Realisasi R.i Okt-nov.xlsx
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DAFTAR REALISASI PENERIMAAN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPIT JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK NO A 1 2 3 4 5 6 7 8 9
RAWAT INAP (40 %)
AMBULANCE (60 %) JANUARI
NAMA PASIEN
YANG MENERIMA NAMA PETUGAS NAMA SOPIR GOLONGAN
Rp.
Kurna Pansa Yunizir Darima Abu Aras Teri Indri Oktari Zulkifli Oramahi Rita Afriyanti Roni Pazlan
Aida Fitri, A. Md Kep Kusmiati, A. Md keb Aida Fitri, A. Md Kep Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Sulistia Ningsih, A.Md Keb Kusmiati, A. Md keb
Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II d II c II d II c II d II d II d II d II c
Rp Rp Rp Rp Rp Rp Rp Rp Rp
32,400 94,200 32,400 32,400 32,400 32,400 32,400 32,400 32,400
Venturinifernanda Syafar Darmy Mursal Ramli M.Fauzan Al-Qadri Saja Sutartih Ayu Permata Sari Okta Indriyanti
Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Aida Fitri, A. Md Kep Kusmiati, A. Md keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb
Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II c II c II d II d II d II d II d II d II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp
32,400 32,400 32,400 32,400 32,400 32,400 32,400 32,400 94,500
Dahlan Syaifullah Nunung Yuliani
Kusmiati, A. Md keb Aida Fitri, A. Md Kep
Very Nofrizal Very Nofrizal
II c II d
Rp Rp
32,400 32,400
FEBRUARI 1 2 3 4 5 6 7 8 9
1 2
MARET
JUMLAH PAJAK (SESUAI GOL)
3 4 5 6 7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
APRIL
1 2 3 4 5 6 7 8
MEI
Sakiah Nurhayati Joli M. Rahli Sadri Sofian
Sulistia Ningsih, A.Md Keb Kusmiati, A. Md keb Juniwarti, A. Md Keb Rita Suryani, A.Md Keb Sulistia Ningsih, A.Md Keb
Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal
II c II c II d II d II c
Rp Rp Rp Rp Rp
32,400 32,400 32,400 32,400 32,400
Siti Nur Suci Amelia Maghdalena Deli Yuniarti Hamidah Khofifah Oktharen Agusniar Desmawati Rosadi Hamid Rati Edison Chan Yosra Dini Buyoang Ahmad Gusnawati Haiyati Noval Permana Anggi Lesta Luhu
Juniwarti, A. Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Rita Suryani, A.Md Keb Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Kusmiati, A. Md keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Yossi Satriani, A. Md Kep Yossi Satriani, A. Md Kep Aida Fitri, A. Md Kep
Very Nofrizal Very Nofrizal Sudarman Sudarman Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II d II d II d II d II c II c II d II c II d II d II d II d II d II c II c II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
32,400 32,400 32,400 32,400 32,400 351,000 32,400 32,400 32,400 32,400 32,400 32,400 32,400 94,500 94,500 32,400
Wahyu Sumbar Darwin Rani Sri Wahyuni Desmeri Jusmaini Ali Anwar Yudarmiati Agmi Purnama
Kusmiati, A. Md keb Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Yossi Satriani, A. Md Kep Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep
Sudarman Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II c II d II d II c II c II c II d II d
Rp Rp Rp Rp Rp Rp Rp Rp
126,000 43,200 43,200 43,200 43,200 43,200 234,000 126,000
9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 2 3 4 5 6 7 8 9 10 11 12 13 14
JUNI
Azwar Arlius Eka Putra Noval Permana Elvirawati Yayat Muhayat M Lizar Rapiyus Zeldi Welfi Jama Yusmanidar Hasri Firdaus B Jalanun Saleh Sawir Hendra joni
Kusmiati, A. Md keb Juniwarti, A. Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Kusmiati, A. Md keb Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep
Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Sudarman Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II c II d II d II d II d II c II c II c II c II d II d II c II d II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
309,600 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200
Dzaka Khairi Surtik Delita Hefni Rapiyus Alvino Mailandro Latifah M. Fariz Ruslan Agustar Sondong Aisam Asril Syabirin Monaliza Zoraida
Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Juniwarti, A. Md Keb Juniwarti, A. Md Keb Rita Suryani, A.Md Keb Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb Yossi Satriani, A. Md Kep Yossi Satriani, A. Md Kep Kusmiati, A. Md keb Rita Suryani, A.Md Keb Juniwarti, A. Md Keb Juniwarti, A. Md Keb
Very Nofrizal Very Nofrizal Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II d II d II d II d II d II d II d II c II c II c II c II d II d II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
180,000 43,200 126,000 43,200 43,200 43,200 43,200 43,200 180,000 43,200 43,200 255,000 43,200 43,200
Setuju dibayar Kuasa Pengguna Anggaran Pimpinan Puskesmas
dr. Sulistia Rossa Nip. 19720307 200212 2 002
AN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK JUMLAH DITERIMA PETUGAS
DITERIMA SOPIR
NO REKENING PETUGAS
NO REKENING SOPIR
