RWJ JLN Sept'14

PEMERINTAH KABUPATEN BIAK NUM
RUMAH SAKIT UMUM DAERAH
Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 227
FORM KLAIM PASIEN JAMKES PAPUA

Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
NAMA
:
:
:
:
:
:
:
SEPTEMBER 2014
RSUD BIAK
229 PASIEN
dr. IRAS B.P RUMBIAK, M Kes,SpPK
RAWAT JALAN TINGKAT LANJUT
TANGGAL
No. MR
1
1
2
By. Debora Y. Sroyer
01 Sept 2014
3
1/209593/14
THN
4
1
An. Adolof Koibur
01 Sept 2014
1/210168/14
3
4
By. Matreda Adadikam

By. Elisabeth Komboy
01 Sept 2014
01 Sept 2014
1/200767/14
2/199852/14
5
6
7
8
9
10
11
12
An. Hans Yapen

An. Agnesia Yapen
An. Petrus Krey
By. Maikel Wakum
An. Samuel Wambrauw
An. Sari Womsiwor
By. Celvin Wahaifimo
An. Tresha I. Kafiar
01
01
01
01
01
01
02
02
1/188737/14
1/188739/14
2/184102/14
2/202825/14
1/210408/14
1/210392/14
1/210442/14
1/210418/14
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
UMUR
BLN
HARI
5
11
3
5
1
10
3
3
2
1
5
P/L
DKTR
6
P
7
dr. Mike W
dr. Mike W
P
P
dr. Mike W
dr. Mike W
L
P
L
L
P
P
L
P
dr. Mike W
dr. Mike W
dr. Mike W
dr. Mike W
dr. Mike W
dr. Mike W
dr. Jonathan
dr. Jonathan
13 An. Imanuel Msen

14 An. Sinabo Mofu
02 Sept 2014
02 Sept 2014
2/160726/14
1/160123/14
3
2
L
L
dr. Jonathan
dr. Jonathan
15
16
17
18
19
02
02
02
02
02
2014
2014
2014
2014
2014
1/188467/14
1/107578/14
1/194078/14
1/159836/14
1/177836/14
1
7
2
2
L
L
L
L
L
dr.
dr.
dr.
dr.
dr.
20 An. Raldo warikar

21 An. Paskalina mofu
02 Sept 2014
02 Sept 2014
2/210134/14
1/179712/14
10
1
P
P
dr. Jonathan
dr. Jonathan
22
23
24
25
02
02
02
03
2014
2014
2014
2014
1/210432/14
1/209442/14
2/201782/14
1/210528/14
2
3
11
L
P
L
P
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Michael
26 By. Laurence Sarewo
03 Sept 2014
1/198932/14
dr. Michael
27 By. Novela Awom
03 Sept 2014
2/203625/14
dr. Michael
28 An. Sostenes D. Muabuay
03 Sept 2014
2/182607/14
dr. Michael
29
30
31
32
33
34
35
36
37
04
04
04
04
04
04
05
05
06
1/210550/14
1/207478/14
2/209630/14
1/161768/14
1/190520/14
1/210590/14
1/210646/14
2/160920/13
1/168710/13
P
P
P
L
L
L
P
L
L
dr. Michael
dr. Mike W
dr. Michael
dr. Michael
dr. Michael
dr. Michael
dr. Jonathan
dr. Jonathan
dr. Lato
An. Dije Diego Rumander

An. Bernard Wamaer
By. Rafandi Kapitarauw
An. Aleks N. Wamaer
An. Sila Beroparay
By. Genesius Sanadi

By. Kristina Mandosir
By. Mersu Rumboryas
An. Mirawati T. Wabiser
An. Deflora Kmur

By. Mei Ralens Mandowen
An. Aprilia Msiren
An. Almember J. Arfayan
By. Kristian Samuel
An. Ismael Iryouw
By. Melani Seran
An. Maikel Aibekob
An. Orisam F. Simbiak
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
2014
11
3
1
5
11
5
1
1
1
Jonathan
Jonathan
Jonathan
Jonathan
Jonathan
38 By. Ramun Rumanasen
06 Sept 2014
2/210233/14
39 An. Darius Ronsumbre
06 Sept 2014
1/154337/12
40 An. Ruth Deda

41 An. Aprilia Kafiar
06 Sept 2014
08 Sept 2014
42
43
44
45
dr. Lato
dr. Lato
2/169217/14
1/186642/14
2
1
P
P
dr. Lato
dr. Delly
08
08
08
08
2014
2014
2014
2014
2/184134/14
2/194470/14
2/145810/12
2/147599/12
2
2
3
4
P
L
P
L
dr.
dr.
dr.
dr.
46 By. Kristian Yandom
08 Sept 2014
1/201877/14
dr. Delly
47
48
49
50
51
09
09
09
09
09
2014
2014
2014
2014
2014
1/146333/12
2/132442/12
1/210804/14
1/104321/10
2/205648/14
2
4
3
L
P
P
P
P
dr.
dr.
dr.
dr.
dr.
52 An. Tina Abidondifu

53 By. Rian Kbarek
54 An. Rika Pariaribo
09 Sept 2014
09 Sept 2014
09 Sept 2014
2/106099/10
1/210819/14
1/185318/14
8
1
P
P
P
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
55 An. Ferdinand Dimara

56 An. Michelle Kapitarauw
09 Sept 2014
09 Sept 2014
2/162561/13
1/153174/13
2
4
L
P
dr. Windhy, SpA

dr. Delly
57 An. Grace Dimara
09 Sept 2014
1/107738/10
dr. Windhy, SpA
58 By. Luther M. Ayer
10 Sept 2014
2/202717/14
dr. Windhy, SpA
59 An. Kawai Kafiar
10 Sept 2014
1/166898/13
dr. Jonathan
An.
An.
An.
An.
Aurel Mansnandifu
Simon S. Arwam
Karolina Sarwa
Maikel Kafiar
An. Juan Rumaseb

An. Aprilia Rumbekwan
By. Gita Wutwensa
An. Jein Dimara
By. Renata Mofu
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
5
6
3
8
Delly
Delly
Delly
Delly
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
SpA
SpA
SpA
SpA
SpA
60 An. Aurel Mansnandifu
10 Sept 2014
2/184134/14
61
62
63
64
65
66
67
68
By. Marsela Pondayar

By. Yusup Rumparmpam
By. Jhonatan N. Koibur
By. Nasrani I. Strik
An. Eka Akeli
An. Alex C. Makmaker
An. Mathias Mofu
An. Ferdi Mayor
10
10
10
10
10
11
11
11
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
1/210867/14
1/210880/14
1/189063/14
1/202270/14
1/210854/14
2/170774/14
2/132535/12
2/133249/12
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
By. Sandra Mayor

An. Yan G. Syufi
By. Rehan Siep
By. Yosep Syufi
An. Glen Amsamsyum
An. Mina Rumbiak
An. Ezekiel Saba
An. Rika Wambrauw
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
11
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
1/200593/14
1/193971/14
1/210917/14
1/210956/14
1/162046/13
2/185698/14
1/171581/14
1/138038/12
2/210509/14
1/205688/14
1/196374/14
1/210897/14
1/198461/14
1/184897/14
1/196373/14
1/205058/14
12 Sept 2014
12 Sept 2014
12 Sept 2014
1/181393/13
2/198522/14
1/203161/14
By. Sidant Wambrauw

By. Andarias Korwa
By. Sesario Kbarek
By.Ny. Chrisana Wakum
By. Irene Ronsumbre
An. Melkisedek Yarangga
By. Sesarendra Kbarek
By. Yusephina Rumbino
85 An. Chardy Wakum

86 An. Grasela Msen
87 A. Enggelina Krey
dr. Syukri
P
L
L
P
P
L
L
L
dr. Michael
dr. Syukri
dr. Syukri
dr. Jonathan
dr. Jonathan
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
P
L
L
L
L
P
L
P
L
L
L
L
P
L
L
P
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr.Windhy,SpA
dr.Windhy,SpA
dr.Windhy,SpA
1
1
1
P
P
P
dr.Mike
dr.Mike
dr.Mike
10
8
9
6
8
4
3
4
5
1
1
4
1
2
2
6
9
3
7
12
7
1
7
88
89
90
91
By. Sella Kmur

