Laporan Pemeriksaan Laboratorium RS Sylvani

Bulan Febuari 2018

JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
1 1/2/2018 Sugeng Bpjs 1 125,000
2 1/2/2018 Sefania Bpjs 1 125,000
3 1/2/2018 Kismun Bpjs 1 1 1 1 224,000
4 1/2/2018 Cokong Bpjs 1 45,000
5 1/2/2018 Eliana Bpjs 1 1 1 225,000
6 1/2/2018 M.Azka Inhelt 1 125,000
7 1/2/2018 Rini Bpjs 1 1 1 225,000
8 1/2/2018 a/d Rini Umum 1 45,000
9 1/2/2018 Tiara Bpjs 1 1 443,500
10 1/2/2018 Tiurma Bpjs 1 1 1 1 224,000
11 1/2/2018 Herlinawat Bpjs 1 1 170,000
12 1/2/2018 Muslimin Bpjs 1 1 1 1 1 1 494,000
13 1/2/2018 M.AlQudri Bpjs 1 318,500
14 1/2/2018 Tomson Bpjs 1 1 1 195,000
15 1/2/2018 Hj.Elijani Bpjs 1 85,000
16 1/2/2018 Sugeng Bpjs 1 318,500
17 1/2/2018 Dewi intana Bpjs 1 1 170,000
18 1/2/2018 Kamisah Bpjs 1 125,000
19 1/2/2018 Heni Bpjs 1 1 170,000
20 1/2/2018 Kamisah Bpjs 1 125,000
21 1/2/2018 Sapriliani Bpjs 1 55,000
22 1/2/2018 Sef Bpjs 1 40,000
23 2/2/2018 Melisa Umum 1 1 170,000
24 2/2/2018 Sugeng Bpjs 1 125,000
25 2/2/2018 Tiara Bpjs 1 125,000
26 2/2/2018 Selly Bpjs 1 1 1 1 224,000
27 2/2/2018 Lili Bpjs 1 1 180,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
28 2/2/2018 M.Azka Inhelt 1 318,500
29 2/2/2018 Fatmah Bpjs 1 1 1 225,000
30 2/2/2018 Sit Selviana Bpjs 1 1 1 225,000
31 2/2/2018 Fitri Bpjs 1 1 1 1 364,000
32 2/2/2018 David Bpjs 1 125,000
33 2/2/2018 a/d Fatmah Umum 1 45,000
34 2/2/2018 M.Yazid Bpjs 1 1 170,000
35 2/2/2018 Dedy Bpjs 1 125,000
36 2/2/2018 Rustam Bpjs 1 45,000
37 3/2/2018 Dr.Mariaty Bpjs 1 1 1 1 1 1 1 505,000
38 3/2/2018 Rusli Bpjs 1 1 170,000
39 3/2/2018 Leni Bpjs 1 1 1 225,000
40 3/2/2018 Tiara Bpjs 1 125,000
41 3/2/2018 Agam Bpjs 1 1 180,000
42 3/2/2018 Mery Bpjs 1 1 1 225,000
43 3/2/2018 Novita Bpjs 1 1 1 225,000
44 3/2/2018 M.Rheyfadli Bpjs 1 125,000
45 3/2/2018 Nurlailah Bpjs 1 1 1 225,000
46 3/2/2018 Rusli Bpjs 1 1 1 1 320,000
47 3/2/2018 M.Syafii Bpjs 1 1 1 1 1 1 415,000
48 3/2/2018 M.Daffa Bpjs 1 125,000
49 3/2/2018 M.Yazid Bpjs 1 55,000
50 3/2/2018 Risma Umum 1 1 1 210,000
51 3/2/2018 Yunita Bpjs 1 1 1 225,000
52 3/2/2018 Khairy Bpjs 1 125,000
53 3/2/2018 Mita Umum 1 40,000
54 3/2/2018 Wiwik Bpjs 1 1 1 225,000
55 3/2/2018 Natania Adm 1 125,000
56 3/2/2018 a/d Wiwik Umum 1 45,000
57 4/2/2018 Orik Bpjs 1 7 440,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
58 4/2/2018 Rusli Bpjs 1 1 1 1 340,000
59 4/2/2018 Tiara Bpjs 1 125,000
60 4/2/2018 Marta Bpjs 1 1 1 225,000
61 4/2/2018 Rina Bpjs 1 1 1 225,000
62 5/2/2018 Herlina Bpjs 1 1 180,000
63 5/2/2018 Ryan Bpjs 1 1 170,000
64 5/2/2018 Eliana Bpjs 1 1 1 225,000
65 5/2/2018 Tiara Bpjs 1 125,000
66 5/2/2018 Orik Bpjs 1 45,000
67 5/2/2018 Duma sari Bpjs 1 1 1 488,500
68 5/2/2018 Helsy Umum 1 1 170,000
69 5/2/2018 Ningrum Bpjs 1 1 1 225,000
70 5/2/2018 Sit Zahara Bpjs 1 125,000
71 5/2/2018 Henny Bpjs 1 1 1 225,000
72 5/2/2018 Sit Fatmah Bpjs 1 1 1 225,000
73 5/2/2018 Juliana Bpjs 1 1 170,000
74 5/2/2018 Suroto Inhelth 1 1 443,500
75 5/2/2018 Susia Bpjs 1 1 1 225,000
76 5/2/2018 Desi Bpjs 1 1 1 1 224,000
77 5/2/2018 M.Daffa Bpjs 1 1 1 1 1 1 706,000
78 5/2/2018 M.Syafii Bpjs 1 45,000
79 5/2/2018 Sit Sahara Bpjs 1 1 170,000
80 5/2/2018 Surya Murni Bpjs 1 125,000
81 5/2/2018 Waitn Umum 1 1 1 225,000
82 5/2/2018 Dewi Afridayani Bpjs 1 1 1 225,000
83 5/2/2018 Nurjanah Bpjs 1 125,000
84 5/2/2018 a/d Sit Umum 1 2 215,000