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 47,100 16,200 16,200 16,200 16,200 16,200 16,200 16,200
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 47,100 16,200 16,200 16,200 16,200 16,200 16,200 16,200
0700. 0203. 05186 - 5 0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0207. 04827 - 7 0700. 0210. 03773 - 8
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250
0700. 0210. 03773 - 8 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0203. 05186 - 5 0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0210. 03773 - 8 0700. 0207. 04827 - 7
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp
16,200 Rp 16,200 Rp
16,200 16,200
0700. 0210. 03773 - 8 0700. 0203. 05186 - 5
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
KETERANGAN
Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200
Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 113,400
0700. 0207. 04827 - 7 0700. 0210. 03773 - 8 0700. 0210. 09270 - 0 0700. 0207. 06214 - 6 0700. 0207. 04827 - 7
0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 175,500 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250 47,250 16,200
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 175,500 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250 47,250 16,200
0700. 0210. 09270 - 0 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0207. 06214 - 6 0700. 0210. 03773 - 8 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0210. 03773 - 8 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0210. 03890 - 0 0700. 0210. 03890 - 0 0700. 0203. 05186 - 5
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp
63,000 21,600 21,600 21,600 21,600 21,600 117,000 63,000
Rp Rp Rp Rp Rp Rp Rp Rp
63,000 21,600 21,600 21,600 21,600 21,600 117,000 63,000
0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0210. 03890 - 0 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5
0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
154,800 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
154,800 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600
0700. 0210. 03773 - 8 0700. 0210. 09270 - 0 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5
0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
90,000 21,600 63,000 21,600 21,600 21,600 21,600 21,600 90,000 21,600 21,600 127,500 21,600 21,600
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
90,000 21,600 63,000 21,600 21,600 21,600 21,600 21,600 90,000 21,600 21,600 127,500 21,600 21,600
0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0210. 09270 - 0 0700. 0210. 09270 - 0 0700. 0207. 06214 - 6 0700. 0210. 03773 - 8 0700. 0207. 04827 - 7 0700. 0210. 03890 - 0 0700. 0210. 03890 - 0 0700. 0210. 03773 - 8 0700. 0207. 06214 - 6 0700. 0210. 09270 - 0 0700. 0210. 09270 - 0
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Lunas Tanggal Bendahara Pengeluaran
Dewi Setia Ningsih, Amd Keb
DAFTAR REALISASI PENERIMAAN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI OKTOBER S/D NOVEMBER 2015 PUSKESMAS GAMBOK NO A 1
2
3
4
5
RAWAT INAP (40 %) OKTOBER
NAMA PASIEN
AMBULANCE (60 %)
Agus Triananda
Yandra
Amarwati
Wardi Agus
Linda Eka Fitri
YANG MENERIMA GOLONGAN NAMA dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Ricenovira Fatroza, A. Md Keb Juniwarti, A. Md Keb
dr. Ricenovira Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Ricenovira Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Ricenovira Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
Rp. Rp
Rp
Rp
Rp
Rp
DITERIMA
JUMLAH PAJAK (SESUAI GOL)
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
2,400 600 3,000 7,200 1,800 9,000 7,200 1,800 9,000 4,800 1,200 6,000 7,200 1,800 9,000
6
7
8
9
10
11
12
Bayu Arga Geovani
Idris
Hayatul Hanifah
Jamaidar
Andriko Lexmana
Awalidin
Devin Yusbarasyid
dr. Ricenovira Fatroza, A. Md Keb Juniwarti, A. Md Keb
dr. Ricenovira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Ricenovira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Juniwarti, A. Md Keb
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II d
IV a III c II d
Rp
Rp
Rp
Rp
Rp
Rp
Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
4,800 1,200 6,000 2,400 600 3,000 7,200 1,800 9,000 4,800 1,200 6,000 4,800 1,200 6,000 7,200 1,800 9,000 2,400 600
13
Nelbahren
14
Hendri Miko
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
IV a III c II d
IV a III c II c
Rp
Rp
Rp B 1
2
3
4
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp 1,120,000
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
3,000 2,400 600 3,000
NOVEMBER Sumarni
M. Aidil
Erna Wilis
Sriyana
dr. Febriyanti Tabri Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Ricenovira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
Rp
Rp
Rp
Rp
2,400 600 3,000 7,200 1,800 9,000 4,800 1,200 6,000 2,400 600 3,000
5
Mukhsis Putra
dr. Febriyanti Tabri Fatroza, A. Md Keb Aida Fitri, A. Md Kep
