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 | 2026/05/31/000029 | 091814 | AYU AMELIA |
Kamar: OK09 - Kamar OK
|
BPJS | dr. Tommy Dwi purnama |
dr. Roza MaulindraSp. OG
|
2026-05-31 | 18:43:12 | Sudah | Belum Bayar |
0603R0010526V003237 INACBG: 0 |
Rp 0 | Rp 1.246.361 | Rp 0 | Rp 0 | Rp 707.850 | Rp 0 | Rp 455.000 | Rp 0 | Rp 83.511 | ||
| 2 | 2026/05/31/000027 | 037602 | AYU NOVITASARI |
Kamar: VIP02 - Kamar VIP Bawah
|
BPJS | dr. Tommy Dwi purnama | - | 2026-05-31 | 17:39:38 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 1.171.102 | Rp 0 | Rp 0 | Rp 707.850 | Rp 0 | Rp 377.000 | Rp 0 | Rp 86.252 | ||
| 3 | 2026/05/31/000021 | 225890 | YENI MEILITA |
Kamar: IRT11 - Kamar IR Tindakan
|
UMUM | dr. Tommy Dwi purnama | - | 2026-05-31 | 15:35:08 | Sudah | Belum Bayar | - | Rp 0 | Rp 571.446 | Rp 0 | Rp 0 | Rp 310.650 | Rp 0 | Rp 117.000 | Rp 0 | Rp 143.796 | ||
| 4 | 2026/05/31/000020 | 225897 | BAYI NYONYA TARI APRIANI |
Kamar: IRA05 - Kamar IRA
|
BPJS | dr. Muhammad Akip Aprianto | - | 2026-05-31 | 15:04:57 | Sudah | Belum Bayar | - | Rp 0 | Rp 757.663 | Rp 0 | Rp 0 | Rp 245.000 | Rp 162.500 | Rp 195.000 | Rp 0 | Rp 155.163 | ||
| 5 | 2026/05/31/000015 | 225895 | AHMAD GABE ARIFUDIN |
Kamar: IRS11 - Kamar IR Isolasi
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Dian Maya SariSp.A
|
2026-05-31 | 12:11:35 | Berkas Diterima | Belum Bayar |
0603R0010526V003236 INACBG: 0 |
Rp 0 | Rp 684.092 | Rp 0 | Rp 0 | Rp 245.000 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 114.092 | ||
| 6 | 2026/05/31/000013 | 225893 | SAWARIA |
Kamar: IRBGK01 - Kamar IRKB Ginekologi KRIS
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Roza MaulindraSp. OG
|
2026-05-31 | 11:23:38 | Berkas Diterima | Belum Bayar |
0603R0010526V003233 INACBG: 0 |
Rp 0 | Rp 8.713.091 | Rp 0 | Rp 0 | Rp 654.550 | Rp 0 | Rp 512.200 | Rp 5.980.000 | Rp 981.341 | ||
| 7 | 2026/05/31/000013 | 225893 | SAWARIA |
Kamar: IRKB05 - Kamar IRKB Obsetri
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Roza MaulindraSp. OG
|
2026-05-31 | 11:23:38 | Berkas Diterima | Belum Bayar |
0603R0010526V003233 INACBG: 0 |
Rp 0 | Rp 8.713.091 | Rp 0 | Rp 0 | Rp 654.550 | Rp 0 | Rp 512.200 | Rp 5.980.000 | Rp 981.341 | ||
| 8 | 2026/05/31/000013 | 225893 | SAWARIA |
Kamar: IRKB06 - Kamar IRKB Obsetri
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Roza MaulindraSp. OG
|
2026-05-31 | 11:23:38 | Berkas Diterima | Belum Bayar |
0603R0010526V003233 INACBG: 0 |
Rp 0 | Rp 8.713.091 | Rp 0 | Rp 0 | Rp 654.550 | Rp 0 | Rp 512.200 | Rp 5.980.000 | Rp 981.341 | ||
| 9 | 2026/05/31/000013 | 225893 | SAWARIA |
Kamar: OK12 - Kamar OK
|
BPJS | dr. Restiko Maleo Fibullah |
dr. Roza MaulindraSp. OG
|
2026-05-31 | 11:23:38 | Berkas Diterima | Belum Bayar |
0603R0010526V003233 INACBG: 0 |
Rp 0 | Rp 8.713.091 | Rp 0 | Rp 0 | Rp 654.550 | Rp 0 | Rp 512.200 | Rp 5.980.000 | Rp 981.341 | ||
| TOTAL | Rp 0 | Rp 39.283.028 | Rp 0 | Rp 0 | Rp 4.834.550 | Rp 325.000 | Rp 3.355.300 | Rp 23.920.000 | Rp 4.508.178 | ||||||||||||||