Persentase Jasa Pelayanan 50%

Pendapatan Pendapatan Rp. Jasa Pelayanan Rp.

BPJS 96,387,700 48,193,850
Kapitasi 96,387,700 48,193,850 96,387,700
Rawat Inap
Persalinan

Umum bln lalu

Rawat Jalan 13,088,000 6,544,000 11,832,000
BP Gigi 3,895,000 1,947,500 2,557,500
KIR Dokter 1,940,000 970,000 1,450,000
MCU HaJi 1,000,000 500,000 -
KIA 1,195,000 597,500 1,110,000
EKG - - -
UGD 1,616,000 808,000 920,000
Laboratorium dan penunjang lainn 7,129,000 3,564,500 6,142,000
Persalinan / KIA 700,000 420,000 700,000
Pustu Sukajaya 800,000 400,000 872,000
Pustu Mekargalih 664,000 332,000 632,000
Lainnya 500,000 250,000 650,000
32,527,000 16,333,500 26,865,500
128,914,700 64,527,350

Nama Jabatan Insentif Manajemen Nama Pegawai

A. Pemimpin BLUD 30% dr.Hj.Sri Cahyatiningsih

B. Pejabat Keuangan 16% Yanyan Supriatna, AMD, S.IP 66
C. Bendahara Penerimaan 8% Tati Sudaryati,AMKG
D. Bendahara Pengeluaran 12% Hj.Husnul Khotimah,S.ST
E. Pejabat Teknis (12%)
UKP, Kefarmasian dan Lab 3% 1. dr.Hj.Sisca Risya Fujiarti
UKM Esensial 3% 2. Ai Neti Srihartati,SKM 12
UKM Pengembangan 3% 3. Wartinah, AMK
Jaringan Pelayanan 3% 4. Rudiana, Am.Kep
F. Pelaksana Teknis (12%)
1.0% 1. Niki Sesbania, SE jkn/blud
2.0% 2. Jemmy Mulyadi, SE kepegawaian
1.5% 2. M Faisal Ali, S.IP teknis bok
2.0% 2. H. Subagja Eska Hidayat, SE p-care
1.5% 2. Indra Sukmana aset
2.0% 3. Dewi Yulianti, AMK, SE kasir
2.0% 4. Ajeng Pratiwi, AMD teknis SIPKP/SINKOR
G. Kontributor Kredensialing (10%)
Dokter Umum 4% 1. dr.Hj.Sri Cahyatiningsih
4% 2. dr.Hj.Sisca Risya Fujiarti
Dokter Gigi 2% 3. drg. In Kharina
 17,525 bpjs 100% 96,387,700
5,500 bpjs 15% 14,458,155
pendapatan bpjs murni 81,929,545

A Honor non pns 14 org x Rp.300.000

selisih susulan jkn 314,200
1,256,000 kapitasi 97,083,100 jml.kapitasi
1,337,500 jasa giro jkn 186,265
490,000 jasa giro blud/ restribusi -
1,000,000 jumlah 97,583,565
85,000 saldo bank jkn -
- saldo bank blud -
696,000
987,000 350,000
-
- 72,000
32,000
- 150,000
5,661,500

