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 | 2026/04/16/000191 | 223788 | BAYI NYONYA LUSITA SARIANA |
Kamar: NICU01 - NICU
|
BPJS | dr. Anggun Nurul Fitria | - | 2026-04-16 | 20:20:25 | Sudah | Belum Bayar | - | Rp 0 | Rp 825.974 | Rp 0 | Rp 0 | Rp 302.500 | Rp 162.500 | Rp 195.000 | Rp 0 | Rp 165.974 | ||
| 2 | 2026/04/16/000176 | 081615 | KAROLIN YULIARTI |
Kamar: VIPB02 - Kamar Kelas I Bawah
|
BPJS | dr. Restiko Maleo Fibullah | - | 2026-04-16 | 16:37:27 | Sudah | Belum Bayar | - | Rp 0 | Rp 911.183 | Rp 0 | Rp 0 | Rp 488.730 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 97.453 | ||
| 3 | 2026/04/16/000175 | 223776 | DESI RATNA SARI |
Kamar: IRKBG03 - Kamar IRKB Ginekologi
|
BPJS | dr. Tommy Dwi purnama | - | 2026-04-16 | 16:23:26 | Sudah | Belum Bayar | - | Rp 0 | Rp 1.150.646 | Rp 0 | Rp 0 | Rp 674.050 | Rp 0 | Rp 422.500 | Rp 0 | Rp 54.096 | ||
| 4 | 2026/04/16/000154 | 223766 | NYAYU NUR FADILAH SOPIATI |
Kamar: IRKB02 - Kamar IRKB Obsetri
|
BPJS | dr. Johannes Lie |
dr. Tomas EdibaSp.OG
|
2026-04-16 | 16:12:37 | Berkas Diterima | Belum Bayar |
0603R0010426V002067 INACBG: 0 |
Rp 0 | Rp 10.103.141 | Rp 0 | Rp 0 | Rp 582.400 | Rp 0 | Rp 435.500 | Rp 7.897.500 | Rp 927.741 | ||
| 5 | 2026/04/16/000154 | 223766 | NYAYU NUR FADILAH SOPIATI |
Kamar: OK04 - Kamar OK
|
BPJS | dr. Johannes Lie |
dr. Tomas EdibaSp.OG
|
2026-04-16 | 16:12:37 | Berkas Diterima | Belum Bayar |
0603R0010426V002067 INACBG: 0 |
Rp 0 | Rp 10.103.141 | Rp 0 | Rp 0 | Rp 582.400 | Rp 0 | Rp 435.500 | Rp 7.897.500 | Rp 927.741 | ||
| 6 | 2026/04/16/000173 | 223775 | BAYI NYONYA TRIYANI |
Kamar: NEO01 - NEONATUS
|
BPJS | dr. Tommy Dwi purnama | - | 2026-04-16 | 14:57:50 | Sudah | Belum Bayar | - | Rp 0 | Rp 1.019.321 | Rp 0 | Rp 0 | Rp 755.730 | Rp 0 | Rp 195.000 | Rp 0 | Rp 68.591 | ||
| 7 | 2026/04/16/000172 | 031381 | YUDI BIN M. YANI |
Kamar: IRCA10 - Kamar IR Non Tindakan
|
BPJS | dr. Tommy Dwi purnama | - | 2026-04-16 | 14:43:12 | Sudah | Belum Bayar | - | Rp 0 | Rp 1.161.020 | Rp 0 | Rp 0 | Rp 393.460 | Rp 162.500 | Rp 507.000 | Rp 0 | Rp 98.060 | ||
| 8 | 2026/04/16/000102 | 223750 | MALIS WATI |
Kamar: IRT16 - Kamar IR Tindakan
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed |
dr. Komang FujiamaSp.B.,M.Biomed
|
2026-04-16 | 14:27:36 | Berkas Diterima | Belum Bayar |
0603R0010426V002073 INACBG: 0 |
Rp 0 | Rp 781.069 | Rp 0 | Rp 0 | Rp 171.860 | Rp 162.500 | Rp 410.800 | Rp 0 | Rp 35.909 | ||
| 9 | 2026/04/16/000149 | 223764 | M. ALI BIN USLAN |
Kamar: IRT25 - Kamar IR Tindakan
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed |
dr. Komang FujiamaSp.B.,M.Biomed
|
2026-04-16 | 13:29:06 | Sudah | Belum Bayar |
0603R0010426V002070 INACBG: 0 |
Rp 0 | Rp 1.488.937 | Rp 0 | Rp 0 | Rp 251.400 | Rp 162.500 | Rp 404.300 | Rp 0 | Rp 85.737 | ||
| 10 | 2026/04/16/000149 | 223764 | M. ALI BIN USLAN |
Kamar: VIPB04 - Kamar Kelas I Bawah
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed |
dr. Komang FujiamaSp.B.,M.Biomed
|
2026-04-16 | 13:29:06 | Sudah | Belum Bayar |
0603R0010426V002070 INACBG: 0 |
Rp 0 | Rp 1.488.937 | Rp 0 | Rp 0 | Rp 251.400 | Rp 162.500 | Rp 404.300 | Rp 0 | Rp 85.737 | ||
