/04/2019 Ruangan Gelatik TFP 5 MG 15,00 6.105
CPZ 100 MG 7,00
877 SLAMET PARTOYO 201904002317 11/04/2019 Psiko Geriatri THD 2 MG 30,00 21.825
RISPERIDONE 2 MG 45,00
878 SLAMET YULIANTO 201904002640 12/04/2019 IGD SPUIT 3 CC 1,00 167.592
TFP 5 MG 6,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
CPZ 100 MG 3,00
201904003400 16/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 12,00 19.230
CLOZAPINE 25 MG 6,00
201904004128 22/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
201904004568 23/04/2019 Ruangan Gelatik THD 2 MG 6,00 2.550
TFP 5 MG 6,00
201904005792 29/04/2019 Ruangan Gelatik TABLET TAMBAH 24,00 19.296
AMOXYCILLIN 500 24,00
201904005831 29/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 15,00 30.629
TFP 5 MG 15,00
CLOZAPINE 25 MG 8,00
THD 2 MG 8,00
879 SOFIATON 201904001382 08/04/2019 Poli Psikiater FOLIC ACID 1 MG 60,00 115.620
THD 2 MG 60,00
RIZODAL 2 MG 60,00
880 SOLEH AFIF INDRA J 201904004797 25/04/2019 IGD CLOZAPINE 25 MG 2,00 13.284
LODOMER 2 MG/ML 1,00
RISPERIDONE 2 MG 4,00
SPUIT 3 CC 1,00
THD 2 MG 4,00
201904004972 25/04/2019 Ruangan Gelatik THD 2 MG 8,00 11.596
CLOZAPINE 25 MG 4,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
880 SOLEH AFIF INDRA J 201904004972 25/04/2019 Ruangan
- Gelatik RISPERIDONE 2 MG 8,00 11.596
201904005802 29/04/2019 Ruangan Gelatik AMOXYCILLIN 500 24,00 9.072
201904005816 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
881 SONY 201904000813 04/04/2019 Poli VCT SERBION 5000 30,00 71.280
882 SRI MUJIAH 201904001647 08/04/2019 Ruangan THD 2 MG 7,00 6.552
RISPERIDONE 2 MG 14,00
201904003061 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 6.552
THD 2 MG 7,00
201904004285 23/04/2019 Ruangan THD 2 MG 7,00 6.552
RISPERIDONE 2 MG 14,00
883 SRI MULYANI 201904005256 26/04/2019 Ruangan CPZ 100 MG 2,00 1.006
TFP 5 MG 2,00
201904005748 29/04/2019 Ruangan TFP 5 MG 14,00 17.132
AMOXYCILLIN 500 15,00
RACIKAN KAPSUL 10,00
CTM 4 MG 10,00
CPZ 100 MG 14,00
SALBUTAMOL 4 MG 5,00
AMBROXOL 30 MG 10,00
KAPSUL NO 2 10,00
884 SRI MURGIANTI 201904002279 11/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 103.320
FOLIC ACID 1 MG 30,00
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
885 SRI POERMINDRA 201904001281 07/04/2019 IGD DIAZEPAM inj 1,00 7.454
SPUIT 3 CC 2,00
LODOMER 2 MG/ML 0,00
201904001994 09/04/2019 Ruangan Puri SPUIT 3 CC 4,00 19.072
DIAZEPAM inj 4,00
201904004111 22/04/2019 Ruangan Puri SEROQUEL XR 200 7,00 147.602
CLOZAPINE 25 MG 14,00
THD 2 MG 14,00
201904004986 25/04/2019 Ruangan Puri CLOZAPINE 100 MG 5,00 20.065
201904005261 26/04/2019 Ruangan Puri DIAZEPAM inj 4,00 31.320
SPUIT 3 CC 8,00
LODOMER 2 MG/ML 4,00
886 SRI RAHAYU 201904004015 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 23.030
VIT B6 10 MG 10,00
TFP 5 MG 60,00
887 SRIAH 201904005614 29/04/2019 Ruangan Wijaya RISPERIDONE 1 MG 14,00 5.040
201904005623 29/04/2019 Ruangan Wijaya CIPROFLOXACIN 500 14,00 70.366
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
887 SRIAH 201904005623 29/04/2019 Ruangan
- Wijaya INFUS SET DEWASA 3,00 70.366
TABLET TAMBAH 22,00
IV CANULLA NO.20 3,00
201904006032 30/04/2019 Ruangan Wijaya BETAMETASON 1,00 1.608
201904006040 30/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 6,00 2.502
888 SRIE NUNGGARYATI 201904002412 12/04/2019 Poli Psikiater CLOBAZAM 10 MG 10,00 132.160
DEPTRAL 50 MG 10,00
201904005859 30/04/2019 Poli Psikiater SERTRALINE 50 MG 20,00 61.560
CLOBAZAM 10 MG 20,00
889 SRIHADAD 201904005252 26/04/2019 Ruangan CLOZAPINE 25 MG 5,00 13.475
RISPERIDONE 2 MG 10,00
201904005788 29/04/2019 Ruangan CLOZAPINE 25 MG 14,00 35.462
RISPERIDONE 3 MG 14,00
890 SRINI 201904000643 03/04/2019 Ruangan DEPAKOTE 250 MG 14,00 28.518
CPZ 100 MG 14,00
RISPERIDONE 2 MG 14,00
891 STEVEN RAMBA 201904005177 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 151.980
CLOZAPINE 25 MG 60,00
892 SUBAERI 201904003696 19/04/2019 IGD THD 2 MG 6,00 71.754
SEROQUEL XR 200 4,00
RISPERIDONE 2 MG 6,00
201904004145 22/04/2019 Ruangan Puri THD 2 MG 14,00 75.906
SEROQUEL XR 200 4,00
RISPERIDONE 2 MG 14,00
201904004770 24/04/2019 Ruangan Puri MINIASPI 80 MG 5,00 4.275
AMLODIPIN 10 5,00
PIRACETAM 800 MG 5,00
201904005651 29/04/2019 Ruangan Puri THD 2 MG 14,00 75.906
SEROQUEL XR 200 4,00
RISPERIDONE 2 MG 14,00
893 SUBANDRIYO 201904002305 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
894 SUBUR 201904001963 09/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 70.830
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
895 SUCI 201904000624 02/04/2019 Ruangan BETAMETASON 1,00 1.608
201904003102 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
896 SUDARINI 201904004052 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 33.480
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
897 SUDARSIH 201904002847 15/04/2019 IGD SPUIT 3 CC 1,00 4.768
DIAZEPAM inj 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
897 SUDARSIH 201904002876 15/04/2019 Ruangan
- Puri HALOPERIDOL 0,5 5,00 3.917
AMLODIPIN 10 5,00
MINIASPI 80 MG 5,00
DIAZEPAM 5 MG 2,00
NEURODEK 4,00
201904004144 22/04/2019 Ruangan Puri HALOPERIDOL 0,5 10,00 9.562
RISPERIDONE 1 MG 14,00
DIAZEPAM 5 MG 14,00
THD 2 MG 14,00
201904004602 23/04/2019 Ruangan Puri ATORVASTATIN 20 15,00 14.310
201904004981 25/04/2019 Ruangan Puri HALOPERIDOL 0,5 15,00 1.680
201904005145 26/04/2019 IGD RISPERIDONE 2 MG 4,00 4.394
KAPSUL NO 2 14,00
THD 2 MG 7,00
DIAZEPAM 5 MG 8,00
RACIKAN KAPSUL 14,00
HALOPERIDOL 5 MG 2,00
898 SUDI KUSTOMO 201904003544 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 138.270
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
201904005540 29/04/2019 Poli Jiwa Dewasa AMLODIPIN 10 30,00 6.930
MINIASPI 80 MG 30,00
899 SUDJIARTO 201904003714 20/04/2019 IGD THD 2 MG 4,00 3.960
KAPSUL NO.00 15,00
ALPRAZOLAM 0.5 MG 4,00
RACIKAN KAPSUL 15,00
HALOPERIDOL 0,5 15,00
900 SUGENG HANDOKO 201904005505 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 172.230
CPZ 100 MG 30,00
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
901 SUGENG HARYANTO 201904003007 15/04/2019 Ruangan Kenari CPZ 100 MG 14,00 7.042
TFP 5 MG 14,00
201904003683 19/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
201904005190 26/04/2019 Poli Jiwa Dewasa CPZ 100 MG 60,00 30.180
TFP 5 MG 60,00
902 SUGENG HERU 201904005565 29/04/2019 Ruangan Kenari VIT B COMPLEX 7,00 2.961
TFP 5 MG 7,00
903 SUGENG KARYONO 201904003381 16/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 15.099
CLOZAPINE 25 MG 7,00
201904004293 23/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 15.099
CLOZAPINE 25 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
903 SUGENG KARYONO 201904005504 29/04/2019 Ruangan
- Kenari HALOPERIDOL 5 MG 14,00 15.099
CLOZAPINE 25 MG 7,00
201904005704 29/04/2019 IGD CLOZAPINE 25 MG 7,00 15.099
HALOPERIDOL 5 MG 14,00
904 SUGIANTO 201904001493 08/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 60,00 151.530
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
905 SUHADI 201904004192 22/04/2019 IGD CPZ 100 MG 2,00 2.028
RISPERIDONE 2 MG 4,00
201904004366 23/04/2019 Ruang Observasi RISPERIDONE 2 MG 4,00 2.028
CPZ 100 MG 2,00
201904005818 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
201904006082 30/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 4,00 16.052
906 SUHANDOKO 201904001891 09/04/2019 Poli Psikiater THD 2 MG 180,00 109.620
CPZ 100 MG 90,00
RISPERIDONE 2 MG 180,00
907 SUHARTINA NJO 201904002672 14/04/2019 Psiko Geriatri ALGANAX 1 MG 10,00 55.440
908 SUHARTONO 201904001025 05/04/2019 Ruangan Kenari SCABIMITE 10mg 1,00 46.260
LORATADIN 10 MG 10,00
201904001509 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 151.530
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
201904002056 10/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 46.260
SCABIMITE 10mg 1,00
909 SUHARTOYO 201904005506 29/04/2019 Psiko Geriatri RISPERIDONE 2 MG 30,00 104.490
THD 2 MG 30,00
CLONAZEPAM 2 MG 15,00
910 SUHERMANTO 201904001520 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 902.220
RISPERIDONE 2 MG 30,00
ABILIFY DISCMELT 10 30,00
SERTRALINE 50 MG 30,00
911 SUHUT RAL NADAEK 201904005916 30/04/2019 Poli Interna AMINOPHYLIN 0,00 0
912 SUJANI 201904004796 25/04/2019 Ruangan Wijaya LODOMER 2 MG/ML 1,00 44.086
RISPERIDONE 2 MG 4,00
SEROQUEL XR 200 2,00
THD 2 MG 6,00
SPUIT 3 CC 1,00
201904004968 25/04/2019 Ruangan Kenari THD 2 MG 8,00 10.844
CLOZAPINE 25 MG 4,00
TFP 5 MG 8,00
201904005711 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 18.977
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
912 SUJANI 201904005711 29/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 7,00 18.977
913 SUKAENI 201904003979 22/04/2019 Poli Interna TABLET TAMBAH 10,00 50.940
FOLIC ACID 1 MG 30,00
NEURODEK 10,00
OMEPRAZOLE 20 MG 10,00
CLOBAZAM 10 MG 30,00
914 SUKARTI 201904003082 15/04/2019 Ruangan CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
915 SUKIR 201904002322 11/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
916 SUKIRNO 201904005652 29/04/2019 IGD SPUIT 3 CC 1,00 167.664
THD 2 MG 6,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
TFP 5 MG 6,00
201904006089 30/04/2019 Ruangan Wijaya THD 2 MG 8,00 3.400
TFP 5 MG 8,00
917 SUKUR 201904004767 24/04/2019 IGD AQUA PRO INJEKSI 1,00 75.532
SPUIT 10 CC 1,00
RINGER LACTAT 3,00
DEXTROSE 5% 2,00
URINE BAG 1,00
NASAL O2 DEWASA 1,00
FOLEY CATETER NO 0,00
918 SULASMI 201904000199 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 27.840
CPZ 100 MG 30,00
TFP 5 MG 60,00
919 SULIATI 201904002418 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 9.690
920 SULISTIONO JATI 201904000434 01/04/2019 Poli Psikiater OLANZPINE 10mg 5,00 269.390
DEPTRAL 50 MG 20,00
921 SULISTIYOWATI 201904001004 04/04/2019 Ruangan LORATADIN 10 MG 5,00 60.210
SCABIMITE 10mg 1,00
201904003095 15/04/2019 Ruangan CPZ 100 MG 4,00 7.986
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
922 SULIYAH 201904001106 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 15.450
THD 2 MG 30,00
CPZ 100 MG 15,00
923 SUMARA 201904000925 04/04/2019 Ruangan Gelatik CENDO XITROL E D 1,00 34.172
201904001751 08/04/2019 Ruangan Gelatik CENDO XITROL E D 1,00 40.122
TFP 5 MG 14,00
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
923 SUMARA 201904003112 15/04/2019 Ruangan
- Gelatik THD 2 MG 14,00 5.950
TFP 5 MG 14,00
201904003418 16/04/2019 Ruangan Gelatik AMOXYCILLIN 500 15,00 5.670
924 SUMARMI 201904000761 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 15.090
TFP 5 MG 30,00
925 SUMARNI 201904000587 02/04/2019 Ruangan HALOPERIDOL 5 MG 14,00 4.760
THD 2 MG 14,00
CPZ 100 MG 7,00
926 SUMIRAN 201904001970 09/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 10.944
CLOZAPINE 25 MG 4,00
THD 2 MG 14,00
927 SUNADI 201904000389 01/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904000605 02/04/2019 Ruangan Gelatik VIT C 100 MG 20,00 5.300
VIT B COMPLEX 20,00
201904001741 08/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 31.892
CLOZAPINE 25 MG 14,00
201904001981 09/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 1,00 417
201904003142 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904003164 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 1,00 2.695
RISPERIDONE 2 MG 2,00
928 SUNAIYAH 201904001500 08/04/2019 Psiko Geriatri SEROQUEL XR 400 4,00 158.800
FOLIC ACID 1 MG 60,00
RACIKAN KAPSUL 60,00
KAPSUL NO.00 60,00
SERTRALINE 50 MG 15,00
CLOZAPINE 100 MG 5,00
LORAZEPAM 2 MG 15,00
929 SUNANDAR DUL HALIM 201904000612 02/04/2019 Ruangan Gelatik TFP 5 MG 14,00 12.880
CPZ 100 MG 14,00
RISPERIDONE 2 MG 14,00
930 SUNAR RADITYA 201904005204 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 145.890
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
931 SUNARDI 201904001232 05/04/2019 IGD CLOZAPINE 25 MG 8,00 14.888
201904001991 09/04/2019 Ruangan Puri DEXTROSE 5% 3,00 87.396
RINGER LACTAT 8,00
INFUS SET DEWASA 1,00
IV CANULLA NO.20 1,00
201904001992 09/04/2019 Ruangan Puri SPUIT 50 CC LUBANG 1,00 54.120
STOMACH TUBE 16 1,00
201904001993 09/04/2019 Ruangan Puri CLOZAPINE 25 MG 13,00 63.883
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
931 SUNARDI 201904001993 09/04/2019 Ruangan
- Puri OLANZPINE 10mg 7,00 63.883
201904003410 16/04/2019 Ruangan Puri CLOZAPINE 25 MG 20,00 93.920
OLANZPINE 10mg 10,00
201904004600 23/04/2019 Ruangan Puri CLOZAPINE 25 MG 15,00 67.605
OLANZPINE 10mg 7,00
201904005659 29/04/2019 Ruangan Puri OLANZPINE 10mg 4,00 22.680
932 SUNARI 201904003509 18/04/2019 Ruangan Gelatik TFP 5 MG 10,00 5.150
THD 2 MG 10,00
CPZ 100 MG 5,00
201904004185 22/04/2019 Ruangan Gelatik BETAMETASON 1,00 1.608
201904005826 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 6.670
CPZ 100 MG 4,00
TFP 5 MG 14,00
933 SUNARYO 201904002310 11/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 8.460
CPZ 100 MG 30,00
934 SUNCONO 201904003421 16/04/2019 Ruangan Gelatik KAPSUL NO.00 10,00 94.050
SCABIMITE 10mg 2,00
RACIKAN KAPSUL 10,00
DOXYCICLIN 100 MG 10,00
CTM 4 MG 10,00
201904005735 29/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904005828 29/04/2019 Ruangan Gelatik SCABIMITE 10 GR 1,00 51.900
KETOKONAZOL 1,00
LORATADIN 10 MG 10,00
935 SUPARDJO 201904004636 24/04/2019 Psiko Geriatri TFP 5 MG 60,00 78.270
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
936 SUPARNO A 201904005709 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
937 SUPIARNI 201904005008 25/04/2019 Poli Psikiater LORAZEPAM 2 MG 7,00 123.140
SEROQUEL XR 200 4,00
CLOBAZAM 10 MG 15,00
RACIKAN KAPSUL 30,00
KAPSUL NO.0 30,00
ELIZAC 20 MG 15,00
938 SUPIYATI 201904003718 20/04/2019 IGD THD 2 MG 15,00 10.295
HALOPERIDOL 5 MG 15,00
LORAZEPAM 2 MG 7,00
939 SUPRAPTI 201904003048 15/04/2019 Ruangan CPZ 100 MG 4,00 10.128
RISPERIDONE 3 MG 14,00
940 SUPRAYITNO 201904004134 22/04/2019 Ruangan Wijaya CLOZAPINE 100 MG 14,00 59.682
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
940 SUPRAYITNO 201904004134 22/04/2019 Ruangan
- Wijaya HALOPERIDOL 5 MG 14,00 59.682
THD 2 MG 14,00
201904005013 25/04/2019 Ruangan Gelatik LORATADIN 10 MG 5,00 3.618
BETAMETASON 1,00
201904006081 30/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 3.500
THD 2 MG 14,00
941 SUPRI 201904000397 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 15.358
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
201904001745 08/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 15.358
TFP 5 MG 14,00
THD 2 MG 14,00
201904003136 15/04/2019 Ruangan Gelatik TFP 5 MG 14,00 15.358
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
942 SUPRIADI 201904004966 25/04/2019 Ruangan Kenari THD 2 MG 8,00 11.596
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 8,00
201904005727 29/04/2019 Ruangan Kenari CLOZAPINE 100 MG 4,00 23.318
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
943 SUPRIATIN 201904004804 25/04/2019 Psiko Geriatri RIZODAL 2 MG-UM 30,00 158.610
RACIKAN KAPSUL 60,00
SIZORIL 25 MG 30,00
FOLIC ACID 1 MG 30,00
THD 2 MG 60,00
KAPSUL NO.00 60,00
944 SUPRIYADI 201904005519 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 18.150
THD 2 MG 30,00
CPZ 100 MG 30,00
945 SUPRIYANTO 201904002366 11/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 31.892
CLOZAPINE 25 MG 14,00
201904003665 18/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 31.892
CLOZAPINE 25 MG 14,00
201904004058 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
201904004987 25/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 31.892
CLOZAPINE 25 MG 14,00
946 SURADI 201904003120 15/04/2019 Ruangan Gelatik CPZ 100 MG 14,00 11.928
RISPERIDONE 3 MG 14,00
201904004327 23/04/2019 Ruangan Gelatik CPZ 100 MG 14,00 11.928
RISPERIDONE 3 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
947 SURATMAN 201904000585 02/04/2019 Ruangan
- Kenari SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
201904001955 09/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904003399 16/04/2019 Ruangan Kenari TFP 5 MG 14,00 8.470
THD 2 MG 14,00
CPZ 100 MG 14,00
201904004240 23/04/2019 Ruangan Kenari THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904004716 24/04/2019 Ruangan Kenari THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
948 SURATMI 201904004013 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
949 SURATNO 201904003975 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 49.140
CPZ 100 MG 15,00
RISPERIDONE 3 MG 60,00
950 SURIP 201904000440 01/04/2019 IGD THD 2 MG 3,00 6.530
CLOZAPINE 25 MG 2,00
RISPERIDONE 2 MG 6,00
201904000620 02/04/2019 Ruangan Wijaya STOMACH TUBE 18 1,00 283.402
INFUS SET DEWASA 1,00
IKANEURON INJ 5000 3,00
SPUIT 50 CC LUBANG 2,00
URINE BAG 1,00
IV CANULA NO. 18 2,00
NORAGES INJEKSI 3,00
SPUIT 3 CC 6,00
FOLEY CATETER NO 1,00
NA CL 0,9 % 500 ML 8,00
IV CANULLA NO.20 1,00
201904000967 04/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 14,00 13.996
THD 2 MG 7,00
CLOZAPINE 25 MG 4,00
201904003053 15/04/2019 Ruangan CLOZAPINE 25 MG 4,00 18.382
RISPERIDONE 3 MG 14,00
THD 2 MG 15,00
201904004263 23/04/2019 Ruangan NUZIP 25 2,00 13.986
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
951 SURIYAH 201904003486 18/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 159.090
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
951 SURIYAH 201904003486 18/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 159.090
CLOZAPINE 25 MG 60,00
952 SURYANI 201904005503 29/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 700.230
CLOZAPINE 25 MG 30,00
953 SUSANTI 201904005259 26/04/2019 Ruangan Puri METFORMIN 500 MG 20,00 42.810
RAMIPRIL 5 MG 10,00
DIAMICRON MR 60 10,00
201904005650 29/04/2019 Ruangan Puri RISPERIDONE 2 MG 14,00 7.986
THD 2 MG 14,00
CPZ 100 MG 4,00
201904005665 29/04/2019 Ruangan Puri CETIRIZINE TABLET 15,00 11.275
SALBUTAMOL 4 MG 5,00
KAPSUL NO 3 20,00
AMBROXOL 30 MG 15,00
RACIKAN KAPSUL 20,00
954 SUSI ERNIWATI 201904002674 14/04/2019 IGD ACYCLOVIR 400 MG 25,00 25.586
DEXAMETASON 0,5 10,00
ACYCLOVIR CREAM 2,00
ASAM MEFENAMAT 10,00
955 SUSILOWATI 201904001662 08/04/2019 Ruangan CLOZAPINE 25 MG 15,00 27.915
201904003049 15/04/2019 Ruangan CLOZAPINE 25 MG 14,00 26.054
956 SUTEKNO 201904000611 02/04/2019 Ruangan Puri NUZIP 25 30,00 47.250
201904001691 08/04/2019 Ruangan Puri OLANZPINE 10mg 10,00 56.700
201904001878 09/04/2019 Ruangan Puri OLANZPINE 10mg 30,00 260.730
RISPERIDONE 3 MG 60,00
NUZIP 25 30,00
THD 2 MG 30,00
957 SUTIANA 201904000999 04/04/2019 Ruangan HALOPERIDOL 5 MG 10,00 1.480
201904001659 08/04/2019 Ruangan CLOZAPINE 100 MG 7,00 36.686
THD 2 MG 15,00
HALOPERIDOL 5 MG 15,00
TFP 5 MG 15,00
201904003100 15/04/2019 Ruangan TFP 5 MG 14,00 36.113
CLOZAPINE 100 MG 7,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
201904005631 29/04/2019 Ruangan Wijaya TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
958 SUTIK 201904003086 15/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904004593 23/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
959 SUTINAH 201904000205 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
960 SUWARNI / SUMARNI 201904000185 01/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 60,00 27.720
CPZ 100 MG 15,00
961 SUWARNO 201904000629 02/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 74.053
SIKZONOATE 1,00
CPZ 100 MG 4,00
TFP 5 MG 14,00
962 SUWONDO 201904002638 12/04/2019 IGD SPUIT 3 CC 1,00 15.934
CLOZAPINE 25 MG 6,00
DIAZEPAM inj 1,00
201904003030 15/04/2019 Ruangan Puri CLOZAPINE 100 MG 7,00 37.627
DIAZEPAM inj 2,00
SPUIT 3 CC 2,00
201904003035 15/04/2019 Ruangan Puri NORAGES INJEKSI 1,00 70.884
RAMIPRIL 5 MG 15,00
SPUIT 5 CC 1,00
DIAMICRON MR 60 15,00
PARACETAMOL 500 6,00
963 SUYATNO SETIADI 201904005212 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 172.095
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
DEPAKOTE 250 MG 60,00
964 SYAFI'UDIN 201904001557 08/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 60,00 129.300
THD 2 MG 15,00
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 10,00
KAPSUL NO.1 60,00
SERTRALINE 50 MG 30,00
ALPRAZOLAM 1 MG 30,00
965 SYAHRONI 201904002127 10/04/2019 Poli Jiwa Dewasa KAPSUL NO 3 60,00 25.932
RACIKAN KAPSUL 60,00
DIAZEPAM 5 MG 12,00
RISPERIDONE 1 MG 60,00
966 SYAIFULLAH 201904005714 29/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
967 SYAMSUL 201904001813 09/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 36.890
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904003156 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 2,00 5.270
RISPERIDONE 3 MG 2,00
THD 2 MG 2,00
201904003179 15/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 36.890
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904004329 23/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 15,00 39.525
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
967 SYAMSUL 201904004329 23/04/2019 Ruangan
- Gelatik THD 2 MG 15,00 39.525
CLOZAPINE 25 MG 15,00
201904005297 27/04/2019 Ruangan Gelatik THD 2 MG 14,00 36.890
CLOZAPINE 25 MG 14,00
RISPERIDONE 3 MG 14,00
201904005544 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
968 TARI 201904004887 25/04/2019 Ruangan SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
201904005782 29/04/2019 Ruangan TFP 5 MG 12,00 5.964
CPZ 100 MG 6,00
FOLIC ACID 1 MG 12,00
969 TARIP 201904003995 22/04/2019 Psiko Geriatri THD 2 MG 60,00 1.319.115
ABILIFY DISCMELT 15 30,00
CLOZAPINE 100 MG 15,00
DEPAKOTE 250 MG 60,00
970 TATIK INDRAWATI 201904005539 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 17.700
CPZ 100 MG 15,00
HALOPERIDOL 5 MG 60,00
971 TEDY HARMOKO 201904002474 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
972 TEGUH 201904003934 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 17.340
THD 2 MG 30,00
ALPRAZOLAM 0.5 MG 30,00
973 TEGUH BASUKI 201904004220 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 15.090
CPZ 100 MG 30,00
974 TEGUH SUMIYANTO 201904003964 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 100.515
CLOZAPINE 100 MG 15,00
975 TEGUH, SH 201904003229 16/04/2019 Psiko Geriatri SEROQUEL XR 400 2,00 99.135
ALPRAZOLAM 1 MG 15,00
SERTRALINE 50 MG 15,00
KAPSUL NO 2 30,00
NUZIP 25 15,00
RACIKAN KAPSUL 30,00
976 THOLIB 201904003134 15/04/2019 Ruangan Gelatik THD 2 MG 14,00 5.796
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 21,00
201904003153 15/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 3,00 750
THD 2 MG 3,00
201904004336 23/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 11.634
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
976 THOLIB 201904004336 23/04/2019 Ruangan
- Gelatik HALOPERIDOL 5 MG 21,00 11.634
RISPERIDONE 2 MG 14,00
977 TINI 201904000213 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.682
CLOZAPINE 100 MG 14,00
TFP 5 MG 60,00
978 TINI 201904000993 04/04/2019 Ruangan RISPERIDONE 2 MG 5,00 2.085
201904000994 04/04/2019 Ruangan RISPERIDONE 2 MG 5,00 2.085
201904001690 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 5.838
201904001873 09/04/2019 Ruangan KETOKONAZOL 200 10,00 18.950
RACIKAN KAPSUL 10,00
KETOKONAZOL 2,00
KAPSUL NO 2 10,00
LORATADIN 10 MG 10,00
201904003057 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 5.838
979 TIO SOE LAN 201904005180 26/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 511.091
ABILIFY DISCMELT 10 15,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
980 TIRANA LARASUCI 201904004594 23/04/2019 IGD THIAMPHENICOL 500 10,00 15.710
ANTASIDA DOEN 10,00
PARACETAMOL 500 10,00
981 TITIK LINARSIH 201904004154 22/04/2019 IGD CPZ 100 MG 2,00 1.652
TFP 5 MG 4,00
201904004580 23/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904005784 29/04/2019 Ruangan FOLIC ACID 1 MG 10,00 19.402
TABLET TAMBAH 30,00
CPZ 100 MG 7,00
TFP 5 MG 14,00
982 TJENDERA WARDHANA 201904004035 22/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 885.060
CLOZAPINE 25 MG 30,00
983 TJIO FANG LAN / MEME 201904000424 01/04/2019 Ruangan Puri THD 2 MG 14,00 247.187
ABILIFY DISCMELT 10 7,00
LUFTEN 100 MG 4,00
201904001692 08/04/2019 Ruangan Puri LISINOPRIL 10 MG 30,00 64.990
ATORVASTATIN 20 30,00
LANSOPRAZOLE 40,00
201904001693 08/04/2019 Ruangan Puri THD 2 MG 6,00 83.535
ABILIFY DISCMELT 10 3,00
201904001995 09/04/2019 Ruangan Puri SIZORIL 100 MG 6,00 224.252
THD 2 MG 8,00
ABILIFY DISCMELT 10 4,00
984 TJIOE MEI 201904005161 26/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 170.100
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
985 TOKIB 201904004207 23/04/2019 Poli Jiwa- Dewasa RISPERIDONE 1 MG 60,00 21.600
986 TONO YUYUD 201904000609 02/04/2019 Ruangan Gelatik CURCUMA 200 MG 20,00 22.200
201904000918 04/04/2019 Ruangan Gelatik TABLET TAMBAH 20,00 8.520
201904001696 08/04/2019 Ruangan Gelatik CURCUMA 200 MG 21,00 23.310
201904001979 09/04/2019 Ruangan Gelatik THD 2 MG 14,00 1.428
201904003145 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 8.526
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904003158 15/04/2019 Ruangan Gelatik THD 2 MG 15,00 1.530
201904003517 18/04/2019 Ruangan Gelatik CURCUMA 200 MG 21,00 23.310
201904004347 23/04/2019 Ruangan Gelatik THD 2 MG 15,00 9.225
CPZ 100 MG 8,00
RISPERIDONE 2 MG 15,00
987 TOTOK WINARNO 201904002130 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
988 TOYIB 201904004195 22/04/2019 Psiko Geriatri FOLIC ACID 1 MG 60,00 36.180
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
989 TRI ARIES HARRY 201904002420 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 103.290
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 30,00
990 TRI HANDAYANI 201904003973 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 4.845
991 TRI MADYONO 201904002589 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
992 TRI SUKO PRAMONO 201904004066 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
993 TRI WULANDARI 201904003437 17/04/2019 IGD ZYPREXA INJ 1,00 165.974
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 2,00
AQUA PRO INJEKSI 1,00
THD 2 MG 2,00
CPZ 100 MG 2,00
201904003637 18/04/2019 Ruangan Wijaya CPZ 100 MG 8,00 2.624
HALOPERIDOL 5 MG 8,00
201904004298 23/04/2019 Ruangan HALOPERIDOL 5 MG 15,00 4.020
CPZ 100 MG 10,00
201904004597 23/04/2019 Ruangan CIPROFLOXACIN 500 14,00 11.914
TABLET TAMBAH 14,00
201904004983 25/04/2019 Ruangan KETOKONAZOL 200 10,00 14.510
KETOKONAZOL 2,00
201904005749 30/04/2019 Ruangan KAPSUL NO 2 10,00 22.102
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
993 TRI WULANDARI 201904005749 30/04/2019 Ruangan
- LORATADIN 10 MG 10,00 22.102
CPZ 100 MG 6,00
KETOKONAZOL 200 10,00
RACIKAN KAPSUL 10,00
HALOPERIDOL 5 MG 14,00
KETOKONAZOL 2,00
994 TRIANA 201904004123 22/04/2019 Ruangan CLOZAPINE 25 MG 7,00 26.126
THD 2 MG 15,00
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 15,00
201904005285 27/04/2019 Ruangan THD 2 MG 10,00 14.495
CLOZAPINE 25 MG 5,00
RISPERIDONE 2 MG 10,00
995 TRIBUSONO 201904001914 09/04/2019 Ruangan Wijaya THD 2 MG 7,00 3.010
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 7,00
201904003393 16/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 4.760
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004257 23/04/2019 Ruangan Kenari CPZ 100 MG 7,00 4.760
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
996 TRISTIADI MEIDUARSA 201904005022 26/04/2019 Poli VCT ALPRAZOLAM 1 MG 30,00 11.190
AMITRIPTILIN 25 MG 30,00
997 TRIWIYANTI 201904005810 29/04/2019 Ruangan TFP 5 MG 14,00 6.670
THD 2 MG 14,00
CPZ 100 MG 4,00
998 TUK AFANDI 201904005182 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 126.015
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
999 TUKIMIN 201904005583 29/04/2019 Ruangan Kenari SCABIMITE 10 GR 1,00 50.025
RISPERIDONE 2 MG 15,00
THD 2 MG 15,00
201904006068 30/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 46.260
SCABIMITE 10 GR 1,00
1000 TUTIK KISWOJO 201904005518 29/04/2019 Psiko Geriatri ABILIFY DISCMELT 10 30,00 860.205
CLOZAPINE 25 MG 15,00
THD 2 MG 30,00
1001 TUTIK WONG 201904005755 29/04/2019 Ruangan RISPERIDONE 2 MG 14,00 28.381
CLOZAPINE 25 MG 7,00
SIMVASTATIN 20 MG 10,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1001 TUTIK WONG 201904005755 29/04/2019 Ruangan
- LORATADIN 10 MG 10,00 28.381
THD 2 MG 14,00
BETAMETASON 1,00
1002 UDIN BAKTIAR 201904004221 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1003 UMAM MUHAWAROH/ 201904005507 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 246.946
HALDOL DECANOAS 1,00
DEPAKOTE 250 MG 60,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CPZ 100 MG 60,00
1004 UMI 201904005761 29/04/2019 Ruangan THD 2 MG 15,00 20.395
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
1005 UMI AMANAH RAHAYU 201904000764 04/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 125.655
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
1006 UMI KALSUM 201904005550 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 26.940
THD 2 MG 60,00
CPZ 100 MG 8,00
1007 UMI ROSIDAH 201904002134 10/04/2019 Ruangan THD 2 MG 5,00 13.985
CLOZAPINE 25 MG 5,00
RISPERIDONE 2 MG 10,00
201904002627 12/04/2019 Ruangan RAMIPRIL 5 MG 10,00 14.480
TABLET TAMBAH 20,00
AMLODIPIN 5 10,00
201904002834 15/04/2019 Ruangan RISPERIDONE 3 MG 16,00 95.267
SPUIT 3 CC 1,00
THD 2 MG 8,00
CLOZAPINE 25 MG 8,00
SIKZONOATE 1,00
1008 UMI SALAMAH 201904001525 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 110.355
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 15,00
1009 UMMI 201904000591 02/04/2019 Ruangan Puri SERTRALINE 50 MG 4,00 12.622
LORAZEPAM 2 MG 2,00
THD 2 MG 4,00
RISPERIDONE 3 MG 4,00
201904001192 05/04/2019 Poli Psikiater LORAZEPAM 2 MG 4,00 22.556
THD 2 MG 7,00
RISPERIDONE 3 MG 7,00
SERTRALINE 50 MG 7,00
1010 UMUL BARIYAH 201904005280 27/04/2019 Poli Psikiater KAPSUL NO.00 20,00 306.670
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1010 UMUL BARIYAH 201904005280 27/04/2019 Poli Psikiater
- MERLOPAM 2 MG 5,00 306.670
RACIKAN KAPSUL 20,00
SEROQUEL XR 200 10,00
DEPTRAL 50 MG 10,00
1011 VALEN 201904003262 16/04/2019 Poli Jiwa Anak VIT B6 10 MG 8,00 127.348
RACIKAN KAPSUL 15,00
ABILIFY DISCMELT 15 2,00
FOLIC ACID 1 MG 6,00
SERTRALINE 50 MG 3,00
PROHIPER 10 8,00
KAPSUL NO 2 15,00
1012 VERA INDRI SASWITA 201904004053 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 153.570
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
1013 VERIL VADLI 201904004362 23/04/2019 IGD TFP 5 MG 4,00 2.420
THD 2 MG 4,00
CPZ 100 MG 4,00
201904004585 23/04/2019 Ruangan Wijaya TFP 5 MG 12,00 7.260
THD 2 MG 12,00
CPZ 100 MG 12,00
201904005835 29/04/2019 Ruangan Gelatik TFP 5 MG 15,00 9.075
THD 2 MG 15,00
CPZ 100 MG 15,00
1014 VIAN MAHENDRA 201904002677 14/04/2019 Poli Psikiater RACIKAN KAPSUL 90,00 347.238
ALGANAX 0,5 MG 90,00
TFP 5 MG 36,00
KAPSUL NO.0 90,00
THD 2 MG 45,00
1015 VINCENT CHRISTIAN 201904002367 11/04/2019 Poli Jiwa Anak CPZ 100 MG 15,00 89.888
KUTOIN 38,00
RACIKAN KAPSUL 30,00
RISPERIDONE 3 MG 10,00
KAPSUL NO.00 30,00
KUTOIN 30,00
RACIKAN KAPSUL 30,00
CPZ 100 MG 6,00
KUTOIN 38,00
KAPSUL NO.00 30,00
RISPERIDONE 3 MG 10,00
1016 VIVI PRAMITA 201904001129 05/04/2019 IGD NUZIP 25 15,00 23.625
201904001229 05/04/2019 Ruangan Puri RISPERIDONE 1 MG 14,00 12.642
THD 2 MG 7,00
NOPRES 20 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1016 VIVI PRAMITA 201904001269 07/04/2019 Ruangan
- Puri DULCOLAX SUPPO 2,00 27.104
201904002513 12/04/2019 Poli Psikolog RISPERIDONE 1 MG 120,00 221.370
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
ELIZAC 20 MG 60,00
1017 W. NATASSA SYLCIA 201904000759 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 142.395
CLOZAPINE 25 MG 15,00
DEPAKOTE 250 MG 60,00
RISPERIDONE 2 MG 60,00
1018 WAHIB SHOLIKHAN 201904001031 05/04/2019 Ruangan Kenari THD 2 MG 5,00 510
201904002606 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
1019 WAHONO 201904002977 15/04/2019 Ruangan Kenari TABLET TAMBAH 14,00 8.952
VIT B COMPLEX 24,00
FOLIC ACID 1 MG 7,00
201904002989 15/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 5.838
201904003404 16/04/2019 Ruangan Kenari LORAZEPAM 2 MG 3,00 2.805
201904004317 23/04/2019 Ruangan Kenari LORAZEPAM 2 MG 4,00 13.148
RISPERIDONE 3 MG 14,00
1020 WAHYU FERDIANSYAH 201904000649 03/04/2019 Poli Umum SPUIT 3 CC 1,00 9.851
NORAGES INJEKSI 1,00
201904001241 06/04/2019 IGD IKANEURON INJ 5000 1,00 43.006
SPUIT 3 CC 2,00
NORAGES INJEKSI 1,00
INFUS SET DEWASA 1,00
RINGER LACTAT 1,00
IV CANULA NO. 18 1,00
1021 WAHYU MARGA S 201904002465 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 414.990
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
TOPAMAX 100 MG 30,00
1022 WAHYUNI 201904003448 17/04/2019 IGD RISPERIDONE 1 MG 12,00 8.672
THD 2 MG 6,00
LORAZEPAM 2 MG 4,00
1023 WANDI 201904002965 15/04/2019 Poli Jiwa Dewasa THD 2 MG 14,00 5.796
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 21,00
201904003012 15/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 21,00 5.796
THD 2 MG 14,00
CPZ 100 MG 7,00
1024 WARAS 201904003015 15/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1024 WARAS 201904004267 23/04/2019 Ruangan
- Kenari CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904005718 29/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 5.838
1025 WARTO 201904001750 08/04/2019 Ruangan Gelatik AMOXYCILLIN 500 15,00 15.156
ASAM MEFENAMAT 10,00
PEHACHAIN INJ 2,00
201904001975 09/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 1,00 9.925
RISPERIDONE 3 MG 12,00
201904003188 16/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 3,00 3.877
CLOZAPINE 25 MG 1,00
1026 WELLI BUDIONO 201904002311 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1027 WIDIATI SAKINAH 201904005895 30/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 238.761
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 6,00
FOLIC ACID 1 MG 15,00
THD 2 MG 8,00
KAPSUL NO.00 30,00
1028 WIDO HARIADI 201904000357 01/04/2019 Ruangan Napza CATAFLAM 50 MG 10,00 168.636
METRONIDAZOLE 20,00
NUZIP 25 14,00
AMOXYCILLIN 500 15,00
RISPERIDONE 3 MG 28,00
CURCUMA 200 MG 42,00
201904002935 15/04/2019 Ruangan Napza RISPERIDONE 3 MG 28,00 44.870
CLOZAPINE 25 MG 14,00
201904004173 22/04/2019 Ruangan Napza RISPERIDONE 3 MG 8,00 55.392
CLOZAPINE 25 MG 6,00
CURCUMA 200 MG 35,00
1029 WIDODO 201904002334 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1030 WIDYA KARINA 201904003940 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 97.845
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
1031 WIDYANDOKO 201904004024 22/04/2019 Poli Jiwa Dewasa HALDOL DECANOAS 1,00 186.196
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1032 WIJANTI 201904003946 22/04/2019 Poli Jiwa Dewasa NOPRES 20 MG 15,00 42.675
CLOZAPINE 25 MG 15,00
1033 WIJAYANTI 201904004075 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 40.388
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1033 WIJAYANTI 201904004075 22/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 8,00 40.388
1034 WIJI ERIPAH 201904001018 04/04/2019 Ruangan Puri RISPERIDONE 2 MG 15,00 67.181
THD 2 MG 15,00
CLOZAPINE 100 MG 7,00
FRIMANIA 400 MG 15,00
201904001989 09/04/2019 Ruangan Puri FRIMANIA 400 MG 8,00 83.586
THD 2 MG 21,00
CLOZAPINE 100 MG 4,00
OLANZPINE 10mg 8,00
RISPERIDONE 2 MG 8,00
201904003023 15/04/2019 Ruangan Puri HALOPERIDOL 5 MG 10,00 1.480
201904003664 18/04/2019 Ruangan Puri CLOZAPINE 100 MG 3,00 12.039
201904004109 22/04/2019 Ruangan Puri CLOZAPINE 100 MG 11,00 161.887
THD 2 MG 15,00
HALOPERIDOL 5 MG 10,00
ABILIFY DISCMELT 10 4,00
RISPERIDONE 2 MG 10,00
1035 WILSON 201904002991 15/04/2019 Ruangan Kenari TFP 5 MG 21,00 17.619
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
201904004286 23/04/2019 Ruangan Kenari THD 2 MG 14,00 14.049
RISPERIDONE 2 MG 14,00
TFP 5 MG 21,00
201904006065 30/04/2019 Ruangan Kenari THD 2 MG 14,00 17.619
RISPERIDONE 3 MG 14,00
TFP 5 MG 21,00
1036 WINARNI 201904000158 01/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 14,00 10.045
LORAZEPAM 2 MG 7,00
THD 2 MG 14,00
201904001645 08/04/2019 Ruangan SIKZONOATE 1,00 78.856
LORAZEPAM 2 MG 7,00
SPUIT 3 CC 1,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
201904001862 09/04/2019 Ruangan FOLIC ACID 1 MG 10,00 23.870
TABLET TAMBAH 20,00
KETOKONAZOL 200 10,00
KETOKONAZOL 2,00
201904003081 15/04/2019 Ruangan LORAZEPAM 2 MG 7,00 10.045
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
201904004591 23/04/2019 Ruangan LORAZEPAM 2 MG 7,00 10.045
THD 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1036 WINARNI 201904004591 23/04/2019 Ruangan
- HALOPERIDOL 5 MG 14,00 10.045
201904005772 29/04/2019 Ruangan HALOPERIDOL 5 MG 14,00 10.045
LORAZEPAM 2 MG 7,00
THD 2 MG 14,00
1037 WINARSIH 201904002372 11/04/2019 IGD SPUIT 3 CC 1,00 11.469
CLOZAPINE 100 MG 1,00
DIAZEPAM inj 1,00
RISPERIDONE 3 MG 4,00
201904002620 12/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 5,00 16.025
RISPERIDONE 3 MG 10,00
201904003060 15/04/2019 Ruangan CLOZAPINE 25 MG 5,00 16.025
RISPERIDONE 3 MG 10,00
201904004283 23/04/2019 Ruangan RISPERIDONE 3 MG 12,00 19.089
NUZIP 25 7,00
1038 WINARTI 201904003059 15/04/2019 Ruangan RISPERIDONE 3 MG 14,00 100.268
CLOZAPINE 100 MG 14,00
THD 2 MG 14,00
LORAZEPAM 2 MG 14,00
DEPAKOTE 250 MG 14,00
201904003682 19/04/2019 Ruangan LORAZEPAM 2 MG 14,00 100.268
DEPAKOTE 250 MG 14,00
RISPERIDONE 3 MG 14,00
CLOZAPINE 100 MG 14,00
THD 2 MG 14,00
1039 WINDA WULAN BIASTUTI 201904005898 30/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 46.592
FOLIC ACID 1 MG 30,00
TFP 5 MG 60,00
KAPSUL NO.00 30,00
THD 2 MG 60,00
CLOZAPINE 100 MG 4,00
1040 WIRO 201904004217 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1041 WONG HIM MOY 201904003021 15/04/2019 Poli Psikiater CLORILEX 25 MG 10,00 57.280
NOPRES 20 MG 10,00
THD 2 MG 20,00
STELAZINE 5 MG 8,00
1042 WULAN SARI SETYO 201904001508 10/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 15 30,00 1.253.370
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1043 YAKUDU 201904004208 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1044 YANTI 201904001488 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 20.400
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1044 YANTI 201904001488 08/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
1045 YATI MALU 201904001667 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.812
THD 2 MG 7,00
CPZ 100 MG 7,00
201904003052 15/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.812
THD 2 MG 7,00
CPZ 100 MG 7,00
201904004259 23/04/2019 Ruangan THD 2 MG 14,00 8.526
CPZ 100 MG 7,00
RISPERIDONE 2 MG 14,00
1046 YENNY ANGGARAINI 201904003505 18/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1047 YENNY OKTAVIA 201904002654 13/04/2019 Poli Psikiater NERIPROS 2 MG 60,00 1.697.460
SEROQUEL XR 400 60,00
THD 2 MG 60,00
1048 YENY WAHYU PRISTA 201904001236 05/04/2019 IGD LORAZEPAM 2 MG 4,00 11.396
SERTRALINE 50 MG 4,00
1049 YOGI HERDIYANTO 201904004755 24/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 105.870
RISPERIDONE 2 MG 120,00
1050 YOHANES BUDIYANTO 201904002476 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 220.605
RISPERIDONE 2 MG 60,00
CLOZAPINE 100 MG 45,00
THD 2 MG 60,00
1051 YONG PURNOMO 201904001036 05/04/2019 Ruangan Kenari LORAZEPAM 2 MG 4,00 3.740
201904003046 15/04/2019 Ruangan Kenari THD 2 MG 14,00 15.015
LORAZEPAM 2 MG 7,00
TFP 5 MG 14,00
CPZ 100 MG 14,00
201904004319 23/04/2019 Ruangan Kenari CPZ 100 MG 14,00 15.015
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
TFP 5 MG 14,00
1052 YUBBY FITRIA 201904001531 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 637.350
LORAZEPAM 2 MG 30,00
FRIMANIA 200 MG 60,00
1053 YUDI 201904004200 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 58.890
THD 2 MG 30,00
1054 YUDISTIRA 201904005568 29/04/2019 Ruangan Kenari THD 2 MG 10,00 5.510
CPZ 100 MG 7,00
TFP 5 MG 10,00
1055 YUHEN ALBERTO 201904003124 15/04/2019 Ruangan Gelatik TFP 5 MG 15,00 7.101
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1055 YUHEN ALBERTO 201904003124 15/04/2019 Ruangan
- Gelatik THD 2 MG 8,00 7.101
CPZ 100 MG 8,00
201904004318 23/04/2019 Ruangan Gelatik TFP 5 MG 15,00 7.101
THD 2 MG 8,00
CPZ 100 MG 8,00
201904005844 29/04/2019 Ruangan Gelatik TFP 5 MG 15,00 7.101
THD 2 MG 8,00
CPZ 100 MG 8,00
201904006087 30/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 12,00 22.944
THD 2 MG 6,00
1056 YULI PURWANTO 201904000431 01/04/2019 Poli Psikiater SIZORIL 25 MG 3,00 28.079
SIZORIL 100 MG 1,00
1057 YULIA SELVIAN 201904003937 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1058 YULIA WATI NOFITA SARI 201904000419 01/04/2019 Ruangan Puri SERTRALINE 50 MG 2,00 11.864
CLOZAPINE 25 MG 4,00
HALOPERIDOL 5 MG 4,00
1059 YULIANA 201904001261 06/04/2019 Medical Check Up CEFADROXIL 500 MG 10,00 14.580
CODEIN 10 MG 10,00
1060 YULIANTI 201904005521 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
1061 YUNARTI 201904003480 18/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 15,00 85.050
1062 YUNIAWATI 201904001753 08/04/2019 Puri Mitra TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904002976 15/04/2019 Puri Mitra TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904004176 22/04/2019 Puri Mitra TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904005207 26/04/2019 Poli Gigi (Jiwa) TFP 5 MG 30,00 15.450
THD 2 MG 30,00
CPZ 100 MG 15,00
1063 YUNITA 201904001263 07/04/2019 Poli Psikiater IKALEP 250 MG 6,00 436.692
KAPSUL NO.00 6,00
ABILIFY DISCMELT 15 3,00
RACIKAN KAPSUL 6,00
CIPRALEX 20 MG 6,00
CLOBAZAM 10 MG 3,00
THD 2 MG 2,00
201904003670 18/04/2019 Poli Psikiater THD 2 MG 2,00 436.692
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1063 YUNITA 201904003670 18/04/2019 Poli Psikiater
- IKALEP 250 MG 6,00 436.692
KAPSUL NO.00 6,00
ABILIFY DISCMELT 15 3,00
RACIKAN KAPSUL 6,00
CIPRALEX 20 MG 6,00
CLOBAZAM 10 MG 3,00
1064 YUNITA DIAH ANGGRAEN 201904002653 13/04/2019 Poli Psikiater THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
1065 YUNITA EGE ATE 201904003088 15/04/2019 IGD DEMACOLIN 10,00 20.503
NEURODEK 10,00
MASKER O2 TANPA 1,00
201904003089 15/04/2019 IGD DEMACOLIN 10,00 20.503
NEURODEK 10,00
MASKER O2 TANPA 1,00
1066 YUSAN WIJAYA 201904003764 22/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 60,00 1.342.200
CLOZAPINE 100 MG 60,00
SEROQUEL XR 400 30,00
RISPERIDONE 2 MG 60,00
1067 YUSI WIDA KUSUMAWATI 201904005314 28/04/2019 IGD THD 2 MG 4,00 12.206
CLOZAPINE 25 MG 4,00
LODOMER 2 MG/ML 1,00
TFP 5 MG 4,00
SPUIT 3 CC 1,00
201904005600 29/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 14,00 32.004
TFP 5 MG 14,00
THD 2 MG 14,00
1068 YUSUB GEBI 201904004706 24/04/2019 Ruangan Wijaya CPZ 100 MG 1,00 826
TFP 5 MG 2,00
201904004970 25/04/2019 Ruangan Gelatik CPZ 100 MG 4,00 3.304
TFP 5 MG 8,00
201904005830 29/04/2019 Ruangan Gelatik SCABIMITE 10 GR 1,00 42.240
201904006074 30/04/2019 Ruangan Gelatik DOXYCICLIN 100 MG 20,00 15.860
1069 YUWONO SEPUTRA 201904005515 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
1070 YUYUN HAMIDAH 201904004029 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 159.690
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
1071 ZAENAL ABIDIN 201904003123 15/04/2019 Ruangan Gelatik TFP 5 MG 15,00 32.760
CLOZAPINE 25 MG 15,00
201904004348 23/04/2019 Ruangan Gelatik TFP 5 MG 15,00 32.760
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1071 ZAENAL ABIDIN 201904004348 23/04/2019 Ruangan
- Gelatik CLOZAPINE 25 MG 15,00 32.760
201904005282 27/04/2019 Ruangan Gelatik TFP 5 MG 14,00 30.576
CLOZAPINE 25 MG 14,00
1072 ZAENAL ARIFIN 201904003669 18/04/2019 IGD CPZ 100 MG 5,00 4.130
TFP 5 MG 10,00
201904004356 23/04/2019 Ruangan Gelatik TFP 5 MG 15,00 6.285
CPZ 100 MG 8,00
201904005839 29/04/2019 Ruangan Gelatik CPZ 100 MG 8,00 6.285
TFP 5 MG 15,00
201904006073 30/04/2019 Ruangan Gelatik THD 2 MG 12,00 1.224
1073 ZAINAL ABIDIN 201904002880 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 20.812
RISPERIDONE 2 MG 15,00
THD 2 MG 15,00
201904004308 23/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904005823 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
1074 ZAINUL ARIF 201904002667 14/04/2019 IGD RISPERIDONE 2 MG 4,00 10.102
THD 2 MG 4,00
CLOZAPINE 100 MG 2,00
201904002964 15/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 21.331
RISPERIDONE 2 MG 16,00
THD 2 MG 16,00
201904003398 16/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 12,00 22.332
201904004138 22/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 10,00 50.495
THD 2 MG 10,00
CLOZAPINE 25 MG 5,00
DEPAKOTE ER 500 5,00
201904005789 29/04/2019 Ruangan Gelatik METFORMIN 500 MG 20,00 3.960
201904005838 29/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 80.273
THD 2 MG 15,00
CLOZAPINE 25 MG 8,00
DEPAKOTE ER 500 8,00
201904006084 30/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 12,00 8.064
1075 ZAINUL ARIFIN 201904001104 05/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 301.695
TFP 5 MG 60,00
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
201904005183 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1076 ZAKARIA 201904004203 22/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
1077 ZENI BUDI LEKSANA 201904000329 01/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 39.823
CLOZAPINE 25 MG 7,00
201904002169 10/04/2019 Ruangan Napza PROBENID 500 MG 12,00 26.244
201904002929 15/04/2019 Ruangan Napza SERTRALINE 50 MG 14,00 39.823
CLOZAPINE 25 MG 7,00
201904003647 18/04/2019 Ruangan Napza SIMVASTATIN 20 MG 15,00 3.690
201904004170 23/04/2019 Ruangan Napza SERTRALINE 50 MG 6,00 66.139
SIMVASTATIN 20 MG 23,00
CLOZAPINE 25 MG 4,00
PROBENID 500 MG 19,00
1078 ZIYADUR ROHMAN 201904004801 25/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 6,00 6.836
THD 2 MG 6,00
CLOZAPINE 25 MG 2,00
201904004967 25/04/2019 Ruangan Kenari HALDOL DECANOAS 1,00 144.539
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 14,00
CLOZAPINE 25 MG 7,00
THD 2 MG 14,00
201904005701 29/04/2019 Ruangan Kenari THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
1079 ZULDA PRAMESTAMA P 201904001230 05/04/2019 Poli Psikiater DEPAKOTE ER 500 30,00 261.810
PHENYTOIN CAP 100 90,00
1080 ZULES ANDI WARTONO 201904001238 05/04/2019 IGD SERTRALINE 50 MG 4,00 22.544
CLOZAPINE 25 MG 8,00
1081 201904000004 01/04/2019 Unit Pelayanan NEW DIATAB 4,00 21.482
PARACETAMOL 500 10,00
ASAM MEFENAMAT 10,00
DEMACOLIN 10,00
GLIMEPIRIDE 4 MG 30,00
201904000934 04/04/2019 Unit Pelayanan AMLODIPIN 10 30,00 16.424
NEW DIATAB 8,00
AMOXYCILLIN 500 10,00
GENTAMYCIN SALEP 1,00
201904001781 09/04/2019 Unit Pelayanan MELOXICAM 15 MG 10,00 37.310
NEURODEK 10,00
METFORMIN 500 MG 10,00
DOMPERIDONE 20,00
NA DICLOFENAC 50 20,00
1082 A FAUZI 201904003362 16/04/2019 Unit Pelayanan THD 2 MG 200,00 168.400
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1082 A FAUZI 201904003362 16/04/2019 Unit Pelayanan
- RISPERIDONE 2 MG 200,00 168.400
TFP 5 MG 200,00
1083 A. MUSLIM (026833) 201904002539 12/04/2019 Unit Pelayanan TFP 5 MG 60,00 190.080
NOPRES 20 MG 60,00
CLOZAPINE 25 MG 60,00
1084 A.SYAIFUDIN (037737) 201904004036 22/04/2019 Unit Pelayanan THD 2 MG 200,00 85.000
TFP 5 MG 200,00
1085 ACH TAUFIQ (024279) 201904002043 10/04/2019 Unit Pelayanan CLOZAPINE 25 MG 100,00 224.520
TFP 5 MG 100,00
THD 2 MG 60,00
1086 ACH TOHA (049039) 201904005881 30/04/2019 Unit Pelayanan BAMGETOL 200 MG 120,00 171.120
1087 ADRIAN 201904001490 08/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 60,00 16.350
AMITRIPTILIN 25 MG 30,00
1088 AGUS 049756 201904002625 12/04/2019 Unit Pelayanan THD 2 MG 120,00 72.600
CPZ 100 MG 120,00
TFP 5 MG 120,00
1089 AGUS M (029267) 201904001360 08/04/2019 Unit Pelayanan CLOZAPINE 25 MG 60,00 137.160
TFP 5 MG 60,00
THD 2 MG 60,00
1090 AGUS NJUDIBJANTO 201904000003 01/04/2019 Unit Pelayanan CLOZAPINE 25 MG 15,00 45.375
CLOBAZAM 10 MG 15,00
1091 AHMAD 201904005021 26/04/2019 Unit Pelayanan IKANEURON INJ 5000 1,00 5.881
1092 AHMAD FAUZI (051180) 201904000351 01/04/2019 Unit Pelayanan THD 2 MG 200,00 121.000
CPZ 100 MG 200,00
TFP 5 MG 200,00
1093 ALIYATUL HIMMAH 201904003195 16/04/2019 Unit Pelayanan KAPSUL NO 2 180,00 269.298
KUTOIN 270,00
LORAZEPAM 2 MG 90,00
HALOPERIDOL 5 MG 36,00
RACIKAN KAPSUL 180,00
1094 ALWI (024818) 201904002537 12/04/2019 Unit Pelayanan CPZ 100 MG 120,00 33.840
THD 2 MG 120,00
201904005855 30/04/2019 Unit Pelayanan RISPERIDONE 2 MG 120,00 50.040
1095 ANANG ASHARUDIN 201904003191 16/04/2019 Unit Pelayanan SIKZONOATE 2,00 132.250
1096 ANDERSON DYE 201904003901 22/04/2019 Unit Pelayanan FRIMANIA 200 MG 90,00 990.523
FRIMANIA 400 MG 179,00
OLANZPINE 10mg 90,00
1097 ANDREW S 201904003758 22/04/2019 Unit Pelayanan TFP 5 MG 15,00 34.466
THD 2 MG 15,00
CLOZAPINE 100 MG 7,00
1098 ANIK M 201904002845 15/04/2019 Unit Pelayanan THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1099 ANTON H 201904002276 11/04/2019 Unit Pelayanan
- ALPRAZOLAM 1 MG 90,00 15.480
1100 ANWAR SADAD (023067) 201904000245 01/04/2019 Unit Pelayanan THD 2 MG 200,00 20.400
1101 ARBIAH 201904005300 27/04/2019 Unit Pelayanan NA DICLOFENAC 50 20,00 27.883
AMITRIPTILIN 25 MG 4,00
VIT B1 50 MG 20,00
KAPSUL NO 2 20,00
RACIKAN KAPSUL 20,00
DIAZEPAM 5 MG 4,00
KAPSUL NO 2 20,00
RACIKAN KAPSUL 20,00
GABAPENTIN 300 MG 7,00
1102 ARIF BUDI WAHONO 201904003739 21/04/2019 Unit Pelayanan SERTRALINE 50 MG 2,00 10.238
CLOZAPINE 25 MG 2,00
RISPERIDONE 3 MG 4,00
1103 ARIFIN 201904002812 15/04/2019 Unit Pelayanan RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1104 ASLAKHA (056564) 201904003746 22/04/2019 Unit Pelayanan ALGANAX 1 MG 25,00 115.500
1105 Aminah (049732) 201904000616 02/04/2019 Unit Pelayanan TFP 5 MG 120,00 162.660
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
1106 Arbiah 201904002362 11/04/2019 Unit Pelayanan RACIKAN KAPSUL 20,00 26.043
DIAZEPAM 5 MG 4,00
KAPSUL NO 2 20,00
RACIKAN KAPSUL 20,00
GABAPENTIN 300 MG 7,00
NA DICLOFENAC 50 20,00
AMITRIPTILIN 25 MG 4,00
VIT B1 IOO MG 10,00
KAPSUL NO 2 20,00
1107 BENY DECTUS 201904004484 23/04/2019 Unit Pelayanan THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
1108 BRAMANTA (040661) 201904001809 09/04/2019 Unit Pelayanan NOPRES 20 MG 15,00 131.914
CLOZAPINE 100 MG 8,00
OLANZPINE 10mg 15,00
201904005019 26/04/2019 Unit Pelayanan SIZORIL 25 MG 60,00 185.340
1109 BUDIANTO HALIM 201904001866 09/04/2019 Unit Pelayanan SIZORIL 25 MG 50,00 2.918.550
ABILIFY DISCMELT 10 100,00
1110 CESAR CORBY (056251) 201904003630 18/04/2019 Unit Pelayanan TFP 5 MG 180,00 76.500
THD 2 MG 180,00
1111 CHARIOS (027300) 201904003420 16/04/2019 Unit Pelayanan CLOZAPINE 100 MG 120,00 650.040
RISPERIDONE 3 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1111 CHARIOS (027300) 201904003420 16/04/2019 Unit Pelayanan
- KAPSUL NO.0 120,00 650.040
THD 2 MG 120,00
CLOBAZAM 10 MG 60,00
RACIKAN KAPSUL 120,00
1112 CHARLES 201904002246 11/04/2019 Unit Pelayanan VENTOLIN INHALER 2,00 409.520
FLIXOTIDE 20,00
1113 CHUSNUL CHOTIMAH 201904003851 22/04/2019 Unit Pelayanan THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
1114 DEBBY P M 201904002526 12/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 60,00 42.915
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
1115 DECRISTO 201904004895 25/04/2019 Unit Pelayanan TFP 5 MG 300,00 859.370
CLOZAPINE 100 MG 190,00
201904004920 25/04/2019 Unit Pelayanan CLOZAPINE 100 MG 190,00 859.370
TFP 5 MG 300,00
1116 DEWI AYU 201904001304 08/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 55.830
1117 DEWI R (034648) 201904001779 09/04/2019 Unit Pelayanan CLOBAZAM 10 MG 60,00 87.600
HALOPERIDOL 5 MG 120,00
201904001789 09/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 60,00 8.880
201904004368 23/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 120,00 51.600
THD 2 MG 120,00
CPZ 100 MG 120,00
201904005890 30/04/2019 Unit Pelayanan THD 2 MG 120,00 51.600
CPZ 100 MG 120,00
HALOPERIDOL 5 MG 120,00
1118 DIAN S (056030) 201904004572 23/04/2019 Unit Pelayanan CPZ 100 MG 150,00 121.950
THD 2 MG 100,00
HALOPERIDOL 5 MG 150,00
RISPERIDONE 2 MG 150,00
1119 DILA LESTARI 201904003954 22/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 15,00 2.580
1120 DINA 201904002253 11/04/2019 Unit Pelayanan THD 2 MG 60,00 45.165
LORAZEPAM 2 MG 15,00
RISPERIDONE 2 MG 60,00
1121 DJUNAIDI (054079) 201904003747 22/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 16,00 2.752
1122 DODDY R 201904001114 05/04/2019 Unit Pelayanan CLOZAPINE 25 MG 15,00 27.915
1123 DR DIYAN W 201904004922 25/04/2019 Unit Pelayanan PARACETAMOL 500 30,00 76.710
CODEIN 20 MG 45,00
RACIKAN KAPSUL 30,00
KAPSUL NO 2 30,00
1124 DR F KINTONO SPKJ 201904002671 14/04/2019 Unit Pelayanan RIZODAL 2 MG 200,00 1.923.600
DEPAKOTE ER 500 100,00
LAMIROS 100 MG 100,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1125 DR HENDRO RIYANTO 201904001772 08/04/2019 Unit Pelayanan
- RISPERDAL CONSTA 2,00 1.916.262
1126 DR MELANI H (508892) 201904001487 08/04/2019 Unit Pelayanan RIZODAL 2 MG 100,00 377.400
ALPRAZOLAM 1 MG 100,00
CLOZAPINE 25 MG 100,00
1127 DR RIZA 201904004713 24/04/2019 Unit Pelayanan EPINEPHRINE INJ 3,00 29.160
1128 DR WIDYA ( 517082 ) 201904002309 11/04/2019 Unit Pelayanan GLUCOSAMINE 60,00 100.320
VALISANBE 2 MG 60,00
1129 DR WIEDYA N 201904000880 04/04/2019 Unit Pelayanan BISOPROLOL 5 MG 30,00 285.300
DIAMICRON MR 60 60,00
ATORVASTATIN 20 60,00
1130 DWI U (053286) 201904000231 01/04/2019 Unit Pelayanan THD 2 MG 60,00 229.440
CLOZAPINE 25 MG 120,00
1131 Dr. Arsanto. S (517744) 201904000430 01/04/2019 Unit Pelayanan RINGER LACTAT 4,00 24.960
1132 EFFENDI 201904003482 18/04/2019 Unit Pelayanan CLOZAPINE 100 MG 5,00 20.065
1133 EKA A (025581) 201904004768 24/04/2019 Unit Pelayanan SIZORIL 25 MG 180,00 556.020
1134 EKA BUDIHARJO (055311) 201904005876 30/04/2019 Unit Pelayanan RISPERIDONE 2 MG 120,00 285.600
THD 2 MG 120,00
CLOZAPINE 25 MG 120,00
1135 ELLYS 201904004774 24/04/2019 Unit Pelayanan NOVOMIX PEN 5,00 605.000
1136 ELLYZABETH 201904002815 15/04/2019 Unit Pelayanan RIZODAL 2 MG 100,00 537.320
THD 2 MG 100,00
SIZORIL 25 MG 60,00
KSR 100,00
1137 ELLYZABETH (515717) 201904005950 30/04/2019 Unit Pelayanan NOVOMIX PEN 5,00 577.500
1138 ELY SPING (039208) 201904001030 05/04/2019 Unit Pelayanan ALPRAZOLAM 0.5 MG 30,00 4.590
1139 ENI FARITA (040866) 201904001094 05/04/2019 Unit Pelayanan LAMIROS 100 MG 15,00 128.310
1140 ERNA (511768) 201904004506 23/04/2019 Unit Pelayanan PIRACETAM 800 MG 30,00 44.520
AMLODIPIN 10 60,00
ATORVASTATIN 20 20,00
1141 ERSALINA 201904002293 11/04/2019 Unit Pelayanan SERTRALINE 50 MG 30,00 57.420
1142 EVA DIAN 201904001231 05/04/2019 Unit Pelayanan CEFIXIME 200 MG 10,00 31.320
GLYSERIL 10,00
1143 F KINTONO 201904004573 23/04/2019 Unit Pelayanan FRIMANIA 200 MG 30,00 35.550
1144 FARHAN 201904002806 18/04/2019 Unit Pelayanan THD 2 MG 14,00 91.070
CLORILEX 25 MG 7,00
IKALEP 250 MG 14,00
1145 FARIS (044303) 201904004367 23/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 120,00 51.600
THD 2 MG 120,00
CPZ 100 MG 120,00
1146 FARIS A (044303) 201904005412 29/04/2019 Unit Pelayanan RISPERIDONE 3 MG 120,00 148.710
THD 2 MG 120,00
CLOZAPINE 25 MG 30,00
1147 FARITA (020818) 201904000032 01/04/2019 Unit Pelayanan THD 2 MG 120,00 51.600
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1147 FARITA (020818) 201904000032 01/04/2019 Unit Pelayanan
- CPZ 100 MG 120,00 51.600
HALOPERIDOL 5 MG 120,00
201904000482 02/04/2019 Unit Pelayanan THD 2 MG 120,00 51.000
TFP 5 MG 120,00
201904003892 22/04/2019 Unit Pelayanan RISPERIDONE 2 MG 120,00 82.920
THD 2 MG 120,00
ALPRAZOLAM 1 MG 120,00
1148 FAUZI (051180) 201904005078 26/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 106.830
TFP 5 MG 120,00
THD 2 MG 120,00
1149 FERY DWI A (041840) 201904003628 18/04/2019 Unit Pelayanan THD 2 MG 180,00 76.500
TFP 5 MG 180,00
1150 FIRDA C (058031) 201904002666 13/04/2019 Unit Pelayanan THD 2 MG 45,00 36.990
RISPERIDONE 1 MG 90,00
1151 FIRMAN FAJAR 201904003844 22/04/2019 Unit Pelayanan ATORVASTATIN 20 30,00 28.620
1152 FITRA 513602 201904000305 01/04/2019 Unit Pelayanan CODEIN 10 MG 20,00 13.200
1153 FITRIANITA (517711) 201904001788 09/04/2019 Unit Pelayanan CONCOR 2,5 MG 20,00 38.520
THYROZOL 5 MG 20,00
SPIRONOLACTONE 20,00
1154 FONDRA (047702) 201904000583 02/04/2019 Unit Pelayanan TFP 5 MG 60,00 36.300
THD 2 MG 60,00
CPZ 100 MG 60,00
1155 FONNY (058866) 201904003604 18/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
1156 FRANKY J (506904) 201904003862 22/04/2019 Unit Pelayanan AMBROXOL 30 MG 30,00 64.140
NA DICLOFENAC 50 30,00
AMOXYCILLIN 500 30,00
DEMACOLIN 30,00
DEXAMETASON 0,5 30,00
NEURODEK 30,00
1157 FREDY RIKO 051062 201904002635 12/04/2019 Unit Pelayanan THD 2 MG 90,00 843.930
HALOPERIDOL 0,5 270,00
ALGANAX 0,5 MG 90,00
SERTRALINE 50 MG 90,00
SIZORIL 25 MG 90,00
ALPRAZOLAM 0.5 MG 180,00
1158 FUAD ROHMAN (038885 ) 201904004924 25/04/2019 Unit Pelayanan TFP 5 MG 4,00 9.726
THD 2 MG 4,00
CLOZAPINE 100 MG 2,00
1159 Fitra Ardiansyah 201904003704 19/04/2019 Unit Pelayanan CODEIN 20 MG 15,00 22.500
1160 GO YENNY (037894) 201904001417 08/04/2019 Unit Pelayanan SIZORIL 25 MG 60,00 185.340
1161 GO YENNY G 201904003773 22/04/2019 Unit Pelayanan SEROQUEL XR 300 30,00 493.350
1162 HAKIM A 201904004884 25/04/2019 Unit Pelayanan CLOZAPINE 25 MG 15,00 164.911
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1162 HAKIM A 201904004884 25/04/2019 Unit Pelayanan
- THD 2 MG 30,00 164.911
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
TFP 5 MG 30,00
1163 HANIFA (058542) 201904000655 04/04/2019 Unit Pelayanan LORAZEPAM 2 MG 30,00 115.470
SERTRALINE 50 MG 30,00
HALOPERIDOL 5 MG 120,00
THD 2 MG 120,00
1164 HANSE A 201904004411 23/04/2019 Unit Pelayanan THD 2 MG 60,00 36.600
CPZ 100 MG 120,00
HALOPERIDOL 5 MG 60,00
1165 HARDINATA 201904000010 01/04/2019 Unit Pelayanan SERTRALINE 50 MG 30,00 57.420
1166 HARI MULYONO 201904004860 25/04/2019 Unit Pelayanan CLOBAZAM 10 MG 120,00 216.240
KUTOIN 120,00
1167 HASAN 201904002242 11/04/2019 Unit Pelayanan CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
1168 HENDRA RINALDI ( 201904004850 25/04/2019 Unit Pelayanan ELIZAC 20 MG 30,00 60.630
KAPSUL NO 2 60,00
RACIKAN KAPSUL 60,00
1169 HENRA RINALDI ( 046919 201904004826 25/04/2019 Unit Pelayanan KAPSUL NO 2 30,00 129.630
THD 2 MG 30,00
RACIKAN KAPSUL 30,00
ELIZAC 20 MG 15,00
CLOZAPINE 25 MG 45,00
RISPERIDONE 2 MG 30,00
1170 HENY 201904005946 30/04/2019 Unit Pelayanan NOPRES 20 MG 15,00 14.760
1171 HERI H 201904004481 23/04/2019 Unit Pelayanan SERTRALINE 50 MG 30,00 57.420
1172 HERI S (049404) 201904005877 30/04/2019 Unit Pelayanan CPZ 100 MG 120,00 51.600
HALOPERIDOL 5 MG 120,00
THD 2 MG 120,00
1173 HERI SUSANTO 201904002072 10/04/2019 Unit Pelayanan RISPERIDONE 2 MG 30,00 18.270
THD 2 MG 30,00
CPZ 100 MG 15,00
1174 HERMAN EFENDI 201904001787 09/04/2019 Unit Pelayanan CLOZAPINE 25 MG 200,00 372.200
201904003487 18/04/2019 Unit Pelayanan THD 2 MG 200,00 50.000
HALOPERIDOL 5 MG 200,00
1175 HILAL 201904004527 23/04/2019 Unit Pelayanan ELIZAC 20 MG 15,00 30.315
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
1176 IMAH 201904002558 12/04/2019 Unit Pelayanan CPZ 100 MG 4,00 11.556
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
1177 INDAH NUR (039412) 201904002062 10/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 120,00 40.800
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1177 INDAH NUR (039412) 201904002062 10/04/2019 Unit Pelayanan
- THD 2 MG 120,00 40.800
CPZ 100 MG 60,00
1178 INDAH S 201904000144 01/04/2019 Unit Pelayanan CPZ 100 MG 30,00 5.400
1179 INDRA 201904000910 04/04/2019 Unit Pelayanan DEPAKOTE ER 500 100,00 720.000
1180 INONG 201904003880 22/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 163.290
RISPERIDONE 2 MG 120,00
SERTRALINE 50 MG 30,00
1181 IVANA 201904005848 30/04/2019 Unit Pelayanan CLOZAPINE 25 MG 90,00 183.330
HALOPERIDOL 5 MG 45,00
THD 2 MG 90,00
1182 IVANA (515898) 201904003352 16/04/2019 Unit Pelayanan CEFIXIME 200 MG 10,00 37.030
METHYLPREDNISOL 10,00
AMBROXOL 30 MG 10,00
1183 JOKO SANTOSO (044678) 201904000238 01/04/2019 Unit Pelayanan RISPERIDONE 2 MG 120,00 279.480
THD 2 MG 60,00
CLOZAPINE 25 MG 120,00
1184 JTING TJONG ( 507509 ) 201904000908 04/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 30,00 4.440
1185 KALIM (010500) 201904000045 01/04/2019 Unit Pelayanan CPZ 100 MG 120,00 72.600
TFP 5 MG 120,00
THD 2 MG 120,00
1186 KARTIKA 201904001459 08/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 30,00 5.160
1187 KARTINI (508582) 201904004743 24/04/2019 Unit Pelayanan KAPSUL NO 2 30,00 19.161
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 15,00
RACIKAN KAPSUL 30,00
HALOPERIDOL 5 MG 3,00
SERTRALINE 50 MG 8,00
201904004780 24/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 100,00 17.200
1188 KASINEM (036544) 201904005847 30/04/2019 Unit Pelayanan HALOPERIDOL 1,5 120,00 132.780
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
1189 KASTINAH (509404) 201904001120 05/04/2019 Unit Pelayanan THD 2 MG 100,00 10.200
201904003923 22/04/2019 Unit Pelayanan CLOZAPINE 25 MG 150,00 279.150
1190 KHOFIFAH 201904000846 04/04/2019 Unit Pelayanan ASAM VALPROAT 1,00 27.585
1191 KIRANA DEWI (021198) 201904003895 22/04/2019 Unit Pelayanan TFP 5 MG 120,00 119.400
NOPRES 20 MG 60,00
CPZ 100 MG 120,00
1192 KIRANA DEWI C 201904000851 04/04/2019 Unit Pelayanan CPZ 100 MG 60,00 36.300
TFP 5 MG 60,00
THD 2 MG 60,00
1193 KOIRUN R 201904003809 22/04/2019 Unit Pelayanan THD 2 MG 30,00 67.770
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1194 LAMINI (058622) 201904004479 23/04/2019 Unit Pelayanan
- SEROQUEL XR 300 30,00 470.940
1195 LELY 201904005130 26/04/2019 Unit Pelayanan THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1196 LEO M (008532) 201904001300 08/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 60,00 25.800
THD 2 MG 60,00
CPZ 100 MG 60,00
1197 LIA CHUSANTI (511887) 201904001548 08/04/2019 Unit Pelayanan THD 2 MG 60,00 25.800
CPZ 100 MG 60,00
HALOPERIDOL 5 MG 60,00
1198 LIANTI 201904000579 02/04/2019 Unit Pelayanan RIZODAL 2 MG 20,00 220.160
SIZORIL 25 MG 60,00
1199 LULUK (517677) 201904001420 08/04/2019 Unit Pelayanan KAPSUL NO 2 15,00 36.569
RACIKAN KAPSUL 15,00
AZITROMYCIN 500 5,00
LORATADIN 10 MG 5,00
SALBUTAMOL 4 MG 1,00
CODEIN 15 MG 15,00
METHYLPREDNISOL 15,00
201904006021 30/04/2019 Unit Pelayanan METHYLPREDNISOL 3,00 18.360
CODEIN 20 MG 8,00
RACIKAN KAPSUL 15,00
KAPSUL NO 2 15,00
CETIRIZINE TABLET 10,00
1200 LULUK FARIDA 201904003527 18/04/2019 Unit Pelayanan RISPERIDONE 2 MG 30,00 71.400
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1201 LUSIANA 201904001234 05/04/2019 Unit Pelayanan THD 2 MG 120,00 575.760
OLANZPINE 10mg 60,00
CLOZAPINE 25 MG 120,00
1202 M CAHYONO 9 057829 0 201904006029 30/04/2019 Unit Pelayanan NERIPROS ORAL 1,00 275.935
1203 M IMAM 201904003802 22/04/2019 Unit Pelayanan SERTRALINE 50 MG 30,00 85.500
THD 2 MG 30,00
RISPERIDONE 2 MG 60,00
1204 M IRFAN 201904004904 25/04/2019 Unit Pelayanan CLOZAPINE 25 MG 2,00 5.798
RISPERIDONE 2 MG 4,00
THD 2 MG 4,00
1205 M SAHID 201904003476 18/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 118.110
RISPERIDONE 2 MG 120,00
THD 2 MG 120,00
1206 M SAMSURI (055886) 201904005878 30/04/2019 Unit Pelayanan THD 2 MG 120,00 51.600
CPZ 100 MG 120,00
HALOPERIDOL 5 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1207 M SUYONO (042000) 201904000229 01/04/2019 Unit Pelayanan
- HALOPERIDOL 5 MG 120,00 23.880
THD 2 MG 60,00
1208 M ZAINUL A (043086) 201904000157 01/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 55.830
1209 M ZAINUL A(043086) 201904002283 11/04/2019 Unit Pelayanan TFP 5 MG 120,00 72.600
THD 2 MG 120,00
CPZ 100 MG 120,00
1210 M ZAINUL ARIFIN 201904005887 30/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 120,00 294.960
THD 2 MG 120,00
CLOZAPINE 25 MG 120,00
TFP 5 MG 120,00
1211 MAJDI (507597) 201904002019 10/04/2019 Unit Pelayanan ATORVASTATIN 20 15,00 47.115
PROBENID 500 MG 15,00
201904002106 10/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 60,00 84.840
THD 2 MG 60,00
CLOBAZAM 10 MG 60,00
1212 MARDIATIM 201904000708 04/04/2019 Unit Pelayanan DIAZEPAM 5 MG 60,00 18.780
ALPRAZOLAM 1 MG 60,00
201904005065 26/04/2019 Unit Pelayanan ALPRAZOLAM 1 MG 90,00 28.170
DIAZEPAM 5 MG 90,00
1213 MARIA (058439) 201904001415 08/04/2019 Unit Pelayanan RISPERIDONE 3 MG 45,00 1.034.535
KAPSUL NO 2 30,00
ABILIFY DISCMELT 10 30,00
RACIKAN KAPSUL 45,00
TFP 5 MG 30,00
KAPSUL NO 2 45,00
SIZORIL 25 MG 45,00
RISPERIDONE 3 MG 30,00
THD 2 MG 30,00
RACIKAN KAPSUL 30,00
1214 MAT HADI (055400) 201904005289 27/04/2019 Unit Pelayanan CPZ 100 MG 120,00 51.600
HALOPERIDOL 5 MG 120,00
THD 2 MG 120,00
201904005879 30/04/2019 Unit Pelayanan THD 2 MG 120,00 72.600
CPZ 100 MG 120,00
TFP 5 MG 120,00
1215 MELANI HANDOJO 201904002629 12/04/2019 Unit Pelayanan RIZODAL 2 MG 100,00 191.300
ALPRAZOLAM 1 MG 100,00
1216 MOCH HANAFI (027869) 201904005891 30/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 120,00 51.600
THD 2 MG 120,00
CPZ 100 MG 120,00
1217 MOCH. HANAFI (027869) 201904003512 18/04/2019 Unit Pelayanan THD 2 MG 60,00 36.300
CPZ 100 MG 60,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1218 MOCH.CHANAFI 201904002819 15/04/2019 Unit Pelayanan
- TFP 5 MG 60,00 36.300
THD 2 MG 60,00
CPZ 100 MG 60,00
1219 MOERSITI 201904005363 29/04/2019 Unit Pelayanan ALPRAZOLAM 0.5 MG 30,00 4.590
1220 MOH HAYAT 201904001293 08/04/2019 Unit Pelayanan CLOZAPINE 100 MG 30,00 176.550
RISPERIDONE 2 MG 120,00
THD 2 MG 60,00
1221 MOH IKROM (056191) 201904005883 30/04/2019 Unit Pelayanan CLOBAZAM 10 MG 120,00 139.680
1222 MOH SAMSURI (055886) 201904002042 10/04/2019 Unit Pelayanan CLOZAPINE 25 MG 100,00 224.520
TFP 5 MG 100,00
THD 2 MG 60,00
1223 MORSIDI 201904003523 18/04/2019 Unit Pelayanan TFP 5 MG 60,00 117.799
THD 2 MG 60,00
CLOZAPINE 100 MG 23,00
1224 MUALIM (058545) 201904004536 23/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 54,00 47.238
RISPERIDONE 3 MG 30,00
KAPSUL NO 2 180,00
THD 2 MG 113,00
RACIKAN KAPSUL 180,00
1225 MUDALI (057901) 201904005853 30/04/2019 Unit Pelayanan THD 2 MG 160,00 96.800
CPZ 100 MG 160,00
TFP 5 MG 160,00
1226 MUH BASOFI 201904001163 05/04/2019 Unit Pelayanan CLOZAPINE 25 MG 4,00 9.705
TFP 5 MG 7,00
1227 MULYADI 201904001504 08/04/2019 Unit Pelayanan PEHACHAIN INJ 2,00 6.726
1228 MULYANI ( 515571) 201904000753 04/04/2019 Unit Pelayanan GLUCOSAMINE 40,00 90.768
DULCOLAX 5MG 12,00
NEURODEK 30,00
1229 MULYONO 201904001006 04/04/2019 Unit Pelayanan ASAM MEFENAMAT 10,00 67.950
DEXAMETASON 0,5 10,00
VALSARTAN NI FCT 20,00
1230 MURTIYANI 201904000656 04/04/2019 Unit Pelayanan ACETYLCYSTEINE 20,00 55.080
CODEIN 20 MG 20,00
201904001387 08/04/2019 Unit Pelayanan PARACETAMOL 500 10,00 2.770
NIFEDIPIN 10 MG 1,00
1231 MURTIYANI (508109) 201904003531 18/04/2019 Unit Pelayanan CODEIN 20 MG 15,00 75.415
SALBUTAMOL 4 MG 4,00
CEFIXIME 200 MG 12,00
KAPSUL NO 2 30,00
CETIRIZINE TABLET 23,00
RACIKAN KAPSUL 30,00
AMBROXOL 30 MG 23,00
1232 Mayda 201904001215 05/04/2019 Unit Pelayanan PARACETAMOL 500 20,00 21.800
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1232 Mayda 201904001215 05/04/2019 Unit Pelayanan
- ACYCLOVIR 400 MG 30,00 21.800
1233 NAILA I R (056598) 201904004390 23/04/2019 Unit Pelayanan THD 2 MG 60,00 121.650
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
1234 NANANG 201904001512 08/04/2019 Unit Pelayanan TFP 5 MG 60,00 25.500
THD 2 MG 60,00
1235 NASIR 201904005120 26/04/2019 Unit Pelayanan RISPERIDONE 1 MG 60,00 55.635
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
1236 NATAWIRA (513043) 201904002243 11/04/2019 Unit Pelayanan MERLOPAM 2 MG 20,00 51.480
201904003768 22/04/2019 Unit Pelayanan THD 2 MG 20,00 12.840
RISPERIDONE 1 MG 30,00
1237 NICO PRASETYO ( 201904003605 18/04/2019 Unit Pelayanan KAPSUL NO 2 30,00 64.077
SERTRALINE 50 MG 15,00
RACIKAN KAPSUL 30,00
THD 2 MG 8,00
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 8,00
