:
Nama Pasien Kelas :
No. RM : Kamar
Dokter P.Jawab
Tgl. Pulang Penjamin :
:
: :
Sub Total 00919501
ATHAYA PRADIPTA RISTIANTI ( P )
Kamar ICU Lv II Non Kelas
dr. Pustika Efar, Sp.A
2020/06/21 14:59 BPJS KESEHATAN
Tipe :BPJS
No Tanggal Deskripsi Kelas Dokter Qty Tarif Diskon
No SEP :
4,461,276.00 Jenis : ::
Farmasi 1 Resep No: O/2006/07346 R/14 SARUNG TANGAN NON
STERIL PF S, MYGUARD/SIGPRO - 1,100.00 0.00 110,800.00
1 06/20/2020 100.00
R/17 FMT NELLCOR COMP.DISP
Sp02 FMT -DNF/ NLO-F - 283,594.00 0.00 284,394.00
2 06/20/2020 1.00
R/6 TRO-SENSOSURGE PLUS SIZE
6.5/SARUNG TANGAN - 12,293.00 0.00 25,386.00
3 06/20/2020 2.00
420,580.00 Farmasi 1 Resep No: O/2006/07353
R/13 TRO-VENOFLOW 3 , 3-WAY
STOPCOCK - 15,744.00 0.00 48,032.00
4 06/20/2020 3.00
R/15 SARUNG TANGAN NON
STERIL PF S, MYGUARD/SIGPRO - 1,100.00 0.00 110,800.00
5 06/20/2020 100.00
R/22 DISP NEEDLE 24 G TERUMO - 389.00 0.00 2,745.00
6 06/20/2020 5.00
R/6 NA CL 0.9 % 100 ML
INF(ecosol) - 9,625.00 0.00 20,050.00
7 06/20/2020 2.00
181,627.00 Farmasi 1 Resep No: O/2006/07470
R/10 NA CL 0.9 % 100 ML
INF(ecosol) - 9,625.00 0.00 10,425.00
8 06/21/2020 1.00
R/19 SARUNG TANGAN NON
STERIL PF S, MYGUARD/SIGPRO - 1,100.00 0.00 110,800.00
9 06/21/2020 100.00
R/7 TRO-VENOFLOW 3 , 3-WAY
STOPCOCK - 15,744.00 0.00 32,288.00
10 06/21/2020 2.00
153,513.00 Farmasi Steril Resep No: O/2006/07412
R/1 DISP NEEDLE 24 G TERUMO - 389.00 0.00 389.00
11 06/21/2020 1.00
R/4 DISP NEEDLE 24 G TERUMO - 389.00 0.00 1,167.00
12 06/21/2020 3.00
1,556.00 ICU / Ruang Wijaya Kusuma
Pasang Akses Vena Sentral (CVC) Non Kelas dr. Felix, Sp.A 3,704,000.00 0.00 3,704,000.00
13 06/20/2020 1.00
3,704,000.00 1,510,000.00
Alat Medis ::
Jenis :
Gawat Darurat(Emergency)
Pemakaian Oksigen/12 Jam Non Kelas dr. Eva Fahmiah 70,000.00 0.00 70,000.00
14 06/20/2020 1.00
Penggunaan Bed Side Monitor Non Kelas dr. Eva Fahmiah 150,000.00 0.00 150,000.00
15 06/20/2020 1.00
Penggunaan Infuse Pump Non Kelas dr. Eva Fahmiah 50,000.00 0.00 50,000.00
16 06/20/2020 1.00
Penggunaan Syringe Pump Non Kelas dr. Eva Fahmiah 50,000.00 0.00 50,000.00
17 06/20/2020 1.00
320,000.00 ICU / Ruang Wijaya Kusuma
Monitoring EKG Kontinu/ TPN +
Monitoring Non Kelas dr. Felix, Sp.A 105,000.00 0.00 105,000.00
18 06/20/2020 1.00
Pemakaian Oksigen/12 Jam Non Kelas dr. Felix, Sp.A 70,000.00 0.00 140,000.00
19 06/20/2020 2.00
Penggunaan Bed Side Monitor Non Kelas dr. Felix, Sp.A 150,000.00 0.00 150,000.00
20 06/20/2020 1.00
Penggunaan Infuse Pump Non Kelas dr. Felix, Sp.A 50,000.00 0.00 50,000.00
21 06/20/2020 1.00
Penggunaan Syringe Pump Non Kelas dr. Felix, Sp.A 50,000.00 0.00 100,000.00
22 06/20/2020 2.00