IV a III c II d
Rp
Rp
Setuju dibayar Kuasa Pengguna Anggaran Pimpinan Puskesmas
dr. Sulistia Rossa Nip. 19720307 200212 2 002
40,000 Rp Rp Rp Rp 320,000 1,440,000
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600 3,000
N PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI OBER S/D NOVEMBER 2015 PUSKESMAS GAMBOK JUMLAH
NO REKENING
JUMLAH Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
KETERANGAN
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp Rp
13,600 11,400 12,000 37,000 1,036,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp Rp
13,600 11,400 12,000 37,000 296,000 1,332,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Lunas Tanggal Bendahara Pengeluaran
Dewi Setia Ningsih, Amd Keb
DAFTAR REALISASI PENERIMAAN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK NO A 1
2
3
4
5
RAWAT INAP (40 %) JANUARI
NAMA PASIEN
AMBULANCE (60 %)
Maryatinar
Yunizir
Syafar darmi
Yoga Evsa Pradifta
Putra Hendri
YANG MENERIMA GOLONGAN NAMA dr. Roosmira. B Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
Rp. Rp
Rp
Rp
Rp
Rp
DITERIMA
JUMLAH PAJAK (SESUAI GOL)
240,000 Rp Rp Rp Rp
96,000 Rp 72,000 Rp 72,000 240,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
14,400 3,600 18,000 7,200 1,800 9,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000
6
7
8
9
10
11
12
Sarmilis
Murdi
Suni
Adrizal SE
Mohammad Edwar
Abu Aras
Saminah
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II d
IV a III c II d
Rp
Rp
Rp
Rp
Rp
Rp
Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
4,800 1,200 6,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200 6,000 2,400 600 3,000 2,400 600 3,000 2,400 600
13
14
15
16
17
18
19
Teri
Fajrios Rahmat. A
Deri Yoelinmas
Aflah Zaki Fitri
Kemala Gusti
Jurianis
Zulgafar HZ
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Rice Novira
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II c
IV a
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
6,000
40,000 Rp
16,000 Rp
2,400
3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200
Fatroza, A. Md Keb Aida Fitri, A. Md Kep
B 1
2
3
4
5
6
III c II d
Rp Rp Rp
12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
600 3,000
FEBRUARI Warni Desrika
Syafar Darmi
Hamiruddin
Kurna pansa
Rafil Reptio. W
Nurbaida
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
Rp
Rp
Rp
Rp
Rp
Rp
7,200 1,800 9,000 7,200 1,800 9,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600
7
8
9
10
11
12
13
Asmin Halim
Suci Fauziah. A
Asnimar
Suryadarma
Teri
Hayati
Ronaldi
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
3,000
40,000 Rp
16,000 Rp
2,400
3,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000 2,400 600 3,000 2,400 600
Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
14
Riani Komaladewi
15
Mery Fra Wilfasari
16
C 1
2
3
Sutartih
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
III c II c
IV a III c II d
IV a III c II c
IV a III c II d
Rp
Rp
Rp
Rp Rp Rp
12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
600 3,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000
MARET Rosmalati
Mardialis
Azwar
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
Rp
Rp
Rp
2,400 600 3,000 2,400 600 3,000 2,400 600
4
5
6
7
8
9
10
Yurba Yani
Edi Sarmika
Nurhayati
Effendi
Hasninurdawilis
Ajroni
M. Rahli Sadri
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Rice Novira Fatroza, A. Md Keb Yossi Satriani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
3,000
40,000 Rp
16,000 Rp
2,400
3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200 6,000 2,400 600
Fatroza, A. Md Keb Aida Fitri, A. Md Kep
11
D 1
2
3
4
5
Sofian
dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
III c II d
IV a III c II c
Rp
Rp Rp Rp
12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000
16,000 12,000 12,000 40,000
600 3,000 2,400 600 3,000
APRIL Afriyenni
Helmiati
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
Safii Manti Penghulu dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
Rosniwilis
Ruswan SE
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
40,000
40,000
40,000
40,000
16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000
2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600
6
Reni Miftahul Dani
7
Susilawati SE
8
Yosra Dini
9
Avianti
10
Syafni warti
11
E
Akbar Yafi
MEI
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
40,000
80,000
40,000
80,000
80,000
40,000
40,000
3,000
16,000 12,000 12,000 40,000
2,400 600
32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000 32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000
3,000 4,800 1,200 6,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000 2,400 600 3,000
1
2
3
4
5
6
7
Katik Taher
Lili Asrita
Subek
M. Deffin Alifiando
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md keb
Anastasya Putri Afka dr. Rice Novira Fatroza, A. Md Keb Juniwarti, A. Md Keb