-792000

13

12

IPKP/SINKOR
10

100
48,193,850
50% 40%
48,193,850 32,771,818 80,965,668
- p3k dan thr
48,193,850

4,200,000 - 50,400,000

17,651

8,762,518
16,607
 Basic Index Kompetensi Risiko Kerja dan Emergency Jabatan
No. Nama
Kepangkatan Lama Ijazah Terakhir STR Sertifikat Penempatan Risiko Tertular Risiko Keuangan Risiko Hukum Risiko Posisi Rangkap
Kerja Keahlian Kerja Penyakit Kecelakaan Jabatan
1 dr.Hj.Sri Cahyatiningsih IV/b 19 S2 2 1 1 1 1 1 1 5 0
2 Yanyan Supriatna, AMD, S.IP III/b 27 S1/D4 0 1 1 1 1 1 1 4 0
3 Hj. Hasanah, S.Kep ,Ners IV/b 21 S2 2 1 1 1 0 0 1 2 0
4 Momoh Rohanah, S.Kep III/d 27 S1/D4 1 1 1 1 0 0 1 3 0
5 Wartinah, AMK III/d 27 D3 2 0 1 1 0 0 1 3 0
6 Elis Supyeni, Am. Keb III/d 27 D3 2 1 1 1 0 0 1 2 0
7 Sri Rahmawati, S.Tr.Keb IV/b 25 S1/D4 2 1 1 1 0 0 1 3 0
8 Ai Neti Srihartati,SKM III/d 23 S1/D4 2 1 1 1 0 0 1 2 0
9 dr.Hj.Sisca Risya Fujiarti III/d 10 S2 2 2 1 1 0 0 1 3 0
10 drg. In Kharina III/d 13 S2 2 2 1 1 0 0 1 3 0
11 Anita Sulistika, AMK III/d 25 D3 2 0 1 1 0 0 1 2 0
12 Tati Sudaryati,AMKG III/d 22 D3 2 1 1 1 1 1 1 3 0
13 Hj.Lina Zenab, AMG III/d 19 S1/D4 2 1 1 1 0 0 1 2 0
14 Hj.Dewi Darojah III/d 25 D3 2 1 1 1 0 0 1 3 0
15 Yoseph Ferry,S.Kep III/c 14 S1/D4 2 1 1 1 0 0 1 3 0
16 Gun Gun Nurdiansyah,S.Kep, Ners III/b 11 S1/D4 1 1 1 1 0 0 1 2 0
17 Rudiana, Am.Kep III/b 13 D3 2 1 1 1 0 0 1 2 0
18 Hj.Husnul Khotimah,S.ST III/b 20 S1/D4 2 1 1 1 1 1 1 3 0
19 Ema Asgaritta,S.ST III/b 20 S1/D4 2 2 1 1 0 0 1 3 0
20 Nenden Nuraeni , S.ST, MH.Kes III/b 14 S1/D4 2 1 1 1 0 0 1 1 0
21 Reni Hidayat, S.ST III/a 14 S1/D4 2 1 1 1 0 0 1 3 0
22 Telli Lindaris, SKM III/a 5 S1/D4 2 0 1 1 0 0 1 2 0
23 Jemmy Mulyadi, SE III/a 13 S1/D4 0 0 1 1 0 0 1 2 0
24 Yeni Rella II/c 27 D3 0 0 1 1 0 0 1 1 0
25 Fitri Dwiyani, S.Tr.Keb II/b 5 S1/D4 1 1 1 1 0 0 1 1 0
26 Rina Kurnia Aprianti, S.Tr.Keb II/c 10 S1/D4 2 1 1 1 0 0 1 3 0
27 Dian Pramesti, Am.Keb II/c 12 D3 2 1 1 1 0 0 1 3 0
28 Irma Nurma Diana, AM.Keb II/c 12 S1/D4 2 1 1 1 0 0 1 3 0
29 Sipa Nurasvia, AMKG Non PNS 12 D3 2 0 1 1 0 0 1 2 0
30 Dewi Yulianti, AMK, SE Non PNS 13 S1/D4 0 0 1 1 1 1 1 3 0
31 Nina Widianty Non PNS 13 S1/D4 1 0 1 1 0 0 1 1 0
32 Niki Sesbania, SE Non PNS 13 S1/D4 0 0 1 1 0 0 1 2 0
33 Elis Supriyanti, AMKG Non PNS 1 D3 2 0 1 1 0 0 1 1 0
34 M Faisal Ali, S.IP Non PNS 1 S1/D4 0 0 1 1 0 0 1 2 0
35 Fatmawati, Am.Keb Non PNS 1 D3 2 1 1 1 0 0 1 1 0
36 Hasan Alvian, S.Kep Non PNS 1 S1/D4 1 1 1 1 0 0 1 2 0
37 Risna D Yulianti, S.ST Non PNS 1 S1/D4 2 1 1 1 0 0 1 3 0
38 H. Subagja Eska Hidayat, SE Non PNS 1 S1/D4 0 0 1 1 0 0 1 3 0
39 Neneng Wulan Non PNS 1 D1/SPK 2 0 1 1 0 0 1 1 0
40 Dadan Nurdiansyah,ST Non PNS 1 S1/D4 0 0 1 1 0 0 1 1 0
41 Tira Febrianti DJ, Am.Kep Non PNS 1 D3 2 0 1 1 0 0 1 2 0
42 Indra Sukmana Non PNS 1 D1/SPK 0 0 1 1 0 0 1 3 0
43 Ajeng Pratiwi, AMD Non PNS 1 D3 0 0 1 1 0 0 1 2 0
44 Wulan Sari Purwanti Non PNS 1 D1/SPK 0 0 1 1 0 0 1 2 0
45 Fitri Nurhayati Non PNS 1 D1/SPK 0 0 1 1 0 0 1 1 0
46 Riski Romadhiansyah,Am.Kep Non PNS 1 D3 2 2 1 1 0 0 1 3 0
47 Inten Rachmayanti, S.ST.RMIK Non PNS 1 S1/D4 2 2 1 1 0 0 1 3 0
48 Gian Laksana Putra, Am.Kep Non PNS 1 D3 2 2 1 1 0 0 1 2 0
49 Mela Nurfaidah, Am.AK Non PNS 1 D3 2 1 1 1 0 0 1 1 0
50 Fadli Fauzan Pratama, Am.Kep Non PNS 1 D3 2 1 1 1 0 0 1 2 0
51 Lina Marlina, S.Si.Apt Non PNS 1 S1/D4 2 0 1 1 0 0 1 3 0
52 Utari Kusuma Wardani, S.Tr.Keb Non PNS 1 S1/D4 2 1 1 1 0 0 1 1 0
53 Agus Mulyana Al-Ishaq, Amd.Kep Non PNS 1 D3 2 2 1 1 0 0 1 1 0
54 Irfan Ramdani Non PNS 1 D1/SPK 0 0 1 1 0 0 1 3 0
54
 64,527,350
Disiplin Dedikasi dan
Basic Index Kompetensi Jabatan Loyalitas RAWAT JALAN RAWAT INAP DAN UGD RUJUKAN UPAYA KESEHATAN MASYARAKAT JASA PELAYANAN LANGSUNG
Risiko Kerja Asuhan OBSERVASI
dan Jumlah JASA PELAYANAN Manajemen Rawat Jumlah Jasa
No. Nama Kepangk Lama Ijazah Sertifikat Penempatan Rangkap Klinik Keperawatan& UGD , poned Front office Promkes Upaya Kehadiran Total Index Pembulatan Hasil Pembulatan
STR Emergency Posisi Apel Kepatuhan Klinik Gigi Klinik KIA Front Office Farmasi Lab Visite Persalinan Sopir Pendampin Kesling KIA Gizi P2 Perkesmas Index TIDAK Rawat Jalan Inap/UGD/Obser Persalinan Pelayanan
atan Kerja Terakhir Keahlian Kerja Jabatan Umum Kebidanan - hanya untuk RI g dan UKS Pengembangan vasi
tindakan dokter LANGSUNG
10 100 10 100 100 100 100 100 100 100 100 0.3 0.6 0.4 0.023 0.023 0.16 1.1 0.4 1.1 2.3 0.023 0.3 0.3 0.1 0.1 0.1 0.1 0.1 0.1 0.1 52,221,115 6,452,735 4,625,500 808,000 420,000
1 dr.Hj.Sri Cahyatiningsih 4.40 3.32 30.00 2.60 2.50 1.85 3.39 4.07 0.00 1.48 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.33 3.33 3.33 3.33 3.33 3.33 3.33 78.78 72 56.72 1,421,812 2,193,930 - - - 3,615,742 - 742 3,615,000
2 Yanyan Supriatna, AMD, S.IP 3.40 4.71 25.00 0.00 2.50 1.85 3.39 3.25 0.00 2.05 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.33 3.33 3.33 3.33 3.33 3.33 3.33 71.34 100 71.34 1,788,263 1,032,438 - - - 2,820,701 - 701 2,820,000
3 Hj. Hasanah, S.Kep ,Ners 4.40 3.66 30.00 2.60 2.50 1.85 1.69 1.63 0.00 2.05 1.85 0.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 52.48 100 52.48 1,315,377 - 135,822 - - 1,451,199 - 199 1,451,000
4 Momoh Rohanah, S.Kep 3.80 4.71 25.00 1.30 2.50 1.85 1.69 2.44 0.00 1.72 1.85 0.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.89 0.00 0.00 47.88 88 42.13 1,056,116 - 66,733 - - 1,122,849 - 849 1,122,000
5 Wartinah, AMK 3.80 4.71 20.00 2.60 0.00 1.85 1.69 2.44 0.00 1.97 1.85 0.34 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.52 41.78 96 40.11 1,005,313 193,582 196,275 - - 1,395,170 - 170 1,395,000