1238 NURHAYATI 201904004489 23/04/2019 Unit Pelayanan CPZ 100 MG 30,00 89.211
SIKZONOATE 1,00
HALOPERIDOL 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
1239 NURMA 201904005321 29/04/2019 Unit Pelayanan BUSCOPAN PLUS 4,00 20.904
1240 NURUL HAWA (511881) 201904005393 29/04/2019 Unit Pelayanan CETIRIZINE TABLET 10,00 6.840
HIDROKORTISON 1,00
1241 NY IMANAH ( 517207) 201904002613 12/04/2019 Unit Pelayanan SERTRALINE 50 MG 90,00 218.970
THD 2 MG 90,00
RISPERIDONE 2 MG 90,00
1242 NY TUMIATI (517186) 201904002345 11/04/2019 Unit Pelayanan AMBROXOL 30 MG 20,00 35.560
CODEIN 20 MG 20,00
1243 NY YULIATI 201904004923 25/04/2019 Unit Pelayanan ASAM MEFENAMAT 10,00 8.430
AMOXYCILLIN 500 15,00
1244 Ny Elisabeth (024526) 201904002651 13/04/2019 Unit Pelayanan SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
1245 PARYONO 201904002234 11/04/2019 Unit Pelayanan METHYLPREDNISOL 20,00 12.480
LORATADIN 10 MG 10,00
1246 PAULUS ROBIN (032325) 201904000474 02/04/2019 Unit Pelayanan KUTOIN 60,00 38.280
1247 PRIHATIN RAHAYU 201904003307 16/04/2019 Unit Pelayanan THD 2 MG 10,00 4.250
TFP 5 MG 10,00
1248 PRIYO WIDODO 201904005449 29/04/2019 Unit Pelayanan CLOZAPINE 100 MG 5,00 29.370
CLOZAPINE 25 MG 5,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1249 PURNAMA SARI (057675) 201904001042 05/04/2019 Unit Pelayanan
- OLANZPINE 10mg 30,00 185.910
TFP 5 MG 30,00
THD 2 MG 60,00
1250 PURWANTO (039694) 201904000806 04/04/2019 Unit Pelayanan CLOBAZAM 10 MG 60,00 69.840
1251 R THERDY 201904001496 08/04/2019 Unit Pelayanan THD 2 MG 5,00 510
1252 RADEN (057890) 201904001823 09/04/2019 Unit Pelayanan THD 2 MG 90,00 153.720
BAMGETOL 200 MG 90,00
CPZ 100 MG 90,00
1253 RADEN ARTO M 201904001801 09/04/2019 Unit Pelayanan CLOZAPINE 100 MG 15,00 60.195
1254 RENY M (511837) 201904001592 08/04/2019 Unit Pelayanan NA CL 0,9 % 500 ML 3,00 19.230
1255 RESOPIN 201904004433 23/04/2019 Unit Pelayanan THD 2 MG 120,00 61.800
CPZ 100 MG 60,00
TFP 5 MG 120,00
1256 REZA 201904001486 08/04/2019 Unit Pelayanan SERTRALINE 50 MG 30,00 97.740
RISPERIDONE 3 MG 60,00
1257 RICKY RIKO 051063 201904002636 12/04/2019 Unit Pelayanan HALOPERIDOL 0,5 270,00 733.410
ALGANAX 0,5 MG 90,00
ALPRAZOLAM 0.5 MG 180,00
SERTRALINE 50 MG 90,00
CLOZAPINE 25 MG 90,00
THD 2 MG 90,00
1258 RISTIONO 201904001464 08/04/2019 Unit Pelayanan ALPRAZOLAM 0.5 MG 30,00 4.590
1259 RIYANI RIKO ( 056792 ) 201904002585 12/04/2019 Unit Pelayanan RISPERIDONE 2 MG 20,00 199.740
CLOBAZAM 10 MG 30,00
THD 2 MG 20,00
CLOZAPINE 25 MG 60,00
BAMGETOL 200 MG 30,00
1260 RIZQI 201904002233 11/04/2019 Unit Pelayanan LORATADIN 10 MG 10,00 34.665
METHYLPREDNISOL 20,00
CLINDAMYCIN 300 15,00
1261 ROCHIMAH 201904005543 29/04/2019 Unit Pelayanan NEURODEK 60,00 115.200
GLUCOSAMINE 60,00
1262 RODIYAH (007988) 201904001294 08/04/2019 Unit Pelayanan AMITRIPTILIN 25 MG 120,00 24.120
1263 ROHMAD 201904002503 12/04/2019 Unit Pelayanan THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
1264 ROSDIANA (507502) 201904001852 09/04/2019 Unit Pelayanan CPZ 100 MG 200,00 78.500
TFP 5 MG 100,00
THD 2 MG 100,00
201904004509 23/04/2019 Unit Pelayanan LORATADIN 10 MG 10,00 16.260
THD 2 MG 120,00
1265 ROSDIANA J (507502 ) 201904001604 08/04/2019 Unit Pelayanan THD 2 MG 60,00 25.500
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1266 ROSITA (517625) 201904002023 11/04/2019 Unit Pelayanan
- RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
CPZ 100 MG 30,00
201904003925 22/04/2019 Unit Pelayanan ALGANAX 0,5 MG 30,00 388.050
CLOZAPINE 25 MG 150,00
1267 ROSITA(517625) 201904002353 12/04/2019 Unit Pelayanan THD 2 MG 40,00 11.280
CPZ 100 MG 40,00
1268 SAIFUDIN 201904002248 11/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 66.390
HALOPERIDOL 1,5 60,00
THD 2 MG 60,00
1269 SAMPINI 201904001043 05/04/2019 Unit Pelayanan ATORVASTATIN 20 60,00 57.240
201904002543 12/04/2019 Unit Pelayanan NA DICLOFENAC 50 5,00 47.112
MYONAL 50 MG 5,00
AMITRIPTILIN 25 MG 1,00
RACIKAN KAPSUL 5,00
VALISANBE 2 MG 3,00
KAPSUL NO 2 5,00
VIT B1 50 MG 5,00
201904005646 29/04/2019 Unit Pelayanan ANTASIDA DOEN 5,00 6.180
DOMPERIDONE 5,00
LANSOPRAZOLE 5,00
1270 SARI 201904001082 05/04/2019 Unit Pelayanan TFP 5 MG 90,00 87.960
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1271 SERLI (517169) 201904002091 10/04/2019 Unit Pelayanan CIPRALEX 10 MG 30,00 601.080
1272 SETIYO (028003) 201904003569 18/04/2019 Unit Pelayanan CLOZAPINE 25 MG 90,00 167.490
1273 SETIYO H 201904003234 16/04/2019 Unit Pelayanan CLOZAPINE 25 MG 90,00 167.490
1274 SHODIKIN (511773) 201904003922 22/04/2019 Unit Pelayanan CLOZAPINE 100 MG 50,00 309.550
ALGANAX 0,5 MG 30,00
201904004574 23/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 150,00 121.950
RISPERIDONE 2 MG 150,00
CPZ 100 MG 150,00
THD 2 MG 100,00
1275 SHOLIKIN (517242) 201904002681 14/04/2019 Unit Pelayanan THD 2 MG 36,00 98.712
LEVOPAR 36,00
1276 SINAR B 201904005863 30/04/2019 Unit Pelayanan CPZ 100 MG 15,00 15.450
TFP 5 MG 30,00
THD 2 MG 30,00
1277 SINAWATI 201904005279 27/04/2019 Unit Pelayanan SIMVASTATIN 20 MG 24,00 5.904
1278 SITI AMINAH (020328) 201904002227 11/04/2019 Unit Pelayanan CPZ 100 MG 120,00 21.600
201904003231 16/04/2019 Unit Pelayanan TFP 5 MG 120,00 51.000
THD 2 MG 120,00
1279 SITI MUARIFAH (506975) 201904002198 11/04/2019 Unit Pelayanan THD 2 MG 15,00 13.920
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1279 SITI MUARIFAH (506975) 201904002198 11/04/2019 Unit Pelayanan
- CPZ 100 MG 15,00 13.920
TFP 5 MG 30,00
1280 SITI ROCHANA ( 050206 ) 201904005018 26/04/2019 Unit Pelayanan DEPTRAL 50 MG 15,00 589.560
CLOBAZAM 10 MG 15,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 10,00
KAPSUL NO 2 30,00
1281 SITI UMAROH (052096) 201904003614 18/04/2019 Unit Pelayanan CLOZAPINE 25 MG 110,00 204.710
1282 SODIKIN (511773) 201904002425 13/04/2019 Unit Pelayanan THD 2 MG 100,00 409.420
DIAZEPAM 5 MG 100,00
TFP 5 MG 40,00
CLOZAPINE 25 MG 200,00
1283 SOEYANTO 201904003560 18/04/2019 Unit Pelayanan TFP 5 MG 30,00 118.050
THD 2 MG 60,00
DEPAKOTE ER 250 30,00
1284 SONNY DWI (050203) 201904001743 08/04/2019 Unit Pelayanan CLONAZEPAM 2 MG 30,00 177.840
1285 SRI SURYATI (059069) 201904006045 30/04/2019 Unit Pelayanan RISPERIDONE 3 MG 200,00 154.800
THD 2 MG 200,00
1286 SUGIH W (049421) 201904001122 05/04/2019 Unit Pelayanan SPUIT 3 CC 3,00 206.433
SIKZONOATE 3,00
1287 SUHERMANTO 201904002872 15/04/2019 Unit Pelayanan CEFADROXIL 500 MG 22,00 17.556
1288 SUKAWIT (058400) 201904003194 16/04/2019 Unit Pelayanan ARICEPT 10 MG 28,00 637.296
PUSPALIN 500mg 60,00
1289 SUKO (037870) 201904004115 22/04/2019 Unit Pelayanan SIZORIL 25 MG 5,00 15.445
1290 SULIATI 201904002414 12/04/2019 Unit Pelayanan TFP 5 MG 30,00 9.690
1291 SULISYAWATI 201904004478 23/04/2019 Unit Pelayanan SPUIT 3 CC 1,00 124.246
HALDOL DECANOAS 1,00
1292 SUNAH /LIFA 201904005401 29/04/2019 Unit Pelayanan TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
1293 SUNARSIH (509750) 201904003613 18/04/2019 Unit Pelayanan PROBENID 500 MG 30,00 65.610
1294 SUNTI YATIM 201904003624 18/04/2019 Unit Pelayanan TFP 5 MG 30,00 9.690
1295 SUPARDI (034210) 201904001451 08/04/2019 Unit Pelayanan SIZORIL 25 MG 30,00 111.300
RISPERIDONE 2 MG 30,00
THD 2 MG 60,00
1296 SUPRIYADI 201904004985 26/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 100,00 111.811
SPUIT 3 CC 1,00
THD 2 MG 100,00
CPZ 100 MG 100,00
SIKZONOATE 1,00
1297 SUPRIYADI 201904005475 29/04/2019 Unit Pelayanan TFP 5 MG 60,00 36.300
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1297 SUPRIYADI 201904005475 29/04/2019 Unit Pelayanan
- CPZ 100 MG 60,00 36.300
1298 SUPRIYADI (015942) 201904005851 30/04/2019 Unit Pelayanan THD 2 MG 120,00 51.600
CPZ 100 MG 120,00
HALOPERIDOL 5 MG 120,00
201904006028 30/04/2019 Unit Pelayanan SIKZONOATE 2,00 423.222
RISPERIDONE 2 MG 120,00
SPUIT 3 CC 2,00
THD 2 MG 120,00
CLOZAPINE 25 MG 120,00
1299 SUROSO (020120) 201904002145 10/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 120,00 30.000
THD 2 MG 120,00
1300 SUSIANA G 201904002854 15/04/2019 Unit Pelayanan LANTUS SOLOSTAR 5,00 446.250
1301 SUUD (016787) 201904004610 24/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 40,00 12.040
THD 2 MG 60,00
1302 SUYONO (020163) 201904000654 04/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 55.830
1303 SYAFI'I 201904002164 10/04/2019 Unit Pelayanan CLOBAZAM 10 MG 100,00 322.800
BAMGETOL 200 MG 100,00
KUTOIN 100,00
1304 SYAIFUL SULUM 201904001295 08/04/2019 Unit Pelayanan RISPERIDONE 2 MG 120,00 72.600
THD 2 MG 120,00
ALPRAZOLAM 1 MG 60,00
1305 SYHARIL A 201904000718 04/04/2019 Unit Pelayanan CPZ 100 MG 15,00 68.520
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
1306 TAUFIK B 201904005094 26/04/2019 Unit Pelayanan PUSPALIN 500mg 30,00 136.620
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
1307 TINI (058864) 201904001037 05/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 70.920
TFP 5 MG 30,00
CPZ 100 MG 30,00
1308 TIWAH (510191) 201904002009 10/04/2019 Unit Pelayanan CLOZAPINE 25 MG 30,00 106.830
TFP 5 MG 120,00
THD 2 MG 120,00
201904003232 16/04/2019 Unit Pelayanan CLOZAPINE 25 MG 10,00 18.610
1309 TJANDRANINGSIH 201904005639 29/04/2019 Unit Pelayanan RACIKAN KAPSUL 2,00 165.283
CLOZAPINE 25 MG 1,00
ABILIFY DISCMELT 15 1,00
PROPANOLOL 10 MG 2,00
AMITRIPTILIN 25 MG 1,00
SERTRALINE 50 MG 62,00
KAPSUL NO 2 31,00
RACIKAN KAPSUL 31,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1309 TJANDRANINGSIH 201904005639 29/04/2019 Unit Pelayanan
- CLOBAZAM 10 MG 2,00 165.283
VIT B6 10 MG 31,00
KAPSUL NO 2 2,00
1310 TN AGUSTINUS SINAGA 201904001283 07/04/2019 Unit Pelayanan THD 2 MG 60,00 99.940
CLOZAPINE 25 MG 40,00
TFP 5 MG 60,00
1311 TN TRI HADI ( 515059) 201904003567 18/04/2019 Unit Pelayanan CENDO XITROL E D 1,00 34.172
1312 TUMIATI (517186) 201904001922 09/04/2019 Unit Pelayanan ATORVASTATIN 20 60,00 57.240
1313 TUNAS H 201904002015 10/04/2019 Unit Pelayanan TFP 5 MG 60,00 19.380
1314 UP 201904000438 01/04/2019 Unit Pelayanan GLIMEPIRIDE 4 MG 30,00 26.572
DEMACOLIN 10,00
ASAM MEFENAMAT 10,00
PARACETAMOL 500 10,00
NEW DIATAB 4,00
BETAHISTINE 6-IF 5,00
VIT B6 10 MG 10,00
201904001016 04/04/2019 Unit Pelayanan ATORVASTATIN 20 6,00 26.484
NEW DIATAB 8,00
AMLODIPIN 10 40,00
BETAMETASON 2,00
AMOXYCILLIN 500 10,00
GENTAMYCIN SALEP 1,00
201904001262 07/04/2019 Unit Pelayanan ACYCLOVIR 400 MG 10,00 19.596
PARACETAMOL 500 10,00
ACYCLOVIR CREAM 2,00
ASAM MEFENAMAT 10,00
201904001756 08/04/2019 Unit Pelayanan AMOXYCILLIN 500 12,00 30.662
PARACETAMOL 500 10,00
AMBROXOL 30 MG 10,00
ASAM MEFENAMAT 10,00
MERSIBION 5000 2,00
AMLODIPIN 10 50,00
CEFADROXIL 500 MG 10,00
201904002005 09/04/2019 Unit Pelayanan NEURODEK 10,00 37.310
METFORMIN 500 MG 10,00
DOMPERIDONE 20,00
NA DICLOFENAC 50 20,00
MELOXICAM 15 MG 10,00
201904003675 18/04/2019 Unit Pelayanan AMLODIPIN 10 30,00 34.035
KETOKONAZOL 2,00
CLINDAMYCIN 300 5,00
DESOXIMETASONE 1,00
201904003709 20/04/2019 Unit Pelayanan GLUCOSAMINE 10,00 22.980
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1314 UP 201904003709 20/04/2019 Unit Pelayanan
- MICONAZOLE 2,00 22.980
201904004180 22/04/2019 Unit Pelayanan AMOXYCILLIN 500 10,00 20.724
ASAM MEFENAMAT 10,00
CATAFLAM 50 MG 2,00
201904004369 23/04/2019 Unit Pelayanan ATORVASTATIN 20 30,00 142.440
PROBENID 500 MG 50,00
DEXAMETASON 0,5 10,00
AMOXYCILLIN 500 10,00
ISDN 5 MG 2,00
201904004735 24/04/2019 Unit Pelayanan GLYSERIL 10,00 31.940
AMLODIPIN 10 10,00
TABLET TAMBAH 20,00
GLIMEPIRIDE 4 MG 50,00
ALLOPURINOL 100 30,00
201904005271 26/04/2019 Unit Pelayanan PARACETAMOL 500 20,00 57.640
AMLODIPIN 10 30,00
CLINDAMYCIN 300 10,00
BEDAK SALICYL 1,00
NA DICLOFENAC 50 10,00
CATGUT CHROMIC 1,00
CEFADROXIL 500 MG 10,00
201904005685 29/04/2019 Unit Pelayanan DEMACOLIN 20,00 23.060
ASAM MEFENAMAT 10,00
AMLODIPIN 10 30,00
SIMVASTATIN 20 MG 20,00
AMOXYCILLIN 500 10,00
1315 UP (KATNO) 201904001119 05/04/2019 Unit Pelayanan NOVORAPID PEN 2,00 200.100
1316 UP HENDRO 201904001065 05/04/2019 Unit Pelayanan MINIASPI 80 MG 100,00 11.900
201904003319 16/04/2019 Unit Pelayanan LEVEMIR FLEX PEN 5,00 488.800
1317 UP IVANA 201904002209 11/04/2019 Unit Pelayanan PLETAAL 100 mg 30,00 202.020
1318 UP PAK KATNO 201904005570 29/04/2019 Unit Pelayanan NOVORAPID PEN 2,00 200.100
1319 Up 201904002369 11/04/2019 Unit Pelayanan ACYCLOVIR CREAM 1,00 24.873
DEMACOLIN 10,00
ASAM MEFENAMAT 10,00
ACYCLOVIR 400 MG 20,00
PARACETAMOL 500 10,00
1320 VERA ( 026797) 201904001608 08/04/2019 Unit Pelayanan SEROQUEL XR 400 60,00 1.659.480
SIZORIL 25 MG 120,00
1321 VIVI D Y (057208) 201904001413 08/04/2019 Unit Pelayanan RIZODAL 2 MG 180,00 696.300
SIZORIL 25 MG 120,00
THD 2 MG 120,00
1322 WAHYU H (507392) 201904004644 24/04/2019 Unit Pelayanan ABILIFY DISCMELT 10 20,00 1.523.000
RIZODAL 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1322 WAHYU H (507392) 201904004644 24/04/2019 Unit Pelayanan
- DEPAKOTE 250 MG 100,00 1.523.000
ALPRAZOLAM 1 MG 10,00
DEPAKOTE ER 500 100,00
201904005150 26/04/2019 Unit Pelayanan RIZODAL 2 MG 60,00 1.345.690
DEPAKOTE 250 MG 100,00
ALPRAZOLAM 1 MG 10,00
DEPAKOTE ER 500 100,00
ABILIFY DISCMELT 10 20,00
1323 WIBISONO ( 037241 ) 201904002612 12/04/2019 Unit Pelayanan TFP 5 MG 160,00 80.480
CPZ 100 MG 160,00
201904004803 25/04/2019 Unit Pelayanan THD 2 MG 120,00 80.540
CPZ 100 MG 200,00
TFP 5 MG 100,00
1324 YENI TEDJA S (050523) 201904003770 22/04/2019 Unit Pelayanan OLANZPINE 10mg 30,00 546.900
SIZORIL 25 MG 120,00
THD 2 MG 60,00
1325 YUDHI PURNOMO 201904002942 15/04/2019 Unit Pelayanan THD 2 MG 20,00 59.460
SERTRALINE 50 MG 30,00
1326 YULIAN M 201904002534 12/04/2019 Unit Pelayanan TFP 5 MG 30,00 12.750
THD 2 MG 30,00
1327 YULIATI 201904004915 25/04/2019 Unit Pelayanan AMOXYCILLIN 500 15,00 8.430
ASAM MEFENAMAT 10,00
1328 YUNUS NAIDI 201904000480 02/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 20,00 2.960
1329 achmad (052872 ) 201904001183 05/04/2019 Unit Pelayanan SEROQUEL XR 200 30,00 514.800
1330 adran datti ( 051505 ) 201904006015 30/04/2019 Unit Pelayanan CLOBAZAM 10 MG 100,00 178.224
RACIKAN KAPSUL 200,00
FOLIC ACID 1 MG 100,00
RISPERIDONE 3 MG 67,00
KAPSUL NO 2 200,00
1331 ahmad F ( 052872 ) 201904000522 02/04/2019 Unit Pelayanan RIKLONA 2 MG 60,00 3.052.380
SEROQUEL XR 400 120,00
1332 ahmad fatih ( 052872 ) 201904000260 01/04/2019 Unit Pelayanan SEROQUEL XR 400 90,00 1.933.200
1333 akhmad busiri 026383 201904001024 04/04/2019 Unit Pelayanan CLOZAPINE 25 MG 4,00 80.815
SIKZONOATE 1,00
RISPERIDONE 2 MG 8,00
SPUIT 3 CC 1,00
THD 2 MG 12,00
1334 andry (055042) 201904003428 16/04/2019 Unit Pelayanan SERTRALINE 50 MG 2,00 12.704
TFP 5 MG 2,00
CLOZAPINE 100 MG 2,00
THD 2 MG 2,00
1335 burhanuddin yunus 201904001023 04/04/2019 Unit Pelayanan PARACETAMOL 500 10,00 11.800
CIPROFLOXACIN 500 6,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1335 burhanuddin yunus 201904001023 04/04/2019 Unit Pelayanan
- CODEIN 10 MG 10,00 11.800
1336 dedet febrian (058742) 201904001193 05/04/2019 Unit Pelayanan RISPERIDONE 2 MG 30,00 69.930
SERTRALINE 50 MG 30,00
1337 dr Deni C 201904001289 08/04/2019 Unit Pelayanan PARACETAMOL 1,00 10.929
VENTOLIN NEBULES 2,00
1338 dr, Esther 201904003685 19/04/2019 Unit Pelayanan DIOVAN FCT 80 MG 120,00 109.200
NOPRES 20 MG 15,00
1339 dr. Rifatul Hasnah 201904000613 02/04/2019 Unit Pelayanan BETAMETASON 3,00 56.773
RANITIDIN TAB 150 20,00
ANTASIDA DOEN 20,00
GENTAMYCIN SALEP 3,00
DEMACOLIN 20,00
ASAM MEFENAMAT 20,00
PARACETAMOL 500 20,00
ACYCLOVIR CREAM 3,00
1340 dr. dewi andojowati 201904003189 16/04/2019 Unit Pelayanan METFORMIN 500 MG 30,00 33.990
LORAZEPAM 2 MG 30,00
1341 dr. kintono (513787) 201904000638 04/04/2019 Unit Pelayanan THD 2 MG 300,00 614.040
ELXION 30,00
RIZODAL 2 MG-UM 100,00
ALPRAZOLAM 1 MG 100,00
1342 elisabeth sunur 201904001198 05/04/2019 Unit Pelayanan NOVOMIX PEN 3,00 688.050
CONCOR 2,5 MG 100,00
RIZODAL 2 MG-UM 15,00
KSR 100,00
ATORVASTATIN 20 30,00
1343 emi farida (040866) 201904001196 05/04/2019 Unit Pelayanan LAMIROS 100 MG 15,00 128.310
1344 galih a (040470) 201904001985 09/04/2019 Unit Pelayanan RISPERIDONE 3 MG 8,00 21.413
LORAZEPAM 2 MG 5,00
THD 2 MG 8,00
CLOZAPINE 100 MG 2,00
RACIKAN KAPSUL 30,00
KAPSUL NO.00 30,00
1345 galuh (056921) 201904003701 19/04/2019 Unit Pelayanan CLOZAPINE 25 MG 10,00 28.670
THD 2 MG 20,00
PROPANOLOL 10 MG 20,00
RISPERIDONE 3 MG 10,00
1346 hinggdrawati (045264) 201904004599 23/04/2019 Unit Pelayanan RAMIPRIL 5 MG 15,00 170.190
OLANZPINE 10mg 15,00
CLOPIDOGREL 75 15,00
NEURODEK 15,00
1347 lamini ( 058622 ) 201904005980 30/04/2019 Unit Pelayanan IKALEP 250 MG 30,00 781.050
SEROQUEL XR 400 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1348 m ikhlas (043925) 201904002656 13/04/2019 Unit Pelayanan
- ALPRAZOLAM 1 MG 10,00 1.720
1349 m. yusuf (058944) 201904005307 28/04/2019 Unit Pelayanan RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
1350 mareko (004097) 201904001276 07/04/2019 Unit Pelayanan HALOPERIDOL 5 MG 60,00 135.390
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
1351 mulyono 201904000630 02/04/2019 Unit Pelayanan CEFIXIME 100 MG 14,00 82.770
CODEIN 20 MG 20,00
ATORVASTATIN 20 30,00
1352 natasna (042326) 201904003403 16/04/2019 Unit Pelayanan CLOZAPINE 25 MG 10,00 18.610
1353 nopian (051233) 201904001257 06/04/2019 Unit Pelayanan OLANZPINE 10mg 15,00 85.050
1354 nur jannah 201904003715 20/04/2019 Unit Pelayanan OLANZPINE 10mg 20,00 229.620
ELIZAC 20 MG 60,00
1355 ny yuliati 201904003246 16/04/2019 Unit Pelayanan CODEIN 20 MG 15,00 28.890
DEXAMETASON 0,5 15,00
CETIRIZINE TABLET 15,00
1356 ny. Lilik P 201904000451 02/04/2019 Unit Pelayanan OMEPRAZOLE 20 MG 40,00 23.600
RANITIDIN TAB 150 40,00
1357 sakinah 201904005846 30/04/2019 Unit Pelayanan CLOZAPINE 25 MG 40,00 159.160
RISPERIDONE 3 MG 120,00
THD 2 MG 40,00
1358 sholikhin (517242) 201904000410 01/04/2019 Unit Pelayanan THD 2 MG 30,00 82.260
LEVOPAR 30,00
1359 siti aminah ( 020328 ) 201904005992 30/04/2019 Unit Pelayanan THD 2 MG 120,00 141.660
CLOZAPINE 25 MG 60,00
HALOPERIDOL 5 MG 120,00
1360 supartono (517640) 201904002676 14/04/2019 Unit Pelayanan DEXAMETASON 0,5 10,00 7.400
ASAM MEFENAMAT 10,00
CIPROFLOXACIN 500 10,00
1361 tn CHRISTHIO R ( 058913 201904004754 24/04/2019 Unit Pelayanan ELIZAC 20 MG 30,00 58.110
1362 up 201904001279 07/04/2019 Unit Pelayanan ANTASIDA SYR 1,00 2.395
201904002668 14/04/2019 Unit Pelayanan AMOXYCILLIN 500 10,00 3.780
201904002686 14/04/2019 Unit Pelayanan CEFIXIME 100 MG 10,00 48.031
GLIMEPIRIDE 3 MG 50,00
CETIRIZINE TABLET 7,00
DEMACOLIN 6,00
AMOXYCILLIN 500 10,00
GENTAMYCIN SALEP 1,00
201904003127 15/04/2019 Unit Pelayanan GLIMEPIRIDE 3 MG 50,00 23.610
METFORMIN 500 MG 20,00
PARACETAMOL 500 10,00
201904003429 16/04/2019 Unit Pelayanan ATORVASTATIN 20 60,00 77.226
AMOXYCILLIN 500 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1362 up 201904003429 16/04/2019 Unit Pelayanan
- DOMPERIDONE 20,00 77.226
ANTASIDA DOEN 10,00
MERSIBION 5000 2,00
201904003446 17/04/2019 Unit Pelayanan AMLODIPIN 10 50,00 10.420
GENTAMYCIN SALEP 1,00
201904003738 21/04/2019 Unit Pelayanan CIPROFLOXACIN 500 10,00 9.670
GLYSERIL 10,00
DEMACOLIN 10,00
201904004800 25/04/2019 Unit Pelayanan CETIRIZINE TABLET 4,00 1.548
201904005276 27/04/2019 Unit Pelayanan MELOXICAM 15 MG 10,00 10.790
1363 wahyu ferdiansyah 201904002186 10/04/2019 Unit Pelayanan CODEIN 10 MG 10,00 18.420
THIAMPHENICOL 500 10,00
1364 yasmin (048926) 201904001909 09/04/2019 Unit Pelayanan RISPERIDONE 1 MG 14,00 5.040
1365 yodi h ( 047341 ) 201904002140 10/04/2019 Unit Pelayanan SIZORIL 25 MG 50,00 184.450
HALOPERIDOL 5 MG 120,00
THD 2 MG 120,00
1366 yuli hermanto 201904001235 05/04/2019 Unit Pelayanan RISPERIDONE 2 MG 8,00 3.336
Dokter: Dr. YERI KURNIAWAN
1367 ADE ACHMAD RAMDHANI 201904003549 18/04/2019 IGD AMBROXOL 30 MG 10,00 2.780
1368 ANDIKA LIDYA MURNI 201904004921 25/04/2019 Ruangan Wijaya TFP 5 MG 4,00 113.720
GENTAMYCIN SALEP 1,00
PEN NEEDLE 32,5 G 1,00
OMEPRAZOLE 20 MG 10,00
NOVORAPID PEN 1,00
CPZ 100 MG 4,00
1369 DIAS MIKAEL HAYER 201904005295 27/04/2019 IGD THD 2 MG 4,00 4.782
CPZ 100 MG 4,00
LODOMER 2 MG/ML 1,00
HALOPERIDOL 5 MG 4,00
SPUIT 3 CC 1,00
1370 EDI WAHYUDI 201904005315 28/04/2019 IGD CPZ 100 MG 6,00 6.080
TFP 5 MG 6,00
SPUIT 3 CC 1,00
LODOMER 2 MG/ML 1,00
1371 HERLIYANNA 201904005679 29/04/2019 IGD CIPROFLOXACIN 500 10,00 8.760
DEXAMETASON 0,5 10,00
DEMACOLIN 10,00
1372 RIZA ALFIAN 201904005684 29/04/2019 Ruangan Wijaya THD 2 MG 2,00 5.218
CLOZAPINE 25 MG 2,00
TFP 5 MG 4,00
1373 SUTIANA 201904005294 27/04/2019 Ruangan Wijaya TFP 5 MG 6,00 3.090
THD 2 MG 6,00
CPZ 100 MG 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
Dokter: ESTHER
1374 LEONARDO (034636) 201904005292 27/04/2019 Unit Pelayanan
- NOPRES 20 MG 15,00 14.760
1375 NUR M AZIS (035661) 201904003036 15/04/2019 Unit Pelayanan OLANZPINE 10mg 60,00 493.785
CLOBAZAM 10 MG 60,00
CLOZAPINE 25 MG 45,00
1376 SITI NURHAYATI (036440) 201904005269 26/04/2019 Unit Pelayanan THD 2 MG 90,00 427.500
HALOPERIDOL 5 MG 60,00
SIZORIL 25 MG 120,00
TFP 5 MG 120,00
1377 sholikhin (517242) 201904003743 22/04/2019 Unit Pelayanan LEVOPAR 30,00 82.260
THD 2 MG 30,00
Dokter: INDAH MIFTAHUL HUDA, S.Psi., M.Si
1378 HAFIZ 201904003379 16/04/2019 Poli Jiwa Anak ASAM MEFENAMAT 10,00 15.156
PEHACHAIN INJ 2,00
AMOXYCILLIN 500 15,00
Dokter: LILA
1379 LAMINI 201904002601 12/04/2019 Unit Pelayanan SEROQUEL XR 200 30,00 514.800
Dokter: Prof. Dr. Lestari, Sp. Kj (Konsultan)
1380 M. RIO ARFIANSYAH 201904000118 01/04/2019 Poli Jiwa Anak THD 2 MG 11,00 39.276
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 0,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 15,00
VIT B12 50 MG 15,00
KAPSUL NO.00 30,00
RACIKAN KAPSUL 30,00
CLOZAPINE 100 MG 3,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
Dokter: dr. AIMEE NUGROHO, Sp.KJ
1381 GIDAH 201904002499 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 71.640
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1382 LUVITA SARI YUNANI 201904003858 22/04/2019 Ruangan CLOZAPINE 25 MG 7,00 19.282
RISPERIDONE 2 MG 15,00
1383 WAHYU SUBAGIO 201904002865 15/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 148.671
TFP 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 30,00
SERTRALINE 50 MG 30,00
1384 ABD FATAH 201904003583 18/04/2019 Poli Jiwa Dewasa DIAZEPAM 5 MG 15,00 117.765
PHENYTOIN CAP 100 90,00
CLOBAZAM 10 MG 60,00
1385 ABD WAKID MARJUKI 201904005491 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.995
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1385 ABD WAKID MARJUKI 201904005491 29/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 55.995
CLOZAPINE 25 MG 15,00
1386 ABDILLAH ASHARY 201904000888 04/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 514.800
1387 ABDULLAH 201904001135 05/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.900
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 30,00
1388 ACH. ROFIK EFENDI 201904001521 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 237.930
DEPAKOTE 250 MG 60,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
1389 ACH. SAMIR 201904002918 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1390 ACHMAD FAUZAN 201904000868 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 4,00 27.662
RISPERIDONE 3 MG 15,00
THD 2 MG 15,00
1391 ACHMAD ALIEF ANSHORI 201904003904 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 104.490
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
HALOPERIDOL 5 MG 15,00
1392 ACHMAD DWI PUTRA 201904002454 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 710.220
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
SEROQUEL XR 400 30,00
1393 ACHMAD MUSTAFAT 201904002807 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 74.850
CLOBAZAM 10 MG 30,00
THD 2 MG 30,00
PHENYTOIN CAP 100 30,00
1394 ACHMAD SUNARDI 201904000471 02/04/2019 Poli Psikiater THD 2 MG 200,00 103.000
CPZ 100 MG 100,00
TFP 5 MG 200,00
1395 ADI ISYANTO 201904002907 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
1396 ADITYA PUTUT 201904005499 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 160.710
CLOZAPINE 100 MG 30,00
1397 AFIFUDIN ALAMSYAH 201904002805 15/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 15,00 17.460
1398 AGUS CHABIB 201904003853 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
1399 AGUS SETIYO 201904003908 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 146.666
TFP 5 MG 60,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
1400 AGUS SUBIANTORO 201904000226 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 85.695
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1400 AGUS SUBIANTORO 201904000226 01/04/2019 Poli Jiwa- Dewasa CLOZAPINE 100 MG 15,00 85.695
TFP 5 MG 60,00
1401 AGUS SUDARMAN 201904005633 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
1402 AGUS SUNARDI 201904000885 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
1403 AGUS SUWITO 201904005645 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
1404 AGUS TRISNO 201904005566 29/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 81.690
ALPRAZOLAM 1 MG 12,00
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
CLOZAPINE 100 MG 3,00
KAPSUL NO 2 30,00
ALPRAZOLAM 1 MG 12,00
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 3,00
1405 AGUSTIN LISDA 201904003275 16/04/2019 Ruangan METFORMIN 500 MG 10,00 1.980
1406 AGUSTINA 201904000942 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
1407 AHMAD DAVID 201904001517 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1408 AHMAD MUKLASON 201904001127 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 154.050
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
RISPERIDONE 2 MG 60,00
1409 AKHUWAN 201904001530 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 103.575
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
1410 ALFIAN INDRA GANI 201904001540 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 91.335
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
1411 ALI BUDI UTOMO 201904005170 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 64.710
CLOZAPINE 25 MG 30,00
1412 ALI MARIYANTO 201904005152 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
201904005340 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 20.400
HALOPERIDOL 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1412 ALI MARIYANTO 201904005340 29/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 20.400
1413 ALI SADIKIN 201904001550 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 27.915
1414 AMALIAH NUGRAHA 201904003864 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 1.198.170
ABILIFY DISCMELT 15 30,00
SERTRALINE 50 MG 15,00
1415 ANAM SURAYA 201904004452 23/04/2019 Poli Jiwa Dewasa KAPSUL NO.00 60,00 69.180
SERTRALINE 50 MG 30,00
RACIKAN KAPSUL 60,00
RISPERIDONE 3 MG 10,00
1416 ANDIK PURWANTO 201904001136 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 126.015
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
1417 ANDIK HERAWANTO 201904005439 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 35.415
CLOZAPINE 25 MG 15,00
HALOPERIDOL 5 MG 30,00
1418 ANDIK SANTOSO 201904003586 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
201904003587 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
1419 ANDIK SUPRIADI 201904003833 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 65.820
CLOBAZAM 10 MG 30,00
TFP 5 MG 60,00
CPZ 100 MG 30,00
1420 ANDRI PURNOMO 201904005556 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
1421 ANDRIS SETIAWAN 201904000113 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 690.840
THD 2 MG 60,00
SEROQUEL XR 400 30,00
1422 ANDRY ISTINANI 201904004458 23/04/2019 Psiko Geriatri TFP 5 MG 30,00 114.990
THD 2 MG 30,00
DEPAKOTE ER 250 30,00
1423 ANIK MUSINI 201904002852 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 15.450
THD 2 MG 30,00
CPZ 100 MG 15,00
1424 ANIS SURYANI 201904001584 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1425 ANTON SUJARWO 201904002943 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 5.760
CPZ 100 MG 15,00
1426 ANVINO ERIX RAFERTHO 201904005158 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1427 APRILIA HARIANTI 201904000137 01/04/2019 Poli Jiwa- Dewasa TFP 5 MG 30,00 38.400
SERTRALINE 50 MG 15,00
1428 ARIFIN 201904003472 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 27.840
TFP 5 MG 60,00
THD 2 MG 30,00
1429 ARISTO SPENCER 201904003592 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 60,00 366.000
FRIMANIA 400 MG 60,00
1430 ARNOLD SUSILO 201904000877 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 155.781
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
SIKZONOATE 1,00
1431 ARNOLDUS JONDO 201904001819 09/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 95.340
VIT B COMPLEX 30,00
CLOBAZAM 10 MG 30,00
1432 ASEP SAEPUDIN 201904000115 01/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 15,00 600.660
SERTRALINE 50 MG 30,00
DEPAKOTE ER 500 30,00
CLOBAZAM 10 MG 60,00
1433 ASLAKHA, SE 201904003223 16/04/2019 Poli Psikiater FRIMANIA 200 MG 60,00 280.561
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 60,00
CLOZAPINE 100 MG 15,00
1434 ASMUDI 201904000360 01/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 22.307
CLOZAPINE 100 MG 4,00
201904005641 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 100.515
CLOZAPINE 100 MG 15,00
1435 ASNGARI 201904002096 10/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 2,00 173.140
SPUIT 3 CC 1,00
ZYPREXA INJ 1,00
AQUA PRO INJEKSI 1,00
1436 ASNITIK 201904000954 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1437 ASRIL SANI 201904003297 16/04/2019 Psiko Geriatri TFP 5 MG 30,00 12.750
THD 2 MG 30,00
1438 ASTRID NUR GUPITA 201904003407 16/04/2019 Ruangan Puri THD 2 MG 7,00 19.996
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 15,00
1439 ASTUTIK 201904000905 04/04/2019 Ruangan Wijaya THD 2 MG 15,00 19.402
CLOZAPINE 25 MG 7,00
TFP 5 MG 15,00
1440 ATIK 201904000537 02/04/2019 Psiko Geriatri TFP 5 MG 60,00 25.500
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1440 ATIK 201904000537 02/04/2019 Psiko Geriatri
- THD 2 MG 60,00 25.500
1441 ATIYEM 201904000951 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 9.840
HALOPERIDOL 5 MG 30,00
1442 AYUM (HJ) 201904000840 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 569.340
SEROQUEL XR 300 30,00
RISPERIDONE 2 MG 60,00
1443 AZIZ GAGAP NAMBUNG 201904002853 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
1444 BADRIYAH 201904005132 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 233.636
CLOZAPINE 25 MG 60,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
1445 BAKTIAR 201904000166 01/04/2019 Ruangan Gelatik THD 2 MG 15,00 24.637
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 15,00
201904000358 01/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 15,00 24.637
THD 2 MG 15,00
CLOZAPINE 25 MG 7,00
1446 BAMBANG PURWANTO 201904001140 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 155.040
THD 2 MG 30,00
CLOZAPINE 25 MG 60,00
1447 BAMBANG SETIONO 201904004932 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 230.881
THD 2 MG 60,00
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
RISPERIDONE 3 MG 60,00
1448 BAMBANG TJAHYO 201904005139 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 256.391
LORAZEPAM 2 MG 15,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 60,00
SIKZONOATE 1,00
CLOZAPINE 100 MG 30,00
1449 BANDI 201904004942 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
1450 BAROKAH 201904004430 23/04/2019 Psiko Geriatri THD 2 MG 100,00 60.500
CPZ 100 MG 100,00
TFP 5 MG 100,00
1451 BASUNI 201904003301 16/04/2019 Psiko Geriatri TFP 5 MG 60,00 480.360
THD 2 MG 60,00
CPZ 100 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1451 BASUNI 201904003301 16/04/2019 Psiko Geriatri
- ARICEPT 10 MG 30,00 480.360
1452 BIBIT SRIWAHYUNI 201904000183 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
1453 BISU NINA 201904000968 04/04/2019 Poli Jiwa Dewasa VIT B COMPLEX 10,00 5.440
HALOPERIDOL 1,5 60,00
1454 BISU BOTAK 201904000968 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 11.580
CPZ 100 MG 15,00
1455 BISU KETRAMPILAN 201904000214 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 35.415
CLOZAPINE 25 MG 15,00
HALOPERIDOL 5 MG 30,00
1456 BISU RUHUT 201904005642 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1457 BISU TOMPEL 201904000929 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1458 BRIAN PRAVILIA MINATA 201904001825 09/04/2019 Poli Psikiater VIT B6 10 MG 30,00 24.990
RISPERIDONE 3 MG 30,00
THD 2 MG 30,00
1459 BUDI DAUD SULAIMAN 201904001569 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 51.135
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 30,00
1460 BUDI SULISTIYO 201904004628 24/04/2019 Poli Psikiater ELXION 30,00 424.440
RISPERIDONE 1 MG 90,00
1461 BUDIANTO HALIM 201904000476 02/04/2019 Poli Psikiater SIZORIL 25 MG 10,00 80.330
FRIMANIA 200 MG 20,00
MERLOPAM 2 MG 10,00
1462 BUDIARTA LESMANA 201904002299 11/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 10,00 11.640
1463 CHARISMA DEVI 201904005468 29/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 77.336
SPUIT 3 CC 1,00
RISPERIDONE 3 MG 5,00
KAPSUL NO.00 30,00
SIKZONOATE 1,00
1464 CHOIRUL ANAM 201904003564 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 17.235
TFP 5 MG 45,00
1465 CHUSNUL YAQIN 201904004753 24/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
1466 DAHRON 201904004107 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 14.010
THD 2 MG 30,00
CPZ 100 MG 7,00
1467 DANIEL 201904005101 26/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 1.239.540
CLOZAPINE 100 MG 30,00
DEPAKOTE ER 500 30,00
HALOPERIDOL 0,5 60,00
CLOBAZAM 10 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1468 DAVID 201904005638 29/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1469 DEDE NONIK TARTAN 201904001666 08/04/2019 Ruangan THD 2 MG 15,00 23.837
CLOZAPINE 100 MG 4,00
RISPERIDONE 2 MG 15,00
201904003358 16/04/2019 Ruangan RISPERIDONE 2 MG 15,00 23.837
THD 2 MG 15,00
CLOZAPINE 100 MG 4,00
1470 DEDIK LAKSONO 201904003921 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 998.310
SERTRALINE 50 MG 30,00
ABILIFY DISCMELT 10 30,00
1471 DEFI EKA WIYANTO 201904001793 09/04/2019 Poli Psikiater SERTRALINE 50 MG 15,00 76.886
KAPSUL NO 2 30,00
SEROQUEL XR 400 2,00
RACIKAN KAPSUL 30,00
ALPRAZOLAM 1 MG 23,00
1472 DENNY ENDRAWANTO 201904001131 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
1473 DENY TANUMIHARJO 201904005192 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
1474 DESMANTORO 201904005202 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1475 DEWAN INDRA JAYA 201904000457 02/04/2019 Poli Psikiater HALOPERIDOL 5 MG 300,00 82.800
THD 2 MG 200,00
CPZ 100 MG 100,00
1476 DEWI ELOK KUSNUL 201904005105 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 156.630
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
THD 2 MG 30,00
1477 DEWI RETNOWATI 201904003577 18/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 15,00 505.375
CLOZAPINE 100 MG 15,00
THD 2 MG 30,00
HALOPERIDOL 5 MG 30,00
DEPAKOTE ER 500 15,00
LORAZEPAM 2 MG 8,00
1478 DIAN IKASARI 201904003469 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 130.761
SPUIT 3 CC 1,00
SIKZONOATE 1,00
CLOZAPINE 25 MG 30,00
1479 DIAN NOVITRI 201904003913 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 161.595
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1479 DIAN NOVITRI 201904003913 22/04/2019 Poli Jiwa- Dewasa DEPAKOTE 250 MG 60,00 161.595
1480 DIAN RUSTINI 201904000862 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 524.490
SEROQUEL XR 200 30,00
1481 DINDA AGRE SELINDA 201904001890 09/04/2019 Poli Psikiater RACIKAN PUYER 15,00 36.190
RACIKAN PUYER 15,00
LORAZEPAM 2 MG 8,00
SERTRALINE 50 MG 15,00
1482 DINI 201904000943 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
1483 DJASMIAH 201904005962 30/04/2019 Psiko Geriatri FOLIC ACID 1 MG 100,00 50.600
CPZ 100 MG 100,00
THD 2 MG 100,00
FOLIC ACID 1 MG 100,00
AMLODIPIN 10 50,00
1484 DJUARIAH 201904003890 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 130.320
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
LORAZEPAM 2 MG 30,00
1485 DJUNAIDI 201904003238 16/04/2019 Psiko Geriatri AMITRIPTILIN 25 MG 60,00 30.420
ALPRAZOLAM 0.5 MG 120,00
1486 DODI INDRA NOVIYANTO 201904005006 25/04/2019 Poli Psikiater RISPERIDONE 2 MG 200,00 103.800
THD 2 MG 200,00
1487 DODI SUHARJO 201904004474 23/04/2019 Psiko Geriatri OLANZPINE 10mg 15,00 147.885
CLOBAZAM 10 MG 30,00
CLOZAPINE 25 MG 15,00
1488 DODIK PRASETYONO 201904001553 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
1489 DODONG 201904002325 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
1490 DONA SONNAR 201904003525 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 142.350
SERTRALINE 50 MG 30,00
CLOBAZAM 10 MG 30,00
TFP 5 MG 30,00
1491 DONI TAULADAN 201904000837 04/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 188.490
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
CLOBAZAM 10 MG 30,00
1492 DONY. A 201904003823 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
1493 DUL KARIM 201904003315 16/04/2019 Psiko Geriatri THD 2 MG 15,00 3.750
HALOPERIDOL 5 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1494 DWI AGUNTONO 201904004835 25/04/2019 Ruangan
- Wijaya LODOMER 2 MG/ML 3,00 31.516
SPUIT 3 CC 6,00
CLOZAPINE 100 MG 2,00
DIAZEPAM inj 3,00
1495 DWI AGUS PURWANTO 201904004054 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 612.540
SEROQUEL XR 200 30,00
RISPERIDONE 3 MG 60,00
1496 DWI ERWANSYAH 201904002290 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 125.640
SERTRALINE 50 MG 30,00
DEPAKOTE 250 MG 30,00
1497 DWI SETYA IRAWAN 201904001079 05/04/2019 Puri Mitra (Laki- HALOPERIDOL 5 MG 15,00 38.096
RISPERIDONE 2 MG 15,00
CLOZAPINE 100 MG 7,00
THD 2 MG 15,00
1498 DYAH PRATIWI 201904001472 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 613.041
SPUIT 3 CC 1,00
SIKZONOATE 1,00
AMITRIPTILIN 25 MG 30,00
1499 EDY TRI YULIANTO 201904003584 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 891.180
ABILIFY DISCMELT 10 30,00
CLOZAPINE 25 MG 30,00
1500 EGA ARIL ABDILLAH 201904001460 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 83.910
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1501 EKO HENDRAWANTO 201904002891 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
1502 EKO JALU SETIAWAN 201904000882 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
1503 ELVIANA 201904000940 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
1504 ELYA SUSANTI 201904003916 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 78.270
TFP 5 MG 60,00
THD 2 MG 30,00
1505 EMANUEL DONY ARIEF 201904002292 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
1506 ENDAH EMILIYA 201904004417 23/04/2019 Psiko Geriatri KAPSUL NO.00 60,00 495.255
THD 2 MG 60,00
RACIKAN KAPSUL 60,00
ARICEPT 10 MG 30,00
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 10,00
1507 ENDRA ARMANSYAH 201904005224 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1507 ENDRA ARMANSYAH 201904005224 26/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 60,00 70.830
1508 ENI 201904004465 23/04/2019 Poli Psikiater TFP 5 MG 120,00 304.860
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
FRIMANIA 200 MG 120,00
1509 ERFAN 201904002451 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 39.525
RISPERIDONE 3 MG 15,00
THD 2 MG 15,00
1510 ERNI ELFI R 201904005918 30/04/2019 Poli Psikiater HALOPERIDOL 5 MG 50,00 25.700
THD 2 MG 50,00
KAPSUL NO 2 100,00
CPZ 100 MG 50,00
RACIKAN KAPSUL 100,00
1511 ERNI PUDJIATI 201904000826 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
1512 ERSALINA 201904002294 11/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 615.000
TFP 5 MG 60,00
SEROQUEL XR 300 30,00
1513 ESTI TOMO 201904005097 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 90,00 164.850
RISPERIDONE 2 MG 60,00
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
1514 FAHMI ADE RIYANTO 201904000233 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1515 FARIZ 201904004941 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
1516 FEBRI WIDIONO 201904003879 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 257.666
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
1517 FERRY YUDA KUSUMA 201904002897 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
1518 FERY ROFIANTO 201904000881 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 85.215
CLOZAPINE 100 MG 15,00
1519 FIDIYA PUTRI PRATAMA 201904005092 26/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 454.335
VIT B6 10 MG 30,00
RISPERIDONE 3 MG 10,00
ABILIFY DISCMELT 10 15,00
KAPSUL NO.00 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1519 FIDIYA PUTRI PRATAMA 201904005092 26/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 15,00 454.335
1520 FIRMAN FAJAR 201904005131 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 865.530
THD 2 MG 60,00
CPZ 100 MG 60,00
ABILIFY DISCMELT 10 30,00
1521 FITRI BUDIANTO 201904004023 22/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 60,00 61.020
CLOBAZAM 10 MG 30,00
RISPERIDONE 3 MG 30,00
KAPSUL NO.0 60,00
THD 2 MG 30,00
1522 FITRIYAH 201904000187 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1523 FUAD 201904002289 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 62.588
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
1524 GENDON 201904005634 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1525 HADI FERDINA 201904001533 08/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 129.006
SPUIT 3 CC 1,00
CLOZAPINE 100 MG 15,00
1526 HALIP 201904005476 29/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 15,00 130.845
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 15,00
LORAZEPAM 2 MG 30,00
1527 HAM YULIANA DJAJADI 201904005200 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 186.210
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
1528 HANDONO KUSUMO 201904001050 05/04/2019 IGD CLOZAPINE 100 MG 3,00 12.039
1529 HARI WIBOWO 201904001427 08/04/2019 Poli Jiwa Dewasa KUTOIN 90,00 82.440
RISPERIDONE 2 MG 60,00
1530 HARIADI 201904001514 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 166.830
CLOZAPINE 100 MG 30,00
RISPERIDONE 3 MG 60,00
1531 HARIYANTO 201904005894 30/04/2019 Poli Psikiater KUTOIN 30,00 78.120
TFP 5 MG 60,00
DIAZEPAM 5 MG 60,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
1532 HARIYONO 201904005481 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 206.790
DEPAKOTE 250 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1533 HARMI 201904000211 01/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
1534 HASAN 201904004683 24/04/2019 Poli Psikiater THD 2 MG 15,00 14.040
RISPERIDONE 2 MG 30,00
1535 HERIYANTO 201904000220 01/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 83.901
CPZ 100 MG 30,00
TFP 5 MG 30,00
SPUIT 3 CC 1,00
1536 HEROE NANIEK 201904001810 09/04/2019 Psiko Geriatri LORAZEPAM 2 MG 15,00 484.563
ARICEPT 10 MG 30,00
HALOPERIDOL 5 MG 6,00
RACIKAN KAPSUL 60,00
CURCUMA 200 MG 10,00
KAPSUL NO.00 60,00
THD 2 MG 15,00
FOLIC ACID 1 MG 30,00
1537 HERU MA'MUN 201904003870 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 126.015
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
1538 HIDAYAT 201904000845 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 231.810
FRIMANIA 200 MG 60,00
CLOZAPINE 100 MG 30,00
201904005156 26/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
1539 HUGIL 201904002851 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
1540 ICUN FATHRA PALACCI 201904001483 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 151.530
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
1541 IE DJ0E HOEN 201904001858 09/04/2019 Poli Psikiater CLOZAPINE 25 MG 100,00 236.100
HALOPERIDOL 5 MG 200,00
THD 2 MG 200,00
1542 IFAN ABDUL SALAM (H) 201904005571 29/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 618.825
KAPSUL NO 2 30,00
FRIMANIA 200 MG 60,00
CLOZAPINE 25 MG 15,00
RACIKAN KAPSUL 30,00
SEROQUEL XR 200 30,00
HALOPERIDOL 5 MG 15,00
1543 IFDANIA FARADILA 201904005216 26/04/2019 Poli Jiwa Dewasa THD 2 MG 45,00 23.355
RISPERIDONE 2 MG 45,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1544 IKA AYU HERAWATI 201904001434 08/04/2019 Poli Jiwa- Dewasa SEROQUEL XR 200 30,00 530.370
RISPERIDONE 2 MG 30,00
THD 2 MG 30,00
1545 IMAM 201904003318 16/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 40.665
TFP 5 MG 30,00
THD 2 MG 30,00
1546 IMAM NAHROWI 201904003542 18/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 96.726
CLOZAPINE 25 MG 15,00
SIKZONOATE 1,00
1547 IMAM SYAFII 201904000856 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
1548 INA 201904000949 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
1549 INDAH HERDIANTY 201904000799 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 39.510
SERTRALINE 50 MG 15,00
1550 INDAH PUSPITASARI 201904004425 23/04/2019 Poli Psikiater CLOBAZAM 10 MG 30,00 73.024
LORAZEPAM 2 MG 8,00
SERTRALINE 50 MG 16,00
1551 INDAH SULISTIYANI 201904000148 01/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 2.700
1552 INDAH SURYANINGSIH 201904002475 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 17.700
THD 2 MG 60,00
CPZ 100 MG 15,00
1553 IRA APRIALA 201904000963 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 139.770
CLOZAPINE 100 MG 30,00
1554 IRFAN 201904004563 23/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 15,00 37.995
RISPERIDONE 3 MG 15,00
1555 IRFAN ARDIANSYAH 201904002437 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 135.390
CLOZAPINE 100 MG 30,00
HALOPERIDOL 5 MG 60,00
1556 IRFAN RACHMAWAN DWI 201904005219 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 100.515
RISPERIDONE 3 MG 60,00
1557 IRMAWATI 201904004668 24/04/2019 Poli Psikiater DEPAKOTE ER 250 30,00 156.435
RISPERIDONE 3 MG 30,00
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
1558 IRWAN CAHYA KUSUMA 201904002868 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
1559 ISMAIL 201904001462 08/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 124.641
CLOZAPINE 25 MG 30,00
SIKZONOATE 1,00
1560 ISMAWATUL 201904000151 01/04/2019 Ruangan CLOZAPINE 25 MG 7,00 17.872
TFP 5 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1560 ISMAWATUL 201904001668 08/04/2019 Ruangan
- TFP 5 MG 15,00 20.897
CLOZAPINE 100 MG 4,00
201904003371 16/04/2019 Ruangan TFP 5 MG 15,00 20.897
CLOZAPINE 100 MG 4,00
1561 ISTIKHOMAH 201904005990 30/04/2019 Psiko Geriatri SIZORIL 25 MG 60,00 211.440
AMLODIPIN 10 60,00
TFP 5 MG 60,00
1562 ISWATI 201904005488 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
1563 IVA ERMAWATI 201904001443 08/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 147.782
CLOZAPINE 100 MG 4,00
SEROQUEL XR 200 7,00
RISPERIDONE 3 MG 15,00
1564 IWAN 201904002842 15/04/2019 Ruangan Gelatik THD 2 MG 7,00 8.259
CPZ 100 MG 15,00
TFP 5 MG 15,00
1565 IWAN KURNIAWAN 201904004782 24/04/2019 Poli Psikiater TFP 5 MG 10,00 47.540
AMLODIPIN 10 10,00
THD 2 MG 30,00
CLOZAPINE 100 MG 10,00
1566 JANAKA 201904000390 01/04/2019 Ruangan Gelatik THD 2 MG 15,00 19.402
CLOZAPINE 25 MG 7,00
TFP 5 MG 15,00
1567 JANNET MUHAIMIN 201904003919 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
1568 JENNY SUAN PRANOTO 201904002479 12/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 654.510
SEROQUEL XR 200 30,00
CLOZAPINE 25 MG 60,00
1569 JUARISEH 201904003299 16/04/2019 Psiko Geriatri CLOBAZAM 10 MG 7,00 21.175
CLOZAPINE 25 MG 7,00
1570 JULSIE 201904000946 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 75.210
CLOZAPINE 25 MG 30,00
1571 JUNAEDI ABDULLAH 201904004687 24/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 276.531
SPUIT 3 CC 1,00
THD 2 MG 120,00
RISPERIDONE 3 MG 120,00
SIKZONOATE 1,00
1572 JUNI ERWANTO 201904003473 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1573 JUWARIYAH 201904000536 02/04/2019 Psiko Geriatri TFP 5 MG 60,00 19.380
1574 KANING 201904003839 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1574 KANING 201904003839 22/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 36.540
1575 KARIYANTO 201904004048 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 17.700
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
1576 KARMADI 201904003876 22/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 15 30,00 1.223.820
SERTRALINE 50 MG 30,00
1577 KASI WIJONO 201904004429 23/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 314.220
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
ARICEPT 10 MG 15,00
1578 KASMINTO 201904004947 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
1579 KESUMAWATI 201904001045 05/04/2019 Poli Psikiater THD 2 MG 100,00 59.920
CLOBAZAM 10 MG 30,00
HALOPERIDOL 5 MG 100,00
1580 KHABIB BULLOH 201904000120 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
1581 KO JOHAN 201904004462 23/04/2019 Psiko Geriatri CLOBAZAM 10 MG 30,00 120.390
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
1582 KOJI 201904005643 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.500
TFP 5 MG 60,00
1583 KURNIAWATI 201904001502 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 82.440
SERTRALINE 50 MG 30,00
1584 KUSMIATUN 201904000938 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
1585 LAILATUL FITRIYAH 201904001900 09/04/2019 Poli Psikiater FOLIC ACID 1 MG 30,00 41.840
SANDEPRIL 10,00
1586 LAILI JUMATI CHOIRIYAH 201904000802 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
1587 LANY PRAKARSA 201904005576 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 46.395
THD 2 MG 30,00
AMITRIPTILIN 25 MG 15,00
1588 LASMI WIJI ASTUTIK 201904004014 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 260.970
OLANZPINE 10mg 30,00
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
1589 LASTRI 201904004561 23/04/2019 Poli Psikiater SERTRALINE 50 MG 100,00 233.100
RISPERIDONE 2 MG 100,00
1590 LATIFAH 201904003215 16/04/2019 Psiko Geriatri RISPERIDONE 3 MG 60,00 166.830
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1590 LATIFAH 201904003215 16/04/2019 Psiko Geriatri
- CLOZAPINE 100 MG 30,00 166.830
1591 LELY SETYOWATI 201904005194 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
1592 LENI /NOWNEM 201904000171 01/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 20.812
RISPERIDONE 2 MG 15,00
THD 2 MG 15,00
1593 LENI ANGGRAINI 201904000200 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
1594 LENNY ANDRIANI 201904002850 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 697.020
HALOPERIDOL 5 MG 60,00
DEPAKOTE 250 MG 60,00
SERTRALINE 50 MG 30,00
SEROQUEL XR 300 30,00
1595 LESTARI ENY MARDIATI 201904004045 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 527.550
SEROQUEL XR 200 30,00
TFP 5 MG 30,00
1596 LIDYA TRISNAWATI 201904002516 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 93.840
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
1597 LINDA 201904000937 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
1598 LIS SANY MARIYANA 201904002507 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 35.415
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
1599 LIS SETYOWATI 201904003848 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 78.225
TFP 5 MG 60,00
AMITRIPTILIN 25 MG 15,00
1600 LUKITO YANI SETYAWAN 201904000895 04/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 644.400
1601 LUKMAN TEDDY IRAWAN 201904005147 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 67.695
CLOZAPINE 100 MG 15,00
HALOPERIDOL 1,5 60,00
1602 LUSIANA 201904001418 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 175.710
RISPERIDONE 3 MG 60,00
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
1603 LUSYE LILIHATA 201904003291 16/04/2019 Poli Psikiater FRIMANIA 200 MG 60,00 721.620
SEROQUEL XR 400 30,00
THD 2 MG 60,00
1604 M. ADI 201904004559 23/04/2019 Ruangan Gelatik RISPERIDONE 1 MG 7,00 11.247
SERTRALINE 50 MG 4,00
ALPRAZOLAM 0.5 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1605 M. ALI 201904005599 29/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 5,00 13.475
RISPERIDONE 2 MG 10,00
1606 M. NASIHIN 201904000900 04/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 60.114
THD 2 MG 15,00
CLOZAPINE 100 MG 4,00
LODOMER 2 MG/ML 1,00
TFP 5 MG 15,00
201904001178 05/04/2019 Ruangan Wijaya AQUA PRO INJEKSI 1,00 165.114
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
201904004101 22/04/2019 Ruangan Gelatik TFP 5 MG 15,00 52.738
CLOZAPINE 100 MG 11,00
THD 2 MG 15,00
HALOPERIDOL 5 MG 15,00
1607 M. SAMSUL ARIFIN 201904004490 23/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1608 M. TEGUH ARI CANDRA 201904004025 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
1609 M. YUSUF 201904002864 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.750
TFP 5 MG 30,00
201904005972 30/04/2019 Poli Psikiater DEPAKOTE 250 MG 30,00 66.420
RISPERIDONE 3 MG 30,00
THD 2 MG 30,00
1610 MAHBUDI SISWANTO 201904004657 24/04/2019 Poli Psikiater HALOPERIDOL 5 MG 40,00 17.970
VIT B12 50 MG 50,00
KAPSUL NO 2 100,00
VIT B6 10 MG 50,00
RACIKAN KAPSUL 100,00
1611 MAIMUNAH 201904002894 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1612 MAISAROH 201904000477 02/04/2019 Poli Psikiater RIZODAL 2 MG 23,00 117.044
THD 2 MG 23,00
KAPSUL NO 2 90,00
NUZIP 25 45,00
RACIKAN KAPSUL 90,00
1613 MAIYANTO 201904003317 16/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 55.830
1614 MAKANI 201904004734 24/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
1615 MAKKI 201904005586 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
1616 MARDIAH 201904000170 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 27.915
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1617 MARIA ROSA 201904003529 18/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 1,5 60,00 188.115
THD 2 MG 60,00
CLOBAZAM 10 MG 30,00
RISPERIDONE 2 MG 60,00
CLOZAPINE 100 MG 15,00
SERTRALINE 50 MG 30,00
1618 MARIYU 201904000926 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
1619 MARJANI 201904005632 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1620 MARJU 201904002909 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1621 MARNI 201904000208 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
1622 MAROBENI 201904003897 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
1623 MARPUAH 201904004902 25/04/2019 Poli Jiwa Dewasa THD 2 MG 10,00 85.683
CLOZAPINE 25 MG 3,00
ARICEPT 10 MG 5,00
RISPERIDONE 2 MG 10,00
1624 MAT MADURA 201904000342 01/04/2019 Ruangan Kenari CLOZAPINE 100 MG 7,00 28.091
201904004717 24/04/2019 Ruangan Kenari CLOZAPINE 100 MG 7,00 28.091
1625 MAT RAI 201904002337 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
1626 MATRAIS 201904005971 30/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 20.293
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
1627 MELLY/MELIN 201904000972 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 55.920
CPZ 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
1628 MENTIK NUNGKI 201904002873 15/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 7,00 142.346
CLOZAPINE 100 MG 4,00
THD 2 MG 7,00
1629 MERRIE 201904004413 23/04/2019 Psiko Geriatri THD 2 MG 30,00 15.450
CPZ 100 MG 15,00
TFP 5 MG 30,00
1630 MIAH 201904004456 23/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 83.910
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1631 MIFTAH FARID 201904003883 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.335
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1632 MILA SARI 201904000543 02/04/2019 Poli Psikiater
- LORAZEPAM 2 MG 10,00 28.490
SERTRALINE 50 MG 10,00
1633 MIMIK 201904000971 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 33.900
HALOPERIDOL 5 MG 60,00
1634 MINATUN 201904000935 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
201904004991 25/04/2019 Ruangan CLOZAPINE 100 MG 3,00 12.039
1635 MIRA ANGGRAENY, SPD 201904002884 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 161.295
CLOZAPINE 25 MG 15,00
DEPAKOTE ER 250 30,00
RISPERIDONE 2 MG 60,00
1636 MIRAH GUNARTI 201904001849 09/04/2019 Psiko Geriatri VIT B COMPLEX 10,00 920.095
CLOZAPINE 25 MG 45,00
ABILIFY DISCMELT 10 30,00
THD 2 MG 60,00
1637 MOCH NADIR 201904001498 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
1638 MOCH. RIFKY AFIANTO 201904001582 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
1639 MOCH. SAFIEK 201904005913 30/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 280.560
ARICEPT 10 MG 15,00
1640 MOCH. SHAIFULLAH 201904005153 26/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 73.980
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
TFP 5 MG 30,00
1641 MOCH.KASIM 201904003239 16/04/2019 Poli Psikiater THD 2 MG 120,00 61.800
CPZ 100 MG 60,00
TFP 5 MG 120,00
1642 MOCHAMAD NURANDI 201904005435 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
1643 MOCHAMAD ZAINUL 201904004009 22/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 130.830
RACIKAN KAPSUL 60,00
KAPSUL NO 2 60,00
DEPAKOTE 250 MG 30,00
PHENYTOIN CAP 100 30,00
1644 MOH. IBRAHIM 201904001475 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 100.515
RISPERIDONE 3 MG 60,00
1645 MOH. RIZAL FALIFI 201904003865 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
1646 MOHAMMAD NAFIK 201904000124 01/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 829.230
1647 MOKH. ULUM ISKANDAR 201904001445 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1648 MOKH.MAHTUF 201904003847 22/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1649 MOLAJI/ ACH MUNAJI 201904002860 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1650 MU AFAH 201904000533 02/04/2019 Psiko Geriatri CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1651 MUCHAMMAD GUFRON 201904002712 15/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 23.837
THD 2 MG 15,00
CLOZAPINE 100 MG 4,00
1652 MUCHAMMAD SUKAMTO 201904003502 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
1653 MUHADI 201904004944 25/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 27.840
TFP 5 MG 60,00
THD 2 MG 30,00
1654 MUHAMAD HAFIZ 201904005273 26/04/2019 Poli Psikiater RACIKAN KAPSUL 6,00 28.608
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 100 MG 3,00
KAPSUL NO 3 6,00
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
1655 MUHAMAD NUH/MUNUR 201904002327 11/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 11.940
THD 2 MG 30,00
1656 MUHAMAD RIFAI 201904005577 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 85.695
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
1657 MUHAMAD SAIFULLAH 201904003520 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
1658 MUHAMMAD FATKULLOH 201904005160 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.540
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
1659 MUHAMMAD HAKHIM 201904001444 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 70.830
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
1660 MUHAMMAD MURI 201904000812 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
1661 MUJIONO 201904005113 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 262.110
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1661 MUJIONO 201904005113 26/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 60,00 262.110
DEPAKOTE 250 MG 60,00
RISPERIDONE 3 MG 60,00
1662 MUKHLIS / MUHLIS 201904005637 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 265.800
CLOZAPINE 100 MG 60,00
1663 MULYONO 201904005630 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
1664 MUNARIYAH 201904005951 30/04/2019 Psiko Geriatri THD 2 MG 60,00 891.180
ABILIFY DISCMELT 10 30,00
CLOZAPINE 25 MG 30,00
1665 MUNAWAN 201904003582 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 974.640
ABILIFY DISCMELT 10 30,00
CLOZAPINE 100 MG 30,00
1666 MUNAWAR/K.ACHMAD 201904003896 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 121.650
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
1667 MUNIROH 201904004428 23/04/2019 Poli Psikiater THD 2 MG 100,00 279.700
CLOZAPINE 25 MG 100,00
RISPERIDONE 2 MG 200,00
1668 MURIYAH QIROMAH 201904003920 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 201.240
OLANZPINE 10mg 30,00
RISPERIDONE 2 MG 60,00
1669 MURTINI 201904001523 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 4.845
1670 MUSRIN 201904004733 24/04/2019 Psiko Geriatri CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
1671 MUSTACHIM 201904002887 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 134.850
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
1672 NABIYL 201904000462 02/04/2019 Poli Psikiater RISPERIDONE 3 MG 200,00 172.800
THD 2 MG 200,00
CPZ 100 MG 100,00
1673 NANANG SETIAWAN 201904005564 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
1674 NARDATI 201904004460 23/04/2019 Psiko Geriatri THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
1675 NELI 201904000149 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 6.105
CPZ 100 MG 7,00
201904001670 08/04/2019 Ruangan CLOZAPINE 100 MG 4,00 22.307
RISPERIDONE 2 MG 15,00
201904003279 16/04/2019 Ruangan METFORMIN 500 MG 10,00 26.552
TABLET TAMBAH 20,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1675 NELI 201904003279 16/04/2019 Ruangan
- CLOZAPINE 100 MG 4,00 26.552
1676 NGATIMEN 201904004945 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
1677 NICO CHRISTANTO 201904001161 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 133.410
RISPERIDONE 3 MG 30,00
SERTRALINE 50 MG 30,00
1678 NOORAFIF 201904000842 04/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 185.136
SPUIT 3 CC 1,00
TFP 5 MG 30,00
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
1679 NORMAN RAHADI 201904001152 05/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 15,00 450.165
FRIMANIA 200 MG 30,00
1680 NOVA KUSUMA 201904000252 01/04/2019 Ruangan TFP 5 MG 15,00 32.936
CLOZAPINE 100 MG 7,00
201904001160 05/04/2019 IGD HALOPERIDOL 5 MG 15,00 36.686
TFP 5 MG 15,00
CLOZAPINE 100 MG 7,00
THD 2 MG 15,00
1681 NOVAN SANJAYA 201904000136 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 14.040
THD 2 MG 15,00
1682 NUNUK 201904000236 01/04/2019 Ruangan CLOZAPINE 25 MG 7,00 13.027
1683 NUNUK WURJANDANI 201904000839 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 0,5 60,00 7.140
THD 2 MG 30,00
1684 NUNUK/NUNUNG 201904003369 16/04/2019 Ruangan CLOZAPINE 25 MG 7,00 19.282
RISPERIDONE 2 MG 15,00
1685 NUNUK/ROMSINA 201904000928 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 60,00 296.100
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
RISPERIDONE 3 MG 60,00
201904004992 25/04/2019 Ruangan CLOZAPINE 25 MG 10,00 26.810
HALOPERIDOL 5 MG 10,00
RISPERIDONE 3 MG 10,00
1686 NUR AFIFAH 201904002441 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 106.350
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
1687 NUR ASIYAH 201904004665 24/04/2019 Poli Psikiater THD 2 MG 100,00 60.500
CPZ 100 MG 100,00
TFP 5 MG 100,00
1688 NUR AZIZAH 201904002488 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 99.711
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1688 NUR AZIZAH 201904002488 12/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 99.711
SIKZONOATE 1,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
1689 NUR FIANA KUSUMA 201904001516 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 549.540
SEROQUEL XR 200 30,00
AMITRIPTILIN 25 MG 30,00
1690 NURSIDAH 201904004449 23/04/2019 Poli Psikiater KAPSUL NO 2 60,00 246.422
THD 2 MG 15,00
CLOBAZAM 10 MG 30,00
RACIKAN KAPSUL 60,00
CLOZAPINE 100 MG 4,00
SERTRALINE 50 MG 100,00
1691 NURTIN 201904004436 23/04/2019 Poli Psikiater TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
1692 NURUL SETIYAWATI 201904005580 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 81.645
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 15,00
1693 NURUL ARIFIN 201904005986 30/04/2019 Poli Psikiater THD 2 MG 120,00 173.940
CLOZAPINE 25 MG 60,00
RISPERIDONE 2 MG 120,00
1694 NURUL FAUZIAH 201904001543 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 75.355
VIT B COMPLEX 10,00
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
1695 NURUL KOMARIYAH 201904003277 16/04/2019 Ruangan GLIMEPIRIDE 3 MG 10,00 2.940
1696 OLIVIA TRISETIANI 201904001177 05/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 7,00 178.141
SPUIT 3 CC 1,00
ZYPREXA INJ 1,00
AQUA PRO INJEKSI 1,00
201904003278 16/04/2019 Ruangan ABILIFY DISCMELT 10 4,00 110.564
1697 ONG YOHANES 201904004446 23/04/2019 Poli Psikiater LORAZEPAM 2 MG 19,00 134.030
AMITRIPTILIN 25 MG 15,00
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
1698 PAIJEM / PAIYEM 201904002804 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 85.695
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
1699 PANGGI 201904005601 29/04/2019 Ruangan Kenari THD 2 MG 15,00 20.812
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 15,00
1700 PARMAN 201904004946 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1701 PAULUS LATIF 201904005977 30/04/2019 Poli Psikiater
- SEROQUEL XR 400 5,00 170.370
KAPSUL NO 2 50,00
RACIKAN KAPSUL 50,00
ALPRAZOLAM 1 MG 20,00
LORAZEPAM 2 MG 8,00
SERTRALINE 50 MG 25,00
KAPSUL NO 2 50,00
RACIKAN KAPSUL 50,00
1702 PHRISKA SANGGA 201904002430 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
1703 PIPIT RIYANI 201904000234 01/04/2019 Ruangan TFP 5 MG 15,00 19.402
THD 2 MG 15,00
CLOZAPINE 25 MG 7,00
1704 POERJADI 201904003240 16/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 178.815
KAPSUL NO 2 60,00
SEROQUEL XR 200 5,00
ALPRAZOLAM 1 MG 30,00
RACIKAN KAPSUL 60,00
CLOZAPINE 25 MG 15,00
1705 PRANOTO UTOMO 201904002427 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
1706 PRIYO WIDODO 201904005480 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 162.465
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
CLOZAPINE 100 MG 15,00
1707 PUDJIONO RACHMADI 201904004008 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 68.580
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1708 PUGUH ARIS ATMIKO 201904003563 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 137.031
SPUIT 3 CC 1,00
RACIKAN KAPSUL 120,00
THD 2 MG 60,00
CPZ 100 MG 60,00
RISPERIDONE 3 MG 40,00
SIKZONOATE 1,00
KAPSUL NO 2 120,00
1709 PUGUH SUMARTONO 201904004092 22/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 15,00 6.255
1710 PUJIANA 201904003859 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1711 PURNOMO 201904002332 11/04/2019 Poli Jiwa Dewasa VIT B COMPLEX 10,00 20.380
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1712 PURWAJI 201904002300 11/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 60,00 25.020
1713 PURWATI PUTRI 201904000945 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 137.160
CLOZAPINE 25 MG 60,00
TFP 5 MG 60,00
1714 R. THERDY 201904001580 08/04/2019 Poli Jiwa Dewasa CARBAMAZEPINE 30,00 51.660
RISPERIDONE 3 MG 60,00
THD 2 MG 30,00
1715 RACHMAD IRIANTO 201904002917 15/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 60.720
RISPERIDONE 3 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
1716 RELAN 201904003314 16/04/2019 Psiko Geriatri THD 2 MG 60,00 27.270
VIT B6 10 MG 30,00
TFP 5 MG 60,00
1717 RENA FERMIDA 201904005099 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 10.800
1718 RENGGA KARTIKA SARI 201904004416 23/04/2019 Poli Psikiater TFP 5 MG 50,00 109.200
CLOZAPINE 25 MG 50,00
1719 RETHA MERYSA 201904002867 15/04/2019 Poli Jiwa Dewasa METFORMIN 850 MG 15,00 73.815
DEPAKOTE 250 MG 30,00
CLOZAPINE 25 MG 15,00
1720 RIAMAH 201904002429 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 55.995
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
