Mix

KODE_RS KELAS_RS KELAS_RAWAT KODE_TARIF PTD ADMISSION_DATE
DISCHARGE_DATE BIRTH_DATE BIRTH_WEIGHT SEX DISCHARGE_STATUS

DIAGLIST PROCLIST ADL1 ADL2 IN_SP IN_SR IN_SI IN_SD INACBG
SUBACUTE CHRONIC SP SR SI SD DESKRIPSI_INACBG TARIF_INACBG
TARIF_SUBACUTE TARIF_CHRONIC DESKRIPSI_SP TARIF_SP DESKRIPSI_SR
TARIF_SR DESKRIPSI_SI TARIF_SI DESKRIPSI_SD TARIF_SD
TOTAL_TARIF TARIF_RS TARIF_POLI_EKS LOS ICU_INDIKATOR ICU_LOS
VENT_HOUR NAMA_PASIEN MRN UMUR_TAHUN UMUR_HARI DPJP SEP NOKARTU
PAYOR_ID CODER_ID VERSI_INACBG VERSI_GROUPER C1 C2 C3
C4 PROSEDUR_NON_BEDAH PROSEDUR_BEDAH KONSULTASI TENAGA_AHLI
KEPERAWATAN PENUNJANG RADIOLOGI LABORATORIUM PELAYANAN_DARAH
REHABILITASI KAMAR_AKOMODASI RAWAT_INTENSIF OBAT ALKES BMHP
SEWA_ALAT OBAT_KRONIS OBAT_KEMO
3206023 C 3 CP 1 26/01/2019 01/02/2019 20/08/2006 0 1
1 K65.0;K66.0;A41.9 54.19;54.59;68.22 - - None None None None
K-1-40-III None None None None None None PROSEDUR SISTEM PENCERNAAN
LAIN-LAIN (BERAT) 10811600 0 0 - 0 - 0 - 0 -
0 10811600 7246558 0 7 0 0 0 RIZKI AL FARIZI
19055378 12 4542 dr H. MARTE ROBIUL SANI, Sp.A,M.Kes UPC-PK/I/2019
445/8 3;JKN NCC; 5.3.5.201902010930 4 266182 1#0##0#0#0.0#2019-
02-01 13:55:19#0#13:50:05#13:50:05#00:00:00 1
350b8def52956407f56d9a9c86f80bd0 7246558 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
3206023 C 1 CP 1 28/01/2019 01/02/2019 19/11/1996 0 2
1 A91;D70 - - - None None None None A-4-13-III None
None None None None None INFEKSI VIRAL & NON-BAKTERIAL LAIN (BERAT)
3819500 0 0 - 0 - 0 - 0 - 0
3819500 2947865 0 5 0 0 0 NAFISAH QUROSIYAH
16014197 22 8105 dr. H. Dani Farid Abdullah Sp.PD
0122R0020119V006456 0002065592553 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268057 1#0##0#0#0.0#2019-
02-13 08:30:36#0#11:15:00#15:20:00#00:00:00 1
0b355cfa6178230f73d01eab58d83ad2 675000 0 500000 0 0
0 0 423825 0 0 900000 0 321362 77678 50000
0 0 0
3206023 C 2 CP 1 29/01/2019 01/02/2019 30/04/1960 0 2
1 I63.9;G81.9 87.03 - - None None None None G-4-14-II None
None None None None None KECEDERAAN PEMBULUH DARAH OTAK DENGAN INFARK
(SEDANG) 5972300 0 0 - 0 - 0 - 0 - 0
5972300 3087864 0 4 0 0 0 SUMARNI 19055701
58 21458 dr. Indra Gunawan, Sp.S 0122R0020119V006840 0001775839419
3;JKN Tia Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4
268058 1#0##0#0#0.0#2019-02-13 08:37:10#0#14:24:00#11:13:00#00:00:00
1 56a66fafb0663161b21b873a06f77f0d 600000 0 210000 0
0 0 1100000 70125 0 0 500000 0 547334 40405
20000 0 0 0
3206023 C 2 CP 1 29/01/2019 01/02/2019 08/08/1958 0 2
1 C73 06.31 - - None None None None E-1-20-I None None
None None None None PROSEDUR PADA TIROID, PARATIROID DAN SALURAN
TIROGLOSAL (RINGAN) 6697900 0 0 - 0 - 0 - 0
- 0 6697900 8867080 0 4 0 0 0 YAYAH SADIAH
17020622 60 22089 dr. Riadhi Yulianto Sp.B. 0122R0020119V006861
0001304645308 3;JKN Tia Siti Nurul Aeni;3206276601940002
5.3.6.201902021030 4 268059 1#0##0#0#0.0#2019-02-13
09:17:59#0#18:40:00#14:41:00#00:00:00 1 d96938991f4ed70bbc7b78028b361326
1164050 2592500 220000 0 0 0 0 986600 0
0 500000 0 928732 2425198 50000 0 0 0
3206023 C 2 CP 1 28/01/2019 01/02/2019 01/01/1968 0 2
1 H46 - - - None None None None H-4-11-I None None
None None None None GANGGUAN SARAF MATA (RINGAN) 2626000 0 0
- 0 - 0 - 0 - 0 2626000 2487324 0
5 0 0 0 OOP HOPSAH 19055491 51 18655 dr. Teguh Budiman
Sp.Ma. 0122R0020119V006455 0002484971594 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268070 1#0##0#0#0.0#2019-
02-13 09:23:35#0#11:14:00#14:31:00#00:00:00 1
9cf930df1cc22c11d32ba6f9f522a8ec 485000 0 350000 0 0
0 0 170850 0 0 625000 0 686276 120198
50000 0 0 0
3206023 C 2 CP 1 30/01/2019 01/02/2019 02/09/1989 0 2
1 O14.1;Z37.0;O82.1 74.99 - - None None None None O-6-10-II
None None None None None None OPERASI PEMBEDAHAN CAESAR (SEDANG)
6122400 0 0 - 0 - 0 - 0 - 0
6122400 5585252 0 3 0 0 0 IMA NURSETIANI
18052784 29 10742 dr. Asep Taslim Sp.OG 0122R0020119V007131
5.3.6.201902021030 4 268073 1#0##0#0#0.0#2019-02-13
09:27:45#0#15:01:00#14:16:00#00:00:00 1 b1e76a860967461c01949085df0b5655
1175000 2468000 180000 0 0 0 0 319625 0
0 375000 0 474614 563013 30000 0 0 0
3206023 C 2 CP 1 30/01/2019 01/02/2019 01/06/2002 0 2
1 D21.0 83.21 - - None None None None M-4-21-I None None
None None None None GANGGUAN SISTEM MUSKULOSKELETAL & JA(RINGAN)
PENGHUBUNG LAIN-LAIN (RINGAN) 2631000 0 0 - 0 - 0 -
0 - 0 2631000 4281034 0 3 0 0 0 RESTU
TAHAJZUDIN ISMAIL 19054072 16 6087 dr. Aa Ahmad Dimyati, Sp.B
Aeni;3206276601940002 5.3.6.201902021030 4 268076 1#0##0#0#0.0#2019-
02-13 09:39:33#0#16:06:00#13:31:00#00:00:00 1
9eac2ba819078bbac81d03327e84e4b3 826525 2105000 160000 0
0 0 0 0 0 0 375000 0 316519 447990
50000 0 0 0
3206023 C 3 CP 1 31/01/2019 01/02/2019 17/04/1996 0 2
1 K40.9 53.00 - - None None None None K-1-14-I None None
None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN)
4528900 0 0 - 0 - 0 - 0 - 0
4528900 5426138 0 2 0 0 0 DIAN PATUROHMAN
19055833 22 8324 dr. Aa Ahmad Dimyati, Sp.B 0122R0020119V007219
5.3.6.201902021030 4 268081 1#0##0#0#0.0#2019-02-13
10:00:07#0#07:29:00#11:08:00#00:00:00 1 7856dfcc3f45577a72852aff880d1b99
510000 3036500 120000 0 0 0 0 168875 0
0 140000 0 636756 784007 30000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 15/11/2003 0 2
1 H26.0 13.71 - - None None None None H-1-30-I None None
None None None None PROSEDUR LENSA DAN INTRA OKULER (RINGAN) 6433000
0 0 - 0 - 0 - 0 - 0 6433000
5054844 0 4 0 0 0 SITI NURMALA 18044347 15
5554 dr. Teguh Budiman Sp.Ma. 0122R0020119V007421 0002479797303
268086 1#0##0#0#0.0#2019-02-13 10:03:52#0#15:09:00#11:28:00#00:00:00
1 31302658a6dc2426bf9d93579d845fb9 571459 2592500 120000
0 0 0 0 0 0 0 280000 0 356364
1084521 50000 0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 20/04/2012 0 2
1 G41.9 - - - None None None None G-4-22-I None None
None None None None SERANGAN KEJANG (RINGAN) 2525300 0 0
- 0 - 0 - 0 - 0 2525300 1106725 0
3 0 0 0 NURI APRILIA, AN 13001468 6 2476 dr. Marte
Robiul Sani Sp.A. 0122R0020119V007482 0001266104621 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268087 1#0##0#0#0.0#2019-
02-13 10:05:35#0#02:08:00#21:24:00#00:00:00 1
bfb2cbbf6dcad34e349871f5e77e8f3c 347500 0 150000 0 0
0 0 83100 0 0 210000 0 85746 200379 30000 0
0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 15/06/1985 0 2
1 D48.6 85.34 - - None None None None L-1-50-I None None
None None None None PROSEDUR PADA PAYUDARA (RINGAN) 4853300 0
0 - 0 - 0 - 0 - 0 4853300 6274241
0 3 0 0 0 TETI SUMIATI 18052490 33 12282 dr.
Riadhi Yulianto Sp.B. 0122R0020119V007149 0002469658893 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268089
1#0##0#0#0.0#2019-02-13 10:10:17#0#18:13:00#14:40:00#00:00:00 1
2ca1ac989412c7fdf86bb44562d70864 1164050 2592500 170000 0
0 0 0 1310100 0 0 210000 0 289702 487889
50000 0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 01/07/1960 0 2
1 I84.9 49.46 - - None None None None K-1-50-I None None
None None None None PROSEDUR ANAL (RINGAN) 4421500 0 0 -
0 - 0 - 0 - 0 4421500 3034262 0 3
0 0 0 SARIKAH 18051961 58 21397 dr. Aa Ahmad Dimyati,
Sp.B 0122R0020119V007151 0002048615458 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268090 1#0##0#0#0.0#2019-
02-13 10:13:22#0#18:33:00#11:07:00#00:00:00 1
fcaca967c326735502635727812648ae 503000 1573750 170000 0
0 0 0 0 0 0 210000 0 231378 316134
30000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 01/02/2004 0 2
1 K35.2;K66.0 54.19;54.59 - - None None None None K-1-40-I
None None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN
(RINGAN) 5786500 0 0 - 0 - 0 - 0 - 0
5786500 4756748 0 4 0 0 0 SELA NOVITA 19055698
14 5476 dr. Aa Ahmad Dimyati, Sp.B 0122R0020119V006841
5.3.6.201902021030 4 268092 1#0##0#0#0.0#2019-02-13
10:16:29#0#14:30:00#14:09:00#00:00:00 1 f2fb413aa1f15cc9dd2f14ed9222cc70
904025 2137750 120000 0 0 0 0 186425 0
0 280000 0 676356 432192 20000 0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 23/05/1990 0 2
1 O32.1;Z37.0;O82.1;O44.1;O46.9 74.99 - - None None None None
O-6-10-I None None None None None None OPERASI PEMBEDAHAN CAESAR
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5150632 0 3 0 0 0 LISTIYANI 19054203
28 10479 dr. Asep Taslim Sp.OG 0122R0020119V006898 0002625888486
268093 1#0##0#0#0.0#2019-02-13 10:20:49#0#07:13:00#12:38:00#00:00:00
1 3c9a98fd56f826ba9afb35baabb8a33a 1433250 2468000 240000
0 0 0 0 225200 0 0 210000 0 356667
197515 20000 0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 04/09/1960 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3920860 0 3 0 0 0 OON 18047800 58 21332 dr.
Teguh Budiman Sp.Ma. 0122R0020119V007481 0002497403035 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268096
1#0##0#0#0.0#2019-02-13 10:24:24#0#15:14:00#14:14:00#00:00:00 1
abc221e610691b1ecaf977df6854530a 384434 2125000 150000 0
0 0 0 0 0 0 210000 0 99899 931527 20000
0 0 0
3206023 C 3 CP 1 24/01/2019 01/02/2019 01/07/1953 0 2
1 K74.6;K42.9;D63.8;N18.9 99.04 - - None None None None B-4-
13-II None None None None None None GANGGUAN HATI LAIN-LAIN (SEDANG)
3637100 0 0 - 0 - 0 - 0 - 0
3637100 4352126 0 9 0 0 0 OMIH 18047096 65
23948 dr. H. Dani Farid Abdullah Sp.PD 0122R0020119V005763
5.3.6.201902021030 4 268097 1#0##0#0#0.0#2019-02-13
10:28:48#0#23:40:00#13:42:00#00:00:00 1 c32900e3811172c89a8a7c80164efa44
730000 0 350000 0 0 0 0 1829175 0 0
630000 0 443545 279406 90000 0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 14/05/2000 0 2
None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN (RINGAN)
2186200 0 0 - 0 - 0 - 0 - 0
2186200 3973283 0 3 0 0 0 FIKRI SAMSUL FAJAR
5.3.6.201902021030 4 268099 1#0##0#0#0.0#2019-02-13
10:36:44#0#18:23:00#11:06:00#00:00:00 1 c952a03e0e2b6a11a46b672dd74f4b42
826525 1825000 170000 0 0 0 0 0 0 0
210000 0 413286 508472 20000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 23/11/1960 0 2
1 I50.0;K30;J18.0;J44.9 87.44 - - None None None None I-4-
12-III None None None None None None KEGAGALAN JANTUNG (BERAT)
3582600 0 0 - 0 - 0 - 0 - 0
3582600 2113964 0 4 0 0 0 ENCENG KOSMANA
Aeni;3206276601940002 5.3.6.201902021030 4 268100 1#0##0#0#0.0#2019-
02-13 10:49:26#0#11:56:00#14:51:00#00:00:00 1
14f537a770b5fe58d98b4d6cb9dfe630 507500 0 150000 0 0
0 140000 178375 0 0 280000 0 595844 118565
40000 103680 0 0
3206023 C 3 CP 1 28/01/2019 01/02/2019 10/11/1990 0 2
1 I11.9 - - - None None None None I-4-17-I None None
None None None None HIPERTENSI (RINGAN) 1758600 0 0 -
0 - 0 - 0 - 0 1758600 2151655 0 5
0 0 0 YETI NURHAYATI 19055512 28 10306 dr. H. Dani Farid
Abdullah Sp.PD 0122R0020119V006338 0000431848056 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268103 1#0##0#0#0.0#2019-
02-13 10:53:15#0#09:42:00#14:58:00#00:00:00 1
e369dca03e4281d9dbd57c3793c58228 487500 0 200000 0 0
0 140000 259225 0 0 350000 0 617256 47674
50000 0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 24/06/1977 0 2
1 L02.1 86.22 - - None None None None L-4-12-I None None
None None None None PERADANGAN KULIT/CELLULITIS (RINGAN) 1262500
0 0 - 0 - 0 - 0 - 0 1262500
4930405 0 3 0 0 0 DEDI 19054917 41 15195 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268104
1#0##0#0#0.0#2019-02-13 10:56:05#0#12:21:00#14:40:00#00:00:00 1
6e87b3186b33d3b1a8b5652875d03784 1090025 1846000 170000 0
0 0 130000 501375 0 0 210000 0 197104
755901 30000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 18/06/2005 0 2
1 I10;G93.4 - - - None None None None I-4-17-III None
None None None None None HIPERTENSI (BERAT) 2456800 0 0
- 0 - 0 - 0 - 0 2456800 1658816 0
4 0 0 0 ANDI 19055706 13 4973 dr. Marte Robiul Sani
Sp.A. 0122R0020119V006857 0000434867106 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268107 1#0##0#0#0.0#2019-
02-13 11:07:44#0#17:55:00#12:24:00#00:00:00 1
7b238d28f87b290bfd6dd86a5d217657 425000 0 195000 0 0
0 0 264500 0 0 280000 0 229519 214797
50000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 14/11/1984 0 2
1 J90 34.04 - - None None None None J-4-20-I None None
None None None None PLEURAL EFUSI DAN PNEUMOTORAK (RINGAN) 3828800
0 0 - 0 - 0 - 0 - 0 3828800
3847613 0 4 0 0 0 DENDI SUGIANTO 19055680 34
12494 dr. Riadhi Yulianto Sp.B. 0122R0020119V006839 0000407734547
268108 1#0##0#0#0.0#2019-02-13 11:11:39#0#14:17:00#14:41:00#00:00:00
1 ab4e802815f2d757f4633ce310f43162 903000 1483750 150000
0 0 0 0 456975 0 0 280000 0 81151 442737
50000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 29/12/2010 0 2
1 A01.0 - - - None None None None A-4-14-I None None
None None None None PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 1299387 0 4 0 0 0 AZKA FAUZAN 19055697
8 2953 dr. Marte Robiul Sani Sp.A. 0122R0020119V006842
5.3.6.201902021030 4 268132 1#0##0#0#0.0#2019-02-13
13:50:33#0#14:33:00#11:19:00#00:00:00 1 a364f02239ebbffccc0d108db45e8da9
367500 0 150000 0 0 0 0 273800 0 0
280000 0 105461 72626 50000 0 0 0
3206023 C 3 CP 1 27/01/2019 01/02/2019 03/03/1943 0 2
(SEDANG) 4976900 0 0 - 0 - 0 - 0 - 0
4976900 3677717 0 6 0 0 0 KIDUS 19055446 75
27724 dr. Indra Gunawan, Sp.S 0122R0020119V006096 0000435389477 3;JKN
Tia Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268136
1#0##0#0#0.0#2019-02-13 14:08:45#0#23:13:00#10:50:00#00:00:00 1
723b95b990f9e3726f7d49ea02a319a2 650000 0 250000 0 0
0 950000 109000 0 0 420000 0 1144553 114164
40000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 01/07/1973 0 2
1 J46;I10 93.94;93.96 - - None None None None J-4-18-I
None None None None None None ASTHMA & BRONKIOLITIS (RINGAN)
2053000 0 0 - 0 - 0 - 0 - 0
2053000 1921057 0 4 0 0 0 NURHAYATI 19055712
45 16648 dr. H. Dani Farid Abdullah Sp.PD 0122R0020119V006879
5.3.6.201902021030 4 268137 1#0##0#0#0.0#2019-02-13
14:17:33#0#23:47:00#13:37:00#00:00:00 1 596baa3493cb8a07f273825c9df13087
599000 0 50000 0 0 0 0 178375 0 0 280000
0 632029 151653 30000 0 0 0
3206023 C 3 CP 1 31/01/2019 01/02/2019 22/12/1993 0 2
None None None None None None PERSALINAN VAGINAL (SEDANG) 1828500
0 0 - 0 - 0 - 0 - 0 1828500
2231340 0 2 0 0 0 HAMIDAH 19055918 25 9171
dr. Damarizqa Dara Sjahruddin, Sp.OG 0122R0020119V007473
5.3.6.201902021030 4 268138 1#0##0#0#0.0#2019-02-13
14:26:52#0#20:52:00#11:18:00#00:00:00 1 4a7f1fc905abc1bc894f6698c10d4424
1495000 0 50000 0 0 0 0 281500 0 0 140000
0 84508 160332 20000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 16/05/1982 0 2
1 I42.9;I50.0 87.44 - - None None None None I-4-22-II None
None None None None None KARDIOMIOPATHI (SEDANG) 3160600 0 0
- 0 - 0 - 0 - 0 3160600 1768671 0
4 0 0 0 SITI SUMIATI 19055595 36 13407 dr. H. Dani
Farid Abdullah Sp.PD 0122R0020119V006536 0000435914278 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268139
1#0##0#0#0.0#2019-02-13 14:33:41#0#06:38:00#13:35:00#00:00:00 1
efb5e59729df3953c45be7265e9b3b93 393500 0 145000 0 0
0 280000 203375 0 0 280000 0 306520 55716
70000 34560 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 01/11/2001 0 2
1 R50.9 - - - None None None None A-4-12-I None None
None None None None DEMAM YANG TIDAK DITENTUKAN (RINGAN) 2509600
0 0 - 0 - 0 - 0 - 0 2509600 977153
0 3 0 0 0 CICA CANTIKA 18034334 17 6299 dr.
Marte Robiul Sani Sp.A. 0122R0020119V007153 0000435533848 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268140
1#0##0#0#0.0#2019-02-13 14:39:00#0#19:19:00#13:07:00#00:00:00 1
a3dd23309567c3f2cd845dab93b91e89 427500 0 100000 0 0
0 0 70125 0 0 210000 0 117389 42139 10000 0
0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 04/12/2011 0 2
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 888118 0 3 0 0 0 SABILA 19055819
5.3.6.201902021030 4 268141 1#0##0#0#0.0#2019-02-13
14:45:04#0#22:36:00#11:21:00#00:00:00 1 348d6b6b0346db6c5b78b708310f4d34
317500 0 100000 0 0 0 0 56100 0 0 210000
0 143118 51400 10000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 11/06/1994 0 2
1 O33.9;Z37.0;O82.1 74.99 - - None None None None O-6-10-I
None None None None None None OPERASI PEMBEDAHAN CAESAR (RINGAN)
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4880964 0 4 0 0 0 UYUN SITI AISAH
5.3.6.201902021030 4 268148 1#0##0#0#0.0#2019-02-14
09:22:46#0#16:12:00#12:39:00#00:00:00 1 8004bda62532e0b1fc7f73ec12e0b4e5
1267000 2137750 290000 0 0 0 0 281500 0
0 280000 0 350289 244425 30000 0 0 0
3206023 C 2 CP 1 27/01/2019 01/02/2019 16/09/1953 0 2
1 D12.8;K66.0;R57.2;E87.8 54.19;54.59;46.10;48.25;54.4 - - None
None None None K-1-20-II None None None None None None PROSEDUR
INTESTINAL KOMPLEKS (SEDANG) 14698600 0 0 - 0 - 0 -
0 - 0 14698600 12798646 0 6 0 0 0
KOMARIAH, NY 17017518 65 23874 DR. AA AHMAD DIMYATI, SP.B
Aeni;3206276601940002 5.3.6.201902021030 4 268067 1#0##0#0#0.0#2019-
02-14 09:33:24#0#00:31:00#11:05:00#00:00:00 3
caa8c74168d7c65a6eb860ee55b642e7 2086550 3665000 580000 0
0 0 0 1290425 0 0 410000 480000 2457655
1606216 50000 172800 0 0
3206023 C 2 CP 1 29/01/2019 01/02/2019 26/07/2016 0 2
(RINGAN) 2511000 0 0 - 0 - 0 - 0 - 0
2511000 1535386 0 4 0 0 0 NOUVAL KAMAL PRANAJA
19055598 2 917 DR. MARTE ROBIUL SANI SP.A. 0122R0020119V006999
5.3.6.201902021030 4 268075 1#0##0#0#0.0#2019-02-14
09:34:44#0#08:20:00#11:20:00#00:00:00 2 1054cdc5d6cb3f83a3f86afa43cc40eb
525000 0 210000 0 0 0 0 0 0 0 540000
0 160673 79713 20000 0 0 0
3206023 C 3 CP 1 25/01/2019 01/02/2019 17/07/1945 0 2
1 I51.9;J90 87.44 - - None None None None I-4-24-III None
None None None None None GANGGUAN SISTEM PEMBULUH DARAH LAIN-LAIN
(BERAT) 6514600 0 0 - 0 - 0 - 0 - 0
6514600 4305870 0 8 0 0 0 OOH, NY 16016070
5.3.6.201902021030 4 268160 1#0##0#0#0.0#2019-02-14
09:40:36#0#10:46:00#12:25:00#00:00:00 1 1a2f0456b480c863c990f66e1c30ddd2
1846000 0 300000 0 0 0 140000 244975 0
0 560000 0 576358 316617 80000 241920 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 27/01/2019 3000 2
1 P70.4;P39.9;P59.9 99.21;99.83 - - None None None None P-8-
17-II None None None None None None NEONATAL, BBL > 2499 GR TANPA PROSEDUR
MAYOR (SEDANG) 5987500 0 0 - 0 - 0 - 0 -
0 5987500 1854037 0 4 0 0 0 BY NY TITIH
PRATIWI 19055711 0 2 DR. MARTE ROBIUL SANI SP.A.
Aeni;3206276601940002 5.3.6.201902021030 4 268164 1#0##0#0#0.0#2019-
02-14 14:27:22#0#02:16:00#11:38:00#00:00:00 2
5d1e7db8e255628e18e752f9f7d3af30 742500 0 210000 0 0
0 0 235000 0 0 375000 0 31795 239742 20000
0 0 0
3206023 C 1 CP 1 30/01/2019 01/02/2019 05/11/1954 0 2
1 A06.0 - - - None None None None K-4-18-I None None
None None None None GANGGUAN SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
1739600 0 0 - 0 - 0 - 0 - 0
1739600 2775987 0 3 0 0 0 SIHABULMILLAH
Aeni;3206276601940002 5.3.6.201902021030 4 268434 1#0##0#0#0.0#2019-
02-18 09:59:58#0#20:36:00#15:30:00#00:00:00 1
e3f08e493ec5494c0fd2a7b0c8aed563 972500 0 330000 0 0
0 0 184125 0 0 900000 0 307004 32358 50000
0 0 0
3206023 C 3 CP 1 30/01/2019 01/02/2019 11/12/1960 0 2
1 D30.0;D64.9;R31 99.04 - - None None None None N-4-16-II
None None None None None None PENYAKIT GINJAL DAN SALURAN URIN LAIN-
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 2349650 0 3 0 0 0 DARSU 19055804
5.3.6.201902021030 4 268600 1#0##0#0#0.0#2019-02-19
11:40:59#0#17:57:00#07:14:00#00:00:00 1 eef06f42e79e2cf37118fec7032a2ffc
277500 0 100000 0 0 0 335000 1127725 0
0 210000 0 149332 120093 30000 0 0 0
3206023 C 3 CP 1 26/01/2019 01/02/2019 21/01/2015 0 2
1 G93.4;A19.9;E87.1;A41.9 99.21 - - None None None None G-4-
21-III None None None None None None KOMA & STUPOR NON TRAUMA (BERAT)
3976400 0 0 - 0 - 0 - 0 - 0
3976400 7524166 0 7 0 0 0 FEGA NURAENISA SANIAH
19055410 4 1466 dr. Lia Rhodia, Sp. A. 0122R0020119V006039
0002125164475 3;JKN Indriyanti Yuda S, S.ST;3206297107870001
5.3.6.201902021030 4 272498 1#0##0#0#0.0#2019-03-11
10:52:02#0#12:03:00#11:21:00#00:00:00 1 960c6dfaaa48d722aca13809f98c534a
925000 0 655000 0 0 0 1290000 1507275 0
0 820000 615000 697218 685473 70000 259200 0
0
3206023 C 2 CP 1 31/01/2019 01/02/2019 01/07/1958 0 2
4 N18.9;I69.4;A09.9;R57.2;G93.4 96.71 - - None None None None
J-1-20-III None None None None None None PROSEDUR SISTEM PERNAFASAN
NON-KOMPLEKS (BERAT) 22381600 0 0 - 0 - 0 - 0
- 0 22381600 6288303 0 2 0 0 0 OJO SUWARDI
SUDARMAN 18051683 60 22129 dr. H. Dani Farid Abdullah Sp.PD
0122R0020119V007474 0002611957094 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 273006
1#0##0#0#0.0#2019-03-12 11:14:22#0#21:00:00#16:27:00#00:00:00 3
180e3fa2ddb22f98f41f266f91d8aeb3 2292500 0 230000 0 15000
0 0 521227 0 0 0 410000 1822690 532166
50000 414720 0 0
3206023 C 2 CP 1 30/01/2019 01/02/2019 12/01/1981 0 2
5434700 0 0 - 0 - 0 - 0 - 0
5434700 5156586 0 3 0 0 0 YOYO 19055820 38
13897 dr. Aa Ahmad Dimyati, Sp.B 0122R0020119V007166 0001133487426
273025 1#0##0#0#0.0#2019-03-12 11:22:41#0#22:20:00#11:07:00#00:00:00
1 7a6714d332e7e3fcd0a021e93cf8a32f 505000 3036500 170000
0 0 0 0 185125 0 0 210000 0 450053
569908 30000 0 0 0
3206023 C 3 CP 1 31/01/2019 01/02/2019 23/05/1986 0 2
None None None None None None PERSALINAN VAGINAL (RINGAN) 1544900
0 0 - 0 - 0 - 0 - 0 1544900
2352148 0 2 0 0 0 EUTIK TARLIAH 19053921 32
11941 dr. Damarizqa Dara Sjahruddin, Sp.OG 0122R0020119V007433
5.3.6.201902021030 4 273028 1#0##0#0#0.0#2019-03-12
11:24:40#0#12:51:00#11:22:00#00:00:00 1 c03d0eb8f25fe416a333fae991506aec
1642500 0 120000 0 0 0 0 276375 0 0
140000 0 37046 116227 20000 0 0 0
3206023 C 3 CP 1 29/01/2019 01/02/2019 26/07/1980 0 2
1 D10.6;J32.0 21.99;21.30 - - None None None None U-1-20-I
None None None None None None PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN
TELINGA LAIN-LAIN (RINGAN) 4458500 0 0 - 0 - 0 -
0 - 0 4458500 4845821 0 4 0 0 0 ENUR
NURSAIDAH 18037849 38 14066 dr. M Sidik Hasanudin Sp.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 273035 1#0##0#0#0.0#2019-
03-12 11:29:19#0#16:30:00#11:23:00#00:00:00 1
95be11b94a0b803e94cfc6e2f5d5f9f5 947025 2592500 220000 0
0 0 0 0 0 0 280000 0 563619 212677
30000 0 0 0
3206023 C 1 CP 1 31/01/2019 01/02/2019 07/01/1946 0 2
1 K71.1;A16.2 96.07;89.52;99.18 - - None None None None B-4-
5091900 0 0 - 0 - 0 - 0 - 0
5091900 4723087 0 2 0 0 0 ATON PATONAH
Aeni;3206276601940002 5.3.6.201902021030 4 269914 1#0##0#0#0.0#2019-
03-12 13:46:35#0#11:52:00#19:28:00#00:00:00 1
2dcf5bab783c148e3bb0c2420503c512 1542500 0 100000 0 0
0 0 252875 0 0 385000 0 1859685 563027
20000 0 0 0
3206023 C 3 CP 1 31/01/2019 01/02/2019 10/09/1976 0 2
4 K35.8;E11.9;A41.9;G93.4 99.21;99.60;96.71 - - None None None
None J-1-20-III None None None None None None PROSEDUR SISTEM
PERNAFASAN NON-KOMPLEKS (BERAT) 18651400 0 0 - 0 - 0
- 0 - 0 18651400 4034546 0 2 0 0 0
LILIS RUKMINI 19055843 42 15483 DR. H. DANI FARID ABDULLAH SP.PD
Septiani;3278085209910012 5.3.7.201902261710 4 268131
1#0##0#0#0.0#2019-03-18 14:34:11#0#14:58:00#09:38:00#00:00:00 2
1ac7a433a328b5649ffd03dbf0bb6e90 1282500 0 230000 0 0
0 0 424475 0 0 205000 205000 1318350 369221
0 0 0 0
3206023 C 1 CP 1 31/01/2019 02/02/2019 23/12/1990 0 2
1 O62.2;J45.9;O99.5 - - - None None None None W-4-16-II
None None None None None None GANGGUAN ANTEPARTUM (SEDANG) 3744000
0 0 - 0 - 0 - 0 - 0 3744000
1745531 0 3 0 0 0 AIDA HALIMATUSADIAH, NY 15016137
28 10266 dr. Damarizqa Dara Sjahruddin, Sp.OG 0122R0020119V007179
0001516417075 3;JKN Nenden Nurul Huda;3278057010840004 5.3.6.201902021030
4 268060 1#0##0#0#0.0#2019-02-13
08:58:00#0#06:24:00#15:15:00#00:00:00 1 d73fded5baf1eb9b3337d8f93d7d460a
727500 0 220000 0 0 0 0 247000 0 0
430000 0 48856 52175 20000 0 0 0
3206023 C 1 CP 1 01/02/2019 02/02/2019 10/11/1940 0 2
1 H11.0 11.39;10.44 - - None None None None H-1-20-I None
None None None None None PROSEDUR EKSTRAOKULER DAN ORBITA (RINGAN)
5918900 0 0 - 0 - 0 - 0 - 0
5918900 2445397 0 2 0 0 0 ERUM RUMDASIH
18050952 78 28572 dr. Teguh Budiman Sp.Ma. 0122R0020219V000162
4 268061 1#0##0#0#0.0#2019-02-13
09:02:39#0#09:22:00#10:18:00#00:00:00 1 f55615338c60dfc1449a65a1349df291
199434 1570000 200000 0 0 0 0 0 0 0
360000 0 84649 11314 20000 0 0 0
3206023 C 2 CP 1 31/01/2019 02/02/2019 29/04/1992 0 2
1 O14.1;O80.0 73.59 - - None None None None W-4-16-II None
None None None None None GANGGUAN ANTEPARTUM (SEDANG) 3209200 0
0 - 0 - 0 - 0 - 0 3209200 3161992
0 3 0 0 0 ARI AFTARINA 19055914 26 9773 dr.
Damarizqa Dara Sjahruddin, Sp.OG 0122R0020119V007467 0001601738379 3;JKN
Nenden Nurul Huda;3278057010840004 5.3.6.201902021030 4 268065
1#0##0#0#0.0#2019-02-13 09:16:18#0#19:38:00#15:22:00#00:00:00 1
8f745e2076d892e5cf1d33926c6807a6 1790000 0 170000 0 0
0 0 724850 0 0 210000 0 62674 174468 30000
0 0 0
3206023 C 3 CP 1 29/01/2019 02/02/2019 05/11/1992 0 2
None None None None None GANGGUAN POSTPARTUM (SEDANG) 2664400 0
0 - 0 - 0 - 0 - 0 2664400 8690196
0 5 0 0 0 NOVI SULASTRI 18046164 26 9581 DR.
ASEP TASLIM SP.OG 0122R0020119V007023 0000434564469 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268066 1#0##0#0#0.0#2019-
02-13 09:19:14#0#02:13:00#11:46:00#00:00:00 1
90151a38ee42459a6f00d3bdf40a28ec 2395000 0 560000 0 0
0 0 2245250 0 0 480000 205000 1272457 749449
40000 743040 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 31/01/2019 2600 2
1 P39.9;P03.4 - - - None None None None P-8-16-I None
None None None None None NEONATAL, BBL > 2499 GR DENGAN
KONGENITAL/INFEKSI PERINATAL (RINGAN) 1786900 0 0 - 0 -
0 - 0 - 0 1786900 1204126 0 3 0 0
0 BY NY TITA 19055832 0 0 dr. Marte Robiul Sani Sp.A.
0122R0020119V007480 0002743876798 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268068 1#0##0#0#0.0#2019-
02-13 09:22:24#0#06:22:00#11:48:00#00:00:00 1
1430d224efd856d506e66dd2ee04aaf9 480000 0 210000 0 0
0 0 0 0 0 375000 0 20352 88774 30000 0 0
0
3206023 C 3 CP 1 31/01/2019 02/02/2019 07/07/2004 0 2
(RINGAN) 5786500 0 0 - 0 - 0 - 0 - 0
5786500 6782452 0 3 0 0 0 LUTFI 19055826 14
5321 DR. AA AHMAD DIMYATI, SP.B 0122R0020119V007274 0000482971487
3;JKN Nenden Nurul Huda;3278057010840004 5.3.6.201902021030 4 268071
1#0##0#0#0.0#2019-02-13 09:26:44#0#07:19:00#08:43:00#00:00:00 1
ba29462d1296dba5e418b2c4ff147d89 787025 3036500 120000 0
0 0 0 701625 0 0 350000 0 900917 856385
30000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 28/06/1994 0 2
O-6-12-I None None None None None None PERSALINAN VAGINAL DENGAN
PROSEDUR SELAIN STERILISASI &/ DILATASI &KURET (RINGAN) 1807500 0 0
- 0 - 0 - 0 - 0 1807500 2752911 0
4 0 0 0 SITI NURBAYA 19055803 24 8982 dr. Asep
Taslim Sp.OG 0122R0020119V007128 0000432638594 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268074 1#0##0#0#0.0#2019-
02-13 09:47:06#0#14:14:00#09:25:00#00:00:00 1
544994d68942b2eb0a761b8e045378ff 1607500 0 150000 0 0
0 0 276375 0 0 280000 0 188836 210200
40000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 07/05/1999 0 2
2186200 0 0 - 0 - 0 - 0 - 0
2186200 4221037 0 3 0 0 0 ANJAS SUKMANA
4 268079 1#0##0#0#0.0#2019-02-13
09:52:05#0#19:35:00#10:33:00#00:00:00 1 fbd8f98fae00c2921040ab310425a1ff
756525 1825000 190000 0 0 0 0 350000 0
0 210000 0 345934 513578 30000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 05/06/1963 0 2
2186200 0 0 - 0 - 0 - 0 - 0
2186200 3983409 0 3 0 0 0 ENING 18045930 55
1#0##0#0#0.0#2019-02-13 09:54:52#0#17:36:00#10:44:00#00:00:00 1
edb9ecc234a084b76766de8af373bbcd 736525 1825000 190000 0
0 0 0 535125 0 0 210000 0 203423 253336
30000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 01/08/1995 0 2
1 N61 85.12;86.22 - - None None None None L-1-50-I None
None None None None None PROSEDUR PADA PAYUDARA (RINGAN) 4853300
0 0 - 0 - 0 - 0 - 0 4853300
4562841 0 3 0 0 0 INE ROSITA 18052577 23 8584
dr. Riadhi Yulianto Sp.B. 0122R0020119V007419 0000434051774 3;JKN
1#0##0#0#0.0#2019-02-13 09:58:33#0#11:38:00#10:35:00#00:00:00 1
5c71c3bb78ad17b66c6bcbc398f4a863 756525 2137750 190000 0
0 0 0 453875 0 0 210000 0 397400 387291
30000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 06/07/1992 0 2
0 0 - 0 - 0 - 0 - 0 4853300
4539006 0 3 0 0 0 DEWI AMINAH 19055741 26 9705
dr. Riadhi Yulianto Sp.B. 0122R0020119V007425 0000434539574 3;JKN
1#0##0#0#0.0#2019-02-13 10:03:00#0#12:00:00#10:45:00#00:00:00 1
49f9e01bbaf7abf2bc6bd34c06a8a0dd 756525 2137750 190000 0
0 0 0 350000 0 0 210000 0 351663 503068
40000 0 0 0
3206023 C 3 CP 1 26/01/2019 02/02/2019 12/12/2018 0 2
1 J18.0 - - - None None None None J-4-16-I None None
None None None None SIMPLE PNEUMONIA & WHOOPING COUGH (RINGAN)
3332600 0 0 - 0 - 0 - 0 - 0
3332600 2756835 0 8 0 0 0 ISYA MUHAMAD BILAL
19055360 0 45 dr. Marte Robiul Sani Sp.A. 0122R0020119V006420
4 268101 1#0##0#0#0.0#2019-02-13
10:55:21#0#17:36:00#11:53:00#00:00:00 1 90262e4d5e90ee0bf40d6f000fb25f22
787500 0 350000 0 0 0 130000 82625 0 0
560000 0 337764 276146 60000 172800 0 0
3206023 C 3 CP 1 29/01/2019 02/02/2019 21/03/1964 0 2
1 J44.1;I10;I25.2 - - - None None None None J-4-17-I
None None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (RINGAN)
2739200 0 0 - 0 - 0 - 0 - 0
2739200 2265043 0 5 0 0 0 ICANG AHMAD 19055593
4 268105 1#0##0#0#0.0#2019-02-13
10:57:29#0#06:29:00#14:14:00#00:00:00 1 cfae889df0caf76f0de43a37d894cbcb
328500 0 100000 0 0 0 140000 103875 0
0 350000 0 1089358 63310 90000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 01/07/1988 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5621078 0 3 0 0 0 RORO 19055891 30
4 268106 1#0##0#0#0.0#2019-02-13
11:06:15#0#11:52:00#15:58:00#00:00:00 1 99c53a7495f97ec8f2ebb3cf4264ac49
1177000 2137750 190000 0 40000 0 0 377975 0
0 210000 0 380611 1067742 40000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 11/12/1968 0 2
1 J90 34.09 - - None None None None J-4-20-I None None
None None None None PLEURAL EFUSI DAN PNEUMOTORAK (RINGAN) 3828800
0 0 - 0 - 0 - 0 - 0 3828800
3553562 0 4 0 0 0 WAHYUDIN 13000332 50 18312
dr. H. Dani Farid Abdullah Sp.PD 0122R0020119V007139 0002612669523
1#0##0#0#0.0#2019-02-13 11:12:03#0#16:40:00#14:09:00#00:00:00 1
3b1306fcb818d71bc41b4e12066afd88 531000 1483750 200000 0
0 0 0 295125 0 0 280000 0 297295 426392
40000 0 0 0
3206023 C 3 CP 1 29/01/2019 02/02/2019 13/01/1963 0 2
1 K74.6;D64.9 99.04 - - None None None None B-4-13-II None
None None None None None GANGGUAN HATI LAIN-LAIN (SEDANG) 3637100
0 0 - 0 - 0 - 0 - 0 3637100
2846021 0 5 0 0 0 ASEP SAEPUL 18050466 56 20470
1#0##0#0#0.0#2019-02-13 11:19:19#0#13:34:00#12:35:00#00:00:00 1
7674b51b0dd511884ffcc04d2c7ffc70 418000 0 150000 0 0
0 0 1505225 0 0 350000 0 191985 180811
50000 0 0 0
3206023 C 3 CP 1 28/01/2019 02/02/2019 14/01/1960 0 2
1 K80.2;D64.9 99.04 - - None None None None B-4-14-II None
None None None None None GANGGUAN SALURAN EMPEDU LAIN-LAIN (SEDANG)
3638400 0 0 - 0 - 0 - 0 - 0
3638400 3929581 0 6 0 0 0 HADI UTOMO 19055572
59 21564 DR. H. DANI FARID ABDULLAH SP.PD 0122R0020119V006508
4 268112 1#0##0#0#0.0#2019-02-13
11:23:40#0#17:38:00#23:49:00#00:00:00 2 1c9522c3527b9b56ffa9eb020164345a
543500 0 300000 0 0 0 335000 1782075 0
0 490000 0 260225 158781 60000 0 0 0
3206023 C 3 CP 1 29/01/2019 02/02/2019 01/06/1964 0 2
1 K92.0;N18.9;D64.9 99.04 - - None None None None K-4-18-II
None None None None None None GANGGUAN SISTEM PENCERNAAN LAIN-LAIN
(SEDANG) 1765800 0 0 - 0 - 0 - 0 - 0
1765800 4088899 0 5 0 0 0 M TAJAB 19055676
4 268114 1#0##0#0#0.0#2019-02-13
11:28:38#0#13:39:00#14:00:00#00:00:00 1 8fbcef86c961ba6b7788f523e385852f
446000 0 200000 0 0 0 465000 2204750 0
0 350000 0 191404 132625 30000 69120 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 05/05/1969 0 2
1 I50.0;N17.9 - - - None None None None I-4-12-III None
None None None None None KEGAGALAN JANTUNG (BERAT) 3582600 0
0 - 0 - 0 - 0 - 0 3582600 1701101
0 4 0 0 0 DIAH 18047575 49 18167 dr. H. Dani Farid
Abdullah Sp.PD 0122R0020119V007156 0000436290434 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268116 1#0##0#0#0.0#2019-
02-13 11:31:18#0#19:30:00#14:11:00#00:00:00 1
28b1ccc7fe24df671a1f6a0112c5a9cc 410500 0 150000 0 0
0 140000 156725 0 0 280000 0 486098 57778
20000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 16/10/1985 0 2
1 E87.6;R11;E86 - - - None None None None E-4-11-I
None None None None None None HIPOVOLEMIA & GANGGUAN ELEKROLIT (RINGAN)
2194200 0 0 - 0 - 0 - 0 - 0
2194200 1372649 0 4 0 0 0 YOGI SAEPUL ANWAR
Huda;3278057010840004 5.3.6.201902021030 4 268117 1#0##0#0#0.0#2019-
02-13 11:35:09#0#22:01:00#15:02:00#00:00:00 1
d42dfe29748de7c6c3cec821e3bcd72b 363500 0 100000 0 0
0 0 385375 0 0 280000 0 138741 65033 40000
0 0 0
3206023 C 3 CP 1 01/02/2019 02/02/2019 01/01/1980 0 2
1 S05.8 11.51 - - None None None None H-1-30-I None None
0 0 - 0 - 0 - 0 - 0 6433000
2931275 0 2 0 0 0 DADAN ROHIMAN 19055983 39
1#0##0#0#0.0#2019-02-13 11:39:36#0#10:42:00#15:42:00#00:00:00 1
3606f5ecc6809a6804e42e035dff8800 459514 1723750 100000 0
0 0 0 83100 0 0 140000 0 45620 369291 10000
0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 20/10/1941 0 2
1 K40.9;R54 53.00 - - None None None None K-1-14-I None
None None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN)
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4667590 0 3 0 0 0 SODIKIN 18052460
4 268121 1#0##0#0#0.0#2019-02-13
11:46:04#0#16:44:00#10:36:00#00:00:00 1 2a7d56c911eac037cb4116512c2f2ea3
470000 2592500 190000 0 0 0 0 103875 0
0 210000 0 419351 651864 30000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 15/04/1992 0 2
1 O02.1 69.01 - - None None None None W-1-10-I None None
None None None None PROSEDUR ABORSI (RINGAN) 1585400 0 0
- 0 - 0 - 0 - 0 1585400 3315386 0
3 0 0 0 FAUZYAH NURUL RAHMAT 19055877 26 9787 dr.
1#0##0#0#0.0#2019-02-13 11:49:54#0#14:33:00#09:23:00#00:00:00 1
ccb6c3bb77679a2e1c7bd958037d74f3 568000 2032812 120000 0
0 0 0 0 0 0 210000 0 91940 272634 20000
0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 30/12/1956 0 2
1 K40.9;R54 53.00 - - None None None None K-1-14-I None
None None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL (RINGAN)
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4462869 0 3 0 0 0 TATANG SUPRIATNA
4 268125 1#0##0#0#0.0#2019-02-13
11:54:58#0#16:36:00#10:35:00#00:00:00 1 124d53375b4712eea204edbee5f706fd
470000 2592500 190000 0 0 0 0 0 0 0
210000 0 434041 536328 30000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 06/04/1982 0 2
- 0 - 0 - 0 - 0 1585400 3210735 0
3 0 0 0 MAHIROH 19055838 36 13449 dr. Damarizqa Dara
Sjahruddin, Sp.OG 0122R0020119V007435 0000432069232 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268127 1#0##0#0#0.0#2019-
02-13 12:02:15#0#13:36:00#09:26:00#00:00:00 1
c9a4eb26e9e5d2090a22d4bd91b7e883 558000 1626250 120000 0
0 0 0 270000 0 0 210000 0 165794 230691
30000 0 0 0
3206023 C 3 CP 1 01/02/2019 02/02/2019 01/07/1978 0 2
1 O48;Z37.0;O80.9;O98.4 73.59 - - None None None None O-6-
13-II None None None None None None PERSALINAN VAGINAL (SEDANG) 1828500
0 0 - 0 - 0 - 0 - 0 1828500
2052952 0 2 0 0 0 SITI MASITOH 19055962 40
4 268129 1#0##0#0#0.0#2019-02-13
12:23:30#0#14:04:00#15:23:00#00:00:00 1 f701e0556a5a49773b4b5e218165da01
1309500 0 120000 0 0 0 0 281500 0 0
140000 0 44659 137293 20000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 01/07/1951 0 2
1 D50.9 99.04 - - None None None None D-4-13-I None None
None None None None GANGGUAN SEL DARAH MERAH SELAIN KRISIS ANEMIA SEL
SICKLE (RINGAN) 2218100 0 0 - 0 - 0 - 0 -
0 2218100 2972307 0 4 0 0 0 MAMAH 19055778
5.3.6.201902021030 4 268134 1#0##0#0#0.0#2019-02-13
14:03:20#0#12:29:00#14:10:00#00:00:00 2 841f8a6f222e274868f038bb50c31bc4
316000 0 150000 0 0 0 0 1987025 0 0
280000 0 142009 67273 30000 0 0 0
3206023 C 3 CP 1 29/01/2019 02/02/2019 10/11/2018 0 2
1 J18.0 93.94;99.21;87.44 - - None None None None J-4-16-I
None None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH
(RINGAN) 3332600 0 0 - 0 - 0 - 0 - 0
3332600 1532409 0 5 0 0 0 RAFKA NURDAFA
5.3.6.201902021030 4 268170 1#0##0#0#0.0#2019-02-14
09:53:39#0#20:40:00#11:34:00#00:00:00 1 8cb526ef74f5ca4fb43e19b5a1d31110
465000 0 200000 0 0 0 140000 70125 0 0
350000 0 150276 107008 50000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 10/02/2017 0 2
1 J18.0;G40.9 93.94;99.21;87.44 - - None None None None J-4-
16-II None None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH
(SEDANG) 4683100 0 0 - 0 - 0 - 0 - 0
4683100 1563248 0 4 0 0 0 TSANIA ZAINATUL ATQIYA
5.3.6.201902021030 4 268173 1#0##0#0#0.0#2019-02-14
09:58:57#0#17:08:00#11:33:00#00:00:00 1 c1fdec91beceec3df1160624e706fb6b
627500 0 150000 0 0 0 140000 70125 0 0
280000 0 155857 99766 40000 0 0 0
3206023 C 3 CP 1 31/01/2019 02/02/2019 26/07/2000 0 2
1 K37 47.09 - - None None None None K-1-13-I None None
None None None None PROSEDUR APPENDIK (RINGAN) 2790800 0 0
- 0 - 0 - 0 - 0 2790800 4766265 0
3 0 0 0 TANTI LESTARI 19055895 18 6763 dr. Aa Ahmad
Dimyati, Sp.B 0122R0020119V007451 0000432865214 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268179 1#0##0#0#0.0#2019-
02-14 10:07:12#0#17:21:00#10:36:00#00:00:00 1
8edb45b2688b4abac7b6214f639ba425 829025 2137750 190000 0
0 0 0 215500 0 0 210000 0 745559 408431
30000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 06/11/1979 0 2
1 A16.2;K21.9 - - - None None None None J-4-15-I None
None None None None None PERADANGAN DAN INFEKSI PERNAFASAN (RINGAN)
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1435210 0 4 0 0 0 TINI 18051862 39
5.3.6.201902021030 4 268183 1#0##0#0#0.0#2019-02-14
10:14:01#0#19:21:00#14:15:00#00:00:00 1 d56c647741c4280e7dcac1927a94c1bc
431000 0 100000 0 0 0 0 235825 0 0
280000 0 314902 33483 40000 0 0 0
3206023 C 3 CP 1 28/01/2019 02/02/2019 12/04/1955 0 2
1 Z49.1;D63.8;N18.5 39.95;99.04 - - None None None None N-4-
16-II None None None None None None PENYAKIT GINJAL DAN SALURAN URIN LAIN-
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 4378960 0 6 0 0 0 MAESAROH, NY
Aeni;3206276601940002 5.3.6.201902021030 4 268189 1#0##0#0#0.0#2019-
02-14 10:30:26#0#12:54:00#14:27:00#00:00:00 1
72a2f80ab44852577ede7d9307377a19 1066710 0 250000 0 645980
0 0 1328325 0 0 420000 0 362729 265216
40000 0 0 0
3206023 C 1 CP 1 27/01/2019 02/02/2019 05/01/1954 0 2
None None None None INFARK MYOKARD AKUT (RINGAN) 4077100 0 0
- 0 - 0 - 0 - 0 4077100 5786499 0
7 0 0 0 ABDUL ROHMAN, NY 14009787 65 23763 dr. H. Dani
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268194
1#0##0#0#0.0#2019-02-14 10:35:58#0#20:44:00#11:52:00#00:00:00 1
6addae532e5b29d1cf9bc7f80f9aa938 1465000 0 860000 0 30000
0 0 359625 0 0 800000 180000 1696189 152885
70000 172800 0 0
3206023 C 1 CP 1 01/02/2019 02/02/2019 03/06/1999 0 2
1 A91 - - - None None None None A-4-13-I None None
None None None None INFEKSI VIRAL & NON-BAKTERIAL LAIN (RINGAN)
2112800 0 0 - 0 - 0 - 0 - 0
2112800 2064653 0 2 0 0 0 FAUZAN AENNUL FIRDAUS
18030845 19 7183 DR. H. DANI FARID ABDULLAH SP.PD
Aeni;3206276601940002 5.3.6.201902021030 4 266198 1#0##0#0#0.0#2019-
02-15 08:28:15#0#01:49:00#12:00:00#00:00:00 3
a4af05a73e86a05a28640131e84d373b 712500 0 330000 0 0
0 0 182475 0 0 600000 0 181629 38049 20000
0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 07/02/1953 0 2
1 N17.9;D64.9;K21.9 99.04 - - None None None None N-4-10-II
None None None None None None TUMOR GINJAL & SALURAN URIN & GAGAL
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 2351421 0 4 0 0 0 SUDIN 19055799
5.3.6.201902021030 4 268351 1#0##0#0#0.0#2019-02-16
09:19:58#0#18:03:00#14:17:00#00:00:00 1 7dbaba9ed4808152bdedba8b76eb4cd8
381000 0 150000 0 0 0 0 1253450 0 0
280000 0 137711 84700 30000 34560 0 0
3206023 C 3 CP 1 01/02/2019 02/02/2019 10/02/1961 0 2
1 I61.9 99.60;89.52;96.07 - - None None None None G-4-13-I
None None None None None None PERDARAHAN INTRA KRANIAL BUKAN TRAUMATIK
(RINGAN) 2194500 0 0 - 0 - 0 - 0 - 0
2194500 2405904 0 2 0 0 0 ADE SUKIRAH 19055928
5.3.6.201902021030 4 269061 1#0##0#0#0.0#2019-03-12
10:00:44#0#02:22:00#17:38:00#00:00:00 1 5f4b6cc5e3eef7bef93a896fb677d720
422500 0 50000 0 0 0 130000 183500 0 0
140000 0 1176874 293030 10000 0 0 0
3206023 C 3 CP 1 30/01/2019 02/02/2019 01/05/1973 0 2
4 E87.5;E87.1;D64.9;I46.9;N18.9 99.04;99.60 - - None None None
None E-4-11-III None None None None None None HIPOVOLEMIA & GANGGUAN
ELEKROLIT (BERAT) 4533100 0 0 - 0 - 0 - 0 -
0 4533100 4635250 0 4 0 0 0 UHAM HIDAYAT
Aeni;3206276601940002 5.3.6.201902021030 4 272836 1#0##0#0#0.0#2019-
03-12 10:06:34#0#15:33:00#15:10:00#00:00:00 1
057cfc1acd6d1fc0356761a411fefe1f 928000 0 150000 0 0
0 0 2148575 0 0 280000 0 587479 511196
30000 0 0 0
3206023 C 3 CP 1 28/01/2019 02/02/2019 07/02/1960 0 2
1 A16.5 34.04 - - None None None None J-4-15-I None None
None None None None PERADANGAN DAN INFEKSI PERNAFASAN (RINGAN)
3999700 0 0 - 0 - 0 - 0 - 0
3999700 3904840 0 6 0 0 0 ENIH 19054695 58
21540 DR. H. DANI FARID ABDULLAH SP.PD 0122R0020119V006527
5.3.6.201902021030 4 272846 1#0##0#0#0.0#2019-03-12
10:53:44#0#00:27:00#14:13:00#00:00:00 2 8dbd9a0ea201882ba2d2f1c7220d75f5
671500 1483750 300000 0 0 0 250000 83100 0
0 350000 0 446179 260311 60000 0 0 0
3206023 C 2 CP 1 28/01/2019 02/02/2019 25/06/2017 0 2
None None None None NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN (RINGAN)
1687500 0 0 - 0 - 0 - 0 - 0
1687500 2712825 0 6 0 0 0 M ARKA RADITYA
5.3.6.201902021030 4 273018 1#0##0#0#0.0#2019-03-12
11:21:19#0#14:21:00#11:35:00#00:00:00 1 5fbc6ea3231f445a042658fd835ea325
552500 0 350000 0 0 0 0 165200 0 0
1080000 0 409390 105735 50000 0 0 0
3206023 C 3 CP 1 29/01/2019 02/02/2019 14/06/1956 0 2
1 E11.9;N18.9;N17.9;I50.0 - - - None None None None E-4-
10-III None None None None None None PENYAKIT KENCING MANIS & GANGGUAN
NUTRISI/ METABOLIK (BERAT) 5776400 0 0 - 0 - 0 -
0 - 0 5776400 3300500 0 5 0 0 0 NANI
Septiani;3278085209910012 5.3.6.201902021030 4 268610
1#0##0#0#0.0#2019-03-14 11:35:02#0#00:00:00#00:00:00#00:00:00 2
4de8ce5e51c00f4deba405fdec3e00ce 810000 0 255000 0 0
0 140000 341575 0 0 515000 0 996993 181932
60000 0 0 0
3206023 C 3 CP 1 30/01/2019 03/02/2019 02/06/1933 0 2
4 I63.9 - - - None None None None G-4-14-I None None
None None None None KECEDERAAN PEMBULUH DARAH OTAK DENGAN INFARK (RINGAN)
3722700 0 0 - 0 - 0 - 0 - 0
3722700 3599781 0 5 0 0 0 EMAN 19055810 85
31288 DR. INDRA GUNAWAN, SP.S 0122R0020119V007479 0000432752804 3;JKN
Santi Wintri Septiani;3278085209910012 5.3.6.201902021030 4 268063
1#0##0#0#0.0#2019-02-13 09:09:40#0#19:10:00#00:10:00#00:00:00 1
672f7ad501c41f5e86ba841a8e36a514 732500 0 200000 0 0
0 950000 70125 0 0 640000 0 528242 332514
60000 86400 0 0
3206023 C 3 CP 1 29/01/2019 03/02/2019 21/08/1995 0 1
1 C62.9;D72.8;D63.0 99.04 - - None None None None V-4-10-II
None None None None None None TUMOR PADA SISTEM REPRODUKSI LAKI-LAKI
(SEDANG) 5271700 0 0 - 0 - 0 - 0 - 0
5271700 4308764 0 6 0 0 0 MULYANA 18024616
23 8562 DR. RIADHI YULIANTO SP.B. 0122R0020119V006831
0002322610997 3;JKN Santi Wintri Septiani;3278085209910012
5.3.6.201902021030 4 268064 1#0##0#0#0.0#2019-02-13
09:16:51#0#13:27:00#09:20:00#00:00:00 1 435a24f85ea139f0cbaa4641efbfa407
565000 0 250000 0 0 0 0 1459050 0 0
420000 0 1519497 45217 50000 0 0 0
3206023 C 1 CP 1 26/01/2019 03/02/2019 01/01/1943 0 2
None None None None PERDARAHAN INTRA KRANIAL BUKAN TRAUMATIK (RINGAN)
3072300 0 0 - 0 - 0 - 0 - 0
3072300 9788970 0 9 0 0 0 K H HOLIS DRS, TN
17003812 76 27784 dr. Indra Gunawan, Sp.S 0122R0020119V006035
5.3.6.201902021030 4 268069 1#0##0#0#0.0#2019-02-13
09:21:50#0#18:26:00#03:49:00#00:00:00 1 017f1a7d484a77715d56b5b11a3a6f99
2942500 0 975000 0 30000 0 1270000 103875 0
0 2580000 0 1446430 287485 50000 103680 0 0
3206023 C 2 CP 1 31/01/2019 03/02/2019 08/09/1967 0 2
1 C11.9;E87.1 - - - None None None None U-4-10-II None
None None None None None NEOPLASMA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN (SEDANG) 7559200 0 0 - 0 - 0 - 0
- 0 7559200 2896357 0 4 0 0 0 IRWAN
NURULOH 19055074 51 18773 dr. Riadhi Yulianto Sp.B.
Septiani;3278085209910012 5.3.6.201902021030 4 268072
1#0##0#0#0.0#2019-02-13 09:26:35#0#12:11:00#14:37:00#00:00:00 1
9dd9eab537f8ae002483a63c9dd5d60f 330000 0 240000 0 0
0 0 315250 0 0 500000 0 1404420 76687 30000
0 0 0
3206023 C 2 CP 1 30/01/2019 03/02/2019 28/11/1984 0 2
O-6-10-II None None None None None None OPERASI PEMBEDAHAN CAESAR
(SEDANG) 6122400 0 0 - 0 - 0 - 0 - 0
6122400 6223645 0 5 0 0 0 WAWAT MUSTIAWATI
19055816 34 12481 dr. Damarizqa Dara Sjahruddin, Sp.OG
Septiani;3278085209910012 5.3.6.201902021030 4 268077
1#0##0#0#0.0#2019-02-13 09:37:50#0#20:04:00#14:09:00#00:00:00 1
26e4ae73edeee76d1a8de1dafc4b414f 1614500 2137750 280000 0
0 0 0 371225 0 0 475000 0 645675 639495
60000 0 0 0
3206023 C 3 CP 1 30/01/2019 03/02/2019 14/01/1997 0 2
1 O42.9;Z37.0;O82.1;O61.0 74.99 - - None None None None O-6-
10-I None None None None None None OPERASI PEMBEDAHAN CAESAR (RINGAN)
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5359092 0 5 0 0 0 TITA APRIANTI
5.3.6.201902021030 4 268078 1#0##0#0#0.0#2019-02-13
09:45:43#0#10:22:00#14:08:00#00:00:00 1 abad2f981baeb70f9e1a1175133a7675
1413000 2137750 170000 0 0 0 0 281500 0
0 350000 0 394044 582798 30000 0 0 0
3206023 C 3 CP 1 03/02/2019 03/02/2019 16/03/1980 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1549844 0 1 0 0 0 NIA KURNIASIH 19056049 38
5.3.6.201902021030 4 268083 1#0##0#0#0.0#2019-02-13
09:56:02#0#00:09:00#14:10:00#00:00:00 1 2a731da3c6d7ccac5c3a47a8c9b30712
970000 0 50000 0 0 0 0 281500 0 0 140000
0 45722 52622 10000 0 0 0
3206023 C 3 CP 1 01/02/2019 03/02/2019 17/12/1990 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1753722 0 3 0 0 0 EVIH WIJAYANTI 19055982 28
5.3.6.201902021030 4 268088 1#0##0#0#0.0#2019-02-13
10:06:33#0#14:07:00#10:19:00#00:00:00 1 5b7b7438e68282441c083125877e18de
1360000 0 50000 0 0 0 0 0 0 0 210000
0 50011 73711 10000 0 0 0
3206023 C 3 CP 1 31/01/2019 03/02/2019 01/01/2007 0 2
1 J45.9 93.94;87.44 - - None None None None J-4-18-I None
None None None None None ASTHMA & BRONKIOLITIS (RINGAN) 2053000
0 0 - 0 - 0 - 0 - 0 2053000
1566029 0 4 0 0 0 RENO 19055910 12 4413 DR.
MARTE ROBIUL SANI SP.A. 0122R0020119V007469 0002185397458 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268205
1#0##0#0#0.0#2019-02-14 14:22:30#0#20:05:00#09:06:00#00:00:00 2
1176460bf2e4fbcc8c8d85b6a2ffd063 687500 0 100000 0 0
0 130000 70125 0 0 350000 0 15126 203278 10000
0 0 0
3206023 C 3 CP 1 02/02/2019 03/02/2019 16/03/1980 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1549844 0 2 0 0 0 NIA KURNIASIH 19056049 38
14202 DR. DAMARIZQA DARA SJAHRUDDIN, SP.OG 0122R0020219V004880
5.3.6.201902021030 4 268083 1#0##0#0#0.0#2019-02-20
10:15:48#0#00:09:00#14:10:00#00:00:00 2 1e748d92831dafa57727e0f0ad00220c
970000 0 50000 0 0 0 0 281500 0 0 140000
0 45722 52622 10000 0 0 0
3206023 C 3 CP 1 30/01/2019 03/02/2019 01/04/2006 0 2
1 N05.9;L08.0 - - - None None None None N-4-11-I None
None None None None None PERADANGAN GINJAL (RINGAN) 1889100 0
0 - 0 - 0 - 0 - 0 1889100 1790847
0 5 0 0 0 M SIDIK 19055822 12 4687 DR. MARTE
ROBIUL SANI SP.A. 0122R0020119V007326 0001991053585 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268091
1#0##0#0#0.0#2019-02-20 10:26:29#0#07:44:00#12:18:00#00:00:00 2
155dd7a971c7df10c0c748df5def95c5 384500 0 150000 0 0
0 0 287000 0 0 500000 0 216245 168542
50000 34560 0 0
3206023 C 3 CP 1 02/02/2019 03/02/2019 04/08/1973 0 2
4 J18.9;A41.9 - - - None None None None J-4-16-III None
None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH (BERAT)
5921100 0 0 - 0 - 0 - 0 - 0
5921100 1143888 0 2 0 0 0 CECENG SUTISMAN
Septiani;3278085209910012 5.3.6.201902021030 4 268622
1#0##0#0#0.0#2019-03-14 11:38:02#0#00:00:00#00:00:00#00:00:00 2
6aab2146ef18f2e7ceb95ea07cb03f5a 177500 0 50000 0 0 0
0 167575 0 0 140000 0 337987 270826 0
0 0 0
3206023 C 2 CP 1 30/01/2019 04/02/2019 30/01/2019 2300 2
1 P70.4;P03.4;P07.1 - - - None None None None P-8-13-I
None None None None None None NEONATAL, BBL 2000 - 2499 GR TANPA
PROSEDUR MAYOR (RINGAN) 5987500 0 0 - 0 - 0 - 0
- 0 5987500 1959975 0 6 0 0 0 BY NY IMA
5.3.6.201902021030 4 268080 1#0##0#0#0.0#2019-02-13
09:51:44#0#18:26:00#09:26:00#00:00:00 1 506ec355f0a1b5c6342906a4d6b97736
797500 0 210000 0 0 0 0 202475 0 0
750000 0 0 0 0 0 0 0
3206023 C 1 CP 1 02/02/2019 04/02/2019 09/05/1984 0 2
1 S32.1;M54.1 - - - None None None None M-4-17-I None
None None None None None MASALAH BAGIAN PUNGGUNG/PINGGANG BELAKANG
(RINGAN) 3833900 0 0 - 0 - 0 - 0 - 0
3833900 2673303 0 3 0 0 0 RINI SUNARTI, NY
5.3.6.201902021030 4 268095 1#0##0#0#0.0#2019-02-13
10:40:54#0#07:52:00#12:35:00#00:00:00 1 76bc880ecd4316cfc8e79a4dbfdb5225
395000 0 300000 0 0 0 400000 70125 0 0
900000 0 467712 110466 30000 0 0 0
3206023 C 1 CP 1 31/01/2019 04/02/2019 27/09/1995 0 2
2112800 0 0 - 0 - 0 - 0 - 0
2112800 4365319 0 5 0 0 0 TAUFIK ANSYORI
Septiani;3278085209910012 5.3.6.201902021030 4 266464
1#0##0#0#0.0#2019-02-13 10:57:10#0#08:27:00#14:50:00#00:00:00 2
c87b81d3451ef34581838a658e1949f7 1187500 0 825000 0 0
0 0 499800 0 0 1500000 0 316938 36081 0
0 0 0
3206023 C 1 CP 1 29/01/2019 04/02/2019 26/10/1984 0 2
1 J40 - - - None None None None J-4-21-I None None
None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM PERNAFASAN LAIN-
LAIN (RINGAN) 3725400 0 0 - 0 - 0 - 0 -
0 3725400 5316096 0 7 0 0 0 SRI NOVRIANTI
Septiani;3278085209910012 5.3.6.201902021030 4 268110
1#0##0#0#0.0#2019-02-13 11:19:46#0#23:53:00#17:33:00#00:00:00 1
ae7566c10afe88514468017f08eecc0a 1482500 0 600000 0 0
0 140000 70125 0 0 1260000 0 1493155 96636 70000
103680 0 0
3206023 C 3 CP 1 03/02/2019 04/02/2019 01/07/1958 0 2
4 N18.9;E87.8;J81;A41.9 99.21 - - None None None None N-4-
10-III None None None None None None TUMOR GINJAL & SALURAN URIN & GAGAL
GINJAL (BERAT) 4377800 0 0 - 0 - 0 - 0 -
0 4377800 2755455 0 2 0 0 0 ENDANG RIDWAN
18048444 60 22132 DR. NURUL SITI MARDIAH, SP.B 0122R0020219V000377
5.3.6.201902021030 4 268115 1#0##0#0#0.0#2019-02-13
11:34:19#0#00:10:00#22:03:00#00:00:00 2 b1df910be2bc807e5865813a52a066a2
1125000 0 115000 0 0 0 130000 300325 0
0 205000 0 276255 552035 0 51840 0 0
3206023 C 3 CP 1 01/02/2019 04/02/2019 10/09/2000 0 2
1 O48;Z37.0;O82.1;O41.0;O68.9 74.99 - - None None None None
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5081358 0 4 0 0 0 POPON PONIRAH
Septiani;3278085209910012 5.3.6.201902021030 4 268118
1#0##0#0#0.0#2019-02-13 11:38:56#0#14:03:00#12:58:00#00:00:00 1
b6c44081111f2e1686c5c0a253190cde 1142000 2137750 70000 0 0
0 0 364125 0 0 280000 0 394535 662948
30000 0 0 0
3206023 C 3 CP 1 01/02/2019 04/02/2019 25/07/2017 0 2
1 R56.0 - - - None None None None G-4-22-I None None
- 0 - 0 - 0 - 0 2525300 1469430 0
4 0 0 0 SAYYID SABIQ AL AZIZ 18045999 1 556 dr.
