Evaluasi Cost of Illness Pasien di Kamar Bedah Emergency Instalasi Gawat Darurat dan Instalasi Bedah Pusat RSUP. H. Adam Malik Medan
Lampiran 1.
No Kode
INACBGs
1
G-1-10-I
2
G-1-10-II
3
J-1-20-I
4
J-1-20-II
5
K-1-10-II
6
K-1-13-III
7
K-1-20-I
8
K-1-20-II
Demografi Pasien, Biaya Terapi Pasien di Kamar Bedah Emergency Instalasi Gawat Darurat Periode April 2016 –
September 2016 RSUP.H.Adam Malik Medan
Deskripsi
Prosedur
kraniotomi ringan
Prosedur
kraniotomi
sedang
Prosedur sistem
pernafasan non
kompleks ringan
Prosedur sistem
pernafasan non
kompleks sedang
Prosedur non
kompleks usus
halus & usus
besar (sedang)
Prosedur
appendik berat
Prosedur
intestinal
kompleks (ringan)
Prosedur
intestinal
kompleks
(sedang)
Jenis
kelamin
(L/PR)
Total tarif
klaim
(Rp)
Total Tari Rs
Selisih Tarif
(Tahun)
(Rp)
(Rp)
KS
PR
5
3
20.343.700
21.272.901
-929.201
68.24.xx
68.25.xx
J
TJB
LK
LK
28
28
3
3
23.490.000
23.490.000
38.762.601
30.601.931
-6.718.280
-12.915.000
67.92.xx
MBRS
PR
27
3
15.093.800
35.556.210
-20.462.410
68.01.xx
MA
PR
36
3
19.009.200
24.380.123
-5.370.923
61.25.xx
66.25.xx
67.89.xx
AJS
HT
RP
LK
LK
PR
4
31
66
3
3
3
12.387.700
12.387.700
12.387.700
19.055.930
20.442.789
19.348.188
-6.668.230
-8.055.089
-6.960.488
68.35.xx
HM
LK
36
3
8.719.500
14.258.147
-7.281.920
66.33.xx
S
LK
38
3
14.658.800
16.683.295
-2.024.495
66.28.xx
66.70.xx
67.83.xx
66.49.xx
RA
RS
MH
FSP
PR
PR
LK
PR
3
44
85
43
1
3
1
3
28.662.100
20.475.000
28.662.100
20.475.000
32.029.413.24
25.757.198
30.024.309
26.798.694
-3.367.313
-5.282.198
-1.362.209
-6.323.694
No.
Rekam
Medis
Inisial
Pasien
68.42.xx
Umur
Kelas
Rawat
57
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
9
K-1-20-III
Prosedur
intestinal
kompleks (berat)
10
K-1-40-II
11
K-1-40-III
12
K-1-50-I
13
K-4-18-I
14
M-1-02-II
15
M-1-20-I
16
M-1-20-II
Prosedur sistem
pencernaan lainlain (sedang)
Prosedur sistem
pencernaan lainlain (berat)
Prosedur anal
ringan
Diagnosis sistem
pencernaan lainlain
(ringan)
Prosedur
amputasi sedang
Prosedur paha dan
sendi panggul
selain sendi
mayor ringan
Prosedur paha dan
sendi panggul
selain sendi
67.65.xx
66.84.xx
57.36.xx
68.20.xx
54.97.xx
AP
BS
TH
T
AM
LK
LK
PR
LK
LK
19
67
38
52
50
3
3
3
3
3
20.475.000
20.475.000
20.475.000
35.803.100
35.803.100
27.614.761
20.549.403
27.702.042
51.155.834
38.334.771
-7.139.761
-74.403
-7.227.042
-15.352.734
-2.531.671
68.51.xx
P
PR
66
3
10.663.500
24.382.152
-13.718.652
67.52.xx
VW
PR
43
2
26.556.200
48.891.405
-22.335.205
67.86.xx
S
PR
55
3
7.390.200
7.647.051
-256.851
66.39.xx
67.15.xx
67.56.xx
AH
HB
MS
LK
LK
PR
0
3
63
2
1
1
4.395.600
5.128.100
5.128.100
8.440.729
8.167.884
7.837.175
-4.045.129
-3.039.784
-2.709.075
68.54.xx
J
LK
27
3
6.360.500
11.827.535
-5.467.035
67.58.xx
PPDA
LK
31
3
15.340.000
30.428.355
-15.088.355
67.34.xx
67.73.xx
AA
DS
PR
LK
16
33
3
3
21.516.900
21.516.900
41.884.910
36.299.478
-20.368.010
-14.782.578
58
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
17
M-1-50-I
18
M-1-60-II
19
M-1-80-I
20
O-6-10-I
mayor sedang
Prosedur jaringan
lunak ringan
Prosedur sistem
muskuloskletal
dan jaringan
penghubung lainlain (sedang)
Prosedur anggota
tubuh atas ringan
Prosedur operasi
pembedahan
caesar ringan
67.73.xx
66.67.xx
66.98.xx
67.94.xx
SS
JWM
DS
KMRS
LK
LK
PR
PR
48
13
20
23
3
1
3
3
21.516.900
8.987.200
6.418.800
12.463.400
74.789.928
11.524.453
10.444.768
43.203.027
-53.273.028
-2.537.253
-4.025.968
-30.739.627
66.73.xx
K
PR
43
3
15.080.700
27.094.309
-12.013.609
67.22.xx
67.40.xx
67.27.xx
67.39.xx
67.26.xx
67.34.xx
67.30.xx
67.23.xx
67.48.xx
66.95.xx
67.46.xx
65.21.xx
67.49.xx
67.72.xx
65.21.xx
AAS
MS
M
SBRS
DM
EP
MAS
MES
BS
DS
DP
ESP
ETMS
EG
ESP
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
27
27
29
30
34
35
36
38
27
20
23
31
33
37
31
3
3
2
1
3
3
3
3
2
3
3
2
3
2
2
5.300.400
5.300.400
6.360.500
7.420.500
5.300.400
5.300.400
5.300.400
5.300.400
6.360.500
5.300.400
2.747.800
6.360.500
5.300.400
6.360.500
6.360.500
12.772.733
21.062.983
12.170.517
14.980.946
11.599.001
12.317.203
19.470.407
11.433.113
18.728.161
8.722.454
4.746.725
15.122.937
10.705.841
12.909.946
15.122.937
-7.472.333
-15.762.583
-5.810.017
-7.560.446
-6.298.601
-7.016.803
-14.170.007
-6.132.713
-12.367.661
-3.422.054
-1.998.925
-8.762.437
-5.405.441
-6.549.446
-8.762.437
59
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
21
U-1-20-I
Prosedur
tenggorokan,
mulut, hidung dan
telinga lain-lain
(ringan)
67.49.xx
67.72.xx
67.91.xx
67.79.xx
67.76.xx
67.94.xx
67.90.xx
67.71.xx
67.73.xx
67.78.xx
67.99.xx
46.03.xx
67.96.xx
68.03.xx
68.00.xx
67.91.xx
67.98.xx
68.54.xx
67.12.xx
68.46.xx
ETMS
EG
GS
HS
LN
NG
RS
SR
SW
SBRS
ESN
E
ILS
M
NT
TDA
TH
FNP
S
K
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
LK
LK
33
37
36
21
36
28
31
25
31
21
28
33
30
42
22
32
40
39
57
51
3
2
3
3
1
2
3
3
2
3
3
3
3
2
3
1
1
2
3
1
5.300.400
6.360.500
5.300.400
5.300.400
7.420.500
6.360.500
5.300.400
5.300.400
6.360.500
5.300.400
5.300.400
5.300.400
5.300.400
6.360.500
5.300.400
7.420.500
7.420.500
3.600.600
7.452.700
10.433.800
10.705.841
12.909.946
13.936.782
9.941.636
9.405.821
10.621.042
11.995.000
10.856.887
14.527.787
11.248.428
9.889.107
7.184.606
11.540.485
11.770.107
6.502.960
9.904.102
13.783.219
8.108.137
16.175.855
13.525.373
-5.405.441
-6.549.446
-8.636.382
-4.641.236
-1.985.321
-4.260.542
-6.694.600
-5.556.487
-8.167.287
-5.948.028
-4.588.707
-1.884.206
-6.240.085
-5.409.607
-1.202.560
-2.483.602
-6.362.719
-4.507.537
-8.723.155
-3.091.573
68.71.xx
HPP
PR
8
3
9.828.100
66.663.265
-56.835.165
60
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
22
W-1-20-I
23
W-1-20-II
Prosedur pada
rahim dan
adneksa ringan
Prosedur pada
rahim dan
adneksa sedang
67.13.xx
67.38.xx
YRH
LA
PR
PR
28
31
2
3
12.310.000
10.258.300
19.287.066
11.244.681
-6.977.066
-986.381
67.85.xx
E
PR
32
3
12.757.900
14.226.017
-1.468.117
61
Universitas Sumatera Utara
Lampiran 2. Demografi Pasien, Biaya Terapi Pasien di Instalasi Bedah Pusat Periode April 2016 – September 2016 RSUP. H.
Adam Malik Medan
Deskripsi
No
Kode
INACBG’s
1
G-1-10-I
Prosedur
kraniotomi
ringan
G-1-10-II
Prosedur
kraniotomi
sedang
J-1-20-I
Prosedur
sistem
pernafasan
non
kompleks
ringan
3
No.
Rekam
Medis
66.49.xx
68.41.xx
51.40.xx
67.72.xx
68.19.xx
63.44.xx
68.29.xx
68.39.xx
67.79.xx
68.22.xx
68.25.xx
68.23.xx
68.20.xx
67.89.xx
68.15.xx
68.23.xx
67.82.xx
Jenis
Umur
Inisial
pasien kelamin
(L/PR) (Tahun)
ASP
DP
ESS
MI
M
TS
M
AS
MS
NS
PS
SR
TT
SM
J
IMD
PNH
LK
LK
LK
LK
LK
LK
PR
LK
PR
PR
LK
LK
LK
PR
PR
PR
PR
5
19
33
20
46
35
51
66
35
48
53
49
65
51
54
31
52
Kls
rawat
3
3
3
3
2
3
2
1
3
3
1
3
1
2
3
1
3
Total tarif
klaim
(Rp)
20.343.700
20.343.700
20.343.700
51.265.600
24.414.800
20.343.700
24.414.800
32.885.900
23.490.000
23.490.000
32.885.900
23.490.000
32.885.900
28.188.000
23.490.000
32.885.900
15.093.800
Total tarif rs
(Rp)
Selisih Tarif
(Rp)
46.600.404
49.505.792
25.321.392
67.809.709
44.904.352
40.347.800
32.939.231
38.407.668
43.985.452
44.100.899
61.653.515
39.191.062
46.652.490
34.754.600
40.152.656
55.527.272
16.692.545
-26.256.704
-29.162.092
-4.977.692
-16.544.109
-20.489.552
-20.004.100
-8.524.431
- 5.521.768
-20.495.452
-20.610.899
-28.767.615
-15.701.062
-13.766.590
-6.566.600
-16.662.656)
- 22.641.372
- 1.598.745
62
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
4
J-1-20-II
5
K-1-10-II
6
K-1-13-III
7
K-1-20-I
8
K-1-20-II
Prosedur
sistem
pernafasan
non
kompleks
sedang
Prosedur non
kompleks
usus halus
dan usus
besar
(sedang)
Prosedur
appendik
Berat
Prosedur
intestinal
kompleks
(ringan)
Prosedur
intestinal
kompleks
(sedang)
64.65.xx
68.07.xx
67.92.xx
HM
HJR
EN
PR
PR
PR
16
80
0
3
1
3
19.009.200
26.612.800
19.009.200
89.596.401
29.338.752
32.002.620
-70.587.201
-2.725.952
-12.993.420
66.32.xx
DS
PR
50
1
17.344.500
21.663.093
- 4.318.593
68.28.xx
RH
LK
18
3
8.719.500
15.882.780
-7.163.280
63.78.xx
W
LK
52
3
14.658.800
15.117.209
- 458.409
64.04.xx
64.28.xx
67.57.xx
67.73.xx
S
RS
CI
JO
PR
PR
PR
LK
40
61
38
7
3
1
2
3
20.475.000
28.662.100
24.567.500
20.475.000
30.012.524
48.839.366
52.390.702
50.011.018
- 9.537.524
- 20.177.266
- 27.823.202
- 29.536.018
67.50.xx
67.65.xx
67.84.xx
M
M
SRTR
G
S
PR
LK
LK
45
55
74
3
3
1
20.475.000
20.475.000
28.662.100
29.978.231
32.323.241
34.915.090
- 9.503.231
-11.848.241
- 6.252.990)
PR
54
1
28.662.100
43.252.822
- 14.590.722
61.16.xx
63
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
9
K-1-20-III
10
K-1-40-II
11
K-1-40-III
12
K-1-50-I
13
K-4-18-I
14
M-1-02-II
Prosedur
intestinal
kompleks
(berat)
Prosedur
sistem
pencernaan
lain-lain
(sedang)
Prosedur
sistem
pencernaan
lain-lain
(berat)
Prosedur
anal ringan
Diagnosis
sistem
pencernaan
lain-lain
(ringan)
Prosedur
amputasi
sedang
67.75.xx
67.24.xx
LK
PR
62
0
1
3
28.662.100
35.803.100
39.721.395
36.984.405
- 11.059.295
-1.181.305
67.05.xx
29.31.xx
67.18.xx
67.10.xx
67.28.xx
68.25.xx
TS
BYN
W
OS
TW
T
DS
PK
S
LK
LK
LK
PR
PR
LK
51
13
50
67
59
62
3
3
3
3
1
3
35.803.100
35.803.100
35.803.100
35.803.100
50.119.300
10.663.500
77.754.116
37.659.370
51.840.440
80.238.532
115.891.951
30.109.744
-41.951.016
- 1.856.270
-16.037.340
- 44.435.432
-65.772.651
-19.446.244
67.66.xx
DO
PR
3
3
22.132.400
24.423.470
- 2.291.070
54.77.xx
NS
PR
3
3
7.390.200
11.601.366
-4.211.166
67.26.xx
67.62.xx
DBS
BS
LK
LK
2
58
2
1
4.395.600
5.128.100
8.649.995
9.655.050
-4.254.395
- 4.526.950
68.67.xx
MM
LK
46
3
18.782.000
19.411.650
-629.650
64
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
15
M-1-20-I
16
M-1-20-II
17
M-1-50-I
18
M-1-60-II
19
M-1-80-I
Prosedur
paha dan
sendi
panggul
selain sendi
mayor ringan
Prosedur
paha dan
sendi
panggul
selain sendi
mayor
sedang
Prosedur
jaringan
lunak ringan
Prosedur
sistem
muskulosklet
al dan
jaringan
penghubung
lain-lain
(sedang)
Prosedur
anggota
tubuh atas
ringan
47.87.xx
65.65.xx
A
AR
PR
PR
50
23
1
3
21.476.000
15.340.000
25.340.986
18.980.968
-3.864.986
-3.640.968
67.14.xx
67.21.xx
66.39.xx
J
KS
RWA
LK
PR
LK
41
28
31
3
3
3
21.516.900
21.516.900
21.516.900
55.722.016
47.538.233
26.461.116
-34.205.116
-26.021.333
- 4.944.216
67.17.xx
67.23.xx
54.22.xx
67.92.xx
67.91.xx
67.73.xx
NABR
NI
MS
R
AA
M
PR
LK
LK
PR
PR
LK
68
21
59
57
12
47
3
3
1
3
3
3
6.418.800
6.418.800
8.987.200
6.418.800
6.418.800
12.463.400
15.374.300
11.058.301
10.260.562
15.047.396
15.668.274
63.878.822
-8.955.500
- 4.639.501
-1.273.362
-8.628.596
- 9.249.474
-51.415.422
37.96.xx
67.63.xx
S
YS
PR
PR
63
48
1
3
21.115.000
15.080.700
29.461.882
35.250.578
-8.346.882
-20.169.878
65
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
20
21
O-6-10-I
U-1-20-I
Prosedur
operasi
pembedahan
caesar ringan
Prosedur
tenggorokan,
mulut,
hidung dan
telinga lainlain (ringan)
58.62.xx
52.86.xx
66.66.xx
67.24.xx
63.31.xx
67.50.xx
67.51.xx
67.86.xx
68.00.xx
68.38.xx
68.55.xx
63.05.xx
66.73.xx
67.20.xx
67.16.xx
67.26.xx
68.0.7.xx
59.77.xx
68.10.xx
68.20.xx
68.28.xx
67.85.xx
68.23.xx
67.90.xx
55.68.xx
A
NHP
SAT
YS
RES
M
N
S
EM
SM
ALR
I
LS
MH
N
AE
PPA
RH
SI
AS
IC
JS
MM
SY
SK
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
LK
LK
LK
LK
LK
PR
LK
LK
LK
LK
LK
LK
LK
LK
40
33
33
24
42
28
32
37
33
29
30
53
59
66
48
54
13
58
57
52
52
50
72
40
54
3
3
3
3
3
3
2
1
3
3
3
1
3
1
3
3
2
1
3
1
3
2
2
3
1
5.300.400
5.300.400
5.300.400
5.300.400
5.300.400
5.300.400
6.360.500
7.420.500
5.300.400
5.300.400
7
5.300.400
10.433.800
7.452.700
10.433.800
7.452.700
7.452.700
8.942.300
10.433.800
7.452.700
10.433.800
7.452.700
8.942.300
8.942.300
7.452.700
10.433.800
13.210.705
8.150.795
8.533.433
6.209.154
11.483.703
8.761.923
8.402.447
10.740.548
8.981.981
7.0186.36
10.947.867
14.060.377
20.163.420
10.778.649
12.022.382
8.561.584
28.898.804
23.156.092
8.138.957
12.548.594
11.915.417
15.189.605
15.483.544
9.528.884
13.390.869
-7.910.305
-2.850.395
-3.233.033
- 908.754
-6.183.303
-3.461.523
-2.041.947
-3.320.048
-3.681.581
-1.718.236/
-5.647.467
-3.626.577
-12.710.720
-344.849
-4.569.682
-1.108.884
-19.956.504
-12.722.292
- 686.257
-2.114.794
-4.462.717
- 6.247.305
-6.541.244
-2.076.184
-2.957.069
66
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
22
W-1-20-I
Prosedur
pada rahim
dan adneksa
ringan
23
W-1-20-II
Prosedur
pada rahim
dan adneksa
sedang
67.43.xx
68.61.xx
66.66.xx
67.13.xx
58.73.xx
66.55.xx
48.90.xx
66.56.xx
67.16.xx
66.75.xx
67.18.xx
67.28.xx
67.42.xx
67.42.xx
67.28.xx
67.19.xx
68.38.xx
67.85.xx
AS
PS
ED
LA
MPS
N
R
YS
RSG
RS
SG
N
NSRP
NAS
AR
F
R
T
LK
LK
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
53
54
50
27
40
54
48
55
59
41
28
48
38
25
22
51
51
76
3
3
3
3
1
1
1
3
3
3
3
3
3
3
2
2
1
3
7.452.700
7.452.700
10.258.300
10.258.300
14.360.200
14.360.200
14.360.200
10.258.300
10.258.300
10.258.300
10.258.300
12.757.900
12.757.900
12.757.900
15.311.000
15.311.000
17.862.800
12.757.900
9.251.726
12.577.051
11.669.142
12.018.355
18.204.872
18.280.004
16.554.968
15.102.283
12.231.082
13.822.946
14.808.486
14.251.623
14.364.957
14.429.313
24.324.079
17.171.778
19.472.851
15.234.773
-1.799.026
-5.124.351
-1.410.842