Monitoring EKG Kontinu/ TPN +
Monitoring Non Kelas dr. Henny Rosita 105,000.00 105,000.00
Iskandar, Sp. A (K) 0.00
23 06/21/2020 1.00
:
Nama Pasien Kelas :
No. RM : Kamar
Dokter P.Jawab
Tgl. Pulang Penjamin :
:
: :
Sub Total 00919501
ATHAYA PRADIPTA RISTIANTI ( P )
Kamar ICU Lv II Non Kelas
dr. Pustika Efar, Sp.A
2020/06/21 14:59 BPJS KESEHATAN
Tipe :BPJS
No Tanggal Deskripsi Kelas Dokter Qty Tarif Diskon
No SEP :
Pemakaian Oksigen/12 Jam Non Kelas dr. Henny Rosita 70,000.00 140,000.00
Iskandar, Sp. A (K) 0.00
24 06/21/2020 2.00
Penggunaan Bed Side Monitor Non Kelas dr. Henny Rosita 150,000.00 150,000.00
Iskandar, Sp. A (K) 0.00
25 06/21/2020 1.00
Penggunaan Infuse Pump Non Kelas dr. Henny Rosita 50,000.00 100,000.00
Iskandar, Sp. A (K) 0.00
26 06/21/2020 2.00
Penggunaan Syringe Pump Non Kelas dr. Henny Rosita 50,000.00 150,000.00
Iskandar, Sp. A (K) 0.00
27 06/21/2020 3.00
1,190,000.00 164,963.00
Alkes ::
Jenis :
Farmasi 1 Resep No: O/2006/07346
R/7 SPUIT 5 CC NIPRO - 1,306.00 0.00 3,412.00
28 06/20/2020 2.00
3,412.00 Farmasi 1 Resep No: O/2006/07353
R/10 ANSELL STERIL NO. 7.0 PF /
SARUNG TANGAN - 13,750.00 0.00 14,550.00
29 06/20/2020 1.00
R/20 SPUIT 10 CC NIPRO - 1,829.00 0.00 19,090.00
30 06/20/2020 10.00
R/21 SPUIT 3 CC NIPRO - 1,155.00 0.00 6,575.00
31 06/20/2020 5.00
R/23 DISP NEEDLE 18 G TERUMO - 389.00 0.00 2,745.00
32 06/20/2020 5.00
R/9 SILK 3/0 CUTT DS 24 - 32,000.00 0.00 32,800.00
33 06/20/2020 1.00
75,760.00 Farmasi 1 Resep No: O/2006/07470
R/13 SPUIT 10 CC NIPRO - 1,829.00 0.00 19,090.00
34 06/21/2020 10.00
R/15 SPUIT 3 CC NIPRO - 1,155.00 0.00 12,350.00
35 06/21/2020 10.00
R/16 SPUIT 5 CC NIPRO - 1,306.00 0.00 13,860.00
36 06/21/2020 10.00
R/4 SILK 3/0 CUTT DS 24 - 32,000.00 0.00 32,800.00
37 06/21/2020 1.00
78,100.00 Farmasi Steril Resep No: O/2006/07412
R/2 SPUIT 1 CC TB NIPRO - 1,279.00 0.00 3,837.00
38 06/21/2020 3.00
R/3 SPUIT 3 CC NIPRO - 1,155.00 0.00 3,465.00
39 06/21/2020 3.00
R/4 DISP NEEDLE 18 G TERUMO - 389.00 0.00 389.00
40 06/21/2020 1.00
7,691.00 2,491,275.00
Kamar/Akomodasi ::
Jenis :
Gawat Darurat(Emergency)
Karcis Non Kelas - 25,000.00 0.00 25,000.00
41 06/20/2020 1.00
25,000.00 ICU / Ruang Wijaya Kusuma
Akomodasi Level III ICU/NICU Non Kelas - 695,000.00 0.00 695,000.00
42 06/20/2020 1.00
Akomodasi Level III ICU/NICU Non Kelas - 695,000.00 0.00 695,000.00
43 06/21/2020 1.00
Biaya Administrasi Non Kelas - 1,070,275.00 0.00 1,070,275.00
44 06/24/2020 1.00
Biaya Materai Non Kelas - 6,000.00 0.00 6,000.00
45 06/24/2020 1.00
2,466,275.00 280,000.00
Keperawatan ::
Jenis :
ICU / Ruang Wijaya Kusuma
Pasang Kateter Urine Non Kelas dr. Henny Rosita 80,000.00 80,000.00
