Laporan detail tindakan dan biaya pasien rawat jalan & inap
| No | No.Rawat | No.R.M. | Nama Pasien | Poli | Cara Bayar | Dokter Poli | Tgl.Reg | Jam Reg | Status | Status Bayar | No SEP | Tarif INA-CBG | Tarif RS | Dokter | Paramedis | Dokter+Paramedis | Radiologi | Laboratorium | Operasi | Farmasi | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026/04/16/000179 | 223778 | RENA WATI | Unit IGD | BPJS | dr. Tommy Dwi purnama | 2026-04-16 | 18:00:20 | Belum | Belum Bayar | - | Rp 0 | Rp 325.000 | Rp 0 | Rp 0 | Rp 0 | Rp 325.000 | Rp 0 | Rp 0 | Rp 0 | ||
| 2 | 2026/04/16/000178 | 223726 | AYLA KHOIRUNNISA | Unit IGD | UMUM | dr. Tommy Dwi purnama | 2026-04-16 | 17:56:41 | Sudah | Sudah Bayar | - | Rp 0 | Rp 112.300 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 92.300 | Rp 0 | Rp 0 | ||
| 3 | 2026/04/16/000177 | 223777 | MUHAMMAD ALVIS AKBAR | Unit IGD | BPJS | dr. Restiko Maleo Fibullah | 2026-04-16 | 17:05:16 | Belum | Belum Bayar | - | Rp 0 | Rp 403.000 | Rp 0 | Rp 0 | Rp 0 | Rp 162.500 | Rp 240.500 | Rp 0 | Rp 0 | ||
| 4 | 2026/04/16/000057 | 223744 | BUDI ARIANSYAH | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 16:57:32 | Sudah | Sudah Bayar | - | Rp 0 | Rp 1.434.236 | Rp 0 | Rp 0 | Rp 331.500 | Rp 487.500 | Rp 391.300 | Rp 0 | Rp 223.936 | ||
| 5 | 2026/04/16/000168 | 223772 | IBRAHIM ARSYAH ALFAREZA | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 16:39:06 | Sudah | Sudah Bayar | - | Rp 0 | Rp 229.433 | Rp 0 | Rp 0 | Rp 104.000 | Rp 0 | Rp 117.000 | Rp 0 | Rp 8.433 | ||
| 6 | 2026/04/16/000176 | 081615 | KAROLIN YULIARTI | Unit IGD | BPJS | dr. Restiko Maleo Fibullah | 2026-04-16 | 16:37:27 | Sudah | Belum Bayar | - | Rp 0 | Rp 162.500 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 162.500 | Rp 0 | Rp 0 | ||
| 7 | 2026/04/16/000174 | 223730 | ENZY RAMADAHANI | Unit IGD | UMUM | dr. Tommy Dwi purnama | 2026-04-16 | 16:16:51 | Sudah | Sudah Bayar | - | Rp 0 | Rp 181.200 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 161.200 | Rp 0 | Rp 0 | ||
| 8 | 2026/04/16/000171 | 223774 | SENI BINTI BAKAR | Unit IGD | UMUM | dr. Tommy Dwi purnama | 2026-04-16 | 15:17:10 | Sudah | Sudah Bayar | - | Rp 0 | Rp 219.651 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 117.000 | Rp 0 | Rp 50.651 | ||
| 9 | 2026/04/16/000169 | 036527 | RUSMI ATI BINTI IBRAHIM | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 14:47:11 | Sudah | Belum Bayar | - | Rp 0 | Rp 24.251 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 24.251 | ||
| 10 | 2026/04/16/000172 | 031381 | YUDI BIN M. YANI | Unit IGD | BPJS | dr. Tommy Dwi purnama | 2026-04-16 | 14:43:12 | Sudah | Belum Bayar | - | Rp 0 | Rp 914.500 | Rp 0 | Rp 0 | Rp 245.000 | Rp 162.500 | Rp 507.000 | Rp 0 | Rp 0 | ||
| 11 | 2026/04/16/000122 | 001761 | EDY SUSANTO | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 14:05:53 | Berkas Diterima | Belum Bayar |
0603R0010426V002025 INACBG: 0 |
Rp 0 | Rp 145.661 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 67.661 | ||
| 12 | 2026/04/16/000068 | 223747 | RANGGA SAPUTRA | Unit IGD | BPJS KETENAGAKERJAAN | dr. Tri Susanti | 2026-04-16 | 13:39:54 | Sudah | Belum Bayar | - | Rp 0 | Rp 685.138 | Rp 0 | Rp 0 | Rp 277.500 | Rp 0 | Rp 0 | Rp 0 | Rp 407.638 | ||
| 13 | 2026/04/16/000164 | 111399 | KOMARIAH | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 13:20:56 | Sudah | Sudah Bayar | - | Rp 0 | Rp 608.582 | Rp 0 | Rp 0 | Rp 97.500 | Rp 487.500 | Rp 0 | Rp 0 | Rp 23.582 | ||
| 14 | 2026/04/16/000170 | 216722 | FARLIDENA BURNIAT | Poli Penyakit Dalam | UMUM | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 12:33:36 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 15 | 2026/04/16/000163 | 223731 | RISKA MELINI | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 12:22:33 | Sudah | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 16 | 2026/04/16/000161 | 223770 | BAYI NYONYA DINASARI 2 | Poli Anak | BPJS | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 12:17:30 | Berkas Diterima | Belum Bayar |
0603R0010426V002064 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 17 | 2026/04/16/000160 | 223768 | BAYI NYONYA dinasari | Poli Anak | BPJS | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 12:16:31 | Berkas Diterima | Belum Bayar |
0603R0010426V002058 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 18 | 2026/04/16/000167 | 223771 | TUWENI | Unit IGD | BPJS | dr. Johannes Lie | 2026-04-16 | 12:07:39 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 967.000 | Rp 0 | Rp 0 | Rp 551.000 | Rp 162.500 | Rp 253.500 | Rp 0 | Rp 0 | ||
| 19 | 2026/04/16/000166 | 018389 | HASMAWATI | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 11:45:04 | Sudah | Belum Bayar |
0603R0010426V002063 INACBG: 0 |
Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 20 | 2026/04/16/000007 | 209229 | FERIADI BIN ASLI | Poli Kulit Kelamin | BPJS | dr. Hartini, Sp. KK | 2026-04-16 | 11:26:13 | Sudah | Belum Bayar |
0603R0010426V002061 INACBG: 0 |
