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No Nama Pasien Tgl Masuk Tgl Keluar Rawat jalan

1 Rizki Andrian (Imam) 02-01-2017 03-01-2017 Rp 50,000


2 Atikah (Imam) 30-01-2016 03-01-2017 Rp 50,000
3 Irma Sundari (Imam) 02-01-2017 03-01-2017 Rp 50,000
4 Imam(Imam) 01/01/2017 4/1/2017 Rp 159,000
5 Ayu (Imam) 03-01-2017 05-01-2017 Rp 50,000
6 Yanti(Imam) 02-01-2017 05-01-2017 Rp 50,000
7 Asep sobandi (Y) 06-01-2017 06-01-2017 Rp 50,000
8 Mulyadi 05-01-2017 07-01-2017 Rp 306,000
9 Intan Megawati 04-01-2017 07-01-2017 Rp 506,000
10 Samsudin bin sugeng 04-01-2017 07-01-2017 Rp -
11 Indrayani 05-01-2017 07-01-2017 Rp 328,000
12 Sudarni 2/1/2017 10/1/2017 Rp 15,000
1651 Amel karlina 05-01-2017 10-01-2017 Rp 353,000
Konsul R.Inap dr.Dewi dr.Yasser dr Ratna

Rp - Rp 700,000 Rp 100,000 Rp - ###


Rp - Rp 1,250,000 Rp 240,000 Rp 50,000 Rp -
Rp - Rp 600,000 Rp - Rp 25,000 Rp -
Rp - Rp 1,000,000 Rp 320,000 Rp - ###
Rp - Rp 1,050,000 Rp 360,000 Rp 25,000 Rp -
Rp - Rp 1,700,000 Rp 440,000 Rp 50,000 Rp -
Rp - Rp 250,000 Rp 80,000 Rp 25,000 Rp -
Rp - Rp 1,500,000 Rp 360,000 Rp 50,000 Rp -
Rp - Rp 1,400,000 Rp 400,000 Rp 50,000 Rp -
Rp - Rp 1,000,000 Rp 320,000 Rp - ###
Rp - Rp 1,500,000 Rp 360,000 Rp - ###
Rp 55,000 Rp 2,250,000 Rp 720,000 Rp 100,000 Rp -
Rp - Rp 3,000,000 Rp 480,000 Rp 50,000 Rp -
dr.Tamu dr Imam Gizi Farmasi Lab

Rp - Rp 50,000 Rp - Rp 1,794,410 Rp 663,000


Rp - Rp 25,000 Rp - Rp 5,390,100 Rp 702,000
Rp - Rp 25,000 Rp - Rp 2,876,133 Rp 415,000
Rp - Rp - Rp - Rp 3,685,902 Rp 399,000
Rp - Rp 25,000 Rp - Rp 3,624,118 Rp 374,000
Rp - Rp 50,000 Rp - Rp 1,800,900 Rp 428,000
Rp - Rp - Rp - Rp 926,047 Rp 661,000
24000(Toto) Rp - Rp - Rp 3,924,921 Rp 78,000
Rp - Rp - Rp - Rp 1,470,083 Rp 278,000
Rp - Rp 50,000 Rp - Rp 3,556,062 Rp 262,000
24000(toto) Rp - Rp - Rp 1,687,799 Rp 296,000
96000(M)48000(Toto) Rp - Rp 20,000 Rp 8,893,571 Rp 1,867,000
Rp - Rp 25,000 Rp - Rp 9,353,702 Rp 522,000
Monitor emergency Rontgen Ct Scan USG Obs(Perawat)

Rp - ### Rp - Rp - Rp -
Rp - Rp 80,000 Rp - Rp - Rp -
Rp - Rp 100,000 Rp - Rp - Rp -
Rp - Rp 80,000 Rp - Rp - Rp -
Rp - ### Rp - Rp - Rp -
Rp - ### Rp - Rp -
Rp - ### Rp - Rp - Rp -
Rp - ### Rp - Rp - Rp -
Rp - ### Rp - Rp - Rp -
Rp - ### Rp - Rp - Rp -
Rp - ### Rp - Rp - Rp -
Rp - Rp 170,000 Rp - Rp - Rp -
Rp - ### Rp - Rp - Rp -
AKHP + BHP Hemodialisa Tindakan tndkan dr tamu Tindakan Operasi

Rp 1,172,977 Rp - Rp 2,522,320 Rp - Rp -
Rp 552,000 Rp - Rp 908,800 Rp - Rp -
Rp 182,000 Rp - Rp 411,360 Rp - Rp -
Rp 134,000 Rp - Rp 296,400 Rp - Rp -
Rp 211,600 Rp - Rp 374,400 Rp - Rp -
Rp 289,000 Rp - Rp 531,440 Rp - Rp -
Rp 410,000 Rp - Rp 462,400 Rp - Rp -
Rp 120,000 Rp - Rp 394,160 Rp - Rp -
Rp 171,000 Rp - Rp 384,800 Rp - Rp -
Rp 61,000 Rp - Rp 338,000 Rp - Rp -
Rp 120,000 Rp - Rp 502,240 Rp - Rp -
Rp 3,581,461 Rp - Rp 3,261,800 Rp - Rp -
Rp 120,000 Rp - Rp 1,038,960 Rp - Rp -
Perawat Total Adm + Materai Reture obat Deposit

