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Rincian Operasi dan Biaya RSU An Nisaa

1. The document is a medical record listing details of a surgical procedure including patient information, diagnosis, procedure type, medical staff involved, supplies and medications used. 2. It provides a list of 40 items of materials and supplies used during the procedure including sutures, drapes, gloves, oxygen and medications. 3. A total cost of supplies and medications of Rp620,000 is noted at the bottom of the list.

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DINA NORINE
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57 views14 pages

Rincian Operasi dan Biaya RSU An Nisaa

1. The document is a medical record listing details of a surgical procedure including patient information, diagnosis, procedure type, medical staff involved, supplies and medications used. 2. It provides a list of 40 items of materials and supplies used during the procedure including sutures, drapes, gloves, oxygen and medications. 3. A total cost of supplies and medications of Rp620,000 is noted at the bottom of the list.

Uploaded by

DINA NORINE
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

BBA OK RSU AN NISAA'

: Operator
Jenis Operasi Sedang Kls.3
Nama / Umur : Kartini Ny Asisten Operator

Alamat : Bence 1/2 Garum Anesthesi

Ruang : Aziziyah 1 Asisten anesthesi


Diagnosa : Instrument
Tindakan : Debudement Onloop
Jenis Ans : SAB Resusitasi bayi
LAB PA : - Perawat
Tanggal : 13-Jan-20 PP
OK : OK 2 RR
Jenis Pasien : umum No. Bukti Pembayaran
No Nama barang Satuan
BAHAN & ALAT
1 [Link] no. 0 mtr
2 [Link] no. 1 / Orthopedic mtr
3 [Link] no. 2 mtr
4 [Link] no. 2/0
5 [Link] no. 3/0 mtr
6 [Link] no. 3 mtr
7 [Link] no. 0 mtr
8 [Link] no. 1 mtr
9 [Link] no. 2/0 mtr
10 [Link] no. 3/0 mtr
11 Dexon no 1/no 0/no 2/0 / no 3/0 / no 4/0 no 5/0 biji
12 Surgicryl / prolene/ iud/orthocast/T vio biji
gizi
13 [Link] no. 0 mtr
14 [Link] no. 1 mtr
15 [Link] no. 2 mtr
16 [Link] no. 2/0 mtr
17 [Link] no. 3/0 mtr
18 Betadine cleanser cc
19 Betadine solution cc
20 Bloodmess no 20 / no 15/ no 11/10 biji
21 ECG Monitor
22 Elektroda 3 biji
23 Handscoen biji
24 Handsweet biji
25 Hypafix cm
26 Kassa mtr
27 Oksigen ….2. ltr/ jam
28 Plester/ Tensoplast cm
29 Spongostan pak
30 Spuit no 10 biji
31 Spuit no3/ nedle/terumo biji
32 Spuit no5 (terumo)/ insulin biji
33 Underpad/ nurse cup/transofix biji
34 bloodset/ngt/alkohol/infuset/slem swiker/canul O2 bayi
35 Venflon/cateter/wingneedle no.23/magslang/spuit 50 cc
36 Urobag/colostomy bag/Nasal Canul Bayi
37 ETT no 3/Tensocrep 10/treeway 22/cateter 3way/non rebritheng mask
38 Hibicef
39 Infuset pump/ xilocain ……..GA 1
40 BBA SAB 1

