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 | 2026/07/26/000039 | 138321 | RAHEL HOLENSI |
Kamar: IRA04 - Kamar IRA
|
BPJS | dr. Nining Sariwati | - | 2026-07-26 | 22:14:09 | Berkas Diterima | Belum Bayar |
0603R0010726V003537 INACBG: 0 |
Rp 0 | Rp 577.704 | Rp 0 | Rp 0 | Rp 195.000 | Rp 0 | Rp 162.500 | Rp 0 | Rp 90.204 | ||
| 2 | 2026/07/26/000047 | 077682 | FIRMANSYAH |
Kamar: VIPB02 - Kamar Kelas I Bawah
|
BPJS | dr. Johannes Lie | - | 2026-07-26 | 20:12:07 | Berkas Diterima | Belum Bayar |
0603R0010726V003534 INACBG: 0 |
Rp 0 | Rp 1.021.957 | Rp 0 | Rp 0 | Rp 351.000 | Rp 0 | Rp 117.000 | Rp 0 | Rp 98.957 | ||
| 3 | 2026/07/26/000046 | 228725 | ROSIDAH BINTI M. UMAR |
Kamar: IRCA06 - Kamar IR Non Tindakan
|
BPJS | dr. Johannes Lie | - | 2026-07-26 | 20:10:07 | Berkas Diterima | Belum Bayar |
0603R0010726V003535 INACBG: 0 |
Rp 0 | Rp 1.081.912 | Rp 0 | Rp 0 | Rp 429.000 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 197.912 | ||
| 4 | 2026/07/26/000043 | 092840 | HOLIDI |
Kamar: IRCA02 - Kamar IR Non Tindakan
|
BPJS | dr. Johannes Lie | - | 2026-07-26 | 18:22:48 | Berkas Diterima | Belum Bayar |
0603R0010726V003536 INACBG: 0 |
Rp 0 | Rp 1.225.122 | Rp 0 | Rp 0 | Rp 280.000 | Rp 162.500 | Rp 195.000 | Rp 0 | Rp 457.622 | ||
| 5 | 2026/07/26/000024 | 228713 | YUNI binti USMAN |
Kamar: IRKB03 - Kamar IRKB Obsetri
|
BPJS | dr. Husti Noprianrest | - | 2026-07-26 | 11:21:05 | Berkas Diterima | Belum Bayar |
0603R0010726V003528 INACBG: 0 |
Rp 0 | Rp 11.350.241 | Rp 0 | Rp 0 | Rp 1.077.780 | Rp 0 | Rp 525.200 | Rp 7.897.500 | Rp 1.459.761 | ||
| 6 | 2026/07/26/000024 | 228713 | YUNI binti USMAN |
Kamar: IRKB07 - Kamar IRKB Obsetri
|
BPJS | dr. Husti Noprianrest | - | 2026-07-26 | 11:21:05 | Berkas Diterima | Belum Bayar |
0603R0010726V003528 INACBG: 0 |
Rp 0 | Rp 11.350.241 | Rp 0 | Rp 0 | Rp 1.077.780 | Rp 0 | Rp 525.200 | Rp 7.897.500 | Rp 1.459.761 | ||
| 7 | 2026/07/26/000024 | 228713 | YUNI binti USMAN |
Kamar: OK09 - Kamar OK
|
BPJS | dr. Husti Noprianrest | - | 2026-07-26 | 11:21:05 | Berkas Diterima | Belum Bayar |
0603R0010726V003528 INACBG: 0 |
Rp 0 | Rp 11.350.241 | Rp 0 | Rp 0 | Rp 1.077.780 | Rp 0 | Rp 525.200 | Rp 7.897.500 | Rp 1.459.761 | ||
| 8 | 2026/07/26/000022 | 228580 | BETTY |
Kamar: IRT22 - Kamar IR Tindakan
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | - | 2026-07-26 | 11:16:03 | Berkas Diterima | Belum Bayar |
0603R0010726V003523 INACBG: 0 |
Rp 0 | Rp 223.860 | Rp 0 | Rp 0 | Rp 93.860 | Rp 0 | Rp 0 | Rp 0 | Rp 0 | ||
| 9 | 2026/07/26/000023 | 228250 | FATIMAH binti AHMAD |
Kamar: IRS01 - Kamar IR Isolasi
|
BPJS | dr. Husti Noprianrest | - | 2026-07-26 | 11:15:21 | Berkas Diterima | Belum Bayar |