Rp - Rp 7,402,842 Rp - Rp - Rp 1,000,000
Rp - Rp 9,707,835 Rp - Rp 279,700 Rp 900,000
Rp - Rp 5,138,118 Rp - Rp 411,551 Rp -
### Rp 6,237,317 Rp 297,015 Rp 81,938 Rp -
### Rp 6,396,324 Rp - Rp 104,078 Rp -
### Rp 5,603,807 Rp - Rp - ###
Rp - Rp 3,005,169 Rp - Rp 47,280 Rp -
### Rp 7,202,485 Rp - Rp - ###
Rp - Rp 4,867,577 Rp - Rp 24,140 Rp 2,200,000
Rp - Rp 5,866,415 Rp - Rp - ###
Rp - Rp 50
Rp - Rp 22,206,974 Rp 1,054,142 Rp 647,359 Rp 17,000,000
Rp - Rp 15,672,145 Rp - Rp 326,326 Rp 3,000,000
Disc Bayar Fisioterapi psioterapi Kemoterapi

Rp - Rp 6,402,842
Rp - Rp 8,528,135
Rp 26,537 Rp 4,726,567
Rp - Rp 6,314,379
Rp - Rp 6,292,246
Rp - Rp 5,603,807
Rp 50,000 Rp 2,907,889
Rp - Rp 7,202,485
Rp - Rp 2,643,437
Rp - Rp 5,866,415

Rp - Rp 4,559,615
Rp - Rp 12,345,819
Ambulance Curratge Hemodialisa2 Partus normal bidan Charge 2%
NO Tanggal Shift Nama Pasien ADM Konsul
1 1/1/2017 Sore M.Tjahyadi(Imam) 15,000 35,000
2 1/1/2017 Sore Rasti(Imam) 15,000 35,000
3 1/1/2017 Sore Kaifa(Imam) 15,000 35,000
4 1/1/2017 Sore Ayu(Imam) 15,000 35,000
5 1/1/2017 Sore M.Gifar(Imam) 15,000 35,000
6 1/1/2017 Sore Lutfi(Imam) 15,000 35,000
7 1/1/2017 Sore Mualim(Imam) 15,000 35,000
8 1/1/2017 Sore Yusra(Imam) 15,000 35,000
9 1/1/2017 Sore Dedeh(Imam) 15,000 35,000
10 1/1/2017 Sore Ahmad(Imam) 15,000 35,000
11 2/1/2017 Pagi Ratna(Imam) 15,000 35,000
12 2/1/2017 Pagi Pupun 15,000 80,000
13 2/1/2017 Pagi Hariyati 15,000 80,000
14 2/1/2017 Pagi Dede(Imam) 15,000 35,000
Total - 210,000 580,000

1 2/1/2017 Pagi Erna 15,000 80,000


2 2/1/2017 Pagi Babas 15,000 80,000
3 2/1/2017 Pagi Aminah(Imam) 15,000 35,000
Total DEBIT

NO Tanggal Shift Nama Pasien ADM Konsul


1 2/1/2017 Sore UPDS - -
2 2/1/2017 Sore Tuti(Imam) 15,000 35,000
3 2/1/2017 Sore Erna 15,000 80,000
4 2/1/2017 Sore Eneng 15,000 80,000
5 2/1/2017 Sore UPDS - -
6 2/1/2017 Sore Azalea(Imam) 15,000 35,000
7 2/1/2017 Sore Rosita 15,000 80,000
8 2/1/2017 Sore Iin 15,000 80,000
9 2/1/2017 Sore UPDS - -
10 2/1/2017 Sore Titin 15,000 80,000
11 2/1/2017 Sore Erna - -
12 2/1/2017 Sore neneng 15,000 80,000
13 2/1/2017 Sore Eneng - -
14 2/1/2017 Sore Tedi 15,000 80,000
15 2/1/2017 Sore Husna 15,000 80,000

TOTAL 150,000 710,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 2/1/2017 Sore Rifo(Imam) 15,000 35,000
2 2/1/2017 Sore Helgi(Imam) 15,000 35,000
3 3/1/2017 Pagi UPDS - -
4 3/1/2017 Pagi Dewi 15,000 80,000
5 3/1/2017 Pagi Tating 15,000 80,000
6 3/1/2017 Pagi N Koharudin - -
7 3/1/2017 Pagi Eni 15,000 80,000
8 3/1/2017 Pagi Mayang 15,000 80,000
9 3/1/2017 Pagi Imanstiar (Y) 15,000 35,000
10 3/1/2017 Pagi M.Yusuf (Y) 15,000 35,000
11 3/1/2017 Pagi Tina (Y) 15,000 35,000
12 3/1/2017 Pagi Tati (Y) 15,000 35,000
13 3/1/2017 Pagi Irna - -
Total 150,000 530,000