1721 RIDA 201904001440 08/04/2019 Poli Jiwa Dewasa DIAZEPAM 5 MG 30,00 20.790
CARBAMAZEPINE 60,00
1722 RIJONO 201904001485 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
1723 RINA 201904000941 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1724 RINA DEWI WAHYUNI 201904003230 16/04/2019 Poli Psikiater CLOZAPINE 25 MG 50,00 93.050
1725 RIO ADHI NUGROHO 201904005587 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.990
RISPERIDONE 3 MG 30,00
1726 RISKA DWI VIANTI 201904005103 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 545.700
SEROQUEL XR 300 30,00
HALOPERIDOL 5 MG 30,00
1727 RISMA RIZKIA 201904001470 08/04/2019 Poli Jiwa Dewasa TOPAMAX 100 MG 15,00 1.048.290
FOLIC ACID 1 MG 30,00
RACIKAN KAPSUL 30,00
KAPSUL NO.00 30,00
ABILIFY DISCMELT 10 30,00
CLOZAPINE 25 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1727 RISMA RIZKIA 201904001470 08/04/2019 Poli Jiwa- Dewasa LORAZEPAM 2 MG 15,00 1.048.290
1728 RITA HAMIMA 201904005003 25/04/2019 Ruangan CLOZAPINE 25 MG 10,00 18.610
1729 ROBI 201904002856 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 75.210
CLOZAPINE 25 MG 30,00
1730 ROCHIMAH 201904005119 26/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 272.456
THD 2 MG 60,00
CPZ 100 MG 30,00
OLANZPINE 10mg 30,00
TFP 5 MG 60,00
SIKZONOATE 1,00
1731 RODALI 201904000865 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 224.931
CPZ 100 MG 30,00
FRIMANIA 400 MG 60,00
TFP 5 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
1732 ROFIATUN 201904004634 24/04/2019 Psiko Geriatri NEURODEK 10,00 244.590
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
CLONAZEPAM 2 MG 30,00
1733 ROHMATOL MAHFIRO 201904003928 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 157.935
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
1734 ROKHMAN 201904004642 24/04/2019 Psiko Geriatri TFP 5 MG 30,00 253.845
CLONAZEPAM 2 MG 30,00
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
1735 RONY GUFRON 201904005864 30/04/2019 Poli Psikiater THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1736 ROSLAN 201904004943 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
1737 RR SOEFIANA 201904000890 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 202.090
CLOBAZAM 10 MG 30,00
RISPERIDONE 3 MG 60,00
CLOZAPINE 25 MG 30,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 8,00
1738 RUDI HARTONO 201904000122 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 185.136
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1739 RUDIANTO 201904005222 26/04/2019 Poli Jiwa- Dewasa CLOZAPINE 100 MG 15,00 60.195
1740 SAMIYAH 201904001863 09/04/2019 Poli Psikiater THD 2 MG 50,00 233.130
CLOZAPINE 25 MG 100,00
RACIKAN KAPSUL 100,00
VIT B12 50 MG 100,00
HALOPERIDOL 5 MG 10,00
RISPERIDONE 2 MG 50,00
AMLODIPIN 10 50,00
KAPSUL NO 2 100,00
1741 SANIK SUYATI 201904004487 23/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 127.735
LORAZEPAM 2 MG 8,00
CLOBAZAM 10 MG 30,00
SERTRALINE 50 MG 30,00
1742 SANTIKA 201904000237 01/04/2019 Ruangan CLOZAPINE 25 MG 15,00 45.375
CLOBAZAM 10 MG 15,00
201904001202 05/04/2019 Ruangan SPUIT 3 CC 2,00 13.516
DIPHENHYDRAMINE 4,00
201904001664 08/04/2019 Ruangan CLOBAZAM 10 MG 15,00 45.551
CLOZAPINE 100 MG 7,00
1743 SARIATI 201904005897 30/04/2019 Poli Psikiater CLOZAPINE 100 MG 60,00 321.420
RISPERIDONE 3 MG 120,00
1744 SATUMI 201904000894 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 18.150
THD 2 MG 30,00
CPZ 100 MG 30,00
1745 SELVY CAHYA APRILIA 201904001558 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 78.435
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 15,00
1746 SENG LIK 201904000560 02/04/2019 Poli Psikiater NUZIP 25 100,00 167.700
THD 2 MG 100,00
1747 SENTOT WIDAYANTO 201904000822 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 94.575
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
1748 SIGIT PRASTYO 201904003927 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
1749 SIMAN 201904005906 30/04/2019 Psiko Geriatri RISPERIDONE 2 MG 200,00 121.800
THD 2 MG 200,00
CPZ 100 MG 100,00
1750 SIRAIT 201904004732 24/04/2019 Psiko Geriatri THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1751 SISWANTO 201904000573 02/04/2019 Poli Psikiater NUZIP 25 7,00 343.133
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1751 SISWANTO 201904000573 02/04/2019 Poli Psikiater
- THD 2 MG 28,00 343.133
RIZODAL 2 MG 28,00
CIPRALEX 10 MG 14,00
1752 SISWOYO 201904005093 26/04/2019 Poli Jiwa Dewasa CPZ 100 MG 60,00 25.800
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
1753 SITI UMAROH 201904003225 16/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 106.365
CLOBAZAM 10 MG 30,00
LORAZEPAM 2 MG 15,00
1754 SITI HOTIMAH 201904001892 09/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 82.245
LORAZEPAM 2 MG 15,00
RISPERIDONE 1 MG 30,00
1755 SITI KHODIJAH 201904000588 02/04/2019 Ruangan Puri NUZIP 25 6,00 31.566
RIZODAL 2 MG 12,00
THD 2 MG 12,00
1756 SITI KOTIMAH/SITI ALISA 201904000535 02/04/2019 Psiko Geriatri TFP 5 MG 60,00 19.380
1757 SITI MARYAM 201904000534 02/04/2019 Psiko Geriatri THD 2 MG 30,00 50.355
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
1758 SITI NAIMAH 201904002893 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 126.015
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
1759 SITI NURIYANI 201904000944 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 25.140
CPZ 100 MG 15,00
TFP 5 MG 60,00
1760 SITI ROKAJAH 201904000906 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 467.440
DEPAKOTE ER 500 30,00
CLOZAPINE 100 MG 15,00
VIT B COMPLEX 10,00
LORAZEPAM 2 MG 15,00
OLANZPINE 10mg 30,00
1761 SITI SHOFIYAH 201904001148 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 81.321
SIKZONOATE 1,00
SPUIT 3 CC 1,00
1762 SITI TASLIMAH 201904003226 16/04/2019 Psiko Geriatri SEROQUEL XR 400 30,00 663.780
TFP 5 MG 60,00
1763 SITI ZAHIROH 201904004894 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1764 SLAMET BUDI 201904005080 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
1765 SLAMET NURWINADI 201904004817 25/04/2019 Ruangan Gelatik TFP 5 MG 15,00 6.105
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1765 SLAMET NURWINADI 201904004817 25/04/2019 Ruangan
- Gelatik CPZ 100 MG 7,00 6.105
1766 SLAMET SANTOSO 201904005484 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 15,00 6.255
1767 SLAMET WIDODO 201904002453 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
1768 SODIK 201904000456 02/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 100.995
THD 2 MG 60,00
LORAZEPAM 2 MG 15,00
RISPERIDONE 2 MG 60,00
1769 SONYA YULIANA 201904004409 23/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 223.455
RACIKAN KAPSUL 60,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
ALPRAZOLAM 1 MG 45,00
LORAZEPAM 2 MG 15,00
SEROQUEL XR 400 4,00
1770 SRI MULYANI 201904000860 04/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 99.820
LORAZEPAM 2 MG 8,00
SERTRALINE 50 MG 30,00
1771 SRI REJEKI 201904001803 09/04/2019 Psiko Geriatri LORAZEPAM 2 MG 30,00 891.510
SEROQUEL XR 400 30,00
THD 2 MG 30,00
DEPAKOTE ER 500 30,00
1772 SRI TUTI 201904004466 23/04/2019 Psiko Geriatri SERTRALINE 50 MG 8,00 17.832
KAPSUL NO.00 30,00
RACIKAN KAPSUL 30,00
1773 SRI WAHYUNI 201904002803 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 106.635
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
1774 SUCI NINGSIH 201904002523 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1775 SUDARMANTO 201904002900 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 208.950
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
1776 SUDARSIH 201904003406 16/04/2019 Ruangan Puri DIAZEPAM 5 MG 7,00 2.667
HALOPERIDOL 0,5 15,00
1777 SUHAYATI 201904000191 01/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1778 SUJATNOKO 201904003846 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 115.515
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
1779 SUKAMTO 201904004662 24/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 8,00 410.214
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1779 SUKAMTO 201904004662 24/04/2019 Psiko Geriatri
- RACIKAN KAPSUL 30,00 410.214
ABILIFY DISCMELT 10 8,00
CLOBAZAM 10 MG 60,00
SERTRALINE 50 MG 60,00
KAPSUL NO 2 30,00
VIT B6 10 MG 30,00
1780 SUKAYAH 201904004643 24/04/2019 Psiko Geriatri RISPERIDONE 2 MG 30,00 71.400
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1781 SULAMI 201904004412 23/04/2019 Poli Psikiater THD 2 MG 50,00 37.400
TFP 5 MG 100,00
1782 SULIYO 201904002910 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
1783 SULTON AFIF 201904005567 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 50.355
TFP 5 MG 60,00
THD 2 MG 30,00
1784 SUMARNO 201904005562 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 142.800
CLOZAPINE 25 MG 60,00
RISPERIDONE 2 MG 60,00
1785 SUNAMAH 201904002436 12/04/2019 Poli Jiwa Dewasa AMITRIPTILIN 25 MG 15,00 21.165
THD 2 MG 30,00
CPZ 100 MG 30,00
TFP 5 MG 30,00
1786 SUPADI 201904001568 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 103.290
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
1787 SUPARMI 201904000465 02/04/2019 Psiko Geriatri VIT B1 50 MG 100,00 71.600
HALOPERIDOL 5 MG 100,00
THD 2 MG 100,00
AMLODIPIN 5 100,00
1788 SUPARNEN 201904003553 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1789 SUPRIYADI HERU 201904005640 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 41.940
THD 2 MG 60,00
CPZ 100 MG 60,00
1790 SUROSO 201904003911 22/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 213.558
HALOPERIDOL 5 MG 6,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 60,00
KAPSUL NO.00 60,00
THD 2 MG 30,00
FOLIC ACID 1 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1790 SUROSO 201904003911 22/04/2019 Poli Jiwa- Dewasa PHENYTOIN CAP 100 90,00 213.558
1791 SUSANTI 201904002466 12/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 628.050
CLOZAPINE 25 MG 30,00
SERTRALINE 50 MG 30,00
1792 SUSILOWATI 201904000142 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 7,00 13.027
201904000511 02/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 8,00 14.888
201904003364 16/04/2019 Ruangan CLOZAPINE 25 MG 15,00 27.915
1793 SUTIAH / SUNAH 201904002869 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 60.195
1794 SUTIANA 201904000235 01/04/2019 Ruangan THD 2 MG 7,00 34.686
HALOPERIDOL 5 MG 7,00
TFP 5 MG 15,00
CLOZAPINE 100 MG 7,00
201904003367 16/04/2019 Ruangan HALOPERIDOL 5 MG 15,00 36.686
TFP 5 MG 15,00
CLOZAPINE 100 MG 7,00
THD 2 MG 15,00
1795 SUTOMO 201904004034 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 103.575
THD 2 MG 30,00
CLOZAPINE 100 MG 15,00
1796 SUTRISNO 201904005908 30/04/2019 Poli Psikiater RISPERIDONE 3 MG 200,00 402.200
CLOZAPINE 100 MG 50,00
THD 2 MG 200,00
LORAZEPAM 2 MG 50,00
1797 SUWAJI 201904005644 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
1798 SUWARNI 201904004649 24/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 40.860
VIT B12 50 MG 60,00
FOLIC ACID 1 MG 30,00
RISPERIDONE 3 MG 40,00
KAPSUL NO 2 60,00
THD 2 MG 30,00
1799 SUWONDO 201904003465 18/04/2019 Poli Psikiater CLOZAPINE 100 MG 45,00 180.585
1800 SYAMSURI 201904005102 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
1801 TAN FENESYIAH 201904003914 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 854.790
ABILIFY DISCMELT 10 30,00
CPZ 100 MG 30,00
1802 TANTI ARIANI 201904005572 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 99.210
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
1803 TARI 201904000939 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1804 TASRI 201904005900 30/04/2019 Poli Psikiater THD 2 MG 200,00 340.900
CLOZAPINE 25 MG 100,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1804 TASRI 201904005900 30/04/2019 Poli Psikiater
- RISPERIDONE 3 MG 200,00 340.900
1805 TEGUH RESTU 201904003891 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
1806 THORIKAH 201904001458 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
1807 TITIN 201904000196 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
1808 TJIOE JAYA DIARTA 201904001529 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 93.735
TFP 5 MG 60,00
CLOZAPINE 25 MG 15,00
THD 2 MG 60,00
1809 TOMMY MANUEL 201904002813 15/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 542.715
CLOZAPINE 25 MG 15,00
1810 TONO RAHMAN 201904001640 08/04/2019 Ruangan Kenari THD 2 MG 7,00 22.199
FOLIC ACID 1 MG 7,00
TFP 5 MG 15,00
CLOZAPINE 100 MG 4,00
201904002073 10/04/2019 Ruangan Kenari CLOZAPINE 100 MG 4,00 22.199
THD 2 MG 7,00
FOLIC ACID 1 MG 7,00
TFP 5 MG 15,00
201904004948 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 85.155
CLOZAPINE 100 MG 15,00
THD 2 MG 30,00
FOLIC ACID 1 MG 30,00
1811 TRI HANDOKO 201904002458 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 18.150
THD 2 MG 30,00
CPZ 100 MG 30,00
1812 TRIASIH ( ASIH ) 201904002423 12/04/2019 Poli Jiwa Dewasa AMITRIPTILIN 25 MG 30,00 41.445
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
HALOPERIDOL 1,5 60,00
1813 TUPIYONO 201904005091 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
1814 TURSITA TRISTY 201904000816 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 69.930
SERTRALINE 50 MG 30,00
1815 TUTIK WONG 201904000935 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
201904004993 25/04/2019 Ruangan CLOZAPINE 25 MG 5,00 14.495
RISPERIDONE 2 MG 10,00
THD 2 MG 10,00
1816 UDIN 201904005635 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
1817 UMBARI 201904005162 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 94.450
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1817 UMBARI 201904005162 26/04/2019 Poli Jiwa- Dewasa LORAZEPAM 2 MG 8,00 94.450
RISPERIDONE 2 MG 60,00
CLOZAPINE 25 MG 30,00
1818 UMI 201904004990 25/04/2019 Ruangan THD 2 MG 10,00 14.495
CLOZAPINE 25 MG 5,00
RISPERIDONE 2 MG 10,00
1819 UMIANI 201904000965 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 27.840
CPZ 100 MG 30,00
TFP 5 MG 60,00
1820 USMAN RIZALNADI 201904002934 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
1821 VITA KUSUMA INDAH 201904005933 30/04/2019 Poli Psikiater THD 2 MG 60,00 25.500
TFP 5 MG 60,00
1822 VIVIN ACHMAD ALFIN 201904000388 01/04/2019 Ruangan Gelatik THD 2 MG 15,00 34.466
CLOZAPINE 100 MG 7,00
TFP 5 MG 15,00
201904000538 02/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 7,00 34.466
TFP 5 MG 15,00
THD 2 MG 15,00
1823 WAGINI 201904000202 01/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
1824 WAHYU ISFA'ATIN 201904003874 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 15.570
THD 2 MG 30,00
1825 WAHYUDO SUKMARAGA 201904001171 05/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 42.915
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
1826 WAKID 201904002871 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.920
TFP 5 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
1827 WARSIAH 201904005909 30/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
1828 WATI 201904000206 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
1829 WIDODO 201904001585 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 117.840
SERTRALINE 50 MG 30,00
ALPRAZOLAM 0.5 MG 30,00
1830 WIJAWATI 201904003903 22/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 91.924
CLOZAPINE 25 MG 8,00
THD 2 MG 30,00
KAPSUL NO.00 30,00
SIKZONOATE 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1830 WIJAWATI 201904003903 22/04/2019 Poli Jiwa- Dewasa SPUIT 3 CC 1,00 91.924
1831 WIJI ERIPAH 201904003411 16/04/2019 Ruangan Puri RISPERIDONE 2 MG 15,00 38.708
CLOZAPINE 100 MG 7,00
THD 2 MG 21,00
HALOPERIDOL 5 MG 15,00
201904004961 25/04/2019 Ruangan Puri CLOZAPINE 100 MG 11,00 165.324
THD 2 MG 21,00
HALOPERIDOL 5 MG 15,00
ABILIFY DISCMELT 10 4,00
RISPERIDONE 2 MG 15,00
1832 WILLIAM 201904000138 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1833 WURI HANDAJANI, DRA 201904005151 26/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 32.262
ALPRAZOLAM 1 MG 6,00
SERTRALINE 50 MG 15,00
KAPSUL NO.00 30,00
1834 YAYUK 201904000947 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
1835 YENNI AMBARWATI 201904005464 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 124.391
RISPERIDONE 2 MG 60,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
1836 YOSI IRIANTO 201904002899 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 726.730
VIT B COMPLEX 10,00
TFP 5 MG 60,00
SEROQUEL XR 400 30,00
THD 2 MG 60,00
1837 YULI MURSIDAH 201904002790 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1838 YULIANTO 201904001132 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 162.465
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1839 YUNA 201904000193 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 24.660
THD 2 MG 30,00
1840 YUSIANA GHOMAROH 201904005582 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 53.220
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
1841 YUSUF EFENDY 201904005077 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 141.330
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1841 YUSUF EFENDY 201904005077 26/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 141.330
THD 2 MG 30,00
RISPERIDONE 2 MG 60,00
1842 ZAHRA MUTIA DEWI 201904001877 09/04/2019 Poli Psikiater SERTRALINE 50 MG 16,00 36.704
RACIKAN KAPSUL 16,00
KAPSUL NO 2 16,00
RISPERIDONE 2 MG 4,00
LORAZEPAM 2 MG 4,00
201904004397 23/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 93.045
LORAZEPAM 2 MG 15,00
RISPERIDONE 1 MG 60,00
1843 ZAINAL ABIDIN 201904004632 24/04/2019 Poli Psikiater CPZ 100 MG 100,00 172.800
RISPERIDONE 3 MG 200,00
THD 2 MG 200,00
Dokter: dr. ARSANTO SIDOHUTOMO
1844 ALWI FAHRUDIN 201904001253 06/04/2019 IGD CLOZAPINE 25 MG 6,00 12.054
HALOPERIDOL 5 MG 6,00
1845 MARIA KRISTIANI 201904001389 08/04/2019 Ruangan Wijaya THD 2 MG 6,00 10.635
RISPERIDONE 2 MG 6,00
TFP 5 MG 6,00
CLOZAPINE 25 MG 3,00
1846 OLIVIA TRISETIANI 201904000866 04/04/2019 IGD THD 2 MG 6,00 612
1847 SANIDI 201904001256 06/04/2019 IGD LODOMER 2 MG/ML 0,00 11.984
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 6,00
AMOXYCILLIN 500 10,00
LORAZEPAM 2 MG 2,00
ASAM MEFENAMAT 10,00
1848 SUDARTIK 201904001536 09/04/2019 IGD NEW DIATAB 12,00 60.003
ONDANSETRON 4 2,00
RINGER LACTAT 1,00
ANTASIDA DOEN 10,00
NORAGES INJEKSI 1,00
ONDANSETRON 8 10,00
INFUS SET DEWASA 1,00
IKANEURON INJ 5000 1,00
COTRIMOXAZOL 480 10,00
RANITIDIN INJEKSI 1,00
IV CANULA NO. 18 1,00
1849 SUTIANA 201904001254 06/04/2019 Ruangan DIPHENHYDRAMINE 4,00 13.516
SPUIT 3 CC 2,00
Dokter: dr. BENEDIKTUS ELIE LIE, Sp.KJ
1850 ACHMAD MUCHSIN 201904002857 15/04/2019 Poli Psikiater RISPERIDONE 3 MG 120,00 243.300
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1850 ACHMAD MUCHSIN 201904002857 15/04/2019 Poli Psikiater
- TFP 5 MG 120,00 243.300
CLOZAPINE 25 MG 60,00
THD 2 MG 120,00
1851 ADE IRMA NASUTION 201904002165 10/04/2019 Poli Psikiater OLANZPINE 10mg 45,00 301.590
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
1852 AGUS SISWANTO 201904005929 30/04/2019 Poli Psikiater RISPERIDONE 3 MG 100,00 123.925
THD 2 MG 100,00
CLOZAPINE 25 MG 25,00
1853 AJENG YUNI FIDIA 201904003247 16/04/2019 Poli Psikiater RACIKAN KAPSUL 30,00 45.323
FOLIC ACID 1 MG 15,00
KAPSUL NO 2 30,00
CLOZAPINE 25 MG 23,00
1854 AMELINDA BATARI 201904002800 15/04/2019 Poli Psikiater ALPRAZOLAM 0.5 MG 30,00 861.735
CLOZAPINE 25 MG 15,00
ABILIFY DISCMELT 10 30,00
1855 ANGGY SUGIHARTO 201904002052 10/04/2019 Poli Psikiater TFP 5 MG 60,00 22.440
THD 2 MG 30,00
1856 ANTONIUS L 201904001404 08/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 50,00 8.600
1857 CHAN EDY CHANDRA 201904002183 10/04/2019 Poli Psikiater CPZ 100 MG 30,00 18.150
TFP 5 MG 30,00
THD 2 MG 30,00
1858 CHOLIFAH 201904002115 10/04/2019 Poli Psikiater TFP 5 MG 180,00 179.100
RISPERIDONE 3 MG 180,00
1859 DWI INDAH NOVITA 201904005537 29/04/2019 Poli Psikiater THD 2 MG 60,00 819.405
SERTRALINE 50 MG 30,00
SEROQUEL XR 400 30,00
LORAZEPAM 2 MG 45,00
TFP 5 MG 90,00
RISPERIDONE 3 MG 60,00
1860 ELISA DELA ANJARSARI 201904002097 10/04/2019 Poli Psikiater RISPERIDONE 2 MG 14,00 55.748
DEPAKOTE ER 250 7,00
CLOZAPINE 25 MG 14,00
1861 ETTY SUTJIATI 201904000870 04/04/2019 Psiko Geriatri CLOBAZAM 10 MG 15,00 318.000
CIPRALEX 10 MG 15,00
1862 FAUZI B. 201904004598 23/04/2019 Psiko Geriatri ALGANAX 1 MG 60,00 447.480
SERTRALINE 50 MG 60,00
1863 GUNAWAN ONG KI 201904001898 09/04/2019 Psiko Geriatri ALPRAZOLAM 0.5 MG 100,00 15.300
1864 HASZAIMAH 201904002030 10/04/2019 Poli Psikiater THD 2 MG 30,00 247.590
RACIKAN KAPSUL 60,00
OLANZPINE 10mg 20,00
ALPRAZOLAM 0.5 MG 90,00
SERTRALINE 50 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1864 HASZAIMAH 201904002030 10/04/2019 Poli Psikiater
- KAPSUL NO 2 60,00 247.590
1865 HJ. KHONAH 201904002132 10/04/2019 Poli Psikiater CLOBAZAM 10 MG 30,00 119.970
OLANZPINE 10mg 15,00
1866 ISMAWATI 201904002064 10/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 286.980
CLOZAPINE 25 MG 60,00
RISPERIDONE 3 MG 90,00
1867 JAMILAH 201904003678 18/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 55.830
1868 JARIYANAH 201904005335 29/04/2019 Poli Psikiater TFP 5 MG 200,00 191.200
THD 2 MG 100,00
CLOBAZAM 10 MG 100,00
1869 KASMAH 201904002026 10/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 173.940
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
1870 M. AJIB 201904002162 10/04/2019 Psiko Geriatri ALGANAX 1 MG 7,00 143.144
VIT B6 10 MG 30,00
DEPTRAL 50 MG 8,00
KAPSUL NO.00 30,00
ALGANAX 0,5 MG 1,00
RACIKAN KAPSUL 30,00
1871 M. SYIFAUR ROHMAN AL 201904002167 10/04/2019 Poli Psikiater RISPERIDONE 1 MG 8,00 3.948
KAPSUL NO.1 15,00
THD 2 MG 4,00
RACIKAN KAPSUL 15,00
1872 MAHMUD 201904002049 10/04/2019 Poli Psikiater CLOZAPINE 25 MG 100,00 269.500
RISPERIDONE 2 MG 200,00
1873 MASRIANAH 201904002154 10/04/2019 Poli Psikiater THD 2 MG 200,00 85.000
TFP 5 MG 200,00
1874 MAYA EKA . W 201904000014 01/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 30,00 104.160
RACIKAN KAPSUL 120,00
CLOBAZAM 10 MG 30,00
NOPRES 20 MG 60,00
KAPSUL NO 2 120,00
1875 MUFAROKHAH 201904004418 23/04/2019 Poli Psikiater THD 2 MG 120,00 372.750
RISPERIDONE 3 MG 120,00
ELIZAC 20 MG 120,00
TFP 5 MG 90,00
ALPRAZOLAM 0.5 MG 120,00
1876 MUFIDA AMALIA R 201904002123 10/04/2019 Poli Psikiater RISPERIDONE 2 MG 45,00 79.245
SERTRALINE 50 MG 30,00
THD 2 MG 30,00
1877 MUTIAH 201904002054 10/04/2019 Poli Psikiater THD 2 MG 120,00 61.800
CPZ 100 MG 60,00
TFP 5 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1878 NIA ALFINATUS SOFA 201904000728 04/04/2019 Poli Psikiater
- CLONAZEPAM 2 MG 30,00 668.700
OLANZPINE 10mg 60,00
RISPERIDONE 2 MG 120,00
NUZIP 25 60,00
THD 2 MG 60,00
1879 RAISATROIKA HANI 201904001906 09/04/2019 Poli Psikiater DEPAKOTE 250 MG 30,00 519.825
SERTRALINE 50 MG 30,00
ABILIFY DISCMELT 10 15,00
ALPRAZOLAM 0.5 MG 30,00
201904004541 23/04/2019 Poli Psikiater SERTRALINE 50 MG 15,00 28.710
1880 RATNA INDRAWATI 201904004833 25/04/2019 Poli Psikiater DEPAKOTE ER 250 100,00 2.488.800
SEROQUEL XR 400 100,00
1881 SALMA 201904002048 10/04/2019 Poli Psikiater KAPSUL NO 2 120,00 428.940
CLORILEX 25 MG 60,00
RACIKAN KAPSUL 120,00
STELAZINE 5 MG 180,00
THD 2 MG 120,00
1882 SEPTIAN NAUTIKA 201904004482 23/04/2019 Poli Psikiater ALPRAZOLAM 0.5 MG 10,00 20.670
SERTRALINE 50 MG 10,00
1883 SLAMET FATKHUR 201904002066 10/04/2019 Poli Psikiater THD 2 MG 120,00 204.540
CLOZAPINE 25 MG 60,00
RISPERIDONE 3 MG 120,00
1884 SRI HANDAYANI 201904002046 10/04/2019 Poli Psikiater THD 2 MG 30,00 230.580
OLANZPINE 10mg 30,00
SERTRALINE 50 MG 30,00
1885 SUKADI 201904002044 10/04/2019 Poli Psikiater THD 2 MG 200,00 103.000
CPZ 100 MG 100,00
TFP 5 MG 200,00
1886 SUKAWIT 201904003249 16/04/2019 Poli Psikiater OLANZPINE 10mg 60,00 535.200
CLOZAPINE 25 MG 60,00
MERLOPAM 2 MG 30,00
THD 2 MG 60,00
1887 UMMI 201904002133 10/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 119.250
THD 2 MG 30,00
RISPERIDONE 3 MG 30,00
MERLOPAM 2 MG 15,00
1888 WIJIONO 201904002088 10/04/2019 Poli Psikiater THD 2 MG 200,00 103.000
CPZ 100 MG 100,00
TFP 5 MG 200,00
1889 WIWIK DWI HANDAYANI 201904002060 10/04/2019 Poli Psikiater SERTRALINE 50 MG 45,00 102.060
RACIKAN KAPSUL 60,00
THD 2 MG 15,00
ALPRAZOLAM 1 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1889 WIWIK DWI HANDAYANI 201904002060 10/04/2019 Poli Psikiater
- RISPERIDONE 3 MG 10,00 102.060
KAPSUL NO 2 60,00
1890 YULI SUHARTATIK 201904002079 10/04/2019 Poli Psikiater CPZ 100 MG 100,00 18.000
1891 ZAINIYAH 201904002035 10/04/2019 Poli Psikiater RISPERIDONE 1 MG 60,00 21.600
Dokter: dr. DEWI ANDOJOWATI
1892 ABDUL KHOLID 201904001821 09/04/2019 Ruangan Gelatik THD 2 MG 7,00 10.842
CPZ 100 MG 4,00
RISPERIDONE 3 MG 14,00
1893 ACHMAD ISA IDRIS 201904001808 09/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 30.163
CLOZAPINE 100 MG 7,00
1894 AGUNG MEDIO 201904000370 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
1895 AGUS SETIYO 201904001829 09/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 17.549
TFP 5 MG 14,00
201904001846 09/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 30.576
TFP 5 MG 14,00
1896 AKBAR RAHMA 201904000393 01/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
1897 AVIN 201904000400 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
201904001844 09/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
1898 BISMA FERRYANSYAH 201904000379 01/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 8.085
CPZ 100 MG 7,00
DIAZEPAM 5 MG 7,00
201904001840 09/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 8.085
DIAZEPAM 5 MG 7,00
RISPERIDONE 2 MG 14,00
1899 BISU RUHUT 201904000349 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 13.174
TABLET TAMBAH 14,00
TFP 5 MG 14,00
CPZ 100 MG 7,00
201904001818 09/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
1900 DJAINURI 201904004094 22/04/2019 Ruangan Gelatik THD 2 MG 15,00 31.614
CLOZAPINE 25 MG 12,00
TFP 5 MG 24,00
1901 HAMIYAH 201904005242 26/04/2019 IGD SPUIT 3 CC 2,00 17.720
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1901 HAMIYAH 201904005242 26/04/2019 IGD
- THD 2 MG 8,00 17.720
CLOZAPINE 25 MG 4,00
LODOMER 2 MG/ML 2,00
RISPERIDONE 2 MG 8,00
1902 IBNU HANY S 201904004085 22/04/2019 Ruangan Gelatik SALEP 2-4 2,00 26.523
KETOKONAZOL 2,00
RISPERIDONE 2 MG 15,00
CPZ 100 MG 15,00
1903 JOKO UTOMO 201904003391 16/04/2019 IGD SPUIT 3 CC 1,00 170.880
HALOPERIDOL 5 MG 4,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
NEEDLE 23 G 1,00
CLOZAPINE 25 MG 2,00
1904 JONI SISWANTO 201904005241 26/04/2019 Ruangan Puri RISPERIDONE 3 MG 14,00 30.250
SERTRALINE 50 MG 7,00
CLOZAPINE 25 MG 4,00
1905 KUMA 201904000380 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904000381 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
1906 M.IQBAL SYA'RANI 201904000387 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 26.888
CLOZAPINE 100 MG 4,00
RISPERIDONE 3 MG 14,00
1907 MARIADI 201904001816 09/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.950
THD 2 MG 14,00
1908 MARULLI TAMPUBOLON 201904001845 09/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
1909 MINTO 201904000405 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 16.198
RISPERIDONE 2 MG 14,00
AMITRIPTILIN 25 MG 14,00
TFP 5 MG 14,00
CPZ 100 MG 7,00
1910 MISBACHUL MUNIR 201904000365 01/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
1911 MR. X 201904000383 01/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
1912 MUHAMMAD NURFAQIH 201904004089 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 15,00 30.795
RISPERIDONE 1 MG 8,00
1913 MUTTAQIN 201904000363 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 34.041
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1913 MUTTAQIN 201904000363 01/04/2019 Ruangan
- Gelatik CLOZAPINE 100 MG 7,00 34.041
TFP 5 MG 14,00
1914 RICO FIRMANSYAH 201904001827 09/04/2019 Ruangan Gelatik THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
1915 ROHENDRO PUTRO 201904001841 09/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 22.435
RISPERIDONE 3 MG 14,00
1916 ROJA BIANA 201904002610 12/04/2019 Poli Jiwa Dewasa NOPRES 20 MG 60,00 110.430
TFP 5 MG 90,00
THD 2 MG 60,00
CPZ 100 MG 90,00
1917 SADIQIN 201904000367 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 8.442
FOLIC ACID 1 MG 14,00
RISPERIDONE 2 MG 14,00
1918 SITI NURIFAH 201904003243 16/04/2019 IGD SPUIT 3 CC 2,00 167.458
THD 2 MG 6,00
CPZ 100 MG 3,00
ZYPREXA INJ 1,00
TFP 5 MG 6,00
1919 SRIAH 201904005124 26/04/2019 IGD NA CL 0,9 % 500 ML 3,00 262.768
NOVORAPID PEN 1,00
INFUS SET DEWASA 1,00
RISPERIDONE 1 MG 6,00
SCABIMITE 10 GR 2,00
IV CANULLA NO.20 2,00
PEN NEEDLE 32,5 G 10,00
1920 SUSANTI 201904005230 26/04/2019 IGD RISPERIDONE 2 MG 6,00 3.834
THD 2 MG 6,00
CPZ 100 MG 4,00
1921 SYAMSUL 201904002107 10/04/2019 Ruangan Gelatik CURCUMA 200 MG 20,00 22.200
1922 WARTO 201904001832 09/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 35.462
RISPERIDONE 3 MG 14,00
201904004091 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 15,00 37.995
RISPERIDONE 3 MG 15,00
1923 ZAINAL ABIDIN 201904004502 23/04/2019 Ruangan Gelatik CURCUMA 200 MG 20,00 22.200
Dokter: dr. DIAN EVA SANJAYA, Sp.S
1924 ABD FATAH 201904004046 22/04/2019 Poli Jiwa Dewasa AMLODIPIN 10 30,00 3.360
1925 ADIM MUSONI 201904000515 02/04/2019 Poli Syaraf PHENYTOIN CAP 100 90,00 79.710
AMLODIPIN 5 30,00
CARBAMAZEPINE 90,00
1926 AGUS JUMANTORO 201904003828 22/04/2019 Poli Syaraf THD 2 MG 30,00 307.620
CLOBAZAM 10 MG 120,00
KUTOIN 180,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1926 AGUS JUMANTORO 201904003828 22/04/2019 Poli Syaraf
- RISPERIDONE 2 MG 120,00 307.620
1927 DWI WANTO SAPUTRO 201904000508 02/04/2019 Poli Syaraf CLOBAZAM 10 MG 20,00 107.680
KUTOIN 120,00
FOLIC ACID 1 MG 40,00
HALOPERIDOL 0,5 40,00
1928 FAIZAL AGUN WIBAWA 201904002051 10/04/2019 Poli Syaraf KUTOIN 30,00 36.600
CLOBAZAM 10 MG 15,00
1929 FEBRIANI PUTRI JAYANTI 201904001857 09/04/2019 Poli Syaraf FOLIC ACID 1 MG 30,00 11.880
PIRACETAM 800 MG 15,00
1930 HARIONO 201904003854 22/04/2019 Poli Syaraf FOLIC ACID 1 MG 30,00 384.660
ADALAT OROS 30 MG 30,00
CLOBAZAM 10 MG 30,00
DEPAKOTE ER 500 30,00
1931 JOKO UTOMO 201904004503 23/04/2019 Ruangan Gelatik DIAZEPAM 5 MG 2,00 4.726
NA DICLOFENAC 50 5,00
KAPSUL NO 2 10,00
RACIKAN KAPSUL 10,00
METHYLPREDNISOL 3,00
1932 KASMIN 201904001054 05/04/2019 Poli Syaraf LEVOPAR 60,00 174.690
AMLODIPIN 10 30,00
MINIASPI 80 MG 30,00
PIRACETAM 800 MG 15,00
1933 KH.SHODIK 201904005381 29/04/2019 Poli Syaraf RACIKAN KAPSUL 20,00 72.264
GABAPENTIN 300 MG 10,00
VALISANBE 2 MG 10,00
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
GLUCOSAMINE 30,00
NA DICLOFENAC 50 10,00
AMITRIPTILIN 25 MG 4,00
VIT B1 50 MG 20,00
KAPSUL NO 2 20,00
1934 KHUSNUL HADI 201904000526 02/04/2019 Poli Syaraf PIRACETAM 800 MG 30,00 133.560
KUTOIN 180,00
1935 LILINCE PANGGABEAN 201904002208 11/04/2019 Poli Syaraf CANDESARTAN 8 MG 30,00 23.610
VIT B1 50 MG 30,00
1936 M FAHRIL AZIZ B 201904002045 10/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 30,00 2.520
1937 MOCH. ATTAR SJAHRIS 201904003576 18/04/2019 Poli Syaraf AMLODIPIN 10 15,00 17.432
NA DICLOFENAC 50 10,00
DIAZEPAM 5 MG 12,00
RACIKAN KAPSUL 60,00
AMITRIPTILIN 25 MG 30,00
KAPSUL NO 2 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1938 MUHAMAD YASIN 201904004847 25/04/2019 Poli Syaraf
- RISPERIDONE 2 MG 60,00 105.375
KUTOIN 60,00
LORAZEPAM 2 MG 45,00
1939 MUSA 201904003840 22/04/2019 Poli Syaraf KAPSUL NO 2 30,00 87.636
VIT B1 IOO MG 15,00
BETAHISTINE 6-IF 70,00
NA DICLOFENAC 50 30,00
VALISANBE 2 MG 15,00
RACIKAN KAPSUL 30,00
AMITRIPTILIN 25 MG 6,00
1940 NASIHUL AMIN 201904002846 15/04/2019 Poli Syaraf VIT B6 10 MG 30,00 90.690
DEPAKOTE 250 MG 60,00
FOLIC ACID 1 MG 30,00
1941 NAZWA AZAROH 201904003551 18/04/2019 Poli Syaraf IKALEP SYRUP 4,00 216.452
FOLIC ACID 1 MG 60,00
1942 NUNUK WURJANDANI 201904001164 05/04/2019 Poli Syaraf CODEIN 10 MG 10,00 172.200
DEPAKOTE 250 MG 60,00
LEVOPAR 30,00
1943 NUR HASANAH 201904003610 18/04/2019 Poli Syaraf CLOBAZAM 10 MG 30,00 206.040
BAMGETOL 200 MG 120,00
1944 NURAINI 201904002500 12/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 950.860
TOPAMAX 100 MG 60,00
HALOPERIDOL 5 MG 120,00
THD 2 MG 60,00
PIRACETAM 800 MG 30,00
KUTOIN 200,00
CLOBAZAM 10 MG 30,00
1945 NURMASARI 201904005893 30/04/2019 Poli Syaraf BAMGETOL 200 MG 120,00 259.680
CLOBAZAM 10 MG 60,00
PIRACETAM 800 MG 30,00
1946 REDA DWI ERLANGGA 201904002745 15/04/2019 Poli Syaraf DEPAKOTE 250 MG 60,00 91.910
NA DICLOFENAC 50 10,00
1947 RENGGA ARTHA 201904001145 09/04/2019 Poli Syaraf PIRACETAM 800 MG 15,00 104.535
ASAM VALPROAT 3,00
CARBAMAZEPINE 45,00
1948 SAHRI ROMADON 201904001397 08/04/2019 Poli Syaraf CODEIN 10 MG 10,00 208.620
PLETAAL 100 mg 30,00
1949 SOEMARDI 201904004844 25/04/2019 Poli Syaraf LEVOPAR 90,00 240.960
AMLODIPIN 10 30,00
1950 SUDARSIH 201904003409 16/04/2019 Ruangan Puri MINIASPI 80 MG 10,00 8.550
AMLODIPIN 10 10,00
PIRACETAM 800 MG 10,00
1951 SULAIMAN 201904001062 05/04/2019 Poli Syaraf KAPSUL NO.00 30,00 36.759
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1951 SULAIMAN 201904001062 05/04/2019 Poli Syaraf
- ALLOPURINOL 100 30,00 36.759
RACIKAN KAPSUL 30,00
GABAPENTIN 300 MG 10,00
NA DICLOFENAC 50 20,00
AMITRIPTILIN 25 MG 5,00
KAPSUL NO.00 20,00
RACIKAN KAPSUL 20,00
DIAZEPAM 5 MG 4,00
1952 SULIS MUNTIANI 201904003251 16/04/2019 Poli Syaraf MINIASPI 80 MG 30,00 25.650
AMLODIPIN 10 30,00
PIRACETAM 800 MG 30,00
1953 SUNARTI 201904003552 18/04/2019 Poli Syaraf METHYLPREDNISOL 10,00 520.940
KUTOIN 180,00
NA DICLOFENAC 50 10,00
CLOBAZAM 10 MG 120,00
BAMGETOL 200 MG 180,00
1954 TEGUH SUSANTO 201904000696 04/04/2019 Poli Syaraf AMLODIPIN 10 60,00 133.320
RISPERIDONE 2 MG 120,00
KUTOIN 120,00
1955 THANIYA RAHADI 201904002484 12/04/2019 Poli Syaraf TOPAMAX 100 MG 30,00 344.160
1956 THE JONG TJANG 201904001883 09/04/2019 Poli Syaraf CLOPIDOGREL 75 30,00 156.690
LISINOPRIL 10 MG 30,00
AMLODIPIN 10 30,00
1957 TRI RAGHIL PRAKOSO 201904002033 10/04/2019 Poli Syaraf FOLIC ACID 1 MG 30,00 157.920
BAMGETOL 200 MG 60,00
CLOBAZAM 10 MG 60,00
1958 YUNIATI 201904001044 05/04/2019 Poli Syaraf CLOBAZAM 10 MG 60,00 128.460
DIAZEPAM 2 MG 20,00
KUTOIN 90,00
Dokter: dr. DJONI PANDAPOTAN SIRAIT, Sp.KK
1959 ASNGARI 201904002101 10/04/2019 Ruangan Gelatik BETAMETASON 1,00 5.628
LORATADIN 10 MG 10,00
1960 HORO 201904002058 10/04/2019 Ruangan Kenari BETAMETASON 1,00 1.608
1961 I'ANATUL MUALIMAH 201904000497 02/04/2019 Ruangan LORATADIN 10 MG 5,00 2.010
1962 INDAH NUR MUFIDA 201904000495 02/04/2019 Ruangan KAPSUL NO.00 5,00 6.770
RACIKAN KAPSUL 5,00
LORATADIN 10 MG 5,00
METHYLPREDNISOL 7,00
1963 ISMAIL KOLIL 201904002398 12/04/2019 Ruangan Kenari BETAMETASON 1,00 5.628
LORATADIN 10 MG 10,00
1964 KUSNO 201904002089 10/04/2019 Ruangan Gelatik LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
1965 M.KOMARUDIN 201904002399 12/04/2019 Ruangan Kenari BETAMETASON 2,00 7.236
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1965 M.KOMARUDIN 201904002399 12/04/2019 Ruangan
- Kenari LORATADIN 10 MG 10,00 7.236
1966 MINTO 201904002071 10/04/2019 Ruangan Gelatik KETOKONAZOL 200 10,00 14.510
KETOKONAZOL 2,00
1967 MUALIMAH 201904005987 30/04/2019 Poli LORATADIN 10 MG 10,00 14.168
BETAMETASON 1,00
METHYLPREDNISOL 13,00
KAPSUL NO.0 10,00
RACIKAN KAPSUL 10,00
1968 MUCHAMMAD GUFRON 201904002074 10/04/2019 Ruangan Gelatik AMOXYCILLIN 500 15,00 10.490
GENTAMYCIN SALEP 1,00
1969 NORI PURWANTO 201904002397 12/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 5.628
BETAMETASON 1,00
1970 RAHMAD HATI 201904000314 01/04/2019 Ruangan Kenari LORATADIN 10 MG 10,00 4.020
1971 RIONO 201904002103 10/04/2019 Ruangan Gelatik BETAMETASON 1,00 1.608
1972 SIAK 201904002391 12/04/2019 Ruangan Kenari BETAMETASON 1,00 5.628
LORATADIN 10 MG 10,00
1973 TRIBUSONO 201904002382 12/04/2019 Ruangan Kenari BETAMETASON 1,00 5.628
LORATADIN 10 MG 10,00
Dokter: dr. Deni Chrismono Raharjo
1974 BAMBANG SRIWAHYUDI 201904002002 09/04/2019 IGD TFP 5 MG 4,00 5.218
THD 2 MG 2,00
CLOZAPINE 25 MG 2,00
1975 DJAINURI 201904001271 07/04/2019 IGD CLOZAPINE 25 MG 4,00 11.626
LODOMER 2 MG/ML 0,00
TFP 5 MG 4,00
SPUIT 3 CC 1,00
THD 2 MG 2,00
1976 FAJAR FAUZAN 201904002000 09/04/2019 IGD CPZ 100 MG 1,00 168.038
SPUIT 3 CC 1,00
TFP 5 MG 4,00
AQUA PRO INJEKSI 1,00
ZYPREXA INJ 1,00
NEEDLE 23 G 1,00
1977 LUTHFI ANDRY ARIESTA 201904001275 07/04/2019 IGD LODOMER 2 MG/ML 0,00 2.686
SPUIT 3 CC 1,00
1978 MOH. SUGENG 201904001278 07/04/2019 IGD RANITIDIN TAB 150 10,00 21.750
DEXAMETASON 0,5 10,00
PARACETAMOL 500 10,00
CEFIXIME 100 MG 10,00
1979 MOHAMMAD KISBIANTO 201904001984 09/04/2019 IGD THD 2 MG 2,00 1.872
RISPERIDONE 2 MG 4,00
1980 ROSIHAN AMARUDIN 201904000443 01/04/2019 IGD RISPERIDONE 3 MG 4,00 6.410
CLOZAPINE 25 MG 2,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1981 SURATMAN 201904000444 01/04/2019 IGD
- TFP 5 MG 4,00 2.060
THD 2 MG 4,00
CPZ 100 MG 2,00
Dokter: dr. ESTHER HARYANTO, Sp.KJ
1982 ABBAS 201904002118 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 10,00 4.170
1983 ABD ROSIDI 201904002047 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 587.520
DEPAKOTE 250 MG 30,00
SEROQUEL XR 300 30,00
1984 ABD SHOMAD 201904002772 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
1985 ABD. RAUP 201904002264 11/04/2019 Poli Psikiater NOPRES 20 MG 30,00 394.740
LORAZEPAM 2 MG 60,00
RISPERIDONE 3 MG 10,00
PIRACETAM 800 MG 60,00
ADALAT OROS 30 MG 60,00
KAPSUL NO 2 60,00
RACIKAN KAPSUL 60,00
1986 ABDI SUSANTO 201904001162 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 147.081
SPUIT 3 CC 1,00
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
SIKZONOATE 1,00
1987 ABDUL CHOLIK 201904002218 11/04/2019 Poli Psikiater CPZ 100 MG 240,00 68.220
RISPERIDONE 2 MG 60,00
1988 ABDUL KARIM 201904002286 11/04/2019 Poli Psikiater SERTRALINE 50 MG 90,00 485.640
RIZODAL 2 MG 180,00
1989 ABDUL LATIF 201904000021 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 18.150
THD 2 MG 30,00
CPZ 100 MG 30,00
1990 ABEDNEGO 201904000691 04/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 234.360
SERTRALINE 50 MG 60,00
NUZIP 25 60,00
1991 ACHMAD FAUZAN 201904001597 08/04/2019 Ruangan Kenari CLOZAPINE 100 MG 4,00 26.888
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
201904006047 30/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 26.888
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
1992 ACHMAD BAIQUNI 201904005166 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 170.910
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
1993 ACHMAD BUDIONO 201904001468 08/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 60,00 70.830
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
1994 ACHMAD IBNU FAWAID 201904000048 01/04/2019 Poli Jiwa Dewasa CLONAZEPAM 2 MG 30,00 705.518
SEROQUEL XR 200 30,00
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
1995 ACHMAD SHOFIYUDDIN 201904000094 01/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 212.895
HALOPERIDOL 5 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 15,00
1996 ADI SETIONO 201904001391 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1997 ADI TRISNO WIDODO 201904002743 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
1998 AGUNG SUROTO 201904003291 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
1999 AGUS ERLANGGA 201904005448 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 153.570
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2000 AGUS FATONI 201904004842 25/04/2019 Poli Psikiater RACIKAN KAPSUL 30,00 47.775
CLOBAZAM 10 MG 15,00
ELIZAC 20 MG 15,00
KAPSUL NO 2 30,00
2001 AGUS JOKO 201904004897 25/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 306.270
FRIMANIA 400 MG 120,00
2002 AGUS MASBUDI 201904004408 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2003 AGUS SATRIONO 201904002481 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 20.018
THD 2 MG 60,00
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
HALOPERIDOL 1,5 60,00
2004 AGUSTIENA WULANDARI 201904000039 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 298.920
SERTRALINE 50 MG 30,00
DEPAKOTE ER 500 30,00
TFP 5 MG 60,00
2005 AGUSTINUS SUNJAYA 201904005137 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 135.685
LORAZEPAM 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2005 AGUSTINUS SUNJAYA 201904005137 26/04/2019 Poli Jiwa- Dewasa VIT B COMPLEX 10,00 135.685
RISPERIDONE 3 MG 60,00
CLOZAPINE 100 MG 15,00
2006 AHADIN PRAMONO 201904000823 04/04/2019 Poli Psikiater THD 2 MG 300,00 155.700
RISPERIDONE 2 MG 300,00
2007 AHMAD JENODIN / MOH. 201904005446 29/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 123.410
OBH 100 ML 1,00
CLOZAPINE 25 MG 60,00
THD 2 MG 30,00
2008 AHMAD SARAWIH 201904005961 30/04/2019 Ruangan Gelatik TFP 5 MG 13,00 18.269
CPZ 100 MG 7,00
THD 2 MG 13,00
SERTRALINE 50 MG 6,00
2009 AHMAD UMARUL FARUQ 201904005023 26/04/2019 Poli Gigi (Jiwa) CLOZAPINE 25 MG 14,00 36.890
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
2010 AHMAT DANISA SANUJI 201904003289 16/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 90,00 19.440
THD 2 MG 60,00
2011 ALVIANITA RACHMAN 201904001473 08/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 1.036.110
TOPAMAX 50 MG 30,00
AMLODIPIN 10 15,00
2012 ALWI FAHRUDIN 201904005911 30/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 3,00 12.200
SPUIT 3 CC 2,00
THD 2 MG 2,00
CLOZAPINE 25 MG 2,00
LODOMER 2 MG/ML 1,00
DIAZEPAM inj 1,00
2013 AMBAR AGUS PRIYADI 201904001465 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
2014 AMIRUDDIN 201904000754 04/04/2019 Psiko Geriatri RISPERIDONE 2 MG 30,00 550.710
SEROQUEL XR 300 30,00
2015 ANDI ARSIN HELMI 201904003345 16/04/2019 Poli Psikiater THD 2 MG 60,00 109.245
CLOZAPINE 25 MG 45,00
TFP 5 MG 60,00
2016 ANDI BUDIANTO 201904002739 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 38.220
RISPERIDONE 2 MG 60,00
AMLODIPIN 10 15,00
THD 2 MG 60,00
2017 ANDI MULIA DARMAWAN 201904000036 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 116.037
PROPANOLOL 10 MG 15,00
TFP 5 MG 24,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2017 ANDI MULIA DARMAWAN 201904000036 01/04/2019 Poli Jiwa- Dewasa RACIKAN KAPSUL 60,00 116.037
THD 2 MG 60,00
KAPSUL NO.00 60,00
2018 ANDREA 201904000332 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904001611 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.236
THD 2 MG 7,00
2019 ANDREW SETIAWAN 201904003762 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 186.210
TFP 5 MG 60,00
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
2020 ANIK IFAWATI 201904000012 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
2021 ANIS ERNAWATI 201904000112 01/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 764.130
SEROQUEL XR 300 30,00
CLOZAPINE 25 MG 30,00
2022 ANISAH SOEGIJAH 201904000798 04/04/2019 Psiko Geriatri RACIKAN KAPSUL 60,00 328.636
MERLOPAM 2 MG 15,00
CLOZAPINE 100 MG 8,00
RISPERIDONE 3 MG 15,00
MERLOPAM 2 MG 8,00
KAPSUL NO 2 60,00
ARICEPT 10 MG 15,00
2023 ANTON ULUM WINARTO 201904003557 18/04/2019 Poli Psikiater THD 2 MG 240,00 347.880
CLOZAPINE 25 MG 120,00
RISPERIDONE 2 MG 240,00
2024 ANTONY LAI 201904004496 23/04/2019 Poli Psikiater ELIZAC 20 MG 45,00 869.805
RACIKAN KAPSUL 120,00
ABILIFY DISCMELT 15 20,00
KAPSUL NO 2 120,00
2025 ARDHI KUNCORO 201904005407 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 138.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2026 ARDIANY HURIATI 201904004426 23/04/2019 Puri Mitra LORAZEPAM 2 MG 7,00 132.125
SEROQUEL XR 300 7,00
201904005949 30/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 566.250
LORAZEPAM 2 MG 30,00
2027 ARDY HARIANTO 201904001118 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 90,00 215.775
THD 2 MG 60,00
CLOZAPINE 100 MG 45,00
2028 ARIEF EKO JUNAIDI 201904001432 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
2029 ARIF 201904005193 26/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 434.340
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2029 ARIF 201904005193 26/04/2019 Poli Jiwa- Dewasa CLONAZEPAM 2 MG 30,00 434.340
OLANZPINE 10mg 30,00
2030 ARIFIN 201904002275 11/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 164.961
RISPERIDONE 3 MG 60,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
2031 ARIFIN ANNUWAR 201904005354 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 110.355
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 15,00
2032 ARYANTO 201904002216 11/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 189.578
THD 2 MG 180,00
SPUIT 3 CC 1,00
DIPHENHYDRAMINE 2,00
ASAM MEFENAMAT 10,00
RISPERIDONE 2 MG 120,00
2033 ASLIKHAH 201904005356 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 18.150
THD 2 MG 30,00
CPZ 100 MG 30,00
2034 ASMAD SUHADI 201904002117 10/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 10,00 13.740
SERTRALINE 50 MG 5,00
2035 ASMIAJI 201904003539 18/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
2036 ASTI MUMPUNI 201904003571 18/04/2019 Psiko Geriatri THD 2 MG 60,00 655.980
SEROQUEL XR 300 30,00
CLOZAPINE 25 MG 60,00
2037 ATIM AMINI 201904000964 04/04/2019 Psiko Geriatri HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
2038 AYUNDA FARADILLAH 201904004400 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 135.390
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
2039 BAGUS 201904001412 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2040 BAMBANG CIRI 201904004545 23/04/2019 Psiko Geriatri RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
2041 BAMBANG SOEWARNO 201904001489 08/04/2019 Psiko Geriatri LORAZEPAM 2 MG 20,00 18.700
2042 BIE SWIE HWA 201904000924 04/04/2019 Psiko Geriatri THD 2 MG 60,00 287.310
PUSPALIN 500mg 10,00
ARICEPT 10 MG 15,00
RISPERIDONE 3 MG 30,00
2043 BOAS LAIBAHAS 201904000835 04/04/2019 Poli Psikiater ALPRAZOLAM 0.5 MG 60,00 37.890
SERTRALINE 50 MG 15,00
2044 BUDI MULYONO 201904001476 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 538.200
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2045 BUDIANTO HALIM 201904002193 11/04/2019 Poli Psikiater
- SIZORIL 25 MG 5,00 15.445
201904003742 22/04/2019 Poli Psikiater MERLOPAM 2 MG 30,00 225.545
SIZORIL 25 MG 25,00
FRIMANIA 200 MG 60,00
2046 BURHAM NURDIN 201904000097 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 50.520
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
2047 CHOIRI 201904003274 16/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 5.838
2048 CIPTO 201904006001 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2049 CLARISSA SEKAR CITRA 201904005064 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 95.430
RISPERIDONE 2 MG 30,00
THD 2 MG 60,00
SERTRALINE 50 MG 30,00
2050 DANIEL PRIYO WAHYUDI 201904005442 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 68.235
CLOZAPINE 25 MG 15,00
2051 DARIYANTI 201904002273 11/04/2019 Poli Psikiater AMLODIPIN 10 45,00 249.030
THD 2 MG 180,00
CLOZAPINE 25 MG 90,00
TFP 5 MG 180,00
2052 DECRISTO U KARAUTA 201904004892 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 171.874
CLOZAPINE 100 MG 38,00
2053 DEDDY WIRATNO 201904004854 25/04/2019 Poli Psikiater CLOZAPINE 25 MG 90,00 305.730
RISPERIDONE 2 MG 180,00
AMLODIPIN 10 45,00
TFP 5 MG 180,00
2054 DEITA 201904005392 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 41.220
SERTRALINE 50 MG 15,00
2055 DESY KRISTIANA 201904002281 11/04/2019 Poli Psikiater THD 2 MG 90,00 94.080
CLOZAPINE 25 MG 30,00
TFP 5 MG 90,00
2056 DEVI KURNIAWATI 201904000069 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
2057 DEWI YULIATIN 201904002450 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 39.855
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
2058 DHONNY PRASETYO 201904004407 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
2059 DIAN FARIANTO 201904006018 30/04/2019 Poli Psikiater ABILIFY DISCMELT 15 4,00 180.505
NOPRES 20 MG 5,00
CLOZAPINE 100 MG 5,00
2060 DIDIK 201904004540 23/04/2019 Psiko Geriatri THD 2 MG 30,00 24.660
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2060 DIDIK 201904004540 23/04/2019 Psiko Geriatri
- RISPERIDONE 1 MG 60,00 24.660
2061 DIDIK ANANG SUSANTO 201904002214 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 857.145
ABILIFY DISCMELT 10 30,00
2062 DJAINURI 201904001168 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 96.623
CLOZAPINE 25 MG 45,00
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
2063 DJOKO WIDYADAHONO 201904001479 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 69.930
SERTRALINE 50 MG 30,00
2064 DJUMITUN 201904003468 18/04/2019 Psiko Geriatri CLOBAZAM 10 MG 30,00 120.060
THD 2 MG 60,00
RISPERIDONE 1 MG 60,00
SERTRALINE 50 MG 30,00
2065 DODDY RUSWANTO 201904001137 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 49.515
RISPERIDONE 1 MG 60,00
2066 DONA TURINO 201904002766 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 105.351
SIKZONOATE 1,00
RISPERIDONE 2 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
2067 DONI ARFIANDI 201904002110 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
2068 DONI HENDRA 201904005112 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
2069 DWI YUNITASARI 201904002426 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
2070 EDI SUPRAPTO 201904004377 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
2071 EDI PURNOMO 201904001439 08/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 17.910
RISPERIDONE 2 MG 30,00
2072 EKO HARIYANTO 201904003285 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
2073 EKSON 201904006004 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
2074 ELLA ROSDIANA 201904005351 29/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 45,00 368.400
CLOZAPINE 25 MG 30,00
SERTRALINE 50 MG 30,00
2075 ELLINDA PRASETIA 201904001150 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 136.680
RISPERIDONE 2 MG 60,00
2076 ELOK MASLAKAH 201904004888 25/04/2019 Psiko Geriatri THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
2077 ENDANG RUBIYANTI 201904004876 25/04/2019 Psiko Geriatri KAPSUL NO.00 60,00 456.918
ARICEPT 10 MG 30,00
RACIKAN KAPSUL 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2077 ENDANG RUBIYANTI 201904004876 25/04/2019 Psiko Geriatri
- HALOPERIDOL 5 MG 6,00 456.918
THD 2 MG 15,00
2078 ENI YUSUP 201904004535 23/04/2019 Psiko Geriatri TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
2079 ERFANDI 201904005380 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
2080 ERI DWILAHYANTO 201904002347 11/04/2019 Poli Psikiater CLOBAZAM 10 MG 45,00 67.140
NOPRES 20 MG 15,00
2081 ERWIN 201904002525 12/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 834.861
SPUIT 3 CC 1,00
TFP 5 MG 60,00
SIKZONOATE 1,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2082 ERY SOA MOLO 201904000710 04/04/2019 Poli Psikiater TFP 5 MG 15,00 51.180
SIZORIL 25 MG 15,00
2083 FAERNANDO 201904001457 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
2084 FAJAR KURNIAWAN 201904003801 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 15.210
CPZ 100 MG 15,00
2085 FAJAR SODIQ 201904004450 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
2086 FARID NOVANDI 201904006094 30/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 92.670
2087 FARIDA HERAWATI 201904003220 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 522.165
KAPSUL NO.00 30,00
SEROQUEL XR 200 30,00
RACIKAN KAPSUL 30,00
2088 FATONAH 201904002492 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 79.635
CLOZAPINE 100 MG 15,00
HALOPERIDOL 5 MG 90,00
2089 FAUZAN 201904006009 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
2090 FAUZIA MUFIDAH 201904003907 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 244.500
DEPAKOTE 250 MG 60,00
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2091 FITRIA 201904003790 22/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 100.628
KAPSUL NO.00 60,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
RACIKAN KAPSUL 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2091 FITRIA 201904003790 22/04/2019 Poli Jiwa- Dewasa DIPHENHYDRAMINE 2,00 100.628
RISPERIDONE 3 MG 40,00
2092 FITRIANA 201904004989 25/04/2019 Ruangan SEROQUEL XR 300 5,00 104.712
THD 2 MG 6,00
DEPAKOTE 250 MG 10,00
2093 FRANSISCUS ELIEZER 201904000803 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 177.991
FOLIC ACID 1 MG 30,00
VIT B6 10 MG 30,00
SPUIT 3 CC 1,00
HALDOL DECANOAS 1,00
CLOZAPINE 25 MG 30,00
2094 FUAD HAMZAH 201904001471 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
2095 FUAD RIZAL 201904002232 11/04/2019 Poli Psikiater CPZ 100 MG 60,00 30.180
TFP 5 MG 60,00
2096 FUAD ROHMAN 201904005739 29/04/2019 Ruangan Kenari THD 2 MG 14,00 62.132
CLOZAPINE 100 MG 14,00
TFP 5 MG 14,00
2097 GARRY SANTOSO 201904003253 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 40,00 263.040
OLANZPINE 10mg 30,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
2098 GEDOR 201904003286 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
2099 GERY AFRIANTO 201904001494 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.500
TFP 5 MG 60,00
2100 GILANG ADI PRASETYA 201904002226 11/04/2019 Poli Psikiater NOPRES 20 MG 60,00 338.040
RACIKAN KAPSUL 120,00
CLOBAZAM 10 MG 60,00
OLANZPINE 10mg 36,00
KAPSUL NO 2 120,00
2101 HABIB 201904002093 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 10,00 3.230
2102 HADI HARNOTO 201904000775 04/04/2019 Poli Psikiater RISPERIDONE 1 MG 120,00 295.965
CLOZAPINE 25 MG 60,00
SERTRALINE 50 MG 60,00
LORAZEPAM 2 MG 15,00
THD 2 MG 120,00
2103 HANIF 201904005384 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 162.615
PHENYTOIN CAP 100 90,00
DIAZEPAM 5 MG 15,00
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2103 HANIF 201904005384 29/04/2019 Poli Jiwa- Dewasa PHENOBARBITAL 30 90,00 162.615
2104 HANIFAH APRILIA 201904001448 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.995
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
2105 HANSE ARNOLD 201904004402 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 18.300
THD 2 MG 30,00
CPZ 100 MG 60,00
2106 HARI MUSTOFA 201904000852 04/04/2019 Psiko Geriatri THD 2 MG 15,00 69.765
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
2107 HARI SUSILO 201904002113 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 58.598
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
RISPERIDONE 3 MG 60,00
CPZ 100 MG 30,00
2108 HARIANTO 201904004420 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2109 HARIYO DJAHRI 201904001482 08/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
2110 HARIYONO 201904002548 12/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 88.560
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
2111 HEBREY JEMIMA 201904005382 29/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 17.700
THD 2 MG 60,00
CPZ 100 MG 15,00
2112 HENI WAHYUNINGTYAS 201904003259 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 94.311
SPUIT 3 CC 1,00
SIKZONOATE 1,00
TFP 5 MG 60,00
2113 HENY MULATSIH 201904003221 16/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 59.850
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
2114 HERMANTO 201904002291 11/04/2019 Poli Psikiater CLOZAPINE 25 MG 45,00 144.225
RISPERIDONE 3 MG 90,00
2115 HERMIN 201904003457 18/04/2019 Psiko Geriatri CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
2116 HERYADI 201904002455 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2117 IBNU SALAST 201904002452 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 108.285
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2117 IBNU SALAST 201904002452 12/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 15,00 108.285
TFP 5 MG 60,00
2118 IDA SUCIATI 201904002306 11/04/2019 Poli Psikiater THD 2 MG 60,00 36.300
CPZ 100 MG 60,00
TFP 5 MG 60,00
2119 IHYA ULUMUDDIN 201904000867 04/04/2019 Poli Psikiater THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
2120 IMAM JAZULI 201904003931 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
2121 IMAM MAULANA 201904005432 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 65.520
CLOZAPINE 25 MG 30,00
2122 IMAM SYAMSUDIN 201904001377 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 235.500
DEPAKOTE 250 MG 60,00
CLOZAPINE 100 MG 30,00
2123 INDRA DJALADRI 201904000674 04/04/2019 Poli Psikiater THD 2 MG 180,00 53.100
CPZ 100 MG 45,00
HALOPERIDOL 5 MG 180,00
2124 INTAN NURSINI HAPSARI 201904000648 03/04/2019 Poli Psikiater FRIMANIA 400 MG 0,00 532.180
THD 2 MG 60,00
SIZORIL 100 MG 5,00
DEPAKOTE ER 500 60,00
2125 IPUNG WIWOHO 201904005396 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 140.036
SIKZONOATE 1,00
TFP 5 MG 30,00
SPUIT 3 CC 1,00
THD 2 MG 30,00
2126 IRFAN 201904002135 10/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 10,00 25.330
RISPERIDONE 3 MG 10,00
2127 ISMAIL 201904003282 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
2128 ISMOYO 201904000391 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
2129 ISYA ANDRIANI 201904002728 15/04/2019 Poli Jiwa Dewasa VIT B COMPLEX 10,00 81.850
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2130 ITAM M .DJUNAIDY 201904003650 18/04/2019 Poli Psikiater CLOZAPINE 25 MG 5,00 17.045
RISPERIDONE 3 MG 10,00
THD 2 MG 10,00
2131 IVAN SUSANTO 201904001180 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2131 IVAN SUSANTO 201904001180 05/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 36.540
2132 IVAN TRIANTO 201904002738 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 179.526
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
2133 JAELANI 201904005973 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 51.840
CPZ 100 MG 30,00
RISPERIDONE 3 MG 60,00
2134 JANI 201904002065 10/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 499.695
CLOZAPINE 25 MG 15,00
RACIKAN KAPSUL 60,00
ABILIFY DISCMELT 15 10,00
FOLIC ACID 1 MG 30,00
SERTRALINE 50 MG 30,00
CLOBAZAM 10 MG 15,00
KAPSUL NO 2 60,00
2135 JATI UTOMO 201904003235 16/04/2019 Poli Jiwa Dewasa CARBAMAZEPINE 90,00 94.680
CLOBAZAM 10 MG 60,00
2136 JERY SETYAWAN 201904000029 01/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 10.200
THD 2 MG 30,00
CPZ 100 MG 15,00
2137 JIHAD AL BARIKI 201904000801 04/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 151.185
CLOZAPINE 100 MG 15,00
THD 2 MG 45,00
2138 JINAH 201904000832 04/04/2019 Psiko Geriatri LORAZEPAM 2 MG 15,00 252.045
THD 2 MG 15,00
RACIKAN PUYER 60,00
ARICEPT 10 MG 15,00
KAPSUL NO.00 60,00
RISPERIDONE 3 MG 10,00
2139 JOHAR 201904006007 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
2140 JOKO AFRIYANTO 201904001125 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 85.215
RISPERIDONE 2 MG 60,00
2141 JUNET 201904000974 04/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 25.020
2142 KADAR RAMELI 201904000695 04/04/2019 Psiko Geriatri CPZ 100 MG 60,00 38.850
LORAZEPAM 2 MG 30,00
2143 KADIR 201904005970 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2144 KANIA AYU FATIMAH 201904000033 01/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 889.170
ABILIFY DISCMELT 10 30,00
FOLIC ACID 1 MG 30,00
2145 KARINA 201904005342 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 534.960
SEROQUEL XR 200 30,00
2146 KARMAN EP 201904000858 04/04/2019 Psiko Geriatri TFP 5 MG 30,00 15.270
THD 2 MG 30,00
FOLIC ACID 1 MG 30,00
2147 KASMIN 201904000714 04/04/2019 Psiko Geriatri THD 2 MG 30,00 425.866
CLOZAPINE 25 MG 15,00
DEPAKOTE ER 250 30,00
SPUIT 3 CC 1,00
HALDOL DECANOAS 1,00
CLONAZEPAM 2 MG 30,00
2148 KASRIP 201904002278 11/04/2019 Poli Psikiater TFP 5 MG 90,00 172.665
THD 2 MG 45,00
SIZORIL 25 MG 45,00
2149 KHOID / ROIS 201904004929 25/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
2150 KODRAT PURNOWO 201904000849 04/04/2019 Poli Psikiater CPZ 100 MG 90,00 54.450
TFP 5 MG 90,00
THD 2 MG 90,00
2151 KRISNA WAHYUNI 201904003471 18/04/2019 Psiko Geriatri AMITRIPTILIN 25 MG 30,00 6.030
2152 KURNIA BASKORO (DRS) 201904004493 23/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 53.220
TFP 5 MG 60,00
CPZ 100 MG 15,00
THD 2 MG 60,00
2153 KUSTANTINA 201904001217 05/04/2019 Ruangan Puri THD 2 MG 7,00 154.385
SEROQUEL XR 300 7,00
CLOZAPINE 100 MG 7,00
2154 KUSWARIYANTO 201904002730 15/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 12.900
THD 2 MG 30,00
CPZ 100 MG 30,00
2155 LAMINI 201904001181 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 154.920
CLOZAPINE 25 MG 60,00
THD 2 MG 60,00
LISINOPRIL 10 MG 15,00
2156 LILIK 201904000664 04/04/2019 Poli Psikiater TFP 5 MG 90,00 214.920
THD 2 MG 180,00
CLOZAPINE 25 MG 90,00
2157 LILIK MUDROFIN 201904003467 18/04/2019 Poli Psikiater RISPERIDONE 2 MG 90,00 46.710
THD 2 MG 90,00
2158 LILIK SURYATI 201904004820 25/04/2019 Psiko Geriatri FOLIC ACID 1 MG 30,00 30.435
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2158 LILIK SURYATI 201904004820 25/04/2019 Psiko Geriatri
- CLOZAPINE 25 MG 15,00 30.435
2159 LO GWAT TIEN 201904002125 10/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 886.650
ABILIFY DISCMELT 10 30,00
2160 LUKAS 201904005991 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2161 LUKMAN HAKIM 201904001416 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 106.200
SERTRALINE 50 MG 30,00
CPZ 100 MG 30,00
THD 2 MG 30,00
2162 LULIK CHODIDJA 201904002424 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 22.440
TFP 5 MG 60,00
2163 LUSIANA 201904006077 30/04/2019 Poli Psikiater NOPRES 20 MG 15,00 111.810
RACIKAN KAPSUL 30,00
SIZORIL 25 MG 30,00
THD 2 MG 30,00
KAPSUL NO 3 30,00
2164 LUTFI IFFANDHI 201904002085 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 10,00 3.230
2165 M ZAINUL 201904005355 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
2166 M. BARDI 201904001107 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 33.480
THD 2 MG 30,00
CPZ 100 MG 30,00
2167 M. FATCHUL HAKIM 201904000712 04/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 105.870
RISPERIDONE 2 MG 120,00
2168 M. IMAM 201904003822 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 85.500
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
2169 M. IRAWAN SYAHRUDDIN 201904004438 23/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 127.286
CLOZAPINE 25 MG 30,00
SIKZONOATE 1,00
2170 M. IRFAN 201904005673 29/04/2019 Puri Mitra (Laki- SPUIT 3 CC 12,00 67.273
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
LODOMER 2 MG/ML 6,00
DIAZEPAM inj 6,00
RISPERIDONE 2 MG 14,00
2171 M. SYAMSUL HUDA 201904001113 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 51.840
THD 2 MG 60,00
CPZ 100 MG 30,00
2172 M. WARDANI 201904000091 01/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 686.610
ALPRAZOLAM 0.5 MG 30,00
SEROQUEL XR 300 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2172 M. WARDANI 201904000091 01/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 686.610
2173 M. ZAED FAUZI 201904003543 18/04/2019 Poli Psikiater CLOZAPINE 25 MG 4,00 10.780
RISPERIDONE 2 MG 8,00
2174 M.KOMARUDIN 201904002138 10/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 17.549
TFP 5 MG 14,00
2175 MADDEI / M.DA'I 201904000829 04/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
2176 MADE AGUS DWI 201904002717 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 67.770
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
2177 MAHARDIAN ABDI 201904003788 22/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 740.550
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2178 MAIMUNAH 201904003356 16/04/2019 Ruangan CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
2179 MAISAROH 201904004434 23/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 138.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2180 MAMAT 201904005958 30/04/2019 Psiko Geriatri CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
2181 MARIA ANGGRAENI 201904002449 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 35.415
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
2182 MARYATI 201904004925 25/04/2019 Psiko Geriatri THD 2 MG 8,00 4.496
VIT B COMPLEX 8,00
RISPERIDONE 1 MG 8,00
2183 MASANDIKUN 201904005954 30/04/2019 Psiko Geriatri RISPERIDONE 1 MG 30,00 66.630
CLOZAPINE 25 MG 30,00
2184 MASITAH 201904002555 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 106.635
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2185 MASWIN 201904004928 25/04/2019 Psiko Geriatri THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
2186 MATKURI 201904002274 11/04/2019 Psiko Geriatri FOLIC ACID 1 MG 30,00 96.255
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
2187 MIRA CHRISTIN 201904003607 18/04/2019 Poli Psikiater SIZORIL 25 MG 25,00 77.225
2188 MISBAHUDIN 201904004926 25/04/2019 Ruangan Kenari RISPERIDONE 1 MG 8,00 2.880
2189 MISDI 201904002719 15/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 26.550
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2190 MISNAN 201904000672 04/04/2019 Poli Psikiater
- KUTOIN 180,00 337.320
CLOBAZAM 10 MG 180,00
VIT B1 IOO MG 90,00
2191 MOCH TOPIK 201904003900 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.335
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
2192 MOCH ZAINI 201904000031 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
2193 MOCH. ATTAR SJAHRIS 201904003258 16/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 18.255
CPZ 100 MG 15,00
LORAZEPAM 2 MG 15,00
2194 MOCH. MUNIP 201904002114 10/04/2019 Poli Jiwa Dewasa THD 2 MG 10,00 11.805
CLOZAPINE 25 MG 5,00
HALOPERIDOL 5 MG 10,00
2195 MOCH. SAIFULLOH 201904002713 15/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 19.268
DIPHENHYDRAMINE 2,00
RISPERIDONE 2 MG 30,00
2196 MOH SUBAKTI 201904000716 04/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 50.040
2197 MOH. HASAN BASRI 201904002284 11/04/2019 Poli Psikiater TFP 5 MG 180,00 243.990
THD 2 MG 180,00
CLOZAPINE 25 MG 90,00
2198 MOHAMAD IMAM 201904000078 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
2199 MOHAMAD RIFAI 201904000011 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
2200 MOKH.GUFRON 201904002541 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 55.995
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
2201 MR. X/SODIQ AJI 201904003288 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
2202 MR.X/ARIEL 201904004491 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 12,00 4.956
CPZ 100 MG 6,00
2203 MUAMMAR BADRUS 201904003772 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 81.330
TFP 5 MG 60,00
THD 2 MG 60,00
2204 MUCHAMMAD GUFRON 201904003842 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 91.335
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
2205 MUCHAMMAD 201904001410 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2206 MUH. BASOFI 201904001172 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2206 MUH. BASOFI 201904001172 05/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 15,00 37.605
2207 MUHAMAD 201904005996 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 28.200
TFP 5 MG 60,00
THD 2 MG 60,00
2208 MUHAMAD HAFIZ 201904001280 07/04/2019 Poli Psikiater KAPSUL NO.0 6,00 33.342
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
RACIKAN KAPSUL 6,00
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 25 MG 9,00
201904003426 16/04/2019 Poli Psikiater RACIKAN KAPSUL 6,00 28.632
DEPAKOTE 250 MG 6,00
HALOPERIDOL 5 MG 6,00
SERTRALINE 50 MG 3,00
CLOZAPINE 100 MG 3,00
KAPSUL NO.0 6,00
THD 2 MG 6,00
DIAZEPAM 5 MG 3,00
2209 MUHAMMAD KAHFI NUR 201904004385 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2210 MUJAYANAH 201904003589 18/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 891.180
THD 2 MG 60,00
ABILIFY DISCMELT 10 30,00