85 5/2/2018 a/d Watni Umum 2 90,000
86 5/2/2018 Zulkarnain Bpjs 1 45,000
87 5/2/2018 Suhardi Bpjs 1 45,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
88 5/2/2018 Rukiah Bpjs 1 45,000
89 5/2/2018 Rahmawat Bpjs 1 45,000
90 5/2/2018 Rasita Bpjs 1 45,000
91 5/2/2018 Yakub Bpjs 1 45,000
92 5/2/2018 Rama Bpjs 1 1 443,500
93 6/2/2018 Watni Umum 1 125,000
94 6/2/2018 Orik Bpjs 1 45,000
95 6/2/2018 Surya Murni Bpjs 1 1 1 1 320,000
96 6/2/2018 Yusnawat Bpjs 1 125,000
97 6/2/2018 a/d Marta Umum 1 1 170,000
98 6/2/2018 Rafi Bpjs 1 1 443,500
99 6/2/2018 Fani Bpjs 1 1 1 220,000
100 6/2/2018 Astra Bpjs 1 125,000
101 6/2/2018 David Bpjs 1 318,500
102 6/2/2018 Suroto Inhelth 1 45,000
103 6/2/2018 Manarsi Bpjs 1 1 170,000
104 6/2/2018 Maghfira Bpjs 1 125,000
105 6/2/2018 Syarifah Bpjs 1 1 1 225,000
106 6/2/2018 Linda Bpjs 1 125,000
107 6/2/2018 Vivi Bpjs 1 125,000
108 6/2/2018 Riana Bpjs 1 45,000
109 6/2/2018 Waginem Bpjs 1 1 1 225,000
110 6/2/2018 Emy Bpjs 1 1 1 225,000
111 6/2/2018 Usman Bpjs 1 45,000
112 6/2/2018 Yurnita Bpjs 1 45,000
113 6/2/2018 Gusmaniar Bpjs 1 45,000
114 6/2/2018 Elly Bpjs 1 45,000
115 6/2/2018 Triyuni Bpjs 1 45,000
116 7/2/2018 Orik Bpjs 1 45,000
117 7/2/2018 Yusmawat Bpjs 1 1 100,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
118 7/2/2018 Astra Bpjs 1 55,000
119 7/2/2018 a/d marta Umum 2 90,000
120 7/2/2018 Surya Murni Bpjs 1 1 180,000
121 7/2/2018 Neliawat Bpjs 1 1 1 225,000
122 7/2/2018 a/d Wiwik I Umum 1 1 1 1 224,000
123 7/2/2018 a/d Wiwik II Umum 1 1 1 1 224,000
124 7/2/2018 Fani Ariana Bpjs 1 318,500
125 7/2/2018 Riana Bpjs 1 1 1 1 1 1 420,000
126 7/2/2018 Fina Bpjs 1 1 1 225,000
127 7/2/2018 Yasna Bpjs 1 1 1 1 1 1 494,000
128 7/2/2018 Maghfira Bpjs 1 125,000
129 7/2/2018 Nazwa Bpjs 1 1 170,000
130 7/2/2018 Kamaliah Bpjs 1 1 1 1 224,000
131 7/2/2018 Ali Jupi Bpjs 1 1 170,000
132 7/2/2018 Desi Nurlani Bpjs 1 318,500
133 7/2/2018 David Bpjs 1 80,000
134 7/2/2018 Syeh malem Bpjs 1 1 1 1 364,000
135 7/2/2018 Suci Maharani Bpjs 1 1 170,000
136 7/2/2018 Vina Indrilia Umum 1 125,000
137 7/2/2018 Sartka Bpjs 1 125,000
138 7/2/2018 Deby Bpjs 1 125,000
139 7/2/2018 Kenzo Bpjs 1 125,000
140 7/2/2018 Sonauli Bpjs 1 45,000
141 7/2/2018 Roslely Bpjs 1 45,000
142 7/2/2018 Hj.Masijem Bpjs 1 45,000
143 7/2/2018 Sri Agustna Bpjs 1 125,000
144 8/2/2018 Linda Bpjs 1 1 100,000
145 8/2/2018 Maghvira Bpjs 1 125,000
146 8/2/2018 Surya Murni Bpjs 1 125,000
147 8/2/2018 a/d Marta Umum 2 90,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
148 8/2/2018 Saqdiah Bpjs 1 1 1 225,000
149 8/2/2018 Feni Bpjs 1 1 1 225,000
150 8/2/2018 Riana Bpjs 1 45,000
151 8/2/2018 Syeh malem Bpjs 1 1 1 1 340,000
152 8/2/2018 Vika Bpjs 1 1 170,000
153 8/2/2018 Ritawana Bpjs 1 1 1 225,000
154 8/2/2018 Hilda Bpjs 1 1 1 210,000
155 8/2/2018 Diva Umum 1 1 170,000
156 8/2/2018 Natanael Bpjs 1 1 1 210,000
157 8/2/2018 a/d Marta Umum 1 45,000
158 8/2/2018 Sutni Umum 1 125,000
159 8/2/2018 Nani Bpjs 1 1 1 225,000
160 8/2/2018 Mazlan Bpjs 1 1 170,000
161 8/2/2018 a/d Marta Umum 1 45,000
162 8/2/2018 Irna Bpjs 1 1 1 225,000
163 8/2/2018 Sulastri Bpjs 1 1 1 225,000
164 8/2/2018 Yet Sinta Bpjs 1 1 1 225,000
165 9/2/2018 Laila Bpjs 1 1 1 225,000
166 9/2/2018 Surya Murni Bpjs 1 125,000
167 9/2/2018 Maghvira Bpjs 1 125,000
168 9/2/2018 a/d Marta Umum 1 45,000