Rp 0 | Rp 155.814 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 77.814 | ||
| 21 | 2026/04/16/000165 | 223209 | MEIZA DEWI ZAHARA | Poli Anak | BPJS | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 11:24:53 | Sudah | Belum Bayar |
0603R0010426V002060 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 22 | 2026/04/16/000028 | 205377 | RAHMI ASMARANI | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 11:16:08 | Sudah | Belum Bayar |
0603R0010426V002059 INACBG: 0 |
Rp 0 | Rp 115.139 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 37.139 | ||
| 23 | 2026/04/16/000159 | 121621 | ALFIN RAMADANI | Poli Prostodonti | BPJS | drg. Budi, Sp.Pros | 2026-04-16 | 11:13:17 | Sudah | Belum Bayar |
0603R0010426V002056 INACBG: 0 |
Rp 0 | Rp 342.490 | Rp 0 | Rp 0 | Rp 332.800 | Rp 0 | Rp 0 | Rp 0 | Rp 9.690 | ||
| 24 | 2026/04/16/000157 | 223767 | KHAYLA PUTRI CARISSA | Poli Mata | UMUM | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 11:09:04 | Sudah | Sudah Bayar | - | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 25 | 2026/04/16/000090 | 220033 | MARLENI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 11:05:38 | Sudah | Belum Bayar |
0603R0010426V002055 INACBG: 0 |
Rp 0 | Rp 130.000 | Rp 0 | Rp 0 | Rp 130.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 26 | 2026/04/16/000156 | 220033 | MARLENI | Poli Akupuntur | UMUM | dr. Edi Suhaimi,Sp.Ak | 2026-04-16 | 11:04:46 | Sudah | Sudah Bayar | - | Rp 0 | Rp 143.000 | Rp 0 | Rp 0 | Rp 143.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 27 | 2026/04/16/000125 | 219869 | NOVIANA | Poli DOT | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 11:04:03 | Sudah | Belum Bayar |
0603R0010426V002029 INACBG: 0 |
Rp 0 | Rp 744.447 | Rp 0 | Rp 0 | Rp 163.000 | Rp 0 | Rp 572.000 | Rp 0 | Rp 9.447 | ||
| 28 | 2026/04/16/000155 | 040008 | EXSY HANDAYANI | Poli Kulit Kelamin | BPJS | dr. Hartini, Sp. KK | 2026-04-16 | 11:02:58 | Sudah | Belum Bayar |
0603R0010426V002054 INACBG: 0 |
Rp 0 | Rp 149.575 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 71.575 | ||
| 29 | 2026/04/16/000135 | 198788 | WAHYUNI BINTI DARUL | Poli DOT | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 10:57:09 | Sudah | Belum Bayar |
0603R0010426V002053 INACBG: 0 |
Rp 0 | Rp 825.500 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 747.500 | Rp 0 | Rp 0 | ||
| 30 | 2026/04/16/000133 | 042854 | SITI MARIAM | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 10:55:08 | Sudah | Belum Bayar |
0603R0010426V002052 INACBG: 0 |
Rp 0 | Rp 30.934 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 30.934 | ||
| 31 | 2026/04/16/000147 | 124749 | ANNISA SYAHRANI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 10:48:04 | Sudah | Belum Bayar |
0603R0010426V002051 INACBG: 0 |
Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 32 | 2026/04/16/000153 | 032754 | VICTORIA AGUSCIK | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 10:43:18 | Sudah | Belum Bayar |
0603R0010426V002050 INACBG: 0 |
Rp 0 | Rp 278.309 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 174.200 | Rp 0 | Rp 26.109 | ||
| 33 | 2026/04/16/000152 | 223765 | ARWATI BINTI ARPINI | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 10:42:54 | Sudah | Belum Bayar |
0603R0010426V002049 INACBG: 0 |
Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 34 | 2026/04/16/000151 | 223711 | MINAH BINTI ROHMAN | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 10:34:25 | Sudah | Belum Bayar |
0603R0010426V002048 INACBG: 0 |
Rp 0 | Rp 420.945 | Rp 0 | Rp 0 | Rp 78.000 | Rp 325.000 | Rp 0 | Rp 0 | Rp 17.945 | ||
| 35 | 2026/04/16/000150 | 044795 | MARIHOT SIMANJUNTAK | Poli Kulit Kelamin | UMUM | dr. Hartini, Sp. KK | 2026-04-16 | 10:31:41 | Sudah | Sudah Bayar | - | Rp 0 | Rp 322.995 | Rp 0 | Rp 0 | Rp 278.000 | Rp 0 | Rp 0 | Rp 0 | Rp 44.995 | ||
| 36 | 2026/04/16/000148 | 223763 | ABDUL RAHMAN | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 10:29:38 | Berkas Diterima | Belum Bayar |
0603R0010426V002046 INACBG: 0 |
Rp 0 | Rp 95.172 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 17.172 | ||
| 37 | 2026/04/16/000130 | 222629 | RUSNAINI BINTI ZAINAL | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 10:24:54 | Berkas Diterima | Belum Bayar |
0603R0010426V002033 INACBG: 0 |
Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 38 | 2026/04/16/000145 | 102236 | BAHARUDIN BIN MAKNUR | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 10:21:06 | Sudah | Belum Bayar |
0603R0010426V002045 INACBG: 0 |
Rp 0 | Rp 164.193 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 86.193 | ||
| 39 | 2026/04/16/000144 | 223762 | HAFIZA OKTARINA | Poli Prostodonti | BPJS | drg. Budi, Sp.Pros | 2026-04-16 | 10:19:51 | Sudah | Belum Bayar |
0603R0010426V002044 INACBG: 0 |
Rp 0 | Rp 182.100 | Rp 0 | Rp 0 | Rp 169.000 | Rp 0 | Rp 0 | Rp 0 | Rp 13.100 | ||
| 40 | 2026/04/16/000117 | 223119 | GHEA TSABITA HALWA | Poli THT-KL | BPJS | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 10:19:27 | Sudah | Belum Bayar |