Marte Robiul Sani Sp.A. 0122R0020219V000216 0002498641121 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268120
1#0##0#0#0.0#2019-02-13 11:43:19#0#17:06:00#12:48:00#00:00:00 1
21eef049b56cba43db6bdbbca9b491e5 427500 0 150000 0 0
0 0 103875 0 0 280000 0 250688 227367
30000 0 0 0
3206023 C 3 CP 1 03/02/2019 04/02/2019 01/10/1991 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2472608 0 2 0 0 0 HELIANAWATI 19053384 27 9987
5.3.6.201902021030 4 268122 1#0##0#0#0.0#2019-02-13
11:47:03#0#21:52:00#11:33:00#00:00:00 1 a8fdb50a87593d9be90bda96069bab01
1647500 0 120000 0 0 0 0 126225 0 0
140000 0 119301 259582 60000 0 0 0
3206023 C 3 CP 1 03/02/2019 04/02/2019 14/08/1998 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2948879 0 2 0 0 0 RISSA A 19056055 20 7478
5.3.6.201902021030 4 268124 1#0##0#0#0.0#2019-02-13
11:54:14#0#01:59:00#11:32:00#00:00:00 1 966d662b97c8b8f5af1fa4ff8ccc6a3c
1942500 0 170000 0 0 0 0 281500 0 0
140000 0 127591 267288 20000 0 0 0
3206023 C 3 CP 1 02/02/2019 04/02/2019 01/07/1987 0 2
0 0 - 0 - 0 - 0 - 0 1828500
3180840 0 3 0 0 0 MIMIN HASANAH 19056027 31
5.3.6.201902021030 4 268126 1#0##0#0#0.0#2019-02-13
12:00:23#0#13:07:00#11:33:00#00:00:00 1 d160224f3d7f2131f53e3e924050904f
1952500 0 170000 0 0 0 0 460875 0 0
210000 0 152467 204998 30000 0 0 0
3206023 C 3 CP 1 04/02/2019 04/02/2019 26/07/1950 0 2
1 M10.0 - - - None None None None M-4-18-I None None
None None None None PENYAKIT TULANG DAN SENDI LAIN-LAIN (RINGAN)
2069900 0 0 - 0 - 0 - 0 - 0
2069900 678642 0 1 0 0 0 UJU 19056208 68
5.3.6.201902021030 4 268128 1#0##0#0#0.0#2019-02-13
12:16:45#0#22:22:00#22:23:00#00:00:00 1 f3b4874f9c92fbe63b510dd90384d59e
167500 0 50000 0 0 0 0 215625 0 0 70000
0 132076 43441 0 0 0 0
3206023 C 3 CP 1 02/02/2019 04/02/2019 13/08/1972 0 2
1 O14.1;Z37.1;O82.1;O33.9;O68.9;O63.1 74.99 - - None None None
None O-6-10-II None None None None None None OPERASI PEMBEDAHAN
CAESAR (SEDANG) 5102000 0 0 - 0 - 0 - 0 -
0 5102000 5409449 0 3 0 0 0 ELAH HAYATI
19056018 46 16974 DR. DAMARIZQA DARA SJAHRUDDIN, SP.OG
Septiani;3278085209910012 5.3.6.201902021030 4 268133
1#0##0#0#0.0#2019-02-13 13:55:02#0#17:48:00#08:21:00#00:00:00 1
670721f6d873fa419cd0640adae0729c 1167000 2137750 70000 0 0
0 0 351025 0 0 350000 0 640173 663501
30000 0 0 0
3206023 C 3 CP 1 01/02/2019 04/02/2019 21/06/2004 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1215955 0 4 0 0 0 NAZAR A 19056000
5.3.6.201902021030 4 268135 1#0##0#0#0.0#2019-02-13
13:58:16#0#20:42:00#13:27:00#00:00:00 1 96489ea05ee82d58faf826eec8248570
317500 0 150000 0 0 0 0 301475 0 0
280000 0 122891 34089 10000 0 0 0
3206023 C 2 CP 1 01/02/2019 04/02/2019 16/06/1997 0 2
(RINGAN) 2511000 0 0 - 0 - 0 - 0 - 0
2511000 2340583 0 4 0 0 0 INA PURWATI 19055987
5.3.6.201902021030 4 268208 1#0##0#0#0.0#2019-02-14
10:57:03#0#13:38:00#15:51:00#00:00:00 1 8bb42f112ce060fc723832b318a5d6ae
522500 0 300000 0 0 0 0 336475 0 0
720000 0 334635 76973 50000 0 0 0
3206023 C 3 CP 1 29/01/2019 04/02/2019 14/09/1948 0 2
3722700 0 0 - 0 - 0 - 0 - 0
3722700 3736012 0 7 0 0 0 ADAH, NY 15007406
70 25704 DR. INDRA GUNAWAN, SP.S 0122R0020119V006892 0000434898461
3;JKN Santi Wintri Septiani;3278085209910012 5.3.6.201902021030 4
268361 1#0##0#0#0.0#2019-02-16 10:08:17#0#06:32:00#11:18:00#00:00:00
1 e938ff92c85bb34779fbe5eff8ad5155 550000 0 250000 0
0 0 950000 103875 0 0 420000 0 1352978
59159 50000 0 0 0
3206023 C 3 CP 1 02/02/2019 04/02/2019 20/06/1982 0 2
1 Z49.1;N18.9 39.95 - - None None None None N-4-16-I None
None None None None None PENYAKIT GINJAL DAN SALURAN URIN LAIN-LAIN
(RINGAN) 2744500 0 0 - 0 - 0 - 0 - 0
2744500 2793916 0 3 0 0 0 ALAMSYAH 18049313
5.3.6.201902021030 4 268366 1#0##0#0#0.0#2019-02-16
10:15:50#0#12:44:00#16:26:00#00:00:00 1 2fcfc002b21a97e255e16494891311d6
831710 0 100000 0 0 0 0 1388825 0 0
210000 0 170777 52604 40000 0 0 0
3206023 C 3 CP 1 31/01/2019 04/02/2019 09/09/1967 0 2
1 K35.2;E87.8;A41.9;K66.0 54.11;54.59;86.22 - - None None None
None K-1-40-III None None None None None None PROSEDUR SISTEM
PENCERNAAN LAIN-LAIN (BERAT) 10811600 0 0 - 0 - 0 -
0 - 0 10811600 14923334 0 5 0 0 0
ROSIDIN 19055575 51 18772 dr. Aa Ahmad Dimyati, Sp.B
Aeni;3206276601940002 5.3.6.201902021030 4 268702 1#0##0#0#0.0#2019-
02-20 08:32:09#0#20:23:00#12:18:00#00:00:00 1
de5fe25f582ff866ebc235a373976256 3461550 3665000 530000 0
15000 0 140000 508075 0 0 410000 480000
3523218 1587531 50000 552960 0 0
3206023 C 3 CP 1 31/01/2019 04/02/2019 08/07/1936 0 2
1 D21.9;D64.9 99.04 - - None None None None M-4-21-II None
None None None None None GANGGUAN SISTEM MUSKULOSKELETAL & JA(RINGAN)
PENGHUBUNG LAIN-LAIN (SEDANG) 2742100 0 0 - 0 - 0 -
0 - 0 2742100 2902311 0 5 0 0 0 MAMURI
19055775 82 30157 DR. RIADHI YULIANTO SP.B. 0122R0020119V007424
5.3.6.201902021030 4 268113 1#0##0#0#0.0#2019-02-20
10:04:44#0#11:57:00#10:40:00#00:00:00 2 6e915bf338be740e87b24e0bcbf7b70a
630000 0 220000 0 0 0 130000 979100 0
0 420000 0 269692 183519 70000 0 0 0
3206023 C 3 CP 1 26/01/2019 04/02/2019 12/11/1950 0 2
4 I63.9;J69.0 87.03;99.60 - - None None None None G-4-14-I
None None None None None None KECEDERAAN PEMBULUH DARAH OTAK DENGAN
INFARK (RINGAN) 3722700 0 0 - 0 - 0 - 0 -
0 3722700 6310061 0 10 0 0 0 ENDANG ABUDIN
5.3.6.201902021030 4 269005 1#0##0#0#0.0#2019-02-21
13:04:53#0#16:10:00#06:34:00#00:00:00 1 c8f513ea765b32c752b1185cd1a88554
1629500 0 450000 0 0 0 1230000 103875 0
0 700000 0 1893017 203669 100000 0 0 0
3206023 C 3 CP 1 28/01/2019 04/02/2019 10/02/1956 0 2
1 I12.0;N13.2 39.95;88.76 - - None None None None N-4-10-II
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 4552032 0 8 0 0 0 ENGKON
Aeni;3206276601940002 5.3.6.201902021030 4 272792 1#0##0#0#0.0#2019-
03-12 09:39:23#0#13:39:00#16:50:00#00:00:00 1
923079034610ee062f00b0d995821e29 793500 0 395000 0 841230
0 335000 712250 0 0 560000 0 504264 320788
90000 0 0 0
3206023 C 3 CP 1 29/01/2019 04/02/2019 01/01/1968 0 2
1 I12.0;K92.0;K31.8;D63.8 99.04 - - None None None None N-4-
10-II None None None None None None TUMOR GINJAL & SALURAN URIN & GAGAL
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 4270423 0 7 0 0 0 CUCU SUMIATI
Aeni;3206276601940002 5.3.6.201902021030 4 272923 1#0##0#0#0.0#2019-
03-12 10:35:48#0#10:23:00#16:58:00#00:00:00 1
ea75a81b1227c6f2dfdd892cadf34f83 803500 0 250000 0 0
0 0 1739050 0 0 490000 0 491130 416743
80000 0 0 0
3206023 C 1 CP 1 01/02/2019 04/02/2019 28/08/1939 0 2
1 I63.9;G81.9 - - - None None None None G-4-14-II None
(SEDANG) 6967700 0 0 - 0 - 0 - 0 - 0
6967700 2773534 0 4 0 0 0 MAESAROH 18052810
268618 1#0##0#0#0.0#2019-03-13 08:49:15#0#12:26:00#08:35:00#00:00:00
1 04b77188b3d4a8b98281ad05433c5afe 1257500 0 100000 0
0 0 0 83100 0 0 720000 0 308758 274176
30000 0 0 0
3206023 C 3 CP 1 28/01/2019 04/02/2019 26/07/1983 0 2
1 Z49.1;I12.0;D63.8 99.04;39.95 - - None None None None N-4-
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 6512350 0 8 0 0 0 AROP AHMAD HIDAYAT
Septiani;3278085209910012 5.3.6.201902021030 4 272935
1#0##0#0#0.0#2019-03-14 11:44:14#0#00:00:00#00:00:00#00:00:00 2
2731f81881a8c8d923bf9182643af255 783500 0 245000 0
1736670 0 0 1411450 0 0 560000 0 653066
963544 90000 69120 0 0
3206023 C 2 CP 1 03/02/2019 05/02/2019 19/04/1964 0 2
5434700 0 0 - 0 - 0 - 0 - 0
5434700 3801505 0 3 0 0 0 SUDE SOLIHIN
18051764 54 20013 dr. Nurul Siti Mardiah, Sp.B 0122R0020219V000358
4 268153 1#0##0#0#0.0#2019-02-14
09:32:51#0#18:56:00#09:56:00#00:00:00 1 c4348c6aa076ec89c86d13c8cd6cf49f
599000 1573750 160000 0 0 0 0 97125 0 0
210000 0 326596 805034 30000 0 0 0
3206023 C 3 CP 1 03/02/2019 05/02/2019 21/07/2009 0 2
None None None None PROSEDUR PADA KULIT, JA(RINGAN) BAWAH KULIT DAN
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 2851180 0 3 0 0 0 AISYAH
4 268165 1#0##0#0#0.0#2019-02-14
10:02:04#0#14:52:00#12:52:00#00:00:00 1 6d74948e7317bc47521f38aa38a91fe0
555025 1573750 120000 0 0 0 0 0 0 0
210000 0 171694 200711 20000 0 0 0
3206023 C 3 CP 1 01/02/2019 05/02/2019 28/01/2018 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1657798 0 5 0 0 0 MUHAMMAD MADANI RAFAN
4 268184 1#0##0#0#0.0#2019-02-14
10:24:42#0#14:45:00#14:05:00#00:00:00 1 0e8bdd6f9d0f0c5da87107161b7a7a12
602500 0 200000 0 0 0 0 147750 0 0
350000 0 190800 136748 30000 0 0 0
3206023 C 3 CP 1 02/02/2019 05/02/2019 04/03/1958 0 2
3722700 0 0 - 0 - 0 - 0 - 0
3722700 3068678 0 4 0 0 0 ILOH 19054732 60
1#0##0#0#0.0#2019-02-14 10:30:55#0#23:21:00#14:15:00#00:00:00 1
2b255b54ae90e79c83c707c175e68c1e 492500 0 150000 0 0
0 950000 156725 0 0 570000 0 642528 96925
10000 0 0 0
3206023 C 3 CP 1 03/02/2019 05/02/2019 13/06/1994 0 2
1 O41.0;O82.1;O34.2;O48 74.99 - - None None None None O-6-
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4855934 0 3 0 0 0 NINING 18051904
1#0##0#0#0.0#2019-02-14 10:36:35#0#11:02:00#13:04:00#00:00:00 1
17f86d4f021ea8b11b28558bb0a50193 1202000 2137750 70000 0 0
0 0 276375 0 0 210000 0 312293 637516
10000 0 0 0
3206023 C 3 CP 1 04/02/2019 05/02/2019 01/07/2004 0 2
1 N92.6;D64.9 99.04 - - None None None None W-4-12-II None
None None None None None GANGGUAN MENSTRUASI & SISTEM REPRODUKSI WANITA
LAIN-LAIN (SEDANG) 3667500 0 0 - 0 - 0 - 0
- 0 3667500 1126541 0 2 0 0 0 YULIA
RIZKIANA 19056112 14 5331 dr. Asep Taslim Sp.OG 0122R0020219V000676
4 268201 1#0##0#0#0.0#2019-02-14
10:47:21#0#15:48:00#13:32:00#00:00:00 1 1fced7ba4d26caa3c4ead071cdeee36f
130000 0 50000 0 0 0 0 680975 0 0 140000
0 22284 53282 50000 0 0 0
3206023 C 3 CP 1 04/02/2019 05/02/2019 07/09/1991 0 2
O-6-13-II None None None None None None PERSALINAN VAGINAL (SEDANG)
1828500 0 0 - 0 - 0 - 0 - 0
1828500 1984445 0 2 0 0 0 TITA SURTIASIH
4 268204 1#0##0#0#0.0#2019-02-14
10:53:44#0#14:38:00#14:09:00#00:00:00 1 a55abb4233c434100447646052a11660
1347500 0 70000 0 0 0 0 300250 0 0 140000
0 31504 25191 70000 0 0 0
3206023 C 3 CP 1 01/02/2019 05/02/2019 03/05/2018 0 2
1 R56.0;J06.9 - - - None None None None G-4-22-I None
None None None None None SERANGAN KEJANG (RINGAN) 2525300 0
0 - 0 - 0 - 0 - 0 2525300 1817354
0 5 0 0 0 FIRDHAN 18052386 0 274 dr. Marte
Robiul Sani Sp.A. 0122R0020219V000217 0002626842565 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268211 1#0##0#0#0.0#2019-
02-14 11:03:55#0#17:08:00#13:39:00#00:00:00 1
57272d88f076c07462204a82a391c7c2 477500 0 200000 0 0
0 0 70125 0 0 350000 0 327488 317681 40000
34560 0 0
3206023 C 2 CP 1 02/02/2019 05/02/2019 29/07/2002 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 1875338 0 4 0 0 0 YOGI BINTARA
5.3.6.201902021030 4 268213 1#0##0#0#0.0#2019-02-14
11:04:52#0#15:20:00#14:34:00#00:00:00 1 fb21f1d049cded7a9ba6e353de1b4b60
487500 0 210000 0 0 0 0 310225 0 0
500000 0 266435 81178 20000 0 0 0
3206023 C 3 CP 1 01/02/2019 05/02/2019 01/07/1969 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 7409982 0 5 0 0 0 NASIDIN 19055991
4 268221 1#0##0#0#0.0#2019-02-14
11:13:18#0#19:34:00#10:37:00#00:00:00 1 f93069a94cc317d979ed25e2632e7d15
995000 3036500 190000 0 0 0 0 190250 0
0 350000 0 1704405 933827 10000 0 0 0
3206023 C 2 CP 1 01/02/2019 05/02/2019 20/12/1960 0 2
1 E24.9;N17.9;M19.9 93.94;87.44 - - None None None None E-4-
13-III None None None None None None GANGGUAN KELENJAR ENDOKRIN LAIN-
LAIN (BERAT) 6308300 0 0 - 0 - 0 - 0 -
0 6308300 2584032 0 5 0 0 0 M DEDE S
Aeni;3206276601940002 5.3.6.201902021030 4 268220 1#0##0#0#0.0#2019-
02-14 11:13:53#0#14:41:00#12:34:00#00:00:00 1
19705ab86b516036b8f5bf6e4cda9fc1 1043500 0 280000 0 0
0 140000 146800 0 0 515000 0 311283 77449
70000 0 0 0
3206023 C 3 CP 1 04/02/2019 05/02/2019 01/02/1980 0 2
1 O13;Z37.0;O80.9 73.59 - - None None None None O-6-13-II
0 0 - 0 - 0 - 0 - 0 1828500
1895487 0 2 0 0 0 ENUR NURJANAH 19056216 39
14248 DR. ASEP TASLIM SP.OG 0122R0020219V001047 0002487954576 3;JKN
1#0##0#0#0.0#2019-02-14 12:01:12#0#21:33:00#14:03:00#00:00:00 2
7e99877bd145cdcae054f115fe25f583 1065000 0 50000 0 0 0
0 306750 0 0 140000 0 53821 259916 20000 0
0 0
3206023 C 1 CP 1 03/02/2019 05/02/2019 02/04/2004 0 2
1 R59.1 40.11 - - None None None None D-1-20-I None None
None None None None PROSEDUR PADA DARAH DAN ORGAN PEMBENTUK DARAH LAIN-
LAIN (RINGAN) 5368700 0 0 - 0 - 0 - 0 -
0 5368700 4617869 0 3 0 0 0 MUHAMMAD HILMI
TAUFIQ MUSLIH 19054601 14 5420 DR. NURUL SITI MARDIAH, SP.B
Huda;3278057010840004 5.3.6.201902021030 4 268145 1#0##0#0#0.0#2019-
02-14 12:02:10#0#20:21:00#08:53:00#00:00:00 2
81171a1c4bd679cd6c087bdab2e84d08 652525 1913750 220000 0
0 0 0 402200 0 0 390000 0 292525 696869
50000 0 0 0
3206023 C 3 CP 1 05/02/2019 05/02/2019 12/07/1978 0 2
4 E11.9;A41.9;N39.0;I50.0 99.60 - - None None None None E-4-
0 - 0 5776400 1444458 0 1 0 0 0 HERU
SUMARTI 19054241 40 14818 dr. H. Dani Farid Abdullah Sp.PD
Aeni;3206276601940002 5.3.6.201902021030 4 268262 1#0##0#0#0.0#2019-
02-14 13:55:00#0#06:09:00#11:14:00#00:00:00 1
a5601820a5463d20bd5b1bcde27aeee3 562500 0 50000 0 0 0
0 257625 0 0 70000 0 331117 173216 0 0
0 0
3206023 C 3 CP 1 31/01/2019 05/02/2019 15/10/1947 0 2
1 E24.9;D64.9;L03.1;I12.0 99.04 - - None None None None E-4-
13-II None None None None None None GANGGUAN KELENJAR ENDOKRIN LAIN-LAIN
(SEDANG) 4021500 0 0 - 0 - 0 - 0 - 0
4021500 3732474 0 6 0 0 0 AISAH 15001797 71
5.3.6.201902021030 4 268266 1#0##0#0#0.0#2019-02-14
14:01:42#0#11:19:00#13:57:00#00:00:00 1 9bc834938d4fc7eb070d95ae6a3367b9
546000 0 300000 0 0 0 0 1405925 0 0
420000 0 478536 512013 70000 0 0 0
3206023 C 3 CP 1 01/02/2019 05/02/2019 31/03/1999 0 2
4 A16.2;I27.2;A41.9 99.60;99.18;99.21 - - None None None None
J-4-15-III None None None None None None PERADANGAN DAN INFEKSI
PERNAFASAN (BERAT) 6429000 0 0 - 0 - 0 - 0
- 0 6429000 5362314 0 5 0 0 0 ELSA NURUL
BADRIYAH 19056007 19 7247 dr. H. Dani Farid Abdullah Sp.PD
Aeni;3206276601940002 5.3.6.201902021030 4 268268 1#0##0#0#0.0#2019-
02-14 14:08:43#0#22:22:00#05:04:00#00:00:00 1
540a2998abfbbcb5b21301782458b768 1555000 0 345000 0 0
0 140000 205375 0 0 275000 615000 1401578
516001 30000 279360 0 0
3206023 C 3 CP 1 03/02/2019 05/02/2019 01/02/2014 0 2
- 0 - 0 - 0 - 0 2525300 865974 0
3 0 0 0 RAKA SENJAYA 16011601 5 1828 DR. LIA
RHODIA, SP. A. 0122R0020219V001132 0002183639409 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268258 1#0##0#0#0.0#2019-
02-14 14:14:49#0#19:24:00#11:11:00#00:00:00 2
e3015f6605f465cb75698b998b0a4c49 232500 0 100000 0 0
0 0 177625 0 0 280000 0 25849 0 50000 0
0 0
3206023 C 3 CP 1 01/02/2019 05/02/2019 01/02/2019 3100 2
1 P21.9;P36.9 99.21 - - None None None None P-8-08-II None
None None None None None NEONATAL, BERAT BADAN LAHIR GROUP-5 DENGAN
SINDROMA DISTRES PERNAFASAN (SEDANG) 5451100 0 0 - 0 -
0 - 0 - 0 5451100 2943093 0 5 0 0
0 BY NY HAMIDAH 19055932 0 0 DR. MARTE ROBIUL SANI SP.A.
Aeni;3206276601940002 5.3.6.201902021030 4 268246 1#0##0#0#0.0#2019-
02-14 14:17:31#0#05:00:00#09:02:00#00:00:00 2
51c06168bd0ca1c08448b017c6d1b240 1315000 0 350000 0 0
0 0 83100 0 0 750000 0 57814 387179 0 0
0 0
3206023 C 1 CP 1 02/02/2019 05/02/2019 22/02/1971 0 2
1 H46 - - - None None None None H-4-11-I None None
None None None None GANGGUAN SARAF MATA (RINGAN) 3063700 0 0
- 0 - 0 - 0 - 0 3063700 3214046 0
4 0 0 0 H AA AHMAD NURDIN 18042773 47 17512 DR. TEGUH
BUDIMAN SP.MA. 0122R0020219V000265 0000070094586 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268227 1#0##0#0#0.0#2019-
02-14 14:20:00#0#12:07:00#09:48:00#00:00:00 2
b75d93131893c59faf726e2214fcba02 717500 0 330000 0 0
0 0 153225 0 0 1500000 0 464771 8550 40000
0 0 0
3206023 C 3 CP 1 04/02/2019 05/02/2019 17/03/1953 0 2
1 I63.9;G81.9 96.07;89.52;99.60 - - None None None None G-4-
14-II None None None None None None KECEDERAAN PEMBULUH DARAH OTAK DENGAN
INFARK (SEDANG) 4976900 0 0 - 0 - 0 - 0 -
0 4976900 1773425 0 2 0 0 0 TOHA SUHANDA
5.3.6.201902021030 4 268440 1#0##0#0#0.0#2019-02-18
10:06:44#0#11:14:00#17:58:00#00:00:00 1 0b755841ef60c8e68880e27d62322095
455000 0 50000 0 0 0 0 103875 0 0 140000
0 923615 50935 50000 0 0 0
3206023 C 3 CP 1 02/02/2019 05/02/2019 23/10/1958 0 2
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 3297258 0 4 0 0 0 ENDANG , TN
Aeni;3206276601940002 5.3.6.201902021030 4 272870 1#0##0#0#0.0#2019-
03-12 10:15:56#0#12:40:00#14:14:00#00:00:00 1
a87128d551cc80cfd89ad68396c8f0c9 831710 0 150000 0 0
0 0 1776300 0 0 280000 0 122243 97005 40000
0 0 0
3206023 C 3 CP 1 28/01/2019 06/02/2019 28/01/2019 1800 2
1 P07.1;P59.9 99.83 - - None None None None P-8-12-I None
None None None None None NEONATAL, BBL 1500 - 1999 GR TANPA PROSEDUR
MAYOR (RINGAN) 5808700 0 0 - 0 - 0 - 0 -
0 5808700 5017049 0 10 0 0 0 BY NY DESI RAHAYU
0002742938616 3;JKN DEVI BUDIARTI;3206246512790001 5.3.6.201902021030
4 268202 1#0##0#0#0.0#2019-02-14
10:50:15#0#06:09:00#11:22:00#00:00:00 1 fb4b57031b74bd4e05e40837b8c8d6ca
2145000 0 700000 0 0 0 0 420250 0 0
1250000 0 50754 451045 0 0 0 0
3206023 C 3 CP 1 31/01/2019 06/02/2019 31/07/1999 0 2
1 J94.2;D38.1;D64.9 34.04;99.04 - - None None None None J-4-
20-II None None None None None None PLEURAL EFUSI DAN PNEUMOTORAK (SEDANG)
5305300 0 0 - 0 - 0 - 0 - 0
5305300 10216731 0 7 0 0 0 RATNA WULANSARI
5.3.6.201902021030 4 268207 1#0##0#0#0.0#2019-02-14
11:06:45#0#11:42:00#14:25:00#00:00:00 1 c76deb0bc175d9681b506edde74263d1
1272500 1285000 310000 0 15000 0 890000 4080325
0 0 490000 0 1352694 521212 0 0 0 0
3206023 C 3 CP 1 05/02/2019 06/02/2019 06/10/1940 0 2
1 L27.0 - - - None None None None L-4-14-I None None
2186200 0 0 - 0 - 0 - 0 - 0
2186200 745031 0 2 0 0 0 RUMNASIH 19056259
78 28611 dr. Eman Arif Rahman, Sp.KK 0122R0020219V000770
5.3.6.201902021030 4 268245 1#0##0#0#0.0#2019-02-14
11:58:04#0#20:58:00#06:55:00#00:00:00 1 bce5d6a5694bf0624f212b56310f6f84
267500 0 50000 0 0 0 0 103875 0 0 140000
0 108506 65150 10000 0 0 0
3206023 C 3 CP 1 01/02/2019 06/02/2019 01/09/1969 0 2
(RINGAN) 5786500 0 0 - 0 - 0 - 0 - 0
5786500 6675971 0 6 0 0 0 ADE SOLIHIN 19055988
49 18050 DR. AA AHMAD DIMYATI, SP.B 0122R0020219V000218
5.3.6.201902021030 4 268253 1#0##0#0#0.0#2019-02-14
14:15:52#0#17:38:00#09:43:00#00:00:00 2 c9cbb0825d18da5cf7c302ac6a2d3a62
1459025 2137750 220000 0 0 0 0 219475 0
0 490000 0 1619884 489837 40000 0 0 0
3206023 C 2 CP 1 04/02/2019 06/02/2019 21/06/1945 0 2
(RINGAN) 2511000 0 0 - 0 - 0 - 0 - 0
2511000 2332944 0 3 0 0 0 E HALIMAH 16010218
5.3.6.201902021030 4 266795 1#1#kelas_1#0#418500#0.0#2019-02-15
08:38:47#0#11:12:00#14:15:00#00:00:00 2 dcacf8ba874bb22d8ecdbc3827a3c1da
851000 0 330000 0 0 0 0 321425 0 0
540000 0 186244 44275 60000 0 0 0
3206023 C 2 CP 1 04/02/2019 06/02/2019 10/12/1950 0 2
1 K74.6;E88.0 99.60 - - None None None None B-4-13-II None
0 0 - 0 - 0 - 0 - 0 4364500
2411805 0 3 0 0 0 ACAH 15018217 68 24893 dr. H.
Dani Farid Abdullah Sp.PD 0122R0020219V000680 0002739989439 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268274
1#0##0#0#0.0#2019-02-15 08:43:41#0#16:54:00#16:04:00#00:00:00 1
b32ed35043e72b37cb94e2e33c934a32 902500 0 100000 0 0
0 0 229750 0 0 375000 0 640398 164157
0 0 0 0
3206023 C 1 CP 1 02/02/2019 06/02/2019 27/02/1952 0 2
1 K21.9;I10 - - - None None None None K-4-12-I None
None None None None None GANGGUAN ESOFAGUS (RINGAN) 3071900 0
0 - 0 - 0 - 0 - 0 3071900 2485711
0 5 0 0 0 OTI 19056040 66 24447 dr. H. Dani Farid
Aeni;3206276601940002 5.3.6.201902021030 4 268276 1#0##0#0#0.0#2019-
02-15 08:55:11#0#19:06:00#14:49:00#00:00:00 2
9544958c4f19d687d394795c0dba255e 607500 0 400000 0 0
0 0 146800 0 0 900000 0 343740 37671 50000
0 0 0
3206023 C 1 CP 1 31/01/2019 06/02/2019 13/07/1963 0 2
1 E11.9;A91;E87.5 - - - None None None None E-4-10-III
None None None None None None PENYAKIT KENCING MANIS & GANGGUAN
0 - 0 8087000 5450401 0 7 0 0 0 OCAH
Aeni;3206276601940002 5.3.6.201902021030 4 266746
1#1#vip#7#6065250#75.0#2019-02-15 09:06:09#0#15:26:00#13:56:00#00:00:00
2 a730d46e024a66cfb6368a7cdb8161c1 1015000 0 925000 0
0 0 0 797550 0 0 1980000 0 643813 39038
50000 0 0 0
3206023 C 3 CP 1 31/01/2019 06/02/2019 07/11/1951 0 2
1 N18.9;D63.8;K21.9;K31.8 99.04 - - None None None None N-4-
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 4394867 0 7 0 0 0 AJ JENAL ARIPIN
Aeni;3206276601940002 5.3.6.201902021030 4 268282 1#0##0#0#0.0#2019-
02-15 09:11:52#0#07:12:00#14:18:00#00:00:00 1
dd2a31843b0656035cfa2915c7b4f328 787500 0 250000 0 0
0 0 1950775 0 0 490000 0 672138 194454
50000 0 0 0
3206023 C 3 CP 1 31/01/2019 06/02/2019 02/06/1964 0 2
1 K74.6;D13.4 - - - None None None None B-4-13-I None
None None None None None GANGGUAN HATI LAIN-LAIN (RINGAN) 3122100
0 0 - 0 - 0 - 0 - 0 3122100
2690291 0 7 0 0 0 ENTIN 19055867 54 19966 dr. H.
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268285
1#0##0#0#0.0#2019-02-15 09:16:59#0#12:29:00#16:31:00#00:00:00 1
d277d7b49e6baaaff26c892c9decda48 550000 0 300000 0 0
0 0 397500 0 0 490000 0 826526 66265 60000
0 0 0
3206023 C 3 CP 1 02/02/2019 06/02/2019 02/02/1975 0 2
SICKLE (RINGAN) 2218100 0 0 - 0 - 0 - 0 -
0 2218100 4293110 0 5 0 0 0 ACAH 19056038
5.3.6.201902021030 4 268287 1#0##0#0#0.0#2019-02-15
09:21:08#0#23:02:00#17:56:00#00:00:00 1 76894172e452dcacc1ca77c6e0f76d26
583500 0 200000 0 0 0 0 2059025 0 0
350000 0 1013700 26885 60000 0 0 0
3206023 C 3 CP 1 01/02/2019 06/02/2019 06/02/1975 0 2
1 N18.9;K31.8;D63.8 99.04;39.95 - - None None None None N-4-
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 3570450 0 6 0 0 0 MASITOH
Aeni;3206276601940002 5.3.6.201902021030 4 268352 1#0##0#0#0.0#2019-
02-16 09:27:25#0#16:46:00#16:55:00#00:00:00 1
bcce8bd1e626f3c520e3db0595cd2b2f 754500 0 200000 0 831230
0 140000 560850 0 0 420000 0 392913 127277
40000 103680 0 0
3206023 C 3 CP 1 05/02/2019 06/02/2019 02/03/2001 0 2
1 A16.2 - - - None None None None J-4-15-I None None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 461246 0 2 0 0 0 YANA MARYANA
5.3.6.201902021030 4 268371 1#0##0#0#0.0#2019-02-16
10:26:47#0#20:28:00#06:39:00#00:00:00 1 776f9a47524adf61339264b44b00cb51
137500 0 50000 0 0 0 0 70125 0 0 140000
0 20242 33379 10000 0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 18/06/1990 0 2
1 O34.2;Z37.0;O82.1;G40.9;O99.3 74.99 - - None None None None
(SEDANG) 5102000 0 0 - 0 - 0 - 0 - 0
5102000 5444652 0 4 0 0 0 YATI AMIATI 19056088
5.3.6.201902021030 4 268374 1#0##0#0#0.0#2019-02-16
10:33:53#0#20:46:00#12:53:00#00:00:00 1 29b8eeba586c436100e78e724d2ab624
1377000 2137750 190000 0 0 0 0 346500 0
0 280000 0 408146 635256 70000 0 0 0
3206023 C 3 CP 1 05/02/2019 06/02/2019 06/09/1993 0 2
1 O72.2;D64.9;O99.0 99.04 - - None None None None W-4-17-II
None None None None None None GANGGUAN POSTPARTUM (SEDANG) 2664400
0 0 - 0 - 0 - 0 - 0 2664400
1739366 0 2 0 0 0 NANI 19056239 25 9283 dr.
Asep Taslim Sp.OG 0122R0020219V001129 0002492158419 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268377
1#0##0#0#0.0#2019-02-16 10:41:42#0#18:13:00#14:00:00#00:00:00 1
7fb2f8c53dbe262a1378c325e785bc20 325000 0 50000 0 0 0
0 1059600 0 0 140000 0 93682 21084 50000 0 0
0
3206023 C 3 CP 1 03/02/2019 06/02/2019 01/01/1959 0 2
1 N81.3 68.59 - - None None None None W-1-30-I None None
None None None None PROSEDUR PADA VAGINA, SERVIK & VULVA (RINGAN)
3464300 0 0 - 0 - 0 - 0 - 0
3464300 5344717 0 4 0 0 0 ODAH SAADAH 18052095
5.3.6.201902021030 4 268393 1#0##0#0#0.0#2019-02-18
08:51:14#0#16:35:00#12:51:00#00:00:00 1 cea3aa88be1650485e22fc2e4e5e57ae
430000 2592500 120000 0 0 0 0 824200 0
0 280000 0 428592 619425 50000 0 0 0
3206023 C 3 CP 1 05/02/2019 06/02/2019 23/09/1987 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2721028 0 2 0 0 0 NIA KUSNIATI 19056225 31
11458 dr. Asep Taslim Sp.OG 0122R0020219V000709 0000436415005 3;JKN
1#0##0#0#0.0#2019-02-18 08:58:28#0#01:07:00#12:59:00#00:00:00 1
5e6469ff16c3d3f3c06222d8cc302c7b 1672000 0 120000 0 0
0 0 425950 0 0 140000 0 144705 198373
20000 0 0 0
3206023 C 3 CP 1 04/02/2019 06/02/2019 25/07/1998 0 2
1 O99.0;Z37.0;O80.0;D64.9 73.59 - - None None None None O-6-
0 0 - 0 - 0 - 0 - 0 1828500
3434044 0 3 0 0 0 SITI NURAISAH 19056207 20
1#0##0#0#0.0#2019-02-18 09:04:55#0#20:39:00#12:57:00#00:00:00 1
f3a9b2f43ac0d573e55310b67c5f3f94 1555000 0 170000 0 0
0 0 1185475 0 0 210000 0 71288 192281 50000
0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 28/12/2018 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1696071 0 4 0 0 0 ASKIA RAHAYU
19056066 0 37 DR. LIA RHODIA, SP. A. 0122r0020219v001157
5.3.6.201902021030 4 268406 1#0##0#0#0.0#2019-02-18
09:10:14#0#12:23:00#08:49:00#00:00:00 1 5bf583277737f4d88bd0926824b54c39
512500 0 200000 0 0 0 140000 70625 0 0
350000 0 249483 123463 50000 0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 15/09/2005 0 2
1 T81.3 54.61 - - None None None None K-1-40-I None None
None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
5786500 0 0 - 0 - 0 - 0 - 0
5786500 3803713 0 4 0 0 0 SITI 19052967 13
4889 dr. Nurul Siti Mardiah, Sp.B 0122R0020219V000364 0000433378269
268423 1#0##0#0#0.0#2019-02-18 09:38:54#0#20:38:00#11:31:00#00:00:00
1 6b9e04543ed480a0c5db122f88fcec63 670025 1573750 170000
0 0 0 0 79100 0 0 280000 0 517531 443307
70000 0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 05/03/1957 0 2
3 K56.6;E87.8 - - - None None None None K-4-15-II None
None None None None None OBSTRUKSI SALURAN GASTROINTESTINAL (SEDANG)
2873100 0 0 - 0 - 0 - 0 - 0
2873100 3057598 0 4 0 0 0 SUNARYO 19055931
61 22615 dr. Nurul Siti Mardiah, Sp.B 0122R0020219V000332
5.3.6.201902021030 4 268429 1#0##0#0#0.0#2019-02-18
09:50:51#0#10:22:00#13:42:00#00:00:00 1 62c0f3453ae15f4d50a61986bb1294a6
505000 0 100000 0 0 0 675000 822550 0
0 280000 0 395701 229347 50000 0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 09/09/1976 0 2
0 - 0 - 0 - 0 4421500 3340581 0 4
0 0 0 EVI MEGAWATI 18051643 42 15487 dr. Nurul Siti
Mardiah, Sp.B 0122R0020219V001085 0001790028189 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268445
1#0##0#0#0.0#2019-02-18 10:25:43#0#17:51:00#13:42:00#00:00:00 1
ca40aad84bee26d0c0bda64a4df3305f 463000 1573750 120000 0
0 0 0 70125 0 0 280000 0 438210 325496
70000 0 0 0
3206023 C 3 CP 1 01/02/2019 06/02/2019 17/01/1995 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 3850912 0 6 0 0 0 SANDI SOPYAN
Septiani;3278085209910012 5.3.6.201902021030 4 268711
1#0##0#0#0.0#2019-02-20 08:58:01#0#12:13:00#16:13:00#00:00:00 1
ca33970223730715d62d7e32bc716a02 614000 1483750 300000 0
0 0 0 277750 0 0 420000 0 429417 285995
40000 0 0 0
3206023 C 2 CP 1 02/02/2019 06/02/2019 15/07/2007 0 2
1 T30.2 - - - None None None None S-4-16-I None None
None None None None LUKA BAKAR (RINGAN) 4600300 0 0 -
0 - 0 - 0 - 0 4600300 1843774 0 5
0 0 0 ARYA ALAM MAULANA 19056047 11 4220 dr. Nurul Siti
Mardiah, Sp.B 0122R0020219V000314 0002212752508 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268714
1#0##0#0#0.0#2019-02-20 09:04:42#0#21:48:00#11:56:00#00:00:00 1
55575330a46ab797a131c47a4e0db94c 575000 0 200000 0 0
0 0 70125 0 0 625000 0 85221 208428 80000 0
0 0
3206023 C 2 CP 1 04/02/2019 06/02/2019 23/11/2001 0 2
1 F44.9;R10.4 - - - None None None None F-4-15-I None
None None None None None FOBIA, ANXIETAS DAN NEUROSIS LAIN-LAIN (RINGAN)
2482900 0 0 - 0 - 0 - 0 - 0
2482900 1079091 0 3 0 0 0 MUHAMAD RAMADAN
5.3.6.201902021030 4 268718 1#0##0#0#0.0#2019-02-20
09:09:33#0#20:16:00#14:01:00#00:00:00 1 e315484739992b23b5940f1760625bf7
452500 0 210000 0 0 0 0 0 0 0 320000
0 37250 9341 50000 0 0 0
3206023 C 2 CP 1 29/01/2019 06/02/2019 15/06/1951 0 2
1 K30;E73.9 - - - None None None None K-4-18-I None
None None None None None GANGGUAN SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
1491100 0 0 - 0 - 0 - 0 - 0
1491100 4787100 0 9 0 0 0 AMAT RAHMAT, TN
Septiani;3278085209910012 5.3.6.201902021030 4 268720
1#0##0#0#0.0#2019-02-20 09:13:47#0#23:15:00#14:06:00#00:00:00 1
d70e7ac9159de390f51eae54c4e9dcb8 848500 0 500000 0 0
0 0 345350 0 0 850000 0 2019062 174188
50000 0 0 0
3206023 C 2 CP 1 01/02/2019 06/02/2019 18/04/1948 0 2
(SEDANG) 5972300 0 0 - 0 - 0 - 0 - 0
5972300 4028493 0 6 0 0 0 ADE HANIASAH
5.3.6.201902021030 4 268717 1#0##0#0#0.0#2019-02-20
09:19:55#0#14:55:00#12:26:00#00:00:00 1 fca7e0d7c4eb955b43d35f7dded11906
835000 0 350000 0 0 0 950000 70125 0 0
750000 0 885215 118153 70000 0 0 0
3206023 C 2 CP 1 03/02/2019 06/02/2019 15/03/1995 0 2
1687500 0 0 - 0 - 0 - 0 - 0
1687500 2070658 0 4 0 0 0 ILHAM PIKRI 19054207
5.3.6.201902021030 4 268726 1#0##0#0#0.0#2019-02-20
09:25:25#0#22:48:00#15:28:00#00:00:00 1 75d2953bf6a541d0ea087b057e2ceed0
690000 0 300000 0 0 0 0 120425 0 0
500000 0 358377 61856 40000 0 0 0
3206023 C 2 CP 1 05/02/2019 06/02/2019 20/03/1947 0 2
2633400 0 0 - 0 - 0 - 0 - 0
2633400 1591594 0 2 0 0 0 ECIN 19056234 71
1#0##0#0#0.0#2019-02-20 09:30:02#0#13:46:00#12:25:00#00:00:00 1
f2d7ae2ccf12a0ce3acc958e6692eb79 617500 0 70000 0 0 0
0 103875 0 0 250000 0 214198 316021 20000
0 0 0
3206023 C 1 CP 1 01/02/2019 06/02/2019 21/01/2003 0 2
2112800 0 0 - 0 - 0 - 0 - 0
2112800 3854996 0 6 0 0 0 RIZKI AHMAD GIPARI
5.3.6.201902021030 4 268732 1#0##0#0#0.0#2019-02-20
09:35:34#0#14:34:00#10:59:00#00:00:00 1 13cadf46d168bbe458d41b9f6ef82ee5
975000 0 500000 0 0 0 0 782700 0 0
1080000 0 453512 13784 50000 0 0 0
3206023 C 1 CP 1 02/02/2019 06/02/2019 21/08/2002 0 2
2112800 0 0 - 0 - 0 - 0 - 0
2112800 3151298 0 5 0 0 0 ANTI FEBRIANTI
5.3.6.201902021030 4 268734 1#0##0#0#0.0#2019-02-20
09:39:47#0#02:57:00#11:28:00#00:00:00 1 feb06acc29cbd5aedd3a6cbc5a59e71d
740000 0 500000 0 0 0 0 535700 0 0
900000 0 352502 53096 70000 0 0 0
3206023 C 3 CP 1 04/02/2019 06/02/2019 03/07/1986 0 2
None None None None PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 4652813 0 3 0 0 0 ENENG SURYATI
19056221 32 11904 DR. ASEP TASLIM SP.OG 0122R0020219V001117
5.3.6.201902021030 4 268381 1#0##0#0#0.0#2019-02-20
09:48:13#0#05:29:00#13:41:00#00:00:00 2 768f23f1c3af32699f7ba22e6141ea6d
1688000 2032812 70000 0 0 0 0 276375 0 0
140000 0 204498 171128 70000 0 0 0
3206023 C 3 CP 1 31/01/2019 06/02/2019 12/11/1957 0 2
1 N18.9;I10 - - - None None None None N-4-10-I None
None None None None None TUMOR GINJAL & SALURAN URIN & GAGAL GINJAL
(RINGAN) 2460800 0 0 - 0 - 0 - 0 - 0
2460800 2079892 0 7 0 0 0 ENAH 18028227 61
5.3.6.201902021030 4 268199 1#0##0#0#0.0#2019-02-20
09:50:07#0#19:02:00#12:43:00#00:00:00 2 e80d46448549823f41f5d2b7eb9947d8
553500 0 200000 0 0 0 335000 205375 0
0 420000 0 207723 98294 60000 0 0 0
3206023 C 3 CP 1 05/02/2019 06/02/2019 23/09/2004 0 2
1 E83.5;N17.9;D64.9 99.04 - - None None None None E-4-11-III
None None None None None None HIPOVOLEMIA & GANGGUAN ELEKROLIT (BERAT)
4533100 0 0 - 0 - 0 - 0 - 0
4533100 6482434 0 2 0 0 0 GINA MAULANI
5.3.6.201902021030 4 268508 1#0##0#0#0.0#2019-02-20
09:51:45#0#06:50:00#20:29:00#00:00:00 2 500692215818d04d6124f4aeec466ea5
1587500 0 460000 0 0 0 0 2830975 0 0
205000 205000 523976 462623 0 207360 0 0
3206023 C 2 CP 1 02/02/2019 06/02/2019 01/07/1935 0 2
2633400 0 0 - 0 - 0 - 0 - 0
2633400 2008175 0 5 0 0 0 MUMUN 18047010 83
1#0##0#0#0.0#2019-02-26 09:48:03#0#08:38:00#08:13:00#00:00:00 1
79edae1215c83ff6aa1ce63dd065a470 490000 0 140000 0 0
0 0 103875 0 0 625000 0 224289 338611
0 86400 0 0
3206023 C 3 CP 1 31/01/2019 06/02/2019 01/01/1960 0 2
None None None None PROSEDUR EKSTRAOKULER DAN ORBITA (RINGAN) 4227800
0 0 - 0 - 0 - 0 - 0 4227800
4541245 0 7 0 0 0 KOYAH 17018065 59 21580 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 270101
1#0##0#0#0.0#2019-03-01 08:40:53#0#19:16:00#13:43:00#00:00:00 1
ebb371b282f59d54dd12cf482ddfbead 1144039 1825000 290000 0
0 0 0 185125 0 0 490000 0 247226 289855
70000 0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 01/01/1989 0 2
None None None None None None ADHESIOLISIS PERITONEAL (RINGAN)
6622400 0 0 - 0 - 0 - 0 - 0
6622400 4174545 0 4 0 0 0 LENA LISTIAWATI, NY
5.3.6.201902021030 4 268436 1#0##0#0#0.0#2019-03-14
11:48:54#0#00:56:00#13:43:00#00:00:00 2 4f5ddd674881a2b9a1194ccb1cfa854b
424500 2137750 140000 0 0 0 0 412000 0
0 210000 0 454062 326233 70000 0 0 0
3206023 C 3 CP 1 04/02/2019 06/02/2019 28/10/1985 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 6387990 0 3 0 0 0 MIMIN SUMINAR
Septiani;3278085209910012 5.3.6.201902021030 4 268408
1#0##0#0#0.0#2019-03-14 11:57:36#0#00:00:00#00:00:00#00:00:00 2
16d8d7ed107de7670a1663d3f2d46d65 1677000 2137750 240000 0
0 0 0 769725 0 0 210000 0 639484 684031
30000 0 0 0
3206023 C 3 CP 1 03/02/2019 06/02/2019 31/05/1995 0 2
1 O32.0;Z37.0;O82.1;O48 74.99 - - None None None None O-6-
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4659665 0 4 0 0 0 HESTI TRIANTI
Septiani;3278085209910012 5.3.6.201902021030 4 268417
1#0##0#0#0.0#2019-03-14 12:02:30#0#00:00:00#00:00:00#00:00:00 2
93eaa41ea3c7e2dfe290d292a862f672 1064500 1825000 190000 0
0 0 0 269975 0 0 280000 0 320735 639455
70000 0 0 0
3206023 C 1 CP 1 28/01/2019 07/02/2019 10/10/1957 0 2
1 A41.9;E05.9 06.09 - - None None None None E-1-20-II None
None None None None None PROSEDUR PADA TIROID, PARATIROID DAN SALURAN
TIROGLOSAL (SEDANG) 10517700 0 0 - 0 - 0 - 0
- 0 10517700 15410706 0 11 0 0 0 ENDA HERLINA
0122R0020119V006484 0000070612413 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 267035
1#1#vip#11#7888275#75.0#2019-02-14 09:18:39#0#14:55:00#13:39:00#00:00:00
3 047b717eb23e5f1bf2a56e81036cae84 3518000 3468750 2000000
0 30000 0 400000 743975 0 0 2100000 0
1467596 847505 40000 794880 0 0
3206023 C 2 CP 1 05/02/2019 07/02/2019 07/04/1991 0 2
0 0 - 0 - 0 - 0 - 0 2194200
3349765 0 3 0 0 0 MIRA 19056271 27 10166 dr.
Asep Taslim Sp.OG 0122R0020219V000781 0001004660188 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 268149 1#0##0#0#0.0#2019-
02-14 09:23:31#0#22:29:00#12:00:00#00:00:00 1
9ae057484656432f50f13a176dec7192 2100000 0 260000 0 0
0 0 311875 0 0 265000 0 109873 263017
40000 0 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 22/12/1978 0 2
- 0 - 0 - 0 - 0 1585400 3142302 0
3 0 0 0 ETIH ATE 19054581 40 14655 dr. Damarizqa Dara
Sjahruddin, Sp.OG 0122R0020219V000740 0000432186333 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 268151 1#0##0#0#0.0#2019-
02-14 09:28:17#0#14:40:00#08:32:00#00:00:00 1
8a73df139ff5f6086bae4a45e4e45444 548000 1626250 70000 0 0
0 0 213875 0 0 210000 0 183901 280276
10000 0 0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 09/09/2018 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1423243 0 4 0 0 0 BY NY SUARSAH
5.3.6.201902021030 4 268155 1#0##0#0#0.0#2019-02-14
09:33:53#0#14:32:00#12:22:00#00:00:00 1 1cfa4f89d3856f5c20a0755d42319348
560000 0 150000 0 0 0 0 93100 0 0 280000
0 184395 71188 50000 34560 0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 25/12/2017 0 2
SICKLE (RINGAN) 2218100 0 0 - 0 - 0 - 0 -
0 2218100 2076820 0 4 0 0 0 ALIKA NURAENI
5.3.6.201902021030 4 268159 1#0##0#0#0.0#2019-02-14
09:40:01#0#11:31:00#15:45:00#00:00:00 1 c90bf62dc1201927ebf8402eee3c978c
220000 0 195000 0 0 0 0 1192100 0 0
280000 0 55306 84414 50000 0 0 0
3206023 C 3 CP 1 06/02/2019 07/02/2019 07/06/1982 0 2
1 O72.2;O99.0;O75.1 69.02 - - None None None None W-1-11-II
None None None None None None PROSEDUR DILATASI, KURET, INTRAUTERIN &
SERVIK (SEDANG) 1828600 0 0 - 0 - 0 - 0 -
0 1828600 3657253 0 2 0 0 0 DEWI KUSMIATI
5.3.6.201902021030 4 268163 1#0##0#0#0.0#2019-02-14
09:53:44#0#10:21:00#12:43:00#00:00:00 1 22a72622e56e09f483e7a60e7fb58c02
448000 2032812 70000 0 0 0 0 306500 0 0
140000 0 361461 268480 30000 0 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 30/07/1998 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2576285 0 3 0 0 0 TIKA KARTIKA 19056260 20
Indriyanti Yuda S, S.ST;3206297107870001 5.3.6.201902021030 4 268174
1#0##0#0#0.0#2019-02-14 09:58:59#0#20:10:00#15:24:00#00:00:00 1
6c1d8d68f9ec18623d9bc04c83310dc4 1535000 0 170000 0 0
0 0 295125 0 0 210000 0 78442 267718 20000
0 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 01/07/1968 0 2
4 I61.9 87.03 - - None None None None G-4-13-I None None
2194500 0 0 - 0 - 0 - 0 - 0
2194500 3288497 0 3 0 0 0 DEDE MARIAH 19056245
3;JKN Indriyanti Yuda S, S.ST;3206297107870001 5.3.6.201902021030 4
268181 1#0##0#0#0.0#2019-02-14 10:09:01#0#21:10:00#08:14:00#00:00:00
1 977f7c3893770a1bd64400c3c17bb66d 939500 0 50000 0 0
0 950000 70125 0 0 210000 0 950394 118478
0 0 0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 03/03/1993 0 2
1 O33.9;O71.1;Z37.0;O82.1;O42.9;O62.0 74.99 - - None None None
None O-6-10-I None None None None None None OPERASI PEMBEDAHAN
CAESAR (RINGAN) 4830200 0 0 - 0 - 0 - 0 -
0 4830200 4908811 0 4 0 0 0 RATIH RATNASARI
5.3.6.201902021030 4 268186 1#0##0#0#0.0#2019-02-14
10:22:12#0#16:56:00#12:40:00#00:00:00 1 7a28ad43b33834b926d4dfd2e5655f25
947000 2137750 120000 0 0 0 0 281500 0
0 280000 0 412934 679627 50000 0 0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 09/12/1988 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5090421 0 4 0 0 0 SRI ANITA 19056214
268192 1#0##0#0#0.0#2019-02-14 10:32:08#0#20:33:00#12:02:00#00:00:00
1 e38e1396d8125695a3705924b40ff74d 897000 2137750 120000
0 0 0 0 364125 0 0 280000 0 501558
739988 50000 0 0 0
3206023 C 3 CP 1 02/02/2019 07/02/2019 26/08/2006 0 2
1 I10;E87.8;N18.9;N04.9 - - - None None None None I-4-
17-II None None None None None None HIPERTENSI (SEDANG) 2047300 0
0 - 0 - 0 - 0 - 0 2047300 3125358
0 6 0 0 0 FAHRUL ROZI 18046644 12 4543 dr. Lia
Rhodia, Sp. A. 0122R0020219V000254 0001853086386 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 268195 1#0##0#0#0.0#2019-
02-14 10:38:27#0#11:24:00#12:21:00#00:00:00 1
72cd5970f93bb69ce569fd157eec5438 487500 0 295000 0 0
0 0 1095750 0 0 420000 0 413805 343303
70000 0 0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 06/06/1982 0 2
(SEDANG) 5102000 0 0 - 0 - 0 - 0 - 0
5102000 5404984 0 4 0 0 0 MAYA 19056135 36
1#0##0#0#0.0#2019-02-14 10:46:10#0#10:50:00#12:02:00#00:00:00 1
7d0fb04f9029449277ec60ee2412db05 1224500 2137750 310000 0
0 0 0 306750 0 0 280000 0 449072 646912
50000 0 0 0
3206023 C 3 CP 1 03/02/2019 07/02/2019 22/08/2018 0 2
(RINGAN) 3332600 0 0 - 0 - 0 - 0 - 0
3332600 1906831 0 5 0 0 0 HERDIN 19056068
0 165 dr. Lia Rhodia, Sp. A. 0122R0020219V000977 0002744275252
268289 1#0##0#0#0.0#2019-02-15 09:25:58#0#15:16:00#12:20:00#00:00:00
1 84bffb9df7b822ef720b32ad6c52fb70 752500 0 200000 0
0 0 140000 56100 0 0 350000 0 138870 174801
60000 34560 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 05/02/2019 3700 2
1 P39.9;P03.4 99.21 - - None None None None P-8-16-I None
0 - 0 - 0 1786900 1334545 0 3 0 0
0 BY NY RATIH 19056233 0 0 dr. Marte Robiul Sani Sp.A.
Aeni;3206276601940002 5.3.6.201902021030 4 268293 1#0##0#0#0.0#2019-
02-15 09:39:28#0#07:21:00#14:02:00#00:00:00 1
27b248448cf5eebfcb2d4a1c28d5785f 555000 0 210000 0 0
0 0 74375 0 0 375000 0 22252 67918 30000 0 0
0
3206023 C 3 CP 1 05/02/2019 07/02/2019 05/02/2019 3600 2
1 P39.9;P59.9;Q66.0 99.21 - - None None None None P-8-16-I
None None None None None None NEONATAL, BBL > 2499 GR DENGAN
0 - 0 - 0 1786900 1099375 0 3 0 0
0 BY NY SRI ANITA 19056237 0 0 dr. Marte Robiul Sani Sp.A.
0122r0020219v001156 0002744426079 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268295 1#0##0#0#0.0#2019-
02-15 09:58:03#0#09:03:00#13:40:00#00:00:00 1
faf56d7ab05845d7d6daf32a4d7398de 410000 0 210000 0 0
0 0 74375 0 0 375000 0 0 0 30000 0 0
0
3206023 C 3 CP 1 28/01/2019 07/02/2019 14/05/1970 0 2
1 M10.0;J45.9 - - - None None None None M-4-18-I None
None None None None None PENYAKIT TULANG DAN SENDI LAIN-LAIN (RINGAN)
2069900 0 0 - 0 - 0 - 0 - 0
2069900 4686597 0 11 0 0 0 HERDI HERDIANA
Aeni;3206276601940002 5.3.6.201902021030 4 268312 1#0##0#0#0.0#2019-
02-15 10:29:31#0#13:21:00#14:46:00#00:00:00 1
c575cf66714d9c0abb575fd27769d89c 832500 0 400000 0 0
0 0 314400 0 0 770000 0 2070358 179339
120000 0 0 0
3206023 C 3 CP 1 03/02/2019 07/02/2019 01/07/1974 0 2
1 J45.9;I10 93.94 - - None None None None J-4-18-I None
0 0 - 0 - 0 - 0 - 0 2053000
2024213 0 5 0 0 0 SURYANI 18032308 44 16288
268321 1#0##0#0#0.0#2019-02-15 10:37:40#0#20:55:00#11:25:00#00:00:00
1 38cee09916f2a84f6d4730c93fa775f7 650000 0 150000 0
0 0 0 70125 0 0 350000 0 537480 127488
70000 69120 0 0
3206023 C 3 CP 1 02/02/2019 07/02/2019 15/09/1963 0 2
None None None None KEGAGALAN JANTUNG (RINGAN) 2575600 0 0
- 0 - 0 - 0 - 0 2575600 2059468 0
6 0 0 0 DIDI 18024510 55 20229 dr. H. Dani Farid
Aeni;3206276601940002 5.3.6.201902021030 4 268324 1#0##0#0#0.0#2019-
02-15 10:45:21#0#10:34:00#11:19:00#00:00:00 1
0e3d98ff941472ea9f8e192195e645d9 654500 0 200000 0 0
0 0 83100 0 0 420000 0 435548 92640 70000 103680
0 0
3206023 C 3 CP 1 02/02/2019 07/02/2019 01/01/1958 0 2
1 N18.9;R57.1;A09.9 - - - None None None None N-4-10-III
GINJAL (BERAT) 4377800 0 0 - 0 - 0 - 0 -
0 4377800 2333840 0 6 0 0 0 NUNUNG, NY
Aeni;3206276601940002 5.3.6.201902021030 4 268329 1#0##0#0#0.0#2019-
02-15 10:51:12#0#15:24:00#11:27:00#00:00:00 1
3ae692adb8f63e7ab5c683313dba7176 931000 0 200000 0 0
0 0 167575 0 0 420000 0 464699 80566 70000
0 0 0
3206023 C 3 CP 1 31/01/2019 07/02/2019 28/06/1977 0 2
1 I11.0;K21.9 87.44 - - None None None None I-4-12-I None
None None None None None KEGAGALAN JANTUNG (RINGAN) 2575600 0
0 - 0 - 0 - 0 - 0 2575600 2837441
0 8 0 0 0 DEDE IRMA, NY 17021580 41 15192 dr. H.
