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 | 2026/04/03/000039 | 223105 | ROSDA OKTAPIA |
Kamar: IRKB08 - Kamar IRKB Obsetri
|
BPJS | dr. Johannes Lie |
dr. H. Ivan SusantoSp.OG
|
2026-04-03 | 23:03:13 | Berkas Diterima | Belum Bayar |
0603R0010426V000352 INACBG: 0 |
Rp 0 | Rp 845.625 | Rp 0 | Rp 0 | Rp 382.850 | Rp 0 | Rp 377.000 | Rp 0 | Rp 85.775 | ||
| 2 | 2026/04/03/000036 | 223103 | LENI BINTI NURLI |
Kamar: IRKB05 - Kamar IRKB Obsetri
|
BPJS | dr. Johannes Lie |
dr. H. Ivan SusantoSp.OG
|
2026-04-03 | 21:39:30 | Sudah | Belum Bayar |
0603R0010426V000350 INACBG: 0 |
Rp 0 | Rp 1.216.755 | Rp 0 | Rp 0 | Rp 525.850 | Rp 0 | Rp 525.200 | Rp 0 | Rp 165.705 | ||
| 3 | 2026/04/03/000032 | 223101 | LENI MARLINA |
Kamar: IRKB03 - Kamar IRKB Obsetri
|
BPJS | dr. Muhammad Akip Aprianto |
dr. H. Ivan SusantoSp.OG
|
2026-04-03 | 20:17:42 | Sudah | Belum Bayar |
0603R0010426V000348 INACBG: 0 |
Rp 0 | Rp 3.737.154 | Rp 0 | Rp 0 | Rp 3.179.150 | Rp 0 | Rp 466.700 | Rp 0 | Rp 91.304 | ||
| 4 | 2026/04/03/000028 | 111129 | IBRAHIM B. BASTIUR |
Kamar: IRS09 - Kamar IR Isolasi
|
BPJS | dr. Tommy Dwi purnama |
dr. H. Lian Lanrika Waidi LubisSp.PD
|
2026-04-03 | 18:08:08 | Berkas Diterima | Belum Bayar |
0603R0010426V000347 INACBG: 0 |
Rp 0 | Rp 632.923 | Rp 0 | Rp 0 | Rp 278.000 | Rp 162.500 | Rp 117.000 | Rp 0 | Rp 75.423 | ||
| 5 | 2026/04/03/000023 | 223096 | M. AWALI AKBAR |
Kamar: IRT10 - Kamar IR Tindakan
|
BPJS | dr. Anggun Nurul Fitria | - | 2026-04-03 | 16:20:00 | Berkas Diterima | Belum Bayar | - | Rp 0 | Rp 1.458.029 | Rp 0 | Rp 0 | Rp 297.000 | Rp 0 | Rp 117.000 | Rp 0 | Rp 1.044.029 | ||
| 6 | 2026/04/03/000026 | 223098 | ROMLI BIN SAINI |
Kamar: IRCA06 - Kamar IR Non Tindakan
|
BPJS | dr. Restiko Maleo Fibullah |
dr. H. Lian Lanrika Waidi LubisSp.PD
|
2026-04-03 | 15:28:09 | Sudah | Belum Bayar |
0603R0010426V000346 INACBG: 0 |
Rp 0 | Rp 841.222 | Rp 0 | Rp 0 | Rp 473.000 | Rp 162.500 | Rp 162.500 | Rp 0 | Rp 43.222 | ||
| 7 | 2026/04/03/000022 | 223095 | LILIS BINTI SAMSURI |
Kamar: IRCA19 - Kamar IR Non Tindakan
|
BPJS | dr. Anggun Nurul Fitria |
dr. H. Lian Lanrika Waidi LubisSp.PD
|
2026-04-03 | 12:08:55 | Berkas Diterima | Belum Bayar |