Iskandar, Sp. A (K) 0.00
46 06/21/2020 1.00
Lepas Catheter/ Longline/ Akses
Arteri/ ETT/ NGT Non Kelas dr. Henny Rosita 145,000.00 145,000.00
Iskandar, Sp. A (K) 0.00
47 06/21/2020 1.00
:
Nama Pasien Kelas :
No. RM : Kamar
Dokter P.Jawab
Tgl. Pulang Penjamin :
:
: :
Sub Total 00919501
ATHAYA PRADIPTA RISTIANTI ( P )
Wijaya Kusuma - ICU 01 Non Kelas
dr. Pustika Efar, Sp.A
2020/06/21 14:59 BPJS KESEHATAN
Tipe :BPJS
No Tanggal Deskripsi Kelas Dokter Qty Tarif Diskon
No SEP :
Lepas Kateter Non Kelas dr. Henny Rosita 55,000.00 55,000.00
Iskandar, Sp. A (K) 0.00
48 06/21/2020 1.00
280,000.00 1,050,000.00
Konsultasi ::
Jenis :
Gawat Darurat(Emergency)
Konsultasi Dokter Jaga Non Kelas dr. Eva Fahmiah 100,000.00 0.00 100,000.00
49 06/20/2020 1.00
Observasi Non Kelas dr. Eva Fahmiah 200,000.00 0.00 200,000.00
50 06/20/2020 1.00
300,000.00 ICU / Ruang Wijaya Kusuma
Visite Dokter Spesialis Level III Non Kelas dr. Felix, Sp.A 375,000.00 0.00 375,000.00
51 06/20/2020 1.00
Visite Dokter Spesialis Level III Non Kelas dr. Henny Rosita 375,000.00 375,000.00
Iskandar, Sp. A (K) 0.00
52 06/21/2020 1.00
750,000.00 6,527,000.00
Laboratorium ::
Jenis : Bank Darah
Cross Match Non Kelas dr. Ni Sayu Dewi 110,000.00 110,000.00
Budhiyani, Sp.PK 0.00
53 06/20/2020 1.00
Cross Match Non Kelas dr. Ni Sayu Dewi 110,000.00 110,000.00
Budhiyani, Sp.PK 0.00
54 06/20/2020 1.00
Packed Red Cell Non Kelas dr. Ni Sayu Dewi 632,000.00 632,000.00
Budhiyani, Sp.PK 0.00
55 06/20/2020 1.00
Packed Red Cell Non Kelas dr. Ni Sayu Dewi 632,000.00 632,000.00
Budhiyani, Sp.PK 0.00
56 06/20/2020 1.00
Cross Match Non Kelas dr. Ni Sayu Dewi 110,000.00 550,000.00
Budhiyani, Sp.PK 0.00
57 06/21/2020 5.00
THROMBOCYTE CONCENTRATE Non Kelas dr. Ni Sayu Dewi 632,000.00 3,160,000.00
Budhiyani, Sp.PK 0.00
58 06/21/2020 5.00
5,194,000.00 Laboratorium Patologi Klinik
ALBUMIN Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
59 06/20/2020 1.00
APTT Non Kelas dr. Ni Sayu Dewi 95,000.00 95,000.00
Budhiyani, Sp.PK 0.00
60 06/20/2020 1.00
BILIRUBIN DIREK Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
61 06/20/2020 1.00
CREATININ Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
62 06/20/2020 1.00
DR + DIFF (Darah Rutin 2) Non Kelas dr. Ni Sayu Dewi 70,000.00 70,000.00
Budhiyani, Sp.PK 0.00
63 06/20/2020 1.00
ELEKTROLIT ( NA+K+CL+CA) Non Kelas dr. Ni Sayu Dewi 105,000.00 105,000.00
Budhiyani, Sp.PK 0.00
64 06/20/2020 1.00
GLUKOSA DARAH SEWAKTU Non Kelas dr. Ni Sayu Dewi 30,000.00 30,000.00
Budhiyani, Sp.PK 0.00
65 06/20/2020 1.00
GLUKOSA DARAH SEWAKTU Non Kelas dr. Ni Sayu Dewi 30,000.00 30,000.00
Budhiyani, Sp.PK 0.00
66 06/20/2020 1.00
