Nama Pasien : MOHAMAD HAERIKAL, SDR Registrasi / MR : RG01062743/072456

Alamat : JL SUKAMULYA RT 4 RW 3 Jaminan : UMUM

Layanan : IGD
Sex / Tgl Lahir : LAKI-LAKI / 11 December 1993 Tgl Rawat : 03-08-2024
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| NO| REKAP | TANGGAL | KETERANGAN | HARGA SATUAN | QTY | TOTAL |
---------------------------------------------------------------------------------------------------------------------------------
| 1|RJ IGD |03-08-2024 |PEMAKAIAN O2 PER HARI | 319,200.00| 1.00| 319,200.00|
| 2| | |SYRINGE PUMP / HARI | 175,700.00| 1.00| 175,700.00|
| 3| | |PASANG CATHETER | 102,800.00| 1.00| 102,800.00|
| | | | -PERAWAT | | | |
| 4| | |PASANG NGT | 141,500.00| 1.00| 141,500.00|
| | | | -PERAWAT | | | |
| 5| | |OBSERVASI LEBIH DARI 1 JAM | 169,300.00| 1.00| 169,300.00|
| | | | -dr. Chetrin Andiani Sianturi | | | |
| 6| | |OBSERVASI LEBIH DARI 1 JAM | 169,300.00| 1.00| 169,300.00|
| | | | -dr Brigitta Silalahi | | | |
| 7| | |LEPAS CATHETER | 64,600.00| 1.00| 64,600.00|
| | | | -PERAWAT | | | |
| 8| | |EKG 6 CHANNEL A | 166,600.00| 1.00| 166,600.00|
| | | | -dr Brigitta Silalahi | | | |
| 9| | |BAGGING | 447,400.00| 1.00| 447,400.00|
| | | | -dr Brigitta Silalahi | | | |
| 10| | |KONSULTASI SPESIALIS VIA IGD | 196,100.00| 1.00| 196,100.00|
| | | | -DR JOSHUA PATRICK M.KED(PD) SP.PD | | | |
| 11| | |JASA DOKTER IGD PUKUL 07.00 - 21.00 WIB | 83,400.00| 1.00| 83,400.00|
| | | | -DR. RIDWAN SETIAWAN | | | |
| 12| | |INJEKSI | 32,800.00| 1.00| 32,800.00|
| | | | -PERAWAT | | | |
| 13| | |PASANG INFUS | 45,700.00| 1.00| 45,700.00|
| | | | -PERAWAT | | | |
| 14| | |PEMAKAIAN O2 MINIMAL | 220,500.00| 1.00| 220,500.00|
| 15| | |EKG 6 CHANNEL A | 166,600.00| 1.00| 166,600.00|
| | | | -DR. RIDWAN SETIAWAN | | | |
| 16| | |NEBULIZER | 76,600.00| 1.00| 76,600.00|
| | | | -PERAWAT | | | |
| 17| | |OBSERVASI LEBIH DARI 1 JAM | 169,300.00| 1.00| 169,300.00|
| | | | -DR. RIDWAN SETIAWAN | | | |
| 18| | |KONSULTASI DOKTER SPESIALIS BY PHONE (VIA IGD) | 77,000.00| 1.00| 77,000.00|
| | | | -DR JOSHUA PATRICK M.KED(PD) SP.PD | | | |
| 19| | |BHP MINIMAL IGD | 21,400.00| 1.00| 21,400.00|
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
SUB TOTAL : RJ IGD 2,845,800.00
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
| 20|FARMASI RAJAL |03-08-2024 |[OBT] NACL 0,9% INFUS 500 ML OBJ SINGLE PORT 1 KOLF | 11,160.00| 1.00| 11,160.00|
| 21| | |[OBT] MEYLON 8,4% 25 ML (BICNAT) INJEKSI (OBJ) 4 KOLF | 8,584.00| 4.00| 34,336.00|
