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CLINICAL PATHWAY dan DRGs CASE SMF BEDAH RSI PURWOKERTO APENDISITIS KRONIS
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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Gula Darah
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Kimia Klinik ( Liver fungsi )
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HBsAg
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Urin rutin
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ECG
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Thorax Foto
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USG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi
Obat - obatan : Antibiotik
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Analgetik
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Nutrisi
Mobilisasi Tindakan Medik Operatif : Apendiktomi /47.0
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Jum Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 36.0
APENDIKTOMI
WAY dan DRGs CASE MIX H RSI PURWOKERTO DISITIS KRONIS Tinggi Badan
ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
APENDIKTOMI
47.0
CLINICAL PATHWAY dan D SMF BEDAH RSI PURW APENDISITIS AK
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Berat Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Kelas
Hari Rawat 1
Tgl Masuk
Hari Rawat 2
Tgl Keluar
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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Gula Darah
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Kimia Klinik ( Liver fungsi )
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HBsAg
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Urin rutin
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ECG
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Thorax Foto
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USG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi
Obat - obatan : Antibiotik
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Analgetik
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Nutrisi
Mobilisasi Tindakan Medik Operatif : Apendiktomi /47.0
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Kode ICD 10
Jenis T
K 36.0
APEN
Nama Pelaksana Verifikasi
Komplikasi
NICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO APENDISITIS AKUT Tinggi Badan Nomor Rekam Medis
ICD X:
Rencana Rawat: 7 Hari
Tgl Keluar
Tarif/hr (Rp)
Hari Rawat 4
Hari Rawat 5
Hari Rawat 6
Biaya (Rp)
Hari Rawat 7
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
APENDIKTOMI
47.0
CLINICAL PATHWAY dan DRGs CASE M SMF BEDAH RSI PURWOKERTO APENDISITIS ABSES
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Jenis Kelamin
Umur
Diagnosis Awal :
Berat Badan Tinggi Badan
Kode ICD X: R.Rawat
Kelas
Tgl Masuk
Tgl Keluar
Aktivitas Pelayanan Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ( Liver Fungsi ) Urin rutin ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan
Hari
Hari
Hari
Obat lainnya Bahan habis pakai Lain - lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Drainase apendix 47.
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 36.0
APENDIKTOMI
Y dan DRGs CASE MIX SI PURWOKERTO ITIS ABSES Nomor Rekam Medis
Rencana Rawat: 7 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
Hari
Jenis Tindakan :
Kode ICD 9 - CM
APENDIKTOMI
47.0
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO HIPERTROPHY PROSTAT
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Tinggi Badan
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Tarif/hr (Rp)
Hari Rawat 4
Asessmen Klinis : Pemeriksaan Dokter
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Masa Pembekuan
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Gula Darah
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● Liver Fungsi
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● Fungsi Ginjal
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HBsAg
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ECG
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Thorax Foto
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Cystogram
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Antibiotik
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Analgetik
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Cairan / IVFD
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Konsultasi
Pemeriksaan Penunjang :
Kimia Klinik:
Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Nutrisi
Mobilisasi
Tindakan Medik Operatif : PROSTATEKTOMY
Hasil ( Outcome ) : 1.
