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7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS NAMA OBAT JUMLAH
1/1/2014 Ny Dian tramado in! "
d#$a in! 2
In%&'#t dara( 1
'&r%o 1) 1
%* 1+ 1&rin# ,a- 1
'.&it "** )
m&*&' #$ 1
Ny O&y Tramado in! "
In%&'#t dara( 1
'&r%o 1) 2
%* 1+ 1
&rin# ,a- 1
'.&it "** )
m&*&' #$ 1
'#an- o2 d' 1ByOi Und#r.#d Bayi "0
ByDian Und#r.#d Bayi "0
tna'no *#%tria$on# 1
a3&a 1
'.&it 10 "
'&r%o 20 1
Pro'o-an 2
Ny Ani. D#$a in! 2
D 1
A3&a 2
5#%ota$im# in! "
Tramado in! "
N##d# 2" 1
In%&'#t dara( 1
I 1) 1
6* 1+ 1
Urin#,a- 1
S.&it 10** 1
Ny Anin-r&m M&*&' 1
S.&it "** )
I 1) 1In%&'#t dara( 1
'.&it ** "
'.&it "** )
'.&it 10** 1
Urin#,a- 1
M&*&' 1
noa-in in! "
%*1+ 1
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N##d# 2" 1
Ny M&dria( 7om#tra8 2
An Naia a#n "A 1
Tn 9o'ma 5o.ram# 2
.ro'o-an 1
S.&it "** 2
1/2/2014 Ny :&y a #n "B 2
M#t(y.r#d In! "
S.&it ** 2
Ny Anin-r&m A'am M#%#namat 1
Ny Ani. Amo$ Ta, 1
A'am M#%#namat 20
Ny :atna :#ian In! 1
Tn S&di,yo A'am M#%#namat 10
A'am Tran#$amat 00 10
5i.ro Ta, 10
:anitidin Ta, 10
Urin# ,a- 1Nn Amaia :anitidin In! 2
D; "
D40; 1
S.&it " ** "
S.&it ** "
S.&it 10 ** "
B&'*otia "
M&*o-ard 1
Ny :&y :anitidin# ta, 10
Ny :ati( In%&'#t ,ia'a 1
i *at 1) 1:#ian in! 2
n##d# 2" 2
Tn T&miran :#ian in! 2
Ny Di in%&'#t ,ia'a 1
:L 4
N##d# 2" 1
Ny M&dria( 5#%tri 4
r 1
D 1
D#$anta 'yr 1
'.&it 10** 2
Nn Am#ia :anitidin in! 2
Tn 9o#'mo Na* 0< L 2
5#%tri 1
:anitidin in! 2
A'am Tran#$amat in! "
B&'*otia "
no7a-in in! 2
S.&it 10** 1
7/21/2019 LAP (Autosaved)
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1/"/2014 Nn Amaia :anitidin Ta, 10
S.&it 10** 1
Ny N&r& 5#%ota$im# In! "
A3&a In! "
In%&'#t Dara( 1
S&r%o 1) 1
Urin#,a- 1
n##d# 2" 1
M&*&' E$ 1
ny :atna Amo$ ta, 1
a'am m#%#namat 1
Ny :iana Amo$ ta, 1
a'am m#%#namat 1
Ny:ati( M#t(y .r#dni'oon in! 2
7#ntoin
M&*o-ard 'yr 1
Ny M&dria( :L OGB 1
D 15#%tria$on# 2
S.&it 10 ** 1
S.&iit ** 2
Tn9o'mo 5#%tria$on# 1
:anitidin 2
a'am m#%#namat "
Na* 2
S.&it 10 ** 2
S.&it ** 1
S.&it " ** 1
1/4/2014 Ny:ati( :L OGB 1S.&it 10** 1
P(amino 1
NyN&r& Amo$ ta, 1
a'am m#%#namat 1
Ny:ini Di :anitidin 2
In%&'#t ,ia'a 1
:L "
S.&it "** 1
Tn9o#'mo In%&' dara( 1
Ny Di :L 1
5#%tria$on# iN! "
D; 1
S.&it "** "
S.&it ** "
Ny :ati( M#ti.r#d In! "
G#ntami*in In! "
D; 1
P(amino In! 1
S.&it "** +
7/21/2019 LAP (Autosaved)
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7#ntoin N#, 4
Ny :ini 6&ro'#mid# In! "
5#%tria$on# iN! 2
S.ironoa*ton# 1
6* 1+ 1
Urin#,a- 1
S.&it "** "
S.&it 10** 2
N##d# 2 1
In%&' Bia'a 1
S.&it 10 ** "
S.&it ** "
S.&it " ** "
Noa-in INJ 2
TnBam,an- D#$a In! 2
Tn9o#'mo P8 2
5#%tria 1
:anitidin IJN 2 A'amtran#$ 1
Noa-in INJ 2
S.&it 10 ** 1
S.&it ** 2
S.&it " ** 2
NyM&dria( :L OGB 1
D 1
5#%tria 2
7om#tra8 2
S.&it 10 ** 2
S.&it ** 1S.&it " ** 1
Ny:ini 6&troid 1
6&ro'#mid in! "
5#%tria$n# 2
:anitidin INJ 2
Noa-in 2
S.&it 10 1
S.&it 2
S.&it " 2
A3&a 2
Ny:ati( 5#%ota$im# "
:L 2
D 1
G#ntami'in in! 2
P(amino "
S.&it ** "
TnBam,an- 5#%tria$on in! 1
A3&a 1
Tramado *a. 10
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S.&it 10** 1
Ny :ati( M#ti In! "
5#%ota$im# In! "
G#nta In! 2
:L 1
D; 1
7#ntoin N#, "
S.&it "**
S.&it ** "
TnBam,an- 5#%tria$on# 2
Noa-in in! "
A3&a 1
S.&it " ** 2
Ny:#ni 5#%tria$on# 1
6&troit in% 1
Noa-in in! "
S.&it 10 ** 2
NyM&dria( 5#%tria$on# 1:L o-, 1
D OGB 1
A3&a in! 1
Tn9o#'ma 5#%tria$on# 2
:anitidin INJ 2
A'am Tran#$ 2
Noa-in 2
1/+/2014 TnM&a' :L "
5#%ota$im# "
A3&a 2
In%&' dara( 1S.&it 10** "
S.&it ** "
S.&it "** 2
AnHiman 7om#tra8 in! 1
Noa-in in! 1
S.&it ** 2
S.&it "** 2
In%&'#t ,ia'a 1
Ny Di Indriyanti D; 2
5#%tri In! 4
A3&a In! 1
S.&it ** 4
Ny Aram,ana In%&'#t ,ia'a 1
S&r%o 1) 1
9#toroa* In! "
S.&it " ** 2
D; 1
Amo$ ta, 10
a'am M#%#namat 00 10
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Ny :&y D#$a In! 4
S.&it " ** 4
In%&'#t Dara( 1
S.&it 10 ** 1
i *at 1) 1
Amo$ ta, 10
a'am M#%#namat 00 10
tn M&a' 9#toroa* In! "
*#%ota$im# in! 2
'.&it "** 2
Tn 9o#'mo D#$anta 'yr 1
:anitidin TA, +
An Himan a#n "A "
Ny :ini Ga'tro%#r 2
6&troit in% 2
tn M&a' 6&troit in% 2
S.&it 10** 2
S.&it ** 21/=/2014 Ny M&dria( Om#.ra8o# 10
M&*o-ard 'yr 1
Tn M&a' Sima'tatin 10 m- 2
BON NEO M&*&' E$ 10
An Mario :L OGB
In%&'#t Dara( 1
Intro*an 22 1
5#%tria$on# In! 1
A3&a In! 1
S.&it 10** 1
NyLaiat& I7 1) 1In%&' dara( 1
:L "
D#$a in! 2
:#ian in! 1
Pro%#nid '&.
6* 1+ 1
Urin# ,a- 1
S.&it 10** 1
5#%ota$im# "
9#toroa* In! "
D 1
A3&a 2
Ny:ati( 5#%ota$im# In! 1
M#ti .r#dni'oon in! 1
P(amino in! 2
:L 2
D 1
7#ntoin n#, 2
S.&it ** 1
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S.&it "** 2
N>Un&n'ari B&'*otia
Ga'tro%#r "
D "
:L "
S.&it "** 2
S.&it 10** "
S.&it ** 2
M&*o-ard 'yr 1
TnM&a' 5i.ro in% 2
9#toroa* In! 2
:anitidin in! 2
:L 2
D 1
S.&it ** "
AnMario 5#%tria$on in! 2
Gantami'in in! 2
Noa-in in! 2D 1/2 NS 2
S.&it "** 4
S.&it ** "
1/)/2014 Tn M&*(a' A'am M#%#namat 00 10
Tn Saido In%&'#t Dara( 1
:L OGB 1
I7 5at 20 1
Ny Laiat& 5i.ro Ta, 10
a'am M#%#namat 00 20
Ny Sri A't&ti In%&'#t Dara( 1
S&r%o 1) 1:L OGB 4
D#$a In! 2
S.&it 10 ** 1
S.&it ** "
S.&it " ** )
6* 1+ 1
S#an- O2 D' 2
Urin# ,a- 1
A3&a In! 2
*#%ota$im# in! "
D; 1
Noa-in in! "
Tn M&a' *i.ro in% 1
?/1/2014 BON O9 5at-&t 5(romi* No 2 1
:#'o*at Pain No 2 1
Tn A,& Hamid I 20 1
S.&it "**
In%&'#t Dara( 1
r "
7/21/2019 LAP (Autosaved)
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6&t(roit "
5#%tri 2
:anitidin in! 2
S.&it ** "
S.&it 10** 2
N##d# 2 1
Noa-in in! 2
Ny Un&'ari :anitidin ta, 10
Tn aBU Hamid noa-in in! 2
'.&it 10** 2
S.&it ** 2
'.&it "** 1
Tn Ari%in In%&'#t Dara( 1
I7 20 1
6&troit in% 4
5#%tria$on# In! 2
:anitidin# in! 1
S.&it "** "S.&it ** "
S.&it 10** 4
A3&a In! 1
1/10/2014 AnSo%i# / In%&' Bia'a 1
S&r%o 22 1
S.&it " ** "
D 1/2 NS "
Ny>&ni In%&' dara( 1
S&r%o 1) 1
:L OGB 2
S#an- O2 d' 1D 1
Urin# ,a- 1
6* 1+ 1
S.&it 10 1
S.&it ** "
S.&it " ** )
N#d# 2" 1
a3&a 1
NyLii D 2
D40 1
S.&it 10 "
:L OGB "
Noa-in INJ "
S.&it ** "
S.&it " ** "
M&*o-ard 'yr 1
NyLaiat& Na* 2
TnAri%in / Noa-in in! 2
S.&it 10** 1
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S.&it ** 1
Ny D#i :atna In%&'#t Dara( 1
S&r%o 1) 1
6* 1+ 1
Urin# ,a- 1
S.&it 10 ** 1
:L OGB 4
S.&it ** "
S.&it " ** )
A3&a In! 2
D; 1
Noa-in in! "
Tn Ari%in 5#%tri In! "
Noa-in in! "
Tn A,& Hamid 5#%tri In! 2
Noa-in in! 2
S.&it " ** 2
:L OGB 1Ny Lii :L OGB 1
D; 1
Noa-in in! "
S.&it " ** "
1/11/2014 Ny Laiat& S.&it "** "
5a*ii G&*ona' In! 2
6&ro'#mid in! 1
P@ 0< 2
:L 1
S.&it 10** 1
Tn Ari%in G#nta In! 11/12/2014 An S(ania In%&'#t ,ia'a 1
I 24 1
N##d# 2 1
Noa-in in! "
1/1"/2014 Tn Bam,an- 6&troit in% "
S.&it "** 2
Ny D#i 5#%ota$im# "
S.&it "** "
S.&it ** 1
Noa-in 2
:L 2
Urin# ,a- 1
6* 1+ 1
A3&a In! "
N##d# 2" 1
Ny Laiat& S.&it ** "
S.&it "** "
An:ama *#%ota$im# in! 2
S.&it " )
7/21/2019 LAP (Autosaved)
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A3&a in! 2
In%&' Bia'a 1
I 22 1
S.&it ** 4
S.&it 10 1
N##d# 2 1
an'o%i '.&it " ** 2
Tn9aryono S.&it 10 ** 2
S.&it " ** "
In%&' Dar( 1
*#%ota$im# in! "
Noa-in +
A3&a In! 1
: o-, "
1/14/2014 Ny9a'mina( ida(#'' 1
In%&'#t ,ia'a 1
:L "
I7 no20 1I7 no22 1
S#an- O2 d' 1
S.&it 10** "
S.&it ** "
S.&it "** "
6* 1+ 1
Urin# ,a- 1
A3&a 1
D#$a in! 1
Tn M&(ammad nyaimin S#an- O2 d' 1
In%&'#t ,ia'a 1I7 5at( 20 1
6* 1+ 1
Urin# ,a- 1
A3&a In! 1
:L OGB 2
D; 2
S.&it 10 ** 2
S.&it ** 2
S.&it " ** 2
N##d# 2 1
5a.to.ri 2 m- ta,
6ar'i$ In! "
Tn Bam,an- N##d# 2 1
Ga'tro%#r 2
N> Laiat& S.&it 10** "
S.&it "** 2
:L 2
Tn M N!amin :L 2
6&ro'#mid in! "
7/21/2019 LAP (Autosaved)
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Tn< Bam,an- 6&troit in% 1
Ga'tro%#r 2
S.&it "** "
S.&it ** 1
S.&it 10** 1
A3&a In! 1
Tn 9aryono *#%ota$im# in! "
Noa-in in! "
:L "
S.&it 10** "
S.&it ** 2
A3&a In! 2
Tn Ma(m&d 9#toroa* In! "
:L 2
D; 2
S.&it "** "
1/1/2014 TnS&.ardi Noa-in in!
S#an- O2 d' 16&troit in% 1
In%&'#t ,ia'a 1
S&r%o 20 1
S.&it ** 2
S.&it "** 2
ISDN )
AnA%ian / BPJS 9 In%&'#t ,ia'a 1
Intro*an 22 2
:L "
S.&it "** "
N##d# 2 1Tn S&.ardi / BPJS A Ga'tro%#r 1
A3&a In! 1
N##d# 2 1
S.ironoa*ton#
Tn M Jaimin 6&ro'#mid in! "
P(amino in! +
S.&it 10** 1
Tn 9aryono I 20 2
Tn S&.ardi N##d# 2 1
Tn 9aryono Noa-in In! "
:L "
S.&it 10** "
S.&it ** 2
I 20 1
Tn Bam,an- Ga'tro%#r 2
6&troit in% 1
S.&it 10** 4
S.&it "** "
A3&a in! 1
7/21/2019 LAP (Autosaved)
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1/1/2014 TnS&.ardi A3&a 1
S.&it 10 2
S.&it " 1
TnBam,an- Intro*an 22 2
Tn:amina( Dia#r'a 1
TnN!aiman 5om,i#nt "
6&ro'#mid in! "
5a.to.ri 2 m- ta,
TnS&.ardi / BPJS A S#an- O2 d' 1
Tn Bam,an- 6&troit in% 1
A3&a In! 1
Tn S&tanto I7 5at( 20 1
In%&'#t ,ia'a 1
N##d# 2 1
A3&a In! 2
:L OGB 4
Ny Ani. Anita 5i.ro Ta, 10
:L OGB 2In%&'#t ,ia'a 1
I7 5at( 20 1
D#$a in! 2
D; 2
Tn S&.ardi 6&troit in% 2
A3&a In! 1
Tn 9aryono Noa-in in! "
A3&a In! 2
:L OGB "
1/1=/2014 An A%ian S.&it " ** 2
Tn 9aryono Amodi.in m- ta, =Tn M N!aimin 6&ro'#mid in! 2
S.&it "** 2
Tn S&.ardi A3&a In! 1
6&troit in% 1
Tn Ba'&i N##d# 2 1
In%&'#t Dara( 1
6&troit in% 1
*#%ota$im# in! 2
Noa-in in! "
Ot'&*at 20 1
S.&it 10** 2
S.&it "** 2
A3&a In! 1
dia8o in% "
:L "
1/1)/2014 An A%ian 5#%adro$i 5a.' 4
Tn Ba'&i Noa-in In! "
:L 1
S.&it 10** 2
7/21/2019 LAP (Autosaved)
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Ny Siti Li'timroa( D; 1
In%&'#t ,ia'a 1
S#an- O2 d' 1
:L "
I 20 1
Pro%#nid '&. 2
:#ian in! 1
S.&it "** +
6* 1+ 1
Urin# ,a- 1
S.&it 10** 1
S.&it ** "
n##d# 2" 1
*#%ota$im# in! "
Tramado in! "
9#toroa* In! "
A3&a In! 2
NyLi'timroa( A'am#%#namat 1NyIi' :L OGB "
In%&' Dara( 1
9#toroa* In! 1
Noa-in "
S&r%o 20 1
S.&it 10 "
S.&it ** "
S.&it " ** "
N##d# 2 1
NyB#ynda S.&it " ** 1
N#d# 2" 1Tn S&.ardi S.&it 10** 2
Tn M M!amin 6&ro'#mid in! "
Ny Ii' Noa-in In! 1
S.&it "** 2
Tn S&.yan :L 2
P@ 0< 1
In%&'#t Dara( 1
I 20 1
S.&it 10** 2
S.&it ** 2
S.&it "** 2
N##d# 2 1
7om#tra8 in! 2
5a.to.ri 2 m- ta,
1/1?/2014 TnSo%yan :L 1
P@ 0< 1
S.&it 10** 1
A3&a 1
TnMN!aimin I 20 1
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NyIi' G#nta In! 2
Noa-in in! "
6&troit in% 1
S.&it 10** 2
S.&it ** 2
S.&it "** "
A3&a 1
AnNa#ndra D 1/4NS 1
In%&'#t ,ia'a 1
I7 24 1
S.&it "** 1
S.&it ** 1
Tn So.yan S.&it 10 ** 1
N##d# 2 1
A3&a In! 1
6&ro'#mid in! 2
Amodi.in m- ta, 10
Tn S&.yan D; 17om#tra8 in! 2
7i*iin In! 2
S.&it 10** 2
S.&it ** 1
S.&it "** "
6&ro'#mid in! "
Tn M N!amin 6&ro'#mid in! "
Tn S&.ardi 6&troit in% 1
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Ny Ii' G#nta In! 26&troit in% 2
1/20/2014 TnS&.ranata 9#toroa* In! "
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:L 1
I7 20 1
D#$a in! 1
A3&a 1
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TnS&.ranata I7 20 1
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7/21/2019 LAP (Autosaved)
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Sdr<6a&8a :L 4
In%&' dara( 1
I7 20 1
9#toroa* In! 2
S.&it 10** "
S.&it ** 2
S.&it "** 2
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TnEo T#-&( A'am Tran#$ 2
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S.&it 10** 10
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TnJamin 5i.ro iN6 2
6&ro'#mid in! "
Na* 1
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TnS&adi D 2
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Pro'o-an 1
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7/21/2019 LAP (Autosaved)
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S.&it " ** 2
A3&a 1
TnSo.yan D 2
Na* 2
6&ro'#mid in! "
7om#tra8 in! 2
7i*iin In! 2
Noa-in 2
S.&it 10 ** "
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1/22/2014 An Ha%id8 :L OGB "
I7 5at( 22 1
In%&'#t Dara( 1
Tn S&.ardi S.&it " ** 2
An Ha%id8 S.&it " ** 1
Noa-in in! 1
Tn S&.ardi I7 5at( 20 1TnDono In%&' Dara( 1
SdrBa*tiar In%&' Bia'a 1
NyDi Inda( D 2
Na* 2
7#ntoin n#, "
In%&' Bi'a 1
" ay 1
An Ha%id8 Noa-in in! 1
D 1/2 NS 2
S.&it "** 2
Nyii In%&' dara( 1I7 1) 1
6* 1+ 1
Urin# ,a- 1
S.&it 10** 2
A3&a 1
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TnSo.yan 7i**in in! 1
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TnN!aimin 6&ro'#mid in! 2
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SdrBa*tiar S.&it 10** 1
S.&it "** 2
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NnDi 7#ntoin n#, 2
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S.&it 10** 2
TnDono Noa-in in! 2
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D 1
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2"/01/2014 Tn S&.ardi S.ironoa*ton#
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7/21/2019 LAP (Autosaved)
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HA:GA OBAT NON BPJS PATEN
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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7/21/2019 LAP (Autosaved)
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+<+00
)<)00
?<000
2<+00
2<000
1<+00
=<+00
22<200
1<+00
+<000
2<+00
2<000
1<000
"0<000
4<=00
+<?00
4<400
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1<00
"<?00
"<000
2<400
2<100
)<400
22<200
+<100
+<?00
+<000
20<400
2<100
2<400
2<000
1<"00
<=00
+<+00
1<+002+<=00
4+<)00
22<200
10<000
2<400
2<000
2<+00
4+<)00
1<000
1)<000
+<10022<200
4<=00
+<?00
2<400
1<000
+<000
+<000
22<200
2<400
11<400
+<100
+<?00
1<"00
2<100
"00
<100
1?<)00
4+<)00
2<+00
7/21/2019 LAP (Autosaved)
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2<000
2<400
1?<)00
1<"00
1<+00
11<400
)<000
2<400
1<000
1"<200
1<+00
?+<000
12<000
+<?00
"<?00
2<000
2<400
2<1004<=00
24<000
2<100
10<)00
4+<)00
)?<)00
1?<)00
1<000
4)<000
12<000
)<4002<400
+<000
"<200
4<000
11<400
<400
24<000
1<"00
4<000
1<+00
+<100
+<?00
1)<000
1<00
4<400
1<"00
"<000
<+00
7/21/2019 LAP (Autosaved)
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"00
1+<200
22<200
2<100
+<000
+<+00
4+<)00
4)<000
10<)00
+<100
+<?00
4<=00
12<000
+<+00
2<400
"<000
"<?00
"002<100
1<00
4<400
24<000
+<100
1"<)00
10<)00
2<100
2<+00
"00
1<00"<"00
+<?00
+<?00
+<100
24<000
2<000
+<000
""<+00
"<200
2<000
+<000
1<00
4<400
+<100
)<000
11<000
1<000
12<000
12<000
7/21/2019 LAP (Autosaved)
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11<200
+<+00
2<100
4)<000
4<=00
24<000
+<?00"<?00
"<000
2<400
+<?00
+<100
4<400
1<00
1<"00
"<000
4<)00
22<200
+<000
12<000
"00
1+<)00
+<"00
1+<)00
2)<)00
1<"00
?<?00
22<200
1<00
4<400
<000
2<+00
4<000
1<00
24<000
+<000
+<?00
+<100
1)<000
11<200
14<)00
"<?00
"<000
4<000
"00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 46/539
11<200
2<000
1<+00
2<00
<00
<+00
=<+00=<400
+<000
+<000
2<400
<=00
2<200
)00
4<000
140<400
+<100"<000
+<?00
11<200
2<100
2<400
"00
+<?00
4<=00
+<100
?"<+00
"<000
"<?00
2<400
+<+00
11<200
4<200
00
1<00
4<400
<000
"<200
11<200
"<?00
2<000
1<+00
4<200
+<100
+<?00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 47/539
1<00
4<400
+<"00
1<"00
4<000
1+<)00
24<000+<000
2<000
0<000
+<100
+<?00
11<200
2<100
"00
2<+00
1?<2001<"00
)00
1?<)00
"<000
"<200
)<)00
<=00
+<000
1<"00
1<00
22<000
12<000
4<=00
"<?00
2<000
1<+00
+<?00
1<00
4<400
2<100
<+00
2<+00
2<400
1<+00
11<000
1<"00
2<000
1<+00
7/21/2019 LAP (Autosaved)
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<+00
1<+00
2<000
1<"00
1<+00
1)<200
+<?004<=00
+<?00
+<100
+<?00
)00
1?<)00
)00
4<000
4<000
+<0004<000
4<000
1<+00
<+00
+<?00
4<=00
"<?00
200
1<000
+<?00
1<"00
2<400
2<400
2<100
1<"00
?<100
11<200
2<100
1<+00
2<000
2<+00
+<000
1<+00
2<000
+<1"4<)00 11<"4=<200 =<)2=<000
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS NAMA OBAT JUMLAH
1/22/2014 Ny S&armi / BPJS 9 5a.to.ri 2 "0
24/01/2014 Tn S&,an& / BPJS A 5a.to.ri 2 10
Tn 9aryono / BPJS A amodi.in m- =
1/2)/2014 An Aan/ /ar#, :#ian 1
TnDamin /Um&m 6* 1) 1TnLamiran Amodi.in# 10
TOTAL
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 50/539
HA:GA OBAT NON BPJS PATEN
+000
2000
"00
00
10000
17000 5500 15500
HA:GA OBAT BPJS GENE:I9 AL9ES BPJS
HA:GA AL9ES U/BPJS
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS GOLONGAN
2/1/2014 Tn Nati-or BPJS A
Ny S&ina( BPJS UMUM
Tn Si'yono
Tn Nati-or BPJS A
An N#ira BPJS 9
An N#ira BPJS 9
Tn Maran BPJS AS9ES
NyNaan- BPJS 9
N>S&ina( BPJS UMUM
TnNati-or BPJS A
Tn6#ry BPJS :SB
2/2/2014 An 6i8a BPJS BPJS
Tn Lamiran BPJS A
An Dima' BPJS JAM9ESMAS
7/21/2019 LAP (Autosaved)
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TnNati-or BPJS A
TnDa&man BPJS BPJS
TnDa&man BPJS BPJS
An Dima' BPJS JAM9ESMAS
An Dima' BPJS JAM9ESMAS
Tn Si'yono
Ny S&ina( BPJS UMUM
2/"/2014 Tn Maran BPJS AS9ES
Tn 6at&r BPJS BPJS
Tn Maran BPJS AS9ES
Tn Da&man BPJS BPJS
An Airan--a BPJS UMUM
Ny 6at(&r :o(im BPJS BPJS
Tn Da&man BPJS BPJS
An Dima' BPJS JAM9ESMAS
BPJS BPJS
Ny 6at(&r :o(im BPJS BPJS
Tn Lamiran BPJS A
Tn Si'yono BPJS AS9ES
7/21/2019 LAP (Autosaved)
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Tn Maran BPJS AS9ES
Tn Nati-or BPJS A
2/4/2014 Andima' BPJS JAM9ESMAS
TnDa&man BPJS BPJS
An Dima' BPJS JAM9ESMAS
Tn Maran BPJS AS9ES
Tn Si'yono BPJS AS9ES
Tn Lamiran BPJS A
Tn NAti-or BPJS A
2//2014 Sdraan UMUM
TnDa&man BPJS BPJS
NySri iyanti BPJS AS9ES
7/21/2019 LAP (Autosaved)
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Tn H#mi BPJS UMUM
TnNati-or BPJS A
Ny6at&r BPJS BPJS
Tn H#mi BPJS UMUM
AnDima' BPJS JAM9ESMAS
TnBadoi BPJS AS9ES
NyS#ndy BPJS 9
NyN&r& A8i8a( BPJS UMUM
TnDian BPJS UMUM
7/21/2019 LAP (Autosaved)
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AnDir-antara BPJS 9
2/+/2014 Ny S#ndi BPJS 9
Ny Sri iyanti BPJS AS9ES
NyS&marni BPJS 9
AnDir-antara BPJS 9
Ny Nini BPJS 9
NyNini BPJS 9
NyS#ri BPJS UMUM
7/21/2019 LAP (Autosaved)
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AnDir-antara BPJS 9
TnDian BPJS UMUM
Ny6At&r BPJS BPJS
NyS&marni BPJS 9
2/=/2014 Ny Nini BPJS 9
NyLa'iy#m BPJS AS9ES
TnAndri BPJS A
Byinarti UMUM
Ny Nini BPJS 9
Ny S#y BPJS UMUM
Ny S#ndi BPJS 9
Tn Dian BPJS &mUM
Ny La'iy#m BPJS AS9ES
Tn Andri BPJS A
7/21/2019 LAP (Autosaved)
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An Dir-antara BPJS J9
Ny S&tri'miati BPJS 9
An Dir-antara BPJS 9
Tn 6at&r BPJS BPJS
Ny Sri a(y&ni BPJS AS9ES
N> S&marni BPJS
N> Nini BPJS 9
Tn Andri BPJS A
N> Sri a(y&ni BPJS AS9ES
An Dir-antara BPJS 9
N> La'iyam BPJS AS9ES
2/)/2014 Ny S&tri'miati BPJS 9
Ny >anti UMUM
Ny S&tia( UMUM
7/21/2019 LAP (Autosaved)
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Tn Andri ,.!' A
Ny Nini BPJS 9
Ny :ati( BPJS 9
NyP&!i A'y&ti BPJS Jam'o't#$
BPJS 9
2/10/2014 NyN&ni BPJS
Ny Nini BPJS 9
Ana%ina%i'a BPJ9S Jam'o't#$
TnPra'#tyo Hadi BPJS &mUM
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 59/539
TnS&adi BPJS MANDI:I
Ny Nini BPJS 9
Tn S&adi BPJS MANDI:I
An a%i BPJS AS9ESNy Sriati UMUM
Tn S&adi BPJS MANDI:I
Tn S&adi BPJS MANDI:I
Ny Nini BPJS 9
2/11/2014 An a%i BPJS AS9ES
NyNini BPJS 9
Ana%i BPJS
TnPra'#tyo Hadi BPJS Ma'in
2/12/2014 Tn Pra'#tyo BPJS JAM9ESMAS
Ny N&raINI BPJS &mUM
TnPra'#tyo Hadi BPJS JAM9ESMAS
Tn Pra'#tyo Hadi BPJS JAM9ESMAS
2/1"/2014 NyIra BPJ9 9
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 60/539
And(y'a BPJ9 9
AnDy'ma BPJ9 9
2/14/2014 An :a'ya BPJS 9
AnDy'ma BPJ9 9
Ny Si'ati UMUM
Ny Sri!ati UMUM
An Dy'ma BPJS 9
Sdr 6r#ddy BPJS 9
2/1+/2014 An Dy'a BPJS 9TnM&!ay#n BPJS A
Sdr6r#ddy BPJS 9
Tn M&!ayin BPJS A
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 61/539
An Dy'a BPJS 9
Sdr%r#ddy BPJS UMUM
2/1=/2014 Sdr6r#dy BPJS UMUM
2/1)/2014 Tn Samad BPJS A
Tn Sam#t BPJS AS9ES
AnDy'ma BPJS 9Tn Sam#t BPJS AS9ES
2/1?/2014 Tn May(#ndra BPJS A
Tn May H#ndra BPJS A
2/20/2014 Ny Nia BPJS 9
Ny Da'ima( JAM9ESMAS
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 62/539
Ny Titi' BPJS 9
Ny Amiia BPJS 9
TnMa(#ndra BPJS A
N>Titi'
TnMay (#ndra BPJS A
Tn May H#ndra BPJS A
Ny Da'ima( BPJS JAM9ESMAS
2/21/2014 Sdr 6r#di BPJS 9
Ny N&r Ati3o( BPJS BPJS
Sdr 6r#di BPJS 9
Ny>&nani BPJS MANDI:I
7/21/2019 LAP (Autosaved)
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NyMariati BPJS AS9ES
Ny>&nai BPJS MANDI:I
NyMarati BPJS AS9ES
Ny Anin BPJS UMUM
2/2"/2014 Sdr Santo'o BPJS MANDI:I
Ny Marati BPJS MANDI:I
ny >&nani BPJS MANDI:I
Tn M&naar UMUM
Tn 9a'nadi UMUM
Nn M#i Diana BPJS 9
7/21/2019 LAP (Autosaved)
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Ny Si'ati UMUM
Nn M#i BPJS 9
Sdr Santo'o BPJSMANDI:I
'D: 6r#dy BPJS 9
2/24/2014 Ny Eo BPJS 9
Ny Si'ati UMUM
TnS idi BPJS A
NyEo BPJS A
7/21/2019 LAP (Autosaved)
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TnSidi BPJS 9
Ny D#i BPJS 9
Ny Eo BPJS 9
Tn Sadi BPJS A
Sdr Santo'o BPJS 9
Nn M#i Diana BPJS 9
Sdr 6r#dy BPJS 9
Ny Nina BPJS 9
2/2/2014 Sdr Santo'o BPJS MANDI:i
Ny Eo BPJS 9
By Ny N&r Nina BPJS 9
Tn a'i' S#tyo BPJS A
SdrSanto'o BPJS MANDI:I
ByHartati BPJS 9
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 66/539
NyHatati ,.!'