1 3/1/2017 Pagi Novelia 15,000 80,000


2 3/1/2017 Pagi Galih 15,000 80,000
Total DEBIT

NO Tanggal Shift Nama Pasien ADM Konsul


1 3/1/2017 Sore N Koharudin - -
2 3/1/2017 Sore Elinda(Y) 15,000 35,000
3 3/1/2017 Sore Yoyoh 15,000 80,000
4 3/1/2017 Sore Vani 15,000 80,000
5 3/1/2017 Sore Dewi - -
6 3/1/2017 Sore Samsudin 15,000 80,000
7 3/1/2017 Sore Dedi 15,000 80,000
8 3/1/2017 Sore Milly 15,000 80,000
9 3/1/2017 Sore Arya 15,000 80,000
10 3/1/2017 Sore Sopiah 15,000 80,000
11 3/1/2017 Sore Ina 15,000 80,000
12 3/1/2017 Sore Lilis(Y) 15,000 35,000
13 3/1/2017 Sore Muhayati(Y) 15,000 35,000
14 3/1/2017 Sore Dindin(Y) 15,000 35,000
15 3/1/2017 Sore Ence 15,000 80,000
16 3/1/2017 Sore Usmada 15,000 80,000
17 3/1/2017 Sore Yasa 15,000 80,000
18 3/1/2017 Sore Samsudin - -
19 3/1/2017 Sore Yuni 15,000 80,000
20 3/1/2017 Sore Rukman 15,000 80,000
21 3/1/2017 Sore Amel 15,000 80,000

TOTAL 270,000 1,260,000

1 3/1/2017 Sore Novalia - -


2 3/1/2017 Sore Endang(Y) 15,000 35,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 04-01-2017 Pagi Yuniar - -
2 04-01-2017 Pagi Dedeh - -
3 04-01-2017 Pagi Ariyanto 15,000 80,000
4 04-01-2017 Pagi Dadang 15,000 80,000
5 04-01-2017 Pagi Adidah 15,000 80,000
6 04-01-2017 Pagi Yuli 15,000 80,000
7 04-01-2017 Pagi Sariyanti 15,000 80,000
8 04-01-2017 Pagi Ilat - -
9 04-01-2017 Pagi Esih 15,000 80,000
10 04-01-2017 Pagi Hety 15,000 80,000
11 04-01-2017 Pagi Dadang - -
12 04-01-2017 Pagi Faridah 15,000 80,000
13 04-01-2017 Pagi Ghofur(Y) 15,000 35,000

TOTAL 135,000 675,000

1 04-01-2017 Pagi Teguh 15,000 80,000


2 04-01-2017 Pagi Ilat 15,000 80,000
3 04-01-2017 Pagi Ilat - -

NO Tanggal Shift Nama Pasien ADM Konsul


1 04-01-2017 Sore Sariyanti(Yeni) 15,000 65,000
2 04-01-2017 Sore Tethy - -
3 04-01-2017 Sore Irwan(Y) 15,000 35,000
4 04-01-2017 Sore Hadsih 15,000 80,000
5 04-01-2017 Sore Imelda 15,000 80,000
6 04-01-2017 Sore Sandy 15,000 80,000
7 04-01-2017 Sore Cucup 15,000 80,000
8 04-01-2017 Sore Euis 15,000 80,000
9 04-01-2017 Sore Sephany 15,000 80,000
10 04-01-2017 Sore Ahid 15,000 80,000
11 04-01-2017 Sore Vivi 15,000 80,000
12 04-01-2017 Sore Noviana(Y) 15,000 35,000
13 04-01-2017 Sore Hasan - -
14 04-01-2017 Sore N.Enung 15,000 80,000
15 04-01-2017 Sore Rina 15,000 80,000
16 04-01-2017 Sore Alamsyah 15,000 80,000
17 04-01-2017 Sore Ai 15,000 80,000
Total 225,000 1,095,000

1 04-01-2017 Sore Mira 15,000 80,000


2 04-01-2017 Sore Hasna 15,000 80,000
Total DEBIT

1 04-01-2017 Sore Iyar 15,000 80,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 05-01-2017 Pagi Eliah 15,000 80,000
2 05-01-2017 Pagi Siti 15,000 80,000
3 05-01-2017 Pagi Burhanudin(Y) 15,000 35,000
4 05-01-2017 Pagi Eneng 15,000 80,000
5 05-01-2017 Pagi Wendi 15,000 80,000
6 05-01-2017 Pagi Yadi 15,000 80,000
7 05-01-2017 Pagi Tianna 15,000 80,000
8 05-01-2017 Pagi M.Syaifulloh 15,000 80,000
9 05-01-2017 Pagi Hendra 15,000 80,000
10 05-01-2017 Pagi M.Amar(Y) 15,000 35,000
11 05-01-2017 Pagi M.Arsyad(Y) 15,000 35,000
12 05-01-2017 Pagi UPDS - -
13 05-01-2017 Pagi Siti (Y) 15,000 35,000
14 05-01-2017 Pagi Siti - -
15 05-01-2017 Pagi Marpuah 15,000 80,000
16 05-01-2017 Pagi Upds - -
17 05-01-2017 Pagi Teh erni - -
Total 195,000 860,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 05-01-2017 Sore Mintaraga(Y) 15,000 35,000
2 05-01-2017 Sore Ipun 15,000 80,000
3 05-01-2017 Sore Nasrullah 15,000 80,000
4 05-01-2017 Sore Hendra - -
5 05-01-2017 Sore Diki 15,000 80,000
6 05-01-2017 Sore UPDS - -
7 05-01-2017 Sore Yuristiana 15,000 80,000
8 05-01-2017 Sore Agus 15,000 80,000