6 Elis Supyeni, Am. Keb 3.80 4.71 20.00 2.60 2.50 1.85 1.69 1.63 0.00 1.81 1.85 0.00 0.00 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.36 0.00 0.00 0.00 0.15 43.06 92 39.61 992,951 - 62,808 - - 1,055,759 - 759 1,055,000
7 Sri Rahmawati, S.Tr.Keb 4.40 4.36 25.00 2.60 2.50 1.85 1.69 2.44 0.00 1.97 1.85 0.14 0.00 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.17 48.99 96 47.03 1,178,857 - 87,931 - - 1,266,788 - 788 1,266,000
8 Ai Neti Srihartati,SKM 3.80 4.01 25.00 2.60 2.50 1.85 1.69 1.63 0.00 1.81 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.85 0.00 0.00 0.00 0.00 0.00 0.00 47.59 100 47.59 1,192,980 193,582 - - - 1,386,562 - 562 1,386,000
9 dr.Hj.Sisca Risya Fujiarti 3.80 1.75 30.00 2.60 5.00 1.85 1.69 2.44 0.00 1.97 1.85 0.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.93 54.15 96 51.98 1,302,977 451,691 134,252 23,389 - 1,912,309 - 309 1,912,000
10 drg. In Kharina 3.80 2.27 30.00 2.60 5.00 1.85 1.69 2.44 0.00 1.81 1.85 0.23 Err:508 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Err:508 96 Err:508 1,288,291 129,055 130,326 - - 1,547,672 - 672 1,547,000
11 Anita Sulistika, AMK 3.80 4.36 20.00 2.60 0.00 1.85 1.69 1.63 0.00 1.97 1.85 0.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.11 96 38.51 965,174 - 202,556 - - 1,167,730 - 730 1,167,000
12 Tati Sudaryati,AMKG 3.80 3.84 20.00 2.60 2.50 1.85 3.39 2.44 0.00 2.05 1.85 0.00 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 44.50 100 44.50 1,115,437 516,219 102,063 - - 1,733,719 - 719 1,733,000
13 Hj.Lina Zenab, AMG 3.80 3.32 25.00 2.60 2.50 1.85 1.69 1.63 0.00 1.64 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.33 0.00 0.00 0.00 49.21 92 45.28 1,134,873 - - - - 1,134,873 - 873 1,134,000
14 Hj.Dewi Darojah 3.80 4.36 20.00 2.60 2.50 1.85 1.69 2.44 0.00 1.64 1.85 0.00 0.00 0.00 0.00 0.00 0.20 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 42.94 88 37.79 947,133 - 113,473 - - 1,060,606 - 606 1,060,000
15 Yoseph Ferry,S.Kep 3.60 2.44 25.00 2.60 2.50 1.85 1.69 2.44 0.00 1.23 1.85 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.04 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 45.27 80 36.22 907,790 - 11,776 31,185 - 950,751 - 751 950,000
16 Gun Gun Nurdiansyah,S.Kep, Ners 3.40 1.92 25.00 1.30 2.50 1.85 1.69 1.63 0.00 1.40 1.85 0.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 42.85 92 39.42 988,159 - 126,401 70,168 - 1,184,728 - 728 1,184,000
17 Rudiana, Am.Kep 3.40 2.27 20.00 2.60 2.50 1.85 1.69 1.63 0.00 1.89 1.85 0.16 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.30 40.22 92 37.00 927,418 193,582 92,642 54,575 - 1,268,217 - 217 1,268,000
18 Hj.Husnul Khotimah,S.ST 3.40 3.49 25.00 2.60 2.50 1.85 3.39 2.44 0.00 1.31 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 47.83 88 42.09 1,055,106 774,328 - - - 1,829,434 - 434 1,829,000
19 Ema Asgaritta,S.ST 3.40 3.49 25.00 2.60 5.00 1.85 1.69 2.44 0.00 1.89 1.85 0.00 0.00 0.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.36 0.00 0.00 0.00 0.00 49.70 92 45.72 1,146,102 - 72,229 - - 1,218,331 - 331 1,218,000
20 Nenden Nuraeni , S.ST, MH.Kes 3.40 2.44 25.00 2.60 2.50 1.85 1.69 0.81 0.00 1.31 1.85 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.33 0.37 0.00 0.00 0.00 0.00 47.18 64 30.19 756,842 - 5,234 - - 762,076 - 76 762,000
21 Reni Hidayat, S.ST 3.20 2.44 25.00 2.60 2.50 1.85 1.69 2.44 0.00 1.89 1.85 0.00 0.00 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.40 0.00 0.00 0.00 0.00 45.88 92 42.21 1,058,008 - 9,421 - - 1,067,429 - 429 1,067,000
22 Telli Lindaris, SKM 3.20 0.87 25.00 2.60 0.00 1.85 1.69 1.63 0.00 2.05 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.82 0.00 0.00 41.57 100 41.57 1,041,934 - - - - 1,041,934 - 934 1,041,000
23 Jemmy Mulyadi, SE 3.20 2.27 25.00 0.00 0.00 1.85 1.69 1.63 0.00 1.64 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39.14 88 34.44 863,236 129,055 - - - 992,291 - 291 992,000
24 Yeni Rella 2.60 4.71 20.00 0.00 0.00 1.85 1.69 0.81 0.00 2.05 1.85 0.00 0.00 0.00 0.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35.68 100 35.68 894,296 - 58,265 - - 952,561 - 561 952,000
25 Fitri Dwiyani, S.Tr.Keb 2.40 0.87 25.00 1.30 2.50 1.85 1.69 0.81 0.00 1.89 1.85 0.17 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.34 96 38.73 970,765 - 94,997 3,898 - 1,069,660 - 660 1,069,000
26 Rina Kurnia Aprianti, S.Tr.Keb 2.60 1.75 25.00 2.60 2.50 1.85 1.69 2.44 0.00 1.72 1.85 0.00 0.00 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.36 0.00 0.00 0.00 0.00 44.47 84 37.36 936,409 - 62,808 - - 999,217 - 217 999,000
27 Dian Pramesti, Am.Keb 2.60 2.09 20.00 2.60 2.50 1.85 1.69 2.44 0.00 1.81 1.85 0.00 0.00 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.37 0.00 0.00 0.00 0.00 39.82 88 35.04 878,374 - 9,421 - - 887,795 - 795 887,000
28 Irma Nurma Diana, AM.Keb 2.60 2.09 25.00 2.60 2.50 1.85 1.69 2.44 0.00 1.72 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.81 0.00 0.00 45.18 92 41.56 1,041,831 - 2,093 - 210,000 1,253,924 - 924 1,253,000
29 Sipa Nurasvia, AMKG 2.00 2.09 20.00 2.60 0.00 1.85 1.69 1.63 0.00 1.89 1.85 0.00 0.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.39 0.00 0.00 0.00 0.00 0.00 0.00 36.26 96 34.81 872,452 - 150,739 - - 1,023,191 - 191 1,023,000
30 Dewi Yulianti, AMK, SE 2.00 2.27 25.00 0.00 0.00 1.85 3.39 2.44 0.00 1.89 1.85 0.00 0.00 0.00 0.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.94 100 40.94 1,026,087 129,055 140,666 - - 1,295,808 - 808 1,295,000
