Laporan detail tindakan dan biaya pasien rawat jalan & inap
| No | No.Rawat | No.R.M. | Nama Pasien | Kamar | Cara Bayar | DPJP Registrasi | DPJP Ranap | Tgl.Reg | Jam Reg | Status | Status Bayar | No SEP | Tarif INA-CBG | Tarif RS | Dokter | Paramedis | Dokter+Paramedis | Radiologi | Laboratorium | Operasi | Farmasi | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026/03/01/000020 | 221552 | DAHLIA |
Kamar: IRKB09 - Kamar IRKB Obsetri
|
BPJS | dr. Restiko Maleo Fibullah | - | 2026-03-01 | 14:49:28 | Sudah | Belum Bayar | - | Rp 0 | Rp 967.349 | Rp 0 | Rp 0 | Rp 510.850 | Rp 0 | Rp 377.000 | Rp 0 | Rp 79.499 | ||
| 2 | 2026/03/01/000019 | 219201 | KASMA BINTI ZAWAWI |
Kamar: IRCA19 - Kamar IR Non Tindakan
|
BPJS | dr. Muhammad Akip Aprianto |
dr. Tri Nisdian WardiahSp.PD
|
2026-03-01 | 14:34:43 | Sudah | Belum Bayar |
0603R0010326V000006 INACBG: 0 |
Rp 0 | Rp 898.976 | Rp 0 | Rp 0 | Rp 330.000 | Rp 162.500 | Rp 279.500 | Rp 0 | Rp 126.976 | ||
| 3 | 2026/03/01/000017 | 221550 | ADINDA AYU SAFITRI |
Kamar: IRT21 - Kamar IR Tindakan
|
BPJS | dr. Restiko Maleo Fibullah |
dr. AyatullahSp. B
|
2026-03-01 | 13:18:20 | Berkas Diterima | Belum Bayar |
0603R0010326V000005 INACBG: 0 |
Rp 0 | Rp 1.170.084 | Rp 0 | Rp 0 | Rp 336.000 | Rp 325.000 | Rp 436.800 | Rp 0 | Rp 72.284 | ||
| 4 | 2026/03/01/000015 | 221549 | KING SATRIA ALFACHRI |
Kamar: IRA01 - Kamar IRA
|
BPJS | dr. Restiko Maleo Fibullah | - | 2026-03-01 | 12:49:55 | Sudah | Belum Bayar | - | Rp 0 | Rp 811.632 | Rp 0 | Rp 0 | Rp 234.000 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 252.632 | ||
| 5 | 2026/03/01/000014 | 203903 | NAZMI BINTI MAKRUN |
Kamar: IRS02 - Kamar IR Isolasi
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Tri Nisdian WardiahSp.PD
|
2026-03-01 | 12:32:21 | Berkas Diterima | Belum Bayar |
0603R0010326V000004 INACBG: 0 |
Rp 0 | Rp 864.072 | Rp 0 | Rp 0 | Rp 358.730 | Rp 162.500 | Rp 253.500 | Rp 0 | Rp 89.342 | ||
| 6 | 2026/03/01/000005 | 210518 | SUFI AGUSTIANI |
Kamar: OK06 - Kamar OK
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Roza MaulindraSp. OG
|
2026-03-01 | 08:44:18 | Sudah | Belum Bayar |
0603R0010326V000002 INACBG: 0 |
Rp 0 | Rp 11.117.202 | Rp 0 | Rp 0 | Rp 1.015.800 | Rp 0 | Rp 573.300 | Rp 7.897.500 | Rp 1.175.602 | ||
| 7 | 2026/03/01/000005 | 210518 | SUFI AGUSTIANI |
Kamar: VIPB04 - Kamar Kelas I Bawah
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Roza MaulindraSp. OG
|
2026-03-01 | 08:44:18 | Sudah | Belum Bayar |
0603R0010326V000002 INACBG: 0 |
Rp 0 | Rp 11.117.202 | Rp 0 | Rp 0 | Rp 1.015.800 | Rp 0 | Rp 573.300 | Rp 7.897.500 | Rp 1.175.602 | ||
| 8 | 2026/03/01/000001 | 221538 | HAMADI |
Kamar: VIP01 - Kamar VIP Bawah
|
UMUM | dr. Rini Utami | - | 2026-03-01 | 03:15:38 | Sudah | Belum Bayar | - | Rp 0 | Rp 1.422.761 | Rp 0 | Rp 0 | Rp 577.460 | Rp 0 | Rp 552.500 | Rp 0 | Rp 292.801 | ||
| 9 | 2026/03/01/000002 | 221539 | BY.NY RISKI KARTILA |
Kamar: NICU01 - NICU
|
BPJS | dr. Roza Maulindra, Sp. OG | - | 2026-03-01 | 01:06:20 | Belum | Belum Bayar | - | Rp 0 | Rp 3.619.607 | Rp 0 | Rp 0 | Rp 3.024.230 | Rp 162.500 | Rp 273.000 | Rp 0 | Rp 159.877 | ||
| TOTAL | Rp 0 | Rp 31.988.885 | Rp 0 | Rp 0 | Rp 7.402.870 | Rp 975.000 | Rp 3.481.400 | Rp 15.795.000 | Rp 3.424.615 | ||||||||||||||