2211 MUJIATI 201904000742 04/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 470.445
ABILIFY DISCMELT 10 15,00
2212 MUKLISIN 201904005458 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 147.165
THD 2 MG 60,00
RISPERIDONE 2 MG 30,00
DEPAKOTE 250 MG 30,00
SERTRALINE 50 MG 30,00
2213 MUNAWIR 201904005974 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.335
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
2214 MUSLIKHA 201904002470 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
2215 MUSRIFAH 201904004868 25/04/2019 Poli Psikiater RISPERIDONE 3 MG 180,00 319.905
THD 2 MG 180,00
CLOZAPINE 100 MG 45,00
2216 MUSTINI 201904004866 25/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 55.830
2217 MUSTOFA 201904000337 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.782
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2217 MUSTOFA 201904000337 01/04/2019 Ruangan
- Kenari CPZ 100 MG 7,00 5.782
201904001622 08/04/2019 Ruangan Kenari CPZ 100 MG 14,00 16.450
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
201904004653 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 14,00 16.450
TFP 5 MG 14,00
CPZ 100 MG 14,00
2218 MUSYAYAROH 201904003489 18/04/2019 Poli Psikiater AMITRIPTILIN 25 MG 60,00 85.260
AMLODIPIN 10 30,00
CLOBAZAM 10 MG 60,00
2219 MUTTAQIN 201904002759 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 214.701
CLOZAPINE 100 MG 30,00
SIKZONOATE 1,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
2220 Michael 201904004822 25/04/2019 Poli Psikiater THD 2 MG 180,00 301.860
NUZIP 25 180,00
2221 NAILA INDANI ROSYIDAH 201904004392 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 121.650
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
2222 NANIK NURYANA 201904004893 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.335
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
2223 NARNIK 201904002783 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2224 NARSIH 201904005927 30/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 68.025
AMITRIPTILIN 25 MG 60,00
CLOZAPINE 25 MG 15,00
2225 NATHASYA STEFANI 201904003868 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 40,00 696.630
KAPSUL NO.00 60,00
THD 2 MG 60,00
RACIKAN KAPSUL 60,00
SEROQUEL XR 300 30,00
CLOZAPINE 100 MG 30,00
2226 NGATEMI INDASARI 201904002156 10/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
2227 NIKMATULLOH 201904004930 25/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
2228 NOER MOLITA INDRIA 201904000050 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 48.960
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2229 NOOR HUSNUL FATIMAH 201904003778 22/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
2230 NUR HASIM 201904005995 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 45.720
RISPERIDONE 3 MG 60,00
2231 NUR HAYATI 201904002270 11/04/2019 Poli Psikiater THD 2 MG 90,00 75.420
CPZ 100 MG 45,00
TFP 5 MG 180,00
2232 NUR ROHMAWATI 201904005159 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 81.330
TFP 5 MG 60,00
THD 2 MG 60,00
2233 NURHADI BANDORO 201904003287 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
2234 NURUL FATMA 201904003479 18/04/2019 Poli Psikiater TFP 5 MG 60,00 25.140
THD 2 MG 30,00
CPZ 100 MG 15,00
2235 NYOO FEN TIONG 201904000875 04/04/2019 Psiko Geriatri CPZ 100 MG 60,00 44.970
LORAZEPAM 2 MG 30,00
THD 2 MG 60,00
2236 ODINKA AYU 201904003796 22/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 514.800
2237 OEY WEE LIANG 201904001219 05/04/2019 Ruangan Puri CLOZAPINE 100 MG 4,00 23.318
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
2238 OKTORA NUR ROKHMAN 201904002781 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 126.015
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
2239 PAINI 201904003511 18/04/2019 Psiko Geriatri HALOPERIDOL 1,5 120,00 35.145
LORAZEPAM 2 MG 15,00
THD 2 MG 120,00
2240 PARTINI 201904000743 04/04/2019 Psiko Geriatri THD 2 MG 90,00 165.960
RIZODAL 2 MG-UM 90,00
2241 PETER 201904000373 01/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 36.890
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904001717 08/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 36.890
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
201904002084 10/04/2019 Ruangan Gelatik THD 2 MG 14,00 36.890
CLOZAPINE 25 MG 14,00
RISPERIDONE 3 MG 14,00
2242 PINGKAN ELIYANI 201904004869 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 470.445
ABILIFY DISCMELT 10 15,00
2243 POSMAK 201904005957 30/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 31.140
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2243 POSMAK 201904005957 30/04/2019 Psiko Geriatri
- THD 2 MG 60,00 31.140
2244 PRATAMA 201904005108 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 137.160
CLOZAPINE 25 MG 60,00
TFP 5 MG 60,00
2245 PRICILLA MARIA 201904000066 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 295.836
CLOZAPINE 100 MG 45,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 60,00
SPUIT 3 CC 1,00
2246 PUTRA GUMILANG 201904000107 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
2247 PUTRI SURYANINGSASI 201904002078 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2248 RADITYA BAGUS 201904005415 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 158.100
CLOZAPINE 25 MG 60,00
RISPERIDONE 3 MG 60,00
2249 RAHMAT ELLIYANTO 201904002095 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 5,00 4.130
TFP 5 MG 10,00
2250 RAHMI RAHENDRA 201904004382 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
2251 RAMIDI 201904000333 01/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 5.838
201904001607 08/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 22.806
SERTRALINE 50 MG 7,00
201904002075 10/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 22.806
SERTRALINE 50 MG 7,00
2252 RANGGA 201904003280 16/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 60,00 8.580
VIT B6 10 MG 60,00
2253 RENDRA DJUNAIDI 201904001401 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 106.635
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2254 RETNOWATI 201904000061 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 159.090
LORAZEPAM 2 MG 30,00
TFP 5 MG 60,00
2255 RICKY TJITRADJAYA 201904002069 10/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 816.060
THD 2 MG 60,00
FRIMANIA 400 MG 60,00
RISPERIDONE 3 MG 60,00
2256 RIDWAN ARIFANDI 201904000330 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904001624 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
201904002070 10/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2257 RIO PRANANCA 201904003730 21/04/2019 Poli Psikiater
- CLOZAPINE 25 MG 100,00 301.650
TFP 5 MG 100,00
AMITRIPTILIN 25 MG 50,00
KAPSUL NO.0 100,00
THD 2 MG 100,00
CLOBAZAM 10 MG 50,00
RACIKAN KAPSUL 100,00
2258 RISANDI MARDANIS 201904000054 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 10.800
2259 RIZKY NUGRAHA 201904002344 11/04/2019 Poli Psikiater CLOBAZAM 10 MG 45,00 138.510
SERTRALINE 50 MG 45,00
2260 ROIKHAN UTOMO 201904000687 04/04/2019 Poli Psikiater CPZ 100 MG 90,00 91.260
RISPERIDONE 2 MG 180,00
2261 ROLAN 201904000359 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904001701 08/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904003340 16/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
2262 RONALD SAMANTA 201904001711 08/04/2019 Ruangan Gelatik THD 2 MG 10,00 22.860
CLOZAPINE 25 MG 10,00
TFP 5 MG 10,00
201904002108 10/04/2019 Ruangan Gelatik THD 2 MG 14,00 38.054
CLOZAPINE 100 MG 8,00
TFP 5 MG 14,00
2263 ROSALINA 201904005071 26/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 23.322
THD 2 MG 15,00
CPZ 100 MG 8,00
RISPERIDONE 3 MG 15,00
KAPSUL NO.00 30,00
TFP 5 MG 24,00
2264 ROSMALA HUTABARAT 201904003593 18/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 531.015
PIRACETAM 800 MG 30,00
CLOBAZAM 10 MG 30,00
ARICEPT 10 MG 30,00
2265 RUDI SISWANTO 201904002013 10/04/2019 Ruangan Puri THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
2266 RULI BOEDI DHANARTI 201904003475 18/04/2019 Poli Psikiater RISPERIDONE 2 MG 2,00 6.576
SERTRALINE 50 MG 3,00
2267 SADIK 201904005362 29/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 211.740
RISPERIDONE 2 MG 240,00
2268 SAINI 201904003456 18/04/2019 Poli Psikiater OLANZPINE 10mg 30,00 283.350
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2268 SAINI 201904003456 18/04/2019 Poli Psikiater
- SERTRALINE 50 MG 30,00 283.350
2269 SALIYAH 201904001453 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 145.890
CLOZAPINE 100 MG 30,00
TFP 5 MG 60,00
2270 SAMPIROTO 201904002709 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.220
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
CPZ 100 MG 15,00
2271 SAMSUL ARIFIN 201904003290 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
2272 SANTOSO 201904000076 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2273 SANURI 201904004813 25/04/2019 Poli Psikiater THD 2 MG 120,00 111.360
CPZ 100 MG 120,00
TFP 5 MG 240,00
2274 SARDI 201904000907 04/04/2019 Psiko Geriatri RISPERIDONE 1 MG 8,00 15.907
CLOZAPINE 25 MG 7,00
2275 SERAFIN TANTINA 201904002280 11/04/2019 Poli Jiwa Dewasa NOPRES 20 MG 15,00 329.179
THD 2 MG 60,00
DEPAKOTE ER 500 30,00
CLOZAPINE 100 MG 23,00
2276 SETIA RAHAYU 201904002769 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 16.740
RISPERIDONE 2 MG 30,00
THD 2 MG 15,00
2277 SETYAWAN 201904005140 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
2278 SEWONOWATI IRAWAN 201904002268 11/04/2019 Psiko Geriatri CLOZAPINE 25 MG 5,00 13.095
RACIKAN KAPSUL 15,00
FOLIC ACID 1 MG 8,00
RISPERIDONE 3 MG 3,00
KAPSUL NO 2 15,00
VIT B6 10 MG 8,00
2279 SHOLICHA 201904005451 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 160.995
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 15,00
2280 SISKAYADI 201904005424 29/04/2019 Poli Jiwa Dewasa DIAZEPAM 5 MG 15,00 33.090
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
2281 SITI AMINAH 201904002489 12/04/2019 Poli Jiwa Dewasa AMITRIPTILIN 25 MG 30,00 105.240
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2281 SITI AMINAH 201904002489 12/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 105.240
RISPERIDONE 3 MG 60,00
2282 SITI AFIFAH 201904000827 04/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
2283 SITI AISAH 201904005054 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
2284 SITI HALIMA 201904005196 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.580
TFP 5 MG 30,00
THD 2 MG 30,00
2285 SITI MACHFIYAH 201904005336 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 15,00 34.170
CLOZAPINE 25 MG 15,00
2286 SITI MALIKHAH 201904001228 05/04/2019 Poli Psikiater RIZODAL 2 MG 30,00 52.230
2287 SLAMET 201904000704 04/04/2019 Psiko Geriatri THD 2 MG 60,00 68.610
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 45,00
201904000747 04/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 34.170
RISPERIDONE 2 MG 15,00
2288 SOETARNO 201904004816 25/04/2019 Poli Psikiater THD 2 MG 120,00 117.030
RACIKAN KAPSUL 60,00
ELIZAC 20 MG 30,00
CPZ 100 MG 30,00
TFP 5 MG 120,00
KAPSUL NO 2 60,00
2289 SOLIKAH 201904003459 18/04/2019 Psiko Geriatri TFP 5 MG 30,00 15.450
THD 2 MG 30,00
CPZ 100 MG 15,00
2290 SONNY ADHIANSYAH 201904001133 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
2291 SRI HANDAYANI 201904005387 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 60,00 36.300
TFP 5 MG 60,00
THD 2 MG 60,00
2292 SRI HAYATI 201904003912 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 121.650
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2293 SRI WAHYUNI 201904005410 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 30.780
THD 2 MG 30,00
CPZ 100 MG 15,00
2294 SUGANDI 201904004537 23/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 86.164
CLOZAPINE 25 MG 30,00
DIPHENHYDRAMINE 2,00
SPUIT 3 CC 1,00
2295 SUGENG 201904003519 18/04/2019 Poli Psikiater RISPERIDONE 2 MG 100,00 41.700
2296 SUGENG HARIYANTO 201904005053 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 179.070
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2296 SUGENG HARIYANTO 201904005053 26/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 179.070
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2297 SUHANDONO 201904004543 23/04/2019 Psiko Geriatri CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
2298 SUHARSONO 201904001186 05/04/2019 Poli Jiwa Dewasa THD 2 MG 90,00 32.340
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 120,00
2299 SUJAMI 201904000044 01/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 15,00 45.165
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2300 SUJATMOKO 201904000805 04/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 219.668
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
DEPAKOTE 250 MG 60,00
DIPHENHYDRAMINE 2,00
2301 SUKATRIN 201904000660 04/04/2019 Poli Psikiater RISPERIDONE 3 MG 180,00 223.065
THD 2 MG 180,00
CLOZAPINE 25 MG 45,00
2302 SUKRI 201904002267 11/04/2019 Psiko Geriatri THD 2 MG 60,00 146.890
CLOZAPINE 100 MG 30,00
VIT B COMPLEX 10,00
TFP 5 MG 60,00
2303 SUKUR 201904000741 04/04/2019 Poli Psikiater THD 2 MG 60,00 100.710
CLOZAPINE 25 MG 30,00
TFP 5 MG 120,00
2304 SULAIMAN 201904000723 04/04/2019 Psiko Geriatri OLANZPINE 10mg 15,00 142.470
SERTRALINE 50 MG 30,00
2305 SULIANA 201904005073 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 581.115
SEROQUEL XR 300 30,00
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
2306 SULIS RIANG 201904004423 23/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 127.376
TFP 5 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
SIKZONOATE 1,00
2307 SUMALI 201904006000 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 11.940
HALOPERIDOL 5 MG 60,00
2308 SUMEI 201904003573 18/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 59.055
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2309 SUMIATI 201904000965 04/04/2019 Psiko Geriatri
- THD 2 MG 60,00 33.660
FOLIC ACID 1 MG 30,00
RISPERIDONE 2 MG 60,00
2310 SUNADI 201904002822 15/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
201904003838 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 136.680
CLOZAPINE 25 MG 60,00
2311 SUNAR 201904004875 25/04/2019 Poli Psikiater THD 2 MG 45,00 17.910
HALOPERIDOL 5 MG 90,00
2312 SUNARDI 201904004546 23/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 27.720
CPZ 100 MG 15,00
2313 SUNARKO 201904002521 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 17.910
CPZ 100 MG 30,00
2314 SUNTARI 201904003597 18/04/2019 Poli Psikiater SIZORIL 25 MG 90,00 345.330
TFP 5 MG 180,00
THD 2 MG 90,00
2315 SUNYOTO 201904003849 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 138.750
THD 2 MG 60,00
SERTRALINE 50 MG 30,00
TFP 5 MG 60,00
2316 SUPENO 201904004534 23/04/2019 Psiko Geriatri TFP 5 MG 60,00 85.695
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
2317 SUPIATI 201904005330 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 67.110
SERTRALINE 50 MG 30,00
2318 SUPINI 201904003478 18/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 502.020
THD 2 MG 120,00
ARICEPT 10 MG 30,00
2319 SUPRI 201904004027 22/04/2019 Ruangan Gelatik THD 2 MG 14,00 15.358
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
201904004093 22/04/2019 Ruangan Gelatik THD 2 MG 14,00 15.358
RISPERIDONE 3 MG 14,00
TFP 5 MG 14,00
2320 SUPRIYADI 201904005982 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
2321 SUPRIYANI 201904005110 26/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 886.650
SERTRALINE 50 MG 30,00
2322 SURADI 201904000375 01/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 11.928
CPZ 100 MG 14,00
201904001725 08/04/2019 Ruangan Gelatik CPZ 100 MG 14,00 11.928
RISPERIDONE 3 MG 14,00
201904004654 24/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 11.928
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2322 SURADI 201904004654 24/04/2019 Ruangan
- Gelatik CPZ 100 MG 14,00 11.928
2323 SUROYO 201904004380 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 102.270
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2324 SURYANI DYAH A 201904003893 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 62.580
ALPRAZOLAM 1 MG 30,00
2325 SUSANTO 201904002230 11/04/2019 Poli Psikiater RISPERIDONE 2 MG 90,00 377.280
SERTRALINE 50 MG 90,00
CLOZAPINE 25 MG 90,00
2326 SUSANTO (SUTANTO) 201904003293 16/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 5.760
THD 2 MG 30,00
2327 SUTJIPTO 201904003807 22/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 250 30,00 133.380
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2328 SUTRIS 201904005983 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 27.720
RISPERIDONE 2 MG 60,00
2329 SUYONO 201904005953 30/04/2019 Psiko Geriatri CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
2330 SYAFI'I 201904002271 11/04/2019 Poli Psikiater TFP 5 MG 60,00 137.160
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
2331 TEGUH HERI SETIAWAN 201904003554 18/04/2019 Poli Psikiater NUZIP 25 30,00 210.060
RIZODAL 2 MG 90,00
THD 2 MG 60,00
2332 THE JONG TJANG 201904001393 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 66.390
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2333 TOEMIYEM 201904002262 11/04/2019 Psiko Geriatri MERLOPAM 2 MG 90,00 317.790
SERTRALINE 50 MG 45,00
2334 TOMY SELAKSA 201904002733 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2335 TONI IRAWAN EFENDI 201904000487 02/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 155.781
RISPERIDONE 2 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2336 TONO YUYUD 201904000346 01/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904001697 08/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
201904002102 10/04/2019 Ruangan Gelatik SPUIT 3 CC 2,00 13.516
DIPHENHYDRAMINE 4,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2336 TONO YUYUD 201904004016 22/04/2019 Ruangan
- Gelatik RISPERIDONE 2 MG 14,00 8.526
THD 2 MG 14,00
CPZ 100 MG 7,00
2337 TRESTJE 201904002504 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 126.015
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2338 TRI EDI SETYAWAN 201904005368 29/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 229.556
RISPERIDONE 3 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
2339 TRI YUDHA SANTOSO 201904001447 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 75.195
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
2340 TRIYASTUTIK 201904000844 04/04/2019 Poli Psikiater SERTRALINE 50 MG 45,00 1.630.530
SEROQUEL XR 200 90,00
2341 UMAR FARUK 201904001423 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2342 UMUL BARIYAH 201904001243 06/04/2019 Poli Psikiater KAPSUL NO.00 20,00 306.670
MERLOPAM 2 MG 5,00
RACIKAN KAPSUL 20,00
SEROQUEL XR 200 10,00
DEPTRAL 50 MG 10,00
2343 VERRA GRACE KAMAGI 201904000472 02/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 102.540
KAPSUL NO.00 60,00
ALPRAZOLAM 1 MG 30,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 30,00
2344 VIVIN ACHMAD ALFIN 201904001461 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 145.890
TFP 5 MG 60,00
THD 2 MG 60,00
2345 WAGIMAN / MARJUKI 201904005956 30/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
2346 WAHYU DWI ARYANTI 201904000052 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 221.820
RISPERIDONE 3 MG 60,00
CLOBAZAM 10 MG 60,00
2347 WAHYU FITRIA WIDHIATI 201904002756 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
2348 WAHYU NOER BAGUS 201904003308 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 75.210
CLOZAPINE 25 MG 30,00
2349 WARAS 201904002092 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 5,00 5.070
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2349 WARAS 201904002092 10/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 10,00 5.070
2350 WARJINAH 201904002303 11/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 117.660
VIT B COMPLEX 60,00
2351 WARSONO 201904004828 25/04/2019 Poli Psikiater LORAZEPAM 2 MG 15,00 86.775
NUZIP 25 30,00
TFP 5 MG 60,00
THD 2 MG 60,00
2352 WAWAN TIANTO 201904005125 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 131.775
CLOZAPINE 25 MG 15,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2353 WIDODO KALIMUJIONO 201904004483 23/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 27.840
CPZ 100 MG 30,00
TFP 5 MG 60,00
2354 WIJAY 201904002109 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
2355 WINDIARTA 201904001371 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 78.165
HALOPERIDOL 5 MG 60,00
AMITRIPTILIN 25 MG 30,00
THD 2 MG 30,00
2356 YESY UMROH 201904002433 12/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 97.845
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
2357 YOANA PURNAMASARI 201904001576 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 655.980
THD 2 MG 60,00
SEROQUEL XR 300 30,00
2358 YONG PURNOMO 201904000343 01/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
201904001617 08/04/2019 Ruangan Kenari LORAZEPAM 2 MG 7,00 13.755
TFP 5 MG 14,00
CPZ 100 MG 7,00
THD 2 MG 14,00
201904004651 24/04/2019 Ruangan Kenari THD 2 MG 14,00 15.015
LORAZEPAM 2 MG 7,00
TFP 5 MG 14,00
CPZ 100 MG 14,00
2359 YUDI KRISTIANTO 201904001441 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 74.355
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
2360 YULI KUSPRIANTO 201904000027 01/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 171.741
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 40,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2360 YULI KUSPRIANTO 201904000027 01/04/2019 Poli Jiwa- Dewasa SPUIT 3 CC 1,00 171.741
KAPSUL NO.00 60,00
THD 2 MG 60,00
AMLODIPIN 5 30,00
RACIKAN KAPSUL 60,00
2361 YULIANI 201904003227 16/04/2019 Poli Jiwa Dewasa DIPHENHYDRAMINE 2,00 77.588
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
2362 YULIANTO 201904002221 11/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
2363 YUNAN 201904004448 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
2364 YUNIAWATI 201904000756 04/04/2019 Poli Psikiater CPZ 100 MG 4,00 4.120
THD 2 MG 8,00
TFP 5 MG 8,00
2365 YUNUS KURNIAWAN 201904003917 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 28.620
RISPERIDONE 3 MG 30,00
THD 2 MG 30,00
2366 YUNUS NAIDI 201904000483 02/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 139.641
HALOPERIDOL 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2367 YUSAK EFENDI MARTA 201904001381 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
2368 YUSRON 201904005976 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
2369 YUSUF DWI SAPUTRO 201904000468 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
2370 YUYUN SUMARDIYANTO 201904005011 25/04/2019 Poli Psikiater THD 2 MG 180,00 151.695
LORAZEPAM 2 MG 45,00
RISPERIDONE 2 MG 180,00
CPZ 100 MG 90,00
2371 YUYUN YUWONO 201904002249 11/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 371.580
RIZODAL 2 MG 120,00
TFP 5 MG 120,00
THD 2 MG 120,00
2372 ZAINUL ARIFIN 201904001429 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 176.520
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2372 ZAINUL ARIFIN 201904001429 08/04/2019 Poli Jiwa- Dewasa RISPERIDONE 3 MG 60,00 176.520
TFP 5 MG 30,00
CLOZAPINE 100 MG 30,00
2373 ZAKARIA MEDIA 201904002266 11/04/2019 Poli Psikiater RISPERIDONE 2 MG 180,00 242.550
CLOZAPINE 25 MG 90,00
Dokter: dr. FATTYAWAN KINTONO, Sp.KJ (K)
2374 ABDU HAFID 201904001344 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2375 ABDUL HAMID 201904004500 23/04/2019 Poli Psikiater RIZODAL 2 MG 60,00 168.000
SERTRALINE 50 MG 30,00
THD 2 MG 60,00
2376 ABDUL KARIM 201904004469 23/04/2019 Poli Psikiater TFP 5 MG 90,00 180.000
THD 2 MG 90,00
NUZIP 25 90,00
2377 ABDUL MAJID 201904005869 30/04/2019 Poli Psikiater TFP 5 MG 120,00 262.080
CLOZAPINE 25 MG 120,00
2378 ABDUL MANAP 201904001812 09/04/2019 Poli Psikiater THD 2 MG 90,00 30.600
CPZ 100 MG 45,00
HALOPERIDOL 5 MG 90,00
2379 ACHMAD 201904002256 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 206.790
DEPAKOTE 250 MG 60,00
2380 ACHMAD AGUS AFANDI 201904004457 23/04/2019 Poli Psikiater NUZIP 25 10,00 52.610
RIZODAL 2 MG 20,00
THD 2 MG 20,00
201904005922 30/04/2019 Ruangan Napza DEPTRAL 50 MG 10,00 120.520
2381 ADI PRAYOGO 201904001066 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
2382 ADIB ANSORI 201904003211 16/04/2019 Poli Psikiater RISPERIDONE 3 MG 20,00 90.606
NUZIP 25 8,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
RACIKAN KAPSUL 60,00
THD 2 MG 15,00
ALPRAZOLAM 1 MG 18,00
2383 AGUS ALI 201904004473 23/04/2019 Poli Psikiater TFP 5 MG 60,00 49.125
THD 2 MG 60,00
NUZIP 25 15,00
2384 AGUS ANGGORO PUTRO 201904002434 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 119.730
RISPERIDONE 3 MG 60,00
CLOBAZAM 10 MG 15,00
THD 2 MG 60,00
2385 AGUS MUSTOFA 201904004663 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 343.826
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2385 AGUS MUSTOFA 201904004663 24/04/2019 Poli Jiwa- Dewasa OLANZPINE 10mg 30,00 343.826
RISPERIDONE 3 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
2386 AGUS PRAJITNO 201904005862 30/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 104.265
THD 2 MG 30,00
RISPERIDONE 3 MG 30,00
NUZIP 25 15,00
2387 AGUSTINA SUSTIAMI 201904002750 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
2388 AHMAD FAUZI 201904000750 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
2389 AHMAD SYAIFUDIN 201904004709 24/04/2019 Poli Psikiater DEPTRAL 50 MG 30,00 456.060
NUZIP 25 60,00
2390 ALBERT 201904001338 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 419.580
ALPRAZOLAM 1 MG 15,00
SEROQUEL XR 300 15,00
RACIKAN KAPSUL 60,00
TFP 5 MG 60,00
CLOBAZAM 10 MG 30,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
KAPSUL NO.00 60,00
2391 ALIMAH 201904002735 15/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 100.380
PHENYTOIN CAP 100 60,00
2392 ANANG ISTIANTO 201904005867 30/04/2019 Poli Psikiater THD 2 MG 240,00 304.020
CLOZAPINE 100 MG 60,00
TFP 5 MG 120,00
2393 ANDRIANTO EKO 201904002594 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 157.935
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
2394 ANDRIC SALIM 201904004499 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 1.268.670
CLOZAPINE 25 MG 30,00
ABILIFY DISCMELT 15 30,00
RISPERIDONE 3 MG 60,00
2395 ANDY AGUS KUSUMA 201904002269 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 106.635
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
2396 ANGGARIO BRAMANTO 201904004529 23/04/2019 Poli Psikiater NUZIP 25 30,00 78.390
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2397 ANNAS BRILLIANTO 201904001088 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 194.931
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2397 ANNAS BRILLIANTO 201904001088 05/04/2019 Poli Jiwa- Dewasa SIKZONOATE 1,00 194.931
SERTRALINE 50 MG 30,00
DEPAKOTE 250 MG 30,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
2398 ARDI NUGROHO 201904003236 16/04/2019 Poli Psikiater THD 2 MG 60,00 404.181
CLOZAPINE 100 MG 30,00
OLANZPINE 10mg 30,00
TFP 5 MG 120,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
2399 ARIES SETIAWAN 201904002421 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
CPZ 100 MG 30,00
2400 ARSAT AFANDI 201904004867 25/04/2019 Ruangan Gelatik SERTRALINE 50 MG 4,00 7.656
2401 AWJIT SHOFIYATULLOH 201904001041 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2402 BASUKI URIP WIDODO 201904005931 30/04/2019 Poli Psikiater TFP 5 MG 50,00 16.150
2403 BRAJA MULYADI 201904002468 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
2404 BUNARI 201904001899 09/04/2019 Poli Psikiater NUZIP 25 14,00 22.050
2405 CATUR SUKARNO 201904005142 26/04/2019 Poli Psikiater RACIKAN KAPSUL 10,00 37.330
RIZODAL 2 MG 10,00
THD 2 MG 10,00
KAPSUL NO 2 10,00
CLORILEX 25 MG 5,00
2406 CRIHARTONO LOEKITO 201904004949 25/04/2019 Puri Mitra (Laki- RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
2407 DAFID TEJA KUSUMA 201904002826 15/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 679.500
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
2408 DAVID 201904001481 08/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 15 30,00 1.366.050
CLOZAPINE 25 MG 30,00
DEPAKOTE 250 MG 60,00
SERTRALINE 50 MG 30,00
2409 DELA RISMANA PUTRA 201904005921 30/04/2019 Poli Psikiater KAPSUL NO 2 60,00 258.825
OLANZPINE 10mg 30,00
RACIKAN KAPSUL 60,00
NUZIP 25 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2409 DELA RISMANA PUTRA 201904005921 30/04/2019 Poli Psikiater
- ALPRAZOLAM 1 MG 30,00 258.825
SERTRALINE 50 MG 30,00
2410 DENNY SUKMAWATI 201904004673 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 71.400
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2411 DEWI MASITA 201904000703 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2412 DIANTO 201904002794 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
2413 DITA YUNIAR LESTARI 201904001059 05/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 650.340
SEROQUEL XR 200 30,00
SERTRALINE 50 MG 30,00
DEPAKOTE 250 MG 30,00
2414 DJA' FAR SHODIQ 201904003320 16/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 336.390
CLOZAPINE 100 MG 30,00
2415 DONA WICAKSANA 201904004630 24/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
2416 DONALD EZAROM 201904002727 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
2417 DWI LULUK 201904005960 30/04/2019 Poli Psikiater CPZ 100 MG 30,00 55.920
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
2418 DWI RETNO PUJIASTUTI 201904004370 23/04/2019 Poli Psikiater THD 2 MG 90,00 225.990
NUZIP 25 90,00
RISPERIDONE 2 MG 180,00
2419 EKAPRIA YUDHISTIRA 201904002833 15/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 153.570
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2420 ELLA ROSDIANA 201904001224 05/04/2019 Ruangan Puri OLANZPINE 10mg 10,00 94.450
CLOZAPINE 25 MG 10,00
SERTRALINE 50 MG 10,00
201904003888 22/04/2019 Ruangan Puri OLANZPINE 10mg 11,00 88.795
CLOZAPINE 25 MG 7,00
SERTRALINE 50 MG 7,00
2421 ENDIAS TOETI 201904001333 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 177.735
CLOZAPINE 100 MG 15,00
FRIMANIA 200 MG 60,00
RISPERIDONE 3 MG 60,00
2422 ERI WIDIANTO 201904000527 02/04/2019 Poli Psikiater OLANZPINE 10mg 15,00 108.675
NUZIP 25 15,00
2423 FAKHMI WAHYUDI 201904004670 24/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 51.840
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2423 FAKHMI WAHYUDI 201904004670 24/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 51.840
RISPERIDONE 3 MG 60,00
2424 FAKHRUSY SYAKIRIN 201904002512 12/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 888.120
CLOZAPINE 25 MG 30,00
THD 2 MG 30,00
2425 FATCHUL RAMADHAN 201904002752 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2426 FITRIANA 201904001807 09/04/2019 Poli Psikiater CLOBAZAM 10 MG 60,00 112.320
ALPRAZOLAM 0.5 MG 120,00
AMITRIPTILIN 25 MG 120,00
2427 FONI KURNIAWATI 201904001356 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 514.800
2428 GAGUK SUPARJOTO(VR) 201904004455 23/04/2019 Poli Psikiater THD 2 MG 60,00 36.540
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
2429 HAMIDAH 201904004853 25/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 727.320
SEROQUEL XR 400 30,00
TFP 5 MG 60,00
THD 2 MG 60,00
2430 HARI BASUKI 201904002323 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2431 HARSONO 201904002477 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 63.330
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 30,00
2432 HARTATIK 201904004405 23/04/2019 Poli Psikiater NUZIP 25 8,00 97.650
OLANZPINE 10mg 15,00
2433 HARTONO 201904001918 09/04/2019 Poli Psikiater LORAZEPAM 2 MG 15,00 494.938
ALPRAZOLAM 1 MG 24,00
RACIKAN KAPSUL 60,00
KAPSUL NO 2 60,00
SEROQUEL XR 300 5,00
ELXION 30,00
2434 HARUN EFENDI 201904002811 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 385.360
RISPERIDONE 3 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 53,00
2435 HERY ISKANDAR 201904001714 08/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
201904003616 18/04/2019 Ruangan Gelatik THD 2 MG 14,00 23.863
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2435 HERY ISKANDAR 201904003616 18/04/2019 Ruangan
- Gelatik CLOZAPINE 25 MG 7,00 23.863
RISPERIDONE 3 MG 14,00
2436 HILDAN FATHONI 201904004057 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 103.860
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2437 HJ.TUKINEM 201904000461 02/04/2019 Psiko Geriatri KAPSUL NO 2 60,00 270.150
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 30,00
SEROQUEL XR 400 8,00
ALPRAZOLAM 1 MG 60,00
RACIKAN KAPSUL 60,00
201904005902 30/04/2019 Psiko Geriatri SEROQUEL XR 400 8,00 256.125
ALPRAZOLAM 1 MG 60,00
RACIKAN KAPSUL 60,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 15,00
2438 HUSIN BALAMAS 201904002257 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 715.371
SIKZONOATE 1,00
DEPAKOTE ER 250 30,00
SPUIT 3 CC 1,00
SEROQUEL XR 300 30,00
2439 IMAM HAMBALI 201904000450 02/04/2019 Poli Psikiater TFP 5 MG 30,00 36.375
THD 2 MG 30,00
NUZIP 25 15,00
2440 IMAM SAKDILI 201904005930 30/04/2019 Poli Psikiater NUZIP 25 15,00 78.915
RIZODAL 2 MG 30,00
THD 2 MG 30,00
2441 IMAM WAHYUDI 201904000727 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2442 ISBANDIYO 201904004857 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2443 ISMONO 201904000786 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
2444 ISMUNAWAN 201904005861 30/04/2019 Poli Psikiater CPZ 100 MG 90,00 16.200
2445 JOKO HANURANTO 201904001046 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 45.990
CPZ 100 MG 60,00
TFP 5 MG 90,00
2446 JUMAIYAH 201904003354 16/04/2019 Poli Psikiater SIKZONOATE 1,00 154.506
TFP 5 MG 60,00
SPUIT 3 CC 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2446 JUMAIYAH 201904003354 16/04/2019 Poli Psikiater
- THD 2 MG 60,00 154.506
CLOZAPINE 100 MG 15,00
2447 KAENI 201904005937 30/04/2019 Poli Psikiater THD 2 MG 30,00 25.140
CPZ 100 MG 15,00
TFP 5 MG 60,00
2448 KASMIAN 201904003214 16/04/2019 Poli Psikiater RIZODAL 2 MG 120,00 221.160
THD 2 MG 120,00
2449 KHADIJA 201904000769 04/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 638.820
SERTRALINE 50 MG 30,00
DEPAKOTE 250 MG 30,00
2450 KRISWANTO 201904002493 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 60.270
CLOZAPINE 25 MG 30,00
2451 KUKUH WIDAGDO 201904001071 05/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 848.610
TFP 5 MG 60,00
2452 LAILI KHAIRIAH 201904002261 11/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
2453 LILY LIBERTY ENDSI 201904005892 30/04/2019 Poli Psikiater NUZIP 25 15,00 70.065
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2454 LULUK SUTAMI 201904002527 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 93.735
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 15,00
2455 LUTHFI ANDRY ARIESTA 201904001093 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 115.020
THD 2 MG 60,00
LORAZEPAM 2 MG 30,00
RISPERIDONE 2 MG 60,00
2456 M JAWAD HADUN 201904001220 05/04/2019 Ruangan Puri CLOZAPINE 100 MG 15,00 73.635
RISPERIDONE 3 MG 20,00
201904002829 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 14,00 75.860
DEPAKOTE ER 500 7,00
CLOZAPINE 100 MG 4,00
2457 M. LUKMAN 201904003339 16/04/2019 Poli Psikiater DEPAKOTE ER 500 60,00 1.647.540
RIZODAL 2 MG 120,00
DEPTRAL 50 MG 60,00
NUZIP 25 180,00
2458 M. MAKRUF 201904004480 23/04/2019 Poli Psikiater THD 2 MG 100,00 197.300
NUZIP 25 100,00
HALOPERIDOL 5 MG 200,00
2459 M. RIZKY FERDIANSYAH 201904000699 04/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 774.211
THD 2 MG 60,00
HALDOL DECANOAS 1,00
SEROQUEL XR 400 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2459 M. RIZKY FERDIANSYAH 201904000699 04/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 60,00 774.211
2460 MARIYAM 201904004467 23/04/2019 Poli Psikiater NUZIP 25 45,00 93.375
HALOPERIDOL 5 MG 90,00
THD 2 MG 90,00
2461 MARJIS 201904003324 16/04/2019 Psiko Geriatri RISPERIDONE 3 MG 10,00 483.104
KAPSUL NO 2 30,00
ARICEPT 10 MG 30,00
RACIKAN KAPSUL 30,00
THD 2 MG 8,00
KAPSUL NO 2 30,00
RISPERIDONE 3 MG 10,00
CLOZAPINE 100 MG 4,00
THD 2 MG 8,00
RACIKAN KAPSUL 30,00
2462 MASIYU 201904002788 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 113.250
SERTRALINE 50 MG 30,00
2463 MASKUR 201904001386 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
2464 MASLI`AH 201904001860 09/04/2019 Psiko Geriatri TFP 5 MG 30,00 15.450
THD 2 MG 30,00
CPZ 100 MG 15,00
2465 MEYLAN SAFITRI 201904002184 10/04/2019 Poli Psikiater TFP 5 MG 60,00 119.895
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
2466 MEYLAN SAFUTRI 201904005012 25/04/2019 Poli Psikiater TFP 5 MG 60,00 119.895
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
2467 MINAR TUMIUR 201904002726 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
2468 MISNATI 201904003930 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2469 MOCH SAICHU HADI 201904000706 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 37.605
TFP 5 MG 30,00
2470 MOCH. ICHBAL 201904001805 09/04/2019 Poli Psikiater THD 2 MG 60,00 186.435
NUZIP 25 15,00
RIZODAL 2 MG 90,00
2471 MOCHAMMAD YUSUF 201904002554 12/04/2019 Poli Psikiater THD 2 MG 20,00 26.130
NUZIP 25 10,00
RISPERIDONE 2 MG 20,00
2472 MOH BASORI 201904001052 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 80.550
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2472 MOH BASORI 201904001052 05/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 15,00 80.550
CPZ 100 MG 30,00
2473 MOH TOYYIB 201904003905 22/04/2019 Poli Psikiater NUZIP 25 30,00 47.250
2474 MOHAMAD FISABILLILAH 201904000773 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 45,00 431.505
DEPAKOTE ER 250 60,00
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2475 MUHAMMAT SIDDIQ 201904003331 16/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 57.420
2476 MUJI SLAMET 201904004859 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 167.790
TFP 5 MG 30,00
CLOZAPINE 25 MG 60,00
THD 2 MG 60,00
2477 MUSLEH 201904003334 16/04/2019 Poli Psikiater NUZIP 25 90,00 630.180
RIZODAL 2 MG 270,00
THD 2 MG 180,00
2478 MUSRIFAH 201904002446 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 284.985
CLOZAPINE 25 MG 45,00
OLANZPINE 10mg 30,00
RISPERIDONE 2 MG 60,00
2479 MUSTOFA KARIM 201904002490 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.415
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 30,00
2480 MUZEMMIL 201904002506 12/04/2019 Poli Psikiater NUZIP 25 90,00 389.070
RISPERIDONE 2 MG 180,00
SERTRALINE 50 MG 90,00
2481 NAILA AMANY 201904004871 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
2482 NISWATUL MUFIDAH 201904001881 09/04/2019 Poli Psikiater LORAZEPAM 2 MG 90,00 122.400
TFP 5 MG 90,00
THD 2 MG 90,00
2483 NUR KHAFIFAH 201904001435 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
2484 NUR RACHMAN ABIDIN 201904000523 02/04/2019 Poli Psikiater NUZIP 25 45,00 144.855
RISPERIDONE 1 MG 180,00
THD 2 MG 90,00
2485 NURIS NUR AFIYAH 201904003357 16/04/2019 Poli Psikiater THD 2 MG 60,00 102.570
HALOPERIDOL 5 MG 60,00
NUZIP 25 30,00
RISPERIDONE 3 MG 60,00
2486 RAHMAD NUR HIDAYAT 201904000719 04/04/2019 Poli Psikiater OLANZPINE 10mg 15,00 189.720
NUZIP 25 30,00
SERTRALINE 50 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2487 RAHMAT HIDAYAT 201904001700 08/04/2019 Ruangan
- Gelatik OLANZPINE 10mg 7,00 52.717
CLOZAPINE 25 MG 7,00
2488 RAHMAT PRASETYA 201904001835 09/04/2019 Poli Psikiater RIZODAL 2 MG 60,00 128.085
NUZIP 25 15,00
2489 RASMINI 201904000469 02/04/2019 Poli Psikiater RACIKAN KAPSUL 30,00 35.082
ALPRAZOLAM 1 MG 18,00
RISPERIDONE 3 MG 3,00
KAPSUL NO 2 30,00
SERTRALINE 50 MG 15,00
201904005912 30/04/2019 Poli Psikiater RACIKAN KAPSUL 30,00 35.082
ALPRAZOLAM 1 MG 18,00
RISPERIDONE 3 MG 3,00
KAPSUL NO 2 30,00
SERTRALINE 50 MG 15,00
2490 RIAN RUBEN KESITA 201904004669 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
2491 RICKY JONY FAISOL 201904004515 23/04/2019 Poli Psikiater DEPTRAL 50 MG 30,00 513.270
NUZIP 25 30,00
RIZODAL 2 MG 60,00
2492 ROFI ISWAHYUDI 201904004874 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 37.605
TFP 5 MG 30,00
2493 ROFI.I 201904000499 02/04/2019 Poli Psikiater SPUIT 3 CC 1,00 6.758
DIPHENHYDRAMINE 2,00
2494 RONY HIMAWAN 201904001904 09/04/2019 Poli Psikiater SEROQUEL XR 400 1,00 154.473
CLONAZEPAM 2 MG 7,00
RACIKAN KAPSUL 14,00
KAPSUL NO 2 14,00
DEPTRAL 50 MG 7,00
LORAZEPAM 2 MG 7,00
2495 ROSIDA 201904003305 16/04/2019 Poli Psikiater CLOZAPINE 25 MG 15,00 106.095
FRIMANIA 400 MG 30,00
RISPERIDONE 2 MG 30,00
THD 2 MG 30,00
2496 SAIFUL RAHMAN 201904004908 25/04/2019 Poli Psikiater DEPTRAL 50 MG 7,00 84.364
2497 SAMSUL ARIFIN 201904001109 05/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 114.840
2498 SAMSUL HIDAYAT 201904000531 02/04/2019 Poli Psikiater THD 2 MG 60,00 25.500
TFP 5 MG 60,00
2499 SANDI 201904003344 16/04/2019 Psiko Geriatri ELIZAC 20 MG 30,00 262.771
CLOZAPINE 25 MG 30,00
LORAZEPAM 2 MG 15,00
HALDOL DECANOAS 1,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2499 SANDI 201904003344 16/04/2019 Psiko Geriatri
- HALOPERIDOL 1,5 60,00 262.771
2500 SARI INDRAWATI 201904001077 05/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 43.980
CLOZAPINE 25 MG 15,00
TFP 5 MG 45,00
2501 SATUMAN 201904003881 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 46.080
CPZ 100 MG 15,00
RISPERIDONE 3 MG 60,00
2502 SAUDI USMAN 201904000072 01/04/2019 Poli Psikiater RISPERIDONE 2 MG 90,00 37.530
2503 SISWANTO 201904003255 16/04/2019 Poli Psikiater THD 2 MG 60,00 526.245
NUZIP 25 15,00
ELXION 30,00
RIZODAL 2 MG 60,00
2504 SITI 201904003889 22/04/2019 Poli Psikiater SEROQUEL XR 400 2,00 197.535
KAPSUL NO 2 30,00
SERTRALINE 50 MG 15,00
LORAZEPAM 2 MG 15,00
DEPAKOTE ER 500 15,00
ALPRAZOLAM 1 MG 15,00
RACIKAN KAPSUL 30,00
2505 SITI FAIZAH 201904004453 23/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2506 SITI FATIMAH 201904001908 09/04/2019 Poli Psikiater THD 2 MG 180,00 120.240
CPZ 100 MG 90,00
VIT B6 10 MG 180,00
RISPERIDONE 2 MG 180,00
2507 SITI KHODIJAH 201904001227 05/04/2019 Ruangan Puri NUZIP 25 10,00 52.610
RIZODAL 2 MG 20,00
THD 2 MG 20,00
2508 SITI ROMLAH 201904000026 01/04/2019 Poli Psikiater ELIZAC 20 MG 22,00 68.222
CLOBAZAM 10 MG 22,00
201904001798 09/04/2019 Poli Psikiater DEPTRAL 50 MG 15,00 193.020
ALPRAZOLAM 1 MG 15,00
RACIKAN KAPSUL 30,00
AMLODIPIN 10 15,00
RISPERIDONE 3 MG 10,00
KAPSUL NO 2 30,00
2509 SLAMET YULIANTO 201904004865 25/04/2019 Ruangan Gelatik TFP 5 MG 3,00 969
2510 SOEMARLIJAH 201904001925 09/04/2019 Psiko Geriatri THD 2 MG 30,00 128.615
DONEPEZIL 5 MG 15,00
RIZODAL 2 MG 15,00
LORAZEPAM 2 MG 10,00
PUSPALIN 500mg 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2511 SRIHADAD 201904004918 25/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 3,00 9.615
RISPERIDONE 3 MG 6,00
2512 ST FAUZIAH 201904002732 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 857.145
ABILIFY DISCMELT 10 30,00
2513 SUHANDOKO 201904001888 09/04/2019 Poli Psikiater NUZIP 25 135,00 544.365
RIZODAL 2 MG 180,00
THD 2 MG 180,00
2514 SUMARDIONO 201904002530 12/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 1 MG 30,00 62.580
SERTRALINE 50 MG 30,00
2515 SUMINI 201904005945 30/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 294.360
ALPRAZOLAM 1 MG 30,00
SERTRALINE 50 MG 60,00
KAPSUL NO 2 60,00
SEROQUEL XR 400 8,00
2516 SUMISRI 201904005943 30/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 469.185
KAPSUL NO 2 60,00
DEPTRAL 50 MG 30,00
LORAZEPAM 2 MG 15,00
SEROQUEL XR 400 4,00
ALPRAZOLAM 1 MG 30,00
2517 SUNARSIH 201904003294 16/04/2019 Poli Psikiater RACIKAN KAPSUL 120,00 327.240
SEROQUEL XR 400 15,00
KAPSUL NO 2 120,00
2518 SUPRIHATIN 201904001358 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
2519 SUPRIYANTO DWI 201904000529 02/04/2019 Poli Psikiater THD 2 MG 90,00 96.750
NUZIP 25 30,00
RISPERIDONE 3 MG 60,00
2520 SUTEKNO 201904001225 05/04/2019 Ruangan Puri OLANZPINE 10mg 10,00 56.700
2521 SUWONDO 201904005870 30/04/2019 Poli Psikiater NUZIP 25 90,00 141.750
2522 SUYATMI 201904000720 04/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 126.090
KAPSUL NO 2 60,00
SEROQUEL XR 300 5,00
RACIKAN KAPSUL 60,00
ALPRAZOLAM 1 MG 30,00
2523 SUYOTO 201904002319 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2524 SYAMSUL ARIFIN MA'RUF 201904005975 30/04/2019 Poli Psikiater NUZIP 25 14,00 73.654
RIZODAL 2 MG 28,00
THD 2 MG 28,00
2525 TAUFIQ RIFAI 201904004011 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
2526 TIF LATUSHOLIHAH 201904003264 16/04/2019 Poli Psikiater NUZIP 25 30,00 78.390
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2526 TIF LATUSHOLIHAH 201904003264 16/04/2019 Poli Psikiater
- RISPERIDONE 2 MG 60,00 78.390
THD 2 MG 60,00
2527 TOHIRMAN 201904002793 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
2528 TRI DUTA MINARSITA 201904003350 16/04/2019 Poli Psikiater KAPSUL NO 2 30,00 191.340
DEPTRAL 50 MG 15,00
RACIKAN KAPSUL 30,00
ALPRAZOLAM 1 MG 15,00
RISPERIDONE 3 MG 10,00
2529 TRI WANDONO 201904004414 23/04/2019 Poli Psikiater THD 2 MG 60,00 150.660
NUZIP 25 60,00
RISPERIDONE 2 MG 120,00
2530 TUTI MEREZA 201904000778 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 85.695
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
2531 UMMU LAFIYAH 201904001364 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 41.160
CPZ 100 MG 30,00
THD 2 MG 60,00
DIAZEPAM 5 MG 30,00
AMITRIPTILIN 25 MG 30,00
2532 URIP DWI PANGESTU 201904001452 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
2533 VIVI DWI JAYANTI 201904001820 09/04/2019 Poli Psikiater NUZIP 25 30,00 53.280
AMITRIPTILIN 25 MG 30,00
2534 WAHYU PRAWOTO 201904003218 16/04/2019 Poli Psikiater NUZIP 25 30,00 207.090
RIZODAL 2 MG-UM 90,00
THD 2 MG 30,00
2535 WAHYU WIDODO 201904000473 02/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 110.355
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
201904005948 30/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 164.880
RISPERIDONE 2 MG 120,00
2536 WASIS WIDODO 201904001856 09/04/2019 Poli Psikiater THD 2 MG 120,00 156.780
NUZIP 25 60,00
RISPERIDONE 2 MG 120,00
2537 WENDELIN LOUISA 201904002443 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 85.695
TFP 5 MG 60,00
THD 2 MG 60,00
2538 WULIYONO 201904004459 23/04/2019 Poli Psikiater RIZODAL 2 MG 180,00 504.000
SERTRALINE 50 MG 90,00
THD 2 MG 180,00
2539 YOVITA RATNAWATI 201904001408 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
2540 YULI HERMANTO 201904001477 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 122.948
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2540 YULI HERMANTO 201904001477 08/04/2019 Poli Jiwa- Dewasa SPUIT 3 CC 1,00 122.948
THD 2 MG 60,00
DIPHENHYDRAMINE 2,00
OLANZPINE 10mg 15,00
2541 YULI SURYA DEWI 201904001414 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
2542 YUNI SETIORINI 201904002285 11/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 89.211
THD 2 MG 60,00
CPZ 100 MG 30,00
SIKZONOATE 1,00
HALOPERIDOL 5 MG 60,00
2543 YUSTI AMALIAH 201904000726 04/04/2019 Poli Psikiater THD 2 MG 90,00 1.272.000
SERTRALINE 50 MG 60,00
ARINIA 15 MG 30,00
TFP 5 MG 60,00
2544 ZAENAL SAPIAN 201904002771 15/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 164.055
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2545 ZAKARIA PERMANA 201904002473 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 106.350
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
2546 ZULAIMAN 201904000528 02/04/2019 Poli Psikiater DEPTRAL 50 MG 15,00 209.531
KAPSUL NO 2 30,00
RIZODAL 2 MG 15,00
RACIKAN KAPSUL 30,00
ALPRAZOLAM 1 MG 8,00
Dokter: dr. HANTO WIHARDJO, Sp.P
2547 ASA CHARISMA PUTRA 201904003765 22/04/2019 Poli Paru KAPSUL NO 2 30,00 22.623
CETIRIZINE TABLET 15,00
RACIKAN KAPSUL 30,00
CODEIN 15 MG 10,00
SALBUTAMOL 4 MG 2,00
AMBROXOL 30 MG 15,00
2548 FAIZAL GOZALI 201904004620 24/04/2019 Poli VCT CURCUMA 200 MG 30,00 33.300
2549 HOJIN 201904001179 05/04/2019 Ruangan Wijaya ONDANSETRON 4 9,00 273.592
CURCUMA 200 MG 20,00
RINGER LACTAT 3,00
SPUIT 5 CC 5,00
OMEPRAZOLE 3,00
ASERING 500CC 6,00
AQUA PRO INJEKSI 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2550 IRFAN 201904004507 23/04/2019 Ruangan
- Gelatik CURCUMA 200 MG 20,00 22.200
2551 JUMIAH 201904001309 08/04/2019 Poli Paru KAPSUL NO 2 30,00 48.096
CTM 4 MG 15,00
CODEIN 20 MG 8,00
RACIKAN KAPSUL 30,00
CURCUMA 200 MG 30,00
SALBUTAMOL 4 MG 4,00
2552 MOCH. RIFQI RIZZA FIRDI 201904002223 11/04/2019 Poli Paru CODEIN 15 MG 10,00 81.816
SALBUTAMOL 4 MG 4,00
CURCUMA 200 MG 60,00
CTM 4 MG 30,00
KAPSUL NO 2 30,00
2553 NANI YUNINGSIH 201904001924 09/04/2019 Poli Paru RACIKAN KAPSUL 20,00 35.712
CURCUMA 200 MG 20,00
SALBUTAMOL 4 MG 3,00
KAPSUL NO 2 20,00
CTM 4 MG 15,00
CODEIN 15 MG 10,00
201904003348 16/04/2019 Poli Paru KAPSUL NO 2 30,00 109.657
CODEIN 20 MG 15,00
RACIKAN KAPSUL 30,00
AMBROXOL 30 MG 23,00
CURCUMA 200 MG 63,00
SALBUTAMOL 4 MG 8,00
CETIRIZINE TABLET 23,00
2554 RONA PUSPA 201904003222 16/04/2019 Poli Paru SALBUTAMOL 4 MG 2,00 52.953
CEFIXIME 100 MG 20,00
KAPSUL NO 2 30,00
CETIRIZINE TABLET 15,00
RACIKAN KAPSUL 30,00
CODEIN 15 MG 10,00
2555 TOMMY LENGKONG 201904005345 29/04/2019 Poli Paru CURCUMA 200 MG 60,00 66.600
2556 TONO YUYUD 201904004508 23/04/2019 Ruangan Gelatik CURCUMA 200 MG 20,00 22.200
Dokter: dr. HENDRO RIYANTO, Sp KJ.MM
2557 ABD. ROSYID 201904005377 29/04/2019 Poli Psikiater HALOPERIDOL 5 MG 180,00 61.200
THD 2 MG 180,00
CPZ 100 MG 90,00
2558 ABDUL HAFIDZ 201904005926 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2559 ABDUL KHARIS 201904001298 08/04/2019 Poli Psikiater THD 2 MG 60,00 50.280
CPZ 100 MG 30,00
TFP 5 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2560 ABDUL ROSYID 201904001456 08/04/2019 Poli Psikiater
- CPZ 100 MG 4,00 92.058
SEROQUEL XR 400 4,00
RISPERIDONE 3 MG 7,00
THD 2 MG 7,00
2561 ABU SUNJAK 201904001433 08/04/2019 Psiko Geriatri THD 2 MG 180,00 109.620
CPZ 100 MG 90,00
RISPERIDONE 2 MG 180,00
2562 ACHMAD ARIFANDY 201904004494 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
2563 ACHMAD RIDWAN 201904001920 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
2564 ACHMAD RUDI 201904005126 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 68.580
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2565 ACHMAD SAFII 201904002339 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
2566 ADE IRMA NASUTION 201904001187 05/04/2019 IGD THD 2 MG 14,00 50.526
OLANZPINE 10mg 7,00
RISPERIDONE 3 MG 14,00
2567 AGOES PERMADI 201904001322 08/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 18,00 62.058
LORAZEPAM 2 MG 30,00
CLOBAZAM 10 MG 18,00
RACIKAN KAPSUL 60,00
KAPSUL NO.00 60,00
VIT B1 50 MG 30,00
2568 AGUS DARMAWAN 201904005934 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 96.236
TFP 5 MG 60,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
2569 AGUS HARIYANTO 201904000481 02/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 35.415
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
2570 AGUS SOEBEKTI 201904002296 11/04/2019 Poli Jiwa Dewasa NOPRES 20 MG 15,00 109.350
RACIKAN KAPSUL 30,00
CARBAMAZEPINE 30,00
OLANZPINE 10mg 15,00
KAPSUL NO 2 30,00
2571 AGUS SUSIADI 201904001343 08/04/2019 Poli Psikiater THD 2 MG 60,00 168.900
STELAZINE 5 MG 60,00
NUZIP 25 30,00
RIZODAL 2 MG 30,00
2572 AGUSNO 201904002912 15/04/2019 Psiko Geriatri FOLIC ACID 1 MG 60,00 8.580
VIT B6 10 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2573 AGUSTINUS STEFANUS 201904002731 15/04/2019 Psiko Geriatri
- DEPAKOTE 250 MG 60,00 978.885
THD 2 MG 30,00
ABILIFY DISCMELT 10 30,00
CLOZAPINE 100 MG 15,00
2574 AIDAH 201904003547 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
2575 AINUL MUSTOFA 201904002740 15/04/2019 Poli Psikiater THD 2 MG 15,00 35.700
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 15,00
2576 AINUR ROFIK 201904000131 01/04/2019 Poli Psikiater THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2577 AINUR ROFIQ 201904005157 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 155.386
SPUIT 3 CC 1,00
THD 2 MG 60,00
HALDOL DECANOAS 1,00
2578 AJAK /AJAI 201904001901 09/04/2019 Poli Jiwa Dewasa THD 2 MG 10,00 6.765
CPZ 100 MG 5,00
TFP 5 MG 15,00
2579 AJI PAWENANG 201904001466 08/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 30,00 79.245
ESILGAN 2 10,00
AMITRIPTILIN 25 MG 15,00
DIAZEPAM 5 MG 30,00
2580 ALDILA DIAN P. 201904005901 30/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 250 30,00 102.240
2581 ALFIN SEPTIAN 201904005538 29/04/2019 Poli Psikiater SERTRALINE 50 MG 20,00 38.280
2582 ALI SADIKIN 201904001332 08/04/2019 Poli Psikiater CPZ 100 MG 90,00 61.200
HALOPERIDOL 5 MG 180,00
THD 2 MG 180,00
2583 AMIR 201904002737 15/04/2019 Psiko Geriatri CPZ 100 MG 60,00 25.800
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
2584 AMIRUL MUKMININ 201904001357 08/04/2019 Poli Psikiater STELAZINE 5 MG 60,00 162.090
THD 2 MG 60,00
SIZORIL 25 MG 30,00
2585 AMRI SANTOSO / ANDRE 201904005899 30/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 303.746
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
DEPAKOTE 250 MG 60,00
TFP 5 MG 60,00
2586 ANA ISTIANANINGSIH 201904004633 24/04/2019 Poli Psikiater TFP 5 MG 60,00 39.525
THD 2 MG 60,00
LORAZEPAM 2 MG 15,00
2587 ANANG NUROCHMAN 201904003322 16/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 14.640
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2587 ANANG NUROCHMAN 201904003322 16/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 14.640
CPZ 100 MG 15,00
2588 ANDI SULISTYO 201904001886 09/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 40.665
CLOZAPINE 25 MG 15,00
TFP 5 MG 30,00
2589 ANDRI ADE IRAWAN 201904000164 01/04/2019 Poli Psikiater HALOPERIDOL 5 MG 60,00 126.660
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
2590 ANGGA PUTRA 201904002749 15/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 43.530
ALPRAZOLAM 1 MG 90,00
2591 ANI KHUSNUL HOTIMAH 201904005081 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 159.690
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
2592 ANSORI 201904000125 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 18.977
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
2593 ARDI PRIANTO 201904003566 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 102.270
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2594 ARTA GUNAWARMAN 201904002723 15/04/2019 Poli Psikiater RACIKAN KAPSUL 90,00 206.196
CLOZAPINE 100 MG 12,00
RISPERIDONE 3 MG 60,00
KAPSUL NO 2 90,00
THD 2 MG 90,00
CLOBAZAM 10 MG 90,00
2595 ASMADI 201904002487 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 63.330
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2596 ASNAN 201904002798 15/04/2019 Psiko Geriatri HALOPERIDOL 5 MG 60,00 70.830
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2597 ASNGARI 201904004501 23/04/2019 Ruangan Gelatik CURCUMA 200 MG 20,00 22.200
2598 ATHIFAH WARDAH 201904003572 18/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 10 30,00 1.016.520
DEPAKOTE ER 250 30,00
OLANZPINE 10mg 15,00
2599 ATIM HADI SUWITO 201904001895 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2600 AZIS JAZULI 201904000041 01/04/2019 Poli Psikiater TFP 5 MG 60,00 25.500
THD 2 MG 60,00
2601 Asmaul Khusna 201904000744 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 106.860
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2601 Asmaul Khusna 201904000744 04/04/2019 Poli Jiwa- Dewasa RISPERIDONE 3 MG 60,00 106.860
ALPRAZOLAM 0.5 MG 30,00
2602 BAKTIAR 201904001879 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 51.840
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2603 BAMBANG YULIANTO 201904002560 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
2604 BENY DECTUS 201904004486 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2605 BINTI MUTO ATIN 201904005085 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 145.890
CLOZAPINE 100 MG 30,00
TFP 5 MG 60,00
2606 BUDI DARMAWAN 201904000694 04/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 764.343
KAPSUL NO 2 30,00
THD 2 MG 15,00
LORAZEPAM 2 MG 15,00
DEPAKOTE ER 250 30,00
HALOPERIDOL 5 MG 6,00
RACIKAN KAPSUL 30,00
2607 BUDI DAUD SULAIMAN 201904004495 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 51.135
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
2608 CHANDRA WIRANATA 201904001154 05/04/2019 Poli Psikiater STELAZINE 5 MG 60,00 124.815
THD 2 MG 60,00
SIZORIL 25 MG 15,00
AMLODIPIN 5 30,00
2609 CINDY ISTIKA RINI 201904003295 16/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 7,00 12.327
TFP 5 MG 14,00
CPZ 100 MG 7,00
201904004437 23/04/2019 Ruangan THD 2 MG 14,00 1.428
2610 CISCA NINIEK 201904000102 01/04/2019 Ruangan Puri RACIKAN KAPSUL 14,00 197.267
FOLIC ACID 1 MG 14,00
THD 2 MG 14,00
KAPSUL NO.00 14,00
ABILIFY DISCMELT 10 7,00
2611 DARMANTO AFFENDI 201904002580 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
2612 DEDI YULIANTO 201904003323 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 126.510
CLOZAPINE 100 MG 30,00
2613 DEDY SETIAWAN 201904001889 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 309.480
OLANZPINE 10mg 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2613 DEDY SETIAWAN 201904001889 09/04/2019 Poli Jiwa- Dewasa RISPERIDONE 1 MG 60,00 309.480
THD 2 MG 60,00
2614 DEVI RATNASARI 201904005199 26/04/2019 Poli Jiwa Dewasa PHENYTOIN CAP 100 90,00 92.250
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
2615 DEWI AISYAH 201904003873 22/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 58.110
RISPERIDONE 2 MG 60,00
FOLIC ACID 1 MG 60,00
2616 DIAN IRAWATY 201904002297 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.335
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
2617 DIAN PURWANTI 201904002491 12/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 48.870
RISPERIDONE 3 MG 30,00
2618 DIDIK SETYA PRIBADI 201904002542 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 148.830
AMLODIPIN 5 30,00
CLOZAPINE 100 MG 30,00
2619 DIDIK SUHARTO 201904005875 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 890.640
CLOZAPINE 25 MG 30,00
ABILIFY DISCMELT 10 30,00
FOLIC ACID 1 MG 30,00
2620 DINA TRI ASPUJI 201904001157 05/04/2019 IGD THD 2 MG 14,00 13.811
LORAZEPAM 2 MG 7,00
RISPERIDONE 2 MG 14,00
2621 DJUNAEDI 201904003233 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
2622 DODIK IRAWAN 201904005939 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 99.210
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2623 DONA WICAKSANA 201904001843 09/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 18.977
TFP 5 MG 14,00
THD 2 MG 14,00
2624 DWI EDDY SAPUTRA 201904002333 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
2625 DWI INDRAWATI 201904004843 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 190.066
HALDOL DECANOAS 1,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
SPUIT 3 CC 1,00
2626 EARLINE MARANTIKA 201904002564 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.810
RISPERIDONE 1 MG 60,00
TFP 5 MG 60,00
2627 EDY ARIFIN 201904004497 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 48.840
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2627 EDY ARIFIN 201904004497 23/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 48.840
PUSPALIN 500mg 10,00
KAPSUL NO 2 60,00
FOLIC ACID 1 MG 30,00
RACIKAN KAPSUL 60,00
2628 EDY WAHYUDI 201904000510 02/04/2019 Ruangan Wijaya SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
2629 EKA LISTRIANI 201904004652 24/04/2019 Poli Psikiater RIZODAL 2 MG 90,00 236.745
THD 2 MG 90,00
NUZIP 25 45,00
2630 EKO PUJI SANTOSO 201904000702 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 95.025
SERTRALINE 50 MG 30,00
TFP 5 MG 30,00
2631 ELFAN SUSANTO 201904000659 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 34.170
RISPERIDONE 2 MG 15,00
2632 ELLY HENG 201904000064 01/04/2019 Psiko Geriatri CPZ 100 MG 30,00 99.711
SIKZONOATE 1,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
2633 ENDANG SULASIH 201904004824 25/04/2019 Poli Psikiater THD 2 MG 40,00 126.140
CLOZAPINE 25 MG 20,00
DEPAKOTE ER 250 20,00
RISPERIDONE 2 MG 40,00
2634 ENI ASTUTIK 201904005402 29/04/2019 Poli Psikiater THD 2 MG 90,00 25.380
CPZ 100 MG 90,00
2635 ERFAN OCTAFIANTO 201904005889 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.300
CPZ 100 MG 60,00
TFP 5 MG 60,00
2636 ERNAWATI ACHADIAH 201904000679 04/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 508.650
ARICEPT 10 MG 30,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2637 ERNI SETIAWATI 201904002509 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 126.015
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
2638 FERY RIOFANTO 201904004510 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.990
RISPERIDONE 3 MG 30,00
2639 GATOT SUDARKO 201904001454 08/04/2019 Poli Psikiater THD 2 MG 180,00 84.600
CPZ 100 MG 45,00
TFP 5 MG 180,00
2640 GUNADI 201904003273 16/04/2019 Ruangan Gelatik FOLIC ACID 1 MG 14,00 7.014
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2640 GUNADI 201904003273 16/04/2019 Ruangan
- Gelatik RISPERIDONE 2 MG 14,00 7.014
2641 GUNAWAN 201904002576 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 55.920
CPZ 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
2642 GUNAWAN TINDIK 201904003329 16/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 30,00 2.520
2643 H. MUCHAMAD NASIR 201904001431 08/04/2019 Psiko Geriatri FOLIC ACID 1 MG 30,00 34.485
THD 2 MG 15,00
KAPSUL NO.00 30,00
CLOZAPINE 25 MG 15,00
RACIKAN KAPSUL 30,00
2644 H.AFAN 201904000059 01/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 92.070
SANDEPRIL 15,00
FOLIC ACID 1 MG 60,00
2645 HADI WIJAYA 201904005197 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
2646 HAFID 201904001428 08/04/2019 Poli Psikiater HALOPERIDOL 5 MG 180,00 61.200
THD 2 MG 180,00
CPZ 100 MG 90,00
2647 HALIMAH 201904000129 01/04/2019 Psiko Geriatri THD 2 MG 30,00 15.570
RISPERIDONE 2 MG 30,00
2648 HAMIYAH / SARJANI 201904004476 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
2649 HANIFA 201904004505 23/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 92.340
CLOBAZAM 10 MG 30,00
2650 HARI JOHANES 201904003310 16/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 8.880
2651 HARI SETIYAWAN 201904003252 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 159.690
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
2652 HENDRO ANDRIONO 201904003786 22/04/2019 Poli Psikiater THD 2 MG 15,00 40.035
RISPERIDONE 2 MG 15,00
VIT B6 10 MG 60,00
SERTRALINE 50 MG 15,00
2653 HENI TRI LESTARI 201904005941 30/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 8,00 22.240
NOPRES 20 MG 15,00
2654 HERI ARUDI 201904002906 15/04/2019 Poli Psikiater LORAZEPAM 2 MG 8,00 38.104
SERTRALINE 50 MG 16,00
2655 HERMAN EFENDI 201904001426 08/04/2019 Poli Psikiater TFP 5 MG 90,00 210.510
THD 2 MG 90,00
SERTRALINE 50 MG 90,00
2656 HERO YUDIANTO 201904005360 29/04/2019 Poli Psikiater THD 2 MG 120,00 316.980
RISPERIDONE 3 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2656 HERO YUDIANTO 201904005360 29/04/2019 Poli Psikiater
- SIZORIL 25 MG 60,00 316.980
TFP 5 MG 120,00
2657 HESTI KESUMA RATIH 201904004872 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 135.510
PUSPALIN 500mg 10,00
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2658 HIDAYAT 201904002744 15/04/2019 Poli Psikiater THD 2 MG 30,00 30.780
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
2659 HOTRIA RUMONDANG 201904005367 29/04/2019 Psiko Geriatri TFP 5 MG 30,00 154.395
NOPRES 20 MG 15,00
LORAZEPAM 2 MG 15,00
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
RACIKAN KAPSUL 60,00
DEPAKOTE ER 250 30,00
KAPSUL NO.00 60,00
2660 ILHAMUDIN / 201904005985 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 151.546
FOLIC ACID 1 MG 30,00
SPUIT 3 CC 1,00
HALDOL DECANOAS 1,00
CPZ 100 MG 30,00
2661 ILKLAS HAKIM 201904005088 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 74.355
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
2662 IMRON 201904001306 08/04/2019 Poli Psikiater CPZ 100 MG 15,00 30.780
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
2663 INDARTI MAYA 201904003250 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
2664 INDRA ISTIANTO 201904004658 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 87.615
TFP 5 MG 60,00
CLOZAPINE 25 MG 15,00
2665 INDRAWATI 201904005472 29/04/2019 Psiko Geriatri HALOPERIDOL 5 MG 120,00 51.600
THD 2 MG 120,00
CPZ 100 MG 120,00
2666 IPAHAD DZULQIFLI 201904005107 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 21.990
CPZ 100 MG 30,00
HALOPERIDOL 1,5 60,00
AMITRIPTILIN 25 MG 30,00
2667 IRI/H.SAMSUL 201904001372 08/04/2019 Poli Psikiater TFP 5 MG 120,00 61.800
THD 2 MG 120,00
CPZ 100 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2668 ISMAIL 201904000037 01/04/2019 Poli Psikiater
- STELAZINE 5 MG 60,00 132.240
SERTRALINE 50 MG 30,00
THD 2 MG 60,00
CPZ 100 MG 30,00
2669 ISWANDI 201904004856 25/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
2670 JAKA AMIN 201904002524 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.500
TFP 5 MG 60,00
2671 JANIYEM 201904003800 22/04/2019 Ruangan Puri RISPERIDONE 2 MG 7,00 10.178
THD 2 MG 7,00
LORAZEPAM 2 MG 7,00
2672 JOHANNES BOSCO BIMO 201904004504 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
2673 JOKO SETIAWAN 201904004655 24/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 123.150
PHENYTOIN CAP 100 90,00
CLOBAZAM 10 MG 60,00
THD 2 MG 30,00
2674 JOKO SUTRISNO 201904002572 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
2675 KARMINA 201904002913 15/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 75.510
FOLIC ACID 1 MG 30,00
THD 2 MG 30,00
RISPERIDONE 2 MG 30,00
2676 KARNO 201904003761 22/04/2019 Psiko Geriatri CPZ 100 MG 120,00 28.320
AMLODIPIN 10 60,00
2677 KARTI BOLA 201904000130 01/04/2019 Psiko Geriatri TFP 5 MG 60,00 25.500
THD 2 MG 60,00
2678 KARYONO 201904002545 12/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 67.770
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2679 KASENO 201904002536 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
2680 KASNURI 201904001363 08/04/2019 Psiko Geriatri THD 2 MG 60,00 16.920
CPZ 100 MG 60,00
2681 KHOIRUDIN GOZALI 201904002519 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
2682 KHOLIL 201904003331 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
2683 KHOMSATUN 201904003952 22/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 118.170
TFP 5 MG 60,00
THD 2 MG 60,00
2684 KUSTIAWAN 201904002761 15/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 87.030
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2684 KUSTIAWAN 201904002761 15/04/2019 Poli Psikiater
- SANDEPRIL 15,00 87.030
2685 LIE JIN HWA 201904003254 16/04/2019 Poli Psikiater TFP 5 MG 30,00 161.880
ATARAX 1mg 45,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
FOLIC ACID 1 MG 60,00
SERTRALINE 50 MG 30,00
KAPSUL NO 2 60,00
2686 LIKUWAN 201904000833 04/04/2019 Poli Psikiater TFP 5 MG 180,00 76.500
THD 2 MG 180,00
2687 LIM KIM SIOK 201904003779 22/04/2019 Psiko Geriatri TFP 5 MG 120,00 61.800
THD 2 MG 120,00
CPZ 100 MG 60,00
2688 LIM YU MING 201904004422 23/04/2019 Poli Psikiater THD 2 MG 30,00 166.725
DIAZEPAM 5 MG 30,00
REMITAL 10 MG 8,00
FOLIC ACID 1 MG 60,00
RIZODAL 2 MG 15,00
2689 LISSIANA 201904002786 15/04/2019 Psiko Geriatri RACIKAN KAPSUL 60,00 28.338
HALOPERIDOL 5 MG 6,00
RISPERIDONE 3 MG 5,00
ALPRAZOLAM 1 MG 15,00
KAPSUL NO 2 60,00
THD 2 MG 15,00