169 9/2/2018 Tarsem Bpjs 1 1 1 1 300,000
170 9/2/2018 Rafip Umum 1 125,000
171 9/2/2018 Mazlan Bpjs 1 125,000
172 9/2/2018 Suci Bpjs 1 1 54,000
173 9/2/2018 Sri Mulyani Bpjs 1 1 170,000
174 9/2/2018 Hilda Bpjs 1 125,000
175 9/2/2018 Risma Bpjs 1 1 1 488,500
176 9/2/2018 Halimah Bpjs 1 45,000
177 9/2/2018 Indriani Bpjs 1 1 1 225,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
178 9/2/2018 Juli Bpjs 1 1 170,000
179 9/2/2018 Rustam Bpjs 1 45,000
180 9/2/2018 Sri Ukur Umum 1 1 1 1 1 1 1 534,000
181 9/2/2018 Riana Bpjs 1 45,000
182 9/2/2018 Deby Bpjs 1 80,000
183 9/2/2018 Nurul Umum 1 1 1 225,000
184 9/2/2018 Nurleni Bpjs 1 1 170,000
185 9/2/2018 Rinanda Bpjs 1 1 1 225,000
186 9/2/2018 a/d Marta Umum 1 45,000
187 10/2/2018 a/d Marta Umum 1 45,000
188 10/2/2018 Nurhaida Bpjs 1 1 1 225,000
189 10/2/2018 Sulasmi Bpjs 1 1 170,000
190 10/2/2018 Maghvira Bpjs 1 125,000
191 10/2/2018 Mazlan Bpjs 1 125,000
192 10/2/2018 Dewi Wahyuni Bpjs 1 1 1 1 265,000
193 10/2/2018 Anggi Bpjs 1 1 1 225,000
194 10/2/2018 Rahmayant Bpjs 1 1 170,000
195 10/2/2018 Sri Mawart Bpjs 1 1 170,000
196 10/2/2018 Sri Ukur Umum 1 1 170,000
197 10/2/2018 Riana Bpjs 1 45,000
198 10/2/2018 Reni Bpjs 1 1 170,000
199 10/2/2018 Dwi Ramadani Bpjs 1 1 443,500
200 10/2/2018 a/d Rinanda Umum 1 1 170,000
201 10/2/2018 a/d Marta Umum 1 45,000
202 10/2/2018 Asal Murni Bpjs 1 1 1 225,000
203 10/2/2018 Lili Sapitri Bpjs 1 1 170,000
204 10/2/2018 a/d Rinanda Umum 1 45,000
205 10/2/2018 Lisina Bpjs 1 1 1 225,000
206 10/2/2018 Duma Sari Umum 1 125,000
207 10/2/2018 Selly Bpjs 1 1 180,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
208 10/2/2018 Riska Bpjs 1 1 1 225,000
209 11/2/2018 Dewi Wahyuni Bpjs 1 125,000
210 11/2/2018
Rahmadani Bpjs 1 1 170,000
211 11/2/2018
Reni Bpjs 1 55,000
212 11/2/2018
Mazlan Bpjs 1 55,000
213 11/2/2018
Devi Bpjs 1 125,000
214 11/2/2018 a/d Nurhasanah Umum 1 45,000
215 11/2/2018 a/d Riska Umum 1 1 170,000
216 11/2/2018 a/d Marta Bpjs 1 45,000
217 11/2/2018 Desi Bpjs 1 1 1 225,000
218 11/2/2018 Dewi Haryat Bpjs 1 1 1 225,000
219 11/2/2018 Mardianto Bpjs 1 1 443,500
220 11/2/2018 Riana Bpjs 1 45,000
221 11/2/2018 a/d Ritawana Umum 1 1 1 319,000
222 11/2/2018 Mazlan Bpjs 1 125,000
223 11/2/2018 Sri Ukur Umum 2 90,000
224 11/2/2018 Erni caniago Bpjs 1 1 170,000
225 11/2/2018 Rahmadani Bpjs 1 1 130,000
226 11/2/2018 a/d Marta Umum 1 45,000
227 11/2/2018 Sri Damayant Bpjs 1 1 1 1 224,000
228 11/2/2018 Sri Wahyuni Bpjs 1 1 170,000
229 12/2/2018 Mazlan Bpjs 1 125,000
230 12/2/2018 Dea Arlina Bpjs 1 1 1 225,000
231 12/2/2018 Riana Bpjs 1 45,000
232 12/2/2018 Erni caniago Bpjs 1 45,000
233 12/2/2018 Marliana Bpjs 1 1 1 179,000
234 12/2/2018 Erni Purnama Bpjs 1 1 1 225,000
235 12/2/2018 Sri Ukur Umum 1 45,000
236 12/2/2018 Oza Bpjs 1 125,000
237 12/2/2018 Rekha Bpjs 1 1 1 1 224,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
238 12/2/2018 Kristna Bpjs 1 1 170,000
239 12/2/2018 Aisha Bpjs 1 125,000
240 12/2/2018 Nuraini Bpjs 1 1 1 210,000
241 12/2/2018 a/d Oza Umum 1 45,000
242 12/2/2018 Sri Ukur Umum 1 45,000
243 12/2/2018 Sri Indayani Bpjs 1 1 170,000
244 12/2/2018 Cokong Bpjs 1 45,000
245 12/2/2018 Surya Dewi Bpjs 1 1 170,000
246 12/2/2018 Radiah Bpjs 1 1 1 225,000
247 12/2/2018 Rosnidar Bpjs 1 125,000
248 12/2/2018 Mardianto Bpjs 1 318,500
249 12/2/2018 Selly Bpjs 1 318,500