Tna'i' BPJS A
TnSadi3 BPJS A
NyEo BPJS 9
2/2+/2014 Ny Eo BPJS 9
Ny 9&'rini BPJS UMUM
Ny 9&'rini BPJS UMUM
Ny 9&'rini BPJS AS9ES
7/21/2019 LAP (Autosaved)
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By Ny Hartati BPJS 9
By Ny N&r 9om'ia( UMUM
Ny >&'ati BPJS UMUM
Tn a'i' BPJS A
Tn Sadi BPJS A
Ny 9&'rini BPJS UMUM
Ny Eo BPJS 9
Ny >a'mini UMUM
2/2=/2014 Tn Anan- BPJS A
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 68/539
Ny Ma'ia( BPJS JAM9ESMAS
Ny Eo BPJS 9
Ny 9&'rini BPJS UMUM
Ny H#ni UMUM
Ny 9artini UMUM
Ny Ma'ia( BPJS JAM9ESMAS
Tn a'i' BPJS A
Tn Sadi BPJS A
An Airan--a BPJS 9
Ny Andriani UMUM
Tn Bam,an- BPJS A
2/2)/2014 TnSama.ta BPJS A
7/21/2019 LAP (Autosaved)
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An :#(andia BPJS UMUM
An Airan--a BPJS 9
Ny L&t%ia( BPJS UMUM
Tn Anan- BPJS A
Tn Bam,an- BPJS A
Tn a'i' BPJS A
Tn Sadi BPJS A
Ny Eo BPJS 9
Ny 9&'rini BPJS AS9ES
Ny Ma'ia( BPJS UMUM
Ny Ei BPJS 9
7/21/2019 LAP (Autosaved)
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TOTAL
PC UMUM "42<"00
PC BPJS UMUM 1<1+<400
PC BPJS 9ELUA:GA "<=40<)00
PC BPJS ANGGOTA "<0+<?00
PC BPJS BPJS "2+<100
PC BPJS AS9ES 1<"0<400
PC BPJS JAM9ESMAS 1<01"<=00
PC BPJS MANDI:I 44<000
PC BPJS :SB +<200
PC BPJS JAMSOSTE9 1?4<000
11<+)<)00
7/21/2019 LAP (Autosaved)
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NAMA OBAT JUMLAH
HA:GA PASIE
UMUM BPJS UMUM BPJS BPJS
M&*o-ard Syr 1 2=<"00
I7 5at( 20 1 +<?00
In%&'#t dara( 1 +<100I7 5at( 20 1 +<?00
I 5at( 22 2 1"<)00
In%&'#t ,ia'a 1 4<=00
i 5at( 20 1 +<?00
S.&it " ** 2 1<+00
S.&it ** 2 2<000
D; 1 +<000
I7 5at( 24 1 +<?00
I7 5at( 22 2 1"<)00
In%&'#t ,ia'a 1 4<=00
*#%ota$im# in! 1 <400a3&a 1 2<100
S.&it ** " "<000
S.&it " ** 4 "<200
D 1/4 NS " 2=<"00
&rin#,a- 1
a3&a 1
S.&it " ** 2
S.&it ** 2
In%&' dara( 1 +<100
D 1 +<000
I 1) 1 +<?00
6* 1+ 1 1<00
&rin#,a- 1 4<400
S.&it 10 ** 1 1<"00
S.&it ** " "<000
S.&it " ** 4 "<200
a3&a 1 2<100
*#%ota$im# in! " 1+<200
5#%tria$on# 2 10<)00
S.&it " ** 4 "<200
S.&it ** " "<000
D 1 +<000
S.&it ** 2 2<000
S.&it " ** 2 1<+00
S.&it " ** 4
S.&it ** "
In%&'#t ,ia'a 1 4<=00
Amodi.in 10 m- + +<+00
In%&'#t Bia'a 1
BPJS9ELUA:GA
BPJS ANGGOTA
7/21/2019 LAP (Autosaved)
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5#%o 1
N##d# 2 1
A3&a 1
I 20 2 1"<)00
Intro-at 22 1 +<?00
D#$a In! " +<000
S.&it " ** = <+00
S.&it ** 2 2<000
Und#r.#d 4 1"<+00
Urin,a- 1 4<400
6* 1+ 1 1<00
A3&a 1 2<100
D 1/2 "
S.&it " ** "
S.&it ** "
*#%ota$im# in! 2
a3&a 1
D 1/2 NS 25#%tria$on# 2
S.&it 10 ** 2
S.&it " ** 4
5#%tria$on# 1 <400
S.&it " ** + 4<)00
a3&a 1 2<100
In%&'#t Bia'a 1
In%&'#t ,ia'a 1 4<=00
i 20 2 1"<)00
'.&it "** " 2<400
'.&it ** " "<000
S.&it 10 ** " "<?00
ni%#di.in 10m- 1 200
Di-o$in "
5#%tria$on# 2 10<)00
In%&'#t ,ia'a 1 4<=00
I 24 2 1"<)00
I 22 2 1"<)00
'.&it "** 1 )00
Amod.in M- 4 2<000
5#%tria$on# 1 <400
a3&a 1 2<100
P@ 0< 1 +<)00
D 1/2 NS 2
*#%ota$im# in! 2 10<)00
:L 2 12<000
:L 2 12<000
'.&it "** 2 1<+00
:L 1
6&ro'#mid# In! 2
7/21/2019 LAP (Autosaved)
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5#%tria$on# 2
Om#.ra8o# In! 1
S.&it 10 ** "
'.&it "** 1
6&ro'#mid# In! 2
D; 1
'.&it "** 4
P@ 0< 1 +<)00
D; 2 12<000
'.&it "** " 2<400
'.&it "** 2
:anitidin in! 2 =<+00
D#$a In! 2 4<000
'.&it "** " 2<400
*#%ota$im# in! 1
D 1/2 1
a3&a 1
:anitidin in! 16&ro'#mid# In! 2
:anitidin in! 2
'.&it "** 2
'.&it ** 2
D; 1
5#%tria$on# 1
Om#.ra8o# In! 1
:L 1
:L 2 12<000
:anitidin in! 2 =<+00
P@ 0< 1 +<)00
D; 2 12<000
6&troit 1 4+<)00
5#%tria$on 2 10<)00
:anitidin In! 2 =<+00
D#$a in! " +<000
S.&it " ** 2 1<+00
S.&it ** 2 2<000
S.&it 10 ** 2 2<+00
Na* 1 +<)00
In%&' dara( 1
I 1) 1
6* 1+ 1
Urin,a- 1
S.&it 10 ** 1
S.&it " ** )
S.&it ** "
*#%ota$im# in! "
D#$a In! 2
D 1
7/21/2019 LAP (Autosaved)
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Amino#,an In% 1 ?"<+00
P@ 0< 1 +<)00
D 1 +<000
:anitidin in! 2 =<+00
S.&it 10* 1 1<"00
'.&it ** 1 1<000
'.&it "** 2 1<+00
:L 2 1<200
S.&it ** 1 1<000
'.&it "** 1 )00
Amino#,an In% 1 ?"<+00
P@ 0< 1 +<)00
:L 1 +<000
5#%tria$on in! 1 <400
Om#.ra8o# In! 1 )?<)00
S.&it 10** 2 2<+00
'.&it ** 1 1<000
D 1/2NS 2*#%ota$im# in! 2
'.&it "** 2
:anitidin in! 1
In%&'#t Bia'a 1
:L "
I7 20 1
'.&it "** "
I7 1) 1 +<?00
In%&' dara( 1 +<100
:L 4 24<000
6* 1+ 1 1<00
&rin#,a- 1 4<400
'.&it "** 4 "<200
'.&it ** " "<000
*#%ota$im# in! " 1+<200
a3&a 1 2<100
S.&it 10** 1 1<"00
D 1 +<000
D#$a In! 2 4<000
N##d# 2" 1 "00
In%&' dara( 1 +<100
I7 20 1 +<?00
:L 2 12<000
'.&it "** 1 )00
5i.ro ta, 10 4<000
D 1 +<000
:L 1 +<000
5#%tria$on in! 2 10<)00
B&'*oti*a " 22<200
S.&it 10* 1 1<"00
7/21/2019 LAP (Autosaved)
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'.&it ** 2 2<000
'.&it "** 2 1<+00
In%&'#t Bia'a 1 4<=00
:L " 1)<000
I7 22 1 +<?00
'.&it "** " 2<400
P5T 'yr 1 2<400
5i.ro ta, 10 4<000
a'am M#%#namat 20 4<000
5i.ro ta, 10
a'am M#%#namat 20
D#$a In! " +<000
S.&it 10 ** " "<?00
S.&it " ** " 2<400
:anitidin in! 2 =<+00
in%&' ,iA'a 1 4<=00
i 20 1 +<?00
6&troit " 140<400S.&it " ** + 4<)00
S.&it ** 1 1<000
*#%ota$im# in! 2 10<)00
a3&a 2 4<200
S.&it ** " "<000
S.&it " ** " 2<400
6&troit 1 4+<)00
" ay '#an- 1 "2<+00
na* 0< 1 +<)00
'.ironoa*ton# 2<00
Amodi.in 10 m- <00
a3&a 1 2<100
In%&'#t Bia'a 1 4<=00
i 1) 1 +<?00
%*1+ 1 1<00
&rin#,a- 1 4<=00
a3&a 1 2<100
%&ro'#mid 2 4<400
'.&it 10** 1 1<"00
I7 1) 1 +<?00
In%&' dara( 1 +<100
:L 4 2<400
6* 1+ 1 1<00
&rin#,a- 1 4<=00
S.&it 10** 1 1<"00
D 1 +<000
'.&it "** " 2<400
S.&it ** " "<000
A3&a 1 2<100
*#%ota$im# in! " 1+<200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 76/539
9#toroa* in! " 1?<)00
D 1/2NS 1 ?<100
D 1 +<000
:L 1 +<000
5#%tria$on in! 2 10<)00
B&'*oti*a " 22<200
S.&it 10** 1 1<"00
'.&it ** 2 2<000
'.&it "** 2 1<+00
:L 2 12<000
S.&it 10** 1 1<"00
'.&it ** 1 1<000
'.&it "** 1 )00
:L 2 12<000
D#$a In! " +<000
:anitidin in! 2 =<+00
S.&it 10** 1 1<"00
'.&it ** 1 1<000'.&it "** 2 1<+00
6&ro'#mid# In! " +<+00
S.&it " ** 2 1<+00
S.&it ** 2 2<000
6&troit 1 4+<)00
a3&a 1 2<100
:L OGB 1
I 20 1
In%&' dara( 1
:L OGB 1 +<000
I 20 1 +<?00
In%&' dara( 1 +<100
:#ian 2 11<000
5#%tri In! 2 10<)00
a3&a 1 2<100
S.&it 10 ** 1 1<"00
N##d# 2 1 "00
5i.ro ta, 10 4<000
5#%o In! 1 <400
S.&it ** 1 1<000
a3&a 1 2<100
5i.ro ta, 10 4<000
: "
*#%ota$im# in! "
9#toroa* in! "
:anitidin in! "
'.&it 10** "
'.&it "** 4
n##d# 2 1
*#%ota$im# in! " 1+<200
7/21/2019 LAP (Autosaved)
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9#toroa* in! " 1?<)00
:anitidin in! " 11<400
'.&it 10** " "<?00
'.&it "** " 2<400
r " 1)<000
n##d# 2 1 "00
In%&'#t dara( 1 +<100
In%&'#t dara( 1 +<100
i 1) 1 +<?00
r 2 12<000
%*1+ 1 1<00
&rin#,a- 1 4<=00
'.&it 10** 1 1<"00
a3&a 2 4<200
*#%o " 1+<200
'.&it ** " "<000
n##d# 2 1 "00
'.&it "** 4 "<200D 1 +<000
9#toroa* in! " 1?<)00
'.&it "** " 2<400
Amodi.in 10 m- + +<+00
: 1
In%&'#t dara( 1
i 20 1
D#$a In! 1 2<000
6&troit 1 4+<)00
6&ro'#mid# In! 4 )<)00
5#%tria$on# in! 1 <400*#%ota$im# in! " 1+<200
9#toroa* in! " 1?<)00
:anitidin in! 2 =<+00
r 4 24<000
S.&it 10** 2 2<+00
a3&a 2 4<200
:L 2
6&troit 1
'.&it "** "
'.&it "** " 2<400
9#toroa* in! "
:anitidin in! 2
*#%ota$im# in! "
:L "
S.&it 10* "
A3&a 2
5i.ro ta, 10 4<000
Urin#,a- 1 4<400
5om,i#nt n#, ) =)<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 78/539
5i.ro ta, 10 4<000
I 20 2 1"<)00
In%&'#t dara( 1 +<100
i 5at( 1) 1 +<?00
6* 1+ 1 1<00
&rin#,a- 1 4<400
S.&it ** " "<000
N##d# 2" 1 "00
a3&a 1 2<100
*#%ota$im# in! " 1+<200
S.&it " ** +
In%&' Dara( 1
I7 1) 1
:L OGB =
S#an- O2 d' 1
D 1
9#toroa* in! "
S.&it 10 ** 1S.&it ** "
*#%ota$im# in! "
N#d# 2" 1
a3&a 1
6* 1+ 1
&rin#,a- 1
a3&a 2 4<200
6&troit 1 4+<)00
6&ro'#mid in! " +<+00
5#%tria$on# 2 10<)00
S.&it " ** 2 1<+00S.&it ** 2 2<000
S.&it 10 ** 2 2<+00
5#%tria$on# 2 10<)00
S.&it ** " "<000
S.&it " ** " 2<400
a3&a 1 2<100
7#ntoin " 2+<=00
5#%tri In! 2 10<)00
S.&it ** " "<000
S.&it " ** " 2<400
a3&a 1 2<100
7#ntoin " 2+<=00
D 1/4NS "
'.&it "** )
D 1/2NS 2
I7 22 1
In%&'#t Bia'a 1
'.&it "** 4<000
'.&it ** <000
7/21/2019 LAP (Autosaved)
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:L 2 12<000
6&troit 2 ?"<+00
:anitidin in! 2 =<+00
D 2 12<000
P@ 0<L 1 +<)00
D 1
'.&it ** "
'.&it "**
In%&' dara( 1
I7 1) 1
5#%tri 2 10<)00
'.&it "** 1 )00
'.&it ** 2 2<000
.(amino " 1<000
%*1+ 1
a3&a 1
Urin#,a- 1
D 1/4NS 2San'&in N 1 100<)00
Udo.a 2
" ay '#an- 1
6&ro'#mid in! "
5o.ram# 1
D#$a In! 1
" ay '#an- 1 +<200
D#$a In! 1
S.&it ** 2 2<000
d 1/4 2 1)<200
D 1na* 0< 1
S.&it ** 2
S.&it " ** 2
D#$a In! 1
'.&it "** 2 1<+00
:L 2 12<000
na* 0< 1 ?<100
S.&it 10** 2
D; 1
P@ 0<L 1
:anitidin in! 2
'.&it ** 1
'.&it "** 2
In%&' dara( 1
:L 10
I7 1) 1
D 1
:#ian 1 <00
I7 20 1 +<?00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 80/539
6* 1+ 1 1<00
&rin#,a- 1 4<400
'.&it ** " "<000
'.&it "** 10 )<000
*#%ota$im# in! " 1+<200
9#toroa* in! " 1?<)00
I7 22 1 +<?00
In%&'#t Bia'a 1 4<=00
'.&it "** " 2<400
'.&it "** " 2<400
'.&it ** 4 4<000
I7 22 2 1"<)00
In%&'#t Bia'a 1 4<=00
D 1/4NS 2 1)<200
D40 " =<200
G#m%i,ro8i 1 +<000
S.&it " ** 4 "<200
:L OGB "0<000In%&'#t Bia'a 1 4<=00
I7 5at( 20 1 +<?00
&rin#,a- 1 4<400
a3&a " +<"00
5#%tri In! " 1+<200
S.&it 10 ** + =<)00
S.&it ** <000
S.&it " ** 4<000
N##d# 2 1 "00
6&ro'#mid in! 2 4<400
'.&it "** 2 1<+00In%&' Bia'a 1 4<=00
na* 0< " 20<400
I7 20 1 +<?00
Om#.ra8o# In! 2 1=?<+00
5#%tria$on 2 10<)00
S.&it 10 ** " "<?00
S.&it ** " "<000
S.&it " ** " 2<400
N#d# 2 1 "00
5a.tro.i 2 1" 2<+00
na* 0< 1 ?<100
N#d# 2 1 "00
6&ro'#mid in! " +<+00 +<+00
S.&it 10** 2 2<+00 2<+00
'.ironoa*ton# 4 2<000
6&troit 1 4+<)00
5#%tri 2 10<)00
S.&it "** " 2<400
A3&a 1 2<100
7/21/2019 LAP (Autosaved)
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D 1/4 2 1)<200
:#ian 2 11<000
na* 0< 1 ?<100
%&ro'#mid in! " +<+00
'.&it "** 2 1<+00
'.&it ** 2 2<000
6&ro'#mid I,! 2 4<400
D&*oa$ '&. 2 2<400
: 1
D 1
In%&'#t Bia'a 1
S&r%o 20 1
6&troit 2
:anitidin in! 2
S.&it "** +
S.&it ** "
No#rty 10 1)<200
D 1/4NS 2: 2
:L " 1)<000
In%&'#t Bia'a 1 4<=00
i 20 1 +<?00
5#%tria$on# in! 2 10<)00
a3&a 1 2<100
'.&it 10* " "<?00
'.&it ** " "<000
'.&it "** " 2<400
N##d# 2 1 "00
5#%tri In! 1 <400D; 2 12<000
:L OGB 1 +<000
S.&it ** 2 2<000
S.&it 10 ** 2 2<+00
S.&it " ** 2 1<+00
In%&'#t dara( 1 +<100
i 1) 1 +<?00
'.&it "** = <+00
'.&it ** " "<000
'.&it 10** 1 1<"00
*#%ota$im# in! " 1+<200
:L 4 24<000
6* 1+ 1 1<00
&rin#,a- 1 4<400
a3&a 1 2<100
9#toroa* in! " 1?<)00
Na* 1 ?<100
:L 4
I 20 1
7/21/2019 LAP (Autosaved)
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In%&'#t Bia'a 1
*#%ota$im# in! "
:anitidin in! 2
'.&it 10* "
N##d# 2 1
'.&it ** "
'.&it "** "
'.&it "** + 4<)00
In%&'#t dara( 1 +<100
i 1) 1 +<?00
6* 1+ 1 1<00
&rin#,a- 1 4<400
'.&it 10** 1 1<"00
'.&it ** " "<000
'.&it "** ) 2<400
9#toroa* in! " 1?<)00
a3&a 1 2<100
r 4 24<000na* 1 +<)00
*#%ota$im# in! " 14<400
5#%tria$on in! 1 <400
In%&'#t Bia'a 1 4<=00
:L + "+<000
I7 1) 1 +<?00
5i.ro ta, 10 4<000
D#$a In! 2 "<)00
D#$a In! " <=00
:anitidin in! 2
S.&it 10** 2'.&it ** 1
S.&it 10* 1 1<"00
I 1) 1 +<?00
In%&'#t dara( 1 +<100
:L 4 24<000
*#%ota$im# in! " 14<400
'.&it ** " "<000
S.&it "** 4 "<200
'.&it 10** 1 1<"00
n##d# 2" 1 "00
6* 1+ 1 1<00
&rin#,a- 1 4<400
A3&a 1 2<100
9#toroa* in! " 1?<)00
D 1 +<000
P@ 0<L 1 +<)00
6&ro'#mid# In! 2 4<400
In%&' dara( 1
I 1) 1
7/21/2019 LAP (Autosaved)
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:L 4
6* 1+ 1
&rin#,a- 1
S.&it 10** 1
'.&it ** "
S.&it "** 4
n##d# 2" 1
A3&a 2
*#%ota$im# in! "
D 1
9#toroa* in! "
I7 1) 2
In%&' dara( 1
:L 4
6* 1+ 1
&rin#,a- 1
a3&a 1
S.&it "** 4S.&it ** "
S.&it 10** 1
*#%ota$im# in! "
N##d# 2" 1
9#toroa* in! "
a'am M#%#namat 20
S.&it " ** 2
In%&'#t dara( 1 +<100
i 1) 1 +<?00
:L " 1)<000
a3&a 1 2<100S.&it 10* 1 1<"00
'.&it "** 4<000
In%&'#t dara( 1
S.&it 10**< "
S.&it ** "
S.&it "** "
i 1) 1
r "
D 2
:anitidin in! 2
5#%tri 2
N##d# 2 1
A3&a 1
5i.ro ta, 10
5i.ro ta, 10
&rin#,a- 1 4<400
6* 1) 1 1<00
&rin#,a- 1 4<400
I7 5at( 20 1 +<?00
7/21/2019 LAP (Autosaved)
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a3&a 1 2<100
In%&'#t Bia'a 1 4<=00
S.&it 10 ** 2 2<+00
S.&it ** " "<000
S.&it " ** 4 "<200
N##d# 2 1 "00
Lod#m ta, 10 14<000
5#%tria$on# in! 2 10<)00
S.&it 10** 1 1<"00
'.&it "** 4 "<200
6&troit 1 4+<)00
5#%tria$on# in! 2
a3&a "
'.&it 10** "
'.&it ** "
D 1/2NS "
Na* 1 +<)00
6&ro'#mid# In! 1 2<200'.&it 10*** 1 1<"00
'.&it "** 2 1<+00
S&r%o 20 1 +<?00
In%&'#t dara( 1 +<100
S.&it 10** " "<?00
S.&it ** " "<000
S.&it "** 4<000
N##d# 1 "00
a3&a In! 1 2<100
6&troit In% 2 ?"<+00
Na* 0< 1 +<)00%&ro'#mid in! 2 4<400
:anitidin# in! 2 "<400
5#%tria$on in! 2 10<)00
D40; 2 4<)00
In%&'#t Bia'a 1 4<=00
I 20 2 1"<)00
r 1 +<000
*#%tri 2 10<)00
ranitidin in! 2 "<400
'.&it "** 2 1<+00
'.&it ** 2 2<000
'.&it 10** 2 2<+00
n##d# 2 1 "00
a3&a 1 2<100
D 1 +<000
na* 2 1"<+00
5#%ota$im 1 4<)00
5i.ro In% 1 2+<400
A3&a 1 2<100
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 85/539
6ar'i$ 2 4<+00
G#m,i,ro$i "00 10 4<000
I7 5at( 1) 1 +<?00
In%&'#t dara( 1 +<100
S.&it " ** 2 1<+00
N##d# 2" 1 "00
:L OGB 2 12<000
D; 1 +<000
P@ 0<L 1 +<)00
:anitidin in! 2 "<400
*#%ota$im# in! 2 ?<+00
5i.ro In% 2 2<)00
a3&a In! 1 2<100
S.&it 10 ** 2 2<+00
S.&it " ** " 2<400
P@ 0<L 2 1"<+00
S.&it 10 ** 2 2<+00
S.&it " ** 2 1<+00a3&a In! 1 2<100
5#%tri In! 2 10<)00
:anitidin in! 2 "<400
S.&it ** " "<000
S.&it " ** 2 1<+00
P@ 0<L 1 +<)00
S.&it 10 ** 1 1<"00
S.&it " ** 2 1<+00
a3&a In! 1 2<100
P@ 0<L 1 +<)00
S.&it ** 1 1<000S.&it " ** 2 1<+00
S.&it " ** ) +<400
S.&it 10 ** 1 1<"00
D 1/2NS "
In%&'#t dara( 1 +<100
M&*&' 1 10<+00
In%&'#t Bia'a 1 4<=00
I7 20 1 +<?00
:L OGB " 1)<000
5#%tria$on# In! 2 10<)00
5i.ro In% 2 2<)00
9#toroa* in! " 1?<)00
'.&it ** 2 2<000
a3&a In! 2 4<200
D 1/2 NS "
5#%tria$on in! 2
S.&it 10 ** 2
S.&it " ** 2
m&*&' 1
7/21/2019 LAP (Autosaved)
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D#$a In! 2 "<)00
S.&it " ** ) +<400
-#ntami*in in! 2 =<+00
:L OGB "0<000
S.&it ** " "<000
%* 1+ 1 1<00
&rin#,a- 1 4<400
n#d# 2" 1 "00
S.&it 10 ** 1 1<"00
a3&a in! 1 2<100
D 1 +<000
*#%ota$im# in! " 14<400
9#toroa* in! " 1?<)00
:L OGB 1 +<000
5#%tria$on# 2 10<)00
#rtoroa* " 1?<)00
*i.ro in% 1 2+<400
S.&it 10 ** 1 1<"00S.&it " ** " 2<400
a3&a in! 1 2<100
:L OGB 1 +<000
5#%tria$on# 1 <400
a3&a in! 1 2<100
S.&it 10 ** 2 2<+00
S.&it " ** 2 1<+00
:anitidin in! 2 "<400
*#%ota$im# in! 2 ?<+00
*i.ro in% 2 2<)00
%&ro'#mid in! 2 4<400%i$ot#d# 2 "=<400
a3&a in! 1 2<100
S.&it 10 ** 1 1<"00
S.&it " ** " 2<400
I7 5at( 20 2 1"<)00
P@ 0<L 2 1"<+00
In%&'#t Bia'a 1 4<=00
i 5at( 20 1 +<?00
5#%tri In! 1 <400
Om#.ra8o# In! 1 )?<)00
a3&a In! 1 2<100
S.&it ** " "<000
S.&it 10 ** " "<?00
N##d# 2 1 "00
In%&'#t dara( 1 +<100
P@ 0<L 1
P@ 0<L 1
:anitidin# in! 2
'.&it "** 1
7/21/2019 LAP (Autosaved)
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'.&it 10** 1
7i**iin In! 2 ?<000
-#ntami*in in! 1 "<)00
'.&it "** 10 )<000
P&- In! 1 2<00
S&r%o 24 2 1"<)00
a3&a In! 1 2<100
D40; 2 4<)00
In%&'#t dara( 1 +<100
%* 1+ 1 1<00
&rin#,a- 1 4<400
S.&it 10** 1 1<"00
S.&it "** " 2<400
S&r%o 1) 1 +<?00
: 4 24<000
D 1 +<000
*#%ota$im# in! " 14<400
S.&it ** " "<000 A3&a 2 4<200
*#%tri 2 10<)00
9#toroa* in! 4 2+<400
5i.ro in%&' 2 2<)00
: " 1)<000
S.&it 10** 2 2<+00
S.&it "** 4 "<200
5#%tri 1 <400
r 2 12<000
Na* 0< 2 1"<+00
5#%tri 1 <400:anitidin in! 2 "<400
D 1 +<000
Na* 0< 1 +<)00
S.&it 10** 1 1<"00
S.&it "** 4 "<200
Na* 0< 1 +<)00
:anitidin in! 2 "<400
*#%o 2 ?<+00
*i.ro%$a*in in%&' 2 2<)00
S.&it 10** " "<?00
S.&it ** 2 2<000
S.&it "** 2 2<+00
5om,i#nt n#, 1 ?<)00
:L " 1)<000
a3&a In! 2 4<200
5#%tria$on# In! 2 10<)00
A3&a In! 2 4<200
-#ntami*in in! " 11<400
D; 2 12<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 88/539
:L OGB 2 12<000
S.&it 10** 2 2<+00
S.&it "** " 2<400
:L OGB 2
P@ 0<L 1
In%&'#t Bia'a 1
I 20 1
5#%tria$on# In! 2
a3&a in! 2
5om,i#nt n#, 2
D#$a In! 2
S.&it 10** 4
S.&it ** 4
'.&it "** 4
n##d# 2 1
*#%ota$im# in! 2 ?<+00
:anitidin in! 2 "<400
5i.ro in%&' 1 2+<400S.&it "** 2 1<+00
S.&it ** 2 2<000
*#%tri 1 <400
:anitidin# in! 2 "<400
S.&it ** " "<000
: 1 +<000
: 2 12<000
*#%tri 2
D#$a In! "
5om,i#nt n#, "
*#%tri 2 10<)005i.ro in%&' 2 2<)00
Lo#no$ 0<+ 2 "1+<)00
S.&it 10** 2 2<+00
S.&it ** 2 2<000
5om,i#nt n#, " 2?<400
S.&it 10** 2 2<+00
S.&it ** 2 2<000
S.&it "** 2 1<+00
: 2 12<000
r " 1)<000
In%&'#t Bia'a 1 4<=00
I 20 1 +<?00
Noa-in in! 2 14<)00
7om#tra' 2 )<)00
S.&it ** 2 2<000
S.&it "** 4 "<200
5a.to.ri 2 1<000
No#rty 10 <000
In%&' dara( 1 +<100
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 89/539
I7 20 2 1"<)00
:L " 1)<000
'.&it "** " 2<400
D 1/4 " 2=<"00
'.&it "** 1 )00
I 1) 1 +<?00
In%&'#t dara( 1 +<100
'.&it "** 1 )00
N##d# 2" 1 "00
-#ntami*in in! 2 =<+00
5#%tria$on# In! 2 10<)00
S.&it 10** 2 2<+00
S.&it "** 2 1<+00
:L 2 12<000
D 1 +<000
S.&it "** 4 "<200
5#%tria$on# In! 2 10<)00
9#toroa* in! 4 2+<4005i.ro in% 2 2<)00
S.&it 10** 2 2<+00
S.&it "** 4 "<200
a3&a In! 1 2<100
5#%tria$on# In! 2 10<)00
S.&it 10** " "<?00
S.&it "** 2 1<+00
*#%ota$im# in! 2 ?<+00
%&ro'#mid in! " +<+00
5i.ro in% 2 2<)00
'.&it 10**** 2 2<+00S.&it "** 4 "<200
5#%tria$on# In! 2
S.&it 10** 2
''.&it "** "
S.&it ** 2
5#%tria$on# in! 2 10<)00
S.&it 10** 2 2<+00
S.&it "** 2 1<+00
In%&'#t dara( 1 +<100
I7 1) 1 +<?00
d 1 +<000
%* 1+ 1 1<00
&rin#,a- 1 4<400
S.&it 10** 1 1<"00
S.&it ** " "<000
S.&it "** " 2<400
D#$a In! 2 "<)00
a3&a In! 1 2<100
N##d# 2" 1 "00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 90/539
*#%ota$im# in! " 14<400
"42<"00 1<1+<400 "<=40<)00 "<0+<?00 "2+<100
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 91/539
BPJS AS9ES BPJS :SB
4<400
2<100
1<+00
2<000
"<200
"<000
4<=00
BPJSJAM9ESMAS
BPJSMANDI:I
BPJSJAMSOSTE9
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 92/539
<400
"00
2<100
2=<"00
2<400
"<000
10<)00
2<100
1)<20010<)00
2<+00
"<200
4<=00
+00
1)<200
+<000
4<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 93/539
10<)00
)?<)00
"<?00
)00
4<400
+<000
<200
1<+00
<400
?<100
2<100
"<)004<400
=<+00
1<+00
2<000
+<000
<400
)?<)00
+<000
+<100
+<?00
1<00
4<400
1<"00
+<400
"<000
1+<200
4<000
+<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 94/539
1)<20010<)00
1<+00
"<)00
4<=00
1)<000
+<?00
2<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 95/539
4<000
4<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 96/539
+<000
+<?00
+<100
1)<000
1+<200
1?<)00
11<400
"<?00
"<200
"00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 97/539
+<000
+<100
+<?00
12<000
4+<)00
2<400
1?<)00
=<+00
1+<200
1)<000
"<?00
4<200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 98/539
4<)00
+<100
+<?00
42<000
+<100
+<000
1?<)00
1<"00"<000
1+<200
"00
2<100
1<00
4<400
2=<"00
2<400
1)<200
+<?00
4<=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 99/539
+<000
"<000
4<000
+<100
+<?00
1<00
2<100
4<400
1)<200
2?<+00
+<200
+<+00
)<400
2<000
2<000
+<000?<100
2<000
1<+00
2<000
2<+00
+<000
?<100
=<+00
1<000
1<+00
+<100
+0<000
+<?00
+<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 100/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 101/539
+<000
+<000
4<=00
+<?00
?"<+00
=<+00
4<)00
"<000
1)<20012<000
24<000
+<?00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 102/539
4<=00
1+<200
=<+00
"<?00
"00
"<000
2<400
"<400
2<+001<000
+<100
+<?00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 103/539
24<000
1<00
4<400
1<"00
"<000
"<200
"00
4<200
14<400
+<000
1?<)00
1"<)00
+<100
24<000
1<00
4<400
2<100
"<200"<000
1<"00
14<400
"00
1?<)00
4<000
1<+00
+<100
"<?00
"<000
2<400
+<?00
1)<000
12<000
"<400
10<)00
"00
2<100
4<000
4<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 104/539
10<)00
+<"00
"<?00
"<000
2=<"00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 105/539
2=<"00
"?100
10<)00
2<+00
1<+00
10<+00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 106/539
+<)00
+<)00
"<400
)00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 107/539
1<"00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 108/539
12<000
+<)00
4<=00
+<?00
10<)00
4<200
1?<+00
"<)00
<200
4<000
"<200
"00
10<)00
<=00
2?<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 109/539
10<)00
2<+00
2<400
2<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 110/539
1<"0<400 1<01"<=00 44<000 +<200 1?4<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 111/539
TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT
2/2/2014 Ny a(y&ni BPJS 9 T#n'o*r#. +F
2/2/2014 N> I'nani BPJS 9 M#t%ormin ta,
dia#r'a ta,
%&ro'#mid# ta,
NyP&!i BPJS 9 Amodi.in# M-
2/14/2014 An Ama BPJS 9 :#ian
An M :i8y 9A:EB P5t 'yr
2/1=/2014 An Pri'ta UMUM 5indami*in 10
2/1)/2014 Ny M&!i :a(ay& BPJS 9 dia#r'a ta,
M#t%ormin ta,
Tn Marno BPJS A Om#.ra8o *a.
Ny Siti Ma'titi UMUM Amodi.in# 10 m-
Ny 9a'mira( UMUM Amodi.in 10 m-
Sima'tatin 10 m-
Tn :amidi UMUM Amodi.in 10 m-2/1?/2014 Ny Sa!iy#m BPJS AS9ES Amodi.in m-
%&ro'#mid# ta,
Ny Endan- BPJS A Om#.ra8o *a.
Tn Hartono BPJS A Amodi.in m-
So(o,ion
2/20/2014 An Ama UMUM Dom.#ridon 'yr
2/24/2014 An<6ar(an BPJS 9 a'a 10$4
2/2/2014 Tn Sa,ran- BPJS A So(o,ion
Amodi.in# M-
Ny S&tarni BPJS AS9ES 5a.to.ri 2
2/2=/2014 Ny Sriyati UMUM Gim#.irid 1m-Tn S&tomo UMUM Amodi.in# 10M-
Tn Sidi P&rnomo BPJS A Amod.in# 10M-
2/2)/2014 NySi'ati UMUM Gim#.irid 1m-
TOTAL
PC UMUM ?)<000
PC BPJS 9ELUA:GA 1+<400
PC BPJS ANGGOTA ""<+00
PC BPJS AS9ES 1<00
PC 9A:EB 2<400"14<?00
7/21/2019 LAP (Autosaved)
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JUMLAH
HA:GA PASIEN
UMUM BPJS ANGGOTA BPJS AS9ES
1 =0<=00
1 "<000
10 =<000
) 1<+00
10 <000
1 <00
1
+ "<000
+0 42<000
"0 +<000
10 <000
22 1=<+00
14 11<200
14 4<200
14 11<2001 =<00
10 2<000
10 <000
20 10<000
) 2<400
1 10<)00
2 +<+00
10 "<000
"0 1<000
+0 +<000
20 12<00014 11<200
14 11<200
2) 1+<)00
?)<000 1+<400 ""<+00 1<00
BPJS9ELUA:GA
BPJSJAM9ESMAS
7/21/2019 LAP (Autosaved)
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BPJS MANDI:I 9A:EB
2<400
2<400
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS GOLONGAN
3/1/2014 NyEi BPJS 9
An :#(andia BPJS U
N> Sa!iy#m BPJS BPJS
By Ny N&r 9om'a( UMUM
Ny 9&'rini BPJS AS9ES
Ny Eo BPJS 9
Tn Bam,an- BPJS A
Tn Sadi BPJS A
Tn a'i' BPJS A
BON 79
"/2/2014Ny M#i# BPJS 9
Ny.Ri)a >mum
-n.Ra!ani)a ;
Tn.-i >(>(
7/21/2019 LAP (Autosaved)
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N> :ia >(>(
N7 umarsi! >(>(
N> Tamina( >(>(ny ?)$ bp%s )
Tn amban" -
Tn ai) -
Tn @asis -
Ny (i)e bp%s )
Tn -i p%s -
N7 a%iyem
-n Re!ani)a bp%s ;
3/3/2014 Ny. is)a >(>(
Ny.u%iyem -;?
Sdr<Ba-&' Pra'#tyo >(>(
N7.Tumina! >(>(
Ny.iti (aAr$! -(;?(-
Tn.@asis -
N>S&mar'i( -;?
Tn -i -
7/21/2019 LAP (Autosaved)
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Ny Ri)a >(>(
3/4/2014 -n. !ani)a ;
-n. !ani)a ; Ny. aiyem >(>(
Ny.unarsi! >
Ny.a%iyem >
Tn.-i bp%s -
Ny.Ri)a >mum
Ny.+9i ;
3/5/2014Ny. u9artinin"si! -;?
Ny. u9artinin"si! -;?
Ny. a%iyem >(>(
Ny.N-NIN >mum
Tn.-i bp%s -
Ny.9artinin"si! -;?
Ny.a%iyem >(>(
Ny.Ri)a >mum
7/21/2019 LAP (Autosaved)
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Ny.-ni) >mum
r.Rui >mum
Tn.-i -
3/#/2014 Tn A(mad -(;?(-
Ny Nyamisi! >(>(
Ny Otian >(>(
Ny. 7amisi! >(>(
Ny. u%iyem >(>(
Tn. -!ma -li -(;?(-
Tn. armani >(>(
Ny. <erline >(>(Ny. Ri)a >(>(
Tn. -!ma -li -(;?(-
Ny Nyami'i( -;?
Ny. u9artinin"si! -;?
Ny. Nyamisi! >(>(
Ny. ?nny ;
3/=/2014 TnD#di -
7/21/2019 LAP (Autosaved)
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Ny. 7amisi! umum
Ny. iti *!$ti%a! -n""$ta
tn. @a!yu >(>(
Tn. +ei -
Tn. -i -;?
Tn. -!ma ali -(;?(-
Ny. Nyamisi! -;?
Ny. Ri)a >(>(
3/=/2014 ny Dini ;
Ny. 7amisi! -;?
Tn. +ei -
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 119/539
Ny. Ri)a >(>(
Tn. -i -
3/B/2014 Ny. Ri)a >(>( Tn. -i -
Ny. 7amisi! -;?
Ny. 7amisi! >(>(
Ny.7amisi! -;?
y.+ini ;
Ny.>mi >(>(
Ny Nyami'i( >(>(
N> Nyami'i( >(>(
Tn -i -
N7 >(I >(>(
3/11/2014Ny. irma TNI
7/21/2019 LAP (Autosaved)
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Ny.ri lestari >(>(
Ny Sri L#'tari >(>(3/12/2014-n. -lmira >(>(
Tn. Raiman -
Ny. irma TNI
Ny. -yu >
ny.)atipa! u(>(
Ny.ri lestari >(>(
Ny.>mi >(>( Tn.Raiman bp%s -
"/1"/2014 y. Ny. Ririn >(>(
Ny. Ririn >(>(
Ny. ri >tami >(>(
7/21/2019 LAP (Autosaved)
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Ny ?vi Ra!ma9ati ;
y. Ny. -ri ;
Ny. -ri ;
Ny.L-I-N- >mum
Tn.(ansur >mum
"/14/2014 Tn ara' -(;?(-
Tn. @aras -(;?(-
"/1/2014 Ny. Laili ;
Ny. ri >tami >
Tn. @aras -(;?(-
3/1#/2014 Tn ?i Tri -
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7/21/2019 LAP (Autosaved)
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Ny. Lasti >(>(
ny. (elati >(>m
by. Ny. L-ti >(>(
y. Ny. (elati >(>(
Ny. Lasti >(>(
Ny. ($na! >mum
ny I'ti3oma( >(>(
"/20/2014 tn. upen$ >(>("/21/2014 Ny. Rina ;
Ny. ulastri -(;?(-
7/21/2019 LAP (Autosaved)
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Tn.?)$ -
Ny.Rina ;
Ny.?ni Raa -
Ny.ulastri (as)in
"/22/2014 Ny. ?ni Raa -
y. Ny. *anra >
Ny. *!anra -(T?;
Ny. ulastri >mum
Ny. Rina ;
3/23/2014 Ny. *!anra ;
7/21/2019 LAP (Autosaved)
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Ny. Rina ;
"/24/2014 Tn.aniin -;?
-n.N$va9ira ;
Tn. aniin -;?
Ny. <eni ur9ati >(>(
"/2/2014 Tn. +ibyant$r$ -
Tn D(i,yantoro -
An 9(an8a ;
Ny 7atemi >mum
N7 <eni >(>(
Tn Panidin -;?
y.;an,a (aniri
Ny. iti umartini >(>(
Tn. aniin >(>(
Tn. +ibiyant$r$ -
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 126/539
3/2#/2014 Ny. @atini >(>(
Tn. Imam >(>(
Tn.aniin bp%s -
Ny ri >ntari -;?
Tn Di,iyantoro -
Tn Imam bp%s a
N> Siti S&martini >(>(
Ny Sri Untari -;?
By 9(an8a >(>(
3/2=/2014 Ny. itria >mum
Ny. ?)$ >mum
Ny.iti sumarsini >(>(
Ny.ri >ntari -;?
Ny.(eria >(>(
7/21/2019 LAP (Autosaved)
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N7 @atini bp%s %a(;?(-
N7 ri >ntari -;?
Tn +ibyant$r$ bp%s -
Tn Imam -
Ny +anria (-N+IRI
"/2)/2014 NN. -mana ;
Ny.ri @ulanari (aniri
Ny.Insap @ati ams$tec
7/21/2019 LAP (Autosaved)
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3/2B/2014 Ny. >mi R$i)!aniati -;?
Ny. ri >ntari -;?
y. Ny. >mi >
y. Ny. >mi - >
ny S&a'tri >mum
Tn ;abul >(>(
Ny Sri Untari -;?
Tn Imam -
N7 @atini -(;?(-
"/"0/2014 Tn. ;abul -(;?(-
y. ;an,a -'ila >
Ny. N$vita ;
Ny. iti Nur aia ;
7/21/2019 LAP (Autosaved)
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Ny. +eiby ;
Ny. iti nur aia ;
y. Ny. N$vita ;
Ny. @inarti) >mum
Tn. Imam >
Ny. ri >ntari >
Ny. @atini -(;?(-
Ny. iti Nur >
"/"1/2014 Sdr M M&min >
Nn S#rita bp%s )
NySri :a(ay& BPJS 9
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NnAmanda BPJS
Tn9a,& BPJS UMUM
NySri Untari BPJS AS9ES
TnImam BPJS A
7/21/2019 LAP (Autosaved)
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NAMA OBAT JUMLAH
UMUM BPJS UMUM
S#an- O2 d' 1 +00
*#%ota$im# in! 1 4)00
'.&it 10*** 1 1"00n##d# 2 1 "00
I 20 1
In%&'#t Bia'a 1
S.&it ** "
'.&it "** "
D40; 1 2400
5#%tria$on# In! 1
5i.ro In% 1 2+400
%&ro'#mid in! 1 2200
5a.to.ri 2 10
'.&it "** 2
'.&it "** 2
a3&a In! 1
9#toroa* in! 2
a3&a In! 1
S.&it 10** 2
Hand'*oon Non 100 1"0000
%&t(roit 4
iv 20 2Infuset iasa 1
spuit 3cc 5
*eftria&$ne In% 2
a'ua In% 2
spuit 10cc 2
neele 23 1
neele 25 1
Lev$C$&acin 1 =8000
$rbivent 5 43500
li&$tite 3 5#1005 1/2 2 18200
puit 3 cc 2 1#00
cef$ta&ime in% 1 4800
puit 3 cc 5 4000
elan" 2 9s 1 #500
puit 5 cc 3 3000
puit 10 cc 3 3B00
BPJS9ELUA:GA
7/21/2019 LAP (Autosaved)
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*eftria&$ne In% 2 10800
Nele 25 1 300
a'ua In% 2 4200
Lev$C$&acin 1 =8000
+ 5 1 #000
+ 5 1 #000
+ 5 1 #000fur$semi in% 3 ##00
spuit 3cc 4 3200
spuit 3cc 4
*eftria&$ne In% 1
puit 10cc 3
a'ua In% 1
spuit 3cc 2
*eftria&$ne In% 2
puit 10c 2
spuit 3cc 4
a'ua In% 1
*eftria&$ne In% 2 10800
utr$lit 3 140400
puit 10c 2 2#00
spuit 3cc 3 2400
a'ua In% 1 2100
*eftria&$ne In% 1
spuit 3cc 4
5 1/4 2 18200spuit 3cc 1 800
-m$& Tab 10 4000
puit 10 cc 1 1300
(ucus e& 1 10#00
puit 3 cc 1 800
a'ua In% 1 2100
I 22 1
Infuset iasa 1 4=00
spuit 3cc 3 2400
Infuset iasa 1 4=00spuit 3cc 3 2400
spuit 3cc 2
metr$ tab 15
puit 10cc 2
puit 3cc 2
a'ua In% 1
puit 5cc 2
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Lev$C$&acin 1 =8000
;- ?N 3 3 3#B00
I *at! 22 1 #B00
I *at! 24 1 #B00
puit 5 cc 1 1000
Infuset iasa 1 4=00
+5 1/4 3 2=300Ranitiine tab 10 2000
*ipr$ tab 10 4000
+10 1 ##00
*eftria&$ne In% 2 10800
puit 10 cc 1 1300
puit 3 cc 3 2400
a'ua In% 1 2100
puit 3 cc 3 2400
puit 3 cc 3
Lev$C$&acin 1 =8000
Infus +ara! 1 #100
I 18 2 13800
puit 3 cc 3 2400
puit 10 cc 1 1300
a'ua In% 1 2100
Infuset iasa 1
Iv *at! 20 1
puit 10 cc 2
puit 5 cc 2puit 3 cc 2
Neele 25 1
*eftria&$ne In% 2
mepra,$le in% 2
Neele 25 1
spuit 10cc 4
Ranitiine tab 10 2000
+5 1 #000
+e&a in% 4
puit 3 cc 3*eftria&$ne In% 2
mepra,$le in% 2
puit 3 cc 2 1#00
*erftria&$ne 2 10800
puit 10 cc 1 1300
Nele 25 1 300
+5 1 #000
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Lev$C$&acin 1 =8000
+5 1 #000
+5 2 12000
+e&a in% 3 #000
puit 3 3 2400
Infuset iasa 1
iv 20 2RL 3
puit 10ccc 3
puit 5cc 3
Neele 25 1
+ 5 2
cef$ta&ime in% 2
c 1# 1 15500
>rine ba" 1 4400
-'ua in% 1 2100
lu" 1 8200
ur$semi in% 10 22000
Neele 23 1 300
spuit 3cc 1 800
Infuset ara! 1 #100
*ipr$ Tab 10 4000
I *at! 20 1 #B00
(etf$rmin Tab 15
nancentr$n in% 2 8#00
nancentr$n in% 2 8#00Lev$C$&acin 1 =8000
cef$ta&ime in% 2
a'ua In% 1
puit 5cc 2
puit 3cc 1
*eftria&$ne In% 2
puit 10cc 4
puit 3cc 2
+ 40 1 2400
iv 18 1 #B00c 1# 1 15500
>rine ba" 1 4400
spuit 10cc 1 1300
a'ua In% 1 2100
RL 4
Infus +ara! 1
I 20 1
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*eftria&$ne In% 2
entamisin in% 1
puit 10cc 3
puit 3cc 3
Neele 25 1
3@ay elan" 1
a'ua In% 1lu" 1 8200
I 20 1 #B00
iv 20 1
Infuset iasa 1
*l$pramel 4
e&anta syr 1
,yf$rt 3
+5 2
+40: 2 4800
entamisin in% 3
e&a in% 2
puit 10cc 2
puit 5cc 1
puit 3cc 2
cef$ta&ime in% 2
puit 10cc 1
puit 5cc 1
puit 3cc 1
ur$semi in% #puit 5cc 2
puit 3cc 1
Lev$C$&acin 1 =8000
Infuset ara! 1 #100
iv 18 2 13800
spuit 3cc 5 4000
+e&a in% 2 4000
entamisin in% 1 3800
c 1# 1 15500
>rine ba" 1 4400-'ua in% 2 4200
puit 10cc 1 1300
puit 5cc 3 3000
ur$semi in% #
spuit 3cc 3
*eftria&$ne In% 2
entamisin in% 2
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puit 10cc 3
puit 5cc 2
-'ua in% 2
Lev$C$&acin 1 =8000
+e&a in% 4
spuit 3cc 3
Lev$C$&acin 1 =8000+e&a in% 3
spuit 3cc 4
ur$semi in% #
spuit 3cc 3
Iv 24 1 #B00
I 20 1 #B00
Try elan" 1
Infus isa 1
*eftria&$ne In% 1
puit 10 cc 2
-'ua in% 1
+40: 1 2400
)cl 1 2500
entamisin in% 1 3800
puit 3 cc 5 4000
infus iasa 1 4=00
Iv 20 1 #B00
puit 10 cc 3 3B00
puit 5 cc 3 3000puit 3 cc 3 2400
Nele 25 1 300
Nacl 1 #800
ur$semi in% 20 44000
e&a in% 3
ranitiine in% 2
Nacl 2
spuit 3cc 4
spuit 3cc 3 2400
iv 18 2fc 1# 1
>rine ba" 1
spuit 10cc 1
spuit 5cc 3
neele 23 1
spuit 3cc 5
cef$ta&ime in% 3
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+5 1
Infus iasa 1 4=00
iv 20 1 #B00
-ml$ipine 5 10 5000
puit 3 cc 5 4000
puit 5 cc 2 2000
-ml$ipine 5 10 11000a'ua In% 2 4200
puit 5cc 3 3000
puit 3cc 4 3200
Infuset iasa 1
I *at! 20 2
*eftria&$ne In% 2
puit 5 cc 2
puit 3 cc 1
Neele 25 1
a'ua In% 1
>rine ba" 1
RL 3 18000
+5: 1 #000
065 L 1 #800
cef$ta&ime in% 3 14400
Trama$l In% 3 23100
nancentr$n in% 3 12B00
puit 3 cc 3 2400
puit 3 cc 2 1#00*eftria&$ne In% 2
puit 3 cc 2
puit 10 cc 1
(ucus e& 1 10#00
puit 10cc 2 2#00
-'ua in% 1 2100
c 1# 1 15500
>rine ba" 1 4400
Infuset ara! 1 #100
Iv 18 1 #B00puit 3cc 4 3200
+e&a in% 2 #000
Infuset iasa 1 4=00
Iv 20 1 #B00
nancentr$n in% 3 12B00
puit 5cc 3 3000
spuit 3cc 3 2400
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neele 25 1
*eftria&$ne In% 2
*apt$pril 25 3
*apt$pril 25 # 1200
puit 5 cc 2 2000
puit 3 cc 1 800
Infus +ara! 1puit 3 cc 8
puit 5 cc 3
puit 10 cc 1
I 18 1
c 1# 1
>rine ba" 1
a'ua In% 1
Nele 23 1
cef$ta&ime in% 3
elan" 2 9s 1
+5 1
ur$semi in% 1
*eftria&$ne In% 2
puit 3 cc 4
Neele 25 1
a'ua In% 1
Infuset ara! 1 #100
I *at! 20 2 13800
*eftria&$ne In% 2 10800puit 10 cc 2 2#00
Neele 25 1 300
-'ua in% 1 2100
puit 3 cc 1 800
relivan 3 1#500
puit 3cc 1 800
cef$ta&ime in% 2 B#00
-'ua in% 1 2100
Neele 25 1 300
iv 22 1 #B00iv 24 1 #B00
*eftria&$ne In% 2
puit 3cc 3
-'ua in% 1
I 24 4 2=#00
;-- 10D4 1 4#00
I 20 1 #B00
7/21/2019 LAP (Autosaved)
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Infuset iasa 1 4=00
c 1# 1 15500
>rine ba" 1 4400
spuit 10cc 2 2#00
puit 5cc 2 2000
-'ua in% 2 4200
Infuset ara! 1 #100iv 18 1 #B00
fc1# 1 15500
>rine ba" 1 4400
puit 3cc 8 #400
puit 5cc 3 3000
puit 10cc 1 1300
Neele 23 1 300
cef$ta&ime in% 3 14400
elan" 2 9s 1 #500
)et$r$lac in% 1 ##00
Infuset ara! 1 #100
iv 18 1 #B00
fc 1# 1 15500
>rine ba" 1 4400
spuit 3cc 8 #400
spuit 5cc 3 3000
spuit 10cc 1 1300
neele 23 1 300
cef$ta&ime in% 3 14400elan" 2 9s 1 #500
+5 1 #000
)et$r$lac in% 3 1B800
a'ua In% 2 4200
(ucus e& 1 10#00
(ucus e& 1 10#00
Inu&in 1 2=00
>$pa 2 2B#00
spuit 5cc 1 1300
!amin$v 1 5000nancentr$n in% 2 8#00
*eftria&$ne In% 1 5400
puit 10 cc 3 3B00
puit 5 cc 3 3000
puit 3 cc 3 2400
Neele 25 1 300
a'ua In% 1
7/21/2019 LAP (Autosaved)
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ur$semi in% 1
puit 5 cc 1
puit 3 cc 1
*$ein 10 m" Tab 10
IN> I-- 1
puit 3 cc 1
nancentr$n in% 2puit 5 cc 1
puit 10 cc 1
puit 10 cc 1 1300
Nele 25 1 300
nancentr$n in% 2 8#00
puit 3 cc 3 2400
a'ua In% 1 2100
Iv 20 1
Infus I- 1
puit 10 cc 4
puit 5 cc 3
puit 3 cc 4
a'ua In% 2
utr$lit 1
*erftria&$ne 2
ur$semi in% 3
)et$r$lac in% 3
puit 10 cc 2
puit 5 cc 1puit 3 cc 3
a'ua In% 1
imvastatin 10
(ucus e& 1 10#00
Infuset ara! 1
Iv 18 1
c 1# 1
>rine ba" 1
puit 5cc 2
puit 3cc 4Neele 23 1
cef$ta&ime in% 3
Neele 23 1 300
ur$semi in% 2 4400
)et$r$lac in% 3 1B800
*l$pramel 3 8400
*efar$&il *aps 10 8000
7/21/2019 LAP (Autosaved)
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+5 1/2N 1 B100
Iv 20 1
Infus iasa 1
elan" 2 9s 1
puit 10 cc 5
puit 5 cc 5
puit 3 cc 3Nele 35 1
+ea& in% 3
-sam Trane&anat in% 3
*eftria&$ne In% 2
-'ua in% 2
Iv 20 1 #B00
Infus I- 1 4=00
puit 5 cc 2 2000
puit 3 cc 5 4000
puit 5cc 3
-'ua in% 1
Infuset ara! 1 #100
I 18 1 #B00
ur$semi in% 1
puit 3cc 1
+5 1/2N 4
*eftria&$ne In% 2
puit 5cc 2
5 1spuit 3cc 1 800
spuit 10cc 1 1300
iv 24 1 #B00
alsartan 80m" 10 48000
Neele 23 1 300
+ 5 1 #000
+e&a in% 3
cef$ta&ime in% 2
ur$semi in% 1
puit 5 cc 2puit 3 cc 10
a'ua In% 1 2100
-sam Trane&anat in% 1 5100
puit 5cc 1 1000
!amin$v 3 15000
Neele 25 1
puit 10cc 1
7/21/2019 LAP (Autosaved)
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a'ua In% 1 2100
puit 10cc 3 3B00
puit 5cc 4 4000
puit 3cc 3 2400
ut!r$lit 1 4#800
*eftria&$ne In% 2 10800
a'ua In% 1 2100puit 10 cc 3 3B00
puit 3 cc 3 2400
puit 5 cc 3 3000
Neele 25 1 300
puit 3 cc 3
puit 10 cc 1
Infus isa 1
cef$ta&ime in% 3
puit 10cc 3
puit 3cc 2
puit 5cc 2
*eftria&$ne In% 2
puit 10cc 3
*eftria&$ne In% 2 10800
puit 3cc 2 1#00
spuit 10cc 2 2#00
a'ua In% 1 2100
Infuset iasa 1
I 20 1cef$ta&ime in% 3
a'ua In% 1
puit 3cc 3
puit 5cc 3
spuit 10cc 3
Neele 25 1
Iv 24 # 41400
r$feni # 30#00
;ut$in in% 10 288000
+e&aE in% 2 4000limepiri 1m" 1# B#00
mepra,$l 8 4000
*eftria&$ne In% 2
Infus +ara! 1 #100
urC$ 18 1 #B00
+5 1 #000
c 1# 1 15500
7/21/2019 LAP (Autosaved)
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>rine ba" 1 4400
puit 10 cc 1 1300
-'ua in% 1 2100
cef$ta&ime in% 3 14400
puit 5 cc 3 3000
puit 3 cc 5 4000
puit 3cc 3spuit 10c 2
*eftria&$ne In% 1
>IT 10* 2
puit 3cc 2
puit 10c 1
*eftria&$ne In% 2
>IT 10* 3
Infuset ara! 1
iv 18 1
+5 1
c 1# 1
>rine ba" 1
>IT 10** 1
puit 5cc 3
cef$ta&ime in% 3
puit 3cc 4
-'ua in% 2
Infuset ara! 1 #100
Rl 2 12000*eftri 2 10800
spuit 3cc 3 2400
spuit 5cc 3 3000
neele 25 1 300
-'ua in% 1 2100
Infus +ara! 1
Iv 18 1
c 1# 1
>rine ba" 1
puit 10 cc 1puit 5 cc 3
puit 3 cc 5
cef$ta&ime in% 3
Nele 23 1
a'ua In% 1
elan" 2 9s 1
Infus +ara! 1
7/21/2019 LAP (Autosaved)
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c 1# 1
>rine ba" 1
puit 5 cc 3
puit 10 cc 1
cef$ta&ime in% 3
a'ua In% 1
Iv 18 1+5 1
puit 3 cc 4
Infuset ara! 1
iv 18 1
>rine ba" 1
spuit 10cc 4
spuit 3cc 4
neele 23 1
a'ua In% 1
5: 1
Trama$l In% 2
imvastatin 10
(ucus e& 1 10#00
(ucus e& 1 10#00
!amin$v 4 20000
puit 10cc 2 2#00
puit 5cc 2 2000
puit 3cc 2 1#00
puit 10cc 1puit 3cc 3
*eftria&$ne In% 1
a'ua In% 1
puit 10cc 2
puit 3cc 1
puit 3cc 4
imvastatin 10
Neele 25 8 2400
puit 3cc 8 #400
+e&a in% 2 4000puit 3cc 3 2400
Neele 23 1 300
Infuset ara! 1 #100
a'ua In% 1 2100
Infuset iasa 1 4=00
*eftri 1 5400
puit 10cc 3 3B00
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puit 5cc 3 3000
puit 3cc 5 4000
Neele 25 1 300
Infuset iasa 1 4=00
relivan 2 11000
puit 3cc 3 2400
+5 2 12000;r 10 23000
imvastatin 10 3000
(ucus e& 1 10#00
+10 1 13500
!amin$v 1 5000
puit 10cc 1 1300
3 9ay selan" 1 32#00
$spar"in in% 1 1800
puit 10 cc 1 1300
*eftri In% 2 10800
puit 10 cc 1 1300
puit 5 cc 2 2000
puit 3 cc 1 800
+e&a in% 3
puit 5 cc 2
puit 3 cc 2
puit 3 cc 2 1#00
Infuset ara! 1 #100
iv 20 1 #B00*eftria&$ne In% 2 10800
-'ua in% 1 2100
spuit 10cc 3 3B00
puit 5cc 3 3000
puit 3cc 3 2400
neele 25 1 300
Infuset iasa 1 4=00
iv 20 1 #B00
*eftria&$ne In% 2 10800
-'ua in% 1 2100nancentr$n in% 2 8#00
spuit 10cc 3 3B00
spuit 5cc 3 3000
spuit 3cc 4 3200
neele 25 1 300
S.&it 10 ** " "?00
S.&it ** 1 1000
7/21/2019 LAP (Autosaved)
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Na* 1L 2 1=200
6* 1+ 1 100
&rin,a- 1 4400
S.&it 10 ** 2 2+00
a3&a in! " +"00
amodi.in# 10 10 11000
Pro%#nid '&. 1 100
5#%tria$on# 2 10)00
9#toroa* " 1?)00
6&trit 2 ?=200
S.&it 10 ** 4 200
S.&it ** 2 2000
a3&a in! 1 2100
S#an- 02 D' 1 +00
S.&it " ** 2 1+00
S.&it ** 2 2000
a3&a in! 1
a3&a in! 1
3604=6300 160=36400 1623#6#00
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HA:GA PASIEN
BPJS AS9ES BPJS MANDI:I
+?00
4=00
"000
2400
400
2000
1+00
1+00
2100
1"400
2100
2+00
1)=200
138004=00
4000
10800
4200
2#00
300
300
BPJS ANGGOTA
BPJSBPJS
BPJSJAM9ESMAS
BPJSJAMSOSTE9
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3200
5400
3B00
2100
1#00
10800
2#00
3200
2100
5400
3200
#B00
1#00
3000
2#00
1#00
2100
2000
7/21/2019 LAP (Autosaved)
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2400
4=00
#B00
2#00
20001#00
300
10800
1=B#00
300
5200
8000
240010800
1=B#00
7/21/2019 LAP (Autosaved)
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4=00
1380018000
3B00
3000
300
12000
B#00
3000
B#00
2100
2000
800
10800
5200
1#00
24000
#100
#B00
7/21/2019 LAP (Autosaved)
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10800
3800
3B00
1800
300
32#00
2100
#B00
4=00
11200
#000
12#00
12000
11400
4000
2#00
1000
1#00
B#00
1300
1000
800
132002000
800
13200
2400
10800
=#00
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3B00
2000
4200
8000
2400
#000
3200
13200
2400
32#00
4=00
5400
2#00
2100
#000
=#00
13#00
3200
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4=00
13800
10800
2000
800
300
2100
10800
#00
1300
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4=00
B3#00
#B00
#500
##00
2400
2000#800
4400
1#00
1300
44001#00
4=00
#B00
#000
3B00
3000
2400
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300
10800
#00
#100#400
3000
1300
#B00
15500
4400
2100
300
14400
#500
#000
2200
10800
3200
300
2100
10800
2400
2100
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2100
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#B00
4=00
#500
#500
5000
2400300
#000
15300
10800
4200
3000
2100
2200
800
32400
10800
2000
#000
#000
B#00
2200
20008000
300
1300
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2400
1300
4=00
14400
3B00
1#00
2000
10800
3B00
4=00
#B0014400
2100
2400
3000
3B00
300
10800
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24002#00
5400
2#00
1#00
1300
10800
3B00
#100
#B00
#000
15500
4400
1300
3000
14400
3200
4200
#100
#B00
15500
4400
13003000
4000
14400
300
2100
#500
#100
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15500
4400
3000
1300
14400
2100
#B00#000
3200
#100
#B00
4400
5200
3200
300
2100
#000
##00
3000
13002400
5400
2100
2#00
800
3200
3000
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#000
2000
1#00
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2100
2100
=886=00 206200 #856B00 4#56200 2246200 1156=00
=6=246300
#326500
8635#6800
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TNI
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1380015500
4400
1300
3000
300
4000
14400
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#000
4400
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#=6100 =6=246300
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT
"/1/2014 TnSidi BPJS A G#m%i,ro8i "00
Ny Ta'o#mi UMUM d#$a*a. 12<
No#rty
"/"/2014 Tn Eo BPJS A 5i.ro Ta,
Nn Li'na BPJS U 5i.ro Ta,
AnI3,a UMUM Ondan*#tron ta,
"/4/2014 Ny Sri P&rnama BPJS 9 Om#.ra8o#
5i.ro Ta,
Tramado 5a.'