-1.760.055
-3.844.672
-3.919.804
-2.194.768
-4.843.983
-1.972.782
-3.564.646
-4.550.186
-1.493.723
-1.607.057
-1.671.413
-9.013.079
-1.860.778
-1.610.051
-2.476.873
67
Universitas Sumatera Utara
Lampiran 3. Biaya Terapi Pasien Meliputi Biaya Penunjang di Kamar Bedah
Emergency Instalasi Gawat Darurat Periode April 2016 –
September 2016 RSUP. H. Adam Malik Medan
No
Kode
INACBG’s
Inisial
Pasien
Biaya Langsung
Medis
Jumlah
(Unit)
Total
Biaya
(Rp)
Dijamin
(Rp)
1
G-1-10-I
KS
Laboratorium
Radiologi
Obat/barang medis
7
3
10,2
217.000
940.000
294.945
206.522
898.941
282.061
2
G-1-10-II
J
Laboratorium
Radiologi
Obat/barang medis
7
3
152
217.000
900.000
6.478.829
131.502
545.397
3.926.147
TJB
Laboratorium
Radiologi
Obat/barang medis
7
5
107
411.000
1.115.000
437.946
234.965
855.872
3.252.696
3
J-1-20-I
MBRS
Laboratorium
Radiologi
Obat/barang medis
16
66
1.242.000
1.907.824
1007.146
809.881
4
J-1-20-II
MA
Laboratorium
Radiologi
Obat/barang medis
11
72
1.137.000
1.897.151
780.480
1.465.175
5
K-1-10-II
AJS
Laboratorium
Radiologi
Obat/barang medis
9
2
128,5
666.000
280.000
321.412
517.376
182.020
208.94.07
HT
Laboratorium
Radiologi
Obat/barang medis
9
2
193
425.000
280.000
5.789.393
230.269
169.671
3.508.194
RP
Laboratorium
Radiologi
Obat/barang medis
7
2
65
217.000
280.000
1.552.184
138.935
179.270
993.788
HM
Laboratorium
11
390.000
302.718
Radiologi
Obat/barang medis
1
163
80.000
2.654.075
48.924
1.623.086
Laboratorium
Radiologi
15
3
1.069.000
360.000
939.718
316.314
6
7
K-1-13III
K-1-20-I
S
68
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
8
9
K-1-20-II
K-1-20III
10
K-1-40-II
11
K-1-40III
Obat/barang medis
107
3.134.757
2.754.358
RA
Laboratorium
Radiologi
Obat/barang medis
12
2
123
1.048.500
280.00
4.158.049
503.381
250.563
3.721.300
RS
Laboratorium
Radiologi
Obat/barang medis
8
1
86
224.500
100.000
1.883.771
208.461
74.492
1.497.454
MH
Laboratorium
Radiologi
Obat/barang medis
12
2
116
562.500
280.000
3.111.784
537.456
267.296
2.970.602
FSP
Laboratorium
Radiologi
Obat/barang medis
10
3
354
617.000
80.000
3.763.357
497.513
59.316
2.875.317
AP
Laboratorium
Radiologi
Obat/barang medis
11
2
58
495.500
280.000
2713.335
367.018
207.426
2.011.806
BS
Laboratorium
Radiologi
Obat/barang medis
7
2
114
217.000
280.000
3.228.681
158.275
278.986
3.216.991
TH
Laboratorium
Radiologi
Obat/barang medis
10
2
139
474.000
280.000
3.920.084
350.371
206.952
2.897.394
Laboratorium
11
495.000
346.443
Radiologi
Obat/barang medis
2
81
280.000
2.545.853
195.967
1.781.799
AM
Laboratorium
Radiologi
Obat/barang medis
13
1
393
1.066.000
80.000
6.852.643
1.066.000
80.000
6.406.461
P
Laboratorium
Radiologi
Obat/barang medis
7
2
179,5
217.000
280.000
4.273.680
94.905
122.458
1.869.088
244.000
132.533
T
VW
Laboratorium
8
69
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
Radiologi
Obat/barang medis
53
649.090
352.564
12
K-1-50-I
S
Laboratorium
Radiologi
Obat/barang medis
11
1
117
305.000
80.000
1.328.484
294.755
77.313
1.283.862
13
K-4-18-I
AH
Laboratorium
Radiologi
Obat/barang medis
11
85
479.000
1.269.137
207.848
550.704
HB
Laboratorium
Radiologi
Obat/barang medis
12
1
54
468.500
125.000
895.071
294.455
78.480
561.960
MS
Laboratorium
Radiologi
Obat/barang medis
13
2
89
267.000
205.000
756.993
174.700
134.138
495.323
14
M-1-02-II
J
Laboratorium
Radiologi
Obat/barang medis
7
3
194
217.000
255.000
3.078.008
176.082
206.917
2.497.611
15
M-1-20-I
PPDA
Laboratorium
Radiologi
Obat/barang medis
10
3
110
650.000
260.000
2.679.706
209.718
131.075
1.350.934
16
M-1-20-II
AA
Laboratorium
Radiologi
Obat/barang medis
10
11
144
468.000
1.660.000
3.791.236
252.907
852.767
1.947.614
DS
Laboratorium
Radiologi
Farmasi
10
2
163
466.000
155.000
4.617.626
237.897
91.878
2.737.146
SS
Laboratorium
Radiologi
Obat/barang medis
16
8
141
795.000
1.475.000
3.228.465
228.720
424.354
928.822
JWM
Laboratorium
Radiologi
Obat/barang medis
10
5
13
468.000
525.000
59.430
364.423
417.213
46.346
Laboratorium
Radiologi
7
2
217.000
160.000
133.357
98.328
17
M-1-50-I
DS
70
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
Obat/barang medis
150
3.047.111
1.872.593
18
M-1-60-II
KMRS
Laboratorium
Radiologi
Obat/barang medis
8
7
110
253.000
575.000
2.262.654
101.836
165.789
652.740
19
M-1-80-I
K
Laboratorium
Radiologi
Obat/barang medis
14
4
109
468.000
330.000
5119518
260.0.489
183.678
2.849.525
20
O-6-10-I
AAS
Laboratorium
Radiologi
Obat/barang medis
10
21
414.000
225.762
171.801
93.686
MYS
Laboratorium
Radiologi
Obat/barang medis
14
78
1.022.000
2.060.030
257.162
518.472
M
Laboratorium
Radiologi
Obat/barang medis
13
109,5
841.000
1.747.667
366.483
761.269
SBRS
Laboratorium
Radiologi
Obat/barang medis
13
80
1.081.000
1.693.201
545.031
838.692
DM
Laboratorium
Radiologi
Obat/barang medis
13
193
740.500
5.132.607
740.500
2.345.449
EP
Laboratorium
Radiologi
Obat/barang medis
14
98
1.106.00
1.650.623
475.939
710.297
MAS
Laboratorium
Radiologi
Obat/barang medis
13
142
769.500
1.849.361
209.479
503.449
MES
Laboratorium
Radiologi
Obat/barang medis
14
112
794.500
3.874.950
188.331
1.796.430
BS
Laboratorium
Radiologi
Obat/barang medis
14
107
1.021.000
2.388.686
346.754
794.270
71
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
DS
Laboratorium
Radiologi
Obat/barang medis
11
28
495.000
118.708
300.799
72.136
DP
Laboratorium
Radiologi
Obat/barang medis
14
108
862.000
343.830
2.566.728
1.023.864
ESP
Laboratorium
Radiologi
Obat/barang medis
16
48
1.121.000
379.588
526.083
133.310
ETMS
Laboratorium
Radiologi
Obat/barang medis
11
165
495.000
4.619.529
374.738
2.287.102
FG
Laboratorium
Radiologi
Obat/barang medis
5
118
523.000
2.227.536
285.318
1.917.320
HYM
Laboratorium
Radiologi
Obat/barang medis
14
640,5
1.298.000
7.312.838
422.503
2.380.354
M
Laboratorium
Radiologi
Obat/barang medis
16
1
143
1.165.000
80.000
2.175.254
556.316
35.500
1.038.737
NA
Laboratorium
Radiologi
Obat/barang medis
10
109,4
468.000
2.929.052
107.678
1.299.784
SMN
Laboratorium
Radiologi
Obat/barang medis
14
103
1.231.000
1.218.790
347.209
783.901
YW
Laboratorium
Radiologi
Obat/barang medis
16
26
629.000
95.470
388.462
56.446
DLN
Laboratorium
Radiologi
Obat/barang medis
2
154
81.000
3.219.589
38.726
1.376.117
72
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
EBRT
Laboratorium
Radiologi
Obat/barang medis
13
134
1.609.631
902.273
EG
Laboratorium
Radiologi
Obat/barang medis
7
145
217.000
2.136.176
106.642
1.052.455
GS
Laboratorium
Radiologi
Obat/barang medis
10
156
468.000
6.338.687
177.989
2.410.713
HS
Laboratorium
Radiologi
Obat/barang medis
10
116
1.779.989
2.063.489
264.443
1.100.148
LN
Laboratorium
Radiologi
Obat/barang medis
7
123
217.000
1.882.978
171.224
1.485.531
NG
Laboratorium
Radiologi
Obat/barang medis
1
56
59.000
3.769.918
27.082
2.257.647
RS
Laboratorium
Radiologi
Obat/barang medis
7
171
217.000
4.721.746
128.240
2.086.465
SR
Laboratorium
Radiologi
Obat/barang medis
15
5
1.165.999
83.854
568.760
40.938
SW
Laboratorium
Radiologi
Obat/barang medis
14
173,5
1.106.000
5.393.058
484.224
2.361.158
SBRS
Laboratorium
Radiologi
Obat/barang medis
10
132
423.000
1.614.662
390.165
760.849
ESN
Laboratorium
Radiologi
Obat/barang medis
11
198
495.000
1.667.720
265.303
893.602
828.000
610.852
E
Laboratorium
8
883.000
490.946
-
73
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
21
22
U-1-20-I
W-1-20-I
Radiologi
Obat/barang medis
123
1.548.249
1.142.212
ILS
Laboratorium
Radiologi
Obat/barang medis
14
133
991.000
3.963.226
610.852
1.820.260
M
Laboratorium
Radiologi
Obat/barang medis
14
166
1.106.000
2.286.157
597.675
1.235.427
NT
Laboratorium
Radiologi
Obat/barang medis
6
125
668.000
1.828.066
560.772
1.490.011
TDA
Laboratorium
Radiologi
Obat/barang medis
12
131
824.000
2.014.912
617.364
1.509.568
TH
Laboratorium
Radiologi
Obat/barang medis
14
164
932.000
2.634.158
501.766
1.418.157
FNP
Laboratorium
Radiologi
Obat/barang medis
13
149
855.000
3.093.501
619.512
1.663.594
S
Laboratorium
Radiologi
Obat/barang medis
8
1
51
362.000
80.000
1.067.441
173.850
36.858
491.802
K
Laboratorium
Radiologi
Obat/barang medis
8
79
410.000
1.101.693
316.283
849.873
HPP
Laboratorium
Radiologi
Obat/barang medis
12
2
149
324.000
205.000
3.382.381
194.024
122.762
877.275
YRH
Laboratorium
Radiologi
Obat/barang medis
11
77
438.500
1.837.228
279.473
1.172.61
Laboratorium
Radiologi
12
-
LA
554.000 505.402
-
74
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
23
W-1-20-II
E
Obat/barang medis
128
2.538.261
2.315.597
Laboratorium
Radiologi
Obat/barang medis
7
1
159,5
217.000
80.000
2.777.045
144.605
71.744
2.042.055
75
Universitas Sumatera Utara
Lampiran 4. Biaya Terapi Pasien meliputi obat/barang medis, di Instalasi Bedah
Pusat Periode April 2016 – September 2016 RSUP.H.Adam Malik
Medan
No
Kode
INA
CBG’s
No.
Rekam
Medis
Inisial
pasien
1
G-1-10-I
2
G-1-10-II
3
4
J-1-20-I
J-1-20-II
5
6
K-1-10-II
K-1-13III
K-1-20-I
K-1-20-II
66.49.xx
68.41.xx
51.40.xx
67.72.xx
68.19.xx
63.44.xx
68.29.xx
68.39.xx
67.79.xx
68.22.xx
68.25.xx
68.23.xx
68.20.xx
67.89.xx
68.15.xx
68.23.xx
67.82.xx
64.65.xx
68.07.xx
67.92.xx
66.32.xx
68.28.xx
7
8
9
K-1-20III
Jumlah
Dijamin
(Unit)
Total
Biaya
(Rp)
ASP
DP
ESS
MI
M
TS
M
AS
MS
NS
PS
SR
TT
SM
J
IMD
PNH
HM
HJR
EN
DS
RH
42
55
33
73
30
72
39
45
33
39
58
48
26
26
47
53
42
134
11
20,2
33
23
25.207.924
10.203.676
3.002.397
13.550.770
5.330.528
20.355.812
3.459.398
2.871.243
5.623.776
4.983.146
6.012.233
2.915.760
3.015.072
3.913.505
4.542.245
5.128.184
1.803.253
46.175.657
1.625.741
2.137.347
2.534.248
863.353
11.004.678
4.193.055
2.412.185
8.152.352
2.898.244
10253488
2.564.131
2.447.807
3.003.332
2.654.234
3.336.810
1.747.623
2.125.361
3.174.080
2.657.292
3.037.153
1.630.544
9.796.849
1.474.689
1.269.560
2.029.039
473.973
63.78.xx
64.04.xx
64.28.xx
67.57.xx
67.73.xx
W
S
RS
CI
JO
218,0
122
99
92
31
3.515.101
2.861.080,00
6.752.288
4.163.674
2.215.346
3.782.132
1.951.872
3.692.680
1.952.466
905.985
67.50.xx
67.65.xx
67.84.xx
61.16.xx
67.75.xx
67.24.xx
MA
MN
SRTRG
S
TS
BYNW
17
27
240,8
41
47
105
592.831
2.312.984
4.190.014
3.382.695
2.997.378
1.329.571,00
404.142
1.464.706
3.439.054
36.918
462.866
1287103
(Rp)
76
Universitas Sumatera Utara
Lampiran 4. (Lanjutan)
10
11
12
13
14
15
K-1-40-II
K-1-40III
K-1-50-I
K-4-18-I
M-1-02II
M-1-20-I
16
M-1-20II
17
M-1-50-I
18
19
M-1-60II
M-1-80-I
20
O-6-10-I
21
U-1-20-I
67.05.xx
29.31.xx
67.18.xx
67.10.xx
67.28.xx
68.25.xx
67.66.xx
OS
TW
T
DS
PK
S
DO
130
183,0
302,0
194,0
69,2
40
26
4.945.756,00
3.120.256
5.543.083
3.714.784
1.728.815
3.556.576
1.329.993
2.277.205
3.545.361
3.828.277
1.657.568
747.653
1.259.578
1.205.232
54.77.xx
67.26.xx
67.62.xx
68.67.xx
NS
DBS
BS
MM
27,2
109,8
30,0
30
1.378.539
1.201.672
1.261.886
1.744.238,07
878.144
610.644
670.227
1687661
47.87.xx
65.65.xx
67.14.xx
67.21.xx
66.39.xx
67.17.xx
67.23.xx
54.22.xx
67.92.xx
67.91.xx
67.73.xx
A
AR
J
KS
RWA
NABR
NI
MS
R
AA
M
58
115
364
365
341,6
98,4
51
33
30,0
32
164
2.441.961
4.502.639
4.745.557,15
25.236.507
6.255.699
1.881.974
2.413.702
1.408.013,00
1.470.232
1.373.479
5.264.510,00
2.069.515
3.638.935
2.177.930
11.422.625
4.909.830
785.728
1.401.035
1233275
627.160
567.671
1.027.159
37.96.xx
67.63.xx
58.62.xx
52.86.xx
66.66.xx
67.24.xx
63.31.xx
67.50.xx
67.51.xx
67.86.xx
68.00.xx
68.38.xx
S
YS
A
NHP
SAT
YS
RES
M
N
S
EM
SM
37
50
133,2
126
129,2
15
149
156
70
40
113
32
19.558.932
21.654.922,64
3.104.890
2.990.420
1.926.762
97.774
1.311.070
3.513.970
1.779.433
1.631.031
3.613.091
1.278.855
14.017.667
13.957.408
1.245.744
1.944.647
1.196.776
83.464
605.135
2.125.726
1.346.998
1.126.857
2.132.139
965.778
68.55.xx
63.05.xx
ALR
I
44
120,0
3.463.404
1.113.671
1.676.804
826.423
66.73.xx
67.20.xx
LS
MH
44
116,0
2.073.669,00
1.163.261
766.125
1.126,045
77
Universitas Sumatera Utara
Lampiran 4. (Lanjutan)
22
W-1-20I
23
W-1-20II
67.16.xx
67.26.xx
68.0.7.xx
59.77.xx
68.10.xx
68.20.xx
68.28.xx
67.85.xx
68.23.xx
67.90.xx
55.68.xx
67.43.xx
67.90.xx
55.68.xx
67.43.xx
68.61.xx
66.66.xx
67.13.xx
58.73.xx
66.55.xx
48.90.xx
66.56.xx
67.16.xx
66.75.xx
67.18.xx
67.28.xx
67.42.xx
67.42.xx
67.28.xx
67.19.xx
68.38.xx
67.85.xx
N
AE
PPA
RS
SI
ASR
IC
JS
MM
SY
SD
AS
SY
SD
AS
PS
ED
LA
MPS
N
R
YS
RSG
RS
SG
N
NSRP
NAS
AR
F
R
T
107
114,4
39
23
7
25
34
22
35
12
29
45
12
29
45
93,2
119,6
123,6
148,7
158,6
136,6
174,6
119
149,2
50,0
51
72
54
114
43
49
37
1.850.455
1.925.086
1.246.471
863.353
677.719
1.700.686
1665043
1.590.840
1.600.561,55
927032
1.486.380
2.876.968
927032
1.486.380
2.876.968
1.983.098
1.856.392
2.091.568
1.615.783
2.361.850
2.450.245
1.642.832
2.033.408
1.583.954
4.332.646
3.978.190
2.678.091
3.265.595
4.944.576
2.100.363
2.956.673
2.479.297
1.146.558
1.675.752
385.702
473.973
620.575
1.414.072
1049463
936.546
924.381
958;340
1.158.147
772.223
958;340
1.158.147
772.223
1.175.111
1.631.947
1.785.264
1.274.547
1.855.396
2.125.405
1.795.157
1.705.434
1.175.486
3.001.359
3.561.233
2.378.848
2.887.327
3.112.406
1.872.762
2.712.210
2.076.212
78
Universitas Sumatera Utara
Lampiran 5.