0603R0010426V002021 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 41 | 2026/04/16/000143 | 221228 | HARTUTI BINTI SAIDI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 10:18:03 | Sudah | Belum Bayar |
0603R0010426V002042 INACBG: 0 |
Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 42 | 2026/04/16/000142 | 043502 | RUSTAM BASTIAR | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 10:17:14 | Sudah | Belum Bayar |
0603R0010426V002040 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 43 | 2026/04/16/000131 | 219501 | ENDRIANTO | Poli Kulit Kelamin | BPJS | dr. Hartini, Sp. KK | 2026-04-16 | 10:15:26 | Sudah | Belum Bayar |
0603R0010426V002034 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 44 | 2026/04/16/000141 | 035189 | ALISHA KHAIRA WILDA | Poli Anak | UMUM | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 10:13:09 | Sudah | Sudah Bayar | - | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 45 | 2026/04/16/000140 | 025084 | FATRI YANTI | Poli Obgyn | UMUM | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 10:06:24 | Sudah | Belum Bayar | - | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 46 | 2026/04/16/000139 | 223761 | ELI PRIMAWATI | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 10:05:17 | Sudah | Belum Bayar |
0603R0010426V002039 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 47 | 2026/04/16/000138 | 223760 | MUHAMMAD HANIF QORI | Poli Umum | UMUM | dr. Johannes Lie | 2026-04-16 | 10:05:03 | Sudah | Sudah Bayar | - | Rp 0 | Rp 39.000 | Rp 0 | Rp 0 | Rp 39.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 48 | 2026/04/16/000137 | 031649 | SITI MUNAWAROH | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 10:04:53 | Sudah | Belum Bayar |
0603R0010426V002037 INACBG: 0 |
Rp 0 | Rp 142.944 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 33.094 | ||
| 49 | 2026/04/16/000136 | 096200 | NISWANA BINTI ABASTARI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 10:04:27 | Sudah | Belum Bayar |
0603R0010426V002038 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 50 | 2026/04/16/000132 | 037152 | VERA DEPITA AYU | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 10:01:13 | Sudah | Belum Bayar |
0603R0010426V002035 INACBG: 0 |
Rp 0 | Rp 110.575 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 32.575 | ||
| 51 | 2026/04/16/000134 | 205073 | MUHAMMAD KAHFI | Poli THT-KL | BPJS | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 10:01:02 | Sudah | Belum Bayar |
0603R0010426V002036 INACBG: 0 |
Rp 0 | Rp 89.497 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 11.497 | ||
| 52 | 2026/04/16/000119 | 063607 | DIAH MARLINA | Poli Prostodonti | BPJS | drg. Budi, Sp.Pros | 2026-04-16 | 09:55:16 | Sudah | Belum Bayar |
0603R0010426V002032 INACBG: 0 |
Rp 0 | Rp 188.650 | Rp 0 | Rp 0 | Rp 169.000 | Rp 0 | Rp 0 | Rp 0 | Rp 19.650 | ||
| 53 | 2026/04/16/000001 | 218601 | MISKA AGUSTINI | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:53:39 | Berkas Diterima | Belum Bayar |
0603R0010426V002031 INACBG: 0 |
Rp 0 | Rp 135.495 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 57.495 | ||
| 54 | 2026/04/16/000128 | 223759 | ALAN SETIAWAN | Poli THT-KL | UMUM | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 09:53:18 | Sudah | Sudah Bayar | - | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 55 | 2026/04/16/000127 | 209740 | ZULPIKAR BIN SARPAWI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:53:03 | Sudah | Belum Bayar |
0603R0010426V002030 INACBG: 0 |
Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 56 | 2026/04/16/000124 | 223122 | NASRIAH BINTI M ALI | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 09:52:20 | Sudah | Belum Bayar |
0603R0010426V002027 INACBG: 0 |
Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 57 | 2026/04/16/000126 | 209740 | ZULPIKAR BIN SARPAWI | Poli Akupuntur | UMUM | dr. Edi Suhaimi,Sp.Ak | 2026-04-16 | 09:51:31 | Sudah | Sudah Bayar | - | Rp 0 | Rp 143.000 | Rp 0 | Rp 0 | Rp 143.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 58 | 2026/04/16/000121 | 121985 | SUSI HERLINA | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:49:41 | Sudah | Belum Bayar |
0603R0010426V002026 INACBG: 0 |
Rp 0 | Rp 112.111 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 34.111 | ||
| 59 | 2026/04/16/000073 | 074055 | MAYUTI BINTI CIKMAT | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:46:29 | Sudah | Belum Bayar |
0603R0010426V002022 INACBG: 0 |
Rp 0 | Rp 86.420 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 8.420 | ||
| 60 | 2026/04/16/000101 | 207660 | SUHERNI BINTI SUMARMO | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:46:25 | Sudah | Belum Bayar |
0603R0010426V002023 INACBG: 0 |
Rp 0 | Rp 935.558 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 857.558 | ||
| 61 | 2026/04/16/000120 | 223758 | AHMAD RIDHO ABIWAN | Poli Umum | UMUM | dr. Johannes Lie | 2026-04-16 | 09:45:58 | Sudah | Sudah Bayar | - | Rp 0 | Rp 39.000 | Rp 0 | Rp 0 | Rp 39.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 62 | 2026/04/16/000092 | 220043 | DARU HW YOGAMINA | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:44:57 | Sudah | Belum Bayar |
