Dor 12

Count of PROVIDER
RECEIVED_DATE HOSP INVOICE NO PAYOR INVOICE NO

SEP-12-2019 0001004932/FIN/AR-OP/IX/2019 P19098364
001-09/KEU-RSDS/IX/2019 P19098209
00120/RJ/RI/RSSH/08/2019 P19098173
0016/IX/ADM/RSB_LDD/2019 P19098200
0024CSRJAS0919 P19098354
0069MCRJAS0919 P19098178
0146/RJ/KEU-RS.FMC/VIII/2019-R P19098034
0171/BAG.TAG/MF/IX/19 P19098335
02/437/INV/VIII/19 P19098199
022/A/SPP/VIII/RSIM/2019-R P19098031
0270SARJAS0819 P19098338
028/AR.RJ/IX/19 P19098339
0356/RJ/VIII/2019 P19098181
0397/RJ/VIII/2019-R P19098029
0506KEU-ADM/RSM/VIII/2019-R P19098023
071/KI.2.12/TG/IX/2019 P19098341
0785-INV/RMC-MKS/IX/2019 P19098353
082/INV/RSIADT/TAG/IX/2019 P19098185
09.A1/MGL/PMC/2019 P19098357
097/RJ/NT/RS-ARP/VIII/2019. P19098336
100220190900119 P19098190
101/INV/RSIADT/TAG/IX/2019 P19098186
1038/DIR/RSUBT/VIII/2019-R P19098026
1165MCRJAS0819 P19098180
117-B/RJ/NT/RSMHTP/IX/2019 P19098337
1324/CL/RSIA-MH/VIII/19-R P19098036
148.432/1908006 P19098361
148.432/1908007 P19098360
15074/INV/RSGK/TAG/IX/2019 P19098188
15137/INV/RSGK/TAG/IX/2019 P19098189
1612704 P19098170
1695/RSABL/PENAG/09/2019 P19098332
1938/D30000/2019-S4 P19098343
19H09510 P19098344
200120190900370 P19098193
200320190800835-R P19098024
200320190800836-R P19098025
2019/08/IMA/094-R P19098030
202500/TAG-UMUM/YKS-BKS/IX/201 P19098326
208/INV/BWCH/TAG/IX/2019 P19098183
2175/RSUI-HA/TGH/IX/2019 P19098340
222/RSU-KI/P/VIII/2019R P19098022
264/19-VIII/BMS-2019-R P19098037
308/INV/CH/TAG/IX/2019 P19098168
326-08/KEU-RSDS/VIII/2019 P19098195
3662/RS.AULIA/KEU/VIII/2019 P19098204
3707/RS.AULIA/KEU/IX/2019 P19098208
400166/RJ-KEU/RSPB/IX/2019 P19098346
4265/KEU/RWJ/RSHBKS/VIII/2019- P19098027
4370/INV/RSUBM/TAG/IX/2019 P19098352
482/P/16/RSKBR/VIII/2019-R P19098033
5049/RSP/VIII/2019 P19098175
630-R.077/TAG-RSBK/IX/19 P19098196
6600/TGH-KEU/IX/2019 P19098331
769/INV-RSHD/IX/2019 P19098328
AII/20190909/00003 P19098197
AMDS2019RJ001191 P19098342
AR-2019/09/10/0071 P19098355
AR-2019/09/11/0051 P19098184
AR-KDY/2019/09/05/0026 P19098177
B.2019.0819 P19098359
B/9284/IX/2019/RSBHAY.TK.I P19098203
B1909.0323 P19098174
BLKK/1909/00106 P19098351
BN-09/07/2019-20793 P19098358
C92787 P19098345
G000012450/RSHGA/8/2019-R P19098020
G000012807/RSHGA/9/2019 P19098192
HOD-136-08/05-08-2019-R P19098035
INV-001329 P19098201
INV2019010000985-R P19098028
IVI190900358 P19098191
K34040819 P19098171
KT/177/ADM/IX/2019 P19098362
KU.26/51/14/RSP.CBN-2019 P19098349
KWR190800301 P19098363
P190301024/KU-RSIJPK - P19098347
P190800209-R P19098019
P1909.1560 P19098176
RJ19003872/ADM-P/INS/VIII/-R P19098032
RSIAMF/KU/A-MEGA/001-002/IX P19098329
SB/PTAMN/839/IX/2019 P19098350
SHYG20190900053 P19098327
TB/AF/UMU/19/08/100501 P19098356
TB/AF/UMU/19/08/100574 P19098348
SEP-12-2019 Total
(blank) (blank) (blank)
(blank) Total
Grand Total
PROVIDER Total
1223ÊKA HOSPITAL BSD 19
0083^RS. DEWI SRI 6
0007^RS. UIN SYARIF HIDAYATULLAH 1
3390^RSIA. LOMBOK DUA DUA ( JL. FLORES) 1
1682^RSU. ST CAROLUS SUMMARECON 3
0796^RS. METROPOLITAN MEDICAL CENTRE (MMC) 3
0835^RS. FAMILY MEDICAL CENTRE BOGOR 1
0742^RSU. MARTHA FRISKA 1
1534^RS. MITRA BANGSA 1
0741^RS. ISLAM MALAHAYATI 1
0022^RS. SARI ASIH KARAWACI 10
0720^RSIA. CITRA INSANI 5
1116^RS. AWAL BROS TANGERANG (D/H RS. GLOBAL MEDIKA 7
1630^RS. AWAL BROS MAKASSAR 1
1269^RS. MULYASARI 1
0119^RSU. KASIH IBU SURAKARTA 24
1388^RATULANGI MEDICAL CENTRE 3
0775^BRAWIJAYA HOSPITAL DUREN TIGA D/H RSIA. DUREN TIGA 2
0308^PAMULANG MEDICAL CENTER (PMC) 3
1545^RS. MH THAMRIN PURWAKARTA 1
1884^SILOAM SRIWIJAYA PALEMBANG 10
0775^BRAWIJAYA HOSPITAL DUREN TIGA D/H RSIA. DUREN TIGA 1
1651^RS. BUNDA THAMRIN MEDAN 1
0796^RS. METROPOLITAN MEDICAL CENTRE (MMC) 1
1545^RS. MH THAMRIN PURWAKARTA 1
0125^RSIA. MELATI HUSADA 1
0795^RS. PUSAT PERTAMINA 3
0795^RS. PUSAT PERTAMINA 11
0643^RS. GRHA KEDOYA 1
0643^RS. GRHA KEDOYA 1
1364^RS. ISLAM SURABAYA JEMURSARI 5
0487^RS. ADVENT LAMPUNG 6
0602^RS. PERTAMINA CIREBON 4
0291^RS. ICHSAN MEDICAL CENTER (IMC) 5
0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 8
0391^SILOAM HOSPITALS LIPPO CIKARANG 1
0391^SILOAM HOSPITALS LIPPO CIKARANG 2
1273^RS. SURYA HUSADHA 1
1293^KLINIK YAKESTI BEKASI 3
0842^BRAWIJAYA WOMEN & CHILDREN HOSPITAL 1
0753^RS. ISLAM HARAPAN ANDA 19
0179^RSU. KASIH IBU DENPASAR 2
2392^KLINIK & APOTIK BONA MEDIKA SERANG 1
1670^CIPUTRA HOSPITAL 3
0083^RS. DEWI SRI 19
0972^RSU. AULIA 1
0972^RSU. AULIA 1
0972^RSU. AULIA 1
0972^RSU. AULIA 1
0322^RSU. PERMATA BUNDA MEDAN 1
0178^RS. HERMINA BEKASI 1
1056^RS. BUNDA MARGONDA 11
0269^RS. KATOLIK BUDI RAHAYU BLITAR 1
0170^RS. PLUIT 2
0185^RS. BHAKTI KARTINI 3
0790^RSIA. BUNDA JAKARTA 2
0230^RS. H. DARJAD 1
0600^RS. ST.CAROLUS 2
2926^RSIA. ANDINI 1
2388^RS. EMC SENTUL (D/H RS. PERTAMEDIKA SENTUL CITY) 5
0737^RS EMC TANGERANG D/H RS. USADA INSANI 1
2294^RS. JAKARTA EYE CENTER (JEC) KEDOYA 1
3972^KLINIK MIRACLE GRAND INDONESIA 1
0944^RS. BHAYANGKARA TK.1 R.SAID SUKANTO (POLRI) 1
5640^RS. PONDOK INDAH BINTARO JAYA 3
1989^RSIA. KARUNIA KASIH (KARUNIA BUNDA) 3
0590^RS. COLUMBIA ASIA MEDAN (D/H GLENI MEDAN) 4
1151^KLINIK QUANTUM SARANA MEDIK 5
1194^RS. HASANAH GRAHA AFIAH 1
1194^RS. HASANAH GRAHA AFIAH 4
0829^RS. PREMIER SURABAYA (RS. SURABAYA INTERNASIONAL) 1
2460^KLINIK UTAMA TUGU SAWANGAN 3
1026^RSIA. TAMBAK 1
1090^RS. PERMATA CIBUBUR 6
0007^RS. UIN SYARIF HIDAYATULLAH 31
0956^KLINIK TOMANG (TANJUNG DUREN ) 7
0293^RS. PELABUHAN CIREBON 1
0029^RSU. EVASARI 2
0102^RS. ISLAM JAKARTA TIMUR (PONDOK KOPI) 3
0620^RS. KARYA MEDIKA II (D/H RSIA. ) 1
0049^RS. PONDOK INDAH 2
0761^RS. SANTO BORROMEUS BANDUNG 3
2741^RSIA. MITRA FAMILY-KARAWANG 1
0191^RS. PERKEBUNAN NUSANTARA 8 SUBANG 9
0991^SILOAM HOSPITALS YOGYAKARTA 1
0468^RS. PMI BOGOR 13
0468^RS. PMI BOGOR 1
349
(blank)
349
PT. Administrasi Medika
Electronic Healthcard Network
PAYOR TERMINAL PAYOR_CL CLAIM

