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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='100%' border='0' align='center' cellpadding='3px' cellspacing='0' class='tbl_form'><tr class='isi2'><td valign='top' align='center'><font size='4' face='Tahoma'>RS SIMRS KHANZA</font><br>Perumnas Guwosari Blok 3C No.22, Pajangan, Bantul<br>Hp: 08562675039, 085296559963, E-mail : khanzasoftmedia@gmail.com<br><br><font size='2' face='Tahoma'>REKAP HARIAN POLI ANAK<br><br></font></td></tr></table>
</head>
<body>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr class="isi2">
<td valign="top" align="left">
TANGGAL : 06-08-2017               DOKTER : D0000041 dr. BAMBANG
KURNIAWAN, Sp.OG
</td>
</tr>
<tr class="isi2">
<td>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center" width="3%" rowspan="3">
NO.
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="5%" rowspan="3">
NO.RM
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="10%" rowspan="3">
NAMA IBU
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="10%" rowspan="3">
NAMA ANAK
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="12%" rowspan="3">
ALAMAT
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="4%" rowspan="3">
TGL.LAHIR
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="6%">
LAHIR
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="1%" rowspan="2">
L/B
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="25%" colspan="10">
USIA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="20%" rowspan="2">
TINDAKAN & HARGA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="4%">
IMUN KE
</td>
</tr>
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center">
DIMANA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
0-6 hari
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
7-28 hari
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
28-1 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
1-4 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
5-14 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
BERAPA
</td>
</tr>
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
</tr>
<tr class="isi3">
<td valign="top" align="center">
1
</td>
<td valign="top">
0102430
</td>
<td valign="top">
0
</td>
<td valign="top">
RAHMAD RAMADHAN
</td>
<td valign="top">
JL. KOLONEL UNTUNG SURAPATI NO. 22 RT. 18, -, -, -
</td>
<td valign="top" align="center">
1992-05-03
</td>
<td valign="top">
KUALA KAPUAS
</td>
<td valign="top" align="center">
L
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top">
<table width="100%" border="0" align="center" cellpadding="0px" cellspacing="0" class="tbl_form">
<tr class="isi3">
<td valign="top" align="left" width="69%">
 Administrasi
</td>
<td valign="top" align="right" width="30%">
90,000
</td>
</tr>
<tr class="isi3">
<td valign="top" align="left" width="69%">
 Administrasi Asuransi / Pihak ke - III
</td>
<td valign="top" align="right" width="30%">
75,000
</td>
</tr>
<tr class="isi3">
<td valign="top" align="left" width="69%">
 Administrasi Rekam Medik Kelas I-II-III
</td>
<td valign="top" align="right" width="30%">
100,000
</td>
</tr>
</table>
</td>
<td valign="top" align="center">
2
</td>
</tr>
<tr class="isi3">
<td valign="top" align="center">
2
</td>
<td valign="top">
0102424
</td>
<td valign="top">
0
</td>
<td valign="top">
MUHAMMAD HABIBI
</td>
<td valign="top">
JLKAPUAS KEC SELAT, -, -, -
</td>
<td valign="top" align="center">
2013-08-31
</td>
<td valign="top">
KAPUAS
</td>
<td valign="top" align="center">
L
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
V
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top">
<table width="100%" border="0" align="center" cellpadding="0px" cellspacing="0" class="tbl_form">
<tr class="isi3">
<td valign="top" align="left" width="69%">
 Administrasi
</td>
<td valign="top" align="right" width="30%">
90,000
</td>
</tr>
<tr class="isi3">
<td valign="top" align="left" width="69%">
 Administrasi Asuransi / Pihak ke - III
</td>
<td valign="top" align="right" width="30%">
75,000
</td>
</tr>
</table>
</td>
<td valign="top" align="center">
</td>
</tr>
<tr class="isi3">
<td valign="top" align="left" colspan="8">
Total :
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
1
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" colspan="2">
</td>
</tr>
<tr class="isi4">
<td valign="top" align="center">
 