0603R0010426V002019 INACBG: 0 |
Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 63 | 2026/04/16/000041 | 223740 | JUNAINAH | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 09:44:19 | Sudah | Belum Bayar |
0603R0010426V002020 INACBG: 0 |
Rp 0 | Rp 520.959 | Rp 0 | Rp 0 | Rp 156.000 | Rp 325.000 | Rp 0 | Rp 0 | Rp 39.959 | ||
| 64 | 2026/04/16/000116 | 196902 | HINDUN | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 09:43:24 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 65 | 2026/04/16/000115 | 223757 | MUHAMMAD KELVIN CHANDRA | Poli Umum | UMUM | dr. Johannes Lie | 2026-04-16 | 09:43:07 | Sudah | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 66 | 2026/04/16/000114 | 223054 | ANGGUN KASIVA | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 09:42:56 | Sudah | Belum Bayar |
0603R0010426V002024 INACBG: 0 |
Rp 0 | Rp 135.330 | Rp 0 | Rp 0 | Rp 135.330 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 67 | 2026/04/16/000113 | 199580 | YUHANIS BINTI SYAHRI | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 09:42:17 | Sudah | Belum Bayar |
0603R0010426V002017 INACBG: 0 |
Rp 0 | Rp 115.320 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 37.320 | ||
| 68 | 2026/04/16/000112 | 130874 | RADO IRWANSYAH | Poli THT-KL | BPJS | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 09:42:13 | Sudah | Belum Bayar |
0603R0010426V002016 INACBG: 0 |
Rp 0 | Rp 90.068 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 12.068 | ||
| 69 | 2026/04/16/000111 | 223756 | ERIN MUSAADAH | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 09:38:46 | Sudah | Belum Bayar |
0603R0010426V002013 INACBG: 0 |
Rp 0 | Rp 280.648 | Rp 0 | Rp 0 | Rp 78.000 | Rp 162.500 | Rp 0 | Rp 0 | Rp 40.148 | ||
| 70 | 2026/04/16/000110 | 223755 | MUHAMMAD FAHREL TANIO DWI PUTRA | Poli Umum | UMUM | dr. Johannes Lie | 2026-04-16 | 09:38:16 | Sudah | Belum Bayar | - | Rp 0 | Rp 20.000 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 71 | 2026/04/16/000047 | 223741 | YANTI ASTUTI | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 09:35:43 | Berkas Diterima | Belum Bayar |
0603R0010426V002011 INACBG: 0 |
Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 72 | 2026/04/16/000107 | 223392 | ROBIYAH | Poli Kulit Kelamin | UMUM | dr. Hartini, Sp. KK | 2026-04-16 | 09:35:25 | Sudah | Sudah Bayar | - | Rp 0 | Rp 453.000 | Rp 0 | Rp 0 | Rp 453.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 73 | 2026/04/16/000109 | 091329 | KINARA JOCELYN NESA | Poli Anak | UMUM | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 09:34:44 | Sudah | Sudah Bayar | - | Rp 0 | Rp 221.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 143.000 | Rp 0 | Rp 0 | ||
| 74 | 2026/04/16/000108 | 128527 | MAHYUNIAR BINTI M AMIN | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:32:04 | Sudah | Belum Bayar |
0603R0010426V002010 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 75 | 2026/04/16/000002 | 222689 | MARIZAL | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:28:16 | Sudah | Belum Bayar |
0603R0010426V002009 INACBG: 0 |
Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 76 | 2026/04/16/000106 | 223754 | SURYATI | Poli Mata | UMUM | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 09:27:50 | Sudah | Sudah Bayar | - | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 77 | 2026/04/16/000056 | 223180 | NOVIZA BINTI RUSMADI | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:25:31 | Berkas Diterima | Belum Bayar |
0603R0010426V002006 INACBG: 0 |
Rp 0 | Rp 81.831 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 3.831 | ||
| 78 | 2026/04/16/000105 | 223753 | NAURA HAFIZHA | Poli THT-KL | BPJS | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 09:25:27 | Sudah | Belum Bayar |
0603R0010426V002005 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 79 | 2026/04/16/000104 | 223752 | MULYATI | Poli Saraf | UMUM | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 09:23:58 | Sudah | Sudah Bayar | - | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 80 | 2026/04/16/000103 | 223751 | DESTI AGUSTINA | Poli Umum | UMUM | dr. Johannes Lie | 2026-04-16 | 09:21:46 | Sudah | Sudah Bayar | - | Rp 0 | Rp 39.000 | Rp 0 | Rp 0 | Rp 39.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 81 | 2026/04/16/000099 | 217045 | SUWARNI BIN MUSTAJIM | Poli THT-KL | BPJS | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 09:19:14 | Sudah | Belum Bayar |
0603R0010426V002000 INACBG: 0 |
Rp 0 | Rp 81.315 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 3.315 | ||
| 82 | 2026/04/16/000100 | 067719 | MARYUNI BINTI RIDWAN | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:18:26 | Berkas Diterima | Belum Bayar |
