LAp Kunjungan PX Gigi FEBRUARI 20177

LAPORAN KUNJUNGAN PASIEN GIGI
PERIODE APRIL 2007
JASA ALAT &

NO TGL NAMA PASIEN TARIF ADM JML
DOKTER BAHAN
1 2/4/2007 Nn. Syfa 80,000 3,000 38,500 38,500 80,000
2 Ny. Niken 60,000 3,000 28,500 28,500 60,000
3 Ny. Ies
4 Gina 20,000 3,000 8,500 8,500 20,000
5 Mari 120,000 3,000 58,500 58,500 120,000
6 Ny. Direni 140,000 3,000 68,500 68,500 140,000
7 Hani 100,000 3,000 48,500 48,500 100,000
8 3/4/2007 Ny. Ester 30,000 3,000 13,500 13,500 30,000
9 4/4/2007 Dian 20,000 3,000 8,500 8,500 20,000
10 Asyfa 80,000 3,000 38,500 38,500 80,000
11 Anto 100,000 3,000 48,500 48,500 100,000
12 Heri 20,000 3,000 8,500 8,500 20,000
13 Dini 50,000 3,000 23,500 23,500 50,000
14 7/4/2007 Tn. Enrizal 15,000 3,000 6,000 6,000 15,000
15 Ny. Ester 40,000 3,000 18,500 18,500 40,000
16 Mulyadin 20,000 3,000 8,500 8,500 20,000
17 Wahyu 30,000 3,000 13,500 13,500 30,000
18 Gina 30,000 3,000 13,500 13,500 30,000
19 Hj. Yoyom 60,000 3,000 28,500 28,500 60,000
20 Anang 60,000 3,000 28,500 28,500 60,000
21 9/4/2007 Tn. Barna 60,000 3,000 28,500 28,500 60,000
22 Septiawan 40,000 3,000 18,500 18,500 40,000
23 Asyfa 80,000 3,000 38,500 38,500 80,000
24 Gina 20,000 3,000 8,500 8,500 20,000
25 M. Reza 30,000 3,000 13,500 13,500 30,000
26 Dian 20,000 3,000 8,500 8,500 20,000
27 10/4/2007 Hj. Yoyom 50,000 3,000 23,500 23,500 50,000
28 Dini 50,000 3,000 23,500 23,500 50,000
29 12/4/2007 Ny. Siti Maemunah 60,000 3,000 28,500 28,500 60,000
30 Wawan 20,000 3,000 8,500 8,500 20,000
31 Reza 100,000 3,000 48,500 48,500 100,000
32 13/4/07 Resi 20,000 3,000 8,500 8,500 20,000
33 Mulyani 20,000 3,000 8,500 8,500 20,000
34 Puquh 20,000 3,000 8,500 8,500 20,000
35 Dini 100,000 3,000 48,500 48,500 100,000
36 14/4/07 Mursal 20,000 3,000 8,500 8,500 20,000
37 16/4/07 An. Finsa 20,000 3,000 8,500 8,500 20,000
38 Asyfa 200,000 3,000 98,500 98,500 200,000
39 Tn. Luthfi 100,000 3,000 48,500 48,500 100,000
40 Iwan
41 Fujiati 20,000 3,000 8,500 8,500 20,000
42 18/4/07 Nn. Lina 20,000 3,000 8,500 8,500 20,000
43 Suryani 20,000 3,000 8,500 8,500 20,000
44 20/4/07 Ny. Idah 100,000 3,000 48,500 48,500 100,000
45 21/4/07 Mulyadin 225,000 3,000 111,000 111,000 225,000
46 Hj. Yoyom 200,000 3,000 98,500 98,500 200,000
47 Rangga 30,000 3,000 13,500 13,500 30,000
48 Florika 80,000 3,000 38,500 38,500 80,000
49 Hesti 30,000 3,000 13,500 13,500 30,000
50 23/4/07 Tn. Andi 50,000 3,000 23,500 23,500 50,000
51 An. Bob Meola. K 40,000 3,000 18,500 18,500 40,000
52 Tn. Anto 80,000 3,000 38,500 38,500 80,000
53 24/4/07 Aisyah 30,000 3,000 13,500 13,500 30,000
54 25/4/07 An. Sindi 20,000 3,000 8,500 8,500 20,000
55 Alan 30,000 3,000 13,500 13,500 30,000
56 26/4/07 Tn. Andi 100,000 3,000 48,500 48,500 100,000
57 An. Bob Meola. K 30,000 3,000 13,500 13,500 30,000
58 Ny. Teti 20,000 3,000 8,500 8,500 20,000
59 Anto 80,000 3,000 38,500 38,500 80,000
60 27/4/07 Ny. Ida 20,000 3,000 8,500 8,500 20,000
61 28/4/07 Ny. Salbilah 20,000 3,000 8,500 8,500 20,000
62 Dwi Helia
63 30/4/07 Zulfa 40,000 3,000 18,500 18,500 40,000
64 Rista 100,000 3,000 48,500 48,500 100,000
TOTAL 3,490,000 183,000 1,653,500 1,653,500 3,490,000
PENGELUARAN APRIL 2007
NO TGL NAMA OBAT & BAHAN QTY JUMLAH

1 14/4/07 Spirtus 2 14,000
2 21/4/07 Pehacain 20 40,000
Pehacain 20 40,000
Bor Diamond 120,000
Batu polos
3 30/04/07 Solare 121,500
Etching 121,500
Fuji IX GP 135,000
4 30/4/07 Insentif drg. Sonya 250,000

TOTAL 842,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI APRIL 2007
KEUNTUNGAN
NO TGL PENERIMAAN PENGELUARAN SISA
KSBL DRG. DEWI
1 APRIL 1,653,500 842,000 811,500 405,750 405,750
Cimahi, 5 Mei 2007

Dibuat oleh, Mengetahui,
Drg. Dewi Muntiatun

Siti Nur Yulia Dokter Gigi
Keuangan
Menyetujui,
dr. H. Pandith. A. Arismunandar, MM

Direktur KSBL
PERIODE MEI 2007
JASA ALAT &

DOKTER BAHAN
1 1/5/2007 Nani 20,000 3,000 8,500 8,500 20,000
2 Ny. Teti 100,000 3,000 48,500 48,500 100,000
3 2/5/2007 An. Rangga 60,000 3,000 28,500 28,500 60,000
4 An. Bob Meola 70,000 3,000 33,500 33,500 70,000
5 3/5/2007 Nidia 40,000 3,000 18,500 18,500 40,000
6 4/5/2007 Ny. Siti 50,000 3,000 23,500 23,500 50,000
7 Amel 20,000 3,000 8,500 8,500 20,000
8 Ny. Susan 20,000 3,000 8,500 8,500 20,000
9 5/5/2007 Ani 24,000 12,000 12,000 24,000
10 Ny. Hj. Cucu 30,000 3,000 13,500 13,500 30,000
11 Joko 30,000 3,000 13,500 13,500 30,000
12 Iis Maemunah 30,000 3,000 13,500 13,500 30,000
13 7/5/2007 Rista 100,000 3,000 48,500 48,500 100,000
14 Aulia 40,000 3,000 18,500 18,500 40,000
15 S. Panca 100,000 3,000 48,500 48,500 100,000
16 Wahyudi 30,000 3,000 13,500 13,500 30,000
17 8/5/2007 Hj. Yoyom 800,000 3,000 398,500 398,500 800,000
18 Bimo 50,000 3,000 23,500 23,500 50,000
19 Risma 100,000 3,000 48,500 48,500 100,000
20 12/5/2007 Ani - - -
21 Bagas 30,000 3,000 13,500 13,500 30,000
22 Joko 100,000 3,000 48,500 48,500 100,000
23 Amelia 50,000 3,000 23,500 23,500 50,000
24 14/5/2007 Ranto 140,000 3,000 68,500 68,500 140,000
25 15/5/2007 Hanifah 20,000 3,000 8,500 8,500 20,000
26 Hairani 20,000 3,000 8,500 8,500 20,000
27 16/5/2007 Hilman 30,000 3,000 13,500 13,500 30,000
28 Ny. Yuyun 20,000 3,000 8,500 8,500 20,000
29 Tn. Sudarnoyo 40,000 3,000 18,500 18,500 40,000
30 17/5/2007 Enur 60,000 3,000 28,500 28,500 60,000
31 21/5/2007 Nn. Ovi 30,000 3,000 13,500 13,500 30,000
32 Ny. Sri Hartati 20,000 3,000 8,500 8,500 20,000
33 Tn. Pujo 60,000 3,000 28,500 28,500 60,000
34 Tn. Ranto 40,000 3,000 18,500 18,500 40,000
35 Ifa 100,000 3,000 48,500 48,500 100,000
36 Nia 20,000 3,000 8,500 8,500 20,000
37 22/5/2007 Ifa 50,000 3,000 23,500 23,500 50,000
38 24/5/2007 Ny. Ida 50,000 3,000 23,500 23,500 50,000
39 Tn. Mirza 60,000 3,000 28,500 28,500 60,000
40 25/5/2007 Ny. Rita 20,000 3,000 8,500 8,500 20,000
41 Tn. Syamsusdin 20,000 3,000 8,500 8,500 20,000
42 27/5/2007 Nn. Ovi 80,000 3,000 38,500 38,500 80,000
43 28/5/2007 Tn. Alex 50,000 3,000 23,500 23,500 50,000
44 Ny. Eni 100,000 3,000 48,500 48,500 100,000
45 Ranto 50,000 3,000 23,500 23,500 50,000
46 29/5/2007 Febi 30,000 3,000 13,500 13,500 30,000
47 Ny. Heri 20,000 3,000 8,500 8,500 20,000
48 Tn. Daud 100,000 3,000 48,500 48,500 100,000
49 30/5/2007 Nugraha 20,000 3,000 8,500 8,500 20,000
50 31/5/2007 Ny. Eni 60,000 3,000 28,500 28,500 60,000
51 Ny. Yeni 80,000 3,000 38,500 38,500 80,000
TOTAL 3,284,000 147,000 1,568,500 1,568,500 3,284,000
JASA ALAT &

NO TGL NAMA PASIEN TARIF OBAT JML
DOKTER BAHAN
1 25/4/2007 Tn. Rahmat 15,000 5,000 5,000 5,000 15,000
2 30/4/2007 Ny. Erin 15,000 5,000 5,000 5,000 15,000
3 11/5/2007 Ny. Rini. M 15,000 5,000 5,000 5,000 15,000
4 25/5/2007 An. Setiawan 15,000 5,000 5,000 5,000 15,000
TOTAL 60,000 20,000 20,000 20,000 60,000
PENGELUARAN MEI 2007

TOTAL 250,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI MEI 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 MEI 1,568,500 250,000 1,318,500 659,250 659,250
2 MEI 20,000.00 20,000 10,000 10,000
669,250 669,250
Cimahi, 5 Juni 2007

Drg. Dewi Muntiatun

Keuangan
Menyetujui,

Direktur KSBL
PERIODE JUNI 2007
JASA ALAT &

DOKTER BAHAN
1 4/6/2007 Ny. Hasanah 80,000 3,000 38,500 38,500 80,000
2 Ny. Ambar 20,000 3,000 8,500 8,500 20,000
3 Ny. Sri . M 60,000 3,000 28,500 28,500 60,000
4 Tn. Sunarto 20,000 3,000 8,500 8,500 20,000
5 Yulia 20,000 3,000 8,500 8,500 20,000
6 7/6/2007 Ny. Oja 100,000 3,000 48,500 48,500 100,000
7 Ny. Nana 20,000 3,000 8,500 8,500 20,000
8 8/6/2007 Maman 100,000 3,000 48,500 48,500 100,000
9 Ny. Hasanah 120,000 60,000 60,000 120,000
10 Rini 40,000 3,000 18,500 18,500 40,000
11 Lani 20,000 3,000 8,500 8,500 20,000
12 9/6/2007 Ny. Eli 20,000 3,000 8,500 8,500 20,000
13 Ani
14 Devina 40,000 3,000 18,500 18,500 40,000
15 11/6/2007 Tn. Wahyudin 60,000 3,000 28,500 28,500 60,000
16 Tn. Endy 20,000 3,000 8,500 8,500 20,000
17 Heni 20,000 3,000 8,500 8,500 20,000
18 Sri 20,000 3,000 8,500 8,500 20,000
19 Nita 20,000 3,000 8,500 8,500 20,000
20 12/6/2007 Ny. Sri . M 20,000 10,000 10,000 20,000
21 Devina 40,000 3,000 18,500 18,500 40,000
22 Sendi 70,000 3,000 33,500 33,500 70,000
23 Dian 40,000 3,000 18,500 18,500 40,000
24 13/6/2007 Oke 20,000 3,000 8,500 8,500 20,000
25 14/6/2007 Tn. Ahmad Sukri 70,000 3,000 33,500 33,500 70,000
26 Ujang Makmun 80,000 3,000 38,500 38,500 80,000
27 15/6/2007 Tn. Aji 50,000 3,000 23,500 23,500 50,000
28 Andika 20,000 3,000 8,500 8,500 20,000
29 Tn. Sugimanto 20,000 3,000 8,500 8,500 20,000
30 Tn. Endy 60,000 3,000 28,500 28,500 60,000
31 Tn. Dian 40,000 3,000 18,500 18,500 40,000
32 16/6/2007 Ani 100,000 3,000 48,500 48,500 100,000
33 18/6/2007 Komariah 20,000 3,000 8,500 8,500 20,000
34 19/6/2007 Rovi 20,000 3,000 8,500 8,500 20,000
35 20/6/2007 Tn. Sugimanto 20,000 3,000 8,500 8,500 20,000
36 Faharay 60,000 3,000 28,500 28,500 60,000
37 Ny. Retno 80,000 3,000 38,500 38,500 80,000
38 Ny. Yayah - - -
39 Tn. Dian 50,000 3,000 23,500 23,500 50,000
40 21/6/2007 Heni 40,000 3,000 18,500 18,500 40,000
41 Angita 20,000 3,000 8,500 8,500 20,000
42 Ny. Komala 60,000 3,000 28,500 28,500 60,000
43 Tn. Ahmad 80,000 3,000 38,500 38,500 80,000
44 22/6/2007 Tn. Heri 100,000 3,000 48,500 48,500 100,000
45 Efendi 20,000 3,000 8,500 8,500 20,000
46 Ny. Euis 20,000 3,000 8,500 8,500 20,000
47 23/6/2007 Joko 30,000 3,000 13,500 13,500 30,000
48 25/6/2007 Ny. Mustahima 20,000 3,000 8,500 8,500 20,000
49 Nanda 20,000 3,000 8,500 8,500 20,000
50 26/6/2007 Ny. Estu Utami 20,000 3,000 8,500 8,500 20,000
51 Ny. Heni 100,000 3,000 48,500 48,500 100,000
52 27/6/2007 Tn. Ahmad 80,000 3,000 38,500 38,500 80,000
53 Tn. Dian 80,000 3,000 38,500 38,500 80,000
54 28/6/2007 Ny. Mustahima 60,000 3,000 28,500 28,500 60,000
55 An. Dewi 40,000 3,000 18,500 18,500 40,000
56 30/6/2007 Tn. Badruzamah 40,000 3,000 18,500 18,500 40,000
57 Bu Yoyom 20,000 3,000 8,500 8,500 20,000
58 Kartini 50,000 3,000 23,500 23,500 50,000
59 Wina 100,000 3,000 48,500 48,500 100,000
60 Awang 40,000 3,000 18,500 18,500 40,000
61 Popi 40,000 3,000 18,500 18,500 40,000
TOTAL 2,760,000 171,000 1,294,500 1,294,500 2,760,000
LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA
PERIODE JUNI 2007
JASA ALAT &

DOKTER BAHAN
1 2/6/2007 Peni 30,000 5,000 12,500 12,500 30,000
2 4/6/2007 Ny. Yati 15,000 5,000 5,000 5,000 15,000
3 An. Bagus 30,000 5,000 12,500 12,500 30,000
4 6/6/2007 Tn. Salami 15,000 5,000 5,000 5,000 15,000
5 Imawati 15,000 5,000 5,000 5,000 15,000
6 14/6/2007 Sukiman 15,000 5,000 5,000 5,000 15,000
7 21/6/2007 Tn. Sulaiman 15,000 5,000 5,000 5,000 15,000
8 Ny. Sri 15,000 5,000 5,000 5,000 15,000
9 Tn. Didi 15,000 5,000 5,000 5,000 15,000
10 30/6/2007 Siti. A 15,000 5,000 5,000 5,000 15,000
11 Tn. Didi Supriyadi 35,000 5,000 15,000 15,000 35,000
TOTAL 215,000 55,000 80,000 80,000 215,000
PENGELUARAN JUNI 2007

TOTAL 250,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI JUNI 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 JUNI 1,294,500 250,000 1,044,500 522,250 522,250
2 JUNI 80,000.00 80,000 40,000 40,000
562,250 562,250
Cimahi, 3 Juli 2007

Drg. Dewi Muntiatun

Keuangan
Menyetujui,

Direktur KSBL
PERIODE JULI 2007
JASA ALAT &

DOKTER BAHAN
1 2/7/2007 Tn. Toton 20,000 3,000 8,500 8,500 20,000
2 Tn. Dede 20,000 3,000 8,500 8,500 20,000
3 Diki 25,000 3,000 11,000 11,000 25,000
4 Rustam 20,000 3,000 8,500 8,500 20,000
5 Yani 20,000 3,000 8,500 8,500 20,000
6 Agus 20,000 3,000 8,500 8,500 20,000
7 3/7/2007 Tn. Wawan 30,000 3,000 13,500 13,500 30,000
8 4/7/2007 Ny. Iin 50,000 3,000 23,500 23,500 50,000
9 Ny. Yanti 50,000 3,000 23,500 23,500 50,000
10 Tn. Sukmi 100,000 3,000 48,500 48,500 100,000
11 Aulia 50,000 3,000 23,500 23,500 50,000
12 Ogi 40,000 3,000 18,500 18,500 40,000
13 Ny. Eko 20,000 3,000 8,500 8,500 20,000
14 Meri 40,000 3,000 18,500 18,500 40,000
15 6/7/2007 Ati 20,000 3,000 8,500 8,500 20,000
16 7/7/2007 Ani - - -
17 Popi 30,000 3,000 13,500 13,500 30,000
18 Ny. Popon 70,000 3,000 33,500 33,500 70,000
19 Wike Susanti 30,000 3,000 13,500 13,500 30,000
20 9/7/2007 Dewi 50,000 3,000 23,500 23,500 50,000
21 Angga 110,000 3,000 53,500 53,500 110,000
22 Bimo - - -
23 Wawan 20,000 3,000 8,500 8,500 20,000
24 10/7/2007 Rifan 20,000 3,000 8,500 8,500 20,000
25 Ny. Gina 20,000 3,000 8,500 8,500 20,000
26 Ahmad 200,000 3,000 98,500 98,500 200,000
27 Ny. Yanti 50,000 3,000 23,500 23,500 50,000
28 Andika 20,000 3,000 8,500 8,500 20,000
29 Meri 50,000 3,000 23,500 23,500 50,000
30 Yuni 100,000 3,000 48,500 48,500 100,000
31 14/7/07 Soleh 30,000 3,000 13,500 13,500 30,000
32 Dadi 30,000 3,000 13,500 13,500 30,000
33 Dani 30,000 3,000 13,500 13,500 30,000
34 16/7/07 Ny. Kartini 30,000 3,000 13,500 13,500 30,000
35 Ny. Ida 20,000 3,000 8,500 8,500 20,000
36 17/7/07 Andika 20,000 3,000 8,500 8,500 20,000
37 18/7/07 Hilman 40,000 3,000 18,500 18,500 40,000
38 Giri 40,000 3,000 18,500 18,500 40,000
39 19/7/07 Tn. Angga 50,000 3,000 23,500 23,500 50,000
40 Tn. Undin 20,000 3,000 8,500 8,500 20,000
41 20/7/07 Tn. Udi 20,000 3,000 8,500 8,500 20,000
42 Ny. Putri 20,000 3,000 8,500 8,500 20,000
43 21/7/07 Ani 40,000 3,000 18,500 18,500 40,000
44 Kartini 30,000 3,000 13,500 13,500 30,000
45 Ditya 60,000 3,000 28,500 28,500 60,000
46 Popi 30,000 3,000 13,500 13,500 30,000
47 Faradilah 40,000 3,000 18,500 18,500 40,000
48 Santi 30,000 3,000 13,500 13,500 30,000
49 23/7/07 Ny. Maria 40,000 3,000 18,500 18,500 40,000
50 An. Anggi 20,000 3,000 8,500 8,500 20,000
51 MNn. Visi 120,000 3,000 58,500 58,500 120,000
52 Tn. Agus 60,000 3,000 28,500 28,500 60,000
53 Ny. Nunung 20,000 3,000 8,500 8,500 20,000
54 Tn. Yadi 100,000 3,000 48,500 48,500 100,000
55 Ny. Mami 80,000 40,000 40,000 80,000
56 24/7/07 Tn. Suroyo 20,000 3,000 8,500 8,500 20,000
57 25/7/07 Ny. Darti 30,000 3,000 13,500 13,500 30,000
58 28/7/07 Ny. Yoyom 60,000 3,000 28,500 28,500 60,000
59 30/7/07 Ny. Ika 20,000 3,000 8,500 8,500 20,000
60 Ny. Mimin 20,000 3,000 8,500 8,500 20,000
61 Nn. Wulan 24,000 12,000 12,000 24,000
62 Mike 40,000 3,000 18,500 18,500 40,000
63 31/7/07 Yayan 20,000 3,000 8,500 8,500 20,000
2,549,000 177,000 1,186,000 1,186,000 2,549,000

PERIODE JULI 2007
JASA ALAT &

DOKTER BAHAN
1 2/7/2007 Tn. Didi 35,000 5,000 15,000 15,000 35,000
2 5/7/2007 Tn. Sukiman 15,000 5,000 5,000 5,000 15,000
3 7/7/2007 Siti. A 40,000 20,000 20,000 40,000
4 9/7/2007 Heru 20,000 10,000 10,000 20,000
5 Tn. Sulaeman 15,000 7,500 7,500 15,000
6 11/7/2007 Devi. A 15,000 7,500 7,500 15,000
7 16/7/2007 Tn. Sulaeman 15,000 7,500 7,500 15,000
8 Fajar 15,000 7,500 7,500 15,000
9 23/7/07 Ken. S 35,000 17,500 17,500 35,000
TOTAL 205,000 10,000 97,500 97,500 205,000
PENGELUARAN JULI 2007

1 14/7/07 Sarung Tangan 45,000
TOTAL 295,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI JULI 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 JULI 1,186,000 295,000 891,000 445,500 445,500
2 JULI 97,500.00 97,500 48,750 48,750
494,250 494,250
Cimahi, 3 Agustus 2007

Drg. Dewi Muntiatun

Keuangan
Menyetujui,

Direktur KSBL
PERIODE AGUSTUS 2007
JASA ALAT &

DOKTER BAHAN
1 1/8/2007 Bina 40,000 3,000 18,500 18,500 40,000
2 2/8/2007 Ny. Ika 40,000 3,000 18,500 18,500 40,000
3 Nunung 20,000 3,000 8,500 8,500 20,000
4 3/8/2007 Ny. Eni 80,000 3,000 38,500 38,500 80,000
5 Seli 150,000 3,000 73,500 73,500 150,000
6 Mary 20,000 3,000 8,500 8,500 20,000
7 6/8/2007 Nn. Firta 60,000 3,000 28,500 28,500 60,000
8 Ani 20,000 3,000 8,500 8,500 20,000
9 Tn. Suryadi 40,000 3,000 18,500 18,500 40,000
10 7/8/2007 Ny. Eni 120,000 3,000 58,500 58,500 120,000
11 8/8/2007 Ny. Eli 40,000 3,000 18,500 18,500 40,000
12 Tn. Manan 20,000 3,000 8,500 8,500 20,000
13 Reky 100,000 3,000 48,500 48,500 100,000
14 10/8/2007 Tn. Suryadinata 40,000 3,000 18,500 18,500 40,000
15 13/8/2007 Ny. Eli 80,000 3,000 38,500 38,500 80,000
16 15/8/2007 Tn. Suryadinata 50,000 3,000 23,500 23,500 50,000
17 16/8/2007 An. Sindy 80,000 3,000 38,500 38,500 80,000
18 Gunadi 50,000 3,000 23,500 23,500 50,000
19 Deni 20,000 3,000 8,500 8,500 20,000
20 18/8/2007 Ogi 40,000 3,000 18,500 18,500 40,000
21 Ny. Maria 30,000 3,000 13,500 13,500 30,000
22 20/8/2007 Ny. Yulian 50,000 3,000 23,500 23,500 50,000
23 Ny. Cici 20,000 3,000 8,500 8,500 20,000
24 Tn. Suryadinata 40,000 3,000 18,500 18,500 40,000
25 21/8/2007 Ny. Gunawan 140,000 3,000 68,500 68,500 140,000
26 23/8/2007 An. Fadil 25,000 3,000 11,000 11,000 25,000
27 24/8/2007 Ny. Yulian 40,000 3,000 18,500 18,500 40,000
28 Alfian 40,000 3,000 18,500 18,500 40,000
29 Ny. Gunawan 60,000 3,000 28,500 28,500 60,000
30 Hanifa 20,000 3,000 8,500 8,500 20,000
31 Subandi 100,000 3,000 48,500 48,500 100,000
32 Firta 20,000 3,000 8,500 8,500 20,000
33 Nabila 20,000 3,000 8,500 8,500 20,000
34 Tn. Suryadinata 80,000 3,000 38,500 38,500 80,000
35 27/8/2007 An. Fadil 25,000 3,000 11,000 11,000 25,000
36 Ny. Yulian 40,000 3,000 18,500 18,500 40,000
37 Subandi 60,000 3,000 28,500 28,500 60,000
38 28/8/2007 Thoriq 20,000 3,000 8,500 8,500 20,000
39 29/8/2007 An. Wildan 60,000 3,000 28,500 28,500 60,000
40 30/8/2007 Tn. Hendra 40,000 3,000 18,500 18,500 40,000
41 Komar 50,000 3,000 23,500 23,500 50,000
42 Thoriq 20,000 3,000 8,500 8,500 20,000
43 31/8/2007 An. Fadil 25,000 3,000 11,000 11,000 25,000
44 Ny. Yulian 80,000 3,000 38,500 38,500 80,000
2,215,000 132,000 1,041,500 1,041,500 2,215,000

JASA ALAT &
DOKTER BAHAN
1 14/8/07 Ny. Yoyoh 20,000 5,000 7,500 7,500 20,000
2 Ny. Siti 20,000 5,000 7,500 7,500 20,000
3 20/8/07 Ny. Yoyoh 20,000 5,000 7,500 7,500 20,000
4 Ny. Siti 25,000 5,000 10,000 10,000 25,000
5 22/8/07 Tn. Komarudin 15,000 5,000 5,000 5,000 15,000
6 27/8/07 Ny. Siti. F 20,000 5,000 7,500 7,500 20,000
7 Ny. Siti A 25,000 12,500 12,500 25,000
8 29/8/07 Tn. Komarudin 35,000 17,500 17,500 35,000
9 30/8/07 Ny. Ika 25,000 12,500 12,500 25,000
TOTAL 205,000 30,000 87,500 87,500 205,000
PENGELUARAN AGUSTUS 2007

1 25/8/07 Lidocain Inj 1 box 42,900
TOTAL 292,900
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI AGUSTUS 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 AGUSTUS 1,041,500 292,900 748,600 374,300 374,300
2 AGUSTUS 87,500.00 87,500 43,750 43,750
418,050 418,050
Cimahi, 5 September 2007

Drg. Dewi Muntiatun

Keuangan
Menyetujui,

Direktur KSBL
PERIODE SEPTEMBER 2007
JASA ALAT &

DOKTER BAHAN
1 1/9/2007 An. Yuliani 60,000 3,000 28,500 28,500 60,000
2 An. Merli 30,000 3,000 13,500 13,500 30,000
3 Lina. K 15,000 3,000 6,000 6,000 15,000
4 Ny. Sri. W 15,000 3,000 6,000 6,000 15,000
5 Tn. Dadang 80,000 3,000 38,500 38,500 80,000
6 3/9/2007 An. Fadil 25,000 3,000 11,000 11,000 25,000
7 6/9/2007 Aisah 30,000 3,000 13,500 13,500 30,000
8 Hanifa 40,000 3,000 18,500 18,500 40,000
9 7/9/2007 Ny. Harlot 15,000 3,000 6,000 6,000 15,000
10 Ny. Eti. K 15,000 3,000 6,000 6,000 15,000
11 Ny. Nunung 40,000 3,000 18,500 18,500 40,000
12 8/9/2007 Mariam 45,000 3,000 21,000 21,000 45,000
13 10/9/2007 Hanifa 40,000 3,000 18,500 18,500 40,000
14 Ny. Yani 130,000 3,000 63,500 63,500 130,000
15 Tn. Abdullah 140,000 3,000 68,500 68,500 140,000
16 11/9/2007 Dian . D 15,000 3,000 6,000 6,000 15,000
17 12/9/2007 Satinem 20,000 3,000 8,500 8,500 20,000
18 Indi 20,000 3,000 8,500 8,500 20,000
19 Hanifa 80,000 3,000 38,500 38,500 80,000
20 Nani 20,000 3,000 8,500 8,500 20,000
21 Dedi 20,000 3,000 8,500 8,500 20,000
22 15/9/07 Haryati 15,000 3,000 6,000 6,000 15,000
23 Ny. Suparjo 15,000 3,000 6,000 6,000 15,000
24 Haryono 60,000 3,000 28,500 28,500 60,000
25 Kartini 100,000 3,000 48,500 48,500 100,000
26 Santi 50,000 3,000 23,500 23,500 50,000
27 Faradilla 50,000 3,000 23,500 23,500 50,000
28 17/9/07 An. Pani 20,000 3,000 8,500 8,500 20,000
29 Ny. Niny 20,000 3,000 8,500 8,500 20,000
30 Muhidin 20,000 3,000 8,500 8,500 20,000
31 18/9/07 Ny. Cucu 15,000 3,000 6,000 6,000 15,000
32 Asep 20,000 3,000 8,500 8,500 20,000
33 Tedi 20,000 3,000 8,500 8,500 20,000
34 Ahmad 20,000 3,000 8,500 8,500 20,000
35 Tn. Dady 50,000 3,000 23,500 23,500 50,000
36 Rara 20,000 3,000 8,500 8,500 20,000
37 Raisya 40,000 3,000 18,500 18,500 40,000
38 21/9/07 Ny. Rukiyah 15,000 3,000 6,000 6,000 15,000
39 Tn. Wahyu 15,000 3,000 6,000 6,000 15,000
40 Cesya 40,000 3,000 18,500 18,500 40,000
41 Roy 60,000 3,000 28,500 28,500 60,000
42 22/9/07 An. Sindi 30,000 3,000 13,500 13,500 30,000
43 Haryono 40,000 3,000 18,500 18,500 40,000
44 Ny. Cucu 15,000 3,000 6,000 6,000 15,000
45 24/9/07 Ny. Santi 100,000 3,000 48,500 48,500 100,000
46 Asmita 30,000 3,000 13,500 13,500 30,000
47 Joko 20,000 3,000 8,500 8,500 20,000
48 25/9/07 Asmita 35,000 3,000 16,000 16,000 35,000
49 26/9/07 Tn. Said 110,000 3,000 53,500 53,500 110,000
50 Bagus 60,000 3,000 28,500 28,500 60,000
51 27/9/07 Ayu 20,000 3,000 8,500 8,500 20,000
52 Ovi 20,000 3,000 8,500 8,500 20,000
53 28/9/07 Tn. Engkos 30,000 3,000 13,500 13,500 30,000
54 29/9/07 Kismiari 25,000 3,000 11,000 11,000 25,000
55 M. Alpiansyah 20,000 3,000 8,500 8,500 20,000
56 Haryono 100,000 3,000 48,500 48,500 100,000
2,215,000 168,000 1,023,500 1,023,500 2,215,000

JASA ALAT &

DOKTER BAHAN
1 1/9/2007 Siti Fatimah 25,000 12,500 12,500 25,000
2 Tn. Komarudin 25,000 5,000 10,000 10,000 25,000
3 Ika 25,000 5,000 10,000 10,000 25,000
4 6/9/2007 Elin Herlina 25,000 5,000 10,000 10,000 25,000
5 7/9/2007 Siti Fatimah 25,000 5,000 10,000 10,000 25,000
6 10/9/2007 Elis Dwi 25,000 5,000 10,000 10,000 25,000
7 Ujang 25,000 5,000 10,000 10,000 25,000
8 11/9/2007 Siti Fatimah 25,000 5,000 10,000 10,000 25,000
9 Ny. Ela 25,000 5,000 10,000 10,000 25,000
10 12/9/2007 Tedy. S 25,000 5,000 10,000 10,000 25,000
11 Rini 25,000 5,000 10,000 10,000 25,000
12 Hanadi 25,000 5,000 10,000 10,000 25,000
13 15/9/2007 Ujang 25,000 5,000 10,000 10,000 25,000
14 Yayuk 25,000 12,500 12,500 25,000
15 17/9/07 Santi K 25,000 5,000 10,000 10,000 25,000
16 Tedy. S 25,000 5,000 10,000 10,000 25,000
17 Indra 25,000 5,000 10,000 10,000 25,000
18 24/9/07 Maesaroh 25,000 5,000 10,000 10,000 25,000
19 Santi K 25,000 12,500 12,500 25,000
20 Siti Fatimah 25,000 5,000 10,000 10,000 25,000
21 25/9/07 Didin S 25,000 5,000 10,000 10,000 25,000
TOTAL 525,000 90,000 217,500 217,500 525,000
PENGELUARAN SEPTEMBER 2007

1 4/9/2007 Bahan Poli Gigi 1 Faktur 97,500
24/9/07 Bahan Poli Gigi 4 Faktur 393,000
TOTAL 740,500
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI SEPTEMBER 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 SEPTEMBER 1,023,500 740,500 283,000 141,500 141,500
2 SEPTEMBER 217,500.00 217,500 108,750 108,750
250,250 250,250
Cimahi, 5 Oktober 2007

Siti Nur Yulia Drg. Dewi Muntiatun
Keuangan Dokter Gigi
Menyetujui,

Direktur KSBL

PERIODE OKTOBER 2007
JASA ALAT &

DOKTER BAHAN
1 1/10/2007 An. Alip 20,000 3,000 8,500 8,500 20,000
2 Tn. Sukandi 50,000 3,000 23,500 23,500 50,000
3 Tn. Sidiq 20,000 3,000 8,500 8,500 20,000
4 Tn. Tedi 20,000 3,000 8,500 8,500 20,000
5 2/10/2007 Wulan 24,000 12,000 12,000 24,000
6 Tn. Asmita 75,000 3,000 36,000 36,000 75,000
7 Tn. Ruyandi 20,000 3,000 8,500 8,500 20,000
8 Tn. Sidiq 20,000 3,000 8,500 8,500 20,000
9 Feni 40,000 3,000 18,500 18,500 40,000
10 6/10/2007 Haryono 80,000 3,000 38,500 38,500 80,000
11 8/10/2007 Ny. Aam 20,000 3,000 8,500 8,500 20,000
12 An. Rahmalia 65,000 3,000 31,000 31,000 65,000
13 Tn. Asmita 20,000 3,000 8,500 8,500 20,000
14 Allia 40,000 3,000 18,500 18,500 40,000
15 10/10/2007 Lia 20,000 3,000 8,500 8,500 20,000
16 Wulan 24,000 12,000 12,000 24,000
17 11/10/2007 Tn. Bambang 50,000 3,000 23,500 23,500 50,000
18 Tn. Hendra 20,000 3,000 8,500 8,500 20,000
19 22/10/07 Ovita 30,000 3,000 13,500 13,500 30,000
20 Tn. Hendra 20,000 3,000 8,500 8,500 20,000
21 Ny. Rita 30,000 3,000 13,500 13,500 30,000
22 Ny. Ernawati 110,000 3,000 53,500 53,500 110,000
23 Tn. Mursid 20,000 10,000 10,000 20,000
24 Riang 80,000 3,000 38,500 38,500 80,000
25 Tn. Dana 20,000 3,000 8,500 8,500 20,000
26 23/10/07 Wigati 30,000 3,000 13,500 13,500 30,000
27 24/10/07 Rahmadani 30,000 3,000 13,500 13,500 30,000
28 25/10/07 Eko 20,000 3,000 8,500 8,500 20,000
29 Riang 70,000 3,000 33,500 33,500 70,000
30 Yusuf 20,000 3,000 8,500 8,500 20,000
31 Rina 150,000 3,000 73,500 73,500 150,000
32 Haeta 20,000 3,000 8,500 8,500 20,000
33 Hana 20,000 3,000 8,500 8,500 20,000
34 26/10/07 Wigati 85,000 3,000 41,000 41,000 85,000
35 Febi 16,000 8,000 8,000 16,000
36 Ny. Ernawati 30,000 3,000 13,500 13,500 30,000
37 27/10/07 An. Arneta 20,000 3,000 8,500 8,500 20,000
38 Sumarya 90,000 3,000 43,500 43,500 90,000
39 Ny. Holilah 20,000 3,000 8,500 8,500 20,000
40 Ny. Sukaesih 80,000 3,000 38,500 38,500 80,000
41 29/10/07 Kholid 50,000 3,000 23,500 23,500 50,000
42 Ogi 40,000 3,000 18,500 18,500 40,000
43 Riang 80,000 3,000 38,500 38,500 80,000
44 30/10/07 Ny. Ernawati 90,000 3,000 43,500 43,500 90,000
45 31/10/07 Tn. Heri 20,000 3,000 8,500 8,500 20,000
46 Rohman 20,000 3,000 8,500 8,500 20,000
47 Ovi 40,000 3,000 18,500 18,500 40,000
48 Eka 20,000 3,000 8,500 8,500 20,000
49 Riang 40,000 3,000 18,500 18,500 40,000
2,039,000 135,000 952,000 952,000 2,039,000
JASA ALAT &

DOKTER BAHAN
1 1/10/2007 Siti Fatimah 25,000 12,500 12,500 25,000
2 Santi Kurniati 25,000 12,500 12,500 25,000
3 3/10/2007 Tn. Supriyadi 80,000 5,000 37,500 37,500 80,000
4 6/10/2007 Santi Kurniati 65,000 5,000 30,000 30,000 65,000
5 8/10/2007 Siti Fatimah 70,000 35,000 35,000 70,000
6 Tn. Didi 25,000 12,500 12,500 25,000
7 27/10/07 Keizia Aveling 15,000 5,000 5,000 5,000 15,000
8 Suharsono 15,000 5,000 5,000 5,000 15,000
9 Didi Supriyadi 25,000 5,000 10,000 10,000 25,000
10 29/10/07 Komarudin 15,000 5,000 5,000 5,000 15,000
11 Suharsono 15,000 5,000 5,000 5,000 15,000
12 Surya 15,000 5,000 5,000 5,000 15,000
TOTAL 390,000 40,000 175,000 175,000 390,000
PENGELUARAN OKTOBER 2007

TOTAL 250,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI OKTOBER 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 Oktober 952,000 250,000 702,000 351,000 351,000
2 Oktober 175,000.00 175,000 87,500 87,500
438,500 438,500
Cimahi, 2 November 2007


Menyetujui,

Direktur KSBL

PERIODE NOVEMBER 2007
JASA ALAT &

DOKTER BAHAN
1 2/11/2007 Ulsi 20,000 3,000 8,500 8,500 20,000
2 3/11/2007 Sumaryo 50,000 3,000 23,500 23,500 50,000
3 Ovi 40,000 3,000 18,500 18,500 40,000
4 Ny. Siti Fatimah 20,000 3,000 8,500 8,500 20,000
5 An. Rizky. F 30,000 3,000 13,500 13,500 30,000
6 5/11/2007 Yeni 20,000 3,000 8,500 8,500 20,000
7 Taufik Hidayat 20,000 3,000 8,500 8,500 20,000
8 Cucu Free Free Free Free Free
9 6/11/2007 Ny. Hj. Fatimah 20,000 3,000 8,500 8,500 20,000
10 Ny. Iis 60,000 3,000 28,500 28,500 60,000
11 Bagas 40,000 3,000 18,500 18,500 40,000
12 Rian 200,000 3,000 98,500 98,500 200,000
13 7/11/2007 Naila 20,000 3,000 8,500 8,500 20,000
14 Ai 40,000 3,000 18,500 18,500 40,000
15 8/11/2007 Ny. Siti Fatimah 30,000 3,000 13,500 13,500 30,000
16 Hengky 20,000 3,000 8,500 8,500 20,000
17 Ihsan 20,000 3,000 8,500 8,500 20,000
18 Assan 40,000 3,000 18,500 18,500 40,000
19 Lita 20,000 3,000 8,500 8,500 20,000
20 Jonathan 20,000 3,000 8,500 8,500 20,000
21 Ai 20,000 3,000 8,500 8,500 20,000
22 10/11/2007 Ny. Siti Fatimah 20,000 3,000 8,500 8,500 20,000
23 Tn. Eman 20,000 3,000 8,500 8,500 20,000
24 12/11/2007 Regi 20,000 3,000 8,500 8,500 20,000
25 Anggita 40,000 3,000 18,500 18,500 40,000
26 Sri 20,000 3,000 8,500 8,500 20,000
27 Sada 30,000 3,000 13,500 13,500 30,000
28 14/11/2007 Tn. Sutardi 60,000 3,000 28,500 28,500 60,000
29 Febri 50,000 3,000 23,500 23,500 50,000
30 15/11/2007 Jesse 100,000 3,000 48,500 48,500 100,000
31 17/11/2007 Tn. Suhengki 30,000 3,000 13,500 13,500 30,000
32 An. Ridwan - - -
33 Ny. Neneng 30,000 3,000 13,500 13,500 30,000
34 Yuyus 20,000 3,000 8,500 8,500 20,000
35 Iskandar 40,000 3,000 18,500 18,500 40,000
36 19/11/2007 Anggita 40,000 3,000 18,500 18,500 40,000
37 Usman 20,000 3,000 8,500 8,500 20,000
38 Jesse 40,000 3,000 18,500 18,500 40,000
39 Euis 120,000 3,000 58,500 58,500 120,000
40 20/11/2007 Tn. Niko 20,000 3,000 8,500 8,500 20,000
41 Ny. Iis 35,000 3,000 16,000 16,000 35,000
42 Ny. Yoza 200,000 3,000 98,500 98,500 200,000
43 Deli 20,000 3,000 8,500 8,500 20,000
44 Tn. Sunaryo 100,000 3,000 48,500 48,500 100,000
45 Jesse 100,000 3,000 48,500 48,500 100,000
46 Euis 35,000 3,000 16,000 16,000 35,000
47 Tn. Suparman 20,000 3,000 8,500 8,500 20,000
48 Tn. Heryanto 20,000 3,000 8,500 8,500 20,000
49 24/11/2007 Lami 20,000 3,000 8,500 8,500 20,000
50 26/11/2007 Imade 20,000 3,000 8,500 8,500 20,000
51 Deni 120,000 3,000 58,500 58,500 120,000
52 27/11/2007 Wardi 20,000 3,000 8,500 8,500 20,000
53 Deni 20,000 3,000 8,500 8,500 20,000
54 29/11/2007 An. Ester Agnes 80,000 3,000 38,500 38,500 80,000
55 Tn. Bronto 28,000 3,000 12,500 12,500 28,000
56 Deni 20,000 3,000 8,500 8,500 20,000
57 Delta 20,000 3,000 8,500 8,500 20,000
58 30/11/2007 Tn. Bronto 28,000 3,000 12,500 12,500 28,000
2,376,000 168,000 1,104,000 1,104,000 2,376,000

JASA ALAT &

DOKTER BAHAN
1 3/11/2007 Tn. Suharsono 50,000 5,000 22,500 22,500 50,000
2 6/11/2007 Axsel Putra 15,000 5,000 5,000 5,000 15,000
3 Ujang 15,000 5,000 5,000 5,000 15,000
4 Tn. Komarudin 35,000 5,000 15,000 15,000 35,000
5 Tn. Didi 15,000 7,500 7,500 15,000
6 12/11/2007 Tn. Didi 35,000 5,000 15,000 15,000 35,000
7 Tn. Ujang 15,000 5,000 5,000 5,000 15,000
8 15/11/2007 Tn. Usep 35,000 5,000 15,000 15,000 35,000
9 17/11/2007 Rizky Agung 20,000 10,000 10,000 20,000
10 Tn. Ujang 15,000 5,000 5,000 5,000 15,000
11 19/11/2007 Ny. Ida 15,000 7,500 7,500 15,000
12 Tn. Ujang 15,000 5,000 5,000 5,000 15,000
13 26/11/2007 Ny. Iceu 35,000 5,000 15,000 15,000 35,000
14 28/11/2007 Tn. Komarudin 35,000 5,000 15,000 15,000 35,000
TOTAL 350,000 55,000 147,500 147,500 350,000
PENGELUARAN NOVEMBER 2007

2 Pehacain Inj 1 box 40,000
TOTAL 290,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI NOVEMBER 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 November 1,104,000 290,000 814,000 407,000 407,000
2 November 147,500.00 147,500 73,750 73,750
480,750 480,750
Cimahi, 8 Desember 2007

Menyetujui,

Direktur KSBL

PERIODE DESEMBER 2007
JASA ALAT &

DOKTER BAHAN
1 1/12/2007 Ny. Samijo 20,000 3,000 8,500 8,500 20,000
2 Riski 20,000 3,000 8,500 8,500 20,000
3 An. Farel 100,000 3,000 48,500 48,500 100,000
4 3/12/2007 Ny. Kismiari 20,000 3,000 8,500 8,500 20,000
5 Tn. Dian 60,000 3,000 28,500 28,500 60,000
6 Asep. S 85,000 3,000 41,000 41,000 85,000
7 Tn. Munawar 20,000 3,000 8,500 8,500 20,000
8 Nani 20,000 3,000 8,500 8,500 20,000
9 6/12/2007 Ny. Euis 50,000 3,000 23,500 23,500 50,000
10 Tn. Gatot 20,000 3,000 8,500 8,500 20,000
11 Nita 40,000 3,000 18,500 18,500 40,000
12 X 20,000 3,000 8,500 8,500 20,000
13 Tn. Iyan 100,000 3,000 48,500 48,500 100,000
14 8/12/2007 Ny. Warsini 70,000 3,000 33,500 33,500 70,000
15 Yeni 60,000 3,000 28,500 28,500 60,000
16 An. M. Fahrudin 20,000 3,000 8,500 8,500 20,000
17 An. Farel 100,000 3,000 48,500 48,500 100,000
18 Deni. R 60,000 3,000 28,500 28,500 60,000
19 10/12/2007 An. Fajar 20,000 3,000 8,500 8,500 20,000
20 Angga 20,000 3,000 8,500 8,500 20,000
21 Anabel 80,000 3,000 38,500 38,500 80,000
22 Arva 20,000 3,000 8,500 8,500 20,000
23 Tn. Iyan 70,000 3,000 33,500 33,500 70,000
24 Hani 20,000 3,000 8,500 8,500 20,000
25 Deni. R 60,000 3,000 28,500 28,500 60,000
26 12/12/2007 An. Riska 80,000 3,000 38,500 38,500 80,000
27 Tn. Hafid 20,000 3,000 8,500 8,500 20,000
28 13/12/07 Ny. Ai Suryani 20,000 3,000 8,500 8,500 20,000
29 R. Mulya 20,000 3,000 8,500 8,500 20,000
30 Dewi 30,000 3,000 13,500 13,500 30,000
31 15/12/07 Ny. Maryati 35,000 3,000 16,000 16,000 35,000
32 Tn. Asep 60,000 3,000 28,500 28,500 60,000
33 Wida. R 20,000 3,000 8,500 8,500 20,000
34 17/12/07 Dewi 60,000 3,000 28,500 28,500 60,000
35 19/12/07 Tn. Setyo 20,000 3,000 8,500 8,500 20,000
36 Tn. Bronto Free Free Free Free Free
37 Soni 20,000 3,000 8,500 8,500 20,000
38 Angga 40,000 3,000 18,500 18,500 40,000
39 21/12/07 Ny. Juju 40,000 3,000 18,500 18,500 40,000
40 22/12/07 Wulan 25,000 3,000 11,000 11,000 25,000
41 Ny. Nurjanah 60,000 3,000 28,500 28,500 60,000
42 Tn. Anen 20,000 3,000 8,500 8,500 20,000
43 24/12/07 Wahyuni 30,000 3,000 13,500 13,500 30,000
44 Tn. Mukhsin 75,000 3,000 36,000 36,000 75,000
45 Suhartoyo 60,000 3,000 28,500 28,500 60,000
46 Nabila 30,000 3,000 13,500 13,500 30,000
47 Abdul 20,000 3,000 8,500 8,500 20,000
48 Ny. Euis 85,000 3,000 41,000 41,000 85,000
49 26/12/07 Ny. Holilah 25,000 3,000 11,000 11,000 25,000
50 Ny. Aah 20,000 3,000 8,500 8,500 20,000
51 Angga 80,000 3,000 38,500 38,500 80,000
52 27/12/07 Dewi Ratna 60,000 3,000 28,500 28,500 60,000
53 Exawati 40,000 3,000 18,500 18,500 40,000
54 Tn. Rustam 20,000 3,000 8,500 8,500 20,000
55 28/12/07 Fauzan 20,000 3,000 8,500 8,500 20,000
56 Nabila 50,000 3,000 23,500 23,500 50,000
57 Suhartoyo 60,000 3,000 28,500 28,500 60,000
58 William 40,000 3,000 18,500 18,500 40,000
59 29/12/07 Gilang 60,000 3,000 28,500 28,500 60,000
60 Ikrisnanda 50,000 3,000 23,500 23,500 50,000
61 William 40,000 3,000 18,500 18,500 40,000
2,610,000 180,000 1,215,000 1,215,000 2,610,000

JASA ALAT &

DOKTER BAHAN
1 3/12/2007 Ny. Aan 25,000 5,000 10,000 10,000 25,000
2 4/12/2007 Tn. Udin 25,000 5,000 10,000 10,000 25,000
3 5/12/2007 Tn. Suharsono 35,000 5,000 15,000 15,000 35,000
4 Ny. Nia Kurniasih 40,000 5,000 17,500 17,500 40,000
5 8/12/2007 Ny. Ida 30,000 15,000 15,000 30,000
6 11/12/2007 Ny. Iceu Susanti 15,000 5,000 5,000 5,000 15,000
7 Ny. Aan 25,000 5,000 10,000 10,000 25,000
8 15/12/07 Ny. Ida 30,000 5,000 12,500 12,500 30,000
9 18/12/07 Ny. Iceu Susanti 15,000 5,000 5,000 5,000 15,000
10 Ny. Aan 25,000 5,000 10,000 10,000 25,000
11 22/12/07 Ny. Ida 40,000 20,000 20,000 40,000
TOTAL 305,000 45,000 130,000 130,000 305,000
PENGELUARAN DESEMBER 2007

1 11/12/2007 Sensi Gloves 1 44,000
2 Corona Masker Kertas 1 30,000
3 14/12/2007 Klor Etil Gigi 1 70,000
4 29/12/07 Service Litek 50,000
TOTAL 444,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI DESEMBER 2007
KEUNTUNGAN
KSBL DRG. DEWI
1 Desember 1,215,000 444,000 771,000 385,500 385,500
2 Desember 130,000.00 130,000 65,000 65,000
450,500 450,500
Cimahi, 3 Januari 2008

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PERIODE JANUARI 2008
JASA ALAT &

DOKTER BAHAN
1 2/1/2008 Dedi 20,000 3,000 8,500 8,500 20,000
2 Angga 80,000 3,000 38,500 38,500 80,000
3 Teni 20,000 3,000 8,500 8,500 20,000
4 3/1/2008 An. Ogi 40,000 3,000 18,500 18,500 40,000
5 Tn. Budi 60,000 3,000 28,500 28,500 60,000
6 Tn. Asep 20,000 3,000 8,500 8,500 20,000
7 7/1/2008 Ny. Lili 60,000 3,000 28,500 28,500 60,000
8 Abdul 20,000 3,000 8,500 8,500 20,000
9 Teni 15,000 3,000 6,000 6,000 15,000
10 Sugih 50,000 3,000 23,500 23,500 50,000
11 Tn.Suryo 100,000 3,000 48,500 48,500 100,000
12 8/1/2008 Devi. M 35,000 3,000 16,000 16,000 35,000
13 Ny. Titi 50,000 3,000 23,500 23,500 50,000
14 9/1/2008 Nungki 20,000 3,000 8,500 8,500 20,000
15 Angga 120,000 3,000 58,500 58,500 120,000
16 Tn. Dwi Noto 20,000 3,000 8,500 8,500 20,000
17 11/1/2008 Ferza 40,000 3,000 18,500 18,500 40,000
18 Yani 10,000 5,000 5,000 10,000
19 Tn. Asep 35,000 3,000 16,000 16,000 35,000
20 Ridho 20,000 3,000 8,500 8,500 20,000
21 Ny. Murni 240,000 3,000 118,500 118,500 240,000
22 12/1/2008 Ny. Idah 75,000 3,000 36,000 36,000 75,000
23 14/1/2008 an. Danil 30,000 3,000 13,500 13,500 30,000
24 Ridho 20,000 3,000 8,500 8,500 20,000
25 Ny. Idah 25,000 3,000 11,000 11,000 25,000
26 Deborah 20,000 3,000 8,500 8,500 20,000
27 15/1/2008 Tn. Dadang 20,000 3,000 8,500 8,500 20,000
28 16/1/2008 Ny. Supadmiyati 20,000 3,000 8,500 8,500 20,000
29 Ny. Maryam 35,000 3,000 16,000 16,000 35,000
30 Angga 80,000 3,000 38,500 38,500 80,000
31 18/1/2008 Tn. Jajang 30,000 3,000 13,500 13,500 30,000
32 Tn. Edi 50,000 3,000 23,500 23,500 50,000
33 M. Zaelani 110,000 3,000 53,500 53,500 110,000
34 Salsabila 30,000 3,000 13,500 13,500 30,000
35 19/1/2008 Danil 25,000 3,000 11,000 11,000 25,000
36 21/1/2008 Mahendra 20,000 3,000 8,500 8,500 20,000
37 Tn. Jindi 20,000 3,000 8,500 8,500 20,000
38 Ny. Yayat 40,000 3,000 18,500 18,500 40,000
39 Ny. Sugiharti 20,000 3,000 8,500 8,500 20,000
40 22/1/2008 Danil 70,000 3,000 33,500 33,500 70,000
41 23/1/2008 Ny. Nunung 20,000 3,000 8,500 8,500 20,000
42 Ny. Murni 40,000 3,000 18,500 18,500 40,000
43 Ny. Ika 60,000 3,000 28,500 28,500 60,000
44 Nn. Rian 30,000 3,000 13,500 13,500 30,000
45 Ridho 20,000 3,000 8,500 8,500 20,000
46 24/1/2008 An. Zelfa 40,000 3,000 18,500 18,500 40,000
47 Nn. Erin 40,000 3,000 18,500 18,500 40,000
48 Ny. Maryam 20,000 3,000 8,500 8,500 20,000
49 Ny. Yanti 140,000 3,000 68,500 68,500 140,000
50 25/1/2008 Musa 30,000 3,000 13,500 13,500 30,000
51 26/1/2008 Zaenudin. S 20,000 3,000 8,500 8,500 20,000
52 Dewi 20,000 3,000 8,500 8,500 20,000
53 Ny. Murni 165,000 3,000 81,000 81,000 165,000
54 28/1/2008 An. M. Rizki 30,000 3,000 13,500 13,500 30,000
55 Ny. Murniati 30,000 3,000 13,500 13,500 30,000
56 An. Mayfa - - -
57 Tn. Doni. H 20,000 3,000 8,500 8,500 20,000
58 29/1/2008 Feri 50,000 3,000 23,500 23,500 50,000
59 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
60 31/1/2008 Tn. Doni. H 60,000 3,000 28,500 28,500 60,000
2,690,000 174,000 1,258,000 1,258,000 2,690,000

JASA ALAT &

DOKTER BAHAN
1 2/1/2008 Abdan 15,000 5,000 5,000 5,000 15,000
2 11/1/2008 Ny. Sanah 15,000 5,000 5,000 5,000 15,000
3 26/1/2008 Ny. Iceu. S 15,000 7,500 7,500 15,000
4 Santi 40,000 20,000 20,000 40,000
5 29/1/2008 Komarudin 15,000 5,000 5,000 5,000 15,000
TOTAL 100,000 15,000 42,500 42,500 100,000
PENGELUARAN JANUARI 2008

1 7/1/2008 Pehacain 1 43,000
Caviton 1 70,000
2 18/1/2008 Fuji IX GP 1-1 Mini Pack 1 150,000
TOTAL 513,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI JANUARI 2008
KEUNTUNGAN
KSBL DRG. DEWI
1 Januari 1,258,000 513,000 745,000 372,500 372,500
2 Januari 42,500.00 42,500 21,250 21,250
393,750 393,750
Cimahi, 5 Febuari 2008

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PERIODE FEBUARI 2008
JASA ALAT &

DOKTER BAHAN
1 2/2/2008 Ny. Silvi 100,000 3,000 48,500 48,500 100,000
2 An. M. Rizki 30,000 3,000 13,500 13,500 30,000
3 4/2/2008 Ny. Murniati 30,000 3,000 13,500 13,500 30,000
4 Mayfa 10,000 5,000 5,000 10,000
5 Geby 40,000 3,000 18,500 18,500 40,000
6 Ny. Yanti 80,000 3,000 38,500 38,500 80,000
7 5/2/2008 An. M. Rizki 30,000 3,000 13,500 13,500 30,000
8 Ayu 20,000 3,000 8,500 8,500 20,000
9 Feri 100,000 3,000 48,500 48,500 100,000
10 8/2/2008 An. M. Rizki 70,000 3,000 33,500 33,500 70,000
11 Ny. Tati 20,000 3,000 8,500 8,500 20,000
12 An. Arva 20,000 3,000 8,500 8,500 20,000
13 9/2/2008 Ny. Maryati 120,000 3,000 58,500 58,500 120,000
14 11/2/2008 Ny. Neng Tati 20,000 3,000 8,500 8,500 20,000
15 Ny. Murniati 75,000 3,000 36,000 36,000 75,000
16 12/2/2008 Mayfa - - -
17 Ny. Nani. S 20,000 3,000 8,500 8,500 20,000
18 14/2/2008 Ny. Elah 20,000 3,000 8,500 8,500 20,000
19 16/2/2008 M. Wijaya 50,000 3,000 23,500 23,500 50,000
20 Mayfa - - -
21 Ny. Ayu 20,000 3,000 8,500 8,500 20,000
22 Tn. Nawawi 50,000 3,000 23,500 23,500 50,000
23 19/2/2008 Tn. Yosef 20,000 3,000 8,500 8,500 20,000
24 20/2/2008 Nita 40,000 3,000 18,500 18,500 40,000
25 22/2/2008 An. Alita 45,000 3,000 21,000 21,000 45,000
26 23/2/2008 An. Alita 20,000 3,000 8,500 8,500 20,000
27 Tn. Andi 50,000 3,000 23,500 23,500 50,000
28 25/2/2008 Ny. Siti Hasanah 20,000 3,000 8,500 8,500 20,000
29 26/2/2008 Mayfa - - -
30 27/2/2008 Ny. Yoza 140,000 3,000 68,500 68,500 140,000
31 Ny. Ely 20,000 3,000 8,500 8,500 20,000
32 28/2/2008 Ny. Wulan 10,000 5,000 5,000 10,000
33 alfan 40,000 3,000 18,500 18,500 40,000
34 29/2/2008 Dede 20,000 3,000 8,500 8,500 20,000
35 Ani Sumarni 20,000 3,000 8,500 8,500 20,000
36 Mayfa 10,000 5,000 5,000 10,000
1,380,000 90,000 645,000 645,000 1,380,000
JASA ALAT &

DOKTER BAHAN
1 4/2/2008 Tn. Dede 15,000 5,000 5,000 5,000 15,000
2 Ny. Iceu 15,000 7,500 7,500 15,000
3 Sashi 15,000 5,000 5,000 5,000 15,000
4 21/2/2008 Tn. Paulus 15,000 5,000 5,000 5,000 15,000
TOTAL 60,000 15,000 22,500 22,500 60,000
PENGELUARAN FEBUARI 2008

TOTAL 250,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI FEBUARI 2008
KEUNTUNGAN
KSBL DRG. DEWI
1 Febuari 645,000 250,000 395,000 197,500 197,500
2 Febuari 22,500.00 22,500 11,250 11,250
208,750 208,750
Cimahi, 4 Maret 2008


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PERIODE MARET 2008
JASA ALAT &

DOKTER BAHAN
1 1/3/2008 Siti Nurjanah 60,000 3,000 28,500 28,500 60,000
2 Tn. Ireng 90,000 3,000 43,500 43,500 90,000
3 3/3/2008 Taryani 35,000 3,000 16,000 16,000 35,000
4 Siti Nurjanah -
5 4/3/2008 Ny. Dedeh 25,000 3,000 11,000 11,000 25,000
6 Mayfa 10,000 10,000 10,000
7 Tn. Hendra 140,000 3,000 68,500 68,500 140,000
8 5/3/2008 An. Arum 20,000 3,000 8,500 8,500 20,000
9 M. Zaky 40,000 3,000 18,500 18,500 40,000
10 Ny. Musri 40,000 3,000 18,500 18,500 40,000
11 Ferdinan 40,000 3,000 18,500 18,500 40,000
12 6/3/2008 Tn. Nawawi 40,000 3,000 18,500 18,500 40,000
13 8/3/2008 Nida 30,000 3,000 13,500 13,500 30,000
14 10/3/2008 Adita 30,000 3,000 13,500 13,500 30,000
15 Taryani 35,000 3,000 16,000 16,000 35,000
16 Tn. Hendra 40,000 3,000 18,500 18,500 40,000
17 11/3/2008 Dina 40,000 3,000 18,500 18,500 40,000
18 Tn. Alex 90,000 3,000 43,500 43,500 90,000
19 Mayfa 10,000 10,000 10,000
20 Liana 20,000 3,000 8,500 8,500 20,000
21 Tn. Maman 20,000 3,000 8,500 8,500 20,000
22 Tn. Nawawi 40,000 3,000 18,500 18,500 40,000
23 An. Alita 80,000 3,000 38,500 38,500 80,000
24 14/3/2008 Nn. Eti 30,000 3,000 13,500 13,500 30,000
25 Dina 30,000 3,000 13,500 13,500 30,000
26 15/3/2008 An. Farhan 30,000 3,000 13,500 13,500 30,000
27 Taryani 90,000 3,000 43,500 43,500 90,000
28 Mayfa 20,000 20,000
29 17/3/2008 Siti Nurjanah 80,000 3,000 38,500 38,500 80,000
30 18/3/2008 An. Atira 30,000 3,000 13,500 13,500 30,000
31 Tn. Joni Suherman 20,000 3,000 8,500 8,500 20,000
32 Ny. Santi 90,000 3,000 43,500 43,500 90,000
33 Dina 35,000 3,000 16,000 16,000 35,000
34 Agnes 80,000 3,000 38,500 38,500 80,000
35 Miske 40,000 3,000 18,500 18,500 40,000
36 Ny. Ginting 50,000 3,000 23,500 23,500 50,000
37 19/3/2008 Tn. Nawawi 80,000 3,000 38,500 38,500 80,000
38 Miske 40,000 3,000 18,500 18,500 40,000
39 22/3/2008 Dina 100,000 3,000 48,500 48,500 100,000
40 An. Atira 30,000 3,000 13,500 13,500 30,000
41 Uus 60,000 3,000 28,500 28,500 60,000
42 Ny. Rumiati 30,000 3,000 13,500 13,500 30,000
43 Cucu 30,000 3,000 13,500 13,500 30,000
44 24/3/2008 Ny. Nilenia 75,000 3,000 36,000 36,000 75,000
45 Tn. Hendra 40,000 3,000 18,500 18,500 40,000
46 25/3/2008 An. Atira 75,000 3,000 36,000 36,000 75,000
47 26/3/2008 Nn. Sintia 50,000 3,000 23,500 23,500 50,000
48 Ny. Cicih 80,000 3,000 38,500 38,500 80,000
49 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
50 Ferdinan 40,000 3,000 18,500 18,500 40,000
51 27/3/2008 Fisi 40,000 3,000 18,500 18,500 40,000
52 28/3/2008 Tn. Yunus 20,000 3,000 8,500 8,500 20,000
53 Nn. Iley 20,000 3,000 8,500 8,500 20,000
54 29/3/2008 Tn. Joni 20,000 3,000 8,500 8,500 20,000
55 Tn. Turino 20,000 3,000 8,500 8,500 20,000
56 Zalfa 30,000 3,000 13,500 13,500 30,000
57 Alif 30,000 3,000 13,500 13,500 30,000
58 Ny. Rumiati 50,000 3,000 23,500 23,500 50,000
59 Cucu 35,000 3,000 16,000 16,000 35,000
60 31/3/2008 Tn. Hendra 150,000 3,000 73,500 73,500 150,000
2,795,000 168,000 1,293,500 1,313,500 2,795,000

PERIODE MARET 2008
JASA ALAT &

DOKTER BAHAN
1 3/3/2008 Tn. Rudi 40,000 20,000 20,000 40,000
2 5/3/2008 Tn. Rudi 40,000 20,000 20,000 40,000
3 7/3/2008 Aan Darwati 25,000 12,500 12,500 25,000
4 Tn. Ujang 15,000 5,000 5,000 5,000 15,000
5 13/3/2008 Tn. Paulu 15,000 5,000 5,000 5,000 15,000
6 19/3/2008 Aan Darwati 15,000 5,000 5,000 5,000 15,000
7 Sri 15,000 5,000 5,000 5,000 15,000
8 Heri 25,000 12,500 12,500 25,000
9 Rini 15,000 5,000 5,000 5,000 15,000
10 Febi 25,000 5,000 10,000 10,000 25,000
TOTAL 230,000 30,000 100,000 100,000 230,000
PENGELUARAN MARET 2008

TOTAL 250,000
PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI MARET 2008
KEUNTUNGAN
KSBL DRG. DEWI
1 Maret 1,313,500 250,000 1,063,500 531,750 531,750
2 Maret 100,000.00 100,000 50,000 50,000
581,750 581,750
Cimahi, 2 April 2008

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PERIODE APRIL 2008
JASA ALAT &

DOKTER BAHAN
1 1/4/2008 Deri 20,000 3,000 8,500 8,500 20,000
2 Leni 20,000 3,000 8,500 8,500 20,000
3 Anisa 20,000 3,000 8,500 8,500 20,000
4 3/4/2008 Tn. Usman 60,000 3,000 28,500 28,500 60,000
5 Tn. Erik 20,000 3,000 8,500 8,500 20,000
6 Tn. Engkos 30,000 3,000 13,500 13,500 30,000
7 Mira 20,000 3,000 8,500 8,500 20,000
8 Ny. Nirmala 80,000 3,000 38,500 38,500 80,000
9 4/4/2008 Tn. Dimas -
10 Tn. Sukarya 15,000 3,000 6,000 6,000 15,000
11 5/4/2008 Ny. Eni 20,000 3,000 8,500 8,500 20,000
12 Anisa 20,000 3,000 8,500 8,500 20,000
13 7/4/2008 Ny. Nirmala 20,000 3,000 8,500 8,500 20,000
14 Masni 20,000 3,000 8,500 8,500 20,000
15 Ny. Sandi 20,000 3,000 8,500 8,500 20,000
16 8/4/2008 Lisman 30,000 3,000 13,500 13,500 30,000
17 Yusuf 20,000 3,000 8,500 8,500 20,000
18 Tomang 20,000 3,000 8,500 8,500 20,000
19 Tn. Cecep 60,000 3,000 28,500 28,500 60,000
20 Ayu Nida 80,000 3,000 38,500 38,500 80,000
21 Tn. Sukarya 20,000 3,000 8,500 8,500 20,000
22 9/4/2008 Tn. Asep Sarif 30,000 3,000 13,500 13,500 30,000
23 10/4/2008 Tn. Asep Sarif - - -
24 Ny. Nila 120,000 3,000 58,500 58,500 120,000
25 11/4/2008 Ny. Silvi 20,000 3,000 8,500 8,500 20,000
26 Tn. Sukarya 20,000 3,000 8,500 8,500 20,000
27 Ny. Titin 30,000 3,000 13,500 13,500 30,000
28 12/4/2008 Tn. Asep Sarif 100,000 3,000 48,500 48,500 100,000
29 Mutia 35,000 3,000 16,000 16,000 35,000
30 An. William 20,000 3,000 8,500 8,500 20,000
31 Nicole 30,000 3,000 13,500 13,500 30,000
32 Tn. Muhidin 75,000 3,000 36,000 36,000 75,000
33 14/4/2008 Tn. Deden 30,000 3,000 13,500 13,500 30,000
34 Lisman 50,000 3,000 23,500 23,500 50,000
35 Ny. Rina 20,000 3,000 8,500 8,500 20,000
36 Mega 20,000 3,000 8,500 8,500 20,000
37 Angga 40,000 3,000 18,500 18,500 40,000
38 Iwan 40,000 3,000 18,500 18,500 40,000
39 15/4/2008 Ny. Nunung 120,000 3,000 58,500 58,500 120,000
40 Sajiah 20,000 3,000 8,500 8,500 20,000
41 Komariah 20,000 3,000 8,500 8,500 20,000
42 18/4/2008 Angga 50,000 3,000 23,500 23,500 50,000
43 19/4/2008 Tn. Suhendar 30,000 3,000 13,500 13,500 30,000
44 21/4/2008 Tn. Yuliono 20,000 3,000 8,500 8,500 20,000
45 Ny. Jeny 20,000 3,000 8,500 8,500 20,000
46 23/4/2008 Minasih 20,000 3,000 8,500 8,500 20,000
47 Beni 20,000 3,000 8,500 8,500 20,000
48 24/4/2008 Ny. Titi Mulyani 80,000 3,000 38,500 38,500 80,000
49 Ny. Rian 25,000 3,000 11,000 11,000 25,000
50 25/4/2008 Eva 30,000 3,000 13,500 13,500 30,000
51 26/4/2008 Usman 80,000 3,000 38,500 38,500 80,000
52 Ny. Berta 20,000 3,000 8,500 8,500 20,000
53 Devi 92,000 46,000 46,000 92,000
54 28/4/2008 Ny. Eva 100,000 3,000 48,500 48,500 100,000
55 Tn. Darsono 20,000 3,000 8,500 8,500 20,000
56 Ny. Komariah 50,000 3,000 23,500 23,500 50,000
57 30/4/2008 Tn. Suhendar 30,000 3,000 13,500 13,500 30,000
2,142,000 162,000 990,000 990,000 2,142,000

PERIODE APRIL 2008
JASA ALAT &

DOKTER BAHAN
1 5/4/2008 Heri Setiawan 25,000 5,000 10,000 10,000 25,000
2 7/4/2008 Rida 15,000 5,000 5,000 5,000 15,000
3 Heri Setiawan 25,000 12,500 12,500 25,000
4 12/4/2008 Heri Setiawan 25,000 12,500 12,500 25,000
5 15/4/2008 Iceu Susanti 15,000 5,000 5,000 5,000 15,000
6 Heri Setiawan 30,000 15,000 15,000 30,000
7 17/4/2008 Heri Setiawan 40,000 5,000 17,500 17,500 40,000
8 18/4/2008 Dita 15,000 5,000 5,000 5,000 15,000
9 26/4/2008 Komarudin 15,000 5,000 5,000 5,000 15,000
10 Yuli 30,000 15,000 15,000 30,000
TOTAL 235,000 30,000 102,500 102,500 235,000

1 19/4/2008 Solare GC 4 Gram 1 135,000
Hand Schoen 1 29,000
Fuji IX 1 150,000
Alkohol 1 33,000
TOTAL 597,000

KEUNTUNGAN
KSBL DRG. DEWI
1 April 990,000 597,000 393,000 196,500 196,500
2 April 102,500.00 102,500 51,250 51,250
247,750 247,750
Cimahi, 2 Mei 2008


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PERIODE MEI 2008
JASA ALAT &

DOKTER BAHAN
1 2/5/2008 Risma 20,000 3,000 8,500 8,500 20,000
2 Tn. Muhtar 20,000 3,000 8,500 8,500 20,000
3 Siti Nurjanah 40,000 3,000 18,500 18,500 40,000
4 3/5/2008 Riki 35,000 3,000 16,000 16,000 35,000
5 Fitria 30,000 3,000 13,500 13,500 30,000
6 Tn. Heri 60,000 3,000 28,500 28,500 60,000
7 5/5/2008 Siti Nurjanah 25,000 3,000 11,000 11,000 25,000
8 Ny. Ratnawati 20,000 3,000 8,500 8,500 20,000
9 Suryana 20,000 3,000 8,500 8,500 20,000
10 Tn. Fredy 20,000 3,000 8,500 8,500 20,000
11 Rio 20,000 3,000 8,500 8,500 20,000
12 6/5/2008 Maria 20,000 3,000 8,500 8,500 20,000
13 Ny. Hana 60,000 3,000 28,500 28,500 60,000
14 Itoh 60,000 3,000 28,500 28,500 60,000
15 7/5/2008 Ny. Dewi 40,000 3,000 18,500 18,500 40,000
16 8/5/2008 Ny. Erna 150,000 3,000 73,500 73,500 150,000
17 Desnalia 80,000 40,000 40,000 80,000
18 Fitria 40,000 3,000 18,500 18,500 40,000
19 Tn. Sukarya 20,000 3,000 8,500 8,500 20,000
20 Maria 20,000 3,000 8,500 8,500 20,000
21 10/5/2008 Nur Anisa 50,000 3,000 23,500 23,500 50,000
22 Mulyanto 85,000 3,000 41,000 41,000 85,000
23 Muji 50,000 3,000 23,500 23,500 50,000
24 Tn. Heri 130,000 3,000 63,500 63,500 130,000
25 12/5/2008 Tn. Mulyanto 50,000 3,000 23,500 23,500 50,000
26 Mutia 140,000 3,000 68,500 68,500 140,000
27 Ny. Jeni 40,000 3,000 18,500 18,500 40,000
28 Ruli 40,000 3,000 18,500 18,500 40,000
29 13/5/2008 Aan 50,000 3,000 23,500 23,500 50,000
30 Erni 20,000 3,000 8,500 8,500 20,000
31 14/5/2008 An. Salma 64,000 32,000 32,000 64,000
32 Mutia 80,000 3,000 38,500 38,500 80,000
33 15/5/2008 Fina 30,000 3,000 13,500 13,500 30,000
34 Ny. Ratnawati 20,000 3,000 8,500 8,500 20,000
35 Ny. Tince 20,000 3,000 8,500 8,500 20,000
36 Reni 40,000 3,000 18,500 18,500 40,000
37 16/5/2008 Supriadi 50,000 3,000 23,500 23,500 50,000
38 17/5/2008 Siti Nurjanah 50,000 3,000 23,500 23,500 50,000
39 Tn. Deni 50,000 3,000 23,500 23,500 50,000
40 19/5/2008 Tn. Hendi 50,000 3,000 23,500 23,500 50,000
41 Mutia 40,000 3,000 18,500 18,500 40,000
42 Ny. Jeni 40,000 3,000 18,500 18,500 40,000
43 22/5/2008 Ny. Mimin 20,000 3,000 8,500 8,500 20,000
44 Mutia 100,000 3,000 48,500 48,500 100,000
45 Lukman 20,000 3,000 8,500 8,500 20,000
46 23/5/2008 Aan 70,000 3,000 33,500 33,500 70,000
47 24/5/2008 Ny. Teti. K 20,000 3,000 8,500 8,500 20,000
48 27/5/2008 Thoriq 65,000 3,000 31,000 31,000 65,000
49 Riki 100,000 3,000 48,500 48,500 100,000
50 Ny. Teti. K 25,000 3,000 11,000 11,000 25,000
51 28/5/2008 Tn. Oman 20,000 3,000 8,500 8,500 20,000
52 Fikri 40,000 3,000 18,500 18,500 40,000
53 Rahmat 150,000 3,000 73,500 73,500 150,000
54 30/5/2008 Ruti 100,000 3,000 48,500 48,500 100,000
55 31/5/2008 Tn. Hengki 40,000 3,000 18,500 18,500 40,000
56 Reni 60,000 3,000 28,500 28,500 60,000
2,819,000 162,000 1,328,500 1,328,500 2,819,000

PERIODE MEI 2008
JASA ALAT &

DOKTER BAHAN
1 2/5/2008 Dita Indriyanti 20,000 10,000 10,000 20,000
2 Cepi Nugraha 20,000 5,000 7,500 7,500 20,000
3 3/5/2008 Paulus 15,000 5,000 5,000 5,000 15,000
4 5/5/2008 Tn. Dadang 30,000 5,000 12,500 12,500 30,000
5 10/5/2008 Sri Handayani 25,000 5,000 10,000 10,000 25,000
6 Suharsono 15,000 5,000 5,000 5,000 15,000
7 12/5/2008 Setiawan Aji. P 25,000 5,000 10,000 10,000 25,000
8 Asep Muhsin 25,000 5,000 10,000 10,000 25,000
9 15/5/2008 Setiawan. A 15,000 5,000 5,000 5,000 15,000
10 17/5/2008 Sri Handayani 25,000 5,000 10,000 10,000 25,000
11 19/5/2008 Sri Handayani 25,000 12,500 12,500 25,000
12 23/5/2008 Sri Handayani 30,000 15,000 15,000 30,000
13 24/5/2008 Sri Handayani 40,000 20,000 20,000 40,000
14 28/5/2008 Setiawan Aji. P 15,000 5,000 5,000 5,000 15,000
15 29/5/2008 Setiawan Aji. P 30,000 5,000 12,500 12,500 30,000
16 30/5/2008 Komarudin 15,000 5,000 5,000 5,000 15,000
TOTAL 370,000 60,000 155,000 155,000 370,000

1 3/5/2008 Chlor Etil 1 70,000
14/5/2008 Pehacain 1 48,500
31/5/2008 Sarung Tangan 1 35,000
Spuit 3 cc 1 75,000
TOTAL 478,500
KEUNTUNGAN
KSBL DRG. DEWI
1 MEI 1,328,500 478,500 850,000 425,000 425,000
2 MEI 155,000.00 155,000 77,500 77,500
502,500 502,500
Cimahi, 3 Juni 2008


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Direktur KSBL

PERIODE JUNI 2008
JASA ALAT &

DOKTER BAHAN
1 2/6/2008 Ny. Febi 20,000 3,000 8,500 8,500 20,000
2 Tn. Oman 20,000 3,000 8,500 8,500 20,000
3 Aan 150,000 3,000 73,500 73,500 150,000
4 3/6/2008 Efri 20,000 3,000 8,500 8,500 20,000
5 4/6/2008 Adrian 20,000 3,000 8,500 8,500 20,000
6 Rahmat 30,000 3,000 13,500 13,500 30,000
7 5/6/2008 Thoriq 40,000 3,000 18,500 18,500 40,000
8 Fani 20,000 3,000 8,500 8,500 20,000
9 Vanny - - -
10 6/6/2008 Ny. Sri. M - - -
11 Tn. Ahmad 20,000 3,000 8,500 8,500 20,000
12 Efri 30,000 3,000 13,500 13,500 30,000
13 7/6/2008 Ny. Ratna 20,000 3,000 8,500 8,500 20,000
14 Tio 16,000 8,000 8,000 16,000
15 Tn. Ahmad 20,000 3,000 8,500 8,500 20,000
16 9/6/2008 Sutisna 20,000 3,000 8,500 8,500 20,000
17 10/6/2008 Farel 50,000 25,000 25,000 50,000
18 Hani 24,000 12,000 12,000 24,000
19 Tn. Mulyono 20,000 3,000 8,500 8,500 20,000
20 Tn. Jefri 20,000 3,000 8,500 8,500 20,000
21 Rendi 20,000 3,000 8,500 8,500 20,000
22 Titin 30,000 3,000 13,500 13,500 30,000
23 11/6/2008 Sutisna 40,000 3,000 18,500 18,500 40,000
24 An.Hasan 20,000 3,000 8,500 8,500 20,000
25 12/6/2008 Thoriq 140,000 3,000 68,500 68,500 140,000
26 Tn. Ridwan 20,000 3,000 8,500 8,500 20,000
27 An. Nalsa - - -
28 13/6/08 Ny. Heni 50,000 3,000 23,500 23,500 50,000
29 An. Hani 40,000 3,000 18,500 18,500 40,000
30 Tn. Mulyono 20,000 3,000 8,500 8,500 20,000
31 14/6/08 Ny. Teti Karwati 40,000 20,000 20,000 40,000
32 Lilis 20,000 3,000 8,500 8,500 20,000
33 Ny. Yati 20,000 3,000 8,500 8,500 20,000
34 Efri 30,000 3,000 13,500 13,500 30,000
35 16/6/08 Thoriq 85,000 3,000 41,000 41,000 85,000
36 Farel 40,000 3,000 18,500 18,500 40,000
37 17/6/08 Ny. Teti Karwati 130,000 3,000 63,500 63,500 130,000
38 18/6/08 Efri 30,000 3,000 13,500 13,500 30,000
39 Ny. Yoza 110,000 3,000 53,500 53,500 110,000
40 Desi 40,000 3,000 18,500 18,500 40,000
41 Yunita 100,000 3,000 48,500 48,500 100,000
42 Ny. Yati 50,000 3,000 23,500 23,500 50,000
43 19/6/08 Tn. Anung 50,000 3,000 23,500 23,500 50,000
44 Ade Saputra 130,000 3,000 63,500 63,500 130,000
45 Yayu 30,000 3,000 13,500 13,500 30,000
46 20/6/08 Tn. Ade 30,000 3,000 13,500 13,500 30,000
47 Ny. Dewi 50,000 3,000 23,500 23,500 50,000
48 21/6/08 Farel 30,000 3,000 13,500 13,500 30,000
49 Ny. Nunung 50,000 3,000 23,500 23,500 50,000
50 23/6/08 Tn. Rudi 75,000 3,000 36,000 36,000 75,000
51 Sela 100,000 3,000 48,500 48,500 100,000
52 Yanti 80,000 3,000 38,500 38,500 80,000
53 Adityo 100,000 3,000 48,500 48,500 100,000
54 24/6/08 M. Sarif. M 40,000 3,000 18,500 18,500 40,000
55 Ny. Elly 20,000 3,000 8,500 8,500 20,000
56 Ny. Wini 20,000 3,000 8,500 8,500 20,000
57 Ade Saputra 85,000 3,000 41,000 41,000 85,000
58 Tn. Supriatna 20,000 3,000 8,500 8,500 20,000
59 Tn. Firman 20,000 3,000 8,500 8,500 20,000
60 Ny. Jeni 20,000 3,000 8,500 8,500 20,000
61 Ny. Dewi 40,000 3,000 18,500 18,500 40,000
62 Anggi 30,000 3,000 13,500 13,500 30,000
63 25/6/08 Ny. Yayu 30,000 3,000 13,500 13,500 30,000
64 Risnawati 20,000 3,000 8,500 8,500 20,000
65 Ruswat 100,000 3,000 48,500 48,500 100,000
66 27/6/08 Ny. Dahlia 80,000 3,000 38,500 38,500 80,000
67 Tn. Ades 85,000 3,000 41,000 41,000 85,000
68 An. Kintan 30,000 3,000 13,500 13,500 30,000
69 Tn. Supriatna 50,000 3,000 23,500 23,500 50,000
70 Tn. Ridwan 50,000 3,000 23,500 23,500 50,000
71 Ny. Turasmi 20,000 3,000 8,500 8,500 20,000
72 Clif 20,000 3,000 8,500 8,500 20,000
73 An. Rami 50,000 3,000 23,500 23,500 50,000