NO Batch NO POLIS CORP CODE PROVIDER
CODE ID AIMS_ID NUMBER
MEGACHS P19098346 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0322^RSU. PERMATA BUNDA MEDAN 12401034 85316922
MEGACHS P19098339 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0720^RSIA. CITRA INSANI 12399266 85665618
MEGACHS P19098339 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0720^RSIA. CITRA INSANI 12399266 85847348
MEGACHS P19098032 0213051800009 MI00000030^THE TRANS HOTEL BANDUNG 0761^RS. SANTO BORROMEUS BANDUNG 12387233 84973828
MEGACHS P19098195 2513051900001 MI00000060ÂRT PISTON INDONESIA, PT 0083^RS. DEWI SRI 12385761 85540181
MEGACHS P19098019 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0620^RS. KARYA MEDIKA II (D/H RSIA. ) 12382831 85000069
MEGACHS P19098340 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0753^RS. ISLAM HARAPAN ANDA 12387568 85183940
MEGACHS P19098340 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0753^RS. ISLAM HARAPAN ANDA 12387568 85183917
MEGACHS P19098337 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 1545^RS. MH THAMRIN PURWAKARTA 12393879 81932590
MEGACHS P19098191 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 1090^RS. PERMATA CIBUBUR 12390611 85744180
MEGACHS P19098189 2713051900051 MI00000129^TARA KUSUMA INDAH, PT 0643^RS. GRHA KEDOYA 12396219 85931939
MEGACHS P19098203 2713051800165 MI00000278ÎNDONUSA TELEMEDIA, PT 0944^RS. BHAYANGKARA TK.1 R.SAID SUKANTO (POLRI) 12380230 84818181
MEGACHS P19098338 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 0022^RS. SARI ASIH KARAWACI 12392022 85467261
MEGACHS P19098168 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 1670^CIPUTRA HOSPITAL 12391380 85679935
MEGACHS P19098193 2713051800185 MI00000353^DHI EXCELLENCE LOGGING, PT 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85447210
MEGACHS P19098185 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0775^BRAWIJAYA HOSPITAL DUREN TIGA D/H RSIA. DUREN TIGA 12380046 85653970
MEGACHS P19098361 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0795^RS. PUSAT PERTAMINA 12397617 85109666
MEGACHS P19098023 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1269^RS. MULYASARI 12392460 85391752
MEGACHS P19098353 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1388^RATULANGI MEDICAL CENTRE 12381223 85651872
MEGACHS P19098353 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1388^RATULANGI MEDICAL CENTRE 12381223 85697215
MEGACHS P19098029 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1630^RS. AWAL BROS MAKASSAR 12390998 85354998
MEGACHS P19098354 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1682^RSU. ST CAROLUS SUMMARECON 12382040 85075005
MEGACHS P19098190 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1884^SILOAM SRIWIJAYA PALEMBANG 12391894 85377440
MEGACHS P19098355 2713051800203 MI00000015^PT. BANK MEGA, TBK. 2388^RS. EMC SENTUL (D/H RS. PERTAMEDIKA SENTUL CITY) 12385621 85811456
MEGACHS P19098349 2713051800187 MI00000070^HONDA PRECISON PARTS M (PKWT), PT 0293^RS. PELABUHAN CIREBON 12399459 85595454
MEGACHS P19098185 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 0775^BRAWIJAYA HOSPITAL DUREN TIGA D/H RSIA. DUREN TIGA 12380046 85655068
MEGACHS P19098191 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 1090^RS. PERMATA CIBUBUR 12390611 85764314
MEGACHS P19098191 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 1090^RS. PERMATA CIBUBUR 12390611 85753473
MEGACHS P19098171 2713051900014 MI00000088^MUTIARA PERMATA MULIA, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382461 85199687
MEGACHS P19098335 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0742^RSU. MARTHA FRISKA 12380013 85254668
MEGACHS P19098362 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85244663
MEGACHS P19098356 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0468^RS. PMI BOGOR 12372436 85256975
MEGACHS P19098020 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 1194^RS. HASANAH GRAHA AFIAH 12392880 85228818
MEGACHS P19098195 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 0083^RS. DEWI SRI 12385761 85475094
Page 7 of 47
Sep-18-2019 06:25:12 PM
MEGACHS P19098329 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 2741^RSIA. MITRA FAMILY-KARAWANG 12386430 85698191
MEGACHS P19098326 2713051900004 MI00000381^TP QQ TRANS REKREASINDO 1293^KLINIK YAKESTI BEKASI 12381030 85425603
MEGACHS P19098360 2713051800171 MI00000439ÎNDONUSA TELEMEDIA - KARYAWAN, PT 0795^RS. PUSAT PERTAMINA 12397617 85364276
MEGACHS P19098352 2513051800030 MI00000446^HUMOLCO QQ MCSI 1056^RS. BUNDA MARGONDA 12398040 85671102
MEGACHS P19098352 2713051900003 MI00000450^FISIP UI 1056^RS. BUNDA MARGONDA 12383449 85715902
MEGACHS P19098171 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0007^RS. UIN SYARIF HIDAYATULLAH 12382461 85016248
MEGACHS P19098363 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0029^RSU. EVASARI 12387657 85252571
MEGACHS P19098363 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0029^RSU. EVASARI 12387657 85359288
MEGACHS P19098207 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0972^RSU. AULIA 12393010 85584330
MEGACHS P19098170 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1364^RS. ISLAM SURABAYA JEMURSARI 12388107 85474478
MEGACHS P19098350 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0191^RS. PERKEBUNAN NUSANTARA 8 SUBANG 12386524 85591431
MEGACHS P19098350 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0191^RS. PERKEBUNAN NUSANTARA 8 SUBANG 12386524 85258668
MEGACHS P19098024 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0391^SILOAM HOSPITALS LIPPO CIKARANG 12383058 85423631
MEGACHS P19098028 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1026^RSIA. TAMBAK 12380386 85233385
MEGACHS P19098181 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1116^RS. AWAL BROS TANGERANG (D/H RS. GLOBAL MEDIKA 12391187 85597958
MEGACHS P19098181 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1116^RS. AWAL BROS TANGERANG (D/H RS. GLOBAL MEDIKA 12391187 85597987
MEGACHS P19098342 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 2926^RSIA. ANDINI 12387003 85621298
MEGACHS P19098036 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0125^RSIA. MELATI HUSADA 12372124 84761589
MEGACHS P19098022 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0179^RSU. KASIH IBU DENPASAR 12388674 84971722
MEGACHS P19098022 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0179^RSU. KASIH IBU DENPASAR 12386368 85317285
MEGACHS P19098343 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0602^RS. PERTAMINA CIREBON 12383903 85541594
MEGACHS P19098343 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0602^RS. PERTAMINA CIREBON 12383903 85541644
MEGACHS P19098205 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0972^RSU. AULIA 12393010 85603924
MEGACHS P19098188 2713051800199 MI00000100^TRANS RETAIL INDONESIA, PT 0643^RS. GRHA KEDOYA 12372610 85893869
MEGACHS P19098171 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382451 85223348
MEGACHS P19098035 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0829^RS. PREMIER SURABAYA (RS. SURABAYA INTERNASIONAL) 12390102 84765531
MEGACHS P19098204 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0972^RSU. AULIA 12393010 85596540
MEGACHS P19098341 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85353479
MEGACHS P19098344 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0291^RS. ICHSAN MEDICAL CENTER (IMC) 12391914 85469697
MEGACHS P19098208 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0972^RSU. AULIA 12382942 85653621
MEGACHS P19098178 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 0796^RS. METROPOLITAN MEDICAL CENTRE (MMC) 12395144 85676512
MEGACHS P19098193 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85586972
Page 8 of 47
Sep-18-2019 06:25:12 PM
MEGACHS P19098193 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85587055
MEGACHS P19098341 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85479413
MEGACHS P19098341 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85472855
MEGACHS P19098174 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 5640^RS. PONDOK INDAH BINTARO JAYA 12395318 85736230
MEGACHS P19098356 2713051800183 MI00000345^SWISS-BELHOTEL INTL IND, PT 0468^RS. PMI BOGOR 12372436 85374078
MEGACHS P19098197 2713051900057 MI00000398^PRIMA ADJUSTERINDO MANDIRI, PT 0600^RS. ST.CAROLUS 12383474 85559470
MEGACHS P19098193 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85291528
MEGACHS P19098193 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85341304
MEGACHS P19098341 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0119^RSU. KASIH IBU SURAKARTA 12372118 85240494
MEGACHS P19098328 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0230^RS. H. DARJAD 12390463 85554094
MEGACHS P19098344 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0291^RS. ICHSAN MEDICAL CENTER (IMC) 12391914 85562998
MEGACHS P19098358 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0590^RS. COLUMBIA ASIA MEDAN (D/H GLENI MEDAN) 12393895 85674978
MEGACHS P19098358 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0590^RS. COLUMBIA ASIA MEDAN (D/H GLENI MEDAN) 12393895 85698769
MEGACHS P19098192 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1194^RS. HASANAH GRAHA AFIAH 12392880 85630199
MEGACHS P19098174 2713051800203 MI00000015^PT. BANK MEGA, TBK. 5640^RS. PONDOK INDAH BINTARO JAYA 12395318 85774510
MEGACHS P19098341 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85359604
MEGACHS P19098173 2713051900014 MI00000088^MUTIARA PERMATA MULIA, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382461 84911767
MEGACHS P19098192 2713051900019 MI00000096^PPSRSHNH AIRLANGGA, PT 1194^RS. HASANAH GRAHA AFIAH 12392880 85673198
MEGACHS P19098347 2713051900025 MI00000097^BAKRIE PANGRIPTA LOKA, PT 0102^RS. ISLAM JAKARTA TIMUR (PONDOK KOPI) 12383046 85616086
MEGACHS P19098339 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0720^RSIA. CITRA INSANI 12399266 85694322
MEGACHS P19098034 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0835^RS. FAMILY MEDICAL CENTRE BOGOR 12388217 85291046
MEGACHS P19098171 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382451 85607527
MEGACHS P19098331 2713051800199 MI00000100^TRANS RETAIL INDONESIA, PT 0790^RSIA. BUNDA JAKARTA 12392510 85753267
MEGACHS P19098341 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85282742
MEGACHS P19098358 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0590^RS. COLUMBIA ASIA MEDAN (D/H GLENI MEDAN) 12393895 85643568
MEGACHS P19098358 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0590^RS. COLUMBIA ASIA MEDAN (D/H GLENI MEDAN) 12393895 85643582
MEGACHS P19098336 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 1545^RS. MH THAMRIN PURWAKARTA 12393879 84852362
MEGACHS P19098209 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0083^RS. DEWI SRI 12385761 85635067
MEGACHS P19098025 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0391^SILOAM HOSPITALS LIPPO CIKARANG 12383058 85469367
MEGACHS P19098364 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 1223ÊKA HOSPITAL BSD 12383419 85558080
MEGACHS P19098180 2713051900059 MI00000156^TRANS FASHION INDONESIA, PT 0796^RS. METROPOLITAN MEDICAL CENTRE (MMC) 12395144 85527657
MEGACHS P19098340 2713051800165 MI00000278ÎNDONUSA TELEMEDIA, PT 0753^RS. ISLAM HARAPAN ANDA 12387568 84928435
MEGACHS P19098345 2413051800005 MI00000301^THE TRANS RESORT BALI 1151^KLINIK QUANTUM SARANA MEDIK 12388722 85345644
MEGACHS P19098178 2413051800006 MI00000332^PT BALI UTAMA CAKRAWALA (BUC) 0796^RS. METROPOLITAN MEDICAL CENTRE (MMC) 12395144 85724043
MEGACHS P19098351 2713051900003 MI00000450^FISIP UI 1989^RSIA. KARUNIA KASIH (KARUNIA BUNDA) 12384560 85725877
MEGACHS P19098032 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0761^RS. SANTO BORROMEUS BANDUNG 12387231 84952467
MEGACHS P19098352 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1056^RS. BUNDA MARGONDA 12383449 85698783
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MEGACHS P19098177 2713051800203 MI00000015^PT. BANK MEGA, TBK. 2294^RS. JAKARTA EYE CENTER (JEC) KEDOYA 12391984 85678596
MEGACHS P19098201 2713051800203 MI00000015^PT. BANK MEGA, TBK. 2460^KLINIK UTAMA TUGU SAWANGAN 12385773 85716044
MEGACHS P19098360 2713051800201 MI00000056^SAWIT SUMBERMAS SARANA, PT 0795^RS. PUSAT PERTAMINA 12397617 85466235
MEGACHS P19098352 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 1056^RS. BUNDA MARGONDA 12398040 85822108
MEGACHS P19098338 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0022^RS. SARI ASIH KARAWACI 12392022 85564408
MEGACHS P19098356 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0468^RS. PMI BOGOR 12372436 85443746
MEGACHS P19098343 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0602^RS. PERTAMINA CIREBON 12383903 85117911
MEGACHS P19098343 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0602^RS. PERTAMINA CIREBON 12383903 85555237
MEGACHS P19098353 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1388^RATULANGI MEDICAL CENTRE 12381223 85654764
MEGACHS P19098199 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1534^RS. MITRA BANGSA 12381635 85874902
MEGACHS P19098190 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1884^SILOAM SRIWIJAYA PALEMBANG 12391894 85447790
MEGACHS P19098341 2713051800198 MI00000099ÂLFA RETAILINDO, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85553763
MEGACHS P19098037 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 2392^KLINIK & APOTIK BONA MEDIKA SERANG 12385571 84507497
MEGACHS P19098340 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 0753^RS. ISLAM HARAPAN ANDA 12387568 85361005
MEGACHS P19098332 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0487^RS. ADVENT LAMPUNG 12396343 85390737
MEGACHS P19098364 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 1223ÊKA HOSPITAL BSD 12383419 85477184
MEGACHS P19098362 2713051800165 MI00000278ÎNDONUSA TELEMEDIA, PT 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85371214
MEGACHS P19098030 2413051800005 MI00000301^THE TRANS RESORT BALI 1273^RS. SURYA HUSADHA 12388672 85607318
MEGACHS P19098331 2713051800158 MI00000309^MEGA CAPITAL SEKURITAS, PT 0790^RSIA. BUNDA JAKARTA 12392510 85732156
MEGACHS P19098364 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 1223ÊKA HOSPITAL BSD 12383419 85603795
MEGACHS P19098354 2713051800204 MI00000430ÂLFA RETAILINDO QQ BINTARO, PT 1682^RSU. ST CAROLUS SUMMARECON 12382040 85179844
MEGACHS P19098356 2713051800177 MI00000440^TRANS PROPERTY QQ PT.ALFA RETAILINDO 0468^RS. PMI BOGOR 12372436 85355049
MEGACHS P19098356 2713051800177 MI00000440^TRANS PROPERTY QQ PT.ALFA RETAILINDO 0468^RS. PMI BOGOR 12372436 85355123
MEGACHS P19098191 2713051800177 MI00000440^TRANS PROPERTY QQ PT.ALFA RETAILINDO 1090^RS. PERMATA CIBUBUR 12390611 85804138
MEGACHS P19098027 2513051800030 MI00000446^HUMOLCO QQ MCSI 0178^RS. HERMINA BEKASI 12388203 85274118
MEGACHS P19098175 2713051800193 MI00000449^YAYASAN PENDIDIKAN AUSTRALIA 0170^RS. PLUIT 12392326 85240278
MEGACHS P19098175 2713051800193 MI00000449^YAYASAN PENDIDIKAN AUSTRALIA 0170^RS. PLUIT 12383200 85244083
MEGACHS P19098168 2713051900087 MI00000467ÂVIA TECHNICS DIRGANTARA, PT 1670^CIPUTRA HOSPITAL 12391380 85751347
MEGACHS P19098168 2713051900087 MI00000467ÂVIA TECHNICS DIRGANTARA, PT 1670^CIPUTRA HOSPITAL 12391380 85835531
MEGACHS P19098332 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0487^RS. ADVENT LAMPUNG 12372455 85040693
MEGACHS P19098340 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0753^RS. ISLAM HARAPAN ANDA 12387568 85554529
MEGACHS P19098183 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0842^BRAWIJAYA WOMEN & CHILDREN HOSPITAL 12380113 85842822
MEGACHS P19098364 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1223ÊKA HOSPITAL BSD 12383419 85590215
MEGACHS P19098347 2713051800201 MI00000056^SAWIT SUMBERMAS SARANA, PT 0102^RS. ISLAM JAKARTA TIMUR (PONDOK KOPI) 12383046 85620121
MEGACHS P19098171 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382451 84974737
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MEGACHS P19098195 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0083^RS. DEWI SRI 12385761 85585251
MEGACHS P19098033 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0269^RS. KATOLIK BUDI RAHAYU BLITAR 12395918 84855175
MEGACHS P19098170 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1364^RS. ISLAM SURABAYA JEMURSARI 12388107 85435349
MEGACHS P19098332 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0487^RS. ADVENT LAMPUNG 12396343 85319712
MEGACHS P19098364 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 1223ÊKA HOSPITAL BSD 12383419 85485100
MEGACHS P19098360 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 0795^RS. PUSAT PERTAMINA 12397617 85614361
MEGACHS P19098360 2713051800165 MI00000278ÎNDONUSA TELEMEDIA, PT 0795^RS. PUSAT PERTAMINA 12397617 85492630
MEGACHS P19098327 2713051800193 MI00000449^YAYASAN PENDIDIKAN AUSTRALIA 0991^SILOAM HOSPITALS YOGYAKARTA 12380280 85538248
MEGACHS P19098200 2713051800193 MI00000449^YAYASAN PENDIDIKAN AUSTRALIA 3390^RSIA. LOMBOK DUA DUA ( JL. FLORES) 12388241 85805311
MEGACHS P19098184 2713051900087 MI00000467ÂVIA TECHNICS DIRGANTARA, PT 0737^RS EMC TANGERANG D/H RS. USADA INSANI 12383337 85874065
MEGACHS P19098362 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85543630
MEGACHS P19098362 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85361738
MEGACHS P19098351 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1989^RSIA. KARUNIA KASIH (KARUNIA BUNDA) 12384560 85691239
MEGACHS P19098340 2713051900033 MI00000043^TP QQ TRANS RITEL PROPERTI 0753^RS. ISLAM HARAPAN ANDA 12387568 84678539
MEGACHS P19098351 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 1989^RSIA. KARUNIA KASIH (KARUNIA BUNDA) 12384560 85645028
MEGACHS P19098193 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85378311
MEGACHS P19098176 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0049^RS. PONDOK INDAH 12389949 85774470
MEGACHS P19098341 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85552327
MEGACHS P19098344 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0291^RS. ICHSAN MEDICAL CENTER (IMC) 12391914 85615975
MEGACHS P19098192 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1194^RS. HASANAH GRAHA AFIAH 12392880 85700769
MEGACHS P19098192 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1194^RS. HASANAH GRAHA AFIAH 12392880 85792608
MEGACHS P19098361 2713051900054 MI00000107^TRANS REKREASINDO, PT 0795^RS. PUSAT PERTAMINA 12397617 85210075
MEGACHS P19098350 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 0191^RS. PERKEBUNAN NUSANTARA 8 SUBANG 12386524 84753738
MEGACHS P19098350 2713051900041 MI00000115^HONDA PRECISION PARTS MFG, PT 0191^RS. PERKEBUNAN NUSANTARA 8 SUBANG 12386524 85453198
MEGACHS P19098360 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0795^RS. PUSAT PERTAMINA 12382904 85332981
MEGACHS P19098186 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 0775^BRAWIJAYA HOSPITAL DUREN TIGA D/H RSIA. DUREN TIGA 12380046 85737152
MEGACHS P19098178 2513051900006 MI00000180^QN INTERNATIONAL INDONESIA, PT 0796^RS. METROPOLITAN MEDICAL CENTRE (MMC) 12395144 85683630
MEGACHS P19098025 2713051900077 MI00000246ÎNDO BHARAT RAYON, PT 0391^SILOAM HOSPITALS LIPPO CIKARANG 12383058 85411282
MEGACHS P19098171 2713051800158 MI00000309^MEGA CAPITAL SEKURITAS, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382451 85514071
MEGACHS P19098191 2713051800180 MI00000338^TRANS CIBUBUR PROPERTY, PT 1090^RS. PERMATA CIBUBUR 12390611 85719332
MEGACHS P19098181 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 1116^RS. AWAL BROS TANGERANG (D/H RS. GLOBAL MEDIKA 12391187 85526942
MEGACHS P19098181 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 1116^RS. AWAL BROS TANGERANG (D/H RS. GLOBAL MEDIKA 12391187 85483904
MEGACHS P19098356 2513051800031 MI00000447^MOL LNG ASIA QQ MCSI 0468^RS. PMI BOGOR 12372436 85479900
MEGACHS P19098191 2513051800031 MI00000447^MOL LNG ASIA QQ MCSI 1090^RS. PERMATA CIBUBUR 12390611 85775925
MEGACHS P19098360 2713051800193 MI00000449^YAYASAN PENDIDIKAN AUSTRALIA 0795^RS. PUSAT PERTAMINA 12397617 85309191
MEGACHS P19098341 2713051900066 MI00000460^PFI MEGA LIFE INSURANCE, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85612262
MEGACHS P19098350 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0191^RS. PERKEBUNAN NUSANTARA 8 SUBANG 12386524 85089529
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MEGACHS P19098181 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1116^RS. AWAL BROS TANGERANG (D/H RS. GLOBAL MEDIKA 12391187 85407141
MEGACHS P19098026 2713051800203 MI00000015^PT. BANK MEGA, TBK. 1651^RS. BUNDA THAMRIN MEDAN 12392020 85267353
MEGACHS P19098032 0213051900001 MI00000054^YUSKITAMA LESTARI (HILTON BANDUNG) 0761^RS. SANTO BORROMEUS BANDUNG 12385169 85006828
MEGACHS P19098196 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0185^RS. BHAKTI KARTINI 12383817 85570093
MEGACHS P19098357 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0308^PAMULANG MEDICAL CENTER (PMC) 12391446 85627424
MEGACHS P19098357 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 0308^PAMULANG MEDICAL CENTER (PMC) 12391446 85701806
MEGACHS P19098352 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1056^RS. BUNDA MARGONDA 12383449 85698105
MEGACHS P19098360 2713051900005 MI00000121^TRANS NEWS CORPORA 0795^RS. PUSAT PERTAMINA 12382904 85552204
MEGACHS P19098362 2713051900051 MI00000129^TARA KUSUMA INDAH, PT 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85535045
MEGACHS P19098361 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 0795^RS. PUSAT PERTAMINA 12397617 85125825
MEGACHS P19098193 2713051800158 MI00000309^MEGA CAPITAL SEKURITAS, PT 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85470739
MEGACHS P19098193 2713051800158 MI00000309^MEGA CAPITAL SEKURITAS, PT 0021^SILOAM HOSPITALS LIPPO VILLAGE (KARAWACI) 12382497 85464619
MEGACHS P19098341 2713051800158 MI00000309^MEGA CAPITAL SEKURITAS, PT 0119^RSU. KASIH IBU SURAKARTA 12372118 85403883
MEGACHS P19098362 2713051800189 MI00000445ÂLCON PHARMACEUTICALS LTD 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85204488
MEGACHS P19098352 2713051900066 MI00000460^PFI MEGA LIFE INSURANCE, PT 1056^RS. BUNDA MARGONDA 12398040 85747822
MEGACHS P19098357 2713051900087 MI00000467ÂVIA TECHNICS DIRGANTARA, PT 0308^PAMULANG MEDICAL CENTER (PMC) 12391446 85773148
MEGACHS P19098364 2713051800197 MI00000098^TRANS RETAIL INDONESIA, PT 1223ÊKA HOSPITAL BSD 12383419 85607824
MEGACHS P19098347 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0102^RS. ISLAM JAKARTA TIMUR (PONDOK KOPI) 12383046 85703489
MEGACHS P19098031 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 0741^RS. ISLAM MALAHAYATI 12384481 85217228
MEGACHS P19098356 2713051900006 MI00000123^TELEVISI TRANSFORMASI INDONESIA, PT 0468^RS. PMI BOGOR 12372436 85302073
MEGACHS P19098171 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382451 85383947
MEGACHS P19098364 2713051800157 MI00000303^MEGA ASSET MANAGEMENT, PT 1223ÊKA HOSPITAL BSD 12383419 85518465
MEGACHS P19098176 2713051800185 MI00000353^DHI EXCELLENCE LOGGING, PT 0049^RS. PONDOK INDAH 12391368 85783338
MEGACHS P19098364 2713051800205 MI00000429ÂLFA RETAILINDO QQ BEKASI, PT 1223ÊKA HOSPITAL BSD 12383419 85500723
MEGACHS P19098364 2713051800205 MI00000429ÂLFA RETAILINDO QQ BEKASI, PT 1223ÊKA HOSPITAL BSD 12383419 85500742
MEGACHS P19098338 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0022^RS. SARI ASIH KARAWACI 12392022 85114473
MEGACHS P19098197 2713051800203 MI00000015^PT. BANK MEGA, TBK. 0600^RS. ST.CAROLUS 12383474 85551479
MEGACHS P19098359 2713051800203 MI00000015^PT. BANK MEGA, TBK. 3972^KLINIK MIRACLE GRAND INDONESIA 12389615 85174245
MEGACHS P19098356 2713051800200 MI00000078^DUTA VISUAL NUSANTARA TIVI TUJUH, PT 0468^RS. PMI BOGOR 12372436 85521411
MEGACHS P19098190 2713051900044 MI00000113^BANK MEGA SYARIAH, PT 1884^SILOAM SRIWIJAYA PALEMBANG 12391894 85563855
MEGACHS P19098354 2713051900005 MI00000121^TRANS NEWS CORPORA 1682^RSU. ST CAROLUS SUMMARECON 12382040 85078308
MEGACHS P19098174 2713051900002 MI00000136ÂGRANET MULTICITRA SIBERKOM, PT 5640^RS. PONDOK INDAH BINTARO JAYA 12395318 85706809
MEGACHS P19098352 2713051800180 MI00000338^TRANS CIBUBUR PROPERTY, PT 1056^RS. BUNDA MARGONDA 12398040 85772642
MEGACHS P19098171 2713051800151 MI00000344^PZ CUSSONS INDONESIA, PT 0007^RS. UIN SYARIF HIDAYATULLAH 12382461 85242856
MEGACHS P19098340 2713051900037 MI00000453^SAHABAT MOBIL NUSANTARA, PT 0753^RS. ISLAM HARAPAN ANDA 12387568 84644024
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MEGACHS P19098362 2713051900066 MI00000460^PFI MEGA LIFE INSURANCE, PT 0956^KLINIK TOMANG (TANJUNG DUREN ) 12380243 85244926
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ADMISSION DISCHARGE DIAGNOSI

