sheet1 1

LAPORAN REKAP KLAIM - RSK ANAK WIJAYAKUSUMA

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Masuk: 1 Feb 2017 s/d 28 Feb 2017
Filter: Metode Pembayaran = Semua / / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS C SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien
1 1 Feb 2017 1 Feb 2017 N160220 NAIRA SYABILA AZZAHRA
2 1 Feb 2017 1 Feb 2017 H090006 HERI PRASETYO
3 1 Feb 2017 1 Feb 2017 L150048 LAFRI YANTO RAMADHAN
4 1 Feb 2017 1 Feb 2017 N170018 NABILA INDANA ZULVA
5 1 Feb 2017 1 Feb 2017 R160048 RIO NUR ADHA
6 1 Feb 2017 1 Feb 2017 F160033 FARIZA ADI NUGROHO
7 1 Feb 2017 1 Feb 2017 A150339 AHSAN NIAM THOYYIB
8 1 Feb 2017 1 Feb 2017 H160106 HASNA SALSABILA
9 1 Feb 2017 1 Feb 2017 P120027 RIZKY RIALISYA PUTRI
10 1 Feb 2017 1 Feb 2017 Z150079 ZULFA SAYYIDAH RAMADHANI
11 1 Feb 2017 1 Feb 2017 K170006 KAFKA MUHAMMAD ANNASIF
12 1 Feb 2017 1 Feb 2017 H150025 HARDHYA FALAH PRIANGGA
13 2 Feb 2017 2 Feb 2017 A160924 ARSYILA KHANZA FARZANA
14 2 Feb 2017 2 Feb 2017 H170007 HANUM FATHINA ABIDAH
15 2 Feb 2017 2 Feb 2017 D160156 DWIKI BAGUS PRASETYO
16 2 Feb 2017 2 Feb 2017 F160234 FARKHAN QOLBU RIZAL
17 2 Feb 2017 2 Feb 2017 D160149 DANU ILHAM ZAH
18 2 Feb 2017 2 Feb 2017 R150071 REZVAN JULIAN RIZALDY
19 2 Feb 2017 2 Feb 2017 S150085 SYAFA KIRANIA PRAMADANI
20 2 Feb 2017 2 Feb 2017 P160024 PUTRI AQILA ZHAFIRA
21 3 Feb 2017 3 Feb 2017 N160317 NAYLA AZ ZAHRA
22 3 Feb 2017 3 Feb 2017 D150061 DANENDRA AL DEBARAN
23 3 Feb 2017 3 Feb 2017 D100124 DAVID DARMA SANTIKO
24 3 Feb 2017 3 Feb 2017 G170006 GILANG RAMADHAN
25 3 Feb 2017 3 Feb 2017 A160948 AHMAD MUWAFIQ AZZAHIR
26 3 Feb 2017 3 Feb 2017 I150008 IMAS PRAMUDITA
27 3 Feb 2017 3 Feb 2017 K160087 KUSALO SEPTRIAN UNTORO
28 3 Feb 2017 3 Feb 2017 B170008 BILAL MUAFIK PAMUNGKAS
29 3 Feb 2017 3 Feb 2017 R150219 REIHANA NURI QONITA NABIHAH
30 3 Feb 2017 3 Feb 2017 K150131 KEYZA ZAHRANA AQILA RAHMAN
31 3 Feb 2017 3 Feb 2017 G160043 GUSNAURA ZYVANA I
32 3 Feb 2017 3 Feb 2017 A150790 ASSYIFA RISTIANTI
33 3 Feb 2017 3 Feb 2017 M140340 MUHAMMAD IBNU KATSIR
34 3 Feb 2017 3 Feb 2017 G140052 GALANG FIRMAN SATRIA
35 3 Feb 2017 3 Feb 2017 S090130 SYIFA LARASATI KHAIRUNNISA
36 4 Feb 2017 4 Feb 2017 F170014 FAUZAN RISKI RAMADHAN
37 4 Feb 2017 4 Feb 2017 F160178 FAIRUS AHMAD SYAKUR
38 4 Feb 2017 4 Feb 2017 S150147 SALENDRA PRATAMA
39 4 Feb 2017 4 Feb 2017 M160432 MOKHAMAD IKHSAN SAFINGI
40 4 Feb 2017 4 Feb 2017 N140281 NAFISHA AURELLIA WARDHANI
41 4 Feb 2017 4 Feb 2017 M170017 MOHAMAD ARFAN KHALIF
42 4 Feb 2017 4 Feb 2017 M160420 MUHAMAD ZIDNI KAMAL
43 4 Feb 2017 4 Feb 2017 F120117 FAIZAL ALDI FITRIANSYAH
44 4 Feb 2017 4 Feb 2017 D160170 DJAUHARA ZHARANI
45 4 Feb 2017 4 Feb 2017 Q150003 QISYA SABRINA QAISHARA
46 4 Feb 2017 4 Feb 2017 A120241 AKBAR JABAL NEHRU
47 4 Feb 2017 4 Feb 2017 F160033 FARIZA ADI NUGROHO
48 4 Feb 2017 4 Feb 2017 A120344 AKBAR FIRLY ARDIANSYAH
49 6 Feb 2017 6 Feb 2017 A150834 ANDRI PUTRA SETIAWAN

Page 1
 sheet1 1

50 6 Feb 2017 6 Feb 2017 B160079 BY NY NUR LAELIYAH I / BALQIS PUTRI HARU
51 6 Feb 2017 6 Feb 2017 R160234 ROBBY AR ROFIAN
52 6 Feb 2017 6 Feb 2017 I090022 IZZATUN NAFQIYA
53 6 Feb 2017 6 Feb 2017 I170013 IKA DWI PURWANTI
54 6 Feb 2017 6 Feb 2017 R170016 RIZIQ ILHAM SYAFAQI
55 6 Feb 2017 6 Feb 2017 C140038 CAHYA AOFA ATIKAH
56 6 Feb 2017 6 Feb 2017 D160097 DANISH AHMAD HAIDAR
57 6 Feb 2017 6 Feb 2017 D120021 DAFFA ABIWARA HIFLY
58 6 Feb 2017 6 Feb 2017 L170010 LAELINA FITHROTUL'IZA
59 6 Feb 2017 6 Feb 2017 R120090 RASYA WIDYA PRATAMA
60 6 Feb 2017 6 Feb 2017 D150143 DAVIN NAZAR ATMOKO
61 6 Feb 2017 6 Feb 2017 A140689 ASSEGAF ALTAF LOVA
62 6 Feb 2017 6 Feb 2017 A120005 AZWA RISKA AMALA
63 6 Feb 2017 6 Feb 2017 H090006 HERI PRASETYO
64 6 Feb 2017 6 Feb 2017 L150048 LAFRI YANTO RAMADHAN
65 6 Feb 2017 6 Feb 2017 B160148 BENEDICTA ANCELLINE SETHYA G
66 7 Feb 2017 7 Feb 2017 A160819 AZHAR RAFIF RAMADHAN
67 7 Feb 2017 7 Feb 2017 G140052 GALANG FIRMAN SATRIA
68 7 Feb 2017 7 Feb 2017 R170022 RAMADANISH AFLAH
69 7 Feb 2017 7 Feb 2017 L110033 LAELA KAMALIAH
70 7 Feb 2017 7 Feb 2017 M160091 MUKHAMMAD HAMZAH NUR SIDIK
71 7 Feb 2017 7 Feb 2017 E170005 ERA HARTADI
72 7 Feb 2017 7 Feb 2017 M160322 MOHAMMAD ARDIANSYAH
73 7 Feb 2017 7 Feb 2017 M170035 MOHAMAD EGA FIRJATULLOH
74 7 Feb 2017 7 Feb 2017 T160040 TRI JANAH LESTARI
75 7 Feb 2017 7 Feb 2017 A160301 AURIDNA KHAULD ASVHA
76 7 Feb 2017 7 Feb 2017 F160240 FARIDA RIZQIANA F
77 7 Feb 2017 7 Feb 2017 E160062 ELIZABETH NARARYAGABE
78 7 Feb 2017 7 Feb 2017 A160948 AHMAD MUWAFIQ AZZAHIR
79 7 Feb 2017 7 Feb 2017 D150061 DANENDRA AL DEBARAN
80 7 Feb 2017 7 Feb 2017 N160317 NAYLA AZ ZAHRA
81 7 Feb 2017 7 Feb 2017 S160275 SYAFIQ AVISCENA
82 8 Feb 2017 8 Feb 2017 A161045 AMMAR MUHAMMAD SYARIF
83 8 Feb 2017 8 Feb 2017 A160945 ANISA DWI AZIZAH
84 8 Feb 2017 8 Feb 2017 D120121 DILLA NUR KHAIRUNISA
85 8 Feb 2017 8 Feb 2017 F160078 FAEYZA ALFATHAN
86 8 Feb 2017 8 Feb 2017 M160432 MOKHAMAD IKHSAN SAFINGI
87 8 Feb 2017 8 Feb 2017 D160156 DWIKI BAGUS PRASETYO
88 8 Feb 2017 8 Feb 2017 E150014 EVAN AT TAQIY AHZA
89 8 Feb 2017 8 Feb 2017 M170032 MELLY LURANI PUTRI
90 8 Feb 2017 8 Feb 2017 A160421 AINUN SALSABILA EFFENDI
91 8 Feb 2017 8 Feb 2017 R150271 RALINE SHEIKA RAMADHANI
92 8 Feb 2017 8 Feb 2017 N090159 NADINE SHEIKA WENDARI
93 8 Feb 2017 8 Feb 2017 A160009 ALIFIANDRA AHMAD AZZAM
94 8 Feb 2017 8 Feb 2017 D140158 DAFFA' ADITYA RAHMAN
95 9 Feb 2017 9 Feb 2017 J160028 JOCELIN SARAH FITRIA
96 9 Feb 2017 9 Feb 2017 M140234 MUHAMMAD ALVIN RAMADHAN H
97 9 Feb 2017 9 Feb 2017 F120028 FARID AHSAN HIDAYAT
98 9 Feb 2017 9 Feb 2017 M130115 MELINA
99 9 Feb 2017 9 Feb 2017 Z130017 ZAHRATUL JANNAH ALHUSNA
100 9 Feb 2017 9 Feb 2017 D130012 DZIKRI AFFAN MUHAMMAD
101 9 Feb 2017 9 Feb 2017 D140121 DENIS WAHYU TRIANSYAH
102 9 Feb 2017 9 Feb 2017 D160111 DAFI' SYAUQI

