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 | 2026/07/26/000048 | 001801 | MARWATI BINTI M. RONI | Unit IGD | BPJS | dr. Dini Mudira Sari | 2026-07-26 | 21:36:44 | Belum | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 2 | 2026/07/26/000045 | 126621 | ELLY YANA | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 19:03:22 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 3 | 2026/07/26/000044 | 197729 | AHMAD RASYIDI | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 18:38:22 | Meninggal | Sudah Bayar | - | Rp 0 | Rp 137.000 | Rp 0 | Rp 0 | Rp 137.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 4 | 2026/07/26/000043 | 092840 | HOLIDI | Unit IGD | BPJS | dr. Johannes Lie | 2026-07-26 | 18:22:48 | Berkas Diterima | Belum Bayar |
0603R0010726V003533 INACBG: 0 |
Rp 0 | Rp 546.500 | Rp 0 | Rp 0 | Rp 189.000 | Rp 162.500 | Rp 195.000 | Rp 0 | Rp 0 | ||
| 5 | 2026/07/26/000040 | 228723 | KAMINING binti TRUNO | Unit IGD | BPJS | dr. Nining Sariwati | 2026-07-26 | 18:14:52 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 715.500 | Rp 0 | Rp 0 | Rp 280.000 | Rp 162.500 | Rp 273.000 | Rp 0 | Rp 0 | ||
| 6 | 2026/07/26/000039 | 138321 | RAHEL HOLENSI | Unit IGD | BPJS | dr. Nining Sariwati | 2026-07-26 | 18:10:19 | Berkas Diterima | Belum Bayar |
0603R0010726V003532 INACBG: 0 |
Rp 0 | Rp 162.500 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 162.500 | Rp 0 | Rp 0 | ||
| 7 | 2026/07/26/000036 | 228719 | ALIYAH ZAHRA | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 18:05:44 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 125.048 | Rp 0 | Rp 0 | Rp 91.000 | Rp 0 | Rp 0 | Rp 0 | Rp 34.048 | ||
| 8 | 2026/07/26/000035 | 228718 | SUPARDI bin SERJET | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 17:12:40 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 119.040 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 58.500 | Rp 0 | Rp 8.540 | ||
| 9 | 2026/07/26/000037 | 228720 | KARLENA APRIANTI | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 16:50:37 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 134.795 | Rp 0 | Rp 0 | Rp 97.500 | Rp 0 | Rp 0 | Rp 0 | Rp 37.295 | ||
| 10 | 2026/07/26/000038 | 228721 | SITI MELATI PUTRI | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 16:50:26 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 105.630 | Rp 0 | Rp 0 | Rp 97.500 | Rp 0 | Rp 0 | Rp 0 | Rp 8.130 | ||
| 11 | 2026/07/26/000032 | 219038 | MUHAMMAD AIDIL ARSHAKA | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 16:33:16 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 0 | ||
| 12 | 2026/07/26/000034 | 123965 | DIANKA QUEENARA PUTRI | Unit IGD | UMUM | dr. Johannes Lie | 2026-07-26 | 16:31:15 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 117.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | Rp 117.000 | Rp 0 | Rp 0 | ||
| 13 | 2026/07/26/000033 | 228717 | MAZAYA ALMAHIRA | Unit IGD | UMUM | dr. Nining Sariwati | 2026-07-26 | 16:03:50 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 14 | 2026/07/26/000003 | 228704 | GRESSELYN FADILLAH | Unit IGD | UMUM | dr. Restiko Maleo Fibullah | 2026-07-26 | 15:40:31 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 667.208 | Rp 0 | Rp 0 | Rp 286.000 | Rp 0 | Rp 305.500 | Rp 0 | Rp 75.708 | ||
| 15 | 2026/07/26/000031 | 228578 | ALEA INARA NAILA | Unit IGD | UMUM | dr. Husti Noprianrest | 2026-07-26 | 15:04:59 | Sudah | Sudah Bayar | - | Rp 0 | Rp 112.300 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 92.300 | Rp 0 | Rp 0 | ||
| 16 | 2026/07/26/000030 | 108498 | CLARISA TAMAKO | Unit IGD | UMUM | dr. Husti Noprianrest | 2026-07-26 | 14:03:51 | Sudah | Sudah Bayar | - | Rp 0 | Rp 163.000 | Rp 0 | Rp 0 | Rp 20.000 | Rp 0 | Rp 143.000 | Rp 0 | Rp 0 | ||