250 12/2/2018 Afifah Bpjs 1 1 443,500
251 12/2/2018 Marlini Umum 1 1 1 225,000
252 12/2/2018 Supardi Bpjs 1 1 1 1 1 365,000
253 12/2/2018 Alya Bpjs 1 1 1 1 364,000
254 12/2/2018 M.Fahreza Bpjs 1 125,000
255 12/2/2018 Susilawat Bpjs 1 55,000
256 12/2/2018 Zulkarnain Bpjs 1 45,000
257 12/2/2018 Rasita Bpjs 1 45,000
258 12/2/2018 Suhardi Bpjs 1 45,000
259 13/2/2018 Nuraini Bpjs 1 125,000
260 13/2/2018 Sri Indayani Bpjs 1 55,000
261 13/2/2018 Sri Ukur Umum 1 45,000
262 13/2/2018 Amelia Bpjs 1 1 1 225,000
263 13/2/2018 Supardi Bpjs 1 55,000
264 13/2/2018 Alya Bpjs 1 55,000
265 13/2/2018 Aisyah Bpjs 1 125,000
266 13/2/2018 Erni caniago Bpjs 1 45,000
267 13/2/2018 Rosita Bpjs 1 1 1 1 224,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
268 13/2/2018 Rosmawart Bpjs 1 45,000
269 13/2/2018 Kayla Bpjs 1 125,000
270 13/2/2018
Gusmaniar Bpjs 1 45,000
271 13/2/2018
Sariani Bpjs 1 1 1 225,000
272 13/2/2018
Yusifa Bpjs 1 1 1 225,000
273 13/2/2018
Giofanny Bpjs 1 125,000
274 13/2/2018 a/d Sariani Bpjs 1 45,000
275 13/2/2018 Rosnidar Bpjs 1 45,000
276 13/2/2018 Nurul Bpjs 1 125,000
277 13/2/2018 Rika Bpjs 1 1 1 225,000
278 13/2/2018 Yurnita Bpjs 1 45,000
279 13/2/2018 Elliyusni Bpjs 1 45,000
280 13/2/2018 Sri Murniat Bpjs 1 45,000
281 13/2/2018 Khairy Bpjs 1 125,000
282 14/2/2018 Deby Bpjs 1 125,000
283 14/2/2018 Rosnidar Bpjs 1 55,000
284 14/2/2018 Kin Bpjs 1 1 1 1 1 350,000
285 14/2/2018 Erni caniago Bpjs 1 45,000
286 14/2/2018 Hj.Masijam Bpjs 1 1 170,000
287 14/2/2018 Tri Yuni Bpjs 1 125,000
288 14/2/2018 a/d Rinanda Bpjs 1 1 1 319,000
289 14/2/2018 Giofanny Bpjs 1 125,000
290 14/2/2018 Darmiah Umum 1 1 1 225,000
291 14/2/2018 Sartka Bpjs 1 125,000
292 14/2/2018 Indri Bpjs 1 1 1 225,000
293 14/2/2018 Sonauli Bpjs 1 45,000
294 14/2/2018 M.Fahreza Bpjs 1 125,000
295 14/2/2018 Yenwi Bpjs 1 1 1 225,000
296 14/2/2018 Annisa Bpjs 1 1 443,500
297 14/2/2018 Nurul Bpjs 1 125,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
298 14/2/2018 Sri Jumaida Bpjs 1 45,000
299 14/2/2018 Syahrul Bpjs 1 45,000
300 14/2/2018 Roslelly Bpjs 1 45,000
301 14/2/2018 Zainudin Bpjs 1 45,000
302 15/2/2018 Het Bpjs 1 1 170,000
303 15/2/2018 Satrya Bpjs 1 125,000
304 15/2/2018 Desi Bpjs 1 1 170,000
305 15/2/2018 Sudarman Bpjs 1 1 1 1 224,000
306 15/2/2018 Kin Bpjs 1 125,000
307 15/2/2018 Nurul Bpjs 1 125,000
308 15/2/2018 Erni caniago Bpjs 1 45,000
309 15/2/2018 Sri Ukur Umum 1 45,000
310 15/2/2018 Sri Indayani Bpjs 1 45,000
311 15/2/2018 Asrawat Bpjs 1 1 170,000
312 15/2/2018 Annisa Bpjs 1 55,000
313 15/2/2018 Dewi Nurlina Umum 1 1 1 1 224,000
314 15/2/2018 Deby Ami Bpjs 1 80,000
315 15/2/2018 Hj.Masijah Bpjs 1 45,000
316 15/2/2018 Anwar Bpjs 1 55,000
317 15/2/2018 Triana Bpjs 1 1 1 1 1 279,000
318 15/2/2018 Ramadhani Bpjs 1 1 1 225,000
319 15/2/2018 Vera Mardani Bpjs 1 125,000
320 15/2/2018 Sakdiyah Bpjs 1 1 1 1 300,000
321 15/2/2018 Nur lisa Bpjs 1 1 170,000
322 15/2/2018 A/d Ramadhani Umum 1 45,000
323 15/2/2018 Rustam Bpjs 1 45,000
324 15/2/2018 Halimah Bpjs 1 45,000
325 16/2/2018 A/d Marta Umum 1 45,000
326 16/2/2018 M.fahreza Bpjs 1 125,000
327 16/2/2018 Annisa Bpjs 1 125,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
328 16/2/2018 Sri Indayani Bpjs 1 45,000
329 16/2/2018 hj Masijah Bpjs 1 1 1 1 340,000
330 16/2/2018 Tri Astut Bpjs 1 1 1 225,000
331 16/2/2018 Tiori Bpjs 1 1 170,000