Page 2
 sheet1 1

103 9 Feb 2017 9 Feb 2017 N110077 NURNGAINI RAHMA AULIA

104 9 Feb 2017 9 Feb 2017 B120022 BIMA SAMUDERA SUBITO
105 10 Feb 2017 10 Feb 2017 G140052 GALANG FIRMAN SATRIA
106 10 Feb 2017 10 Feb 2017 Y150018 YUSUF HIZRUL JAUSYAN
107 10 Feb 2017 10 Feb 2017 L110033 LAELA KAMALIAH
108 10 Feb 2017 10 Feb 2017 R170022 RAMADANISH AFLAH
109 10 Feb 2017 10 Feb 2017 W140006 WAHYU DWI MAHARTANTO
110 10 Feb 2017 10 Feb 2017 M170037 MARGARETHA TIURMANINGDYAH
111 10 Feb 2017 10 Feb 2017 D170020 DIMAS ABIMANYU
112 10 Feb 2017 10 Feb 2017 E140072 EYSHA MUTIA RAHMAH
113 10 Feb 2017 10 Feb 2017 I150070 IBRAHIM ARFA ARJUNA
114 10 Feb 2017 10 Feb 2017 J170006 JABBAR ASADEL
115 10 Feb 2017 10 Feb 2017 A150578 ADZKIA SAMHA SAUFA
116 10 Feb 2017 10 Feb 2017 S160164 SABRINA RHEA MAULIDYA
117 10 Feb 2017 10 Feb 2017 M160295 MOHAMMAD ROSYID YAHYA
118 10 Feb 2017 10 Feb 2017 N170019 NARADESYA ADYA
119 10 Feb 2017 10 Feb 2017 F140066 FAZA AQILA
120 10 Feb 2017 10 Feb 2017 M160201 MUHAMMAD BAHIJ
121 10 Feb 2017 10 Feb 2017 D160068 DEVAN WAHYU FEBRIANTO
122 10 Feb 2017 10 Feb 2017 M160091 MUKHAMMAD HAMZAH NUR SIDIK
123 10 Feb 2017 10 Feb 2017 S140051 SABRINA NAILA SANTOSO
124 10 Feb 2017 10 Feb 2017 J170005 JANUAR AMANAH PUTRI
125 10 Feb 2017 10 Feb 2017 A160945 ANISA DWI AZIZAH
126 10 Feb 2017 10 Feb 2017 R120090 RASYA WIDYA PRATAMA
127 10 Feb 2017 10 Feb 2017 A160421 AINUN SALSABILA EFFENDI
128 10 Feb 2017 10 Feb 2017 A160056 ARSHAD PUTRA RAMADHAN
129 10 Feb 2017 10 Feb 2017 H170010 HIBNI FATHUR DZAKY
130 10 Feb 2017 10 Feb 2017 B170008 BILAL MUAFIK PAMUNGKAS
131 11 Feb 2017 11 Feb 2017 I170002 ISNAINUN BILQIS ISLAMI
132 11 Feb 2017 11 Feb 2017 M150385 MUHAMMAD AYYUB FAZLURRAHMAN
133 11 Feb 2017 11 Feb 2017 K160087 KUSALO SEPTRIAN UNTORO
134 11 Feb 2017 11 Feb 2017 N160198 NAZWA BULAN AZAHRHA
135 11 Feb 2017 11 Feb 2017 R090053 RADITYA YUDHA PUTRA
136 11 Feb 2017 11 Feb 2017 M170032 MELLY LURANI PUTRI
137 11 Feb 2017 11 Feb 2017 A140161 AHMAD NUR ALFIYANSAH
138 11 Feb 2017 11 Feb 2017 R170016 RIZIQ ILHAM SYAFAQI
139 11 Feb 2017 11 Feb 2017 T160040 TRI JANAH LESTARI
140 11 Feb 2017 11 Feb 2017 A130477 ADAM FAWWAZ FI N
141 11 Feb 2017 11 Feb 2017 S160275 SYAFIQ AVISCENA
142 11 Feb 2017 11 Feb 2017 N090159 NADINE SHEIKA WENDARI
143 11 Feb 2017 11 Feb 2017 H160150 HAVIKA GAVA PUTRI
144 11 Feb 2017 11 Feb 2017 T130016 TAJNAJI
145 11 Feb 2017 11 Feb 2017 M170044 MUHAMMAD ATTHAP WICAKSANA
146 11 Feb 2017 11 Feb 2017 K130024 KENZIE SANTIKA DEVI
147 11 Feb 2017 11 Feb 2017 D170021 DENISSA DWI ARDELIA
148 11 Feb 2017 11 Feb 2017 S140172 SEKAR ARUM KURNIA
149 11 Feb 2017 11 Feb 2017 D150143 DAVIN NAZAR ATMOKO
150 13 Feb 2017 13 Feb 2017 A161044 ANDHIKA RAZIQ HANAN
151 13 Feb 2017 13 Feb 2017 H160071 HANA AN NAFISAH
152 13 Feb 2017 13 Feb 2017 A160129 ARIEF BUDHI SETIAJI
153 13 Feb 2017 13 Feb 2017 A160839 AHMAD AZIZ NURHADI
154 13 Feb 2017 13 Feb 2017 A150804 ADEEVA MIKHAYLA RIYADI
155 13 Feb 2017 13 Feb 2017 N090038 NIDA KHANSA MAGHFIRA