Yusnawati
Asnimar
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Yossi Satriani, A. Md kep
IV a III c
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II d
IV a III c II c
160,000
40,000
80,000
40,000
40,000
160,000
80,000
64,000 48,000 48,000 160,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 64,000 48,000 48,000 160,000 32,000 24,000 24,000
9,600 2,400 12,000 2,400 600 3,000 4,800 1,200 6,000 2,400 600 3,000 2,400 600 3,000 9,600 2,400 12,000 4,800 1,200
8
9
10
11
12
13
14
Rezki Akbar
Arlius Eka Putra
Kurnia Fitri
Rapiyus
Mawardi
Jalanun Saleh
Yarpendi
dr. Rice Novira Fatroza, A. Md Keb Juniwarti, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A.Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Rita Suryani, A.Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md kep
dr. Sulistia Rossa
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II d
IV a
40,000
40,000
40,000
40,000
80,000
40,000
40,000
80,000
6,000
16,000 12,000 12,000 40,000
2,400 600
16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000
3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200 6,000
16,000 12,000 12,000 40,000
2,400 600 3,000
16,000
2,400
Fatroza, A. Md Keb Aida Fitri, A. Md kep
F 1
2
3
4
5
6
III c II d
12,000 12,000 40,000
600 3,000
JUNI Gustilawati
dr. Rice Novira Fatroza, A. Md Keb Juniwarti, A. Md Keb
Tsafiq Ahmad Naufal dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md keb
Idrus
Nopa
Latifah
Ostim, BE
dr. Rice Novira Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Juniwarti, A.Md keb
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II d
IV a III c II d
IV a III c II d
80,000
40,000
80,000
80,000
120,000
40,000
32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000 32,000 24,000 24,000 80,000 48,000 36,000 36,000 120,000 16,000 12,000 12,000
4,800 1,200 6,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000 7,200 1,800 9,000 2,400 600
40,000
Setuju dibayar Kuasa Pengguna Anggaran Pimpinan Puskesmas
dr. Sulistia Rossa Nip. 19720307 200212 2 002
3,000
AN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK JUMLAH
NO REKENING
JUMLAH Rp Rp Rp Rp
81,600 68,400 72,000 222,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp
40,800 34,200
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp
75,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
KETERANGAN
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0203. 05186 - 5 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0203. 05186 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp
13,600
0700. 0210. 09043 - 0
Rp Rp Rp
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp
13,600
0700. 0210. 10421 - 0
Rp Rp Rp
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp
13,600
0700. 0210. 09043 - 0
Rp Rp Rp
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
13,600 11,400 12,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
37,000 13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
54,400 45,600 48,000 148,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
54,400 45,600 48,000 148,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
27,200 22,800 24,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
74,000 13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
13,600 11,400 12,000 37,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600
0700. 0210. 10421 - 0
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
40,800 34,200 36,000 111,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
37,000
Lunas Tanggal Bendahara Pengeluaran
Dewi Setia Ningsih, Amd Keb
RAWAT INAP (40 %)
AMBULANCE (60 %) JANUARI
NAMA PASIEN
YANG MENERIMA NAMA PETUGAS NAMA SOPIR GOLONGAN
Rp.
Kurna Pansa Yunizir Darima Abu Aras Teri Indri Oktari Zulkifli Oramahi Rita Afriyanti Roni Pazlan
Aida Fitri, A. Md Kep Kusmiati, A. Md keb Aida Fitri, A. Md Kep Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Sulistia Ningsih, A.Md Keb Kusmiati, A. Md keb
Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II d II c II d II c II d II d II d II d II c
Rp Rp Rp Rp Rp Rp Rp Rp Rp
32,400 94,200 32,400 32,400 32,400 32,400 32,400 32,400 32,400
Venturinifernanda Syafar Darmy Mursal Ramli M.Fauzan Al-Qadri Saja Sutartih Ayu Permata Sari Okta Indriyanti
Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Aida Fitri, A. Md Kep Kusmiati, A. Md keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb
Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II c II c II d II d II d II d II d II d II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp
32,400 32,400 32,400 32,400 32,400 32,400 32,400 32,400 94,500
Dahlan Syaifullah Nunung Yuliani
Kusmiati, A. Md keb Aida Fitri, A. Md Kep
Very Nofrizal Very Nofrizal
II c II d
Rp Rp
32,400 32,400
FEBRUARI 1 2 3 4 5 6 7 8 9
1 2
MARET
JUMLAH PAJAK (SESUAI GOL)