Tn Sidi BPJS A Amodi.in 10 m- ta,
3/5/2014 dr-Ad# BPJS A 5#%adro$i 00 m-
3/#/2014 Tn Sarmani UMUM Ondan*#tron In!
3/B/2014 Ny Ha%i8( UMUM Erytromi*in 20m-
Tn. armani >(>( ?rytr$micin 250 m"Ny Si'ati 9A:EB Gim#.irid# 1 m-
3/11/2014 Tn ar'ito UMUM Erytromi*in 20
"/1"/2014 Tn Sidi BPJS A Amodi.in 10 m- ta,
5am#o*
"/14/2014 M, Dia( BPJS A T#n'o*r#.# + In*(i
Ny Ety BPJS AS9#' Lomat&#
"/1)/2014 Ny M&!i BPJS U M#t%ormin
Ny S&tarni BPJS U 5a.to.ri 2 m-
Amodi.in 10 m- ta,
Ny Sri a(y&ni BPJS A Amodi.in 10 m- ta,
Ny S&darni UMUM Amodi.in 10 m- ta,
Tn Adi UMUM 5am#o*
"/20/2014 Ny Ani' UMUM Do$i$*in 100 m-
Ny Sri BPJS 9 Om#.ra8o#
"/21/2014 P9U 9aitid& ida(#'
3/23/2014 Ny D#i BPJS 9 5#%adro$i 00 m-
"/2/2014 Ny<S&darti &mUM Amodi.in 10 m- ta,
Ny S&yatmi BPJS 9 Amodi.in 10 m- ta,
Tn Bam,an- BPJS A 5od#in 10 m- Ta,
3/2=/2014 Ny Sri BPJS 9 Amodi.in m-
IGD Pro%#nid '&.
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JUMLAH
HA:GA PASIEN
UMUM BPJS BPJS
10
1
10
10 4000
" ""000
+ "000
10 4000
) 2400
20 22000
10 )000
" ""000
40 20000
20 10000
20
20 10000
14 1400
14 )400
1 =0=00
1 1=200
+0 12000
4 ?000
1 1+00
00
= ==00
14 )400
10 4000
10 000
1+"00
10 )000
14 "0)00
10 22000
10 +000
20 10000
10 1000 "")<400 =4<00 +0<400 1"0<000 1=<200
BPJSUMUM
BPJS9ELUA:GA
BPJS ANGGOTA
BPJS AS9ES
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9A:EB
12000
12<000 +"2<00
BPJSJAM9ESMA
S
BPJSMANDI:I
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT
3/31/2014 Nn. Serlita BPJS DINAS 3 way elan!
By. Ny. N"#iati BPJS DINAS $%l
A&'a in(
Genta)i%in in(
*a !l'+"na
S,'it 3%%S,'it 10%%
D40
Ny. Siti BPJS DINAS -%1
elan! O2 w
i# 20
,'it 10%%
'rinea!
ea in(
aa) tranea)at in(
,'it %%
,'it 3%%
in-'et araTn. $a'l BPJS MM 5'r"e)ie In(
S,'it 3 %%
Ny. 6atini BPJS MM ea in(
S,'it 3 %%
S,'it %%
Tn. I)a) BPJS MM *E5T7I In(
S,'it 10 %%
S,'it %%
Ny. Sri ntari BPJS MM *E5T7I In(
S,'it %%
A&'a in(
Nn. Serlita BPJS DINAS *E5T7I In(A&'a in(
4/1/2014 Tn I)a) BPJS DINAS in-'et ara
3 way elan!
S,'it 3 %%
Ny 7eni 7i+a BPJS DINAS in-'et ara
S'r-l" 18
5* 1
'rinea!
S,'it 3 %%
S,'it %%
S,'it 10 %%
Ny S'latri MM Pa)in"# Ny Daiy BPJS DINAS Pr"-eni S',,
S,'it 3 %%
Ny Siti N'r 7")a BPJS MM Pr"-eni S',,
in-'et ara
S'r-l" 18
5* 1
'rinea!
S,'it 10 %%
S,'it %%
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An.Eri% BPJS MM S,'it 3 %%
S,'it %%
Ny.Dei BPJS MM In-' Dara
i# 18
5* 1
'rinea!
S,'it 10 %%
*e-"tai)eea in(
S,'it 3 %%
Tn $a'l BPJS MM 5'r"e)ie In(
,'it 3%%
Ny S')arni BPJS MM O)e,ra9"l in(
Antrain In(
*E5T7I In(
S,'it 10%%
S,'it 3%%
Tn I)a) BPJS DINAS S,'it 10%%
*E5T7I In(
N: Mina BPJS MM *E5T7I In(S,'it 10%%
,'it %%
S,'it 3%%
Nn Serlita BPJS DINAS Antrain In(
S,'it 10%%
,'it %%
ny Siti n'r BPJS DINAS S,y'it 3%%
Ny Inrianin!i BPJS MM S,'it 3%%
S,'it 10%%
4/4/2014 Ny. Sri 6ay'ni BPJS MM S,'it 3%%
Ny. Gal' BPJS DINAS i# 20
In-'et Biaa-'tr"lit
S,'itn 10%%
S,'it %%
S,'it 3%%
Neele 2
Antrain In(
An. Eri% BPJS MM S,'it 3 %%
BON ;* ;an%""n N"n
Nn Serlita BPJS DINAS O)e,ra9"l Ta
Ny :ei+a BPJS DINAS in-'et ara
S'r-l" 20
S,'it 10 %%S,'it 3 %%
Ny Dei M'+li-at'n BPJS MM S,'it %%
*e-"tai)e
Pr"-eni S',,
Ny.$'tini BPJS MM *e-"tai)e
In-' Dara
I< 18
S,'it %%
S,'it 3 %%
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Nele 23
Ny S')ar)i BPJS MM I# 22
An Eri% G BPJS DINAS *e-"tai)e
Tn I)a) BPJS DINAS S,'it 10%%
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Ny Inrianin!i BPJS MM S,'it 10%%
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,'it %%
Nn :ei+a BPJS MM S,'it 3%%
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I< *at 20 Neele 2
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,'it
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S,'it 3 %%
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Ny.Erni BPJS MM In-' Dara
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4//2014 Ny. Ay' 'anti BPJS MM in-'et ara
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aa) tranea)at in(O)e,ra9"l in(
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By $an9a BPJS MM ,'it 3%%
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Tn. S')arn" BPJS DINAS In-'et Biaa
4/8/2014 Ny. Siti $"ir"t'n Nia BPJS MM S,'it 3 %%
Ny. Satiye) BPJS MM I< *at 20
Ny. S')ar)i BPJS MM ea in(
S,'it 3%%
Tn. Praety" BPJS MM ea in(
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Neele 2
Ny. $"ir"t'n BPJS MM in-'et ara
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Tn. S'y"n" BPJS DINAS 5'r"e)ie In(
Tn. S')arn" BPJS DINAS 5'r"e)ie In(
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Sr. Pa+an BPJS DINAS $et"r"la% In(Genta)i%in in(
,'it 3%%
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Ny. T'ti+ BPJS MM in-'et ara
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Tn.S'("n" BPJS DINAS 5'r"e)ie In(
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Tn.Nai BPJS DINAS S,'it 10 %%
S,'it 3 %%
N%al
Nele 2
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Onan%etr"n
Dia9"le
S",'it %%
S,'it 10 %%
Ny.N"#ita ari BPJS DINAS S,'it 3 %%
Nele 23
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S,'it %%
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S,'it 3 %%
$et"r"la%
Ny.Inranin!i BPJS DINAS Selan! 02 Dw
In-' Dara
I# 20
By Ny M'tin BPJS MM M'%'Ma Dey BPJS MM P? 1 ltr
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An. ?yra BPJS DINAS In-'et BiaaI# 22
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Metr" Ta
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Antrain In(
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S,'it 3 %%
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Ny. Mariyat'n BPJS MM *e-tria"ne
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S,'it 10%%
S,'it %%
,'it 3%%
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Tn. S',"y" BPJS DINAS *e-tria"neS,'it 10%%
,'it 3%%
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S,'it %%
,'it 3%%
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,'it 3%%
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,'it 3%%
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S,'it %%
S,'it 10%%
Tn. S'+'r BPJS MM S,'it %%
S,'it 3%%
Tn. A)a BPJS MM *e-tria"ne
S,'it 10%%
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A&'a in(
5'r"e)ie In(
Ny. Mariyat'n BPJS MM *e-tria"ne
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Ny. Deiy BPJS DINAS S,'it %%
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Ny. Dei BPJS MM Dia9"le
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Tn S"e+"n" BPJS DINAS ,'it 3%%
Tn Nati!"r BPJS DINAS ,'it 3%%
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Tn Tar)ii BPJS MM *e-tria"ne
N: )ariat'n B,( MM *e-tria"ne
S,'it 10%%
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elan! O2 wS,'it 3%%
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Neele 23
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i# 20
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Tn. TASri, BPJS DINAS In-'et Biaa
i# 20elan! O2 w
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Tn. TASri, BPJS DINAS Al,ra9"la) 1 )!
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Ny Matiyat'n BPJS MM *e-tria"ne
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S,'it 10%%
Tn Tar)ii BPJS MM S,'it 10%%
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Tn S"e+"n" BPJS MM S,'it 10%%
Tn A)a BPJS MM 5'r"e)ie In(
ea in(
*e-tria"ne
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S,'it 3%%
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4/1@/2014 An. 7i9+y BPJS DINAS In-'et BiaaD 1/4
I# 22
I# 24
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Ny. Mariat'n BPJS MM S,'it 10%%
Tn. NAti!"r BPJS DINAS S,'it 3%%
Ny. Parni BPJS MM S,'it 3%%
tn. S"e+"n" BPJS DINA S,'it 10%%
S,'it %%
S,'it 3%%
Tn. Tar)ii BPJS MM S,'it 10%%
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4/21/2014 An 7i9+y BPJS DINAS Pl'!
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Ny. Sa)iai MM L")at'lle
Ny. :ani+ BPJS MM in-'et ara
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Ny N'r'l BPJS MM in-'et ara
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rina!
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Ny. Parni BPJS MM in-'et arai# 20
3 way elan!
Tn. TASri, BPJS DINAS Antrain In(
Tn. N'rai MM Antrain In(
Ny. J'wini MM Antrain In(
Tn. Ja-ar MM Antrain In(
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4/23/2014 Ny. I-a BPJS MM in-'et ara
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S,'it 3%%S,'it %%
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Neele 23
Ny. $ASiyati MM Antrain In(
Ny. Ne%i B,( MM S,'it 3 %%
Ny. Parni BPJS MM S,'it 3 %%
Ny. :ayi BPJS MM in-'et ara
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S,'it %%
ea in(
Neele 23
rina!
S,'it 10 %%
A&'a in(
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S,'it 3 %% Ny. Ne%i B,( MM in-'et ara
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Tn. N'r ;ai MM Antrain In(
Tn. TASri, BPJS DINAS Antrain In(S,'it %%
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4/24/2014 Ny. $'nia MM Antrain In(
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Ny. Ain'n B,( MM in-'et ara
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S,'it %%
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neele 23
*e-"tai)e in(
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Antrain In(
An. 7e#ania BPJS DINAS In-'et Biaai# *at 24
Onan%etr"n
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Ny. Al-ini MM Antrain In(
Ny Tati+ BPJS MM I# 18
I# 20
in-'et ara
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An. 7e#aia BPJS DINAS $aen 3A
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S,'it 3%%
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Ny. Parni BPJS MM ea in(
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A&'a in(
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By. Ny. 6atini M) M'%'
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Neele 2
Ny. Sya-ri+a BPJS MM S,'it 3%%
Neele 23
Sr. T!ri etyawan BPJS DINAS Neele 2
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A&'a in( Ny L'tini B,( MM in-'et ara
i# 18
rina!
S,'it 10%%
*e-"tai)e in(
S,'it %%
S,'it 3%%
Tra)a"l
Ny Dwi 7ay' BPJS MM S,'it 3%%
S,'it 10%%
3 way elan!
!enta in(ea in(
SDr ADI BPJS MM *e-tria"ne
Antrain In(
S,'it 10%%
S,'it 3%%
4/2>/2014 Sr. Ani+ MM Antrain In(
Tn. A)ri9al BPJS DINAS in-'et ara
i# *at 20
A&'a in(
elan! O2 w
,'it 10 %%
S,'it %%S,'it 3 %%
Neele 2
By. Ny. Li%+a BPJS MM M'%'
Ny. Li%+a BPJS MM S,'it 3%%
in-'et ara
S'r-l" 18
S,'it 10%%
Neele 23
Ny. Dwi BPJS MM Onan%etr"n
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 205/539
!enta in(
r.ai BPJS MM Antrain In(
,'it 3
A&'a in(
Tn.Atawa BPJS INAS In-' Bia
I# 20
*e-tr
S,'it 10S,'it
S,'it 3
nele 2
A&'a in(
elan! O2 w
4/28/2014 Ny. <era BPJS MM in-'et ara
S'r-l" 18
S,'it 3 %%
S,'it 10 %%
A&'a in(
Sr. Setiawan BPJS INAS Onan%etr"n
*e-"tai)e in(Tn. I Nen!a BPJS INAS Pa)in"#
Ny. 7i+a BPJS MM in-'et ara
i# *at 18
A&'a in(
S,'it 3 %%
S,'it 10 %%
Ny. Li%+a BPJS MM S,'it 3%%
Ny. ;arti BPJS MM !enta in(
S,'it 3%%
elan! O2 w
S,'it 10%%
y. Ny. 7i+a BPJS MM M'%'By. Ny. ;arti BPJS MM M'%'
Ny.:'nita BPJS MM In-' Dara
i# 18
S,'it 3
S,'it 10
nele 23
,",ar!in in(
Sr.Tri BPJS INAS Onan%etr"n
SPIT 10
S,'it
S,'it 3
Sr.Ai BPJS MM Antrain In(,'it 10
,'it
,'it 3
Tn.AMI7L BPJS INAS S,'it 10
S,'it
Tn.Atawa BPJS DINAS <ent"lin
S,'it 10
S,'it
S,'it 3
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 206/539
Ny.Dwi BPJS MM !enta in(
ea in(
S,'it 10
S,'it
S,'it 3
4/2@/2013 Ny. P'(i At'ti+ BPJS MM in-'et ara
I< 18
S,'it 3%%S,'it 10%%
By. Ny. :'nita BPJS MM M'%'
By. Ny. P'(i At'ti+ BPJS MM M'%'
By. Ny. Al-ini BPJS MM S,'it 3%%
!enta in(
Ny. S',iyati BPJS MM In-'et Biaa
I# 20
S,'it 3%%
S,'it %%
Ny. :'li BPJS MM In-'et iaa
I< *at 20
S,'it %%S,'it 3 %%
S,'it 10 %%
Antrain In(
<ati!" Ta
Ny. S',iyati BPJS MM A)l"i,in )! Ta
Ny. Sri 6ay'tin BPJS MM in-'et ara
I< *at 18
rina!
S,'it 10 %%
S,'it 3 %%
S,'it %%
A&'a in(5'r"e)ie In(
Ny. Ia $'rniawati BPJS MM i# *at 18
in-'et ara
ea in(
rina!
S,'it 10 %%
S,'it %%
A&'a in(
S,'it 3 %%
Sr. Atawa BPJS INAS *e-tria"ne
S,'it 10%%
S,'it %%S,'it 3%%
A&'a in(
Ny. :'li Sety"wati BPJS MM Onan%etr"n
Antrain In(
S,'it %%
S,'it 3%%
Ny. S',iyati BPJS MM S,'it 3%%
tn. A)ir'l BPJS INAS aa) tranea)at in(
*e-tria"ne
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 207/539
S,'it 10%%
A&'a in(
Sr. Aitya BPJS MM Antrain In(
S,'it 10%%
S,'it %%
S,'it 3%%
Ny. Dwi BPJS MM *e-"tai)e in(
!enta in(S,'it 10%%
S,'it %%
S,'it 3%%
A&'a in(
Ny. S',arni MM Antrain In(
An. Ina BPJS INAS In-'et iaa
i# 20
A&'a in(
*e-tri
Antrain In(
S,'it %%
S,'it 3%%4/30/2014 ny 6i(i MM Antrain In(
Tn A)ir'l BPJS DINAS S,'it 10%%
Ny Dwi BPJS MM I# 20
Ny Ina BPJS MM *e-tria"ne
Antrain In(
N: 6i(i MM Antrain In(
Tn A)ir'l BPJS DINAS rina!
S,'it 10%%
A&'a in(
Ny Siti :'liati BPJS MM I# 20
in-'et ara
Ny 6ay' BPJS MM In-'et IASAI# 18
S,'it 3%%
A&'a in(
S,'it 10%%
elan! O2 w
B: N y Sri 6ay'tin BPJS MM M'%'
Tn A)ir'l BPJS DINAS S,'it 3%%
Neele 23
Tn. Atawa BPJS DINAS In-'et Biaa
Ny. Siti :'liati BPJS MM !enta in(
Antrain In(
S,'it 3%% Ny. Sri 6ay'tin BPJS MM 5'r"e)ie In(
S,'it 3%%
*e-"tai)e in(
$et"r"la% In(
I# 18
S,'it %%
elan! O2 w
A&'a in(
Nn. Ina BPJS INAS *e-tri
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 208/539
Antrain In(
S,'it 10%%
S,'it %%
S,'it 3%%
Ny. Dwi BPJS DINAS !enta in(
*e-"tai)e in(
S,'it 10%%
S,'it %%S,'it 3%%
Sr. Aitya BPJS DINAS Antrain In(
S,'it %%
S,'it 3%%
Tn. Atawa BPJS DINAS *e-tri
S,'it 10%%
S,'it %%
S,'it 3%%
Ny. S',riyatin BPJS MM S,'it 3%%
TOTAL
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 209/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 210/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 211/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 212/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 213/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 214/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 215/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 216/539
JMLA;;A7GA PASIEN
MM BPJS MM BPJS DINAS
1 32=00
1 2=00
1 2=100
1 3=800
1 12=00
10 8=0002 2=00
2 4=800
1 1=00
1 =00
3 20=>00
=00
1 4=400
1 2=000
1 =100
3 3=000
3 2=400
2 12=2001 2=200
2 1=00
3 =000
2 1=00
2 2=000
1 =400
1 1=300
2 2=000
2 =400
1 1=000
1 2=100
2 10=8001 2=100
1 =100
1 32=00
1 800
1 =100
1 =@00
1 1=00
1 4=400
8 =400
3 3=000
1 1=300
2=0002 10=200
2 1=00
2 10=200
1 =100
1 =@00
1 1=00
1 4=400
1 1=300
3 3=000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 217/539
4=800
1 4=300
3 14=400
2 2=800
1 =100
1 32=00
1 =00
3 1=0001 =000
3 24=000
2 1=00
1 8=000
1 2=200
2 1=00
2 10=000
2 4=000
2 1=00
2 10=800
3 24=000
2 1=002 2=000
2 2=00
2 1=00
1 4=>00
1 =@00
2 2=00
4 3=200
1 2=100
1 =00
10 @=000
1 4=>00
1 =@001 =@00
1 1=000
1 =400
4=000
2 2=00
2 4=400
1 2=200
3 2=400
2 1=00
2 2=800
4=000
3 3=@002 2=800
1 =400
1 10=00
2 11=000
2 1=00
2 @=00
3 3=000
2 13=800
1 =100
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 218/539
1 800
1 1=000
1 =100
1 =@00
1 1=00
1 4=400
2 2=00
3 14=400 12=000
2 1=00
1 2=200
3 2=400
1 8=000
3 24=000
2 10=800
3 3=@00
1 800
2 2=00
2 10=800
2 10=8002 2=00
4 4=000
1 800
3 24=000
2 2=00
3 3=000
3 2=400
3 2=400
2 2=00
3 2=400
1 =@00
1 4=>004 18>=200
3 3=@00
3 3=000
4=000
1 300
2 1=000
3 2=400
0 =000
3=000
1 =100
1 =@00
1 1=3002 1=00
8 8=000
3 14=400
3 1=300
1 4=800
1 =100
1 =@00
1 1=000
2 1=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 219/539
1 300
3 20=>00
2 @=00
2 2=00
1 2=200
2 2=00
3 2=400
2 1>2=0003 24=000
3 3=@00
3 2=400
3 24=000
1 8=000
2 2=000
4 3=200
1 4=>00
1 =@00
3 1=200
3 24=000
=00010 8=000
1 4=>00
1 =@00
3 3=000
1 =00
1 =00
1 =400
2 400
3 2=00
3 3=000
3 2=400
1 =@001 300
1 1=000
1 1=300
2 1=00
1 1=300
2 1=00
1 1=300
2 2=000
2 1=00
1 800
1 1=000
2 2=001 4=800
2 1=00
2 2=000
2 2=00
1 =100
1 =@00
1 1=00
1 4=400
1 1=300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 220/539
4 3=200
1 300
3 18=000
3 14=400
1 =100
1 =@00
4 24=000
1 1=8001 1=300
1 800
1 300
3 1=300
3 3=000
1 =00
3 2=400
4 8=000
1 =00
1 =000
20 12=000
3 18=0002 13=800
3 3=000
3 3=@00
3 2=400
1 =@00
1 300
1 4=>00
1 =@00
1 4=>00
1 =@00
3 00
1 100=8001 100=800
1 =000
3 1=200
3 24=000
4 3=200
1 =000
1 =100
3 24=000
1 8=000
2 2=00
3 2=400
1 1=3003 2=400
1 =100
1 =@00
1 4=800
2 1=00
2 2=000
3 18=000
2 2=00
2 12=000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 221/539
1 =400
3 2=400
1 1=300
3 18=000
1 4=>00
2 13=800
4=800
3 3=0001 3=800
2 13=800
2 2=000
4=800
1 =100
1 =@00
4 1=200
10 8=000
1 =100
3 20=>00
1 300
3 1=3002 1>2=000
3 3=@00
3 3=000
3 2=400
2 1=000
2 1=00
3 3=@00
2 2=000
1 300
1 =100
4=000
1 1=3001 1=000
1 800
2 12=200
1 1=300
1 1=000
1 800
1 =100
3 8=400
1 8=000
2 2=00
1 1=000
2 1=001 =100
1 800
1 2=800
1 800
1 =100
2 13=800
2 1>2=000
3 3=@00
2 2=000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 222/539
3 2=400
1 4=>00
4 3=200
1 =@00
2 4=000
2 1=00
2 4=000
2 1=002 2=00
1 300
1 =100
1 =@00
1 1=00
1 4=400
1 1=300
3 3=000
4=800
3 14=400
3 1@=800
1 3=8001 =800
1 10=00
1 =800
1 =800
1 8=000
1 2=000
2 13=00
3 8=400
1 8=000
3 12=@00
1 2=800
3 =001 8=000
1 =@00
1 4=>00
1 =00
3 3=000
1 300
2 4=400
1 =100
1 =@00
3 18=@00
4=000
1 4=4001 1=00
2 2=00
3 3=000
3 1@=800
1 3=300
3 =@00
1 =@00
2 2=00
2 2=000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 223/539
1 =@00
2 4=400
1 2=200
1=200
1 =100
1 2=000
1 10=00
4=0002 2=00
4 3=200
1 =100
1 =@00
1 300
1 =00
3 =00
3 2=400
1 8=000
1 2=000
3 2=400
3 1@=8001 3=800
1 800
1 1=300
4 8=800
1 =100
1 =@00
1 1=00
2 8=800
1 1=300
4 3=200
3 30=000
1 3003 1@=800
1 10=00
2 21=200
1 32=00
1 1=000
1 4=>00
1 =@00
4 2>=00
2 13=800
1 1=00
1 1=300
3 3=0003 2=400
1 2=100
1 4=800
3 =00
3 3=@00
2 2=00
3 =00
1 1=300
2 2=000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 224/539
3 2=400
1 4=800
3 3=@00
3 2=400
1 =800
1 300
3 20=400
1 1=3001 3=800
1 800
1 =100
2 13=800
2 13=00
1 =000
1 1=00
1 4=400
1 1=300
2 4=200
3 14=400
4 4=0004 3=200
1 3=300
3 1@=800
1 4=>00
2 13=800
3 2=400
3 14=400
3 1>4=000
3 3=000
1 300
2 21=200
1 =1001 =400
1 2=100
1 1=300
1 300
1 4=800
1 8=000
1 300
2 10=800
1 =800
2 @=00
2 2=00
2 1=002 13=00
1 =400
2 10=800
3 12=@00
3 1>4=000
2 2=000
3 3=@00
2 1=00
1 300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 225/539
1 800
1=000
1 =100
1 =@00
1 =800
1 1=00
1 4=400
1 1=3003 3=000
4=000
1 2=100
1 300
3 14=400
3 @=@00
3 24=000
1 10=00
1 4=400
1 =@00
1 4=>00
1 2=2003 =00
4 4=000
4=000
=00
1 1=00
1 4=400
2 2=00
1 2=100
1 =100
1 =@00
2 1=00
1 1=0001 =00
4 8=000
1 1=00
1 2=100
1 2=200
1 =800
2 @=00
1 1=300
3 2=400
1 2=100
1 =400
1 2=1002 1=00
2 2=000
3 24=000
3 2=400
1 =100
1 =@00
1 1=00
1 4=400
1 1=300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 226/539
3 3=000
3 14=400
4=800
3 1@=800
1 =00
1 =100
2 13=800
1 10=001 8=00
2 11=000
1 4=>00
2 13=800
2 10=800
3 24=000
3 3=000
2 2=00
2 1=00
1 300
1 =00
1 10=002 12=200
1 =@00
3 2=400
1 1=00
2 10=800
2 11=000
2 10=800
1 2=100
3 12=00
1 =00
1 1=300
1 4=>001 =@00
1 4=800
1 2=000
2 2=00
2 2=000
2 1=00
1 300
1 4=>00
1 =@00
2 10=800
2 4=200
3 3=@003 3=000
3 2=400
1 300
3 24=000
10 2=000
2 10=800
3 24=000
3 3=@00
3 2=400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 227/539
2 >=00
> =00
3 14=400
3 3=000
1 10=000
1 =100
1 4=>00
1 =@001 =400
1 2=100
2 2=00
2 2=000
2 1=00
1 300
1 @=300
1 2=100
2 2=00
3 2=400
2 1=000
1 1=3003 2=400
1 2=100
1 1=300
3 2=400
1 3=800
2 2=00
1 =00
3 1=000
2 2=000
2 1=00
1 =@00
1 8=0003 1=300
1 =@00
1 1=300
3 3=000
1 800
1 4=400
2 13=800
1 =100
3 12=@00
2 2=000
2 13=800
1 4=>002 10=800
1 2=100
2 1=00
2 2=000
1 =400
2 2=00
1 1=000
2 1=00
1 =400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 228/539
2 2=00
2 10=800
2 1=000
2 2=00
1 1=000
2 1=00
1 2=100
2 10=8002 2=00
1 800
1 2=100
2 @=00
1 1=300
1 1=000
1 800
1 2=100
3 12=@00
2 2=000
2 1=00
2 @=001 1=300
1 1=000
2 1=00
3 =000
3 2=400
1 =400
2 4=000
1 4=800
1 2=000
1 2=100
28=800
=0002 4=200
1 4=>00
1 =@00
4 3=200
1 8=200
1 =100
1 =@00
2 11=000
3 14=400
4 1=200
4 4=000
4 3=2002 2=00
3 2=400
2 10=800
2 2=000
1 1=300
3 3=000
2 1=00
2 10=800
2 2=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 229/539
1 2=100
2 4=400
2 10=800
1 2=100
2 1=00
1 =00
1 =100
1 =@001 1=00
1 4=400
> >=000
1 2=100
3 2=400
1 300
3 14=400
3 @=@00
3 1@=800
1 10=00
2 13=800
1 =001 32=00
3 2=400
2 18=200
2 13=800
1 2=000
4=000
1 2=100
1 4=800
1 =100
1 =@00
2 2=00
1 4=400 =000
1 300
1 =100
3 2>=300
3 1>4=000
1 800
3 3=000
1 2=100
3 @00
4 4=000
2 4=200
3=4001 300
2 11=000
2 00
1 300
10 2=000
2 10=800
3 2=400
3 2=400
2 1=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 230/539
1 =400
2 10=800
2 2=00
1 32=00
1 4=>00
1 =100
1 =@00
1 =004 3=200
=000
1 4=400
3 24=000
3 14=400
1 300
1 10=00
3 =00
4 2>=00
1 10=00
1 4=>00
2 13=8001 =00
3 3=000
3 3=@00
3 14=400
1 4=800
1 32=00
3 3=000
1 4=>00
2 13=800
2 10=800
1 2=100
3 3=@003 2=400
3 3=000
1 300
1 =@00
1 4=>00
3 12=@00
2 10=800
1 2=100
1 300
3 3=@00
3 3=000
3 2=4001 300
3 1@=800
3 2=400
4=000
2 10=800
2 1=000
2 2=00
2 2=00
2 10=800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 231/539
3 3=@00
3 =00
3 =000
2 10=800
1 2=100
2 1=00
2 2=000
1 4=>003 2>=300
2 13=800
2 13=800
1 4=800
2 4=000
4=000
1 2=100
4 @=00
1 2=200
2 =00
2 1=00
2 4=4003 =000
2 =00
3 1@=800
2 4=000
2 18=200
4 3=200
3 2=400
2 10=800
1 2=100
2 2=00
2 2=000
3 2=4001 1=300
2 10=800
1 2=100
1 1=300
2 2=000
2 2=400
1 1=300
2 13=800
3 3=000
3 2=400
1 4=>00
3 1@=8004 3=200
1 1=300
4 3=200
3 2=400
1 1=300
2 2=000
2 1=00
1 1=300
2 11=000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 232/539
1 8=200
2 4=800
2 34=800
1 =100
1 =@00
1 =00
3 14=400
1 3003 @=@00
1 4=400
1 =@00
1 =@00
3 =000
14 2=800
1 10=00
1 10=00
1 10=00
1 103=800
3 1=000
2 11=0001 =@00
1 =@00
1 10=00
1 =100
1 =@00
1 4=400
8 8=000
8 =400
1 =00
2 2=00
3 24=000
1 =1001 =@00
1 32=00
2 1=000
3 24=000
3 24=000
2 1=000
1 2=100
3 24=000
1 2=100
1 =100
1 =@00
4=8004 4=000
1 1=300
1 4=400
2 00
3 24=000
4 3=200
1 800
1 =100
1 =@00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 233/539
=000
4 8=000
1 300
1 4=400
1 1=300
1 2=100
3 24=000
2 1=001 =100
1 =@00
1 =00
3 3=000
1 2=100
1 1=300
3 24=000
2 1=00
1 =100
4 =200
3 3=000
3 2=4001 2=100
1 300
1 2=200
1 800
1 =400
2 11=00
2 1=000
3 24=000
1 8=000
3 24=000
3 24=000
2 1=0002 2=000
2 1=00
3 =000
1 1=000
1 800
3 24=000
2 2=000
2 1=00
3 24=000
1 1=00
1 4=400
1 =1001 =@00
=000
3 24=000
3 14=400
1 4=400
1 =00
1 1=300
4=000
1 =100
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1 =@00
> >=000
1 1=300
1 300
3 14=400
1 4=400
3 24=000
1 4=>001 =@00
1 4=300
2 2=000
3 2=400
3 24=000
1 =@00
1 =@00
1 =100
2 1=00
2 24=00
1 12=300
2 1=001 2=200
2 1=000
2 1=00
2 2=000
3 =000
1 1=000
1 800
1 1=300
1 10=00
2 21=200
1 =100
1 =@001 4=400
=000
8 =400
3 @=@00
1 300
1 2=100
1 =100
1 =@00
1 4=400
=000
8 =400
3 @=@001 300
1 2=100
1 =00
1 4=>00
1 =@00
1 1=300
2 2=000
2 1=000
2 2=000
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1 2=100
1 10=00
1 10=00
1 10=00
1 =00
1 4=400
2 4=200
3 3=@003 3=000
4 3=200
1 300
1 800
1 300
1 300
2 10=800
1 300
3 3=@00
3 3=000
3 2=400
1 2=1001 =100
1 =@00
1 4=400
1 1=300
3 14=400
3 3=000
3 2=400
3 @=@00
4 3=200
1 1=300
1 32=00
2 >=003 =000
2 10=800
2 1=000
1 1=300
3 2=400
2 1=000
1 =100
1 =@00
1 2=100
1 =00
3 3=@00
3 3=0003 2=400
1 300
1 10=00
2 1=00
1 =100
1 =@00
1 1=300
1 300
1 4=300
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1 3=800
2 1=000
4 3=200
1 2=100
1 4=>00
1 =@00
1 =400
2 2=002 2=000
3 2=400
1 300
1 2=100
1 =00
1 =100
1 =@00
4=000
1 1=300
1 2=100
3 14=100
2 @=003 1=000
1 =100
1 =@00
1 2=100
2 1=00
1 1=300
1 800
1 3=800
3 2=400
1 =00
1 1=300
1 10=001 10=00
1 =100
1 =@00
2 1=00
1 1=300
1 300
1 1=800
3 12=@00
2 1=000
1 800
1
2 1=0002 2=00
1 1=000
2 1=00
1 1=300
2 2=000
3 2=>00
2 2=00
1 1=000
2 1=00
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2 3=800
3 =000
3 3=@00
1 1=000
2 1=00
1 =100
1 =@00
4=8001 1=300
1 10=00
1 10=00
4=800
1 1=00
1 4=>00
1 =@00
4=000
2 2=000
1 4=>00
2 13=800
4 4=0004 4=800
4 =200
2 1=000
10 =000
14 >=000
1 =100
1 =@00
1 4=400
2 2=00
4=000
3 3=000
1 2=1001 2=200
1 =@00
1 =100
2 4=000
1 4=400
1 1=300
3 3=000
1 2=100
4=000
2 10=800
1 1=300
1 1=0002 1=00
1 2=100
1 4=300
2 1=000
2 2=000
1 800
2 1=00
4 20=400
1 =400
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2 2=00
1 2=100
2 1=000
1 1=300
2 2=000
2 1=00
2 @=00
2 3=2002 2=00
1 1=000
2 800
1 2=100
2 1=000
1 4=>00
1 =@00
1 2=100
1 =400
1 8=000
2 2=000
3 3=@002 1=000
2 2=00
1 =@00
1 =400
2 1=000
2 1=000
1 4=400
1 1=300
1 2=100
1 =@00
1 =100
1 4=>002 13=800
3 2=400
1 2=100
1 1=300
1 =00
1 10=00
1 800
1 300
1 4=>00
2 3=200
4 32=000
4 3=2002 4=400
4=000
4 1@=200
3 1@=800
1 =@00
3 3=000
1 =00
1 2=100
1 =400
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2 1=000
1 1=300
1 1=000
2 1=00
2 3=200
2 10=800
2 2=00
1 1=0001 800
2 1=000
1 1=000
1 800
2 10=800
2 2=00
2 2=000
1 800
2 1=00
724,100 7,300,800 2,778,100 10=803=000
1403400 2000
1288800 1203200
13404>00 4@@400
4004@00 1142>00
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44000 14@02@00
1@84>00 1180>300
4802100 13>2000
111@2300 40282200
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TANGGAL NAMA PASIEN BPJS GOLONGAN
4/1/2014 Ny.JAMI7A; MM
Ny.Binti BPJS DINAS
4/3/2014 Ny S'tarni BPJS MM
An Sa-itri Dwi BPJS DINASAn Mir9a BPJS DINAS
4/4/2014 An. ?a+i BPJS DINAS
4/13/2014 An. M. ?a--an BPJS DINAS
4/14/2014 Ny. Erna MM
Tn.Sii+ BPJS DINAS
Ny P'(i BPJS DINAS
Ny Al)ira BPJS MM
4/1>/2014 Tn Awana BPJS DINAS
4/23/2014 Tn. S'!en! MM
4/28/2014 POLI BEDA; 3 6A: STOP *;O*$
TOTAL
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NAMA OBAT JMLA;
;A7GA PASIEN
MM BPJS MM BPJS DINAS
Si)#atatin 10 3=000
*e-ar"il 10 8=000
*anerartan 8 )! 30 240=000
7eli#an 1 =007eli#an 2 11=000
*lina)i%in 10 10 =000
7eli#an 1 =00
S,'it 3% 1 800
Onan%etr"n Ta @=000
Met-"r)in 30 =000
E%li 0 )! 40 48=000
7anitiinne ta 10 2=000
7anitiinne ta 10 2=000
5* 18 1 1=00
A&'a In( 1 2=100
1 2=@00
55,500 242,000 91,800 38@=300
10803000
11=1@2=300
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT JMLA;
/1/2014 Ny. Siti *"li-a BPJS MM In-'et ara 1
i# 18 1
S,'it 10%% 2
rinea! 1
S,'it %% 3A&'a 1
S,'it 3%%
Tra)a"l in( 3
Neele 23 1
Ny. B'iyani MM Antrain in( 3
Ny. Siti Eni BPJS MM In-'et ara 1
i# 18 2
rinea! 1
S,'it 10%% 1
S,'it %% 3S,'it 3%%
Neele 23 1
A&'a 1
Tra)a"l in( 3
Ny. T'ti+ S'il"wati MM Antrain in( 3
By. Ny. B'iyani MM M'%' 1
By. Ny. Siti Eni BPJS MM M'%' 1
By. Ny. Siti *"li-a B BPJS MM M'%' 1
By. Ny. Siti *"li-a A BPJS MM M'%' 1
Ny.Ja)iat'n BPJS MM In-' Biaa 1
I# 20 1
*e-tria"n 2
A&'a 1
Onan%etr"n 2
S,'it 10 2
S,'it 2
S,'it 3 2
Nele 2 1
An.Al)ira BPJS MM In-' Biaa 1
D4 1/4 2
N: Sar)i BPJS MM *e-tria"n 1
S,'it 10%% 2
S,'it 3%% 2
A&'a 1
neele 2 1
An Al)ira BPJS MM *e-tria"n 2
A&'a 2
S,'it 10%% 2
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S,'it 3%% 3
Neele 2 1
Ny :'ni BPJS MM Neele 23 1
S,'it 3%% 1
Ny. :'lity"wati BPJS MM I# 22 1
Ny. Ja)iat'n BPJS MM *e-tria"n 2
S,'it 10%% 2 Ny. Dwi BPJS MM *e-"tai)e In( 2
Genta)i%in In( 2
A&'a 1
S,'it 10%% 2
Ny. Sar)i BPJS MM *e-tria"n 1
S,'it 3%% 2
An. Al)ira BPJS MM *e-tria"n 1
S,'it 3%% 2
An. Ael MM *e-tria"n 1
S,'it 3%% 4A&'a 1
/2/2014 Tn Ma'!i BPJS MM Selan! "2 w 1
S,'it 10%% 2
S,'it %% 2
rinea! 1
A&'a 1
Ny J',riyat'n BPJS MM *e-"tai)e In( 2
S,'it 10%% 3
S,'it %% 3
S,'it 3%% 3
In-'et ara 1
I# 20 1
Neele 2 1
D7 G't")" BPJS MM *e-"tai)e In( 2
S,'it 10%% 3
S,'it %% 3
S,'it 3%% 3
Neele 2 1
N: 6a+iya BPJS MM In-'et ara 1
i# 18 1
S,'it 3%% 2
SDr. G't")" BPJS MM *e-tria"n 2
O)e,ra9"le In( 1
Antrain in( 3
Neele 2 1
An. Irai) MM Antrain in( 2
Ny. J',riat'n BPJS MM *e-"tai)e In( 2
S,'it 3%% 1
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Ny. Sar)i BPJS MM *e-tria"n 1
S,'it 3%% 2
A&'a 1
Tn. Ma'&i BPJS MM *e-tria"n 2
DEA In( 4
S,'it 3%% 2
/3/2014 Ny. Enny S. BPJS Dina In-'et ara 1S'r-l" 18 1
rina! 1
S,'it %% 3
S,'it 10 %% 1
S,'it 3%% 6
Neele 23 1
Tra)a"l in( 3
Ny. 6iwi+ S. BPJS Dina In-'et ara 1
S'r-l" 18 1
rina! 1
S,'it %% 3
S,'it 10 %% 1
S,'it 3%% 6
Neele 23 1
Tra)a"l in( 3
Tn. S'+a)t" BPJS Dina *e-tri in( 2
A&'a 2
In-'et ara 1
Antrain in( 2
S,'it 10 %% 3
S,'it %% 3
S,'it 3%% 3
Neele 2 1
By. Ny. 6a+i(a BPJS MM M'%' 1
By. Ny.6iwi+ BPJS Dina M'%' 1
By. Ny. Enny BPJS Dina M'%' 1
Ny.7',iati BPJS MM I# 18 1
5'r"e)i In( 1
S,'it 3 4S,'it %% 4
Aa) trane 3
Ny.Mar)i BPJS UMUM rina! 2
S,'it 10 %% 1
S,'it %% 4
S,'it 3 4
*e-tri 4
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A&'a 1
Ny.J',riyat'n BPJS MM ia9"l in- 3
S,'it 3 3
Tn S'+a)t" BPJS Dina *e-tri 1
S,'it 3%% 3