332 16/2/2018 Sit Erika Bpjs 1 1 170,000
333 16/2/2018 M.afrianda Bpjs 1 1 170,000
334 16/2/2018
Aryanto Bpjs 1 1 170,000
335 16/2/2018
Devi Yunika Bpjs 1 1 1 225,000
336 17/2/2018
Shinta Bpjs 1 1 1 225,000
337 17/2/2018
Novalia Bpjs 1 1 1 225,000
338 17/2/2018
Rizki Wilanda Bpjs 1 1 170,000
339 17/2/2018
Chairunnisa Bpjs 1 1 1 1 1 340,000
340 17/2/2018
Besta Umum 1 1 1 1 224,000
341 17/2/2018
Richa Fauziah Bpjs 1 1 1 488,500
342 17/2/2018 Denis Prasetyo Bpjs 1 125,000
343 17/2/2018 Nazihah Bpjs 1 125,000
344 17/2/2018 Sonauli Bpjs 1 1 170,000
345 17/2/2018 M.afrianda Bpjs 1 55,000
346 17/2/2018 Shinta Bpjs 1 125,000
347 17/2/2018 M.Fahri Bpjs 1 125,000
348 17/2/2018 Novalia Bpjs 1 125,000
349 18/2/2018 Nona Abdiana Bpjs 1 1 1 225,000
350 18/2/2018 Tiori Bpjs 1 55,000
351 18/2/2018 M.afrianda Bpjs 1 125,000
352 18/2/2018 Aryanto Bpjs 1 45,000
353 18/2/2018 Alya Nurhasanah Bpjs 1 55,000
354 18/2/2018 Oct Wirasari Bpjs 1 1 1 225,000
355 18/2/2018 Dinda Bpjs 1 1 1 225,000
356 18/2/2018 Anggi Bpjs 1 1 1 225,000
357 18/2/2018 Tiori Bpjs 1 225,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
358 18/2/2018 Mega Bpjs 1 1 1 225,000
359 18/2/2018 Agus Salim Bpjs 1 1 1 488,500
360 19/2/2018 Isnadiar Bpjs 1 125,000
361 19/2/2018 Sri Ukur Bpjs 1 3 260,000
362 19/2/2018 Aryanto Bpjs 1 318,500
363 19/2/2018 Chairunisa Bpjs 1 125,000
364 19/2/2018 M.afrianda Bpjs 1 125,000
365 19/2/2018 Reni Ardiani Bpjs 1 1 170,000
366 19/2/2018 M.Fahreza Bpjs 1 125,000
367 19/2/2018 Suhermanto Bpjs 1 1 1 488,000
368 19/2/2018 Tumin Bpjs 1 1 170,000
369 19/2/2018 Rina Bpjs 1 1 1 225,000
370 19/2/2018 Gita Rizki Bpjs 1 1 170,000
371 19/2/2018 Agilla Bpjs 1 125,000
372 19/2/2018 Suci Bpjs 1 125,000
373 19/2/2018
Samsuda Bpjs 1 1 1 1 224,000
374 19/2/2018
Heni Bpjs 1 1 1 225,000
375 19/2/2018
Fitri Bpjs 1 1 1 225,000
376 19/2/2018
Dewi Bpjs 1 1 1 225,000
377 19/2/2018 Anjas lesmana Bpjs 1 1 1 1 224,000
378 19/2/2018 Arbriani Bpjs 1 1 1 1 224,000
379 19/2/2018 Suhest Bpjs 1 1 1 1 1 355,000
380 19/2/2018 Roslely Bpjs 1 1 1 1 224,000
381 19/2/2018 Dwi Afriant Bpjs 1 125,000
382 19/2/2018 M.Bob Bpjs 1 125,000
383 19/2/2018 Nurhayani Bpjs 1 1 1 1 1 1 1 1 1 1 1 808,000
384 19/2/2018 Yunita Bpjs 1 1 180,000
385 19/2/2018 Wanda Bpjs 1 125,000
386 19/2/2018 Sentce Bpjs 1 1 1 1 224,000
387 19/2/2018 Sri Indayani Bpjs 1 45,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
388 19/2/2018 Orik Bpjs 1 45,000
389 19/2/2018 Suhardi Bpjs 1 45,000
390 19/2/2018 Zulkarnain Bpjs 1 45,000
391 19/2/2018 Rasita Bpjs 1 45,000
392 19/2/2018 Cokong Bpjs 1 45,000
393 20/2/2018 Agus Salim Bpjs 1 55,000
394 20/2/2018 M.afrianda Bpjs 1 125,000
395 20/2/2018 Sri Ukur Bpjs 1 45,000
396 20/2/2018 Aryanto Bpjs 1 45,000
397 20/2/2018 Asimah Umum 1 1 1 225,000
398 20/2/2018
Sri Susella Umum 1 1 1 1 1 1 1 1 1 1 1 808,000
399 20/2/2018
Mariana Bpjs 1 1 1 225,000
400 20/2/2018
Kartni Bpjs 1 1 1 225,000
401 20/2/2018
Dwi Afriant Bpjs 1 125,000
402 20/2/2018 Agus Salim Bpjs 1 125,000
403 20/2/2018 Wanda Bpjs 1 1 443,500
404 20/2/2018 M.Bob Bpjs 1 125,000
405 20/2/2018 Surya Umum 1 125,000
406 20/2/2018 Sri Damayant Bpjs 1 1 1 225,000
407 20/2/2018 Putri Bpjs 1 1 170,000
408 20/2/2018 Daffa Bpjs 1 125,000
409 20/2/2018 Setaman Umum 1 45,000
410 20/2/2018 Sabriah Bpjs 1 1 1 1 224,000
411 20/2/2018 A/d Asimah Umum 1 1 170,000