Page 3
 sheet1 1

156 13 Feb 2017 13 Feb 2017 Y150018 YUSUF HIZRUL JAUSYAN

157 13 Feb 2017 13 Feb 2017 W140006 WAHYU DWI MAHARTANTO
158 13 Feb 2017 13 Feb 2017 W140029 WICAKSONO RAGIL F
159 13 Feb 2017 13 Feb 2017 A160486 ARIF ARDIANSYAH
160 13 Feb 2017 13 Feb 2017 A150790 ASSYIFA RISTIANTI
161 13 Feb 2017 13 Feb 2017 C140038 CAHYA AOFA ATIKAH
162 13 Feb 2017 13 Feb 2017 K140058 KAMARATIH TUNJUNG WULAN
163 13 Feb 2017 13 Feb 2017 A160056 ARSHAD PUTRA RAMADHAN
164 13 Feb 2017 13 Feb 2017 B170010 BOY ADHYASTHA PRASRAYA
165 13 Feb 2017 13 Feb 2017 A160924 ARSYILA KHANZA FARZANA
166 13 Feb 2017 13 Feb 2017 J170005 JANUAR AMANAH PUTRI
167 13 Feb 2017 13 Feb 2017 M160390 MEGA AULYA SALSABILA
168 13 Feb 2017 13 Feb 2017 A140073 ANAS SAMUDRA
169 13 Feb 2017 13 Feb 2017 L140018 LITUHAYU AL MAHYRA ASWINDA
170 13 Feb 2017 13 Feb 2017 M140234 MUHAMMAD ALVIN RAMADHAN H
171 13 Feb 2017 13 Feb 2017 F120028 FARID AHSAN HIDAYAT
172 13 Feb 2017 13 Feb 2017 A170090 ARSILA NOVADRIANA
173 13 Feb 2017 13 Feb 2017 F170025 FADILA CHOMIZATUN
174 14 Feb 2017 14 Feb 2017 D170019 DWI CAHYANTO
175 14 Feb 2017 14 Feb 2017 R150219 REIHANA NURI QONITA NABIHAH
176 14 Feb 2017 14 Feb 2017 H160147 HAIZ HUDHORI
177 14 Feb 2017 14 Feb 2017 A150339 AHSAN NIAM THOYYIB
178 14 Feb 2017 14 Feb 2017 H160106 HASNA SALSABILA
179 14 Feb 2017 14 Feb 2017 R150145 RASYA ALVARO
180 14 Feb 2017 14 Feb 2017 R160219 RASENDRIYA ARYASATYA AL K
181 14 Feb 2017 14 Feb 2017 A120005 AZWA RISKA AMALA
182 14 Feb 2017 14 Feb 2017 P160024 PUTRI AQILA ZHAFIRA
183 14 Feb 2017 14 Feb 2017 L110033 LAELA KAMALIAH
184 14 Feb 2017 14 Feb 2017 K160197 KAMILA DZAFIRA AZNI PRASTYONO
185 14 Feb 2017 14 Feb 2017 A130477 ADAM FAWWAZ FI N
186 14 Feb 2017 14 Feb 2017 G100011 GREATEST SOULHONEST
187 14 Feb 2017 14 Feb 2017 C160040 CAHYA TRIYAN PRASETYO
188 14 Feb 2017 14 Feb 2017 K150157 KARAISSA FARZANA AYUNINDYA
189 14 Feb 2017 14 Feb 2017 A170091 AFFAN ARAFAH
190 15 Feb 2017 15 Feb 2017 F150123 FAIZ MUHAMMAD FAALIQ
191 15 Feb 2017 15 Feb 2017 D160156 DWIKI BAGUS PRASETYO
192 15 Feb 2017 15 Feb 2017 W150006 WILDAN AMZAR KHALIFI
193 15 Feb 2017 15 Feb 2017 M170044 MUHAMMAD ATTHAP WICAKSANA
194 15 Feb 2017 15 Feb 2017 M150332 MUHAMMAD NABIL HAFIDZ ARRIZKI
195 15 Feb 2017 15 Feb 2017 A150215 AHSAN ABDURROHMAN QOSA
196 15 Feb 2017 15 Feb 2017 I090022 IZZATUN NAFQIYA
197 15 Feb 2017 15 Feb 2017 R090053 RADITYA YUDHA PUTRA
198 15 Feb 2017 15 Feb 2017 M150385 MUHAMMAD AYYUB FAZLURRAHMAN
199 15 Feb 2017 15 Feb 2017 M140161 MELISA A
200 15 Feb 2017 15 Feb 2017 N160220 NAIRA SYABILA AZZAHRA
201 15 Feb 2017 15 Feb 2017 H160150 HAVIKA GAVA PUTRI
202 15 Feb 2017 15 Feb 2017 K150136 KHUSNIA NURUL AZIZAH
203 15 Feb 2017 15 Feb 2017 T130016 TAJNAJI
204 15 Feb 2017 15 Feb 2017 S140172 SEKAR ARUM KURNIA
205 16 Feb 2017 16 Feb 2017 M130267 MUHAMMAD REGAN NADHIF SUTOPO
206 16 Feb 2017 16 Feb 2017 A140534 ALISHBA MIKA XAVIERA
207 16 Feb 2017 16 Feb 2017 A160748 ARSENIO ADHYASTHA ZIANDRU/ BY NY DANY
208 16 Feb 2017 16 Feb 2017 N150279 NOVIANTO PUTRA AKHSAN

Page 4
 sheet1 1

209 16 Feb 2017 16 Feb 2017 K140058 KAMARATIH TUNJUNG WULAN

210 16 Feb 2017 16 Feb 2017 H160010 HARJUNA ADHIASTA
211 16 Feb 2017 16 Feb 2017 A160138 AZZAM FATKHURROHMAN
212 16 Feb 2017 16 Feb 2017 D160097 DANISH AHMAD HAIDAR
213 16 Feb 2017 16 Feb 2017 A160819 AZHAR RAFIF RAMADHAN
214 16 Feb 2017 16 Feb 2017 D150061 DANENDRA AL DEBARAN
215 16 Feb 2017 16 Feb 2017 N160198 NAZWA BULAN AZAHRHA
216 16 Feb 2017 16 Feb 2017 W160034 WAHYU NANDA P
217 16 Feb 2017 16 Feb 2017 M170042 MIRA KURNIA SARI
218 16 Feb 2017 16 Feb 2017 A150060 ADILA SHERLI SHAFANA
219 16 Feb 2017 16 Feb 2017 J090028 JATI HIDAYATURROHMAN
220 16 Feb 2017 16 Feb 2017 M130262 MYISHA ATMANEGARA SUTOPO
221 17 Feb 2017 17 Feb 2017 N160160 NIMAS ARIMBI
222 17 Feb 2017 17 Feb 2017 K150131 KEYZA ZAHRANA AQILA RAHMAN
223 17 Feb 2017 17 Feb 2017 C150001 CINTA ARUM PRAWESTRI
224 17 Feb 2017 17 Feb 2017 F160033 FARIZA ADI NUGROHO
225 17 Feb 2017 17 Feb 2017 A110328 AZZAMY INSAN A
226 17 Feb 2017 17 Feb 2017 A150790 ASSYIFA RISTIANTI
227 17 Feb 2017 17 Feb 2017 C160040 CAHYA TRIYAN PRASETYO
228 17 Feb 2017 17 Feb 2017 M140161 MELISA A
229 17 Feb 2017 17 Feb 2017 R170025 RAYYAN HADID KEANDRA YUSUF
230 17 Feb 2017 17 Feb 2017 A170101 ADE TRI IRIANTO
231 17 Feb 2017 17 Feb 2017 I140077 IRSYAD FARHAN AL FAIZ
232 17 Feb 2017 17 Feb 2017 F160072 FARROS SUKHUF AL 'BAQIY
233 17 Feb 2017 17 Feb 2017 A170104 ALULA ADIBA KHUMAIRA
234 17 Feb 2017 17 Feb 2017 A150273 AHNAF ZAIM RASENDRIYAN
235 17 Feb 2017 17 Feb 2017 L140018 LITUHAYU AL MAHYRA ASWINDA
236 17 Feb 2017 17 Feb 2017 K130083 KEILA SIFA FAUZIAH
237 17 Feb 2017 17 Feb 2017 F170022 FRANS DAYA DANADIYAKA
238 17 Feb 2017 17 Feb 2017 D120025 DHIENIATI ILMI ROSYANA
239 17 Feb 2017 17 Feb 2017 A160839 AHMAD AZIZ NURHADI
240 17 Feb 2017 17 Feb 2017 Z170009 ZARA AISHA AZZALEA QAIREEN
241 17 Feb 2017 17 Feb 2017 S150085 SYAFA KIRANIA PRAMADANI
242 18 Feb 2017 18 Feb 2017 A160561 ADELIA FARANISA AZNII
243 18 Feb 2017 18 Feb 2017 F160178 FAIRUS AHMAD SYAKUR
244 18 Feb 2017 18 Feb 2017 F160059 VERDI ARDIYANTO
245 18 Feb 2017 18 Feb 2017 F150123 FAIZ MUHAMMAD FAALIQ
246 18 Feb 2017 18 Feb 2017 J090028 JATI HIDAYATURROHMAN
247 18 Feb 2017 18 Feb 2017 D170019 DWI CAHYANTO
248 18 Feb 2017 18 Feb 2017 D160170 DJAUHARA ZHARANI
249 18 Feb 2017 18 Feb 2017 N140281 NAFISHA AURELLIA WARDHANI
250 18 Feb 2017 18 Feb 2017 T160040 TRI JANAH LESTARI
251 18 Feb 2017 18 Feb 2017 M160420 MUHAMAD ZIDNI KAMAL
252 18 Feb 2017 18 Feb 2017 K140036 KHANZA MAHIRA
253 18 Feb 2017 18 Feb 2017 N150036 NAUFAL DARY ABIYYU
254 18 Feb 2017 18 Feb 2017 N170028 NUR FEBRIYANTO
255 18 Feb 2017 18 Feb 2017 D150065 DANANG AL MAISAN ZHAFAR
256 18 Feb 2017 18 Feb 2017 A170091 AFFAN ARAFAH
257 18 Feb 2017 18 Feb 2017 A170112 ARKAN AL JABIR
258 20 Feb 2017 20 Feb 2017 M130073 MUHAMMAD SYARIF ILHAM
259 20 Feb 2017 20 Feb 2017 R150272 RESTI GUNAWAN
260 20 Feb 2017 20 Feb 2017 R140220 RIZQY WIDI RIYANI
261 20 Feb 2017 20 Feb 2017 K170015 KUNNI BAROKAH