PATIENT NAME CARD NO GENDER DOB TYPE STATUS
DATE DATE S
FIFI ARDHINI SARI LUBIS 8000100609378311 F 7/2/1983 AUG-22-2019 AUG-22-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R50.9
POPI HARYANTI 8000100608896578 F 6/20/1979 SEP-02-2019 SEP-02-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 A88.1
POPI HARYANTI 8000100608896578 F 6/20/1979 SEP-09-2019 SEP-09-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K29.6
MARCO MEDAGLIA 8000100608238961 M 3/9/1973 AUG-12-2019 AUG-12-2019 E MEGACHS ^ THE TRANS HOTEL BANDUNG 40 M19
ALIN JULFIAN 8000100603077398 M 7/27/1989 AUG-29-2019 AUG-29-2019 W MEGACHS ^ ART PISTON INDONESIA, PT 40 K02
ALIN JULFIAN 8000100603077398 M 7/27/1989 AUG-29-2019 AUG-29-2019 W MEGACHS ^ ART PISTON INDONESIA, PT 40 R50
ERIKA SHEARES ADRIATIK 8000100602559271 F 4/6/1992 AUG-13-2019 AUG-13-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
MUHAMAD ARFAN WAHYUDIN 8000100602450331 M 10/4/2011 AUG-19-2019 AUG-19-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 N30
AHMAD SYARIF WAHYUDIN 8000100603275562 M 9/30/2015 AUG-19-2019 AUG-19-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J02
FAJAR SETO UTAMI 8000100603195901 M 3/14/1987 APR-30-2019 APR-30-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 K01.1
YESI FEBRIANTI 8000100603010993 F 2/5/1983 SEP-05-2019 SEP-05-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 H10
SIVA OCTVIATI 8000100608162641 F 10/1/1988 SEP-11-2019 SEP-11-2019 W MEGACHS ^ TARA KUSUMA INDAH, PT 40 R10
ASHILLA ZAHRANTIARA ASAD 8000100609487484 F 9/22/2014 AUG-07-2019 AUG-07-2019 W MEGACHS ^ INDONUSA TELEMEDIA, PT 40 J06
EVAN ADITYA RAMA 8000100606706977 M 12/30/2009 AUG-27-2019 AUG-27-2019 M MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 B34.9
PUTRI WINA UTARI 8000100606700954 F 8/6/1987 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 K04.0
RIDA KUSRIDA 8000100617122578 F 4/10/1974 AUG-27-2019 AUG-27-2019 W MEGACHS ^ DHI EXCELLENCE LOGGING, PT 40 J02
NURUL AINI 8000100615340776 F 11/4/1987 SEP-02-2019 SEP-02-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R10
PUTRI NUR ASHRI PRABOWO 8000100602159965 F 2/15/2002 AUG-16-2019 AUG-16-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R51
AGUNG SUTANTO 8000100602152671 M 3/31/1984 AUG-25-2019 AUG-25-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J06
AGUM ROCHITA ALMARSIDIN 8000100605590570 M 1/27/2002 SEP-02-2019 SEP-02-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K04.0
NADYA DIAN PRATIWI LANGGA 8000100609222881 F 12/4/1985 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K02
MAISARAH NURIA PUTRI RAHMAT 8000100621182774 F 5/2/2019 AUG-24-2019 AUG-24-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 L30
RAFISQY TSAQIB ALKHAIRIL 8000100619448252 M 3/22/2019 AUG-15-2019 AUG-15-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 B37.0
PUTI SALWA DH 8000100602196553 F 12/1/2011 AUG-24-2019 AUG-24-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 L20
Y.E.A EKO LAKSONO 8000100602135809 M 6/12/1974 AUG-27-2019 AUG-27-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R51
RUSTIN PRAFDAWATI 8000100615358281 F 4/27/1971 AUG-27-2019 AUG-27-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R51
NILAWATI 8000100602364219 F 4/4/1973 AUG-24-2019 AUG-24-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 M72.2
BAYU SIH HANGGORO 8000100602104409 M 6/1/1971 SEP-07-2019 SEP-07-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K29.6
TRESHA UTAMI HANGGARINI 8000100602104391 F 5/16/1999 SEP-07-2019 SEP-07-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 M54.1
AHZA GHANI RAQILLA 8000100602101801 M 3/18/2014 SEP-08-2019 SEP-08-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R11
KATARINA WURI CANDRAAYU 8000100602104383 F 1/15/2003 SEP-07-2019 SEP-07-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J06
IRENE PUSPITASARI ANGGARUNA 8000100621872960 F 3/10/1984 SEP-06-2019 SEP-06-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K05
MOCHAMAD SYAIFURACHMAN 8000100620535923 M 8/15/1995 AUG-31-2019 AUG-31-2019 W MEGACHS ^ HONDA PRECISON PARTS M (PKWT), PT 40 A01.0
ANNISA FARIHA NALADHIPA 8000100605740266 F 7/2/2016 SEP-02-2019 SEP-02-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 J06
MUMTAZA 8000100620992496 F 12/22/1989 SEP-05-2019 SEP-05-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 Z34
SHANALA NAQIYYA MAULANA 8000100602784507 F 12/15/2014 SEP-05-2019 SEP-05-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 N30.9
FATHAN JABAT HANDIMSAH PUTRA 8000100618170675 M 4/3/2010 AUG-19-2019 AUG-19-2019 W MEGACHS ^ MUTIARA PERMATA MULIA, PT 40 N45
PRICILIA CASSANDRA BR NABABAN 8000100617873436 F 2/4/2018 AUG-21-2019 AUG-21-2019 M MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J20
ASEP SAEPUDIN 8000100620692260 M 8/8/1978 AUG-20-2019 AUG-20-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
SITI MULIAWATI NINGRUM 8000100615201465 F 7/27/1991 AUG-21-2019 AUG-21-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 L20
FITRIA ROHAENI 8000100619500912 F 3/15/1994 AUG-27-2019 AUG-27-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 R05
FITRIA ROHAENI 8000100619500912 F 3/15/1994 AUG-31-2019 AUG-31-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J06
SITI HAMIDAH 8000100603399008 F 3/10/1983 AUG-20-2019 AUG-20-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 S62.60
EJA FARIDA 8000100603183212 F 8/13/1993 AUG-28-2019 AUG-28-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 A88.1
EJA FARIDA 8000100603183212 F 8/13/1993 AUG-29-2019 AUG-29-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 R11
ADE SUHERIS 8000100603217655 M 10/3/1983 AUG-28-2019 AUG-28-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 K30
SANIYAH 8000100603191371 F 12/30/1990 AUG-29-2019 AUG-29-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 K01.1
CINTIA 8000100607785855 F 5/25/1993 AUG-30-2019 AUG-30-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 R51
AI ASMAWATI 8000100612320664 F 9/27/1997 AUG-29-2019 AUG-29-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 L50
SUTEJA JOHAN P 8000100603215311 M 7/12/1986 AUG-30-2019 AUG-30-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 R51
ARI PRAWIRA 8000100603207599 M 5/6/1982 AUG-29-2019 AUG-29-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 L02
DARMAN 8000100603176034 M 11/12/1993 AUG-29-2019 AUG-29-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 J02
ZAENAL ABDULLAH 8000100603215832 M 3/4/1981 AUG-29-2019 AUG-29-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 A15.0
YENNI RAHMADANI 8001001000193199 F 2/23/1995 AUG-28-2019 AUG-28-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 R10
ADIBA KHANZA AZZAHRA 8000100603177370 F 11/10/2015 AUG-28-2019 AUG-28-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 J20
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DANA SURYANA 8000100603213423 M 12/3/1981 AUG-30-2019 AUG-30-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 A01.0
ARIQ RADEVA GUNAWAN 8000100622068832 M 6/30/2019 AUG-30-2019 AUG-30-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 Z24.0
RIKI SEPTIAN 8000100603609000 M 12/23/1983 AUG-28-2019 AUG-28-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 L02
SANIYAH 8000100603191371 F 12/30/1990 AUG-31-2019 AUG-31-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 K05.3
HARNITIA NINGSIH 8000100603186082 F 6/25/1991 SEP-03-2019 SEP-03-2019 E MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 Z34
CUCI HERMAWATI 8000100611685182 F 9/12/1987 AUG-26-2019 AUG-26-2019 W MEGACHS ^ TP QQ TRANS REKREASINDO 40 J06.9
MUHAMMAD FAKHRI FAUZI 8000100611685190 M 6/18/2010 AUG-26-2019 AUG-26-2019 W MEGACHS ^ TP QQ TRANS REKREASINDO 40 J03
MUHAMMAD FARHAN FADILLAH 8000100614469048 M 5/6/2018 AUG-01-2019 AUG-01-2019 W MEGACHS ^ TP QQ TRANS REKREASINDO 40 A01.1
AHZA KIANARFA ALIFANANDO 8000100616259876 M 12/28/2010 AUG-24-2019 AUG-24-2019 W MEGACHS ^ INDONUSA TELEMEDIA - KARYAWAN, PT 40 H60
FENTI RAHMAWATI 8000100617394078 F 2/13/1986 SEP-03-2019 SEP-03-2019 W MEGACHS ^ HUMOLCO QQ MCSI 40 L20
LA ODE IBRAHIM AQMAR KUBAISY 8000100617394086 M 10/10/2017 SEP-05-2019 SEP-05-2019 W MEGACHS ^ HUMOLCO QQ MCSI 40 J20
LA ODE IBRAHIM AQMAR KUBAISY 8000100617394086 M 10/10/2017 SEP-03-2019 SEP-03-2019 W MEGACHS ^ HUMOLCO QQ MCSI 40 A15.0
YUUHI AL BIRRAN MUHAMMADAN 8000100618085774 M 8/17/2018 SEP-04-2019 SEP-04-2019 E MEGACHS ^ FISIP UI 40 J20
YUUHI AL BIRRAN MUHAMMADAN 8000100618085774 M 8/17/2018 SEP-03-2019 SEP-03-2019 E MEGACHS ^ FISIP UI 40 J02
YUUHI AL BIRRAN MUHAMMADAN 8000100618085774 M 8/17/2018 SEP-02-2019 SEP-02-2019 W MEGACHS ^ FISIP UI 40 J20
SURYOWIRAWAN PANDU WIBISONO 8000100610656556 M 12/11/1984 AUG-13-2019 AUG-13-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 E78.0
NICKY IRAWAN PUTRA 8000100602170491 M 12/21/1988 AUG-13-2019 AUG-13-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 M76.6
NICKY IRAWAN PUTRA 8000100602170491 M 12/21/1988 AUG-27-2019 AUG-27-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 M79.1
NICKY IRAWAN PUTRA 8000100602170491 M 12/21/1988 AUG-12-2019 AUG-12-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 R52
RIZKI SRI ALDIANTI 8000100608974631 F 10/22/1983 AUG-26-2019 AUG-26-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 J02
BOBY GUSWANTO 8000100605630624 M 8/25/1985 AUG-16-2019 AUG-16-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K02
NICKY IRAWAN PUTRA 8000100602170491 M 12/21/1988 AUG-14-2019 AUG-14-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 M79.19
RIZKI SRI ALDIANTI 8000100608974631 F 10/22/1983 AUG-13-2019 AUG-13-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 B37
AVIGNAM RABBANI 8000100602126386 M 12/19/2006 AUG-29-2019 AUG-29-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 B00.0
SAKHA IBADIL KIRAM 8000100602091499 M 9/25/2013 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J02
SURYOWIRAWAN PANDU WIBISONO 8000100610656556 M 12/11/1984 AUG-14-2019 AUG-14-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 E78.0
YULIYANTY 8000100605576108 F 7/21/1991 AUG-21-2019 AUG-21-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z34
CALISTA ANINDYA 8000100617837746 F 4/17/2005 AUG-24-2019 AUG-24-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H61.2
PUTRI PRASISTIAWATI 8000100609673273 F 4/27/1990 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z34
KOMETA DWIJAYANTI HERMANDA 8000100602129810 F 5/18/1986 AUG-27-2019 AUG-27-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R06.0
RISKA ARIESTA 8000100603077596 F 3/28/1988 SEP-02-2019 SEP-02-2019 W MEGACHS ^ ART PISTON INDONESIA, PT 40 H60
MARLINA OKTARA 8000100612407875 F 10/26/1989 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K12
REYNALD HERLINO MULIADI 8000100612407883 M 1/21/2011 AUG-21-2019 AUG-21-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K02
NADYA PUTRI ZULKARNAIN 8000100602512668 F 8/8/2006 AUG-26-2019 AUG-26-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 M62.6
ISTIHANA 8000100621492132 F 5/20/1986 AUG-20-2019 AUG-20-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
SALMA SALSABILA 8000100602456452 F 11/3/2011 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K02
ARUM KUSUMA DEWI 8000100602456429 F 12/1/1977 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K02
CHITIA DEWI 8000100611497554 F 6/29/1990 SEP-01-2019 SEP-01-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 Z30
SUHADI 8000100602414840 M 3/20/1972 AUG-05-2019 AUG-05-2019 W MEGACHS ^ ALFA RETAILINDO, PT 40 J06
CATUR DIDY PRASETYA 8000100618635628 M 11/6/1984 AUG-12-2019 AUG-12-2019 W MEGACHS ^ ALFA RETAILINDO, PT 40 A15.8
UMAR ALI USMAN 8000100618625421 M 2/3/1982 AUG-22-2019 AUG-22-2019 E MEGACHS ^ ALFA RETAILINDO, PT 40 B07
INDAH SULISTYANINGSIH 8000100607654044 F 7/27/1973 AUG-29-2019 AUG-29-2019 W MEGACHS ^ ALFA RETAILINDO, PT 40 J06.9
AIN GIBRAN ALANO 8000100607654010 M 2/3/2014 AUG-29-2019 AUG-29-2019 W MEGACHS ^ ALFA RETAILINDO, PT 40 J06.9
HAIKALA 8000100620085523 M 8/1/1992 AUG-31-2019 AUG-31-2019 W MEGACHS ^ ALFA RETAILINDO, PT 40 R51
PRUDENCE PUKANDA 8000100611937559 F 2/7/2003 SEP-10-2019 SEP-10-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J02
SITI DAROJATUN HASANAH 8000100603405656 F 10/14/1983 AUG-20-2019 AUG-20-2019 E MEGACHS ^ BANK MEGA SYARIAH, PT 40 J03
MUHAMMAD TAMA ABQARY 8000100618678057 M 11/15/2015 AUG-15-2019 AUG-15-2019 E MEGACHS ^ BANK MEGA SYARIAH, PT 40 J06
NEJAT AHMAD MAKSUM 8000100618748751 M 2/20/2008 AUG-22-2019 AUG-22-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J06
WIDYASTARI 8000100603378127 F 10/25/1972 AUG-15-2019 AUG-15-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 L30
AHDA NAQIYA MAKSUM 8000100618748736 F 2/6/2013 AUG-13-2019 AUG-13-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J02
NAILAH FARAFISHAH 8000100603405649 F 10/26/2015 AUG-20-2019 AUG-20-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J03
FAYZA ALIYYA RAMADHANI 8000100618203252 F 11/18/2002 AUG-05-2019 AUG-05-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 T14
NISSA IRAWATY 8000100615264299 F 2/12/1989 AUG-31-2019 AUG-31-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 K02
KEANU BAGUS PRANADIPTA 8000100616168176 M 11/11/2016 AUG-24-2019 AUG-24-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 R50.9
ANA AGUSTINA 8000100603003717 F 8/2/1987 AUG-27-2019 AUG-27-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 A88.1
ZAHRA OKTAVIANA 8000100613901900 F 10/6/1994 SEP-02-2019 SEP-02-2019 M MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 K80
DEWI MAYESTIKA 8000100612434143 F 10/1/1987 SEP-03-2019 SEP-03-2019 W MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 E05
ADIA KANANTA SYAFIRA 8000100612651233 F 3/22/2018 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 J20
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FITRI ASTUTI STIANINGSIH 8000100607211357 F 9/24/1977 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 J02
DWI SANSITO 8000100606692011 M 12/13/1973 AUG-28-2019 AUG-28-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 N39.0
DWI SANSITO 8000100606692011 M 12/13/1973 AUG-27-2019 AUG-27-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 R10.0
DARRYL AZKA RESYA 8000100606682210 M 11/16/2010 SEP-04-2019 SEP-04-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 K02
VIRLY NUR AFRIANI 8000100621247197 F 4/10/1992 AUG-24-2019 AUG-24-2019 W MEGACHS ^ SWISS-BELHOTEL INTL IND, PT 40 J06
IRMA WIDO SREE YANTI TARIGAN 8000100612589250 F 7/20/1982 AUG-30-2019 AUG-30-2019 E MEGACHS ^ PRIMA ADJUSTERINDO MANDIRI, PT 40 B37.3
DEWIANA SARI UTAMI 8000100619448930 F 3/22/1987 AUG-22-2019 AUG-22-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 B34.9
DIMAS PRABAWAMULIAWAN 8000100602164320 M 6/25/1979 AUG-23-2019 AUG-23-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 E88.2
YUSHIE AQUARIUSITTA HARTONO 8000100602170780 F 2/7/1980 AUG-20-2019 AUG-20-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K03.6
MOCH PRING MUSIBATAWI 8000100602201247 M 5/27/1985 AUG-26-2019 AUG-26-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J04.0
MOCH ADLA ADHYASTHA 8000100602201239 M 7/2/2012 AUG-26-2019 AUG-26-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J31.0
AUFA HAFIZ.PUTRA HARSANA 8000100602184856 M 1/31/2010 AUG-23-2019 AUG-23-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J00
M CAYAPATA DAMARLANGIT 8000100619448260 M 1/12/2019 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J00
SHOLAHUDDIN HOJA PUTRANAYAN 8000100603895252 F 1/1/2009 AUG-20-2019 AUG-20-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R50.9
AGNES KANAYA ARISTYA PUTRI 8000100603696924 F 1/22/2012 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H60
SETIORINI 8000100602147234 F 4/14/1987 AUG-29-2019 AUG-29-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z36
APRILIA NURSITA HANDAYANI 8000100602201221 F 4/15/1984 AUG-26-2019 AUG-26-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H61.2
AKIFA NAILA PUTRI HARSANA 8000100602340094 F 6/29/2015 AUG-25-2019 AUG-25-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J00
DEDI IRAWAN 8000100621872655 M 3/8/1990 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J05
INTAN INDRIANI 8000100602143472 F 4/27/1983 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J18.0
INTAN INDRIANI 8000100602143472 F 4/27/1983 AUG-28-2019 AUG-28-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z34
INTAN INDRIANI 8000100602143472 F 4/27/1983 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J18.0
SYAKILA ADIBA NOVIZA 8000100607210375 F 11/11/2016 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J06
MUHAMMAD SHAQIL ARIQ 8000100608190527 M 2/17/2017 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J20
KARTINI 8000100618550835 F 5/15/1992 SEP-02-2019 SEP-02-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z34
NETTY JUNITA MARBUN 8000100621872713 F 6/1/1982 SEP-06-2019 SEP-06-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 G44.2
LISTUHAYU ANJANTA PUTRI 8000100602783764 F 1/3/2011 AUG-24-2019 AUG-24-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 K02
IMELDA TARIGAN 8000100618170683 F 8/30/1974 AUG-09-2019 AUG-09-2019 M MEGACHS ^ MUTIARA PERMATA MULIA, PT 40 A90
UUN DAYANI 8000100607576866 F 8/14/1987 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PPSRSHNH AIRLANGGA, PT 40 L28.0
FACHDANI 8000100612024126 M 1/6/1979 SEP-01-2019 SEP-01-2019 E MEGACHS ^ BAKRIE PANGRIPTA LOKA, PT 40 K29
FAHRUL ROZI 8000100602442197 M 2/20/1988 SEP-03-2019 SEP-03-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
NURFA BAIGUS 8000100602482219 M 3/21/1981 SEP-09-2019 SEP-09-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
YUMNA HANIFA 8000100618162318 F 12/27/2018 SEP-03-2019 SEP-03-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
AHMAD SYARIF 8000100606172634 M 1/3/2015 AUG-22-2019 AUG-22-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
NURHAYATI 8000100602421597 F 12/7/1977 AUG-31-2019 AUG-31-2019 E MEGACHS ^ ALFA RETAILINDO, PT 40 K02
YENNY WIRAWAN 8000100602703200 F 8/15/1972 SEP-05-2019 SEP-05-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
BAGAS WICAKSONO 8000100603412173 M 5/18/2005 AUG-21-2019 AUG-21-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J06
ARSHA RIBI ADKINS SIREGAR 8000100608190287 M 2/8/2013 SEP-02-2019 SEP-02-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J06
ADRA RIBI ISYA SIREGAR 8000100608190279 F 9/1/2014 SEP-02-2019 SEP-02-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J06
DZAKY ALMAER Y. 8000100603177461 M 8/29/2014 SEP-02-2019 SEP-02-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 J06
CARMINAH 8000100603177446 F 2/1/1984 SEP-02-2019 SEP-02-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 Z36
HAFIDZAH AULIA PUTRI 8000100616545266 F 11/4/2018 SEP-03-2019 SEP-03-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 J20
NENSHI MUNINGGAR 8000100603183741 F 11/29/1989 SEP-03-2019 SEP-03-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 J02
AMALIA PUTRI AKHLAQUL K. 8000100603714164 F 12/17/1995 AUG-08-2019 AUG-08-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 N39.0
IBNU AMMAR RASHADI 8000100603027674 M 9/7/2012 SEP-02-2019 SEP-02-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 J06
PEBRIA LESTARI 8000100610583289 F 2/13/1983 AUG-27-2019 AUG-27-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 L23
DANI RUSWIDIYANA 8000100602781602 M 9/15/1984 AUG-30-2019 AUG-30-2019 W MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 S02.2
ANNA LISTIANA 8000100622540384 F 5/11/1970 AUG-29-2019 AUG-29-2019 W MEGACHS ^ TRANS FASHION INDONESIA, PT 40 N60
LUTFIAH 8000100610861875 F 3/11/1983 AUG-10-2019 AUG-10-2019 W MEGACHS ^ INDONUSA TELEMEDIA, PT 40 N70.0
YULIA NOVIALY 8000100621668707 F 11/3/1989 AUG-23-2019 AUG-23-2019 W MEGACHS ^ THE TRANS RESORT BALI 40 K80
YULIA NOVIALY 8000100621668707 F 11/3/1989 AUG-07-2019 AUG-07-2019 W MEGACHS ^ THE TRANS RESORT BALI 40 K29.6
SUSIANA 8000100610921901 F 8/5/1986 SEP-04-2019 SEP-04-2019 W MEGACHS ^ PT BALI UTAMA CAKRAWALA (BUC) 40 A09
JABAL MALIK ABRAR 8000100618634852 M 4/13/2008 SEP-04-2019 SEP-04-2019 W MEGACHS ^ FISIP UI 40 A09
HANNA HARFIA SARI 8000100602175995 F 11/23/1987 AUG-11-2019 AUG-11-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K29.7
SALMAN ARSYADIA MUFRENA 8000100614481936 M 3/26/2010 SEP-03-2019 SEP-03-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K04.1
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NISHYA GAVRILA PURBA 8000100602619679 F 8/5/1998 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H10
SHAHIRA SHAFA SHASIKIRANA 8000100602188154 F 12/10/2011 SEP-04-2019 SEP-04-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 B01
FAHMIATI ILMI 8000100602188139 F 5/22/1983 SEP-04-2019 SEP-04-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J06
MAHIRA MARWA MISEF 8000100602188147 F 8/1/2013 SEP-04-2019 SEP-04-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J30.4
NOVALI RIDHONA HAKIM 8000100613861187 F 11/16/1990 AUG-27-2019 AUG-27-2019 W MEGACHS ^ SAWIT SUMBERMAS SARANA, PT 40 K29.7
DELISHA CALLISTA LUMBAN TOBING 8000100616835477 F 2/24/2018 SEP-07-2019 SEP-07-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 L20
ELI SOBARI 8000100613158279 M 6/19/1983 AUG-30-2019 AUG-30-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 S83.1
TSAQIF KHAIRY AZFAR 8000100613158253 M 9/29/2016 AUG-28-2019 AUG-28-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
TSAQIF KHAIRY AZFAR 8000100613158253 M 9/29/2016 AUG-30-2019 AUG-30-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 H10
ANDI IMELDA MUNIER S.SI 8000100603722910 F 9/10/1977 AUG-27-2019 AUG-27-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 N30.9
ANDI IMELDA MUNIER S.SI 8000100603722910 F 9/10/1977 AUG-28-2019 AUG-28-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 N30
ADZKIYA SHABIRA MILANI PUTRI 8000100617954079 F 12/29/2017 AUG-16-2019 AUG-16-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 A15
ADZKIYA SHABIRA MILANI PUTRI 8000100617954079 F 12/29/2017 AUG-30-2019 AUG-30-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 A15.3
MUHAMMAD YUDHISTIRA PUTRA HARD 8000100607713360 M 2/25/2011 SEP-02-2019 SEP-02-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 A01.0
RIDA NUR KARIMA SH M.HUM. 8000100602511421 F 10/6/1978 SEP-09-2019 SEP-09-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K04.1
KAYYISAH ADELIA 8000100621118786 F 7/6/2015 AUG-27-2019 AUG-27-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J02
NAVISCHA AZKADINA 8000100621118802 F 8/4/2017 AUG-28-2019 AUG-28-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
NAVISCHA AZKADINA 8000100621118802 F 8/4/2017 AUG-27-2019 AUG-27-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
DYAH PURWANTI AMBARSARI 8000100620991035 F 1/28/1972 AUG-30-2019 AUG-30-2019 W MEGACHS ^ ALFA RETAILINDO, PT 40 I49
WINDA SETIAWATI 8000100619447775 F 10/21/1985 JUL-28-2019 JUL-28-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 B37.0
NANI KURNIASIH 8000100608472966 F 12/8/1991 AUG-24-2019 AUG-24-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 Z34
M SAKHA IRAWAN 8000100618748546 M 6/4/2018 AUG-25-2019 AUG-25-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 J06
BIRENDRA RAYDEN PUTRAMA 8000100614481027 M 8/1/2018 AUG-28-2019 AUG-28-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 J06
MOCHAMAD IMRAN 8000100619358337 M 7/20/1982 AUG-24-2019 AUG-24-2019 E MEGACHS ^ INDONUSA TELEMEDIA, PT 40 J45
NI MADE BELLA DANAYANTI PUTRI 8000100610023633 F 4/20/2009 AUG-31-2019 AUG-31-2019 W MEGACHS ^ THE TRANS RESORT BALI 40 B26
SHAQUEENA ASHALINA ANDRIANSYAH 8000100615223634 F 8/16/2018 SEP-04-2019 SEP-04-2019 W MEGACHS ^ MEGA CAPITAL SEKURITAS, PT 40 D64
WYNDHA CYNTHIA CHADIJAH MARPAU 8000100606679125 F 9/14/1981 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 L28.0
WAHYU WIKANDARI 8000100606697226 F 6/21/1978 AUG-30-2019 AUG-30-2019 E MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 G70.9
RUDY ARI ANANTA 8000100619069058 M 7/2/1986 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 K05.0
SHINTA ARYADI 8001001000112095 F 7/31/1986 AUG-19-2019 AUG-19-2019 W MEGACHS ^ ALFA RETAILINDO QQ BINTARO, PT 40 A09
RINA MEGAWATI A.MD 8000100618724968 F 12/19/1981 AUG-24-2019 AUG-24-2019 W MEGACHS ^ TRANS PROPERTY QQ PT.ALFA RETAILINDO 40 K02
RD. AALIKA KHAIRUNNISA MUHARRA 8000100618724943 F 4/29/2015 AUG-24-2019 AUG-24-2019 W MEGACHS ^ TRANS PROPERTY QQ PT.ALFA RETAILINDO 40 J06
NADIA MAHARANI 8000100622611656 F 5/30/1983 SEP-06-2019 SEP-06-2019 W MEGACHS ^ TRANS PROPERTY QQ PT.ALFA RETAILINDO 40 R10.0
AHMAD ALVINO SUGIARTO 8000100617395851 M 6/1/2010 AUG-21-2019 AUG-21-2019 W MEGACHS ^ HUMOLCO QQ MCSI 40 J45
HARRIS WANGSANATA 8000100621118539 M 10/4/1994 AUG-20-2019 AUG-20-2019 W MEGACHS ^ YAYASAN PENDIDIKAN AUSTRALIA 40 E20
HARRIS WANGSANATA 8000100621118539 M 10/4/1994 AUG-20-2019 AUG-20-2019 E MEGACHS ^ YAYASAN PENDIDIKAN AUSTRALIA 40 E20
M. AZZAM GHIFFARI HANIFA 8000100622754746 M 4/21/2005 SEP-05-2019 SEP-05-2019 W MEGACHS ^ AVIA TECHNICS DIRGANTARA, PT 40 J35.0
NINING YUSTININGSIH 8000100622753698 F 4/2/1976 SEP-07-2019 SEP-07-2019 W MEGACHS ^ AVIA TECHNICS DIRGANTARA, PT 40 J02
MUHAMMAD ALTHAF DARMAWAN 8000100611082604 M 6/17/2012 AUG-14-2019 AUG-14-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K02
DEDI NOVIYANTO 8000100602188337 M 11/23/1982 SEP-02-2019 SEP-02-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K02
RUNIFAH 8000100602109093 F 6/30/1981 AUG-14-2019 AUG-14-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K29
RHESTY ARIE JUWITA 8000100602107733 F 8/27/1981 AUG-29-2019 AUG-29-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K12
LARAS AYUDIA INARA 8000100609129623 F 2/20/2017 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 A19
KANAYA LISTUHAYU NIMPUNA 8000100617837878 F 10/17/2017 AUG-13-2019 AUG-13-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H61.2
KANAYA LISTUHAYU NIMPUNA 8000100617837878 F 10/17/2017 AUG-13-2019 AUG-13-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H60
CATRA OKTIASRI 8000100602156219 F 10/13/1987 AUG-14-2019 AUG-15-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 M54.5
INDRA AKMALADEWI 8000100602160211 F 12/18/1980 AUG-15-2019 AUG-15-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 E13
FARIKHA TRIUMI MARIYANTI K 8000100618090444 F 5/25/1991 AUG-14-2019 AUG-15-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J00
KANAYA LISTUHAYU NIMPUNA 8000100617837878 F 10/17/2017 AUG-16-2019 AUG-16-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H65
ARRAYA RAZLEEN 8000100609075131 F 11/7/2003 SEP-08-2019 SEP-08-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 J00
DEWI NURMALA 8000100602221492 F 11/16/1986 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J02
REZA LOCKHEEDINATA 8000100618947643 M 11/18/1982 SEP-01-2019 SEP-01-2019 E MEGACHS ^ SAWIT SUMBERMAS SARANA, PT 40 A09
MUHAMMAD RAFA AZKA PRASETYA 8000100619049175 M 1/17/2018 AUG-12-2019 AUG-12-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 H10
ZAHWA AULIYA SALSABILAH 8000100602487291 F 3/28/2007 AUG-19-2019 AUG-19-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 B35.6
NUNIK SUPRAPTI 8000100602553563 F 5/10/1980 AUG-31-2019 AUG-31-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 E78.4
RIZQI PUTRI FATHONI 8000100611160038 F 3/11/1993 AUG-26-2019 AUG-26-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
NUNIK SUPRAPTI 8000100602553563 F 5/10/1980 AUG-30-2019 AUG-30-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R51
OVI CHANDRA 8000100603867665 M 10/27/1972 AUG-26-2019 AUG-26-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R51
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RASYA PUTRA BARA PRATAMA 8000100602466188 M 2/28/2007 AUG-14-2019 AUG-14-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K30
RIZQI PUTRI FATHONI 8000100611160038 F 3/11/1993 AUG-20-2019 AUG-20-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
ALFABET DESI K 8000100602460041 F 12/11/1984 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
HERIKA IRIANTI PUTRI 8000100613392449 F 8/9/1997 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 A91
DENI CANDRA BUDIHARTINI 8000100602515471 F 7/12/1987 AUG-08-2019 AUG-08-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
INDAH RAHAYU 8000100622301944 F 1/9/1997 AUG-26-2019 AUG-26-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 XXX
MUHAMMAD RAFIF KHAIRUNNAS RAMA 8000100621491977 M 5/29/2019 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J40
DIYAH SURYANI 8000100605252106 F 9/11/1979 AUG-29-2019 AUG-29-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
INDAH RAHAYU 8000100622301944 F 1/9/1997 AUG-28-2019 AUG-28-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R10
NENENG NURAINI 8000100609774303 F 7/21/1993 AUG-23-2019 AUG-23-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 N30.9
PRIMA DIMITRI 8000100603375800 F 1/22/1972 AUG-28-2019 AUG-28-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J04
FERRY NUGRAHA GUSTIADI 8000100612433632 M 8/7/1989 SEP-01-2019 SEP-01-2019 W MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 H82
MIRANDA SITI NURCAHYA 8000100609487815 F 3/16/1977 AUG-28-2019 AUG-28-2019 W MEGACHS ^ INDONUSA TELEMEDIA, PT 40 L20
OCTAVIA RIAYUSTINA PUTRI 8000100617480224 F 9/8/1990 AUG-29-2019 AUG-29-2019 W MEGACHS ^ YAYASAN PENDIDIKAN AUSTRALIA 40 K29.0
KIRANA ALDILA SANGGARA 8000100621118562 F 11/30/2016 SEP-06-2019 SEP-06-2019 W MEGACHS ^ YAYASAN PENDIDIKAN AUSTRALIA 40 B37.0
EKO CAHAYO SAPUTRO 8000100622754605 M 5/31/1984 SEP-09-2019 SEP-09-2019 W MEGACHS ^ AVIA TECHNICS DIRGANTARA, PT 40 L03
FITRIA NUR ANITA 8000100602167786 F 4/16/1990 AUG-29-2019 AUG-29-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K29
ALKHANSA RUFAIDAH WAFIA 8000100617838330 F 9/24/2017 AUG-24-2019 AUG-24-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 J06
FAZIO RAJENDRA PERMANA 8000100611458275 M 12/5/2017 SEP-03-2019 SEP-03-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J02
SITI ROKHANA 8000100618203757 F 11/25/1991 AUG-02-2019 AUG-02-2019 W MEGACHS ^ TP QQ TRANS RITEL PROPERTI 40 B16
MUHAMMAD NAJIB ABDILLAH 8000100614245463 F 6/27/2016 AUG-02-2019 AUG-02-2019 W MEGACHS ^ TP QQ TRANS RITEL PROPERTI 40 J20
TAUFIK 8000100618203765 M 6/15/1988 AUG-02-2019 AUG-02-2019 W MEGACHS ^ TP QQ TRANS RITEL PROPERTI 40 B16
SYIFA MAULIDEA 8000100620990516 F 11/15/2018 AUG-02-2019 AUG-02-2019 W MEGACHS ^ TP QQ TRANS RITEL PROPERTI 40 B16
ACHA PUTRI PRAMITA 8000100616127123 F 12/10/1992 SEP-02-2019 SEP-02-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 Z34
TAUFIQURRAHMAN 8000100602443633 M 1/16/1965 AUG-24-2019 AUG-24-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J20
ARAYA DARRELL PUTRANSYAH 8000100608883162 M 5/24/2017 SEP-06-2019 SEP-06-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R11
M. NOOR KHOLIS 8000100608740354 M 11/19/1972 AUG-30-2019 AUG-30-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
TANTRI PRATIWI 8000100608740347 F 9/8/1982 AUG-21-2019 AUG-21-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J06
MUFIDA PUTRI PRATIWI 8000100608740339 F 3/28/2011 AUG-30-2019 AUG-30-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J00
ZULEYKA ALIFA FIKRIYA 8000100604402793 F 9/2/2006 AUG-20-2019 AUG-20-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 I88
MUFIDA PUTRI PRATIWI 8000100608740339 F 3/28/2011 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J00
ZULEYKA ALIFA FIKRIYA 8000100604402793 F 9/2/2006 AUG-22-2019 AUG-22-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 I88.9
HENDANG SUKARDI 8000100602448905 M 12/31/1977 SEP-01-2019 SEP-01-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J02
CHITRA MEGA ARISTIANTY 8000100614342112 F 5/19/1983 AUG-09-2019 AUG-09-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 I10
HAFIZH NAJWAN 8000100602458243 M 2/1/2007 SEP-03-2019 SEP-03-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 B01
ACHMAD 8000100602481658 M 7/28/1985 SEP-06-2019 SEP-06-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 N39
SIGIT WIJANARKO 8000100610966583 M 5/10/1980 AUG-20-2019 AUG-20-2019 W MEGACHS ^ TRANS REKREASINDO, PT 40 A16
LADYA CHERRYL 8000100603213613 F 9/20/2015 AUG-05-2019 AUG-05-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 J45
MAMAT RAHMAT 8000100603185431 M 2/13/1985 AUG-27-2019 AUG-27-2019 W MEGACHS ^ HONDA PRECISION PARTS MFG, PT 40 K02
KEIRRA PUTRI RAMADHANI 8000100603042608 F 6/17/2006 AUG-23-2019 AUG-23-2019 E MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 K35
NURISMA FAUZIA 8000100619585467 F 1/3/1992 SEP-04-2019 SEP-04-2019 W MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 Z34
GANANG RINDARKO 8000100608603883 M 11/6/1966 SEP-03-2019 SEP-03-2019 W MEGACHS ^ QN INTERNATIONAL INDONESIA, PT 40 L30
SHWETAMA SHRIVASTAVA 8000100609282315 F 6/30/1972 AUG-26-2019 AUG-26-2019 W MEGACHS ^ INDO BHARAT RAYON, PT 40 L28
DIAN RAHMAWATI 8000100610140585 F 2/20/1984 AUG-29-2019 AUG-29-2019 E MEGACHS ^ MEGA CAPITAL SEKURITAS, PT 40 K02
JENIFER PUTRI 8001001000112086 F 1/6/1994 SEP-04-2019 SEP-04-2019 W MEGACHS ^ TRANS CIBUBUR PROPERTY, PT 40 K04.1
TRI RAHAYU 8000100606701077 F 1/7/1989 AUG-29-2019 AUG-29-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 A15
TRI RAHAYU 8000100606701077 F 1/7/1989 AUG-28-2019 AUG-28-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 L04
IRA EMILIA 8000100617408563 F 8/24/1986 AUG-28-2019 AUG-28-2019 W MEGACHS ^ MOL LNG ASIA QQ MCSI 40 Z34
MUHAMMAD ZIDANE ALDEBARAN 8000100617408910 M 3/9/2016 SEP-06-2019 SEP-06-2019 W MEGACHS ^ MOL LNG ASIA QQ MCSI 40 J20
ELEGI PUTRI MONALISA 8000100617479333 F 1/19/1988 AUG-22-2019 AUG-22-2019 W MEGACHS ^ YAYASAN PENDIDIKAN AUSTRALIA 40 C73
DHIANA WIDYANINGTYAS 8000100620539461 F 3/25/1989 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PFI MEGA LIFE INSURANCE, PT 40 R50.9
SAEPUDIN 8000100602133457 M 6/4/1984 AUG-15-2019 AUG-15-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K02
SYIFA AMALIA 8000100616161668 F 12/17/1995 AUG-20-2019 AUG-20-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 A88.1
SYIFA AMALIA 8000100616161668 F 12/17/1995 AUG-12-2019 AUG-12-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 H10.5
MILA PAULAN WULANDARI 8000100602221666 F 3/15/1975 AUG-22-2019 AUG-22-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J06.9
TUTI ANDAYANI 8000100602104847 F 11/22/1971 AUG-26-2019 AUG-26-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 D24
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TUTI ANDAYANI 8000100602104847 F 11/22/1971 AUG-29-2019 AUG-29-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 D24
PUTRI ANDINI SR S 8000100602103443 F 9/15/1975 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K30
AZ ZAHRA PUTRI PERMANA 8000100621247452 F 6/13/2019 AUG-26-2019 AUG-26-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R05
AZ ZAHRA PUTRI PERMANA 8000100621247452 F 6/13/2019 AUG-24-2019 AUG-24-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 R05
ARDIANTI WIDORINI 8000100619448732 F 6/21/1993 AUG-30-2019 AUG-30-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z34
CORRY FEBIOLA MELIALA 8000100619448385 F 2/9/1990 AUG-21-2019 AUG-21-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 I47
TONY EKA SAPUTRA 8000100606739275 M 10/20/1981 AUG-13-2019 AUG-13-2019 E MEGACHS ^ YUSKITAMA LESTARI (HILTON BANDUNG) 40 J06
KUSNADI 8000100602579691 M 9/19/1964 AUG-30-2019 AUG-30-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 L84
KUSNADI 8000100602579691 M 9/19/1964 AUG-23-2019 AUG-23-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 L84
NABILLA OKTAVIA PUTRI 8000100602579675 F 10/3/2002 AUG-30-2019 AUG-30-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 L20
ADRYAN YUSUF SEPTIAN 8000100602562408 M 9/19/2007 SEP-02-2019 SEP-02-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 A09
IRFAN 8000100609870549 M 10/9/1986 SEP-03-2019 SEP-03-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 A09
DIAN WIDIYANTI 8000100602509201 F 11/27/1976 SEP-03-2019 SEP-03-2019 E MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J02
SAPTA HADINATA 8000100608133212 M 9/7/1986 AUG-30-2019 AUG-30-2019 E MEGACHS ^ TRANS NEWS CORPORA 40 K02
HERDA 8000100608162773 F 8/2/1986 AUG-29-2019 AUG-29-2019 E MEGACHS ^ TARA KUSUMA INDAH, PT 40 N39.0
HERLINA LOVIGA 8000100613757203 F 7/4/1993 AUG-16-2019 AUG-16-2019 W MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 L04
BAMBANG SETIADI 8000100610139694 M 5/28/1975 AUG-27-2019 AUG-27-2019 W MEGACHS ^ MEGA CAPITAL SEKURITAS, PT 40 M21
BAMBANG SETIADI 8000100610139694 M 5/28/1975 AUG-27-2019 AUG-27-2019 W MEGACHS ^ MEGA CAPITAL SEKURITAS, PT 40 M21
ASTI AYU ANDARI 8000100613695023 F 1/4/1993 AUG-26-2019 AUG-26-2019 W MEGACHS ^ MEGA CAPITAL SEKURITAS, PT 40 J31.0
MARLIANA 8000100617392056 F 7/7/1982 AUG-19-2019 AUG-19-2019 E MEGACHS ^ ALCON PHARMACEUTICALS LTD 40 K21.0
KEVINO SEBASTIAN MARBUN 8000100620540147 M 7/17/2014 SEP-05-2019 SEP-05-2019 W MEGACHS ^ PFI MEGA LIFE INSURANCE, PT 40 J02
RAHMAT HADIYATUL AKBAR 8000100622754282 M 4/17/1994 SEP-05-2019 SEP-05-2019 W MEGACHS ^ AVIA TECHNICS DIRGANTARA, PT 40 I84
NAEK PARSAULIAN OMPUSUNGGU 8000100602455470 M 12/12/1978 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 M15.0
HERY KRISNAWATI 8000100602703002 F 2/27/1972 AUG-27-2019 AUG-27-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 R51
NICHOLAS JONATHAN SUWANDI 8000100603763880 M 5/1/2004 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K05.0
ANDRIANI KUSUMAJAYA 8000100603763864 F 7/11/1971 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K04.0
NICHOLAS JONATHAN SUWANDI 8000100603763880 M 5/1/2004 AUG-26-2019 AUG-26-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 J02
CATHERINE NICHOLE SUWANDI 8000100603763872 F 9/7/2002 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 H61.2
P. KURNIA HANDOKO 8000100602703036 M 2/12/1971 AUG-28-2019 AUG-28-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 E78.5
CATHERINE NICHOLE SUWANDI 8000100603763872 F 9/7/2002 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 K05.0
ANDRIANI KUSUMAJAYA 8000100603763864 F 7/11/1971 AUG-31-2019 AUG-31-2019 W MEGACHS ^ TRANS RETAIL INDONESIA, PT 40 E78.5
RAFIF AL FATIH RAZAQ 8000100611194854 M 8/12/2014 SEP-04-2019 SEP-04-2019 E MEGACHS ^ BANK MEGA SYARIAH, PT 40 R50.9
NININ RAHAYU 8000100603409526 F 9/24/1974 AUG-20-2019 AUG-20-2019 E MEGACHS ^ BANK MEGA SYARIAH, PT 40 L50
BANY HANINDITA PRIBADI 8000100618694385 M 6/13/1978 AUG-22-2019 AUG-22-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 K02
HANI PRANAYADATI 8000100603030488 F 1/14/1977 AUG-22-2019 AUG-22-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 K02
ZHAFRAN HANAN FAEYZA ARDHANI 8000100608189636 M 1/27/2017 AUG-30-2019 AUG-30-2019 W MEGACHS ^ TELEVISI TRANSFORMASI INDONESIA, PT 40 Z24.0
RAMADHANTI VIANY SAHITA 8000100611095960 F 1/12/1997 AUG-24-2019 AUG-24-2019 E MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 J02
THERESIA AVILIA TUTI HANDAYANI 8000100610068505 F 2/17/1983 AUG-29-2019 AUG-29-2019 W MEGACHS ^ MEGA ASSET MANAGEMENT, PT 40 A09
ANTON ADHI NUGROHO 8000100617122289 M 12/4/1981 SEP-06-2019 SEP-06-2019 M MEGACHS ^ DHI EXCELLENCE LOGGING, PT 40 J45
HANUM LARASATI ADIWIBOWO 8001001000136616 F 3/6/2014 AUG-28-2019 AUG-28-2019 W MEGACHS ^ ALFA RETAILINDO QQ BEKASI, PT 40 J06
FITRYA DYAH WIJAYANTI 8001001000136615 F 12/3/1984 AUG-28-2019 AUG-28-2019 W MEGACHS ^ ALFA RETAILINDO QQ BEKASI, PT 40 J02
SYAFIRAH ZAHRA 8000100603598880 F 3/25/1990 AUG-16-2019 AUG-16-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 L04
SYAFIRAH ZAHRA 8000100603598880 F 3/25/1990 AUG-31-2019 AUG-31-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J06
ANGI SEPTIAWATI 8000100602366784 F 9/25/1992 AUG-27-2019 AUG-27-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 Z34
SYAFIRAH ZAHRA 8000100603598880 F 3/25/1990 AUG-28-2019 AUG-28-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 J02
EVI USI RIMONA SIRAIT 8000100620034729 F 2/15/1985 AUG-30-2019 AUG-30-2019 E MEGACHS ^ PT. BANK MEGA, TBK. 40 K04.1
IVAN PURNAMA SANOESI 8000100609195319 M 5/29/1961 AUG-19-2019 AUG-19-2019 W MEGACHS ^ PT. BANK MEGA, TBK. 40 K03.6
AFIF AMRULLAH FAKHRI 8000100602815582 M 1/31/1983 AUG-29-2019 AUG-29-2019 W MEGACHS ^ DUTA VISUAL NUSANTARA TIVI TUJUH, PT 40 K04.1
DINAR DWI APRINA 8000100612829110 F 4/4/1980 AUG-30-2019 AUG-30-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 E05
YASMIN FAIZAH PUTRI ALIYAH 8000100603414773 F 4/25/2012 AUG-24-2019 AUG-24-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 J02
SULTAN FAIZ AQIL DZAKWAN 8000100603414757 M 11/28/2013 AUG-24-2019 AUG-24-2019 W MEGACHS ^ BANK MEGA SYARIAH, PT 40 B37.0
NAKATA FAHRI ALVARO 8000100621423673 M 9/30/2016 AUG-15-2019 AUG-15-2019 W MEGACHS ^ TRANS NEWS CORPORA 40 J02
HARY PRAMONO 8000100612483959 M 3/24/1992 SEP-04-2019 SEP-04-2019 W MEGACHS ^ AGRANET MULTICITRA SIBERKOM, PT 40 N39.0
THERESIA BEATRIX YENNY M. SINA 8000100610973126 F 10/27/1980 SEP-05-2019 SEP-05-2019 W MEGACHS ^ TRANS CIBUBUR PROPERTY, PT 40 R11
WAHYUDI HADI ATMAJI 8000100606683937 M 6/12/1984 AUG-20-2019 AUG-20-2019 W MEGACHS ^ PZ CUSSONS INDONESIA, PT 40 R50.9
HERY MARIJANTO 8000100618460225 M 11/13/1969 AUG-01-2019 AUG-01-2019 W MEGACHS ^ SAHABAT MOBIL NUSANTARA, PT 40 I25
Page 19 of 47
Sep-18-2019 06:25:12 PM
AFIT WIRAWAN 8000100618460092 M 9/3/1981 AUG-12-2019 AUG-12-2019 W MEGACHS ^ SAHABAT MOBIL NUSANTARA, PT 40 L50
ATHAFARIZ ADNAN RAFFASYA 8000100618460068 M 10/17/2017 AUG-05-2019 AUG-05-2019 W MEGACHS ^ SAHABAT MOBIL NUSANTARA, PT 40 J02
CHOLIDAH 8000100618460183 F 6/11/1980 AUG-20-2019 AUG-20-2019 W MEGACHS ^ SAHABAT MOBIL NUSANTARA, PT 40 J31.2
EVA NOVITA 8000100620539958 F 1/13/1992 AUG-20-2019 AUG-20-2019 E MEGACHS ^ PFI MEGA LIFE INSURANCE, PT 40 J02
Page 20 of 47
Sep-18-2019 06:25:12 PM
AMT NOT AMT ASO