By. Yesaya Wakum
An. Ferdinand Dimara
An. Bepondi Ayemseba
2014
2014
2014
2014
2/210476/14
2/205892/14
2/162561/13
2/183041/14
2
9
P
L
L
P
dr.Mike
dr. Michael.
dr. Michael.
dr. Michael.
92 An. Grace Mansumber

93 An. Aleks N. Wamaer
94 An. Syalomitha T. Sarakan
13 Sept 2014
13 Sept 2014
15 Sept 2014
1/202595/14
1/159836/13
1/167852/14
1
2
1
P
L
P
dr. Michael.
dr. Michael.
dr I Gede S
95 By. Roselia Marsyom
15 Sept 2014
1/199972/14
dr. Lato
96 An. Fina Rumbrawer
15 Sept 2014
1/134346/12
dr. Lato
97 An. Ernita Worabay
15 Sept 2014
2/164044/13
dr. Lato
98 An. Sambrono M. Ronsumbre
15 Sept 2014
1/198803/14
dr. Lato
99 An. Lily Warnares
15 Sept 2014
1/202444/14
dr. Lato
100 An. Kartini Anouw

101 An. Febrianti Kosai
15 Sept 2014
15 Sept 2014
P
P
dr. Lato
dr. Lato
102 By. Karnita Sada
15 Sept 2014
dr. Lato
103 By. Ferince Krar
15 Sept 2014
1/211208/14
dr. Lato
104
105
106
107
108
109
16
16
16
16
16
16
1/211297/14
1/146780/14
1/211269/14
1/203161/14
1/124999/14
1/203152/14
By. Lis Inonjer Msiren

An. Marice Manufandu
By. Saleh Infandi
An. Enggelina Krey
An. Tonci Mansoben
An. Maryana Kafiar
12
13
13
13
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
10
5
11
4
8
6
4
3
1
1
1
P
P
L
P
L
P
dr.
dr.
dr.
dr.
dr.
dr.
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
SpA
SpA
SpA
SpA
SpA
SpA
110
111
112
113
An. Willy Mangaara

An. Nasrani I. Senik
By. Demianus Faisa
An. Jomonda Sarwa
2014
2014
2014
2014
1/101090/10
1/201270/14
1/211366/14
1/181318/14
L
P
L
L
dr.
dr.
dr.
dr.
114 An. Jessica W. Lengkong

115 An. Marthina Womssiwor
116 An. Yan S. Kapisa
16 Sept 2014
16 Sept 2014
16 Sept 2014
1/116266/13
1/187378/14
2/203720/14
5
1
1
P
P
L
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
117 An. Brian Waimbo
16 Sept 2014
1/116827/11
dr. Windhy, SpA
118
119
120
121
122
By. Sarce Kbarek

An. Jhosua W. Lengkong
An. Michelle Kapitarauw
An. Denilson Yawan
An. Milan Inggabouw
16
16
16
17
17
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2/210757/14
1/157548/13
1/153174/14
P
L
P
L
P
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
dr. Delly
dr. Delly
123
124
125
126
127
128
129
By. Hermelina Kurni

By. Isak Ajelo
An. Gerry Kaisiri
An. Cici Noriwari
17
17
18
18
18
18
18
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2/204491/14
2/203638/14
6
3
P
L
L
P
8
5
11
L
L
L
dr. Delly
dr. Delly
dr.Mike
dr.Mike
dr.Mike
dr.Mike
dr.Mike
130 By. Selviana Msiren
18 Sept 2014
1/211530/14
11
dr.Mike
131 An. Abia Wabdaron

132 An. Velicia Kawer
18 Sept 2014
18 Sept 2014
2/113915/14
2/211234/14
L
P
dr.Mike
dr.Mike
133 By. Kenzie Msen
18 Sept 2014
1/204407/14
dr.Mike
By. Yusuf Rumparmpam

By. Viktor Morin
By. Yonas Kafiar
16
16
16
16
Sept
Sept
Sept
Sept
1/211437/14
1/177293/14
1/176828/14
2/167771/14
2/211241/14
1/211544/14
1/195912/14
3
14
2
4
4
2
6
2
4
1
3
Windhy,
Windhy,
Windhy,
Windhy,
SpA
SpA
SpA
SpA
134 An. Jhosua W. Lengkong
18 Sept 2014
1/157548/13
dr.Mike
135 An. Yohanes Morin
19 Sept 2014
1/173578/14
dr. Benyamin
136
137
138
139
140
141
142
An. Oridek Rumbiak

An. Beonani Aibekob
An. Panjel Gausario
By. Paskalino Mandibondibo
By. Nasrani I Senik
An. Yosephina Pariaribo
Nn. Tirsya Putuhena
20
20
22
22
22
22
22
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
1/148858/12
2/211302/14
1/211732/14
2/208279/14
1/201270/14
1/181315/14
1/211700/14
5
1
L
P
L
L
p
p
p
dr.
dr.
dr.
dr.
dr.
dr.
dr.
143
144
145
146
147
148
149
150
151
By. Regina Ronsumbre

an. Max O. Pariaribo
An. Agusta Ruminur
An. Yosepus Yarangga
An. Yuliana F. Yarangga
An. Salomita T. Sarakan
By. Yosep Rumbrawer
An. Reinold Wakum
By. Orisam Solosa
22
22
22
22
22
22
23
23
23
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
2014
1/199025/14
1/200590/14
1/211687/14
1/100963/10
1/100960/10
1/167852/13
2/211402/14
2/211772/14
1/211759/14
152 An. Bentovel Weyai
23 Sept 2014
2/211239/14
153 By. Janes Bonggoibo

154 An. Darius Ronsumbre
23 Sept 2014
23 Sept 2014
2/211137/14
1/154337/13
155 An. Luis Rumbewas

156 An. Raflin Yarangga
23 Sept 2014
23 Sept 2014
1/193468/14
2/211490/14
157 By. Kamasan Mansawan
23 Sept 2014
1/211779/14
4
5
6
1
12
9
Jonathan
Jonathan
Jonathan
Jonathan
Jonathan
Jonathan
Jonathan
P
L
P
L
P
P
L
L
L
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
dr. Windhy, SpA
L
L
dr. Windhy, SpA

dr. Windhy, SpA
8
1
L
L
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
6
11
7
4
1
9
2
7
1
18
158
159
160
161
162
An. Yohanes Rumbino

An. Gerry Rumbrapuk
By. Arman Msen
By. Nikolas Simopiaref
By. Victor Emenu
23
23
23
23
23
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
1/162406/14
1/178873/14
2/204550/14
1/210897/14
2/207886/14
1
1
9
1
8
L
L
L
L
L
dr.
dr.
dr.
dr.
dr.
163 An. Emelia Sanadi

164 By. Gita Wutwensa
23 Sept 2014
23 Sept 2014
1/156097/13
1/210804/14
165 By. Marice Sesa
23 Sept 2014
2/211507/14
166
167
168
169
170
By. Yohana Sada

An. Louisa Wambrauw
An. Cici Noriwari
An. Melkias B.a. Sroyer
An. Samuel Kurni
23
23
23
24
24
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
1/199339/14
2/158139/13
2/167771/13
2/210344/14
1/172874/14
P
P
dr. Windhy, SpA

dr. Windhy, SpA
11
dr. Windhy, SpA
P
P
P
L
L
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
dr. Delly
dr. Delly
171
172
173
174
175
176
177
An. Aleks N. Wamaer

An. Tresia Msen
An. Cindy Rumbiak
By. Febiola Sayori
An. Monika Rumbiak
By. Janes Bonggoibo
An. Almendo Wamafma
24
24
24
24
24
25
25
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
1/159836/13
1/122253/12
1/143940/12
2/210192/14
1/145038/12
2/211137/14
1/211349/14
L
P
P
P
P
L
L
dr. Delly
dr. Delly
dr. Delly
dr. Delly
dr. Delly
dr. Windhy, SpA
dr. Windhy, SpA
178 By. Andika Mansumber

179 By. Jhon P. Rumbiak
25 Sept 2014
25 Sept 2014
1/197300/14
1/211961/14
L
L
dr. Windhy, SpA

dr. Windhy, SpA
180 An. Timo Rumere
25 Sept 2014
1/110392/11
dr. Windhy, SpA
181 An. Melkias Ofias
25 Sept 2014
1/208555/14
dr. Windhy, SpA
4
2
3
1
2
12
2
7
7
14
2
7
3
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
SpA
SpA
SpA
SpA
SpA
182 By. Rico Maker
25 Sept 2014
1/205528/14
dr. Windhy, SpA
183 An. Ronald Mambiyeuw
25 Sept 2014
1/150127/12
dr. Windhy, SpA
184 An. Misael Amsamsyum