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Varians
Pendidikan / Rencana Pemulangan
Jumlah Bia Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 36.0
PROSTATEKTOMY
CASE MIX ERTO AT Nomor Rekam Medis
Rencana Rawat: 5 Hari
if/hr (Rp)
Biaya (Rp)
Hari Rawat 5
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an :
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Jumlah Biaya Kode ICD 9 - CM 47.0
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO BATU EMPEDU
PURWOKERTO
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Gula Darah
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Kimia Klinik ( Liver fungsi )
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ECG
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Thorax Foto
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USG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
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Nutrisi
Mobilisasi Tindakan Medik Operatif : KOLESISTEKTOMI / 51.22 Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
J Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
k 80.2
KOLESISTEKTOMI
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO BATU EMPEDU Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
KOLESISTEKTOMI
51.22
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO STRUMA
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Masa Pembekuan
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Gula Darah
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● TSH
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● T3
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● T4
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ECG
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Thorax Foto
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Konsultasi
Pemeriksaan Penunjang :
Kimia Klinik: ● Liver Fungsi Endokrin :
Diagnosa : Penyakit Utama Penyakit Penyerta
Komplikasi Obat - obatan : Antibiotik
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Analgetik
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Nutrisi
Mobilisasi Tindakan Medik Operatif : TIROIDEKTOMI/ 06.1
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
J Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Kode ICD 10
Jenis Tindakan :
E 04.1
TIROIDEKTOMI
Nama Pelaksana Verifikasi
Komplikasi
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO STRUMA Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
TIROIDEKTOMI
06.1
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERT Ca MAMMAE
RUMAH SAKIT ISL PURWOKERTOAM
Umur
Nama Pasien :
Jenis Kelamin Berat Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Kelas
Tgl Masuk
Tgl Keluar
Hari
Hari
Aktivitas Pelayanan Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Masa Pembekuan Gula Darah Kimia Klinik: ● Liver Fungsi Thorax Foto ECG USG Payudara Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
Cairan
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif MASTEKTOMI/ 85.41
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Nama Pelaksana Verifikasi Komplikasi
Kode ICD 10
Jenis Tindakan :
C 50.9
MASTEKTOMI
HWAY dan DRGs CASE MIX H RSI PURWOKERTO Ca MAMMAE Tinggi Badan
ode ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
Jenis Tindakan :
Kode ICD 9 - CM
MASTEKTOMI
85.41
CLINICAL PATHWAY dan DRGs SMF BEDAH RSI PURWOK TUMOR MAMMAE JINA
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Diagnosis Awal :
Kode ICD 10 : R. Rawat
Aktivitas Pelayanan
Jenis Kelamin
Kelas
Hari Rawat 1
Tgl Masuk
Hari Rawat 2
Assesmen Klinis : Pemeriksaan dokter
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Darah Rutin
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Masa Pembekuan
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Gula Darah
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Kimia Klinik ( Liver Fungsi )
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Thorax Foto
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ECG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : EKSISI / 85.20
Hasil ( Outcome )
Varians :
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir Utama
Nama Perawat : Nama Pelaksana Verifikasi :
Penyerta Komplikasi
CAL PATHWAY dan DRGs CASE MIX MF BEDAH RSI PURWOKERTO TUMOR MAMMAE JINAK Berat Badan
Tinggi Badan
de ICD 10 :
Nomor Rekam Medis
Rencana Rawat : 3 hari Tgl Keluar
Hari Rawat 2
Tarif/hr ( Rp )
Hari Rawat 3
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Biaya ( Rp )
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Jumlah Biaya ICD 10
Jenis Tindakan :
ICD 9 - CM
D. 24
EKSISI
85.20
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO SOFT TISSUE TUMOR
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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2.
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Darah rutin
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Masa Pembekuan
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Gula Darah
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Antibiotik
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Analgetik
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif :
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO T TISSUE TUMOR Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO FRAKTUR
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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1.
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2.
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Darah rutin
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[-]
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[-]
Masa Pembekuan
[+]
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[-]