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268340
1#0##0#0#0.0#2019-02-15 11:02:47#0#07:59:00#14:28:00#00:00:00 1
c9f5e9390c3afac65cacd043f6861900 728500 0 300000 0 0
0 140000 203375 0 0 560000 0 761181 54385
90000 0 0 0
3206023 C 3 CP 1 06/02/2019 07/02/2019 01/01/1941 0 2
4 I50.0 99.60 - - None None None None I-4-12-I None None
- 0 - 0 - 0 - 0 2575600 1082842 0
2 0 0 0 TARKIAH 18038789 78 28525 dr. H. Dani Farid
Aeni;3206276601940002 5.3.6.201902021030 4 268342 1#0##0#0#0.0#2019-
02-15 11:07:25#0#23:11:00#08:09:00#00:00:00 1
9af4221d0a4c066e8c3b734194890ed5 482500 0 50000 0 0 0
0 171625 0 0 140000 0 52236 186481 0 0
0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 23/10/1995 0 2
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 3455848 0 4 0 0 0 SRI WULAN SARI
Aeni;3206276601940002 5.3.6.201902021030 4 268346 1#0##0#0#0.0#2019-
02-15 11:13:50#0#11:50:00#11:59:00#00:00:00 1
9c25933895d0471019c291a7de226ebf 771710 0 150000 0 500710
0 0 1396950 0 0 280000 0 260674 65804 30000
0 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 28/11/1995 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3173778 0 3 0 0 0 SELI KARLINA
5.3.6.201902021030 4 268350 1#0##0#0#0.0#2019-02-16
09:04:14#0#21:07:00#12:01:00#00:00:00 1 a8cf4f02c7f3e5a46a78fdbd5955c803
378000 1626250 70000 0 0 0 0 576750 0 0
210000 0 179864 92914 40000 0 0 0
3206023 C 2 CP 1 05/02/2019 07/02/2019 12/04/1947 0 2
5434700 0 0 - 0 - 0 - 0 - 0
5434700 3703202 0 3 0 0 0 ABDUL ROHMAN
5.3.6.201902021030 4 268355 1#0##0#0#0.0#2019-02-16
09:52:26#0#17:26:00#10:40:00#00:00:00 1 a2a234509e66f622107bf92360d4e352
358000 1784000 160000 0 0 0 0 98875 0 0
320000 0 230037 712290 40000 0 0 0
3206023 C 2 CP 1 05/02/2019 07/02/2019 12/07/1957 0 2
1 J05.1 - - - None None None None U-4-13-I None None
None None None None PERADANGAN EPIGLOTIS, TELINGA TENGAH, ISPA DAN
LARINGOTRAKEITIS (RINGAN) 2191600 0 0 - 0 - 0 -
0 - 0 2191600 1395247 0 3 0 0 0 AAN
SEMARBAJA 19056232 61 22488 dr. M Sidik Hasanudin Sp.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 268353 1#0##0#0#0.0#2019-
02-16 10:00:20#0#15:16:00#13:45:00#00:00:00 1
d625d59bcd5b8ec5852c149b80b5a4bb 395000 0 140000 0 0
0 200000 178375 0 0 210000 0 171996 59876
40000 0 0 0
3206023 C 3 CP 1 30/01/2019 07/02/2019 07/11/1962 0 2
1 I27.9;J44.9;M19.9 89.52;87.44 - - None None None None I-4-
24-II None None None None None None GANGGUAN SISTEM PEMBULUH DARAH LAIN-LAIN
(SEDANG) 5152700 0 0 - 0 - 0 - 0 - 0
5152700 3640959 0 9 0 0 0 NY NENGSIH 11002719
5.3.6.201902021030 4 268365 1#0##0#0#0.0#2019-02-16
10:15:55#0#16:58:00#15:56:00#00:00:00 1 c18af80e4e19f599b4e5c5d92fac1d03
792500 0 350000 0 0 0 140000 169000 0
0 630000 0 1354029 105430 100000 0 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 11/06/1983 0 2
1 J35.0;J34.3 22.2;21.69 - - None None None None U-1-20-I
0 - 0 4458500 3818404 0 3 0 0 0 YATI
NURHAYATI 19054835 35 13023 dr. M Sidik Hasanudin Sp.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 268368 1#0##0#0#0.0#2019-
02-16 10:32:13#0#17:13:00#13:39:00#00:00:00 1
c1b66ba5321173c5da83dd1dc4cffe30 765025 1573750 140000 0
0 0 0 120125 0 0 210000 0 398831 580673
30000 0 0 0
3206023 C 3 CP 1 05/02/2019 07/02/2019 22/07/2017 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3271420 0 3 0 0 0 MUHAMMAD DZULFIQOR NUR
RIZKY 18050672 1 563 dr. Nurul Siti Mardiah, Sp.B 0122R0020219V000756
5.3.6.201902021030 4 268376 1#0##0#0#0.0#2019-02-16
10:36:50#0#17:25:00#12:20:00#00:00:00 1 a9fe59e7ed338c85847a4a288ee46393
640025 1573750 170000 0 0 0 0 0 0 0
210000 0 142667 504978 30000 0 0 0
3206023 C 3 CP 1 03/02/2019 07/02/2019 15/06/1983 0 2
1 I50.0;N17.9;I25.1 - - - None None None None I-4-12-III
None None None None None None KEGAGALAN JANTUNG (BERAT) 3582600
0 0 - 0 - 0 - 0 - 0 3582600
2667350 0 5 0 0 0 HERMAN 19056085 35 13017
268382 1#0##0#0#0.0#2019-02-16 10:49:40#0#21:01:00#15:57:00#00:00:00
1 8f2bdeae7ea24dd142b15e855889f1bd 592500 0 200000 0
0 0 430000 257475 0 0 350000 0 652694
55561 60000 69120 0 0
3206023 C 3 CP 1 02/02/2019 07/02/2019 07/04/1954 0 2
1 I63.9;L89.9;G81.9;J69.0;I48 87.03 - - None None None None
G-4-14-II None None None None None None KECEDERAAN PEMBULUH DARAH
OTAK DENGAN INFARK (SEDANG) 4976900 0 0 - 0 - 0 -
0 - 0 4976900 3939679 0 6 0 0 0 E
KUSNADI 19056031 64 23677 dr. Indra Gunawan, Sp.S 0122R0020219V000659
5.3.6.201902021030 4 268652 1#0##0#0#0.0#2019-02-19
13:27:30#0#20:10:00#23:16:00#00:00:00 1 0ac5105be3a26b1ffa486bb8ffb218eb
982500 0 250000 0 0 0 950000 70125 0 0
420000 0 917556 299498 50000 0 0 0
3206023 C 3 CP 1 03/02/2019 07/02/2019 03/12/1957 0 2
1 J44.9;K21.9;I25.1 87.44 - - None None None None J-4-17-I
2739200 0 0 - 0 - 0 - 0 - 0
2739200 2529817 0 5 0 0 0 BASIROH 18048577
5.3.6.201902021030 4 269014 1#0##0#0#0.0#2019-02-21
13:12:55#0#17:17:00#15:00:00#00:00:00 1 84afc9efedb285f0dc7f89e0e9fa399c
618500 0 200000 0 0 0 130000 178375 0
0 350000 0 881883 41939 60000 69120 0 0
3206023 C 3 CP 1 04/02/2019 07/02/2019 14/05/1981 0 2
1 D70;C41.9;D63.0 99.04 - - None None None None D-4-10-II
None None None None None None AGRANULOSITOSIS (SEDANG) 3447200
0 0 - 0 - 0 - 0 - 0 3447200
2928505 0 4 0 0 0 NANANG SURYA 18050165 37
13780 DR. RIADHI YULIANTO SP.B. 0122R0020219V001016 0002054955172
268446 1#0##0#0#0.0#2019-03-19 08:07:21#0#17:21:00#13:40:00#00:00:00
4 088b16dfd5b37138006e6dd3f7ceef34 370000 0 100000 0
0 0 0 1119075 0 0 210000 0 982582 96848
50000 0 0 0
3206023 C 1 CP 1 08/02/2019 08/02/2019 21/04/1983 0 2
(RINGAN) 2320000 0 0 - 0 - 0 - 0 - 0
2320000 1000000 0 1 0 0 0 FERA MUTIARAWATI, NY
17017286 35 13077 DR. DAMARIZQA DARA SJAHRUDDIN, SP.OG 0122R00
5.3.6.201902021030 4 267183 1#1#vip#1#1740000#75.0#2019-02-08
12:29:51#0#10:18:37#10:18:37#00:00:00 1 63639bc666ba2f13f630bdecfb042436
1000000 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0
3206023 C 1 CP 1 06/02/2019 08/02/2019 08/04/1943 0 1
1 K21.9 - - - None None None None K-4-12-I None None
None None None None GANGGUAN ESOFAGUS (RINGAN) 3071900 0 0
- 0 - 0 - 0 - 0 3071900 2407553 0
3 0 0 0 ABDUL HALIM 19056411 75 27698 dr. DANI FARID
ABDULLAH, Sp.PD 0122R 0000070345484 3;JKN INACBG;123123123123
5.3.6.201902021030 4 267311 1#1#vip#3#2303925#75.0#2019-02-08
17:50:40#0#17:43:44#17:43:44#00:00:00 1 2c3e3403212f04dac63480008d5a7221
0 0 0 330000 667500 0 0 70125 0 0 900000
0 439928 0 0 0 0 0
3206023 C 3 CP 1 07/02/2019 08/02/2019 25/02/1983 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2725682 0 2 0 0 0 RINI MARYANI 19056431 35
5.3.6.201902021030 4 268177 1#0##0#0#0.0#2019-02-14
10:03:38#0#06:19:00#12:42:00#00:00:00 1 4bb8a2ec34e79c5c45164f1a67e0424c
1530000 0 240000 0 0 0 0 484875 0 0
140000 0 55837 254970 20000 0 0 0
3206023 C 2 CP 1 06/02/2019 08/02/2019 01/07/1950 0 2
1 D70;C11.9 - - - None None None None D-4-10-I None
None None None None None AGRANULOSITOSIS (RINGAN) 2751900 0
0 - 0 - 0 - 0 - 0 2751900 1562407
0 3 0 0 0 KIMIN 18028552 68 25057 DR. RIADHI
YULIANTO SP.B. 0122R0020219V001155 0002437521568 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268277 1#0##0#0#0.0#2019-
02-15 08:57:46#0#14:06:00#20:35:00#00:00:00 2
1054fd5a567355fc98a2ab791452228c 320000 0 150000 0 0
0 0 82625 0 0 375000 0 544810 59972 30000 0
0 0
3206023 C 2 CP 1 07/02/2019 08/02/2019 07/05/1975 0 2
(RINGAN) 1988600 0 0 - 0 - 0 - 0 - 0
1988600 4640082 0 2 0 0 0 ENOK ROHMAWATI
Huda;3278057010840004 5.3.6.201902021030 4 268279 1#0##0#0#0.0#2019-
02-15 09:06:29#0#16:48:00#13:03:00#00:00:00 1
eb878439e4d7e7a7eae2726390d886f9 603000 2572500 120000 0
0 0 0 542850 0 0 360000 0 284858 116874
40000 0 0 0
3206023 C 2 CP 1 06/02/2019 08/02/2019 21/06/1958 0 2
1 N18.9;D63.8 99.04;39.95 - - None None None None N-4-10-II
GINJAL (SEDANG) 3571600 0 0 - 0 - 0 - 0 -
0 3571600 3456735 0 3 0 0 0 HAYATI
Huda;3278057010840004 5.3.6.201902021030 4 268283 1#0##0#0#0.0#2019-
02-15 09:29:43#0#17:19:00#08:41:00#00:00:00 2
e82ef9818b78b0bbb25d265518f48038 1055960 0 140000 0 0
0 0 1095275 0 0 720000 0 238530 176970
30000 0 0 0
3206023 C 1 CP 1 05/02/2019 08/02/2019 08/03/1950 0 2
(SEDANG) 6967700 0 0 - 0 - 0 - 0 - 0
6967700 4075171 0 4 0 0 0 DJAKA KURNIA, TN
5.3.6.201902021030 4 268310 1#0##0#0#0.0#2019-02-15
10:20:51#0#17:02:00#11:12:00#00:00:00 1 063516586c8ef05d8eb438072bf15db7
592500 0 300000 0 0 0 1150000 178375 0
0 720000 0 763318 89058 40000 241920 0 0
3206023 C 1 CP 1 06/02/2019 08/02/2019 21/04/1983 0 2
(RINGAN) 2320000 0 0 - 0 - 0 - 0 - 0
2320000 4844923 0 3 0 0 0 FERA MUTIARAWATI, NY
4 268302 1#0##0#0#0.0#2019-02-15
10:21:30#0#17:07:00#12:40:00#00:00:00 1 5a2456c02b43ef709e806438337579f3
623000 2471250 350000 0 0 0 0 213875 0
0 900000 0 178686 88112 20000 0 0 0
3206023 C 1 CP 1 07/02/2019 08/02/2019 04/11/1969 0 2
- 0 - 0 - 0 - 0 3071900 2166594 0
2 0 0 0 N ETI MULYATI, NY 15007970 49 17992 DR. H. DANI
FARID ABDULLAH SP.PD 0122R0020219V001643 0000070110551 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268313 1#0##0#0#0.0#2019-
02-15 10:26:11#0#21:07:00#01:03:00#00:00:00 1
0181cf4135e0157d95e3312b71acdba4 587500 0 165000 0 0
0 0 178375 0 0 900000 0 286208 29511 20000
0 0 0
3206023 C 1 CP 1 06/02/2019 08/02/2019 08/04/1943 0 2
- 0 - 0 - 0 - 0 3071900 2407553 0
3 0 0 0 ABDUL HALIM 19056411 75 27698 DR. H. DANI FARID
ABDULLAH SP.PD 0122R0020219V001195 0000070345484 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268315 1#0##0#0#0.0#2019-
02-15 10:28:44#0#20:57:00#17:36:00#00:00:00 1
365707fdeaa126d32cf793d9bd83a077 667500 0 330000 0 0
0 0 70125 0 0 900000 0 375545 34383 30000 0
0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 13/01/2000 0 2
1 D24 85.21 - - None None None None L-1-50-I None None
0 - 0 - 0 - 0 - 0 4853300 4022330
0 3 0 0 0 LELI LAILATUL LATIFAH 18047056 19 6964
DR. RIADHI YULIANTO SP.B. 0122R0020219V001189 0002499810568 3;JKN
1#0##0#0#0.0#2019-02-15 10:32:06#0#19:10:00#20:37:00#00:00:00 1
3ca64cea73bb0627867643db78ff82fb 706525 1825000 170000 0
0 0 0 385125 0 0 210000 0 378921 316759
30000 0 0 0
3206023 C 3 CP 1 31/01/2019 08/02/2019 25/05/2005 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 2512626 0 9 0 0 0 NISA ARMELIA
4 268318 1#0##0#0#0.0#2019-02-15
10:35:42#0#12:55:00#11:02:00#00:00:00 1 2f8569cd1b4f56e7c673549241c0338d
605000 0 445000 0 0 0 130000 157625 0
0 630000 0 294628 115813 100000 34560 0 0
3206023 C 3 CP 1 05/02/2019 08/02/2019 19/08/1985 0 2
1 K80.4 - - - None None None None B-4-14-I None None
None None None None GANGGUAN SALURAN EMPEDU LAIN-LAIN (RINGAN)
3118700 0 0 - 0 - 0 - 0 - 0
3118700 3657542 0 4 0 0 0 EROS ROSITA 19056236
4 268322 1#0##0#0#0.0#2019-02-15
10:39:11#0#17:16:00#11:51:00#00:00:00 1 385087a72ea7eaba37a4e94d8d3be4f1
813500 0 215000 0 0 0 335000 160625 0
0 350000 0 1660407 83010 40000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 01/01/1970 0 2
1 C50.9;D63.0 99.04 - - None None None None L-4-11-II None
None None None None None TUMOR PAYUDARA (SEDANG) 3653700 0 0
- 0 - 0 - 0 - 0 3653700 1145248 0
3 0 0 0 SUTIRAH, NY 17021792 49 17933 dr. Riadhi
Yulianto Sp.B. 0122R0020219V001149 0000432678802 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268328 1#0##0#0#0.0#2019-
02-15 10:50:06#0#13:27:00#20:36:00#00:00:00 1
d0cfdf41192600fd6fe1284a27d6358b 350000 0 150000 0 0
0 0 206600 0 0 210000 0 165042 33606 30000
0 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 15/08/1957 0 2
None None None None None PERDARAHAN INTRA KRANIAL BUKAN TRAUMATIK
(SEDANG) 3826700 0 0 - 0 - 0 - 0 - 0
3826700 2896315 0 5 0 0 0 TITI 14002800 61
1#0##0#0#0.0#2019-02-15 10:50:52#0#15:13:00#10:45:00#00:00:00 1
fea6ccd9e915044a4647bdc58e563a43 452500 0 200000 0 0
0 950000 70125 0 0 350000 0 730767 42923 100000
0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 18/08/1970 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 3363268 0 3 0 0 0 JUJU 18048443
48 17704 DR. RIADHI YULIANTO SP.B. 0122R0020219V001193
4 268333 1#0##0#0#0.0#2019-02-15
10:54:42#0#20:14:00#20:34:00#00:00:00 1 384a077ba72dad0c4a48e4aa1b7e36b5
680025 1573750 170000 0 0 0 0 70125 0 0
210000 0 390796 238572 30000 0 0 0
3206023 C 3 CP 1 05/02/2019 08/02/2019 10/11/1990 0 2
None None None None PROSEDUR PADA RAHIM & ADNEKSA (RINGAN) 6136900
0 0 - 0 - 0 - 0 - 0 6136900
4791459 0 4 0 0 0 YETI SUMIATI 18051235 28
5.3.6.201902021030 4 268336 1#0##0#0#0.0#2019-02-15
10:57:51#0#15:57:00#12:51:00#00:00:00 1 30408ef2e104a48c58d797a62b7ad69a
434500 1825000 170000 0 0 0 0 514975 0
0 280000 0 524005 982979 60000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 06/03/1964 0 2
0 - 0 - 0 - 0 - 0 4853300 5082558
0 3 0 0 0 IYAR 18048659 54 20060 DR. RIADHI
YULIANTO SP.B. 0122R0020219V001161 0002611436747 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268337 1#0##0#0#0.0#2019-
02-15 10:58:52#0#15:26:00#20:34:00#00:00:00 1
e77aa44c220b1f33364f46340a7e8ce4 701525 1825000 170000 0
0 0 0 340125 0 0 210000 0 307303
1498605 30000 0 0 0
3206023 C 3 CP 1 07/02/2019 08/02/2019 10/06/1996 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3802277 0 2 0 0 0 NIA KURNIASIH
Huda;3278057010840004 5.3.6.201902021030 4 268339 1#0##0#0#0.0#2019-
02-15 11:04:25#0#15:49:00#12:50:00#00:00:00 1
a5c1e939f3446ac3c8cee1e69c1dfb11 418000 2068906 70000 0 0
0 0 225200 0 0 140000 0 640741 219430
20000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 03/04/1988 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2770805 0 3 0 0 0 MARYAM 19056415 30 11266
DR. DAMARIZQA DARA SJAHRUDDIN, SP.OG 0122R0020219V001202
4 268343 1#0##0#0#0.0#2019-02-15
11:08:09#0#23:32:00#13:52:00#00:00:00 1 d37be6011aa05cd3ec25fbab7cf1c082
1762500 0 120000 0 0 0 0 386375 0 0
210000 0 93090 178840 20000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 03/04/1964 0 2
0 0 - 0 - 0 - 0 - 0 6433000
4185445 0 3 0 0 0 MADIN B 18049734 54 20032
dr. Teguh Budiman Sp.Ma. 0122R0020219V001186 0000436026262 3;JKN
1#0##0#0#0.0#2019-02-15 11:11:03#0#18:37:00#14:20:00#00:00:00 1
4584c8bbd0d83c6561257a095a924e89 344434 2125000 150000 0
0 0 0 171500 0 0 210000 0 94057 1030454
60000 0 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 03/02/2019 3500 2
1 P59.9;P21.9;P36.9 99.83;93.90 - - None None None None P-8-
17-II None None None None None None NEONATAL, BBL > 2499 GR TANPA PROSEDUR
MAYOR (SEDANG) 5987500 0 0 - 0 - 0 - 0 -
0 5987500 2833867 0 5 0 0 0 BY NY WIWIN
WIDIYAWATI 19056102 0 1 DR. MARTE ROBIUL SANI SP.A.
Huda;3278057010840004 5.3.6.201902021030 4 268326 1#0##0#0#0.0#2019-
02-15 11:17:42#0#06:30:00#08:05:00#00:00:00 1
fd478072243c9a89d0f45a4264a88227 1175000 0 350000 0 0
0 0 271500 0 0 750000 0 72545 214822 0
0 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 14/09/1984 0 2
10-II None None None None None None OPERASI PEMBEDAHAN CAESAR (SEDANG)
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5414772 0 5 0 0 0 YANI HERLINA
5.3.6.201902021030 4 268306 1#0##0#0#0.0#2019-02-16
08:52:41#0#17:08:00#13:00:00#00:00:00 3 4a5ddfda1e9e6f4c72e9c004983f8a63
1277000 2137750 260000 0 0 0 0 301375 0
0 350000 0 473169 565478 50000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 12/02/1962 0 2
0 0 - 0 - 0 - 0 - 0 6433000
4120807 0 3 0 0 0 NANI 18050073 56 20813 dr.
Teguh Budiman Sp.Ma. 0122R0020219V001165 0000432501772 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268348 1#0##0#0#0.0#2019-
02-16 08:56:59#0#16:02:00#14:20:00#00:00:00 1
a8cefa81fa92951d21f484cf573127ad 364434 2125000 150000 0
0 0 0 103875 0 0 210000 0 94057 1023441
50000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 04/08/1963 0 2
0 0 - 0 - 0 - 0 - 0 6433000
4195721 0 3 0 0 0 ELAN 17021809 55 20275 dr.
Teguh Budiman Sp.Ma. 0122R0020219V001800 0002500344628 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268349 1#0##0#0#0.0#2019-
02-16 09:01:32#0#16:43:00#14:21:00#00:00:00 1
f2507464d6a96861179c612dd7d67c1f 324434 2125000 150000 0
0 0 0 185125 0 0 210000 0 125307
1015855 60000 0 0 0
3206023 C 2 CP 1 06/02/2019 08/02/2019 14/08/1996 0 2
(SEDANG) 6122400 0 0 - 0 - 0 - 0 - 0
6122400 5471368 0 3 0 0 0 TIA SETIAWATI
4 268354 1#0##0#0#0.0#2019-02-16
09:44:54#0#00:55:00#12:50:00#00:00:00 1 649b1cc5440aa4ff03e85391fb5b1bb1
1020750 2468000 90000 0 0 0 0 311875 0 0
375000 0 585812 579931 40000 0 0 0
3206023 C 3 CP 1 05/02/2019 08/02/2019 12/07/1979 0 2
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5314624 0 4 0 0 0 YULI NURHAYANI
4 268357 1#0##0#0#0.0#2019-02-16
09:54:58#0#19:20:00#12:48:00#00:00:00 1 969753ee9aa1e880c9dd2f4a3e876035
1249500 2137750 310000 0 0 0 0 325500 0
0 280000 0 424259 547615 40000 0 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 20/06/1992 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5261505 0 5 0 0 0 LISNAWATI 19056215
1#0##0#0#0.0#2019-02-16 10:02:27#0#21:37:00#12:49:00#00:00:00 1
4dd3cf0c1cf846c2219e9e848381758d 1262000 2137750 210000 0
0 0 0 281500 0 0 350000 0 386230 584025
50000 0 0 0
3206023 C 3 CP 1 02/02/2019 08/02/2019 24/04/1983 0 2
1 O14.1;Z37.0;O82.9;E87.6;E88.0 74.99 - - None None None None
(SEDANG) 5102000 0 0 - 0 - 0 - 0 - 0
5102000 15505785 0 7 0 0 0 ENDE 19056030 35
4 268362 1#0##0#0#0.0#2019-02-16
10:08:36#0#13:42:00#19:42:00#00:00:00 1 c5a31a10898a401c6d8890039b9bdd55
3420375 2756250 815000 0 0 0 0 2659050 0
0 755000 410000 3352851 835259 70000 432000 0
0
3206023 C 3 CP 1 06/02/2019 08/02/2019 24/04/1995 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1941324 0 3 0 0 0 LINA APRILIANTI 19056329 23
1#0##0#0#0.0#2019-02-16 10:20:28#0#16:13:00#15:38:00#00:00:00 1
0488cce919380b4eacd0c4d021df8e48 1105000 0 100000 0 0
0 0 0 0 0 210000 0 375697 120627 30000
0 0 0
3206023 C 3 CP 1 05/02/2019 08/02/2019 20/11/1997 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1379599 0 4 0 0 0 AI NURFITRI 19056250
4 268370 1#0##0#0#0.0#2019-02-16
10:24:16#0#16:13:00#16:30:00#00:00:00 1 3a94bcc4df0cf7e0befd17f4c27961d9
407500 0 120000 0 0 0 0 305500 0 0
280000 0 185970 40629 40000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 18/02/1997 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5388783 0 3 0 0 0 CUCU UTARI 16021464
1#0##0#0#0.0#2019-02-16 10:32:28#0#10:23:00#12:47:00#00:00:00 1
406fcc6d8ed753d6d6b06e95c088db8a 1112000 2137750 260000 0
0 0 0 347600 0 0 210000 0 506492 774941
40000 0 0 0
3206023 C 2 CP 1 06/02/2019 08/02/2019 18/07/1960 0 2
1 D69.3;D64.9;I10 99.04 - - None None None None D-4-11-II
None None None None None None GANGGUAN PEMBEKUAN DARAH (SEDANG)
6473700 0 0 - 0 - 0 - 0 - 0
6473700 2413557 0 3 0 0 0 YAYAT NURHAYATI, NY
Aeni;3206276601940002 5.3.6.201902021030 4 268384 1#0##0#0#0.0#2019-
02-16 10:54:41#0#10:45:00#19:50:00#00:00:00 1
25b7248c3a8d0faa9553c05ebd752aed 398500 0 210000 0 0
0 0 1349425 0 0 375000 0 50632 0 30000 0
0 0
3206023 C 3 CP 1 07/02/2019 08/02/2019 25/11/1983 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3575940 0 2 0 0 0 RINI NOPIANI
Aeni;3206276601940002 5.3.6.201902021030 4 268389 1#0##0#0#0.0#2019-
02-18 08:41:26#0#06:16:00#12:51:00#00:00:00 1
fbd79619d22426cdeb6b67dd4034cbe4 593000 2032812 140000 0
0 0 0 301375 0 0 140000 0 200447 138306
30000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 29/06/1944 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 2668742 0 3 0 0 0 EJE ZENAL MUTTAQIN, TN
Aeni;3206276601940002 5.3.6.201902021030 4 268394 1#0##0#0#0.0#2019-
02-18 08:47:20#0#15:08:00#16:51:00#00:00:00 1
2dba099dbdf2d4879d21dbd5d7879e6c 1198500 0 100000 0 0
0 140000 87200 0 0 210000 0 763339 70583 30000
69120 0 0
3206023 C 3 CP 1 07/02/2019 08/02/2019 18/01/1981 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1353575 0 2 0 0 0 DEDE AWAN HERMANSYAH
Aeni;3206276601940002 5.3.6.201902021030 4 268396 1#0##0#0#0.0#2019-
02-18 08:53:53#0#10:47:00#16:16:00#00:00:00 1
3aa33a8cd40ce4bb96c63e72b7a6be6e 388500 0 100000 0 0
0 0 222875 0 0 140000 0 371625 70575 60000
0 0 0
3206023 C 3 CP 1 05/02/2019 08/02/2019 27/07/1988 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1841139 0 4 0 0 0 YULIANTI 17009862
5.3.6.201902021030 4 268398 1#0##0#0#0.0#2019-02-18
08:58:20#0#16:23:00#11:47:00#00:00:00 1 795c5405fb16180a5eac2bd5691152e2
473500 0 120000 0 0 0 0 318000 0 0
280000 0 411987 187652 50000 0 0 0
3206023 C 1 CP 1 01/02/2019 08/02/2019 13/05/1950 0 2
1 I21.4;D72.8 - - - None None None None I-4-10-II None
None None None None None INFARK MYOKARD AKUT (SEDANG) 7280100 0
0 - 0 - 0 - 0 - 0 7280100 11722450
0 8 0 0 0 MAIL 19055930 68 25101 dr. H. Dani Farid
Aeni;3206276601940002 5.3.6.201902021030 4 268360 1#0##0#0#0.0#2019-
02-18 09:42:06#0#09:28:00#11:31:00#00:00:00 1
ed3cb675141afaa67c4ba71544479254 2912500 0 1385000 0 15000
0 0 359625 0 0 205000 1410000 3725791 603494
90000 1016040 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 27/03/1957 0 2
1 R13;D72.8 - - - None None None None K-4-18-I None
1242600 0 0 - 0 - 0 - 0 - 0
1242600 1738764 0 5 0 0 0 A MUNAWAROH 17004976
61 22594 DR. NURUL SITI MARDIAH, SP.B 0122R0020219V000677
5.3.6.201902021030 4 268402 1#0##0#0#0.0#2019-02-18
09:47:32#0#16:16:00#09:23:00#00:00:00 2 19f7391c2ed950ff6bb771d8629e3d01
667500 0 250000 0 0 0 0 103875 0 0
350000 0 225730 81659 60000 0 0 0
3206023 C 3 CP 1 29/01/2019 08/02/2019 17/07/1949 0 2
1 L03.1;A41.9;N17.9 86.22 - - None None None None L-4-12-III
None None None None None None PERADANGAN KULIT/CELLULITIS (BERAT)
4417100 0 0 - 0 - 0 - 0 - 0
4417100 9853389 0 11 0 0 0 TOHA KUSDIANA
Aeni;3206276601940002 5.3.6.201902021030 4 268388 1#0##0#0#0.0#2019-
02-18 09:51:10#0#07:31:00#18:04:00#00:00:00 2
31bd07a48606675284794b89508ad8d2 898000 1846000 420000 0
0 0 450000 574450 0 0 700000 0 3802042
1052897 110000 0 0 0
3206023 C 3 CP 1 01/02/2019 08/02/2019 10/09/1978 0 2
1 I84.9;D64.9 99.04 - - None None None None K-4-18-II None
None None None None None GANGGUAN SISTEM PENCERNAAN LAIN-LAIN (SEDANG)
1765800 0 0 - 0 - 0 - 0 - 0
1765800 4649640 0 8 0 0 0 NURHAYATI 19055975
5.3.6.201902021030 4 268386 1#0##0#0#0.0#2019-02-18
09:52:19#0#16:57:00#10:28:00#00:00:00 2 e6c9142680d3d21d99f9f1c9f6792fe9
727500 0 300000 0 0 0 0 2369275 0 0
630000 0 496943 45922 80000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 01/07/1940 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3362042 0 3 0 0 0 UDIN 18051754 78
268658 1#0##0#0#0.0#2019-02-19 13:34:19#0#20:05:00#14:22:00#00:00:00
1 1b6f83f960f795883cf5db2c2921d695 353000 1573750 170000
0 0 0 0 166375 0 0 210000 0 361788
497129 30000 0 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 25/08/1969 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 5534143 0 5 0 0 0 DIDIN JAMALUDIN
5.3.6.201902021030 4 268664 1#0##0#0#0.0#2019-02-19
13:38:58#0#23:01:00#14:21:00#00:00:00 1 1650ece5e3d9985df333a7f739735337
962000 2137750 190000 0 0 0 140000 514750
0 0 350000 0 383508 796135 60000 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 13/04/1958 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3472194 0 3 0 0 0 MASKAT 18051763
5.3.6.201902021030 4 268680 1#0##0#0#0.0#2019-02-19
14:02:59#0#17:57:00#14:22:00#00:00:00 1 8b377e602b5c184019ee1630d172812f
463000 1573750 100000 0 0 0 0 103875 0
0 210000 0 0 1001569 20000 0 0 0
3206023 C 3 CP 1 08/02/2019 08/02/2019 10/12/1970 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1435887 0 1 0 0 0 ELI WARLIAH 19056622
5.3.6.201902021030 4 268696 1#0##0#0#0.0#2019-02-19
14:16:03#0#13:27:00#16:24:00#00:00:00 1 17706dcff68f1b2beaccaed69648f1c9
253500 0 50000 0 0 0 140000 178375 0 0
70000 0 300308 443704 0 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 16/08/2008 0 2
2186200 0 0 - 0 - 0 - 0 - 0
2186200 4080314 0 3 0 0 0 ADITYA HERDIANSYAH
5.3.6.201902021030 4 268700 1#0##0#0#0.0#2019-02-20
08:13:48#0#16:48:00#13:45:00#00:00:00 2 0bcf59d0088c56da2a500c76ffef7af1
601525 1825000 120000 0 0 0 0 350000 0
0 210000 0 341662 632127 0 0 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 20/07/2009 0 2
1 J35.0 28.2 - - None None None None U-1-15-I None None
None None None None PROSEDUR TONSIL & ADENOID (RINGAN) 3549300 0
0 - 0 - 0 - 0 - 0 3549300 3292117
0 3 0 0 0 REVI RIANA PUTRA 19054914 9 3488 dr. M
Sidik Hasanudin Sp.THT-KL 0122R0020219V001170 0000432291183 3;JKN Santi
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 268316
1#0##0#0#0.0#2019-02-20 09:57:20#0#16:33:00#13:08:00#00:00:00 1
f80c101f8ca367287e5f3ac7f60aca12 561525 1825000 120000 0
0 0 0 0 0 0 210000 0 343162 192430
40000 0 0 0
3206023 C 3 CP 1 04/02/2019 08/02/2019 04/05/1928 0 2
4 G93.4;A41.9 89.52 - - None None None None G-4-21-III None
None None None None None KOMA & STUPOR NON TRAUMA (BERAT) 3976400
0 0 - 0 - 0 - 0 - 0 3976400
3605725 0 5 0 0 0 ENDOS 19056209 90 33148 DR. H.
DANI FARID ABDULLAH SP.PD 0122R0020219V000747 0000435142449 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268379
1#0##0#0#0.0#2019-03-12 10:49:45#0#16:08:00#17:34:00#00:00:00 3
5e41a4ee700707cecd908f949f5a17e9 892500 0 100000 0 0
0 0 447500 0 0 280000 0 1586656 145389
50000 103680 0 0
3206023 C 3 CP 1 06/02/2019 08/02/2019 31/12/1967 0 2
4 K56.6;N17.9;E87.1 54.19;86.11;96.71 - - None None None None
LAIN-LAIN (BERAT) 10811600 0 0 - 0 - 0 - 0 -
0 10811600 12980572 0 3 0 0 0 NY YANI
5.3.6.201902021030 4 270621 1#0##0#0#0.0#2019-03-12
11:38:02#0#22:30:00#13:21:00#00:00:00 1 760917a0560f7ab461b417410381be7d
4014050 2277500 350000 0 0 0 340000 1606752
0 0 345000 205000 1638450 1991020 40000 172800
0 0
3206023 C 1 CP 1 06/02/2019 08/02/2019 20/02/1944 0 2
None None None None None PROSEDUR LENSA DAN INTRA OKULER (RINGAN)
9006300 0 0 - 0 - 0 - 0 - 0
9006300 4740159 0 3 0 0 0 YAHYA 17015616 74
27380 DR. TEGUH BUDIMAN SP.MA. 0122R0020219V001071 0000070478199
268214 1#0##0#0#0.0#2019-03-14 11:18:41#0#10:16:00#11:39:00#00:00:00
2 0ea867fa2367928378e6d894e4dcc6b9 419434 2915000 300000
0 0 0 0 183500 0 0 540000 0 303867
38358 40000 0 0 0
3206023 C 3 CP 1 05/02/2019 09/02/2019 01/01/1969 0 1
1 N40 60.69 - - None None None None V-1-13-I None None
None None None None PROSEDUR PADA SKROTUM DAN PROSTAT NON KOMPLEK
(RINGAN) 3346700 0 0 - 0 - 0 - 0 - 0
3346700 5527129 0 5 0 0 0 YAYAN 18050326 50
268303 1#0##0#0#0.0#2019-02-15 10:08:08#0#15:43:00#13:00:00#00:00:00
1 72d4c70e9277ef6f9d8c1487f2ceac8e 754500 1825000 240000
0 0 0 0 373875 0 0 350000 0 1009809
943945 30000 0 0 0
3206023 C 3 CP 1 04/02/2019 09/02/2019 14/01/1952 0 2
1 E11.4;G63.2;N18.9 - - - None None None None G-4-17-II
None None None None None None GANGUAN SARAF KRANIAL DAN PERIFER
(SEDANG) 4379200 0 0 - 0 - 0 - 0 - 0
4379200 2494387 0 6 0 0 0 ATENG 18036712 67
5.3.6.201902021030 4 268309 1#0##0#0#0.0#2019-02-15
10:20:39#0#21:55:00#08:02:00#00:00:00 1 5f91ff008c5bd334e75e43895f08770d
428500 0 195000 0 0 0 0 308500 0 0
420000 0 987371 85016 70000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 03/05/2016 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 2999996 0 3 0 0 0 AGAM FATHUL ANUGRAH
5.3.6.201902021030 4 268465 1#0##0#0#0.0#2019-02-18
10:47:05#0#18:22:00#10:45:00#00:00:00 1 2b065a64d73f40dd232021d0837bd8e9
550025 1573750 70000 0 0 0 0 0 0 0 210000
0 206161 370060 20000 0 0 0
3206023 C 3 CP 1 30/01/2019 09/02/2019 01/07/1966 0 2
1 D64.9;D69.6 99.04 - - None None None None D-4-13-II None
None None None None None GANGGUAN SEL DARAH MERAH SELAIN KRISIS ANEMIA
SEL SICKLE (SEDANG) 3139300 0 0 - 0 - 0 - 0
- 0 3139300 4797083 0 11 0 0 0 ASIH
Aeni;3206276601940002 5.3.6.201902021030 4 268472 1#0##0#0#0.0#2019-
02-18 11:23:10#0#20:50:00#17:10:00#00:00:00 1
bef8112546aa2503df2f70bfbf9cbb30 943500 0 450000 0 0
0 0 1034550 0 0 770000 0 1049745 367448
130000 51840 0 0
3206023 C 2 CP 1 06/02/2019 09/02/2019 26/04/1994 0 2
1 O32.1;Z37.0;O82.0;O28.3;O48;O41.0 74.99 - - None None None
CAESAR (RINGAN) 5796300 0 0 - 0 - 0 - 0 -
0 5796300 5287331 0 4 0 0 0 LIS SULASTRI
5.3.6.201902021030 4 268495 1#0##0#0#0.0#2019-02-18
12:44:47#0#16:58:00#11:07:00#00:00:00 1 392e1f6fc16be4daace589968dcbd68a
969500 2105000 300000 0 0 0 0 401750 0
0 500000 0 420840 560241 30000 0 0 0
3206023 C 2 CP 1 07/02/2019 09/02/2019 20/12/1998 0 2
(RINGAN) 1988600 0 0 - 0 - 0 - 0 - 0
1988600 3171897 0 3 0 0 0 RINA RANIASIH
5.3.6.201902021030 4 268496 1#0##0#0#0.0#2019-02-18
12:57:24#0#19:11:00#11:06:00#00:00:00 1 86813a6df3e1dc571c766ea667d7e557
318000 1875000 180000 0 0 0 0 171100 0
0 375000 0 165061 67736 20000 0 0 0
3206023 C 2 CP 1 08/02/2019 09/02/2019 01/07/1976 0 2
LAIN (SEDANG) 4700700 0 0 - 0 - 0 - 0 -
0 4700700 2144548 0 2 0 0 0 SURYATI, NY
Aeni;3206276601940002 5.3.6.201902021030 4 268497 1#0##0#0#0.0#2019-
02-18 13:06:13#0#12:18:00#12:44:00#00:00:00 1
7942aab3182c665485e9c2b422a56f0d 721710 0 100000 0 0
0 0 941325 0 0 140000 0 155504 56009 30000
0 0 0
3206023 C 3 CP 1 08/02/2019 09/02/2019 02/07/1980 0 2
0 0 - 0 - 0 - 0 - 0 1828500
3020441 0 2 0 0 0 MAMAH MARYAMAH 19056594 38
1#0##0#0#0.0#2019-02-18 13:19:49#0#08:50:00#12:42:00#00:00:00 1
8f37841bbe0c76c88650a50a59960c21 2242500 0 70000 0 0 0
0 311875 0 0 140000 0 70434 165632 20000 0
0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 18/04/2002 0 2
1 O62.0;O98.8;O99.0 99.04 - - None None None None W-4-16-II
0 0 - 0 - 0 - 0 - 0 2674300
3190747 0 3 0 0 0 IKHFA LISTAMAYA 19054364 16
5.3.6.201902021030 4 268505 1#0##0#0#0.0#2019-02-18
13:33:32#0#11:15:00#13:59:00#00:00:00 1 9d12afd28c9eb5fbb08a160fc5fe9b2f
650000 0 100000 0 0 0 0 1247425 0 0
210000 0 681719 22403 20000 259200 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 15/08/1996 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4922172 0 3 0 0 0 LISNA AGUSTINA
Aeni;3206276601940002 5.3.6.201902021030 4 268509 1#0##0#0#0.0#2019-
02-18 13:51:16#0#23:36:00#14:00:00#00:00:00 1
52a31f2cec0a2a5dc764f4aa231ca97b 1314500 2137750 190000 0
0 0 0 225875 0 0 210000 0 393368 420679
30000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 12/10/1983 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 2843485 0 3 0 0 0 EHA JULAEHA 19056549
5.3.6.201902021030 4 268513 1#0##0#0#0.0#2019-02-18
13:59:12#0#15:04:00#14:00:00#00:00:00 1 d5006e4eee598097a2f325093e58744e
870000 0 120000 0 0 0 0 389550 0 0
210000 0 448630 765305 40000 0 0 0
3206023 C 3 CP 1 06/02/2019 09/02/2019 13/10/1995 0 2
1 O30.0;O32.2;Z37.2;O82.1 74.99 - - None None None None O-6-
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5285837 0 4 0 0 0 RISMA YULIANA
5.3.6.201902021030 4 268517 1#0##0#0#0.0#2019-02-19
08:18:00#0#17:12:00#11:08:00#00:00:00 1 57c6319980179196078013b8e608e410
1324500 1825000 310000 0 0 0 0 420975 0
0 280000 0 526995 568367 30000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 01/11/1985 0 2
- 0 - 0 - 0 - 0 1585400 2693483 0
3 0 0 0 JUJU JUARIAH 19056172 33 12151 dr. Asep
Taslim Sp.OG 0122R0020219V001624 0002600375782 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268521 1#0##0#0#0.0#2019-
02-19 08:26:23#0#17:52:00#11:09:00#00:00:00 1
2560e1a98618d4c459ba16e9b1b525f7 313000 1626250 140000 0
0 0 0 171100 0 0 210000 0 175576 37557
20000 0 0 0
3206023 C 3 CP 1 08/02/2019 09/02/2019 27/08/1990 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2368343 0 2 0 0 0 SRI MULYANI 16004555 28 10392
dr. Asep Taslim Sp.OG 0122R0020219V001894 0000435099341 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268524
1#0##0#0#0.0#2019-02-19 08:37:29#0#16:49:00#12:41:00#00:00:00 1
7f9688b869cf234f4d5fc8a75dd45b2f 1457500 0 70000 0 0 0
0 391500 0 0 140000 0 76861 212482 20000 0
0 0
3206023 C 3 CP 1 06/02/2019 09/02/2019 22/08/1997 0 2
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 4977779 0 4 0 0 0 SONIA AZKIYATUS SELMA
5.3.6.201902021030 4 268526 1#0##0#0#0.0#2019-02-19
08:44:05#0#17:15:00#11:10:00#00:00:00 1 36ef121fe1515dca1be0972b7f624be5
1097000 1825000 240000 0 0 0 0 401750 0
0 280000 0 515667 588362 30000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 12/07/1956 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3356056 0 3 0 0 0 KARSIDI 19052935
5.3.6.201902021030 4 268536 1#0##0#0#0.0#2019-02-19
09:03:37#0#19:50:00#12:20:00#00:00:00 1 71877dd676d132cae4cf0b1c704a2bd2
433000 1573750 170000 0 0 0 0 83100 0 0
210000 0 213091 653115 20000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 09/02/1969 0 2
1 Z03.1 86.3 - - None None None None L-1-40-I None None
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 6201068 0 3 0 0 0 POPO AHMAD PAUJI
5.3.6.201902021030 4 268539 1#0##0#0#0.0#2019-02-19
09:10:15#0#18:45:00#12:21:00#00:00:00 1 f5ec08da640ff497f82628777fb71596
1044050 2592500 170000 0 0 0 0 471100 0
0 210000 0 464939 1228479 20000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 07/03/1996 0 2
0 - 0 - 0 - 0 - 0 4853300 4198349
0 3 0 0 0 MALA NURMALASARI 18049000 22 8372 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268544
1#0##0#0#0.0#2019-02-19 09:17:20#0#18:51:00#12:21:00#00:00:00 1
a385d4aa7b29b3418a7b63e6911ab1e0 716525 1825000 170000 0
0 0 0 256100 0 0 210000 0 483012 507712
30000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 18/06/1950 0 2
1 Z51.1;C20 99.25 - - None None None None C-4-13-I None
None None None None None KEMOTERAPI (RINGAN) 1645900 0 0
- 0 - 0 - 0 - 0 1645900 2092893 0
3 0 0 0 SALIM SUTISNA 18049924 68 25071 dr. Riadhi
Yulianto Sp.B. 0122R0020219V001411 0000430070016 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268547 1#0##0#0#0.0#2019-
02-19 09:22:36#0#08:53:00#12:59:00#00:00:00 1
fb0680dcbb5c06a9eb56403745302bfc 1400000 0 150000 0 0
0 0 0 0 0 210000 0 185845 127048 20000
0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 04/05/1976 0 2
1 E87.6;E83.5 - - - None None None None E-4-11-II None
None None None None None HIPOVOLEMIA & GANGGUAN ELEKROLIT (SEDANG)
3345300 0 0 - 0 - 0 - 0 - 0
3345300 1450600 0 3 0 0 0 RAHMAT ROHIMAT
Aeni;3206276601940002 5.3.6.201902021030 4 268549 1#0##0#0#0.0#2019-
02-19 09:27:22#0#19:30:00#12:45:00#00:00:00 1
531a53f72956517194278cfef265d5ba 453500 0 100000 0 0
0 0 475850 0 0 210000 0 127245 74005 10000
0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 08/09/1960 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3439358 0 3 0 0 0 HAPID 19052995 58
268564 1#0##0#0#0.0#2019-02-19 10:09:24#0#17:14:00#12:54:00#00:00:00
1 087307b665604b6f3a9b191152e86768 433000 1573750 170000
0 0 0 0 185125 0 0 210000 0 251533
595950 20000 0 0 0
3206023 C 3 CP 1 06/02/2019 09/02/2019 03/09/1948 0 2
1 K40.9;D64.9 99.04;53.00 - - None None None None K-1-14-II
None None None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL
(SEDANG) 5307800 0 0 - 0 - 0 - 0 - 0
5307800 6205750 0 4 0 0 0 ULOH SAEPULOH
5.3.6.201902021030 4 268569 1#0##0#0#0.0#2019-02-19
10:26:45#0#18:16:00#12:59:00#00:00:00 1 467e08a94d93e3fd9929e86e2fb6d9e5
747000 1825000 220000 0 0 0 140000 1497700
0 0 280000 0 680982 775068 40000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 24/06/2011 0 2
1406200 0 0 - 0 - 0 - 0 - 0
1406200 985403 0 3 0 0 0 SALSABILA NURASYIFA
5.3.6.201902021030 4 268571 1#0##0#0#0.0#2019-02-19
10:32:04#0#20:23:00#12:12:00#00:00:00 1 b39e712a5faa506e64ffba60addb3e03
287500 0 100000 0 0 0 0 133000 0 0
210000 0 187916 46987 20000 0 0 0
3206023 C 3 CP 1 06/02/2019 09/02/2019 12/03/2018 0 2
1 A16.2 87.44;93.94 - - None None None None J-4-15-I None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1635185 0 4 0 0 0 M MUTAQIN 19056401
5.3.6.201902021030 4 268573 1#0##0#0#0.0#2019-02-19
10:38:22#0#17:23:00#12:13:00#00:00:00 1 71b23b6758ddafa78be0603a2c04bf03
552500 0 150000 0 0 0 140000 103875 0
0 280000 0 211502 108188 20000 69120 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 01/07/1951 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3388811 0 3 0 0 0 SARIP 18050584 67
268575 1#0##0#0#0.0#2019-02-19 10:42:59#0#16:43:00#12:55:00#00:00:00
1 bdd1309a1793e9a705ec1a04ce41db38 433000 1573750 170000
0 0 0 0 208250 0 0 210000 0 234232
539579 20000 0 0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 23/03/1981 0 2
1 O98.8;A09.9 - - - None None None None W-4-16-I None
None None None None None GANGGUAN ANTEPARTUM (RINGAN) 1999800 0
0 - 0 - 0 - 0 - 0 1999800 1023520
0 3 0 0 0 EKI RATNAWATI 19056421 37 13835 dr. H.
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268577
1#0##0#0#0.0#2019-02-19 10:49:21#0#22:20:00#12:43:00#00:00:00 1
b331cb869e7c32c2026e4e903da61d31 313500 0 100000 0 0
0 0 70125 0 0 210000 0 283148 26747 20000 0
0 0
3206023 C 3 CP 1 07/02/2019 09/02/2019 17/07/2018 0 2
None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH (RINGAN)
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1500409 0 3 0 0 0 DILA NURFADILA
5.3.6.201902021030 4 268580 1#0##0#0#0.0#2019-02-19
10:55:06#0#22:48:00#10:45:00#00:00:00 1 3ba95ce68ba24e80812c7a630deb2da1
527500 0 100000 0 0 0 140000 103875 0
0 210000 0 237277 92637 20000 69120 0 0
3206023 C 3 CP 1 06/02/2019 09/02/2019 17/07/1998 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 6206417 0 4 0 0 0 DIANAWATI 17002106
268583 1#0##0#0#0.0#2019-02-19 11:00:03#0#17:03:00#11:11:00#00:00:00
1 9b06202ea0181e2edf6f0a4fa9f68027 1124000 2137750 290000
0 0 0 0 281500 0 0 280000 0 536819
1516348 40000 0 0 0
3206023 C 3 CP 1 05/02/2019 09/02/2019 01/03/1954 0 2
(SEDANG) 4976900 0 0 - 0 - 0 - 0 - 0
4976900 2804842 0 5 0 0 0 ENGKOS KOSASIH
19056267 64 23717 DR. INDRA GUNAWAN, SP.S 0122R0020219V001601
5.3.6.201902021030 4 268551 1#0##0#0#0.0#2019-02-19
11:05:57#0#05:57:00#11:12:00#00:00:00 2 e8d26cbac783969babbf7bc7c5ac9035
427500 0 150000 0 0 0 950000 70125 0 0
280000 0 813125 64092 50000 0 0 0
3206023 C 3 CP 1 02/02/2019 09/02/2019 20/06/1960 0 2
1 E11.5;I10;A41.9 84.01 - - None None None None M-1-80-III
None None None None None None PROSEDUR ANGGOTA TUBUH ATAS (BERAT)
16696900 0 0 - 0 - 0 - 0 - 0
16696900 6979708 0 8 0 0 0 DIAH 19056053 58
21411 DR. NURUL SITI MARDIAH, SP.B 0122R0020219V000321 0000435586206
268531 1#0##0#0#0.0#2019-02-19 11:08:06#0#00:43:00#13:00:00#00:00:00
2 af317ff31e2f3f1b33cb59136281f226 995500 1846000 270000
0 0 0 200000 1316925 0 0 490000 0
1266192 515091 80000 0 0 0
3206023 C 2 CP 1 05/02/2019 09/02/2019 02/06/1989 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 1609725 0 5 0 0 0 LAELY RIZKI UTAMI
Aeni;3206276601940002 5.3.6.201902021030 4 268485 1#0##0#0#0.0#2019-
02-19 11:12:03#0#00:15:00#11:12:00#00:00:00 2
790cbb291e65ca1daa2b56c09e30b38d 401000 0 210000 0 0
0 0 297450 0 0 500000 0 159309 1966 40000
0 0 0
3206023 C 2 CP 1 07/02/2019 09/02/2019 08/09/1967 0 2
4 C11.9;N17.9 54.19;99.60;89.52 - - None None None None K-1-
40-III None None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-
LAIN (BERAT) 12973900 0 0 - 0 - 0 - 0 -
0 12973900 7367987 0 3 0 0 0 IRWAN NURULOH
5.3.6.201902021030 4 268456 1#0##0#0#0.0#2019-03-12
13:03:08#0#21:20:00#20:37:00#00:00:00 1 d61022e61f7f4df5a7eed085bcddc9ee
1290050 3496750 90000 0 0 0 140000 384625 0
0 375000 0 503113 1068449 20000 0 0 0
3206023 C 3 CP 1 01/02/2019 09/02/2019 01/07/1970 0 2
1 A35;I63.9 - - - None None None None A-4-14-III None
None None None None None PENYAKIT INFEKSI BAKTERI DAN PARASIT LAIN-LAIN
(BERAT) 3048000 0 0 - 0 - 0 - 0 - 0
3048000 6105603 0 9 0 0 0 JAKA 19056004 48
1#0##0#0#0.0#2019-03-13 08:55:24#0#00:49:00#10:43:00#00:00:00 4
79f3ce13792e7f5a21079bfa24e6b4af 1192500 0 400000 0 0
0 0 260125 0 0 560000 0 3298375 314603
80000 0 0 0
3206023 C 3 CP 1 08/02/2019 09/02/2019 10/04/1972 0 2
1 Z49.1;D63.8;I13.2 99.04;39.95 - - None None None None N-4-
16-III None None None None None None PENYAKIT GINJAL DAN SALURAN URIN
LAIN-LAIN (BERAT) 5214200 0 0 - 0 - 0 - 0 -
0 5214200 1584037 0 2 0 0 0 MUPLIHAH
Aeni;3206276601940002 5.3.6.201902021030 4 273426 1#0##0#0#0.0#2019-
03-13 09:28:43#0#12:14:00#12:45:00#00:00:00 1
40e9a51557ee9ca61389775f054f5751 721710 0 50000 0 0 0
0 484200 0 0 140000 0 131071 47056 10000 0
0 0
3206023 C 3 CP 1 04/02/2019 10/02/2019 05/04/1965 0 2
1 J18.9;Z03.0;I50.0 87.44 - - None None None None J-4-16-II
(SEDANG) 4683100 0 0 - 0 - 0 - 0 - 0
4683100 2592213 0 7 0 0 0 DUDUD 19056096 53
5.3.6.201902021030 4 268458 1#0##0#0#0.0#2019-02-18
10:30:37#0#01:08:00#15:54:00#00:00:00 1 0c55810bdb94cfe67c2e6da1fa6fc4c7
668500 0 300000 0 0 0 140000 128875 0
0 490000 0 728319 56519 80000 0 0 0
3206023 C 3 CP 1 09/02/2019 10/02/2019 21/05/1990 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2388775 0 2 0 0 0 VIEN ROSITA 19056675 28 10491
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268522
1#0##0#0#0.0#2019-02-19 08:33:23#0#09:11:00#10:45:00#00:00:00 1
da80e757432af45dac9539ec05336e37 1660000 0 70000 0 0 0
0 281500 0 0 140000 0 70462 146813 20000 0
0 0
3206023 C 1 CP 1 09/02/2019 10/02/2019 23/02/1972 0 2
None None None None GASTRITIS & ULKUS PEPTIKUM (RINGAN) 2995300 0
0 - 0 - 0 - 0 - 0 2995300 1068775
0 2 0 0 0 ELI DAHLIA 19056677 46 17153 dr. H. Dani
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268704
1#0##0#0#0.0#2019-02-20 08:40:33#0#15:41:00#14:10:00#00:00:00 1
bfdc99952c376a459d6c7ebd07334f49 435000 0 0 0 0 0
0 103875 0 0 360000 0 96004 53896 20000 0 0
0
3206023 C 1 CP 1 07/02/2019 10/02/2019 08/09/1976 0 2
1 E04.1 06.39 - - None None None None E-1-20-I None None
- 0 7814200 8135498 0 4 0 0 0 DIDAH SITI
KALIMATUSADIAH 18047865 42 15492 dr. Riadhi Yulianto Sp.B.
Aeni;3206276601940002 5.3.6.201902021030 4 268706 1#0##0#0#0.0#2019-
02-20 08:47:24#0#19:07:00#15:00:00#00:00:00 1
445c3f668b6fe3189d722e942bd20f24 1331550 3080000 120000 0
0 0 0 1125075 0 0 720000 0 530999
1217874 10000 0 0 0
3206023 C 3 CP 1 06/02/2019 10/02/2019 28/08/1973 0 2
1 I12.0;D63.8 99.04;39.95 - - None None None None N-4-10-II
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 3883718 0 5 0 0 0 TN SOPYAN
Aeni;3206276601940002 5.3.6.201902021030 4 268716 1#0##0#0#0.0#2019-
02-20 09:07:52#0#22:28:00#11:20:00#00:00:00 1
ad313ad064fa1de671fdc28f966a0af2 658500 0 305000 0 843730
0 0 1355800 0 0 350000 0 228512 102176
40000 0 0 0
3206023 C 3 CP 1 04/02/2019 10/02/2019 18/04/2016 0 2
1 A16.2;D61.9;Q24.9;I51.9 99.04 - - None None None None J-4-
15-III None None None None None None PERADANGAN DAN INFEKSI PERNAFASAN
(BERAT) 6429000 0 0 - 0 - 0 - 0 - 0
6429000 3717383 0 7 0 0 0 ALULA SHAHIN LASHIRA
5.3.6.201902021030 4 268719 1#0##0#0#0.0#2019-02-20
09:17:35#0#15:41:00#14:12:00#00:00:00 1 32cb1e6f4f4d4f9c7c67987fd8e62dd5
877500 0 250000 0 0 0 140000 1410100 0
0 490000 0 264144 166519 50000 69120 0 0
3206023 C 3 CP 1 06/02/2019 10/02/2019 10/07/1955 0 2
(SEDANG) 4976900 0 0 - 0 - 0 - 0 - 0
4976900 4161309 0 5 0 0 0 WIWI 19056282 63
1#0##0#0#0.0#2019-02-20 09:22:22#0#07:14:00#23:40:00#00:00:00 1
eea077d7bcf193ae79dc9be5a1242098 832500 0 150000 0 0
0 950000 103875 0 0 350000 0 1598043 176891
0 0 0 0
3206023 C 3 CP 1 10/02/2019 10/02/2019 10/11/1966 0 2
4 N18.9;J81 99.60 - - None None None None N-4-10-III None
(BERAT) 4377800 0 0 - 0 - 0 - 0 - 0
4377800 1185081 0 1 0 0 0 DADAH SOLIHAT
Aeni;3206276601940002 5.3.6.201902021030 4 268735 1#0##0#0#0.0#2019-
02-20 09:56:52#0#13:42:00#15:10:00#00:00:00 1
46f094150088c15046d850b03d627440 487500 0 50000 0 0 0
0 339750 0 0 70000 0 15478 222353 0 0 0
0
3206023 C 3 CP 1 09/02/2019 10/02/2019 11/05/1984 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3016842 0 2 0 0 0 EPON WISUMIATI
5.3.6.201902021030 4 268740 1#0##0#0#0.0#2019-02-20
10:03:21#0#20:51:00#12:23:00#00:00:00 1 a32364d40fc5ef9440963e56ef8c43ff
338000 2032812 70000 0 0 0 0 202750 0 0
140000 0 117703 95577 20000 0 0 0
3206023 C 3 CP 1 08/02/2019 10/02/2019 21/04/1981 0 2
1 O99.0;D64.9 99.04 - - None None None None W-4-16-I None
0 - 0 - 0 - 0 - 0 1999800 2187939
0 3 0 0 0 ACAH 19056651 37 13807 dr. Asep Taslim
Sp.OG 0122R0020219V001900 0000433664998 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268742 1#0##0#0#0.0#2019-
02-20 10:08:22#0#19:53:00#20:05:00#00:00:00 1
0c5fd2aaa27757c7052ef9441219f417 565000 0 100000 0 0
0 0 849625 0 0 210000 0 77030 97084 30000 259200
0 0
3206023 C 3 CP 1 07/02/2019 10/02/2019 15/02/1982 0 2
1 O72.2;O82.2;Z37.1;O62.2;O99.0;O62.0 74.99;68.9 - - None None
None None W-1-20-II None None None None None None PROSEDUR PADA
RAHIM & ADNEKSA (SEDANG) 7668100 0 0 - 0 - 0 -
0 - 0 7668100 11177735 0 4 0 0 0 IDA
Aeni;3206276601940002 5.3.6.201902021030 4 268744 1#0##0#0#0.0#2019-
02-20 10:31:28#0#12:02:00#12:25:00#00:00:00 1
ce9bccfc396e17e9e8174c641dcf4ed7 1720000 3665000 350000 0
0 0 0 1194175 0 0 275000 275000 2135719
1063561 50000 449280 0 0
3206023 C 3 CP 1 09/02/2019 10/02/2019 02/02/2000 0 2
0 0 - 0 - 0 - 0 - 0 1544900
2821260 0 2 0 0 0 ENONG RUKOYAH 19056680 19
1#0##0#0#0.0#2019-02-20 10:42:40#0#12:31:00#10:47:00#00:00:00 1
d72730ed2832aa2c032e6df6c220a20c 1972500 0 70000 0 0 0
0 292250 0 0 140000 0 70311 256199 20000 0
0 0
3206023 C 3 CP 1 08/02/2019 10/02/2019 20/06/1962 0 2
1406200 0 0 - 0 - 0 - 0 - 0
1406200 1518324 0 3 0 0 0 BANAH RUKBANAH
Aeni;3206276601940002 5.3.6.201902021030 4 268761 1#0##0#0#0.0#2019-
02-20 10:47:27#0#20:49:00#11:42:00#00:00:00 1
730289920952056ebbdd3d7e6e6efda8 379500 0 100000 0 0
0 0 178375 0 0 210000 0 576144 44305 30000
0 0 0
3206023 C 3 CP 1 06/02/2019 10/02/2019 17/08/1996 0 2
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 1888142 0 5 0 0 0 SINTIA 19056424
5.3.6.201902021030 4 268764 1#0##0#0#0.0#2019-02-20
10:52:22#0#22:38:00#13:11:00#00:00:00 1 fc4eab7dcf400b3fc52ed38d8669136c
608500 0 220000 0 0 0 0 285425 0 0
350000 0 351886 22331 50000 0 0 0
3206023 C 3 CP 1 08/02/2019 10/02/2019 10/09/1964 0 2
1 E11.5 86.22;86.70;86.3 - - None None None None L-1-30-I
None None None None None None PEMINDAHAN KULIT TANPA LUKA BAKAR
(RINGAN) 6596700 0 0 - 0 - 0 - 0 - 0
6596700 4038756 0 3 0 0 0 DADAN BURHANUDIN
19056510 54 19874 DR. AA AHMAD DIMYATI, SP.B 0122R0020219V001908
5.3.6.201902021030 4 268728 1#0##0#0#0.0#2019-02-20
11:54:52#0#07:28:00#11:02:00#00:00:00 2 3d914e26cfe2a4a1edbb660b6aa99d77
539500 2137750 70000 0 0 0 0 0 0 0 140000
0 777674 343832 30000 0 0 0
3206023 C 1 CP 1 09/02/2019 10/02/2019 12/08/1962 0 2
1 J81;N18.9 - - - None None None None J-4-21-II None
None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM PERNAFASAN
LAIN-LAIN (SEDANG) 6001500 0 0 - 0 - 0 - 0
- 0 6001500 1221400 0 2 0 0 0 OOM
18050935 56 20635 dr. Mutiara Azhara Nurwanti 0122R0020219V001974
5.3.6.201902021030 4 267540 1#0##0#0#0.0#2019-03-01
08:46:42#0#22:49:00#19:43:00#00:00:00 1 86694dccf8f1135a520cb7ccddb2de06
227500 0 50000 0 0 0 0 178375 0 0 140000
0 248782 149383 20000 207360 0 0
3206023 C 1 CP 1 03/02/2019 10/02/2019 31/12/1935 0 2
4 N17.9;R57.2;G93.4 - - - None None None None N-4-10-III
GINJAL (BERAT) 6128900 0 0 - 0 - 0 - 0 -
0 6128900 8397176 0 8 0 0 0 HASANAH
Aeni;3206276601940002 5.3.6.201902021030 4 273212 1#0##0#0#0.0#2019-
03-12 13:40:40#0#21:23:00#19:56:00#00:00:00 1
7e315e9251438ea52229c8e98ddbf248 1970000 0 700000 0 30000
0 0 519150 0 0 1110000 0 2248724 264102
0 1555200 0 0
3206023 C 2 CP 1 07/02/2019 10/02/2019 30/10/1999 0 2
(RINGAN) 2511000 0 0 - 0 - 0 - 0 - 0
2511000 1789534 0 4 0 0 0 ASEP SAEPUL MILAH
Aeni;3206276601940002 5.3.6.201902021030 4 268713 1#0##0#0#0.0#2019-
03-14 10:50:32#0#21:33:00#11:01:00#00:00:00 2
a2a7b5e2d004859bc6b38dddffee4096 538500 0 190000 0 0
0 0 257875 0 0 280000 0 452269 40890 30000
0 0 0
3206023 C 3 CP 1 04/02/2019 10/02/2019 15/02/1982 0 2
1 O72.2;O62.0;O99.0;O62.2;Z37.1;O82.2 74.99;68.9 - - None None
None None W-1-20-II None None None None None None PROSEDUR PADA
RAHIM & ADNEKSA (SEDANG) 7668100 0 0 - 0 - 0 -
0 - 0 7668100 13316365 0 7 0 0 0 IDA
S.ST;3206297107870001 5.3.6.201902021030 4 274076 1#0##0#0#0.0#2019-
03-18 09:02:22#0#12:02:00#12:25:00#00:00:00 2
036c1b5adcf3179f232df95054402ab0 2307500 3665000 450000 0
0 0 0 2248650 0 0 485000 275000 2208588
1137347 90000 449280 0 0
3206023 C 3 CP 1 09/02/2019 10/02/2019 06/07/1994 0 2
None None None None GANGGUAN POSTPARTUM (RINGAN) 1475700 0 0
- 0 - 0 - 0 - 0 1475700 1326635 0
2 0 0 0 SITI SAODAH 19056676 24 8984 dr. Asep Taslim
Aeni;3206276601940002 5.3.6.201902021030 4 268782 1#0##0#0#0.0#2019-
03-18 09:31:50#0#09:52:00#12:29:00#00:00:00 1
e2299782c5359c622c82741ab15b60a3 810000 0 50000 0 0 0
0 103875 0 0 140000 0 0 202760 20000 0
0 0
3206023 C 1 CP 1 06/02/2019 11/02/2019 25/01/1951 0 2
None None None None ANGINA PEKTORIS DAN NYERI DADA (RINGAN) 4238000
0 0 - 0 - 0 - 0 - 0 4238000
6391591 0 6 0 0 0 H KUSNANDAR 19056306 68 24849
268723 1#0##0#0#0.0#2019-02-20 09:18:52#0#12:31:00#15:16:00#00:00:00
1 ae7700336ea6f7f7b54d44c5ff064365 1462500 0 500000 0
0 0 0 462575 0 0 1080000 0 2162919 135197
70000 518400 0 0
3206023 C 1 CP 1 10/02/2019 11/02/2019 06/07/1985 0 2
- 0 - 0 - 0 - 0 3605900 1897359 0
2 0 0 0 YENI NURYENI 19056710 33 12272 dr. H. Dani
Farid Abdullah Sp.PD 0122R0020219V001979 0002257990931 3;JKN Indriyanti
Yuda S, S.ST;3206297107870001 5.3.6.201902021030 4 268725
1#0##0#0#0.0#2019-02-20 09:23:05#0#02:24:00#15:17:00#00:00:00 1
5e6ed1e197e8cc6ca163b0d57ebf30cf 492500 0 200000 0 0
0 140000 178375 0 0 360000 0 195771 117913
40000 172800 0 0
3206023 C 1 CP 1 09/02/2019 11/02/2019 01/06/1988 0 2
2112800 0 0 - 0 - 0 - 0 - 0
2112800 1641634 0 3 0 0 0 YOGIE RIDWANSYAH
S.ST;3206297107870001 5.3.6.201902021030 4 268727 1#0##0#0#0.0#2019-
02-20 09:27:05#0#16:01:00#15:17:00#00:00:00 1
9a7980e75459b0b395213fd97fe7d573 467500 0 200000 0 0
0 0 266625 0 0 540000 0 93098 34411 40000 0
0 0
3206023 C 1 CP 1 03/02/2019 11/02/2019 22/02/1961 0 2
1 E11.5;N18.9 86.09 - - None None None None L-1-40-II None
None None None None None PROSEDUR PADA KULIT, JA(RINGAN) BAWAH KULIT DAN
PAYUDARA (SEDANG) 10381300 0 0 - 0 - 0 - 0 -
0 10381300 10828237 0 9 0 0 0 AHYAR SUJANA
S.ST;3206297107870001 5.3.6.201902021030 4 268731 1#0##0#0#0.0#2019-
02-20 09:46:42#0#13:42:00#15:15:00#00:00:00 1
0ec55246198c3528d039ee57435bdb7e 1943000 2240000 820000 0
0 0 0 1371025 0 0 1620000 0 1374157
1256375 100000 103680 0 0
3206023 C 3 CP 1 08/02/2019 11/02/2019 03/04/1978 0 2
0 0 - 0 - 0 - 0 - 0 1828500
3214861 0 4 0 0 0 OOH 19056642 40 14921 DR.
