JAMSOSKES SUMSEL SEMESTA REKAPITULASI KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA

KAB/KOTA EMPAT LAWANG Nama PPK : UPTD PKM Lesung Batu

KLAIM BULAN : Batu Ampar Januari 2017
NO TANGGAL NO.KTP/KK NAMA PASIEN Tgl.Lahir/ L/ DIAGNOSIS TINDAKAN MEDIS BIAYA(Rp) (SESUAI PERDA)
Umur P RETRIBUSI TINDAKAN JUMLAH(Rp)
1 2 3 4 5 6 7 8 9 10 11(9+10)
1 03-01-17 1611051308700001 Riduan 13-08-70 L Gastritis Injk. Dryl
2 1611050110750001 Supri 30-09-75 L Diare Injk.oxsi
3 1611050701800002 Suriansa 07-01-80 L Ao Injk. B1
4 1611052006770002 Sirri 20-06-77 L Febris Injk. Dryl
5 1611051711640001 Suyono 17-11-69 L Ao Injek. B1
6 05-01-17 1611056603800001 Linda 25-03-80 P Ao Injek. B1
7 1611050202050004 Rizki 02-02-05 L Ispa Injek.don+dryl
8 1611055103900003 Meta 11-03-90 P Kb Injk. Devo
9 1611050107650064 Muhar 01-07-65 L Gastritis Injk. Dryl,neoro
10 1611050604700001 Nasarudin 06-04-70 L Alergi Injk.dexa
11 1611051408130002 Rajuaza 14-08-13 L Alergi Injk. -
12 06-01-17 1611052211850001 Suratman 22-11-85 L Ao Injek. B1
13 1611054810880002 Holilah 08-10-88 P Alergi Injek. Dexa
14 1611051004650001 Eflan 10-04-65 L Gastritis Injek.dryl
15 1611055106840002 Suyanti 11-03-84 P Gastritis Injk. Dryl
16 1611051008050001 Arif setiawan 10-08-05 L Febris Injk. Dryl
17 1611051606630001 Dencik 16-06-63 L Ao Injk. B1
18 07-01-17 1611051101030001 Haji lekat 11-01-03 L Ispa Injk. Don+dryl
19 1611051707780002 Sahril 17-07-78 L Gastritis Injek. Dryl
20 1611055409060001 Lina 14-09-06 P Ispa Injek. dryl
21 1611054206680001 Lison 02-06-68 P Alergi Injek. Dexa
22 1611057006080001 Reka 23-06-08 P Ispa Injk.-
23 1611054506980003 Anzi 05-06-98 L Gastritis Injk. Dryl
24 10-01-17 1611050506680001 Sakir 05-06-68 L Ispa Injk. Don+dryl
25 1611055011650006 Lela 10-11-65 P Ao Injek. B1
26 1611051701070001 Zapira 17-01-07 L Diare Injek. Oxsi
27 1611051605760001 Amin 15-05-76 L Ispa Injek. Dryl+don
28 1611050295720001 Erlin 02-02-95 P Gastritis Injk. Dryl
29 1611051101680001 Wawi 11-01-68 L Ispa Injk. Don+dryl
30 13-01-17 1611054303890005 Minsi 03-03-89 P Gastritis Injk.dryl
31 1611050810020001 Imron 08-10-02 L Pebris Injek.dryl
32 1611051202670001 Ruli 12-02-67 L Dermatitis Injek.dexa
33 1611051607640001 Napi 15-07-64 L Gastritis Injek. dryl
34 14-01-17 1611055008800003 Putri 10-08-80 P Diare Injk. Oxsi
35 1611050607160001 Reyke anggara 06-07-16 L Ispa Injk.-
36 1611054218850001 Marni 02-12-85 P Gastritis Injk. Dryl
37 1611051812880001 Defri 18-12-88 L Gastritis Injk. Dryl,neo
38 19-01-17 1611055011650001 Ela 10-11-65 P Ao Injek. B1
39 1611054310670002 Murti 03-10-67 P Kb Injek. Devo
40 1611063012810001 Mi 30-12-81 P Ispa Injek. Don+dryl
41 1611050107550005 Mansur 30-06-55 L Dermatitis Injk. Dexa
42 21-01-17 1611050506680001 Sukri 05-06-68 L Ao Injk. B1
43 1611062908050002 Aqila 09-08-05 P Alergi Injek. Dexa
44 1611051112150001 Fadil 11-12-15 L Ispa Injek.-
45 1611054709120001 Hamza 07-09-12 L Asma Injek.-
46 1611057105740001 Vivi 01-05-74 P Ao Injek.B1
47 24-01-17 1611055910800001 Emri 19-10-80 P Gastritis Injek.dryl
48 1611054102780003 Evi 01-02-78 P Ao Injek. B1
49 1611054809940001 Junia 08-09-94 P Alergi Injek.dexa
50 1611052010810001 Santo 20-10-81 L Gastritis Injek.dryl
51 28-01-17 1611050812090004 Muharramah 08-12-09 L Ispa Injek, don+dryl
51 1611050107870001 Nasir 01-07-87 L Ao Injek. B1

Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang

Tim Verifikasi Jamsoskes Lesung Batu Bendahara UPTD Puskesmas Lesung Batu
Dinas Kesehatan Kab/Kota Empat Lawang