| 11 | 2026/04/16/000069 | 223746 | MUKHLIS |
Kamar: VIPB05 - Kamar Kelas I Bawah
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed |
dr. Komang FujiamaSp.B.,M.Biomed
|
2026-04-16 | 13:25:11 | Sudah | Belum Bayar |
0603R0010426V002069 INACBG: 0 |
Rp 0 | Rp 867.176 | Rp 0 | Rp 0 | Rp 251.400 | Rp 162.500 | Rp 410.800 | Rp 0 | Rp 42.476 | ||
| 12 | 2026/04/16/000162 | 200469 | WINIA SATRIANI |
Kamar: IRCA18 - Kamar IR Non Tindakan
|
BPJS | dr. Fatkhuriyati Sayekti, Sp.PD | - | 2026-04-16 | 11:28:51 | Sudah | Belum Bayar | - | Rp 0 | Rp 702.562 | Rp 0 | Rp 0 | Rp 122.460 | Rp 0 | Rp 265.200 | Rp 0 | Rp 314.902 | ||
| 13 | 2026/04/16/000054 | 222147 | USMAN BIN NAWAWI |
Kamar: IRCA13 - Kamar IR Non Tindakan
|
BPJS | dr. Johannes Lie |
dr. Made SuwarnoSp.PD.,M.Biomed
|
2026-04-16 | 11:09:53 | Berkas Diterima | Belum Bayar |
0603R0010426V002057 INACBG: 0 |
Rp 0 | Rp 945.400 | Rp 0 | Rp 0 | Rp 404.690 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 85.710 | ||
| 14 | 2026/04/16/000146 | 222995 | AYU BINTI JONDAN |
Kamar: IRKBG05 - Kamar IRKB Ginekologi
|
BPJS | dr. Johannes Lie |
dr. Tomas EdibaSp.OG
|
2026-04-16 | 10:24:05 | Berkas Diterima | Belum Bayar |
0603R0010426V002066 INACBG: 0 |
Rp 0 | Rp 8.022.190 | Rp 0 | Rp 0 | Rp 564.200 | Rp 0 | Rp 539.500 | Rp 5.980.000 | Rp 678.490 | ||
| 15 | 2026/04/16/000146 | 222995 | AYU BINTI JONDAN |
Kamar: OK08 - Kamar OK
|
BPJS | dr. Johannes Lie |
dr. Tomas EdibaSp.OG
|
2026-04-16 | 10:24:05 | Berkas Diterima | Belum Bayar |
0603R0010426V002066 INACBG: 0 |
Rp 0 | Rp 8.022.190 | Rp 0 | Rp 0 | Rp 564.200 | Rp 0 | Rp 539.500 | Rp 5.980.000 | Rp 678.490 | ||
| 16 | 2026/04/16/000129 | 223715 | JONI ISKANDAR |
Kamar: IRT04 - Kamar IR Tindakan
|
BPJS | dr. Johannes Lie |
dr. Komang FujiamaSp.B.,M.Biomed
|
2026-04-16 | 09:55:10 | Sudah | Belum Bayar |
0603R0010426V002071 INACBG: 0 |
Rp 0 | Rp 1.258.393 | Rp 0 | Rp 0 | Rp 652.920 | Rp 162.500 | Rp 240.500 | Rp 0 | Rp 202.473 | ||
| 17 | 2026/04/16/000097 | 088597 | ABDULLAH |
Kamar: IRCA13 - Kamar IR Non Tindakan
|
BPJS | dr. Johannes Lie |
dr. Made SuwarnoSp.PD.,M.Biomed
|
2026-04-16 | 09:15:48 | Sudah | Belum Bayar |
0603R0010426V002072 INACBG: 0 |
Rp 0 | Rp 957.931 | Rp 0 | Rp 0 | Rp 481.190 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 151.741 | ||
| 18 | 2026/04/16/000036 | 223623 | INAWATI BINTI SUDIONO |
Kamar: IRT06 - Kamar IR Tindakan
|
BPJS | dr. Faisal Muttaqien, Sp. B |
dr. Faisal MuttaqienSp. B
|
2026-04-16 | 07:49:49 | Berkas Diterima | Belum Bayar |
0603R0010426V001945 INACBG: 0 |
Rp 0 | Rp 324.015 | Rp 0 | Rp 0 | Rp 239.460 | Rp 0 | Rp 0 | Rp 0 | Rp 84.555 | ||
| 19 | 2026/04/16/000021 | 223734 | RAEFAL AHMAD SYAFID |
Kamar: IRA10 - Kamar IRA
|
BPJS | dr. Tri Susanti |
dr. Dian Maya SariSp.A
|
2026-04-16 | 07:19:42 | Berkas Diterima | Belum Bayar |
0603R0010426V002007 INACBG: 0 |
Rp 0 | Rp 922.791 | Rp 0 | Rp 0 | Rp 390.000 | Rp 0 | Rp 377.000 | Rp 0 | Rp 155.791 | ||
| TOTAL | Rp 0 | Rp 51.056.017 | Rp 0 | Rp 0 | Rp 8.124.450 | Rp 1.625.000 | Rp 6.269.900 | Rp 27.755.000 | Rp 4.941.667 | ||||||||||||||