0603R0010426V002014 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 83 | 2026/04/16/000098 | 223749 | M.HUSIN | Poli Bedah | UMUM | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 09:16:49 | Sudah | Sudah Bayar | - | Rp 0 | Rp 240.500 | Rp 0 | Rp 0 | Rp 78.000 | Rp 162.500 | Rp 0 | Rp 0 | Rp 0 | ||
| 84 | 2026/04/16/000096 | 223653 | MAHREEN | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 09:13:40 | Sudah | Sudah Bayar | - | Rp 0 | Rp 112.300 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 92.300 | Rp 0 | Rp 0 | ||
| 85 | 2026/04/16/000095 | 223692 | RALINE BINTI FRANTI JAYA | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 09:13:17 | Sudah | Sudah Bayar | - | Rp 0 | Rp 112.300 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 92.300 | Rp 0 | Rp 0 | ||
| 86 | 2026/04/16/000094 | 223727 | RAFANZA BIN ABDUL GANI | Unit IGD | UMUM | dr. Johannes Lie | 2026-04-16 | 09:13:08 | Sudah | Sudah Bayar | - | Rp 0 | Rp 112.300 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 92.300 | Rp 0 | Rp 0 | ||
| 87 | 2026/04/16/000034 | 060148 | NEHRU BHM SALEH | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:12:49 | Sudah | Belum Bayar |
0603R0010426V001999 INACBG: 0 |
Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 88 | 2026/04/16/000093 | 018293 | LIN BINTI DIK | Poli Prostodonti | BPJS | drg. Budi, Sp.Pros | 2026-04-16 | 09:12:31 | Sudah | Belum Bayar |
0603R0010426V001997 INACBG: 0 |
Rp 0 | Rp 260.590 | Rp 0 | Rp 0 | Rp 250.900 | Rp 0 | Rp 0 | Rp 0 | Rp 9.690 | ||
| 89 | 2026/04/16/000033 | 004508 | SITI JARAI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:11:10 | Sudah | Belum Bayar |
0603R0010426V001996 INACBG: 0 |
Rp 0 | Rp 208.000 | Rp 0 | Rp 0 | Rp 208.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 90 | 2026/04/16/000091 | 200469 | WINIA SATRIANI | Poli Penyakit Dalam | UMUM | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 09:10:52 | Sudah | Sudah Bayar | - | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 91 | 2026/04/16/000072 | 066253 | ALI HANAFIAH | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:09:18 | Berkas Diterima | Belum Bayar |
0603R0010426V001995 INACBG: 0 |
Rp 0 | Rp 110.556 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 32.556 | ||
| 92 | 2026/04/16/000089 | 218780 | SUSILOWATI BINTI NURHADI | Poli Hemodialisa | BPJS | dr. Deddy Primadona Mulia, Sp. PD - K.GH, FINASIM | 2026-04-16 | 09:08:02 | Sudah | Belum Bayar |
0603R0010426V001998 INACBG: 0 |
Rp 0 | Rp 929.574 | Rp 0 | Rp 0 | Rp 850.000 | Rp 0 | Rp 0 | Rp 0 | Rp 79.574 | ||
| 93 | 2026/04/16/000087 | 010949 | MISDAR WIYAH | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:07:35 | Sudah | Belum Bayar |
0603R0010426V001994 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 94 | 2026/04/16/000088 | 078079 | RUSMAN BIN M NUR | Poli Penyakit Dalam | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 09:05:14 | Sudah | Belum Bayar |
0603R0010426V001991 INACBG: 0 |
Rp 0 | Rp 90.830 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 12.830 | ||
| 95 | 2026/04/16/000014 | 223725 | SUARDI | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 09:03:58 | Sudah | Belum Bayar |
0603R0010426V001990 INACBG: 0 |
Rp 0 | Rp 113.650 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 35.650 | ||
| 96 | 2026/04/16/000076 | 197178 | HELMAINI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 09:02:56 | Sudah | Belum Bayar |
0603R0010426V001989 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 97 | 2026/04/16/000086 | 217486 | MUNAYAH | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 09:01:28 | Sudah | Belum Bayar |
0603R0010426V001988 INACBG: 0 |
Rp 0 | Rp 186.239 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 108.239 | ||
| 98 | 2026/04/16/000085 | 211215 | ZAINAL ABIDIN | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 09:01:22 | Sudah | Belum Bayar |
0603R0010426V001983 INACBG: 0 |
Rp 0 | Rp 180.407 | Rp 0 | Rp 0 | Rp 123.500 | Rp 0 | Rp 0 | Rp 0 | Rp 56.907 | ||
| 99 | 2026/04/16/000005 | 223258 | IDRIS BIN DAUD | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:55:25 | Sudah | Belum Bayar |
0603R0010426V002018 INACBG: 0 |
Rp 0 | Rp 55.207 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 55.207 | ||
| 100 | 2026/04/16/000084 | 223045 | PENDI SURYA HARJA | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:55:04 | Sudah | Belum Bayar |
0603R0010426V002015 INACBG: 0 |
Rp 0 | Rp 49.917 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 49.917 | ||
| 101 | 2026/04/16/000023 | 223735 | FATIMAH ROZAK | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 08:54:19 | Sudah | Sudah Bayar | - | Rp 0 | Rp 147.477 | Rp 0 | Rp 0 | Rp 104.000 | Rp 0 | Rp 0 | Rp 0 | Rp 43.477 | ||
| 102 | 2026/04/16/000006 | 223709 | ABDURRAHMAN | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:54:16 | Sudah | Belum Bayar |
0603R0010426V002043 INACBG: 0 |
Rp 0 | Rp 729.800 | Rp 0 | Rp 0 | Rp 163.000 | Rp 162.500 | Rp 404.300 | Rp 0 | Rp 0 | ||
| 103 | 2026/04/16/000083 | 199341 | MUHAMMAD YUSUP BIN USMAN BAJIK | Poli Kulit Kelamin | BPJS | dr. Hartini, Sp. KK | 2026-04-16 | 08:52:11 | Sudah | Belum Bayar |