3 4 5 6 7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
APRIL
1 2 3 4 5 6 7 8
MEI
Sakiah Nurhayati Joli M. Rahli Sadri Sofian
Sulistia Ningsih, A.Md Keb Kusmiati, A. Md keb Juniwarti, A. Md Keb Rita Suryani, A.Md Keb Sulistia Ningsih, A.Md Keb
Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal
II c II c II d II d II c
Rp Rp Rp Rp Rp
32,400 32,400 32,400 32,400 32,400
Siti Nur Suci Amelia Maghdalena Deli Yuniarti Hamidah Khofifah Oktharen Agusniar Desmawati Rosadi Hamid Rati Edison Chan Yosra Dini Buyoang Ahmad Gusnawati Haiyati Noval Permana Anggi Lesta Luhu
Juniwarti, A. Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Rita Suryani, A.Md Keb Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Kusmiati, A. Md keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Yossi Satriani, A. Md Kep Yossi Satriani, A. Md Kep Aida Fitri, A. Md Kep
Very Nofrizal Very Nofrizal Sudarman Sudarman Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II d II d II d II d II c II c II d II c II d II d II d II d II d II c II c II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
32,400 32,400 32,400 32,400 32,400 351,000 32,400 32,400 32,400 32,400 32,400 32,400 32,400 94,500 94,500 32,400
Wahyu Sumbar Darwin Rani Sri Wahyuni Desmeri Jusmaini Ali Anwar Yudarmiati Agmi Purnama
Kusmiati, A. Md keb Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Yossi Satriani, A. Md Kep Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep
Sudarman Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II c II d II d II c II c II c II d II d
Rp Rp Rp Rp Rp Rp Rp Rp
126,000 43,200 43,200 43,200 43,200 43,200 234,000 126,000
9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 2 3 4 5 6 7 8 9 10 11 12 13 14
JUNI
Azwar Arlius Eka Putra Noval Permana Elvirawati Yayat Muhayat M Lizar Rapiyus Zeldi Welfi Jama Yusmanidar Hasri Firdaus B Jalanun Saleh Sawir Hendra joni
Kusmiati, A. Md keb Juniwarti, A. Md Keb Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Sulistia Ningsih, A.Md Keb Kusmiati, A. Md keb Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Sulistia Ningsih, A.Md Keb Rita Suryani, A.Md Keb Aida Fitri, A. Md Kep
Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Sudarman Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II c II d II d II d II d II c II c II c II c II d II d II c II d II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
309,600 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200 43,200
Dzaka Khairi Surtik Delita Hefni Rapiyus Alvino Mailandro Latifah M. Fariz Ruslan Agustar Sondong Aisam Asril Syabirin Monaliza Zoraida
Aida Fitri, A. Md Kep Aida Fitri, A. Md Kep Juniwarti, A. Md Keb Juniwarti, A. Md Keb Juniwarti, A. Md Keb Rita Suryani, A.Md Keb Kusmiati, A. Md keb Sulistia Ningsih, A.Md Keb Yossi Satriani, A. Md Kep Yossi Satriani, A. Md Kep Kusmiati, A. Md keb Rita Suryani, A.Md Keb Juniwarti, A. Md Keb Juniwarti, A. Md Keb
Very Nofrizal Very Nofrizal Very Nofrizal Sudarman Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal Very Nofrizal
II d II d II d II d II d II d II d II c II c II c II c II d II d II d
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
180,000 43,200 126,000 43,200 43,200 43,200 43,200 43,200 180,000 43,200 43,200 255,000 43,200 43,200
Setuju dibayar Kuasa Pengguna Anggaran Pimpinan Puskesmas
dr. Sulistia Rossa Nip. 19720307 200212 2 002
AN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK JUMLAH DITERIMA PETUGAS
DITERIMA SOPIR
NO REKENING PETUGAS
NO REKENING SOPIR
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 47,100 16,200 16,200 16,200 16,200 16,200 16,200 16,200
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 47,100 16,200 16,200 16,200 16,200 16,200 16,200 16,200
0700. 0203. 05186 - 5 0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0207. 04827 - 7 0700. 0210. 03773 - 8
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250
Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250
0700. 0210. 03773 - 8 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0203. 05186 - 5 0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0210. 03773 - 8 0700. 0207. 04827 - 7
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp
16,200 Rp 16,200 Rp
16,200 16,200
0700. 0210. 03773 - 8 0700. 0203. 05186 - 5
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
KETERANGAN
Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200
Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 113,400
0700. 0207. 04827 - 7 0700. 0210. 03773 - 8 0700. 0210. 09270 - 0 0700. 0207. 06214 - 6 0700. 0207. 04827 - 7
0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 175,500 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250 47,250 16,200
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
16,200 16,200 16,200 16,200 16,200 175,500 16,200 16,200 16,200 16,200 16,200 16,200 16,200 47,250 47,250 16,200