CLOBAZAM 10 MG 15,00
2690 LIUNIWATI MURIANI A 201904001411 08/04/2019 Psiko Geriatri KUTOIN 60,00 107.970
FOLIC ACID 1 MG 30,00
CARBAMAZEPINE 30,00
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
2691 LULUK FARIDA 201904003575 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 15,00 35.700
THD 2 MG 15,00
CLOZAPINE 25 MG 15,00
2692 LUTFIYATI 201904003825 22/04/2019 Poli Psikiater CPZ 100 MG 15,00 182.091
SIKZONOATE 1,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
RIZODAL 2 MG 60,00
2693 M MUHAJIR 201904003836 22/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
2694 M. ILHAM 201904001422 08/04/2019 Poli Psikiater FOLIC ACID 1 MG 30,00 2.520
2695 M.FIQI ARISANDI 201904004470 23/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 15,00 130.710
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2695 M.FIQI ARISANDI 201904004470 23/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 130.710
2696 MALA 201904000494 02/04/2019 Ruangan SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
201904003366 16/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
2697 MANTAN 201904005467 29/04/2019 Psiko Geriatri RISPERIDONE 2 MG 120,00 80.160
THD 2 MG 120,00
CPZ 100 MG 60,00
VIT B6 10 MG 120,00
2698 MARATUS SOLIKHAH 201904003781 22/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 62.280
THD 2 MG 120,00
2699 MARGIATI 201904000737 04/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 550.530
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
ALPRAZOLAM 0.5 MG 30,00
2700 MARIYAM 201904003824 22/04/2019 Poli Psikiater AMITRIPTILIN 25 MG 60,00 30.420
ALPRAZOLAM 0.5 MG 120,00
2701 MARUFAH 201904002501 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 31.120
CLOZAPINE 25 MG 10,00
2702 MARULLI TAMPUBOLON 201904000092 01/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
2703 MAT 201904004720 24/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
2704 MIMIK SUNARTI 201904001379 08/04/2019 Psiko Geriatri RISPERIDONE 3 MG 60,00 71.220
TFP 5 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
2705 MINARTI 201904005404 29/04/2019 Poli Psikiater THD 2 MG 120,00 61.680
FOLIC ACID 1 MG 120,00
HALOPERIDOL 5 MG 120,00
CPZ 100 MG 120,00
2706 MISLIADI 201904002706 15/04/2019 Psiko Geriatri CPZ 100 MG 90,00 16.200
2707 MOCH SOFWATUL HAQ 201904005509 29/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 97.710
FOLIC ACID 1 MG 60,00
2708 MOCH. ARIS 201904001913 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 235.641
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
SIKZONOATE 1,00
2709 MOCH. FAQIH 201904000857 04/04/2019 Ruangan Kenari THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2710 MOCH. FITROH 201904002586 12/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 60,00 136.680
RISPERIDONE 2 MG 60,00
2711 MOCH. SAIFULLOH 201904003830 22/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 58.890
THD 2 MG 30,00
2712 MOCH. SJAMSUL 201904002478 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 17.700
CPZ 100 MG 15,00
HALOPERIDOL 5 MG 60,00
2713 MOCHAMAD CHOLIK 201904000752 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
2714 MOCHAMAD FAISAL 201904000159 01/04/2019 Ruangan Napza SERTRALINE 50 MG 7,00 13.398
2715 MOH. KHOFI 201904003306 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
2716 MOH. MUHID 201904001329 08/04/2019 Poli Psikiater THD 2 MG 90,00 25.380
CPZ 100 MG 90,00
2717 MOH. SHOLEH 201904005428 29/04/2019 Poli Psikiater SIZORIL 25 MG 50,00 154.450
2718 MOHAMAD SAPTONO 201904002721 15/04/2019 Psiko Geriatri TFP 5 MG 60,00 53.550
THD 2 MG 60,00
LORAZEPAM 2 MG 30,00
2719 MOHAMAD 201904003878 22/04/2019 Poli Psikiater THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
2720 MOHAMMAD 201904002298 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 150.141
SIKZONOATE 1,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
2721 MOKH. ANSORI 201904005144 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
2722 MUDJIONO 201904004839 25/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 60,00 1.060.740
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2723 MUH. HAKIM 201904004883 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 164.911
CLOZAPINE 25 MG 15,00
THD 2 MG 30,00
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
2724 MUHAMMAD SULAIM H 201904003816 22/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
2725 MUJIATI TAMON 201904001317 08/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 33.840
THD 2 MG 60,00
CPZ 100 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2726 MUJIWIYATI 201904000127 01/04/2019 Psiko Geriatri
- RISPERIDONE 2 MG 60,00 33.660
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
2727 MUNA'AM 201904005075 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 23.010
KAPSUL NO.00 60,00
THD 2 MG 30,00
CPZ 100 MG 15,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 30,00
2728 MURNAJIANTONO 201904001903 09/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 29.617
FRIMANIA 200 MG 14,00
2729 MUSLIK 201904004849 25/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 11.880
AMLODIPIN 10 15,00
THD 2 MG 30,00
CPZ 100 MG 15,00
2730 MUSTIKA ANGGRAINI 201904002753 15/04/2019 Poli Psikiater RISPERIDONE 2 MG 180,00 379.530
THD 2 MG 180,00
CPZ 100 MG 45,00
SIZORIL 25 MG 90,00
2731 MUTHANISAH 201904000128 01/04/2019 Poli Psikiater TFP 5 MG 60,00 25.500
THD 2 MG 60,00
201904002763 15/04/2019 Poli Psikiater TFP 5 MG 120,00 51.000
THD 2 MG 120,00
2732 MUTMAINNAH 201904002568 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
2733 NANIK INDAH YANTI 201904005923 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 186.210
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
2734 NANING SRI WAHYUNI 201904002747 15/04/2019 Poli Psikiater THD 2 MG 45,00 150.255
SIZORIL 25 MG 45,00
HALOPERIDOL 5 MG 45,00
2735 NARSIH 201904001144 05/04/2019 Puri Mitra AMITRIPTILIN 25 MG 14,00 9.695
LORAZEPAM 2 MG 7,00
2736 NASURI 201904000886 04/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 173.940
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
2737 NOER RACHMAWATI 201904004846 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
2738 NORI PURWANTO 201904004955 25/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2739 NORMAN ALOYSIUS 201904005919 30/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2740 NUNUK/ROMSINA 201904004695 24/04/2019 Ruangan CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
2741 NUR CHOLIDAH 201904000043 01/04/2019 Poli Psikiater THD 2 MG 30,00 98.025
LORAZEPAM 2 MG 15,00
RIZODAL 2 MG 30,00
SERTRALINE 50 MG 15,00
2742 NUR HASIM 201904003333 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
2743 NURIL QOMARIYAH 201904002776 15/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 87.030
SANDEPRIL 15,00
2744 NURUL HALIM 201904002584 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
2745 NURUL LATIFAH 201904000755 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 640.440
FRIMANIA 200 MG 60,00
RISPERIDONE 2 MG 60,00
SEROQUEL XR 300 30,00
2746 NYOMAN PARWATA 201904005059 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 316.110
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
CLONAZEPAM 2 MG 30,00
2747 NYOTO 201904003327 16/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 5.760
CPZ 100 MG 15,00
2748 PANDAM GURITNO 201904004858 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
2749 PRIHATIN RAHAYU 201904003298 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.300
THD 2 MG 60,00
NEURODEK 10,00
2750 PUDJU SEMEDI 201904003330 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
2751 PURWANTO 201904001320 08/04/2019 Poli Psikiater ARINIA 15 MG 40,00 1.636.611
SPUIT 3 CC 1,00
SERTRALINE 50 MG 30,00
SIKZONOATE 1,00
KAPSUL NO 2 60,00
THD 2 MG 30,00
RACIKAN KAPSUL 60,00
2752 PUTRI INDRA LESMANA 201904005940 30/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 60,00 698.280
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2752 PUTRI INDRA LESMANA 201904005940 30/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 698.280
THD 2 MG 60,00
CLOZAPINE 100 MG 60,00
2753 RACHEL RATNAWATI 201904000099 01/04/2019 Psiko Geriatri RACIKAN KAPSUL 60,00 584.325
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 20,00
ABILIFY DISCMELT 10 15,00
KAPSUL NO.00 60,00
SERTRALINE 50 MG 30,00
CLOBAZAM 10 MG 30,00
2754 RAHAYU P 201904005489 29/04/2019 Poli Psikiater SERTRALINE 50 MG 15,00 42.735
LORAZEPAM 2 MG 15,00
2755 RAHMAD SUGIANTO 201904001352 08/04/2019 Poli Psikiater CPZ 100 MG 90,00 92.700
TFP 5 MG 180,00
THD 2 MG 180,00
2756 RAHMAWATI 201904002566 12/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 102.651
RISPERIDONE 2 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
CPZ 100 MG 15,00
2757 RANGGA CATUR TEGUH 201904000670 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
2758 RATNAWATI 201904001327 08/04/2019 Poli Psikiater ALGANAX 1 MG 15,00 259.590
FOLIC ACID 1 MG 30,00
RACIKAN KAPSUL 60,00
SEROQUEL XR 400 4,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 30,00
2759 RENY SAYEKTI 201904000700 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 104.715
SERTRALINE 50 MG 30,00
TFP 5 MG 60,00
2760 RINI SUYANTI 201904005928 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 52.035
CLOZAPINE 25 MG 15,00
FOLIC ACID 1 MG 30,00
2761 RITA HAMIMA 201904004696 24/04/2019 Ruangan CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
2762 RIZAL ARDENI 201904000051 01/04/2019 Poli Psikiater FOLIC ACID 1 MG 14,00 5.698
TFP 5 MG 14,00
2763 RIZQI ARDENI 201904004511 23/04/2019 Poli Psikiater FOLIC ACID 1 MG 60,00 27.960
TFP 5 MG 60,00
VIT B6 10 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2764 RM. PANGABEAN 201904005370 29/04/2019 Psiko Geriatri
- CLOZAPINE 25 MG 30,00 594.030
SEROQUEL XR 300 30,00
2765 ROBIATUL ADEWIYAH 201904001438 08/04/2019 Poli Psikiater TFP 5 MG 60,00 53.550
THD 2 MG 60,00
LORAZEPAM 2 MG 30,00
2766 ROCHAINAH 201904002751 15/04/2019 Psiko Geriatri THD 2 MG 90,00 54.450
CPZ 100 MG 90,00
TFP 5 MG 90,00
2767 ROFI'AH CHOIRIYAH (HJ. 201904005376 29/04/2019 Psiko Geriatri VIT B6 10 MG 90,00 168.940
SIZORIL 25 MG 50,00
THD 2 MG 90,00
2768 ROFIQ NURHUDA 201904000070 01/04/2019 Poli Psikiater TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
2769 ROHMAD 201904002546 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
2770 RUDI GUNAWAN 201904003328 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
2771 S. MIIFATHUL JANAH , A 201904002471 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 190.461
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
2772 SAHRI ROMADON 201904000748 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 10.425
FOLIC ACID 1 MG 30,00
TFP 5 MG 15,00
2773 SAIFUN NADZIR 201904005098 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 37.605
TFP 5 MG 30,00
2774 SALALLUDIN 201904001518 08/04/2019 Poli Psikiater TFP 5 MG 180,00 282.471
CPZ 100 MG 90,00
THD 2 MG 180,00
RISPERIDONE 3 MG 180,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
2775 SAMSUL HADI 201904005430 29/04/2019 Poli Psikiater THD 2 MG 60,00 36.540
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
2776 SAMSUL HAYATULAH 201904000086 01/04/2019 Poli Psikiater ARINIA 15 MG 30,00 1.184.040
CLORILEX 25 MG 15,00
2777 SAMSUL HUDA 201904004513 23/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 20.970
CPZ 100 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2777 SAMSUL HUDA 201904004513 23/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 30,00 20.970
2778 SANTI PUSPITA SARI 201904001885 09/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 15,00 414.615
2779 SANUSI 201904002915 15/04/2019 Psiko Geriatri FOLIC ACID 1 MG 30,00 21.900
TFP 5 MG 60,00
2780 SAPIYAH 201904005143 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 18.270
THD 2 MG 30,00
CPZ 100 MG 15,00
2781 SARINI 201904005434 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 90,00 62.550
CPZ 100 MG 60,00
THD 2 MG 90,00
FOLIC ACID 1 MG 60,00
2782 SARJONO 201904005067 26/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 30,00 15.030
RISPERIDONE 2 MG 30,00
2783 SATINGEN 201904001348 08/04/2019 Psiko Geriatri THD 2 MG 15,00 438.240
ARICEPT 5 MG 15,00
RIZODAL 2 MG 15,00
2784 SEE SIANG 201904001406 08/04/2019 Psiko Geriatri CARBAMAZEPINE 60,00 76.680
VIT B6 10 MG 30,00
CLOZAPINE 25 MG 30,00
FOLIC ACID 1 MG 30,00
2785 SIAK 201904001911 09/04/2019 Ruangan Wijaya CPZ 100 MG 7,00 3.332
HALOPERIDOL 5 MG 14,00
201904002396 12/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 4.452
ALLOPURINOL 100 7,00
CPZ 100 MG 7,00
201904004954 25/04/2019 Ruangan Kenari CPZ 100 MG 7,00 4.452
HALOPERIDOL 5 MG 14,00
ALLOPURINOL 100 7,00
2786 SIDIQ 201904006014 30/04/2019 Poli Jiwa Dewasa HALDOL DECANOAS 1,00 146.146
SPUIT 3 CC 1,00
TFP 5 MG 60,00
FOLIC ACID 1 MG 30,00
2787 SIMA 201904001366 08/04/2019 Psiko Geriatri TFP 5 MG 180,00 92.700
THD 2 MG 180,00
CPZ 100 MG 90,00
2788 SINGAL NADEAK 201904005366 29/04/2019 Psiko Geriatri THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
2789 SITI FATMAWATI 201904002561 12/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 15,00 914.280
ABILIFY DISCMELT 10 30,00
2790 SITI IMAROPAH 201904005485 29/04/2019 Psiko Geriatri THD 2 MG 60,00 388.005
CLOZAPINE 25 MG 15,00
ARICEPT 10 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2790 SITI IMAROPAH 201904005485 29/04/2019 Psiko Geriatri
- RISPERIDONE 3 MG 60,00 388.005
CLONAZEPAM 2 MG 15,00
2791 SOFIATON 201904001370 08/04/2019 Poli Psikiater RIZODAL 2 MG 60,00 115.620
FOLIC ACID 1 MG 60,00
THD 2 MG 60,00
2792 SOLIKAN 201904002714 15/04/2019 Poli Psikiater CPZ 100 MG 90,00 92.700
TFP 5 MG 180,00
THD 2 MG 180,00
2793 SOLIKIN 201904005346 29/04/2019 Psiko Geriatri AMLODIPIN 10 30,00 65.370
SERTRALINE 50 MG 30,00
ALPRAZOLAM 0.5 MG 30,00
2794 SRI HARTATI 201904001347 08/04/2019 Psiko Geriatri RACIKAN KAPSUL 60,00 76.485
KAPSUL NO.00 60,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 15,00
2795 SRI MULYATI 201904000739 04/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 95.025
TFP 5 MG 30,00
CLOZAPINE 25 MG 15,00
2796 SRI MURNIATI 201904005109 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 43.485
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
2797 SRI SUWARNI 201904005378 29/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
2798 SUDARSIH 201904001916 09/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
2799 SUDARTIK 201904003806 22/04/2019 Poli Psikiater THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
2800 SUGIANTO 201904004877 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
2801 SUKANDAR TREJASA 201904001167 05/04/2019 Poli Psikiater NOPRES 20 MG 30,00 122.190
SIZORIL 25 MG 30,00
2802 SUKARTI 201904001635 08/04/2019 Ruangan THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
201904003355 16/04/2019 Ruangan THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
2803 SUKEMI 201904004845 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 147.930
CLOZAPINE 100 MG 30,00
FOLIC ACID 1 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2804 SUKUR 201904005742 29/04/2019 Ruangan
- Kenari TFP 5 MG 14,00 5.950
THD 2 MG 14,00
2805 SULFIA AHMADHA 201904005149 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
2806 SULIANAH 201904001407 08/04/2019 Poli Psikiater CLOZAPINE 25 MG 15,00 130.155
DEPAKOTE ER 250 30,00
2807 SULIS SETIYAWATI 201904003242 16/04/2019 Poli Jiwa Dewasa KAPSUL NO 2 60,00 17.790
TFP 5 MG 30,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 30,00
THD 2 MG 30,00
2808 SULISTIOWATI 201904002579 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
2809 SULISTIYO AGUNG 201904001880 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
2810 SUMILAH 201904002559 12/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 43.620
RISPERIDONE 2 MG 30,00
THD 2 MG 30,00
2811 SUMINAH 201904005388 29/04/2019 Psiko Geriatri THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
2812 SUMIRAH 201904005365 29/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 55.965
LORAZEPAM 2 MG 30,00
2813 SUNARI 201904003276 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
2814 SURATIN 201904005477 29/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 27.915
2815 SURIYAH 201904000493 02/04/2019 Ruangan LORAZEPAM 2 MG 6,00 5.610
201904001641 08/04/2019 Ruangan LORAZEPAM 2 MG 14,00 44.786
ALLOPURINOL 100 7,00
TFP 5 MG 14,00
CLOZAPINE 25 MG 14,00
201904002464 12/04/2019 Ruangan ALLOPURINOL 100 7,00 44.786
TFP 5 MG 14,00
CLOZAPINE 25 MG 14,00
LORAZEPAM 2 MG 14,00
2816 SURYA ARIF 201904000490 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 130.320
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
LORAZEPAM 2 MG 30,00
2817 SURYO ADI PURNOMO 201904005138 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 30,00 4.740
FOLIC ACID 1 MG 30,00
201904005420 29/04/2019 Poli Psikiater HALOPERIDOL 1,5 30,00 18.765
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2817 SURYO ADI PURNOMO 201904005420 29/04/2019 Poli Psikiater
- LORAZEPAM 2 MG 15,00 18.765
FOLIC ACID 1 MG 30,00
2818 SUSILOWATI / ISWATI 201904001893 09/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 240.906
TFP 5 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
2819 SUTARNI 201904000088 01/04/2019 Psiko Geriatri CPZ 100 MG 15,00 15.450
TFP 5 MG 30,00
THD 2 MG 30,00
2820 SYAHRIL ALAN MUSTOFA 201904000733 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 65.460
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
2821 TAN IE SIN 201904001351 08/04/2019 Psiko Geriatri THD 2 MG 30,00 102.681
CPZ 100 MG 30,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
AMITRIPTILIN 25 MG 30,00
2822 TARI 201904004697 24/04/2019 Ruangan TFP 5 MG 14,00 6.958
CPZ 100 MG 7,00
FOLIC ACID 1 MG 14,00
2823 TARMUJI 201904005364 29/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 123.810
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
2824 TAUFIK BINA SONY 201904005115 26/04/2019 Poli Jiwa Dewasa PUSPALIN 500mg 10,00 64.020
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
2825 TAUFIKUR RAHMAN 201904003793 22/04/2019 Poli Psikiater CLOZAPINE 25 MG 15,00 112.296
SIKZONOATE 1,00
RISPERIDONE 2 MG 30,00
SPUIT 3 CC 1,00
THD 2 MG 30,00
2826 THOMAS IRAWAN 201904005083 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 81.296
SPUIT 3 CC 1,00
THD 2 MG 0,00
CPZ 100 MG 30,00
SIKZONOATE 1,00
2827 TITIN ALIFAH 201904005422 29/04/2019 Poli Psikiater THD 2 MG 240,00 135.360
CPZ 100 MG 60,00
RISPERIDONE 2 MG 240,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2828 TRIBUSONO 201904004722 24/04/2019 Ruangan
- Kenari CPZ 100 MG 7,00 4.760
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
2829 TUTIK WONG 201904004692 24/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 14,00 6.958
TFP 5 MG 14,00
CPZ 100 MG 7,00
2830 TUTUK SUPRASTI 201904000665 04/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 97.920
CPZ 100 MG 30,00
THD 2 MG 60,00
2831 UMI 201904004686 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 7,00 6.958
FOLIC ACID 1 MG 14,00
TFP 5 MG 14,00
2832 UMMU ATHIYAH 201904000713 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 166.830
CLOZAPINE 100 MG 30,00
RISPERIDONE 3 MG 60,00
2833 USWATUN KASANAH 201904005344 29/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 110.490
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
2834 VICTOR IMANUEL 201904002288 11/04/2019 Poli Psikiater VIT B6 10 MG 60,00 198.381
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
FOLIC ACID 1 MG 60,00
SIKZONOATE 1,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
KAPSUL NO 2 60,00
RISPERIDONE 3 MG 40,00
SPUIT 3 CC 1,00
2835 WAGINO 201904004879 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 123.270
PUSPALIN 500mg 10,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
2836 WAHONO 201904002522 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 30.780
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
2837 WAHYU ULFATUS 201904002316 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 41.220
SERTRALINE 50 MG 15,00
2838 WARSINI 201904005406 29/04/2019 Psiko Geriatri ARICEPT 5 MG 15,00 423.915
FOLIC ACID 1 MG 30,00
RISPERIDONE 1 MG 30,00
2839 WARSITO 201904001346 08/04/2019 Psiko Geriatri SEROQUEL XR 300 5,00 225.876
CLOBAZAM 10 MG 60,00
SERTRALINE 50 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2839 WARSITO 201904001346 08/04/2019 Psiko Geriatri
- KAPSUL NO.00 60,00 225.876
TFP 5 MG 12,00
RACIKAN KAPSUL 60,00
2840 WINDARSIH 201904000154 01/04/2019 Poli Psikiater TFP 5 MG 120,00 162.660
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
2841 WIWIK RUSITAWATI 201904000736 04/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 175.446
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 60,00
2842 WIYONO 201904003283 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
2843 YANCE FEBRIYANTO 201904004512 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 12.900
HALOPERIDOL 5 MG 30,00
THD 2 MG 30,00
2844 YASMIN RACHMAWATI 201904001896 09/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 247.530
CLOZAPINE 25 MG 30,00
RISPERIDONE 1 MG 60,00
2845 YOLANDA 201904002505 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 126.015
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
2846 YOSEP SUSANTO 201904002533 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
2847 YOU ERLY 201904002553 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 113.250
SERTRALINE 50 MG 30,00
2848 YOYOK KADIYONO 201904002444 12/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 35.700
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 15,00
2849 YUHEN ALBERTO 201904001910 09/04/2019 Poli Jiwa Dewasa THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
2850 YULI RIANTO 201904001307 08/04/2019 Poli Psikiater THD 2 MG 60,00 50.580
FOLIC ACID 1 MG 60,00
NEURODEK 30,00
RISPERIDONE 2 MG 60,00
2851 YUNUS ARTHUR 201904003831 22/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 232.950
CLOZAPINE 25 MG 30,00
THD 2 MG 120,00
RISPERIDONE 2 MG 120,00
2852 ZAINUL MUSTAKIM 201904001887 09/04/2019 Poli Jiwa Dewasa PUSPALIN 500mg 10,00 48.810
RISPERIDONE 2 MG 30,00
Dokter: dr. IMAM SOEDJONO
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2853 AGUS WIJAYA 201904001194 05/04/2019 IGD
- THD 2 MG 10,00 13.555
CLOZAPINE 25 MG 5,00
TFP 5 MG 10,00
2854 ASTUTIK 201904001644 08/04/2019 Ruangan TFP 5 MG 14,00 18.977
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
2855 DAMIRAH 201904000201 01/04/2019 Ruangan RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
2856 DIAH AMANI 201904000250 01/04/2019 Ruangan CLOZAPINE 100 MG 14,00 146.986
DEPAKOTE ER 500 7,00
THD 2 MG 7,00
OLANZPINE 10mg 7,00
201904001673 08/04/2019 Ruangan OLANZPINE 10mg 7,00 146.986
CLOZAPINE 100 MG 14,00
DEPAKOTE ER 500 7,00
THD 2 MG 7,00
2857 DINA TRI ASPUJI 201904000249 01/04/2019 Ruangan RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
2858 DRS. HERMAN 201904002440 12/04/2019 IGD CENDO XITROL E D 1,00 44.023
NORAGES INJEKSI 1,00
SPUIT 3 CC 1,00
2859 DUWI ASTUTI 201904000244 01/04/2019 Ruangan TFP 5 MG 14,00 5.242
CPZ 100 MG 4,00
201904001675 08/04/2019 Ruangan CPZ 100 MG 7,00 8.043
TFP 5 MG 21,00
2860 DWI ISNAENI 201904001650 08/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
2861 DWI PRAHASTUTI 201904000254 01/04/2019 Ruangan THD 2 MG 14,00 33.320
CLOZAPINE 25 MG 14,00
RISPERIDONE 2 MG 14,00
2862 ELLY SPING 201904001679 08/04/2019 Ruangan HALOPERIDOL 5 MG 14,00 39.578
DEPAKOTE 250 MG 14,00
SERTRALINE 50 MG 7,00
CPZ 100 MG 14,00
THD 2 MG 14,00
2863 FELSI 201904001686 08/04/2019 Ruangan RISPERIDONE 3 MG 14,00 10.836
THD 2 MG 14,00
2864 FONI ANDRIANI 201904000192 01/04/2019 Ruangan THD 2 MG 14,00 5.950
TFP 5 MG 14,00
2865 GIYEM 201904002342 11/04/2019 Ruangan THD 2 MG 6,00 5.616
RISPERIDONE 2 MG 12,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2866 HOTIMAH 201904000255 01/04/2019 Ruangan
- TFP 5 MG 7,00 2.261
2867 JUS HAJATI 201904001663 08/04/2019 Ruangan NOPRES 20 MG 7,00 18.444
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
CPZ 100 MG 4,00
2868 KARNIYAH / PRETTY 201904001677 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
2869 KENSIWI NARASWATI 201904003601 18/04/2019 Ruangan TFP 5 MG 1,00 1.295
THD 2 MG 6,00
CPZ 100 MG 2,00
2870 MAIMUNAH 201904000195 01/04/2019 Ruangan CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
201904001651 08/04/2019 Ruangan CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
2871 MALA 201904000248 01/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
2872 MARPUAH 201904000186 01/04/2019 Ruangan THD 2 MG 7,00 19.579
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
201904001657 08/04/2019 Ruangan THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
2873 MUJAYANAH 201904000243 01/04/2019 Ruangan TFP 5 MG 7,00 2.261
2874 NINIK KUSYANTI 201904001646 08/04/2019 Ruangan CLOZAPINE 100 MG 4,00 20.574
TFP 5 MG 14,00
2875 NURUL KOMARIYAH 201904000197 01/04/2019 Ruangan RISPERIDONE 3 MG 14,00 28.385
TFP 5 MG 14,00
CLOZAPINE 25 MG 7,00
THD 2 MG 14,00
201904001683 08/04/2019 Ruangan TFP 5 MG 14,00 28.385
CLOZAPINE 25 MG 7,00
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
2876 RENDA STARY ANJANI 201904001688 08/04/2019 Ruangan THD 2 MG 14,00 14.710
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 14,00
2877 RIAMAH 201904000182 01/04/2019 Ruangan CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
2878 RINI HERMIYATI / 201904001681 08/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
2879 RONALD SAMANTA 201904001080 05/04/2019 IGD CLOZAPINE 25 MG 14,00 74.459
LODOMER 2 MG/ML 1,00
DIAZEPAM inj 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2879 RONALD SAMANTA 201904001080 05/04/2019 IGD
- TFP 5 MG 14,00 74.459
SPUIT 3 CC 2,00
THD 2 MG 14,00
2880 SENEN 201904001685 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
2881 SITI USWATUN 201904001660 08/04/2019 Ruangan IKALEP 250 MG 14,00 74.333
CPZ 100 MG 21,00
TFP 5 MG 21,00
2882 SRINI 201904000190 01/04/2019 Ruangan RISPERIDONE 2 MG 14,00 28.518
DEPAKOTE 250 MG 14,00
CPZ 100 MG 14,00
2883 SUCI 201904001658 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
2884 SUKARTI 201904000198 01/04/2019 Ruangan CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
2885 SULISTIYOWATI 201904001671 08/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.986
THD 2 MG 14,00
CPZ 100 MG 4,00
2886 SUPRAPTI 201904001655 08/04/2019 Ruangan RISPERIDONE 3 MG 14,00 10.128
CPZ 100 MG 4,00
2887 SUPRIYANTO 201904001153 05/04/2019 Ruangan Puri CLOZAPINE 25 MG 14,00 31.892
RISPERIDONE 2 MG 14,00
2888 SURIP 201904001648 09/04/2019 Ruangan RISPERIDONE 3 MG 14,00 18.280
THD 2 MG 14,00
CLOZAPINE 25 MG 4,00
2889 SURIYAH 201904000256 01/04/2019 Ruangan ALLOPURINOL 100 7,00 38.241
TFP 5 MG 14,00
CLOZAPINE 25 MG 14,00
LORAZEPAM 2 MG 7,00
2890 SUTIK 201904001643 08/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
2891 TINI 201904000184 01/04/2019 Ruangan RISPERIDONE 1 MG 14,00 5.040
2892 WINARTI 201904001654 08/04/2019 Ruangan LORAZEPAM 2 MG 11,00 97.463
DEPAKOTE 250 MG 14,00
RISPERIDONE 3 MG 14,00
CLOZAPINE 100 MG 14,00
THD 2 MG 14,00
Dokter: dr. Ivana Sajogo, Sp. KJ
2893 ABD. ROCHMAN 201904003827 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 27.840
CPZ 100 MG 30,00
TFP 5 MG 60,00
2894 ABDUL HAFIDZ 201904001833 09/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 5.838
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2894 ABDUL HAFIDZ 201904004679 24/04/2019 Ruangan
- Gelatik THD 2 MG 14,00 33.320
CLOZAPINE 25 MG 14,00
RISPERIDONE 2 MG 14,00
2895 ABDUL ROKHIB 201904002828 15/04/2019 Poli Jiwa Anak OLANZPINE 10mg 30,00 403.380
CLOZAPINE 25 MG 60,00
DEPAKOTE ER 250 30,00
TFP 5 MG 60,00
2896 ABU RAIHAN AL BIRUNI 201904002823 15/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 35.490
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
METHYLPHENIDATE 23,00
RACIKAN PUYER 30,00
2897 ACHMAD BASUKI 201904003837 22/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 89.606
THD 2 MG 30,00
CPZ 100 MG 30,00
SIKZONOATE 1,00
TFP 5 MG 30,00
2898 ACHMAD MUCHIBBUDIN 201904002581 12/04/2019 Poli Jiwa Anak VIT B6 10 MG 7,00 9.593
KAPSUL NO 2 14,00
CLOBAZAM 10 MG 7,00
RACIKAN KAPSUL 14,00
HALOPERIDOL 5 MG 3,00
2899 ACIN HANANTA OEI 201904000496 02/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 39.465
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 8,00
ABILIFY DISCMELT 15 0,00
KAPSUL NO.00 30,00
SERTRALINE 50 MG 12,00
2900 AGUNG SETIA BUDI 201904002393 12/04/2019 Ruangan Kenari RISPERIDONE 2 MG 10,00 9.753
CLOZAPINE 25 MG 3,00
201904005037 26/04/2019 Ruangan Kenari CLOZAPINE 25 MG 14,00 32.004
TFP 5 MG 14,00
THD 2 MG 14,00
2901 AHMAD HUSEN ASHARI 201904000285 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 34.041
THD 2 MG 14,00
CLOZAPINE 100 MG 7,00
201904001634 08/04/2019 Ruangan Kenari THD 2 MG 7,00 18.263
CLOZAPINE 25 MG 7,00
TFP 5 MG 14,00
201904003245 16/04/2019 Ruangan Kenari THD 2 MG 7,00 18.263
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2901 AHMAD HUSEN ASHARI 201904003245 16/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 7,00 18.263
TFP 5 MG 14,00
2902 AHMAD KHUSNI NURIZAL 201904005176 26/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 30,00 273.480
DEPAKOTE ER 250 60,00
KAPSUL NO.00 60,00
THD 2 MG 45,00
CLOBAZAM 10 MG 30,00
RACIKAN KAPSUL 60,00
VIT B6 10 MG 30,00
FOLIC ACID 1 MG 30,00
2903 AHMAD SYAFRIZA 201904002775 15/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 60,00 113.415
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 15,00
THD 2 MG 30,00
2904 AJENG WANUDYA 201904002784 15/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 4,00 198.411
FOLIC ACID 1 MG 18,00
ASAM VALPROAT 1,00
KAPSUL NO.00 60,00
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 6,00
RACIKAN PUYER 60,00
2905 ALIYA FAADHILLAH 201904002514 12/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 68.811
SERTRALINE 50 MG 8,00
METHYLPHENIDATE 30,00
KAPSUL NO.00 30,00
VIT B6 10 MG 15,00
CLOBAZAM 10 MG 6,00
RACIKAN KAPSUL 30,00
2906 AMILUS SOLIKAH 201904003777 22/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 170.100
2907 ANA ISTIANANINGSIH 201904001632 08/04/2019 Ruangan LORAZEPAM 2 MG 7,00 11.067
TFP 5 MG 14,00
2908 ANDIEN S APRILIA 201904001842 09/04/2019 Poli Jiwa Anak NERIPROS ORAL 1,00 275.935
2909 ANDRI SOLEGORO 201904004671 24/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 5,00 16.146
KAPSUL NO 2 60,00
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 6,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 18,00
2910 ANIK MUJAYANTI 201904003241 16/04/2019 Puri Mitra TFP 5 MG 14,00 17.549
CLOZAPINE 25 MG 7,00
2911 ARYANANDA 201904004666 24/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 353.613
ABILIFY DISCMELT 15 8,00
CLOBAZAM 10 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2911 ARYANANDA 201904004666 24/04/2019 Poli Jiwa
- Anak SERTRALINE 50 MG 12,00 353.613
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
2912 ASNOTO 201904005989 30/04/2019 Ruangan Gelatik SPUIT 3 CC 1,00 124.246
HALDOL DECANOAS 1,00
2913 BILFY JAMIL FAZA 201904002801 15/04/2019 Poli Jiwa Anak KAPSUL NO.00 30,00 216.462
ABILIFY DISCMELT 15 4,00
METHYLPHENIDATE 30,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 8,00
2914 BUDIMAN WISANTO 201904003792 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 49.140
CPZ 100 MG 15,00
RISPERIDONE 3 MG 60,00
2915 CHRISTHIO RIONARDO 201904004756 24/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 250 30,00 121.620
TFP 5 MG 60,00
2916 DEBORA SONYA JUNITA 201904002605 12/04/2019 Poli Jiwa Anak CLOBAZAM 10 MG 15,00 176.385
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 15 4,00
2917 DEVIAN HEAVENIY 201904002818 15/04/2019 Poli Jiwa Anak KAPSUL NO 2 30,00 81.165
ABILIFY DISCMELT 15 2,00
RACIKAN PUYER 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
2918 DWI PRAHASTUTI 201904000504 02/04/2019 Ruangan SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
2919 EKO SANI 201904005288 27/04/2019 Poli Psikiater HALOPERIDOL 5 MG 120,00 51.600
THD 2 MG 120,00
CPZ 100 MG 120,00
2920 EKO SUPRIYANTO 201904003810 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 163.770
THD 2 MG 30,00
CLOZAPINE 100 MG 30,00
2921 ELA RIZKI 201904004951 25/04/2019 Poli Psikiater THD 2 MG 60,00 187.260
RACIKAN KAPSUL 60,00
RISPERIDONE 3 MG 40,00
KAPSUL NO 2 60,00
ELIZAC 20 MG 60,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
KAPSUL NO 2 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2921 ELA RIZKI 201904004951 25/04/2019 Poli Psikiater
- RISPERIDONE 3 MG 40,00 187.260
2922 ELTON DAFFA S 201904004836 25/04/2019 Poli Jiwa Anak RACIKAN PUYER 30,00 334.371
ABILIFY DISCMELT 15 6,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 9,00
PROHIPER 10 15,00
KAPSUL NO.00 30,00
VIT B6 10 MG 15,00
2923 FADHILAH AZHAR 201904004678 24/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 6,00 263.309
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 8,00
SERTRALINE 50 MG 3,00
KAPSUL NO 2 30,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
SERTRALINE 50 MG 5,00
HALOPERIDOL 5 MG 5,00
2924 FAJAR FAUZAN 201904002392 12/04/2019 Ruangan Kenari CPZ 100 MG 3,00 3.770
TFP 5 MG 10,00
201904004982 25/04/2019 Ruangan Kenari CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
2925 FATDHEKUL FERRI 201904000545 02/04/2019 Puri Mitra (Laki- DEPAKOTE ER 250 3,00 10.224
201904001331 08/04/2019 Puri Mitra (Laki- NOPRES 20 MG 4,00 3.936
2926 FAUSTINA ELITA 201904005146 26/04/2019 Poli Jiwa Anak SERTRALINE 50 MG 9,00 418.674
KAPSUL NO.00 30,00
THD 2 MG 8,00
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 10,00
CLOBAZAM 10 MG 8,00
2927 FEVBRINA SYLVIA 201904002517 12/04/2019 Poli Psikiater VIT B6 10 MG 15,00 69.735
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 1,00
SERTRALINE 50 MG 15,00
KAPSUL NO 2 30,00
2928 FIRIND BAHIYAH SABY 201904002570 12/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 12.270
FOLIC ACID 1 MG 30,00
VIT B12 50 MG 30,00
KAPSUL NO.00 60,00
VIT B6 10 MG 30,00
2929 FRASMI SANDY 201904000297 01/04/2019 Ruangan Kenari THD 2 MG 14,00 35.029
CLOZAPINE 25 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2929 FRASMI SANDY 201904000297 01/04/2019 Ruangan
- Kenari TFP 5 MG 14,00 35.029
CLOZAPINE 100 MG 4,00
2930 GALUH CHANDRA HP 201904003803 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.010
PROPANOLOL 10 MG 60,00
RISPERIDONE 3 MG 30,00
CLOZAPINE 25 MG 30,00
2931 GRACIANO RIONAL M 201904003270 16/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 230.577
ABILIFY DISCMELT 15 5,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 8,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
CLOBAZAM 10 MG 15,00
2932 HANA TERISIA 201904002287 11/04/2019 Poli Psikiater THD 2 MG 30,00 6.290
TFP 5 MG 10,00
2933 HANS CHRISTOPHER 201904003775 22/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 1.010.280
FRIMANIA 400 MG 60,00
CLOZAPINE 25 MG 30,00
2934 HENY PURWANINGSIH 201904003272 16/04/2019 Ruangan SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
2935 HERU ROHMADI 201904000277 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 4.522
2936 HIDAYATUL TAUFIK 201904001375 08/04/2019 Poli Jiwa Anak VIT B6 10 MG 30,00 133.422
FOLIC ACID 1 MG 30,00
RACIKAN KAPSUL 60,00
DEPAKOTE 250 MG 60,00
HALOPERIDOL 5 MG 18,00
THD 2 MG 15,00
CLOZAPINE 25 MG 18,00
KAPSUL NO.00 60,00
2937 HISBULLAH 201904004829 25/04/2019 Poli Jiwa Anak KAPSUL NO.00 30,00 10.407
VIT B6 10 MG 15,00
RACIKAN PUYER 30,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 3,00
2938 HOTIMAH 201904001266 07/04/2019 IGD TFP 5 MG 7,00 2.261
2939 ILMA NUR LAILI ROHMAH 201904001368 08/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 91.152
THD 2 MG 15,00
CLOBAZAM 10 MG 30,00
RISPERIDONE 3 MG 20,00
VIT B6 10 MG 30,00
KAPSUL NO.00 60,00
SERTRALINE 50 MG 18,00
2940 INDAH CHOIRUNNISA 201904005680 29/04/2019 Ruangan Puri CLOZAPINE 100 MG 14,00 85.988
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2940 INDAH CHOIRUNNISA 201904005680 29/04/2019 Ruangan
- Puri DEPAKOTE ER 250 7,00 85.988
TFP 5 MG 14,00
THD 2 MG 14,00
2941 INDRAJID 201904000278 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.956
THD 2 MG 7,00
CPZ 100 MG 4,00
201904001616 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.956
THD 2 MG 7,00
CPZ 100 MG 4,00
2942 JULIANTO DWI 201904002855 15/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 133.784
RACIKAN KAPSUL 30,00
SERTRALINE 50 MG 6,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 10 4,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
SERTRALINE 50 MG 3,00
HALOPERIDOL 5 MG 3,00
2943 KARNO 201904001785 09/04/2019 Ruangan Gelatik SIKZONOATE 1,00 73.333
SPUIT 3 CC 1,00
TFP 5 MG 14,00
201904002082 10/04/2019 Ruangan Gelatik TFP 5 MG 14,00 4.522
2944 LISAWATI 201904004647 24/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 162.191
CLOZAPINE 100 MG 15,00
TFP 5 MG 60,00
KAPSUL NO.00 60,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
RACIKAN KAPSUL 60,00
2945 LUCKI KRISDIANTO 201904001345 08/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 848.835
NOPRES 20 MG 15,00
TFP 5 MG 15,00
2946 M ROYCHAN AINUR 201904005050 26/04/2019 Poli Jiwa Anak KAPSUL NO.00 30,00 46.905
PROHIPER 10 8,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
2947 M. DAFFA RAFARDHAN 201904004621 24/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 165.927
SERTRALINE 50 MG 3,00
KAPSUL NO.00 30,00
VIT B6 10 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2947 M. DAFFA RAFARDHAN 201904004621 24/04/2019 Poli Jiwa
- Anak RACIKAN PUYER 30,00 165.927
ABILIFY DISCMELT 15 4,00
2948 M. RAFLI RAMADHANI 201904002136 10/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 1,00 68.837
RACIKAN KAPSUL 14,00
CLOBAZAM 10 MG 7,00
SERTRALINE 50 MG 3,00
KAPSUL NO 2 14,00
RACIKAN KAPSUL 14,00
CLOBAZAM 10 MG 7,00
VIT B6 10 MG 7,00
KAPSUL NO 2 14,00
SERTRALINE 50 MG 3,00
FOLIC ACID 1 MG 7,00
2949 MARCO ACHMAD 201904002260 11/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 303.390
CLOBAZAM 10 MG 15,00
VIT B6 10 MG 30,00
KAPSUL NO 2 30,00
RISPERIDONE 3 MG 10,00
FOLIC ACID 1 MG 30,00
ABILIFY DISCMELT 15 6,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 30,00
VIT B12 50 MG 30,00
KAPSUL NO 2 60,00
2950 MIRA SARAH 201904004939 25/04/2019 Psiko Geriatri KAPSUL NO 2 30,00 20.586
TFP 5 MG 6,00
RACIKAN KAPSUL 30,00
THD 2 MG 8,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 8,00
2951 MOCH. SAIFULLOH 201904000275 01/04/2019 Ruangan Kenari THD 2 MG 10,00 21.725
RACIKAN KAPSUL 10,00
CLOZAPINE 25 MG 10,00
TFP 5 MG 5,00
KAPSUL NO.0 10,00
2952 MOCH. TOYYIB 201904002802 15/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 20,00 265.605
FOLIC ACID 1 MG 15,00
DEPAKOTE ER 250 60,00
RACIKAN KAPSUL 60,00
THD 2 MG 30,00
KAPSUL NO.00 60,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2952 MOCH. TOYYIB 201904002802 15/04/2019 Poli Jiwa
- Anak VIT B6 10 MG 15,00 265.605
KAPSUL NO.00 30,00
2953 MOCH.ANWAR 201904003813 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
2954 MOCH.DIMAS PUTRA 201904005154 26/04/2019 Poli Jiwa Anak KAPSUL NO.00 60,00 17.580
THD 2 MG 15,00
RACIKAN KAPSUL 60,00
VIT B6 10 MG 30,00
FOLIC ACID 1 MG 30,00
RISPERIDONE 3 MG 10,00
2955 MOCK ARKHA AZZAM D 201904004699 24/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 1.260
2956 MOHAMMAD KISBIANTO 201904004988 25/04/2019 Ruangan Kenari CPZ 100 MG 4,00 6.558
RISPERIDONE 2 MG 14,00
2957 MORSIDI 201904001384 08/04/2019 Ruangan Gelatik CLOZAPINE 100 MG 4,00 37.290
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
TFP 5 MG 21,00
2958 MR. X 201904001786 09/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 74.593
TFP 5 MG 14,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
201904005627 29/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
2959 MUH SYIFA' LASETIYO 201904005141 26/04/2019 Poli Jiwa Anak CLONAZEPAM 2 MG 45,00 766.290
VIT B1 50 MG 30,00
KAPSUL NO.00 60,00
DEPAKOTE 250 MG 60,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 30,00
VIT B6 10 MG 30,00
KAPSUL NO.00 60,00
RACIKAN KAPSUL 60,00
KAPSUL NO.00 60,00
ABILIFY DISCMELT 15 10,00
RACIKAN KAPSUL 60,00
2960 MUHAJIR MUHAMMAD 201904004952 25/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 141.586
CPZ 100 MG 30,00
THD 2 MG 30,00
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
2961 MUHAMMAD AZKA 201904001560 08/04/2019 Poli Jiwa Anak KAPSUL NO 3 8,00 30.479
VIT B6 10 MG 4,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2961 MUHAMMAD AZKA 201904001560 08/04/2019 Poli Jiwa
- Anak RACIKAN PUYER 8,00 30.479
ABILIFY DISCMELT 10 1,00
FOLIC ACID 1 MG 4,00
SERTRALINE 50 MG 1,00
2962 MUHAMMAD DEVANDA 201904002768 15/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 155.910
KAPSUL NO.00 30,00
FOLIC ACID 1 MG 15,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
ABILIFY DISCMELT 15 3,00
METHYLPHENIDATE 23,00
2963 MUHAMMAD MAHDI 201904004533 23/04/2019 Poli Jiwa Anak CLOZAPINE 25 MG 45,00 223.215
DEPAKOTE 250 MG 60,00
LORAZEPAM 2 MG 30,00
RISPERIDONE 2 MG 60,00
2964 MUHAMMAD ZHAFRAN 201904002495 12/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 124.275
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
ABILIFY DISCMELT 15 2,00
METHYLPHENIDATE 30,00
RACIKAN KAPSUL 30,00
2965 MUJAYANAH 201904000501 02/04/2019 Ruangan TFP 5 MG 14,00 4.522
201904001571 08/04/2019 Ruangan TFP 5 MG 14,00 30.576
CLOZAPINE 25 MG 14,00
2966 MUSYAFI ASSYA'BANI 201904002825 15/04/2019 Poli Jiwa Anak VIT B12 50 MG 15,00 4.875
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
RACIKAN PUYER 30,00
FOLIC ACID 1 MG 15,00
2967 NAJWA ARIMBI 201904000646 03/04/2019 Poli Jiwa Anak SERTRALINE 50 MG 1,00 36.936
KAPSUL NO.00 10,00
RACIKAN KAPSUL 10,00
VIT B6 10 MG 5,00
KAPSUL NO.00 10,00
SERTRALINE 50 MG 1,00
CLOBAZAM 10 MG 3,00
ABILIFY DISCMELT 10 1,00
RACIKAN KAPSUL 10,00
2968 NILAM NUR KHALIMATUS 201904000484 02/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 17.112
SERTRALINE 50 MG 3,00
KAPSUL NO.00 30,00
CLOBAZAM 10 MG 5,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2968 NILAM NUR KHALIMATUS 201904000484 02/04/2019 Poli Jiwa
- Anak VIT B6 10 MG 30,00 17.112
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 0,00
2969 NOFRINA KHOLIKAWATI 201904000165 01/04/2019 Ruangan FOLIC ACID 1 MG 7,00 588
2970 NURUL NANIK 201904003782 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
2971 PASCALIS BINTANG 201904002255 11/04/2019 Poli Psikiater ABILIFY DISCMELT 10 10,00 295.550
SERTRALINE 50 MG 10,00
2972 PURWATI 201904003412 16/04/2019 Ruangan Puri TFP 5 MG 7,00 32.557
KAPSUL NO 3 7,00
SERTRALINE 50 MG 7,00
THD 2 MG 7,00
KAPSUL NO.00 7,00
TFP 5 MG 7,00
CLOZAPINE 25 MG 7,00
RACIKAN KAPSUL 7,00
201904004403 23/04/2019 Ruangan Puri SERTRALINE 50 MG 7,00 32.837
CLOZAPINE 25 MG 7,00
THD 2 MG 7,00
RACIKAN KAPSUL 7,00
TFP 5 MG 7,00
KAPSUL NO.00 7,00
RACIKAN KAPSUL 7,00
TFP 5 MG 7,00
KAPSUL NO.00 7,00
2973 R. SATRYA NOVANTARA 201904002120 10/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 401.517
VIT B6 10 MG 15,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 15 10,00
CLOBAZAM 10 MG 8,00
RACIKAN KAPSUL 30,00
2974 RAYHAN ALDINATA 201904001859 09/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 199.065
KAPSUL NO.00 30,00
ABILIFY DISCMELT 15 5,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
2975 RENGGA ARTHA 201904001853 09/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 328.116
VIT B6 10 MG 30,00
FOLIC ACID 1 MG 24,00
RISPERIDONE 3 MG 10,00
ABILIFY DISCMELT 15 8,00
KAPSUL NO.00 60,00
THD 2 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2976 RIAMAH 201904000507 02/04/2019 Ruangan
- TFP 5 MG 14,00 24.560
THD 2 MG 14,00
CLOZAPINE 25 MG 10,00
201904001267 07/04/2019 IGD TFP 5 MG 14,00 32.004
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
2977 RISKY ADITYA 201904002808 15/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 36.750
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
METHYLPHENIDATE 23,00
2978 SAFIUDDIN 201904002254 11/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 31.698
VIT B12 50 MG 30,00
KAPSUL NO 2 60,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 12,00
VIT B6 10 MG 30,00
KAPSUL NO 2 30,00
RISPERIDONE 3 MG 10,00
FOLIC ACID 1 MG 30,00
2979 SAMUEL KUNCORO 201904002272 11/04/2019 Psiko Geriatri LORAZEPAM 2 MG 15,00 76.605
SERTRALINE 50 MG 30,00
ALPRAZOLAM 1 MG 30,00
2980 SARI 201904004890 25/04/2019 Ruangan THD 2 MG 14,00 29.554
CLOZAPINE 25 MG 14,00
HALOPERIDOL 5 MG 14,00
2981 SAYATI 201904004938 25/04/2019 Psiko Geriatri KAPSUL NO 2 4,00 2.516
VIT B6 10 MG 2,00
FOLIC ACID 1 MG 2,00
RACIKAN KAPSUL 4,00
HALOPERIDOL 1,5 2,00
SERTRALINE 50 MG 1,00
2982 SIH WINARNI (SE) 201904005682 29/04/2019 Ruangan Puri THD 2 MG 4,00 4.832
RACIKAN KAPSUL 4,00
TFP 5 MG 4,00
KAPSUL NO 3 4,00
RACIKAN KAPSUL 4,00
CPZ 100 MG 2,00
THD 2 MG 4,00
KAPSUL NO 3 4,00
TFP 5 MG 4,00
CPZ 100 MG 4,00
2983 SIVA NUR AINI 201904000530 02/04/2019 Poli Jiwa Anak CLOZAPINE 25 MG 5,00 14.495
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2983 SIVA NUR AINI 201904000530 02/04/2019 Poli Jiwa
- Anak THD 2 MG 10,00 14.495
RISPERIDONE 2 MG 10,00
2984 SOEHARTINI 201904002100 10/04/2019 Poli Psikiater TFP 5 MG 3,00 49.332
RACIKAN KAPSUL 14,00
MERLOPAM 2 MG 7,00
SERTRALINE 50 MG 7,00
KAPSUL NO 2 14,00
THD 2 MG 4,00
RACIKAN KAPSUL 14,00
TFP 5 MG 3,00
KAPSUL NO 2 14,00
THD 2 MG 4,00
SERTRALINE 50 MG 7,00
FOLIC ACID 1 MG 7,00
2985 SOFIYATUN FADILAH 201904001855 09/04/2019 Poli Jiwa Anak THD 2 MG 30,00 207.870
CLOZAPINE 100 MG 30,00
FRIMANIA 200 MG 60,00
HALOPERIDOL 5 MG 90,00
2986 STEVE DANLEE THE 201904003686 19/04/2019 Poli Jiwa Anak PROHIPER 10 10,00 52.800
2987 SUGENG KARYONO 201904002401 12/04/2019 Ruangan Kenari LORAZEPAM 2 MG 6,00 6.498
HALOPERIDOL 5 MG 6,00
2988 SUHARTINA NJO 201904001008 04/04/2019 Psiko Geriatri ALGANAX 1 MG 20,00 110.880
2989 SULTHAN PRAMUDYA 201904005391 29/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 4,00 226.839
KAPSUL NO.00 30,00
ASAM VALPROAT 2,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 6,00
2990 SUMINAH 201904002282 11/04/2019 Psiko Geriatri TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
2991 TINI 201904003353 16/04/2019 Ruangan RISPERIDONE 2 MG 14,00 5.838
2992 UMI ROSIDAH 201904004373 23/04/2019 Ruangan THD 2 MG 7,00 23.149
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
2993 YUAN ORLANDO 201904004488 23/04/2019 Poli Jiwa Anak RACIKAN PUYER 30,00 123.873
ABILIFY DISCMELT 15 3,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 2,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
2994 Z.IFTINA ASSYABIYA 201904001403 08/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 3,00 143.085
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
2994 Z.IFTINA ASSYABIYA 201904001403 08/04/2019 Poli Jiwa
- Anak KAPSUL NO.00 30,00 143.085
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 15,00
RACIKAN KAPSUL 30,00
METHYLPHENIDATE 9,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 5,00
2995 ZHAFIRA RIZKY 201904002575 12/04/2019 Poli Jiwa Anak DEPAKOTE ER 250 30,00 237.630
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
2996 ZUMROTUL KHAURO' 201904004532 23/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 30,00 107.289
LORAZEPAM 2 MG 15,00
THD 2 MG 15,00
HALOPERIDOL 5 MG 18,00
RACIKAN KAPSUL 60,00
CARBAMAZEPINE 90,00
VIT B6 10 MG 30,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
Dokter: dr. KINTONO
2997 M.NUR HADI 201904005963 30/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 62.280
THD 2 MG 120,00
2998 NURUL NASEHA 201904005988 30/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 274.770
OLANZPINE 10mg 30,00
NUZIP 25 30,00
2999 SABULLAH 201904000153 01/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 57.420
Dokter: dr. LILA NURMAYANTI, Sp.Kj
3000 YAHJA ENDANG 201904003860 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 71.400
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 30,00
3001 ABDUL HAFIDZ 201904001712 08/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 53.536
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
3002 ABDUL MAJIT 201904005031 26/04/2019 Poli Psikiater RISPERIDONE 3 MG 120,00 142.590
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3003 ABDUL ROKHIM 201904000316 01/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 34.643
THD 2 MG 7,00
CLOZAPINE 100 MG 7,00
201904001620 08/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 34.643
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3003 ABDUL ROKHIM 201904001620 08/04/2019 Ruangan
- Kenari THD 2 MG 7,00 34.643
CLOZAPINE 100 MG 7,00
3004 ABDUL WAHID 201904002153 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3005 ABDULLAH TEGAL 201904004556 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
3006 ACHMAD HUSNI 201904000111 01/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 25.800
THD 2 MG 60,00
CPZ 100 MG 60,00
3007 ACHMAD SUHAIRI 201904001942 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3008 ADIANTO / ARMAN 201904004558 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
3009 ADIM MUSONI 201904000807 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 45,00 83.745
3010 ADITYA 201904002152 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3011 ADITYA DJOHAN 201904000891 04/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 92.340
SERTRALINE 50 MG 30,00
3012 AGUS SUKOCO 201904000800 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3013 AHMAT SLAMET 201904004524 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 31.700
CTM 4 MG 10,00
TFP 5 MG 60,00
THD 2 MG 60,00
3014 AIYIK 201904004555 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
3015 ALDY PRADANA DIPTYA 201904000445 02/04/2019 Poli Psikiater THD 2 MG 7,00 10.857
RACIKAN KAPSUL 7,00
NOPRES 20 MG 7,00
RISPERIDONE 2 MG 7,00
KAPSUL NO.0 7,00
3016 ALI SUJUD 201904004519 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 24.300
CPZ 100 MG 15,00
3017 ANDIK KUSBENY 201904001933 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3018 ANWAR 201904002155 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 50.520
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
3019 ARIFULLAH HAQIQI 201904005471 29/04/2019 Poli Psikiater KAPSUL NO 2 30,00 49.864
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3019 ARIFULLAH HAQIQI 201904005471 29/04/2019 Poli Psikiater
- RACIKAN KAPSUL 30,00 49.864
CLOZAPINE 100 MG 8,00
RISPERIDONE 3 MG 20,00
3020 ARIK SULISTIYO 201904003918 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3021 ARPI 201904001946 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 39.540
TFP 5 MG 60,00
3022 ASIA 201904000975 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3023 ASMANTO 201904000861 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3024 ASNAH 201904003785 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3025 AUDRY 201904004530 23/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 15 30,00 1.356.960
TFP 5 MG 30,00
CLOZAPINE 100 MG 30,00
THD 2 MG 30,00
SERTRALINE 50 MG 30,00
3026 AYU WAHYUNI 201904000989 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 24.120
FOLIC ACID 1 MG 30,00
3027 BISU AUAU 201904000554 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3028 BISU TUA 201904000980 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 4.845
3029 BUDI KURNIAWAN 201904002142 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
3030 BUDI BAMBANG 201904001965 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
3031 DADANG 201904004522 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3032 DAROJI 201904001961 09/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 7.500
THD 2 MG 30,00
3033 DEBORA PASKARINA S. 201904005548 29/04/2019 Poli Psikiater KAPSUL NO 2 30,00 91.416
SEROQUEL XR 400 2,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 24,00
3034 DEDIK IRIYANTO 201904002144 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 160.245
NA DICLOFENAC 50 15,00
RISPERIDONE 3 MG 60,00
3035 DENY HUSEN 201904002137 10/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3036 DEWI MANDASARI 201904004516 23/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 138.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3037 DHEA OCTA AKALILI 201904003799 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 131.340
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 90,00
3038 DIAN EKO FEBRIANTO 201904000544 02/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 635.475
CLOZAPINE 100 MG 15,00
SEROQUEL XR 200 30,00
SERTRALINE 50 MG 30,00
3039 DIAN IRAWATY 201904000259 01/04/2019 Ruangan RISPERIDONE 2 MG 14,00 46.347
THD 2 MG 14,00
CLOZAPINE 25 MG 21,00
3040 DODIK SISWANTO 201904001962 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 90,00 34.470
CPZ 100 MG 30,00
3041 DODY SUCAHYONO 201904003855 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 117.615
SERTRALINE 50 MG 30,00
3042 DONI. B 201904004551 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3043 ENCAH 201904000145 01/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 14,00 20.356
THD 2 MG 14,00
LORAZEPAM 2 MG 14,00
3044 ENI 201904000978 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 12.390
CPZ 100 MG 15,00
3045 ENI AYU WAHNINGSIH 201904000976 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.540
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
3046 ENI MUSRIPAH 201904001051 05/04/2019 Poli Psikiater TFP 5 MG 90,00 54.450
THD 2 MG 90,00
CPZ 100 MG 90,00
3047 ERNI/ENI 201904000576 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3048 FATHURRACHMAN 201904001169 05/04/2019 Poli Syaraf PARACETAMOL 500 15,00 84.675
METHYCOBAL 500 20,00
3049 FEBRIANI PUTRI JAYANTI 201904000109 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 8.100
KAPSUL NO.00 60,00
ABILIFY DISCMELT 15 0,00
RACIKAN KAPSUL 60,00
3050 FELSI 201904000246 01/04/2019 Ruangan ASAM MEFENAMAT 15,00 14.976
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
3051 GAGUK HADI PRASETYO 201904002146 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 78.270
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3052 GAK NOK 201904000549 02/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 20.400
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
3053 GINAH/GIMA 201904000567 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3054 GIO 201904001956 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3055 GIYANTO 201904002597 12/04/2019 Poli Psikiater THD 2 MG 60,00 111.525
CLOZAPINE 25 MG 15,00
ELIZAC 20 MG 30,00
TFP 5 MG 60,00
3056 GIYEM 201904000225 01/04/2019 Ruangan THD 2 MG 7,00 5.754
RISPERIDONE 1 MG 14,00
201904000565 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 137.160
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
201904002838 15/04/2019 Ruangan RISPERIDONE 2 MG 8,00 7.484
THD 2 MG 4,00
LORAZEPAM 2 MG 4,00
3057 HABSAH 201904000574 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3058 HANDOKO 201904004528 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3059 HARI SANTOSO 201904004548 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.220
GENTAMYCIN SALEP 1,00
HALOPERIDOL 5 MG 60,00
CPZ 100 MG 30,00
3060 HARIATI 201904000547 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3061 HARTO 201904001951 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3062 HARY TOMY 201904001953 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3063 HASANI 201904004552 23/04/2019 Poli Jiwa Dewasa GENTAMYCIN SALEP 1,00 29.600
TFP 5 MG 60,00
CPZ 100 MG 30,00
3064 HJ.NURHAYATI 201904003845 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 387.870
KAPSUL NO.00 60,00
THD 2 MG 60,00
RACIKAN KAPSUL 60,00
DEPAKOTE ER 500 30,00
CLOZAPINE 100 MG 30,00
3065 HORO 201904000318 01/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 19.579
RISPERIDONE 2 MG 14,00
THD 2 MG 7,00
201904001610 08/04/2019 Ruangan Kenari THD 2 MG 7,00 19.579
CLOZAPINE 25 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3065 HORO 201904001610 08/04/2019 Ruangan
- Kenari RISPERIDONE 2 MG 14,00 19.579
201904002068 10/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 19.579
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
3066 HOTIJAH 201904001067 05/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3067 IMAM SANTOSO 201904003769 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 71.400
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 30,00
201904003774 22/04/2019 Poli Jiwa Dewasa ISDN 5 MG 2,00 300
3068 IMANUDIN ABIL FIDA 201904000879 04/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 421.605
CLOZAPINE 100 MG 45,00
RISPERIDONE 2 MG 60,00
3069 IMRON 201904000095 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 76.784
SPUIT 3 CC 1,00
SIKZONOATE 1,00
LORAZEPAM 2 MG 7,00
201904004520 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.550
LORAZEPAM 2 MG 30,00
TFP 5 MG 60,00
3070 IMRON SUJARWO 201904001930 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
CPZ 100 MG 30,00
3071 INDAH MARSANI 201904000569 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3072 INDRI WIKANI 201904001124 05/04/2019 Poli Psikiater SIKZONOATE 1,00 94.311
TFP 5 MG 60,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
3073 INTAN BERLIAN 201904000961 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
3074 ISMAIL 201904000455 02/04/2019 Poli Psikiater TFP 5 MG 120,00 243.300
CLOZAPINE 25 MG 60,00
THD 2 MG 120,00
RISPERIDONE 3 MG 120,00
3075 JABRIK/ELI SUGIARTI 201904000933 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3076 JAKFAR SODIQ 201904001159 05/04/2019 Poli Psikiater ESILGAN 2 30,00 264.960
NOPRES 20 MG 30,00
CLOBAZAM 10 MG 30,00
3077 JAMAL FAUZI 201904004549 23/04/2019 Poli Psikiater RISPERIDONE 2 MG 30,00 1.670.970
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3077 JAMAL FAUZI 201904004549 23/04/2019 Poli Psikiater
- ABILIFY DISCMELT 10 60,00 1.670.970
3078 JAYUS 201904001934 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3079 JUNDI MUCHLAS 201904003884 22/04/2019 Poli Psikiater DEPTRAL 50 MG 15,00 180.780
3080 JUSAK 201904000892 04/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 777.240
RISPERIDONE 3 MG 60,00
SEROQUEL XR 400 30,00
THD 2 MG 60,00
3081 KADIR 201904001966 09/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3082 KALISA 201904000550 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
3083 KARIMAH 201904000546 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 82.560
CPZ 100 MG 15,00
THD 2 MG 30,00
SERTRALINE 50 MG 30,00
3084 KARTONO 201904001957 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
201904003820 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 115.530
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
3085 KASMINTO 201904000323 01/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 19.579
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
201904001636 08/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
3086 KASMURI 201904005936 30/04/2019 Puri Mitra (Laki- THD 2 MG 14,00 16.527
CLOZAPINE 25 MG 7,00
HALOPERIDOL 5 MG 14,00
3087 KOKO HENDRASYAH 201904002143 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3088 KUSNO 201904004562 23/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 14,00 3.500
THD 2 MG 14,00
3089 KUSTANTO 201904001949 09/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 30,00 15.270
TFP 5 MG 30,00
THD 2 MG 30,00
3090 KUTUT PURWANTYO W 201904003863 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 121.650
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3091 LAILATUS SEMBADRA 201904001060 05/04/2019 Poli Psikiater LORAZEPAM 2 MG 60,00 71.100
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3091 LAILATUS SEMBADRA 201904001060 05/04/2019 Poli Psikiater
- THD 2 MG 60,00 71.100
HALOPERIDOL 5 MG 60,00
3092 LIMBUK 201904000580 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
3093 LINA FADILAH FIRDAUSA 201904000230 01/04/2019 Ruangan SERTRALINE 50 MG 7,00 33.691
CLOZAPINE 25 MG 7,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
201904001274 07/04/2019 Ruangan CLOZAPINE 25 MG 7,00 33.691
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
SERTRALINE 50 MG 7,00
3094 LUCKY DWI KURNIAWAN 201904002614 12/04/2019 Poli Napza SERTRALINE 50 MG 90,00 256.410
LORAZEPAM 2 MG 90,00
3095 LUKMAN HAKIM 201904005459 29/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 81.330
TFP 5 MG 60,00
THD 2 MG 60,00
3096 LUSIANA 201904000116 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 158.070
DEPAKOTE ER 250 30,00
3097 M. ADI 201904001727 08/04/2019 Ruangan Gelatik SERTRALINE 50 MG 4,00 11.247
ALPRAZOLAM 0.5 MG 7,00
RISPERIDONE 1 MG 7,00
3098 M. DAUD 201904003760 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 22.860
RISPERIDONE 3 MG 30,00
3099 M. TOHIR 201904001940 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 30.780
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3100 M.AGUS 201904004554 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3101 MAESAROH / OOM 201904000548 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
3102 MAMA MARIA 201904000958 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
3103 MANIYEH 201904000950 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 46.440
RISPERIDONE 3 MG 60,00
3104 MARYATI 201904000563 02/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 7.500
THD 2 MG 30,00
3105 MELANI SAPUTRA 201904000902 04/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 30,00 110.490
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
3106 MENIK 201904000564 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3107 MOCH. ARIS 201904000509 02/04/2019 Ruangan
- Gelatik ASAM MEFENAMAT 10,00 32.138
RISPERIDONE 2 MG 14,00
CLOZAPINE 100 MG 4,00
THD 2 MG 14,00
AMOXYCILLIN 500 15,00
DEXAMETASON 0,5 10,00
3108 MOCH. HASANUDIN 201904002578 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 6.375
THD 2 MG 15,00
3109 MOCH. YACUB 201904004521 23/04/2019 Poli Psikiater RISPERIDONE 2 MG 30,00 41.955
THD 2 MG 15,00
CLOZAPINE 25 MG 15,00
3110 MOH. WAHYUDI 201904000320 01/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 19.579
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
201904001627 08/04/2019 Ruangan Kenari CLOZAPINE 25 MG 7,00 19.579
RISPERIDONE 2 MG 14,00
THD 2 MG 7,00
201904004617 24/04/2019 Ruangan Kenari THD 2 MG 7,00 19.579
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
3111 MOH.SOHIBUL AFKAR 201904004531 23/04/2019 Poli Jiwa Anak THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3112 MOKH.HUSNAN ALI 201904001164 05/04/2019 Poli Psikiater HALOPERIDOL 5 MG 30,00 7.500
THD 2 MG 30,00
3113 MUCHLAS YULIANTO 201904005452 29/04/2019 Poli Psikiater OLANZPINE 10mg 60,00 366.840
FOLIC ACID 1 MG 60,00
RISPERIDONE 1 MG 60,00
3114 MUH. 201904000899 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 500.310
CLOZAPINE 100 MG 15,00
ABILIFY DISCMELT 10 15,00
TFP 5 MG 60,00
3115 MUHAMMAD RIZAL . H 201904005030 26/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 110.355
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 15,00
3116 MUKLIS 201904000317 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 11.781
THD 2 MG 7,00
LORAZEPAM 2 MG 7,00
201904001605 08/04/2019 Ruangan Kenari THD 2 MG 7,00 11.781
LORAZEPAM 2 MG 7,00
TFP 5 MG 14,00
3117 MUNGGAR PRASTOWO 201904003812 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 18.270
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3117 MUNGGAR PRASTOWO 201904003812 22/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 15,00 18.270
3118 MUNIROH AUWALANAH 201904002229 11/04/2019 Poli Psikiater THD 2 MG 135,00 70.065
RISPERIDONE 2 MG 135,00
3119 MUNTINGAH 201904005487 29/04/2019 Poli Psikiater RISPERIDONE 1 MG 120,00 108.420
THD 2 MG 60,00
LORAZEPAM 2 MG 60,00
VIT B COMPLEX 30,00
3120 NADHIM AHMAD 201904002195 11/04/2019 Ruang Observasi CPZ 100 MG 10,00 1.800
3121 NANIK NUR 201904000559 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3122 NANIK SUNIATI 201904000814 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 81.330
TFP 5 MG 60,00
THD 2 MG 60,00
3123 NASIR ABDUL HAMID 201904000897 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 74.700
TFP 5 MG 60,00
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
3124 NOOR MASRUROH 201904003805 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 132.900
RISPERIDONE 2 MG 30,00
3125 NOVI DARA 201904000952 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 24.300
RISPERIDONE 1 MG 60,00
3126 NUR SOHIB UDIN 201904001959 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
3127 NURHAYATI 201904004492 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 91.856
SIKZONOATE 1,00
HALOPERIDOL 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
3128 NURUL 201904000932 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3129 NUVIA KUSUMAWATI 201904003852 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 65.820
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3130 PAINEM 201904000553 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 15.000
HALOPERIDOL 5 MG 60,00
3131 PATNO 201904004550 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 28.200
TFP 5 MG 60,00
THD 2 MG 60,00
3132 PETRUS WIJAYA 201904002643 13/04/2019 Poli Psikiater ESILGAN 2 10,00 66.840
3133 PONIMAN 201904004525 23/04/2019 Poli Jiwa Dewasa GENTAMYCIN SALEP 1,00 60.020
RISPERIDONE 2 MG 60,00
CPZ 100 MG 60,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3134 PONIYEM 201904000584 02/04/2019 Poli Jiwa- Dewasa RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
3135 PRASETYO AGUS 201904001937 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3136 PUJI ASTUTIK 201904000843 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 137.046
SPUIT 3 CC 1,00
SIKZONOATE 1,00
CLOZAPINE 25 MG 15,00
3137 PUTRI 201904000566 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3138 PUTRI RACHMAWATI 201904000239 01/04/2019 Ruangan RISPERIDONE 2 MG 14,00 30.401
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
FRIMANIA 200 MG 14,00
3139 RACHMAD ROMADHON 201904003787 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 151.530
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3140 RAKI 201904001128 05/04/2019 Poli Psikiater KAPSUL NO 2 60,00 74.310
THD 2 MG 30,00
RACIKAN KAPSUL 60,00
NOPRES 20 MG 60,00
TFP 5 MG 30,00
3141 RANI SANTANA 201904001938 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3142 RENDA STARY ANJANI 201904000516 02/04/2019 Ruangan Wijaya SERTRALINE 50 MG 7,00 53.088
OLANZPINE 10mg 7,00
3143 RIA PUTRI KUSUMA 201904000853 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 15.570
RISPERIDONE 2 MG 30,00
3144 RIANY RIKO 201904002608 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 251.430
CARBAMAZEPINE 120,00
RISPERIDONE 2 MG 60,00
CLOBAZAM 10 MG 60,00
THD 2 MG 30,00
3145 RICKE DIAH FITALOKA 201904000854 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 52.035
CLOZAPINE 25 MG 15,00
FOLIC ACID 1 MG 30,00
3146 RIDWAN 201904004553 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.500
TFP 5 MG 60,00
3147 RIDWAN BISU 201904001947 09/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 82.440
RISPERIDONE 2 MG 60,00
3148 RIDWANULLAH 201904000871 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3149 RIONO 201904001836 09/04/2019 Ruangan Gelatik TFP 5 MG 14,00 4.522
201904004031 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 4,00 13.394
TFP 5 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3149 RIONO 201904004031 22/04/2019 Ruangan
- Gelatik THD 2 MG 14,00 13.394