AMT AMT AMT EXCESS PAID TO LENGTH APPROVA REJECT MODIFIED
APPROVE APPROVE REFERRAL MC DAYS COVERAGE
INCURRED APPROVED MEMBER PAY PAID PROVIDER OF STAY L CODE CODE BY
D D
385,860.00 385,860.00 0 0 0.00 NO 0 20486229 GP
868,000.00 868,000.00 0 0 0.00 NO 0 21052526 GP
904,100.00 904,100.00 0 0 0.00 NO 0 21346517 GP
6,000,000.00 1,660,000.00 4340000 0 4,340,000.00 4340000 1660000 NO 0 1 19954073 GP YAFARA
420,450.00 420,450.00 0 0 0.00 NO 0 20849017 DENTAL
65,000.00 65,000.00 0 0 0.00 NO 0 20842127 GP
565,500.00 565,500.00 0 0 0.00 0 565500 NO 0 1 20000132 545 SP DIVERT TO GP SXMOUL
283,392.00 283,392.00 0 0 0.00 NO 0 20282400 GP
318,350.00 318,350.00 0 0 0.00 NO 0 20282675 GP
2,255,745.00 1,000,000.00 1255745 0 1,255,745.00 0 2255745 NO 0 1 15121440 DENTAL YAN_M
357,372.00 260,003.40 97368.6 0 97,368.60 NO 0 1 21176884 GP LXLIND
2,540,481.00 2,057,981.00 482500 0 482,500.00 NO 0 1 21493940 GP PK0643
327,000.00 294,300.00 32700 0 32,700.00 NO 0 19697251 GP
180,100.00 180,100.00 0 0 0.00 NO 1 20738701 H&S AXFRIS
1,217,312.00 1,217,312.00 0 0 0.00 NO 0 21074709 DENTAL
922,000.00 697,000.00 225000 0 225,000.00 NO 0 20705972 GP
679,800.00 679,800.00 0 0 0.00 NO 0 21030577 GP
275,000.00 275,000.00 0 0 0.00 NO 0 20163476 GP
315,000.00 315,000.00 0 0 0.00 0 315000 NO 0 1 20614228 GP SXMOUL
253,800.00 253,800.00 0 0 0.00 NO 0 21040365 DENTAL DIVERT TO GP
1,375,000.00 1,375,000.00 0 0 0.00 NO 0 1 21107323 DENTAL DIVERT TO GP GXPUSP
328,899.00 328,899.00 0 0 0.00 0 328899 NO 0 1 20550973 GP SXMOUL
315,000.00 315,000.00 0 0 0.00 NO 0 20107140 GP
924,413.00 924,413.00 0 0 0.00 NO 0 20588485 GP
2,364,540.00 2,364,540.00 0 0 0.00 NO 0 20708808 GP
949,500.00 949,500.00 0 0 0.00 NO 0 20709066 GP
1,791,800.00 1,791,800.00 0 0 0.00 NO 0 20577455 GP
1,417,079.00 1,417,079.00 0 0 0.00 NO 0 21290814 GP
176,000.00 176,000.00 0 0 0.00 NO 0 21281164 GP
425,791.00 425,791.00 0 0 0.00 NO 0 21339866 GP
1,226,451.00 1,226,451.00 0 0 0.00 NO 0 21292412 GP
513,184.00 341,364.00 171820 0 171,820.00 NO 0 20941391 GP
500,529.00 110,559.00 389970 0 389,970.00 NO 0 21035260 GP
415,000.00 270,000.00 145000 0 145,000.00 NO 0 21205396 SP DIVERT TO MAT
517,660.00 462,277.00 55383 0 55,383.00 NO 0 21194973 GP
295,314.00 230,314.00 65000 0 65,000.00 NO 0 20311001 GP
142,174.00 142,174.00 0 0 0.00 YES 0 20402301 GP
210,650.00 200,650.00 10000 0 10,000.00 YES 0 20376712 GP
1,740,100.00 1,740,100.00 0 0 0.00 NO 0 20400756 GP
627,100.00 627,100.00 0 0 0.00 NO 0 1 20730351 GP NFDWIX
539,400.00 539,400.00 0 0 0.00 NO 0 20949512 GP
1,186,240.00 1,026,240.00 160000 0 160,000.00 160000 1026240 NO 0 1 20364567 GP SXMOUL
428,800.00 428,800.00 0 0 0.00 NO 0 20746032 GP
70,000.00 70,000.00 0 0 0.00 NO 0 20804281 GP
324,200.00 65,000.00 259200 0 259,200.00 NO 0 20769800 GP
400,350.00 400,350.00 0 0 0.00 NO 0 20823830 DENTAL
680,750.00 680,750.00 0 0 0.00 NO 0 20893214 GP
506,856.00 506,856.00 0 0 0.00 NO 0 20845262 GP
417,350.00 417,350.00 0 0 0.00 NO 0 20875576 GP
1,352,596.00 0.00 1352596 0 1,352,596.00 NO 0 20852889 GP
246,200.00 246,200.00 0 0 0.00 NO 0 20844937 GP
1,662,700.00 0.00 1662700 0 1,662,700.00 NO 0 20833588 GP
254,000.00 249,000.00 5000 0 5,000.00 NO 0 20761858 GP
120,395.00 115,000.00 5395 0 5,395.00 NO 0 20750242 GP
Page 21 of 47
Sep-18-2019 06:25:12 PM
678,300.00 678,300.00 0 0 0.00 NO 0 20864780 GP

