Rajawali.xlsx

DAFTAR CLAIM PASIEN CATHLAB BULAN OKTOBER 2016 (SUSULAN)

No

Nama Pasien

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Yohanes Kaendo Enay Sunarsih Aa Suhara Hidayat Didin Dadang Sutarya Santi Eliawati Tati Kustiah Asmawar Bakrie Novi Susanti Cahyadi Yusuf Affandi Asep Supiandi Setia Mulyana Taufik Rahman Udin Nurdin Djanawi Legimin Total

Tarif BPJS

Tarif RS

BHP KSO

Rumah Sakit

Rp 33,794,200 Rp 16,597,300 Rp 10,248,200 Rp 18,855,200 Rp 10,248,200 Rp 7,099,700 Rp 7,099,700 Rp 52,408,600 Rp 52,408,600 Rp 47,061,100 Rp 47,061,100 Rp 24,992,200 Rp 33,794,200 Rp 18,792,200 Rp 10,248,200 Rp 6,085,200 Rp 6,085,200 Rp 402,879,100

Rp 47,186,100 Rp 21,925,400 Rp 11,113,100 Rp 18,270,400 Rp 10,248,200 Rp 21,925,400 Rp 21,925,400 Rp 52,706,292 Rp 52,859,600 Rp 47,697,100 Rp 47,061,100 Rp 26,091,930 Rp 47,061,100 Rp 18,792,200 Rp 10,248,200 Rp 18,792,200 Rp 8,060,360 Rp 481,964,082

Rp 17,499,660 Rp 3,161,250 Rp 2,633,580 Rp 2,941,080 Rp 2,443,580 Rp 2,767,750 Rp 2,710,800 Rp 13,881,160 Rp 20,308,300 Rp 27,110,900 Rp 14,270,600 Rp 19,878,660 Rp 14,373,660 Rp 2,751,080 Rp 3,012,300 Rp 2,847,750 Rp 2,553,580 Rp 155,145,690

Rp 4,691,322 Rp 8,076,968 Rp 8,069,998 Rp 7,469,130 Rp 5,604,475 Rp 2,877,195 Rp 2,387,337 Rp 8,379,045 Rp 5,060,323 Rp 6,381,336 Rp 8,290,367 Rp 6,213,270 Rp 7,563,841 Rp 3,185,590 Rp 5,179,524 Rp 5,808,430 Rp 5,600,187 Rp 100,838,338

Tarif dikurang RS+BHP KSO Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

11,603,218 5,359,082 (455,378) 8,444,990 2,200,145 1,454,755 2,001,563 30,148,395 27,039,977 13,568,864 24,500,133 (1,099,730) 11,856,699 12,855,530 2,056,376 (2,570,980) (2,068,567) 146,895,072

Jasa 70% Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

RS + KSO 30%

8,122,253 3,751,357 (318,765) 5,911,493 1,540,102 1,018,329 1,401,094 21,103,877 18,927,984 9,498,205 17,150,093 (769,811) 8,299,689 8,998,871 1,439,463 (1,799,686) (1,447,997) 102,826,550

Rp 3,480,965 Rp 1,607,725 Rp (136,613) Rp 2,533,497 Rp 660,044 Rp 436,427 Rp 600,469 Rp 9,044,519 Rp 8,111,993 Rp 4,070,659 Rp 7,350,040 Rp (329,919) Rp 3,557,010 Rp 3,856,659 Rp 616,913 Rp (771,294) Rp (620,570) Rp 44,068,522

Fasilitas RS (40%) Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

1,392,386 643,090 (54,645) 1,013,399 264,017 174,571 240,188 3,617,807 3,244,797 1,628,264 2,940,016 (131,968) 1,422,804 1,542,664 246,765 (308,518) (248,228) 17,627,409

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners

PNS III/c NIP. 198303122007122001

Sewa Alat Rajawali (60%) Rp 2,088,579 Rp 964,635 Rp (81,968) Rp 1,520,098 Rp 396,026 Rp 261,856 Rp 360,281 Rp 5,426,711 Rp 4,867,196 27490977 Rp 2,442,396 14204864 Rp 4,410,024 24500133 Rp (197,951) Rp 2,134,206 25123599 Rp 2,313,995 12855530 Rp 370,148 2056376 Rp (462,776) 10136020 Rp (372,342) Rp 26,441,113