No
Komponen Biaya Aktual Rumah Sakit Berdasarkan Tarif Badan Layanan Umum (BLU ) RSUP. H. Adam Malik
Medan
Kode
INA-CBG’s
Inisial
Pasien
Klaim INACBG’s
Laboratorium
Rp
Radiologi
Rp
Obat/Barang Medis
Rp
(%)
217.000
1,06
(%)
940.000
4,62
(%)
2.940.945
14,45
Total Biaya
Aktual
Rp
(%)
4.097.945
20,13
1
G-1-10-I
KS
20.343.700
2
G-1-10-II
J
23.490.000
217.000
0,92
900.000
3,83
6.478.829
27,58
7.595.829
32,33
TJB
23.490.000
411.000
1,74
1.115.000
4,74
437.946
1,86
1.963.946
8,34
3
J-1-20-I
MBRS
15.093.800
1.242.000
8,22
0
1.907.824
12,63
3.149.824
20,85
4
J-1-20-II
MA
19.009.200
1.137.000
5,98
0
1.897.151
9,98
3.044.824
15,96
5
K-1-10-II
AJS
12.387.700
666.000
5,37
280.000
2,26
321.4100
2,59
1.267.400
11,22
HT
12.387.700
425.000
3,43
280.000
2,26
5.789.393
46,73
9.094.393
52,42
79
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
RP
12.387.700
217.000
1,75
280.000
2,26
1.552.184
12,53
2.049.184
16,54
6
K-1-13-III
HM
8.719.500
390.000
4,47
80.000
0,91
2.654.075
30,43
3.124.075
35,81
7
K-1-20-I
S
14.658.800
1.069.000
7,29
360.000
2,45
3.134.757
21,38
4.563.757
31,12
8
K-1-20-II
RA
28.662.100
1.048.500
3,65
280.000
0,09
4.158.590
14,50
5.487.090
18,24
RS
20.475.000
224.500
1,09
100.000
0,48
1.883.771
9,2
2.208.271
10,77
MH
28.662.100
562.500
1,96
280.000
0,97
3.111.784
1,08
3.954.284
4,01
FSP
20.475.000
617.000
3,01
80.000
0,39
3.763.357
18,38
4.460.357
21,78
AP
20.475.000
495.500
2,41
280.000
1,36
270.335
1,32
1.045.835
5,09
BS
20.475.000
217.000
1,05
280.000
1,36
3.228.681
15,76
3,725.681
18,17
80
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
9
K-1-20-III
TH
20.475.000
474.000
2,31
280.000
1,36
3.920.084
19,14
4.674.084
22,81
T
35.803.100
495.000
1,38
280.000
0,78
2.545.853
7,11
3.320.853
9,27
AM
35.803.100
1.066.000
2,97
80.000
0,22
6.852.643
19,13
7.998.643
22,32
10
K-1-40-II
P
10.663.500
217.000
2,03
280.000
1,05
4.273.680
40,07
4.490.680.
42,1
11
K-1-40-III
VW
26.556.200
244.000
0,91
0
649.090
2,44
1.173.000
4,4
12
K-1-50-I
S
7.390.200
305.000
4,12
80.000
1,08
1.328.484
17,97
1.713.484
23,17
13
K-4-18-I
AH
4.395.600
479.000
11,30
0
1.269.137
28,87
1.748.137
40,17
HB
5.128.100
468.500
9,13
125.000
2,43
895.071
17,45
1.488.071
20,01
MS
5.128.100
267.000
5,20
205.000
3,99
756.993
14,76
1.228.993
23,95
81
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
14
M-1-02-II
J
6.360.500
217.000
4,98
255.000
4,0
3.078.008
48,39
3.550.008
57,37
15
M-1-20-I
PPDA
15.340.000
650.000
4,23
260.000
1,69
2.679.706
17,46
3.589.706
23,38
16
M-1-20-II
AA
21.516.900
468.000
2,17
1.660.000
7,71
3.791.236
17,61
5.919,236
27,49
DS
21.516.900
466.000
2,16
155.000
0,72
4.617.626
21,46
5.238.626
24,34
SS
21.516.900
795.000
3,69
1.475.000
6,85
3.228.465
15
2.598.465
25,54
JWM
8.987.200
468.000
5,2
525.000
5,84
59.430
0,66
998.943
11,7
DS
6.418.800
217.000
3,38
160.000
2,49
3.047.011
47,47
3.424.011
53,61
17
M-1-50-I
18
M-1-60-II
KMRS
12.463.400
253.000
2,02
575.000
4,61
2.262.654
18,15
3.090.654
24,78
19
M-1-80-I
K
15.080.700
468.000
3,10
330.000
2,18
5.119.518
33,94
5.917.518
39,22
82
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
20
O-6-10-I
AAS
5.300.400
414.000
7,81
0
225.762
4,81
639.762
11,99
MYS
5.300.400
1.022.000
19,28
0
2.060.030
38,86
3.082.030
58,16
M
6.360.500
841.000
13,22
0
1.747.667
27,47
2.588.667
40,69
SBRS
7.420.500
1.081.000
14,56
0
1.693.201
22,81
2.774.201
37,37
DM
5.300.400
740.500
13,97
0
5.132.607
96,83
5.873.107
110,8
EP
5.300.400
1.106.00
20,86
0
1.650.623
31,14
2.757.123
52
MAS
5.300.400
769.500
14,51
0
1.849.361
34,89
2.618.861
49,4
MES
5.300.400
794.500
14,98
0
3.874.950
73,10
4.669.450
88,08
BS
6.360.500
1.021.000
16,05
0
2.388.686
37,55
3.409.686
53,6
83
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
DS
5.300.400
495.000
9,33
0
118.708
2,33
613.708
2,66
DP
2.747.800
862.000
31,37
0
2.566.728
93,41
3,418.728
124,78
ESP
6.360.500
1.121.000
17,62
0
379.588
5,96
1.500.588
23,58
ETMS
5.300.400
495.000
9,3
0
4.619.529
87,15
4.814.529
96,45
FG
6.360.500
523.000
8,22
0
2.227.536
35,02
2.750.536
43,24
HYM
5.300.400
1.298.000
24,48
0
7.312.838
137,96
8.610.838
162,44
M
5.300.400
1.165.000
21,97
80.000
1,50
2.175.254
41,03
3.420.254
64,5
NA
5.300.400
468.000
8,82
0
2.929.052
55,26
3.397.052
64,08
SMN
7.420.500
1.231.000
16,58
0
1.218.790
16,42
1.359.790
33
84
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
YW
6.360.500
629.000
9,88
0
95.470
1,50
724.470
11,38
DLN
6.360.500
81.000
1,27
0
3.219.589
50,61
3.300.589
51,88
EBRT
5.300.400
883.000
15,71
0
1.609.631
30,36
2.492.631
46,07
EG
6.360.500
217.000
3,41
0
2.136.176
33,58
2.353.176
36,96
GS
5.300.400
468.000
8,82
0
6.338.687
119,58
6.806.687
128,4
HS
5.300.400
1.779.989
33,58
0
2.063.489
38,93
3.843.478
72,51
LN
7.420.500
217.000
2,92
0
1.882.978
25,37
2.099.078
28,29
NG
6.360.500
59.000
0,92
0
3.769.918
59,27
3.828.918
60,19
RS
5.300.400
217.000
4,09
0
4.721.746
89,08
4.938.746
93,17
85
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
SR
5.300.400
1.165.999
21,99
0
83.854
1,58
1.249.853
23,57
SW
6.360.500
1.106.000
17,38
0
5.393.058
84,78
3.499.058
102,16
SBRS
5.300.400
423.000
7,98
0
1.614.662
30,46
2.037.662
38,44
ESN
5.300.400
495.000
9,33
0
1.667.720
31,46
2.162.720
40,79
E
5.300.400
828.000
15,62
0
1.548.249
29,21
2.376.249
44,83
ILS
5.300.400
991.000
18,69
0
3.963.226
74,77
4.954.2226
93,46
M
6.360.500
1.106.000
17,38
0
2.286.157
35,94
3.392.157
53,32
NT
5.300.400
668.000
12,60
0
1.828.066
34,48
2.496.066
47,08
TDA
7.420.500
824.000
11,10
0
2.014.912
27,15
2.838.912
38,25
86
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
21
22
23
U-1-20-I
W-1-20-I
W-1-20-II
TH
7.420.500
932.000
12,51
0
2.634.158
35,49
3.563.158
48
FNP
3.600.600
855.000
23,74
0
3.093.501
85,91
3.948.501
109,65
S
7.452.700
362.000
4,85
80.000
1,07
1.067.441
14,32
1.509.441
20,24
K
10.433.800
410.000
3,92
0
1.101.693
10,55
1.511.639
14,47
HPP
9.828.100
324.000
3,29
205.000
2,08
3.382.381
34,41
3..911.381
40,5
YRH
12.310.000
438.500
3,56
0
1.837.228
14,92
2.275.728
18,48
LA
10.258.300
554.000
5,40
0
2.538.261
24,74
3.092.261
30,14
E
12.757.900
217.000
1,70
80.000
0,62
2.777.045
21,76
3.074.045
24,08
87
Universitas Sumatera Utara
Lampiran 6. Diagram Persentase Penggunaan Biaya Pelayanan Penunjang dari
Total Klaim INA-CBG’s di KBE RSUP. H. Adam Malik Medan
Diagram Persentase Penggunaan Biaya Pelayanan Penunjang
dari Total Biaya Klaim INA-CBG's di KBE RSUP. H. Adam
Malik Medan
1%
6%
23%
60%
10%
laboratorium
radiologi
obat/barang medis
biaya penunjang selain di KBE
biaya selain pelayanan penunjang
88
Universitas Sumatera Utara
Lampiran 7. Rekapitulasi Penggunaan Obat di Kamar Bedah Emergency
PeriodeApril 2016 – September 2016 RSUP. H. Adam Malik
Medan
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Nama Obat
Ringer Laktat Lar infus botol
500 ml
Nacl 0,9% 100 ml
Fentanil injeksi 0,05 mg/ml
(Sebagai Sitrat) 2 ml
Otsu Water injeksi ampul @ 25
ml
Oxytoxin injeksi 10 IU/ml
Asam Traneksamat injeksi 250
mg/ 5 ml ampul
ketorolac injeksi 30 mg / ml
ampul 1 ml
Deksametason injeksi 5mg/ml
(Sebagai Natrium F)
Epinefrine injeksi 0,1 % (
sebagai HCL / Bitartrat
Atropin Sulfas 0,25 % injeksi
Ranitidine injeksi 50mg/ 2 ml
@ampul 2 ml
Propofol - Fresofol 1 % MCT/
LCT
Metilergometrin injeksi 0,200
mg/ml ampul @1ml
Lidokain Hcl 2 % (HCL)
Neostigmin injeksi 0,5mg/ml
Hameln
Roculax injeksi 5 ml
Efedrin - Vasodrin injeksi
Rokuronium - Esmeron injeksi
50 mg / ml
Otsu - MGSO4 injeksi 20%
ampul 20 ml
Seftazidim injeksi 1000 mg/vial
Asam Traneksamat injeksi 500
mg
Ketamin injeksi 50 mg / ml Ketamin Hameln
Gentamycin injeksi 40mg/2ml
Furosemid injeksi 10mg/ml
ampul @ 2 ml
Midazolam - Fortanest 1 mg /
5 ml
Pehacain injeksi 2 ml
Satuan
Jumlah
Botol
305
Total Biaya
(Rp)
2.351.233,00
Botol
Ampul
299
229
2.293.621,20
10.515.460,00
Botol
127
345.840,00
Botol
Ampul
120
102
410.160,00
373..053,60
Ampul
100
220.109,00
Ampul
98
`95098,40
Ampul
98
566.435,00
Ampul
Ampul
95
93
450.148,00
235.774,42
Ampul
79
1.168.048,00
Ampul
74
244.200,00
Vial
Vial
66
50
69.469,80
570.630
Ampul
Ampul
Vial
50
44
44
4.295.480,00
1.662.600,00
2.189.096
Ampul
42
196.315,20
Vial
Ampul
42
39
899.905,60
113.497,40
Vial
35
2.783,220
Vial
Ampul
34
26
136.954,80
49.688,00
Ampul
26
203.486,40
Ampul
26
236.310,12
89
Universitas Sumatera Utara
Lampiran 7. (Lanjutan)
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
Gelofusine infus 100 ml
Sefazolin 1 gram
Petidin injeksi 50 mg/ml (HCL)
ampul @2ml
Ketamin injeksi 100 mg / ml –
KTM
Glukosa 10 % infus 10% botol
500 ml
Isofluran 250 ml - Terrel
Sotatic injeksi 5mg/ml
(Metoclopramide)
Fitomenadion injeksi 2g/ml
Marcain 0,5% Heavy (Marcain
Spinal)
Ringer Soluition botol 500 ml
Alkohol 70 % 300 ml RS
Nifedipin tablet 10 mg
Metronidazol larutan infus
5mg/ml botol 100
Seftriakson serbuk injeksi 1000
mg / vial
Atrakurium - Notrixum injeksi
25mg/2,5 ml
Naropin 7,5 mg
Stesolid injeksi 10 mg ampul/2
ml
Norepinefrin injeksi 1mg/ml –
Levosol
Aminofilin injeksi 24mg/ml
ampul @10ml
Paracetamol infus 10mg/ml
@10 ml
Sefotaksim serbuk injeksi 1000
mg /vial
Epinephrine
Povidone Iodine 300 cc
Bupivakain /Recain injeksi 4mg
5ml
Atropin Sulfas 0,25 mg
Dobutamin injeksi 50mg/ml –
Doburan
Alkohol 70 % 100 ml
Atropin injeksi 0,25ml/ampul
@1ml
Bupivakain injeksi 0,50%
Marcain
Kantong
Vial
Ampul
25
25
24
1.714.376,00
536.490,00
607.480,00
Vial
23
2.783.127,00
Botol
22
180.000,00
Vial
Ampul
21
20
5.263.084,50
73.920,00
Ampul
Ampul
19
19
76.947,80
631.508,27
Botol
Botol
Tablet
Botol
19
18
18
17
265.666,74
972.384,44
2.376,00
206.968,80
Vial
15
81.000,00
Vial
14
211.524,00
Vial
Ampul
14
14
1.362.149,60
67.200
Ampul
13
805.805,00
Ampul
12
51.407,60
Botol
12
223.154,00
Vial
12
142.583,60
Ampul
Botol
Vial
11
11
10
45.578,20
463.307,06
270.000,00
Tablet
Ampul
9
9
13.960
308.736,00
Botol
Ampul
8
6
35.874,31
9.360
Vial
6
230.400,00
90
Universitas Sumatera Utara
Lampiran 7. (Lanjutan)
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
Noveron (Rokuronium)
50mg/ml
Isodine/ Betadine Sol 100 ml
Neo – K (Potasium Klorida 500
mg)
Otsu - D40 Infus 40% ampul
25 ml
Efedrin injeksi
Meropenem 1000 mg
Oxytetracyclin SM
Ozid 40 mg injeksi
Kalsium Glukonat -C4 Glukonas
100ml
Larutan Asam Amino Aminofluid 500 ml
Otsu - D4040 infus 40% ampul
25 ml
Pethidin Hcl injeksi 2 ml
Albumin - Albure Injeksi 20%
100ml
Aquadest Non Steril
Bupivacain Spinal injeksi 4 ml
Dobutamin injeksi 250mg/ml –
Doburan
Farsix Injeksi 2 ml
Genoit tetes mata 0,3% botol 5
ml
Glukosa 5% infus 5% botol 500
ml
Kamadol Injeksi
Kombinasi Iprat 0,5+sal Combivent UDV
Larutan Lipid - Lipofudin
MCT/LCT100 ml
Manitol larutan infus 5mg/ml
botol 100
Manitol Larutan Infus 20%
botol 500 ml
Natrium Bikarbonat 8,4% Myelon
Propanolol Tablet 10 mg
Sevorane 250 ml (Sevoflurane)
Vial
6
335.080,00
Botol
Tablet
5
4
166.454,12
42.235,20
Ampul
4
15.360,00
Ampul
Tablet
Tube
Vial
Vial
3
3
3
3
2
189.750
196.607,58
95.045,00
129.780
23.892,00
Botol
2
149.477
Ampul
2
7.677,60
Ampul
Vial
2
1
36.538
900.900
Botol
Ampul
Ampul
1
1
1
3.000
32.254,46
39.600,00
Ampul
Botol
1
1
4.408,80
4.680,00
Botol
1
8280
Ampul
Vial
1
1
899,76
5.994,00
Vial
1
121325
Botol
1
71.300,00
Botol
1
52.800,00
Botol
1
7.440
Buah
Botol
1
0,20
8.400
245.173,32
91
Universitas Sumatera Utara
Lampiran 8. Rekapitulasi Penggunaan Barang Medis di Kamar Bedah
Emergency Periode April 2016 – September 2016 RSUP. H.