……………………

JAMSOSKES SUMSEL SEMESTA DAFTAR REGISTER KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA
KAB/KOTA EMPAT LAWANG (KEABSAHAN PESERTA)
Nama PPK : UPTD PKM Lesung Batu
KLAIM BULAN : Batu Ampar Januari 2017
NO TANGGAL NO.KTP/KK NAMA PASIEN NAMA Tgl.Lahir/ L/P ALAMAT TANDA TANGAN
KEP.KELUARGA Umur
1 03-01-17 1611051308700001 Riduan Riduan 13-08-70 L Bt ampar
2 1611050110750001 Supri Supri 30-09-75 L Bt ampar
3 1611050701800002 Suriansa Suriansa 07-01-80 L Bt ampar
4 1611052006770002 Sirri Sirri 20-06-77 L Bt ampar
5 1611051711640001 Suyono Suyono 17-11-69 L Bt ampar
6 05-01-17 1611056603800001 Linda Sudin 25-03-80 P Bt ampar
7 1611050202050004 Rizki Tagok 02-02-05 L Bt ampar
8 1611055103900003 Meta Budi 11-03-90 P Bt ampar
9 1611050107650064 Muhar Muhar 01-07-65 L Bt ampar
10 1611050604700001 Nasarudin Nasarudin 06-04-70 L Bt ampar
11 1611051408130002 Rajuaza Tolel 14-08-13 L Bt ampar
12 06-01-17 1611052211850001 Suratman Suratman 22-11-85 L Bt ampar
13 1611054810880002 Holilah Saril 08-10-88 P Bt ampar
14 1611051004650001 Eflan Eflan 10-04-65 L Bt ampar
15 1611055106840002 Suyanti Man 11-03-84 P Bt ampar
16 1611051008050001 Arif setiawan Wanci 10-08-05 L Bt ampar
17 1611051606630001 Dencik Dencik 16-06-63 L Bt ampar
18 07-01-17 1611051101030001 Haji lekat Yan 11-01-03 L Bt ampar
19 1611051707780002 Sahril Sahril 17-07-78 L Bt ampar
20 1611055409060001 Lina Den 14-09-06 P Bt ampar
21 1611054206680001 Lison - 02-06-68 P Bt ampar
22 1611057006080001 Reka Man 23-06-08 P Bt ampar
23 1611054506980003 Anzi Anzi 05-06-98 L Bt ampar
24 10-01-17 1611050506680001 Sakir Sakir 05-06-68 L Bt ampar
25 1611055011650006 Lela Yun 10-11-65 P Bt ampar
26 1611051701070001 Zapira Zapira 17-01-07 L Bt ampar
27 1611051605760001 Amin Amin 15-05-76 L Bt ampar
28 1611050295720001 Erlin Erlin 02-02-95 P Bt ampar
29 1611051101680001 Wawi Wawi 11-01-68 L Bt ampar
30 13-01-17 1611054303890005 Minsi Ko 03-03-89 P Bt ampar
31 1611050810020001 Imron Habil 08-10-02 L Bt ampar
32 1611051202670001 Ruli Ruli 12-02-67 L Bt ampar
33 1611051607640001 Napi Napi 15-07-64 L Bt ampar
34 14-01-17 1611055008800003 Putri Wan 10-08-80 P Bt ampar
35 1611050607160001 Reyke anggara Peby 06-07-16 L Bt ampar
36 1611054218850001 Marni Yanto 02-12-85 P Bt ampar
37 1611051812880001 Defri Defri 18-12-88 L Bt ampar
38 19-01-17 1611055011650001 Ela Ela 10-11-65 P Bt ampar
39 1611054310670002 Murti Yasi 03-10-67 P Bt ampar
40 1611063012810001 Mi Sapel 30-12-81 P Bt ampar
41 1611050107550005 Mansur Mansur 30-06-55 L Bt ampar
42 21-01-17 1611050506680001 Sukri Sukri 05-06-68 L Bt ampar
43 1611062908050002 Aqila Qodel 09-08-05 P Bt ampar
44 1611051112150001 Fadil Sup 11-12-15 L Bt ampar
45 1611054709120001 Hamza Hasan 07-09-12 L Bt ampar
46 1611057105740001 Vivi Suriansa 01-05-74 P Bt ampar
47 24-01-17 1611055910800001 Emri Marden 19-10-80 P Bt ampar
48 1611054102780003 Evi Ali 01-02-78 P Bt ampar
49 1611054809940001 Junia Mawan 08-09-94 P Bt ampar
50 1611052010810001 Santo Santo 20-10-81 L Bt ampar
51 28-01-17 1611050812090004 Muharramah santo 08-12-09 L Bt ampar
52 1611050107870001 Nasir Nasir 01-07-87 L Bt ampar
Bt ampar
Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang
Tim Verifikasi Jamsoskes Lesung Batu Petugas Registrasi
Dinas Kesehatan Kab/Kota Empat Lawang

JAMSOSKES SUMSEL SEMESTA REKAPITULASI KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA

KAB/KOTA EMPAT LAWANG Nama PPK : UPTD PKM Lesung Batu
 NO TANGGAL NO.KTP/KK NAMA PASIEN Tgl.Lahir/ L/ DIAGNOSIS TINDAKAN MEDIS BIAYA(Rp) (SESUAI PERDA)