PERIODE JUNI 2008
JASA ALAT &

DOKTER BAHAN
74 28/6/08 Alif 30,000 3,000 13,500 13,500 30,000
75 Tri Wardiman 7,000 3,000 2,000 2,000 7,000
76 Dyon Rizal 30,000 3,000 13,500 13,500 30,000
77 Farel 30,000 3,000 13,500 13,500 30,000
78 Ny. Haryati 30,000 3,000 13,500 13,500 30,000
79 Tn. Aap 20,000 3,000 8,500 8,500 20,000
80 30/6/08 Ny. Dahlia 30,000 3,000 13,500 13,500 30,000
81 Ny. Jeni 95,000 3,000 46,000 46,000 95,000
82 Tn. Mirza 20,000 3,000 8,500 8,500 20,000
83 Ismail 20,000 3,000 8,500 8,500 20,000
3,502,000 228,000 1,637,000 1,637,000 3,502,000

PERIODE JUNI 2008
JASA ALAT &

DOKTER BAHAN
1 2/6/2008 Sani Mulyani 15,000 5,000 5,000 5,000 15,000
2 4/6/2008 Iceu 15,000 5,000 5,000 5,000 15,000
3 Siti 30,000 5,000 12,500 12,500 30,000
4 7/6/2008 Komarudin 15,000 5,000 5,000 5,000 15,000
5 10/6/2008 Azizah Nur . F 20,000 5,000 7,500 7,500 20,000
6 12/6/2008 Komarudin 15,000 5,000 5,000 5,000 15,000
7 14/6/2008 Faizal Mansyur 25,000 5,000 10,000 10,000 25,000
8 16/6/2008 Surya Bakti 15,000 5,000 5,000 5,000 15,000
9 Putri 40,000 20,000 20,000 40,000
10 Komarudin 15,000 5,000 5,000 5,000 15,000
11 Rida 15,000 5,000 5,000 5,000 15,000
12 18/6/08 Asep Hataryana 35,000 5,000 15,000 15,000 35,000
13 19/6/08 Asep Hataryana 35,000 17,500 17,500 35,000
14 Rida 40,000 5,000 17,500 17,500 40,000
15 21/6/08 Faizal Mansyur 25,000 12,500 12,500 25,000
16 23/6/08 Ny. Nia. K 40,000 20,000 20,000 40,000
17 Ujang 15,000 5,000 5,000 5,000 15,000
18 26/6/08 Ny. Sri Aminah 15,000 5,000 5,000 5,000 15,000
19 30/6/08 An. Rizky 25,000 5,000 10,000 10,000 25,000
20 Ny. Sri Aminah 15,000 5,000 5,000 5,000 15,000
21 Ujang 15,000 5,000 5,000 5,000 15,000
TOTAL 480,000 85,000 197,500 197,500 480,000
LAPORAN KUNJUNGAN PASIEN GIGI PT. DIRGANTARA INDONESIA

PERIODE JUNI 2008
JASA ALAT &

DOKTER BAHAN
1 3/6/2008 Laura 50,000 3,000 23,500 23,500 50,000
2 7/6/2008 Tn. Iwan 50,000 3,000 23,500 23,500 50,000
3 Tn. Bondan 50,000 3,000 23,500 23,500 50,000
4 10/6/2008 Shoffi. M 25,000 3,000 11,000 11,000 25,000
5 14/6/2008 Shoffi. M 35,000 3,000 16,000 16,000 35,000
6 21/6/2008 Afina Zahra 40,000 3,000 18,500 18,500 40,000
7 Anne Setiana 50,000 3,000 23,500 23,500 50,000
8 23/6/08 Tn. Anggoro 25,000 3,000 11,000 11,000 25,000
9 Afina Zahra 40,000 3,000 18,500 18,500 40,000
10 Shoffi. M 35,000 3,000 16,000 16,000 35,000
11 26/6/08 Tn. Anggoro 25,000 3,000 11,000 11,000 25,000
12 30/6/08 Shoffi. M 70,000 3,000 33,500 33,500 70,000
495,000 36,000 229,500 229,500 495,000

1 5/6/2008 Minocin 52,500
Perbaikan Alat 10,000
2 9/6/2008 Servic Alat Gigi 150,000
3 18/6/06 Bahan Gigi 20,000
4 25/6/08 Gaji Drg. Sonya 250,000
5 30/6/08 Bahan Gigi 240,000
TOTAL 722,500
KEUNTUNGAN
KSBL DRG. DEWI
1 Juni 1,637,000 722,500 914,500 457,250 457,250
2 Juni 427,000.00 427,000 213,500 213,500
670,750 670,750
Cimahi, 2 Juli 2008

Menyetujui,

Direktur KSBL

PERIODE JULI 2008
JASA ALAT &

DOKTER BAHAN
1 1/7/2008 Tn. Ruswat 30,000 3,000 13,500 13,500 30,000
2 Ny. Heni 20,000 3,000 8,500 8,500 20,000
3 Ny. Yayu 95,000 3,000 46,000 46,000 95,000
4 Clif 20,000 3,000 8,500 8,500 20,000
5 2/7/2008 Tn. Aap 60,000 3,000 28,500 28,500 60,000
6 3/7/2008 Ny. Dahlia 100,000 3,000 48,500 48,500 100,000
7 Tn. Surachman 90,000 3,000 43,500 43,500 90,000
8 4/7/2008 Tn. Ruswat 20,000 3,000 8,500 8,500 20,000
9 Nn. Eka 20,000 3,000 8,500 8,500 20,000
10 5/7/2008 Dwi Indra 20,000 3,000 8,500 8,500 20,000
11 Ny. Haryati 30,000 3,000 13,500 13,500 30,000
12 Ismi Putri 20,000 3,000 8,500 8,500 20,000
13 Oyon Rizal 40,000 3,000 18,500 18,500 40,000
14 Farel 30,000 3,000 13,500 13,500 30,000
15 7/7/2008 An. Haura 30,000 3,000 13,500 13,500 30,000
16 Devina 20,000 3,000 8,500 8,500 20,000
17 M. Irham 20,000 3,000 8,500 8,500 20,000
18 Ny. Ida 30,000 3,000 13,500 13,500 30,000
19 Deni 70,000 3,000 33,500 33,500 70,000
20 Vera 30,000 3,000 13,500 13,500 30,000
21 9/7/2008 Vera 30,000 3,000 13,500 13,500 30,000
22 Dio 20,000 3,000 8,500 8,500 20,000
23 10/7/2008 An. Haura 25,000 3,000 11,000 11,000 25,000
24 Ny. Heni 120,000 3,000 58,500 58,500 120,000
25 11/7/2008 M. Wijaya 30,000 3,000 13,500 13,500 30,000
26 Ny. E. Saragih 20,000 3,000 8,500 8,500 20,000
27 Tn. Lili 20,000 3,000 8,500 8,500 20,000
28 Tn. Ruswat 85,000 3,000 41,000 41,000 85,000
29 Ela 100,000 3,000 48,500 48,500 100,000
30 Ny. Silvi 40,000 3,000 18,500 18,500 40,000
31 12/7/2008 Hadiyanti 20,000 3,000 8,500 8,500 20,000
32 Fersi 30,000 3,000 13,500 13,500 30,000
33 Tn. Edi 20,000 3,000 8,500 8,500 20,000
34 Farel 85,000 3,000 41,000 41,000 85,000
35 Ny. Haryati 100,000 3,000 48,500 48,500 100,000
36 14/7/2008 Tn. Ukat 50,000 3,000 23,500 23,500 50,000
37 An. Andira 30,000 3,000 13,500 13,500 30,000
38 Tn. Oyon Rizal 100,000 3,000 48,500 48,500 100,000
39 M. Wijaya 20,000 3,000 8,500 8,500 20,000
40 Wida Ayu 20,000 3,000 8,500 8,500 20,000
41 Ismi Putri 20,000 3,000 8,500 8,500 20,000
42 Vera 85,000 3,000 41,000 41,000 85,000
43 Nonik 20,000 3,000 8,500 8,500 20,000
44 15/7/2008 Dio 20,000 3,000 8,500 8,500 20,000
45 16/7/2008 Tn. Kusmawan 40,000 3,000 18,500 18,500 40,000
46 An. Haura 20,000 3,000 8,500 8,500 20,000
47 17/7/2008 Nn. Nenden 20,000 3,000 8,500 8,500 20,000
48 18/7/2008 Riska 30,000 3,000 13,500 13,500 30,000
49 M. Wijaya 20,000 3,000 8,500 8,500 20,000
50 Dio 30,000 3,000 13,500 13,500 30,000
51 21/7/2008 Siti 160,000 3,000 78,500 78,500 160,000
52 Epby 100,000 3,000 48,500 48,500 100,000
53 Devina 40,000 3,000 18,500 18,500 40,000
54 An. Haura 20,000 3,000 8,500 8,500 20,000
55 22/7/2008 Riska 40,000 3,000 18,500 18,500 40,000
56 23/7/2008 Ai Linda. A 70,000 3,000 33,500 33,500 70,000
57 Ahmad 30,000 3,000 13,500 13,500 30,000
58 24/7/2008 Toto 20,000 3,000 8,500 8,500 20,000
59 25/7/2008 An. William 30,000 3,000 13,500 13,500 30,000
60 Riska 85,000 3,000 41,000 41,000 85,000
61 26/7/2008 Tn. Erwin 20,000 3,000 8,500 8,500 20,000
62 Sustriyanti 20,000 3,000 8,500 8,500 20,000
63 Ahmad. F 80,000 3,000 38,500 38,500 80,000
64 Jesse 20,000 3,000 8,500 8,500 20,000
65 28/7/2008 Annisa 50,000 3,000 23,500 23,500 50,000
66 Asrun 50,000 3,000 23,500 23,500 50,000
67 29/7/2008 Ai. M 85,000 3,000 41,000 41,000 85,000
68 An. William 40,000 3,000 18,500 18,500 40,000
69 An. William 40,000 3,000 18,500 18,500 40,000
70 31/7/2008 Tn. Agus 20,000 3,000 8,500 8,500 20,000
71 Ny. E. Saragih 150,000 3,000 73,500 73,500 150,000
3,235,000 213,000 1,511,000 1,511,000 3,235,000

PERIODE JULI 2008
JASA ALAT &

DOKTER BAHAN
1 5/7/2008 Heri. S 15,000 5,000 5,000 5,000 15,000
2 8/7/2008 Ny. Jumariah 15,000 5,000 5,000 5,000 15,000
3 10/7/2008 Ny. Jumariah 15,000 5,000 5,000 5,000 15,000
4 11/7/2008 M. Ramdan 30,000 5,000 12,500 12,500 30,000
5 14/7/2008 Ny. Jumariah 15,000 5,000 5,000 5,000 15,000
6 16/7/2008 Tn. Komarudin 35,000 5,000 15,000 15,000 35,000
7 21/7/2008 Sri Handayani 25,000 5,000 10,000 10,000 25,000
8 28/7/2008 Ny. Jumariah 15,000 5,000 5,000 5,000 15,000
9 31/7/2008 An. Yulia 25,000 5,000 10,000 10,000 25,000
10 31/7/2008 Tn. Komarudin 15,000 5,000 5,000 5,000 15,000
TOTAL 205,000 50,000 77,500 77,500 205,000
LAPORAN KUNJUNGAN PASIEN GIGI PT. DIRGANTARA INDONESIA

PERIODE JULI 2008
JASA ALAT &

DOKTER BAHAN
1 12/7/2008 Tn. Iwan. W 30,000 3,000 13,500 13,500 30,000
2 18/7/2008 Sarah 35,000 3,000 16,000 16,000 35,000
3 22/7/2008 Sarah 45,000 3,000 21,000 21,000 45,000
4 25/7/2008 Sarah 35,000 3,000 16,000 16,000 35,000
5 26/7/2008 Tn. Iwan. W 60,000 3,000 28,500 28,500 60,000
6 29/7/2008 Tn. Iwan. W 30,000 3,000 13,500 13,500 30,000
7 31/7/2008 Ny. Sri Yatun 35,000 3,000 16,000 16,000 35,000
270,000 21,000 124,500 124,500 270,000

1 5/7/2008 Bahan Gigi 53,600
2 10/7/2008 Servic Alat Gigi 40,000
3 28/7/2008 Bahan Gigi 166,000
4 25/6/08 Gaji Drg. Sonya 250,000
TOTAL 509,600
KEUNTUNGAN
KSBL DRG. DEWI
1 Juli 1,511,000 509,600 1,001,400 500,700 500,700
2 Juli 202,000.00 202,000 101,000 101,000
601,700 601,700


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/8/2008 Ny. E. Saragih 150,000 3,000 73,500 73,500 150,000
2 Ny. Siti. F 20,000 3,000 8,500 8,500 20,000
3 2/8/2008 Lilis 20,000 3,000 8,500 8,500 20,000
4 4/8/2008 Heru 120,000 3,000 58,500 58,500 120,000
5 Tn. Jamil 20,000 3,000 8,500 8,500 20,000
6 Ny. Endang 50,000 3,000 23,500 23,500 50,000
7 5/8/2008 Ai. M 60,000 3,000 28,500 28,500 60,000
8 6/8/2008 Ai. M 20,000 3,000 8,500 8,500 20,000
9 Benedigta 20,000 3,000 8,500 8,500 20,000
10 11/8/2008 Tn. Santri 60,000 3,000 28,500 28,500 60,000
11 An. Felix 35,000 3,000 16,000 16,000 35,000
12 An. Vina 20,000 3,000 8,500 8,500 20,000
13 Ny. Ooh 20,000 3,000 8,500 8,500 20,000
14 12/8/2008 Erry 20,000 3,000 8,500 8,500 20,000
15 Fahrul 230,000 3,000 113,500 113,500 230,000
16 13/8/2008 Ny. Noviyanti 20,000 3,000 8,500 8,500 20,000
17 Diana 20,000 3,000 8,500 8,500 20,000
18 Ine 70,000 3,000 33,500 33,500 70,000
19 14/8/2008 An. Felix 50,000 3,000 23,500 23,500 50,000
20 Markus 70,000 3,000 33,500 33,500 70,000
21 Nn. Rian 30,000 3,000 13,500 13,500 30,000
22 An. Egita 30,000 3,000 13,500 13,500 30,000
23 An. Maeisya 30,000 3,000 13,500 13,500 30,000
24 15/8/2008 Fahrul 120,000 3,000 58,500 58,500 120,000
25 Andra 120,000 3,000 58,500 58,500 120,000
26 16/8/2008 Ny. Santi 70,000 3,000 33,500 33,500 70,000
27 19/8/2008 Silalahi 20,000 3,000 8,500 8,500 20,000
28 Tn. Agus 50,000 3,000 23,500 23,500 50,000
29 20/8/2008 Tn. Akup 20,000 3,000 8,500 8,500 20,000
30 Ny. Ies 60,000 3,000 28,500 28,500 60,000
31 Markus 35,000 3,000 16,000 16,000 35,000
32 Ny. Heni 60,000 3,000 28,500 28,500 60,000
33 Haryono 20,000 3,000 8,500 8,500 20,000
34 21/8/2008 Nn. Rian 60,000 3,000 28,500 28,500 60,000
35 22/8/2008 Tn. Sumarto 20,000 3,000 8,500 8,500 20,000
36 Arya 30,000 3,000 13,500 13,500 30,000
37 23/8/2008 Tn. Sumarto 30,000 3,000 13,500 13,500 30,000
38 Ny. Devi 20,000 3,000 8,500 8,500 20,000
39 Juariah 10,000 10,000 10,000
40 25/8/2008 An. Fitria 40,000 3,000 18,500 18,500 40,000
41 Ny. Fitri 20,000 3,000 8,500 8,500 20,000
42 26/8/2008 Nunung 50,000 3,000 23,500 23,500 50,000
43 An. Agus 20,000 3,000 8,500 8,500 20,000
44 27/8/2008 An. Felix 30,000 3,000 13,500 13,500 30,000
45 Fadian 20,000 3,000 8,500 8,500 20,000
46 Ny. Heni 80,000 3,000 38,500 38,500 80,000
47 Markus 247,500 3,000 122,250 122,250 247,500
48 An. Fadian 50,000 3,000 23,500 23,500 50,000
49 28/8/2008 An. Wildan 70,000 3,000 33,500 33,500 70,000
50 Opik 20,000 3,000 8,500 8,500 20,000
51 Tn. Eko 85,000 3,000 41,000 41,000 85,000
52 Sri Rohayati 55,000 3,000 26,000 26,000 55,000
53 Nn. Rian 40,000 3,000 18,500 18,500 40,000
54 29/8/2008 Taryo 40,000 3,000 18,500 18,500 40,000
55 Hendro 60,000 3,000 28,500 28,500 60,000
56 Ny. Fitri 20,000 3,000 8,500 8,500 20,000
57 Ny. Hermin 40,000 3,000 18,500 18,500 40,000
2,917,500 168,000 1,369,750 1,379,750 2,917,500

JASA ALAT &

DOKTER BAHAN
1 4/8/2008 Tn. Komarudin 15,000 5,000 5,000 5,000 15,000
2 Putri 25,000 5,000 10,000 10,000 25,000
3 5/8/2008 Tn. Dindin 15,000 5,000 5,000 5,000 15,000
4 11/8/2008 Ny. Rini 25,000 5,000 10,000 10,000 25,000
5 12/8/2008 Santi Kurnia 40,000 5,000 17,500 17,500 40,000
6 14/8/2008 Tn. Suharsono 15,000 5,000 5,000 5,000 15,000
JASA ALAT &

DOKTER BAHAN
7 21/8/2008 Tn. Dede 15,000 5,000 5,000 5,000 15,000

8 25/8/2008 An. Yosan 15,000 5,000 5,000 5,000 15,000
9 Ny. Iceu 35,000 5,000 15,000 15,000 35,000
10 26/8/2008 Ny. Nia. K 40,000 20,000 20,000 40,000
11 28/8/2008 Rudi Suharsono 40,000 20,000 20,000 40,000
12 29/8/2008 Tn. Komarudin 15,000 5,000 5,000 5,000 15,000
13 30/8/2008 Jubaedah 15,000 5,000 5,000 5,000 15,000
TOTAL 310,000 55,000 127,500 127,500 310,000
LAPORAN KUNJUNGAN PASIEN GIGI PT. DIRGANTARA & TEGAR & ASKES
JASA ALAT &

DOKTER BAHAN
1 1/8/2008 Sarah 110,000 3,000 53,500 53,500 110,000
2 2/8/2008 Tn. Iwan 45,000 3,000 21,000 21,000 45,000
3 4/8/2008 Ny. Sriyatun 45,000 3,000 21,000 21,000 45,000
4 6/8/2008 Ny. Sriyatun 70,000 3,000 33,500 33,500 70,000
5 8/8/2008 Bagus 25,000 3,000 11,000 11,000 25,000
6 9/8/2008 Tn. Iwan 30,000 3,000 13,500 13,500 30,000
7 11/8/2008 Ny. Rini 30,000 3,000 13,500 13,500 30,000
8 15/8/2008 Bagus 30,000 3,000 13,500 13,500 30,000
9 20/8/2008 Hendi 20,000 3,000 8,500 8,500 20,000
10 Ny. Ilah 20,000 3,000 8,500 8,500 20,000
11 23/8/2008 Ari Akbar 70,000 3,000 33,500 33,500 70,000
12 Ny. Henny 70,000 3,000 33,500 33,500 70,000
13 Tn. Iwan 50,000 3,000 23,500 23,500 50,000
14 25/8/2008 Ny. Imas 30,000 3,000 13,500 13,500 30,000
15 30/8/2008 Tn. Iwan 70,000 3,000 33,500 33,500 70,000
16 Ny. Henny 70,000 3,000 33,500 33,500 70,000
785,000 48,000 368,500 368,500 785,000

1 2/8/2008 Cloraethyl, Hand Schoen 127,000
2 9/8/2008 Alat Gigi 260,000

3 15/8/2008 Service Alat Gigi 77,000
4 21/8/2008 Pehacain Inj 49,400
5 22/8/2008 Spuit , Moldano 32,000
6 26/8/2008 Alginat 25,000
7 30/8/2008 Gaji Drg. Sonya 250,000
TOTAL 820,400
KEUNTUNGAN
KSBL DRG. DEWI
1 Agustus 1,379,750 820,400 559,350 279,675 279,675
2 Agustus 496,000.00 496,000 248,000 248,000
527,675 527,675


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/9/2008 Tn. Syarif 20,000 3,000 8,500 8,500 20,000
2 Hendro 53,000 3,000 25,000 25,000 53,000
3 Ny. Hermin 40,000 3,000 18,500 18,500 40,000
4 3/9/2008 Nn. Meiyani 70,000 3,000 33,500 33,500 70,000
5 Ny. Heni 110,000 3,000 53,500 53,500 110,000
6 4/9/2008 An. Clarens 20,000 3,000 8,500 8,500 20,000
7 Ruti 100,000 3,000 48,500 48,500 100,000
8 Nn. Rian 150,000 3,000 73,500 73,500 150,000
9 5/9/2008 Hendro 53,000 3,000 25,000 25,000 53,000
10 Salsabila 40,000 3,000 18,500 18,500 40,000
11 6/9/2008 Fadilah 30,000 3,000 13,500 13,500 30,000
12 9/9/2008 Ny. Grace 30,000 3,000 13,500 13,500 30,000
13 Tn. Misnan 20,000 3,000 8,500 8,500 20,000
14 10/9/2008 Ny. Heni 110,000 3,000 53,500 53,500 110,000
15 Tn. Ayi 20,000 3,000 8,500 8,500 20,000
16 Rini 30,000 3,000 13,500 13,500 30,000
17 11/9/2008 Tanti 50,000 3,000 23,500 23,500 50,000
18 Nn. Rian 30,000 3,000 13,500 13,500 30,000
19 12/9/2008 Tn. Sembiring 60,000 3,000 28,500 28,500 60,000
20 Ny. Ati 20,000 3,000 8,500 8,500 20,000
21 13/9/2008 Devi 20,000 3,000 8,500 8,500 20,000
22 Ny. Ooh 10,000 10,000 10,000
23 15/9/2008 Tn. Iwan 60,000 3,000 28,500 28,500 60,000
24 An. Salsabila 140,000 3,000 68,500 68,500 140,000
25 Ny. Heni 70,000 3,000 33,500 33,500 70,000
26 16/9/2008 Ny. Nunung 60,000 3,000 28,500 28,500 60,000
27 Ny. Yuyun 20,000 3,000 8,500 8,500 20,000
28 Andri 20,000 3,000 8,500 8,500 20,000
29 Suryati 20,000 3,000 8,500 8,500 20,000
30 18/9/2008 An. Ola 70,000 3,000 33,500 33,500 70,000
31 Tn. Ahmad 20,000 3,000 8,500 8,500 20,000
32 Ny. Heni 185,000 3,000 91,000 91,000 185,000
33 Nn. Rian 30,000 3,000 13,500 13,500 30,000
34 20/9/2008 Ny. Vika 30,000 3,000 13,500 13,500 30,000
35 22/9/2008 Ny. Magdalena 50,000 3,000 23,500 23,500 50,000
36 Ny. Wawah 150,000 3,000 73,500 73,500 150,000
37 Ny. Yuyun 20,000 3,000 8,500 8,500 20,000
38 24/9/2008 Ny. Heni 50,000 3,000 23,500 23,500 50,000
39 An. Asep 30,000 3,000 13,500 13,500 30,000
40 25/9/2008 An. Doni 30,000 3,000 13,500 13,500 30,000
41 Ny. Sudarwati 50,000 3,000 23,500 23,500 50,000
42 Tn. Rusmidi 30,000 3,000 13,500 13,500 30,000
43 Ny. Magdalena 20,000 3,000 8,500 8,500 20,000
44 Ny. Heni 150,000 3,000 73,500 73,500 150,000
45 Nn. Rian 120,000 3,000 58,500 58,500 120,000
46 27/9/2008 Aini 40,000 3,000 18,500 18,500 40,000
47 Raihan 20,000 3,000 8,500 8,500 20,000
2,571,000 138,000 1,211,500 1,221,500 2,571,000

JASA ALAT &

DOKTER BAHAN
1 1/9/2008 Ny. Iceu 15,000 7,500 7,500 15,000
2 3/9/2008 Tn. Komarudin 15,000 5,000 5,000 5,000 15,000
3 6/9/2008 Siti Leli 15,000 5,000 5,000 5,000 15,000
4 8/9/2008 Tn. Komarudin 40,000 5,000 17,500 17,500 40,000
5 11/9/2008 Tn. Ujang 20,000 5,000 7,500 7,500 20,000
6 Santi 40,000 20,000 20,000 40,000
7 24/9/2008 Putri 70,000 35,000 35,000 70,000
8 Julia 70,000 35,000 35,000 70,000
9 25/9/2008 Tn. Suryabakti 15,000 5,000 5,000 5,000 15,000
TOTAL 300,000 25,000 137,500 137,500 300,000
LAPORAN KUNJUNGAN PASIEN GIGI PT. TEGAR

JASA ALAT &

DOKTER BAHAN
1 3/9/2008 M. Ikbal 30,000 3,000 13,500 13,500 30,000
2 9/9/2008 Tn. Karim 35,000 3,000 16,000 16,000 35,000
3 6/9/2008 Ny. Sumiati 40,000 3,000 18,500 18,500 40,000
4 20/9/2008 Pesta Ulina 20,000 3,000 8,500 8,500 20,000
125,000 12,000 56,500 56,500 125,000

Bukaan Bur ,
1 2/9/2008 75,000
Handschoen
2 6/9/2008 Alginat 35,000
3 9/9/2008 Masker 20,000
4 11/9/2008 Spongostan, Bur 140,000
TOTAL 520,000
KEUNTUNGAN
KSBL DRG. DEWI
1 September 1,221,500 520,000 701,500 350,750 350,750
2 September 194,000.00 194,000 97,000 97,000
447,750 447,750


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 6/10/2008 Tn. Petter 20,000 3,000 8,500 8,500 20,000
2 Davina 60,000 3,000 28,500 28,500 60,000
3 Reva 30,000 3,000 13,500 13,500 30,000
4 7/10/2008 Tn. Sodik 40,000 3,000 18,500 18,500 40,000
5 Tn. Hendra 130,000 3,000 63,500 63,500 130,000
6 Tn. Salam 40,000 3,000 18,500 18,500 40,000
7 8/10/2008 Tanti 100,000 3,000 48,500 48,500 100,000
8 Ripai 20,000 3,000 8,500 8,500 20,000
9 Cika 60,000 3,000 28,500 28,500 60,000
10 10/10/2008 Ny. Deti 20,000 3,000 8,500 8,500 20,000
11 Ny. Indra 105,000 3,000 51,000 51,000 105,000
12 11/10/2008 Kukuh 70,000 3,000 33,500 33,500 70,000
13 13/10/2008 An. Raihan Misa 20,000 3,000 8,500 8,500 20,000
14 An. Fitria 100,000 3,000 48,500 48,500 100,000
15 14/10/2008 Cika 40,000 3,000 18,500 18,500 40,000
16 Zaki Permana 30,000 3,000 13,500 13,500 30,000
17 An. Ari 30,000 3,000 13,500 13,500 30,000
18 Ny. Indra 40,000 3,000 18,500 18,500 40,000
19 15/10/2008 Dahlia 20,000 3,000 8,500 8,500 20,000
20 Ny. Heni 20,000 3,000 8,500 8,500 20,000
21 Rian 35,000 3,000 16,000 16,000 35,000
22 16/10/2008 Tn. Deli 20,000 3,000 8,500 10,000 21,500
23 Ny. Heni 120,000 3,000 58,500 58,500 120,000
24 Tn. Ayub 40,000 3,000 18,500 18,500 40,000
25 18/10/2008 Dela 20,000 3,000 8,500 8,500 20,000
26 20/10/2008 Ny. Ima 60,000 3,000 28,500 28,500 60,000
27 Tn. Salam 20,000 3,000 8,500 8,500 20,000
28 Tn. Diding 20,000 3,000 8,500 8,500 20,000
29 Ny. Pesta Uli 20,000 3,000 8,500 8,500 20,000
30 Rosmawati 50,000 3,000 23,500 23,500 50,000
31 22/10/2008 Yayan 20,000 3,000 8,500 8,500 20,000
32 An. Fauzan 60,000 3,000 28,500 28,500 60,000
33 Erry 50,000 3,000 23,500 23,500 50,000
34 23/10/2008 Ferri 30,000 3,000 13,500 13,500 30,000
35 Tn. Ayub 100,000 3,000 48,500 48,500 100,000
36 Rian 662,500 3,000 329,750 329,750 662,500
37 24/10/2008 Ravita 20,000 3,000 8,500 8,500 20,000
38 25/10/2008 Ny. Martini 70,000 3,000 33,500 33,500 70,000
39 Farel 20,000 3,000 8,500 8,500 20,000
40 Tn. Abdul. G 20,000 3,000 8,500 8,500 20,000
41 28/10/2008 Tn. Abdul. G 20,000 3,000 8,500 8,500 20,000
42 Angga 20,000 3,000 8,500 8,500 20,000
43 29/10/2008 Raisya 30,000 3,000 13,500 13,500 30,000
44 Ferri 30,000 3,000 13,500 13,500 30,000
45 Erry 30,000 3,000 13,500 13,500 30,000
46 30/10/2008 Allen. R 24,000 12,000 12,000 24,000
47 31/10/2008 Feri 115,000 3,000 56,000 56,000 115,000
2,721,500 138,000 1,291,750 1,293,250 2,723,000

JASA ALAT &

DOKTER BAHAN
1 7/10/2008 Ny. Ida . J 40,000 20,000 20,000 40,000
2 Santi 25,000 12,500 12,500 25,000
3 20/10/2008 Isnawati 20,000 5,000 7,500 7,500 20,000
4 25/10/2008 Rizki. A 30,000 5,000 12,500 12,500 30,000
5 Ny. Ika 15,000 5,000 5,000 5,000 15,000
6 27/10/2008 Rizki. A 30,000 5,000 12,500 12,500 30,000
7 29/10/2008 Aep Komarudin 15,000 5,000 5,000 5,000 15,000
TOTAL 175,000 25,000 75,000 75,000 175,000

1 15/10/08 Bahan Tambal 245,000
2 25/10/08 Bahan 40,000
TOTAL 535,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Oktober 1,293,250 535,000 758,250 379,125 379,125
2 Oktober 75,000.00 75,000 37,500 37,500
416,625 416,625


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/11/2008 Salma Sabila 30,000 3,000 13,500 13,500 30,000
2 Tn. Muhidin 75,000 3,000 36,000 36,000 75,000
3 Feri 70,000 3,000 33,500 33,500 70,000
4 3/11/2008 Ny. Purnama 50,000 3,000 23,500 23,500 50,000
5 4/11/2008 Ny. Deina 120,000 3,000 58,500 58,500 120,000
6 5/11/2008 Tn. Krisna 35,000 3,000 16,000 16,000 35,000
7 Allen. R 24,000 12,000 12,000 24,000
8 An. Fauzan 60,000 3,000 28,500 28,500 60,000
9 Sri 60,000 3,000 28,500 28,500 60,000
10 Heri 115,000 3,000 56,000 56,000 115,000
11 6/11/2008 Ny. Sulasmiyati 20,000 3,000 8,500 8,500 20,000
12 8/11/2008 Alip 35,000 3,000 16,000 16,000 35,000
13 Feri 35,000 3,000 16,000 16,000 35,000
14 10/11/2008 Ny. Indra 40,000 3,000 18,500 18,500 40,000
15 11/11/2008 Amelia 45,000 3,000 21,000 21,000 45,000
16 Ny. Rani 35,000 3,000 16,000 16,000 35,000
17 Feri 215,000 3,000 106,000 106,000 215,000
18 Ny. Emil 20,000 3,000 8,500 8,500 20,000
19 12/11/2008 Ny. ELah 20,000 3,000 8,500 8,500 20,000
20 Tn. Abdul 20,000 3,000 8,500 8,500 20,000
21 Allen. R 24,000 12,000 12,000 24,000
22 13/11/2008 Ny. Aas 30,000 3,000 13,500 10,000 26,500
23 Ny. Adah 30,000 3,000 13,500 13,500 30,000
24 17/11/2008 Tn. Soni 20,000 3,000 8,500 8,500 20,000
25 Virgiawan 20,000 3,000 8,500 8,500 20,000
26 Ny. Tete 20,000 3,000 8,500 8,500 20,000
27 18/11/2008 Ny. Sukaesih 45,000 3,000 21,000 21,000 45,000
28 Vanny 20,000 3,000 8,500 8,500 20,000
29 19/11/2008 Rubi 35,000 3,000 16,000 16,000 35,000
30 Eka 20,000 3,000 8,500 8,500 20,000
31 Bayu 60,000 3,000 28,500 28,500 60,000
32 Rian 25,000 3,000 11,000 11,000 25,000
33 20/11/2008 Allen. R 125,000 3,000 61,000 61,000 125,000
34 24/11/2008 Ny. Hj. Maryam 60,000 3,000 28,500 28,500 60,000
35 Dina Mustofa 40,000 3,000 18,500 18,500 40,000
36 Ny. Dian 35,000 3,000 16,000 16,000 35,000
37 Yasmin 20,000 3,000 8,500 8,500 20,000
38 Mirham 20,000 3,000 8,500 8,500 20,000
39 Hani 20,000 3,000 8,500 8,500 20,000
40 25/11/2008 Mirham 20,000 3,000 8,500 8,500 20,000
41 Ajeng 35,000 3,000 16,000 16,000 35,000
42 27/11/2008 Tn. Arahman 30,000 3,000 13,500 13,500 30,000
43 Medi 80,000 3,000 38,500 38,500 80,000
44 Tn. Ayub 50,000 3,000 23,500 23,500 50,000
45 Asyifa 70,000 3,000 33,500 33,500 70,000
46 Aisyah 30,000 3,000 13,500 13,500 30,000
47 28/11/2008 An. Monica 30,000 3,000 13,500 13,500 30,000
48 an. Hani 30,000 3,000 13,500 13,500 30,000
49 29/11/2008 Tn. Waryat 20,000 3,000 8,500 8,500 20,000
50 Ny. Eni 40,000 3,000 18,500 18,500 40,000
51 Femi 35,000 3,000 16,000 16,000 35,000
52 Martini 60,000 3,000 28,500 28,500 60,000
53 Riyanti 100,000 3,000 48,500 48,500 100,000
54 Raihan 20,000 3,000 8,500 8,500 20,000
2,443,000 156,000 1,143,500 1,140,000 2,439,500

JASA ALAT &

DOKTER BAHAN
1 7/11/2008 Ny. Siti Alfiah 15,000 7,500 7,500 15,000
2 Ramdhan 30,000 15,000 15,000 30,000
3 Siti 25,000 5,000 10,000 10,000 25,000
4 15/11/2008 Entin Surtii 15,000 5,000 5,000 5,000 15,000
5 17/11/2008 Entin Surtii 15,000 7,500 7,500 15,000
6 18/11/2008 Elis 25,000 12,500 12,500 25,000
7 Tn. Dindin 25,000 12,500 12,500 25,000
8 21/11/2008 Elis 30,000 15,000 15,000 30,000
28/11/2008 Ellis. D 40,000 5,000 17,500 17,500 40,000
Santi Kurnia 40,000 5,000 17,500 17,500 40,000
TOTAL 260,000 20,000 120,000 120,000 260,000

1 11/11/2008 Benzotop, Komposit 179,000
Articulating Paper, Spuit 3
2 29/11/08 321,000
cc, Fuji IX GP
TOTAL 750,000
KEUNTUNGAN
KSBL DRG. DEWI
1 November 1,140,000 750,000 390,000 195,000 195,000
2 November 120,000.00 120,000 60,000 60,000
255,000 255,000


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/12/2008 Ny. Min 20,000 3,000 8,500 8,500 20,000
2 Tn. Sutisna 60,000 3,000 28,500 28,500 60,000
3 Tn. Toipin 30,000 3,000 13,500 13,500 30,000
4 2/12/2008 Tata 30,000 3,000 13,500 13,500 30,000
5 3/12/2008 Widaningsih 35,000 3,000 16,000 16,000 35,000
6 Ny. Atikah 20,000 3,000 8,500 8,500 20,000
7 4/12/2008 Tn. Dina Mustofa 50,000 3,000 23,500 23,500 50,000
8 Ny. Rismawati 30,000 3,000 13,500 13,500 30,000
9 Ny. Sri 20,000 3,000 8,500 8,500 20,000
10 Nabila 55,000 3,000 26,000 26,000 55,000
11 Nn. Rian 25,000 3,000 11,000 11,000 25,000
12 Tn. Suhartoyo 40,000 3,000 18,500 18,500 40,000
13 5/12/2008 An. Wildan 60,000 3,000 28,500 28,500 60,000
14 Ny. Ernawati 110,000 3,000 53,500 53,500 110,000
15 Asyfa 70,000 3,000 33,500 33,500 70,000
16 Aisyah 35,000 3,000 16,000 16,000 35,000
17 6/12/2008 Femi 50,000 3,000 23,500 23,500 50,000
18 9/12/2008 Ny. Lamizar 40,000 3,000 18,500 18,500 40,000
19 Tn. Karsim 20,000 3,000 8,500 8,500 20,000
20 Asyifa 70,000 3,000 33,500 33,500 70,000
21 10/12/2008 Ny. Ernawati 105,000 3,000 51,000 51,000 105,000
22 Safrudin 20,000 3,000 8,500 8,500 20,000
23 Asep Suryana 50,000 3,000 23,500 23,500 50,000
24 11/12/2008 Tn. Karsim 50,000 3,000 23,500 23,500 50,000
25 An. Agung. F 70,000 3,000 33,500 33,500 70,000
26 Medi. H 110,000 3,000 53,500 53,500 110,000
27 12/12/2008 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
28 Monika 40,000 3,000 18,500 18,500 40,000
29 Tommy 30,000 3,000 13,500 13,500 30,000
30 13/12/2008 Andra 30,000 3,000 13,500 13,500 30,000
31 Femi 40,000 3,000 18,500 18,500 40,000
32 Ny. Popon 50,000 3,000 23,500 23,500 50,000
33 Putri 40,000 3,000 18,500 18,500 40,000
34 16/12/2008 Ny. Nita 150,000 3,000 73,500 73,500 150,000
35 Ny. Nawa 150,000 3,000 73,500 73,500 150,000
36 Asyfa 60,000 3,000 28,500 28,500 60,000
37 17/12/2008 Tn. Ade Yanto 150,000 3,000 73,500 73,500 150,000
38 Umi 20,000 3,000 8,500 8,500 20,000
39 Ny. Popon 50,000 3,000 23,500 23,500 50,000
40 Ny. Ida 40,000 3,000 18,500 18,500 40,000
41 Afina 30,000 3,000 13,500 13,500 30,000
42 18/12/2008 Ny. Evi 150,000 3,000 73,500 73,500 150,000
43 Tn. Rofin 20,000 3,000 8,500 8,500 20,000
44 An. Arsyah 30,000 3,000 13,500 13,500 30,000
45 Asep Suryana 50,000 3,000 23,500 23,500 50,000
46 Rian 25,000 3,000 11,000 11,000 25,000
47 19/12/2008 Ny. Ernawati 40,000 3,000 18,500 18,500 40,000
48 Ny. Nana 20,000 3,000 8,500 8,500 20,000
49 Tn. Dedi 30,000 3,000 13,500 13,500 30,000
50 Asyifa 140,000 3,000 68,500 68,500 140,000
51 22/12/2008 Ny. Tri 40,000 3,000 18,500 18,500 40,000
52 Femi 75,000 3,000 36,000 36,000 75,000
53 Ny. Ida 30,000 3,000 13,500 13,500 30,000
54 23/12/2008 Tn. Rohim 40,000 3,000 18,500 18,500 40,000
55 Asyifa 110,000 3,000 53,500 53,500 110,000
56 Tn. Hasan 20,000 3,000 8,500 8,500 20,000
57 24/12/2008 An. Denis 20,000 3,000 8,500 8,500 20,000
58 An. Anjeli 25,000 3,000 11,000 11,000 25,000
59 An. Arsyah 30,000 3,000 13,500 13,500 30,000
60 Nn. Rian 25,000 3,000 11,000 11,000 25,000
61 Tn. Hamdani 20,000 3,000 8,500 8,500 20,000
62 26/12/2008 Ny. Ida 30,000 3,000 13,500 13,500 30,000
63 Sri Mulyani 30,000 3,000 13,500 13,500 30,000
64 27/12/2008 Tn. Wiharya 20,000 3,000 8,500 8,500 20,000
65 Tn. Alex 30,000 3,000 13,500 13,500 30,000
66 Tn. R. Sutopo 20,000 3,000 8,500 8,500 20,000
67 Tn. Didik 20,000 3,000 8,500 8,500 20,000
68 30/12/2008 An. Adelia 20,000 3,000 8,500 8,500 20,000
69 Tn. Hamdani 20,000 3,000 8,500 8,500 20,000
70 Ny. Ida 30,000 3,000 13,500 13,500 30,000
71 Yuda 60,000 3,000 28,500 28,500 60,000
72 31/12/2008 An. Patiya 25,000 3,000 11,000 11,000 25,000
3,420,000 216,000 1,602,000 1,602,000 3,420,000

JASA ALAT &

DOKTER BAHAN
1 1/12/2008 An. Siti Jubaedah 20,000 10,000 10,000 20,000
2 Elis 40,000 5,000 17,500 17,500 40,000
3 Elis 15,000 5,000 5,000 5,000 15,000
4 4/12/2008 Nn. Lia 15,000 5,000 5,000 5,000 15,000
5 Ny. Elin 15,000 7,500 7,500 15,000
6 Kezia. H 15,000 7,500 7,500 15,000
7 Santi 25,000 12,500 12,500 25,000
8 6/12/2008 Elin 40,000 5,000 17,500 17,500 40,000
9 9/12/2008 Ny. Siti 40,000 5,000 17,500 17,500 40,000
10 11/12/2008 Siti 40,000 5,000 17,500 17,500 40,000
11 13/12/2008 Ny. Santi 25,000 12,500 12,500 25,000
12 16/12/2008 Ny. Siti 25,000 12,500 12,500 25,000
13 18/12/2008 Ny. Elin 25,000 5,000 10,000 10,000 25,000
14 22/12/2008 Santi 25,000 12,500 12,500 25,000
15 Elin 25,000 12,500 12,500 25,000
16 23/12/2008 Siti 25,000 12,500 12,500 25,000
17 30/12/2008 Siti. F 25,000 12,500 12,500 25,000
18 Elin 30,000 15,000 15,000 30,000
19 31/12/2008 Santi 25,000 12,500 12,500 25,000
TOTAL 495,000 35,000 230,000 230,000 495,000

1 5/12/2008 Sarung Tangan 40,000
2 6/12/2008 Bahan Gigi 101,600
3 19/12/2008 Bahan Gigi 312,500
TOTAL 704,100
KEUNTUNGAN
KSBL DRG. DEWI
1 Desember 1,602,000 704,100 897,900 448,950 448,950
2 Desember 230,000.00 230,000 115,000 115,000
563,950 563,950


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 2/1/2009 Ny. Imat 20,000 3,000 8,500 8,500 20,000
2 Ny. Ernawati 110,000 3,000 53,500 53,500 110,000
3 Dimas 150,000 3,000 73,500 73,500 150,000
4 Winda 20,000 3,000 8,500 8,500 20,000
5 3/1/2009 Karina 20,000 3,000 8,500 8,500 20,000
6 Iqbal 20,000 3,000 8,500 8,500 20,000
7 Tn. Alex 25,000 3,000 11,000 11,000 25,000
8 Ny. Tri 20,000 3,000 8,500 8,500 20,000
9 Nunung 35,000 3,000 16,000 16,000 35,000
10 Farel 60,000 3,000 28,500 28,500 60,000
11 5/1/2009 Nn. Dewi 100,000 3,000 48,500 48,500 100,000
12 An. Karina 35,000 3,000 16,000 16,000 35,000
13 An. Dewi 30,000 3,000 13,500 13,500 30,000
14 Aisyah 30,000 3,000 13,500 13,500 30,000
15 Triyani 50,000 3,000 23,500 23,500 50,000
16 6/1/2009 Tn. Alex 25,000 3,000 11,000 11,000 25,000
17 An. Farel 60,000 3,000 28,500 28,500 60,000
18 Ny. Ida 30,000 3,000 13,500 13,500 30,000
19 Tn. Entam 20,000 3,000 8,500 8,500 20,000
20 7/1/2009 Tn. Hamdani 60,000 3,000 28,500 28,500 60,000
21 Amalia 20,000 3,000 8,500 8,500 20,000
22 Veni 155,000 3,000 76,000 76,000 155,000
23 8/1/2009 Tn. Eko 30,000 3,000 13,500 13,500 30,000
24 Nn. Nurhaeni 20,000 3,000 8,500 8,500 20,000
25 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
26 Medi Hendrawan 30,000 3,000 13,500 13,500 30,000
27 Rian 25,000 3,000 11,000 11,000 25,000
28 9/1/2009 Ny. Nila 20,000 3,000 8,500 8,500 20,000
29 10/1/2009 Farel 140,000 3,000 68,500 68,500 140,000
30 Tn. Alex 70,000 3,000 33,500 33,500 70,000
31 Yuli 60,000 3,000 28,500 28,500 60,000
32 Ny. Lilis 10,000 10,000 10,000
33 Karina 40,000 3,000 18,500 18,500 40,000
34 13/1/2009 Karina 40,000 3,000 18,500 18,500 40,000
35 Fitri 60,000 3,000 28,500 28,500 60,000
36 Aneira 80,000 3,000 38,500 38,500 80,000
37 14/1/2009 Novi 20,000 3,000 8,500 8,500 20,000
38 Aisyah 20,000 3,000 8,500 8,500 20,000
39 15/1/2009 Ny. Lina 50,000 3,000 23,500 23,500 50,000
40 16/1/2009 Ny. Lilis 10,000 10,000 10,000
41 Nurhaeni 35,000 3,000 16,000 16,000 35,000
42 Mayfa 10,000 10,000 10,000
43 Dariyanto 100,000 3,000 48,500 48,500 100,000
44 17/1/2009 Siti 50,000 3,000 23,500 23,500 50,000
45 Farel 90,000 3,000 43,500 43,500 90,000
46 Rayhan 50,000 3,000 23,500 23,500 50,000
47 Karina 30,000 3,000 13,500 13,500 30,000
48 Ny. Juarti 50,000 3,000 23,500 23,500 50,000
49 19/1/2009 Tn. Nori 30,000 3,000 13,500 13,500 30,000
50 An. Tiara 20,000 3,000 8,500 8,500 20,000
51 Maulana 80,000 3,000 38,500 38,500 80,000
52 Mandela 40,000 3,000 18,500 18,500 40,000
53 20/1/2009 Ny. Lilis 10,000 10,000 10,000
54 Karina 30,000 3,000 13,500 13,500 30,000
55 Risal Asri 60,000 3,000 28,500 28,500 60,000
56 Ny. Ida 95,000 3,000 46,000 46,000 95,000
57 Medi Hendrawan 80,000 3,000 38,500 38,500 80,000
58 21/1/2009 Tn. Bemble 20,000 3,000 8,500 8,500 20,000
59 Tn. Dimas. F 85,000 3,000 41,000 41,000 85,000
60 22/1/2009 Ny. Tuti 20,000 3,000 8,500 8,500 20,000
61 Ny. Marsiyem 40,000 3,000 18,500 18,500 40,000
62 Ny. Lina 50,000 3,000 23,500 23,500 50,000
63 nn. Rian 25,000 3,000 11,000 11,000 25,000
64 24/1/2009 Tn. Wahyudin 210,000 3,000 103,500 103,500 210,000
65 Mayfa 10,000 10,000 10,000
66 Karina 85,000 3,000 41,000 41,000 85,000
67 Farel 80,000 3,000 38,500 38,500 80,000
68 27/1/2009 Mayfa 10,000 10,000 10,000
69 Tn. Beben 110,000 3,000 53,500 53,500 110,000
70 Tn. Wahyu 40,000 3,000 18,500 18,500 40,000
71 Ira 20,000 3,000 8,500 8,500 20,000
72 Tn. Entam 20,000 3,000 8,500 8,500 20,000
3,525,000 198,000 1,633,500 1,693,500 3,525,000

JASA ALAT &

DOKTER BAHAN
73 28/1/2009 An. M. Rizal 30,000 3,000 13,500 13,500 30,000
74 Tn. Dede Supriyadi 30,000 3,000 13,500 13,500 30,000
75 Anisa 20,000 3,000 8,500 8,500 20,000
76 Mandela 40,000 3,000 18,500 18,500 40,000
77 29/1/2009 Tn. Fernandes 20,000 3,000 8,500 8,500 20,000
78 Ny. Lina 40,000 3,000 18,500 18,500 40,000
79 Ny. Marsiyem 40,000 3,000 18,500 18,500 40,000
80 30/1/2009 Ibnu 40,000 3,000 18,500 18,500 40,000
81 31/1/2009 Tn. Dede Supriyadi 40,000 3,000 18,500 18,500 40,000
82 Tn. Edi. F 30,000 3,000 13,500 13,500 30,000
83 Farel 30,000 3,000 13,500 13,500 30,000
84 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
85 Mayfa 15,000 15,000 15,000
86 Tn. Wahyudin 220,000 3,000 108,500 108,500 220,000
87 Fitri 70,000 3,000 33,500 33,500 70,000
88 Ani 10,000 10,000 10,000
4,220,000 240,000 1,947,500 2,032,500 4,220,000

JASA ALAT &

DOKTER BAHAN
1 6/1/2009 Siti. F 30,000 15,000 15,000 30,000
2 Santi 30,000 5,000 12,500 12,500 30,000
3 7/1/2009 Tn. Paulus 15,000 5,000 5,000 5,000 15,000
4 10/1/2009 Tn. Paulus 15,000 5,000 5,000 5,000 15,000
5 Kezia 15,000 5,000 5,000 5,000 15,000
6 Tn. Rohaendi 15,000 5,000 5,000 5,000 15,000
7 12/1/2009 Tn. Dedi. M 15,000 5,000 5,000 5,000 15,000
8 Tn. Rohaendi 15,000 5,000 5,000 5,000 15,000
9 Ny. Cahyana 15,000 5,000 5,000 5,000 15,000
10 Ida ubaedah 25,000 5,000 10,000 10,000 25,000
11 13/1/2009 Elin 40,000 20,000 20,000 40,000
12 Siti. F 40,000 20,000 20,000 40,000
13 14/1/2009 Kezia 25,000 12,500 12,500 25,000
14 Tn. Paulus 40,000 20,000 20,000 40,000
15 16/1/2009 Ida ubaedah 25,000 5,000 10,000 10,000 25,000
16 19/1/2009 Ida ubaedah 25,000 12,500 12,500 25,000
17 20/1/2009 Eli 25,000 12,500 12,500 25,000
18 Kezia 25,000 5,000 10,000 10,000 25,000
19 21/1/2009 Tn. Dedi. M 15,000 7,500 7,500 15,000
20 An. Embun 20,000 10,000 10,000 20,000
21 Santi 40,000 20,000 20,000 40,000
22 22/1/2009 An. Embun 20,000 10,000 10,000 20,000
23 27/1/2009 Kezia 25,000 12,500 12,500 25,000
24 30/1/2009 Ida ubaedah 30,000 15,000 15,000 30,000
TOTAL 585,000 55,000 190,000 190,000 435,000

Masker, Handscoon, Clor
1 10/1/2009 164,000
Etil
2 14/1/2009 Fuji IX 195,000
TOTAL 609,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Januari 2,032,500 609,000 1,423,500 711,750 711,750
2 Januari 190,000.00 190,000 95,000 95,000
806,750 806,750


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Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 2/2/2009 Monika 20,000 3,000 8,500 8,500 20,000
2 M. Yopi 40,000 3,000 18,500 18,500 40,000
3 Luthfi 20,000 20,000 20,000
4 3/2/2009 Ny. Neneng 35,000 3,000 16,000 16,000 35,000
5 Tn. Edi. F 50,000 3,000 23,500 23,500 50,000
6 Ny. Maryam 100,000 3,000 48,500 48,500 100,000
7 James 60,000 3,000 28,500 28,500 60,000
8 An. Alian 30,000 3,000 13,500 13,500 30,000
9 Medi 30,000 3,000 13,500 13,500 30,000
10 4/2/2009 Tn. Dede Supriadi 30,000 3,000 13,500 13,500 30,000
11 Ny. Ina Kustina 115,000 3,000 56,000 56,000 115,000
12 Ny. Ina Kustina 100,000 3,000 48,500 48,500 100,000
13 Farel 30,000 3,000 13,500 13,500 30,000
14 Ny. Marsiyem 30,000 3,000 13,500 13,500 30,000
15 Floresita 20,000 3,000 8,500 8,500 20,000
16 Tn. Waluyo 40,000 3,000 18,500 18,500 40,000
17 Ny. Sri 40,000 3,000 18,500 18,500 40,000
18 Akhmad Khabier 80,000 3,000 38,500 38,500 80,000
19 5/2/2009 Ny. Sukeksi 20,000 3,000 8,500 8,500 20,000
20 Lina 125,000 3,000 61,000 61,000 125,000
21 James 60,000 3,000 28,500 28,500 60,000
22 Medi. H 110,000 3,000 53,500 53,500 110,000
23 Tn. Bambang 60,000 3,000 28,500 28,500 60,000
24 Meni 20,000 3,000 8,500 8,500 20,000
25 6/2/2009 Yudi 120,000 3,000 58,500 58,500 120,000
26 7/2/2009 Ny. Neneng 40,000 3,000 18,500 18,500 40,000
27 Mayfa 15,000 15,000 15,000
28 Fitri 80,000 3,000 38,500 38,500 80,000
29 Ny. Heni 120,000 3,000 58,500 58,500 120,000
30 Farel 80,000 3,000 38,500 38,500 80,000
31 Adita 30,000 3,000 13,500 13,500 30,000
32 Agnes 20,000 20,000 20,000
33 Monika 85,000 3,000 41,000 41,000 85,000
34 Delta Tania 30,000 3,000 13,500 13,500 30,000
35 9/2/2009 Ny. Neneng 30,000 3,000 13,500 13,500 30,000
36 Ambar 20,000 3,000 8,500 8,500 20,000
37 Tn. Agus 20,000 3,000 8,500 8,500 20,000
38 Luthfi 20,000 20,000 20,000
39 10/2/2009 Ny. Marsiyem 30,000 3,000 13,500 13,500 30,000
40 Floresita 20,000 3,000 8,500 8,500 20,000
41 Tio 40,000 3,000 18,500 18,500 40,000
42 James 90,000 3,000 43,500 43,500 90,000
43 Lian 25,000 3,000 11,000 11,000 25,000
44 11/2/2009 Ny. Neneng 115,000 3,000 56,000 56,000 115,000
45 Ny. Ina 25,000 3,000 11,000 11,000 25,000
46 Agnes 40,000 3,000 18,500 18,500 40,000
47 Ny. Sri 110,000 3,000 53,500 53,500 110,000
48 12/2/2009 Nining 40,000 3,000 18,500 18,500 40,000
49 Medi. H 40,000 3,000 18,500 18,500 40,000
50 Davina 20,000 3,000 8,500 8,500 20,000
51 Reni 30,000 3,000 13,500 13,500 30,000
52 Eka 50,000 3,000 23,500 23,500 50,000
53 13/2/2009 Ny. Siti 50,000 3,000 23,500 23,500 50,000
54 Anbar 40,000 3,000 18,500 18,500 40,000
55 Luthfi 20,000 20,000 20,000
56 14/2/2009 Yeni 20,000 3,000 8,500 8,500 20,000
57 Dede Supriadi 65,000 3,000 31,000 31,000 65,000
58 Monika 45,000 3,000 21,000 21,000 45,000
59 16/2/2009 An. Ikhsan 50,000 3,000 23,500 23,500 50,000
60 An. Bayu 30,000 3,000 13,500 13,500 30,000
61 Tn. Yudi 20,000 3,000 8,500 8,500 20,000
62 Luthfi 15,000 15,000 15,000
63 17/2/2009 Tn. Tatang 50,000 3,000 23,500 23,500 50,000
64 Tn. Agus 20,000 3,000 8,500 8,500 20,000
65 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
66 Ny. Neneng 35,000 3,000 16,000 16,000 35,000
67 Ny. Marsiyem 95,000 3,000 46,000 46,000 95,000
68 James. P 100,000 3,000 48,500 48,500 100,000
69 Aisyah 30,000 3,000 13,500 13,500 30,000
70 Fayat 90,000 3,000 43,500 43,500 90,000
71 18/2/2009 Mayfa 10,000 10,000 10,000
72 Monika 40,000 3,000 18,500 18,500 40,000
3,495,000 195,000 1,590,000 1,710,000 3,495,000

JASA ALAT &

DOKTER BAHAN
73 18/2/2009 Nining 80,000 3,000 38,500 38,500 80,000
74 Romi 30,000 3,000 13,500 13,500 30,000
75 19/2/2009 Dani 20,000 3,000 8,500 8,500 20,000
76 Tn. Diki 35,000 3,000 16,000 16,000 35,000
77 Ny. Butiek 50,000 3,000 23,500 23,500 50,000
78 Ny. Ina 25,000 3,000 11,000 11,000 25,000
79 Risa 30,000 3,000 13,500 13,500 30,000
80 Ny. Eka 40,000 3,000 18,500 18,500 40,000
81 20/2/2009 Ny. Neneng - - -
82 21/2/2009 Alif 30,000 3,000 13,500 13,500 30,000
83 Monika 100,000 3,000 48,500 48,500 100,000
84 23/2/2009 Ny. Neneng 30,000 3,000 13,500 13,500 30,000
85 An. Salma 30,000 3,000 13,500 13,500 30,000
86 24/2/2009 An. Teni 35,000 3,000 16,000 16,000 35,000
87 Ayi. S 90,000 3,000 43,500 43,500 90,000
88 An. Ebanov 60,000 3,000 28,500 28,500 60,000
89 25/2/2009 Kartinaya 28,000 14,000 14,000 28,000
90 Mayfa 10,000 10,000 10,000
91 Risa 40,000 3,000 18,500 18,500 40,000
92 Nining 125,000 3,000 61,000 61,000 125,000
93 Rian 25,000 3,000 11,000 11,000 25,000
94 Ny. Eka 40,000 3,000 18,500 18,500 40,000
95 26/2/2009 Tn. Bronto 64,000 32,000 32,000 64,000
96 Medi. H 30,000 15,000 15,000 30,000
97 Yani 15,000 15,000 15,000
98 27/2/2009 An. Azmi 20,000 3,000 8,500 8,500 20,000
99 Anbar 100,000 3,000 48,500 48,500 100,000
100 28/2/2009 Tn. Tarya 20,000 3,000 8,500 8,500 20,000
101 Mayfa 10,000 10,000 10,000
102 Aurel 35,000 3,000 16,000 16,000 35,000
4,742,000 264,000 2,161,500 2,316,500 4,742,000

JASA ALAT &

DOKTER BAHAN
1 2/2/2009 Tn. Asep Jewih 15,000 5,000 5,000 5,000 15,000
2 Tn. Surya Bakti 15,000 5,000 5,000 5,000 15,000
3 2/2/2009 Ny. Ida 40,000 20,000 20,000 40,000
4 3/2/2009 Kezia 25,000 12,500 12,500 25,000
5 5/2/2009 Usep 25,000 12,500 12,500 25,000
6 7/2/2009 Siti Leli 25,000 12,500 12,500 25,000
7 9/2/2009 Waluyo 25,000 12,500 12,500 25,000
8 10/2/2009 Kezia 25,000 12,500 12,500 25,000
9 11/2/2009 Rida Farida 25,000 5,000 10,000 10,000 25,000
10 14/2/09 Siti Leli 25,000 12,500 12,500 25,000
11 17/2/09 Ny. Sri Handayani 25,000 5,000 10,000 10,000 25,000
12 Kezia 25,000 12,500 12,500 25,000
13 18/2/09 Siti Leli 25,000 5,000 10,000 10,000 25,000
14 Sutanto 15,000 5,000 5,000 5,000 15,000
15 Rida Farida 25,000 12,500 12,500 25,000
16 21/2/09 Ny. Sri Handayani 25,000 12,500 12,500 25,000
17 Siti Leli 30,000 15,000 15,000 30,000
18 23/2/09 Ny. Siti Aisyah 25,000 12,500 12,500 25,000
19 24/2/09 An. Ramdhan 20,000 10,000 10,000 20,000
20 Rida Farida 25,000 12,500 12,500 25,000
21 25/2/09 Ny. Sri Handayani 25,000 12,500 12,500 25,000
22 Dindin. S 25,000 5,000 10,000 10,000 25,000
23 26/2/09 Ny. Siti Aisyah 25,000 5,000 10,000 10,000 25,000
24 27/2/09 Cahyana 15,000 7,500 7,500 15,000
25 28/2/09 Ny. Sri Handayani 30,000 15,000 15,000 30,000
26 Siti Leli 40,000 20,000 20,000 40,000
TOTAL 645,000 40,000 302,500 302,500 645,000

1 18/2/09 Faktur Gigi 281,500
TOTAL 531,500
KEUNTUNGAN
KSBL DRG. DEWI
1 Febuari 2,316,500 531,500 1,785,000 892,500 892,500
2 Febuari 302,500.00 302,500 151,250 151,250
1,043,750 1,043,750


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Direktur KSBL

PERIODE MARET 2009
JASA ALAT &
DOKTER BAHAN
1 2/3/2009 Anbar 40,000 3,000 18,500 18,500 40,000
2 Tn. Risris 20,000 3,000 8,500 8,500 20,000
3 3/3/2009 Tn. Dede 20,000 3,000 8,500 8,500 20,000
4 Ebanov 55,000 3,000 26,000 26,000 55,000
5 Wiwi. W 20,000 3,000 8,500 8,500 20,000
6 Susi 30,000 3,000 13,500 13,500 30,000
7 Iley 30,000 3,000 13,500 13,500 30,000
8 4/3/2009 Syifa 28,000 14,000 14,000 28,000
9 Tn. Irfan 60,000 3,000 28,500 28,500 60,000
10 Ny. Neneng 30,000 3,000 13,500 13,500 30,000
11 Ny. Ina 60,000 3,000 28,500 28,500 60,000
12 An. Risa 50,000 3,000 23,500 23,500 50,000
13 Mayfa 15,000 15,000 15,000
14 Januar 310,000 3,000 153,500 153,500 310,000
15 Eka 45,000 3,000 21,000 21,000 45,000
16 Neni 40,000 3,000 18,500 18,500 40,000
17 5/3/2009 Tn. Fery 35,000 3,000 16,000 16,000 35,000
18 6/3/2009 Ny. Lisma 20,000 3,000 8,500 8,500 20,000
19 10/3/2009 Alda 30,000 3,000 13,500 13,500 30,000
20 11/3/2009 Ny. Ayu 20,000 3,000 8,500 8,500 20,000
21 Ny. Rani 50,000 3,000 23,500 23,500 50,000
22 Ella 20,000 3,000 8,500 8,500 20,000
23 Nining 95,000 3,000 46,000 46,000 95,000
24 Neni 50,000 3,000 23,500 23,500 50,000
25 Adisya 10,000 3,000 7,000 10,000
26 Nn. Rian 25,000 3,000 11,000 11,000 25,000
27 12/3/2009 Medi 30,000 3,000 13,500 13,500 30,000
28 13/3/2009 Ny. Nenden 20,000 20,000 20,000
29 Syafira 30,000 3,000 13,500 13,500 30,000
30 14/3/09 Andika 20,000 3,000 8,500 8,500 20,000
31 Limbar 70,000 3,000 33,500 33,500 70,000
32 Yulianti 70,000 3,000 33,500 33,500 70,000
33 Ny. Eni 70,000 3,000 33,500 33,500 70,000
34 16/3/09 Tn. Agustinus 30,000 3,000 13,500 13,500 30,000
35 Ny. Musira 20,000 3,000 8,500 8,500 20,000
36 Ny. Nenden 30,000 30,000 30,000
37 18/3/09 Ny. Reni 30,000 3,000 13,500 13,500 30,000
38 Andika 30,000 3,000 13,500 13,500 30,000
39 19/3/09 Ny. Tati 70,000 3,000 33,500 33,500 70,000
40 Tn. Ridwan 60,000 3,000 28,500 28,500 60,000
41 Ny. Rani 40,000 3,000 18,500 18,500 40,000
42 Medi 115,000 3,000 56,000 56,000 115,000
43 Neni 40,000 3,000 18,500 18,500 40,000
44 Aditya 35,000 3,000 16,000 16,000 35,000
45 20/3/09 Ny. Yulianti 30,000 3,000 13,500 13,500 30,000
46 Ruti 200,000 3,000 98,500 98,500 200,000
47 Ny. Musira 20,000 3,000 8,500 8,500 20,000
48 21/3/09 Bagas 10,000 10,000 10,000
49 23/3/09 An. Fahmi 35,000 3,000 16,000 16,000 35,000
50 Wildan 30,000 3,000 13,500 13,500 30,000
51 Oriza 30,000 3,000 13,500 13,500 30,000
52 24/3/09 Ny. Imat 25,000 3,000 11,000 11,000 25,000
53 Ny. Eni 75,000 3,000 36,000 36,000 75,000
54 Tati 25,000 3,000 11,000 11,000 25,000
55 M. Aldi 25,000 3,000 11,000 11,000 25,000
56 25/3/09 Teti 30,000 3,000 13,500 13,500 30,000
57 Ny. Neneng 30,000 3,000 13,500 13,500 30,000
58 Ny. Rani 40,000 3,000 18,500 18,500 40,000
59 27/3/09 Ny. Yulianti 30,000 3,000 13,500 13,500 30,000
60 Eva 70,000 3,000 33,500 33,500 70,000
61 Farel 30,000 3,000 13,500 13,500 30,000
62 30/3/09 Ristia 70,000 3,000 33,500 33,500 70,000
63 Tati 85,000 3,000 41,000 41,000 85,000
64 Adelia 60,000 3,000 28,500 28,500 60,000
65 31/3/09 Ny. Yulianti 20,000 3,000 8,500 8,500 20,000
66 Ny. Imet 40,000 3,000 18,500 18,500 40,000
67 Ny. Eni 100,000 3,000 48,500 48,500 100,000
3,128,000 186,000 1,437,000 1,505,000 3,128,000
PERIODE MARET 2009
JASA ALAT &

DOKTER BAHAN
1 4/3/2009 Ny. Siti Aisyah 25,000 5,000 10,000 10,000 25,000
2 Ny. Sri Handayani 40,000 20,000 20,000 40,000
3 Tn. Dindin. S 25,000 12,500 12,500 25,000
4 7/3/2009 Tn. Paulus Anang 15,000 5,000 5,000 5,000 15,000
5 10/3/2009 Ny. Siti Aisyah 25,000 12,500 12,500 25,000
6 An. Putri 25,000 12,500 12,500 25,000
7 Kezia 25,000 12,500 12,500 25,000
8 Rida. F 30,000 15,000 15,000 30,000
9 11/3/2009 Tn. Dindin. S 30,000 15,000 15,000 30,000
10 16/3/09 Ny. Siti Aisyah 25,000 5,000 10,000 10,000 25,000
11 Kartika 15,000 5,000 5,000 5,000 15,000
12 17/3/09 Ny. Koyimah 15,000 5,000 5,000 5,000 15,000
13 An. Putri 25,000 12,500 12,500 25,000
14 18/3/09 Tn. Dindin. S 15,000 7,500 7,500 15,000
15 An. Putri 25,000 5,000 10,000 10,000 25,000
16 19/3/09 Kezia 25,000 12,500 12,500 25,000
17 Ida 25,000 12,500 12,500 25,000
18 Tn. Dindin. S 15,000 7,500 7,500 15,000
19 20/3/09 Kezia 25,000 12,500 12,500 25,000
20 Ida 40,000 20,000 20,000 40,000
21 21/3/09 Ida 25,000 12,500 12,500 25,000
22 An. Putri 25,000 12,500 12,500 25,000
23 23/3/09 Ny. Siti Aisyah 25,000 5,000 10,000 10,000 25,000
24 24/3/09 Kartika 15,000 5,000 5,000 5,000 15,000
25 Rida. F 40,000 20,000 20,000 40,000
26 Tn. Dindin. S 15,000 7,500 7,500 15,000
27 27/3/09 An. Putri 30,000 15,000 15,000 30,000
28 Ny. Mila 15,000 5,000 5,000 5,000 15,000
29 28/3/09 Ida 40,000 20,000 20,000 40,000
30 An. Putri 40,000 20,000 20,000 40,000
31 31/3/09 Ny. Siti Aisyah 15,000 5,000 5,000 5,000 15,000
Kezia 40,000 20,000 20,000 40,000
Tn. Dindin. S 40,000 20,000 20,000 40,000
TOTAL 855,000 40,000 317,500 317,500 855,000

1 3/3/2009 Faktur Gigi 94,000
3 22/3/09 Faktur Gigi 41,000
TOTAL 435,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Maret 1,505,000 435,000 1,070,000 535,000 535,000
2 Maret 317,500.00 317,500 158,750 158,750
693,750 693,750


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Direktur KSBL
PERIODE APRIL 2009
JASA ALAT &

DOKTER BAHAN
1 1/4/2009 Dian Eka 40,000 3,000 18,500 18,500 40,000
2 Nurhayati 60,000 3,000 28,500 28,500 60,000
3 Andika 50,000 3,000 23,500 23,500 50,000
30,000 3,000 13,500 13,500 30,000
4 Ny. Neneng 50,000 3,000 23,500 23,500 50,000
5 Ny. Rani 40,000 3,000 18,500 18,500 40,000
6 Iis Santi 20,000 3,000 8,500 8,500 20,000
7 Rian 60,000 3,000 28,500 28,500 60,000
8 3/4/2009 Tn. Aceng 40,000 3,000 18,500 18,500 40,000
9 Ridwan 20,000 3,000 8,500 8,500 20,000
10 4/4/2009 Syifa - - -
11 Ny. Tati 100,000 3,000 48,500 48,500 100,000
12 Adelia 40,000 3,000 18,500 18,500 40,000
13 Reynol 20,000 3,000 8,500 8,500 20,000
14 6/4/2009 Tn. Asep Taryana 25,000 3,000 11,000 11,000 25,000
15 Yasmin 20,000 3,000 8,500 8,500 20,000
16 7/4/2009 Ny. Yulianti 40,000 3,000 18,500 18,500 40,000
17 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
18 Ny. Imet 20,000 3,000 8,500 8,500 20,000
19 Neni 40,000 3,000 18,500 18,500 40,000
20 8/4/2009 Tn. Fery 30,000 3,000 13,500 13,500 30,000
21 Andila 20,000 3,000 8,500 8,500 20,000
22 Dian Eka 40,000 3,000 18,500 18,500 40,000
23 Sabrina 16,000 8,000 8,000 16,000
24 Rani 40,000 3,000 18,500 18,500 40,000
25 11/4/2009 Ny. Yulianti 40,000 3,000 18,500 18,500 40,000
26 Tn. Indra 95,000 3,000 46,000 46,000 95,000
27 14/4/2009 Tn. Fery 60,000 3,000 28,500 28,500 60,000
28 Tn. Riski 20,000 3,000 8,500 8,500 20,000
29 Sutiono 50,000 3,000 23,500 23,500 50,000
30 Ny. Fatimah 50,000 3,000 23,500 23,500 50,000
31 Ny. Eni 75,000 3,000 36,000 36,000 75,000
32 15/4/09 Farel 30,000 3,000 13,500 13,500 30,000
33 Ny. Sukarsih 20,000 3,000 8,500 8,500 20,000
34 Winda 10,000 10,000 10,000
35 Ny. Dedeh 20,000 3,000 8,500 8,500 20,000
36 Andika 70,000 3,000 33,500 33,500 70,000
37 Sutiono 130,000 3,000 63,500 63,500 130,000
38 Anisa 100,000 3,000 48,500 48,500 100,000
39 Neneng 40,000 3,000 18,500 18,500 40,000
40 16/4/09 Tn. Nanang 70,000 3,000 33,500 33,500 70,000
41 An. Rian 30,000 3,000 13,500 13,500 30,000
42 Dian Eka 40,000 3,000 18,500 18,500 40,000
43 Sutiono 150,000 3,000 73,500 73,500 150,000
44 Neni 120,000 3,000 58,500 58,500 120,000
45 17/4/09 An. Hisyam 30,000 3,000 13,500 13,500 30,000
46 Tn. Adit 10,000 10,000 10,000
47 Tn. Ade 20,000 3,000 8,500 8,500 20,000
48 18/4/09 Farel 25,000 3,000 11,000 11,000 25,000
49 Wildan 60,000 3,000 28,500 28,500 60,000
50 Hesti 20,000 3,000 8,500 8,500 20,000
51 Bagas 10,000 10,000 10,000
52 Ny. Wahyuni 10,000 10,000 10,000
53 20/4/09 Tn. E. Koswara 25,000 3,000 11,000 11,000 25,000
54 Andika 70,000 3,000 33,500 33,500 70,000
55 Erwin 130,000 3,000 63,500 63,500 130,000
56 Ny. Reni 50,000 3,000 23,500 23,500 50,000
57 Nt. Ruti 25,000 3,000 11,000 11,000 25,000
58 23/4/09 An. Rian 30,000 3,000 13,500 13,500 30,000
59 Neneng 100,000 3,000 48,500 48,500 100,000
60 Ny. Fatimah 30,000 3,000 13,500 13,500 30,000
61 Nurhayati 16,000 8,000 8,000 16,000
62 An. Syfa 30,000 3,000 13,500 13,500 30,000
63 25/4/09 Syifa 10,000 10,000 10,000
64 Farel 20,000 3,000 8,500 8,500 20,000
65 Resti 50,000 3,000 23,500 23,500 50,000
66 Irfan 60,000 3,000 28,500 28,500 60,000
67 Wildan 30,000 3,000 13,500 13,500 30,000
68 Ny. Ooh 10,000 10,000 10,000
69 Tn. Wahyu 10,000 10,000 10,000
2,982,000 180,000 1,366,000 1,436,000 2,982,000
PERIODE APRIL 2009
JASA ALAT &

DOKTER BAHAN
70 27/4/09 Tn. Iwan 50,000 3,000 23,500 23,500 50,000
71 Ny. Cicih 25,000 3,000 11,000 11,000 25,000
72 28/4/09 An. Farel 25,000 3,000 11,000 11,000 25,000
73 Heri 60,000 3,000 28,500 28,500 60,000
74 Ny. Eni 230,000 3,000 113,500 113,500 230,000
75 Miftah 50,000 3,000 23,500 23,500 50,000
76 29/4/09 Ny. Yayu 150,000 3,000 73,500 73,500 150,000
77 Ny. Sri 25,000 3,000 11,000 11,000 25,000
78 Andika 70,000 3,000 33,500 33,500 70,000
79 Nurhayati 50,000 25,000 25,000 50,000
80 Ny. Fatimah 30,000 3,000 13,500 13,500 30,000
81 30/4/09 Ny. Teti 30,000 3,000 13,500 13,500 30,000
82 Tegar 100,000 3,000 48,500 48,500 100,000
TOTAL 3,877,000 216,000 1,795,500 1,865,500 3,877,000

PERIODE APRIL 2009
JASA ALAT &

DOKTER BAHAN
1 1/4/2009 Kezia 30,000 15,000 15,000 30,000
2 Tn. Dindin. S 40,000 20,000 20,000 40,000
3 3/4/2009 Azizah 20,000 10,000 10,000 20,000
4 4/4/2009 Rini Mariani 15,000 5,000 5,000 5,000 15,000
5 7/4/2009 Kezia 40,000 20,000 20,000 40,000
6 8/4/2009 Kezia 25,000 12,500 12,500 25,000
7 Ny. Jumariah 25,000 5,000 10,000 10,000 25,000
8 11/4/2009 Ny. Djenab 30,000 15,000 15,000 30,000
9 11/3/2009 Siti 15,000 5,000 5,000 5,000 15,000
10 16/4/09 Ny. Ellis 20,000 5,000 7,500 7,500 20,000
11 Ny. Djenab 25,000 12,500 12,500 25,000
12 17/4/09 Tn. Jajang 15,000 7,500 7,500 15,000
13 20/4/09 Tn. Surya 25,000 12,500 12,500 25,000
14 21/4/09 Ny. Djenab 25,000 12,500 12,500 25,000
15 22/4/09 Ny. Djenab 25,000 12,500 12,500 25,000
16 23/4/09 Axsel 15,000 5,000 5,000 5,000 15,000
17 Ny. Djenab 25,000 12,500 12,500 25,000
18 27/4/09 Siti. F 15,000 5,000 5,000 5,000 15,000
19 Tn. Surya 25,000 5,000 10,000 10,000 25,000
20 28/4/09 Ny. Djenab 25,000 12,500 12,500 25,000
21 29/4/09 Ny. Djenab 25,000 12,500 12,500 25,000
22 30/4/09 Axsel 15,000 7,500 7,500 15,000
TOTAL 520,000 35,000 242,500 242,500 520,000

1 14/4/09 Faktur Gigi Alkohol 1 liter 37,500
2 16/4/09 Service Dental Point 160,000
3 24/4/09 Hand Schoen 1 Box 41,000
4 29/4/09 Chlor Etil 105,000
TOTAL 593,500
KEUNTUNGAN
KSBL DRG. DEWI
1 April 1,436,000 593,500 842,500 421,250 421,250
2 April 242,500.00 242,500 121,250 121,250
542,500 542,500
Cimahi, 5 Mei 2009