185 By. Elisabeth Komboy
186 By. Injil Yawan
25 Sept 2014
25 Sept 2014
25 Sept 2014
2/211790/14
2/199852/14
1/202589/14
L
P
P
dr. Windhy, SpA

dr. Windhy, SpA
dr. Windhy, SpA
187 Nn. Carlin Asmuruf
25 Sept 2014
1/211998/14
dr. Windhy, SpA
188 An. Aliance Kafiar

189 An. Selfiana Manggara
25 Sept 2014
25 Sept 2014
1/192561/14
1/106451/10
5
3
P
P
dr. Windhy, SpA

dr. Windhy, SpA
190 An. Paskalina Msen

191 An. Novalin Rumbiak
25 Sept 2014
25 Sept 2014
2/172572/13
1/211960/14
4
3
P
P
dr. Windhy, SpA

dr. Windhy, SpA
192 An. Sinandi Rumbino

193 An. Keliopas Bebari
25 Sept 2014
26 Sept 2014
1/186052/14
1/212061/14
1
6
L
L
dr. Delly
dr. Delly
194 An. Enjelika Bonsapia

195 An. Aurel Ansanay
26 Sept 2014
26 Sept 2014
1/212116/14
1/212053/14
1
5
P
P
dr. Delly
dr. Delly
196 An. Syalomita T. Sarakan

197 By. Maya Rumbewas
26 Sept 2014
26 Sept 2014
1/167852/13
1/212102/14
P
P
dr. Delly
dr. Delly
198 An. Elvira Kafiar

199 An. Katrin Marandof
27 Sept 2014
27 Sept 2014
1/128619/11
1/151081/12
3
2
P
P
dr. Benyamin
dr.Mike
200 An. Risal Kbarek
27 Sept 2014
2/185458/14
dr. Benyamin
201 An. Lutfi Bab
27 Sept 2014
1/205311/14
dr. Benyamin
5
7
10
202 An. Jekson Mayor
29 Sept 2014
1/197788/14
dr. Windhy, SpA
203 An. Juan Rumaseb

204 An. Samuel Kurni
29 Sept 2014
29 Sept 2014
1/146333/12
1/172874/14
2
1
L
L
dr. Windhy, SpA

dr. Windhy, SpA
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
29
29
29
29
29
29
30
30
30
30
30
30
30
30
30
30
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2/132535/12
1/212207/14
1/212264/14
2/173069/14
1/158065/13
2/152271/13
2/203808/14
2/204846/14
1/212420/14
1/212399/14
1/178584/14
1/212355/14
1/199907/14
1/153700/13
2/205244/14
2/211926/14
3
4
13
L
L
L
P
P
P
L
L
L
L
L
L
L
P
P
P
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
221 An. Aprilia Kaise
30 Sept 2014
1/187787/14
dr. Windhy, SpA
222
223
224
225
30
30
30
30
2014
2014
2014
2014
2/211725/14
2/209192/14
2/211803/14
1/207550/14
P
P
P
P
dr.
dr.
dr.
dr.
30 Sept 2014
30 Sept 2014
2/211543/14
1/169127/13
P
P
dr. Windhy, SpA

dr. Windhy, SpA
An. Mathias Mofu

An. Micha Ayamiseba
By. Roy Sanadi
An. Nona Warpur
An. Laurina Mofu
An. Rina Manggombo
An. Wilyam Mayor
By. Yan Abraham Ronsumbre
By. Agustinus Wabiser
By. Anthonius Wader
An. Yermias Ayer
By. Joe Mandowen
By. Joel Sombuk
An. Elona Rumbewas
By. Afika Wakaf
An. Oktalia Rumbiak
By. Mince Kogoya

An. Debora Mayor
An. Jenitha Makuker
By. Roselina Randongkir
226 By. Aprilia Simbiak

227 An. Mariana Burako
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
1
2
2
2
4
3
1
2
1
27
9
2
3
1
1
1
6
5
2
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
Windhy,
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
SpA
228 An. Jil A. Andarek

229 An. Silvia F. Koibur
30 Sept 2014
30 Sept 2014
1/201293/14
2/211788/14
1
2
P
P
dr. Windhy, SpA

dr. Windhy, SpA
T O T A L >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
AH KABUPATEN BIAK NUMFOR