2017 antung

p Ners

7122001

DAFTAR CLAIM PASIEN CATHLAB BULAN NOVEMBER 2016 (SUSULAN) No

Nama Pasien

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

Kalam Saragih Rita Rohaeni Manah Iting Wartini A.R. Rozali Endang Asiah Rasiti Zaenudin Emay Mardiah Marsih Tutik Hariyani Sarip Wida Sutarsih Evi Lisnawati Jajang Etty Kustiawati Abad Badrudin Harmon Sukarya Suwarso Abas Kurnia Tutis Nugraha Endang Kustoyo Umar Saleh Mamat Nurahmat Entin Sulastri Parhan Total

Tarif BPJS

Tarif RS

BHP KSO

Rumah Sakit

Rp 16,597,300 Rp 6,172,100 Rp 11,855,200 Rp 14,937,500 Rp 14,226,200 Rp 14,226,200 Rp 24,971,400 Rp 43,766,800 Rp 43,766,800 Rp 57,108,100 Rp 50,437,500 Rp 7,387,900 Rp 14,937,500 Rp 14,226,200 Rp 5,290,400 Rp 11,855,200 Rp 16,597,300 Rp 16,597,300 Rp 11,855,200 Rp 6,172,100 Rp 8,619,200 Rp 50,437,500 Rp 40,379,100 Rp 45,373,400 Rp 40,024,100 Rp 57,108,100 Rp 50,437,500 Rp 50,437,500 Rp 50,437,500 Rp 796,238,100

Rp 6,493,997 Rp 5,155,627 Rp 8,177,879 Rp 8,379,504 Rp 5,591,710 Rp 14,937,500 Rp 37,500,100 Rp 60,429,600 Rp 46,200,100 Rp 60,338,600 Rp 54,165,127 Rp 7,268,128 Rp 6,400,132 Rp 14,937,500 Rp 5,554,900 Rp 11,855,200 Rp 6,741,809 Rp 7,957,016 Rp 11,855,200 Rp 9,334,845 Rp 7,875,352 Rp 52,959,400 Rp 42,900,100 Rp 48,388,100 Rp 53,154,400 Rp 60,445,600 Rp 50,437,500 Rp 52,959,400 Rp 53,270,400 Rp 811,664,726

Rp 3,155,250 Rp 2,861,080 Rp 3,096,250 Rp 2,936,080 Rp 2,694,800 Rp 2,851,080 Rp 3,725,830 Rp 10,741,100 Rp 28,269,980 Rp 13,882,080 Rp 23,094,080 Rp 2,715,800 Rp 2,861,080 Rp 3,646,580 Rp 3,297,380 Rp 3,754,580 Rp 3,217,750 Rp 3,401,800 Rp 3,096,250 Rp 2,882,080 Rp 2,861,080 Rp 38,093,240 Rp 10,417,080 Rp 24,418,660 Rp 19,127,660 Rp 34,430,410 Rp 19,434,660 Rp 14,244,330 Rp 15,336,560 Rp 304,544,590

Rp 3,338,747 Rp 2,294,547 Rp 5,081,629 Rp 5,443,424 Rp 2,896,910 Rp 9,123,883 Rp 6,036,759 Rp 5,191,412 Rp 10,032,091 Rp 4,561,671 Rp 6,823,473 Rp 4,552,328 Rp 3,539,052 Rp 3,485,967 Rp 2,892,559 Rp 3,100,949 Rp 3,524,059 Rp 4,555,216 Rp 4,358,644 Rp 7,824,765 Rp 7,875,352 Rp 5,598,672 Rp 8,097,343 Rp 4,743,058 Rp 5,122,153 Rp 4,690,221 Rp 7,800,337 Rp 6,733,555 Rp 5,894,939 Rp 155,213,715

Tarif dikurang RS+BHP KSO Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

10,103,303 1,016,473 3,677,321 6,557,996 8,634,490 2,251,237 15,208,811 27,834,288 5,464,729 38,664,349 20,519,947 119,772 8,537,368 7,093,653 (899,539) 4,999,671 9,855,491 8,640,284 4,400,306 (4,534,745) (2,117,232) 6,745,588 21,864,677 16,211,682 15,774,287 17,987,469 23,202,503 29,459,615 29,206,001 336,479,795

