DAFTAR PENERIMAAN BANTUAN TRANSPORT SUSPEC TB PARU

DALAM RANGKA KEGIATAN SCREENING TB PARU DI MASYARAKAT KEC. KLEDUNG KAB. TEMANGGUNG
PADA TANGGAL 20 OKTOBER TH 2016
TEMPAT : BALAI DESA KLEDUNG
NAMA

SUSPEC

UMUR

NO

NIK

ALAMAT

45

3323176906620001

Kruwisan

60

3323171007000147

69

UNIT COST
( Rp )

PPH.Psl 21 6%
( Rp )

JML DITERIMA
( Rp )

TANDA TANG

25,000.00

1,500.00

23,500.00

Tlahab

25,000.00

1,500.00

23,500.00

3323171409500001

Tlahab

25,000.00

1,500.00

23,500.00

60

3323171008470001

Tlahab

25,000.00

1,500.00

23,500.00

70

3323173017980001

Paponan

25,000.00

1,500.00

23,500.00

50

3323174608700001

Kwd Gunung

25,000.00

1,500.00

23,500.00

17

3323170911001000

Batursari

25,000.00

1,500.00

23,500.00

70

3323170512450001

Kwd Gunung

25,000.00

1,500.00

23,500.00

74

3323174607410001

Petarangan

25,000.00

1,500.00

23,500.00

10

43

3323175909040001

Tlahab

25,000.00

1,500.00

23,500.00 10

11

55

3323170909550001

Tuksari

25,000.00

1,500.00

23,500.00

12

51

3323171452650003

Kwd Gunung

25,000.00

1,500.00

23,500.00 12

13

47

3323176811680002

Kalirejo

25,000.00

1,500.00

23,500.00

14

60

3323170611500001

Jeketro

25,000.00

1,500.00

23,500.00 14

15

65

3323170101150001

Tuksari

25,000.00

1,500.00

23,500.00

16

21

3323170211930001

Kwadungan Jurang

25,000.00

1,500.00

23,500.00 16

17

59

3323174408650002

Tlahab

25,000.00

1,500.00

23,500.00

18

48

3323175211660001

Kwadungan Jurang

25,000.00

1,500.00

23,500.00 18

19

60

3323175706550001

Kledung

25,000.00

1,500.00

23,500.00

20

41

3323172106730002

Tlahab

25,000.00

1,500.00

23,500.00 20

21

49

3323170811700001

Petarangan

25,000.00

1,500.00

23,500.00

22

58

3323171012550002

Paponan

25,000.00

1,500.00

23,500.00 22

23

70

3323170512450001

Kwd Gunung

25,000.00

1,500.00

23,500.00

24

66

3323171110490002

Tlahab

25,000.00

1,500.00

23,500.00 24

25

30

3323175203180007

Tuksari

25,000.00

1,500.00

23,500.00

26

21

3323176412050001

Kwd Gunung

25,000.00

1,500.00

23,500.00 26

27

60

3323171106540002

Jambu

25,000.00

1,500.00

23,500.00

28

50

3323170110040001

Canggal

25,000.00

1,500.00

23,500.00 28

29

34

3323175203810007

Tuksari

25,000.00

1,500.00

23,500.00

30

37

3323171106720001

Kruwisan

25,000.00

1,500.00

23,500.00 30

31

3323174304100001

Tlahab

25,000.00

1,500.00

23,500.00

32

60

3323170108490001

Tlahab

25,000.00

1,500.00

23,500.00 32

33

60

3323175506540002

Kwd Gunung

25,000.00

1,500.00

23,500.00

34

59

3323172206550001

Kledung

25,000.00

1,500.00

23,500.00 34

35

37

3323171011780002

Tlahab

25,000.00

1,500.00

23,500.00

36

52

3323171007690003

Jeketro

25,000.00

1,500.00

23,500.00 36

37

25

3323174510890001

Paponan

25,000.00

1,500.00

23,500.00

38

3323172411130001

Petarangan

25,000.00

1,500.00

23,500.00 38

39

53

3323147704620001

Jeketro

25,000.00

1,500.00

23,500.00

40

35

3323174408650001

Tlahab

25,000.00

1,500.00

23,500.00 40

41

35

3323176110590001

Jeketro

25,000.00

1,500.00

23,500.00

42

51

3323174711630001

Tuksari

25,000.00

1,500.00

23,500.00 42

43

67

3323172610490001

Petarangan

25,000.00

1,500.00

23,500.00

44

3323170701090002

Tlahab

25,000.00

1,500.00

23,500.00 44

45

63

3323170009510003

Tlahab

25,000.00

1,500.00

23,500.00

46

22

3323174705420001

Tlahab

25,000.00

1,500.00

23,500.00 46

47

66

3323177504800002

Kruwisan

25,000.00

1,500.00

23,500.00

48

24

3323174109910002

Paponan

25,000.00

1,500.00

23,500.00 48

49

47

3323170308740001

Tuksari