H SAKIT UMUM DAERAH
( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
LAIM PASIEN JAMKES PAPUA
DIAGNOSA
ICD
8
Stomatitis
Malter
Selulitis
Ispa
Ispa
Ispa
Malaria Klinis
Malaria Klinis
Ispa
Ispa
Conjuctivitis
TINDAKAN
ICD
BIAYA
JUMLAH
KETERANGAN
10
11
12
13
14
Kontrol
Lab
B51.9
J06.9
J06.9
J06.9
B54
B54
J06.9
J06.9
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
27,500
18,000
27,500
18,000
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
45,500
45,500
###
45,500
###
###
###
###
###
###
###
###
Gea
Gea
K52,9
K52,9
Combutio
Kontrol
Bronchitis
TB. Paru
Malaria Tersiana
J40
A15.0
B51.9
TB. Paru
Ispa
A15.0
J06.9
Ispa
Malaria Klinis
J06.9
B54
K52,9
Gea
Varisela
Dyspepsia
Kontrol
Kontrol
Lab
K30
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Malaria Tersiana
B51.9
Malaria Tropika
B50,9
Malaria Tersiana
TB. Paru
Malaria Tersiana
B51.9
A15.0
B51.9
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
B51.9
B54
Lab
Kontrol
Kontrol
K52,9
Kontrol
Malaria Tersiana
Malaria Klinis
Infeksi Tali Pusat
Gea
TB. Paru
25,500
27,500
18,000
27,500
27,500
27,500
27,500
18,000
27,500
27,500
18,000
27,500
27,500
27,500
27,500
18,000
27,500
18,000
27,500
18,000
27,500
18,000
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
###
45,500
###
###
###
45,500
###
###
45,500
###
###
###
45,500
45,500
45,500
###
45,500
###
###
45,500
###
###
###
###
Malaria Tersiana
Malaria Tersiana
B51.9
Kontrol
B51.9
Lab
Kontrol
Lab
Kontrol
Kontrol
Morbili
Ispa
Bronchitis Akut
TB Paru
TB Paru
Malaria Tersiana
Malaria Tersiana
Lab
Kontrol
A15,0
A15,0
B51.9
Kontrol
Kontrol
Kontrol
B51.9
Lab
Kontrol
B51.9
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
A15,0
J40
B51.9
Lab
Kontrol
Kontrol
Kontrol
Malaria Tersiana
Ispa
B51.9
J06.9
Lab
Kontrol
Kontrol
Malaria Tersiana
B51.9
Kontrol
Malaria Tersiana
B51.9
Lab
Kontrol
B54
Lab
Kontrol
Bronchitis
Rhinitis Alergi
Bronchitis
Pio Derm
Malaria Tersiana
TB Paru
Bronchitis
Malaria Tersiana
Malaria Klinis
J40
J40
27,500
18,000
45,500
27,500
18,000
27,500
27,500
18,000
27,500
27,500
27,500
45,500
###
###
45,500
###
###
###
27,500
18,000
45,500
27,500
18,000
45,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
18,000
27,500
27,500
###
###
###
45,500
###
###
45,500
###
###
27,500
18,000
45,500
27,500
18,000
27,500
45,500
###
TB Paru
Infeksi Neonatorum
Malaria Klinis
Malaria Klinis
Ispa
Malaria Klinis
Pio Derm
Bronchitis
Malaria Tersiana
Rhinitis Alergi
Bronchitis
BHA
Bronchitis
Bronchitis
Bronchitis
Bronco Pnemonia
Omsk Kanan
Ispa
Urti Caria
GEA
Hisprung
Kongjungtivitas
Bronchitis
GEA
Congjungtivitas
Ispa
Ispa
Ascariasis
A15,0
B54
B54
J06.9
B54
J40
B51.9
J40
J40
J40
J40
J06.9
K52,9
J40
K52,9
J06.9
J06.9
B77
Kontrol
Lab
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
kontrol
Kontrol
kontrol
kontrol
kontrol
Kontrol
kontrol
kontrol
Lab
Kontrol
Kontrol
Kontrol
27,500
18,000
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
###
63,500
###
###
###
###
###
27,500
###
45,500
###
###
27,500
27,500
###
27,500
27,500
###
###
###
###
###
###
27,500
###
###
45,500
###
###
###
Gea
Malaria Klinis
Bronchitis
Malaria Tersiana
K52,9
B54
J40
B51.9
TB Paru
TB Paru
Malaria Tersiana
A15,0
A15,0
B51.9
Bronchitis
J40
Malaria Tersiana
B51.9
Gea
K52,9
Malaria Tersiana
B51.9
Malaria Tersiana
B51.9
Congjungtivitas
Malaria Tropika
Malaria Tersiana
Malaria Tersiana
Bronchitis
Malaria Tersiana
Bronchitis
TB Paru
Dispepsia
ISK
B50,9
B51.9
B51.9
J40
B51.9
J40
A15,0
K30
N39,9
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
18,000
27,500
18,000
27,500
18,000
27,500
18,000
27,500
18,000
27,500
18,000
27,500
27,500
18,000
27,500
18,000
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
###
###
27,500
45,500
###
###
45,500
45,500
45,500
45,500
45,500
45,500
###
45,500
45,500
45,500
###
27,500
###
###
###
Prurigo
Furunkel
Candidiasis Oral
Impertigo
Epistaksis
Impertigo
Malaria Tersiana
Malaria Tersiana
Vertikulomegali
Bronchitis Akut
Rhinitis
Kongjungtivitis akut
Malaria Tropika
B37,0
B51.9
B51.9
J20,9
J31,0
H10,1
B50,9
Ispa
Ispa
Ispa
Cerebral Palsy
Malaria Klinis
Malaria Klinis
Ispa
J06.9
J06.9
J06.9
Malaria Tersiana
B51.9
Kp
Malaria Tersiana
Ispa
B54
B54
J06.9
A15,0
B51.9
J06.9
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
18,000
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
27,500
18,000
27,500
18,000
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
18,000
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
18,000
27,500
45,500
###
###
###
45,500
###
45,500
45,500
###
###
###
###
45,500
###
###
###
###
###
###
###
45,500
45,500
###
45,500
###
Malaria Tersiana
B51.9
Diare Ringan
Ispa
Bronchitis
Malaria Klinis+Ispa
Bronchitis
Ispa
GEA
Bronchitis
Broncopneumonia
Oma
Ispa - Gastritis Akut
Malaria Klinis+Ispa
Ispa
Ispa
Dysentri
Malaria Tersiana
Malaria Klinis
Malaria Tersiana
Ikterus
Bronchitis Akut
TB Paru
Bronchitis Akut
Bronchitis
J06.9
J40
B54
J40
J06.9
K52,9
J40
J18,0
B54
J06.9
J06.9
B51.9
B54
B51.9
J20,9
A15,0
J20,9
J40
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
27,500
18,000
27,500
18,000
27,500
45,500
45,500
###
27,500
27,500
###
###
27,500
27,500
27,500
###
###
###
27,500
25,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
18,000
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
53,000
###
###
###
###
###
###
###
###
45,500
63,500
###
45,500
###
45,500
###
Malaria Klinis
Inpertigo Bulosa
Helminthiasis
Enterokolitis
GEA
Extrima
Bronchitis Akut
GEA
OMSK
Epistaksis
Cerebral Palsy
Ispa
Malaria Tersiana
TB Paru
Mumps
Bronchitis Akut
Ispa
Ispa
Ispa
Bronchitis
B54
L01
B83,9
K52,9
J20,9
K52,9
J06.9
B51.9
A15,0
B26
J20,9
J06.9
J06.9
J06.9
J40
Anemia
Bronchitis
D64,9
J40
Malaria Klinis
B54
Malaria Tersiana
B51.9
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
18,000
18,000
27,500
18,000
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
18,000
27,500
18,000
27,500
###
###
###
###
45,500
###
63,500
45,500
###
###
###
###
45,500
###
###
###
###
###
###
45,500
###
45,500
45,500
Dysentri
Inpertigo
L01
GEA
Varisella
Rinitis
K52,9
Ispa
J06.9
TB Paru
Malaria Tersiana
A15,0
B51.9
Bronchitis
Malaria Tersiana
J40
B51.9
GEA
ISK
K52,9
N39,9
Ispa
Trauma Capitis
Malaria Klinis
GEA
J06.9
S09,9
B54
K52,9
TB Paru
Malter+Ispa
A15,0
B51.9
Malaria Tersiana
B51.9
Malaria Tersiana
B51.9
Lab
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
18,000
27,500
18,000
27,500
18,000
27,500
27,500
27,500
18,000
27,500
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
18,000
27,500
45,500
45,500
45,500
###
###
###
45,500
45,500
###
45,500
###
45,500
###
45,500
###
45,500
###
45,500
###
45,500
45,500
Malaria Tersiana
B51.9
Ispa
TB Paru
J06.9
A15,0
Ispa
Malaria Tersiana
Bronchitis
Malnutrisi
Ispa
TB Paru
TB Paru
Ispa
J06.9
B51.9
J40
E46
J06.9
A15,0
A15,0
J06.9
K52,9
J40
J40
GEA
Bronchitis
Bronchitis
Dermatitis
Bronchiolitis
Dispepsia
Folikulitis
Malaria Tersiana
J21,9
K30
B51.9
Malaria Tersiana
B51.9
Bronchitis
Bronchitis Akut
Malaria Klinis
Malaria Tersiana
J40
J20,9
B54
B51.9
Anorekxia
Malaria Tropika
B50,9
Lab
Kontrol
Lab
Kontrol
Kontrol
RO
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
18,000
27,500
18,000
27,500
27,500
45,500
25,500
27,500
27,500
53,000
###
###
27,500
27,500
27,500
27,500
27,500
27,500
27,500
###
###
###
###
###
###
###
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
18,000
###
###
###
###
###
###
27,500
27,500
27,500
27,500
18,000
27,500
27,500
45,500
###
45,500
45,500
###
###
###
45,500
###
TB Paru
Ispa
>>>>>>>>>>>>>>>>>>>>>
A15,0
J06.9
Lab
Kontrol
Kontrol
18,000
27,500
27,500
45,500
###
###
7,751,500
PEMER
RU
Jl. Sriwijaya Ridge
FOR
Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
:
:
:
:
:
:
:
NAMA
SEPTEMBER 2014
RSUD BIAK
76 PASIEN
TANGGAL
No. MR
UMUR
1
1
2
2
Tn. Alex Randongkir
Tn. Daeng T. Rumbewas
01 Sept 2014
01 Sept 2014
3
2/146075/12
1/209353/14
THN
4
59
60
Ny. Anna A. Mofu
01 Sept 2014
1/124481/13
35
4
5
Tn. Mesak L. Insyur

Ny. Miryam Sada
02 Sept 2014
03 Sept 2014
1/210443/14
1/210361/14
22
67
6
7
Ny. Erna Prawar

Ny. Magdalena Ronsumbre
04 Sept 2014
04 Sept 2014
1/108207/10
1/145370/12
27
39
8
9
Tn. Nelson Ofahe

Tn. William Engels
04 Sept 2014
04 Sept 2014
1/210556/14
1/210591/14
22
56
10
Tn Marvin Siwabessy
05 Sept 2014
1/210643/14
17
11
Tn. Wihelmus Ronsumbre
06 Sept 2014
2/117310/11
67
12
Tn. Daeng T. Rumbewas
06 Sept 2014
2/209353/14
60
13
14
15
16
Ny.
Ny.
Tn.
Ny.
06
06
08
08
2014
2014
2014
2014
2/196655/14
2/210191/14
1/102385/10
1/100919/10
40
33
82
47
17
18
19
20
21
Ny. Margaretha Padwa

Tn. Andrias A. Rumpaidus
Tn. Stevi Sroyer
Tn. Nelson Ofahe
Nyg. Fiktor Bab
08 Sept 2014
08 Sept 2014
9 Sept 2014
9 Sept 2014
9 Sept 2014
1/108093/10
1/210753/14
2/177943/14
1/210556/14
1/210837/14
60
50
38
22
15
Karolina Rumbino
Orpa Rumbrawer
Habel Wakum
Hamida Kafiar
Sept
Sept
Sept
Sept
22
Nn. Feronika Kosai
23
24
25
26
Ny.
Ny.
Ny.
Tn.
1/210811/14
18
2014
2014
2014
2014
1/104040/10
1/210874/14
1/156086/13
2/147945/12
50
27
50
43
27
28
29
Tn. Yehuda Uduas