Menyetujui,

Direktur KSBL
PERIODE MEI 2009
JASA ALAT &

DOKTER BAHAN
1 1/5/2009 Ny. Nila 100,000 3,000 48,500 48,500 100,000
2 2/5/2009 Farel 30,000 3,000 13,500 13,500 30,000
3 Anisah 20,000 3,000 8,500 8,500 20,000
4 Ahlan 10,000 10,000 10,000
5 6/5/2009 Ny. Erni 30,000 3,000 13,500 13,500 30,000
6 Ny. Rani 40,000 3,000 18,500 18,500 40,000
7 Andra 35,000 3,000 16,000 16,000 35,000
8 7/5/2009 Tn. Zulmusril 90,000 3,000 43,500 43,500 90,000
9 Ny. Rani Free -
10 8/5/2009 Farel 50,000 3,000 23,500 23,500 50,000
11 11/5/2009 Ny. Nining 50,000 3,000 23,500 23,500 50,000
12 12/5/2009 Farel 100,000 3,000 48,500 48,500 100,000
13 Heri 80,000 3,000 38,500 38,500 80,000
14 Anggita 40,000 3,000 18,500 18,500 40,000
15 Ny. Rani 40,000 3,000 18,500 18,500 40,000
16 14/5/09 Dewi 25,000 3,000 11,000 11,000 25,000
17 Tn. Zulmusril 35,000 3,000 16,000 16,000 35,000
18 15/5/09 Ny. Nila 90,000 3,000 43,500 43,500 90,000
19 Salsa 40,000 3,000 18,500 18,500 40,000
20 Tn. Bronto 10,000 10,000 10,000
21 16/5/09 Farel 30,000 3,000 13,500 13,500 30,000
22 18/5/09 Siti. K 30,000 3,000 13,500 13,500 30,000
23 19/5/09 Ny. Lilis 20,000 20,000 20,000
24 Farel 30,000 3,000 13,500 13,500 30,000
25 Ny. Siti Aminah 40,000 3,000 18,500 18,500 40,000
26 20/5/09 Andika 105,000 3,000 51,000 51,000 105,000
27 Anggita 40,000 3,000 18,500 18,500 40,000
28 Heri 80,000 3,000 38,500 38,500 80,000
29 Fita 70,000 3,000 33,500 33,500 70,000
30 22/5/09 Apandi 100,000 3,000 48,500 48,500 100,000
31 Alif 40,000 3,000 18,500 18,500 40,000
32 Tn. Bronto 70,000 3,000 33,500 33,500 70,000
33 Ny. Teti 25,000 3,000 11,000 11,000 25,000
34 23/5/09 Farel 60,000 3,000 28,500 28,500 60,000
35 25/5/09 Ny. Siti Aminah 40,000 3,000 18,500 18,500 40,000
36 26/5/09 Ny. Lilis 20,000 20,000 20,000
37 Ny. Dwi 50,000 3,000 23,500 23,500 50,000
38 Putu Putra 100,000 3,000 48,500 48,500 100,000
39 Ny. Fatimah 50,000 3,000 23,500 23,500 50,000
40 Ny. Rani 110,000 3,000 53,500 53,500 110,000
41 27/5/09 Andika 80,000 3,000 38,500 38,500 80,000
42 Heri 80,000 3,000 38,500 38,500 80,000
43 28/5/09 Ny. Dedeh 40,000 3,000 18,500 18,500 40,000
44 An. Erika 40,000 3,000 18,500 18,500 40,000
45 29/5/09 Ny. Jami 40,000 3,000 18,500 18,500 40,000
46 Deni Ismail 50,000 3,000 23,500 23,500 50,000
47 An. Yasmin 90,000 3,000 43,500 43,500 90,000
48 Tn. Tarsosno 25,000 3,000 11,000 11,000 25,000
49 30/5/09 Reni 40,000 3,000 18,500 18,500 40,000
50 Farel 75,000 3,000 36,000 36,000 75,000
2,585,000 135,000 1,195,000 1,255,000 2,585,000
PERIODE MEI 2009
JASA ALAT &

DOKTER BAHAN
1 1/5/2009 Teguh 25,000 12,500 12,500 25,000
2 4/5/2009 Ny. Ai 40,000 20,000 20,000 40,000
3 6/5/2009 Jumariah 25,000 5,000 10,000 10,000 25,000
4 Djaenab 25,000 12,500 12,500 25,000
5 7/5/2009 Djaenab 25,000 12,500 12,500 25,000
6 11/5/2009 Jumariah 25,000 12,500 12,500 25,000
7 S. Ade 25,000 12,500 12,500 25,000
8 15/5/09 Amal 30,000 15,000 15,000 30,000
9 19/5/09 Djaenab 30,000 15,000 15,000 30,000
10 20/5/09 Djaenab 30,000 15,000 15,000 30,000
11 22/5/09 Adi 15,000 7,500 7,500 15,000
12 Azizah 40,000 20,000 20,000 40,000
13 26/5/09 Ny. Elin 40,000 20,000 20,000 40,000
14 Tn. Waluyo 25,000 12,500 12,500 25,000
15 27/5/09 Ny. Ellis 15,000 7,500 7,500 15,000
TOTAL 415,000 5,000 205,000 205,000 415,000

1 2/5/2009 Fuji IX ART Mini Pack 1 pak 240,000
2 15/5/09 Pehacain Inj 1 Box 61,500
TOTAL 551,500
KEUNTUNGAN
KSBL DRG. DEWI
1 Mei 1,255,000 551,500 703,500 351,750 351,750
2 Mei 205,000.00 205,000 102,500 102,500
454,250 454,250
Cimahi, 2 Juni 2009


Menyetujui,

Direktur KSBL
PERIODE JUNI 2009
JASA ALAT &

DOKTER BAHAN
1 1/6/2009 Siti Aminah 40,000 3,000 18,500 18,500 40,000
2 Ny. Ati 25,000 3,000 11,000 11,000 25,000
3 Tn. Tomi 40,000 3,000 18,500 18,500 40,000
4 2/6/2009 Tn. Tarsono 60,000 3,000 28,500 28,500 60,000
5 Thomas. A 120,000 3,000 58,500 58,500 120,000
6 Devi 120,000 3,000 58,500 58,500 120,000
7 Ny. Neng Sri 25,000 3,000 11,000 11,000 25,000
8 Sutiyono 120,000 3,000 58,500 58,500 120,000
9 Ny. Fatimah 40,000 3,000 18,500 18,500 40,000
10 3/6/2009 Ny. Devi. S 50,000 3,000 23,500 23,500 50,000
11 Dani 25,000 3,000 11,000 11,000 25,000
12 Heni 80,000 3,000 38,500 38,500 80,000
13 4/6/2009 Tn. Setiawan 80,000 3,000 38,500 38,500 80,000
14 an. Fani 50,000 3,000 23,500 23,500 50,000
15 Ny. Tri 40,000 3,000 18,500 18,500 40,000
16 Nani 100,000 3,000 48,500 48,500 100,000
17 Ny. Teti 25,000 3,000 11,000 11,000 25,000
18 5/6/2009 Sugianti 150,000 3,000 73,500 73,500 150,000
19 Elin 70,000 3,000 33,500 33,500 70,000
20 6/6/2009 Reni 40,000 3,000 18,500 18,500 40,000
21 Farel 60,000 3,000 28,500 28,500 60,000
22 Tn. Sugiono 20,000 3,000 8,500 8,500 20,000
23 8/6/2009 Ny. Jami 100,000 3,000 48,500 48,500 100,000
24 Tn. Irfan 40,000 3,000 18,500 18,500 40,000
25 An. Zelfa 40,000 3,000 18,500 18,500 40,000
26 Ny. Pratiwi 25,000 3,000 11,000 11,000 25,000
27 Tn. Tomi 40,000 3,000 18,500 18,500 40,000
28 9/6/2009 Tn. Sugiono 75,000 3,000 36,000 36,000 75,000
29 Devi 80,000 3,000 38,500 38,500 80,000
30 Ny. Tri 120,000 3,000 58,500 58,500 120,000
31 Reni 40,000 3,000 18,500 18,500 40,000
32 10/6/2009 Yola 100,000 3,000 48,500 48,500 100,000
33 Nani 80,000 3,000 38,500 38,500 80,000
34 Tn. Dedi. S 75,000 3,000 36,000 36,000 75,000
35 Thomas. A 120,000 3,000 58,500 58,500 120,000
36 Ny. Fatimah 115,000 3,000 56,000 56,000 115,000
37 Tn. Ripai 35,000 3,000 16,000 16,000 35,000
38 11/6/2009 Ny. Pratiwi 25,000 3,000 11,000 11,000 25,000
39 Dani 100,000 3,000 48,500 48,500 100,000
40 Heni 230,000 3,000 113,500 113,500 230,000
41 Bintang 80,000 3,000 38,500 38,500 80,000
42 Sutiyono 120,000 3,000 58,500 58,500 120,000
43 12/6/2009 Farel 40,000 3,000 18,500 18,500 40,000
44 Tn. Mulyana 65,000 3,000 31,000 31,000 65,000
45 Adnin 40,000 3,000 18,500 18,500 40,000
46 Tn. Zulmusril 105,000 3,000 51,000 51,000 105,000
47 Mela 100,000 3,000 48,500 48,500 100,000
48 Ny. Pratiwi 70,000 3,000 33,500 33,500 70,000
49 Tn. Koswara 25,000 3,000 11,000 11,000 25,000
50 15/6/2009 Maria 30,000 3,000 13,500 13,500 30,000
51 Eko 100,000 3,000 48,500 48,500 100,000
52 Ny. Endang 25,000 3,000 11,000 11,000 25,000
53 Tn. Tomi 40,000 3,000 18,500 18,500 40,000
54 Tn. Adit 10,000 10,000 10,000
55 16/6/2009 Teti 50,000 3,000 23,500 23,500 50,000
56 Sucipto 50,000 3,000 23,500 23,500 50,000
57 Saufa 130,000 3,000 63,500 63,500 130,000
58 Nani 80,000 3,000 38,500 38,500 80,000
59 Reni 40,000 3,000 18,500 18,500 40,000
60 Devi 80,000 3,000 38,500 38,500 80,000
61 17/6/2009 Siti Aminah 40,000 3,000 18,500 18,500 40,000
62 Tn. Suhendar 70,000 3,000 33,500 33,500 70,000
63 Thomas. A 120,000 3,000 58,500 58,500 120,000
64 18/6/2009 Yuda 20,000 3,000 8,500 8,500 20,000
65 Yudi 20,000 3,000 8,500 8,500 20,000
66 Ny. Teti 50,000 3,000 23,500 23,500 50,000
67 Bintang 80,000 3,000 38,500 38,500 80,000
68 Ny. Tri 40,000 3,000 18,500 18,500 40,000
69 Ny. Lilis 25,000 3,000 11,000 11,000 25,000
70 19/6/2009 Ny. Nila 40,000 3,000 18,500 18,500 40,000
71 Ny. Tri 40,000 3,000 18,500 18,500 40,000

PERIODE JUNI 2009
JASA ALAT &

DOKTER BAHAN
72 Tn. Handri 70,000 3,000 33,500 33,500 70,000
73 20/6/09 Tn. Zulmusril 35,000 3,000 16,000 16,000 35,000
74 Dimas Arya 20,000 3,000 8,500 8,500 20,000
75 Farel 35,000 3,000 16,000 16,000 35,000
76 22/6/09 Ifran 80,000 3,000 38,500 38,500 80,000
77 Marcelino 40,000 3,000 18,500 18,500 40,000
78 Tomi 40,000 3,000 18,500 18,500 40,000
79 Devi 130,000 3,000 63,500 63,500 130,000
80 Ny. Tarsilah 80,000 3,000 38,500 38,500 80,000
81 23/6/09 Farel 40,000 3,000 18,500 18,500 40,000
82 Tn. Zulmusril 35,000 3,000 16,000 16,000 35,000
83 Ny. Ernawati 80,000 3,000 38,500 38,500 80,000
84 Yuda 20,000 3,000 8,500 8,500 20,000
85 Yudi 20,000 3,000 8,500 8,500 20,000
86 Reni 40,000 3,000 18,500 18,500 40,000
87 Dewi 40,000 3,000 18,500 18,500 40,000
88 24/6/09 Yuli 96,000 48,000 48,000 96,000
89 Siti Aminah 40,000 3,000 18,500 18,500 40,000
90 Ny. Nila 105,000 3,000 51,000 51,000 105,000
91 Teti 80,000 3,000 38,500 38,500 80,000
92 Saufa 50,000 3,000 23,500 23,500 50,000
93 Sucipto 40,000 3,000 18,500 18,500 40,000
94 25/6/09 Ny. Ernawati 65,000 3,000 31,000 31,000 65,000
95 Ny. Tarsilah 90,000 3,000 43,500 43,500 90,000
96 Siti Aminah 60,000 3,000 28,500 28,500 60,000
97 Devi 40,000 3,000 18,500 18,500 40,000
98 Bintang 40,000 3,000 18,500 18,500 40,000
99 26/6/2009 Wildan 150,000 3,000 73,500 73,500 150,000
100 Tn. Irfan 40,000 3,000 18,500 18,500 40,000
101 Tn. Tata 80,000 3,000 38,500 38,500 80,000
102 Nn. Ai. M 40,000 20,000 20,000 40,000
103 An. Adela 70,000 3,000 33,500 33,500 70,000
104 27/6/09 Farel 85,000 3,000 41,000 41,000 85,000
105 29/6/09 Tn. Tomi 40,000 3,000 18,500 18,500 40,000
106 30/6/09 Reni 40,000 3,000 18,500 18,500 40,000
6,701,000 309,000 3,191,000 3,201,000 6,701,000

PERIODE JUNI 2009
JASA ALAT &

DOKTER BAHAN
1 1/6/2009 An. Gita 25,000 5,000 10,000 10,000 25,000
2 Ny. Tin tin 40,000 5,000 17,500 17,500 40,000
3 2/6/2009 Tn. Surya Bakti 15,000 5,000 5,000 5,000 15,000
4 Tn. Waluyo 25,000 12,500 12,500 25,000
5 Djaenab 40,000 20,000 20,000 40,000
6 3/6/2009 Djaenab 25,000 12,500 12,500 25,000
7 4/6/2009 Djaenab 25,000 12,500 12,500 25,000
8 6/6/2009 Iceu Susanti 15,000 5,000 5,000 5,000 15,000
9 8/6/2009 Tn. Waluyo 25,000 12,500 12,500 25,000
10 9/6/2009 Aulia 20,000 10,000 10,000 20,000
11 Tn. Waluyo 25,000 12,500 12,500 25,000
12 10/6/2009 Ny. Sri. W 45,000 22,500 22,500 45,000
13 15/6/2009 Teguh 30,000 15,000 15,000 30,000
14 16/6/2009 Djaenab 25,000 12,500 12,500 25,000
15 Tn. Jajang 15,000 7,500 7,500 15,000
16 19/6/2009 Teguh 25,000 12,500 12,500 25,000
17 20/6/2009 Teguh 25,000 12,500 12,500 25,000
18 22/6/2009 Santi 40,000 5,000 17,500 17,500 40,000
19 23/6/2009 Djaenab 30,000 15,000 15,000 30,000
20 24/6/2009 Djaenab 40,000 20,000 20,000 40,000
21 25/6/2009 Tn. Waluyo 30,000 15,000 15,000 30,000
22 29/6/2009 Tn. Jajang 25,000 5,000 10,000 10,000 25,000
23 30/6/2009 Djaenab 25,000 12,500 12,500 25,000
TOTAL 635,000 30,000 302,500 302,500 635,000

1 2/6/2009 Sensi Gloves Size 2 1 pak 52,000
2 16/6/09 Crcsopate 1 Box 220,000
3 22/6/09 Hand Schoen 1 Box 37,000
4 26/6/09 Pehacain Inj 1 Box 64,900
5 Caviton Pink / White 99,000
6 Fuji IX GP 1-1 218,000
7 Masker 24,000
TOTAL 964,900
KEUNTUNGAN
KSBL DRG. DEWI
1 Juni 3,201,000 964,900 2,236,100 1,118,050 1,118,050
2 Juni 302,500.00 302,500 151,250 151,250
1,269,300 1,269,300
Cimahi, 3 Juli 2009


Menyetujui,

Direktur KSBL
PERIODE JULI 2009
JASA ALAT &

DOKTER BAHAN
1 1/7/2009 Ny. Tri 20,000 3,000 8,500 8,500 20,000
2 Wiki 65,000 3,000 31,000 31,000 65,000
3 Bintang 120,000 3,000 58,500 58,500 120,000
4 Ny. Yayat 40,000 3,000 18,500 18,500 40,000
5 2/7/2009 An. Wiliam 60,000 3,000 28,500 28,500 60,000
6 Ai Mudoniah 80,000 40,000 40,000 80,000
7 Ny. Jai 110,000 3,000 53,500 53,500 110,000
8 Ny. Tarwilah 80,000 3,000 38,500 38,500 80,000
9 Devi 40,000 3,000 18,500 18,500 40,000
10 Nani 80,000 3,000 38,500 38,500 80,000
11 3/7/2009 Dela 40,000 3,000 18,500 18,500 40,000
12 Eko 80,000 3,000 38,500 38,500 80,000
13 Wilana 90,000 3,000 43,500 43,500 90,000
14 4/7/2009 Ny. Tri 20,000 3,000 8,500 8,500 20,000
15 M. Zen Drajat 20,000 20,000 20,000
16 Andi 20,000 3,000 8,500 8,500 20,000
17 Ny. Lili 40,000 3,000 18,500 18,500 40,000
18 Ny. Yayu 220,000 3,000 108,500 108,500 220,000
19 6/7/2009 An. Sintia 20,000 3,000 8,500 8,500 20,000
20 An. Satria 80,000 3,000 38,500 38,500 80,000
21 Tn. Tomi 110,000 3,000 53,500 53,500 110,000
22 7/7/2009 Feni 40,000 3,000 18,500 18,500 40,000
23 An. Anisa 40,000 3,000 18,500 18,500 40,000
24 Devi 90,000 3,000 43,500 43,500 90,000
25 5/7/2009 Ny. Sananis 60,000 3,000 28,500 28,500 60,000
26 Rifan 40,000 3,000 18,500 18,500 40,000
27 Ny. Tarwilah 80,000 3,000 38,500 38,500 80,000
28 Dedy 20,000 3,000 8,500 8,500 20,000
29 Teti 80,000 3,000 38,500 38,500 80,000
30 Ai 80,000 3,000 38,500 38,500 80,000
31 10/7/2009 Ny. Eka 40,000 3,000 18,500 18,500 40,000
32 An. Ahmad Rifan 140,000 3,000 68,500 68,500 140,000
33 11/7/2009 An. Sabda 40,000 3,000 18,500 18,500 40,000
34 Ny. Yayu 60,000 3,000 28,500 28,500 60,000
35 13/7/2009 M. Zainul 100,000 3,000 48,500 48,500 100,000
36 Lina 50,000 3,000 23,500 23,500 50,000
37 Moh. Robi 25,000 3,000 11,000 11,000 25,000
38 Triyani 50,000 3,000 23,500 23,500 50,000
39 Elin 25,000 3,000 11,000 11,000 25,000
40 Suharyono 60,000 3,000 28,500 28,500 60,000
41 14/7/2009 Ny. Tri 70,000 3,000 33,500 33,500 70,000
42 An. Sabda 40,000 3,000 18,500 18,500 40,000
43 Feri 40,000 3,000 18,500 18,500 40,000
44 Ai 115,000 57,500 57,500 115,000
45 15/7/2009 Ny. Maryati 40,000 3,000 18,500 18,500 40,000
46 Ai 85,000 42,500 42,500 85,000
47 Ny. Zen 25,000 3,000 11,000 11,000 25,000
48 17/7/2009 Nifa 40,000 3,000 18,500 18,500 40,000
49 Moh. Robi 80,000 3,000 38,500 38,500 80,000
50 Teti 120,000 3,000 58,500 58,500 120,000
51 Tn. Suhartoyo 60,000 3,000 28,500 28,500 60,000
52 Sucipto 40,000 3,000 18,500 18,500 40,000
53 18/7/2009 An. Sabda 40,000 3,000 18,500 18,500 40,000
54 21/7/2009 An. Sabda 40,000 3,000 18,500 18,500 40,000
55 Moh. Robi 80,000 3,000 38,500 38,500 80,000
56 22/7/2009 Irfan 80,000 3,000 38,500 38,500 80,000
57 Tn. Bronto 60,000 3,000 28,500 28,500 60,000
58 Ny. Ayu 20,000 3,000 8,500 8,500 20,000
59 Rangga 40,000 3,000 18,500 18,500 40,000
60 Ny. Kushadayani 40,000 3,000 18,500 18,500 40,000
61 Weni. M 200,000 3,000 98,500 98,500 200,000
62 Reni 115,000 3,000 56,000 56,000 115,000
63 Feni 40,000 3,000 18,500 18,500 40,000
64 23/7/2009 Ny. Sarmini 60,000 3,000 28,500 28,500 60,000
65 24/7/2009 An. Meiza 50,000 3,000 23,500 23,500 50,000
66 25/7/2009 Ani - - -
67 Dani Supardan - - -
68 An. Sabda 105,000 3,000 51,000 51,000 105,000
69 Bagas - - -
70 28/7/2009 Tn. Gojali 40,000 3,000 18,500 18,500 40,000
71 Rangga 40,000 3,000 18,500 18,500 40,000

PERIODE JULI 2009
JASA ALAT &

DOKTER BAHAN
72 28/7/2009 Tn. Asep Sopandi 25,000 3,000 11,000 11,000 25,000
73 Feni 40,000 3,000 18,500 18,500 40,000
74 Bebin 40,000 3,000 18,500 18,500 40,000
75 29/7/2009 Tn. Firdaus 20,000 3,000 8,500 8,500 20,000
76 Ny. Kushadayani 40,000 3,000 18,500 18,500 40,000
77 30/7/2009 Tn. Hari 25,000 3,000 11,000 11,000 25,000
78 Tn. Nandi 40,000 3,000 18,500 18,500 40,000
79 Delta 40,000 3,000 18,500 18,500 40,000
4,630,000 216,000 2,197,000 2,217,000 4,630,000

PERIODE JULI 2009
JASA ALAT &

DOKTER BAHAN
1 2/7/2009 Ace. T 25,000 5,000 10,000 10,000 25,000
2 7/7/2009 Djenab. S 25,000 12,500 12,500 25,000
3 9/7/2009 Waluyo 40,000 20,000 20,000 40,000
4 10/7/2009 Irfan 15,000 5,000 5,000 5,000 15,000
5 13/7/2009 Djenab. S 25,000 12,500 12,500 25,000
6 14/7/2009 Ny. Teguh. W 15,000 7,500 7,500 15,000
7 14/7/2009 Irfan 25,000 5,000 10,000 10,000 25,000
8 15/7/2009 Irfan 40,000 20,000 20,000 40,000
9 15/7/2009 Djenab. S 25,000 12,500 12,500 25,000
10 16/7/2009 Irfan 25,000 12,500 12,500 25,000
11 17/7/2009 Irfan 40,000 20,000 20,000 40,000
12 Djenab. S 30,000 15,000 15,000 30,000
13 21/7/2009 Irfan 25,000 12,500 12,500 25,000
14 22/7/2009 Irfan 30,000 15,000 15,000 30,000
15 27/7/2009 An. Nur Tahara 25,000 5,000 10,000 10,000 25,000
16 28/7/2009 Irfan 40,000 20,000 20,000 40,000
17 Djenab. S 40,000 20,000 20,000 40,000
18 29/7/2009 Irfan 40,000 20,000 20,000 40,000
19 30/7/2009 An. Amal 35,000 17,500 17,500 35,000
20 An. Kartika 40,000 20,000 20,000 40,000
TOTAL 605,000 20,000 292,500 292,500 605,000

1 23/7/09 Clor Etil 1 107,500
2 25/7/09 Bahan Tambal 300,000
TOTAL 657,500
KEUNTUNGAN
KSBL DRG. DEWI
1 Juli 2,217,000 657,500 1,559,500 779,750 779,750
2 Juli 292,500.00 292,500 146,250 146,250
926,000 926,000

Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 3/8/2009 Ny. Ayu 40,000 3,000 18,500 18,500 40,000
2 Ny. Mintarsih 60,000 3,000 28,500 28,500 60,000
3 Evi 20,000 3,000 8,500 8,500 20,000
4 Mia 40,000 3,000 18,500 18,500 40,000
5 4/8/2009 Tina 40,000 3,000 18,500 18,500 40,000
6 5/8/2009 Ny. Kushandayani 40,000 3,000 18,500 18,500 40,000
7 Risnawati 40,000 3,000 18,500 18,500 40,000
8 Robi 40,000 3,000 18,500 18,500 40,000
9 Bintang 40,000 3,000 18,500 18,500 40,000
10 Ny. Yayat 40,000 3,000 18,500 18,500 40,000
11 6/8/2009 Ny. Maryati 40,000 3,000 18,500 18,500 40,000
12 Sucipto 40,000 3,000 18,500 18,500 40,000
13 Bayu 140,000 3,000 68,500 68,500 140,000
14 8/8/2009 Ny. Dwiyani 130,000 3,000 63,500 63,500 130,000
15 Robi 10,000 10,000 10,000
16 Fadillah 40,000 3,000 18,500 18,500 40,000
17 Tn. Asep 70,000 3,000 33,500 33,500 70,000
18 Tn. Aseri 55,000 3,000 26,000 26,000 55,000
19 11/8/2009 Riska. R 36,000 18,000 18,000 36,000
20 Risnawati 25,000 3,000 11,000 11,000 25,000
21 Rangga 40,000 3,000 18,500 18,500 40,000
22 Tina 40,000 3,000 18,500 18,500 40,000
23 Feri 115,000 3,000 56,000 56,000 115,000
24 12/8/2009 Ny. Kushandayani 115,000 3,000 56,000 56,000 115,000
25 Bintang 115,000 3,000 56,000 56,000 115,000
26 Ny. Yayat 40,000 3,000 18,500 18,500 40,000
27 13/8/2009 Teti. K 25,000 3,000 11,000 11,000 25,000
28 Sucipto 115,000 3,000 56,000 56,000 115,000
29 Bayu 100,000 3,000 48,500 48,500 100,000
30 14/8/2009 Adnin 40,000 3,000 18,500 18,500 40,000
31 Sofi 20,000 3,000 8,500 8,500 20,000
32 Hj. Aminah 20,000 3,000 8,500 8,500 20,000
33 Tn. Sugito 20,000 3,000 8,500 8,500 20,000
34 Ny. Mintarsih 35,000 3,000 16,000 16,000 35,000
35 15/8/2009 Irawan 20,000 3,000 8,500 8,500 20,000
36 18/8/2009 Resti Ayu 40,000 3,000 18,500 18,500 40,000
37 Ny. Sartini 80,000 3,000 38,500 38,500 80,000
38 An. Salma 40,000 3,000 18,500 18,500 40,000
39 Tina 40,000 3,000 18,500 18,500 40,000
40 Chandra 80,000 3,000 38,500 38,500 80,000
41 Nn. Rian 50,000 3,000 23,500 23,500 50,000
42 Riska. R 36,000 18,000 18,000 36,000
43 19/8/2009 Fauzan 40,000 3,000 18,500 18,500 40,000
44 Agil 35,000 3,000 16,000 16,000 35,000
45 Teti. K 25,000 3,000 11,000 11,000 25,000
46 Risnawati 40,000 3,000 18,500 18,500 40,000
47 20/8/2009 Andu 20,000 3,000 8,500 8,500 20,000
48 Robi 165,000 3,000 81,000 81,000 165,000
49 Bintang 50,000 3,000 23,500 23,500 50,000
50 Ny. Yayat 115,000 3,000 56,000 56,000 115,000
51 21/8/2009 Ny. Mintarsih 360,000 3,000 178,500 178,500 360,000
52 22/8/2009 Tn. Subandi 20,000 3,000 8,500 8,500 20,000
53 24/8/2009 Ny. Eli 80,000 3,000 38,500 38,500 80,000
54 Erwin 30,000 3,000 13,500 13,500 30,000
55 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
56 25/8/2009 Rangga 115,000 3,000 56,000 56,000 115,000
57 Riska. R 64,000 32,000 32,000 64,000
58 Tina 110,000 3,000 53,500 53,500 110,000
59 26/8/2009 Wahyu 20,000 3,000 8,500 8,500 20,000
60 Riska. R 20,000 20,000 20,000
61 28/8/2009 Wahyu 50,000 3,000 23,500 23,500 50,000
62 Tn. Suryana 20,000 3,000 8,500 8,500 20,000
63 Tn. Deni 20,000 3,000 8,500 8,500 20,000
64 Ny. Mintarsih 20,000 3,000 8,500 8,500 20,000
65 29/8/2009 Theresia 40,000 3,000 18,500 18,500 40,000
66 Mimin 300,000 3,000 148,500 148,500 300,000
67 31/8/2009 Tn. Ukat 20,000 3,000 8,500 8,500 20,000
68 Indah Lestari 40,000 3,000 18,500 18,500 40,000
4,071,000 189,000 1,926,000 1,956,000 4,071,000

JASA ALAT &

DOKTER BAHAN
1 4/8/2009 Irfan 40,000 20,000 20,000 40,000
2 5/8/2009 Irfan 40,000 20,000 20,000 40,000
3 7/8/2009 Rafli 15,000 5,000 5,000 5,000 15,000
4 8/8/2009 Ny. Santi 15,000 5,000 5,000 5,000 15,000
5 10/8/2009 Tn. Surya Bakti 25,000 5,000 10,000 10,000 25,000
6 Tn. Tajudin 15,000 5,000 5,000 5,000 15,000
7 An. Setiawan 40,000 20,000 20,000 40,000
8 11/8/2009 Irfan 15,000 7,500 7,500 15,000
9 Tn. Tajudin 15,000 5,000 5,000 5,000 15,000
10 13/8/2009 Tn. Setiawan 20,000 10,000 10,000 20,000
11 14/8/2009 Tn. Surya Bakti 25,000 12,500 12,500 25,000
12 18/8/2009 Maesaroh 15,000 5,000 5,000 5,000 15,000
13 Rudi. S 40,000 20,000 20,000 40,000
14 24/8/2009 Rafli 15,000 5,000 5,000 5,000 15,000
15 31/8/2009 Tn. Surya Bakti 25,000 12,500 12,500 25,000
16 Tn. Soma 15,000 5,000 5,000 5,000 15,000
TOTAL 375,000 40,000 167,500 167,500 375,000

TOTAL 250,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Agustus 1,956,000 250,000 1,706,000 853,000 853,000
2 Agustus 167,500.00 167,500 83,750 83,750
936,750 936,750


Menyetujui,

Direktur KSBL
JASA ALAT &

DOKTER BAHAN
1 1/9/2009 Sri 20,000 10,000 10,000 20,000
2 Dwi 20,000 3,000 8,500 8,500 20,000
3 Riska. R 135,000 67,500 67,500 135,000
4 2/9/2009 Wahyu 155,000 3,000 76,000 76,000 155,000
5 Sania 20,000 3,000 8,500 8,500 20,000
6 Shandy. A 32,000 16,000 16,000 32,000
7 Neng Ipa 56,000 28,000 28,000 56,000
8 Riska. R 112,000 56,000 56,000 112,000
9 Dwi 50,000 3,000 23,500 23,500 50,000
10 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
11 3/9/2009 Ny. Yayat 150,000 3,000 73,500 73,500 150,000
12 Bintang 50,000 3,000 23,500 23,500 50,000
13 4/9/2009 Regita 40,000 3,000 18,500 18,500 40,000
14 Indah Lestari 40,000 3,000 18,500 18,500 40,000
15 5/9/2009 Toby 20,000 3,000 8,500 8,500 20,000
16 Theresia 40,000 3,000 18,500 18,500 40,000
17 Wahyu 80,000 3,000 38,500 38,500 80,000
18 Tn. Samsudin 20,000 3,000 8,500 8,500 20,000
19 7/9/2009 Lia. K 40,000 3,000 18,500 18,500 40,000
20 Iwan 50,000 3,000 23,500 23,500 50,000
21 8/9/2009 Alif 40,000 3,000 18,500 18,500 40,000
22 Ny. Lita 80,000 3,000 38,500 38,500 80,000
23 Suharso 25,000 3,000 11,000 11,000 25,000
24 James 40,000 3,000 18,500 18,500 40,000
25 Ny. Yayat 50,000 3,000 23,500 23,500 50,000
26 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
27 9/9/2009 Wahyu 80,000 3,000 38,500 38,500 80,000
28 Ny. Lita 70,000 3,000 33,500 33,500 70,000
29 Theresia 80,000 3,000 38,500 38,500 80,000
30 10/9/2009 James 50,000 3,000 23,500 23,500 50,000
31 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
32 11/9/2009 Anindha 10,000 10,000 10,000
33 12/9/2009 Tn. Ujang 20,000 3,000 8,500 8,500 20,000
34 Sobandi 80,000 3,000 38,500 38,500 80,000
35 Ny. Siti Jubaeda 20,000 3,000 8,500 8,500 20,000
36 Wahyu 80,000 3,000 38,500 38,500 80,000
37 Feni 20,000 3,000 8,500 8,500 20,000
38 14/9/2009 An. Dion 20,000 3,000 8,500 8,500 20,000
39 15/9/2009 Tn. Fikri 70,000 3,000 33,500 33,500 70,000
40 James 80,000 3,000 38,500 38,500 80,000
41 Rolan 25,000 3,000 11,000 11,000 25,000
42 Theresia 80,000 3,000 38,500 38,500 80,000
43 Anistin 32,000 16,000 16,000 32,000
44 Dio 40,000 3,000 18,500 18,500 40,000
45 Saefudin 20,000 3,000 8,500 8,500 20,000
46 16/9/2009 Wahyu 185,000 3,000 91,000 91,000 185,000
47 An. Dion 100,000 3,000 48,500 48,500 100,000
48 An. Salma 40,000 3,000 18,500 18,500 40,000
49 Ny. Devina 75,000 3,000 36,000 36,000 75,000
50 17/9/2009 Wahyu 75,000 3,000 36,000 36,000 75,000
51 Ny. Yulianti 65,000 3,000 31,000 31,000 65,000
52 Rian 45,000 3,000 21,000 21,000 45,000
53 Reza 40,000 3,000 18,500 18,500 40,000
54 Ny. Yayat 120,000 3,000 58,500 58,500 120,000
55 28/9/2009 Ny. Hadijah 80,000 3,000 38,500 38,500 80,000
56 29/9/2009 Theresia 80,000 3,000 38,500 38,500 80,000
57 Kharisma 80,000 3,000 38,500 38,500 80,000
58 James 115,000 3,000 56,000 56,000 115,000
59 Tn. Beny 100,000 3,000 48,500 48,500 100,000
60 30/9/2009 Lis Kusmiati 80,000 3,000 38,500 38,500 80,000
3,642,000 159,000 1,736,500 1,746,500 3,642,000

JASA ALAT &

DOKTER BAHAN
1 2/9/2009 Ny. Winarsih 15,000 5,000 5,000 5,000 15,000
2 4/9/2009 Tn. Tajudin 15,000 5,000 5,000 5,000 15,000
3 7/9/2009 Tn. Agus 30,000 5,000 12,500 12,500 30,000
4 11/9/2009 Tn. Surya 25,000 5,000 10,000 10,000 25,000
5 17/9/2009 Ny. Jubaedah 15,000 5,000 5,000 5,000 15,000
6 28/9/2009 Tn. Surya 25,000 5,000 10,000 10,000 25,000
7 28/9/2009 Ny. Djenab 30,000 5,000 12,500 12,500 30,000
8 30/9/2009 Ridwan 15,000 7,500 7,500 15,000
TOTAL 170,000 35,000 67,500 67,500 170,000

Solare PGC, Sarung
1 3/9/2009 239,000
Tangan
2 5/9/2009 Elite Cement 110,000
3 8/9/2009 Gip Stone 1 Kg 19,000
4 16/9/09 Masker 50,000
TOTAL 668,000
KEUNTUNGAN
KSBL DRG. DEWI
1 September 1,746,500 668,000 1,078,500 539,250 539,250
2 September 67,500.00 67,500 33,750 33,750
573,000 573,000


Menyetujui,

Direktur KSBL
JASA ALAT &

DOKTER BAHAN
1 1/10/2009 Ramdani 30,000 3,000 13,500 13,500 30,000
2 Dio 40,000 3,000 18,500 18,500 40,000
3 2/10/2009 dr. Yanti 10,000 10,000 10,000
4 Bu Nuni 10,000 10,000 10,000
5 3/10/2009 Ny. Titis 20,000 3,000 8,500 8,500 20,000
6 Septi 155,000 3,000 76,000 76,000 155,000
7 5/10/2009 Ramdani 30,000 3,000 13,500 13,500 30,000
8 Endi 50,000 3,000 23,500 23,500 50,000
Endi 50,000 3,000 23,500 23,500 50,000
9 6/10/2009 Theresia 100,000 3,000 48,500 48,500 100,000
10 Kharisma 100,000 3,000 48,500 48,500 100,000
11 7/10/2009 Ny. Ratih 30,000 3,000 13,500 13,500 30,000
12 8/10/2009 Tn. Ruslan 80,000 3,000 38,500 38,500 80,000
13 Ny. Ayu 25,000 3,000 11,000 11,000 25,000
14 Reza 40,000 3,000 18,500 18,500 40,000
15 9/10/2009 Tn. Aceng 40,000 3,000 18,500 18,500 40,000
16 10/10/2009 Umar Adipura 100,000 3,000 48,500 48,500 100,000
17 12/10/2009 Rahadian 25,000 3,000 11,000 11,000 25,000
18 Supriyadi 20,000 3,000 8,500 8,500 20,000
19 Tn. Abdul Mukti 25,000 3,000 11,000 11,000 25,000
20 13/10/2009 Markus 40,000 3,000 18,500 18,500 40,000
21 James 350,000 3,000 173,500 173,500 350,000
22 Malus 15,000 3,000 6,000 6,000 15,000
23 Theresia 120,000 3,000 58,500 58,500 120,000
24 Maryati 50,000 3,000 23,500 23,500 50,000
25 15/10/2009 Ny. Lilis 30,000 3,000 13,500 13,500 30,000
26 Wildan 40,000 3,000 18,500 18,500 40,000
27 Markus 110,000 3,000 53,500 53,500 110,000
28 Lia. K 130,000 3,000 63,500 63,500 130,000
29 Dio 40,000 3,000 18,500 18,500 40,000
30 16/10/2009 Tn. Imam 40,000 3,000 18,500 18,500 40,000
31 17/10/2009 Ny. Sri 40,000 3,000 18,500 18,500 40,000
32 19/10/2009 Neng 25,000 3,000 11,000 11,000 25,000
33 Najwa 10,000 10,000 10,000
34 Rizqul 80,000 3,000 38,500 38,500 80,000
35 Suryana 25,000 3,000 11,000 11,000 25,000
36 20/10/2009 Ramdani 30,000 3,000 13,500 13,500 30,000
37 22/10/2009 Mulya 100,000 3,000 48,500 48,500 100,000
38 23/10/2009 Tn. Tomi 40,000 3,000 18,500 18,500 40,000
39 24/10/2009 Tn. Poniman 80,000 3,000 38,500 38,500 80,000
40 30/10/2009 Pujianti 40,000 3,000 18,500 18,500 40,000
41 Dini Rostina 30,000 3,000 13,500 13,500 30,000
42 Ny. Popon 25,000 3,000 11,000 11,000 25,000
2,470,000 120,000 1,160,000 1,190,000 2,470,000

JASA ALAT &

DOKTER BAHAN
1 5/10/2009 Djenab 30,000 15,000 15,000 30,000
2 M. Lukman 15,000 5,000 5,000 5,000 15,000
3 9/10/2009 Setiawan Aji 40,000 20,000 20,000 40,000
4 10/10/2009 M. Lukman 40,000 20,000 20,000 40,000
5 Sti 15,000 5,000 5,000 5,000 15,000
6 13/10/2009 Djenab 30,000 15,000 15,000 30,000
7 14/10/2009 Djenab 40,000 20,000 20,000 40,000
8 15/10/2009 Ny. Lilis 50,000 25,000 25,000 50,000
9 15/10/2009 Djenab 40,000 20,000 20,000 40,000
10 16/10/2009 M. Lukman 30,000 15,000 15,000 30,000
11 17/10/2009 Rita Rosita 15,000 5,000 5,000 5,000 15,000
12 17/10/2009 Setiawan Aji 20,000 10,000 10,000 20,000
13 19/10/2009 Setiawan Aji 40,000 20,000 20,000 40,000
14 20/10/2009 Rita Rosita 15,000 5,000 5,000 5,000 15,000
15 24/10/2009 Ari Susianti 40,000 20,000 20,000 40,000
16 27/10/2009 Tn. Dedi 25,000 5,000 10,000 10,000 25,000
TOTAL 485,000 10,000 165,000 165,000 345,000

1 6/10/2009 Pehacain Inj 1 box 60,000
2 6/10/2009 Bahan Gigi + Spuit 315,000
TOTAL 625,000
KEUNTUNGAN
KSBL DRG. DEWI
1 OKT 1,190,000 625,000 565,000 282,500 282,500
2 OKT 165,000.00 165,000 82,500 82,500
365,000 365,000


Menyetujui,

Direktur KSBL
JASA ALAT &

DOKTER BAHAN
1 2/11/2009 Aga 100,000 3,000 48,500 48,500 100,000
2 Arci 100,000 3,000 48,500 48,500 100,000
3 Asifa 25,000 3,000 11,000 11,000 25,000
4 Tomi 40,000 3,000 18,500 18,500 40,000
5 Sugianto 25,000 3,000 11,000 11,000 25,000
6 3/11/2009 Ny. Yanti 65,000 3,000 31,000 31,000 65,000
7 Wildan 40,000 3,000 18,500 18,500 40,000
8 4/11/2009 Ny. Dwi 100,000 3,000 48,500 48,500 100,000
9 Salma. N 40,000 3,000 18,500 18,500 40,000
10 Lia. K 110,000 3,000 53,500 53,500 110,000
11 Ny. Dwi 50,000 3,000 23,500 23,500 50,000
12 5/11/2009 Retno 40,000 3,000 18,500 18,500 40,000
13 6/11/2009 Pujianti 40,000 3,000 18,500 18,500 40,000
14 9/11/2009 Ny. Fitriani 75,000 3,000 36,000 36,000 75,000
15 Ny. Hani 10,000 10,000 10,000
16 Tn. Tomi 130,000 3,000 63,500 63,500 130,000
17 11/11/2009 Ny. Dwi 165,000 3,000 81,000 81,000 165,000
18 Ny. Susna Komariah 25,000 3,000 11,000 11,000 25,000
19 12/11/2009 Yuliana 40,000 3,000 18,500 18,500 40,000
20 Ramdani 30,000 3,000 13,500 13,500 30,000
21 13/11/2009 Pujianti 50,000 3,000 23,500 23,500 50,000
22 Romi 110,000 3,000 53,500 53,500 110,000
23 16/11/2009 Ny. Heni 100,000 3,000 48,500 48,500 100,000
24 Amin 20,000 3,000 8,500 8,500 20,000
25 Tn. Hari 20,000 20,000 20,000
26 Tn. Hendra 20,000 3,000 8,500 8,500 20,000
27 Ramdani 30,000 3,000 13,500 13,500 30,000
28 Tn. Wahyo 75,000 3,000 36,000 36,000 75,000
29 Fitri 50,000 3,000 23,500 23,500 50,000
30 Sustin -
31 19/11/09 Tn. Martus 60,000 3,000 28,500 28,500 60,000
32 Yuliana 40,000 3,000 18,500 18,500 40,000
33 20/11/09 Ny. Ai 20,000 3,000 8,500 8,500 20,000
34 Ny. Santi 50,000 3,000 23,500 23,500 50,000
35 Romi 80,000 3,000 38,500 38,500 80,000
36 23/11/09 Sesilia 30,000 3,000 13,500 13,500 30,000
37 Pujianti 80,000 3,000 38,500 38,500 80,000
38 24/11/09 Tn. Gustinyoman 150,000 3,000 73,500 73,500 150,000
39 An. Putri 40,000 3,000 18,500 18,500 40,000
40 Retno 65,000 3,000 31,000 31,000 65,000
41 25/11/09 Ifa 150,000 3,000 73,500 73,500 150,000
42 Amelia 20,000 3,000 8,500 8,500 20,000
43 Yuliana 115,000 3,000 56,000 56,000 115,000
44 Tn. Mukhsin 40,000 3,000 18,500 18,500 40,000
45 Fitri 130,000 3,000 63,500 63,500 130,000
46 29/11/09 Ny. Santi 380,000 3,000 188,500 188,500 380,000
47 Han Han 150,000 3,000 73,500 73,500 150,000
48 30/11/09 Dimas 100,000 3,000 48,500 48,500 100,000
3,425,000 135,000 1,630,000 1,660,000 3,425,000

JASA ALAT &

DOKTER BAHAN
1 3/11/2009 Tn. Setiawan 15,000 5,000 5,000 5,000 15,000
2 Ny. Teguh 15,000 5,000 5,000 5,000 15,000
3 Tn. Wahid 15,000 5,000 5,000 5,000 15,000
4 6/11/2009 Kartika 15,000 5,000 5,000 5,000 15,000
5 Ida 30,000 5,000 12,500 12,500 30,000
6 Ny. Teguh 15,000 5,000 5,000 5,000 15,000
7 13/11/09 Ny. Siti. A 15,000 5,000 5,000 5,000 15,000
8 14/11/09 Ny. Ida 40,000 20,000 20,000 40,000
9 21/11/09 Ny. Siti. A 40,000 5,000 17,500 17,500 40,000
10 24/11/09 Ny. Djaenab 40,000 20,000 20,000 40,000
11 25/11/09 Ny. Sri 15,000 5,000 5,000 5,000 15,000
12 Tn. Tajudin 15,000 5,000 5,000 5,000 15,000
13 29/11/09 Ny. Sri 40,000 20,000 20,000 40,000
14 30/11/09 Tn. Jajang 15,000 5,000 5,000 5,000 15,000
TOTAL 325,000 55,000 135,000 135,000 325,000

1 11/11/2009 Alat dan Bahan Gigi 1 box 183,500
TOTAL 433,500
KEUNTUNGAN
KSBL DRG. DEWI
1 NOV 1,660,000 433,500 1,226,500 613,250 613,250
2 NOV 135,000.00 135,000 67,500 67,500
680,750 680,750


Menyetujui,

Direktur KSBL
JASA ALAT &

DOKTER BAHAN
1 1/12/2009 Ny. Hj. Sumini 60,000 3,000 28,500 28,500 60,000
2 Sopi 40,000 3,000 18,500 18,500 40,000
3 Ratna 50,000 3,000 23,500 23,500 50,000
4 Ifa 200,000 3,000 98,500 98,500 200,000
5 3/12/2009 Ny. Elis 25,000 3,000 11,000 11,000 25,000
6 Sopi 50,000 3,000 23,500 23,500 50,000
7 Tn. Dadang 50,000 3,000 23,500 23,500 50,000
8 4/12/2009 Monalisa 35,000 3,000 16,000 16,000 35,000
9 5/12/2009 Tn. Mukhsin 35,000 3,000 16,000 16,000 35,000
10 7/12/2009 Ny. Sri 120,000 3,000 58,500 58,500 120,000
11 Iis 40,000 3,000 18,500 18,500 40,000
12 Sopi 40,000 3,000 18,500 18,500 40,000
13 Ny. Mimin 60,000 3,000 28,500 28,500 60,000
14 Sopi 50,000 3,000 23,500 23,500 50,000
15 8/12/2009 Nisrina 80,000 3,000 38,500 38,500 80,000
16 Rohana 20,000 3,000 8,500 8,500 20,000
17 Nurhayati 25,000 3,000 11,000 11,000 25,000
18 10/12/2009 Ny. Sri 120,000 3,000 58,500 58,500 120,000
19 Tn. Sulaeman 100,000 3,000 48,500 48,500 100,000
20 Ramdani 60,000 3,000 28,500 28,500 60,000
21 Anita 25,000 3,000 11,000 11,000 25,000
22 11/12/2009 Tn. Surya 200,000 3,000 98,500 98,500 200,000
23 Firda 40,000 3,000 18,500 18,500 40,000
24 Ny. Wiwin 25,000 3,000 11,000 11,000 25,000
25 12/12/2009 Dinda 20,000 3,000 8,500 8,500 20,000
26 14/12/2009 Ny. Sri 240,000 3,000 118,500 118,500 240,000
27 Ny. Eni 70,000 3,000 33,500 33,500 70,000
28 Tn. Fahrudin 150,000 3,000 73,500 73,500 150,000
29 Septiany 25,000 3,000 11,000 11,000 25,000
30 Rosa 25,000 3,000 11,000 11,000 25,000
31 Risa 40,000 3,000 18,500 18,500 40,000
32 15/12/2009 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
33 Sulam Taufik 40,000 3,000 18,500 18,500 40,000
34 Nisrina 80,000 3,000 38,500 38,500 80,000
35 16/12/2009 Ifa 50,000 3,000 23,500 23,500 50,000
36 Ny. Poniman 25,000 3,000 11,000 11,000 25,000
37 Ny. Eva 50,000 3,000 23,500 23,500 50,000
38 17/12/2009 Sopi 110,000 3,000 53,500 53,500 110,000
39 Tn. Mukhsin 40,000 3,000 18,500 18,500 40,000
40 Ny. Lilis 20,000 20,000 20,000
41 Nurhayati 64,000 32,000 32,000 64,000
42 Tati 70,000 3,000 33,500 33,500 70,000
43 19/12/2009 Tn. Poniman 100,000 3,000 48,500 48,500 100,000
44 21/12/2009 Ny. Lies 60,000 3,000 28,500 28,500 60,000
45 Risa 40,000 3,000 18,500 18,500 40,000
46 Tn. Maman 80,000 3,000 38,500 38,500 80,000
47 Tn. Fahrudin 80,000 3,000 38,500 38,500 80,000
48 22/12/2009 Ny. Poniman 140,000 3,000 68,500 68,500 140,000
49 Nisrina 170,000 3,000 83,500 83,500 170,000
50 Warsiyem 40,000 3,000 18,500 18,500 40,000
51 Sulam Taufik 80,000 3,000 38,500 38,500 80,000
52 23/12/2009 Tn. Suyoto 150,000 3,000 73,500 73,500 150,000
53 Ai Mudoriah 48,000 3,000 22,500 22,500 48,000
54 Oom Romli 40,000 3,000 18,500 18,500 40,000
55 Supriyadi 25,000 3,000 11,000 11,000 25,000
56 Bintang 25,000 3,000 11,000 11,000 25,000
57 24/12/2009 Ny. Mila 50,000 3,000 23,500 23,500 50,000
58 Arvi 20,000 3,000 8,500 8,500 20,000
59 26/12/2009 Atlan 40,000 3,000 18,500 18,500 40,000
60 Sera Bilkis 32,000 3,000 14,500 14,500 32,000
61 29/12/2009 Ny. Sri 170,000 3,000 83,500 83,500 170,000
62 Sulistia 40,000 3,000 18,500 18,500 40,000
63 Ny. Poniman 50,000 3,000 23,500 23,500 50,000
64 29/12/2009 Oom Romli 80,000 3,000 38,500 38,500 80,000
65 Warsiyem 100,000 3,000 48,500 48,500 100,000
66 M. Hadi 80,000 3,000 38,500 38,500 80,000
67 Nisrina 40,000 3,000 18,500 18,500 40,000
68 31/12/2009 Resti 25,000 3,000 11,000 11,000 25,000
4,514,000 198,000 2,148,000 2,168,000 4,514,000

JASA ALAT &

DOKTER BAHAN
1 2/12/2009 Anisa 15,000 5,000 5,000 5,000 15,000
2 3/12/2009 Tn. Asep 40,000 20,000 20,000 40,000
3 5/12/2009 Achmad. M 15,000 5,000 5,000 5,000 15,000
4 7/12/2009 Ny. Sri 15,000 5,000 5,000 5,000 15,000
5 Tn. Jajang 15,000 5,000 5,000 5,000 15,000
6 9/12/2009 Djenab 30,000 5,000 12,500 12,500 30,000
7 10/12/2009 Djenab 30,000 15,000 15,000 30,000
8 Ny. Sri 25,000 12,500 12,500 25,000
9 Tn. Surya 15,000 5,000 5,000 5,000 15,000
10 14/12/2009 Ny. Teguh Wiratmi 15,000 5,000 5,000 5,000 15,000
11 Ny. Sri 30,000 15,000 15,000 30,000
12 16/12/2009 Ny. Santi 15,000 5,000 5,000 5,000 15,000
13 17/12/2009 Ny. Teguh Wiratmi 40,000 5,000 17,500 17,500 40,000
14 Ny. Sri 40,000 5,000 17,500 17,500 40,000
15 17/12/2009 Ny. Teguh Wiratmi 50,000 5,000 22,500 22,500 50,000
16 Ny. Sri 35,000 17,500 17,500 35,000
17 22/12/2009 Djenab 40,000 20,000 20,000 40,000
18 23/12/2009 Djenab 40,000 20,000 20,000 40,000
19 Asep. H 40,000 5,000 17,500 17,500 40,000
20 24/12/2009 Ny. Teguh Wiratmi 40,000 5,000 17,500 17,500 40,000
21 28/12/2009 Ny. Sri 40,000 5,000 17,500 17,500 40,000
22 30/12/2009 Ny. Sri 30,000 5,000 12,500 12,500 30,000
23 31/12/2009 Embun 35,000 5,000 15,000 15,000 35,000
TOTAL 690,000 80,000 305,000 305,000 690,000

1 1/12/2009 Service Dental Unit 160,000
2 5/12/2009 Pehacain inj 68,000
3 19/12/09 Bahan Tambal 205,000
4 21/12/2009 Sarung Tangan 59,400
5 25/12/2009 Insentif Drg. Sonya 250,000
TOTAL 742,400

KEUNTUNGAN
KSBL DRG. DEWI
1 DES 2,168,000 742,400 1,425,600 712,800 712,800
2 DES 305,000.00 305,000 152,500 152,500
865,300 865,300


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 2/1/2010 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
2 Tn. Agung Angkasa 50,000 3,000 23,500 23,500 50,000
3 Ny. Lilis 40,000 3,000 18,500 18,500 40,000
4 Atlan 110,000 3,000 53,500 53,500 110,000
5 Tn. Sumardi 60,000 3,000 28,500 28,500 60,000
6 4/1/2010 Mayang 80,000 3,000 38,500 38,500 80,000
7 Fatimah 25,000 3,000 11,000 11,000 25,000
8 Ny. Sri 35,000 3,000 16,000 16,000 35,000
9 5/1/2010 Nisrina 110,000 3,000 53,500 53,500 110,000
10 Tn. Muchsin 115,000 3,000 56,000 56,000 115,000
11 Fitriani 170,000 3,000 83,500 83,500 170,000
12 Vikar 25,000 3,000 11,000 11,000 25,000
13 6/1/2010 Ny. Sugiarti 80,000 3,000 38,500 38,500 80,000
14 Eka 25,000 3,000 11,000 11,000 25,000
15 7/1/2010 Ny. Sri 175,000 3,000 86,000 86,000 175,000
16 Mayang 40,000 3,000 18,500 18,500 40,000
17 Ny. Sri 30,000 3,000 13,500 13,500 30,000
18 Bintang 25,000 3,000 11,000 11,000 25,000
19 8/1/2010 Resti. F 16,000 8,000 8,000 16,000
20 9/1/2010 Aryane 40,000 3,000 18,500 18,500 40,000
21 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
22 Anya 35,000 3,000 16,000 16,000 35,000
23 Reza 20,000 3,000 8,500 8,500 20,000
24 Atlan 40,000 3,000 18,500 18,500 40,000
25 Juariah 25,000 25,000 25,000
26 11/1/2010 Tn. Yosepin 25,000 3,000 11,000 11,000 25,000
27 Ny. Sugiarti 15,000 3,000 6,000 6,000 15,000
28 Ny. Sri 3,000 3,000 - - 3,000
29 Tn. Bambang 25,000 3,000 11,000 11,000 25,000
30 12/1/2010 Ny. Sri 20,000 3,000 8,500 8,500 20,000
31 Tn. Agung Angkasa 150,000 3,000 73,500 73,500 150,000
32 Tn. Agus 20,000 20,000 20,000
33 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
34 Dwi Sany 50,000 3,000 23,500 23,500 50,000
35 13/1/2010 Fitriani 20,000 3,000 8,500 8,500 20,000
36 Ny. Sri 515,000 3,000 256,000 256,000 515,000
37 Tn. Tenang 75,000 3,000 36,000 36,000 75,000
38 Ny. Sukriah 25,000 3,000 11,000 11,000 25,000
39 14/1/2010 Tn. Yosepin 150,000 3,000 73,500 73,500 150,000
40 15/1/2010 Ny. Nila 130,000 3,000 63,500 63,500 130,000
41 Tn. Kurniawan 20,000 3,000 8,500 8,500 20,000
42 Noviani 20,000 3,000 8,500 8,500 20,000
43 16/1/2010 Ny. Eem 20,000 3,000 8,500 8,500 20,000
44 Ny. Yanti 130,000 3,000 63,500 63,500 130,000
45 Farel 40,000 3,000 18,500 18,500 40,000
46 Ny. Lilis 85,000 3,000 41,000 41,000 85,000
47 Fauzy Risky 45,000 3,000 21,000 21,000 45,000
48 Irma 125,000 3,000 61,000 61,000 125,000
49 18/1/2010 Risa 40,000 3,000 18,500 18,500 40,000
50 Ny. Ina 80,000 3,000 38,500 38,500 80,000
51 An. Luthfi 25,000 3,000 11,000 11,000 25,000
52 Ny. Yuli 25,000 3,000 11,000 11,000 25,000
53 19/1/2010 Zahwa 20,000 3,000 8,500 8,500 20,000
54 Nisrina 20,000 3,000 8,500 8,500 20,000
55 Egita 90,000 3,000 43,500 43,500 90,000
56 20/1/2010 Tn. Wawan Datu 75,000 3,000 36,000 36,000 75,000
57 Aisah 25,000 3,000 11,000 11,000 25,000
58 21/1/2010 Tn. Yosepin 20,000 3,000 8,500 8,500 20,000
59 Emma 70,000 3,000 33,500 33,500 70,000
60 Ny. Sri - - -
61 Sofi 50,000 3,000 23,500 23,500 50,000
62 22/1/2010 Tn. Freddy 20,000 3,000 8,500 8,500 20,000
63 Ny. Iim 150,000 3,000 73,500 73,500 150,000
64 Ny. Sukinah 75,000 3,000 36,000 36,000 75,000
65 23/1/2010 Farel 40,000 3,000 18,500 18,500 40,000
66 Ny. Santi 65,000 3,000 31,000 31,000 65,000
67 Lia Astika 16,000 8,000 8,000 16,000
68 Rena 60,000 3,000 28,500 28,500 60,000
69 Ny. Yulianti 70,000 3,000 33,500 33,500 70,000
70 Asyfa 40,000 3,000 18,500 18,500 40,000
4,275,000 195,000 2,017,500 2,062,500 4,275,000

JASA ALAT &

DOKTER BAHAN
71 25/1/2010 Indra 35,000 3,000 16,000 16,000 35,000
72 Ny. Sri 50,000 3,000 23,500 23,500 50,000
73 Kusnadi 40,000 3,000 18,500 18,500 40,000
74 26/1/2010 Tn. Akun 20,000 3,000 8,500 8,500 20,000
75 Risa 50,000 3,000 23,500 23,500 50,000
76 Ny. Ina 100,000 3,000 48,500 48,500 100,000
77 27/1/2010 Nurul 20,000 3,000 8,500 8,500 20,000
78 Ny. Hidayati 140,000 3,000 68,500 68,500 140,000
79 Ardiyansyah 20,000 3,000 8,500 8,500 20,000
80 Ny. Nenden 40,000 3,000 18,500 18,500 40,000
81 Dikdik 20,000 3,000 8,500 8,500 20,000
82 28/1/2010 Irmaya 50,000 3,000 23,500 23,500 50,000
83 29/1/2010 Ny. Nila 195,000 3,000 96,000 96,000 195,000
84 Tn. Edi Darmo 50,000 3,000 23,500 23,500 50,000
85 Egita 50,000 3,000 23,500 23,500 50,000
86 Meisya 50,000 3,000 23,500 23,500 50,000
87 30/1/2010 Tn. Joko Susilo 105,000 3,000 51,000 51,000 105,000
88 Fareel 90,000 3,000 43,500 43,500 90,000
89 Tn. Edi Darmo 40,000 20,000 20,000 40,000
90 Anya 30,000 3,000 13,500 13,500 30,000
5,470,000 252,000 2,586,500 2,631,500 5,470,000

JASA ALAT &

DOKTER BAHAN
1 7/1/2010 Ny. Teguh 20,000 5,000 7,500 7,500 20,000
2 18/1/2010 Jubaedah 30,000 5,000 12,500 12,500 30,000
3 Ny. Rita 20,000 5,000 7,500 7,500 20,000
4 22/1/2010 Tn. Ace Tarkana 15,000 5,000 5,000 5,000 15,000
5 26/1/2010 Ny. Rita 15,000 5,000 5,000 5,000 15,000
6 27/1/2010 Ny. Hani 25,000 12,500 12,500 25,000
7 Paulus 25,000 5,000 10,000 10,000 25,000
8 28/1/2010 Ny. Teguh 25,000 5,000 10,000 10,000 25,000
9 29/1/2010 Ny. Rita 15,000 5,000 5,000 5,000 15,000
10 30/1/2010 Putri 15,000 5,000 5,000 5,000 15,000
TOTAL 205,000 45,000 80,000 80,000 205,000

1 4/1/2010 Sarung Tangan 1 Box 35,000
2 Spuit 3 CC 1 Box 100,000
3 16/1/2010 Arsen 150,000
4 22/1/2010 Kaca Mulut 75,000
5 23/1/2010 Masker 74,000
6 27/1/2010 Service Dental Point 90,000
TOTAL 774,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Jan 2,062,500 774,000 1,288,500 644,250 644,250
2 Jan 80,000.00 80,000 40,000 40,000
684,250 684,250


Menyetujui,

Direktur KSBL
JASA ALAT &

DOKTER BAHAN
1 1/2/2010 Irmaya 120,000 3,000 58,500 58,500 120,000
2 Fatimah 20,000 3,000 8,500 8,500 20,000
3 Joko Sulistio - - -
4 Cecep 20,000 3,000 8,500 8,500 20,000
5 Indra 35,000 3,000 16,000 16,000 35,000
6 Tn. Kusnadi 40,000 3,000 18,500 18,500 40,000
7 Salma 40,000 3,000 18,500 18,500 40,000
8 Gres 20,000 3,000 8,500 8,500 20,000
9 2/2/2010 Ny. Hidayati 20,000 3,000 8,500 8,500 20,000
10 Nurul 80,000 3,000 38,500 38,500 80,000
11 Agus 50,000 3,000 23,500 23,500 50,000
12 Euis 10,000 10,000 10,000
13 Nerma 10,000 10,000 10,000
14 4/2/2010 Habibah 20,000 3,000 8,500 8,500 20,000
15 Tn. Dadan 25,000 3,000 11,000 11,000 25,000
16 Tn. Hendra 150,000 3,000 73,500 73,500 150,000
17 Risa 85,000 3,000 41,000 41,000 85,000
18 5/2/2010 Ny. Nila 85,000 3,000 41,000 41,000 85,000
19 Ny Imas 50,000 3,000 23,500 23,500 50,000
20 6/2/2010 Ny. Iswati 105,000 3,000 51,000 51,000 105,000
21 Ny. Santi 75,000 3,000 36,000 36,000 75,000
22 8/2/2010 Ny. Iis 20,000 3,000 8,500 8,500 20,000
23 Ny. Nunung 25,000 3,000 11,000 11,000 25,000
24 Tn. Dada 20,000 3,000 8,500 8,500 20,000
25 Bela 40,000 3,000 18,500 18,500 40,000
26 Indra 35,000 3,000 16,000 16,000 35,000
27 Winda 20,000 3,000 8,500 8,500 20,000
28 Tn. Kusnadi 40,000 3,000 18,500 18,500 40,000
29 9/2/2010 Tn. Agung Angkasa 100,000 3,000 48,500 48,500 100,000
30 Nerma 10,000 10,000 10,000
31 10/2/2010 Wildan 20,000 3,000 8,500 8,500 20,000
32 Ny. Imas 20,000 3,000 8,500 8,500 20,000
33 Nurul 90,000 3,000 43,500 43,500 90,000
34 Ny. Hidayati 50,000 3,000 23,500 23,500 50,000
35 11/2/2010 Ny. Iis 75,000 3,000 36,000 36,000 75,000
36 Tn. Nasar 75,000 3,000 36,000 36,000 75,000
37 12/2/2010 Ny. Imas 60,000 3,000 28,500 28,500 60,000
38 Marissa 25,000 3,000 11,000 11,000 25,000
39 Ardiansyah 20,000 3,000 8,500 8,500 20,000
40 Ny. Santi 50,000 3,000 23,500 23,500 50,000
41 15/2/2010 Nazwa 60,000 3,000 28,500 28,500 60,000
42 Admin 80,000 3,000 38,500 38,500 80,000
43 Tn. Kusnadi 150,000 3,000 73,500 73,500 150,000
44 Ny. Euis 20,000 3,000 8,500 8,500 20,000
45 Umar 200,000 3,000 98,500 98,500 200,000
46 Ny. Santi 50,000 3,000 23,500 23,500 50,000
47 Ny. Rini. P 60,000 3,000 28,500 28,500 60,000
48 Galih 50,000 3,000 23,500 23,500 50,000
49 Ai. M 48,000 24,000 24,000 48,000
50 Arci 150,000 3,000 73,500 73,500 150,000
51 17/2/2010 Ifa 25,000 3,000 11,000 11,000 25,000
52 Satria. N 60,000 3,000 28,500 28,500 60,000
53 Ny. Imas 40,000 3,000 18,500 18,500 40,000
54 Nerma 10,000 3,000 3,500 3,500 10,000
55 19/2/2010 Putri 40,000 3,000 18,500 18,500 40,000
56 Nurul 40,000 3,000 18,500 18,500 40,000
57 20/2/2010 Ny. Rini. P 80,000 3,000 38,500 38,500 80,000
58 Umar 200,000 3,000 98,500 98,500 200,000
59 Ny. Tanti 165,000 3,000 81,000 81,000 165,000
60 22/2/2010 Dahlia 20,000 3,000 8,500 8,500 20,000
61 Nazwa - - -
62 Ega 20,000 3,000 8,500 8,500 20,000
63 M. Exa 20,000 3,000 8,500 8,500 20,000
64 23/2/2010 Restu Akbar 40,000 3,000 18,500 18,500 40,000
65 Auzan 20,000 3,000 8,500 8,500 20,000
66 Ny. Imas 40,000 3,000 18,500 18,500 40,000
67 Tn. Sucipto 50,000 3,000 23,500 23,500 50,000
68 24/2/2010 Tn. Roni 90,000 3,000 43,500 43,500 90,000
69 Dahlia 20,000 3,000 8,500 8,500 20,000
70 Nazwa 70,000 3,000 33,500 33,500 70,000
3,773,000 192,000 1,775,500 1,805,500 3,773,000

JASA ALAT &

DOKTER BAHAN
71 24/2/10 Putri 40,000 3,000 18,500 18,500 40,000
72 Nerma 10,000 10,000 10,000
73 25/2/10 Ny. Murni 50,000 3,000 23,500 23,500 50,000
74 Ika Ivana 20,000 3,000 8,500 8,500 20,000
75 27/2/2010 Tn. Budi 20,000 3,000 8,500 8,500 20,000
76 Tn. Agus 20,000 3,000 8,500 8,500 20,000
77 Ny. Aas 20,000 3,000 8,500 8,500 20,000
78 Karina 40,000 3,000 18,500 18,500 40,000
79 Ny. Tanti 205,000 3,000 101,000 101,000 205,000
80 Umar 500,000 3,000 248,500 248,500 500,000
4,698,000 219,000 2,219,500 2,259,500 4,698,000

JASA ALAT &

DOKTER BAHAN
1 2/2/2010 Ny. Lia 15,000 5,000 5,000 5,000 15,000
2 Ny. Hani 40,000 20,000 20,000 40,000
3 5/2/2010 Asep Sarifudin 25,000 5,000 10,000 10,000 25,000
4 Paulus 25,000 12,500 12,500 25,000
5 Kezia 25,000 12,500 12,500 25,000
6 6/2/2010 Azizah Nur. F 30,000 5,000 12,500 12,500 30,000
7 9/2/2010 Paulus 25,000 12,500 12,500 25,000
8 10/2/2010 Anisa 25,000 12,500 12,500 25,000
9 Yulia Leanita 30,000 15,000 15,000 30,000
10 12/2/2010 Asep Sarifudin 25,000 12,500 12,500 25,000
11 15/2/2010 Embun 20,000 5,000 7,500 7,500 20,000
12 Putri 15,000 5,000 5,000 5,000 15,000
13 16/2/2010 Tn. Asep 25,000 12,500 12,500 25,000
14 17/2/2010 Arsa 25,000 12,500 12,500 25,000
15 18/2/2010 Putri 20,000 10,000 10,000 20,000
16 22/2/2010 Putri 30,000 15,000 15,000 30,000
17 Ny. Imas 20,000 5,000 7,500 7,500 20,000
18 23/2/2010 Yusuf 15,000 5,000 5,000 5,000 15,000
19 Paulus 30,000 15,000 15,000 30,000
20 24/2/2010 Tn. Asep 30,000 15,000 15,000 30,000
21 Paulus 25,000 12,500 12,500 25,000
22 Ny. Imas 25,000 5,000 10,000 10,000 25,000
23 27/2/2010 Ny. Jubaedah 40,000 5,000 17,500 17,500 40,000
24 Ny. Imas 25,000 12,500 12,500 25,000
TOTAL 610,000 45,000 282,500 282,500 610,000

1 5/2/2010 Sarung Tangan 1 Box 39,000
2 19/2/2010 Lidocain comp 20 1 Box 38,500
TOTAL 327,500
KEUNTUNGAN
KSBL DRG. DEWI
1 Feb 2,259,500 327,500 1,932,000 966,000 966,000
2 Feb 282,500.00 282,500 141,250 141,250
1,107,250 1,107,250


Menyetujui,

Direktur KSBL
PERIODE MARET 2010
JASA ALAT &

DOKTER BAHAN
1 1/3/2010 Sakhy 10,000 10,000 10,000
2 Ny. Murni 90,000 3,000 43,500 43,500 90,000
3 Tn. Tatang 70,000 3,000 33,500 33,500 70,000
4 2/3/2010 Bilqis 20,000 3,000 8,500 8,500 20,000
5 Ny. Riri 40,000 3,000 18,500 18,500 40,000
6 4/3/2010 Tn. Idrin 20,000 20,000 20,000
7 Ny. Murni 50,000 3,000 23,500 23,500 50,000
8 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
9 Ny. Hidayati 35,000 3,000 16,000 16,000 35,000
10 Nurul 40,000 3,000 18,500 18,500 40,000
11 Tn. Widi 20,000 3,000 8,500 8,500 20,000
12 Nerma 10,000 10,000 10,000
13 5/3/2010 An. Bintang 20,000 3,000 8,500 8,500 20,000
14 Tn. Yanwar 100,000 3,000 48,500 48,500 100,000
15 Ny. Imas 115,000 3,000 56,000 56,000 115,000
16 Putri 40,000 3,000 18,500 18,500 40,000
17 Arci 150,000 3,000 73,500 73,500 150,000
18 Nunung 60,000 3,000 28,500 28,500 60,000
19 6/3/2010 Ny. Lilis 10,000 10,000 10,000
20 Tn. Wahyudin 215,000 3,000 106,000 106,000 215,000
21 Riana 40,000 3,000 18,500 18,500 40,000
22 Ny. Murni 390,000 3,000 193,500 193,500 390,000
23 Tn. Ujang 20,000 3,000 8,500 8,500 20,000
24 8/3/2010 Najwa 35,000 3,000 16,000 16,000 35,000
25 Ny. Hidayati 35,000 3,000 16,000 16,000 35,000
26 Ny. Tanti 105,000 3,000 51,000 51,000 105,000
27 Ny. Neneng 25,000 3,000 11,000 11,000 25,000
28 9/3/2010 Tn. Ujang 40,000 3,000 18,500 18,500 40,000
29 Tn. Rujia 25,000 3,000 11,000 11,000 25,000
30 Tn. Wahyudin 40,000 3,000 18,500 18,500 40,000
31 Refika 25,000 3,000 11,000 11,000 25,000
32 10/3/2010 Gres 40,000 3,000 18,500 18,500 40,000
33 Ny. Nunung 150,000 3,000 73,500 73,500 150,000
34 Utirahayu 200,000 3,000 98,500 98,500 200,000
35 11/3/2010 Ny. Hidayati 90,000 3,000 43,500 43,500 90,000
36 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
37 Najwa 20,000 3,000 8,500 8,500 20,000
38 Siti Aisya 20,000 3,000 8,500 8,500 20,000
39 Ny. Nunung 20,000 3,000 8,500 8,500 20,000
40 12/3/2010 Amelia 10,000 10,000 10,000
41 Ny. Tanti 175,000 3,000 86,000 86,000 175,000
42 Ny. Nunung 50,000 3,000 23,500 23,500 50,000
43 Ny. Dedeh 40,000 3,000 18,500 18,500 40,000
44 Putri 40,000 3,000 18,500 18,500 40,000
45 13/3/2010 Diana 20,000 3,000 8,500 8,500 20,000
46 Endah 20,000 3,000 8,500 8,500 20,000
47 Nandang - - -
48 Ny. Dedeh 40,000 3,000 18,500 18,500 40,000
49 Ny. Ina 170,000 85,000 85,000 170,000
50 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
51 Winda 40,000 3,000 18,500 18,500 40,000
52 18/3/2010 Ny. Mintarsih 20,000 3,000 8,500 8,500 20,000
53 Tn. Aji 20,000 3,000 8,500 8,500 20,000
54 19/3/2010 Putri 40,000 3,000 18,500 18,500 40,000
55 Gres 40,000 3,000 18,500 18,500 40,000
56 Ai 64,000 32,000 32,000 64,000
57 20/3/2010 Yulianti 20,000 3,000 8,500 8,500 20,000
58 22/3/2010 Tn. Ujang 40,000 3,000 18,500 18,500 40,000
59 23/3/2010 Tn. Kurnia 65,000 3,000 31,000 31,000 65,000
60 Yulliani 70,000 3,000 33,500 33,500 70,000
61 Ny. Tanti 125,000 62,500 62,500 125,000
62 Tn. Radiman - - -
63 Ny. Dedeh 40,000 3,000 18,500 18,500 40,000
64 Ny. Ina 85,000 3,000 41,000 41,000 85,000
65 Riana 40,000 3,000 18,500 18,500 40,000
66 Winda 200,000 3,000 98,500 98,500 200,000
67 24/3/2010 Ny. Ipey 150,000 3,000 73,500 73,500 150,000
68 Ny. Mimin 20,000 3,000 8,500 8,500 20,000
69 Iwan 150,000 3,000 73,500 73,500 150,000
4,309,000 177,000 2,036,000 2,096,000 4,309,000

PERIODE MARET 2010
JASA ALAT &

DOKTER BAHAN
70 26/3/2010 Tn. Radiman 240,000 3,000 118,500 118,500 240,000
71 Tn. Yusuf 20,000 3,000 8,500 8,500 20,000
72 Ny. Siti 140,000 3,000 68,500 68,500 140,000
73 Winda 90,000 3,000 43,500 43,500 90,000
74 Salfia 20,000 3,000 8,500 8,500 20,000
75 Gres 40,000 3,000 18,500 18,500 40,000
76 Aisah 60,000 3,000 28,500 28,500 60,000
77 Putri 110,000 3,000 53,500 53,500 110,000
78 Bintang 50,000 3,000 23,500 23,500 50,000
79 27/3/2010 Karina 20,000 3,000 8,500 8,500 20,000
80 Ny. Wulan 90,000 3,000 43,500 43,500 90,000
81 29/3/2010 Tn. Asep 20,000 3,000 8,500 8,500 20,000
82 30/3/2010 Winda 40,000 3,000 18,500 18,500 40,000
83 Ny. Dedeh 50,000 3,000 23,500 23,500 50,000
84 Ny. Siti 40,000 3,000 18,500 18,500 40,000
85 Tn. Edidarmo 40,000 3,000 18,500 18,500 40,000
86 Riana 40,000 3,000 18,500 18,500 40,000
87 31/3/2010 Tn. Agus 20,000 3,000 8,500 8,500 20,000
88 Tn. Sejo 70,000 3,000 33,500 33,500 70,000
89 Dimas 40,000 3,000 18,500 18,500 40,000
90 Dian 50,000 3,000 23,500 23,500 50,000
91 Ny. Nursolihat 25,000 3,000 11,000 11,000 25,000
92 Gres 40,000 3,000 18,500 18,500 40,000
5,664,000 246,000 2,679,000 2,739,000 5,664,000
PERIODE MARET 2010
JASA ALAT &

DOKTER BAHAN
1 1/4/2010 Ny. Imas 25,000 12,500 12,500 25,000
2 2/4/2010 Putri 15,000 5,000 5,000 5,000 15,000
3 Djenab 40,000 5,000 17,500 17,500 40,000
4 Siti 25,000 5,000 10,000 10,000 25,000
5 Tn.Asep 40,000 5,000 17,500 17,500 40,000
6 Ny. Imas 25,000 12,500 12,500 25,000
7 Tn. Ace Tariana 15,000 5,000 5,000 5,000 15,000
8 5/3/2010 Ny. Lisnayati 15,000 5,000 5,000 5,000 15,000
9 Tn. Paulus 40,000 20,000 20,000 40,000
10 6/3/2010 Tn. Paulus 25,000 12,500 12,500 25,000
11 8/3/2010 Ny. Imas 25,000 12,500 12,500 25,000
12 Tn. Asep 35,000 5,000 15,000 15,000 35,000
13 Siti Leli 25,000 5,000 10,000 10,000 25,000
14 9/3/2010 Tn. Asep 40,000 20,000 20,000 40,000
15 Kezia 25,000 5,000 10,000 10,000 25,000
16 10/3/2010 Tn. Paulus 25,000 12,500 12,500 25,000
17 11/3/2010 Tn. Paulus 15,000 7,500 7,500 15,000
18 Ny. Imas 25,000 12,500 12,500 25,000
19 Azizah 30,000 15,000 15,000 30,000
20 12/3/2010 Kezia 25,000 12,500 12,500 25,000
21 15/3/2010 Putri 40,000 5,000 17,500 17,500 40,000
22 Ny. Imas 70,000 5,000 32,500 32,500 70,000
23 17/3/2010 Anisa 15,000 5,000 5,000 5,000 15,000
24 Teguh 15,000 5,000 5,000 5,000 15,000
25 Tn. Paulus 30,000 15,000 15,000 30,000
26 Kezia 25,000 12,500 12,500 25,000
27 22/3/2010 Ny. Imas 40,000 5,000 17,500 17,500 40,000
28 Siti Leli 25,000 5,000 10,000 10,000 25,000
29 23/3/2010 Kezia 25,000 5,000 10,000 10,000 25,000
30 24/3/2010 Anisa 25,000 12,500 12,500 25,000
31 26/3/2010 Tn. Paulus 40,000 20,000 20,000 40,000
32 31/3/2010 Teguh 25,000 5,000 10,000 10,000 25,000
33 Yoseph 25,000 5,000 10,000 10,000 25,000
TOTAL 935,000 90,000 422,500 422,500 935,000

1 9/3/2010 Handschoen, Fuji GP 1-1 244,000
2 18/3/2010 Cresophate 1 bh 197,500

TOTAL 691,500
KEUNTUNGAN
KSBL DRG. DEWI
1 Maret 2,739,000 691,500 2,047,500 1,023,750 1,023,750
2 Maret 422,500.00 422,500 211,250 211,250
1,235,000 1,235,000

Menyetujui,

Direktur KSBL

PERIODE APRIL 2010
JASA ALAT &

DOKTER BAHAN
1 1/4/2010 Ny. Nursolihat 50,000 3,000 23,500 23,500 50,000
2 Wildan 40,000 3,000 18,500 18,500 40,000
3 Ny. Mintarsih 15,000 3,000 6,000 6,000 15,000
4 Ny. Anggia 40,000 3,000 18,500 18,500 40,000
5 An. Iqbal 20,000 3,000 8,500 8,500 20,000
6 Syifa 15,000 3,000 6,000 6,000 15,000
7 Anita 80,000 3,000 38,500 38,500 80,000
8 3/4/2010 Yoga 40,000 3,000 18,500 18,500 40,000
9 Tn. Emen 20,000 3,000 8,500 8,500 20,000
10 Wati Susanti 80,000 3,000 38,500 38,500 80,000
11 5/4/2010 Sarah 10,000 10,000 10,000
12 Dania -
13 Ayu Dia 40,000 3,000 18,500 18,500 40,000
14 6/4/2010 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
15 Ny. Nursolihat 240,000 3,000 118,500 118,500 240,000
16 7/4/2010 Meta 20,000 3,000 8,500 8,500 20,000
17 Ny. Dedeh 65,000 3,000 31,000 31,000 65,000
18 Ny. Anggia 70,000 3,000 33,500 33,500 70,000
19 Ny. Siti 40,000 3,000 18,500 18,500 40,000
20 Dimas 80,000 3,000 38,500 38,500 80,000
21 8/4/2010 Alma 80,000 3,000 38,500 38,500 80,000
22 Piqri 40,000 3,000 18,500 18,500 40,000
23 Eka 20,000 3,000 8,500 8,500 20,000
24 Anita 80,000 3,000 38,500 38,500 80,000
25 9/4/2010 Ny. Nia 100,000 3,000 48,500 48,500 100,000
26 Grace 40,000 3,000 18,500 18,500 40,000
27 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
28 10/4/2010 Nadia 20,000 3,000 8,500 8,500 20,000
29 13/4/2010 Ny. Siti 110,000 3,000 53,500 53,500 110,000
30 Ujang 40,000 3,000 18,500 18,500 40,000
31 Agung 20,000 3,000 8,500 8,500 20,000
32 Yanti 110,000 3,000 53,500 53,500 110,000
33 Ny. Henti 40,000 3,000 18,500 18,500 40,000
34 Ny. Anggia 90,000 3,000 43,500 43,500 90,000
35 14/4/2010 Tn. Daus 20,000 3,000 8,500 8,500 20,000
36 Tn. Dyah 20,000 3,000 8,500 8,500 20,000
37 Samuel 40,000 3,000 18,500 18,500 40,000
38 Echa 60,000 3,000 28,500 28,500 60,000
39 15/4/2010 Ny. Soraya 40,000 3,000 18,500 18,500 40,000
40 Ny. Sri 20,000 3,000 8,500 8,500 20,000
41 16/4/2010 Samuel 80,000 3,000 38,500 38,500 80,000
42 Grece 110,000 3,000 53,500 53,500 110,000
43 Sri . W 80,000 3,000 38,500 38,500 80,000
44 17/4/2010 Tn. Gunawan 20,000 3,000 8,500 8,500 20,000
45 19/4/2010 Ny. Iim 30,000 3,000 13,500 13,500 30,000
46 Faries 25,000 3,000 11,000 11,000 25,000
47 Asih 20,000 3,000 8,500 8,500 20,000
48 Tn. Arif 20,000 3,000 8,500 8,500 20,000
49 22/4/2010 Tn. Ujang 35,000 3,000 16,000 16,000 35,000
50 Ny. Soraya 40,000 3,000 18,500 18,500 40,000
51 Ny. Iim 30,000 3,000 13,500 13,500 30,000
52 Piqri 40,000 3,000 18,500 18,500 40,000
53 Tn. Prianto 20,000 3,000 8,500 8,500 20,000
54 Salma 40,000 3,000 18,500 18,500 40,000
55 23/4/2010 Ny. Bolarah 100,000 3,000 48,500 48,500 100,000
56 Samuel 40,000 3,000 18,500 18,500 40,000
57 Edi 30,000 3,000 13,500 13,500 30,000
58 Difa 40,000 3,000 18,500 18,500 40,000
59 Sri . W 90,000 3,000 43,500 43,500 90,000
60 Henti 120,000 3,000 58,500 58,500 120,000
61 Ny. Ina - - -
62 24/4/2010 Ny. Titi 120,000 3,000 58,500 58,500 120,000
63 Diana 20,000 3,000 8,500 8,500 20,000
64 Ny. Tika 20,000 3,000 8,500 8,500 20,000
65 Deasy ( FO ) 10,000 10,000 10,000
66 26/4/2010 Ny. Ria 60,000 3,000 28,500 28,500 60,000
67 Tn. Binarto 35,000 3,000 16,000 16,000 35,000
68 Ny. Nilenia 60,000 3,000 28,500 28,500 60,000
69 26/4/2010 Ny. Endang 35,000 3,000 16,000 16,000 35,000
3,405,000 195,000 1,595,000 1,615,000 3,405,000