| 22| | |[OBT] ESOMEPRAZOLE 40 MG INJEKSI 1 VIAL | 14,150.00| 1.00| 14,150.00|
| 23| | |[OBT] KETOROLAC 30 MG INJ (OBJ) 1 AMPUL | 8,196.00| 1.00| 8,196.00|
| 24| | |[OBT] DEXAMETHASONE 5 MG/ML INJ 1 AMPUL | 3,750.00| 1.00| 3,750.00|
| 25| | |[OBT] NASAL O2 DEWASA TRANSPARAN 1 PIECE | 15,596.00| 1.00| 15,596.00|
| 26| | |[ALK] IV CATH NO 22 INFLO PLUS PORT INJECTION 1 PIECE | 5,695.00| 1.00| 5,695.00|
| 27| | |[OBT] IV FILM DRESSING 6X8 LEUKOMED 72390/TEGADERM 1 PIE| 10,062.00| 1.00| 10,062.00|
| 28| | |[OBT] SPUIT 10 CC 1 PIECE | 3,276.00| 1.00| 3,276.00|
| 29| | |[OBT] SPUIT 3 CC 1 PIECE | 2,232.00| 1.00| 2,232.00|
| 30| | |[OBT] SPUIT 1 CC ONEMED 1 PIECE | 1,850.00| 1.00| 1,850.00|
| 31| | |[OBT] INFUS SET MAKRO Y TUBE STERA 1 PIECE | 8,000.00| 1.00| 8,000.00|
| 32| | |[OBT] NACL 0,9% INFUS 500 ML OBJ SINGLE PORT 1 KOLF | 11,160.00| 1.00| 11,160.00|
| 33| | |[OBT] ESOMEPRAZOLE 40 MG INJEKSI 1 VIAL | 14,150.00| 1.00| 14,150.00|
| 34| | |[OBT] ONDANSETRON 8 MG INJ 1 VIAL | 10,900.00| 1.00| 10,900.00|
| 35| | |[OBT] SUKRALFAT 500 MG/5 ML SUSPENSI 100 ML (OBJ) 1 BOTO| 12,708.00| 1.00| 12,708.00|
| 36| | |[OBT] SALBUTAMOL 2 MG TABLET 2 TABLET | 510.00| 2.00| 1,020.00|
| 37| | |[OBT] VELUTINE PLUS NEBULES 2,5 ML 1 VIAL | 13,991.00| 1.00| 13,991.00|
| 38| | |[OBT] ACTACORT 1 MG/2ML NEBULES (BUDESONIDE) OBJ 1 AMPUL| 19,350.00| 1.00| 19,350.00|
| 39| | |[OBT] MASKER NEBULIZER DEWASA 1 PIECE | 36,575.00| 1.00| 36,575.00|
| 40| | |[OBT] VELUTINE PLUS NEBULES 2,5 ML 1 VIAL | 13,991.00| 1.00| 13,991.00|
| 41| | |[OBT] BUDESMA 0.5 MG/ML NEBULES (OBJ) 1 AMPUL | 24,742.00| 1.00| 24,742.00|
| 42| |04-08-2024 |[OBT] CEFTRIAXONE 1 GR DRY INJ 2 VIAL | 19,009.00| 2.00| 38,018.00|
| 43| | |[OBT] NACL 0,9% 100 ML (ECOSOL) OBJ 1 BOTOL | 8,566.00| 1.00| 8,566.00|
| 44| | |[OBT] CALCII GLUCONAS 100 MG/ML INJ 1 AMPUL | 24,069.00| 1.00| 24,069.00|
| 45| | |[OBT] BICARBONAS NATRIUM 500 MG TABLET (BICNAT) 2 TABLET| 406.00| 2.00| 812.00|
| 46| | |[OBT] SPUIT 50 CC CATHETER TIP 1 PIECE | 10,934.00| 1.00| 10,934.00|
| 47| | |[OBT] FOLEY CATHETER NO 16 1 PIECE | 36,230.90| 1.00| 36,230.90|
| 48| | |[OBT] NGT (STOMACH TUBE) NO. 16 1 PIECE | 56,450.00| 1.00| 56,450.00|
| 49| | |[OBT] URINE BAG T VALVE + HANGER (UROBAG) 1 PIECE | 16,928.00| 1.00| 16,928.00|
| 50| | |[OBT] SPUIT 20 CC LL 1 PIECE | 3,076.60| 1.00| 3,076.60|
| 51| | |[OBT] WFI WATER FOR INJECTION 25 ML (OBJ) 2 AMPUL | 4,150.00| 2.00| 8,300.00|