Jasa 70% Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

7,072,312 711,531 2,574,125 4,590,597 6,044,143 1,575,866 10,646,168 19,484,002 3,825,310 27,065,044 14,363,963 83,840 5,976,158 4,965,557 (629,677) 3,499,770 6,898,844 6,048,199 3,080,214 (3,174,322) (1,482,062) 4,721,912 15,305,274 11,348,177 11,042,001 12,591,228 16,241,752 20,621,731 20,444,201 235,535,857

RS + KSO 30%

Fasilitas RS (40%)

Rp 3,030,991 Rp 304,942 Rp 1,103,196 Rp 1,967,399 Rp 2,590,347 Rp 675,371 Rp 4,562,643 Rp 8,350,286 Rp 1,639,419 Rp 11,599,305 Rp 6,155,984 Rp 35,932 Rp 2,561,210 Rp 2,128,096 Rp (269,862) Rp 1,499,901 Rp 2,956,647 Rp 2,592,085 Rp 1,320,092 Rp (1,360,424) Rp (635,170) Rp 2,023,676 Rp 6,559,403 Rp 4,863,505 Rp 4,732,286 Rp 5,396,241 Rp 6,960,751 Rp 8,837,885 Rp 8,761,800 Rp 100,943,939

Rp 1,212,396 Rp 121,977 Rp 441,279 Rp 786,960 Rp 1,036,139 Rp 270,148 Rp 1,825,057 Rp 3,340,115 Rp 655,767 Rp 4,639,722 Rp 2,462,394 Rp 14,373 Rp 1,024,484 Rp 851,238 Rp (107,945) Rp 599,961 Rp 1,182,659 Rp 1,036,834 Rp 528,037 Rp (544,169) Rp (254,068) Rp 809,471 Rp 2,623,761 Rp 1,945,402 Rp 1,892,914 Rp 2,158,496 Rp 2,784,300 Rp 3,535,154 Rp 3,504,720 Rp 40,377,575

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners PNS III/c NIP. 198303122007122001

Sewa Alat Rajawali (60%) Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

1,818,595 182,965 661,918 1,180,439 1,554,208 405,223 2,737,586 -712382 5,010,172 44584568 983,651 7898029 6,959,583 41894849 3,693,590 24247574 21,559 1,536,726 1,276,858 7804953 (161,917) -635039 899,941 4999671 1,773,988 1,555,251 792,055 4400306 (816,254) 2993096 (381,102) 1,214,206 9272051 3,935,642 24385677 2,918,103 19226382 2,839,372 28904587 3,237,744 21329532 4,176,451 23207066 5,302,731 31986078 5,257,080 32038901 60,566,363

2017 antung

p Ners 7122001

DAFTAR CLAIM PASIEN CATHLAB BULAN DESEMBER 2016 No

Nama Pasien

Tarif BPJS

Tarif RS

BHP KSO

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Sopan Sopandi Ruhiat Rohmat Sri Mulya Iin Rochdriyani Moch Toha Udin Muhayat Momor Suminto Hioe Siauw Ling Nina Rustiana Ferdinand Parlindungan Sortaini LBN Raja Rachmat Setiawan Syamsudin dr. Jono Ulomo Meiske Ullmer Total

Rp 46,373,400 Rp 50,437,500 Rp 43,766,800 Rp 16,597,300 Rp 8,619,200 Rp 5,290,400 Rp 50,437,500 Rp 50,437,500 Rp 16,597,300 Rp 14,226,200 Rp 16,597,300 Rp 5,290,400 Rp 4,408,700 Rp 16,597,300 Rp 16,597,300 Rp 14,226,200 Rp 376,500,300

Rp 46,403,400 Rp 51,062,500 Rp 50,773,500 Rp 16,597,300 Rp 8,619,200 Rp 7,387,900 Rp 50,437,500 Rp 50,437,500 Rp 16,597,300 Rp 14,226,200 Rp 16,597,300 Rp 5,290,400 Rp 4,408,700 Rp 16,597,300 Rp 16,597,300 Rp 14,226,200 Rp 386,259,500