Umur P RETRIBUSI TINDAKAN JUMLAH(Rp)
1 2 3 4 5 6 7 8 9 10 11(9+10)
1 03-02-17 1611054303830004 Epi 03-03-83 P Kb Injk. Devo
2 1611050312830002 Padmi 03-12-83 L Diare Injk.oxsi KLAIM
3 1611054406870002 Yuniati 04-08-87 P Gastritis Injk. Dryl BULAN : Batu
4 1611051101690002 Nawawi 11-01-69 L Febris Injk. Dryl Ampar Februari
2017 5 1611054204550001 Nurhuda 02-04-55 P Ao Injek. B1
6 05-02-17 1611051602040002 Adryansa 16-02-04 P Pebris Injek. Dryl
7 1611055206920002 Puspita 12-06-92 P Ispa Injek.don+dryl
8 1611050805740002 Riyanto 08-05-74 L Ao Injk. B1
Mengetahui,
9 1611050805950002 Nodi 08-05-95 L Gastritis Injk. Dryl,neoro
10 1611055806120001 Azzah 18-06-12 P Alergi Injk. -
11 1611050309150002 Zelki 03-09-15 L Alergi Injk. - Pimpinan
12 06-02-17 1611050107720001 Zalma 01-07-72 P Ao Injek. B1 PKK/Puskesmas
13 1611050403070002 Gusti 24-03-07 L Alergi Injek. Dexa
14 1611055606940001 Seli 16-06-94 P Gastritis Injek.dryl Kab/Kota Empat
15 1611056608050002 Hermiyanti 28-08-05 P Gastritis Injk. Dryl Lawang
Tim Verifikasi
16 1611051703510002 Mat 17-05-51 P Ao Injk. B1
Jamsoskes
17 1611054104600004 Rusmala 01-04-60 P Ao Injk. B1
18 07-02-17 1611056106010001 Aries sastri 21-05-01 P Ispa Injk. Don+dryl Lesung Batu
19 1611054311840001 Masyati 03-11-84 P Kb Injek. Devo
20 1611050107570020 Ishak 30-06-57 L Ao Injek. B1 Bendahara
UPTD 21 1611056101680002 Nurul 11-01-68 P Alergi Injek. Dexa Puskesmas Lesung
Batu 22 1611050501120001 Andi 05-11-02 L Ispa Injk. Don+dryl
Dinas Kesehatan
23 1611054303890005 Minti 03-03-89 P Kb implant Injk. Lido Kab/Kota Empat
24 10-02-17 1611050908090001 Yandri 09-08-09 L Ispa Injk. - Lawang
25 1611058105730003 Nuraini 21-05-73 P Ao Injek. B1
26 1611051106970002 Asep 11-06-97 L Diare Injek. Oxsi ……………………
27 1611054607710001 Maria 06-07-71 P Ispa Injek. Dryl+don
28 1611054812900002 Manan 28-12-90 P Gastritis Injk. Dryl
29 1611051002830001 Rudi 10-02-83 L Ispa Injk. Don+dryl
30 13-02-17 1611054107570002 Hadisa 01-07-67 P Gastritis Injk.dryl
31 1611050101760008 Ali 01-07-75 L Pebris Injek.dryl+don
32 1611057008130001 Najwa 30-08-13 P Dermatitis Injek. -
33 1611051604060003 Herliza 05-04-06 P Gastritis Injek. Dryl
34 14-02-17 1611051611710001 Hardi 16-11-71 L Diare Injk. Oxsi
35 1611050107620001 Ropi 01-07-62 L Ispa Injk.-
36 1611054708910002 Gusmi 11-11-91 P Gastritis Injk. Dryl
37 1611051202570001 Ruslan 12-02-67 L Gastritis Injk. Dryl,neo
38 19-02-17 1611056406060002 Raymi 24-06-06 P Pebris Injek. dryl
39 1611050805950002 Nodi 08-05-95 L Gastritis Injek. Dryl
JAMSOSKES SUMSEL SEMESTA DAFTAR REGISTER KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA
KAB/KOTA EMPAT LAWANG (KEABSAHAN PESERTA)
Nama PPK : UPTD PKM Lesung Batu
KLAIM BULAN : Batu Ampar Februari 2017
NO TANGGAL NO.KTP/KK NAMA PASIEN NAMA Tgl.Lahir/ L/P ALAMAT TANDA TANGAN
KEP.KELUARGA Umur
1 03-02-17 1611054303830004 Epi Santo 03-03-83 P Bt ampar
2 1611050312830002 Padmi Padmi 03-12-83 L Bt ampar
3 1611054406870002 Yuniati Edi 04-08-87 P Bt ampar
4 1611051101690002 Nawawi Nawawi 11-01-69 L Bt ampar
5 1611054204550001 Nurhuda Mat 02-04-55 P Bt ampar
6 05-02-17 1611051602040002 Adryansa Yansa 16-02-04 P Bt ampar
7 1611055206920002 Puspita Asnawi 12-06-92 P Bt ampar
8 1611050805740002 Riyanto Riyanto 08-05-74 L Bt ampar
9 1611050805950002 Nodi Nodi 08-05-95 L Bt ampar
10 1611055806120001 Azzah Raga 18-06-12 P Bt ampar
11 1611050309150002 Zelki Zet 03-09-15 L Bt ampar
12 06-02-17 1611050107720001 Zalma Jono 01-07-72 P Bt ampar
