2.Rincian Biaya Nur Arofah

RINCIANI BIAYA PENGOBATAN NUR AROFAH

JENIS BIAYATANGGAL UANG PERIKSA LABORAT TINDAKAN AKOMODASI ALAT ALAT OBAT SUBTOTAL

DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATAN4 35,000 100,000 50,000 30,000 215,000 5 40,000 30,000 231,500 301,500 6 257,000 40,000 100,000 50,000 30,000 477,000 7 40,000 30,000 230,000 300,000 8 40,000 100,000 50,000 30,000 220,000 9 40,000 30,000 70,000

AHAD 30,000 30,000 11 100,000 40,000 100,000 100,000 30,000 750,000 1,120,000 12 40,000 20,000 30,000 15,000 105,000 13 40,000 30,000 70,000 14 40,000 100,000 50,000 30,000 220,000 15 40,000 30,000 70,000 16 40,000 100,000 50,000 30,000 220,000

AHAD 30,000 30,000 18 40,000 100,000 50,000 30,000 150,000 370,000 19 40,000 30,000 70,000 20 40,000 100,000 50,000 30,000 220,000 21 40,000 30,000 70,000 22 40,000 100,000 50,000 30,000 220,000 23 40,000 30,000 70,000

AHAD 30,000 30,000 25 40,000 30,000 100,000 170,000 26 40,000 30,000 70,000 27 40,000 100,000 50,000 30,000 220,000 28 40,000 30,000 70,000 29 40,000 100,000 50,000 30,000 220,000 30 40,000 30,000 70,000

JUMLAH 35,000 200,000 257,000 920,000 1,000,000 20,000 600,000 810,000 900,000 15,000 561,500 5,318,500

RINCIANI 3 BULAN KE I BULAN NOPEMBER 2013

Bulan Nopember 13 5,318,500


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANLANJUTAN 35,000 200,000 - 257,000 920,000 1,000,000 20,000 600,000 - 810,000 900,000 15,000 561,500 5,318,500 AHAD 40,000 30,000 231,500 301,500

2 40,000 100,000 50,000 30,000 220,000 3 100,000 40,000 50,000 30,000 280,000 500,000 4 40,000 100,000 50,000 30,000 220,000 5 100,000 40,000 50,000 30,000 220,000 6 40,000 100,000 50,000 30,000 220,000 7 40,000 30,000 70,000

AHAD 30,000 30,000 9 40,000 100,000 50,000 30,000 220,000

10 40,000 30,000 70,000 11 40,000 100,000 50,000 30,000 220,000 12 40,000 30,000 70,000 13 40,000 100,000 50,000 30,000 220,000 14 40,000 30,000 70,000

AHAD 30,000 30,000 16 40,000 100,000 50,000 30,000 220,000 17 40,000 30,000 70,000 18 40,000 100,000 50,000 30,000 220,000 19 40,000 30,000 70,000 20 40,000 100,000 50,000 30,000 220,000 21 40,000 30,000 100,000 170,000

AHAD 30,000 30,000 23 40,000 100,000 50,000 30,000 220,000 24 40,000 30,000 70,000 25 40,000 100,000 50,000 30,000 220,000 26 40,000 30,000 70,000 27 40,000 100,000 50,000 30,000 220,000 28 40,000 30,000 70,000

AHAD 30,000 30,000 30 40,000 100,000 50,000 30,000 220,000 31 40,000 30,000 70,000

JUMLAH 35,000 300,000 100,000 257,000 2,000,000 2,300,000 20,000 1,350,000 - 1,740,000 900,000 15,000 1,173,000 10,190,000

RINCIAN 3 BULAN KE I, BULAN DESEMBER 2013

Bulan Desember 13 4,871,500


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANLANJUTAN 35,000 300,000 100,000 257000 2,000,000 2,300,000 20,000 1,350,000 - 1,740,000 900,000 15,000 1,173,000 10,190,000

1 100,000 40,000 100,000 50,000 30,000 320,000 2 100,000 40,000 50,000 30,000 220,000 3 40,000 100,000 50,000 30,000 220,000 4 40,000 30,000 70,000

AHAD 30,000 30,000 6 40,000 100,000 50,000 30,000 220,000 7 40,000 30,000 70,000 8 40,000 100,000 50,000 30,000 220,000 9 40,000 30,000 70,000

10 40,000 100,000 50,000 30,000 220,000 11 40,000 30,000 70,000

AHAD 30,000 30,000 13 40,000 100,000 50,000 30,000 220,000 14 40,000 30,000 70,000 15 40,000 100,000 50,000 30,000 220,000 16 40,000 30,000 70,000 17 40,000 100,000 50,000 30,000 220,000 18 40,000 30,000 70,000

AHAD 30,000 30,000 20 40,000 100,000 50,000 30,000 220,000 21 40,000 30,000 70,000 22 40,000 100,000 50,000 30,000 220,000 23 40,000 30,000 70,000 24 40,000 100,000 50,000 30,000 220,000 25 40,000 30,000 70,000

