You are on page 1of 6

PROGRAM PEMBAGIAN JASA PELAYANAN JKN SESUAI PERMENKES NO 21 TAHUN 2016

UPTD : PUSKESMAS Martimbang
BULAN : Januari (diisi bulan sesuai jaspel)
DANA : Rp 8,910,000 (diisi angka jaspel yang akan dibagi bulan ini)
PERNILAI : Rp 5,066 (jangan dirubah)

NILAI
NAMA
NO JABATAN PROFESI (diisi sesuai KOREKTOR*) Tanggung TOTAL POINT PERNILAI NAMA REALISASI
Pendidikan Masa Rangkap Tugas TOTAL POINT JLH HARI JUMLAH HARI PERSENTASE
jabatan) jawab
Kerja Administratif program KETENAGAAN MASUK KERJA KERJA KEHADIRAN

(jangan (jangan (bisa (jangan (bisa (jangan (bisa dirubah) (bisa dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah)
lupa!!!) dirubah) dirubah) dirubah) dirubah) dirubah)
1 Kepala UPTD Puskemas Medis dr.Eva M Tampubolon 1 150 8 100 10 268 26 26 100% 268 Rp 5,066 dr.Eva M Tampubolon Rp 1,357,640
2 Non medis / S1 0 60 0 100 0 160 0 26 0% 0 Rp 5,066 0 Rp -
3 KTU Apt/ Ners 0 100 0 30 0 130 0 26 0% 0 Rp 5,066 0 Rp -
4 S1 / D IV kes 0 80 0 30 0 110 0 26 0% 0 Rp 5,066 0 Rp -
5 D III Kes 0 60 0 30 0 90 0 26 0% 0 Rp 5,066 0 Rp -
7 D III Non Kes /< D III Kes 0 50 0 30 0 80 0 26 0% 0 Rp 5,066 0 Rp -
< D III Non Kes Espita Siburian 1 25 27 30 10 92 25 26 96% 88.4615384615 Rp 5,066 Espita Siburian Rp 448,130
8 Bendahara Apt/ Ners 0 100 0 50 0 150 0 26 0% 0 Rp 5,066 0 Rp -
9 S1 / D IV kes 0 80 5 50 0 135 0 26 0% 0 Rp 5,066 0 Rp -
10 D III Kes 0 60 0 50 0 110 0 26 0% 0 Rp 5,066 0 Rp -
11 D III Non Kes /< D III Kes Ida Riama Sianturi 1 50 18 50 10 128 25 26 96% 123.0769230769 Rp 5,066 Ida Riama Sianturi Rp 623,486
< D III Non Kes 0 25 0 50 0 75 0 26 0% 0 Rp 5,066 Rp -
13 Medis Dokter Umum 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
14 Dokter Umum dr Tonggo HS Siagian 1 150 8 0 10 168 26 26 100% 168 Rp 5,066 dr Tonggo HS Siagian Rp 851,058
15 Dokter Umum 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
16 Dokter Umum 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
17 Dokter Umum 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
18 Dokter Umum 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
19 Dokter Umum 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
20 Dokter Umum 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
21 Dokter Gigi 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
22 Dokter Gigi 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
23 Dokter Gigi 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
24 Dokter Gigi 0 150 0 0 0 150 0 26 0% 0 Rp 5,066 0 Rp -
25 Apt/ Ners Apoteker 0 100 0 0 0 100 0 26 0% 0 Rp 5,066 0 Rp -
26 Apoteker 0 100 0 0 0 100 0 26 0% 0 Rp 5,066 0 Rp -
27 NERS 0 100 0 0 0 100 0 26 0% 0 Rp 5,066 0 Rp -
28 NERS 0 100 0 0 0 100 0 26 0% 0 Rp 5,066 0 Rp -
29 S1 / D IV kes SKM 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