0603R0010426V001981 INACBG: 0 |
Rp 0 | Rp 298.182 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 156.000 | Rp 0 | Rp 64.182 | ||
| 104 | 2026/04/16/000082 | 069725 | SULAIMAN BIN ADAM | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 08:51:36 | Sudah | Belum Bayar |
0603R0010426V002004 INACBG: 0 |
Rp 0 | Rp 169.562 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 59.712 | ||
| 105 | 2026/04/16/000081 | 038084 | AINUN SANAH | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:50:42 | Sudah | Belum Bayar |
0603R0010426V001980 INACBG: 0 |
Rp 0 | Rp 183.995 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 105.995 | ||
| 106 | 2026/04/16/000080 | 045814 | INDRA WATI | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:49:47 | Sudah | Belum Bayar |
0603R0010426V001979 INACBG: 0 |
Rp 0 | Rp 189.441 | Rp 0 | Rp 0 | Rp 135.330 | Rp 0 | Rp 0 | Rp 0 | Rp 54.111 | ||
| 107 | 2026/04/16/000079 | 222835 | NARA RATI | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 08:48:56 | Sudah | Belum Bayar |
0603R0010426V002002 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 108 | 2026/04/16/000013 | 200107 | YESSY NOVIANTY | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 08:48:44 | Sudah | Belum Bayar |
0603R0010426V001993 INACBG: 0 |
Rp 0 | Rp 102.931 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 24.931 | ||
| 109 | 2026/04/16/000077 | 211130 | TETRI RAHMAWATI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 08:47:59 | Sudah | Belum Bayar |
0603R0010426V001978 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 110 | 2026/04/16/000078 | 201304 | HAMSON NAINGGOLAN | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:47:54 | Sudah | Belum Bayar |
0603R0010426V001992 INACBG: 0 |
Rp 0 | Rp 194.000 | Rp 0 | Rp 0 | Rp 135.330 | Rp 0 | Rp 0 | Rp 0 | Rp 58.670 | ||
| 111 | 2026/04/16/000012 | 001328 | SAMMANI BIN ABDUL RAHMAN | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 08:47:37 | Sudah | Belum Bayar |
0603R0010426V001977 INACBG: 0 |
Rp 0 | Rp 208.000 | Rp 0 | Rp 0 | Rp 208.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 112 | 2026/04/16/000074 | 223748 | JOHAN PUTRA | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 08:45:20 | Sudah | Belum Bayar |
0603R0010426V001974 INACBG: 0 |
Rp 0 | Rp 419.783 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 287.300 | Rp 0 | Rp 22.633 | ||
| 113 | 2026/04/16/000064 | 130552 | PARIYEM BINTI KASRI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 08:44:52 | Sudah | Belum Bayar |
0603R0010426V001976 INACBG: 0 |
Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 286.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 114 | 2026/04/16/000003 | 223297 | IMAM SUBUH | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:43:58 | Sudah | Belum Bayar |
0603R0010426V001986 INACBG: 0 |
Rp 0 | Rp 177.611 | Rp 0 | Rp 0 | Rp 123.500 | Rp 0 | Rp 0 | Rp 0 | Rp 54.111 | ||
| 115 | 2026/04/16/000075 | 218008 | NANISA | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:43:39 | Sudah | Belum Bayar |
0603R0010426V001984 INACBG: 0 |
Rp 0 | Rp 499.509 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 421.509 | ||
| 116 | 2026/04/16/000067 | 212992 | SOLINAH BINTI ADAMSIR | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:43:32 | Sudah | Belum Bayar |
0603R0010426V001975 INACBG: 0 |
Rp 0 | Rp 633.741 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 32.500 | Rp 0 | Rp 523.241 | ||
| 117 | 2026/04/16/000071 | 205867 | ABDUL RAHMAN | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 08:41:03 | Sudah | Belum Bayar |
0603R0010426V001982 INACBG: 0 |
Rp 0 | Rp 133.744 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 23.894 | ||
| 118 | 2026/04/16/000062 | 095710 | M YAMIN | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:38:59 | Berkas Diterima | Belum Bayar |
0603R0010426V001973 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 119 | 2026/04/16/000065 | 216571 | SAK ODAH | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 08:36:01 | Sudah | Belum Bayar |
0603R0010426V001971 INACBG: 0 |
Rp 0 | Rp 211.314 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 101.464 | ||
| 120 | 2026/04/16/000066 | 223420 | RATNA | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 08:34:57 | Sudah | Belum Bayar |
0603R0010426V001972 INACBG: 0 |
Rp 0 | Rp 205.300 | Rp 0 | Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 0 | Rp 16.800 | ||
| 121 | 2026/04/16/000063 | 107492 | SITI AISYAH | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 08:31:28 | Sudah | Belum Bayar |
0603R0010426V001970 INACBG: 0 |
Rp 0 | Rp 251.187 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 173.187 | ||
| 122 | 2026/04/16/000061 | 223745 | KARTINI | Poli Penyakit Dalam | UMUM | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:29:36 | Sudah | Sudah Bayar | - | Rp 0 | Rp 163.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 123 | 2026/04/16/000060 | 128120 | A WILI ROBAI | Poli Hemodialisa | BPJS | dr. Deddy Primadona Mulia, Sp. PD - K.GH, FINASIM | 2026-04-16 | 08:28:51 | Sudah | Belum Bayar |