PERIODE MARET 2010
JASA ALAT &

DOKTER BAHAN
70 26/4/2010 Ny. Ima 100,000 3,000 48,500 48,500 100,000
71 Tn. Prianto 15,000 3,000 6,000 6,000 15,000
72 Rajib 40,000 3,000 18,500 18,500 40,000
73 Afina 40,000 3,000 18,500 18,500 40,000
74 29/4/2010 Ny. Ina 100,000 3,000 48,500 48,500 100,000
75 Tn. Ade 50,000 3,000 23,500 23,500 50,000
76 Tn. Jhon 20,000 3,000 8,500 8,500 20,000
77 30/4/2010 Ny. Wulan 20,000 3,000 8,500 8,500 20,000
78 Diana 80,000 3,000 38,500 38,500 80,000
79 Relyki 150,000 3,000 73,500 73,500 150,000
4,020,000 225,000 1,887,500 1,907,500 4,020,000

PERIODE APRIL 2010
JASA ALAT &
DOKTER BAHAN
1 1/4/2010 Siti Alfiah 15,000 5,000 5,000 5,000 15,000
2 3/4/2010 Teguh 25,000 5,000 10,000 10,000 25,000
3 6/4/2010 Anisa 15,000 5,000 5,000 5,000 15,000
4 7/4/2010 Surya 15,000 5,000 5,000 5,000 15,000
5 9/4/2010 Kezia 25,000 12,500 12,500 25,000
6 12/4/2010 Teguh 25,000 12,500 12,500 25,000
7 12/4/2010 Usep 25,000 12,500 12,500 25,000
8 13/4/2010 Ira 40,000 20,000 20,000 40,000
9 13/4/2010 Kezia 25,000 12,500 12,500 25,000
10 14/3/2010 Ira 40,000 20,000 20,000 40,000
11 15/4/2010 Teguh 25,000 12,500 12,500 25,000
12 16/4/2010 Kezia 30,000 15,000 15,000 30,000
13 17/4/2010 Annisa 25,000 12,500 12,500 25,000
14 19/4/2010 Usep 25,000 12,500 12,500 25,000
15 20/4/2010 Annisa 25,000 12,500 12,500 25,000
16 22/4/2010 Teguh 25,000 12,500 12,500 25,000
17 23/4/2010 Annisa 30,000 15,000 15,000 30,000
18 Kezia 40,000 20,000 20,000 40,000
19 24/4/2010 Annisa 40,000 20,000 20,000 40,000
20 26/4/2010 Usep 25,000 12,500 12,500 25,000
21 30/4/2010 Ny. Mila 15,000 5,000 5,000 5,000 15,000
22 Usep 30,000 15,000 15,000 30,000
TOTAL 585,000 25,000 280,000 280,000 585,000

1 17/4/10 Caviton Pink/White 95,000
2 17/4/10 Handschoen 39,000
TOTAL 384,000
KEUNTUNGAN
KSBL DRG. DEWI
1 April 1,907,500 384,000 1,523,500 761,750 761,750
2 April 280,000.00 280,000 140,000 140,000
901,750 901,750
Cimahi, 3 Mei 2010


Menyetujui,

Direktur KSBL
PERIODE MEI 2010
JASA ALAT &

DOKTER BAHAN
1 1/5/2010 Dinda 20,000 3,000 8,500 8,500 20,000
2 Ny. Ipah 30,000 3,000 13,500 13,500 30,000
3 Tn. Julius 130,000 3,000 63,500 63,500 130,000
4 Naila 20,000 3,000 8,500 8,500 20,000
5 3/5/2010 Ny. Ria 15,000 3,000 6,000 6,000 15,000
6 Dhiya 60,000 3,000 28,500 28,500 60,000
7 Ny. Wulan 20,000 3,000 8,500 8,500 20,000
8 Ny. Nilendra 85,000 3,000 41,000 41,000 85,000
9 Ny. Endang 35,000 3,000 16,000 16,000 35,000
10 Ny. Cucu 70,000 3,000 33,500 33,500 70,000
11 Ahnan 20,000 3,000 8,500 8,500 20,000
12 6/5/2010 Dhiya 70,000 3,000 33,500 33,500 70,000
13 Ny. Endang 30,000 3,000 13,500 13,500 30,000
14 Ny. Ria 120,000 3,000 58,500 58,500 120,000
15 Hafsah 30,000 3,000 13,500 13,500 30,000
16 Sakhi 30,000 3,000 13,500 13,500 30,000
17 Afina 40,000 3,000 18,500 18,500 40,000
18 3/5/2010 Asyfa 20,000 3,000 8,500 8,500 20,000
19 10/5/2010 Dedi 20,000 3,000 8,500 8,500 20,000
20 Tn. Edi 40,000 3,000 18,500 18,500 40,000
21 11/5/2010 Rifa 20,000 3,000 8,500 8,500 20,000
22 Ny. Nilendra 40,000 3,000 18,500 18,500 40,000
23 Gita 20,000 3,000 8,500 8,500 20,000
24 Ny. Yoyoh 140,000 3,000 68,500 68,500 140,000
25 17/5/10 Ny. Nilendra 80,000 3,000 38,500 38,500 80,000
26 Ny. Ria 30,000 3,000 13,500 13,500 30,000
27 Ny. Imas 65,000 3,000 31,000 31,000 65,000
28 Tn. Asep 20,000 3,000 8,500 8,500 20,000
29 18/5/10 Rifa 20,000 3,000 8,500 8,500 20,000
30 20/5/10 Hafsah 30,000 3,000 13,500 13,500 30,000
31 Ny. Ria 30,000 3,000 13,500 13,500 30,000
32 21/5/10 Sri Fujianti 40,000 3,000 18,500 18,500 40,000
33 Tn. Kris 60,000 3,000 28,500 28,500 60,000
34 24/5/10 Ny. Ria 80,000 3,000 38,500 38,500 80,000
35 An. Reza 40,000 3,000 18,500 18,500 40,000
36 25/5/10 Tn. Atun 20,000 3,000 8,500 8,500 20,000
37 Ny. Yani 20,000 3,000 8,500 8,500 20,000
38 An. Sylvanus 20,000 3,000 8,500 8,500 20,000
39 Eka Fahmi 20,000 3,000 8,500 8,500 20,000
40 28/5/10 Ny. Endang 25,000 12,500 12,500 25,000
41 31/5/10 Sofi 35,000 3,000 16,000 16,000 35,000
42 Yudi 40,000 3,000 18,500 18,500 40,000
1,800,000 123,000 838,500 838,500 1,800,000

PERIODE MEI 2010
JASA ALAT &

DOKTER BAHAN
1 6/5/2010 Tn. Yosef 25,000 5,000 10,000 10,000 25,000
2 10/5/2010 Tn. Surya 15,000 5,000 5,000 5,000 15,000
3 11/5/2010 Tn. Yosef 25,000 5,000 10,000 10,000 25,000
4 14/5/10 Ny. Winarsih 40,000 5,000 17,500 17,500 40,000
5 19/5/10 Ny. Winarsih 15,000 5,000 5,000 5,000 15,000
6 22/5/10 Winarsih 40,000 5,000 17,500 17,500 40,000
7 Ira Febrianti 15,000 5,000 5,000 5,000 15,000
8 Ida Jubaedah 40,000 5,000 17,500 17,500 40,000
9 24/5/10 Asti Wahyuni 25,000 5,000 10,000 10,000 25,000
10 Tn. Usep 40,000 20,000 20,000 40,000
11 25/5/10 Tn. Yusuf 15,000 5,000 5,000 5,000 15,000
12 Tn. Yosef 15,000 5,000 5,000 5,000 15,000
13 29/5/10 Ny. Djenab 35,000 5,000 15,000 15,000 35,000
14 Tn. Yosef 40,000 5,000 17,500 17,500 40,000
15 31/5/10 Annisa 25,000 12,500 12,500 25,000
16 Tn. Yusuf 15,000 5,000 5,000 5,000 15,000
17 Asti Wahyuni 25,000 5,000 10,000 10,000 25,000
TOTAL 450,000 75,000 187,500 187,500 450,000

1 7/5/2010 C Liquid 1 105,000
2 8/5/2010 Pehacain Inj 1 58,400
4 14/5/10 Masker 1 26,000
6 29/5/10 Sarung Tangan 1 39,000
TOTAL 528,400
KEUNTUNGAN
KSBL DRG. DEWI
1 Mei 838,500 528,400 310,100 155,050 155,050
2 Mei 187,500.00 187,500 93,750 93,750
248,800 248,800
Cimahi, 1 Juni 2010


Menyetujui,

Direktur KSBL

PERIODE JUNI 2010
JASA ALAT &

DOKTER BAHAN
1 1/6/2010 Ny. Yayat 40,000 3,000 18,500 18,500 40,000
2 3/6/2010 Endang 50,000 3,000 23,500 23,500 50,000
3 Yohana 100,000 3,000 48,500 48,500 100,000
4 Tn. Edi Free -
5 Ny. Entin 80,000 3,000 38,500 38,500 80,000
6 Fitri 60,000 3,000 28,500 28,500 60,000
7 4/6/2010 Muthia Zalina 20,000 3,000 8,500 8,500 20,000
8 Tri 25,000 3,000 11,000 11,000 25,000
9 7/6/2010 Yohana 10,000 10,000 10,000
10 Fatimah 80,000 3,000 38,500 38,500 80,000
11 Neng Dina 100,000 3,000 48,500 48,500 100,000
12 Tn. Denden 40,000 3,000 18,500 18,500 40,000
13 Ny. Amalia 20,000 3,000 8,500 8,500 20,000
14 David Free
15 8/6/2010 Syifa 30,000 3,000 13,500 13,500 30,000
16 Ubay 100,000 3,000 48,500 48,500 100,000
17 Ny. Nurmawiyah Free
18 Ny. Yayat 110,000 3,000 53,500 53,500 110,000
19 9/6/2010 Tn. Enceng 80,000 3,000 38,500 38,500 80,000
20 11/6/2010 Retno 20,000 3,000 8,500 8,500 20,000
21 12/6/2010 Riana 40,000 3,000 18,500 18,500 40,000
22 14/6/2010 Ny. Eni 85,000 3,000 41,000 41,000 85,000
23 15/6/2010 Tn. Denden 40,000 3,000 18,500 18,500 40,000
24 Tn. Suyoto 40,000 3,000 18,500 18,500 40,000
25 Ny. Risna 40,000 3,000 18,500 18,500 40,000
26 16/6/2010 Indri 40,000 3,000 18,500 18,500 40,000
27 Prayitno 40,000 3,000 18,500 18,500 40,000
28 Tn. Enceng 130,000 3,000 63,500 63,500 130,000
29 17/6/2010 An. Aldi Nugraha 40,000 3,000 18,500 18,500 40,000
30 An. Krisna 50,000 3,000 23,500 23,500 50,000
31 18/6/2010 Tn. Iwan 30,000 3,000 13,500 13,500 30,000
32 Ny. Lia 25,000 3,000 11,000 11,000 25,000
33 Lince 50,000 3,000 23,500 23,500 50,000
34 Nisrina 40,000 3,000 18,500 18,500 40,000
35 19/6/2010 Ny. Santi 130,000 3,000 63,500 63,500 130,000
36 Nurmareta 160,000 3,000 78,500 78,500 160,000
37 Retno 30,000 3,000 13,500 13,500 30,000
38 Tn. Deden 110,000 3,000 53,500 53,500 110,000
39 Tn. Hamid 10,000 10,000 10,000
40 22/6/2010 Ny. Risna 40,000 3,000 18,500 18,500 40,000
41 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
42 Indri 40,000 3,000 18,500 18,500 40,000
43 Sella 20,000 3,000 8,500 8,500 20,000
44 23/6/2010 Tn. Iwan 160,000 3,000 78,500 78,500 160,000
45 24/6/2010 Riana 40,000 3,000 18,500 18,500 40,000
46 25/6/2010 Retno 50,000 3,000 23,500 23,500 50,000
47 Ny. Yanti 50,000 3,000 23,500 23,500 50,000
48 Tn. Enceng 130,000 3,000 63,500 63,500 130,000
49 Indri 40,000 3,000 18,500 18,500 40,000
50 26/6/2010 Tn. Bustami 30,000 30,000 30,000
51 29/6/2010 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
52 Jade 150,000 3,000 73,500 73,500 150,000
53 30/6/2010 Erna 20,000 3,000 8,500 8,500 20,000
54 Susan - - -
55 Riana 110,000 3,000 53,500 53,500 110,000
56 Tn. Iwan - - -
57 Ny. Risna 40,000 3,000 18,500 18,500 40,000
58 Indri 40,000 3,000 18,500 18,500 40,000
3,135,000 150,000 1,467,500 1,517,500 3,135,000

PERIODE JUNI 2010
JASA ALAT &

DOKTER BAHAN
1 1/6/2010 An. Fitri 25,000 5,000 10,000 10,000 25,000
2 2/6/2010 Tn. Asep 15,000 5,000 5,000 5,000 15,000
3 Anisa 25,000 12,500 12,500 25,000
4 Tn. Deden 15,000 7,500 7,500 15,000
5 7/6/2010 Anisa 25,000 12,500 12,500 25,000
6 Dedi 15,000 5,000 5,000 5,000 15,000
7 Astri 25,000 12,500 12,500 25,000

PERIODE JUNI 2010
JASA ALAT &

DOKTER BAHAN
8 8/6/2010 Tn. Asep 25,000 12,500 12,500 25,000
9 12/6/2010 Ny. Rita Rosita 15,000 5,000 5,000 5,000 15,000
10 14/6/2010 Astri 25,000 5,000 10,000 10,000 25,000
11 Anisa 25,000 5,000 10,000 10,000 25,000
12 17/6/2010 Anisa 25,000 12,500 12,500 25,000
13 21/6/2010 Tn. Surya 15,000 5,000 5,000 5,000 15,000
14 Astri 25,000 12,500 12,500 25,000
15 22/6/10 Asep 25,000 12,500 12,500 25,000
16 Naufal 30,000 15,000 15,000 30,000
17 Djenab 25,000 12,500 12,500 25,000
18 Tn. Surya 40,000 20,000 20,000 40,000
19 23/6/10 Naufal 30,000 15,000 15,000 30,000
20 Djenab 40,000 20,000 20,000 40,000
21 25/6/2010 Asep 30,000 15,000 15,000 30,000
22 Djenab 40,000 20,000 20,000 40,000
23 26/6/2010 Asep 40,000 20,000 20,000 40,000
24 28/6/2010 Teguh 40,000 5,000 17,500 17,500 40,000
25 29/6/2010 Kezia 25,000 5,000 10,000 10,000 25,000
26 Waluyo 25,000 12,500 12,500 25,000
TOTAL 690,000 45,000 322,500 322,500 690,000

1 4/6/2010 Masker 1 27,000
2 19/6/10 Tambal Gigi 1 234,000
4 30/6/10 Tambal Gigi 1 190,000
TOTAL 701,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Juni 1,517,500 701,000 816,500 408,250 408,250
2 Juni 322,500.00 322,500 161,250 161,250
569,500 569,500
Cimahi, 1 Juli 2010


Menyetujui,

Direktur KSBL

PERIODE JULI 2010
JASA ALAT &

DOKTER BAHAN
1 1/7/2010 Murni 25,000 3,000 11,000 11,000 25,000
2 Taryan 90,000 3,000 43,500 43,500 90,000
3 2/7/2010 Ny. Sri Dewi 85,000 3,000 41,000 41,000 85,000
4 Riani 20,000 3,000 8,500 8,500 20,000
5 Ny. Yanti 110,000 3,000 53,500 53,500 110,000
6 Nitras 80,000 3,000 38,500 38,500 80,000
7 Nisrina 110,000 3,000 53,500 53,500 110,000
8 Ny. Susan 75,000 3,000 36,000 36,000 75,000
9 5/7/2010 Salma 20,000 3,000 8,500 8,500 20,000
10 Muh. Aga 120,000 3,000 58,500 58,500 120,000
11 6/7/2010 Ny. Nurjanah free -
12 An. Shofina 40,000 3,000 18,500 18,500 40,000
13 Tn. Sembiring 20,000 3,000 8,500 8,500 20,000
14 Aulia 20,000 3,000 8,500 8,500 20,000
15 9/7/2010 Pricilia 120,000 3,000 58,500 58,500 120,000
16 Ruti 150,000 3,000 73,500 73,500 150,000
17 12/7/2010 Triyani 60,000 3,000 28,500 28,500 60,000
18 13/7/2010 Ny. Yuni 20,000 3,000 8,500 8,500 20,000
19 14/7/2010 Tn. Iwan 80,000 3,000 38,500 38,500 80,000
20 Ny. Risna 40,000 3,000 18,500 18,500 40,000
21 Ny. Aksi. M 40,000 3,000 18,500 18,500 40,000
22 16/7/2010 Melani 20,000 3,000 8,500 8,500 20,000
23 Supriyanto 20,000 3,000 8,500 8,500 20,000
24 17/7/2010 Yuyun 10,000 10,000 10,000
25 Ny. Sumarsih 160,000 3,000 78,500 78,500 160,000
26 Ebanov 40,000 3,000 18,500 18,500 40,000
27 19/7/2010 Tn. Cecep 20,000 3,000 8,500 8,500 20,000
28 Tn. Ari. S 150,000 3,000 73,500 73,500 150,000
29 20/7/2010 Melani 40,000 3,000 18,500 18,500 40,000
30 Tn. Enceng 120,000 3,000 58,500 58,500 120,000
31 Tn. Rujia 40,000 3,000 18,500 18,500 40,000
32 21/7/2010 Tn. Heru 40,000 3,000 18,500 18,500 40,000
33 Ny. Aksi. M 40,000 3,000 18,500 18,500 40,000
34 Ny. Risna 110,000 3,000 53,500 53,500 110,000
35 22/7/2010 An. Reza 40,000 3,000 18,500 18,500 40,000
36 Ny. Yayu 20,000 3,000 8,500 8,500 20,000
37 Ari 40,000 3,000 18,500 18,500 40,000
38 23/7/2010 Ny. Nila 85,000 3,000 41,000 41,000 85,000
39 Wahyu 40,000 3,000 18,500 18,500 40,000
40 24/7/2010 Dian Fauziah 20,000 3,000 8,500 8,500 20,000
41 Ny. Alya 30,000 3,000 13,500 13,500 30,000
42 Anti 20,000 3,000 8,500 8,500 20,000
43 27/7/2010 Melani 40,000 3,000 18,500 18,500 40,000
44 Ari 40,000 3,000 18,500 18,500 40,000
45 Ebanov 80,000 3,000 38,500 38,500 80,000
46 Bilqis 32,000 3,000 14,500 14,500 32,000
47 28/7/2010 Tn. Iwan 80,000 3,000 38,500 38,500 80,000
48 29/7/2010 Ny. Iis 20,000 3,000 8,500 8,500 20,000
49 30/7/2010 Raninta 40,000 3,000 18,500 18,500 40,000
50 Ari 40,000 3,000 18,500 18,500 40,000
51 Reza 80,000 3,000 38,500 38,500 80,000
52 Ny. Aksi. M 40,000 3,000 18,500 18,500 40,000
53 31/7/2010 Deasy 10,000 10,000 10,000
54 Ny. Emma - - -
55 Tn. Sukamto 120,000 3,000 58,500 58,500 120,000
56 Ny. Murniati 65,000 3,000 31,000 31,000 65,000
3,117,000 156,000 1,470,500 1,490,500 3,117,000

PERIODE JULI 2010
JASA ALAT &

DOKTER BAHAN
1 1/7/2010 Teguh 40,000 5,000 17,500 17,500 40,000
2 3/7/2010 Ny. Teguh 25,000 5,000 10,000 10,000 25,000
3 Annisa 25,000 5,000 10,000 10,000 25,000
4 5/7/2010 Yosef 25,000 12,500 12,500 25,000
5 Astri 40,000 20,000 20,000 40,000
6 6/7/2010 Tn. Ace 15,000 5,000 5,000 5,000 15,000
7 8/7/2010 Zidane 30,000 15,000 15,000 30,000
8 19/7/2010 Tn. Dedi Samsuri 15,000 5,000 5,000 5,000 15,000
9 20/7/2010 Tn. Yosef 25,000 12,500 12,500 25,000
10 Tn. Dedi Samsuri 25,000 12,500 12,500 25,000
11 21/7/2010 Tn. Dedi Samsuri 15,000 5,000 5,000 5,000 15,000
12 Kezia 25,000 12,500 12,500 25,000
13 22/7/2010 Tn. Yosef 25,000 5,000 10,000 10,000 25,000
14 28/7/2010 Tn. Yosef 25,000 5,000 10,000 10,000 25,000
15 29/7/2010 Tn. Yosef 25,000 5,000 10,000 10,000 25,000
TOTAL 380,000 45,000 167,500 167,500 380,000

1 17/7/2010 Handschoen 1 36,000
TOTAL 286,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Juli 1,490,500 286,000 1,204,500 602,250 602,250
2 Juli 167,500.00 167,500 83,750 83,750
686,000 686,000


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 2/8/2010 Bintang Free -
2 Tn. Edi 40,000 3,000 18,500 18,500 40,000
3 Suhartoyo 40,000 3,000 18,500 18,500 40,000
4 M. Iqbal 40,000 3,000 18,500 18,500 40,000
5 3/8/2010 Tn. Tatang 20,000 20,000 20,000
6 Tn. Idris 50,000 3,000 23,500 23,500 50,000
7 Budy 40,000 3,000 18,500 18,500 40,000
8 Ani 110,000 3,000 53,500 53,500 110,000
9 Melanie 200,000 3,000 98,500 98,500 200,000
10 Ranita 40,000 3,000 18,500 18,500 40,000
11 4/8/2010 Ny. Ema 25,000 3,000 11,000 11,000 25,000
12 Risyad 10,000 10,000 10,000
13 5/8/2010 Tn. Endang 20,000 3,000 8,500 8,500 20,000
14 6/8/2010 Tn. Ruhiyat 20,000 3,000 8,500 8,500 20,000
15 Risyad 10,000 10,000 10,000
16 Ny. Aksi 40,000 3,000 18,500 18,500 40,000
17 Reza 60,000 3,000 28,500 28,500 60,000
18 7/8/2010 Ny. Ema 125,000 3,000 61,000 61,000 125,000
19 Ny. Murniati 30,000 3,000 13,500 13,500 30,000
20 9/8/2010 Tn. Endang 20,000 3,000 8,500 8,500 20,000
21 Suhartoyo 70,000 3,000 33,500 33,500 70,000
22 M. Iqbal 100,000 3,000 48,500 48,500 100,000
23 Tn. Asep 20,000 3,000 8,500 8,500 20,000
24 Tn. Sulistriyono 20,000 3,000 8,500 8,500 20,000
25 10/8/2001 Ranita 140,000 3,000 68,500 68,500 140,000
26 Tn. Idris 20,000 20,000 20,000
27 Reza 40,000 3,000 18,500 18,500 40,000
28 11/8/2010 Tn. Tatang 80,000 3,000 38,500 38,500 80,000
29 Risyad 20,000 20,000 20,000
30 12/8/2010 Rani 40,000 3,000 18,500 18,500 40,000
31 13/8/2010 Ny. Murniati 130,000 3,000 63,500 63,500 130,000
32 14/8/2010 Luthfi 150,000 3,000 73,500 73,500 150,000
33 Tn. Ayu 60,000 3,000 28,500 28,500 60,000
34 15/8/2010 Reza 40,000 3,000 18,500 18,500 40,000
35 20/8/201 Sabda 80,000 40,000 40,000 80,000
36 21/8/2010 Rika 20,000 3,000 8,500 8,500 20,000
37 Greti 20,000 3,000 8,500 8,500 20,000
38 24/8/2010 Ranita 40,000 3,000 18,500 18,500 40,000
39 27/8/2010 Tn. Idris 30,000 30,000 30,000
40 Lusi 150,000 3,000 73,500 73,500 150,000
41 Mutiara 50,000 3,000 23,500 23,500 50,000
42 31/8/2010 Ranita 40,000 3,000 18,500 18,500 40,000
43 Ny. Anggia 120,000 3,000 58,500 58,500 120,000
2,420,000 105,000 1,102,500 1,212,500 2,420,000

JASA ALAT &

DOKTER BAHAN
1 9/8/2010 Nurtahana 30,000 15,000 15,000 30,000
2 10/8/2010 Tn. Yoseph 25,000 5,000 10,000 10,000 25,000
3 11/8/2010 Tn. Yoseph 25,000 12,500 12,500 25,000
4 13/8/2010 Tn. Surya Bakti 15,000 5,000 5,000 5,000 15,000
5 18/8/2010 Tn. Yoseph 25,000 12,500 12,500 25,000
6 19/8/2010 Tn. Yoseph 25,000 12,500 12,500 25,000
7 19/8/2010 Setiawan 30,000 15,000 15,000 30,000
8 23/8/2010 Ny. Elis 25,000 5,000 10,000 10,000 25,000
9 24/8/2010 Mira 20,000 10,000 10,000 20,000
10 24/8/2010 Kezia 25,000 12,500 12,500 25,000
11 27/8/2010 Paulus 25,000 12,500 12,500 25,000
12 27/8/2010 Tn. Yoseph 30,000 15,000 15,000 30,000
13 28/8/2010 Tn. Yosef 30,000 5,000 12,500 12,500 30,000
TOTAL 330,000 20,000 155,000 155,000 330,000

1 12/8/2010 Bahan Gigi 1 205,000
TOTAL 455,000
KEUNTUNGAN
KSBL DRG. DEWI
1 AGUSTUS 1,212,500 455,000 757,500 378,750 378,750
2 AGUSTUS 155,000.00 155,000 77,500 77,500
456,250 456,250


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/9/2010 Eti Susanti 40,000 3,000 18,500 18,500 40,000
2 2/9/2010 Eti Susanti 20,000 3,000 8,500 8,500 20,000
3 Saripudin 20,000 3,000 8,500 8,500 20,000
4 Tn. B. Sinaga 60,000 3,000 28,500 28,500 60,000
5 3/9/2010 Melani 55,000 3,000 26,000 26,000 55,000
6 Reza 110,000 3,000 53,500 53,500 110,000
7 4/9/2010 Tn. Paul 80,000 3,000 38,500 38,500 80,000
8 Eti Susanti 40,000 3,000 18,500 18,500 40,000
9 Cucu Rohaeni 20,000 3,000 8,500 8,500 20,000
10 Tegina Lestari 40,000 3,000 18,500 18,500 40,000
11 7/9/2010 Ny. Anggia 180,000 3,000 88,500 88,500 180,000
12 8/9/2010 Amelia 30,000 3,000 13,500 13,500 30,000
13 Eti Susanti 60,000 3,000 28,500 28,500 60,000
14 Reza 80,000 3,000 38,500 38,500 80,000
15 Mayang 150,000 3,000 73,500 73,500 150,000
16 18/9/2010 Tn. Wahyudin 150,000 3,000 73,500 73,500 150,000
17 Ana. J. N 40,000 3,000 18,500 18,500 40,000
18 Eti Susanti 40,000 3,000 18,500 18,500 40,000
19 Ny. Ayu 20,000 3,000 8,500 8,500 20,000
20 Noval 20,000 3,000 8,500 8,500 20,000
21 20/9/2010 An. Fakhrudin 40,000 3,000 18,500 18,500 40,000
22 21/9/2010 Ana. J. N 40,000 3,000 18,500 18,500 40,000
23 Ayu 40,000 3,000 18,500 18,500 40,000
24 22/9/2010 Ny. Nina 50,000 3,000 23,500 23,500 50,000
25 Cintami 16,000 8,000 8,000 16,000
26 23/9/2010 Ny. Dewi
27 Nn. Ika 20,000 3,000 8,500 8,500 20,000
28 Regina Lestri 40,000 3,000 18,500 18,500 40,000
29 Tn. Agus 70,000 3,000 33,500 33,500 70,000
30 25/9/2010 Eti Susanti 60,000 3,000 28,500 28,500 60,000
31 Ana. J. N 40,000 3,000 18,500 18,500 40,000
32 29/9/2010 Ana. J. N 40,000 3,000 18,500 18,500 40,000
33 29/9/2010 Alfiatur 85,000 3,000 41,000 41,000 85,000
34 Ny. Elis 20,000 3,000 8,500 8,500 20,000
35 Ny. Siti Wamiatul 40,000 3,000 18,500 18,500 40,000
36 Wahyu Ambari 85,000 3,000 41,000 41,000 85,000
37 Warisem 65,000 3,000 31,000 31,000 65,000
38 Tn. Dadan 20,000 3,000 8,500 8,500 20,000
39 30/9/2010 Tn. Edi 20,000 3,000 8,500 8,500 20,000
2,046,000 111,000 967,500 967,500 2,046,000

JASA ALAT &

DOKTER BAHAN
1 3/9/2010 Yosep 40,000 20,000 20,000 40,000
2 Paulus 25,000 12,500 12,500 25,000
3 4/9/2010 Yosep 40,000 20,000 20,000 40,000
4 8/9/2010 Paulus 30,000 15,000 15,000 30,000
5 9/9/2010 Paulus 40,000 20,000 20,000 40,000
6 Yayu. K 15,000 7,500 7,500 15,000
7 21/9/2010 Waluyo 20,000 5,000 7,500 7,500 20,000
8 28/9/2010 Tn. Usep 60,000 30,000 30,000 60,000
TOTAL 270,000 5,000 132,500 132,500 270,000

TOTAL 250,000
KEUNTUNGAN
KSBL DRG. DEWI
1 September 967,500 250,000 717,500 358,750 358,750
2 September 132,500.00 132,500 66,250 66,250
425,000 425,000


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/10/2010 An. Devi 80,000 3,000 38,500 38,500 80,000
2 Tn. Teguh 20,000 3,000 8,500 8,500 20,000
3 2/10/2010 Ny. Alfiatur 80,000 3,000 38,500 38,500 80,000
4 4/10/2010 Risna 20,000 3,000 8,500 8,500 20,000
5 Aminah 16,000 8,000 8,000 16,000
6 Ervana 40,000 3,000 18,500 18,500 40,000
7 5/10/2010 An. Devi 40,000 3,000 18,500 18,500 40,000
8 Ny. Ai 20,000 3,000 8,500 8,500 20,000
9 7/10/2010 Ny. Lia 150,000 3,000 73,500 73,500 150,000
10 Ny. Lusi 85,000 3,000 41,000 41,000 85,000
11 9/10/2010 Cintami - - -
12 11/10/2010 Ny. Ade 20,000 3,000 8,500 8,500 20,000
13 Linda 60,000 3,000 28,500 28,500 60,000
14 12/10/2010 Ny. Sumaryadi 20,000 3,000 8,500 8,500 20,000
15 Cintami 48,000 24,000 24,000 48,000
16 14/10/2010 Ny. Yani 30,000 30,000
17 16/10/2010 Syifa 40,000 20,000 20,000 40,000
18 Anita. N 100,000 3,000 48,500 48,500 100,000
19 Sucipto 20,000 3,000 8,500 8,500 20,000
20 Bayu Samudra 40,000 3,000 18,500 18,500 40,000
21 18/10/2010 Ny. Ade. S 60,000 3,000 28,500 28,500 60,000
22 Ny. Inas. S 60,000 3,000 28,500 28,500 60,000
23 Tn. Suseno 20,000 3,000 8,500 8,500 20,000
24 Tn. Koswara 20,000 3,000 8,500 8,500 20,000
25 E. Saragih - - -
26 19/10/2010 Arci 40,000 3,000 18,500 18,500 40,000
27 21/10/2010 Tn. Entam 20,000 3,000 8,500 8,500 20,000
28 Dian 75,000 3,000 36,000 36,000 75,000
29 22/10/2010 Tn. Oke 80,000 3,000 38,500 38,500 80,000
30 Ny. Lilis 150,000 3,000 73,500 73,500 150,000
31 23/10/2010 Rifa Nairah 40,000 3,000 18,500 18,500 40,000
32 Tn. Anis Kuncoro 20,000 3,000 8,500 8,500 20,000
33 Ny. Dewi 90,000 3,000 43,500 43,500 90,000
34 Tn. Warsun 140,000 3,000 68,500 68,500 140,000
35 Eva 130,000 3,000 63,500 63,500 130,000
36 Tri Fajayani 20,000 20,000 20,000
37 25/10/2010 Ny. E. Saragih 40,000 3,000 18,500 18,500 40,000
38 Ny. Ade 60,000 3,000 28,500 28,500 60,000
39 Melani 20,000 3,000 8,500 8,500 20,000
40 Tn. Tapian 40,000 3,000 18,500 18,500 40,000
41 27/10/2010 Rifa Nairah 40,000 3,000 18,500 18,500 40,000
42 Denis 40,000 3,000 18,500 18,500 40,000
43 Ny. Yani 40,000 3,000 18,500 18,500 40,000
44 Melani 40,000 3,000 18,500 18,500 40,000
45 Tn. Sugandi 40,000 3,000 18,500 18,500 40,000
46 30/10/2010 Eva 70,000 3,000 33,500 33,500 70,000
47 Rifa Nairah 40,000 3,000 18,500 18,500 40,000
2,364,000 120,000 1,097,000 1,117,000 2,364,000

JASA ALAT &

DOKTER BAHAN
1 4/10/2010 Siti Fatimah 20,000 5,000 7,500 7,500 20,000
2 Ace 20,000 5,000 7,500 7,500 20,000
3 19/10/2010 Tn. Rudi 25,000 5,000 10,000 10,000 25,000
4 20/10/2010 Tn. Rudi 25,000 12,500 12,500 25,000
5 22/10/2010 Kezia 25,000 5,000 10,000 10,000 25,000
6 23/10/2010 Tn.Ace Tarkana 15,000 5,000 5,000 5,000 15,000
7 27/10/2010 Tn. Rudi 25,000 12,500 12,500 25,000
8 Paulus 15,000 5,000 5,000 5,000 15,000
9 28/10/2010 Tn. Rudi 25,000 5,000 10,000 10,000 25,000
10 Tn. Surya 20,000 5,000 7,500 7,500 20,000
TOTAL 215,000 40,000 87,500 87,500 215,000

Dentin Enamel Bonding
1 2/10/2010 1 126,000
One Step 5 ml
2 14/10/10 Spuit Terumo 3 cc 1 120,000
3 23/10/10 Masker 1 26,000
4 26/10/10 Pehacain Inj 1 60,000
TOTAL 582,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Oktober 1,117,000 582,000 535,000 267,500 267,500
2 Oktober 87,500.00 87,500 43,750 43,750
311,250 311,250


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/11/2010 Heni Suprihatin 40,000 3,000 18,500 18,500 40,000
2 2/11/2010 Tn. Tapian 40,000 3,000 18,500 18,500 40,000
3 3/11/2010 Ny. Lilis 40,000 3,000 18,500 18,500 40,000
4 Selvi 20,000 3,000 8,500 8,500 20,000
5 Rifa. N 40,000 3,000 18,500 18,500 40,000
6 Eka 125,000 3,000 61,000 61,000 125,000
7 5/11/2010 Melani 40,000 3,000 18,500 18,500 40,000
8 6/11/2010 Rifa Nairah 95,000 3,000 46,000 46,000 95,000
9 Ruszeinda 36,000 3,000 16,500 16,500 36,000
10 Raihan - - -
11 Tn. Misyanto 60,000 3,000 28,500 28,500 60,000
12 Lintang 60,000 3,000 28,500 28,500 60,000
13 8/11/2010 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
14 Salsa 50,000 3,000 23,500 23,500 50,000
15 8/11/2010 An. Abdul Rahma 20,000 3,000 8,500 8,500 20,000
16 An. Rista 50,000 3,000 23,500 23,500 50,000
17 Erlia 40,000 3,000 18,500 18,500 40,000
18 Nn. Romlah 20,000 3,000 8,500 8,500 20,000
19 9/11/2010 Tn. Ridwan 20,000 3,000 8,500 8,500 20,000
20 Lusiana 80,000 3,000 38,500 38,500 80,000
21 Thia 40,000 3,000 18,500 18,500 40,000
22 11/11/2010 Tn. Cecep 60,000 3,000 28,500 28,500 60,000
23 12/11/2010 Rangga 25,000 3,000 11,000 11,000 25,000
24 Tn. Samsul 90,000 3,000 43,500 43,500 90,000
25 13/11/2010 Ruszeinda 36,000 3,000 16,500 16,500 36,000
26 Lintang 30,000 3,000 13,500 13,500 30,000
27 Tn. Deni 30,000 3,000 13,500 13,500 30,000
28 18/11/2010 Ny. Enok 20,000 3,000 8,500 8,500 20,000
29 M. Zaki 16,000 8,000 8,000 16,000
30 19/11/2010 Ny. Siti 40,000 3,000 18,500 18,500 40,000
31 Ny. Enok 40,000 20,000 20,000 40,000
32 Ridho 20,000 3,000 8,500 8,500 20,000
33 Tn. Muin 20,000 3,000 8,500 8,500 20,000
34 Tn. Samsul 80,000 3,000 38,500 38,500 80,000
35 Muh Aga 120,000 3,000 58,500 58,500 120,000
36 20/11/2010 Ruszeinda 36,000 3,000 16,500 16,500 36,000
37 Ananda 40,000 3,000 18,500 18,500 40,000
38 Tn. Syarbaini 70,000 3,000 33,500 33,500 70,000
39 Lintang 30,000 3,000 13,500 13,500 30,000
40 23/11/2010 Tn. Edi 20,000 3,000 8,500 8,500 20,000
41 Tria 40,000 3,000 18,500 18,500 40,000
42 Haris 20,000 3,000 8,500 8,500 20,000
43 24/11/2010 Lintang 30,000 3,000 13,500 13,500 30,000
44 Ny. Heni 20,000 3,000 8,500 8,500 20,000
45 25/11/2010 Ny. Enok 40,000 3,000 18,500 18,500 40,000
46 Ny. Siti 30,000 3,000 13,500 13,500 30,000
47 Hani 40,000 3,000 18,500 18,500 40,000
48 26/11/2010 Ny. Hj. Aah 20,000 3,000 8,500 8,500 20,000
49 27/11/2010 Ny. Lilis 35,000 3,000 16,000 16,000 35,000
50 Ny. Heni 20,000 3,000 8,500 8,500 20,000
51 Lintang 30,000 3,000 13,500 13,500 30,000
52 M. Rizki 40,000 3,000 18,500 18,500 40,000
53 M. Ikbal 280,000 3,000 138,500 138,500 280,000
54 Ny. Mia 40,000 3,000 18,500 18,500 40,000
55 28/11/2010 Tn. Reby 20,000 20,000 20,000
56 30/11/2010 Tria 40,000 3,000 18,500 18,500 40,000
27 Ny. Hj. Aah 40,000 3,000 18,500 18,500 40,000
2,544,000 159,000 1,182,500 1,202,500 2,544,000
LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA PRATAMA

JASA ALAT &

DOKTER BAHAN
1 1/11/2010 Komarudin 20,000 5,000 7,500 7,500 20,000
2 2/11/2010 Tn. Rudi 25,000 12,500 12,500 25,000
3 3/11/2010 Surya 15,000 5,000 5,000 5,000 15,000
4 4/11/2010 Rudi 25,000 12,500 12,500 25,000
5 Kezia 25,000 5,000 10,000 10,000 25,000
6 5/11/2010 Komarudin 25,000 12,500 12,500 25,000
7 Kezia 25,000 5,000 10,000 10,000 25,000
8 Rudi 25,000 12,500 12,500 25,000
9 6/11/2010 Rudi 25,000 12,500 12,500 25,000
10 8/11/2010 Rudi 30,000 15,000 15,000 30,000
11 9/11/2010 Rudi 30,000 15,000 15,000 30,000
12 12/11/2010 Kezia 25,000 12,500 12,500 25,000
13 Rudi 40,000 5,000 17,500 17,500 40,000
14 13/11/2010 Rudi 40,000 20,000 20,000 40,000
15 Ria Rosmayanti 25,000 5,000 10,000 10,000 25,000
16 M. Lukman 40,000 5,000 17,500 17,500 40,000
17 19/11/2010 Rudi 40,000 5,000 17,500 17,500 40,000
18 Ny. Jaenab 40,000 20,000 20,000 40,000
19 20/11/2010 Rudi 40,000 20,000 20,000 40,000
20 Ny. Jaenab 40,000 20,000 20,000 40,000
21 Tn. Ace 15,000 5,000 5,000 5,000 15,000
22 Ria Rosmayanti 25,000 12,500 12,500 25,000
23 22/11/2010 Rida Farida 25,000 5,000 10,000 10,000 25,000
24 Santi Kurniati 15,000 5,000 5,000 5,000 15,000
25 Kezia 25,000 12,500 12,500 25,000
26 24/11/2010 Ria Rosmayanti 25,000 12,500 12,500 25,000
27 Maryati 35,000 5,000 15,000 15,000 35,000
28 25/11/2010 Rida Farida 40,000 5,000 17,500 17,500 40,000
29 26/11/2010 Rudi 15,000 5,000 5,000 5,000 15,000
30 Kezia 25,000 12,500 12,500 25,000
31 27/11/2010 Ria Rosmayanti 30,000 15,000 15,000 30,000
32 Maryati 35,000 5,000 15,000 15,000 35,000
TOTAL 910,000 75,000 417,500 417,500 910,000

1 6/11/2010 Sensiglove 1 38,000
2 13/11/2010 Caviton 1 95,000
Fuji 9 MP 1 205,000
3 29/11/2010 Servis Dental Unit 1 150,000
TOTAL 738,000
KEUNTUNGAN
KSBL DRG. DEWI
1 November 1,202,500 738,000 464,500 232,250 232,250
2 November 910,000.00 910,000 455,000 455,000
687,250 687,250


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 1/12/2010 Ny. Lilis 100,000 3,000 48,500 48,500 100,000
2 Lintang 75,000 3,000 36,000 36,000 75,000
3 2/12/2010 Ny. Enok 40,000 3,000 18,500 18,500 40,000
4 Dedi 20,000 3,000 8,500 8,500 20,000
5 Tn. Kris 60,000 3,000 28,500 28,500 60,000
6 Ayu 40,000 3,000 18,500 18,500 40,000
7 3/12/2010 Dea 20,000 3,000 8,500 8,500 20,000
8 4/12/2010 M. Risky 20,000 3,000 8,500 8,500 20,000
9 Raihan 15,000 15,000 15,000
10 Ananda 40,000 3,000 18,500 18,500 40,000
11 Tn. Syarbaini 50,000 3,000 23,500 23,500 50,000
12 Ny. Mia 105,000 3,000 51,000 51,000 105,000
13 8/12/2010 Wena 15,000 15,000 15,000
14 Ananda 100,000 3,000 48,500 48,500 100,000
15 Tn. Faturohman 40,000 3,000 18,500 18,500 40,000
16 Difa 30,000 3,000 13,500 13,500 30,000
17 Heni 130,000 3,000 63,500 63,500 130,000
18 Ny. Hj. Aah 40,000 3,000 18,500 18,500 40,000
19 9/12/2010 Ny. Enok 40,000 3,000 18,500 18,500 40,000
20 Ny. Tati 20,000 3,000 8,500 8,500 20,000
21 Alma 20,000 3,000 8,500 8,500 20,000
22 10/12/2010 Ny. Nila 100,000 3,000 48,500 48,500 100,000
23 11/12/2010 Ny. Maryati 35,000 3,000 16,000 16,000 35,000
24 Ruszeinda 36,000 3,000 16,500 16,500 36,000
25 Ny. Yozak 40,000 3,000 18,500 18,500 40,000
26 13/12/2010 Galang. A 20,000 3,000 8,500 8,500 20,000
27 Ny. Titi 20,000 3,000 8,500 8,500 20,000
28 14/12/2010 Insan 40,000 3,000 18,500 18,500 40,000
29 Ny. Hj. Aah 40,000 3,000 18,500 18,500 40,000
30 Deti 100,000 3,000 48,500 48,500 100,000
31 Tina 40,000 3,000 18,500 18,500 40,000
32 15/12/2010 Ny. Maryati 140,000 3,000 68,500 68,500 140,000
33 Wena 20,000 20,000 20,000
34 Tn. Faturohman 40,000 3,000 18,500 18,500 40,000
35 Zestzeilast Fairene 40,000 3,000 18,500 18,500 40,000
36 Heri 130,000 3,000 63,500 63,500 130,000
37 Ahmad 20,000 3,000 8,500 8,500 20,000
38 16/12/2010 Ny. Enok 40,000 3,000 18,500 18,500 40,000
39 Ny. Tati 40,000 3,000 18,500 18,500 40,000
40 18/12/2010 Wena 20,000 20,000 20,000
41 Erna 20,000 3,000 8,500 8,500 20,000
42 Tn. Andri 40,000 3,000 18,500 18,500 40,000
43 Tn. Darmin Efendi 60,000 3,000 28,500 28,500 60,000
44 20/12/2010 Ny. Mintarsih 20,000 3,000 8,500 8,500 20,000
45 21/12/2010 Ny. Hj. Aah 110,000 3,000 53,500 53,500 110,000
46 Enceng 90,000 3,000 43,500 43,500 90,000
47 22/12/2010 Tn. Faturohman 120,000 3,000 58,500 58,500 120,000
48 Wena 20,000 20,000 20,000
49 Ny. Meilani 20,000 3,000 8,500 8,500 20,000
50 Tina 40,000 3,000 18,500 18,500 40,000
51 Heri 30,000 3,000 13,500 13,500 30,000
52 Tria 110,000 3,000 53,500 53,500 110,000
53 23/12/2010 Ny. Tuti 40,000 3,000 18,500 18,500 40,000
54 24/12/2010 Mimin 20,000 3,000 8,500 8,500 20,000
55 X 32,000 16,000 16,000 32,000
56 28/12/2010 Tina 30,000 3,000 13,500 13,500 30,000
57 Siti 40,000 3,000 18,500 18,500 40,000
58 29/12/2010 Wena 20,000 20,000 20,000
59 Heri 150,000 3,000 73,500 73,500 150,000
60 30/12/2010 Ny. Mintarsih 20,000 3,000 8,500 8,500 20,000
61 Tina 40,000 3,000 18,500 18,500 40,000
3,053,000 162,000 1,390,500 1,500,500 3,053,000

JASA ALAT &

DOKTER BAHAN
1 1/12/2010 Ny. Ria Rosmiati 40,000 20,000 20,000 40,000
2 Rudi 40,000 5,000 17,500 17,500 40,000
3 Kezia 25,000 5,000 10,000 10,000 25,000
4 Setiawan Adi 15,000 7,500 7,500 15,000
5 2/12/2010 Komarudin 40,000 20,000 20,000 40,000
6 6/12/2010 Aqsel 20,000 10,000 10,000 20,000
7 8/12/2010 Komarudin 25,000 5,000 10,000 10,000 25,000
8 10/12/2010 M. Nathan Fachri. M 15,000 5,000 5,000 5,000 15,000
9 Waluyo 25,000 12,500 12,500 25,000
10 15/12/2010 Komarudin 25,000 12,500 12,500 25,000
11 Waluyo 15,000 5,000 5,000 5,000 15,000
12 21/12/2010 Gisti 15,000 7,500 7,500 15,000
13 22/12/2010 Komarudin 25,000 12,500 12,500 25,000
14 29/12/2010 Komarudin 30,000 15,000 15,000 30,000
15 29/12/2010 Maryati 15,000 7,500 7,500 15,000
16 30/12/2010 Andreanes 40,000 5,000 17,500 17,500 40,000
TOTAL 410,000 30,000 190,000 190,000 410,000

1 18/12/10 Pehacain 1 59,000
TOTAL 309,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Desember 1,500,500 309,000 1,191,500 595,750 595,750
2 Desember 410,000.00 410,000 205,000 205,000
800,750 800,750


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 3/1/2011 Rizkya 40,000 3,000 18,500 18,500 40,000
2 4/1/2011 Toni 20,000 3,000 8,500 8,500 20,000
3 Tn. Surya Dinata 40,000 3,000 18,500 18,500 40,000
4 Tina 30,000 3,000 13,500 13,500 30,000
5 6/1/2011 Raffi 30,000 3,000 13,500 13,500 30,000
6 Ny. Enok 40,000 20,000 20,000 40,000
7 Tn. Umar 60,000 3,000 28,500 28,500 60,000
8 Ny. Atira 40,000 3,000 18,500 18,500 40,000
9 Cecep 10,000 3,000 3,500 3,500 10,000
10 Yuga. T 80,000 3,000 38,500 38,500 80,000
11 7/1/2011 Ny. Nila 100,000 3,000 48,500 48,500 100,000
12 8/1/2011 Tn. Agus 80,000 3,000 38,500 38,500 80,000
13 Raffi 50,000 25,000 25,000 50,000
14 Ny. Enok 40,000 20,000 20,000 40,000
15 10/1/2011 An. Ibnu 40,000 3,000 18,500 18,500 40,000
16 Ny. Erna 20,000 3,000 8,500 8,500 20,000
17 Deasy 20,000 20,000
18 Agung 20,000 3,000 8,500 8,500 20,000
19 11/1/2011 Ny. Yanti 20,000 3,000 8,500 8,500 20,000
20 Ny. Mintarsih - - -
21 Ny. Neneng 15,000 3,000 6,000 6,000 15,000
22 Wildan 70,000 3,000 33,500 33,500 70,000
23 Tn. Surya Dinata 40,000 3,000 18,500 18,500 40,000
24 Raffel 50,000 3,000 23,500 23,500 50,000
25 Tn. Reikan 20,000 3,000 8,500 8,500 20,000
26 12/1/2011 Tina 30,000 3,000 13,500 13,500 30,000
27 William 40,000 3,000 18,500 18,500 40,000
28 12/1/2011 Ny. Enok 40,000 20,000 20,000 40,000
29 Nn. Irma 40,000 20,000 20,000 40,000
30 14/1/2011 Salsabila 20,000 3,000 8,500 8,500 20,000
31 15/1/2011 Asep 80,000 3,000 38,500 38,500 80,000
32 Ebanov 40,000 3,000 18,500 18,500 40,000
33 17/1/2011 Nurlaela 20,000 3,000 8,500 8,500 20,000
34 18/1/2011 Deasy 10,000 10,000
35 Ny. Yanti 40,000 3,000 18,500 18,500 40,000
36 Tn. Bayu 40,000 3,000 18,500 18,500 40,000
37 Tn. Encep 40,000 3,000 18,500 18,500 40,000
38 19/1/2011 Tina 110,000 3,000 53,500 53,500 110,000
39 William 40,000 3,000 18,500 18,500 40,000
40 20/1/2011 Nn. Irma 50,000 3,000 23,500 23,500 50,000
41 Ny. Enok 20,000 3,000 8,500 8,500 20,000
42 Melani 40,000 3,000 18,500 18,500 40,000
43 Desi Retno 40,000 3,000 18,500 18,500 40,000
44 22/1/2011 Tn. Ade Efendi 20,000 3,000 8,500 8,500 20,000
45 Ebanov 40,000 3,000 18,500 18,500 40,000
46 Noer Isti 70,000 3,000 33,500 33,500 70,000
47 25/1/2011 Agung 50,000 3,000 23,500 23,500 50,000
48 Yanti 40,000 3,000 18,500 18,500 40,000
49 William 40,000 3,000 18,500 18,500 40,000
50 Merlyn 40,000 3,000 18,500 18,500 40,000
51 Encep 50,000 3,000 23,500 23,500 50,000
52 26/1/2011 Tn. Bayu 40,000 3,000 18,500 18,500 40,000
53 Deasy 10,000 10,000
54 28/1/2011 Ny. Nila 80,000 3,000 38,500 38,500 80,000
55 Abu Zakwa. S 20,000 3,000 8,500 8,500 20,000
56 An. Dias 25,000 3,000 11,000 11,000 25,000
57 Desi 40,000 3,000 18,500 18,500 40,000
58 Tanti 50,000 3,000 23,500 23,500 50,000
59 29/1/2011 Irgi 20,000 3,000 8,500 8,500 20,000
60 Ny. Mia 40,000 3,000 18,500 18,500 40,000
61 Nadar 130,000 3,000 63,500 63,500 130,000
62 Ilyas 30,000 3,000 13,500 13,500 30,000
63 Riska 60,000 3,000 28,500 28,500 60,000
64 31/1/2011 Ny. Atira 50,000 3,000 23,500 23,500 50,000
65 Ny. Eni 20,000 3,000 8,500 8,500 20,000
2,680,000 168,000 1,236,000 1,236,000 2,680,000

JASA ALAT &

DOKTER BAHAN
1 3/1/2011 Ellis Dwi 15,000 5,000 5,000 5,000 15,000
2 6/1/2011 Frida Ramadhan 15,000 7,500 7,500 15,000
3 Reni 40,000 5,000 17,500 17,500 40,000
4 11/1/2011 Surya 10,000 5,000 2,500 2,500 10,000
5 15/1/2011 Salma 10,000 5,000 2,500 2,500 10,000
6 17/1/2011 Sumiati 10,000 5,000 2,500 2,500 10,000
7 18/1/2011 Tn. Ilham 10,000 5,000 2,500 2,500 10,000
8 20/1/2011 Ny. Santi 10,000 5,000 2,500 2,500 10,000
9 21/1/2011 Tn. Soma 10,000 5,000 2,500 2,500 10,000
10 24/1/2011 Rifki 10,000 5,000 5,000 10,000
11 26/1/2011 Tn. Komarudin 30,000 15,000 15,000 30,000
12 26/1/2011 Rifki 15,000 7,500 7,500 15,000
TOTAL 185,000 40,000 72,500 72,500 185,000

1 3/1/2011 Hand Schoen 1 36,000
Elite Cement Mini Pack 1 105,000
2 26/1/2011 Masker 1 26,000
TOTAL 167,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Januari 1,236,000 167,000 1,069,000 534,500 534,500
2 Januari 185,000.00 185,000 92,500 92,500
627,000 627,000


Menyetujui,

Direktur KSBL

JASA ALAT &

DOKTER BAHAN
1 2/1/2011 Yanti 40,000 3,000 18,500 18,500 40,000
2 2/2/2011 Tati 125,000 3,000 61,000 61,000 125,000
3 Ny. Iis 30,000 3,000 13,500 13,500 30,000
4 An. Difa 15,000 3,000 6,000 6,000 15,000
5 Mia 20,000 3,000 8,500 8,500 20,000
6 Tn. Bayu 40,000 3,000 18,500 18,500 40,000
7 Tn. Surya Dinata 40,000 3,000 18,500 18,500 40,000
8 William 40,000 3,000 18,500 18,500 40,000
9 Desi 40,000 3,000 18,500 18,500 40,000
10 Ny. Merlin 40,000 3,000 18,500 18,500 40,000
11 2/4/2011 Tn. Mujiono 80,000 3,000 38,500 38,500 80,000
12 Mia 30,000 3,000 13,500 13,500 30,000
13 Ny. Mia 40,000 3,000 18,500 18,500 40,000
14 2/6/2011 Luthfi 50,000 3,000 23,500 23,500 50,000
15 Tasya 50,000 3,000 23,500 23,500 50,000
16 Amang 20,000 3,000 8,500 8,500 20,000
17 2/8/2011 Tati 50,000 3,000 23,500 23,500 50,000
18 Desi 40,000 3,000 18,500 18,500 40,000
19 Yanti 40,000 3,000 18,500 18,500 40,000
20 Ny. Dewi 50,000 3,000 23,500 23,500 50,000
21 Ny. Elis 40,000 3,000 18,500 18,500 40,000
22 2/9/2011 Tn. Surya Dinata 40,000 3,000 18,500 18,500 40,000
23 2/12/2011 Tn. Catur 80,000 3,000 38,500 38,500 80,000
24 Ebanov 40,000 3,000 18,500 18,500 40,000
25 2/14/2011 Sabda 80,000 3,000 38,500 38,500 80,000
26 Septi 50,000 3,000 23,500 23,500 50,000
27 Fariq 50,000 3,000 23,500 23,500 50,000
28 Ny. Mintarsih 20,000 3,000 8,500 8,500 20,000
29 2/16/2011 Tn. Surya Dinata 40,000 3,000 18,500 18,500 40,000
30 Ny. Euis 100,000 3,000 48,500 48,500 100,000
31 Merlya 40,000 3,000 18,500 18,500 40,000
32 William 40,000 3,000 18,500 18,500 40,000
33 Bayu 40,000 3,000 18,500 18,500 40,000
34 Ebanov 80,000 3,000 38,500 38,500 80,000
35 2/19/2011 Yumiati 16,000 3,000 6,500 6,500 16,000
36 Juariah 15,000 15,000 15,000
37 Ebanov 40,000 3,000 18,500 18,500 40,000
38 2/21/2011 Septi 50,000 3,000 23,500 23,500 50,000
39 Fitra 80,000 3,000 38,500 38,500 80,000
40 Resti 20,000 3,000 8,500 8,500 20,000
41 2/22/2011 Tn. Surya Dinata 110,000 3,000 53,500 53,500 110,000
42 Ny. Risya 150,000 3,000 73,500 73,500 150,000
43 Ebanov 40,000 3,000 18,500 18,500 40,000
44 William 40,000 3,000 18,500 18,500 40,000
45 Ny. Merlin 40,000 3,000 18,500 18,500 40,000
46 Ny. Euis 90,000 3,000 43,500 43,500 90,000
47 Desi 30,000 3,000 13,500 13,500 30,000
48 Resti 15,000 3,000 6,000 6,000 15,000
49 Bayu 40,000 3,000 18,500 18,500 40,000
50 2/25/2011 Eti Susanti 40,000 3,000 18,500 18,500 40,000
51 Ny. Umar 50,000 3,000 23,500 23,500 50,000
52 2/26/2011 Ny. Mia 105,000 3,000 51,000 51,000 105,000
53 Yani 10,000 10,000 10,000
54 dr. Munir 25,000 25,000 25,000
2,626,000 153,000 1,211,500 1,261,500 2,626,000

JASA ALAT &

DOKTER BAHAN
1 2/6/2011 Kartika . M 20,000 10,000 10,000 20,000
2 2/9/2011 Kezia 30,000 15,000 15,000 30,000
3 2/12/2011 Anissa 10,000 5,000 2,500 2,500 10,000
4 2/14/2011 Dede 15,000 5,000 5,000 5,000 15,000
5 2/19/2011 Fini 15,000 7,500 7,500 15,000
6 Ny. Tintin 30,000 5,000 12,500 12,500 30,000
7 2/23/2011 Ny. Tintin 30,000 5,000 12,500 12,500 30,000
TOTAL 150,000 20,000 65,000 65,000 150,000

1 2/4/2011 Bahan Gigi 1 72,000
2 2/5/2011 Glass Ionemer Cement 1 35,000
Handschoen, Bahan
3 2/21/2011 1 256,000
Tambal
4 2/23/2011 Pehacain + Lidocain 19 Amp 50,000
TOTAL 413,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Febuari 1,261,500 413,000 848,500 424,250 424,250
2 Febuari 150,000.00 150,000 75,000 75,000
499,250 499,250


Menyetujui,

Penanggung Jawab KSBL

PERIODE MARET 2011
JASA ALAT &

DOKTER BAHAN
1 3/2/2011 Yani 10,000 10,000 10,000
2 Desi 110,000 3,000 53,500 53,500 110,000
3 Yunira 80,000 3,000 38,500 38,500 80,000
4 Puspita 15,000 3,000 6,000 6,000 15,000
5 Ebanov 40,000 3,000 18,500 18,500 40,000
6 3/7/2011 Tn. Saman 20,000 3,000 8,500 8,500 20,000
7 Nazar 20,000 3,000 8,500 8,500 20,000
8 Irfan 20,000 3,000 8,500 8,500 20,000
9 Enung 20,000 3,000 8,500 8,500 20,000
10 Jeti 20,000 3,000 8,500 8,500 20,000
11 Attar 20,000 3,000 8,500 8,500 20,000
12 Febi 50,000 3,000 23,500 23,500 50,000
13 Septi 50,000 3,000 23,500 23,500 50,000
14 3/8/2011 Ny. Umar 20,000 3,000 8,500 8,500 20,000
15 Tn. Taufik 20,000 3,000 8,500 8,500 20,000
16 3/9/2011 Ny. Suyanti 40,000 3,000 18,500 18,500 40,000
17 An. Alifia 40,000 3,000 18,500 18,500 40,000
18 Supriyadi 40,000 3,000 18,500 18,500 40,000
19 Grece - - -
20 Ny. Tati 40,000 3,000 18,500 18,500 40,000
21 Anisah 80,000 3,000 38,500 38,500 80,000
22 3/12/2011 Asep Soleh 40,000 3,000 18,500 18,500 40,000
23 Tn. Handi 25,000 3,000 11,000 11,000 25,000
24 Silmi 15,000 15,000 15,000
25 Riyanti 185,000 3,000 91,000 91,000 185,000
26 3/14/2011 Syifa 50,000 3,000 23,500 23,500 50,000
27 Gilang 20,000 3,000 8,500 8,500 20,000
28 Dhea 20,000 3,000 8,500 8,500 20,000
29 Tn. Oman 20,000 3,000 8,500 8,500 20,000
30 3/15/2011 Ny. Imas 20,000 3,000 8,500 8,500 20,000
31 3/17/2011 Ny. Suyanti 40,000 3,000 18,500 18,500 40,000
32 Tn. Jajat 20,000 3,000 8,500 8,500 20,000
33 3/17/2011 Mega 105,000 3,000 51,000 51,000 105,000
34 Ny. Endah 40,000 3,000 18,500 18,500 40,000
35 Wulan . P 80,000 3,000 38,500 38,500 80,000
36 3/18/2011 Tn. Krisman 150,000 3,000 73,500 73,500 150,000
37 3/19/2011 Asep Soleh 40,000 3,000 18,500 18,500 40,000
38 3/21/2011 Septi 50,000 3,000 23,500 23,500 50,000
39 Tn. Sugandi 20,000 3,000 8,500 8,500 20,000
40 3/22/2011 Salma 40,000 3,000 18,500 18,500 40,000
41 3/24/2011 Ny. Vita 130,000 3,000 63,500 63,500 130,000
42 3/25/2011 Mega 100,000 3,000 48,500 48,500 100,000
43 Tn. Krisman 160,000 3,000 78,500 78,500 160,000
44 3/26/2011 Tn. Jati 130,000 3,000 63,500 63,500 130,000
45 Septi 120,000 3,000 58,500 58,500 120,000
46 3/29/2011 An. Ilham 20,000 3,000 8,500 8,500 20,000
47 Ny. Heni 40,000 3,000 18,500 18,500 40,000
48 3/30/2011 Usman 150,000 3,000 73,500 73,500 150,000
49 Mery 25,000 3,000 11,000 11,000 25,000
2,610,000 138,000 1,223,500 1,248,500 2,610,000

PERIODE MARET 2011
JASA ALAT &

DOKTER BAHAN
1 3/2/2011 Ria 10,000 5,000 2,500 2,500 10,000
2 M. Lukman 20,000 10,000 10,000 20,000
3 Djaenab 20,000 10,000 10,000 20,000
4 3/8/2011 Ny. Ellis 15,000 5,000 5,000 5,000 15,000
5 3/9/2011 Djaenab 30,000 15,000 15,000 30,000
6 Rezia 30,000 15,000 15,000 30,000
7 Paulus 30,000 15,000 15,000 30,000
8 3/10/2011 Ny. Santi 30,000 5,000 12,500 12,500 30,000
9 3/15/2011 Maman Rachman 10,000 5,000 5,000 10,000
10 3/16/2011 Tn. Ace Tarkan 10,000 5,000 2,500 2,500 10,000
11 3/18/2011 Paulus 30,000 15,000 15,000 30,000
12 3/21/2011 Ny. Sumarsih 15,000 5,000 5,000 5,000 15,000
13 3/21/2011 Purwanti 15,000 7,500 7,500 15,000
14 3/22/2011 Djaenab 30,000 15,000 15,000 30,000
15 3/23/2011 Djaenab 30,000 15,000 15,000 30,000
16 3/25/2011 Ujang Suryaman 10,000 5,000 2,500 2,500 10,000
17 3/26/2011 Santi 20,000 5,000 7,500 7,500 20,000
18 3/30/2011 Djaenab 30,000 15,000 15,000 30,000
TOTAL 385,000 35,000 175,000 175,000 385,000

2 3/16/2011 Needle, Excavator 1, 2 84,000
3 3/22/2011 C Liquid 1 118,000
TOTAL 322,000
KEUNTUNGAN
KSBL DRG. DEWI
1 Maret 1,248,500 322,000 926,500 463,250 463,250
2 Maret 385,000.00 385,000 192,500 192,500
655,750 655,750


Menyetujui,


PERIODE APRIL 2011
JASA ALAT &

DOKTER BAHAN
1 4/1/2011 Adi Ahmal 75,000 3,000 36,000 36,000 75,000
2 Ny. Merlyn 80,000 3,000 38,500 38,500 80,000
3 Ny. Komariah 75,000 3,000 36,000 36,000 75,000
4 4/2/2011 Alifia 40,000 3,000 18,500 18,500 40,000
5 Tn. Saefudin 130,000 3,000 63,500 63,500 130,000
6 Agil 40,000 3,000 18,500 18,500 40,000
7 Aliya 40,000 3,000 18,500 18,500 40,000
8 4/5/2011 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
9 William 40,000 3,000 18,500 18,500 40,000
10 Sucipto 40,000 3,000 18,500 18,500 40,000
11 4/6/2011 Devi 40,000 3,000 18,500 18,500 40,000
12 4/9/2011 Agil 40,000 3,000 18,500 18,500 40,000
13 Ny. Ika 65,000 3,000 31,000 31,000 65,000
14 Ebanov 40,000 3,000 18,500 18,500 40,000
15 4/11/2011 Septi 50,000 3,000 23,500 23,500 50,000
16 Tn. O. Sudarman 20,000 3,000 8,500 8,500 20,000
17 Ny. Heny 20,000 3,000 8,500 8,500 20,000
18 4/12/2011 Ny. Risma 150,000 3,000 73,500 73,500 150,000
19 Dwi 15,000 3,000 6,000 6,000 15,000
20 4/13/2011 Siti 40,000 3,000 18,500 18,500 40,000
21 Imas 16,000 8,000 8,000 16,000
22 Nurhakim 16,000 8,000 8,000 16,000
23 Endang 120,000 60,000 60,000 120,000
24 Sucipto 110,000 3,000 53,500 53,500 110,000
25 4/14/2011 Ebanov 40,000 3,000 18,500 18,500 40,000
26 Aulia 20,000 3,000 8,500 8,500 20,000
27 4/15/2011 Aulia - - -
28 Felly 50,000 3,000 23,500 23,500 50,000
29 Mardirah 75,000 3,000 36,000 36,000 75,000
30 4/16/2011 Ny. Heny 20,000 3,000 8,500 8,500 20,000
31 4/18/2011 Ebanov 40,000 3,000 18,500 18,500 40,000
32 4/20/2011 Tn. Sofyan 20,000 3,000 8,500 8,500 20,000
33 Arti 20,000 3,000 8,500 8,500 20,000
34 4/21/2011 Rosid 20,000 3,000 8,500 8,500 20,000
35 Imas 56,000 3,000 26,500 26,500 56,000
36 4/23/2011 Nurhayati 40,000 3,000 18,500 18,500 40,000
37 4/25/2011 Tn. Ajul 50,000 3,000 23,500 23,500 50,000
38 Tn. Agus 20,000 3,000 8,500 8,500 20,000
39 4/26/2011 Tn. Rohandi 20,000 3,000 8,500 8,500 20,000
40 Ny. Heny 100,000 3,000 48,500 48,500 100,000
41 Diah 16,000 8,000 8,000 16,000
42 Siti 40,000 3,000 18,500 18,500 40,000
43 4/28/2011 Ny. Sri Wahyuningsih 20,000 3,000 8,500 8,500 20,000
44 Gilang 75,000 3,000 36,000 36,000 75,000
45 Ny. Nia 20,000 3,000 8,500 8,500 20,000
46 Ny. Endah 50,000 3,000 23,500 23,500 50,000
47 Ny. Heni 20,000 3,000 8,500 8,500 20,000
48 4/29/2011 Gilang 130,000 3,000 63,500 63,500 130,000
49 X 130,000 3,000 63,500 63,500 130,000
50 4/30/2011 Tn. Marcell 75,000 3,000 36,000 36,000 75,000
2,489,000 135,000 1,177,000 1,177,000 2,489,000

PERIODE APRIL 2011
JASA ALAT &

DOKTER BAHAN
1 4/2/2011 Santi 20,000 10,000 10,000 20,000
2 Zestzetlas 15,000 7,500 7,500 15,000
3 4/7/2011 Waryati 15,000 5,000 5,000 5,000 15,000
4 4/12/2011 Santi 20,000 10,000 10,000 20,000
5 4/13/2011 Kezia 30,000 15,000 15,000 30,000
6 4/16/2011 Gita 15,000 5,000 5,000 5,000 15,000
7 4/18/2011 Dewi 30,000 15,000 15,000 30,000
8 4/19/2011 Gita 15,000 5,000 5,000 5,000 15,000
9 4/20/2011 Santi 20,000 10,000 10,000 20,000
10 4/21/2011 Frida 20,000 5,000 7,500 7,500 20,000
11 Ny. Siti 15,000 5,000 5,000 5,000 15,000
12 4/26/2011 Dzaenab 30,000 15,000 15,000 30,000
13 Irmawati 30,000 5,000 12,500 12,500 30,000
14 Suryana 15,000 5,000 5,000 5,000 15,000
15 4/28/2011 Frida 15,000 5,000 5,000 5,000 15,000
TOTAL 305,000 40,000 132,500 132,500 305,000

1 4/2/2011 Hand Schoen 38,700
2 4/16/2011 Masker 1 35,000
TOTAL 73,700
KEUNTUNGAN
KSBL DRG. DEWI
1 Maret 1,177,000 73,700 1,103,300 551,650 551,650
2 Maret 305,000.00 305,000 152,500 152,500
704,150 704,150
Cimahi, 5 Mei 2011


Menyetujui,


PERIODE MEI 2011
JASA ALAT &
DOKTER BAHAN
1 5/2/2011 Tn. Lukman 20,000 3,000 8,500 8,500 20,000
2 Athan 20,000 3,000 8,500 8,500 20,000
3 Ny. Sri 20,000 3,000 8,500 8,500 20,000
4 5/3/2011 Siti. N 40,000 3,000 18,500 18,500 40,000
5 Nendi 70,000 3,000 33,500 33,500 70,000
6 5/4/2011 Ny. Endah 80,000 3,000 38,500 38,500 80,000
7 5/6/2011 Tn. Dedi 20,000 3,000 8,500 8,500 20,000
8 5/7/2011 Tn. Handi 20,000 3,000 8,500 8,500 20,000
9 5/10/2011 Aura 40,000 3,000 18,500 18,500 40,000
10 Ny. Hotean 20,000 3,000 8,500 8,500 20,000
11 5/11/2011 Ny. Ai 70,000 3,000 33,500 33,500 70,000
12 Felly 40,000 3,000 18,500 18,500 40,000
13 5/12/2011 Ny. Endah 50,000 3,000 23,500 23,500 50,000
14 5/13/2011 Ny. Sri 50,000 3,000 23,500 23,500 50,000
15 Rahmat 20,000 3,000 8,500 8,500 20,000
16 Ny. Siti Muryani 50,000 3,000 23,500 23,500 50,000
17 5/17/2001 Ny. Yati 80,000 3,000 38,500 38,500 80,000
18 5/18/2011 Ny. Dewi 80,000 3,000 38,500 38,500 80,000
19 5/19/2011 Ahmad. B 110,000 3,000 53,500 53,500 110,000
20 Arti 140,000 3,000 68,500 68,500 140,000
21 Tn. Ceplili 20,000 3,000 8,500 8,500 20,000
22 Ny. Endah 60,000 3,000 28,500 28,500 60,000
23 5/20/2011 Ahmad. B 50,000 3,000 23,500 23,500 50,000
24 Ny. Sutilati 20,000 3,000 8,500 8,500 20,000
25 Ny. Siti Muryani 40,000 3,000 18,500 18,500 40,000
26 3/21/2011 Tn. Agus 20,000 3,000 8,500 8,500 20,000
27 Ny. Ema 20,000 3,000 8,500 8,500 20,000
28 5/23/2011 Deti. H 20,000 3,000 8,500 8,500 20,000
29 Ny. Iis 50,000 3,000 23,500 23,500 50,000
30 Ny. Aan 20,000 3,000 8,500 8,500 20,000
31 Ny. Iis - - -
32 5/24/2011 Arti 50,000 3,000 23,500 23,500 50,000
33 5/25/2011 Gilang - - -
34 Resma 20,000 3,000 8,500 8,500 20,000
35 Ny. Siti Muryani 20,000 3,000 8,500 8,500 20,000
36 5/26/2011 Toto 20,000 3,000 8,500 8,500 20,000
37 Ny. Sri 100,000 3,000 48,500 48,500 100,000
38 5/27/2011 Nia 100,000 3,000 48,500 48,500 100,000
39 5/28/2011 Efri 20,000 3,000 8,500 8,500 20,000
40 Ny. Rita 35,000 3,000 16,000 16,000 35,000
41 Tn. Asep 50,000 3,000 23,500 23,500 50,000
42 Imam 50,000 3,000 23,500 23,500 50,000
43 5/31/2011 Diah 40,000 20,000 20,000 40,000
1,865,000 120,000 872,500 872,500 1,865,000

PERIODE MEI 2011
JASA ALAT &

DOKTER BAHAN
1 5/3/2011 Djaenab 30,000 15,000 15,000 30,000
2 Santi 20,000 10,000 10,000 20,000
3 5/6/2011 Neng 35,000 17,500 17,500 35,000
4 Tajudin 15,000 7,500 7,500 15,000
5 5/10/2011 Santi 20,000 10,000 10,000 20,000
6 Kokom 15,000 5,000 5,000 5,000 15,000
7 Siti 15,000 7,500 7,500 15,000
8 Ny. Ellis 15,000 5,000 5,000 5,000 15,000
9 5/13/2011 Ny. Ellis 15,000 5,000 5,000 5,000 15,000
10 Naufal 20,000 10,000 10,000 20,000
11 5/15/2011 Santi 25,000 12,500 12,500 25,000
12 5/20/2011 Redi Mulyadi 15,000 5,000 5,000 5,000 15,000
13 Anum 15,000 5,000 5,000 5,000 15,000
14 5/21/2011 Santi Kurniati 30,000 5,000 12,500 12,500 30,000
15 5/30/2011 Udin 15,000 5,000 5,000 5,000 15,000
16 Kurnia 15,000 7,500 7,500 15,000
Tn. Ujang 15,000 5,000 5,000 5,000 15,000
Adi. S 15,000 7,500 7,500 15,000
TOTAL 345,000 40,000 152,500 152,500 345,000

1 5/19/2011 Pehacain Inj 63,600
2 5/21/2011 Aroma Normal 1 75,000
3 5/25/2011 Cresofat 1 180,000
TOTAL 318,600
KEUNTUNGAN
KSBL DRG. DEWI
1 MEI 872,500 318,600 553,900 276,950 276,950
2 MEI 345,000.00 345,000 172,500 172,500
449,450 449,450
Cimahi, 4 Juni 2011


Menyetujui,

PERIODE JUNI 2011
JASA ALAT &

DOKTER BAHAN
1 6/1/2011 Ny. Yus. R 40,000 3,000 18,500 18,500 40,000
2 6/7/2011 Diah 16,000 8,000 8,000 16,000
3 Lingga 100,000 3,000 48,500 48,500 100,000
4 6/8/2011 Ny. Siti. M 100,000 3,000 48,500 48,500 100,000
5 6/9/2011 Arti 50,000 3,000 23,500 23,500 50,000
6 Ani 75,000 3,000 36,000 36,000 75,000
7 6/10/2011 Meri 50,000 3,000 23,500 23,500 50,000
8 6/11/2011 Wena 25,000 25,000 25,000
9 Tn. Joko 180,000 3,000 88,500 88,500 180,000
10 6/13/2011 Herina 100,000 3,000 48,500 48,500 100,000
11 Tribuana 20,000 3,000 8,500 8,500 20,000
12 Ny. Nilenia 20,000 3,000 8,500 8,500 20,000
13 6/14/2011 Alifia 40,000 3,000 18,500 18,500 40,000
14 Lingga 90,000 3,000 43,500 43,500 90,000
15 6/15/2011 Ahmad 20,000 3,000 8,500 8,500 20,000
16 Tn. Joko 100,000 3,000 48,500 48,500 100,000
17 6/16/2011 Ny. Ambar 125,000 3,000 61,000 61,000 125,000
18 Eko 130,000 3,000 63,500 63,500 130,000
19 6/17/2011 Meri 50,000 3,000 23,500 23,500 50,000
20 Ny. Sri. W 50,000 3,000 23,500 23,500 50,000
21 Shifa 20,000 3,000 8,500 8,500 20,000
22 Restuni 20,000 3,000 8,500 8,500 20,000
23 6/18/2011 Vera Maudy 40,000 3,000 18,500 18,500 40,000
24 Marsudi 20,000 3,000 8,500 8,500 20,000
25 6/22/2011 Arti 110,000 3,000 53,500 53,500 110,000
26 Ny. E. Saragih 20,000 3,000 8,500 8,500 20,000
27 Ny. Restuni 50,000 3,000 23,500 23,500 50,000
28 Diaz 20,000 3,000 8,500 8,500 20,000
29 6/23/2011 Nn. Ambar 50,000 3,000 23,500 23,500 50,000
30 Nurhayati 150,000 3,000 73,500 73,500 150,000
31 6/24/2011 Ny. E. Saragih 150,000 3,000 73,500 73,500 150,000
32 Ny. Ervi 180,000 3,000 88,500 88,500 180,000
33 Meri 50,000 3,000 23,500 23,500 50,000
34 6/25/2011 Ny. Markamah 20,000 3,000 8,500 8,500 20,000
35 Tn. Joko 170,000 3,000 83,500 83,500 170,000
36 6/28/2011 Tn. Heryanto 20,000 3,000 8,500 8,500 20,000
37 6/30/2011 Ny. Vita 125,000 3,000 61,000 61,000 125,000
38 Nurhayati 75,000 3,000 36,000 36,000 75,000
39 Ratih 130,000 3,000 63,500 63,500 130,000
2,801,000 111,000 1,332,500 1,357,500 2,801,000

PERIODE JUNI 2011
JASA ALAT &

DOKTER BAHAN
1 6/6/2011 Setawati Adi 15,000 5,000 5,000 5,000 15,000
2 6/11/2011 Ny. Ria 30,000 5,000 12,500 12,500 30,000
3 Ny. Maryati 20,000 5,000 7,500 7,500 20,000
4 6/13/2011 Adi. S 15,000 7,500 7,500 15,000
5 6/14/2011 Suryana 15,000 5,000 5,000 5,000 15,000
6 6/14/2011 Kezia 30,000 15,000 15,000 30,000
7 6/17/2011 Suryana 20,000 10,000 10,000 20,000
8 6/18/2011 Ny. Maryati 20,000 5,000 7,500 7,500 20,000
9 6/21/2011 Marsudi 15,000 5,000 5,000 5,000 15,000
10 Suryana 20,000 10,000 10,000 20,000
11 6/25/2011 Maryati 20,000 5,000 7,500 7,500 20,000
12 Tn. Suryana 20,000 10,000 10,000 20,000
13 6/28/2011 Tn. Suryana 20,000 10,000 10,000 20,000
14 6/30/2011 Tn. Paulus 20,000 5,000 7,500 7,500 20,000
TOTAL 280,000 40,000 120,000 120,000 280,000

1 6/1/2011 Handschoen 1 43,000
Caviton 1 100,000
TOTAL 363,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JUNI 1,357,500 363,000 994,500 497,250 497,250
2 JUNI 280,000.00 280,000 140,000 140,000
637,250 637,250
Cimahi, 2 Juli 2011