3150 RITA HAMIMA 201904000960 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3151 ROHANI 201904000957 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3152 ROHMAD 201904004526 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 25.140
TFP 5 MG 60,00
THD 2 MG 30,00
3153 ROSIDAH 201904005822 29/04/2019 Ruangan THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
3154 RUKMIYAH 201904005390 29/04/2019 Poli Gigi (Jiwa) THD 2 MG 14,00 8.526
CPZ 100 MG 7,00
RISPERIDONE 2 MG 14,00
3155 RULI BOEDI DHANARTI 201904003872 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 82.440
SERTRALINE 50 MG 30,00
3156 RUSDI 201904005445 29/04/2019 Psiko Geriatri RACIKAN KAPSUL 120,00 198.840
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
RISPERIDONE 3 MG 20,00
KAPSUL NO 2 120,00
SERTRALINE 50 MG 30,00
ALPRAZOLAM 1 MG 30,00
3157 RUSMINAH 201904000578 02/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 14.280
CPZ 100 MG 30,00
3158 S.SUNARYO 201904001954 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3159 SADIQIN 201904004557 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 33.660
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
3160 SAFITRI 201904000570 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 79.575
TFP 5 MG 60,00
3161 SAIFUL ANWAR 201904005043 26/04/2019 Psiko Geriatri THD 2 MG 15,00 6.450
CPZ 100 MG 15,00
HALOPERIDOL 1,5 30,00
3162 SAIFUL ASWAR 201904003910 22/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 120.990
THD 2 MG 60,00
KAPSUL NO 2 60,00
RISPERIDONE 3 MG 40,00
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
3163 SAKINAH 201904000948 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.500
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3164 SANIYAAYU 201904001105 05/04/2019 Poli Psikiater
- NOPRES 20 MG 30,00 166.680
CLOBAZAM 10 MG 30,00
DEPAKOTE ER 250 30,00
3165 SARTONO 201904000821 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 60.675
CLOZAPINE 25 MG 30,00
3166 SENEN 201904000228 01/04/2019 Ruangan THD 2 MG 7,00 6.552
RISPERIDONE 2 MG 14,00
3167 SILVI 201904000930 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.500
THD 2 MG 60,00
3168 SINTA SRI MULYATI 201904000575 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3169 SISUM 201904000581 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 14.280
HALOPERIDOL 5 MG 60,00
3170 SISWANTO 201904004468 23/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 88.320
TFP 5 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
3171 SITAS/SITATUN 201904000931 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
3172 SITI 201904005058 26/04/2019 Poli Psikiater THD 2 MG 30,00 54.750
NUZIP 25 30,00
HALOPERIDOL 5 MG 30,00
3173 SITI UMROATUN 201904000582 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 102.270
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
3174 SITI HILDANIA 201904004514 23/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 458.100
CLOZAPINE 25 MG 15,00
ABILIFY DISCMELT 10 15,00
RISPERIDONE 2 MG 30,00
3175 SITI MAUNAH 201904000962 04/04/2019 Poli Jiwa Dewasa CARBAMAZEPINE 60,00 47.100
PHENYTOIN CAP 100 60,00
3176 SITI 201904000557 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3177 SLAMET M 201904001931 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3178 SLAMET NURWINADI 201904001720 08/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
3179 SLAMET YUDHAYA 201904003784 22/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 464.901
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 30,00
DEPAKOTE ER 500 30,00
RISPERIDONE 3 MG 60,00
3180 SOEHARTATIK 201904001086 05/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 30,00 90.495
CLOZAPINE 25 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3180 SOEHARTATIK 201904001086 05/04/2019 Psiko Geriatri
- SERTRALINE 50 MG 30,00 90.495
3181 SRI MUJIAH 201904000150 01/04/2019 Ruangan THD 2 MG 7,00 6.552
RISPERIDONE 2 MG 14,00
3182 SRI MULYANI 201904000524 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 158.100
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
3183 SRI WAHYUNI 201904003885 22/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 31.665
CLOZAPINE 25 MG 15,00
HALOPERIDOL 1,5 30,00
3184 SRIYATUN 201904001070 05/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 173.940
THD 2 MG 120,00
CLOZAPINE 25 MG 60,00
3185 SUGENG 201904002151 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 117.780
CLOZAPINE 25 MG 60,00
3186 SUGENG 201904004547 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 19.820
THD 2 MG 60,00
GENTAMYCIN SALEP 1,00
3187 SUHARTONO 201904000322 01/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 4.760
THD 2 MG 14,00
CPZ 100 MG 7,00
201904001633 08/04/2019 Ruangan Kenari CPZ 100 MG 7,00 4.760
HALOPERIDOL 5 MG 14,00
THD 2 MG 14,00
201904002462 12/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 4.760
THD 2 MG 14,00
CPZ 100 MG 7,00
3188 SUHERMAN 201904001952 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
3189 SUKARNIATI 201904000561 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3190 SULIS INDARI 201904002973 15/04/2019 Poli Psikiater ABILIFY DISCMELT 15 4,00 203.835
CLOBAZAM 10 MG 15,00
SERTRALINE 50 MG 15,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
3191 SUMARA 201904004560 23/04/2019 Ruangan Gelatik THD 2 MG 14,00 5.950
TFP 5 MG 14,00
3192 SUMIRAN 201904000319 01/04/2019 Ruangan Kenari THD 2 MG 7,00 10.230
CLOZAPINE 25 MG 4,00
HALOPERIDOL 5 MG 14,00
201904001629 08/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 10.944
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3192 SUMIRAN 201904001629 08/04/2019 Ruangan
- Kenari THD 2 MG 14,00 10.944
CLOZAPINE 25 MG 4,00
3193 SUPIK 201904000555 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.180
CPZ 100 MG 60,00
3194 SUTEDJO BASUKI 201904000539 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3195 SUTRI 201904001182 05/04/2019 Poli Psikiater LORAZEPAM 2 MG 15,00 53.445
NOPRES 20 MG 15,00
RISPERIDONE 1 MG 60,00
THD 2 MG 30,00
3196 SUTRISNO 201904001943 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3197 SUWA 201904002141 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 26.388
BETAMETASON 1,00
CPZ 100 MG 30,00
3198 SYAFII 201904004523 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3199 TARI 201904000927 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3200 TAUFIK HIDAYAT 201904000893 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 65.820
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3201 TERRY 201904002615 12/04/2019 Poli Jiwa Dewasa KAPSUL NO 2 60,00 47.910
NOPRES 20 MG 15,00
LORAZEPAM 2 MG 30,00
ALPRAZOLAM 1 MG 15,00
RACIKAN KAPSUL 60,00
3202 TRI MULYASTUTI 201904003606 18/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 90,00 91.980
TFP 5 MG 180,00
THD 2 MG 180,00
3203 UCOK SAPULELE 201904001936 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 28.200
TFP 5 MG 60,00
THD 2 MG 60,00
3204 UMI 201904000982 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 137.160
CLOZAPINE 25 MG 60,00
TFP 5 MG 60,00
3205 UMIRAH 201904000551 02/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 22.440
TFP 5 MG 60,00
3206 VIDELIS 201904004518 23/04/2019 Poli Jiwa Dewasa PARACETAMOL 500 10,00 26.280
TFP 5 MG 60,00
CIPROFLOXACIN 500 10,00
3207 VIVI PRAMITA 201904000572 02/04/2019 Poli Umum ESILGAN 2 4,00 26.736
3208 WAHYU WIDAYATI 201904002587 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 159.690
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3208 WAHYU WIDAYATI 201904002587 12/04/2019 Poli Jiwa- Dewasa RISPERIDONE 3 MG 60,00 159.690
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
3209 WATI 201904000562 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3210 WATINAH 201904000571 02/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3211 WENDY/WIKE 201904000556 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3212 WINARTI 201904000232 01/04/2019 Ruangan LORAZEPAM 2 MG 11,00 97.463
DEPAKOTE 250 MG 14,00
RISPERIDONE 3 MG 14,00
CLOZAPINE 100 MG 14,00
THD 2 MG 14,00
3213 WIWIK WIDYAWATI 201904003835 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 121.650
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
3214 WIWIN WINDA 201904000985 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3215 YANI 201904000988 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 82.440
SERTRALINE 50 MG 30,00
3216 YATI 201904000955 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 8.880
3217 YATI ( B ) / YAPDARI 201904000568 02/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 17.340
THD 2 MG 30,00
CPZ 100 MG 30,00
3218 YATI MALU 201904000143 01/04/2019 Ruangan THD 2 MG 7,00 7.812
CPZ 100 MG 7,00
RISPERIDONE 2 MG 14,00
3219 YUDI ISWANTO 201904000864 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3220 YULI GUN 201904000983 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
3221 YULI KRISTIYANI 201904003924 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 159.690
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3222 YULIATI 201904000577 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 24.780
CPZ 100 MG 30,00
3223 YUNI 201904000558 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 9.690
3224 ZULFAN AFIF 201904004472 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 79.350
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3224 ZULFAN AFIF 201904004472 23/04/2019 Poli Jiwa- Dewasa ASAM MEFENAMAT 15,00 79.350
Dokter: dr. LILIEK MURTININGSIH, Sp.JP
3225 Misbahul Munir 201904001185 05/04/2019 Poli Jantung NOPRES 20 MG 30,00 60.660
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
Dokter: dr. M GRACE IRAWATI NATAWIRA
3226 AGUNG BUDIANTO 201904004086 22/04/2019 Ruangan Gelatik TFP 5 MG 21,00 18.879
CPZ 100 MG 7,00
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
201904004087 22/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 10.836
THD 2 MG 14,00
3227 AKHMAD BAYU 201904004090 22/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
3228 ALI MUHSIN 201904003460 18/04/2019 Ruangan Gelatik CENDO XITROL E D 1,00 34.172
3229 ALWI FAHRUDIN 201904004098 22/04/2019 Ruangan Gelatik THD 2 MG 14,00 30.590
CLOZAPINE 25 MG 14,00
HALOPERIDOL 5 MG 21,00
3230 BUDIONO 201904001705 08/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 8.526
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
3231 HERU HARIYANTO 201904004099 22/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 22.435
CLOZAPINE 25 MG 7,00
3232 JONATHAN WIDJAJA 201904001967 09/04/2019 IGD RISPERIDONE 3 MG 4,00 55.196
SERTRALINE 50 MG 4,00
CLOZAPINE 100 MG 4,00
DEPAKOTE ER 500 4,00
3233 KASIANI 201904001698 08/04/2019 Ruangan Gelatik THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
201904005722 29/04/2019 Ruangan Gelatik THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
3234 LUKITO DODIK 201904004096 22/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
3235 LUKMAN HAKIM 201904001728 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 14,00 5.950
THD 2 MG 14,00
GENTAMYCIN SALEP 0,00
3236 MANSYUR 201904001699 08/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 48.860
SERTRALINE 50 MG 7,00
CLOZAPINE 25 MG 14,00
3237 MINTO 201904002349 11/04/2019 Ruangan Gelatik AMITRIPTILIN 25 MG 14,00 15.148
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3237 MINTO 201904002349 11/04/2019 Ruangan
- Gelatik TFP 5 MG 14,00 15.148
CPZ 100 MG 7,00
THD 2 MG 7,00
RISPERIDONE 2 MG 14,00
3238 MISBACHUL MUNIR 201904001707 08/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
3239 MOCH. FADLI 201904004100 22/04/2019 Ruangan Gelatik THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
3240 RIONO 201904001723 08/04/2019 Ruangan Gelatik BETAMETASON 3,00 18.218
THD 2 MG 14,00
CLOZAPINE 25 MG 4,00
TFP 5 MG 14,00
3241 SUGENG KARYONO 201904001919 09/04/2019 IGD AQUA PRO INJEKSI 1,00 168.936
THD 2 MG 2,00
NEEDLE 23 G 1,00
HALOPERIDOL 5 MG 2,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
LORAZEPAM 2 MG 2,00
3242 SUNARI 201904004088 22/04/2019 Ruangan Gelatik TFP 5 MG 14,00 6.670
THD 2 MG 14,00
CPZ 100 MG 4,00
3243 SUNCONO 201904004097 22/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
3244 UMI ROSIDAH 201904001923 09/04/2019 Ruangan Wijaya RISPERIDONE 3 MG 4,00 6.818
THD 2 MG 4,00
CLOZAPINE 25 MG 2,00
3245 WAELLA SEPTAMARI 201904001905 09/04/2019 Poli Umum NEURODEK 10,00 4.800
3246 YUSUB GEBI 201904005729 29/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
Dokter: dr. NUGROHO E. BRODJONEGORO, Sp.KJ.,MARS
3247 A. SUBKHAN 201904000771 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 25.920
CPZ 100 MG 15,00
RISPERIDONE 3 MG 30,00
3248 ABD. ROZEK 201904002228 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
3249 ABDUL AMIN 201904005123 26/04/2019 Poli Psikiater RISPERIDONE 3 MG 120,00 198.420
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
3250 ABDUL AMSORI 201904002348 11/04/2019 Ruangan Gelatik RISPERIDONE 1 MG 30,00 21.635
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3250 ABDUL AMSORI 201904002348 11/04/2019 Ruangan
- Gelatik THD 2 MG 15,00 21.635
CLOZAPINE 25 MG 5,00
3251 ABDUL GANI 201904001794 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 37.605
TFP 5 MG 30,00
3252 ABDUL GONI 201904002694 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 68.235
CLOZAPINE 25 MG 15,00
3253 ABDUL HAKIM 201904001339 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 15.090
CPZ 100 MG 30,00
3254 ABDUL RASID 201904001057 05/04/2019 Poli Psikiater THD 2 MG 200,00 103.000
CPZ 100 MG 100,00
TFP 5 MG 200,00
3255 ABID YAFIA RASYID 201904004631 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 246.606
ABILIFY DISCMELT 15 5,00
KAPSUL NO.00 30,00
SERTRALINE 50 MG 15,00
RACIKAN KAPSUL 30,00
THD 2 MG 8,00
3256 ACH ARIS 201904004371 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3257 ACH. HENDRA 201904000072 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 638.715
SEROQUEL XR 300 30,00
CLOZAPINE 100 MG 15,00
3258 ACH. MUSYAFI 201904005357 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 115.530
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3259 ACH. ROESLAN RIEFAIE 201904001084 05/04/2019 Poli Psikiater RISPERIDONE 3 MG 20,00 33.070
THD 2 MG 10,00
CLOZAPINE 25 MG 10,00
3260 ACHMAD HENDRIK 201904002741 15/04/2019 Poli Jiwa Dewasa PHENYTOIN CAP 100 90,00 140.490
CARBAMAZEPINE 90,00
CLOBAZAM 10 MG 60,00
3261 ACMAT ROKMAN 201904002217 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3262 ADI WINARTO 201904001425 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3263 AFIFUDIN ALAMSYAH 201904004618 24/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 48.435
CLOBAZAM 10 MG 15,00
CLOZAPINE 25 MG 15,00
3264 AGUNG TIRTA WIJAYA 201904000791 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3265 AGUS KURNIAWAN 201904004659 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 115.530
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3266 AGUS MASLIKH 201904003887 22/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
3267 AGUS NURCAHYO 201904003766 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3268 AGUS PURWANTO 201904005431 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 100.515
RISPERIDONE 3 MG 60,00
3269 AGUS SUJARNO 201904005400 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 155.580
CLOZAPINE 100 MG 30,00
TFP 5 MG 90,00
3270 AGUS SUPARDI 201904002925 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.750
TFP 5 MG 30,00
3271 AGUS SURYANTO 201904002210 11/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 62.970
LORAZEPAM 2 MG 30,00
3272 AGUS WINARNO 201904001467 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3273 AGUSTINA 201904004688 24/04/2019 Ruangan CPZ 100 MG 3,00 4.790
TFP 5 MG 10,00
THD 2 MG 10,00
201904004998 25/04/2019 Ruangan THD 2 MG 2,00 850
TFP 5 MG 2,00
3274 AHMAD DJAJADI 201904005034 26/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 138.870
CLOBAZAM 10 MG 30,00
RACIKAN KAPSUL 60,00
KAPSUL NO.00 60,00
RISPERIDONE 3 MG 20,00
LORAZEPAM 2 MG 30,00
3275 AHMAD FAUZAN 201904001802 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 64.290
THD 2 MG 30,00
CPZ 100 MG 30,00
3276 AHMAD HUSEN ASHARI 201904004444 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
3277 AJAK / AJAI 201904002098 10/04/2019 Ruangan Gelatik TFP 5 MG 15,00 6.765
THD 2 MG 10,00
CPZ 100 MG 5,00
201904004565 23/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
3278 AKBAR SANTOSO 201904005579 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
3279 AKSANUL BAIHAQI 201904004401 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 34.170
RISPERIDONE 2 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3280 ALAM NUR FACHRUDIN 201904004811 25/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 199.110
CLOZAPINE 25 MG 30,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
RISPERIDONE 3 MG 20,00
CLOBAZAM 10 MG 45,00
KAPSUL NO.00 60,00
3281 ALFIYATUR ROCHMAH 201904001437 08/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 680.430
SEROQUEL XR 300 30,00
CLOZAPINE 25 MG 30,00
3282 ALI 201904005874 30/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 0.5 MG 30,00 15.465
AMITRIPTILIN 25 MG 30,00
TFP 5 MG 15,00
3283 ALI MASHURI 201904003524 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 104.580
FRIMANIA 200 MG 60,00
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3284 ALI MUHSIN 201904001706 08/04/2019 Ruangan Gelatik TFP 5 MG 21,00 27.077
AMITRIPTILIN 25 MG 14,00
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
3285 AMELINDA LESMANA 201904005856 30/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 60.480
THD 2 MG 30,00
3286 AMIRUDDIN 201904002508 12/04/2019 Poli Psikiater TFP 5 MG 60,00 22.440
THD 2 MG 30,00
3287 ANANDA FATIKAH 201904002219 11/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 35.580
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3288 ANAS ILHAM RAMADHAN 201904004629 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 55.920
CPZ 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
3289 ANDIK HARIANTO 201904002742 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 14.040
THD 2 MG 15,00
3290 ANDRI PURNOMO 201904003347 16/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 5,00 13.475
RISPERIDONE 2 MG 10,00
201904004095 22/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 18.865
CLOZAPINE 25 MG 7,00
201904004441 23/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 18.865
RISPERIDONE 2 MG 14,00
3291 ANDRY SETYO 201904002792 15/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 139.641
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3291 ANDRY SETYO 201904002792 15/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 139.641
SIKZONOATE 1,00
HALOPERIDOL 5 MG 60,00
3292 ANGGY SUGIHARTO 201904004656 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 59.700
TFP 5 MG 60,00
3293 ANIK SUSANTI 201904000058 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 15.450
CPZ 100 MG 15,00
TFP 5 MG 30,00
3294 ANIK WIWIN PURWATI 201904004808 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 210.420
OLANZPINE 10mg 30,00
3295 ANISAH 201904004821 25/04/2019 Poli Jiwa Dewasa SANDEPRIL 15,00 85.515
LORAZEPAM 2 MG 15,00
RISPERIDONE 2 MG 30,00
3296 ANTOK SUJARWO 201904001442 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 60.270
CLOZAPINE 25 MG 30,00
3297 ARDI NUGRAHANTO S 201904003207 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 90.675
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3298 ARDO DELTA 201904002445 12/04/2019 Poli Psikiater SIZORIL 25 MG 60,00 235.380
RISPERIDONE 2 MG 120,00
3299 ARI 201904006002 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
3300 ARIF RAHMAN 201904003470 18/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 187.380
DEPAKOTE 250 MG 60,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3301 ARIFIN 201904004611 24/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 236.040
CLOZAPINE 100 MG 30,00
PHENYTOIN CAP 100 90,00
3302 ARINA MANASIKANA 201904002211 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 335.895
DEPAKOTE ER 500 30,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3303 ARIP 201904000788 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3304 ARIYANTO MEYRLAN 201904003462 18/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 125.655
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
3305 ARNIA MARYANA 201904005574 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 118.590
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3306 ARSNALDIN 201904001474 08/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 389.160
OLANZPINE 10mg 30,00
DEPAKOTE ER 500 30,00
3307 ASTIYAH 201904003565 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3308 ATNAH 201904002222 11/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 42.420
THD 2 MG 30,00
CLOBAZAM 10 MG 30,00
3309 BAHRI 201904005386 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 80.490
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
3310 BAKTIAR ALAMSAH 201904003857 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3311 BAMBANG CAHYANTO 201904001565 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 92.340
CLOBAZAM 10 MG 30,00
3312 BAMBANG WAHYU 201904001446 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
3313 BAYU ALFA DIPUTRA 201904004419 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 22.200
RISPERIDONE 2 MG 30,00
3314 BENY ADAM 201904003894 22/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 67.770
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
3315 BERLIN SIMANGUNSONG 201904004625 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
3316 BILLY KUMALA 201904004388 23/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 595.620
SEROQUEL XR 300 30,00
3317 BINAWATI 201904005028 26/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 77.430
RISPERIDONE 1 MG 60,00
3318 BISU JIMY 201904005621 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
3319 BISU WAWAH 201904000241 01/04/2019 Ruangan CPZ 100 MG 4,00 6.670
TFP 5 MG 14,00
THD 2 MG 14,00
201904003370 16/04/2019 Ruangan TFP 5 MG 14,00 9.282
CPZ 100 MG 7,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 14,00
3320 BONNIE AMANTA 201904002703 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
3321 BRIAN RACHMANAJI 201904004421 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 70.830
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3322 BUDI SANTOSO 201904003219 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3322 BUDI SANTOSO 201904003219 16/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 30,00 40.425
3323 BUDIONO 201904000047 01/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 35.415
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
201904004814 25/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 68.580
CLOZAPINE 25 MG 30,00
TFP 5 MG 30,00
3324 BUNGA EVY INDRAWATI 201904005417 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 82.440
SERTRALINE 50 MG 30,00
3325 CAHYANINGWATI 201904003771 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 914.445
ABILIFY DISCMELT 10 30,00
CLOZAPINE 100 MG 15,00
3326 CANDRA TRI HASTANA 201904002863 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 27.915
3327 CHOIRUL ANAM 201904002693 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3328 CHRISTIAN KATIANDA 201904002710 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 15.450
CPZ 100 MG 15,00
TFP 5 MG 30,00
3329 CRISTIANA BORU 201904002785 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3330 DARTOK 201904005615 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
3331 DAVID GUNAWAN 201904005334 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 131.640
CLOZAPINE 100 MG 15,00
LORAZEPAM 2 MG 15,00
3332 DAYUKUSUMAHERAWATI 201904000677 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 46.080
RISPERIDONE 3 MG 60,00
THD 2 MG 30,00
3333 DEDI 201904000735 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
3334 DEMIN 201904005608 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3335 DENNY WILDAN QADAFI 201904001072 05/04/2019 Poli Psikiater THD 2 MG 20,00 13.565
CLOZAPINE 25 MG 5,00
HALOPERIDOL 1,5 30,00
201904002439 12/04/2019 Poli Psikiater RISPERIDONE 2 MG 15,00 14.329
KAPSUL NO 2 15,00
RACIKAN KAPSUL 15,00
CLOZAPINE 25 MG 4,00
201904005240 26/04/2019 Poli Psikiater RISPERIDONE 2 MG 30,00 12.510
3336 DENTRI AGENG 201904005865 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 97.740
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3336 DENTRI AGENG 201904005865 30/04/2019 Poli Jiwa- Dewasa SERTRALINE 50 MG 30,00 97.740
3337 DEWI AYU MAHARANI 201904001308 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
3338 DEWI SRI WULANDARI 201904005379 29/04/2019 Poli Jiwa Dewasa DIAZEPAM 5 MG 30,00 66.180
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3339 DHANIE RISWANDONO 201904005343 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 115.530
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
3340 DIAN 201904002067 10/04/2019 Ruangan Gelatik TFP 5 MG 5,00 2.155
CPZ 100 MG 3,00
3341 DIAN ANGGA PERMANA 201904004806 25/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 85.500
THD 2 MG 30,00
RISPERIDONE 2 MG 60,00
3342 DIAN BUDIARTI 201904001854 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 10.200
HALOPERIDOL 5 MG 30,00
THD 2 MG 30,00
3343 DIDIT ARIYANTO 201904005591 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 115.530
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3344 DINA FEBRIANTI 201904003463 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 46.080
THD 2 MG 30,00
CPZ 100 MG 15,00
3345 DINI HARIANI 201904004851 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 95.025
SERTRALINE 50 MG 30,00
TFP 5 MG 30,00
3346 DINING WAHYUNINGSIH 201904002774 15/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 138.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3347 DJOKO SUPRIJANTO, ST 201904005369 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3348 DJUNAIDI 201904005155 26/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 30,00 14.250
AMITRIPTILIN 25 MG 30,00
THD 2 MG 30,00
3349 DODI PRIAMBUDI 201904000035 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 55.320
HALOPERIDOL 5 MG 60,00
RISPERIDONE 3 MG 60,00
3350 DONO INDARTO 201904000452 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 97.845
RISPERIDONE 2 MG 30,00
SERTRALINE 50 MG 30,00
3351 DONY ANDRIAS 201904000668 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3352 DONY EKA KRISTIAWAN 201904004667 24/04/2019 Puri Mitra (Laki- RISPERIDONE 2 MG 10,00 13.985
THD 2 MG 5,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3352 DONY EKA KRISTIAWAN 201904004667 24/04/2019 Puri Mitra
- (Laki- CLOZAPINE 25 MG 5,00 13.985
3353 DRS. MOH. MOHDOR 201904000013 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3354 DWI AGUSTININGTYAS 201904003458 18/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 168.855
CLOZAPINE 25 MG 15,00
DEPAKOTE 250 MG 30,00
RISPERIDONE 3 MG 60,00
3355 DWI ISNAENI 201904003555 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
3356 DWI KARTINASARI 201904000459 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3357 DWI RACHMAD BASUKI 201904002901 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 100.230
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
3358 DWI ROMAWANTO 201904000025 01/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3359 DWI SETYA IRAWAN 201904002212 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 111.075
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
HALOPERIDOL 1,5 60,00
3360 EDY PRIYANTO 201904002020 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3361 EFI SETIJAWATI 201904002200 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 63.330
HALOPERIDOL 5 MG 30,00
THD 2 MG 30,00
3362 EKA DESI NURVANTI 201904002201 11/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 143.166
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 60,00
3363 EKO BUDI UTOMO 201904002213 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 124.440
HALOPERIDOL 1,5 90,00
THD 2 MG 60,00
3364 EKO PRASETYO BUDI 201904001099 05/04/2019 Poli Psikiater SPUIT 3 CC 1,00 110.751
THD 2 MG 60,00
CPZ 100 MG 60,00
SIKZONOATE 1,00
RISPERIDONE 2 MG 60,00
3365 EKO SISWAHYUDI 201904003906 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.990
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3365 EKO SISWAHYUDI 201904003906 22/04/2019 Poli Jiwa- Dewasa RISPERIDONE 3 MG 30,00 75.990
3366 EKO SUPRAYITNO 201904001455 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 573.570
THD 2 MG 60,00
DIAZEPAM 5 MG 30,00
SEROQUEL XR 300 30,00
3367 ELIN IKMALIA 201904001303 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 69.885
TFP 5 MG 30,00
3368 ELISA DELA ANJARSARI 201904005872 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 183.090
DEPAKOTE ER 250 30,00
CLOZAPINE 25 MG 30,00
3369 ELITA SUSANTI 201904000464 02/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 21.572
KAPSUL NO.00 30,00
SERTRALINE 50 MG 8,00
LORAZEPAM 2 MG 4,00
3370 ELVIANA 201904004999 25/04/2019 Ruangan TFP 5 MG 2,00 850
THD 2 MG 2,00
3371 ELY NURYANTI 201904000008 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 15.450
CPZ 100 MG 15,00
TFP 5 MG 30,00
3372 EMI WULANDARI 201904000817 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
3373 ENDAH KURNIAWATI 201904000707 04/04/2019 Poli Jiwa Dewasa KUTOIN 30,00 85.770
CLOZAPINE 25 MG 30,00
RISPERIDONE 1 MG 30,00
3374 EODEA BUDI SETIATI 201904004681 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 190.260
OLANZPINE 10mg 30,00
3375 ERICK CHRISTIAWAN 201904004394 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 20.160
3376 ERLANGGA 201904005618 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3377 ERLINA 201904001075 05/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
3378 ERNA BUDIANTI 201904005052 26/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 64.710
HALOPERIDOL 5 MG 60,00
3379 ERWAN TARUNA 201904005041 26/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 60,00 96.480
LORAZEPAM 2 MG 30,00
ELIZAC 20 MG 30,00
3380 ETTY WIDJAJATI 201904005873 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 115.530
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
3381 FAJAR ARDIANSYAH 201904004812 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3382 FARID MAKAMINAN 201904002028 10/04/2019 Poli Jiwa Dewasa NOPRES 20 MG 15,00 14.760
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3383 FARID SETYADI 201904002691 15/04/2019 Poli Jiwa- Dewasa RISPERIDONE 3 MG 60,00 139.350
DEPAKOTE 250 MG 30,00
CLOZAPINE 25 MG 30,00
3384 FATMAWATI 201904001321 08/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 63.330
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
3385 FENDI ACHMAD 201904001806 09/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 116.280
CLOBAZAM 10 MG 60,00
RISPERIDONE 3 MG 60,00
3386 FERRY IRAWAN 201904002707 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 68.220
DEPAKOTE 250 MG 30,00
3387 FIKROTUL AZIZAH 201904002773 15/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 522.300
HALOPERIDOL 5 MG 30,00
THD 2 MG 30,00
3388 FIRANI LAILIYAH 201904001334 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 538.200
3389 FIVI FAISAH 201904002885 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3390 FREDI 201904002920 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.080
CPZ 100 MG 15,00
3391 FRIDA SURYANI 201904000466 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 90,00 75.510
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3392 GATOT SANTOSO 201904003453 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 4.230
THD 2 MG 15,00
3393 H. MOHAMMAD DJONI 201904002442 12/04/2019 Poli Psikiater CLOBAZAM 10 MG 60,00 77.712
NOPRES 20 MG 8,00
3394 HADI SUROYO 201904001828 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3395 HADI WIJAYA SUTANTO 201904003526 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3396 HANDAYANI 201904005585 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3397 HANDONO KUSUMO 201904001380 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3398 HANDRI ARDIAN LIPUTO 201904003871 22/04/2019 Poli Psikiater TFP 5 MG 10,00 23.009
CLOZAPINE 100 MG 3,00
THD 2 MG 10,00
RISPERIDONE 3 MG 10,00
3399 HARI 201904001463 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 85.695
CLOZAPINE 100 MG 15,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3400 HARI WAHYUDI S 201904001087 05/04/2019 Poli Psikiater
- THD 2 MG 100,00 237.650
CLOZAPINE 25 MG 50,00
RISPERIDONE 3 MG 200,00
3401 HARIS LABA 201904005625 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
3402 HARIS M 201904005629 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3403 HARSO SENO 201904003752 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3404 HARTONO 201904000087 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
3405 HARY MUJI SANTOSO 201904000774 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
3406 HASAN 201904002240 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
3407 HENI PUSPITA SARI 201904002859 15/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 68.811
SIKZONOATE 1,00
3408 HENIK TA 201904000019 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3409 HENKY BUDIHARTO 201904002410 12/04/2019 Psiko Geriatri SEROQUEL XR 400 8,00 205.320
KAPSUL NO 2 60,00
RACIKAN KAPSUL 60,00
ALPRAZOLAM 1 MG 180,00
3410 HENNY ADITIANA 201904000734 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 707.160
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
SEROQUEL XR 400 30,00
3411 HENY PURWANINGSIH 201904002236 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 16.335
CPZ 100 MG 5,00
THD 2 MG 10,00
SERTRALINE 50 MG 5,00
3412 HERI DARIYANTO 201904001096 05/04/2019 Poli Psikiater THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3413 HERMAN SAFI'I 201904002402 12/04/2019 Poli Psikiater CPZ 100 MG 100,00 38.400
THD 2 MG 200,00
3414 HERMIN SRIATI 201904005326 29/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 142.676
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3415 HORRIJATUL FIKRIYAH 201904005044 26/04/2019 Psiko Geriatri
- SEROQUEL XR 300 30,00 552.225
LORAZEPAM 2 MG 15,00
3416 I MADE PARLEY 201904004863 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 55.710
DEPAKOTE 250 MG 30,00
3417 I'ANATUL MUALIMAH 201904004379 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 118.470
CLOZAPINE 25 MG 30,00
DEPAKOTE 250 MG 30,00
HALOPERIDOL 5 MG 90,00
3418 I'IL KHAIRUL ANSYAR 201904002031 10/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 172.386
CLOZAPINE 100 MG 15,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 60,00
SPUIT 3 CC 1,00
3419 INDAH WIDIASTUTI 201904003804 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3420 INDRA PRAMUDYA 201904003780 22/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 167.130
PHENYTOIN CAP 100 90,00
DEPAKOTE 250 MG 60,00
3421 INGGAWATI HANDJOJO 201904001117 05/04/2019 Psiko Geriatri THD 2 MG 60,00 65.820
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3422 INJA SARI 201904002692 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
3423 IRA APRIALA 201904004694 24/04/2019 Ruangan TFP 5 MG 15,00 6.765
THD 2 MG 10,00
CPZ 100 MG 5,00
201904005000 25/04/2019 Ruangan THD 2 MG 2,00 1.353
CPZ 100 MG 1,00
TFP 5 MG 3,00
3424 IRFAN 201904003909 22/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3425 IRWAN L. RAHIM 201904002898 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
3426 IRWAN DWI 201904002883 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 39.045
LORAZEPAM 2 MG 15,00
3427 IRWAN SYAFRANI 201904005329 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3428 ISANAH KHASANAH 201904001792 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
3429 ISDRAWATI 201904000040 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3430 ISMAIL KOLIL 201904001902 09/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
3431 ISNAWATI MUSAILINA 201904000701 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 539.820
SEROQUEL XR 200 30,00
3432 ISTIARINI 201904001078 05/04/2019 Psiko Geriatri THD 2 MG 30,00 62.760
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3433 JARMI 201904001049 05/04/2019 Psiko Geriatri CLOBAZAM 10 MG 15,00 30.810
ALPRAZOLAM 1 MG 30,00
KAPSUL NO.00 30,00
AMITRIPTILIN 25 MG 15,00
RACIKAN KAPSUL 30,00
ALPRAZOLAM 0.5 MG 15,00
3434 JAUHARI 201904003210 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 66.450
AMITRIPTILIN 25 MG 30,00
THD 2 MG 60,00
CLOBAZAM 10 MG 30,00
3435 JIMI 201904005924 30/04/2019 Ruangan Gelatik CPZ 100 MG 5,00 5.150
TFP 5 MG 10,00
THD 2 MG 10,00
3436 JOHANSYAH 201904001790 09/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 46.590
DIAZEPAM 5 MG 30,00
CARBAMAZEPINE 60,00
HALOPERIDOL 5 MG 60,00
CPZ 100 MG 60,00
3437 JOKO PRIONO 201904001815 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 40.590
TFP 5 MG 90,00
THD 2 MG 60,00
3438 JOKO SUNTORO 201904003808 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3439 JULSIE 201904004693 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 3,00 8.813
TFP 5 MG 10,00
3440 JUNAEDI MULYO 201904001799 09/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
3441 JUNAIDI 201904003452 18/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 34.920
3442 JUNAWATI 201904002409 12/04/2019 Ruangan Puri TFP 5 MG 21,00 103.881
FRIMANIA 400 MG 14,00
THD 2 MG 14,00
CLOZAPINE 100 MG 4,00
DEPAKOTE ER 500 7,00
3443 KAMALI 201904005079 26/04/2019 Psiko Geriatri KAPSUL NO.00 30,00 14.115
THD 2 MG 15,00
CPZ 100 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3443 KAMALI 201904005079 26/04/2019 Psiko Geriatri
- RACIKAN KAPSUL 30,00 14.115
FOLIC ACID 1 MG 30,00
TFP 5 MG 15,00
3444 KARINA ARIEF PUTRI 201904002237 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 100.515
CLOZAPINE 100 MG 15,00
3445 KARNO 201904005624 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3446 KARTIKA CAHYANI 201904004619 24/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 68.214
SERTRALINE 50 MG 15,00
KAPSUL NO.00 30,00
ALPRAZOLAM 1 MG 12,00
RACIKAN KAPSUL 30,00
3447 KASIAMAH 201904005066 26/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 53.935
VIT B COMPLEX 10,00
CLOZAPINE 25 MG 15,00
3448 KASIANI 201904000347 01/04/2019 Ruangan Gelatik TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
3449 KASIAT 201904005968 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.140
THD 2 MG 30,00
CPZ 100 MG 15,00
3450 KASRORI KHAYARUN M 201904002708 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3451 KASTIMIN 201904003861 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
3452 KENSIWI NARASWATI 201904002770 15/04/2019 Poli Jiwa Dewasa THD 2 MG 10,00 6.765
CPZ 100 MG 5,00
TFP 5 MG 15,00
201904003375 16/04/2019 Ruangan THD 2 MG 4,00 2.060
CPZ 100 MG 2,00
TFP 5 MG 4,00
3453 KHOIRUL YANTINI 201904000062 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
3454 KHOIRUR ROSYID 201904003829 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 67.770
HALOPERIDOL 5 MG 60,00
THD 2 MG 30,00
3455 KHUSNUL ARIF 201904000060 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 115.530
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
3456 KO MAI LIE 201904001800 09/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3457 KRISTIN 201904003237 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 63.600
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3457 KRISTIN 201904003237 16/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 63.600
DEPAKOTE 250 MG 30,00
HALOPERIDOL 5 MG 60,00
3458 KUSNUL KHOTIMAH 201904002448 12/04/2019 Poli Psikiater THD 2 MG 200,00 103.000
CPZ 100 MG 100,00
TFP 5 MG 200,00
3459 KUSTYOWATI 201904002390 12/04/2019 Psiko Geriatri CPZ 100 MG 50,00 77.300
RISPERIDONE 1 MG 100,00
TFP 5 MG 100,00
3460 L. SUGENG HERMANTO 201904005857 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 75.990
CLOZAPINE 25 MG 30,00
3461 LAILY NOVITA / LELY 201904001784 09/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 94.680
CARBAMAZEPINE 90,00
3462 LAMADIN 201904000034 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 118.590
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 30,00
3463 LESTARI 201904001388 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 30.780
THD 2 MG 30,00
CPZ 100 MG 15,00
3464 LIENNIWATI 201904005935 30/04/2019 Poli Psikiater THD 2 MG 60,00 40.590
CPZ 100 MG 30,00
TFP 5 MG 90,00
3465 LILIK HAMIDAH 201904001396 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3466 LILIK ROSIDAH 201904001047 05/04/2019 Psiko Geriatri RISPERIDONE 1 MG 30,00 38.715
CLOZAPINE 25 MG 15,00
3467 LILINCE PANGGABEAN 201904005082 26/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 30,00 90.630
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
3468 LINA FADILAH FIRDAUSA 201904002796 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 138.270
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
3469 LINDA DEWI 201904002413 12/04/2019 Psiko Geriatri HALOPERIDOL 1,5 300,00 22.200
3470 LUDIA 201904000242 01/04/2019 Ruangan THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
3471 LUKMAN 201904001837 09/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 93.900
CLOBAZAM 10 MG 60,00
HALOPERIDOL 1,5 60,00
CARBAMAZEPINE 60,00
3472 LUKMAN HARUN 201904002206 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 115.530
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3472 LUKMAN HARUN 201904002206 11/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 115.530
3473 M FAHMI 201904000782 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3474 M NUR AZIZI AL FADHLI 201904003899 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
3475 M. AFIFUDIN 201904002754 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 873.870
RISPERIDONE 2 MG 30,00
ABILIFY DISCMELT 10 30,00
TFP 5 MG 90,00
3476 M. CHOIRUL ANAM 201904002205 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3477 M. KHARIRI 201904003507 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 30.780
THD 2 MG 30,00
CPZ 100 MG 15,00
3478 M. MUJAHIDIN 201904004855 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
3479 M. SAHRI 201904002014 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3480 M.MUKSON 201904001349 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 74.355
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
3481 M.SUBAGI 201904003753 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 65.520
CLOZAPINE 25 MG 30,00
3482 MAMI ULFA 201904002892 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 95.385
CLOZAPINE 100 MG 15,00
TFP 5 MG 90,00
3483 MARATUS SOLICHAH 201904003877 22/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 537.240
TFP 5 MG 60,00
THD 2 MG 30,00
3484 MARES SUBAGIO 201904000030 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 43.380
RISPERIDONE 3 MG 60,00
3485 MARHAWI, MM. 201904002025 10/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3486 MARIAH 201904005114 26/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 67.770
HALOPERIDOL 5 MG 60,00
THD 2 MG 30,00
3487 MARIANAH 201904002244 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 246.405
CLOZAPINE 100 MG 45,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3488 MARK CONGER 201904002295 11/04/2019 Poli Psikiater SERTRALINE 50 MG 10,00 95.620
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3488 MARK CONGER 201904002295 11/04/2019 Poli Psikiater
- ALPRAZOLAM 1 MG 100,00 95.620
CLONAZEPAM 2 MG 10,00
3489 MARTEN ELLISA FENAN 201904003866 22/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 39.135
CLOZAPINE 25 MG 15,00
TFP 5 MG 30,00
3490 MASHAR 201904005984 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 40.590
CPZ 100 MG 30,00
TFP 5 MG 90,00
3491 MASRUH 201904005405 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3492 MAT 201904005613 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3493 MAT HOSEN 201904005136 26/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3494 MAT IMANUALIM 201904000081 01/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 97.740
RISPERIDONE 3 MG 60,00
3495 MAWADDAH ASSOLIHA 201904002029 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
3496 MELANI SUNTORO 201904001336 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 138.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3497 MIFTAHUL HUDA 201904004832 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3498 MIFTAKHUL FAIZIN 201904002701 15/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 886.650
ABILIFY DISCMELT 10 30,00
3499 MINARTI 201904001326 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 119.895
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3500 MINTO 201904002874 15/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 15.862
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
AMITRIPTILIN 25 MG 14,00
TFP 5 MG 14,00
3501 MISWANTO 201904000690 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3502 MOCH FARUK 201904001330 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3503 MOCH HENDRA 201904002699 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 402.210
DEPAKOTE ER 500 30,00
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3503 MOCH HENDRA 201904002699 15/04/2019 Poli Jiwa- Dewasa CLOZAPINE 100 MG 30,00 402.210
THD 2 MG 60,00
3504 MOCH KHOIFULLAH 201904002858 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 10.800
3505 MOCH PAUSI 201904000467 02/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 15,00 39.045
RISPERIDONE 2 MG 60,00
3506 MOCH WAHIB 201904005127 26/04/2019 Poli Psikiater TFP 5 MG 90,00 40.590
THD 2 MG 60,00
CPZ 100 MG 30,00
3507 MOCH. ARIEF 201904005056 26/04/2019 Poli Psikiater THD 2 MG 100,00 34.000
CPZ 100 MG 50,00
HALOPERIDOL 5 MG 100,00
3508 MOCH. ARIFIN 201904001626 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
3509 MOCH. ERIDONI 201904001817 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
3510 MOCH. FADLI 201904004862 25/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 9.471
TFP 5 MG 21,00
THD 2 MG 14,00
3511 MOCH. FAUZI 201904001297 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
3512 MOCH. IRFAN SURINDRO 201904000049 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3513 MOCH. SAHADI 201904003217 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
3514 MOCH. SYUKUR 201904003466 18/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 30.780
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3515 MOCH.TOYIB 201904002895 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 118.590
CLOZAPINE 25 MG 30,00
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
3516 MOCHAMAD JUSUF 201904004396 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3517 MOCHAMAD MANSUR , 201904001354 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 79.635
HALOPERIDOL 5 MG 90,00
THD 2 MG 60,00
3518 MOCHAMMAD NUR 201904002729 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 126.660
CLOZAPINE 25 MG 60,00
HALOPERIDOL 5 MG 60,00
3519 MOH ROSID 201904001296 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3519 MOH ROSID 201904001296 08/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 15,00 37.605
3520 MOH TOLIB 201904005560 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3521 MOH. ASIPUDIN 201904000325 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 18.263
THD 2 MG 7,00
CLOZAPINE 25 MG 7,00
3522 MOH. WAHYUDI 201904005885 30/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3523 MOKH SOKHIFU 201904001556 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 68.160
CPZ 100 MG 30,00
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
3524 MOKH. ROHIM 201904002928 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 111.660
3525 MOKH. SAINI 201904002472 12/04/2019 Poli Psikiater TFP 5 MG 90,00 40.590
THD 2 MG 60,00
CPZ 100 MG 30,00
3526 MR. X (SYAIFUL ARIF) 201904000326 01/04/2019 Ruangan Kenari TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
3527 MUDRIKAH 201904001353 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 110.355
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 15,00
3528 MUHAMAD SUKIR 201904001340 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 37.605
TFP 5 MG 30,00
3529 MUHAMMAD RUSLI 201904005418 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 111.420
DEPAKOTE 250 MG 60,00
3530 MUJIANTO 201904004834 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 52.860
CPZ 100 MG 30,00
THD 2 MG 30,00
RISPERIDONE 2 MG 60,00
3531 MUJIATI 201904001313 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 309.420
SEROQUEL XR 300 15,00
3532 MUKLIS 201904005622 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 50.490
LORAZEPAM 2 MG 30,00
TFP 5 MG 60,00
3533 MULYONO 201904004375 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.420
RISPERIDONE 2 MG 60,00
3534 MUNTARI 201904005069 26/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3535 MURDJIATI 201904005172 26/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 55.995
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
3536 MUSRIKAH 201904004815 25/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 15,00 442.530
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3536 MUSRIKAH 201904004815 25/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 15,00 442.530
3537 MUSRIN 201904005967 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3538 MUSTABA 201904005554 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 63.255
THD 2 MG 30,00
3539 MUTMAINAH 201904002839 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3540 MUZZAYIN AL SAYIN 201904005339 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3541 NANAK 201904005611 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3542 NANIK SUHARTINI 201904001373 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 33.480
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
3543 NASRUDIN / ALIMAN 201904001081 05/04/2019 Poli Psikiater THD 2 MG 200,00 94.000
CPZ 100 MG 50,00
TFP 5 MG 200,00
3544 NASRUL FA'AT 201904005397 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3545 NOER ASIJAH 201904004381 23/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 0.5 MG 30,00 62.010
SERTRALINE 50 MG 30,00
3546 NOERSIADI 201904002231 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 74.355
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
3547 NONO ADHI TOMO 201904004837 25/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3548 NOORMA NAVIAINI 201904002697 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
3549 NOVI DJATMIKO 201904004809 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
3550 NOVITA AYU MELANIA 201904002207 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 63.360
DEPAKOTE 250 MG 30,00
3551 NUNUK HANDAYANI 201904000808 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 675.300
THD 2 MG 60,00
CPZ 100 MG 30,00
SEROQUEL XR 400 30,00
3552 NUR NAFIAH 201904000463 02/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 8,00 112.628
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
3553 NUR FADILAH 201904002711 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3553 NUR FADILAH 201904002711 15/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 30,00 30.900
3554 NUR SUHADI 201904001405 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 91.335
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
3555 NUR WAHIDA MURTI 201904002199 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 15,00 10.080
3556 NUR WINDYAH HASAN 201904004848 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
3557 NURFARIDA 201904001319 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
3558 NURIS NUR AFIYAH 201904000212 01/04/2019 Ruangan RISPERIDONE 2 MG 14,00 27.126
TFP 5 MG 14,00
CLOZAPINE 100 MG 4,00
THD 2 MG 7,00
201904002149 10/04/2019 Ruangan TFP 5 MG 14,00 24.101
CLOZAPINE 25 MG 7,00
THD 2 MG 7,00
RISPERIDONE 2 MG 14,00
3559 NURKHOLIS 201904001061 05/04/2019 Poli Psikiater THD 2 MG 100,00 42.500
TFP 5 MG 100,00
3560 NURUL 201904004691 24/04/2019 Ruangan TFP 5 MG 10,00 4.790
THD 2 MG 10,00
CPZ 100 MG 3,00
201904005001 25/04/2019 Ruangan TFP 5 MG 2,00 850
THD 2 MG 2,00
3561 NURUL HUDA 201904004616 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 33.480
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3562 NURUL ISNAENI 201904000485 02/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 60,00 43.050
ALPRAZOLAM 1 MG 15,00
RISPERIDONE 3 MG 10,00
KAPSUL NO.00 60,00
SERTRALINE 50 MG 15,00
3563 NURUL LAILI AZIZAH 201904000663 04/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 85.335
CLOZAPINE 25 MG 15,00
3564 NYONO 201904000453 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 75.195
CLOZAPINE 100 MG 15,00
HALOPERIDOL 5 MG 60,00
3565 OENIK TRI ADJENG 201904002715 15/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3566 OKI ADI K 201904005090 26/04/2019 Poli Psikiater RISPERIDONE 3 MG 15,00 95.309
SPUIT 3 CC 1,00
THD 2 MG 15,00
CLOZAPINE 25 MG 8,00
SIKZONOATE 1,00
3567 OKI SUPRIYADI 201904003815 22/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 11.220
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3567 OKI SUPRIYADI 201904003815 22/04/2019 Poli Jiwa- Dewasa THD 2 MG 15,00 11.220
3568 OLIVIA MUKTI 201904001824 09/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 118.590
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
3569 ORNANDO GUNAWAN 201904000448 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 367.530
CLOZAPINE 100 MG 30,00
DEPAKOTE ER 500 30,00
RISPERIDONE 2 MG 60,00
3570 PEGY HADI ROHANI 201904004825 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
3571 PIPIT RIYANI 201904002215 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 78.270
TFP 5 MG 60,00
THD 2 MG 30,00
3572 PONCO KUSUMO 201904000079 01/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 63.330
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
3573 PRANOVIANTI., S.SOS 201904005349 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 60,00 756.060
SEROQUEL XR 400 30,00
3574 PRIYANTO 201904000038 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
3575 PUSPAWATI 201904000785 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3576 PUTRI 201904000090 01/04/2019 Poli Jiwa Dewasa FRIMANIA 200 MG 60,00 90.480
TFP 5 MG 60,00
3577 PUTUT WIJISONO 201904001419 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 104.595
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
3578 RACHMAT FAISAL ALFAN 201904001399 08/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 29.250
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
3579 RAHMAD HATI 201904000328 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 20.608
CPZ 100 MG 7,00
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
3580 RAHMAD KURNIAWAN 201904000018 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
3581 RAHMAD SULISTIANTO 201904001138 05/04/2019 Poli Psikiater TFP 5 MG 30,00 78.501
SIKZONOATE 1,00
SPUIT 3 CC 1,00
3582 RAHMATULLOH ANDRIAN 201904004807 25/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 35.415
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3582 RAHMATULLOH ANDRIAN 201904004807 25/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 15,00 35.415
3583 RASIDI 201904005038 26/04/2019 Psiko Geriatri THD 2 MG 15,00 77.520
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 30,00
3584 REDA DWI ERLANGGA 201904002022 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 62.760
THD 2 MG 30,00
RISPERIDONE 3 MG 60,00
3585 REFFY 201904001121 05/04/2019 Poli Psikiater RISPERIDONE 3 MG 200,00 340.900
THD 2 MG 200,00
CLOZAPINE 25 MG 100,00
3586 RENDHA PRAHASTAMA 201904000458 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 119.955
HALOPERIDOL 5 MG 90,00
RISPERIDONE 3 MG 60,00
CLOZAPINE 100 MG 15,00
3587 RENGGA ADITIYA 201904005423 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
3588 RESOPIN 201904004427 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3589 RETNO WAHYUNING 201904001314 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 84.420
DEPAKOTE 250 MG 30,00
RISPERIDONE 2 MG 30,00
3590 REZHA AINURROHMAN 201904001554 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 97.740
SERTRALINE 50 MG 30,00
3591 RHEZA HAFIZH 201904004612 24/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 30,00 118.410
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3592 RIAN ANDRE PARULIAN 201904004646 24/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 1 MG 30,00 122.520
SERTRALINE 50 MG 30,00
CLOBAZAM 10 MG 30,00
RISPERIDONE 2 MG 60,00
3593 RINDRA SULISTYAWAN 201904001316 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
3594 RIRIK THREE 201904001791 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 12.750
THD 2 MG 30,00
3595 RIRIS PUSPITA KASIH 201904000075 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 697.335
SEROQUEL XR 400 30,00
CLOZAPINE 25 MG 15,00
3596 RISKY FEBRIANTO 201904001318 08/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 135.690
SERTRALINE 50 MG 30,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3597 RISMAWAN CANDRA 201904002780 15/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 111.726
CLOZAPINE 25 MG 15,00
SIKZONOATE 1,00
HALOPERIDOL 5 MG 60,00
SPUIT 3 CC 1,00
3598 ROBIN YANUARKO 201904002722 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 208.641
CLOZAPINE 100 MG 30,00
SIKZONOATE 1,00
HALOPERIDOL 5 MG 90,00
SPUIT 3 CC 1,00
3599 ROHANI 201904005002 25/04/2019 Ruangan RISPERIDONE 3 MG 2,00 1.446
THD 2 MG 1,00
3600 ROHMAN 201904006003 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3601 ROOSDIANSYAH PRIBADI 201904000790 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3602 RORI AGUS SETIAWAN 201904005325 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
3603 ROSIHAN AMARUDIN 201904001383 08/04/2019 Ruangan Puri CLOZAPINE 25 MG 4,00 16.852
RISPERIDONE 3 MG 14,00
3604 RUHAMAAU 201904005858 30/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 101.310
RISPERIDONE 3 MG 60,00
ALPRAZOLAM 1 MG 30,00
3605 RUSIYAH 201904001795 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3606 SABAR 201904006025 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 27.720
CPZ 100 MG 15,00
3607 SAFI'I 201904005128 26/04/2019 Psiko Geriatri ARICEPT 10 MG 30,00 498.465
KAPSUL NO.00 60,00
RISPERIDONE 3 MG 40,00
LORAZEPAM 2 MG 15,00
THD 2 MG 30,00
RACIKAN KAPSUL 60,00
3608 SAIFUDIN 201904002247 11/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 66.390
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3609 SAMANI 201904002911 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3610 SAMIATI 201904000006 01/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 7.500
THD 2 MG 30,00
3611 SAMSUL ANAM 201904000783 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3612 SAMSUL ARIFIN 201904002395 12/04/2019 Poli Psikiater THD 2 MG 30,00 79.860
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3612 SAMSUL ARIFIN 201904002395 12/04/2019 Poli Psikiater
- SERTRALINE 50 MG 30,00 79.860
TFP 5 MG 60,00
201904002916 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 30.420
CPZ 100 MG 30,00
3613 SAMSUL MUARIP 201904003545 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 151.446
SPUIT 3 CC 1,00
THD 2 MG 30,00
CLOZAPINE 100 MG 15,00
SIKZONOATE 1,00
3614 SANDRA YUNITA 201904005324 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 28.710
3615 SATINGEN 201904001074 05/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
3616 SAUT NAIBAHO 201904004622 24/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
3617 SETIONO 201904005371 29/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 167.606
SIKZONOATE 1,00
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3618 SHODIKUN ADIM 201904000009 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 33.480
CPZ 100 MG 30,00
RISPERIDONE 2 MG 60,00
3619 SIGIT WARDANA 201904001083 05/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 88.275
THD 2 MG 30,00
CLOZAPINE 100 MG 15,00
3620 SINAR BUDIARSO 201904005868 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 15.450
THD 2 MG 30,00
CPZ 100 MG 15,00
3621 SISWADI 201904005394 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 50.355
TFP 5 MG 60,00
THD 2 MG 30,00
3622 SISWANTO 201904004406 23/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 67.770
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
3623 SITI MUARIFAH 201904002197 11/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 13.920
CPZ 100 MG 15,00
TFP 5 MG 30,00
3624 SITI AISAH 201904002202 11/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 247.680
CLONAZEPAM 2 MG 30,00
3625 SITI MASITOH 201904001328 08/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 41.220
RISPERIDONE 2 MG 30,00
3626 SITI MUNAWAROH 201904000828 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 90.750
CLOBAZAM 10 MG 30,00
3627 SITI ROHMAH 201904005117 26/04/2019 Poli Psikiater RACIKAN KAPSUL 90,00 322.595
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3627 SITI ROHMAH 201904005117 26/04/2019 Poli Psikiater
- THD 2 MG 68,00 322.595
HALDOL DECANOAS 2,00
RISPERIDONE 3 MG 90,00
KAPSUL NO 2 90,00
TFP 5 MG 9,00
SPUIT 3 CC 2,00
3628 SLAMET KARJADI 201904003754 22/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3629 SOFYAN BAGUS 201904002705 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
3630 SONNY WAKARY, TJIA 201904003759 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 76.860
THD 2 MG 60,00
HALOPERIDOL 5 MG 90,00
3631 SONO 201904000678 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 8.460
THD 2 MG 30,00
3632 SRI HARTATIK 201904000447 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3633 SRI HARTININGDYAH 201904004395 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3634 SRI SUHARLIN 201904002736 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
3635 SRIAMAH 201904001216 05/04/2019 Poli Jiwa Lansia THD 2 MG 30,00 57.885
CLOZAPINE 25 MG 15,00
NEURODEK 30,00
RISPERIDONE 2 MG 30,00
3636 SUBEKI 201904000730 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
3637 SUBIANTO TEGUH 201904000042 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
3638 SUCAHYO 201904002734 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
3639 SUCI ANGGRAINI 201904004475 23/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 97.740
SERTRALINE 50 MG 30,00
3640 SUGIANTO 201904002926 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.300
CPZ 100 MG 60,00
TFP 5 MG 60,00
3641 SUGIHARTO 201904004682 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 75.990
CLOZAPINE 25 MG 30,00
3642 SUGIYANTORO 201904004823 25/04/2019 Poli Jiwa Dewasa HALDOL DECANOAS 1,00 187.576
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 30,00
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3642 SUGIYANTORO 201904004823 25/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 187.576
3643 SUHARTONO 201904003454 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 20.400
CPZ 100 MG 30,00
HALOPERIDOL 5 MG 60,00
3644 SUHUT RAL NADAEK 201904005408 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 113.250
CLOZAPINE 25 MG 30,00
3645 SUJITO 201904003850 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 22.440
TFP 5 MG 60,00
3646 SUKAENI 201904003455 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 106.350
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
3647 SUKARLAN 201904001409 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3648 SUKIYAT 201904000067 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 18.150
THD 2 MG 30,00
CPZ 100 MG 30,00
3649 SUKMA YATI 201904002245 11/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
3650 SULAKSA GUMILAR 201904002746 15/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 50.355
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
3651 SULIHAN 201904002923 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3652 SUMADIONO 201904005854 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
3653 SUMANING 201904005328 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 153.570
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
3654 SUMARNI 201904000262 01/04/2019 Ruangan THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
3655 SUMIATUN 201904002757 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3656 SUNAH / LIFA 201904005399 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3657 SUNARDI 201904005620 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 145.410
CLOZAPINE 100 MG 30,00
3658 SUNARMIATIK 201904000681 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 123.480
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3658 SUNARMIATIK 201904000681 04/04/2019 Poli Jiwa- Dewasa CLOBAZAM 10 MG 30,00 123.480
3659 SUNCONO 201904002877 15/04/2019 Ruangan Wijaya THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
3660 SUNOTO 201904002404 12/04/2019 Poli Psikiater HALOPERIDOL 5 MG 50,00 21.500
THD 2 MG 50,00
CPZ 100 MG 50,00
3661 SUPARNO 201904000709 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.990
RISPERIDONE 3 MG 30,00
201904005060 26/04/2019 Psiko Geriatri THD 2 MG 30,00 28.470
AMITRIPTILIN 25 MG 30,00
TFP 5 MG 60,00
3662 SUPENAN 201904006005 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
3663 SUPRAPTI 201904000689 04/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 108.120
KUTOIN 60,00
3664 SUPRIJONO, SE 201904004852 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3665 SURATI 201904005389 29/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 110.355
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
3666 SURIP 201904005057 26/04/2019 Poli Gigi (Jiwa) THD 2 MG 7,00 17.566
CLOZAPINE 25 MG 4,00
RISPERIDONE 3 MG 14,00
3667 SUROTO 201904002696 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 67.770
HALOPERIDOL 5 MG 60,00
THD 2 MG 30,00
3668 SURYANTI 201904004372 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
3669 SUTIKNADI 201904001146 05/04/2019 Psiko Geriatri THD 2 MG 30,00 43.485
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
3670 SUTRISNO 201904001831 09/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
3671 SUWANDI 201904001335 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 53.415
TFP 5 MG 60,00
THD 2 MG 60,00
3672 SWANDARU HARTANTO 201904000717 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 115.530
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3673 SYAIFUDIN 201904000077 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3673 SYAIFUDIN 201904000077 01/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 60,00 52.935
3674 SYAMSUL ARIFIN 201904000449 02/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 78.270
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
3675 SYAMSUL HIDAYATUL 201904004805 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
3676 TARI CIPTOWATI 201904000746 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 189.435
CLONAZEPAM 2 MG 15,00
CLOZAPINE 100 MG 15,00
3677 TEGUH TRIYANTOBUDI 201904001369 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 68.235
RISPERIDONE 3 MG 60,00
3678 THOLIB 201904000514 02/04/2019 Ruangan Wijaya CPZ 100 MG 10,00 5.040
HALOPERIDOL 5 MG 15,00
THD 2 MG 10,00
201904001709 08/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 11.634
THD 2 MG 14,00
HALOPERIDOL 5 MG 21,00
RISPERIDONE 2 MG 14,00
201904004840 25/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 11.634
CPZ 100 MG 7,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 21,00