30 SKM 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
31 S.Kep 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
32 S.Kep 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
33 S.Kep 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
34 SST 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
35 SST 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
36 SST 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
37 SGz 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
38 SGz 0 80 0 0 0 80 0 26 0% 0 Rp 5,066 0 Rp -
39 D III Kes Amd. Kep Lisbeth M Samosir 1 60 29 0 10 99 21 26 81% 79.9615384615 Rp 5,066 Lisbeth M Samosir Rp 405,071
40 Amd. Kep Nonorita lumbanraja 1 60 17 0 0 77 24 26 92% 71.0769230769 Rp 5,066 Nonorita lumbanraja Rp 360,063
41 Amd. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5,066 0 Rp -
42 Amd. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5,066 0 Rp -
43 Amd. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5,066 0 Rp -
44 Amd. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5,066 0 Rp -

G 0 60 0 0 0 60 0 26 0% 0 Rp 5.501 60 Amd. 0 60 0 0 0 60 0 26 0% 0 Rp 5.910. Yanti R Hutahaean 1 60 20 0 10 90 23 26 88% 79. diisi dengan angka 1 bila ADA.066 0 Rp - 89 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5. Keb.066 Alfrida OJ Na70 Rp 374.8462 Rp 8.6153846154 Rp 5.066 0 Rp - 66 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 yunita Sijabat Rp 346.799 52 Amd.066 0 Rp - 82 < D III Non Kes Staf Hasiholan S 1 25 23 0 10 58 25 26 96% 55. Keb.066 0 Rp - 46 Amd.066 0 Rp - 49 Amd.066 0 Rp - 88 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.066 0 Rp - 85 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.066 0 Rp - 64 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 Yanti R Hutahaean Rp 403.066 0 Rp - 58 Amd. yunita Sijabat 1 60 4 0 10 74 24 26 92% 68.5 Rp 5.066 0 Rp - 57 Amd. bisa diberikan atau tidak.948 75 < D III Kes Tienny Sulastri 1 50 18 0 10 78 21 26 81% 63 Rp 5. 45 Amd. disesuaikan dengan kebijakan puskesmas masing-masing .066 0 Rp - 72 D III Non Kes /< D III Kes < D III Kes Basaria Sitorus 1 50 23 0 10 83 25 26 96% 79.066 0 Rp - 65 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 80 D III Non Kes 0 50 0 0 0 50 0 26 0% 0 Rp 5. 0 60 0 0 0 60 0 26 0% 0 Rp 5. Keb. Keb.035 51 Amd.066 0 Rp - 90 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.066 Tienny Sulastri Rp 319.066 0 Rp - 79 D III Non Kes 0 50 0 0 0 50 0 26 0% 0 Rp 5. Keb.066 0 Rp - 63 0 60 0 0 0 60 0 26 0% 0 Rp 5.332 77 < D III Kes Rismauli Siboro 1 50 15 0 10 75 26 26 100% 75 Rp 5.066 Lamria Sinaga Rp 411. disesuaikan kehadiran pegawai ***) : Nilai tambahan.066 Rismauli Siboro Rp 379.066 0 Rp - 69 0 60 0 0 0 60 0 26 0% 0 Rp 5.3076923077 Rp 5. KG Lamria Sinaga 1 60 18 0 10 88 24 26 92% 81.066 Damewati Rp 410.4230769231 Rp 5.2307692308 Rp 5.517 83 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.8076923077 Rp 5.066 0 Rp - 67 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 48 Amd.066 Albine Marpaung Rp 369. Keb. Keb. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 Endang Aprianti Rp 383. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 84 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 Juni serpicce S Rp 407. 0 60 0 0 0 60 0 26 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 81 D III Non Kes 0 50 0 0 0 50 0 26 0% 0 Rp 5.066 0 Rp - 70 0 60 0 0 0 60 0 26 0% 0 Rp 5. Alfrida OJ Na70 1 60 4 0 10 74 26 26 100% 74 Rp 5.444 54 Amd.066 0 Rp - 56 Amd.066 0 Rp - 91 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5. 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 62 Amd.871 53 Amd. Keb.066 0 Rp - 68 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 55 Amd.066 Basaria Sitorus Rp 404. 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 0 Rp - 61 Amd. Keb.066 Sonti Panjaitan Rp 371.317 50 Amd.066 0 Rp - 47 Amd.066 0 Rp - 0 JUMLAH PEGAWAI 19 TOTAL 1758.066 0 Rp - 71 0 60 0 0 0 60 0 26 0% 0 Rp 5. Endang Aprianti 1 60 12 0 10 82 24 26 92% 75. Juni serpicce S 1 60 21 0 10 91 23 26 88% 80.066 0 Rp - 59 Amd.937 78 D III Non Kes 0 50 0 0 0 50 0 26 0% 0 Rp 5.6923076923 Rp 5.000 Keterangan : *) : Korektor.147 76 < D III Kes Damewati 1 50 21 0 10 81 26 26 100% 81 Rp 5.9230769231 Rp 5.066 0 Rp - 93 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.7692307692 Rp 5.415 74 < D III Kes Sonti Panjaitan 1 50 23 0 10 83 23 26 88% 73.066 0 Rp - 86 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.066 0 Rp - 92 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5.066 0 Rp - 87 Staf 0 25 0 0 0 25 0 26 0% 0 Rp 5. **) : Kehadiran harian tiap bulan. Keb. G 0 60 0 0 0 60 0 26 0% 0 Rp 5.066 Hasiholan S Rp 282. KG 0 60 0 0 0 60 0 26 0% 0 Rp 5.291 73 < D III Kes Albine Marpaung 1 50 29 0 0 79 24 26 92% 72.

3043478261 Rp 5.183 0 Rp - 17 Dokter Umum 0 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - 30 SKM 0 80 0 0 0 80 0 23 0% 0 Rp 5.183 Espita Siburian Rp 456.135 2 Non medis / S1 0 60 0 100 0 160 0 23 0% 0 Rp 5. Kep Lisbeth M Samosir 1 60 29 0 10 99 20 23 87% 86.183 Rp - 13 Medis Dokter Umum 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - 32 S.183 0 Rp - 27 NERS 0 100 0 0 0 100 0 23 0% 0 Rp 5.183 0 Rp - 4 S1 / D IV kes 0 80 0 30 0 110 0 23 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 3 KTU Apt/ Ners 0 100 0 30 0 130 0 23 0% 0 Rp 5.183 0 Rp - 22 Dokter Gigi 0 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - 23 Dokter Gigi 0 150 0 0 0 150 0 23 0% 0 Rp 5.411 41 Amd.183 0 Rp - 9 S1 / D IV kes 0 80 5 50 0 135 0 23 0% 0 Rp 5.183 0 Rp - 19 Dokter Umum 0 