1,083,000.00 556,000.00 527000 0 527,000.00 NO 0 1 20902770 GP TXDERM
966,600.00 113,000.00 853600 0 853,600.00 NO 0 20775095 GP
531,850.00 165,950.00 365900 0 365,900.00 NO 0 20946839 DENTAL
903,300.00 903,300.00 0 0 0.00 NO 0 21104564 SP DIVERT TO MAT
59,842.00 59,842.00 0 0 0.00 NO 0 20668339 GP
140,087.00 140,087.00 0 0 0.00 NO 0 20667937 GP
70,526.00 70,526.00 0 0 0.00 NO 0 19400966 GP
475,000.00 427,500.00 47500 0 47,500.00 NO 0 20562323 GP
445,753.00 400,753.00 45000 0 45,000.00 NO 0 1 21071911 GP MXNURU
260,000.00 225,000.00 35000 0 35,000.00 NO 0 21189634 GP
1,205,726.00 1,117,176.00 88550 0 88,550.00 NO 0 1 21081308 GP IRRIAN
149,000.00 149,000.00 0 0 0.00 NO 0 1 21133359 GP NXATIK
149,000.00 149,000.00 0 0 0.00 NO 0 21074404 GP
1,037,778.00 1,037,778.00 0 0 0.00 NO 0 1 21028633 GP PK1056
127,360.00 127,360.00 0 0 0.00 NO 0 20014188 GP
330,000.00 330,000.00 0 0 0.00 NO 0 19993787 GP
145,000.00 145,000.00 0 0 0.00 NO 0 20704252 GP
591,062.00 591,062.00 0 0 0.00 NO 0 1 19981219 GP IRRIAN
420,290.00 420,290.00 0 0 0.00 NO 0 20661381 GP
800,740.00 495,320.00 305420 0 305,420.00 NO 0 20170909 DENTAL DIVERT TO GP
145,000.00 145,000.00 0 0 0.00 NO 0 20097846 GP
284,000.00 284,000.00 0 0 0.00 NO 0 20040732 GP
466,379.00 466,379.00 0 0 0.00 NO 0 20856276 GP
470,139.00 470,139.00 0 0 0.00 NO 0 20907549 GP
1,253,380.00 1,253,380.00 0 0 0.00 NO 0 20062142 GP
701,290.00 701,290.00 0 0 0.00 NO 0 1 20397017 SP DIVERT TO GP LXMELIX
759,624.00 759,624.00 0 0 0.00 NO 0 1 20554447 GP IRRIAN
232,767.00 232,767.00 0 0 0.00 NO 0 20947212 SP DIVERT TO GP
1,018,711.00 864,600.00 154111 0 154,111.00 NO 0 20745391 GP
422,700.00 277,700.00 145000 0 145,000.00 NO 0 21017746 GP
186,813.00 186,813.00 0 0 0.00 NO 0 20922219 GP
152,250.00 152,250.00 0 0 0.00 NO 0 20394926 DENTAL
378,617.00 378,617.00 0 0 0.00 0 378617 NO 0 1 20669073 GP SXMOUL
355,100.00 340,100.00 15000 0 15,000.00 15000 340100 YES 0 1 20354238 GP SXMOUL
725,000.00 710,000.00 15000 0 15,000.00 NO 0 1 20941043 DENTAL NFDWIX
715,000.00 715,000.00 0 0 0.00 NO 0 1 20940860 DENTAL NFDWIX
70,800.00 70,800.00 0 0 0.00 NO 0 1 20981668 GP NFDWIX
103,930.00 83,930.00 20000 0 20,000.00 20000 83930 NO 0 1 19600147 GP YAFARA
368,250.00 368,250.00 0 0 0.00 0 368250 NO 0 1 19974114 GP SXMOUL
704,067.00 264,067.00 440000 0 440,000.00 440000 264067 NO 0 1 20484089 GP SXMOUL
226,004.00 226,004.00 0 0 0.00 NO 0 20848936 GP
347,814.00 347,814.00 0 0 0.00 NO 0 20848739 GP
159,572.00 109,572.00 50000 0 50,000.00 NO 0 20949175 GP
643,754.00 643,754.00 0 0 0.00 NO 0 1 21426974 GP MXNURU
292,643.00 292,643.00 0 0 0.00 NO 0 20340015 GP
236,681.00 236,681.00 0 0 0.00 NO 0 20153444 GP
591,110.00 591,110.00 0 0 0.00 NO 0 20484699 GP
242,788.00 242,788.00 0 0 0.00 NO 0 20113714 GP
222,517.00 222,517.00 0 0 0.00 NO 0 19994217 GP
235,654.00 235,654.00 0 0 0.00 NO 0 20336685 GP
297,217.00 187,217.00 110000 0 110,000.00 110000 187217 NO 0 1 19608888 GP YAFARA
775,750.00 775,750.00 0 0 0.00 NO 0 1 20936982 DENTAL TXDERM
83,136.00 78,979.20 4156.8 0 4,156.80 NO 0 20542553 GP
201,032.00 121,855.40 79176.6 0 79,176.60 NO 0 20739274 GP
435,960.00 260,460.00 175500 0 175,500.00 NO 1 21032230 H&S LXMELIX
515,000.00 370,000.00 145000 0 145,000.00 NO 0 21084150 GP
870,022.00 870,022.00 0 0 0.00 NO 0 1 20935008 GP LXLIND
Page 22 of 47
Sep-18-2019 06:25:12 PM
880,080.00 880,080.00 0 0 0.00 NO 0 20919216 GP

750,020.00 750,020.00 0 0 0.00 NO 0 1 20757633 GP LXLIND
392,628.00 386,628.00 6000 0 6,000.00 NO 0 20744362 GP
1,150,000.00 1,150,000.00 0 0 0.00 NO 0 21163412 DENTAL
765,700.00 755,700.00 10000 0 10,000.00 NO 0 20583070 GP
504,738.82 324,738.82 180000 0 180,000.00 NO 0 20874347 GP
1,858,456.00 1,858,456.00 0 0 0.00 NO 0 20461315 GP
350,000.00 350,000.00 0 0 0.00 NO 0 20531549 GP
291,230.00 291,230.00 0 0 0.00 NO 0 20636910 GP
334,000.00 334,000.00 0 0 0.00 NO 0 20636819 GP
103,670.00 103,670.00 0 0 0.00 NO 0 20496430 GP
213,057.00 213,057.00 0 0 0.00 NO 0 20912288 GP
563,034.00 563,034.00 0 0 0.00 NO 0 20376912 GP
284,481.00 284,481.00 0 0 0.00 NO 0 20939114 GP
389,060.00 389,060.00 0 0 0.00 NO 0 20818930 SP DIVERT TO GP
322,000.00 322,000.00 0 0 0.00 NO 0 20633829 GP
257,589.00 257,589.00 0 0 0.00 NO 0 20608625 GP
4,443,667.00 720,178.00 3723489 0 3,723,489.00 3723489 720178 NO 4 4 20864574 GP LXMELIX
218,855.00 218,855.00 0 0 0.00 NO 0 1 20885126 GP AXFRIS
239,000.00 239,000.00 0 0 0.00 NO 0 20795693 SP DIVERT TO GP
734,967.00 579,501.00 155466 0 155,466.00 NO 0 1 20887792 GP TXDERM
381,200.00 381,200.00 0 0 0.00 NO 0 21066699 GP
682,335.00 682,335.00 0 0 0.00 NO 0 21104525 GP
433,150.00 138,050.00 295100 0 295,100.00 NO 0 21003411 SP DIVERT TO GP
1,301,761.00 1,301,761.00 0 0 0.00 NO 0 21220747 GP
198,000.00 188,100.00 9900 0 9,900.00 NO 0 20552573 DENTAL
302,188.00 300,025.00 2163 0 2,163.00 NO 1 19844568 H&S NXNGES
323,130.00 218,130.00 105000 0 105,000.00 NO 0 21091039 GP
282,013.00 201,711.70 80301.3 0 80,301.30 YES 0 20971772 GP
446,600.00 434,600.00 12000 0 12,000.00 NO 0 21095774 GP
786,100.00 759,100.00 27000 0 27,000.00 NO 0 21347162 GP
440,400.00 440,400.00 0 0 0.00 NO 0 21097368 GP
369,200.00 369,200.00 0 0 0.00 0 369200 NO 0 1 20455421 GP YAFARA
201,690.00 201,690.00 0 0 0.00 NO 0 20957297 DENTAL
973,900.00 973,900.00 0 0 0.00 NO 0 1 21186398 GP MXAZIS
278,950.00 278,950.00 0 0 0.00 NO 0 20434329 GP
642,742.00 632,742.00 10000 0 10,000.00 NO 0 21024269 GP
486,583.00 476,583.00 10000 0 10,000.00 NO 0 21024178 GP
274,700.00 274,700.00 0 0 0.00 NO 0 21004281 GP
1,073,050.00 1,073,050.00 0 0 0.00 NO 0 21004570 SP DIVERT TO MAT
375,345.00 369,950.00 5395 0 5,395.00 NO 0 21074985 GP
117,700.00 117,700.00 0 0 0.00 NO 0 21097205 GP
243,654.00 243,654.00 0 0 0.00 0 243654 NO 0 1 19755024 GP FARID
384,200.00 346,740.00 37460 0 37,460.00 NO 0 21019896 GP
423,276.00 388,612.00 34664 0 34,664.00 34664 388612 NO 0 1 20738593 GP SXMOUL
1,458,280.00 1,362,366.00 95914 0 95,914.00 NO 0 20875960 GP
1,865,000.00 1,275,000.00 590000 0 590,000.00 NO 0 20826035 GP
217,695.00 195,925.50 21769.5 0 21,769.50 NO 0 19866711 GP
1,649,870.00 1,244,553.80 405316.2 0 405,316.20 NO 0 20530703 GP LABQUANT
335,000.00 301,500.00 33500 0 33,500.00 NO 0 19835391 GP
1,602,623.00 1,442,360.70 160262.3 0 160,262.30 NO 0 19734026 GP LABQUANT
1,133,975.00 1,020,577.50 113397.5 0 113,397.50 NO 0 19842018 GP LABQUANT
160,000.00 144,000.00 16000 0 16,000.00 NO 0 19788966 GP
492,320.00 317,320.00 175000 0 175,000.00 NO 0 21143787 GP
393,700.00 393,700.00 0 0 0.00 NO 0 21143529 GP
326,797.00 326,797.00 0 0 0.00 0 326797 NO 0 1 19910581 GP YAFARA
Page 23 of 47
Sep-18-2019 06:25:12 PM
692,000.00 692,000.00 0 0 0.00 NO 0 1 21076590 GP MXAZIS