aantraain in( 3
Tn Ma'!i BPJS MM *e-tri 2
Dea in( 4
*LOP7AMEL INJ 3
S,'it 10 %% 2
,'it % 3
S,'it 3%% 3
Ny Sar)i BPJS MM *e-tri 1
S,'it 10% 1
S,'it 3%% 2
A&'a 1
N: J',riat'n BPJS MM *e-" 2
*LOP7AMEL INJ 3
S,'it 10%% 2
S,'it 3%% 2
A&'a 1
/4/2014 Ny. Inrawati MM Antrain in( 3
Ny Marmi BPJS UMUM diazol inf 5
needle 23 3
ceftri 2
Spuit 3cc 2Spuit 5cc 2
Tn S'+a)t" BPJS Dinas Ceftri 2
Antrain in 3
A!ua 1
spuit 1"c 3
N> J&.riat&n BPJS UMUM Cefo 1
diazol inf 3
C#$P%AM&# '(J 1
Tn Ma'!i BPJS UMUM C&)tri in 2
C#$P%AM&# '(J 1Spuit 3cc 5
Ny i!i UMUM Antrain in 2
//2014 ny. J'wari BPJS UMUM Selan* o2 d+s 1
'nfuset dara, 1
i- 1. 1
Ny. S'art'ti+ BPJS UMUM i- 1. 1
'nfuset dara, 1
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Mucus 1
Tn.Ma'+&i BPJS UMUM Ceftri 2
D&/A 'n 2
Spuit 1" 2
Spuit 3 3
A!ua 1
Tn.S'+a)t" BPJS UMUM Antrain in 3
Ny.J',riyat'n BPJS UMUM Ceftri 2
diazol inf 2
Spuit 1" 1
Spuit 3 3
A!ua 1
//2014 Tn. $a)ani UMUM Antrain in 2
Ny. Mar)i BPJS UMUM Spuit 5cc 1
Spuit 3cc 1
An. 7ayan'n BPJS Dinas 'nfuset 0iasa 1
i- 22 1
Spuit 5cc 2
Spuit 3cc 2
Cefotaie 'n 1
A!ua 1
Dea in 1
Spuit 1"cc 2
pct sr 1
needle 25 1
Tn. S'+a)t" BPJS Dinas 'nfuset dara, 1 Ny. S'%iati BPJS UMUM Alodipin 5 * 5
Captopril 25 2
ny. I+a BPJS UMUM 'nfuset dara, 1
Surflo 1. 1
entaicin 'n 2
N> 'Iti J&aia( BPJS UMUM Mucus 1
Spuit 5cc 4
Urine0a* 1
B ( 'a BPJS UMUM Mucus 1
7n Masru BPJS UMUM Cefotaie 'n 3'- 2" 1
Spuit 1"cc 1
Spuit 5cc 3
(eedle 25 1
Tn.S'+a)t" BPJS Dinas Antrain in 3
Spuit 3cc 2
Tn. MAS'!i BPJS UMUM Spuit 1"cc 1
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Sr. Aan BPJS UMUM Antrain in 3
Spuit 3cc 1
Tn. )Ar'n BPJS UMUM Antrain in 3
Spuit 1"cc 1
Spuit 5cc 2
Spuit 3cc 1
7n %ADini UMUM #e-ofloacin 1
7n 8asani UMUM Antrain in 1
( Suiati UMUM Antrain in 3
/8/2014 n 'a BPJS UMUM )uroseid 'n 1
( Siti 9ulaia, BPJS UMUM )uroseid 'n 1
Sdr Aan BPJS UMUM )uroseid 'n 2
7n MAsdu!i BPJS UMUM Si-astatin 1"M* 3
Sdr Aan BPJS UMUM Antrain in 3
Spuit 1"cc 2
7n MASdu*i BPJS UMUM Spuit 5cc 2
Sspuit 3cc 2
tn (ur aadi BPJS UMUM Spuit 5cc 1
Spuit 3cc 2
( Ani BPJS UMUM Antrain in 2
Spuit 1"cc 2
Spuit 5cc 1
Spuit 3cc 1
( Suciati BPJS UMUM i- 1. 1
7raadol in 1
Spuit 3cc 1"Urine0a* 1
Spuit 1"cc 1
A!ua 1
Spuit 5cc 6
(eedle 23 1
7n Suato BPJS Dinas Antrain in 2
/@/2014 SdrMustain BPJS UMUM Spuit 3 3
Spuit 5 3
B#isto+ati Uu Mucus 1
B&ti Uu Mucus 1N> &%a BPJS UMUM Selan* o2 d+s 1
i- 1. 1
Urinne0a* 2
spuit 1"cc 1
A!ua 1
7raadol in 1
Antrain in 3
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Spuit 3cc :
Spuit 5cc 3
7n Suato BPJS Dinas D4" 5
By Ny Ei BPJS UMUM Mucus 1
B ( Juliani uu Mucus 1
( &#' BPJS UMUM i- 1. 1
Urine0a* 2
SPU'7 1"C 1
Spuit 3cc 5
Spuit 5cc 3
(eedle 23 1
A!ua 2
Cefotaie 'n 3
7raadol in 1
Antrain in 3
Ny L&'i BPJS UMUM i- 1. 1
'- 2" 1
Urine0a* 2
A!ua 2
spuit 1"c 1
7raadol in 1
aantraain in 3
Spuit 3cc 5
Spuit 5cc 3
An %a,anun BPJS UMUM '; 24 2
Cefotaie 'n 1Dea in 2
P#U 1
Ny 9&r'iati BPJS UMUM $eprazole 'n 2
spuit 1"c 3
Spuit 5cc 3
Spuit 3cc 3
A!ua 1
Ny S&i!a( UMUM Antrain in 2
By Ny &%a BPJS UMUM Mucus 1
B ( #usi BPJS UMUM Mucus 17n nU%AJ' BPJS UMUM )c 14 1
Urine0a* 1
A!ua 1
spuit 1"c 1
7n Sardi BPJS UMUM )futrolit 'nf 2
$eprazole 'n 2
)uroseid 'n 4
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A!ua 1
Urine0a* 1
Spuit 1"cc 3
Spuit 5cc 3
Spuit 3cc 3
'- 2" 1
Selan* o2 d+s 1
An %a,anun BPJS Dinas Sspuit 3cc 3
7n MAsru BPJS UMUM Antrain in 3
Spuit 1"cc 3
A!ua 1
7n Sardi BPJS UMUM 3<a Selan* 1
tn (ur aadi BPJS UMUM Cipro 'nf 1
Sspuit 1"cc 2
Spuit 5cc 3
7n Suato BPJS Dina Antrain in 3
Spuit 1"cc 2
Spuit 3cc 3
( 8ursiati BPJS UMUM Spuit 3cc 2
/10/2014 By Sa%itri BPJS UMUM ;icilin 2
entaicin 'n 1
Spuit 3cc =
spuit 1"cc 1
'- 24 2
P#U 1
sd% Aan BPJS UMUM '- 2" 1Tn.S'+a)t" BPJS Dina *l",ra)el 3
Ny.Lina BPJS MM I< 18 1
SPIT 10 4
Tra)a"l 3
S,'it 3
S,'it 3 8
rina! 1
Ny.;eny BPJS UMUM *e-" 3
Tra)a"l 3
I# 18 1
rina! 1
S,'it 10 1
S,'it 3
S,'it 3 3
Ny.I+a BPJS Dinas I< 18 1
rina! 1
SPIT 10 1
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S,'it 3
S,'it 3
*e-" 3
Tra)a"l 1
A&'a 3
Ny.Sa-itri BPJS UMUM S,'it 10 1
S,'it 3
S,'it 3
Nele 23 1
Selan! O2 Dw 1
I< 18 1
Antrain in( 3
*e-"tai) 3
7n Suato BPJS Dinas D4" 4
C#$P%AM&# '(J 3
Spuit 3cc 2
7n (urai BPJS UMUM Cipro 'nf 2
Cipro 7a0 2
Spuit 3cc 2
( 8ursiati BPJS UMUM Spuit 3cc 2
( 9aini UMUM Cloprael 'n 3
Sdr Aan BPJS UMUM Ceftriaon 1
/11/2014 tn Suato BPJS Dinas udopa 2
( Juriati BPJS Dinas Spuit 3cc 2
B ( (*uoin UMUM Ca *luconas 1
B ( C,aeri UMUM Ca *luconas 1B ( Juriati BPJS Dinas Mucus 1
nntiti BPJS UMUM entaicin 'n 2
-entolin 3
co0i-ent 3
spuit 1" 3
spuit 3 3
spuit 5 3
Cefotaie 'n 1
(edle 23 1
Selan* o2 d+s 1infus 0iasa 1
'- 2" 1
nia, BPJS UMUM '; 1. 1
urin0a* 1
spuit 1" 1
spuit 5 3
spuit 3 6
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cefo 3
Tn Samiran uMUM Antrain in 2
7n Muito UMUM Antrain in 1
N> Titi BPJS UMUM Cefo 1
Spuit 1"c 2
Spuit 3cc 3
Sdr Aan BPJS UMUM )uroseid 'n 2
ceftri 1
$eprazole 'n 2
Tn Sardi BPJS Dinas )uroseid 'n 1"
Spuit 1"c 2
7n (u%AJ' BPJS UMUM Cipro inf 2
Spuit 5cc 2
Spuit 3cc 2
N> Tri :&iana BPJS UMUM '; 1. 1
Urine0a* 1
Spuit 3cc 4
Spuit 5cc 3
spuit 1"c 1
needle 23 1
4/12/2014 Sdr Aan BPJS UMUM Spuit 1" cc 2
Spuit 5 cc 2
Spuit 3 cc 2
7n Sardi BPJS UMUM Spuit 3 cc 3
B> Ny Tri : BPJS UMUM Mucus 1
( Juriati BPJS UMUM '- 1. 1( 7iti BPJS UMUM Ceftriaon 2
(eedle 25 1
Ny Lina BPJS UMUM Spuit 5cc 3
Spuit 1"C 2
Spuit 3cc .
(eedel 23 1
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entaicin 'n 2
Selan* $2 D+s 1
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( Sofia BPJS UMUM '; 1. 1
Urine0a* 1
Spuit 1"cc 1
Selan* $2 D+s 1
Spuit 3cc 6
Spuit 5cc 3
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Cefotaie 'n 3
(eedle 23 1
Dea in 2
7raadol in 1
SdrAan BPJS UMUM Ceftri 1
Antrain in 3
$eprazole 'n 2
Spuit 1" 3
Spuit 3 2
7nSardi BPJS UMUM spuit 1" 2
7nSairan Uu Antrain in 2
7nMuito Uu Antrain in 2
(8arsiati BPJS UMUM Spuit 3 1
nntiti BPJS UMUM -entolin 3
Ceftriaon 1
entaicin 'n 2
spuit 1" 1
spuit 3 2
/13/2014 ( Suparti BPJS UMUM surflo 2" 1
(eedle 25 1
Spuit 1" cc 3
spuit 5 cc 3
spuit 3 cc 3
*eftria&$n 2
+e&a in% 1
Ny utarti) >(>( I 18 2>rinba" 1
puit 5 cc 3
puit 3 cc 4
elan" $2 9s 1
y. Ny. ?vi +inas 3@ay elan" 1
y. Ny. Nurul +inas (ucus 1
Ny. Nurul ; +inas Iv 18 1
>rineba" 1
puit 5cc 2
puit 3cc =*ef$ta&ime In% 3
-'ua 1
Trama$l in% 1
Ny. Titi) +inas Iv 20 1
ceftri 2
puit 10cc 3
puit 5cc 3
7/21/2019 LAP (Autosaved)
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Neele 1
Ny. +9i >(>( iv 18 1
Iv 20 1
>rineba" 1
trama$l in% 1
cef$ 3
neele 23 1-n. ;eysa >(>( +5 1/4 2
Ny Nanin- >(>( -ntrain in% 3
by. Ny. Lina >(>( lu" 1
iv 24 2
puit 3cc =
y.?vi >(>( puit 3 =
Ny.Titi) >(>( entamicin In% 2
-ntrain in% 3
puit 3 2
puit 5 2
TnSardi >(>( ur$semi In% 8
puit 5 2
puit 10 2
Ny.Titi) >(>( *eftri 2
entamicin In% 2
puit 10 1
puit 3 2
r.-an >(>( *eftri 1
mepra,$le In% 1ur$semi In% 2
puit 10 1
puit 3 1
Ny.Nanin" >(>( *eftri 2
-ntrain in% 1
puit 10 1
puit 5 1
puit 3 1
nn.titi) >(>( ceftri 2
entamicin In% 2vent$lin 1
spuit 10 1
spuit 5 1
spuit 3 2
/14/2014 Ny. <artati) >(>( Iv 20 2
Infuset iasa 1
puit 10cc 3
7/21/2019 LAP (Autosaved)
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puit 5cc 3
puit 3cc 3
-'ua 1
Neele 25 1
utr$lit Inf 3
ur$semi In% 3
Tn. ari >(>( puit 3cc 2
Ny. ($ni)a +inas Infuset ara! 1
Iv 20 1
Iv 18 1
>rineba" 1
puit 5cc 3
*ef$ta&ime In% 3
puit 10cc 1
-'ua 2
puit 3cc =
Trama$l in% 1
Neele 23 1
by. Ny. ($ni)a +inas (ucus 1
-n. 7$n")i >(>( Infuset iasa 1
I 22 1
Iv 24 1
puit 3cc 1
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iv 118 1
cef$ta&ime in% 3urineba" 1
spuit 10cc 1
spuit 5cc 3
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spuit 3cc =
neele 23 1
elan" $2 9s 1
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Ny. ri >ntari +inas Infuset iasa 1
Iv 20 2puit 5cc 2
puit 3cc 2
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Ny. Nanin" >(>( puit 3cc 3
Ny. ri >ntari >(>( puit 3cc 3
nn. Titi) >(>( !aminn$v 4
7/21/2019 LAP (Autosaved)
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entamicin In% 2
puit 10cc 3
puit 3cc 3
Tn. u!art$ >(>( elan" $2 9s 1
Infuset iasa 1
Iv 20 1
ansulin r 1puit 3cc 2
-ll$purin$l 100 5
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puit 10c 1
puit 5cc 3
puit 3cc 4
neele 23 1
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/1/2014Ny. <artati) >(>( utr$lit Inf 1
ur$semi In% 2
puit 3cc 2
Tn. ari >(>( ur$semi In% 3
Ny. amini >(>( utr$lit Inf 1
ur$semi In% 2
mepra,$le In% 1
puit 3cc 2
puit 5cc 2y. Ny. ?nan" >(>( (ucus 1
Ny. <eni >(>( Iv 18 1
puit 3cc #
puit 10cc 1
y. Ny. +9i alu! >(>( lu" 1
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ur$semi In% 1
puit 5cc 2 Tn. $e!art$ +inas puit 5cc 1
ur$semi In% 1
Ny. ri >ntari +inas Lev$C$&acin 1
3@ay inf 1
Infuset iasa 1
puit 5cc 1
r. -an >(>( ur$semi In% 2
7/21/2019 LAP (Autosaved)
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puit 10cc 2
puit 5cc 2
Ny. amini >(>( utr$lit Inf 1
mepra,$le In% 1
Ny. utipa! >(>( Infuset iasa 1
Iv 20 2
*eftria&$n 1puit 10cc 2
puit 5cc 2
puit 3cc 2
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puit 10cc 3
puit 5cc 2
puit 3cc 2
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nancetr$n In% 4
*ef$ta&ime In% 4
spuit 3cc 8puit 5cc 4
Neele 23 3
Ny. Tria +inas puit 3cc 1
Neele 23 1
Ny. ri >ntari +inas Lev$C$&acin 1
puit 5cc 2
puit 3cc 2
Ny. <artati) +inas utr$lit Inf 1
ur$semi In% 1
spuit 5cc 2puit 3cc 1
Tn. u!art$ >(>( puit 3cc 3
ur$semi In% 1
Ny. amini >(>( utr$lit Inf 1
ur$semi In% 1
mepra,$le In% 1
r. *atur +inas puit 10cc 2
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spuit 3cc 2
Ny. utipa! >(>( puit 10cc 1
spuit 5cc 1
puit 3cc 1
tn. ari >(>( puit 10cc 2
puit 3cc 2
/1)/2014 Ny.amini +inas urC$ 20 1puit 3 1
puit 10 1
amin$v in% 3
Nele 25 1
Infus i-sa 1
39ay ?L-N 1
Ny.Tria +inas puit 5 1
-'ua in% 2
Ny.ri >ntari +inas *eftri 2
puit 10 2
Nele 25 1
Tn.<ai +inas puit 10 3
puit 5 3
puit 3 3
Nele 25 1
+ia,$l Inf 3
*ipr$ iNf 3
puit 10 3
amin$v in% 3elan" 2 +9s 1
N> Tria +inas Neele 23 3
puit 5cc 3
Ny Aria +inas infuset ara! 1
iv 18 1
puit 5cc 3
cef$ 3
Neele 23 1
trama$l in% 3
urineba" 1puit 10 1
elan" 2 +9s 2
B> Ny Aria >(>( (ucus 1
y Ny Ina! >(>( (ucus 1
N> Inda( >(>( infuset ara! 1
iv 20 3
urineba" 1
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puit 10 1
puit 5cc 3
spuit 3c 5
Neele 23 1
cef$ in% 3
Ny. amini >(>( utr$lit Inf 1
*eftria&$n 2ur$semi In% 2
mepra,$le In% 1
Tn. ari >(>( ur$semi In% 2
*eftria&$n 2
Ny. utipa! >(>( *eftria&$n 1
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puit 3cc 3
ur$semi In% 1
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r. *atur +inas *eftria&$n 1
puit 10cc 1
puit 5cc 3
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puit 5 1
puit 3 2
Ny.7an" 7un" >(>( *ef$ta&ime In% 2
puit 10 2
puit 3 3
-n.-!lul >(>( nancetr$n In% 2
puit 3 4
Tn.<ai >(>( +40 #
Ny. ri >ntari +inas *eftria&$n 1
puit 10cc 2
puit 5cc 3
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*eftria&$n 2
puit 10cc 2
puit 3cc 2
r. *atur +inas *eftria&$n 1
spuit 10cc 1
spuit 5cc 3
Tn. u!art$ >(>( ur$semi In% 1
spuit 3cc 3
Ny. utipa! >(>( *eftria&$n 1
puit 10cc 1
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puit 5cc 2
Ny. 7an"yun" >(>( *ef$ta&ime In% 2
trama$l in% 2
+10: 1
-n. -!lul >(>( nancetr$n In% 2
puit 3cc 4
puit 5cc 2s+R *atur +inas *eftria&$n 1
puit 3cc 2
Ny 7an"yun" >(>( puit 5cc 2
spuit 3cc 2
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>IT 3* 3
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spuit 10cc 2
puit 5cc 2Ny utipa! >(>( *eftria&$n 1
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spuit 10cc 2
/20/2014 Ny. amini >(>( *eftri 2
mepra,$le In% 1
puit 10cc 2
Iv 20 1
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,yf$rt 2
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puit 3cc =
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;*L 1
+40 1
Tn.<ai >(>( Iv 20 2
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iv 18 1
urineba" 1
spuit 10c 1
puit 5cc 3
spuit 3c =
cef$ 3
-ntrain in% 3
trama$l in% 1
Ny amini >(>( *eftri 2
puit 10c 3
Ny >an- y&n- >(>( *ef$ 2
7/21/2019 LAP (Autosaved)
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spuit 10ccc 2
spuit 3c 3
y Ny ?vi >(>( I 24 1
entamicin In% 1
ur$semi In% 1
>IT 3* 4
Tn (adi >(>( *eftria&$n 2>IT 10* 2
>IT 3* 1
+ia,$l Inf 3
/21/2014 y. Ny. Riris >(>( (ucus 1
y. Ny. -ri)a +inas entamicin In% 2
y. Ny. a!r$tul >(>( (ucus 1
Nn. is)a -yu +inas Infuset iasa 1
I 20 2
puit 5cc 3
y. Ny. Rini >(>( (ucus 1Ny. @iayanti >(>( infuset ara! 1
I 18 1
urineba" 1
puit 10cc 1
puit 5cc 3
trama$l in% 1
Neele 23 1
Ny. a!r$tul >(>( puit 10cc 1
puit 5cc 4
Nn. is)a +inas Neele 25 1
y. Ny. @iayati >(>( (ucus 1
Ny.Reni >(>( +10: 1
nancetr$n In% 2
*eftria&$n 2
puit 10 1
puit 5 1
puit 3 2
Nele 25 1
Ny.7an"yun" >(>( 10 1
trama$l in% 2
*ef$ta&ime In% 2
puit 10 2
puit 5 1
puit 3 1
Ny.Reni >(>( Infus $isa 1
Iv 20 2
usc$tica 3
puit 10 3
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puit 3 #
puit 5 2
Nele 25 1
/22/2014 by ny isti)a >(>( mucus 1
Ny. 7unie >(>( infuset ara! 1
Iv 18 1
ny. 9anayani >(>( ;R #y. Ny. 7ulie >(>( (ucus 1
Ny.Reni >(>( *eftria&$n 2
>IT 10 2
>IT 5 1
>IT 3 1
NN.I;- >(>( trama$l in% 2
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nancetr$n In% 2
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/23/2014 Tn H#rmai >(>( puit 5cc 2
spuit 3cc 2
infuset ara! 1
r an%i >(>( puit 5cc 3
spuit 3c 3
Sdr Pan!i >(>( *ef$ta&ime In% 3
neele 25 1
spuit 10cc 2
r ira >(>( infuset ara! 1
*eftria&$n 1
iv 20 1
puit 10cc 2
puit 5cc 2
spuit 3cc 2
Neele 23 1
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-n yifa >(>( Infuset iasa 1
iv 24 2
puit 5cc 2
spuit 3cc 2
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Iv 20 1
Tn. <ermali >(>( puit 3cc 3
Ny. <ermin >(>( infuset ara! 1
iv 18 1
urineba" 1
*ef$ta&ime In% 3
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trama$l in% 3
puit 5cc 3
puit 3cc 3
puit 10cc 1
Nn. Rifa >(>( urineba" 1
*eftria&$n 2
puit 10cc 3puit 5cc 3
Nn. is)a >(>( usc$tica 3
nancetr$n In% 1
puit 10cc 1
puit 3cc 3
trama$l in% 2
Ny. Reni >(>( +10 1
nancetr$n In% 2
usc$tica 3
puit 10cc 2puit 3cc 3
nn. is)a +inas Infuset iasa 1
iv 22 2
iv 24 1
/24/2014 y Ny <ermin >(>( (ucus 1
N> Sri Utami umum *eftria&$n 2
puit 5cc 2
spuit 10c 2
spuit 3c 3
neele 23 3
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puit 10cc 2
puit 3c 3
*eftria&$n 1
urineba" 1
Neele 25 1
puit 5cc 2
Tn Resi)arn$ +inas >$pa 2
3 @ay 1
7/21/2019 LAP (Autosaved)
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;A7GA PASIEN
MM BPJS MM BPJS DINAS
100
@00
200
4400
30002100
4000
23100
300
24000
100
13800
4400
1300
30004000
300
2100
@@00
24000
1000
1000
1000
1000
4>00
@00
10800
2100
800
200
2000
100
300
4>00
18200
400
200
100
2100
300
10800
4200
200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 302/539
2400
300
300
800
@00
10800
200@00
>00
2100
200
400
100
400
100
400
32002100
00
200
2000
4400
2100
@00
3@00
3000
2400
100
@00
300
@00
3@00
3000
2400
300
100
@00
100
10800
8000
24000
300
1000
@00
800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 303/539
400
100
2100
10800
8000
100
61""6=""
44""
3"""
13""
4.""
3""
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61""
6=""
44""
3"""
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4.""
3""
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1".""
22""
61""
16"""
3=""
3"""
24""
3""
1"6""
1"6""
1"6""
6=""
22""
32""4"""
153""
..""
13""
4"""
32""
216""
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 304/539
21""
1:4"""
24""
54""
24""
24"""
1".""
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.4""
26""
3"""
24""
54""
13""
16""
21""
1".""
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16""2"""
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61""
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http://slidepdf.com/reader/full/lap-autosaved 305/539
1"6""
1".""
4"""
26""
24""
21""
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116"""
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4.""
21""
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26""
43""
3""
61""25""
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1"6""
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44""
1"6""
144""6=""
13""
3"""
3""
24"""
16""
13""
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 306/539
24"""
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24"""
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2"""
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24"""
22""
22""
44""
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 307/539
56""
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144""
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1:2"""
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 308/539
21""
44""
3=""
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65""
24""
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326""
264""
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 309/539
3"""
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144""
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63""
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65""4:""
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4400
1300
3000
4800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 310/539
14400
16"""
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4.""
26""
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 311/539
144""
3""
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54""
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3=""
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24""
10800
2000
138004400
3000
3200
#500
10#00
#B00
4400
2000
5#0014400
2100
3300
#B00
10800
3B00
3000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 312/539
300
#B00
#B00
4400
3300
14400
30018200
24000
13800
5#00
5#00
=800
24000
1#00
2000
1=#00
2000
2#00
10800
=800
1300
1#00
5400
8#0004400
1300
800
10800
8000
1300
1000
800
10800
=800
1300
1000
1#00
13800
4=00
3B00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 313/539
3000
2400
2100
300
144000
##00
1#00#100
#B00
#B00
4400
3000
14400
1300
4200
5#00
3300
300
10#00
4=00
#B00
#B00
800
1B00
#B00
144004400
1300
3000
3300
5#00
300
#500
10#00
4=00
138002000
1#00
1#00
1#00
2400
2400
20000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 314/539
=#00
3B00
2400
#500
4=00
#B00
1008001#00
1000
#500
#B00
4400
1300
3000
5200
300
3300
4#800
4400
1#00
##00
4#800
4400
8#000
1#00
200010#00
#B00
4800
1300
8200
5#00
#B00
4#800
2200
20001000
2200
=8000
32#00
4=00
1000
4400
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2000
2000
4#800
8#000
4=00
13800
54002#00
2000
1#00
300
8200
1#00
4=00
#B00
10800
3B00
2000
1#00
4800
#100
#B00
#B00
1=200
1B200
#4004000
B00
800
300
=8000
2000
1#00
4#800
2200
2000800
2400
2200
4#800
2200
8#000
2#00
7/21/2019 LAP (Autosaved)
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1#00
1300
1000
800
2#00
1#00
#B00800
1300
15000
300
4=00
32#00
1000
4200
10800
2#00
300
3B00
3000
2400
300
1=4000
=B200
3B00
15000#500
B00
3000
#100
#B00
3000
14400
300
BB00
44001300
13000
10#00
10#00
#100
20=00
4400
7/21/2019 LAP (Autosaved)
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1300
3000
4000
300
14400
4#800
108004400
8#000
4400
10800
5400
3B00
2400
2200
5400
5400
1300
3000
4=00
138008#00
1000
1#00
B#00
2#00
2400
8#00
3200
14400
5400
2#00
3000
4400
10800
2#00
1#00
5400
1300
3000
2200
2400
5400
1300
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2000
B#00
##00
##00
8#00
3200
20005400
1#00
2000
1#00
2400
2#00
2400
10800
2#00
20005400
1#00
2#00
10800
8#000
2#00
#B00
4=00
8400
11200
5#00
#B00
1300
2500
2400
13800
#100
#B00
4400
1300
3000
5#00
14400
24000
3300
10800
3B00
B#00
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2#00
2400
#B00
3800
2200
3200
108002#00
800
1=4000
10#00
=#00
10#00
4=00
13800
3000
10#00#100
#B00
4400
1300
3000
3300
300
1300
4000
300
10#00
##00
8#00
10800
1300
1000
1#00
300
##00
##00
B#00
2#00
1000
800
4=00
13800
22200
3B00
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4800
2000
300
10#00
#100
#B00
1380010#00
10800
2#00
1000
800
##00
10800
8#00
1300
2000800
2000
1#00
#100
3000
2400
14400
300
2#00
#100
5400
#B00
2#00
2000
1#00
300
5400
4=00
13800
2000
1#00
#100
#B00
2400
#100
#B00
4400
14400
7/21/2019 LAP (Autosaved)
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BB00
3000
2400
1300
4400
10800
3B003000
22200
4300
1300
2400
##00
##00
8#00
22200
2#002400
4=00
13800
#B00
10#00
10800
2000
2#00
2400
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100800
3000
#000
2#00
2400
5400
4400
300
2000
2B#00
32#00
50##00 =452=00 1#01B00 B5#1200
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT JMLA;
5/3/2014 Tn. A)al'in BPJS Dina *"ein 10)! 12
//2014 Tn.I Mae BPJS Dina *a)el"% 1 )! 10
4/12/2014 r. M'naan!!ita L"#en" 0= 2
/1)/2014 Nyyan- y&n- BPJS Dina I# 20 2
S,'it 3
/1@/2014 Ny. Mey BPJS Dina 7anitiine ta 10
Tn.;ai BPJS Dina 40
Tn.M'+ai BPJS Dina In-' ara 1
7/21/2019 LAP (Autosaved)
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;A7GA PASIEN
MM BPJS MM BPJS DINAS
>200
000
31800
13800
4000
2000
12000
@00
31800 1@00
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT
5/25/2014 y. N7. Riris >(>( Iv 24
puit 3cc
An Syi%a >(>( *eftri
Tn -"us >(>( Infuset biasa
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spuit 5cc
spuit 10cc
c 1#
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-n ;an,a >(>( Infuset biasa
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spuit 5
spuit 3
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Tn.(ar!aban >(>( urC$ 22
urC$ 20
Infus isa
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puit 3
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-n.ifa >(>( lu"
-n.?van$ >(>( Iv 20
Tn.Resi ;arn$ >(>( ur$semi In%
Tn 9a'ma!i >(>( Iv 20
Tn. -"us >(>( *eftri
puit 3cc
Tn. uta%i >(>( puit 10cc
Neele 25
Iv 20
;et$r$lac In%
*eftri
7/21/2019 LAP (Autosaved)
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spuit 5cc
puit 3cc
-n. ?van$ >(>( *eftri
enta in%
spuit 10cc
puit 3cc
Tn. (ar!aban >(>( puit 3ccspuit 5cc
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ur$semi In%
*itic$lin
Ranitiin in%
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puit 3 cc
puit 10 cc
y. Ny. Nurul >(>( (ucus
Ny. Nurul >(>( urC$ 18c 1#
>rine ba"
puit 10 cc
puit 3 cc
puit 5 cc
*ef$ in%
Neele 23
Ny.;$lifatun >(>( Iv 20
c 1#
>rine ba"
puit 10
puit 5
puit 3
selan" 02 +9s
Ny.Nurul >(>( *efar$&il Tab
Tn (uc!tar >(>( *eftri
selan" 02 +9s
spuit 10cc
spuit 5cc
puit 3cc
neele 25
B> Ny 9(oi%at& >(>( puit 3cc
spuit 5cc
3 9ay selan"
spuit 10cc
10
Tn uta%i >(>( enta in%
Tn (ar!aban >(>( puit 3cc
7/21/2019 LAP (Autosaved)
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Tn (u!tar >(>( puit 3cc
TN Resi)aarn$ >(>( *eftri
>$fa
puit 3cc
5/28/2014 Ny ?rlina N$vi >(>( puit 10 cc
puit 3 cc
(ucus Tn (uc!tar >(>( I *!ateter N$. 20
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y Ny Riris >(>( puit 3 cc
TN Resi)aarn$ >(>( I *!ateter N$. 20
Ny (u%iati >(>( selan" 02 +9s
I *!ateter N$. 18
puit 3 cc
puit 10 cc
Ny.uprapti >(>( Iv 20
puit 3puit 5
puit 10
neele 25
Ny.;artini >(>( Infus isa
iv 20
spuit 5
spuit 3
spuit 10
nele 25
Ny.@ariat$i >(>( Infus isa
iv 20
spuit 3
spuit 5
tn.%alal >(>( Infus isa
iv 20
spuit 3
spuit 5
spuit 10
nele 25
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spuit 10
spuit 3
Ny.uprapti >(>( $mepra,$l In%
5/2B/2014 Tn. Resi)arn$ +IN- ur$semi In%
Ny. umintri >(>( Iv 18
c 1#
>rine ba"
7/21/2019 LAP (Autosaved)
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puit 10cc
puit 3cc
spuit 5cc
Neele 23
*ef$ta&ime In%
Tn. (u!tar >(>( +e&a
puit 3ccy. Ny. umintri >(>( (ucus
Ny. aini >(>( Iv 20
Trama$l In%
-sam Trane) In%
puit 3cc
spuit 5cc
Ny.@ariati >(>( puit 10
puit 3
puit 5
Tn.Resi ;arn$ +IN- +e&a*eftri
spuit 10
puit 5
puit 3
n.+%alal >(>( puit 5
puit 3
Tn.(uct!ar >(>( *eftri
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puit 10
puit 5
puit 3
Ny.uprapti >(>( $mepra,$l In%
*eftri
puit 10
puit 5
puit 3
-N.Feisya >(>( Iv 24
puit 3
Infus isa
Ny.Ririn >(>( selan" 02 +9s
c 1#
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spuit 10
*ef$ta&ime In%
puit 5
puit 3
5/30/2014 Ny. umintri >(>( Iv 18
Ny. R$!ayati >(>( *efar$&il Tab
7/21/2019 LAP (Autosaved)
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Tn. aini >(>( Iv 20
ur$semi In%
*eftri
Neele 25
selan" 02 +9s
Ny. aini >(>( -sam Trane) In%
Trama$l In%spuit 5cc
puit 3cc
Ny. umintri >(>( *ef$ta&ime In%
spuit 5cc
puit 3cc
Ny.@ariati >(>( iv 20
Tn.+%alal >(>( I 22
Ny.alima! >(>( selan" 02 +9s
c 1#
>rine ba"Infus isa
Iv 20
puit 10
puit 5
puit 3
Ny.-"us utiya! >(>( puit 3
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*eftri
spuit 3
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ny.9iarti >(>( spuit 3
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spuit 3
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ny.suprapti >(>( spuit 10
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Ny D#i,y >(>( puit 3cc
Infuset ara!
Iv 18
selan" 02 +9s
c 1#
>rine ba"
puit 10cc
7/21/2019 LAP (Autosaved)
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spuit 5cc
*ef$ta&ime In%
Neele 23
Trama$l In%
Ny A'i( >(>( Infuset ara!
c 1#
>rine ba"puit 10cc
spuit 5cc
puit 3cc
neele 23
*ef$ta&ime In%
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iv 18
c 1#
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puit 10ccspuit 5cc
puit 3cc
*ef$ta&ime In%
neele 23
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puit 3cc
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puit 10cc
puit 3cc
Ny. uparapti >(>( $mepra,$l In%
puit 10cc
Ny. @ariati >(>( puit 3cc
Tn. +%alal >(>( spuit 5cc
puit 3cc
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N7 Ina! >(>( puit 3cc
c 1#
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puit 10cc
I 18
selan" 02 +9s
N7 @ariati >(>( Iv 22
y. Ny. Inan" >(>( (ucus
y. Ny. Rubiyatun >(>( (ucus
Tn. -"us >(>( ;et$r$lac In%
puit 10cc
puit 3cc
7/21/2019 LAP (Autosaved)
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spuit 5cc
Ny. alima! >(>( puit 3cc
Tn. -ini >(>( puit 3cc
Ny. uparapti >(>( puit 10cc
puit 3cc
Ny. @ariati >(>( spuit 5cc
Tn. (u!tar >(>( e&a in%puit 10cc
puit 3cc
Tn. +%alal >(>( puit 10cc
puit 3cc
Tn. Resi)arn$ +IN- e&a in%
puit 10cc
puit 3cc
spuit 5cc
Ny. ri etyanin"si! +IN- puit 3cc
02/0#/22014 Tn ;$les$n >(>( selan" 02 +9s*eftria&$ne
puit 5 cc
nele 25
urC$ 20
c 1#
>rine ba"
puit 10 cc
puit 3 cc
Ny alima! >(>( I *!ateter N$. 20
Tn ;$les$n >(>( +e&ametas$n in%
Tn +%alal >(>( I *!ateter 20
I *!ateter 22
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+e&a In%
puit 3 cc
selan" 02 +9s
Ny ri etyanin"si! +IN- I N$ 18
puit 3 cc
spuit 5 cc
spuit 10 cc
*ef$ta&ime In%
c 1#
>rine ba"
Neele 23
Trama$l In%
;et$r$lac In%
Ny @i%i >mum <arnal 062 m"
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 331/539
Tn u9arn$ >(>( I *!ateter N$. 20
puit 10 cc
puit 5 cc
puit 3 cc
*eftria&$ne
Tn 9o#'on >(>( +ea&a
*eftria&$neNy (ursiti >(>( *eftriaa
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Tn -"us >(>( *eftria&$ne
;et$r$lac In%
puit 10cc
sssspuit 5cc
spuit 3cc
Tn S&arno >(>( *eftria
puit 10cc
spuit 5ccpuit 3cc
Tn alal >(>( puit 10cc
spuit 5cc
puit 3cc
Tn M&(tar >(>( *eftria
puit 10cc
spuit 5cc
puit 3cc
Tn Resi)arn$ >(>( ur$semi In%
+e&a
puit 10cc
spui 5c
puit 3cc
*eftri
Tn !aini >(>( puit 3c
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spuit 5cs
sspuit 3c
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Ny iti muri)a! >(>( Iv 18
selan" 02 +9s
>rine ba"
e&a in%
spuit 10ccccc
sspuit 5cc
*ef$ta&ime In%
7/21/2019 LAP (Autosaved)
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spuit 3c
neele 23
#/2/2014 ny.faria umum iv 18
spuit 10
spuit 5
spuit 3
)et$r$lac*ef$ta&im
Ny.(ursiti umum Infus iasa
Iv 22
*ef$ta&im
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puit 10
puit 5
puit 3
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Ny.elvi umum Iv 18*ef$ta&im
Trama$l In %
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puit 5
puit 3
Tn.;$les$n >mum Lev$v$)sacin Inf
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Tn 6irman +IN- +e&a in%
spuit 3cc
neele 25
+/"/2014 y. Ny. ?nan" +IN- (ucus
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puit 5 cc
puit 3 cc
Neele 23
Ny M&r'iti >(>( *eftri
Tn 9o#''on >(>( *eftri
e&a in%
Tn :#'iarno +IN- 6&ro'#mid# in!