0603R0010426V001969 INACBG: 0 |
Rp 0 | Rp 911.166 | Rp 0 | Rp 0 | Rp 850.000 | Rp 0 | Rp 0 | Rp 0 | Rp 61.166 | ||
| 124 | 2026/04/16/000058 | 135317 | NURPATIMAH | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 08:24:38 | Sudah | Belum Bayar |
0603R0010426V001965 INACBG: 0 |
Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 125 | 2026/04/16/000027 | 119635 | SITI MARDIYAH | Poli Hemodialisa | BPJS | dr. Deddy Primadona Mulia, Sp. PD - K.GH, FINASIM | 2026-04-16 | 08:24:36 | Berkas Diterima | Belum Bayar |
0603R0010426V001966 INACBG: 0 |
Rp 0 | Rp 920.118 | Rp 0 | Rp 0 | Rp 850.000 | Rp 0 | Rp 0 | Rp 0 | Rp 70.118 | ||
| 126 | 2026/04/16/000011 | 207782 | HAIRUNISA AULIANTI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 08:24:24 | Sudah | Belum Bayar |
0603R0010426V001967 INACBG: 0 |
Rp 0 | Rp 253.500 | Rp 0 | Rp 0 | Rp 253.500 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 127 | 2026/04/16/000004 | 223370 | AHMAD YANI | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 08:24:22 | Sudah | Belum Bayar |
0603R0010426V001968 INACBG: 0 |
Rp 0 | Rp 173.417 | Rp 0 | Rp 0 | Rp 123.500 | Rp 0 | Rp 0 | Rp 0 | Rp 49.917 | ||
| 128 | 2026/04/16/000055 | 072215 | LISPUR MAIZA | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:22:38 | Sudah | Belum Bayar |
0603R0010426V001964 INACBG: 0 |
Rp 0 | Rp 125.010 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 47.010 | ||
| 129 | 2026/04/16/000050 | 112335 | RABIN BIN CIKRO | Poli DOT | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 08:17:13 | Sudah | Belum Bayar |
0603R0010426V001962 INACBG: 0 |
Rp 0 | Rp 1.385.922 | Rp 0 | Rp 0 | Rp 163.000 | Rp 162.500 | Rp 1.033.500 | Rp 0 | Rp 26.922 | ||
| 130 | 2026/04/16/000053 | 088660 | ADRIANSYAH BINTI MUDENALI | Poli Hemodialisa | BPJS | dr. Deddy Primadona Mulia, Sp. PD - K.GH, FINASIM | 2026-04-16 | 08:15:23 | Sudah | Belum Bayar |
0603R0010426V001963 INACBG: 0 |
Rp 0 | Rp 950.018 | Rp 0 | Rp 0 | Rp 850.000 | Rp 0 | Rp 29.900 | Rp 0 | Rp 70.118 | ||
| 131 | 2026/04/16/000052 | 208508 | ISNAINI BINTI ISMAIL | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:14:09 | Sudah | Belum Bayar |
0603R0010426V001961 INACBG: 0 |
Rp 0 | Rp 171.464 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 93.464 | ||
| 132 | 2026/04/16/000051 | 223743 | ANDRIA NINGSI | Unit IGD | BPJS | dr. Johannes Lie | 2026-04-16 | 08:13:45 | Sudah | Belum Bayar |
0603R0010426V002068 INACBG: 0 |
Rp 0 | Rp 719.889 | Rp 0 | Rp 0 | Rp 330.000 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 64.889 | ||
| 133 | 2026/04/16/000049 | 223742 | LINA NATALIA | Poli Prostodonti | BPJS | drg. Budi, Sp.Pros | 2026-04-16 | 08:12:22 | Sudah | Belum Bayar |
0603R0010426V001960 INACBG: 0 |
Rp 0 | Rp 91.100 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 13.100 | ||
| 134 | 2026/04/16/000048 | 136204 | MASNUN | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:10:16 | Sudah | Belum Bayar |
0603R0010426V001959 INACBG: 0 |
Rp 0 | Rp 115.320 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 37.320 | ||
| 135 | 2026/04/16/000020 | 112314 | HERMAWANI BINTI M RANTAI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 08:07:36 | Sudah | Belum Bayar |
0603R0010426V001958 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 136 | 2026/04/16/000046 | 097223 | NURHIDAYAH | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 08:06:51 | Sudah | Belum Bayar |
0603R0010426V001957 INACBG: 0 |
Rp 0 | Rp 195.490 | Rp 0 | Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 0 | Rp 6.990 | ||
| 137 | 2026/04/16/000045 | 037868 | JUWITA BINTI M SOLEH | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 08:04:05 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 138 | 2026/04/16/000044 | 100089 | MUKSIN | Poli DOT | BPJS | dr. Made Suwarno, Sp.PD.,M.Biomed | 2026-04-16 | 08:02:44 | Sudah | Belum Bayar |
0603R0010426V001955 INACBG: 0 |
Rp 0 | Rp 249.134 | Rp 0 | Rp 0 | Rp 78.000 | Rp 162.500 | Rp 0 | Rp 0 | Rp 8.634 | ||
| 139 | 2026/04/16/000025 | 213054 | MUHAMMAD RUZAYN ALGHANI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 08:00:05 | Sudah | Belum Bayar |
0603R0010426V001954 INACBG: 0 |
Rp 0 | Rp 130.000 | Rp 0 | Rp 0 | Rp 130.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 140 | 2026/04/16/000059 | 107492 | SITI AISYAH | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 08:00:00 | Belum | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 141 | 2026/04/16/000043 | 215635 | JONSI BIN SEROTA | Poli Hemodialisa | BPJS | dr. Deddy Primadona Mulia, Sp. PD - K.GH, FINASIM | 2026-04-16 | 07:59:03 | Berkas Diterima | Belum Bayar |
0603R0010426V001952 INACBG: 0 |
Rp 0 | Rp 70.118 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 70.118 | ||
| 142 | 2026/04/16/000040 | 214379 | M. ALI | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 07:58:09 | Sudah | Belum Bayar |
0603R0010426V001951 INACBG: 0 |
Rp 0 | Rp 143.483 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 58.500 | Rp 0 | Rp 6.983 | ||