Adam Malik Medan
No
Nama Obat
1
2
3
4
Topi (Nurse Cup) One
Masker Tali OM
Disp. Syringe / Spuit 3 cc
Sarung Tangan Steril No. 7,0
Trge
Sarung Tangan Steril No. 7,5
Trge
Celemek Plastik / Apron
Disp. Syringe / Spuit 5 cc
Topi (Nurse Cup) One
Cuticell Classic 10cmx10cm
Sikat Operasi/ Scrub Brush
Steril
Sarung Tangan NS M Ax
Sarung Tangan Steril No. 6,5
Trge
Sarung Tangan Steril No. 8,0
Trge
Silk Peters 2/0 S25339 TP25
Disp. Syringe / Spuit 10 cc
Sarug Tangan Karet Pjg
Cover A ll Flu Burung UK XI
Kaca Mata Clear
Masker Karet
Optime 1 18S40G TP 48mm
Electroda Adult FSTFA (43 x
51)
Suction Connec Tube No 2,5
mtr
Masker Tali Ax
Vicryl No. 1 VCP359H RB40
CT-1-90cm
Cauther/ Goldline Pencil
Three Way Venoflow
Disp. Syringe / Spuit1 cc
Tuberculin
Disp. Syringe / Spuit 10 ml
Term
C.Gut Plain 1 HR37
Sarung Tangan Nitile S
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Buah
Buah
Buah
Pasang
415
440
369
251
Total Biaya
(Rp)
601.695.72
188.357,00
1.408.842,12
1.929.595,00
Pasang
221
1.748.994,00
Buah
Buah
Buah
Buah
Buah
219
205
184
171
152
612.791,52
2.344.677,66
73.725,12
1.179.853,16
1.627.740,00
Pasang
Pasang
151
133
83.714,00
1.054.531,00
Pasang
132
1.277.554
Buah
Buah
Pasang
Buah
Buah
Buah
Buah
Buah
129
118
110
101
100
96
85
83
6.106.959,20
232.930,00
2.395.800,00
2.044.563.315,00
4.321.176,02
38.016,00
8.620.012,46
288.048,00
Buah
73
1.642.391,00
Pasang
Buah
70
69
33.354,00
5.851.540,92
Buah
Buah
Buah
61
61
53
8.900.583,35
1.285.270,60
318.619
Buah
48
190.030,00
Buah
Pasang
44
43
1.413.322,40
29.515,00
Satuan Jumlah
92
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
Polysorb 1CL 925 RB
Urine Bag T Type
Abbocath Safety Plus No 18
Celelemek / Plastik Putih 25
Micron
Celemek/ Apron Surg
Sarung Tangan Nitile M
Suction Connection 300 cm
Safil No. 1 HR48
Optime 3/0 18S20K RC 24mm
Kaus kaki /shoe cover Non
Moven
C Gut Chromic 2 HR50
Koloid HES BM13000 6%Voluven
Silk Peters 3/0 S5266 TP25
Spinocan No.25
Suction Catheter No. 6 Ax
Tranfusi Set
Masker - Surgical Respiratot
N95
C Gut Chromic 2/0 HR26
C.Gut Plain 2/0 210
Daryan - Tulle Kasa Steril 10 x
10 cm
ETT With Cup No 7.5
Sarung Tangan / Gloves Steril
No. 7,5 Trge
Sarung Tangan NS UK M
Disp. Syringe / Spuit 20 cc
Disp. Syringe / Spuit 50 cc
UT
Silk Black 2/0 HR26
Disp. Syringe / Spuit 10 cc
Elastis Verban / FM Crepe 4
Urine Bag With Hanger
Askina Soft Clear 9 x 25cm
Disp. Syringe / Spuit 3 cc
Optime 3/0 18S20FE RB26
Abbocath Pjg No. 16
Abbocath Safety Sine No 18
ETT With Cup No 7
Gybs (Polygips ) 6
Buah
Buah
Buah
Buah
39
39
38
38
4.209.108,31
573.546,00
784.388.944,00
92.293,60
Buah
Pasang
Buah
Buah
Buah
Pasang
38
38
37
36
34
33
502.199
26.063,20
980.214,74
4.268.538,36
2.803.313,20
39.204,00
Buah
Buah
26
26
1.022.280,00
1.029.600,00
Buah
Buah
Buah
Buah
Buah
26
26
26
24
23
1.281.463,20
1.036.636,24
238.788,00
119.999.327,80
468.000,00
Buah
Buah
Buah
21
21
21
881.590,22
927.489,00
642.982,12
Buah
Pasang
20
20
580.800,00
182.400,00
Pasang
Buah
Buah
20
19
19
7.800,00
154.339,92
391.635,60
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
19
18
18
16
15
15
15
14
14
14
14
252.000
28.104,00
950.118,40
101.376,00
377.491,20
148.960,00
1.180.468,55
120.322.052,00
429.727,01
380.984,00
398.831,20
93
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
Perifix Paed /Epidural Set 400
G18 x 3
Selang Oxygen Dws
Suction Catheter No. 14 Ax
CVC DBL Lumen 7F (70220Y)
Infus Set Ped Term
C.Gut Plain 0 HR37
C.Gut Plain 0 TP 35mm
Corolene2/0 20S30B RC26
Gybs (Polygips ) 4
Optime 2/0 18S20E RB26mm
Piasu Operasi No.20
Selang Oxygen Bayi be
Silk Black 3/0 HR26
Suction Catheter No. 16 Ax
Corolene 3/0 S20E RB26
Electroda FS - TC1 PED
Polysorb 3/0 SL693
Abbocath Safety Plus No 20
C.Gut Plain 1 225
Colostomy Bag No. 3 OM
Corolene 2/0 20S30B RC26
Corolene 3/020S2OH RC19
Onescrub 500 cc
Polysorb 2/0 GL-123
Sarung Tangan NS S Ax
Sarung Tangan NS L Ax
Sarung Tangan NS UK S
Silk Peters 1 TC35mm S25509
Suction Catheter No. 12 Ax
Suction Catheter No.6
Tranfusi Set / Sangofix ES
Camelux
Foley Cath 2Way No.18
Optime 1 S40FE RB40
Optime 2/0 18S30GE
TP36mm
Pisau Operasi No.15
Pisau Opperasi No.11
Clipper Blade 9660
Disp. Syringe / Spuit1 ml
Buah
14
4.774.000,00
Buah
Buah
Buah
14
14
13
92.400,00
123.616,00
1281858,,60
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Pasang
Pasang
Pasang
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
13
12
12
12
12
12
12
12
12
12
11
11
11
10
10
10
10
10
10
10
10
10
10
10
10
10
10
9
9
9
9
231.358,85
349.027,20
739.585,30
1.070.460,00
303.552,00
105.949,28
43.200,00
72.600,00
196.070
106.128,00
1.550.618,08
28.418,28
1.125.158,58
277.200,00
561.216,00
34.782,00
891.825,00
1.093.955,00
724.063,00
713.547,40
5.544,00
5.544,00
6.996
543.066,78
88.440,00
52.140,00
601.147,78
190.080,00
118.800,00
819.176,05
510.656,93
Buah
Buah
Buah
Buah
9
9
8
8
32.400,00
32.400,00
582.864,65
7.968,00
94
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
106 Disp. Syringe / Spuit 100 cc
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
UT
Foley catheter 2Way Fr16
Rectal Tube No.28 - 40 cm
Vicryl No. 1 VCP519 TC36
Bone Wax
C Gut Chromic 1 HR48
C.Gut Plain 2/0 180S TS24
Disp. Syringe / Spuit 50 cc
Foley catheter No.18 Bard
Infus Set Y
NGT N0.12
C Gut Chromic 0 HR37
C.Gut Plain 0 TP 35mm
Corolene 4/0 20S15K RC19
Disp. Syringe / Spuit 1 cc
Disp. Syringe / Spuit 50 cc UP
Ecosorb 2/0 E29RH260
Electroda Red Dot 2228
Filapeau 2/0 F87499 RC25
Selang Oxygen O2 Size L
Silkam 2/0 NNS 13 x 60 cm
Suction Catheter No 6.Ax
Suction Catheter No.14
Suprasorb C20481
Three Way With Extentiom
Vicryl No. 2/0 VCP339H
C.Gut Plain 2/0 HR26
Cauter / Harum Pen
Corolene 5/0 SG 20S10H
TP18
Disp. Syringe / Spuit 10cc
ETT No. 7.0
ETT No. 2,5
Infus Set Adult Ax
NGT N0.14 Med
Premilene 6/0 DS12
Silk Black 3/0 DS24 SMI
Three Way (3Way)
Vicryl No. 3/0 W9890
Corolene 6/0 20AS07D
ETT With Cup No 6,5
Buah
8
172.704
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
8
8
8
7
7
7
7
7
7
7
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
5
5
5
105.474,80
63.360,00
1.027.053,52
416.990,00
248.799,60
312.346,40
27.447,60
139.524,00
620.880,00
89.620,55
581.171
354.832,50
573.804,00
4.976,00
36.744,40
406.824,00
67.709,00
360.112,20
47.520,00
217.021,17
53.064,00
31.284,00
649.363,00
12.540,00
559.921,20
321.310
552.000
649.071,50
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
5
5
5
5
5
5
5
5
5
4
4
7.812,00
198.000,00
167.400,20
28.800,00
89.100,00
328.815,75
92.982
58.080,00
300.953,80
812.889
116.160,00
95
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
Optime 3/0 18S20EE TP22
Perfusor Tub. White 150cm
Pharmafix 10 cm x 5cm
Polysorb 4/0 SL5629 Cut
Safil No. 1 HR40S
Safil No. 2/0 HRT 37S
Surgipro 3/0 C-14 TS684
Umbilical Catheter PVC 3,5
mtr
Underpad Adult
Vicryl No. 3/0 VCP311H
RB22
Abbocath Safety Sine No 24
C.Gut Plain 0 224 HRG38
C.Gut Plain 3/0 HR271804
Corolene N0 2/0 20S308B
RC26
Disp. Syringe /Spuit 20 cc
Elastis Verban / Pro Crepe
15cmx 4,55m
Infus Set Adult Term
Infusion Set Med
Medifix Line 90cm With
Intrafix
NGT Levin No.18 -125 cm
NGT N0.18
NGT No. 8 100cm
Safil No. 1 HR49
Safil No.4/ 0 HR22
Selang Oxygen Anak BE
Selang Oxygen Baby / Infant
Silkam 1 HR37S
Steinman PIN DIA 4,5 mm
Suction Catheter No. 10 Ax
Suction Catheter No. 8Ax
Suction Catheter T No.14
Suction Connecting Tube
Surgical Skin Marker
Surgicel W 1913T
Abbocath No. 20G
Abbocath No. 24 Ter
Askina Soft Clear 7,5x5 cm
Askina Soft Clear 9 x 30cm
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
4
4
4
4
4
4
4
4
337.276,60
168.000
182.033,00
451.605,00
432.285,00
459.540,00
303.600,00
197.485,00
Buah
Buah
4
4
22.176,00
366.219,80
Buah
Buah
Buah
Buah
3
3
3
3
79,894,80
168.364,80
133.927,00
268.523,85
Buah
Buah
3
3
7.034,40
150.876,00
Buah
Buah
Buah
3
3
3
53.627,58
19.611,00
416.057,20
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
19.800
144.147,00
31.831,64
343.447,50
314.122,50
19.800,00
19.800,00
128.261,81
724.500
26.532
26.532,00
15.552,00
71.280,00
231.115,50
249.995,60
23.562,00
24.052,00
23.572,80
81.600,00
96
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
C Gut Chromic 1 HS37
C Gut Chromic 0 HR 40
C Gut Chromic 0 HR40
C.Gut Plain 3/0 180S HR26
C.Gut Plain 3/0 HR26
C.Gut Plain No 3/0 HR271804
Colostomy Bag No.2 OM
Corolene 2/0 20S30A TP26
Corolene 5/0 20S5K RC16
CV Certofix Duo V720
Disp. Syringe / Spuit 100 cc
UT
Disp. Syringe / Spuit100 ml
UT
Disp. Syringe / Spuit 1000 cc
UT
Disp. Syringe / Spuit 50 ml
Cath Tip UT
Ecolene 3/0 R37CD240
Ecosorb 4/0 E47CD190
G.Cut Chromic 1 HR48
Infus Set Luer Slip
Infusion Set Adult
Medifix Line 100 cm
Medifix Monometer
NGT N0. 18
NGT N0.10 Med
NGT N0.16
NGT No. 14
Plastik Klip35 x 25cm
Polyhesive II Ret Elect E7507
Pot Plastik 100cc
Premilene 2/0 DS24 Cut
Premilene 3/0 DS24 Cut
Premilene 4/0 DS19
Rectal Tube No.30
Safil No.1 HR48
Silk Peters 1TC35mm
Softband (Padding) 4 SNA
Softsilk 2/0 GS833 RB
Suction Catheter No.16
Surgicryl 910 3/0 HR26
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
2
2
2
2
2
2
2
2
2
2
2
75.892,80
68.317,92
68.317,92
112780
56.858,40
89.284,80
36.300
207.556,60
191.987,90
1.155.000,00
84.000,00
Buah
2
88.704,00
Buah
2
86.352
Buah
2
58.080
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
153.824,00
144.716,00
7.186
12.196,80
17.570,40
163.269,00
529.668,15
24.024
35.904
24.022,02
24.024
2.042,40
311.949,00
3.828,00
119.597,08
119.574,08
175.899,40
33.000
28.965,00
99.266,40
34.622,40
103.200
10.428,00
179.630
97
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
222 Vicryl No. 5/0 VCP303H
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
RB17
Vicryl No. 6/0 J544G TG 100 G
Abbocath Intocan Safety No
20BB
Abbocath Intocan Safety No
22B
Abbocath No. 18 Ter
Abbocath Pjg No. 14
Abbocath Pjg No. 18
Abbocath Safety Plus No 22
Abbocath/ Port No. 24 Ter
Asering infus
Askina Sorb 10 x 10
C Gut Chromic 1 HR37
C.Gut Plain No. 1 HR 48 BB
C.Gut Plain3/0 HR26
Colostomy Bag No. 2 pho
Colostomy Bag No. 3 pho
CVC DBL Lum 5Fr x 13cm
CVC Double No 5 FV2564
Disp. Syringe / Spuit 1 cc
Disp. Syringe /Spuit 10 cc UT
Disp. Syringe /Spuit 10 ml
Term
Disp. Syringe /Spuit 100 cc
UT
ETT No. 7.5
ETT Non Cup 3,5Fr
ETT No. 3,5 Rusch
ETT No. 4,5mm
ETT With Cup No 3
ETT With Cup No 4.5
ETT With Cup No.3
ETT With Cup No.4
Fixomull Transparent 5 x 10m
Foley Cath 2Way No.10
Foley Cath 2Way No.14
Foley Cath 2Way No.18 Bard
Foley Cath 3Way No.22 Norta
Foley catheter No.12 Norta
Foley catheter No.212 Rusch
Buah
2
153.381,26
Buah
2
708.736
No Kode
INACBGs
1
G-1-10-I
2
G-1-10-II
3
J-1-20-I
4
J-1-20-II
5
K-1-10-II
6
K-1-13-III
7
K-1-20-I
8
K-1-20-II
Demografi Pasien, Biaya Terapi Pasien di Kamar Bedah Emergency Instalasi Gawat Darurat Periode April 2016 –
September 2016 RSUP.H.Adam Malik Medan
Deskripsi
Prosedur
kraniotomi ringan
Prosedur
kraniotomi
sedang
Prosedur sistem
pernafasan non
kompleks ringan
Prosedur sistem
pernafasan non
kompleks sedang
Prosedur non
kompleks usus
halus & usus
besar (sedang)
Prosedur
appendik berat
Prosedur
intestinal
kompleks (ringan)
Prosedur
intestinal
kompleks
(sedang)
Jenis
kelamin
(L/PR)
Total tarif
klaim
(Rp)
Total Tari Rs
Selisih Tarif
(Tahun)
(Rp)
(Rp)
KS
PR
5
3
20.343.700
21.272.901
-929.201
68.24.xx
68.25.xx
J
TJB
LK
LK
28
28
3
3
23.490.000
23.490.000
38.762.601
30.601.931
-6.718.280
-12.915.000
67.92.xx
MBRS
PR
27
3
15.093.800
35.556.210
-20.462.410
68.01.xx
MA
PR
36
3
19.009.200
24.380.123
-5.370.923
61.25.xx
66.25.xx
67.89.xx
AJS
HT
RP
LK
LK
PR
4
31
66
3
3
3
12.387.700
12.387.700
12.387.700
19.055.930
20.442.789
19.348.188
-6.668.230
-8.055.089
-6.960.488
68.35.xx
HM
LK
36
3
8.719.500
14.258.147
-7.281.920
66.33.xx
S
LK
38
3
14.658.800
16.683.295
-2.024.495
66.28.xx
66.70.xx
67.83.xx
66.49.xx
RA
RS
MH
FSP
PR
PR
LK
PR
3
44
85
43
1
3
1
3
28.662.100
20.475.000
28.662.100
20.475.000
32.029.413.24
25.757.198
30.024.309
26.798.694
-3.367.313
-5.282.198
-1.362.209
-6.323.694
No.