HS-CRP Non Kelas dr. Ni Sayu Dewi 110,000.00 110,000.00
Budhiyani, Sp.PK 0.00
67 06/20/2020 1.00
INR Non Kelas dr. Ni Sayu Dewi 105,000.00 105,000.00
Budhiyani, Sp.PK 0.00
68 06/20/2020 1.00
ITR Non Kelas dr. Ni Sayu Dewi 70,000.00 70,000.00
Budhiyani, Sp.PK 0.00
69 06/20/2020 1.00
PROTEIN TOTAL Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
70 06/20/2020 1.00
:
Nama Pasien Kelas :
No. RM : Kamar
Dokter P.Jawab
Tgl. Pulang Penjamin :
:
: :
Sub Total 00919501
ATHAYA PRADIPTA RISTIANTI ( P )
- Non Kelas
dr. Pustika Efar, Sp.A
2020/06/21 14:59 BPJS KESEHATAN
Tipe :BPJS
No Tanggal Deskripsi Kelas Dokter Qty Tarif Diskon
No SEP :
PROTHROMBINE TIME Non Kelas dr. Ni Sayu Dewi 105,000.00 105,000.00
Budhiyani, Sp.PK 0.00
71 06/20/2020 1.00
SGOT/AST Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
72 06/20/2020 1.00
SGPT/ALT Non Kelas dr. Ni Sayu Dewi 40,000.00 40,000.00
Budhiyani, Sp.PK 0.00
73 06/20/2020 1.00
UREUM Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
74 06/20/2020 1.00
URIC ACID Non Kelas dr. Ni Sayu Dewi 35,000.00 35,000.00
Budhiyani, Sp.PK 0.00
75 06/20/2020 1.00
Analisa Gas Darah Non Kelas - 160,000.00 0.00 160,000.00
76 06/20/2020 1.00
Darah Rutin 3 Non Kelas dr. Yosanti Elsa 63,000.00 63,000.00
Kartikawati, Sp.PK, M.Kes
0.00
77 06/21/2020 1.00
MORFOLOGI DARAH TEPI Non Kelas dr. Yosanti Elsa 70,000.00 70,000.00
Kartikawati, Sp.PK, M.Kes
0.00
78 06/21/2020 1.00
RETIKULOSIT Non Kelas dr. Yosanti Elsa 35,000.00 35,000.00
Kartikawati, Sp.PK, M.Kes
0.00
79 06/21/2020 1.00
1,333,000.00 2,220,252.00
Obat ::
Jenis :
Farmasi 1 Resep No: O/2006/07346 R/10 NASSAL CANNULA ADULT
(hospitech) - 11,688.00 0.00 12,488.00
80 06/20/2020 1.00
R/11 SARUNG TANGAN PANJANG - 17,188.00 0.00 17,988.00
81 06/20/2020 1.00
R/12 MEYLON 8.4% 25 ML INJ - 8,060.00 0.00 8,860.00
82 06/20/2020 1.00
R/13 ALCOHOL SWAB (BD) - 487.00 0.00 5,670.00
83 06/20/2020 10.00
R/15 ELECTRODE MEDICO
MSGST-37 - 1,468.00 0.00 5,204.00
84 06/20/2020 3.00
R/16 KA-EN 3 B . 500 ML INF - 13,370.00 0.00 14,170.00
85 06/20/2020 1.00
R/1 NA CL 0.9 % 500 ML
INF(ecosol) - 8,938.00 0.00 9,738.00
86 06/20/2020 1.00
R/2 BLOOD ADM.SET (TERUMO)
TBU800 - 17,470.00 0.00 18,270.00
87 06/20/2020 1.00
R/3 SURFLO 24 G X 3/4 - 7,838.00 0.00 8,638.00
88 06/20/2020 1.00
R/4 FOLLEY CATH FR 10 NORTA - 53,750.00 0.00 54,550.00
89 06/20/2020 1.00
R/5 DRAINAGE BAG ADULT JMS - 70,950.00 0.00 71,750.00
90 06/20/2020 1.00
R/8 OMNIFIX LUER LOCK 20 ML - 10,625.00 0.00 11,425.00
91 06/20/2020 1.00
R/9 AQUA DEST STERIL 25 CC
(wfi) - 3,575.00 0.00 7,950.00
92 06/20/2020 2.00
246,701.00 Farmasi 1 Resep No: O/2006/07353
R/11 SURFLO 20 G X 2 - 8,453.00 0.00 17,706.00
