REKAPITULASI KLAIM RAWAT JALAN SJKD

BULAN MEI 2017

PUSKESMAS :GONDANG
KECAMATAN :GONDANG
KABUPATEN :TULUNGAGUNG
PROPINSI :JAWA TIMUR
BULAN May-17

NO TGL KUNJ NO REG NAMA DESA NO KARTU

1 25/04/2017 09517D NAJWA KHAIRA W KRAJAN 3504094704150001

2 25/04/2017 32554A BUNHARI DUKUH 3504096111590001
3 25/05/2017 06337B SUSILOWATI DUKUH 3504096904580002
4 25/05/2017 32504A PRAWITO DUKUH 3504090911730004
5 26/05/2017 32195A MUYAKIN KRAJAN 350409610790001
6 26/05/2017 32047B WITRIATI BARENG 3504096103750001
7 02/05/2017 04484B SRIANIK BARENG 3504090101890001
8 02/05/2017 32175A SULASTRI BARENG 3504090101890001
9 02/05/2017 33277A RAHMAT ADI N JALAS 3504090107140004
10 02/05/2017 06003A SUPANI KRAJAN 3504091809580004
11 02/05/2017 06003B MORELAH KRAJAN 3504094707710001
12 02/05.2017 06337B SUSILOWATI DUKUH 3504096904580002
13 02/05/2017 32047B WITRIATI KRAJAN 3504096103750001
14 02/05/2017 32047A MUYAKIN KRAJAN 3504096107490004
15 04/05/2017 11293A MAMIK KRAJAN 3504090904090004
16 04/05/2017 32244B TUSINI KRAJAN 3504096107640004
17 05/05/2017 16157B MURTIAH KRAJAN 3504185605810002
18 05/05/2017 32036B ERNAWATI JALAS 3504095864870003
19 06/05/2017 32078B ANI MUHIBAH KRAJAN 3504095864870003
20 08/05/2017 32175A SULASTRI BARENG 3504090101890001
21 08/05.2017 04484B SRIANIK BARENG 3504096811730001
22 09/05/2017 10126D ANDRI WULANDARI JALAS 3504095107870001
23 15/05/2017 32701B MUSRIIN BARENG 3504095606480003
24 15/05/2017 33227B SRI KATMINI BARENG 3504015112580001
25 15/05/2017 32683B YATIYAH BARENG 3504095605590001
26 15/05/2017 16741B KALIMAH BARENG 3504094107360066
27 15/05/2017 17441B MINATEN BARENG 3504094504550001
28 15/05/2017 00713A TUMIDJAN BARENG 3504091607650001
29 15/05/2017 00713B SISMIATI BARENG 3504095864890002
30 15/05.2017 32283B UMI HARTINI BARENG 3504095205660001
31 15/05.2017 33223B ROPINGAH BARENG 3504094104650001
32 15/05/2017 07582B PAISAH BARENG 3504094107550112
33 15/05/2017 32663B MONAH BARENG 3504094909560001
34 15/05/2017 32704A ISTINAROH BARENG 3504097112590001
35 15/05/2017 32175A SULASTRI BARENG 3504097112590001
36 15/05/2017 33223B MUTINI BARENG 3504095209650001
37 15/05/2017 33303B HARYATI BARENG 3504096512670001
38 15/05/2017 04474B SUPIYAH BARENG 3504095205550001
39 15/05/2017 32699B MUNIRAH BARENG 3504095011460001
40 15/05.2017 33225B AYU ISTININGRUM BARENG 3504096808120001
41 15/05/2017 32240B YATINI BARENG 3504094107550111
42 15/05/2017 02636A SUKARLAN BARENG 3504094104350001
43 15/05/2017 32694A PINGAH BARENG 3504094104350001
44 15/05/2017 06443A KUSNOTO BARENG 350409010150002
45 15/05.2017 18533B KARMINI BARENG 3504096111450001
46 18/05/2017 05785A KOMINI KRAJAN 350409410760019
47 18/05/2017 321785ASULASTRI BARENG 3504090101890001
48 18/05/2017 04637A NURYASIN KRAJAN 3504090107380047
49 18/05/2017 011293BMAMIK BARENG 3504095212630001
50 18/05/2017 32332A MARTINI MCBANG 3504094101610013
51 18/05/2017 00686A KAROLAH KRAJAN 3504094207530002
52 18/05/2017 04484B SRIANIK JALAS 3504096309660001
53 18/05/2017 16879B SITI KOMARIYAH KRAJAN 3504096909620002
54 18/05/2017 32088B SITI RUKAYAH KRAJAN 350409417280082
55 18/05.2017 12752B MUTIAH KRAJAN 3504095007520001
56 18/05/2017 32383B SUMINI KRAJAN 3504096104600001
57 18/05/2017 04637B TUMINAH KRAJAN 3504094112370001
58 18/05/2017 32004B SAINAH KRAJAN 3504094107044004
59 18/05.2017 33272B JINAB KRAJAN 3504096408350001
60 18/05/2017 32645B MUTI JALAS 3504094107370023
61 18/05/2017 15845B SUPARMIN KRAJAN 3504095004510002
62 18/05/2017 32490B SUPINGAH JALAS 3504094107420033
63 18/05/2017 01286B MISNAH JALAS 3504094302550001
64 18/05/2017 14491B NURDALINGSIH KRAJAN 350409570730001
65 18/05/2017 32047A MUYAKIN KRAJAN 3504096107490001
66 18/05/2017 03777B SUPRIHATIN KRAJAN 3504094201590001
67 18/05/2017 33204A RAHMATADI N JALAS 3504090107140004
68
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71
72
73
74
75
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79
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214
215
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240
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255
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258
259
260
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350
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353
354
355

TOTAL

MENGETAHUI:
Kepala UPTD Puskesmas Gondang

(RENA ERNANI, S.Kep.Ns.)

NIP. 19640424 198501 2 002
ALAN SJKD

RAWAT JALAN *)
PUSKESMAS PUSTU POLINDES
V
Rp - Rp - Rp -

BENDAHARA RETRIBUSI
UPTD Puskesmas Gondang

(SRI NURYATI)
NIP. 119640616 200604 2 003
 RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN MEI 2017

NAMA FASKES : UPTD PUSKESMAS GONDANG

ALAMAT : JL. RAYA GONDANG, DESA / KEC. GONDANG, KAB TULUNGAGUNG

NO TANGGAL NO KARTU PESERTA NAMA PESERTA DIAGNOSA DIRUJUK

1 4/26/2017 0000107010674 Muntinah M79.1

2 4/26/2017 6302155105710001 Suparti J00
3 5/9/2017 0000107103521 Musringanah K31.9
4 5/10/2017 00001813903784 Parinah 110
5 5/15/2017 0001037298993 Mairah N29.1
6 5/15/2017 0001037295252 Suparmi N29.2
7 5/17/2017 0002025402287 Munar N29.3
8
9
10
11
12
13
14
15
16
17
18
19
20

Total Peserta Yang Berkunjung : orang

Total Peserta Yang Dirujuk : orang

Mengetahui,
Kepala UPTD Puskesmas Gondang

SIGIT JAKA PURNAMA, SKM, M.Kes.

NIP. 19670412 198811 1 002
NGAGUNG

TANDA
TANGAN
PASIEN

Gondang

KM, M.Kes.