412 20/2/2018 a/d Rafida Umum 1 1 1 1 1 1 513,000
413 20/2/2018 Yunita Bpjs 1 1 1 225,000
414 20/2/2018 Heru Bpjs 1 125,000
415 20/2/2018 Karjumiah Bpjs 1 1 1 1 1 365,000
416 20/2/2018 Arina Bpjs 1 125,000
417 20/2/2018 Yurnita Bpjs 1 45,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
418 20/2/2018 Gusmaniar Bpjs 1 45,000
419 21/2/2018 Syaroh Bpjs 1 1 170,000
420 21/2/2018 Karjumiah Bpjs 1 55,000
421 21/2/2018 Endang Bpjs 1 125,000
422 21/2/2018 Heru Bpjs 1 1 180,000
423 21/2/2018 M.Bob Bpjs 1 125,000
424 21/2/2018 Wanda Bpjs 1 125,000
425 21/2/2018 Sri Lin Bpjs 1 1 1 225,000
426 21/2/2018 a/d Syaroh Umum 1 125,000
427 21/2/2018 Yuli Bpjs 1 1 1 225,000
428 21/2/2018 Yuniar Bpjs 1 1 170,000
429 21/2/2018 Agus Salim Bpjs 1 125,000
430 21/2/2018 Putri Umum 1 55,000
431 21/2/2018 Mariana Bpjs 1 1 1 1 340,000
432 21/2/2018 Suci Ningrum Bpjs 1 1 1 225,000
433 21/2/2018 Mema Bpjs 1 1 1 225,000
434 21/2/2018 Ika Riani Umum 1 1 170,000
435 21/2/2018 Ahmad Syahputra Bpjs 1 125,000
436 21/2/2018 Annisa Bpjs 1 1 1 225,000
437 21/2/2018 Warsito Bpjs 1 1 1 1 224,000
438 21/2/2018 Nur maya Bpjs 1 1 170,000
439 21/2/2018 Yusniar Bpjs 1 1 1 1 224,000
440 21/2/2018 a/d Suci Umum 1 45,000
441 21/2/2018 Suci Ningrum Bpjs 1 1 1 225,000
442 21/2/2018 Linda Wat Bpjs 1 1 1 225,000
443 21/2/2018 Maya Bpjs 1 125,000
444 21/2/2018 M.Saleh Bpjs 1 1 1 1 1 1 494,000
445 21/2/2018 Sofia Bpjs 1 1 1 1 1 1 494,000
446 21/2/2018 Wiji Bpjs 1 45,000
447 21/2/2018 Fika Bpjs 1 1 1 225,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
448 21/2/2018 Ahmad Syahputra Bpjs 1 80,000
449 21/2/2018 Suhest Bpjs 1 45,000
450 21/2/2018 Hj.Masijem Bpjs 1 45,000
451 21/2/2018 Erni Bpjs 1 45,000
452 21/2/2018 Sri Murniat Bpjs 1 45,000
453 21/2/2018 Usman Bpjs 1 45,000
454 22/2/2018 Heru Bpjs 1 125,000
455 22/2/2018 M.Bob Bpjs 1 125,000
456 22/2/2018 Widya Bpjs 1 1 1 225,000
457 22/2/2018 Mahyudin Bpjs 1 1 443,500
458 22/2/2018 Linda Andriani Bpjs 1 1 1 225,000
459 22/2/2018 a/d Suci Umum 1 45,000
460 22/2/2018 Rini Wardani Bpjs 1 1 1 225,000
461 22/2/2018 Karjumiah Bpjs 1 1 1 1 340,000
462 22/2/2018 Sant Bpjs 1 1 170,000
463 22/2/2018 M.Agus Umum 1 125,000
464 22/2/2018 a/d Suci Umum 1 125,000
465 22/2/2018 Sant Bpjs 1 1 170,000
466 22/2/2018 a/d Rafida Umum 1 1 1 1 388,000
467 22/2/2018 Normal Bpjs 1 1 1 1 300,000
468 22/2/2018 Pitriani Bpjs 1 1 1 225,000
469 22/2/2018 Kasmi Bpjs 1 1 125,000
470 22/2/2018 Boini Bpjs 1 1 170,000
471 22/2/2018 Sukirman Bpjs 1 1 170,000
472 22/2/2018 Halimah Bpjs 1 45,000
473 22/2/2018 Rustam Bpjs 1 45,000
474 22/2/2018 Suwaibatul Bpjs 1 125,000
475 22/2/2018 Cokong Bpjs 1 45,000
476 23/2/2018 M.Saleh Bpjs 1 45,000
477 23/2/2018 Sit Zahara Bpjs 1 1 180,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
478 23/2/2018 Kasmi Bpjs 1 55,000
479 23/2/2018 Boini Bpjs 1 55,000
480 23/2/2018 Sofia Bpjs 1 45,000
481 23/2/2018 Normal Bpjs 1 55,000
482 23/2/2018 a/d Kartni Umum 1 1 1 319,000
483 23/2/2018 Sit Rahayu Bpjs 1 1 1 225,000
484 23/2/2018 Mia Umum 1 1 1 225,000
485 23/2/2018 Sarika Bpjs 1 1 1 225,000
486 23/2/2018 Suriadi Bpjs 1 1 170,000
487 23/2/2018 Sri Julita Bpjs 1 1 170,000
488 23/2/2018 Sukirman Bpjs 1 55,000
489 23/2/2018 Dewi Nurhayat Umum 1 125,000
490 23/2/2018 Athala Bpjs 1 125,000
491 23/2/2018 Zuanda Adm 1 1 170,000