174,000.00 174,000.00 0 0 0.00 NO 0 21134641 GP
122,000.00 122,000.00 0 0 0.00 NO 0 21134779 GP
151,000.00 151,000.00 0 0 0.00 NO 0 21134693 GP
666,639.00 666,639.00 0 0 0.00 NO 0 20734710 GP
465,821.00 410,029.95 55791.05 0 55,791.05 NO 0 1 21300298 GP IRRIAN
717,500.00 547,500.00 170000 0 170,000.00 NO 0 1 20908200 GP AXDINA1
199,300.00 199,300.00 0 0 0.00 NO 0 1 20767362 GP NFDWIX
190,250.00 190,250.00 0 0 0.00 NO 0 20877174 GP
548,300.00 548,300.00 0 0 0.00 NO 0 20710256 GP
380,000.00 380,000.00 0 0 0.00 NO 0 20762197 GP
204,677.00 204,677.00 0 0 0.00 NO 0 20190079 GP
299,354.00 299,354.00 0 0 0.00 NO 0 20871945 GP
804,900.00 804,900.00 0 0 0.00 NO 0 1 21050008 GP AXFRIS
208,500.00 208,500.00 0 0 0.00 NO 0 21388226 DENTAL
582,731.00 582,731.00 0 0 0.00 NO 0 20710161 GP
175,000.00 175,000.00 0 0 0.00 NO 0 20767083 GP
655,089.00 655,089.00 0 0 0.00 NO 0 20710034 GP
316,510.00 316,510.00 0 0 0.00 NO 0 20879032 GP
254,600.00 254,600.00 0 0 0.00 0 254600 NO 0 1 19196394 GP YAFARA
249,710.00 197,359.50 52350.5 0 52,350.50 NO 0 20612500 GP
1,453,765.00 573,290.00 880475 0 880,475.00 NO 0 20763397 GP
129,200.00 116,280.00 12920 0 12,920.00 YES 0 20575943 GP
519,788.00 460,809.00 58979 0 58,979.00 58979 460809 NO 0 1 20959582 GP SXMOUL
475,000.00 250,000.00 225000 0 225,000.00 NO 0 1 21152851 GP LCMART
768,919.00 768,919.00 0 0 0.00 NO 0 20951549 GP
1,055,467.00 1,055,467.00 0 0 0.00 NO 0 20901737 GP
942,000.00 942,000.00 0 0 0.00 NO 0 20894897 DENTAL
405,640.00 405,640.00 0 0 0.00 NO 0 20270330 GP AD1682
221,400.00 221,400.00 0 0 0.00 NO 0 20578016 DENTAL
356,000.00 356,000.00 0 0 0.00 NO 0 20578113 GP
1,040,434.00 1,005,434.00 35000 0 35,000.00 NO 0 21271584 GP
1,289,890.00 1,016,990.00 272900 0 272,900.00 272900 1016990 NO 0 1 20419590 GP SXMOUL
350,000.00 225,000.00 125000 0 125,000.00 NO 0 1 20367909 GP PRJ0170
222,000.00 222,000.00 0 0 0.00 YES 0 20372568 GP
979,444.00 779,444.00 200000 0 200,000.00 NO 0 21187441 GP
198,995.00 198,995.00 0 0 0.00 NO 0 21323945 GP
296,100.00 296,100.00 0 0 0.00 YES 0 20057475 DENTAL DIVERT TO GP
350,300.00 350,300.00 0 0 0.00 YES 0 21010059 DENTAL DIVERT TO GP
342,800.00 342,800.00 0 0 0.00 YES 0 20057744 GP
330,700.00 330,700.00 0 0 0.00 NO 0 20847060 GP
240,430.00 240,430.00 0 0 0.00 NO 0 20872251 GP
236,000.00 236,000.00 0 0 0.00 NO 0 20025712 GP
282,170.00 282,170.00 0 0 0.00 NO 0 20008672 GP
534,700.00 534,700.00 0 0 0.00 NO 0 20121299 GP
441,970.00 441,970.00 0 0 0.00 NO 0 20117988 GP
173,208.00 173,208.00 0 0 0.00 NO 0 20120088 GP
238,157.00 238,157.00 0 0 0.00 NO 0 20195635 GP
941,100.00 941,100.00 0 0 0.00 YES 0 21338464 GP
1,320,963.00 1,320,963.00 0 0 0.00 NO 0 20949652 GP
556,871.00 556,871.00 0 0 0.00 YES 0 20981797 GP
307,788.00 307,788.00 0 0 0.00 NO 0 1 19950465 GP MXNURU
194,989.00 188,989.00 6000 0 6,000.00 NO 0 20302837 GP
1,283,730.00 1,277,730.00 6000 0 6,000.00 NO 0 20938530 GP
389,040.00 389,040.00 0 0 0.00 NO 0 1 20660008 545 SP DIVERT TO GP AXFRIS
157,880.00 151,880.00 6000 0 6,000.00 NO 0 1 20883654 GP TXDERM
146,380.00 146,380.00 0 0 0.00 NO 0 20683470 GP
Page 24 of 47
Sep-18-2019 06:25:12 PM
365,505.00 359,505.00 6000 0 6,000.00 NO 0 20050048 GP

683,290.00 683,290.00 0 0 0.00 NO 0 1 20344985 545 SP DIVERT TO GP IRRIAN
526,300.00 526,300.00 0 0 0.00 NO 0 1 20929652 545 SP DIVERT TO GP AXFRIS
308,000.00 308,000.00 0 0 0.00 NO 0 20924011 GP
105,500.00 105,500.00 0 0 0.00 0 105500 NO 0 1 19748025 GP YAFARA
832,300.00 832,300.00 0 0 0.00 NO 0 1 20682281 545 GP LCMART
261,100.00 261,100.00 0 0 0.00 NO 0 20925867 GP
341,000.00 341,000.00 0 0 0.00 NO 0 1 20852497 545 SP DIVERT TO GP MXNURU
330,000.00 330,000.00 0 0 0.00 NO 0 1 20793085 SP DIVERT TO GP IRRIAN
696,568.00 681,200.00 15368 0 15,368.00 NO 0 20500701 GP
717,025.00 702,025.00 15000 0 15,000.00 NO 0 20765391 GP
2,003,073.00 1,277,419.35 725653.65 0 725,653.65 NO 0 20968718 GP
836,252.00 752,626.80 83625.2 0 83,625.20 NO 0 20773259 GP
499,529.00 499,529.00 0 0 0.00 NO 0 20843795 GP
439,586.00 389,586.00 50000 0 50,000.00 NO 0 21268309 GP
647,490.00 647,490.00 0 0 0.00 NO 0 21408647 GP
206,100.00 206,100.00 0 0 0.00 YES 0 20853752 GP
106,500.00 106,500.00 0 0 0.00 YES 0 20557235 GP
828,210.00 828,210.00 0 0 0.00 NO 0 21089620 GP
547,404.00 547,404.00 0 0 0.00 NO 0 19476362 GP
334,558.00 334,558.00 0 0 0.00 NO 0 19454328 GP
497,371.00 497,371.00 0 0 0.00 NO 0 19476352 GP
289,740.00 289,740.00 0 0 0.00 NO 0 19464258 GP
1,714,435.00 1,714,435.00 0 0 0.00 NO 0 20593669 GP
490,080.00 490,080.00 0 0 0.00 NO 0 21220697 GP
323,890.00 323,890.00 0 0 0.00 NO 0 20872105 GP
197,864.00 197,864.00 0 0 0.00 NO 0 20385336 GP
446,822.00 446,822.00 0 0 0.00 NO 0 20869432 GP
289,060.00 289,060.00 0 0 0.00 NO 0 20375991 GP
301,000.00 301,000.00 0 0 0.00 NO 0 20959916 GP
200,000.00 200,000.00 0 0 0.00 NO 0 20489374 GP
413,246.00 403,246.00 10000 0 10,000.00 NO 0 20972512 GP
1,446,700.00 1,446,700.00 0 0 0.00 NO 0 19824105 GP
225,000.00 210,000.00 15000 0 15,000.00 NO 0 21108900 GP
198,250.00 178,250.00 20000 0 20,000.00 NO 0 21255532 GP
275,000.00 265,000.00 10000 0 10,000.00 NO 0 20322144 GP
235,298.00 235,298.00 0 0 0.00 NO 0 19588091 GP
560,498.00 560,498.00 0 0 0.00 NO 0 20707879 DENTAL
275,000.00 243,000.00 32000 0 32,000.00 YES 0 20507624 GP
1,071,800.00 1,071,800.00 0 0 0.00 NO 0 21161286 SP DIVERT TO MAT
935,786.00 740,786.00 195000 0 195,000.00 NO 0 21079284 GP
759,964.00 759,964.00 0 0 0.00 0 759964 NO 0 1 20652300 GP SXMOUL
345,940.00 345,940.00 0 0 0.00 NO 0 20811283 DENTAL
823,924.00 823,924.00 0 0 0.00 NO 0 1 21137735 DENTAL LCMART
867,210.00 847,210.00 20000 0 20,000.00 NO 0 1 20839790 GP LXMELIX
1,057,000.00 1,037,000.00 20000 0 20,000.00 NO 0 1 20780039 GP LCMART
645,300.00 645,300.00 0 0 0.00 NO 0 20765630 SP DIVERT TO MAT
635,622.00 600,622.00 35000 0 35,000.00 NO 0 21225777 GP
616,796.00 306,796.00 310000 0 310,000.00 NO 0 20475549 GP
353,028.00 353,028.00 0 0 0.00 NO 0 20965812 GP
143,750.00 143,750.00 0 0 0.00 NO 0 20338226 GP
395,737.00 395,737.00 0 0 0.00 NO 0 19920170 GP
761,700.00 761,700.00 0 0 0.00 NO 0 20465862 GP
507,646.00 507,646.00 0 0 0.00 NO 0 20678442 GP
Page 25 of 47
Sep-18-2019 06:25:12 PM
700,000.00 82,724.00 617276 0 617,276.00 YES 0 20830015 GP

520,751.00 520,751.00 0 0 0.00 NO 0 20893833 GP
251,000.00 251,000.00 0 0 0.00 NO 0 20643527 GP
880,680.00 880,680.00 0 0 0.00 NO 0 1 20573627 GP LCMART
586,290.00 586,290.00 0 0 0.00 NO 0 20902390 SP DIVERT TO GP
99,000.00 99,000.00 0 0 0.00 0 99000 NO 0 1 20410886 GP SXMOUL
277,570.00 237,570.00 40000 0 40,000.00 40000 237570 NO 0 1 20001534 GP YAFARA
618,911.00 618,911.00 0 0 0.00 YES 0 20892571 GP
235,000.00 235,000.00 0 0 0.00 YES 0 20521863 GP
160,960.00 160,960.00 0 0 0.00 YES 0 20897569 GP
267,800.00 267,800.00 0 0 0.00 NO 0 20993152 GP
312,500.00 312,500.00 0 0 0.00 NO 0 21109114 GP
853,910.00 853,910.00 0 0 0.00 NO 0 1 21109432 GP AXDINA1
690,000.00 627,800.00 62200 0 62,200.00 YES 0 20866267 DENTAL
86,000.00 66,000.00 20000 0 20,000.00 YES 0 20837829 GP
539,550.00 466,322.50 73227.5 0 73,227.50 NO 0 20179447 GP
352,300.00 352,300.00 0 0 0.00 NO 0 20736505 GP
919,000.00 899,000.00 20000 0 20,000.00 NO 0 20732665 GP
407,280.00 382,280.00 25000 0 25,000.00 NO 0 20640400 GP
206,600.00 206,600.00 0 0 0.00 YES 1 20315597 GP
630,572.00 630,572.00 0 0 0.00 NO 0 21187589 GP
463,000.00 463,000.00 0 0 0.00 NO 0 21219329 GP
390,000.00 200,000.00 190000 0 190,000.00 NO 0 20959394 GP
2,689,491.00 2,689,491.00 0 0 0.00 NO 0 20740201 GP
841,000.00 841,000.00 0 0 0.00 NO 0 20927598 DENTAL
1,950,000.00 1,950,000.00 0 0 0.00 NO 0 20948917 DENTAL
543,416.00 543,416.00 0 0 0.00 NO 0 20666606 GP
2,686,343.00 2,686,343.00 0 0 0.00 NO 0 20939958 GP
1,798,544.00 1,798,544.00 0 0 0.00 NO 0 20796348 GP
1,446,000.00 1,446,000.00 0 0 0.00 NO 0 1 20939784 DENTAL TXDERM
1,005,000.00 1,005,000.00 0 0 0.00 NO 0 1 20948748 GP MXAZIS
247,170.00 223,170.00 24000 0 24,000.00 YES 0 21112785 GP
132,732.00 132,732.00 0 0 0.00 0 132732 YES 0 1 20332456 GP SXMOUL
550,000.00 510,000.00 40000 0 40,000.00 NO 0 20462359 DENTAL
295,000.00 295,000.00 0 0 0.00 NO 0 20462297 DENTAL
541,801.00 514,710.95 27090.05 0 27,090.05 NO 0 20898586 GP
254,771.00 83,400.00 171371 0 171,371.00 NO 0 20599169 GP
850,023.00 469,514.00 380509 0 380,509.00 NO 0 20816169 GP
917,860.00 917,860.00 0 0 0.00 0 917860 NO 1 1 21237768 H&S TINA
622,309.00 622,309.00 0 0 0.00 NO 0 20785035 GP
1,327,026.00 1,327,026.00 0 0 0.00 NO 0 20795158 GP
260,000.00 260,000.00 0 0 0.00 NO 0 20168190 GP
291,000.00 291,000.00 0 0 0.00 NO 0 20912898 GP
395,250.00 395,250.00 0 0 0.00 NO 0 1 20724946 SP DIVERT TO GP MXAZIS
396,500.00 396,500.00 0 0 0.00 NO 0 20190163 GP
140,000.00 140,000.00 0 0 0.00 NO 0 20662892 GP
132,550.00 132,550.00 0 0 0.00 NO 0 20753424 GP
910,000.00 681,163.00 228837 0 228,837.00 NO 0 20266539 DENTAL DIVERT TO GP MIRACLEG
465,000.00 441,750.00 23250 0 23,250.00 NO 0 20817177 DENTAL
875,090.00 367,090.00 508000 0 508,000.00 NO 0 20906098 GP
513,554.00 513,554.00 0 0 0.00 NO 0 20587278 GP
308,100.00 308,100.00 0 0 0.00 NO 0 20586826 GP
537,499.00 476,374.05 61124.95 0 61,124.95 NO 0 20108895 GP
696,210.00 438,314.00 257896 0 257,896.00 NO 0 21120225 GP
629,355.00 629,355.00 0 0 0.00 NO 0 1 21218875 GP MXMILA
505,947.00 505,947.00 0 0 0.00 NO 0 20374729 GP
538,000.00 538,000.00 0 0 0.00 NO 0 19410278 GP
Page 26 of 47
Sep-18-2019 06:25:12 PM
219,980.00 219,980.00 0 0 0.00 NO 0 19967746 GP

261,936.00 261,936.00 0 0 0.00 NO 0 19590481 GP
197,212.00 197,212.00 0 0 0.00 NO 0 20320246 GP
123,000.00 123,000.00 0 0 0.00 YES 0 20377310 GP
Page 27 of 47
Sep-18-2019 06:25:12 PM
PAYOR
RECAP_FL RECAPPED RECEIVED_ INVOICE_DA AdMed
FOLLOW-UP-DATE REGISTER VERIFY BY HOSP INVOICE NO INVOICE ICD
AG _BY DATE TE No.
NO
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 400166/RJ-KEU/RSPB/IX/2019 P19098346
[] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 028/AR.RJ/IX/19 P19098339
SEP-12-2019 03:37:52 PM [2 ] Y-SXAGIX3 FXSARA N SEP-12-2019 AUG-23-2019 RJ19003872/ADM-P/INS/VIII/-R P19098032
[] Y-SXAGIX1 N SEP-12-2019 AUG-31-2019 326-08/KEU-RSDS/VIII/2019 P19098195
SEP-12-2019 03:22:28 PM [3 ] Y-SXAGIX3 LFIKAX N SEP-12-2019 AUG-20-2019 P190800209-R P19098019
[] Y-SXAGIX3 N SEP-12-2019 SEP-02-2019 2175/RSUI-HA/TGH/IX/2019 P19098340
JUL-15-2019 04:53:43 PM [3 ] Y-SXAGIX3 N SEP-12-2019 SEP-05-2019 117-B/RJ/NT/RSMHTP/IX/2019 P19098337
SEP-05-2019 09:43:21 AM [] Y-SXAGIX1 N SEP-12-2019 SEP-09-2019 IVI190900358 P19098191
SEP-11-2019 12:45:40 PM [] Y-SXAGIX1 N SEP-12-2019 SEP-12-2019 15137/INV/RSGK/TAG/IX/2019 P19098189
[] Y-SXAGIX1 N SEP-12-2019 SEP-06-2019 B/9284/IX/2019/RSBHAY.TK.I P19098203
AUG-27-2019 07:49:37 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0270SARJAS0819 P19098338 J06
[] Y-SXAGIX2 N SEP-12-2019 SEP-10-2019 308/INV/CH/TAG/IX/2019 P19098168
[] Y-SXAGIX2 N SEP-12-2019 SEP-10-2019 200120190900370 P19098193
[] Y-SXAGIX2 N SEP-12-2019 SEP-06-2019 082/INV/RSIADT/TAG/IX/2019 P19098185
[] Y-SXAGIX3 N SEP-12-2019 SEP-11-2019 148.432/1908006 P19098361
SEP-12-2019 03:43:25 PM [3 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-29-2019 0506KEU-ADM/RSM/VIII/2019-R P19098023
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0785-INV/RMC-MKS/IX/2019 P19098353
SEP-03-2019 08:19:35 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0785-INV/RMC-MKS/IX/2019 P19098353
SEP-12-2019 03:02:11 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-31-2019 0397/RJ/VIII/2019-R P19098029
[] Y-SXAGIX3 N SEP-12-2019 SEP-11-2019 0024CSRJAS0919 P19098354
[] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 AR-2019/09/10/0071 P19098355
[] Y-SXAGIX3 N SEP-12-2019 SEP-06-2019 KU.26/51/14/RSP.CBN-2019 P19098349
[] Y-SXAGIX1 N SEP-12-2019 SEP-09-2019 IVI190900358 P19098191
[] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 K34040819 P19098171
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0171/BAG.TAG/MF/IX/19 P19098335
[] Y-SXAGIX3 N SEP-12-2019 SEP-12-2019 KT/177/ADM/IX/2019 P19098362
[] Y-SXAGIX3 N SEP-12-2019 SEP-06-2019 TB/AF/UMU/19/08/100501 P19098356
AUG-27-2019 05:41:31 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-06-2019 TB/AF/UMU/19/08/100501 P19098356
SEP-12-2019 03:00:16 PM [2 ] Y-SXAGIX3 N SEP-12-2019 AUG-28-2019 G000012450/RSHGA/8/2019-R P19098020
Page 28 of 47
Sep-18-2019 06:25:12 PM