ASEP TASLIM SP.OG 0122R0020219V001893 0001005260512 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268752 1#0##0#0#0.0#2019-
02-20 11:52:27#0#16:49:00#08:40:00#00:00:00 2
73a3c35ddbe8e1ffdd722dd630113f36 1890000 0 200000 0 0
0 0 460875 0 0 350000 0 98479 165507 50000
0 0 0
3206023 C 2 CP 1 09/02/2019 11/02/2019 31/07/2016 0 2
1 R56.8;A09.9 - - - None None None None G-4-22-I None
0 - 0 - 0 - 0 - 0 3030400 1172148
0 3 0 0 0 MUHAMAD RIDWAN IRPANA 19056704 2 923
dr. Lia Rhodia, Sp. A. 0122R0020219V001973 0002224673425 3;JKN
1#0##0#0#0.0#2019-02-20 13:40:27#0#22:43:00#11:43:00#00:00:00 1
18b8f395582c0767825dccc73bbc924c 280000 0 180000 0 0
0 0 70125 0 0 375000 0 189373 47650 30000 0
0 0
3206023 C 3 CP 1 05/02/2019 11/02/2019 09/09/1972 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 4395295 0 7 0 0 0 ENANG SYARIP
S.ST;3206297107870001 5.3.6.201902021030 4 268863 1#0##0#0#0.0#2019-
02-21 08:29:57#0#14:25:00#15:18:00#00:00:00 1
55999f38d7b23b7572bdca5035ebffa5 1047500 0 300000 0 0
0 140000 339475 0 0 490000 0 1734884 100636
70000 172800 0 0
3206023 C 3 CP 1 06/02/2019 11/02/2019 01/09/2008 0 2
1 A91;H02.8;R57.9 - - - None None None None A-4-13-II
None None None None None None INFEKSI VIRAL & NON-BAKTERIAL LAIN
(SEDANG) 2273500 0 0 - 0 - 0 - 0 - 0
2273500 2998936 0 6 0 0 0 RASTI RAHMADANI
5.3.6.201902021030 4 268869 1#0##0#0#0.0#2019-02-21
08:45:54#0#17:44:00#15:01:00#00:00:00 1 b3210a43f3fa080407cc81e29a4f94c6
567500 0 250000 0 0 0 0 974075 0 0
420000 0 439589 184092 60000 103680 0 0
3206023 C 3 CP 1 06/02/2019 11/02/2019 01/05/1956 0 2
1 I51.9;J44.9;I11.9 - - - None None None None I-4-24-II
None None None None None None GANGGUAN SISTEM PEMBULUH DARAH LAIN-LAIN
(SEDANG) 5152700 0 0 - 0 - 0 - 0 - 0
5152700 3080718 0 6 0 0 0 MARIYAM 15002823
5.3.6.201902021030 4 268879 1#0##0#0#0.0#2019-02-21
08:58:07#0#00:40:00#15:17:00#00:00:00 1 74a9b86d511f03456c89ce56065c8fd2
627500 0 300000 0 0 0 130000 103875 0
0 420000 0 1236492 222851 40000 0 0 0
3206023 C 3 CP 1 08/02/2019 11/02/2019 14/12/1985 0 2
1 B20.9;D64.9 99.04 - - None None None None A-4-15-II None
None None None None None INFEKSI HIV (SEDANG) 4917700 0 0
- 0 - 0 - 0 - 0 4917700 1873058 0
4 0 0 0 DEWI KOMALASARI 18038227 33 12109 dr. H. Dani
Farid Abdullah Sp.PD 0122R0020219V001739 0002183641953 3;JKN Indriyanti
Yuda S, S.ST;3206297107870001 5.3.6.201902021030 4 268883
1#0##0#0#0.0#2019-02-21 09:03:12#0#08:07:00#15:16:00#00:00:00 1
491f7763a0ec791622adf0d3095d4e23 463500 0 150000 0 0
0 0 570850 0 0 280000 0 322940 35768 50000
0 0 0
3206023 C 3 CP 1 07/02/2019 11/02/2019 01/01/1958 0 2
1 E11.9;I25.1 - - - None None None None E-4-10-I None
None None None None None PENYAKIT KENCING MANIS & GANGGUAN NUTRISI/
METABOLIK (RINGAN) 3330600 0 0 - 0 - 0 - 0
- 0 3330600 2150169 0 5 0 0 0 MAMAN
S.ST;3206297107870001 5.3.6.201902021030 4 268888 1#0##0#0#0.0#2019-
02-21 09:08:18#0#20:51:00#15:13:00#00:00:00 1
a3739ca68b1242c32693dd1e53ebfaf6 607500 0 200000 0 0
0 140000 296950 0 0 350000 0 431401 64318
60000 0 0 0
3206023 C 3 CP 1 08/02/2019 11/02/2019 28/11/2006 0 2
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 1319054 0 4 0 0 0 M FIRMAN NURALAM
5.3.6.201902021030 4 268893 1#0##0#0#0.0#2019-02-21
09:15:48#0#11:17:00#15:00:00#00:00:00 1 216f064c1938a4fb19bbdda433bb7e17
397500 0 150000 0 0 0 0 235375 0 0
280000 0 156624 49555 50000 0 0 0
3206023 C 3 CP 1 04/02/2019 11/02/2019 08/08/1988 0 2
1 K74.6;D64.9;K92.2 99.04 - - None None None None B-4-13-II
None None None None None None GANGGUAN HATI LAIN-LAIN (SEDANG)
3637100 0 0 - 0 - 0 - 0 - 0
3637100 4266011 0 8 0 0 0 ENAH MAHENAH
S.ST;3206297107870001 5.3.6.201902021030 4 268900 1#0##0#0#0.0#2019-
02-21 09:22:03#0#13:53:00#15:17:00#00:00:00 1
ec75a94f83d3076eccb8c019b9ad6b31 577500 0 250000 0 0
0 335000 1758925 0 0 560000 0 495908 208678
80000 0 0 0
3206023 C 3 CP 1 10/02/2019 11/02/2019 01/01/1973 0 2
- 0 - 0 - 0 - 0 2575600 938342 0
2 0 0 0 ATENG 18039931 46 16841 dr. H. Dani Farid
Abdullah Sp.PD 0122R0020219V002042 0002497543086 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 268913 1#0##0#0#0.0#2019-
02-21 09:37:44#0#20:38:00#15:09:00#00:00:00 1
8a0b15b8af72d93bfa8d5446e64fd1ed 353500 0 50000 0 0 0
140000 103875 0 0 140000 0 18459 43388 20000 69120
0 0
3206023 C 3 CP 1 11/02/2019 11/02/2019 02/07/1995 0 2
None None None None KARDIOMIOPATHI (RINGAN) 2538900 0 0 -
0 - 0 - 0 - 0 2538900 1280989 0 1
0 0 0 ROROS ROSTIKAWATI 19056853 23 8625 dr. H. Dani Farid
Abdullah Sp.PD 0122R0020219V002418 0000436385463 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 268926 1#0##0#0#0.0#2019-
02-21 10:02:32#0#15:17:00#19:55:00#00:00:00 1
401403e95faa87d0c705298334778f3f 447500 0 50000 0 0 0
0 178375 0 0 70000 0 288494 236620 10000 0
0 0
3206023 C 3 CP 1 10/02/2019 11/02/2019 07/07/1992 0 2
1 O62.0;O46.9 - - - None None None None W-4-16-I None
0 - 0 - 0 - 0 - 0 1999800 786563
0 2 0 0 0 LINA SAKINATUN NISA 18041319 26 9714
dr. Asep Taslim Sp.OG 0122R0020219V002001 0000433842478 3;JKN
1#0##0#0#0.0#2019-02-21 10:10:04#0#11:39:00#11:22:00#00:00:00 1
53d25e2d82adbcc9544429056e7c32b2 410000 0 50000 0 0 0
0 70125 0 0 140000 0 62154 34284 20000 0 0 0
3206023 C 3 CP 1 11/02/2019 11/02/2019 01/01/1984 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2128244 0 1 0 0 0 CULISNAWATI 17017439 35 12825
dr. Asep Taslim Sp.OG 0122R0020219V002413 0002469371523 3;JKN
1#0##0#0#0.0#2019-02-21 10:29:01#0#12:17:00#18:38:00#00:00:00 1
81b636dcdfa66817d481926024074061 1482500 0 120000 0 0
0 0 221100 0 0 70000 0 75054 139590 20000 0
0 0
3206023 C 3 CP 1 09/02/2019 11/02/2019 18/08/2000 0 2
1 O14.1;Z37.0;O80.9;O42.9 73.59;57.94 - - None None None None
1828500 0 0 - 0 - 0 - 0 - 0
1828500 3145633 0 3 0 0 0 FETI WULANSARI
5.3.6.201902021030 4 268955 1#0##0#0#0.0#2019-02-21
10:33:11#0#21:29:00#11:50:00#00:00:00 1 9aa78d5eee4420951530fac05f6733d5
2055000 0 170000 0 0 0 0 320250 0 0
210000 0 96457 243926 50000 0 0 0
3206023 C 3 CP 1 06/02/2019 11/02/2019 30/11/2003 0 2
5786500 0 0 - 0 - 0 - 0 - 0
5786500 5423034 0 6 0 0 0 RIFQI FAUZAN
4 268962 1#0##0#0#0.0#2019-02-21
10:47:38#0#18:43:00#12:57:00#00:00:00 1 cf0362c353b7ab2b3c706c50d184b54e
1094025 2137750 270000 0 0 0 0 185250 0
0 420000 0 734047 501962 80000 0 0 0
3206023 C 3 CP 1 10/02/2019 11/02/2019 30/11/1998 0 2
4 A19.9 89.52 - - None None None None A-4-14-I None None
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 2129023 0 2 0 0 0 SUSILAWATI 18028702
1#0##0#0#0.0#2019-02-21 10:50:42#0#20:23:00#11:14:00#00:00:00 1
fc18edda5d2c93e9443c7e0726ca4ca2 842500 0 120000 0 0
0 200000 307225 0 0 140000 0 403250 86048
30000 0 0 0
3206023 C 3 CP 1 09/02/2019 11/02/2019 13/05/1960 0 2
2 R90.0;G91.9 87.03 - - None None None None G-4-26-I None
None None None None None GANGGUAN - PENYAKIT SISTEM SARAF LAIN-LAIN
(RINGAN) 2959900 0 0 - 0 - 0 - 0 - 0
2959900 2684341 0 3 0 0 0 DARSO 19056682 58
4 268970 1#0##0#0#0.0#2019-02-21
10:53:37#0#19:51:00#16:30:00#00:00:00 1 e6707c90ec97a2079ce705f415340195
655000 0 150000 0 0 0 950000 171625 0
0 210000 0 313037 100999 30000 103680 0 0
3206023 C 3 CP 1 07/02/2019 11/02/2019 21/09/1953 0 2
1 I12.9;D63.8 99.04 - - None None None None N-4-16-II None
None None None None None PENYAKIT GINJAL DAN SALURAN URIN LAIN-LAIN
(SEDANG) 3917300 0 0 - 0 - 0 - 0 - 0
3917300 2083720 0 5 0 0 0 SAJIDIN 18044702
4 268974 1#0##0#0#0.0#2019-02-21
10:57:49#0#13:50:00#15:10:00#00:00:00 1 8264ae40c8109e903ccda3a548f25af3
340000 0 200000 0 0 0 0 882300 0 0
350000 0 177608 83812 50000 0 0 0
3206023 C 3 CP 1 06/02/2019 11/02/2019 03/07/2011 0 2
1 A16.2;N39.0 99.21;87.44 - - None None None None J-4-15-II
None None None None None None PERADANGAN DAN INFEKSI PERNAFASAN
(SEDANG) 4778500 0 0 - 0 - 0 - 0 - 0
4778500 2493635 0 6 0 0 0 IRMA YULIANTI
5.3.6.201902021030 4 273076 1#0##0#0#0.0#2019-03-12
12:57:24#0#19:30:00#15:01:00#00:00:00 1 ba2f5e7d12a4dbec47f266e4e061469f
570000 0 315000 0 0 0 140000 347075 0
0 585000 0 336524 140036 60000 0 0 0
3206023 C 3 CP 1 07/02/2019 11/02/2019 02/04/1964 0 2
1 K29.1;D64.9 99.04 - - None None None None K-4-11-II None
None None None None None GASTRITIS & ULKUS PEPTIKUM (SEDANG) 3040400
0 0 - 0 - 0 - 0 - 0 3040400
2532940 0 5 0 0 0 EEM EMAWATI 19056558 54 20034
DR. H. DANI FARID ABDULLAH SP.PD 0122R0020219V001732 0000436876683
268906 1#0##0#0#0.0#2019-03-14 13:46:22#0#08:02:00#15:05:00#00:00:00
2 6ca8e1b65f9180a5d9eff7a17d59c42d 326000 0 200000 0
0 0 0 1263850 0 0 280000 0 275305 147785
40000 0 0 0
3206023 C 3 CP 1 09/02/2019 11/02/2019 04/01/1999 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2372535 0 3 0 0 0 NENDAH FARIDAH 19056707 20
1#0##0#0#0.0#2019-03-14 13:47:07#0#02:22:00#11:21:00#00:00:00 2
b1a81ef985bf326c79a0584a2ab02d04 1585000 0 100000 0 0
0 0 300250 0 0 140000 0 46134 171151 30000
0 0 0
3206023 C 2 CP 1 08/02/2019 12/02/2019 17/09/1965 0 2
1 D64.9;I84.9 99.04 - - None None None None D-4-13-I None
None None None None None GANGGUAN SEL DARAH MERAH SELAIN KRISIS ANEMIA
SEL SICKLE (RINGAN) 2661700 0 0 - 0 - 0 - 0
- 0 2661700 4974474 0 5 0 0 0 TATI
RUHIYATI 19056635 53 19502 dr. H. Dani Farid Abdullah Sp.PD
Septiani;3278085209910012 5.3.6.201902021030 4 268759
1#0##0#0#0.0#2019-02-20 10:52:26#0#15:08:00#11:24:00#00:00:00 1
5eb3b3d3a9d1a00663e7927bb3be3fde 842500 0 500000 0 0
0 0 2159525 0 0 680000 0 453300 175469
60000 103680 0 0
3206023 C 2 CP 1 10/02/2019 12/02/2019 11/03/1980 0 2
None None None None PROSEDUR SISTEM MUSKULOSKLETAL & JARINGAN PENGHUBUNG
LAIN-LAIN (RINGAN) 7117300 0 0 - 0 - 0 - 0
- 0 7117300 3837459 0 3 0 0 0 EMALIA SARI
5.3.6.201902021030 4 268772 1#0##0#0#0.0#2019-02-20
11:56:57#0#19:13:00#13:19:00#00:00:00 1 c22c33f4b9689f2986b557297f50e2eb
823525 1573750 160000 0 0 0 0 350000 0
0 320000 0 218171 372013 20000 0 0 0
3206023 C 2 CP 1 11/02/2019 12/02/2019 20/02/1993 0 2
0 0 - 0 - 0 - 0 - 0 1853900
2619151 0 2 0 0 0 RINI ROHAYANI 19056864 25
1#0##0#0#0.0#2019-02-20 12:25:11#0#13:39:00#10:06:00#00:00:00 1
9c62a49f527ec2fb3252075f8863d162 1851380 0 120000 0 0
0 0 231100 0 0 140000 0 0 256671 20000
0 0 0
3206023 C 2 CP 1 09/02/2019 12/02/2019 28/09/1956 0 2
1 N18.9;J45.9 - - - None None None None N-4-10-I None
(RINGAN) 2952900 0 0 - 0 - 0 - 0 - 0
2952900 1832974 0 4 0 0 0 ONENG DEWI NINGRUM, NY
Septiani;3278085209910012 5.3.6.201902021030 4 268808
1#0##0#0#0.0#2019-02-20 12:53:14#0#18:30:00#14:51:00#00:00:00 1
92a19bc2b356d7003de6a6a290ea9406 498500 0 100000 0 0
0 0 156725 0 0 500000 0 296706 241043
40000 0 0 0
3206023 C 3 CP 1 09/02/2019 12/02/2019 05/10/1960 0 2
1 A16.2;B90.9 - - - None None None None J-4-15-I None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1587178 0 4 0 0 0 HARIS 19056698 58
5.3.6.201902021030 4 268827 1#0##0#0#0.0#2019-02-20
13:36:05#0#20:15:00#15:02:00#00:00:00 1 aab6f3f1c17d24c55f4c79cf98966276
427500 0 150000 0 0 0 140000 203375 0
0 280000 0 299040 47263 40000 0 0 0
3206023 C 3 CP 1 07/02/2019 12/02/2019 05/02/1962 0 2
1 N18.9;D63.8 99.04 - - None None None None N-4-10-II None
(SEDANG) 2976400 0 0 - 0 - 0 - 0 - 0
2976400 4035852 0 6 0 0 0 MIMI MARTINI
Septiani;3278085209910012 5.3.6.201902021030 4 268837
1#0##0#0#0.0#2019-02-20 13:44:10#0#18:12:00#15:02:00#00:00:00 1
ef6e283e0894f30ad257126a24887b41 517500 0 250000 0 0
0 335000 1673125 0 0 420000 0 585911 194316
60000 0 0 0
3206023 C 3 CP 1 11/02/2019 12/02/2019 18/03/1959 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3761263 0 2 0 0 0 NURDIN 18045937 59 21880
1#0##0#0#0.0#2019-02-20 13:53:52#0#09:21:00#12:01:00#00:00:00 1
9569f8ff3029952cd7b5008645fff0d3 264434 2125000 100000 0
0 0 0 0 0 0 140000 0 64495 1037334 30000
0 0 0
3206023 C 3 CP 1 08/02/2019 12/02/2019 28/06/1954 0 2
1 A16.5;R54 - - - None None None None J-4-15-I None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 3918251 0 5 0 0 0 TIKOH 19056652 64
5.3.6.201902021030 4 268866 1#0##0#0#0.0#2019-02-21
08:38:33#0#23:20:00#16:00:00#00:00:00 1 c0b34d905a516ffe68bfcb3e8a2a42bf
585500 1483750 150000 0 0 0 140000 307475
0 0 350000 0 590558 270968 40000 0 0 0
3206023 C 3 CP 1 03/02/2019 12/02/2019 03/02/2019 1500 2
None None None None None NEONATAL, BBL 1500 - 1999 GR TANPA PROSEDUR
MAYOR (RINGAN) 5808700 0 0 - 0 - 0 - 0 -
0 5808700 4740112 0 10 0 0 0 BY NY NIA
5.3.6.201902021030 4 268874 1#0##0#0#0.0#2019-02-21
08:53:55#0#15:52:00#08:36:00#00:00:00 1 30a310dd95cbe397cd60c0f8c4e645eb
2037500 0 560000 0 0 0 0 496250 0 0
1250000 0 120374 195988 80000 0 0 0
3206023 C 3 CP 1 09/02/2019 12/02/2019 02/08/1982 0 2
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5380647 0 4 0 0 0 WINDA 19055785 36
1#0##0#0#0.0#2019-02-21 09:04:31#0#20:37:00#11:49:00#00:00:00 1
feeb2097d9e6978de81959c3c6fb61a0 1369500 2137750 340000 0
0 0 0 313750 0 0 280000 0 358268 531379
50000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 11/03/1995 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3516348 0 3 0 0 0 EVIT ERIANA 16006638
268891 1#0##0#0#0.0#2019-02-21 09:10:24#0#07:35:00#11:48:00#00:00:00
1 f6877c236cf03fa691f6b6cbb7ba7c3c 1043000 1626250 170000
0 0 0 0 320125 0 0 210000 0 43670 63303
40000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 04/06/1996 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4332635 0 3 0 0 0 HENDRA 19055049
5.3.6.201902021030 4 268902 1#0##0#0#0.0#2019-02-21
09:24:54#0#17:42:00#11:21:00#00:00:00 1 c11548ac003ea71c8d93d1b04d0189bb
460000 2592500 140000 0 0 0 0 0 0 0
210000 0 347840 542295 40000 0 0 0
3206023 C 3 CP 1 11/02/2019 12/02/2019 01/07/1940 0 2
0 0 - 0 - 0 - 0 - 0 6433000
4085085 0 2 0 0 0 SARIPIN 18043954 78 28714
1#0##0#0#0.0#2019-02-21 09:28:58#0#09:26:00#12:01:00#00:00:00 1
75b451a5ba833972d7736f8004b48f08 626459 2550000 120000 0
0 0 0 0 0 0 140000 0 210273 408353
30000 0 0 0
3206023 C 3 CP 1 08/02/2019 12/02/2019 14/08/1954 0 2
1 J44.1;Z03.0 - - - None None None None J-4-17-I None
None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (RINGAN)
2739200 0 0 - 0 - 0 - 0 - 0
2739200 2221761 0 5 0 0 0 U MUMAN 19056631
5.3.6.201902021030 4 268912 1#0##0#0#0.0#2019-02-21
09:37:07#0#19:46:00#10:51:00#00:00:00 1 85fbfa6461c2ada2dbc073efb4b2d390
786000 0 150000 0 0 0 140000 203375 0
0 350000 0 467627 64759 60000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 11/07/1966 0 2
4 C85.9 - - - None None None None C-4-11-I None None
None None None None LIMFOMA & LEUKEMIA NON AKUT (RINGAN) 3288000
0 0 - 0 - 0 - 0 - 0 3288000
1586538 0 3 0 0 0 AAY NURHAYATI 18052128 52
268918 1#0##0#0#0.0#2019-02-21 09:42:05#0#23:45:00#02:04:00#00:00:00
1 5561db25aaf93648c6592fb375ef1baa 572000 0 70000 0 0
0 0 97125 0 0 210000 0 606754 30659 0 0
0 0
3206023 C 3 CP 1 04/02/2019 12/02/2019 16/03/1959 0 2
1 A91;K92.2 99.05 - - None None None None A-4-13-II None
None None None None None INFEKSI VIRAL & NON-BAKTERIAL LAIN (SEDANG)
2273500 0 0 - 0 - 0 - 0 - 0
2273500 5977066 0 9 0 0 0 ADAH SAODAH 19056192
5.3.6.201902021030 4 268920 1#0##0#0#0.0#2019-02-21
09:45:30#0#15:43:00#00:24:00#00:00:00 1 50cb06baa569e1c3df38228a3b9f6c26
962500 0 350000 0 0 0 0 2473150 0 0
630000 0 1307583 173833 80000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 05/08/1975 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 2765018 0 3 0 0 0 HAYATI 19056152
268922 1#0##0#0#0.0#2019-02-21 09:46:51#0#16:07:00#11:51:00#00:00:00
1 214305b3dc5d8b1cbe877e48399f48c3 303000 1626250 70000 0
0 0 0 213875 0 0 210000 0 235640 66253
40000 0 0 0
3206023 C 3 CP 1 08/02/2019 12/02/2019 04/02/1991 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5797614 0 5 0 0 0 ASIH 19056632 28
1#0##0#0#0.0#2019-02-21 09:52:51#0#18:51:00#11:50:00#00:00:00 1
bbf0ce08c7f3872b72764662c643d99f 1372000 2137750 340000 0
0 0 0 460875 0 0 350000 0 593128 473861
70000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 18/09/1985 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 2815128 0 3 0 0 0 IPAH 19056370 33
1#0##0#0#0.0#2019-02-21 09:57:29#0#17:39:00#11:45:00#00:00:00 1
6544e0a483c3a576c177ac72910baba4 258000 1626250 120000 0
0 0 0 213875 0 0 210000 0 227775 119228
40000 0 0 0
3206023 C 3 CP 1 08/02/2019 12/02/2019 19/09/1982 0 2
(RINGAN) 5786500 0 0 - 0 - 0 - 0 - 0
5786500 5617395 0 5 0 0 0 ELIS LISNAWATI
5.3.6.201902021030 4 268938 1#0##0#0#0.0#2019-02-21
10:28:00#0#09:07:00#11:21:00#00:00:00 1 ed2cede44dd7c153e73a6d36d967f407
931525 2137750 220000 0 0 0 0 0 0 0
350000 0 1343542 564578 70000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 10/05/1948 0 2
1 J44.1;I11.0 - - - None None None None J-4-17-III None
None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (BERAT)
4304800 0 0 - 0 - 0 - 0 - 0
4304800 3061308 0 3 0 0 0 SITI LUGOYAH, NY
Septiani;3278085209910012 5.3.6.201902021030 4 268958
1#0##0#0#0.0#2019-02-21 10:34:47#0#09:10:00#14:58:00#00:00:00 1
27e405850b9b2da79d4fa13c7df2e4d7 553500 0 120000 0 0
0 140000 270500 0 0 210000 0 1471996 265312
30000 0 0 0
3206023 C 3 CP 1 09/02/2019 12/02/2019 14/12/1976 0 2
1 A91;D69.6 - - - None None None None A-4-13-II None
None None None None None INFEKSI VIRAL & NON-BAKTERIAL LAIN (SEDANG)
2273500 0 0 - 0 - 0 - 0 - 0
2273500 1442831 0 4 0 0 0 ISMAIL 19056703
5.3.6.201902021030 4 268991 1#0##0#0#0.0#2019-02-21
11:24:41#0#23:37:00#10:07:00#00:00:00 1 efb9f81f7358b38bf925be81b3015753
397500 0 120000 0 0 0 0 269125 0 0
280000 0 241544 94662 40000 0 0 0
3206023 C 3 CP 1 11/02/2019 12/02/2019 01/04/1968 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3776263 0 2 0 0 0 MUSTOPA 18047671 50 18578
1#0##0#0#0.0#2019-02-21 13:17:41#0#09:17:00#12:02:00#00:00:00 1
9d5ae3798b8bdcb32c769a4b04f4a81e 279434 2125000 100000 0
0 0 0 0 0 0 140000 0 64495 1037334 30000
0 0 0
3206023 C 3 CP 1 09/02/2019 12/02/2019 06/07/1960 0 2
1 K30;Z03.1 - - - None None None None K-4-18-I None
1242600 0 0 - 0 - 0 - 0 - 0
1242600 1461247 0 4 0 0 0 EMAR 19056686 58
5.3.6.201902021030 4 269424 1#0##0#0#0.0#2019-02-25
13:48:51#0#15:15:00#16:06:00#00:00:00 1 cdc08940b876cb54e7e207529aafd478
467500 0 150000 0 0 0 130000 178375 0
0 280000 0 129888 85484 40000 0 0 0
3206023 C 3 CP 1 07/02/2019 12/02/2019 02/05/1959 0 2
1 D13.4;R18 54.19 - - None None None None K-1-40-II None
None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN (SEDANG)
6379900 0 0 - 0 - 0 - 0 - 0
6379900 7024840 0 6 0 0 0 YAYAH 19054407 59
5.3.6.201902021030 4 269700 1#0##0#0#0.0#2019-02-26
09:07:45#0#22:34:00#18:15:00#00:00:00 1 7b2a4e5ef99cb9cde0c1e2fd873197a0
1756025 2137750 250000 0 15000 0 130000 236500
0 0 420000 0 1133971 678234 60000 207360 0
0
3206023 C 2 CP 1 09/02/2019 12/02/2019 04/06/1969 0 2
SICKLE (RINGAN) 2661700 0 0 - 0 - 0 - 0 -
0 2661700 3651630 0 4 0 0 0 WATI 19056685
5.3.6.201902021030 4 269732 1#0##0#0#0.0#2019-02-26
09:18:13#0#14:38:00#10:50:00#00:00:00 1 e147140adf69b58ac6f2adaa6dce4c8b
636000 0 210000 0 0 0 0 1580325 0 0
500000 0 515294 160011 50000 0 0 0
3206023 C 3 CP 1 10/02/2019 12/02/2019 18/03/2001 0 2
0 - 0 2192500 4072592 0 3 0 0 0 USEP
NUGRAHA 18047313 17 6538 dr. Riadhi Yulianto Sp.B.
Septiani;3278085209910012 5.3.6.201902021030 4 269744
1#0##0#0#0.0#2019-02-26 09:23:57#0#19:54:00#16:38:00#00:00:00 1
fc2d496d7092b9fe890da3a0ffbc2eb3 601525 1825000 120000 0
0 0 0 350000 0 0 210000 0 293390 652677
20000 0 0 0
3206023 C 3 CP 1 08/02/2019 12/02/2019 02/06/1944 0 2
1 D38.1;N17.9;I25.2 - - - None None None None J-4-21-III
None None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM
PERNAFASAN LAIN-LAIN (BERAT) 5981900 0 0 - 0 - 0 -
0 - 0 5981900 2623823 0 5 0 0 0 TASLIM
Septiani;3278085209910012 5.3.6.201902021030 4 269757
1#0##0#0#0.0#2019-02-26 09:32:10#0#19:36:00#10:49:00#00:00:00 1
68b65fba71bf96178581b350c4939d5b 731000 0 150000 0 0
0 130000 270500 0 0 350000 0 696987 235336
60000 0 0 0
3206023 C 3 CP 1 12/02/2019 12/02/2019 21/03/1952 0 2
(SEDANG) 3826700 0 0 - 0 - 0 - 0 - 0
3826700 2153874 0 1 0 0 0 MIMIN 19056894 66
1#0##0#0#0.0#2019-02-26 09:43:23#0#01:26:00#15:36:00#00:00:00 2
96b895b8bf5a949dcf30b42d9b76ae16 697500 0 50000 0 0 0
950000 70125 0 0 70000 0 288775 27474 0 0 0
0
3206023 C 3 CP 1 05/02/2019 12/02/2019 21/06/2014 0 2
1 R56.0;J06.9;G83.8 - - - None None None None G-4-22-II
None None None None None None SERANGAN KEJANG (SEDANG) 3226600
0 0 - 0 - 0 - 0 - 0 3226600
2978033 0 8 0 0 0 FAREL 16007058 4 1690 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269826
1#0##0#0#0.0#2019-02-26 09:45:46#0#12:17:00#08:36:00#00:00:00 1
883eda5d122ccbcbd9101f2dda27a1ab 647500 0 350000 0 0
0 0 444125 0 0 560000 0 559885 406523
10000 0 0 0
3206023 C 1 CP 1 11/02/2019 12/02/2019 28/06/2001 0 2
1 F31.2 87.03 - - None None None None F-4-13-I None None
None None None None GANGGUAN BIPOLAR (RINGAN) 3187900 0 0
- 0 - 0 - 0 - 0 3187900 1762500 0
2 0 0 0 LILIS BADRIYANI, AN 16014077 17 6437 dr.
Lia Rhodia, Sp. A. 0122R0020219V002399 0000070756119 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269760
1#0##0#0#0.0#2019-03-01 14:11:34#0#12:24:00#13:53:00#00:00:00 2
109ddae4ee30a51af29c0ad7a64b5e31 1192500 0 200000 0 0
0 0 0 0 0 360000 0 0 0 10000 0 0
0
3206023 C 3 CP 1 11/02/2019 12/02/2019 01/07/1951 0 2
1 I11.9;K30 - - - None None None None I-4-17-I None
None None None None None HIPERTENSI (RINGAN) 1758600 0 0
- 0 - 0 - 0 - 0 1758600 1029321 0
2 0 0 0 HJ. KURAESIN 18029996 67 24697 dr. H. Dani
Farid Abdullah Sp.PD 0122R0020219V002424 0001315272093 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271303
1#0##0#0#0.0#2019-03-05 10:17:12#0#17:44:00#19:47:00#00:00:00 1
147c568874a635a11ff667e508f45dd9 363500 0 70000 0 0 0
140000 178375 0 0 140000 0 90699 26747 20000 0
0 0
3206023 C 3 CP 1 09/02/2019 12/02/2019 11/06/1995 0 2
1 A91;D69.6;D70 - - - None None None None A-4-13-III
(BERAT) 2728200 0 0 - 0 - 0 - 0 - 0
2728200 1456821 0 4 0 0 0 RATNA 16003527 23
5.3.6.201902021030 4 269018 1#0##0#0#0.0#2019-03-05
10:18:26#0#11:10:00#15:06:00#00:00:00 1 5872e13e8032ca223ac29c107aac70a2
457500 0 150000 0 0 0 0 305500 0 0
280000 0 189271 44550 30000 0 0 0
3206023 C 3 CP 1 09/02/2019 12/02/2019 29/07/2018 0 2
1 J40;A09.9 93.94;87.44;99.21 - - None None None None J-4-
21-I None None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM
PERNAFASAN LAIN-LAIN (RINGAN) 2661000 0 0 - 0 - 0 -
0 - 0 2661000 1375163 0 4 0 0 0 DAIFA
DAHLIA 19056702 0 195 DR. LIA RHODIA, SP. A. 0122R0020219V002405
5.3.6.201902021030 4 273066 1#0##0#0#0.0#2019-03-12
13:07:34#0#06:20:00#13:33:00#00:00:00 2 407e70279330744a59f12660dc29d973
457500 0 150000 0 0 0 140000 70125 0 0
210000 0 130073 63785 50000 103680 0 0
3206023 C 3 CP 1 11/02/2019 12/02/2019 19/07/1968 0 2
1 Z51.1;C85.9 99.25 - - None None None None C-4-13-I None
- 0 - 0 - 0 - 0 1645900 1867338 0
2 0 0 0 TETI HERNAWATI 19054396 50 18469 DR. RIADHI
YULIANTO SP.B. 0122R0020219V002126 0002489229977 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268844
1#0##0#0#0.0#2019-03-14 11:09:31#0#07:48:00#09:52:00#00:00:00 2
66fe9d8a123111c7b7c3610225159cf9 1310000 0 100000 0 0
0 0 0 0 0 210000 0 142916 74422 30000 0
0 0
3206023 C 3 CP 1 06/02/2019 12/02/2019 01/03/1959 0 2
1 E11.1;N39.0;N17.9;E79.0 - - - None None None None E-4-
0 - 0 5776400 8297788 0 7 0 0 0 ANAH
Septiani;3278085209910012 5.3.6.201902021030 4 269734
1#0##0#0#0.0#2019-03-18 09:22:44#0#05:44:00#15:03:00#00:00:00 2
cc951f0bd5093afb7e076bcc5fb5611c 1295000 0 840000 0 0
0 0 1303375 0 0 615000 480000 2975358 477135
70000 241920 0 0
3206023 C 1 CP 1 08/02/2019 13/02/2019 01/01/1969 0 2
1 I63.9;L03.0;R47.0;E11.5;I10 87.03;86.22;86.23 - - None None
None None G-4-14-II None None None None None None KECEDERAAN
PEMBULUH DARAH OTAK DENGAN INFARK (SEDANG) 6967700 0 0 - 0
- 0 - 0 - 0 6967700 13060577 0 6 0
0 0 RENI HENDRIYANI 19056647 50 18300 dr. Indra Gunawan, Sp.S
Huda;3278057010840004 5.3.6.201902021030 4 268098
1#1#vip#6#5225775#75.0#2019-02-13 10:42:31#0#19:34:00#10:19:00#00:00:00
1 7c241c51a920f0b1f70193d9a07f13ea 2317000 3951500 1215000
0 0 0 1100000 840500 0 0 1800000 0
1383623 412954 40000 0 0 0
3206023 C 3 CP 1 06/02/2019 13/02/2019 24/04/1969 0 2
1 C50.0;D70;D63.0 99.04 - - None None None None L-4-11-III
None None None None None None TUMOR PAYUDARA (BERAT) 8302300 0
0 - 0 - 0 - 0 - 0 8302300 3443747
0 8 0 0 0 WAWAT HERAWATI 18025846 49 18185 dr.
Riadhi Yulianto Sp.B. 0122R0020219V001154 0002421294197 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268814
1#0##0#0#0.0#2019-02-20 13:10:24#0#14:01:00#09:52:00#00:00:00 1
4110ff79e3e06492149fcf51961c0cae 410000 0 300000 0 0
0 0 1317850 0 0 560000 0 733451 52446 70000
0 0 0
3206023 C 3 CP 1 10/02/2019 13/02/2019 30/11/1981 0 2
0 - 0 - 0 - 0 - 0 4853300 4407682
0 4 0 0 0 TITA ROSITA 18048356 37 13586 dr. Riadhi
Yulianto Sp.B. 0122R0020219V002032 0001451724884 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268823
1#0##0#0#0.0#2019-02-20 13:22:07#0#18:12:00#09:51:00#00:00:00 1
2edc04539d52da6e2b2575e21c35cfdd 756525 1825000 140000 0
0 0 0 517625 0 0 280000 0 353190 505342
30000 0 0 0
3206023 C 3 CP 1 10/02/2019 13/02/2019 02/01/1948 0 2
0 - 0 - 0 - 0 - 0 4853300 3682256
0 4 0 0 0 ATANG 19056615 71 25972 dr. Riadhi
Septiani;3278085209910012 5.3.6.201902021030 4 268880
1#0##0#0#0.0#2019-02-21 08:58:17#0#16:22:00#09:50:00#00:00:00 1
07241daa6a997bcfa939ebaa3b7134ae 700025 1573750 140000 0
0 0 0 350000 0 0 280000 0 274960 333521
30000 0 0 0
3206023 C 3 CP 1 10/02/2019 13/02/2019 07/12/1959 0 2
1 H81.3 - - - None None None None U-4-11-I None None
None None None None DYSEQUILIBRIUM (RINGAN) 1311700 0 0 -
0 - 0 - 0 - 0 1311700 1824315 0 4
0 0 0 YAYAH 19056690 59 21615 dr. Indra Gunawan, Sp.S
Septiani;3278085209910012 5.3.6.201902021030 4 268898
1#0##0#0#0.0#2019-02-21 09:20:08#0#18:21:00#08:29:00#00:00:00 1
ab2cd32749e5fd87f732cae59db3abd4 432500 0 100000 0 0
0 0 141125 0 0 280000 0 783966 36724 50000
0 0 0
3206023 C 2 CP 1 11/02/2019 13/02/2019 27/03/1969 0 2
1 D39.0;D64.9 99.04 - - None None None None W-4-12-II None
LAIN-LAIN (SEDANG) 4401000 0 0 - 0 - 0 - 0
- 0 4401000 2779671 0 3 0 0 0 TINI
SUMARTINI 18050420 49 18218 dr. Asep Taslim Sp.OG 0122R0020219V002444
5.3.6.201902021030 4 269803 1#0##0#0#0.0#2019-02-26
09:42:45#0#21:20:00#13:24:00#00:00:00 1 896996739e1d62cbba9e1ee72a45921a
435000 0 120000 0 0 0 0 1653675 0 0
265000 0 274440 11556 20000 0 0 0
3206023 C 1 CP 1 11/02/2019 13/02/2019 08/06/2016 0 2
- 0 - 0 - 0 - 0 3535500 913047 0
3 0 0 0 FIRSTLY KANAKA 17011614 2 978 dr. Lia
Rhodia, Sp. A. 0122R0020219V002409 0002427641133 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 269837 1#0##0#0#0.0#2019-
02-26 09:48:17#0#13:46:00#10:55:00#00:00:00 1
42c27b95bb41856b527c9b432cc5382e 327500 0 100000 0 0
0 0 103875 0 0 210000 0 56446 85226 30000 0
0 0
3206023 C 2 CP 1 11/02/2019 13/02/2019 24/03/1946 0 2
2633400 0 0 - 0 - 0 - 0 - 0
2633400 3809461 0 3 0 0 0 UYUN 19056888 72
1#0##0#0#0.0#2019-02-26 09:53:05#0#21:15:00#14:04:00#00:00:00 1
b52d67b5faaf1cb76578194287f49f10 1110000 0 140000 0 0
0 1090000 357075 0 0 320000 0 668549 123837
0 0 0 0
3206023 C 2 CP 1 08/02/2019 13/02/2019 14/03/1959 0 2
1 J44.9;D38.1 - - - None None None None J-4-17-I None
3287100 0 0 - 0 - 0 - 0 - 0
3287100 3664716 0 6 0 0 0 KUSMAYADI 19056621
5.3.6.201902021030 4 269863 1#0##0#0#0.0#2019-02-26
09:56:55#0#13:36:00#12:13:00#00:00:00 1 5b4838b4324582c6f18acacbc68b4f61
653500 0 350000 0 0 0 190000 196625 0
0 420000 0 1629857 204734 20000 0 0 0
3206023 C 1 CP 1 10/02/2019 13/02/2019 13/07/1942 0 2
1 J44.0;A91 - - - None None None None J-4-17-III None
None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (BERAT)
6026700 0 0 - 0 - 0 - 0 - 0
6026700 6092836 0 4 0 0 0 UYO SURAYA 14011875
5.3.6.201902021030 4 269883 1#0##0#0#0.0#2019-02-26
10:02:20#0#21:58:00#12:10:00#00:00:00 1 80cca262783be1ed144161f841054e93
2184000 0 660000 0 0 0 140000 574375 0
0 1200000 0 1043800 53301 30000 207360 0 0
3206023 C 1 CP 1 06/02/2019 13/02/2019 24/06/1954 0 2
1 I51.9;E11.9;I10 - - - None None None None I-4-24-I
None None None None None None GANGGUAN SISTEM PEMBULUH DARAH LAIN-LAIN
(RINGAN) 3132700 0 0 - 0 - 0 - 0 - 0
3132700 6080406 0 8 0 0 0 LESMANA NINGSIH
Septiani;3278085209910012 5.3.6.201902021030 4 269890
1#0##0#0#0.0#2019-02-26 10:05:46#0#08:13:00#11:59:00#00:00:00 1
d9dfd2c9792d788b730dbd0341a1e132 1407500 0 700000 0 0
0 140000 820100 0 0 1440000 0 1243653 110913
80000 138240 0 0
3206023 C 1 CP 1 11/02/2019 13/02/2019 05/09/1967 0 2
PAYUDARA (RINGAN) 5175700 0 0 - 0 - 0 - 0 -
0 5175700 4339992 0 3 0 0 0 UDIN, TN
5.3.6.201902021030 4 269894 1#0##0#0#0.0#2019-02-26
10:09:57#0#17:46:00#12:17:00#00:00:00 1 920ba192657e95e5121b4d54f5fb50d5
705025 1913750 220000 0 0 0 0 103875 0
0 540000 0 305055 428607 20000 103680 0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 08/11/1964 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 4273034 0 3 0 0 0 ITOH 18048627
54 19818 dr. Riadhi Yulianto Sp.B. 0122R0020219V002427
5.3.6.201902021030 4 269904 1#0##0#0#0.0#2019-02-26
10:16:24#0#18:10:00#13:50:00#00:00:00 1 cc715477618da98337edb5a4adb7d8a3
736525 1825000 190000 0 0 0 0 189125 0
0 210000 0 303172 779212 40000 0 0 0
3206023 C 3 CP 1 10/02/2019 13/02/2019 01/07/1965 0 2
- 0 5581600 6728482 0 4 0 0 0 IMAS
5.3.6.201902021030 4 269911 1#0##0#0#0.0#2019-02-26
10:18:37#0#17:19:00#13:50:00#00:00:00 1 753a98c03fc5f9561e3e2d024143b44e
912025 2592500 190000 0 0 0 0 1434850 0
0 280000 0 406646 872461 40000 0 0 0
3206023 C 3 CP 1 12/02/2019 13/02/2019 01/05/1953 0 2
4 I25.1;I46.9 99.60;89.52;93.96 - - None None None None I-4-
16-III None None None None None None ATHEROSKLEROSIS (BERAT) 3010100
0 0 - 0 - 0 - 0 - 0 3010100 946075
0 2 0 0 0 SUHERMAN 19057023 65 24028 DR. H. DANI
FARID ABDULLAH SP.PD 0122R0020219V002928 0001310265066 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269842
1#0##0#0#0.0#2019-02-28 10:03:02#0#09:03:00#11:28:00#00:00:00 2
7ddba1d601235641cbba1ea527d32df2 467500 0 50000 0 0 0
0 70125 0 0 70000 0 110963 108367 0 69120 0
0
3206023 C 3 CP 1 11/02/2019 13/02/2019 01/07/1969 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 4799191 0 3 0 0 0 ASIH 19056302
5.3.6.201902021030 4 269917 1#0##0#0#0.0#2019-03-01
10:06:56#0#19:39:00#13:24:00#00:00:00 1 95e4c58be6846149d887fa3e2b3feab1
786525 1825000 190000 0 0 0 0 38875 0 0
210000 0 586870 1131921 30000 0 0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 01/01/1986 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 5139290 0 3 0 0 0 HENDRA 19054924
5.3.6.201902021030 4 270285 1#0##0#0#0.0#2019-03-01
10:09:25#0#18:54:00#13:26:00#00:00:00 1 93479a045db671794c033a643e03948a
490000 2592500 190000 0 0 0 0 38875 0 0
210000 0 920688 667227 30000 0 0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 10/06/2001 0 2
0 - 0 - 0 - 0 - 0 4853300 3722001
0 3 0 0 0 SITI ALINDA 18049932 17 6455 dr. Riadhi
Septiani;3278085209910012 5.3.6.201902021030 4 270374
1#0##0#0#0.0#2019-03-01 10:31:14#0#17:55:00#15:46:00#00:00:00 1
e98fdbdc6bdd72fc40c0d0281f4b946d 676525 1825000 120000 0
0 0 0 200000 0 0 210000 0 282987 387489
20000 0 0 0
3206023 C 3 CP 1 10/02/2019 13/02/2019 15/06/1990 0 2
None None None None PROSEDUR HERNIA TIDAK TERMASUK INGUINAL & FEMORAL
(RINGAN) 2474500 0 0 - 0 - 0 - 0 - 0
2474500 4768027 0 4 0 0 0 SONAR 19054865 28
270382 1#0##0#0#0.0#2019-03-01 10:34:20#0#17:08:00#13:25:00#00:00:00
1 dda78478f616af0cb1cb6f7646e9f9a4 535000 2592500 190000
0 0 0 0 0 0 0 280000 0 689733 440794
40000 0 0 0
3206023 C 3 CP 1 07/02/2019 13/02/2019 10/08/1948 0 2
(SEDANG) 4976900 0 0 - 0 - 0 - 0 - 0
4976900 4473029 0 7 0 0 0 ANAH 19056526 70
1#0##0#0#0.0#2019-03-01 10:52:25#0#11:10:00#13:42:00#00:00:00 1
0d994658a88f07eee795a626aba9d0eb 1030000 0 250000 0 0
0 950000 103875 0 0 490000 0 1359460 229694
60000 0 0 0
3206023 C 3 CP 1 12/02/2019 13/02/2019 01/07/1953 0 2
0 0 - 0 - 0 - 0 - 0 6433000
2766556 0 2 0 0 0 ASIAH 16022191 65 23967 dr.
Teguh Budiman Sp.Ma. 0122R0020219V002613 0002206904354 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 270429
1#0##0#0#0.0#2019-03-01 10:54:47#0#09:32:00#13:27:00#00:00:00 1
5191d21e70379439b8c81752903db58e 309434 2125000 100000 0
0 0 0 0 0 0 140000 0 82122 0 10000 0
0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 04/04/1967 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 3897471 0 3 0 0 0 WIDA NINGSIH
5.3.6.201902021030 4 270498 1#0##0#0#0.0#2019-03-01
13:25:52#0#19:28:00#13:25:00#00:00:00 1 ea285f480919576e2a17e07d8de9c52d
770025 1573750 190000 0 0 0 0 38875 0 0
210000 0 720495 364326 30000 0 0 0
3206023 C 3 CP 1 12/02/2019 13/02/2019 05/07/1993 0 2
1 O99.0;D64.9 99.04 - - None None None None W-4-16-I None
0 - 0 - 0 - 0 - 0 1999800 1321960
0 2 0 0 0 ITA NURPAIDA 19056984 25 9353 dr.
Septiani;3278085209910012 5.3.6.201902021030 4 270573
1#0##0#0#0.0#2019-03-01 13:28:28#0#15:07:00#11:37:00#00:00:00 1
56d5a0f67e7962bf8a2f712562a47fe8 280000 0 50000 0 0 0
0 759200 0 0 140000 0 32867 49893 10000 0 0
0
3206023 C 3 CP 1 11/02/2019 13/02/2019 01/01/1979 0 2
1 O72.2;D64.9;O99.0 99.04 - - None None None None W-4-17-II
0 0 - 0 - 0 - 0 - 0 2664400
1182090 0 3 0 0 0 UTIH SADIAH 19056868 40 14651
dr. Asep Taslim Sp.OG 0122R0020219V002673 0002490209008 3;JKN Santi
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 270585
1#0##0#0#0.0#2019-03-01 13:38:28#0#11:37:00#11:35:00#00:00:00 1
3b67cbefbbbb0e15779e38830d795fdd 445000 0 50000 0 0 0
0 310725 0 0 210000 0 54306 66139 20000 25920 0
0
3206023 C 3 CP 1 11/02/2019 13/02/2019 04/12/1971 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3382294 0 3 0 0 0 MULYANI 19055621
270592 1#0##0#0#0.0#2019-03-01 13:42:04#0#13:54:00#11:43:00#00:00:00
1 5dbc5104a732a417e874e848b972ba24 603000 1626250 120000
0 0 0 0 378500 0 0 210000 0 178512
246032 20000 0 0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 12/03/1954 0 2
1 N93.8;N84.1 69.09;67.39 - - None None None None W-1-30-I
None None None None None None PROSEDUR PADA VAGINA, SERVIK & VULVA
(RINGAN) 3464300 0 0 - 0 - 0 - 0 - 0
3464300 3620464 0 3 0 0 0 MUMU MUPLIHAH
5.3.6.201902021030 4 270613 1#0##0#0#0.0#2019-03-01
13:56:04#0#17:06:00#23:16:00#00:00:00 1 baaf026216659afbc8e36926c6cb2863
623000 1626250 120000 0 0 0 0 498875 0
0 210000 0 162290 360049 20000 0 0 0
3206023 C 3 CP 1 12/02/2019 13/02/2019 12/08/1965 0 2
1 I25.0;I50.0 - - - None None None None I-4-16-II None
None None None None None ATHEROSKLEROSIS (SEDANG) 2508400 0
0 - 0 - 0 - 0 - 0 2508400 805132
0 2 0 0 0 IMAS 17002131 53 19542 dr. H. Dani Farid
Abdullah Sp.PD 0122R0020219V002709 0002321624125 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 270615
1#0##0#0#0.0#2019-03-01 13:58:12#0#18:03:00#11:57:00#00:00:00 1
18053d7149b9611f459b8cd6c82cdfe0 303500 0 50000 0 0 0
0 178375 0 0 140000 0 63661 29596 40000 0 0
0
3206023 C 3 CP 1 11/02/2019 13/02/2019 13/04/1981 0 2
1 N93.8;D64.9 99.04 - - None None None None W-4-12-II None
LAIN-LAIN (SEDANG) 3667500 0 0 - 0 - 0 - 0
- 0 3667500 703335 0 3 0 0 0 ENTIN
5.3.6.201902021030 4 270617 1#0##0#0#0.0#2019-03-01
14:03:03#0#13:00:00#17:26:00#00:00:00 1 eedc52df9abb95f8fa88a7bf967313de
150000 0 100000 0 0 0 0 79625 0 0 210000
0 39489 84221 40000 0 0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 09/11/1995 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2019827 0 3 0 0 0 ENENG LASTRI 19056837 23
1#0##0#0#0.0#2019-03-01 14:07:21#0#15:02:00#10:14:00#00:00:00 1
3b5dd82f3e6e7a87061f69a23315a4ce 1445000 0 170000 0 0
0 0 0 0 0 210000 0 66227 118600 10000 0
0 0
3206023 C 3 CP 1 12/02/2019 13/02/2019 04/10/1997 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2407839 0 2 0 0 0 NURWILDANSARI 19056977 21
1#0##0#0#0.0#2019-03-01 14:09:20#0#12:32:00#10:14:00#00:00:00 1
482d40066a947daed883627ee16f108e 1705000 0 70000 0 0 0
0 231100 0 0 140000 0 80237 161502 20000 0
0 0
3206023 C 3 CP 1 11/02/2019 13/02/2019 04/04/1995 0 2
1 O14.1;O32.1;O62.0 - - - None None None None W-4-16-II
0 0 - 0 - 0 - 0 - 0 2674300
1399955 0 3 0 0 0 INDRIYANI 19054078 23 8714
dr. Asep Taslim Sp.OG 0122R0020219V002420 0000434044462 3;JKN Santi
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 271208
1#0##0#0#0.0#2019-03-05 09:16:26#0#15:30:00#11:38:00#00:00:00 1
73f4e5d676c43f6b622693f863a56dff 712500 0 100000 0 0
0 0 100500 0 0 210000 0 246955 0 30000
0 0 0
3206023 C 3 CP 1 08/02/2019 13/02/2019 10/11/1988 0 2
12-I None None None None None None PERSALINAN VAGINAL DENGAN PROSEDUR SELAIN
STERILISASI &/ DILATASI &KURET (RINGAN) 1807500 0 0 - 0 -
0 - 0 - 0 1807500 3909854 0 6 0 0
0 IDA PARIDA 19056659 30 11047 DR. ASEP TASLIM SP.OG
Septiani;3278085209910012 5.3.6.201902021030 4 271224
1#0##0#0#0.0#2019-03-14 13:56:38#0#02:14:00#08:48:00#00:00:00 2
7ae3e3f1bf610b86d76203a6dfcf761e 2525000 0 270000 0 0
0 0 371375 0 0 350000 0 173586 159893
60000 0 0 0
3206023 C 2 CP 1 10/02/2019 14/02/2019 23/08/2000 0 2
1 A90;K30 - - - None None None None A-4-13-I None
None None None None None INFEKSI VIRAL & NON-BAKTERIAL LAIN (RINGAN)
1811000 0 0 - 0 - 0 - 0 - 0
1811000 2319307 0 5 0 0 0 TINTA DARA, NN
S.ST;3206297107870001 5.3.6.201902021030 4 268243
1#1#kelas_1#5#301800#0.0#2019-02-14 11:55:25#0#11:12:00#11:50:00#00:00:00
1 49b176418fd14a7bc24d515098ec4a36 558500 0 370000 0
0 0 0 255450 0 0 790000 0 158599 33078
50000 103680 0 0
3206023 C 1 CP 1 10/02/2019 14/02/2019 30/01/1968 0 2
(SEDANG) 6967700 0 0 - 0 - 0 - 0 - 0
6967700 4545646 0 5 0 0 0 NANANG BUDIMAN
5.3.6.201902021030 4 268810 1#0##0#0#0.0#2019-02-20
12:54:19#0#13:12:00#09:58:00#00:00:00 1 1e194c5133251305274b4c53c94d5f5a
705000 0 400000 0 0 0 1150000 70125 0 0
900000 0 995348 102373 50000 172800 0 0
3206023 C 1 CP 1 08/02/2019 14/02/2019 04/03/1966 0 2
2112800 0 0 - 0 - 0 - 0 - 0
2112800 6278582 0 7 0 0 0 IING FARID 14014592
5.3.6.201902021030 4 268812 1#0##0#0#0.0#2019-02-20
12:59:31#0#01:09:00#13:05:00#00:00:00 1 261d307c54c6cbe3e92879e325e6d855
1697500 0 1155000 0 0 0 0 904200 0 0
1440000 0 879104 132778 70000 0 0 0
3206023 C 1 CP 1 12/02/2019 14/02/2019 07/06/1957 0 2
0 - 0 - 0 - 0 - 0 6794700 4821518
0 3 0 0 0 ADE 18052829 61 22530 dr. Riadhi
Aeni;3206276601940002 5.3.6.201902021030 4 268813 1#0##0#0#0.0#2019-
02-20 13:06:18#0#19:21:00#13:05:00#00:00:00 1
71f48e06907087e374ee4388b0f9257d 800025 1913750 220000 0
0 0 0 562125 0 0 540000 0 399646 365972
20000 0 0 0
3206023 C 1 CP 1 12/02/2019 14/02/2019 10/11/1962 0 2
- 0 - 0 - 0 - 0 2304200 2092982 0
3 0 0 0 ENDANG KOSWARA 19055102 56 20548 dr. Riadhi
Aeni;3206276601940002 5.3.6.201902021030 4 268820 1#0##0#0#0.0#2019-
02-20 13:17:18#0#07:32:00#11:08:00#00:00:00 1
d6d5ff4106c0670f71fc48c9957ad9c2 1400000 0 150000 0 0
0 0 0 0 0 210000 0 190519 112463 30000
0 0 0
3206023 C 2 CP 1 12/02/2019 14/02/2019 22/07/1971 0 2
1 Z03.1;D63.0 85.12;99.04 - - None None None None L-1-50-II
None None None None None None PROSEDUR PADA PAYUDARA (SEDANG)
9373100 0 0 - 0 - 0 - 0 - 0
9373100 4338008 0 3 0 0 0 ELIT 19056917 47
268840 1#0##0#0#0.0#2019-02-20 13:48:30#0#12:48:00#14:42:00#00:00:00
1 9e5cb1e24f5c3a7cbbe3e09cb3578f59 509000 1465000 140000
0 0 0 0 1308475 0 0 375000 0 37355 483178
20000 0 0 0
3206023 C 2 CP 1 12/02/2019 14/02/2019 05/08/1968 0 2
1 N85.0;D64.9;N93.8 99.04 - - None None None None W-4-12-II
None None None None None None GANGGUAN MENSTRUASI & SISTEM REPRODUKSI
WANITA LAIN-LAIN (SEDANG) 4401000 0 0 - 0 - 0 -
0 - 0 4401000 1745620 0 3 0 0 0 KOKOM
5.3.6.201902021030 4 268862 1#0##0#0#0.0#2019-02-21
08:20:39#0#13:19:00#11:17:00#00:00:00 1 312e42468f374f0593c8fb6cf7ccbb9c
242500 0 140000 0 0 0 0 933800 0 0
375000 0 23465 855 30000 0 0 0
3206023 C 2 CP 1 10/02/2019 14/02/2019 23/10/1998 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 2966637 0 5 0 0 0 RESTIA OKTAVIANI
Aeni;3206276601940002 5.3.6.201902021030 4 268864 1#0##0#0#0.0#2019-
02-21 08:30:47#0#12:27:00#09:42:00#00:00:00 1
f60e9caba086f4bf567fd2ce049ee35e 648500 0 280000 0 0
0 0 357575 0 0 460000 0 1099804 70758 50000
0 0 0
3206023 C 2 CP 1 12/02/2019 14/02/2019 01/09/1986 0 2
1 O63.9;Z37.0;O82.1;O48;O42.2;O32.1 74.99 - - None None None
CAESAR (RINGAN) 5796300 0 0 - 0 - 0 - 0 -
0 5796300 4849096 0 3 0 0 0 LENI SETIANI
5.3.6.201902021030 4 268865 1#0##0#0#0.0#2019-02-21
08:35:35#0#07:38:00#10:58:00#00:00:00 1 a114b2379277b06f20beffaab927309c
842000 2137750 120000 0 0 0 0 295125 0
0 210000 0 443777 770444 30000 0 0 0
3206023 C 3 CP 1 07/02/2019 14/02/2019 07/02/2019 1500 2
1 P21.9;P59.9;P01.5;P07.1 93.96 - - None None None None P-8-
12-I None None None None None None NEONATAL, BBL 1500 - 1999 GR TANPA
- 0 5808700 4201435 0 8 0 0 0 BY NY RINI M
11 19056538 0 0 dr. Marte Robiul Sani Sp.A. 0122R0020219V001930
5.3.6.201902021030 4 268870 1#0##0#0#0.0#2019-02-21
08:45:56#0#13:01:00#10:01:00#00:00:00 1 cedb2b8489e71359d9f66309bc677a1d
1847500 0 560000 0 0 0 0 235375 0 0
1000000 0 114463 364097 80000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 17/02/1985 0 2
0 - 0 - 0 - 0 - 0 4853300 4152186
0 3 0 0 0 SUSAN NURJANAH 18049928 33 12413 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268872
1#0##0#0#0.0#2019-02-21 08:50:17#0#21:54:00#15:32:00#00:00:00 1
b6966c8e3083128e831b72b70276db24 726525 1825000 170000 0
0 0 0 340125 0 0 210000 0 453324 397212
30000 0 0 0
3206023 C 3 CP 1 11/02/2019 14/02/2019 15/07/2000 0 2
1 K35.2;L02.2 54.19;86.04 - - None None None None K-1-40-II
(SEDANG) 6379900 0 0 - 0 - 0 - 0 - 0
6379900 5187262 0 4 0 0 0 ARMAN MAULANA
5.3.6.201902021030 4 268890 1#0##0#0#0.0#2019-02-21
09:23:32#0#10:46:00#11:10:00#00:00:00 1 5401fe8430fd28386d06845330ce8b72
1198550 2137750 240000 0 0 0 0 38875 0 0
280000 0 514843 737244 40000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 18/10/1949 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4866302 0 3 0 0 0 BASIR, TN 16010949
5.3.6.201902021030 4 268911 1#0##0#0#0.0#2019-02-21
09:36:11#0#17:28:00#11:10:00#00:00:00 1 277cc0f63fdfffb75332551e6bddbd8a
430000 2592500 170000 0 0 0 0 0 0 0
210000 0 726588 707214 30000 0 0 0
3206023 C 3 CP 1 11/02/2019 14/02/2019 03/03/1983 0 2
1 D14.0;D64.9;J32.9 99.04 - - None None None None U-4-15-II
None None None None None None PENYAKIT TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN LAIN-LAIN (SEDANG) 2739900 0 0 - 0 - 0
- 0 - 0 2739900 3363028 0 4 0 0 0
SITI ATIKAH 19054911 35 13129 dr. M Sidik Hasanudin Sp.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 268917 1#0##0#0#0.0#2019-
02-21 09:48:52#0#12:03:00#15:33:00#00:00:00 1
770e4079b2238117d5c2342e83275a0c 370000 0 200000 0 0
0 0 2150025 0 0 280000 0 214012 108991
40000 0 0 0
3206023 C 3 CP 1 11/02/2019 14/02/2019 02/01/1988 0 2
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5028432 0 4 0 0 0 ELIS NURLELA
5.3.6.201902021030 4 268954 1#0##0#0#0.0#2019-02-21
10:54:21#0#13:52:00#10:56:00#00:00:00 1 d2bffb86d2e25b221b5ec0a77ab4d9be
1002000 1825000 240000 0 0 0 0 465125 0
0 280000 0 492299 684008 40000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 07/04/2006 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4751587 0 3 0 0 0 DADAN RAMDANI
5.3.6.201902021030 4 268976 1#0##0#0#0.0#2019-02-21
11:03:01#0#17:43:00#09:45:00#00:00:00 1 3aac0941bd02b6bd4ff023cc5d49ed70
657025 2592500 170000 0 0 0 0 0 0 0
210000 0 716119 375943 30000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 08/08/1964 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4963446 0 3 0 0 0 JUNAEDIN 19056123
5.3.6.201902021030 4 268986 1#0##0#0#0.0#2019-02-21
11:16:09#0#17:09:00#11:09:00#00:00:00 1 0319bdf54bf41c60b0958737e16dd626
430000 2592500 170000 0 0 0 0 0 0 0
210000 0 865739 665207 30000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 05/07/1965 0 2
None None None None PROSEDUR ANGGOTA TUBUH ATAS (RINGAN) 6246500
0 0 - 0 - 0 - 0 - 0 6246500
4172940 0 3 0 0 0 TUJO DARYANTO 18052763 53
269030 1#0##0#0#0.0#2019-02-21 13:38:52#0#21:33:00#15:38:00#00:00:00
1 2ac5107fd783a67cf8220558ae6bea44 726525 1825000 170000
0 0 0 0 373875 0 0 210000 0 482136
365404 20000 0 0 0
3206023 C 3 CP 1 11/02/2019 14/02/2019 01/06/1974 0 2
1 D11.0 26.30 - - None None None None U-1-13-I None None
None None None None PROSEDUR KELENJAR LUDAH (RINGAN) 4887100 0
0 - 0 - 0 - 0 - 0 4887100 6719536
0 4 0 0 0 DEDEN SUWARNI 18048440 44 16326 DR.
RIADHI YULIANTO SP.B. 0122R0020219V002430 0000435506117 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 268877
1#0##0#0#0.0#2019-02-25 09:04:00#0#19:00:00#09:04:00#00:00:00 2
2827ea3ae51fd1b78fd2785f030414c9 1209050 2592500 240000 0
0 0 0 490375 0 0 350000 0 447755
1349856 40000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 08/02/2019 3500 2
1 P36.9;P22.0 99.21 - - None None None None P-8-16-III None
KONGENITAL/INFEKSI PERINATAL (BERAT) 7002400 0 0 - 0 -
0 - 0 - 0 7002400 1367847 0 3 0 0
0 JASMINE MAFAZA SIDATIL AYAMI 19056986 0 4 DR. MARTE ROBIUL
SANI SP.A. 0122R0020219V002996 0002745815005 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268867 1#0##0#0#0.0#2019-
02-25 09:05:02#0#01:59:00#09:57:00#00:00:00 2
94f026162c7bf0b2910c466fadc830c8 660000 0 140000 0 0
0 0 130875 0 0 250000 0 38541 118431 30000
0 0 0
3206023 C 2 CP 1 13/02/2019 14/02/2019 21/04/1951 0 2
- 0 - 0 - 0 - 0 1975100 1922837 0
2 0 0 0 ATENG 18039106 67 24770 DR. RIADHI YULIANTO
SP.B. 0122R0020219V002862 0002466550045 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268824 1#0##0#0#0.0#2019-
02-25 09:08:04#0#08:35:00#09:05:00#00:00:00 2
09da1c78d9021a1d4a29b67f6fa6d3ed 1320000 0 100000 0 0
0 0 0 0 0 375000 0 86187 31650 10000 0 0
0
3206023 C 3 CP 1 14/02/2019 14/02/2019 17/07/2003 0 2
1 O72.2;O70.9;O62.2 75.69 - - None None None None W-4-17-I
None None None None None None GANGGUAN POSTPARTUM (RINGAN) 1475700
0 0 - 0 - 0 - 0 - 0 1475700
1644190 0 1 0 0 0 YULIA LESTARI 19057117 15
1#0##0#0#0.0#2019-02-25 09:10:38#0#07:35:00#08:46:00#00:00:00 2
7ea4987a6812e492ba83af4e476d0fc2 877500 0 50000 0 0 0
0 356000 0 0 70000 0 76788 193902 20000 0 0
0
3206023 C 3 CP 1 20/01/2019 14/02/2019 19/01/2019 1500 2
1 P36.9;P07.1;Q79.4;P59.9 93.90 - - None None None None P-8-
12-III None None None None None None NEONATAL, BBL 1500 - 1999 GR TANPA
PROSEDUR MAYOR (BERAT) 9347800 0 0 - 0 - 0 - 0
- 0 9347800 13438707 0 26 0 0 0 BY NY SELIA
NURHALIZAH 19054821 0 1 DR. MARTE ROBIUL SANI SP.A.
Aeni;3206276601940002 5.3.6.201902021030 4 268929 1#0##0#0#0.0#2019-
02-25 09:12:11#0#06:52:00#00:00:00#00:00:00 4
e3f32d986fe5263bae63d04d8f93fc01 6170000 0 1750000 0 0
0 260000 1217575 0 0 2260000 0 393424
1147708 240000 0 0 0
3206023 C 3 CP 1 13/02/2019 14/02/2019 17/10/1954 0 2
2194500 0 0 - 0 - 0 - 0 - 0
2194500 1257443 0 2 0 0 0 SOMA 18049458 64
5.3.6.201902021030 4 269852 1#0##0#0#0.0#2019-02-26
09:52:23#0#22:29:00#03:08:00#00:00:00 1 d1cd4996946a325b190d977b522765e6
583500 0 50000 0 0 0 0 103875 0 0 140000
0 156458 117210 20000 86400 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 05/07/1954 0 2
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 2448122 0 3 0 0 0 DODO 19056993 64
1#0##0#0#0.0#2019-02-26 09:54:22#0#20:07:00#07:57:00#00:00:00 1
0c2481a9722f7c542696a2755b801f28 969500 0 150000 0 0
0 0 70125 0 0 210000 0 836799 65298 60000 86400
0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 18/08/1974 0 2
1 J32.0;J34.3 22.2;21.69 - - None None None None U-1-20-I
0 - 0 4458500 4862888 0 3 0 0 0 NINING
NINGRUM 18049386 44 16249 dr. M Sidik Hasanudin Sp.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 269885 1#0##0#0#0.0#2019-
02-26 10:03:55#0#17:04:00#15:35:00#00:00:00 1
feae61ba270734321a652c724350601a 765025 1573750 170000 0
0 0 0 0 0 0 210000 0 723641 1390472
30000 0 0 0
3206023 C 2 CP 1 13/02/2019 14/02/2019 03/04/2011 0 2
0 - 0 - 0 - 0 - 0 4259200 3937325
0 2 0 0 0 AJENG AZKIA 19056954 7 2873 dr. M Sidik
Hasanudin Sp.THT-KL 0122R0020219V002932 0001196734667 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269900
1#0##0#0#0.0#2019-02-26 10:11:25#0#10:07:00#12:34:00#00:00:00 1
2746c88e7214d83ad11e6280e6915aeb 666525 2105000 160000 0
0 0 0 70125 0 0 250000 0 409526 256149
20000 0 0 0
3206023 C 2 CP 1 12/02/2019 14/02/2019 02/04/1954 0 2
1 E11.3;H28.0 13.71 - - None None None None H-1-30-I None
7719600 0 0 - 0 - 0 - 0 - 0
7719600 3887120 0 3 0 0 0 SUWARTO, TN 15005888
64 23692 DR. TEGUH BUDIMAN SP.MA. 0122R0020219V002707
5.3.6.201902021030 4 269896 1#0##0#0#0.0#2019-02-28
09:58:49#0#17:51:00#08:10:00#00:00:00 2 8af66c63494e344bec7afc2155ba139f
341934 2125000 140000 0 0 0 0 0 0 0
445000 0 96537 708649 30000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 01/07/1945 0 2
1 Z03.1;R59.1 84.11;45.27 - - None None None None M-1-30-I
None None None None None None PROSEDUR KAKI (RINGAN) 6295600 0
0 - 0 - 0 - 0 - 0 6295600 4506433
0 3 0 0 0 EMEN 19053666 73 26889 DR. RIADHI
YULIANTO SP.B. 0122R0020219V003389 0002518036738 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 269889 1#0##0#0#0.0#2019-
02-28 10:00:05#0#17:59:00#09:03:00#00:00:00 2
73147531027c7030ec19641d1ec405ca 439500 1825000 170000 0
0 0 0 690125 0 0 280000 0 531636 540172
30000 0 0 0
3206023 C 3 CP 1 10/02/2019 14/02/2019 04/01/2010 0 2
1 J35.0;R13 28.2 - - None None None None U-1-15-II None
None None None None None PROSEDUR TONSIL & ADENOID (SEDANG) 5046100
0 0 - 0 - 0 - 0 - 0 5046100
3358115 0 5 0 0 0 SOPI 19055683 9 3324 dr. M
Sidik Hasanudin Sp.THT-KL 0122R0020219V002017 0000432319803 3;JKN Santi
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 270391
1#0##0#0#0.0#2019-03-01 10:47:30#0#16:15:00#08:19:00#00:00:00 1
9518e3645e9f9b3d1c49e52a8a9117e1 601525 1825000 170000 0
0 0 0 0 0 0 350000 0 222804 178786
10000 0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 14/10/1998 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2175016 0 3 0 0 0 AYU 19056906 20 7426 dr.