13 1611050403070002 Gusti Adam 24-03-07 L Bt ampar
14 1611055606940001 Seli Andik 16-06-94 P Bt ampar
15 1611056608050002 Hermiyanti Herman 28-08-05 P Bt ampar
16 1611051703510002 Mat Mat 17-05-51 P Bt ampar
17 1611054104600004 Rusmala - 01-04-60 P Bt ampar
18 07-02-17 1611056106010001 Aries sastri Sahmin 21-05-01 P Bt ampar
19 1611054311840001 Masyati Wartono 03-11-84 P Bt ampar
20 1611050107570020 Ishak Ishak 30-06-57 L Bt ampar
21 1611056101680002 Nurul Engkat 11-01-68 P Bt ampar
22 1611050501120001 Andi Andra 05-11-02 L Bt ampar
23 1611054303890005 Minti Ucan 03-03-89 P Bt ampar
24 10-02-17 1611050908090001 Yandri Jon 09-08-09 L Bt ampar
25 1611058105730003 Nuraini Sarpudin 21-05-73 P Bt ampar
26 1611051106970002 Asep Asep 11-06-97 L Bt ampar
27 1611054607710001 Maria Ansor 06-07-71 P Bt ampar
28 1611054812900002 Manan Manan 28-12-90 P Bt ampar
29 1611051002830001 Rudi Rudi 10-02-83 L Bt ampar
30 13-02-17 1611054107570002 Hadisa Ropi 01-07-67 P Bt ampar
31 1611050101760008 Ali Ali 01-07-75 L Bt ampar
32 1611057008130001 Najwa Irawan 30-08-13 P Bt ampar
33 1611051604060003 Herliza Sukri 05-04-06 P Bt ampar
34 14-02-17 1611051611710001 Hardi Hardi 16-11-71 L Bt ampar
35 1611050107620001 Ropi Ropi 01-07-62 L Bt ampar
36 1611054708910002 Gusmi reri 11-11-91 P Bt ampar
37 1611051202570001 Ruslan Ruslan 12-02-67 L Bt ampar
38 19-02-17 1611056406060002 Raymi Son 24-06-06 P Bt ampar
39 1611050805950002 Nodi Nodi 08-05-95 L Bt ampar
40 1611054310840001 Armila Yanto 03-10-84 P Bt ampar
41 1611056305980001 Defita Devid 23-05-98 P Bt ampar
42 21-02-17 1611051803780003 Irawan Irawan 18-03-78 L Bt ampar
43 1611057003740001 Lien Lian 30-03-94 P Bt ampar
44 1611055411940002 Yesi Jono 11-03-94 P Bt ampar
45 1611052107100002 Sander Rusan 21-07-10 L Bt ampar
46 1611054608010001 Ratna Ratna 08-08-01 P Bt ampar
47 24-02-17 1611051609700005 Zainal Zainal 16-09-70 L Bt ampar
48 1611056003820002 Yumis Yayuk 20-03-82 P Nibung
49 1611055506830001 Evika Tono 15-06-83 P Bt ampar
50 1611050410130001 Azizwan Wnto 04-10-13 L Bt ampar
51 27-02-17 1611056405830002 Mawan Matsirri 24-05-83 P Bt ampar
52 1611050703730002 Adly Adly 07-03-73 L Bt ampar
Bt ampar
Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang
Tim Verifikasi Jamsoskes Lesung Batu Petugas Registrasi
Dinas Kesehatan Kab/Kota Empat Lawang
NO TANGGAL NO.KTP/KK NAMA PASIEN Tgl.Lahir/ L/ DIAGNOSIS TINDAKAN MEDIS BIAYA(Rp) (SESUAI PERDA)
Umur P RETRIBUSI TINDAKAN JUMLAH(Rp)
1 2 3 4 5 6 7 8 9 10 11(9+10)
JAMSOSKES
1 01-03-17 1611054401760001 Elvi 04-01-76 P Ao Injk. B1 SUMSEL
2 1611051010040002 Alde heriyanto 10-10-04 P Diare Injk.oxsi SEMESTA
3 1611054809730001 Sulastri 08-09-73 P Ao Injk. B1
4 1611056406900001 Yurti 24-06-90 P Kb Injk. Devo
5 1611051606700001 Alwi 16-06-70 L Ao Injek. B1 REKAPITULASI
6 02-03-17 1611054810880002 Sukahati 04-05-98 P Pebris Injek. Dryl KUNJUNGAN
7 1611051210750002 Hedi 12-10-75 L Ispa Injek.don+dryl
PASIEN
8 1611054306030002 Liansi 03-06-03 P Alergi Injk. Dexa
9 1611050810070001 Aliansa 08-10-07 L Gastritis Injk. Dryl
JAMSOSKES
10 1611055108720001 Elma 11-08-72 P conjungtvtis Injk, SUMSEL
11 1611052707770002 Herson 27-07-77 L Alergi Injk. Dexa SEMESTA
12 04-03-17 1611055705000002 Lidia 17-05-00 P Diare Injek. Oxsi KAB/KOTA
13 1611053012040006 Raden imam 20-12-04 L Alergi Injek. Dexa EMPAT LAWANG
14 1611055107850002 Hadismawati 11-07-85 P Kb Injek. Devo
15 05-03-17 1611052106040003 Danil 21-06-04 L Gastritis Injk. Dryl Nama PPK
: UPTD PKM