Rp 22,893,400 Rp 18,394,500 Rp 28,773,000 Rp 3,463,660 Rp 2,882,080 Rp 2,711,250 Rp 13,437,100 Rp 14,869,660 Rp 8,819,660 Rp 2,866,080 Rp 3,283,580 Rp 3,080,250 Rp 2,882,080 Rp 3,096,250 Rp 2,866,080 Rp 3,479,580 Rp 137,798,210

Rumah Sakit Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

10,030,613 4,195,576 8,483,692 9,693,095 4,440,345 2,757,586 8,809,714 8,163,116 4,357,458 3,336,962 9,174,215 1,577,207 9,059,866 2,482,379 2,501,077 2,869,514 91,932,415

Tarif dikurang RS+BHP KSO Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

13,449,387 27,847,424 6,510,108 3,440,545 1,296,775 (178,436) 28,190,686 27,404,724 3,420,182 8,023,158 4,139,505 632,943 (7,533,246) 11,018,671 11,230,143 7,877,106 146,769,675

Jasa 70% Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

RS + KSO 30%

9,414,571 19,493,197 4,557,076 2,408,382 907,743 (124,905) 19,733,480 19,183,307 2,394,127 5,616,211 2,897,654 443,060 (5,273,272) 7,713,070 7,861,100 5,513,974 102,738,773

Rp 4,034,816 Rp 8,354,227 Rp 1,953,032 Rp 1,032,164 Rp 389,033 Rp (53,531) Rp 8,457,206 Rp 8,221,417 Rp 1,026,055 Rp 2,406,947 Rp 1,241,852 Rp 189,883 Rp (2,259,974) Rp 3,305,601 Rp 3,369,043 Rp 2,363,132 Rp 44,030,903

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners PNS III/c NIP. 19830312200712200

Fasilitas RS (40%) Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

1,613,926 3,341,691 781,213 412,865 155,613 (21,412) 3,382,882 3,288,567 410,422 962,779 496,741 75,953 (903,990) 1,322,241 1,347,617 945,253 17,612,361

Sewa Alat Rajawali (60%) Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

, 2017 nit Kateterisasi Jantung

a Wijayanti, S.kep Ners IP. 198303122007122001

2,420,890 5,012,536 1,171,819 619,298 233,420 (32,118) 5,074,323 4,932,850 615,633 1,444,168 745,111 113,930 (1,355,984) 1,983,361 2,021,426 1,417,879 26,418,542

Rp 13,479,387 Rp 28,474,424 Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

3,440,545 1,296,775 1,919,064 28,190,686 27,404,724 3,420,182 8,023,158 1,680,705 2,730,443 713,254 11,018,671 11,244,750 7,877,106

DAFTAR CLAIM PASIEN CATHLAB BULAN DESEMBER 2016

No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Nama Pasien Ecin Aceng Qudsi U.S Kingrad Kusnaedi Tuti Takarina Kuraesin Rusminah Sihombing Hamam James Lontoh Supriyatna Yetti Hendarsih Wina Sukmawati Suherlan Asep Sukmawan Siti Djuariah Ulpanita Sirait Siti Chaeroni Joko Triyanto Olih Iswandi Iyus Rustama Wowon Total

Tarif BPJS

Tarif RS

BHP KSO

Rumah Sakit

Rp 6,156,600 Rp 7,387,900 Rp 6,172,100 Rp 12,496,100 Rp 5,290,400 Rp 11,855,200 Rp 16,597,300 Rp 8,619,200 Rp 8,613,200 Rp 16,597,300 Rp 8,619,200 Rp 4,408,700 Rp 45,373,400 Rp 8,619,200 Rp 45,373,400 Rp 5,290,000 Rp 7,387,900 Rp 45,373,400 Rp 35,384,800 Rp 45,373,400 Rp 22,909,500 Rp 373,898,200

Rp 6,156,600 Rp 7,387,900 Rp 16,597,300 Rp 50,783,544 Rp 5,290,400 Rp 11,855,200 Rp 16,597,300 Rp 8,619,200 Rp 8,613,200 Rp 20,472,521 Rp 8,619,200 Rp 4,408,700 Rp 45,649,400 Rp 8,619,200 Rp 45,373,400 Rp 7,387,900 Rp 7,387,900 Rp 45,373,400 Rp 35,384,800 Rp 46,221,400 Rp 23,596,500 Rp 430,394,965