Septiani;3278085209910012 5.3.6.201902021030 4 270616
1#0##0#0#0.0#2019-03-01 14:00:17#0#12:23:00#07:02:00#00:00:00 1
1757669112d325bb9c2eb74e8fb02e58 1095000 0 50000 0 0 0
0 281500 0 0 210000 0 288620 219896 30000
0 0 0
3206023 C 3 CP 1 12/02/2019 14/02/2019 08/07/1996 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2426160 0 3 0 0 0 MAYA ROMANTIR 19056992 22
1#0##0#0#0.0#2019-03-01 14:05:47#0#16:59:00#07:03:00#00:00:00 1
83f7f8b5b73a70a3c4c38b18d9a2d350 1265000 0 50000 0 0 0
0 460875 0 0 210000 0 256709 153576 30000
0 0 0
3206023 C 2 CP 1 12/02/2019 14/02/2019 21/06/1986 0 2
1 O44.1 - - - None None None None W-4-16-I None None
None None None None GANGGUAN ANTEPARTUM (RINGAN) 2399800 0 0
- 0 - 0 - 0 - 0 2399800 2523614 0
3 0 0 0 KARNIAWATI 19056898 32 11924 DR. ASEP TASLIM
SP.OG 0122R0020219V002451 0000204163751 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268850
1#0##0#0#0.0#2019-03-14 14:05:41#0#00:00:00#00:00:00#00:00:00 2
e453c96661497dd3bb57fba19f4e3660 617500 0 100000 0 0
0 0 1441475 0 0 210000 0 40598 84041 30000 0
0 0
3206023 C 2 CP 1 13/02/2019 14/02/2019 06/09/1944 0 2
1 R42;I10 - - - None None None None U-4-11-I None
None None None None None DYSEQUILIBRIUM (RINGAN) 1574000 0 0
- 0 - 0 - 0 - 0 1574000 1497819 0
2 0 0 0 IROH AISAH, NY 17003537 74 27188 DR. INDRA
GUNAWAN, SP.S 0122R0020219V002733 0000070326303 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 268829
1#0##0#0#0.0#2019-03-14 14:06:27#0#00:00:00#00:00:00#00:00:00 2
f57c038d75d218e3d0588924acd6bd4f 400000 0 140000 0 0
0 0 70125 0 0 250000 0 550607 67087 20000 0
0 0
3206023 C 3 CP 1 11/02/2019 14/02/2019 03/01/1958 0 2
1 J33.0;J34.3;J32.0 21.30;22.2;21.69 - - None None None None
U-1-20-I None None None None None None PROSEDUR TENGGOROKAN, MULUT,
HIDUNG DAN TELINGA LAIN-LAIN (RINGAN) 4458500 0 0 - 0 -
0 - 0 - 0 4458500 5390743 0 4 0 0
0 JUHDI 18048891 61 22319 DR. M SIDIK HASANUDIN SP.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 269868 1#0##0#0#0.0#2019-
03-18 09:08:09#0#17:51:00#15:34:00#00:00:00 2
5a034ddc557b27fd80646f817010e48d 902025 2592500 240000 0
0 0 0 132625 0 0 280000 0 616553 587040
40000 0 0 0
3206023 C 2 CP 1 10/02/2019 15/02/2019 26/11/2009 0 2
1 K35.2;E87.8;A41.9 54.19 - - None None None None K-1-40-III
(BERAT) 12973900 0 0 - 0 - 0 - 0 - 0
12973900 8575475 0 6 0 0 0 MUHAMMAD RAYA PUTRA
SANTIKA 19056728 9 3363 dr. Aa Ahmad Dimyati, Sp.B
Septiani;3278085209910012 5.3.6.201902021030 4 268320
1#1#kelas_1#6#2162300#0.0#2019-02-15 10:38:03#0#12:36:00#10:35:00#00:00:00
1 ed0108dcf49c1122029238df284ca10c 1367025 3036500 470000
0 0 0 0 716875 0 0 860000 0 1346252
748823 30000 0 0 0
3206023 C 3 CP 1 06/02/2019 15/02/2019 15/04/1975 0 2
- 0 - 0 - 0 - 0 1645900 2903482 0
10 0 0 0 AAY 18026217 43 16003 dr. Riadhi Yulianto
Sp.B. 0122R0020219V000996 0002426178328 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 268670 1#0##0#0#0.0#2019-
02-19 13:48:08#0#09:31:00#09:30:00#00:00:00 1
053321e3b69013bc1e2fc374f52675c5 1490000 0 150000 0 0
0 0 242100 0 0 700000 0 186677 94705 40000
0 0 0
3206023 C 2 CP 1 11/02/2019 15/02/2019 13/03/1997 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 1875596 0 5 0 0 0 UTARI ANJANI
Aeni;3206276601940002 5.3.6.201902021030 4 269153 1#0##0#0#0.0#2019-
02-25 09:21:10#0#15:12:00#11:19:00#00:00:00 1
543223c3239b5059858a0cc394fa91dc 528500 0 230000 0 0
0 0 297450 0 0 350000 0 398609 21037 50000
0 0 0
3206023 C 2 CP 1 09/02/2019 15/02/2019 05/02/1956 0 2
1 A91;A01.0;K30 99.21 - - None None None None A-4-13-III
(BERAT) 3273800 0 0 - 0 - 0 - 0 - 0
3273800 3896912 0 7 0 0 0 EHA ROSIDA 19056700
5.3.6.201902021030 4 269160 1#0##0#0#0.0#2019-02-25
09:23:31#0#23:33:00#09:58:00#00:00:00 1 b321f2acc81c869c64f8875c578b9f3c
850000 0 600000 0 0 0 0 550200 0 0
1260000 0 501228 85484 50000 0 0 0
3206023 C 2 CP 1 14/02/2019 15/02/2019 21/02/1994 0 2
0 0 - 0 - 0 - 0 - 0 2194200
2383753 0 2 0 0 0 SANTINI 19057121 24 9124
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269165
1#0##0#0#0.0#2019-02-25 09:25:12#0#12:34:00#11:07:00#00:00:00 1
611890803cb7208e3f1eb9c8c7360d9e 1487500 0 170000 0 0
0 0 311875 0 0 140000 0 67565 186813 20000
0 0 0
3206023 C 2 CP 1 13/02/2019 15/02/2019 10/11/1986 0 2
1 O34.2;O99.8 - - - None None None None W-4-16-II None
0 - 0 - 0 - 0 - 0 3209200 1895477
0 3 0 0 0 SITI NURAENI 19056951 32 11783 dr.
Asep Taslim Sp.OG 0122R0020219V002730 0001176648693 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 269171 1#0##0#0#0.0#2019-
02-25 09:31:42#0#00:37:00#20:13:00#00:00:00 1
90d8e8cdc340dce8af96fc7b411055b2 837500 0 140000 0 0
0 0 100500 0 0 375000 0 7077 84360 40000 311040
0 0
3206023 C 1 CP 1 13/02/2019 15/02/2019 21/02/1958 0 2
9006300 0 0 - 0 - 0 - 0 - 0
9006300 4457945 0 3 0 0 0 LILIS DARLIPAH
5.3.6.201902021030 4 269180 1#0##0#0#0.0#2019-02-25
09:35:39#0#17:12:00#12:07:00#00:00:00 1 9b8600b2d4f777e3bb98d0cadae58d19
199434 2530000 200000 0 0 0 0 296375 0
0 540000 0 187360 494776 10000 0 0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 11/03/2000 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 4534338 0 5 0 0 0 AGUNG GUNAWAN
Aeni;3206276601940002 5.3.6.201902021030 4 269188 1#0##0#0#0.0#2019-
02-25 09:38:20#0#12:08:00#17:15:00#00:00:00 1
7f69d1b60fe9613ad157217e72d3a568 776500 1483750 270000 0
0 0 0 415100 0 0 350000 0 858059 350929
30000 0 0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 12/10/1960 0 2
1 L53.9;L21.9;L40.0 - - - None None None None L-4-14-I
None None None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN
(RINGAN) 2186200 0 0 - 0 - 0 - 0 - 0
2186200 1729355 0 5 0 0 0 SAMSA 19056832 58
21306 dr. Eman Arif Rahman, Sp.KK 0122R0020219V002394 0000435249325
269192 1#0##0#0#0.0#2019-02-25 09:42:21#0#11:56:00#12:13:00#00:00:00
1 c3d7ad58df2d2d977d83247f0d0478e5 210000 0 200000 0
0 0 0 356075 0 0 680000 0 168953 84327
30000 0 0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 25/05/1953 0 2
1 H25.0;I10 13.71 - - None None None None H-1-30-I None
6433000 0 0 - 0 - 0 - 0 - 0
6433000 5952926 0 5 0 0 0 SAUN 18047029 65
269204 1#0##0#0#0.0#2019-02-25 09:45:11#0#19:45:00#14:25:00#00:00:00
1 479a66944de64a42a13a054adec1dd00 1041893 3012500 290000
0 0 0 0 126875 0 0 350000 0 163741
937917 30000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 20/07/1979 0 2
3722700 0 0 - 0 - 0 - 0 - 0
3722700 3445231 0 3 0 0 0 UJANG LILI 19057089
269210 1#0##0#0#0.0#2019-02-25 09:49:42#0#14:58:00#23:41:00#00:00:00
1 31c134e77e2d1e083bd79ca18c6f8913 755000 0 100000 0
0 0 950000 70125 0 0 210000 0 1156883 116823
0 86400 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 23/04/1972 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4706919 0 3 0 0 0 IIP SARIP 18027271
5.3.6.201902021030 4 269226 1#0##0#0#0.0#2019-02-25
09:57:06#0#18:01:00#14:26:00#00:00:00 1 95edd46abe2ec70838dcd58d3688300d
355000 2592500 170000 0 0 0 0 218875 0
0 210000 0 785777 344767 30000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 05/05/1998 0 2
1 B05.9 - - - None None None None A-4-13-I None None
1509200 0 0 - 0 - 0 - 0 - 0
1509200 919321 0 3 0 0 0 UAN RUSTANDI
Aeni;3206276601940002 5.3.6.201902021030 4 269232 1#0##0#0#0.0#2019-
02-25 09:59:10#0#18:22:00#17:13:00#00:00:00 1
60d3b300e4377561a651186e672b2e27 311000 0 100000 0 0
0 0 148725 0 0 210000 0 104233 35363 10000
0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 01/01/1953 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3339202 0 3 0 0 0 EMPAT 18050556 66 24149 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269239
1#0##0#0#0.0#2019-02-25 10:00:46#0#20:28:00#14:26:00#00:00:00 1
162ed4ad6bcab8a612d9b5d156a2c54d 354434 2125000 150000 0
0 0 0 0 0 0 210000 0 51172 418596 30000
0 0 0
3206023 C 3 CP 1 14/02/2019 15/02/2019 12/08/2017 0 2
4 Q21.1;Q90.9;A41.9 93.96;99.21;99.60 - - None None None None
I-4-18-III None None None None None None PENYAKIT JANTUNG KONGENITAL
DAN KATUP JANTUNG (BERAT) 6228500 0 0 - 0 - 0 -
0 - 0 6228500 1264653 0 2 0 0 0
FADHLAN FARID MAARIF 19057199 1 551 dr. Marte Robiul Sani Sp.A.
Aeni;3206276601940002 5.3.6.201902021030 4 269254 1#0##0#0#0.0#2019-
02-25 10:09:12#0#15:48:00#04:59:00#00:00:00 1
2df45dbf57f8b2d286e77c03ac4700cd 737500 0 50000 0 0 0
0 56100 0 0 140000 0 90981 152792 20000 17280 0
0
3206023 C 3 CP 1 14/02/2019 15/02/2019 01/07/1965 0 2
1 R11 - - - None None None None K-4-17-I None None
1406200 0 0 - 0 - 0 - 0 - 0
1406200 874010 0 2 0 0 0 AROM 18040440 53
5.3.6.201902021030 4 269263 1#0##0#0#0.0#2019-02-25
10:10:53#0#08:45:00#17:14:00#00:00:00 1 8661cd2a05aa9576f2c117de960c9933
343500 0 50000 0 0 0 0 142700 0 0 140000
0 121818 55992 20000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 14/04/1977 0 2
- 0 - 0 - 0 - 0 1585400 2891554 0
3 0 0 0 NUR AISYAH 19056801 41 15280 dr. Asep Taslim
Aeni;3206276601940002 5.3.6.201902021030 4 269321 1#0##0#0#0.0#2019-
02-25 10:38:30#0#17:19:00#20:13:00#00:00:00 1
ae87ce0fc06c9b601f16bb955c2e578e 398000 1626250 120000 0
0 0 0 185125 0 0 210000 0 232051 110128
10000 0 0 0
3206023 C 3 CP 1 14/02/2019 15/02/2019 12/08/1996 0 2
1 O42.2;Z37.0;O80.0 73.59;57.94 - - None None None None O-6-
0 0 - 0 - 0 - 0 - 0 1828500
2412161 0 2 0 0 0 SANTI SITI NURSYAMSIAH 19057216
5.3.6.201902021030 4 269332 1#0##0#0#0.0#2019-02-25
10:41:44#0#20:40:00#17:15:00#00:00:00 1 bb5316b7774c49d0f4379bb4304354d0
1470000 0 120000 0 0 0 0 281500 0 0
140000 0 105756 274905 20000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 07/01/1950 0 2
1 D15.2;I87.1 - - - None None None None J-4-14-II None
None None None None None TUMOR PARU (SEDANG) 5334600 0 0
- 0 - 0 - 0 - 0 5334600 1041110 0
3 0 0 0 OJOH 19057006 69 25239 dr. H. Dani Farid
Aeni;3206276601940002 5.3.6.201902021030 4 269348 1#0##0#0#0.0#2019-
02-25 10:48:06#0#13:38:00#14:29:00#00:00:00 1
9eca98d7b972383e9a8fec80b1c87f7d 301000 0 100000 0 0
0 0 70125 0 0 210000 0 289142 40843 30000 0
0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 08/06/2000 0 2
1 K37;K66.0 47.09;54.59 - - None None None None K-1-11-I
6622400 0 0 - 0 - 0 - 0 - 0
6622400 4937483 0 3 0 0 0 NURUL MAULIDA
5.3.6.201902021030 4 269373 1#0##0#0#0.0#2019-02-25
10:57:33#0#16:31:00#14:25:00#00:00:00 1 0dcc4e4505e8e2028edd7fc29a8a1922
764025 1825000 170000 0 0 0 0 273275 0
0 210000 0 1223386 399957 20000 51840 0 0
3206023 C 2 CP 1 12/02/2019 15/02/2019 12/02/2019 3600 2
1 P39.9;P83.8;P03.4 - - - None None None None P-8-16-I
None None None None None None NEONATAL, BBL > 2499 GR DENGAN
0 - 0 - 0 2144200 1333724 0 4 0 0
0 BY NY LENI 19056981 0 0 dr. Marte Robiul Sani Sp.A.
0122r0020219v003453 0002746117304 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 269384 1#0##0#0#0.0#2019-
02-25 11:06:28#0#14:50:00#08:48:00#00:00:00 1
7b11570de2d6a5994772e6b4ec6666b2 552500 0 210000 0 0
0 0 0 0 0 500000 0 13432 57792 0 0 0
0
3206023 C 3 CP 1 13/02/2019 15/02/2019 17/04/2014 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3247345 0 3 0 0 0 DAFA NUGRAHA
5.3.6.201902021030 4 269398 1#0##0#0#0.0#2019-02-25
11:17:07#0#18:25:00#09:51:00#00:00:00 1 3ee07ea34537a19a6b7dd8d2599a812f
640025 1573750 120000 0 0 0 0 0 0 0
210000 0 274439 399131 30000 0 0 0
3206023 C 3 CP 1 12/02/2019 15/02/2019 09/02/2019 2700 2
None None None None None NEONATAL, BBL > 2499 GR TANPA PROSEDUR MAYOR
(RINGAN) 3326400 0 0 - 0 - 0 - 0 - 0
3326400 1432000 0 4 0 0 0 BY NY IDA PARIDA
5.3.6.201902021030 4 269400 1#0##0#0#0.0#2019-02-25
11:19:46#0#22:27:00#11:43:00#00:00:00 1 cfc725129b564c61daf7b631956b99e2
662500 0 210000 0 0 0 0 59500 0 0 500000
0 0 0 0 0 0 0
3206023 C 3 CP 1 07/02/2019 15/02/2019 09/11/1967 0 2
1 A18.2;N17.9;J90 34.04 - - None None None None D-4-14-III
None None None None None None GANGGUAN PADA DARAH & ORGAN PEMBENTUK
DARAH LAIN-LAIN (BERAT) 4764000 0 0 - 0 - 0 - 0
- 0 4764000 7848507 0 9 0 0 0 ADIMAN DARMA
WADI 18050472 51 18718 dr. H. Dani Farid Abdullah Sp.PD
Aeni;3206276601940002 5.3.6.201902021030 4 269404 1#0##0#0#0.0#2019-
02-25 11:30:32#0#11:06:00#17:11:00#00:00:00 1
f4278b0f24ba5ef1cd7df29a516c3f6a 1128000 1483750 350000 0
0 0 270000 1149875 0 0 630000 0 2413542
423340 0 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 01/12/1975 0 2
1 T83.3 97.71 - - None None None None W-4-12-I None None
None None None None GANGGUAN MENSTRUASI & SISTEM REPRODUKSI WANITA LAIN-
LAIN (RINGAN) 2671300 0 0 - 0 - 0 - 0 -
0 2671300 2664299 0 3 0 0 0 YANI 19056348
269419 1#0##0#0#0.0#2019-02-25 11:34:34#0#11:38:00#12:47:00#00:00:00
1 c9db496b566b94d98895a3240c67b7c1 348000 1573750 120000
0 0 0 0 0 0 0 210000 0 135820 246729
30000 0 0 0
3206023 C 3 CP 1 12/02/2019 15/02/2019 09/12/1998 0 2
1 O00.9 54.11 - - None None None None K-1-40-I None None
5786500 0 0 - 0 - 0 - 0 - 0
5786500 3960002 0 4 0 0 0 SANTI 19056907 20
1#0##0#0#0.0#2019-02-25 13:35:10#0#13:41:00#12:45:00#00:00:00 1
99629e68342699c2500d8865a9ffb513 489500 1825000 170000 0
0 0 0 200000 0 0 280000 0 516664 448838
30000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 21/06/1992 0 2
1 T83.3 97.71 - - None None None None W-4-12-I None None
None None None None GANGGUAN MENSTRUASI & SISTEM REPRODUKSI WANITA LAIN-
LAIN (RINGAN) 2671300 0 0 - 0 - 0 - 0 -
0 2671300 2912322 0 3 0 0 0 SITI MARYATI
5.3.6.201902021030 4 269549 1#0##0#0#0.0#2019-02-25
13:38:19#0#11:43:00#12:46:00#00:00:00 1 678730b5175d3f808ac6325e2850152a
588000 1573750 120000 0 0 0 0 0 0 0
210000 0 136090 254482 30000 0 0 0
3206023 C 3 CP 1 09/02/2019 15/02/2019 01/01/1954 0 2
1 I25.1;N17.9;I50.0 - - - None None None None I-4-16-III
None None None None None None ATHEROSKLEROSIS (BERAT) 3010100 0
0 - 0 - 0 - 0 - 0 3010100 3285358
0 7 0 0 0 SITI HALIMAH, NY 16018885 65 23780 dr. H.
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269553
1#0##0#0#0.0#2019-02-25 13:41:22#0#19:59:00#13:55:00#00:00:00 1
fa6d591f590a33f838584b9fe853c3f1 633500 0 250000 0 0
0 140000 568825 0 0 490000 0 681095 348258
70000 103680 0 0
3206023 C 3 CP 1 09/02/2019 15/02/2019 01/07/1970 0 2
1 N18.9;D63.8;B20.9;A09.9 99.04 - - None None None None N-4-
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 4276714 0 7 0 0 0 DEDEH KURNIASIH
Aeni;3206276601940002 5.3.6.201902021030 4 269021 1#0##0#0#0.0#2019-
02-25 13:53:49#0#23:36:00#09:47:00#00:00:00 1
353b90a4d66eb03f9394c4d21d6e323f 597500 0 300000 0 0
0 0 1935425 0 0 490000 0 564483 329306
60000 0 0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 11/08/1974 0 2
4 C50.9;R57.2 - - - None None None None L-4-11-I None
None None None None None TUMOR PAYUDARA (RINGAN) 2658300 0 0
- 0 - 0 - 0 - 0 2658300 1735486 0
5 0 0 0 ALIAH 19056866 44 16255 dr. H. Dani Farid
Abdullah Sp.PD 0122R0020219V002415 0000435864982 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 269622
1#0##0#0#0.0#2019-02-25 14:06:27#0#15:07:00#09:30:00#00:00:00 1
325f34567f7dd24fc7d3d9e407109415 427500 0 50000 0 0 0
0 66100 0 0 140000 0 575716 476170 0 0
0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 02/04/1982 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 6037384 0 5 0 0 0 WATI APRIANI
5.3.6.201902021030 4 269430 1#0##0#0#0.0#2019-02-26
08:30:46#0#13:48:00#19:18:00#00:00:00 2 1b6e04e0b50fd315718802fb356ed10d
1374500 2137750 340000 0 0 0 0 281500 0
0 490000 0 608725 794909 10000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 11/04/1982 0 2
None None None None PENYAKIT TELINGA, HIDUNG, MULUT DAN TENGGOROKAN LAIN-
LAIN (RINGAN) 2199200 0 0 - 0 - 0 - 0 -
0 2199200 5629239 0 3 0 0 0 AFRIANTI
5.3.6.201902021030 4 269305 1#0##0#0#0.0#2019-02-26
08:37:36#0#20:07:00#08:54:00#00:00:00 3 acc3da9ca48596f8ce3330ccb6fa4459
837025 2592500 270000 0 0 0 0 420125 0
0 420000 0 541804 497785 50000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 03/06/1994 0 2
0 - 0 - 0 - 0 - 0 4853300 5314741
0 3 0 0 0 LINDA 18049671 24 9021 DR. RIADHI
Aeni;3206276601940002 5.3.6.201902021030 4 269301 1#0##0#0#0.0#2019-
02-26 08:38:10#0#20:19:00#08:55:00#00:00:00 2
1e61051847aac00c73359dbaca4f0500 797025 2592500 270000 0
0 0 0 270125 0 0 420000 0 382568 552523
30000 0 0 0
3206023 C 3 CP 1 14/02/2019 15/02/2019 14/05/1981 0 2
1 C41.9;D63.0 99.04 - - None None None None M-4-13-II None
None None None None None TUMOR MUSKULOSKLETAL,JARINGAN KONEKTIF DAN
FRAKTUR PATOLOGIS (SEDANG) 5475400 0 0 - 0 - 0 -
0 - 0 5475400 1992906 0 2 0 0 0 NANANG
SURYA 18050165 37 13790 DR. RIADHI YULIANTO SP.B. 0122R0020219V003448
5.3.6.201902021030 4 269280 1#0##0#0#0.0#2019-02-26
08:38:42#0#13:53:00#08:09:00#00:00:00 2 7a7eeb7aee173953a46858bf6725ca6f
410000 0 220000 0 0 0 0 805100 0 0
350000 0 149106 38700 20000 0 0 0
3206023 C 3 CP 1 12/02/2019 15/02/2019 01/01/1993 0 2
1 C50.9 85.12 - - None None None None L-1-50-I None None
0 - 0 - 0 - 0 - 0 4853300 7395382
0 4 0 0 0 ANGGI MIRANTI 18027647 26 9538 DR.
RIADHI YULIANTO SP.B. 0122R0020219V002716 0002437984449 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 269278
1#0##0#0#0.0#2019-02-26 08:39:27#0#19:30:00#08:55:00#00:00:00 2
502d72aefc74f2e4f9b1a97a6ffff935 1279050 2592500 320000 0
0 0 0 198625 0 0 490000 0 665216
1799991 50000 0 0 0
3206023 C 3 CP 1 14/02/2019 15/02/2019 11/01/1962 0 2
1 D36.7;E16.2 96.07 - - None None None None C-4-14-I None
None None None None None TUMOR MYELOPROLIFERATIF LAIN-LAIN (RINGAN)
2734700 0 0 - 0 - 0 - 0 - 0
2734700 1170213 0 2 0 0 0 OMAN 19057222 57
20853 DR. AA AHMAD DIMYATI, SP.B 0122R0020219V003492 0002004053038
269247 1#0##0#0#0.0#2019-02-26 08:42:01#0#00:32:00#14:41:00#00:00:00
2 08fb422c6ece8a8b0da6f1cbbd5da8f2 337500 0 50000 0 0
0 200000 103875 0 0 140000 0 287010 31828
20000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 01/07/1940 0 2
1 N39.0;E11.9 88.76 - - None None None None N-4-12-I None
None None None None None INFEKSI GINJAL DAN SALURAN URIN (RINGAN)
2155400 0 0 - 0 - 0 - 0 - 0
2155400 2046975 0 3 0 0 0 UKA 19057040 78
5.3.6.201902021030 4 269393 1#0##0#0#0.0#2019-02-26
08:56:07#0#15:19:00#09:32:00#00:00:00 2 664af3a7abfcbc5e4a1e6cc168ed350a
273500 0 50000 0 0 0 335000 391300 0 0
630000 0 246925 90250 30000 0 0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 12/05/1975 0 2
None None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN
(SEDANG) 3283700 0 0 - 0 - 0 - 0 - 0
3283700 2727344 0 5 0 0 0 ILA AMALIA, NY
5.3.6.201902021030 4 270295 1#0##0#0#0.0#2019-03-01
10:29:10#0#19:30:00#09:10:00#00:00:00 1 2e1e34ca9366a1ffd7634d84b51a9032
390000 0 120000 0 0 0 0 1755600 0 0
280000 0 75799 75945 30000 0 0 0
3206023 C 3 CP 1 13/02/2019 15/02/2019 15/07/1994 0 2
1 L97;Z03.1 86.11;86.22 - - None None None None L-4-10-I
None None None None None None PENYAKIT KULIT MAYOR (RINGAN) 1269400
0 0 - 0 - 0 - 0 - 0 1269400
3965518 0 3 0 0 0 SITI KHODIJAH 18052567 24
269243 1#0##0#0#0.0#2019-03-05 12:35:50#0#19:42:00#14:27:00#00:00:00
1 10bb0b87816c03f82e6799c5ef05620e 354500 1825000 170000
0 0 0 0 200000 0 0 210000 0 842377
343641 20000 0 0 0
3206023 C 3 CP 1 08/02/2019 15/02/2019 10/02/1979 0 2
1 K74.6;E88.0;K30 99.04;87.03 - - None None None None B-4-
3637100 0 0 - 0 - 0 - 0 - 0
3637100 6704754 0 8 0 0 0 ABDUL ROSID 19056657
5.3.6.201902021030 4 271800 1#0##0#0#0.0#2019-03-06
13:47:15#0#06:16:00#11:17:00#00:00:00 2 ccfbce5152ec0755487e862aa5d9b19e
822500 0 350000 0 0 0 1230000 2859250 0
0 490000 0 634661 258343 60000 0 0 0
3206023 C 3 CP 1 12/02/2019 15/02/2019 02/11/2018 0 2
0 - 0 - 0 - 0 - 0 2525300 2045970
0 4 0 0 0 NADILA NURSA'BAN 19057004 0 102 DR.
MARTE ROBIUL SANI SP.A. 0122R0020219V004531 0002617628545 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 272467
1#0##0#0#0.0#2019-03-11 14:13:11#0#00:00:00#10:57:00#00:00:00 2
d46bd9a7e26dbca2f01d437dac4b31c0 707500 0 150000 0 0
0 130000 130875 0 0 210000 0 234224 260411
30000 192960 0 0
3206023 C 3 CP 1 11/02/2019 15/02/2019 18/06/1984 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 4365600 0 5 0 0 0 PIAT SUPRIATNA
Aeni;3206276601940002 5.3.6.201902021030 4 272815 1#0##0#0#0.0#2019-
03-12 09:48:06#0#19:18:00#13:01:00#00:00:00 1
24e3692a9eda22eb699d492c65282cdd 718500 1483750 270000 0
0 0 0 309000 0 0 350000 0 714134 406536
10000 103680 0 0
3206023 C 2 CP 1 14/02/2019 15/02/2019 31/08/1994 0 2
0 0 - 0 - 0 - 0 - 0 2194200
2384251 0 2 0 0 0 RIANI 19057204 24 8933 dr.
1#0##0#0#0.0#2019-03-12 11:31:55#0#13:07:00#11:06:00#00:00:00 1
77497d886dd0b5113a6841011b08452b 1702500 0 50000 0 0 0
0 281500 0 0 140000 0 38917 151334 20000 0
0 0
3206023 C 2 CP 1 12/02/2019 15/02/2019 05/08/1974 0 2
1 J18.9;K30;N18.9;E11.2;J45.9 87.44;93.94;93.96 - - None None
None None J-4-16-II None None None None None None SIMPLE PNEUMONIA &
WHOOPING COUGH (SEDANG) 5619800 0 0 - 0 - 0 - 0
- 0 5619800 2366558 0 4 0 0 0 IIS
SUKMAWATI 19056999 44 16262 DR. H. DANI FARID ABDULLAH SP.PD
Septiani;3278085209910012 5.3.6.201902021030 4 269177
1#0##0#0#0.0#2019-03-14 14:12:30#0#00:00:00#00:00:00#00:00:00 2
60be756d559baf72faa8a11645bb82e8 786000 0 210000 0 0
0 140000 242475 0 0 445000 0 492770 20313
30000 0 0 0
3206023 C 3 CP 1 12/02/2019 15/02/2019 01/08/1996 0 2
CAESAR (RINGAN) 4830200 0 0 - 0 - 0 - 0 -
0 4830200 5644703 0 4 0 0 0 RISA 19056508
22 8230 DR. ASEP TASLIM SP.OG 0122R0020219V002679 0000433197314
269269 1#0##0#0#0.0#2019-03-14 14:14:14#0#00:00:00#00:00:00#00:00:00
3 0352f84a25f88803d773b865f99e98ef 1437000 2137750 290000
0 0 0 0 455500 0 0 420000 0 308483
565970 30000 0 0 0
3206023 C 1 CP 1 15/02/2019 16/02/2019 23/03/1940 0 2
1 K72.9;K74.6 89.52 - - None None None None B-4-13-I None
None None None None None GANGGUAN HATI LAIN-LAIN (RINGAN) 4370900
0 0 - 0 - 0 - 0 - 0 4370900
1136366 0 2 0 0 0 E SUMIATMADJA 19057279 78
5.3.6.201902021030 4 270105 1#0##0#0#0.0#2019-03-01
08:51:36#0#11:03:00#07:02:00#00:00:00 1 904a0eac0716fdeab5044642f1894025
290000 0 0 0 0 0 0 317875 0 0 140000
0 172103 206388 10000 0 0 0
3206023 C 1 CP 1 12/02/2019 16/02/2019 10/07/2003 0 2
(RINGAN) 2929500 0 0 - 0 - 0 - 0 - 0
2929500 3047310 0 5 0 0 0 YULIA NURHIDAYAH
5.3.6.201902021030 4 270111 1#0##0#0#0.0#2019-03-01
08:59:53#0#17:01:00#11:33:00#00:00:00 1 ff0f18924df8037d0a20ddcd58b6461a
875000 0 400000 0 0 0 0 411350 0 0
900000 0 351817 79143 30000 0 0 0
3206023 C 1 CP 1 15/02/2019 16/02/2019 01/01/1970 0 2
0 0 - 0 - 0 - 0 - 0 9006300
3575616 0 2 0 0 0 EMAN ONDI, TN 15000184 49
270112 1#0##0#0#0.0#2019-03-01 09:07:24#0#10:59:00#14:20:00#00:00:00
1 c744d9bd47184bf5d40f7d13bcdb4f5f 199434 2530000 100000
0 0 0 0 0 0 0 360000 0 102726 263456
20000 0 0 0
3206023 C 1 CP 1 14/02/2019 16/02/2019 01/07/1962 0 2
1 C44.7 84.15 - - None None None None M-1-02-I None None
None None None None AMPUTASI (RINGAN) 9589100 0 0 - 0
- 0 - 0 - 0 9589100 5787888 0 3 0
0 0 UJANG RUSDAYAT 17022351 56 20682 dr. Riadhi Yulianto
Sp.B. 0122R0020219V003465 0001967754071 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 270113 1#0##0#0#0.0#2019-
03-01 09:17:37#0#14:25:00#14:21:00#00:00:00 1
4846be1e3be5b3d0040b24d8946061ec 502500 3080000 220000 0
0 0 0 351000 0 0 540000 0 543224 531164
20000 0 0 0
3206023 C 1 CP 1 14/02/2019 16/02/2019 03/04/1949 0 2
3060600 0 0 - 0 - 0 - 0 - 0
3060600 4853169 0 3 0 0 0 H MAMAT KANDAATMAJA
5.3.6.201902021030 4 270129 1#0##0#0#0.0#2019-03-01
09:20:58#0#19:42:00#13:18:00#00:00:00 1 f2a7a527070d458a6915adfe2a3bac6b
782525 1913750 220000 0 0 0 0 636625 0
0 540000 0 323923 426346 10000 0 0 0
3206023 C 1 CP 1 11/02/2019 16/02/2019 15/12/1934 0 2
1 H16.0;H40.5;H44.0 16.39 - - None None None None H-1-20-I
None None None None None None PROSEDUR EKSTRAOKULER DAN ORBITA (RINGAN)
5918900 0 0 - 0 - 0 - 0 - 0
5918900 8827873 0 6 0 0 0 MAMAN 17018704 84
270137 1#0##0#0#0.0#2019-03-01 09:26:33#0#10:33:00#13:19:00#00:00:00
1 c378d36e29ed2914c1e7b62a82c17cab 1529039 2711250 620000
0 0 0 150000 253200 0 0 1080000 0
1050334 1384050 50000 0 0 0
3206023 C 2 CP 1 12/02/2019 16/02/2019 02/10/1987 0 2
1 O61.9;Z37.0;O82.1;O48;O42.2 74.99 - - None None None None
(RINGAN) 5796300 0 0 - 0 - 0 - 0 - 0
5796300 6485585 0 5 0 0 0 NITA OKTAVIANI
5.3.6.201902021030 4 270172 1#0##0#0#0.0#2019-03-01
09:37:34#0#11:59:00#13:01:00#00:00:00 1 aac5604dd837f4b44a60c4c88f74b67c
1633250 2468000 300000 0 0 0 0 295125 0
0 515000 0 542160 702050 30000 0 0 0
3206023 C 2 CP 1 13/02/2019 16/02/2019 13/02/2019 3700 2
0 - 0 - 0 2144200 1085155 0 4 0 0
0 BY NY NITA 19057107 0 0 dr. Marte Robiul Sani Sp.A.
Aeni;3206276601940002 5.3.6.201902021030 4 270212 1#0##0#0#0.0#2019-
03-01 09:51:47#0#21:56:00#12:39:00#00:00:00 1
effaea1c335e180968bec77d9826f0c2 290000 0 210000 0 0
0 0 0 0 0 500000 0 8830 76325 0 0 0
0
3206023 C 3 CP 1 14/02/2019 16/02/2019 12/08/1970 0 2
1 E06.9 - - - None None None None E-4-13-I None None
None None None None GANGGUAN KELENJAR ENDOKRIN LAIN-LAIN (RINGAN)
2745400 0 0 - 0 - 0 - 0 - 0
2745400 1818053 0 3 0 0 0 DEDE 19057104 48
5.3.6.201902021030 4 270223 1#0##0#0#0.0#2019-03-01
09:55:24#0#08:39:00#18:16:00#00:00:00 1 9c8d9e3879af603c8d760310d711f4b1
363500 0 100000 0 0 0 0 507975 0 0
210000 0 536907 89671 10000 0 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 18/03/1965 0 2
2194500 0 0 - 0 - 0 - 0 - 0
2194500 3855706 0 4 0 0 0 UYU 19057081 53
1#0##0#0#0.0#2019-03-01 10:01:58#0#16:47:00#14:05:00#00:00:00 1
a52c6343d70ec1044d928e9cff4e3261 1060000 0 150000 0 0
0 1100000 56100 0 0 280000 0 900488 309118
0 0 0 0
3206023 C 3 CP 1 12/02/2019 16/02/2019 03/02/2019 0 2
1 P70.4;P39.9;P59.9 99.83;99.21 - - None None None None E-4-
12-II None None None None None None GANGGUAN METABOLIK BAWAAN (SEDANG)
4366000 0 0 - 0 - 0 - 0 - 0
4366000 3271698 0 5 0 0 0 ALBY 19056893 0
9 dr. Marte Robiul Sani Sp.A. 0122R0020219V002662 0002745424495
270267 1#0##0#0#0.0#2019-03-01 10:08:24#0#07:43:00#12:36:00#00:00:00
1 dc4d57d520a55c9266f51383fecf33f0 1577500 0 350000 0
0 0 0 280600 0 0 625000 0 75514 363084
0 0 0 0
3206023 C 3 CP 1 12/02/2019 16/02/2019 05/07/1953 0 2
1 N10;N39.0;Z03.8 88.76 - - None None None None N-4-12-I
None None None None None None INFEKSI GINJAL DAN SALURAN URIN (RINGAN)
2155400 0 0 - 0 - 0 - 0 - 0
2155400 2729141 0 5 0 0 0 MAYA 19056983 65
5.3.6.201902021030 4 270298 1#0##0#0#0.0#2019-03-01
10:13:46#0#18:31:00#13:03:00#00:00:00 1 36e564b03603bd67be93405883f2d42f
543500 0 200000 0 0 0 335000 102425 0
0 350000 0 1051233 96983 50000 0 0 0
3206023 C 3 CP 1 12/02/2019 16/02/2019 01/07/1940 0 2
1 I25.2;J44.9 - - - None None None None I-4-16-II None
None None None None None ATHEROSKLEROSIS (SEDANG) 2508400 0
0 - 0 - 0 - 0 - 0 2508400 2399240
0 5 0 0 0 DAYAT 19056980 78 28715 dr. H. Dani Farid
Aeni;3206276601940002 5.3.6.201902021030 4 270362 1#0##0#0#0.0#2019-
03-01 10:28:21#0#17:55:00#13:02:00#00:00:00 1
97dbd9a01ed0517730550b455e316af4 758500 0 200000 0 0
0 0 178375 0 0 350000 0 623819 159426
60000 69120 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 07/04/1984 0 2
1 O61.9;O82.1;O48;Z37.0;O44.1;O46.9;O14.1 74.99 - - None None
None None O-6-10-II None None None None None None OPERASI PEMBEDAHAN
CAESAR (SEDANG) 5102000 0 0 - 0 - 0 - 0 -
0 5102000 5998583 0 4 0 0 0 IMAS 19054287
270370 1#0##0#0#0.0#2019-03-01 10:31:59#0#09:06:00#15:11:00#00:00:00
1 88de20bc1c53896df951043e72b1aadf 1432000 2137750 290000
0 0 0 0 720750 0 0 280000 0 475621
642462 20000 0 0 0
3206023 C 3 CP 1 14/02/2019 16/02/2019 25/01/2017 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3053621 0 3 0 0 0 YASIR RIJAL AMIN
5.3.6.201902021030 4 270395 1#0##0#0#0.0#2019-03-01
10:39:32#0#17:33:00#09:41:00#00:00:00 1 ea1c8645c0dd36807dd3178d6a53763a
521525 1825000 70000 0 0 0 0 0 0 0 210000
0 202986 204110 20000 0 0 0
3206023 C 3 CP 1 12/02/2019 16/02/2019 05/12/1945 0 2
1 J44.9;I27.9;I51.9 87.44 - - None None None None J-4-17-II
None None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (SEDANG)
3280300 0 0 - 0 - 0 - 0 - 0
3280300 2545760 0 5 0 0 0 AHMADIN 19056973
5.3.6.201902021030 4 270401 1#0##0#0#0.0#2019-03-01
10:43:49#0#11:50:00#14:28:00#00:00:00 1 83c5c306def4001e64f2473547095daf
648500 0 200000 0 0 0 140000 237975 0
0 350000 0 609218 240947 50000 69120 0 0
3206023 C 3 CP 1 14/02/2019 16/02/2019 01/07/1984 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2506817 0 3 0 0 0 NARISKA 19057201 34 12646
5.3.6.201902021030 4 270411 1#0##0#0#0.0#2019-03-01
10:46:42#0#12:40:00#13:22:00#00:00:00 1 c13852dffef8c3816fa082240dca87a1
1457500 0 150000 0 0 0 0 240600 0 0
210000 0 160555 218162 70000 0 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 06/11/1962 0 2
3722700 0 0 - 0 - 0 - 0 - 0
3722700 2763283 0 4 0 0 0 UNEN ZULKARNAIN
5.3.6.201902021030 4 270424 1#0##0#0#0.0#2019-03-01
10:54:26#0#07:30:00#12:18:00#00:00:00 1 d8025ac55f66c403747595a5a64858a9
432500 0 150000 0 0 0 1100000 70125 0 0
280000 0 641978 88680 0 0 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 01/01/1983 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5459879 0 4 0 0 0 ROYANI 19057013
270533 1#0##0#0#0.0#2019-03-01 13:10:34#0#23:57:00#19:21:00#00:00:00
2 3537f31bae83a3b80667dbc9acd2d732 1277000 2137750 290000
0 0 0 0 311875 0 0 420000 0 578311
394943 50000 0 0 0
3206023 C 2 CP 1 14/02/2019 16/02/2019 23/12/1995 0 2
0 0 - 0 - 0 - 0 - 0 2194200
2307136 0 3 0 0 0 TIA SITI NUR LATHIFAH 18050117
23 8454 DR. DAMARIZQA DARA SJAHRUDDIN, SP.OG 0122R0020219V003494
5.3.6.201902021030 4 270165 1#0##0#0#0.0#2019-03-01
13:18:10#0#01:10:00#19:15:00#00:00:00 2 b735751469bccfdb6d18d12667b15689
997500 0 210000 0 0 0 0 306750 0 0
375000 0 159703 238183 20000 0 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 01/01/1992 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4671852 0 4 0 0 0 LITA LISMAYANI
5.3.6.201902021030 4 270311 1#0##0#0#0.0#2019-03-01
13:26:50#0#13:56:00#19:12:00#00:00:00 2 a0f90763b5d21aac7ede96262ad43fb8
1009500 1825000 240000 0 0 0 0 219000 0
0 350000 0 428124 570228 30000 0 0 0
3206023 C 1 CP 1 14/02/2019 16/02/2019 09/12/1980 0 2
0 0 - 0 - 0 - 0 - 0 2559900
3854354 0 3 0 0 0 NURDIAHWATI 19057195 38 13946
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 270148
1#0##0#0#0.0#2019-03-01 14:03:05#0#12:03:00#13:11:00#00:00:00 1
b0ccf6a2c2335d5f71a3d2cdc30980cc 2497500 0 200000 0 0
0 0 281500 0 0 540000 0 185891 129463
20000 0 0 0
3206023 C 3 CP 1 12/02/2019 16/02/2019 09/06/1951 0 2
1 K56.6;R59.1;K46.9;E87.8 54.11;53.00;86.11 - - None None None
None K-1-40-II None None None None None None PROSEDUR SISTEM
PENCERNAAN LAIN-LAIN (SEDANG) 6379900 0 0 - 0 - 0 -
0 - 0 6379900 8311778 0 5 0 0 0 PAKIH
5.3.6.201902021030 4 271403 1#0##0#0#0.0#2019-03-05
12:53:47#0#15:36:00#12:48:00#00:00:00 1 649c48fc9ff0152d5508b19f66ea8271
1159525 2592500 270000 0 0 0 200000 1024950
0 0 350000 0 1739118 965685 10000 0 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 15/04/1964 0 2
1 C56 68.49;65.61;54.4 - - None None None None K-1-40-I
(RINGAN) 5786500 0 0 - 0 - 0 - 0 - 0
5786500 7213211 0 4 0 0 0 IYAM 19054840 54
1#0##0#0#0.0#2019-03-05 13:39:12#0#17:08:00#19:16:00#00:00:00 2
6981e474d25082752c2568fbcb869ab7 440000 2592500 170000 0
0 0 0 1676325 0 0 350000 0 759157
1185229 40000 0 0 0
3206023 C 3 CP 1 13/02/2019 16/02/2019 25/06/2018 0 2
1406200 0 0 - 0 - 0 - 0 - 0
1406200 1299401 0 4 0 0 0 SIYAMI SRI WAHYUNI
5.3.6.201902021030 4 272492 1#0##0#0#0.0#2019-03-11
10:49:43#0#22:17:00#08:13:00#00:00:00 1 7476ad10ffaee4195f36a0fa367b9162
367500 0 100000 0 0 0 130000 133000 0
0 280000 0 179100 79801 30000 0 0 0
3206023 C 2 CP 1 15/02/2019 16/02/2019 26/09/1990 0 2
0 0 - 0 - 0 - 0 - 0 2194200
2655651 0 2 0 0 0 SINTA LISTA SARI 19057324 28
5.3.6.201902021030 4 270189 1#0##0#0#0.0#2019-03-14
14:22:22#0#00:00:00#00:00:00#00:00:00 2 b64250b28125e0a35b79e9bc7cf08db2
1702500 0 70000 0 0 0 0 300250 0 0 265000
0 102411 195490 20000 0 0 0
3206023 C 3 CP 1 14/02/2019 16/02/2019 22/03/1979 0 2
1 O14.9;Z37.0;O80.0;O99.8;Z22.5 73.59;93.96;57.94 - - None None
None None O-6-13-II None None None None None None PERSALINAN VAGINAL
(SEDANG) 1828500 0 0 - 0 - 0 - 0 - 0
1828500 2102869 0 3 0 0 0 MAE NURAENA 18050835
5.3.6.201902021030 4 271402 1#0##0#0#0.0#2019-03-14
14:25:15#0#00:00:00#00:00:00#00:00:00 2 2b268708524e63f9f42a6f4085c9514a
1277500 0 100000 0 0 0 0 281500 0 0
210000 0 108761 105108 20000 0 0 0
3206023 C 3 CP 1 15/02/2019 16/02/2019 05/04/1999 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2584786 0 2 0 0 0 PUPUT PATIMAH 19057328 19
5.3.6.201902021030 4 274202 1#0##0#0#0.0#2019-03-18
12:40:44#0#23:17:00#13:21:00#00:00:00 1 c184bf2fc2d7545dcbb0d6c91c60c9dc
1812500 0 100000 0 0 0 0 281500 0 0
140000 0 74006 156780 20000 0 0 0
3206023 C 2 CP 1 13/02/2019 17/02/2019 22/04/1949 0 2
4 I61.9;E87.8;G93.4 87.03;99.60;96.07;89.52 - - None None None
None G-4-13-III None None None None None None PERDARAHAN INTRA KRANIAL
BUKAN TRAUMATIK (BERAT) 5446300 0 0 - 0 - 0 - 0
- 0 5446300 3956203 0 5 0 0 0 IPAH
SYARIPAH 19055764 69 25499 DR. INDRA GUNAWAN, SP.S 0122R0020219V002951
5.3.6.201902021030 4 269724 1#0##0#0#0.0#2019-02-28
10:06:02#0#11:02:00#08:03:00#00:00:00 2 38ba58b89fbdf630f003a6c06331f563
940000 0 280000 0 0 0 1100000 0 0 0
750000 0 684492 131711 70000 0 0 0
3206023 C 3 CP 1 14/02/2019 17/02/2019 11/12/1980 0 2
0 - 0 - 0 - 0 - 0 2674300 2354226
0 4 0 0 0 SYARIFAH 19055709 38 13944 dr.
1#0##0#0#0.0#2019-03-01 09:45:17#0#14:31:00#15:52:00#00:00:00 1
49b95e29dcdc099b2aef9d9e1ed0c1da 430000 0 150000 0 0
0 0 1372450 0 0 280000 0 58872 32904 30000 0
0 0
3206023 C 3 CP 1 13/02/2019 17/02/2019 15/12/2000 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 6209460 0 5 0 0 0 AIDA RAHMADANI
4 270205 1#0##0#0#0.0#2019-03-01
09:49:32#0#16:03:00#15:53:00#00:00:00 1 12d814d560033b606ce92b376828a10b
947000 2137750 240000 0 0 0 0 1205800 0
0 350000 0 672834 606076 50000 0 0 0
3206023 C 3 CP 1 14/02/2019 17/02/2019 01/04/1981 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4082247 0 4 0 0 0 WINA 19056595 37
4 270220 1#0##0#0#0.0#2019-03-01
09:58:23#0#13:59:00#16:29:00#00:00:00 1 33f7bb3350db75e3b63e67ee66a55b8e
639500 1825000 170000 0 0 0 0 82625 0 0
280000 0 514373 540749 30000 0 0 0
3206023 C 3 CP 1 14/02/2019 17/02/2019 15/04/1959 0 2
0 - 0 - 0 - 0 4421500 3864527 0 4
0 0 0 UJU 19056289 59 21855 dr. Aa Ahmad Dimyati, Sp.B
Huda;3278057010840004 5.3.6.201902021030 4 270293 1#0##0#0#0.0#2019-
03-01 10:11:57#0#18:55:00#15:55:00#00:00:00 1
b1394e96e616c962d74703aca9c6b7d3 483000 1573750 220000 0
0 0 0 103875 0 0 280000 0 702236 451666
50000 0 0 0
3206023 C 3 CP 1 13/02/2019 17/02/2019 12/10/1994 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5277025 0 5 0 0 0 DEA DAMAYANTI
4 270342 1#0##0#0#0.0#2019-03-01
10:24:17#0#14:00:00#15:48:00#00:00:00 1 46971f6b9486af5330114c8ce25b6520
932000 2137750 240000 0 0 0 0 356000 0
0 350000 0 626739 594536 40000 0 0 0
3206023 C 3 CP 1 13/02/2019 17/02/2019 29/06/2000 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4653955 0 5 0 0 0 AI SINTA 19057065
1#0##0#0#0.0#2019-03-01 10:26:33#0#13:57:00#15:49:00#00:00:00 1
73fcc4dc2995f39c90a72fdf3433034c 1074500 1825000 340000 0
0 0 0 0 0 0 350000 0 545026 469429
50000 0 0 0
3206023 C 3 CP 1 16/02/2019 17/02/2019 03/06/1976 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2283089 0 2 0 0 0 SRI LESTARI 19057351 42 15598
4 270365 1#0##0#0#0.0#2019-03-01
10:30:18#0#15:51:00#10:58:00#00:00:00 1 a948ad261cce007ba56a25d50e64f8d5
1395000 0 70000 0 0 0 0 256100 0 0 140000
0 111360 290629 20000 0 0 0
3206023 C 3 CP 1 15/02/2019 17/02/2019 20/07/2007 0 2
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 1185650 0 3 0 0 0 ELIS LISNAWATI
4 270381 1#0##0#0#0.0#2019-03-01
10:33:42#0#13:09:00#09:43:00#00:00:00 1 5d9af19fd200b11931dff4dbb8f1ffd5
327500 0 100000 0 0 0 0 274250 0 0
210000 0 188318 35582 50000 0 0 0
3206023 C 3 CP 1 14/02/2019 17/02/2019 17/06/1966 0 2
1 N21.0;N39.0 57.19 - - None None None None N-1-30-II None
None None None None None PROSEDUR KANDUNG KEMIH DAN SALURAN URIN BAWAH
(SEDANG) 9756600 0 0 - 0 - 0 - 0 - 0
9756600 4397059 0 4 0 0 0 ODAN 19056612 52
1#0##0#0#0.0#2019-03-01 10:38:41#0#15:27:00#16:07:00#00:00:00 1
28ed60d33b7593929b5a059ad95fb772 554500 1825000 170000 0
0 0 0 103875 0 0 280000 0 814838 628846
20000 0 0 0
3206023 C 3 CP 1 13/02/2019 17/02/2019 05/08/2016 0 2
- 0 - 0 - 0 - 0 2525300 1765622 0
5 0 0 0 SYAKIRA HASNA ADZKIYA 19057108 2 922 dr.
Marte Robiul Sani Sp.A. 0122R0020219V003032 0002266773614 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 268390
1#1#kelas_2#0#505100#0.0#2019-03-01 10:40:42#0#22:30:00#09:21:00#00:00:00
2 0113800781440c3da9d563ff0c74a0cf 547500 0 280000 0
0 0 0 70125 0 0 515000 0 210278 102719
40000 0 0 0
3206023 C 3 CP 1 14/02/2019 17/02/2019 01/12/1997 0 2
LAIN (RINGAN) 3834800 0 0 - 0 - 0 - 0 -
0 3834800 4627510 0 4 0 0 0 RATNA 18050093
4 270406 1#0##0#0#0.0#2019-03-01
11:47:13#0#19:07:00#15:54:00#00:00:00 1 506505565be59863d0fac3fc1d93d3b1
756525 1825000 170000 0 0 0 0 340125 0
0 280000 0 601421 624439 30000 0 0 0
3206023 C 3 CP 1 15/02/2019 17/02/2019 09/01/2007 0 2
4 C95.9;E87.6 - - - None None None None C-4-11-II None
None None None None None LIMFOMA & LEUKEMIA NON AKUT (SEDANG)
4399800 0 0 - 0 - 0 - 0 - 0
4399800 3928148 0 3 0 0 0 RAKA ADIWIJAYA
5.3.6.201902021030 4 270517 1#0##0#0#0.0#2019-03-05
11:04:51#0#19:54:00#20:42:00#00:00:00 1 ed099b2ebf93efc1171fdf6e069cf3f2
1643000 0 200000 0 0 0 0 482750 0 0
615000 0 210170 397068 0 380160 0 0
3206023 C 2 CP 1 15/02/2019 17/02/2019 24/11/1991 0 2
(RINGAN) 5796300 0 0 - 0 - 0 - 0 - 0
5796300 4690024 0 3 0 0 0 MEGA NOPITASARI
S.ST;3206297107870001 5.3.6.201902021030 4 271388 1#0##0#0#0.0#2019-
03-05 11:08:09#0#14:01:00#15:50:00#00:00:00 1
f1eaae11a10ba3c81d9ff11b92fdc1c7 832000 2137750 210000 0
0 0 0 82625 0 0 320000 0 523017 564632
20000 0 0 0
3206023 C 2 CP 1 16/02/2019 17/02/2019 15/01/1996 0 2
0 0 - 0 - 0 - 0 - 0 1853900
2436581 0 2 0 0 0 ROSI ROSIDAH 19055128 23
5.3.6.201902021030 4 271391 1#0##0#0#0.0#2019-03-05
11:12:26#0#18:59:00#10:53:00#00:00:00 1 d1dbc5d70170a7faeb03afdfd6946b15
1688000 0 70000 0 0 0 0 276375 0 0 140000
0 58852 193354 10000 0 0 0
3206023 C 2 CP 1 15/02/2019 17/02/2019 01/08/1989 0 2
- 0 - 0 - 0 - 0 2399800 2892346 0
3 0 0 0 DEDE SANTI SANI 18039224 29 10790 dr.
1#0##0#0#0.0#2019-03-05 11:13:42#0#13:49:00#17:33:00#00:00:00 1
11a9559953fb02143f28a5fa4802f768 525000 0 150000 0 0
0 0 1692200 0 0 430000 0 30826 34320 30000 0
0 0
3206023 C 3 CP 1 13/02/2019 17/02/2019 13/02/2019 2700 2
4 Q41.1;P28.5;Q79.2;P59.9;P74.3;K42.9;Q70.9 45.90;45.62;96.71;54.19;53.00
- - None None None None P-8-14-III None None None None None
None NEONATAL, BBL > 2499 GR DENGAN ANOMALI MAYOR ATAU KONDISI HEREDITER
(BERAT) 9942500 0 0 - 0 - 0 - 0 - 0
9942500 14510141 0 5 0 0 0 BY NY LINDA NURAIDA
5.3.7.201902261710 4 274209 1#0##0#0#0.0#2019-03-18
14:27:26#0#23:47:00#17:21:00#00:00:00 2 8e64640bd827cdc9a26513df0912de05
6939050 3087500 565000 0 0 0 400000 1023625
0 0 525000 125000 235806 1510040 30000 69120 0
0
3206023 C 2 CP 1 14/02/2019 18/02/2019 02/04/1941 0 2
1 K92.2;D64.9 99.04 - - None None None None K-4-18-II None
2119000 0 0 - 0 - 0 - 0 - 0
2119000 4509584 0 5 0 0 0 ROSID SARIPUDIN
Aeni;3206276601940002 5.3.6.201902021030 4 268568
1#1#kelas_1#0#353100#0.0#2019-02-19 10:16:02#0#11:16:00#15:02:00#00:00:00
1 a0aebd87217d825a571e5d13e98b0e3e 535000 0 300000 0
0 0 0 2377025 0 0 900000 0 233518 104041
60000 0 0 0
3206023 C 3 CP 1 15/02/2019 18/02/2019 15/04/1987 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1848327 0 4 0 0 0 RENI MARLINA 19057211 31
5.3.6.201902021030 4 269343 1#0##0#0#0.0#2019-02-25
10:45:03#0#09:12:00#09:00:00#00:00:00 1 c0be08380d366f11ca5b16d76de236a6
1072500 0 50000 0 0 0 0 281500 0 0 140000
0 109428 184899 10000 0 0 0
3206023 C 3 CP 1 16/02/2019 18/02/2019 14/12/2013 0 2
- 0 - 0 - 0 - 0 2525300 892972 0
3 0 0 0 MUHAMAD AL-HAFIZD 19057334 5 1890 dr. Marte
Robiul Sani Sp.A. 0122R0020219V003793 0001744597293 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 270656 1#0##0#0#0.0#2019-
03-04 08:53:19#0#09:45:00#14:20:00#00:00:00 1
e86d8df154f1bc2e801ca48ac845ab65 337500 0 100000 0 0
0 0 56100 0 0 210000 0 106946 52426 30000 0
0 0
3206023 C 3 CP 1 14/02/2019 18/02/2019 20/11/1982 0 2
1 C50.9;D63.0 85.41;99.04 - - None None None None L-1-50-II
None None None None None None PROSEDUR PADA PAYUDARA (SEDANG)
7810900 0 0 - 0 - 0 - 0 - 0
7810900 9121756 0 5 0 0 0 HENI 18047186 36
270660 1#0##0#0#0.0#2019-03-04 08:59:19#0#16:14:00#17:32:00#00:00:00
1 3dde44b886e53d1227f39e9883ab7403 1361550 3036500 220000
0 0 0 0 2119475 0 0 350000 0 758655
1225576 50000 0 0 0
3206023 C 3 CP 1 13/02/2019 18/02/2019 01/01/1956 0 2
1 C07;D63.0 26.29;99.04 - - None None None None U-1-13-II
None None None None None None PROSEDUR KELENJAR LUDAH (SEDANG)
5694200 0 0 - 0 - 0 - 0 - 0
5694200 10604218 0 6 0 0 0 EUIS HODIJAH, NY
5.3.6.201902021030 4 270669 1#0##0#0#0.0#2019-03-04
09:03:26#0#19:48:00#17:34:00#00:00:00 1 7151b82e92508b1d39ea541d4ab01100
1623025 3665000 500000 0 0 0 190000 1442050
0 0 620000 70000 971536 1368927 50000 103680 0
0
3206023 C 3 CP 1 16/02/2019 18/02/2019 08/03/1965 0 2
5786500 0 0 - 0 - 0 - 0 - 0
5786500 5768245 0 3 0 0 0 DIDI SUPARMAN
5.3.6.201902021030 4 270684 1#0##0#0#0.0#2019-03-04
09:19:05#0#13:44:00#14:22:00#00:00:00 1 441a36e0caeae67dffd683a35a7ac4f2
552000 2137750 120000 0 0 0 0 346500 0
0 210000 0 1238783 1123212 40000 0 0 0
3206023 C 3 CP 1 14/02/2019 18/02/2019 08/08/1975 0 2
1 I12.0;K21.9;D63.8 99.04;89.52 - - None None None None N-4-
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 2377143 0 5 0 0 0 ENUNG NURJANAH
Aeni;3206276601940002 5.3.6.201902021030 4 270715 1#0##0#0#0.0#2019-
03-04 09:27:37#0#10:52:00#12:06:00#00:00:00 1
4c4c93b7db68c9aaee35d1a1499d4361 503500 0 150000 0 0
0 0 889350 0 0 350000 0 303991 130302
50000 0 0 0
3206023 C 3 CP 1 16/02/2019 18/02/2019 04/07/1977 0 2
1 Z49.1;D63.8;I12.0 99.04;39.95 - - None None None None N-4-
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 2527775 0 3 0 0 0 AI HERNI
Aeni;3206276601940002 5.3.6.201902021030 4 270726 1#0##0#0#0.0#2019-
03-04 09:30:56#0#14:41:00#12:35:00#00:00:00 1
f9221a384f1331ea2efb7ff794b80145 886710 0 70000 0 0 0
0 1071575 0 0 210000 0 145443 64047 80000 0
0 0
3206023 C 3 CP 1 13/02/2019 18/02/2019 01/03/1987 0 2
1 K92.2;I84.9;D64.9 99.04 - - None None None None K-4-18-II
(SEDANG) 1765800 0 0 - 0 - 0 - 0 - 0
1765800 4853405 0 6 0 0 0 MAIL ISMAIL 19057093
5.3.6.201902021030 4 270731 1#0##0#0#0.0#2019-03-04
09:39:56#0#16:15:00#12:31:00#00:00:00 1 a0f201186349dffaea1734fc7b019b21
651000 0 300000 0 0 0 0 2441375 0 0
420000 0 855969 135061 50000 0 0 0
3206023 C 3 CP 1 12/02/2019 18/02/2019 22/12/1993 0 2
1 A16.2;K30 - - - None None None None J-4-15-I None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 5400218 0 7 0 0 0 TISNAWAN 19056927
5.3.6.201902021030 4 270745 1#0##0#0#0.0#2019-03-04
09:42:18#0#10:42:00#12:44:00#00:00:00 1 938c2518333ea3bdd2e82e25efe97f6f
1143500 0 170000 0 0 0 0 255375 0 0
490000 0 3053205 208138 80000 0 0 0
3206023 C 3 CP 1 18/02/2019 18/02/2019 14/10/1982 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1644537 0 1 0 0 0 NIA KURNIASIH 19057437 36
5.3.6.201902021030 4 270754 1#0##0#0#0.0#2019-03-04
09:46:48#0#11:30:00#14:34:00#00:00:00 1 49a610f469107293b174f92a5f84a231
1050000 0 50000 0 0 0 0 276375 0 0 70000
0 53078 115084 30000 0 0 0
3206023 C 3 CP 1 17/02/2019 18/02/2019 25/11/1992 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2535982 0 2 0 0 0 NISA ROSMALA DEWI 18032514 26
5.3.6.201902021030 4 270770 1#0##0#0#0.0#2019-03-04
09:49:57#0#16:57:00#12:57:00#00:00:00 1 1518a7fde0383dbecdad23c1ce5cd071
1665000 0 120000 0 0 0 0 385375 0 0
140000 0 76300 129307 20000 0 0 0
3206023 C 3 CP 1 16/02/2019 18/02/2019 21/11/1973 0 2
None None None None None None ASTHMA & BRONKIOLITIS (RINGAN)
2053000 0 0 - 0 - 0 - 0 - 0
2053000 1776041 0 3 0 0 0 SITI FATIMAH
Aeni;3206276601940002 5.3.6.201902021030 4 270776 1#0##0#0#0.0#2019-
03-04 09:53:14#0#10:55:00#12:54:00#00:00:00 1
593a3e73deca6c3da577ee3bc41f0247 623500 0 120000 0 0
0 140000 142700 0 0 210000 0 306320 203521
30000 0 0 0
3206023 C 3 CP 1 16/02/2019 18/02/2019 24/07/1992 0 2
1828500 0 0 - 0 - 0 - 0 - 0
1828500 2451101 0 3 0 0 0 ELIS HENDRAYANI
Aeni;3206276601940002 5.3.6.201902021030 4 270782 1#0##0#0#0.0#2019-
03-04 09:54:27#0#22:24:00#13:00:00#00:00:00 1
0972809596d3445c70bfac6a223686a5 1485000 0 120000 0 0
0 0 305800 0 0 210000 0 122508 177793
30000 0 0 0
3206023 C 3 CP 1 17/02/2019 18/02/2019 05/06/2000 0 2
1 O13;O99.0;Z37.0;O80.0 73.59;99.04 - - None None None None
1828500 0 0 - 0 - 0 - 0 - 0
1828500 4133918 0 2 0 0 0 MUNAWAROH 19057421
5.3.6.201902021030 4 270784 1#0##0#0#0.0#2019-03-04
09:56:28#0#23:55:00#13:02:00#00:00:00 1 931c64b3e6162ed2e7f30f01ed70abd8
2076000 0 120000 0 0 0 0 1347325 0 0
140000 0 120885 309708 20000 0 0 0
3206023 C 3 CP 1 17/02/2019 18/02/2019 16/01/1950 0 2
1 N18.9;I11.9;J44.1;I48;J81 99.60 - - None None None None
N-4-10-III None None None None None None TUMOR GINJAL & SALURAN URIN &
GAGAL GINJAL (BERAT) 4377800 0 0 - 0 - 0 - 0
- 0 4377800 2277507 0 2 0 0 0 ICIH
Aeni;3206276601940002 5.3.6.201902021030 4 270798 1#0##0#0#0.0#2019-
03-04 10:14:41#0#23:12:00#19:13:00#00:00:00 1
5785552ae9acb7f1e20b87be84dccf22 677500 0 50000 0 0 0
140000 339750 0 0 140000 0 436726 473531
20000 0 0 0
3206023 C 2 CP 1 12/02/2019 18/02/2019 08/12/1971 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 3197978 0 7 0 0 0 IIS KANIA NINGRUM, NY
Aeni;3206276601940002 5.3.6.201902021030 4 270831 1#0##0#0#0.0#2019-
03-04 10:31:50#0#19:45:00#16:06:00#00:00:00 1
6da834ebee5bd96572b227d5018af9d4 723500 0 360000 0 0
0 0 637950 0 0 710000 0 491433 185095
90000 0 0 0
3206023 C 2 CP 1 14/02/2019 18/02/2019 14/02/2019 1800 2
1 P59.9;P01.5;P07.1 99.83 - - None None None None P-8-12-I
- 0 6970500 1777037 0 5 0 0 0 BY NY ELIN
5.3.6.201902021030 4 270834 1#0##0#0#0.0#2019-03-04
10:34:52#0#08:47:00#13:58:00#00:00:00 1 b9e36d97c9948b7396eb1f9ff832e097
802500 0 210000 0 0 0 0 225250 0 0
515000 0 0 24287 0 0 0 0
3206023 C 2 CP 1 16/02/2019 18/02/2019 21/04/2017 0 2
1 A09.9;H66.9 - - - None None None None K-4-17-I None
None None None None None NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN
(RINGAN) 1687500 0 0 - 0 - 0 - 0 - 0
1687500 866791 0 3 0 0 0 M ABIDZAR KHOIRURROPIQ
5.3.6.201902021030 4 270846 1#0##0#0#0.0#2019-03-04
10:44:59#0#16:17:00#14:21:00#00:00:00 1 8e8d429caecf537884e36d5691b5538f
317500 0 100000 0 0 0 0 56100 0 0 210000
0 98624 54567 30000 0 0 0
3206023 C 2 CP 1 14/02/2019 18/02/2019 31/10/2018 0 2
1 J18.0 87.44;99.21;93.94;93.96 - - None None None None J-4-
16-I None None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH
(RINGAN) 3999100 0 0 - 0 - 0 - 0 - 0
3999100 3278420 0 5 0 0 0 VANESSA OKTAVIA NATHA
5.3.6.201902021030 4 270863 1#0##0#0#0.0#2019-03-04
10:52:49#0#10:24:00#14:19:00#00:00:00 1 d4560b73bf9da4fc1db23bf75c13ac0a
1570000 0 280000 0 0 0 140000 70125 0 0
625000 0 308948 165227 50000 69120 0 0
3206023 C 2 CP 1 15/02/2019 18/02/2019 05/07/1959 0 2
4 I63.9;G81.9 87.03;89.52 - - None None None None G-4-14-II
None None None None None None KECEDERAAN PEMBULUH DARAH OTAK DENGAN
INFARK (SEDANG) 5972300 0 0 - 0 - 0 - 0 -
0 5972300 3315837 0 4 0 0 0 YAYAH 14014850
59 21775 dr. Rini Widiastuti, Sp. PD 0122R0020219V003721
5.3.6.201902021030 4 270865 1#0##0#0#0.0#2019-03-04
10:56:33#0#18:30:00#15:47:00#00:00:00 1 446e55783159406e13ba77c7948ac2d7
871000 0 210000 0 0 0 1100000 70125 0 0
390000 0 501925 122787 50000 0 0 0
3206023 C 2 CP 1 15/02/2019 18/02/2019 22/06/1963 0 2
0 0 - 0 - 0 - 0 - 0 7719600
3239171 0 4 0 0 0 DINDIN 19055104 55 20327
1#0##0#0#0.0#2019-03-04 10:59:05#0#10:50:00#09:55:00#00:00:00 1
3a2d1964e836e384e1de87216b27de8d 264434 2125000 190000 0
0 0 0 0 0 0 280000 0 102726 257011
20000 0 0 0
3206023 C 2 CP 1 16/02/2019 18/02/2019 25/03/1990 0 2
(RINGAN) 5796300 0 0 - 0 - 0 - 0 - 0
5796300 5249870 0 3 0 0 0 AI MULYATI 19057366
5.3.6.201902021030 4 270825 1#0##0#0#0.0#2019-03-04
11:02:46#0#00:07:00#16:04:00#00:00:00 2 fec3919d1abc9dd03dd26aef45c77af0
1009500 2137750 240000 0 0 0 0 359000 0
0 140000 0 563678 759942 40000 0 0 0
3206023 C 2 CP 1 16/02/2019 18/02/2019 04/06/1993 0 2
1 O41.0;O70.1;Z37.0;O80.0 73.59;93.96 - - None None None None
2194200 0 0 - 0 - 0 - 0 - 0
2194200 2470552 0 3 0 0 0 RANI INDRIANI, NY
Aeni;3206276601940002 5.3.6.201902021030 4 270813 1#0##0#0#0.0#2019-
03-04 11:03:45#0#06:27:00#16:24:00#00:00:00 2
dc8a59d323a07f5faafd15c2ef33dd7e 1360000 0 120000 0 0
0 0 271250 0 0 250000 0 102088 347214
20000 0 0 0
3206023 C 3 CP 1 17/02/2019 18/02/2019 15/04/1975 0 2
0 0 - 0 - 0 - 0 - 0 1544900
2493629 0 2 0 0 0 SITI MASUNAH 19056620 43
5.3.6.201902021030 4 271295 1#0##0#0#0.0#2019-03-05
10:45:12#0#06:09:00#12:56:00#00:00:00 1 4db38cf5072cb779a77ca0e6719812f3
1687500 0 120000 0 0 0 0 276375 0 0
140000 0 75184 174570 20000 0 0 0
3206023 C 3 CP 1 15/02/2019 18/02/2019 01/07/1965 0 2
LAIN (RINGAN) 2199200 0 0 - 0 - 0 - 0 -
0 2199200 1623101 0 4 0 0 0 RAEBIN
19057257 53 19587 dr. Adya Arradikha, Sp. T.H.T.K.L
Aeni;3206276601940002 5.3.6.201902021030 4 271346 1#0##0#0#0.0#2019-
03-05 10:57:11#0#11:54:00#14:23:00#00:00:00 1
b2c78c93a55c2014b2558abb63270e41 561000 0 170000 0 0
0 130000 56100 0 0 280000 0 312491 73510 40000
0 0 0
3206023 C 1 CP 1 02/02/2019 18/02/2019 06/06/1942 0 2
1 D56.9;D63.8;J44.9;N18.9;A41.9 39.95;99.04;93.94 - - None None
None None D-4-13-III None None None None None None GANGGUAN SEL DARAH
MERAH SELAIN KRISIS ANEMIA SEL SICKLE (BERAT) 5621400 0 0 - 0
- 0 - 0 - 0 5621400 18202724 0 17 0
0 0 EDEM ARIFIN 19056043 76 28000 dr. H. Dani Farid Abdullah
Sp.PD 0122R0020219V000307 0000070365352 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 271426 1#0##0#0#0.0#2019-
03-05 13:14:26#0#20:17:00#16:41:00#00:00:00 1
ac838e140620de79b8d92b8c62a91d8e 3960000 0 1500000 0
1786940 0 0 3258700 0 0 3060000 0 2661986
389898 30000 1555200 0 0
3206023 C 3 CP 1 17/02/2019 18/02/2019 14/12/1941 0 2
1 R33 - - - None None None None N-4-15-I None None
None None None None GEJALA,TANDA GANGGUAN GINJAL DAN SALURAN URIN
(RINGAN) 2241300 0 0 - 0 - 0 - 0 - 0
2241300 3028253 0 2 0 0 0 ABDU MAZAH AHMAD
5.3.6.201902021030 4 271447 1#0##0#0#0.0#2019-03-06
13:19:14#0#06:21:00#14:23:00#00:00:00 1 fd189690da0be2314b115a1330e428ea
350000 0 50000 0 0 0 0 1344850 0 0 140000
0 1019546 83857 40000 0 0 0
3206023 C 3 CP 1 14/02/2019 18/02/2019 02/08/2014 0 2
1 A01.0;N39.0 - - - None None None None A-4-14-II None
(SEDANG) 2540000 0 0 - 0 - 0 - 0 - 0
2540000 1667426 0 5 0 0 0 SANI NUR ANGGRAENI
5.3.6.201902021030 4 272485 1#0##0#0#0.0#2019-03-11
10:47:23#0#08:36:00#14:19:00#00:00:00 1 90d00a89901c543ab70d41ada4e31fdd
487500 0 200000 0 0 0 0 261750 0 0
350000 0 220906 77270 70000 0 0 0
3206023 C 3 CP 1 13/02/2019 18/02/2019 01/01/2002 0 2
1 K30;K59.0 - - - None None None None K-4-18-I None
1242600 0 0 - 0 - 0 - 0 - 0
1242600 2783199 0 6 0 0 0 AI SITI NURJANAH
5.3.6.201902021030 4 272797 1#0##0#0#0.0#2019-03-12
09:40:19#0#17:32:00#14:18:00#00:00:00 1 494ad5dd74bd8e0ccd014b838db54b13
525000 0 335000 0 0 0 0 218750 0 0
420000 0 1101934 112515 70000 0 0 0
3206023 C 3 CP 1 15/02/2019 18/02/2019 13/04/1999 0 2
4 T63.0;E87.2;D65;D64.9;D69.6 96.71;99.04 - - None None None
None J-1-20-II None None None None None None PROSEDUR SISTEM
PERNAFASAN NON-KOMPLEKS (SEDANG) 12179400 0 0 - 0 - 0
- 0 - 0 12179400 11997960 0 4 0 0 0
WILI APRILIANSYAH 19057299 19 7248 dr. Aa Ahmad Dimyati, Sp.B
Septiani;3278085209910012 5.3.6.201902021030 4 273046
1#0##0#0#0.0#2019-03-12 11:45:46#0#18:37:00#16:22:00#00:00:00 1
9bbc6180e95f13e863f65dec41ae33aa 2752500 0 810000 0 15000
0 0 4593903 0 0 345000 410000 1755562 713035
50000 552960 0 0
3206023 C 3 CP 1 15/02/2019 18/02/2019 15/06/1980 0 2
(SEDANG) 5102000 0 0 - 0 - 0 - 0 - 0
5102000 5478287 0 4 0 0 0 YULIA YULIANTI
Aeni;3206276601940002 5.3.6.201902021030 4 273576 1#0##0#0#0.0#2019-
03-13 14:03:53#0#14:16:00#14:32:00#00:00:00 1
9e7733a6ed91791cef33812ee2f94d1f 987000 2137750 240000 0
0 0 0 359000 0 0 280000 0 653941 780596
40000 0 0 0
3206023 C 3 CP 1 13/02/2019 18/02/2019 30/09/1994 0 2
1 K74.6;E78.5;E88.0;N17.9;D64.9 99.04;54.91 - - None None None
None B-4-13-III None None None None None None GANGGUAN HATI LAIN-LAIN
(BERAT) 5010400 0 0 - 0 - 0 - 0 - 0
5010400 4677142 0 6 0 0 0 IWAN 19057080 24
5.3.6.201902021030 4 273988 1#0##0#0#0.0#2019-03-14
13:21:05#0#11:48:00#12:13:00#00:00:00 1 bb3d9ab426b122b3abd025ca8d7f4934
647000 0 250000 0 0 0 0 1800400 0 0
420000 0 1336553 173189 50000 0 0 0
3206023 C 3 CP 1 14/02/2019 18/02/2019 04/04/2000 0 2
1 D64.9;I84.9;K92.2 99.04 - - None None None None D-4-13-II
None None None None None None GANGGUAN SEL DARAH MERAH SELAIN KRISIS
ANEMIA SEL SICKLE (SEDANG) 3139300 0 0 - 0 - 0 -
0 - 0 3139300 3582325 0 5 0 0 0 SAADAH
Septiani;3278085209910012 5.3.6.201902021030 4 270794
1#0##0#0#0.0#2019-03-14 14:31:03#0#00:00:00#00:00:00#00:00:00 2
5b849e3701b70ea3e6e6e88bbaee3c71 523500 0 200000 0 0
0 0 1765600 0 0 350000 0 487645 205580
50000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 01/12/1997 0 2
1 O62.0;O99.6 - - - None None None None W-4-16-II None
0 - 0 - 0 - 0 - 0 2674300 1221296
0 3 0 0 0 WINDA, NY 16006676 21 7748 dr.