0700. 0210. 09270 - 0 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0207. 06214 - 6 0700. 0210. 03773 - 8 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0210. 03773 - 8 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0210. 03890 - 0 0700. 0210. 03890 - 0 0700. 0203. 05186 - 5
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp
63,000 21,600 21,600 21,600 21,600 21,600 117,000 63,000
Rp Rp Rp Rp Rp Rp Rp Rp
63,000 21,600 21,600 21,600 21,600 21,600 117,000 63,000
0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0210. 03890 - 0 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5
0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
154,800 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
154,800 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600 21,600
0700. 0210. 03773 - 8 0700. 0210. 09270 - 0 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0207. 04827 - 7 0700. 0210. 03773 - 8 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0207. 04827 - 7 0700. 0207. 06214 - 6 0700. 0203. 05186 - 5
0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
90,000 21,600 63,000 21,600 21,600 21,600 21,600 21,600 90,000 21,600 21,600 127,500 21,600 21,600
Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp Rp
90,000 21,600 63,000 21,600 21,600 21,600 21,600 21,600 90,000 21,600 21,600 127,500 21,600 21,600
0700. 0203. 05186 - 5 0700. 0203. 05186 - 5 0700. 0210. 09270 - 0 0700. 0210. 09270 - 0 0700. 0210. 09270 - 0 0700. 0207. 06214 - 6 0700. 0210. 03773 - 8 0700. 0207. 04827 - 7 0700. 0210. 03890 - 0 0700. 0210. 03890 - 0 0700. 0210. 03773 - 8 0700. 0207. 06214 - 6 0700. 0210. 09270 - 0 0700. 0210. 09270 - 0
0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0201. 03619 - 2 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3 0700. 0210. 12512 - 3
Lunas Tanggal Bendahara Pengeluaran
Dewi Setia Ningsih, Amd Keb
DAFTAR REALISASI PENERIMAAN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI OKTOBER S/D NOVEMBER 2015 PUSKESMAS GAMBOK NO A 1
2
3
4
5
RAWAT INAP (40 %) OKTOBER
NAMA PASIEN
AMBULANCE (60 %)
Agus Triananda
Yandra
Amarwati
Wardi Agus
Linda Eka Fitri
YANG MENERIMA GOLONGAN NAMA dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Ricenovira Fatroza, A. Md Keb Juniwarti, A. Md Keb
dr. Ricenovira Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Ricenovira Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Ricenovira Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
Rp. Rp
Rp
Rp
Rp
Rp
DITERIMA
JUMLAH PAJAK (SESUAI GOL)
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
2,400 600 3,000 7,200 1,800 9,000 7,200 1,800 9,000 4,800 1,200 6,000 7,200 1,800 9,000
6
7
8
9
10
11
12
Bayu Arga Geovani
Idris
Hayatul Hanifah
Jamaidar
Andriko Lexmana
Awalidin
Devin Yusbarasyid
dr. Ricenovira Fatroza, A. Md Keb Juniwarti, A. Md Keb
dr. Ricenovira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Ricenovira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Juniwarti, A. Md Keb
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II d
IV a III c II d
Rp
Rp
Rp
Rp
Rp
Rp
Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
4,800 1,200 6,000 2,400 600 3,000 7,200 1,800 9,000 4,800 1,200 6,000 4,800 1,200 6,000 7,200 1,800 9,000 2,400 600
13
Nelbahren
14
Hendri Miko
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
IV a III c II d
IV a III c II c
Rp
Rp
Rp B 1
2
3
4
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp 1,120,000
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
3,000 2,400 600 3,000
NOVEMBER Sumarni
M. Aidil
Erna Wilis
Sriyana
dr. Febriyanti Tabri Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Ricenovira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
Rp
Rp
Rp
Rp
2,400 600 3,000 7,200 1,800 9,000 4,800 1,200 6,000 2,400 600 3,000
5
Mukhsis Putra
dr. Febriyanti Tabri Fatroza, A. Md Keb Aida Fitri, A. Md Kep
IV a III c II d
Rp
Rp
Setuju dibayar Kuasa Pengguna Anggaran Pimpinan Puskesmas
dr. Sulistia Rossa Nip. 19720307 200212 2 002
40,000 Rp Rp Rp Rp 320,000 1,440,000
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600 3,000
N PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI OBER S/D NOVEMBER 2015 PUSKESMAS GAMBOK JUMLAH
NO REKENING
JUMLAH Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
KETERANGAN
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp Rp
13,600 11,400 12,000 37,000 1,036,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp Rp
13,600 11,400 12,000 37,000 296,000 1,332,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Lunas Tanggal Bendahara Pengeluaran
Dewi Setia Ningsih, Amd Keb
DAFTAR REALISASI PENERIMAAN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK NO A 1
2
3
4
5
RAWAT INAP (40 %) JANUARI
NAMA PASIEN
AMBULANCE (60 %)
Maryatinar
Yunizir
Syafar darmi
Yoga Evsa Pradifta