93 06/20/2020 2.00
R/12 EXTENSION TUBE 1 - 35,475.00 0.00 71,750.00
94 06/20/2020 2.00
R/14 TERUFUSION BLOOD SET
FOR PUMP - 43,038.00 0.00 43,838.00
95 06/20/2020 1.00
R/16 AQUA PACK 340 ML - 40,000.00 0.00 40,800.00
96 06/20/2020 1.00
R/17 AQUA DEST STERIL 25 CC
(wfi) - 3,575.00 0.00 36,550.00
97 06/20/2020 10.00
R/18 OMNIFIX LUER LOCK 30 ML - 11,250.00 0.00 57,050.00
98 06/20/2020 5.00
R/19 OMNIFIX LUER LOCK 50 ML - 18,750.00 0.00 94,550.00
99 06/20/2020 5.00
R/1 CEFTRIAXONE 1 G INJ - 5,885.00 0.00 12,570.00
100 06/20/2020 2.00
:
Nama Pasien Kelas :
No. RM : Kamar
Dokter P.Jawab
Tgl. Pulang Penjamin :
:
: :
Sub Total 00919501
ATHAYA PRADIPTA RISTIANTI ( P )
Kamar ICU Lv II Non Kelas
dr. Pustika Efar, Sp.A
2020/06/21 14:59 BPJS KESEHATAN
Tipe :BPJS
No Tanggal Deskripsi Kelas Dokter Qty Tarif Diskon
No SEP :
R/2 DEXAMETHASONE 5 MG INJ - 1,371.00 0.00 2,171.00
101 06/20/2020 1.00
R/3 CA.GLUCONAS 0.1G/10ML INJ - 12,939.00 0.00 26,678.00
102 06/20/2020 2.00
R/4 MEYLON 8.4% 25 ML INJ - 8,060.00 0.00 8,860.00
103 06/20/2020 1.00
R/5 KA-EN 1 B . 500 ML INF - 12,055.00 0.00 49,020.00
104 06/20/2020 4.00
R/7 DEXTROSE 5 % 100 ML INF - 8,938.00 0.00 18,676.00
105 06/20/2020 2.00
R/8 CERTOFIX MONO V 220 - 446,791.00 0.00 447,591.00
106 06/20/2020 1.00
927,810.00 Farmasi 1 Resep No: O/2006/07451
R/1 FUROSEMIDE 20MG/2ML INJ - 2,041.00 0.00 21,210.00
107 06/21/2020 10.00
21,210.00 Farmasi 1 Resep No: O/2006/07470
R/11 GUIDEL AIRWAY NO. 3 - 30,375.00 0.00 31,175.00
108 06/21/2020 1.00
R/12 NON REBREATH PED 1058 - 35,375.00 0.00 36,175.00
109 06/21/2020 1.00
R/14 OMNIFIX LUER LOCK 30 ML - 11,250.00 0.00 57,050.00
110 06/21/2020 5.00
R/17 OMNIFIX LUER LOCK 50 ML - 18,750.00 0.00 94,550.00
111 06/21/2020 5.00
R/18 SUCTION CATH. FR 8
hospitech - 4,496.00 0.00 5,296.00
112 06/21/2020 1.00
R/1 DEXTROSE 5 % 100 ML INF - 8,938.00 0.00 9,738.00
113 06/21/2020 1.00
R/2 CERTOFIX MONO V 220 - 446,791.00 0.00 447,591.00
114 06/21/2020 1.00
R/3 SURFLO 20 G X 2 - 8,453.00 0.00 17,706.00
115 06/21/2020 2.00
R/5 AQUA DEST STERIL 25 CC
(wfi) - 3,575.00 0.00 18,675.00
116 06/21/2020 5.00
R/6 EXTENSION TUBE 1 - 35,475.00 0.00 71,750.00
117 06/21/2020 2.00
R/8 DRAINAGE BAG ADULT JMS - 70,950.00 0.00 71,750.00
118 06/21/2020 1.00
R/9 FOLLEY CATH FR 10 NORTA - 53,750.00 0.00 54,550.00
119 06/21/2020 1.00
916,006.00 Farmasi Steril Resep No: O/2006/07412
R/1 AQUA DEST STERIL 25 CC
(wfi) - 3,575.00 0.00 3,575.00
120 06/21/2020 1.00
R/1 CEFTRIAXONE 1 G INJ - 5,885.00 0.00 12,570.00
121 06/21/2020 2.00
R/1 OMNIFIX LUER LOCK 20 ML - 10,625.00 0.00 10,625.00
122 06/21/2020 1.00
R/2 DEXAMETHASONE 5 MG INJ - 1,371.00 0.00 2,171.00