Menyetujui,

PERIODE JULI 2011
JASA ALAT &

DOKTER BAHAN
1 7/1/2011 Nn. Ambar 50,000 3,000 23,500 23,500 50,000
2 Ny. Restini 50,000 3,000 23,500 23,500 50,000
3 Tn. Tukiyo 90,000 3,000 43,500 43,500 90,000
4 7/2/2011 Ny. Ibut 100,000 3,000 48,500 48,500 100,000
5 Ny. Nanik 20,000 3,000 8,500 8,500 20,000
6 Alfian 50,000 3,000 23,500 23,500 50,000
7 7/5/2011 Lingga 100,000 3,000 48,500 48,500 100,000
8 7/6/2011 Nn. Ambar 110,000 3,000 53,500 53,500 110,000
9 Meri 100,000 3,000 48,500 48,500 100,000
10 Sarah 100,000 3,000 48,500 48,500 100,000
11 Ny. Restini 110,000 3,000 53,500 53,500 110,000
12 7/7/2011 Ahmad 20,000 3,000 8,500 8,500 20,000
13 Vita 75,000 3,000 36,000 36,000 75,000
14 Ambar - - -
15 7/8/2011 Putri 70,000 3,000 33,500 33,500 70,000
16 Tn. Tukiyo 90,000 3,000 43,500 43,500 90,000
17 Shifa 75,000 3,000 36,000 36,000 75,000
18 Asti 50,000 3,000 23,500 23,500 50,000
19 7/9/2011 Ny. Ibut 40,000 3,000 18,500 18,500 40,000
20 Irmawati 10,000 5,000 5,000 10,000
21 Reza 20,000 3,000 8,500 8,500 20,000
22 Raffi 4,000 3,000 500 500 4,000
23 7/11/2011 Dede 20,000 3,000 8,500 8,500 20,000
24 Agil 50,000 3,000 23,500 23,500 50,000
25 Alfian 50,000 3,000 23,500 23,500 50,000
26 7/13/2011 Raffi. N 50,000 3,000 23,500 23,500 50,000
27 Risma - - -
28 Ny. Restini 100,000 3,000 48,500 48,500 100,000
29 7/14/2011 Nn. Ambar 175,000 3,000 86,000 86,000 175,000
30 Ny. Vita 75,000 3,000 36,000 36,000 75,000
31 Aura 20,000 3,000 8,500 8,500 20,000
32 7/15/2011 Putri 50,000 3,000 23,500 23,500 50,000
33 Yeni 140,000 3,000 68,500 68,500 140,000
34 dr. Munir 45,000 22,500 22,500 45,000
35 7/16/2011 Irmawati 10,000 5,000 5,000 10,000
36 Risyad 10,000 5,000 5,000 10,000
37 Rahayu 85,000 3,000 41,000 41,000 85,000
38 Jeki 85,000 3,000 41,000 41,000 85,000
39 7/19/2011 Lingga 100,000 3,000 48,500 48,500 100,000
40 Fakhri 80,000 3,000 38,500 38,500 80,000
41 7/20/2011 Raffi 50,000 3,000 23,500 23,500 50,000
42 7/21/2011 Nn. Ambar 20,000 3,000 8,500 8,500 20,000
43 Ny. Susi 20,000 3,000 8,500 8,500 20,000
44 7/22/2011 Putri 50,000 3,000 23,500 23,500 50,000
45 Risma 100,000 3,000 48,500 48,500 100,000
46 7/23/2011 Ny. Maryani 20,000 3,000 8,500 8,500 20,000
47 7/25/2011 Bayu 20,000 3,000 8,500 8,500 20,000
48 Tn. Nurdin 20,000 3,000 8,500 8,500 20,000
49 Ny. Maryani 20,000 3,000 8,500 8,500 20,000
50 Pujianti 50,000 3,000 23,500 23,500 50,000
51 7/27/2011 Irwan 20,000 3,000 8,500 8,500 20,000
52 Asti 150,000 3,000 73,500 73,500 150,000
53 Raffi 50,000 3,000 23,500 23,500 50,000
54 Susi 50,000 3,000 23,500 23,500 50,000
55 7/28/2011 Diyeri Susan 150,000 3,000 73,500 73,500 150,000
56 Raffel - - -
57 7/29/2011 Putri 50,000 3,000 23,500 23,500 50,000
58 Irwan 75,000 3,000 36,000 36,000 75,000
59 Ny. Susi 50,000 3,000 23,500 23,500 50,000
60 7/30/2011 Raffi 40,000 3,000 18,500 18,500 40,000
61 Tn. Jimmy 20,000 3,000 8,500 8,500 20,000
62 Rafly 40,000 3,000 18,500 18,500 40,000
3,544,000 165,000 1,689,500 1,689,500 3,544,000
PERIODE JULI 2011
JASA ALAT &

DOKTER BAHAN
1 7/2/2011 Tn. Suryana 20,000 10,000 10,000 20,000
2 7/5/2011 Tn. Suryana 25,000 12,500 12,500 25,000
3 Tn. Asep 30,000 15,000 15,000 30,000
4 7/6/2011 Tn. Paulus 20,000 10,000 10,000 20,000
5 7/8/2011 Abil 15,000 5,000 5,000 5,000 15,000
6 7/11/2011 Tn. Suryana 30,000 15,000 15,000 30,000
7 7/12/2011 Ny. Djaenab 30,000 15,000 15,000 30,000
8 7/13/2011 Tn. Paulus 20,000 10,000 10,000 20,000
9 7/16/2011 M. Rifki 15,000 7,500 7,500 15,000
10 7/18/2011 Sukma 15,000 7,500 7,500 15,000
11 Mulyono 15,000 5,000 5,000 5,000 15,000
12 7/20/2011 Dedi. R 20,000 10,000 10,000 20,000
13 Tn. Paulus 25,000 12,500 12,500 25,000
14 7/25/2011 Apip 15,000 5,000 5,000 5,000 15,000
15 7/26/2011 Ny. Djaenab 30,000 15,000 15,000 30,000
16 7/27/2011 Dedi. R 20,000 10,000 10,000 20,000
17 Tn. Paulus 30,000 15,000 15,000 30,000
18 7/28/2011 Naufal 20,000 5,000 7,500 7,500 20,000
19 7/29/2011 Surya 15,000 5,000 5,000 5,000 15,000
20 Giat 15,000 5,000 5,000 5,000 15,000
TOTAL 425,000 30,000 197,500 197,500 425,000

2 7/9/2011 Sarung Tangan 1 39,000
2 7/16/2011 Alkes Gigi + Masker 1 461,000
TOTAL 580,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JULI 1,689,500 580,000 1,109,500 554,750 554,750
2 JULI 425,000.00 425,000 212,500 212,500
767,250 767,250


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 8/1/2011 Pujianti 65,000 3,000 31,000 31,000 65,000
2 Nuriska 20,000 3,000 8,500 8,500 20,000
3 8/2/2011 Tn. Atang 50,000 3,000 23,500 23,500 50,000
4 Tn. Samsudin 20,000 3,000 8,500 8,500 20,000
5 Sri 40,000 3,000 18,500 18,500 40,000
6 8/3/2011 Rafi 40,000 3,000 18,500 18,500 40,000
7 Ferdinan 20,000 3,000 8,500 8,500 20,000
8 Jovi 40,000 3,000 18,500 18,500 40,000
9 Tn. Rahmat 60,000 3,000 28,500 28,500 60,000
10 Ny. Evi 20,000 3,000 8,500 8,500 20,000
11 Asti 125,000 3,000 61,000 61,000 125,000
12 8/4/2011 Roni 20,000 3,000 8,500 8,500 20,000
13 Najwa 20,000 3,000 8,500 8,500 20,000
14 8/5/2011 Nn. Ambar 120,000 3,000 58,500 58,500 120,000
15 Asti 150,000 3,000 73,500 73,500 150,000
16 Putri 50,000 3,000 23,500 23,500 50,000
17 Slamet Riyadi 30,000 3,000 13,500 13,500 30,000
18 Ny. Euis 20,000 3,000 8,500 8,500 20,000
19 8/6/2011 Tn. Redi 20,000 3,000 8,500 8,500 20,000
20 Ny. Sri Rahayu 30,000 3,000 13,500 13,500 30,000
21 Raffi 120,000 3,000 58,500 58,500 120,000
22 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
23 8/8/2011 Ny. Sri Rahayu 20,000 3,000 8,500 8,500 20,000
24 Sakila 20,000 3,000 8,500 8,500 20,000
25 Fahira 20,000 3,000 8,500 8,500 20,000
26 Tn. Yahya 50,000 3,000 23,500 23,500 50,000
27 8/9/2011 Tn. Erdy 50,000 3,000 23,500 23,500 50,000
28 Ny. Sri Rahayu 40,000 3,000 18,500 18,500 40,000
29 8/10/2011 Tn. Asep 60,000 3,000 28,500 28,500 60,000
30 Resita 20,000 3,000 8,500 8,500 20,000
31 Tn. Dedi 50,000 3,000 23,500 23,500 50,000
32 8/11/2011 Asti 225,000 3,000 111,000 111,000 225,000
33 Vita 70,000 3,000 33,500 33,500 70,000
34 8/12/2011 Neng Yati 16,000 8,000 8,000 16,000
35 8/13/2011 Ny. Ruyanah 80,000 3,000 38,500 38,500 80,000
36 Tn. Beben 150,000 3,000 73,500 73,500 150,000
37 Tn. Agus 20,000 3,000 8,500 8,500 20,000
38 Tn. Tatang 50,000 3,000 23,500 23,500 50,000
39 8/15/2011 Ratih 100,000 3,000 48,500 48,500 100,000
40 Ny. Lilis 180,000 3,000 88,500 88,500 180,000
41 Silvia 50,000 3,000 23,500 23,500 50,000
42 8/16/2011 Tn. Erdy 50,000 3,000 23,500 23,500 50,000
43 8/18/2011 Putri 50,000 3,000 23,500 23,500 50,000
44 Yani 105,000 3,000 51,000 51,000 105,000
45 Ny. Rohayati 20,000 3,000 8,500 8,500 20,000
46 8/20/2011 Elvina 50,000 3,000 23,500 23,500 50,000
47 8/22/2011 Putri 50,000 3,000 23,500 23,500 50,000
48 Silvia 50,000 3,000 23,500 23,500 50,000
49 Putri 50,000 3,000 23,500 23,500 50,000
50 Rian 100,000 3,000 48,500 48,500 100,000
51 Andi 150,000 3,000 73,500 73,500 150,000
52 Erdy 50,000 3,000 23,500 23,500 50,000
53 8/25/2011 Ambar - - -
54 Putri 50,000 3,000 23,500 23,500 50,000
55 Tatang 20,000 3,000 8,500 8,500 20,000
56 8/26/2011 Ny. Rita 75,000 3,000 36,000 36,000 75,000
57 8/27/2011 Rayhan 25,000 25,000 25,000
3,286,000 162,000 1,549,500 1,574,500 3,286,000
JASA ALAT &

DOKTER BAHAN
1 8/2/2011 Kezia 20,000 10,000 10,000 20,000
2 8/3/2011 Dedi. R 20,000 10,000 10,000 20,000
3 Giat 20,000 10,000 10,000 20,000
4 8/5/2011 Tn. Yosef 10,000 5,000 2,500 2,500 10,000
5 8/9/2011 Kezia 20,000 10,000 10,000 20,000
6 8/10/2011 Giat 20,000 10,000 10,000 20,000
7 8/11/2011 Tn. Apip 10,000 5,000 2,500 2,500 10,000
8 8/12/2011 Ismawati 20,000 10,000 10,000 20,000
9 Giat 20,000 10,000 10,000 20,000
10 8/23/2011 Kezia 20,000 10,000 10,000 20,000
TOTAL 180,000 10,000 85,000 85,000 180,000

1 8/13/2011 Sensi Gloves 39,000
Solare X, Bur Diamond
2 8/20/2011 1 219,000
Edenta Kode A
TOTAL 258,000
KEUNTUNGAN
KSBL DRG. DEWI
1 AGUSTUS 1,574,500 258,000 1,316,500 658,250 658,250
2 AGUSTUS 180,000.00 180,000 90,000 90,000
748,250 748,250


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 9/5/2011 Alfini 20,000 3,000 8,500 8,500 20,000
2 Nina 100,000 3,000 48,500 48,500 100,000
3 Abi 100,000 3,000 48,500 48,500 100,000
4 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
5 Ny. Eva 20,000 3,000 8,500 8,500 20,000
6 9/6/2011 Rafael 120,000 3,000 58,500 58,500 120,000
7 9/7/2011 Elisabeth 16,000 8,000 8,000 16,000
8 9/8/2011 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
9 Dani 200,000 3,000 98,500 98,500 200,000
10 9/9/2011 Tn. Jajang 130,000 3,000 63,500 63,500 130,000
11 Aura 40,000 3,000 18,500 18,500 40,000
12 Putri 100,000 3,000 48,500 48,500 100,000
13 Ny. Euis 20,000 3,000 8,500 8,500 20,000
14 Tn. Yogi 75,000 3,000 36,000 36,000 75,000
15 9/10/2011 An. Baildhan 20,000 3,000 8,500 8,500 20,000
16 Fahreza 40,000 20,000 20,000 40,000
17 9/12/2011 Hiswanto 20,000 3,000 8,500 8,500 20,000
18 Elisabeth 16,000 8,000 8,000 16,000
19 Ny. Melati 50,000 3,000 23,500 23,500 50,000
20 Andi 140,000 3,000 68,500 68,500 140,000
21 9/13/2011 Tn. Ujang 40,000 3,000 18,500 18,500 40,000
22 Ny. Ryan 20,000 3,000 8,500 8,500 20,000
23 9/15/2011 Fahreza 20,000 3,000 8,500 8,500 20,000
24 Dedi 150,000 3,000 73,500 73,500 150,000
25 9/16/2011 Ida 50,000 3,000 23,500 23,500 50,000
26 Ny. Euis 150,000 3,000 73,500 73,500 150,000
27 Tn. Amiruloh 150,000 3,000 73,500 73,500 150,000
28 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
29 9/17/2011 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
30 9/19/2011 Ida. R 20,000 3,000 8,500 8,500 20,000
31 Sari 20,000 3,000 8,500 8,500 20,000
32 9/20/2011 Adi 170,000 3,000 83,500 83,500 170,000
33 9/23/2011 Asti 25,000 3,000 11,000 11,000 25,000
34 Anisa Julianti 20,000 3,000 8,500 8,500 20,000
35 Dewi 200,000 3,000 98,500 98,500 200,000
36 Ny. Euis 75,000 3,000 36,000 36,000 75,000
37 9/24/2011 Asri 35,000 3,000 16,000 16,000 35,000
38 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
39 Tegar 40,000 3,000 18,500 18,500 40,000
40 Ny. Nila 40,000 3,000 18,500 18,500 40,000
41 Alfi 80,000 3,000 38,500 38,500 80,000
42 9/26/2011 Cinta 170,000 3,000 83,500 83,500 170,000
43 Dani 20,000 3,000 8,500 8,500 20,000
44 Devan 20,000 3,000 8,500 8,500 20,000
45 Masturi 20,000 3,000 8,500 8,500 20,000
46 9/27/2011 Ollyvia 20,000 3,000 8,500 8,500 20,000
47 Kaylila 20,000 3,000 8,500 8,500 20,000
48 Sudrajat 100,000 3,000 48,500 48,500 100,000
49 9/28/2011 Tn. Bambang 20,000 3,000 8,500 8,500 20,000
50 Ayu 50,000 3,000 23,500 23,500 50,000
51 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
52 9/29/2011 Tn. Dede 20,000 3,000 8,500 8,500 20,000
53 9/30/2011 Ny. Eli 20,000 3,000 8,500 8,500 20,000
54 Ny. Euis 170,000 3,000 83,500 83,500 170,000
3,362,000 153,000 1,604,500 1,604,500 3,362,000
JASA ALAT &

DOKTER BAHAN
1 9/13/2011 Kezia 20,000 10,000 10,000 20,000
2 Djaenab 30,000 15,000 15,000 30,000
3 Ilham 15,000 5,000 5,000 5,000 15,000
4 9/19/2011 Ismawanti 15,000 7,500 7,500 15,000
5 9/27/2011 Elawati 15,000 5,000 5,000 5,000 15,000
6 Kezia 20,000 10,000 10,000 20,000
7 Waluyo 20,000 10,000 10,000 20,000
8 Rudi 15,000 7,500 7,500 15,000
TOTAL 10,000 70,000 70,000 150,000

Obat Kumur Minosep PP
1 9/17/2011 65,000
15/40
Pehacain
2 9/21/2011 1 30,000
lidocain
3 9/21/2011 Chlor Etil 1 118,000

213,000
KEUNTUNGAN
KSBL DRG. DEWI
1 SEPTEMBER 1,604,500 213,000 1,391,500 695,750 695,750
2 SEPTEMBER 150,000.00 150,000 75,000 75,000
770,750 770,750


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 10/1/2011 Devan 40,000 3,000 18,500 18,500 40,000
2 Hawasi 40,000 3,000 18,500 18,500 40,000
3 Murjen 16,000 3,000 6,500 6,500 16,000
4 Tegar 80,000 3,000 38,500 38,500 80,000
5 10/3/2011 Ayu 50,000 3,000 23,500 23,500 50,000
6 Rudi 70,000 3,000 33,500 33,500 70,000
7 Prisilia 20,000 3,000 8,500 8,500 20,000
8 10/5/2011 Ria 100,000 3,000 48,500 48,500 100,000
9 Tegar 80,000 3,000 38,500 38,500 80,000
10 Jimay 40,000 3,000 18,500 18,500 40,000
11 Nurjen 20,000 10,000 10,000 20,000
12 10/6/2011 Tn. Anang 75,000 3,000 36,000 36,000 75,000
13 Tn. Rustam 50,000 3,000 23,500 23,500 50,000
14 Ny. Euis 50,000 3,000 23,500 23,500 50,000
15 10/7/2011 Bagja 174,000 3,000 85,500 85,500 174,000
16 Melani 40,000 3,000 18,500 18,500 40,000
17 10/8/2011 Tegar 80,000 3,000 38,500 38,500 80,000
18 Reni 50,000 3,000 23,500 23,500 50,000
19 Tn. Jummy 40,000 3,000 18,500 18,500 40,000
20 10/10/2011 Bagja 20,000 3,000 8,500 8,500 20,000
21 Yeni 20,000 3,000 8,500 8,500 20,000
22 10/11/2011 Tegar 80,000 3,000 38,500 38,500 80,000
23 Ayu 60,000 3,000 28,500 28,500 60,000
24 10/13/2011 Ny. Euis 75,000 3,000 36,000 36,000 75,000
25 10/14/2011 Imas 55,000 3,000 26,000 26,000 55,000
26 Dewi 50,000 3,000 23,500 23,500 50,000
27 10/15/2011 Novia Fitri 40,000 3,000 18,500 18,500 40,000
28 Ny. Ros 60,000 3,000 28,500 28,500 60,000
29 Tegar 165,000 3,000 81,000 81,000 165,000
30 Hawasi 50,000 3,000 23,500 23,500 50,000
31 10/17/2011 Andri 20,000 3,000 8,500 8,500 20,000
32 Fahmi 100,000 3,000 48,500 48,500 100,000
33 10/18/2011 Ny. Ai 20,000 3,000 8,500 8,500 20,000
34 10/19/2011 Tegas 40,000 3,000 18,500 18,500 40,000
35 Ayu 50,000 3,000 23,500 23,500 50,000
36 10/20/2011 Bagja 37,000 3,000 17,000 17,000 37,000
37 10/22/2011 Tegar 125,000 3,000 61,000 61,000 125,000
38 Tn. Siswanto 40,000 3,000 18,500 18,500 40,000
39 Novia Fitri 40,000 3,000 18,500 18,500 40,000
40 Tn. Jimmy 60,000 3,000 28,500 28,500 60,000
41 Ny. Siti Salamah 20,000 3,000 8,500 8,500 20,000
42 10/25/2011 Lilis 20,000 3,000 8,500 8,500 20,000
43 Pak Asep 25,000 3,000 11,000 11,000 25,000
44 10/26/2011 Vanessa 50,000 3,000 23,500 23,500 50,000
45 Tegar 100,000 3,000 48,500 48,500 100,000
46 Andi 80,000 3,000 38,500 38,500 80,000
47 10/27/2011 Ny. Yani 20,000 3,000 8,500 8,500 20,000
48 Ahmad Fauzi 50,000 3,000 23,500 23,500 50,000
49 10/28/2011 Tn. Goleng 20,000 3,000 8,500 8,500 20,000
50 10/29/2011 Novia Fitri 40,000 3,000 18,500 18,500 40,000
51 Devi 50,000 3,000 23,500 23,500 50,000
52 10/31/2011 Tn. Hendi 20,000 3,000 8,500 8,500 20,000
53 Tia 20,000 3,000 8,500 8,500 20,000
54 Yuliansyah 20,000 3,000 8,500 8,500 20,000
55 Ny. Mudji 20,000 3,000 8,500 8,500 20,000
56 Ny. Imas 20,000 3,000 8,500 8,500 20,000
57 Ayu 100,000 3,000 48,500 48,500 100,000
58 Ny. Nia 100,000 3,000 48,500 48,500 100,000
3,097,000 171,000 1,463,000 1,463,000 3,097,000

JASA ALAT &

DOKTER BAHAN
1 10/3/2011 Elawati 15,000 5,000 5,000 5,000 15,000
2 Kezia 25,000 12,500 12,500 25,000
3 Waluyo 20,000 10,000 10,000 20,000
4 Elawati 20,000 10,000 10,000 20,000
5 10/10/2011 Fini 15,000 7,500 7,500 15,000
6 10/14/2011 Tin - tin 30,000 5,000 12,500 12,500 30,000
7 10/15/2011 Khoirudin 15,000 5,000 5,000 5,000 15,000
8 Gita 20,000 10,000 10,000 20,000
9 10/17/2011 Elawati 20,000 10,000 10,000 20,000
10 10/18/2011 Kezia 20,000 10,000 10,000 20,000
11 10/19/2011 Santi 20,000 10,000 10,000 20,000
12 10/22/2011 Ismawnti 15,000 5,000 5,000 5,000 15,000
13 10/24/2011 Santi 30,000 15,000 15,000 30,000
14 10/25/2011 Kezia 30,000 15,000 15,000 30,000
15 Waluyo 20,000 10,000 10,000 20,000
16 10/27/2011 Siti 30,000 15,000 15,000 30,000
17 10/31/2011 Elawati 20,000 10,000 10,000 20,000
TOTAL 365,000 20,000 172,500 172,500 365,000

1 10/3/2011 Caviton, Masker 116,000
2 10/4/2011 Sensi Gloves 1 40,000
3 10/15/2011 Bukaan Bur, GIP Stone 1 124,000
4 10/30/2011 PSR HS, Scandonest 1 100,000
380,000
KEUNTUNGAN
KSBL DRG. DEWI
1 OKTOBER 1,463,000 380,000 1,083,000 541,500 541,500
2 OKTOBER 365,000.00 365,000 182,500 182,500
724,000 724,000


Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 11/1/2011 Lilis 80,000 3,000 38,500 38,500 80,000
2 Dimas 50,000 3,000 23,500 23,500 50,000
3 11/4/2011 Anisa 145,000 3,000 71,000 71,000 145,000
4 Sukmawati 20,000 3,000 8,500 8,500 20,000
5 Tn. Fredi 50,000 3,000 23,500 23,500 50,000
6 Fauzi 190,000 3,000 93,500 93,500 190,000
7 11/5/2011 Tiara 32,000 3,000 14,500 14,500 32,000
8 Tegar 180,000 3,000 88,500 88,500 180,000
9 Ny. Lili 20,000 3,000 8,500 8,500 20,000
10 Novia Fitri 105,000 3,000 51,000 51,000 105,000
11 11/7/2011 Guntara 20,000 3,000 8,500 8,500 20,000
12 Rifa 20,000 3,000 8,500 8,500 20,000
13 Windi 100,000 3,000 48,500 48,500 100,000
14 Yasmin 50,000 3,000 23,500 23,500 50,000
15 11/8/2011 Lilis 100,000 3,000 48,500 48,500 100,000
16 11/9/2011 Aura 50,000 3,000 23,500 23,500 50,000
17 Tn. X 20,000 3,000 8,500 8,500 20,000
18 11/10/2011 Ny. Susilawati 75,000 3,000 36,000 36,000 75,000
19 Asty 170,000 3,000 83,500 83,500 170,000
20 11/11/2011 Asty 50,000 3,000 23,500 23,500 50,000
21 11/14/2011 Rifa 50,000 3,000 23,500 23,500 50,000
22 11/15/2011 Rifa 20,000 3,000 8,500 8,500 20,000
23 11/15/2011 Ny. Lilis - - -
24 11/16/2011 Wulan 70,000 3,000 33,500 33,500 70,000
25 Yasmin 50,000 3,000 23,500 23,500 50,000
26 Anisa 50,000 3,000 23,500 23,500 50,000
27 11/17/2011 Ny. Lilis - - -
28 Ny. Titi 50,000 3,000 23,500 23,500 50,000
29 Tn. Goleng 80,000 3,000 38,500 38,500 80,000
30 Tn. Heryadi 20,000 3,000 8,500 8,500 20,000
31 11/18/2011 Tn. Adi. A 70,000 3,000 33,500 33,500 70,000
32 Tn. Tatang 150,000 3,000 73,500 73,500 150,000
33 11/19/2011 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
34 Indra 190,000 3,000 93,500 93,500 190,000
35 11/21/2011 Rifa 100,000 3,000 48,500 48,500 100,000
36 Asifa 40,000 20,000 20,000 40,000
37 11/22/2011 Lingga 100,000 3,000 48,500 48,500 100,000
38 11/25/2011 Resti 12,000 6,000 6,000 12,000
39 11/26/2011 Mila 20,000 3,000 8,500 8,500 20,000
40 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
41 11/28/2011 Rifa 50,000 3,000 23,500 23,500 50,000
42 Asifa 56,000 28,000 28,000 56,000
43 11/29/2011 Tn. Tarya 20,000 3,000 8,500 8,500 20,000
44 Tn. Wahyu 20,000 3,000 8,500 8,500 20,000
45 Tn. Ahmad 30,000 3,000 13,500 13,500 30,000
46 11/30/2011 Wulan 70,000 3,000 33,500 33,500 70,000
47 Aura 50,000 3,000 23,500 23,500 50,000
48 Ny. Susilawati 100,000 3,000 48,500 48,500 100,000
49 Andita 50,000 3,000 23,500 23,500 50,000
3,125,000 132,000 1,496,500 1,496,500 3,125,000

JASA ALAT &

DOKTER BAHAN
1 11/4/2011 Faizal 20,000 5,000 7,500 7,500 20,000
2 M. Idhar 15,000 5,000 5,000 5,000 15,000
3 Elawati 25,000 12,500 12,500 25,000
4 11/10/2011 Kartika 15,000 5,000 5,000 5,000 15,000
5 11/11/2011 Faizal 20,000 10,000 10,000 20,000
6 M. Idhar 20,000 10,000 10,000 20,000
7 11/12/2011 M. Kurniawan 20,000 5,000 7,500 7,500 20,000
8 11/18/2011 Hariyadi 15,000 5,000 5,000 5,000 15,000
9 Faisal 20,000 10,000 10,000 20,000
10 M. Idhar 20,000 10,000 10,000 20,000
11 11/19/2011 Rizky 15,000 7,500 7,500 15,000
12 M. Kurniawan 20,000 10,000 10,000 20,000
13 11/22/2011 Kezia 20,000 10,000 10,000 20,000
14 11/25/2011 Faizal 20,000 10,000 10,000 20,000
15 M. Idhar 20,000 10,000 10,000 20,000
16 11/26/2011 Uden 15,000 5,000 5,000 5,000 15,000
17 11/28/2011 M. Idhar 10,000 5,000 5,000 10,000
18 Tn. Ace 15,000 5,000 5,000 5,000 15,000
TOTAL 325,000 35,000 145,000 145,000 325,000

1 11/5/2011 Spuit 3 cc 1 box 75,350
75,350
KEUNTUNGAN
KSBL DRG. DEWI
1 NOVEMBER 1,496,500 75,350 1,421,150 710,575 710,575
2 NOVEMBER 325,000.00 325,000 162,500 162,500
873,075 873,075

Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 12/1/2011 Asty 850,000 3,000 423,500 423,500 850,000
2 12/3/2011 Tn. Roni 20,000 3,000 8,500 8,500 20,000
3 Tn. Yono 20,000 3,000 8,500 8,500 20,000
4 Tn. Ayi Herdi 20,000 3,000 8,500 8,500 20,000
5 12/5/2011 Tn. Tarya 100,000 3,000 48,500 48,500 100,000
6 Rifa 50,000 3,000 23,500 23,500 50,000
7 Tutik 20,000 3,000 8,500 8,500 20,000
8 Febi 100,000 3,000 48,500 48,500 100,000
9 12/6/2011 Lingga 100,000 3,000 48,500 48,500 100,000
10 Tn. Ahmad 200,000 3,000 98,500 98,500 200,000
11 12/7/2011 Tera 64,000 32,000 32,000 64,000
12 12/8/2011 Ny. Tuti 75,000 3,000 36,000 36,000 75,000
13 Anita 180,000 3,000 88,500 88,500 180,000
14 12/9/2011 Nur Fatimah 200,000 200,000 200,000
15 Devani 20,000 3,000 8,500 8,500 20,000
16 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
17 Resti 60,000 30,000 30,000 60,000
18 12/10/2011 Nur Fatimah 160,000 3,000 78,500 78,500 160,000
19 Anita 200,000 200,000 200,000
20 12/12/2011 Tn. Tarya 150,000 3,000 73,500 73,500 150,000
21 Rifa 50,000 3,000 23,500 23,500 50,000
22 Ny. Rini 20,000 3,000 8,500 8,500 20,000
23 Fadil 50,000 3,000 23,500 23,500 50,000
24 Rina 20,000 3,000 8,500 8,500 20,000
25 12/13/2011 Tn. Tulayo 20,000 3,000 8,500 8,500 20,000
26 Asep Soleh 20,000 3,000 8,500 8,500 20,000
27 Tn. Yayat 20,000 3,000 8,500 8,500 20,000
28 12/15/2011 Navita 15,000 3,000 6,000 6,000 15,000
29 Ny. Rini 150,000 3,000 73,500 73,500 150,000
30 12/16/2011 Ny. Hj. Euis 40,000 3,000 18,500 18,500 40,000
31 12/17/2011 Ny. Mulyani 130,000 3,000 63,500 63,500 130,000
32 Hayanaka 20,000 3,000 8,500 8,500 20,000
33 Rosatin 16,000 8,000 8,000 16,000
34 Rayandra 50,000 3,000 23,500 23,500 50,000
35 Rifa 100,000 3,000 48,500 48,500 100,000
36 Virgiawan 100,000 3,000 48,500 48,500 100,000
37 12/27/2011 Tn. Deni 20,000 3,000 8,500 8,500 20,000
38 Lingga 100,000 3,000 48,500 48,500 100,000
39 12/28/2011 Hayanaka 80,000 3,000 38,500 38,500 80,000
40 Shakira 40,000 3,000 18,500 18,500 40,000
41 Rosalita 125,000 62,500 62,500 125,000
42 12/29/2011 Aprianti 20,000 3,000 8,500 8,500 20,000
43 Adi 80,000 3,000 38,500 38,500 80,000
44 Rustam 50,000 3,000 23,500 23,500 50,000
45 12/30/2011 Jimmy 40,000 3,000 18,500 18,500 40,000
46 Sinta 130,000 3,000 63,500 63,500 130,000
47 Alika 100,000 3,000 48,500 48,500 100,000
48 Asti 75,000 3,000 36,000 36,000 75,000
49 12/31/2011 Tn. Rudi 20,000 3,000 8,500 8,500 20,000
50 Ny. Eris 20,000 3,000 8,500 8,500 20,000
4,350,000 132,000 1,909,000 2,309,000 4,350,000

JASA ALAT &

DOKTER BAHAN
1 12/2/2011 Faizal 35,000 5,000 17,500 17,500 40,000
2 Zidan 10,000 5,000 5,000 10,000
3 12/5/2011 Tn. Ace 10,000 5,000 5,000 10,000
4 Tn. Wily 10,000 5,000 5,000 10,000
5 12/6/2011 Kezia 25,000 12,500 12,500 25,000
6 12/8/2011 M. Idhar 35,000 5,000 17,500 17,500 40,000
7 12/10/2011 Tn. Wily 35,000 5,000 17,500 17,500 40,000
8 12/14/2011 Fini 15,000 7,500 7,500 15,000
9 12/16/2011 Mimin 25,000 10,000 12,500 12,500 35,000
10 Faizal 20,000 10,000 10,000 20,000
11 12/17/2011 Blessyka 20,000 10,000 10,000 20,000
12 12/19/2011 Reka 20,000 10,000 10,000 20,000
13 Ny. Ratnasih 10,000 10,000 5,000 5,000 20,000
14 Tn. Waluyo 20,000 10,000 10,000 10,000 30,000
15 12/24/2011 Astri Wahyuni 20,000 10,000 10,000 10,000 30,000
16 12/27/2011 Tn. Karyana 10,000 5,000 5,000 10,000
17 Akum 10,000 5,000 5,000 10,000
18 Mulyono 10,000 10,000 5,000 5,000 20,000
19 Mimin 10,000 10,000 5,000 5,000 20,000
20 12/28/2011 Astri Wahyuni 35,000 10,000 17,500 17,500 45,000
21 12/30/2011 Faizal 25,000 12,500 12,500 25,000
22 12/31/2011 Anggi Firmansyah 20,000 10,000 10,000 10,000 30,000
TOTAL 430,000 95,000 215,000 215,000 525,000

1 12/13/2011 Sarung Tangan 1 box 40,000
2 12/16/2011 Tambal Gigi 1 box 325,000
4 12/17/2011 Masker 1 box 45,000
460,000
KEUNTUNGAN
KSBL DRG. DEWI
1 DESEMBER 2,309,000 460,000 1,849,000 924,500 924,500
2 DESEMBER 215,000.00 215,000 107,500 107,500
1,032,000 1,032,000


Menyetujui,


JASA ALAT &

NO TARIF ADM JML
DOKTER BAHAN
1 1/2/2012 Ny. Endang 20,000 3,000 8,500 8,500 20,000
2 Ny. Watih 150,000 3,000 73,500 73,500 150,000
3 Tukiyo 20,000 3,000 8,500 8,500 20,000
4 Tn. Agus 20,000 3,000 8,500 8,500 20,000
5 Suci 50,000 3,000 23,500 23,500 50,000
6 1/3/2012 Lingga 100,000 3,000 48,500 48,500 100,000
7 1/4/2012 Melisusanti 90,000 3,000 43,500 43,500 90,000
8 Wida 50,000 3,000 23,500 23,500 50,000
9 Aura 20,000 3,000 8,500 8,500 20,000
10 1/5/2012 Shakira 40,000 3,000 18,500 18,500 40,000
11 Quinta Rafela 90,000 3,000 43,500 43,500 90,000
12 Alika 40,000 3,000 18,500 18,500 40,000
13 Jushua 40,000 3,000 18,500 18,500 40,000
14 Marisa 20,000 3,000 8,500 8,500 20,000
15 1/6/2012 Adi 200,000 3,000 98,500 98,500 200,000
16 Rafli 60,000 3,000 28,500 28,500 60,000
17 Rustam Hofni 50,000 3,000 23,500 23,500 50,000
18 Anang 50,000 3,000 23,500 23,500 50,000
19 1/9/2012 Wida 50,000 3,000 23,500 23,500 50,000
20 Agil 50,000 3,000 23,500 23,500 50,000
21 Ny. Sri 20,000 3,000 8,500 8,500 20,000
22 Tukiyo 70,000 3,000 33,500 33,500 70,000
23 Daffa 20,000 3,000 8,500 8,500 20,000
24 1/11/2012 Anita 15,000 7,500 7,500 15,000
25 Lela 100,000 3,000 48,500 48,500 100,000
26 1/12/2012 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
27 Marisa 20,000 3,000 8,500 8,500 20,000
28 1/13/2012 Raizal 90,000 3,000 43,500 43,500 90,000
29 an. Anang 50,000 3,000 23,500 23,500 50,000
30 Tn. Rustam 150,000 3,000 73,500 73,500 150,000
31 Nurhayati 50,000 3,000 23,500 23,500 50,000
32 1/16/2012 Tukiyo 50,000 3,000 23,500 23,500 50,000
33 Wida 150,000 3,000 73,500 73,500 150,000
34 Ny. Julaeha 100,000 3,000 48,500 48,500 100,000
35 Ny. Ida 70,000 3,000 33,500 33,500 70,000
36 1/18/2012 Ny. Risti 20,000 3,000 8,500 8,500 20,000
37 1/19/2012 Asyfa 40,000 3,000 18,500 18,500 40,000
38 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
39 1/20/2012 Andre 65,000 3,000 31,000 31,000 65,000
40 Alexander 20,000 3,000 8,500 8,500 20,000
41 1/21/2012 Ronny 120,000 3,000 58,500 58,500 120,000
42 1/24/2012 Bidan Nuke - - -
43 Ebanov 50,000 3,000 23,500 23,500 50,000
44 Tyas 50,000 3,000 23,500 23,500 50,000
45 Tn. Tukiyo 60,000 3,000 28,500 28,500 60,000
46 Zulfa 25,000 3,000 11,000 11,000 25,000
47 Amelia 20,000 3,000 8,500 8,500 20,000
48 1/25/2012 Ny. Teti 100,000 3,000 48,500 48,500 100,000
49 Dian 20,000 3,000 8,500 8,500 20,000
50 Ny. Risti 100,000 3,000 48,500 48,500 100,000
51 1/26/2012 Wasis 16,000 8,000 8,000 16,000
52 Asyfa 80,000 3,000 38,500 38,500 80,000
53 Anang 50,000 3,000 23,500 23,500 50,000
54 1/27/2012 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
55 1/28/2012 Alfi 40,000 3,000 18,500 18,500 40,000
56 Ny. Teti 20,000 3,000 8,500 8,500 20,000
57 1/30/2012 Tn. Jajang 20,000 3,000 8,500 8,500 20,000
58 1/31/2012 Nabila 20,000 3,000 8,500 8,500 20,000
59 Ny. Mulyani 50,000 3,000 23,500 23,500 50,000
60 Tn. Tukiyo 80,000 3,000 38,500 38,500 80,000
3,351,000 171,000 1,590,000 1,590,000 3,351,000

JASA ALAT &

DOKTER BAHAN
1 1/2/2012 Tn. Dedi 10,000 10,000 5,000 5,000 20,000
2 Ny. Ratnasih 10,000 10,000 5,000 5,000 20,000
3 1/3/2012 Kezia 35,000 17,500 17,500 35,000
4 Komarudin 10,000 10,000 5,000 5,000 20,000
5 Mimin 10,000 5,000 5,000 10,000
6 1/4/2012 Ida 20,000 10,000 10,000 20,000
7 Dewi 30,000 15,000 15,000 30,000
8 1/6/2012 Raizal 30,000 15,000 15,000 30,000
9 1/7/2012 Dewi 10,000 5,000 5,000 10,000
10 1/16/2012 Ny. Ida 35,000 17,500 17,500 35,000
11 Astri 20,000 10,000 10,000 20,000
12 1/17/2012 Tn. Dede 10,000 5,000 5,000 10,000
13 1/18/2012 Tn. Dede 10,000 5,000 5,000 10,000
14 1/28/2012 Astri 30,000 15,000 15,000 30,000
15 1/31/2012 Irfan 25,000 10,000 12,500 12,500 35,000
16 Kezia 35,000 17,500 17,500 35,000
17 Ghina 10,000 5,000 5,000 10,000
TOTAL 340,000 40,000 170,000 170,000 380,000

2 1/16/2012 Bahan Gigi 127,000
3 1/31/2012 Sarung Tangan 77,000
224,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JANUARI 1,590,000 224,000 1,366,000 683,000 683,000
2 JANUARI 170,000.00 170,000 85,000 85,000
768,000 768,000


Menyetujui,


JASA ALAT &

NO TARIF ADM JML
DOKTER BAHAN
1 2/1/2012 Ny. Wida 150,000 3,000 73,500 73,500 150,000
2 Fachrin 100,000 3,000 48,500 48,500 100,000
3 2/2/2012 Asyfa 120,000 3,000 58,500 58,500 120,000
4 Anang 120,000 3,000 58,500 58,500 120,000
5 Ny. Neli 50,000 3,000 23,500 23,500 50,000
6 2/3/2012 Tn. Franky 225,000 3,000 111,000 111,000 225,000
7 2/4/2012 Tn. Samsul 70,000 3,000 33,500 33,500 70,000
8 an. Keisha 40,000 3,000 18,500 18,500 40,000
9 Asyfa 30,000 3,000 13,500 13,500 30,000
10 2/6/2012 Fahmi 20,000 3,000 8,500 8,500 20,000
11 Ny. Neli 50,000 3,000 23,500 23,500 50,000
12 Tn. Agus 20,000 3,000 8,500 8,500 20,000
13 12/7/2012 Ayu 170,000 3,000 83,500 83,500 170,000
14 Ny. Mulyani 50,000 3,000 23,500 23,500 50,000
15 Tn. Wahyu 15,000 3,000 6,000 6,000 15,000
16 2/8/2012 Ny. Nerma 50,000 3,000 23,500 23,500 50,000
17 Ny. Nunung 50,000 3,000 23,500 23,500 50,000
18 Ny. Erni 20,000 3,000 8,500 8,500 20,000
19 2/9/2012 Mega 20,000 3,000 8,500 8,500 20,000
20 2/10/2012 Civita 80,000 3,000 38,500 38,500 80,000
21 Fitrianti 20,000 3,000 8,500 8,500 20,000
22 Asyfa 40,000 3,000 18,500 18,500 40,000
23 Ira 50,000 3,000 23,500 23,500 50,000
24 Dian 100,000 3,000 48,500 48,500 100,000
25 2/10/2012 an. Keisha 40,000 3,000 18,500 18,500 40,000
26 an. Sofura 100,000 3,000 48,500 48,500 100,000
27 2/13/2012 Tn. Aom 20,000 3,000 8,500 8,500 20,000
28 Tn. Jajang 150,000 3,000 73,500 73,500 150,000
29 Hayanaka 50,000 3,000 23,500 23,500 50,000
30 Rini 20,000 3,000 8,500 8,500 20,000
31 2/14/2012 Umah 250,000 3,000 123,500 123,500 250,000
32 Ayu 140,000 3,000 68,500 68,500 140,000
33 Ahmad 50,000 3,000 23,500 23,500 50,000
34 2/15/2012 Ny. Noviana 50,000 3,000 23,500 23,500 50,000
35 Ny. Nunung 50,000 3,000 23,500 23,500 50,000
36 2/16/2012 Ny. Neli 50,000 3,000 23,500 23,500 50,000
37 Asyfa 120,000 3,000 58,500 58,500 120,000
38 M. Ferdi 40,000 3,000 18,500 18,500 40,000
39 2/17/2012 Tn. Sodic 30,000 3,000 13,500 13,500 30,000
40 2/18/2012 an. Keisha 40,000 3,000 18,500 18,500 40,000
41 an. Sofura 40,000 3,000 18,500 18,500 40,000
42 an. Cristian Alexander 140,000 3,000 68,500 68,500 140,000
43 2/20/2012 Tn. Sodik 30,000 3,000 13,500 13,500 30,000
44 Tn. Paul 20,000 3,000 8,500 8,500 20,000
45 Jones 20,000 3,000 8,500 8,500 20,000
46 2/21/2012 Ahmad 70,000 3,000 33,500 33,500 70,000
47 Anna 180,000 3,000 88,500 88,500 180,000
48 Ayu 120,000 3,000 58,500 58,500 120,000
49 Ny. Nunung 70,000 3,000 33,500 33,500 70,000
50 Aura 20,000 3,000 8,500 8,500 20,000
51 2/23/2012 Ny. Pujiyanti 30,000 3,000 13,500 13,500 30,000
52 Vita 100,000 3,000 48,500 48,500 100,000
53 Wasis - - -
54 2/24/2012 Ferdi 40,000 3,000 18,500 18,500 40,000
55 2/25/2012 An. Keisha 120,000 3,000 58,500 58,500 120,000
56 Ny. Eti 50,000 3,000 23,500 23,500 50,000
57 an. Christian 80,000 3,000 38,500 38,500 80,000
58 Tn. Jimmy 40,000 3,000 18,500 18,500 40,000
59 2/27/2012 Siti 20,000 3,000 8,500 8,500 20,000
60 Adi. S 20,000 3,000 8,500 8,500 20,000
61 Ny. Nila 60,000 3,000 28,500 28,500 60,000
62 Aulia 150,000 3,000 73,500 73,500 150,000
63 Nurmaesari 150,000 3,000 73,500 73,500 150,000
64 2/28/2012 Ny. Hikmatul 170,000 3,000 83,500 83,500 170,000
65 Ahmad 100,000 3,000 48,500 48,500 100,000
66 2/29/2012 Ny. Santi 150,000 3,000 73,500 73,500 150,000
67 Ny. Noviana 100,000 3,000 48,500 48,500 100,000
68 Ny. Nila 170,000 3,000 83,500 83,500 170,000
69 Ny. Widia 50,000 3,000 23,500 23,500 50,000
70 Ny. Fajar 150,000 3,000 73,500 73,500 150,000
5,320,000 207,000 2,556,500 2,556,500 5,320,000

JASA ALAT &

DOKTER BAHAN
1 2/1/2012 Putri 20,000 10,000 10,000 20,000
2 Ace 10,000 10,000 5,000 5,000 20,000
3 2/2/2012 Tn. Dede 10,000 5,000 5,000 10,000
4 2/3/2012 an. Teuku Deas 10,000 5,000 5,000 10,000
5 2/4/2012 Ny. Sarmini 35,000 10,000 17,500 17,500 45,000
6 An. Astri 10,000 5,000 5,000 10,000
7 2/6/2012 Astri 25,000 10,000 12,500 12,500 35,000
8 Tn. Edi 10,000 10,000 5,000 5,000 20,000
9 2/7/2012 Syahrul 10,000 5,000 5,000 10,000
10 2/8/2012 Surya 10,000 10,000 5,000 5,000 20,000
11 2/9/2012 Syahrul 20,000 10,000 10,000 20,000
12 2/13/2012 Astri 25,000 12,500 12,500 25,000
13 2/14/2012 Bekti 10,000 5,000 5,000 10,000
14 Irfan 25,000 12,500 12,500 25,000
15 Amin 10,000 10,000 5,000 5,000 20,000
16 Albilasyazil 10,000 5,000 5,000 10,000
17 Siti. A 10,000 5,000 5,000 10,000
18 Axsel 25,000 12,500 12,500 25,000
19 2/15/2012 Ace 10,000 10,000 5,000 5,000 20,000
20 2/18/2012 Tn. Yosep Nugraha 25,000 12,500 12,500 25,000
21 Tn. Giat 25,000 12,500 12,500 25,000
22 2/21/2012 Kezia 35,000 17,500 17,500 35,000
23 Mulyono 10,000 10,000 5,000 5,000 20,000
24 Suharsono 10,000 10,000 5,000 5,000 20,000
25 2/22/2012 Tn. Yosef 10,000 10,000 5,000 5,000 20,000
26 Astri 25,000 12,500 12,500 25,000
27 2/23/2012 Tn. Grat 25,000 12,500 12,500 25,000
28 Astri 25,000 12,500 12,500 25,000
TOTAL 485,000 100,000 242,500 242,500 585,000

1 2/8/2012 Chlor Etil 1 90,000
90,000
KEUNTUNGAN
KSBL DRG. DEWI
1 FEBUARI 2,556,500 90,000 2,466,500 1,233,250 1,233,250
2 FEBUARI 242,500.00 242,500 121,250 121,250
1,354,500 1,354,500


Menyetujui,


PERIODE MARET 2012
JASA ALAT &

NO TANGGAL NAMA PASIEN TARIF ADM JML
DOKTER BAHAN
1 3/3/2012 Tn. Heru 80,000 3,000 38,500 38,500 80,000
2 Ny. Fitri 150,000 3,000 73,500 73,500 150,000
3 Fery 80,000 3,000 38,500 38,500 80,000
4 Alexander Cristian 80,000 3,000 38,500 38,500 80,000
5 3/5/2012 Tn. Eka 150,000 3,000 73,500 73,500 150,000
6 Ny. Neneng 20,000 3,000 8,500 8,500 20,000
7 Ny. Wilda 220,000 3,000 108,500 108,500 220,000
8 Tn. Rukmana 20,000 3,000 8,500 8,500 20,000
9 Nurmaesari 150,000 3,000 73,500 73,500 150,000
10 3/6/2012 Amad 100,000 3,000 48,500 48,500 100,000
11 Siti 200,000 3,000 98,500 98,500 200,000
12 3/8/2012 Pujianti 75,000 3,000 36,000 36,000 75,000
13 M.Ferdi 40,000 3,000 18,500 18,500 40,000
14 3/10/2012 Heru 40,000 3,000 18,500 18,500 40,000
15 An. Grace Adinda 60,000 3,000 28,500 28,500 60,000
16 an. Christian Alexander 50,000 3,000 23,500 23,500 50,000
17 Tn. Adi 80,000 3,000 38,500 38,500 80,000
18 an. Santi 15,000 3,000 6,000 6,000 15,000
19 an. Anisa 15,000 3,000 6,000 6,000 15,000
20 3/12/2012 Ny. Neni 150,000 3,000 73,500 73,500 150,000
21 Melky 20,000 3,000 8,500 8,500 20,000
22 Ny. Noviana 170,000 3,000 83,500 83,500 170,000
23 Rifa 50,000 3,000 23,500 23,500 50,000
24 3/13/2012 Heru 40,000 3,000 18,500 18,500 40,000
25 Nelawati 70,000 3,000 33,500 33,500 70,000
26 Intan 40,000 3,000 18,500 18,500 40,000
27 Ahmad 190,000 3,000 93,500 93,500 190,000
28 3/14/2012 Ny. Wilda 50,000 3,000 23,500 23,500 50,000
29 Tn. Jimmy 50,000 3,000 23,500 23,500 50,000
30 Norman 50,000 3,000 23,500 23,500 50,000
31 Ebanov 50,000 3,000 23,500 23,500 50,000
32 Ny. Dewi 20,000 3,000 8,500 8,500 20,000
33 3/17/2012 an. Rita Aulia 50,000 3,000 23,500 23,500 50,000
34 Ajeng 120,000 3,000 58,500 58,500 120,000
35 an. Syarin 140,000 3,000 68,500 68,500 140,000
36 3/19/2012 Tn. Agus 20,000 3,000 8,500 8,500 20,000
37 Melky 50,000 3,000 23,500 23,500 50,000
38 Norman 70,000 3,000 33,500 33,500 70,000
39 Heru 50,000 3,000 23,500 23,500 50,000
40 3/20/2012 M. Andika 70,000 3,000 33,500 33,500 70,000
41 3/21/2012 Nayla 50,000 3,000 23,500 23,500 50,000
42 Tn. Abdul 20,000 3,000 8,500 8,500 20,000
43 Ikhsan 20,000 3,000 8,500 8,500 20,000
44 3/22/2012 Fitriyani 80,000 3,000 38,500 38,500 80,000
45 Ny. Mulyani 20,000 3,000 8,500 8,500 20,000
46 3/26/2012 Tn. Mamat 20,000 3,000 8,500 8,500 20,000
47 Melky 50,000 3,000 23,500 23,500 50,000
48 Ny. Noviana 150,000 3,000 73,500 73,500 150,000
49 3/27/2012 Ny. Eka 130,000 3,000 63,500 63,500 130,000
50 Heru 40,000 3,000 18,500 18,500 40,000
51 Intan 50,000 3,000 23,500 23,500 50,000
52 3/28/2012 Wida 50,000 3,000 23,500 23,500 50,000
53 Ny. Sofia 20,000 3,000 8,500 8,500 20,000
54 Tn. Tanjung 20,000 3,000 8,500 8,500 20,000
55 3/29/2012 Adit 20,000 3,000 8,500 8,500 20,000
56 Ny. Lely 150,000 3,000 73,500 73,500 150,000
57 3/30/2012 Suminar 20,000 3,000 8,500 8,500 20,000
58 Tn. Dedih 50,000 3,000 23,500 23,500 50,000
4,105,000 174,000 1,965,500 1,965,500 4,105,000

PERIODE MARET 2012
JASA ALAT &

DOKTER BAHAN
1 3/1/2012 Yosep 10,000 5,000 5,000 10,000
2 Giat 25,000 10,000 12,500 12,500 35,000
3 3/3/2012 Ria. R 35,000 10,000 17,500 17,500 45,000
4 3/5/2012 Ny. Hermita 10,000 10,000 5,000 5,000 20,000
5 Jesicca 10,000 10,000 5,000 5,000 20,000
6 3/6/2012 Suharsono 40,000 20,000 20,000 40,000
7 3/7/2012 Yosep 10,000 10,000 5,000 5,000 20,000
8 3/8/2012 Giat 30,000 15,000 15,000 30,000
9 Astri 25,000 12,500 12,500 25,000
10 3/9/2012 Giat 35,000 17,500 17,500 35,000
11 Blessyka 10,000 10,000 5,000 5,000 20,000
12 3/12/2012 Blessyka 10,000 10,000 5,000 5,000 20,000
13 Astri 25,000 12,500 12,500 25,000
14 3/13/2012 Yosep 25,000 12,500 12,500 25,000
15 Suharsono 35,000 10,000 17,500 17,500 45,000
16 3/14/2012 Blessyka 10,000 5,000 5,000 10,000
17 Tn. Jamaludin 10,000 10,000 5,000 5,000 20,000
18 Tn. Waluyo 10,000 10,000 5,000 5,000 20,000
19 3/19/2012 Blessyka 25,000 12,500 12,500 25,000
20 Blessyka 25,000 12,500 12,500 25,000
21 Astri 35,000 17,500 17,500 35,000
22 3/22/2012 Putri 20,000 10,000 10,000 20,000
23 3/26/2012 Blessyka 25,000 12,500 12,500 25,000
TOTAL 495,000 100,000 247,500 247,500 595,000

1 3/7/2012 Bahan Gigi 1 63,700
2 3/14/2012 Masker 45,000
Kasa Hidrofil, Kapas
3 3/21/2012 140,000
Bunda, Masker
248,700
KEUNTUNGAN
KSBL DRG. DEWI
1 MARET 1,965,500 248,700 1,716,800 858,400 858,400
2 MARET 247,500.00 247,500 123,750 123,750
982,150 982,150


Menyetujui,


PERIODE APRIL 2012
JASA ALAT &

DOKTER BAHAN
1 4/2/2012 Tn. Gatot 20,000 3,000 8,500 8,500 20,000
2 Heru 50,000 3,000 23,500 23,500 50,000
3 Farhan 20,000 3,000 8,500 8,500 20,000
4 Tn. Agung 70,000 3,000 33,500 33,500 70,000
5 Rifa 50,000 3,000 23,500 23,500 50,000
6 4/3/2012 Intan 40,000 3,000 18,500 18,500 40,000
7 Aura 20,000 3,000 8,500 8,500 20,000
8 4/5/2012 Alika 80,000 3,000 38,500 38,500 80,000
9 Qinta 80,000 3,000 38,500 38,500 80,000
10 4/7/2012 Ny. Fajar 50,000 3,000 23,500 23,500 50,000
11 Hasbi 50,000 3,000 23,500 23,500 50,000
13 4/9/2012 Ny. Susana 30,000 3,000 13,500 13,500 30,000
14 4/10/2012 Ny. Nurhaeti 70,000 3,000 33,500 33,500 70,000
15 Novita 50,000 3,000 23,500 23,500 50,000
16 Heru 120,000 3,000 58,500 58,500 120,000
17 Intan 40,000 3,000 18,500 18,500 40,000
18 4/11/2012 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
19 Nurhayati 50,000 3,000 23,500 23,500 50,000
20 Susan 100,000 3,000 48,500 48,500 100,000
21 Wida 50,000 3,000 23,500 23,500 50,000
22 Ny. Ratna 150,000 3,000 73,500 73,500 150,000
23 4/12/2012 Asifa 50,000 3,000 23,500 23,500 50,000
24 Aris 20,000 3,000 8,500 8,500 20,000
25 Alika 30,000 3,000 13,500 13,500 30,000
26 Diane 70,000 3,000 33,500 33,500 70,000
27 Oke 50,000 3,000 23,500 23,500 50,000
28 4/13/2012 Tn. Edi. F 20,000 3,000 8,500 8,500 20,000
29 Ny. Yeti 150,000 3,000 73,500 73,500 150,000
30 4/14/2012 Tn. Bronto 40,000 3,000 18,500 18,500 40,000
31 Ny. Fajar 50,000 3,000 23,500 23,500 50,000
32 an. Shakira 60,000 3,000 28,500 28,500 60,000
33 Ny. Nani 60,000 3,000 28,500 28,500 60,000
35 4/16/2012 Ny. Suhaeha 20,000 3,000 8,500 8,500 20,000
36 Hasbi 50,000 3,000 23,500 23,500 50,000
37 Ny. Susana 50,000 3,000 23,500 23,500 50,000
38 Puspita 20,000 3,000 8,500 8,500 20,000
39 Nurhayati 200,000 3,000 98,500 98,500 200,000
40 Adi 20,000 3,000 8,500 8,500 20,000
41 Aditya 20,000 3,000 8,500 8,500 20,000
42 4/17/2012 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
43 Yuni 150,000 3,000 73,500 73,500 150,000
44 4/18/2012 Akbar 50,000 3,000 23,500 23,500 50,000
45 Ny. Neni 20,000 3,000 8,500 8,500 20,000
46 Ny. Wida 50,000 3,000 23,500 23,500 50,000
47 Aura 20,000 3,000 8,500 8,500 20,000
48 Ny. Ratna 200,000 3,000 98,500 98,500 200,000
49 Anggi 50,000 3,000 23,500 23,500 50,000
50 4/19/2012 Asyka 50,000 3,000 23,500 23,500 50,000
51 Alika 20,000 3,000 8,500 8,500 20,000
52 4/20/2012 Ny. Susana 20,000 3,000 8,500 8,500 20,000
53 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
54 4/21/2012 Nn. Ancenia 50,000 3,000 23,500 23,500 50,000
56 an. Hayanaka 110,000 3,000 53,500 53,500 110,000
57 Ny. Fajar 50,000 3,000 23,500 23,500 50,000
58 Tn. Edi. F 20,000 3,000 8,500 8,500 20,000
59 4/23/2012 Ny. Susana 20,000 3,000 8,500 8,500 20,000
60 Ilyas 50,000 3,000 23,500 23,500 50,000
61 4/25/2012 Tn. Roy 120,000 3,000 58,500 58,500 120,000
62 Guntur 60,000 3,000 28,500 28,500 60,000
63 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
64 Wida 50,000 3,000 23,500 23,500 50,000
65 Aura 50,000 3,000 23,500 23,500 50,000
66 Ny. Sri 50,000 3,000 23,500 23,500 50,000
67 4/26/2012 Asifa 20,000 3,000 8,500 8,500 20,000
68 Putri 20,000 3,000 8,500 8,500 20,000
69 Ny. Ai 20,000 3,000 8,500 8,500 20,000
70 Lia 50,000 3,000 23,500 23,500 50,000

PERIODE APRIL 2012
JASA ALAT &

DOKTER BAHAN
71 4/27/2012 Tn. Ahmad 20,000 3,000 8,500 8,500 20,000
72 4/28/2012 Retno 20,000 3,000 8,500 8,500 20,000
73 Tn. Soleh 80,000 3,000 38,500 38,500 80,000
74 an. Dian Fauziah 20,000 3,000 8,500 8,500 20,000
76 an. Alika 100,000 3,000 48,500 48,500 100,000
77 Ny. Fajar 60,000 3,000 28,500 28,500 60,000
78 4/30/2012 Putri 50,000 3,000 23,500 23,500 50,000
4,370,000 234,000 2,068,000 2,068,000 4,370,000

PERIODE APRIL 2012
JASA ALAT &

DOKTER BAHAN
1 4/9/2012 Siti 20,000 10,000 10,000 20,000
2 Blesyka 25,000 12,500 12,500 25,000
3 Holyka 10,000 5,000 5,000 10,000
4 Sri 20,000 10,000 10,000 20,000
5 4/10/2012 Sri 10,000 10,000 5,000 5,000 20,000
6 Djaenab 25,000 12,500 12,500 25,000
7 4/16/2012 Blesyka 25,000 12,500 12,500 25,000
8 4/19/2012 Naufal 10,000 10,000 5,000 5,000 20,000
9 Mira 10,000 5,000 5,000 10,000
10 4/20/2012 Blesyka 35,000 17,500 17,500 35,000
11 4/21/2012 Ny. Ria 35,000 10,000 17,500 17,500 45,000
12 Blesyka 25,000 12,500 12,500 25,000
13 Encep 10,000 10,000 5,000 5,000 20,000
14 4/24/2012 Djaenab 35,000 17,500 17,500 35,000
15 Asep 30,000 15,000 15,000 30,000
16 4/30/2012 Supriatna 10,000 10,000 5,000 5,000 20,000
TOTAL 335,000 50,000 167,500 167,500 385,000

1 4/10/2012 Orafil G 1 85,000
2 4/18/2012 Bahan Gigi 3 Item 247,000
332,000
KEUNTUNGAN
KSBL DRG. DEWI
1 APRIL 2,068,000 332,000 1,736,000 868,000 868,000
2 APRIL 167,500.00 167,500 83,750 83,750
951,750 951,750
Cimahi, 30 Mei 2012


Menyetujui,


PERIODE MEI 2012
JASA ALAT &

DOKTER BAHAN
1 5/2/2012 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
2 Ny. Susana 50,000 3,000 23,500 23,500 50,000
3 Ny. Lia 50,000 3,000 23,500 23,500 50,000
4 5/3/2012 Jimmy 50,000 3,000 23,500 23,500 50,000
5 Ny. Sri 50,000 3,000 23,500 23,500 50,000
6 Raka 50,000 3,000 23,500 23,500 50,000
7 5/5/2012 Ny. Fajar 160,000 3,000 78,500 78,500 160,000
8 an. Hayanaka 40,000 3,000 18,500 18,500 40,000
9 an. Chiristian Alexander 60,000 3,000 28,500 28,500 60,000
10 Tn. Soleh 80,000 3,000 38,500 38,500 80,000
11 an. Dian Fauziah 80,000 3,000 38,500 38,500 80,000
12 5/7/2012 Tn. Paul 20,000 3,000 8,500 8,500 20,000
13 Susana 50,000 3,000 23,500 23,500 50,000
14 Ny. Herlina 20,000 3,000 8,500 8,500 20,000
15 Putri 50,000 3,000 23,500 23,500 50,000
16 5/8/2012 Silvia 50,000 3,000 23,500 23,500 50,000
17 Rafael 70,000 3,000 33,500 33,500 70,000
18 Rian 140,000 3,000 68,500 68,500 140,000
19 Ny. Entin 75,000 3,000 36,000 36,000 75,000
20 5/9/2012 Tn. Umar 80,000 3,000 38,500 38,500 80,000
21 Wida 50,000 3,000 23,500 23,500 50,000
22 Tn. Iyan 150,000 3,000 73,500 73,500 150,000
23 M. Rizki 20,000 3,000 8,500 8,500 20,000
24 Tn. Oke 70,000 3,000 33,500 33,500 70,000
25 Ny. Diane 70,000 3,000 33,500 33,500 70,000
26 Mulyanti 20,000 3,000 8,500 8,500 20,000
27 5/10/2012 Jimy 50,000 3,000 23,500 23,500 50,000
28 Alika 20,000 3,000 8,500 8,500 20,000
29 5/14/2012 Ny. Susana 50,000 3,000 23,500 23,500 50,000
30 Fachri 100,000 3,000 48,500 48,500 100,000
31 Ny. Inge 20,000 3,000 8,500 8,500 20,000
32 Ny. Diane 70,000 3,000 33,500 33,500 70,000
33 M. Rizky 50,000 3,000 23,500 23,500 50,000
34 5/15/2012 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
35 Anindya 150,000 3,000 73,500 73,500 150,000
36 5/18/2012 Ny. Siti 75,000 3,000 36,000 36,000 75,000
37 5/19/2012 Nn. Wine 30,000 3,000 13,500 13,500 30,000
38 5/21/2012 Ny. Susana 50,000 3,000 23,500 23,500 50,000
39 Ny. Dani 20,000 3,000 8,500 8,500 20,000
40 5/24/2012 Tn. Suherman 20,000 3,000 8,500 8,500 20,000
41 5/26/2012 Tn. Jimmy 50,000 3,000 23,500 23,500 50,000
42 5/28/2012 Ny. Susana 50,000 3,000 23,500 23,500 50,000
43 Lintang 50,000 3,000 23,500 23,500 50,000
44 Ny. Lisa 20,000 3,000 8,500 8,500 20,000
45 Tn. Suherman 150,000 3,000 73,500 73,500 150,000
46 5/29/2012 Rian 100,000 3,000 48,500 48,500 100,000
47 Suyoto 100,000 3,000 48,500 48,500 100,000
48 Grece 100,000 3,000 48,500 48,500 100,000
49 5/30/2012 Wida 50,000 3,000 23,500 23,500 50,000
50 Retno 20,000 3,000 8,500 8,500 20,000
51 5/31/2012 Polin 20,000 3,000 8,500 8,500 20,000
52 Farhan 20,000 3,000 8,500 8,500 20,000
3,140,000 156,000 1,492,000 1,492,000 3,140,000

PERIODE MEI 2012
JASA ALAT &

DOKTER BAHAN
1 5/2/2012 Zidan 10,000 10,000 5,000 5,000 20,000
2 5/5/2012 Tn. Willy 35,000 10,000 17,500 17,500 45,000
3 5/12/2012 Ny. Ria 10,000 10,000 5,000 5,000 20,000
4 Ny. Dian 35,000 10,000 17,500 17,500 45,000
5 5/26/2012 Ny. Santi 10,000 10,000 5,000 5,000 20,000
6 5/28/2012 Ny. Rini 10,000 5,000 5,000 10,000
7 5/29/2012 Asep 35,000 17,500 17,500 35,000
TOTAL 145,000 50,000 72,500 72,500 195,000
KEUNTUNGAN
KSBL DRG. DEWI
1 MEI 1,492,000 - 1,492,000 746,000 746,000
2 MEI 72,500.00 72,500 36,250 36,250
782,250 782,250
Cimahi, Juli 2012

Menyetujui,


PERIODE JUNI 2012
JASA ALAT &

DOKTER BAHAN
1 6/1/2012 Anita 20,000 20,000 20,000
2 Vita 10,000 10,000 10,000
3 6/4/2012 Yuda 20,000 3,000 8,500 8,500 20,000
4 Lintang 50,000 3,000 23,500 23,500 50,000
5 Ny. Susana 50,000 3,000 23,500 23,500 50,000
6 Ny. Wida 170,000 3,000 83,500 83,500 170,000
7 Rifa 100,000 3,000 48,500 48,500 100,000
8 6/5/2012 Tn. Bronto 150,000 3,000 73,500 73,500 150,000
9 Ny. Sarah 100,000 3,000 48,500 48,500 100,000
10 Keysa 40,000 3,000 18,500 18,500 40,000
11 Grece 150,000 3,000 73,500 73,500 150,000
12 6/6/2012 Lintang 50,000 3,000 23,500 23,500 50,000
13 Ilyas 50,000 3,000 23,500 23,500 50,000
14 Alina 20,000 3,000 8,500 8,500 20,000
15 6/7/2012 Yuda 20,000 3,000 8,500 8,500 20,000
16 Eka 20,000 3,000 8,500 8,500 20,000
17 Amalia 20,000 3,000 8,500 8,500 20,000
18 6/9/2012 M. Firdaus 80,000 3,000 38,500 38,500 80,000
19 Tn. Imam 100,000 3,000 48,500 48,500 100,000
20 Mirna 20,000 3,000 8,500 8,500 20,000
21 6/11/2012 Ny. Susana 100,000 3,000 48,500 48,500 100,000
22 Tn. Edi 150,000 3,000 73,500 73,500 150,000
23 6/13/2012 Ny. Nurhaeti - - -
24 6/13/2012 Anggun 20,000 3,000 8,500 8,500 20,000
25 6/14/2012 Syifa 50,000 3,000 23,500 23,500 50,000
26 Syakira 50,000 3,000 23,500 23,500 50,000
27 6/15/2012 Ny. Sampurna 20,000 3,000 8,500 8,500 20,000
28 6/18/2012 Ny. Susana 100,000 3,000 48,500 48,500 100,000
29 6/20/2012 Ebanov 50,000 3,000 23,500 23,500 50,000
30 6/21/2012 Nadya 20,000 3,000 8,500 8,500 20,000
31 6/21/2012 Nanda 20,000 3,000 8,500 8,500 20,000
32 6/22/2012 Yandi 150,000 3,000 73,500 73,500 150,000
33 6/23/2012 Ny. Evi 10,000 3,000 3,500 3,500 10,000
34 Tn. Bambang 10,000 3,000 3,500 3,500 10,000
35 6/27/2012 Ny. Sukowati 20,000 3,000 8,500 8,500 20,000
36 6/28/2012 Samudra 50,000 3,000 23,500 23,500 50,000
37 Heru 100,000 3,000 48,500 48,500 100,000
38 6/29/2012 Budi - - -
39 Ny. Maemunah 20,000 3,000 8,500 8,500 20,000
40 Tn. Johan 30,000 3,000 13,500 13,500 30,000
2,210,000 108,000 1,036,000 1,066,000 2,210,000

PERIODE JUNI 2012
JASA ALAT &

DOKTER BAHAN
1 6/6/2012 Tn. Willy 10,000 5,000 5,000 10,000
2 6/9/2012 Rita 20,000 10,000 10,000 10,000 30,000
3 6/11/2012 Syahidah 10,000 10,000 5,000 5,000 20,000
4 Siti Murdiani 25,000 12,500 12,500 25,000
5 6/14/2012 Farida 10,000 10,000 5,000 5,000 20,000
6 6/18/2012 Ny. Siti 35,000 17,500 17,500 35,000
7 Farida 25,000 10,000 12,500 12,500 35,000
8 6/20/2012 Bleska 35,000 17,500 17,500 35,000
9 6/25/2012 Ramlan 10,000 10,000 5,000 5,000 20,000
10 Farida 25,000 10,000 12,500 12,500 35,000
11 6/27/2012 Vina 25,000 12,500 12,500 25,000
12 6/28/2012 Farida 25,000 12,500 12,500 25,000
13 6/28/2012 Komarah 25,000 12,500 12,500 25,000
TOTAL 280,000 60,000 140,000 140,000 340,000

1 6/27/2012 Sarung Tangan, Masker 63,700
63,700
KEUNTUNGAN
KSBL DRG. DEWI
1 JUNI 1,066,000 63,700 1,002,300 501,150 501,150
2 JUNI 140,000.00 140,000 70,000 70,000
571,150 571,150
Cimahi, Juli 2012

Menyetujui,


PERIODE JULI 2012
JASA ALAT &

DOKTER BAHAN
1 7/2/2012 Nisa 20,000 3,000 8,500 8,500 20,000
2 7/5/2012 Ny. Iis Nurlaela 20,000 3,000 8,500 8,500 20,000
3 Heru 70,000 3,000 33,500 33,500 70,000
4 Wawan 20,000 3,000 8,500 8,500 20,000
5 Budi 20,000 3,000 8,500 8,500 20,000
6 Divania 20,000 3,000 8,500 8,500 20,000
7 Aura 50,000 3,000 23,500 23,500 50,000
8 7/6/2012 Divania 40,000 3,000 18,500 18,500 40,000
9 Ny. Hasanah 15,000 3,000 6,000 6,000 15,000
10 Atma 20,000 3,000 8,500 8,500 20,000
11 7/9/2012 Ny. Deti 20,000 3,000 8,500 8,500 20,000
12 Ny. Iis Nurlaela 20,000 3,000 8,500 8,500 20,000
13 Yuliansyah 20,000 3,000 8,500 8,500 20,000
14 Nunung 20,000 3,000 8,500 8,500 20,000
15 7/11/2012 Ny. Mira 20,000 3,000 8,500 8,500 20,000
16 7/12/2012 Tn. Sudar 20,000 3,000 8,500 8,500 20,000
17 Devan 50,000 3,000 23,500 23,500 50,000
18 7/17/2012 Tn. Abdul 150,000 3,000 73,500 73,500 150,000
19 Bu Entin 160,000 3,000 78,500 78,500 160,000
20 Gina 80,000 3,000 38,500 38,500 80,000
21 7/18/2012 Ny. Tuti 20,000 3,000 8,500 8,500 20,000
22 Aura 50,000 3,000 23,500 23,500 50,000
23 7/19/2012 Deden 20,000 3,000 8,500 8,500 20,000
24 7/23/2012 Tn. Yudi 20,000 3,000 8,500 8,500 20,000
25 7/25/2012 Fahri 20,000 3,000 8,500 8,500 20,000
26 Silva 50,000 3,000 23,500 23,500 50,000
27 7/26/2012 Aliyah Syifa 40,000 3,000 18,500 18,500 40,000
28 7/31/2012 Ny. Noviana 90,000 3,000 43,500 43,500 90,000
29 Neng. K 50,000 3,000 23,500 23,500 50,000
1,215,000 87,000 564,000 564,000 1,215,000

PERIODE JULI 2012
JASA ALAT &

DOKTER BAHAN
1 7/2/2012 Ny. Imas 25,000 12,500 12,500 25,000
2 Tn. Suharto 10,000 10,000 5,000 5,000 20,000
3 7/4/2012 an. Aulia 20,000 10,000 10,000 20,000
4 Vina 35,000 17,500 17,500 35,000
5 Agung 10,000 5,000 5,000 10,000
6 7/5/2012 Komariah 35,000 17,500 17,500 35,000
7 Sri. N 25,000 12,500 12,500 25,000
8 Komarudin 25,000 12,500 12,500 25,000
9 7/6/2012 Ny. Elawati 35,000 10,000 17,500 17,500 45,000
10 7/9/2012 Ny. Imas 25,000 10,000 12,500 12,500 35,000
11 Rahma 25,000 12,500 12,500 25,000
12 7/11/2012 Komarudin 25,000 12,500 12,500 25,000
13 Ny. Sri 35,000 17,500 17,500 35,000
14 Ny. Farida 25,000 12,500 12,500 25,000
15 7/14/2012 Yohanes 10,000 10,000 5,000 5,000 20,000
16 7/16/2012 Ny. Winarti 10,000 10,000 5,000 5,000 20,000
17 Komarudin 25,000 12,500 12,500 25,000
18 Rahma 10,000 10,000 5,000 5,000 20,000
19 Farida 25,000 12,500 12,500 25,000
20 7/17/2012 Tn. Purnama 10,000 10,000 5,000 5,000 20,000
21 Tn. Asep 35,000 17,500 17,500 35,000
22 Ny. Sarti 25,000 10,000 12,500 12,500 35,000
23 Moh. Hasby 25,000 10,000 12,500 12,500 35,000
24 7/18/2012 Rahman 20,000 10,000 10,000 20,000
25 Ujang 10,000 10,000 5,000 5,000 20,000
26 Daffa 40,000 20,000 20,000 40,000
27 7/19/2012 Kusmana 10,000 10,000 5,000 5,000 20,000
28 7/23/2012 Komarudin 25,000 12,500 12,500 25,000
29 7/24/2012 Santi 25,000 12,500 12,500 25,000
30 7/25/2012 Siti 25,000 12,500 12,500 25,000
31 Asep 10,000 10,000 5,000 5,000 20,000
32 7/30/2012 Siti 35,000 17,500 17,500 35,000
33 Komarudin 35,000 10,000 17,500 17,500 45,000
34 7/31/2012 Jamaludin 40,000 10,000 20,000 20,000 50,000
35 Santi 25,000 10,000 12,500 12,500 35,000
TOTAL 830,000 150,000 415,000 415,000 980,000

1
KEUNTUNGAN
KSBL DRG. DEWI
1 JULI 564,000 - 564,000 282,000 282,000
2 JULI 415,000.00 415,000 207,500 207,500
489,500 489,500


Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 9/3/2012 Lukman 20,000 3,000 8,500 8,500 20,000
2 Lisha 50,000 3,000 23,500 23,500 50,000
3 Ny. Deti 210,000 3,000 103,500 103,500 210,000
4 Tn. Dadang 150,000 3,000 73,500 73,500 150,000
5 Dian 20,000 3,000 8,500 8,500 20,000
6 9/4/2012 Tn. Slamet 70,000 3,000 33,500 33,500 70,000
7 Ny. Wina 150,000 3,000 73,500 73,500 150,000
8 Rai 80,000 3,000 38,500 38,500 80,000
9 Ny. Susi 40,000 3,000 18,500 18,500 40,000
10 Hisyam 25,000 12,500 12,500 25,000
11 9/5/2012 Ny. Santi 300,000 3,000 148,500 148,500 300,000
12 Ny. Ai Dedeh 20,000 3,000 8,500 8,500 20,000
13 9/6/2012 Lisha 200,000 3,000 98,500 98,500 200,000
14 Tatu 20,000 3,000 8,500 8,500 20,000
15 Yuki 20,000 3,000 8,500 8,500 20,000
16 9/10/2012 M. Kemal 100,000 3,000 48,500 48,500 100,000
17 Ny. Yeni 40,000 3,000 18,500 18,500 40,000
18 Tn. Ivan 20,000 3,000 8,500 8,500 20,000
19 Rian 200,000 3,000 98,500 98,500 200,000
20 9/11/2012 Ny. Noviana 80,000 3,000 38,500 38,500 80,000
21 Hisyam 90,000 45,000 45,000 90,000
22 Soyoto 40,000 3,000 18,500 18,500 40,000
23 Jajang 20,000 3,000 8,500 8,500 20,000
24 9/12/2012 Nurpalah 70,000 3,000 33,500 33,500 70,000
25 an. Citra 20,000 3,000 8,500 8,500 20,000
26 9/12/2012 Sukdi 70,000 3,000 33,500 33,500 70,000
27 Tn. Teguh 20,000 3,000 8,500 8,500 20,000
28 9/13/2012 Verra 20,000 3,000 8,500 8,500 20,000
29 9/14/2012 Jajang 100,000 3,000 48,500 48,500 100,000
30 Ny. Irma 100,000 3,000 48,500 48,500 100,000
31 9/15/2012 Tn. Wit Andrianto 80,000 3,000 38,500 38,500 80,000
32 9/17/2012 Ny. Ayu 100,000 3,000 48,500 48,500 100,000
33 Ny. Jelly 20,000 3,000 8,500 8,500 20,000
34 Friska 20,000 3,000 8,500 8,500 20,000
35 Noviana 180,000 3,000 88,500 88,500 180,000
36 Hisyam 56,000 28,000 28,000 56,000
37 9/19/2012 Ny. Dewi 20,000 3,000 8,500 8,500 20,000
38 Tn. Akib 20,000 3,000 8,500 8,500 20,000
39 9/22/2012 Nn. Puri 50,000 3,000 23,500 23,500 50,000
40 Utami 190,000 3,000 93,500 93,500 190,000
41 9/22/2012 Tn. Ansori 120,000 3,000 58,500 58,500 120,000
42 9/24/2012 Dian 20,000 3,000 8,500 8,500 20,000
43 Tn. Suyoto 60,000 3,000 28,500 28,500 60,000
44 Neli 20,000 3,000 8,500 8,500 20,000
45 Hisyam 150,000 75,000 75,000 150,000
46 Alif 20,000 3,000 8,500 8,500 20,000
47 Ny. Supriyadi 50,000 3,000 23,500 23,500 50,000
48 Siti 20,000 3,000 8,500 8,500 20,000
49 Tn. Suhartoyo 80,000 3,000 38,500 38,500 80,000
50 9/26/2012 Ny. Eka 20,000 3,000 8,500 8,500 20,000
51 Ny. Tita 20,000 3,000 8,500 8,500 20,000
52 9/27/2012 Candiya 50,000 3,000 23,500 23,500 50,000
53 Alien 75,000 3,000 36,000 36,000 75,000
54 Rian 150,000 3,000 73,500 73,500 150,000
55 Tn. Suhartoyo 20,000 3,000 8,500 8,500 20,000
56 9/28/2012 Civita 100,000 3,000 48,500 48,500 100,000
57 Ardelia 50,000 3,000 23,500 23,500 50,000
58 Ny. Ratna 130,000 3,000 63,500 63,500 130,000
59 Ny. Rani
4,256,000 162,000 2,047,000 2,047,000 4,256,000