Tn. Farid Riansyah
Nyg. Fiktor Bab
10 Sept 2014
11 Sept 2014
11 Sept 2014
1/111220/11
1/180338/14
1/210837/14
39
30
15
30
31
32
33
34
Tn. Laban Sanadi

Tn David Aprombis
Tn. Yosep Rumaikeuw
Tn. Apot Nagolix Lokobal
Ny. Welmina Maninemwarba
11
11
11
11
11
2014
2014
2014
2014
2014
1/210945/14
1/210946/14
1/191886/14
1/128444/12
1/210896/14
30
25
30
46
34
35
Ny. Heni Miokbun
11 Sept 2014
2/122517/12
41
36
37
38
39
40
Ny.
Ny.
Ny.
Ny.
Tn.
11
11
11
12
12
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
1/210924/14
2/173433/14
1/210990/14
1/210874/14
1/211103/14
49
51
37
27
35
41
42
43
44
45
46
47
Ny. Henny Wonatorey

Tn. Yehuda Uduas
Ny. Elsina Horik
Nn. Feronika Kosai
Nn. Marlina Farwas
Ny. Welmina Maninemwarba
Tn. Isak Samuel Korwa
13
13
15
15
16
16
16
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
1/211168/14
1/111220/11
1/206279/14
1/210811/14
1/211376/14
1/210896/14
1/148415/12
35
39
48
18
12
30
27
48
49
Tn. Armando Mandowen

Ny. Elisabeth oibur
18 Sept 2014
19 Sept 2014
1/211547/14
2/106126/10
27
65
50
51
52
Ny. Costantina Wakum

Tn. Tommy Yawan
Tn. Hofni Kapitarauw
22 Sept 2014
22 Sept 2014
22 Sept 2014
1/125195/12
1/211713/14
2/120560/11
79
45
29
53
54
Tn. Nelson Ofahe

Ny. Miryam Ronsumbre
22 Sept 2014
23 Sept 2014
1/210556/14
2/152891/13
22
57
Eunike Usior
Arnelda Imbiri
Yohana Wadibar
Noak Rumbekwan
Suerni Rahakbouw
Sofia Sada
Levina Maniabe
Arnelda Imbiri
Maxie H. Saba
9 Sept 2014
10
10
10
10
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
55
56
57
58
59
Ny.
Ny.
Ny.
Ny.
Ny.
60
61
Ruth Lea Randongkir

Yubelina Yarangga
Christina Mambobo
Suslin Mampioper
Tabita Miokbun
2014
2014
2014
2014
2014
2/198396/14
1/211762/14
1/103764/10
2/144898/12
1/137612/12
27
60
57
45
31
Ny. Sofia Sada

Ny. Magdalena Komboy
24 Sept 2014
25 Sept 2014
2/173433/14
1/134074/12
51
50
62
63
Ny. Nurhayati Maniani

Nn. Yuli Sabarofek
26 Sept 2014
26 Sept 2014
1/212101/14
1/212074/14
25
21
64
Nn. Gustavina Brabar
26 Sept 2014
1/212104/14
15
65
66
67
68
69
70
71
Ny. Pona Rumsowek

Ny. Lince Sarawan
Tn. Marselo Rumabar
Ny. Sofia Sada
Nn. Yuli Sabarofek
An. Gloria Siwabessy
Ny. Dina Omega Rumere
26
27
27
29
29
29
29
2014
2014
2014
2014
2014
2014
2014
1/212111/14
1/115237/11
2/201128/14
2/173433/14
1/212074/14
1/140774/12
2/195136/14
24
62
24
51
21
2
56
72
Ny. Sujarwati
29 Sept 2014
1/179681/14
47
73
Ny. Ester Koibur
29 Sept 2014
2/211941/14
59
74
Tn. Makmeser Kafiar
29 Sept 2014
1/212271/14
25
75
Ny. Anace Wondal
29 Sept 2014
1/200370/14
56
76
Ny. Yemima Arwakon
30 Sept 2014
1/155893/13
49
23
23
23
23
24
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
T O T A L >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
PEMERINTAH KABUPATEN BIAK NUMFOR

Jl. Sriwijaya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
BIAK, M Kes,SpPK
NGKAT LANJUT
UMUR
BLN HARI
5
P/L
DKTR
DIAGNOSA
ICD
6
L
L
7
dr. Mike W
dr. Michael
8
Gea
Malaria Tersiana
9
K52,9
B51,9
dr. Michael
Stomatitis
L
P
dr. Jonathan
dr. Syukri
Susp. Tb. Paru