AHAD 30,000 30,000 27 40,000 100,000 50,000 30,000 220,000 28 40,000 30,000 70,000 29 40,000 100,000 50,000 30,000 220,000 30 100000 250000 40,000 50,000 30,000 300,000 770,000 31 40,000 100000 50000 30,000 220,000

JUMLAH 35,000 400,000 300,000 507000 3,080,000 3,700,000 20,000 2,150,000 - 2,670,000 900,000 15,000 1,473,000 15,250,000

RINCIAN 3 BULAN KE I, BULAN JANUARI 2014

Bulan Januari 14 5,060,000


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANLANJUTAN 35,000 400,000 300,000 507000 3,080,000 3,700,000 20,000 2,150,000 - 2,670,000 900,000 15,000 1,473,000 10,190,000

1 40,000 30,000 70,000 AHAD 30,000 30,000

3 40,000 100,000 50,000 30,000 220,000 4 40,000 30,000 70,000 5 40,000 30,000 70,000 6 40,000 30,000 70,000 7 40,000 100,000 50,000 30,000 220,000 8 40,000 30,000 70,000

AHAD 30,000 30,000 10 40,000 100,000 50,000 30,000 220,000 11 40,000 30,000 70,000 12 40,000 30,000 70,000 13 40,000 30,000 70,000 14 40,000 100,000 50,000 30,000 220,000 15 40,000 30,000 70,000

AHAD 30,000 30,000 17 40,000 100,000 50,000 30,000 220,000 18 40,000 30,000 70,000 19 40,000 30,000 70,000 20 40,000 30,000 70,000 21 40,000 100,000 50,000 30,000 220,000 22 40,000 30,000 70,000

AHAD 30,000 30,000 23 40,000 100,000 50,000 30,000 220,000 24 40,000 30,000 70,000 25 40,000 30,000 70,000 26 100,000 250,000 40,000 50,000 30,000 300,000 770,000 27 40,000 100000 50000 30,000 220,000 28 40,000 30,000 70,000

JUMLAH 35,000 400,000 400,000 757,000 4,080,000 4,500,000 20,000 2,600,000 - 3,540,000 900,000 15,000 1,773,000 13,960,000

RINCIAN 3 BULAN KE ii, BULAN PEBRUARI 2014

Bulan Pebruari 14 3,770,000


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANLANJUTAN 35,000 400,000 400,000 757000 4,080,000 4,500,000 20,000 2,600,000 - 3,540,000 900,000 15,000 1,773,000 13,960,000 AHAD 30,000 30,000

2 40,000 100,000 50,000 30,000 220,000 3 40,000 30,000 70,000 4 40,000 30,000 70,000 5 40,000 30,000 70,000 6 40,000 100,000 50,000 30,000 220,000 7 40,000 30,000 70,000

AHAD 30,000 30,000 9 40,000 100,000 50,000 30,000 220,000

10 40,000 30,000 70,000 11 40,000 30,000 70,000 12 40,000 30,000 70,000 13 40,000 100,000 50,000 30,000 220,000 14 40,000 30,000 70,000

AHAD 30,000 30,000 16 40,000 100,000 50,000 30,000 220,000 17 40,000 30,000 70,000 18 40,000 30,000 70,000 19 40,000 30,000 70,000 20 40,000 100,000 50,000 30,000 220,000 21 40,000 30,000 70,000

AHAD 30,000 30,000 23 40,000 30,000 70,000 24 40,000 30,000 70,000 25 40,000 100,000 50,000 30,000 220,000 26 100,000 40,000 50,000 30,000 220,000 27 40,000 30,000 70,000 28 40,000 30,000 70,000

AHAD 30,000 30,000 30 40,000 100,000 50,000 30,000 220,000 31 40,000 30,000 70,000

JUMLAH 35,000 400,000 500,000 757,000 5,120,000 5,300,000 20,000 3,050,000 - 4,470,000 900,000 15,000 1,773,000 17,280,000

RINCIAN 3 BULAN KE ii, BULAN MARETI 2014

Maret 14 3,320,000


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANLANJUTAN 35,000 400,000 500,000 757,000 5,120,000 5,300,000 20,000 3,050,000 - 4,470,000 900,000 15,000 1,773,000 17,280,000

1 30,000 30,000 2 40,000 30,000 70,000 3 40,000 30,000 70,000 4 40,000 100,000 50,000 30,000 220,000

AHAD 30,000 30,000 6 40,000 100,000 50,000 30,000 220,000 7 40,000 30,000 70,000 8 40,000 30,000 70,000 9 40,000 100,000 50,000 30,000 220,000

10 40,000 30,000 70,000 11 40,000 30,000 70,000

AHAD 30,000 30,000 13 40,000 100,000 50,000 30,000 220,000 14 40,000 30,000 70,000 15 40,000 30,000 70,000 16 40,000 100,000 50,000 30,000 220,000 17 40,000 30,000 70,000 18 40,000 30,000 70,000

