ng Rawat Jalan Tanggal 01-10-2023 s/d 24-10-2023

No Tanggal No.Reg. Rek.Med. Nama

UGD
1 08-10-2023 P231004770 00319056 WINA ENDRA NITHA
2 20-10-2023 P231012800 00414009 NGATMIN
3 20-10-2023 P231012531 00414003 ARIEF RAHMAN
4 16-10-2023 P231010264 00413739 JOKO SUMARTONO
5 14-10-2023 P231009250 00413612 LIA HARTATI
TOTAL :
POLI UMUM
1 21-10-2023 P231013639 00414115 SEPTYANINGTYAS ANGGIA SARI
2 21-10-2023 P231013479 00386958 QC SIMRS TES TESS
3 24-10-2023 P231015189 00388199 RADIKA TAMA RAVANTINO
4 24-10-2023 P231015148 00414309 GHARIZA MUTIA DANAR
5 23-10-2023 P231014432 00317929 NISA RESMI NASTITI
6 13-10-2023 P231008658 00122761 INDRINI PUSPITA SARI
7 13-10-2023 P231008676 00062673 HELEN BR. GINTING
8 14-10-2023 P231009269 00413614 MARTITUS HULU
TOTAL :
POLI THT
1 02-10-2023 P231000743 00062926 LISNA SUHAENDAH, NY
2 23-10-2023 P231014182 00399469 SYARIFAH ALSYAHZANI SYAUKANI
TOTAL :
POLI NEURO
1 24-10-2023 P231015012 00165874 NYONGLI
2 24-10-2023 P231014741 00333771 NOVIE
3 23-10-2023 P231014207 00298146 SOLEHA
TOTAL :
POLI KEBIDANAN DAN KANDUNGAN
1 14-10-2023 P231008911 00029351 NADYA KAITJILY
2 23-10-2023 P231014286 00414210 VIKY DIANAROSE
TOTAL :
POLI JANTUNG DAN PEMBULUH DARAH
1 24-10-2023 P231015001 00003116 NYOMAN SUMARTA
2 24-10-2023 P231015263 00405506 ZAMRONI
3 09-10-2023 P231005575 00413167 AWEN HARSONO
TOTAL :
POLI PENYAKIT DALAM
1 02-10-2023 P231000249 00384846 ANGGELINA TAKENDARE M
2 24-10-2023 P231015109 00047026 IRENE CHRISHANTY MARPAUNG
3 12-10-2023 P231007582 00409204 WARTINI
4 17-10-2023 P231010997 00413129 NITA FUJI LESTARI
5 17-10-2023 P231010328 00163042 NATALIA DESI ARYANI, SPD
 TOTAL :
POLI GIGI DAN MULUT
1 23-10-2023 P231014193 00375343 ANIDAH
TOTAL :
PSS GASTROENTERO-HEPATOLOGI
1 23-10-2023 P231014264 00401258 DESI PURNAMA SARI
2 23-10-2023 P231014177 00414190 YUDI MUAMAL
TOTAL :
PSS ENDOKRIN DAN PENYAKIT METABOLIK
1 23-10-2023 P231013840 00304872 TENNY LIE GIOK SIAN
2 23-10-2023 P231013838 00216043 NELLY
3 23-10-2023 P231013852 00369921 AGUS SUTARMAN
TOTAL :
PS BEDAH UMUM
1 18-10-2023 P231011562 00165317 ANIKE AGUS SUPRIANTI
2 18-10-2023 P231011553 00413876 MUHAMMAD FALIZANLI ADZKA
TOTAL :
PS BEDAH VASKULER
1 20-10-2023 P231013168 00410348 NURLELA
TOTAL :
PS BEDAH UROLOGI
1 23-10-2023 P231014316 00414213 MIE HA
2 23-10-2023 P231014260 00010949 DRG.SUSI ANGGRAINI
TOTAL :
PS BEDAH ORTHOPEDI
1 10-10-2023 P231006392 00331496 SUJITO
TOTAL :
PS BEDAH ONKOLOGI
1 18-10-2023 P231011752 00279574 ADE SRI SETIAHATI
TOTAL :
PS BEDAH ANAK
1 20-10-2023 P231013029 00385776 ARSENA BILAL BARRA
TOTAL :
PS ANAK
1 24-10-2023 P231014711 00351109 NATHAN REIN AL HADID
2 24-10-2023 P231015405 00202802 FARANNISA HAMIDAH ALFI
3 21-10-2023 P231013530 00318775 FEBRIYZA RANAYYA ZEA. Y
4 16-10-2023 P231009981 00062080 KEINO JUBRAN MAULANA, AN
5 16-10-2023 P231010111 00379877 CARAMEL DAARINA FADILLAH