123 06/21/2020 1.00
R/3 FUROSEMIDE 20MG/2ML INJ - 2,041.00 0.00 6,923.00
124 06/21/2020 3.00
R/4 Biaya IV Admixture - 12,500.00 0.00 12,500.00
125 06/21/2020 1.00
R/4 Jasa Pelayanan IV Admixture - 12,000.00 0.00 12,000.00
126 06/21/2020 1.00
R/4 OMNIFIX LUER LOCK 20 ML - 10,625.00 0.00 31,875.00
127 06/21/2020 3.00
R/4 PARACETAMOL 100 ML INFUS - 15,486.00 0.00 16,286.00
128 06/21/2020 1.00
108,525.00 300,000.00
Pelayanan Darah ::
Jenis :
ICU / Ruang Wijaya Kusuma
Monitoring Transfusi Darah Non Kelas dr. Felix, Sp.A 100,000.00 0.00 100,000.00
129 06/20/2020 1.00
Monitoring Transfusi Darah Non Kelas dr. Henny Rosita 100,000.00 200,000.00
Iskandar, Sp. A (K) 0.00
130 06/21/2020 2.00
300,000.00 3,002,000.00
Prosedur Non - Bedah ::
Jenis :
Gawat Darurat(Emergency)
Pasang Infus Non Kelas - 55,000.00 0.00 55,000.00
131 06/20/2020 1.00
Pasang Spalk Non Kelas - 65,000.00 0.00 65,000.00
132 06/20/2020 1.00
:
Nama Pasien Kelas :
No. RM : Kamar
Dokter P.Jawab
Tgl. Pulang Penjamin :
:
: :
Sub Total 00919501
ATHAYA PRADIPTA RISTIANTI ( P )
- Non Kelas
dr. Pustika Efar, Sp.A
2020/06/21 14:59 BPJS KESEHATAN
Tipe :BPJS
No Tanggal Deskripsi Kelas Dokter Qty Tarif Diskon
No SEP :
120,000.00 ICU / Ruang Wijaya Kusuma
Injeksi Non Kelas dr. Felix, Sp.A 50,000.00 0.00 200,000.00
133 06/20/2020 4.00
Monitoring & Intervensi Non Kelas dr. Felix, Sp.A 125,000.00 0.00 125,000.00
134 06/20/2020 1.00
Sedasi Sedang Anak Non Kelas dr. Felix, Sp.A 1,242,000.00 0.00 1,242,000.00
135 06/20/2020 1.00
Injeksi Non Kelas dr. Henny Rosita 50,000.00 500,000.00
Iskandar, Sp. A (K) 0.00
136 06/21/2020 10.00
Monitoring & Intervensi Non Kelas dr. Henny Rosita 125,000.00 125,000.00
Iskandar, Sp. A (K) 0.00
137 06/21/2020 1.00
Tracheal Toilet Non Kelas dr. Henny Rosita 60,000.00 300,000.00
Iskandar, Sp. A (K) 0.00
138 06/21/2020 5.00
Lepas Akses Arteri Non Kelas dr. Henny Rosita 60,000.00 60,000.00
Iskandar, Sp. A (K) 0.00
139 06/21/2020 1.00
Lepas NGT Non Kelas dr. Henny Rosita 60,000.00 60,000.00
Iskandar, Sp. A (K) 0.00
140 06/21/2020 1.00
Resusitasi Jantung Paru Non Kelas dr. Henny Rosita 270,000.00 270,000.00
Iskandar, Sp. A (K) 0.00
141 06/21/2020 1.00
2,882,000.00 235,000.00
Radiologi ::
Jenis : Radiologi
Foto Thorax Non Kelas dr. Ido Narpati 235,000.00 235,000.00
Bramantya, Sp.Rad 0.00
142 06/20/2020 1.00
235,000.00 240,000.00
Rehabilitasi ::
Jenis :
ICU / Ruang Wijaya Kusuma
Nebulizer Non Kelas dr. Henny Rosita 80,000.00 240,000.00
Iskandar, Sp. A (K) 0.00
143 06/21/2020 3.00
240,000.00 :
# DUA PULUH DUA JUTA EMPAT RATUS DELAPAN PULUH SATU RIBU TUJUH RATUS ENAM PULUH ENAM RUPIAH #
JUMLAH BILL 22,481,766.00
TERBILANG :