AHAD 30,000 30,000 20 40,000 100,000 50,000 30,000 220,000 21 40,000 30,000 70,000 22 40,000 30,000 70,000 23 40,000 100,000 50,000 30,000 220,000 24 40,000 30,000 70,000 25 40,000 30,000 70,000

AHAD 30,000 30,000 27 100,000 40,000 100,000 50,000 30,000 300,000 300,000 920,000 28 100,000 40,000 50,000 30,000 100,000 320,000 29 40,000 30,000 70,000 30 40,000 100,000 50,000 30,000 220,000

JUMLAH 35,000 500,000 600,000 757,000 6,120,000 6,200,000 20,000 3,550,000 - 5,370,000 1,200,000 15,000 2,173,000 21,480,000

RINCIAN 3 BULAN KE ii, BULAN APRILI 2014

14-Apr 4,200,000


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANLANJUTAN 35,000 500,000 600,000 757,000 6,120,000 6,200,000 20,000 3,550,000 - 5,370,000 1,200,000 15,000 2,173,000 21,480,000

1 40,000 30,000 70,000 2 40,000 100,000 50,000 30,000 220,000

AHAD 30,000 30,000 4 40,000 100,000 50,000 30,000 220,000 5 40,000 30,000 70,000 6 40,000 100,000 50,000 30,000 220,000 7 40,000 30,000 70,000 8 40,000 30,000 70,000 9 40,000 30,000 70,000

AHAD 30,000 30,000 11 40,000 100,000 50,000 30,000 220,000 12 40,000 30,000 70,000 13 40,000 100,000 50,000 30,000 220,000 14 40,000 30,000 70,000 15 40,000 30,000 70,000 16 40,000 30,000 70,000

AHAD 30,000 30,000 18 40,000 100,000 50,000 30,000 220,000 19 40,000 30,000 70,000 20 40,000 100,000 50,000 30,000 220,000 21 40,000 30,000 70,000 22 40,000 30,000 70,000 23 40,000 30,000 70,000

AHAD 30,000 30,000 25 40,000 100,000 50,000 30,000 220,000 26 40,000 30,000 70,000 27 100,000 40,000 50,000 30,000 300,000 520,000 28 100,000 40,000 50,000 30,000 100,000 320,000 29 40,000 30,000 70,000 30 40,000 100,000 50,000 30,000 220,000

AHAD 40,000 30,000 70,000 JUMLAH 35,000 600,000 700,000 757000 7,200,000 7,100,000 20,000 4,100,000 - 6,300,000 1,200,000 15,000 2,573,000 25,540,000

REKAPITRULASI 3 BULAN KE III, BULAN Mei 2014

Mei 14 3,990,000


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATANJUNI 14Pekan 1 - Pekan 2 - Pekan 3 - Pekan 4 100,000 100,000 20,000 100,000 300,000 620,000 JML - 100,000 100,000 20,000 - 100,000 - - - - - - 300,000 620,000

Bulan Juni - Dese 14 620,000


DR UMUM DR. SP. BDH TLG DR SP. PARU VISITE DR FISIOTX MEDIS JASA ANTAR SEWA KAMAR KONSUMSI FISIOTX KESEHATAN15-Jan

Pekan 1 - Pekan 2 - Pekan 3 - Pekan 4 100,000 20,000 100,000 300,000 520,000 JML - - 100,000 20,000 - 100,000 - - - - - - 300,000 520,000

Bulan Jan- okt 15 520,000

RINCIAN BIAYA TIAP BULAN dst sampe 24 bulan

REKAPITULASI BIAYA PENGOBATAN NUR AROFAH

BULAN TAHUN BIAYA AKUMULASI11 2013 5,318,500 5,318,500 12 2013 4,871,500 10,190,000 1 2014 5,060,000 15,250,000 2 2014 3,770,000 19,020,000 3 2014 3,320,000 22,340,000 4 2014 4,200,000 26,540,000 5 2014 3,990,000 30,530,000 6 2014 620,000 31,150,000 7 2014 620,000 31,770,000 8 2014 620,000 32,390,000 9 2014 620,000 33,010,000

10 2014 620,000 33,630,000 11 2014 620,000 34,250,000 12 2014 620,000 34,870,000 1 2015 520,000 35,390,000 2 2015 520,000 35,910,000 3 2015 520,000 36,430,000 4 2015 520,000 36,950,000 5 2015 520,000 37,470,000 6 2015 520,000 37,990,000 7 2015 520,000 38,510,000 8 2015 520,000 39,030,000 9 2015 520,000 39,550,000

10 2015 520,000 40,070,000 JUMLAH 40,070,000

Terbilang: Empat puluh juta tujuh puluh ribu rupiah

Catatan : Jombang, 2 Desember 2013- Tidak dikenakan biaya kamar dan akomodasi yang lain

- Biaya konsumsi untuk 3 orang Klinik MGA MarasakeDirektur,

Dr. H Muhammad Wahid

Documents

2.Rincian Biaya Nur Arofah