Putra Hendri
YANG MENERIMA GOLONGAN NAMA dr. Roosmira. B Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
Rp. Rp
Rp
Rp
Rp
Rp
DITERIMA
JUMLAH PAJAK (SESUAI GOL)
240,000 Rp Rp Rp Rp
96,000 Rp 72,000 Rp 72,000 240,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
14,400 3,600 18,000 7,200 1,800 9,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000
6
7
8
9
10
11
12
Sarmilis
Murdi
Suni
Adrizal SE
Mohammad Edwar
Abu Aras
Saminah
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II d
IV a III c II d
Rp
Rp
Rp
Rp
Rp
Rp
Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
4,800 1,200 6,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200 6,000 2,400 600 3,000 2,400 600 3,000 2,400 600
13
14
15
16
17
18
19
Teri
Fajrios Rahmat. A
Deri Yoelinmas
Aflah Zaki Fitri
Kemala Gusti
Jurianis
Zulgafar HZ
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Roosmira. B Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Rice Novira
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II c
IV a
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
6,000
40,000 Rp
16,000 Rp
2,400
3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200
Fatroza, A. Md Keb Aida Fitri, A. Md Kep
B 1
2
3
4
5
6
III c II d
Rp Rp Rp
12,000 Rp 12,000 40,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
120,000 Rp Rp Rp Rp
48,000 Rp 36,000 Rp 36,000 120,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
600 3,000
FEBRUARI Warni Desrika
Syafar Darmi
Hamiruddin
Kurna pansa
Rafil Reptio. W
Nurbaida
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
Rp
Rp
Rp
Rp
Rp
Rp
7,200 1,800 9,000 7,200 1,800 9,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600
7
8
9
10
11
12
13
Asmin Halim
Suci Fauziah. A
Asnimar
Suryadarma
Teri
Hayati
Ronaldi
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Rice Novira Fatroza, A. Md Keb Kusmiati , A.Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
IV a
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
3,000
40,000 Rp
16,000 Rp
2,400
3,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000 2,400 600 3,000 2,400 600
Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
14
Riani Komaladewi
15
Mery Fra Wilfasari
16
C 1
2
3
Sutartih
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
III c II c
IV a III c II d
IV a III c II c
IV a III c II d
Rp
Rp
Rp
Rp Rp Rp
12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp
16,000 Rp 12,000 Rp 12,000
600 3,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000
MARET Rosmalati
Mardialis
Azwar
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
Rp
Rp
Rp
2,400 600 3,000 2,400 600 3,000 2,400 600
4
5
6
7
8
9
10
Yurba Yani
Edi Sarmika
Nurhayati
Effendi
Hasninurdawilis
Ajroni
M. Rahli Sadri
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Rice Novira Fatroza, A. Md Keb Yossi Satriani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a
Rp
Rp
Rp
Rp
Rp
Rp
Rp
Rp
40,000 Rp
3,000
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
2,400 600
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
80,000 Rp Rp Rp Rp
32,000 Rp 24,000 Rp 24,000 80,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
3,000
40,000 Rp
16,000 Rp
2,400
3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200 6,000 2,400 600
Fatroza, A. Md Keb Aida Fitri, A. Md Kep
11
D 1
2
3
4
5
Sofian
dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
III c II d
IV a III c II c
Rp
Rp Rp Rp
12,000 Rp 12,000 40,000 Rp
40,000 Rp Rp Rp Rp
16,000 Rp 12,000 Rp 12,000 40,000 Rp
40,000
16,000 12,000 12,000 40,000
600 3,000 2,400 600 3,000
APRIL Afriyenni
Helmiati
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
Safii Manti Penghulu dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
Rosniwilis
Ruswan SE
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II c
40,000
40,000
40,000
40,000
16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000
2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 2,400 600
6
Reni Miftahul Dani
7
Susilawati SE
8
Yosra Dini
9
Avianti
10
Syafni warti
11
E
Akbar Yafi
MEI
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Sulistia Ningsih, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md Keb
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II c
IV a III c II c
40,000
80,000
40,000
80,000
80,000
40,000
40,000
3,000
16,000 12,000 12,000 40,000
2,400 600
32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000 32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000
3,000 4,800 1,200 6,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000 2,400 600 3,000
1
2
3
4
5
6
7
Katik Taher
Lili Asrita
Subek
M. Deffin Alifiando
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Kusmiati, A. Md keb
Anastasya Putri Afka dr. Rice Novira Fatroza, A. Md Keb Juniwarti, A. Md Keb
Yusnawati
Asnimar
dr. Rice Novira Fatroza, A. Md Keb Aida Fitri, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Yossi Satriani, A. Md kep