TOTAL 90,000 435,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 05-01-2017 Sore Binari(Y) 15,000 35,000
2 06-01-2017 Pagi Keysya(Y) 15,000 35,000
3 06-01-2017 Pagi Kayla(Y) 15,000 35,000
4 06-01-2017 Pagi Rahtmat(Y) 15,000 35,000
5 06-01-2017 Pagi Yuristiana - -
6 06-01-2017 Pagi Enti(Y) 15,000 35,000
7 06-01-2017 Pagi Masriah 15,000 80,000
8 06-01-2017 Pagi Uun 15,000 80,000
9 06-01-2017 Pagi Ahmad 15,000 80,000
10 06-01-2017 Pagi Nur azizah 15,000 80,000
11 06-01-2017 Pagi M.Jainul 15,000 80,000
12 06-01-2017 Pagi Dede(Y) 15,000 35,000
13 06-01-2017 Pagi Sumaryeti 15,000 80,000
14 06-01-2017 Pagi Susi 15,000 80,000
15 06-01-2017 Pagi Nur azizah - -
16 06-01-2017 Pagi UPDS - -
Total 195,000 770,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 06-01-2017 Sore Nurhasanah 15,000 80,000
2 06-01-2017 Sore UPDS - -
3 06-01-2017 Sore UPDS - -
4 06-01-2017 Sore Ina 15,000 80,000
5 06-01-2017 Sore M Kaifan 15,000 80,000
6 06-01-2017 Sore Fatimah 15,000 80,000

TOTAL 60,000 320,000

1 06-01-2017 Sore Dani 15,000 80,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 06-01-2017 Sore Supriah - -
2 06-01-2017 Sore Sri 15,000 80,000
3 07-01-2017 Pagi M.Raditya(Y) 15,000 35,000
4 07-01-2017 Pagi Sephia(Y) 15,000 35,000
5 07-01-2017 Pagi UPDS - -
6 07-01-2017 Pagi Naila (Y) 15,000 35,000
7 07-01-2017 Pagi UPDS - -
8 07-01-2017 Pagi Nurhayati(Y) 15,000 35,000
9 07-01-2017 Pagi Nurhayati - -
10 07-01-2017 Pagi UPDS - -
Total 75,000 220,000

1 07-01-2017 Pagi Anggi (Y) 15,000 35,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 07-01-2017 Sore teh sherly - -
2 07-01-2017 MLM Ai (Imam) 15,000 55,000
3 07-01-2017 Sore Septia(Imam) 15,000 35,000
4 07-01-2017 Sore Novi(Imam) 15,000 35,000
5 07-01-2017 Sore Onih(Imam) 15,000 35,000
6 07-01-2017 Sore Yudi(Imam) 15,000 35,000
Total 75,000 195,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 08-01-2017 Pagi Devi(Imam) 15,000 35,000
2 08-01-2017 Pagi Alis(Imam) 15,000 35,000
3 08-01-2017 Pagi UPDS - -
4 08-01-2017 Pagi Irfan(Imam) 15,000 35,000
Total - 45,000 105,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 08-01-2017 Sore Maman(Imam) 15,000 35,000
2 08-01-2017 Sore Nuwal(Imam) 15,000 35,000
3 08-01-2017 Sore Aden(Imam) 15,000 35,000
4 08-01-2017 Sore UPDS - -
5 08-01-2017 Sore UPDS - -
6 08-01-2017 Sore UPDS - -
7 08-01-2017 Sore Riski(Imam) 15,000 35,000
8 08-01-2017 Sore Dewi 15,000 80,000
9 08-01-2017 Sore M Adhyasta 15,000 35,000
10 08-01-2017 Sore Andi(Imam) 15,000 35,000
11 08-01-2017 Sore M Nauval(Imam) 15,000 35,000
12 08-01-2017 Sore Resti(Imam) 15,000 35,000
13 08-01-2017 Sore M Hamka(Imam) 15,000 35,000
14 08-01-2017 Sore UPDS - -
15 08-01-2017 Sore Riyan(Imam) 15,000 35,000
16 9/1/2017 Pagi Nurhayati 15,000 80,000
17 9/1/2017 Pagi Sri 15,000 80,000
18 9/1/2017 Pagi Salomo 15,000 80,000
19 9/1/2017 Pagi Holidin 15,000 80,000
20 9/1/2017 Pagi Septa(Imam) 15,000 35,000
21 9/1/2017 Pagi Ratnawati 15,000 80,000
22 9/1/2017 Pagi Imas 15,000 80,000
23 9/1/2017 Pagi Lim 15,000 80,000
24 9/1/2017 Pagi Ateng 15,000 80,000
25 9/1/2017 Pagi Kokom 15,000 80,000
26 9/1/2017 Pagi Syamsul 15,000 80,000
27 9/1/2017 Pagi Devi 15,000 80,000
28 9/1/2017 Pagi Endah 15,000 80,000
29 9/1/2017 Pagi Rima 15,000 80,000
30 9/1/2017 Pagi Iis 15,000 80,000
31 9/1/2017 Pagi Ani - -