0603R0010426V000345 INACBG: 0 |
Rp 0 | Rp 534.825 | Rp 0 | Rp 0 | Rp 78.000 | Rp 0 | Rp 344.500 | Rp 0 | Rp 112.325 | ||
| 8 | 2026/04/03/000018 | 095127 | ANA MARIA |
Kamar: IRCA19 - Kamar IR Non Tindakan
|
BPJS | dr. Anggun Nurul Fitria |
dr. H. Lian Lanrika Waidi LubisSp.PD
|
2026-04-03 | 11:16:39 | Berkas Diterima | Belum Bayar |
0603R0010426V000343 INACBG: 0 |
Rp 0 | Rp 443.088 | Rp 0 | Rp 0 | Rp 273.000 | Rp 0 | Rp 117.000 | Rp 0 | Rp 53.088 | ||
| 9 | 2026/04/03/000015 | 209994 | YULI IBRAHIM |
Kamar: IRCA23 - Kamar IR Non Tindakan
|
BPJS | dr. Anggun Nurul Fitria |
dr. H. Lian Lanrika Waidi LubisSp.PD
|
2026-04-03 | 10:01:26 | Berkas Diterima | Belum Bayar |
0603R0010426V000344 INACBG: 0 |
Rp 0 | Rp 863.549 | Rp 0 | Rp 0 | Rp 450.300 | Rp 162.500 | Rp 208.000 | Rp 0 | Rp 42.749 | ||
| 10 | 2026/04/03/000011 | 223087 | NASIAH |
Kamar: IRCA15 - Kamar IR Non Tindakan
|
BPJS | dr. Anggun Nurul Fitria |
dr. H. Lian Lanrika Waidi LubisSp.PD
|
2026-04-03 | 08:28:12 | Berkas Diterima | Belum Bayar |
0603R0010426V000342 INACBG: 0 |
Rp 0 | Rp 892.778 | Rp 0 | Rp 0 | Rp 470.730 | Rp 0 | Rp 312.000 | Rp 0 | Rp 110.048 | ||
| 11 | 2026/04/03/000003 | 128932 | NURMIATI |
Kamar: IRCA14 - Kamar IR Non Tindakan
|
BPJS | dr. Husti Noprianrest |
dr. Made SuwarnoSp.PD.,M.Biomed
|
2026-04-03 | 02:15:02 | Berkas Diterima | Belum Bayar |
0603R0010426V000337 INACBG: 0 |
Rp 0 | Rp 907.741 | Rp 0 | Rp 0 | Rp 486.000 | Rp 162.500 | Rp 195.000 | Rp 0 | Rp 64.241 | ||
| 12 | 2026/04/03/000002 | 223084 | IDA ROHANI |
Kamar: IRKB01 - Kamar IRKB Obsetri
|
BPJS | dr. Husti Noprianrest |
dr. Tomas EdibaSp.OG
|
2026-04-03 | 01:54:16 | Sudah | Belum Bayar |
0603R0010426V000334 INACBG: 0 |
Rp 0 | Rp 1.549.066 | Rp 0 | Rp 0 | Rp 776.310 | Rp 0 | Rp 377.000 | Rp 0 | Rp 135.756 | ||
| 13 | 2026/04/03/000002 | 223084 | IDA ROHANI |
Kamar: IRKI01 - Kamar IRKB Isolasi
|
BPJS | dr. Husti Noprianrest |
dr. Tomas EdibaSp.OG
|
2026-04-03 | 01:54:16 | Sudah | Belum Bayar |
0603R0010426V000334 INACBG: 0 |
Rp 0 | Rp 1.549.066 | Rp 0 | Rp 0 | Rp 776.310 | Rp 0 | Rp 377.000 | Rp 0 | Rp 135.756 | ||
| TOTAL | Rp 0 | Rp 15.471.821 | Rp 0 | Rp 0 | Rp 8.446.500 | Rp 650.000 | Rp 3.695.900 | Rp 0 | Rp 2.159.421 | ||||||||||||||