AUG-30-2019 07:45:58 PM [] Y-SXAGIX1 N SEP-12-2019 AUG-31-2019 326-08/KEU-RSDS/VIII/2019 P19098195
[] Y-SXAGIX3 N SEP-12-2019 SEP-11-2019 RSIAMF/KU/A-MEGA/001-002/IX P19098329
[] Y-SXAGIX3 N SEP-12-2019 SEP-05-2019 202500/TAG-UMUM/YKS-BKS/IX/201 P19098326
SEP-03-2019 09:46:11 AM [] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 4370/INV/RSUBM/TAG/IX/2019 P19098352
[] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 4370/INV/RSUBM/TAG/IX/2019 P19098352
SEP-03-2019 01:27:26 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 4370/INV/RSUBM/TAG/IX/2019 P19098352
SEP-04-2019 11:58:07 AM [] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 4370/INV/RSUBM/TAG/IX/2019 P19098352
AUG-12-2019 08:57:16 PM [] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 K34040819 P19098171
AUG-21-2019 11:24:54 AM [] Y-SXAGIX3 N SEP-12-2019 AUG-31-2019 KWR190800301 P19098363
AUG-24-2019 10:08:03 AM [] Y-SXAGIX3 N SEP-12-2019 AUG-31-2019 KWR190800301 P19098363
[] Y-SXAGIX1 N SEP-12-2019 SEP-04-2019 3677/RS.AULIA/KEU/VIII/2019 P19098207
[] Y-SXAGIX1 N SEP-12-2019 SEP-03-2019 001-09/KEU-RSDS/IX/2019 P19098209
[] Y-SXAGIX3 N SEP-12-2019 SEP-05-2019 SB/PTAMN/839/IX/2019 P19098350
SEP-12-2019 03:11:47 PM [3 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-30-2019 200320190800835-R P19098024
SEP-12-2019 03:03:29 PM [3 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 SEP-02-2019 INV2019010000985-R P19098028
AUG-31-2019 12:35:51 PM [] Y-SXAGIX2 N SEP-12-2019 AUG-31-2019 0356/RJ/VIII/2019 P19098181
SEP-01-2019 07:41:09 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 AMDS2019RJ001191 P19098342
SEP-12-2019 03:41:43 PM [2 ] Y-SXAGIX3 VMIKEX N RENCE SEP-12-2019 AUG-28-2019 1324/CL/RSIA-MH/VIII/19-R P19098036
SEP-12-2019 03:17:21 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-31-2019 222/RSU-KI/P/VIII/2019R P19098022
SEP-12-2019 03:17:34 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-31-2019 222/RSU-KI/P/VIII/2019R P19098022
[] Y-SXAGIX3 N SEP-12-2019 SEP-02-2019 1938/D30000/2019-S4 P19098343
[] Y-SXAGIX1 N SEP-12-2019 SEP-04-2019 3674/RS.AULIA/KEU/VIII/2019 P19098205
SEP-10-2019 10:38:35 AM [] Y-SXAGIX1 N SEP-12-2019 SEP-11-2019 15074/INV/RSGK/TAG/IX/2019 P19098188
SEP-12-2019 03:33:25 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-23-2019 HOD-136-08/05-08-2019-R P19098035
AUG-31-2019 12:31:09 PM [] Y-SXAGIX1 N SEP-12-2019 SEP-04-2019 3662/RS.AULIA/KEU/VIII/2019 P19098204
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 071/KI.2.12/TG/IX/2019 P19098341
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 19H09510 P19098344
SEP-02-2019 05:04:49 PM [] Y-SXAGIX1 N SEP-12-2019 SEP-04-2019 3707/RS.AULIA/KEU/IX/2019 P19098208 N21.1
[] Y-SXAGIX2 N SEP-12-2019 SEP-09-2019 0069MCRJAS0919 P19098178
AUG-31-2019 10:16:17 AM [] Y-SXAGIX2 N SEP-12-2019 SEP-10-2019 200120190900370 P19098193
Page 29 of 47
Sep-18-2019 06:25:12 PM

AUG-28-2019 09:05:59 AM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 071/KI.2.12/TG/IX/2019 P19098341
[] Y-SXAGIX2 N SEP-12-2019 SEP-10-2019 B1909.0323 P19098174
[] Y-SXAGIX1 N SEP-12-2019 SEP-09-2019 AII/20190909/00003 P19098197
SEP-02-2019 09:24:16 AM [] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 769/INV-RSHD/IX/2019 P19098328
AUG-30-2019 02:41:33 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 19H09510 P19098344
AUG-30-2019 03:29:59 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 19H09510 P19098344
[] Y-SXAGIX3 N SEP-12-2019 SEP-07-2019 BN-09/07/2019-20793 P19098358
[] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 G000012807/RSHGA/9/2019 P19098192
AUG-09-2019 08:42:15 PM [] Y-SXAGIX2 N SEP-12-2019 AUG-27-2019 00120/RJ/RI/RSSH/08/2019 P19098173
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 P190301024/KU-RSIJPK - P19098347
SEP-12-2019 03:40:37 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-25-2019 0146/RJ/KEU-RS.FMC/VIII/2019-R P19098034
SEP-05-2019 11:34:38 AM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 6600/TGH-KEU/IX/2019 P19098331
[2 ] Y-SXAGIX3 N SEP-12-2019 AUG-21-2019 097/RJ/NT/RS-ARP/VIII/2019. P19098336
[] Y-SXAGIX3 N SEP-12-2019 SEP-05-2019 0001004932/FIN/AR-OP/IX/2019 P19098364
[] Y-SXAGIX3 N SEP-12-2019 SEP-03-2019 C92787 P19098345
[] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 BLKK/1909/00106 P19098351
Page 30 of 47
Sep-18-2019 06:25:12 PM
SEP-03-2019 12:07:49 PM [] Y-SXAGIX2 N SEP-12-2019 SEP-05-2019 AR-KDY/2019/09/05/0026 P19098177

[] Y-SXAGIX2 N SEP-12-2019 SEP-09-2019 INV-001329 P19098201
AUG-30-2019 09:49:00 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0270SARJAS0819 P19098338
AUG-28-2019 11:44:42 AM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0270SARJAS0819 P19098338
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0270SARJAS0819 P19098338
SEP-02-2019 07:28:26 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0785-INV/RMC-MKS/IX/2019 P19098353
[] Y-SXAGIX1 N SEP-12-2019 SEP-10-2019 02/437/INV/VIII/19 P19098199
SEP-12-2019 03:46:17 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-19-2019 264/19-VIII/BMS-2019-R P19098037
[] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 1695/RSABL/PENAG/09/2019 P19098332
SEP-12-2019 03:19:01 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 SEP-03-2019 2019/08/IMA/094-R P19098030
SEP-04-2019 05:59:01 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 6600/TGH-KEU/IX/2019 P19098331
SEP-12-2019 03:13:51 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-28-2019 4265/KEU/RWJ/RSHBKS/VIII/2019- P19098027
AUG-20-2019 07:26:00 PM [] Y-SXAGIX2 AXFRIS N SEP-12-2019 AUG-10-2019 5049/RSP/VIII/2019 P19098175
[] Y-SXAGIX2 N SEP-12-2019 AUG-10-2019 5049/RSP/VIII/2019 P19098175
[] Y-SXAGIX2 N SEP-12-2019 SEP-09-2019 208/INV/BWCH/TAG/IX/2019 P19098183
Page 31 of 47
Sep-18-2019 06:25:12 PM

AUG-31-2019 11:18:36 AM [] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 K34040819 P19098171
SEP-12-2019 03:39:36 PM [2 ] Y-SXAGIX3 LFIKAX N SEP-12-2019 AUG-20-2019 482/P/16/RSKBR/VIII/2019-R P19098033
AUG-26-2019 08:51:08 PM [] Y-SXAGIX2 N SEP-12-2019 SEP-09-2019 1612704 P19098170
[] Y-SXAGIX3 N SEP-12-2019 SEP-06-2019 SHYG20190900053 P19098327
[] Y-SXAGIX2 N SEP-12-2019 SEP-06-2019 0016/IX/ADM/RSB_LDD/2019 P19098200
[] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 P1909.1560 P19098176
SEP-04-2019 12:59:52 PM [] Y-SXAGIX1 N SEP-12-2019 SEP-09-2019 IVI190900358 P19098191
AUG-28-2019 11:08:44 AM [] Y-SXAGIX2 N SEP-12-2019 AUG-31-2019 0356/RJ/VIII/2019 P19098181
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Sep-18-2019 06:25:12 PM

[] Y-SXAGIX2 N SEP-12-2019 AUG-31-2019 0356/RJ/VIII/2019 P19098181
AUG-24-2019 11:24:07 AM [] Y-SXAGIX2 N SEP-12-2019 AUG-31-2019 0356/RJ/VIII/2019 P19098181
[] Y-SXAGIX2 N SEP-12-2019 AUG-31-2019 0356/RJ/VIII/2019 P19098181
SEP-12-2019 03:24:25 PM [2 ] Y-SXAGIX3 LFIKAX N SEP-12-2019 AUG-26-2019 1038/DIR/RSUBT/VIII/2019-R P19098026
[] Y-SXAGIX2 N SEP-12-2019 SEP-06-2019 630-R.077/TAG-RSBK/IX/19 P19098196
[] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 09.A1/MGL/PMC/2019 P19098357
AUG-31-2019 01:01:53 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-05-2019 0001004932/FIN/AR-OP/IX/2019 P19098364
AUG-31-2019 12:07:12 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-05-2019 0001004932/FIN/AR-OP/IX/2019 P19098364
SEP-12-2019 03:15:33 PM [2 ] Y-SXAGIX3 VMIKEX N SEP-12-2019 AUG-31-2019 022/A/SPP/VIII/RSIM/2019-R P19098031
SEP-06-2019 11:41:30 AM [] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 P1909.1560 P19098176
AUG-27-2019 04:39:55 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-09-2019 0270SARJAS0819 P19098338
[] Y-SXAGIX1 N SEP-12-2019 SEP-09-2019 AII/20190909/00003 P19098197
[] Y-SXAGIX3 N SEP-12-2019 SEP-06-2019 B.2019.0819 P19098359
SEP-05-2019 10:19:04 PM [] Y-SXAGIX3 N SEP-12-2019 SEP-10-2019 4370/INV/RSUBM/TAG/IX/2019 P19098352 G44.1
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Sep-18-2019 06:25:12 PM
REMARKS
PENDING KLAIM : MOHON LAMPIRKAN FORM RAWAT JALAN YANG DILENGKAPI DENGAN DIAGNOSA MEDIS DAN ANAMNESA SECARA JELAS - EMAIL TGL 6/9, REMINDER VIA EMAIL TGL 9/9, FU IBU YOSI BAG. PENAGIHAN VIA TELP TGL 10/9 JAM 14.3
PENDING KLAIM : PGCUALIAN - TEST DIAGNOSTIK TIDAK SSUAI ( HBSAG ) RP. 139.500 UNCOVER, KARENA MERUPAKAN SKRINNING KEHAMILAN . KONFIRMASI DENGAN ATIKA ( ADMEDIKA ) HANYA SEBATAS PENOLAKAN KODE DIAGNOSA - PENGUR
KLAIM PENDING - MOHON MELAMPIRKAN HASIL PEMERIKSAAN/ESTERPISE PANORAMIC GIGI 18 - [ X ] SYARAT KELENGKAPAN TIDAK TERPENUHI (HASIL PEMERIKSAAN ESTERPISE PANORAMIC GIGI 18 TIDAK TERLAMPIR)MOHON DAPAT DILENGKAP
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/ KONJUCTIVITIS VELIKULASIS/ KELUHAN: MATA KANAN BERAT PEDIH SEJAK 3 HARI YANG LALU/ CENDO PROTAGENTA (UNCOVER), CENDO THOBROSON (COVER) TINDAKAN SLIP LAMP/REFR
KONFIRMASI IBU PUSPA SEMUA DIJAMIN KECUALI TEST KEHAMILAN DAN OBAT NUTRIFLAM NEO. KODE R10.
DX AKHIR: VIRAL INFECTION + ISPA. POST KONTROL KE-1..
KLAIM PENDING=== PENGURANGAN TAG RP. 21.000,- (BECOM-C) TIDAK DIJAMIN - PENGURANGAN TAGIHAN RP. 21.000,- (BECOM-C) TIDAK DIJAMINEMAIL DAN FU NIA TGL 11/9 PK 14.019, REMINDERTGL 12/9ACC PENGURANGAN TAGIHAN OLEH
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH-IBU NOVI/DX : HIPEREMI PULPA DAN GINGIVITIS KRONIS/KELUHAN : GIGI NGILU DAN GUSI BERDARAH, GIGI BERLUBANG/TINDAKAN : SCALING 4 REGIO (COVER) DAN TAMBALAN 3 GIGI (CO
KLAIM PENDING=== PENGURANGAN TAG RP. 59.400,- (APIALYS) TIDAK DIJAMIN - PENGURANGAN TAG RP. 59.400,- (APIALYS) TIDAK DIJAMINEMAIL TGL 11/9ACC PENGURANGAN TAGIHAN OLEH BAPAK DIDITBAG PENAGIHAN TGL 12/09/2019 VIA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH ==> IBU ICI ==> DARI POLI UMUM ==> DX: HERPES SIMPLEX + ISPA ==> KEL: BATUK PILEK, SUSAH TIDUR, VESIKEL DI SUDUT BIBIR BAWAH KIRI, THT: FARING HIPEREMIS (TD: 120/80)
PENDING KLAIM : BERDASARKAN KRONOLOGI KLL , MOHON LAMPIRKAN SIM JIKA PESERTA SEBAGAI PENGENDARA . - MOHON LAMPIRKAN SIM JIKA PESERTA SEBAGAI PENGENDARAEMAIL TGL 11/9HASIL DITERIMA TGL 12/09/2019 VIA EMAIL
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IMUNISASI HEXAXIM (DPT,HEPATITISB, POLIO, HIB) PENALANGAN ==> IBU LILIS
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/IBU SANTI/DX: FLAK ERITEMA/ GATAL PADA TANGAN /ETIOLOGI: ALERGI/OBAT: KLODERMA, HISTRINE TAB,ASKAVIN TAB (UNCVR), VASELIN ( UNCVR)
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH // IBU RISTA // DX: TB PARU VAKSIN PPD KELUHAN : BATUK KRONIK BERULANG SUDAH 3 MINGGU LAB : HT LENGKAP LED, THORAX // COVER
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/IBU SARI/HRB + RFA/KEL BATUK PILEK/FISIOTERAPI NEBULIZER YG KE 2/INHALASI SAJA/OBAT SUDAH DI SAHKAN KEMARIN INFONYA/MASUK BENEFIT DOKTER
ACC IBU ERMA DICOVER SEMUA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH // IBU RENI // SP.OT // DX: TENDINGITIS LUTU KANAN, ANTERIOR TIBIAL SINPLEN KELUHAN : NYERI PADA TUNGKAI BAWAH KIRI DAN LUTUT KANAN OBAT : INFELD GEL 2 BUAH // 1 DIPAKA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH == IBU ROMA ADM RI == 8000100605576108 == DX G3P2A0 HAMIL 151-16 MINGGU == USG 2 DIMESI DENGAN PRINT (GABUNGAN, HARGA PRINT TIDAK TERPISAH) == FOLAMIL GENIO ==
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH // IBU SRI // SP.THT // DX: SERUMEN PROF ADE, KELUHAN : TELINGA NYERI TND : ENDOSKOPI TELEINGAN DAN IRIGASI 2 TELINGAN ALKES : ALKOHOL SWAB // COVER
KLAIM PENDING=== PENGURANGAN TAG RP. 93.066,- (CAVIT D3) TIDAK DIJAMIN - PENGURANGAN TAGIHAN RP 93.066,- (CAVIT D3) TIDAK DIJAMINEMAIL TGL 11/09/2019, REMINDER TGL 12/09/2019ACC PENGURANGAN TAGIHAN OLEH IBU VICK
KLAIM PENDING=== PENGURANGAN TAG RP. 99.460,- (PROAXTIN) TIDAK DIJAMIN - PENGURANGAN TAG RP. 99.460,- (PROAXTIN) TIDAK DIJAMINEMAIL TGL 11/09/2019, REMINDER TGL 12/09/2019ACC PENGURANGAN TAGIHAN OLEH IBU YULI BA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH ==> IBU YULI ==> DX: CARIES GIGI KE 54 DAN 55 ==> R/ TAMBAL (COVER)
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH == IBU YULI ==> DX: CARIES GIGI 36 ==> R/ TAMBAL (COVER)
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH ==> IBU ROZI ==> OS SUNTIK KB (CYCLOFEM) == COVER == * KELUARGA BERENCANA: DIJAMIN UNTUK KARYAWATI MENIKAH/ ISTRI KARYAWAN SEBATAS PADA SUNTIK, SUSUK, IUD , PI
KLAIM PENDING=== PENGURANGAN TAG RP. 20.000,- (KLAIM MANUAL INPUT BIAYA TIMBUL EXCESS DI DOKTER UMUM, RS TIDAK MELAKUKAN PENGESAHAN SAAT PASIEN PULANG BEROBAT) - PENGURANGAN TAGIHAN RP 20.000,- (KLAIM MANUA
KLAIM PENDING=== PENGURANGAN TAG RP. 173.250,- (INTERXANTHIN) TIDAK DIJAMIN. * FOOD SUPPLEMENT DIJAMINKAN HANYA UNTUK PENYAKIT HATI ATAU DIARE - KELENGKAPAN DOKUMEN YANG BELUM DILENGKAPI YAITU LIST TERLAMPI
KLAIM PENDING=== PENGURANGAN TAG RP. 440.000,- (RS SALH POSTING BIAYA TINDAKAN ELECTRO CAUTER, SEHARUSNYA MASUK KEBENEFIT DOKTER) - KELENGKAPAN DOKUMEN YANG BELUM DILENGKAPI YAITU LIST TERLAMPIRACC PENGUR
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/DX; RFA+CERUMEN DS/KEL: BATUK, PILEK DAN NYERI TELINGA/EAR TOILET/KENACORT , RYVEL
KLIM PENDING=== PENGURANGAN TAG RP. 4.456,- (GLOVES) TIDAK DIJAMIN - PENGURANGAN TAGIHAN RP 4.456,- (GLOVES) TIDAK DIJAMIN // EMAIL TGL 11/9, ACC PENGURANGAN TAGIHAN IBU MAYA BAG. PENAGIHAN VIA EMAIL TGL 12/09/19
DX: GIGI 7 ABSES PERIODENTAL + GIGI 2 4 5 PULP[ITIS, KEL: GIGI BELAKANG BAWAH KIRI BERLUBANG DAN BENGKAK, T/ TAMBAL, PERAWATAN SALURAN AKAR, OBAT: MEFINAL CVR, DAN DEXA CVR==> IBU REFI
DIAGNOSA AKHIR: KONTROL POST RI DENGAN CHOLELITHIASIS DAN NEFROLITHIASIS. PENJAMINAN SESUAI BENEFIT. SELISIH BIAYA RP. 175.500,- (SUPLEMEN SANFULIQ) DITAGIHKAN DI RUMAH SAKIT. MOHON FORM INI DITANDATANGANI PIHA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/DR SP.A/ HYPERSEKRENSI BRONCHUS KELUHAN BATIK PILEK / MASKER NEBULIZER (CVR)
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KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/IBU MERY PENDAFTARAN EXT 2111 / RADIOLOGI USG ABDOMEN RP 600.000,- DX COLIK SUSP BATU SALURAN KEMIH KELUHAN NYERI PINGGANG SAMPAI BAGIA PERUT SEJAK TANGGAL 6, M
DIAGNOSA AKHIR: ISPA DAN COMMON COLD. MENEMPATI KELAS I RP. 605.000,- (4 HARI), PENJAMINAN SEBATAS RAWAT JALAN. SELISIH BIAYA RP. 3.723.489,- (TERDIRI DARI BIAYA KAMAR 4 HARI RP. 2.420.000,- PERAWAT 4 HARI TP. 420.000,-
MASKER NEBU SUDAH DIPAKAI DI RS DI BAWA PULANG/ PENJAMINAN KE SPESIALIS BERDASRKAN DIAGNOSA/ IBU PIPIT
DX: SUSP BRONCCHOPOENUMONIA + ISK , KEL: BAPIL, LAB: DARAH LENGKAP, MASA PENDARAHAN, MASA PEMBEKUAN, GLUKOSA SEWAKTU, URIN LENGKAP, HBSAG KUANTITATIF, R/BERSALIN SC , LAB NYA PRE OP SC SARAN REIUMBUST , OBAT:
DX AKHIR : SUSP DHF. PASIEN POST RI. SELISIH BIAYA PERAWATAN RP 2.163,- BERUPA : CETRIZINE 3 TAB (DIJAMIN UNTUK 7 HARI) TIDAK DIJAMIN ASURANSI , MOHON BAYAR DI RS .NOTE : MOHON FORM INI AGAR DI TANDA TANGANI OLEH P
KLAIM PENDING=== MOHON REVISI KWITANSI INVOICE TOTAL TIDAK SSUAI DENGAN REKAPITULASI, TOTAL SEHARUSNYA RP. 369.200,- - MOHON REVISI KWITANSI INVOICE TOTAL TIDAK SESUAI DENGAN REKAPITULASI, TOTAL SEHARUSNYA R
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/ KISTA OVARIUM/ KELUHAN: HAID TIDAK TERATUR, PERUT KRAM/ USG 2 DIMENSI, KASSA, PERIKSA DALAM, CEK LAB ANTI MULERIAN, LH, FSH, EKSTRADIOL, PROLACTIN,CA OVARIUM (DIJA
PENDING KLAIM : MOHON LAMPIRKAN FORM MEDIS RJ DENGAN ANAMNESA LENGKAP DAN DIAGNOSA TEGAK - [ X ] SYARAT KELENGKAPAN TIDAK TERPENUHI (HASIL FORM MEDIS RJ DENGAN ANAMNESA LENGKAP DAN DIAGNOSA TEGAK TIDAK TE
KLAIM PENDING=== PENGURANGAN TAG RP. 106.609,- ( SELOXY AA, GLOVES) TIDAK DIJAMIN - KELENGKAPAN DOKUMEN YANG BELUM DILENGKAPI YAITU LIST TERLAMPIRACC PENGURANGAN TAGIHAN OLEH IBU VICTOR BAG PENAGIHAN TGL 12
CHOLECYSTITIS
GASTRITIS AKUT DD CHOLERYSTITIS