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[-]
Gula Darah
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[-]
Rontgen
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Antibiotik
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[-]
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[-]
Analgetik
[+]
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[+]
[-]
[+]
[-]
Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif :
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO FRAKTUR Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
CLINICAL PATHWAY dan DRGs CA SMF BEDAH RSI PURWOKER ILEUS
RUMAH SAKIT ISL PURWOKERTOAM
NAMA PASIEN:
Umur
Diagnosis Awal:
Jenis Kelamin
Berat Badan
Kode ICD 10 : R. Rawat
Kelas
Tgl Masuk
Tgl Keluar
Aktivitas Pelayanan Hari
Assesmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang : Darah rutin Masa Pembekuan Masa Perdarahan Gula darah Kimia Klinik ● Liver Fungsi ● HBsAg ECG Thorax foto Diagnosis: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan: Antibiotik
Hari
Hari
Hari
Hari
Hari
Analgetik
Cairan
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif
Hasil ( Out come ) :
Varian
INA DRG
Nama Perawat
Diagnosis Akhir Utama Penyerta
Nama Dokter Nama Pelaksana Verifikasi :
Komplikasi
ICD 10
Jenis Tindakan
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO ILEUS Berat Badan
Tinggi Badan
Nomor Rekam Medis
Rencana Rawat: 10 Hari Tgl Keluar
Hari
Tarif/hr(Rp)
Hari
Hari
Biaya ( Rp ): Hari
Jenis Tindakan
ICD 9 - CM
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERT TUMOR KOLON
RUMAH SAKIT ISL PURWOKERTOAM
Umur
Nama Pasien :
Jenis Kelamin Berat Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Masa Pembekuan Masa Perdarahan Gula Darah Kimia Klinik: ● Liver Fungsi ECG Thorax Foto Colon in loop Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Kelas
Hari
Tgl Masuk
Tgl Keluar
Hari
Hari
Analgetik
Cairan
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif HEMIKOLEKTOMI/45.73
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
C 18.9
HEMIKOLEKTOM
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO UMOR KOLON Tinggi Badan
e ICD X:
Nomor Rekam Medis
Rencana Rawat: 6 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
Hari
Jenis Tindakan :
Kode ICD 9 - CM
HEMIKOLEKTOMI
45.73
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO HERNIA INGUINALIS
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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[-]
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Gula Darah
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[-]
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[-]
Kimia Klinik ( Liver Fungsi )
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[-]
HBsAg
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ECG
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Thorax Foto
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : REPAIR ING HERNIA
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
J Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 40.9
REPAIR ING HERNIA
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO RNIA INGUINALIS Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
REPAIR ING HERNIA
53.01
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO HERNIA FEMORALIS
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin Berat Badan Tinggi Badan
Kelas
Tgl Masuk
Kode ICD X: Tgl Keluar
Hari
Hari
Diagnosis Awal : R.Rawat Aktivitas Pelayanan
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ( Liver Fungsi ) ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
Cairan
Hari
Tarif/hr (Rp) Hari
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif Repair Femoral Hernia
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta
Komplikasi
Kode ICD 10
Jenis Tindakan :
K 41.9
Repair Femoral Hernia
n DRGs CASE MIX URWOKERTO ORALIS Nomor Rekam Medis Rencana Rawat: 5 Hari Tarif/hr (Rp) Biaya (Rp) Hari
s Tindakan :
Femoral Hernia
Kode ICD 9 - CM 53.29
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO PALATOSCHISIS UNILATERAL
RUMAH SAKIT ISL PURWOKERTOAM
Umur Jenis Kelamin Berat Badan
Nama Pasien : Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Diagnostik : Darah rutin Colon inloop Pemeriksaan Penunjang Tindakan OP : Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan Obat lainya Bahan habis pakai
Kelas
Tgl Masuk
Tgl Keluar
Hari
Hari
Lain-lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Repair Cleft Pal
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta
Komplikasi
Kode ICD 10 Jenis Tindakan : K 37.2
Repair Cleft Pal
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO SCHISIS UNILATERAL Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
nis Tindakan :
epair Cleft Pal
Kode ICD 9 - CM
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO LABIOSCHISIS UNILATERAL
RUMAH SAKIT ISL PURWOKERTOAM
Umur
Nama Pasien :
Jenis Kelamin
Diagnosis Awal : Kelas
Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Diagnostik : Darah rutin Colon inloop Pemeriksaan Penunjang Tindakan OP : Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan Obat lainya Bahan habis pakai
Tinggi Badan
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Berat Badan
Tgl Masuk
Tgl Keluar
Hari
Hari
Tarif/hr (Rp)
Hari
Lain-lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Repair Cleft Lip
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta
Komplikasi
Kode ICD 10 Jenis Tindakan : K 36.0
Repair Cleft Lip
DRGs CASE MIX WOKERTO LATERAL Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Biaya (Rp)
Kode ICD 9 - CM 47.0
CLINICAL PATHWAY dan DRGs CASE MIX
RUMAH SAKIT ISL PURWOKERTOAM
SMF BEDAH RSI PURWOKERTO LABIOSCHISIS BILATERAL Umur
Nama Pasien :