TOTAL 390,000 1,585,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 9/1/2017 Sore Itim (Imam) 15,000 35,000
2 9/1/2017 Sore Tethy - -
3 9/1/2017 Sore Iis - -
4 9/1/2017 Sore Eka 15,000 80,000
5 9/1/2017 Sore Nuryani 15,000 80,000
6 9/1/2017 Sore Anisa (Imam) 15,000 35,000
7 9/1/2017 Sore Ratu 15,000 80,000
8 9/1/2017 Sore Acih 15,000 80,000
9 9/1/2017 Sore Doddy 15,000 80,000
10 9/1/2017 Sore Tomi 15,000 80,000
11 9/1/2017 Sore Asih 15,000 80,000
12 9/1/2017 Sore Heniel 15,000 80,000
13 9/1/2017 Sore Enjelina (Imam) 15,000 35,000
14 9/1/2017 Sore Heniel - -
15 9/1/2017 Sore Sutimat 15,000 80,000
16 9/1/2017 Sore Sri 15,000 80,000
17 9/1/2017 Sore Oki 15,000 80,000
18 9/1/2017 Sore Nuryanti(Imam) 15,000 35,000
19 9/1/2017 Sore Siti 15,000 80,000
20 9/1/2017 Sore Wafa 15,000 80,000
21 9/1/2017 Sore Udi 15,000 80,000
22 9/1/2017 Sore Ece(Imam) 15,000 35,000
Total 285,000 1,295,000

1 9/1/2017 Sore Khayla 15,000 80,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 10/01/2017 Pagi UPDS - -
2 10/01/2017 Pagi Wawan 15,000 80,000
3 10/01/2017 Pagi Heniel - -
4 10/01/2017 Pagi Suryani 15,000 80,000
5 10/01/2017 Pagi Oding 15,000 80,000
6 10/01/2017 Pagi Zaquela(Y) 15,000 35,000
7 10/01/2017 Pagi Anisa 15,000 80,000
8 10/01/2017 Pagi Irma 15,000 80,000

TOTAL 90,000 435,000


1 10/01/2017 Pagi Azizah(Imam) 15,000 35,000
2 10/01/2017 Pagi Suprihatin 15,000 80,000

NO Tanggal Shift Nama Pasien ADM Konsul


1 10/01/2017 Sore Viliandani (Y) 15,000 35,000
2 10/01/2017 Sore Dani - -
3 10/01/2017 Sore Hasan - -
4 10/01/2017 Sore Masnoneh(Ratna) 15,000 96,000
5 10/01/2017 Sore Astri (Y) 15,000 35,000
6 10/01/2017 Sore Wafa - -
7 10/01/2017 Sore Bu Yeni - -
8 10/01/2017 Sore Dumaria 15,000 80,000
9 10/01/2017 Sore Tati 15,000 80,000
10 10/01/2017 Sore UPDS - -
11 10/01/2017 Sore Dedi 15,000 80,000
12 10/01/2017 Sore Gunawan 15,000 80,000
13 10/01/2017 Sore Nina 15,000 80,000
14 10/01/2017 Sore Wandi (Y) 15,000 35,000
15 10/01/2017 Sore Melia 15,000 80,000
16 10/01/2017 Sore Nuryono 15,000 80,000
Total 165,000 761,000

1 10/01/2017 Sore siti 15,000 80,000


NO Tanggal Shift Nama Pasien ADM Konsul
1 11/1/2017 Pagi Gibran 15,000 80,000
2 11/1/2017 Pagi UPDS - -
3 11/1/2017 Pagi Darmo (Y) 15,000 35,000
4 11/1/2017 Pagi Susi 15,000 80,000
5 11/1/2017 Pagi M.Ilyas 15,000 80,000
6 11/1/2017 Pagi Iis Muniroh 15,000 80,000
7 11/1/2017 Pagi Liza 15,000 80,000
8 11/1/2017 Pagi Aan (Y) 15,000 35,000
9 11/1/2017 Pagi
10 11/1/2017 Pagi
11 11/1/2017 Pagi
12 11/1/2017 Pagi
13 11/1/2017 Pagi
14 11/1/2017 Pagi
15 11/1/2017 Pagi
Total 105,000 470,000
Tindakan Farmasi Lab Rad IGD USG
85,000 38,300 - ### -
- 73,900 109,000 - ###
- - - ### -
- 74,000 109,000 - ###
- 46,000 - ### -
- 66,400 - ### -
- 145,900 - ### -
- 94,700 - ### -
- - - ### -
- - - ### -
- - 139,000 - ###
- 689,000 - ### -
- 511,000 - ### -
- 138,000 109,000 - ###
85,000 1,877,200 466,000 - -

- - 109,000 - ###
- 509,480 211,000 250,000 -
- 61,352 243,000 - ###

Tindakan Farmasi Lab Rad IGD USG


- 57,000 - ### - ###
- 109,700 - ### - ###
- - 174,000 - ### -
- - 421,000 - ### -
- 2,100 - ### - ###
- 172,500 - ### - ###
- 349,100 109,000 - ### -
- 247,100 - ### - ###
- 37,000 - ### - ###
- 253,400 - ### - ###
- 156,000 - ### - ###
- 262,000 109,000 - ### -
- 507,000 - ### - ###
- 801,500 92,000 - ### -
- 143,100 109,000 - ### -

- 3,097,500 1,014,000 - - -

Khitan Farmasi Lab Rad IGD USG


- 152,500 - ### - ###
- 159,500 - ### - ###
20,000 - - ### - ###
- - 465,000 - ### -
- 461,500 88,000 - ### -
- - - 80,000 - ###
- 88,000 - ### - ###
- 88,000 224,000 - ### -
- 161,800 109,000 - ### -
850,000 231,000 84,000 - ### -
- - - ### - ###
- 132,000 - ### - ###
- - 458,000 - ### -
870,000 1,474,300 1,428,000 80,000 - -