Bronchitis+Anemia
A16,1
J40
P
P
dr. Lia
dr. Lia
Dyspepsia
Malaria Klinis
K30
B54
L
L
dr. Lia
dr. Benyamin
Dyspepsia
Hepatitis
K30
K75,9
dr. Jonathan
Bronchitis
J40
dr. Michael
COPD
J44,0
dr. Michael
COPD+HT+Vertigo
J44,0
P
P
L
P
dr. Michael
dr. Michael
dr. Syukri
dr. Syukri
TB. Paru
Bronchitis
SNHL
Hemoroid Eksternal
A15.0
J40
P
L
L
L
L
dr. Syukri
dr Aslan SpPD
dr. Delly
dr. Delly
dr. Delly
Malaria Klinis
Faringitis Acut
Dyspepsia
Susp. Tb. Paru
Artritis Genue Sinistra
B54
J02
I84,4
K30
A16,1
dr. Delly
P
P
P
L
dr.
dr.
dr.
dr.
Jonathan
Jonathan
Jonathan
Jonathan
L
L
L
dr. Jonathan
dr I Gede
dr I Gede
I
I
I
I
I
Gede
Gede
Gede
Gede
Gede
Pan Sinusitis
Osteo Artritis
Bronchitis
Malaria Klinis+Dispepsia
Bronchitis Chroris
M15,9
J40
B54
J41,8
Malter+Ispa
Malaria Klinis+Ispa
Gout Artritis
B51,9
B54
M10
Malaria Klinis
GO
Asma Bronckiale
OMA
Malaria Tersiana
B54
B51,9
L
L
L
L
P
dr
dr
dr
dr
dr
dr I Gede
Nefritis
N00
P
P
P
P
L
dr I Gede
dr I Gede
dr I Gede
dr. Benyamin
dr. Benyamin
Bronchitis
CHF+Dyspepsia
Malaria Klinis
Bronchitis
Malaria Tersiana
J40
I11,0
B54
J40
B51,9
P
L
P
P
P
P
L
dr. Michael
dr. Michael
dr. Lato
dr. Lato
dr. Reni R
dr. Reni R
dr. Reni R
Malaria Tropika
Gastritis+Mal.Klinis
Hyperurimea
Sinusitis
Gastritis Akut
Gastritis Akut
App. Acut
B50,9
K52,9
L
P
dr. Reni R
dr. Jonathan
Scizofrenia
Malter+Dm Type II
P
L
L
dr. Michael
dr. Michael
dr. Michael
RA
Hipemetop
Gastritis Kronis
L
P
dr. Delly
dr. Jonathan
Dyspepsia
Malaria Klinis+Gea
J45
J01,9
K29,1
K29,1
B51,9
K30
B54
P
P
P
P
P
dr.
dr.
dr.
dr.
dr.
P
P
Jonathan
Jonathan
Jonathan
Jonathan
Jonathan
Bronchitis
Katarak ODS
Osteo Artritis
Bronchitis+Dyspepsia
Malter+Ispa
J40
H26
M15,9
J40
B51,9
dr. Jonathan
dr. Lato
CHF+Dyspepsia
Bronchitis
I11,0
J40
P
P
dr. Benyamin
dr. Benyamin
Low Cat Ae
Bronchiolitis
J21,9
dr. Benyamin
PPOK+Dispepsia
P
P
L
P
P
P
P
dr. Benyamin
dr. Mike W
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Jonathan
dr. Jonathan
PPOK+TB
Dyspepsia
Malaria Klinis
Gastritis Cronis
Bronchitis Cronis
Dermatitis Infeksi
Malter+Dyspepsia
B51,9
dr. Jonathan
Malter+Dyspepsia
B51,9
dr. Jonathan
Malter+Dyspepsia
B51,9
dr. Jonathan
TB. Paru
A15,0
dr. Lia
Hipercholerterolemia
dr. Lia
Susp. CKD
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
K30
B54
J40
TINDAKAN
ICD
10
11
Kontrol
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Lab
Lab
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Lab
Kontrol
RO
Kontrol
Lab
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
USG
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
BIAYA
12
27,500
27,500
18,000
27,500
18,000
27,500
27,500
18,000
18,000
27,500
27,500
18,000
27,500
27,500
18,000
27,500
25,500
27,500
18,000
27,500
18,000
27,500
27,500
27,500
27,500
53,000
27,500
27,500
27,500
27,500
27,500
JUMLAH
13
27,500
45,500
45,500
27,500
63,500
27,500
45,500
27,500
45,500
53,000
45,500
45,500
27,500
27,500
27,500
80,500
27,500
27,500
27,500
27,500
27,500
KETERANGAN
14
Kontrol
CT Scan
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Lab
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Lab
USG
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
USG
Kontrol
Kontrol
Lab
Lab
Lab
Kontrol
Kontrol
Kontrol
Lab
Lab
Kontrol
Kontrol
27,500
680,000
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
18,000
18,000
27,500
27,500
27,500
27,500
27,500
18,000
27,500
18,000
18,000
53,000
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
53,000
27,500
27,500
18,000
18,000
18,000
27,500
27,500
27,500
18,000
18,000
27,500
27,500
707,500
27,500
27,500
27,500
45,500
27,500
27,500
63,500
27,500
27,500
27,500
27,500
45,500
116,500
27,500
27,500
27,500
27,500
45,500
27,500
27,500
27,500
27,500
27,500
27,500
80,500
27,500
81,500
27,500
27,500
63,500
27,500
27,500
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Lab
RO
Kontrol
Lab
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Lab
Lab
Kontrol
Lab
Kontrol
RO
Kontrol
Lab
Lab
Kontrol
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
25,500
27,500
18,000
27,500
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
18,000
18,000
27,500
18,000
27,500
25,500
27,500
18,000
18,000
27,500
45,500
27,500
27,500
71,000
45,500
27,500
27,500
27,500
27,500
27,500
27,500
45,500
63,500
45,500
27,500
53,000
63,500
27,500
3,555,000
PEMERINTAH K
RUMAH S
Jl. Sriwijaya Ridge I Tlp ( 09
FORM KLAIM
Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
:
:
:
:
:
:
:
NAMA
SEPTEMBER 2014
RSUD BIAK
51 PASIEN
TANGGAL
No. MR
1
1
2
2
Ny. Yuli Rumbrawer
Ny.Yulina Pariaribo
03 Sept 2014
03 Sept 2014
3
2/210342/14
2/156776/14
THN
4
20
24
Ny.Sindi Rumere
03 Sept 2014
1/208995/14
33
4
5
Ny.Maryangke Bleskadit
Ny.Ningsih Obinaru
01 Sept 2014
03 Sept 2014
2/206111/14
2/209867/14
25
19
6
7
Ny.Feronika Womsiwor
Ny.Anike Asso
04 Sept 2014
05 Sept 2014
1/102648/10
2/208441/14
24
17
8
9
10
11
12
13
14
15
16
17
18
Ny.Anita I Pondagintan
Ny.Neli Mandowen
Ny.Yohana Aibekob
Ny.Nelce Waiberi
Ny.Delan M S Ulayananan
Ny.Grasela Ayomi
Ny.Fawelda Sada
Ny.Ernita Monim
Ny. Keterina Manufandu
08
09
10
11
11
11
12
12
12
15
15
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2/195864/14
1/161704/13
2/106019/14
2/136738/14
2/240984/14
1/210938/14
1/209801/14
1/211109/14
1/146483/14
2/195864/14
1/211227/14
25
37
38
55
19
26
19
24
40
25
32
19
20
Ny. Orpa Prawar

Ny. Hernia Kabes
15 Sept 2014
18 Sept 2014
1/116531/11
2/211129/14
34
22
21
Ny. Naomi Mansmor
18 Sept 2014
1/210938/14
36
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
UMUR
BLN
5
HARI
22
Ny. Delan Ms. Uluyanan
19 Sept 2014
1/210938/14
26
23
Ny. Hernia Kabes
20 Sept 2014
2/211129/14
19
24
Ny. Hernia Kabes
22 Sept 2014
2/211129/14
19
25
26
Ny. Oktovina Rumbewas

Ny. Ester Meokbun
22 Sept 2014
22 Sept 2014
1/211702/14
2/154505/13
24
22
27
Ny. Grasela Ayomi
23 Sept 2014
1/209801/14
18
28
Ny. Hernia Kabes
23 Sept 2014
2/211129/14
19
29
30
Ny. Elisabeth Kayoi

Ny. Grasela Ayomi
23 Sept 2014
24 Sept 2014
2/208545/14
1/209801/14
44
18
31
32
33
Ny. Orpa Prawar

Nn. Yemima Kararbo
Ny. Hernia Kabes
24 Sept 2014
25 Sept 2014
25 Sept 2014
1/116531/11
1/211953/14
2/211129/14
34
18
19
34
Ny. Juliana Rumbino
25 Sept 2014
1/151538/12
22
35
Tn. Darius Kiin
25 Sept 2014
1/199107/14
43
36
Ny. Grasela Ayomi
22 Sept 2014
1/209801/14
18
37
Tn. Darius Kiin
23 Sept 2014
1/199107/14
43
38
Ny. Grasela Ayomi
26 Sept 2014
1/209801/14
18
39
40
Ny. Juliana Rumbino

Ny. Novela Korwa
26 Sept 2014
26 Sept 2014
1/151538/12
1/177524/14
28
25
41
42
43
Ny. Rosalina Prawar

Ny. Elisabeth Kayoi
Ny. Grasela Ayomi
27 Sept 2014
27 Sept 2014
29 Sept 2014
1/212147/14
2/208545/14
1/209801/14
24
44
18
44
45
46
Ny. Marianke Bleskadit

Ny. Alfonsina Asyerem
Ny. Anike Asso
29 Sept 2014
29 Sept 2014
29 Sept 2014
2/195864/14
1/212351/14
2/208441/14
25
31
17
47
Ny. Hernia Kabes
29 Sept 2014
2/211129/14
19
48
49
Ny. Sonya Mandowen

Ny. Novela Rumainum
29 Sept 2014
29 Sept 2014
2/100274/10
2/187922/14
35
23
50
51
Ny. Tuksi N. Wanma

Ny. Elisabeth Kayoi
30 Sept 2014
30 Sept 2014
2/161952/14
2/208545/14
23
44
T O T A L >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

ya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
P/L
DKTR
DIAGNOSA
ICD
6
P
P
7
dr. Fery Wijaya
dr. Fery Wijaya
8
Gravida
Gravida
TINDAKAN
ICD
10
11
Kontrol
Kontrol
dr. Fery Wijaya
post Laparascopi
Usg
Kontrol
P
P
dr. Fery Wijaya

dr. Fery Wijaya
Gravida,Diare
Post Sc
kontrol
kontrol
P
P
dr. Fery Wijaya

dr. Fery Wijaya
Mastitis,Post Partum
Akseptor,Post Sc
Kontrol
Kontrol
Gv
P
P
P
P
P
P
P
P
P
P
P
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
dr.
Gravida
Amenothoe
Gravida
Agnesitis
Kontrol
Kontrol
Kontrol
P
P
dr. Fery Wijaya

dr. Fery Wijaya
Gravida
Post Sc
Kontrol
Kontrol
Kontrol
Lab
Kontrol
Kontrol
dr. Fery Wijaya
Gravida+Anamia
Kontrol
Fery
Fery
Fery
Fery
Fery
Fery
Fery
Fery
Fery
Fery
Fery
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Wijaya
Gravida
Gravida
Gravida
Gravida
Adnesitis
Gravida
Gravida+Dyspepsia
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Lab
dr. Fery Wijaya
Gravida
dr. Fery Wijaya
Post Sc
dr. Fery Wijaya
Post Sc
P
P
dr. Fery Wijaya

dr. Fery Wijaya
Apseptor KB Implant
Gravida
dr. Fery Wijaya
Post Sc
dr. Fery Wijaya
Post Sc
P
P
dr. Tjendono H
dr. Fery Wijaya
Amonorhoe
Post Sc
P
P
P
dr. Fery Wijaya