TOTAL :
RADIOLOGI
1 20-10-2023RAD2310200042 00081775 ROSLIANA BR SINURAYA
2 17-10-2023RAD2310170056 00329461 TRISHA ABIGAEL MONGAN
TOTAL :
LABORATORIUM
1 24-10-2023 LAB2310240095 00399758 HERAHYANI DJUHDI MELYANA
2 20-10-2023 LAB2310200230 00361540 LISSIE NOVA KALANGI
3 20-10-2023 LAB2310200161 00399746 SANDRY MELIA SARI
4 20-10-2023 LAB2310200143 00400314 NURHAYATI
5 18-10-2023 LAB2310180107 00370717 SASONO HARINTOBOWO
6 24-10-2023 LAB2310240069 00378098 LULUK SETYOWATI
7 19-10-2023 LAB2310190114 00379005 AAN IRIANI
8 16-10-2023 LAB2310160195 00029383 DORA MELYANI
9 24-10-2023 LAB2310240166 00411401 CLARA CB POSSUMAH
10 11-10-2023 LAB2310110174 00271670 NUR AZIZAH
11 24-10-2023 LAB2310240177 00397808 ELIA TSAMROTUS SYAADAH
12 07-10-2023 LAB2310070087 00082601 R.PUTRIASIH MULYANI
13 24-10-2023 LAB2310240222 00407980 VONIE CAROLINE SIADI
14 04-10-2023 LAB2310040246 00191497 MAY ANGRIANI PARDEDE
TOTAL :
HOME CARE
1 24-10-2023 P231015106 00410930 JUNITA RAHMANIA ALKARU
2 24-10-2023 P231014476 00414237 CYNTIYA MARAMIS
TOTAL :
REHABILITASI MEDIK
1 24-10-2023 P231014859 00410378 ADE RAHMAT KUSDINAR
2 23-10-2023 P231013924 00178244 AFNI AMIEN WASIATI
3 20-10-2023 P231012871 00409900 TANTI AGUSTRIANAH
4 19-10-2023 P231012316 00398388 SRI GIARTI
TOTAL :
POLI GIGI PERIODONTI
1 16-10-2023 P231009810 00413669 GLORIA TWINDA PRASASTI
TOTAL :
POLI GIGI ANAK
1 23-10-2023 P231014469 00414235 ASMA' QURROTA'AYUN
TOTAL :
POLI BEDAH MULUT
1 24-10-2023 P231015384 00002672 SITI HURIYATUN
TOTAL :
FARMASI UTAMA
1 21-10-2023 FU2310001711 00000000 WIWIT
2 21-10-2023 FU2310001715 00000000 NORITIA
3 21-10-2023 FU2310001714 00000000 SITI HUMAYRA
4 21-10-2023 FU2310001713 00000000 RIA AJENG
5 21-10-2023 FU2310001712 00000000 AJENG VELLA
6 21-10-2023 FU2310001718 00000000 PASIEN LUAR
7 05-10-2023 FU2310000378 00000000 AULIA TISNA
8 24-10-2023 FU2310001971 00000000 MIMI, NY
 9 24-10-2023 FU2310001983 00403757 NURUL KARLINA
10 21-10-2023 FU2310001710 00000000 DITA WULANDARI
11 24-10-2023 FU2310001986 00000000 PASIEN LUAR
12 21-10-2023 FU2310001709 00000000 BARKAH F
13 21-10-2023 FU2310001716 00000000 RINI AFRIANI
14 21-10-2023 FU2310001717 00000000 TUTI YANTI
15 21-10-2023 FU2310001719 00000000 RANY LESTARI
16 21-10-2023 FU2310001720 00000000 MAYADIZA
17 23-10-2023 FU2310001911 00000000 NELLA
18 23-10-2023 FU2310001900 00232348 AFFAN ARKAAN FARJANA
19 23-10-2023 FU2310001874 00000000 PASIEN LUAR
20 21-10-2023 FU2310001721 00000000 ERY FUDJIATI
21 23-10-2023 FU2310001860 00000000 PASIEN LUAR
22 21-10-2023 FU2310001707 00000000 PASIEN LUAR
23 21-10-2023 FU2310001722 00000000 MUHAMMAD NAUFAL PRATAMA
24 21-10-2023 FU2310001706 00000000 CICI PITERIANI
25 21-10-2023 FU2310001705 00000000 HANNY PRASETYAWATI
26 21-10-2023 FU2310001704 00000000 IKNA S
27 21-10-2023 FU2310001670 00000000 NENI
TOTAL :
TOTAL :
 Dokter Penjamin Total Layanan