3679 TITIK ENDAYANI 201904004614 24/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3680 TITO YANSON BABOE 201904001064 05/04/2019 Psiko Geriatri KAPSUL NO.00 60,00 52.515
THD 2 MG 60,00
RACIKAN KAPSUL 60,00
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 20,00
3681 TONI 201904004624 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 857.145
ABILIFY DISCMELT 10 30,00
3682 TOTOK SUHENDRO 201904002234 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 149.661
RISPERIDONE 2 MG 60,00
SPUIT 3 CC 1,00
SIKZONOATE 1,00
3683 TRINA ASTUTI YULIANI 201904003795 22/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 15,00 257.400
3684 TRIYONO 201904000479 02/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 578.520
RISPERIDONE 3 MG 60,00
3685 TUNAS HARIYANTO 201904002016 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 189.480
OLANZPINE 10mg 30,00
3686 TUSINI 201904005347 29/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 8,00 103.630
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3686 TUSINI 201904005347 29/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 103.630
3687 TUTI HANDAYANI 201904005383 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 99.210
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
3688 TUTIK MUDJIWATI 201904000056 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 106.635
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
3689 UDIK PARSIYONO 201904002725 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
3690 UJANG PAMUNGKAS 201904004374 23/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 100.800
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 30,00
3691 UJANG TUA 201904005979 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3692 UMAR FARUK 201904000082 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 90,00 40.590
THD 2 MG 60,00
CPZ 100 MG 30,00
3693 UMAR HADI WIJAYA 201904004386 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 30.780
THD 2 MG 30,00
CPZ 100 MG 15,00
3694 UMI FAUZIYAH 201904001782 09/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 74.880
CLOBAZAM 10 MG 15,00
3695 UMI KOMARIYAH 201904004404 23/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 102.356
SIKZONOATE 1,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
3696 USMAN 201904002888 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 103.575
RISPERIDONE 3 MG 60,00
THD 2 MG 30,00
3697 WAHAB ALMANAF 201904000683 04/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 889.425
CLOZAPINE 100 MG 15,00
3698 WAHYUDI EKO SANTOSO 201904002203 11/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 67.695
THD 2 MG 30,00
CLOZAPINE 100 MG 15,00
3699 WAHYUDI TEJOMOYO 201904005866 30/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 127.286
SPUIT 3 CC 1,00
CLOZAPINE 25 MG 30,00
3700 WALUYO 201904001342 08/04/2019 Poli Jiwa Dewasa VIT B6 10 MG 30,00 349.710
OLANZPINE 10mg 30,00
CLONAZEPAM 2 MG 30,00
3701 WANDI 201904001631 08/04/2019 Ruangan Kenari THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3702 WARSO 201904005606 29/04/2019 Poli Jiwa- Dewasa TFP 5 MG 30,00 12.750
THD 2 MG 30,00
3703 WARYANTO 201904001783 09/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
3704 WAWAN KURNIAWAN 201904003228 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 85.215
RISPERIDONE 2 MG 60,00
3705 WIDYO PRATIKNYO 201904001847 09/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 572.220
SERTRALINE 50 MG 30,00
3706 WILDAN MAHARILLAH 201904002695 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 103.290
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 30,00
3707 WINARTI 201904002486 12/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 150.270
SIZORIL 25 MG 30,00
THD 2 MG 30,00
NOPRES 20 MG 30,00
3708 WIWIK TRISNOWATI 201904000114 01/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 45.255
KAPSUL NO.00 30,00
SERTRALINE 50 MG 15,00
LORAZEPAM 2 MG 15,00
3709 YUDHI WIDARTO 201904005353 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 63.330
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 30,00
3710 YUDI HERU 201904005617 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
3711 YULI PURWANTO 201904001732 08/04/2019 Poli Psikiater SIZORIL 100 MG 10,00 211.580
TFP 5 MG 60,00
THD 2 MG 40,00
3712 YUNIAR 201904002196 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 122.955
TFP 5 MG 60,00
CLOZAPINE 100 MG 15,00
THD 2 MG 30,00
3713 YUYUN 201904000046 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.020
CLOZAPINE 25 MG 30,00
TFP 5 MG 90,00
3714 ZAINIYAH 201904004615 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 124.391
SPUIT 3 CC 1,00
SIKZONOATE 1,00
CLOZAPINE 25 MG 15,00
3715 ZAKARIA 201904003843 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 10.800
Dokter: dr. PERMATA PENALAR
3716 AANG ISKANDAR 201904005882 30/04/2019 IGD RISPERIDONE 2 MG 6,00 19.048
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3716 AANG ISKANDAR 201904005882 30/04/2019 IGD
- SPUIT 3 CC 1,00 19.048
THD 2 MG 6,00
CLOZAPINE 25 MG 6,00
DIAZEPAM inj 1,00
3717 ABDUL ROHMAN 201904000281 01/04/2019 Ruangan Kenari THD 2 MG 14,00 10.731
CPZ 100 MG 14,00
TFP 5 MG 21,00
3718 ANAS ILHAM RAMADHAN 201904000309 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 9.730
THD 2 MG 14,00
CPZ 100 MG 21,00
3719 ASRORI 201904000279 01/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
3720 DEDIK SUPRIYADI 201904000293 01/04/2019 Ruangan Kenari CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
3721 DJONI KARTOLO 201904000289 01/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 18.280
THD 2 MG 14,00
CLOZAPINE 25 MG 4,00
201904001613 08/04/2019 Ruangan Kenari THD 2 MG 14,00 14.710
CLOZAPINE 25 MG 4,00
RISPERIDONE 2 MG 14,00
3722 HANDONO KUSUMO 201904000023 01/04/2019 Ruangan Kenari SIKZONOATE 1,00 98.000
SPUIT 3 CC 1,00
THD 2 MG 15,00
CLOZAPINE 100 MG 4,00
NEW DIATAB 8,00
RISPERIDONE 2 MG 15,00
3723 MAT MADURA 201904001615 08/04/2019 Ruangan Kenari RISPERIDONE 1 MG 14,00 33.131
CLOZAPINE 100 MG 7,00
3724 MOCH LUTFI 201904000282 01/04/2019 Ruangan Kenari THD 2 MG 7,00 3.506
CPZ 100 MG 4,00
HALOPERIDOL 5 MG 14,00
3725 MOCH. ARIFIN 201904000303 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.210
THD 2 MG 14,00
CPZ 100 MG 7,00
3726 MUNAWAN 201904000288 01/04/2019 Ruangan Kenari CLOZAPINE 100 MG 7,00 228.844
ABILIFY DISCMELT 10 7,00
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
201904001619 08/04/2019 Ruangan Kenari ABILIFY DISCMELT 10 7,00 227.416
CLOZAPINE 100 MG 7,00
RISPERIDONE 2 MG 14,00
3727 NGATIMEN 201904000310 01/04/2019 Ruangan Kenari CLOZAPINE 100 MG 4,00 23.318
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3727 NGATIMEN 201904000310 01/04/2019 Ruangan
- Kenari RISPERIDONE 2 MG 14,00 23.318
THD 2 MG 14,00
3728 OKI SUHERMAN YANTO 201904000286 01/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 38.927
THD 2 MG 14,00
CLOZAPINE 100 MG 7,00
3729 R.DWI AGUNG 201904004365 23/04/2019 Ruang Observasi CLOZAPINE 25 MG 2,00 4.556
RISPERIDONE 2 MG 2,00
3730 RAHMAD HATI 201904001595 08/04/2019 Ruangan Kenari SERTRALINE 50 MG 7,00 20.608
TFP 5 MG 14,00
CPZ 100 MG 7,00
THD 2 MG 14,00
3731 RIAMAH 201904005880 30/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 6,00 11.778
THD 2 MG 6,00
3732 RIFAI 201904000290 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 6.670
THD 2 MG 14,00
CPZ 100 MG 4,00
201904001612 08/04/2019 Ruangan Kenari THD 2 MG 14,00 6.670
CPZ 100 MG 4,00
TFP 5 MG 14,00
201904005852 30/04/2019 IGD RISPERIDONE 2 MG 6,00 3.042
CPZ 100 MG 3,00
3733 RIFAN HAFIFI 201904006016 30/04/2019 IGD SPUIT 3 CC 1,00 22.607
NORAGES INJEKSI 1,00
CLOZAPINE 25 MG 6,00
PARACETAMOL 500 6,00
3734 SUGENG HARYANTO 201904000283 01/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
3735 WAHIB SHOLIKHAN 201904000291 01/04/2019 Ruangan Kenari CPZ 100 MG 4,00 6.558
RISPERIDONE 2 MG 14,00
3736 WANDI 201904000284 01/04/2019 Ruangan Kenari THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
Dokter: dr. RIFATUL HASNA
3737 AFLAHAH 201904001141 05/04/2019 Puri Mitra TFP 5 MG 8,00 10.028
CLOZAPINE 25 MG 4,00
3738 ANIK MUJAYANTI 201904001143 05/04/2019 Puri Mitra RISPERIDONE 2 MG 8,00 18.224
CLOZAPINE 25 MG 8,00
3739 HENINGPRABOWO 201904002001 09/04/2019 Ruangan Napza NA DICLOFENAC 50 5,00 2.755
3740 RUDI SETIYAWAN 201904002419 12/04/2019 Puri Mitra (Laki- AMLODIPIN 10 11,00 1.232
3741 RUMIYATI 201904004660 24/04/2019 IGD RISPERIDONE 3 MG 4,00 46.390
SPUIT 3 CC 2,00
DEPAKOTE ER 250 1,00
CLOZAPINE 25 MG 2,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3741 RUMIYATI 201904004660 24/04/2019 IGD
- LODOMER 2 MG/ML 2,00 46.390
Dokter: dr. RIKE SOVIA MATULESSY
3742 ABDUL ROHMAN 201904001598 08/04/2019 Ruangan Kenari THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
3743 ADNAN 201904000307 01/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 4.760
THD 2 MG 14,00
CPZ 100 MG 7,00
201904001623 08/04/2019 Ruangan Kenari THD 2 MG 14,00 4.760
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 14,00
3744 ANAS ILHAM RAMADHAN 201904001639 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 9.730
THD 2 MG 14,00
CPZ 100 MG 21,00
3745 BUDI ANTON 201904000396 01/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
3746 BUDIONO 201904000364 01/04/2019 Ruangan Gelatik RISPERIDONE 2 MG 14,00 8.526
THD 2 MG 14,00
CPZ 100 MG 7,00
3747 DEDIK SUPRIYADI 201904001609 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.242
CPZ 100 MG 4,00
3748 EDY WAHYUDI 201904001602 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 8.470
THD 2 MG 14,00
CPZ 100 MG 14,00
3749 ENOL 201904000386 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.236
THD 2 MG 7,00
3750 HERU ROHMADI 201904001175 05/04/2019 Ruangan Kenari SALBUTAMOL 4 MG 3,00 74.518
CLOPIDOGREL 75 7,00
KAPSUL NO.00 20,00
AMBROXOL 30 MG 10,00
TFP 5 MG 14,00
CODEIN 20 MG 5,00
RACIKAN KAPSUL 20,00
AMLODIPIN 10 7,00
CTM 4 MG 15,00
CURCUMA 200 MG 20,00
3751 M. NAIM 201904001600 08/04/2019 Ruangan Kenari THD 2 MG 14,00 6.670
CPZ 100 MG 4,00
TFP 5 MG 14,00
201904003654 18/04/2019 Ruangan Kenari ANTASIDA SYR 1,00 2.395
3752 MARIADI 201904000395 01/04/2019 Ruangan Gelatik THD 2 MG 7,00 5.236
TFP 5 MG 14,00
3753 MOCH LUTFI 201904001618 08/04/2019 Ruangan Kenari THD 2 MG 7,00 3.506
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3753 MOCH LUTFI 201904001618 08/04/2019 Ruangan
- Kenari CPZ 100 MG 4,00 3.506
HALOPERIDOL 5 MG 14,00
201904003648 18/04/2019 Ruangan Kenari NEW DIATAB 10,00 6.820
ANTASIDA DOEN 10,00
3754 MOCH. ARIS 201904000377 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 23.318
CLOZAPINE 100 MG 4,00
RISPERIDONE 2 MG 14,00
3755 MOCHAMMAD FATCHUR 201904001621 08/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 6.020
THD 2 MG 14,00
CPZ 100 MG 14,00
3756 PAIKIN 201904000402 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
3757 RIONO 201904000374 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 13.394
THD 2 MG 14,00
CLOZAPINE 25 MG 4,00
3758 SAIFUL HADI 201904000369 01/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 7.210
TFP 5 MG 14,00
THD 2 MG 14,00
3759 SUGENG HARYANTO 201904001599 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
3760 SUMARA 201904000382 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 66.160
THD 2 MG 14,00
LORATADIN 10 MG 5,00
SCABIMITE 10mg 1,00
3761 SUNANDAR DUL HALIM 201904000366 01/04/2019 Ruangan Gelatik CPZ 100 MG 14,00 12.880
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
3762 SUPRIADI 201904004769 24/04/2019 Ruangan Wijaya LODOMER 2 MG/ML 1,00 12.246
RISPERIDONE 2 MG 2,00
SPUIT 3 CC 1,00
THD 2 MG 2,00
CLOZAPINE 25 MG 2,00
3763 SUWARNO 201904000295 01/04/2019 Ruangan Kenari CPZ 100 MG 4,00 5.242
TFP 5 MG 14,00
3764 ZAENAL ABIDIN 201904000362 01/04/2019 Ruangan Gelatik TFP 5 MG 14,00 30.576
CLOZAPINE 25 MG 14,00
Dokter: dr. SOERYA PRANOTO, Sp.KJ
3765 GO TWAN SIUNG 201904002050 10/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 456.000
STELAZINE 5 MG 60,00
THD 2 MG 60,00
DEPTRAL 50 MG 30,00
3766 A'AN ANSORI 201904002318 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.180
CPZ 100 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3767 ABD WESIK 201904001350 08/04/2019 Poli Psikiater
- THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3768 ABDUL BARI 201904000809 04/04/2019 Poli Jiwa Dewasa THD 2 MG 15,00 9.075
CPZ 100 MG 15,00
TFP 5 MG 15,00
3769 ABDUL GHOFUR 201904005047 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 222.675
CLOZAPINE 25 MG 15,00
OLANZPINE 10mg 30,00
RISPERIDONE 1 MG 60,00
3770 ABDUL HAFIDZ 201904000898 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3771 ABDUL HAKIM 201904002225 11/04/2019 Poli Psikiater STELAZINE 5 MG 120,00 218.040
CPZ 100 MG 60,00
RISPERIDONE 3 MG 120,00
3772 ABDUL HAMID 201904005541 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 90,00 75.780
TFP 5 MG 90,00
THD 2 MG 90,00
3773 ABDUL ROCHIM 201904005029 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3774 ABDUL SALAM MASKUR 201904002718 15/04/2019 Psiko Geriatri THD 2 MG 30,00 55.032
RACIKAN KAPSUL 60,00
FRIMANIA 200 MG 30,00
DIAZEPAM 5 MG 12,00
TFP 5 MG 30,00
KAPSUL NO.00 60,00
3775 ABDULLAH 201904004741 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3776 ABDUS SALAM 201904000135 01/04/2019 Poli Psikiater TFP 5 MG 180,00 234.810
THD 2 MG 90,00
CLOZAPINE 25 MG 90,00
201904002090 10/04/2019 Ruangan Wijaya CPZ 100 MG 5,00 4.130
TFP 5 MG 10,00
3777 ABRAM GUNAWAN 201904000552 02/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 223.890
DEPAKOTE ER 250 30,00
TFP 5 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
3778 ACH.FAISOL HASAN 201904005032 26/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 45.720
RISPERIDONE 3 MG 60,00
3779 ADI CANDRA 201904005884 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 142.800
CLOZAPINE 25 MG 60,00
RISPERIDONE 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3780 ADISA AUGUSTSILA 201904002528 12/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 292.095
CLOZAPINE 25 MG 15,00
DEPAKOTE ER 250 60,00
RISPERIDONE 3 MG 60,00
3781 AGNES MARIA PUJI 201904002259 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 110.715
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
3782 AGUNG WAHYU N 201904003834 22/04/2019 Poli Psikiater NUZIP 25 60,00 156.780
RISPERIDONE 2 MG 120,00
THD 2 MG 120,00
3783 AGUS KURNIA 201904001864 09/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.300
CPZ 100 MG 60,00
TFP 5 MG 60,00
3784 AGUS PRASETIO 201904001874 09/04/2019 Poli Psikiater THD 2 MG 60,00 153.165
STELAZINE 5 MG 60,00
CLOZAPINE 25 MG 45,00
3785 AGUS SIGIT SUSANTO 201904000015 01/04/2019 Poli Psikiater KAPSUL NO 2 60,00 27.270
THD 2 MG 45,00
RACIKAN KAPSUL 60,00
RISPERIDONE 3 MG 30,00
3786 AGUS SOLEH 201904000779 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 88.740
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
VIT B6 10 MG 30,00
3787 AGUS SUPRIYADI 201904004831 25/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 62.550
THD 2 MG 60,00
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 15,00
3788 AGUS SUPRIYANTO 201904000475 02/04/2019 Poli Psikiater KAPSUL NO 2 60,00 84.276
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 9,00
DOGMATIL FORTE 8,00
201904001897 09/04/2019 Poli Psikiater ELIZAC 20 MG 27,00 52.299
201904005910 30/04/2019 Poli Psikiater DOGMATIL FORTE 12,00 302.625
KAPSUL NO 2 90,00
ELIZAC 20 MG 45,00
RACIKAN KAPSUL 90,00
CLOBAZAM 10 MG 90,00
3789 AGUS SUSETYO 201904002116 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 168.495
CLOZAPINE 100 MG 15,00
SERTRALINE 50 MG 30,00
HALOPERIDOL 1,5 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3789 AGUS SUSETYO 201904002116 10/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 168.495
3790 AGUS WIDJAJANTO 201904005087 26/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 47.460
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
3791 AGUSTINA VIANTI 201904001305 08/04/2019 Poli Psikiater FOLIC ACID 1 MG 30,00 262.734
ALGANAX 1 MG 36,00
KAPSUL NO 2 60,00
ELIZAC 20 MG 30,00
RACIKAN KAPSUL 60,00
3792 AHMAD FANI MASYUDI 201904002405 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 160.710
RISPERIDONE 3 MG 60,00
3793 AHMAD FARID NUR 201904005236 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
3794 AISYAH 201904005419 29/04/2019 Psiko Geriatri RISPERIDONE 3 MG 60,00 235.920
OLANZPINE 10mg 30,00
TFP 5 MG 60,00
THD 2 MG 60,00
3795 AJI 201904002126 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 1,00 1.014
RISPERIDONE 2 MG 2,00
3796 AKHMAD BRAWIJAYA 201904002535 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3797 AKHMAD SAIFUL ANWAR 201904001834 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 126.015
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
3798 ALBERTO HENU USSILLY 201904005026 26/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 98.460
THD 2 MG 60,00
CLOBAZAM 10 MG 30,00
3799 ALDI NALA 201904000181 01/04/2019 Poli Psikiater CLOZAPINE 25 MG 15,00 59.055
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3800 ALFI SUNARYA 201904002131 10/04/2019 Poli Psikiater TFP 5 MG 60,00 189.480
OLANZPINE 10mg 30,00
3801 ALI 201904002406 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3802 ALI MASUM 201904003209 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 116.610
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 30,00
3803 ALIF MUSTAJAB 201904002400 12/04/2019 Ruangan Kenari CPZ 100 MG 6,00 4.956
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3803 ALIF MUSTAJAB 201904002400 12/04/2019 Ruangan
- Kenari TFP 5 MG 12,00 4.956
201904004378 23/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904005871 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3804 ALIYATUL HIMMAH 201904000063 01/04/2019 Poli Psikiater LORAZEPAM 2 MG 30,00 53.070
RISPERIDONE 2 MG 60,00
201904005322 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 106.140
LORAZEPAM 2 MG 60,00
3805 AMIR NUDIN 201904002087 10/04/2019 Poli Jiwa Dewasa TFP 5 MG 10,00 5.030
CPZ 100 MG 10,00
201904004727 24/04/2019 Ruangan Kenari CPZ 100 MG 14,00 7.042
TFP 5 MG 14,00
3806 ANANG 201904004740 24/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
3807 ANAS ILHAM RAMADHAN 201904003643 18/04/2019 Ruangan Kenari THD 2 MG 14,00 14.308
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
CPZ 100 MG 14,00
3808 ANDI MUHAMMAD 201904004736 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
3809 ANDRE MAHARDIKA 201904002063 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 123.240
SERTRALINE 50 MG 30,00
TFP 5 MG 60,00
RISPERIDONE 3 MG 60,00
3810 ANDRE SAPUTRA 201904000174 01/04/2019 Poli Psikiater CLOBAZAM 10 MG 10,00 212.000
CIPRALEX 10 MG 10,00
201904005558 29/04/2019 Poli Psikiater CLOBAZAM 10 MG 30,00 426.960
ELXION 30,00
3811 ANDRIYANTO 201904000669 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
3812 ANI MARTINI 201904004901 25/04/2019 Ruangan CPZ 100 MG 8,00 4.024
TFP 5 MG 8,00
3813 ANIS KUSKUMALASARI 201904002258 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
3814 ANIS SULISTYOWATI 201904000258 01/04/2019 Ruangan CPZ 100 MG 14,00 14.308
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
201904001158 05/04/2019 IGD TFP 5 MG 14,00 14.308
CPZ 100 MG 14,00
THD 2 MG 14,00
RISPERIDONE 2 MG 14,00
3815 ANITA EKA SYALINA 201904005068 26/04/2019 Poli Psikiater THD 2 MG 120,00 92.880
RISPERIDONE 3 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3816 ANNA SULISTARI 201904001545 08/04/2019 Poli Jiwa- Dewasa DEPAKOTE 250 MG 60,00 173.370
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3817 ANTON HARIJANTO 201904002277 11/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 1 MG 30,00 64.140
SANDEPRIL 15,00
3818 ANWAR SADAT 201904000161 01/04/2019 Poli Psikiater THD 2 MG 60,00 86.970
RISPERIDONE 2 MG 60,00
CLOZAPINE 25 MG 30,00
3819 ARDITA LESTARI 201904003461 18/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 63.330
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 30,00
3820 ARI DARMAWAN 201904004936 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
3821 ARIFAN 201904005373 29/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 59.055
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3822 ARINI FIRSTY DELIA 201904002562 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 30.158
RACIKAN KAPSUL 30,00
CLOZAPINE 25 MG 8,00
TFP 5 MG 30,00
KAPSUL NO.00 30,00
3823 ARIS SUSANTO 201904004751 24/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3824 ARMANU SALEH 201904000740 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3825 ASEP 201904003309 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3826 ASIA 201904004896 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 2,00 1.006
CPZ 100 MG 2,00
3827 ATIK YUNIATIK 201904002417 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
3828 ATNAMAH (LAKI2) 201904000874 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 14,00 26.054
3829 AUNUL FITRI 201904002061 10/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
3830 AYU RIZQI AMALIA 201904002003 09/04/2019 Poli Psikiater IKALEP 250 MG 20,00 91.100
3831 AZAUL HASANAH / 201904000780 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 47.295
TFP 5 MG 60,00
3832 B. SITI AMINATIN 201904000792 04/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 670.215
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3832 B. SITI AMINATIN 201904000792 04/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 670.215
THD 2 MG 30,00
AMITRIPTILIN 25 MG 15,00
3833 BAKHRUDIN 201904001069 05/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 39.855
CLOZAPINE 25 MG 15,00
HALOPERIDOL 5 MG 60,00
3834 BETA DENA QOWIMA 201904005492 29/04/2019 Poli Psikiater CLOBAZAM 10 MG 7,00 99.624
ELXION 7,00
3835 BING HADISAPUTRA LIE 201904004623 24/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 90,00 49.455
RACIKAN KAPSUL 60,00
CLOZAPINE 25 MG 15,00
VIT B6 10 MG 60,00
KAPSUL NO 2 60,00
3836 BISU SUNAN 201904004749 24/04/2019 Poli Jiwa Dewasa AMITRIPTILIN 25 MG 15,00 3.015
3837 BOY MASON 201904003533 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
3838 BUDI ANTON 201904000179 01/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
3839 BUDI SANTOSO 201904004739 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3840 BUDI SUDIONO 201904004933 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 65.520
CLOZAPINE 25 MG 30,00
3841 BUDI UTOMO 201904005465 29/04/2019 Poli Psikiater THD 2 MG 120,00 67.680
CPZ 100 MG 30,00
RISPERIDONE 2 MG 120,00
3842 BUDIARTA LESMANA 201904005231 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 106.635
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
3843 CELEMEK 201904004760 24/04/2019 Poli Jiwa Dewasa CLONAZEPAM 2 MG 30,00 177.840
3844 CHAVIVA 201904002789 15/04/2019 Poli Psikiater TFP 5 MG 45,00 23.715
THD 2 MG 90,00
3845 DACHLAN 201904005104 26/04/2019 Poli Jiwa Dewasa ARICEPT 10 MG 15,00 252.645
CLOZAPINE 25 MG 15,00
3846 DAISEN TANTOWI 201904003700 19/04/2019 Poli Psikiater CPZ 100 MG 45,00 54.810
RISPERIDONE 2 MG 90,00
THD 2 MG 90,00
3847 DAMAR SURYAWAN 201904000028 01/04/2019 Poli Psikiater STELAZINE 5 MG 60,00 162.090
THD 2 MG 60,00
SIZORIL 25 MG 30,00
3848 DAMATIUS WAGIMAN ADI 201904001450 08/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 50.520
TFP 5 MG 60,00
THD 2 MG 60,00
3849 DANIEL SATIBI 201904001197 05/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 114.840
201904005649 29/04/2019 Poli Psikiater SERTRALINE 50 MG 60,00 114.840
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3850 DEBY PUTRA MIHARJA 201904002573 12/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 60,00 42.915
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
3851 DENI ALFA RISI 201904000896 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 145.890
CLOZAPINE 100 MG 30,00
TFP 5 MG 60,00
3852 DESNA DWI KUMALA 201904002602 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 88.275
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
3853 DETTY ARIYANI 201904005061 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 10.800
3854 DEVI VINDYARANI 201904000253 01/04/2019 Poli Psikiater NOPRES 20 MG 30,00 189.612
KAPSUL NO 2 60,00
THD 2 MG 30,00
ALPRAZOLAM 1 MG 18,00
RACIKAN KAPSUL 60,00
IKALEP 250 MG 30,00
DIAZEPAM 5 MG 36,00
TFP 5 MG 30,00
201904005907 30/04/2019 Poli Psikiater RACIKAN KAPSUL 90,00 97.880
NOPRES 20 MG 45,00
DIAZEPAM 5 MG 54,00
TFP 5 MG 90,00
KAPSUL NO 2 90,00
THD 2 MG 90,00
ALPRAZOLAM 1 MG 23,00
3855 DEWI INDAH P 201904003622 18/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 152.220
TFP 5 MG 60,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
3856 DEWI RETNOWATI 201904001147 05/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 500 30,00 619.920
LORAZEPAM 2 MG 15,00
SEROQUEL XR 400 15,00
CLOZAPINE 100 MG 15,00
THD 2 MG 30,00
HALOPERIDOL 5 MG 30,00
3857 DHANI HIDAYAT 201904003196 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3858 DHIMAS ADITYA 201904000784 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 46.440
RISPERIDONE 3 MG 60,00
3859 DIAH AMANI 201904005942 30/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 629.940
CLOZAPINE 100 MG 60,00
DEPAKOTE ER 500 30,00
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3860 DIAN KUSWANDANI 201904004931 25/04/2019 IGD
- CARBAMAZEPINE 14,00 21.196
RISPERIDONE 3 MG 14,00
CPZ 100 MG 21,00
HALOPERIDOL 5 MG 28,00
3861 DIAN SURYA MEGA 201904004424 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
3862 DIAN UMALASARI, S.PSI. 201904001150 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 116.610
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 30,00
3863 DIANA CAKRA 201904000810 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 85.215
RISPERIDONE 2 MG 60,00
3864 DIDIK MUCHAMMAD 201904005237 26/04/2019 Poli Jiwa Dewasa KAPSUL NO 2 30,00 61.826
VIT B6 10 MG 30,00
RACIKAN KAPSUL 30,00
ALPRAZOLAM 1 MG 8,00
SERTRALINE 50 MG 30,00
3865 DIDIK SUMANTRI 201904004903 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.140
THD 2 MG 30,00
CPZ 100 MG 15,00
3866 DINA TRI ASPUJI 201904002252 11/04/2019 Poli Jiwa Dewasa LORAZEPAM 2 MG 8,00 11.791
RISPERIDONE 2 MG 3,00
THD 2 MG 30,00
3867 DITO SEPTYANTO 201904002239 11/04/2019 Poli Psikiater THD 2 MG 60,00 183.360
ELIZAC 20 MG 30,00
CLOZAPINE 25 MG 30,00
STELAZINE 5 MG 60,00
3868 DWI INDAYANI 201904005133 26/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 15,00 414.615
3869 DWI ISNAENI 201904000223 01/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
201904002574 12/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
3870 DWI JUMARIYANTO 201904002483 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
3871 DWI SUSANTI 201904004757 24/04/2019 Poli Psikiater THD 2 MG 10,00 14.495
CLOZAPINE 25 MG 5,00
RISPERIDONE 2 MG 10,00
3872 EDI PRIANTO 201904003313 16/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 27.840
CPZ 100 MG 30,00
TFP 5 MG 60,00
3873 EDY SETIAWAN 201904002844 15/04/2019 Poli Psikiater SIZORIL 25 MG 30,00 313.830
THD 2 MG 120,00
RIZODAL 2 MG 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3874 EKA ERNA 201904002497 12/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 60,00 25.020
3875 EKA NURITA 201904005528 29/04/2019 Poli Psikiater THD 2 MG 120,00 212.700
RISPERIDONE 2 MG 120,00
TFP 5 MG 120,00
CLOZAPINE 25 MG 60,00
3876 EKO BUDIONO 201904000675 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
3877 EKO JUNAIDI 201904000838 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 37.605
TFP 5 MG 30,00
3878 EKO PURNOMO 201904005135 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 74.355
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
3879 EKO TRIDA NUGROHO 201904002902 15/04/2019 Poli Psikiater SERTRALINE 50 MG 15,00 95.667
RIZODAL 2 MG 15,00
KAPSUL NO 2 30,00
THD 2 MG 15,00
RACIKAN KAPSUL 30,00
MERLOPAM 2 MG 8,00
CLOBAZAM 10 MG 15,00
3880 EKO WIJAYA KUSUMA 201904002797 15/04/2019 Poli Psikiater IKALEP 250 MG 60,00 471.960
TFP 5 MG 120,00
RIZODAL 2 MG 60,00
CLORILEX 25 MG 15,00
3881 ELITA 201904001424 08/04/2019 Poli Psikiater TFP 5 MG 180,00 92.700
THD 2 MG 180,00
CPZ 100 MG 90,00
3882 ELLY SPING 201904000227 01/04/2019 Ruangan HALOPERIDOL 5 MG 14,00 39.578
DEPAKOTE 250 MG 14,00
SERTRALINE 50 MG 7,00
CPZ 100 MG 14,00
THD 2 MG 14,00
201904003271 16/04/2019 Ruangan SPUIT 3 CC 1,00 124.246
HALDOL DECANOAS 1,00
3883 ENI FARIDA 201904001134 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 35.370
DIAZEPAM 5 MG 30,00
RISPERIDONE 2 MG 60,00
3884 ENI ARIANTI 201904004680 24/04/2019 Ruangan Wijaya SPUIT 50 CC LUBANG 1,00 61.230
HANDSCHOEN 2,00
SPUIT 3 CC 3,00
SPUIT 5 CC 3,00
3885 ENOL 201904002083 10/04/2019 Ruangan Gelatik THD 2 MG 7,00 5.236
TFP 5 MG 14,00
201904006013 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 22.440
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3885 ENOL 201904006013 30/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 22.440
3886 ERIK ERIANTO 201904002119 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 25.140
TFP 5 MG 60,00
THD 2 MG 30,00
3887 ERINDA 201904003336 16/04/2019 Poli Psikiater HALOPERIDOL 5 MG 60,00 311.925
NUZIP 25 15,00
THD 2 MG 60,00
IKALEP 250 MG 60,00
3888 ERLANGGA WISNU 201904001449 08/04/2019 Poli Psikiater SIZORIL 25 MG 8,00 59.422
STELAZINE 5 MG 30,00
THD 2 MG 30,00
201904003797 22/04/2019 Poli Psikiater THD 2 MG 60,00 25.500
TFP 5 MG 60,00
3889 ERLINDA AYU MEGA 201904002053 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 570.630
SEROQUEL XR 200 30,00
3890 ERNY PRASETYA 201904004698 24/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 43.626
RACIKAN KAPSUL 30,00
CLOZAPINE 25 MG 6,00
RISPERIDONE 2 MG 60,00
KAPSUL NO.1 30,00
3891 ERWIN SITOMPUL 201904004398 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 50.355
TFP 5 MG 60,00
THD 2 MG 30,00
3892 FAHMI 201904002301 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
3893 FAHMI ALFIYAH 201904000729 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
3894 FAHMI YULIANTO 201904000841 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 91.335
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3895 FARIDAH 201904001315 08/04/2019 Poli Psikiater CLOZAPINE 25 MG 30,00 264.930
ELIZAC 20 MG 60,00
RISPERIDONE 3 MG 120,00
THD 2 MG 120,00
3896 FARUL 201904006020 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
3897 FATCHUL AMAR 201904002428 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 100.515
RISPERIDONE 3 MG 60,00
3898 FATKHUL MUBIN 201904005148 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 50.115
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
3899 FENNY NILAMSARI 201904003561 18/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 65.460
PHENYTOIN CAP 100 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3900 FIKRA/FITRA 201904002111 10/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 1,00 826
TFP 5 MG 2,00
3901 FIKRIE A.M 201904002032 10/04/2019 Poli Psikiater OLANZPINE 10mg 30,00 173.160
THD 2 MG 30,00
3902 FITRI YESSY 201904000542 02/04/2019 Poli Psikiater SEROQUEL XR 400 3,00 254.734
CLORILEX 100 MG 14,00
KAPSUL NO 2 35,00
MERLOPAM 2 MG 4,00
RACIKAN KAPSUL 35,00
3903 FITRIANI 201904001830 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3904 FUTTIYAH 201904002870 15/04/2019 Poli Psikiater TFP 5 MG 180,00 70.380
THD 2 MG 120,00
3905 GALIH ANDHIKA 201904003477 18/04/2019 Poli Psikiater CLORILEX 100 MG 7,00 135.134
THD 2 MG 5,00
OLANZPINE 10mg 8,00
3906 GARIMUN 201904004746 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
3907 GIANTO SETIAWAN 201904005122 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 106.635
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
3908 GUNAWAN 201904005235 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
3909 GUNTUR RAMADHAN 201904000820 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 85.215
CLOZAPINE 100 MG 15,00
3910 H FAUZI 201904003338 16/04/2019 Poli Psikiater CPZ 100 MG 15,00 44.520
TFP 5 MG 120,00
THD 2 MG 30,00
3911 HADI PURWANTO 201904001850 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 12.510
3912 HANA KARINA ALEYSIA 201904002408 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 40.665
CLOZAPINE 25 MG 15,00
TFP 5 MG 30,00
3913 HANI 201904000680 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 4.845
3914 HANIF DARMAWAN 201904001378 08/04/2019 Poli Psikiater NERIPROS 2 MG 90,00 845.190
THD 2 MG 60,00
DOGMATIL 50 MG 60,00
3915 HARI DARMAWAN 201904002331 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
3916 HARI MAHARDIKA 201904001312 08/04/2019 Poli Psikiater KAPSUL NO 2 30,00 120.261
RIZODAL 2 MG 15,00
RACIKAN KAPSUL 30,00
SIZORIL 100 MG 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3916 HARI MAHARDIKA 201904001312 08/04/2019 Poli Psikiater
- CLOBAZAM 10 MG 30,00 120.261
THD 2 MG 15,00
3917 HARIANTO 201904000884 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 145.890
CLOZAPINE 100 MG 30,00
TFP 5 MG 60,00
3918 HARITSAH AKHDA 201904000657 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
3919 HARRY SUMARTONO 201904002338 11/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 78.270
TFP 5 MG 60,00
THD 2 MG 30,00
3920 HARUN ROSIDI 201904005233 26/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 152.786
TFP 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3921 HARYO ADHA 201904002081 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 38.715
RISPERIDONE 1 MG 30,00
3922 HASAN BUSRI 201904002104 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
3923 HASINAH 201904005323 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 180,00 177.165
THD 2 MG 180,00
CLOZAPINE 25 MG 45,00
3924 HAUW FIE TJEN 201904002515 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
3925 HAYLIANTO 201904005436 29/04/2019 Psiko Geriatri AMITRIPTILIN 25 MG 30,00 21.510
ALPRAZOLAM 1 MG 90,00
3926 HENDRA HIDAYAT 201904001537 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 907.425
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 45,00
3927 HENDRA RINALDI 201904004827 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 142.800
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
3928 HENDY EKO AGUNG 201904001826 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 929.181
SIKZONOATE 1,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
ABILIFY DISCMELT 10 30,00
3929 HENNDRA VAN HELEN 201904002250 11/04/2019 Poli Jiwa Dewasa KAPSUL NO.0 60,00 106.455
THD 2 MG 30,00
RACIKAN KAPSUL 60,00
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3930 HERI HERMANSYAH 201904004471 23/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 727.320
SERTRALINE 50 MG 30,00
SEROQUEL XR 400 30,00
TFP 5 MG 60,00
3931 HERI SUSANTO 201904002076 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 18.270
RISPERIDONE 2 MG 30,00
THD 2 MG 30,00
3932 HERU HARIYANTO 201904003302 16/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 3,00 9.615
RISPERIDONE 3 MG 6,00
3933 HERY ISKANDAR 201904005072 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
3934 HINDUN 201904004410 23/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 569.340
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3935 HJ. SITI AFRIDA, SRG 201904004719 24/04/2019 Poli Psikiater HALOPERIDOL 5 MG 18,00 1.290.564
THD 2 MG 60,00
SEROQUEL XR 400 30,00
KAPSUL NO 2 60,00
DEPTRAL 50 MG 30,00
RACIKAN KAPSUL 60,00
IKALEP 250 MG 60,00
3936 HONA 201904004906 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 28.080
THD 2 MG 30,00
3937 HORO 201904004937 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 83.910
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
3938 HOSIMAH 201904001421 08/04/2019 Psiko Geriatri ALPRAZOLAM 1 MG 30,00 90.630
LORAZEPAM 2 MG 30,00
SERTRALINE 50 MG 30,00
3939 IBNU HANY S 201904002112 10/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 10,00 5.970
CPZ 100 MG 10,00
201904004564 23/04/2019 Ruangan Gelatik CPZ 100 MG 14,00 8.358
RISPERIDONE 2 MG 14,00
3940 ILHAM MAULANA 201904001139 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 302.970
DEPAKOTE ER 500 30,00
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
3941 IMAM BAIDOWI 201904005045 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3942 IMAM CHAMBALI 201904002099 10/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
3943 IMAM FAUZI 201904005036 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 140.970
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3943 IMAM FAUZI 201904005036 26/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 140.970
THD 2 MG 60,00
RISPERIDONE 1 MG 60,00
3944 IMAM HUDHORI 201904003621 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 863.400
ABILIFY DISCMELT 10 30,00
LORAZEPAM 2 MG 30,00
3945 IMAM SANTOSO 201904002532 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 20.400
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
3946 IMING 201904003580 18/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 153.570
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3947 INAWATI LAYTNO 201904004891 25/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 743.025
SEROQUEL XR 200 30,00
KAPSUL NO 2 30,00
SERTRALINE 50 MG 30,00
LORAZEPAM 2 MG 15,00
ABILIFY DISCMELT 15 4,00
3948 INDAH SURYANI 201904004432 23/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 85.620
SERTRALINE 50 MG 30,00
TFP 5 MG 60,00
CPZ 100 MG 15,00
3949 INDAH TRIASTUTI 201904005055 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 69.885
CLOZAPINE 100 MG 15,00
3950 IRFAN HARSONO 201904004399 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 49.515
RISPERIDONE 1 MG 60,00
3951 IRIANTO SETYOAJI 201904001797 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 81.330
TFP 5 MG 60,00
THD 2 MG 60,00
3952 ISKANDAR EFENDI/RAJIS 201904000139 01/04/2019 Poli Psikiater SIZORIL 25 MG 25,00 172.175
STELAZINE 5 MG 90,00
3953 ISMATUL CHASANAH 201904005100 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 137.280
PROPANOLOL 10 MG 60,00
DEPAKOTE ER 250 30,00
RISPERIDONE 2 MG 60,00
3954 ISWAHYUDI 201904002407 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 100.515
CLOZAPINE 100 MG 15,00
3955 ITA FARIANA 201904003997 22/04/2019 Poli Psikiater THD 2 MG 60,00 229.320
CLOBAZAM 10 MG 60,00
BAMGETOL 200 MG 90,00
RISPERIDONE 2 MG 60,00
3956 IWAN HERMANSYAH 201904001058 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 206.100
CARBAMAZEPINE 90,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3956 IWAN HERMANSYAH 201904001058 05/04/2019 Poli Jiwa- Dewasa DEPAKOTE 250 MG 60,00 206.100
CLOBAZAM 10 MG 60,00
3957 J.HARRY POERNOMO 201904003832 22/04/2019 Psiko Geriatri NOPRES 20 MG 15,00 41.610
ALPRAZOLAM 1 MG 15,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 15,00
VIT B6 10 MG 30,00
KAPSUL NO.00 60,00
3958 JAMALUDIN 201904002335 11/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
3959 JANAKA 201904005998 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 145.890
CLOZAPINE 100 MG 30,00
TFP 5 MG 60,00
3960 JANUAR HENU USSILY 201904005338 29/04/2019 Psiko Geriatri LORAZEPAM 2 MG 23,00 77.845
RACIKAN KAPSUL 30,00
KAPSUL NO.00 30,00
SEROQUEL XR 300 3,00
3961 JEMMY 201904002765 15/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 170.646
ELIZAC 20 MG 30,00
CLOBAZAM 10 MG 60,00
TFP 5 MG 12,00
KAPSUL NO 2 60,00
ALGANAX 0,5 MG 10,00
201904004431 23/04/2019 Poli Psikiater ELIZAC 20 MG 45,00 247.854
RACIKAN KAPSUL 90,00
SIZORIL 25 MG 15,00
CLOBAZAM 10 MG 90,00
TFP 5 MG 18,00
KAPSUL NO 2 90,00
3962 JIMMY HIDAYAT 201904005039 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 61.170
RISPERIDONE 3 MG 60,00
KAPSUL NO.00 60,00
TFP 5 MG 30,00
RACIKAN KAPSUL 60,00
3963 JOFAN TANJUNG 201904001063 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 40.665
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
3964 JOHANES KURNIAWAN 201904000503 02/04/2019 Ruangan Puri HALOPERIDOL 5 MG 28,00 15.981
LORAZEPAM 2 MG 7,00
CARBAMAZEPINE 14,00
THD 2 MG 14,00
3965 JOHN 201904004745 24/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
3966 JOHN EDWARD 201904005025 26/04/2019 Poli Psikiater THD 2 MG 60,00 139.215
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3966 JOHN EDWARD 201904005025 26/04/2019 Poli Psikiater
- KAPSUL NO 2 60,00 139.215
RIZODAL 2 MG 75,00
RACIKAN KAPSUL 60,00
3967 JOKO 201904002139 10/04/2019 Ruangan Kenari CLOZAPINE 25 MG 3,00 10.773
RISPERIDONE 2 MG 10,00
THD 2 MG 10,00
3968 JOKO PRASETYO 201904004675 24/04/2019 Ruangan Kenari TFP 5 MG 10,00 4.130
CPZ 100 MG 5,00
3969 JOKO SANTOSO 201904001519 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
3970 JOKO SLAMET 201904002010 10/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 30,00 58.410
CPZ 100 MG 15,00
RISPERIDONE 2 MG 30,00
3971 JOKO SUMADIO 201904001501 08/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
3972 JOSEPH HENDRO 201904005111 26/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3973 JUWARIAH 201904005483 29/04/2019 Psiko Geriatri THD 2 MG 60,00 38.010
RISPERIDONE 2 MG 30,00
TFP 5 MG 60,00
3974 KAMIN 201904001324 08/04/2019 Psiko Geriatri RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
3975 KARNIYAH / PRETTY 201904000247 01/04/2019 Ruangan CPZ 100 MG 4,00 6.558
RISPERIDONE 2 MG 14,00
201904003363 16/04/2019 Ruangan RISPERIDONE 2 MG 14,00 6.558
CPZ 100 MG 4,00
3976 KHAMBALI 201904000661 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 68.340
RISPERIDONE 2 MG 30,00
3977 KHO SIOE MEI 201904001524 08/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 90.460
THD 2 MG 30,00
VIT B COMPLEX 10,00
3978 KHOIRIYAH 201904002011 10/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 102.270
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
3979 KHOIRO UMMAH 201904003326 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 74.355
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
3980 KHOIRUL HIDAYATI 201904005040 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3981 KHOIRUN NISYAK 201904004838 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3982 KHOTIMAH KURNIATI 201904004498 23/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 12,00 26.988
HALOPERIDOL 5 MG 12,00
CARBAMAZEPINE 6,00
THD 2 MG 12,00
3983 KIKI 201904006023 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 67.440
THD 2 MG 60,00
PUSPALIN 500mg 10,00
3984 KOJI 201904002077 10/04/2019 Ruangan Gelatik TFP 5 MG 14,00 5.950
THD 2 MG 14,00
3985 KRISTIN SUSILOWATI 201904002438 12/04/2019 IGD RISPERIDONE 3 MG 14,00 23.863
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
3986 KUNTARI YULI P 201904000126 01/04/2019 Poli Psikiater CLORILEX 25 MG 8,00 84.858
RIZODAL 2 MG 30,00
THD 2 MG 30,00
3987 KURNIAWAN ABD.HALIQ 201904005063 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
3988 KUS INDRAYANI 201904000071 01/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 167.790
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
TFP 5 MG 30,00
3989 KUSTAMI 201904003198 16/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
3990 Kurniawati Dini Rosita 201904004443 23/04/2019 Poli Psikiater CPZ 100 MG 90,00 109.620
RISPERIDONE 2 MG 180,00
THD 2 MG 180,00
3991 LAELA MAYASAROH 201904002861 15/04/2019 Poli Psikiater DIPHENHYDRAMINE 2,00 38.222
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 34,00
CLOZAPINE 25 MG 6,00
THD 2 MG 60,00
3992 LASMI 201904005403 29/04/2019 Psiko Geriatri THD 2 MG 60,00 874.095
RACIKAN KAPSUL 60,00
ABILIFY DISCMELT 15 20,00
CLOZAPINE 25 MG 15,00
SERTRALINE 50 MG 30,00
KAPSUL NO.00 60,00
3993 LEXI ANDRI KARTONO 201904001090 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
3994 LIDIAWATI NINGSIH 201904002835 15/04/2019 Poli Psikiater THD 2 MG 120,00 141.048
RACIKAN KAPSUL 120,00
CLORILEX 25 MG 23,00
TFP 5 MG 120,00
KAPSUL NO 2 120,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
3995 LILIK NURHAYATI 201904003955 22/04/2019 Poli Psikiater
- THD 2 MG 120,00 571.782
SPUIT 3 CC 2,00
NERIPROS 2 MG 60,00
TFP 5 MG 60,00
SIKZONOATE 2,00
3996 LILIS.SUNINGSIH 201904000019 01/04/2019 Poli Psikiater TFP 5 MG 90,00 54.450
THD 2 MG 90,00
CPZ 100 MG 90,00
3997 LINDA IFRIATY NATA 201904001796 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 189.210
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
DEPAKOTE ER 250 30,00
3998 LUKMAN HAKIM 201904000117 01/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 153.390
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
OLANZPINE 10mg 15,00
KAPSUL NO 2 60,00
TFP 5 MG 60,00
201904001056 05/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.180
CPZ 100 MG 60,00
201904005409 29/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 153.390
OLANZPINE 10mg 15,00
KAPSUL NO 2 60,00
TFP 5 MG 60,00
RACIKAN KAPSUL 60,00
THD 2 MG 60,00
3999 LULUK KAROMI 201904000147 01/04/2019 Poli Psikiater KUTOIN 270,00 381.780
CLOBAZAM 10 MG 180,00
4000 LULUK KURNIANTI 201904001822 09/04/2019 Poli Jiwa Dewasa AMITRIPTILIN 25 MG 15,00 190.551
SEROQUEL XR 300 10,00
KAPSUL NO.00 60,00
ALPRAZOLAM 1 MG 18,00
RACIKAN KAPSUL 60,00
4001 LUSIANA 201904003869 22/04/2019 Poli Psikiater THD 2 MG 180,00 331.740
RIZODAL 2 MG 180,00
4002 M TAUFIQ 201904004415 23/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 233.641
CLOZAPINE 100 MG 15,00
RISPERIDONE 3 MG 60,00
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
4003 M. AJIB 201904004539 23/04/2019 Psiko Geriatri DEPTRAL 50 MG 15,00 234.353
KAPSUL NO 2 30,00
NUZIP 25 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4003 M. AJIB 201904004539 23/04/2019 Psiko Geriatri
- ALPRAZOLAM 1 MG 15,00 234.353
RACIKAN KAPSUL 30,00
RIZODAL 2 MG 15,00
AMLODIPIN 10 14,00
4004 M. BASUKI 201904004674 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 5,00 4.130
TFP 5 MG 10,00
4005 M. NAIM 201904000312 01/04/2019 Ruangan Kenari THD 2 MG 14,00 6.670
CPZ 100 MG 4,00
TFP 5 MG 14,00
201904005226 26/04/2019 Poli Gigi (Jiwa) CPZ 100 MG 4,00 6.670
TFP 5 MG 14,00
THD 2 MG 14,00
4006 M. NOER CAHYONO 201904000804 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4007 M. UBAIDILLAH 201904003303 16/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 507.210
DEPAKOTE ER 500 60,00
CLOZAPINE 25 MG 30,00
4008 M.ARIFIN 201904002336 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4009 M.RISA HERFANGKI 201904003750 22/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 142.620
RIZODAL 2 MG 60,00
THD 2 MG 60,00
KAPSUL NO 2 60,00
NOPRES 20 MG 30,00
4010 MA'IN 201904004748 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.500
THD 2 MG 60,00
4011 MAHENDRA KURNIAWAN 201904001126 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
4012 MAHMUDAH FINTA 201904005455 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4013 MALIK 201904002432 12/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 78.270
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
201904004935 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 85.215
RISPERIDONE 2 MG 60,00
4014 MARI SUGENG 201904002457 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 60.270
HALOPERIDOL 5 MG 30,00
4015 MARIA ULFA 201904003342 16/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 74.355
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
4016 MARIADI 201904002080 10/04/2019 Ruangan Gelatik THD 2 MG 7,00 5.236
TFP 5 MG 14,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4017 MARIANAH 201904001102 05/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
4018 MARISA DWI JAYANTI 201904003791 22/04/2019 Poli Psikiater DOGMATIL 50 MG 60,00 350.100
SERTRALINE 50 MG 60,00
4019 MARPENJUN 201904001361 08/04/2019 Psiko Geriatri CPZ 100 MG 45,00 46.350
TFP 5 MG 90,00
THD 2 MG 90,00
4020 MASITO RASMY 201904000794 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 40.320
4021 MASKONAH 201904000863 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 85.425
THD 2 MG 30,00
LORAZEPAM 2 MG 15,00
RISPERIDONE 2 MG 30,00
4022 MASMAN 201904002340 11/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4023 MATOJI 201904003312 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 11.520
CPZ 100 MG 30,00
4024 MINATUN 201904004685 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 2,00 1.480
TFP 5 MG 2,00
4025 MISNI 201904003199 16/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 21.525
HALOPERIDOL 1,5 60,00
LORAZEPAM 2 MG 15,00
4026 MOCH. BAGUS 201904005033 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 158.100
THD 2 MG 60,00
CLOZAPINE 25 MG 60,00
4027 MOCH. FONDRA IRAWAN 201904000264 01/04/2019 Poli Psikiater IKALEP 250 MG 30,00 199.950
STELAZINE 5 MG 60,00
4028 MOCH. HANAFI 201904001089 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 128.040
CPZ 100 MG 60,00
DEPAKOTE ER 250 30,00
HALOPERIDOL 5 MG 60,00
4029 MOCH. RIPAI 201904000815 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 24.780
TFP 5 MG 60,00
4030 MOCH. SJAMSUL ARIFIN 201904005938 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 30,00 12.570
VIT B6 10 MG 30,00
4031 MOCHAMAD ANDI 201904002520 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 85.695
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
4032 MOCHAMAD CHOIRON 201904004387 23/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
4033 MOCHAMAD KASAN 201904002502 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
4034 MOCHAMAD UDIN 201904003464 18/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4035 MOEH DJUPRI 201904000662 04/04/2019 Poli Jiwa- Dewasa DIAZEPAM 5 MG 30,00 64.425
CLOZAPINE 100 MG 15,00
4036 MOERSITI 201904005375 29/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 72.480
ALPRAZOLAM 0.5 MG 30,00
AMITRIPTILIN 25 MG 60,00
4037 MOH. LUKMAN FATONI 201904002431 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 87.615
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
4038 MOH. NUR YASIN 201904005999 30/04/2019 Poli Psikiater THD 2 MG 6,00 3.630
CPZ 100 MG 6,00
TFP 5 MG 6,00
4039 MOH. SHOFIUDIN 201904003817 22/04/2019 Poli Psikiater NEURODEK 60,00 194.670
RIZODAL 2 MG 90,00
THD 2 MG 90,00
4040 MOHAMMAD FIRMAN 201904005545 29/04/2019 Poli Psikiater TFP 5 MG 60,00 81.330
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4041 MOHAMMAD YAKIN 201904002799 15/04/2019 Poli Psikiater CLOZAPINE 25 MG 67,00 194.752
RISPERIDONE 2 MG 135,00
THD 2 MG 135,00
4042 MOKH URIP 201904001367 08/04/2019 Psiko Geriatri CPZ 100 MG 15,00 15.450
TFP 5 MG 30,00
THD 2 MG 30,00
4043 MOKH. KHOIRI 201904002700 15/04/2019 Poli Psikiater CPZ 100 MG 100,00 18.000
4044 MOKH. YUSUF JULAIDON 201904002599 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 166.830
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
4045 MORSIDI 201904003562 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 23,00 117.799
TFP 5 MG 60,00
THD 2 MG 60,00
4046 MR-X/ ABDULLAH 201904004762 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4047 MRS X /RIPKA 201904004900 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 2,00 826
CPZ 100 MG 1,00
4048 MUCHLAS ROZI 201904000745 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 45,00 220.905
RISPERIDONE 3 MG 60,00
4049 MUFTI A'LA ARIFUDDIN 201904005531 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
CPZ 100 MG 30,00
4050 MUHAIMIN 201904001116 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 40.425
CLOZAPINE 25 MG 15,00
4051 MUHAMMAD FATIH 201904005886 30/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 49.515
RISPERIDONE 1 MG 60,00
4052 MUHAMMAD MAHMUDIN 201904004039 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 576.416
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4052 MUHAMMAD MAHMUDIN 201904004039 22/04/2019 Poli Jiwa- Dewasa SIKZONOATE 1,00 576.416
SPUIT 3 CC 1,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 60,00
DEPAKOTE ER 250 60,00
4053 MUHAMMAD SYAMSUL 201904000676 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 290.946
DEPAKOTE ER 250 30,00
RISPERIDONE 3 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
4054 MUHLIS EFENDI 201904006024 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
4055 MUJI 201904004744 24/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
4056 MUKREH 201904004761 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4057 MULYANI 201904005341 29/04/2019 Psiko Geriatri RACIKAN KAPSUL 30,00 76.146
ALPRAZOLAM 1 MG 15,00
SERTRALINE 50 MG 9,00
KAPSUL NO.00 30,00
SEROQUEL XR 300 3,00
4058 MULYONO 201904003536 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 8,00 17.472
CLOZAPINE 25 MG 8,00
4059 MUSFIQ 201904002779 15/04/2019 Poli Psikiater THD 2 MG 180,00 441.180
RISPERIDONE 3 MG 180,00
DEPAKOTE 250 MG 90,00
SERTRALINE 50 MG 90,00
4060 MUSIATI 201904000776 04/04/2019 Psiko Geriatri RISPERIDONE 2 MG 30,00 47.005
CLOZAPINE 25 MG 15,00
THD 2 MG 30,00
FOLIC ACID 1 MG 30,00
VIT B COMPLEX 10,00
4061 MUSLIH 201904000176 01/04/2019 Poli Psikiater CLORILEX 25 MG 15,00 124.860
STELAZINE 5 MG 60,00
THD 2 MG 60,00
201904005959 30/04/2019 Poli Psikiater THD 2 MG 60,00 80.940
CLORILEX 25 MG 15,00
TFP 5 MG 60,00
4062 MUSTOFA 201904002905 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 92.940
RISPERIDONE 3 MG 40,00
KAPSUL NO 2 60,00
SERTRALINE 50 MG 30,00
RACIKAN KAPSUL 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4063 NABROWI 201904000169 01/04/2019 Poli Psikiater
- THD 2 MG 100,00 44.670
CPZ 100 MG 30,00
TFP 5 MG 90,00
4064 NAFIUDDIN A.A 201904006036 30/04/2019 Poli Psikiater THD 2 MG 30,00 75.555
RISPERIDONE 3 MG 30,00
NUZIP 25 15,00
SERTRALINE 50 MG 15,00
4065 NAILIL FARIHAH 201904003341 16/04/2019 Poli Psikiater TFP 5 MG 60,00 68.880
THD 2 MG 90,00
RISPERIDONE 3 MG 60,00
4066 NANANG WIYONO 201904000705 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 194.446
HALDOL DECANOAS 1,00
SPUIT 3 CC 1,00
HALOPERIDOL 5 MG 90,00
CLOZAPINE 100 MG 15,00
4067 NAPSIAH 201904004898 25/04/2019 Ruangan CPZ 100 MG 4,00 3.304
TFP 5 MG 8,00
4068 NARTO 201904001848 09/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
4069 NASIR 201904005167 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 55.635
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
4070 NENENG 201904004899 25/04/2019 Poli Jiwa Dewasa THD 2 MG 1,00 748
TFP 5 MG 2,00
4071 NGATIMAH 201904002760 15/04/2019 Poli Psikiater TFP 5 MG 45,00 23.445
THD 2 MG 45,00
CPZ 100 MG 24,00
4072 NITA DESI RUSWITA 201904000460 02/04/2019 Poli Psikiater KAPSUL NO 2 30,00 86.070
TFP 5 MG 6,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 12,00
SERTRALINE 50 MG 36,00
201904005920 30/04/2019 Poli Psikiater SERTRALINE 50 MG 68,00 151.245
KAPSUL NO 2 45,00
TFP 5 MG 9,00
RACIKAN KAPSUL 45,00
CLOBAZAM 10 MG 14,00
4073 NORHAYATI 201904002875 15/04/2019 Poli Psikiater CLOBAZAM 10 MG 11,00 156.552
ELXION 11,00
4074 NOVI ANDIKA 201904005426 29/04/2019 Poli Psikiater CLOZAPINE 100 MG 60,00 333.660
RISPERIDONE 3 MG 120,00
THD 2 MG 120,00
4075 NOVITA RINI 201904003197 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.300
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4075 NOVITA RINI 201904003197 16/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 60,00 36.300
TFP 5 MG 60,00
4076 NUR CHOLIDAH 201904002755 15/04/2019 Poli Syaraf VIT B1 50 MG 30,00 86.410
PIRACETAM 800 MG 30,00
RIZODAL 2 MG 30,00
THD 2 MG 30,00
LORAZEPAM 2 MG 8,00
4077 NUR SLAMET 201904002598 12/04/2019 Poli Jiwa Dewasa DIAZEPAM 5 MG 15,00 61.005
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
4078 NUR SUJAYADI 201904000671 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 65.520
TFP 5 MG 30,00
4079 NURYATI 201904000876 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 56.790
SERTRALINE 50 MG 15,00
THD 2 MG 30,00
4080 OJON 201904004910 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4081 PAIKIN 201904004912 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.180
CPZ 100 MG 60,00
4082 PANJI ADI SAPUTRO 201904002263 11/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 160.680
DEPAKOTE 250 MG 60,00
CLOBAZAM 10 MG 60,00
4083 PITANI 201904004018 22/04/2019 Psiko Geriatri RISPERIDONE 2 MG 60,00 167.250
DEPAKOTE 250 MG 60,00
CLOZAPINE 25 MG 30,00
4084 PRAMESWARI 201904001048 05/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 817.605
CLOZAPINE 25 MG 45,00
SEROQUEL XR 400 30,00
THD 2 MG 30,00
4085 PRAMONO 201904002094 10/04/2019 Poli Jiwa Dewasa CPZ 100 MG 5,00 4.130
TFP 5 MG 10,00
201904004724 24/04/2019 Ruangan Kenari TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
4086 PRASETYA 201904004750 24/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
4087 PURWANTO 201904001355 08/04/2019 Poli Psikiater TFP 5 MG 60,00 131.370
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 120,00
4088 Petrus Limantoro 201904001310 08/04/2019 Psiko Geriatri RISPERIDONE 3 MG 30,00 97.680
KAPSUL NO 2 90,00
THD 2 MG 45,00
CLOZAPINE 25 MG 30,00
RACIKAN KAPSUL 90,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4088 Petrus Limantoro 201904001310 08/04/2019 Psiko Geriatri
- HALOPERIDOL 5 MG 90,00 97.680
4089 QUR'ANIN RIEDHA 201904001398 08/04/2019 Poli Psikiater RIZODAL 2 MG 30,00 68.317
CLOZAPINE 25 MG 7,00
THD 2 MG 30,00
201904003856 22/04/2019 Poli Psikiater THD 2 MG 30,00 87.108
RIZODAL 2 MG 44,00
CLOZAPINE 25 MG 4,00
4090 QURRATU AININLIY 201904000693 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 72.090
RISPERIDONE 3 MG 60,00
SERTRALINE 50 MG 15,00
4091 R. DJOKO PURNOMO, 201904002724 15/04/2019 Psiko Geriatri ALPRAZOLAM 0.5 MG 30,00 19.350
NOPRES 20 MG 15,00
4092 RACHMAD, DRS.EC 201904000749 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 45.420
CPZ 100 MG 30,00
THD 2 MG 60,00
HALOPERIDOL 5 MG 60,00
4093 RAGIL BAGUS 201904004383 23/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 71.400
RISPERIDONE 2 MG 30,00
THD 2 MG 30,00
4094 RAHMAN HAKIM 201904004376 23/04/2019 Poli Psikiater HALOPERIDOL 5 MG 90,00 239.806
SPUIT 3 CC 1,00
DEPAKOTE ER 250 30,00
HALDOL DECANOAS 1,00
4095 RAHMAT HIDAYAT 201904002329 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
4096 RAMIDI 201904004911 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 97.740
SERTRALINE 50 MG 30,00
4097 RAMLI 201904001311 08/04/2019 Psiko Geriatri CLOZAPINE 25 MG 30,00 90.750
CLOBAZAM 10 MG 30,00
4098 RASMIN 201904004747 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 45.720
RISPERIDONE 3 MG 60,00
4099 RATIH PUSPITASARI K 201904000824 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 90,00 277.116
THD 2 MG 60,00
KAPSUL NO.00 60,00
DEPAKOTE ER 250 60,00
CLOZAPINE 100 MG 12,00
RACIKAN KAPSUL 60,00
4100 REBIAH 201904000686 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
4101 REKAMANA 201904004763 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4102 REOLINA JUNI TIWI 201904000869 04/04/2019 Poli Jiwa- Dewasa THD 2 MG 60,00 495.936
CLOZAPINE 100 MG 45,00
DEPAKOTE ER 250 60,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
SIKZONOATE 1,00
CARBAMAZEPINE 60,00
4103 RESYU EFENDI 201904002720 15/04/2019 Poli Psikiater THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
4104 RIFA SUSIANI 201904002821 15/04/2019 Poli Psikiater RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
4105 RIFAI 201904002716 15/04/2019 Poli Psikiater RISPERIDONE 2 MG 135,00 224.515
THD 2 MG 135,00
SIZORIL 25 MG 50,00
201904004764 24/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
4106 RIFQI HARTANTO 201904001376 08/04/2019 Poli Psikiater NERIPROS 2 MG 60,00 513.420
CLORILEX 25 MG 30,00
4107 RINA 201904004684 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 1,00 1.014
RISPERIDONE 2 MG 2,00
4108 RINA TARYIYATI 201904003206 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 382.830
CLOZAPINE 100 MG 30,00
DEPAKOTE ER 500 30,00
RISPERIDONE 3 MG 60,00
4109 RINI HERMIYATI / 201904000222 01/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904003360 16/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
4110 RINI PUJI ASTUTI 201904000883 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 8,00 27.398
RISPERIDONE 2 MG 30,00
4111 ROFIKHUL JAMIL 201904005374 29/04/2019 Poli Psikiater THD 2 MG 100,00 263.500
CLOZAPINE 25 MG 100,00
RISPERIDONE 3 MG 100,00
4112 ROWI 201904004742 24/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 22.080
TFP 5 MG 60,00
4113 RUDI SISWANTO 201904003208 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4114 RUDIANTO 201904002557 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 30,00 160.710
RISPERIDONE 3 MG 60,00
4115 RUKEMI 201904000666 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 30,00 48.075
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4115 RUKEMI 201904000666 04/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 15,00 48.075
4116 RULLY 201904004905 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
4117 RULYA TRI PRASTYA 201904000263 01/04/2019 Poli Psikiater CLOZAPINE 25 MG 60,00 203.340
THD 2 MG 60,00
BAMGETOL 200 MG 60,00
4118 RUSMINI 201904000872 04/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 91.335
CLOZAPINE 100 MG 15,00
RISPERIDONE 2 MG 60,00
4119 RUSTYANINGSIH 201904003789 22/04/2019 Poli Psikiater ARINIA 15 MG 30,00 1.200.471
SPUIT 3 CC 1,00
SIKZONOATE 1,00
THD 2 MG 30,00
4120 SADELI 201904005534 29/04/2019 Poli Psikiater TFP 5 MG 60,00 25.500
THD 2 MG 60,00
4121 SAFIIH 201904001436 08/04/2019 Poli Psikiater THD 2 MG 180,00 61.200
CPZ 100 MG 90,00
HALOPERIDOL 5 MG 180,00
4122 SAID AUDAH 201904005352 29/04/2019 Psiko Geriatri THD 2 MG 60,00 38.820
RACIKAN KAPSUL 60,00
CPZ 100 MG 60,00
TFP 5 MG 60,00
KAPSUL NO 2 60,00
4123 SAIDAH SAID 201904000789 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 45,00 204.630
THD 2 MG 60,00
LORAZEPAM 2 MG 15,00
PROPANOLOL 10 MG 60,00
4124 SAMSUL HAYATULAH 201904005395 29/04/2019 Poli Psikiater ARINIA 15 MG 35,00 1.316.700
4125 SAMSURI 201904005358 29/04/2019 Psiko Geriatri CPZ 100 MG 15,00 2.700
201904005359 29/04/2019 Psiko Geriatri CPZ 100 MG 15,00 2.700
4126 SAMUJI 201904005443 29/04/2019 Poli Psikiater HALOPERIDOL 5 MG 60,00 144.646
HALDOL DECANOAS 1,00
THD 2 MG 60,00
SPUIT 3 CC 1,00
CPZ 100 MG 30,00
4127 SANTANU SONYAWAN 201904000887 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
4128 SAPURA 201904003969 22/04/2019 Psiko Geriatri DEPTRAL 50 MG 45,00 1.934.820
FOLIC ACID 1 MG 90,00
RACIKAN KAPSUL 90,00
HALOPERIDOL 5 MG 9,00
ARICEPT 10 MG 90,00
CLOBAZAM 10 MG 27,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4128 SAPURA 201904003969 22/04/2019 Psiko Geriatri
- KAPSUL NO 2 90,00 1.934.820
4129 SARMEDI PURBA 201904004440 23/04/2019 Poli Psikiater RISPERIDONE 2 MG 56,00 28.350
THD 2 MG 49,00
4130 SARMON 201904004919 25/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 154.506
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
SIKZONOATE 1,00
TFP 5 MG 60,00
4131 SARWONO 201904004737 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4132 SATIJAH 201904000177 01/04/2019 Psiko Geriatri RISPERIDONE 2 MG 90,00 213.030
THD 2 MG 90,00
CLORILEX 25 MG 45,00
4133 SAVIN AL HINDUWAN 201904004818 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 80.850
CLOZAPINE 25 MG 30,00
4134 SELAMET RIYADI 201904000738 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4135 SEPTIN ERNAWATI 201904005027 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 104.715
TFP 5 MG 60,00
CLOZAPINE 25 MG 15,00
4136 SHOLEH 201904002321 11/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 30.900
TFP 5 MG 60,00
THD 2 MG 60,00
4137 SIMAH 201904001323 08/04/2019 Poli Psikiater RIZODAL 2 MG 60,00 133.020
TFP 5 MG 60,00
THD 2 MG 90,00
4138 SIMON 201904004940 25/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 28.200
TFP 5 MG 60,00
THD 2 MG 60,00
4139 SIN TIANI DEWI 201904001478 08/04/2019 Psiko Geriatri THD 2 MG 60,00 50.520
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
4140 SISMIADI 201904000787 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
4141 SISWANTO 201904003202 16/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 55.920
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
CPZ 100 MG 30,00
4142 SISWANTO 201904004934 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
4143 SITI AMINAH 201904005035 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 56.130
RISPERIDONE 3 MG 60,00
TFP 5 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4144 SITI CHOMARIYAH 201904001469 08/04/2019 Psiko Geriatri
- CLOBAZAM 10 MG 30,00 92.340
SERTRALINE 50 MG 30,00
4145 SITI FATIMAH 201904005457 29/04/2019 Poli Psikiater RISPERIDONE 1 MG 90,00 32.400
4146 SITI FITRIA 201904003749 22/04/2019 Poli Psikiater SIZORIL 25 MG 15,00 71.835
TFP 5 MG 60,00
THD 2 MG 60,00
4147 SITI MAKHMIROH. SPD 201904000855 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 52.935
RISPERIDONE 2 MG 60,00
4148 SITI MARYATI 201904001394 08/04/2019 Poli Psikiater THD 2 MG 90,00 38.250
TFP 5 MG 90,00
4149 SITI MUJIATI 201904003337 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 71.220
TFP 5 MG 60,00
CPZ 100 MG 30,00
THD 2 MG 60,00
4150 SITI MUNTIAH 201904002551 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 15.450
TFP 5 MG 30,00
THD 2 MG 30,00
4151 SITI NURHIDAYATI 201904004384 23/04/2019 Poli Psikiater RIZODAL 2 MG 60,00 113.280
CPZ 100 MG 15,00
THD 2 MG 60,00
4152 SITI RAHAYU 201904003335 16/04/2019 Psiko Geriatri TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
4153 SITI ROCHANI 201904003595 18/04/2019 Psiko Geriatri SEROQUEL XR 400 30,00 962.640
DEPAKOTE ER 250 30,00
DEPAKOTE ER 500 30,00
4154 SITI ROKHIMAH 201904005062 26/04/2019 Poli Psikiater NUZIP 25 5,00 405.045
KAPSUL NO 2 60,00
ALGANAX 1 MG 30,00
RIZODAL 2 MG 60,00
RACIKAN KAPSUL 60,00
ELIZAC 20 MG 60,00
THD 2 MG 75,00
4155 SITI SAHRO 201904003886 22/04/2019 Poli Psikiater NUZIP 25 30,00 140.130
RISPERIDONE 3 MG 120,00
THD 2 MG 120,00
4156 SITI SULAIHAH 201904001337 08/04/2019 Poli Psikiater THD 2 MG 60,00 115.251
SPUIT 3 CC 1,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 60,00
4157 SITI USWATUN 201904000219 01/04/2019 Ruangan IKALEP 250 MG 14,00 87.479
STELAZINE 5 MG 21,00
CPZ 100 MG 21,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4158 SITI ZUHROH 201904000016 01/04/2019 Poli Psikiater
- FOLIC ACID 1 MG 15,00 45.737
SEROQUEL XR 300 1,00
KAPSUL NO 2 30,00
CLOBAZAM 10 MG 23,00
RACIKAN KAPSUL 30,00
201904005350 29/04/2019 Poli Psikiater SEROQUEL XR 400 2,00 86.358
CLOBAZAM 10 MG 34,00
RACIKAN KAPSUL 45,00
FOLIC ACID 1 MG 23,00
KAPSUL NO 2 45,00
4159 SIYAAMI ROMADHON 201904005888 30/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 15,00 142.470
SERTRALINE 50 MG 30,00
4160 SJRI WIDASIH 201904004861 25/04/2019 Poli Psikiater ARINIA 15 MG 5,00 188.100
4161 SLAMET 201904004907 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
201904006026 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 36.540
THD 2 MG 60,00
CPZ 100 MG 30,00
4162 SLAMET MUGIARTO 201904000146 01/04/2019 Poli Psikiater SERTRALINE 50 MG 45,00 93.015
ALPRAZOLAM 0.5 MG 45,00
4163 SOEMARDI 201904003798 22/04/2019 Psiko Geriatri RACIKAN KAPSUL 30,00 441.585
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 4,00
CLONAZEPAM 2 MG 5,00
KAPSUL NO.00 30,00
ARICEPT 10 MG 15,00
CLOZAPINE 25 MG 15,00
4164 SOEYANTO SANDJAJA 201904003588 18/04/2019 Psiko Geriatri THD 2 MG 60,00 118.050
DEPAKOTE ER 250 30,00
TFP 5 MG 30,00
4165 SONI MASKUR 201904002762 15/04/2019 Poli Psikiater THD 2 MG 30,00 105.420
SIZORIL 25 MG 30,00
TFP 5 MG 30,00
4166 SONNY DWI PRASETYO 201904001561 08/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 1.066.080
CLOZAPINE 100 MG 60,00
THD 2 MG 30,00
CLONAZEPAM 2 MG 30,00
4167 SRI MULYANI 201904004677 24/04/2019 Ruangan CPZ 100 MG 10,00 5.030
TFP 5 MG 10,00
4168 SRI RUSDIANTI 201904000711 04/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 167.730
TFP 5 MG 60,00