| 143 | 2026/04/16/000042 | 217680 | RASMINA BINTI BUSTAMI | Poli Saraf | BPJS | dr. Natasya Wanda Yuniza, Sp.N | 2026-04-16 | 07:57:51 | Sudah | Belum Bayar |
0603R0010426V001956 INACBG: 0 |
Rp 0 | Rp 110.428 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 32.428 | ||
| 144 | 2026/04/16/000031 | 054224 | SUMYATI | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 07:57:19 | Sudah | Belum Bayar |
0603R0010426V001950 INACBG: 0 |
Rp 0 | Rp 165.520 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 55.670 | ||
| 145 | 2026/04/16/000008 | 024983 | M.RIZQI ARRAAFI | Poli Anak | BPJS | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 07:57:10 | Sudah | Belum Bayar |
0603R0010426V001953 INACBG: 0 |
Rp 0 | Rp 490.100 | Rp 0 | Rp 0 | Rp 78.000 | Rp 162.500 | Rp 249.600 | Rp 0 | Rp 0 | ||
| 146 | 2026/04/16/000039 | 223739 | WARDIAH | Poli Obgyn | BPJS | dr. Tomas Ediba, Sp.OG | 2026-04-16 | 07:54:54 | Sudah | Belum Bayar |
0603R0010426V001949 INACBG: 0 |
Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 188.500 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 147 | 2026/04/16/000038 | 111866 | TINA OKTARINA | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 07:53:52 | Sudah | Belum Bayar |
0603R0010426V001948 INACBG: 0 |
Rp 0 | Rp 95.991 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 17.991 | ||
| 148 | 2026/04/16/000037 | 223738 | ALVINDO | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 07:50:51 | Sudah | Sudah Bayar | - | Rp 0 | Rp 468.184 | Rp 0 | Rp 0 | Rp 132.000 | Rp 325.000 | Rp 0 | Rp 0 | Rp 11.184 | ||
| 149 | 2026/04/16/000030 | 223737 | MARTINA | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 07:50:33 | Sudah | Belum Bayar |
0603R0010426V001946 INACBG: 0 |
Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 150 | 2026/04/16/000035 | 201354 | SAZILI HAYAN | Poli Mata | BPJS | dr. Muchtar Luthfi Sp.M | 2026-04-16 | 07:49:10 | Sudah | Belum Bayar |
0603R0010426V001947 INACBG: 0 |
Rp 0 | Rp 135.362 | Rp 0 | Rp 0 | Rp 109.850 | Rp 0 | Rp 0 | Rp 0 | Rp 25.512 | ||
| 151 | 2026/04/16/000022 | 222990 | NURDIANAH BINTI M. ALWANI | Poli Rehabilitasi Medik | BPJS | dr. Hesty Oktarina, Sp.KFR | 2026-04-16 | 07:47:56 | Sudah | Belum Bayar |
0603R0010426V001943 INACBG: 0 |
Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 152 | 2026/04/16/000032 | 000499 | NURLELA BINTI HALIM | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 07:47:17 | Sudah | Sudah Bayar | - | Rp 0 | Rp 133.930 | Rp 0 | Rp 0 | Rp 123.500 | Rp 0 | Rp 0 | Rp 0 | Rp 10.430 | ||
| 153 | 2026/04/16/000010 | 083061 | SANTI BINTI M SOLEH | Poli Penyakit Dalam | BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | 2026-04-16 | 07:44:21 | Sudah | Belum Bayar |
0603R0010426V001941 INACBG: 0 |
Rp 0 | Rp 113.990 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 35.990 | ||
| 154 | 2026/04/16/000026 | 204141 | ASNAWI BIN AHMAD | Poli Bedah | BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | 2026-04-16 | 07:43:10 | Sudah | Belum Bayar |
0603R0010426V001940 INACBG: 0 |
Rp 0 | Rp 177.611 | Rp 0 | Rp 0 | Rp 123.500 | Rp 0 | Rp 0 | Rp 0 | Rp 54.111 | ||
| 155 | 2026/04/16/000019 | 119046 | AYUB KHOIR | Poli Anak | BPJS | dr. Dian Maya Sari, Sp.A | 2026-04-16 | 07:41:40 | Sudah | Belum Bayar |
0603R0010426V001939 INACBG: 0 |
Rp 0 | Rp 480.461 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 247.000 | Rp 0 | Rp 155.461 | ||
| 156 | 2026/04/16/000029 | 118140 | UCI LESTARI | Poli THT-KL | BPJS | dr. Widya Adiarti Minwal, Sp. THT-KL | 2026-04-16 | 07:40:45 | Sudah | Belum Bayar |
0603R0010426V001942 INACBG: 0 |
Rp 0 | Rp 103.540 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 0 | Rp 0 | Rp 25.540 | ||
| 157 | 2026/04/16/000024 | 223736 | ACHMAD FAQIH | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 07:11:14 | Sudah | Sudah Bayar | - | Rp 0 | Rp 444.893 | Rp 0 | Rp 0 | Rp 277.500 | Rp 0 | Rp 0 | Rp 0 | Rp 167.393 | ||
| 158 | 2026/04/16/000018 | 223733 | JAUHARI | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 06:10:52 | Sudah | Sudah Bayar | - | Rp 0 | Rp 269.583 | Rp 0 | Rp 0 | Rp 219.000 | Rp 0 | Rp 0 | Rp 0 | Rp 50.583 | ||
| 159 | 2026/04/16/000017 | 061735 | NASOR | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 03:43:55 | Sudah | Sudah Bayar | - | Rp 0 | Rp 241.033 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 149.500 | Rp 0 | Rp 39.533 | ||
| 160 | 2026/04/16/000015 | 015430 | BAKIAH BINTI BURLIAN RUSLI | Unit IGD | UMUM | dr. Tri Susanti | 2026-04-16 | 02:21:31 | Sudah | Sudah Bayar | - | Rp 0 | Rp 68.386 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 0 | Rp 16.386 | ||
| 161 | 2026/04/16/000016 | 223732 | SUMYATI | Unit IGD | BPJS | dr. Tri Susanti | 2026-04-16 | 01:17:06 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 1.201.000 | Rp 0 | Rp 0 | Rp 785.000 | Rp 162.500 | Rp 253.500 | Rp 0 | Rp 0 | ||
| TOTAL | Rp 0 | Rp 39.693.944 | Rp 0 | Rp 0 | Rp 22.573.690 | Rp 4.062.500 | Rp 7.020.000 | Rp 0 | Rp 5.952.754 | |||||||||||||