25,000.00

1,500.00

23,500.00

50

44

3323174501710001

Petarangan

25,000.00

1,500.00

23,500.00 50

J U M L A H

Kledung, 20 Oktober 2016

PPTK

Programer TB

Pengendalian Penyakit Menular

Puskesmas Kledung

SUKAMSIH, SKM

NURCHOLIS, SKM
NIP196701071988031006

NIP 196206101983071001

DAFTAR PENERIMAAN BANTUAN TRANSPORT SUSPEC TB PARU

DALAM RANGKA PENGIRIMAN SPESIMEN TB DARI DESA DI WIL KEC. KLEDUNG KE PUSKESMAS KLEDUNG
KABUPATEN TEMANGGUNG BULAN SEPTEMBER TH 2015

T
G
L

NAMA
SUSPEC

UMUR

NO

NIK

ALAMAT

P
E
N PPH.Psl 21 6%
G
( Rp )
I
R
I
M
A
N

JML DITERIMA
Rp )

Ngahadi

40

3323172412470002

Kwadungan Jurang

S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00 1

TANDA TANG

Sugiarni

66

3323175010480002

Paponan

S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00

900.00

14,100.00 3

Suyanto

67

3323171507480002

Petarangan

S
e
p
t
e
m
b
e
r
2
0
1
5

Agus S

32

3323171408840001

Tlahab

S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00

900.00

14,100.00 5

Slamet Sudi

46

3323171409670001

Jeketrro

S
e
p
t
e
m
b
e
r
2
0
1
5

Misyati

34

3323170210810001

Kledung

S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00

900.00

14,100.00 7

Sifa Nurul

30

3323175804120002

Jeketrro

S
e
p
t
e
m
b
e
r
2
0
1
5

Suratman

40

3323173105540001

Kalirejo

S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00

900.00

14,100.00 9

Sugiyono

35

3323171269700001

Kruwisan

S
e
p
t
e
m
b
e
r
2
0
1
5

10

11

Sardi

Rati

49

16

3323174265500001

3323171302070002

Kalirejo

S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00

Canggal

1
0
S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00 11

12

13

Istiqomah

Sutomo

35

64

3323175004800002

3323172907510001

Canggal

1
0
S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00

Petarangan

1
1
S
e
p
t
e
m
b
e
r
2
0
1
5

900.00

14,100.00 13

14
15

Munjainah
Suradi

56
52

3323176201580001
3323171007650001

Kalirejo
Jeketrro

1
1
S
e
p
t
e
m
b
e
r
2
0
1
5
12

16
17
18
19
20
21
22
23
24
25
26
27

Sarwadi
Muhyakub
Suyono
Isminah
Sarpi
Untung
Waljinah
Rinoto
Suradi
Sutomo
Kurniawan
Bonadi

30
66
51
40
45
49
43
67
60
64
27
40

3323171210840003
3323173107490001
3323172912600001
3323177007150002
3323174207650001
3323176409640003
3323175008720001
3323172710500001
3323170506500001
3323172901510001
3323170055588000
3323171286000002

Kwadungann Jurang
Tlahab
Kalirejo
Kalirejo
Kalirejo
Kwadungan Gunung
Kruwisan
Petarangan
Petarangan
Petarangan
Kruwisan
Kruwisan

14
14
15
16
17
18
21
22
22
23
23
25

900.00
900.00

14,100.00
14,100.00 15

900.00
900.00
900.00
900.00
900.00
900.00
900.00
900.00
900.00
900.00
900.00
900.00

14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00
14,100.00

17
19
21
23
25
27

28
29
30

Zudi
Sari
Sukardi

30
60
37

3323170305840001
3323174704540002
3323171207810001

Paponan
Jeketro
Petarangan
J U M L A H

25
25
25

900.00
900.00
900.00
27,000.00

14,100.00
14,100.00 29
14,100.00
477,000.00

Kepala Puskesmas Kledung

Kledung, 30 September 2015

Pengelola P2TB Puskesmas kledung

dr. LESTARI WAHYU WIDAYAT

NIP.196603302007012007

NURCHOLIS
NIP196701071988031006

KAB. TEMANGGUNG

TANDA TANGAN

11

350,000.00
450,000.00

13

450,000.00
200,000.00

1,450,000.00
15
329000
17

19

21

23

25

27

29

31

423000

33

35

37

39

41

43
329,000.00
45

423,000.00
423,000.00

47

49

#REF!

#REF!

edung, 20 Oktober 2016

Programer TB
Puskesmas Kledung

NURCHOLIS, SKM
P196701071988031006

U
PUSKESMAS KLEDUNG

TANDA TANGAN

10

12

14

16
18
20
22
24
26

dung, 30 September 2015

la P2TB Puskesmas kledung

NURCHOLIS
P196701071988031006

28
30