31 Nina Widianty 2.00 2.27 25.00 1.30 0.00 Err:508 1.69 0.81 0.00 2.05 1.85 0.46 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.52 Err:508 100 Err:508 951,925 - 259,868 19,491 - 1,231,284 - 284 1,231,000
32 Niki Sesbania, SE 2.00 2.27 25.00 0.00 0.00 1.85 1.69 1.63 0.00 2.13 1.85 0.00 0.00 0.00 0.16 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38.59 96 37.05 928,602 64,527 92,754 - - 1,085,883 - 883 1,085,000
33 Elis Supriyanti, AMKG 2.00 0.17 20.00 2.60 0.00 1.85 1.69 0.81 0.00 1.97 1.85 0.00 0.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.39 0.00 0.00 0.00 0.00 0.00 0.00 33.66 96 32.32 810,061 - 183,713 - - 993,774 - 774 993,000
34 M Faisal Ali, S.IP 2.00 0.17 25.00 0.00 0.00 1.85 1.69 1.63 0.00 1.89 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36.09 92 33.20 832,188 96,791 - - - 928,979 - 979 928,000
35 Fatmawati, Am.Keb 2.00 0.17 20.00 2.60 2.50 1.85 1.69 0.81 0.00 1.40 1.85 0.00 0.00 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.36 0.00 0.00 0.00 0.00 35.36 88 31.11 779,873 - 60,714 - 210,000 1,050,587 - 587 1,050,000
36 Hasan Alvian, S.Kep 2.00 0.17 25.00 1.30 2.50 1.85 1.69 1.63 0.00 1.81 1.85 0.30 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.33 40.47 96 38.85 973,746 - 172,722 23,389 - 1,169,857 - 857 1,169,000
37 Risna D Yulianti, S.ST 2.00 0.17 25.00 2.60 2.50 1.85 1.69 2.44 0.00 2.05 1.85 0.00 0.00 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.40 0.00 0.81 0.00 0.00 43.39 100 43.39 1,087,504 - 9,421 - - 1,096,925 - 925 1,096,000
38 H. Subagja Eska Hidayat, SE 2.00 0.17 25.00 0.00 0.00 1.85 1.69 2.44 0.00 1.81 1.85 0.00 0.00 0.00 0.22 0.00 0.00 0.00 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 37.05 100 37.05 928,578 129,055 127,003 3,898 - 1,188,534 - 534 1,188,000
39 Neneng Wulan 2.00 0.17 15.00 2.60 0.00 1.85 1.69 0.81 0.00 1.81 1.85 0.00 0.00 0.00 0.00 0.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27.93 100 27.93 700,140 - 81,378 - - 781,518 - 518 781,000
40 Dadan Nurdiansyah,ST 2.00 0.17 25.00 0.00 0.00 1.85 1.69 0.81 0.00 2.05 1.85 0.00 0.00 0.00 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35.59 100 35.59 892,123 - 87,277 - - 979,400 - 400 979,000
41 Tira Febrianti DJ, Am.Kep 2.00 0.17 20.00 2.60 0.00 1.85 1.69 1.63 0.00 1.81 1.85 0.16 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.85 0.00 0.00 0.00 0.00 0.00 0.00 34.62 96 33.23 832,961 - 91,856 - - 924,817 - 817 924,000
42 Indra Sukmana 2.00 0.17 15.00 0.00 0.00 1.85 1.69 2.44 0.00 1.72 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26.74 84 22.46 562,934 96,791 - - - 659,725 - 725 659,000
43 Ajeng Pratiwi, AMD 2.00 0.17 20.00 0.00 0.00 1.85 1.69 1.63 0.00 2.05 1.85 0.00 0.00 0.00 0.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 31.31 100 31.31 784,742 129,055 31,901 - - 945,698 - 698 945,000
44 Wulan Sari Purwanti 2.00 0.17 15.00 0.00 0.00 1.85 1.69 1.63 0.00 1.97 1.85 0.00 0.00 0.00 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26.32 100 26.32 659,733 - 86,013 - - 745,746 - 746 745,000
45 Fitri Nurhayati 2.00 0.17 15.00 0.00 0.00 1.85 1.69 0.81 0.00 1.97 1.85 0.00 0.00 0.00 0.00 0.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25.50 100 25.50 639,151 - 81,378 - - 720,529 - 529 720,000
46 Riski Romadhiansyah,Am.Kep 2.00 0.17 20.00 2.60 5.00 1.85 1.69 2.44 0.00 2.05 1.85 0.65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.04 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.42 40.76 100 40.76 1,021,695 - 369,783 27,287 - 1,418,765 - 765 1,418,000
47 Inten Rachmayanti, S.ST.RMIK 2.00 0.17 25.00 2.60 5.00 1.85 1.69 2.44 0.00 1.89 1.85 0.00 0.00 0.00 0.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 44.64 96 42.86 1,074,270 - 83,485 - - 1,157,755 - 755 1,157,000
48 Gian Laksana Putra, Am.Kep 2.00 0.17 20.00 2.60 5.00 1.85 1.69 1.63 0.00 2.05 1.85 0.29 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39.36 100 39.36 986,672 - 164,086 175,424 - 1,326,182 - 182 1,326,000
49 Mela Nurfaidah, Am.AK 2.00 0.17 20.00 2.60 2.50 1.85 1.69 0.81 0.00 1.97 1.85 0.00 0.00 0.00 0.00 0.00 0.20 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35.65 96 34.23 857,911 - 113,473 - - 971,384 - 384 971,000
50 Fadli Fauzan Pratama, Am.Kep 2.00 0.17 20.00 2.60 2.50 1.85 1.69 1.63 0.00 2.05 1.85 0.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.29 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.33 0.00 40.20 100 40.20 1,007,514 - 125,610 226,098 - 1,359,222 - 222 1,359,000
51 Lina Marlina, S.Si.Apt 2.00 0.17 25.00 2.60 0.00 1.85 1.69 2.44 0.00 1.89 1.85 0.00 0.00 0.00 0.00 0.29 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.85 0.00 0.00 0.00 0.00 0.00 0.00 40.64 92 37.38 937,088 - 162,696 - - 1,099,784 - 784 1,099,000
52 Utari Kusuma Wardani, S.Tr.Keb 2.00 0.17 25.00 2.60 2.50 1.85 1.69 0.81 0.00 1.97 1.85 0.00 0.00 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.36 0.00 0.00 0.00 0.00 40.92 96 39.28 984,661 - 60,739 - - 1,045,400 - 400 1,045,000
53 Agus Mulyana Al-Ishaq, Amd.Kep 2.00 0.17 20.00 2.60 5.00 Err:508 1.69 0.81 0.00 2.05 1.85 0.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Err:508 100 Err:508 916,680 - 110,699 149,198 - 1,176,577 - 577 1,176,000
54 Irfan Ramdani 2.00 0.17 15.00 0.00 0.00 0.00 1.69 2.44 0.00 2.05 1.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25.21 100 25.21 631,973 - - - - 631,973 - 973 631,000