Jenis Kelamin Berat Badan Tinggi Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Diagnostik : Darah rutin Colon inloop Pemeriksaan Penunjang Tindakan OP : Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan Obat lainya Bahan habis pakai
Kelas
Tgl Masuk
Tgl Keluar
Hari
Hari
Tarif/hr (Rp)
Hari
Lain-lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Repair Cleft Lip
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Nama Pelaksana Verifikasi Komplikasi
Kode ICD 10 Jenis Tindakan : K 36.0
Repair Clef Lip
RGs CASE MIX
WOKERTO
ATERAL Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Biaya (Rp)
Kode ICD 9 - CM 47.0
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERT HEMOROID
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Diagnosis Awal :
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Assesmen Klinis : Pemeriksaan dokter
Tinggi Badan
Kode ICD 10 : R. Rawat
Aktivitas Pelayanan
Jenis Kelamin
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Antibiotik
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : Hemoroidektomi/ 49.46
Hasil ( Outcome )
Varians :
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi :
Penyerta Komplikasi
Hemoroid
ICD 10
Jenis Ti
I 84.9
Hemoro
an DRGs CASE MIX PURWOKERTO OID Tinggi Badan
Nomor Rekam Medis
Rencana Rawat : 3 hari Tarif/hr ( Rp )
Hari Rawat 3
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Biaya ( Rp )
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Jumlah Biaya Jenis Tindakan :
ICD 9 - CM
Hemoroidektomi
49.46
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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Gula Darah
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Kimia Klinik ( Liver fungsi )
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HBsAg
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Urin rutin
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ECG
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Thorax Foto
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USG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi
Obat - obatan : Antibiotik
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Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : Apendiktomi /47.0
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Jum Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 36.0
APENDIKTOMI
WAY dan DRGs CASE MIX H RSI PURWOKERTO DISITIS KRONIS Tinggi Badan
ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
APENDIKTOMI
47.0
CLINICAL PATHWAY dan D SMF BEDAH RSI PURW APENDISITIS AK
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Berat Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Kelas
Hari Rawat 1
Tgl Masuk
Hari Rawat 2
Tgl Keluar
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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Gula Darah
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Kimia Klinik ( Liver fungsi )
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HBsAg
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Urin rutin
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ECG
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Thorax Foto
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USG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi
Obat - obatan : Antibiotik
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Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : Apendiktomi /47.0
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Kode ICD 10
Jenis T
K 36.0
APEN
Nama Pelaksana Verifikasi
Komplikasi
NICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO APENDISITIS AKUT Tinggi Badan Nomor Rekam Medis
ICD X:
Rencana Rawat: 7 Hari
Tgl Keluar
Tarif/hr (Rp)
Hari Rawat 4
Hari Rawat 5
Hari Rawat 6
Biaya (Rp)
Hari Rawat 7
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
APENDIKTOMI
47.0
CLINICAL PATHWAY dan DRGs CASE M SMF BEDAH RSI PURWOKERTO APENDISITIS ABSES
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Jenis Kelamin
Umur
Diagnosis Awal :
Berat Badan Tinggi Badan
Kode ICD X: R.Rawat
Kelas
Tgl Masuk
Tgl Keluar
Aktivitas Pelayanan Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ( Liver Fungsi ) Urin rutin ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan
Hari
Hari
Hari
Obat lainnya Bahan habis pakai Lain - lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Drainase apendix 47.
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 36.0
APENDIKTOMI
Y dan DRGs CASE MIX SI PURWOKERTO ITIS ABSES Nomor Rekam Medis
Rencana Rawat: 7 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
Hari
Jenis Tindakan :
Kode ICD 9 - CM
APENDIKTOMI
47.0
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO HIPERTROPHY PROSTAT
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Tinggi Badan
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Tarif/hr (Rp)
Hari Rawat 4
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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Gula Darah
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● Liver Fungsi
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● Fungsi Ginjal
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HBsAg
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ECG
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Thorax Foto
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Cystogram
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Antibiotik
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Analgetik
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Cairan / IVFD
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Konsultasi
Pemeriksaan Penunjang :
Kimia Klinik:
Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Nutrisi
Mobilisasi
Tindakan Medik Operatif : PROSTATEKTOMY
Hasil ( Outcome ) : 1.