492 23/2/2018 Asmanila Bpjs 1 1 1 1 1 365,000
493 23/2/2018
Tunem Bpjs 1 1 170,000
494 23/2/2018
Wira Gunawan Bpjs 1 1 1 225,000
495 24/2/2018
Winda Bpjs 1 1 1 225,000
496 24/2/2018
Ade asma Bpjs 1 1 1 225,000
497 24/2/2018 Sri Kunant Bpjs 1 1 170,000
498 24/2/2018 M.saleh Bpjs 1 45,000
499 24/2/2018 Sofia Bpjs 1 45,000
500 24/2/2018 Jalaludin Pruden 1 1 1 1 1 365,000
501 24/2/2018 Kiki Dewi Bpjs 1 1 1 225,000
502 24/2/2018 Rasita Bpjs 1 1 1 225,000
503 24/2/2018 Dewi Umum 1 1 1 1 1 1 443,000
504 24/2/2018 Wira Bpjs 1 1 1 195,000
505 24/2/2018 Asmanila Bpjs 1 55,000
506 24/2/2018 Suriadi Bpjs 1 1 1 1 1 1 443,000
507 24/2/2018 Dwi Mandayant Bpjs 1 1 1 225,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
508 24/2/2018 Irma Bpjs 1 1 1 225,000
509 24/2/2018 Juliarseh Bpjs 1 1 1 225,000
510 24/2/2018 a/d Dwi mandayant Umum 2 90,000
511 24/2/2018 Lengsi Bpjs 1 1 1 225,000
512 24/2/2018 a/d Dwi mandayant Umum 1 1 170,000
513 24/2/2018 Dewi Umum 1 40,000
514 24/2/2018 Safrida Bpjs 1 125,000
515 24/2/2018 Marta Uli Bpjs 1 125,000
516 24/2/2018 Fabia Bpjs 1 1 1 225,000
517 24/2/2018 Nindi Bpjs 1 1 170,000
518 24/2/2018 Elmaya Bpjs 1 1 170,000
519 24/2/2018 Ernawat Bpjs 1 125,000
520 25/2/2018 Dwi Mandayant Bpjs 1 125,000
521 25/2/2018 Demiya Bpjs 1 1 1 225,000
522 25/2/2018 Jihan Umum 1 125,000
523 25/2/2018 Dewi Nurhayat Umum 1 125,000
524 25/2/2018 Kasmi Bpjs 1 125,000
525 25/2/2018 Sit Fitri Bpjs 1 1 170,000
526 25/2/2018 Yuani Bpjs 1 1 170,000
527 25/2/2018 M.Saleh Bpjs 1 45,000
528 25/2/2018 Sofia Bpjs 1 45,000
529 25/2/2018 Brelly Inhelt 1 1 443,000
530 25/2/2018 Putriani Bpjs 1 1 1 225,000
531 25/2/2018 Kurnia Bpjs 1 1 1 498,000
532 25/2/2018 Tunem Bpjs 1 1 1 1 240,000
533 25/2/2018 Zuanda Admdk 1 1 1 1 1 1 1 1 1 1 1 1 1 978,000
534 25/2/2018 Rasita Bpjs 1 1 1 1 1 1 434,000
535 25/2/2018 Jalaludin Medlm 1 1 1 1 1 385,000
536 25/2/2018 a/d Pitriani Umum 1 1 1 319,000
537 25/2/2018 Agussalim Bpjs 1 125,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
538 25/2/2018 Warni Bpjs 1 1 1 1 1 365,000
539 25/2/2018 Putri Bpjs 1 1 1 1 1 365,000
540 25/2/2018 a/d fabia Umum 1 1 170,000
541 25/2/2018 Bunna Bpjs 1 125,000
542 25/2/2018 Novita Umum 1 125,000
543 25/2/2018 T.Zeihan Bpjs 1 1 1 225,000
544 26/2/2018 Suheri Bpjs 1 125,000
545 26/2/2018 Putri Bpjs 1 55,000
546 26/2/2018 Yuani Bpjs 1 45,000
547 26/2/2018 Netty Bpjs 1 1 1 1 360,000
548 26/2/2018 Warni Bpjs 1 55,000
549 26/2/2018 Marta Uli Bpjs 1 125,000
550 26/2/2018 Rasita Bpjs 1 45,000
551 26/2/2018 Sumiyat Bpjs 1 1 170,000
552 26/2/2018 M.Saleh Bpjs 2 90,000
553 26/2/2018 Sofia Bpjs 1 45,000
554 26/2/2018 Sarman Bpjs 1 125,000
555 26/2/2018 Suheri Bpjs 1 55,000
556 26/2/2018 Tunem Bpjs 1 55,000
557 26/2/2018 Marsiah Umum 1 40,000
558 26/2/2018 Sherly Bpjs 1 1 1 225,000
559 26/2/2018 Sonauli Bpjs 1 45,000
560 26/2/2018 Rosmawart Bpjs 1 45,000
561 26/2/2018 Zulkarnain Bpjs 1 45,000
562 26/2/2018 Orik Bpjs 1 45,000
563 26/2/2018 Maria Bpjs 1 45,000
564 26/2/2018 Aryanto Bpjs 1 45,000
565 26/2/2018 Suhardi Bpjs 1 45,000
566 26/2/2018 M.Yunus Bpjs 1 45,000
567 26/2/2018 Yuani Bpjs 1 45,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
568 26/2/2018 Anwar Bpjs 1 45,000
569 26/2/2018 David Bpjs 1 1 170,000
570 26/2/2018 Suriono Bpjs 1 224,000
571 26/2/2018 Bambang Bpjs 1 1 1 1 224,000
572 26/2/2018 Yuani Bpjs 1 45,000