JUMLAH 52,853,088 6,452,735 4,625,500 808,000 420,000 65,159,323 - 32,323 65,127,000

 Presensi Disiplin Dedikasi dan Loyalitas RAWAT JALAN RAWAT INAP DAN UGD RUJUKAN UPAYA KESEHATAN MASYARAKAT

Lab Asuhan Upaya

No. Nama Waktu Kerja Klinik Klinik Klinik Front
Kehadiran Apel (harI) Kepatuhan Farmasi dan Visite Keperawata OBSERVASI Persalinan Front Sopir Pendam Promkes Kesling KIA Gizi P2 Perkesm Pengemb
Efektif Umum Gigi KIA Office RO n& UGD , poned Office ping dan UKS as angan
Kebidanan

kehad

apel
iran
1 dr.Hj.Sri Cahyatiningsih 25 18 18 2 309 36 661 70 275 35 516 7 7 dr.Hj.Sri Cahyatiningsih
2 Yanyan Supriatna, AMD, S.IP 25 25 25 2 309 36 661 70 275 35 516 0 0 Yanyan Supriatna, AMD, S.IP
3 Hj. Hasanah, S.Kep ,Ners 25 25 25 2 173 0 0 Hj. Hasanah, S.Kep ,Ners
4 Momoh Rohanah, S.Kep 25 22 21 2 85 74 3 4 Momoh Rohanah, S.Kep
5 Wartinah, AMK 25 24 24 2 250 80 KIA 1 1 Wartinah, AMK
6 Elis Supyeni, Am. Keb 25 23 22 2 60 71 23 P2P 2 3 Elis Supyeni, Am. Keb
7 Sri Rahmawati, S.Tr.Keb 25 24 24 2 100 9 26 P2P 1 1 Sri Rahmawati, S.Tr.Keb
8 Ai Neti Srihartati,SKM 25 25 22 2 79 0 3 Ai Neti Srihartati,SKM
9 dr.Hj.Sisca Risya Fujiarti 25 24 24 2 171 6 144 1 1 dr.Hj.Sisca Risya Fujiarti
10 drg. In Kharina 25 24 22 2 166 1 3 drg. In Kharina
11 Anita Sulistika, AMK 25 24 24 2 258 1 1 Anita Sulistika, AMK
12 Tati Sudaryati,AMKG 25 25 25 2 65 0 0 Tati Sudaryati,AMKG
13 Hj.Lina Zenab, AMG 25 23 20 2 70 2 5 Hj.Lina Zenab, AMG
14 Hj.Dewi Darojah 25 22 20 2 271 3 5 Hj.Dewi Darojah
15 Yoseph Ferry,S.Kep 25 20 15 2 15 8 5 10 Yoseph Ferry,S.Kep
16 Gun Gun Nurdiansyah,S.Kep, Ners 25 23 17 2 161 18 2 8 Gun Gun Nurdiansyah,S.Kep, Ners
17 Rudiana, Am.Kep 25 23 23 2 118 14 47 2 2 Rudiana, Am.Kep
18 Hj.Husnul Khotimah,S.ST 25 22 16 2 3 9 Hj.Husnul Khotimah,S.ST
19 Ema Asgaritta,S.ST 25 23 23 2 69 71 KIA 2 2 Ema Asgaritta,S.ST
20 Nenden Nuraeni , S.ST, MH.Kes 25 16 16 2 5 36 73 KIA 9 9 Nenden Nuraeni , S.ST, MH.Kes
21 Reni Hidayat, S.ST 25 23 23 2 9 79 2 2 Reni Hidayat, S.ST
22 Telli Lindaris, SKM 25 25 25 2 68 0 0 Telli Lindaris, SKM
23 Jemmy Mulyadi, SE 25 22 20 2 - 3 5 Jemmy Mulyadi, SE
24 Yeni Rella 25 25 25 2 968 0 0 Yeni Rella
25 Fitri Dwiyani, S.Tr.Keb 25 24 23 2 121 1 1 2 Fitri Dwiyani, S.Tr.Keb
26 Rina Kurnia Aprianti, S.Tr.Keb 25 21 21 2 60 71 4 4 Rina Kurnia Aprianti, S.Tr.Keb
27 Dian Pramesti, Am.Keb 25 22 22 2 9 73 lansia 3 3 Dian Pramesti, Am.Keb
28 Irma Nurma Diana, AM.Keb 25 23 21 2 2 1.0 67 2 4 Irma Nurma Diana, AM.Keb
29 Sipa Nurasvia, AMKG 25 24 23 2 96 36 1 2 Sipa Nurasvia, AMKG
30 Dewi Yulianti, AMK, SE 25 25 23 2 2,337 0 2 Dewi Yulianti, AMK, SE
31 Nina Widianty 25 25 25 2 331 5 80 0 0 Nina Widianty
32 Niki Sesbania, SE 25 24 26 2 1,541 0 0 Niki Sesbania, SE
33 Elis Supriyanti, AMKG 25 24 24 2 117 36 1 1 Elis Supriyanti, AMKG
34 M Faisal Ali, S.IP 25 23 23 2 2 2 M Faisal Ali, S.IP
35 Fatmawati, Am.Keb 25 22 17 2 58 1.0 71 3 8 Fatmawati, Am.Keb
36 Hasan Alvian, S.Kep 25 24 22 2 220 6 51 1 3 Hasan Alvian, S.Kep
37 Risna D Yulianti, S.ST 25 25 25 2 9 79 67 0 0 Risna D Yulianti, S.ST
38 H. Subagja Eska Hidayat, SE 25 25 22 2 2,110 1 0 3 H. Subagja Eska Hidayat, SE
39 Neneng Wulan 25 25 22 2 1,352 Gizi Masy 0 3 Neneng Wulan
40 Dadan Nurdiansyah,ST 25 25 25 2 1,450 0 0 Dadan Nurdiansyah,ST
41 Tira Febrianti DJ, Am.Kep 25 24 22 2 117 79 1 3 Tira Febrianti DJ, Am.Kep
42 Indra Sukmana 25 21 21 2 4 4 Indra Sukmana
43 Ajeng Pratiwi, AMD 25 25 25 2 530 0 0 Ajeng Pratiwi, AMD
44 Wulan Sari Purwanti 25 25 24 2 1,429 0 1 Wulan Sari Purwanti
45 Fitri Nurhayati 25 25 24 2 1,352 0 1 Fitri Nurhayati
46 Riski Romadhiansyah,Am.Kep 25 25 25 2 471 7 64 0 0 Riski Romadhiansyah,Am.Kep
47 Inten Rachmayanti, S.ST.RMIK 25 24 23 2 1,387 P2P 1 2 Inten Rachmayanti, S.ST.RMIK
48 Gian Laksana Putra, Am.Kep 25 25 25 2 209 45 0 0 Gian Laksana Putra, Am.Kep
49 Mela Nurfaidah, Am.AK 25 24 24 2 271 1 1 Mela Nurfaidah, Am.AK
50 Fadli Fauzan Pratama, Am.Kep 25 25 25 2 160 58 35 0 0 Fadli Fauzan Pratama, Am.Kep
51 Lina Marlina, S.Si.Apt 25 23 23 2 2,703 79 2 2 Lina Marlina, S.Si.Apt
52 Utari Kusuma Wardani, S.Tr.Keb 25 24 24 2 58 71 1 1 Utari Kusuma Wardani, S.Tr.Keb
53 Agus Mulyana Al-Ishaq, Amd.Kep 25 25 25 2 141 38 1 0 0 Agus Mulyana Al-Ishaq, Amd.Kep
54 Irfan Ramdani 25 25 25 2 Irfan Ramdani
 CAKUPAN TARGET
JENIS KEGIATAN SASARAN PENCAPAIAN TARGET
(4/3 X 100%) BULANAN
2 3 4 5 6
UPAYA KIA & KB Sukagalih
Cakupan Kunjungan Ibu Hamil K4 394 229 58.12 95.00 55.42
Cakupan Pertolongan Persalinan oleh Tenaga Kesehatan 376 221 58.78 90.00 52.50
Cakupan Komplikasi Kebidanan yang ditangani 394 6 1.52 65.00 37.92
Cakupan Pelayanan Nifas 376 221 58.78 90.00 52.50
Cakupan Kunjungan Neonatus 1 (KN1) 376 221 58.78 90.00 52.50
Cakupan Kunjungan Neonatus Lengkap (KN Lengkap) 376 221 58.78 90.00 52.50
Cakupan Neonatus dengan Komplikasi yang ditangani - - 65.00 37.92
Cakupan Kunjungan Bayi 358 221 61.73 80.85 47.16
Cakupan Pelayanan Anak Balita 358 - - 90.00 52.50
Cakupan Peserta KB Aktif 350 96 27.43 100.00 58.33

UPAYA KIA & KB Sukakarya

Cakupan Kunjungan Ibu Hamil K4 179 105 58.66 95.00 55.42
Cakupan Pertolongan Persalinan oleh Tenaga Kesehatan 171 100 58.48 90.00 52.50
Cakupan Komplikasi Kebidanan yang ditangani 179 2 1.12 65.00 37.92
Cakupan Pelayanan Nifas 171 100 58.48 90.00 52.50
Cakupan Kunjungan Neonatus 1 (KN1) 171 100 58.48 90.00 52.50
Cakupan Kunjungan Neonatus Lengkap (KN Lengkap) 171 100 58.48 90.00 52.50
Cakupan Neonatus dengan Komplikasi yang ditangani - - 65.00 37.92
Cakupan Kunjungan Bayi 163 100 61.35 80.85 47.16
Cakupan Pelayanan Anak Balita 163 - - 90.00 52.50
Cakupan Peserta KB Aktif 160 96 60.00 100.00 58.33