JASA ALAT &

DOKTER BAHAN
1 9/4/2012 M. Naufal 10,000 10,000 5,000 5,000 20,000
2 Santi 30,000 15,000 15,000 30,000
3 Hasby 25,000 12,500 12,500 25,000
4 9/5/2012 Rahma 25,000 12,500 12,500 25,000
5 Wahdi 10,000 10,000 5,000 5,000 20,000
6 Wahyu 25,000 10,000 12,500 12,500 35,000
7 9/10/2012 Tn. Tajudin 10,000 10,000 5,000 5,000 20,000
8 Ny. Rida 10,000 10,000 5,000 5,000 20,000
9 X 35,000 17,500 17,500 35,000
10 9/11/2012 Pungut 10,000 10,000 5,000 5,000 20,000
11 Santi 35,000 17,500 17,500 35,000
12 9/12/2012 Wahdi 10,000 10,000 5,000 5,000 20,000
13 9/13/2012 Tn. Dedi 10,000 10,000 5,000 5,000 20,000
14 Tn. Mulyono 10,000 10,000 5,000 5,000 20,000
15 Tn. Wahyu 25,000 12,500 12,500 25,000
16 9/17/2012 Rahma 35,000 10,000 17,500 17,500 45,000
17 Hasby 30,000 15,000 15,000 30,000
18 Santi 25,000 12,500 12,500 25,000
19 9/18/2012 Dewi 10,000 10,000 5,000 5,000 20,000
20 9/20/2012 Ny. Yanti 10,000 5,000 5,000 10,000
21 9/21/2012 Tn. Jhoni 25,000 12,500 12,500 25,000
22 9/24/2012 Blesyka 20,000 10,000 10,000 20,000
23 Fatimah 10,000 10,000 5,000 5,000 20,000
24 Dewi 25,000 12,500 12,500 25,000
25 Wahyu 30,000 15,000 15,000 30,000
26 Isnawati 35,000 17,500 17,500 35,000
27 9/26/2012 Siti. N 10,000 5,000 5,000 10,000
28 Rahma 25,000 12,500 12,500 25,000
29 Tajudi 10,000 5,000 5,000 10,000
TOTAL 580,000 120,000 290,000 290,000 700,000

Hand Schoen, Fuji IX GP
1 9/4/2012 263,000
1-1 Mini Pack
2 9/25/2012 Bahan Poli Gigi 80,000
343,000
KEUNTUNGAN
KSBL DRG. DEWI
1 SEPTEMBER 2,047,000 343,000 1,704,000 852,000 852,000
2 SEPTEMBER 290,000.00 290,000 145,000 145,000
997,000 997,000


Menyetujui,


JASA ALAT &
DOKTER BAHAN
1 10/1/2012 Ny. Eka 50,000 3,000 23,500 23,500 50,000
2 Listia 70,000 3,000 33,500 33,500 70,000
3 Tn. Nana 120,000 3,000 58,500 58,500 120,000
4 Tn. Akim 20,000 3,000 8,500 8,500 20,000
5 10/2/2012 Ny. Supriyati 120,000 3,000 58,500 58,500 120,000
6 Siti 200,000 3,000 98,500 98,500 200,000
7 Ny. Ani 20,000 3,000 8,500 8,500 20,000
8 Hisyam 120,000 60,000 60,000 120,000
9 Alep 70,000 3,000 33,500 33,500 70,000
10 Evi 20,000 3,000 8,500 8,500 20,000
11 10/4/2012 Tn. Alung 100,000 3,000 48,500 48,500 100,000
12 10/5/2012 Tn. Nana 100,000 3,000 48,500 48,500 100,000
13 Indra 50,000 3,000 23,500 23,500 50,000
14 Gishela 50,000 3,000 23,500 23,500 50,000
15 Tn. Agustin 20,000 3,000 8,500 8,500 20,000
16 10/8/2012 Ny. Eka 150,000 3,000 73,500 73,500 150,000
17 10/8/2012 Tn. Suhartoyo 50,000 3,000 23,500 23,500 50,000
18 Lovely 20,000 3,000 8,500 8,500 20,000
19 Samuel 20,000 3,000 8,500 8,500 20,000
20 10/9/2012 Alep 50,000 3,000 23,500 23,500 50,000
21 Hisyam 40,000 20,000 20,000 40,000
22 Siti 50,000 3,000 23,500 23,500 50,000
23 Fadil 70,000 3,000 33,500 33,500 70,000
24 10/10/2012 Rina 50,000 3,000 23,500 23,500 50,000
25 10/11/2012 Ny. Euis 50,000 3,000 23,500 23,500 50,000
26 Ny. Aryanti 200,000 3,000 98,500 98,500 200,000
27 Tn. Asep 50,000 3,000 23,500 23,500 50,000
28 10/12/2012 Nn. Icha 20,000 3,000 8,500 8,500 20,000
29 10/13/2012 Tn. Agus. S 20,000 3,000 8,500 8,500 20,000
30 10/15/2012 Tn. Hayat 200,000 3,000 98,500 98,500 200,000
31 Ny. Aryanti 250,000 3,000 123,500 123,500 250,000
32 Ny. Euis 150,000 3,000 73,500 73,500 150,000
33 Silva 50,000 3,000 23,500 23,500 50,000
34 Rina 50,000 3,000 23,500 23,500 50,000
35 Tn. Asep 100,000 3,000 48,500 48,500 100,000
36 10/19/2012 Rury 100,000 3,000 48,500 48,500 100,000
37 10/20/2012 Ezra 120,000 3,000 58,500 58,500 120,000
38 Supia 50,000 3,000 23,500 23,500 50,000
39 Padli 20,000 3,000 8,500 8,500 20,000
40 Tn. Hadi 50,000 3,000 23,500 23,500 50,000
41 10/22/2012 X 50,000 3,000 23,500 23,500 50,000
42 Lina 20,000 3,000 8,500 8,500 20,000
43 Imas 50,000 3,000 23,500 23,500 50,000
44 Tn. Suparman 20,000 3,000 8,500 8,500 20,000
45 10/23/2012 Hisyam 56,000 28,000 28,000 56,000
46 Ny. Novian 30,000 3,000 13,500 13,500 30,000
47 Siti 50,000 3,000 23,500 23,500 50,000
48 10/24/2012 Tn. Hadi 20,000 3,000 8,500 8,500 20,000
49 Nauval 100,000 3,000 48,500 48,500 100,000
50 Aldi 200,000 3,000 98,500 98,500 200,000
51 Edi - - -
52 10/25/2012 Neng Nur 20,000 3,000 8,500 8,500 20,000
53 Hafiz 20,000 3,000 8,500 8,500 20,000
54 10/27/2012 Firman 100,000 3,000 48,500 48,500 100,000
55 Puri 60,000 3,000 28,500 28,500 60,000
56 Rudi 80,000 3,000 38,500 38,500 80,000
57 Nana 80,000 3,000 38,500 38,500 80,000
58 10/29/2012 Aryanti 50,000 3,000 23,500 23,500 50,000
59 10/30/2012 Hisyam 40,000 3,000 18,500 18,500 40,000
60 Imas 50,000 3,000 23,500 23,500 50,000
61 Siti 50,000 3,000 23,500 23,500 50,000
62 10/31/2012 Fitria 150,000 3,000 73,500 73,500 150,000
63 Rafka 20,000 3,000 8,500 8,500 20,000
64 Ny. Susi 80,000 3,000 38,500 38,500 80,000
65 Rafety 100,000 3,000 48,500 48,500 100,000
4,606,000 183,000 2,211,500 2,211,500 4,606,000
LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA PRATAMA DAN JAMSOSTEK

JASA ALAT &

DOKTER BAHAN
1 10/1/2012 Renita 40,000 20,000 20,000 40,000
2 Rahma 25,000 12,500 12,500 25,000
3 10/3/2012 Wahyu 35,000 17,500 17,500 35,000
4 Surya 10,000 10,000 5,000 5,000 20,000
5 Rahma 10,000 10,000 5,000 5,000 20,000
6 Gatot 10,000 10,000 5,000 5,000 20,000
7 10/9/2012 jajang 10,000 10,000 5,000 5,000 20,000
8 Heby 35,000 17,500 17,500 35,000
9 Santi 35,000 17,500 17,500 35,000
10 Wahyu 25,000 12,500 12,500 25,000
11 10/10/2012 Haryadi 10,000 5,000 5,000 10,000
12 10/12/2012 Setiawan Aji 20,000 10,000 10,000 10,000 30,000
13 10/15/2012 Alip 10,000 10,000 5,000 5,000 20,000
14 10/17/2012 Dede 10,000 10,000 5,000 5,000 20,000
15 10/18/2012 wawan 10,000 10,000 5,000 5,000 20,000
16 10/19/2012 Dewi 35,000 17,500 17,500 35,000
17 10/22/2012 Arif 10,000 10,000 5,000 5,000 20,000
18 Geisya 10,000 10,000 5,000 5,000 20,000
19 Rizki 10,000 10,000 5,000 5,000 20,000
20 Kezia 35,000 17,500 17,500 35,000
21 Jumiiati 10,000 10,000 5,000 5,000 20,000
22 10/24/2012 Yuni 25,000 12,500 12,500 25,000
23 10/25/2012 Kinarya 35,000 17,500 17,500 35,000
24 Abbot 10,000 10,000 5,000 5,000 20,000
25 10/29/2012 Alif 10,000 10,000 5,000 5,000 20,000
26 Haryadi 25,000 12,500 12,500 25,000
27 Resyanti 25,000 12,500 12,500 25,000
28 10/30/2012 Warnawati 10,000 10,000 5,000 5,000 20,000
29 Santi 35,000 17,500 17,500 35,000
30 Desi 25,000 10,000 12,500 12,500 35,000
31 Salwa 10,000 10,000 5,000 5,000 20,000
615,000 170,000 307,500 307,500 785,000

Aroma Normal / Fast,
1 10/2/2012 Tempat Protesa Bertali, C 221,000
Liquid
341,000
KEUNTUNGAN
KSBL DRG. DEWI
1 OKTOBER 2,211,500 341,000 1,870,500 935,250 935,250
2 OKTOBER 307,500.00 307,500 153,750 153,750
1,089,000 1,089,000


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 11/1/2012 Hafiz 50,000 3,000 23,500 23,500 50,000
2 Anisa 50,000 3,000 23,500 23,500 50,000
3 Nerma 10,000 5,000 5,000 10,000
4 11/2/2012 Tn. Doni 150,000 3,000 73,500 73,500 150,000
5 11/5/2012 Ny. Eka 20,000 3,000 8,500 8,500 20,000
6 Ny. Aryanti 50,000 3,000 23,500 23,500 50,000
7 Hasna 50,000 3,000 23,500 23,500 50,000
8 Anisa 50,000 3,000 23,500 23,500 50,000
9 11/6/2012 Ny. Imas 50,000 3,000 23,500 23,500 50,000
10 Salma 50,000 3,000 23,500 23,500 50,000
11 Tn . Dizul 100,000 3,000 48,500 48,500 100,000
12 11/7/2012 Ny. Eka 15,000 3,000 6,000 6,000 15,000
13 Aditya 40,000 3,000 18,500 18,500 40,000
14 11/7/2012 Tn. Surya 20,000 3,000 8,500 8,500 20,000
15 10/8/2012 Atep 60,000 3,000 28,500 28,500 60,000
16 Anisa 50,000 3,000 23,500 23,500 50,000
17 11/9/2012 Nirmala Sari 50,000 3,000 23,500 23,500 50,000
18 Ratu 65,000 3,000 31,000 31,000 65,000
19 11/12/2012 Ny. Aryanti 170,000 3,000 83,500 83,500 170,000
20 Anisa 50,000 3,000 23,500 23,500 50,000
21 Akbar 20,000 3,000 8,500 8,500 20,000
22 Fredi 20,000 3,000 8,500 8,500 20,000
23 Niza 20,000 3,000 8,500 8,500 20,000
24 11/13/2012 Noviana 50,000 3,000 23,500 23,500 50,000
25 Hisyam 800,000 3,000 398,500 398,500 800,000
26 Yuli 150,000 3,000 73,500 73,500 150,000
27 11/16/2012 an. Anisa 100,000 3,000 48,500 48,500 100,000
28 Jonathan 16,000 8,000 8,000 16,000
29 11/17/2012 Nisa 36,000 18,000 18,000 36,000
30 Nirmala Sari 40,000 3,000 18,500 18,500 40,000
31 Ratna 60,000 3,000 28,500 28,500 60,000
32 11/19/2012 Ny. Tuti 50,000 3,000 23,500 23,500 50,000
33 11/20/2012 Fani 70,000 3,000 33,500 33,500 70,000
34 Aulia 70,000 3,000 33,500 33,500 70,000
35 Nisa 50,000 3,000 23,500 23,500 50,000
36 Algi 20,000 3,000 8,500 8,500 20,000
37 11/21/2012 Ratna - - -
38 Fiana 100,000 3,000 48,500 48,500 100,000
39 Ny. Tuti 75,000 3,000 36,000 36,000 75,000
40 11/24/2012 Ny. Ratna 50,000 3,000 23,500 23,500 50,000
41 Nirmala Sari 90,000 3,000 43,500 43,500 90,000
42 Ati 20,000 3,000 8,500 8,500 20,000
43 11/26/2012 Ny. Tuti 75,000 3,000 36,000 36,000 75,000
44 Fiana 100,000 3,000 48,500 48,500 100,000
45 11/28/2012 Ny. Rosita 60,000 3,000 28,500 28,500 60,000
46 11/30/2012 Ny. Fatimah - - -
3,292,000 123,000 1,584,500 1,584,500 3,292,000

JASA ALAT &

DOKTER BAHAN
1 11/1/2012 Yuni 35,000 17,500 17,500 35,000
2 Jumanah 10,000 10,000 5,000 5,000 20,000
3 Harmadi 25,000 12,500 12,500 25,000
4 11/2/2012 Ny. Desi 25,000 12,500 12,500 25,000
5 Ny. Fitri 25,000 10,000 12,500 12,500 35,000
6 11/3/2012 Ny. Warnati 35,000 10,000 17,500 17,500 45,000
7 Ny. Ai 10,000 10,000 5,000 5,000 20,000
8 11/5/2012 Tn. Suroto 10,000 10,000 5,000 5,000 20,000
9 Arif 25,000 12,500 12,500 25,000
10 Blesyka 10,000 10,000 5,000 5,000 20,000
11 11/6/2012 Dewi 25,000 10,000 12,500 12,500 35,000
12 Desi 25,000 12,500 12,500 25,000
13 11/7/2012 Surya 35,000 17,500 17,500 35,000
14 Najwa 35,000 17,500 17,500 35,000
15 11/8/2012 Fitri 25,000 10,000 12,500 12,500 35,000
16 Ai 10,000 10,000 5,000 5,000 20,000
17 11/8/2012 Harmadi 25,000 12,500 12,500 25,000
18 11/12/2012 Blesyka 10,000 10,000 5,000 5,000 20,000
JASA ALAT &

DOKTER BAHAN
19 11/13/2012 Desi 25,000 12,500 12,500 25,000
20 Dewi 25,000 10,000 12,500 12,500 35,000
21 Ana 25,000 12,500 12,500 25,000
22 Kezia 35,000 17,500 17,500 35,000
23 11/14/2012 Abil 25,000 12,500 12,500 25,000
24 Harmadi 35,000 17,500 17,500 35,000
25 Yuni 25,000 12,500 12,500 25,000
26 11/17/2012 Fitri 25,000 12,500 12,500 25,000
27 11/20/2012 Arif 25,000 12,500 12,500 25,000
28 1/20/2012 Iwan 10,000 5,000 5,000 10,000
29 Dewi 25,000 12,500 12,500 25,000
30 Ana 25,000 12,500 12,500 25,000
31 Syarif 25,000 10,000 12,500 12,500 35,000
32 11/21/2012 Silvi 10,000 10,000 5,000 5,000 20,000
33 Ai 10,000 5,000 5,000 10,000
34 Harmadi 35,000 17,500 17,500 35,000
35 11/23/2012 Syarif 25,000 10,000 12,500 12,500 35,000
36 11/24/2012 Fitri 25,000 12,500 12,500 25,000
37 Paulus 10,000 10,000 5,000 5,000 20,000
38 11/26/2012 Ai 10,000 10,000 5,000 5,000 20,000
39 Ai 10,000 10,000 5,000 5,000 20,000
40 Silvi 25,000 12,500 12,500 25,000
41 11/28/2012 Anisa 20,000 10,000 10,000 10,000 30,000
910,000 180,000 455,000 455,000 1,090,000
1 11/6/2012 Cresophate, Handschoen 428,000
Bur diamond, Kaca Mulut,

2 11/21/2012 568,800
Fuji GP 1-1
996,800
KEUNTUNGAN
KSBL DRG. DEWI
1 NOVEMBER 1,584,500 996,800 587,700 293,850 293,850
2 NOVEMBER 455,000.00 455,000 227,500 227,500
521,350 521,350


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 12/1/2012 Ita 60,000 3,000 28,500 28,500 60,000
2 Vera 50,000 3,000 23,500 23,500 50,000
3 Endah 80,000 3,000 38,500 38,500 80,000
4 12/3/2012 Ny. Tri 75,000 3,000 36,000 36,000 75,000
5 Wiwin 20,000 3,000 8,500 8,500 20,000
6 Siti 20,000 3,000 8,500 8,500 20,000
7 12/4/2012 Hisyam 1,230,000 3,000 613,500 613,500 1,230,000
8 12/6/2012 Ny. Rina 20,000 3,000 8,500 8,500 20,000
9 12/8/2012 Sofia 20,000 3,000 8,500 8,500 20,000
10 Nia 40,000 3,000 18,500 18,500 40,000
11 12/10/2012 Ny. Tri 75,000 3,000 36,000 36,000 75,000
12 Ny. Ani 25,000 3,000 11,000 11,000 25,000
13 12/11/2012 Salwa 10,000 5,000 5,000 10,000
14 Nunik 20,000 3,000 8,500 8,500 20,000
15 12/12/2012 an. Saiful 20,000 3,000 8,500 8,500 20,000
16 12/13/2012 Dani 20,000 3,000 8,500 8,500 20,000
17 an. Tati 20,000 3,000 8,500 8,500 20,000
18 12/15/2012 Nanda Sopia 50,000 3,000 23,500 23,500 50,000
19 Siti Aisyah 20,000 3,000 8,500 8,500 20,000
20 12/17/2012 Ny. Tri 200,000 3,000 98,500 98,500 200,000
21 Ny. Subhan 20,000 3,000 8,500 8,500 20,000
22 Ny. Jumiati 50,000 3,000 23,500 23,500 50,000
23 Saeful 50,000 3,000 23,500 23,500 50,000
24 Asep 50,000 3,000 23,500 23,500 50,000
25 Yuli 20,000 3,000 8,500 8,500 20,000
26 12/20/2012 Rudy 20,000 3,000 8,500 8,500 20,000
27 Jihan 20,000 3,000 8,500 8,500 20,000
28 12/21/2012 Endang 64,000 32,000 32,000 64,000
29 Alika 50,000 3,000 23,500 23,500 50,000
30 12/22/2012 Rivana 50,000 3,000 23,500 23,500 50,000
31 12/24/2012 Jumiati 150,000 3,000 73,500 73,500 150,000
32 Ayu 20,000 3,000 8,500 8,500 20,000
33 Setia. P 60,000 3,000 28,500 28,500 60,000
34 Nanda Sopia 50,000 3,000 23,500 23,500 50,000
35 Fiana 40,000 3,000 18,500 18,500 40,000
36 Hayanaka 20,000 3,000 8,500 8,500 20,000
37 Sakra 20,000 3,000 8,500 8,500 20,000
38 Welfa 20,000 3,000 8,500 8,500 20,000
39 Ny. Fajar 80,000 3,000 38,500 38,500 80,000
40 Alika 170,000 3,000 83,500 83,500 170,000
41 12/26/2012 Feri 20,000 3,000 8,500 8,500 20,000
42 M. Joheri 150,000 3,000 73,500 73,500 150,000
43 12/27/2012 Sakra - - -
44 Alika 200,000 3,000 98,500 98,500 200,000
45 Tatang 20,000 3,000 8,500 8,500 20,000
46 12/28/2012 Ani 150,000 3,000 73,500 73,500 150,000
47 Nia 100,000 3,000 48,500 48,500 100,000
48 Yati 20,000 3,000 8,500 8,500 20,000
49 12/29/2012 Tn. H. Lukman 80,000 3,000 38,500 38,500 80,000
50 Ny. Dini 50,000 3,000 23,500 23,500 50,000
3,889,000 141,000 1,874,000 1,874,000 3,889,000

JASA ALAT &

DOKTER BAHAN
1 12/1/2012 Ny. Fitri 25,000 10,000 12,500 12,500 35,000
2 Tn. Wahyu 35,000 10,000 17,500 17,500 45,000
3 Syarif 25,000 10,000 12,500 12,500 35,000
4 12/3/2012 Arif 10,000 5,000 5,000 10,000
5 Anggot 25,000 12,500 12,500 25,000
6 Abie 20,000 10,000 10,000 20,000
7 Salli 25,000 12,500 12,500 25,000
8 12/4/2012 Ana 25,000 12,500 12,500 25,000
9 dewi 25,000 12,500 12,500 25,000
10 Desi 25,000 12,500 12,500 25,000
11 12/5/2012 Ai 10,000 5,000 5,000 10,000
12 Ratnasih 10,000 5,000 5,000 10,000
13 12/6/2012 Tedy 25,000 12,500 12,500 25,000
14 12/8/2012 Salma 20,000 10,000 10,000 20,000
15 Desi 25,000 12,500 12,500 25,000
16 12/10/2012 Abbot 25,000 12,500 12,500 25,000
17 12/11/2012 M. Ramadhan 10,000 5,000 5,000 10,000
18 12/15/2012 Syarif 30,000 15,000 15,000 30,000

JASA ALAT &

DOKTER BAHAN
19 Blesyka 10,000 10,000 5,000 5,000 20,000
20 12/18/2012 Rini 10,000 5,000 5,000 10,000
21 Dewi 25,000 12,500 12,500 25,000
22 Desi 25,000 12,500 12,500 25,000
23 12/19/2012 Sarif 35,000 17,500 17,500 35,000
24 12/19/2012 Abbot 40,000 20,000 20,000 40,000
25 12/20/2012 Puji 20,000 10,000 10,000 20,000
26 12/21/2012 Santi 10,000 10,000 5,000 5,000 20,000
27 12/22/2012 Fitri 25,000 10,000 12,500 12,500 35,000
28 12/24/2012 Rini 10,000 10,000 5,000 5,000 20,000
29 Rahma 25,000 12,500 12,500 25,000
30 12/26/2012 Mulyono 50,000 10,000 25,000 25,000 60,000
31 Oke Oktaviani 25,000 12,500 12,500 25,000
32 Kokom Komalasari 50,000 10,000 25,000 25,000 60,000
33 Siti Jubaedah 25,000 12,500 12,500 25,000
34 Ellis 40,000 10,000 20,000 20,000 50,000
35 12/27/2012 M. Jaisy 20,000 10,000 10,000 20,000
36 Ratina 65,000 32,500 32,500 65,000
37 Natasya 20,000 10,000 10,000 20,000
38 12/28/2012 Titing 10,000 10,000 5,000 5,000 20,000
39 12/29/2012 Fitri 25,000 12,500 12,500 25,000
960,000 110,000 480,000 480,000 1,070,000

Tambal Sementara
1 12/18/2012 70,000
Masker
70,000
KEUNTUNGAN
KSBL DRG. DEWI
1 DESEMBER 1,874,000 70,000 1,804,000 902,000 902,000
2 DESEMBER 480,000.00 480,000 240,000 240,000
1,142,000 1,142,000


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 1/2/2013 Ny. Titin 20,000 3,000 8,500 8,500 20,000
2 Gatan 50,000 3,000 23,500 23,500 50,000
3 1/3/2013 Nia 50,000 3,000 23,500 23,500 50,000
4 Alfian 50,000 3,000 23,500 23,500 50,000
5 1/4/2013 Herlin 100,000 3,000 48,500 48,500 100,000
6 1/5/2013 Tn. Toni 20,000 3,000 8,500 8,500 20,000
7 1/5/2013 Rafel 140,000 3,000 68,500 68,500 140,000
8 1/7/2013 Ny. Dini 50,000 3,000 23,500 23,500 50,000
9 1/8/2013 Nia Yuliana 50,000 3,000 23,500 23,500 50,000
10 Devian 40,000 3,000 18,500 18,500 40,000
11 Ny. Yayat 70,000 3,000 33,500 33,500 70,000
12 1/9/2013 Novi 190,000 3,000 93,500 93,500 190,000
13 Yeni 80,000 3,000 38,500 38,500 80,000
14 Santi 150,000 3,000 73,500 73,500 150,000
15 1/9/2013 Ny. Yulianti 50,000 3,000 23,500 23,500 50,000
16 Ny. Anis 20,000 3,000 8,500 8,500 20,000
17 An. Nazwa 50,000 3,000 23,500 23,500 50,000
18 1/12/2013 Alfian 40,000 3,000 18,500 18,500 40,000
19 Ny. Neni 90,000 3,000 43,500 43,500 90,000
20 Cecep 20,000 3,000 8,500 8,500 20,000
21 1/14/2013 Rizkiah 20,000 3,000 8,500 8,500 20,000
22 Tn. Suripto 20,000 3,000 8,500 8,500 20,000
23 Vanza 50,000 3,000 23,500 23,500 50,000
24 Deni 20,000 3,000 8,500 8,500 20,000
25 Redi 150,000 3,000 73,500 73,500 150,000
26 1/15/2013 Keisha 20,000 3,000 8,500 8,500 20,000
27 Rumaenda 20,000 3,000 8,500 8,500 20,000
28 Najwa 50,000 3,000 23,500 23,500 50,000
29 Yulianti 100,000 3,000 48,500 48,500 100,000
30 Azmi 60,000 3,000 28,500 28,500 60,000
31 Derian 40,000 3,000 18,500 18,500 40,000
32 1/19/2013 Shelvi 20,000 3,000 8,500 8,500 20,000
33 1/22/2013 Ny. Yulianti 100,000 3,000 48,500 48,500 100,000
34 Derian 40,000 3,000 18,500 18,500 40,000
35 Abu 20,000 3,000 8,500 8,500 20,000
36 Winda 20,000 3,000 8,500 8,500 20,000
37 1/23/2013 Ema Rismayanti 130,000 3,000 63,500 63,500 130,000
38 1/23/2013 Devian 50,000 3,000 23,500 23,500 50,000
39 Dyah 150,000 3,000 73,500 73,500 150,000
40 Kusna 50,000 3,000 23,500 23,500 50,000
41 1/25/2013 Ayudian 20,000 3,000 8,500 8,500 20,000
42 Cecep 50,000 3,000 23,500 23,500 50,000
43 Ny. Imas 70,000 3,000 33,500 33,500 70,000
44 Nia 110,000 3,000 53,500 53,500 110,000
45 1/26/2013 Deni 140,000 3,000 68,500 68,500 140,000
46 1/28/2013 Shelvi 50,000 3,000 23,500 23,500 50,000
47 Aura 50,000 3,000 23,500 23,500 50,000
48 1/29/2013 Yulianti 100,000 3,000 48,500 48,500 100,000
49 Derian 40,000 3,000 18,500 18,500 40,000
50 1/30/2013 Kushandayani 50,000 3,000 23,500 23,500 50,000
51 Herlin 20,000 3,000 8,500 8,500 20,000
52 Tn. Minta 20,000 3,000 8,500 8,500 20,000
3,180,000 156,000 1,512,000 1,512,000 3,180,000

JASA ALAT &

DOKTER BAHAN
1 1/2/2013 Ellis 25,000 10,000 12,500 12,500 35,000
2 Fina 20,000 10,000 10,000 10,000 30,000
3 Yunas 10,000 10,000 5,000 5,000 20,000
4 bbas 25,000 10,000 12,500 12,500 35,000
5 Titing 10,000 5,000 5,000 10,000
6 1/5/2013 Heizkel 35,000 17,500 17,500 35,000
7 Hisar 20,000 10,000 10,000 20,000
8 Rizal Hasan 10,000 5,000 5,000 10,000
9 1/7/2013 Pungut 40,000 20,000 20,000 40,000
10 1/8/2013 Ana 25,000 12,500 12,500 25,000

JASA ALAT &

DOKTER BAHAN
11 Desi 25,000 12,500 12,500 25,000
12 1/10/2013 Nengsih 35,000 17,500 17,500 35,000
13 1/12/2013 Thifa 20,000 10,000 10,000 20,000
14 1/14/2013 Ellis 25,000 12,500 12,500 25,000
15 Komarudin 10,000 5,000 5,000 10,000
16 1/15/2003 Martonah 25,000 10,000 12,500 12,500 35,000
17 1/16/2013 Abod 25,000 12,500 12,500 25,000
18 Fina 20,000 10,000 10,000 20,000
19 Puspa 25,000 12,500 12,500 25,000
20 1/22/2013 Martonah 25,000 12,500 12,500 25,000
21 Tn. Asep 35,000 17,500 17,500 35,000
22 1/23/2013 Puspa 35,000 17,500 17,500 35,000
23 Tn. Suroso 25,000 12,500 12,500 25,000
24 Tn. Aep 10,000 5,000 5,000 10,000
25 1/25/2013 Hezkiel 20,000 10,000 10,000 10,000 30,000
26 1/26/2013 Asep 40,000 20,000 20,000 40,000
27 1/28/2013 Ny. Komariah 10,000 10,000 5,000 5,000 20,000
28 Naufal 20,000 10,000 10,000 10,000 30,000
29 1/29/2013 Keizia 35,000 17,500 17,500 35,000
30 Salwa 25,000 12,500 12,500 25,000
31 Hasby 35,000 17,500 17,500 35,000
32 Martonah 25,000 12,500 12,500 25,000
770,000 80,000 385,000 385,000 850,000

Excavator Pakistan,
Sonde se Halfmoon, C.
1 1/3/2013 221,000
Liquid, cotton Roll
Prodental
2 1/3/2013 Cal Excel 71,000
3 1/3/2013 Sensi Gloves 2 78,000
Liquid PH Kaca Dos Isi
20, Kaca Mulut
4 1/10/2013 188,000
Dentamerica, Handle/
Gagang Kaca Mulut
558,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JANUARI 1,512,000 558,000 954,000 477,000 477,000
2 JANUARI 385,000.00 385,000 192,500 192,500
669,500 669,500


Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 2/1/2013 Tn. Rahmat 20,000 3,000 8,500 8,500 20,000
2 Ny. Suhaeja 100,000 3,000 48,500 48,500 100,000
3 Bilqis 50,000 3,000 23,500 23,500 50,000
4 Eko 120,000 3,000 58,500 58,500 120,000
5 2/4/2013 Satria 30,000 3,000 13,500 13,500 30,000
6 Teti 20,000 3,000 8,500 8,500 20,000
7 2/5/2013 Satria 20,000 3,000 8,500 8,500 20,000
8 Yulianti 100,000 3,000 48,500 48,500 100,000
9 Devina 40,000 3,000 18,500 18,500 40,000
10 2/6/2013 Ny. Kushandayani 60,000 3,000 28,500 28,500 60,000
11 2/7/2013 Dadi 20,000 3,000 8,500 8,500 20,000
12 2/11/2013 Grace 50,000 3,000 23,500 23,500 50,000
13 Anisa 50,000 3,000 23,500 23,500 50,000
14 2/13/2013 Maria 50,000 3,000 23,500 23,500 50,000
15 Ferdiansyah 20,000 3,000 8,500 8,500 20,000
16 Bilqis 30,000 3,000 13,500 13,500 30,000
17 Daniel 50,000 3,000 23,500 23,500 50,000
18 Tn. Masri 20,000 3,000 8,500 8,500 20,000
19 Ny. Kushandayani 50,000 3,000 23,500 23,500 50,000
20 Ny. Puji 250,000 3,000 123,500 123,500 250,000
21 2/15/2013 Rahma 80,000 3,000 38,500 38,500 80,000
22 Ny. Sumiati 130,000 3,000 63,500 63,500 130,000
23 Tn. Iwan 100,000 3,000 48,500 48,500 100,000
24 Adelia 40,000 3,000 18,500 18,500 40,000
25 2/16/2013 Ny. Ai Dini 50,000 3,000 23,500 23,500 50,000
26 Alika 50,000 3,000 23,500 23,500 50,000
27 Meliana 50,000 3,000 23,500 23,500 50,000
28 Evan 30,000 3,000 13,500 13,500 30,000
29 2/18/2013 Yani 20,000 3,000 8,500 8,500 20,000
30 Grace 100,000 3,000 48,500 48,500 100,000
31 2/19/2013 Dadan 40,000 3,000 18,500 18,500 40,000
32 Kati 20,000 3,000 8,500 8,500 20,000
33 Denyan 150,000 3,000 73,500 73,500 150,000
34 2/20/2013 Ahmad Hidayat 20,000 3,000 8,500 8,500 20,000
35 Ny. Kushandayani 60,000 3,000 28,500 28,500 60,000
36 Yahya 20,000 3,000 8,500 8,500 20,000
37 Grace 20,000 3,000 8,500 8,500 20,000
38 2/22/2013 Ahmad Hidayat 20,000 3,000 8,500 8,500 20,000
39 Hanayaka 40,000 3,000 18,500 18,500 40,000
40 2/23/2013 Tn. Dadan 120,000 3,000 58,500 58,500 120,000
41 2/25/2013 Ny. Titi 200,000 3,000 98,500 98,500 200,000
42 Ardelia 25,000 3,000 11,000 11,000 25,000
43 Grace 100,000 3,000 48,500 48,500 100,000
44 Ny. Kushandayani 50,000 3,000 23,500 23,500 50,000
45 2/26/2013 Wahyudi 20,000 3,000 8,500 8,500 20,000
46 Yulianti 60,000 3,000 28,500 28,500 60,000
47 Suyoto 40,000 3,000 18,500 18,500 40,000
48 Yahya 20,000 3,000 8,500 8,500 20,000
49 2/27/2013 Meliana 50,000 3,000 23,500 23,500 50,000
50 Roy 20,000 3,000 8,500 8,500 20,000
51 Heni 40,000 3,000 18,500 18,500 40,000
52 2/28/2013 Ny. Titi 50,000 3,000 23,500 23,500 50,000
53 Desi 20,000 3,000 8,500 8,500 20,000
54 Indra 50,000 3,000 23,500 23,500 50,000
3,055,000 162,000 1,446,500 1,446,500 3,055,000
JASA ALAT &

DOKTER BAHAN
1 2/1/2013 Rubianto 10,000 10,000 5,000 5,000 20,000
2 2/4/2013 Naufal 10,000 10,000 5,000 5,000 20,000
3 Hezkiel 20,000 10,000 10,000 10,000 30,000
4 Abbot 10,000 10,000 5,000 5,000 20,000
5 Sansan 10,000 5,000 5,000 10,000
6 Eli 25,000 12,500 12,500 25,000
7 2/5/2013 Rahayu 80,000 40,000 40,000 80,000
8 Rifa 35,000 17,500 17,500 35,000
9 Markomah 25,000 12,500 12,500 25,000
10 Raihan 10,000 5,000 5,000 10,000

JASA ALAT &

DOKTER BAHAN
11 2/6/2013 Syaidah 25,000 12,500 12,500 25,000
12 Ahmad Fauzan 20,000 - 10,000 10,000 20,000
13 2/7/2013 Vira 25,000 12,500 12,500 25,000
14 Lina 10,000 10,000 5,000 5,000 20,000
15 Tn. Supriyanto 10,000 10,000 5,000 5,000 20,000
16 2/11/2013 Tiara 10,000 10,000 5,000 5,000 20,000
17 Maya 25,000 12,500 12,500 25,000
18 2/13/2013 Syaidah 65,000 10,000 32,500 32,500 75,000
19 Suryana 25,000 12,500 12,500 25,000
20 Elis 25,000 12,500 12,500 25,000
21 Usep 10,000 10,000 5,000 5,000 20,000
22 2/14/2013 Herwin 10,000 10,000 5,000 5,000 20,000
23 Yeni 10,000 10,000 5,000 5,000 20,000
24 2/15/2013 Fini 20,000 10,000 10,000 20,000
25 2/16/2013 Rubianto 35,000 10,000 17,500 17,500 45,000
26 Vira 35,000 17,500 17,500 35,000
27 2/10/2013 Yulias Wahyudi 10,000 10,000 5,000 5,000 20,000
28 Sandi Yudana 10,000 10,000 5,000 5,000 20,000
29 2/18/2013 Pradipta 10,000 10,000 5,000 5,000 20,000
30 Maya 25,000 12,500 12,500 25,000
31 Abbot 10,000 10,000 5,000 5,000 20,000
32 2/19/2013 Pusparini 25,000 10,000 12,500 12,500 35,000
33 Markonah 30,000 15,000 15,000 30,000
34 Widyaningsuh 10,000 5,000 5,000 10,000
35 2/20/2013 Syaidah 25,000 12,500 12,500 25,000
36 Suryana 35,000 17,500 17,500 35,000
37 Reni Permana 25,000 12,500 12,500 25,000
38 Jajang 10,000 10,000 5,000 5,000 20,000
39 Siti 20,000 10,000 10,000 20,000
40 2/21/2013 Fikri 25,000 12,500 12,500 25,000
41 Siti 20,000 10,000 10,000 20,000
42 Fini 20,000 10,000 10,000 20,000
43 2/25/2013 Widyaningsuh 10,000 10,000 5,000 5,000 20,000
44 Reni Permana 35,000 17,500 17,500 35,000
45 Naufal 20,000 10,000 10,000 20,000
46 Eris 10,000 10,000 5,000 5,000 20,000
47 Usep 10,000 10,000 5,000 5,000 20,000
48 Akbar 20,000 10,000 10,000 20,000
49 Maya 25,000 12,500 12,500 25,000
50 2/26/2013 Maria 10,000 10,000 5,000 5,000 20,000
51 Roswati 25,000 10,000 12,500 12,500 35,000
52 Markonah 35,000 17,500 17,500 35,000
53 Ahmad Fauzan 10,000 10,000 5,000 5,000 20,000
54 Anggi 25,000 12,500 12,500 25,000
55 Raihan 35,000 17,500 17,500 35,000
56 2/28/2013 Syaidah 10,000 5,000 5,000 10,000
57 Fikri 35,000 17,500 17,500 35,000
685,000 170,000 342,500 342,500 855,000
Bur Diamond Meisinger A,

1 2/4/2013 Bur Diamond 1 , Arsen, 389,000
Z250 A2
Sensi Gloves, Surgical

2 2/23/2013 76,000
Mask
3 2/28/2013 Ethil Clhorida, Spuit 3 cc 155,000

620,000
KEUNTUNGAN
KSBL DRG. DEWI
1 FEBUARI 1,446,500 620,000 826,500 413,250 413,250
2 FEBUARI 342,500.00 342,500 171,250 171,250
584,500 584,500


Menyetujui,

PERIODE MARET 2012
JASA ALAT &

DOKTER BAHAN
1 3/1/2013 Faiz 20,000 3,000 8,500 8,500 20,000
2 Ny. Esih 30,000 3,000 13,500 13,500 30,000
3 Resti 25,000 3,000 11,000 11,000 25,000
4 Susi 40,000 3,000 18,500 18,500 40,000
5 M. Hafidz 80,000 3,000 38,500 38,500 80,000
6 3/4/2013 Lilis 80,000 3,000 38,500 38,500 80,000
7 Sumiati 170,000 3,000 83,500 83,500 170,000
8 Rahma 50,000 3,000 23,500 23,500 50,000
9 Desi 20,000 3,000 8,500 8,500 20,000
10 3/5/2013 Dani 50,000 3,000 23,500 23,500 50,000
11 Ny. Yoseptiana 50,000 3,000 23,500 23,500 50,000
12 Yulianti 200,000 3,000 98,500 98,500 200,000
13 3/6/2013 Kushandayani 50,000 3,000 23,500 23,500 50,000
14 Grace 75,000 3,000 36,000 36,000 75,000
15 3/7/2013 Susilawati 20,000 3,000 8,500 8,500 20,000
16 Akmal 20,000 3,000 8,500 8,500 20,000
17 3/7/2013 Rahma 100,000 3,000 48,500 48,500 100,000
18 Indri 70,000 3,000 33,500 33,500 70,000
19 Teti 20,000 3,000 8,500 8,500 20,000
20 Divania 50,000 3,000 23,500 23,500 50,000
21 3/8/2013 Diki 210,000 3,000 103,500 103,500 210,000
22 Wanda 80,000 3,000 38,500 38,500 80,000
23 3/11/2013 Grace 100,000 3,000 48,500 48,500 100,000
24 Ibu Ros 150,000 3,000 73,500 73,500 150,000
25 Nova 25,000 3,000 11,000 11,000 25,000
26 Hesti 80,000 3,000 38,500 38,500 80,000
27 3/13/2013 Ny. Rina 50,000 3,000 23,500 23,500 50,000
28 3/13/2003 Ny. Kushayani 100,000 3,000 48,500 48,500 100,000
29 Tn. Dadang 20,000 3,000 8,500 8,500 20,000
30 3/14/2013 Iceu 80,000 3,000 38,500 38,500 80,000
31 Indra 70,000 3,000 33,500 33,500 70,000
32 3/15/2013 Ardelia 50,000 3,000 23,500 23,500 50,000
33 Hayanaka 20,000 3,000 8,500 8,500 20,000
34 Tn. Dedi 20,000 3,000 8,500 8,500 20,000
35 Sakra 40,000 3,000 18,500 18,500 40,000
36 Ny. Fajar 100,000 3,000 48,500 48,500 100,000
37 Huwelfa 50,000 3,000 23,500 23,500 50,000
38 3/18/2013 Dedi 20,000 3,000 8,500 8,500 20,000
39 Vanza 50,000 3,000 23,500 23,500 50,000
40 Dhiya 50,000 3,000 23,500 23,500 50,000
41 3/19/2013 Suyoto 40,000 3,000 18,500 18,500 40,000
42 Ny. Iceu 50,000 3,000 23,500 23,500 50,000
43 3/20/2013 Ny. Kushandayani 120,000 3,000 58,500 58,500 120,000
44 Tn. Agus 20,000 3,000 8,500 8,500 20,000
45 3/21/2013 Ikhsan 50,000 3,000 23,500 23,500 50,000
46 Gisela 150,000 3,000 73,500 73,500 150,000
47 3/21/2013 Ny. Lena 20,000 3,000 8,500 8,500 20,000
48 Grace 150,000 3,000 73,500 73,500 150,000
49 Raymond 250,000 3,000 123,500 123,500 250,000
50 3/22/2013 Tn. Kuswandi 20,000 3,000 8,500 8,500 20,000
51 Ibu Iceu 150,000 3,000 73,500 73,500 150,000
52 Marlina 20,000 3,000 8,500 8,500 20,000
53 Saeful 50,000 3,000 23,500 23,500 50,000
54 Irli 50,000 3,000 23,500 23,500 50,000
55 3/23/2013 Hayanaka 40,000 20,000 20,000 40,000
56 Kenzi 150,000 3,000 73,500 73,500 150,000
57 Tn. Wawan 100,000 3,000 48,500 48,500 100,000
58 3/23/2013 Alika 20,000 3,000 8,500 8,500 20,000
59 Sharka 20,000 3,000 8,500 8,500 20,000
60 3/26/2013 Suyoto 40,000 3,000 18,500 18,500 40,000
61 Tn. Kuswandi 10,000 3,000 3,500 3,500 10,000
62 Hadi 20,000 3,000 8,500 8,500 20,000
63 3/27/2013 Nia 50,000 3,000 23,500 23,500 50,000
64 Grace 170,000 3,000 83,500 83,500 170,000
65 3/28/2013 Trimugi 20,000 3,000 8,500 8,500 20,000
66 Hawelfa 50,000 3,000 23,500 23,500 50,000
4,415,000 195,000 2,110,000 2,110,000 4,415,000

PERIODE MARET 2013
JASA ALAT &

DOKTER BAHAN
1 3/1/2013 Usep 35,000 10,000 17,500 17,500 45,000
2 Dwi 10,000 10,000 5,000 5,000 20,000
3 3/2/2013 Desti 20,000 10,000 10,000 20,000
4 Nana 20,000 10,000 10,000 10,000 30,000
5 3/4/2013 Didin 25,000 12,500 12,500 25,000
6 Fanda 35,000 17,500 17,500 35,000
7 Rizki 10,000 10,000 5,000 5,000 20,000
8 3/5/2013 Pusparini 25,000 12,500 12,500 25,000
9 Tn. Suryana 30,000 15,000 15,000 30,000
10 3/6/2013 Maya 25,000 12,500 12,500 25,000
11 3/7/2013 Abbot 10,000 10,000 5,000 5,000 20,000
12 3/9/2013 Rahma Syatiti 20,000 10,000 10,000 20,000
13 Roni 35,000 17,500 17,500 35,000
14 Roswati 10,000 5,000 5,000 10,000
15 Yani 25,000 10,000 12,500 12,500 35,000
16 Lia 10,000 5,000 5,000 10,000
17 3/13/2013 Maya 35,000 10,000 17,500 17,500 45,000
18 3/18/2013 Yuyun 10,000 10,000 5,000 5,000 20,000
19 3/19/2013 M. Ngatijo 10,000 5,000 5,000 10,000
20 Ny. Rini 10,000 10,000 5,000 5,000 20,000
21 3/20/2013 Maya 35,000 17,500 17,500 35,000
22 3/21/2013 Sani 35,000 10,000 17,500 17,500 45,000
23 Rizki 20,000 10,000 10,000 20,000
24 3/21/2013 Yohanes 10,000 10,000 5,000 5,000 20,000
25 3/22/2013 M. Ramdan 35,000 17,500 17,500 35,000
26 3/25/2013 Najwa. F 25,000 10,000 12,500 12,500 35,000
27 3/26/2013 Rini 10,000 10,000 5,000 5,000 20,000
28 Yuli Hartati 25,000 12,500 12,500 25,000
29 Mujiono 10,000 5,000 5,000 10,000
30 Tn. Sunarya 35,000 17,500 17,500 35,000
31 Dewi. N 35,000 17,500 17,500 35,000
450,000 90,000 225,000 225,000 540,000

1 3/22/2013 Sensi Box 2 77,000
77,000
KEUNTUNGAN
KSBL DRG. DEWI
1 MARET 2,110,000 77,000 2,033,000 1,016,500 1,016,500
2 MARET 225,000.00 225,000 112,500 112,500
1,129,000 1,129,000

Menyetujui,


PERIODE APRIL 2013
JASA ALAT &

DOKTER BAHAN
1 4/1/2013 Tuti 20,000 3,000 8,500 8,500 20,000
2 4/3/2013 Ny. Tuti 20,000 3,000 8,500 8,500 20,000
3 Ardian 50,000 3,000 23,500 23,500 50,000
4 4/4/2013 Indra 100,000 3,000 48,500 48,500 100,000
5 Mimbar. S 20,000 3,000 8,500 8,500 20,000
6 4/5/2013 Ny. Enung 20,000 3,000 8,500 8,500 20,000
7 Ny. Hengky 20,000 3,000 8,500 8,500 20,000
8 4/6/2013 Mimbar. S 70,000 3,000 33,500 33,500 70,000
9 Priyanti 65,000 3,000 31,000 31,000 65,000
10 4/8/2013 Santi 80,000 3,000 38,500 38,500 80,000
11 Ardelia 20,000 3,000 8,500 8,500 20,000
12 M. Rizal 20,000 3,000 8,500 8,500 20,000
13 Mimbar. S 80,000 3,000 38,500 38,500 80,000
14 Rahayu 20,000 3,000 8,500 8,500 20,000
15 Irli 50,000 3,000 23,500 23,500 50,000
16 4/9/2013 Aulia 50,000 3,000 23,500 23,500 50,000
17 Komar 20,000 3,000 8,500 8,500 20,000
18 Suyoto 110,000 3,000 53,500 53,500 110,000
19 Iceu 10,000 3,000 3,500 3,500 10,000
20 Mimbar. S 80,000 3,000 38,500 38,500 80,000
21 4/10/2013 Priyanti 65,000 3,000 31,000 31,000 65,000
22 Nisa 50,000 3,000 23,500 23,500 50,000
23 Oky. S 20,000 3,000 8,500 8,500 20,000
24 Ny. Novi 20,000 3,000 8,500 8,500 20,000
25 Carolina 20,000 3,000 8,500 8,500 20,000
26 Agus 70,000 3,000 33,500 33,500 70,000
27 Mimbar. S 50,000 3,000 23,500 23,500 50,000
28 Putri 120,000 3,000 58,500 58,500 120,000
29 4/11/2013 Tn. Sanyoto 20,000 3,000 8,500 8,500 20,000
30 Ardelia 50,000 3,000 23,500 23,500 50,000
31 4/13/2013 Tn. Dudin 40,000 3,000 18,500 18,500 40,000
32 an. Fatiya 120,000 3,000 58,500 58,500 120,000
33 4/15/2013 Oky. S 30,000 3,000 13,500 13,500 30,000
34 Ardelia 20,000 3,000 8,500 8,500 20,000
35 Waty 150,000 3,000 73,500 73,500 150,000
36 Parini 20,000 3,000 8,500 8,500 20,000
37 Dian 20,000 3,000 8,500 8,500 20,000
38 4/16/2013 Nisa 50,000 3,000 23,500 23,500 50,000
39 Hayanaka 50,000 3,000 23,500 23,500 50,000
40 Mimbar. S 50,000 3,000 23,500 23,500 50,000
41 Tn. Agus 20,000 3,000 8,500 8,500 20,000
42 Ny. Ratna 20,000 3,000 8,500 8,500 20,000
43 4/17/2013 Carolina 80,000 3,000 38,500 38,500 80,000
44 Indra 100,000 3,000 48,500 48,500 100,000
45 Ardian 50,000 3,000 23,500 23,500 50,000
46 4/18/2013 Ny. Yuyun 50,000 3,000 23,500 23,500 50,000
47 4/18/2013 Rina 16,000 8,000 8,000 16,000
48 Tn. Sobandi 20,000 3,000 8,500 8,500 20,000
49 Nazril 20,000 3,000 8,500 8,500 20,000
50 Ardelia 50,000 3,000 23,500 23,500 50,000
51 Fadil 100,000 3,000 48,500 48,500 100,000
52 Wahyu 150,000 3,000 73,500 73,500 150,000
53 4/20/2013 Ika 140,000 3,000 68,500 68,500 140,000
54 Priyanti 50,000 3,000 23,500 23,500 50,000
55 4/22/2013 Riwaty 70,000 3,000 33,500 33,500 70,000
56 Yudi 25,000 3,000 11,000 11,000 25,000
57 4/22/2013 Gatan 50,000 3,000 23,500 23,500 50,000
58 Indra 50,000 3,000 23,500 23,500 50,000
59 Retno 20,000 3,000 8,500 8,500 20,000
60 Tn. Joko 20,000 3,000 8,500 8,500 20,000
61 Wulan 50,000 3,000 23,500 23,500 50,000
62 4/23/2013 Zilfana 16,000 8,000 8,000 16,000
63 Yoga 20,000 3,000 8,500 8,500 20,000
64 Boy 160,000 3,000 78,500 78,500 160,000
65 Dwi 140,000 3,000 68,500 68,500 140,000
66 Dewi 20,000 3,000 8,500 8,500 20,000
67 4/24/2013 Usi 20,000 3,000 8,500 8,500 20,000

PERIODE APRIL 2013
JASA ALAT &

DOKTER BAHAN
68 Mimbar. S 50,000 3,000 23,500 23,500 50,000
69 4/29/2013 Keisha 16,000 8,000 8,000 16,000
70 Bronto 16,000 8,000 8,000 16,000
71 Yusi 30,000 3,000 13,500 13,500 30,000
72 Nazwa 20,000 3,000 8,500 8,500 20,000
73 Daniel 50,000 3,000 23,500 23,500 50,000
74 Mimbar. S 50,000 3,000 23,500 23,500 50,000
75 Bambang 50,000 3,000 23,500 23,500 50,000
76 4/30/2013 Komar 80,000 3,000 38,500 38,500 80,000
77 Mayang 100,000 3,000 48,500 48,500 100,000
78 Wulan 90,000 3,000 43,500 43,500 90,000
4,039,000 222,000 1,908,500 1,908,500 4,039,000
LAPORAN KUNJUNGAN PASIEN GIGI JAMSOSTEK

PERIODE APRIL 2013
JASA ALAT &

DOKTER BAHAN
1 4/2/2013 Eli 35,000 17,500 17,500 35,000
2 M. Azis 20,000 10,000 10,000 20,000
3 Rahma. S 20,000 10,000 10,000 20,000
4 Anggi. C 35,000 17,500 17,500 35,000
5 Kezia 35,000 17,500 17,500 35,000
6 4/5/2013 Yuyun 25,000 10,000 12,500 12,500 35,000
7 4/6/2013 Andri Noor Lucky 25,000 10,000 12,500 12,500 35,000
8 4/8/2013 Jajabg 25,000 12,500 12,500 25,000
9 Mimin 25,000 12,500 12,500 25,000
10 4/9/2013 Djaenab 35,000 17,500 17,500 35,000
11 Rika 25,000 12,500 12,500 25,000
12 4/11/2013 Abbot 25,000 12,500 12,500 25,000
13 Rina 10,000 10,000 5,000 5,000 20,000
14 4/12/2013 Yuyun 25,000 12,500 12,500 25,000
15 Naufal 10,000 5,000 5,000 10,000
16 Hendi Mulya 25,000 12,500 12,500 25,000
17 Imam Tabrani 10,000 5,000 5,000 10,000
18 4/13/2013 Hendri Mulya 25,000 12,500 12,500 25,000
19 Dian Anggraenny 120,000 10,000 60,000 60,000 130,000
20 Andri Noor Lucky 25,000 10,000 12,500 12,500 35,000
21 4/16/2013 Jajang 35,000 17,500 17,500 35,000
22 Rina 25,000 12,500 12,500 25,000
23 Rini 40,000 10,000 20,000 20,000 50,000
24 4/17/2013 Rahma. S 10,000 10,000 5,000 5,000 20,000
25 4/18/2013 Hendri Mulya 30,000 10,000 15,000 15,000 40,000
26 4/20/2013 Hendri Mulya 25,000 12,500 12,500 25,000
27 Andri Noor Lucky 25,000 12,500 12,500 25,000
28 Ari. S 50,000 10,000 25,000 25,000 60,000
29 4/22/2013 Suryana 35,000 17,500 17,500 35,000
30 Ridwan 10,000 10,000 5,000 5,000 20,000
31 4/23/2013 Zidane 10,000 10,000 5,000 5,000 20,000
32 Rini 25,000 12,500 12,500 25,000
33 Rika 35,000 17,500 17,500 35,000
34 Hesty 10,000 10,000 5,000 5,000 20,000
35 Engkos 40,000 10,000 20,000 20,000 50,000
36 4/24/2013 Natasya 20,000 10,000 10,000 20,000
37 Tika 10,000 10,000 5,000 5,000 20,000
38 4/29/2013 Ayesha 20,000 10,000 10,000 20,000
39 Zidane 25,000 10,000 12,500 12,500 35,000
40 4/29/2013 Siti 10,000 10,000 5,000 5,000 20,000
41 Abbot 25,000 12,500 12,500 25,000
42 4/30/2013 Rini 25,000 12,500 12,500 25,000
43 Rika 25,000 12,500 12,500 25,000
44 Hesty 10,000 10,000 5,000 5,000 20,000
45 Astry 25,000 12,500 12,500 25,000
46 Hendri Mulya 25,000 12,500 12,500 25,000
47 Andri Noor Lucky 25,000 12,500 12,500 25,000
1,230,000 170,000 615,000 615,000 1,400,000

1 3/22/2013 Sensi Box 2 100,000
100,000
KEUNTUNGAN
KSBL DRG. DEWI
1 APRIL 1,908,500 100,000 1,808,500 904,250 904,250
2 APRIL 615,000.00 615,000 307,500 307,500
1,211,750 1,211,750
Cimahi, 3 Mei 2013


Menyetujui,

PERIODE MEI 2013
JASA ALAT &

DOKTER BAHAN
1 5/1/2013 Tn. Suhendar 20,000 3,000 8,500 8,500 20,000
2 Ardelia 50,000 3,000 23,500 23,500 50,000
3 M. Zaki 50,000 3,000 23,500 23,500 50,000
4 5/2/2013 Tn. Bambang 20,000 3,000 8,500 8,500 20,000
5 Tn. Wahyu 120,000 3,000 58,500 58,500 120,000
6 Tn. Indra 70,000 3,000 33,500 33,500 70,000
7 5/3/2013 Tn. Dion 20,000 3,000 8,500 8,500 20,000
8 Ny. X 20,000 3,000 8,500 8,500 20,000
9 5/4/2013 Priyanti 50,000 3,000 23,500 23,500 50,000
10 Tn. Mimbar 70,000 3,000 33,500 33,500 70,000
11 5/6/2013 Tn. Bronto 40,000 20,000 20,000 40,000
12 Tn. Indra 50,000 3,000 23,500 23,500 50,000
13 Wahyu 240,000 3,000 118,500 118,500 240,000
14 Tn. Safrudin - - -
15 5/7/2013 Rudiana 30,000 3,000 13,500 13,500 30,000
16 5/8/2013 Anisa 20,000 3,000 8,500 8,500 20,000
17 5/10/2013 Ali 20,000 3,000 8,500 8,500 20,000
18 4/11/2013 Ny. Ratna 20,000 3,000 8,500 8,500 20,000
19 4/13/2013 Ardelia 50,000 3,000 23,500 23,500 50,000
20 Indra 50,000 3,000 23,500 23,500 50,000
21 Hamzah 50,000 3,000 23,500 23,500 50,000
22 5/15/2013 Iyan 60,000 3,000 28,500 28,500 60,000
23 Zaki 50,000 3,000 23,500 23,500 50,000
24 Ratna 20,000 3,000 8,500 8,500 20,000
25 5/18/2013 Dian 20,000 3,000 8,500 8,500 20,000
26 Warlian 50,000 3,000 23,500 23,500 50,000
27 Tn. Dadan 120,000 3,000 58,500 58,500 120,000
28 Widya 97,500 3,000 47,250 47,250 97,500
29 5/20/2013 Tn. Bronto 25,000 12,500 12,500 25,000
30 Ny. Lilis 80,000 3,000 38,500 38,500 80,000
31 Rafael 40,000 3,000 18,500 18,500 40,000
32 Anis 50,000 3,000 23,500 23,500 50,000
33 5/20/2013 Tn. Suhartoyo 20,000 3,000 8,500 8,500 20,000
34 Suci 20,000 3,000 8,500 8,500 20,000
35 Indra 180,000 3,000 88,500 88,500 180,000
36 5/21/2013 Teti 220,000 3,000 108,500 108,500 220,000
37 Mira 100,000 3,000 48,500 48,500 100,000
38 5/22/2013 Tn. Imam 20,000 3,000 8,500 8,500 20,000
39 Renjani - - -
40 5/23/2013 Alika 20,000 3,000 8,500 8,500 20,000
41 5/23/2013 Tn. Imam 80,000 3,000 38,500 38,500 80,000
42 5/25/2013 Ny. Erlin 180,000 3,000 88,500 88,500 180,000
43 Ny. Ros Rosita 30,000 3,000 13,500 13,500 30,000
44 5/27/2013 Maudy 30,000 3,000 13,500 13,500 30,000
45 Tn. Bronto 25,000 12,500 12,500 25,000
46 Tn. Iwan 20,000 3,000 8,500 8,500 20,000
47 5/28/2013 Zaenudin 100,000 50,000 50,000 100,000
48 Sri 150,000 3,000 73,500 73,500 150,000
49 5/29/2013 Ani 50,000 3,000 23,500 23,500 50,000
50 Tn. Bronto 50,000 3,000 23,500 23,500 50,000
51 Sumi 20,000 3,000 8,500 8,500 20,000
52 5/30/2013 Hadi 50,000 3,000 23,500 23,500 50,000
53 Paryadi 50,000 3,000 23,500 23,500 50,000
54 5/31/2013 Rina 80,000 40,000 40,000 80,000
3,167,500 141,000 1,513,250 1,513,250 3,167,500

PERIODE MEI 2013
JASA ALAT &

DOKTER BAHAN
1 5/1/2013 Voppy 10,000 10,000 5,000 5,000 20,000
2 Siti. M 10,000 10,000 5,000 5,000 20,000
3 5/3/2013 Yuyun - - -
4 5/4/2013 Aris 20,000 10,000 10,000 20,000
5 5/6/2013 Fitri 25,000 12,500 12,500 25,000
6 Apon 25,000 12,500 12,500 25,000
7 Daffa 20,000 10,000 10,000 20,000
8 Rifa 20,000 10,000 10,000 20,000
9 Tika 10,000 10,000 5,000 5,000 20,000
10 Yuyun 10,000 10,000 5,000 5,000 20,000
11 5/7/2013 Rini 30,000 15,000 15,000 30,000
12 Siti. M 10,000 5,000 5,000 10,000
13 Hendri 25,000 10,000 12,500 12,500 35,000
14 Hasby 10,000 5,000 5,000 10,000
15 Rina 25,000 12,500 12,500 25,000
16 Asty 25,000 12,500 12,500 25,000
17 Santi 30,000 15,000 15,000 30,000
18 5/8/2013 Ayi 35,000 17,500 17,500 35,000
19 Lies 30,000 15,000 15,000 30,000
20 5/10/2013 M. Rizki 25,000 12,500 12,500 25,000
21 Acep 10,000 5,000 5,000 10,000
Siti Zubaedah 25,000 12,500 12,500 25,000
Asep Saepudin 10,000 10,000 5,000 5,000 20,000
22 5/11/2013 Widya. N 10,000 10,000 5,000 5,000 20,000
23 5/13/2013 Apon 35,000 17,500 17,500 35,000
24 Tika 10,000 10,000 5,000 5,000 20,000
25 Aziz 10,000 10,000 5,000 5,000 20,000
26 Hermano 10,000 10,000 5,000 5,000 20,000
27 5/14/2013 Apon 30,000 15,000 15,000 30,000
28 5/15/2013 Ny. Ratna 30,000 15,000 15,000 30,000
29 5/15/2013 Kamelia 10,000 10,000 5,000 5,000 20,000
30 Hendi 10,000 10,000 5,000 5,000 20,000
31 Lies 30,000 15,000 15,000 30,000
32 Siti. M 35,000 17,500 17,500 35,000
33 Aulia 25,000 12,500 12,500 25,000
34 5/16/2013 Ratna 30,000 15,000 15,000 30,000
35 3/17/2013 M. Fikri 35,000 10,000 17,500 17,500 45,000
36 Ade. S 30,000 15,000 15,000 30,000
37 Andri. N 25,000 12,500 12,500 25,000
38 5/18/2013 Daman. AR 20,000 10,000 10,000 10,000 30,000
39 Widya. P 30,000 15,000 15,000 30,000
40 9/20/2013 Renata 10,000 10,000 5,000 5,000 20,000
41 Apon 30,000 15,000 15,000 30,000
42 5/20/2013 M. Ramdan 10,000 10,000 5,000 5,000 20,000
43 Teten. T 10,000 10,000 5,000 5,000 20,000
44 Salamah 10,000 10,000 5,000 5,000 20,000
45 Rachmad 20,000 10,000 10,000 20,000
46 5/21/2013 Nurul 25,000 12,500 12,500 25,000
47 Rika 25,000 12,500 12,500 25,000
48 M. Hasby 40,000 10,000 20,000 20,000 50,000
49 Astri 25,000 12,500 12,500 25,000
50 Santi 35,000 17,500 17,500 35,000
51 Hendri 25,000 12,500 12,500 25,000
52 Ahmad 25,000 10,000 12,500 12,500 35,000
53 Rini 35,000 17,500 17,500 35,000
54 5/22/2013 Adnan 35,000 17,500 17,500 35,000
55 5/23/2013 Alivia 25,000 12,500 12,500 25,000
56 Abot 25,000 12,500 12,500 25,000
57 Tika 10,000 10,000 5,000 5,000 20,000
58 Kamilia 10,000 1,000 5,000 5,000 11,000
59 Lies 30,000 15,000 15,000 30,000
60 5/24/2013 M. Azis 10,000 5,000 5,000 10,000
61 5/27/2013 Ayesha 20,000 10,000 10,000 20,000
62 5/28/2013 Ratna. N 30,000 15,000 15,000 30,000

PERIODE MEI 2013
JASA ALAT &

DOKTER BAHAN
63 Apon 30,000 15,000 15,000 30,000
64 Adnan 25,000 12,500 12,500 25,000
65 Nurul 25,000 12,500 12,500 25,000
66 Hendri 25,000 10,000 12,500 12,500 35,000
67 Rini 10,000 10,000 5,000 5,000 20,000
68 Raihan 25,000 12,500 12,500 25,000
69 5/29/2013 Salawati 25,000 12,500 12,500 25,000
70 5/30/2013 Ratna 30,000 15,000 15,000 30,000
71 Nies 30,000 15,000 15,000 30,000
72 Alvia 25,000 12,500 12,500 25,000
1,625,000 231,000 812,500 812,500 1,856,000

1 5/15/2013 Masker Diapro 1 23,000
C Liquid 1 126,000
Caviton 1 109,250
2 5/21/2013 Caviton 1 115,000
Chlor Ethyl 1 76,500
449,750
KEUNTUNGAN
KSBL DRG. DEWI
1 MEI 1,513,250 449,750 1,063,500 531,750 531,750
2 MEI 812,500.00 812,500 406,250 406,250
938,000 938,000
Cimahi, 5 Juni 2013

Menyetujui,


PERIODE JUNI 2013
JASA ALAT &

DOKTER BAHAN
1 6/1/2013 Ny. Muliani 70,000 3,000 33,500 33,500 70,000
2 Tn. Dudung 50,000 3,000 23,500 23,500 50,000
3 6/3/2013 Ny. Eli 50,000 3,000 23,500 23,500 50,000
4 Tn. Wahyudin 190,000 3,000 93,500 93,500 190,000
5 Ny. Nurhayati 50,000 3,000 23,500 23,500 50,000
6 Nabila 20,000 3,000 8,500 8,500 20,000
7 Oriza 50,000 3,000 23,500 23,500 50,000
8 Ardelia 50,000 3,000 23,500 23,500 50,000
9 6/5/2013 Ny. Nurhayati 100,000 3,000 48,500 48,500 100,000
10 6/7/2013 Kania 20,000 3,000 8,500 8,500 20,000
11 6/8/2013 Syifa 80,000 3,000 38,500 38,500 80,000
12 Jesica 20,000 3,000 8,500 8,500 20,000
13 Tn. Agus 50,000 3,000 23,500 23,500 50,000
14 Ny. Asmiyatun 20,000 3,000 8,500 8,500 20,000
15 Nirma Aulia 50,000 3,000 23,500 23,500 50,000
16 6/10/2013 Ny. Ani 100,000 3,000 48,500 48,500 100,000
17 Tn. Bronto 40,000 20,000 20,000 40,000
18 Ny. Asmiyatun 20,000 3,000 8,500 8,500 20,000
19 Ardelia 100,000 3,000 48,500 48,500 100,000
20 Tn. Dedy 30,000 3,000 13,500 13,500 30,000
21 6/11/2013 Sri 110,000 3,000 53,500 53,500 110,000
22 6/13/2013 Tn. Bronto 40,000 20,000 20,000 40,000
23 Lilies 150,000 3,000 73,500 73,500 150,000
24 Rizki 20,000 3,000 8,500 8,500 20,000
25 Ansor 20,000 3,000 8,500 8,500 20,000
26 6/14/2013 Nn. Ipah 130,000 3,000 63,500 63,500 130,000
27 Diva 20,000 3,000 8,500 8,500 20,000
28 6/14/2013 Sri 200,000 3,000 98,500 98,500 200,000
29 6/15/2013 Ny. Chamil 20,000 3,000 8,500 8,500 20,000
30 Nn. Hera 40,000 3,000 18,500 18,500 40,000
31 Hamzah 50,000 3,000 23,500 23,500 50,000
32 6/17/2013 Nn. Isnaeni 20,000 3,000 8,500 8,500 20,000
33 an. Della 50,000 3,000 23,500 23,500 50,000
34 Ny. Tien Hartini 100,000 3,000 48,500 48,500 100,000
35 6/18/2013 Tn. Bronto 80,000 40,000 40,000 80,000
36 Ardelia 100,000 3,000 48,500 48,500 100,000
37 Ny. Ruli 20,000 3,000 8,500 8,500 20,000
38 6/19/2013 Ny. Marlina 20,000 3,000 8,500 8,500 20,000
39 6/20/2013 Tn. Bronto 80,000 40,000 40,000 80,000
40 Ny. Yuli 250,000 3,000 123,500 123,500 250,000
41 6/21/2013 Hamzah 50,000 3,000 23,500 23,500 50,000
42 Anifah 50,000 3,000 23,500 23,500 50,000
43 6/22/2013 Nn. Hera 40,000 3,000 18,500 18,500 40,000
44 Tn. Feri 20,000 3,000 8,500 8,500 20,000
45 6/24/2013 Tn. Imam 20,000 3,000 8,500 8,500 20,000
46 6/25/2013 Tn. Asep 80,000 3,000 38,500 38,500 80,000
47 Ny. Sri 40,000 3,000 18,500 18,500 40,000
48 Hamzah 50,000 3,000 23,500 23,500 50,000
49 6/26/2013 Tn. Agustina 130,000 3,000 63,500 63,500 130,000
50 Rury 100,000 3,000 48,500 48,500 100,000
51 Faris 20,000 3,000 8,500 8,500 20,000
52 Niswa 20,000 3,000 8,500 8,500 20,000
53 Lithfi 50,000 3,000 23,500 23,500 50,000
54 Ahmad 20,000 3,000 8,500 8,500 20,000
55 6/27/2013 Nn. Hera 40,000 3,000 18,500 18,500 40,000
56 Yono 40,000 3,000 18,500 18,500 40,000
57 Agus 50,000 3,000 23,500 23,500 50,000
58 6/29/2013 Regi 50,000 3,000 23,500 23,500 50,000
3,550,000 162,000 1,694,000 1,694,000 3,550,000

PERIODE JUNI 2013
JASA ALAT &

DOKTER BAHAN
1 6/3/2013 Eva. R 35,000 17,500 17,500 35,000
2 Jarkasih 25,000 12,500 12,500 25,000
3 Agi. F 10,000 10,000 5,000 5,000 20,000
4 6/5/2013 Lies 30,000 15,000 15,000 30,000
5 Salamah 25,000 12,500 12,500 25,000
6 6/8/2013 Leni Roheni 20,000 10,000 10,000 10,000 30,000
7 M. Agus 30,000 15,000 15,000 30,000
8 Alura 25,000 12,500 12,500 25,000
9 6/10/2013 Ahmad Fauzan 20,000 10,000 10,000 20,000
10 Elbi 20,000 10,000 10,000 20,000
11 Abot 10,000 10,000 5,000 5,000 20,000
12 Camelia 25,000 12,500 12,500 25,000
13 Metta 10,000 10,000 5,000 5,000 20,000
14 6/11/2013 Maryani 35,000 10,000 17,500 17,500 45,000
15 Ahmad Fauzan 20,000 10,000 10,000 20,000
16 Adhita 10,000 5,000 5,000 10,000
17 Nurul 25,000 12,500 12,500 25,000
18 Andri 25,000 12,500 12,500 25,000
19 Hudi 30,000 15,000 15,000 30,000
20 6/13/2013 Frida 10,000 5,000 5,000 10,000
21 Lies 30,000 15,000 15,000 30,000
22 6/14/2013 Abot 10,000 5,000 5,000 10,000
23 6/15/2013 Alvia 25,000 12,500 12,500 25,000
24 Dewi 40,000 20,000 20,000 40,000
25 6/17/2013 Kamelia 25,000 12,500 12,500 25,000
26 6/18/2013 Herianto 10,000 10,000 5,000 5,000 20,000
27 6/19/2013 Suwarna 10,000 10,000 5,000 5,000 20,000
28 6/21/2013 Andri 40,000 10,000 20,000 20,000 50,000
29 Warny 40,000 10,000 20,000 20,000 50,000
30 Sarah 25,000 12,500 12,500 25,000
31 6/22/2013 an. Rizki 20,000 10,000 10,000 20,000
32 an. Erfan 20,000 10,000 10,000 10,000 30,000
33 Alvia 25,000 12,500 12,500 25,000
34 Ny. Siti. H 35,000 17,500 17,500 35,000
35 6/24/2013 Kamilia 25,000 12,500 12,500 25,000
36 Siti. J 10,000 10,000 5,000 5,000 20,000
37 Erfan 10,000 10,000 5,000 5,000 20,000
38 Tyara 10,000 10,000 5,000 5,000 20,000
39 Irma 10,000 10,000 5,000 5,000 20,000
40 Abot 25,000 12,500 12,500 25,000
41 Sarah 25,000 12,500 12,500 25,000
42 Nurul 10,000 10,000 5,000 5,000 20,000
43 Dian 10,000 10,000 5,000 5,000 20,000
44 Agus 25,000 12,500 12,500 25,000
45 6/25/2013 Hendri 35,000 17,500 17,500 35,000
46 Andri 30,000 15,000 15,000 30,000
47 Leni Roheni 25,000 10,000 12,500 12,500 35,000
48 Nurul 25,000 12,500 12,500 25,000
49 Sumarna 25,000 12,500 12,500 25,000
50 Rohana 35,000 17,500 17,500 35,000
51 Ahmad Fauzan 25,000 12,500 12,500 25,000
52 6/26/2013 Dewi 25,000 10,000 12,500 12,500 35,000
53 Salamah 25,000 12,500 12,500 25,000
54 Agung 10,000 5,000 5,000 10,000
55 6/27/2013 Sumarna 25,000 12,500 12,500 25,000
56 Farida 25,000 12,500 12,500 25,000
57 Yusuf 10,000 5,000 5,000 10,000
58 Puspa 10,000 5,000 5,000 10,000
59 6/28/2013 Sarah 10,000 5,000 5,000 10,000
1,295,000 180,000 647,500 647,500 1,475,000

237,500
KEUNTUNGAN
KSBL DRG. DEWI
1 JUNI 1,694,000 237,500 1,456,500 728,250 728,250
2 JUNI 647,500.00 647,500 323,750 323,750
1,052,000 1,052,000
Cimahi, 3 Juli 2013


Menyetujui,


PERIODE JULI 2013
JASA ALAT &

DOKTER BAHAN
1 7/1/2013 Sri 30,000 3,000 13,500 13,500 30,000
2 Tati 20,000 3,000 8,500 8,500 20,000
3 7/2/2013 Agus 50,000 3,000 23,500 23,500 50,000
4 Triyani 40,000 3,000 18,500 18,500 40,000
5 Faris 20,000 3,000 8,500 8,500 20,000
6 Wawan. S 20,000 3,000 8,500 8,500 20,000
7 7/2/2013 Sri 180,000 3,000 88,500 88,500 180,000
8 Mira 50,000 3,000 23,500 23,500 50,000
9 7/3/2013 Rury 40,000 3,000 18,500 18,500 40,000
10 Chandra 20,000 3,000 8,500 8,500 20,000
11 Ny. Esih 50,000 3,000 23,500 23,500 50,000
12 7/4/2013 Linawati 80,000 3,000 38,500 38,500 80,000
13 Tn. Zinur 20,000 3,000 8,500 8,500 20,000
14 Tn. Ambrosius 50,000 3,000 23,500 23,500 50,000
15 7/5/2013 Nazwa 20,000 3,000 8,500 8,500 20,000
16 7/6/2013 Oriza 40,000 3,000 18,500 18,500 40,000
17 Alma. F 120,000 3,000 58,500 58,500 120,000
18 7/8/2013 Sri Karyeni 45,000 3,000 21,000 21,000 45,000
19 7/9/2013 Riska 100,000 3,000 48,500 48,500 100,000
20 Faris 40,000 3,000 18,500 18,500 40,000
21 Agus 100,000 3,000 48,500 48,500 100,000
22 Tn. Ambrosius 50,000 3,000 23,500 23,500 50,000
23 7/10/2013 Anisa 50,000 3,000 23,500 23,500 50,000
24 7/11/2013 Ny. Yuyun 110,000 3,000 53,500 53,500 110,000
25 Hera. N 40,000 3,000 18,500 18,500 40,000
26 7/12/2013 Tn. Wahyu 20,000 3,000 8,500 8,500 20,000
27 Reiska 20,000 3,000 8,500 8,500 20,000
28 7/13/2013 Anisa 50,000 3,000 23,500 23,500 50,000
29 Titin 20,000 3,000 8,500 8,500 20,000
30 7/13/2013 Tn. Ambrosius 100,000 3,000 48,500 48,500 100,000
31 Ervan 80,000 3,000 38,500 38,500 80,000
32 7/15/2013 Santi 20,000 3,000 8,500 8,500 20,000
33 7/16/2013 Hera. N 40,000 3,000 18,500 18,500 40,000
34 Sri 150,000 3,000 73,500 73,500 150,000
35 7/17/2013 Anisa 100,000 3,000 48,500 48,500 100,000
36 7/17/2013 Faris 50,000 3,000 23,500 23,500 50,000
37 Triyani 60,000 3,000 28,500 28,500 60,000
38 Yayan 20,000 3,000 8,500 8,500 20,000
39 7/18/2013 Ny. Leticia 40,000 3,000 18,500 18,500 40,000
40 Mardiyono - - -
41 7/19/2013 Ny. Santi Sartika 60,000 3,000 28,500 28,500 60,000
42 7/20/2013 Ridwan 290,000 3,000 143,500 143,500 290,000
43 Anisa 260,000 3,000 128,500 128,500 260,000
44 Tn. Agus 20,000 3,000 8,500 8,500 20,000
45 7/22/2013 Tn. Bronto 20,000 3,000 8,500 8,500 20,000
46 Tn. Tian 20,000 3,000 8,500 8,500 20,000
47 Ridwan 160,000 3,000 78,500 78,500 160,000
48 7/23/2013 Ny. Euis Tuti 80,000 3,000 38,500 38,500 80,000
49 Nn. Hera 120,000 3,000 58,500 58,500 120,000
50 7/24/2013 an. Azka 20,000 3,000 8,500 8,500 20,000
51 Ny. Triyani 50,000 3,000 23,500 23,500 50,000
52 Ny. Sunarti 50,000 3,000 23,500 23,500 50,000
53 Adi Yusuf 20,000 3,000 8,500 8,500 20,000
54 7/25/2013 Ahmad 150,000 3,000 73,500 73,500 150,000
55 Adi Yusuf 80,000 3,000 38,500 38,500 80,000
56 7/26/2013 Ny. Maryati 20,000 3,000 8,500 8,500 20,000
57 7/27/2013 Tn. Indra 20,000 3,000 8,500 8,500 20,000
58 Ridwan 45,000 3,000 21,000 21,000 45,000
59 Ny. Santi Sartika 20,000 3,000 8,500 8,500 20,000
60 7/29/2013 Heni 200,000 3,000 98,500 98,500 200,000
61 7/30/2013 Darsono 30,000 3,000 13,500 13,500 30,000
62 Anisa 120,000 3,000 58,500 58,500 120,000
63 Hamzah 150,000 3,000 73,500 73,500 150,000
64 7/31/2013 Ny. Kushandayani 40,000 3,000 18,500 18,500 40,000
4,200,000 189,000 2,005,500 2,005,500 4,200,000

PERIODE JULI 2013
JASA ALAT &

DOKTER BAHAN
1 7/1/2013 Dewi 10,000 10,000 5,000 5,000 20,000
2 Farida 25,000 12,500 12,500 25,000
3 Tiya 10,000 10,000 5,000 5,000 20,000
4 Irma 10,000 5,000 5,000 10,000
5 Kamila 25,000 12,500 12,500 25,000
6 Agus 25,000 12,500 12,500 25,000
7 Yulia 10,000 10,000 5,000 5,000 20,000
8 7/2/2013 Siti Fatimah 20,000 10,000 10,000 10,000 30,000
9 Theresia 35,000 17,500 17,500 35,000
10 Nurul 30,000 15,000 15,000 30,000
11 Yuni 25,000 12,500 12,500 25,000
12 Andi 35,000 17,500 17,500 35,000
13 Rendi 40,000 10,000 20,000 20,000 50,000
14 Mini 35,000 17,500 17,500 35,000
15 Salamah 25,000 12,500 12,500 25,000
16 Raihan 35,000 17,500 17,500 35,000
17 7/3/2013 Theresia 35,000 17,500 17,500 35,000
18 Ny. Dewi 40,000 10,000 20,000 20,000 50,000
19 Surya 10,000 10,000 5,000 5,000 20,000
20 7/4/2013 Wawan 25,000 10,000 12,500 12,500 35,000
21 Kusnandar 10,000 10,000 5,000 5,000 20,000
22 Mulyono 10,000 10,000 5,000 5,000 20,000
23 7/9/2013 Herdian 25,000 10,000 12,500 12,500 35,000
24 Juariah 10,000 5,000 5,000 10,000
25 Agus 25,000 12,500 12,500 25,000
26 Sumarna 10,000 5,000 5,000 10,000
27 Dian 25,000 12,500 12,500 25,000
28 Riski 10,000 5,000 5,000 10,000
29 Novira 25,000 12,500 12,500 25,000
30 7/10/2013 Anik. S 25,000 12,500 12,500 25,000
31 7/10/2013 Salamah 25,000 12,500 12,500 25,000
32 Afiani 10,000 10,000 5,000 5,000 20,000
33 Axsel 10,000 10,000 5,000 5,000 20,000
34 7/12/2013 M. Abdullah 20,000 10,000 10,000 10,000 30,000
35 7/15/2013 Nurdiana. S 10,000 10,000 5,000 5,000 20,000
36 Agus 30,000 15,000 15,000 30,000
37 Riska 25,000 12,500 12,500 25,000
38 7/16/2013 Riska 25,000 10,000 12,500 12,500 35,000
39 Rini 40,000 20,000 20,000 40,000
40 Sri. M 25,000 12,500 12,500 25,000
41 Setiawan 35,000 17,500 17,500 35,000
42 Sumarna 25,000 12,500 12,500 25,000
43 Dian 25,000 12,500 12,500 25,000
44 Yuni 35,000 17,500 17,500 35,000
45 Herdian 25,000 12,500 12,500 25,000
46 Anik. S 25,000 12,500 12,500 25,000
47 7/18/2013 Abbot 25,000 12,500 12,500 25,000
48 Mardiyanto 30,000 15,000 15,000 30,000
49 Afiani 25,000 12,500 12,500 25,000
50 Salamah 25,000 12,500 12,500 25,000
51 7/19/2013 Ny. Siti. M 20,000 10,000 10,000 10,000 30,000
52 7/20/2013 Andi Maman 20,000 10,000 10,000 10,000 30,000
53 7/22/2013 Ny. Siti. M 25,000 12,500 12,500 25,000
54 7/22/2013 Bambang 10,000 5,000 5,000 10,000
55 Ny. Salamah 25,000 12,500 12,500 25,000
56 Afiani 25,000 12,500 12,500 25,000
57 Herdian 25,000 12,500 12,500 25,000
58 Abbot 25,000 12,500 12,500 25,000
59 7/27/2013 Maryati 10,000 5,000 5,000 10,000
60 Muhidin 25,000 10,000 12,500 12,500 35,000
61 Maryati 10,000 5,000 5,000 10,000
62 Alivia 30,000 15,000 15,000 30,000
63 Kamilia 10,000 10,000 5,000 5,000 20,000
64 Bambang 10,000 10,000 5,000 5,000 20,000
65 7/30/2013 Yuni 25,000 12,500 12,500 25,000
66 Ardian 25,000 12,500 12,500 25,000
67 Ahmad 25,000 10,000 12,500 12,500 35,000
68 Sumarna 25,000 12,500 12,500 25,000
69 7/31/2013 Euis. D 10,000 5,000 5,000 10,000
Alvia. A 35,000 17,500 17,500 35,000
M. Rafli 25,000 12,500 12,500 25,000
1,615,000 220,000 807,500 807,500 1,835,000
1 7/6/2013 Cresophate, Handscoen 1 493,000