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Varians
Pendidikan / Rencana Pemulangan
Jumlah Bia Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 36.0
PROSTATEKTOMY
CASE MIX ERTO AT Nomor Rekam Medis
Rencana Rawat: 5 Hari
if/hr (Rp)
Biaya (Rp)
Hari Rawat 5
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an :
OMY
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Jumlah Biaya Kode ICD 9 - CM 47.0
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO BATU EMPEDU
PURWOKERTO
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Gula Darah
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Kimia Klinik ( Liver fungsi )
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ECG
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Thorax Foto
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USG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : KOLESISTEKTOMI / 51.22 Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
J Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
k 80.2
KOLESISTEKTOMI
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO BATU EMPEDU Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
KOLESISTEKTOMI
51.22
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO STRUMA
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Gula Darah
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● TSH
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● T3
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● T4
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ECG
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Thorax Foto
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Konsultasi
Pemeriksaan Penunjang :
Kimia Klinik: ● Liver Fungsi Endokrin :
Diagnosa : Penyakit Utama Penyakit Penyerta
Komplikasi Obat - obatan : Antibiotik
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Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : TIROIDEKTOMI/ 06.1
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
J Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Kode ICD 10
Jenis Tindakan :
E 04.1
TIROIDEKTOMI
Nama Pelaksana Verifikasi
Komplikasi
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO STRUMA Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
TIROIDEKTOMI
06.1
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERT Ca MAMMAE
RUMAH SAKIT ISL PURWOKERTOAM
Umur
Nama Pasien :
Jenis Kelamin Berat Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Kelas
Tgl Masuk
Tgl Keluar
Hari
Hari
Aktivitas Pelayanan Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Masa Pembekuan Gula Darah Kimia Klinik: ● Liver Fungsi Thorax Foto ECG USG Payudara Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
Cairan
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif MASTEKTOMI/ 85.41
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Nama Pelaksana Verifikasi Komplikasi
Kode ICD 10
Jenis Tindakan :
C 50.9
MASTEKTOMI
HWAY dan DRGs CASE MIX H RSI PURWOKERTO Ca MAMMAE Tinggi Badan
ode ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
Jenis Tindakan :
Kode ICD 9 - CM
MASTEKTOMI
85.41
CLINICAL PATHWAY dan DRGs SMF BEDAH RSI PURWOK TUMOR MAMMAE JINA
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Diagnosis Awal :
Kode ICD 10 : R. Rawat
Aktivitas Pelayanan
Jenis Kelamin
Kelas
Hari Rawat 1
Tgl Masuk
Hari Rawat 2
Assesmen Klinis : Pemeriksaan dokter
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Darah Rutin
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Masa Pembekuan
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[-]
Gula Darah
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[-]
Kimia Klinik ( Liver Fungsi )
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Thorax Foto
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ECG
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : EKSISI / 85.20
Hasil ( Outcome )
Varians :
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir Utama
Nama Perawat : Nama Pelaksana Verifikasi :
Penyerta Komplikasi
CAL PATHWAY dan DRGs CASE MIX MF BEDAH RSI PURWOKERTO TUMOR MAMMAE JINAK Berat Badan
Tinggi Badan
de ICD 10 :
Nomor Rekam Medis
Rencana Rawat : 3 hari Tgl Keluar
Hari Rawat 2
Tarif/hr ( Rp )
Hari Rawat 3
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Biaya ( Rp )
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Jumlah Biaya ICD 10
Jenis Tindakan :
ICD 9 - CM
D. 24
EKSISI
85.20
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO SOFT TISSUE TUMOR
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Gula Darah
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Antibiotik
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Analgetik