*i.ro in%
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7/21/2019 LAP (Autosaved)
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cipr$ inf
ur$semie in%
spuit 5c
spuit 3c
Tn M&(tar >(>( puit 3c
Tn A-&' >(>( *eftri
;et$r$lac In%spuit 10cc
spuit 5c
spuit 3c
Tn '&arno >(>( *eftri
spuit 10c
spuit 3c
Tn iani >(>( ur$semie in%
N7 u%iati >(>( Iv 18
spuit 3c
spuit 10cN7 ulisty$ >(>( Infuset biasa
Iv 20
;et$r$lac In%
puit 5cc
spuit 3c
#/4/2014 y. Ny. u%iati +IN- (ucus
Ny. (ursiti >(>( puit 3cc
Ny. -nriyanti >(>( iv 18
>rine ba"
puit 3cc
Tn (ali)i >(>( In%&'#t Bia'a
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nan in%
spuit 3cc
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Iv 24
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Ny. Lina9ati >(>( selan" 02 +9s
Iv 20
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7/21/2019 LAP (Autosaved)
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c 1#
>rine ba"
*ef$ta&ime In%
puit 5cc
puit 3cc
Neele 23
Tn. Resi)arn$ +IN- iv 20Infuset biasa
an. (. arta +IN- puit 5cc
Iv 22
Iv 24
Infuset biasa
Ny.Lina9ati >(>( *eftri In%
+e&a In%
puit 5
puit 3
Nelle 25Ny.ulastri >(>( puit 3
Infus isa
Tn6(uct!ar >(>( puit 3
Tn.Resi ;arn$ +IN- puit 5
puit 3
Tn.iani >(>( spuit 3
Tn.-"ius >(>( *eftria&$ne
;et$r$lac In%
puit 10
puit 5
puit 3
Ny.ulisty$ +IN- spuit 3
Tn.;$les$n >(>( cetria&$ne
e&a in%
spuit 3
spuit 5
lev$C$cacin
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spuit 3
Tn.(ali)i >(>( *eftria&$ne
spuit 10
>IT 3
#/5/2014 Ny. iti atima >(>( Infuset ara!
urC$ 18
e&a in%
puit 3 cc
*ef$ in%
puit 5 cc
7/21/2019 LAP (Autosaved)
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c 1#
>rine ba"
puit 10 cc
Neele 23
Trama$l In%
;et$r$lac In%
7. Ny. iti atima >(>( (ucusNy. ulatim >(>( *ef$ta&ime In%
puit 10cc
neele 25
Tn. ;$les$n >(>( puit 3cc
Ny. (ursiti >(>( Infuset ara!
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Ny. ulatin >(>( puit 5cc
Nn. ulisty$ +IN- spuit 3cc
imvastatin
tn. Resi)arn$ +IN- ur$semi in%*l$pamel in%
puit 5cc
puit 3cc
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puit 5cc
tn. ;$les$n >(>( +e&a In%
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#/#/2014 NyD#i 5antia >(>( (ucus
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-n. iti >(>( S.&it **
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Ny.+e9i *anti)a >(>( Infuset ara!
iv 18
neele 23
puit 10cc
spuit 5cc
cef$
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spuit 3cc
Trama$l In%
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Ny. ulatim >(>( Iv 20
Infuset biasa
Tn. ;$les$n >(>( Iv 20
7/21/2019 LAP (Autosaved)
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$n. ; @ia!es
Ny. (ursiti >(>( *eftria&$ne
-sam Trane) In%
Ny. ulatim >(>( *ef$ta&ime In%
*l$pamel in%
puit 10cc
puit 3cc Tn. (u! ?i >(>( +ia,$le
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puit 10cc
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puit 10c
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puit 5cc
puit 3cc
Neele 23
Ny. iti ?nan" >(>( Infset +ara!
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c 1#
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puit 3 cc
puit 5 cc
Neele 23
;et$r$lac In%
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Ny. (ursiti >(>( *eftria&$ne in%
puit 5cc
puit 3cc
Tn. ;$les$n >(>( Lev$C$&acin Inf
*eftria&$ne in%
puit 10cc
puit 5cc
puit 3cc
y. Ny. ri ?nan" >(>( (ucus
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7/21/2019 LAP (Autosaved)
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Tn. ($!. ?i >(>( *eftria&$ne in%
spuit 10cc
+/)/2014 y.Riris >(>( entamicin IN
puit 3
puit 10
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puit 10cc
nan in%
cef$iv 20
spuit 5cc
spuit 3cc
Neele 25
-n. iti -yu >mum cef$ta&ime in%
Infuset biasa
+/?/2014 Ny.ulastri >(>( Infus isa
Iv 20
An Siti Ay& >mum *ef$ta&ime In%
puit 3cc
Tn a-iyo >(>( nan in%
>IT 3**
>IT 5**
Iv 20
Infuset biasa
Ny S&atim >(>( Iv 22
Ny arni >(>( puit 3cc
Infuset ara!
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Tn. $t%ipt$ >(>( $mepra,$l In%
Tn. @a"it$ >(>( puit 10cc
puit 5cc
r. -"un" +IN- *ef$ta&ime in%
puit 10cc
puit 5cc
puit 3cc
Tn. ;$les$n >(>( Lev$C$&aacin
ceftri
7/21/2019 LAP (Autosaved)
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puit 10cc
puit 5cc
puit 3cc
Ny. ulatim >(>( puit 5cc
N7.Ia ;urnia >(>( Iv 20
puit 3cc
*eftrispuit 5cc
y Ny arni >(>( (ucus
Tn S&marto bp%s umum Infuset ara!
>(>( iv 20
spuit 3cc
spuit 5cc
puit 10cc
Tn . $emart$ >(>( ur$semi in%
Ny. 7uni >(>( Infuset biasa
I 20puit 3cc
puit 5cc
puit 10cc
+e&a in%
Ny :ia >mum Infuset ara!
iv 18
puit 10cc
cef$ta&ime in%
spuit 5cc
spuit 3cc
+e&a in%
;et$r$lac In%
elan" 2 9s
Ny Listy$9ati >(>( Infuset ara!
I 18
elan" 2 9s
c 1#
>rine ba"
spuit 10cc
;et$r$lac In%
spuit 5cc
spuit 3cc
cef$ta&&ime in%
entamicin IN
Tn. umart$ >(>( $mepra,$l In%
*eftria&$n in%
ur$semi in%
Ny. ulatim >(>( -ml$ipin 5 m"
7/21/2019 LAP (Autosaved)
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r. -"un" +IN- Ranitiin Tab
Tn. @a"it$ >(>( nan in%
NyMa#'aro( +IN- Infus ara!
I 18
+e&a in%
* 1#
>rine ba"puit 3cc
puit 5cc
puit 10cc
Neele 23
*ef$ta&ime
;et$r$lac In%
Tn.@a"iy$ >(>( nan in%
puit 3cc
Tn.;$les$n >(>( Lev$C$&acin Inf
*eftria&$n in%puit 10cc
Ny.ulatin >(>( puit 3cc
r.-"un" +IN- *ef$ta&ime
puit 10cc
puit 3cc
Tn.$emarm$ >(>( $mepra,$l In%
*eftri in%
+10
puit 10cc
puit 5cc
ur$semi in%
puit 3cc
Ny.Ia ; >(>( I 18
Infus ara!
Ny.7uni >(>( +e&a in%
puit 3cc
puit 5cc
Ny Pindar'i( +IN- I 20
Infuset ara!
>IT 10**
>IT 5cc
puit 3ccc
*ef$
Neele 25
N> Nani +IN- (ucus
spuit 3cc
7 (aesar$! >(>( (ucus
y Listy$9ati >(>( (ucus
7/21/2019 LAP (Autosaved)
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y Ria >(>( (ucus
N> Ma#'aro( >(>( ur$semi in%
spuit 3cc
N> Pindar'i( +IN- *ef$ta
nan in%
Tn.;$les$n bp%s >mum entamicin IN
Tn.umart$ >(um Infus ara!NyPindar'i( +IN- *ef$ta&ime
Sdr<A-&n- +IN- *ef$ta&ime
puit 10cc
puit 3cc
Tn9o#'on >(>( *eftria&$n in%
entamicin IN
puit 10cc
puit 3cc
Tn.unart$ >(>( $mepra,$l In%
puit 10ccpuit 5cc
Tna-iyo >(>( nan in%
puit 3cc
y. Ny. (aesaar$! +IN- (ucus
Ny. +e9i >(>( >rineba"
-n. -i)$ +IN- ;aen 3
Infuset biasa
iv 22
iv 24
spuit 5cc
Tn. ;$les$n -s)es Neele 23
Ny. Ia ) >(>( puit 10cc
*eftri
puit 5cc
r. -"un" +IN- cipr$C$&acin 500 m"
Ranitiin Tab
Ny. (aesar$! +IN- I v118
>rineba"
ur$semi in%
+e&a in%
spuit 3cc
cef$
)et$r$lac in%
spuit 5cc
Tn.;$les$n nele 23
Tn.umart$ $mepra,$l In%
*eftri in%
puit 10
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puit 5
puit 3
Ny.iti )$iriya! bp%s um>( Infus ara!
Iv 18
puit 3
puit 5
puit 10 Trama$l In%
cef$ta&ime in%
Nele 23
* 1#
>rinba"
#/13/2014y. Ny. iti ;!$iriya! >(>( (ucus
Tn. $emart$ >(>( Infuset ara!
iv 20
Ny. iti ;!$iriya! >(>( puit 3 cc
elan" 2 9sny. u9arni >(>( Infuset ara!
iv 18
fc 1#
urineba"
cef$
Trama$l In%
spuit 3cc
neele 23
spuit 10cc
spuit 5cc
Ny. ri @eni >(>( elan" 2 9s
iv 20
Infuset biasa
puit 3cc
puit 5cc
puit 10cc
nan in%
Neele 25
Ny. (aesar$! +IN- fur$semi in%
Ny. <artini um>( Infuset +-ra!
I 18
* 1#
>rineba"
cef$ta&ime in%
puit 10cc
puit 5cc
puit 3cc
)et$r$lac in%
7/21/2019 LAP (Autosaved)
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Trama$l In%
Tn. upyan um>( Infuset ara!
I 20
nan in%
spuit 3cc
puit 5cc
Tn. Tatan" um>( Infuset ara!I 20
spuit 3cc
puit 5cc
Ny. ?)a9ati u(>( Infuset ara!
Iv 18
* 1#
>rineba"
puit 10cc
cef$ta&ime in%
puit 3ccNeele 23
Trama$l In%
)et$r$lac in%
puit 5cc
Ny. ruini >(>( *eftria&$ne in%
y. Ny. <artini >(>( (ucus
y. Ny. ?)a9ati >(>( (ucus
Nn. -rum u(>( Iv 20
*eftria&$ne in%
puit 3cc
spuit 5cc
spuit 10cc
Nn.-rum u(>( *eftri in%
puit 3
Ny.ruini bp%s u(>( Ranitiin IN
puit 10
puit 5
puit 3
Tn.Tatan" um>( puit 3
Tn.umant$ bp%s um>( spuit 10
spuit 5
spuit 3
#/14/2014 nn.aR>( um>( )et$r$lac in%
cipr$C$&acin 500 m"
*ipr$ inf
Tn Tatan- um>( *eftria&$ne in%
neele 25
$mepra,$l In%
7/21/2019 LAP (Autosaved)
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spuit 10cc
spuit 5cc
N7 ?)a9ati um>( Trama$l cap
Ny. ruini >(>( *eftria&$ne in%
puit 3cc
Tn. Tatan" >(>( puit 10cc6
puit 5ccpuit 3cc
Nn. -rum >(>( Trama$l In%
*ipr$ inf
puit 5cc
puit 3cc
Ny. ruini >(>( * 1#
urineba"
3 9ay selan"
Nn. -rum u(>( *ipr$ inf
puit 3cc Trama$l In%
Tn. Tatan" >(>( puit 10cc
puit 3cc
#/1#/2014 Ny. -nisa! >mum elan" 2 9s
Infuset ara!
puit 3 cc
I 18
-n. -!ma intan" >(>( Infuset ara!
I 24
Ny.-nisa >(>( puit 1 cc
puit 5 cc
(ucus
Ny Ta'mi >(>( elan" 2 9s
Iv 20
puit 5cc
Neele 25
Ny 7uliasi! )areb puit 10cc
Ny Ea >(>( Iv 20
nan in%
puit 5cc
spuit 3cc
Ny Tasmi >m>( $mepra,$l In%
>IT 10**
Tn. $li)in >(>( elan" 2 9s
iv 20
puit 5cc
puit 3cc
Ny. u)artani) >(>( -min$leban
7/21/2019 LAP (Autosaved)
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Ny. ?)a >(>( nan in%
Tn. $li)in >(>( ceftri
Neele 25
puit 10cc
puit 5cc
puit 3cc
Ny. T-mi >(>( *ceftri$mepra,$l In%
puit 3cc
spuit 10cc
NyNita Infus ara!
I 20
*ef$ta&ime
puit 10cc
TnSidi +IN- Infuset biasa
I 20
puit 5ccpuit 3cc
Ny. Nita >(>( nan in%
Tn. $li)in >(>( *eftri
puit 10cc
puit 5cc
puit 3cc
Ny. Tasmi >(>( *eftri
puit 10cc
puit 5cc
puit 3cc
Tn. ii) +IN- puit 10cc
puit 5cc
puit 3cc
Ny. ?)a >(>( puit 5cc
puit 3cc
Ny. Nunin" >(>( spuit 3cc
Neele 23
TnSidi +IN- Infus ara!
ur$semi in%
puit 5cc
TnA-&' +IN- I 20
Infus ara!
puit 5cc
*eftria&$n in%
entamicin IN
spuit 10 cc
spuit 3 cc
neele 25
7/21/2019 LAP (Autosaved)
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Ny. arpi >(>( puit 3 cc
* 1#
urineba"
puit 10
y. Ny. ;atmiasi! >(>( (ucus
puit 1 cc
N7 ?)a >(>( puit 3cc Tn $li)in >(>( puit 10ccc
spuit 5cc
spuit 3cc
N7 Tasmi >(>( puit 10cc
spuit 5cc
spuit 3cc
N7 u)artini) >(>( *eftria&$ne in%
TN ii) +IN- puit 10cc
spuit 5cc
spuit 3ccspuit 1cc
Ny @arsiti >(>( *eftria
Infuset ara!
I 18
puit 3cc
spuit 5c
spuit 10cc
Tn -"us >(>( *eftri
Ny arpi >(>( puit 3ccc
#/1B/2014 N>M&ntoi%a( >(>( Infus ara!
I 18
I 20
* 1#
>rine ba"
puit 10cc
puit 5cc
puit 3cc
Neele 23
*ef$ta&ime
Trama$l in%
Tn.ii' +IN- Infus +ara!
I 20
Ny. u)artini) >(>( -ml$ipin 5 m"
Tn $li)in >(>( *eftria
spuit 10c
spuit 5c
N7 ?)a >(>( puit 3cc
Ny @arsiti >(>( *eftria
7/21/2019 LAP (Autosaved)
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puit 5cc
spuit 3cc
spuit 10cc
Tn ii) +IN- spuit 1cc
spuit 3cccc
N7 Tasmi >(>( *eftria
puit 10ccspuit 5c
Ny 7ati >(>( *eftria
N7 u)artini) >(>( *eftria
Tn -"us >(>( *eftria
)et$r$lac in%
puit 10cc
spuit 3cc
#/20/2014 Ny. @i9in >(>( urC$ 18
e&a in%
puit 3ccNy. u)artani) >(>( puit 3cc
puit 5cc
iv 20
iv 22
Ny. 7arti >(>( puit 3cc
puit 5cc
ny. ?)a >(>( iv 20
Ny. @arsiti >(>( Infuset ara!
y. Ny. @i9in >(>( (ucus
Ny. u)artani) >(>( iv 24
iv22
Infuset ara!
Ny. @i9in >(>( spuit 10cc
Ny. @arsiti >(>( $mepra,$l In%
Ny. ri >tami >(>( ansulin n
Ny.@arsi! >(>( *eftria&ine
spuit 10
spuit 5
spuit 3
Tn.ii) +IN- spuit 10
spuit 3
Ny.Tasmi >(>( *eftria&$ne in%
>IT 3
puit 10
Ny.uarmisi! +IN- *ipr$ inf
spuit 3
Ny.u)artini) >(>( >IT 5
puit 3
7/21/2019 LAP (Autosaved)
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Ny. @arsiti >(>( Infuset ara!
y. Ny. Lina >(>( (ucus
Ny. ?rlina >(>( Infuset ara!
* 1#
urineba"
spuit 10cc
neele 23iv 118
cef$ta&ime in%
)et$r$lac in%
spuit 3cc
spuit 5cc
Ny. uarmisi! +IN- ceftri
ia,$le
ulc$la& supp
neele 25
spuit 10ccNy. 7ati >(>( urineba"
Tn. ii) +IN- Iv 20
Iv 22
Ny.@arsiti >(>( $mepra,$l In%
Ny.uarmisi! >(>( *eftria&$ne in%
ia,$le
spuit 10 cc
Ny.itri >(>( infus ara!
iv 18
* 1#
>rinba"
spuit 10
spuit 5
puit 3
Trama$l in%
cef$ta&ime in%
nele 23
Ny.7ati >(>( *eftria&$ne in%
Tn.sii) >(>( spuit 3 cc
NySri Nin-'i( >(>( Infus ara!
I 18
*ef$ta&ime in%
puit 5cc
Nele 23
N7.7ati >(>( Infus ara!
I 22
I 20
Ny<Sri a(y&ni >(>( Infuset biasa
7/21/2019 LAP (Autosaved)
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I 20
puit 5cc
puit 3cc
puit 10cc
By6itri >(>( (ucus
dr6anny +IN- Infuset biasa
I 20*eftri
puit 10cc
puit 5cc
puit 3cc
Ny. NiNi) >(>( luc$e&
Ny. @arsiti >(>( La&ana
Ny. ri >tami >(>( usc$ti)a In%
tn. -"us >(>( e&a in%
spuit 3cc
spuit 5ccNy. suarmisi! >(>( *eftria&$ne in%
ia,$le
Ny. u)artini) >(>( *eftria&$ne in%
puit 10cc
puit 3cc
-min$leban
Ny. 7-ti >(>( *eftria&$n e in%
puit 10cc
puit 3cc
Ny. anny +IN- usc$ti)a In%
puit 10cc
puit 3cc
Tn. ii) +IN- puit 1cc
puit 3cc
Ny. ri @a!yuni >(>( puit 3cc
puit 5cc
Ny. @arsiti >(>( puit 10cc
puit 5cc
puit 3cc
ByN#tty >(>( puit 1cc
(ucus
Ny.(u%iati) >(>( Infus ara!
I 20
elan" 2 9s
* 1#
urine ba"
puit 10cc
puit 5cc
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puit 3cc
puit 1cc
NyN#tty >(>( e&a in%
Infus ara!
I 20
puit 3cc
elan" 2 9s* 1#
urine ba"
puit 5cc
cef$ta&ime
Trama$l in%
)et$r$lac in%
Tn Joo >(>( Infuset ara!
iv 20
spuit 10cc
spuit 5ccneele 25
r. anny +IN- iv 22
iv 20
Ny. (u%iati >(>( Neele 25
*eftri
puit 1cc
Tn. ii' +IN- limepirie 4 m"
Ny. ri 9a!yuni >(>( -ll$purin$l 100 m"
emAbr$,il 300
Ny. Netty >(>( puit 3cc
Tn. $)$ >(>( puit 5cc
Ny. @arsiti >(>( puit 10cc
puit 5cc
puit 3cc
$mepra,$l In%
Ny. 7-ti >(>( puit 5cc
puit 3cc
Ny. u)artini) >(>( puit 10cc
puit 3cc
Ny. ri @a!yuni >(>( Trama$l in%
puit 3c
Tn. -"us >(>( puit 3cc
Ny. uarmisi! >(>( *ipr$ inf
#/24/2014 Ny. iti R$mla! >(>( puit 3 cc
puit 5 cc
N7. @arsiti >(>( )et$r$lac in%
*l$pramel
puit 3 cc
7/21/2019 LAP (Autosaved)
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Ny.uarmisi! >(>( *ef$ta&ime in%
Nele 23
N> S&artini >(>( Iv 24
I 22
Ny Siti 9(oi.a( >(>( Infuset ara!
iv 18
urine ba"* 1#
spuit 10cc
spuit 5cc
spuit 3c
Ny. iti r$mla! >(>( puit 5cc
puit 3ccNeele 25
Tn. -"us >(>( puuit 3cc
Ny. ri @ >(>( ;aen 3
Trama$l in%
Ny. u)artani) >(>( puit 10cc
puit 3cc
Ny. uarmisi! >(>( nancentr$n in%
*ef$
spuit 10cc
Tn. $)$ >(>( puit 3cc
Tn. unart$ >(>( puit 3 cc
Infuset biasa
I 20
r. Nur9an +IN- puit 10 cc
puit 5 cc
puit 3 cc
*eftri
e&a in%
* 1#
urine ba"
elan" 2 9s
y. Ny. -nna >(>( (ucus
TnA G(o8ai >(>( 3 9ay selan"
puit 10cc
puit 3ccTnS&naryo >(>( *eftria&$n in%
Niran >(>( +e&a in%
tn. unary$ >(>( *l$pramel
*eftria&$ne in%
puit 10cc
puit 5cc
puit 3cc
7/21/2019 LAP (Autosaved)
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Ny. ri @ >(>( Trama$l in%
puit 5cc
puit 3cc
Ny. u)artani) >(>( ceftri
puit 10cc
puit 5cc
puit 3cc Tn. !$,ali >(>( >$pa
puit 3cc
puit 10cc
Infuset biasa
;asa 4G10
+40
Ny. iti R$mla! >(>( puit 3cc
puit 5cc
puit 10cc
sr. Nir9an +IN- ceftrie&a in%
puit 3cc
puit 10cc
puit 5cc
Infuset biasa
Tn.$,ali >(>( Iv 20
Infus iasa
elan" 2 +9s
puit 10
puit 3
puit 5
Nele 23
Tn.-"us >(>( Iv 20
Tn.$,ali >(>( 40
*eftri
puit 5
Nele 25
mepra,$l In%
Ny.-na >(>( Infus +ara!
iv 18
c 1#
>rinba"
puit 10
puit 5
puit 3
Nele
Trama$l
;et$r$lac
7/21/2019 LAP (Autosaved)
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*ef$
Ny.iti ;$lifa! >(>( +ia,$l
*eftri
puit 5
puit 3
+/2+/2014 N> S&artini >(>( iv 20
Ny Siti 9(oi%a( >(>( I 18*?TRI
Ny Siti 9(oi%a( >(>( puit 3cc
sr. Nir9an +IN- puit 10cc
entamicin IN
Iv 20
Iv 22
Ny. (eiyana >(>( Infuset ara!
I 18
* 1#
>Rineba"*ef$ta&ime in%
puit 10cc
puit 5cc
puit 3cc
Trama$l In%
Neele 23
N><Sri Ani >(>( puit 3cc
puit 10cc
Tn.-6!a,li >(>( *eftri in%
mepra,$le in%
r.Nir9an +IN- *eftri in%
entamicin IN
Tn.unary$ >(>( *eftri in%
puit 10cc
N7.u)artini) >(>( puit 10cc
puit 3cc
N76sri @a!yuni >(>( puit 3cc
+/2=/2014 y. Ny. ri -ni >(>( puit 1 cc
(ucus
Ny. iti ;!$lifa! >(>( *eftri in%
puit 5 cc
Ny. un"atmi >(>( Infuset biasa
I 20
puit 3 cc
puit 5 cc
NySri a(y&ni >(>( Trama$l in%
*eftri in%
NyS&n-atmi >(>( puit 5cc
7/21/2019 LAP (Autosaved)
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TnAG(o8ai >(>( *eftri in%
r.Nir9an +IN- *eftri in%
entamicin IN
Ny.iti R$mla! >(>( *eftri in%
puit 10cc
puit 5cc
puit 3cc#/28/2014 TN. !$,alli >(>( iv 20
puit 10cc
y. Ny. u%i >(>( (ucus
Ny. u%i >(>( Infuset ara!
Iv 18
c 1#
>Rineba"
puit 10cc
puit 5cc
*ef$ta&ime in%;et$r$lac In%
puit 3cc
Neele 23
Tn. -. !a,ali +IN- +40:
e&a in%
Tn. -bul Ra!man -NT- Infuset biasa
Iv 20
puit 10cc
puit 5cc
Neele 25
emAbr$,il 300
Ny. Trivina -(T?; (ucus
-n. enita ; Infuset biasa
Iv 22
tn. <ufr$n +IN- Infuset biasa
iv 20
puit 10cc
spuit 5cc
spuit 3cc
Neele 25
-n. enita +IN- puit 3cc
Ny. Inra9ati >(>( Infuset biasa
iv 18
Tn. -bul +IN- puit 3cc
Ny. ri @ >(>( *eftri
*l$pramel
-min$leban
Tn. <ufr$n +IN- *eftri
7/21/2019 LAP (Autosaved)
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*l$pramel
Neele 25
puit 5cc
NyIndraati puit 10cc
puit 3cc
ByIndraati puit 1cc
AnJ#nita 5#%tria$on# In!S.&it 1**
S.&it "**
I7 24
#/30/2014 Tn. Ri,ali >(>( ur$semi in%
nancentr$n in%
puit 10 cc
puit 5 cc
puit 3 cc
Tn. <ufr$n +IN- -lpra,$lam 1 m"
Tn. -bul +IN- puit 3ccNy. iti R$mla! >(>( puit 10cc
tn. <ufr$n +IN- puit 10cc
puit 3cc
Tn. Ri,ali >(>( puit 10cc
puit 3cc
y. Ny. Isabella >(>( (ucus
7/21/2019 LAP (Autosaved)
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JMLA;;A7GA PASIEN
MM BPJS MM BPJS DINAS
1 #6B00
10 86000
1 56400
1 46=00
1 #6B003 26400
3 36000
3 36B00
1 156500
1 46400
2 106800
1 300
1 46=00
2 #6B00
1 564003 446400
1 26000
1 56400
1 56400
1 16300
1 16000
1 800
1 56400
5 56000
1 #6B00
1 #6B00
1 46=00
2 26000
1 800
2 126#00
10 26000
1 86200
2 136800
3 #6#00
1 #6B00
2 56400
2 800
1 16300
2 #00
2 136800
3 1B6800
2 106800
7/21/2019 LAP (Autosaved)
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2 26000
3 26400
1 56400
1 36800
2 26#00
2 16#00
3 264002 26000
4 5B6200
2 46400
2 3B6#00
2 =6#00
1 56400
4 126000
2 26#00
1 106#00
2 1368001 156500
1 46400
1 16300
4 36200
3 36000
3 1#6200
1 300
1 #6#00
1 156500
1 46400
1 16300
3 36000
= 56#00
1 #6500
10 86000
1 56400
1 #6500
2 26#00
2 26000
2 16#00
1 300
# 46800
2 26000
1 326#00
1 16300
1 #6#00
2 =6#00
2 16#00
7/21/2019 LAP (Autosaved)
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2 16#00
1 56400
2 146800
3 26400
1 16300
# 46800
1 106#001 #6#00
1 106#00
8 #6400
1 #6#00
1 #6500
1 #6B00
3 26400
1 16300
2 #6#00
3 264003 36000
3 36B00
1 300
1 46=00
2 #6#00
4 46000
4 36200
4 56200
1 300
1 46=00
2 #6#00
5 46000
5 56000
1 46=00
2 #6#00
4 36200
4 46000
4 56200
1 300
1 56400
2 56400
2 26#00
3 B6000
1 8#6000
2 46400
1 #6B00
1 156500
1 46400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 358/539
2 26#00
5 46000
3 36000
1 300
3 1#6200
4 86000
3 264001 106#00
1 #6#00
4 136200
4 206400
5 46000
5 56000
1 16300
1 800
1 16000
4 860001 56400
3 36B00
2 26000
2 16#00
2 26000
1 800
2 106800
4 86000
2 26#00
1 16000
3 26400
1 8#6000
1 56400
1 16300
2 26000
1 800
1 #6B00
2 16#00
1 46=00
1 #6500
1 156500
1 46400
1 16300
3 1#6200
3 36000
4 36200
1 #6B00
10 86000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 359/539
1 #6#00
1 26200
2 106800
1 300
1 #6500
4 206400
4 1362004 46000
4 36200
3 1#6200
3 36000
3 246000
2 #6#00
2 #6#00
1 #6500
1 156500
1 464001 46=00
2 #6#00
2 26#00
3 36000
3 26400
1 800
2 46000
2 46400
3 #6000
1 56400
3 26400
2 26#00
2 16#00
2 106800
2 16#00
2 26#00
2 26#00
2 #6#00
1 106#00
1 106#00
1 106#00
3 26400
1 #6100
1 #6B00
1 #6500
1 156500
1 46400
1 16300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 360/539
3 36000
3 1#6200
1 300
3 B6B00
1 #6100
1 156500
1 464001 16300
3 36000
= 56#00
1 300
3 1#6200
1 #6#00
2 #6B00
1 156500
1 46400
1 163003 36000
= 56#00
3 1#6200
1 300
2 46400
2 16#00
2 46400
3 36B00
2 16#00
1 8#6000
2 26#00
2 16#00
2 26000
2 16#00
3 26400
1 800
1 156500
1 #6B00
1 800
1 16300
1 156500
1 #6500
1 #6#00
1 106#00
1 106#00
4 2#6400
1 16300
3 26400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 361/539
1 16000
3 26400
2 16#00
1 16300
3 26400
3 36000
1 260002 26#00
4 36200
1 16300
3 26400
1 26000
2 26#00
4 36200
1 16000
4 36200
1 #65002 106800
2 26000
1 300
1 #6#00
1 156500
1 46400
5 #6500
3 26400
2 #6#00
3 #6000
1 #6#00
1 #6#00
1 106#00
1 #6B00
2 46000
1 800
1 #6500
1 #6B00
5 46000
3 36000
1 16300
3 1#6200
1 156500
1 46400
1 300
1 36300
3 1B6800
# 8#6400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 362/539
2 136200
3 36B00
3 36000
3 26400
2 106800
3 #6000
2 1068001 56400
4 36200
2 106800
4 2#6400
2 26#00
1 16000
1 800
2 106800
2 26#00
1 160001 800
1 16300
1 16000
1 800
2 106800
1 16300
1 16000
1 800
2 46400
1 26000
1 16300
2 26000
1 800
1 56400
2 16#00
1 16300
1 16000
1 800
1 800
1 #6#00
1 #6500
1 #6B00
1 #6500
1 46400
2 46000
2 26#00
4 46000
3 1#6200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 363/539
4 36200
2 #00
1 #6B00
1 16300
3 36000
# 46800
3 1B68003 1#6200
1 46=00
2 136200
2 106800
1 #6500
3 36B00
3 36000
3 26400
1 300
1 #6B003 1#6200
3 B6B00
3 1B6800
2 #6800
3 36000
8 #6400
1 =86000
1 326#00
1 46=00
1 26000
1 800
1 300
1 106#00
1 106#00
1 #6500
1 326#00
1 56400
1 26000
1 16000
3 26400
1 300
1 56400
2 106800
3 #6000
2 46400
2 526800
4 36200
3 126B00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 364/539
2 526800
2 46400
4 46000
3 26400
4 36200
2 106800
4 2#64002 26#00
2 26000
3 26400
2 106800
2 16300
2 16#00
1 26200
1 #6B00
4 36200
1 163001 46=00
1 #6#00
2 136200
2 26000
4 36#00
1 106#00
2 16#00
1 #6B00
1 46400
4 36200
1 4<=00
2 +<+00
1 <400
" 2<400
1 "00
2 #6#00
1 46=00
3 126B00
5 46000
3 36000
5 500
5 56000
1 #6#00
1 #6#00
1 46=00
1 #6500
1 #6#00
1 46=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 365/539
1 156500
1 46400
3 1#6200
4 46000
5 46000
1 300
1 #6#001 46=00
3 36000
1 #6#00
1 #6#00
1 46=00
2 106800
4 86000
2 26000
3 26400
1 3001 800
1 46=00
3 26400
3 36000
2 16#00
1 800
2 106800
4 2#6400
2 26#00
3 36000
2 16#00
2 16#00
2 106800
2 46000
3 26400
1 16000
1 =86000
2 26000
2 16#00
2 106800
2 26#00
3 26400
1 #6100
1 #6B00
2 46000
8 #6400
3 1#6200
3 36000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 366/539
1 156500
1 46400
1 16300
1 300
3 B6B00
3 1B6800
1 106#002 106800
2 26#00
2 #00
3 26400
1 #6100
2 16#00
2 26000
2 16#00
# 16800
2 464002 56#00
2 26000
2 16#00
2 16#00
2 26000
2 46000
1 #6500
1 106#00
1 =86000
2 26000
2 16#00
1 #6#00
4 2326000
1 300
1 #6100
1 #6B00
1 300
1 16300
3 36000
3 1#6200
1 156500
1 46400
5 46000
1 36300
3 1B6800
1 #6#00
1 46=00
1 #6#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 367/539
3 #336#00
1 56400
3 156300
1 56400
2 26800
2 26#00
3 264003 1=46000
2 106800
3 36B00
1 800
2 16#00
2 106800
4 126000
1 300
1 #6100
1 #6B001 156500
1 46400
1 16300
3 36000
8 #6400
4 216#00
4 46000
4 36200
1 300
1 #6100
1 #6B00
1 156500
1 46400
8 #6400
2 26000
1 300
3 1B6800
1 1B6800
1 56400
2 26000
1 800
1 =86000
2 106800
1 16300
2 26000
2 16#00
1 106#00
1 16000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 368/539
2 106800
4 56200
2 =6#00
8 #6400
1 16300
2 106800
2 #60002 106800
2 46000
1 56400
1 56400
3 1=46000
1 #6500
1 #6100
3 36B00
3 126B00
3 1#62001 #6#00
3 36000
3 26400
1 300
1 56400
1 46=00
1 46=00
1 #6#00
2 B6#00
5 46000
2 86#00
# 46800
1 16000
1 #6B00
1 46=00
1 #6B00
2 16#00
1 #6100
1 #6B00
1 4#6800
2 26#00
1 16000
3 1#6200
2 26#00
2 26000
2 16#00
1 =86000
2 106800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 369/539
2 26#00
1 16000
1 800
2 26000
1 #6#00
3 26400
3 1#62003 36000
1 106#00
1 #6100
1 #6#00
3 26400
3 36000
3 36B00
2 46400
1 46=00
1 #6#003 26400
3 36000
3 36B00
3 #6000
1 #6100
1 #6B00
1 16300
3 1#6200
5 56000
5 46000
4 86000
3 1B6800
1 #6500
1 #6100
1 #6B00
1 #6500
1 156500
1 46400
1 16300
3 1B6800
4 46000
4 36200
3 1#6200
2 =6#00
2 1=26000
2 106800
2 46400
3 16500
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 370/539
10 #6000
3 126B00
1 #6100
1 #6B00
4 86000
1 156500
1 464005 46000
5 56000
3 36B00
3 B00
3 1#6200
3 1B6800
3 126B00
5 46000
1 =86000
2 1068002 26#00
3 26400
2 106800
1 16300
1 800
2 1=26000
2 106800
1 #6#00
4 56200
4 46000
1 26200
1 800
1 #6B00
1 #6100
4 86000
4 36200
2 26000
1 #6#00
1 #6100
3 36B00
3 36000
3 26400
2 106800
1 300
1 106#00
1 800
1 106#00
1 106#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 371/539
1 106#00
1 26200
1 800
3 1#6200
3 126B00
2 =6#00
1 #61003 146400
2 B6#00
2 26#00
1 800
2 106800
2 =6#00
2 26#00
2 16#00
2 1=26000
2 26#004 46000
3 126B00
5 46000
1 106#00
1 4400
3 3#6B00
1 46=00
1 #6#00
1 #6#00
1 16000
1 300
1 16300
1 56400
1 16000
10 46000
10 26000
1 #6B00
1 46400
1 26200
2 46000
# 46800
3 56400
3 1B6800
3 36000
1 300
2 1=26000
2 106800
2 26#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 372/539
1 16000
1 800
1 #6100
2 #6B00
= 56#00
2 26000
1 163001 36300
3 1#6200
1 300
1 156500
1 46400
1 106#00
1 #6100
1 #6#00
1 800
1 #65001 #6100
1 #6B00
1 156500
1 46400
3 1#6200
3 B6B00
5 46000
1 300
1 16300
3 36000
1 #6500
1 #6#00
1 46=00
2 16#00
2 26000
2 26#00
2 86#00
1 300
1 26200
1 #6100
1 #6B00
1 156500
1 46400
3 1#6200
1 16300
3 26400
5 56000
3 1B6800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 373/539
1 36300
1 #6100
1 #6#00
2 86#00
3 26400
3 36000
1 #61001 #6#00
2 16#00
1 16000
1 #6100
1 #6B00
1 156500
1 46400
1 16300
3 1#6200
8 #64001 300
1 36300
3 1B6800
3 36000
4 216#00
1 106#00
1 106#00
1 #6#00
1 56400
2 16#00
2 26000
2 26#00
2 106800
2 16#00
1 36800
2 26#00
2 26000
3 26400
3 26400
2 26#00
2 26000
2 16#00
3 1B6800
5 26000
2 1#46200
2 106800
1 300
1 8#6000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 374/539
2 26#00
2 26000
15 46500
1 56400
1 800
1 16300
1 160003 26400
2 #6#00
2 1#46200
1 16000
3 26400
1 156500
1 46400
1 326#00
2 1#46200
4 362002 #6#00
1 16300
3 26400
1 #6500
1 #6100
1 800
1 #6B00
1 #6100
1 #6B00
1 800
1 16000
1 106#00
1 #6500
1 #6#00
2 26000
1 300
2 26#00
1 #6#00
2 86#00
3 36000
5 46000
1 8#6000
1 16300
1 #6500
1 #6#00
2 26000
2 16#00
1 B36#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 375/539
1 46300
2 106800
1 300
4 56200
2 26000
1 800
2 1068001 8#6000
3 26400
3 36B00
1 #6100
2 136200
2 106800
2 26#00
1 46=00
2 136200
2 260002 16#00
3 46300
2 106800
3 36B00
2 26000
2 16#00
1 56400
1 16300
2 26000
1 800
1 16300
2 26000
1 800
1 16000
2 16#00
1 800
1 300
1 #6100
2 46400
2 26000
1 #6#00
1 #6100
2 26000
2 106800
2 =6#00
3 36B00
3 26400
1 300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 376/539
4 36200
1 156500
1 46400
1 16300
1 106#00
1 #6000
2 260002 26#00
1 16000
2 16#00
1 16300
1 16000
2 16#00
2 106800
1 16300
2 26000
1 8003 26400
2 106800
1 #6100
1 #6B00
5 46000
5 56000
2 26#00
2 106800
5 46000
1 #6100
1 #6B00
1 #6B00
1 156500
1 46400
1 16300
3 36000
# 46800
1 300
3 1#6200
3 B6B00
1 #6100
1 #6B00
5 26500
1 56400
1 16300
3 36000
2 16#00
2 106800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 377/539
3 36000
3 26400
2 26#00
3 186000
3 246000
1 56400
1 163002 26000
2 106800
2 106800
2 106800
3 11B6800
2 26#00
2 16#00
1 #6B00
4 86000
4 362003 26400
1 16000
1 #6B00
1 #6B00
2 16#00
2 26000
1 #6B00
1 #6100
1 106#00
1 #6B00
1 #6B00
1 #6100
1 16300
1 8#6000
1 100800
2 106800
3 36B00
3 36000
3 246000
3 36B00
3 26400
1 56400
3 26400
3 36B00
2 526800
3 26400
2 26000
3 26400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 378/539
1 #6100
1 106#00
1 #6100
1 156500
1 46=00
2 26#00
1 3001 #6B00
3 146400
3 11B6800
= 56#00
3 36000
2 106800
3 1=46000
2 26000
1 300
4 562001 46=00
1 #6B00
3 206=00
1 8#6000
2 106800
2 11#6000
4 56200
1 #6100
1 #6B00
1 156500
1 46=00
1 16300
4 46000
5 46000
1 36300
3 146400
1 300
2 106800
2 16#00
1 #6100
1 #6B00
1 46800
1 16000
1 300
1 #6100
2 136800
1 #6B00
1 46=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 379/539
2 136800
5 56000
5 46000
3 36B00
1 106#00
1 46=00
3 206=001 56400
2 26#00
2 26000
2 16#00
10 4000
2 16200
# 44400
2 46000
2 16#00
2 260001 56400
3 1=46000
2 106800
1 16300
4 36200
1 B36#00
2 106800
1 16300
2 16#00
3 226200
2 26#00
3 26400
3 186000
3 26400
2 16#00
1 16000
2 26#00
1 16000
4 36200
1 #6000
1 106#00
1 #6100
1 #6B00
1 #6500
1 156500
1 46=00
3 36B00
3 36000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 380/539
3 26400
2 126000
2 46000
1 #6100
1 #6B00
= 56#00
1 #65001 106#00
1 46=00
3 36000
3 146400
1 36300
3 1B6800
1 #6100
1 #6B00
3 36B00
2 260001 300
2 #6#00
1 #6B00
1 300
1 56400
3 186000
5 86500
5 16000
5 26000
1 800
2 26000
2 26#00
2 26000
2 26400
1 8#6000
2 26000
2 16#00
2 26#00
4 36200
2 #6#00
4 36200
3 26400
2 526800
2 16#00
2 26000
1 #6#00
5 146000
2 16#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 381/539
2 106800
1 300
2 136200
1 #6#00
1 #6100
1 #6B00
1 464001 156500
1 16300
3 36000
3 26400
1 16000
3 264001 300
2 16#00
1 126300
2 #6#00
2 26#00
3 26400
3 126B00
2 106800
4 56200
3 26400
5 56000
1 46=00
1 #6#00
3 36B00
3 36000
3 26400
1 56400
3 #6000
2 316000
1 46400
1 #6500
1 106#00
1 326#00
1 16300
1 8002 106800
2 46000
3 86400
2 106800
2 26#00
1 16000
1 800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 382/539
2 #6#00
2 26000
1 800
2 106800
1 16300
1 16000
2 16#004 5B6200
4 36200
2 26#00
1 46=00
2 56400
2 46800
4 26400
2 26000
1 16300
2 1068002 46000
4 36200
2 26#00
1 16000
1 46=00
1 #6B00
1 46=00
1 #6500
3 36B00
3 26400
3 36000
1 300
1 #6B00
2 46800
2 106800
2 26000
1 300
1 8#6000
1 #6100
1 #6B00
1 156500
1 46400
1 16300
3 36000
5 46000
1 300
1 36300
3 1B6800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 383/539
3 1#6200
2 11#6000
1 56400
1 16000
3 26400
1 #6B00
1 #6B002 106800
# 46800
1 16300
2 =6#00
2 136800
1 #6#00
1 #6=00
1 #6B00
1 156500
1 464003 1#6200
1 16300
3 36000
# 46800
1 36300
1 300
1 800
1 16300
2 106800
1 8#6000
2 106800
4 156200
2 106800
2 36#00
2 36#00
3 26400
3 26400
1 #6000
1 106#00
3 1#6200
3 36000
1 46=00
1 #6B00
3 26400
3 36000
2 #6#00
2 106800
2 26000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 384/539
2 106800
2 106800
2 =6#00
2 106800
2 26#00
2 26000
2 16#001 #6B00
2 26#00
1 106#00
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
3 36000
3 1#62003 1B6800
# 46800
1 300
3 =6200
2 46000
1 46=00
1 #6B00
2 26#00
2 26000
1 300
10 46000
1 106#00
1 46=00
1 #6#00
2 46=00
1 #6B00
3 36B00
3 36000
5 46000
1 300
1 800
1 46=00
1 #6B00
2 16#00
2 106800
2 56#00
1 B36#00
2 106800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 385/539
3 86400
1 300
2 26000
1 16300
3 26400
1 #6000
2 10)001 +000
4 "200
2 1"200
3 #6#00
2 86#00
2 26#00
2 26000
4 36200
5 126000
3 264001 16300
2 26#00
3 26400
2 26#00
3 26400
1 106#00
312500 1361106B00 1644B6300 148=2=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 386/539
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Tn.@i$$ bp%s - aml$ipine 5 20
#/2=/2014 Tn. abran" - -ml$ipin 5 (" 30
#/28/2014 <*> >+- 5
NAMA PASIENBPJS
7/21/2019 LAP (Autosaved)
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;A7GA PASIEN
MM BPJS MM BPJS DINAS ;-R?