Page 5
 sheet1 1

262 20 Feb 2017 20 Feb 2017 Q150003 QISYA SABRINA QAISHARA

263 20 Feb 2017 20 Feb 2017 A160993 ARKANA GIBRAN RAFASYA
264 20 Feb 2017 20 Feb 2017 G160043 GUSNAURA ZYVANA I
265 20 Feb 2017 20 Feb 2017 M170042 MIRA KURNIA SARI
266 20 Feb 2017 20 Feb 2017 F170027 FAATI HULISAN
267 20 Feb 2017 20 Feb 2017 K150106 KEISYA NUR CELIA
268 20 Feb 2017 20 Feb 2017 R150145 RASYA ALVARO
269 20 Feb 2017 20 Feb 2017 M160432 MOKHAMAD IKHSAN SAFINGI
270 20 Feb 2017 20 Feb 2017 S150147 SALENDRA PRATAMA
271 20 Feb 2017 20 Feb 2017 A110039 ANTASENA KURNIAWAN
272 20 Feb 2017 20 Feb 2017 M130262 MYISHA ATMANEGARA SUTOPO
273 20 Feb 2017 20 Feb 2017 P130034 PUTRI CAHAYA RAMADHANI
274 20 Feb 2017 20 Feb 2017 A130538 ARTHANA RASKA RAJASWA
275 20 Feb 2017 20 Feb 2017 A150834 ANDRI PUTRA SETIAWAN
276 20 Feb 2017 20 Feb 2017 N150279 NOVIANTO PUTRA AKHSAN
277 20 Feb 2017 20 Feb 2017 N150138 NAIYA PUTRI NUR FADILA
278 21 Feb 2017 21 Feb 2017 F160072 FARROS SUKHUF AL 'BAQIY
279 21 Feb 2017 21 Feb 2017 M170049 MARTIN ADE SAPUTRA
280 21 Feb 2017 21 Feb 2017 C140038 CAHYA AOFA ATIKAH
281 21 Feb 2017 21 Feb 2017 I170013 IKA DWI PURWANTI
282 21 Feb 2017 21 Feb 2017 A170101 ADE TRI IRIANTO
283 21 Feb 2017 21 Feb 2017 A170109 ARSEN AL ZUFAR FELANI
284 21 Feb 2017 21 Feb 2017 C160040 CAHYA TRIYAN PRASETYO
285 21 Feb 2017 21 Feb 2017 D150143 DAVIN NAZAR ATMOKO
286 21 Feb 2017 21 Feb 2017 Z170009 ZARA AISHA AZZALEA QAIREEN
287 21 Feb 2017 21 Feb 2017 F160234 FARKHAN QOLBU RIZAL
288 21 Feb 2017 21 Feb 2017 N150036 NAUFAL DARY ABIYYU
289 21 Feb 2017 21 Feb 2017 I150070 IBRAHIM ARFA ARJUNA
290 21 Feb 2017 21 Feb 2017 F170028 FARAH KHAIRUNNISA
291 21 Feb 2017 21 Feb 2017 F170022 FRANS DAYA DANADIYAKA
292 21 Feb 2017 21 Feb 2017 A170115 AZKA DZAKI HARYANTO
293 22 Feb 2017 22 Feb 2017 G140052 GALANG FIRMAN SATRIA
294 22 Feb 2017 22 Feb 2017 A150108 AHMAD FAUZY RIZQULLAH
295 22 Feb 2017 22 Feb 2017 A160138 AZZAM FATKHURROHMAN
296 22 Feb 2017 22 Feb 2017 Z130017 ZAHRATUL JANNAH ALHUSNA
297 22 Feb 2017 22 Feb 2017 R170007 RASKA HANANTA PUTRA
298 22 Feb 2017 22 Feb 2017 A160301 AURIDNA KHAULD ASVHA
299 22 Feb 2017 22 Feb 2017 R120090 RASYA WIDYA PRATAMA
300 22 Feb 2017 22 Feb 2017 S140109 SABRINA NURASIYAH
301 22 Feb 2017 22 Feb 2017 M090011 M RAFLI AL RAIHAN
302 22 Feb 2017 22 Feb 2017 A160300 ADEEVA AFSHEEN MYESHA NAYTRES
303 22 Feb 2017 22 Feb 2017 M150332 MUHAMMAD NABIL HAFIDZ ARRIZKI
304 22 Feb 2017 22 Feb 2017 F160078 FAEYZA ALFATHAN
305 22 Feb 2017 22 Feb 2017 M110113 MUHAMAD RAFFI AFANDY
306 22 Feb 2017 22 Feb 2017 A150339 AHSAN NIAM THOYYIB
307 22 Feb 2017 22 Feb 2017 R170032 RENDRA AL FARIZI YAMAN
308 23 Feb 2017 23 Feb 2017 M150359 MUHAMMAD ARFAN ADITYA
309 23 Feb 2017 23 Feb 2017 D120121 DILLA NUR KHAIRUNISA
310 23 Feb 2017 23 Feb 2017 A160059 ALZAM IQODZUL HIMAM
311 23 Feb 2017 23 Feb 2017 R150219 REIHANA NURI QONITA NABIHAH
312 23 Feb 2017 23 Feb 2017 A161045 AMMAR MUHAMMAD SYARIF
313 23 Feb 2017 23 Feb 2017 A140430 AINIYA FAIDA YASMIN
314 23 Feb 2017 23 Feb 2017 A170116 AKHMAD HUSEIN