Rp 3,096,250 Rp 3,046,580 Rp 6,897,080 Rp 29,176,500 Rp 2,715,800 Rp 2,258,500 Rp 2,715,800 Rp 2,715,800 Rp 2,715,800 Rp 4,630,000 Rp 5,018,700 Rp 2,866,080 Rp 22,297,080 Rp 2,887,080 Rp 19,054,660 Rp 2,887,080 Rp 3,057,580 Rp 22,998,000 Rp 15,145,250 Rp 14,429,000 Rp 13,052,100 Rp 183,660,720

Rp 5,285,935 Rp 5,844,164 Rp 3,011,747 Rp 5,005,431 Rp 6,450,322 Rp 3,602,266 Rp 18,440,869 Rp 5,087,005 Rp 7,883,060 Rp 10,364,191 Rp 3,406,421 Rp 969,340 Rp 5,801,570 Rp 5,746,747 Rp 5,046,137 Rp 3,347,478 Rp 2,571,600 Rp 14,117,962 Rp 7,640,464 Rp 5,720,107 Rp 5,047,054 Rp 130,389,870

Tarif dikurang RS+BHP KSO Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

(2,225,585) (1,502,844) (3,736,727) (21,685,831) (3,875,722) 5,994,434 (4,559,369) 816,395 (1,985,660) 1,603,109 194,079 573,280 17,274,750 (14,627) 21,272,603 (944,558) 1,758,720 8,257,438 12,599,086 25,224,293 4,810,346 59,847,610

Jasa 70% Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

RS + KSO 30%

(1,557,910) (1,051,991) (2,615,709) (15,180,082) (2,713,005) 4,196,104 (3,191,558) 571,477 (1,389,962) 1,122,176 135,855 401,296 12,092,325 (10,239) 14,890,822 (661,191) 1,231,104 5,780,207 8,819,360 17,657,005 3,367,242 41,893,327

Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

(667,676) (450,853) (1,121,018) (6,505,749) (1,162,717) 1,798,330 (1,367,811) 244,919 (595,698) 480,933 58,224 171,984 5,182,425 (4,388) 6,381,781 (283,367) 527,616 2,477,231 3,779,726 7,567,288 1,443,104 17,954,283

Fasilitas RS (40%)

Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

(267,070) 7,347,008 6,748,474 26,691,262 10,326,044 (2,392,168) 23,000,238 4,270,610 9,868,720 8,761,082 3,212,342 396,060 (11,473,180) 5,761,374 (16,226,466) 4,292,036 812,880 5,860,524 (4,958,622) (19,504,186) 236,708 70,542,260

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners PNS III/c NIP. 19830312200712200

Sewa Alat Rajawali (60%) Rp (400,605) Rp (2,225,585) Rp 5,142,906 Rp (1,502,844) Rp 4,723,932 Rp 6,688,473 Rp 18,683,883 Rp 16,601,613 Rp 7,228,231 Rp (3,875,722) Rp (1,674,518) Rp 5,994,434 Rp 16,100,167 Rp (4,559,369) Rp 2,989,427 Rp 816,395 Rp 6,908,104 Rp (1,979,660) Rp 6,132,757 Rp 5,478,330 Rp 2,248,639 Rp 194,079 Rp 277,242 Rp 573,280 Rp (8,031,226) Rp 17,570,838 Rp 4,032,962 Rp (14,627) Rp (11,358,526) Rp 21,272,603 Rp 3,004,425 Rp 1,153,342 Rp 569,016 Rp 1,758,720 Rp 4,102,367 Rp 8,257,438 Rp (3,471,035) Rp 12,599,086 Rp (13,652,930) Rp 165,696 Rp 5,497,346 Rp 49,379,582

2017 antung

p Ners 7122001

DAFTAR PASIEN CATHLAB BULAN JANUARI 2017

No 1 2 3 4 5 6 7 8 9 10 11 12

Nama Pasien Asep Redy Rachmat Suhartono Aji Pranoto Asep Wahyu Deden Toni Suparman Sumarti Wiwi Lindayani Eman Suherman Dwi Sulistyowati Aminah Pelu Aan Encem Tri Hariyani Total