UPAYA KIA & KB Sukajaya

Cakupan Kunjungan Ibu Hamil K4 393 230 58.52 95.00 55.42
Cakupan Pertolongan Persalinan oleh Tenaga Kesehatan 375 219 58.40 90.00 52.50
Cakupan Komplikasi Kebidanan yang ditangani 393 7 1.78 65.00 37.92
Cakupan Pelayanan Nifas 375 219 58.40 90.00 52.50
Cakupan Kunjungan Neonatus 1 (KN1) 375 219 58.40 90.00 52.50
Cakupan Kunjungan Neonatus Lengkap (KN Lengkap) 375 219 58.40 90.00 52.50
Cakupan Neonatus dengan Komplikasi yang ditangani - - 65.00 37.92
Cakupan Kunjungan Bayi 357 219 61.34 80.85 47.16
Cakupan Pelayanan Anak Balita 357 - - 90.00 52.50
Cakupan Peserta KB Aktif 340 96 28.24 100.00 58.33

UPAYA KIA & KB Mekargalih

Cakupan Kunjungan Ibu Hamil K4 180 105 58.33 95.00 55.42
Cakupan Pertolongan Persalinan oleh Tenaga Kesehatan 172 100 58.14 90.00 52.50
Cakupan Komplikasi Kebidanan yang ditangani 180 4 2.22 65.00 37.92
Cakupan Pelayanan Nifas 172 100 58.14 90.00 52.50
Cakupan Kunjungan Neonatus 1 (KN1) 172 100 58.14 90.00 52.50
Cakupan Kunjungan Neonatus Lengkap (KN Lengkap) 172 100 58.14 90.00 52.50
Cakupan Neonatus dengan Komplikasi yang ditangani - - 65.00 37.92
Cakupan Kunjungan Bayi 164 100 60.98 80.85 47.16
Cakupan Pelayanan Anak Balita 164 - - 90.00 52.50
Cakupan Peserta KB Aktif 159 96 60.38 100.00 58.33

10
 KINERJA
(5/6 X 100%)
7
73.46
104.88
111.96
4.02
111.96
111.96
111.96
-
130.89
-
47.02

78.73
105.85
111.39
2.95
111.39
111.39
111.39
-
130.08
-
102.86

73.37
105.61
111.24
4.70
111.24
111.24
111.24
-
130.07
-
48.40

78.69
105.26
110.74
5.86
110.74
110.74
110.74
-
129.29
-
103.50

11
 DAFTAR PENERIMA
UPT PUSKESMAS
BULAN J

Jasa Pelayanan atas P

Jumlah Total Puskesmas Manajemen

No. Nama Gol Kehadiran
Index Index

52,221,115 6,452,735

1 dr.Hj.Sri Cahyatiningsih IV/b 78.78 72.00 56.72 1,421,812 2,193,930

2 Yanyan Supriatna, AMD, S.IP III/b 71.34 100.00 71.34 1,788,263 1,032,438

3 Hj. Hasanah, S.Kep ,Ners IV/b 52.48 100.00 52.48 1,315,377 -

4 Momoh Rohanah, S.Kep III/d 47.88 88.00 42.13 1,056,116 -

5 Wartinah, AMK III/d 41.78 96.00 40.11 1,005,313 193,582

6 Elis Supyeni, Am. Keb III/d 43.06 92.00 39.61 992,951 -

7 Sri Rahmawati, S.Tr.Keb IV/b 48.99 96.00 47.03 1,178,857 -

8 Ai Neti Srihartati,SKM III/d 47.59 100.00 47.59 1,192,980 193,582

9 dr.Hj.Sisca Risya Fujiarti III/d 54.15 96.00 51.98 1,302,977 451,691

10 drg. In Kharina III/d 53.54 96.00 51.40 1,288,291 129,055

11 Anita Sulistika, AMK III/d 40.11 96.00 38.51 965,174 -

12 Tati Sudaryati,AMKG III/d 44.50 100.00 44.50 1,115,437 516,219

13 Hj.Lina Zenab, AMG III/d 49.21 92.00 45.28 1,134,873 -

14 Hj.Dewi Darojah III/d 42.94 88.00 37.79 947,133 -

15 Yoseph Ferry,S.Kep III/c 45.27 80.00 36.22 907,790 -

16 Gun Gun Nurdiansyah,S.Kep, Ner III/b 42.85 92.00 39.42 988,159 -

17 Rudiana, Am.Kep III/b 40.22 92.00 37.00 927,418 193,582

18 Hj.Husnul Khotimah,S.ST III/b 47.83 88.00 42.09 1,055,106 774,328

19 Ema Asgaritta,S.ST III/b 49.70 92.00 45.72 1,146,102 -

20 Nenden Nuraeni , S.ST, MH.Kes III/b 47.18 64.00 30.19 756,842 -

21 Reni Hidayat, S.ST III/a 45.88 92.00 42.21 1,058,008 -

22 Telli Lindaris, SKM III/a 41.57 100.00 41.57 1,041,934 -

23 Jemmy Mulyadi, SE III/a 39.14 88.00 34.44 863,236 129,055

24 Yeni Rella II/c 35.68 100.00 35.68 894,296 -

25 Fitri Dwiyani, S.Tr.Keb II/b 40.34 96.00 38.73 970,765 -

26 Rina Kurnia Aprianti, S.Tr.Keb II/c 44.47 84.00 37.36 936,409 -

27 Dian Pramesti, Am.Keb II/c 39.82 88.00 35.04 878,374 -

28 Irma Nurma Diana, AM.Keb II/c 45.18 92.00 41.56 1,041,831 -

29 Sipa Nurasvia, AMKG Non PNS 36.26 96.00 34.81 872,452 -

30 Dewi Yulianti, AMK, SE Non PNS 40.94 100.00 40.94 1,026,087 129,055

31 Nina Widianty Non PNS 37.98 100.00 37.98 951,925 -

32 Niki Sesbania, SE Non PNS 38.59 96.00 37.05 928,602 64,527

33 Elis Supriyanti, AMKG Non PNS 33.66 96.00 32.32 810,061 -

34 M Faisal Ali, S.IP Non PNS 36.09 92.00 33.20 832,188 96,791

35 Fatmawati, Am.Keb Non PNS 35.36 88.00 31.11 779,873 -

36 Hasan Alvian, S.Kep Non PNS 40.47 96.00 38.85 973,746 -

37 Risna D Yulianti, S.ST Non PNS 43.39 100.00 43.39 1,087,504 -

38 H. Subagja Eska Hidayat, SE Non PNS 37.05 100.00 37.05 928,578 129,055

39 Neneng Wulan Non PNS 27.93 100.00 27.93 700,140 -

40 Dadan Nurdiansyah,ST Non PNS 35.59 100.00 35.59 892,123 -

41 Tira Febrianti DJ, Am.Kep Non PNS 34.62 96.00 33.23 832,961 -

42 Indra Sukmana Non PNS 26.74 84.00 22.46 562,934 96,791

43 Ajeng Pratiwi, AMD Non PNS 31.31 100.00 31.31 784,742 129,055

44 Wulan Sari Purwanti Non PNS 26.32 100.00 26.32 659,733 -

45 Fitri Nurhayati Non PNS 25.50 100.00 25.50 639,151 -

46 Riski Romadhiansyah,Am.Kep Non PNS 40.76 100.00 40.76 1,021,695 -

47 Inten Rachmayanti, S.ST.RMIK Non PNS 44.64 96.00 42.86 1,074,270 -

48 Gian Laksana Putra, Am.Kep Non PNS 39.36 100.00 39.36 986,672 -

49 Mela Nurfaidah, Am.AK Non PNS 35.65 96.00 34.23 857,911 -

50 Fadli Fauzan Pratama, Am.Kep Non PNS 40.20 100.00 40.20 1,007,514 -

51 Lina Marlina, S.Si.Apt Non PNS 40.64 92.00 37.38 937,088 -

52 Utari Kusuma Wardani, S.Tr.Keb Non PNS 40.92 96.00 39.28 984,661 -

53 Agus Mulyana Al-Ishaq, Amd.Kep Non PNS 36.57 100.00 36.57 916,680 -

54 Irfan Ramdani Non PNS 25.21 100.00 25.21 631,973 -

JUMLAH 52,221,115 6,452,735

Pejabat Pengelola Keuangan

UPT Puskesmas Pembangunan

YANYAN SUPRIATNA, AMD, S.IP,SKM

NIP. 19690217 200701 1 010
Mengetahui,
Kepala UPT Puskesmas Pemba
Kecamatan Tarogong Kid