1#0##0#0#0.0#2019-03-04 13:54:50#0#20:21:00#14:04:00#00:00:00 1
908178c2ffe11ab85d0c2187a5c42583 577500 0 100000 0 0
0 0 103875 0 0 210000 0 121820 78101 30000
0 0 0
3206023 C 3 CP 1 18/02/2019 19/02/2019 25/03/1981 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2703729 0 2 0 0 0 IYEN MULYANI 19057435 37
5.3.6.201902021030 4 271007 1#0##0#0#0.0#2019-03-04
13:57:13#0#06:55:00#12:02:00#00:00:00 1 f4637d68161e36c6dba195658f2af4d4
1755000 0 170000 0 0 0 0 301375 0 0
140000 0 134331 183023 20000 0 0 0
3206023 C 3 CP 1 13/02/2019 19/02/2019 12/12/1959 0 2
1 A16.2;N17.9 - - - None None None None J-4-15-III None
None None None None None PERADANGAN DAN INFEKSI PERNAFASAN (BERAT)
6429000 0 0 - 0 - 0 - 0 - 0
6429000 3856751 0 7 0 0 0 CUCU 19057084 59
5.3.6.201902021030 4 271018 1#0##0#0#0.0#2019-03-04
14:09:20#0#15:46:00#14:32:00#00:00:00 1 96bb9a4b72f9ff841c5161c7f73118b7
993500 0 300000 0 0 0 140000 349600 0
0 490000 0 1230991 282660 70000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 01/04/1979 0 2
1 N93.8;N85.0 69.09 - - None None None None W-1-11-I None
None None None None None PROSEDUR DILATASI, KURET, INTRAUTERIN & SERVIK
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 4016203 0 3 0 0 0 LILIS SURYANI
5.3.6.201902021030 4 271035 1#0##0#0#0.0#2019-03-04
14:11:27#0#17:21:00#13:25:00#00:00:00 1 b89954c698d2419a3e598d6fcc42680e
548000 1626250 120000 0 0 0 0 926000 0
0 210000 0 278231 277722 30000 0 0 0
3206023 C 3 CP 1 18/02/2019 19/02/2019 03/01/1997 0 2
0 0 - 0 - 0 - 0 - 0 1828500
3169346 0 2 0 0 0 CINDY ANGGRAENI 19057495 22
1#0##0#0#0.0#2019-03-04 14:17:33#0#09:33:00#11:54:00#00:00:00 1
f608fee6399ae5af3947b1968b20b17b 2347500 0 120000 0 0
0 0 281500 0 0 140000 0 79261 181085 20000
0 0 0
3206023 C 3 CP 1 18/02/2019 19/02/2019 01/06/1993 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2362560 0 2 0 0 0 PITRI FITRIYANI 19057483 25
1#0##0#0#0.0#2019-03-04 14:20:59#0#09:44:00#11:58:00#00:00:00 1
2c70ba4a7182dde2de0b903d2a200f3b 1465000 0 120000 0 0
0 0 281500 0 0 140000 0 109016 207044
40000 0 0 0
3206023 C 3 CP 1 16/02/2019 19/02/2019 20/12/2002 0 2
1 B19.9 - - - None None None None B-4-13-I None None
None None None None GANGGUAN HATI LAIN-LAIN (RINGAN) 3122100 0
0 - 0 - 0 - 0 - 0 3122100 1434534
0 4 0 0 0 DIKI RAHMAT RIYADI 19057340 16 5902
dr. Lia Rhodia, Sp. A. 0122R0020219V003804 0000432261246 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271073
1#0##0#0#0.0#2019-03-04 14:28:37#0#10:45:00#11:07:00#00:00:00 1
a7faf8cbada059d44ce94dc914822919 347500 0 195000 0 0
0 0 366375 0 0 280000 0 151142 44517 50000
0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 13/07/1996 0 2
1 Q83.1 85.12 - - None None None None L-1-50-I None None
0 - 0 - 0 - 0 - 0 4853300 4991740
0 3 0 0 0 FITRI YULIANI 18049076 22 8254 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271079
1#0##0#0#0.0#2019-03-04 14:32:58#0#17:39:00#13:54:00#00:00:00 1
e2ef7072df97bf09e297e748431f4c9b 727025 2592500 120000 0
0 0 0 453875 0 0 210000 0 409921 418419
60000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 02/07/1944 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3509640 0 3 0 0 0 UCA 18052028 74
271088 1#0##0#0#0.0#2019-03-04 14:37:59#0#17:23:00#13:51:00#00:00:00
1 6cfa9ff08fb876ff0120c61fdaf44127 413000 1573750 120000
0 0 0 0 103875 0 0 210000 0 361587
697428 30000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 05/04/1965 0 2
1 N60.1 85.12 - - None None None None L-1-50-I None None
0 - 0 - 0 - 0 - 0 4853300 4421389
0 3 0 0 0 PUPU 19056338 53 19676 dr. Riadhi
Aeni;3206276601940002 5.3.6.201902021030 4 271094 1#0##0#0#0.0#2019-
03-05 08:17:07#0#19:36:00#13:54:00#00:00:00 1
9b07d83464be937029831882cb567ebb 726525 1825000 120000 0
0 0 0 540000 0 0 210000 0 339206 600658
60000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 01/11/1963 0 2
2186200 0 0 - 0 - 0 - 0 - 0
2186200 5486413 0 3 0 0 0 YANI 18050193 55
271095 1#0##0#0#0.0#2019-03-05 08:22:19#0#18:55:00#13:53:00#00:00:00
1 a4e946759b55865208f0485288e432eb 1024050 2592500 120000
0 0 0 0 420125 0 0 210000 0 400708
659030 60000 0 0 0
3206023 C 3 CP 1 18/02/2019 19/02/2019 19/06/1950 0 2
6433000 0 0 - 0 - 0 - 0 - 0
6433000 3303953 0 2 0 0 0 KONDI 18031206 68
271101 1#0##0#0#0.0#2019-03-05 08:26:53#0#11:03:00#12:01:00#00:00:00
1 28b1b5fca899d98e430af998716f9d8f 254434 2125000 100000
0 0 0 0 0 0 0 140000 0 112447 552072
20000 0 0 0
3206023 C 3 CP 1 15/02/2019 19/02/2019 01/07/1969 0 2
1 N39.0;N18.9;K30;E11.9;A41.9 - - - None None None None
N-4-12-III None None None None None None INFEKSI GINJAL DAN SALURAN
URIN (BERAT) 4813800 0 0 - 0 - 0 - 0 -
0 4813800 2797145 0 5 0 0 0 TUTI 19057282
5.3.6.201902021030 4 271104 1#0##0#0#0.0#2019-03-05
08:28:37#0#14:05:00#10:42:00#00:00:00 1 5a0aa500b9a8d70884989a5574a78d90
603500 0 200000 0 0 0 0 370125 0 0
350000 0 1039597 183923 50000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 02/07/1945 0 2
1 K31.8;N17.9;N20.0;K92.1 - - - None None None None K-4-
18-III None None None None None None GANGGUAN SISTEM PENCERNAAN LAIN-
LAIN (BERAT) 2119000 0 0 - 0 - 0 - 0 -
0 2119000 1142054 0 3 0 0 0 SUPARMAN
19057408 73 26893 dr. Rini Widiastuti, Sp. PD 0122R0020219V003954
5.3.6.201902021030 4 271107 1#0##0#0#0.0#2019-03-05
08:30:42#0#18:19:00#10:41:00#00:00:00 1 9348fa23d8727479271d728733f2b684
343500 0 100000 0 0 0 0 178375 0 0
210000 0 206548 73631 30000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 01/12/1997 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3413164 0 3 0 0 0 N HILMA NURUL HALIMAH
5.3.6.201902021030 4 271110 1#0##0#0#0.0#2019-03-05
08:33:17#0#17:54:00#13:52:00#00:00:00 1 4ec41db7ed4ad1943ef94a4d1a7d5f36
413000 1573750 120000 0 0 0 0 97125 0 0
210000 0 343076 626213 30000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 26/06/1978 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3426512 0 3 0 0 0 HINDRA JAYA 19053295
5.3.6.201902021030 4 271112 1#0##0#0#0.0#2019-03-05
08:34:35#0#20:58:00#13:53:00#00:00:00 1 3dd6b0e33f1c300712c09930645d904b
413000 1573750 120000 0 0 0 0 185125 0
0 210000 0 279358 625279 20000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 01/01/1945 0 2
1 K41.9 53.00;54.4 - - None None None None K-1-40-I None
None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-LAIN (RINGAN)
5786500 0 0 - 0 - 0 - 0 - 0
5786500 3744079 0 3 0 0 0 ENCUM KULSUM, NY
5.3.6.201902021030 4 271114 1#0##0#0#0.0#2019-03-05
08:37:38#0#20:51:00#13:52:00#00:00:00 1 65859a0a0925beb360ace1ced3d6e437
429500 1825000 120000 0 0 0 0 185125 0
0 210000 0 353436 601018 20000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 27/08/2007 0 2
0 - 0 - 0 - 0 - 0 3549300 3695348
0 3 0 0 0 NOVAL RAHADIAN 19056572 11 4192 dr.
Adya Arradikha, Sp. T.H.T.K.L 0122R0020219V003928 0000432267434 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271118
1#0##0#0#0.0#2019-03-05 08:39:13#0#16:11:00#13:36:00#00:00:00 1
b4521c537c7312747f42fa935e69458a 571525 1825000 120000 0
0 0 0 0 0 0 210000 0 533247 405576
30000 0 0 0
3206023 C 3 CP 1 14/02/2019 19/02/2019 04/08/1971 0 2
1 I50.0;J90;I45.1;I25.1;K30 93.94;87.44;89.52 - - None None
None None I-4-12-III None None None None None None KEGAGALAN JANTUNG
(BERAT) 3582600 0 0 - 0 - 0 - 0 - 0
3582600 2527073 0 6 0 0 0 SARTIWI 19057212
5.3.6.201902021030 4 271014 1#0##0#0#0.0#2019-03-05
08:41:47#0#22:29:00#14:34:00#00:00:00 1 26bedb201f5bbdd299a996aea46b4012
757500 0 250000 0 0 0 140000 203375 0
0 420000 0 457739 228459 70000 0 0 0
3206023 C 2 CP 1 18/02/2019 19/02/2019 04/07/1951 0 2
0 0 - 0 - 0 - 0 - 0 7719600
3818028 0 2 0 0 0 KARNA SUHYANA 18049547 67
271135 1#0##0#0#0.0#2019-03-05 08:45:07#0#10:53:00#10:55:00#00:00:00
1 0a7fa2b9ee1f8d9144c7fd6c3f67a191 246934 2455000 70000 0
0 0 0 0 0 0 250000 0 101493 674601
20000 0 0 0
3206023 C 2 CP 1 14/02/2019 19/02/2019 02/12/2016 0 2
1 R56.0;J06.9 - - - None None None None G-4-22-I None
0 - 0 - 0 - 0 - 0 3030400 2242273
0 6 0 0 0 KIREY KHANZA ASHKIA 18051068 2 804
dr. Marte Robiul Sani Sp.A. 0122R0020219V003412 0001778148191 3;JKN
1#0##0#0#0.0#2019-03-05 08:46:34#0#11:55:00#11:09:00#00:00:00 1
4463a89cdc29c418e3c53cab4b071ed2 740000 0 350000 0 0
0 0 70125 0 0 750000 0 210273 61875 60000 0
0 0
3206023 C 2 CP 1 17/02/2019 19/02/2019 24/06/2017 0 2
1 J18.0 87.44 - - None None None None J-4-16-I None None
3999100 0 0 - 0 - 0 - 0 - 0
3999100 2093521 0 3 0 0 0 MUHAMAD FATHIAN SHARIQ
5.3.6.201902021030 4 271150 1#0##0#0#0.0#2019-03-05
08:49:39#0#06:16:00#11:08:00#00:00:00 1 ff366f1706d31bb522e89cb3ab4ea3d4
965000 0 210000 0 0 0 140000 103875 0
0 375000 0 147074 122572 30000 0 0 0
3206023 C 2 CP 1 18/02/2019 19/02/2019 01/02/2017 0 2
0 - 0 - 0 - 0 - 0 3030400 837669
0 2 0 0 0 ABRISHAM, AN 17018061 2 747 dr.
Lia Rhodia, Sp. A. 0122R0020219V004378 0002294722359 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271154
1#0##0#0#0.0#2019-03-05 08:50:43#0#20:58:00#11:22:00#00:00:00 1
42e2df849179a7490492df49465beece 255000 0 50000 0 0 0
0 66100 0 0 250000 0 139656 56913 20000 0 0
0
3206023 C 1 CP 1 15/02/2019 19/02/2019 05/07/1975 0 2
(SEDANG) 6967700 0 0 - 0 - 0 - 0 - 0
6967700 5305783 0 5 0 0 0 YANTI ROSMAYANTI
5.3.6.201902021030 4 271164 1#0##0#0#0.0#2019-03-05
08:55:09#0#09:45:00#10:40:00#00:00:00 1 df8a75f75ae881ba117ea5cc0bc98a7c
1432500 0 660000 0 0 0 894800 83100 0 0
1500000 0 683905 51478 0 0 0 0
3206023 C 1 CP 1 15/02/2019 19/02/2019 06/03/1940 0 2
1 A91;R42;K30;I10 - - - None None None None A-4-13-I
(RINGAN) 2112800 0 0 - 0 - 0 - 0 - 0
2112800 4019490 0 5 0 0 0 HJ N GOYOH B A
Aeni;3206276601940002 5.3.6.201902021030 4 271179 1#0##0#0#0.0#2019-
03-05 09:03:05#0#19:24:00#10:48:00#00:00:00 1
de457ae7b52ccca859c577fb1b216e27 1065000 0 595000 0 0
0 0 647150 0 0 1040000 0 456874 165466
50000 0 0 0
3206023 C 2 CP 1 14/02/2019 19/02/2019 08/11/1981 0 2
1 A91;R04.0;K30 - - - None None None None A-4-13-II
(SEDANG) 2728200 0 0 - 0 - 0 - 0 - 0
2728200 3634562 0 6 0 0 0 SUSI SUSILAWATI
Aeni;3206276601940002 5.3.6.201902021030 4 268567
1#1#kelas_1#6#454700#0.0#2019-03-05 09:30:19#0#09:13:00#09:39:00#00:00:00
4 2ffab97b11eb703338c9d402d9813d22 983500 0 400000 0
0 0 0 565675 0 0 1040000 0 494381 81006
70000 0 0 0
3206023 C 3 CP 1 18/02/2019 19/02/2019 18/12/1969 0 2
- 0 - 0 - 0 - 0 1645900 2300018 0
2 0 0 0 AGUS SUGIANTO 18039664 49 17959 DR. RIADHI
Aeni;3206276601940002 5.3.6.201902021030 4 271092 1#0##0#0#0.0#2019-
03-05 09:37:56#0#09:05:00#08:57:00#00:00:00 2
18551fa98140e02f06d6dd42cf0b09db 1310000 0 100000 0 0
0 0 66100 0 0 630000 0 118948 54970 20000 0
0 0
3206023 C 3 CP 1 13/02/2019 19/02/2019 04/08/1967 0 2
1 I21.4;K30 - - - None None None None I-4-10-I None
None None None None None INFARK MYOKARD AKUT (RINGAN) 2912200 0
0 - 0 - 0 - 0 - 0 2912200 5906084
0 7 0 0 0 TOLIB 17018180 51 18821 DR. H. DANI FARID
ABDULLAH SP.PD 0122R0020219V003243 0000430485491 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 271068 1#0##0#0#0.0#2019-
03-05 09:40:32#0#00:25:00#14:33:00#00:00:00 2
a218d289b3942346735be12a50c23b0e 2003500 0 660000 0 0
0 0 493350 0 0 415000 275000 1569637 143117
70000 276480 0 0
3206023 C 3 CP 1 15/02/2019 19/02/2019 01/10/1972 0 2
1 A91;K30;A09.9 - - - None None None None A-4-13-I
(RINGAN) 1509200 0 0 - 0 - 0 - 0 - 0
1509200 1701622 0 5 0 0 0 SARIPUDIN 19057316
5.3.6.201902021030 4 271042 1#0##0#0#0.0#2019-03-05
09:41:59#0#06:12:00#14:35:00#00:00:00 2 60a834971e79e316ba18de99b65c3e54
468500 0 120000 0 0 0 0 327100 0 0
280000 0 335650 120372 50000 0 0 0
3206023 C 3 CP 1 14/02/2019 19/02/2019 11/01/1964 0 2
1 I11.0;K30;R73.9 87.44 - - None None None None I-4-12-I
None None None None None None KEGAGALAN JANTUNG (RINGAN) 2575600
0 0 - 0 - 0 - 0 - 0 2575600
2344055 0 6 0 0 0 OTIH 19057217 55 20123 DR. H.
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 270981
1#0##0#0#0.0#2019-03-05 09:47:04#0#05:29:00#14:35:00#00:00:00 2
8931f36697df93df159ddad1c4366b2c 931000 0 265000 0 0
0 140000 246000 0 0 350000 0 273654 78401
60000 0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 10/02/1987 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3097078 0 3 0 0 0 KURNIA KHOERUNNISA
Aeni;3206276601940002 5.3.6.201902021030 4 271285 1#0##0#0#0.0#2019-
03-05 10:11:11#0#17:06:00#07:18:00#00:00:00 1
db269a9b451c4986d7a25b9524855038 588000 1626250 40000 0 0
0 0 219000 0 0 210000 0 93359 280469 40000
0 0 0
3206023 C 3 CP 1 17/02/2019 19/02/2019 23/06/1973 0 2
- 0 - 0 - 0 - 0 1585400 3031207 0
3 0 0 0 NENENG ROMANAH 19057233 45 16675 dr.
1#0##0#0#0.0#2019-03-05 10:12:34#0#20:19:00#07:18:00#00:00:00 1
1ff50a81705138e92178a4af0241f6e5 568000 1626250 20000 0 0
0 0 0 0 0 210000 0 247664 319293 40000
0 0 0
3206023 C 2 CP 1 17/02/2019 19/02/2019 01/07/1984 0 2
PAYUDARA (RINGAN) 4436300 0 0 - 0 - 0 - 0 -
0 4436300 2839737 0 3 0 0 0 NUNUNG NURMAYA
5.3.6.201902021030 4 271395 1#0##0#0#0.0#2019-03-05
11:18:10#0#16:34:00#14:18:00#00:00:00 1 e881240035e81d87b00d81fa3174e0bb
364000 1465000 160000 0 0 0 0 151375 0
0 265000 0 106504 277858 50000 0 0 0
3206023 C 2 CP 1 09/02/2019 19/02/2019 02/07/1956 0 2
1 E11.9;I12.0;E87.5;A41.9;D63.8 39.95;99.04 - - None None None
None E-4-10-III None None None None None None PENYAKIT KENCING MANIS &
GANGGUAN NUTRISI/ METABOLIK (BERAT) 6931700 0 0 - 0 - 0
- 0 - 0 6931700 9365722 0 11 0 0 0
MIRSAH 19056705 62 22867 dr. H. Dani Farid Abdullah Sp.PD
Aeni;3206276601940002 5.3.6.201902021030 4 271195 1#0##0#0#0.0#2019-
03-06 13:38:48#0#23:16:00#10:56:00#00:00:00 1
1fee658d58eb62c570ce7afd23fb2c92 2276230 0 630000 0
1174420 0 375000 2299800 0 0 1320000 0 659284
540988 90000 0 0 0
3206023 C 3 CP 1 14/02/2019 19/02/2019 20/11/1940 0 2
1 L21.9;L27.0;L53.9 - - - None None None None L-4-14-II
None None None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN
(SEDANG) 3283700 0 0 - 0 - 0 - 0 - 0
3283700 2769962 0 6 0 0 0 JUHRIAH 19057135
78 28575 dr. Eman Arif Rahman, Sp.KK 0122R0020219V003296
5.3.6.201902021030 4 270679 1#0##0#0#0.0#2019-03-12
10:44:13#0#09:37:00#11:12:00#00:00:00 1 e2c9966a023b8625b07161793b90c0f7
467500 0 250000 0 0 0 0 483850 0 0
1080000 0 340048 98564 50000 0 0 0
3206023 C 3 CP 1 18/02/2019 19/02/2019 01/05/2013 0 2
1 J40;A41.9 99.21 - - None None None None J-4-21-III None
None None None None None GEJALA, TANDA DAN DIAGNOSIS SISTEM PERNAFASAN
LAIN-LAIN (BERAT) 5981900 0 0 - 0 - 0 - 0 -
0 5981900 1183302 0 2 0 0 0 ZAKKIY MUHAMMAD
5.3.6.201902021030 4 273032 1#0##0#0#0.0#2019-03-12
11:26:22#0#02:30:00#13:14:00#00:00:00 1 9da2bc603608eba6d3c47f7e7a1dc1b5
400000 0 50000 0 0 0 130000 261750 0 0
140000 0 80640 100912 20000 0 0 0
3206023 C 2 CP 1 08/02/2019 19/02/2019 13/08/1957 0 2
1 I51.9;J90;N17.9;I25.1 99.18;87.44 - - None None None None
I-4-24-III None None None None None None GANGGUAN SISTEM PEMBULUH
DARAH LAIN-LAIN (BERAT) 7817500 0 0 - 0 - 0 - 0
- 0 7817500 10085506 0 12 0 0 0 ASEP LILI
Aeni;3206276601940002 5.3.6.201902021030 4 271130 1#0##0#0#0.0#2019-
03-12 13:49:02#0#20:45:00#14:32:00#00:00:00 3
eff7e58e4fdee4dc24e1852fe678580c 2359500 0 1450000 0 0
0 140000 802100 0 0 625000 1025000 2868813
557733 50000 207360 0 0
3206023 C 3 CP 1 13/02/2019 19/02/2019 23/01/2019 2100 2
1 P36.9;P22.9 93.90 - - None None None None A-4-14-I None
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 4559370 0 7 0 0 0 RAKA RIZKY RIZWAN
5.3.6.201902021030 4 273683 1#0##0#0#0.0#2019-03-14
09:22:34#0#15:32:00#09:58:00#00:00:00 1 c95a0f138cf00741f487063c4927896c
2535000 0 420000 0 0 0 0 165750 0 0
875000 0 80186 403434 80000 0 0 0
3206023 C 1 CP 1 17/02/2019 19/02/2019 18/10/1987 0 2
1 O99.8;R42 - - - None None None None W-4-16-I None
0 - 0 - 0 - 0 - 0 2799800 1774029
0 3 0 0 0 DEWI FITRIA 18040499 31 11445 DR.
DAMARIZQA DARA SJAHRUDDIN, SP.OG 0122R0020219V003926 0002357019257 3;JKN
1#0##0#0#0.0#2019-03-15 09:00:08#0#00:00:00#00:00:00#00:00:00 2
0a5eb44af4a49a28c256b23a3ac4fd5f 512500 0 200000 0 0
0 0 311875 0 0 540000 0 106195 73459 30000
0 0 0
3206023 C 1 CP 1 14/02/2019 19/02/2019 09/06/1950 0 2
1 E11.9;I51.9;N18.9 - - - None None None None E-4-10-II
None None None None None None PENYAKIT KENCING MANIS & GANGGUAN
NUTRISI/ METABOLIK (SEDANG) 6515500 0 0 - 0 - 0 -
0 - 0 6515500 6011315 0 6 0 0 0 H.
DION 19057196 68 25087 DR. H. DANI FARID ABDULLAH SP.PD
Septiani;3278085209910012 5.3.6.201902021030 4 268587
1#0##0#0#0.0#2019-03-15 09:01:08#0#00:00:00#00:00:00#00:00:00 3
8f42ec00e401f2af0d67da978dbc8134 2527500 0 475000 0 0
0 140000 780225 0 0 1500000 0 224511 200399
60000 103680 0 0
3206023 C 1 CP 1 18/02/2019 20/02/2019 14/07/1949 0 2
1 J44.1;I48;I11.0 - - - None None None None J-4-17-III
None None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (BERAT)
6026700 0 0 - 0 - 0 - 0 - 0
6026700 2196704 0 3 0 0 0 MAMAD AHMAD AZIZ
Septiani;3278085209910012 5.3.6.201902021030 4 268779
1#1#vip#3#4520025#75.0#2019-02-20 11:46:04#0#17:47:00#11:19:00#00:00:00
2 f91f76c0385577022869a149518bea82 780000 0 330000 0
0 0 0 0 0 0 900000 0 166704 0 20000
0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 08/02/1962 0 2
1 D64.9;I11.9;N18.9 - - - None None None None D-4-13-II
0 - 0 3139300 2589807 0 3 0 0 0 WAWAN
Septiani;3278085209910012 5.3.6.201902021030 4 271327
1#0##0#0#0.0#2019-03-05 10:34:59#0#10:54:00#12:02:00#00:00:00 1
809e4feefd5e8f7bd81329c45f46b1a3 936980 0 100000 0 0
0 0 918825 0 0 210000 0 215820 208182
0 0 0 0
3206023 C 1 CP 1 20/02/2019 20/02/2019 14/07/1949 0 2
1 J44.1;I48;I11.9 - - - None None None None J-4-17-II
None None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (SEDANG)
4592400 0 0 - 0 - 0 - 0 - 0
4592400 3033332 0 1 0 0 0 MAMAD AHMAD AZIZ
Septiani;3278085209910012 5.3.6.201902021030 4 271377
1#0##0#0#0.0#2019-03-05 11:02:16#0#11:29:00#12:12:00#00:00:00 1
461b6c3e8c891a51e00f41e59ae5c104 1007500 0 330000 0 0
0 140000 231500 0 0 900000 0 303813 100519
20000 0 0 0
3206023 C 3 CP 1 14/02/2019 20/02/2019 14/02/2019 1900 2
- 0 5808700 3306017 0 7 0 0 0 BY NY RENI
MARLINA 19057224 0 0 dr. Marte Robiul Sani Sp.A.
Septiani;3278085209910012 5.3.6.201902021030 4 271384
1#0##0#0#0.0#2019-03-05 11:04:38#0#22:05:00#08:52:00#00:00:00 1
87631150ca03a5f558889e949bdd955f 1834700 0 420000 0 0
0 0 222875 0 0 710000 0 32052 69110 0 17280
0 0
3206023 C 3 CP 1 19/02/2019 20/02/2019 02/10/1958 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 5344790 0 2 0 0 0 NUNU JUNAEDIN
5.3.6.201902021030 4 271439 1#0##0#0#0.0#2019-03-05
13:16:40#0#10:41:00#13:47:00#00:00:00 1 482edbe431291b8403ed199e71ccb7ca
380000 3036500 90000 0 0 0 0 0 0 0 140000
0 872296 805994 20000 0 0 0
3206023 C 3 CP 1 13/02/2019 20/02/2019 01/07/1951 0 2
1 J44.1;K30;I25.2 - - - None None None None J-4-17-I
2739200 0 0 - 0 - 0 - 0 - 0
2739200 4434063 0 8 0 0 0 IPING 18028734 67
24699 dr. Rini Widiastuti, Sp. PD 0122R0020219V003029 0000434908181
271455 1#0##0#0#0.0#2019-03-05 13:30:57#0#21:14:00#14:46:00#00:00:00
1 df90e2cd8b0a2fdec6c425168a1ceade 1553500 0 250000 0
0 0 130000 367750 0 0 560000 0 1076856
415957 80000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 01/11/1960 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3306027 0 3 0 0 0 SUPYAN 18051673
5.3.6.201902021030 4 271465 1#0##0#0#0.0#2019-03-05
13:50:56#0#23:59:00#13:47:00#00:00:00 1 14c4e53bf304f9689beb30b0beca06b2
323000 1573750 120000 0 0 0 0 185125 0
0 210000 0 268720 595432 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 20/02/2019 08/06/1999 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3074304 0 2 0 0 0 WAHYUNI 19057465
271477 1#0##0#0#0.0#2019-03-05 14:01:40#0#15:15:00#14:02:00#00:00:00
1 6a701bd67a657095971fa7666d9f089a 413000 2032812 70000 0
0 0 0 276375 0 0 140000 0 98672 23445 20000
0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 17/06/1945 0 2
1 A09.9;K30 - - - None None None None K-4-17-I None
(RINGAN) 1406200 0 0 - 0 - 0 - 0 - 0
1406200 1504827 0 3 0 0 0 YAYAH 19057532 73
5.3.6.201902021030 4 271480 1#0##0#0#0.0#2019-03-05
14:04:10#0#12:20:00#12:03:00#00:00:00 1 a4ed1ec1b9d0dd35f0c5923fb5d1c4c4
303500 0 100000 0 0 0 0 178375 0 0
210000 0 566423 126529 20000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 23/03/1990 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3095143 0 3 0 0 0 DEVI RATNASARI
5.3.6.201902021030 4 271543 1#0##0#0#0.0#2019-03-06
08:58:11#0#18:10:00#11:41:00#00:00:00 1 4b6f0c90a5f6cd00d2959d1e700ad127
495500 1626250 70000 0 0 0 0 306750 0 0
210000 0 263586 93057 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 20/02/2019 15/02/1994 0 2
0 0 - 0 - 0 - 0 - 0 1544900
2043994 0 2 0 0 0 RISMAWATI SIREGAR , NY 15012846
271548 1#0##0#0#0.0#2019-03-06 09:00:31#0#20:53:00#11:44:00#00:00:00
1 a40fc68202a700bb917651da94a8f643 1342500 0 100000 0
0 0 0 281500 0 0 140000 0 43487 116507
20000 0 0 0
3206023 C 3 CP 1 19/02/2019 20/02/2019 18/12/1988 0 2
1 O13;O80.0;Z37.0 73.59 - - None None None None O-6-13-II
0 0 - 0 - 0 - 0 - 0 1828500
2525372 0 2 0 0 0 ASIH 19054399 30 11020 dr.
Septiani;3278085209910012 5.3.6.201902021030 4 271554
1#0##0#0#0.0#2019-03-06 09:04:28#0#20:19:00#11:47:00#00:00:00 1
760fa47c97aeb1183a6e303842543301 1567500 0 100000 0 0
0 0 320250 0 0 140000 0 96283 281339 20000
0 0 0
3206023 C 3 CP 1 16/02/2019 20/02/2019 01/07/1945 0 2
1 J44.1;I11.9;K30 - - - None None None None J-4-17-I
2739200 0 0 - 0 - 0 - 0 - 0
2739200 2422381 0 5 0 0 0 ENDAH 18040964 73
5.3.6.201902021030 4 271564 1#0##0#0#0.0#2019-03-06
09:06:43#0#11:05:00#12:29:00#00:00:00 1 7ab2ec646a57aa574f38426449dd28e4
643500 0 200000 0 0 0 140000 142700 0
0 350000 0 619684 216497 110000 0 0 0
3206023 C 3 CP 1 19/02/2019 20/02/2019 20/07/1981 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2131786 0 2 0 0 0 SITI MASITOH 18042254 37
1#0##0#0#0.0#2019-03-06 09:08:30#0#16:15:00#12:21:00#00:00:00 1
7f6e8a6e548373e3ef6735278ffefd71 1450000 0 50000 0 0 0
0 281500 0 0 140000 0 47678 142608 20000 0
0 0
3206023 C 3 CP 1 13/02/2019 20/02/2019 17/04/1950 0 2
1 J44.1;N17.9;K30;I50.0;I45.1 - - - None None None None
J-4-17-III None None None None None None PENYAKIT PARU OBSTRUKTIF
KRONIS (BERAT) 4304800 0 0 - 0 - 0 - 0 -
0 4304800 2837679 0 8 0 0 0 MEDI 19057112
5.3.6.201902021030 4 271573 1#0##0#0#0.0#2019-03-06
09:11:45#0#11:48:00#12:17:00#00:00:00 1 3b59eb97c456afa98ba6300007e7a4e0
978500 0 300000 0 0 0 140000 178375 0
0 490000 0 376589 245095 60000 69120 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 18/06/1972 0 2
1 R33 - - - None None None None N-4-15-I None None
(RINGAN) 2241300 0 0 - 0 - 0 - 0 - 0
2241300 2018134 0 3 0 0 0 SARIHON HARAHAP
5.3.6.201902021030 4 271579 1#0##0#0#0.0#2019-03-06
09:14:15#0#07:09:00#00:57:00#00:00:00 1 fd152e281da612ec05b750f99bf4d971
605000 0 150000 0 0 0 465000 70125 0 0
280000 0 179468 218541 50000 0 0 0
3206023 C 3 CP 1 17/02/2019 20/02/2019 06/06/1957 0 2
1 D48.7 86.04 - - None None None None C-4-14-I None None
None None None None TUMOR MYELOPROLIFERATIF LAIN-LAIN (RINGAN)
2734700 0 0 - 0 - 0 - 0 - 0
2734700 5508764 0 4 0 0 0 DEDI BASTAMAN
5.3.6.201902021030 4 271582 1#0##0#0#0.0#2019-03-06
09:17:13#0#16:20:00#10:02:00#00:00:00 2 513d6f241c98e62c97005ae446ab5cc7
782025 2592500 170000 0 0 0 0 453875 0
0 350000 0 472878 647486 40000 0 0 0
3206023 C 3 CP 1 14/02/2019 20/02/2019 17/09/2018 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 3142493 0 7 0 0 0 SALMAN 18043802
5.3.6.201902021030 4 271587 1#0##0#0#0.0#2019-03-06
09:18:35#0#10:57:00#08:51:00#00:00:00 1 8b396d972f89bdbefa128c2b2ad29a80
1447500 0 300000 0 0 0 140000 70125 0 0
490000 0 358117 173071 60000 103680 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 01/06/1993 0 2
1 D56.9;K74.6;E83.1 99.04 - - None None None None D-4-13-II
0 - 0 3139300 1777601 0 3 0 0 0 YOGA
SENJAYA, TN 16000810 25 9393 dr. H. Dani Farid Abdullah Sp.PD
Septiani;3278085209910012 5.3.6.201902021030 4 271607
1#0##0#0#0.0#2019-03-06 09:45:11#0#12:48:00#12:22:00#00:00:00 1
1e43ac73a107d9ae2d1095fa85fa0593 296000 0 100000 0 0
0 0 1114925 0 0 210000 0 25106 31570 0 0
0 0
3206023 C 3 CP 1 16/02/2019 20/02/2019 16/06/1994 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1551879 0 5 0 0 0 RINI, NY 14005602
5.3.6.201902021030 4 271612 1#0##0#0#0.0#2019-03-06
09:50:48#0#19:56:00#14:35:00#00:00:00 1 290d6e7c4a428425306de66e87ca8201
383500 0 150000 0 0 0 0 371600 0 0
350000 0 178877 67902 50000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 05/06/1984 0 2
LAIN (RINGAN) 2199200 0 0 - 0 - 0 - 0 -
0 2199200 2846882 0 3 0 0 0 ISUR SURYADI
MARTHA 19056779 34 12676 dr. Adya Arradikha, Sp. T.H.T.K.L
Septiani;3278085209910012 5.3.6.201902021030 4 271616
1#0##0#0#0.0#2019-03-06 09:55:30#0#16:43:00#13:47:00#00:00:00 1
de0aa39368d89a6e152892a5e3cc4034 413000 1285000 150000 0
0 0 0 517300 0 0 210000 0 133750 107832
30000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 01/06/1961 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3917140 0 3 0 0 0 SARIP 18052119 57
271621 1#0##0#0#0.0#2019-03-06 10:00:28#0#20:04:00#13:46:00#00:00:00
1 f7bb289021f760e9d1006f793f3ad4a2 429500 1825000 170000
0 0 0 0 252300 0 0 210000 0 302074
698266 30000 0 0 0
3206023 C 2 CP 1 18/02/2019 20/02/2019 20/07/1970 0 2
LAIN (RINGAN) 2639000 0 0 - 0 - 0 - 0 -
0 2639000 3725577 0 3 0 0 0 ADIR SUDIRMAN
18050020 48 17745 dr. Adya Arradikha, Sp. T.H.T.K.L
Septiani;3278085209910012 5.3.6.201902021030 4 271650
1#0##0#0#0.0#2019-03-06 10:20:51#0#16:29:00#14:11:00#00:00:00 1
1cc5fc5bb3776969d606c53ffcd0ad76 370500 1465000 140000 0
0 0 0 328875 0 0 375000 0 886777 139425
20000 0 0 0
3206023 C 3 CP 1 17/02/2019 20/02/2019 01/01/1969 0 2
1 S09.9 - - - None None None None G-4-24-I None None
None None None None TRAUMA KEPALA (RINGAN) 2192000 0 0 -
0 - 0 - 0 - 0 2192000 3438521 0 4
0 0 0 CUCU 19057391 50 18309 DR. NURUL SITI MARDIAH, SP.B
Septiani;3278085209910012 5.3.6.201902021030 4 271443
1#0##0#0#0.0#2019-03-08 11:06:28#0#07:20:00#13:44:00#00:00:00 2
6335409723afd76b1d8325a4f6f9ab72 597500 0 150000 0 0
0 1490000 103875 0 0 210000 0 439735 427411
20000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 05/08/1955 0 2
- 0 - 0 - 0 - 0 1645900 2869589 0
3 0 0 0 JUMNISAH 17020193 63 23208 DR. RIADHI
Septiani;3278085209910012 5.3.6.201902021030 4 271432
1#0##0#0#0.0#2019-03-08 11:07:37#0#08:34:00#09:05:00#00:00:00 3
e103e5fb9e5351b17a43bce3a5a40fbc 1400000 0 150000 0 0
0 0 242100 0 0 770000 0 183848 103641
20000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 06/07/1943 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3160976 0 3 0 0 0 EMAR 18051771 75
271974 1#0##0#0#0.0#2019-03-08 11:13:24#0#17:45:00#13:46:00#00:00:00
1 44be16e9f78abd7b32af2da8288601d9 413000 1573750 170000
0 0 0 0 56100 0 0 210000 0 230370 477756
30000 0 0 0
3206023 C 3 CP 1 15/02/2019 20/02/2019 15/09/1945 0 2
1 I63.9;M10.0 87.03 - - None None None None G-4-14-I None
(RINGAN) 3722700 0 0 - 0 - 0 - 0 - 0
3722700 3289006 0 6 0 0 0 FADIL 19057314 73
1#0##0#0#0.0#2019-03-12 13:21:57#0#06:04:00#11:06:00#00:00:00 2
6417eab9ccf310516be7ca82d0168036 570000 0 250000 0 0
0 950000 114025 0 0 350000 0 775197 229784
50000 0 0 0
3206023 C 3 CP 1 19/02/2019 20/02/2019 22/12/2000 0 2
- 0 - 0 - 0 - 0 1645900 1994050 0
2 0 0 0 IHSAN SISWANDI 18029006 18 6633 DR. RIADHI
Septiani;3278085209910012 5.3.6.201902021030 4 271405
1#0##0#0#0.0#2019-03-14 11:11:37#0#08:57:00#10:07:00#00:00:00 3
f360e496ab533778a7ae783e5b1abfe4 1310000 0 100000 0 0
0 0 0 0 0 210000 0 265396 78654 30000 0
0 0
3206023 C 3 CP 1 13/02/2019 20/02/2019 14/05/1995 0 2
None None None None INFEKSI-INFEKSI GASTROINTESTINAL (RINGAN) 2738000
0 0 - 0 - 0 - 0 - 0 2738000
3561110 0 8 0 0 0 AGEUNG SOPANDI 19057042 23
5.3.6.201902021030 4 271416 1#0##0#0#0.0#2019-03-15
09:12:35#0#00:00:00#00:00:00#00:00:00 2 afa2ae46c73cbbb5e1eba2988a176f98
1048500 0 395000 0 0 0 475000 247200 0
0 560000 0 661161 174249 0 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 01/11/1967 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3288255 0 3 0 0 0 OJAH 19053164 51 18737 DR.
TEGUH BUDIMAN SP.MA. 0122R0020219V004376 0000436555001 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271629
1#0##0#0#0.0#2019-03-15 09:20:51#0#00:00:00#00:00:00#00:00:00 3
e06598717ad8ab291024ee35d2726298 344434 2125000 100000 0
0 0 0 185125 0 0 280000 0 49599 194097
10000 0 0 0
3206023 C 3 CP 1 18/02/2019 20/02/2019 15/04/1945 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3573917 0 3 0 0 0 GANDI SUGANDI
5.3.6.201902021030 4 274200 1#0##0#0#0.0#2019-03-18
12:39:26#0#17:42:00#13:45:00#00:00:00 1 c6a2b516d34499084ee5808a2099e451
429500 1825000 170000 0 0 0 0 70125 0 0
210000 0 246652 592640 30000 0 0 0
3206023 C 1 CP 1 20/02/2019 21/02/2019 12/04/1948 0 2
1 H40.9;H25.1 13.71;12.54 - - None None None None H-1-30-I
None None None None None None PROSEDUR LENSA DAN INTRA OKULER (RINGAN)
9006300 0 0 - 0 - 0 - 0 - 0
9006300 4182597 0 2 0 0 0 HJ ROKAYAH 18029348
70 25881 dr. Teguh Budiman Sp.Ma. 0122R0020219V004912
5.3.6.201902021030 4 271336 1#0##0#0#0.0#2019-03-05
10:40:53#0#11:35:00#08:22:00#00:00:00 1 50adf4f02ae9653ded7afcfad73fac53
209434 2530000 200000 0 0 0 0 0 0 0
900000 0 138473 194690 10000 0 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 11/11/1963 0 2
1 L02.4;R73.9;A41.9 86.04;86.22 - - None None None None L-4-
12-III None None None None None None PERADANGAN KULIT/CELLULITIS (BERAT)
4417100 0 0 - 0 - 0 - 0 - 0
4417100 4294655 0 4 0 0 0 U SUBADRI 19057515
5.3.6.201902021030 4 271649 1#0##0#0#0.0#2019-03-06
10:30:26#0#12:09:00#13:46:00#00:00:00 1 605c0b1c19eaa6fe71ef702cf854b593
675500 1846000 220000 0 0 0 0 191875 0
0 280000 0 411483 629797 40000 0 0 0
3206023 C 1 CP 1 16/02/2019 21/02/2019 02/05/1949 0 2
1 A09.9;N17.9;D64.9;K30;N40;I10 99.04 - - None None None None
K-4-17-III None None None None None None NYERI ABDOMEN &
GASTROENTERITIS LAIN-LAIN (BERAT) 3231200 0 0 - 0 - 0
- 0 - 0 3231200 6329098 0 6 0 0 0
H. ABDUL KHOLIK DIMYATI 19057345 69 25492 dr. H. Dani Farid Abdullah
Sp.PD 0122R0020219V004601 0001902769716 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271664
1#0##0#0#0.0#2019-03-06 10:31:37#0#16:09:00#11:07:00#00:00:00 1
2bd64d10654da5cc7040e5f403e433d3 1452500 0 825000 0 0
0 495000 945525 0 0 1800000 0 674012 87061
50000 0 0 0
3206023 C 1 CP 1 21/02/2019 21/02/2019 24/08/1969 0 2
1 N18.9;I10 - - - None None None None N-4-10-I None
(RINGAN) 3445100 0 0 - 0 - 0 - 0 - 0
3445100 833106 0 1 0 0 0 AI HARYATI 19057822
5.3.6.201902021030 4 271676 1#0##0#0#0.0#2019-03-06
10:42:35#0#10:58:00#22:03:00#00:00:00 1 6e949bef0918e8ce94233ed1f0596af8
182500 0 50000 0 0 0 0 334625 0 0 70000
0 82931 103050 10000 0 0 0
3206023 C 2 CP 1 15/02/2019 21/02/2019 04/06/1929 0 2
1 I50.0;N18.9 - - - None None None None I-4-12-II None
None None None None None KEGAGALAN JANTUNG (SEDANG) 3582600 0
0 - 0 - 0 - 0 - 0 3582600 3512919
0 7 0 0 0 ANEM SUKIRMAN 19057304 89 32763 dr.
Rini Widiastuti, Sp. PD 0122R0020219V003724 0000070293115 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271683
1#0##0#0#0.0#2019-03-06 10:50:03#0#18:51:00#13:06:00#00:00:00 1
1c2e6ab6b212369d1b34e3bdc2390a9e 1183500 0 420000 0 0
0 140000 203375 0 0 490000 0 882503 123541
70000 0 0 0
3206023 C 2 CP 1 20/02/2019 21/02/2019 05/04/1994 0 2
0 0 - 0 - 0 - 0 - 0 2194200
2631477 0 2 0 0 0 AI ANI SUMARNI 19057682 24
5.3.6.201902021030 4 271685 1#0##0#0#0.0#2019-03-06
10:53:10#0#14:42:00#11:05:00#00:00:00 1 723adf3e5bf193e7d4654d80588b65a8
1767500 0 120000 0 0 0 0 291375 0 0
140000 0 114102 178500 20000 0 0 0
3206023 C 2 CP 1 19/02/2019 21/02/2019 03/03/1958 0 2
7719600 0 0 - 0 - 0 - 0 - 0
7719600 4464092 0 3 0 0 0 IIS NURHAYATI, NY
5.3.6.201902021030 4 271687 1#0##0#0#0.0#2019-03-06
10:55:42#0#16:49:00#13:50:00#00:00:00 1 f47d5dbaa4913beff36f9662ed5a4279
261934 2455000 210000 0 0 0 0 106500 0
0 375000 0 98063 927595 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 15/11/2012 0 2
1 A09.9;R56.0 - - - None None None None K-4-17-II None
(SEDANG) 1923400 0 0 - 0 - 0 - 0 - 0
1923400 1154557 0 3 0 0 0 FAUZAN NUR IHROM
5.3.6.201902021030 4 271698 1#0##0#0#0.0#2019-03-06
11:04:42#0#20:40:00#09:42:00#00:00:00 1 f944745b2b9d01ef38fe965ad719d6af
252500 0 145000 0 0 0 0 260125 0 0
210000 0 227038 29894 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 06/08/1991 0 2
1 O33.9;O82.1;Z37.0;O48 74.99 - - None None None None O-6-
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5276215 0 3 0 0 0 ANGGI LESTARI
5.3.6.201902021030 4 271715 1#0##0#0#0.0#2019-03-06
11:15:33#0#07:16:00#11:09:00#00:00:00 1 d87cfc4b459242822fde2afafbb660d1
1222000 2137750 240000 0 0 0 0 328875 0
0 210000 0 485355 622235 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 09/09/1986 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4967533 0 3 0 0 0 ROSMAYATI 19057559
271720 1#0##0#0#0.0#2019-03-06 11:17:27#0#05:09:00#11:11:00#00:00:00
1 cdd70fde34457a90661d5542b6e1393e 1169500 2137750 290000
0 0 0 0 295125 0 0 210000 0 352599
482559 30000 0 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 01/05/1987 0 2
1 O00.9;O00.1 54.11;66.62 - - None None None None K-1-40-I
(RINGAN) 5786500 0 0 - 0 - 0 - 0 - 0
5786500 4932437 0 4 0 0 0 NUNUNG SITI NURBARIYAH
5.3.6.201902021030 4 271726 1#0##0#0#0.0#2019-03-06
11:25:09#0#13:05:00#11:08:00#00:00:00 1 a35d5bc2648d908034f4aa4bb06f408e
602000 2137750 170000 0 0 0 0 907100 0
0 280000 0 303879 491708 40000 0 0 0
3206023 C 3 CP 1 14/02/2019 21/02/2019 08/02/1967 0 2
1 N18.9;D64.9;I11.9 99.04;39.95 - - None None None None N-4-
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 5642501 0 8 0 0 0 II SUPIYATI
Septiani;3278085209910012 5.3.6.201902021030 4 271754
1#0##0#0#0.0#2019-03-06 11:38:07#0#10:20:00#12:08:00#00:00:00 1
1a105b1146540c2f97ce62669db11fe0 1301710 0 350000 0
1241420 0 0 1165325 0 0 560000 0 525808
334558 60000 103680 0 0
3206023 C 3 CP 1 17/02/2019 21/02/2019 14/04/1999 0 2
1 J15.7;K30;B90.9 - - - None None None None J-4-16-I
(RINGAN) 3332600 0 0 - 0 - 0 - 0 - 0
3332600 1868301 0 5 0 0 0 WIDA NINGSIH, NN
Septiani;3278085209910012 5.3.6.201902021030 4 271756
1#0##0#0#0.0#2019-03-06 11:43:08#0#22:26:00#12:10:00#00:00:00 1
27144fe90098952e158e6c95d93ee2d7 563500 0 150000 0 0
0 140000 95125 0 0 350000 0 379520 53756 50000
86400 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 02/06/1928 0 2
1 K30;D64.9 99.04 - - None None None None K-4-18-II None
1765800 0 0 - 0 - 0 - 0 - 0
1765800 2796570 0 4 0 0 0 OMOD 19057457 90
271759 1#0##0#0#0.0#2019-03-06 11:52:45#0#11:32:00#12:10:00#00:00:00
1 40ad9b835567e8f00abc968121c1431c 278500 0 100000 0
0 0 0 1496350 0 0 280000 0 316323 285397
40000 0 0 0
3206023 C 3 CP 1 17/02/2019 21/02/2019 01/01/1955 0 2
2 J44.1;R73.9;I11.0 - - - None None None None J-4-17-III
None None None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (BERAT)
4304800 0 0 - 0 - 0 - 0 - 0
4304800 2445407 0 5 0 0 0 ERI TARIAH 18045311
5.3.6.201902021030 4 271761 1#0##0#0#0.0#2019-03-06
11:57:13#0#21:31:00#14:05:00#00:00:00 1 e5ef11aa5cf9a0e93742425ccfa005ac
588500 0 150000 0 0 0 140000 203375 0
0 350000 0 869155 59817 50000 34560 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 11/06/1957 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3465554 0 3 0 0 0 IDIM 19053099 61
271779 1#0##0#0#0.0#2019-03-06 13:15:20#0#22:37:00#13:44:00#00:00:00
1 c089315491c54d82f68f7dee1b7d6ed8 463000 1573750 140000
0 0 0 0 103875 0 0 210000 0 247814
697115 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 05/06/1967 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3836434 0 3 0 0 0 ASEP KURNIA 19054522
5.3.6.201902021030 4 271789 1#0##0#0#0.0#2019-03-06
13:18:42#0#17:13:00#11:37:00#00:00:00 1 9b91bd97deffda807a6aa688495a468a
479500 1825000 140000 0 0 0 0 70125 0 0
210000 0 300200 751609 60000 0 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 31/07/1999 0 2
1 J94.2;D64.9 99.04 - - None None None None J-4-20-II None
None None None None None PLEURAL EFUSI DAN PNEUMOTORAK (SEDANG)
5305300 0 0 - 0 - 0 - 0 - 0
5305300 3452087 0 4 0 0 0 RATNA WULANSARI
5.3.6.201902021030 4 271795 1#0##0#0#0.0#2019-03-06
13:21:31#0#17:51:00#13:46:00#00:00:00 1 5963d840e2ac6adf244629d46a7a5c4f
357500 0 120000 0 0 0 380000 1328325 0
0 280000 0 799912 146350 40000 0 0 0
3206023 C 3 CP 1 20/02/2019 21/02/2019 01/01/1963 0 2
1 A16.5;E11.9 34.04 - - None None None None J-4-15-I None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 2960060 0 2 0 0 0 NANI 19055746 56
271796 1#0##0#0#0.0#2019-03-06 13:24:24#0#11:52:00#13:43:00#00:00:00
1 97b38309bdc7fdca7e9f6ba3006f7f6b 293000 1483750 100000
0 0 0 0 103875 0 0 140000 0 508794
310641 20000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 28/10/2017 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1541992 0 3 0 0 0 RISKA FITRI 19057610
5.3.6.201902021030 4 271799 1#0##0#0#0.0#2019-03-06
13:28:23#0#12:18:00#09:40:00#00:00:00 1 ec6992030c1075090391f97d20015e55
467500 0 100000 0 0 0 140000 70125 0 0
210000 0 249961 101606 30000 172800 0 0
3206023 C 3 CP 1 20/02/2019 21/02/2019 16/07/1950 0 2
1 I50.9;I46.9;A90 99.60 - - None None None None I-4-12-III
0 0 - 0 - 0 - 0 - 0 3582600 803761
0 2 0 0 0 SUHAMAH 18029150 68 25056 dr. H. Dani
Farid Abdullah Sp.PD 0122R0020219V004845 0000434421538 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271802
1#0##0#0#0.0#2019-03-06 13:30:42#0#09:21:00#06:34:00#00:00:00 1
3ac0aeaa541b0fa86f28ec4ff48ab2a9 332500 0 50000 0 0 0
0 103875 0 0 140000 0 85673 51713 40000 0 0
0
3206023 C 3 CP 1 19/02/2019 21/02/2019 25/03/1953 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3823743 0 3 0 0 0 OJA 19057249 65 24072 dr.
Teguh Budiman Sp.Ma. 0122R0020219V004627 0000436156299 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271805
1#0##0#0#0.0#2019-03-06 13:36:57#0#17:04:00#13:45:00#00:00:00 1
cadaf0bb2b2fd789a29213c46081ca03 274434 2125000 120000 0
0 0 0 0 0 0 210000 0 62316 1011993 20000
0 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 01/07/1946 0 2
6433000 0 0 - 0 - 0 - 0 - 0
6433000 4805574 0 4 0 0 0 ATIKAH, NY 16013103
5.3.6.201902021030 4 271806 1#0##0#0#0.0#2019-03-06
13:41:19#0#19:22:00#10:28:00#00:00:00 2 717880838ff1491e494e44f4f83ce296
544434 2125000 250000 0 0 0 0 184475 0
0 350000 0 200010 1131655 20000 0 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 03/03/1983 0 2
4 D38.5;E87.2;E88.0;E83.5;E87.1;N17.9 96.71 - - None None None
None J-1-20-III None None None None None None PROSEDUR SISTEM
PERNAFASAN NON-KOMPLEKS (BERAT) 18651400 0 0 - 0 - 0
- 0 - 0 18651400 15204307 0 4 0 0 0
SITI ATIKAH 19054911 35 13136 dr. Adya Arradikha, Sp. T.H.T.K.L
Septiani;3278085209910012 5.3.6.201902021030 4 271812
1#0##0#0#0.0#2019-03-06 13:49:00#0#12:15:00#17:28:00#00:00:00 2
441a43b745e144b8a5cd33903e46995e 5395000 0 1035000 0 15000
0 0 2372377 0 0 275000 410000 2905798
1536532 50000 1209600 0 0
3206023 C 3 CP 1 16/02/2019 21/02/2019 13/02/2018 0 2
1 J18.0;Q44.2 99.21 - - None None None None J-4-16-II None
None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH (SEDANG)
4683100 0 0 - 0 - 0 - 0 - 0
4683100 2526364 0 6 0 0 0 AQILA MISYA SYAFANA
19057357 1 368 DR. LIA RHODIA, SP. A. 0122R0020219V003850
5.3.6.201902021030 4 271814 1#0##0#0#0.0#2019-03-06
13:51:02#0#17:05:00#14:30:00#00:00:00 1 e08f3b5c108d08d0c234d3df01509c4b
677500 0 250000 0 0 0 140000 401125 0
0 420000 0 284294 215205 0 138240 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 01/07/1955 0 2
1 K35.2;K55.0;K66.0 47.09;54.59;54.4;86.22 - - None None None
None K-1-40-III None None None None None None PROSEDUR SISTEM
PENCERNAAN LAIN-LAIN (BERAT) 10811600 0 0 - 0 - 0 -
0 - 0 10811600 5858369 0 3 0 0 0 KIKI
5.3.6.201902021030 4 271819 1#0##0#0#0.0#2019-03-06
13:56:05#0#13:03:00#13:45:00#00:00:00 1 d420c5ae41ea8e51798f254ad659c045
792025 3036500 140000 0 0 0 0 0 0 0
210000 0 1202049 447795 30000 0 0 0
3206023 C 3 CP 1 15/02/2019 21/02/2019 13/07/2000 0 2
1 G93.4;R57.9;A90 - - - None None None None G-4-21-II
None None None None None None KOMA & STUPOR NON TRAUMA (SEDANG)
3383500 0 0 - 0 - 0 - 0 - 0
3383500 6523239 0 7 0 0 0 INDRA MAULANA
Septiani;3278085209910012 5.3.6.201902021030 4 271822
1#0##0#0#0.0#2019-03-06 13:59:23#0#08:40:00#13:34:00#00:00:00 1
129c47ea10e3d9b8a1a1e906f3957719 1869500 0 725000 0 40000
0 130000 1109725 0 0 485000 410000 1187706
298948 60000 207360 0 0
3206023 C 3 CP 1 15/02/2019 21/02/2019 24/05/2015 0 2
1 K56.6;E87.8;Q43.1 54.11;45.79;46.10;45.14 - - None None None
None K-1-20-II None None None None None None PROSEDUR INTESTINAL
KOMPLEKS (SEDANG) 12248900 0 0 - 0 - 0 - 0 -
0 12248900 10535051 0 7 0 0 0 PETI 19057286
5.3.6.201902021030 4 271839 1#0##0#0#0.0#2019-03-06
14:12:04#0#14:44:00#09:56:00#00:00:00 1 9dd6aafc12c9f6ce17686c8b40bfa60e
2826550 3087500 500000 0 15000 0 140000 559250
0 0 625000 0 1098351 1527000 70000 86400 0 0
3206023 C 3 CP 1 14/02/2019 21/02/2019 15/09/1955 0 2
1 I50.0;R73.9;N17.9;J18.9 - - - None None None None I-4-
12-III None None None None None None KEGAGALAN JANTUNG (BERAT)
3582600 0 0 - 0 - 0 - 0 - 0
3582600 3823748 0 8 0 0 0 ABDUL LATIF 18044996
5.3.6.201902021030 4 271847 1#0##0#0#0.0#2019-03-06
14:17:10#0#16:39:00#06:45:00#00:00:00 1 a0b0202a200ca56cee283e5be75e829e
1243500 0 300000 0 0 0 0 653075 0 0
560000 0 768609 228564 70000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 06/03/1989 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1318028 0 3 0 0 0 ASEP SAEPULOH
Septiani;3278085209910012 5.3.6.201902021030 4 271804
1#0##0#0#0.0#2019-03-08 10:42:03#0#13:54:00#10:32:00#00:00:00 2
4d4b80b25af6ecadbf9775f2e1b532a5 483500 0 100000 0 0
0 0 235375 0 0 210000 0 136565 122588
30000 0 0 0
3206023 C 3 CP 1 19/02/2019 21/02/2019 03/08/2000 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 9456668 0 3 0 0 0 ARNI ARNITASARI
5.3.6.201902021030 4 271803 1#0##0#0#0.0#2019-03-08
10:43:08#0#10:21:00#13:50:00#00:00:00 2 f0a01f068c4bdf456e058cc5860b77bf
1464500 2756250 420000 0 0 0 0 763125 0
0 210000 70000 2675689 884304 40000 172800 0 0
3206023 C 2 CP 1 20/02/2019 21/02/2019 05/08/1968 0 2
1 N93.8;N85.9 69.09 - - None None None None W-1-11-I None
(RINGAN) 1988600 0 0 - 0 - 0 - 0 - 0
1988600 3455579 0 2 0 0 0 KOKOM 19056955 50
1#0##0#0#0.0#2019-03-08 10:54:07#0#18:04:00#06:56:00#00:00:00 2
31af71383baec6531cb23b60e4f6745f 573000 1626250 70000 0 0
0 0 200000 0 0 375000 0 199794 381535
30000 0 0 0
3206023 C 1 CP 1 19/02/2019 21/02/2019 03/03/1970 0 2
- 0 7814200 7521872 0 3 0 0 0 ENGKAR
KARTINI 19054304 48 17885 DR. RIADHI YULIANTO SP.B.