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - < D III Non Kes Espita Siburian 1 25 27 30 10 92 22 23 96% 88 Rp 5.183 dr Tonggo HS Siagian Rp 870.183 0 Rp - 39 D III Kes Amd.183 0 Rp - 33 S.183 Ida Riama Sianturi Rp 663. Kep Nonorita lumbanraja 1 60 17 0 0 77 21 23 91% 70.134 8 Bendahara Apt/ Ners 0 100 0 50 0 150 0 23 0% 0 Rp 5.183 0 Rp - 18 Dokter Umum 0 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - 10 D III Kes 0 60 0 50 0 110 0 23 0% 0 Rp 5.183 0 Rp - 5 D III Kes 0 60 0 30 0 90 0 23 0% 0 Rp 5.Eva M Tampubolon 1 150 8 100 10 268 23 23 100% 268 Rp 5.Kep 0 80 0 0 0 80 0 23 0% 0 Rp 5.PROGRAM PEMBAGIAN JASA PELAYANAN JKN SESUAI PERMENKES NO 21 TAHUN 2016 UPTD : PUSKESMAS Martimbang BULAN : Februari (diisi bulan sesuai jaspel) DANA : Rp 9.183 0 Rp - 28 NERS 0 100 0 0 0 100 0 23 0% 0 Rp 5.040 (diisi angka jaspel yang akan dibagi bulan ini) PERNILAI : Rp 5.183 0 Rp - 37 SGz 0 80 0 0 0 80 0 23 0% 0 Rp 5.468 < D III Non Kes 0 25 0 50 0 75 0 23 0% 0 Rp 5.218 40 Amd.183 0 Rp - 24 Dokter Gigi 0 150 0 0 0 150 0 23 0% 0 Rp 5.005.183 (jangan dirubah) NILAI NAMA NO JABATAN PROFESI (diisi sesuai KOREKTOR*) Tanggung TOTAL POINT PERNILAI NAMA REALISASI Pendidikan Masa Rangkap Tugas TOTAL POINT JLH HARI JUMLAH HARI PERSENTASE jabatan) jawab Kerja Administratif program KETENAGAAN MASUK KERJA KERJA KEHADIRAN (jangan (jangan (bisa (jangan (bisa (jangan (bisa dirubah) (bisa dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) lupa!!!) dirubah) dirubah) dirubah) dirubah) dirubah) 1 Kepala UPTD Puskemas Medis dr.183 0 Rp - 20 Dokter Umum 0 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - 29 S1 / D IV kes SKM 0 80 0 0 0 80 0 23 0% 0 Rp 5.183 0 Rp - 14 Dokter Umum dr Tonggo HS Siagian 1 150 8 0 10 168 23 23 100% 168 Rp 5.183 0 Rp - 43 Amd.801 15 Dokter Umum 0 150 0 0 0 150 0 23 0% 0 Rp 5.183 0 Rp - 31 S.183 0 Rp - 44 Amd.Kep 0 80 0 0 0 80 0 23 0% 0 Rp 5.183 0 Rp - 35 SST 0 80 0 0 0 80 0 23 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.Kep 0 80 0 0 0 80 0 23 0% 0 Rp 5.183 Nonorita lumbanraja Rp 364.183 dr.183 0 Rp - 25 Apt/ Ners Apoteker 0 100 0 0 0 100 0 23 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 21 Dokter Gigi 150 0 0 0 150 0 23 0% 0 Rp 5.0869565217 Rp 5.183 0 Rp - 26 Apoteker 0 100 0 0 0 100 0 23 0% 0 Rp 5.183 0 Rp - 42 Amd.183 0 Rp - 34 SST 0 80 0 0 0 80 0 23 0% 0 Rp 5.Eva M Tampubolon Rp 1.183 0 Rp - .183 Lisbeth M Samosir Rp 446.183 0 Rp - 11 D III Non Kes /< D III Kes Ida Riama Sianturi 1 50 18 50 10 128 23 23 100% 128 Rp 5.183 0 Rp - 16 Dokter Umum 0 150 0 0 0 150 0 23 0% 0 Rp 5.389.183 0 Rp - 38 SGz 0 80 0 0 0 80 0 23 0% 0 Rp 5.183 0 Rp - 36 SST 0 80 0 0 0 80 0 23 0% 0 Rp 5.183 0 Rp - 7 D III Non Kes /< D III Kes 0 50 0 30 0 80 0 23 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.