Page 6
 sheet1 1

315 23 Feb 2017 23 Feb 2017 D130012 DZIKRI AFFAN MUHAMMAD

316 23 Feb 2017 23 Feb 2017 F170025 FADILA CHOMIZATUN
317 23 Feb 2017 23 Feb 2017 A130477 ADAM FAWWAZ FI N
318 23 Feb 2017 23 Feb 2017 M170042 MIRA KURNIA SARI
319 23 Feb 2017 23 Feb 2017 M170053 MUHAMMAD MANNAF SHAFIULLA
320 23 Feb 2017 23 Feb 2017 K140036 KHANZA MAHIRA
321 23 Feb 2017 23 Feb 2017 A160009 ALIFIANDRA AHMAD AZZAM
322 23 Feb 2017 23 Feb 2017 K150103 KARUNIA WULAN AGUSTIN
323 23 Feb 2017 23 Feb 2017 F160059 VERDI ARDIYANTO
324 23 Feb 2017 23 Feb 2017 M130115 MELINA
325 24 Feb 2017 24 Feb 2017 A120005 AZWA RISKA AMALA
326 24 Feb 2017 24 Feb 2017 W140029 WICAKSONO RAGIL F
327 24 Feb 2017 24 Feb 2017 Z170009 ZARA AISHA AZZALEA QAIREEN
328 24 Feb 2017 24 Feb 2017 A160056 ARSHAD PUTRA RAMADHAN
329 24 Feb 2017 24 Feb 2017 F160041 FATIMATUZ ZAHRA
330 24 Feb 2017 24 Feb 2017 E140072 EYSHA MUTIA RAHMAH
331 24 Feb 2017 24 Feb 2017 N090159 NADINE SHEIKA WENDARI
332 24 Feb 2017 24 Feb 2017 J160028 JOCELIN SARAH FITRIA
333 24 Feb 2017 24 Feb 2017 A110039 ANTASENA KURNIAWAN
334 24 Feb 2017 24 Feb 2017 D160110 DAFI' SYAUQI
335 24 Feb 2017 24 Feb 2017 R150272 RESTI GUNAWAN
336 24 Feb 2017 24 Feb 2017 M160432 MOKHAMAD IKHSAN SAFINGI
337 24 Feb 2017 24 Feb 2017 N150138 NAIYA PUTRI NUR FADILA
338 24 Feb 2017 24 Feb 2017 P130034 PUTRI CAHAYA RAMADHANI
339 25 Feb 2017 25 Feb 2017 A140161 AHMAD NUR ALFIYANSAH
340 25 Feb 2017 25 Feb 2017 A140159 ALI FIRMANSYAH
341 25 Feb 2017 25 Feb 2017 D160068 DEVAN WAHYU FEBRIANTO
342 25 Feb 2017 25 Feb 2017 I170002 ISNAINUN BILQIS ISLAMI
343 25 Feb 2017 25 Feb 2017 A150578 ADZKIA SAMHA SAUFA
344 25 Feb 2017 25 Feb 2017 A150671 ANNISA ZHAFIRAH ZAHRO
345 25 Feb 2017 25 Feb 2017 F170028 FARAH KHAIRUNNISA
346 25 Feb 2017 25 Feb 2017 M170049 MARTIN ADE SAPUTRA
347 25 Feb 2017 25 Feb 2017 S140109 SABRINA NURASIYAH
348 25 Feb 2017 25 Feb 2017 M160295 MOHAMMAD ROSYID YAHYA
349 25 Feb 2017 25 Feb 2017 F160178 FAIRUS AHMAD SYAKUR
350 25 Feb 2017 25 Feb 2017 K160087 KUSALO SEPTRIAN UNTORO
351 25 Feb 2017 25 Feb 2017 R160219 RASENDRIYA ARYASATYA AL K
352 27 Feb 2017 27 Feb 2017 A150637 ADITYA WICAKSONO
353 27 Feb 2017 27 Feb 2017 N150100 NAAILA AZ-ZAHRA
354 27 Feb 2017 27 Feb 2017 F150242 FATIN ADIBA NAHARININGSIH
355 27 Feb 2017 27 Feb 2017 K150157 KARAISSA FARZANA AYUNINDYA
356 27 Feb 2017 27 Feb 2017 S160193 SHAKILA EILIYAH AL KHANZA
357 27 Feb 2017 27 Feb 2017 N170028 NUR FEBRIYANTO
358 27 Feb 2017 27 Feb 2017 N110077 NURNGAINI RAHMA AULIA
359 27 Feb 2017 27 Feb 2017 M140368 MUHAMMAD HAFIZH WASKITA
360 27 Feb 2017 27 Feb 2017 A160924 ARSYILA KHANZA FARZANA
361 27 Feb 2017 27 Feb 2017 M160201 MUHAMMAD BAHIJ
362 27 Feb 2017 27 Feb 2017 A110328 AZZAMY INSAN A
363 27 Feb 2017 27 Feb 2017 A140073 ANAS SAMUDRA
364 27 Feb 2017 27 Feb 2017 A160300 ADEEVA AFSHEEN MYESHA NAYTRES
365 27 Feb 2017 27 Feb 2017 D140073 DESTRI WULANDARI
366 27 Feb 2017 27 Feb 2017 J170007 JELITA PUSPIANA
367 27 Feb 2017 27 Feb 2017 D160156 DWIKI BAGUS PRASETYO

Page 7
 sheet1 1

368 27 Feb 2017 27 Feb 2017 W160034 WAHYU NANDA P

369 27 Feb 2017 27 Feb 2017 A150804 ADEEVA MIKHAYLA RIYADI
370 27 Feb 2017 27 Feb 2017 C140038 CAHYA AOFA ATIKAH
371 27 Feb 2017 27 Feb 2017 R150311 RANIA HUMAYRA ZIDNI
372 27 Feb 2017 27 Feb 2017 A160879 AL DAFFA AZKA RAMADHAN
373 27 Feb 2017 27 Feb 2017 A161044 ANDHIKA RAZIQ HANAN
374 28 Feb 2017 28 Feb 2017 F170030 FAVIANSYAH
375 28 Feb 2017 28 Feb 2017 W150006 WILDAN AMZAR KHALIFI
376 28 Feb 2017 28 Feb 2017 H160071 HANA AN NAFISAH
377 28 Feb 2017 28 Feb 2017 A170112 ARKAN AL JABIR
378 28 Feb 2017 28 Feb 2017 R170031 RIDLO INDRA SAKTI
379 28 Feb 2017 28 Feb 2017 F160234 FARKHAN QOLBU RIZAL
380 28 Feb 2017 28 Feb 2017 G140052 GALANG FIRMAN SATRIA
381 28 Feb 2017 28 Feb 2017 A150108 AHMAD FAUZY RIZQULLAH
382 28 Feb 2017 28 Feb 2017 K150136 KHUSNIA NURUL AZIZAH
383 28 Feb 2017 28 Feb 2017 G150023 GENTA ADITYA PRATAMA
384 28 Feb 2017 28 Feb 2017 F160041 FATIMATUZ ZAHRA
385 28 Feb 2017 28 Feb 2017 R150145 RASYA ALVARO
386 28 Feb 2017 28 Feb 2017 H160106 HASNA SALSABILA
387 28 Feb 2017 28 Feb 2017 D170027 DAFFA AINURROFIQ
388 28 Feb 2017 28 Feb 2017 R170033 ROYYAN MUMTAZAN
389 28 Feb 2017 28 Feb 2017 R120044 RAFA FAJAR ASMORO
390 28 Feb 2017 28 Feb 2017 R150219 REIHANA NURI QONITA NABIHAH
391 28 Feb 2017 28 Feb 2017 K160197 KAMILA DZAFIRA AZNI PRASTYONO
392 28 Feb 2017 28 Feb 2017 N160315 NURAFFA KAISAN FAQIH
Total
Kode RS: 3305081

Page 8
 sheet1 1

F RS KELAS C SWASTA
No. SEP INACBG Top Up Total Tarif Tarif RS Jenis
0145R01102170000004 Q-5-44-0 190,400 140,000 RJ
0145R01102170000007 J-3-13-0 323,900 190,000 RJ
0145R01102170000008 J-3-13-0 323,900 190,000 RJ
0145R01102170000009 Q-5-44-0 190,400 140,000 RJ
0145R01102170000013 Q-5-44-0 190,400 140,000 RJ
0145R01102170000012 Q-5-44-0 190,400 140,000 RJ
0145R01102170000011 J-3-13-0 323,900 190,000 RJ
0145R01102170000010 Q-5-44-0 190,400 140,000 RJ
0145R01102170000005 Q-5-44-0 190,400 140,000 RJ
0145R01102170000003 Q-5-44-0 190,400 140,000 RJ
0145R01102170000014 Q-5-44-0 190,400 140,000 RJ
0145R01102170000002 J-3-13-0 323,900 190,000 RJ
0145R01102170000015 Q-5-44-0 190,400 140,000 RJ
0145R01102170000018 Q-5-44-0 190,400 140,000 RJ
0145R01102170000019 Q-5-44-0 190,400 140,000 RJ
0145R01102170000016 J-3-13-0 323,900 190,000 RJ
0145R01102170000017 J-3-13-0 323,900 190,000 RJ
0145R01102170000020 J-3-13-0 323,900 190,000 RJ
0145R01102170000021 Q-5-44-0 190,400 140,000 RJ
0145R01102170000022 Q-5-44-0 190,400 140,000 RJ
0145R01102170000026 J-3-13-0 323,900 190,000 RJ
0145R01102170000023 J-3-13-0 323,900 190,000 RJ
0145R01102170000031 J-3-13-0 323,900 190,000 RJ
0145R01102170000033 Q-5-44-0 190,400 140,000 RJ
0145R01102170000032 J-3-13-0 323,900 190,000 RJ
0145R01102170000025 J-3-13-0 323,900 190,000 RJ
0145R01102170000042 Q-5-44-0 190,400 140,000 RJ
0145R01102170000040 J-3-13-0 323,900 190,000 RJ
0145R01102170000044 Q-5-44-0 190,400 140,000 RJ
0145R01102170000049 Q-5-44-0 190,400 140,000 RJ
0145R01102170000048 Q-5-44-0 190,400 140,000 RJ
0145R01102170000047 Q-5-44-0 190,400 140,000 RJ
0145R01102170000045 J-3-13-0 323,900 190,000 RJ
0145R01102170000046 J-3-13-0 323,900 190,000 RJ
0145R01102170000043 J-3-13-0 323,900 190,000 RJ
0145R01102170000071 J-3-13-0 323,900 190,000 RJ
0145R01102170000070 Q-5-44-0 190,400 140,000 RJ
0145R01102170000067 J-3-13-0 323,900 190,000 RJ
0145R01102170000058 J-3-13-0 323,900 190,000 RJ
0145R01102170000052 G-3-13-0 296,900 350,000 RJ
0145R01102170000059 Q-5-44-0 190,400 140,000 RJ
0145R01102170000061 J-3-13-0 323,900 190,000 RJ
0145R01102170000062 J-3-13-0 323,900 190,000 RJ
0145R01102170000060 Q-5-44-0 190,400 140,000 RJ
0145R01102170000057 Q-5-44-0 190,400 140,000 RJ
0145R01102170000053 Q-5-44-0 190,400 140,000 RJ
0145R01102170000072 Q-5-44-0 190,400 140,000 RJ
0145R01102170000053 Q-5-44-0 190,400 140,000 RJ
0145R01102170000080 Q-5-44-0 190,400 140,000 RJ