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif :
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO T TISSUE TUMOR Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO FRAKTUR
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Gula Darah
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Rontgen
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Antibiotik
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Analgetik
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[-]
[+]
[-]
Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif :
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO FRAKTUR Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
CLINICAL PATHWAY dan DRGs CA SMF BEDAH RSI PURWOKER ILEUS
RUMAH SAKIT ISL PURWOKERTOAM
NAMA PASIEN:
Umur
Diagnosis Awal:
Jenis Kelamin
Berat Badan
Kode ICD 10 : R. Rawat
Kelas
Tgl Masuk
Tgl Keluar
Aktivitas Pelayanan Hari
Assesmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang : Darah rutin Masa Pembekuan Masa Perdarahan Gula darah Kimia Klinik ● Liver Fungsi ● HBsAg ECG Thorax foto Diagnosis: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan: Antibiotik
Hari
Hari
Hari
Hari
Hari
Analgetik
Cairan
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif
Hasil ( Out come ) :
Varian
INA DRG
Nama Perawat
Diagnosis Akhir Utama Penyerta
Nama Dokter Nama Pelaksana Verifikasi :
Komplikasi
ICD 10
Jenis Tindakan
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO ILEUS Berat Badan
Tinggi Badan
Nomor Rekam Medis
Rencana Rawat: 10 Hari Tgl Keluar
Hari
Tarif/hr(Rp)
Hari
Hari
Biaya ( Rp ): Hari
Jenis Tindakan
ICD 9 - CM
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERT TUMOR KOLON
RUMAH SAKIT ISL PURWOKERTOAM
Umur
Nama Pasien :
Jenis Kelamin Berat Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Masa Pembekuan Masa Perdarahan Gula Darah Kimia Klinik: ● Liver Fungsi ECG Thorax Foto Colon in loop Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Kelas
Hari
Tgl Masuk
Tgl Keluar
Hari
Hari
Analgetik
Cairan
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif HEMIKOLEKTOMI/45.73
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
C 18.9
HEMIKOLEKTOM
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO UMOR KOLON Tinggi Badan
e ICD X:
Nomor Rekam Medis
Rencana Rawat: 6 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
Hari
Jenis Tindakan :
Kode ICD 9 - CM
HEMIKOLEKTOMI
45.73
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERTO HERNIA INGUINALIS
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Jenis Kelamin
Diagnosis Awal :
Kode ICD X: R. Rawat
Aktivitas Pelayanan
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Hari Rawat 3
Asessmen Klinis : Pemeriksaan Dokter
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Darah rutin
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Masa Pembekuan
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Masa Perdarahan
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Gula Darah
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[-]
Kimia Klinik ( Liver Fungsi )
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HBsAg
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ECG
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Thorax Foto
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Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
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Cairan / IVFD
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Nutrisi
Mobilisasi Tindakan Medik Operatif : REPAIR ING HERNIA
Hasil ( Outcome ) :
Varians
Pendidikan / Rencana Pemulangan
J Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta Komplikasi
Kode ICD 10
Jenis Tindakan :
K 40.9
REPAIR ING HERNIA
THWAY dan DRGs CASE MIX DAH RSI PURWOKERTO RNIA INGUINALIS Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari Rawat 4
Biaya (Rp)
Hari Rawat 5
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Jumlah Biaya Jenis Tindakan :
Kode ICD 9 - CM
REPAIR ING HERNIA
53.01
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO HERNIA FEMORALIS
RUMAH SAKIT ISL PURWOKERTOAM
Nama Pasien :
Umur
Jenis Kelamin Berat Badan Tinggi Badan
Kelas
Tgl Masuk
Kode ICD X: Tgl Keluar
Hari
Hari
Diagnosis Awal : R.Rawat Aktivitas Pelayanan
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ( Liver Fungsi ) ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Antibiotik
Analgetik
Cairan
Hari
Tarif/hr (Rp) Hari
Lain - lain Diit Lain - lain JUMLAH BIAYA Tindakan Medik Operatif Repair Femoral Hernia
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta
Komplikasi
Kode ICD 10
Jenis Tindakan :
K 41.9
Repair Femoral Hernia
n DRGs CASE MIX URWOKERTO ORALIS Nomor Rekam Medis Rencana Rawat: 5 Hari Tarif/hr (Rp) Biaya (Rp) Hari