- - 172,000 - ### -
- 308,200 98,000 95,000 - ###

Tindakan Farmasi Lab Rad Alkes EKG


- - - ### - 125,000
- 212,500 - ### - ###
20,000 454,400 - ### - ###
- 265,000 - ### - ###
- 494,500 - ### - ###
- - 371,000 - ### -
- 475,000 - ### - ###
- 440,000 - ### - ###
- - - ### - ###
- 518,400 - ### - ###
- 464,500 194,000 - ### -
- 82,600 - ### - ###
25,000 153,700 - ### 8,000 -
- 166,100 - ### - ###
20,000 183,300 - ### - ###
- 250,600 - ### - ###
- 185,100 - ### - ###
- 423,600 - ### - ###
- 297,200 - ### - ###
- 520,700 279,000 80,000 - ###
- 641,900 220,000 - ### -

65,000 6,229,100 1,064,000 80,000 8,000 125,000

- 672,040 - ### - ###


- 218,150 - ### - ###

Tindakan Farmasi Lab Rad Alkes EKG


- 25,000 - ### - ###
20,000 - - ### - ###
20,000 514,100 - ### - ###
- - 98,000 - ### -
- 377,000 - ### - ###
- 408,000 180,000 - ### -
- 104,000 153,000 - ### -
- 81,700 - ### - ###
- 437,500 - ### - ###
- 298,000 - ### - ###
- 281,300 - ### - ###
- 461,400 148,000 - ### -
- 183,500 - ### - ###

40,000 3,171,500 579,000 - - -

- 313,750 - ### - ###


- - 148,000 - ### -
- 350,000 - ### - ###

Tindakan Farmasi Lab Rad Alkes Fisioterapi


- - - ### 182,000
- 5,000 - ### -
- 219,500 - ### -
- 116,600 - ### -
- 344,800 - ### -
- 239,000 - ### -
- 417,000 156,000 - ###
- 847,500 109,000 - ###
- - 67,000 - ###
- 1,674,300 174,000 - ###
- 369,000 - ### -
25,000 192,000 - 7,000 -
- 74,000 - ### -
- 184,800 109,000 - ###
- 341,700 - ### -
- 274,000 113,000 - ### -
- 298,000 144,000 - ### -
25,000 5,597,200 872,000 - 7,000 182,000

- 290,324 - ### - ###


- 365,660 18,000 - ### -

- 401,400 153,000 - ### -

Tindakan Farmasi Lab Rad Alkes Fisioterapi


- 236,000 - ### - ###
- 148,600 - ### - ###
- 193,600 - ### - ###
- 118,800 - ### - ###
- 454,500 153,000 80,000 - ###
- - 153,000 - ### -
- - - ### - ###
- 212,000 - ### - ###
- - 350,000 - ### -
- 225,000 - ### - ###
- 161,900 - ### - ###
- 26,000 - ### - ###
- - - ### - ###
- 208,000 - ### - ###
- 246,900 199,000 - ### -
- 16,000 - ### - ###
- 8,000 - ### - ###
- 2,255,300 855,000 80,000 - -

Tindakan Farmasi Lab Rad Alkes


- - - ### - ###
- - - ### - ###
- 160,000 - ### - ###
- 243,800 - ### - ###
- 322,400 98,000 154,000 - ###
- 31,000 - ### - ###
- 138,800 350,000 - ### -
- 252,500 260,000 - ### -

- 1,148,500 708,000 154,000 - -

Tindakan Farmasi Lab Rad Alkes


- 47,000 - ### - ###
- 161,900 - ### - ###
- 124,800 - ### - ###
- 265,500 - ### - ###
- 386,400 - ### - ###
- 149,800 220,000 - ### -
- 298,900 184,000 - ### -
- - 67,000 - ### -
- 306,000 - ### - ###
125,000 - - ### - ###
- 320,000 - 92,000 - ###
- - 18,000 - ### -
- 234,600 214,000 92,000 - ###
- - 268,000 - ### -
125,000 - - ### - ###
- 4,500 - ### - ###
250,000 2,299,400 971,000 184,000 - -

Tindakan Farmasi Lab Rad Alkes


- 625,700 140,000 92,000 - ###
- 17,000 - ### - ###
- 14,700 - ### - ###
- 251,700 18,000 - ### -
- - 104,000 - ### -
- 231,900 228,000 92,000 - ###

- 1,141,000 490,000 184,000 - -

- 245,200 - ### - ###

Tindakan Farmasi Lab Rad Alkes


- - - 182,000 - ###
- 397,700 260,000 92,000 - ###
- 197,200 - ### - ###
25,000 20,600 - ### 14,000 -
- 30,900 - ### - ###
- - - ### - ###
- 67,000 - ### - ###
25,000 148,000 - ### 5,000 -
- 12,000 - ### - ###
- 116,000
50,000 989,400 260,000 274,000 19,000 -

- 221,124 - ### - ###

Tindakan Farmasi Lab Rad Alkes


- 14,000 - ### - ###
- 65,200 - ### - ###
25,000 62,600 - ### 31,000 -
- 111,000 - ### - ###
- - - 92,000 - ###
- 169,800 - ### - ###
25,000 422,600 - 92,000 31,000 -