Page 9
 sheet1 1

0145R01102170000082 Q-5-44-0 190,400 140,000 RJ

0145R01102170000085 Q-5-44-0 190,400 140,000 RJ
0145R01102170000079 Q-5-44-0 190,400 140,000 RJ
0145R01102170000084 Q-5-44-0 190,400 140,000 RJ
0145R01102170000079 Q-5-44-0 190,400 140,000 RJ
0145R01102170000076 J-3-13-0 323,900 190,000 RJ
0145R01102170000077 Q-5-44-0 190,400 140,000 RJ
0145R01102170000081 Q-5-44-0 190,400 140,000 RJ
0145R01102170000093 Q-5-44-0 190,400 140,000 RJ
0145R01102170000090 Q-5-44-0 190,400 140,000 RJ
0145R01102170000089 Q-5-44-0 190,400 140,000 RJ
0145R01102170000092 Q-5-44-0 190,400 140,000 RJ
0145R01102170000091 Q-5-44-0 190,400 140,000 RJ
0145R01102170000094 J-3-13-0 323,900 190,000 RJ
0145R01102170000095 J-3-13-0 323,900 190,000 RJ
0145R01102170000096 J-3-13-0 323,900 190,000 RJ
0145R01102170000099 J-3-13-0 323,900 190,000 RJ
0145R01102170000108 J-3-13-0 323,900 190,000 RJ
0145R01102170000110 J-3-13-0 323,900 190,000 RJ
0145R01102170000109 J-3-13-0 323,900 190,000 RJ
0145R01102170000119 J-3-13-0 323,900 190,000 RJ
0145R01102170000118 Q-5-44-0 190,400 140,000 RJ
0145R01102170000117 Q-5-44-0 190,400 140,000 RJ
0145R01102170000116 J-3-13-0 323,900 190,000 RJ
0145R01102170000115 J-3-13-0 323,900 190,000 RJ
0145R01102170000114 Q-5-44-0 190,400 140,000 RJ
0145R01102170000113 Q-5-44-0 190,400 140,000 RJ
0145R01102170000112 Q-5-44-0 190,400 140,000 RJ
0145R01102170000111 J-3-13-0 323,900 190,000 RJ
0145R01102170000098 J-3-13-0 323,900 190,000 RJ
0145R01102170000097 J-3-13-0 323,900 190,000 RJ
0145R01102170000101 J-3-13-0 323,900 190,000 RJ
0145R01102170000129 J-3-13-0 323,900 190,000 RJ
0145R01102170000130 Q-5-44-0 190,400 140,000 RJ
0145R01102170000124 Q-5-44-0 190,400 140,000 RJ
0145R01102170000126 Q-5-44-0 190,400 140,000 RJ
0145R01102170000125 J-3-13-0 323,900 190,000 RJ
0145R01102170000140 Q-5-44-0 190,400 140,000 RJ
0145R01102170000145 Q-5-44-0 190,400 140,000 RJ
0145R01102170000141 Q-5-44-0 190,400 140,000 RJ
0145R01102170000131 Q-5-44-0 190,400 140,000 RJ
0145R01102170000144 Q-5-44-0 190,400 140,000 RJ
0145R01102170000143 J-3-13-0 323,900 190,000 RJ
0145R01102170000128 Q-5-44-0 190,400 140,000 RJ
0145R01102170000146 J-3-13-0 323,900 190,000 RJ
0145R01102170000157 Q-5-44-0 190,400 140,000 RJ
0145R01102170000159 J-3-13-0 323,900 190,000 RJ
0145R01102170000158 Q-5-44-0 190,400 140,000 RJ
0145R01102170000163 Q-5-44-0 190,400 140,000 RJ
0145R01102170000162 Q-5-44-0 190,400 140,000 RJ
0145R01102170000166 Q-5-44-0 190,400 140,000 RJ
0145R01102170000165 Q-5-44-0 190,400 140,000 RJ
0145R01102170000164 Q-5-44-0 190,400 140,000 RJ

Page 10
 sheet1 1

0145R01102170000161 Q-5-44-0 190,400 140,000 RJ

0145R01102170000179 J-3-13-0 323,900 190,000 RJ
0145R01102170000183 J-3-13-0 323,900 190,000 RJ
0145R01102170000192 J-3-13-0 323,900 190,000 RJ
0145R01102170000198 J-3-13-0 323,900 190,000 RJ
0145R01102170000188 J-3-13-0 323,900 190,000 RJ
0145R01102170000190 J-3-13-0 323,900 190,000 RJ
0145R01102170000182 J-3-13-0 323,900 190,000 RJ
0145R01102170000195 Q-5-44-0 190,400 140,000 RJ
0145R01102170000199 Q-5-44-0 190,400 140,000 RJ
0145R01102170000181 Q-5-44-0 190,400 140,000 RJ
0145R01102170000167 Q-5-44-0 190,400 140,000 RJ
0145R01102170000174 Q-5-44-0 190,400 140,000 RJ
0145R01102170000175 Q-5-44-0 190,400 140,000 RJ
0145R01102170000169 Q-5-44-0 190,400 140,000 RJ
0145R01102170000172 Q-5-44-0 190,400 140,000 RJ
0145R01102170000170 Q-5-44-0 190,400 140,000 RJ
0145R01102170000171 Q-5-44-0 190,400 140,000 RJ
0145R01102170000168 Q-5-44-0 190,400 140,000 RJ
0145R01102170000173 J-3-13-0 323,900 190,000 RJ
0145R01102170000196 Q-5-44-0 190,400 140,000 RJ
0145R01102170000191 Q-5-44-0 190,400 140,000 RJ
0145R01102170000184 Q-5-44-0 190,400 140,000 RJ
0145R01102170000193 Q-5-44-0 190,400 140,000 RJ
0145R01102170000197 Q-5-44-0 190,400 140,000 RJ
0145R01102170000194 Q-5-44-0 190,400 140,000 RJ
0145R01102170000185 Q-5-44-0 190,400 140,000 RJ
0145R01102170000189 Q-5-44-0 190,400 140,000 RJ
0145R01102170000202 J-3-13-0 323,900 190,000 RJ
0145R01102170000209 Q-5-44-0 190,400 140,000 RJ
0145R01102170000205 Q-5-44-0 190,400 140,000 RJ
0145R01102170000204 Q-5-44-0 190,400 140,000 RJ
0145R01102170000201 Q-5-44-0 190,400 140,000 RJ
0145R01102170000206 Q-5-44-0 190,400 140,000 RJ
0145R01102170000213 Q-5-44-0 190,400 140,000 RJ
0145R01102170000208 Q-5-44-0 190,400 140,000 RJ
0145R01102170000211 Q-5-44-0 190,400 140,000 RJ
0145R01102170000221 J-3-13-0 323,900 190,000 RJ
0145R01102170000219 Q-5-44-0 190,400 140,000 RJ
0145R01102170000224 J-3-13-0 323,900 190,000 RJ
0145R01102170000220 J-3-13-0 323,900 190,000 RJ
0145R01102170000222 Q-5-44-0 190,400 140,000 RJ
0145R01102170000215 J-3-13-0 323,900 190,000 RJ
0145R01102170000212 J-3-13-0 323,900 190,000 RJ
0145R01102170000203 Q-5-44-0 190,400 140,000 RJ
0145R01102170000214 Q-5-44-0 190,400 190,000 RJ
0145R01102170000200 Q-5-44-0 190,400 140,000 RJ
0145R01102170000232 J-3-13-0 323,900 190,000 RJ
0145R01102170000244 Q-5-44-0 190,400 140,000 RJ
0145R01102170000243 Q-5-44-0 190,400 140,000 RJ
0145R01102170000241 J-3-13-0 323,900 190,000 RJ
0145R01102170000242 Q-5-44-0 190,400 140,000 RJ
0145R01102170000225 Q-5-44-0 190,400 140,000 RJ