493,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JULI 2,005,500 493,000 1,512,500 756,250 756,250
2 JULI 807,500.00 807,500 403,750 403,750
1,160,000 1,160,000

Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 8/1/2013 Ny. Neni 120,000 3,000 58,500 58,500 120,000
2 Maisa 20,000 3,000 8,500 8,500 20,000
3 8/2/2013 Misgon 20,000 3,000 8,500 8,500 20,000
4 8/3/2013 Ny. Kushandayani 110,000 3,000 53,500 53,500 110,000
5 Tn. Yoseph 20,000 3,000 8,500 8,500 20,000
6 Siti Saharah 20,000 3,000 8,500 8,500 20,000
7 8/5/2013 Tn. Aji 80,000 3,000 38,500 38,500 80,000
8 Ny. Ai Cahya 100,000 3,000 48,500 48,500 100,000
9 8/14/2013 Zaki 20,000 3,000 8,500 8,500 20,000
10 Andi 160,000 3,000 78,500 78,500 160,000
11 8/15/2013 M. Arya 20,000 3,000 8,500 8,500 20,000
12 Nazwa 50,000 3,000 23,500 23,500 50,000
13 Dhiya 100,000 3,000 48,500 48,500 100,000
14 8/19/2013 Adinda 50,000 3,000 23,500 23,500 50,000
15 Dewi 100,000 3,000 48,500 48,500 100,000
16 Faris 50,000 3,000 23,500 23,500 50,000
17 Sunarti 50,000 3,000 23,500 23,500 50,000
18 8/20/2013 Ny. Lilis 40,000 3,000 18,500 18,500 40,000
19 Hisyam 10,000 3,000 3,500 3,500 10,000
20 8/21/2013 Ny. Kushandayani 50,000 3,000 23,500 23,500 50,000
21 Triyani 120,000 3,000 58,500 58,500 120,000
22 8/22/2013 Hardini 150,000 3,000 73,500 73,500 150,000
Tn. Anjar 20,000 3,000 8,500 8,500 20,000
23 8/24/2013 Zaki 20,000 3,000 8,500 8,500 20,000
24 8/26/2013 Ny. Kushandayani 50,000 3,000 23,500 23,500 50,000
25 8/26/2013 Ny. Sunarti 150,000 3,000 73,500 73,500 150,000
26 Adinda 50,000 3,000 23,500 23,500 50,000
27 Triyani 150,000 3,000 73,500 73,500 150,000
28 Dhiya 50,000 3,000 23,500 23,500 50,000
29 Dhita 20,000 3,000 8,500 8,500 20,000
30 8/27/2013 Della 40,000 3,000 18,500 18,500 40,000
31 Koko 50,000 3,000 23,500 23,500 50,000
32 8/28/2013 Nita 60,000 3,000 28,500 28,500 60,000
33 8/29/2013 Setia 20,000 3,000 8,500 8,500 20,000
34 Faris 50,000 3,000 23,500 23,500 50,000
35 8/30/2013 Tn. Zaenudin 100,000 3,000 48,500 48,500 100,000
36 8/31/2013 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
37 Nanda 65,000 3,000 31,000 31,000 65,000
38 Siti. H 291,000 3,000 144,000 144,000 291,000
2,666,000 117,000 1,274,500 1,274,500 2,666,000

JASA ALAT &

DOKTER BAHAN
1 8/1/2013 Ayesha 20,000 10,000 10,000 20,000
2 Salamah 30,000 15,000 15,000 30,000
3 Aviani 30,000 15,000 15,000 30,000
4 8/3/2013 Theresia 35,000 17,500 17,500 35,000
5 Siti Salamah 25,000 12,500 12,500 25,000
6 Herdian 25,000 12,500 12,500 25,000
7 8/5/2013 Ny. Neni 25,000 10,000 12,500 12,500 35,000
8 Tn. Wawan 35,000 17,500 17,500 35,000
9 8/14/2013 Siti Salamah 25,000 12,500 12,500 25,000
10 8/15/2013 an. Reihan 10,000 5,000 5,000 10,000
11 Theresia 35,000 17,500 17,500 35,000
12 Dian Anggraeni 35,000 10,000 17,500 17,500 45,000
13 8/17/2013 Siti. H 25,000 12,500 12,500 25,000
14 8/19/2013 Windu 10,000 10,000 5,000 5,000 20,000
15 Nining 10,000 10,000 5,000 5,000 20,000
16 Agniya 20,000 10,000 10,000 20,000
17 Shalsa 10,000 5,000 5,000 10,000
18 Cindy 20,000 10,000 10,000 20,000
19 Santi 10,000 10,000 5,000 5,000 20,000
20 8/20/2013 Didin 25,000 12,500 12,500 25,000
21 Sumarna 40,000 20,000 20,000 40,000
22 8/21/2013 Ny. Reni 10,000 5,000 5,000 10,000
23 Ny. Neni 25,000 12,500 12,500 25,000
24 Ny. Sri. H 10,000 5,000 5,000 10,000
25 Ny. Reni 45,000 22,500 22,500 45,000

JASA ALAT &

DOKTER BAHAN
26 8/22/2013 Ny. Dian 25,000 12,500 12,500 25,000
27 Neni 10,000 10,000 5,000 5,000 20,000
28 Herdian 25,000 12,500 12,500 25,000
29 Axsel 10,000 10,000 5,000 5,000 20,000
30 8/23/2013 Shara 10,000 10,000 5,000 5,000 20,000
31 Abbot 25,000 12,500 12,500 25,000
32 Farida 25,000 12,500 12,500 25,000
33 8/24/2013 Reni Sutriati 10,000 5,000 5,000 10,000
34 8/26/2013 Wulan 35,000 17,500 17,500 35,000
35 Herdian 25,000 12,500 12,500 25,000
36 Irma 10,000 5,000 5,000 10,000
37 Ny. Tini 10,000 10,000 5,000 5,000 20,000
38 Salsabila 20,000 10,000 10,000 20,000
39 Ny. Ning 40,000 10,000 20,000 20,000 50,000
40 8/27/2013 Ny. Eli 35,000 17,500 17,500 35,000
41 Abil 20,000 10,000 10,000 20,000
42 Ismawati 30,000 10,000 15,000 15,000 40,000
43 Tn. Kusna 35,000 17,500 17,500 35,000
44 Tn. Didi 25,000 10,000 12,500 12,500 35,000
45 8/28/2013 Dewi Murti 50,000 25,000 25,000 50,000
46 Asep F. S 35,000 17,500 17,500 35,000
47 Dian Anggraeni 25,000 12,500 12,500 25,000
48 Ida 10,000 10,000 5,000 5,000 20,000
49 Irfan 20,000 10,000 10,000 20,000
50 Kamilia 10,000 10,000 5,000 5,000 20,000
51 8/29/2013 Adnan M. Ikhsan 25,000 12,500 12,500 25,000
52 Mega Lestari 60,000 30,000 30,000 60,000
53 8/30/2013 Denis Yanuari 10,000 5,000 5,000 10,000
54 Oki Artika 20,000 10,000 10,000 10,000 30,000
55 Maryati 20,000 10,000 10,000 10,000 30,000
56 8/31/2013 Windu. T 20,000 10,000 10,000 10,000 30,000
57 Heri. G 10,000 5,000 5,000 10,000
58 Naufal AS 30,000 15,000 15,000 30,000
59 Wulan. S 25,000 12,500 12,500 25,000
60 Siti. H 25,000 12,500 12,500 25,000
61 Neni. S 25,000 12,500 12,500 25,000
1,435,000 170,000 717,500 717,500 1,605,000

1 8/24/2013 Bahan Gigi 1 727,000
727,000
KEUNTUNGAN
KSBL DRG. DEWI
1 AGUSTUS 1,274,500 727,000 547,500 273,750 273,750
2 AGUSTUS 717,500.00 717,500 358,750 358,750
632,500 632,500


Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 9/2/2013 Ny. Novi 20,000 3,000 8,500 8,500 20,000
2 Ny. Tini 20,000 3,000 8,500 8,500 20,000
3 Ny. Endang 20,000 3,000 8,500 8,500 20,000
4 9/4/2013 Ny. Kushandayani 120,000 3,000 58,500 58,500 120,000
5 Mega. L 40,000 3,000 18,500 18,500 40,000
6 Dillah 20,000 3,000 8,500 8,500 20,000
7 9/5/2013 Enci 20,000 3,000 8,500 8,500 20,000
8 Rafly 50,000 3,000 23,500 23,500 50,000
9 9/7/2013 Hayanaka 60,000 3,000 28,500 28,500 60,000
10 Qintha Rafela 40,000 3,000 18,500 18,500 40,000
11 Aliko 40,000 3,000 18,500 18,500 40,000
12 Tn. Dede 40,000 3,000 18,500 18,500 40,000
13 9/9/2013 Rizki Reza 20,000 3,000 8,500 8,500 20,000
14 9/10/2013 Ny. Supriyati 50,000 3,000 23,500 23,500 50,000
15 9/11/2013 Ahmad. K 40,000 3,000 18,500 18,500 40,000
16 Fino. F 20,000 3,000 8,500 8,500 20,000
17 Ny. Kushandayani 100,000 3,000 48,500 48,500 100,000
18 9/12/2013 Corry 150,000 3,000 73,500 73,500 150,000
19 Rizky 20,000 3,000 8,500 8,500 20,000
20 Ahmad Rizki 20,000 3,000 8,500 8,500 20,000
21 9/14/2013 Alfito 40,000 3,000 18,500 18,500 40,000
22 Sakra 80,000 3,000 38,500 38,500 80,000
Qinta Rafela 40,000 3,000 18,500 18,500 40,000
23 Alika 40,000 3,000 18,500 18,500 40,000
24 Rayandra 60,000 3,000 28,500 28,500 60,000
25 Hayanaka 60,000 3,000 28,500 28,500 60,000
26 Tn. Dede 80,000 3,000 38,500 38,500 80,000
27 9/16/2013 Khansa 40,000 3,000 18,500 18,500 40,000
28 Rafly 100,000 3,000 48,500 48,500 100,000
29 Dedi 20,000 3,000 8,500 8,500 20,000
30 9/17/2013 Ny. Tini 20,000 3,000 8,500 8,500 20,000
31 9/18/2013 Tn. Dadan 70,000 3,000 33,500 33,500 70,000
32 Saeful Malik 80,000 3,000 38,500 38,500 80,000
33 9/19/2013 Corry 150,000 3,000 73,500 73,500 150,000
34 Tn. Supardi 40,000 3,000 18,500 18,500 40,000
35 Siti. K 20,000 3,000 8,500 8,500 20,000
36 Mr. Aulia 50,000 3,000 23,500 23,500 50,000
37 9/20/2013 Ny. Titi 30,000 3,000 13,500 13,500 30,000
38 9/21/2013 Khansa 40,000 3,000 18,500 18,500 40,000
39 Tn. Mukhsin 20,000 3,000 8,500 8,500 20,000
40 9/21/2013 Iwan 140,000 3,000 68,500 68,500 140,000
41 Alfito 40,000 3,000 18,500 18,500 40,000
42 9/23/2013 Tn. Agus 20,000 3,000 8,500 8,500 20,000
43 9/23/2013 Adinda 20,000 3,000 8,500 8,500 20,000
44 Fajria 70,000 3,000 33,500 33,500 70,000
45 Rafly 100,000 3,000 48,500 48,500 100,000
46 Naufal 30,000 3,000 13,500 13,500 30,000
47 Hawari 50,000 3,000 23,500 23,500 50,000
48 Fauzan 20,000 3,000 8,500 8,500 20,000
49 9/26/2013 M. Alfi 20,000 3,000 8,500 8,500 20,000
50 Leli 50,000 3,000 23,500 23,500 50,000
51 Abdul 20,000 3,000 8,500 8,500 20,000
52 Suhartoyo 50,000 3,000 23,500 23,500 50,000
53 9/27/2013 Ny. Riska 70,000 3,000 33,500 33,500 70,000
54 9/28/2013 Yusni. A 20,000 3,000 8,500 8,500 20,000
55 Riska 20,000 3,000 8,500 8,500 20,000
56 Ningsih 20,000 3,000 8,500 8,500 20,000
57 9/28/2013 Alika 40,000 3,000 18,500 18,500 40,000
58 Qinta Rafela 80,000 3,000 38,500 38,500 80,000
59 Kenzi 60,000 3,000 28,500 28,500 60,000
60 Hayanaka 40,000 3,000 18,500 18,500 40,000
61 9/30/2013 Riska 60,000 3,000 28,500 28,500 60,000
62 Ny. Iceu 50,000 3,000 23,500 23,500 50,000
63 9/30/2013 Nazwa 50,000 3,000 23,500 23,500 50,000
64 Khanza 20,000 3,000 8,500 8,500 20,000
65 Hawari 80,000 3,000 38,500 38,500 80,000
66 Della 50,000 3,000 23,500 23,500 50,000
67 Nanan. S 20,000 3,000 8,500 8,500 20,000
68 Alfito 50,000 3,000 23,500 23,500 50,000
3,350,000 207,000 1,571,500 1,571,500 3,350,000

JASA ALAT &

DOKTER BAHAN
1 9/2/2013 Marsini 20,000 10,000 10,000 10,000 30,000
2 Mega.L 35,000 10,000 17,500 17,500 45,000
3 Sucipto 25,000 12,500 12,500 25,000
4 9/2/2013 Sarah 20,000 10,000 10,000 20,000
5 Lina 10,000 10,000 5,000 5,000 20,000
6 Hizkia 10,000 10,000 5,000 5,000 20,000
7 Heri 10,000 10,000 5,000 5,000 20,000
8 Windu 10,000 5,000 5,000 10,000
9 9/3/2013 Rifa 25,000 10,000 12,500 12,500 35,000
10 Sansan 30,000 15,000 15,000 30,000
11 Eli 30,000 15,000 15,000 30,000
12 9/4/2013 Diana 25,000 12,500 12,500 25,000
13 Hana 10,000 10,000 5,000 5,000 20,000
14 Dewi 25,000 12,500 12,500 25,000
15 Herdiana 35,000 17,500 17,500 35,000
16 Abot 25,000 12,500 12,500 25,000
17 Djemi 10,000 10,000 5,000 5,000 20,000
18 9/5/2013 Agus Setiawan 20,000 10,000 10,000 10,000 30,000
19 9/7/2013 Siti. H 25,000 12,500 12,500 25,000
20 Wulan 25,000 12,500 12,500 25,000
21 Neni. S 25,000 12,500 12,500 25,000
22 9/9/2013 Ny. Sofiyah 30,000 15,000 15,000 30,000
23 Neni. S 25,000 12,500 12,500 25,000
24 Maryati 10,000 5,000 5,000 10,000
25 9/10/2013 An. Indra Yoga 10,000 10,000 5,000 5,000 20,000
26 9/10/2013 Ririn 10,000 10,000 5,000 5,000 20,000
27 Nurul 35,000 17,500 17,500 35,000
28 Acep 25,000 10,000 12,500 12,500 35,000
29 Sumarna 25,000 12,500 12,500 25,000
30 9/11/2013 Sofiyah 35,000 10,000 17,500 17,500 45,000
31 Siti Halimah 10,000 5,000 5,000 10,000
32 9/12/2013 Fatimah 20,000 10,000 10,000 10,000 30,000
33 Herdian 10,000 10,000 5,000 5,000 20,000
34 Ari 10,000 10,000 5,000 5,000 20,000
35 9/14/2013 Wulan 30,000 15,000 15,000 30,000
36 Siti. H 25,000 12,500 12,500 25,000
37 9/16/2013 M. Daka. A 10,000 5,000 5,000 10,000
38 Abbot 30,000 15,000 15,000 30,000
39 Wiwin 20,000 10,000 10,000 10,000 30,000
40 Tn. Dadan 20,000 10,000 10,000 10,000 30,000
41 Neni 25,000 12,500 12,500 25,000
42 Sofiyah 25,000 12,500 12,500 25,000
43 9/17/2013 Ny. Oke Oktaviani 10,000 5,000 5,000 10,000
44 Tn. Sucipto 50,000 25,000 25,000 50,000
45 9/18/2013 Fawwaz Nadit 20,000 10,000 10,000 10,000 30,000
46 Dadan. S 20,000 10,000 10,000 10,000 30,000
47 9/19/2013 Hana 20,000 10,000 10,000 20,000
48 Naufal 10,000 10,000 5,000 5,000 20,000
49 9/20/2013 Wulan 35,000 17,500 17,500 35,000
50 Siti Halimah 25,000 12,500 12,500 25,000
51 9/23/2013 an. Tanzil 25,000 10,000 12,500 12,500 35,000
52 Ny. Sri Wulansari 10,000 10,000 5,000 5,000 20,000
53 Tn. Priyana 10,000 10,000 5,000 5,000 20,000
54 Shela 35,000 10,000 17,500 17,500 45,000
55 Ny. Neni. S 30,000 15,000 15,000 30,000
56 Ny. Sofiyah 25,000 12,500 12,500 25,000
57 Abbot 25,000 12,500 12,500 25,000
58 Zidan 20,000 10,000 10,000 20,000
59 Naufal 25,000 12,500 12,500 25,000
60 Reza 25,000 12,500 12,500 25,000
61 9/25/2013 Ny. Nia. K 10,000 10,000 5,000 5,000 20,000
62 Ny. Etika Emi 35,000 10,000 17,500 17,500 45,000
63 An. Afiani 25,000 10,000 12,500 12,500 35,000
64 an. Fawwaz 20,000 10,000 10,000 20,000
65 Zidan 20,000 10,000 10,000 20,000
66 Aziz 20,000 10,000 10,000 20,000
67 Dian 25,000 10,000 12,500 12,500 35,000
68 M. Sidik 10,000 5,000 5,000 10,000

JASA ALAT &

DOKTER BAHAN
69 9/26/2013 Siti 10,000 10,000 5,000 5,000 20,000
70 Edy 10,000 10,000 5,000 5,000 20,000
71 9/27/2013 Siti Jubaedah 20,000 10,000 10,000 20,000
72 9/28/2013 Afiani 25,000 12,500 12,500 25,000
73 Siti Halimah 30,000 15,000 15,000 30,000
74 Sahira 20,000 10,000 10,000 10,000 30,000
75 9/30/2013 Budi. K 10,000 10,000 5,000 5,000 20,000
76 Sofiyah 25,000 12,500 12,500 25,000
77 Siti . F 10,000 10,000 5,000 5,000 20,000
1,110,000 240,000 555,000 555,000 1,350,000

1 9/26/2013 Bahan Gigi 1 154,000
154,000
KEUNTUNGAN
KSBL DRG. DEWI
1 SEPTEMBER 1,571,500 154,000 1,417,500 708,750 708,750
2 SEPTEMBER 555,000.00 555,000 277,500 277,500
986,250 986,250


Menyetujui,


JASA ALAT &

DOKTER BAHAN
1 10/1/2013 Tn. Bronto 20,000 3,000 8,500 8,500 20,000
2 Ny. Sri 100,000 3,000 48,500 48,500 100,000
3 Ny. Supriyati 90,000 3,000 43,500 43,500 90,000
4 Tn. Tono 50,000 3,000 23,500 23,500 50,000
5 10/2/2013 Santi 20,000 3,000 8,500 8,500 20,000
6 10/3/2013 Suhartoyo 80,000 3,000 38,500 38,500 80,000
7 Yusni 20,000 3,000 8,500 8,500 20,000
8 10/5/2013 Nazzala 40,000 3,000 18,500 18,500 40,000
9 Raihan 40,000 3,000 18,500 18,500 40,000
10 Alika 80,000 3,000 38,500 38,500 80,000
11 Qintha 160,000 3,000 78,500 78,500 160,000
12 Tn. M. Natsir 60,000 3,000 28,500 28,500 60,000
13 an. Andika 40,000 3,000 18,500 18,500 40,000
14 10/7/2013 Ny. Siti 30,000 3,000 13,500 13,500 30,000
15 Fajria 50,000 3,000 23,500 23,500 50,000
16 Melani 50,000 3,000 23,500 23,500 50,000
17 10/9/2013 Tn. Bronto 80,000 3,000 38,500 38,500 80,000
18 10/10/2013 Tn. Seno 200,000 3,000 98,500 98,500 200,000
19 Ny. Siti 20,000 3,000 8,500 8,500 20,000
20 10/10/2013 Anisa 150,000 3,000 73,500 73,500 150,000
21 10/11/2013 Ny. Yani 30,000 3,000 13,500 13,500 30,000
22 Angga Nurdyansyah 80,000 3,000 38,500 38,500 80,000
Sri Hartati 80,000 3,000 38,500 38,500 80,000
23 10/12/2013 Ny. Fitri 100,000 3,000 48,500 48,500 100,000
24 Tarma 30,000 3,000 13,500 13,500 30,000
25 Rizki 50,000 3,000 23,500 23,500 50,000
26 10/14/2013 Tn. Adi 20,000 3,000 8,500 8,500 20,000
27 Siti Nuraeni 70,000 3,000 33,500 33,500 70,000
28 Ny. Risma 20,000 3,000 8,500 8,500 20,000
29 Nuni 20,000 3,000 8,500 8,500 20,000
30 Aqila 20,000 3,000 8,500 8,500 20,000
31 Heru 20,000 3,000 8,500 8,500 20,000
32 Gema 20,000 3,000 8,500 8,500 20,000
33 10/18/2013 Tn. Nanang 30,000 3,000 13,500 13,500 30,000
34 Siti Nurraeti 30,000 3,000 13,500 13,500 30,000
35 10/19/2013 Alfito 40,000 3,000 18,500 18,500 40,000
36 Dewi 160,000 3,000 78,500 78,500 160,000
37 Rizki 40,000 3,000 18,500 18,500 40,000
38 Andika 40,000 3,000 18,500 18,500 40,000
39 10/21/2013 an. Raka 20,000 3,000 8,500 8,500 20,000
40 Nn. Lestia 40,000 3,000 18,500 18,500 40,000
41 Ny. Lesita 20,000 3,000 8,500 8,500 20,000
42 Hizkia 140,000 3,000 68,500 68,500 140,000
43 10/21/2013 Alfito 50,000 3,000 23,500 23,500 50,000
44 Gema 100,000 3,000 48,500 48,500 100,000
45 Yuli 20,000 3,000 8,500 8,500 20,000
46 10/23/2013 Tn. Turdi 70,000 3,000 33,500 33,500 70,000
47 M. Iqbal 20,000 3,000 8,500 8,500 20,000
48 10/26/2013 Rizki 50,000 3,000 23,500 23,500 50,000
49 Tn. Encep 20,000 3,000 8,500 8,500 20,000
50 10/28/2013 an. M. Faiq 20,000 3,000 8,500 8,500 20,000
51 an. Abiyu 20,000 3,000 8,500 8,500 20,000
52 Alfito 50,000 3,000 23,500 23,500 50,000
53 10/30/2013 Listia 40,000 3,000 18,500 18,500 40,000
54 Siti Nuraini 600,000 600,000 600,000
55 10/31/2013 Jaky 50,000 3,000 23,500 23,500 50,000
3,610,000 165,000 1,422,500 2,022,500 3,610,000

JASA ALAT &

DOKTER BAHAN
1 10/1/2013 Ny. Tuliyah 10,000 10,000 5,000 5,000 20,000
2 Hendar 10,000 10,000 5,000 5,000 20,000
3 Nurul 25,000 12,500 12,500 25,000
4 Eli 35,000 17,500 17,500 35,000
5 Sansan 35,000 17,500 17,500 35,000
6 10/2/2013 Sri Wulansari 10,000 5,000 5,000 10,000
7 Afiani 25,000 12,500 12,500 25,000
8 Ayep 10,000 5,000 5,000 10,000
9 Ika 10,000 5,000 5,000 10,000
10 Dian 35,000 17,500 17,500 35,000
11 Eka 10,000 5,000 5,000 10,000
12 Rahmat 20,000 10,000 10,000 20,000
13 10/3/2013 Herdian 25,000 12,500 12,500 25,000
14 Siskawati 10,000 10,000 5,000 5,000 20,000
15 Sidik 20,000 10,000 10,000 20,000
16 Dadi 10,000 10,000 5,000 5,000 20,000
17 Sri Wulansari 10,000 10,000 5,000 5,000 20,000
18 10/5/2013 Ny. Sri. W 10,000 5,000 5,000 10,000
19 Ny. Siti. H 35,000 17,500 17,500 35,000
20 Ny. Imas 10,000 5,000 5,000 10,000
21 Tn. Widiawan 20,000 10,000 10,000 20,000
22 10/7/2013 Ny. Sofiyah 25,000 10,000 12,500 12,500 35,000
23 An. Afiani 25,000 12,500 12,500 25,000
24 10/7/2013 Ida. F 10,000 10,000 5,000 5,000 20,000
25 Ahmad. H 10,000 10,000 5,000 5,000 20,000
26 Abbot 25,000 12,500 12,500 25,000
27 Siti. F 25,000 12,500 12,500 25,000
28 10/9/2013 Maryanah 10,000 5,000 5,000 10,000
29 Maryati 10,000 5,000 5,000 10,000
30 Turiyah 10,000 5,000 5,000 10,000
31 10/9/2013 Dian 35,000 17,500 17,500 35,000
32 10/10/2013 Herdian 25,000 12,500 12,500 25,000
33 10/11/2013 Ricka Indriani 45,000 10,000 22,500 22,500 55,000
34 Etika 40,000 10,000 20,000 20,000 50,000
35 Ida Hamidah 10,000 10,000 5,000 5,000 20,000
36 10/12/2013 Imas 10,000 5,000 5,000 10,000
37 Neni. S 35,000 17,500 17,500 35,000
38 M. Rizki 10,000 5,000 5,000 10,000
39 Trya. R 35,000 17,500 17,500 35,000
40 10/14/2013 Afiani Aulia. S 65,000 32,500 32,500 65,000
41 10/16/2013 Tn. Priyana 10,000 5,000 5,000 10,000
42 amel 25,000 12,500 12,500 25,000
43 Abbot 25,000 12,500 12,500 25,000
44 10/17/2013 Muhamad Fahrizal 25,000 12,500 12,500 25,000
45 Robbani 25,000 12,500 12,500 25,000
46 10/17/2013 Herdian 25,000 12,500 12,500 25,000
47 Warjiatun 10,000 10,000 5,000 5,000 20,000
48 Afri 10,000 10,000 5,000 5,000 20,000
49 Herry 10,000 5,000 5,000 10,000
50 10/18/2013 Jumiyati 30,000 15,000 15,000 30,000
51 Etika 30,000 10,000 15,000 15,000 40,000
52 Ricka Indriani 35,000 17,500 17,500 35,000
53 Muhamad Fahrizal 35,000 10,000 17,500 17,500 45,000
54 10/19/2013 Naufal Agustian 20,000 10,000 10,000 20,000
55 Deni Korsa 10,000 10,000 5,000 5,000 20,000
56 10/21/2013 Elvina Indi 20,000 10,000 10,000 10,000 30,000
57 Ika Sartikawati 20,000 10,000 10,000 10,000 30,000
58 Suhirmanto 20,000 10,000 10,000 10,000 30,000
59 Ace Tarkano 20,000 10,000 10,000 20,000
60 Rizki Kustian 35,000 10,000 17,500 17,500 45,000
61 10/21/2013 Siti. F 25,000 12,500 12,500 25,000
62 10/23/2013 an. Ririn 20,000 10,000 10,000 10,000 30,000
63 an. Zaqie 10,000 5,000 5,000 10,000
64 Ny. Sofiyah 65,000 32,500 32,500 65,000
65 10/25/2013 Jumiyati 25,000 12,500 12,500 25,000
66 Turiyah 10,000 5,000 5,000 10,000
67 10/26/2013 Hezkiel Aritonang 30,000 10,000 15,000 15,000 40,000
68 Nely. S 10,000 10,000 5,000 5,000 20,000

JASA ALAT &

DOKTER BAHAN
69 10/26/2013 an. M. Halim 10,000 10,000 5,000 5,000 20,000
70 Siti Halimah 25,000 12,500 12,500 25,000
71 10/28/2013 Asep Suherman 25,000 10,000 12,500 12,500 35,000
72 Siti. H 30,000 15,000 15,000 30,000
73 10/29/2013 M. Ardian 10,000 10,000 5,000 5,000 20,000
74 Rika. M 10,000 10,000 5,000 5,000 20,000
75 Santi 25,000 12,500 12,500 25,000
76 10/30/2013 An. M. Naufal 10,000 10,000 5,000 5,000 20,000
77 Rizky 25,000 12,500 12,500 25,000
78 Ai. H 10,000 10,000 5,000 5,000 20,000
79 Rahmi 10,000 5,000 5,000 10,000
80 Neng Ika 10,000 10,000 5,000 5,000 20,000
81 10/31/2013 M. Ardian 40,000 10,000 20,000 20,000 50,000
82 Herdian 35,000 17,500 17,500 35,000
83 Yuki 25,000 12,500 12,500 25,000
1,195,000 200,000 597,500 597,500 1,395,000

1 9/6/2013 Bahan Gigi 1 105,000
2 9/10/2013 Bahan Gigi 1 33,000
3 10/2/2013 Bahan Gigi 1 270,750
4 10/7/2013 Bahan Gigi 1 715,000
5 10/30/2013 Bahan Gigi 1 66,000
1,189,750
KEUNTUNGAN
KSBL DRG. DEWI
1 OKTOBER 2,022,500 1,189,750 832,750 416,375 416,375
2 OKTOBER 597,500.00 597,500 298,750 298,750
715,125 715,125


Menyetujui,


JASA ALAT &
DOKTER BAHAN
1 11/2/2013 Agustian 20,000 3,000 8,500 8,500 20,000
2 Tn. Kelik 60,000 3,000 28,500 28,500 60,000
3 Jumiyati 90,000 3,000 43,500 43,500 90,000
4 Alika 120,000 3,000 58,500 58,500 120,000
5 Tn. Satya 50,000 3,000 23,500 23,500 50,000
6 Murti 50,000 3,000 23,500 23,500 50,000
7 11/4/2013 Susi 40,000 3,000 18,500 18,500 40,000
8 Listia 40,000 3,000 18,500 18,500 40,000
9 Tn. Murti 20,000 3,000 8,500 8,500 20,000
10 Arjuna 40,000 3,000 18,500 18,500 40,000
11 11/5/2013 Tn. X 20,000 3,000 8,500 8,500 20,000
12 Alfino 50,000 3,000 23,500 23,500 50,000
13 Ifan 75,000 3,000 36,000 36,000 75,000
14 Rusdani 20,000 3,000 8,500 8,500 20,000
15 Tn. Firdaus 20,000 3,000 8,500 8,500 20,000
16 11/6/2013 Ny. Upik 50,000 3,000 23,500 23,500 50,000
17 an. Wildan 20,000 3,000 8,500 8,500 20,000
18 11/7/2013 Nazar 40,000 3,000 18,500 18,500 40,000
19 Tn. Ayi 20,000 3,000 8,500 8,500 20,000
20 Argaeni 20,000 3,000 8,500 8,500 20,000
21 Zulfi 20,000 3,000 8,500 8,500 20,000
22 Ny. Elin 20,000 3,000 8,500 8,500 20,000
Ny. Chiska 20,000 3,000 8,500 8,500 20,000
23 11/9/2013 Ny. Euis 20,000 3,000 8,500 8,500 20,000
24 Rizki 150,000 3,000 73,500 73,500 150,000
25 11/11/2013 Tn. Abdul 20,000 3,000 8,500 8,500 20,000
26 Listia 40,000 3,000 18,500 18,500 40,000
27 Siti Komariah 80,000 3,000 38,500 38,500 80,000
28 Alfino 150,000 3,000 73,500 73,500 150,000
29 Ny. Ety 20,000 3,000 8,500 8,500 20,000
30 Ifan 50,000 3,000 23,500 23,500 50,000
31 11/12/2013 Tn. Ayi 50,000 3,000 23,500 23,500 50,000
32 Tn. Nana 20,000 3,000 8,500 8,500 20,000
33 11/13/2013 Stefani 20,000 3,000 8,500 8,500 20,000
34 Susi 70,000 3,000 33,500 33,500 70,000
35 Euis 50,000 3,000 23,500 23,500 50,000
36 11/14/2013 Tn. Bronto 64,000 32,000 32,000 64,000
37 Risti 150,000 3,000 73,500 73,500 150,000
38 11/18/2013 Ruli 16,000 8,000 8,000 16,000
39 Lena 50,000 3,000 23,500 23,500 50,000
40 Ny. Sri Hartati 30,000 3,000 13,500 13,500 30,000
41 Ridfani 20,000 3,000 8,500 8,500 20,000
42 Dadan 80,000 3,000 38,500 38,500 80,000
43 Alfino 100,000 3,000 48,500 48,500 100,000
44 Daud 20,000 3,000 8,500 8,500 20,000
45 11/20/2013 Ridfani 80,000 3,000 38,500 38,500 80,000
46 Dina Lestari 40,000 3,000 18,500 18,500 40,000
47 Ny. Upik 100,000 3,000 48,500 48,500 100,000
48 Rizki 20,000 3,000 8,500 8,500 20,000
49 11/21/2013 M. Gilang 40,000 3,000 18,500 18,500 40,000
50 Ifan 100,000 3,000 48,500 48,500 100,000
51 X 100,000 3,000 48,500 48,500 100,000
52 Ny. Friska 20,000 3,000 8,500 8,500 20,000
53 11/22/2013 Andi 50,000 3,000 23,500 23,500 50,000
54 Indriyani 35,000 3,000 16,000 16,000 35,000
55 11/23/2013 Ridfani 50,000 3,000 23,500 23,500 50,000
56 11/25/2013 Ny. Friska 50,000 3,000 23,500 23,500 50,000
57 Candya 50,000 3,000 23,500 23,500 50,000
58 Ardian 20,000 3,000 8,500 8,500 20,000
59 11/26/2013 Ny. Aan 180,000 3,000 88,500 88,500 180,000
60 Ny. Vera 20,000 3,000 8,500 8,500 20,000
61 Ayudia 20,000 3,000 8,500 8,500 20,000
62 Tn. Asep 20,000 3,000 8,500 8,500 20,000
63 11/27/2013 Dina. L 40,000 3,000 18,500 18,500 40,000
64 Upik 100,000 3,000 48,500 48,500 100,000
65 anggia 20,000 3,000 8,500 8,500 20,000
JASA ALAT &

DOKTER BAHAN
66 Evi 50,000 3,000 23,500 23,500 50,000
67 11/28/2013 Tn. Zulkarnaen 20,000 3,000 8,500 8,500 20,000
68 Ny. Evi 150,000 3,000 73,500 73,500 150,000
69 Ismi 100,000 3,000 48,500 48,500 100,000
70 Rina 20,000 3,000 8,500 8,500 20,000
71 11/29/2013 Eka. M 20,000 3,000 8,500 8,500 20,000
72 Rayandra 20,000 3,000 8,500 8,500 20,000
73 Hayanaka 40,000 3,000 18,500 18,500 40,000
74 Indriyani 20,000 3,000 8,500 8,500 20,000
75 11/30/2013 Hayanaka 100,000 3,000 48,500 48,500 100,000
76 Ny. Yanti 160,000 3,000 78,500 78,500 160,000
77 Alika 80,000 3,000 38,500 38,500 80,000
78 Satya 50,000 3,000 23,500 23,500 50,000
79 Jihan 30,000 3,000 13,500 13,500 30,000
4,210,000 234,000 1,988,000 1,988,000 4,210,000

JASA ALAT &

DOKTER BAHAN
1 11/2/2013 Theresia Stela. N 35,000 17,500 17,500 35,000
2 Ny. Imas 30,000 15,000 15,000 30,000
3 11/4/2013 Ahmad Fauzan 20,000 10,000 10,000 10,000 30,000
4 Tn. Dasar 25,000 10,000 12,500 12,500 35,000
5 Silva 25,000 10,000 12,500 12,500 35,000
6 Turiyah 10,000 5,000 5,000 10,000
7 11/6/2013 Yuyun . Y 10,000 10,000 5,000 5,000 20,000
8 an. Afiani 25,000 10,000 12,500 12,500 35,000
9 Salamah 25,000 12,500 12,500 25,000
10 Imas. S 30,000 15,000 15,000 30,000
11 Ny. Eka 10,000 5,000 5,000 10,000
12 Ny. Lilis 10,000 10,000 5,000 5,000 20,000
13 11/7/2013 Tn. Dasar 23,000 11,500 11,500 23,000
14 11/8/2013 Surya Bakti 20,000 10,000 10,000 10,000 30,000
15 Etika Emi 30,000 15,000 15,000 30,000
16 Ricka 35,000 10,000 17,500 17,500 45,000
17 Mega 70,000 35,000 35,000 70,000
18 11/9/2013 Seldini. M 10,000 10,000 5,000 5,000 20,000
19 Empong. K 10,000 10,000 5,000 5,000 20,000
20 Herry. N 35,000 17,500 17,500 35,000
21 Imas. S 30,000 15,000 15,000 30,000
22 Siti. H 35,000 17,500 17,500 35,000
23 Silva. Z 25,000 12,500 12,500 25,000
24 11/11/2013 Wartini 30,000 10,000 15,000 15,000 40,000
25 Suciani 35,000 17,500 17,500 35,000
26 11/11/2013 Nanilo 10,000 5,000 5,000 10,000
27 Dwi 10,000 5,000 5,000 10,000
28 Iyan. T 10,000 5,000 5,000 10,000
29 Reva 20,000 10,000 10,000 20,000
30 Ny. Rini 10,000 5,000 5,000 10,000
31 Agung 10,000 5,000 5,000 10,000
32 Yuni 25,000 12,500 12,500 25,000
33 Ai. H 10,000 5,000 5,000 10,000
34 Siti. H 25,000 12,500 12,500 25,000
35 Yaman 25,000 12,500 12,500 25,000
36 Dadi 10,000 5,000 5,000 10,000
37 Dasar 25,000 12,500 12,500 25,000
38 Kartika 20,000 10,000 10,000 20,000
39 11/12/2013 Bambang 10,000 5,000 5,000 10,000
40 11/13/2013 An. Aurel 10,000 5,000 5,000 10,000
41 11/14/2013 Jajat 10,000 10,000 5,000 5,000 20,000
JASA ALAT &

DOKTER BAHAN
42 Sri Elva 10,000 5,000 5,000 10,000
43 11/15/2013 Mega 30,000 15,000 15,000 30,000
44 Yusuf. M 20,000 10,000 10,000 10,000 30,000
45 Roni. S 20,000 10,000 10,000 10,000 30,000
46 11/16/2013 Dasar 25,000 12,500 12,500 25,000
47 Ny. Empong 10,000 10,000 5,000 5,000 20,000
48 Silva. Z.E 25,000 12,500 12,500 25,000
49 Iyan. T 35,000 10,000 17,500 17,500 45,000
50 11/18/2013 Afiani 25,000 12,500 12,500 25,000
51 Ny. Salamah 25,000 12,500 12,500 25,000
52 Sultan 20,000 10,000 10,000 10,000 30,000
53 Imas. S 30,000 15,000 15,000 30,000
54 Zaenal 30,000 15,000 15,000 30,000
55 11/18/2013 Abbot 25,000 12,500 12,500 25,000
56 Naufal 25,000 12,500 12,500 25,000
57 Yuni 25,000 12,500 12,500 25,000
58 11/19/2013 Nurul 25,000 12,500 12,500 25,000
59 Anik. S 25,000 12,500 12,500 25,000
60 Dasar 25,000 12,500 12,500 25,000
61 11/20/2013 Kartika 10,000 5,000 5,000 10,000
62 Tamarudin 10,000 5,000 5,000 10,000
63 Irma 10,000 5,000 5,000 10,000
64 Rifa 10,000 5,000 5,000 10,000
65 Tiki 10,000 10,000 5,000 5,000 20,000
66 11/21/2013 Euis Nurmoyah 35,000 10,000 17,500 17,500 45,000
67 Eka 25,000 12,500 12,500 25,000
68 Irawati 10,000 5,000 5,000 10,000
69 11/22/2013 Cucun Yunengsih 20,000 10,000 10,000 10,000 30,000
70 Euis Nuryamah 45,000 10,000 22,500 22,500 55,000
71 11/22/2013 M. Rizky. R 20,000 10,000 10,000 20,000
72 Ismawanti 10,000 10,000 5,000 5,000 20,000
73 Megasari 25,000 12,500 12,500 25,000
74 11/23/2013 Ahmad Fauzan 20,000 10,000 10,000 20,000
75 Silva. Z 25,000 12,500 12,500 25,000
76 Tamarudin 10,000 5,000 5,000 10,000
77 Dasar 25,000 12,500 12,500 25,000
78 Dede. H 30,000 15,000 15,000 30,000
79 11/25/2013 Afiani 25,000 12,500 12,500 25,000
80 Salamah 25,000 12,500 12,500 25,000
81 Tamarudin 10,000 5,000 5,000 10,000
82 Ismawati 10,000 5,000 5,000 10,000
83 Khalimah 10,000 5,000 5,000 10,000
84 Yuni 25,000 12,500 12,500 25,000
85 Siti. F 25,000 12,500 12,500 25,000
86 Julaeha 10,000 5,000 5,000 10,000
87 Wahyuni 10,000 5,000 5,000 10,000
88 11/26/2013 Ika Kartika 25,000 12,500 12,500 25,000
89 Nurul. H 25,000 12,500 12,500 25,000
90 Ucu. S 10,000 5,000 5,000 10,000
91 Rifa 25,000 10,000 12,500 12,500 35,000
92 11/27/2013 Sofyan 10,000 10,000 5,000 5,000 20,000
93 Ny. Ucu 35,000 10,000 17,500 17,500 45,000
94 Dasar 25,000 12,500 12,500 25,000
95 Sofyan 10,000 5,000 5,000 10,000
96 Aulia 25,000 12,500 12,500 25,000
97 Rika 25,000 10,000 12,500 12,500 35,000
98 abbot 35,000 17,500 17,500 35,000
99 Kartika 20,000 10,000 10,000 20,000
100 Eka 25,000 12,500 12,500 25,000
101 11/29/2013 Nn. Eka Merdeka 20,000 10,000 10,000 10,000 30,000
102 Nn. Thereseia 10,000 5,000 5,000 10,000
103 Alisetiawan 20,000 10,000 10,000 20,000
104 Megasari 25,000 12,500 12,500 25,000
JASA ALAT &

DOKTER BAHAN
105 Nia Tresnawati 35,000 17,500 17,500 35,000
106 Moljana Hendrawan 35,000 10,000 17,500 17,500 45,000
107 11/30/2013 Ucu. S 10,000 5,000 5,000 10,000
108 Ria. S 35,000 17,500 17,500 35,000
109 Silva. Z 30,000 15,000 15,000 30,000
110 Salamah 25,000 12,500 12,500 25,000
111 Afiani 20,000 10,000 10,000 20,000
112 M. Ariel 10,000 10,000 5,000 5,000 20,000
113 Windu 35,000 10,000 17,500 17,500 45,000
2,443,000 300,000 1,221,500 1,221,500 2,743,000

1 11/7/2013 Bahan Gigi 1 189,000
189,000
KEUNTUNGAN
KSBL DRG. DEWI
1 NOVEMBER 1,988,000 189,000 1,799,000 899,500 899,500
2 NOVEMBER 1,221,500.00 1,221,500 610,750 610,750
1,510,250 1,510,250


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 12/2/2013 Tn. Asep 70,000 3,000 33,500 33,500 70,000
2 Freska 80,000 3,000 38,500 38,500 80,000
3 Rhegina 20,000 3,000 8,500 8,500 20,000
4 12/3/2013 Erna 20,000 3,000 8,500 8,500 20,000
5 Ny. Susan 80,000 3,000 38,500 38,500 80,000
6 Tn. Sugino 100,000 3,000 48,500 48,500 100,000
7 12/4/2013 Dina Lestari 40,000 3,000 18,500 18,500 40,000
8 Melani 50,000 3,000 23,500 23,500 50,000
9 12/5/2013 Erna 20,000 3,000 8,500 8,500 20,000
10 Ifa 50,000 3,000 23,500 23,500 50,000
11 Ismi 100,000 3,000 48,500 48,500 100,000
12 12/6/2013 Aisyah 50,000 3,000 23,500 23,500 50,000
13 Fahmi 40,000 3,000 18,500 18,500 40,000
14 12/7/2013 Ezra 160,000 3,000 78,500 78,500 160,000
15 M. Irfan Fadillah 80,000 3,000 38,500 38,500 80,000
16 Ridja 40,000 3,000 18,500 18,500 40,000
17 12/11/2013 Tn. Sugino 90,000 3,000 43,500 43,500 90,000
18 Ny. Upik. R 50,000 3,000 23,500 23,500 50,000
19 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
20 Ny. Teti 20,000 3,000 8,500 8,500 20,000
21 Ny. Euis 50,000 3,000 23,500 23,500 50,000
22 Jahra 20,000 3,000 8,500 8,500 20,000
23 12/12/2013 Tn. Ayi 60,000 3,000 28,500 28,500 60,000
24 Ismi 100,000 3,000 48,500 48,500 100,000
25 12/13/2013 Tn. Daryanto 160,000 3,000 78,500 78,500 160,000
26 Aris 20,000 3,000 8,500 8,500 20,000
27 Lintang 40,000 3,000 18,500 18,500 40,000
28 Aris 20,000 3,000 8,500 8,500 20,000
29 Diva 100,000 3,000 48,500 48,500 100,000
30 Khalimah 25,000 3,000 11,000 11,000 25,000
31 12/14/2013 Anita 20,000 3,000 8,500 8,500 20,000
32 Tn. Satya 60,000 3,000 28,500 28,500 60,000
33 Alika 80,000 3,000 38,500 38,500 80,000
34 Andy 75,000 3,000 36,000 36,000 75,000
35 12/16/2013 Nazma 40,000 3,000 18,500 18,500 40,000
36 Tn. Ayi 50,000 3,000 23,500 23,500 50,000
37 Susi 50,000 3,000 23,500 23,500 50,000
38 Ebanov 50,000 3,000 23,500 23,500 50,000
39 12/17/2013 Melani 40,000 3,000 18,500 18,500 40,000
40 Ny. Eva 130,000 3,000 63,500 63,500 130,000
41 12/18/2013 Sri Nengsih 50,000 3,000 23,500 23,500 50,000
42 Dina Lestari 120,000 3,000 58,500 58,500 120,000
43 Upik Rahmi 170,000 3,000 83,500 83,500 170,000
44 Ny. Tini. W 20,000 3,000 8,500 8,500 20,000
45 Aulya Pasha 20,000 3,000 8,500 8,500 20,000
46 12/19/2013 Ela Nurlaela 20,000 3,000 8,500 8,500 20,000
47 12/23/2013 Tn. Sugino 40,000 3,000 18,500 18,500 40,000
48 Arjuna 40,000 3,000 18,500 18,500 40,000
49 Susi 70,000 3,000 33,500 33,500 70,000
50 12/24/2013 Ebanov 20,000 3,000 8,500 8,500 20,000
51 Ropi Hayudi 25,000 3,000 11,000 11,000 25,000
52 12/26/2013 Tn. Sugino 30,000 3,000 13,500 13,500 30,000
53 Nisa 30,000 3,000 13,500 13,500 30,000
54 Murdiana 100,000 3,000 48,500 48,500 100,000
55 12/27/2013 Ny. Nani 160,000 3,000 78,500 78,500 160,000
56 Gina 150,000 3,000 73,500 73,500 150,000
57 Tn. Tatang 100,000 3,000 48,500 48,500 100,000
58 M. Irfan Fadillah 40,000 3,000 18,500 18,500 40,000
59 12/28/2013 Tn. Sugino 50,000 3,000 23,500 23,500 50,000
60 Tn. Amin 20,000 3,000 8,500 8,500 20,000
61 Tn. Satya 90,000 3,000 43,500 43,500 90,000
62 Alika 160,000 3,000 78,500 78,500 160,000
63 12/30/2013 Keisya 20,000 3,000 8,500 8,500 20,000
64 Susi. S 180,000 3,000 88,500 88,500 180,000
65 Andy. L 50,000 3,000 23,500 23,500 50,000
66 Aditya 20,000 3,000 8,500 8,500 20,000
4,165,000 198,000 1,983,500 1,983,500 4,165,000
JASA ALAT &

DOKTER BAHAN
1 12/2/2013 Ika Sartikawati 25,000 10,000 12,500 12,500 35,000
2 Naura. S 20,000 10,000 10,000 10,000 30,000
3 Ucu. S 20,000 10,000 10,000 10,000 30,000
4 Agus. S 25,000 10,000 12,500 12,500 35,000
5 Siti. F 35,000 17,500 17,500 35,000
6 Nunik 25,000 12,500 12,500 25,000
7 Yohanah 35,000 17,500 17,500 35,000
8 Yuni 35,000 17,500 17,500 35,000
9 12/3/2013 Marice 25,000 10,000 12,500 12,500 35,000
10 Sahira azahra 25,000 10,000 12,500 12,500 35,000
11 Mnurul Hasanah 45,000 22,500 22,500 45,000
12 Susan 25,000 12,500 12,500 25,000
13 Sugiono 45,000 22,500 22,500 45,000
14 erna 25,000 12,500 12,500 25,000
15 12/4/2013 Silva 35,000 17,500 17,500 35,000
16 Afiani 35,000 17,500 17,500 35,000
17 Yusuf. M 10,000 10,000 5,000 5,000 20,000
18 Salamah 25,000 10,000 12,500 12,500 35,000
19 Siti. F 25,000 12,500 12,500 25,000
20 Farida 25,000 12,500 12,500 25,000
21 12/5/2013 Ny. Khalimah 25,000 12,500 12,500 25,000
22 Tn. Mardiyono 25,000 10,000 12,500 12,500 35,000
23 M. Ramdan 10,000 5,000 5,000 10,000
24 Eka 25,000 12,500 12,500 25,000
25 Ella 25,000 12,500 12,500 25,000
26 Ari 10,000 10,000 5,000 5,000 20,000
27 12/6/2013 Mohamad Ramdan 25,000 12,500 12,500 25,000
28 Ari Nuryanto 10,000 10,000 5,000 5,000 20,000
29 Nabila 25,000 12,500 12,500 25,000
30 12/7/2013 Aris Jaka 25,000 10,000 12,500 12,500 35,000
31 Theresia Stella 25,000 12,500 12,500 25,000
32 Siti Nurjana 10,000 10,000 5,000 5,000 20,000
33 Sahira azahra 25,000 10,000 12,500 12,500 35,000
34 12/9/2013 Tn. Amin 35,000 10,000 17,500 17,500 45,000
35 Siti Nurjana 10,000 5,000 5,000 10,000
36 Ucu. S 10,000 5,000 5,000 10,000
37 Tn. Udin 25,000 10,000 12,500 12,500 35,000
38 Nabila 25,000 12,500 12,500 25,000
39 12/10/2013 Shela Anugrah 35,000 10,000 17,500 17,500 45,000
40 Ny. Khalimah 25,000 12,500 12,500 25,000
41 Tn. Mardiyono 25,000 12,500 12,500 25,000
42 12/10/2013 Endang Ernawati 10,000 5,000 5,000 10,000
43 Maryati 10,000 5,000 5,000 10,000
44 M. Ramdan 25,000 12,500 12,500 25,000
45 Nurul Hasanah 30,000 15,000 15,000 30,000
46 Tn. Aris Jaka 25,000 12,500 12,500 25,000
47 Risyanti Nur 25,000 10,000 12,500 12,500 35,000
48 Yuyun Yuhanah 25,000 12,500 12,500 25,000
49 12/11/2013 Aris Jaka 30,000 10,000 15,000 15,000 40,000
50 Marice 25,000 10,000 12,500 12,500 35,000
51 Salamah 25,000 12,500 12,500 25,000
52 Yuyun Yuhanah 25,000 12,500 12,500 25,000
53 Winni 10,000 10,000 5,000 5,000 20,000
54 Siti. F 35,000 17,500 17,500 35,000
55 12/12/2013 Tn. Saeful Hayat 10,000 5,000 5,000 10,000
56 Tn. Endang Ernawati 30,000 15,000 15,000 30,000
57 Abbot 35,000 17,500 17,500 35,000
58 Ny. Yani 35,000 17,500 17,500 35,000
59 12/13/2013 Tn. Wahid Suhendar 20,000 10,000 10,000 10,000 30,000
60 Sukaesih 20,000 10,000 10,000 10,000 30,000
61 Mega 25,000 12,500 12,500 25,000
62 12/14/2013 M. Nur Saepuloh 10,000 10,000 5,000 5,000 20,000
63 Djemi 20,000 10,000 10,000 10,000 30,000
64 Maesaroh 10,000 10,000 5,000 5,000 20,000
65 Suskawati 10,000 10,000 5,000 5,000 20,000
JASA ALAT &

DOKTER BAHAN
66 M. Ramdan 25,000 10,000 12,500 12,500 35,000
67 Siti Halimah 35,000 17,500 17,500 35,000
68 12/16/2013 Aris Jaka 35,000 10,000 17,500 17,500 45,000
69 Siti. R 20,000 10,000 10,000 10,000 30,000
70 Ucu. S 25,000 12,500 12,500 25,000
71 Salamah 30,000 15,000 15,000 30,000
72 Tn. Dasar 30,000 15,000 15,000 30,000
73 Mardiyono 25,000 12,500 12,500 25,000
74 Nabila 25,000 12,500 12,500 25,000
75 Farida 10,000 5,000 5,000 10,000
76 Eka 25,000 12,500 12,500 25,000
77 Nengsih 35,000 17,500 17,500 35,000
78 Siti. F 35,000 17,500 17,500 35,000
79 Winni 25,000 12,500 12,500 25,000
80 12/17/2013 Anik Setyaningrum 25,000 12,500 12,500 25,000
81 Deni Korsa 25,000 10,000 12,500 12,500 35,000
82 Ny. Pratiwi 10,000 10,000 5,000 5,000 20,000
83 Ny. Khalimah 25,000 10,000 12,500 12,500 35,000
84 Risyanti Nur 25,000 12,500 12,500 25,000
85 Tn. Dadang 25,000 10,000 12,500 12,500 35,000
86 Nurul Hasanah 35,000 17,500 17,500 35,000
87 Sahira Azahra 25,000 12,500 12,500 25,000
88 Marice 25,000 12,500 12,500 25,000
89 12/18/2013 Tajudin 25,000 10,000 12,500 12,500 35,000
90 Mutiara Aurelia 10,000 5,000 5,000 10,000
91 Thifa Rona. A 20,000 10,000 10,000 20,000
92 M. Ramdan 25,000 12,500 12,500 25,000
93 Ani Puspita 25,000 12,500 12,500 25,000
94 Dhafa 20,000 10,000 10,000 20,000
95 Ika Sartikawati 25,000 12,500 12,500 25,000
96 Ida Hamidah 25,000 12,500 12,500 25,000
97 Maesaroh 30,000 15,000 15,000 30,000
98 Suhartati 20,000 10,000 10,000 20,000
99 12/19/2013 Tn. Dasar 20,000 10,000 10,000 20,000
100 Moh. Ramdan 25,000 12,500 12,500 25,000
101 Idah Jubaedah 20,000 10,000 10,000 20,000
102 12/20/2013 Muhamad Fakhrial 35,000 17,500 17,500 35,000
103 Ria Sundari 10,000 5,000 5,000 10,000
104 Mega 35,000 17,500 17,500 35,000
105 12/23/2013 Siti Robiah 25,000 10,000 12,500 12,500 35,000
106 Yuyun. Y 25,000 12,500 12,500 25,000
107 Salamah 35,000 17,500 17,500 35,000
108 Sri Wahyuni 30,000 15,000 15,000 30,000
109 Imas . S 10,000 5,000 5,000 10,000
111 Mohamad Ramdan 25,000 12,500 12,500 25,000
112 Titin 30,000 15,000 15,000 30,000
113 Sopiyan 35,000 17,500 17,500 35,000
114 12/26/2013 Ucu 35,000 17,500 17,500 35,000
115 Murdiyono 30,000 15,000 15,000 30,000
116 Anik Setyaningrum 10,000 5,000 5,000 10,000
117 Tajudin 35,000 17,500 17,500 35,000
118 Khalimah 25,000 12,500 12,500 25,000
119 12/27/2013 Wulan Safitri 20,000 10,000 10,000 10,000 30,000
120 Hasya Hanipan 35,000 10,000 17,500 17,500 45,000
121 Mega 25,000 12,500 12,500 25,000
122 Kukuf 25,000 12,500 12,500 25,000
123 Siti Robiah 25,000 12,500 12,500 25,000
124 Maryani 35,000 17,500 17,500 35,000
125 Anida Sabila 10,000 5,000 5,000 10,000
126 Ida Hamidah 35,000 17,500 17,500 35,000
127 Imas Atikah 35,000 17,500 17,500 35,000
128 12/28/2013 Maryani 35,000 17,500 17,500 35,000
129 Ahmad. W 10,000 10,000 5,000 5,000 20,000
130 Imas. K 10,000 10,000 5,000 5,000 20,000

JASA ALAT &

DOKTER BAHAN
131 Gilrandy 10,000 5,000 5,000 10,000
132 Ucu 10,000 5,000 5,000 10,000
133 Anggi Desiana 10,000 10,000 5,000 5,000 20,000
134 Sri Wahyuni 30,000 15,000 15,000 30,000
135 Salamh 30,000 15,000 15,000 30,000
136 Siti Robiah 25,000 12,500 12,500 25,000
137 Windu Tiare 30,000 15,000 15,000 30,000
3,185,000 400,000 1,592,500 1,592,500 3,585,000

1 12/11/2013 Bahan Gigi 1 449,000
2 12/28/2013 1 260,000
135,000
3 12/30/2013 1 77,500
921,500
KEUNTUNGAN
KSBL DRG. DEWI
1 DESEMBER 1,983,500 921,500 1,062,000 531,000 531,000
2 DESEMBER 1,592,500.00 1,592,500 796,250 796,250
1,327,250 1,327,250


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 1/2/2014 Ny. Retno 20,000 3,000 8,500 8,500 20,000
2 Ny. Mulyani 100,000 3,000 48,500 48,500 100,000
3 1/3/2014 Tn. Andy 50,000 3,000 23,500 23,500 50,000
4 Tn. Tatang 100,000 3,000 48,500 48,500 100,000
5 M. Irfan 40,000 3,000 18,500 18,500 40,000
6 1/4/2014 Candya 20,000 3,000 8,500 8,500 20,000
7 Alika 80,000 3,000 38,500 38,500 80,000
8 Waffa 40,000 3,000 18,500 18,500 40,000
9 Jabir 50,000 3,000 23,500 23,500 50,000
10 1/6/2014 Tn. Tatang 20,000 3,000 8,500 8,500 20,000
11 1/8/2014 an. Dimas 30,000 3,000 13,500 13,500 30,000
12 Tn. Tata 20,000 3,000 8,500 8,500 20,000
13 1/9/2014 Tn. Hermansyah 40,000 3,000 18,500 18,500 40,000
14 Ny. Tien Hartini 50,000 3,000 23,500 23,500 50,000
15 1/11/2014 Tn. Afdi Priatna 20,000 3,000 8,500 8,500 20,000
16 Andi 170,000 3,000 83,500 83,500 170,000
17 1/13/2014 Kansa 120,000 3,000 58,500 58,500 120,000
18 Ucu. S 172,000 3,000 84,500 84,500 172,000
19 1/15/2014 Ny. Lismawati 120,000 3,000 58,500 58,500 120,000
20 Zaki 20,000 3,000 8,500 8,500 20,000
21 Tn. Aam 30,000 3,000 13,500 13,500 30,000
22 1/17/2014 Asep. N 20,000 3,000 8,500 8,500 20,000
23 Kansa 40,000 3,000 18,500 18,500 40,000
24 1/18/2014 Tn. Sugino 50,000 3,000 23,500 23,500 50,000
25 Ayi Setiawati 50,000 3,000 23,500 23,500 50,000
26 Kansa 20,000 3,000 8,500 8,500 20,000
27 Rahma 100,000 3,000 48,500 48,500 100,000
28 Ifa 50,000 3,000 23,500 23,500 50,000
29 Grace 150,000 3,000 73,500 73,500 150,000
30 1/21/2014 Noviani 40,000 3,000 18,500 18,500 40,000
31 Ny. Uce 20,000 3,000 8,500 8,500 20,000
Ropi. H 25,000 3,000 11,000 11,000 25,000
32 1/22/2014 Andika 40,000 3,000 18,500 18,500 40,000
33 Anisa 50,000 3,000 23,500 23,500 50,000
34 Tn. Yudi Sulistiana 100,000 3,000 48,500 48,500 100,000
35 Naila 20,000 3,000 8,500 8,500 20,000
36 1/24/2014 Kanza 40,000 3,000 18,500 18,500 40,000
37 Asep. N 80,000 3,000 38,500 38,500 80,000
38 1/25/2014 Mailina 50,000 3,000 23,500 23,500 50,000
39 Ilmi Royan 20,000 3,000 8,500 8,500 20,000
40 Maryani 150,000 3,000 73,500 73,500 150,000
41 Tn. Iwan 20,000 3,000 8,500 8,500 20,000
42 An. Pandu 20,000 3,000 8,500 8,500 20,000
43 1/27/2014 Lia 20,000 3,000 8,500 8,500 20,000
44 Anisa 50,000 3,000 23,500 23,500 50,000
45 Haydarso 20,000 3,000 8,500 8,500 20,000
46 Grace 50,000 3,000 23,500 23,500 50,000
47 Pandu 20,000 3,000 8,500 8,500 20,000
48 Reby 50,000 3,000 23,500 23,500 50,000
49 1/28/2014 an. Divania 50,000 3,000 23,500 23,500 50,000
50 An. Noviani 40,000 3,000 18,500 18,500 40,000
51 Arini 35,000 3,000 16,000 16,000 35,000
52 Misyanto 40,000 3,000 18,500 18,500 40,000
53 Ny. E. Saragih 50,000 3,000 23,500 23,500 50,000
54 1/29/2014 an. Feisha 16,000 8,000 8,000 16,000
55 Eko 50,000 3,000 23,500 23,500 50,000
56 1/30/2014 Acep 50,000 3,000 23,500 23,500 50,000
57 lilis 20,000 3,000 8,500 8,500 20,000
58 Alfhan 20,000 3,000 8,500 8,500 20,000
59 Salishono 20,000 3,000 8,500 8,500 20,000
3,068,000 177,000 1,445,500 1,445,500 3,068,000
LAPORAN KUNJUNGAN PASIEN GIGI BPJS KESEHATAN

JASA ALAT &

DOKTER BAHAN
1 1/2/2014 Adam Sultan 35,000 17,500 17,500 35,000
2 Zaenal Ikhwan 30,000 15,000 15,000 30,000
3 Ahmad Malik 35,000 17,500 17,500 35,000
4 Indah Lestari 30,000 15,000 15,000 30,000
5 1/3/2014 Mutiara. A 10,000 10,000 5,000 5,000 20,000
6 Ahmad Malik. F 25,000 12,500 12,500 25,000
7 Indah. L 30,000 15,000 15,000 30,000
8 Theresia Stela. N 25,000 12,500 12,500 25,000
9 Mega. S 25,000 12,500 12,500 25,000
10 Nabila 25,000 12,500 12,500 25,000
11 Ria. S 25,000 12,500 12,500 25,000
12 Khalimah 25,000 12,500 12,500 25,000
13 1/4/2014 Maryani 10,000 5,000 5,000 10,000
14 Thifa Rona 20,000 10,000 10,000 20,000
15 Didik Ardiyanto 35,000 17,500 17,500 35,000
16 Anik 25,000 12,500 12,500 25,000
17 Ahmad Hidayat 35,000 17,500 17,500 35,000
18 Sri. P 25,000 12,500 12,500 25,000
19 Mimin. H 30,000 15,000 15,000 30,000
20 Nazilah 20,000 10,000 10,000 20,000
21 Naura 20,000 10,000 10,000 20,000
22 Gilrandy. O 35,000 17,500 17,500 35,000
23 Wahyu 10,000 5,000 5,000 10,000
24 1/6/2014 Ucu. S 35,000 17,500 17,500 35,000
25 Rius Djuanda 10,000 5,000 5,000 10,000
26 Dwi Ratna 10,000 10,000 5,000 5,000 20,000
27 Tajudin 25,000 10,000 12,500 12,500 35,000
28 Robiah 10,000 10,000 5,000 5,000 20,000
29 Ria. S 25,000 10,000 12,500 12,500 35,000
30 Nunik 10,000 10,000 5,000 5,000 20,000
31 Anik 10,000 10,000 5,000 5,000 20,000
32 1/7/2014 Rafka Hamada 35,000 17,500 17,500 35,000
33 Edi Sopian 10,000 5,000 5,000 10,000
34 Ahmad Taufik 10,000 5,000 5,000 10,000
35 Dadang. R 25,000 12,500 12,500 25,000
36 Moh. Ramdan 30,000 15,000 15,000 30,000
37 1/7/2014 Khalimah Assa Biyah 65,000 32,500 32,500 65,000
38 Mimin Hasanah 30,000 15,000 15,000 30,000
39 Neneng Sumira 25,000 12,500 12,500 25,000
40 Kusnaesih 25,000 12,500 12,500 25,000
41 Yadi Mulyadi 25,000 12,500 12,500 25,000
42 Nabila 25,000 12,500 12,500 25,000
43 Theresia. S 25,000 12,500 12,500 25,000
44 dra. Sri Purwani 30,000 15,000 15,000 30,000
45 1/8/2014 Moh. Ramdan 20,000 10,000 10,000 10,000 30,000
46 Mega Rangga 35,000 10,000 17,500 17,500 45,000
47 Mega Sari 10,000 5,000 5,000 10,000
48 1/9/2014 Shirley Simon 10,000 5,000 5,000 10,000
49 Tn. Sarbini 25,000 12,500 12,500 25,000
50 Shirley Simon 10,000 10,000 5,000 5,000 20,000
51 Kharulah 35,000 17,500 17,500 35,000
52 Dean 10,000 10,000 5,000 5,000 20,000
53 1/11/2014 Ali Setiawan 10,000 10,000 5,000 5,000 20,000
54 Melianti 30,000 10,000 15,000 15,000 40,000
55 Shakiela. K 10,000 10,000 5,000 5,000 20,000
56 Imas 25,000 12,500 12,500 25,000
57 Shirley Simon 25,000 12,500 12,500 25,000
58 Sarbini 25,000 12,500 12,500 25,000
59 1/13/2014 Yuyun. Y 30,000 15,000 15,000 30,000
60 M. Ramdan 35,000 17,500 17,500 35,000
61 Ucu. S 35,000 17,500 17,500 35,000
62 Siti Nurjanah 10,000 5,000 5,000 10,000
63 Dadang. R 25,000 10,000 12,500 12,500 35,000
64 Eka 25,000 12,500 12,500 25,000
65 Nunik 10,000 10,000 5,000 5,000 20,000

JASA ALAT &

DOKTER BAHAN
66 Tanti 10,000 5,000 5,000 10,000
67 Nabila 25,000 12,500 12,500 25,000
68 Ria 25,000 12,500 12,500 25,000
69 Fina 10,000 5,000 5,000 10,000
70 1/15/2014 Moh. Ramdan 35,000 17,500 17,500 35,000
71 1/17/2014 Ayep Kusnadi 10,000 10,000 5,000 5,000 20,000
72 Shirley Simon 25,000 12,500 12,500 25,000
73 Widiana. K 25,000 12,500 12,500 25,000
74 Megasari 25,000 12,500 12,500 25,000
75 1/18/2014 Maryani 10,000 5,000 5,000 10,000
76 Irfan Nabil 20,000 10,000 10,000 20,000
77 Melianti 25,000 12,500 12,500 25,000
78 Ali Setiawan 10,000 5,000 5,000 10,000
79 Yovi Ferliandi 25,000 10,000 12,500 12,500 35,000
80 Abil asyadzilly 20,000 10,000 10,000 10,000 30,000
81 Kukuf Wijayanti 25,000 10,000 12,500 12,500 35,000
82 1/20/2014 Nabila 25,000 12,500 12,500 25,000
83 Dadang 25,000 12,500 12,500 25,000
84 Sintia 20,000 10,000 10,000 20,000
85 Eka 25,000 12,500 12,500 25,000
86 Yovi Ferliandi 10,000 5,000 5,000 10,000
87 Yunengsih 10,000 5,000 5,000 10,000
88 Taufik 10,000 5,000 5,000 10,000
89 Nabila 10,000 5,000 5,000 10,000
90 1/21/2014 Ayep. K 40,000 20,000 20,000 40,000
91 Yadi. M 25,000 12,500 12,500 25,000
92 Kusnaesih 25,000 12,500 12,500 25,000
93 dra. Sri Purwani 40,000 20,000 20,000 40,000
94 1/22/2014 Theresia Stela 25,000 12,500 12,500 25,000
95 Ani 10,000 10,000 5,000 5,000 20,000
96 Neneng 10,000 10,000 5,000 5,000 20,000
97 Sopian 10,000 10,000 5,000 5,000 20,000
98 Ria 25,000 10,000 12,500 12,500 35,000
99 Waludin 10,000 10,000 5,000 5,000 20,000
100 Farida 25,000 12,500 12,500 25,000
101 1/24/2014 Sunarni 25,000 12,500 12,500 25,000
102 Yeyen 10,000 5,000 5,000 10,000
103 Dadang. R 25,000 12,500 12,500 25,000
104 Megasari 25,000 12,500 12,500 25,000
105 1/25/2014 Mimin 35,000 17,500 17,500 35,000
106 Melianti 25,000 12,500 12,500 25,000
107 Sarbini Rais 25,000 12,500 12,500 25,000
108 Siti Halimah 25,000 12,500 12,500 25,000
109 1/27/2014 Neneng Nurahmah 25,000 10,000 12,500 12,500 35,000
110 Yuyun. Y 35,000 17,500 17,500 35,000
111 Waludin 25,000 10,000 12,500 12,500 35,000
112 Nia. K 10,000 5,000 5,000 10,000
113 Suharsono 25,000 12,500 12,500 25,000
114 Ria 25,000 12,500 12,500 25,000
115 Imas 25,000 12,500 12,500 25,000
116 Syntia 20,000 10,000 10,000 20,000
117 M. Ridwan 25,000 12,500 12,500 25,000
118 Nabila 25,000 12,500 12,500 25,000
119 1/28/2014 Siti Halimah 25,000 12,500 12,500 25,000
120 Yadi Mulyadi 25,000 12,500 12,500 25,000
121 Ny. Kusnaesih 10,000 5,000 5,000 10,000
122 Sunarni 25,000 12,500 12,500 25,000
123 Rafi. B 10,000 10,000 5,000 5,000 20,000
124 1/29/2014 Khalimah 35,000 17,500 17,500 35,000
125 Ani 10,000 10,000 5,000 5,000 20,000
126 Santi 25,000 12,500 12,500 25,000
127 Ismawati 10,000 10,000 5,000 5,000 20,000
128 1/30/2014 Abbot 25,000 12,500 12,500 25,000
129 Dadang 25,000 12,500 12,500 25,000
130 Siti Nurjanah 10,000 5,000 5,000 10,000
LAPORAN KUNJUNGAN PASIEN GIGI BPJS

JASA ALAT &

DOKTER BAHAN
131 1/30/2014 Theresia 25,000 12,500 12,500 25,000
132 Nabila 35,000 17,500 17,500 35,000
133 Eka 35,000 17,500 17,500 35,000
134 Ani 10,000 10,000 5,000 5,000 20,000
135 M. Ridwan 35,000 17,500 17,500 35,000
136 Feby 10,000 10,000 5,000 5,000 20,000
2,905,000 300,000 1,452,500 1,452,500 3,205,000

1 1/24/2014 Fuji GP 1-1 1 636,500
2 12/28/2013 ALKES GIGI 15 198,000
3 1/29/2014 Handschoon, Masker 1 63,500
898,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JANUARI 1,445,500 898,000 547,500 273,750 273,750
2 JANUARI 1,452,500.00 1,452,500 726,250 726,250
1,000,000 1,000,000


Menyetujui,

JASA ALAT &

DOKTER BAHAN
1 1/2/2014 Ina Kustiana 100,000 3,000 48,500 48,500 100,000
2 Larisa 100,000 3,000 48,500 48,500 100,000
3 Anisa 100,000 3,000 48,500 48,500 100,000
4 Waryat 20,000 3,000 8,500 8,500 20,000
5 Arini 50,000 3,000 23,500 23,500 50,000
6 Dani 50,000 3,000 23,500 23,500 50,000
7 3/2/2014 Delita 20,000 3,000 8,500 8,500 20,000
8 Azi 80,000 3,000 38,500 38,500 80,000
9 Grace 50,000 3,000 23,500 23,500 50,000
10 Eko 50,000 3,000 23,500 23,500 50,000
11 Acep 50,000 3,000 23,500 23,500 50,000
12 Lilis 50,000 3,000 23,500 23,500 50,000
13 Misyanto 50,000 3,000 23,500 23,500 50,000
14 Ifa 50,000 3,000 23,500 23,500 50,000
15 4/2/2014 Kun Maharso 50,000 3,000 23,500 23,500 50,000
16 Meilina 70,000 3,000 33,500 33,500 70,000
17 Sugino 40,000 3,000 18,500 18,500 40,000
18 Aam g 50,000 3,000 23,500 23,500 50,000
19 Zaki 20,000 3,000 8,500 8,500 20,000
20 5/2/2014 Siti r 80,000 3,000 38,500 38,500 80,000
21 Neng Fatimah 180,000 3,000 88,500 88,500 180,000
22 7/2/2014 Kansa 20,000 3,000 8,500 8,500 20,000
23 Arini 50,000 3,000 23,500 23,500 50,000
24 8/2/2014 Iim 20,000 3,000 8,500 8,500 20,000
25 Sri 20,000 3,000 8,500 8,500 20,000
26 Dani 50,000 3,000 23,500 23,500 50,000
27 10/2/2014 Asiatun 30,000 3,000 13,500 13,500 30,000
28 Dewi 50,000 3,000 23,500 23,500 50,000
29 11/2/2014 Kun Maharso 50,000 3,000 23,500 23,500 50,000
30 Oban 50,000 3,000 23,500 23,500 50,000
31 Nazril 50,000 3,000 23,500 23,500 50,000
12/2/2014 Sri 20,000 3,000 8,500 8,500 20,000
32 Meilina 100,000 3,000 48,500 48,500 100,000
33 Eko 50,000 3,000 23,500 23,500 50,000
34 Acep 50,000 3,000 23,500 23,500 50,000
35 Lilis 50,000 3,000 23,500 23,500 50,000
36 14/02/2014 Wita 20,000 3,000 8,500 8,500 20,000
37 Divania 20,000 3,000 8,500 8,500 20,000
38 Iceu 100,000 3,000 48,500 48,500 100,000
39 Dadan 80,000 3,000 38,500 38,500 80,000
40 Ela 20,000 3,000 8,500 8,500 20,000
41 Arini 50,000 3,000 23,500 23,500 50,000
42 15/02/2014 Arini 200,000 3,000 98,500 98,500 200,000
43 Dedi 100,000 3,000 48,500 48,500 100,000
44 Imam 20,000 3,000 8,500 8,500 20,000
45 Wieke 20,000 3,000 8,500 8,500 20,000
46 Siti N 100,000 3,000 48,500 48,500 100,000
47 Meilina 90,000 3,000 43,500 43,500 90,000
48 17/02/2014 Yunan 260,000 3,000 128,500 128,500 260,000
49 Ria Susanti 50,000 3,000 23,500 23,500 50,000
50 Yogi Trisantoso 90,000 3,000 43,500 43,500 90,000
51 Fariz 20,000 3,000 8,500 8,500 20,000
52 Ifa 100,000 3,000 48,500 48,500 100,000
53 Diva 20,000 3,000 8,500 8,500 20,000
54 18/02/2014 Kun Maharso 50,000 3,000 23,500 23,500 50,000
55 Sehmi 40,000 3,000 18,500 18,500 40,000
56 Sutinah 20,000 3,000 8,500 8,500 20,000
57 Eko Rahayu 50,000 3,000 23,500 23,500 50,000
58 Ropi Hayudi 50,000 3,000 23,500 23,500 50,000
59 M alfarid 40,000 3,000 18,500 18,500 40,000
60 19/02/2014 imam 20,000 3,000 8,500 8,500 20,000
61 acep 50,000 3,000 23,500 23,500 50,000
62 lilis 50,000 3,000 23,500 23,500 50,000
63 divania 50,000 3,000 23,500 23,500 50,000
64 misyanto 50,000 3,000 23,500 23,500 50,000
65 dela 20,000 3,000 8,500 8,500 20,000
66 21/02/2014 ayub 30,000 3,000 13,500 13,500 30,000
67 tika julianti 100,000 3,000 48,500 48,500 100,000
68 22/02/2014 imam 30,000 3,000 13,500 13,500 30,000
69 22/02/2014 tugiran 20,000 3,000 8,500 8,500 20,000
70 bagas 40,000 3,000 18,500 18,500 40,000
71 dani 50,000 3,000 23,500 23,500 50,000
72 bustami 80,000 3,000 38,500 38,500 80,000
73 24/02/2014 ria s 50,000 3,000 23,500 23,500 50,000
74 maria 20,000 3,000 8,500 8,500 20,000
75 25/02/2014 Asep dedi 50,000 3,000 23,500 23,500 50,000
76 Asep dedi 20,000 3,000 8,500 8,500 20,000
77 sutinah 80,000 3,000 38,500 38,500 80,000
78 26/02/2014 ai karyamah 20,000 3,000 8,500 8,500 20,000
79 tursina 64,000 3,000 30,500 30,500 64,000
80 yenny 80,000 3,000 38,500 38,500 80,000
81 faizal 20,000 3,000 8,500 8,500 20,000
salwa 50,000 3,000 23,500 23,500 50,000
acep 75,000 3,000 36,000 36,000 75,000
lilis 50,000 3,000 23,500 23,500 50,000
27/02/2014 Kun Maharso 50,000 3,000 23,500 23,500 50,000
reni 100,000 3,000 48,500 48,500 100,000
misyanto 50,000 3,000 23,500 23,500 50,000
suhendar 20,000 3,000 8,500 8,500 20,000
Ropi Hayudi 20,000 3,000 8,500 8,500 20,000
28/02/2014 tusdayman 50,000 3,000 23,500 23,500 50,000
ayub 30,000 3,000 13,500 13,500 30,000
siti 100,000 3,000 48,500 48,500 100,000
arini 50,000 3,000 23,500 23,500 50,000
nisa 20,000 3,000 8,500 8,500 20,000
bagas 80,000 3,000 38,500 38,500 80,000
3,580,000 180,000 1,700,000 1,700,000 3,580,000