116000
406000
156400
16500156000
336000
1500
B6800
226000
336000
156000
156000
=46000
1006400 12#6500 5=6800 1500 28#6200148=2=00
1561586B00
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT JMLA;
=/1/2014 Ny I'a,#a >(>( I 18 1
Infuset ara! 1
* 1# 1
urine ba" 1
*?T-GI( IN 3>IT 3cc 5
puit 5cc 3
spuit 10cc 1
selan" $2 9s 1
Ny Di +IN- Infuset ara! 1
elan" $2 9s 1
I 18 2
c 1# 1
urine ba" 1
puit 3c 3spuit 10cc 1
An Mi# +IN- I 20 1
Infuset biasa 1
puit 10cc 3
puit 5cc 3
spuit 3cc 3
neele 25 1
ceftria 2
selan" $2 9a 1
ByNyDi Indriyani +IN- (ucus 1
Ny. +9i ;umalasari +IN- iv 18 1
Infuset ara! 1
puit 10cc 1
puit 3cc 3
y. Ny. +9i ; +IN- puit 1cc 1
(ucus 1
Ny. iti R$mla! >(>( ceftri 1
puit 10cc 1
Tn. -bul +IN- puit 3cc 3
Ny. (ie)e +IN- puit 10cc 1
puit 3cc 1
03/0=/02014 Tn. u9arn$ >(>( I 20 1
Infuset biasa 1
puit 3 cc 3
-ml$ipin 5 m" 5
*anersartan 8m" 5
Ny. irina +IN- Iv 20 1
Infuset biasa 1
7/21/2019 LAP (Autosaved)
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*eftria&$ne in% 2
+e&a In% 2
elan" 2 +9s 1
spuit 10cc 2
puit 3cc 3
Tn. -bul +IN- -ml$ipin 10 m" 5
Ny. irina +IN- Infuset biasa 13@ay elan" 1
puit 5cc 1
spuit 10cc 1
Ny6irina +IN- *eftri in% 2
+e&a In% 3
spuit 10cc 2
puit 3cc 4
Tn.-bul +IN- puit 3cc 3
emAbr$,il 300 4
Infuset biasa 1 Tn.u9arn$ +IN- ur$semi in% 4
puit 3cc 3
Nyarina( >(>( Infuset biasa 1
puit 3cc 4
puit 5cc 3
puit 10cc 2
I 20 1
=/4/2014 Ny.NaAa! >(>( Iv 18 1
* 1# 1
urine ba" 1
puit 10 1
Nele 23 1
*?T-GI( IN 3
puit 5 cc 3
puit 3 cc 5
Trama$l in % 1
Ny.($ni)a >(>( Iv 18 2
* 1# 1
urine ba" 1
puit 10 1
Nele 23 1
*?T-GI( IN 3
puit 5 cc 3
puit 3 cc #
Trama$l in % 1
selan" $2 9s 1
y.NaAa! >(>( (ucus 1
y.m$ni)a >(>( (ucus 1
7/21/2019 LAP (Autosaved)
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Ny. (aryuliati >(>( I 20 1
Infuset biasa 1
*eftri in% 2
puit 10 cc 2
puit 3 cc =
neele 25 1
Ny. irina +IN- (etf$rmin tab 10 Tn. ii) urn$m$ +IN- Iv 20 1
Infuset biasa 1
;aen 3 1
*?T-GI( IN 2
ur$semi in% 1
spuit 10cc 2
puit 3cc 3
puit 5cc 1
Nyarina( >(>( puit 10cc 2
puit 3cc 3RL 2
Ny. irina +IN- *eftri in% 2
+e&a In% 3
puit 10cc 2
puit 3cc 3
Tn. -bul +IN- puit 3cc 3
Tn.ii) +IN- *?T-GI( IN 2
ur$semi in% 1
puit 3cc 2
puit 10cc 2
Ny. (aryuliati >(>( *eftri in% 2
puit 10cc 2
Tn.u9arn$ +IN- ur$semi in% 1
puit 3cc 2
puit 10cc 2
*eftri in% 2
=/5/2014 Ny. Liya +IN- Infuset ara! 1
Iv 20 1
+e&a In% 4
puit 3cc =
Ny. upina! >(>( elan" 2 +9s 1
Iv 20 1
Infuset biasa 1
puit 5cc 3
puit 3cc 3
Ny. NaAEa! >(>( iv 18 1
Ny. Ia >(>( +e&a In% 4
puit 3cc 4
7/21/2019 LAP (Autosaved)
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puit 10cc 2
spuit 5cc 1
Neele 23 1
* 1# 1
urine ba" 1
Ny. upina! >(>( Infuset ara! 1
Tn.ii) +IN- ;aen 3 1*?T-GI( IN 2
puit 10 cc 2
ur$semi in% 1
puit 3 cc 1
Ny.(aryuliati >(>( *eftri in% 2
puit 10 cc 2
Tn.u9arn$ >(>( ur$semi in% 1
*eftri in% 2
puit 10 cc 2
puit 3 cc 2Ny.irina >(>( *eftri in% 2
+e&a In% 3
puit 10 cc 3
puit 3 cc 3
Tn.-bul >(>( puit 3 cc 2
Ny.upina! >(>( puit 5 cc 2
puit 3 cc 2
=/#/2014 Ny. Ia >(>( puit 10cc 2
ur$semi in% 2
puit 3cc 3
elan" 2 +9s 1
Ny. Listy$9ati >(>( Infuset ara! 1
I 20 1
* 1# 1
urine ba" 1
puit 10cc 1
*?T-GI( IN 3
Trama$l in % 1
puit 5cc 3
puit 3cc 5
elan" 2 +9s 1
Ny. Nunu) >(>( Iv 18 1
Infuset ara! 1
* 1# 1
urine ba" 1
spuit 10cc 1
Trama$l in % 1
puit 3cc 5
7/21/2019 LAP (Autosaved)
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enta In% 3
*?T-GI( IN 3
puit 5cc 3
Tn. u9arn$ >(>( * 1# 1
urine ba" 1
y. Ny. Ia >(>( (ucus 1
puit 1cc 1y. Ny. Listya9ati >(>( (ucus 1
puit 1cc 1
y. Ny. Nunu) >(>( (ucus 1
puit 1cc 1
Ny. upina! >(>( Infuset ara! 1
Ny. Ia >(>( puit 3cc 1
ur$semi in% 1
N7 Ria >(>( Infuset ara! 1
Iv 18 1
* 1# 1urine ba" 1
Neele 23 1
*?T-GI( IN 3
Trama$l in % 3
puit 3cc =
Ny 7a)uta >(>( Infuset ara! 1
iv 18 1
* 1# 1
urine ba" 1
Neele 23 1
Trama$l in % 1
*?T-GI( IN 3
puit 10cc 1
puit 5cc 3
spuit 3cc 5
7 Ny 7a)uta >(>( (ucus 1
y Ny Ria >(>( (ucus 1
Ny.(anyu9ati >(>( *eftria&$ne in% 2
puit 5 cc 2
Tn.ii) +IN- ;aen 3 1
*?T-GI( IN 2
ur$semi in% 1
puit 5 cc 3
puit 3 cc 2
Tn.u9arn$ >(>( *eftria&$ne in% 2
puit 5 cc 2
Ny.ir!a >(>( *eftria&$ne in% 2
+e&a In% 2
7/21/2019 LAP (Autosaved)
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Tn.-+>L +IN- emAbr$,il 300 #
puit 3 cc 3
Ny.upina! >(>( puit 3 cc 3
puit 5 cc 2
=/=/2014 ByM&!i L#'tari >(>( puit 3 cc 8
Nyi# idya >(>( Infus ara! 1
I 18 1* 1# 1
urine ba" 1
puit 10cc 1
puit 5cc 1
*?T-GI( IN 3
puit 3cc 5
Trama$l in % 1
Nele 23 1
Tn#o +IN- Infuset biasa 1
I 20 1puit 10cc 4
puit 5cc 3
puit 3cc 3
Neele 25 1
+10 1
*eftri in% 2
Ny. 7uyun >(>( @ia!es 1
Tn Sidi3 BPJS DINAS 5and#'artan +
Ny. Licta +IN- Infuset ara! 1
iv 20 1
+e&a In% 4
elan" 2 9s 1
*eftri 4
puit 5cc 4
puit 3cc =
Neele 23 1
Ny. asri >(>( * 14 1
tn sii' bp%s inas Infuset biasa 1
Ny. iti Riyani >(>( *eftria&$ne in% 2
nansetr$n In% 3
Tn. ii) +IN- ;aen 3 1
*eftria&$ne in% 2
ur$semi in% 1
puit 1cc 3
puit 10cc 2
puit 3cc 2
Tn. u9arn$ +IN- ur$semi in% 2
;et$r$lac In% 2
7/21/2019 LAP (Autosaved)
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*eftria&$ne in% 1
spuit 10cc 2
puit 3cc 3
Tn. -bul +IN- puit 3cc 3
-ml$ipine 5(" 10
Ny. upina! >(>( puit 5cc 3
puit 3cc 2 Tn. ?)$ +IN- *eftria&$ne in% 2
spuit 10cc 4
puit 3cc 2
puit 5cc 2
Ny. ;is9antini >(>( puit 10cc 2
puit 3cc 2
=/8/2014 tn.$emart$ >(>( ceftri in% 2
I 20 1
Infus ara! 1
puit 10cc 3puit 5cc 3
puit 3cc 3
Neele 25 1
Tn.u9arn$ >(>( *?T-GI( IN 2
NyS&i'tin >(>( puit 3cc 3
I 20 1
Infus ara! 1
Ny. iti Riyani >(>( *eftri in% 1
enta In% 1
Ny. +ya! -yu >(>( Infuset ara! 1
iv 18 1
c 1# 1
urine ba" 1
puit 10 cc 1
puit 5 cc 3
puit 3 cc 4
*?T-GI( IN 1
Trama$l in % 1
;et$r$lac In% 3
Ny. upina! >(>( Iv 20 1
Infuset biasa 1
Tn $emart$ >(>( Infuset ara! 1
Ny. ulistin >(>( puit 3 cc 1
nansetr$n In% 1
Ny. ur9anin"si! >(>( Infuset ara! 1
Iv 18 1
* 1# 1
urine ba" 1
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 395/539
puit 10 cc 1
puit 5 cc 3
puit 3 cc =
Trama$l in % 1
;et$r$lac In% 3
Neele 23 2
y. Ny. iti Nurul >(>( puit 3 cc =y. Ny. +ya! ayu >(>( (ucus 1
Tn. $emart$ >(>( Neele 25 1
Tn. u9arn$ >(>( *eftria&$ne in% 2
;et$r$lac In% 1
puit 10cc 2
puit 3cc 2
Tn. ?)$ +IN- puit 3cc 3
+10: 1
Tn. -bul +IN- puit 3cc 3
Tn. ii) +IN- *eftria&$ne in% 1ur$semi in% 1
puit 1cc 3
;aen 3 1
Ny. ;is9antini >(>( puit 10cc 2
puit 3cc 2
Tn. $emart$ >(>( puit 10cc 2
puit 5cc 2
puit 3cc 2
y.iti Nurul >(>( pit 10 cc 3
)cl 2
+40 1
Tn. -bul +IN- emAbr$,il 300 5
TN a$9i >(>( Iv 20 1
infuset b 1
puit 3c 2
Tn S&marto >(>( puit 10cc 3
puit 5cc 3
N7;is9ati >(>( puit 10cc 2
spuit 5 2
Tn ?)$ >(>( puit 10cc 3
spuit 3c 2
Tn u9arn$ >(>( puit 10cc 1
puit 5cc 2
Tn ii) >(>( puit 10cc 3
spuit 3c 1
puit 1cc 3
N7 ?rna >(>( ?L-n" 2 9s 1
* 1# 1
7/21/2019 LAP (Autosaved)
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urine ba" 1
Infuset ara! 1
iv 18 1
N??+L? 23 1
puit 10cc 1
puit 5cc 3
>IT 3* 3=/10/2014 Tn.umart$ >(>( Infus ara! 1
Neele 23 1
Tn. a$9i >(>( -ml$ipine 10 m" 4
Tn. -nan" +IN- Infuset biasa 1
I 20 2
puit 10 cc 1
puit 5 cc 1
puit 3 cc 3
*apt$pril 25m" 10
Ny Sri H&nin- >(>( spuit 10cc 1spuit 3cc 3
TN Sidi +IN- *anesartan #
-ml$ipin 5 m" #
TN umart$ >(>( spuit 10cc 2
spuit 5cc 1
spuit 3c 4
Tn S&arno >(>( ur$semi in% 1
puit 10cc 1
>IT 3**** 3
Tn -nan" >(>( puit 3cc 4
=/11/2014by. Ny. ri >(>( puit 1cc 1
mucus 1
Ny. ?la >(>( Infuset ara! 1
Iv 18 1
* 1# 1
>ba 1
puit 10 cc 1
puit 3 cc 4
puit 5 cc 3
;et$r$lac In% 3
Neele 23 1
Tn. -nan" +IN- N$perten 10 m" 5
Ny. ;uni >(>( Infuset ara! 1
iv 18 1
* 1# 1
urine ba" 1
puit 10cc 1
Trama$l in % 1
7/21/2019 LAP (Autosaved)
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;et$r$lac In% 3
spuit 3cc 5
puit 5cc 3
neele 23 1
Tn. ?i >(>( -min$leban 1
Tn.umart$ >(>( puit 10cc 3
puit 5cc 1puit 3cc 3
Tn.-nan" +IN- puit 3cc 3
Tn.u9arn$ >(>( ur$semi in% 1
;et$r$lac In% 1
puit 10cc 2
puit 3cc 3
-ll$purin$l 100 15
Ny.+e9i >(>( Infus ara! 1
I 18 1
* 1# 1urine ba" 1
puit 10cc 1
puit 5cc 3
Neele 23 1
puit 3cc #
Trama$l in % 1
=/11/2014Ny. utarni >(>( Trama$l cap #
y.?lla >(>( put 1 cc 1
mucus 1
y.;uni >(>( put 1 cc 1
mucus 1
y6iti Nurul >(>( +40 2
puit 3 cc #
Ny. @armi >(>( Infuset ara! 1
urC$ 20 1
elan" 2 9s 1
puit 3cc 4
neele 23 1
urine ba" 1
fc 1# 1
spuit 10cc 1
Tn. ai$9i >(>( -ml$ipin 10 m" 5
TnS&arto >(>( ur$semi in% 2
;et$r$lac In% 2
puit 3cc 1
puit 5cc 1
puit 10cc 2
Tn.-nan" >(>( puit 3cc 2
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 398/539
puit 5cc 1
Tn.umart$ >(>( puit 3cc 1
puit 5cc 1
puit 10cc 2
Ny. Nurina >(>( urine ba" 1
y.@arni >(>( urine ba" 1
* 1# 1puit 10 1
Tn.u9arn$ >(>( puit 10 cc 2
puit 3 cc 1
Tn.umart$ >(>( puit 10 cc 3
puit 5 cc 3
puit 3 cc 3
=/14/2014 Ny. Tuti) >(>( puit 10cc 1
spuit 3cc 2
y. Ny. Tuti) Inarti >(>( (ucus 1
Ny. +e9i >(>( Iv 20 1Iv 18 1
y. Ny. iti Nurul >(>( +40: 1
*- luc$nas In% 1
puit 1cc 1
=/1/2014 Tn.-nan" +IN- N$perten 10 m" 5
TnS&d!atmio >(>( I 20 1
Infuset biasa 1
nansetr$n In% 2
puit 5cc 2
spuit 3cc 2
Tn. uma%i >(>( puit 3cc 4
=/1+/2014 Ny -prilia Nurul +IN- puit 3 cc 2
puit 10 cc 1
Tn. uma%i >(>( ur$semi in% 1
puit 3cc 3
Ny. uprapti >(>( Infuset ara! 1
I 18 2
* 1# 1
urine ba" 1
puit 10cc 2
*?T-GI( IN 3
Trama$l In% 1
+e&a In% 2
puit 5cc 3
puit 3cc 5
Neele 23 1
elan" 2 9s 1
=/1=/2014 Ny ii +IN- Infuset ara! 1
7/21/2019 LAP (Autosaved)
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Iv 18 1
* 1# 1
urine ba" 1
puit 10cc 1
puit 5cc 3
spuit 3cc =
*?T-GI( IN 3 Trama$l In% 1
elan" 2 9s 1
Tn.uma%i >(>( +i"$&in 8
Ny. Lasmina! >(>( Infuset ara! 1
puit 1cc 3
puit 5cc 3
puit 10cc 3
Neele 25 1
elan" 2 9s 1
ceftri 3Nn. ;!$irunisa >(>( Infuset ara! 1
iv 20 1
urine ba" 1
puit 10cc 1
puit 3cc 5
puit 5cc 5
Trama$l in% 3
;et$r$lac In% 3
*?T-GI( IN 3
Neele 23 1
tn. uma%i >(>( ur$semi in% 4
*l$pramel in% 3
+e&a In% 2
puit 3cc 2
puit 5cc 2
4/18/2014 Ny. arti >(>( Infuset biasa 1
Iv 20 1
puit 10 cc 1
puit 5 cc 2
puit 3 cc 5
Ranitiin in% 2
-ml$ipin 5 m" 5
ny. arti >(>( puit 3cc 3
puit 5cc 1
Ny. uni)a! >m>( Infuset ara! 1
iv 20 1
puit 5cc 1
Neele 25 1
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 400/539
fc 1# 1
urine ba" 1
puit 3cc 1
Tn. uma%i >(>( iv 20 1
ur$semi in% 1
*l$pramel in% 4
puit 3c 2Infuset biasa 1
tn. ?i >(>( *l$pramel in% 3
=/1B/2014 y. Ny. uni)a! >(>( (ucus 1
Ny. arti >(>( imvastatin 10(" 5
Ny. -na >(>( Infuset ara! 1
Iv 20 1
puit 3cc 3
puit 10cc 1
elan" 2 9s 1
puit 1cc 1(ucus 1
Tn. ariman >(>( *$mbivent Neb 3
Tn.ari >(>( put 10 2
puit 5 cc 2
puit 3 cc 1
nele 25 1
Tn.uma%i >(>( puit 5 cc 1
Tn.(a ali >(>( Iv 20 2
elan" 2 9s 1
*eftria&$ne in% 2
puit 3 cc 3
puit 5 cc 3
puit 10 cc 3
Nele 25 1
TnMatai >(>( puit 3 cc 3
*eftria&$ne in% 1
puit 10 cc 2
Ny6arti >(>( puit 3 cc 3
TnSardi >(>( puit 3 cc 2
Ranitiin in% 2
TnS&mad!i >(>( ur$semi in% 2
puit 3cc 3
I 20 1
=/20/2014 TN. (at -li >(>( puit 5cc 2
Ny. (usri >(>( Infuset ara! 1
I 18 1
elan" 2 9s 1
spuit 3cc 5
7/21/2019 LAP (Autosaved)
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*?T-GI( IN #
puit 5cc #
puit 10cc 1
* 1# 1
urine ba" 1
NyH#ni >(>( Infus ara! 1
I 18 1elan" 2 9s 1
* 1# 1
urine ba" 1
*?T-GI( IN 3
Trama$l in% 1
;et$r$lac In% 3
puit 3cc #
puit 5cc 5
puit 10cc 1
neele 23 1Ny.!$lia)tun >(>( elan" 2 9s 1
Infus ara! 1
I 18 1
fc 1# 1
urine ba" 1
Trama$l in% 1
;et$r$lac In% 3
puit 3cc #
puit 5cc 3
puit 10cc 1
Neele 23 1
Ny.arti >(>( puit 3cc 2
=/21/2014 n7 arti >(>( Iv 20 1
I 22 1
Ny. 7uli N$Ata ari +IN- puit 3cc 1
Ny. (ifta!ul <asana! >(>( puit 3cc 2
puit 10cc 1
+e&a In% 2
Ny. <eni >(>( Trama$l In% 1
Ny.arti >(>( puit 3 cc 2
Tn.(uly$n$ +IN- nele 25 1
puit 3 cc 3
puit 5 cc 3
puit 10 cc 3
=/22/2014 Ny S#tyani >(>( Iv 18 1
+e&a In% 4
Ny Tri +e9i >(>( I 18 1
Neele 23 2
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 402/539
elan" 2 9s 1
*?T-GI( IN 3
puit 5cc 3
Trama$l in% 1
puit 3cc 4
fc 1# 1
urine ba" 1puit 10cc 3
y Ny Tri >(>( (ucus 1
puit 1 cc 2
y Ny (ifta!ul < >(>( (ucus 1
puit 1 cc 2
Ny. @a!yunin"si! >(>( Iv 18 1
Infuset ara! 1
puit 10 cc 1
puit 5 cc 3
puit 3 cc # Trama$l in% 3
Neele 23 1
*?T-GI( IN 3
* 1# 1
urine ba" 1
Ny. amuti) >(>( I 18 1
Iv 20 1
Infuset ara! 1
puit 3 cc 3
Ny. arti >(>( imvastatin 10(" 14
y. Ny. @a!yunin"si! >(>( (ucus 1
=/23/2014 y. Ny. I)a >(>( (ucus 1
Ny. I)a >(>( puit 10cc 1
Ny. Tri +e9i >(>( puit 5cc 2
Ny. etyani >(>( * 1# 1
urine ba" 1
*?T-GI( IN 3
puit 5cc 3
spuit 10cc 1
spuit 3cc =
neele 25 1
;et$r$lac In% 3
"entamicin in% 1
Tn (uliana +IN- ur$semi in% 4
puit 10cc 2
puit 5cc 2
puit 3cc 2
NySri inarti >(>( Infuset biasa 1
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 403/539
I 20 1
Ranitiin in% 2
elan" 2 9s 1
puit 3cc 5
puit 5cc 2
puit 10cc 2
-ml$ipin 10m" 10=/24/2014 Tn S&a(ir >(>( -alat $r$s 10
+e&acap 1265 20
Tn (usbian >(>( +40: 1
Ny :ia >(>( puit 10cc 1
spuit 3cc 2
I 18 1
Infuset biasa 1
Tn M&iana +IN- Iv 20 2
y. Ny. I)a >(>( (ucus 1
y. Ny. etyani >(>( erytr$micin 250 2+40: 4
)cl 2
*- luc$nas In% 2
puit 10cc 2
3 9ay selan" 2
puit 3cc 12
puit 5cc 2
Ny6amini >(>( Infuset biasa 1
Ny<Si'a >(>( puit 3cc 2
puit 10cc 1
NyS&ntari >(>( I 20 1
Infuset biasa 1
*eftri in% 1
puit 10cc 3
puit 5cc 1
puit 3cc 3
Tn. (usta)im +IN- *eftria&$ne in% 1
puit 5cc 2
puit 3cc 2
Ny. ri @inarti >(>( puit 3cc 3
Ny. umini >(>( puit 3cc 3
Tn. (uliana +IN- ur$semi in% 2
puit 10cc 2
puit 3cc 4
Ny. ri untari >(>( *eftria&$ne in% 1
puit 10cc 2
puit 5cc 2
y. Ny. etyani >(>( "entamicin in% 1
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 404/539
Tn. unt$r$ >(>( Neele 23 1
Ny. untari >(>( *linamicyn 150 10
;et$r$lac In% 3
Ny. umini >(>( Ranitiin tab 10
y. Ny. etyani >(>( >pa ayi 20
Ny. 7ulia +IN- Infuset ara! 1
iv 18 2N> Sri >(>( *eftria&$ne in% 2
+e&a In% 2
puit 10cc 2
spuit 3cc 2
N> Sri >(>( *anerin 8m" 5
-ml$ipin 10m" 10
Ny ri @ >(>( *eftria&$ne in% 2
+e&a In% 2
Neele 23 1
Tn M&iana >(>( ur$semi in% 2puit 10cc 2
spuit 3c 4
Ny ri > >(>( *eftria&$ne in% 1
;et$r$lac In% 3
puit 10cc 2
spuit 3cc 3
=/2#/2014 Tn.(usta)in >(>( *eftria 1
Ranitiin in% 2
-ntrain IN 3
puit 3 cc 2
puit 5 cc 2
puit 10 cc 2
Ny.ri suntari >(>( Nucral yr 1
Tn.(uli$n$ +IN- Iv 20 2
3 ?L-N 1
Infus iasa 2
*?T-GI( IN 2
Nele 23 1
Tn.irman +IN- puit 3 cc 3
puit 5 cc 3
InAus iasa 1
Iv 20 1
ur$semi in% 4
Ny. ri 9 >(>( $m, " in% 10
Ny9a'mi >(>( I 20 2
Infuset biasa 1
spuit 10cc 3
puit 5cc 3
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 405/539
puit 3cc 3
Neele 25 1
Ranitiin in% 2
-ntrain IN 3
y.etiyani >(>( puit 3cc 12
Ny ;asmi >(>( *eftria 3
ranitiine in% 3-ntrain IN 3
puit 10cc 2
puit 5cc 1
spuit 3c 2
neele 25 1
r irman +IN- ur$semi in% 1
puit 10cc 1
puit 5cc 1
spuit 3cc 2
N7 ;asmi >(>( ranitiine in% 2-ntrain IN 3
*l$pramel in% 2
puit 10cc 2
spuit 3cc 3
Tn M&iana +IN- *?T-GI( IN 2
puit 10cc 2
puit 5cc 1
spuit 3cc 3
Tn M&'taim +IN- *eftria 1
-ntrain IN 3
puit 10cc 1
spuit 3cc 3
=/2=/2014 Tn.Ismail >(>( Infuset biasa 1
I 20 1
*eftri in% 2
puit 10cc 3
puit 5cc 2
TNM&iana +IN- *ef$ in% 2
puit 10c6 2
puit 5cc 1
puit 3cc 1
Sdr6irman +IN- ur$semi in% 3
puit 5cc 1
puit 3cc 3
=/2)/2014 r. irman +IN- lu" 1
Ny. u)arti >(>( I 20 1
Infuset biasa 1
Ranitiin in% 2
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 406/539
-ntrain IN 2
*?T-GI( IN 1
puit 10 cc 2
puit 5 cc 1
puit 3 cc 4
Tn. Ismail >(>( 3 9ay Tube 1
*ipr$ inf 2puit 3 cc 3
Tn. Ismail >(>( Infuset biasa 1
r. irman +IN- iv 22 2
Infuset biasa 1
ur$semi in% 3
tn. Ismail +IN- *ipr$ inf 2
yf$rt 2
puit 10cc 1
puit 5cc 1
puit 3cc 1 Tn. (uliana +IN- *l$pramel in% 2
*?T-GI( IN 2
puit 10cc 2
puit 5cc 1
puit 3cc 2
ny. u)arti >(>( *?T-GI( IN 2
ranitiin in% 2
-ntrain IN 2
puit 10cc 2
spuit 5cc 1
puit 3cc 1
Ny. ri re%e)i >(>( puit 3cc 1
Ny. etyani >(>( >nerpa bayi 40
=/2B/2014 y. Ny. <iayatum >(>( >nerpa bayi 40
y. Ny. +amis >(>( (ucus 1
SDr 6irman +IN- iv 22 2
lu" 1
Tn.Ismail >(>( *ipr$ inf 1
puit 3 cc 1
ar"$&in 0.25 5
Ny.u)arti >(>( *?T-GI( IN 2
Ranitiin in% 2
-ntrain IN 2
puit 10 cc 2
=/30/2014 Tn. Ismail >(>( Lev$C$&acin inf 1
3 9ay selan" 1
Infuset biasa 1
y.etyani - >(>( erytr$micin 250 2
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 407/539
y.etyarini >(>( erytr$micin 250 1
r.irman >(>( -ml$ipin 10m" #
Ny.utri >(>( Infus ara! 1
Iv 18 1
Nele 23 1
puit 10 1
puit 5 cc 1*eftri in% 1
Ny. u)arti >(>( *?T-GI( IN 2
Ranitiin in% 2
puit 5 cc 2
puit 10 cc 2
Tn. Ismail >(>( puit 3 cc 2
=/31/2014 y. Ny. ani >(>( (ucus 1
Ny. ani >(>( +e&a In% 2
puit 3cc 2
Neele 23 1Infuset ara! 1
Iv 18 1
elan" 2 9s 1
ByS&tri >(>( (ucus 1
NyPani >(>( puit 3 cc 3
Tn Ismail >(>( *eftria&$ne in% 1
Tn (art$n$ +IN- Infuset b 1
iv 20 1
puit 3cc 5
puit 5cc 5
spuit 10cc 5
neele 25 1
ceftria 1
ranitiine in% 2
Ny. u)arti >(>( Ranitiine Tab #
Ny. IstiEa! >(>( puit 3cc 4
elan" 2 9s 1
puit 10cc 2
Tn. (art$n$ +IN- usc$ti)a 3
*eftri 2
Tn. Ismail >(>( *eftri 2
*ipr$ inf 2
puit 5cc 2
puit 3cc 2
Ny. uparti >(>( Iv 20 1
Infuset biasa 1
puit 5cc 3
puit 3cc 5
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 408/539
Neele 25 1
-ntrain IN 3
y. Ny. upartini >(>( (ucus ?&. 1
>nerpa bayi 10
Ny. upartini >(>( * 1# 1
urine ba" 1
puit 10 cc 1puit 3 cc #
Infuset ara! 1
urC$ 18 1
elan" 2 9s 1
-ntrain IN 3
Trama$l in% 1
"entamicin in% 1
Neele 23 1
*?T-GI( IN 3
puit 5 cc 3y. Ny. Istia! >(>( (ucus ?&. 2
>nerpa bayi 10
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 409/539
;A7GA PASIEN
MM BPJS MM BPJS DINAS
#6B00
#6=00
156500
46400
1#620046000
36000
16300
#6500
#6=00
#6500
136800
156500
46400
2640016300
#6B00
#6=00
36B00
36000
26400
300
106800
#6500
106#00.00
#6B00.00
#6=00.00
16300.00
26400.00
#6000.00
106#00.00
56400
16300
26400
16300
800
#6B00
#6=00
26400
26500
206000
#6B00
46=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 410/539
106800
46000
#6500
26#00
26400
56500
46=00326#00
16000
16300
106800
#6000
26#00
36200
26400
16#00
46=0086800
26400
46=00
36200
36000
26#00
#6B00
#6B00
156500
46400
16300
300
1#6200
36000
46000
36300
#6B00
156500
46400
16300
300
1#6200
36000
46800
36300
#6500
106#00
106#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 411/539
#6B00
46=00
106800
26#00
56#00
300
26000#6B00
46=00
126300
106800
26200
26#00
26400
16000
26#00
26400126#00
106800
#6000
26#00
26400
26400
106800
26200
16#00
26#00
106800
26#00
26200
16#00
26#00
106800
106#00
#6B00
86000
56#00
#6500
#6B00
46=00
36000
26400
#6B00
86000
36200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 412/539
26#00
16000
300
156500
46400
106#00
126300106800
26#00
26200
800
106800
26#00
26200
106800
26#00
16#00106800
#6000
36B00
26400
16#00
26000
16#00
26#00
46400
26400
#6500
#6=00
#6B00
156500
46400
16300
1#6200
36300
36000
46000
#6500
#6B00
#6=00
156500
46400
16300
36300
46000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 413/539
116400
1#6200
36000
156500
46400
106#00
#6000106#00
#6000
106#00
#6000
#6=00
800
36300
#6=00
#6B00
15650046400
300
1#6200
B6B00
56#00
#6=00
#6B00
156500
46400
300
36300
1#6200
16300
36000
46000
106#00
106#00
106800
26000
126300
106800
26200
36000
16#00
106800
26000
106800
46000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 414/539
26400
26400
26400
26000
#6400
#6=00
#6B00156500
46400
16300
16000
1#6200
26400
36300
300
#6=00
#6B0056200
36000
26400
300
#6#00
106800
2116200
24<000
#6=00
#6B00
86000
#6500
216#00
46000
56400
300
326400
46=00
106800
126B00
126300
106800
26200
186000
26#00
16#00
46400
136200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 415/539
56400
26#00
26400
26400
116000
36000
16#00106800
56200
16#00
26000
26#00
16#00
106800
#6B00
#6=00
36B0036000
26400
300
106800
26400
#6B00
#6=00
56400
36800
#6=00
#6B00
156500
46400
16300
36000
36200
56400
36300
1B6800
#6B00
46=00
#6=00
800
46300
#6=00
#6B00
156500
46400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 416/539
16300
36000
56400
36300
#6#00
#00
56400106#00
300
106800
36300
26#00
16#00
26400
#6#00
26400
5640026200
186000
126300
26#00
16#00
26#00
26000
16#00
36B00
56000
26400
26000
#6B00
46=00
16#00
36B00
36000
26#00
26000
36B00
16#00
16300
26000
36B00
800
186000
#6500
156500
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 417/539
46400
#6=00
#6B00
300
16300
36000
26400#6=00
300
46400
46=00
136800
16300
16000
26400
26000
1630026400
246000
36000
26#00
16000
36200
26200
16300
26400
36200
#6000
106#00
#6=00
#6B00
156500
46400
16300
36200
36000
B6B00
300
#6000
#6=00
#6B00
156500
46400
16300
36300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 418/539
B6B00
46000
36000
300
B36#00
36B00
1600026400
26400
26200
36300
26#00
26400
36000
#6=00
#6B00
15650046400
1300
3000
300
4800
3300
16800
#6000
106#00
#6000
106#00
46800
46800
#=00
#B00
#500
3200
300
4400
15500
1300
5500
4400
##00
800
1000
2#00
1#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 419/539
1000
800
1000
2#00
4400
4400
155001300
2#00
800
3B00
3000
2400
1300
1#00
10#00
#B00#B00
2400
10000
#000
#000
#B00
4=00
8#00
2000
1#00
3200
1#00
1300
2200
2400
#=00
#B00
15500
4400
2#00
1#200
3300
4000
3000
4000
300
#500
#=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 420/539
#B00
15500
4400
1300
3000
5#00
2=0003300
#500
1#00
#=00
18000
3000
3B00
300
#500
1#200#=00
#B00
4400
1300
4000
5000
BB00
BB00
1#200
300
8800
8400
4000
1#00
2000
#=00
#B00
1300
2000
4000
=#00
2500
2400
1000
#=00
#B00
1000
300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 421/539
15500
4400
800
#B00
2200
11200
1#004=00
8400
10#00
1500
#=00
#B00
2400
1300
#500
#00010#00
2B400
2#00
2000
800
300
1000
13800
#500
10800
2400
3000
3B00
300
2400
5400
2#00
2400
1#00
=#00
4400
2400
#B00
2000
#=00
#B00
#500
4000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 422/539
32400
#000
1300
15500
4400
#=00
#B00#500
15500
4400
1#200
3300
1B800
4800
5000
1300
300#500
#=00
#B00
15500
4400
3300
1B800
4800
3000
1300
300
1#00
#B00
##00
800
1#00
1300
4000
3300
1#00
300
2400
3000
3B00
#B00
8000
#B00
#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 423/539
#500
1#200
3000
3300
3200
15500
44003B00
10#00
12000
10#00
12000
#B00
#=00
1300
3000
4800BB00
300
1#200
15500
4400
#B00
#B00
#=00
2400
4200
10#00
10#00
1300
2000
15500
4400
1#200
3000
1300
5#00
300
1B800
3800
8800
3#00
2000
1#00
4=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 424/539
#B00
=#00
#500
4000
2000
2#00
1100042000
2000
2400
1300
1#00
#B00
4=00
13800
10#00
100011200
5000
20000
2#00
#5200
B#00
2000
4=00
1#00
1300
#B00
4=00
5400
3B00
1000
2400
5400
2000
1#00
2400
2400
4400
2#00
3200
5400
2#00
2000
3800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 425/539
300
5000
1B800
2000
18000
#=00
1380010800
4000
2#00
1#00
20000
11000
10800
4000
300
44002#00
3200
5400
1B800
2#00
2400
5400
=#00
24000
1#00
2000
2#00
88500
13800
32#00
B400
10800
300
2400
3000
4=00
#B00
8800
8#0000
13800
4=00
3B00
3000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 426/539
2400
300
=#00
24000
B#00
1#200
1140024000
2#00
1000
1#00
300
2200
1300
1000
1#00
=#0024000
5#00
2#00
2400
10800
2#00
1000
2400
5400
24000
1300
2400
4=00
#B00
10800
3B00
2000
10800
2#00
1000
800
##00
1000
2400
8200
#B00
4=00
=#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 427/539
1#000
5400
2#00
1000
3200
25B00
528002400
4=00
13200
4=00
##00
52800
8400
1300
1000
8005#00
10800
2#00
1000
1#00
10800
=#00
1#000
2#00
1000
800
800
3#000
3#000
10#00
13200
12000
2#400
800
1000
10800
=#00
1#000
2#00
=8000
32#00
4=00
100
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 428/539
500
##00
#=00
#B00
300
1300
10005400
10800
=#00
2000
2#00
1#00
10#00
4000
1#00
300#=00
#B00
#500
10#00
2400
5400
4=00
#B00
4000
5000
#500
300
5400
=#00
1200
3200
#500
2#00
22200
10800
10800
52800
2000
1#00
#B00
4=00
3000
4000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 429/539
300
2=300
10#00
B000
15500
4400
13004800
#100
#B00
#500
2=300
3300
3800
300
14400
300021200
B000
H 56=456200 262106800 =6B5#6000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 430/539
TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT JMLA;
=/2/2014 Ny utarmi *anesartan 8m" 30
-ml$ipin 10m" 30
=/#/2014 Ny. Ri)a (el$&icam 15(" 10
Tn.-s ari L$ven$& In% 2 Tn.u9arn$ -ml$ipin 10m" 4
*anesartan 8m" 8
=/14/2014 Ny. arti >(>( -ml$ipin 10m" 10
=/1+/2014 Ny N-atmina( >(>( limepirie 1m" 40
=/2=/2014 Tn. $ears$n$ >(>( Ranitiin Tab 10
=/2B/2014 Ny. 7uliama! >(>( Ranitiin Tab 10
-n. +evanan$ >(>( Ranitiin Tab 2
=/30/2014 Tn. <an$)$ ;areb Ranitiin Tab 10
Tn.uparn$ -ml$ipin 10m" 10
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 431/539
;A7GA PASIEN
MM BPJS MM BPJS DINAS ;-R?
1206000
336000
1=6000
31#800 4400
32000
11000
24000
2000
2000
400
26000
116000
3=46800 2006800 5=56#00
=B5#000
865316#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 432/539
TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT
8/1/2014 TnMartono +IN- *ipr$ inf
Ny.Istia! >(>( ur$semi tab
I 20
Tn. (art$n$ +IN- *ipr$ inf Ranitin in%
usc$ti)a
puit 3cc
Tn. Ismail >(>( *eftri
*ipr$ inf
puit 10cc
Ny. uprapti >(>( puit 3cc
Ny. Rusni >(>( * 1#
urine ba"
puit 10cc
puit 5cc
*ef$
puit 3cc
Infuset ara!
iv 20
;et$r$lac In%
elan" 2 9s
)/2/2014 y Ny Istia! >(>( puit 3cc
iv 24
a'ua in%
ny. Ru)mi >(>( *?T-GI( IN
spuit 10cc
spuit 3cc
iv 20
tn. (art$n$ +IN- *ipr$ inf
ranitiin in%
usc$ti)a
spuit 10cc
spuit 5cc
Tn. Ismail >(>( *eftria&$ne in%
*ipr$ inf puit 10cc
Ny. uprapti >(>( puit 3cc
8/3/2014Ny. I)a >(>( Infuset ara!
iv *at! 20
puit 3 cc
Ny. +armani >(>( Infuset ara!
I *at! 18
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 433/539
* 1#
urine ba"
puit 10 cc
spuit 5 cc
puit 3 cc
Neele 18
trama$l In%antrain In%
*?T-GI( IN
Tn. Ismail >(>( ceftri In%
I *at! 20
y. Ny. +armini >(>( (ucus
)/4/2014 ny. Ru)mi >(>( -ml$ipin 10 m" Tab
Ny. iti *!$ti%a! +IN- spuit 5 cc
puit 3 cc
y. Ny. iti *!$ti%a! +IN- (ucus
Ny. (asriatun >(>( I *at! 20Infuset biasa
puit 10 cc
spuit 5 cc
puit 3 cc
elan" 2 9s
antrain In%
ranitiin in%
* 1#
urine ba"
a'ua in%
Ny. Ru)mini >(>( Iv *at! 20
(Masriatun >(>( d5 1>4
ranitidin
spuit 3
7n'SMA'# >(>( Ceftriaon
(edle 25
SPU'7 1"
SPU'7 5
SPU'7 3
(%ui >(>( Cefotaie 'nspuit 1"
spuit 5
spuit 3
8/5/2014 7n (ati*or BPJS D'(AS 'nfuset 0iasa
'- 2"
ranitidin
Aantrain 'n
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 434/539
Cefotaie 'n
Spuit 3cc
Spuit 5cc
Spuit 1"cc
( Su+arni BPJS UMUM 'nfuset dara,
'- 1.
)c 16
Urine0a*
Spuit 1"cc
Spuit 5cc
Spuit 3cc
Antrain in
7raadol in
(eedle 23
Cefotaie 'n
7n (aati*or BPJS Dinas 'nfuset dara,
( 9uan**i BPJS Dinas 'nfuset dara,
'- 1.
)c 16
Urine0a*
Spuit 1"cc
Spuit 5cc
Spuit 3cc
(eedle 23
Cefotaie 'n
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Ny. Ru)mi >(>( -sam Trane&amat
mepra,$le cap
Tn. Nati"$r +IN- 3 @ay elan" Inf
y. Ny. 7ayu) -(;?(- (ucus
y. Ny. 7uan""i +IN- (ucus
Tn. Ismail >(>( I *at! 20
Ny (uRI-T>N >(>( puit 1c
ranitiine in%
puit 3cc Tn Ismail >(>( *eftria
spuit 10cc
spuit 3cc
N> La'iana >(>( Iv 18
Infuset ara!
>rine ba"
* 1#
spuit 10cc
7/21/2019 LAP (Autosaved)
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puit 3cc
trama$l In%
antrain In%
neele 23
cef$
puit 5cc
Nn Ema >(>( *eftria"enta in%
antrain In%
puit 10cc
8/#/2014 y. Ny. Lasiana >(>( (ucus
r. ira9an +inas ceftri In%
Infuset ara!
puit 3 cc
puit 5 cc
urC$ 20
Tn. ii) +inas puit 10 ccantrain In%
Neele 25
Infuset ara!
Ny. Ina! >(>( "enta in%
Infuset ara!
iv *at! 18
puit 5 cc
>rineba"
*ef$ta&ime In%
* 1#
Trama$l in%
antrain In%
elan" 2 9s
Tn. umarn$ +IN- elan" 2 9s
Infuset biasa
iv *at! 20
antrain In%
+e&a In%
ranitiin in%
puit 10 cc
puit 5 cc
puit 3 cc
Tn. ii) +inas ceftri In%
"enta in%
-ntrain in%
nancentr$n In%
puit 3 cc
puit 5 cc
7/21/2019 LAP (Autosaved)
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Tn. umarn$ +inas -ntrain in%
Ranitiin in%
nancentr$n In%
-sam Trane&amat
*ef$ta&ime In%
puit 5 cc
Tn. ii) +inas ;et$r$lac In%nancentr$n In%
*eftria&$n In%
"enta in%
Ny. (asriatun >(>( Infuset ara!
ur$semi tab
puit 3 cc
N> Nani >(>( Trama$l in%
-ntrain in%
puit 3cc
TN S&marno +inas *ef$ranitiine in%
N7 iTI (asria! >(>( puit 3cc
ranitiine in%
Infuset ara!
iv 20
n7 Nani) >(>( puit 10cc
Neele 23
elan" 2 9s
*ef$
puit 5cc
puit 3cc
-ntrain in%
Trama$l in%
N7 7esi >(>( puit 10cc
puit 3cc
N7 (asriatun >(>( ranitiine in%
Tn sii) +IN- *eftri
"enta in%
-ntrain in%
spuit 10cc
r i'ia9an >(>( *ef$
spuit 10cc
8/=/2014 Ny9&'damiati >(>( Infus ara!
I 18
ceftri In%
puit 5cc
Neele 23
An:ama >(>( Infus biasa
7/21/2019 LAP (Autosaved)
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I 24
+e&a In%
puit 3cc
puit 5cc
Neele 25
Ny>a'ri >(>( Infus ara!
I 18* 1#
urine ba"
spuit 10cc
puit 5cc
puit 3cc
*ef$ta&ime In%
Ny.iti (artia! >(>( elan" 2 9s
Ny. Reni ?)a9ati >(>( puit 3cc
puit 5cc
puit 10ccInfuset ara!
Iv 18
* 1#
urineba"
cef$
y. Ny. Reni ?)a9ati >(>( (ucus
y. Ny. 7asri >(>( (ucus
Tn. (u)ri >(>( Iv 20
Infuset ara!