Septiani;3278085209910012 5.3.6.201902021030 4 271656
1#0##0#0#0.0#2019-03-08 11:05:55#0#15:38:00#17:48:00#00:00:00 2
c25865c3ad7f422cc2634ccb4e8c8ebd 752025 3080000 120000 0
0 0 0 1457225 0 0 540000 0 602187 940435
30000 0 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 13/11/1995 0 2
0 - 0 - 0 - 0 - 0 4853300 4094616
0 4 0 0 0 RENO CANDRA 18042695 23 8498 dr. Nurul
Siti Mardiah, Sp.B 0122R0020219V004374 0002488457204 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272745
1#0##0#0#0.0#2019-03-12 09:04:44#0#20:20:00#10:06:00#00:00:00 1
e23b17e21fee6c83da41b084774c36a9 726525 1825000 170000 0
0 0 0 336100 0 0 280000 0 312715 414276
30000 0 0 0
3206023 C 3 CP 1 16/02/2019 21/02/2019 07/06/1990 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1348090 0 6 0 0 0 RUDI 19057352 28
5.3.6.201902021030 4 272777 1#0##0#0#0.0#2019-03-12
10:57:48#0#05:52:00#06:11:00#00:00:00 2 b1e803c6daf2dc0588aad41d62dee48f
447500 0 100000 0 0 0 0 70125 0 0 140000
0 284677 236668 0 69120 0 0
3206023 C 3 CP 1 18/02/2019 21/02/2019 16/11/1970 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 4326825 0 4 0 0 0 DADAH NURDANIAH,
NY 16006061 48 17626 dr. Riadhi Yulianto Sp.B. 0122R0020219V004365
5.3.6.201902021030 4 274069 1#0##0#0#0.0#2019-03-18
08:56:13#0#19:30:00#10:04:00#00:00:00 1 4abfe6f3817b513c4b723e5691f11b60
710025 1573750 170000 0 0 0 0 474200 0
0 280000 0 379927 708923 30000 0 0 0
3206023 C 3 CP 1 21/02/2019 22/02/2019 12/11/1951 0 2
(SEDANG) 4976900 0 0 - 0 - 0 - 0 - 0
4976900 1420778 0 2 0 0 0 HASAN BASRI 17006692
271767 1#0##0#0#0.0#2019-03-06 13:50:25#0#20:55:00#17:48:00#00:00:00
2 21765f129f8d2a3ff8b5510b12f4fd46 480000 0 50000 0 0
0 0 70125 0 0 140000 0 597966 82687 0 0
0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 01/03/2008 0 2
1 K35.2;A41.9 54.19;54.59;86.22;54.4 - - None None None None
LAIN-LAIN (BERAT) 10811600 0 0 - 0 - 0 - 0 -
0 10811600 6238540 0 5 0 0 0 RISMAWAN
5.3.6.201902021030 4 271755 1#0##0#0#0.0#2019-03-06
13:51:12#0#20:24:00#06:58:00#00:00:00 2 86651be249cad7290fef2200617acb90
906525 2137750 265000 0 15000 0 0 898600 0
0 350000 0 737195 878470 50000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 15/06/1974 0 2
- 0 5581600 4826644 0 3 0 0 0 AAS HERAWATI
5.3.6.201902021030 4 271753 1#0##0#0#0.0#2019-03-06
13:52:11#0#19:25:00#10:17:00#00:00:00 2 d36d5f6017af81ad268091fc2cea2953
727025 2592500 170000 0 0 0 0 838225 0
0 210000 0 114919 153975 20000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 07/03/1996 0 2
0 0 - 0 - 0 - 0 - 0 4853300
3795321 0 3 0 0 0 ANISA ROSMIATI 17022413 22
8385 DR. RIADHI YULIANTO SP.B. 0122R0020219V004915 0000433691436
271739 1#0##0#0#0.0#2019-03-06 13:53:16#0#11:45:00#10:25:00#00:00:00
2 65055d87eefddc03c7a2d9d25d405071 726525 1825000 170000
0 0 0 0 270000 0 0 210000 0 352772
211024 30000 0 0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 12/05/1975 0 2
2186200 0 0 - 0 - 0 - 0 - 0
2186200 7640263 0 5 0 0 0 ILA AMALIA, NY
5.3.6.201902021030 4 271729 1#0##0#0#0.0#2019-03-06
13:54:06#0#20:40:00#10:26:00#00:00:00 2 6050aca1e4cbbd634083dd3eb93dbe97
882025 2592500 270000 0 0 0 0 1991675 0
0 350000 0 779162 724901 50000 0 0 0
3206023 C 3 CP 1 21/02/2019 22/02/2019 10/10/1967 0 2
1 K92.2;K31.8;D64.9 99.04 - - None None None None K-4-18-II
(SEDANG) 1765800 0 0 - 0 - 0 - 0 - 0
1765800 1656209 0 2 0 0 0 IDOH 18040887 51
5.3.6.201902021030 4 271721 1#0##0#0#0.0#2019-03-06
13:54:51#0#14:34:00#06:49:00#00:00:00 2 e8be1a99833d1decd79cc71092770435
156000 0 50000 0 0 0 0 1211225 0 0 140000
0 47414 31570 20000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 16/04/2003 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3222447 0 3 0 0 0 SITI NURYANTI
5.3.6.201902021030 4 271681 1#0##0#0#0.0#2019-03-06
13:55:29#0#19:50:00#18:02:00#00:00:00 2 0e9276ecb88bd4fa36a5d180fe6ecdd2
543000 1626250 120000 0 0 0 0 264100 0
0 210000 0 167137 261960 30000 0 0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 01/09/2003 0 2
1 K35.2;A41.9;K66.0 54.19;54.59 - - None None None None K-1-
40-III None None None None None None PROSEDUR SISTEM PENCERNAAN LAIN-
LAIN (BERAT) 10811600 0 0 - 0 - 0 - 0 -
0 10811600 5010551 0 5 0 0 0 ILHAM 19057557
5.3.6.201902021030 4 271678 1#0##0#0#0.0#2019-03-06
13:56:10#0#06:58:00#08:31:00#00:00:00 2 dd07017b30df70084eee3015e1c2ca9f
799025 2137750 265000 0 15000 0 0 191875 0
0 280000 0 745305 536596 40000 0 0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 21/04/1992 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1686328 0 5 0 0 0 ABDUL HOLIK 19057526
5.3.6.201902021030 4 271667 1#0##0#0#0.0#2019-03-06
13:57:34#0#12:45:00#06:57:00#00:00:00 2 3f5fc376dbcf692c4250032eb260f78a
346000 0 200000 0 0 0 0 280250 0 0
350000 0 311967 158111 40000 0 0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 10/11/1955 0 2
None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (RINGAN) 2739200
0 0 - 0 - 0 - 0 - 0 2739200
2044599 0 5 0 0 0 HUSEN, TN 15009142 63 23111
DR. RINI WIDIASTUTI, SP. PD 0122R0020219V004388 0000433844166 3;JKN
1#0##0#0#0.0#2019-03-06 13:59:18#0#06:42:00#08:22:00#00:00:00 2
b9183a2b4a054e607733fa3e28882b8c 573500 0 150000 0 0
0 140000 178375 0 0 280000 0 624420 48304
50000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 05/10/1967 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3526924 0 3 0 0 0 AMAH ROHMAH 18050959 51 18766
DR. TEGUH BUDIMAN SP.MA. 0122R0020219V005568 0002451609832 3;JKN
1#0##0#0#0.0#2019-03-06 14:00:40#0#17:34:00#10:10:00#00:00:00 2
949090bb1576b6a7b2759bc634e990ce 314434 2125000 100000 0
0 0 0 0 0 0 210000 0 90852 666638 20000
0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 02/10/1998 0 2
LAIN (RINGAN) 3834800 0 0 - 0 - 0 - 0 -
0 3834800 3609518 0 3 0 0 0 YANTI LESTARI
5.3.6.201902021030 4 271637 1#0##0#0#0.0#2019-03-06
14:01:52#0#20:08:00#10:11:00#00:00:00 2 03b281c88d9ead91cf126f677478d35b
710025 1573750 120000 0 0 0 0 200000 0
0 210000 0 362115 403628 30000 0 0 0
3206023 C 3 CP 1 17/02/2019 22/02/2019 24/12/1968 0 2
1 A91;R51;A09.9 - - - None None None None A-4-13-I
(RINGAN) 1509200 0 0 - 0 - 0 - 0 - 0
1509200 3097083 0 6 0 0 0 SARKIAH 16020573
5.3.6.201902021030 4 271630 1#0##0#0#0.0#2019-03-06
14:03:00#0#20:39:00#06:49:00#00:00:00 2 3f6b68035c8dd4270448ea327d93e6db
718500 0 200000 0 0 0 0 574625 0 0
420000 0 891212 222746 70000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 08/10/1965 0 2
1 D25.9;N93.8 69.09 - - None None None None W-1-11-I None
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3592539 0 3 0 0 0 UKA 19057454 53
1#0##0#0#0.0#2019-03-06 14:04:18#0#17:54:00#06:50:00#00:00:00 2
b59bfd47b9ffbd77812d76219f957f59 531525 1626250 120000 0
0 0 0 674600 0 0 210000 0 139385 260779
30000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 29/09/1996 0 2
1 Q18.1 18.39 - - None None None None U-1-20-I None None
None None None None PROSEDUR TENGGOROKAN, MULUT, HIDUNG DAN TELINGA LAIN-
LAIN (RINGAN) 4458500 0 0 - 0 - 0 - 0 -
0 4458500 4789337 0 3 0 0 0 LATIFAH HANUM
NASUTION 17021566 22 8179 DR. M SIDIK HASANUDIN SP.THT-KL
Aeni;3206276601940002 5.3.6.201902021030 4 271611 1#0##0#0#0.0#2019-
03-06 14:05:14#0#16:20:00#07:29:00#00:00:00 2
c7dd6a0a38e9da174d60e2d0865a5f5e 1089550 1825000 120000 0
0 0 0 385125 0 0 210000 0 640601 489061
30000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 09/11/1988 0 2
None None None None TUMOR MUSKULOSKLETAL,JARINGAN KONEKTIF DAN FRAKTUR
PATOLOGIS (RINGAN) 3644300 0 0 - 0 - 0 - 0
- 0 3644300 2066618 0 3 0 0 0 ERLIN
HERLINA 18047642 30 11060 DR. RIADHI YULIANTO SP.B.
Aeni;3206276601940002 5.3.6.201902021030 4 271606 1#0##0#0#0.0#2019-
03-06 14:05:58#0#08:41:00#09:08:00#00:00:00 2
fddde15945b36dcd3c40f217098d9d10 1400000 0 150000 0 0
0 0 0 0 0 210000 0 169734 116884 20000
0 0 0
3206023 C 3 CP 1 19/02/2019 22/02/2019 10/10/1954 0 2
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 4358243 0 4 0 0 0 E SURYATI
Aeni;3206276601940002 5.3.6.201902021030 4 271584 1#0##0#0#0.0#2019-
03-06 14:06:46#0#13:58:00#08:23:00#00:00:00 2
20c0aa4e8b75f79bed5b8c140c80bd1f 970980 0 150000 0 630710
0 0 1926150 0 0 280000 0 293214 107189
0 0 0 0
3206023 C 3 CP 1 21/02/2019 22/02/2019 06/04/1980 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1417760 0 2 0 0 0 RANI 19057849 38 14200 DR.
1#0##0#0#0.0#2019-03-06 14:07:44#0#21:14:00#06:47:00#00:00:00 2
6fa1649347ed2a3afcc16c97461d1175 607500 0 120000 0 0
0 0 276375 0 0 140000 0 93642 160243 20000
0 0 0
3206023 C 3 CP 1 15/02/2019 22/02/2019 01/01/1957 0 2
None None None None PENYAKIT PARU OBSTRUKTIF KRONIS (RINGAN) 2739200
0 0 - 0 - 0 - 0 - 0 2739200
4203669 0 8 0 0 0 TARYA 19057296 62 22690 DR. H.
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271576
1#0##0#0#0.0#2019-03-06 14:08:46#0#17:17:00#08:21:00#00:00:00 2
72bed60271d479c8b54df892c95bc928 1245500 0 370000 0 0
0 140000 295500 0 0 560000 0 964456 360853
60000 207360 0 0
3206023 C 3 CP 1 19/02/2019 22/02/2019 01/11/1960 0 1
1 N43.3 63.1 - - None None None None V-1-12-I None None
None None None None PROSEDUR PADA SKROTUM DAN PROSTAT KOMPLEK-MODERAT
(RINGAN) 6416100 0 0 - 0 - 0 - 0 - 0
6416100 3544053 0 4 0 0 0 SODIKIN 19053268
5.3.6.201902021030 4 271562 1#0##0#0#0.0#2019-03-06
14:10:32#0#19:19:00#10:06:00#00:00:00 2 829c921c15a132ebd53cce6bdf419870
518000 1573750 190000 0 0 0 0 103875 0
0 280000 0 351549 496879 30000 0 0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 15/03/1945 0 2
1 A09.9;N17.9;K30 - - - None None None None K-4-17-III
None None None None None None NYERI ABDOMEN & GASTROENTERITIS LAIN-LAIN
(BERAT) 2308000 0 0 - 0 - 0 - 0 - 0
2308000 2633540 0 5 0 0 0 IMAS 19057553 73
27003 DR. RINI WIDIASTUTI, SP. PD 0122R0020219V004372 0000434088178
271555 1#0##0#0#0.0#2019-03-06 14:11:42#0#00:03:00#08:22:00#00:00:00
2 1f176369765d6da327d81040ffd5dec3 493500 0 150000 0
0 0 0 440625 0 0 560000 0 770154 119261
100000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 12/06/1999 0 2
1828500 0 0 - 0 - 0 - 0 - 0
1828500 1106324 0 3 0 0 0 NENG YANTI 19056308
5.3.6.201902021030 4 271546 1#0##0#0#0.0#2019-03-06
14:13:05#0#14:38:00#06:48:00#00:00:00 2 cbbb01081e182eef63188e3a7b7a0a8b
442500 0 170000 0 0 0 0 0 0 0 210000
0 98286 165538 20000 0 0 0
3206023 C 3 CP 1 22/02/2019 22/02/2019 20/07/1984 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3157342 0 1 0 0 0 AAS AISYAH 18044900
5.3.6.201902021030 4 271544 1#0##0#0#0.0#2019-03-06
14:15:30#0#12:12:00#17:55:00#00:00:00 2 6c1130b58dd42bb72e3fec4d5f2d4d24
393000 2032812 70000 0 0 0 0 276375 0 0
70000 0 166901 138254 10000 0 0 0
3206023 C 2 CP 1 17/02/2019 22/02/2019 18/12/1998 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 4177395 0 6 0 0 0 RIDWAN 19057387
5.3.6.201902021030 4 271538 1#0##0#0#0.0#2019-03-06
14:17:58#0#09:14:00#17:49:00#00:00:00 2 bdba5b63764140bf02d527ff1c407925
925000 0 500000 0 0 0 0 541725 0 0
1440000 0 670818 49852 50000 0 0 0
3206023 C 1 CP 1 17/02/2019 22/02/2019 11/09/1954 0 2
1 I11.0;E11.9;N18.9 - - - None None None None I-4-12-II
None None None None None None KEGAGALAN JANTUNG (SEDANG) 4179700
0 0 - 0 - 0 - 0 - 0 4179700
3865730 0 6 0 0 0 ROSID 11000541 64 23535 DR. H.
DANI FARID ABDULLAH SP.PD 0122R0020219V003982 0000070157979 3;JKN Santi
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 271852
1#0##0#0#0.0#2019-03-06 14:19:38#0#23:30:00#06:54:00#00:00:00 1
2ea2661e93c0b1bc8e9babc1e8483f86 775000 0 400000 0 0
0 140000 468675 0 0 970000 0 766866 87829
50000 207360 0 0
3206023 C 2 CP 1 20/02/2019 22/02/2019 21/06/1986 0 2
6122400 0 0 - 0 - 0 - 0 - 0
6122400 5028355 0 3 0 0 0 KARNIAWATI 19056898
5.3.6.201902021030 4 271527 1#0##0#0#0.0#2019-03-06
14:19:55#0#14:28:00#18:07:00#00:00:00 2 6199a5404d947491309b46bd36c1ff63
697000 2137750 230000 0 0 0 0 500725 0
0 320000 0 446683 666197 30000 0 0 0
3206023 C 2 CP 1 21/02/2019 22/02/2019 10/04/1977 0 2
1811000 0 0 - 0 - 0 - 0 - 0
1811000 707907 0 2 0 0 0 RENI PATMAWATI
17018008 41 15292 DR. RINI WIDIASTUTI, SP. PD 0122R0020219V005550
5.3.6.201902021030 4 271523 1#0##0#0#0.0#2019-03-06
14:20:29#0#00:26:00#13:55:00#00:00:00 2 e3e5c0ecb9ee7df104862c1f5f309b3e
356000 0 70000 0 0 0 0 140250 0 0 70000
0 42820 28837 0 0 0 0
3206023 C 2 CP 1 18/02/2019 22/02/2019 28/05/2000 0 2
1 K35.2;E87.8;A41.9 54.19;86.22;54.59 - - None None None None
LAIN-LAIN (BERAT) 12973900 0 0 - 0 - 0 - 0 -
0 12973900 7279517 0 5 0 0 0 RIFKI PRATAMA
5.3.6.201902021030 4 271520 1#0##0#0#0.0#2019-03-06
14:21:30#0#23:52:00#17:42:00#00:00:00 2 02c662e7e6da96cdab3fca4ea8034cde
1186525 2105000 300000 0 0 0 200000 561600
0 0 625000 0 1080416 1130976 90000 0 0 0
3206023 C 1 CP 1 20/02/2019 22/02/2019 17/08/1953 0 2
1 K40.9;D64.9 53.00;99.04 - - None None None None K-1-14-II
None None None None None None PROSEDUR HERNIA INGUINAL DAN FEMORAL
(SEDANG) 7430900 0 0 - 0 - 0 - 0 - 0
7430900 5622712 0 3 0 0 0 ENTUS RUSTANDI
5.3.6.201902021030 4 271857 1#0##0#0#0.0#2019-03-06
14:22:36#0#17:40:00#06:52:00#00:00:00 2 3feaf096b93e48a30d0717d515d12e37
844000 1846000 220000 0 0 0 0 1388750 0
0 210000 0 403193 680769 30000 0 0 0
3206023 C 1 CP 1 19/02/2019 22/02/2019 23/10/1963 0 2
1 L53.9;L10.9 86.11 - - None None None None L-4-14-II None
None None None None None GANGGUAN PADA KULIT & PAYUDARA LAIN-LAIN
(SEDANG) 4597200 0 0 - 0 - 0 - 0 - 0
4597200 4159917 0 4 0 0 0 IDA NINGSIH 19057622
55 20208 DR. EMAN ARIF RAHMAN, SP.KK 0122R0020219V004604
5.3.6.201902021030 4 271866 1#0##0#0#0.0#2019-03-06
14:27:02#0#12:19:00#17:48:00#00:00:00 1 792993602b71243a04494cab810c4a53
615500 1570000 300000 0 0 0 0 402000 0
0 720000 0 194048 328369 30000 0 0 0
3206023 C 1 CP 1 20/02/2019 22/02/2019 25/10/1964 0 2
1 L84 86.3 - - None None None None L-1-40-I None None
PAYUDARA (RINGAN) 5175700 0 0 - 0 - 0 - 0 -
0 5175700 3772482 0 3 0 0 0 H AEP SAEPUDIN
5.3.6.201902021030 4 271869 1#0##0#0#0.0#2019-03-06
14:30:40#0#20:33:00#06:53:00#00:00:00 2 05300a3e184c9cd742f5e30999871a72
388000 1913750 120000 0 0 0 0 0 0 0
540000 0 393733 386999 30000 0 0 0
3206023 C 3 CP 1 19/02/2019 22/02/2019 03/12/1960 0 2
SICKLE (RINGAN) 2218100 0 0 - 0 - 0 - 0 -
0 2218100 2846995 0 4 0 0 0 NANDANG
Septiani;3278085209910012 5.3.6.201902021030 4 271919
1#0##0#0#0.0#2019-03-08 10:04:04#0#18:06:00#06:47:00#00:00:00 1
838460400e30cc0790405513371afcae 353500 0 100000 0 0
0 475000 1270600 0 0 280000 0 201196 136699
30000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 01/01/1970 0 2
1 N18.9;I11.0;E88.0 - - - None None None None N-4-10-III
GINJAL (BERAT) 4377800 0 0 - 0 - 0 - 0 -
0 4377800 1522311 0 3 0 0 0 DEDE HENI
Septiani;3278085209910012 5.3.6.201902021030 4 271926
1#0##0#0#0.0#2019-03-08 10:14:42#0#17:27:00#08:23:00#00:00:00 2
585969d6f16da7d57ccf329cd318921e 363500 0 100000 0 0
0 140000 396375 0 0 210000 0 180393 102043
30000 0 0 0
3206023 C 3 CP 1 18/02/2019 22/02/2019 06/10/1958 0 2
1 I50.0;K30;K76.1 - - - None None None None I-4-12-II
None None None None None None KEGAGALAN JANTUNG (SEDANG) 2985500
0 0 - 0 - 0 - 0 - 0 2985500
2173982 0 5 0 0 0 HAJAR 18052550 60 22050 DR. H.
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 271933
1#0##0#0#0.0#2019-03-08 10:19:50#0#01:24:00#08:22:00#00:00:00 2
867cf1d74289d94807ddcaa6d552c273 513500 0 200000 0 0
0 130000 178375 0 0 350000 0 440662 311445
50000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 10/12/1978 0 2
1 D48.7;A09.9;K30;D64.9 99.04 - - None None None None C-4-
14-II None None None None None None TUMOR MYELOPROLIFERATIF LAIN-LAIN
(SEDANG) 3836200 0 0 - 0 - 0 - 0 - 0
3836200 1551265 0 3 0 0 0 ACENG RAHMAT
Septiani;3278085209910012 5.3.6.201902021030 4 271923
1#0##0#0#0.0#2019-03-08 10:34:10#0#13:32:00#08:23:00#00:00:00 2
19c7eef01eb2b00f7a72cb9a16cd005d 126000 0 50000 0 0 0
0 991600 0 0 210000 0 92643 61022 20000 0 0
0
3206023 C 1 CP 1 18/02/2019 22/02/2019 18/05/1956 0 2
1 J44.1;I10;D64.9;B90.9;J18.9 99.04 - - None None None None
J-4-17-III None None None None None None PENYAKIT PARU OBSTRUKTIF
KRONIS (BERAT) 6026700 0 0 - 0 - 0 - 0 -
0 6026700 4983004 0 5 0 0 0 BARNAS
Septiani;3278085209910012 5.3.6.201902021030 4 271873
1#0##0#0#0.0#2019-03-15 09:59:07#0#00:00:00#00:00:00#00:00:00 3
5d02c76e45fea5f2a4c5bf6e1adaf190 1455000 0 500000 0 0
0 150000 718600 0 0 900000 0 1024710 81014
50000 103680 0 0
3206023 C 2 CP 1 20/02/2019 22/02/2019 18/08/1974 0 2
0 - 0 2631000 4262219 0 3 0 0 0 NATA
5.3.6.201902021030 4 271531 1#0##0#0#0.0#2019-03-15
10:01:24#0#21:13:00#17:47:00#00:00:00 3 7f5e229f32fb765738052847289ea677
755025 1913750 220000 0 0 0 0 0 0 0
900000 0 205581 247863 20000 0 0 0
3206023 C 3 CP 1 20/02/2019 22/02/2019 01/07/1956 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3556941 0 3 0 0 0 ENTIN 18050991 62 22879 DR.
TEGUH BUDIMAN SP.MA. 0122R0020219V004957 0000435608403 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271542
1#0##0#0#0.0#2019-03-15 10:04:20#0#18:09:00#10:21:00#00:00:00 3
3bb9bd74956b42d961f0bf2ce635d6c4 344434 2125000 100000 0
0 0 0 0 0 0 210000 0 96046 671461 10000
0 0 0
3206023 C 3 CP 1 21/02/2019 22/02/2019 28/12/1981 0 2
0 0 - 0 - 0 - 0 - 0 1544900 938596
0 2 0 0 0 MARYANI 18042172 37 13569 DR.
1#0##0#0#0.0#2019-03-15 10:08:18#0#12:09:00#06:55:00#00:00:00 3
43cee91c593e8d5633def8fe06c75bc5 415000 0 120000 0 0
0 0 0 0 0 140000 0 78195 165401 20000 0
0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 04/12/1994 0 2
1 O48;Z37.0;O80.9;O28.3;O41.0 73.59 - - None None None None
1828500 0 0 - 0 - 0 - 0 - 0
1828500 2250192 0 3 0 0 0 DESI RIZKY RAHAYU
5.3.6.201902021030 4 271677 1#0##0#0#0.0#2019-03-06
10:45:06#0#12:02:00#09:50:00#00:00:00 1 093183f898533efcc995e761e496d2cf
1300000 0 100000 0 0 0 0 305800 0 0
210000 0 117840 186552 30000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 19/07/1993 0 2
1 O14.1;O62.2;Z37.0;O80.9;O71.3;O72.1 73.59 - - None None None
None O-6-13-II None None None None None None PERSALINAN VAGINAL
(SEDANG) 1828500 0 0 - 0 - 0 - 0 - 0
1828500 1904479 0 3 0 0 0 MILLAWATI 19057814
271826 1#0##0#0#0.0#2019-03-06 14:01:57#0#11:57:00#10:25:00#00:00:00
1 95a49ac59e8c14a4eef0fc9c86224e55 682500 0 170000 0
0 0 0 284425 0 0 210000 0 214732 312822
30000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 06/07/1976 0 2
1 M67.4 82.21 - - None None None None M-1-80-I None None
None None None None PROSEDUR ANGGOTA TUBUH ATAS (RINGAN) 6246500
0 0 - 0 - 0 - 0 - 0 6246500
3226761 0 3 0 0 0 ILYAS 19055674 42 15570 DR.
NURUL SITI MARDIAH, SP.B 0122R0020219V005339 0000430946482 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271569
1#0##0#0#0.0#2019-03-06 14:09:37#0#18:14:00#06:30:00#00:00:00 2
95163c2c63757af2bd68b3810fb42c2a 680025 1573750 70000 0 0
0 0 0 0 0 210000 0 376310 286676 30000
0 0 0
3206023 C 3 CP 1 22/02/2019 23/02/2019 16/08/1936 0 2
1 R33 57.94 - - None None None None N-4-15-I None None
(RINGAN) 2241300 0 0 - 0 - 0 - 0 - 0
2241300 1048462 0 2 0 0 0 SOBIRIN 19057933
5.3.6.201902021030 4 273005 1#0##0#0#0.0#2019-03-12
11:15:15#0#22:38:00#19:53:00#00:00:00 1 ba981366c1c624d11f1a7124a1c025c1
423500 0 70000 0 0 0 0 103875 0 0 140000
0 119682 161405 30000 0 0 0
3206023 C 2 CP 1 20/02/2019 23/02/2019 05/09/1998 0 2
(RINGAN) 5796300 0 0 - 0 - 0 - 0 - 0
5796300 4768306 0 4 0 0 0 ENDAH KURNIASARI
Septiani;3278085209910012 5.3.6.201902021030 4 271653
1#0##0#0#0.0#2019-03-15 10:21:42#0#23:26:00#11:10:00#00:00:00 2
37a642852466e0505c3e8070df0ae87d 839500 2137750 170000 0
0 0 0 303725 0 0 280000 0 412177 585154
40000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 15/04/1975 0 2
- 0 - 0 - 0 - 0 1645900 1972788 0
3 0 0 0 AAY 18026217 43 16018 DR. RIADHI YULIANTO
SP.B. 0122R0020219V005231 0002426178328 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271842
1#0##0#0#0.0#2019-03-15 10:26:16#0#09:30:00#10:14:00#00:00:00 2
5fbdf2f7e55d5bbe83f4683efbd40705 1415000 0 100000 0 0
0 0 0 0 0 210000 0 144465 93323 10000 0
0 0
3206023 C 1 CP 1 20/02/2019 23/02/2019 19/08/1933 0 2
3072300 0 0 - 0 - 0 - 0 - 0
3072300 5306239 0 4 0 0 0 NY HJ NONOH 19057758
271633 1#0##0#0#0.0#2019-03-15 10:27:23#0#22:04:00#18:04:00#00:00:00
2 b0a524f2da919079a62eda3018bd7b21 1157500 0 495000 0
0 0 1350000 103875 0 0 1500000 0 613379
46485 40000 0 0 0
3206023 C 2 CP 1 20/02/2019 23/02/2019 13/07/1988 0 2
1 C02.9;D63.0 99.04 - - None None None None U-4-10-II None
None None None None None NEOPLASMA TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN (SEDANG) 7559200 0 0 - 0 - 0 - 0
- 0 7559200 2251148 0 4 0 0 0 ABDUL KUDUS
N 19057759 30 11179 DR. RIADHI YULIANTO SP.B. 0122R0020219V005629
5.3.6.201902021030 4 271639 1#0##0#0#0.0#2019-03-15
10:28:52#0#10:24:00#06:43:00#00:00:00 2 b28c4477f01d455db501952eedb703f5
437500 0 50000 0 0 0 0 1126700 0 0 375000
0 203238 28710 30000 0 0 0
3206023 C 2 CP 1 20/02/2019 23/02/2019 13/03/1957 0 2
1 N39.0 - - - None None None None N-4-12-I None None
None None None None INFEKSI GINJAL DAN SALURAN URIN (RINGAN) 2586500
0 0 - 0 - 0 - 0 - 0 2586500
1894110 0 4 0 0 0 UJU JUANDA 11002939 61 22624
271636 1#0##0#0#0.0#2019-03-15 10:29:54#0#11:32:00#06:31:00#00:00:00
2 f0c2033aa3248c976b8a22faaa767f0e 497500 0 210000 0
0 0 0 208750 0 0 555000 0 309070 73790
40000 0 0 0
3206023 C 3 CP 1 22/02/2019 23/02/2019 02/09/1999 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2254428 0 2 0 0 0 AINUN 18039130 19 7113 DR.
ASEP TASLIM SP.OG 0122R0020219V005601 0000431816038 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271832
1#0##0#0#0.0#2019-03-15 10:32:49#0#03:31:00#09:51:00#00:00:00 2
9521d28776e1368094aa16813ea8b91f 1600000 0 50000 0 0 0
0 281500 0 0 70000 0 64102 168826 20000 0 0
0
3206023 C 3 CP 1 22/02/2019 23/02/2019 01/06/1991 0 2
(RINGAN) 1657100 0 0 - 0 - 0 - 0 - 0
1657100 3657735 0 2 0 0 0 AIDAH 19057937 27
1#0##0#0#0.0#2019-03-15 10:39:01#0#00:56:00#17:53:00#00:00:00 2
de7306aaadd14ac247619c593e6a17b2 398000 2343750 90000 0 0
0 0 306750 0 0 195000 0 110225 184010
30000 0 0 0
3206023 C 3 CP 1 22/02/2019 23/02/2019 03/08/1987 0 2
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 2164626 0 2 0 0 0 RIZAL MUZAKI
Septiani;3278085209910012 5.3.6.201902021030 4 271856
1#0##0#0#0.0#2019-03-15 10:42:05#0#13:04:00#17:45:00#00:00:00 2
1a118f498fe41c31bdbd0f172be57e05 665710 0 100000 0 0
0 0 887725 0 0 210000 0 133585 147606
20000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 21/02/1972 0 2
1 S09.9;T07 - - - None None None None G-4-24-I None
None None None None None TRAUMA KEPALA (RINGAN) 2192000 0 0
- 0 - 0 - 0 - 0 2192000 2451246 0
3 0 0 0 SUJONO 19057803 47 17167 DR. NURUL SITI
MARDIAH, SP.B 0122R0020219V005297 0000435912017 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271704
1#0##0#0#0.0#2019-03-15 10:43:22#0#11:19:00#06:34:00#00:00:00 2
f3c148c433cc6fc5e220ca21936188b9 472500 0 50000 0 0 0
540000 178375 0 0 210000 0 458599 511772
30000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 05/11/1997 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 3341114 0 3 0 0 0 EUIS TRI UTAMI
5.3.6.201902021030 4 271697 1#0##0#0#0.0#2019-03-15
10:46:03#0#19:45:00#06:34:00#00:00:00 2 f965772cd029f58127aa6fb1aa88d73f
650025 1573750 70000 0 0 0 0 0 0 0 280000
0 331647 405692 30000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 20/11/1959 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 3267217 0 3 0 0 0 AAN SOLEHUDIN
5.3.6.201902021030 4 271694 1#0##0#0#0.0#2019-03-15
10:46:47#0#19:43:00#06:36:00#00:00:00 2 d131dca7217a88ef31f5be6c91f53200
383000 1573750 70000 0 0 0 0 0 0 0 280000
0 286173 644294 30000 0 0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 17/02/1974 0 2
1 K80.1 51.22 - - None None None None B-1-12-I None None
None None None None CHOLESISTEKTOMI TANPA LAPAROSKOPIK (RINGAN)
5070500 0 0 - 0 - 0 - 0 - 0
5070500 5269902 0 4 0 0 0 ENDANG BUDININGSIH
5.3.6.201902021030 4 271693 1#0##0#0#0.0#2019-03-15
10:47:55#0#19:18:00#06:32:00#00:00:00 2 5548fbae38ad491a9548ce49b7b8b39d
591000 2592500 170000 0 0 0 0 433100 0
0 280000 0 600758 562544 40000 0 0 0
3206023 C 3 CP 1 22/02/2019 23/02/2019 07/05/1952 0 2
1 J18.9;R54;J44.9 - - - None None None None J-4-16-II
(SEDANG) 4683100 0 0 - 0 - 0 - 0 - 0
4683100 1449267 0 2 0 0 0 WOWO 19057928 66
5.3.6.201902021030 4 271679 1#0##0#0#0.0#2019-03-15
10:48:56#0#23:45:00#06:34:00#00:00:00 2 9a9b7d6dd802a5c30743dc092a50315c
127500 0 50000 0 0 0 140000 183500 0 0
140000 0 600472 207795 0 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 01/03/1967 0 2
1 D27;D63.0 99.04 - - None None None None W-4-12-II None
LAIN-LAIN (SEDANG) 3667500 0 0 - 0 - 0 - 0
- 0 3667500 1515695 0 3 0 0 0 HABIBAH
Septiani;3278085209910012 5.3.6.201902021030 4 271674
1#0##0#0#0.0#2019-03-15 10:49:55#0#12:53:00#06:43:00#00:00:00 2
852198bbfbaa88d60fbff0ad42a1a887 150000 0 100000 0 0
0 0 884725 0 0 280000 0 37211 33759 30000 0
0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 03/07/1991 0 2
1 C50.9 85.45 - - None None None None L-1-50-I None None
0 - 0 - 0 - 0 - 0 4853300 6850788
0 4 0 0 0 RISKA YULIANSIH 18043533 27 10094 DR.
RIADHI YULIANTO SP.B. 0122R0020219V004955 0002485600751 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271865
1#0##0#0#0.0#2019-03-15 10:50:56#0#17:59:00#10:24:00#00:00:00 2
5ccb1aecff2516d10df8af1fd5915e80 1149050 1825000 220000 0
0 0 0 768100 0 0 420000 0 795779
1642859 30000 0 0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 01/07/1935 0 2
1 A16.2;I10;J44.1 - - - None None None None J-4-15-II
None None None None None None PERADANGAN DAN INFEKSI PERNAFASAN
(SEDANG) 4778500 0 0 - 0 - 0 - 0 - 0
4778500 2206952 0 4 0 0 0 UWAT 19057736 83
30550 DR. R. ABYAKSA 0122R0020219V004958 0001005493882 3;JKN Santi
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 271863
1#0##0#0#0.0#2019-03-15 10:51:36#0#18:12:00#06:28:00#00:00:00 2
5152e778c697a242cd3bb8d7df4d7bce 585500 0 150000 0 0
0 140000 203375 0 0 280000 0 761819 46258
40000 0 0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 01/07/1995 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1519305 0 4 0 0 0 ALIMIN 19057735
5.3.6.201902021030 4 271860 1#0##0#0#0.0#2019-03-15
10:52:16#0#12:33:00#06:29:00#00:00:00 2 7bc19b660d5567b684a911b9ec3c0d06
373500 0 150000 0 0 0 0 318000 0 0
280000 0 320034 37771 40000 0 0 0
3206023 C 3 CP 1 19/02/2019 23/02/2019 01/05/1996 0 2
1 A91;K92.2;K92.1 - - - None None None None A-4-13-II
(SEDANG) 2273500 0 0 - 0 - 0 - 0 - 0
2273500 2075071 0 5 0 0 0 YOGA ISKANDAR
5.3.6.201902021030 4 271816 1#0##0#0#0.0#2019-03-15
10:53:08#0#17:52:00#06:41:00#00:00:00 2 67a1b82053a260d0a6c349d9bbfe3cc4
543500 0 200000 0 0 0 0 400625 0 0
350000 0 408811 92135 80000 0 0 0
3206023 C 3 CP 1 19/02/2019 23/02/2019 15/03/1971 0 2
1 N20.0 - - - None None None None N-4-13-I None None
None None None None BATU URIN (RINGAN) 3249600 0 0 -
0 - 0 - 0 - 0 3249600 2450147 0 5
0 0 0 DIDIN KOMARUDIN 19057616 47 17508 DR. H. DANI FARID
ABDULLAH SP.PD 0122R0020219V004599 0000432682569 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 271815
1#0##0#0#0.0#2019-03-15 10:54:03#0#11:32:00#08:24:00#00:00:00 2
647f374948a307d5047e66305a8be59e 553500 0 200000 0 0
0 465000 178375 0 0 350000 0 495676 88476
50000 69120 0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 14/01/1965 0 2
1 T09.3;D64.9;S32.0 99.04 - - None None None None G-4-10-II
None None None None None None KECEDERAAN & GANGGUAN TULANG BELAKANG
(SEDANG) 3844900 0 0 - 0 - 0 - 0 - 0
3844900 4741685 0 4 0 0 0 TATANG 19057732
271813 1#0##0#0#0.0#2019-03-15 10:54:48#0#14:32:00#17:47:00#00:00:00
2 de160fb91955b34d8d5a0be3862fa55d 462500 0 200000 0
0 0 200000 1275100 0 0 350000 0 2134054
80031 40000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 17/04/1983 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 5058028 0 3 0 0 0 IMAS PERWATI
Septiani;3278085209910012 5.3.6.201902021030 4 271801
1#0##0#0#0.0#2019-03-15 10:57:13#0#20:40:00#06:36:00#00:00:00 2
a5a7e920c9d92d4c6746991d0540e0b8 697000 2137750 240000 0
0 0 0 389125 0 0 210000 0 686338 667815
30000 0 0 0
3206023 C 3 CP 1 17/02/2019 23/02/2019 08/01/1997 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 6614882 0 7 0 0 0 TUTI SURYANI
Septiani;3278085209910012 5.3.6.201902021030 4 271798
1#0##0#0#0.0#2019-03-15 10:58:15#0#19:14:00#11:08:00#00:00:00 2
b3d4f75a389c11640f18d744657c82c5 1487500 2137750 340000 0
0 0 0 926850 0 0 490000 0 434598 728184
70000 0 0 0
3206023 C 3 CP 1 16/02/2019 23/02/2019 18/01/1990 0 2
1 K80.2;K75.9 - - - None None None None B-4-14-II None
None None None None None GANGGUAN SALURAN EMPEDU LAIN-LAIN (SEDANG)
3638400 0 0 - 0 - 0 - 0 - 0
3638400 4086697 0 8 0 0 0 AI RIDATI ZULKARNAEN
Septiani;3278085209910012 5.3.6.201902021030 4 271764
1#0##0#0#0.0#2019-03-15 10:59:30#0#09:48:00#06:28:00#00:00:00 2
964cfe5d9f361120f35b3300948997c7 743500 0 370000 0 0
0 300000 257950 0 0 560000 0 1516408 248839
90000 0 0 0
3206023 C 3 CP 1 21/02/2019 23/02/2019 01/01/1968 0 2
- 0 - 0 - 0 - 0 2575600 1169535 0
3 0 0 0 TN CUCUN 18042725 51 18679 DR. H. DANI FARID
Septiani;3278085209910012 5.3.6.201902021030 4 271711
1#0##0#0#0.0#2019-03-15 11:00:19#0#11:42:00#14:03:00#00:00:00 2
e492762732c61dca95f181f0cd2acc24 345500 0 100000 0 0
0 140000 178375 0 0 210000 0 62960 92700 40000
0 0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 01/07/1950 0 2
1 N83.2;N73.6 68.49;65.61 - - None None None None W-1-20-I
None None None None None None PROSEDUR PADA RAHIM & ADNEKSA (RINGAN)
6136900 0 0 - 0 - 0 - 0 - 0
6136900 6466099 0 4 0 0 0 IYAH 19053571 68
1#0##0#0#0.0#2019-03-15 11:01:03#0#17:18:00#06:26:00#00:00:00 2
eb35597f7e28af26404c8f65a6ec05f2 455000 2592500 120000 0
0 0 0 1238100 0 0 350000 0 1082485 588014
40000 0 0 0
3206023 C 3 CP 1 20/02/2019 23/02/2019 01/01/1976 0 2
1 K92.1;K21.9;L40.9 - - - None None None None K-4-18-I
(RINGAN) 1242600 0 0 - 0 - 0 - 0 - 0
1242600 1300042 0 4 0 0 0 HERAWATI 19057756
5.3.6.201902021030 4 271835 1#0##0#0#0.0#2019-03-15
11:16:46#0#22:38:00#17:04:00#00:00:00 2 2d6017163cdbbf64ac345cfb9202aa0e
373500 0 100000 0 0 0 0 212125 0 0
280000 0 205044 89373 40000 0 0 0
3206023 C 3 CP 1 22/02/2019 23/02/2019 20/03/1952 0 2
1 D21.2;R63.3;D64.9 99.04;96.07 - - None None None None M-4-
21-II None None None None None None GANGGUAN SISTEM MUSKULOSKELETAL &
JA(RINGAN) PENGHUBUNG LAIN-LAIN (SEDANG) 2742100 0 0 - 0 -
0 - 0 - 0 2742100 1841432 0 2 0 0
0 ITOH 18046133 66 24445 DR. RIADHI YULIANTO SP.B.
Septiani;3278085209910012 5.3.6.201902021030 4 271846
1#0##0#0#0.0#2019-03-15 11:19:30#0#00:27:00#19:52:00#00:00:00 2
84de594d85dc7ec54f5244dd1ad9373c 310000 0 120000 0 0
0 0 984850 0 0 140000 0 145839 110743
30000 0 0 0
3206023 C 2 CP 1 19/02/2019 23/02/2019 02/12/1955 0 1
(RINGAN) 4016000 0 0 - 0 - 0 - 0 - 0
4016000 6332955 0 5 0 0 0 MEDI 16014850 63
23090 DR. NURUL SITI MARDIAH, SP.B 0122R0020219V004629 0000070332355
271644 1#0##0#0#0.0#2019-03-15 11:25:53#0#17:18:00#06:40:00#00:00:00
3 e1ee23257f04cfe0501abd5496506661 765500 2105000 300000
0 0 0 0 403875 0 0 625000 0 1249282
834298 50000 0 0 0
3206023 C 3 CP 1 16/02/2019 24/02/2019 05/06/1965 0 2
(SEDANG) 3826700 0 0 - 0 - 0 - 0 - 0
3826700 3921488 0 9 0 0 0 TATI RAHMAWATI
5.3.6.201902021030 4 271551 1#0##0#0#0.0#2019-03-06
09:02:00#0#14:32:00#06:52:00#00:00:00 1 6a1ea084dbf0d7c85cf7db462bb29d7a
632500 0 300000 0 0 0 950000 56100 0 0
490000 0 1275829 147059 70000 0 0 0
3206023 C 3 CP 1 21/02/2019 24/02/2019 08/05/1973 0 2
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 3083175 0 4 0 0 0 WATI 19054472
5.3.6.201902021030 4 271684 1#0##0#0#0.0#2019-03-06
10:52:09#0#15:53:00#06:30:00#00:00:00 1 3874ca8b021cf5813542644d0a579bd3
393000 1573750 70000 0 0 0 0 82625 0 0 210000
0 296301 427499 30000 0 0 0
3206023 C 3 CP 1 21/02/2019 24/02/2019 01/10/1971 0 2
0 0 - 0 - 0 - 0 - 0 6433000
4653990 0 4 0 0 0 JAJANG GUNAWAN 19057790 47
271817 1#0##0#0#0.0#2019-03-06 13:56:19#0#11:55:00#06:42:00#00:00:00
1 f1aae0882be4673ee2eec6ef362f2c71 1021064 2137750 120000
0 0 0 130000 293375 0 0 210000 0 517382
194419 30000 0 0 0
3206023 C 3 CP 1 22/02/2019 24/02/2019 11/07/2001 0 2
1 O15.9;Z37.0;O82.9 74.99 - - None None None None O-6-10-III
None None None None None None OPERASI PEMBEDAHAN CAESAR (BERAT)
6396100 0 0 - 0 - 0 - 0 - 0
6396100 6992415 0 3 0 0 0 DEWI 19057926 17
1#0##0#0#0.0#2019-03-08 10:11:58#0#11:44:00#17:57:00#00:00:00 1
83600c5e3feb13efd5abace9ad0a748a 1927000 2173750 185000 0
0 0 0 311875 0 0 345000 0 1072240 833870
40000 103680 0 0
3206023 C 3 CP 1 22/02/2019 24/02/2019 10/07/1982 0 2
1 O13 - - - None None None None W-4-16-I None None
- 0 - 0 - 0 - 0 1999800 1203569 0
3 0 0 0 HARNI 18051096 36 13376 dr. Asep Taslim Sp.OG
Aeni;3206276601940002 5.3.6.201902021030 4 271928 1#0##0#0#0.0#2019-
03-08 10:13:05#0#12:02:00#17:55:00#00:00:00 1
9e0997bf40a1921efedc00a821fdb15a 470000 0 100000 0 0
0 0 196375 0 0 210000 0 121170 66024 40000
0 0 0
3206023 C 3 CP 1 22/02/2019 24/02/2019 01/07/1950 0 2
1 B02.3;G53.0 - - - None None None None H-4-12-II None
None None None None None GANGGUAN MATA LAIN-LAIN (SEDANG) 3082700
0 0 - 0 - 0 - 0 - 0 3082700
1037350 0 3 0 0 0 WASPI 19057921 68 25073 dr.
Eman Arif Rahman, Sp.KK 0122R0020219V005563 0000434884094 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 271935
1#0##0#0#0.0#2019-03-08 10:19:43#0#12:05:00#13:05:00#00:00:00 1
c711b6bda8c83fc78934ccab6df29a96 345000 0 150000 0 0
0 0 0 0 0 210000 0 260889 61461 10000 0
0 0
3206023 C 3 CP 1 22/02/2019 24/02/2019 25/07/1989 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5003324 0 3 0 0 0 TUNISAH 19057791
271942 1#0##0#0#0.0#2019-03-08 10:25:15#0#09:02:00#18:01:00#00:00:00
1 2ca61ae66d3d1bb3549e96acf4fccfe0 1182000 2137750 120000
0 0 0 0 320125 0 0 210000 0 344922
648527 40000 0 0 0
3206023 C 3 CP 1 21/02/2019 24/02/2019 10/07/2001 0 2
1 B01.9;Z03.1 86.3 - - None None None None L-1-40-I None
None None None None None PROSEDUR PADA KULIT, JA(RINGAN) BAWAH KULIT DAN
PAYUDARA (RINGAN) 3696900 0 0 - 0 - 0 - 0 -
0 3696900 2261379 0 4 0 0 0 RIZALURROBI
19057174 17 6435 dr. Eman Arif Rahman, Sp.KK 0122R0020219V005326
5.3.6.201902021030 4 271588 1#0##0#0#0.0#2019-03-08
10:54:19#0#16:02:00#17:45:00#00:00:00 1 5d4eb5e0a8e8821c0818614cc333687c
270500 1570000 50000 0 0 0 0 0 0 0 140000
0 18038 192841 20000 0 0 0
3206023 C 3 CP 1 20/02/2019 24/02/2019 15/03/1959 0 2
1 K76.9;D64.9;K21.9;I51.9 99.04 - - None None None None B-4-
3637100 0 0 - 0 - 0 - 0 - 0
3637100 6185668 0 5 0 0 0 MAHPUD 19057671
5.3.6.201902021030 4 271917 1#0##0#0#0.0#2019-03-08
11:05:19#0#11:16:00#08:26:00#00:00:00 2 59095fc3131ae3e24cb76759d4ba4f86
2026000 0 150000 0 0 0 0 2825025 0 0
350000 0 338021 298382 60000 138240 0 0
3206023 C 3 CP 1 23/02/2019 24/02/2019 05/09/1981 0 2
1 I84.9;D64.9 99.04 - - None None None None K-4-18-II None
1765800 0 0 - 0 - 0 - 0 - 0
1765800 3340135 0 2 0 0 0 ARIPIN 19057962
5.3.6.201902021030 4 271939 1#0##0#0#0.0#2019-03-08
11:10:54#0#06:51:00#08:18:00#00:00:00 2 366ea86e23692969bba04f46b7f97b1b
343500 0 120000 0 0 0 0 1990350 0 0
210000 0 591713 64572 20000 0 0 0
3206023 C 3 CP 1 21/02/2019 24/02/2019 13/09/1972 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1472093 0 4 0 0 0 WAHYU NANA 19057852
5.3.6.201902021030 4 271932 1#0##0#0#0.0#2019-03-08
11:16:17#0#21:36:00#08:28:00#00:00:00 2 6aa712e309ce9075553da6b7ab70c2d2
433500 0 150000 0 0 0 0 343625 0 0
280000 0 126631 78337 60000 0 0 0
3206023 C 3 CP 1 22/02/2019 24/02/2019 10/02/1981 0 2
5102000 0 0 - 0 - 0 - 0 - 0
5102000 4793666 0 3 0 0 0 IIS 19057879 38
5.3.6.201902021030 4 271930 1#0##0#0#0.0#2019-03-08
11:17:18#0#12:13:00#10:16:00#00:00:00 2 91148b4ea2c2c86068a07e7e1c1f11ac
914500 2137750 120000 0 0 0 0 394500 0
0 140000 0 399215 657701 30000 0 0 0
3206023 C 3 CP 1 22/02/2019 24/02/2019 04/09/1988 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2570172 0 3 0 0 0 ENUNG 19057932 30 11128 DR.
ASEP TASLIM SP.OG 0122R0020219V005574 0000426211457 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 271921 1#0##0#0#0.0#2019-
03-08 11:19:00#0#13:34:00#08:22:00#00:00:00 2
f5845f87be75996f6bd8343a9257f569 1667500 0 170000 0 0
0 0 225200 0 0 280000 0 66163 121309 40000
0 0 0
3206023 C 3 CP 1 21/02/2019 24/02/2019 01/01/1945 0 2
1 I50.0;J90;I25.2;N17.9 99.60;89.52 - - None None None None
I-4-12-III None None None None None None KEGAGALAN JANTUNG (BERAT)
3582600 0 0 - 0 - 0 - 0 - 0
3582600 1889461 0 4 0 0 0 OOM 16013920 74
5.3.6.201902021030 4 271914 1#0##0#0#0.0#2019-03-08
11:20:02#0#13:09:00#09:20:00#00:00:00 2 5144699c68e60e493ff062640c948e11
626000 0 150000 0 0 0 140000 277250 0
0 280000 0 235472 140739 40000 0 0 0
3206023 C 3 CP 1 23/02/2019 24/02/2019 08/11/1982 0 2
4 G93.4;E11.9;A41.9 96.07;89.52;99.60 - - None None None None
G-4-21-III None None None None None None KOMA & STUPOR NON TRAUMA
(BERAT) 3976400 0 0 - 0 - 0 - 0 - 0
3976400 1253243 0 2 0 0 0 DIAN SADIAT 19056637
5.3.6.201902021030 4 271910 1#0##0#0#0.0#2019-03-08
11:20:58#0#01:35:00#01:42:00#00:00:00 2 f6544286ce00abd1fcc6766263c683f1
479500 0 50000 0 0 0 0 103875 0 0 140000
0 292624 187244 0 0 0 0
3206023 C 2 CP 1 21/02/2019 24/02/2019 04/01/1987 0 2
0 - 0 - 0 - 0 - 0 2399800 1506164
0 4 0 0 0 ELIS SUKIARTI 19057867 32 11736 DR.
1#0##0#0#0.0#2019-03-08 11:21:46#0#02:57:00#17:52:00#00:00:00 2
ac1a33ff691df743de4055232d8218da 455000 0 100000 0 0
0 0 291375 0 0 430000 0 101240 68549 60000
0 0 0
3206023 C 2 CP 1 20/02/2019 24/02/2019 11/12/2002 0 2
1 N39.0;K59.0 99.21 - - None None None None N-4-12-I None
None None None None None INFEKSI GINJAL DAN SALURAN URIN (RINGAN)
2586500 0 0 - 0 - 0 - 0 - 0
2586500 1833583 0 5 0 0 0 BIBAH HABIBAH
5.3.6.201902021030 4 271902 1#0##0#0#0.0#2019-03-08
11:22:44#0#11:27:00#09:58:00#00:00:00 2 d44a8c29225c01f6d63f0b9d21c4cc27
507500 0 280000 0 0 0 0 126125 0 0
625000 0 175662 69296 50000 0 0 0
3206023 C 2 CP 1 22/02/2019 24/02/2019 09/06/2015 0 2
(RINGAN) 2511000 0 0 - 0 - 0 - 0 - 0
2511000 1550234 0 3 0 0 0 ALFIANDI WIZDHAN
5.3.6.201902021030 4 271898 1#0##0#0#0.0#2019-03-08
11:23:55#0#22:31:00#08:20:00#00:00:00 3 74b0ca4a5f69a27219d387980452c46b
522500 0 200000 0 0 0 0 70125 0 0 540000
0 122964 54645 40000 0 0 0
3206023 C 3 CP 1 21/02/2019 24/02/2019 20/11/1973 0 2
1 L51.1;L27.0;L53.9 - - - None None None None L-4-10-II
None None None None None None PENYAKIT KULIT MAYOR (SEDANG) 1473400
0 0 - 0 - 0 - 0 - 0 1473400
1165865 0 4 0 0 0 WARYATI 18039293 45 16529
dr. Eman Arif Rahman, Sp.KK 0122R0020219V005294 0002250175004 3;JKN
1#0##0#0#0.0#2019-03-11 10:46:14#0#10:34:00#17:46:00#00:00:00 1
8fddc1dca77862a9597e38d97c9616f8 465000 0 150000 0 0
0 0 152000 0 0 280000 0 65256 13609 40000 0
0 0
3206023 C 3 CP 1 14/02/2019 24/02/2019 28/02/2004 0 2
(RINGAN) 2092500 0 0 - 0 - 0 - 0 - 0
2092500 4416306 0 11 0 0 0 CANDRA FEBRIAN
5.3.6.201902021030 4 272486 1#0##0#0#0.0#2019-03-11
14:12:14#0#00:36:00#08:33:00#00:00:00 2 76a197b6a7805eb18d75b008a665cbf5
795000 0 520000 0 0 0 0 771825 0 0
770000 0 1265662 173819 120000 0 0 0
3206023 C 3 CP 1 20/02/2019 24/02/2019 01/01/1979 0 2
1 O72.2;O99.0 69.09;99.04;70.79 - - None None None None W-1-
30-II None None None None None None PROSEDUR PADA VAGINA, SERVIK & VULVA
(SEDANG) 5525600 0 0 - 0 - 0 - 0 - 0
5525600 3073605 0 5 0 0 0 UTIH SADIAH 19056868
5.3.6.201902021030 4 271741 1#0##0#0#0.0#2019-03-12
08:24:26#0#15:07:00#18:06:00#00:00:00 1 bcbf0add307581261f890084d934da6d
168000 1626250 120000 0 0 0 0 561850 0
0 210000 0 237543 129962 20000 0 0 0
3206023 C 3 CP 1 20/02/2019 24/02/2019 01/07/1972 0 2
1 A16.2 89.52;87.44 - - None None None None J-4-15-I None
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1274329 0 5 0 0 0 TITIN 19057742 46
5.3.6.201902021030 4 273203 1#0##0#0#0.0#2019-03-12
13:37:23#0#18:58:00#06:45:00#00:00:00 1 8c94c0d58c16e6ef694b347e6461612c
469500 0 50000 0 0 0 140000 108100 0 0
280000 0 53622 34867 0 138240 0 0
3206023 C 3 CP 1 24/02/2019 25/02/2019 01/01/2000 0 2
0 - 0 - 0 - 0 - 0 4853300 15000 0
2 0 0 0 SITI AINUN, NN 15015951 19 6994 DR. RIADHI
YULIANTO SP.B. 0122R002 0002485015233 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 269468
1#0##0#0#0.0#2019-02-26 11:04:13#0#12:28:39#12:28:39#00:00:00 1
afed2941d7f93b0d8db5f1793c16d34e 15000 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
3206023 C 3 CP 1 19/02/2019 25/02/2019 11/11/2003 0 2
1 D20.1 54.11 - - None None None None K-1-40-I None None
5786500 0 0 - 0 - 0 - 0 - 0
5786500 5387777 0 7 0 0 0 YOGI TRIANA 19055654
5.3.6.201902021030 4 271763 1#0##0#0#0.0#2019-03-06
13:03:36#0#19:14:00#08:30:00#00:00:00 1 c0ef0dcfdfeca9e443c4d7239f61ce10
671525 1825000 170000 0 0 0 0 868600 0
0 350000 0 858245 614407 30000 0 0 0
3206023 C 2 CP 1 22/02/2019 25/02/2019 23/11/2011 0 2
1 R50.9;Z03.0 - - - None None None None A-4-12-I None
None None None None None DEMAM YANG TIDAK DITENTUKAN (RINGAN)
3011500 0 0 - 0 - 0 - 0 - 0
3011500 945554 0 4 0 0 0 MUHAMAD NAJRIL ISMAIL
5.3.6.201902021030 4 271954 1#0##0#0#0.0#2019-03-08
11:02:56#0#01:45:00#13:41:00#00:00:00 3 bd29373676f8c5d8038c347782a444cf
347500 0 150000 0 0 0 0 0 0 0 210000
0 177212 30842 30000 0 0 0
3206023 C 1 CP 1 21/02/2019 25/02/2019 02/01/1961 0 2
1 C50.9;D70 - - - None None None None L-4-11-III None
None None None None None TUMOR PAYUDARA (BERAT) 11623200 0 0
- 0 - 0 - 0 - 0 11623200 4866954 0
5 0 0 0 AI SAIDAH 18047944 58 21234 dr. Riadhi
Septiani;3278085209910012 5.3.6.201902021030 4 271985
1#0##0#0#0.0#2019-03-08 11:22:04#0#11:31:00#16:00:00#00:00:00 1
e24b4597ce03d9037b2fe9330c6761b2 1245000 0 495000 0 0
0 0 1106800 0 0 1500000 0 225527 244627
50000 0 0 0
3206023 C 1 CP 1 17/02/2019 25/02/2019 12/10/1966 0 1
(RINGAN) 4685400 0 0 - 0 - 0 - 0 - 0
4685400 10918673 0 9 0 0 0 DEDI AKHDIAT
5.3.6.201902021030 4 271989 1#0##0#0#0.0#2019-03-08
11:25:28#0#17:47:00#08:57:00#00:00:00 1 f85ebb480a165ada7e4f5911add1876c
1419500 2317500 720000 0 0 0 0 420125 0
0 1800000 0 2819844 1331704 90000 0 0 0
3206023 C 1 CP 1 24/02/2019 25/02/2019 15/06/1962 0 2
None None None None INFARK MYOKARD AKUT (RINGAN) 4077100 0 0
- 0 - 0 - 0 - 0 4077100 1564432 0
2 0 0 0 AKHMAD YANI 19058048 56 20708 DR. H. DANI FARID
Septiani;3278085209910012 5.3.6.201902021030 4 271991
1#0##0#0#0.0#2019-03-08 11:28:53#0#06:23:00#13:22:00#00:00:00 1
0390696509f1417c68b265d762f2692e 607500 0 165000 0 0
0 0 104375 0 0 300000 0 317700 69857 0
0 0 0
3206023 C 3 CP 1 23/02/2019 25/02/2019 01/02/1986 0 2
13-I None None None None None None PERSALINAN VAGINAL (RINGAN) 1544900
0 0 - 0 - 0 - 0 - 0 1544900
1390245 0 3 0 0 0 EEN KUNIASIH 17015927 33
1#0##0#0#0.0#2019-03-08 11:36:31#0#12:25:00#11:24:00#00:00:00 1
46680216ba784e15a178ad613f31e0ca 642500 0 100000 0 0
0 0 197625 0 0 210000 0 60309 139811 40000
0 0 0
3206023 C 3 CP 1 22/02/2019 25/02/2019 14/05/2013 0 2
1 A09.9;A41.9 99.21 - - None None None None K-4-17-III None
(BERAT) 2308000 0 0 - 0 - 0 - 0 - 0
2308000 1290029 0 4 0 0 0 AN RESA FAUZAN
5.3.6.201902021030 4 271996 1#0##0#0#0.0#2019-03-08
11:36:38#0#20:40:00#13:22:00#00:00:00 1 dbbc051f25c7eda847e58081a0311c21
387500 0 150000 0 0 0 0 70125 0 0 280000
0 273668 78736 50000 0 0 0
3206023 C 3 CP 1 24/02/2019 25/02/2019 01/10/1986 0 2
1 O62.2;Z37.0;O80.0;O42.1;R50.9;O99.8 73.59 - - None None None
(SEDANG) 1828500 0 0 - 0 - 0 - 0 - 0
1828500 2308884 0 2 0 0 0 KIKI ROHAETI
5.3.6.201902021030 4 272000 1#0##0#0#0.0#2019-03-08
11:42:01#0#21:01:00#16:02:00#00:00:00 1 124b1a6af4235432f737dfc05a9de919
1487500 0 120000 0 0 0 0 281500 0 0
140000 0 58670 201214 20000 0 0 0
3206023 C 3 CP 1 23/02/2019 25/02/2019 04/01/1986 0 2
1 O14.1;O80.1;Z37.1;O36.4;O32.1 72.54 - - None None None None
O-6-12-II None None None None None None PERSALINAN VAGINAL DENGAN
PROSEDUR SELAIN STERILISASI &/ DILATASI & KURET (SEDANG) 2170700 0 0
- 0 - 0 - 0 - 0 2170700 1973554 0
3 0 0 0 YANI MULYANI 19057976 33 12103 dr. Asep
Taslim Sp.OG 0122R0020219V005971 0000432436173 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272262
1#0##0#0#0.0#2019-03-11 08:52:29#0#16:55:00#11:11:00#00:00:00 1
dd6df974ad99c071653d202f827729c7 765000 0 50000 0 0 0
0 479625 0 0 210000 0 330906 118023 20000
0 0 0
3206023 C 3 CP 1 22/02/2019 25/02/2019 23/08/1996 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 5060449 0 4 0 0 0 RINA NURDIANA
5.3.6.201902021030 4 272302 1#0##0#0#0.0#2019-03-11
09:11:31#0#21:54:00#11:28:00#00:00:00 1 bb000a45e41b0d650ba824514523835e
967000 2137750 310000 0 0 0 0 276375 0
0 280000 0 408054 641270 40000 0 0 0
3206023 C 3 CP 1 21/02/2019 25/02/2019 12/05/1970 0 2
1 I25.9;E24.9;E27.4;N17.9 - - - None None None None I-4-
16-III None None None None None None ATHEROSKLEROSIS (BERAT) 3010100
0 0 - 0 - 0 - 0 - 0 3010100
2034213 0 5 0 0 0 HERLINA 19057718 48 17817
272308 1#0##0#0#0.0#2019-03-11 09:16:21#0#09:03:00#12:27:00#00:00:00
1 71fb630c8d995841ffbed54ac4de0627 723500 0 150000 0
0 0 0 163475 0 0 280000 0 382762 264476
70000 0 0 0
3206023 C 3 CP 1 21/02/2019 25/02/2019 29/03/1997 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1729445 0 5 0 0 0 MOHAMMAD NIRWAN
Septiani;3278085209910012 5.3.6.201902021030 4 272329
1#0##0#0#0.0#2019-03-11 09:26:35#0#11:45:00#13:39:00#00:00:00 1
38015ff4df600037cad910298f7f446c 463500 0 200000 0 0
0 0 400625 0 0 350000 0 217421 37899 60000
0 0 0
3206023 C 3 CP 1 21/02/2019 25/02/2019 21/02/1954 0 2
1 J06.9;Z03.0 - - - None None None None U-4-13-I None
None None None None None PERADANGAN EPIGLOTIS, TELINGA TENGAH, ISPA DAN
0 - 0 1826300 4053597 0 5 0 0 0 IWAN
5.3.6.201902021030 4 272335 1#0##0#0#0.0#2019-03-11
09:28:46#0#12:25:00#10:39:00#00:00:00 1 3d6bb2e7b65b779911ebc36a7ca2f23b
497500 0 150000 0 0 0 140000 138375 0
0 280000 0 2662180 115542 70000 0 0 0
3206023 C 3 CP 1 19/02/2019 25/02/2019 09/11/1963 0 2
(SEDANG) 3826700 0 0 - 0 - 0 - 0 - 0
3826700 3624150 0 7 0 0 0 MAMAT RAHMAT
5.3.6.201902021030 4 272349 1#0##0#0#0.0#2019-03-11
09:32:37#0#12:42:00#10:20:00#00:00:00 1 b53aa9c994e97a6cbecc32a3596d034d
657500 0 350000 0 0 0 894800 70125 0 0
490000 0 1064872 16853 80000 0 0 0
3206023 C 3 CP 1 16/02/2019 25/02/2019 16/02/2019 2400 2
- 0 4989600 3451758 0 10 0 0 0 BY NY PUPUT
PATIMAH 19057330 0 0 dr. Marte Robiul Sani Sp.A.
