RUMAH SAKIT CITAMA

Cepat, Tepat, Akrab dan Tuntas

Jl. Raya Pabuaran No.52 Bojonggede, Bogor – Jawa Barat 16922
Telepon : 021-8798 4444 / 8798 5555, Fax. : 021-8798 6666, Email : rumahsakitcitama@gmail.com

DAFTAR PAKET OBAT / ALKES TONSILEKTOMY RS CITAMA

Nama Pasi : Dokter :
No. RM : Assisten :
Tgl, jam : Anastesi :
Tindakan : Ruang/kls :
Pembiyaya:

No Nama Obat dan Alkes Jumlah Harga Total

1 Apron Disposible 2 6,000 12,000
2 Betadin, Alkohol, Aquabides 1 50,000 50,000
3 Couter Paket / Suction 1 29,000 29,000
4 Formalin cair (per cc) 10 600 6,000
5 Handscoon non steril 2 2,500 5,000
6 Handscoon steril no. ..... 3 16,000 48,000
7 Hibiscrub (per cc) 100 450 45,000
8 Injeksi As. Tranexamat 2 15,000 30,000
9 Kassa X-Ray / Non X-Ray 10x10 cm 20 1,700 34,000
10 Masker 7 2,000 14,000
11 Micropore/CM 30 300 9,000
12 Nacl 500 ml 1 15,000 15,000
13 Silk 0 tuper 1 50,000 50,000
14 Silk 2.0 Tumpul 2 44,000 88,000
15 Stericide (per cc) 10 300 3,000
16 Sterizym (per cc) 3 3000 9,000
17 Topi Disposible 7 2,000 14,000
461,000

PAKET PEMAKAIAN OBAT TONSILEKTOMI PASIEN BPJS DI RUANGAN

NO NAMA OBAT DAN ALKES DEWASA QTT HARGA TOTAL

1 ABOCATH NO 20 1 28,000 28,000
2 ALKOHOL SWAB 10 800 8,000
3 BLOOD SET / MICRO SET 1 25,000 25,000
4 HYPAVIX /CM 10 1,700 17,000
5 AQUABIDEST 25 ml 2 8,000 16,000
6 HANDSCOON DISPOSIBLE 5 2,500 12,500
7 CEFOTAXIME INJ 3 13,000 39,000
8 SPUID 1CC 1 4,000 4,000
 9 SPUID 10CC 2 6,000 12,000
10 SPUIT 3CC 2 3,000 6,000
11 TEGADERM I.V 1 10,500 10,500
12 KETOROLAC INJ 2 20,000 40,000
13 CAIRAN R/aseringL 500 ML 4 16,000 64,000
14 PENENG 1 5,000 5,000
15 CEFADROXIL TAB 500 MG TAB 10 1,700 17,000
16 NATRIUM DICLOFENAC 50 MG TAB 10 500 5,000
TOTAL 309,000

ATAU
PAKET PEMAKAIAN OBAT TONSILEKTOMI PASIEN ANAK BPJS DI RUANGAN

NO NAMA OBAT DAN ALKES ANAK QTT HARGA TOTAL

1 ABOCATH NO 24 1 28,000 28,000
2 ALKOHOL SWAB 10 750 7,500
3 BLOOD SET / MICRO SET 1 25,000 25,000
4 HYPAVIX /CM 10 1,700 17,000
5 AQUABIDEST 25 ml 2 8,000 16,000
6 HANDSCOON DISPOSIBLE 5 2,500 12,500
7 CEFOTAXIME INJ 3 13,000 39,000
8 SPUID 1CC 1 4,000 4,000
9 SPUID 10CC 2 6,000 12,000
10 SPUIT 3CC 2 3,000 6,000
11 TEGADERM I.V 1 10,500 10,500
12 KETOROLAC INJ 2 20,000 40,000
13 CAIRAN RL/asering 500 ML 3 16,000 48,000
14 PENENG 1 1,700 1,700
15 CEFADROXIL SYR 1 13,000 13,000
16 IBUPROFEN SYR 1 10,000 10,000
17 nacl 100 3 16,500 49,500
339,700