Page 11
 sheet1 1

0145R01102170000276 J-3-13-0 323,900 190,000 RJ

0145R01102170000274 J-3-13-0 323,900 190,000 RJ
0145R01102170000273 Q-5-44-0 190,400 140,000 RJ
0145R01102170000272 Q-5-44-0 190,400 140,000 RJ
0145R01102170000271 Q-5-44-0 190,400 140,000 RJ
0145R01102170000270 Q-5-44-0 190,400 140,000 RJ
0145R01102170000268 Q-5-44-0 190,400 140,000 RJ
0145R01102170000275 J-3-13-0 323,900 190,000 RJ
0145R01102170000245 Q-5-44-0 190,400 140,000 RJ
0145R01102170000226 Q-5-44-0 190,400 140,000 RJ
0145R01102170000231 Q-5-44-0 190,400 140,000 RJ
0145R01102170000228 J-3-13-0 323,900 190,000 RJ
0145R01102170000230 Q-5-44-0 190,400 140,000 RJ
0145R01102170000227 J-3-13-0 323,900 190,000 RJ
0145R01102170000233 J-3-13-0 323,900 190,000 RJ
0145R01102170000234 Q-5-44-0 190,400 140,000 RJ
0145R01102170000267 Q-5-44-0 190,400 140,000 RJ
0145R01102170000269 Q-5-44-0 190,400 140,000 RJ
0145R01102170000266 Q-5-44-0 190,400 140,000 RJ
0145R01102170000265 Q-5-44-0 190,400 140,000 RJ
0145R01102170000264 Q-5-44-0 190,400 140,000 RJ
0145R01102170000262 Q-5-44-0 190,400 140,000 RJ
0145R01102170000263 Q-5-44-0 190,400 140,000 RJ
0145R01102170000261 Q-5-44-0 190,400 140,000 RJ
0145R01102170000260 Q-5-44-0 190,400 140,000 RJ
0145R01102170000256 Q-5-44-0 190,400 140,000 RJ
0145R01102170000255 Q-5-44-0 190,400 140,000 RJ
0145R01102170000254 J-3-13-0 323,900 190,000 RJ
0145R01102170000247 Q-5-44-0 190,400 140,000 RJ
0145R01102170000252 Q-5-44-0 190,400 140,000 RJ
0145R01102170000251 Q-5-44-0 190,400 140,000 RJ
0145R01102170000257 J-3-13-0 323,900 190,000 RJ
0145R01102170000253 Q-5-44-0 190,400 140,000 RJ
0145R01102170000259 J-3-13-0 323,900 190,000 RJ
0145R01102170000290 Q-5-44-0 190,400 140,000 RJ
0145R01102170000287 Q-5-44-0 190,400 140,000 RJ
0145R01102170000286 Q-5-44-0 190,400 140,000 RJ
0145R01102170000288 J-3-13-0 323,900 190,000 RJ
0145R01102170000291 Q-5-44-0 190,400 140,000 RJ
0145R01102170000278 Q-5-44-0 190,400 140,000 RJ
0145R01102170000280 Q-5-44-0 190,400 140,000 RJ
0145R01102170000289 Q-5-44-0 190,400 140,000 RJ
0145R01102170000285 J-3-13-0 323,900 190,000 RJ
0145R01102170000296 Q-5-44-0 190,400 140,000 RJ
0145R01102170000295 Q-5-44-0 190,400 140,000 RJ
0145R01102170000294 J-3-13-0 323,900 190,000 RJ
0145R01102170000335 J-3-13-0 323,900 190,000 RJ
0145R01102170000297 Q-5-44-0 190,400 140,000 RJ
0145R01102170000279 J-3-13-0 323,900 190,000 RJ
0145R01102170000323 Q-5-44-0 190,400 140,000 RJ
0145R01102170000321 J-3-13-0 323,900 190,000 RJ
0145R01102170000322 J-3-13-0 323,900 190,000 RJ
0145R01102170000317 J-3-13-0 323,900 190,000 RJ

Page 12
 sheet1 1

0145R01102170000320 Q-5-44-0 190,400 140,000 RJ

0145R01102170000318 Q-5-44-0 190,400 140,000 RJ
0145R01102170000311 Q-5-44-0 190,400 140,000 RJ
0145R01102170000303 Q-5-44-0 190,400 140,000 RJ
0145R01102170000300 J-3-13-0 323,900 190,000 RJ
0145R01102170000302 J-3-13-0 323,900 190,000 RJ
0145R01102170000304 Q-5-44-0 190,400 140,000 RJ
0145R01102170000299 J-3-13-0 323,900 190,000 RJ
0145R01102170000298 G-3-13-0 296,900 350,000 RJ
0145R01102170000313 Q-5-44-0 190,400 140,000 RJ
0145R01102170000316 Q-5-44-0 190,400 140,000 RJ
0145R01102170000324 Q-5-44-0 190,400 140,000 RJ
0145R01102170000342 Q-5-44-0 190,400 140,000 RJ
0145R01102170000350 Q-5-44-0 190,400 140,000 RJ
0145R01102170000341 Q-5-44-0 190,400 140,000 RJ
0145R01102170000347 Q-5-44-0 190,400 140,000 RJ
0145R01102170000339 J-3-13-0 323,900 190,000 RJ
0145R01102170000348 Q-5-44-0 190,400 140,000 RJ
0145R01102170000349 J-3-13-0 323,900 190,000 RJ
0145R01102170000338 Q-5-44-0 190,400 140,000 RJ
0145R01102170000340 Q-5-44-0 190,400 140,000 RJ
0145R01102170000331 Q-5-44-0 190,400 140,000 RJ
0145R01102170000326 J-3-13-0 323,900 190,000 RJ
0145R01102170000329 J-3-13-0 323,900 190,000 RJ
0145R01102170000334 J-3-13-0 323,900 190,000 RJ
0145R01102170000333 J-3-13-0 323,900 190,000 RJ
0145R01102170000330 J-3-13-0 323,900 190,000 RJ
0145R01102170000332 J-3-13-0 323,900 190,000 RJ
0145R01102170000328 J-3-13-0 323,900 190,000 RJ
0145R01102170000327 J-3-13-0 323,900 190,000 RJ
0145R01102170000325 J-3-13-0 323,900 190,000 RJ
0145R01102170000343 J-3-13-0 323,900 190,000 RJ
0145R01102170000346 Q-5-44-0 190,400 140,000 RJ
0145R01102170000353 Q-5-44-0 190,400 140,000 RJ
0145R01102170000362 Q-5-44-0 190,400 140,000 RJ
0145R01102170000358 J-3-13-0 323,900 190,000 RJ
0145R01102170000354 J-3-13-0 323,900 190,000 RJ
0145R01102170000361 J-3-13-0 323,900 190,000 RJ
0145R01102170000355 Q-5-44-0 190,400 140,000 RJ
0145R01102170000356 J-3-13-0 323,900 190,000 RJ
0145R01102170000360 Q-5-44-0 190,400 140,000 RJ
0145R01102170000357 Q-5-44-0 190,400 140,000 RJ
0145R01102170000352 Q-5-44-0 190,400 140,000 RJ
0145R01102170000364 J-3-13-0 323,900 190,000 RJ
0145R01102170000351 Q-5-44-0 190,400 140,000 RJ
0145R01102170000367 Q-5-44-0 190,400 140,000 RJ
0145R01102170000366 Q-5-44-0 190,400 140,000 RJ
0145R01102170000365 J-3-13-0 323,900 190,000 RJ
0145R01102170000368 J-3-13-0 323,900 190,000 RJ
0145R01102170000393 J-3-13-0 323,900 190,000 RJ
0145R01102170000395 J-3-13-0 323,900 190,000 RJ
0145R01102170000377 J-3-13-0 323,900 190,000 RJ
0145R01102170000386 Q-5-44-0 190,400 140,000 RJ