dr. Fery Wijaya
dr. Fery Wijaya
Gravida
Gravida
Post Sc
dr. Fery Wijaya
Ad Kontraksi
dr. Fery Wijaya
Gonorhoe
dr. Fery Wijaya
Post Sc
dr. Fery Wijaya
Gonorhoe
dr. Fery Wijaya
Post Sc
P
P
dr. Fery Wijaya

dr. Fery Wijaya
Ad Kontraksi
Gravida
P
P
P
dr. Fery Wijaya

dr. Fery Wijaya
dr. Fery Wijaya
Gravida
Ad Kontraksi
Post Sc
P
P
P
dr. Fery Wijaya

dr. Fery Wijaya
dr. Fery Wijaya
Gravida
Gravida
Post Sc
dr. Fery Wijaya
Post Sc
P
P
dr. Fery Wijaya

dr. Fery Wijaya
Gravida
Kista Ovarium
Kontrol
Usg
Kontrol
Gv
Kontrol
Gv
Kontrol
Kontrol
Usg
Kontrol
Gv
Kontrol
Gv
Kontrol
Kontrol
Gv
Kontrol
Kontrol
Kontrol
Gv
Kontrol
Usg
Kontrol
Gv
Kontrol
Gv
Kontrol
Gv
Kontrol
Gv
Kontrol
Kontrol
Usg
Kontrol
Kontrol
Kontrol
Gv
Kontrol
Kontrol
Kontrol
Gv
Kontrol
Gv
Kontrol
Kontrol
p
P
dr. Fery Wijaya

dr. Fery Wijaya
Apseptor KB
Amonorhoe
Usg
Kontrol
Kontrol
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
BIAYA
JUMLAH
12
27,500
27,500
53,000
27,500
20,000
20,000
27,500
13
27,500
27,500
27,500
20,000
27,500
27,500
27,500
27,500
25,700
27,500
27,500
27,500
27,500
27,500
27,500
18,000
27,500
27,500
27,500
27,500
18,000
80,500
47,500
47,500
47,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
45,500
27,500
27,500
45,500
KETERANGAN
14
27,500
53,000
27,500
20,000
27,500
20,000
27,500
27,500
53,000
27,500
20,000
27,500
20,000
27,500
27,500
20,000
27,500
27,500
27,500
20,000
27,500
53,000
27,500
20,000
27,500
20,000
27,500
20,000
27,500
20,000
27,500
27,500
53,000
27,500
27,500
27,500
20,000
27,500
27,500
27,500
20,000
27,500
20,000
27,500
27,500
80,500
47,500
47,500
27,500
80,500
47,500
47,500
27,500
47,500
27,500
27,500
47,500
80,500
47,500
47,500
47,500
47,500
27,500
80,500
27,500
27,500
47,500
27,500
27,500
47,500
47,500
27,500
53,000
27,500
27,500
80,500
27,500
27,500
2,049,000
PEMERINTAH
RUMAH
FORM KLA
Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
1
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
30
31
:
:
:
:
:
:
:
NAMA
2
Nn. Rina H. Anggresu
Tn. Ramlan Kafiar
Nn. Gandis F. Kafiar
Nn. Amanda Sineri
Tn. Saul Wabiser
An. Jan Richard Mayor
Agustinus Womsiwor
An. Fando Watimena
Tn. Matius Kaisiri
An. Yunita Mayor
Nn. Achnes Fonataba
Matius Kaisiri
Matius Kaisiri
Tn. Hans Suruan
Ny. Maya Dimara
Ny. Welmina Rumpaidus
Tn. Thedorus Jauply
Tn. Daud Wutwensa
Tn. Yosias Yaupli
An. Ofni T. Mandosir
Tn. Daud R. Mansnembra
An. Jack Halitopo
Ny. Yulina Kogoya
Ny. Maya Dimara
Ny. Mina Dimara
Tn. Daud Wutwensa
Tn. Alfian Makmaker
Nn. Christina R. Dagang
An. Azmyra N. N. Andrianty
An. Ruth Fiona Rumbewas
TANGGAL
01
02
03
03
04
05
05
07
08
09
10
11
12
15
16
17
17
17
17
18
18
19
19
19
20
20
20
22
22
23
24
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
SEPTEMBER 2014
RSUD BIAK
44 PASIEN
No. MR
3
1/210330/14
1/203538/14
1/210539/14
2/135713/12
2/210557/14
1/185047/14
1/210571/14
1/212790/14
1/135933/12
1/210839/14
1/200631/14
1/135933/12
1/135933/12
1/154191/13
2/100463/10
2/148350/12
1/211439/14
1/211427/14
1/210912/14
1/159946/13
1/112334/11
1/112334/11
1/196742/14
2/188088/14
2/100463/10
1/107763/10
1/211427/14
1/211690/14
1/104659/10
1/211777/14
1/211873/14
UMUR
THN
4
23
29
15
13
31
5
16
5
20
11
18
20
20
52
28
26
20
35
22
13
23
23
14
18
28
44
35
22
21
6
9
32
33
34
35
36
37
38
39
40
41
42
43
44
Tn. Yakob Rumbiak

Nn. Lidia Bethani Istia
Nn. Merry Rumbino
An. Nanda Dayan Rumbino
Ny. Alberthina Sroyer
An. Januarius Mayor
An. Jan Richard Mayor
An. Ruth Fiona Rumbewas
Nn. Lidia Bethani Istia
Ny. Andrice Saba
Tn. Manasa Marandof
Ny. Andrice Saba
24
25
26
27
27
27
27
27
29
29
29
30
30
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
Sept
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
1/143942/12
1/131944/12
1/112334/11
2/149198/12
1/212136/14
2/125257/12
1/104098/10
1/185047/14
1/211873/14
1/131944/12
1/155521/13
2/184944/14
1/155521/13
43
16
23
18
11
25
15
5
9
16
58
52
58
T O T A L >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
PEMERINTAH
RUMAH
FORM KLA
Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
1
1
2
3
4
5
6
7
8
9
10
11
:
:
:
:
:
:
:
NAMA
2
Dominikus Lermatan
Ny. Diana Repasi
An. Ebenhaezer Yarangga
Tn. Yusak Ronsumbre
Tn. Otto Simopiaref
Nn. Lidya B. Istia
An. Alexander Sabarofek
Ny. Ruth Swabra
Tn. Noak Yom
TANGGAL
01
01
02
03
03
03
04
04
07
07
08
3
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
Okt 2014
OKTOBER 2014
RSUD BIAK
35 PASIEN
No. MR
4
2/191129/14
1/212432/14
1/108157/10
2/194516/14
1/159531/12
1/112334/11
1/112334/11
1/131944/12
2/140680/12
1/212768/14
1/212841/14
UMUR
THN
5
21
33
7
41
62
23
23
16
7
67
73
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
An. Adinda Pondayar