dr. Hj. SRI CAHYATINING

NIP. 19681006 200212 2 0
NERIMA JASA PELAYANAN
KESMAS PEMBANGUNAN
BULAN JULI 2018

elayanan atas Pendapatan

Rawat
Rawat Jalan Inap / Persalinan Jumlah Jasa Hasil
Pajak Pph 21 Zakat Pembulatan
UGD Pelayanan Pembulatan

4,625,500 808,000 420,000

- - - 3,615,742 542,361 - - 3,073,381

- - - 2,820,701 141,035 - - 2,679,666

135,822 - - 1,451,199 217,680 - - 1,233,519

66,733 - - 1,122,849 168,427 - - 954,422

196,275 - - 1,395,170 69,759 - - 1,325,412

62,808 - - 1,055,759 52,788 - - 1,002,971

87,931 - - 1,266,788 190,018 - - 1,076,770

- - - 1,386,562 69,328 - - 1,317,234

134,252 23,389 - 1,912,309 95,615 - - 1,816,694

130,326 - - 1,547,672 77,384 - - 1,470,288

202,556 - - 1,167,730 58,387 - - 1,109,344

102,063 - - 1,733,719 86,686 - - 1,647,033

- - - 1,134,873 56,744 - - 1,078,129

113,473 - - 1,060,606 53,030 - - 1,007,576

11,776 31,185 - 950,751 47,538 - - 903,213

126,401 70,168 - 1,184,728 59,236 - - 1,125,492

92,642 54,575 - 1,268,217 63,411 - - 1,204,806

 - - - 1,829,434 91,472 - - 1,737,962

72,229 - - 1,218,331 60,917 - - 1,157,414

5,234 - - 762,076 38,104 - - 723,972

9,421 - - 1,067,429 53,371 - - 1,014,058

- - - 1,041,934 52,097 - - 989,837

- - - 992,291 49,615 - - 942,676

58,265 - - 952,561 - - - 952,561

94,997 3,898 - 1,069,660 - - - 1,069,660

62,808 - - 999,217 - - - 999,217

9,421 - - 887,795 - - - 887,795

2,093 - 210,000 1,253,924 - - - 1,253,924

150,739 - - 1,023,191 51,160 - - 972,031

140,666 - - 1,295,808 64,790 - - 1,231,017

259,868 19,491 - 1,231,284 61,564 - - 1,169,720

92,754 - - 1,085,883 54,294 - - 1,031,589

183,713 - - 993,774 49,689 - - 944,085

- - - 928,979 46,449 - - 882,530

60,714 - 210,000 1,050,587 52,529 - - 998,058

172,722 23,389 - 1,169,857 58,493 - - 1,111,364

9,421 - - 1,096,925 54,846 - - 1,042,079

127,003 3,898 - 1,188,534 59,427 - - 1,129,107

81,378 - - 781,518 39,076 - - 742,442

87,277 - - 979,400 48,970 - - 930,430

91,856 - - 924,817 46,241 - - 878,576

- - - 659,725 32,986 - - 626,739

31,901 - - 945,698 47,285 - - 898,413

86,013 - - 745,746 37,287 - - 708,459

 81,378 - - 720,529 36,026 - - 684,503

369,783 27,287 - 1,418,765 70,938 - - 1,347,827

83,485 - - 1,157,755 57,888 - - 1,099,867

164,086 175,424 - 1,326,182 66,309 - - 1,259,873

113,473 - - 971,384 48,569 - - 922,815

125,610 226,098 - 1,359,222 67,961 - - 1,291,261

162,696 - - 1,099,784 54,989 - - 1,044,795

60,739 - - 1,045,400 52,270 993,130

110,699 149,198 - 1,176,577 58,829 1,117,748

- - - 631,973 31,599 600,374

4,625,500 808,000 420,000 64,527,350 3,713,867 - - 60,813,483

Garut, 07 Agustus 2018

Bendahara Pengeluaran Pembantu

Hj. HUSNUL KHOTIMAH, S.ST

NIP. 197501242007012006
ngetahui,
kesmas Pembangunan
Tarogong Kidul

AHYATININGSIH
006 200212 2 001
 TANDA TANGAN

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 PEMERINTAH KABUPATEN GARUT
DINAS KESEHATAN
UPT PUSKESMAS PEMBANGUNAN
Jl.Pembangunan No 216 Tlp.0262. email_uptdpembangunan@gmail.com

Nomor :823/ /PKM/2018

Lam -
Hal : Permohonan Pemindah bukuan
Kepada;
Yth. Direktur Bank Jabar Banten
cabang Garut
di
Tempat

Bersama ini kami sampaikan permohonan untuk pemindah bukuan uang sejumlah RP. 64.527.350 (Enam Puluh Empat Juta Lima Ra
Puluh Tujuh Ribu Tiga Ratus Lima Puluh Rupiah ) dari No rekening 0059326147001 atas nama Puskesmas Pembangunan untuk pem
Jasa pelayanan BLUD UPT Puskesmas Pembangunan Bulan Juli 2018 ke daftar rekening karyawan UPT Puskesmas Pembangunan ya
dibawah ini :