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4169 SRI WAHYUNI 201904000797 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 71.400
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4169 SRI WAHYUNI 201904000797 04/04/2019 Poli Jiwa- Dewasa CLOZAPINE 25 MG 30,00 71.400
RISPERIDONE 2 MG 30,00
4170 SRI WAHYUNINGSIH 201904003200 16/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 50.355
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
4171 SRI WIYANTI WIDIASTUTI 201904003814 22/04/2019 Poli Psikiater CPZ 100 MG 90,00 61.200
HALOPERIDOL 5 MG 180,00
THD 2 MG 180,00
4172 SRIE NUNGGARYATI 201904000446 02/04/2019 Poli Psikiater DEPTRAL 50 MG 10,00 132.160
CLOBAZAM 10 MG 10,00
201904003748 22/04/2019 Poli Psikiater SERTRALINE 50 MG 10,00 30.780
CLOBAZAM 10 MG 10,00
4173 SRIYATUN 201904001362 08/04/2019 Psiko Geriatri SERTRALINE 50 MG 30,00 556.434
KAPSUL NO.00 30,00
CLOBAZAM 10 MG 60,00
ABILIFY DISCMELT 10 15,00
RACIKAN KAPSUL 30,00
CLOZAPINE 100 MG 3,00
4174 SUBAHRI 201904005969 30/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 28.200
TFP 5 MG 60,00
THD 2 MG 60,00
4175 SUCI 201904000215 01/04/2019 Ruangan CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904003361 16/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.098
CPZ 100 MG 7,00
4176 SUCIANI 201904005372 29/04/2019 Poli Psikiater KAPSUL NO 2 60,00 194.610
RISPERIDONE 3 MG 30,00
TFP 5 MG 60,00
RACIKAN KAPSUL 60,00
SERTRALINE 50 MG 60,00
KAPSUL NO 2 60,00
THD 2 MG 60,00
RACIKAN KAPSUL 60,00
TFP 5 MG 90,00
4177 SUDIONO 201904004909 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
4178 SUDIYANI 201904003027 15/04/2019 Ruangan Puri SPUIT 50 CC LUBANG 2,00 73.920
STOMACH TUBE 16 1,00
201904003346 16/04/2019 Ruangan Puri NOPRES 20 MG 8,00 25.684
FOLIC ACID 1 MG 8,00
RISPERIDONE 3 MG 11,00
KAPSUL NO 2 16,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4178 SUDIYANI 201904003346 16/04/2019 Ruangan
- Puri THD 2 MG 16,00 25.684
CLOZAPINE 25 MG 4,00
RACIKAN KAPSUL 16,00
201904003821 22/04/2019 Psiko Geriatri RIZODAL 2 MG 60,00 230.190
KAPSUL NO 2 60,00
OLANZPINE 10mg 15,00
RACIKAN KAPSUL 60,00
NOPRES 20 MG 30,00
FOLIC ACID 1 MG 30,00
THD 2 MG 60,00
4179 SUGENG 201904006019 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 31.140
RISPERIDONE 2 MG 60,00
4180 SUGENG PURNOMO 201904005049 26/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 30,00 34.485
THD 2 MG 15,00
KAPSUL NO.00 30,00
CLOZAPINE 25 MG 15,00
RACIKAN KAPSUL 30,00
4181 SUGENG TRI HANDOKO 201904002767 15/04/2019 Poli Psikiater THD 2 MG 60,00 71.835
SIZORIL 25 MG 15,00
TFP 5 MG 60,00
4182 SUHENIK 201904002485 12/04/2019 Poli Jiwa Dewasa RACIKAN KAPSUL 30,00 21.173
CLOZAPINE 25 MG 8,00
TFP 5 MG 15,00
KAPSUL NO.0 30,00
4183 SUKARIYONO 201904000187 01/04/2019 Poli Psikiater RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
4184 SUKARNI 201904003875 22/04/2019 Poli Psikiater THD 2 MG 30,00 22.440
TFP 5 MG 60,00
4185 SUKARNO WIDAGDO 201904000831 04/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 60.270
CLOZAPINE 25 MG 30,00
4186 SULAIMAN 201904001811 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
201904005218 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 17.700
CPZ 100 MG 15,00
HALOPERIDOL 5 MG 60,00
4187 SULAIMAN 201904005955 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 43.380
RISPERIDONE 3 MG 60,00
4188 SULISNO 201904000859 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
4189 SULISTIONO 201904005234 26/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 30,00 63.630
SERTRALINE 50 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4190 SULISTIYOWATI 201904000217 01/04/2019 Ruangan
- RISPERIDONE 2 MG 14,00 7.986
THD 2 MG 14,00
CPZ 100 MG 4,00
201904003365 16/04/2019 Ruangan RISPERIDONE 2 MG 14,00 7.986
THD 2 MG 14,00
CPZ 100 MG 4,00
4191 SULISTRIONO 201904005508 29/04/2019 Poli Psikiater ELIZAC 20 MG 7,00 23.855
MERLOPAM 2 MG 4,00
4192 SULTON MUHAZIR 201904002510 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
4193 SUMARIADI 201904004759 24/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 22.440
THD 2 MG 30,00
4194 SUMARTINI 201904000715 04/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 15,00 889.425
ABILIFY DISCMELT 10 30,00
4195 SUMIANI 201904000089 01/04/2019 Psiko Geriatri THD 2 MG 60,00 83.550
CLOZAPINE 25 MG 30,00
RISPERIDONE 1 MG 60,00
4196 SUMIDI 201904002782 15/04/2019 Poli Psikiater THD 2 MG 120,00 527.691
SIKZONOATE 1,00
SPUIT 3 CC 1,00
NUZIP 25 60,00
TFP 5 MG 120,00
RIZODAL 2 MG 180,00
4197 SUMIRAN 201904004917 25/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 42.915
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
4198 SUNANDAR DUL HALIM 201904004913 25/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.200
TFP 5 MG 60,00
CPZ 100 MG 60,00
4199 SUNAWATI 201904001040 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 158.100
CLOZAPINE 25 MG 60,00
RISPERIDONE 3 MG 60,00
4200 SUNTI YATIM Z 201904003620 18/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
4201 SUNYOTO 201904005552 29/04/2019 Poli Psikiater CPZ 100 MG 15,00 15.450
TFP 5 MG 30,00
THD 2 MG 30,00
4202 SUPARMI 201904000057 01/04/2019 Poli Psikiater CPZ 100 MG 45,00 8.100
4203 SUPARNO A 201904004676 24/04/2019 Ruangan Kenari CPZ 100 MG 5,00 5.070
RISPERIDONE 2 MG 10,00
4204 SUPRAPTI 201904000218 01/04/2019 Ruangan RISPERIDONE 2 MG 14,00 6.558
CPZ 100 MG 4,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4204 SUPRAPTI 201904003359 16/04/2019 Ruangan
- CPZ 100 MG 4,00 10.128
RISPERIDONE 3 MG 14,00
4205 SUPRIATUN 201904004389 23/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
4206 SUPRIYANTO 201904002569 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 75.210
TFP 5 MG 60,00
4207 SURATMAN 201904005337 29/04/2019 Poli Psikiater TFP 5 MG 120,00 61.800
THD 2 MG 120,00
CPZ 100 MG 60,00
4208 SUSENO BUDIANTO 201904004661 24/04/2019 Poli Psikiater RACIKAN KAPSUL 60,00 398.851
SIZORIL 100 MG 8,00
CLONAZEPAM 2 MG 15,00
THD 2 MG 60,00
SIZORIL 25 MG 15,00
KAPSUL NO 2 60,00
RIZODAL 2 MG 60,00
4209 SUTARMI 201904000017 01/04/2019 Psiko Geriatri KAPSUL NO 2 120,00 126.870
THD 2 MG 120,00
RACIKAN KAPSUL 120,00
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 80,00
4210 SUTIK 201904000224 01/04/2019 Ruangan TFP 5 MG 14,00 5.782
CPZ 100 MG 7,00
201904004650 24/04/2019 Ruangan CPZ 100 MG 7,00 5.782
TFP 5 MG 14,00
4211 SUUDIYAH MUHAMMAD 201904000261 01/04/2019 Poli Psikiater KAPSUL NO 2 120,00 135.048
TFP 5 MG 96,00
RACIKAN KAPSUL 120,00
THD 2 MG 180,00
RISPERIDONE 3 MG 120,00
4212 SUWANDI 201904000688 04/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 20.400
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
4213 SUWARNI 201904005051 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 27.720
RISPERIDONE 1 MG 60,00
4214 SUYITNO 201904000692 04/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 83.910
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
4215 SWIE HWA 201904001484 08/04/2019 Psiko Geriatri THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
4216 SYAFA'ATUS SHOLIHAH 201904003755 22/04/2019 Poli Psikiater PUSPALIN 500mg 90,00 575.505
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4216 SYAFA'ATUS SHOLIHAH 201904003755 22/04/2019 Poli Psikiater
- THD 2 MG 135,00 575.505
RIZODAL 2 MG 135,00
4217 SYAFIUR RAHMAN 201904003751 22/04/2019 Poli Psikiater RISPERIDONE 2 MG 120,00 195.840
THD 2 MG 60,00
CLOBAZAM 10 MG 120,00
4218 SYAFRUDIN KURNIAWAN 201904001804 09/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 60,00 375.411
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
SIKZONOATE 1,00
SPUIT 3 CC 1,00
TFP 5 MG 60,00
4219 SYAIFULLAH 201904003819 22/04/2019 Poli Psikiater TFP 5 MG 14,00 7.042
CPZ 100 MG 14,00
4220 SYARIEF KUSBIYANTO 201904002795 15/04/2019 Poli Psikiater KAPSUL NO 2 60,00 168.540
CLORILEX 25 MG 15,00
RACIKAN KAPSUL 60,00
RIZODAL 2 MG 60,00
THD 2 MG 60,00
4221 TAN BING KING 201904004728 24/04/2019 Psiko Geriatri RIZODAL 2 MG 90,00 237.630
THD 2 MG 60,00
CLORILEX 25 MG 15,00
TFP 5 MG 60,00
4222 THERESIA WINNY 201904001156 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 55.830
4223 TIAS AFIFAH 201904000173 01/04/2019 Poli Psikiater RIZODAL 2 MG 180,00 539.640
THD 2 MG 180,00
STELAZINE 5 MG 180,00
VIT B COMPLEX 180,00
4224 TITIK SETYARINI 201904000697 04/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.500
THD 2 MG 60,00
4225 TJANDRANINGSIH 201904002758 15/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 58.935
KAPSUL NO 2 15,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 15,00
201904005647 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 1.304.520
RACIKAN KAPSUL 60,00
AMITRIPTILIN 25 MG 30,00
KAPSUL NO.00 60,00
ABILIFY DISCMELT 15 30,00
CLOBAZAM 10 MG 60,00
PROPANOLOL 40 MG 15,00
4226 TJING JONG SUDARSO 201904000904 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 139.371
CPZ 100 MG 60,00
THD 2 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4226 TJING JONG SUDARSO 201904000904 04/04/2019 Poli Jiwa- Dewasa HALOPERIDOL 5 MG 90,00 139.371
SIKZONOATE 1,00
SPUIT 3 CC 1,00
4227 TRI NUR HIDAYATI 201904003325 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
4228 TRI WULANDARI 201904001839 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 55.995
THD 2 MG 30,00
CLOZAPINE 25 MG 15,00
4229 TUMINA 201904001392 08/04/2019 Poli Psikiater STELAZINE 5 MG 120,00 144.240
CPZ 100 MG 30,00
THD 2 MG 120,00
4230 TUMINI INDRAWATI 201904002565 12/04/2019 Poli Jiwa Dewasa FRIMANIA 200 MG 60,00 135.810
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
4231 TUPANI 201904000065 01/04/2019 Poli Psikiater THD 2 MG 120,00 109.530
NUZIP 25 30,00
RISPERIDONE 2 MG 120,00
4232 TUTIK WALUYOWATI 201904002447 12/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 15,00 91.170
THD 2 MG 60,00
4233 UBEK 201904006011 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.020
FOLIC ACID 1 MG 30,00
TFP 5 MG 60,00
4234 UMA LISTIYOWATI 201904002403 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 125.760
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
4235 UMBARI 201904004738 24/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 7.500
THD 2 MG 30,00
4236 UNDAH ANIK 201904002265 11/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
4237 USMAN SAFI 201904006006 30/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 30.900
THD 2 MG 60,00
CPZ 100 MG 30,00
4238 WAHYU HERLIYANTO 201904001374 08/04/2019 Poli Psikiater STELAZINE 5 MG 90,00 106.470
CPZ 100 MG 30,00
THD 2 MG 60,00
4239 WAHYU TRIANTORO 201904005048 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 1 MG 60,00 123.840
DEPAKOTE ER 250 30,00
4240 WAHYUDI 201904003898 22/04/2019 Psiko Geriatri THD 2 MG 120,00 72.600
CPZ 100 MG 120,00
TFP 5 MG 120,00
4241 WAHYUNI 201904005514 29/04/2019 Poli Psikiater RISPERIDONE 2 MG 14,00 12.383
LORAZEPAM 2 MG 7,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4242 WARDAH WULANDARI 201904004702 24/04/2019 Poli Psikiater
- VIT B6 10 MG 30,00 1.570.110
SERTRALINE 50 MG 120,00
ARINIA 15 MG 30,00
KAPSUL NO 2 60,00
THD 2 MG 30,00
DEPAKOTE ER 250 60,00
RACIKAN KAPSUL 60,00
4243 WARNO 201904004758 24/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 15.000
THD 2 MG 60,00
201904006012 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 30.900
CPZ 100 MG 30,00
TFP 5 MG 60,00
4244 WARSONO BUDIARTO 201904001341 08/04/2019 Poli Psikiater TFP 5 MG 180,00 76.500
THD 2 MG 180,00
4245 WELLY FRANS EDWARD 201904005046 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 81.330
CLOZAPINE 25 MG 30,00
TFP 5 MG 60,00
4246 WIDIANTO 201904000889 04/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4247 WINARTI 201904001851 09/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 45,00 18.765
4248 WIWIK WAHYUNI 201904003201 16/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4249 WULYO 201904001142 05/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 83.910
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
4250 WURIJANTI 201904001301 08/04/2019 Psiko Geriatri OLANZPINE 10mg 30,00 932.280
CLOZAPINE 25 MG 60,00
SEROQUEL XR 400 30,00
THD 2 MG 60,00
4251 YANUAR KUSUMA 201904004841 25/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 215.040
THD 2 MG 60,00
DEPAKOTE ER 250 60,00
4252 YANUAR PRATAMA 201904003311 16/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 171.100
VIT B COMPLEX 10,00
4253 YANUAR PRIBADI 201904002914 15/04/2019 Poli Psikiater TFP 5 MG 120,00 61.800
THD 2 MG 120,00
CPZ 100 MG 60,00
4254 YENI OKTAVIAN SARI 201904004964 25/04/2019 Poli Psikiater TFP 5 MG 20,00 6.460
4255 YOSY CITRA PERTIWI S 201904003902 22/04/2019 Poli Psikiater OLANZPINE 10mg 45,00 255.150
4256 YUDHA HENGKIYONO 201904000541 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4256 YUDHA HENGKIYONO 201904000541 02/04/2019 Poli Jiwa- Dewasa TFP 5 MG 60,00 28.200
4257 YUDHA KUSUMA 201904005463 29/04/2019 Poli Psikiater CLOZAPINE 25 MG 120,00 262.080
TFP 5 MG 120,00
4258 YUDHI PURNOMO 201904002941 15/04/2019 Poli Jiwa Dewasa CARBAMAZEPINE 60,00 176.250
SERTRALINE 50 MG 30,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
4259 YUDI ARAFAT 201904000470 02/04/2019 Poli Psikiater SERTRALINE 50 MG 30,00 264.270
KAPSUL NO 2 60,00
THD 2 MG 30,00
RACIKAN KAPSUL 60,00
NERIPROS 2 MG 30,00
4260 YUDI HERMANTO 201904002459 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
4261 YULI SETYOWATI 201904005042 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 72.315
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 60,00
4262 YULIANA 201904002538 12/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 14.040
THD 2 MG 15,00
4263 YULIANTO BUDI N 201904001539 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 23,00 186.610
SIKZONOATE 1,00
TFP 5 MG 60,00
SPUIT 3 CC 1,00
THD 2 MG 60,00
4264 YULIUS YUDIANTO 201904002411 12/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 69.135
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
4265 YUNITA 201904002376 12/04/2019 Poli Psikiater CLOBAZAM 10 MG 3,00 436.452
THD 2 MG 2,00
IKALEP 250 MG 6,00
KAPSUL NO 3 6,00
ABILIFY DISCMELT 15 3,00
RACIKAN KAPSUL 6,00
CIPRALEX 20 MG 6,00
201904004798 25/04/2019 Poli Psikiater CIPRALEX 20 MG 6,00 420.630
KAPSUL NO.0 6,00
THD 2 MG 2,00
RACIKAN KAPSUL 6,00
ABILIFY DISCMELT 15 3,00
CLOBAZAM 10 MG 3,00
SERTRALINE 50 MG 6,00
4266 YUNITA RAHMAWATI 201904002435 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 4.230
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4266 YUNITA RAHMAWATI 201904002435 12/04/2019 Poli Jiwa- Dewasa THD 2 MG 15,00 4.230
4267 ZAINI 201904004830 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 19.380
4268 ZAINUL ARIFIN 201904005440 29/04/2019 Poli Psikiater THD 2 MG 60,00 65.820
RISPERIDONE 3 MG 60,00
TFP 5 MG 60,00
4269 ZUBAIRAHMAT 201904003343 16/04/2019 Poli Jiwa Anak CLOBAZAM 10 MG 15,00 74.880
SERTRALINE 50 MG 30,00
4270 ZULFATUL LAILI 201904002777 15/04/2019 Poli Psikiater TFP 5 MG 60,00 28.200
THD 2 MG 60,00
CPZ 100 MG 15,00
Dokter: dr. VERRY YUDHANA
4271 AKHMAD BAYU 201904002962 15/04/2019 IGD DIAZEPAM inj 1,00 10.566
RISPERIDONE 2 MG 4,00
SPUIT 3 CC 1,00
THD 2 MG 4,00
CLOZAPINE 25 MG 2,00
4272 ARDI ZULKARNAIN 201904002191 10/04/2019 Ruangan Puri CLOZAPINE 25 MG 4,00 9.112
RISPERIDONE 2 MG 4,00
4273 ARSAT AFANDI 201904002642 13/04/2019 Ruangan Wijaya THD 2 MG 6,00 612
4274 FARIS HERMANSYAH 201904005274 26/04/2019 IGD RISPERIDONE 2 MG 8,00 11.596
THD 2 MG 8,00
CLOZAPINE 25 MG 4,00
4275 GURITNO ANGGA 201904003707 19/04/2019 IGD NEEDLE 23 G 1,00 175.263
CLOZAPINE 25 MG 3,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
RISPERIDONE 2 MG 6,00
AQUA PRO INJEKSI 1,00
THD 2 MG 6,00
4276 M YUNUS 201904001270 07/04/2019 IGD VIT B COMPLEX 10,00 7.540
AMOXYCILLIN 500 10,00
ASAM MEFENAMAT 10,00
4277 MIFTAKHUL ULUM 201904005268 26/04/2019 IGD RISPERIDONE 2 MG 8,00 176.710
AQUA PRO INJEKSI 1,00
THD 2 MG 8,00
CLOZAPINE 25 MG 4,00
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
4278 MOCH. FADLI 201904000172 01/04/2019 IGD THD 2 MG 6,00 3.270
CPZ 100 MG 4,00
TFP 5 MG 6,00
4279 NADHIM AHMAD 201904002188 10/04/2019 Ruang Observasi DIAZEPAM inj 1,00 4.768
SPUIT 3 CC 1,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4280 SURYO ADI PURNOMO 201904005270 26/04/2019 IGD
- HALOPERIDOL 1,5 3,00 474
FOLIC ACID 1 MG 3,00
4281 THOLIB 201904000265 01/04/2019 Ruangan Wijaya CPZ 100 MG 4,00 2.016
HALOPERIDOL 5 MG 6,00
THD 2 MG 4,00
4282 ZAINAL ABIDIN 201904003212 16/04/2019 Ruangan Wijaya AQUA PRO INJEKSI 1,00 165.114
ZYPREXA INJ 1,00
SPUIT 3 CC 1,00
Dokter: dr. WIDEYA NOER, Sp.PD
4283 ABDUL GHOFUR 201904000093 01/04/2019 Poli Interna PROPANOLOL 10 MG 30,00 30.540
CURCUMA 200 MG 10,00
NEURODEK 10,00
METHYLPREDNISOL 30,00
4284 ACHMAD RIDWAN 201904005594 29/04/2019 Poli Interna GLUCOSAMINE 10,00 198.070
AMLODIPIN 10 30,00
BIOPREXUM 5 MG 30,00
GEMFIBROZIL 300MG 30,00
PROBENID 500 MG 30,00
4285 ADITYA DJOHAN 201904001170 05/04/2019 Poli Interna CLOPIDOGREL 75 30,00 394.695
HARNAL OCAS 30,00
AMLODIPIN 10 15,00
GLUCOSAMINE 10,00
CEFIXIME 200 MG 10,00
CENDO LYTEERS 15 1,00
4286 AGUSTIN LISDA 201904000506 02/04/2019 Ruangan METFORMIN 500 MG 10,00 13.894
TABLET TAMBAH 14,00
CIPROFLOXACIN 500 14,00
4287 ANAS ILHAM RAMADHAN 201904001638 08/04/2019 Ruangan Kenari MELOXICAM 15 MG 7,00 39.189
GLUCOSAMINE 22,00
201904003651 18/04/2019 Ruangan Kenari CIPROFLOXACIN 500 14,00 36.710
GLUCOSAMINE 20,00
VIT B COMPLEX 20,00
4288 ANNA SULISTARI 201904002817 15/04/2019 Poli Interna SIMVASTATIN 20 MG 0,00 178.830
PROBENID 500 MG 30,00
SPIRONOLACTONE 30,00
METFORMIN 500 MG 30,00
BIOPREXUM 5 MG 30,00
4289 ARDIANY HURIATI 201904001996 09/04/2019 Puri Mitra THIAMPHENICOL 500 30,00 35.460
4290 ASNOTO 201904005717 29/04/2019 Ruangan Gelatik PROBENID 500 MG 10,00 27.820
CIPROFLOXACIN 500 14,00
4291 ASRIL SANI 201904003591 18/04/2019 Poli Interna AMLODIPIN 10 30,00 148.288
SIMVASTATIN 20 MG 30,00
CANDESARTAN 16 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4291 ASRIL SANI 201904003591 18/04/2019 Poli Interna
- KSR 30,00 148.288
CEFIXIME 200 MG 14,00
4292 AVIN 201904002086 10/04/2019 Ruangan Gelatik TABLET TAMBAH 30,00 13.620
FOLIC ACID 1 MG 10,00
4293 CORNELIUS PRIYO 201904003244 16/04/2019 Poli VCT ALPRAZOLAM 1 MG 30,00 5.160
4294 DAFID TEJA KUSUMA 201904001174 05/04/2019 Poli Interna SIMVASTATIN 20 MG 30,00 23.280
NEURODEK 10,00
CURCUMA 200 MG 10,00
4295 DENTRI AGENG 201904003649 18/04/2019 Ruangan Kenari NEURODEK 10,00 12.240
OMEPRAZOLE 20 MG 10,00
VIT B COMPLEX 30,00
4296 DETTY ARIYANI 201904003522 18/04/2019 Poli Interna DIAMICRON MR 60 30,00 199.530
GEMFIBROZIL 300MG 30,00
NEURODEK 10,00
METFORMIN 500 MG 60,00
ACARBOSE 100 MG 60,00
4297 DHEA OCTA AKALILI 201904000498 02/04/2019 Ruangan FOLIC ACID 1 MG 10,00 9.360
TABLET TAMBAH 20,00
4298 DIDIK HARIYANTO 201904003953 22/04/2019 Poli Interna DIAZEPAM 5 MG 30,00 86.758
ATORVASTATIN 20 30,00
RAMIPRIL 5 MG 30,00
CEFIXIME 200 MG 14,00
4299 DINA TRI ASPUJI 201904000492 02/04/2019 Ruangan TABLET TAMBAH 14,00 8.724
PYRANTEL 125 MG 8,00
4300 DJUM SISWANTO 201904005530 29/04/2019 Ruangan Wijaya RAMIPRIL 5 MG 10,00 62.220
ADALAT OROS 30 MG 10,00
CURCUMA 200 MG 14,00
4301 DYAH PRATIWI 201904002518 12/04/2019 Poli Interna CLOPIDOGREL 75 30,00 316.380
ADALAT OROS 30 MG 30,00
RAMIPRIL 5 MG 30,00
CANDESARTAN 16 30,00
SIMVASTATIN 20 MG 0,00
4302 EGI PANRUB 201904002389 12/04/2019 Ruangan Kenari AMOXYCILLIN 500 22,00 8.316
4303 FIRMAN FAJAR 201904003926 22/04/2019 Poli Interna GLUCOSAMINE 10,00 164.140
METFORMIN 500 MG 30,00
BISOPROLOL 5 MG 30,00
ADALAT OROS 30 MG 30,00
4304 FONI ANDRIANI 201904000489 02/04/2019 Ruangan RAMIPRIL 5 MG 10,00 17.040
CURCUMA 200 MG 10,00
METFORMIN 500 MG 10,00
201904003372 16/04/2019 Ruangan CLOZAPINE 25 MG 14,00 64.726
METFORMIN 500 MG 10,00
GLUCOSAMINE 10,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4304 FONI ANDRIANI 201904003372 16/04/2019 Ruangan
- RAMIPRIL 5 MG 10,00 64.726
AMLODIPIN 5 10,00
MELOXICAM 15 MG 10,00
TFP 5 MG 14,00
4305 GARRY SANTOSO 201904003578 18/04/2019 Poli Interna PROBENID 500 MG 30,00 90.690
GEMFIBROZIL 300MG 30,00
METFORMIN 850 MG 30,00
4306 GIARTO 201904004705 24/04/2019 Poli VCT GENTAMYCIN SALEP 2,00 31.620
LANSOPRAZOLE 20,00
METHYLPREDNISOL 20,00
4307 HANANINGTYAS 201904000133 01/04/2019 Poli Interna TABLET TAMBAH 10,00 53.510
LORATADIN 10 MG 10,00
CEFIXIME 200 MG 10,00
METHYLPREDNISOL 30,00
FOLIC ACID 1 MG 30,00
4308 HERU HARIYANTO 201904004626 24/04/2019 Ruangan Gelatik METHYLPREDNISOL 20,00 28.030
PARACETAMOL 500 14,00
DOXYCICLIN 100 MG 20,00
4309 INDAH SURYANINGSIH 201904002764 15/04/2019 Poli Interna DIAMICRON MR 60 30,00 155.970
GLIMEPIRIDE 2 MG 60,00
METFORMIN 500 MG 60,00
GEMFIBROZIL 300MG 30,00
4310 IRFAN 201904003351 16/04/2019 Ruangan Gelatik FOLIC ACID 1 MG 8,00 12.586
TABLET TAMBAH 14,00
CIPROFLOXACIN 500 14,00
4311 IVA ERMAWATI 201904001983 09/04/2019 Ruangan Wijaya PROBENID 500 MG 10,00 33.330
RAMIPRIL 5 MG 10,00
TABLET TAMBAH 20,00
4312 IVAN NUR SOCHIB 201904002778 15/04/2019 Poli Interna AMLODIPIN 10 15,00 34.860
CANDESARTAN 16 30,00
SALBUTAMOL 4 MG 10,00
4313 JONI HARSANTO 201904002841 15/04/2019 Poli Jiwa Dewasa CANDESARTAN 16 30,00 69.740
CEFIXIME 200 MG 10,00
AMLODIPIN 10 30,00
LORATADIN 10 MG 10,00
4314 JUS HAJATI 201904001871 09/04/2019 Ruangan METFORMIN 500 MG 10,00 7.930
CIPROFLOXACIN 500 14,00
4315 LUSI RATNANINGSIH 201904000335 01/04/2019 Poli Interna DEXAMETASON 0,5 10,00 11.150
AMBROXOL 30 MG 10,00
CEFADROXIL 500 MG 10,00
4316 MAIMUNAH 201904000502 02/04/2019 Ruangan TABLET TAMBAH 14,00 5.964
201904003266 16/04/2019 Ruangan RAMIPRIL 5 MG 10,00 8.220
TABLET TAMBAH 10,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4317 MOCH. AHYAN 201904004915 25/04/2019 Poli Interna
- SIMVASTATIN 20 MG 30,00 316.350
NOVORAPID PEN 3,00
RAMIPRIL 5 MG 30,00
4318 MOCHAMMAD YUSUF 201904005244 26/04/2019 Ruangan Napza CIPROFLOXACIN 500 14,00 5.950
4319 MOHAMAD SAPTONO 201904004461 23/04/2019 Poli Interna GLIMEPIRIDE 2 MG 60,00 42.200
METFORMIN 500 MG 60,00
GENTAMYCIN SALEP 1,00
RAMIPRIL 5 MG 30,00
4320 MULYANI 201904000751 04/04/2019 Poli Interna DULCOLAX 5MG 12,00 90.688
NEURODEK 30,00
GLUCOSAMINE 40,00
4321 MURNAJIANTONO 201904002388 12/04/2019 Ruangan Kenari PROBENID 500 MG 10,00 25.830
METFORMIN 500 MG 20,00
4322 MUSRIKAH 201904005129 26/04/2019 Poli Interna SPIRONOLACTONE 30,00 23.250
AMLODIPIN 10 15,00
LISINOPRIL 10 MG 30,00
4323 MUSTOFA 201904000313 01/04/2019 Ruangan Kenari GLYSERIL 22,00 22.528
METFORMIN 500 MG 10,00
AMOXYCILLIN 500 22,00
TABLET TAMBAH 22,00
4324 NANIK NURYANA 201904004084 23/04/2019 Poli Interna GLIMEPIRIDE 4 MG 30,00 35.980
GLUCOSAMINE 10,00
METFORMIN 500 MG 60,00
4325 NINIK KUSYANTI 201904001870 09/04/2019 Ruangan FOLIC ACID 1 MG 10,00 9.360
TABLET TAMBAH 20,00
4326 PONTJO MARTO 201904005590 29/04/2019 Poli Interna CURCUMA 200 MG 10,00 20.800
VIT B COMPLEX 10,00
OMEPRAZOLE 20 MG 10,00
TABLET TAMBAH 10,00
4327 PUGUH ARIS ATMIKO 201904005978 30/04/2019 Poli Interna PARACETAMOL 500 10,00 31.320
AMLODIPIN 10 30,00
RAMIPRIL 5 MG 30,00
CIPROFLOXACIN 500 10,00
SPIRONOLACTONE 30,00
4328 RINI HERMIYATI / 201904000488 02/04/2019 Ruangan CIPROFLOXACIN 500 14,00 21.490
CURCUMA 200 MG 14,00
4329 ROCHIMAH 201904005584 29/04/2019 Poli Interna GLIMEPIRIDE 4 MG 30,00 55.900
RAMIPRIL 5 MG 30,00
GLUCOSAMINE 10,00
CURCUMA 200 MG 10,00
METFORMIN 500 MG 60,00
4330 RUKMIYAH 201904003268 16/04/2019 Ruangan CIPROFLOXACIN 500 14,00 5.950
4331 SAHAB 201904002385 12/04/2019 Ruangan Kenari PYRANTEL 125 MG 8,00 10.924
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4331 SAHAB 201904002385 12/04/2019 Ruangan
- Kenari TABLET TAMBAH 14,00 10.924
VIT B COMPLEX 22,00
4332 SAIFUL BAKRI 201904002386 12/04/2019 Ruangan Kenari CIPROFLOXACIN 500 14,00 11.914
TABLET TAMBAH 14,00
4333 SENEN 201904000505 02/04/2019 Ruangan TABLET TAMBAH 14,00 9.132
RAMIPRIL 5 MG 8,00
201904003269 16/04/2019 Ruangan RAMIPRIL 5 MG 10,00 8.780
TABLET TAMBAH 10,00
AMLODIPIN 10 5,00
4334 SERAFIN TANTINA 201904002810 15/04/2019 Poli Jiwa Dewasa METFORMIN 500 MG 60,00 40.800
SPIRONOLACTONE 30,00
GLIMEPIRIDE 2 MG 60,00
4335 SINGAL NADEAK 201904000108 01/04/2019 Poli Interna ISDN 5 MG 30,00 52.960
CANDESARTAN 16 30,00
LORATADIN 10 MG 10,00
CURCUMA 200 MG 10,00
VIT B COMPLEX 10,00
201904005914 30/04/2019 Poli Interna Coralan 5 mg Tablet 30,00 298.720
VIT B COMPLEX 10,00
CANDESARTAN 16 30,00
LORATADIN 10 MG 10,00
4336 SITI FATIMAH 201904003408 16/04/2019 Ruangan Puri METHYLPREDNISOL 3,00 183.957
SPUIT 5 CC 3,00
RINGER LACTAT 8,00
INFUS SET DEWASA 1,00
SPUIT 3 CC 3,00
IKANEURON INJ 5000 3,00
IV CANULLA NO.20 1,00
4337 SITI NURIFAH 201904004878 25/04/2019 Ruangan PYRANTEL 125 MG 8,00 12.120
TABLET TAMBAH 20,00
FOLIC ACID 1 MG 10,00
4338 SUGENG KARYONO 201904002384 12/04/2019 Ruangan Kenari CURCUMA 200 MG 10,00 15.060
METFORMIN 500 MG 20,00
4339 SUHERMANTO 201904002886 15/04/2019 Poli Interna CODEIN 20 MG 10,00 253.760
CANDESARTAN 16 30,00
HARNAL OCAS 30,00
CEFIXIME 200 MG 10,00
4340 SUHUT RAL NADAEK 201904000110 01/04/2019 Poli Interna RAMIPRIL 5 MG 30,00 176.220
HERBESER CD 200 30,00
201904005917 30/04/2019 Poli Interna HERBESER CD 200 30,00 176.220
RAMIPRIL 5 MG 30,00
4341 SUNCONO 201904004627 24/04/2019 Ruangan Gelatik METHYLPREDNISOL 10,00 20.090
DOXYCICLIN 100 MG 20,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4342 SUPENO 201904004927 25/04/2019 Psiko Geriatri
- ISDN 5 MG 30,00 4.500
4343 SUSILOWATI 201904001872 09/04/2019 Ruangan METHYLPREDNISOL 13,00 22.002
CIPROFLOXACIN 500 14,00
RACIKAN KAPSUL 10,00
KAPSUL NO 2 10,00
TABLET TAMBAH 14,00
BETAMETASON 1,00
4344 SUTIANA 201904000500 02/04/2019 Ruangan PYRANTEL 125 MG 8,00 8.724
TABLET TAMBAH 14,00
4345 TIRANA LARASUCI 201904005084 26/04/2019 Poli Interna SUKRALFAT SIRUP 1,00 31.144
DOMPERIDONE 14,00
LANSOPRAZOLE 20,00
4346 WANDI 201904001630 08/04/2019 Ruangan Kenari AMOXYCILLIN 500 22,00 20.636
DOMPERIDONE 14,00
OMEPRAZOLE 20 MG 14,00
4347 WIDODO 201904001917 09/04/2019 Poli Interna RAMIPRIL 5 MG 30,00 102.230
GEMFIBROZIL 300MG 30,00
PROBENID 500 MG 30,00
LANSOPRAZOLE 10,00
4348 WIDODO KALIMUJIONO 201904003556 18/04/2019 Poli Interna CANDESARTAN 16 30,00 44.820
DOMPERIDONE 10,00
LANSOPRAZOLE 10,00
4349 YONG PURNOMO 201904000339 01/04/2019 Ruangan Kenari METFORMIN 500 MG 14,00 2.772
Dokter: dr. YERRY KURNIAWAN
4350 ADE ACHMAD RAMDHANI 201904003474 18/04/2019 Poli Paru THIAMPHENICOL 500 10,00 50.040
ONDANSETRON 4 1,00
BUSCOPAN INJ 1,00
INFUS SET DEWASA 1,00
RINGER LACTAT 1,00
METOCLOPRAMIDE 5 10,00
201904003596 18/04/2019 IGD NORAGES INJEKSI 1,00 12.501
SPUIT 3 CC 1,00
PARACETAMOL 500 10,00
4351 ARINA FITRIYAH 201904003724 20/04/2019 IGD THD 2 MG 6,00 7.083
CLOZAPINE 25 MG 3,00
HALOPERIDOL 5 MG 6,00
4352 FITRIANA 201904004819 25/04/2019 IGD LODOMER 2 MG/ML 1,00 5.144
DIAZEPAM inj 1,00
SPUIT 3 CC 1,00
4353 NURMAWATI 201904005319 29/04/2019 IGD NORAGES INJEKSI 1,00 38.385
SPUIT 3 CC 2,00
BUSCOPAN INJ 1,00
4354 OSEN 201904005648 29/04/2019 Ruangan Wijaya CLOZAPINE 25 MG 2,00 5.218
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4354 OSEN 201904005648 29/04/2019 Ruangan
- Wijaya TFP 5 MG 4,00 5.218
THD 2 MG 2,00
4355 SHYBILHA KONSHA 201904003726 21/04/2019 IGD BUSCOPAN PLUS 10,00 53.720
RANITIDIN TAB 150 10,00
4356 SUTIANA 201904005293 27/04/2019 Ruangan Wijaya RINGER LACTAT 1,00 24.588
INFUS SET DEWASA 1,00
IV CANULLA NO.20 1,00
4357 TRIANA 201904003725 20/04/2019 IGD THD 2 MG 6,00 8.697
CLOZAPINE 25 MG 3,00
RISPERIDONE 2 MG 6,00
Dokter: dr. YUNITA RETNO BUDIARTI, Sp.KJ
4358 ABDUL KHOLID 201904004873 25/04/2019 Ruangan Gelatik CPZ 100 MG 7,00 12.096
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
4359 ABDUL ROHMAN 201904004776 24/04/2019 Ruangan Kenari THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
4360 ABDURRAHMAN FAIZ 201904003841 22/04/2019 Poli Jiwa Anak VIT B12 50 MG 30,00 12.270
KAPSUL NO.00 60,00
VIT B6 10 MG 30,00
RACIKAN KAPSUL 60,00
FOLIC ACID 1 MG 30,00
4361 ADE IRMA NASUTION 201904001226 05/04/2019 IGD THD 2 MG 8,00 45.882
OLANZPINE 10mg 7,00
RISPERIDONE 3 MG 8,00
4362 ADELIA PUTRI YUNIAR 201904005903 30/04/2019 Poli Jiwa Anak THD 2 MG 15,00 671.220
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 10,00
CLOBAZAM 10 MG 30,00
SERTRALINE 50 MG 15,00
DEPAKOTE ER 500 30,00
KAPSUL NO 2 30,00
4363 ADNAN 201904003652 18/04/2019 Ruangan Kenari SPUIT 3 CC 1,00 124.246
HALDOL DECANOAS 1,00
4364 AGUS PRASETYO 201904005425 29/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 514.800
4365 AGUS SETIYO 201904000368 01/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 17.549
TFP 5 MG 14,00
4366 AHMAD BAKHRUDIN 201904003530 18/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 34.230
VIT B6 10 MG 15,00
METHYLPHENIDATE 23,00
4367 AHMAD DANI IRFANSAH 201904000119 01/04/2019 Poli Jiwa Anak THD 2 MG 30,00 43.485
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4368 AHMAD FATIH SUHADAK 201904005416 29/04/2019 Poli Psikiater
- SERTRALINE 50 MG 16,00 66.124
RACIKAN KAPSUL 40,00
THD 2 MG 40,00
FOLIC ACID 1 MG 20,00
RISPERIDONE 3 MG 40,00
VIT B6 10 MG 20,00
KAPSUL NO 2 40,00
4369 ALAMSYAH IMAM 201904000106 01/04/2019 Poli Jiwa Anak TFP 5 MG 24,00 78.459
RACIKAN KAPSUL 60,00
THD 2 MG 15,00
CLOZAPINE 25 MG 15,00
SERTRALINE 50 MG 18,00
VIT B6 10 MG 30,00
KAPSUL NO.00 60,00
4370 ALI CHUDAFI 201904000084 01/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 142.470
DEPAKOTE ER 250 30,00
FOLIC ACID 1 MG 30,00
RISPERIDONE 3 MG 20,00
KAPSUL NO.00 60,00
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 15,00
4371 ANDRIAN PERMANA 201904000085 01/04/2019 Poli Jiwa Anak VIT B12 50 MG 15,00 21.826
HALOPERIDOL 5 MG 5,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B12 50 MG 15,00
KAPSUL NO.1 30,00
CLOBAZAM 10 MG 9,00
RACIKAN KAPSUL 30,00
HALOPERIDOL 5 MG 5,00
VIT B6 10 MG 15,00
KAPSUL NO.1 30,00
FOLIC ACID 1 MG 15,00
4372 ANINDYA RARAS 201904003568 18/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 25.590
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
METHYLPHENIDATE 15,00
RACIKAN KAPSUL 30,00
4373 ARJUNA BAGASKARA 201904003570 18/04/2019 Poli Jiwa Anak METHYLPHENIDATE 30,00 364.287
KAPSUL NO.00 30,00
ABILIFY DISCMELT 15 8,00
CLOBAZAM 10 MG 6,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4373 ARJUNA BAGASKARA 201904003570 18/04/2019 Poli Jiwa
- Anak RACIKAN KAPSUL 30,00 364.287
FOLIC ACID 1 MG 12,00
VIT B6 10 MG 15,00
4374 ASHRAF BOBY 201904000835 04/04/2019 Poli Jiwa Anak KAPSUL NO.00 30,00 62.895
VIT B6 10 MG 15,00
RACIKAN PUYER 30,00
MERSITROPIL 1,00
FOLIC ACID 1 MG 15,00
VIT B12 50 MG 15,00
4375 ATSILAH NAI PRASASTI 201904005327 29/04/2019 Poli Jiwa Anak VIT B12 50 MG 15,00 6.543
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 15,00
RISPERIDONE 2 MG 4,00
KAPSUL NO 2 30,00
4376 AYU FEBRIANA 201904005905 30/04/2019 Poli Jiwa Anak KAPSUL NO 2 60,00 8.770
VIT B6 10 MG 30,00
RACIKAN PUYER 60,00
FOLIC ACID 1 MG 30,00
VIT B12 50 MG 20,00
4377 BINSAR XAVI 201904003579 18/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 5,00 247.899
CLOBAZAM 10 MG 6,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
METHYLPHENIDATE 30,00
KAPSUL NO.00 30,00
4378 BRAYEN STEVANI KEVI N 201904005493 29/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 30,00 25.986
RISPERIDONE 3 MG 4,00
KAPSUL NO.00 60,00
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 12,00
RACIKAN KAPSUL 60,00
4379 BULAN OKTAVIANA 201904000825 04/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 27.060
METHYLPHENIDATE 15,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B12 50 MG 15,00
KAPSUL NO.00 30,00
4380 DAFFA WIDJAYA 201904003516 18/04/2019 Poli Jiwa Anak THD 2 MG 8,00 74.661
KAPSUL NO 2 60,00
RACIKAN KAPSUL 60,00
CLOBAZAM 10 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4380 DAFFA WIDJAYA 201904003516 18/04/2019 Poli Jiwa
- Anak ASAM VALPROAT 1,00 74.661
PHENYTOIN CAP 100 30,00
RISPERIDONE 3 MG 10,00
KAPSUL NO 2 60,00
VIT B6 10 MG 30,00
RACIKAN KAPSUL 60,00
4381 DAVID DYLON TANJAYA 201904003989 22/04/2019 Poli Jiwa Anak VIT B6 10 MG 8,00 134.152
KAPSUL NO 2 16,00
RACIKAN KAPSUL 16,00
CLOBAZAM 10 MG 4,00
ABILIFY DISCMELT 10 4,00
KAPSUL NO 2 16,00
SERTRALINE 50 MG 4,00
HALOPERIDOL 5 MG 1,00
RACIKAN KAPSUL 16,00
CLOBAZAM 10 MG 8,00
4382 DEDIK SUPRIYADI 201904003653 18/04/2019 Ruangan Kenari SPUIT 3 CC 2,00 71.497
SIKZONOATE 1,00
4383 DEVINKA 201904001068 05/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 16.805
METHYLPHENIDATE 8,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B12 50 MG 10,00
KAPSUL NO.00 30,00
4384 DIAH AMANI 201904004880 25/04/2019 Ruangan THD 2 MG 7,00 146.986
OLANZPINE 10mg 7,00
CLOZAPINE 100 MG 14,00
DEPAKOTE ER 500 7,00
4385 DIAS MIKAEL HAYER 201904005348 29/04/2019 Ruangan Wijaya LODOMER 2 MG/ML 2,00 13.472
DIAZEPAM inj 1,00
HALOPERIDOL 5 MG 6,00
SPUIT 3 CC 3,00
THD 2 MG 6,00
CPZ 100 MG 6,00
4386 DIORIVO ANANDIKA 201904005385 29/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 211.650
KAPSUL NO.00 30,00
RISPERIDONE 3 MG 5,00
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 5,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
RACIKAN KAPSUL 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4386 DIORIVO ANANDIKA 201904005385 29/04/2019 Poli Jiwa
- Anak CLOBAZAM 10 MG 5,00 211.650
4387 DJAINURI 201904002350 11/04/2019 Ruangan Gelatik TFP 5 MG 5,00 2.125
THD 2 MG 5,00
4388 DJUM SISWANTO 201904005533 29/04/2019 Ruangan Wijaya SPUIT 3 CC 4,00 13.588
LODOMER 2 MG/ML 2,00
HALOPERIDOL 1,5 3,00
LORAZEPAM 2 MG 2,00
4389 FADLILAH NUR AZZAHRA 201904000098 01/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 16.968
FOLIC ACID 1 MG 12,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
METHYLPHENIDATE 9,00
4390 FARAH MEYDINA 201904000619 02/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 31.872
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 15,00
ASAM VALPROAT 1,00
KAPSUL NO.00 15,00
VIT B12 50 MG 9,00
4391 FITRIA AINI 201904005478 29/04/2019 Poli Jiwa Dewasa HALOPERIDOL 1,5 60,00 9.270
THD 2 MG 30,00
VIT B6 10 MG 30,00
4392 H. TASDI MARSONO 201904005398 29/04/2019 Psiko Geriatri VIT B6 10 MG 15,00 402.600
KAPSUL NO 2 30,00
RISPERIDONE 3 MG 10,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
THD 2 MG 15,00
KAPSUL NO 2 30,00
ABILIFY DISCMELT 15 10,00
RACIKAN KAPSUL 30,00
4393 HAFIZH ILHAM PRAYOGO 201904000811 04/04/2019 Poli Jiwa Anak THD 2 MG 15,00 51.045
CLOZAPINE 25 MG 15,00
RISPERIDONE 1 MG 60,00
4394 HANANDA M. ZIMAM AS. 201904001073 05/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 30,00 44.370
METHYLPHENIDATE 30,00
4395 HERI NANANG WAHYUDI 201904005470 29/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 70.830
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4396 I WAYAN PASEK ANAGHA 201904004435 23/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 10 15,00 574.275
DEPAKOTE ER 250 30,00
SERTRALINE 50 MG 30,00
4397 IDE SETIAWAN 201904005444 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 71.295
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4397 IDE SETIAWAN 201904005444 29/04/2019 Poli Jiwa- Dewasa THD 2 MG 30,00 71.295
CLOZAPINE 25 MG 15,00
4398 IKBAL FAROSI 201904000834 04/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 248.049
DEPAKOTE 250 MG 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO.1 30,00
ABILIFY DISCMELT 15 5,00
CLOBAZAM 10 MG 6,00
4399 M. DIMAS PRAYOGO 201904005490 29/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 60,00 75.615
CLOZAPINE 25 MG 15,00
THD 2 MG 60,00
FOLIC ACID 1 MG 15,00
4400 MAHBUB KHOIRUL 201904001098 05/04/2019 Poli Jiwa Anak KAPSUL NO.00 30,00 80.070
VIT B6 10 MG 15,00
METHYLPHENIDATE 15,00
RACIKAN KAPSUL 30,00
DEPAKOTE ER 250 15,00
FOLIC ACID 1 MG 15,00
RISPERIDONE 3 MG 5,00
4401 MARPUAH 201904003368 16/04/2019 Ruangan THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
4402 MELIANA JELITA ARIYANI 201904003619 18/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 153.094
ABILIFY DISCMELT 10 5,00
FOLIC ACID 1 MG 15,00
SERTRALINE 50 MG 6,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
4403 MOCH LUTFI 201904004715 24/04/2019 Ruangan Kenari CPZ 100 MG 7,00 4.046
HALOPERIDOL 5 MG 14,00
THD 2 MG 7,00
4404 MOCH. HILAL MASYRIQI 201904004447 23/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 30,00 33.030
THD 2 MG 30,00
CLOBAZAM 10 MG 15,00
4405 MOCHAMMAD FATCHUR 201904000311 01/04/2019 Ruangan Kenari HALOPERIDOL 5 MG 14,00 2.072
201904004517 23/04/2019 Poli Gigi (Jiwa) THD 2 MG 14,00 6.020
CPZ 100 MG 14,00
HALOPERIDOL 5 MG 14,00
4406 MOH. KHOLIQ SAPUTRA 201904005454 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 173.726
CLOZAPINE 25 MG 30,00
SIKZONOATE 1,00
RISPERIDONE 3 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4406 MOH. KHOLIQ SAPUTRA 201904005454 29/04/2019 Poli Jiwa- Dewasa SPUIT 3 CC 1,00 173.726
4407 MORSIDI 201904000361 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 64.041
CLOZAPINE 25 MG 30,00
TFP 5 MG 21,00
4408 MRS X /RIPKA 201904006022 30/04/2019 Ruangan Wijaya TFP 5 MG 14,00 74.593
SPUIT 3 CC 1,00
SIKZONOATE 1,00
CPZ 100 MG 7,00
4409 MUHAMMAD AZKA 201904003574 18/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 171.498
ABILIFY DISCMELT 15 4,00
FOLIC ACID 1 MG 18,00
SERTRALINE 50 MG 4,00
KAPSUL NO.00 60,00
VIT B6 10 MG 30,00
4410 MUHAMMAD DAFFA EL 201904004445 23/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 4,00 160.185
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
4411 MUHAMMAD HAMZAH 201904000074 01/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 10.683
CLOBAZAM 10 MG 5,00
RACIKAN KAPSUL 30,00
ABILIFY DISCMELT 15 0,00
FOLIC ACID 1 MG 12,00
THD 2 MG 15,00
KAPSUL NO.0 30,00
4412 MUHAMMAD ZACKY 201904000796 04/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 4,00 167.169
CLOBAZAM 10 MG 6,00
RACIKAN KAPSUL 30,00
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
4413 MUHAMMAD ZAIDAN 201904001173 05/04/2019 Poli Jiwa Anak KAPSUL NO.00 30,00 82.957
VIT B6 10 MG 15,00
RACIKAN PUYER 30,00
ABILIFY DISCMELT 15 2,00
FOLIC ACID 1 MG 12,00
VIT B12 50 MG 8,00
4414 MUJI RAHAYU 201904005482 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 74.460
RISPERIDONE 2 MG 30,00
THD 2 MG 60,00
4415 NADYA ALLYSSA 201904004005 22/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 51.861
CLOBAZAM 10 MG 3,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4415 NADYA ALLYSSA 201904004005 22/04/2019 Poli Jiwa
- Anak PROHIPER 10 8,00 51.861
KAPSUL NO 3 30,00
RISPERIDONE 3 MG 2,00
FOLIC ACID 1 MG 15,00
RACIKAN KAPSUL 30,00
VIT B6 10 MG 15,00
KAPSUL NO 3 30,00
4416 NAJWA NUR RAHMA 201904002346 11/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 15,00 22.545
THD 2 MG 15,00
NOPRES 20 MG 15,00
4417 NICO ADRIAN MAULANA 201904004442 23/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 486.801
CLOZAPINE 25 MG 30,00
VIT B6 10 MG 15,00
KAPSUL NO.00 60,00
THD 2 MG 30,00
FOLIC ACID 1 MG 15,00
ABILIFY DISCMELT 15 10,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 24,00
VIT B12 50 MG 15,00
KAPSUL NO.00 30,00
4418 NUR INSANI 201904000848 04/04/2019 Poli Psikiater KAPSUL NO 2 180,00 109.039
RACIKAN KAPSUL 180,00
CLOZAPINE 100 MG 23,00
THD 2 MG 90,00
4419 NURUL KOMARIYAH 201904003794 22/04/2019 Ruangan RISPERIDONE 3 MG 14,00 36.890
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
4420 NURWAHID BAGUS 201904005450 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
4421 PAESAL RAMADHANI 201904004454 23/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 132.789
ABILIFY DISCMELT 15 3,00
KAPSUL NO.00 30,00
SERTRALINE 50 MG 6,00
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 15,00
4422 PARMIN 201904005441 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 17.340
VIT B6 10 MG 30,00
RISPERIDONE 2 MG 30,00
4423 PETRONELLA OKTORINI 201904004463 23/04/2019 Ruangan Wijaya RISPERIDONE 2 MG 4,00 2.742
THD 2 MG 7,00
CPZ 100 MG 2,00
4424 PUTRI MAZAYA 201904003818 22/04/2019 Poli Jiwa Anak VIT B6 10 MG 15,00 241.710
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4424 PUTRI MAZAYA 201904003818 22/04/2019 Poli Jiwa
- Anak FOLIC ACID 1 MG 12,00 241.710
SERTRALINE 50 MG 8,00
ABILIFY DISCMELT 15 5,00
KAPSUL NO.00 30,00
ASAM VALPROAT 1,00
RACIKAN KAPSUL 30,00
4425 RAHMA NIA JULIA 201904005473 29/04/2019 Poli Jiwa Anak THD 2 MG 8,00 306.207
FOLIC ACID 1 MG 15,00
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
RACIKAN KAPSUL 30,00
CLOZAPINE 25 MG 18,00
ABILIFY DISCMELT 15 6,00
KAPSUL NO.00 30,00
CLOBAZAM 10 MG 12,00
4426 RASENDRIYA 201904000819 04/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 30,00 88.245
FOLIC ACID 1 MG 15,00
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
ABILIFY DISCMELT 15 2,00
CLOBAZAM 10 MG 5,00
4427 RINA GABRELA 201904002341 11/04/2019 Ruangan Wijaya DEPAKOTE ER 250 5,00 31.721
CLOZAPINE 25 MG 5,00
RISPERIDONE 3 MG 8,00
201904003598 18/04/2019 Ruangan Wijaya TFP 5 MG 4,00 1.802
THD 2 MG 5,00
4428 SAHRUL RAHMADAN 201904003559 18/04/2019 Poli Jiwa Anak RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
4429 SURYANTO 201904005456 29/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 30,00 7.500
THD 2 MG 30,00
4430 SUTAM PANDU 201904001176 05/04/2019 Poli Psikiater ALPRAZOLAM 1 MG 30,00 62.730
LORAZEPAM 2 MG 30,00
NOPRES 20 MG 30,00
4431 SYAMSUL 201904000371 01/04/2019 Ruangan Gelatik THD 2 MG 14,00 36.890
CLOZAPINE 25 MG 14,00
RISPERIDONE 3 MG 14,00
4432 TRI WULANDARI 201904003593 18/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 8,00 2.624
CPZ 100 MG 8,00
4433 WAHIB SHOLIKHAN 201904001272 07/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 7.272
THD 2 MG 7,00
CPZ 100 MG 4,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4434 WARTO 201904000403 01/04/2019 Ruangan
- Gelatik CLOZAPINE 25 MG 14,00 35.462
RISPERIDONE 3 MG 14,00
4435 YANTI IRYAWATI 201904005429 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
4436 YUDHISTIRA PURNAMA 201904003915 22/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 12,00 15.897
SERTRALINE 50 MG 6,00
KAPSUL NO.00 30,00
VIT B6 10 MG 15,00
RACIKAN KAPSUL 30,00
4437 YULIA WATI NOFITA SARI 201904001222 05/04/2019 Ruangan Puri HALOPERIDOL 5 MG 4,00 4.420
SERTRALINE 50 MG 2,00
201904001780 09/04/2019 Ruangan Puri SERTRALINE 50 MG 7,00 27.905
CLOZAPINE 25 MG 7,00
HALOPERIDOL 5 MG 10,00
4438 ZULFIKAR 201904002496 12/04/2019 Poli Jiwa Anak RISPERIDONE 3 MG 10,00 49.458
KAPSUL NO 2 60,00
SERTRALINE 50 MG 12,00
CLOBAZAM 10 MG 12,00
RACIKAN KAPSUL 60,00
VIT B6 10 MG 30,00
FOLIC ACID 1 MG 18,00
Dokter: dr.Benediktus, SpKJ
4439 ABD SHOMAD 201904001861 09/04/2019 Ruangan Gelatik THD 2 MG 14,00 7.210
CPZ 100 MG 7,00
TFP 5 MG 14,00
4440 ADI TRIE GUNAWAN 201904004051 22/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 131.340
RISPERIDONE 3 MG 60,00
TFP 5 MG 90,00
CLOZAPINE 25 MG 30,00
4441 ADRIAN YOHANES 201904001573 08/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 15,00 591.495
AMITRIPTILIN 25 MG 60,00
DEPAKOTE ER 250 30,00
SERTRALINE 50 MG 30,00
ALPRAZOLAM 1 MG 30,00
4442 AGNES ABON KERANSZ 201904003413 16/04/2019 Ruangan Puri SIKZONOATE 1,00 68.811
SPUIT 3 CC 1,00
201904006091 30/04/2019 Ruangan Puri THD 2 MG 14,00 23.863
CLOZAPINE 25 MG 7,00
RISPERIDONE 3 MG 14,00
4443 AGUNG BUDIANTO 201904000105 01/04/2019 Poli Jiwa Dewasa THD 2 MG 14,00 18.879
RISPERIDONE 3 MG 14,00
TFP 5 MG 21,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4443 AGUNG BUDIANTO 201904000105 01/04/2019 Poli Jiwa- Dewasa CPZ 100 MG 7,00 18.879
201904005004 25/04/2019 Ruangan Gelatik TFP 5 MG 21,00 18.879
CPZ 100 MG 7,00
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
4444 AGUS DARMAWAN 201904000141 01/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 145.890
THD 2 MG 60,00
CLOZAPINE 100 MG 30,00
4445 AGUS NJUDIBJANTO 201904002017 10/04/2019 Psiko Geriatri CLOZAPINE 25 MG 15,00 45.375
CLOBAZAM 10 MG 15,00
4446 AGUS SITOMPUL 201904001166 05/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 138.270
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
4447 AGUSTIN LISDA 201904000240 01/04/2019 Ruangan TFP 5 MG 14,00 5.950
THD 2 MG 14,00
201904004648 24/04/2019 Ruangan TFP 5 MG 21,00 8.211
THD 2 MG 14,00
4448 AHMAD FAROP 201904000123 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 83.910
THD 2 MG 30,00
CLOZAPINE 25 MG 30,00
4449 AISYAH ADLINA 201904000132 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 88.560
RISPERIDONE 2 MG 60,00
SERTRALINE 50 MG 30,00
4450 AJI 201904004714 24/04/2019 Ruangan Kenari CPZ 100 MG 4,00 10.128
RISPERIDONE 3 MG 14,00
4451 AJIANTO SUWAJI 201904002122 10/04/2019 Psiko Geriatri RISPERIDONE 2 MG 30,00 15.570
THD 2 MG 30,00
4452 AKHMAD BAYU 201904005952 30/04/2019 IGD RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
4453 ALWI FAHRUDIN 201904001729 08/04/2019 Ruangan Gelatik HALOPERIDOL 5 MG 21,00 29.162
CLOZAPINE 25 MG 14,00
201904004451 23/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 30.590
HALOPERIDOL 5 MG 21,00
THD 2 MG 14,00
4454 ANANDA FATIKAH 201904001221 05/04/2019 Ruangan Puri DEPAKOTE ER 250 7,00 34.230
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
HALOPERIDOL 5 MG 21,00
4455 ANDI DWI RUFIANTO 201904003296 16/04/2019 Poli Jiwa Anak LORAZEPAM 2 MG 8,00 30.700
RISPERIDONE 3 MG 30,00
THD 2 MG 30,00
4456 ANDIK HARIANTO 201904000276 01/04/2019 Ruangan Kenari THD 2 MG 14,00 20.293
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4456 ANDIK HARIANTO 201904000276 01/04/2019 Ruangan
- Kenari CLOZAPINE 25 MG 7,00 20.293
RISPERIDONE 2 MG 14,00
201904001359 08/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 20.293
THD 2 MG 14,00
CLOZAPINE 25 MG 7,00
4457 ANIS ZULFATIN 201904002816 15/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 15,00 69.135
CLOZAPINE 25 MG 15,00
RISPERIDONE 2 MG 30,00
4458 ARDIANTO 201904005462 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 59.055
THD 2 MG 60,00
CLOZAPINE 25 MG 15,00
4459 ARIF 201904006027 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
4460 ARIFIN 201904002824 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 86.970
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4461 ASA CHARISMA PUTRA 201904003260 16/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 12,00 21.798
RISPERIDONE 3 MG 20,00
KAPSUL NO 2 60,00
THD 2 MG 30,00
RACIKAN KAPSUL 60,00
VIT B6 10 MG 30,00
4462 ASTUTIK 201904004886 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 201.319
RISPERIDONE 3 MG 60,00
ALPRAZOLAM 1 MG 30,00
SERTRALINE 50 MG 30,00
CLOZAPINE 100 MG 23,00
4463 ATIE HASTUTI Z 201904003617 18/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 225.930
CLOZAPINE 25 MG 30,00
4464 BIMO NARENDRO 201904002571 12/04/2019 Poli Jiwa Dewasa FOLIC ACID 1 MG 30,00 139.710
CLOBAZAM 10 MG 30,00
RISPERIDONE 3 MG 60,00
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
4465 BINTANG APRILIYA 201904002787 15/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 15,00 29.775
VIT B6 10 MG 15,00
KAPSUL NO.00 30,00
METHYLPHENIDATE 18,00
RACIKAN PUYER 30,00
4466 BUDI DAUD SULAIMAN 201904000408 01/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 10.836
THD 2 MG 14,00
4467 CEN FONG / FONGKY 201904001123 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 1.470.720
CLOZAPINE 100 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4467 CEN FONG / FONGKY 201904001123 05/04/2019 Poli Jiwa- Dewasa ABILIFY DISCMELT 15 30,00 1.470.720
SERTRALINE 50 MG 30,00
4468 CHOIRUL 201904001578 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 52.935
CLOZAPINE 25 MG 15,00
4469 DEDIK SISWANTO 201904000121 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
4470 DENTRI AGENG 201904004645 24/04/2019 Ruangan Kenari THD 2 MG 14,00 12.075
VIT B6 10 MG 21,00
RISPERIDONE 3 MG 14,00
4471 DHEA OCTA AKALILI 201904000204 01/04/2019 Ruangan THD 2 MG 14,00 24.164
RISPERIDONE 3 MG 14,00
TFP 5 MG 21,00
LORAZEPAM 2 MG 7,00
201904002698 15/04/2019 Ruangan LORAZEPAM 2 MG 4,00 21.359
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
TFP 5 MG 21,00
4472 DIAH RACHMAWATI 201904003618 18/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 86.970
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 60,00
4473 DJI SAMSU 201904005993 30/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 27.720
CPZ 100 MG 15,00
4474 DJOKO SISWANTO 201904003932 22/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 93.855
CLOZAPINE 100 MG 15,00
THD 2 MG 60,00
FOLIC ACID 1 MG 30,00
4475 DWI ESTI NAWANG 201904000442 01/04/2019 IGD KASA STERIL ISI 16 1,00 17.363
CIPROFLOXACIN 500 10,00
SPUIT 1 CC INSULIN 1,00
LIDOCAIN INJ 1,00
ASAM MEFENAMAT 10,00
4476 DWI PRAHASTUTI 201904002583 12/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 142.800
CLOZAPINE 25 MG 60,00
RISPERIDONE 2 MG 60,00
4477 DWI WIJAYANTI 201904002600 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 40.425
RISPERIDONE 2 MG 30,00
4478 EDY RIYANTO 201904005575 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 195.585
CLOZAPINE 100 MG 45,00
HALOPERIDOL 5 MG 60,00
4479 EDY SANTOSO 201904005433 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
4480 EGI PANRUB 201904001928 09/04/2019 Psiko Geriatri LORAZEPAM 2 MG 4,00 8.780
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4480 EGI PANRUB 201904001928 09/04/2019 Psiko Geriatri
- RISPERIDONE 1 MG 14,00 8.780
4481 ELIN ARIAN NINGSIH 201904005106 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 779.790
CLOZAPINE 100 MG 30,00
SEROQUEL XR 400 30,00
HALOPERIDOL 5 MG 60,00
4482 F.A. OCTAVIANUS 201904001495 08/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 65.820
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
4483 FAISOL 201904002861 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 86.970
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
4484 FARDANI ARI BASYAR 201904000155 01/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 891.390
CLOZAPINE 25 MG 30,00
DEPAKOTE ER 250 30,00
CLONAZEPAM 2 MG 15,00
4485 FATKHUL KHOIR 201904005221 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 97.920
RISPERIDONE 3 MG 60,00
VIT B6 10 MG 30,00
4486 FIKRA/FITRA 201904002394 12/04/2019 Ruangan Kenari THD 2 MG 8,00 8.260
CLOZAPINE 25 MG 4,00
4487 FIKRIE A.M 201904005301 27/04/2019 Poli Psikiater THD 2 MG 20,00 115.440
OLANZPINE 10mg 20,00
4488 FOANY SUSILOWATI 201904005096 26/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 206.535
CLONAZEPAM 2 MG 15,00
CLOZAPINE 100 MG 15,00
4489 HAMAMA HANAN 201904005411 29/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 1.559.325
TFP 5 MG 60,00
SEROQUEL XR 400 30,00
THD 2 MG 60,00
CLOZAPINE 100 MG 15,00
4490 HARI WIRANTO 201904000304 01/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 8.526
THD 2 MG 14,00
CPZ 100 MG 7,00
201904001628 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 28.756
RISPERIDONE 3 MG 14,00
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
201904004957 25/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 31.017
THD 2 MG 14,00
SERTRALINE 50 MG 7,00
TFP 5 MG 21,00
4491 HARMIYANTO 201904003599 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 110.760
TFP 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4491 HARMIYANTO 201904003599 18/04/2019 Poli Jiwa- Dewasa FRIMANIA 200 MG 30,00 110.760
4492 HARY PAMUNGKAS 201904005229 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 113.250
SERTRALINE 50 MG 30,00
4493 HENDRIK 201904005965 30/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 36.060
VIT B1 50 MG 30,00
RISPERIDONE 2 MG 60,00
4494 HENY MULATSIH 201904001814 09/04/2019 Ruangan SERTRALINE 50 MG 7,00 24.234
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
4495 HERI MUZAKI 201904002547 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 12.750
THD 2 MG 30,00
4496 HERI PURWANTO 201904000517 02/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 623.535
CLOZAPINE 25 MG 15,00
SERTRALINE 50 MG 30,00
4497 HERU ROHMADI 201904003248 16/04/2019 Psiko Geriatri LORAZEPAM 2 MG 15,00 33.405
TFP 5 MG 60,00
4498 HOLIL 201904005074 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 30.420
CPZ 100 MG 30,00
4499 HOTIMAH 201904002556 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 25.500
THD 2 MG 60,00
4500 I'ANATUL MUALIMAH 201904000207 01/04/2019 Ruangan THD 2 MG 14,00 54.446
CLOZAPINE 25 MG 14,00
DEPAKOTE ER 250 7,00
HALOPERIDOL 5 MG 21,00
201904002027 10/04/2019 Ruangan HALOPERIDOL 5 MG 21,00 54.446
THD 2 MG 14,00
CLOZAPINE 25 MG 14,00
DEPAKOTE ER 250 7,00
4501 IDA NUR AIDA 201904002498 12/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 27.840
THD 2 MG 30,00
CPZ 100 MG 30,00
4502 INDAH NUR MUFIDA 201904000209 01/04/2019 Ruangan THD 2 MG 14,00 5.796
CPZ 100 MG 7,00
HALOPERIDOL 5 MG 21,00
4503 INDRA SETYAWAN 201904005134 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 50.880
THD 2 MG 60,00
HALOPERIDOL 5 MG 30,00
4504 INTAN PERDANA 201904003961 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 1.282.710
CLOZAPINE 25 MG 30,00
ABILIFY DISCMELT 15 30,00
SERTRALINE 50 MG 30,00
4505 INYOK 201904005964 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 11.940
HALOPERIDOL 5 MG 60,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4506 IRFAN 201904004030 22/04/2019 Poli Jiwa- Dewasa KAPSUL NO.0 30,00 167.610
THD 2 MG 30,00
CLONAZEPAM 2 MG 15,00
RACIKAN KAPSUL 30,00
SEROQUEL XR 400 2,00
FOLIC ACID 1 MG 30,00
SERTRALINE 50 MG 15,00
4507 IRFAN KAHARUDIN 201904005944 30/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 219.104
CLONAZEPAM 2 MG 15,00
KAPSUL NO 2 30,00
TFP 5 MG 60,00
CLOZAPINE 100 MG 11,00
RACIKAN KAPSUL 30,00
THD 2 MG 60,00
CLOZAPINE 25 MG 1,00
4508 ISMAIL HABIBI LUBIS 201904001155 05/04/2019 Poli Jiwa Dewasa DEPAKOTE 250 MG 60,00 270.420
LORAZEPAM 2 MG 30,00
KUTOIN 60,00
CLOZAPINE 25 MG 30,00
SERTRALINE 50 MG 30,00
HALOPERIDOL 1,5 60,00
4509 ITA PERMATA 201904001555 08/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 27.915
4510 IVAN SETIAWAN 201904005414 29/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 30.780
CPZ 100 MG 15,00
RISPERIDONE 2 MG 60,00
4511 JATMIKO 201904002881 15/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 9.408
4512 JONI HARSANTO 201904002540 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 25.140
TFP 5 MG 60,00
THD 2 MG 30,00
4513 JULSIE 201904004996 25/04/2019 Ruangan TFP 5 MG 2,00 646
4514 KASDI 201904000287 01/04/2019 Ruangan Kenari TFP 5 MG 21,00 9.471
THD 2 MG 14,00
CPZ 100 MG 7,00
4515 KHADIJAH 201904000168 01/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 99.210
CLOZAPINE 25 MG 30,00
RISPERIDONE 3 MG 60,00
4516 KUSNANTO 201904000300 01/04/2019 Ruangan Kenari CPZ 100 MG 7,00 9.471
TFP 5 MG 21,00
THD 2 MG 14,00
201904001480 08/04/2019 Ruangan Kenari THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
TFP 5 MG 21,00
201904001614 08/04/2019 IGD TFP 5 MG 21,00 9.471
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4516 KUSNANTO 201904001614 08/04/2019 IGD
- THD 2 MG 14,00 9.471
CPZ 100 MG 7,00
4517 LAMSIR 201904000178 01/04/2019 Poli Jiwa Dewasa CPZ 100 MG 30,00 18.150
TFP 5 MG 30,00
THD 2 MG 30,00
4518 LILIK ARIYANI 201904005479 29/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 93.840
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 2 MG 30,00
4519 LUKITO 201904005603 29/04/2019 Ruangan Wijaya HALOPERIDOL 5 MG 14,00 2.792
CPZ 100 MG 4,00
4520 LUKITO DODIK 201904003349 16/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 6,00 16.170
RISPERIDONE 2 MG 12,00
201904004391 23/04/2019 Ruangan Gelatik THD 2 MG 14,00 20.293
CLOZAPINE 25 MG 7,00
RISPERIDONE 2 MG 14,00
4521 LUSIANAH 201904005466 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 53.415
CLOZAPINE 25 MG 15,00
TFP 5 MG 60,00
4522 MAHFUDZI 201904005118 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 15,00 9.075
THD 2 MG 15,00
CPZ 100 MG 15,00
4523 MAKSUM ANAS 201904000512 02/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 134.850
CLOZAPINE 25 MG 30,00
RISPERIDONE 1 MG 60,00
4524 MANSYUR 201904000409 01/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 14,00 35.462
RISPERIDONE 3 MG 14,00
201904004021 22/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 15.358
THD 2 MG 14,00
TFP 5 MG 14,00
4525 MARDIAH 201904000513 02/04/2019 Ruangan Wijaya SERTRALINE 50 MG 7,00 36.078
OLANZPINE 10mg 4,00
4526 MARIADI 201904005597 29/04/2019 Ruangan Kenari VIT B COMPLEX 14,00 7.238
RISPERIDONE 2 MG 14,00
4527 MEGAWATI TJANDRA 201904005095 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 49.140
CPZ 100 MG 15,00
RISPERIDONE 3 MG 60,00
4528 MOCH SOEJATNO 201904005447 29/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 12.390
TFP 5 MG 30,00
4529 MOCH ZAINAL 201904002820 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 25.020
4530 MOCH. RAFI WAHYU 201904002577 12/04/2019 Poli Jiwa Dewasa CPZ 100 MG 15,00 30.780
RISPERIDONE 2 MG 60,00
THD 2 MG 30,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4531 MOCH. SYAHRONI 201904001532 08/04/2019 Poli Jiwa- Dewasa SEROQUEL XR 300 30,00 566.910
SERTRALINE 50 MG 15,00
4532 MOCHAMAD SOLEH 201904000384 01/04/2019 Ruangan Gelatik CLOZAPINE 25 MG 7,00 20.293
RISPERIDONE 2 MG 14,00
THD 2 MG 14,00
4533 MOCHAMMAD ARIFIN 201904001526 08/04/2019 Poli Jiwa Dewasa SPUIT 3 CC 1,00 71.031
HALOPERIDOL 1,5 30,00
SIKZONOATE 1,00
4534 MOCHAMMAD ISMAIL 201904002596 12/04/2019 Poli Jiwa Dewasa CLOBAZAM 10 MG 60,00 228.360
HALOPERIDOL 0,5 60,00
CARBAMAZEPINE 90,00
DEPAKOTE 250 MG 90,00
4535 MRS. X (NURUL) 201904000257 01/04/2019 Ruangan RISPERIDONE 3 MG 14,00 9.408
201904000878 04/04/2019 Ruangan RISPERIDONE 3 MG 14,00 9.408
4536 MU'IZZAHTUL ROHMAH 201904002343 11/04/2019 Ruangan LORAZEPAM 2 MG 1,00 28.576
ABILIFY DISCMELT 10 1,00
4537 MUH. HAFID AL-ASSYAD 201904001130 05/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 28.200
CPZ 100 MG 15,00
TFP 5 MG 60,00
4538 MUHAMMAD NASUHA 201904002904 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 25.500
TFP 5 MG 60,00
4539 MULYO SLAMET 201904005070 26/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
4540 MUSALIM 201904006010 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 12.750
TFP 5 MG 30,00
4541 NINA FITRIYA 201904005437 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 50.520
RISPERIDONE 2 MG 60,00
TFP 5 MG 60,00
4542 NUR KOMARI 201904002832 15/04/2019 Poli Jiwa Dewasa SEROQUEL XR 400 30,00 663.780
TFP 5 MG 60,00
4543 NUR QOMARI 201904001506 08/04/2019 Poli Jiwa Dewasa DEPAKOTE ER 250 30,00 183.561
SPUIT 3 CC 1,00
SIKZONOATE 1,00
RISPERIDONE 2 MG 30,00
4544 NURUL HUDA 201904000302 01/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904001603 08/04/2019 Ruangan Kenari CPZ 100 MG 7,00 7.098
RISPERIDONE 2 MG 14,00
201904002038 10/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 8.526
THD 2 MG 14,00
CPZ 100 MG 7,00
4545 PONIYAH 201904000532 02/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.055
CLOZAPINE 25 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4545 PONIYAH 201904000532 02/04/2019 Poli Jiwa- Dewasa RISPERIDONE 2 MG 60,00 59.055
4546 PRADITA PANDU W 201904004882 25/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 59.190
LORAZEPAM 2 MG 30,00
RISPERIDONE 2 MG 60,00
4547 PRASETYO BUDI 201904005076 26/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 30,00 68.340
CLOZAPINE 25 MG 30,00
4548 PRIYONO HERU 201904004068 22/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 18.150
CPZ 100 MG 30,00
TFP 5 MG 30,00
4549 PUGUH INDRAWAN 201904005225 26/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 89.730
RISPERIDONE 2 MG 60,00
CLOZAPINE 25 MG 30,00
4550 PUTRA ERLANGGA 201904003321 16/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 15,00 1.408
HALOPERIDOL 1,5 5,00
THD 2 MG 4,00
KAPSUL NO 2 15,00
4551 RACHMAD RAVIANTO 201904005461 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
4552 RAFI AHMAD 201904003263 16/04/2019 Poli Jiwa Anak ABILIFY DISCMELT 15 5,00 216.845
GENTAMYCIN SALEP 1,00
SERTRALINE 50 MG 6,00
CLOBAZAM 10 MG 3,00
KAPSUL NO 2 30,00
VIT B6 10 MG 15,00
FOLIC ACID 1 MG 6,00
RACIKAN KAPSUL 30,00
4553 RAHMAT HIDAYAT 201904005486 29/04/2019 Poli Jiwa Dewasa OLANZPINE 10mg 30,00 225.930
CLOZAPINE 25 MG 30,00
4554 RINA 201904004997 25/04/2019 Ruangan RISPERIDONE 2 MG 10,00 4.530
CPZ 100 MG 2,00
4555 RIZAL BASALAMAH 201904002567 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 100 MG 45,00 279.735
LORAZEPAM 2 MG 30,00
FRIMANIA 200 MG 60,00
4556 RUSI LIMELANI S I 201904001566 08/04/2019 Poli Jiwa Dewasa SIKZONOATE 1,00 124.641
SPUIT 3 CC 1,00
CLOZAPINE 25 MG 30,00
4557 SAHAB 201904001926 09/04/2019 Psiko Geriatri RISPERIDONE 2 MG 14,00 7.266
THD 2 MG 14,00
201904004958 25/04/2019 Ruangan Kenari LORAZEPAM 2 MG 4,00 11.594
RISPERIDONE 2 MG 14,00
FOLIC ACID 1 MG 7,00
THD 2 MG 14,00
4558 SAIFUL BAKRI 201904001927 09/04/2019 Psiko Geriatri RISPERIDONE 2 MG 14,00 5.838
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4558 SAIFUL BAKRI 201904002383 12/04/2019 Ruangan
- Kenari THD 2 MG 8,00 816
201904004956 25/04/2019 Ruangan Kenari RISPERIDONE 2 MG 14,00 13.811
THD 2 MG 14,00
LORAZEPAM 2 MG 7,00
4559 SARMAN 201904002124 10/04/2019 Psiko Geriatri DIAZEPAM 5 MG 15,00 6.555
HALOPERIDOL 1,5 60,00
4560 SESAR HARYO 201904002827 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 46.440
THD 2 MG 60,00
4561 SETYAWAN ADI 201904002836 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 30,00 37.605
CLOZAPINE 25 MG 15,00
4562 SITI CHOLISAH 201904003929 22/04/2019 Poli Jiwa Dewasa SERTRALINE 50 MG 30,00 159.690
CLOZAPINE 25 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
4563 SITI HASANAH 201904005453 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 84.960
SERTRALINE 50 MG 30,00
FOLIC ACID 1 MG 30,00
4564 SITI YULIANI 201904002896 15/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 15,00 42.915
HALOPERIDOL 5 MG 60,00
THD 2 MG 60,00
4565 SODIK 201904001544 08/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 102.270
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4566 SRI ENDANG HARTITIK 201904005164 26/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 70.830
CLOZAPINE 25 MG 30,00
HALOPERIDOL 5 MG 60,00
4567 SRI HARTATI ARNADHA 201904002024 10/04/2019 Psiko Geriatri SIKZONOATE 1,00 779.031
SPUIT 3 CC 1,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
SEROQUEL XR 400 30,00
TFP 5 MG 60,00
4568 SUHARTATIK 201904005421 29/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 532.260
CLOBAZAM 10 MG 15,00
4569 SUKIRNO 201904001929 09/04/2019 Psiko Geriatri RISPERIDONE 1 MG 60,00 27.720
THD 2 MG 60,00
4570 SULIS MUNTIANI 201904002544 12/04/2019 Poli Jiwa Dewasa SEROQUEL XR 300 30,00 569.340
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
4571 SUMIANI 201904001149 05/04/2019 Poli Jiwa Dewasa ALPRAZOLAM 0.5 MG 15,00 67.245
RACIKAN KAPSUL 30,00
CLOBAZAM 10 MG 30,00
SERTRALINE 50 MG 15,00
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4571 SUMIANI 201904001149 05/04/2019 Poli Jiwa- Dewasa KAPSUL NO 3 30,00 67.245
4572 SUWAJI 201904005947 30/04/2019 Poli Jiwa Dewasa HALOPERIDOL 5 MG 60,00 25.800
THD 2 MG 60,00
CPZ 100 MG 60,00
4573 SUYANTO 201904000134 01/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 248.130
CLOZAPINE 100 MG 30,00
DEPAKOTE ER 250 30,00
TFP 5 MG 60,00
4574 SYLVIA TEJA TANOKO 201904000175 04/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 15 30,00 1.169.100
CPZ 100 MG 15,00
4575 TANTIWORO SULISTYA 201904002563 12/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
4576 TONI EFENDI 201904003590 18/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 96.150
RISPERIDONE 3 MG 60,00
4577 TOYIB ARFIAN 201904000080 01/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 14,00 17.878
TFP 5 MG 14,00
CPZ 100 MG 14,00
THD 2 MG 14,00
4578 TRIWIYANTI 201904004914 25/04/2019 Poli Jiwa Dewasa TFP 5 MG 10,00 4.790
THD 2 MG 10,00
CPZ 100 MG 3,00
4579 TURTI MALA 201904001110 05/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 71.400
CLOZAPINE 25 MG 30,00
RISPERIDONE 2 MG 30,00
4580 TUTUT INDAYATI 201904002903 15/04/2019 Poli Jiwa Dewasa ABILIFY DISCMELT 10 30,00 860.370
RISPERIDONE 2 MG 60,00
THD 2 MG 60,00
4581 UMMI FUKAYNA 201904003300 16/04/2019 Poli Jiwa Anak FOLIC ACID 1 MG 12,00 7.260
RACIKAN PUYER 30,00
KAPSUL NO 2 30,00
PIRACETAM 800 MG 8,00
4582 USWATUN HASANAH 201904005427 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 74.355
CLOZAPINE 25 MG 15,00
RISPERIDONE 3 MG 60,00
4583 UTOMO AFDOUH 201904005474 29/04/2019 Poli Jiwa Dewasa RISPERIDONE 2 MG 60,00 31.140
THD 2 MG 60,00
4584 VIRTAMA SURYA RINJANI 201904005460 29/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 80.850
RISPERIDONE 2 MG 60,00
4585 WAHONO 201904002121 10/04/2019 Psiko Geriatri RISPERIDONE 1 MG 14,00 5.040
201904004953 25/04/2019 Ruangan Kenari RISPERIDONE 3 MG 14,00 13.862
THD 2 MG 7,00
LORAZEPAM 2 MG 4,00
4586 WARTO 201904005296 27/04/2019 Ruangan Gelatik RISPERIDONE 3 MG 14,00 35.462
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4586 WARTO 201904005296 27/04/2019 Ruangan
- Gelatik CLOZAPINE 25 MG 14,00 35.462
4587 WIDI 201904005966 30/04/2019 Poli Jiwa Dewasa THD 2 MG 30,00 28.080
RISPERIDONE 2 MG 60,00
4588 WILSON 201904000306 01/04/2019 Ruangan Kenari THD 2 MG 14,00 11.788
RISPERIDONE 2 MG 14,00
TFP 5 MG 14,00
201904001625 08/04/2019 Ruangan Kenari TFP 5 MG 14,00 15.358
THD 2 MG 14,00
RISPERIDONE 3 MG 14,00
4589 WINDIA YANTI 201904005116 26/04/2019 Poli Jiwa Dewasa TFP 5 MG 60,00 186.210
CLOZAPINE 100 MG 30,00
THD 2 MG 60,00
RISPERIDONE 3 MG 60,00
4590 WISMIARTI 201904002830 15/04/2019 Poli Jiwa Dewasa TFP 5 MG 90,00 91.020
THD 2 MG 60,00
CLOZAPINE 25 MG 30,00
4591 WIWIN ANTONO 201904005232 26/04/2019 Poli Jiwa Dewasa FRIMANIA 200 MG 30,00 105.405
CLOZAPINE 25 MG 30,00
LORAZEPAM 2 MG 15,00
4592 WIWIN MARDIANA 201904002814 15/04/2019 Poli Jiwa Dewasa RISPERIDONE 3 MG 60,00 96.150
CLOZAPINE 25 MG 30,00
4593 YANSEN 201904000100 01/04/2019 Poli Jiwa Dewasa CLOZAPINE 25 MG 30,00 102.270
RISPERIDONE 3 MG 60,00
THD 2 MG 60,00
4594 YERIE FANTHONI 201904002890 15/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 158.100
CLOZAPINE 25 MG 60,00
RISPERIDONE 3 MG 60,00
4595 YUDDY WICAJSONO 201904002889 15/04/2019 Poli Jiwa Dewasa SEROQUEL XR 200 30,00 514.800
4596 YULIANA FENNI 201904005497 29/04/2019 Poli Jiwa Dewasa THD 2 MG 60,00 43.050
HALOPERIDOL 5 MG 60,00
LORAZEPAM 2 MG 30,00
Dokter: dr.Ivana,Spkj
4597 DESI WINDA HARIYANTI 201904004973 25/04/2019 Ruangan THD 2 MG 10,00 14.495
CLOZAPINE 25 MG 5,00
RISPERIDONE 2 MG 10,00
4598 ENY ARIANA 201904003826 22/04/2019 Poli Jiwa Dewasa KAPSUL NO.00 30,00 900.210
SERTRALINE 50 MG 30,00
RACIKAN KAPSUL 30,00
THD 2 MG 30,00
FOLIC ACID 1 MG 15,00
RISPERIDONE 3 MG 10,00
ABILIFY DISCMELT 10 30,00
4599 INDAH CHOIRUNNISA 201904004995 25/04/2019 Ruangan Puri DEMACOLIN 6,00 7.786
No Nama Pasien No. Resep Tanggal Ruang Nama Obat Jml Bayar
4599 INDAH CHOIRUNNISA 201904004995 25/04/2019 Ruangan
- Puri SPUIT 3 CC 1,00 7.786
DIPHENHYDRAMINE 2,00
4600 MUHAMMAD ADI 201904002220 11/04/2019 Poli Jiwa Anak RACIKAN KAPSUL 60,00 184.938
VIT B6 10 MG 30,00
CLOBAZAM 10 MG 30,00
RISPERIDONE 3 MG 30,00
DEPAKOTE ER 250 30,00
KAPSUL NO.0 60,00
SERTRALINE 50 MG 12,00
Dokter: drg. ASRIATI
4601 AJI 201904002387 12/04/2019 Ruangan Kenari AMOXYCILLIN 500 15,00 8.430
ASAM MEFENAMAT 10,00
Dokter: drg. Debby Hendrawan, SpKg
4602 MULYADI 201904002690 15/04/2019 Poli Gigi ASAM MEFENAMAT 10,00 15.156
PEHACHAIN INJ 2,00
AMOXYCILLIN 500 15,00
Dokter: drg. RIZA RUMAN NURRAHMAN, MM
4603 ANNISA KARIMA 201904004881 25/04/2019 Poli Gigi PEHACHAIN INJ 3,00 86.679
AMOXYCILLIN 500 15,00
CATAFLAM 50 MG 10,00
4604 ASMUDI 201904001703 08/04/2019 Ruangan Gelatik AMOXYCILLIN 500 15,00 15.156
ASAM MEFENAMAT 10,00
PEHACHAIN INJ 2,00
4605 SALAMI 201904002251 11/04/2019 Poli Gigi CLOBAZAM 10 MG 50,00 58.200
Jumlah Pasien 4605 Total 555677.0 556.472.966
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