| 52| | |[OBT] NOREPINEPHRINE BITARTRATE 4 MG/4 ML INJEKSI OBJ 1 | 43,790.00| 1.00| 43,790.00|
| 53| | |[OBT] SPUIT 50 CC CATHETER TIP 1 PIECE | 10,934.00| 1.00| 10,934.00|
| 54| | |[OBT] THREE WAY STOPCOCK 1 PIECE | 7,196.00| 1.00| 7,196.00|
| 55| | |[OBT] NEEDLE No.18 TERUMO 1 PIECE | 2,418.00| 1.00| 2,418.00|
| 56| | |[OBT] EXTENTION TUBE 150 CM 1 PIECE | 62,604.00| 1.00| 62,604.00|
| 57| | |[OBT] NOREPINEPHRINE BITARTRATE 4 MG/4 ML INJEKSI OBJ 2 | 43,540.00| 2.00| 87,080.00|
| 58| | |[OBT] NOREPINEPHRINE BITARTRATE 4 MG/4 ML INJEKSI OBJ 2 | 43,540.00| 2.00| 87,080.00|
| 59| | |[OBT] NACL 0,9% 100 ML (ECOSOL) OBJ 1 BOTOL | 8,566.00| 1.00| 8,566.00|
| 60| | |[OBT] NACL 0,9% INFUS 500 ML OBJ SINGLE PORT 1 KOLF | 11,160.00| 1.00| 11,160.00|
| 61| | |[OBT] SPUIT 3 CC 1 PIECE | 2,232.00| 1.00| 2,232.00|
| 62| | |[OBT] NOREPINEPHRINE BITARTRATE 4 MG/4 ML INJEKSI OBJ 2 | 43,540.00| 2.00| 87,080.00|
| 63| | |[OBT] VALISANBE 10 MG/2 ML INJ (Diazepam) 1 AMPUL | 27,150.00| 1.00| 27,150.00|
| 64| | |[OBT] SPUIT 3 CC 1 PIECE | 2,232.00| 1.00| 2,232.00|
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
SUB TOTAL : FARMASI RAJAL 919,796.50
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
| 65|RJ LABORATORIUM |03-08-2024 |E.2 ANALISA GAS DARAH | 745,000.00| 1.00| 745,000.00|
| 66| | |E.1 NA K CL | 446,300.00| 1.00| 446,300.00|
| 67| | |D.3 SGOT | 62,800.00| 1.00| 62,800.00|
| 68| | |D.4 SGPT | 62,800.00| 1.00| 62,800.00|
| 69| | |HEMATOLOGI RUTIN | 134,100.00| 1.00| 134,100.00|
| 70| | |GULA DARAH SEWAKTU | 43,100.00| 1.00| 43,100.00|
| 71| | |A.1 UREUM | 62,800.00| 1.00| 62,800.00|
| 72| | |A.2 KREATININ | 80,600.00| 1.00| 80,600.00|
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
SUB TOTAL : RJ LABORATORIUM 1,637,500.00
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
| 73|RJ RADIOLOGI |03-08-2024 |THORAX AP/PA | 214,000.00| 1.00| 214,000.00|
| | | | -DR. ANDY J NASUTION,SP,RAD | | | |
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
SUB TOTAL : RJ RADIOLOGI 214,000.00
+---+------------------+-----------+--------------------------------------------------------+--------------+-----+--------------+
KETERANGAN PEMBAYARAN : Subtotal 5,617,096.50
ADM PASIEN LAMA (IGD) 25,000.00
Pembulatan 3.50
 Grand total 5,642,100.00
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KAS TUNAI 5,642,100.00

catatan: BOGOR, 05-08-2024

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