573 26/2/2018 Ema Bpjs 1 55,000
574 26/2/2018 M.Yunus Bpjs 1 125,000
575 26/2/2018 Evi Bpjs 1 1 170,000
576 26/2/2018 Rosmalinda Bpjs 1 1 170,000
577 26/2/2018 Latfah Bpjs 1 1 170,000
578 27/2/2018 Maisa Bpjs 1 1 1 225,000
579 27/2/2018 Eri Indra Bpjs 1 55,000
580 27/2/2018 Julianta Umum 1 1 1 225,000
581 27/2/2018 Sunardi Bpjs 1 125,000
582 27/2/2018 Yuani Bpjs 1 45,000
583 27/2/2018 Sumiyat Bpjs 1 45,000
584 27/2/2018 Marta Uli Bpjs 1 125,000
585 27/2/2018 M.Saleh Bpjs 1 45,000
586 27/2/2018 Sofia Bpjs 1 45,000
587 27/2/2018 Rasita Bpjs 1 45,000
588 27/2/2018 Jalaludin Bpjs 1 45,000
589 27/2/2018 Netty Bpjs 1 45,000
590 27/2/2018 Latfah Bpjs 1 1 1 195,000
591 27/2/2018 Evi Indra Bpjs 1 1 1 195,000
592 27/2/2018 Eka Damai Bpjs 1 40,000
593 27/2/2018 Ema Bpjs 1 125,000
594 27/2/2018 Yuani Bpjs 1 45,000
595 27/2/2018 Susilawat Bpjs 1 125,000
596 27/2/2018 Gusmaniar Bpjs 1 45,000
597 27/2/2018 Sri Ukur Bpjs 1 45,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CRE AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
598 27/2/2018 Elly Bpjs 1 45,000
599 27/2/2018 Fitri Bpjs 1 1 1 225,000
600 27/2/2018 Putri Bpjs 1 125,000
601 27/2/2018 Yuhani Bpjs 1 125,000
602 27/2/2018 Latfah Bpjs 1 55,000
603 27/2/2018 Nuraini Bpjs 1 1 170,000
604 27/2/2018 Hervani Bpjs 1 1 170,000
605 27/2/2018 Riris Bpjs 1 1 1 225,000
606 27/2/2018 Widia Bpjs 1 125,000
607 27/2/2018 Yuani Bpjs 1 45,000
608 27/2/2018 Sukmawat Bpjs 1 1 170,000
609 27/2/2018 Yusmania Bpjs 1 1 170,000
610 27/2/2018 a/d Julianta Umum 1 45,000
611 27/2/2018 Roslely Bpjs 1 45,000
612 28/2/2018 Marta Uli Bpjs 1 125,000
613 28/2/2018 Ema Bpjs 1 125,000
614 28/2/2018 Husin Bpjs 1 125,000
615 28/2/2018 Putri Bpjs 1 125,000
616 28/2/2018 Yuani Bpjs 1 45,000
617 28/2/2018
Warni Bpjs 1 45,000
618 28/2/2018
M.Saleh Bpjs 1 45,000
619 28/2/2018
Sofia Bpjs 1 45,000
620 28/2/2018
Rasita Bpjs 1 45,000
621 28/2/2018
Netty Bpjs 1 45,000
622 28/2/2018 Tunem Bpjs 1 45,000
623 28/2/2018 Hervani Bpjs 1 125,000
624 28/2/2018 David Bpjs 1 125,000
625 28/2/2018 Brelly Inhelt 1 125,000
626 28/2/2018 Restanda Bpjs 1 1 180,000
627 28/2/2018 M.Raid Bpjs 1 125,000
 JENIS PEMERIKSAAN
NO Tanggal Nama Pasien Status
DL KGD UR G.D FR WD URE CR AU BT BD OT PT AL CT BT TBX DGHCVHBSCho TG HDL LDL Alb Glo PL Harga
628 28/2/2018 Sumiyat Bpjs 1 45,000
629 28/2/2018 Yuani Bpjs 1 45,000
630 28/2/2018 Netty Bpjs 1 45,000
631 28/2/2018 Usman Bpjs 1 45,000
632 28/2/2018 Yurnita Bpjs 1 45,000
633 28/2/2018 Erni Bpjs 1 45,000
634 28/2/2018 Arnaiyah Bpjs 1 45,000
635 28/2/2018 a/d fabia Umum 1 125,000
636 28/2/2018 Yusmania Umum 1 1 1 1 1 1 1 530,000
637 28/2/2018 Evi Indra Bpjs 1 1 1 1 340,000
638 28/2/2018 Rita Bpjs 1 45,000
639 28/2/2018 Warni Bpjs 1 45,000
640 28/2/2018 Yuhani Umum 1 125,000
641 28/2/2018 Wiji Bpjs 1 45,000
642 28/2/2018 Doni Bpjs 1 1 443,500
643 28/2/2018 Sukmawat Bpjs 1 1 194,000
644 28/2/2018 Salmon Bpjs 1 45,000
645 28/2/2018 Lencina Bpjs 1 45,000
646 28/2/2018 Surip Bpjs 1 1 1 1 1 365,000
647 28/2/2018 Dewi Bpjs 1 125,000
648 28/2/2018 Maya Umum 1 1 180,000
649 28/2/2018 Hennawat Umum 1 125,000

418 421 162 6 5 36 36 22 14 14 19 19 7 22 22 29 11 9 9 9 7 106,770,000

Ka. Ruangan Penanggung Jawab Diketahui Direktur RSU Sylvani

(Putri Mustka Am. AK) (dr. Suliarni, SpPK.) (dr. Dovi Camela Sitepu, M. Kes.)