Tarif BPJS

Tarif RS

BHP KSO

Rp 40,379,100 Rp 35,384,800 Rp 45,373,400 Rp 5,290,450 Rp 50,437,500 Rp 40,379,100 Rp 35,384,800 Rp 35,384,800 Rp 16,597,300 Rp 45,373,400 Rp 50,437,500 Rp 29,965,700 Rp 430,387,850

Rp 50,773,500 Rp 35,810,800 Rp 44,748,400 Rp 5,290,450 Rp 50,437,500 Rp 40,514,928 Rp 38,121,237 Rp 35,384,800 Rp 16,597,300 Rp 57,975,596 Rp 50,437,500 Rp 40,379,100 Rp 466,471,111

Rp 23,659,660 Rp 13,702,500 Rp 22,658,660 Rp 2,258,500 Rp 29,302,550 Rp 24,194,000 Rp 2,951,080 Rp 16,125,000 Rp 3,096,250 Rp 22,150,100 Rp 20,656,240 Rp 8,670,500 Rp 189,425,040

Rumah Sakit Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

4,544,357 6,584,211 4,621,413 1,877,740 11,136,545 10,600,213 3,061,761 4,862,558 3,168,987 6,021,124 9,342,442 5,848,879 71,670,230

Tarif dikurang RS+BHP KSO Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

22,569,483 15,524,089 17,468,327 1,154,210 9,998,405 5,720,715 32,108,396 14,397,242 10,332,063 29,804,372 20,438,818 25,859,721 205,375,841

Jasa 70% Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

15,798,638 10,866,862 12,227,829 807,947 6,998,884 4,004,501 22,475,877 10,078,069 7,232,444 20,863,060 14,307,173 18,101,805 143,763,089

RS + KSO 30% Rp 6,770,845 Rp 4,657,227 Rp 5,240,498 Rp 346,263 Rp 2,999,522 Rp 1,716,215 Rp 9,632,519 Rp 4,319,173 Rp 3,099,619 Rp 8,941,312 Rp 6,131,645 Rp 7,757,916 Rp 61,612,752

Fasilitas RS (40%)

Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

(18,025,126) (8,939,878) (12,846,914) 723,530 1,138,140 4,879,498 (29,046,635) (9,534,684) (7,163,076) (23,783,248) (11,096,376) (20,010,842) (133,705,611)

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners PNS III/c NIP. 198303122007122001

Sewa Alat Rajawali (60%) Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

(12,617,588) (6,257,915) (8,992,840) 506,471 796,698 3,415,649 (20,332,645) (6,674,279) (5,014,153) (16,648,274) (7,767,463) (14,007,589) (93,593,928)

Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

22,569,483 15,524,089 17,468,327 1,154,210 10,002,968 5,720,715 (722,441) 14,397,242 10,336,626 29,804,372 20,438,818 25,859,721

DAFTAR PASIEN CATHLAB BULAN FEBRUARI 2017

No 1 2 3 4 5

Nama Pasien Taram Wisnu Mutedjo Mimi Budi Trisantosa Sutira Hidayat Total

Tarif BPJS

Tarif RS

Rp 45,373,400 Rp 46,694,700 Rp 4,408,700 Rp 6,172,100 Rp 11,855,200 Rp 114,504,100

Rp 56,509,080 Rp 57,894,100 Rp 4,878,531 Rp 6,172,100 Rp 11,588,200 Rp 137,042,011

BHP KSO Rp Rp Rp Rp Rp Rp

10,904,980 22,561,560 4,683,580 3,548,580 2,279,500 43,978,200

Rumah Sakit Rp Rp Rp Rp Rp Rp

6,329,228 5,402,004 3,013,978 3,698,818 3,162,690 21,606,718

Tarif dikurang RS+BHP KSO

Jasa 70%

RS + KSO 30%

Rp 39,274,872 Rp 27,492,410 Rp 11,782,462 Rp 29,930,536 Rp 20,951,375 Rp 8,979,161 Rp (2,819,027) Rp (1,973,319) Rp (845,708) Rp (1,075,298) Rp (752,709) Rp (322,589) Rp 6,146,010 Rp 4,302,207 Rp 1,843,803 Rp 71,457,093 Rp 50,019,965 Rp 21,437,128

Fasilitas RS (40%)

Rp Rp Rp Rp Rp Rp

(32,945,644) (24,528,532) 5,833,005 4,774,116 (2,983,320) (49,850,375)