1 Handscoon steril no. .... 1 16,000 16,000

2 fresofol inj 1 20,000 20,000
3 Fentanyl inj / Pethydine inj 2 60,700 121,400
4 Ketorolac inj 1 20,000 20,000
5 Ondancetron 4 mg inj 1 11,000 11,000
6 Isoflurane (per cc) 15 12,000 180,000
7 Sevoflurane (per cc) 15 15,000 225,000
8 Spuid 10 cc 1 6,000 6,000
9 Spuid 5 cc 1 5,000 5,000
10 Spuid 3 cc 1 3,000 3,000
11 N2O (per Liter) 50 2,000 100,000
12 O2 (per BAR) 1 35,000 35,000
13 Cairan Rl 2 13,000 26,000
14 Notrixum inj 1 25,000 25,000
15 Tramadol inj 1 9,000 9,000
802,400

NO NAMA OBAT GA JUMLAH HARGA TOTAL

1 Handscoon steril no. .... 1 16,000 16,000
2 fresofol inj 1 20,000 20,000
3 Fentanyl inj / Pethydine inj 1 55,000 55,000
4 Ketorolac inj 1 20,000 20,000
5 Ondancetron 4 mg inj 1 11,000 11,000
6 Isoflurane (per cc) 15 12,000 180,000
7 Sevoflurane (per cc) 15 15,000 225,000
8 Spuid 10 cc 1 6,000 6,000
9 Spuid 5 cc 1 5,000 5,000
10 Spuid 3 cc 1 3,000 3,000
11 N2O (per Liter) 50 2000 100,000
12 O2 (per BAR) 1 35,000 35,000
13 Cairan Rl 2 16,000 32,000
14 Tramadol inj 1 9,000 9,000
717,000

NO JUMLAH HARGA TOTAL

1 Sewa Ruang Ok 1 500,000 500,000
2 Kamar Dewasa 2 90,000 180,000
3 Biaya Perawatan 2 40,000 80,000
-
1 Jasa Dokter Masuk 1 30,000 30,000
2 Asisten 1 190,000 190,000
3 Penata Anastesi 1 100,000 100,000
4 Anastesi 1 304,000 304,000
5 Operator 1 760,000 760,000
6 Visite Dokter Umum Ruangan 2 40,000 80,000
7 Visite Dokter Spesialis Bedah 2 100,000 200,000
-
1 Pemasangan Infus Dewasa 1 20,000 20,000
2 BHP + ADM 1 140,000 140,000
3 Skin Test 1 10,000 10,000
4 Obs pre/post op 2 10,000 20,000
5 GV 1 20,000 20,000
HARGA TOTAL 2,634,000
@gmail.com
Menggunakan Ceftriaxon 1 gr 90,000
DAFTAR PAKET OBAT / ALKES TONSILEKTOMY RS CITAMA
Nama Pasie: Dokter :
No. RM : Assisten :
Tgl, jam : Anastesi :
Tindakan : Ruang/kls :
Pembiyaya :

No Nama Obat dan Alkes Jumlah Harga Total

1 Silk 0 tuper 2 50,000 100,000
2 Silk 2.0 Tumpul 2 44,000 88,000
3 Handscoon steril no. ..... 3 16,000 48,000
4 Kassa X-Ray / Non X-Ray 10x10 cm 20 1,700 34,000
5 Apron Disposible 2 6,000 12,000
6 Betadin, Alkohol, Aquabides 1 50,000 50,000
7 Couter Paket / Suction 1 29,000 29,000
8 Handscoon non steril 2 2,500 5,000
9 Micropore/CM 30 300 9,000
10 Masker 7 2,000 14,000
11 Topi Disposible 7 2,000 14,000
12 Stericide (per cc) 10 300 3,000
13 Sterizym (per cc) 3 3000 9,000
14 Formalin cair (per cc) 100 600 60,000
15 Nacl 500 ml 1 8,000 8,000
16 Hibiscrub (per cc) 100 450 45,000
17 Injeksi As. Tranexamat 2 15,000 30,000
558,000

PAKET PEMAKAIAN OBAT TONSILEKTOMI PASIEN BPJS DI RUANGAN

NO NAMA OBAT DAN ALKES DEWASA QTT HARGA TOTAL

1 ABOCATH NO 20 1 28,000 28,000
2 ALKOHOL SWAB 10 750 7,500
3 BLOOD SET / MICRO SET 1 25,000 25,000
4 HYPAVIX /10CM 10 1,700 17,000
5 AQUABIDEST 25 ml 2 8,000 16,000
6 HANDSCOON DISPOSIBLE 5 2,500 12,500
7 CEFOTAXIME INJ 3 13,000 39,000
8 SPUID 1CC 1 4,000 4,000
 9 SPUID 10CC 2 6,000 12,000
10 SPUIT 3CC 2 3,000 6,000
11 TEGADERM I.V 1 10,500 10,500
12 KETOROLAC INJ 2 20,000 40,000
13 CAIRAN R/aseringL 500 ML 4 16,000 64,000
14 PENENG 1 1,700 1,700
15 CEFADROXIL TAB 500 MG TAB 10 1,700 17,000
16 NATRIUM DICLOFENAC 50 MG TAB 10 500 5,000
TOTAL 305,200