Rekam
Medis
Inisial
Pasien
68.42.xx
Umur
Kelas
Rawat
57
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
9
K-1-20-III
Prosedur
intestinal
kompleks (berat)
10
K-1-40-II
11
K-1-40-III
12
K-1-50-I
13
K-4-18-I
14
M-1-02-II
15
M-1-20-I
16
M-1-20-II
Prosedur sistem
pencernaan lainlain (sedang)
Prosedur sistem
pencernaan lainlain (berat)
Prosedur anal
ringan
Diagnosis sistem
pencernaan lainlain
(ringan)
Prosedur
amputasi sedang
Prosedur paha dan
sendi panggul
selain sendi
mayor ringan
Prosedur paha dan
sendi panggul
selain sendi
67.65.xx
66.84.xx
57.36.xx
68.20.xx
54.97.xx
AP
BS
TH
T
AM
LK
LK
PR
LK
LK
19
67
38
52
50
3
3
3
3
3
20.475.000
20.475.000
20.475.000
35.803.100
35.803.100
27.614.761
20.549.403
27.702.042
51.155.834
38.334.771
-7.139.761
-74.403
-7.227.042
-15.352.734
-2.531.671
68.51.xx
P
PR
66
3
10.663.500
24.382.152
-13.718.652
67.52.xx
VW
PR
43
2
26.556.200
48.891.405
-22.335.205
67.86.xx
S
PR
55
3
7.390.200
7.647.051
-256.851
66.39.xx
67.15.xx
67.56.xx
AH
HB
MS
LK
LK
PR
0
3
63
2
1
1
4.395.600
5.128.100
5.128.100
8.440.729
8.167.884
7.837.175
-4.045.129
-3.039.784
-2.709.075
68.54.xx
J
LK
27
3
6.360.500
11.827.535
-5.467.035
67.58.xx
PPDA
LK
31
3
15.340.000
30.428.355
-15.088.355
67.34.xx
67.73.xx
AA
DS
PR
LK
16
33
3
3
21.516.900
21.516.900
41.884.910
36.299.478
-20.368.010
-14.782.578
58
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
17
M-1-50-I
18
M-1-60-II
19
M-1-80-I
20
O-6-10-I
mayor sedang
Prosedur jaringan
lunak ringan
Prosedur sistem
muskuloskletal
dan jaringan
penghubung lainlain (sedang)
Prosedur anggota
tubuh atas ringan
Prosedur operasi
pembedahan
caesar ringan
67.73.xx
66.67.xx
66.98.xx
67.94.xx
SS
JWM
DS
KMRS
LK
LK
PR
PR
48
13
20
23
3
1
3
3
21.516.900
8.987.200
6.418.800
12.463.400
74.789.928
11.524.453
10.444.768
43.203.027
-53.273.028
-2.537.253
-4.025.968
-30.739.627
66.73.xx
K
PR
43
3
15.080.700
27.094.309
-12.013.609
67.22.xx
67.40.xx
67.27.xx
67.39.xx
67.26.xx
67.34.xx
67.30.xx
67.23.xx
67.48.xx
66.95.xx
67.46.xx
65.21.xx
67.49.xx
67.72.xx
65.21.xx
AAS
MS
M
SBRS
DM
EP
MAS
MES
BS
DS
DP
ESP
ETMS
EG
ESP
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
27
27
29
30
34
35
36
38
27
20
23
31
33
37
31
3
3
2
1
3
3
3
3
2
3
3
2
3
2
2
5.300.400
5.300.400
6.360.500
7.420.500
5.300.400
5.300.400
5.300.400
5.300.400
6.360.500
5.300.400
2.747.800
6.360.500
5.300.400
6.360.500
6.360.500
12.772.733
21.062.983
12.170.517
14.980.946
11.599.001
12.317.203
19.470.407
11.433.113
18.728.161
8.722.454
4.746.725
15.122.937
10.705.841
12.909.946
15.122.937
-7.472.333
-15.762.583
-5.810.017
-7.560.446
-6.298.601
-7.016.803
-14.170.007
-6.132.713
-12.367.661
-3.422.054
-1.998.925
-8.762.437
-5.405.441
-6.549.446
-8.762.437
59
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
21
U-1-20-I
Prosedur
tenggorokan,
mulut, hidung dan
telinga lain-lain
(ringan)
67.49.xx
67.72.xx
67.91.xx
67.79.xx
67.76.xx
67.94.xx
67.90.xx
67.71.xx
67.73.xx
67.78.xx
67.99.xx
46.03.xx
67.96.xx
68.03.xx
68.00.xx
67.91.xx
67.98.xx
68.54.xx
67.12.xx
68.46.xx
ETMS
EG
GS
HS
LN
NG
RS
SR
SW
SBRS
ESN
E
ILS
M
NT
TDA
TH
FNP
S
K
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
LK
LK
33
37
36
21
36
28
31
25
31
21
28
33
30
42
22
32
40
39
57
51
3
2
3
3
1
2
3
3
2
3
3
3
3
2
3
1
1
2
3
1
5.300.400
6.360.500
5.300.400
5.300.400
7.420.500
6.360.500
5.300.400
5.300.400
6.360.500
5.300.400
5.300.400
5.300.400
5.300.400
6.360.500
5.300.400
7.420.500
7.420.500
3.600.600
7.452.700
10.433.800
10.705.841
12.909.946
13.936.782
9.941.636
9.405.821
10.621.042
11.995.000
10.856.887
14.527.787
11.248.428
9.889.107
7.184.606
11.540.485
11.770.107
6.502.960
9.904.102
13.783.219
8.108.137
16.175.855
13.525.373
-5.405.441
-6.549.446
-8.636.382
-4.641.236
-1.985.321
-4.260.542
-6.694.600
-5.556.487
-8.167.287
-5.948.028
-4.588.707
-1.884.206
-6.240.085
-5.409.607
-1.202.560
-2.483.602
-6.362.719
-4.507.537
-8.723.155
-3.091.573
68.71.xx
HPP
PR
8
3
9.828.100
66.663.265
-56.835.165
60
Universitas Sumatera Utara
Lampiran 1. (Lanjutan)
22
W-1-20-I
23
W-1-20-II
Prosedur pada
rahim dan
adneksa ringan
Prosedur pada
rahim dan
adneksa sedang
67.13.xx
67.38.xx
YRH
LA
PR
PR
28
31
2
3
12.310.000
10.258.300
19.287.066
11.244.681
-6.977.066
-986.381
67.85.xx
E
PR
32
3
12.757.900
14.226.017
-1.468.117
61
Universitas Sumatera Utara
Lampiran 2. Demografi Pasien, Biaya Terapi Pasien di Instalasi Bedah Pusat Periode April 2016 – September 2016 RSUP. H.
Adam Malik Medan
Deskripsi
No
Kode
INACBG’s
1
G-1-10-I
Prosedur
kraniotomi
ringan
G-1-10-II
Prosedur
kraniotomi
sedang
J-1-20-I
Prosedur
sistem
pernafasan
non
kompleks
ringan
3
No.
Rekam
Medis
66.49.xx
68.41.xx
51.40.xx
67.72.xx
68.19.xx
63.44.xx
68.29.xx
68.39.xx
67.79.xx
68.22.xx
68.25.xx
68.23.xx
68.20.xx
67.89.xx
68.15.xx
68.23.xx
67.82.xx
Jenis
Umur
Inisial
pasien kelamin
(L/PR) (Tahun)
ASP
DP
ESS
MI
M
TS
M
AS
MS
NS
PS
SR
TT
SM
J
IMD
PNH
LK
LK
LK
LK
LK
LK
PR
LK
PR
PR
LK
LK
LK
PR
PR
PR
PR
5
19
33
20
46
35
51
66
35
48
53
49
65
51
54
31
52
Kls
rawat
3
3
3
3
2
3
2
1
3
3
1
3
1
2
3
1
3
Total tarif
klaim
(Rp)
20.343.700
20.343.700
20.343.700
51.265.600
24.414.800
20.343.700
24.414.800
32.885.900
23.490.000
23.490.000
32.885.900
23.490.000
32.885.900
28.188.000
23.490.000
32.885.900
15.093.800
Total tarif rs
(Rp)
Selisih Tarif
(Rp)
46.600.404
49.505.792
25.321.392
67.809.709
44.904.352
40.347.800
32.939.231
38.407.668
43.985.452
44.100.899
61.653.515
39.191.062
46.652.490
34.754.600
40.152.656
55.527.272
16.692.545
-26.256.704
-29.162.092
-4.977.692
-16.544.109
-20.489.552
-20.004.100
-8.524.431
- 5.521.768
-20.495.452
-20.610.899
-28.767.615
-15.701.062
-13.766.590
-6.566.600
-16.662.656)
- 22.641.372
- 1.598.745
62
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
4
J-1-20-II
5
K-1-10-II
6
K-1-13-III
7
K-1-20-I
8
K-1-20-II
Prosedur
sistem
pernafasan
non
kompleks
sedang
Prosedur non
kompleks
usus halus
dan usus
besar
(sedang)
Prosedur
appendik
Berat
Prosedur
intestinal
kompleks
(ringan)
Prosedur
intestinal
kompleks
(sedang)
64.65.xx
68.07.xx
67.92.xx
HM
HJR
EN
PR
PR
PR
16
80
0
3
1
3
19.009.200
26.612.800
19.009.200
89.596.401
29.338.752
32.002.620
-70.587.201
-2.725.952
-12.993.420
66.32.xx
DS
PR
50
1
17.344.500
21.663.093
- 4.318.593
68.28.xx
RH
LK
18
3
8.719.500
15.882.780
-7.163.280
63.78.xx
W
LK
52
3
14.658.800
15.117.209
- 458.409
64.04.xx
64.28.xx
67.57.xx
67.73.xx
S
RS
CI
JO
PR
PR
PR
LK
40
61
38
7
3
1
2
3
20.475.000
28.662.100
24.567.500
20.475.000
30.012.524
48.839.366
52.390.702
50.011.018
- 9.537.524
- 20.177.266
- 27.823.202
- 29.536.018
67.50.xx
67.65.xx
67.84.xx
M
M
SRTR
G
S
PR
LK
LK
45
55
74
3
3
1
20.475.000
20.475.000
28.662.100
29.978.231
32.323.241
34.915.090
- 9.503.231
-11.848.241
- 6.252.990)
PR
54
1
28.662.100
43.252.822
- 14.590.722
61.16.xx
63
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
9
K-1-20-III
10
K-1-40-II
11
K-1-40-III
12
K-1-50-I
13
K-4-18-I
14
M-1-02-II
Prosedur
intestinal
kompleks
(berat)
Prosedur
sistem
pencernaan
lain-lain
(sedang)
Prosedur
sistem
pencernaan
lain-lain
(berat)
Prosedur
anal ringan
Diagnosis
sistem
pencernaan
lain-lain
(ringan)
Prosedur
amputasi
sedang
67.75.xx
67.24.xx
LK
PR
62
0
1
3
28.662.100
35.803.100
39.721.395
36.984.405
- 11.059.295
-1.181.305
67.05.xx
29.31.xx
67.18.xx
67.10.xx
67.28.xx
68.25.xx
TS
BYN
W
OS
TW
T
DS
PK
S
LK
LK
LK
PR
PR
LK
51
13
50
67
59
62
3
3
3
3
1
3
35.803.100
35.803.100
35.803.100
35.803.100
50.119.300
10.663.500
77.754.116
37.659.370
51.840.440
80.238.532
115.891.951
30.109.744
-41.951.016
- 1.856.270
-16.037.340
- 44.435.432
-65.772.651
-19.446.244
67.66.xx
DO
PR
3
3
22.132.400
24.423.470
- 2.291.070
54.77.xx
NS
PR
3
3
7.390.200
11.601.366
-4.211.166
67.26.xx
67.62.xx
DBS
BS
LK
LK
2
58
2
1
4.395.600
5.128.100
8.649.995
9.655.050
-4.254.395
- 4.526.950
68.67.xx
MM
LK
46
3
18.782.000
19.411.650
-629.650
64
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
15
M-1-20-I
16
M-1-20-II
17
M-1-50-I
18
M-1-60-II
19
M-1-80-I
Prosedur
paha dan
sendi
panggul
selain sendi
mayor ringan
Prosedur
paha dan
sendi
panggul
selain sendi
mayor
sedang
Prosedur
jaringan
lunak ringan
Prosedur
sistem
muskulosklet
al dan
jaringan
penghubung
lain-lain
(sedang)
Prosedur
anggota
tubuh atas
ringan
47.87.xx
65.65.xx
A
AR
PR
PR
50
23
1
3
21.476.000
15.340.000
25.340.986
18.980.968
-3.864.986
-3.640.968
67.14.xx
67.21.xx
66.39.xx
J
KS
RWA
LK
PR
LK
41
28
31
3
3
3
21.516.900
21.516.900
21.516.900
55.722.016
47.538.233
26.461.116
-34.205.116
-26.021.333
- 4.944.216
67.17.xx
67.23.xx
54.22.xx
67.92.xx
67.91.xx
67.73.xx
NABR
NI
MS
R
AA
M
PR
LK
LK
PR
PR
LK
68
21
59
57
12
47
3
3
1
3
3
3
6.418.800
6.418.800
8.987.200
6.418.800
6.418.800
12.463.400
15.374.300
11.058.301
10.260.562
15.047.396
15.668.274
63.878.822
-8.955.500
- 4.639.501
-1.273.362
-8.628.596
- 9.249.474
-51.415.422
37.96.xx
67.63.xx
S
YS
PR
PR
63
48
1
3
21.115.000
15.080.700
29.461.882
35.250.578
-8.346.882
-20.169.878
65
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
20
21
O-6-10-I
U-1-20-I
Prosedur
operasi
pembedahan
caesar ringan
Prosedur
tenggorokan,
mulut,
hidung dan
telinga lainlain (ringan)
58.62.xx
52.86.xx
66.66.xx
67.24.xx
63.31.xx
67.50.xx
67.51.xx
67.86.xx
68.00.xx
68.38.xx
68.55.xx
63.05.xx
66.73.xx
67.20.xx
67.16.xx
67.26.xx
68.0.7.xx
59.77.xx
68.10.xx
68.20.xx
68.28.xx
67.85.xx
68.23.xx
67.90.xx
55.68.xx
A
NHP
SAT
YS
RES
M
N
S
EM
SM
ALR
I
LS
MH
N
AE
PPA
RH
SI
AS
IC
JS
MM
SY
SK
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
LK
LK
LK
LK
LK
PR
LK
LK
LK
LK
LK
LK
LK
LK
40
33
33
24
42
28
32
37
33
29
30
53
59
66
48
54
13
58
57
52
52
50
72
40
54
3
3
3
3
3
3
2
1
3
3
3
1
3
1
3
3
2
1
3
1
3
2
2
3
1
5.300.400
5.300.400
5.300.400
5.300.400
5.300.400
5.300.400
6.360.500
7.420.500
5.300.400
5.300.400
7
5.300.400
10.433.800
7.452.700
10.433.800
7.452.700
7.452.700
8.942.300
10.433.800
7.452.700
10.433.800
7.452.700
8.942.300
8.942.300
7.452.700
10.433.800
13.210.705
8.150.795
8.533.433
6.209.154
11.483.703
8.761.923
8.402.447
10.740.548
8.981.981
7.0186.36
10.947.867
14.060.377
20.163.420
10.778.649
12.022.382
8.561.584
28.898.804
23.156.092
8.138.957
12.548.594
11.915.417
15.189.605
15.483.544
9.528.884
13.390.869
-7.910.305
-2.850.395
-3.233.033
- 908.754
-6.183.303
-3.461.523
-2.041.947
-3.320.048
-3.681.581
-1.718.236/
-5.647.467
-3.626.577
-12.710.720
-344.849
-4.569.682
-1.108.884
-19.956.504
-12.722.292
- 686.257
-2.114.794
-4.462.717
- 6.247.305
-6.541.244
-2.076.184
-2.957.069
66
Universitas Sumatera Utara
Lampiran 2. (Lanjutan)
22
W-1-20-I
Prosedur
pada rahim
dan adneksa
ringan
23
W-1-20-II
Prosedur
pada rahim
dan adneksa
sedang
67.43.xx
68.61.xx
66.66.xx
67.13.xx
58.73.xx
66.55.xx
48.90.xx
66.56.xx
67.16.xx
66.75.xx
67.18.xx
67.28.xx
67.42.xx
67.42.xx
67.28.xx
67.19.xx
68.38.xx
67.85.xx
AS
PS
ED
LA
MPS
N
R
YS
RSG
RS
SG
N
NSRP
NAS
AR
F
R
T
LK
LK
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
PR
53
54
50
27
40
54
48
55
59
41
28
48
38
25
22
51
51
76
3
3
3
3
1
1
1
3
3
3
3
3
3
3
2
2
1
3
7.452.700
7.452.700
10.258.300
10.258.300
14.360.200
14.360.200
14.360.200
10.258.300
10.258.300
10.258.300
10.258.300
12.757.900
12.757.900
12.757.900
15.311.000
15.311.000
17.862.800
12.757.900
9.251.726
12.577.051
11.669.142
12.018.355
18.204.872
18.280.004
16.554.968
15.102.283
12.231.082
13.822.946
14.808.486
14.251.623
14.364.957
14.429.313
24.324.079
17.171.778
19.472.851
15.234.773
-1.799.026
-5.124.351
-1.410.842
-1.760.055
-3.844.672
-3.919.804
-2.194.768
-4.843.983
-1.972.782
-3.564.646
-4.550.186
-1.493.723
-1.607.057
-1.671.413
-9.013.079
-1.860.778
-1.610.051
-2.476.873
67
Universitas Sumatera Utara
Lampiran 3. Biaya Terapi Pasien Meliputi Biaya Penunjang di Kamar Bedah
Emergency Instalasi Gawat Darurat Periode April 2016 –
September 2016 RSUP. H. Adam Malik Medan
No
Kode
INACBG’s
Inisial
Pasien
Biaya Langsung
Medis
Jumlah
(Unit)
Total
Biaya
(Rp)
Dijamin
(Rp)
1
G-1-10-I
KS
Laboratorium
Radiologi
Obat/barang medis
7
3
10,2
217.000
940.000
294.945
206.522
898.941
282.061
2
G-1-10-II
J
Laboratorium
Radiologi
Obat/barang medis
7
3
152
217.000
900.000
6.478.829
131.502
545.397
3.926.147
TJB
Laboratorium
Radiologi
Obat/barang medis
7
5
107
411.000
1.115.000
437.946