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners PNS III/c NIP. 198303122007122001

Sewa Alat Rajawali (60%) Rp (23,061,951) Rp (17,169,972) Rp 4,083,104 Rp 3,341,881 Rp (2,088,324) Rp (34,895,263)

Rp Rp Rp Rp Rp

39,274,872 29,930,536 (2,819,027) (1,075,298) 6,413,010

DAFTAR PASIEN CATHLAB BULAN MARET 2017

No 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Nama Pasien Imas Suryani Karna Akin Makalalag Elien Agustiyanti Dadang Kosasih Ade Titin Syafdianto Egbert Barahama Apudin Wahidi Mane Siti Saomah Ujang Rusdaya Eti Sumiati Total

Tarif BPJS

Tarif RS

Rp 8,172,100 Rp 5,290,400 Rp 5,290,400 Rp 6,172,100 Rp 22,909,500 Rp 8,619,200 Rp 6,172,100 Rp 6,172,100 Rp 4,408,700 Rp 5,290,400 Rp 6,172,100 Rp 5,290,400 Rp 4,408,700 Rp 14,226,200 Rp 108,594,400

Rp 4,681,082 Rp 5,290,400 Rp 52,904,003 Rp 6,172,100 Rp 51,263,210 Rp 8,619,200 Rp 6,172,100 Rp 8,619,200 Rp 4,408,700 Rp 5,290,400 Rp 16,597,300 Rp 5,290,400 Rp 4,408,700 Rp 14,226,200 Rp 193,942,995

BHP KSO Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

2,497,060 2,861,080 3,913,000 2,882,080 22,006,160 3,888,160 3,191,080 3,004,750 2,317,300 2,790,580 2,097,300 2,483,580 2,483,580 2,447,300 53,932,130

Rumah Sakit Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp

2,134,022 5,290,400 3,736,166 3,488,613 4,644,865 8,619,200 3,071,351 6,383,136 5,560,469 8,201,386 8,468,217 6,569,031 2,706,977 3,273,652 -

Tarif dikurang RS+BHP KSO

Jasa 70%

RS + KSO 30% Fasilitas RS (40%)

Rp 50,000 Rp 35,000 Rp 15,000 Rp (2,861,080) Rp (2,002,756) Rp (858,324) Rp 45,254,837 Rp 31,678,386 Rp 13,576,451 Rp (198,593) Rp (139,015) Rp (59,578) Rp 24,612,185 Rp 17,228,530 Rp 7,383,656 Rp (3,888,160) Rp (2,721,712) Rp (1,166,448) Rp (90,331) Rp (63,232) Rp (27,099) Rp (768,686) Rp (538,080) Rp (230,606) Rp (3,469,069) Rp (2,428,348) Rp (1,040,721) Rp (5,701,566) Rp (3,991,096) Rp (1,710,470) Rp 6,031,783 Rp 4,222,248 Rp 1,809,535 Rp (3,762,211) Rp (2,633,548) Rp (1,128,663) Rp (781,857) Rp (547,300) Rp (234,557) Rp 8,505,248 Rp 5,953,674 Rp 2,551,574 Rp 140,010,865 Rp 98,007,606 Rp 42,003,260

Sewa Alat Rajawali (60%)

Rp 2,084,022 Rp Rp 8,151,480 Rp Rp (41,518,671) Rp Rp 3,687,206 Rp Rp (19,967,320) Rp Rp 12,507,360 Rp Rp 3,161,682 Rp Rp 7,151,822 Rp Rp 9,029,538 Rp Rp 13,902,952 Rp Rp 2,436,434 Rp Rp 10,331,242 Rp Rp 3,488,834 Rp Rp (5,231,596) Rp Rp (140,010,865) Rp

Cimahi, 2017 Kepala Unit Kateterisasi Jantung

Dewi Eka Wijayanti, S.kep Ners PNS III/c NIP. 198303122007122001

1,458,815 5,706,036 (29,063,070) 2,581,044 (13,977,124) 8,755,152 2,213,177 5,006,275 6,320,677 9,732,066 1,705,504 7,231,869 2,442,184 (3,662,117) (98,007,606)

### ### ### ### ### ### ### ### ### ### ### ### ###