16 1611051006640004 Sahnin 10-06-64 L Ao Injk. B1
Lesung Batu
17 1611055209770002 Linda 12-09-77 P Ao Injk. B1
18 1611057011070002 Zulgita 30-11-07 P Ispa Injk. Don+dryl
19 1611052010070001 Ogiman 20-10-07 L Pebris Injek. Dryl KLAIM
20 1611054302100001 Aljazira 03-02-10 L Alergi Injek. - BULAN : Batu
21 06-03-17 1611051012850003 Darlim 10-12-85 L Alergi Injek. Dexa Ampar Maret 2017
22 1611056305980001 Defi 23-05-98 P Ispa Injk. Don+dryl
23 1611051504060003 M.herliansa 15-04-06 L Pebris Injk. dryl
24 1611056204810002 Evik 22-04-81 P Kb Injk. Devo -
25 1611051904010001 Mauli abzan 19-06-88 L Ispa Injek.don+dryl Mengetahui,
26 10-03-17 1611056006880002 Hodiyana 20-06-88 P Diare Injek. Oxsi
27 1611050811040002 Maekel 08-11-04 L Ispa Injek. Dryl+don Pimpinan
28 1611054707810001 Laini 07-07-81 P Gastritis Injk. Dryl PKK/Puskesmas
29 1611051202620002 Mahli 12-02-62 L Ao Injk. B1
30 1611054105030002 Ayu lestari 01-05-03 P Ispa Injk.dryl Kab/Kota Empat
31 13-03-17 1611050609150001 Abizar 06-09-15 L Pebris Injek, - Lawang
32 1611055701630001 Yana 17-01-63 P Ao Injek. B1
33 1611052002450001 H.Yunus 20-02-45 L Gastritis Injek. Dryl
34 1611050206690002 Kori 05-06-69 L Ao Injk. B1
35 15-03-17 1611054303830001 Epi puspa 03-03-83 P Ispa Injk. Don+dryl
36 1611050607870003 Argandi 06-07-87 L Gastritis Injk. Dryl
37 1611054511870002 Ristina 05-11-87 P Kb Injk. Devo
38 18-03-17 1611056011790001 Erly 20-11-79 P Pebris Injek. dryl
39 1611051812880001 Def 18-12-88 L Gastritis Injek. Dryl
Tim Verifikasi Jamsoskes Lesung Batu Bendahara UPTD Puskesmas Lesung Batu
Dinas Kesehatan Kab/Kota Empat Lawang

……………………

JAMSOSKES SUMSEL SEMESTA DAFTAR REGISTER KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA
KAB/KOTA EMPAT LAWANG (KEABSAHAN PESERTA)
Nama PPK : UPTD PKM Lesung Batu
KLAIM BULAN : Batu Ampar maret 2017
NO TANGGAL NO.KTP/KK NAMA PASIEN NAMA Tgl.Lahir/ L/P ALAMAT TANDA TANGAN
KEP.KELUARGA Umur
1 01-03-17 1611054401760001 Elvi Ronal 04-01-76 P Bt ampar
2 1611051010040002 Alde heriyanto Heri 10-10-04 P Bt ampar
3 1611054809730001 Sulastri Lani 08-09-73 P Bt ampar
4 1611056406900001 Yurti dyki 24-06-90 P Bt ampar
5 1611051606700001 Alwi Alwi 16-06-70 L Bt ampar
6 02-03-17 1611054810880002 Sukahati beni 04-05-98 P Bt ampar
7 1611051210750002 Hedi Hedi 12-10-75 L Bt ampar
8 1611054306030002 Liansi Liansi 03-06-03 P Bt ampar
9 1611050810070001 Aliansa Amin 08-10-07 L Bt ampar
10 1611055108720001 Elma Wit 11-08-72 P Bt ampar
11 1611052707770002 Herson Herson 27-07-77 L Bt ampar
12 04-03-17 1611055705000002 Lidia Harun 17-05-00 P Bt ampar
13 1611053012040006 Raden imam Imam 20-12-04 L Bt ampar
14 1611055107850002 Hadismawati Hadi 11-07-85 P Bt ampar
15 05-03-17 1611052106040003 Danil Dani 21-06-04 L Bt ampar
16 1611051006640004 Sahnin Sahnin 10-06-64 L Bt ampar
17 1611055209770002 Linda Toha 12-09-77 P Bt ampar
18 1611057011070002 Zulgita Zul 30-11-07 P Bt ampar
19 1611052010070001 Ogiman Hedi 20-10-07 L Bt ampar
20 1611054302100001 Aljazira Rahmat 03-02-10 L Bt ampar
21 06-03-17 1611051012850003 Darlim Darlim 10-12-85 L Bt ampar
22 1611056305980001 Defi Depin 23-05-98 P Bt ampar
23 1611051504060003 M.herliansa Runi 15-04-06 L Bt ampar
24 1611056204810002 Evik Edi 22-04-81 P Bt ampar
25 1611051904010001 Mauli abzan Abzan 19-06-88 L Bt ampar
26 10-03-17 1611056006880002 Hodiyana Her 20-06-88 P Bt ampar
27 1611050811040002 Maekel Santo 08-11-04 L Bt ampar
28 1611054707810001 Laini Yuyuk 07-07-81 P Bt ampar
29 1611051202620002 Mahli Mahli 12-02-62 L Umo jati