234.965
855.872
3.252.696
3
J-1-20-I
MBRS
Laboratorium
Radiologi
Obat/barang medis
16
66
1.242.000
1.907.824
1007.146
809.881
4
J-1-20-II
MA
Laboratorium
Radiologi
Obat/barang medis
11
72
1.137.000
1.897.151
780.480
1.465.175
5
K-1-10-II
AJS
Laboratorium
Radiologi
Obat/barang medis
9
2
128,5
666.000
280.000
321.412
517.376
182.020
208.94.07
HT
Laboratorium
Radiologi
Obat/barang medis
9
2
193
425.000
280.000
5.789.393
230.269
169.671
3.508.194
RP
Laboratorium
Radiologi
Obat/barang medis
7
2
65
217.000
280.000
1.552.184
138.935
179.270
993.788
HM
Laboratorium
11
390.000
302.718
Radiologi
Obat/barang medis
1
163
80.000
2.654.075
48.924
1.623.086
Laboratorium
Radiologi
15
3
1.069.000
360.000
939.718
316.314
6
7
K-1-13III
K-1-20-I
S
68
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
8
9
K-1-20-II
K-1-20III
10
K-1-40-II
11
K-1-40III
Obat/barang medis
107
3.134.757
2.754.358
RA
Laboratorium
Radiologi
Obat/barang medis
12
2
123
1.048.500
280.00
4.158.049
503.381
250.563
3.721.300
RS
Laboratorium
Radiologi
Obat/barang medis
8
1
86
224.500
100.000
1.883.771
208.461
74.492
1.497.454
MH
Laboratorium
Radiologi
Obat/barang medis
12
2
116
562.500
280.000
3.111.784
537.456
267.296
2.970.602
FSP
Laboratorium
Radiologi
Obat/barang medis
10
3
354
617.000
80.000
3.763.357
497.513
59.316
2.875.317
AP
Laboratorium
Radiologi
Obat/barang medis
11
2
58
495.500
280.000
2713.335
367.018
207.426
2.011.806
BS
Laboratorium
Radiologi
Obat/barang medis
7
2
114
217.000
280.000
3.228.681
158.275
278.986
3.216.991
TH
Laboratorium
Radiologi
Obat/barang medis
10
2
139
474.000
280.000
3.920.084
350.371
206.952
2.897.394
Laboratorium
11
495.000
346.443
Radiologi
Obat/barang medis
2
81
280.000
2.545.853
195.967
1.781.799
AM
Laboratorium
Radiologi
Obat/barang medis
13
1
393
1.066.000
80.000
6.852.643
1.066.000
80.000
6.406.461
P
Laboratorium
Radiologi
Obat/barang medis
7
2
179,5
217.000
280.000
4.273.680
94.905
122.458
1.869.088
244.000
132.533
T
VW
Laboratorium
8
69
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
Radiologi
Obat/barang medis
53
649.090
352.564
12
K-1-50-I
S
Laboratorium
Radiologi
Obat/barang medis
11
1
117
305.000
80.000
1.328.484
294.755
77.313
1.283.862
13
K-4-18-I
AH
Laboratorium
Radiologi
Obat/barang medis
11
85
479.000
1.269.137
207.848
550.704
HB
Laboratorium
Radiologi
Obat/barang medis
12
1
54
468.500
125.000
895.071
294.455
78.480
561.960
MS
Laboratorium
Radiologi
Obat/barang medis
13
2
89
267.000
205.000
756.993
174.700
134.138
495.323
14
M-1-02-II
J
Laboratorium
Radiologi
Obat/barang medis
7
3
194
217.000
255.000
3.078.008
176.082
206.917
2.497.611
15
M-1-20-I
PPDA
Laboratorium
Radiologi
Obat/barang medis
10
3
110
650.000
260.000
2.679.706
209.718
131.075
1.350.934
16
M-1-20-II
AA
Laboratorium
Radiologi
Obat/barang medis
10
11
144
468.000
1.660.000
3.791.236
252.907
852.767
1.947.614
DS
Laboratorium
Radiologi
Farmasi
10
2
163
466.000
155.000
4.617.626
237.897
91.878
2.737.146
SS
Laboratorium
Radiologi
Obat/barang medis
16
8
141
795.000
1.475.000
3.228.465
228.720
424.354
928.822
JWM
Laboratorium
Radiologi
Obat/barang medis
10
5
13
468.000
525.000
59.430
364.423
417.213
46.346
Laboratorium
Radiologi
7
2
217.000
160.000
133.357
98.328
17
M-1-50-I
DS
70
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
Obat/barang medis
150
3.047.111
1.872.593
18
M-1-60-II
KMRS
Laboratorium
Radiologi
Obat/barang medis
8
7
110
253.000
575.000
2.262.654
101.836
165.789
652.740
19
M-1-80-I
K
Laboratorium
Radiologi
Obat/barang medis
14
4
109
468.000
330.000
5119518
260.0.489
183.678
2.849.525
20
O-6-10-I
AAS
Laboratorium
Radiologi
Obat/barang medis
10
21
414.000
225.762
171.801
93.686
MYS
Laboratorium
Radiologi
Obat/barang medis
14
78
1.022.000
2.060.030
257.162
518.472
M
Laboratorium
Radiologi
Obat/barang medis
13
109,5
841.000
1.747.667
366.483
761.269
SBRS
Laboratorium
Radiologi
Obat/barang medis
13
80
1.081.000
1.693.201
545.031
838.692
DM
Laboratorium
Radiologi
Obat/barang medis
13
193
740.500
5.132.607
740.500
2.345.449
EP
Laboratorium
Radiologi
Obat/barang medis
14
98
1.106.00
1.650.623
475.939
710.297
MAS
Laboratorium
Radiologi
Obat/barang medis
13
142
769.500
1.849.361
209.479
503.449
MES
Laboratorium
Radiologi
Obat/barang medis
14
112
794.500
3.874.950
188.331
1.796.430
BS
Laboratorium
Radiologi
Obat/barang medis
14
107
1.021.000
2.388.686
346.754
794.270
71
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
DS
Laboratorium
Radiologi
Obat/barang medis
11
28
495.000
118.708
300.799
72.136
DP
Laboratorium
Radiologi
Obat/barang medis
14
108
862.000
343.830
2.566.728
1.023.864
ESP
Laboratorium
Radiologi
Obat/barang medis
16
48
1.121.000
379.588
526.083
133.310
ETMS
Laboratorium
Radiologi
Obat/barang medis
11
165
495.000
4.619.529
374.738
2.287.102
FG
Laboratorium
Radiologi
Obat/barang medis
5
118
523.000
2.227.536
285.318
1.917.320
HYM
Laboratorium
Radiologi
Obat/barang medis
14
640,5
1.298.000
7.312.838
422.503
2.380.354
M
Laboratorium
Radiologi
Obat/barang medis
16
1
143
1.165.000
80.000
2.175.254
556.316
35.500
1.038.737
NA
Laboratorium
Radiologi
Obat/barang medis
10
109,4
468.000
2.929.052
107.678
1.299.784
SMN
Laboratorium
Radiologi
Obat/barang medis
14
103
1.231.000
1.218.790
347.209
783.901
YW
Laboratorium
Radiologi
Obat/barang medis
16
26
629.000
95.470
388.462
56.446
DLN
Laboratorium
Radiologi
Obat/barang medis
2
154
81.000
3.219.589
38.726
1.376.117
72
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
EBRT
Laboratorium
Radiologi
Obat/barang medis
13
134
1.609.631
902.273
EG
Laboratorium
Radiologi
Obat/barang medis
7
145
217.000
2.136.176
106.642
1.052.455
GS
Laboratorium
Radiologi
Obat/barang medis
10
156
468.000
6.338.687
177.989
2.410.713
HS
Laboratorium
Radiologi
Obat/barang medis
10
116
1.779.989
2.063.489
264.443
1.100.148
LN
Laboratorium
Radiologi
Obat/barang medis
7
123
217.000
1.882.978
171.224
1.485.531
NG
Laboratorium
Radiologi
Obat/barang medis
1
56
59.000
3.769.918
27.082
2.257.647
RS
Laboratorium
Radiologi
Obat/barang medis
7
171
217.000
4.721.746
128.240
2.086.465
SR
Laboratorium
Radiologi
Obat/barang medis
15
5
1.165.999
83.854
568.760
40.938
SW
Laboratorium
Radiologi
Obat/barang medis
14
173,5
1.106.000
5.393.058
484.224
2.361.158
SBRS
Laboratorium
Radiologi
Obat/barang medis
10
132
423.000
1.614.662
390.165
760.849
ESN
Laboratorium
Radiologi
Obat/barang medis
11
198
495.000
1.667.720
265.303
893.602
828.000
610.852
E
Laboratorium
8
883.000
490.946
-
73
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
21
22
U-1-20-I
W-1-20-I
Radiologi
Obat/barang medis
123
1.548.249
1.142.212
ILS
Laboratorium
Radiologi
Obat/barang medis
14
133
991.000
3.963.226
610.852
1.820.260
M
Laboratorium
Radiologi
Obat/barang medis
14
166
1.106.000
2.286.157
597.675
1.235.427
NT
Laboratorium
Radiologi
Obat/barang medis
6
125
668.000
1.828.066
560.772
1.490.011
TDA
Laboratorium
Radiologi
Obat/barang medis
12
131
824.000
2.014.912
617.364
1.509.568
TH
Laboratorium
Radiologi
Obat/barang medis
14
164
932.000
2.634.158
501.766
1.418.157
FNP
Laboratorium
Radiologi
Obat/barang medis
13
149
855.000
3.093.501
619.512
1.663.594
S
Laboratorium
Radiologi
Obat/barang medis
8
1
51
362.000
80.000
1.067.441
173.850
36.858
491.802
K
Laboratorium
Radiologi
Obat/barang medis
8
79
410.000
1.101.693
316.283
849.873
HPP
Laboratorium
Radiologi
Obat/barang medis
12
2
149
324.000
205.000
3.382.381
194.024
122.762
877.275
YRH
Laboratorium
Radiologi
Obat/barang medis
11
77
438.500
1.837.228
279.473
1.172.61
Laboratorium
Radiologi
12
-
LA
554.000 505.402
-
74
Universitas Sumatera Utara
Lampiran 3. (Lanjutan)
23
W-1-20-II
E
Obat/barang medis
128
2.538.261
2.315.597
Laboratorium
Radiologi
Obat/barang medis
7
1
159,5
217.000
80.000
2.777.045
144.605
71.744
2.042.055
75
Universitas Sumatera Utara
Lampiran 4. Biaya Terapi Pasien meliputi obat/barang medis, di Instalasi Bedah
Pusat Periode April 2016 – September 2016 RSUP.H.Adam Malik
Medan
No
Kode
INA
CBG’s
No.
Rekam
Medis
Inisial
pasien
1
G-1-10-I
2
G-1-10-II
3
4
J-1-20-I
J-1-20-II
5
6
K-1-10-II
K-1-13III
K-1-20-I
K-1-20-II
66.49.xx
68.41.xx
51.40.xx
67.72.xx
68.19.xx
63.44.xx
68.29.xx
68.39.xx
67.79.xx
68.22.xx
68.25.xx
68.23.xx
68.20.xx
67.89.xx
68.15.xx
68.23.xx
67.82.xx
64.65.xx
68.07.xx
67.92.xx
66.32.xx
68.28.xx
7
8
9
K-1-20III
Jumlah
Dijamin
(Unit)
Total
Biaya
(Rp)
ASP
DP
ESS
MI
M
TS
M
AS
MS
NS
PS
SR
TT
SM
J
IMD
PNH
HM
HJR
EN
DS
RH
42
55
33
73
30
72
39
45
33
39
58
48
26
26
47
53
42
134
11
20,2
33
23
25.207.924
10.203.676
3.002.397
13.550.770
5.330.528
20.355.812
3.459.398
2.871.243
5.623.776
4.983.146
6.012.233
2.915.760
3.015.072
3.913.505
4.542.245
5.128.184
1.803.253
46.175.657
1.625.741
2.137.347
2.534.248
863.353
11.004.678
4.193.055
2.412.185
8.152.352
2.898.244
10253488
2.564.131
2.447.807
3.003.332
2.654.234
3.336.810
1.747.623
2.125.361
3.174.080
2.657.292
3.037.153
1.630.544
9.796.849
1.474.689
1.269.560
2.029.039
473.973
63.78.xx
64.04.xx
64.28.xx
67.57.xx
67.73.xx
W
S
RS
CI
JO
218,0
122
99
92
31
3.515.101
2.861.080,00
6.752.288
4.163.674
2.215.346
3.782.132
1.951.872
3.692.680
1.952.466
905.985
67.50.xx
67.65.xx
67.84.xx
61.16.xx
67.75.xx
67.24.xx
MA
MN
SRTRG
S
TS
BYNW
17
27
240,8
41
47
105
592.831
2.312.984
4.190.014
3.382.695
2.997.378
1.329.571,00
404.142
1.464.706
3.439.054
36.918
462.866
1287103
(Rp)
76
Universitas Sumatera Utara
Lampiran 4. (Lanjutan)
10
11
12
13
14
15
K-1-40-II
K-1-40III
K-1-50-I
K-4-18-I
M-1-02II
M-1-20-I
16
M-1-20II
17
M-1-50-I
18
19
M-1-60II
M-1-80-I
20
O-6-10-I
21
U-1-20-I
67.05.xx
29.31.xx
67.18.xx
67.10.xx
67.28.xx
68.25.xx
67.66.xx
OS
TW
T
DS
PK
S
DO
130
183,0
302,0
194,0
69,2
40
26
4.945.756,00
3.120.256
5.543.083
3.714.784
1.728.815
3.556.576
1.329.993
2.277.205
3.545.361
3.828.277
1.657.568
747.653
1.259.578
1.205.232
54.77.xx
67.26.xx
67.62.xx
68.67.xx
NS
DBS
BS
MM
27,2
109,8
30,0
30
1.378.539
1.201.672
1.261.886
1.744.238,07
878.144
610.644
670.227
1687661
47.87.xx
65.65.xx
67.14.xx
67.21.xx
66.39.xx
67.17.xx
67.23.xx
54.22.xx
67.92.xx
67.91.xx
67.73.xx
A
AR
J
KS
RWA
NABR
NI
MS
R
AA
M
58
115
364
365
341,6
98,4
51
33
30,0
32
164
2.441.961
4.502.639
4.745.557,15
25.236.507
6.255.699
1.881.974
2.413.702
1.408.013,00
1.470.232
1.373.479
5.264.510,00
2.069.515
3.638.935
2.177.930
11.422.625
4.909.830
785.728
1.401.035
1233275
627.160
567.671
1.027.159
37.96.xx
67.63.xx
58.62.xx
52.86.xx
66.66.xx
67.24.xx
63.31.xx
67.50.xx
67.51.xx
67.86.xx
68.00.xx
68.38.xx
S
YS
A
NHP
SAT
YS
RES
M
N
S
EM
SM
37
50
133,2
126
129,2
15
149
156
70
40
113
32
19.558.932
21.654.922,64
3.104.890
2.990.420
1.926.762
97.774
1.311.070
3.513.970
1.779.433
1.631.031
3.613.091
1.278.855
14.017.667
13.957.408
1.245.744
1.944.647
1.196.776
83.464
605.135
2.125.726
1.346.998
1.126.857
2.132.139
965.778
68.55.xx
63.05.xx
ALR
I
44
120,0
3.463.404
1.113.671
1.676.804
826.423
66.73.xx
67.20.xx
LS
MH
44
116,0
2.073.669,00
1.163.261
766.125
1.126,045
77
Universitas Sumatera Utara
Lampiran 4. (Lanjutan)
22
W-1-20I
23
W-1-20II
67.16.xx
67.26.xx
68.0.7.xx
59.77.xx
68.10.xx
68.20.xx
68.28.xx
67.85.xx
68.23.xx
67.90.xx
55.68.xx
67.43.xx
67.90.xx
55.68.xx
67.43.xx
68.61.xx
66.66.xx
67.13.xx
58.73.xx
66.55.xx
48.90.xx
66.56.xx
67.16.xx
66.75.xx
67.18.xx
67.28.xx
67.42.xx
67.42.xx
67.28.xx
67.19.xx
68.38.xx
67.85.xx
N
AE
PPA
RS
SI
ASR
IC
JS
MM
SY
SD
AS
SY
SD
AS
PS
ED
LA
MPS
N
R
YS
RSG
RS
SG
N
NSRP
NAS
AR
F
R
T
107
114,4
39
23
7
25
34
22
35
12
29
45
12
29
45
93,2
119,6
123,6
148,7
158,6
136,6
174,6
119
149,2
50,0
51
72
54
114
43
49
37
1.850.455
1.925.086
1.246.471
863.353
677.719
1.700.686
1665043
1.590.840
1.600.561,55
927032
1.486.380
2.876.968
927032
1.486.380
2.876.968
1.983.098
1.856.392
2.091.568
1.615.783
2.361.850
2.450.245
1.642.832
2.033.408
1.583.954
4.332.646
3.978.190
2.678.091
3.265.595
4.944.576
2.100.363
2.956.673
2.479.297
1.146.558
1.675.752
385.702
473.973
620.575
1.414.072
1049463
936.546
924.381
958;340
1.158.147
772.223
958;340
1.158.147
772.223
1.175.111
1.631.947
1.785.264
1.274.547
1.855.396
2.125.405
1.795.157
1.705.434
1.175.486
3.001.359
3.561.233
2.378.848
2.887.327
3.112.406
1.872.762
2.712.210
2.076.212
78
Universitas Sumatera Utara
Lampiran 5.