S.ST;3206297107870001 5.3.6.201902021030 4 272505 1#0##0#0#0.0#2019-
03-11 10:54:47#0#01:34:00#09:41:00#00:00:00 1
bf50596c6e62fe689d97d3730638e858 1285000 0 420000 0 0
0 0 651850 0 0 875000 0 48464 171444 0
0 0 0
3206023 C 3 CP 1 24/02/2019 25/02/2019 07/07/1997 0 2
0 0 - 0 - 0 - 0 - 0 1544900
2438674 0 2 0 0 0 ADE IKA DARMAYATI 19058015 21
1#0##0#0#0.0#2019-03-12 08:40:27#0#13:33:00#12:05:00#00:00:00 2
0ced1cf41f9e1b721621a223e2f95d0a 1467500 0 170000 0 0
0 0 281500 0 0 140000 0 101452 248222
30000 0 0 0
3206023 C 3 CP 1 25/02/2019 25/02/2019 31/05/2000 0 2
None None None None GANGGUAN - PENYAKIT SISTEM SARAF LAIN-LAIN (RINGAN)
2959900 0 0 - 0 - 0 - 0 - 0
2959900 1141627 0 1 0 0 0 SUSI 18051453 18
6844 DR. MUHAMMAD THAIFUR YANUAR 0122R0020219V007091 0000431879409
272720 1#0##0#0#0.0#2019-03-12 08:53:41#0#12:00:00#12:00:00#00:00:00
1 c81057f49ff8e002de34a1cece1cedc6 457500 0 0 0 0
0 0 339750 0 0 0 0 64585 131552 10000 138240
0 0
3206023 C 3 CP 1 22/02/2019 25/02/2019 12/04/1982 0 2
(SEDANG) 5102000 0 0 - 0 - 0 - 0 - 0
5102000 6148779 0 4 0 0 0 TETI SUMIATI
5.3.6.201902021030 4 272295 1#0##0#0#0.0#2019-03-12
09:28:14#0#01:40:00#11:26:00#00:00:00 2 94240e3139a4f4d1c43cb3ba7986f135
1273875 2711250 270000 0 0 0 0 301375 0
0 540000 0 480674 521605 50000 0 0 0
3206023 C 3 CP 1 20/02/2019 25/02/2019 01/01/1980 0 2
1 A91;K21.9 - - - None None None None A-4-13-I None
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1569170 0 6 0 0 0 BOBOY SUMIRAT
Aeni;3206276601940002 5.3.6.201902021030 4 272811 1#0##0#0#0.0#2019-
03-12 09:46:43#0#20:03:00#13:58:00#00:00:00 1
c2bfa5bd4f00e16ef06371d3d9f64c3e 413500 0 150000 0 0
0 0 318000 0 0 280000 0 327612 30058 50000
0 0 0
3206023 C 3 CP 1 18/02/2019 25/02/2019 01/01/1960 0 2
1 K92.2;D47.3;D64.9 99.04 - - None None None None K-4-18-II
(SEDANG) 1765800 0 0 - 0 - 0 - 0 - 0
1765800 5002042 0 8 0 0 0 MASUROH 18051038
5.3.6.201902021030 4 272902 1#0##0#0#0.0#2019-03-12
10:32:01#0#23:47:00#12:15:00#00:00:00 1 e66b6e04043f264423e966a18a3b401e
693500 0 300000 0 0 0 0 2714300 0 0
560000 0 439447 204795 90000 0 0 0
3206023 C 3 CP 1 19/02/2019 25/02/2019 16/03/1973 0 2
1 A90;A01.0;R57.9 99.18 - - None None None None A-4-13-III
(BERAT) 2728200 0 0 - 0 - 0 - 0 - 0
2728200 6967528 0 7 0 0 0 ELIM 19057643 45
272857 1#0##0#0#0.0#2019-03-12 10:52:00#0#15:52:00#12:40:00#00:00:00
2 b73d788647f91dddf70ad4477ac59b9b 2125000 0 610000 0
0 0 0 1066700 0 0 275000 890000 1205647
443261 110000 241920 0 0
3206023 C 3 CP 1 14/02/2019 25/02/2019 10/10/1974 0 2
1 K92.2;D64.9;K92.0 99.04 - - None None None None K-4-18-II
(SEDANG) 1765800 0 0 - 0 - 0 - 0 - 0
1765800 7829882 0 12 0 0 0 SUPYAN 19057220
5.3.6.201902021030 4 272787 1#0##0#0#0.0#2019-03-12
10:56:39#0#05:33:00#12:21:00#00:00:00 2 30bdfa37c7918d84c74694e83756175e
1201000 0 520000 0 0 0 0 2405025 0 0
770000 0 2576764 297093 60000 0 0 0
3206023 C 2 CP 1 23/02/2019 25/02/2019 27/05/1998 0 2
1 O42.9;Z37.0;O80.0 - - - None None None None O-6-13-II
0 0 - 0 - 0 - 0 - 0 2194200
2695753 0 3 0 0 0 ELA NURLAELA 19057972 20
1#0##0#0#0.0#2019-03-13 14:05:08#0#11:55:00#08:16:00#00:00:00 1
c02d63c30dbe1c1878ee8fec15532e60 1800000 0 50000 0 0 0
0 281500 0 0 210000 0 65218 269035 20000 0
0 0
3206023 C 3 CP 1 22/02/2019 25/02/2019 03/03/1986 0 2
CAESAR (RINGAN) 4830200 0 0 - 0 - 0 - 0 -
0 4830200 4668430 0 4 0 0 0 NURLAELA SARI
5.3.6.201902021030 4 273580 1#0##0#0#0.0#2019-03-15
13:19:09#0#00:09:00#10:03:00#00:00:00 3 fe28e65eb241d9d0bf1c0641a0cc9a87
809500 2137750 170000 0 0 0 0 276375 0
0 210000 0 488836 535969 40000 0 0 0
3206023 C 3 CP 1 22/02/2019 25/02/2019 29/01/1997 0 2
0 0 - 0 - 0 - 0 - 0 2053000
1603922 0 4 0 0 0 KESI KARISMA 19057948 22
5.3.6.201902021030 4 272806 1#0##0#0#0.0#2019-03-15
13:19:53#0#00:35:00#12:51:00#00:00:00 2 c1ff7f511a877c830ef8ae1f5113e67f
467500 0 150000 0 0 0 0 70125 0 0 210000
0 542645 44532 50000 69120 0 0
3206023 C 3 CP 1 22/02/2019 25/02/2019 01/10/2003 0 2
1 K30;R11 - - - None None None None K-4-18-I None
1242600 0 0 - 0 - 0 - 0 - 0
1242600 1156556 0 4 0 0 0 MOH. RIZKY SAPUTRA
5.3.6.201902021030 4 272006 1#0##0#0#0.0#2019-03-15
13:20:28#0#01:46:00#08:21:00#00:00:00 3 fbc47b4b029ea47635a54111a6997d86
327500 0 150000 0 0 0 0 70125 0 0 280000
0 236410 42521 50000 0 0 0
3206023 C 3 CP 1 24/02/2019 25/02/2019 07/04/1984 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2750073 0 2 0 0 0 ANIAH 19058011 34 12741 DR.
ASEP TASLIM SP.OG 0122R0020219V005652 0000436519113 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272315
1#0##0#0#0.0#2019-03-15 13:40:40#0#11:17:00#08:49:00#00:00:00 2
2a3bb0fdcc844086bf177f7d7b9d4611 1767500 0 170000 0 0
0 0 281500 0 0 210000 0 91080 199993 30000
0 0 0
3206023 C 3 CP 1 25/02/2019 26/02/2019 28/04/1981 0 2
1 O48;O41.0;O28.3;O99.8;O82.1;Z37.1 74.99 - - None None None
CAESAR (SEDANG) 5102000 0 0 - 0 - 0 - 0 -
0 5102000 1000000 0 2 0 0 0 OOY 1902250418
37 13817 DR. ASEP TASLIM SP.OG 0001 000001 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 269921
1#0##0#0#0.0#2019-02-26 10:28:36#0#10:26:59#10:26:59#00:00:00 1
324155d94c95026fffcf8d22e03314ad 1000000 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
3206023 C 3 CP 1 14/02/2019 26/02/2019 05/05/1978 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 7337788 0 13 0 0 0 NANA SETIAWAN
S.ST;3206297107870001 5.3.6.201902021030 4 271657 1#0##0#0#0.0#2019-
03-06 10:27:04#0#18:06:00#08:26:00#00:00:00 1
b1ed15e405afdb77c46d88869e3493c1 1422000 1285000 895000 0
0 0 130000 95125 0 0 910000 0 1681578 680845
100000 138240 0 0
3206023 C 2 CP 1 25/02/2019 26/02/2019 13/08/1958 0 2
0 0 - 0 - 0 - 0 - 0 7719600
3710811 0 2 0 0 0 IAH SUPRIATIN 18042634 60
272375 1#0##0#0#0.0#2019-03-11 09:43:44#0#09:44:00#11:32:00#00:00:00
1 413d66284bf734b2510b2b9cf28a58d4 206934 2455000 70000 0
0 0 0 0 0 0 140000 0 92110 726767 20000
0 0 0
3206023 C 3 CP 1 23/02/2019 26/02/2019 29/12/1996 0 2
1 O61.9;Z37.0;O82.9;O48;O42.0 74.99 - - None None None None
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5148002 0 4 0 0 0 YUNYUN YUNIATI
5.3.6.201902021030 4 272022 1#0##0#0#0.0#2019-03-11
10:16:46#0#19:04:00#08:22:00#00:00:00 2 a0d1a77b3bbb105524e3f5fac96becb7
1097000 2137750 120000 0 0 0 0 281500 0
0 280000 0 640201 561551 30000 0 0 0
3206023 C 3 CP 1 23/02/2019 26/02/2019 25/05/1995 0 2
1 O99.5;Z37.0;O14.1;O28.3;O41.0;O61.9;O82.9 74.99 - - None None
None None O-6-10-II None None None None None None OPERASI PEMBEDAHAN
CAESAR (SEDANG) 5102000 0 0 - 0 - 0 - 0 -
0 5102000 7823582 0 4 0 0 0 IROS ROSITA
5.3.6.201902021030 4 272019 1#0##0#0#0.0#2019-03-11
10:17:08#0#15:03:00#08:21:00#00:00:00 2 5620628358ed4db167087f7d40925f91
2378875 2756250 205000 0 0 0 0 311875 0
0 210000 70000 1040166 717736 30000 103680 0 0
3206023 C 3 CP 1 24/02/2019 26/02/2019 17/08/1988 0 2
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 5444140 0 3 0 0 0 DEDAH JUBAEDAH
5.3.6.201902021030 4 272004 1#0##0#0#0.0#2019-03-11
10:18:02#0#06:32:00#08:23:00#00:00:00 2 e3ed4dc46f178bd283928e0b613c28b3
1089500 2468000 300000 0 0 0 0 281500 0
0 375000 0 351282 548858 30000 0 0 0
3206023 C 3 CP 1 24/02/2019 26/02/2019 16/07/1987 0 2
4830200 0 0 - 0 - 0 - 0 - 0
4830200 4851227 0 3 0 0 0 YENI NURAENI
5.3.6.201902021030 4 271999 1#0##0#0#0.0#2019-03-11
10:20:40#0#07:29:00#08:23:00#00:00:00 2 195ece65d98fc815cc6e1688ed0fe8ef
1017000 2137750 190000 0 0 0 0 281500 0
0 210000 0 436710 538267 40000 0 0 0
3206023 C 2 CP 1 25/02/2019 26/02/2019 02/06/1991 0 2
1 O41.0;Z37.0;O80.0;O28.3;O48 73.59;93.96 - - None None None
(SEDANG) 2194200 0 0 - 0 - 0 - 0 - 0
2194200 2546339 0 2 0 0 0 RISKAWATI 19058124
271997 1#0##0#0#0.0#2019-03-11 10:21:27#0#14:28:00#08:20:00#00:00:00
2 a325544691e8377062769dd5b8b36b42 1415000 0 140000 0
0 0 0 300250 0 0 375000 0 101278 194811
20000 0 0 0
3206023 C 2 CP 1 19/02/2019 26/02/2019 27/10/2015 0 2
1 R56.0;B86;J40 99.21;93.94 - - None None None None G-4-
22-II None None None None None None SERANGAN KEJANG (SEDANG) 3871900
0 0 - 0 - 0 - 0 - 0 3871900
3480495 0 8 0 0 0 HAIKAL, AN 16011031 3 1211
dr. Lia Rhodia, Sp. A. 0122R0020219V004648 0002067784378 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 272497
1#0##0#0#0.0#2019-03-11 10:51:27#0#22:27:00#13:53:00#00:00:00 1
67efdf1b7c04f09e6e7ac11340886d7e 1127500 0 490000 0 0
0 140000 250275 0 0 835000 0 343124 224596
70000 0 0 0
3206023 C 2 CP 1 23/02/2019 26/02/2019 24/02/2016 0 2
1 R56.0 99.21 - - None None None None G-4-22-I None None
- 0 - 0 - 0 - 0 3030400 1549428 0
4 0 0 0 M DAFA PATHUL RAHMAT 17020206 2 1095 dr.
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 272506
1#0##0#0#0.0#2019-03-11 10:53:54#0#15:04:00#13:55:00#00:00:00 1
c64322ae7bba5b12aa38b252f9824278 437500 0 150000 0 0
0 0 70125 0 0 280000 0 342585 239218 30000
0 0 0
3206023 C 3 CP 1 25/02/2019 26/02/2019 26/08/1983 0 2
1 E04.1 06.2;40.11 - - None None None None E-1-20-I None
None None None None None PROSEDUR PADA TIROID, PARATIROID DAN SALURAN
- 0 5581600 7403021 0 2 0 0 0 WAWAT
KUSMAWATI 13004869 35 12967 DR. RIADHI YULIANTO SP.B.
Septiani;3278085209910012 5.3.6.201902021030 4 272520
1#0##0#0#0.0#2019-03-11 11:19:59#0#15:53:00#11:08:00#00:00:00 2
44a9481fecbefadabcd813ad7b752798 962025 2592500 170000 0
0 0 0 1198225 0 0 280000 0 1175524 954747
70000 0 0 0
3206023 C 3 CP 1 24/02/2019 26/02/2019 06/03/1963 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4891983 0 3 0 0 0 TARYONO 19055147
5.3.6.201902021030 4 272523 1#0##0#0#0.0#2019-03-11
11:31:31#0#18:56:00#08:18:00#00:00:00 2 4039ea73cf81d92809400ef0e9dce280
430000 2592500 120000 0 0 0 0 0 0 0
280000 0 776696 662787 30000 0 0 0
3206023 C 3 CP 1 21/02/2019 26/02/2019 01/07/1960 0 2
1 J44.9;B90.9 - - - None None None None J-4-17-I None
2739200 0 0 - 0 - 0 - 0 - 0
2739200 2438169 0 6 0 0 0 IING IBROHIM
Septiani;3278085209910012 5.3.6.201902021030 4 272582
1#0##0#0#0.0#2019-03-11 13:41:14#0#13:05:00#13:24:00#00:00:00 2
348c8e975a9a82208c8d7a694aa9576b 625500 0 250000 0 0
0 140000 128875 0 0 420000 0 756007 67787
50000 0 0 0
3206023 C 3 CP 1 25/02/2019 26/02/2019 01/02/1991 0 2
0 0 - 0 - 0 - 0 - 0 1828500
2225090 0 2 0 0 0 EVI ROSMIATI 19058107 28
1#0##0#0#0.0#2019-03-11 13:48:13#0#14:09:00#13:02:00#00:00:00 1
ce41054859f9100e6cb04e572c67a351 1337500 0 120000 0 0
0 0 300250 0 0 140000 0 97413 199927 30000
0 0 0
3206023 C 3 CP 1 24/02/2019 26/02/2019 01/01/2002 0 2
0 - 0 - 0 - 0 - 0 4853300 4226305
0 3 0 0 0 NURLELA 18031310 17 6263 dr. Aa Ahmad
Dimyati, Sp.B 0122R0020219V005695 0002616584477 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272649
1#0##0#0#0.0#2019-03-11 14:05:14#0#20:37:00#13:56:00#00:00:00 1
96638b7478fd1245f07f35735f20f950 651525 1825000 120000 0
0 0 0 270000 0 0 210000 0 813003 336777
0 0 0 0
3206023 C 3 CP 1 21/02/2019 26/02/2019 14/05/1970 0 2
1 K21.9;N20.0;M10.0;K92.2 88.76 - - None None None None K-4-
12-II None None None None None None GANGGUAN ESOFAGUS (SEDANG) 2952800
0 0 - 0 - 0 - 0 - 0 2952800
2608382 0 6 0 0 0 HERDI HERDIANA 15002072 48
5.3.6.201902021030 4 272509 1#0##0#0#0.0#2019-03-11
14:08:42#0#15:09:00#13:31:00#00:00:00 3 adce940dcf3e1c0600a093f89419eb65
573500 0 200000 0 0 0 335000 233250 0
0 420000 0 750228 46404 50000 0 0 0
3206023 C 3 CP 1 21/02/2019 26/02/2019 03/12/1976 0 2
1 A91;K30;K92.0 99.05 - - None None None None A-4-13-II
(SEDANG) 2273500 0 0 - 0 - 0 - 0 - 0
2273500 4388512 0 6 0 0 0 JAMILAH 19057872
5.3.6.201902021030 4 272514 1#0##0#0#0.0#2019-03-11
14:09:08#0#11:07:00#13:30:00#00:00:00 3 7f0606259159df389a3e4e37b6a683da
411000 0 220000 0 0 0 0 2671100 0 0
350000 0 355470 310942 70000 0 0 0
3206023 C 3 CP 1 24/02/2019 26/02/2019 01/01/2000 0 2
0 - 0 - 0 - 0 - 0 4853300 4447349
0 3 0 0 0 SITI AINUN, NN 15015951 19 6994 DR. AA
AHMAD DIMYATI, SP.B 0122R0020219V006066 0002485015233 3;JKN Tia Siti
Nurul Aeni;3206276601940002 5.3.6.201902021030 4 272529
1#0##0#0#0.0#2019-03-11 14:09:39#0#20:23:00#08:19:00#00:00:00 2
61fac5fc0db2ce45bae0c5f58b897e74 726525 1825000 120000 0
0 0 0 326100 0 0 280000 0 780348 359376
30000 0 0 0
3206023 C 3 CP 1 20/02/2019 26/02/2019 16/11/1947 0 2
1 A91;I10;K30 - - - None None None None A-4-13-I None
1509200 0 0 - 0 - 0 - 0 - 0
1509200 3612396 0 7 0 0 0 EEM 18051142 71
26029 DR. R. ABYAKSA 0122R0020219V004946 0000435347493 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 272530
1#0##0#0#0.0#2019-03-11 14:10:08#0#17:23:00#13:27:00#00:00:00 2
3f2d1a4d31791d2e4d0600a5d8c08646 663500 0 300000 0 0
0 0 768000 0 0 490000 0 1146560 174336
70000 0 0 0
3206023 C 3 CP 1 25/02/2019 26/02/2019 08/09/1978 0 2
1 D13.4;K83.1 88.76 - - None None None None B-4-13-II None
0 0 - 0 - 0 - 0 - 0 3637100
1467254 0 2 0 0 0 NUNUNG 18047131 40 14780
DR. AA AHMAD DIMYATI, SP.B 0122R0020219V006055 0000434504531 3;JKN
1#0##0#0#0.0#2019-03-11 14:10:35#0#16:24:00#08:19:00#00:00:00 2
fb454a9459e8d5116408ed1b8a62db48 337500 0 50000 0 0 0
375000 252125 0 0 210000 0 127797 84832 30000
0 0 0
3206023 C 3 CP 1 22/02/2019 26/02/2019 17/07/2002 0 2
None None None None PERADANGAN EPIGLOTIS, TELINGA TENGAH, ISPA DAN
0 - 0 1826300 1488177 0 5 0 0 0 M
AKHMAL ISMAWAN 19057938 16 6064 dr. Marte Robiul Sani Sp.A.
Septiani;3278085209910012 5.3.6.201902021030 4 272732
1#0##0#0#0.0#2019-03-12 08:55:25#0#22:32:00#13:55:00#00:00:00 1
330e3e4d5540dccdffdc0a5412df03ca 517500 0 200000 0 0
0 0 70125 0 0 350000 0 233729 76823 40000 0
0 0
3206023 C 3 CP 1 22/02/2019 26/02/2019 01/12/1997 0 2
0 - 0 - 0 - 0 - 0 1999800 1292510
0 5 0 0 0 WINDA, NY 16006676 21 7753 DR. ASEP
TASLIM SP.OG 0122R0020219V005611 0000433262619 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272737
1#0##0#0#0.0#2019-03-12 08:58:16#0#17:18:00#11:28:00#00:00:00 1
5de1a0eb417061599f1ab540c454583e 369500 0 150000 0 0
0 0 281500 0 0 280000 0 53210 118300 40000
0 0 0
3206023 C 3 CP 1 23/02/2019 26/02/2019 24/03/1995 0 2
None None None None ABORTUS MENGANCAM (RINGAN) 1234300 0 0
- 0 - 0 - 0 - 0 1234300 1579416 0
4 0 0 0 NENG LINA SARI 19057995 23 8737 DR. ASEP
TASLIM SP.OG 0122R0020219V005709 0000432401444 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272739
1#0##0#0#0.0#2019-03-12 09:08:35#0#00:53:00#08:22:00#00:00:00 2
b157784c80dd965ff6905d1bba1c24fb 467500 0 150000 0 0
0 0 306750 0 0 280000 0 237101 98065 40000
0 0 0
3206023 C 3 CP 1 22/02/2019 26/02/2019 01/07/1957 0 2
1 D64.9;N17.9;K27.4;K92.0 99.04 - - None None None None D-4-
13-III None None None None None None GANGGUAN SEL DARAH MERAH SELAIN
KRISIS ANEMIA SEL SICKLE (BERAT) 4015300 0 0 - 0 - 0
- 0 - 0 4015300 3030325 0 5 0 0 0
AEN 19057940 61 22516 DR. H. DANI FARID ABDULLAH SP.PD
Septiani;3278085209910012 5.3.6.201902021030 4 272681
1#0##0#0#0.0#2019-03-12 09:11:01#0#23:43:00#09:30:00#00:00:00 2
322b7ca925993620c2c9fee10ad55cf6 543500 0 200000 0 0
0 335000 1317625 0 0 350000 0 177406 76794
30000 0 0 0
3206023 C 3 CP 1 21/02/2019 26/02/2019 02/10/1953 0 2
0 0 - 0 - 0 - 0 - 0 1262500
3509340 0 6 0 0 0 EEN 19057837 65 23883 DR. H.
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 272654
1#0##0#0#0.0#2019-03-12 09:13:39#0#21:49:00#08:45:00#00:00:00 2
5c4ae7fd8950e2b8d97dbdd47af99927 543500 0 250000 0 0
0 0 103875 0 0 420000 0 2014170 127795
50000 0 0 0
3206023 C 3 CP 1 23/02/2019 26/02/2019 01/01/1994 0 2
1 O68.9;O48;O82.1;Z37.0;O33.9 74.99 - - None None None None
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 4957798 0 4 0 0 0 NENENG SULASTRI
5.3.6.201902021030 4 272653 1#0##0#0#0.0#2019-03-12
09:15:19#0#22:26:00#08:22:00#00:00:00 2 ed2e525a07405f46765395b2d54d235d
877000 2137750 260000 0 0 0 0 281500 0
0 350000 0 470901 550647 30000 0 0 0
3206023 C 2 CP 1 24/02/2019 26/02/2019 17/06/1950 0 2
(SEDANG) 5972300 0 0 - 0 - 0 - 0 - 0
5972300 4015126 0 3 0 0 0 UKA SUKANDAR
5.3.6.201902021030 4 272796 1#0##0#0#0.0#2019-03-12
09:41:57#0#06:28:00#11:40:00#00:00:00 1 21a0ffbd86af084d5c811216bb82d935
485000 0 280000 0 0 0 1234800 70125 0 0
250000 0 1620164 45037 30000 0 0 0
3206023 C 3 CP 1 24/02/2019 26/02/2019 26/10/1999 0 2
0 - 0 - 0 - 0 - 0 3549300 4463028
0 3 0 0 0 ROBI MUSTARI 19057268 19 7061 DR. M
SIDIK HASANUDIN SP.THT-KL 0122R0020219V005666 0002740585781 3;JKN Tia
Siti Nurul Aeni;3206276601940002 5.3.6.201902021030 4 273989
1#0##0#0#0.0#2019-03-14 13:05:46#0#15:56:00#08:48:00#00:00:00 2
d7f29a80c99165b10ea55915da74f4a6 691525 1825000 160000 0
0 0 0 0 0 0 420000 0 596310 740193
30000 0 0 0
3206023 C 2 CP 1 24/02/2019 26/02/2019 07/09/2002 0 2
1 K37 47.09 - - None None None None K-1-13-I None None
None None None None PROSEDUR APPENDIK (RINGAN) 3348900 0 0
- 0 - 0 - 0 - 0 3348900 4798981 0
3 0 0 0 SHELA EVISTA, AN 17006420 16 6014 DR. AA AHMAD
DIMYATI, SP.B 0122R0020219V005690 0001903904403 3;JKN Santi Wintri
Septiani;3278085209910012 5.3.6.201902021030 4 272362
1#0##0#0#0.0#2019-03-15 13:39:53#0#19:23:00#13:56:00#00:00:00 5
0ffdabf8375f5e89a8dec0b3057cb1b8 877525 2105000 160000 0
0 0 0 215500 0 0 375000 0 629854 406102
30000 0 0 0
3206023 C 3 CP 1 25/02/2019 26/02/2019 21/12/2012 0 2
1 Q89.2 - - - None None None None E-4-13-I None None
None None None None GANGGUAN KELENJAR ENDOKRIN LAIN-LAIN (RINGAN)
2745400 0 0 - 0 - 0 - 0 - 0
2745400 411337 0 2 0 0 0 M RAFA 18048476
6 2257 DR. MARTE ROBIUL SANI SP.A. 0122R0020219V006073
5.3.6.201902021030 4 272525 1#0##0#0#0.0#2019-03-15
13:46:27#0#00:00:00#00:00:00#00:00:00 3 d44d560d9746ba4feeba58f497f14524
120000 0 50000 0 0 0 0 0 0 0 140000
0 8012 93325 0 0 0 0
3206023 C 1 CP 1 24/02/2019 27/02/2019 04/01/1956 0 2
1 E11.5 86.22;86.04 - - None None None None I-4-15-I None
None None None None None PENYAKIT PEMBULUH DARAH PERIFER DAN LAIN-LAIN
(RINGAN) 5966900 0 0 - 0 - 0 - 0 - 0
5966900 7036785 0 4 0 0 0 EDE UJU 19058039
5.3.6.201902021030 4 272023 1#0##0#0#0.0#2019-03-08
12:35:55#0#22:56:00#10:21:00#00:00:00 1 4cb27ecba74728b1dd10346b53974f3b
1260025 2240000 420000 0 0 0 0 467250 0
0 720000 0 1301387 588123 40000 0 0 0
3206023 C 1 CP 1 21/02/2019 27/02/2019 10/07/1966 0 2
1 J18.9;N17.9;K30;D15.2 - - - None None None None J-4-
16-III None None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH
(BERAT) 8289600 0 0 - 0 - 0 - 0 - 0
8289600 11406048 0 7 0 0 0 LILIS HERLINA
Aeni;3206276601940002 5.3.6.201902021030 4 270011
1#1#vip#0#6217200#75.0#2019-03-08 12:56:27#0#07:43:00#15:17:00#00:00:00
3 e7b593d172e82c20043bbcd58e9f6d3a 2227500 0 825000 0
15000 0 170000 1054302 0 0 2100000 0 1785904
413542 50000 2764800 0 0
3206023 C 2 CP 1 25/02/2019 27/02/2019 27/11/2015 0 2
1 J18.0;Q25.0 99.21;93.94;87.44 - - None None None None J-4-
16-II None None None None None None SIMPLE PNEUMONIA & WHOOPING COUGH
(SEDANG) 5619800 0 0 - 0 - 0 - 0 - 0
5619800 2373040 0 3 0 0 0 ZENITA NAUFALYN
CASSANDRA 16014342 3 1186 dr. Marte Robiul Sani Sp.A.
Aeni;3206276601940002 5.3.6.201902021030 4 272027 1#0##0#0#0.0#2019-
03-08 13:01:36#0#13:35:00#10:34:00#00:00:00 1
ae794e5f0f849d4baa0d1b8ac0e71d41 822500 0 140000 0 0
0 140000 70125 0 0 375000 0 681001 59854 50000
34560 0 0
3206023 C 3 CP 1 23/02/2019 27/02/2019 28/07/2018 0 2
1 J18.0;R56.0 87.44;93.94 - - None None None None J-4-16-II
(SEDANG) 4683100 0 0 - 0 - 0 - 0 - 0
4683100 2386434 0 5 0 0 0 MUHAMAD RIDWAN
5.3.6.201902021030 4 272033 1#0##0#0#0.0#2019-03-08
13:15:08#0#11:23:00#10:32:00#00:00:00 1 ba08f733265c39b2a7998b6a75f78521
1062500 0 245000 0 0 0 140000 70125 0 0
350000 0 257316 176933 50000 34560 0 0
3206023 C 3 CP 1 22/02/2019 27/02/2019 21/05/1960 0 2
1 I21.3;N17.9;I11.9;N39.0 89.52;99.21;57.94 - - None None None
None I-4-10-III None None None None None None INFARK MYOKARD AKUT
(BERAT) 7492600 0 0 - 0 - 0 - 0 - 0
7492600 7093996 0 6 0 0 0 JUJU 19057909 58
5.3.6.201902021030 4 272034 1#0##0#0#0.0#2019-03-08
13:23:20#0#11:05:00#13:30:00#00:00:00 1 db45b52aef02ac70815ce55d14cf4772
2445000 0 330000 0 0 0 0 398200 0 0
455000 615000 2362724 265272 50000 172800 0 0
3206023 C 3 CP 1 24/02/2019 27/02/2019 24/02/2019 3100 2
0 - 0 - 0 1786900 1358122 0 4 0 0
0 BY NY YUNYUN YUNIATI 19058025 0 0 dr. Marte Robiul Sani
Sp.A. 0122R0020219V006034 0002748356572 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 272252 1#0##0#0#0.0#2019-
03-11 08:21:52#0#15:39:00#08:23:00#00:00:00 1
c84da29a132bdb85bf3c97a50f227d97 612500 0 210000 0 0
0 0 0 0 0 500000 0 5250 30372 0 0 0
0
3206023 C 3 CP 1 27/02/2019 27/02/2019 12/03/1955 0 2
4 J18.9;E16.2;N17.9;G93.4;A41.9 - - - None None None None
J-4-16-III None None None None None None SIMPLE PNEUMONIA & WHOOPING
COUGH (BERAT) 5921100 0 0 - 0 - 0 - 0 -
0 5921100 1839983 0 1 0 0 0 ENDANG
Aeni;3206276601940002 5.3.6.201902021030 4 272253 1#0##0#0#0.0#2019-
03-11 08:26:16#0#09:08:00#16:49:00#00:00:00 1
df8dcebc8ba5e8415e69996273ab3ecc 517500 0 50000 0 0 0
0 349300 0 0 70000 0 596563 256620 0 0
0 0
3206023 C 3 CP 1 26/02/2019 27/02/2019 03/02/1981 0 2
0 0 - 0 - 0 - 0 - 0 1544900
2295794 0 2 0 0 0 NANI 19058229 38 13902 dr.
Asep Taslim Sp.OG 0122R0020219V006322 0000435052157 3;JKN Tia Siti Nurul
Aeni;3206276601940002 5.3.6.201902021030 4 272290 1#0##0#0#0.0#2019-
03-11 08:57:31#0#11:28:00#11:35:00#00:00:00 1
eeef0ad90f70fb081b2ba8923868c6a1 1352500 0 120000 0 0
0 0 311875 0 0 140000 0 101866 249553
20000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 01/01/1982 0 2
1 O48;Z37.0;O80.0;O28.3 73.59 - - None None None None O-6-
0 0 - 0 - 0 - 0 - 0 1828500
1507157 0 3 0 0 0 RINA RISMAWATI, NY 15017958
272280 1#0##0#0#0.0#2019-03-11 09:16:41#0#14:30:00#11:34:00#00:00:00
2 6f3cdc53a525f411341c1f788a873b2f 417500 0 170000 0
0 0 0 295125 0 0 320000 0 87659 176873
40000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 29/09/1996 0 2
0 0 - 0 - 0 - 0 - 0 1828500
1543395 0 3 0 0 0 AJRINA ADINI 19057513 22
1#0##0#0#0.0#2019-03-11 09:19:08#0#14:44:00#11:33:00#00:00:00 1
270ec05b19d67fc9ff3b884593141197 527500 0 170000 0 0
0 0 300250 0 0 210000 0 67674 217971 50000
0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 21/06/1949 0 2
None None None None TUMOR MUSKULOSKLETAL,JARINGAN KONEKTIF DAN FRAKTUR
PATOLOGIS (RINGAN) 3644300 0 0 - 0 - 0 - 0
- 0 3644300 2008852 0 3 0 0 0 ILOH
5.3.6.201902021030 4 272326 1#0##0#0#0.0#2019-03-11
09:25:25#0#07:50:00#08:58:00#00:00:00 1 9600bc1b388fdc5d4a3d8efc554988f3
1310000 0 100000 0 0 0 0 0 0 0 210000
0 251142 107710 30000 0 0 0
3206023 C 3 CP 1 22/02/2019 27/02/2019 13/10/1986 0 2
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 3852590 0 6 0 0 0 SUSAN 18051530
5.3.6.201902021030 4 272330 1#0##0#0#0.0#2019-03-11
09:27:36#0#15:19:00#13:26:00#00:00:00 1 23886820a283a8fb0855eec32788a9f0
1031710 0 250000 0 0 0 0 1833075 0 0
420000 0 184502 93303 40000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 05/06/1958 0 2
1 D26.0;D64.9 99.04 - - None None None None W-4-12-II None
LAIN-LAIN (SEDANG) 3667500 0 0 - 0 - 0 - 0
- 0 3667500 2774936 0 3 0 0 0 WAWAT
5.3.6.201902021030 4 272363 1#0##0#0#0.0#2019-03-11
09:36:47#0#14:50:00#19:21:00#00:00:00 1 b165a4c13f0d2b11fd5f66b6fd526e7c
270000 0 100000 0 0 0 0 2108100 0 0
210000 0 28504 48332 10000 0 0 0
3206023 C 3 CP 1 20/02/2019 27/02/2019 11/08/1995 0 2
1 J90;J18.8;Z03.0 34.04 - - None None None None J-4-20-III
None None None None None None PLEURAL EFUSI DAN PNEUMOTORAK (BERAT)
6219400 0 0 - 0 - 0 - 0 - 0
6219400 4718820 0 8 0 0 0 DADANG 19057076
5.3.6.201902021030 4 272379 1#0##0#0#0.0#2019-03-11
09:45:05#0#12:25:00#13:26:00#00:00:00 1 6c902241d0885d73aace76f7e0a85daa
604000 1285000 400000 0 0 0 130000 477750
0 0 560000 0 911126 280944 70000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 15/04/1972 0 2
LAIN (RINGAN) 3834800 0 0 - 0 - 0 - 0 -
0 3834800 3921860 0 3 0 0 0 DEDE KUSTAMAN
19055341 46 17117 DR. AA AHMAD DIMYATI, SP.B 0122R0020219V006076
5.3.6.201902021030 4 272320 1#0##0#0#0.0#2019-03-11
10:00:31#0#19:25:00#09:18:00#00:00:00 2 068a287195a7a3ed0fa6df202f4e79a6
374500 1795000 120000 0 0 0 0 419000 0
0 280000 0 556319 337041 40000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 28/04/1981 0 2
1 O41.0;Z37.0;O82.9;Z22.5;O28.3;O48 74.99 - - None None None
CAESAR (RINGAN) 4830200 0 0 - 0 - 0 - 0 -
0 4830200 4483823 0 3 0 0 0 OOY ROKAYAH
5.3.6.201902021030 4 272307 1#0##0#0#0.0#2019-03-11
10:01:42#0#15:02:00#12:28:00#00:00:00 2 1d859446ce4fd2cb5ef4253aa9fa6d60
1192000 1825000 360000 0 0 0 0 219000 0
0 280000 0 336454 241369 30000 0 0 0
3206023 C 3 CP 1 23/02/2019 27/02/2019 07/07/1956 0 2
LAIN (SEDANG) 3917300 0 0 - 0 - 0 - 0 -
0 3917300 2547850 0 5 0 0 0 SAHMEDI
Aeni;3206276601940002 5.3.6.201902021030 4 272303 1#0##0#0#0.0#2019-
03-11 10:02:42#0#06:46:00#13:31:00#00:00:00 2
5b785c44c84b86f7caff3f46997f2d0c 741710 0 250000 0 0
0 0 1055050 0 0 210000 0 100010 141080
50000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 28/05/1986 0 2
LAIN (RINGAN) 2199200 0 0 - 0 - 0 - 0 -
0 2199200 4120010 0 3 0 0 0 SANDI SUSANTO
5.3.6.201902021030 4 272250 1#0##0#0#0.0#2019-03-11
10:05:10#0#20:29:00#09:15:00#00:00:00 2 8847478d5af15739c05941bcf473694e
726525 1825000 120000 0 0 0 0 270000 0
0 210000 0 463732 464753 40000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 06/05/1960 0 2
4528900 0 0 - 0 - 0 - 0 - 0
4528900 4779655 0 3 0 0 0 AIH SETIAWAN
5.3.6.201902021030 4 272249 1#0##0#0#0.0#2019-03-11
10:05:49#0#17:51:00#09:18:00#00:00:00 2 67dfba612919a6ebec7e576096e10014
410000 2592500 140000 0 0 0 0 0 0 0
210000 0 831262 555893 40000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 09/01/2019 0 2
3332600 0 0 - 0 - 0 - 0 - 0
3332600 1876045 0 3 0 0 0 HAFIZAH FAUZIAH
19058140 0 47 DR. LIA RHODIA, SP. A. 0122R0020219V006989
5.3.6.201902021030 4 272032 1#0##0#0#0.0#2019-03-11
10:07:17#0#22:24:00#14:31:00#00:00:00 2 9b7a1dec5cf651192fcf2490de5fd472
782500 0 150000 0 0 0 140000 70125 0 0
280000 0 198723 180137 40000 34560 0 0
3206023 C 1 CP 1 21/02/2019 27/02/2019 01/01/1944 0 2
1 D12.6;M13.9;A09.9;D64.9;G93.4 99.04 - - None None None None
K-4-18-III None None None None None None GANGGUAN SISTEM PENCERNAAN
LAIN-LAIN (BERAT) 2966500 0 0 - 0 - 0 - 0 -
0 2966500 5819528 0 7 0 0 0 RUKIAH
Aeni;3206276601940002 5.3.6.201902021030 4 272026 1#0##0#0#0.0#2019-
03-11 10:12:01#0#02:58:00#15:34:00#00:00:00 3
765d545ae822a07aa6879b78508a28ca 837500 0 500000 0 0
0 0 2302050 0 0 860000 0 1074391 185587
60000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 01/07/1975 0 2
0 - 0 - 0 - 0 - 0 4853300 6515883
0 3 0 0 0 NAMI 18051844 43 15945 DR. RIADHI
Aeni;3206276601940002 5.3.6.201902021030 4 272038 1#0##0#0#0.0#2019-
03-11 10:28:02#0#18:37:00#09:15:00#00:00:00 2
5ad0a8d2b0ed02a432df1c1e064b0fe5 1024050 2592500 120000 0
0 0 0 768100 0 0 210000 0 609987
1161246 30000 0 0 0
3206023 C 2 CP 1 26/02/2019 27/02/2019 01/01/1945 0 2
4 J18.9;N17.9;G93.4;R57.2 - - - None None None None J-4-
(BERAT) 7105300 0 0 - 0 - 0 - 0 - 0
7105300 1539602 0 2 0 0 0 DAMIJI 19058240
5.3.6.201902021030 4 272516 1#0##0#0#0.0#2019-03-11
11:06:32#0#23:51:00#01:47:00#00:00:00 1 89afa0516081b252a64ce474eee42713
582500 0 50000 0 0 0 0 178375 0 0 70000
0 466978 181749 10000 0 0 0
3206023 C 3 CP 1 24/02/2019 27/02/2019 02/06/2009 0 2
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1515786 0 4 0 0 0 MUHAMMAD RAHMAT WASKITA
5.3.6.201902021030 4 272517 1#0##0#0#0.0#2019-03-11
11:10:16#0#06:34:00#10:33:00#00:00:00 1 ece5f13b6a9fa49b76ef3e9d43756364
417500 0 150000 0 0 0 0 384575 0 0
280000 0 176598 67113 40000 0 0 0
3206023 C 3 CP 1 24/02/2019 27/02/2019 09/04/1967 0 2
1 N39.0;D64.9 99.04 - - None None None None N-4-12-II None
None None None None None INFEKSI GINJAL DAN SALURAN URIN (SEDANG)
3999300 0 0 - 0 - 0 - 0 - 0
3999300 3561443 0 4 0 0 0 MARIF RAHMAN
S.ST;3206297107870001 5.3.6.201902021030 4 272518 1#0##0#0#0.0#2019-
03-11 11:12:20#0#20:30:00#13:30:00#00:00:00 1
46467095299d422adc2f0b1261dcc49f 491000 0 150000 0 0
0 0 1777350 0 0 280000 0 722078 101015
40000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 18/06/1950 0 2
- 0 - 0 - 0 - 0 1645900 1968796 0
3 0 0 0 SALIM SUTISNA 18049924 68 25089 dr. Riadhi
Yulianto Sp.B. 0122R0020219V005926 0000430070016 3;JKN Indriyanti Yuda S,
S.ST;3206297107870001 5.3.6.201902021030 4 272521 1#0##0#0#0.0#2019-
03-11 11:20:56#0#09:39:00#08:59:00#00:00:00 1
9a03459b534f8dd0117f1c32bd2b16bc 1310000 0 100000 0 0
0 0 0 0 0 210000 0 213055 105741 30000
0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 18/06/1980 0 2
(SEDANG) 1828600 0 0 - 0 - 0 - 0 - 0
1828600 2946718 0 3 0 0 0 TATI SUSILAWATI
5.3.6.201902021030 4 272522 1#0##0#0#0.0#2019-03-11
11:30:11#0#15:01:00#10:58:00#00:00:00 1 70ba2487cb8893f21130384269f62b5f
283000 1626250 120000 0 0 0 0 213875 0
0 210000 0 334239 129354 30000 0 0 0
3206023 C 3 CP 1 24/02/2019 27/02/2019 25/08/1984 0 2
1 O00.9;O99.0;O00.1;O08.3 65.49;99.04 - - None None None None
W-1-20-III None None None None None None PROSEDUR PADA RAHIM & ADNEKSA
(BERAT) 8889300 0 0 - 0 - 0 - 0 - 0
8889300 9667405 0 4 0 0 0 NUNUR NURBAEDAH
5.3.6.201902021030 4 272524 1#0##0#0#0.0#2019-03-11
11:50:46#0#19:25:00#11:00:00#00:00:00 1 5883f1f858d777935b0a65a5859edeb4
1562025 3665000 235000 0 0 0 0 1564300 0
0 210000 70000 1315619 832661 40000 172800 0 0
3206023 C 3 CP 1 23/02/2019 27/02/2019 28/10/1968 0 2
1 K74.6;K65.9 99.21 - - None None None None B-4-13-II None
0 0 - 0 - 0 - 0 - 0 3637100
4174742 0 5 0 0 0 ABU BAKAR M YACUP 17013280 50
5.3.6.201902021030 4 272526 1#0##0#0#0.0#2019-03-11
14:08:51#0#17:13:00#10:32:00#00:00:00 3 693d95d984d1312d67d479a45aece46f
783500 0 200000 0 0 0 335000 218750 0
0 420000 0 2097449 60043 60000 0 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 11/05/1962 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 1655614 0 3 0 0 0 YANI 19057529 56
5.3.6.201902021030 4 272344 1#0##0#0#0.0#2019-03-12
13:24:56#0#13:47:00#09:08:00#00:00:00 2 ea15b933b1f0ebbd7ff1ba5de1ff827f
293000 0 100000 0 0 0 0 571000 0 0
210000 0 351148 100466 30000 0 0 0
3206023 C 3 CP 1 17/02/2019 27/02/2019 01/07/1945 0 2
1 I50.0;E87.7;D61.9 99.04 - - None None None None I-4-12-III
0 0 - 0 - 0 - 0 - 0 3582600
13793609 0 11 0 0 0 SAJAN 19057426 73 26894 DR. H.
Wintri Septiani;3278085209910012 5.3.6.201902021030 4 272519
1#0##0#0#0.0#2019-03-15 14:04:31#0#00:31:00#13:23:00#00:00:00 2
183b4104aa518b12dbae4b1c4623b950 1093500 0 450000 0 0
0 130000 7676600 0 0 700000 0 2256327 484062
70000 933120 0 0
3206023 C 3 CP 1 25/02/2019 27/02/2019 01/07/1977 0 2
1 H25.1;H18.9 13.71 - - None None None None H-1-30-I None
6433000 0 0 - 0 - 0 - 0 - 0
6433000 3358701 0 3 0 0 0 HIKMAT 18051703
5.3.6.201902021030 4 272251 1#0##0#0#0.0#2019-03-15
14:08:39#0#19:40:00#09:28:00#00:00:00 3 d24e50bfcae8e66500ad7e54c9a0ae34
344434 2125000 100000 0 0 0 0 0 0 0
210000 0 61278 477989 40000 0 0 0
3206023 C 3 CP 1 26/02/2019 27/02/2019 23/05/1974 0 2
None None None None None TUMOR PAYUDARA (SEDANG) 3653700 0 0
- 0 - 0 - 0 - 0 3653700 1556418 0
2 0 0 0 HIDAYAH 18032224 44 16350 DR. RIADHI
Aeni;3206276601940002 5.3.6.201902021030 4 274203 1#0##0#0#0.0#2019-
03-18 12:47:11#0#12:30:00#09:16:00#00:00:00 2
149ded99ffbb1fcc24c7256133acd8d4 210000 0 50000 0 0 0
0 805100 0 0 140000 0 225402 95916 30000 0
0 0
3206023 C 2 CP 1 25/02/2019 28/02/2019 12/04/1966 0 2
1 J33.0;J32.9 22.2;21.31;22.60 - - None None None None U-1-
12-I None None None None None None PROSEDUR MASTOID DAN SINUS (RINGAN)
5860400 0 0 - 0 - 0 - 0 - 0
5860400 6236214 0 4 0 0 0 UDUNG 19056839 52
19312 dr. M Sidik Hasanudin Sp.THT-KL 0122R0020219V006068
4 272040 1#0##0#0#0.0#2019-03-09
08:55:26#0#17:42:00#15:12:00#00:00:00 1 21346f47838f8fa406dedb5a74c6d4df
1089525 2977500 230000 0 0 0 0 230000 0
0 500000 0 794983 394206 20000 0 0 0
3206023 C 3 CP 1 22/02/2019 28/02/2019 20/12/1940 0 2
1 I63.9;I10 87.03 - - None None None None G-4-14-I None
(RINGAN) 3722700 0 0 - 0 - 0 - 0 - 0
3722700 3661401 0 7 0 0 0 TATANG SOMANTRI
4 272062 1#0##0#0#0.0#2019-03-09
09:44:21#0#11:11:00#15:11:00#00:00:00 1 2b46432cf45c304413541fcccad555a6
678500 0 300000 0 0 0 894800 56100 0 0
490000 0 1043226 128775 70000 0 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 14/05/2001 0 2
1 R90.0;G40.9 87.03 - - None None None None G-4-26-I None
None None None None None GANGGUAN - PENYAKIT SISTEM SARAF LAIN-LAIN
(RINGAN) 2959900 0 0 - 0 - 0 - 0 - 0
2959900 2672464 0 4 0 0 0 NINA ROHMATILAH
4 272069 1#0##0#0#0.0#2019-03-09
09:59:55#0#22:26:00#15:11:00#00:00:00 1 c582433d8c4aab1caab4859a85cccf9e
472500 0 150000 0 0 0 894800 70125 0 0
280000 0 713640 61399 30000 0 0 0
3206023 C 3 CP 1 23/02/2019 28/02/2019 07/05/1955 0 2
1 J18.9;J98.0 - - - None None None None J-4-16-I None
3332600 0 0 - 0 - 0 - 0 - 0
3332600 5078125 0 6 0 0 0 ODAH 18051520 63
4 272089 1#0##0#0#0.0#2019-03-09
10:16:11#0#17:05:00#15:13:00#00:00:00 1 4b3ea126958438ba04188e47bd00d83f
1308500 0 250000 0 0 0 140000 178375 0
0 420000 0 2258549 413581 40000 69120 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 03/07/1953 0 2
0 0 - 0 - 0 - 0 - 0 1262500
3440064 0 4 0 0 0 MIMING 19058034 65 23978
dr. Aa Ahmad Dimyati, Sp.B 0122R0020219V005707 0000435216126 3;JKN
1#0##0#0#0.0#2019-03-09 10:19:02#0#06:27:00#11:09:00#00:00:00 1
dff7a84afcae43b159a80faf253fd867 512500 0 200000 0 0
0 0 103875 0 0 280000 0 1998693 294996
50000 0 0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 04/05/1967 0 2
3999700 0 0 - 0 - 0 - 0 - 0
3999700 4235756 0 3 0 0 0 EHA 19057537 51
1#0##0#0#0.0#2019-03-09 11:29:13#0#22:41:00#11:11:00#00:00:00 1
04922ac9f25fd420265675f8ddad2d36 726525 2137750 120000 0
0 0 0 0 0 0 210000 0 686808 334673
20000 0 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 02/04/1961 0 2
0 0 - 0 - 0 - 0 - 0 6433000
3798168 0 4 0 0 0 MAMAN R 18050642 57 21148
1#0##0#0#0.0#2019-03-09 11:30:34#0#09:48:00#09:29:00#00:00:00 1
1c0ec8d7de65f5142bcef3451608c289 434434 2125000 200000 0
0 0 0 0 0 0 280000 0 60860 677874 20000
0 0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 10/12/1997 0 2
0 - 0 - 0 - 0 - 0 4853300 4468843
0 3 0 0 0 YUYUN KARTIKA 18049066 21 7748 DR. AA
AHMAD DIMYATI, SP.B 0122R0020219V006346 0000435948805 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 272184 1#0##0#0#0.0#2019-
03-09 11:33:43#0#20:42:00#08:42:00#00:00:00 2
a678b3c82fff0ebed16a281fc912773a 756525 1825000 170000 0
0 0 0 340125 0 0 210000 0 802300 354893
10000 0 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 01/01/1979 0 2
1 J18.9;Z03.0 - - - None None None None J-4-16-I None
3332600 0 0 - 0 - 0 - 0 - 0
3332600 2863047 0 4 0 0 0 ENUNG 19058137 40
4 272187 1#0##0#0#0.0#2019-03-09
11:35:22#0#22:42:00#11:39:00#00:00:00 1 af6e4667ade3cd4b07b5a64f756d0611
380500 0 150000 0 0 0 140000 128875 0
0 280000 0 1612789 120883 50000 0 0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 01/07/1990 0 2
- 0 - 0 - 0 - 0 1999800 1172811 0
3 0 0 0 MASIDAH 19058237 28 10467 dr. Asep Taslim
Sp.OG 0122R0020219V006373 0001005299921 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 272200 1#0##0#0#0.0#2019-
03-09 11:42:49#0#23:50:00#12:23:00#00:00:00 1
5fc9c138bf384314c267adc07dcf425d 427500 0 150000 0 0
0 0 276375 0 0 210000 0 23968 74968 10000 0
0 0
3206023 C 3 CP 1 19/02/2019 28/02/2019 07/08/1960 0 2
1 N18.5;K30;D63.8;I12.9 39.95 - - None None None None N-4-
GINJAL (SEDANG) 2976400 0 0 - 0 - 0 - 0 -
0 2976400 6414927 0 10 0 0 0 SATIBI
Huda;3278057010840004 5.3.6.201902021030 4 272202 1#0##0#0#0.0#2019-
03-09 11:45:36#0#23:39:00#11:34:00#00:00:00 1
d4578e2c33642a6bf8053e4bf315dc6e 621000 0 445000 0 841230
0 335000 2666675 0 0 700000 0 635512 120510
50000 0 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 07/11/1987 0 2
1 A91;A09.9 - - - None None None None A-4-13-I None
1509200 0 0 - 0 - 0 - 0 - 0
1509200 1308566 0 4 0 0 0 TITIN KURNIA
Huda;3278057010840004 5.3.6.201902021030 4 272207 1#0##0#0#0.0#2019-
03-09 11:47:15#0#16:02:00#11:37:00#00:00:00 1
21ec394f3dabe619afcf206e2787ec26 286000 0 170000 0 0
0 0 247875 0 0 280000 0 232225 42466 50000
0 0 0
3206023 C 3 CP 1 27/02/2019 28/02/2019 07/02/2000 0 2
1 O48;O80.9;O14.1;O99.0 73.59 - - None None None None W-4-
16-II None None None None None None GANGGUAN ANTEPARTUM (SEDANG) 2674300
0 0 - 0 - 0 - 0 - 0 2674300
1983065 0 2 0 0 0 GINA SYAYIDATUL KHODIJAH
4 272208 1#0##0#0#0.0#2019-03-09
11:52:12#0#18:00:00#11:44:00#00:00:00 1 b95a35fe0c91ab75d91a1574e65efcea
1132500 0 120000 0 0 0 0 163000 0 0
140000 0 74248 333317 20000 0 0 0
3206023 C 3 CP 1 28/02/2019 28/02/2019 16/01/1983 0 2
0 0 - 0 - 0 - 0 - 0 1544900
1955365 0 1 0 0 0 IDAH HAMIDAH 19058385 36
1#0##0#0#0.0#2019-03-09 11:53:59#0#03:42:00#12:10:00#00:00:00 1
be94faf717ecf142ae5eb8eea6b445e5 1240000 0 120000 0 0
0 0 276375 0 0 0 0 81506 217484 20000 0
0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 01/01/2014 0 2
None None None None GANGGUAN MATA LAIN-LAIN (RINGAN) 2580100 0
0 - 0 - 0 - 0 - 0 2580100 3653936
0 3 0 0 0 M RIZKI 19058249 5 1882 dr. Teguh
Budiman Sp.Ma. 0122R0020219V006357 0002393160996 3;JKN Nenden Nurul
Huda;3278057010840004 5.3.6.201902021030 4 272217 1#0##0#0#0.0#2019-
03-09 12:01:36#0#23:16:00#14:31:00#00:00:00 1
17c5df1de4cb128b833b2fc80245dc7f 686539 1825000 70000 0 0
0 0 500375 0 0 210000 0 57000 295022 10000
0 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 22/10/1996 0 2
(RINGAN) 4830200 0 0 - 0 - 0 - 0 - 0
4830200 6284479 0 4 0 0 0 SUAIDAH 19058069
1#0##0#0#0.0#2019-03-09 12:03:56#0#14:47:00#11:23:00#00:00:00 1
28fcce81237a7e242b8d6d738a3ebf4f 1044500 2137750 290000 0
0 0 0 300250 0 0 280000 0 985673
1216306 30000 0 0 0
3206023 C 2 CP 1 26/02/2019 28/02/2019 06/06/1970 0 2
5073400 0 0 - 0 - 0 - 0 - 0
5073400 2253088 0 3 0 0 0 ADE NENI 19056451
4 272231 1#0##0#0#0.0#2019-03-09
12:07:07#0#23:42:00#15:12:00#00:00:00 1 38c53066f3a40ea6c35cd7807f9a7b63
206934 1285000 140000 0 0 0 0 0 0 0
320000 0 47763 243391 10000 0 0 0
3206023 C 2 CP 1 27/02/2019 28/02/2019 07/01/1997 0 2
0 0 - 0 - 0 - 0 - 0 2194200
2043835 0 2 0 0 0 RENI RAHAYU 19058359 22 8086
dr. Asep Taslim Sp.OG 0122R0020219V007018 0001670238325 3;JKN Nenden
Nurul Huda;3278057010840004 5.3.6.201902021030 4 272235
1#0##0#0#0.0#2019-03-09 12:10:44#0#14:48:00#14:43:00#00:00:00 1
746f001552e0626010e816f404203690 1082500 0 50000 0 0 0
0 258750 0 0 140000 0 97812 394773 20000 0
0 0
3206023 C 1 CP 1 26/02/2019 28/02/2019 31/12/1929 0 2
5918900 0 0 - 0 - 0 - 0 - 0
5918900 2942178 0 3 0 0 0 UU SURYANA 18033520
4 272238 1#0##0#0#0.0#2019-03-09
12:12:10#0#22:47:00#12:05:00#00:00:00 1 0dd2aa8361e8eb2f48709613d00b096f
339434 1570000 200000 0 0 0 0 0 0 0
540000 0 48412 234332 10000 0 0 0
3206023 C 1 CP 1 26/02/2019 28/02/2019 19/06/1937 0 2
1 J18.9;I50.9;I48;I63.9 - - - None None None None J-4-
(BERAT) 8289600 0 0 - 0 - 0 - 0 - 0
8289600 3984724 0 3 0 0 0 IIK ATIKAH 19058166
4 270085 1#1#vip#0#6217200#75.0#2019-03-09
12:22:08#0#08:43:00#11:08:00#00:00:00 3 bdfa75f5a6aeb9b4e1a949a7610cbcfa
917500 0 330000 0 0 0 140000 142700 0
0 900000 0 733384 99940 30000 691200 0 0
3206023 C 1 CP 1 25/02/2019 28/02/2019 11/06/1963 0 2
SICKLE (RINGAN) 3105300 0 0 - 0 - 0 - 0 -
0 3105300 5159205 0 4 0 0 0 HENDRA KUSMANTO
4 270100 1#1#vip#4#2328975#75.0#2019-03-09
12:26:46#0#12:11:00#08:03:00#00:00:00 2 624c384abc2d58cbed27f4940a376ab2
850000 0 660000 0 0 0 0 2007975 0 0
1500000 0 49434 51796 40000 0 0 0
3206023 C 1 CP 1 25/02/2019 28/02/2019 05/01/1995 0 2
1 O61.9;Z37.0;O82.9;O99.0;O41.0 74.99;99.04 - - None None None
CAESAR (SEDANG) 7142800 0 0 - 0 - 0 - 0 -
0 7142800 6786061 0 4 0 0 0 SHELLA PUSPITA
DEWI 18044034 24 8817 dr. Asep Taslim Sp.OG 0122R0020219V006023
4 272247 1#0##0#0#0.0#2019-03-09
12:31:06#0#12:56:00#12:27:00#00:00:00 1 8967a5f9c8e55ff3b523162d3e174270
829500 2711250 590000 0 0 0 0 1069475 0
0 500000 0 428035 637801 20000 0 0 0
3206023 C 1 CP 1 26/02/2019 28/02/2019 01/04/2000 0 2
- 0 7814200 10038159 0 3 0 0 0 SITI
NURHAMZAH 18050813 18 6905 dr. Riadhi Yulianto Sp.B.
Huda;3278057010840004 5.3.6.201902021030 4 270097
1#1#vip#3#5860650#75.0#2019-03-09 12:38:34#0#22:42:00#11:26:00#00:00:00
3 d800586161608717d89be68d72f4edf3 1720025 3945000 495000
0 0 0 0 2265575 0 0 900000 0 303168
389391 20000 0 0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 05/05/1968 0 2
6622400 0 0 - 0 - 0 - 0 - 0
6622400 6013874 0 3 0 0 0 CUCU RUSMANA
5.3.6.201902021030 4 272510 1#0##0#0#0.0#2019-03-11
11:00:32#0#13:43:00#11:10:00#00:00:00 1 7d2cf0dd637e037949457cc679a1bc38
545000 3036500 170000 0 0 0 0 298625 0
0 210000 0 1082865 650884 20000 0 0 0
3206023 C 3 CP 1 24/02/2019 28/02/2019 17/07/1956 0 2
1 I61.9;G81.9 96.07;99.60;89.52;87.03 - - None None None None
G-4-13-II None None None None None None PERDARAHAN INTRA KRANIAL
BUKAN TRAUMATIK (SEDANG) 3826700 0 0 - 0 - 0 -
0 - 0 3826700 3679932 0 5 0 0 0 EUTIK
MARDIAH 19058020 62 22867 dr. Indra Gunawan, Sp.S 0122R0020219V006310
5.3.6.201902021030 4 272567 1#0##0#0#0.0#2019-03-11
13:25:53#0#16:01:00#05:07:00#00:00:00 1 3f9a2ee34f4dee2ed73320ef5c82dbe2
962500 0 200000 0 0 0 894800 103875 0
0 350000 0 1042930 55827 70000 0 0 0
3206023 C 3 CP 1 19/02/2019 28/02/2019 13/02/2019 2900 2
1 P90;P36.9;P70.4 88.71 - - None None None None P-8-17-II
None None None None None None NEONATAL, BBL > 2499 GR TANPA PROSEDUR
MAYOR (SEDANG) 5987500 0 0 - 0 - 0 - 0 -
0 5987500 5425456 0 10 0 0 0 BY NY RISA
RISMAWATI 19057633 0 6 dr. Marte Robiul Sani Sp.A.
Aeni;3206276601940002 5.3.6.201902021030 4 272573 1#0##0#0#0.0#2019-
03-11 13:28:48#0#10:51:00#08:50:00#00:00:00 1
973196561053424660a023b797be02ee 2280000 0 630000 0 0
0 290000 454000 0 0 1250000 0 110501 410955
0 0 0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 05/09/1964 0 2
4227800 0 0 - 0 - 0 - 0 - 0
4227800 2141349 0 3 0 0 0 PIAH SOPIAH 18034543
5.3.6.201902021030 4 272551 1#0##0#0#0.0#2019-03-11
14:03:41#0#23:44:00#08:43:00#00:00:00 2 9d6c4ca81170da98a6440bc20f5138f2
254434 1285000 100000 0 0 0 0 0 0 0
210000 0 46110 235805 10000 0 0 0
3206023 C 3 CP 1 25/02/2019 28/02/2019 29/03/1945 0 2
1 D10.6;K30;E87.1 - - - None None None None U-4-15-II
None None None None None None PENYAKIT TELINGA, HIDUNG, MULUT DAN
TENGGOROKAN LAIN-LAIN (SEDANG) 2739900 0 0 - 0 - 0
- 0 - 0 2739900 3737950 0 4 0 0 0
OHA 18026373 73 26996 DR. AA AHMAD DIMYATI, SP.B
Aeni;3206276601940002 5.3.6.201902021030 4 272540 1#0##0#0#0.0#2019-
03-11 14:04:32#0#18:01:00#09:33:00#00:00:00 2
87093768dd7bc4be05f914a61b6998e7 780000 0 300000 0 0
0 140000 993850 0 0 560000 0 779780 144320
40000 0 0 0
3206023 C 3 CP 1 24/02/2019 28/02/2019 01/12/1985 0 2
1 D21.2;D64.9 83.21;99.04 - - None None None None M-4-21-II
None None None None None None GANGGUAN SISTEM MUSKULOSKELETAL &
JA(RINGAN) PENGHUBUNG LAIN-LAIN (SEDANG) 2742100 0 0 - 0 -
0 - 0 - 0 2742100 6682281 0 5 0 0
0 RINA MEGASARI 18040832 33 12138 dr. Aa Ahmad Dimyati, Sp.B
Aeni;3206276601940002 5.3.6.201902021030 4 272028 1#0##0#0#0.0#2019-
03-13 09:26:32#0#12:28:00#09:17:00#00:00:00 1
874cd09c0b0a2c56895de6cfe7daef75 703000 1825000 190000 0
0 0 0 1781225 0 0 280000 0 1636214 226842
40000 0 0 0
3206023 C 3 CP 1 27/02/2019 28/02/2019 20/10/1984 0 2
1828500 0 0 - 0 - 0 - 0 - 0
1828500 2111838 0 2 0 0 0 NURJAMILAH 19058368
273845 1#0##0#0#0.0#2019-03-14 10:47:02#0#16:47:00#18:31:00#00:00:00
1 691b196377bdaee8c09703113477e21a 272500 0 50000 0 0
0 0 1216325 0 0 140000 0 316553 76460 40000
0 0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 19/09/1996 0 2
1 O72.0;O99.0 75.4;99.04 - - None None None None W-4-17-II
0 0 - 0 - 0 - 0 - 0 2664400
2462952 0 3 0 0 0 WATI RUHAETI 19058256 22
1#0##0#0#0.0#2019-03-15 14:19:27#0#00:37:00#12:12:00#00:00:00 2
64d74cd3410044d4f3652a12b605244f 470000 0 100000 0 0
0 0 1613975 0 0 140000 0 82581 26396 30000 0
0 0
3206023 C 3 CP 1 26/02/2019 28/02/2019 01/02/1959 0 2
1 T14.6 83.88;86.22 - - None None None None M-1-50-I None
None None None None None PROSEDUR JARINGAN LUNAK (RINGAN) 3840300
0 0 - 0 - 0 - 0 - 0 3840300
4465488 0 3 0 0 0 ADE SUGANDA 19058250 60 21940
DR. AA AHMAD DIMYATI, SP.B 0122R0020219V006374 0000431143751 3;JKN
1#0##0#0#0.0#2019-03-15 14:21:48#0#23:53:00#08:42:00#00:00:00 2
7dacff38145c8580576d210f34f40c87 242000 2137750 20000 0 0
0 0 216225 0 0 210000 0 801768 827745
10000 0 0 0
3206023 C 3 CP 1 21/02/2019 28/02/2019 10/11/1977 0 2
1 I48;K76.1;I21.3 99.18 - - None None None None I-4-19-III
None None None None None None GANGGUAN KONDUKSI & ARITMIA JANTUNG
(BERAT) 5417700 0 0 - 0 - 0 - 0 - 0
5417700 9507456 0 8 0 0 0 YADI 18026934 41
5.3.6.201902021030 4 272555 1#0##0#0#0.0#2019-03-15
14:24:14#0#20:40:00#15:37:00#00:00:00 2 5a1f3a9a155eb8d783ba1411085cff68
2767500 0 495000 0 0 0 0 781000 0 0
615000 890000 2654167 222549 80000 1002240 0 0

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