1739130435 Rp 5.073 74 < D III Kes Sonti Panjaitan 1 50 23 0 10 83 20 23 87% 72. yunita Sijabat 1 60 4 0 10 74 20 23 87% 64.4782608696 Rp 5. Keb.183 0 Rp - 66 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 57 Amd.183 0 Rp - 55 Amd.183 0 Rp - 91 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.6956521739 Rp 5. 0 60 0 0 0 60 0 23 0% 0 Rp 5.4347826087 Rp 5.183 Damewati Rp 401.9130434783 Rp 5. Keb.040 Keterangan : *) : Korektor.350 83 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5. **) : Kehadiran harian tiap bulan.183 Lamria Sinaga Rp 416.183 0 Rp - 88 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.183 0 Rp - 69 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 Rismauli Siboro Rp 388.183 0 Rp - 86 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.183 Juni serpicce S Rp 410.183 0 Rp - 93 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.596 77 < D III Kes Rismauli Siboro 1 50 15 0 10 75 23 23 100% 75 Rp 5. Keb.537 51 Amd.370 50 Amd. Yanti R Hutahaean 1 60 20 0 10 90 19 23 83% 74.183 0 Rp - 63 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 71 0 60 0 0 0 60 0 23 0% 0 Rp 5.890 53 Amd.183 0 Rp - 64 0 60 0 0 0 60 0 23 0% 0 Rp 5. Keb.183 0 Rp - 79 D III Non Kes 0 50 0 0 0 50 0 23 0% 0 Rp 5.102 75 < D III Kes Tienny Sulastri 1 50 18 0 10 78 19 23 83% 64. bisa diberikan atau tidak. 0 60 0 0 0 60 0 23 0% 0 Rp 5.8695652174 Rp 5. Keb.183 Alfrida OJ Na70 Rp 366. diisi dengan angka 1 bila ADA.183 Yanti R Hutahaean Rp 385.751 78 D III Non Kes 0 50 0 0 0 50 0 23 0% 0 Rp 5.183 0 Rp - 81 D III Non Kes 0 50 0 0 0 50 0 23 0% 0 Rp 5. 0 60 0 0 0 60 0 23 0% 0 Rp 5. KG Lamria Sinaga 1 60 18 0 10 88 21 23 91% 80. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.347826087 Rp 5.074 54 Amd.183 0 Rp - 90 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.183 0 Rp - 47 Amd.183 0 Rp - 49 Amd.183 0 Rp - 65 0 60 0 0 0 60 0 23 0% 0 Rp 5. G 0 60 0 0 0 60 0 23 0% 0 Rp 5.3913043478 Rp 5. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.347826087 Rp 5. Keb.183 0 Rp - 72 D III Non Kes /< D III Kes < D III Kes Basaria Sitorus 1 50 23 0 10 83 22 23 96% 79.183 Albine Marpaung Rp 356.183 0 Rp - 58 Amd.183 0 Rp - 70 0 60 0 0 0 60 0 23 0% 0 Rp 5. KG 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 56 Amd. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 84 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5. 45 Amd.183 Tienny Sulastri Rp 333.183 0 Rp - 0 JUMLAH PEGAWAI 19 TOTAL 1737. Keb.183 0 Rp - 48 Amd. Keb. Keb. 0 60 0 0 0 60 0 23 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 92 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.3043 Rp 9.183 0 Rp - 67 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 80 D III Non Kes 0 50 0 0 0 50 0 23 0% 0 Rp 5.470 60 Amd.512 73 < D III Kes Albine Marpaung 1 50 29 0 0 79 20 23 87% 68. disesuaikan dengan kebijakan puskesmas masing-masing .7826086957 Rp 5.347826087 Rp 5.183 0 Rp - 62 Amd. Alfrida OJ Na70 1 60 4 0 10 74 22 23 96% 70.183 Endang Aprianti Rp 388.183 0 Rp - 68 0 60 0 0 0 60 0 23 0% 0 Rp 5.160 52 Amd.987 76 < D III Kes Damewati 1 50 21 0 10 81 22 23 96% 77. Endang Aprianti 1 60 12 0 10 82 21 23 91% 74.183 0 Rp - 85 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.183 Basaria Sitorus Rp 411.183 0 Rp - 61 Amd.1304347826 Rp 5. disesuaikan kehadiran pegawai ***) : Nilai tambahan.183 0 Rp - 89 2 0 25 0 0 0 25 0 23 0% 0 Rp 5.183 0 Rp - 59 Amd.183 Hasiholan S Rp 248.183 yunita Sijabat Rp 333.005. G 0 60 0 0 0 60 0 23 0% 0 Rp 5.183 0 Rp - 82 < D III Non Kes Staf Hasiholan S 1 25 23 0 10 58 19 23 83% 47. Juni serpicce S 1 60 21 0 10 91 20 23 87% 79. 0 60 0 0 0 60 0 23 0% 0 Rp 5. Keb.183 0 Rp - 46 Amd.183 Sonti Panjaitan Rp 374.183 0 Rp - 87 Staf 0 25 0 0 0 25 0 23 0% 0 Rp 5.