dr. Priscilia INHEALTH INDEMNITY 1,876,186.00

dr. Eunike Brigita Herlinda P UMUM/Pribadi 2,395,262.00
dr. Ahmad Jaladani Husen BPJS KETENAGAKERJAAN 776,758.50
dr. Esther Damayanti BPJS KETENAGAKERJAAN 762,898.40
dr. Priscilia UMUM/Pribadi 412,000.00
6,223,104.90

dr. Anggie Pradetya Maharani UMUM/Pribadi 150,000.00

dr. Yoana Periskila, MKK PERTAMINA TRANS KONTINEN 50,000.00
dr. Yoana Periskila, MKK BEBAN KARYAWAN (Inti) 251,679.05
dr. Yoana Periskila, MKK MANULIFE - HALODOC 1,121,000.00
dr. Dyah Sri Kusumaningayu UMUM/Pribadi 90,532.00
dr. Yoana Periskila, MKK BEBAN KARYAWAN (Inti) 76,341.90
dr. Khadijah Cahya Yunita BEBAN KARYAWAN (Inti) 111,964.55
dr. Dyah Sri Kusumaningayu UMUM/Pribadi 150,000.00
2,001,517.50

dr. Vika Aryan Sari, Sp.THT-KL UMUM/Pribadi 605,000.00

dr. Vika Aryan Sari, Sp.THT-KL UMUM/Pribadi 280,000.00
885,000.00

dr. Fakhrunnisa, Sp.N BPJS 0

dr. David Susanto, Sp. N, FINA UMUM/Pribadi 851,000.00
dr. Fakhrunnisa, Sp.N BPJS 50,000.00
901,000.00

dr. Christina Sitorus, Sp.OG UMUM/Pribadi 50,000.00

dr. Wulandari Eka Sari, Sp.OG BPJS 0
50,000.00

dr. Henry Pakpahan, Sp.JP, FIHA AXA INSURANCE INDONESIA 1,815,970.00

dr. Robert Edward Saragih, Sp.JP (K) BPJS 50,000.00
dr. Henry Pakpahan, Sp.JP, FIHA UMUM/Pribadi 280,000.00
2,145,970.00

dr. Johana Prihatini, Sp.PD, FINASIM BPJS 364,336.00

dr. Kartariadi Gandadinata, Sp.PD, F UMUM/Pribadi 115,800.00
dr. Mochamad Iqbal Hassarief Putra, BPJS 897,890.00
dr. Nur Asicha, Sp.PD BPJS 0
dr. Mochamad Iqbal Hassarief Putra, BPJS 0
 1,378,026.00

drg. Shinta Puspitasari UMUM/Pribadi 0

0

dr. Ahmar Abyadh, Sp.PD-KGEH, FI BPJS 50,000.00

dr. Ahmar Abyadh, Sp.PD-KGEH, FI BPJS 0
50,000.00

dr. Khomimah, Sp.PD-KEMD, FINASI BPJS 372,400.00

dr. Khomimah, Sp.PD-KEMD, FINASI BPJS 50,000.00
dr. Khomimah, Sp.PD-KEMD, FINASI BPJS 298,800.00
721,200.00