NAMA Pajak PPh

NO NAMA JABATAN NO REKENING Jumlah yang di terima
BANK Pasal 21
1 dr.Hj.Sri Cahyatiningsih Kepala Puskesmas BJB 0173110172813 3,615,742 542,361
2 Yanyan Supriatna, AMD, S.IP Kepala Sub bag TU BJB 0005010845100 2,820,701 141,035
3 Hj. Hasanah, S.Kep ,Ners Prog.MTBS BJB 0173210076042 1,451,199 217,680
4 Momoh Rohanah, S.Kep Prog.TB Paru/Kusta BJB 0173110220209 1,122,849 168,427
5 Wartinah, AMK Prog. USILA BJB 0173110288450 1,395,170 69,759
6 Elis Supyeni, Am. Keb Prog SDIDTK BJB 0173110270876 1,055,759 52,788
7 Sri Rahmawati, S.Tr.Keb Prog. Batra BJB 0173200117167 1,266,788 190,018
8 Ai Neti Srihartati,SKM Promkes BJB 0001394428100 1,386,562 69,328
9 dr.Hj.Sisca Risya Fujiarti dr.Fungsional BJB 0009399399100 1,912,309 95,615
10 drg. In Kharina dr.Fungsional Gigi BJB 0003688021100 1,547,672 77,384
11 Anita Sulistika, AMK Prog Ispa Diare BJB 0173110106710 1,167,730 58,387
12 Tati Sudaryati,AMKG BP Penerimaan BJB 0005473845100 1,733,719 86,686
13 Hj.Lina Zenab, AMG TPG BJB 0173200180203 1,134,873 56,744
14 Hj.Dewi Darojah Analis / Lab BJB 0173200095266 1,060,606 53,030
15 Yoseph Ferry,S.Kep UGD/Prog.Nafza BJB 0009980733100 950,751 47,538
16 Gun Gun Nurdiansyah,S.Kep, Ners UGD/Prog.Nafza BJB 0173100135663 1,184,728 59,236
17 Rudiana, Am.Kep Prog.Indera BJB 0068964970100 1,268,217 63,411
18 Hj.Husnul Khotimah,S.ST BP Pengeluaran BJB 0064912992101 1,829,434 91,472
19 Ema Asgaritta,S.ST Bikor BJB 0004585437100 1,218,331 60,917
20 Nenden Nuraeni , S.ST, MH.Kes Kesling BJB 0068246105100 762,076 38,104
21 Reni Hidayat, S.ST Bides Mekargalih BJB 0069281737100 1,067,429 53,371
22 Telli Lindaris, SKM Epidemiologi BJB 0072299922100 1,041,934 52,097
23 Jemmy Mulyadi, SE Kepegawaian BJB 0064583190100 992,291 49,615
24 Yeni Rella Pel.Administrasi BJB 0069791298100 952,561 -
25 Fitri Dwiyani, S.Tr.Keb Prog.PTM BJB 0063777943100 1,069,660 -
26 Rina Kurnia Aprianti, S.Tr.Keb Bides Sukagalih BJB 0069792571100 999,217 -
27 Dian Pramesti, Am.Keb Bides Sukajaya BJB 0069911382100 887,795 -
28 Irma Nurma Diana, AM.Keb Korim BJB 0069793096100 1,253,924 -
29 Sipa Nurasvia, AMKG Prog. UKGMD BJB 0069890733100 1,023,191 51,160
30 Dewi Yulianti, AMK, SE Kasir BJB 0069793568100 1,295,808 64,790
31 Nina Widianty Pelaksana Perawat BJB 0069710281100 1,231,284 61,564
32 Niki Sesbania, SE Pel.Administrasi BJB 0069793274100 1,085,883 54,294
33 Elis Supriyanti, AMKG Prog.UKGS BJB 0069864666100 993,774 49,689
34 M Faisal Ali, S.IP Pel.Administrasi BJB 0069655459100 928,979 46,449
35 Fatmawati, Am.Keb Bidan Fungsional BJB 0082317031102 1,050,587 52,529
36 Hasan Alvian, S.Kep Surveilans/Kesorga BJB 0058904864100 1,169,857 58,493
37 Risna D Yulianti, S.ST Bides Sukajaya BJB 0069910866100 1,096,925 54,846
38 H. Subagja Eska Hidayat, SE Operator JKN BJB 0064981323101 1,188,534 59,427
39 Neneng Wulan Pel.Harian Obat BJB 0069654916100 781,518 39,076
40 Dadan Nurdiansyah,ST Pel.Administrasi BJB 0069687563100 979,400 48,970
41 Tira Febrianti DJ, Am.Kep Prog UKS BJB 0069910645100 924,817 46,241
42 Indra Sukmana Pel.Administrasi BJB 0069652298100 659,725 32,986
43 Ajeng Pratiwi, AMD Pel.Administrasi BJB 0069458858100 945,698 47,285
44 Wulan Sari Purwanti Pel.Administrasi BJB 0076478996100 745,746 37,287
45 Fitri Nurhayati Pel.Harian Obat BJB 0077938559100 720,529 36,026
46 Riski Romadhiansyah,Am.Kep Prog Jiwa BJB 0071315312100 1,418,765 70,938
47 Inten Rachmayanti, S.ST.RMIK Rekam Medik BJB 0077891110100 1,157,755 57,888
48 Gian Laksana Putra, Am.Kep Pel.Perawat BJB 0078370866100 1,326,182 66,309
49 Mela Nurfaidah, Am.AK Analis / Lab BJB 0077952225100 971,384 48,569
50 Fadli Fauzan Pratama, Am.Kep Prog.Perkesmas BJB 0067809009100 1,359,222 67,961
51 Lina Marlina, S.Si.Apt Apoteker BJB 0068774764100 1,099,784 54,989
52 Utari Kusuma Wardani, S.Tr.Keb Bidan Fungsional BJB 0078742348100 1,045,400 52,270
53 Agus Mulyana Al-Ishaq, Amd.Kep Pelaksana perawat BJB 0083788126100 1,176,577 58,829
54 Irfan Ramdani Pelaksana perawat BJB 631,973 31,599
JUMLAH 64,527,350 3,713,867

Garut, 07 Agustus 2018

Pimpinan BLUD UPT Puskesmas Pembanguna

dr.Hj.SRI CAHYATININGSIH
NIP.19681006.200212.2.001
a Lima Ratus Dua
untuk pembayaran
angunan yang tersebut

Jumlah yang di
Transper ( Rp )
3,073,381
2,679,666
1,233,519
954,422
1,325,412
1,002,971
1,076,770
1,317,234
1,816,694
1,470,288
1,109,344
1,647,033
1,078,129
1,007,576
903,213
1,125,492
1,204,806
1,737,962
1,157,414
723,972
1,014,058
989,837
942,676
952,561
1,069,660
999,217
887,795
1,253,924
972,031
1,231,017
1,169,720
1,031,589
944,085
882,530
998,058
1,111,364
1,042,079
1,129,107
742,442
930,430
878,576
626,739
898,413
708,459
684,503
1,347,827
1,099,867
1,259,873
922,815
 1,291,261
1,044,795
993,130
1,117,748
600,374
60,813,483

mbangunan

SIH
01
 rekap

kapitasi

susualan jkn bulan lalu 55% 45%

bulan pendapatan Blud
jan 20,936,500 374,500 49,958,150 40,874,850
feb 20,322,000 231,500 50,109,400 40,998,600
mar 26,010,500 446,000 50,236,175 41,102,325
apr 21,098,000 204,000 47,894,041 39,186,034
mei 32,527,000 314,200 53,013,235 43,374,465
jun - -
jul 53,013,235 43,374,465
agu - -
sep - -
okt - -
nov - -
des - -
jan - -
feb - -
mar - -
apr - -
mei - -
jun - -
jul - -
agu - -
sep - -
okt - -
nov - -
des - -
asi

jumlah kapitasi
Jumlah jasa giro jkn jasa giro blud/restribusi keseluruhan

90,833,000 187,469 247,165 112,578,634

91,108,000 301,636 261,574 112,224,710
91,338,500 538,183 347,819 118,681,002
87,080,075 374,046 4,692,000 113,448,121
96,387,700 186,265 - 96,888,165
-
96,387,700 96,387,700
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
jumlah yg dibagikan jumlah sampai dengan jumlah seluruh GU LS
jaspel bulan ini (JKN+BLUD)

49,958,150 62,620,484 62,620,484

50,109,400 62,115,310 124,735,794
50,236,175 68,444,827 193,180,621
47,894,041 65,554,080 258,734,701
53,013,235 43,874,930 302,609,631
- -
53,013,235 43,374,465
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 susulan jkn
kapitasi
jasa giro jkn
jasa giro blud/ restribusi
jumlah

###
187,469
247,165