No
Komponen Biaya Aktual Rumah Sakit Berdasarkan Tarif Badan Layanan Umum (BLU ) RSUP. H. Adam Malik
Medan
Kode
INA-CBG’s
Inisial
Pasien
Klaim INACBG’s
Laboratorium
Rp
Radiologi
Rp
Obat/Barang Medis
Rp
(%)
217.000
1,06
(%)
940.000
4,62
(%)
2.940.945
14,45
Total Biaya
Aktual
Rp
(%)
4.097.945
20,13
1
G-1-10-I
KS
20.343.700
2
G-1-10-II
J
23.490.000
217.000
0,92
900.000
3,83
6.478.829
27,58
7.595.829
32,33
TJB
23.490.000
411.000
1,74
1.115.000
4,74
437.946
1,86
1.963.946
8,34
3
J-1-20-I
MBRS
15.093.800
1.242.000
8,22
0
1.907.824
12,63
3.149.824
20,85
4
J-1-20-II
MA
19.009.200
1.137.000
5,98
0
1.897.151
9,98
3.044.824
15,96
5
K-1-10-II
AJS
12.387.700
666.000
5,37
280.000
2,26
321.4100
2,59
1.267.400
11,22
HT
12.387.700
425.000
3,43
280.000
2,26
5.789.393
46,73
9.094.393
52,42
79
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
RP
12.387.700
217.000
1,75
280.000
2,26
1.552.184
12,53
2.049.184
16,54
6
K-1-13-III
HM
8.719.500
390.000
4,47
80.000
0,91
2.654.075
30,43
3.124.075
35,81
7
K-1-20-I
S
14.658.800
1.069.000
7,29
360.000
2,45
3.134.757
21,38
4.563.757
31,12
8
K-1-20-II
RA
28.662.100
1.048.500
3,65
280.000
0,09
4.158.590
14,50
5.487.090
18,24
RS
20.475.000
224.500
1,09
100.000
0,48
1.883.771
9,2
2.208.271
10,77
MH
28.662.100
562.500
1,96
280.000
0,97
3.111.784
1,08
3.954.284
4,01
FSP
20.475.000
617.000
3,01
80.000
0,39
3.763.357
18,38
4.460.357
21,78
AP
20.475.000
495.500
2,41
280.000
1,36
270.335
1,32
1.045.835
5,09
BS
20.475.000
217.000
1,05
280.000
1,36
3.228.681
15,76
3,725.681
18,17
80
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
9
K-1-20-III
TH
20.475.000
474.000
2,31
280.000
1,36
3.920.084
19,14
4.674.084
22,81
T
35.803.100
495.000
1,38
280.000
0,78
2.545.853
7,11
3.320.853
9,27
AM
35.803.100
1.066.000
2,97
80.000
0,22
6.852.643
19,13
7.998.643
22,32
10
K-1-40-II
P
10.663.500
217.000
2,03
280.000
1,05
4.273.680
40,07
4.490.680.
42,1
11
K-1-40-III
VW
26.556.200
244.000
0,91
0
649.090
2,44
1.173.000
4,4
12
K-1-50-I
S
7.390.200
305.000
4,12
80.000
1,08
1.328.484
17,97
1.713.484
23,17
13
K-4-18-I
AH
4.395.600
479.000
11,30
0
1.269.137
28,87
1.748.137
40,17
HB
5.128.100
468.500
9,13
125.000
2,43
895.071
17,45
1.488.071
20,01
MS
5.128.100
267.000
5,20
205.000
3,99
756.993
14,76
1.228.993
23,95
81
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
14
M-1-02-II
J
6.360.500
217.000
4,98
255.000
4,0
3.078.008
48,39
3.550.008
57,37
15
M-1-20-I
PPDA
15.340.000
650.000
4,23
260.000
1,69
2.679.706
17,46
3.589.706
23,38
16
M-1-20-II
AA
21.516.900
468.000
2,17
1.660.000
7,71
3.791.236
17,61
5.919,236
27,49
DS
21.516.900
466.000
2,16
155.000
0,72
4.617.626
21,46
5.238.626
24,34
SS
21.516.900
795.000
3,69
1.475.000
6,85
3.228.465
15
2.598.465
25,54
JWM
8.987.200
468.000
5,2
525.000
5,84
59.430
0,66
998.943
11,7
DS
6.418.800
217.000
3,38
160.000
2,49
3.047.011
47,47
3.424.011
53,61
17
M-1-50-I
18
M-1-60-II
KMRS
12.463.400
253.000
2,02
575.000
4,61
2.262.654
18,15
3.090.654
24,78
19
M-1-80-I
K
15.080.700
468.000
3,10
330.000
2,18
5.119.518
33,94
5.917.518
39,22
82
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
20
O-6-10-I
AAS
5.300.400
414.000
7,81
0
225.762
4,81
639.762
11,99
MYS
5.300.400
1.022.000
19,28
0
2.060.030
38,86
3.082.030
58,16
M
6.360.500
841.000
13,22
0
1.747.667
27,47
2.588.667
40,69
SBRS
7.420.500
1.081.000
14,56
0
1.693.201
22,81
2.774.201
37,37
DM
5.300.400
740.500
13,97
0
5.132.607
96,83
5.873.107
110,8
EP
5.300.400
1.106.00
20,86
0
1.650.623
31,14
2.757.123
52
MAS
5.300.400
769.500
14,51
0
1.849.361
34,89
2.618.861
49,4
MES
5.300.400
794.500
14,98
0
3.874.950
73,10
4.669.450
88,08
BS
6.360.500
1.021.000
16,05
0
2.388.686
37,55
3.409.686
53,6
83
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
DS
5.300.400
495.000
9,33
0
118.708
2,33
613.708
2,66
DP
2.747.800
862.000
31,37
0
2.566.728
93,41
3,418.728
124,78
ESP
6.360.500
1.121.000
17,62
0
379.588
5,96
1.500.588
23,58
ETMS
5.300.400
495.000
9,3
0
4.619.529
87,15
4.814.529
96,45
FG
6.360.500
523.000
8,22
0
2.227.536
35,02
2.750.536
43,24
HYM
5.300.400
1.298.000
24,48
0
7.312.838
137,96
8.610.838
162,44
M
5.300.400
1.165.000
21,97
80.000
1,50
2.175.254
41,03
3.420.254
64,5
NA
5.300.400
468.000
8,82
0
2.929.052
55,26
3.397.052
64,08
SMN
7.420.500
1.231.000
16,58
0
1.218.790
16,42
1.359.790
33
84
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
YW
6.360.500
629.000
9,88
0
95.470
1,50
724.470
11,38
DLN
6.360.500
81.000
1,27
0
3.219.589
50,61
3.300.589
51,88
EBRT
5.300.400
883.000
15,71
0
1.609.631
30,36
2.492.631
46,07
EG
6.360.500
217.000
3,41
0
2.136.176
33,58
2.353.176
36,96
GS
5.300.400
468.000
8,82
0
6.338.687
119,58
6.806.687
128,4
HS
5.300.400
1.779.989
33,58
0
2.063.489
38,93
3.843.478
72,51
LN
7.420.500
217.000
2,92
0
1.882.978
25,37
2.099.078
28,29
NG
6.360.500
59.000
0,92
0
3.769.918
59,27
3.828.918
60,19
RS
5.300.400
217.000
4,09
0
4.721.746
89,08
4.938.746
93,17
85
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
SR
5.300.400
1.165.999
21,99
0
83.854
1,58
1.249.853
23,57
SW
6.360.500
1.106.000
17,38
0
5.393.058
84,78
3.499.058
102,16
SBRS
5.300.400
423.000
7,98
0
1.614.662
30,46
2.037.662
38,44
ESN
5.300.400
495.000
9,33
0
1.667.720
31,46
2.162.720
40,79
E
5.300.400
828.000
15,62
0
1.548.249
29,21
2.376.249
44,83
ILS
5.300.400
991.000
18,69
0
3.963.226
74,77
4.954.2226
93,46
M
6.360.500
1.106.000
17,38
0
2.286.157
35,94
3.392.157
53,32
NT
5.300.400
668.000
12,60
0
1.828.066
34,48
2.496.066
47,08
TDA
7.420.500
824.000
11,10
0
2.014.912
27,15
2.838.912
38,25
86
Universitas Sumatera Utara
Lampiran 5. (Lanjutan)
21
22
23
U-1-20-I
W-1-20-I
W-1-20-II
TH
7.420.500
932.000
12,51
0
2.634.158
35,49
3.563.158
48
FNP
3.600.600
855.000
23,74
0
3.093.501
85,91
3.948.501
109,65
S
7.452.700
362.000
4,85
80.000
1,07
1.067.441
14,32
1.509.441
20,24
K
10.433.800
410.000
3,92
0
1.101.693
10,55
1.511.639
14,47
HPP
9.828.100
324.000
3,29
205.000
2,08
3.382.381
34,41
3..911.381
40,5
YRH
12.310.000
438.500
3,56
0
1.837.228
14,92
2.275.728
18,48
LA
10.258.300
554.000
5,40
0
2.538.261
24,74
3.092.261
30,14
E
12.757.900
217.000
1,70
80.000
0,62
2.777.045
21,76
3.074.045
24,08
87
Universitas Sumatera Utara
Lampiran 6. Diagram Persentase Penggunaan Biaya Pelayanan Penunjang dari
Total Klaim INA-CBG’s di KBE RSUP. H. Adam Malik Medan
Diagram Persentase Penggunaan Biaya Pelayanan Penunjang
dari Total Biaya Klaim INA-CBG's di KBE RSUP. H. Adam
Malik Medan
1%
6%
23%
60%
10%
laboratorium
radiologi
obat/barang medis
biaya penunjang selain di KBE
biaya selain pelayanan penunjang
88
Universitas Sumatera Utara
Lampiran 7. Rekapitulasi Penggunaan Obat di Kamar Bedah Emergency
PeriodeApril 2016 – September 2016 RSUP. H. Adam Malik
Medan
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Nama Obat
Ringer Laktat Lar infus botol
500 ml
Nacl 0,9% 100 ml
Fentanil injeksi 0,05 mg/ml
(Sebagai Sitrat) 2 ml
Otsu Water injeksi ampul @ 25
ml
Oxytoxin injeksi 10 IU/ml
Asam Traneksamat injeksi 250
mg/ 5 ml ampul
ketorolac injeksi 30 mg / ml
ampul 1 ml
Deksametason injeksi 5mg/ml
(Sebagai Natrium F)
Epinefrine injeksi 0,1 % (
sebagai HCL / Bitartrat
Atropin Sulfas 0,25 % injeksi
Ranitidine injeksi 50mg/ 2 ml
@ampul 2 ml
Propofol - Fresofol 1 % MCT/
LCT
Metilergometrin injeksi 0,200
mg/ml ampul @1ml
Lidokain Hcl 2 % (HCL)
Neostigmin injeksi 0,5mg/ml
Hameln
Roculax injeksi 5 ml
Efedrin - Vasodrin injeksi
Rokuronium - Esmeron injeksi
50 mg / ml
Otsu - MGSO4 injeksi 20%
ampul 20 ml
Seftazidim injeksi 1000 mg/vial
Asam Traneksamat injeksi 500
mg
Ketamin injeksi 50 mg / ml Ketamin Hameln
Gentamycin injeksi 40mg/2ml
Furosemid injeksi 10mg/ml
ampul @ 2 ml
Midazolam - Fortanest 1 mg /
5 ml
Pehacain injeksi 2 ml
Satuan
Jumlah
Botol
305
Total Biaya
(Rp)
2.351.233,00
Botol
Ampul
299
229
2.293.621,20
10.515.460,00
Botol
127
345.840,00
Botol
Ampul
120
102
410.160,00
373..053,60
Ampul
100
220.109,00
Ampul
98
`95098,40
Ampul
98
566.435,00
Ampul
Ampul
95
93
450.148,00
235.774,42
Ampul
79
1.168.048,00
Ampul
74
244.200,00
Vial
Vial
66
50
69.469,80
570.630
Ampul
Ampul
Vial
50
44
44
4.295.480,00
1.662.600,00
2.189.096
Ampul
42
196.315,20
Vial
Ampul
42
39
899.905,60
113.497,40
Vial
35
2.783,220
Vial
Ampul
34
26
136.954,80
49.688,00
Ampul
26
203.486,40
Ampul
26
236.310,12
89
Universitas Sumatera Utara
Lampiran 7. (Lanjutan)
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
Gelofusine infus 100 ml
Sefazolin 1 gram
Petidin injeksi 50 mg/ml (HCL)
ampul @2ml
Ketamin injeksi 100 mg / ml –
KTM
Glukosa 10 % infus 10% botol
500 ml
Isofluran 250 ml - Terrel
Sotatic injeksi 5mg/ml
(Metoclopramide)
Fitomenadion injeksi 2g/ml
Marcain 0,5% Heavy (Marcain
Spinal)
Ringer Soluition botol 500 ml
Alkohol 70 % 300 ml RS
Nifedipin tablet 10 mg
Metronidazol larutan infus
5mg/ml botol 100
Seftriakson serbuk injeksi 1000
mg / vial
Atrakurium - Notrixum injeksi
25mg/2,5 ml
Naropin 7,5 mg
Stesolid injeksi 10 mg ampul/2
ml
Norepinefrin injeksi 1mg/ml –
Levosol
Aminofilin injeksi 24mg/ml
ampul @10ml
Paracetamol infus 10mg/ml
@10 ml
Sefotaksim serbuk injeksi 1000
mg /vial
Epinephrine
Povidone Iodine 300 cc
Bupivakain /Recain injeksi 4mg
5ml
Atropin Sulfas 0,25 mg
Dobutamin injeksi 50mg/ml –
Doburan
Alkohol 70 % 100 ml
Atropin injeksi 0,25ml/ampul
@1ml
Bupivakain injeksi 0,50%
Marcain
Kantong
Vial
Ampul
25
25
24
1.714.376,00
536.490,00
607.480,00
Vial
23
2.783.127,00
Botol
22
180.000,00
Vial
Ampul
21
20
5.263.084,50
73.920,00
Ampul
Ampul
19
19
76.947,80
631.508,27
Botol
Botol
Tablet
Botol
19
18
18
17
265.666,74
972.384,44
2.376,00
206.968,80
Vial
15
81.000,00
Vial
14
211.524,00
Vial
Ampul
14
14
1.362.149,60
67.200
Ampul
13
805.805,00
Ampul
12
51.407,60
Botol
12
223.154,00
Vial
12
142.583,60
Ampul
Botol
Vial
11
11
10
45.578,20
463.307,06
270.000,00
Tablet
Ampul
9
9
13.960
308.736,00
Botol
Ampul
8
6
35.874,31
9.360
Vial
6
230.400,00
90
Universitas Sumatera Utara
Lampiran 7. (Lanjutan)
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
Noveron (Rokuronium)
50mg/ml
Isodine/ Betadine Sol 100 ml
Neo – K (Potasium Klorida 500
mg)
Otsu - D40 Infus 40% ampul
25 ml
Efedrin injeksi
Meropenem 1000 mg
Oxytetracyclin SM
Ozid 40 mg injeksi
Kalsium Glukonat -C4 Glukonas
100ml
Larutan Asam Amino Aminofluid 500 ml
Otsu - D4040 infus 40% ampul
25 ml
Pethidin Hcl injeksi 2 ml
Albumin - Albure Injeksi 20%
100ml
Aquadest Non Steril
Bupivacain Spinal injeksi 4 ml
Dobutamin injeksi 250mg/ml –
Doburan
Farsix Injeksi 2 ml
Genoit tetes mata 0,3% botol 5
ml
Glukosa 5% infus 5% botol 500
ml
Kamadol Injeksi
Kombinasi Iprat 0,5+sal Combivent UDV
Larutan Lipid - Lipofudin
MCT/LCT100 ml
Manitol larutan infus 5mg/ml
botol 100
Manitol Larutan Infus 20%
botol 500 ml
Natrium Bikarbonat 8,4% Myelon
Propanolol Tablet 10 mg
Sevorane 250 ml (Sevoflurane)
Vial
6
335.080,00
Botol
Tablet
5
4
166.454,12
42.235,20
Ampul
4
15.360,00
Ampul
Tablet
Tube
Vial
Vial
3
3
3
3
2
189.750
196.607,58
95.045,00
129.780
23.892,00
Botol
2
149.477
Ampul
2
7.677,60
Ampul
Vial
2
1
36.538
900.900
Botol
Ampul
Ampul
1
1
1
3.000
32.254,46
39.600,00
Ampul
Botol
1
1
4.408,80
4.680,00
Botol
1
8280
Ampul
Vial
1
1
899,76
5.994,00
Vial
1
121325
Botol
1
71.300,00
Botol
1
52.800,00
Botol
1
7.440
Buah
Botol
1
0,20
8.400
245.173,32
91
Universitas Sumatera Utara
Lampiran 8. Rekapitulasi Penggunaan Barang Medis di Kamar Bedah
Emergency Periode April 2016 – September 2016 RSUP. H.