Tindakan Farmasi Lab Rad Alkes


- 90,500 - ### - ###
- 149,500 - ### - ###
- 50,000 - ### - ###
- 200,500 - ### - ###
- 490,500 - - - -

Tindakan Farmasi Lab Rad Alkes


- 40,000 - ### - ###
- 251,000 - ### - ###
60,400 342,400 - ### 79,500 -
- 6,000 - ### - ###
- 37,000 - ### - ###
- 24,000 - ### - ###
- 207,000 - ### - ###
- 276,500 - ### - ###
- 152,000 - ### - ###
- 73,000 - ### - ###
- 184,000 - ### - ###
- 103,500 - ### - ###
- 161,000 - ### - ###
- 80,500 - ### - ###
- 47,500 - ### - ###
- 221,500 - ### - ###
- 193,700 - ### - ###
- 279,900 - ### - ###
20,000 351,200 - ### - ###
13,200 248,500 - ### - ###
- 339,600 180,000 - ### -
- 386,200 197,000 - ### -
80,000 226,200 - ### - ###
- 531,900 33,000 - ### -
- 238,400 184,000 - ### -
- 426,300 - ### - ###
- 266,800 - ### - ###
- 416,500 153,000 - ### -
- 304,000 153,000 - ### -
- - 281,000 - ### -
- - 33,000 - ### -

173,600 6,416,100 1,214,000 - 79,500 -

Tindakan Farmasi Lab Rad Alkes


- 244,900 - ### - ###
- 10,000 - ### - ###
- 379,500 - ### - ###
- 257,000 - ### - ###
- 145,000 109,000 102,000 - ###
- 153,700 - ### - ###
5,200 124,400 - ### - ###
- 501,000 139,000 - ### -
20,000 390,000 - ### - ###
- 496,000 - ### - ###
- 209,900 - ### - ###
- - 375,000 - ### -
- - - ### - ###
- 3,000 - ### - ###
- 145,500 365,000 - ### -
- 416,000 153,000 - ### -
- 301,000 109,000 - ### -
- 63,000 - ### - ###
- 211,800 - ### - ###
- - 320,000 102,000 - ###
- 751,800 226,000 - ### -
- 248,000 109,000 - ### -
25,200 5,051,500 1,905,000 204,000 - -

- 308,788 109,000 - ### -

Tindakan Farmasi Lab Rad Alkes


- 26,000 - ### - ###
- 209,000 - ### - ###
- 230,800 - ### - ###
- 207,000 274,000 - ### -
- 568,900 253,000 - ### -
- 94,000 - ### - ###
- 240,500 - ### - ###
- 186,200 260,000 92,000 - ###

- 1,762,400 787,000 92,000 - -


- 190,800 - ### - ###
- - 304,000 - ### -

Tindakan Farmasi Lab Rad Alkes USG


5,000 143,000 - ### 8,000 -
- 13,000 - ### - ###
- 121,000 - ### - ###
- - - 92,000 - ###
- 197,600 - ### - ###
- 365,600 - ### - ###
- 137,000 - ### - ###
- 241,200 - ### -
- 306,000 151,000 92,000 - ###
- 38,000 - ### - ###
60,000 235,800 - ### - ###
- 406,800 214,000 92,000 - ###
- 350,900 379,000 - ### -
- 185,800 - ### - ###
125,000 - 302,000 - ### -
- 187,500 77,000 - ### -
190,000 2,929,200 1,123,000 276,000 8,000 -

- 378,120 - ### - ###


Tindakan Farmasi Lab Rad Alkes USG
- 351,400 60,000 - ### -
- 255,800 - ### - ###
60,000 208,500 - ### - ###
- 330,000 - ### - ###
- 165,000 - ### -
- 215,000 98,000 92,000 -
- - 316,000 - ###
- 218,000 - ### -

60,000 1,743,700 474,000 92,000 - -


Potongan Total
34,600 138,600
- 232,900
- 50,000
- 233,000
- 96,000
- 116,400
- 195,900
- 144,700
- 50,000
- 50,000
- 189,000
- 784,000
- 606,000
- 297,000
34,600 3,183,500

- 204,000 DEBIT
- 1,065,480 DEBIT
- 354,352 DEBIT
1,623,832 DEBIT

Potongan Total
- 57,000
- 159,700
- 269,000
- 516,000
- 2,100
- 222,500
- 553,100
- 342,100
- 37,000
- 348,400
- 156,000
- 466,000
- 507,000
- 988,500
- 347,100

- 4,971,500

Ptongan Total
34,000 168,500
- 209,500
- 20,000
- 560,000
- 644,500
- 80,000
- 183,000
- 407,000
- 320,800
- 1,215,000
- 50,000
- 182,000
- 458,000
34,000 4,498,300

- 267,000 DEBIT
- 596,200 DEBIT
863,200 DEBIT

Potongan Total
- 125,000
- 262,500
- 569,400
- 360,000
- 494,500
- 466,000
- 570,000
- 535,000
- 95,000
- 613,400
- 753,500
17,000 115,600
- 236,700
- 216,100
- 298,300
- 345,600
45,000 235,100
- 423,600
- 392,200
- 974,700
- 956,900

62,000 9,039,100

- 672,040 DEBIT
- 268,150 DEBIT

Potongan Total
- 25,000
- 20,000
- 629,100
- 193,000
- 472,000
- 683,000
- 352,000
- 81,700
- 532,500
- 393,000
- 281,300
- 704,400
- 233,500