ATAU
PAKET PEMAKAIAN OBAT TONSILEKTOMI PASIEN ANAK BPJS DI RUANGAN

NO NAMA OBAT DAN ALKES ANAK QTT HARGA TOTAL

1 ABOCATH NO 24 1 28,000 28,000
2 ALKOHOL SWAB 10 750 7,500
3 BLOOD SET / MICRO SET 1 25,000 25,000
4 HYPAVIX /10CM 10 1,700 17,000
5 AQUABIDEST 25 ml 2 8,000 16,000
6 HANDSCOON DISPOSIBLE 5 2,500 12,500
7 CEFOTAXIME INJ 3 13,000 39,000
8 SPUID 1CC 1 4,000 4,000
9 SPUID 10CC 2 6,000 12,000
10 SPUIT 3CC 2 3,000 6,000
11 TEGADERM I.V 1 10,500 10,500
12 KETOROLAC INJ 2 20,000 40,000
13 CAIRAN RL/asering 500 ML 3 16,000 48,000
14 PENENG 1 1,700 1,700
15 CEFADROXIL SYR 1 13,000 13,000
16 IBUPROFEN SYR 1 10,000 10,000
17 nacl 100 3 16,500 49,500
339,700

1 Handscoon steril no. .... 1 16,000 16,000

2 fresofol inj 1 20,000 20,000
3 Fentanyl inj / Pethydine inj 2 55,000 110,000
4 Ketorolac inj 1 20,000 20,000
5 Ondancetron 4 mg inj 1 11,000 11,000
6 Isoflurane (per cc) 15 12,000 180,000
7 Sevoflurane (per cc) 15 15,000 225,000
8 Spuid 10 cc 1 6,000 6,000
9 Spuid 5 cc 1 5,000 5,000
10 Spuid 3 cc 1 3,000 3,000
11 N2O (per Liter) 50 2,000 100,000
12 O2 (per BAR) 1 35,000 35,000
13 Cairan Rl 2 13,000 26,000
14 Notrixum inj 1 25,000 25,000
15 Tramadol inj 1 9,000 9,000
791,000

NO NAMA OBAT GA JUMLAH HARGA TOTAL

1 Handscoon steril no. .... 1 16,000 16,000
2 fresofol inj 1 20,000 20,000
3 Fentanyl inj / Pethydine inj 1 55,000 55,000
4 Ketorolac inj 1 20,000 20,000
5 Ondancetron 4 mg inj 1 11,000 11,000
6 Isoflurane (per cc) 15 12,000 180,000
7 Sevoflurane (per cc) 15 15,000 225,000
8 Spuid 10 cc 1 6,000 6,000
9 Spuid 5 cc 1 5,000 5,000
10 Spuid 3 cc 1 3,000 3,000
11 N2O (per Liter) 50 2,000 100,000
12 O2 (per BAR) 1 35,000 35,000
13 Cairan Rl 2 16,000 32,000
14 Tramadol inj 1 9,000 9,000
717,000

NO JUMLAH HARGA TOTAL

1 Sewa Ruang Ok 1 500,000 500,000
2 Kamar Dewasa 2 90,000 180,000
3 Biaya Perawatan 2 40,000 80,000
-
1 Jasa Dokter Masuk 1 10,000 10,000
2 Asisten 1 150,000 150,000
3 Penata Anastesi 1 100,000 100,000
4 Anastesi 1 304,000 304,000
5 Operator 1 760,000 760,000
6 Visite Dokter Umum Ruangan 2 40,000 80,000
7 Visite Dokter Spesialis Bedah 1 100,000 100,000
-
1 Pemasangan Infus Dewasa 1 20,000 20,000
2 BHP + ADM 1 140,000 140,000
3 Skin Test 1 10,000 10,000
4 Obs pre/post op 2 10,000 20,000
5 GV 1 20,000 20,000
HARGA TOTAL 2,474,000