30 1611054105030002 Ayu lestari Efran 01-05-03 P Bt ampar
31 13-03-17 1611050609150001 Abizar Ahmad 06-09-15 L Bt ampar
32 1611055701630001 Yana Yana 17-01-63 P Bt ampar
33 1611052002450001 H.Yunus H.Yunus 20-02-45 L Bt ampar
34 1611050206690002 Kori Kori 05-06-69 L Bt ampar
35 15-03-17 1611054303830001 Epi puspa Ali 03-03-83 P Bt ampar
36 1611050607870003 Argandi Argandi 06-07-87 L Bt ampar
37 1611054511870002 Ristina Subki 05-11-87 P Bt ampar
38 18-03-17 1611056011790001 Erly Rilan 20-11-79 P Bt ampar
39 1611051812880001 Def Def 18-12-88 L Bt ampar
40 1611051610610001 Musli Musli 16-10-61 L Bt ampar
41 1611054504000001 Liska Mus 21-11-89 P Bt ampar
42 20-03-17 1611053112030001 Elantra Ramzi 03-12-03 L Bt ampar
43 1611055008920001 Anita Emriadi 10-08-92 P Bt ampar
44 1611052908050002 Alamsyah Redi 29-08-15 L Bt ampar
45 1611056008850001 Arlina Irin 20-08-85 P Bt ampar
46 25-03-17 1611051106890001 Arien Tomi 11-06-89 P Bt ampar
47 1611051104600002 Sanal Sanal 11-04-60 L Bt ampar
48 1611050104040004 Deri Deri 01-04-04 L Nibung
49 1611054107500016 Hawani Hawani 01-02-50 P Bt ampar
50 26-03-17 1611050512690001 Habil Habil 05-12-69 L Bt ampar
51 1611051310060002 Aldiyan Ahmad 13-10-06 L Bt ampar
52 1611056504020001 Mutiara Mustofa 25-04-02 P Bt ampar
Bt ampar
Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang
Tim Verifikasi Jamsoskes Lesung Batu Petugas Registrasi
Dinas Kesehatan Kab/Kota Empat Lawang
NO TANGGAL NO.KTP/KK NAMA PASIEN Tgl.Lahir/ L/ DIAGNOSIS TINDAKAN MEDIS BIAYA(Rp) (SESUAI PERDA)
Umur P RETRIBUSI TINDAKAN JUMLAH(Rp)
1 2 3 4 5 6 7 8 9 10 11(9+10)
1 01-04-17 1611054305870002 Wesi 03-05-87 P Gastritis Injk. Dryl
2 1611050109780002 Efran 01-09-79 L Ao Injk. B1
3 1611056106890001 Megawati 21-06-89 P Ispa Injk.dryl
4 1611055404100002 Pirana 14-04-10 P Pebris Injek, -
5 1611051005550002 Saripudin 10-05-55 L Ao Injek. B1
6 03-04-17 1611055610020002 Zilvia 16-10-02 P Gastritis Injek. Dryl
7 1611056511800001 Mahdalena 25-11-80 P Ao Injk. B1
8 1611050911110001 Vicky 09-11-11 L Ispa Injk. Don+dryl
9 1611055410110001 Dinda winatu 14-10-11 P Gastritis Injk. Dryl
10 05-04-17 1611057004780001 Yurnani 30-04-78 P Kb Injk. Devo
11 1611050206980002 Deri 02-06-98 L Pebris Injek. dryl
12 1611054605020001 Putri mayasari 06-06-02 P Gastritis Injek. Dryl
13 1611022306900003 Zet darmawan 23-08-90 L Pebris Injek.dryl
14 08-04-17 1611055808930003 Dera 18-08-93 P Dermatitis Injk. Dexa JAMSOSKES
15 1611054107450035 Haluna 01-07-45 P Ispa Injk .dryl+don SUMSEL
SEMESTA
16 1611054412920001 Pitriani 24-12-92 P Alergi Injek. Dexa
17 1611052212890002 Desi 22-12-89 P Ispa Injek.don+dryll
18 10-04-17 1611054611620002 Kholima 06-11-62 P Asma Injek.-
REKAPITULASI
19 1611055901110001 Zastya 19-01-11 P Alergi Injek. -
20 1611050611120001 Anggi 15-11-12 L otitis Injek. - KUNJUNGAN
21 13-04-17 1611055010720001 Rohisa 10-10-72 P Alergi Injek. dexa PASIEN
22 1611050607120002 Apriansah 06-07-12 L Pebris Injek. - JAMSOSKES
23 1611057008130001 Muthmainah 30-08-13 P Ispa Injek. SUMSEL
24 1611054303050003 Sasti ilahi 03-03-05 P Ispa Injek, don+dryl SEMESTA
25 15-04-17 1611055206020001 Rila 12-08-01 P Pebris Injek.dryl+don KAB/KOTA
26 1611050904070002 Hoiron aldi 09-04-07 L Diare Injek. Oxsi EMPAT LAWANG
27 1611052303050002 Riki 23-03-05 L Ispa Injek. Dryl+don
28 18-04-17 1611052303050001 Riko 23-03-05 L Diare Injk. Oxsi Nama PPK
29 1611054306740001 Artila 03-06-74 L Ao Injk. B1 : UPTD PKM
30 1611054212850003 Mariana 02-12-85 P Ispa Injk.dryl Lesung Batu