- 4,600,500

- 408,750 DEBIT
- 243,000 DEBIT
- 350,000 DEBIT

charge Total
- 262,000
- 5,000
- 269,500
- 211,600
- 439,800
- 334,000
- 668,000
- 1,051,500
- 162,000
- 1,943,300
- 464,000
- 274,000
- 74,000
- 388,800
- 436,700
- 482,000
- 537,000
- 8,003,200

- 385,324 DEBIT
- 478,660 DEBIT
863,984 DEBIT

16,235 665,635 Credit

Ptongan Total
- 331,000
- 243,600
- 243,600
- 213,800
- 782,500
- 248,000
- 95,000
95,000 212,000
- 445,000
- 275,000
- 211,900
- 26,000
- 50,000
- 208,000
- 540,900
- 16,000
- 8,000
95,000 4,150,300

Ptongan Total
- 50,000
- 95,000
- 255,000
- 243,800
- 669,400
- 31,000
- 583,800
- 607,500

- 2,535,500

Ptongan Total
- 97,000
- 211,900
- 174,800
- 315,500
- 386,400
- 419,800
- 577,900
- 162,000
- 401,000
- 220,000
- 507,000
- 68,000
- 635,600
- 363,000
- 125,000
- 4,500
- 4,669,400

Ptongan Total
- 952,700
- 17,000
- 14,700
- 364,700
- 199,000
- 646,900

- 2,195,000

- 340,200 DEBIT

Ptongan Total
- 182,000
- 844,700
- 247,200
- 109,600
- 30,900
- 50,000
- 67,000
- 228,000
12,000
116,000
- 1,887,400

- 271,124 DEBIT

Ptongan Total
- 14,000
- 135,200
168,600
161,000
12,000 130,000
- 219,800
12,000 828,600

Ptongan Total
- 140,500
- 199,500
- 50,000
- 250,500
- 640,500

Ptongan Total
- 90,000
- 301,000
- 532,300
- 6,000
- 37,000
- 24,000
- 257,000
- 371,500
- 202,000
- 123,000
- 234,000
- 153,500
- 211,000
- 80,500
- 97,500
- 316,500
- 288,700
- 374,900
- 466,200
- 311,700
- 614,600
- 678,200
- 401,200
- 659,900
- 517,400
- 521,300
- 361,800
- 664,500
- 552,000
- 376,000
- 33,000

- 9,858,200

Ptongan Total
- 294,900
- 10,000
- 379,500
- 352,000
- 451,000
- 203,700
- 224,600
- 735,000
- 505,000
- 591,000
- 304,900
- 470,000
- 50,000
- 3,000
- 605,500
- 664,000
- 505,000
- 113,000
- 306,800
- 517,000
- 1,072,800
- 407,000
- 8,765,700

- 512,788 DEBIT

Total
26,000
304,000
230,800
576,000
916,900
144,000
335,500
633,200

3,166,400
240,800 DEBIT
399,000 DEBIT

Pot Total
- 206,000
- 13,000
- 121,000
- 203,000
- 247,600
- 365,600
- 137,000
- 336,200
- 644,000
- 38,000
- 390,800
- 807,800
- 824,900
- 235,800
- 522,000
- 359,500
- 5,452,200

473,120 DEBIT
Pot Total
- 506,400
- 255,800
- 318,500
- 425,000
260,000
500,000
411,000
268,000

- 2,944,700
KLINIK RAWAT INAP PERMATA
JL.RA. Kosasih (ciaul) no.112 Sukabumi
Telp: (0266) 219188
Fax: (0266) 6247781
DATA PASIEN
Nama Pasien Tn.H.Tony Kustiwa MD
Jenis Kelamin Pria
Alamat Jl.Mayawati atas no.01 Rt/Rw 02/01
Gunung Parang,Cikole
RINCIAN BIAYA
ADMINISTRASI = Rp 22,000 KAMAR = Rp -
DOKTER = Rp 35,000 RUANGAN = Rp -
OBSERVASI IGD = Rp - RADIOLOGI = Rp -
NEBULIZER = Rp - MCU = Rp -
OBAT = Rp - TOTAL = Rp -
LABORATORIUM = Rp - POTONGAN = Rp -
PASIEN
Tn.H.Tony Kustiwa MD
KWITANSI
Tanggal Kunjungan : 26/12/2016
Nomor Pendaftaran : 0001
Nomor RM : 0001-0827
PASIEN
Jenis Pasien : Umum
Jenis Layanan : Dokter Umum

AN BIAYA
CHARGE Rp 57,000
ADM RI MATERAI = Rp -
GRAND TOTAL = Rp -

NET BAYAR = Rp 57,000

PASIEN KASIR
Tn.H.Tony Kustiwa MD Shera
LAPORAN KASIR
Tanggal 11 Januari 2017 Pagi
Rj Pagi Rp 4,402,100

Rp 4,402,100
Pengeluaran :
Bubur Rp 56,000
Kue Pasien Rp 27,000
Foto Copy Surat Pernyataan Rp 7,000
Tinta Catridge Rp 31,800
Bubur 1 Rp 8,000
kentang &kecap Rp 50,000
Terminal (Rolan) 1 Rp 60,000
Rp 239,800

TOTAL SETOR : Rp 4,162,300


Penerima Kasir `