No OBAT & CAIRAN Satuan


1 Cairan Aquabidest biji
2 Cairan D % sanbe fls
3 Cairan PZ/NS 0,5ltr fls
4 Cairan PZ 1 lt/ Larutan irigasi 1lt fls
5 Cairan RL sanbe fls
6 Cairan RL wida/ otsu/ogb fls
7 OB. Miloz amp
8 OB. Ethran cc
9 OB. Halotan cc
10 OB. Ketalar/ KTM/ Diazepam cc
11 OB. Lidocain 2% / Asam Tranexamat amp
12 OB. Pehacain 2% amp
13 OB. Pentothal cc
14 OB. Petidine / Fentanil/Clopedin amp
15 [Link] Cholin cc
16 [Link] Atropin(SA) / Isofluran amp
17 [Link]=notrixum amp
18 Metergin/ dexamethason/ulsikur/ kalmet/oksitosin amp
19 Primperan/ Aminopilin/ondancetron amp
20 Syntocinon/prostigmin/ softband/cmbivent amp
21 Widahes / Haemecel / gelafusal / OPSITE
22 Epedrin/ Profenid supp/ tensocrep 7,5/NGT 16
23 Regivell/ Markain/Decain/spongostan/curaspon/ Selang Suction/cromic 2/0
24 Spinocan no.25 / 26 / 27/cendrantron
25 Remopain/teranol/ketorolac/ketopain/toramin
26 Safol /Tensocrep 15
27 Cortidex / pehidrol 1lt/ tradosix/ adrenalin/Noprostol
28 lain lain ok
29 kalnex/lumatul/cutiself/poliban/poligyp/stokinet/spuit 50 cc
TOTAL
TOTAL OBAT & ALAT 620,000
Catatan: Ka Kamar Operasi
* Jam : :13.35-14.00

BBA OK RSU AN NISAA'

: Operator
Jenis Operasi SC Kls. 3
AN NISAA'

dr. Dwiyanto, Sp.B

Misnanto Tidak Dinas


dr. M. Yani Faudi, [Link]

Sugeng Tidak Dinas


Asnawi Tidak Dinas Jl. Suparyono Timur No. 1 B
Nanang Tidak Dinas

Tidak Dinas
Tanggal :
Nama / Umur :
04 - 00175 Alamat :
Harga Jenis Pasien :

27,000 -
30,000 - No
99,000 - 1.
45,000 - 2.
20,000 - 3.
35,000 - 4.
75,000 - 5.
26,000 - 6.
90,000 - 7.
26,000 - 8.
150,000 - 9.
160,000 - 10
65,000 -
12,000 -
12,000 -
17,000 - 1.
15,000 - 2.
11,000 - TOTAL
200 30 6,000
200 200 40,000
5,000 1 5,000
125,000 1 125,000
5,000 1 5,000
25,000 -
25,000 -
1,500 1 1,500
4,000 3 12,000
20,000 -
1,000 -
74,500 -
5,000 1 5,000
4,500 -
7,500 2 15,000
7,500 -
47,000 -
45,000 -
18,500 -
85,000 -
500 50 25,000
15,000 1 15,000
80,000 1 80,000
334,500

Harga Total
7,500 1 7,500
21,000 -
18,000 -
28,000 1 28,000
25,000 -
20,000 -
51,500 -
7,000 -
7,000 -
32,000 -
8,000 -
6,000 -
87,500 -
51,500 -
31,000 -
10,000 -
97,500 -
20,000 -
22,000 -
25,000 -
231,000 -
70,000 -
96,500 -
54,000 -
55,000 -
123,000 -
25,000 -
250,000 1 250,000
35,000 -
285,500

Ka Kamar Operasi

AN NISAA'

dr. Puspita, [Link]


RUMAH SAKIT UMUM AN NISAA'
Jl. Suparyono Timur No. 1 Bajang Talun Blitar Telp. 0342- 692999, Fax 693999

BUKTI PEMBAYARAN OPERASI

13-Jan-20 Ruang :
Kartini Ny Jenis Operasi:
Bence 1/2 Garum Tindakan :
umum No. Bukti :

Uraian
Administrasi
Pemakaian Alat & Kamar Operasi
Ruang Pemulihan (RR)
Jasa operator dr. Dwiyanto, Sp.B
Jasa anastesi dr. M. Yani Faudi, [Link]
Jasa Tim
Asuhan Keperawatan OK
Resusitasi -
Perawatan
Lain-lain

Bahan & alat Kesehatan


Obat & Cairan

GRAND TOTAL : 5,120,000


Petugas
Kholifatul Rohmah

48,200

(800)

652,700
611,600
491,200
Aziziyah 1
Sedang Kls.3
Debudement
04 - 00175

Jumlah
125,000
700,000
250,000
1,500,000
750,000
550,000
100,000
500,000
25,000

4,500,000

334,500
285,500
620,000
14,424,500

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