s Tindakan :
Femoral Hernia
Kode ICD 9 - CM 53.29
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO PALATOSCHISIS UNILATERAL
RUMAH SAKIT ISL PURWOKERTOAM
Umur Jenis Kelamin Berat Badan
Nama Pasien : Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Diagnostik : Darah rutin Colon inloop Pemeriksaan Penunjang Tindakan OP : Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan Obat lainya Bahan habis pakai
Kelas
Tgl Masuk
Tgl Keluar
Hari
Hari
Lain-lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Repair Cleft Pal
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta
Komplikasi
Kode ICD 10 Jenis Tindakan : K 37.2
Repair Cleft Pal
HWAY dan DRGs CASE MIX AH RSI PURWOKERTO SCHISIS UNILATERAL Tinggi Badan
de ICD X:
Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Hari
Biaya (Rp)
nis Tindakan :
epair Cleft Pal
Kode ICD 9 - CM
CLINICAL PATHWAY dan DRGs CASE MIX SMF BEDAH RSI PURWOKERTO LABIOSCHISIS UNILATERAL
RUMAH SAKIT ISL PURWOKERTOAM
Umur
Nama Pasien :
Jenis Kelamin
Diagnosis Awal : Kelas
Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Diagnostik : Darah rutin Colon inloop Pemeriksaan Penunjang Tindakan OP : Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan Obat lainya Bahan habis pakai
Tinggi Badan
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Berat Badan
Tgl Masuk
Tgl Keluar
Hari
Hari
Tarif/hr (Rp)
Hari
Lain-lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Repair Cleft Lip
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi
Penyerta
Komplikasi
Kode ICD 10 Jenis Tindakan : K 36.0
Repair Cleft Lip
DRGs CASE MIX WOKERTO LATERAL Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Biaya (Rp)
Kode ICD 9 - CM 47.0
CLINICAL PATHWAY dan DRGs CASE MIX
RUMAH SAKIT ISL PURWOKERTOAM
SMF BEDAH RSI PURWOKERTO LABIOSCHISIS BILATERAL Umur
Nama Pasien :
Jenis Kelamin Berat Badan Tinggi Badan
Diagnosis Awal :
Kode ICD X: R.Rawat
Aktivitas Pelayanan
Hari
Asessmen Klinis : Pemeriksaan Dokter Konsultasi Pemeriksaan Penunjang Diagnostik : Darah rutin Colon inloop Pemeriksaan Penunjang Tindakan OP : Darah rutin Faktor Pembekuan Gula Darah Kimia Klinik ECG Thorax Foto Diagnosa: Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan : Obat Anastesi Cairan Obat lainya Bahan habis pakai
Kelas
Tgl Masuk
Tgl Keluar
Hari
Hari
Tarif/hr (Rp)
Hari
Lain-lain Nutrisi Mobilisasi JUMLAH BIAYA Tindakan Medik Operatif Repair Cleft Lip
Hasil ( Out come ) :
Varian
INA DRG
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat :
Penyerta
Nama Pelaksana Verifikasi Komplikasi
Kode ICD 10 Jenis Tindakan : K 36.0
Repair Clef Lip
RGs CASE MIX
WOKERTO
ATERAL Nomor Rekam Medis
Rencana Rawat: 5 Hari Tarif/hr (Rp)
Hari
Biaya (Rp)
Kode ICD 9 - CM 47.0
CLINICAL PATHWAY dan DRGs CAS SMF BEDAH RSI PURWOKERT HEMOROID
RUMAH SAKIT ISL PURWOKERTO AM
Nama Pasien :
Umur
Diagnosis Awal :
Berat Badan
Kelas
Hari Rawat 1
Tgl Masuk
Tgl Keluar
Hari Rawat 2
Assesmen Klinis : Pemeriksaan dokter
Tinggi Badan
Kode ICD 10 : R. Rawat
Aktivitas Pelayanan
Jenis Kelamin
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1.
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2.
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[-]
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Darah Rutin
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[-]
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[-]
Masa Pembekuan
[+]
[-]
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[-]
Masa Perdarahan
[+]
[-]
[+]
[-]
Gula Darah
[+]
[-]
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[-]
Anoskopi
[+]
[-]
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[-]
Antibiotik
[+]
[-]
[+]
[-]
Analgetik
[+]
[-]
[+]
[-]
Konsultasi
Pemeriksaan Penunjang :
Diagnosa : Penyakit Utama Penyakit Penyerta Komplikasi Obat - obatan :
Cairan / IVFD
[+]
[-]
[+]
[-]
[+]
[-]
[+]
[-]
1.
[+]
[-]
[+]
[-]
2.
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[-]
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[-]
1.
[+]
[-]
[+]
[-]
2.
[+]
[-]
[+]
[-]
Nutrisi
Mobilisasi Tindakan Medik Operatif : Hemoroidektomi/ 49.46
Hasil ( Outcome )
Varians :
Pendidikan / Rencana Pemulangan
Nama Dokter :
Diagnosis Akhir : Utama
Nama Perawat : Nama Pelaksana Verifikasi :
Penyerta Komplikasi
Hemoroid
ICD 10
Jenis Ti
I 84.9
Hemoro
an DRGs CASE MIX PURWOKERTO OID Tinggi Badan
Nomor Rekam Medis
Rencana Rawat : 3 hari Tarif/hr ( Rp )
Hari Rawat 3
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Biaya ( Rp )
[+]
[-]
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[-]
[+]
[-]
[+]
[-]
[+]
[-]
[+]
[-]
Jumlah Biaya Jenis Tindakan :
ICD 9 - CM
Hemoroidektomi
49.46
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