CHRONIC CHOLECYSTITIS,TRANSMITIS SGOT SGPT
PENDING KLAIM : PENGURANGAN TAGIHAN NON MEDIS (HANDSCHOEN) RP 1.987,- TIDAK DIJAMIN - EMAIL TGL 6/9, REMINDER VIA EMAIL TGL 9/9, FU IBU YOSI BAG. PENAGIHAN VIA TELP TGL 10/9 JAM 14.34 PROSES, ACC PENGURANGAN TAGIH
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KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/ DX: HORDEOLUM/KELOPAK MATA KANAN BINTITAN/ PITHALMIC, LINCOCIN (COVER0, PEMERIKSAAN AUTOREFRAKSI, REFRAKSI, TONOMETRI (UNCOVER)
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH // IBU LITA // DX: DERMATITIS AKTOPIK KELUHAN BERUNTUSAN PADA KAKI // ETIOLOGI : JAMUR // OBAT : DERMOCOID CREAM ( 1 TUB ) , TIRIZ// COVER
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/ KE DOKTER BEDAH/ DX: DISLOCATION OF KNEE/ KELUHAN: NYERI LUTUT KAKI SKALA 4-5, AKIBAT JATUH DARI MOTOR(SEBAGAI PENGENDARA ADA SIM C)/TIDAK ADA TINDAKAN HEACTING
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH ==> IBU PUTRI ==> OS DARI DOKTER SPESIALIS ANAK ==> DX: ISPA => KEL: BATUK 3 HARI, PILEK, MATA KANAN MERAH ==> OBAT: PROSPAN--UNCOVER, PRAXION--COVER, RACIKAN (T
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH DX: THYPOID / KELUHAN : DEMAM 1 MINGGU NAIK TURUN, PILEK, DAN BATUK / IBU HARTANTI /LAB: DARAH LENGKAP WIDAL/
KLAIM PENDING=== PENGURANGAN TAG BIAYA OBAT BECOM C MOHON LAMPIRKAN HARGANYA, - PENGURANGAN TAG BIAYA OBAT BECOM C MOHON LAMPIRKAN HARGANYA // EMAIL TGL 11/9, ACC PENGURANGAN TAGIHAN BAPAK HARI BAG. PE
KLAIM PENDING=== PENGURANGAN TAG RP. 1.488,- (HANDSCON) TIDKA DIJAMIN - PENGURANGAN TAG RP. 1.488,- (HANDSCON) TIDKA DIJAMINEMAIL TGL 11/9, RMEINDER TGL 12/9ACC PENGURANGAN TAGIHAN OLEH IBU DEWI BAG PENAGIHA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH// IBU OCA DIAGNOSA : ANEMIA DEFISIENSI BESI, KELUHAN : TAMPAK PUCAT, )KURANG TINGGI OBAT : OREZINC 2 BTL (UNCVER ) DIJAMINKAN SEBATAS KONSULTASI SAJA
ISPA
KLAIM PENDING=== PENGURANGAN TAG RP. 151.900,- (SYMBICORT OBAT FISIO SEHARUSNYA MASUK KEBENFIT FISIOTERAPI, RS SALAH POSTING BIAYA) TIDAK DIJAMIN - PENGURANGAN TAG RP. 151.900,- (SYMBICORT OBAT FISIO SEHARUSNY
KONFIRMASI DGN MBA FRISKA MEGA INSURANCE ADMEDIKA DIBERI KODE E.20
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/DX: CONJUNTIVITIS/KEL: KEDUA MATA KERING/ETIOLOGI: ALERGI/OBAT : CENDO HYALUB (UNCVR),CENDO CONVER,CENDO ALEGYSAL/BAPAK FARIS TIDK BD REFRAKSI
KONFIRMASI PENOLAKAN/KONTROL HAMIL/ IBU NADIA BAG KASIR RJ EXT 116

DX: CHEPALGIA + RIWAYAT DISLIPIDEMIA, KEL: PUSING, SAKIT KEPALA, OBAT: PRONEURO UNCVR , LAPIBAL CVR ==> IBU RENI
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KONFIRMASI PENJAMINAN IBU RENI FARMASI/ DX: G1P0A0 HAMIL 5 MINGGU/ KELUHAN: KONTROL HAMIL/ OBAT: FOLAMIL GENIO, CALPLEX// COVER (R10)
KONFIRMASI PENOLAKAN/IBU SINTA/ R10
PENDING KLAIM : PGCUALIAN - FOOD SUPLEMEN ( ZEGAVIT ) RP.19.500 UNCOVER, DALAM BPOM SUPLEMEN . - PENGURANGAN TAGIHAN FOOD SUPLEMEN ( ZEGAVIT ) RP.19.500 UNCOVER, DALAM BPOM SUPLEMEN // EMAIL TGL 6/9, REMINDER V
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH// BAPAK VITO DIAGNOSA : ABORTUS IMINEN KELUHAN : KELUAR DARAH, USG HAMIL 2 MGG, JANIN DI PERTAHANKAN KODE DAIGNOSA PENGGANTI R10
KONFIRMASI PENOLAKAN/BAPAK VITO /G1P0A0 HAMIL 28-29/R10

KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH // BAPAK TITO // SP.OG DX: G1P0AO HAMIL 7 MINGGU DATE KONSEPTUS , KELUHAN : KELUAR DARAH BERGUMPAL
KLAIM PENDING=== PENGURANGAN TAG RP. 112.891,- (MCC STD DR MARSIA, SM KR, GLOVES) TIDAK DIJAMIN - KELENGKAPAN DOKUMEN YANG BELUM DILENGKAPI YAITU LIST TERLAMPIREMAIL TGL 11/09/2019, REMINDER TGL 12/09/2019PENO
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH// IBU MAYA DIAGNOSA : IMPAKSI GIGI 38, KELUHAN : GUSI BENGKAK DIBANGIAN BELAKANG ATAS DAN BAWAH TINDAKAN : PANORAMIC ( COVER)
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH == IBU ADEL ADM RJ == DARI DR UMUM == DX SUSP TB PARU => DIRUJUK KE DOKTER PARU => PENJAMINAN SESUSIA BENEFIT BERDASARKAN DIAGNOSA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH//BPK KIKI DIAGNOSA : LIMFA DENI COLI KELUHAN : ADA BENJOLAN LEHER SEBALAH KANAN, PEM : USG COLI DEXTRA RP. 932.000,- ( COVER )
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KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH//IBU SISI DIAGNOSA : BATUK KRONIS BERLUNGAN, TINDAKAN UAP (CVR)
PENDING KLAIM :PGCUALIAN - FOOD SUPLEMEN ( BECOM C ) RP. 18.000 UNCOVER , DALAM BPOM SUPLEMEN . - PENGURANGAN TAGIHAN FOOD SUPLEMEN ( BECOM C ) RP 18.000 UNCOVER , DALAM BPOM SUPLEMEN .EMAIL TGL 11/9, REMINDER
PENDING KLAIM : PENGURANGAN TAGIHAN FOOD SUPLEMENT (BECOM C) RP 15.730,- TIDAK DIJAMIN - EMAIL TGL 6/9, REMINDER VIA EMAIL TGL 9/9, FU IBU YOSI BAG. PENAGIHAN VIA TELP TGL 10/9 JAM 14.34 PROSES, ACC PENGURANGAN TAG
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/ DX: FARYNGITIS + LIMFADENOPATI/ KELUHAN: BENGKAK PADA BAHU SEPERTI BENJOLAN, NYERI DAN, MUAL, BATUK, PILEK/ OBAT: NIRCEF KAP, ASCAVIN(CVR), RACIKAN: MYONEP TAB, LA
PESERTA KE 2 DOKTER DLM SEHARI , OBAT: MINOSEP CVR ==> BPK TAMA
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/ PASIEN/ DX:GANGGUAN VASKULAR VERIFER EKSTREMITAS SUSP CARPAL TUNEL SYNDROM SINSITRA+ DISLIPIDEDIMIA/ KESEMUTAN DI UJUNG JARI KIRI SEJAK 3 MINGGU, MATI RASA/ HEM
KLAIM PENDING=== PENGURANGAN TAG RP. 2.000,- (HANDSCON) TIDAK DIJAMIN - PENGURANGAN TAG RP. 2.000,- (HANDSCON) TIDAK DIJAMINEMAIL TGL 11/9, REMINDER TGL 12/9ACC PENGURANGAN TAGIHAN OLEH IBU EGGY BAG PENAGIHA
KONTROL POST RANAP PASCA ASTHMA. PENJAMINAN SESUAI BENEFIT. TIDAK ADA SELISIH BIAYA PERAWATAN SAAT INI.
KONFIRMASI PENJAMINAN DX/TINDAKAN/LAB/OBAT/TH/G2P1A0 HAMIL 26 MINGGU/ KELUHAN: KEPUTIHAN DAN GATAL LEBIH DARI 7 HARI/ ELKANA (UNCOVER), FOLAMYL GENIO, SALEP MYCORINE (COVER)
K02
KONFIRMASI RJ / RISTA / KE DR UMUM/ DX. FEBRIS + CHEPALGIA/SKALA NYERI 5 DARI 6/ TH: ZITANID, ANALSIK, INJ KETOROLAC/ ACC
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PROCESSE Age 21 Age 45 Age 60

Age 14 Day Age 30 Day
D Day Day Day
Y 1909050062/0322/HS
Y
Y
Y 1908265969/0761/HS
Y 1909122698/0083/HS
Y 1909122698/0083/HS
Y 1908271273/0620/HS
Y 1909020943/0753/HS
Y 1909020943/0753/HS
Y
Y
Y
Y 1908211353/0944/HS 1909063282/0944/HS
Y 1909106886/0022/HS
Y
Y 1909105890/0021/HS
Y
Y 1908301385/0795/HS
Y
Y
Y
Y
Y 1908297063/1682/HS
Y 1909076952/1884/HS
Y 1909107107/1884/HS
Y 1909107107/1884/HS
Y 1909076952/1884/HS
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y 1909020518/0007/HS
Y 1909045853/0742/HS
Y 1909034472/0956/HS
Y 1909047605/0468/HS
Y 1909105894/0468/HS
Y
Y
Y 1909118913/0083/HS
Y 1909122698/0083/HS
Y 1909118913/0083/HS
Y 1909122698/0083/HS
Y
Y 1909122698/0083/HS
Y
Y 1909122698/0083/HS
Y 1909122698/0083/HS
Y 1909122698/0083/HS
Y 1909118913/0083/HS
Y 1909118913/0083/HS
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Y
Y
Y 1909118913/0083/HS
Y
Y
Y 1909093840/1293/HS
Y 1909093840/1293/HS
Y 1908150791/1293/HS 1908314326/1293/HS
Y 1909076965/0795/HS
Y
Y
Y
Y
Y
Y
Y 1908279488/0007/HS 1909124520/0007/HS
Y 1908279488/0007/HS 1909124520/0007/HS
Y 1909104950/0007/HS
Y 1908266008/0007/HS 1909110896/0007/HS
Y 1909092084/0007/HS
Y 1908300506/0007/HS
Y 1908283217/0007/HS
Y 1908279488/0007/HS 1909124520/0007/HS
Y 1909122281/0007/HS
Y
Y 1908283217/0007/HS
Y 1909046663/0029/HS
Y 1909077021/0029/HS
Y
Y 1909105274/1364/HS
Y
Y
Y 1909045842/0191/HS
Y
Y 1909032923/1026/HS
Y
Y
Y
Y
Y 1908268162/0179/HS
Y
Y 1909123786/0602/HS
Y 1909123786/0602/HS
Y
Y
Y 1909033922/0007/HS
Y 1908297729/0007/HS
Y 1909050642/0007/HS
Y 1908297729/0007/HS
Y 1908279488/0007/HS 1909124520/0007/HS
Y 1909033922/0007/HS
Y 1908194520/0829/HS
Y
Y 1909076622/0119/HS
Y 1909104971/0291/HS
Y
Y
Y
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Y
Y 1909118652/0119/HS
Y 1909105321/0119/HS
Y
Y 1909077614/0468/HS
Y
Y 1909050280/0021/HS
Y 1909063456/0021/HS
Y 1909034248/0119/HS
Y 1909092415/0119/HS
Y 1909092415/0119/HS
Y 1909063789/0119/HS
Y
Y 1909034248/0119/HS
Y
Y 1909122275/0119/HS
Y 1909092415/0119/HS
Y 1909089521/0119/HS
Y 1909136846/0230/HS
Y 1909135318/0291/HS
Y 1909118983/0291/HS
Y 1909135318/0291/HS
Y
Y
Y
Y
Y 1909076622/0119/HS
Y 1908238114/0007/HS 1909080446/0007/HS
Y
Y
Y
Y
Y
Y
Y
Y
Y 1909046254/0119/HS
Y
Y
Y
Y
Y
Y
Y 1908225880/1545/HS
Y
Y
Y 1909136048/1223/HS
Y 1909122419/0796/HS
Y 1908242124/0753/HS 1909093215/0753/HS
Y 1909063578/1151/HS
Y 1908230067/1151/HS 1909080183/1151/HS
Y 1908211107/1151/HS 1909065320/1151/HS
Y 1908230067/1151/HS 1909080183/1151/HS
Y 1908226618/1151/HS 1909078735/1151/HS
Y
Y
Y 1908254642/0761/HS
Y
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Y
Y
Y
Y
Y 1909107099/0795/HS
Y
Y 1909137653/0022/HS
Y 1909118266/0022/HS
Y 1909137653/0022/HS
Y 1909105894/0468/HS
Y 1909110338/0468/HS
Y 1908300809/0602/HS
Y 1909136051/0602/HS
Y
Y
Y 1909107107/1884/HS
Y 1909118925/1884/HS
Y 1909107107/1884/HS
Y 1909135352/0119/HS
Y 1908118229/2392/HS 1908279687/2392/HS
Y 1909078261/0753/HS
Y 1909089812/0487/HS
Y 1909110297/1223/HS
Y 1909078329/0956/HS
Y
Y
Y
Y 1909136048/1223/HS
Y 1909136048/1223/HS
Y 1909028411/1682/HS
Y 1909077614/0468/HS
Y 1909077614/0468/HS
Y
Y
Y 1909034279/0170/HS
Y 1909034279/0170/HS
Y
Y
Y 1908282815/0487/HS 1909135921/0487/HS
Y
Y 1908282815/0487/HS 1909135921/0487/HS
Y 1909123437/0487/HS
Y 1909135377/0753/HS
Y 1908279423/0753/HS 1909122512/0753/HS
Y 1908279423/0753/HS 1909122512/0753/HS
Y 1908297370/0753/HS
Y 1908297370/0753/HS
Y 1908297370/0753/HS
Y 1908301735/0753/HS
Y
Y
Y
Y 1908266008/0007/HS 1909110896/0007/HS
Y 1909020518/0007/HS
Y
Y 1909092084/0007/HS
Y
Y 1909092084/0007/HS
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Y 1908283217/0007/HS
Y 1909033922/0007/HS
Y
Y
Y 1908225199/0269/HS
Y 1909093062/1364/HS
Y
Y 1909121904/1364/HS
Y 1909110701/1364/HS
Y 1909064152/0487/HS
Y 1909110297/1223/HS
Y
Y 1909118563/0795/HS
Y 1909122441/0991/HS
Y
Y
Y 1909122688/0956/HS
Y 1909078329/0956/HS
Y
Y 1908166315/0753/HS 1909017287/0753/HS
Y 1908166315/0753/HS 1909017287/0753/HS
Y 1908166315/0753/HS 1909017287/0753/HS
Y 1908166315/0753/HS 1909017287/0753/HS
Y
Y 1909076277/0021/HS
Y
Y 1909135352/0119/HS
Y 1909046254/0119/HS
Y 1909135352/0119/HS
Y 1909034248/0119/HS
Y
Y 1909059999/0119/HS
Y
Y 1908237732/0468/HS 1909081370/0468/HS
Y
Y
Y 1909034208/0795/HS
Y 1908195185/0191/HS 1909046834/0191/HS
Y 1909106323/0191/HS
Y 1909063450/0795/HS
Y
Y
Y
Y 1909122281/0007/HS
Y
Y 1909122431/1116/HS
Y 1909119610/1116/HS
Y 1909110338/0468/HS
Y
Y 1909051716/0795/HS
Y
Y 1908297702/0191/HS
Y 1909033265/0191/HS
Y 1909136868/0191/HS
Y 1909106323/0191/HS
Y 1908266023/0191/HS 1909110122/0191/HS
Y 1909051716/0795/HS
Y 1909092733/0795/HS
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Y 1909122271/0795/HS
Y 1909136773/0795/HS
Y 1909093076/1116/HS
Y 1909078265/1116/HS
Y
Y
Y 1908271544/0761/HS
Y
Y 1909064170/0185/HS
Y
Y
Y
Y
Y 1909136773/0795/HS
Y 1909122688/0956/HS
Y 1908301385/0795/HS
Y 1909105890/0021/HS
Y 1909105890/0021/HS
Y 1909092415/0119/HS
Y 1909029915/0956/HS
Y
Y
Y
Y 1909105862/1223/HS
Y
Y
Y 1909093052/1223/HS
Y
Y 1909110297/1223/HS
Y
Y
Y
Y 1909033398/0741/HS
Y 1909059978/0468/HS
Y 1909059978/0468/HS
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Y 1909078284/0007/HS
Y 1909122282/1223/HS
Y
Y 1909110297/1223/HS
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Y 1908300234/0022/HS
Y
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Y 1908300234/0022/HS
Y 1909091727/0022/HS
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Y
Y 1909029851/3972/HS
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Y
Y 1909076952/1884/HS
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Y
Y
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Y 1908266667/0753/HS 1909110105/0753/HS
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Y 1909034472/0956/HS
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Count of PROVIDER

RECEIVED_DATE HOSP INVOICE NO PAYOR INVOICE NO

PAYOR TERMINAL PAYOR_CL CLAIM

ADMISSION DISCHARGE DIAGNOSI

AMT NOT AMT ASO

678,300.00 678,300.00 0 0 0.00 NO 0 20864780 GP

880,080.00 880,080.00 0 0 0.00 NO 0 20919216 GP

692,000.00 692,000.00 0 0 0.00 NO 0 1 21076590 GP MXAZIS

365,505.00 359,505.00 6000 0 6,000.00 NO 0 20050048 GP

700,000.00 82,724.00 617276 0 617,276.00 YES 0 20830015 GP

219,980.00 219,980.00 0 0 0.00 NO 0 19967746 GP

[] Y-SXAGIX1 N SEP-12-2019 AUG-31-2019 326-08/KEU-RSDS/VIII/2019 P19098195

[] Y-SXAGIX2 N SEP-12-2019 SEP-10-2019 200120190900370 P19098193

SEP-03-2019 12:07:49 PM [] Y-SXAGIX2 N SEP-12-2019 SEP-05-2019 AR-KDY/2019/09/05/0026 P19098177

[] Y-SXAGIX2 N SEP-12-2019 SEP-11-2019 K34040819 P19098171

[] Y-SXAGIX3 N SEP-12-2019 SEP-11-2019 148.432/1908007 P19098360

[] Y-SXAGIX3 N SEP-12-2019 SEP-02-2019 2175/RSUI-HA/TGH/IX/2019 P19098340

DX AKHIR: VIRAL INFECTION + ISPA. POST KONTROL KE-1..

IMUNISASI HEXAXIM (DPT,HEPATITISB, POLIO, HIB) PENALANGAN ==> IBU LILIS

ACC IBU ERMA DICOVER SEMUA

GASTRITIS AKUT DD CHOLERYSTITIS

KONFIRMASI PENOLAKAN/KONTROL HAMIL/ IBU NADIA BAG KASIR RJ EXT 116

KONFIRMASI PENOLAKAN/BAPAK VITO /G1P0A0 HAMIL 28-29/R10

PROCESSE Age 21 Age 45 Age 60

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