*ipr$ inf
ur$semie In%
Ranitiin In%
puit 5cc
puit 3cc
elan" 2 9s
* 1#
>rineba"
alsartan 80m"
Ny. iti ( >(>( puit 3 cc
Ny. Ismiati >(>( puit 3 cc
Tn. umarn$ +IN- *ef$ta&ime In%
-sam Trane&amat
nancentr$n In%
antrain In%
ranitiin in%
puit 3 cc
puit 5 cc
Ny. iti (arsia! >(>( ceftri In%
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 438/539
-ntrain in%
puit 5 cc
Tn. (u)ri >(>( *ipr$ inf
Ranitiin in%
puit 3 cc
puit 5 cc
-n. atriy$ +IN- iv *at! 22Infuset biasa
+5 1/2 N
puit 3 cc
)/)/2014 -n. Rama +IN- +e&a In%
puit 3
Ny.Lasiana >(>( I 20
Tn. (u)ri >(>( *ipr$ inf
*ipr$C$&acin 500
-n. attri$ +inas +5 1/2 N
puit 3ccr. ir"ia9an +inas -ntrain in%
-sam Trane&amat
*eftria&$ne in%
puit 5cc
Tn. u)arn$ >(>( Iv 20
Infuset biasa
puit 10cc
puit 5cc
puit 3cc
Neele 25
*ef$ta&ime In%
Ny. iti ( >(>( *eftria&$n In%
-ntrain in%
puit 5 cc
puit 10 cc
puit 3 cc
Tn. (u)ir >(>( Ranitiin In%
puit 3 cc
Ny. Reni >(>( >nerpa ayi
Tn. umarn$ +inas -ntrain in%
puit 10 cc
puit 3 cc
Tn. ibria9an >(>( -ntrain in%
puit 5
Tn. u9arn$ +inas *ef$ta&ime In%
nancentr$n In%
-ntrain in%
Ranitiin in%
7/21/2019 LAP (Autosaved)
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puit 10 cc
puit 5 cc
)/?/2014 Ny. (aspua! >(>( Infuset ara!
I *at! 18
*ef$ta&ime In%
puit 5 cc
puit 3 ccNeele 23
Ny. Nani) >(>( -ml$ipin 5 m"
Sdr M#i-y >(>( Infuset biasa
Iv 20
puit 3cc
puit 5cc
spuit 10cc
Ranitiin In%
Neele 25
Tn (arsin >(>( *ipr$ tabBy Ny S&mar'i( >(>( (ucus
7 Ny -riani >(>( (ucus
Ny Ariani >(>( Infuset ara!
Iv 18
* 1#
urine ba"
puit 10cc
puit 5cc
*ef$ta&ime In%
puit 3cc
antrain In%
Trama$l in%
neele 23
-n Rama >(>( *efar$&il
Ny umarsi! >(>( Iv 18
Infuset ara!
* 1#
urine ba"
puit 10cc
Trama$l in%
antrain In%
puit 3cc
puit 5cc
Neele 23
Ny 9&'d&mati >(>( puit 5cc
puit 3cc
Ny.iti ( >(>( +e&a In%
ur$semi in%
7/21/2019 LAP (Autosaved)
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puit 3cc
Ny6-ti) >(>( Infus ara!
I 18
puit 3cc
puit 10cc
-n. !erene >(>( Infuset biasa
Iv 24puit 3cc
Ny. iti (asria! >(>( -antrain In%
+e&a In%
puit 10cc
Tn. (u)ri >(>( Ranitiin in%
puit 3cc
r. (ei"y >(>( Ranitiin in%
)/10/2014 N> S&mar'i( >(>( Iv 18
Tn (u)ri >(>( Iv 20
Ny. (usria! >(>( L$em-n.Rif)i >(>( +5 1/4
puit 3
-n. Rif)i +inas +5 1/4N
Tn. (u)ri >(>( *ipr$ inf
8/11/2014 Tn (u)ri >(>( Iv 22
An A-a >(>( Infuset biasa
Iv 22
puit 10cc
spuit 5cc
spuit 3cc
Tn S&ardi >(>( Iv 20
Infuset biasa
-ntrain in%
puit 5cc
puit 3cc
N> L&& >(>( Infuset biasa
I 20
puit 3cc
Ny 9&'d&miati >(>( puit 3cc
Ny. itriana >(>( Trama$l in%
Infuset ara!
Iv 18
puit 3 cc
-ntrain in%
+e&a In%
elan" 2 9s
* 1#
>rine ba"
7/21/2019 LAP (Autosaved)
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puit 10 cc
puit 5 cc
Neele 23
y. Ny. itriana >(>( (ucus
Tn. +u)ut >(>( Iv 20
Infuset biasa
nancentr$n In%puit 10 cc
puit 5 cc
puit 3 cc
* 1#
urine ba"
Tn. (. unaii +inas Infuset ara!
Iv 20
TnS&ardi >(>( ceftri In%
spuit 10cc
puit 3ccNeele 25
Ny.iti ( >(>( ceftri In%
antrain In%
ur$smi in%
+e&a In%
spuit 10cc
puit 3cc
r.(el"y >(>( Ranitiin in%
puit 3cc
Tn.(u)ri >(>( *ipr$ inf
ur$smi in%
Ranitiin in%
puit 3cc
Tn.u9$n$ >(>( ceftri In%
puit 3cc
puit 5cc
puit 10cc
Infuset biasa
Neele 25
I 20
Tn.+u)ut >(>( ceftri In%
antrain In%
puit 10cc
puit 5cc
puit 3cc
+e&a In%
Neelee 25
Tn.unaii >(>( antrain In%
7/21/2019 LAP (Autosaved)
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puit 3cc
Tn.u9$n$ >(>( ceftri In%
puit 10cc
puit 3cc
8/12/2014 Tn. Ny$m$ >(>( ansulin N
-n. -r"a >(>( puit 3 cc
TN 9(oir& +inas Iv 20Infuset ara!
NySiti M >(>( ;et$r$lac In%
ceftri In%
+e&a In%
puit 10cc
spuit 5cc
puit 3cc
SdrM#-y >(>( Ranitiin in%
puit 10cc
spuit 5ccpuit 3cc
Ny.Imr$atun >(>( +5 1/2N
puit 3cc
elan" 2 9s
Tn.u)ari >(>( ceftri In%
puit 10cc
spuit 5cc
puit 3cc
TnS&ano >(>( +10
ceftri In%
puit 10cc
spuit 5cc
puit 3cc
NyMar'i( >(>( Infus ara!
I 18
* 1#
puit 10cc
spuit 5cc
+e&a In%
spuit 3cc
N7.Lulu) +inas Infus ara!
I 18
I 20
puit 3cc
spuit 10cc
8/13/2014 y Ny Lulu) +inas (ucus
y Ny (arsi! >(>( (ucus
Ny. Lulu) >(>( spuit 10cc
7/21/2019 LAP (Autosaved)
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Tn. ;!$irul +inas puit 3cc
spuit 10cc
*eftria&$ne in%
-ntrain in%
Neele 23
Ny. Lulu) >(>( puit 3cc
Ny. u9arni >(>( Infuset biasa An Ar-a >(>( puit 3cc
Tn S&ono +inas spuit 10cc
puit 5cc
puit 3cc
Tn u)ari >(>( spuit 10cc
puit 5cc
puit 3cc
*eftria
N> Imroat&n +inas spuit 10cc
spuit 5ccpuit 3cc
+r (ei"y +inas spuit 10cc
spuit 5cc
puit 3cc
TN 9(oir& +inas *eftri
spuit 10cc
14/14/)/2014 Tn. T$ni +inas *eftria&$ne in%
Ny. u)artini >(>( Infuset ara!
iv 20
puit 3cc
* 1#
urine ba"
spuit 10cc
puit 5cc
;et$r$lac In%
Trama$l in%
Tn. T$ni +inas Iv 20
Infuset ara!
puit 10cc
puit 5cc
Neele 25
-n. Rif)y +inas Iv 24
Infuset biasa
puit 3cc
-n -r"a >(>( *eftria&$ne in%
Tn u9$n$ >(>( I *!ateter N$. 20
-n Rif)y +inas I *!ateter N$. 24
N7 Imr$atun (-N+IRI I *!ateter N$. 20
7/21/2019 LAP (Autosaved)
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Ny. u!artini >(>( iv 18
Ny. Lulu) >(>( puit 3cc
y. N7. u!artini >(>( (ucus
Ny. eni +inas Infuset ara!
Iv 20
;asa 10D4
puit 3ccspuit 5cc
puit 10cc
Neele 25
Tn. T$ni +inas antrain In%
"enta in%
puit 3 cc
-n -r"a +inas *eftri
puit 10cc
puit 3cc
-n Rif)y +inas puit 3cc TN ;!$irul +inas -ntrain in%
*eftria
Tn T$ni >(>( *eftri
"enta in%
-ntrain in%
puit 10c
8/15/2014 Tn:&'tama!i >(>( I 20
Infus ara!
puit 10cc
spuit 5cc
puit 3cc
Nele 25
ceftri In%
TnS&amto +inas Infuset biasa
Ny. Ira +inas Infuset ara!
iv 18
* 1#
urine ba"
spuit 10cc
puit 5cc
puit 3cc
*ef$ta&ime In%
Trama$l in%
-ntrain in%
Ny. Lanatul +inas iv 18
Infuset ara!
puit 3cc
Ny. Tesi +inas puit 10cc
7/21/2019 LAP (Autosaved)
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puit 3cc
Tn. Rustama%i >(>( *ipr$ inf
Ny. eni +inas *ef$ta&ime In%
puit 5 cc
Ny:&tin >(>( Infus ara!
I 18
* 1#urine ba"
puit 10cc
elan" 2 9s
puit 3cc
puit 5cc
;et$r$lac In%
*ef$ta&ime In%
Tn. Rustama%i >(>( Infuset biasa
Tn. Tabit >(>( puit 10 cc
puit 5 ccpuit 3 cc
Neele 25
*ef$ta&ime In%
Tn. Rustama%i >(>( *ipr$ inf
*a lu)$nas In%
8/1=/2014 Tn. ;!$irul +inas ceftri In%
y. Ny. Tesi +inas (ucus
y. Ny. Rutin >(>( (ucus
y. Ny. Ira +inas (ucus
Ny. !ima >(>( Infuset ara!
iv 18
puit 3 cc
+e&a In%
Ny.-ni) >(>( Infus ara!
I 18
* 1#
urine ba"
puit 10cc
puit 5cc
puit 3cc
Neele 23
Trama$l in%
;et$r$lac In%
*ef$ta&ime In%
N7.?l Tuni) >(>( I 18
Infus ara!
puit 10cc
puit 5cc
7/21/2019 LAP (Autosaved)
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puit 3cc
Trama$l in%
;et$r$lac In%
*ef$ta&ime In%
Neele 23
* 1#
urine ba"Ny.7a!mi >(>( * 1#
urine ba"
puit 10cc
puit 5cc
puit 3cc
Neele 23
Trama$l in%
;et$r$lac In%
*ef$ta&ime In%
Ny. !inta >(>( +e&a In%puit 3cc
y. Ny. ?l Tuni) -J >(>( (ucus
spuit 5cc
y. Ny. ?l Tuni) J >(>( (ucus
spuit 5cc
y. Ny. ?l Tuni) K >(>( (ucus
spuit 5cc
Ny. ?(i >(>( Ranitiin in%
puit 3cc
Tn. Rustama%i >(>( *ipr$ inf
puit 3cc
8/18/2014 Ny iti Ima >(>( * 1#
urine ba"
puit 5 cc
*ef$ta&ime In%
puit 3 cc
;et$r$lac In%
Trama$l in%
puit 10 cc
y.ani) >(>( (ucus
y.7a!mi >(>( (ucus
y. Ny. !ima >(>( (ucus
y. Ny. atri >(>( (ucus
Ny. -ptri >(>( Iv 18
Infuset ara!
+e&a In%
* 1#
urine ba"
7/21/2019 LAP (Autosaved)
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puit 10cc
puit 3cc
puit 5cc
*ef$ta&ime In%
Trama$l in%
TnTa,it >(>( *ef$ta&ime In%
Ranitiin in%puit 10cc
puit 5cc
puit 3cc
Ny.emi >(>( Ranitiin in%
puit 5cc
puit 3cc
NyS&imi >(>( Infus ara!
I 20
* 1#
urine ba"+e&a In%
*ef$ta&ime In%
puit 5cc
puit 3cc
elan" 2 9s
)/1?/2014 Ny. Riyati >(>( ansulin N
NyS&ndari >(>( Infus ara!
I 18
* 1#
urine ba"
puit 10cc
puit 3cc
puit 5cc
*ef$ta&ime In%
Nele 23
Trama$l in%
;et$r$lac In%
Ny.I)e Ri,)i >(>( Infus ara!
I 18
elan" 2 9s
puit 10cc
puit 3cc
Ny.artini >(>( Iv 20
Infus isa
puit 3 cc
*eftria&$ne in%
puit 5 cc
Ranitiin in%
7/21/2019 LAP (Autosaved)
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Ny.aniti >(>( Infus ara!
Iv 18
* 1#
urine ba"
puit 10 cc
puit 5 cc
Nel9e 23;et$r$lac In%
puit 3 cc
*ef$
Trama$l in%
Ny.iti ;LI-< >(>( Iv 20
Infus isa
Ranitiin in%
-ntrain in%
puit 10 cc
puit 5 ccpuit 3 cc
nele 23
Ny.;urnia >(>( Infus ara!
Iv 18
Ny.emi >(>( *eftria&$ne in%
-ntrain in%
puit 10 cc
puit 3 cc
Tn.Tabit >(>( ceftri In%
-ntrain in%
puit 10 cc
puit 3 cc
Ny.iti ;$lifa! >(>( puit 3 cc
)/20/2014 Ny. uyati >(>( Infuset ara!
iv cat! 20
elan" 2 9s
puit 10 cc
puit 3 cc
Ny. umini >(>( Infuset biasa
Iv 20
elan" 2 9s
ceftri In%
Ranitiin in%
puit 10 cc
puit 5 cc
puit 3 cc
*l$pramel
Neele 25
7/21/2019 LAP (Autosaved)
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Ny. ulimi >(>( -ml$ipin 10 m" Tab
Ny.@arni >(>( Infuset biasa
I 20
puit 5cc
puit 3cc
puit 10cc
Neele 25mepra,$le in%
-ntrain in%
-n.Ra!ani)a +inas Iv 22
Infus biasa
puit 3 cc
puit 5 cc
Ny.armi >(>( *eftria&$n In%
Ranitiin in%
puit 10 cc
puit 5 ccpuit 3 cc
Ny.artini >(>( puit 10 cc
puit 5 cc
puit 3 cc
Ny.iti ;$lifa! >(>( )cl
puit 10 cc
puit 5 cc
puit 3 cc
Ny.emi >(>( *eftria&$ne in%
-ntrain in%
puit 10 cc
puit 5 cc
puit 3 cc
Ny.@arni >(>( -ntrain in%
puit 10 cc
puit 5 cc
puit 3 cc
)/21/2014 Tn S&t#!o >(>( imvastatin 10m"
Ny. Ri,)a >(>( Infuset ara!
I 18
* 1#
urine ba"
puit 10 cc
puit 5 cc
puit 3 cc
*ef$ In%
Trama$l in%
;et$r$lac In%
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 450/539
y. Ny. Ri,)a >(>( (ucus
y. Ny. u9inari ;-R? (ucus
Tn. Tas9iyant$ >(>( Infuset ara!
I 20
elan" 2 9s
* 1#
urine ba"puit 10 cc
puit 5 cc
puit 3 cc
Neele 23
ceftri In%
-ntrain in%
Tn. )a >(>( ansulin N
ansulin R
Ny. iti ;!$lifa! >(>( * 1#
urine ba"Ny. @arni >(>( -ml$ipin 10 m" Tab
Ny. iti ;!$lifa! (-N+IRI elan" 2 9s
-n.Ra!ani)a +inas puit 3 cc
r. -pril >(>( puit 3 cc
-sam Trane)samat In%
;et$r$lac In%
puit 10 cc
Ny. emi >(>( ceftri In%
mepra,$le in%
-ntrain in%
puit 10 cc
puit 5 cc
puit 3 cc
Tn. ute%$ >(>( Ranitiin in%
puit 5 cc
puit 3 cc
Ny. artini >(>( puit 5 cc
puit 3 cc
puit 10 cc
Ny. umini >(>( ceftri In%
puit 10 cc
puit 5 cc
puit 3 cc
-ntrain in%
Infuset biasa
3 @ay elan" Inf
Tn. ute%$ >(>( ceftri In%
-ntrain in%
7/21/2019 LAP (Autosaved)
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+e&a In%
puit 10 cc
puit 5 cc
puit 3 cc
3 @ay elan" Inf
8/22/2014 Ny. 7ustini >(>( +e&a In%
puit 3 ccurine ba"
y Ny 7ustini >(>( (ucus
r. I)val >(>( Infuset ara!
I 20
puit 10 cc
puit 5 cc
puit 3 cc
mepra,$le in%
Ny. artini >(>( * 1#
urine ba"puit 10 cc
Ny. ;asri >(>( puit 10 cc
Ny. iti Ru)!aya! >(>( puit 10 cc
r. -pril >(>( ceftri In%
-sam Trane)samat In%
;et$r$lac In%
puit 10 cc
Ny. ;asri >(>( elan" 2 9s
iv 18
* 1#
Infuset ara!
Ny. iti Ru)aya! >(>( elan" 2 9s
* 1#
urine ba"
puit 10cc
Ny. T-ripa! >(>( -ml$ipin 10 m" Tab
r. I)val >(>( mepra,$le in%
tn. ute%$ >(>( Ranitiin in%
puit 3cc
Ny. amini >(>( puit 3cc
puit 5cc
puit 10cc
Ny. atini >(>( puit 3cc
puit 5cc
-ml$ipin 10 m" Tab
)/2"/2014 Ny.artini >(>( * 1#
urine ba"
puit 10cc
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 452/539
By9a'ri >(>( (ucus
y6iti Ru)aya! >(>( (ucus
Ny<6itriya >(>( * 1#
urine ba"
puit 10cc
puit 3cc
puit 5cccef$
Infus ara!
I 18
Neele 23
-ntrain in%
Trama$l in%
Ny. artini >(>( -ntrain in%
ceftri In%
puit 10
Tn. ute%$ >(>( elan" 2 9sRanitiin in%
r. (. I)val >(>( mepra,$le in%
puit 5cc
puit 3cc
Ny. umini >(>( *eftri
-ntrain in%
puit 5cc
ny. artini >(>( -ntrain in%
*eftri
puit 5cc
puit 3cc
Ny. iti Nurul >(>( Infuset ara!
Iv 18
* 1#
urine ba"
puit 10cc
puit 5cc
puit 3cc
elan" 2 9s
Trama$l in%
-ntrain in%
y.itriya >(>( (ucus e&
y iti Nurul >(>( (ucus e&
NyS&marni >(>( I 20
Infuset biasa
puit 10cc
puit 5cc
puit 3cc
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 453/539
Ranitiin in%
ceftri In%
Ny.umini >(>( I 20
I 22
Ny. artini >(>( Iv 20
Iv 22
Ny. umini >(>( Infuset ara!-ntrain in%
puit 10 cc
puit 3 cc
Ny. @arni >(>( -ml$ipin 10 m" Tab
Ny. -sartini >(>( -ntrain in%
8/25/2014 Tn S&t#!a >(>( Iv 20
puit 3cc
Ny S&marni >(>( Iv 20
Ny6itria +inas Neele 23
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puit 3cc
NyS&marni >(>( ceftri In%
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puit 10cc
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Ny. umarni >(>( *eftri
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puit 3cc
puit 10cc
puit 5cc
Ny. umini >(>( *ettri
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puit 10cc
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puit 10cc
puit 5cc
spuit 3cc
8/2#/2014 Tn ute%$ >(>( +i"$&in
Ny P&rati >(>( +e&a In%
puit 3cc
-n. ?)a +inas Iv 22
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puit 3cc
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 454/539
puit 3cc
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Infus ara!
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puit 10cc
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puit 3 cc
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puit 5 cc
puit 3 cc
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puit 3cc
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-n.?)a +inas puit 3cc
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puit 3cc
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puit 10 cc
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 455/539
AnSandi >(>( *ef$ta&ime In%
-ntrain in%
puit 3cc
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puit 10cc
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puit 5 cc
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spuit 10cc
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puit 10c
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puit 10c
puit 3cc
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puit 3cc
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 456/539
*ef$ta&ime in%
antrain in%
spuit 10c
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puit 10cc
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puit 3cc
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puit 3 cc
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puit 10 cc
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7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 457/539
JMLA;
;A7GA PASIEN
MM BPJS MM BPJS DINAS
2 526800
5 116000
1 #6B00
2 5268002 =6#00
4 2B6#00
4 36200
2 106800
2 526800
2 26#00
3 26400
1 156500
1 46400
1 16300
3 36000
3 1#6200
1 800
1 #6=00
1 #6B00
3 1B6800
1 #6500
8 #6400
1 #6#00
1 46000
2 106800
2 26#00
3 26400
1 #6B00
2 526800
2 =6#00
4 2B6#00
2 26#00
2 26000
2 106800
2 5268001 16300
3 26400
1 #6=00
1 #6B00
2 16#00
1 #6=00
1 #6B00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 458/539
1 156500
1 46400
1 16300
3 36000
= 56#00
1 300
1 363003 246000
3 1#6200
4 216#00
2 136800
1 106#00
10 116000
1 16000
1 800
1 106#00
1 #6B001 46=00
3 36B00
# #6000
5 46000
1 #6500
4 326000
4 156200
1 156500
1 46400
1 46000
1 #6B00
2 186200
2 =6#00
2 16#00
2 106800
1 300
2 26#00
1 16000
2 16#00
1 564002 26#00
1 16000
2 16#00
1 46=00
2 136800
2 =6#00
2 1#6000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 459/539
2 106800
3 26400
3 36000
3 36B00
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
3 36000
5 46000
3 246000
1 36300
1 300
3 1#6200
1 #6=00
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
3 36000
5 46000
1 300
3 1#6200
3 2460001 36300
10 B36000
8 46000
1 326#00
1 106#00
1 106#00
1 #6B00
1 #6000
2 =6#00
2 16#002 106800
2 26#00
3 26400
1 #6B00
1 #6=00
1 46400
1 156500
1 16300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 460/539
# 46800
1 36300
3 246000
1 300
3 1#6200
3 36000
2 1068002 =6#00
3 246000
3 36B00
1 106#00
2 106800
1 #6=00
3 26400
3 36000
1 #6B00
3 36B003 246000
1 300
1 #6=00
2 =6#00
1 #6=00
1 #6B00
2 26000
1 46400
1 56400
1 156500
1 36300
3 246000
1 #6500
1 #6500
1 46=00
1 #6B00
2 1#6000
2 46000
1 36800
2 26#00
2 26000
4 36200
1 56400
2 =6#00
2 1#6000
2 86#00
3 26400
1 16000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 461/539
3 246000
2 =6#00
3 126B00
# 306#00
3 1#6200
2 26000
3 1B68003 126B00
2 106800
2 =6#00
1 #6=00
1 26200
1 800
3 B6B00
4 326000
2 16#00
3 1#62003 106800
5 46000
3 106800
1 #6=00
1 #6B00
2 26#00
2 #00
1 #6500
3 1#6200
3 36000
8 #6400
3 246000
1 36300
1 16300
1 800
2 =6#00
2 106800
2 =6#00
3 246000
3 36B00
2 106800
2 26#00
1 #6=00
1 #6B00
4 216#00
4 46000
1 300
1 46=00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 462/539
2 #6#00
1 26000
3 26400
3 36000
1 300
1 #6=00
1 #6B001 156500
1 46400
1 16300
3 36000
5 46000
3 1#6200
1 #6500
5 46000
3 36000
1 163001 #6=00
1 #6B00
1 156500
1 46400
3 1#6200
1 106#00
1 106#00
1 #6B00
1 #6=00
2 106800
3 #6#00
2 =6#00
1 16000
5 46000
1 #6500
1 156500
1 46400
5 246000
2 16#00
2 16#00
1 56400
2 106200
1 46300
2 1#6000
3 106800
3 26400
2 26000
2 106800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 463/539
3 246000
2 26000
2 526800
2 =6#00
2 16#00
2 26000
1 #6#001 46=00
2 186200
5 46000
2 46000
3 26400
1 #6B00
4 1056#00
5 26000
3 2=6300
1 8003 246000
2 106200
2 106800
2 26000
1 #6B00
1 46=00
3 36B00
3 36000
3 26400
1 300
2 106800
2 106800
3 246000
2 26000
2 26#00
2 16#00
2 =6#00
4 36200
10 B6000
3 246000
2 26#00
2 16#00
1 86000
1 16000
3 1#6200
2 86#00
3 246000
1 36800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 464/539
3 36B00
2 26000
1 #6=00
1 #6B00
1 56400
1 16000
1 8002 #00
10 56000
1 4=6000
1 #6B00
5 46000
5 56000
5 #6500
2 =6#00
1 300
10 460001 106#00
1 106#00
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
3 36000
2 106800
8 #6400
3 246000
3 B6B00
2 #00
3 16200
1 #6B00
1 #6=00
1 156500
1 46400
1 16300
3 B6B00
= 5#6000
3 26400
3 36000
2 #00
3 36000
1 800
2 46000
1 26200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 465/539
1 800
1 #6=00
1 #6B00
3 26400
1 16300
1 46=00
1 #6#002 16#00
3 246000
3 #6000
1 16300
2 =6#00
1 800
2 =6#00
1 #6B00
1 #6B00
5 =60002 186200
5 46000
2 186200
2 526800
1 #6#00
1 46=00
1 #6#00
2 26#00
1 16000
3 26400
1 #6B00
1 46=00
3 246000
1 16000
3 26400
1 46=00
1 #6B00
3 26400
4 36200
1 36300
1 #6=00
1 #6B00
# 46800
3 246000
2 46000
1 #6500
1 156500
1 46400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 466/539
1 16300
3 36000
1 300
1 106#00
2 #6B00
1 46=00
2 86#002 26#00
2 26000
2 16#00
1 156500
1 46400
1 M #6=00
1 #6B00
2 106800
2 26#00
2 16#001 300
2 106800
3 246000
1 26200
3 #6000
2 26#00
3 26400
2 =6#00
3 26400
2 526800
3 #6#00
2 =6#00
3 26400
2 106800
5 46000
5 56000
5 #6500
1 46=00
1 300
1 #6B00
5 2=6000
# 486000
4 56200
2 26000
5 46000
4 86000
1 300
2 1#6000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 467/539
2 16#00
2 106800
2 26#00
2 16#00
1 1006800
3 26400
2 #6B001 #6=00
3 1B6800
2 106800
3 #6000
2 26#00
2 26000
2 16#00
2 =6#00
1 16300
2 260001 800
2 186200
3 26400
1 #6500
2 106800
1 16300
1 16000
1 800
1 #6#00
2 106800
2 26#00
1 16000
1 800
1 #6=00
1 #6B00
2 316000
3 36B00
1 16000
2 46000
= 56#00
1 #6=00
1 #6B00
1 #6B00
= 56#00
1 16300
1 106#00
1 106#00
1 16300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 468/539
2 16#00
2 26#00
2 106800
3 246000
1 300
3 26400
1 #6=002 16#00
1 16300
1 16000
1 800
1 16300
1 16000
1 800
2 106800
1 16300
1 160001 800
1 16300
1 16000
1 800
2 106800
3 36B00
2 106800
1 #6=00
1 #6B00
= 56#00
1 156500
1 46400
1 16300
3 36000
3 1B6800
1 36300
1 #6B00
1 #6=00
2 26#00
1 16000
1 300
1 #6#00
1 46=00
4 36200
1 56400
2 #6B00
2 #6#00
2 #6B00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 469/539
1 #6B00
2 16#00
1 106#00
1 #6=00
1 #6B00
1 26=00
5 460005 26000
5 #6500
1 300
3 246000
3 156000
2 16#00
2 106800
2 26#00
2 16#00
3 264003 246000
2 106800
3 1#6200
2 =6#00
3 246000
3 36B00
1 #6B00
1 #6=00
3 36B00
3 36000
5 46000
1 300
1 56400
1 46=00
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
3 36000
8 #6400
3 1#6200
1 36300
3 246000
1 #6B00
1 #6=00
1 800
1 16300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 470/539
2 16#00
2 526800
2 106800
1 16000
1 #6=00
1 #6B00
1 1565001 46400
2 26#00
1 #6500
8 #6400
3 36000
3 1B6800
3 1#6200
1 46=00
3 36B00
3 360003 26400
1 300
2 106800
2 526800
1 106000
1 56400
1 106#00
1 106#00
1 106#00
1 #6=00
1 #6B00
3 26400
4 86000
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
3 36000
5 46000
1 300
1 36300
3 1B6800
3 1#6200
1 #6B00
1 #6=00
1 16300
3 36000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 471/539
5 46000
3 B6B00
3 1B6800
3 1#6200
1 300
1 156500
1 464001 156500
1 46400
1 16300
3 36000
5 46000
1 300
1 36300
3 1B6800
3 1#6200
2 460001 800
1 106#00
1 16000
1 106#00
1 16000
1 106#00
1 16000
2 =6#00
2 16#00
2 526800
2 16#00
1 156500
1 46400
3 36000
3 1#6200
5 46000
3 1B6800
1 36300
1 16300
1 106#00
1 106#00
1 106#00
1 106#00
1 #6B00
1 #6=00
2 46000
1 156500
1 46400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 472/539
2 26#00
B =6200
3 36000
3 1#6200
1 36300
2 106800
2 =6#001 16300
2 26000
1 800
2 =6#00
1 16000
1 800
1 #6=00
1 #6B00
1 156500
1 464004 86000
1 56400
1 16000
4 36200
1 #6500
1 1006800
1 #6=00
1 #6B00
1 156500
1 46400
1 16300
5 46000
3 36000
3 1#6200
1 300
1 36300
3 1B6800
1 #6=00
1 #6B00
1 #6500
1 16300
2 16#00
1 #6B00
1 46=00
# 46800
2 106800
3 36000
2 =6#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 473/539
1 #6=00
2 136800
1 156500
1 46400
1 16300
3 36000
1 3003 1B6800
= 56#00
3 1#6200
1 36300
1 #6B00
1 46=00
2 =6#00
2 1#6000
1 16300
1 16000= 56#00
1 300
1 #6=00
1 #6B00
1 56400
2 1#6000
2 26#00
3 26400
1 56400
2 1#6000
2 26#00
3 26400
3 26400
1 #6=00
1 #6B00
1 #6500
1 16300
# 46800
1 46=00
1 #6B00
1 #6500
2 106800
2 =6#00
5 #6500
2 26000
5 46000
3 86400
1 300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 474/539
10 116000
1 46=00
1 #6B00
5 56000
5 46000
5 #6500
1 3002 1=26000
3 246000
2 #6#00
1 46=00
3 26400
2 26000
2 106800
2 =6#00
2 26#00
1 160001 800
1 16300
2 26000
1 800
1 26500
1 16300
1 16000
1 800
1 56400
2 1#6000
1 16300
1 16000
1 800
3 246000
1 16300
1 16000
2 16#00
5 16500
1 #6=00
2 136800
1 156500
1 46400
1 16300
3 36000
= 56#00
3 1#6200
1 36300
3 1B6800
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 475/539
1 106#00
1 106#00
1 #6=00
2 136800
1 #6500
1 156500
1 464003 36B00
3 36000
3 26400
1 300
2 106800
2 1#6000
1 1006800
1 1006800
1 156500
1 464005 56500
1 #6500
3 26400
3 26400
4 206400
4 2#6400
3 36B00
1 56400
1 8#6000
2 1#6000
1 16300
1 16000
1 800
2 =6#00
2 26000
1 800
2 26000
1 800
4 56200
1 56400
1 16300
1 16000
2 16#00
3 246000
1 46=00
1 326#00
1 56400
2 1#6000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 476/539
3 #6000
2 26#00
2 26000
1 800
1 326#00
2 46000
2 16#001 46400
1 106#00
1 #6=00
1 #6B00
1 16300
1 16000
3 26400
2 1=26000
1 156500
1 464001 16300
1 16300
1 16300
3 1#6200
3 156300
3 1B6800
3 36B00
1 #6500
2 #6B00
1 156500
1 46400
1 #6500
2 156500
2 46400
3 36B00
# #6#00
2 1=26000
2 =6#00
2 16#00
2 16#00
2 26000
1 16300
2 16#00
2 26000
10 116000
1 156500
1 46400
1 16300
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 477/539
1 106#00
1 106#00
1 156500
1 46400
1 16300
8 #6400
3 360003 1#6200
1 #6=00
1 #6B00
2 #00
3 246000
3 B6B00
2 1#6000
2 106800
1 16300
1 #65002 =6#00
2 1=26000
2 26000
4 36200
1 56400
3 246000
2 26000
2 1#6000
2 106800
3 36000
2 16#00
1 #6=00
1 #6B00
1 156500
1 46400
3 36B00
3 36000
8 #6400
1 #6500
1 36300
3 246000
1 106#00
1 106#00
1 #6B00
1 46=00
3 36B00
5 56000
5 46000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 478/539
3 116400
2 106800
1 #6B00
1 #6#00
1 #6B00
1 #6#00
1 #6=003 246000
2 26#00
2 16#00
10 116000
2 1#6000
1 #6B00
2 16#00
1 #6B00
1 300
1 46=001 #6#00
1 #6500
2 16#00
2 106800
2 1#6000
1 16300
1 300
2 106800
2 1#6000
2 16#00
2 26#00
2 26000
1 56400
3 246000
3 36B00
2 1#6000
2 106800
3 36B00
2 26000
2 16#00
15 36000
4 86000
# 46800
1 #6#00
1 46=00
2 106800
5 46000
2 =6#00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 479/539
= 56#00
1 300
4 86000
1 #6=00
1 #6B00
1 16300
1 1565002 #6B00
1 #6=00
2 186200
1 #6=00
2 #6#00
1 #6B00
1 56400
2 26#00
1 300
1 3001 46=00
1 #6B00
1 #6500
3 246000
3 26400
1 1586400
1 300
2 1#6000
1 B6100
2 26000
3 1056000
1 800
1 106#00
3 1#6200
1 800
1 16000
2 16#00
2 106800
2 26000
3 26400
2 26000
1 800
3 246000
1 800
2 106800
1 800
2 106800
2 26#00
7/21/2019 LAP (Autosaved)
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4 216#00
2 1#6000
2 16#00
3 246000
1 16000
1 800
1 46=001 #6B00
2 =6#00
3 26400
2 26000
2 26#00
2 1=26000
2 26000
1 #6=00
1 #6B00
# 468002 46000
1 46400
1 156500
2 26#00
1 300
3 1#6200
3 246000
3 36B00
3 246000
2 106800
4 56200
4 36200
2 1#6000
2 16#00
1 #6=00
1 156500
1 #6B00
1 16300
1 300
= 56#00
3 36000
3 1#6200
3 B6B00
1 156500
3 1B6800
1 106#00
10 B6000
2 =6#00
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3 1#6200
2 1#6000
3 36B00
3 246000
2 106800
4 56200
1 #6=001 #6B00
1 156500
1 46400
1 16300
3 36000
# 46800
3 1#6200
1 36300
3 1B6800
1 256B003 1B6800
5 46000
2 26000
1 #6B00
2 B6400
2 106800
1 8#6000
1 26300
1 106#00
4 86000
# 46800
3 116400
1 300
1 16300
1 106#00
3 246000
H 1463336=00 261306500
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TANGGAL NAMA PASIEN BPJS GOLONGAN NAMA OBAT
8/5/2014 Tn. A!' BPJS Dina S,'it 10%%
Neele 2
8/#/2014 Tn. 5ir)an BPJS Dina Si)#atatin ta
ur$semie Tabmepra,$le *aps
8/=/2014 Tn. is9$y$ +inas puit 3 cc
)/)/2014 Tn.ut$m$ +IN- limepiri 4m"
(etf$rmin
8/12/2014Ny. Rusiana >(>( mepra,$le *aps
imvastatin tab
Ny utarmi >(>( -ml$ipin 10 m" Tab
*apt$pril 25 m" Tab
8/13/2014Tn. Nur <ai >(>( -ml$ipin 10 m" Tab
Ny. umsini +inas -ml$ipin 5("8/15/2014 (b). (e"a T;; *ipr$C$&acin
)/21/2014 Tn. -!ma >(>( ranitiin tab
8/23/2014r. (. -bulla! +inas puit 5 cc
Neele 23
8/2#/2014 Ny P&!i +IN- imvastatin tab
limepiri 4m"
)/2)/2014Ny. -,i,a! >(>( +$&yciclin
Tn. uyant$ +IN- L$ven$& In%
Ny. Lailatur R$Aa! >(>( +$&yciclin
Ny. iti >(>( +$&yciclin@a)ap$lres +IN- imvastatin tab
7/21/2019 LAP (Autosaved)
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JMLA;
;A7GA PASIEN
MM BPJS MM BPJS DINAS ;-R?