Page 13
 sheet1 1

0145R01102170000376 Q-5-44-0 190,400 140,000 RJ

0145R01102170000391 Q-5-44-0 190,400 140,000 RJ
0145R01102170000383 Q-5-44-0 190,400 140,000 RJ
0145R01102170000378 J-3-13-0 323,900 190,000 RJ
0145R01102170000374 J-3-13-0 323,900 190,000 RJ
0145R01102170000384 Q-5-44-0 190,400 190,000 RJ
0145R01102170000388 J-3-13-0 323,900 190,000 RJ
0145R01102170000390 J-3-13-0 323,900 190,000 RJ
0145R01102170000385 J-3-13-0 323,900 190,000 RJ
0145R01102170000389 J-3-13-0 323,900 190,000 RJ
0145R01102170000398 Q-5-44-0 190,400 140,000 RJ
0145R01102170000397 Q-5-44-0 190,400 140,000 RJ
0145R01102170000399 Q-5-44-0 190,400 140,000 RJ
0145R01102170000375 Q-5-44-0 190,400 140,000 RJ
0145R01102170000396 J-3-13-0 323,900 190,000 RJ
0145R01102170000400 J-3-13-0 323,900 190,000 RJ
0145R01102170000409 J-3-13-0 323,900 190,000 RJ
0145R01102170000402 J-3-13-0 323,900 190,000 RJ
0145R01102170000401 Q-5-44-0 190,400 140,000 RJ
0145R01102170000403 Q-5-44-0 190,400 140,000 RJ
0145R01102170000406 Q-5-44-0 190,400 140,000 RJ
0145R01102170000408 Q-5-44-0 190,400 140,000 RJ
0145R01102170000414 Q-5-44-0 190,400 140,000 RJ
0145R01102170000413 Q-5-44-0 190,400 140,000 RJ
0145R01102170000415 J-3-13-0 323,900 190,000 RJ
0145R01102170000416 Q-5-44-0 190,400 140,000 RJ
0145R01102170000417 J-3-13-0 323,900 190,000 RJ
0145R01102170000410 Q-5-44-0 190,400 140,000 RJ
0145R01102170000407 J-3-13-0 323,900 190,000 RJ
0145R01102170000405 J-3-13-0 323,900 190,000 RJ
0145R01102170000411 Q-5-44-0 190,400 140,000 RJ
0145R01102170000438 Q-5-44-0 190,400 140,000 RJ
0145R01102170000436 Q-5-44-0 190,400 140,000 RJ
0145R01102170000440 Q-5-44-0 190,400 140,000 RJ
0145R01102170000435 Q-5-44-0 190,400 140,000 RJ
0145R01102170000439 Q-5-44-0 190,400 140,000 RJ
0145R01102170000437 Q-5-44-0 190,400 140,000 RJ
0145R01102170000434 Q-5-44-0 190,400 140,000 RJ
0145R01102170000430 J-3-13-0 323,900 190,000 RJ
0145R01102170000432 J-3-13-0 323,900 190,000 RJ
0145R01102170000420 J-3-13-0 323,900 190,000 RJ
0145R01102170000422 J-3-13-0 323,900 190,000 RJ
0145R01102170000421 Q-5-44-0 190,400 140,000 RJ
0145R01102170000442 Q-5-44-0 190,400 140,000 RJ
0145R01102170000431 Q-5-44-0 190,400 140,000 RJ
0145R01102170000441 J-3-13-0 323,900 190,000 RJ
0145R01102170000451 J-3-13-0 323,900 190,000 RJ
0145R01102170000443 J-3-13-0 323,900 190,000 RJ
0145R01102170000449 J-3-13-0 323,900 190,000 RJ
0145R01102170000447 J-3-13-0 323,900 190,000 RJ
0145R01102170000446 Q-5-44-0 190,400 140,000 RJ
0145R01102170000453 J-3-13-0 323,900 190,000 RJ
0145R01102170000444 Q-5-44-0 190,400 140,000 RJ

Page 14
 sheet1 1

0145R01102170000452 Q-5-44-0 190,400 140,000 RJ

0145R01102170000454 Q-5-44-0 190,400 140,000 RJ
0145R01102170000445 Q-5-44-0 190,400 140,000 RJ
0145R01102170000450 Q-5-44-0 190,400 140,000 RJ
0145R01102170000455 Q-5-44-0 190,400 140,000 RJ
0145R01102170000462 J-3-13-0 323,900 190,000 RJ
0145R01102170000459 Q-5-44-0 190,400 140,000 RJ
0145R01102170000460 Q-5-44-0 190,400 140,000 RJ
0145R01102170000461 Q-5-44-0 190,400 140,000 RJ
0145R01102170000458 Q-5-44-0 190,400 140,000 RJ
0145R01102170000487 Q-5-44-0 190,400 140,000 RJ
0145R01102170000491 Q-5-44-0 190,400 140,000 RJ
0145R01102170000488 J-3-13-0 323,900 190,000 RJ
0145R01102170000484 J-3-13-0 323,900 190,000 RJ
0145R01102170000485 J-3-13-0 323,900 190,000 RJ
0145R01102170000486 Q-5-44-0 190,400 140,000 RJ
0145R01102170000482 J-3-13-0 323,900 190,000 RJ
0145R01102170000472 Q-5-44-0 190,400 140,000 RJ
0145R01102170000473 Q-5-44-0 190,400 140,000 RJ
0145R01102170000475 Q-5-44-0 190,400 140,000 RJ
0145R01102170000483 J-3-13-0 323,900 190,000 RJ
0145R01102170000476 J-3-13-0 323,900 190,000 RJ
0145R01102170000489 J-3-13-0 323,900 190,000 RJ
0145R01102170000490 Q-5-44-0 190,400 140,000 RJ
0145R01102170000510 Q-5-44-0 190,400 140,000 RJ
0145R01102170000503 Q-5-44-0 190,400 140,000 RJ
0145R01102170000499 Q-5-44-0 190,400 140,000 RJ
0145R01102170000498 Q-5-44-0 190,400 140,000 RJ
0145R01102170000502 Q-5-44-0 190,400 140,000 RJ
0145R01102170000495 J-3-13-0 323,900 190,000 RJ
0145R01102170000494 J-3-13-0 323,900 190,000 RJ
0145R01102170000497 J-3-13-0 323,900 190,000 RJ
0145R01102170000508 J-3-13-0 323,900 190,000 RJ
0145R01102170000496 Q-5-44-0 190,400 140,000 RJ
0145R01102170000511 Q-5-44-0 190,400 140,000 RJ
0145R01102170000507 Q-5-44-0 190,400 140,000 RJ
0145R01102170000512 J-3-13-0 323,900 190,000 RJ
0145R01102170000541 J-3-13-0 323,900 190,000 RJ
0145R01102170000543 Q-5-44-0 190,400 140,000 RJ
0145R01102170000538 Q-5-44-0 190,400 140,000 RJ
0145R01102170000542 Q-5-44-0 190,400 140,000 RJ
0145R01102170000539 Q-5-44-0 190,400 140,000 RJ
0145R01102170000540 Q-5-44-0 190,400 140,000 RJ
0145R01102170000531 Q-5-44-0 190,400 140,000 RJ
0145R01102170000536 J-3-13-0 323,900 190,000 RJ
0145R01102170000518 J-3-13-0 323,900 190,000 RJ
0145R01102170000515 Q-5-44-0 190,400 140,000 RJ
0145R01102170000517 J-3-13-0 323,900 190,000 RJ
0145R01102170000529 Q-5-44-0 190,400 140,000 RJ
0145R01102170000528 J-3-13-0 323,900 190,000 RJ
0145R01102170000516 Q-5-44-0 190,400 140,000 RJ
0145R01102170000514 Q-5-44-0 190,400 140,000 RJ
0145R01102170000527 Q-5-44-0 190,400 140,000 RJ

Page 15
 sheet1 1

0145R01102170000525 Q-5-44-0 190,400 140,000 RJ

0145R01102170000537 J-3-13-0 323,900 190,000 RJ
0145R01102170000524 J-3-13-0 323,900 190,000 RJ
0145R01102170000534 Q-5-44-0 190,400 140,000 RJ
0145R01102170000535 J-3-13-0 323,900 190,000 RJ
0145R01102170000526 Q-5-44-0 190,400 140,000 RJ
0145R01102170000560 Q-5-44-0 190,400 140,000 RJ
0145R01102170000558 Q-5-44-0 190,400 140,000 RJ
0145R01102170000557 Q-5-44-0 190,400 140,000 RJ
0145R01102170000556 J-3-13-0 323,900 190,000 RJ
0145R01102170000545 Q-5-44-0 190,400 140,000 RJ
0145R01102170000551 Q-5-44-0 190,400 140,000 RJ
0145R01102170000566 Q-5-44-0 190,400 140,000 RJ
0145R01102170000563 Q-5-44-0 190,400 140,000 RJ
0145R01102170000565 Q-5-44-0 190,400 190,000 RJ
0145R01102170000562 J-3-13-0 323,900 190,000 RJ
0145R01102170000561 J-3-13-0 323,900 190,000 RJ
0145R01102170000549 J-3-13-0 323,900 190,000 RJ
0145R01102170000550 J-3-13-0 323,900 190,000 RJ
0145R01102170000546 J-3-13-0 323,900 190,000 RJ
0145R01102170000547 Q-5-44-0 190,400 140,000 RJ
0145R01102170000552 Q-5-44-0 190,400 140,000 RJ
0145R01102170000544 J-3-13-0 323,900 190,000 RJ
0145R01102170000553 Q-5-44-0 190,400 140,000 RJ
0145R01102170000564 Q-5-44-0 190,400 140,000 RJ
95,008,300 63,000,000

Page 16