dr. Dariatno, Sp.B UMUM/Pribadi 280,000.00

dr. Dariatno, Sp.B UMUM/Pribadi 2,381,000.00
2,661,000.00

dr. Mursid Fadli, Sp.B,Subsp.BVE (K) BPJS 0

0

dr. Muhammad Fitrah, Sp.U BPJS 0

dr. Siti Tersiani Kamil, Sp.U BPJS 0
0

dr. M. Taufiq, Sp. OT (K) BPJS 739,962.90

739,962.90

dr. Haris Maruli, Sp.B (K) Onk BPJS 50,000.00

50,000.00

dr. Dina Perdanasari, Sp.BA BPJS 0

0

dr. Ali Syaugi, Sp.A BPJS 0

dr. Atiek W. Oswari, Sp.A INHEALTH INDEMNITY 2,028,268.00
dr. Muhammad Enri Danni, Sp.A BEBAN KARYAWAN (Inti) 198,091.65
dr. Muhammad Enri Danni, Sp.A HLGRP -ADMEDIKA 819,288.00
dr. Irdian Nofriansyah Taim, Sp.A, M. BEBAN KARYAWAN (Inti) 312,823.80
3,358,471.45

dr. Sri Pardiastuti, Sp.Rad BPJS ( RAD,LAB ) 1,066,000.00

dr. Sri Pardiastuti, Sp.Rad UMUM/Pribadi 320,000.00
1,386,000.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 50,000.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 436,400.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 393,200.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 393,200.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 362,600.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 50,000.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 318,800.00
dr. Regina A. Meilinda, Sp.PK BEBAN KARYAWAN (Lain) 1,608,000.00
dr. Regina A. Meilinda, Sp.PK BPJS 50,000.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 393,200.00
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 50,000.00
dr. Regina A. Meilinda, Sp.PK UMUM/Pribadi 0
dr. Regina A. Meilinda, Sp.PK BPJS ( RAD,LAB ) 50,000.00
dr. Regina A. Meilinda, Sp.PK BEBAN RS 0
4,155,400.00

dr. Dara Deanita PERTAMINA PERSERO , PT. 5,434,724.18

dr. Dara Deanita PERTAMINA TRANS KONTINEN 50,000.00
5,484,724.18

Fisioterapis BPJS 50,000.00

Fisioterapis BPJS 50,000.00
dr. Deasy Erika, Sp.KFR BPJS 50,000.00
Fisioterapis BPJS 50,000.00
200,000.00

drg. Martina Ichsanti, Sp.Perio BPJS 50,000.00

50,000.00

drg. Rizki Dwiandhana, Sp.KGA BPJS 50,000.00

50,000.00

drg. Tony Agust Purnomo, Sp.BM UMUM/Pribadi 50,000.00

50,000.00

UMUM/Pribadi 91,483.00
UMUM/Pribadi 131,400.00
UMUM/Pribadi 114,356.00
UMUM/Pribadi 93,648.00
UMUM/Pribadi 141,317.00
UMUM/Pribadi 0
UMUM/Pribadi 304,677.00
UMUM/Pribadi 0
dr. Christina Sitorus, Sp.OG UMUM/Pribadi 0
UMUM/Pribadi 71,778.00
UMUM/Pribadi 0
UMUM/Pribadi 373,524.00
UMUM/Pribadi 15,290.00
UMUM/Pribadi 49,358.00
UMUM/Pribadi 111,264.00
UMUM/Pribadi 124,036.00
UMUM/Pribadi 0
dr. Ricca Fauziyah, Sp.A UMUM/Pribadi 0
UMUM/Pribadi 0
UMUM/Pribadi 344,570.00
UMUM/Pribadi 0
UMUM/Pribadi 0
dr. Muhammad Enri Danni, Sp.A UMUM/Pribadi 31,103.00
UMUM/Pribadi 149,854.00
UMUM/Pribadi 189,500.00
UMUM/Pribadi 19,107.00
UMUM/Pribadi 208,573.00
2,564,838.00
35,106,214.93
Total Bayar Catatan Gantung

0
0
0
0
0
0

0
0
0
0
0
0
0
0
0

0
0
0

0
399,000.00
0
399,000.00

280,000.00
0
280,000.00

0
0
0
0

0
0
0
0
0
0

0
0

0
0
0

0
0
0
0

0
0
0

0
0

0
0
0

0
0

0
0

0
0

0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0

0
0

0
0

0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
679,000.00