0603R0010726V003526 INACBG: 0 |
Rp 0 | Rp 741.811 | Rp 0 | Rp 0 | Rp 330.000 | Rp 0 | Rp 195.000 | Rp 0 | Rp 86.811 | ||
| 10 | 2026/07/26/000021 | 228581 | ERINA |
Kamar: IRT06 - Kamar IR Tindakan
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | - | 2026-07-26 | 10:42:32 | Berkas Diterima | Belum Bayar |
0603R0010726V003522 INACBG: 0 |
Rp 0 | Rp 232.381 | Rp 0 | Rp 0 | Rp 67.860 | Rp 0 | Rp 0 | Rp 0 | Rp 34.521 | ||
| 11 | 2026/07/26/000016 | 228711 | UMITA binti SAMSUDEN |
Kamar: IRKBK01 - Kamar IRKB Obsetri KRIS
|
BPJS | dr. Husti Noprianrest | - | 2026-07-26 | 10:17:15 | Berkas Diterima | Belum Bayar |
0603R0010726V003525 INACBG: 0 |
Rp 0 | Rp 11.096.575 | Rp 0 | Rp 0 | Rp 1.187.350 | Rp 0 | Rp 526.500 | Rp 7.897.500 | Rp 1.160.225 | ||
| 12 | 2026/07/26/000016 | 228711 | UMITA binti SAMSUDEN |
Kamar: OK02 - Kamar OK
|
BPJS | dr. Husti Noprianrest | - | 2026-07-26 | 10:17:15 | Berkas Diterima | Belum Bayar |
0603R0010726V003525 INACBG: 0 |
Rp 0 | Rp 11.096.575 | Rp 0 | Rp 0 | Rp 1.187.350 | Rp 0 | Rp 526.500 | Rp 7.897.500 | Rp 1.160.225 | ||
| 13 | 2026/07/26/000015 | 125299 | SAIMAN BIN SANDIASA |
Kamar: IRT18 - Kamar IR Tindakan
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | - | 2026-07-26 | 10:07:53 | Belum | Belum Bayar | - | Rp 0 | Rp 265.973 | Rp 0 | Rp 0 | Rp 93.860 | Rp 0 | Rp 0 | Rp 0 | Rp 42.113 | ||
| 14 | 2026/07/26/000012 | 228587 | MIRANTI |
Kamar: IRT14 - Kamar IR Tindakan
|
BPJS | dr. Komang Fujiama, Sp.B.,M.Biomed | - | 2026-07-26 | 08:47:42 | Berkas Diterima | Belum Bayar |
0603R0010726V003520 INACBG: 0 |
Rp 0 | Rp 266.593 | Rp 0 | Rp 0 | Rp 93.860 | Rp 0 | Rp 0 | Rp 0 | Rp 42.733 | ||
| 15 | 2026/07/26/000009 | 228709 | ATHAR ALPIANSYAH |
Kamar: IRA08 - Kamar IRA
|
BPJS | dr.Paradila Navia Tuzzuhra | - | 2026-07-26 | 08:16:24 | Sudah | Belum Bayar | - | Rp 0 | Rp 607.932 | Rp 0 | Rp 0 | Rp 200.460 | Rp 0 | Rp 162.500 | Rp 0 | Rp 114.972 | ||
| 16 | 2026/07/26/000006 | 228706 | NURLAILATUL MUBAROKAH |
Kamar: IRA03 - Kamar IRA
|
BPJS | dr. Restiko Maleo Fibullah | - | 2026-07-26 | 06:16:40 | Berkas Diterima | Belum Bayar |
0603R0010726V003521 INACBG: 0 |
Rp 0 | Rp 738.462 | Rp 0 | Rp 0 | Rp 390.000 | Rp 0 | Rp 162.500 | Rp 0 | Rp 55.962 | ||
| 17 | 2026/07/26/000004 | 069561 | MALISA BINTI ISKANDAR |
Kamar: IRKB04 - Kamar IRKB Obsetri
|
BPJS | dr. Restiko Maleo Fibullah | - | 2026-07-26 | 06:01:53 | Sudah | Belum Bayar |
0603R0010726V003519 INACBG: 0 |
Rp 0 | Rp 5.014.022 | Rp 0 | Rp 0 | Rp 3.816.400 | Rp 0 | Rp 525.200 | Rp 0 | Rp 542.422 | ||
| TOTAL | Rp 0 | Rp 68.241.602 | Rp 0 | Rp 0 | Rp 11.949.340 | Rp 325.000 | Rp 4.310.800 | Rp 39.487.500 | Rp 8.463.962 | ||||||||||||||