IV a III c
IV a III c II c
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II d
IV a III c II c
160,000
40,000
80,000
40,000
40,000
160,000
80,000
64,000 48,000 48,000 160,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 64,000 48,000 48,000 160,000 32,000 24,000 24,000
9,600 2,400 12,000 2,400 600 3,000 4,800 1,200 6,000 2,400 600 3,000 2,400 600 3,000 9,600 2,400 12,000 4,800 1,200
8
9
10
11
12
13
14
Rezki Akbar
Arlius Eka Putra
Kurnia Fitri
Rapiyus
Mawardi
Jalanun Saleh
Yarpendi
dr. Rice Novira Fatroza, A. Md Keb Juniwarti, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md Keb
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A.Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Rita Suryani, A.Md Keb
dr. Sulistia Rossa Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Aida Fitri, A. Md kep
dr. Sulistia Rossa
IV a III c II d
IV a III c II c
IV a III c II d
IV a III c II d
IV a III c II c
IV a III c II d
IV a
40,000
40,000
40,000
40,000
80,000
40,000
40,000
80,000
6,000
16,000 12,000 12,000 40,000
2,400 600
16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000
3,000 2,400 600 3,000 2,400 600 3,000 2,400 600 3,000 4,800 1,200 6,000
16,000 12,000 12,000 40,000
2,400 600 3,000
16,000
2,400
Fatroza, A. Md Keb Aida Fitri, A. Md kep
F 1
2
3
4
5
6
III c II d
12,000 12,000 40,000
600 3,000
JUNI Gustilawati
dr. Rice Novira Fatroza, A. Md Keb Juniwarti, A. Md Keb
Tsafiq Ahmad Naufal dr. Rice Novira Fatroza, A. Md Keb Kusmiati, A. Md keb
Idrus
Nopa
Latifah
Ostim, BE
dr. Rice Novira Fatroza, A. Md Keb Yossi Satriani, A. Md Kep
dr. Rice Novira Fatroza, A. Md Keb Rita Suryani, A. Md Keb
dr. Febriyanti Tabri Fatroza, A. Md Keb Aida Fitri, A. Md Kep
dr. Sulistia Rossa Fatroza, A. Md Keb Juniwarti, A.Md keb
IV a III c II d
IV a III c II c
IV a III c II c
IV a III c II d
IV a III c II d
IV a III c II d
80,000
40,000
80,000
80,000
120,000
40,000
32,000 24,000 24,000 80,000 16,000 12,000 12,000 40,000 32,000 24,000 24,000 80,000 32,000 24,000 24,000 80,000 48,000 36,000 36,000 120,000 16,000 12,000 12,000
4,800 1,200 6,000 2,400 600 3,000 4,800 1,200 6,000 4,800 1,200 6,000 7,200 1,800 9,000 2,400 600
40,000
Setuju dibayar Kuasa Pengguna Anggaran Pimpinan Puskesmas
dr. Sulistia Rossa Nip. 19720307 200212 2 002
3,000
AN PEMBAYARAN JASA PELAYANAN KLAIM NON KAPITASI JANUARI S/D JUNI 2015 PUSKESMAS GAMBOK JUMLAH
NO REKENING
JUMLAH Rp Rp Rp Rp
81,600 68,400 72,000 222,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp
40,800 34,200
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp
75,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0271.01.004055. 50 9 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
KETERANGAN
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0203. 05186 - 5 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0203. 05186 - 5 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp
13,600
0700. 0210. 09043 - 0
Rp Rp Rp
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
40,800 34,200 36,000 111,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp
13,600
0700. 0210. 10421 - 0
Rp Rp Rp
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp
37,000
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
Rp
13,600
0700. 0210. 09043 - 0
Rp Rp Rp
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
Rp Rp Rp Rp
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
13,600 11,400 12,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
37,000 13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 04827 - 7
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
54,400 45,600 48,000 148,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
54,400 45,600 48,000 148,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
27,200 22,800 24,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
74,000 13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
13,600 11,400 12,000 37,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
27,200 22,800 24,000 74,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
13,600 11,400 12,000 37,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600
0700. 0210. 10421 - 0
11,400 12,000 37,000
0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
13,600 11,400 12,000 37,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03773 - 8
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0210. 03890 - 0
27,200 22,800 24,000 74,000
0700. 0210. 09043 - 0 0700. 0210. 10401 - 6 0700. 0207. 06214 - 6
40,800 34,200 36,000 111,000
0700. 0210. 13497 - 5 0700. 0210. 10401 - 6 0700. 0203. 05186 - 5
13,600 11,400 12,000
0700. 0210. 10421 - 0 0700. 0210. 10401 - 6 0700. 0210. 09270 - 0
37,000
Lunas Tanggal Bendahara Pengeluaran
Dewi Setia Ningsih, Amd Keb
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