1 16300
4 16200
1 46500
5 1600010 56000
1 800
5 36000
30 #6000
11 56500
15 46500
30 336000
=# 156200
30 336000
10 5600010 46000
10 26000
1 16000
1 300
30 B6000
45 2=6000
15 #6000
2 31#6800
15 2=6000
15 2=600020 #6000
H B36200 4516B00
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TANGGAL NAMA PASIEN BPJS NAMA OBAT JMLA; ;A7GA
B/1/2014 y6!$Ayatun puit 10cc 1 1300
NyS(o%iyat&n elan" 2 9s 1 #500
Infus ara! 1 4=00
I 18 1 #B00
puit 3cc 1 800puit 10cc 1 1300
Neele 23 1 300
AnA(mada Iv 22 2 13800
puit 3cc 1 800
-n. ali! iv 22 1 #B00
Infuset biasa 1 4=00
puit 3cc 3 2400
-n. an""i *ef$ta&ime In% 3 1#200
Ny. +ia! I *at! 20 1 #B00
I *at! 22 1 #B00
Infuset biasa 1 4=00
puit 5 cc 3 3000
puit 3 cc 3 2400
elan" 2 9s 1 #500
Ny. Tri -ntrain In% 3 24000
puit 5 cc 3 3000
B/2/2014 Ny. aaa! Iv 20 1 #B00
Infuset +ara! 1 #=00
puit 10cc 3 3B00
puit 5 cc 3 3000
puit 3cc 3 2400
*eftria&$ne In% 1 5400
Ranitiin in% 2 =#00
-ntrain In% 2 1#000
Tn <asan Infuset +ara! 1 #=00
Iv 20 1 #B00
puit 10cc 3 3B00
spuit 5c 3 3000
puit 3cc 3 2400
Neele 25 1 300
Ranitiin in% 2 =#00
elan" 2 9s 1 #500
-n ima *eftria&$ne In% 2 10800
puit 3cc 3 2400
spuit 5c 2 2000
+e&a 1 2000
ny aaa! 40 2 4800
puit 10cc 1 1300
Ny. abina! arsi& in% 10 23000
-n. ima *eftria&$ne In% 2 10800
Ny. aaaa! *eftria&$ne In% 2 10800
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Ranitiin in% 2 =#00
puit 10cc 2 2#00
Ny.ttri -ntrain In% 3 24000
puit 5cc 3 3000
Ny. +ya! puit 3cc 3 2400
Tn <asan Ranitiin in% 2 =#00
puit 3cc 4 3200B/3/2014 Nn. itr$! Infuset +ara! 1 #=00
Iv 20 1 #B00
*ef$ta&ime In% 2 10800
puit 10cc 2 2#00
Neele 25 1 300
Ny. ?na! Iv 18 1 #B00
Infuset +ara! 1 #=00
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
puit 5cc 2 2000
enta In% 3 11400
*ef$ta&ime In% 1 5400
*eftria&$ne In% 1 5400
puit 3cc 8 #400
-ntrain In% 3 24000
Trama$l In% 1 3300
-n. ali! ;aen 3 2 24#00
-n. -!maa Infuset biasa 1 4=00
puit 3cc 3 2400
Ny. (uc!$lifatun Infuset +ara! 1 #=00
I 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
puit 5cc 3 3000
*ef$ta&ime In% 3 1#200
puit 3cc = 5#00
-ntrain In% 3 24000
Trama$l In% 1 3300
Neele 23 1 300
y. Ny. (uc!$lifatun (ucus e& 1 10#00
y. Ny. ?na! (ucus e& 1 10#00
puit 3cc # 4#00
puit 10cc 1 1300
Iv 24 1 #B00
+10: 1 ##00
Ny. itr$! *ef$ta&ime In% 3 1#200
-ntrain In% 3 24000
puit 10cc 3 3B00
Tn.u)ran *a luc$nas 2 20000
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puit 10 2 2#00
Ny. +ia! puit 3cc 3 2400
-n. I,,a +5 1/2 3 2=300
iv 22 1 #B00
puit 10cc 2 2#00
puit 5cc 2 2000
puit 3cc 3 2400Ny. itr$! *ef$ta&ime In% 3 1#200
-ntrain In% 3 24000
puit 10cc 2 2#00
puit 3cc 2 1#00
Tn. <asan Ranitiin in% 2 =#00
puit 3cc 4 3200
Ny. Nur -ini puit 5 cc 1 1000
puit 10 cc 1 1300
elan" 2 9s 1 #500
Ny. +ia! puit 3cc 4 3200
Tn. <asan Ranitiin in% 1 =#00
puit 3cc 2 1#00
Ny. u9anti *eftria&$ne In% 2 10800
-ntrain In% 2 1#000
puit 3cc 3 2400
puit 10cc 1 1300
Tn. a)iman urC$ 20 1 #B00
puit 3 cc 4 3200
puit 5 cc 2 2000
Infuset biasa 1 4=00
B/5/2014 Ny6u9anti I 20 1 #B00
Tn.<asan I 18 1 #B00
Ny:atna +e&a in% 2 4000
puit 3cc 3 2400
Infus ara! 1 #=00
I 18 1 #B00
Ny. Rupia! puit 3 cc 2 1#00
puit 10 cc 1 1300
Tn. <asan Infuset +ara! 1 #=00
Tn. (unasir Iv 20 1 #B00
Infuset biasa 1 4=00
puit 5cc 1 1000
+i"$&in Tab 5 1000
Ny +9i Ra!ayu Infuset +ara! 1 #=00
I 20 2 13800
puit 10cc 2 2#00
puit 3cc 2 1#00
Neele 25 2 #00
*ef$ta&ime In% 2 10800
Tn M&na'ir *eftria&$ne In% 3 1#200
puit 5cc 3 3000
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Neele 25 1 300
Tn A,d& M&(aimin I 20 1 #B00
lu" 1 8200
*eftria&$ne In% 2 10800
puit 3cc 3 2400
spuit 5cc 2 2000
puit 10cc 3 3B00Neele 25 1 300
-ml$ipin 10 10 11000
Tn -bul (><-I(IN Infuset biasa 1 4=00
y. Ny. ?na! Iv 24 1 #B00
puit 3 cc 8 #400
puit 5 cc 1 1000
Tn. -bul *eftria&$ne In% 2 10800
puit 10 cc 2 2#00
puit 3 cc 4 3200
Ny. +ya! puit 3 cc 4 3200
Ny. u9anti *eftria&$ne In% 2 10800
-ntrain In% 3 24000
puit 10 cc 2 2#00
puit 3 cc 3 2400
Tn. (unasir *eftria&$ne In% 2 10800
puit 10 cc 2 2#00
Ny. a)iman puit 3 cc 3 2400
Tn. <asan puit 3 cc 3 2400
Ny. +9i *ef$ta&ime In% 3 1#200
-ntrain In% 3 24000
puit 10 cc 4 5200
B/#/2014 An I@A *efar$&il cap = 5#00
Tn a)man -ml$ipin 10 5 5500
Ny @inani) Infuset +ara! 1 4=00
I 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
spuit 5cc 3 3000
puit 3cc 5 4000
Neele 23 1 300
Trama$l In% 1 3300
-ntrain In% 3 24000
*ef$ta&ime In% 3 1#200
N> P&!i L#'tari >nerpa bayi 10 B000
(ucus e& 1 10#00
y Ny >lfa >nerpa bayi 10 B000
(ucus e& 1 10#00
B> Ny inani (ucus e& 1 10#00
>nerpa bayi 10 B000
y Ny iti Rupia! puit 3cc # 4800
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I 24 2 13800
lu" 1 8200
N> :iyati -ml$ipin 5m" 5 2500
emAbr$,il 300 5 2000
Tn M&na'ir +e&acap 1265 10 1000
pir$n$lact$n 5 2500
Tn. (unasir ur$semie In% 2 4400Inf 3@-y elan" 1 32#00
*eftria&$ne In% 2 10800
Ny. +9i -ntrain In% 3 24000
*ef$ta&ime In% 1 5400
Ny. u9anti *eftria&$ne In% 2 10800
puit 3cc 1 800
puit 5cc 2 2000
B/=/2014 N> E%ni Infuset +ara! 1 4=00
I 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
puit 5cc 3 3000
puit 3cc 5 4000
Neele 23 1 300
puit 10cc 1 1300
Trama$l In% 1 3300
-ntrain In% 3 24000
*ef$ta&ime In% 3 1#200
-n atria Infuset biasa 1 4=00
iv 22 2 #B00
puit 3cc 1 800
N> 6itri nUr I 18 1 #B00
Infuset +ara! 1 #=00
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
-ntrain In% 3 24000
puit 3cc 4 3200
spuit 5c 4 4000
*ef$ta&ime In% 3 1#200
-n atria puit 3cc 3 2400
Ny.Nila Infus ara! 1 #=00
Iv 18 1 #B00
spuit 10 1 1300
puit 3 cc 3 2400
elan" 2 9s 1 #500
Ny. +9i lu" 1 8200
Tn. (unasir ur$semie In% 2 4400
Tn. a)iman puit 3cc 2 1#00
8/B/2014 y. Ny. Nila (ucus e& 1 10#00
Tn. apuan Infuset biasa 1 4=00
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puit 3cc 2 1#00
puit 5cc 2 2000
urC$ 20 1 #B00
tn. ur$t$ Infuset biasa 1 4=00
Iv 20 1 #B00
Tn. apuan mepra,$le 1 8#000
-ntrain In% 2 1#000*eftria&$ne In% 2 10800
puit 10cc 1 1300
puit 5cc 1 1000
Neele 25 1 300
Tn. a)iman )sr 8 18400
-ll$purin$l 8 1#00
emAbr$,il 300 8 3200
r.$)$ Infus ara! 1 #=00
I 20 1 #B00
Tn. apuan mepra,$le 2 1=2000
-ntrain In% 3 24000
Tn. (una%ir ur$semie In% 2 4400
puit 5 cc 2 2000
?/?/2014Ny.umiati urC$ 20 1 #B00
surC$ 18 1 #B00
ifus ara! 1 #=00
y.Nini (ucus e& 1 10#00
r. a!rul Infuset +ara! 1 #=00
iv 20 2 13800
puit 10cc 3 3B00
puit 5cc 3 3000
puit 3cc 5 4000
neele 25 1 300
*ef$ta&ime In% 2 10800
Ranitiin in% 1 3#00
-ntrain In% 1 8000
Tn. @an!ari +i"$&in Tab 5 1000
Tn. apuan mepra,$le 2 1=2000
puit 10 cc 1 1300
Tn. (una%ir puit 10 cc 2 2#00
r. a!rul *ef$ta&ime In% 4 21#00
-ntrain In% 3 24000
mepra,$le 2 1=2000
puit 10 cc 2 2#00
puit 5 cc 2 2000
puit 3 cc 2 1#00
Ny. iti ;ayasi! Infuset +ara! 1 #=00
Iv *at! 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
spuit 10 cc 3 2B00
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Ny. etri)a elan" 2 9s 1 #500
I *-T< 20 1 #B00
I *-T< 18 1 #B00
Infuset +ara! 1 #=00
puit 3 cc # 4800
Neele 23 2 #00
enta In% 1 3800*ef$ta&ime In% 3 1#200
c 1# 1 15500
>RIneba" 1 4400
Trama$l In% 1 3300
)et$r$lac In% 3 1B800
spuit 10 cc 2 2#00
puit 5 cc 2 2000
Ny. 7uliasi! elan" 2 9s 1 #500
puit 3 cc 3 2400
?/10/2014By Ny 6#tria (ucus e& 1 10#00
y Ny uliasi! (ucus e& 1 10#00
Tn ;usairi Infuset 1 4=00
I n$ 20 1 #B00
+ 40 1 2400
*eftria&$ne In% 1 5400
puit 10 cc 2 2#00
puit 5 cc 1 1000
puit 3 cc 3 2400
Neele 25 1 300
-ml$ipine 10 m" 5 5500
N7 Nasriatin Infuset +ara! 1 #=00
surC$ 18 1 #B00
puit 10cc 1 1300
*ef$ta&ime In% 3 1#200
c 1# 1 15500
>RIneba" 1 4400
Trama$l In% 1 3300
puit 3cc 8 #400
puit 5c 3 3000
e&a 2 4000
-ntrain In% 3 24000
N> Erna Infuset +ara! 1 #=00
Iv 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
puit 5c 3 3000
*ef$ta&ime In% 3 1#200
Trama$l In% 1 3300
-ntrain In% 3 24000
puit 3cc 8 #400
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eG- 2 4000
r. (. -t!$Eila! Infuset +ara! 1 #=00
I 20 1 #B00
puit 10 cc 2 2#00
Neele 25 1 300
Ny. a%iyem Infuset biasa 1 4=00
Iv 20 1 #B00puit 10 cc 2 2#00
puit 5 cc 2 2000
puit 3 cc 2 1#00
-ml$ipin 5m" 10 5000
mepra,$le 1 8#000
r. (. -t!$Eila! enta In% 3 11400
-ntrain In% 4 32000
puit 10 cc 3 3B00
r. ac!rul *ef$ta&ime In% 3 1#200
mepra,$le 3 258000
puit 10 cc 3 3B00
Tn. (unasir ur$semie In% 1 2200
puit 10 cc 1 1300
puit 3 cc 3 2400
Tn. apuan puit 10 cc 2 2#00
puit 3 cc 4 3200
Ny. a%iyem mepra,$le 1 8#000
puit 10 cc 1 1300
puit 3 cc 3 2400
B/11/2014 By Ny Na'riati (ucus e& 1 10#00
y Ny ?rra (ucus e& 1 10#00
puit 10cc 1 1300
Tn. apuan mepra,$le 10
Ny. <eny Infuset +ara! 1 #=00
iv 118 1 #B00
*ef$ta&ime In% 3 1#200
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
puit 5cc 3 3000
puit 3cc 8 #400
Trama$l In% 1 3300
)et$r$lac In% 3 1B800
Neele 23 1 300
Ny. umiati +e&a in% 4 8000
puit 3cc # 4800
elan" 2 9s 1 #500
)et$r$lac In% 3 1B800
Trama$l In% 1 3300
*ef$ta&ime In% 3 1#200
Neele 23 1 300
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Infuset +ara! 1 #=00
Iv 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
spuit 10cc 1 1300
puit 5cc 3 3000
Tn. ii) iv 20 1 #B00Infuset biasa 1 4=00
Infusst ara! 1 #=00
*eftria&$ne In% 2 10800
ur$semie In% 2 4400
Ranitiin in% 2 =#00
puit 10cc 2 2#00
puit 5cc 2 2000
puit 3cc 2 1#00
+5 1/2 1 B100
*apt$pril 25 10 2000
-ml$ipin 10 m" 5 5500
-ll$purin$l 5 1000
r. <enri) iv 20 1 #B00
Neele 25 1 300
Ranitiin tab 10 2000
Tn. ii' ur$semie In% 2 4400
Ranitiin in% 2 =#00
Ny. a%iyem mepra,$le 1 8#000
puit 3cc 2 1#00
Tn. (unasir ur$semie In% 1 3300
r. <enri) puit 10cc 1 1300
puit 3cc 2 1#00
B/12/2014 ByS&miati A (ucus e& 1 10#00
y.<eni (ucus e& 1 10#00
(ucus e& 1 10#00
r. <enri) Infuset +ara! 1 #=00
Ny Dya( +e&a in% 4 8000
enta In% 2 =#00
puit 3cc 5 4000
Ny u%i !ari I 20 1 #B00
Infuset biasa 1 4=00
puit 3cc 3 2400
N> Maria( puit 10cc 3 3B00
puit 3cc 3 2400
I 20 1 #B00
Neele 25 1 300
-ntrain In% 2 1#000
c 1# 1 15500
>RIneba" 1 4400
N> Maria( *a luc$nas 1 10000
puit 10cc 1 1300
ByS&miati B
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-n. ;arisa -li)a puit 3 cc 3 2400
I 22 1 #B00
Ny. (arlia! -ntrain In% 3 24000
puit 5 cc 1 1000
Tn. u%i!ari puit 5 cc 2 2000
r <enri) *eftria&$ne In% 1 5400
Lev$C$&acin Inf 1 =8000puit 10 cc 1 1300
puit 5 cc 1 1000
Infuset +ara! 1 #=00
Tn. (unasir puit 10 cc 1 1300
puit 5 cc 1 1000
B/13/2014 N> Pra.ti puit 3cc 1 800
Neele 23 1 300
Ny Sri P&!i iv 20 1 #B00
puit 5cc 2 2000
N> :ina elan" 2 9s 1 #500
puit 3cc 1 800
(ucus e& 1 10#00
Ny. iti au,iya! +e&a in% 2 4000
puit 3cc B =200
Infuset +ara! 1 #=00
Iv 18 1 #B00
Trama$l In% 1 3300
-ntrain In% 3 24000
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
puit 5cc 3 2400
*ef$ta&ime In% 3 1#200
n7 (arlia! c 1# 1 15500
puit 10cc 1 1300
Ny. ri u%i -ntrain In% 1 8000
NyS&narti puit 3cc 3 2400
puit 5cc 5 5000
I 18 1 #B00
Infuset biasa 1 4=00
mepra,$le 3 258000
*eftria&$ne In% 2 10800
puit 10cc 2 2#00
elan" 2 9s 1 #500
TNM&na'ir ur$semie In% 1 2200
*eftria&$ne In% 2 10800
spuit 10cc 2 2#00
puit 3cc 1 800
r6<enri) *eftria&$ne In% 1 5400
Lev$C$&acin Inf 1 =8000
spuit 10cc 2 2#00
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NyMaria( iccilin in% 3 13500
spuit 10cc 3 3B00
puit 3cc 3 2400
NySri .&!i puit 3cc 4 3200
?/14/2014Ny S&narti imvastatin 5 1500
Tn -"us Infuset +ara! 1 #=00
iv 20 1 #B00*eftria&$ne In% 2 10800
)et$r$lac In% 3 13200
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 3 3B00
spuit 5cc 3 3000
puit 3cc 3 2400
neele 25 1 300
"limepiri 5 3000
Ny N-at#ni N$perten 5 #000
Ny. (arlia! I *at! 22 1 #B00
y. Ny. iti au,ia! (ucus e& 1 10#00
SdrH#ndi Lev$C$&acin Inf 2 15#000
*eftria&$ne In% 1 5400
puit 5cc 1 1000
N7.unarti mepra,$le 1 8#000
*eftria&$ne In% 1 5400
N>Sri P&!i puit 3cc 4 3200
NyMaria( iccilin in% 2 B000
-ntrain In% 2 1#000
puit 5cc 2 2000
puit 10cc 1 1300
puit 3cc 1 800
TNA-&' *eftria&$ne In% 2 10800
)et$r$lac In% 3 13200
puit 10cc 3 3B00
TnM&na'ir ur$semie In% 1 2200
*eftria&$ne In% 2 10800
puit 5cc 2 2000
puit 3cc 2 1#00
?/1/2014Ny%itri Infus ara! 1 #=00
I 18 1 #B00
+e&a in% 2 4000
puit 3cc # 4800
-ntrain In% 3 24000
Trama$l In% 1 3300
*ef$ta&ime In% 3 1#200
puit 5cc 3 3000
puit 10cc 1 1300
c 1# 1 15500
>RIneba" 1 4400
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Neele 23 1 300
Ny.-nti I 20 1 #B00
Infuset biasa 2 B400
-ntrain In% 3 24000
-sam trane)samat in% 3 15300
mepra,$le 1 8#00
puit 10cc 5 #500puit 3cc 8 #400
puit 5cc 5 5000
r. <enri) elan" 2 9s 1 #500
Ny. eni Neele 25 1 300
puit 3 cc 5 4000
puit 5 cc 5 5000
puit 10 cc 5 #500
iv *at! 20 2 13800
mepra,$le 1 8#000
Tn. -"us *eftria&$ne In% 2 10800
y. Ny. itriana (ucus e& 1 10#00
y. Ny. +iana (ucus e& 1 10#00
Tn. -"us +40: 2 4800
ny P#ni *eftria&$ne In% 2 10800
Ranitiine in% 2 =#00
puit 10cc 3 3B00
puit 3cc 2 1#00
Ny unarti )et$r$lac In% 3 1B800
Ny Sri puit 3cc 4 3200
Tn (unasir *eftria&$ne In% 2 10800
puit 5cc 2 2000
puit 3cc 2 1#00
Ny Maria( puit 5cc 2 2000
puit 3cc 3 2400
?/1+/2014 Tn.-"us *eftria&$ne In% 2 10800
-ntrain In% 3 24000
puit 10 cc 3 3B00
puit 5 cc 1 1000
puit 3 cc 2 1#00
Ny. ri @a!yuni elan" 2 9s 1 #500
iv 20 1 #B00
Ranitiin in% 2 =#00
spuit 10cc 2 2#00
Neele 25 1 300
Ny. unarti tens$crepe # 1 =0=00
Tn. (unasir pir$n$lact$ne 25 # 3000
-ll$purin$l 10 2000
fur$semi tab 10 2000
Tn. aifuin I *at! 20 1 #B00
*eftria&$ne In% 2 10800
+e&a in% 2 4000
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puit 10 cc 2 2#00
puit 5 cc 1 1000
puit 3 cc 3 2400
Tn. yaifuin *eftria&$ne In% 1 5400
Ny. unarti )et$r$lac In% 1 ##00
*eftria&$ne In% 1 5400
puit 10 cc 2 2#00Ny. ri @ Ranitiin in% 2 =#00
*ipr$ Inf 1 2#400
Ny. eni *eftria&$ne In% 2 10800
Ny. (arlia! puit 5 cc 2 2000
?/1=/2014ny.sunarti N$perten 3 3#00
Tn.-"us luc$e& 5 2000
NyP#ni luc$e& 12 4800
Ny:iyati emAbr$,il 300 5 2000
Ny. (arlia! -ntrain In% 3 24000
puit 5 cc 2 2000
puit 10 cc 3 3B00
Ny. ri @a!yuni *ipr$ Inf 2 52800
Ranitiin in% 2 =#00
puit 3 cc 2 1#00
Tn. -"us -ntrain In% 3 24000
Ny. unarti )et$r$lac In% 3 1B800
mepra,$le 1 8#000
puit 10 cc 2 2#00
puit 5 cc 3 3000
puit 3 cc 2 1#00
Ny. eni Ranitiin in% 1 3#00
puit 10 cc 2 2#00
Tn. yaifuin puit 5 cc 1 1000
puit 10 cc 2 2#00
?/1)/2014Ny. ;usumiati Iv 18 1 #B00
c 1# 1 15500
>RIneba" 1 4400
puit 10cc 2 2#00
puit 5cc 5 5000
puit 3cc = 5#00
Neele 23 1 300
*ef$ta&ime In% 3 1#200
+e&a in% 2 4000
-ntrain In% 3 24000
Trama$l In% 1 3300
Ranitiin In% 1 3#00
Ny. >mi I 18 1 #B00
I 20 1 #B00
puit 3 cc 2 1#00
-ml$ipin 5m" 5 2500
Ny. (arlia! luc$e& 10 4000
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Ny. ri @ *ipr$ Inf 2 52800
mepra,$le 1 8#000
puit 10cc 2 2#00
spuit 3cc 2 1#00
Ny. eni *eftria&$ne In% 2 10800
Ranitiin in% 2 =#00
puit 3cc 2 1#00 Tn. yaifuin puit 3cc 3 2400
Neele 25 1 300
NyS ri a(y&ni ur$semi in% 2 4400
spuit 3cc 2 1#00
?/1?/2014Ny.iti -I7-< puit 10 2 2#00
Iv 18 1 #B00
>RIneba" 2 8800
c 1# 2 31000
Ny. -ni) iv 20 2 13800
puit 5cc 1 1000
Ranitiin in% 2 =#00
Tn. ;arimu *ipr$ Inf 2 52800
Ny. ri @ *ipr$ Inf 2 52800
Ny. iti iv 20 1 #B00
puit 10cc 5 #500
puit 3cc 5 4000
*eftria&$ne In% 2 10800
?/20/2014NyAni *eftria&$ne In% 2 10800
Neele 25 1 300
usc$tica in% 2 14800
puit 10cc 2 2#00
Ny -ni) Trama$l In% 2 ##00
Nn. unia elan" 2 9s 1 #500
Tn. ;arimu ur$semi In% 2 4400
Ny. -ni) puit 10 cc 1 1300
Trama$l In% 2 ##00
Nn. iti puit 3 cc 5 4000
B/21/2014 Nn. iti Ranitiin in% 3 11400
puit 10 cc 3 3B00
Ny S&marni Iv 20 2 13800
mepra,$le 1 8#000
-ntrain In% 2 1#000
puit 3cc 3 2400
spuit 5c 3 3000
spuit 10cc 3 3B00
Nn. iti Ranitiin in% 3 11400
Iv 22 4 2=#00
Ny. 7ustia (ucus e& 1 10#00
elan" 2 9s 1 #500
Iv 18 1 #B00
puit 10 cc 1 1300
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puit 3 cc 5 4000
Ny. -ni) *eftria&$ne In% 1 5400
usc$tica in% 3 22200
puit 10 cc 4 5200
puit 3 cc 3 2400
Trama$l In% 2 ##00
Ny. ri @ *ipr$ Inf 2 52800puit 10 cc 2 2#00
Ny. umarni -ntrain In% 2 1#000
puit 5 cc 1 1000
puit 3 cc 4 3200
Tn. ;arimu *ipr$ Inf 2 52800
ur$semie In% 2 4400
puit 3 cc 2 1#00
B/22/2014 Ny iti Tri Iv *!ateter N$. 18 1 #B00
* 1# 1 15500
>RIneba" 2 8800
Nn iti Iv *!ateter N$. 22 2 #B00
Tn ;arimu I *!ateter N$. 20 1 #B00
Ny umini puit 10 cc 2 2#00
puit 3 cc 2 1#00
Nele 25 1 300
Ny S&mini -ntrain In% 4 32000
enta In% 3 11400
*eftria&$ne In% 2 10800
puit 10cc 3 3B00
NN iti -ntrain In% 3 24000
Ranitiin in% 3 11400
puit 10cc 2 2#00
Ny Ani Ranitiin in% 1 1=00
N7 Riyati emAbr$,il 300 10 4000
?/2"/2014 Tn ribai elan" 2 9s 1 #500
Infuset biasa 1 4=00
urC$ 20 1 #B00
* 1# 1 15500
>RIneba" 1 4400
ur$semie In% 2 4400
puit 10 cc 3 3B00
puit 5 cc 3 3000
puit 3 cc 3 2400
Nele 25 1 300
*eftria&$ne In% 1 5400
Tn (ast$eri I 20 1 #B00
*eftria&$ne In% 2 10800
-ntrain In% 2 1#000
spuit 10 cc 3 3B00
puit 5 cc 3 3000
puit 3 cc 3 2400
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Nele 25 1 300
r.7usuf Infus ara! 1 #=00
I 20 1 #B00
puit 3cc 5 4000
puit 5cc 5 5000
puit 10cc 5 #500
Neele 25 1 300*ef$ta&ime In% 3 1#200
Tn.m-s)uri N$perten 2 2400
Ny.uyuti I 20 1 #B00
Infuset biasa 1 4=00
-ntrain In% 3 24000
puit 5cc 2 2000
puit 3cc # 4800
asti"$ 10 5000
Nn Siti -ntrain In% 2 1#000
nancetr$n in% 2 8#00
Ranitiin in% 2 =#00
Iv 22 1 #B00
Tn >&'&% *ef$ta&ime In% 3 1#200
-ntrain In% 3 24000
puit 10cc 3 3B00
Ny uryati -ntrain In% 2 1#000
puit 5cc 3 3000
puit 3cc 2 1#00
Tn Pri,adi *eftria&$ne In% 1 5400
puit 5cc 2 2000
puit 10cc 3 3B00
* 1# 1 15500
>RIneba" 1 4400
Tn ($estari *eftria&$ne In% 2 10800
-ntrain In% 2 1#000
puit 5cc 2 2000
puit 3cc 2 1#00
N> S&mini Ranitiin in% 2 =#00
-ntrain In% 2 1#000
enta In% 2 =#00
spuit 10cc 3 3B00
Ny Ea Iv 18 2 13800
enta In% 1 3800
Neele 23 2 #00
puit 3cc 2 1#00
spuit 10cc 2 2#00
B/24/2014 y Ny ?)a 7uni - (ucus e& 1 10#00
Tn. (as)uri puit 10 cc 2 2#00
Tn. ribai ur$semie In% 1 2200
*ipr$ Inf 1 2#400
puit 10 cc 1 1300
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puit 3 cc 3 2400
B/25/2014 Ny. +ami Iv 18 1 #B00
* 1# 1 15500
>RIneba" 1 4400
puit 10 cc 1 1300
*ef$ta&ime In% 3 1#200
puit 5 cc 3 3000puit 3 cc = 5#00
Trama$l In% 1 3300
y. Ny. $nia9ati (ucus e& 1 10#00
Ny. $nia9ati puit 3 cc 4 3200
puit 5 cc 1 1000
Neele 23 1 300
elan" 2 9s 1 #500
puit 10 cc 2 2#00
Tn. (as)uri puit 5 cc 2 2000
Tn. ribai ur$semie In% 1 2200
*ipr$ Inf 1 2#400
puit 5 cc 1 1000
puit 3 cc 1 800
B/2#/2014 y. Ny. ?rin (ucus e& 1 10#00
Ny. ?rin Iv 18 1 #B00
Infuset biasa 1 4=00
* 1# 1 15500
>RIneba" 1 4400
puit 10cc 1 1300
puit 5cc 3 3000
puit 3cc = 5#00
Neele 23 1 300
*ef$ta&ime In% 3 1#200
)et$r$lac In% 3 1B800
Tn. a$9i puit 10cc 3 3B00
puit 5cc 3 3000
puit 3cc 3 2400
Iv 20 2 13800
Ny. $nia9ati ur$semie In% 2 4400
puit 3cc 2 1#00
Ny. -la9iya! -ntrain In% 2 1#000
Iv 20 2 13800
puit 10cc 3 3B00
puit 5cc 3 3000
puit 3cc 3 2400
Neele 25 1 300
Tn. ui (ariy$n$ Iv 20 1 #B00
Ranitiin in% 3 11400
puit 5cc 3 3000
puit 3cc 3 2400
puit 10cc 2 2#00
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Tn. (ast$eri Iv 22 1 #B00
Iv 20 2 13800
Tn.(u)iman Iv 20 1 #B00
puit 5 cc 1 1000
Nele 25 1 300
Tn. utant$ +5 1/4 N 2 18200
Infuset biasa 1 4=00I 20 1 #B00
puit 10 cc 2 2#00
puit 5 cc 2 2000
puit 3 cc 3 2400
Iv 22 2 13800
Ny. 7anuar Iv 18 1 #B00
puit 5 cc 1 1000
puit 3 cc 2 1#00
elan" 2 9s 1 #500
(ucus e& 1 10#00
Ny. -la9iya! -ntrain In% 2 1#000
puit 10cc 2 2#00
puit 3cc 3 2400
Tn. utant$ +5 1/2 2 18200
puit 3cc 2 1#00
Tn. a$9i puit 3cc 2 1#00
Tn. (as)uri *eftria&$ne In% 2 10800
puit 3cc 2 1#00
puit 10cc 1 1300
?/2=/2014 Tn. utant$ )et$r$lac In% 3 1B800
Neele 25 1 300
puit 10cc 2 2#00
r. (ifta!ul Neele 25 2 #00
iv 20 1 #B00
puit 3cc 5 4500
puit 5cc 5 5000
puit 10cc 5 #500
*eftria&$ne In% 2 10800
Ranitiin in% 2 3400
Tn. a$9i puit 3cc 2 1800
Tn. (-t$eri *eftria&$ne In% 2 10800
-ntrain In% 3 24000
puit 10cc 3 3B00
N$perten 5 #000
Tn. utant$ +5 1/2 2 18200
)et$r$lac In% 3 1B800
*eftria&$ne In% 2 10800
puit 10cc 1 1300
puit 5cc 1 1000
puit 3cc 3 2=00
Ny. -la9iya! -ntrain In% 2 1#000
7/21/2019 LAP (Autosaved)
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Tn. -"us usc$ti)a in% 3 22200
Ranitiin in% 2 3400
*eftria&$ne In% 2 10800
-ntrain In% 3 24000
iv 20 2 13800
puit 3cc 5 4500
puit 5cc 5 5000puit 10cc 5 #500
Neele 25 1 300
?/2)/2014 TnA-&' elan" 2 9s 1 #500
ur$semi in% 1 2200
Ranitiin in% 2 3400
r6(ifta)ul elan" 2 9s 1 #500
3 9ay ( 1 32#00
lib$tic 4 533#00
puit 10cc 1 1300
puit 5cc 1 1000
Tn6utamt$ I 20 1 #B00
By Ny Siti (a'ana( (ucus e& 1 13200
Tn. utant$ *eftria&$ne In% 1 5400
)et$r$lac In% 2 13200
puit 3 cc 3 2=00
r. (ifta!ul *eftria&$ne In% 2 10800
puit 10 cc 2 2#00
puit 3 cc 3 2=00
Tn. -"us Ranitiin in% 1 1=00
puit 3 cc 3 2=00
Tn. -l$9iya! Iv 22 2 13800
*eftria&$ne In% 2 10800
-ntrain In% 2 1#000
puit 10 cc 2 2#00
puit 3 cc 2 1800
Tn. (asturi *eftria&$ne In% 2 10800
-ntrain In% 3 24000
B/2B/2014 Ny. +9inta elan" 2 9s 1 #500
Iv 18 1 #B00
* 1# 1 15500
>RIneba" 1 4400
puit 10 cc 1 1300
puit 5 cc 5 5000
puit 3 cc 8 =200
Neele 23 1 300
*ef$ta&ime In% 3 14400
Trama$l In% 1 ##00
-ntrain In% 3 24000
(ucus e& 1 13200
Ny6 Nur!ayati puit 3 cc 4 3200
iv *at! 18 1 #B00
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Tn Ma't&ri N$perten 4 4800
Tn S&di Ranitiine tab # 1200
Tn utant$ Ranitiine tab 10 2000
Ny. -la9iya! *eftria&$ne In% 2 10800
-ntrain In% 2 1#000
r. (ifta!ul *eftria&$ne In% 2 10800
lib$tic 3 400200puit 10 cc 3 3B00
puit 5 cc 3 3000
puit 3 cc 3 2=00
B/30/2014 Ny Naiya( I No 20 1 +<?00
I7 No 22 1 +<?00
Tn A-&' S.&it " ** " 2<=00
S.&it 10 ** 2 2<+00
Ny iA +e&a in% 4 8000
puit 3 cc 8 =200
I 18 1 #B00
enta In% 1 3800
*ef$ta&ime In% 3 14400
Trama$l In% 1 ##00
)et$r$lac In% 3 1B800
puit 10 cc 1 1300
puit 5 cc 3 3000
Nele 25 1 300
* 1# 1 15500
>RIneba" 1 4400
elan" 2 9s 1 #500
NyMaryama( *apt$pril 25 10 2000
NyM&aana( Ranitiin in% 2 3400
y. Ny. iA Iv 24 2 13800
puit 3cc # 5400
y. Ny. iti ;asana! Iv 24 2 13800
puit 3cc # 5400
ny -la9iya! *eftria&$ne In% 2 10800
-ntrain In% 2 1#000
spuit 5c 3 3000
R (ifta!ul lib$tic 3 400200
puit 5c 2 2000
spuit 3cccc 3 2=00
12441100
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS NAMA OBAT JMLA; ;A7GA
B/1/2014 Nn. ic!i Ranitiin tab 10 2000
Ny. ?nan" <uman -lbumin 1 1200000
?/10/2014Tn S&tomo limepirie 2 m" 10 #000
B/12/2014 Tn AndI Tens$crep 4 ic! 1 =0=00
?/14/2014Pidodo Tens$crep 4 ic! 2 =0=00?/1+/2014 -ml$ipin 10 m" 30 33000
limepirie 2 m" 30 18000
Tn. a)iman emAbr$,il 300 14 5#00
r. -ri (etr$nia,$le 500 10 2000
?/1)/2014Ny. Ra!ayu limepirie 4(" 15 25500
?/1?/2014Ny. utarni -ml$ipin 10 m" 30 33000
?/2"/2014Ny Ira9ati -ml$ipin 10 m" 15 1#500
Ranitiin tab 10 2000
B/24/2014 -n -!ma ai!a'i +$mperi$ne syr 1 11000
B/30/2014 Tn ur$y$ -ml$ipin 10 m" 20 22000
1518000
12441100
13B5B100
7/21/2019 LAP (Autosaved)
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TANGGAL NAMA PASIEN BPJS NAMA OBAT JUMLAH
10/1/2014 Tn Na8mi T#n'o*r#.# 4 in*( 1
By Ny :#'mi Indrayani M&*&' 1
Ny :#'mi D#$a In! 2
S.&it " ** +
I7 1) 1
65 1+ 1Urin#,a- 1
S.&it 10 ** 1
N#d# 2" 1
5#%ota$im# "
S.&it ** "
9#toroa* in! 1
Sdr Mi%ta(& Gi,oti* In! "
Ny Maryama( Gim#.irid# 1 m- 12
Ny Aaiya( S.&it ** 2
S.&it "** 2
Sdr Mi%ta(& S.&it ** 2
S.&it "** 2
S.&it 10** 2
Ny M&ntia( S.&it ** 2
S.&it "** 2
S.&it 10** 2
10/2/2014 Tn Aama i 20 2
5#%ota$im# 1
N##d# 2 1
S.&it 10** "
S.&it ** "
S.&it "** "
Tn H#ri 5#%ota$im# 2S.&it 10 ** "
N##d# 2 1
Tn Jatmio i 5at( 20 1
S.&it 10 **
S.&it **
S.&it " **
Ny L#nny I 1) 1
S.&it 10 ** 1
By Ny L#nny M&*&' 1
Tn H#ri S.&it 10 ** "
S.&it " ** "
Sdr Ai M&rtad(o( In%&'#t Bia'a 1i 20 1
S.&it " **
S.&it **
S.&it 10 **
N##d# 2 1
Antrain In! 2
A'am tran# In! 2
Tn H#ri 5#%ota$im# 1
Sdr Mi%ta(& Gi,oti* In! "
S.&it 10** 2
S.&it ** 1
S.&it "** 1
N##d# 2 2
Ny M&ntia( S.&it "** 1
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N> M#rry S.&it "** 1
n##d# 2" 1
ny Narti I 1) 1
65 1+ 1
Urin#,a- 1
Antrain In! "
5#%ota$im# "
S.&it 10** 1S.&it ** "
S.&it "**
N##d# 2" 1
10/"/2014 Ny M&ntia( I 20 1
I 22 1
Tn S&.riyono I7 20 1
In%&'#t Bia'a 1
S.&it 10 **
S.&it **
S.&it " **
Om#.ra8o# in! "
Antrain In! "
N##d# 2 1
Ny M&ntia( Om#.ra8o# in! 1
S.&it 10 ** 2
S.&it " ** 2
Sdr Mi%ta(& Gi,oti* In! "
S.&it 10 ** 2
S.&it " ** 4
N##d# 2 2
10/4/2014 Tn H#ri Antrain In! 1
NyPan*a In%&'#t Bia'a 1
I 20 25#%tria$on# 1
S.&it ** 2
S.&it 10 ** 2
S.&it " ** 2
ranitidin in! 2
SdrMi%ta& Gi,oti* In! "
S.&it 10** 2
S.&it "** "
NyPan*a S.&it 10** 1
S.&it "** "
5#%tria$on# 1
ranitidin in! 210//2014 TnM&!i 9#toroa* in! "
S.&it "** "
NyPan*a 5#%tria$on# 1
S.&it "** "
SdrMi%ta& Gi,oti* In! 4
S.&it ** "
S.&it 10** "
10/+/2014 Ny Sri L#'tari I 20 1
S.&it "**
S.&it **
S.&it 10**
Om#.ra8o# In! 2
,&'*oti*a in! "
5#%tria$on 2
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N##d# 2 1
N> Sri L#'tari :anitidin# ta, 10
Ny Sri L#'tari 5i.ro Ta, )
Ny Intan In%&'#t Bia'a 1
i 5at( 20 1
S#an- O2 D' 1
Antrain In! 2
ranitidin in! 2TnM&!i 9#toroa* in! 1
S.&it "** 4
NnIntan ranitidin in! 1
Antrain In! 1
S.&it "** 4
NyPan*a ranitidin in! 2
5#%tri in! 1
S.&it ** 2
S.&it "** "
S.&it 10** 2
NyIn*# Antrain In! 1
I7 20 2
10/=/2014 An:ai(an I7 24 2
Ny Laiat& Urin#,a- 1
I7 20 1
9#toroa* in! "
S.&it " **
S.&it ** "
S.&it 10 ** 1
N#d# 2" 1
Ny Inda( S.&it 10 ** 2
S.&it " ** "
N##d# 2 110/)/2014 N> Dina maya'ari Urin#,a- 1
S.&it 10*5 1
N##d# 2" 1
Tramado in! "
Ny Pan*a S.&it ** 2
S#an- O2 D' 1
Ny 9ri'tianaati I7 1) 1
5#%tria$on In! 1
N##d# 2" 1
S.&it " ** 2
N> Siti Umiro( S#an- O2 D' 1
I 20 1Ny PAn*a S.&it 10** 2
S.&it ** 1
S.&it "** 1
TnN-&dar!i S.&it 10 **
S.&it **
S.&it " **
Antrain In! "
Om#.ra8o# in! 2
5#%tria$on 2
N#d# 2 1
10/?/2014 Sdr :&di 5andra I7 20 1
In%&'#t Bia'a 1
N##d# 2 1
S.&it 10 **
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S.&it **
S.&it " **
5#%tria$on In! 2
:anitidin in! 2
Antrain In! "
Tn A,d& Om#.ra8o# in! 1
ny Siti Ta'%iat&n S.&it "** 1
n##d# 2" 1Ny A8a( S.&it "** 1
S.&it 10** 1
n##d# 2" 1
S#an- O2 D' 1
Ny Eti I 1) 1
65 1+ 1
Urin#,a- 1
S.&it 10** 1
S.&it ** 1
S.&it "** "
n##d# 2" 4
10/10/2014 B>Eti N&raini U.ad ,ayi "0
M&*&' 1
ByA8a( M&*&' 1
Nyy&iani I7 1) 1
65 1+ 1
Urin#,a- 1
S.&it 10** 1
S.&it "**
S.&it **
5#%tri in! 4
D#$a In! 1
Tramado in! 19#toroa* in! 2
Tn N-&dar!i :anitidin ta, 10
Ny Siti :oma( S.&it 10 ** "
Ny >&i S&am'ana( Und#r.#d 2
S.&it 10 ** 2
S.&it ** "
S.&it " ** )
Urin#,a- 1
65 1+ 1
5#%ota$im# "
Tramado in! 1
9#toroa* in! "Tn :&di S.&it 10** 2
S.&it "** "
Ny Siti S.&it 10** 1
'.&it "** "
10/11/2014 An M#inda I7 24 1
S.&it 10 ** 2
S.&it ** 2
S.&it " ** 2
Ny Siti :oma( N##d# 2 1
Ny >&i S&am'ana( 6&ro'#mid# In! 1
An Ari%in Di In%&'#t Bia'a 1
I 22 1
Sdr :&di i 22 1
Ny Siti :oma( In%&'#t Bia'a 1
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Ny A'i( Lomat&# 2
An Ar%in Und#r.ad 2
NySiti Antrain In! "
5#%tria$on# 2
S.&it " ** 2
S.&it 10 ** 2
Tn:&di 5#%tria$on# 2
:anitidin# In! 2S.&it 10 ** 2
S.&it " ** 2
TnNy&dar!i Antrain In! 1
S.&it " ** 1
10/12/2014 Ny Anim I7 1) 1
Und#r.#d 4
S.&it " **
S.&it 10 ** 1
Ny Dya( Und#r.ad 2
S.&it "** 2
S.&it ** "
65 1+ 1
Urin#,a- 1
5#%ota$im# "
9#toroa* in! "
Tramado in! 1
I 1) 1
By Ny Anim M&*&' 1
Um,ii*a 1
Und#r.ad Bayi 20
Und#r.ad 1
S.&it "** 1
D10; 1By Ny Dia( Und#r.ad Bayi "0
Und#r.ad 2
M&*&' 1
Um,ii*a 1
NySiti S.&it " ** 1
S.&it 10 ** 1
Und#r.#d 2
N## 2" 1
NySiti : 5#%tria$on# 2
S.&it ** 2
'dr :&di 5#%tria$on# 1
Antrain In! 2:anitidin# iNJ 2
10/1"/2014 An Sa%ira d 1/2 N' "
In%&'#t Bia'a 1
I7 20 1
S.&it "**
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?00
24<+00
4<"00
1<)00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 526/539
1<000
"00
+<?00
")<400
2<000
=<200
4<=00
+<?00<000
2<000
24<+00
1+<200
11<400
2<400
"<000
1<"00
"00
+<00
1<000
+<400
"<)00
)<)00
+<=00
+<?00
1<+00
2<000
4<=00
+<?00
+<00
<000
4<00010<+00
"00
)00
1<000
+<?00
+<?00
4<=00
2<400
2<000
"00
+<?00
1"<200+<=00
+<?00
1<00
4<400
1<"00
"<000
4<)00
+<000
"0<)00
+<00
+<?00
+<400
1<"00
"<000
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 527/539
"00
1+<200
+<+00
24<000
+<=00
1<00
4<400
2<400=+<000
1<+00
<400
10<+00
2<200
)00
2<200
2=<000
4<"00
+<100
1<"00
12<?00
)<00
12<=00
4<400
<400
"<000
1<"00
"00
+<?00
)<000
?00
10<)004<=00
)<+00
1"<200
"00
12?<+00
10<)00
1<200
24<000
1<"00
+<00
+<000
4<00+00
1?<)00
10<)00
"<400
4<400
4<=00
+<?00
1<"00
1<000
)+<400
"0<100
=<200
)<00
+<?00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 528/539
12<=00
4<400
14<400
"<"00
1<"00
+<+00
+<00
24<000=<+00
24<000
"<?00
1<"00
4"<200
2<=00
2<400
=+<000
?00
2<)00
)<00
+<?00
12<=00
4<400
1<"00
"<000
<400
+<+00
14<400
"00
+<00
<000
4<004<=00
+<?00
4<=00
+<00
<000
4<00
+<?00
10<)00
"<400
)<200
+<?00
11<000+<00
<000
4<00
"00
"<400
=<+00
24<000
"<?00
1=4<000
"<400
2<+00
1<000
?00
)+<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 529/539
1<"00
1<000
=+<000
?00
1<000
1<"00
1<000
?00"<400
1<=00
4"<200
1<"00
1<000
?00
4<"00
?00
"00
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=+<000
"<400
)+<400
"<400
+<+00
1<)00
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)<00
+<?00
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2<4004<400
"00
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4<400
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"<+00
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+<?00
4<4002<+00
+00
)<+00
+<00
"<000
4<00
24<000
)<+00
+<100
+<?00
)<000
1<"00
1<)00
4<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 530/539
12<=00
1"<200
)<+00
2<200
2<200
1"<200
2<200
2<2004<"00
1)<000
1=<200
)<200
1?<)00
14<400
24<000
+<00
1<)00
2<+00
+<?00
4<00
"<000
1+<000
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1<"00
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"<+00
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2<+00
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2<=00
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2<=00
"00
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1?<)00
24<000
1<"00
2<000
?00
1<)00
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2<)00
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+<?00
+<"00
+<00
+<?00
1<)00
1=<200
+<?00
+<?00
+<100
"<)00
1<)00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 531/539
1<000
"4<00
4<=00
11<=00
"<000
2<=00
4<=00
20<=004<=00
+<?00
"<?00
"<000
2<=00
"<?00
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4<00
"00
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1+<000
2<000
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1=<200
4<=00
+<?00
4<=00
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1<"00
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1+<0002<000
24<000
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<200
2<000
1<)00
"<+00
4<=00
"00
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"<400
1+<000"<000
+<?00
)<+00
2<=00
1"<)00
4<=00
+<00
<000
4<000
"00
24<000
=<+00
24<000
"00
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 532/539
1+<000
1<"00
1<"00
1+<000
"<?00
"<000
2<=00
4)0<000)<+00
1"<)00
+<?00
)<+00
+<100
+<?00
12<=00
4<400
1<"00
"<000
+<"00
"00
+<+00
14<400
1"<200
2<200
2<200
+<100
4<"00
1"<200
2<200
2<200
+<1004<"00
1+<000
4<"00
1<)00
4<=00
1"<)00
"<000
4<00
<100
24<000
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+<?00+<?00
"<+00
1<"00
12<=00
+<100
+<?00
20<400
+00
+<"00
2<000
24<000
24<000
"<000
4<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 533/539
1+<000
1<"00
1<)00
2<)00
12<=00
+<100
+<?00
4<4002<+00
"<)00
"00
2<=00
24<+00
+<100
1"<200
2<200
2<00
12<=00
4<400
+<100
+<?00
+<"00
+<00
1<"00
14<400
"<000
1?<)00
+<+00
1<200
1<000
1<004<200
+<?00
4<=00
"<?00
"<000
2<=00
"00
"<400
+<?00
4<=00
"<?00
<0004<00
"00
4"<200
+<000
10<)00
+<00
12<=00
?00
1<"00
1+<200
1<"00
+<000
24<000
"<400
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 534/539
1<)00
2<000
"<400
1<"00
1<)00
1<=00
4)<000
+<?00+<100
+<00
<000
4<00
"00
4"<200
)<100
+<100
2=<000
1"<200
2<200
2<200
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 535/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 536/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 537/539
TANGGAL NAMA PASIEN BPJS NAMA OBAT JMLA;
10/2/2014Ny. LutA -aml$ipin 10 m" 10
10/3/2014 Ny. Ra!ayu limepirie 4 m" 30
10/4/2014 Ny. ?rna (etr$ Tab 3
Ranitiin Tab 4
10/+/2014-n. yafa Ranitiin Tab 310/=/2014Ny unarsi! / u $ste$cal 30
r <am,a! *ipr$ tab 30
10/8/2014 Tn. Nur!ai -ml$ipin 10m" 30
10/10/2014-n. -riAn Ranitiin Tab 3
10/1"/2014Ny :o,iatin Ranitiin Tab 10
Ny -ni I *ipr$ tab 10
Ny. 7ani +$mperi$ne syr 1
10/14/2014Ny. (aria *efar$&il *aps 20
r. -li -sam Trane& Tab 20
Tn. -inur *ipr$ tab 22
10/1/2014Ny. ari ?vi *ipr$ tab 10
Tn S#-#r *efar$&il *aps 10
Ny.Lastri iv 20 1
)et$r$lac in% 3
neele 25 1
10/1#/2014 -n. ;ae) +$mperi$ne syr 1
Ny. ri L I *at! 20 2
Infuset biasa 1
10/20/2014 Ny. unarti *efar$&il *aps 10
10/21/2014 N> S&tarni -ml$ipin 10m" 30
Ny.Ina! Ranitiin Tab =
N> Ma(ardini limepirie 4 m" 8
Ny Nin" (etf$rmin tab 45
"emAbr$,il 300 15
Tn (uralim limepirie 4 m" 8
(etf$rmin tab 45
Ny ati%a( +ia, 2m" 5
10/28/2014 Ny. u%i Tr$lip 100 30
(etf$rmin tab B0
+ia, 2m" 10
11/1/2014
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 538/539
7/21/2019 LAP (Autosaved)
http://slidepdf.com/reader/full/lap-autosaved 539/539
;A7GA
116000
516000
#00
800
#00216000
126000
336000
#00
26000
46000
116000
1# 000