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi2">
<td valign="top" align="left">
TANGGAL : 11-08-2017               DOKTER : D0000012 dr. AZIS ARI
WIBOWO
</td>
</tr>
<tr class="isi2">
<td>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center" width="3%" rowspan="3">
NO.
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="5%" rowspan="3">
NO.RM
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="10%" rowspan="3">
NAMA IBU
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="10%" rowspan="3">
NAMA ANAK
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="12%" rowspan="3">
ALAMAT
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="4%" rowspan="3">
TGL.LAHIR
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="6%">
LAHIR
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="1%" rowspan="2">
L/B
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="25%" colspan="10">
USIA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="20%" rowspan="2">
TINDAKAN & HARGA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="4%">
IMUN KE
</td>
</tr>
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center">
DIMANA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
0-6 hari
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
7-28 hari
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
28-1 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
1-4 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
5-14 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
BERAPA
</td>
</tr>
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
</tr>
<tr class="isi3">
<td valign="top" align="center">
1
</td>
<td valign="top">
0102425
</td>
<td valign="top">
0
</td>
<td valign="top">
RINA SUSANTI2 BY.NY
</td>
<td valign="top">
BASARANG, -, -, -
</td>
<td valign="top" align="center">
2016-03-31
</td>
<td valign="top">
KAPUAS
</td>
<td valign="top" align="center">
L
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
V
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top">
<table width="100%" border="0" align="center" cellpadding="0px" cellspacing="0" class="tbl_form">
</table>
</td>
<td valign="top" align="center">
</td>
</tr>
<tr class="isi3">
<td valign="top" align="center">
2
</td>
<td valign="top">
000045
</td>
<td valign="top">
-
</td>
<td valign="top">
SAIDAH SHALEHAH
</td>
<td valign="top">
ALAMAT, KELURAHAN, KECAMATAN, KABUPATEN
</td>
<td valign="top" align="center">
1960-11-10
</td>
<td valign="top">
-
</td>
<td valign="top" align="center">
L
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top">
<table width="100%" border="0" align="center" cellpadding="0px" cellspacing="0" class="tbl_form">
</table>
</td>
<td valign="top" align="center">
</td>
</tr>
<tr class="isi3">
<td valign="top" align="center">
3
</td>
<td valign="top">
0102432
</td>
<td valign="top">
-
</td>
<td valign="top">
RINA SUSANTI I BY. NY
</td>
<td valign="top">
ALAMAT, KELURAHAN, KECAMATAN, KABUPATEN
</td>
<td valign="top" align="center">
2016-03-31
</td>
<td valign="top">
KAPUAS
</td>
<td valign="top" align="center">
B
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
V
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top">
<table width="100%" border="0" align="center" cellpadding="0px" cellspacing="0" class="tbl_form">
</table>
</td>
<td valign="top" align="center">
</td>
</tr>
<tr class="isi3">
<td valign="top" align="left" colspan="8">
Total :
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
1
</td>
<td valign="top" align="center">
1
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" colspan="2">
</td>
</tr>
<tr class="isi4">
<td valign="top" align="center">
 
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi2">
<td valign="top" align="left">
TANGGAL : 22-08-2017               DOKTER : D0000001 dr. Dewi
</td>
</tr>
<tr class="isi2">
<td>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center" width="3%" rowspan="3">
NO.
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="5%" rowspan="3">
NO.RM
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="10%" rowspan="3">
NAMA IBU
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="10%" rowspan="3">
NAMA ANAK
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="12%" rowspan="3">
ALAMAT
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="4%" rowspan="3">
TGL.LAHIR
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="6%">
LAHIR
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="1%" rowspan="2">
L/B
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="25%" colspan="10">
USIA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="20%" rowspan="2">
TINDAKAN & HARGA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" width="4%">
IMUN KE
</td>
</tr>
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center">
DIMANA
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
0-6 hari
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
7-28 hari
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
28-1 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
1-4 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center" colspan="2">
5-14 thn
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
BERAPA
</td>
</tr>
<tr class="isi3">
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
L
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
P
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
<td valign="middle" bgcolor="#f8fdf3" align="center">
 
</td>
</tr>
<tr class="isi3">
<td valign="top" align="center">
1
</td>
<td valign="top">
0102338
</td>
<td valign="top">
HJ.AN
</td>
<td valign="top">
AMALIA
</td>
<td valign="top">
MURUNG KERAMAT RT.III, -, -, -
</td>
<td valign="top" align="center">
1992-07-09
</td>
<td valign="top">
MURUNG KERAMAT
</td>
<td valign="top" align="center">
L
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top">
<table width="100%" border="0" align="center" cellpadding="0px" cellspacing="0" class="tbl_form">
</table>
</td>
<td valign="top" align="center">
</td>
</tr>
<tr class="isi3">
<td valign="top" align="left" colspan="8">
Total :
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>
<td valign="top" align="center">
0
</td>