Adam Malik Medan
No
Nama Obat
1
2
3
4
Topi (Nurse Cup) One
Masker Tali OM
Disp. Syringe / Spuit 3 cc
Sarung Tangan Steril No. 7,0
Trge
Sarung Tangan Steril No. 7,5
Trge
Celemek Plastik / Apron
Disp. Syringe / Spuit 5 cc
Topi (Nurse Cup) One
Cuticell Classic 10cmx10cm
Sikat Operasi/ Scrub Brush
Steril
Sarung Tangan NS M Ax
Sarung Tangan Steril No. 6,5
Trge
Sarung Tangan Steril No. 8,0
Trge
Silk Peters 2/0 S25339 TP25
Disp. Syringe / Spuit 10 cc
Sarug Tangan Karet Pjg
Cover A ll Flu Burung UK XI
Kaca Mata Clear
Masker Karet
Optime 1 18S40G TP 48mm
Electroda Adult FSTFA (43 x
51)
Suction Connec Tube No 2,5
mtr
Masker Tali Ax
Vicryl No. 1 VCP359H RB40
CT-1-90cm
Cauther/ Goldline Pencil
Three Way Venoflow
Disp. Syringe / Spuit1 cc
Tuberculin
Disp. Syringe / Spuit 10 ml
Term
C.Gut Plain 1 HR37
Sarung Tangan Nitile S
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Buah
Buah
Buah
Pasang
415
440
369
251
Total Biaya
(Rp)
601.695.72
188.357,00
1.408.842,12
1.929.595,00
Pasang
221
1.748.994,00
Buah
Buah
Buah
Buah
Buah
219
205
184
171
152
612.791,52
2.344.677,66
73.725,12
1.179.853,16
1.627.740,00
Pasang
Pasang
151
133
83.714,00
1.054.531,00
Pasang
132
1.277.554
Buah
Buah
Pasang
Buah
Buah
Buah
Buah
Buah
129
118
110
101
100
96
85
83
6.106.959,20
232.930,00
2.395.800,00
2.044.563.315,00
4.321.176,02
38.016,00
8.620.012,46
288.048,00
Buah
73
1.642.391,00
Pasang
Buah
70
69
33.354,00
5.851.540,92
Buah
Buah
Buah
61
61
53
8.900.583,35
1.285.270,60
318.619
Buah
48
190.030,00
Buah
Pasang
44
43
1.413.322,40
29.515,00
Satuan Jumlah
92
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
Polysorb 1CL 925 RB
Urine Bag T Type
Abbocath Safety Plus No 18
Celelemek / Plastik Putih 25
Micron
Celemek/ Apron Surg
Sarung Tangan Nitile M
Suction Connection 300 cm
Safil No. 1 HR48
Optime 3/0 18S20K RC 24mm
Kaus kaki /shoe cover Non
Moven
C Gut Chromic 2 HR50
Koloid HES BM13000 6%Voluven
Silk Peters 3/0 S5266 TP25
Spinocan No.25
Suction Catheter No. 6 Ax
Tranfusi Set
Masker - Surgical Respiratot
N95
C Gut Chromic 2/0 HR26
C.Gut Plain 2/0 210
Daryan - Tulle Kasa Steril 10 x
10 cm
ETT With Cup No 7.5
Sarung Tangan / Gloves Steril
No. 7,5 Trge
Sarung Tangan NS UK M
Disp. Syringe / Spuit 20 cc
Disp. Syringe / Spuit 50 cc
UT
Silk Black 2/0 HR26
Disp. Syringe / Spuit 10 cc
Elastis Verban / FM Crepe 4
Urine Bag With Hanger
Askina Soft Clear 9 x 25cm
Disp. Syringe / Spuit 3 cc
Optime 3/0 18S20FE RB26
Abbocath Pjg No. 16
Abbocath Safety Sine No 18
ETT With Cup No 7
Gybs (Polygips ) 6
Buah
Buah
Buah
Buah
39
39
38
38
4.209.108,31
573.546,00
784.388.944,00
92.293,60
Buah
Pasang
Buah
Buah
Buah
Pasang
38
38
37
36
34
33
502.199
26.063,20
980.214,74
4.268.538,36
2.803.313,20
39.204,00
Buah
Buah
26
26
1.022.280,00
1.029.600,00
Buah
Buah
Buah
Buah
Buah
26
26
26
24
23
1.281.463,20
1.036.636,24
238.788,00
119.999.327,80
468.000,00
Buah
Buah
Buah
21
21
21
881.590,22
927.489,00
642.982,12
Buah
Pasang
20
20
580.800,00
182.400,00
Pasang
Buah
Buah
20
19
19
7.800,00
154.339,92
391.635,60
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
19
18
18
16
15
15
15
14
14
14
14
252.000
28.104,00
950.118,40
101.376,00
377.491,20
148.960,00
1.180.468,55
120.322.052,00
429.727,01
380.984,00
398.831,20
93
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
Perifix Paed /Epidural Set 400
G18 x 3
Selang Oxygen Dws
Suction Catheter No. 14 Ax
CVC DBL Lumen 7F (70220Y)
Infus Set Ped Term
C.Gut Plain 0 HR37
C.Gut Plain 0 TP 35mm
Corolene2/0 20S30B RC26
Gybs (Polygips ) 4
Optime 2/0 18S20E RB26mm
Piasu Operasi No.20
Selang Oxygen Bayi be
Silk Black 3/0 HR26
Suction Catheter No. 16 Ax
Corolene 3/0 S20E RB26
Electroda FS - TC1 PED
Polysorb 3/0 SL693
Abbocath Safety Plus No 20
C.Gut Plain 1 225
Colostomy Bag No. 3 OM
Corolene 2/0 20S30B RC26
Corolene 3/020S2OH RC19
Onescrub 500 cc
Polysorb 2/0 GL-123
Sarung Tangan NS S Ax
Sarung Tangan NS L Ax
Sarung Tangan NS UK S
Silk Peters 1 TC35mm S25509
Suction Catheter No. 12 Ax
Suction Catheter No.6
Tranfusi Set / Sangofix ES
Camelux
Foley Cath 2Way No.18
Optime 1 S40FE RB40
Optime 2/0 18S30GE
TP36mm
Pisau Operasi No.15
Pisau Opperasi No.11
Clipper Blade 9660
Disp. Syringe / Spuit1 ml
Buah
14
4.774.000,00
Buah
Buah
Buah
14
14
13
92.400,00
123.616,00
1281858,,60
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Pasang
Pasang
Pasang
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
13
12
12
12
12
12
12
12
12
12
11
11
11
10
10
10
10
10
10
10
10
10
10
10
10
10
10
9
9
9
9
231.358,85
349.027,20
739.585,30
1.070.460,00
303.552,00
105.949,28
43.200,00
72.600,00
196.070
106.128,00
1.550.618,08
28.418,28
1.125.158,58
277.200,00
561.216,00
34.782,00
891.825,00
1.093.955,00
724.063,00
713.547,40
5.544,00
5.544,00
6.996
543.066,78
88.440,00
52.140,00
601.147,78
190.080,00
118.800,00
819.176,05
510.656,93
Buah
Buah
Buah
Buah
9
9
8
8
32.400,00
32.400,00
582.864,65
7.968,00
94
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
106 Disp. Syringe / Spuit 100 cc
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
UT
Foley catheter 2Way Fr16
Rectal Tube No.28 - 40 cm
Vicryl No. 1 VCP519 TC36
Bone Wax
C Gut Chromic 1 HR48
C.Gut Plain 2/0 180S TS24
Disp. Syringe / Spuit 50 cc
Foley catheter No.18 Bard
Infus Set Y
NGT N0.12
C Gut Chromic 0 HR37
C.Gut Plain 0 TP 35mm
Corolene 4/0 20S15K RC19
Disp. Syringe / Spuit 1 cc
Disp. Syringe / Spuit 50 cc UP
Ecosorb 2/0 E29RH260
Electroda Red Dot 2228
Filapeau 2/0 F87499 RC25
Selang Oxygen O2 Size L
Silkam 2/0 NNS 13 x 60 cm
Suction Catheter No 6.Ax
Suction Catheter No.14
Suprasorb C20481
Three Way With Extentiom
Vicryl No. 2/0 VCP339H
C.Gut Plain 2/0 HR26
Cauter / Harum Pen
Corolene 5/0 SG 20S10H
TP18
Disp. Syringe / Spuit 10cc
ETT No. 7.0
ETT No. 2,5
Infus Set Adult Ax
NGT N0.14 Med
Premilene 6/0 DS12
Silk Black 3/0 DS24 SMI
Three Way (3Way)
Vicryl No. 3/0 W9890
Corolene 6/0 20AS07D
ETT With Cup No 6,5
Buah
8
172.704
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
8
8
8
7
7
7
7
7
7
7
6
6
6
6
6
6
6
6
6
6
6
6
6
6
6
5
5
5
105.474,80
63.360,00
1.027.053,52
416.990,00
248.799,60
312.346,40
27.447,60
139.524,00
620.880,00
89.620,55
581.171
354.832,50
573.804,00
4.976,00
36.744,40
406.824,00
67.709,00
360.112,20
47.520,00
217.021,17
53.064,00
31.284,00
649.363,00
12.540,00
559.921,20
321.310
552.000
649.071,50
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
5
5
5
5
5
5
5
5
5
4
4
7.812,00
198.000,00
167.400,20
28.800,00
89.100,00
328.815,75
92.982
58.080,00
300.953,80
812.889
116.160,00
95
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
Optime 3/0 18S20EE TP22
Perfusor Tub. White 150cm
Pharmafix 10 cm x 5cm
Polysorb 4/0 SL5629 Cut
Safil No. 1 HR40S
Safil No. 2/0 HRT 37S
Surgipro 3/0 C-14 TS684
Umbilical Catheter PVC 3,5
mtr
Underpad Adult
Vicryl No. 3/0 VCP311H
RB22
Abbocath Safety Sine No 24
C.Gut Plain 0 224 HRG38
C.Gut Plain 3/0 HR271804
Corolene N0 2/0 20S308B
RC26
Disp. Syringe /Spuit 20 cc
Elastis Verban / Pro Crepe
15cmx 4,55m
Infus Set Adult Term
Infusion Set Med
Medifix Line 90cm With
Intrafix
NGT Levin No.18 -125 cm
NGT N0.18
NGT No. 8 100cm
Safil No. 1 HR49
Safil No.4/ 0 HR22
Selang Oxygen Anak BE
Selang Oxygen Baby / Infant
Silkam 1 HR37S
Steinman PIN DIA 4,5 mm
Suction Catheter No. 10 Ax
Suction Catheter No. 8Ax
Suction Catheter T No.14
Suction Connecting Tube
Surgical Skin Marker
Surgicel W 1913T
Abbocath No. 20G
Abbocath No. 24 Ter
Askina Soft Clear 7,5x5 cm
Askina Soft Clear 9 x 30cm
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
4
4
4
4
4
4
4
4
337.276,60
168.000
182.033,00
451.605,00
432.285,00
459.540,00
303.600,00
197.485,00
Buah
Buah
4
4
22.176,00
366.219,80
Buah
Buah
Buah
Buah
3
3
3
3
79,894,80
168.364,80
133.927,00
268.523,85
Buah
Buah
3
3
7.034,40
150.876,00
Buah
Buah
Buah
3
3
3
53.627,58
19.611,00
416.057,20
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
19.800
144.147,00
31.831,64
343.447,50
314.122,50
19.800,00
19.800,00
128.261,81
724.500
26.532
26.532,00
15.552,00
71.280,00
231.115,50
249.995,60
23.562,00
24.052,00
23.572,80
81.600,00
96
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
C Gut Chromic 1 HS37
C Gut Chromic 0 HR 40
C Gut Chromic 0 HR40
C.Gut Plain 3/0 180S HR26
C.Gut Plain 3/0 HR26
C.Gut Plain No 3/0 HR271804
Colostomy Bag No.2 OM
Corolene 2/0 20S30A TP26
Corolene 5/0 20S5K RC16
CV Certofix Duo V720
Disp. Syringe / Spuit 100 cc
UT
Disp. Syringe / Spuit100 ml
UT
Disp. Syringe / Spuit 1000 cc
UT
Disp. Syringe / Spuit 50 ml
Cath Tip UT
Ecolene 3/0 R37CD240
Ecosorb 4/0 E47CD190
G.Cut Chromic 1 HR48
Infus Set Luer Slip
Infusion Set Adult
Medifix Line 100 cm
Medifix Monometer
NGT N0. 18
NGT N0.10 Med
NGT N0.16
NGT No. 14
Plastik Klip35 x 25cm
Polyhesive II Ret Elect E7507
Pot Plastik 100cc
Premilene 2/0 DS24 Cut
Premilene 3/0 DS24 Cut
Premilene 4/0 DS19
Rectal Tube No.30
Safil No.1 HR48
Silk Peters 1TC35mm
Softband (Padding) 4 SNA
Softsilk 2/0 GS833 RB
Suction Catheter No.16
Surgicryl 910 3/0 HR26
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
2
2
2
2
2
2
2
2
2
2
2
75.892,80
68.317,92
68.317,92
112780
56.858,40
89.284,80
36.300
207.556,60
191.987,90
1.155.000,00
84.000,00
Buah
2
88.704,00
Buah
2
86.352
Buah
2
58.080
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
153.824,00
144.716,00
7.186
12.196,80
17.570,40
163.269,00
529.668,15
24.024
35.904
24.022,02
24.024
2.042,40
311.949,00
3.828,00
119.597,08
119.574,08
175.899,40
33.000
28.965,00
99.266,40
34.622,40
103.200
10.428,00
179.630
97
Universitas Sumatera Utara
Lampiran 8. (Lanjutan)
222 Vicryl No. 5/0 VCP303H
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
RB17
Vicryl No. 6/0 J544G TG 100 G
Abbocath Intocan Safety No
20BB
Abbocath Intocan Safety No
22B
Abbocath No. 18 Ter
Abbocath Pjg No. 14
Abbocath Pjg No. 18
Abbocath Safety Plus No 22
Abbocath/ Port No. 24 Ter
Asering infus
Askina Sorb 10 x 10
C Gut Chromic 1 HR37
C.Gut Plain No. 1 HR 48 BB
C.Gut Plain3/0 HR26
Colostomy Bag No. 2 pho
Colostomy Bag No. 3 pho
CVC DBL Lum 5Fr x 13cm
CVC Double No 5 FV2564
Disp. Syringe / Spuit 1 cc
Disp. Syringe /Spuit 10 cc UT
Disp. Syringe /Spuit 10 ml
Term
Disp. Syringe /Spuit 100 cc
UT
ETT No. 7.5
ETT Non Cup 3,5Fr
ETT No. 3,5 Rusch
ETT No. 4,5mm
ETT With Cup No 3
ETT With Cup No 4.5
ETT With Cup No.3
ETT With Cup No.4
Fixomull Transparent 5 x 10m
Foley Cath 2Way No.10
Foley Cath 2Way No.14
Foley Cath 2Way No.18 Bard
Foley Cath 3Way No.22 Norta
Foley catheter No.12 Norta
Foley catheter No.212 Rusch
Buah
2
153.381,26
Buah
2
708.736