| 17 | 2026/07/26/000029 | 228716 | SARIP | Unit IGD | BPJS | dr. Husti Noprianrest | 2026-07-26 | 13:46:16 | Berkas Diterima | Belum Bayar |
0603R0010726V003531 INACBG: 0 |
Rp 0 | Rp 670.100 | Rp 0 | Rp 0 | Rp 336.000 | Rp 0 | Rp 334.100 | Rp 0 | Rp 0 | ||
| 18 | 2026/07/26/000026 | 228714 | AL AFIK | Unit IGD | UMUM | dr. Husti Noprianrest | 2026-07-26 | 13:14:50 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 361.645 | Rp 0 | Rp 0 | Rp 227.500 | Rp 0 | Rp 0 | Rp 0 | Rp 134.145 | ||
| 19 | 2026/07/26/000025 | 200282 | A RAHMAN BIN MUHAMMAD ALI | Unit IGD | BPJS | dr.Paradila Navia Tuzzuhra | 2026-07-26 | 11:41:14 | Berkas Diterima | Sudah Bayar |
0603R0010726V003529 INACBG: 0 |
Rp 0 | Rp 248.207 | Rp 0 | Rp 0 | Rp 180.000 | Rp 0 | Rp 0 | Rp 0 | Rp 68.207 | ||
| 20 | 2026/07/26/000017 | 092586 | REANU FILARYAN JIWA | Unit IGD | UMUM | dr.Paradila Navia Tuzzuhra | 2026-07-26 | 11:37:56 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 66.675 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 0 | Rp 14.675 | ||
| 21 | 2026/07/26/000018 | 049942 | ARMITA BINTI M LAORI | Unit IGD | BPJS | dr.Paradila Navia Tuzzuhra | 2026-07-26 | 10:35:58 | Sudah | Sudah Bayar |
0603R0010726V003530 INACBG: 0 |
Rp 0 | Rp 588.897 | Rp 0 | Rp 0 | Rp 464.000 | Rp 0 | Rp 29.900 | Rp 0 | Rp 94.997 | ||
| 22 | 2026/07/26/000014 | 132243 | FITRI FEBIYANTI BINTI M. HAJI | Unit IGD | UMUM | dr.Paradila Navia Tuzzuhra | 2026-07-26 | 10:05:43 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 23 | 2026/07/26/000007 | 228707 | RIDHONI BIN ASBANI | Unit IGD | UMUM | dr. Restiko Maleo Fibullah | 2026-07-26 | 09:38:36 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 169.101 | Rp 0 | Rp 0 | Rp 137.000 | Rp 0 | Rp 0 | Rp 0 | Rp 32.101 | ||
| 24 | 2026/07/26/000013 | 135784 | KOHAR HUSIN | Unit IGD | UMUM | dr. Husti Noprianrest | 2026-07-26 | 09:34:20 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 280.907 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 195.000 | Rp 0 | Rp 33.907 | ||
| 25 | 2026/07/26/000011 | 228710 | SAMSUL BAHRI | Unit IGD | UMUM | dr. Husti Noprianrest | 2026-07-26 | 08:34:10 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 77.758 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 0 | Rp 25.758 | ||
| 26 | 2026/07/26/000010 | 228700 | SITI HARDIANTI | Unit IGD | UMUM | dr.Paradila Navia Tuzzuhra | 2026-07-26 | 08:24:11 | Sudah | Sudah Bayar | - | Rp 0 | Rp 510.000 | Rp 0 | Rp 0 | Rp 510.000 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 27 | 2026/07/26/000008 | 228708 | AL KHALIFAH AGUNG WIBOWO | Unit IGD | UMUM | dr. Restiko Maleo Fibullah | 2026-07-26 | 07:35:43 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 377.000 | Rp 0 | Rp 0 | Rp 52.000 | Rp 325.000 | Rp 0 | Rp 0 | Rp 0 | ||
| 28 | 2026/07/26/000005 | 228705 | LUKMAN | Unit IGD | UMUM | dr. Restiko Maleo Fibullah | 2026-07-26 | 06:13:59 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 277.470 | Rp 0 | Rp 0 | Rp 227.500 | Rp 0 | Rp 0 | Rp 0 | Rp 49.970 | ||
| 29 | 2026/07/26/000001 | 228702 | AHMAD EVRAN BACHTIAR | Unit IGD | UMUM | dr. Muhammad Akip Aprianto | 2026-07-26 | 04:43:37 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 287.365 | Rp 0 | Rp 0 | Rp 104.000 | Rp 0 | Rp 117.000 | Rp 0 | Rp 66.365 | ||
| 30 | 2026/07/26/000002 | 228703 | LENI MARLINA | Unit IGD | UMUM | dr. Muhammad Akip Aprianto | 2026-07-26 | 02:20:51 | Berkas Diterima | Sudah Bayar | - | Rp 0 | Rp 79.191 | Rp 0 | Rp 0 | Rp 52.000 | Rp 0 | Rp 0 | Rp 0 | Rp 27.191 | ||
| TOTAL | Rp 0 | Rp 7.398.837 | Rp 0 | Rp 0 | Rp 3.820.000 | Rp 650.000 | Rp 2.217.800 | Rp 0 | Rp 711.037 | |||||||||||||