An. Ebenhaezer Yarangga
An. Ruth F. Rumbewas
Tn. Elipius Bahabol
Ny. Mariana Kbarek
Nn. Lidya B. Istia
An. Jack Halitopo
Ny. Nurhasanah
Tn. Elipius Bahabol
Ny. Alberthina Sroyer
An. Anace Randongkir
Nn. Merry Rumbino
Tn. Elipius Bahabol
Tn. Faisal Rumbiak
Ny. Mariana Kbarek
Nn. Merry Rumbino
Tn. Jefri Rumbiak
Nn. Ninfa Papuani Insyur
Nn. Fonni Simopiaref
Tn. Agustinus Womsiwor
Tn. Elipius Bahabol
08
09
10
13
13
13
13
14
17
17
18
18
21
22
24
28
28
28
29
29
30
30
31
31
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
Okt
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
1/185791/14
1/108157/10
1/211873/14
2/212864/14
1/145745/12
1/131944/12
1/196742/14
1/169238/13
2/212864/14
1/211873/14
2/125257/12
1/211873/14
2/117995/11
2/149198/12
2/212864/14
1/214160/14
1/145745/12
2/149198/12
1/214236/14
1/128095/12
2/171218/12
1/210571/14
2/212864/14
1/211873/14
7
7
9
24
26
16
14
22
24
9
25
9
8
17
24
33
26
17
27
14
15
16
24
9
T O T A L >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
PEMERINTAH
RUMAH
FORM KLA
Bulan Pelayanan
Nama RS
Kode RS
Kelas RS
Jumlah Pasien
Nama Direktur RS
Jenis Perawatan
NO
1
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
:
:
:
:
:
:
:
NAMA
2
Tn. Kristian Mansnandifu
Ny. Mariana Kbarek
Nn. Ninfa Papuani Insyur
Tn. Faisal Rumbiak
Abraham Rumbarar
Tn. Jefri Rumbiak
Nn. Filda Rumbewas
Tn. Elipius Bahabol
Ny. Yenny Marice Rumaropen
Ny. Delila Rumawak
Tn. Jefri Rumbiak
Tn. Elipius Bahabol
An. Yunus Rumbiak
Ny. Jelkina Swabra
Tn. Jefri Rumbiak
Tn. Hanok S. Rumabar
Abraham Rumbarar
Ny. Jelkina Swabra
Nn. Delvanisa L. Y. Duwiri
Nn. Gadis F. Kafiar
Nn. Leorina Lidia Dam
Tn. Timotius Rumbrawer
Abraham Rumbarar
Ny. Diana Womsiwor
TANGGAL
01
01
01
03
04
04
05
06
06
07
07
07
12
13
13
14
15
15
15
17
20
21
22
22
24
24
28
29
29
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
Nov
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
2014
NOVEMBER 2014
RSUD BIAK
29 PASIEN
No. MR
3
2/171582/14
1/211873/14
1/145745/12
1/128095/12
2/171582/14
1/214160/14
1/214784/14
1/214236/14
2/171582/14
2/119972/11
2/212864/14
1/211873/14
1/128339/12
1/119390/11
1/214236/14
2/212864/14
1/211873/14
2/215194/14
1/126727/12
1/214236/14
2/151143/12
1/214784/14
1/126727/12
1/116275/11
1/210539/14
2/127897/12
1412T0003/14
1/214784/14
1412D0014/14
UMUR
THN
4
36
9
29
14
36
33
14
27
36
16
24
9
28
49
27
24
9
12
36
27
19
14
36
12
15
20
70
14
27
T O T A L >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

wijaya Ridge I Tlp ( 0981 ) 21294 Fax ( 0981 ) 22747 BIAK PAPUA
MBIAK, M Kes,SpPK
TINGKAT LANJUT
UMUR
BLN HARI
5
P/L
DKTR
DIAGNOSA
6
P
L
P
P
L
L
L
L
L
P
P
L
L
L
P
P
L
L
L
L
L
L
L
P
P
P
L
L
P
P
P
7
dr. Iba G
Drg. Sabam S
Drg. Sabam S
Drg. Sabam S
dr. Iba G
dr. Iba G
dr. Iba G
8
Periodentik
Drg. Sabam
Drg. Sabam
dr. Iba G
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
dr. Iba G
Drg. Sabam
S
S
S
S
S
S
S
S
S
S
S
S
S
S
ICD
TINDAKAN
ICD
10
11
HP
Sialolitiasis
K04.00
K11.5
GP
HP
HP
Periodentik
Periodentik
K04.01
K04.00
K04.00
K0.5
K0.5
Ko4.7
K08.3
K08.3
K04.00
K04.01
K04.01
K04.01
K0.5
K04.01
K0.5
K0.5
K08.3
K04.01
K04.7
K00.63
K04.01
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
HP
Periodentik
K0.5
K04.02
K04.00
Ko4.7
K0.5
K04.00
K0.5
Gangren radix
HP
Abses+Inasis
Periodentik
Abses+Inasis
GR
GR
HP
Pulp
GP
GP
Periodentik
Pulp
Periodentik
Periodentik
GR
Pulp
Abses+Inasis
PT
Pulp
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
L
P
L
P
P
P
L
L
P
P
P
L
P
dr. Iba G
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
dr. Iba G
dr. Iba G
Periodentik
S
S
S
S
S
S
S
S
Abses+Inasis
GP
HP
Pulp
Pulp
Pulp
Pulp
PT
Abses+Inasis
HP
Abses+Inasis
HP
K0.5
Ko4.7
K04.1
K04.00
K04.01
K04.01
K04.01
K04.01
K00.63
Ko4.7
K04.00
Ko4.7
K04.00
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

MBIAK, M Kes,SpPK
TINGKAT LANJUT
UMUR
BLN HARI
6
7
P/L
8
L
P
L
L
L
L
L
P
L
P
L
DKTR
9
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
dr. Iba G
dr. Iba G
dr. Iba G
Drg. Sabam
DIAGNOSA
S
S
S
S
S
10
Gangren Pulpa
Abses
Pulpitis
Periodontitis
Mobility
Non Vital
Gangren Pulpa
Gangren Pulpa
Abses
Periodontitis
Periodontitis
ICD
TINDAKAN
ICD
11
12
13
K04,1
K04,7
K04,0
K05
K04
K04,1
K04,1
K04,1
K04,7
K05
K05
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
P
L
P
L
P
P
L
P
L
P
P
P
P
P
L
L
P
P
L
P
P
L
L
P
dr. Iba G
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
dr. Iba G
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
dr. Iba G
dr. Iba G
Drg. Sabam
dr. Iba G
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
S
S
S
S
S
Periodontitis
Pulpitis
Pulpitis
Periodontitis
Pulpitis
Gangren Pulpa
Periodontitis
Periodontitis
Hiperemi Pulpa
K05
K04,0
K04,0
K05
K04,0
K04,1
K08,3
K04,0
K04,0
K04,1
K04,0
Ko4,7
Ko4,7
K04,0
K04,1
K05
K05
K04,0
Gingivitis
Pulpitis
Pulpitis
Pulpitis
Gangren Pulpa
Gangren Pulpa
K04,0
K04,0
K04,0
K04,1
K04,1
Radix
Pulpitis
Pulpitis
Gangren Pulpa
Hiperemi Pulpa
Persistensi
Persistensi
Pulpitis
Gangren Pulpa
S
S
S
S
S
S
S
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol

MBIAK, M Kes,SpPK
TINGKAT LANJUT
UMUR
BLN HARI
5
P/L
6
L
P
P
P
L
L
L
L
L
P
L
P
P
P
L
L
P
L
P
L
L
L
P
P
P
P
L
L
L
DKTR
7
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
dr. Iba G
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
dr. Iba G
Drg. Sabam
dr. Iba G
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
Drg. Sabam
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
DIAGNOSA
ICD
TINDAKAN
ICD
8
Gangren Pulpa
10
11
K04,1
K00,63
K04,1
K04,1
K04,1
K04,1
K04,0
K056
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
8908
Persistensi
Gangren Pulpa
Gangren Pulpa
Gangren Pulpa
Gangren Pulpa
Pulpitis
Gingivitis
Gangren Pulpa
Pulpitis
Pulpitis
Gangren Pulpa
Impaksi
Periodontitis
Pulpitis
Pulpitis
Pulpitis
Periodontitis
Pulpitis
Pulpitis
Pulpitis
Pulpitis
Pulpitis
Pulpitis
Abses
Periodontitis
Periodontitis
Gangren Pulpa
Periodontitis
K04,1
K04,0
K04,0
K04,1
K01
K050
K04,0
K04,0
K04,0
K050
K04,0
K04,0
K04,0
K04,0
K04,0
K04,0
K04,7
K050
K050
K04,1
K050
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
Kontrol
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
BIAYA
12
27,500
65,500
27,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
65,500.00
65,500.00
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500.00
27,500
65,500
65,500
27,500
JUMLAH
13
27,500
65,500
27,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
65,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
27,500
65,500
65,500
27,500
KETERANGAN
14
27,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
65,500
27,500
65,500
27,500
27,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
65,500
27,500
65,500
27,500
1,638,500
BIAYA
14
27,500
65,500
27,500
27,500
65,500
27,500
65,500
27,500
65,500
27,500
27,500
JUMLAH
15
27,500
65,500
27,500
27,500
65,500
27,500
65,000
27,500
65,500
27,500
27,500
KETERANGAN
16
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
1,025,000
BIAYA
12
27,500
65,500
65,500
65,500
27,500
65,500
27,500
27,500
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
27,500
27,500
27,500
27,500
JUMLAH
13
27,500
65,500
65,500
65,500
27,500
65,500
27,500
###
65,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
27,500
65,500
27,500
27,500
27,500
27,500
KETERANGAN
14
1,025,500

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