31 1611050102800003 Sugiman 01-02-80 L Pebris Injek, -dryl
32 20-04-17 1611054610820001 Yurna 06-10-82 P Ao Injek. B1
KLAIM
33 1611052303640002 Supripto 23-03-64 L Ao Injek. B1
BULAN : Batu
34 1611054601730002 Wiwin 06-01-73 P Ao Injk. B1
Ampar April 2017
35 22-04-17 1611054501960001 Winda 05-01-96 P Ispa Injk. Don+dryl
36 1611055409700001 Nisba 14-09-70 P Gastritis Injk. Dryl
37 1611050101040004 David 01-01-04 L Alergi Injk. Dexa
38 25-04-17 1611050108750001 Heri 31-07-75 L Pebris Injek. dryl
39 1611050507780001 Selamat 05-07-78 L Gastritis Injek. Dryl
Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang
Tim Verifikasi Jamsoskes Lesung Batu Bendahara UPTD Puskesmas Lesung Batu
Dinas Kesehatan Kab/Kota Empat Lawang

……………………

JAMSOSKES SUMSEL SEMESTA DAFTAR REGISTER KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA
KAB/KOTA EMPAT LAWANG (KEABSAHAN PESERTA)
 Nama PPK : UPTD PKM Lesung Batu
KLAIM BULAN : Batu Ampar April 2017
NO TANGGAL NO.KTP/KK NAMA PASIEN NAMA Tgl.Lahir/ L/P ALAMAT TANDA TANGAN
KEP.KELUARGA Umur
1 01-04-17 1611054305870002 Wesi Rendi 03-05-87 P Bt ampar
2 1611050109780002 Efran Efran 01-09-79 L Bt ampar
3 1611056106890001 Megawati Ef 21-06-89 P Bt ampar
4 1611055404100002 Pirana Suriansa 14-04-10 P Bt ampar
5 1611051005550002 Saripudin Saripudin 10-05-55 L Bt ampar
6 03-04-17 1611055610020002 Zilvia Udi 16-10-02 P Bt ampar
7 1611056511800001 Mahdalena Kacik 25-11-80 P Bt ampar
8 1611050911110001 Vicky Vicky 09-11-11 L Bt ampar
9 1611055410110001 Dinda winatu Renaldi 14-10-11 P Bt ampar
10 05-04-17 1611057004780001 Yurnani Lihin 30-04-78 P Bt ampar
11 1611050206980002 Deri Deri 02-06-98 L Bt ampar
12 1611054605020001 Putri mayasari Wan 06-06-02 P Bt ampar
13 1611022306900003 Zet darmawan Zet darmawan 23-08-90 L Bt ampar
14 08-04-17 1611055808930003 Dera Dedi 18-08-93 P Bt ampar
15 1611054107450035 Haluna Hamsi 01-07-45 P Bt ampar
16 1611054412920001 Pitriani Tono 24-12-92 P Bt ampar
17 1611052212890002 Desi Desi 22-12-89 P Bt ampar
18 10-04-17 1611054611620002 Kholima Rusli 06-11-62 P Bt ampar
19 1611055901110001 Zastya Samin 19-01-11 P Bt ampar
20 1611050611120001 Anggi Rudi 15-11-12 L Bt ampar
21 13-04-17 1611055010720001 Rohisa Riswan 10-10-72 P Bt ampar
22 1611050607120002 Apriansah Riswan 06-07-12 L Bt ampar
23 1611057008130001 Muthmainah Sudi 30-08-13 P Bt ampar
24 1611054303050003 Sasti ilahi Irwan 03-03-05 P Bt ampar
25 15-04-17 1611055206020001 Rila Riswan 12-08-01 P Bt ampar
26 1611050904070002 Hoiron aldi Roni 09-04-07 L Bt ampar
27 1611052303050002 Riki Sakir 23-03-05 L Bt ampar
28 18-04-17 1611052303050001 Riko Sakir 23-03-05 L Bt ampar
29 1611054306740001 Artila Arsan 03-06-74 L Umo jati
30 1611054212850003 Mariana Manap 02-12-85 P Bt ampar
31 1611050102800003 Sugiman Sugiman 01-02-80 L Bt ampar
32 20-04-17 1611054610820001 Yurna Lihin 06-10-82 P Bt ampar
33 1611052303640002 Supripto Supripto 23-03-64 L Bt ampar
34 1611054601730002 Wiwin Peri 06-01-73 P Bt ampar
35 22-04-17 1611054501960001 Winda Yansa 05-01-96 P Bt ampar
36 1611055409700001 Nisba Ef 14-09-70 P Bt ampar
37 1611050101040004 David Efri 01-01-04 L Bt ampar
38 25-04-17 1611050108750001 Heri Heri 31-07-75 L Bt ampar
39 1611050507780001 Selamat Selamat 05-07-78 L Bt ampar
40 1611056205800001 Eka Sup 22-05-80 P Bt ampar
41 1611050809800001 Lihin Lihin 08-09-80 L Bt ampar
42 26-04-17 1611056404760002 Rita Andika 24-04-70 P Bt ampar
43 1611051001040003 Dandi Andika 10-01-04 L Bt ampar
44 1611050507640004 Amron Amron 05-07-64 L Bt ampar