674 0 Rp - 16 Dokter Umum 0 150 0 0 0 150 0 25 0% 0 Rp 5.674 (jangan dirubah) NILAI NAMA NO JABATAN PROFESI (diisi sesuai KOREKTOR*) Tanggung TOTAL POINT PERNILAI NAMA REALISASI Pendidikan Masa Rangkap Tugas TOTAL POINT JLH HARI JUMLAH HARI PERSENTASE jabatan) jawab Kerja Administratif program KETENAGAAN MASUK KERJA KERJA KEHADIRAN (jangan (jangan (bisa (jangan (bisa (jangan (bisa dirubah) (bisa dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) (jangan dirubah) lupa!!!) dirubah) dirubah) dirubah) dirubah) dirubah) 1 Kepala UPTD Puskemas Medis dr.674 0 Rp - 7 D III Non Kes /< D III Kes 0 50 0 30 0 80 0 25 0% 0 Rp 5.674 0 Rp - 31 S.674 0 Rp - 9 S1 / D IV kes 0 80 5 50 0 135 0 25 0% 0 Rp 5.674 0 Rp - 4 S1 / D IV kes 0 80 0 30 0 110 0 25 0% 0 Rp 5.674 0 Rp - 29 S1 / D IV kes SKM 0 80 0 0 0 80 0 25 0% 0 Rp 5.975.674 0 Rp - 10 D III Kes 0 60 0 50 0 110 0 25 0% 0 Rp 5.605 8 Bendahara Apt/ Ners 0 100 0 50 0 150 0 25 0% 0 Rp 5.674 0 Rp - .674 0 Rp - < D III Non Kes Espita Siburian 1 25 27 30 10 92 20 25 80% 73.PROGRAM PEMBAGIAN JASA PELAYANAN JKN SESUAI PERMENKES NO 21 TAHUN 2016 UPTD : PUSKESMAS Martimbang BULAN : Maret (diisi bulan sesuai jaspel) DANA : Rp 8.674 0 Rp - 28 NERS 0 100 0 0 0 100 0 25 0% 0 Rp 5.993 41 Amd.380 40 Amd.674 0 Rp - 17 Dokter Umum 0 150 0 0 0 150 0 25 0% 0 Rp 5.Kep 0 80 0 0 0 80 0 25 0% 0 Rp 5.674 0 Rp - 37 SGz 0 80 0 0 0 80 0 25 0% 0 Rp 5.674 0 Rp - 25 Apt/ Ners Apoteker 0 100 0 0 0 100 0 25 0% 0 Rp 5.674 0 Rp - 27 NERS 0 100 0 0 0 100 0 25 0% 0 Rp 5.674 0 Rp - 26 Apoteker 0 100 0 0 0 100 0 25 0% 0 Rp 5.Eva M Tampubolon 1 150 8 100 10 268 25 25 100% 268 Rp 5.674 0 Rp - 36 SST 0 80 0 0 0 80 0 25 0% 0 Rp 5.674 0 Rp - 21 Dokter Gigi 150 0 0 0 150 0 25 0% 0 Rp 5.674 0 Rp - 3 KTU Apt/ Ners 0 100 0 30 0 130 0 25 0% 0 Rp 5.674 0 Rp - 23 Dokter Gigi 0 150 0 0 0 150 0 25 0% 0 Rp 5.520.2 Rp 5.Eva M Tampubolon Rp 1.674 0 Rp - 24 Dokter Gigi 0 150 0 0 0 150 0 25 0% 0 Rp 5.674 0 Rp - 32 S.674 0 Rp - 33 S. Kep Nonorita lumbanraja 1 60 17 0 0 77 21 25 84% 64. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 Espita Siburian Rp 417.674 dr. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 43 Amd.674 0 Rp - 19 Dokter Umum 0 150 0 0 0 150 0 25 0% 0 Rp 5.674 0 Rp - 20 Dokter Umum 0 150 0 0 0 150 0 25 0% 0 Rp 5.28 Rp 5.Kep 0 80 0 0 0 80 0 25 0% 0 Rp 5.674 0 Rp - 44 Amd.674 Nonorita lumbanraja Rp 366.674 0 Rp - 11 D III Non Kes /< D III Kes Ida Riama Sianturi 1 50 18 50 10 128 23 25 92% 117.169 < D III Non Kes 0 25 0 50 0 75 0 25 0% 0 Rp 5.629 2 Non medis / S1 0 60 0 100 0 160 0 25 0% 0 Rp 5.674 0 Rp - 34 SST 0 80 0 0 0 80 0 25 0% 0 Rp 5.68 Rp 5. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 Rp - 13 Medis Dokter Umum 150 0 0 0 150 0 25 0% 0 Rp 5.674 0 Rp - 42 Amd.6 Rp 5.674 Lisbeth M Samosir Rp 449.101 15 Dokter Umum 0 150 0 0 0 150 0 25 0% 0 Rp 5.674 Ida Riama Sianturi Rp 668.674 0 Rp - 38 SGz 0 80 0 0 0 80 0 25 0% 0 Rp 5. Kep Lisbeth M Samosir 1 60 29 0 10 99 20 25 80% 79.674 0 Rp - 39 D III Kes Amd.674 0 Rp - 35 SST 0 80 0 0 0 80 0 25 0% 0 Rp 5. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.340 (diisi angka jaspel yang akan dibagi bulan ini) PERNILAI : Rp 5.Kep 0 80 0 0 0 80 0 25 0% 0 Rp 5.76 Rp 5.674 dr Tonggo HS Siagian Rp 915.674 0 Rp - 14 Dokter Umum dr Tonggo HS Siagian 1 150 8 0 10 168 24 25 96% 161.674 0 Rp - 22 Dokter Gigi 0 150 0 0 0 150 0 25 0% 0 Rp 5.674 0 Rp - 5 D III Kes 0 60 0 30 0 90 0 25 0% 0 Rp 5.674 0 Rp - 18 Dokter Umum 0 150 0 0 0 150 0 25 0% 0 Rp 5.674 0 Rp - 30 SKM 0 80 0 0 0 80 0 25 0% 0 Rp 5.

674 Basaria Sitorus Rp 414. disesuaikan kehadiran pegawai ***) : Nilai tambahan.674 0 Rp - 79 D III Non Kes 0 50 0 0 0 50 0 25 0% 0 Rp 5.674 0 Rp - 90 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.04 Rp 5.12 Rp 5.4 Rp 5. G 0 60 0 0 0 60 0 25 0% 0 Rp 5. 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 88 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.674 0 Rp - 87 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.88 Rp 5.674 Hasiholan S Rp 250.674 0 Rp - 61 Amd. Keb.08 Rp 5.674 0 Rp - 93 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.428 73 < D III Kes Albine Marpaung 1 50 29 0 0 79 20 25 80% 63.674 0 Rp - 59 Amd.674 Sonti Panjaitan Rp 376. Keb. Keb.674 0 Rp - 72 D III Non Kes /< D III Kes < D III Kes Basaria Sitorus 1 50 23 0 10 83 22 25 88% 73.674 0 Rp - 91 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.674 0 Rp - 68 0 60 0 0 0 60 0 25 0% 0 Rp 5.824 54 Amd.442 77 < D III Kes Rismauli Siboro 1 50 15 0 10 75 23 25 92% 69 Rp 5.674 0 Rp - 64 0 60 0 0 0 60 0 25 0% 0 Rp 5. bisa diberikan atau tidak.674 0 Rp - 46 Amd. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 Endang Aprianti Rp 390.674 Yanti R Hutahaean Rp 142.674 Rismauli Siboro Rp 391.674 0 Rp - 58 Amd.28 Rp 5. yunita Sijabat 1 60 4 0 10 74 22 25 88% 65.674 0 Rp - 48 Amd.674 Juni serpicce S Rp 413. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5. Keb.674 0 Rp - 84 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.674 0 Rp - 47 Amd.84 Rp 8.674 0 Rp - 82 < D III Non Kes Staf Hasiholan S 1 25 23 0 10 58 19 25 76% 44. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.975.674 Alfrida OJ Na70 Rp 369.753 75 < D III Kes Tienny Sulastri 1 50 18 0 10 78 19 25 76% 59. disesuaikan dengan kebijakan puskesmas masing-masing .674 0 Rp - 57 Amd. Endang Aprianti 1 60 12 0 10 82 21 25 84% 68.109 83 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5. 0 60 0 0 0 60 0 25 0% 0 Rp 5.421 60 Amd.674 0 Rp - 65 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 80 D III Non Kes 0 50 0 0 0 50 0 25 0% 0 Rp 5.596 74 < D III Kes Sonti Panjaitan 1 50 23 0 10 83 20 25 80% 66.674 0 Rp - 62 Amd. diisi dengan angka 1 bila ADA.674 0 Rp - 86 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.674 0 Rp - 49 Amd. **) : Kehadiran harian tiap bulan.340 Keterangan : *) : Korektor. Kep 0 60 0 0 0 60 0 25 0% 0 Rp 5.490 53 Amd.28 Rp 5.674 0 Rp - 69 0 60 0 0 0 60 0 25 0% 0 Rp 5.2 Rp 5.354 76 < D III Kes Damewati 1 50 21 0 10 81 22 25 88% 71.2 Rp 5.92 Rp 5.674 Damewati Rp 404.674 0 Rp - 71 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 0 JUMLAH PEGAWAI 19 TOTAL 1581.490 51 Amd. 0 60 0 0 0 60 0 25 0% 0 Rp 5. Keb. Alfrida OJ Na70 1 60 4 0 10 74 22 25 88% 65.984 50 Amd.674 yunita Sijabat Rp 369. 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 Lamria Sinaga Rp 419.674 0 Rp - 56 Amd.674 0 Rp - 85 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5. KG Lamria Sinaga 1 60 18 0 10 88 21 25 84% 73.8 Rp 5.674 Albine Marpaung Rp 358. Juni serpicce S 1 60 21 0 10 91 20 25 80% 72.674 0 Rp - 67 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 89 2 0 25 0 0 0 25 0 25 0% 0 Rp 5.066 52 Amd. 45 Amd. Keb.674 0 Rp - 66 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 55 Amd. Keb. Keb. Keb.12 Rp 5. G 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 81 D III Non Kes 0 50 0 0 0 50 0 25 0% 0 Rp 5. Yanti R Hutahaean 1 60 20 0 10 90 7 25 28% 25.674 0 Rp - 70 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 63 0 60 0 0 0 60 0 25 0% 0 Rp 5.505 78 D III Non Kes 0 50 0 0 0 50 0 25 0% 0 Rp 5. 0 60 0 0 0 60 0 25 0% 0 Rp 5.674 0 Rp - 92 Staf 0 25 0 0 0 25 0 25 0% 0 Rp 5.674 Tienny Sulastri Rp 336. KG 0 60 0 0 0 60 0 25 0% 0 Rp 5. Keb.