45 1611050107550015 Mansur Mansur 30-06-55 L Bt ampar
46 1611056805910002 Suci Anton 28-05-91 P Bt ampar
47 1611052708970001 Sopwan Ron 27-08-97 L Bt ampar
48 27-04-17 1611050407000004 Weren Ip 04-07-00 L Nibung
49 1611055207850001 Suna Bustari 12-07-85 P Bt ampar
50 1611050911040003 Oji Bus 09-11-04 L Bt ampar
51 1611050502980001 Pebri Pebri 05-02-98 L Bt ampar
52 1611054103700002 Inna Amrul 01-03-70 P Bt ampar
Bt ampar
Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang
Tim Verifikasi Jamsoskes Lesung Batu Petugas Registrasi
Dinas Kesehatan Kab/Kota Empat Lawang

JAMSOSKES SUMSEL SEMESTA REKAPITULASI KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA

KAB/KOTA EMPAT LAWANG Nama PPK : UPTD PKM Lesung Batu
KLAIM BULAN : Batu Ampar Mei 2017
 NO TANGGAL NO.KTP/KK NAMA PASIEN Tgl.Lahir/ L/ DIAGNOSIS TINDAKAN MEDIS BIAYA(Rp) (SESUAI PERDA)
Umur P RETRIBUSI TINDAKAN JUMLAH(Rp)
1 2 3 4 5 6 7 8 9 10 11(9+10)
1 1611051706870005 Pance Ao Injk. B1
2 1611055508650002 Patima Diare Injk.oxsi
3 1611050608730001 Purhan Ao Injk. B1 Mengetahui,
4 1611051610980001 Rian Kb Injk. Devo
5 1611054108880003 Pika Ao Injek. B1
Pimpinan
6 1611050704840004 Azandri Pebris Injek. Dryl
PKK/Puskesmas
7 1611057006080001 Reka Ispa Injek.don+dryl
8 1611056811080002 Yopa Alergi Injk. Dexa Kab/Kota Empat
9 1611054703120001 Ririn Gastritis Injk. Dryl Lawang
10 1611055805090002 Penti conjungtvtis Injk, Tim Verifikasi
11 161105 Paisal Alergi Injk. Dexa Jamsoskes
12 161105 Adelia Diare Injek. Oxsi
Lesung Batu
13 161105 Raples Alergi Injek. Dexa
14 161105 Hilma Kb Injek. Devo Bendahara
UPTD 15 161105 Bustari Gastritis Injk. Dryl Puskesmas Lesung
Batu 16 161105 Karisma Ao Injk. B1
17 161105 Faulin Ao Injk. B1 Dinas Kesehatan
18 161105 Wandira Ispa Injk. Don+dryl Kab/Kota Empat
Lawang
19 161105 Deka Pebris Injek. Dryl
20 161105 Yur Alergi Injek. -
……………………
21 161105 Wanto Alergi Injek. Dexa
22 161105 Sunarti Ispa Injk. Don+dryl
23 161105 Maya Pebris Injk. dryl
24 161105 Serli Kb Injk. Devo -
25 161105 Sinta Ispa Injek.don+dryl
26 161105 Gustiawan Diare Injek. Oxsi
27 161105 Ispa Injek. Dryl+don
28 161105 Gastritis Injk. Dryl
29 161105 Ao Injk. B1
30 161105 Ispa Injk.dryl
31 161105 Pebris Injek, -
32 161105 Ao Injek. B1
33 161105 Gastritis Injek. Dryl
34 161105 Ao Injk. B1
35 161105 Ispa Injk. Don+dryl
36 161105 Gastritis Injk. Dryl
37 161105 Kb Injk. Devo
38 161105 Pebris Injek. dryl
39 161105 Gastritis Injek. Dryl
JAMSOSKES SUMSEL SEMESTA DAFTAR REGISTER KUNJUNGAN PASIEN JAMSOSKES SUMSEL SEMESTA
KAB/KOTA EMPAT LAWANG (KEABSAHAN PESERTA)
Nama PPK : UPTD PKM Lesung Batu
KLAIM BULAN : Batu Ampar Mei 2017
NO TANGGAL NO.KTP/KK NAMA PASIEN NAMA Tgl.Lahir/ L/P ALAMAT TANDA TANGAN
KEP.KELUARGA Umur
1 Bt ampar
2 Bt ampar
3 Bt ampar
4 Bt ampar
5 Bt ampar
6 Bt ampar
7 Bt ampar
8 Bt ampar
9 Bt ampar
10 Bt ampar
11 Bt ampar
12 Bt ampar
13 Bt ampar
14 Bt ampar
15 Bt ampar
16 Bt ampar
17 Bt ampar
18 Bt ampar
19 Bt ampar
20 Bt ampar
21 Bt ampar
22 Bt ampar
23 Bt ampar
24 Bt ampar
25 Bt ampar
26 Bt ampar
27 Bt ampar
28 Bt ampar
29 Umo jati
30 Bt ampar
31 Bt ampar
32 Bt ampar
33 Bt ampar
34 Bt ampar
35 Bt ampar
36 Bt ampar
37 Bt ampar
38 Bt ampar
39 Bt ampar
40 Bt ampar
41 Bt ampar
42 Bt ampar
43 Bt ampar
44 Bt ampar
45 Bt ampar
46 Bt ampar
47 Bt ampar
48 Nibung
49 Bt ampar
50 Bt ampar
51 Bt ampar
52 Bt ampar
Bt ampar
Mengetahui, Pimpinan PKK/Puskesmas Kab/Kota Empat Lawang
Tim Verifikasi Jamsoskes Lesung Batu Petugas Registrasi
Dinas Kesehatan Kab/Kota Empat Lawang