JASA ALAT &

DOKTER BAHAN
1 2/1/2014 Shirley 25,000 12,500 12,500 25,000
2 Neneng 25,000 12,500 12,500 25,000
3 Luthfi 20,000 10,000 10,000 10,000 30,000
4 Mimin 60,000 30,000 30,000 60,000
5 Imas 25,000 12,500 12,500 25,000
6 Siti H 25,000 12,500 12,500 25,000
7 Dadi R 10,000 10,000 5,000 5,000 20,000
8 Aina A F 20,000 10,000 10,000 10,000 30,000
10 Nia Kurniasih 25,000 12,500 12,500 25,000
11 Dadang Romansyah 25,000 12,500 12,500 25,000
12 Siti Nurjanah 10,000 5,000 5,000 10,000
13 Imas Sumiati 10,000 5,000 5,000 10,000
14 Ismawanti 25,000 12,500 12,500 25,000
15 Neneng Nurahmah 10,000 10,000 5,000 5,000 20,000
16 Sipa Tri Napsari 10,000 5,000 5,000 10,000
17 Neng Kaniawati 10,000 10,000 5,000 5,000 20,000
18 2/5/2014 Kustiyati 35,000 17,500 17,500 35,000
19 Teten T 35,000 17,500 17,500 35,000
20 Rosita 25,000 12,500 12,500 25,000
21 M Ramdan 25,000 12,500 12,500 25,000
22 Santi 35,000 17,500 17,500 35,000
23 Ria 25,000 12,500 12,500 25,000
24 Tantri 10,000 5,000 5,000 10,000
25 2/7/2014 Komalasari 25,000 10,000 12,500 12,500 35,000
26 Shirley 35,000 17,500 17,500 35,000
27 Susilawati 25,000 10,000 12,500 12,500 35,000
28 Ema 10,000 5,000 5,000 10,000
29 Mutiara 10,000 5,000 5,000 10,000
30 Imas 25,000 12,500 12,500 25,000
31 Sofyani 20,000 10,000 10,000 20,000
32 2/8/2014 Megasari 25,000 12,500 12,500 25,000
33 Maryani 30,000 15,000 15,000 30,000
34 Melianti 25,000 12,500 12,500 25,000
35 Anik S 25,000 12,500 12,500 25,000
36 Siti H 25,000 12,500 12,500 25,000
37 Mimin 35,000 17,500 17,500 35,000
38 Sarbini 25,000 12,500 12,500 25,000
39 Siti Nurhayati 10,000 10,000 5,000 5,000 20,000
40 Suharsono 35,000 10,000 17,500 17,500 45,000
41 2/10/2014 Tresni Amalia 20,000 10,000 10,000 20,000
42 Nia Kurniasih 25,000 12,500 12,500 25,000
43 Sarbini 30,000 15,000 15,000 30,000
44 Nabila 35,000 17,500 17,500 35,000
45 Eka 25,000 12,500 12,500 25,000
46 Nanik 10,000 10,000 5,000 5,000 20,000
47 Ani 10,000 5,000 5,000 10,000
48 Imas 25,000 12,500 12,500 25,000
49 Dias 20,000 10,000 10,000 20,000
50 Sintia 20,000 10,000 10,000 20,000
51 Akasyah 10,000 10,000 5,000 5,000 20,000
52 Biduri 10,000 10,000 5,000 5,000 20,000
53 Susilawati 25,000 12,500 12,500 25,000
54 Ridwan 20,000 10,000 10,000 20,000
55 2/11/2014 Dadang 30,000 15,000 15,000 30,000
56 Siti N 10,000 5,000 5,000 10,000
57 Ismawanti 25,000 12,500 12,500 25,000
58 Neneng 30,000 15,000 15,000 30,000
59 Anik s 25,000 12,500 12,500 25,000
60 2/12/2014 Teten 25,000 12,500 12,500 25,000
61 Moh Ramdan 25,000 12,500 12,500 25,000
62 Imas 10,000 5,000 5,000 10,000
63 Sarbini 25,000 12,500 12,500 25,000
64 Warny 25,000 12,500 12,500 25,000
65 Ria 35,000 17,500 17,500 35,000

JASA ALAT &

DOKTER BAHAN
66 Mulyono 10,000 10,000 5,000 5,000 20,000
67 2/13/2014 Neti 15,000 10,000 7,500 7,500 25,000
68 Herdian 15,000 10,000 7,500 7,500 25,000
69 Nengsih 30,000 10,000 15,000 15,000 40,000
70 2/14/2014 Megasari 30,000 15,000 15,000 30,000
71 Arum m 15,000 10,000 7,500 7,500 25,000
72 Sunarni 30,000 15,000 15,000 30,000
73 Shirley 30,000 15,000 15,000 30,000
74 2/15/2014 Dwijo Prasetyo 60,000 10,000 30,000 30,000 70,000
75 Anik s 30,000 15,000 15,000 30,000
76 Teten T 30,000 15,000 15,000 30,000
77 Naila 15,000 10,000 7,500 7,500 25,000
78 Melianti 30,000 15,000 15,000 30,000
79 Maryani 15,000 7,500 7,500 15,000
80 2/15/2014 Siti Nurhayati 15,000 10,000 7,500 7,500 25,000
81 Khoirunnisa 60,000 30,000 30,000 60,000
82 Siti Halimah 30,000 15,000 15,000 30,000
83 17/02/2014 Yuningsih 15,000 10,000 7,500 7,500 25,000
84 M Ramdan 30,000 15,000 15,000 30,000
85 Teten 30,000 15,000 15,000 30,000
86 Sarbini 30,000 15,000 15,000 30,000
87 Sanuki 30,000 10,000 15,000 15,000 40,000
88 M Ridwan 30,000 15,000 15,000 30,000
89 Feby 15,000 10,000 7,500 7,500 25,000
90 Nanik 15,000 7,500 7,500 15,000
91 Eka 30,000 15,000 15,000 30,000
92 18/02/2014 Siti Nurjanah 60,000 30,000 30,000 60,000
93 Sri Rusmiati 35,000 17,500 17,500 35,000
94 Ismawati 40,000 20,000 20,000 40,000
95 Arum Maemunah 15,000 10,000 7,500 7,500 25,000
96 19/02/2014 Juju Endang 15,000 10,000 7,500 7,500 25,000
97 Asep S 20,000 10,000 10,000 20,000
98 Elis Yuniarti 15,000 10,000 7,500 7,500 25,000
99 Nia Kurniasih 30,000 15,000 15,000 30,000
100 Deni 15,000 10,000 7,500 7,500 25,000
101 Ria 35,000 17,500 17,500 35,000
102 20/02/2014 Mamat Sudrajat 30,000 15,000 15,000 30,000
103 Yuyun Yuningsih 30,000 15,000 15,000 30,000
104 Rini Dewi 30,000 15,000 15,000 30,000
105 Abbot 30,000 15,000 15,000 30,000
106 Biduri 15,000 10,000 7,500 7,500 25,000
107 Saffina 15,000 7,500 7,500 15,000
108 Eka 35,000 17,500 17,500 35,000
109 Jubaedah 10,000 5,000 5,000 10,000
110 21/02/2014 nazmi 15,000 7,500 7,500 15,000
111 Shirley 70,000 35,000 35,000 70,000
112 theresia 30,000 15,000 15,000 30,000
113 Megasari 30,000 15,000 15,000 30,000
114 22/02.2014 melianti 30,000 15,000 15,000 30,000
115 ali setiawan 70,000 35,000 35,000 70,000
116 asep 30,000 15,000 15,000 30,000
117 mamat 30,000 15,000 15,000 30,000
118 warnati 70,000 35,000 35,000 70,000
119 ida hamidah 30,000 15,000 15,000 30,000
120 Ismawati 30,000 15,000 15,000 30,000
121 siti n 15,000 10,000 7,500 7,500 25,000
122 siti n 30,000 15,000 15,000 30,000
123 sunarni 30,000 15,000 15,000 30,000
124 24/02/2014 tajudin 30,000 15,000 15,000 30,000
125 teten 30,000 15,000 15,000 30,000
126 m ramdan 70,000 35,000 35,000 70,000
127 alvian 70,000 35,000 35,000 70,000
128 suharsono 15,000 10,000 7,500 7,500 25,000
129 mamat 15,000 7,500 7,500 15,000
130 jubaedah 15,000 7,500 7,500 15,000
131 imas 30,000 15,000 15,000 30,000
132 sanuki 30,000 15,000 15,000 30,000
133 nanik 30,000 15,000 15,000 30,000
134 25/02/2014 yuyun y 15,000 10,000 7,500 7,500 25,000
135 warnati 15,000 10,000 7,500 7,500 25,000
136 imas atikah 30,000 15,000 15,000 30,000
137 cecep 30,000 10,000 15,000 15,000 40,000
138 sopiyan 30,000 10,000 15,000 15,000 40,000
139 ismawati 60,000 30,000 30,000 60,000
140 ida hamidah 30,000 15,000 15,000 30,000
141 risyanti 15,000 7,500 7,500 15,000
142 26/02/2014 nia kurniasih 40,000 20,000 20,000 40,000
143 warny 70,000 35,000 35,000 70,000
144 santi 30,000 15,000 15,000 30,000
145 aulia 15,000 10,000 7,500 7,500 25,000
146 Anik s 30,000 15,000 15,000 30,000
147 27/02/2014 teten 30,000 15,000 15,000 30,000
148 vidi ramdan 30,000 15,000 15,000 30,000
149 mamat 30,000 15,000 15,000 30,000
LAPORAN KUNJUNGAN PASIEN GIGI BPJS
JASA ALAT &

DOKTER BAHAN
150 ace 15,000 7,500 7,500 15,000
151 ismawati 15,000 7,500 7,500 15,000
152 biduri 15,000 7,500 7,500 15,000
153 28/02/2014 abbot 35,000 17,500 17,500 35,000
154 luthfi 20,000 10,000 10,000 20,000
155 shirley 30,000 15,000 15,000 30,000
156 nazmi 30,000 15,000 15,000 30,000
157 shinta 30,000 15,000 15,000 30,000
158 sri r 70,000 35,000 35,000 70,000
90,000 45,000 45,000 90,000
105,000 52,500 52,500 105,000
120,000 60,000 60,000 120,000
135,000 67,500 67,500 135,000
150,000 75,000 75,000 150,000
165,000 82,500 82,500 165,000
180,000 90,000 90,000 180,000
3,990,000 350,000 1,995,000 1,995,000 4,340,000

1 1/24/2014 Fuji GP 1-1 1 636,500
2 12/28/2013 ALKES GIGI 15 198,000
898,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JANUARI 1,700,000 898,000 802,000 401,000 401,000
2 JANUARI 1,995,000.00 1,995,000 997,500 997,500
1,398,500 1,398,500


Menyetujui,


PERIODE MARET 2014
JASA ALAT &
DOKTER BAHAN
1 1/3/2014 marsel 50,000 3,000 23,500 23,500 50,000
2 rahman 20,000 3,000 8,500 8,500 20,000
3 3/3/2014 reni 20,000 3,000 8,500 8,500 20,000
4 aji 80,000 3,000 38,500 38,500 80,000
5 ria s 50,000 3,000 23,500 23,500 50,000
6 karmidah 20,000 3,000 8,500 8,500 20,000
7 tusdayman 20,000 3,000 8,500 8,500 20,000
8 bagas 100,000 3,000 48,500 48,500 100,000
9 4/3/2014 kun maharso 50,000 3,000 23,500 23,500 50,000
10 lina 10,000 3,000 3,500 3,500 10,000
11 5/3/2014 rendi anggara 180,000 3,000 88,500 88,500 180,000
12 acep 75,000 3,000 36,000 36,000 75,000
13 lilis 50,000 3,000 23,500 23,500 50,000
14 6/3/2014 erwin 20,000 3,000 8,500 8,500 20,000
15 asep 50,000 3,000 23,500 23,500 50,000
16 momo 50,000 3,000 23,500 23,500 50,000
17 nisa 20,000 3,000 8,500 8,500 20,000
18 dinda 20,000 3,000 8,500 8,500 20,000
19 lintang 50,000 3,000 23,500 23,500 50,000
20 misyanto 60,000 3,000 28,500 28,500 60,000
21 7/3/2014 arini 50,000 3,000 23,500 23,500 50,000
22 habibi 20,000 3,000 8,500 8,500 20,000
23 8/3/2014 DANI 140,000 3,000 68,500 68,500 140,000
24 tusdayman 50,000 3,000 23,500 23,500 50,000
25 10/3/2014 ria 70,000 3,000 33,500 33,500 70,000
26 aulya 20,000 3,000 8,500 8,500 20,000
27 bagas 100,000 3,000 48,500 48,500 100,000
28 lilis 50,000 3,000 23,500 23,500 50,000
29 11/3/2014 kun maharso 140,000 3,000 68,500 68,500 140,000
30 hidayat 70,000 3,000 33,500 33,500 70,000
31 asep 140,000 3,000 68,500 68,500 140,000
muslim 80,000 40,000 40,000 80,000
32 della 120,000 3,000 58,500 58,500 120,000
33 gilang 20,000 3,000 8,500 8,500 20,000
34 12/3/2014 rulita 50,000 3,000 23,500 23,500 50,000
35 13/03/2014 mudiyono 20,000 3,000 8,500 8,500 20,000
36 aulya 144,000 72,000 72,000 144,000
37 misyanto 50,000 3,000 23,500 23,500 50,000
38 momo 50,000 3,000 23,500 23,500 50,000
39 14/03/2014 kusnandar 20,000 3,000 8,500 8,500 20,000
40 rulita 50,000 3,000 23,500 23,500 50,000
41 15/03/2014 ahnaf 20,000 3,000 8,500 8,500 20,000
42 arini 50,000 3,000 23,500 23,500 50,000
43 elis h(dede m) 20,000 3,000 8,500 8,500 20,000
44 bayina 20,000 3,000 8,500 8,500 20,000
45 17/03/2014 marsel 50,000 3,000 23,500 23,500 50,000
46 aurel 80,000 3,000 38,500 38,500 80,000
47 qistina 100,000 3,000 48,500 48,500 100,000
48 yong weni 80,000 3,000 38,500 38,500 80,000
49 evi 40,000 20,000 20,000 40,000
50 reni 40,000 20,000 20,000 40,000
51 tofan 50,000 3,000 23,500 23,500 50,000
52 18/03/2014 asep - - -
53 kun maharso 40,000 3,000 18,500 18,500 40,000
54 dewi 20,000 3,000 8,500 8,500 20,000
55 sariningsih 40,000 3,000 18,500 18,500 40,000
56 alifa 50,000 3,000 23,500 23,500 50,000
57 19/03/2014 lilis 75,000 3,000 36,000 36,000 75,000
58 20/03/2014 kun maharso 50,000 3,000 23,500 23,500 50,000
59 21/03/2014 anisah 20,000 3,000 8,500 8,500 20,000
60 divania 50,000 3,000 23,500 23,500 50,000
61 shofia 20,000 3,000 8,500 8,500 20,000
62 misyanto 50,000 3,000 23,500 23,500 50,000
63 nisa 20,000 3,000 8,500 8,500 20,000
64 22/03/2014 rahmatullah 20,000 3,000 8,500 8,500 20,000
65 ropi 50,000 3,000 23,500 23,500 50,000
66 23/03/2014 rulita 50,000 3,000 23,500 23,500 50,000
67 marcel 50,000 3,000 23,500 23,500 50,000
68 jabir 40,000 3,000 18,500 18,500 40,000
69 anita 40,000 3,000 18,500 18,500 40,000
70 imas rukiah 50,000 3,000 23,500 23,500 50,000
71 momo 50,000 3,000 23,500 23,500 50,000
72 aliya 20,000 3,000 8,500 8,500 20,000
73 reni 50,000 3,000 23,500 23,500 50,000
74 evi 50,000 3,000 23,500 23,500 50,000
75 25/03/2014 kun maharso - - -
76 akbar 40,000 3,000 18,500 18,500 40,000
77 topan 40,000 3,000 18,500 18,500 40,000
78 amalia 20,000 3,000 8,500 8,500 20,000
79 haqqi 20,000 3,000 8,500 8,500 20,000
80 nisa kadiati 50,000 3,000 23,500 23,500 50,000
81 iceu 40,000 3,000 18,500 18,500 40,000
82 eko rahayu 70,000 3,000 33,500 33,500 70,000
83 26/03/2014 m zaeludin 20,000 3,000 8,500 8,500 20,000
84 nida 50,000 3,000 23,500 23,500 50,000
85 27/03/2014 misyanto 100,000 3,000 48,500 48,500 100,000
86 imas 80,000 3,000 38,500 38,500 80,000
87 ina 50,000 3,000 23,500 23,500 50,000
88 annisa 200,000 3,000 98,500 98,500 200,000
89 shofia 50,000 3,000 23,500 23,500 50,000
4,734,000 252,000 2,241,000 2,241,000 4,734,000

PERIODE MARET 2014
JASA ALAT &

DOKTER BAHAN
1 1/3/2014 ali s 70,000 35,000 35,000 70,000
2 melianti 30,000 15,000 15,000 30,000
3 keli 15,000 10,000 7,500 7,500 25,000
4 eutik s 15,000 10,000 7,500 7,500 25,000
5 ida h 30,000 15,000 15,000 30,000
6 juju e 70,000 35,000 35,000 70,000
7 salsa bila 15,000 10,000 7,500 7,500 25,000
8 siti h 30,000 10,000 15,000 15,000 40,000
9 aina a.f 35,000 10,000 17,500 17,500 45,000
10 imas atikah 30,000 15,000 15,000 30,000
11 3/3/2014 abd zulfiqar 15,000 10,000 7,500 7,500 25,000
12 nia k 70,000 10,000 35,000 35,000 80,000
13 teten t 30,000 15,000 15,000 30,000
14 moh ramdan 30,000 15,000 15,000 30,000
15 sarbini 40,000 20,000 20,000 40,000
16 gina 30,000 15,000 15,000 30,000
17 jubaedah 15,000 10,000 7,500 7,500 25,000
18 nazmi 30,000 15,000 15,000 30,000
19 4/3/2014 arum maemunah 60,000 10,000 30,000 30,000 70,000
20 imas sumiati 15,000 10,000 7,500 7,500 25,000
21 siti halimah 30,000 10,000 15,000 15,000 40,000
22 kezia 30,000 15,000 15,000 30,000
23 ida hamidah 30,000 15,000 15,000 30,000
24 risyanti nursoleha 15,000 7,500 7,500 15,000
25 adilla rifai 70,000 10,000 35,000 35,000 80,000
26 neneng n 30,000 15,000 15,000 30,000
27 5/3/2014 warny 30,000 15,000 15,000 30,000
28 ani 15,000 10,000 7,500 7,500 25,000
29 dadang 70,000 35,000 35,000 70,000
30 siti nurjanah 30,000 15,000 15,000 30,000
31 6/3/2014 mamat 30,000 15,000 15,000 30,000
32 nanik 30,000 15,000 15,000 30,000
33 7/3/2014 yusuf 15,000 7,500 7,500 15,000
34 dedi 15,000 10,000 7,500 7,500 25,000
35 meilan 15,000 10,000 7,500 7,500 25,000
36 megasari 30,000 10,000 15,000 15,000 40,000
37 maryani 15,000 7,500 7,500 15,000
38 koswara 15,000 10,000 7,500 7,500 25,000
39 danie pierre 15,000 7,500 7,500 15,000
40 nazmi nadirah 30,000 15,000 15,000 30,000
41 biduri 30,000 15,000 15,000 30,000
42 8/3/2014 sunarni 30,000 15,000 15,000 30,000
43 theresia 30,000 15,000 15,000 30,000
44 warnati 15,000 10,000 7,500 7,500 25,000
45 anik 30,000 15,000 15,000 30,000
46 yuyun y 30,000 15,000 15,000 30,000
47 siti h 30,000 15,000 15,000 30,000
48 yudi t 15,000 7,500 7,500 15,000
49 10/3/2014 sarbini 70,000 35,000 35,000 70,000
50 teten t 40,000 20,000 20,000 40,000
51 m ramdan 30,000 15,000 15,000 30,000
52 yudi 15,000 10,000 7,500 7,500 25,000
53 juju 70,000 35,000 35,000 70,000
54 arini 25,000 12,500 12,500 25,000
55 eva 15,000 10,000 7,500 7,500 25,000
56 jubaedah 30,000 15,000 15,000 30,000
57 asep 15,000 10,000 7,500 7,500 25,000
58 raisya 15,000 10,000 7,500 7,500 25,000
59 revika 30,000 10,000 15,000 15,000 40,000
60 11/3/2014 kezia 70,000 35,000 35,000 70,000
61 ida 30,000 15,000 15,000 30,000
62 imas 30,000 15,000 15,000 30,000
63 12/3/2014 sarbini 30,000 15,000 15,000 30,000
64 nazwar a w 15,000 10,000 7,500 7,500 25,000
65 didin 30,000 15,000 15,000 30,000
66 warni 70,000 35,000 35,000 70,000
67 13/03/2014 m ramdan 30,000 15,000 15,000 30,000
68 danie pierre 15,000 7,500 7,500 15,000
69 sunarni 30,000 15,000 15,000 30,000
70 rini 30,000 15,000 15,000 30,000
71 mudiyono 30,000 15,000 15,000 30,000
72 mamat s 30,000 15,000 15,000 30,000
73 yuyun 30,000 15,000 15,000 30,000
74 jubaedah 30,000 15,000 15,000 30,000
75 hani 30,000 15,000 15,000 30,000
76 nanik 40,000 20,000 20,000 40,000
77 14/03/2014 shela 15,000 7,500 7,500 15,000
78 nazmi 30,000 15,000 15,000 30,000
79 imas 30,000 15,000 15,000 30,000
80 siti n 70,000 35,000 35,000 70,000
81 shirley 30,000 15,000 15,000 30,000
82 mardiyono 15,000 10,000 7,500 7,500 25,000
83 biduri 30,000 15,000 15,000 30,000
84 megasari 40,000 20,000 20,000 40,000
85 15/03/2014 sunarni 30,000 15,000 15,000 30,000
86 alfiyya 30,000 15,000 15,000 30,000
87 didin r 30,000 15,000 15,000 30,000
88 mamat s 30,000 15,000 15,000 30,000
89 imas a 40,000 20,000 20,000 40,000
90 siti h 70,000 35,000 35,000 70,000
91 melianti 30,000 15,000 15,000 30,000
92 ali setiawan 70,000 35,000 35,000 70,000
93 sarbini r 30,000 10,000 15,000 15,000 40,000
94 aina 35,000 17,500 17,500 35,000
95 yuyun y 30,000 10,000 15,000 15,000 40,000
96 17/03/2014 yaman h 15,000 10,000 7,500 7,500 25,000
97 nining m 15,000 10,000 7,500 7,500 25,000
98 m ramdan 30,000 15,000 15,000 30,000
99 teten t 70,000 35,000 35,000 70,000
100 khalimah ad 70,000 35,000 35,000 70,000
101 abbot 30,000 15,000 15,000 30,000
102 m abdullah 15,000 10,000 7,500 7,500 25,000
103 imas n 30,000 15,000 15,000 30,000
104 18/03/2014 arum maemunah 15,000 7,500 7,500 15,000
105 alfiyya 30,000 15,000 15,000 30,000
106 ida hamidah 40,000 20,000 20,000 40,000
107 19/03/2014 arum maemunah 30,000 15,000 15,000 30,000
108 biduri 30,000 15,000 15,000 30,000
109 jubaedah 15,000 10,000 7,500 7,500 25,000
110 mamat 30,000 15,000 15,000 30,000
111 warny 70,000 35,000 35,000 70,000
112 acep 15,000 10,000 7,500 7,500 25,000
113 hani 30,000 15,000 15,000 30,000
114 nanik 70,000 35,000 35,000 70,000
115 21/03/2014 andi 15,000 10,000 7,500 7,500 25,000
116 theresia 30,000 10,000 15,000 15,000 40,000
117 nazmi 30,000 15,000 15,000 30,000
118 aira 30,000 15,000 15,000 30,000
119 22/03/2014 anik 30,000 15,000 15,000 30,000
120 arum m 30,000 15,000 15,000 30,000
121 irfan 35,000 17,500 17,500 35,000
122 alfiyya 30,000 15,000 15,000 30,000
123 siti halimah 30,000 15,000 15,000 30,000
124 donitha 15,000 7,500 7,500 15,000
125 24/03/2014 imas atikah 70,000 35,000 35,000 70,000
126 siti mariam 70,000 35,000 35,000 70,000
127 m ramdan 40,000 20,000 20,000 40,000
128 agus 15,000 10,000 7,500 7,500 25,000
129 theresia 30,000 15,000 15,000 30,000
130 rusgandi 15,000 10,000 7,500 7,500 25,000
131 alfiyya 30,000 15,000 15,000 30,000
132 sulki 30,000 15,000 15,000 30,000
133 25/03/2014 axel putra 30,000 10,000 15,000 15,000 40,000
134 raid nauval 30,000 10,000 15,000 15,000 40,000
135 kezia aveling 30,000 15,000 15,000 30,000
136 arum maemunah 30,000 15,000 15,000 30,000
137 ida hamidah 70,000 35,000 35,000 70,000
138 26/03/2014 sarbini rais 30,000 15,000 15,000 30,000
139 djemi 30,000 15,000 15,000 30,000
140 warny 70,000 35,000 35,000 70,000
141 santi 30,000 15,000 15,000 30,000
142 27/03/2014 arum 30,000 10,000 15,000 15,000 40,000
143 theresia 30,000 15,000 15,000 30,000
144 nurdiana 15,000 10,000 7,500 7,500 25,000
145 hani 30,000 15,000 15,000 30,000
146 28/03/2014 mamat s 30,000 15,000 15,000 30,000
147 alvian 70,000 35,000 35,000 70,000
148 trya r 30,000 10,000 15,000 15,000 40,000
149 titin 15,000 10,000 7,500 7,500 25,000
150 agus w 15,000 7,500 7,500 15,000
151 nazmi 30,000 15,000 15,000 30,000
152 biduri 30,000 15,000 15,000 30,000
9,689,000 672,000 4,718,500 4,718,500 10,109,000

1 1/24/2014 Fuji GP 1-1 1 636,500
2 12/28/2013 ALKES GIGI 15 198,000
898,000
KEUNTUNGAN
KSBL DRG. DEWI
1 JANUARI 23,500 898,000 (874,500) (437,250) (437,250)
2 JANUARI 4,718,500.00 4,718,500 2,359,250 2,359,250
1,922,000 1,922,000


Menyetujui,


PERIODE APRIL 2014
JASA ALAT &

DOKTER BAHAN
1 1/4/2014 romi 20,000 3,000 8,500 8,500 20,000
2 febri 20,000 3,000 8,500 8,500 20,000
3 amalia 50,000 3,000 23,500 23,500 50,000
4 2/4/2014 febri 80,000 3,000 38,500 38,500 80,000
5 ria 50,000 3,000 23,500 23,500 50,000
6 kusmiati 90,000 3,000 43,500 43,500 90,000
7 euis 100,000 3,000 48,500 48,500 100,000
8 3/4/2014 rustini 20,000 3,000 8,500 8,500 20,000
9 rulik 50,000 3,000 23,500 23,500 50,000
10 misyanto 150,000 3,000 73,500 73,500 150,000
11 jubaedah 150,000 3,000 73,500 73,500 150,000
12 momo 100,000 3,000 48,500 48,500 100,000
13 naila 20,000 3,000 8,500 8,500 20,000
14 lilis 75,000 3,000 36,000 36,000 75,000
15 alfan 20,000 3,000 8,500 8,500 20,000
16 evi 120,000 60,000 60,000 120,000
17 ade 150,000 3,000 73,500 73,500 150,000
18 4/4/2014 imas 50,000 3,000 23,500 23,500 50,000
19 eko rahayu 50,000 3,000 23,500 23,500 50,000
20 irma 30,000 3,000 13,500 13,500 30,000
21 topan 80,000 3,000 38,500 38,500 80,000
22 romi 50,000 3,000 23,500 23,500 50,000
23 5/4/2014 arini 30,000 3,000 13,500 13,500 30,000
24 alfiansyah 40,000 3,000 18,500 18,500 40,000
25 7/4/2014 holilah 20,000 3,000 8,500 8,500 20,000
26 ria s 50,000 3,000 23,500 23,500 50,000
27 m zaeludin 20,000 3,000 8,500 8,500 20,000
28 eko 50,000 3,000 23,500 23,500 50,000
29 evi 120,000 60,000 60,000 120,000
30 dewi 20,000 3,000 8,500 8,500 20,000
31 siti 20,000 3,000 8,500 8,500 20,000
32 jubaedah 50,000 3,000 23,500 23,500 50,000
33 8/4/2014 rasya 80,000 3,000 38,500 38,500 80,000
34 tantia 50,000 3,000 23,500 23,500 50,000
35 entin 80,000 3,000 38,500 38,500 80,000
36 10/4/2014 imas 50,000 30,000 10,000 10,000 50,000
37 rini 20,000 3,000 8,500 8,500 20,000
38 rizki 50,000 3,000 23,500 23,500 50,000
39 riska 100,000 3,000 48,500 48,500 100,000
40 momo 120,000 3,000 58,500 58,500 120,000
41 12/4/2014 rulita 60,000 3,000 28,500 28,500 60,000
42 alfiansyah 80,000 3,000 38,500 38,500 80,000
43 14/04/2014 akasha 20,000 3,000 8,500 8,500 20,000
44 15/04/2014 arum maemunah 300,000 3,000 148,500 148,500 300,000
45 kun maharso 40,000 3,000 18,500 18,500 40,000
46 fadli 20,000 3,000 8,500 8,500 20,000
47 romi 20,000 3,000 8,500 8,500 20,000
48 16/04/2014 ria s 120,000 3,000 58,500 58,500 120,000
49 ade efendi 20,000 3,000 8,500 8,500 20,000
50 fredy 200,000 3,000 98,500 98,500 200,000
51 riska 120,000 3,000 58,500 58,500 120,000
52 naila 20,000 3,000 8,500 8,500 20,000
53 19/04/2014 ani s 20,000 3,000 8,500 8,500 20,000
54 21/04/2014 imas 50,000 3,000 23,500 23,500 50,000
55 22/04/2014 kun maharso 60,000 3,000 28,500 28,500 60,000
56 rulita 40,000 3,000 18,500 18,500 40,000
57 ade efendi 40,000 3,000 18,500 18,500 40,000
58 wiriyati 10,000 3,000 3,500 3,500 10,000
59 ineu 20,000 3,000 8,500 8,500 20,000
60 23/04/2014 tony 30,000 3,000 13,500 13,500 30,000
61 yandi 200,000 3,000 98,500 98,500 200,000
62 nurdin 20,000 3,000 8,500 8,500 20,000
63 24/04/2014 gunawan 20,000 3,000 8,500 8,500 20,000
64 nurlela 20,000 3,000 8,500 8,500 20,000
65 25/04/2014 fani 200,000 100,000 100,000 200,000
66 naimatul azka 80,000 3,000 38,500 38,500 80,000
67 26/04/2014 dani yanuar 20,000 3,000 8,500 8,500 20,000
68 ridwan 50,000 3,000 23,500 23,500 50,000
69 elly 80,000 3,000 38,500 38,500 80,000
70 holilah 20,000 3,000 8,500 8,500 20,000
71 usman 20,000 3,000 8,500 8,500 20,000
72 nurhayati 20,000 3,000 8,500 8,500 20,000
73 andrian 20,000 3,000 8,500 8,500 20,000
74 28/04/2014 apif 50,000 3,000 23,500 23,500 50,000
75 imas 50,000 25,000 25,000 50,000
76 rani 20,000 3,000 8,500 8,500 20,000
77 fani 3,000 (1,500) (1,500) -
78 29/04/2014 kun maharso 260,000 3,000 128,500 128,500 260,000
79 ade 110,000 3,000 53,500 53,500 110,000
80 mae 40,000 3,000 18,500 18,500 40,000
81 entin 80,000 3,000 38,500 38,500 80,000
82 listia 50,000 3,000 23,500 23,500 50,000
83 siti 100,000 3,000 48,500 48,500 100,000
84 30/04/2014 ridwan 150,000 3,000 73,500 73,500 150,000
85 3,000 (1,500) (1,500) -
86 3,000 (1,500) (1,500) -
87 3,000 (1,500) (1,500) -
88 3,000 (1,500) (1,500) -
89 3,000 (1,500) (1,500) -
5,465,000 282,000 2,591,500 2,591,500 5,465,000

PERIODE APRIL 2014
JASA ALAT &

DOKTER BAHAN
1 1/4/2014 ismawati 50,000 25,000 25,000 50,000
2 kezia 30,000 10,000 15,000 15,000 40,000
3 anik 30,000 10,000 15,000 15,000 40,000
4 cahyana 15,000 10,000 7,500 7,500 25,000
5 ida h 15,000 7,500 7,500 15,000
6 alfiyya 15,000 10,000 7,500 7,500 25,000
7 2/4/2014 sarbini 30,000 15,000 15,000 30,000
8 sunarni 40,000 20,000 20,000 40,000
9 neni s 40,000 20,000 20,000 40,000
10 moh ramdan 70,000 35,000 35,000 70,000
11 kusmiati 70,000 35,000 35,000 70,000
12 sukaesih 15,000 10,000 7,500 7,500 25,000
13 ibut 70,000 35,000 35,000 70,000
14 ecin 15,000 10,000 7,500 7,500 25,000
15 3/4/2014 mamat sudrajat 30,000 15,000 15,000 30,000
16 theresia 30,000 15,000 15,000 30,000
17 panji ilyas 30,000 15,000 15,000 30,000
18 hani 30,000 15,000 15,000 30,000
19 maesaroh 15,000 10,000 7,500 7,500 25,000
20 nely 15,000 10,000 7,500 7,500 25,000
21 4/4/2014 saidah 30,000 10,000 15,000 15,000 40,000
22 sunani 30,000 10,000 15,000 15,000 40,000
23 fikri r.s 30,000 10,000 15,000 15,000 40,000
24 koswara 60,000 30,000 30,000 60,000
25 tjutju 15,000 7,500 7,500 15,000
26 biduri 70,000 35,000 35,000 70,000
27 ropi 35,000 17,500 17,500 35,000
28 5/4/2014 megasari 40,000 20,000 20,000 40,000
29 ade lukman 60,000 30,000 30,000 60,000
30 ali setiawan 70,000 35,000 35,000 70,000
31 djemi 30,000 15,000 15,000 30,000
32 arum 30,000 15,000 15,000 30,000
33 siti h 30,000 15,000 15,000 30,000
34 deni k 15,000 10,000 7,500 7,500 25,000
35 melianti 30,000 10,000 15,000 15,000 40,000
36 neni s 30,000 15,000 15,000 30,000
37 7/4/2014 rina noviana 15,000 10,000 7,500 7,500 25,000
38 sa adah 30,000 10,000 15,000 15,000 40,000
39 mardiyono 30,000 15,000 15,000 30,000
40 syafrudin 15,000 7,500 7,500 15,000
41 asep s 15,000 7,500 7,500 15,000
42 8/4/2014 mamat sudrajat 40,000 20,000 20,000 40,000
43 theresia 30,000 15,000 15,000 30,000
44 sunani 15,000 10,000 7,500 7,500 25,000
45 kezia 30,000 15,000 15,000 30,000
46 emang 60,000 10,000 30,000 30,000 70,000
47 alfiyya 30,000 15,000 15,000 30,000
48 asep m 30,000 10,000 15,000 15,000 40,000
49 imas a 30,000 15,000 15,000 30,000
50 panji i 30,000 15,000 15,000 30,000
51 10/4/2014 warny 70,000 35,000 35,000 70,000
52 arum m 40,000 20,000 20,000 40,000
53 anik 30,000 15,000 15,000 30,000
54 intan 15,000 7,500 7,500 15,000
55 11/4/2014 arin 70,000 35,000 35,000 70,000
56 hasanah 15,000 10,000 7,500 7,500 25,000
57 12/4/2014 suharsono 15,000 10,000 7,500 7,500 25,000
58 ali s 70,000 35,000 35,000 70,000
59 melianti 30,000 15,000 15,000 30,000
60 theresia 40,000 20,000 20,000 40,000
61 djemi l 30,000 15,000 15,000 30,000
62 abbot 35,000 17,500 17,500 35,000
63 imas n 30,000 15,000 15,000 30,000
64 sa'adah 30,000 15,000 15,000 30,000
65 siti h 40,000 20,000 20,000 40,000
66 14/04/2014 melianti 15,000 7,500 7,500 15,000
67 theresia 30,000 15,000 15,000 30,000
68 asep s 30,000 15,000 15,000 30,000
69 hani 30,000 15,000 15,000 30,000
70 ibnu 30,000 15,000 15,000 30,000
71 ismawati 15,000 10,000 7,500 7,500 25,000
72 15/04/2014 panji ilyas 30,000 15,000 15,000 30,000
73 mamat s 70,000 35,000 35,000 70,000
74 arum maemunah 70,000 35,000 35,000 70,000
75 ismawati 15,000 10,000 7,500 7,500 25,000
76 yulius 15,000 10,000 7,500 7,500 25,000
77 anik 40,000 20,000 20,000 40,000
78 rohayati 30,000 10,000 15,000 15,000 40,000
79 alfiyya 30,000 10,000 15,000 15,000 40,000
80 kezia 30,000 15,000 15,000 30,000
81 dini 30,000 15,000 15,000 30,000
82 16/04/2014 deli 70,000 35,000 35,000 70,000
83 sarbini r 30,000 15,000 15,000 30,000
84 mega 15,000 7,500 7,500 15,000
85 17/04/2014 alvi yunita 30,000 15,000 15,000 30,000
86 maesaroh 15,000 10,000 7,500 7,500 25,000
87 hani 30,000 15,000 15,000 30,000
88 ibnu 30,000 15,000 15,000 30,000
89 fikri 30,000 15,000 15,000 30,000
90 19/04/2014 hasanah 30,000 10,000 15,000 15,000 40,000
91 yulias 60,000 10,000 30,000 30,000 70,000
92 agus j 15,000 10,000 7,500 7,500 25,000
93 rini 30,000 10,000 15,000 15,000 40,000
94 sa'adah 30,000 15,000 15,000 30,000
95 panji 30,000 15,000 15,000 30,000
96 m agung 30,000 15,000 15,000 30,000
97 imas n 30,000 15,000 15,000 30,000
98 melianti 40,000 20,000 20,000 40,000
99 ali s 70,000 35,000 35,000 70,000
100 siti h 70,000 35,000 35,000 70,000
101 aldistarian 35,000 17,500 17,500 35,000
102 djemi 30,000 15,000 15,000 30,000
103 abbot 70,000 35,000 35,000 70,000
104 dwiyanto 15,000 7,500 7,500 15,000
105 21/04/2014 haisya zahra 25,000 10,000 12,500 12,500 35,000
106 tita fatimah 30,000 15,000 15,000 30,000
107 taufik hidayat 15,000 10,000 7,500 7,500 25,000
108 yuni herliani 30,000 15,000 15,000 30,000
109 sunarni 70,000 35,000 35,000 70,000
110 fawas 15,000 10,000 7,500 7,500 25,000
111 22/04/2014 ismawati 30,000 10,000 15,000 15,000 40,000
112 suharsono 30,000 15,000 15,000 30,000
113 priatna 30,000 15,000 15,000 30,000
114 warnati 30,000 15,000 15,000 30,000
115 alfiyya 30,000 15,000 15,000 30,000
116 23/04/2014 sunarni 30,000 15,000 15,000 30,000
117 ibut 70,000 35,000 35,000 70,000
118 ani 30,000 15,000 15,000 30,000
119 30,000 15,000 15,000 30,000
120 koswara 15,000 10,000 7,500 7,500 25,000
121 sopiyan 15,000 10,000 7,500 7,500 25,000
122 24/04/2014 theresia 70,000 35,000 35,000 70,000
123 faiz 35,000 17,500 17,500 35,000
124 hani 35,000 17,500 17,500 35,000
125 nazmi 30,000 15,000 15,000 30,000
126 rayya 50,000 25,000 25,000 50,000
127 25/04/2014 titin r 30,000 15,000 15,000 30,000
128 ai 15,000 10,000 7,500 7,500 25,000
129 intan 70,000 35,000 35,000 70,000
130 fikrie 30,000 15,000 15,000 30,000
131 zhafira 35,000 17,500 17,500 35,000
132 faiz 35,000 17,500 17,500 35,000
133 syifa 30,000 10,000 15,000 15,000 40,000
134 26/04/2014 elly 70,000 35,000 35,000 70,000
135 subiati 30,000 15,000 15,000 30,000
136 maysti 35,000 17,500 17,500 35,000
137 nabila 35,000 17,500 17,500 35,000
138 megasari 40,000 20,000 20,000 40,000
139 tita fatimah 30,000 15,000 15,000 30,000
140 slamet priyadi 15,000 10,000 7,500 7,500 25,000
141 rini supriatin 30,000 15,000 15,000 30,000
142 windu tiare 70,000 35,000 35,000 70,000
143 ira febrianti 25,000 12,500 12,500 25,000
144 abbot 35,000 17,500 17,500 35,000
145 djemi 30,000 15,000 15,000 30,000
146 28/04/2014 melianti 15,000 10,000 7,500 7,500 25,000
147 yuni herliani 30,000 15,000 15,000 30,000
148 sa'adah 40,000 20,000 20,000 40,000
149 panji 30,000 15,000 15,000 30,000
150 sunarni 30,000 15,000 15,000 30,000
151 tiara 15,000 7,500 7,500 15,000
152 rini 15,000 7,500 7,500 15,000
153 dafinal 25,000 12,500 12,500 25,000
154 subiati 15,000 7,500 7,500 15,000
155 29/04/2014 arum m 30,000 15,000 15,000 30,000
156 suharsono 30,000 15,000 15,000 30,000
157 priatna 30,000 15,000 15,000 30,000
158 siti v 15,000 7,500 7,500 15,000
159 rohaendi 15,000 7,500 7,500 15,000
160 surya 15,000 10,000 7,500 7,500 25,000
161 sumarsih 30,000 15,000 15,000 30,000
162 alifyya 30,000 15,000 15,000 30,000
163 kezia 70,000 35,000 35,000 70,000
164 30/04/2014 tita fatimah 30,000 15,000 15,000 30,000
165 ani 30,000 15,000 15,000 30,000
166 marwati 15,000 7,500 7,500 15,000
167 hani 70,000 35,000 35,000 70,000
11,090,000 692,000 5,404,000 5,404,000 11,500,000

PERIODE MEI 2014
JASA ALAT &

DOKTER BAHAN
1 5/2/2014 ridwan 80,000 3,000 38,500 38,500 80,000
2 imam 40,000 3,000 18,500 18,500 40,000
3 bobi 30,000 3,000 13,500 13,500 30,000
4 5/3/2014 omih 20,000 3,000 8,500 8,500 20,000
5 afif 80,000 3,000 38,500 38,500 80,000
6 arim 100,000 3,000 48,500 48,500 100,000
7 ridwan 50,000 3,000 23,500 23,500 50,000
8 5/6/2014 kun maharso 50,000 3,000 23,500 23,500 50,000
9 ade 115,000 3,000 56,000 56,000 115,000
10 mae 100,000 3,000 48,500 48,500 100,000
11 5/7/2014 ridwan 50,000 3,000 23,500 23,500 50,000
12 lina 200,000 3,000 98,500 98,500 200,000
13 5/8/2014 nurdin 50,000 3,000 23,500 23,500 50,000
14 faiz hilmi 20,000 3,000 8,500 8,500 20,000
15 rulita 40,000 3,000 18,500 18,500 40,000
16 5/9/2014 fadly 40,000 3,000 18,500 18,500 40,000
17 iwan 200,000 3,000 98,500 98,500 200,000
18 listia 50,000 3,000 23,500 23,500 50,000
19 nabila 50,000 3,000 23,500 23,500 50,000
20 4/10/2014 yuli 50,000 3,000 23,500 23,500 50,000
21 ridwan 70,000 3,000 33,500 33,500 70,000
22 melianti 150,000 3,000 73,500 73,500 150,000
23 usman 40,000 3,000 18,500 18,500 40,000
24 amah 100,000 3,000 48,500 48,500 100,000
25 5/12/2014 aina 50,000 3,000 23,500 23,500 50,000
26 aji r 80,000 3,000 38,500 38,500 80,000
27 lilis 50,000 3,000 23,500 23,500 50,000
28 5/13/2014 nur m 50,000 3,000 23,500 23,500 50,000
29 ade 90,000 3,000 43,500 43,500 90,000
30 entin 70,000 3,000 33,500 33,500 70,000
31 widiyati 60,000 3,000 28,500 28,500 60,000
32 usman 40,000 3,000 18,500 18,500 40,000
33 5/16/2014 hery santoso 100,000 3,000 48,500 48,500 100,000
34 mudiana 200,000 3,000 98,500 98,500 200,000
35 yui 50,000 3,000 23,500 23,500 50,000
36 silmi 20,000 30,000 (5,000) (5,000) 20,000
37 5/17/2014 silmi 50,000 3,000 23,500 23,500 50,000
38 imas 100,000 3,000 48,500 48,500 100,000
39 wawan 20,000 3,000 8,500 8,500 20,000
40 mudiana 200,000 3,000 98,500 98,500 200,000
41 asep 20,000 3,000 8,500 8,500 20,000
42 ismail nurdin 200,000 3,000 98,500 98,500 200,000
43 m susan 20,000 3,000 8,500 8,500 20,000
44 5/19/2014 lilis 50,000 3,000 23,500 23,500 50,000
45 andina 20,000 3,000 8,500 8,500 20,000
46 anita 20,000 3,000 8,500 8,500 20,000
47 5/20/2014 m ristul 40,000 3,000 18,500 18,500 40,000
48 silmi 100,000 3,000 48,500 48,500 100,000
49 rulita 130,000 3,000 63,500 63,500 130,000
50 kun maharso 50,000 3,000 23,500 23,500 50,000
51 5/21/2014 ratna ne 20,000 3,000 8,500 8,500 20,000
52 jasmine 50,000 3,000 23,500 23,500 50,000
53 usman 50,000 3,000 23,500 23,500 50,000
54 santi 50,000 3,000 23,500 23,500 50,000
55 retna 50,000 3,000 23,500 23,500 50,000
56 5/22/2014 iryani 50,000 3,000 23,500 23,500 50,000
57 4/23/2014 imas 200,000 3,000 98,500 98,500 200,000
58 arini 100,000 3,000 48,500 48,500 100,000
59 agus 100,000 3,000 48,500 48,500 100,000
60 zahra 50,000 3,000 23,500 23,500 50,000
61 mega 50,000 3,000 23,500 23,500 50,000
62 5/24/2014 hayat 20,000 3,000 8,500 8,500 20,000
63 dian f 210,000 3,000 103,500 103,500 210,000
64 solihin 270,000 3,000 133,500 133,500 270,000
65 5/26/2014 anita 40,000 3,000 18,500 18,500 40,000
66 budi 140,000 3,000 68,500 68,500 140,000
67 lilis 60,000 3,000 28,500 28,500 60,000
68 listia 50,000 3,000 23,500 23,500 50,000
69 iryani 100,000 3,000 48,500 48,500 100,000
70 naila 20,000 3,000 8,500 8,500 20,000
71 5/28/2014 harmadi 170,000 3,000 83,500 83,500 170,000
72 kushandayani 150,000 3,000 73,500 73,500 150,000
73 ahmad 150,000 3,000 73,500 73,500 150,000
74 mei 35,000 3,000 16,000 16,000 35,000
75 yulianto 85,000 42,500 42,500 85,000
76 5/31/2014 wiwit 120,000 3,000 58,500 58,500 120,000
77 tri w 100,000 3,000 48,500 48,500 100,000
78 dian f 120,000 3,000 58,500 58,500 120,000
79 yohanes 200,000 3,000 98,500 98,500 200,000
6,465,000 261,000 3,102,000 3,102,000 6,465,000

PERIODE MEI 2014
JASA ALAT &

TGL NAMA PASIEN TARIF OBAT JML
DOKTER BAHAN
1 5/2/2014 subiati 30,000 10,000 15,000 15,000 40,000
2 shirley 30,000 15,000 15,000 30,000
3 zhafira 35,000 17,500 17,500 35,000
4 syafrudin 70,000 35,000 35,000 70,000
5 nazmi 30,000 15,000 15,000 30,000
6 trya 30,000 15,000 15,000 30,000
7 theresia 30,000 15,000 15,000 30,000
8 sumarsih 30,000 10,000 15,000 15,000 40,000
9 yulias 15,000 10,000 7,500 7,500 25,000
10 5/3/2014 almahyra 15,000 7,500 7,500 15,000
11 syafrudin 70,000 35,000 35,000 70,000
12 elly r 70,000 35,000 35,000 70,000
13 syifa 30,000 15,000 15,000 30,000
14 subiati 30,000 15,000 15,000 30,000
15 agus jaelani 15,000 10,000 7,500 7,500 25,000
16 slamet p 30,000 10,000 15,000 15,000 40,000
17 rifan 25,000 12,500 12,500 25,000
18 donitha 25,000 12,500 12,500 25,000
19 djemi 25,000 12,500 12,500 25,000
20 5/5/2014 subiati 60,000 10,000 30,000 30,000 70,000
21 titin s 15,000 10,000 7,500 7,500 25,000
22 e surtiati 15,000 10,000 7,500 7,500 25,000
23 sa'adah 70,000 35,000 35,000 70,000
24 tita f 40,000 20,000 20,000 40,000
25 sarbini 30,000 15,000 15,000 30,000
26 rifan 25,000 12,500 12,500 25,000
27 panji 35,000 17,500 17,500 35,000
28 sumarsih 30,000 15,000 15,000 30,000
29 hana 25,000 12,500 12,500 25,000
30 trya 30,000 15,000 15,000 30,000
31 5/6/2014 ecin kuraesin 30,000 15,000 15,000 30,000
32 anik s 70,000 35,000 35,000 70,000
33 hasanah 30,000 15,000 15,000 30,000
34 ismawanti 15,000 7,500 7,500 15,000
35 5/7/2014 yuni h 30,000 15,000 15,000 30,000
36 ani 30,000 15,000 15,000 30,000
37 silviana 15,000 7,500 7,500 15,000
38 alvi 15,000 7,500 7,500 15,000
39 5/9/2014 agus irawan 15,000 10,000 7,500 7,500 25,000
40 trya r 30,000 15,000 15,000 30,000
41 nazmi 40,000 20,000 20,000 40,000
42 ibut sukarti 30,000 15,000 15,000 30,000
43 jajang s 70,000 35,000 35,000 70,000
44 5/10/2014 syifa 30,000 15,000 15,000 30,000
45 elly r 30,000 15,000 15,000 30,000
46 permayanti 15,000 10,000 7,500 7,500 25,000
47 subiati 30,000 15,000 15,000 30,000
48 theresia 30,000 15,000 15,000 30,000
49 murwati 30,000 15,000 15,000 30,000
50 engkus 30,000 15,000 15,000 30,000
51 djemi 30,000 15,000 15,000 30,000
52 abbot 70,000 35,000 35,000 70,000
53 aran 15,000 7,500 7,500 15,000
54 zaradipataa 15,000 7,500 7,500 15,000
55 5/12/2014 sa'adah 70,000 35,000 35,000 70,000
56 tita fatimah 70,000 35,000 35,000 70,000
57 sarbini 30,000 15,000 15,000 30,000
58 elly r 30,000 10,000 15,000 15,000 40,000
59 windu 60,000 10,000 30,000 30,000 70,000
60 epa 15,000 7,500 7,500 15,000
61 juju 15,000 7,500 7,500 15,000
62 5/13/2014 imas 60,000 30,000 30,000 60,000
63 ecin 30,000 15,000 15,000 30,000
64 victor 15,000 10,000 7,500 7,500 25,000
65 qiza 30,000 15,000 15,000 30,000
66 priatna 70,000 35,000 35,000 70,000
67 diny 30,000 15,000 15,000 30,000
68 murwati 30,000 15,000 15,000 30,000
69 5/14/2014 engkus kusmiati 30,000 15,000 15,000 30,000
70 nabila 25,000 12,500 12,500 25,000
71 yuni h 40,000 20,000 20,000 40,000
72 asrofiatun 30,000 15,000 15,000 30,000
73 ani 30,000 15,000 15,000 30,000
74 neni 15,000 7,500 7,500 15,000
75 5/16/2014 m ramdan 35,000 17,500 17,500 35,000
76 atin p 15,000 7,500 7,500 15,000
77 agus 70,000 35,000 35,000 70,000
78 dafi albrian 35,000 17,500 17,500 35,000
79 trya 30,000 15,000 15,000 30,000
80 sumaryanto 60,000 30,000 30,000 60,000
81 m azmi 30,000 10,000 15,000 15,000 40,000
82 nazmi 70,000 35,000 35,000 70,000
83 5/17/2014 titin 15,000 7,500 7,500 15,000
84 irma 15,000 7,500 7,500 15,000
85 rifa 15,000 7,500 7,500 15,000
86 syifa 15,000 7,500 7,500 15,000
87 elly 70,000 35,000 35,000 70,000
88 5/19/2014 silvester 15,000 7,500 7,500 15,000
89 yuni herliani 70,000 35,000 35,000 70,000
90 arin 30,000 10,000 15,000 15,000 40,000
91 zaskia 25,000 10,000 12,500 12,500 35,000
92 amira 15,000 10,000 7,500 7,500 25,000
93 salma 15,000 10,000 7,500 7,500 25,000
94 neti 15,000 10,000 7,500 7,500 25,000
95 herdiawan 15,000 10,000 7,500 7,500 25,000
96 m rizky 25,000 12,500 12,500 25,000
97 karwati 30,000 15,000 15,000 30,000
98 ani 30,000 15,000 15,000 30,000
99 5/20/2014 erna rochaeni 15,000 10,000 7,500 7,500 25,000
100 5/21/2014 syifa 30,000 15,000 15,000 30,000
101 sarbini 40,000 20,000 20,000 40,000
102 engkus 30,000 15,000 15,000 30,000
103 mugi 70,000 35,000 35,000 70,000
104 elly r 30,000 10,000 15,000 15,000 40,000
105 asyik k 30,000 10,000 15,000 15,000 40,000
106 egi 25,000 12,500 12,500 25,000
107 ratnawati 15,000 10,000 7,500 7,500 25,000
108 deti 30,000 15,000 15,000 30,000
109 wahyu i 15,000 10,000 7,500 7,500 25,000
110 m azmi 30,000 15,000 15,000 30,000
111 5/22/2014 marwati 15,000 10,000 7,500 7,500 25,000
112 5/23/2014 siti 15,000 7,500 7,500 15,000
113 eti setiawati 15,000 7,500 7,500 15,000
114 silvester 15,000 10,000 7,500 7,500 25,000
115 theresia 40,000 20,000 20,000 40,000
116 thrya 40,000 20,000 20,000 40,000
117 titin 15,000 7,500 7,500 15,000
118 5/24/2014 elly 30,000 15,000 15,000 30,000
119 shifa 30,000 15,000 15,000 30,000
120 djemi 40,000 20,000 20,000 40,000
121 eti s 15,000 7,500 7,500 15,000
122 nurjaman 30,000 10,000 15,000 15,000 40,000
123 murwati 30,000 10,000 15,000 15,000 40,000
124 sumaryanto 15,000 10,000 7,500 7,500 25,000
125 5/26/2014 yuli y 30,000 10,000 15,000 15,000 40,000
126 aran komara 15,000 10,000 7,500 7,500 25,000
127 sarbini 70,000 35,000 35,000 70,000
128 hana deni 25,000 12,500 12,500 25,000
129 didin 15,000 7,500 7,500 15,000
130 5/28/2014 yuni h 70,000 35,000 35,000 70,000
131 engkus kusmiati 30,000 15,000 15,000 30,000
132 asyik k 30,000 15,000 15,000 30,000
133 bagas 15,000 10,000 7,500 7,500 25,000
134 silvester 15,000 10,000 7,500 7,500 25,000
135 wawan 60,000 10,000 30,000 30,000 70,000
136 syachril khalid 70,000 35,000 35,000 70,000
137 dimas agung 30,000 15,000 15,000 30,000
138 achmad sukiran 70,000 35,000 35,000 70,000
139 jihan fitria 70,000 35,000 35,000 70,000
140 5/30/2014 dani m 15,000 10,000 7,500 7,500 25,000
141 aditya s 15,000 7,500 7,500 15,000
142 neti 30,000 10,000 15,000 15,000 40,000
143 amira 15,000 7,500 7,500 15,000
144 salma 15,000 7,500 7,500 15,000
145 theresia 70,000 35,000 35,000 70,000
146 shirley 40,000 20,000 20,000 40,000
147 trya 70,000 35,000 35,000 70,000
148 murwati 30,000 15,000 15,000 30,000
149 faiz 35,000 17,500 17,500 35,000
150 nandang 30,000 10,000 15,000 15,000 40,000
151 5/31/2014 theresia 70,000 35,000 35,000 70,000
152 suradeya 15,000 7,500 7,500 15,000
153 ely 30,000 15,000 15,000 30,000
154 syifa 40,000 20,000 20,000 40,000
155 asrofiatun 30,000 15,000 15,000 30,000
156 syahbudi 15,000 10,000 7,500 7,500 25,000
157 sumiatun 15,000 10,000 7,500 7,500 25,000
11,545,000 641,000 5,642,000 5,642,000 11,925,000
LAPORAN KUNJUNGAN PASIEN GIGI MP KESEHATAN

PERIODE MEI 2014
JASA ALAT &

DOKTER BAHAN
1 5/2/2014 siti n 15,000 7,500 7,500 15,000
2 fikrie 30,000 15,000 15,000 30,000
3 5/3/2014 ismawanti 30,000 10,000 15,000 15,000 40,000
4 imas 30,000 15,000 15,000 30,000
5 5/6/2014 susi lawati 30,000 10,000 15,000 15,000 40,000
6 5/7/2014 susi l 15,000 10,000 7,500 7,500 25,000
7 5/9/2014 siti n 15,000 7,500 7,500 15,000
8 fikrie 30,000 15,000 15,000 30,000
9 10/052014 melianti 15,000 10,000 7,500 7,500 25,000
10 imas 40,000 20,000 20,000 40,000
11 5/12/2014 esih 30,000 10,000 15,000 15,000 40,000
12 5/13/2014 arum m 30,000 15,000 15,000 30,000
13 riqhi 30,000 15,000 15,000 30,000
14 5/16/2014 arum 30,000 15,000 15,000 30,000
15 fikrie 50,000 25,000 25,000 50,000
16 5/17/2014 imas 70,000 35,000 35,000 70,000
17 rizki 40,000 20,000 20,000 40,000
18 arum 70,000 35,000 35,000 70,000
19 5/19/2014 imas r 50,000 10,000 25,000 25,000 60,000
20 5/20/2014 engkos 30,000 15,000 15,000 30,000
21 imas 50,000 25,000 25,000 50,000
22 5/21/2014 dasar 70,000 35,000 35,000 70,000
23 5/22/2014 engkos 30,000 10,000 15,000 15,000 40,000
24 5/23/2014 fikrie 50,000 25,000 25,000
25 siti n 30,000 10,000 15,000 15,000 40,000
26 5/24/2014 imas 50,000 10,000 25,000 25,000
27 5/28/2014 hendriana 50,000 10,000 25,000 25,000 60,000
28 nani s 30,000 10,000 15,000 15,000 40,000
29 5/30/2014 engkos 80,000 10,000 40,000 40,000 90,000
30 fikrie 50,000 25,000 25,000
31 5/31/2014 imas 50,000 10,000 25,000 25,000
32 wily 70,000 35,000 35,000 70,000
16,960,000 1,071,000 8,349,500 8,349,500 17,720,000

PERIODE JULI 2014
JASA ALAT &

DOKTER BAHAN
1 7/2/2014 sugeng riyadi 50,000 3,000 23,500 23,500 50,000
2 ayi kusnandar 50,000 3,000 23,500 23,500 50,000
3 kushandayani 160,000 3,000 78,500 78,500 160,000
4 husna 100,000 3,000 48,500 48,500 100,000
5 nia 50,000 3,000 23,500 23,500 50,000
6 michelle 50,000 3,000 23,500 23,500 50,000
7 7/3/2014 dian 70,000 3,000 33,500 33,500 70,000
8 cucu 60,000 3,000 28,500 28,500 60,000
9 saefudin 50,000 3,000 23,500 23,500 50,000
10 indra 100,000 3,000 48,500 48,500 100,000
11 7/4/2014 sadiah 170,000 3,000 83,500 83,500 170,000
12 irfan 20,000 3,000 8,500 8,500 20,000
13 7/5/2014 mega isa 50,000 3,000 23,500 23,500 50,000
14 dwi rahayu 30,000 3,000 13,500 13,500 30,000
15 candra 120,000 3,000 58,500 58,500 120,000
16 tri 300,000 3,000 148,500 148,500 300,000
17 vera 160,000 3,000 78,500 78,500 160,000
18 7/7/2014 yayu 20,000 3,000 8,500 8,500 20,000
19 husna 120,000 3,000 58,500 58,500 120,000
20 sofiah 20,000 3,000 8,500 8,500 20,000
21 aris 150,000 3,000 73,500 73,500 150,000
22 euis 100,000 3,000 48,500 48,500 100,000
23 7/8/2014 sri 40,000 3,000 18,500 18,500 40,000
24 dewi 80,000 3,000 38,500 38,500 80,000
25 7/10/2014 yayu 20,000 3,000 8,500 8,500 20,000
26 vonia 80,000 3,000 38,500 38,500 80,000
27 7/11/2014 naia 100,000 3,000 48,500 48,500 100,000
28 7/12/2014 yayu 20,000 3,000 8,500 8,500 20,000
29 mega isa 100,000 3,000 48,500 48,500 100,000
30 hariz 50,000 3,000 23,500 23,500 50,000
31 7/14/2014 kushandayani 80,000 3,000 38,500 38,500 80,000
32 riska 50,000 3,000 23,500 23,500 50,000
33 lina 20,000 3,000 8,500 8,500 20,000
34 rani 50,000 3,000 23,500 23,500 50,000
35 7/15/2014 wikijah 60,000 3,000 28,500 28,500 60,000
36 eli 60,000 30,000 15,000 15,000 60,000
37 7/17/2014 sugeng riyadi 50,000 3,000 23,500 23,500 50,000
38 dafinal 35,000 3,000 16,000 16,000 35,000
39 ayi kusnandar 60,000 3,000 28,500 28,500 60,000
40 refiani 30,000 3,000 13,500 13,500 30,000
41 7/18/2014 erlin 100,000 3,000 48,500 48,500 100,000
42 pheili 50,000 3,000 23,500 23,500 50,000
43 irfan 150,000 3,000 73,500 73,500 150,000
44 7/19/2014 mega isa 100,000 3,000 48,500 48,500 100,000
45 haris 60,000 3,000 28,500 28,500 60,000
46 rizky 80,000 3,000 38,500 38,500 80,000
47 7/21/2014 iwan 50,000 3,000 23,500 23,500 50,000
48 ilyas 20,000 3,000 8,500 8,500 20,000
49 erin 100,000 3,000 48,500 48,500 100,000
50 adlar 50,000 3,000 23,500 23,500 50,000
51 7/22/2014 sri 20,000 3,000 8,500 8,500 20,000
52 7/23/2014 sugeng 60,000 3,000 28,500 28,500 60,000
53 tati 40,000 3,000 18,500 18,500 40,000
54 tatang 30,000 3,000 13,500 13,500 30,000
55 indra 300,000 3,000 148,500 148,500 300,000
56 omah 30,000 3,000 13,500 13,500 30,000
57 7/25/2014 dewi 90,000 3,000 43,500 43,500 90,000
58 erlin 100,000 3,000 48,500 48,500 100,000
59 siti sopian 120,000 3,000 58,500 58,500 120,000
4,535,000 204,000 2,165,500 2,165,500 4,535,000

PERIODE JULI 2014
JASA ALAT &

DOKTER BAHAN
1 7/2/2014 melinda a 30,000 10,000 15,000 15,000 40,000
2 asmiliwarti 15,000 10,000 7,500 7,500 25,000
3 maman 30,000 15,000 15,000 30,000
4 risti 25,000 12,500 12,500 25,000
5 michelle n 50,000 25,000 25,000 50,000
6 wasmin 30,000 15,000 15,000 30,000
7 saeful 30,000 15,000 15,000 30,000
8 7/3/2014 heppi 30,000 15,000 15,000 30,000
9 ihsan 70,000 35,000 35,000 70,000
10 7/4/2014 ika 30,000 15,000 15,000 30,000
11 nurma 30,000 10,000 15,000 15,000 40,000
12 siti atikah 30,000 15,000 15,000 30,000
13 imas 15,000 10,000 7,500 7,500 25,000
14 giva 70,000 35,000 35,000 70,000
15 7/5/2014 mega 40,000 20,000 20,000 40,000
16 7/7/2014 jomuk bernadetta 30,000 10,000 15,000 15,000 40,000
17 agus s 70,000 35,000 35,000 70,000
18 maman 40,000 10,000 20,000 20,000 50,000
19 saepudin 35,000 10,000 17,500 17,500 45,000
20 naufal 25,000 12,500 12,500 25,000
21 eka 15,000 10,000 7,500 7,500 25,000
22 lilis 15,000 10,000 7,500 7,500 25,000
23 7/8/2014 heppy s 30,000 15,000 15,000 30,000
24 iis suhaibah 50,000 25,000 25,000 50,000
25 7/10/2014 ja'ah 60,000 10,000 30,000 30,000 70,000
26 heppy s 15,000 7,500 7,500 15,000
27 theresia 30,000 15,000 15,000 30,000
28 7/11/2014 laeli rukmini 30,000 15,000 15,000 30,000
29 siti atikah 30,000 15,000 15,000 30,000
30 heppi s 30,000 15,000 15,000 30,000
31 adi p 15,000 7,500 7,500 15,000
32 yulius 15,000 7,500 7,500 15,000
33 numa 30,000 15,000 15,000 30,000
34 7/12/2014 mega sari 70,000 35,000 35,000 70,000
35 ratna j 70,000 35,000 35,000 70,000
36 agus y 15,000 10,000 7,500 7,500 25,000
37 melinda a 30,000 15,000 15,000 30,000
38 m zufar 30,000 15,000 15,000 30,000
39 7/14/2014 ade kurniasih 15,000 10,000 7,500 7,500 25,000
40 maman w 70,000 35,000 35,000 70,000
41 heppi s 70,000 35,000 35,000 70,000
42 agus h 70,000 35,000 35,000 70,000
43 lilis 60,000 30,000 30,000 60,000
44 7/15/2014 subiati 15,000 10,000 7,500 7,500 25,000
45 aii 70,000 35,000 35,000 70,000
46 7/16/2014 anwar 15,000 10,000 7,500 7,500 25,000
47 wawan 30,000 10,000 15,000 15,000 40,000
48 heppi s 30,000 15,000 15,000 30,000
49 siti 15,000 10,000 7,500 7,500 25,000
50 theresia 40,000 20,000 20,000 40,000
51 azzahra 25,000 12,500 12,500 25,000
52 fawwaz 30,000 15,000 15,000 30,000
53 viona 30,000 15,000 15,000 30,000
54 7/18/2014 jomuk bernadetta 30,000 15,000 15,000 30,000
55 siti 15,000 10,000 7,500 7,500 25,000
56 siti atikah 30,000 15,000 15,000 30,000
57 saeli 30,000 15,000 15,000 30,000
58 ati winarti 15,000 10,000 7,500 7,500 25,000
59 biduri 30,000 15,000 15,000 -
60 wagimin 30,000 15,000 15,000 30,000
61 nadza 30,000 15,000 15,000 30,000
62 7/19/2014 vilia y 15,000 10,000 7,500 7,500 25,000
63 yafi 30,000 15,000 15,000 30,000
64 zufar 30,000 10,000 15,000 15,000 40,000
65 7/21/2014 nurmeilisa 70,000 35,000 35,000 70,000
66 heppi s 40,000 20,000 20,000 40,000
67 umar 70,000 35,000 35,000 70,000
68 aurelia 25,000 12,500 12,500 25,000
69 melinda 30,000 15,000 15,000 30,000
70 ja'ah 30,000 15,000 15,000 30,000
71 lilis r 60,000 30,000 30,000 60,000
72 irham 15,000 10,000 7,500 7,500 25,000
73 7/23/2014 sudarwanti 30,000 15,000 15,000 30,000
74 m zufar 30,000 15,000 15,000 30,000
75 dani mardhani 15,000 10,000 7,500 7,500 25,000
76 siti munawaroh 15,000 10,000 7,500 7,500 25,000
77 7/25/2014 m ircham 15,000 7,500 7,500 15,000
78 elih 30,000 10,000 15,000 15,000 40,000
79 shela 15,000 10,000 7,500 7,500 25,000
80 7/26/2014 m zufar 70,000 35,000 35,000 70,000
81 ecin k 30,000 10,000 15,000 15,000 40,000
7,300,000 464,000 3,548,000 3,548,000 7,530,000

PERIODE JULI 2014
JASA ALAT &

DOKTER BAHAN
1 04/072014 endang 30,000 15,000 15,000 30,000
2 7/5/2014 willy 70,000
3 7/12/2014 endang 30,000 10,000
4 willy 70,000 35,000 35,000 70,000
5 zidan aulia 50,000
6 7/14/2014 lilis 70,000
7 7/16/2014 siti 30,000 10,000 15,000 15,000 40,000
8 7/19/2014 aris jaka 70,000 35,000 35,000 70,000
9 willy 671,000 335,500 335,500 671,000
10 22/07/214 deni 70,000 10,000 35,000 35,000 80,000
11 7/23/2014 engkos k 30,000 15,000 15,000 30,000
12 7/26/2014 willy 30,000 15,000 15,000 30,000
10,586,000 684,000 5,081,000 5,081,000 10,776,000

JASA ALAT &

DOKTER BAHAN
1 8/4/2014 indra 50,000 3,000 23,500 23,500 50,000
2 hera 20,000 3,000 8,500 8,500 20,000
3 yusni 50,000 3,000 23,500 23,500 50,000
4 yeti 20,000 3,000 8,500 8,500 20,000
5 euis 200,000 3,000 98,500 98,500 200,000
6 wawan 50,000 3,000 23,500 23,500 50,000
7 suti 20,000 3,000 8,500 8,500 20,000
8 irma 20,000 3,000 8,500 8,500 20,000
9 8/6/2014 sugeng 100,000 3,000 48,500 48,500 100,000
10 nida 50,000 3,000 23,500 23,500 50,000
11 jaenal 20,000 3,000 8,500 8,500 20,000
8 8/9/2014 endang 100,000 3,000 48,500 48,500 100,000
13 popon 150,000 3,000 73,500 73,500 150,000
14 rudi 100,000 3,000 48,500 48,500 100,000
15 farah 50,000 3,000 23,500 23,500 50,000
16 imas 50,000 3,000 23,500 23,500 50,000
17 heni 280,000 3,000 138,500 138,500 280,000
18 8/11/2014 arjuna 40,000 3,000 18,500 18,500 40,000
19 wawan 50,000 3,000 23,500 23,500 50,000
20 rani 80,000 3,000 38,500 38,500 80,000
21 8/13/2014 aisya 40,000 3,000 18,500 18,500 40,000
22 euis 200,000 3,000 98,500 98,500 200,000
23 nayla 50,000 3,000 23,500 23,500 50,000
24 irma 20,000 3,000 8,500 8,500 20,000
25 nunung 20,000 3,000 8,500 8,500 20,000
26 8/14/2014 tati 20,000 10,000 10,000 20,000
27 fitri 20,000 3,000 8,500 8,500 20,000
28 8/15/2014 pheili 40,000 3,000 18,500 18,500 40,000
29 8/16/2014 dani 30,000 3,000 13,500 13,500 30,000
30 lisa 60,000 3,000 28,500 28,500 60,000
31 nirma 30,000 3,000 13,500 13,500 30,000
32 8/18/2014 irwan 100,000 3,000 48,500 48,500 100,000
33 wawan 50,000 3,000 23,500 23,500 50,000
34 atik 20,000 3,000 8,500 8,500 20,000
35 rafi 50,000 3,000 23,500 23,500 50,000
36 8/19/2014 ahmat 40,000 30,000 5,000 5,000 40,000
37 8/20/2014 eti 100,000 3,000 48,500 48,500 100,000
38 dani 50,000 3,000 23,500 23,500 50,000
39 rhesia 20,000 3,000 8,500 8,500 20,000
40 nayla 50,000 3,000 23,500 23,500 50,000
41 endang 20,000 3,000 8,500 8,500 20,000
42 8/21/2014 yeti 20,000 3,000 8,500 8,500 20,000
43 8/22/2014 sudarno 100,000 3,000 48,500 48,500 100,000
44 8/23/2014 voppy 80,000 3,000 38,500 38,500 80,000
45 8/25/2014 tursiah 20,000 3,000 8,500 8,500 20,000
46 heru 20,000 3,000 8,500 8,500 20,000
47 siti s 50,000 3,000 23,500 23,500 50,000
48 wawan 100,000 3,000 48,500 48,500 100,000
49 euis 200,000 3,000 98,500 98,500 200,000
50 8/26/2014 rohaeti 20,000 3,000 8,500 8,500 20,000
51 dani 50,000 3,000 23,500 23,500 50,000
52 yusni 70,000 3,000 33,500 33,500 70,000
53 8/27/2014 ardi 50,000 3,000 23,500 23,500 50,000
54 surtinah 100,000 3,000 48,500 48,500 100,000
55 8/28/2014 jihan 15,000 3,000 6,000 6,000 15,000
56 yogi 25,000 3,000 11,000 11,000 25,000
57 8/29/2014 agus 100,000 3,000 48,500 48,500 100,000
58 sri 200,000 3,000 98,500 98,500 200,000
59 ardy l 120,000 3,000 58,500 58,500 120,000
60 andy 60,000 3,000 28,500 28,500 60,000
61 8/30/2014 m taufik h 20,000 3,000 8,500 8,500 20,000
3,950,000 207,000 1,871,500 1,871,500 3,950,000

JASA ALAT &

DOKTER BAHAN
1 8/4/2014 indri yani 60,000 10,000 30,000 30,000 70,000
2 heppi s 30,000 10,000 15,000 15,000 40,000
3 endah 30,000 10,000 15,000 15,000 40,000
4 ilham 25,000 10,000 12,500 12,500 35,000
5 jomuk 30,000 15,000 15,000 30,000
6 sudarwanti 30,000 15,000 15,000 30,000
7 saerul 15,000 7,500 7,500 15,000
8 iwan 30,000 15,000 15,000 30,000
9 dayat 15,000 7,500 7,500 15,000
10 eva 15,000 10,000 7,500 7,500 25,000
11 achmad 15,000 10,000 7,500 7,500 25,000
12 refah 15,000 7,500 7,500 15,000
13 mutiara 15,000 7,500 7,500 15,000
14 lilis 60,000 30,000 30,000 60,000
15 meysa 25,000 12,500 12,500 25,000
16 8/5/2014 tarwilah 30,000 15,000 15,000 30,000
17 eka 35,000 17,500 17,500 35,000
18 zaky 15,000 10,000 7,500 7,500 25,000
19 hani 70,000 10,000 35,000 35,000 80,000
20 rafi 15,000 10,000 7,500 7,500 25,000
21 metta 15,000 10,000 7,500 7,500 25,000
22 wagimin 30,000 15,000 15,000 30,000
23 fadilla 15,000 7,500 7,500 15,000
24 dadang 30,000 10,000 15,000 15,000 40,000
25 salwa 70,000 35,000 35,000 70,000
26 8/6/2014 rahma s 25,000 12,500 12,500 25,000
27 yuli 30,000 15,000 15,000 30,000
28 siti k 30,000 10,000 15,000 15,000 40,000
29 m ramdan 15,000 10,000 7,500 7,500 25,000
30 yaman 15,000 10,000 7,500 7,500 25,000
31 suwarna 15,000 10,000 7,500 7,500 25,000
32 reyandra 25,000 12,500 12,500 25,000
33 8/7/2014 albert 15,000 10,000 7,500 7,500 25,000
34 imas r 15,000 10,000 7,500 7,500 25,000
35 kokom k 15,000 10,000 7,500 7,500 25,000
36 rusmana 15,000 10,000 7,500 7,500 25,000
37 mayra 15,000 10,000 7,500 7,500 25,000
38 8/8/2014 heppi s 30,000 15,000 15,000 30,000
39 sudarwati 30,000 15,000 15,000 30,000
40 dadan 30,000 10,000 15,000 15,000 40,000
41 eti 15,000 7,500 7,500 15,000
42 ilham 35,000 17,500 17,500 35,000
43 aris 15,000 10,000 7,500 7,500 25,000
44 biduri 30,000 15,000 15,000 30,000
45 8/9/2014 laeli r 30,000 15,000 15,000 30,000
46 8/11/2014 mayra 30,000 15,000 15,000 30,000
47 siti k 30,000 15,000 15,000 30,000
48 yuli y 30,000 15,000 15,000 30,000
49 kurnia 30,000 10,000 15,000 15,000 40,000
50 didin s 15,000 10,000 7,500 7,500 25,000
51 iwan b 70,000 35,000 35,000 70,000
52 rivan 25,000 12,500 12,500 25,000
53 susanto 15,000 7,500 7,500 15,000
54 8/13/2014 agus s 30,000 10,000 15,000 15,000 40,000
55 tarwilah 15,000 10,000 7,500 7,500 25,000
56 ajang 30,000 10,000 15,000 15,000 40,000
57 slamet 30,000 10,000 15,000 15,000 40,000
58 heppi s 70,000 35,000 35,000 70,000
59 tajudin 15,000 10,000 7,500 7,500 -
60 a nando 15,000 10,000 7,500 7,500 25,000
61 yogi 15,000 10,000 7,500 7,500 25,000
62 lasmidah 15,000 10,000 7,500 7,500 25,000
63 ridya 50,000 25,000 25,000 50,000
64 8/14/2014 wagimin 30,000 15,000 15,000 30,000
65 rusmana 15,000 10,000 7,500 7,500 25,000
66 siti 15,000 10,000 7,500 7,500 25,000
67 ikhsan 15,000 10,000 7,500 7,500 25,000
68 8/15/2014 sudarwati 15,000 7,500 7,500 15,000
69 laeli 30,000 15,000 15,000 30,000
70 candra 70,000 35,000 35,000 70,000
71 susanto 15,000 7,500 7,500 15,000
72 hadi s 15,000 10,000 7,500 7,500 25,000
73 8/16/2014 andi b 30,000 15,000 15,000 30,000
74 mayra 30,000 15,000 15,000 30,000
75 kokom 60,000 10,000 30,000 30,000 70,000
76 voppy 50,000 25,000 25,000 50,000
77 tajudin 60,000 30,000 30,000 60,000
78 yafi 70,000 35,000 35,000 70,000
79 mysella 35,000 17,500 17,500 35,000
80 8/18/2014 yuli 30,000 15,000 15,000 30,000
81 wahyudi 15,000 7,500 7,500 15,000
82 sipatri 15,000 10,000 7,500 7,500 25,000
83 fitrianingsih 60,000 10,000 30,000 30,000 70,000
84 susanto 60,000 10,000 30,000 30,000 70,000
85 hermansyah 15,000 10,000 7,500 7,500 25,000
86 fahira 25,000 12,500 12,500 25,000
87 8/19/2014 yuyun 70,000 35,000 35,000 70,000
88 widy 15,000 7,500 7,500 15,000
89 salwa 70,000 35,000 35,000 70,000
90 dadi 30,000 10,000 15,000 15,000 40,000
91 heny 15,000 7,500 7,500 15,000
92 neni 15,000 7,500 7,500 15,000
93 annisa 70,000 35,000 35,000 70,000
94 8/20/2014 jomuk 30,000 15,000 15,000 30,000
95 azka 15,000 10,000 7,500 7,500 25,000
96 frida 30,000 10,000 15,000 15,000 40,000
97 ari p 30,000 10,000 15,000 15,000 40,000
98 rasmana 15,000 10,000 7,500 7,500 25,000
99 syifa 15,000 10,000 7,500 7,500 25,000
100 8/21/2014 resnawah 15,000 10,000 7,500 7,500 25,000
101 agus s 30,000 15,000 15,000 30,000
102 puraniati 15,000 10,000 7,500 7,500 25,000
103 noneng 15,000 10,000 7,500 7,500 25,000
104 nanda 15,000 10,000 7,500 7,500 25,000
105 wagimin 35,000 17,500 17,500 35,000
106 sarmi 15,000 10,000 7,500 7,500 25,000
107 8/23/2014 devan 15,000 10,000 7,500 7,500 25,000
108 andi b 30,000 15,000 15,000 30,000
109 zaradipta 25,000 12,500 12,500 25,000
110 iis a 15,000 7,500 7,500 15,000
111 ahmad 25,000 12,500 12,500 25,000
112 siti h 70,000 35,000 35,000 70,000
113 8/25/2014 sukarni 15,000 10,000 7,500 7,500 25,000
114 kurnia 30,000 10,000 15,000 15,000 40,000
115 heppi s 30,000 15,000 15,000 30,000
116 sarbini 70,000 35,000 35,000 70,000
117 refiani 30,000 15,000 15,000 30,000
118 mubarok 30,000 15,000 15,000 30,000
119 8/26/2014 ani 30,000 15,000 15,000 30,000
120 edy 15,000 10,000 7,500 7,500 25,000
121 8/27/2014 elih 30,000 10,000 15,000 15,000 40,000
122 shela 60,000 10,000 30,000 30,000 70,000
123 siti k 30,000 15,000 15,000 30,000
124 8/28/2014 wagini 70,000 35,000 35,000 70,000
125 reskiawan 15,000 10,000 7,500 7,500 25,000
126 susilawati 15,000 10,000 7,500 7,500 25,000
127 sarmi 30,000 15,000 15,000 30,000
128 deni 15,000 10,000 7,500 7,500 25,000
129 8/30/2014 aiman 15,000 10,000 7,500 7,500 25,000
130 hadiyan 70,000 35,000 35,000 70,000
131 asep r 15,000 7,500 7,500 15,000
132 zaskia t 25,000 12,500 12,500 25,000
133 siti h 15,000 7,500 7,500 15,000
134 syachril 30,000 15,000 15,000 30,000
7,860,000 827,000 3,826,500 3,826,500 8,455,000

JASA ALAT &

DOKTER BAHAN
1 8/4/2014 mamat 50,000 10,000 25,000 25,000 60,000
2 8/9/2014 endang 100,000
3 8/11/2014 mardiyono 50,000
4 mamat 30,000
5 4/13/2014 pungut 30,000 10,000 15,000 15,000 40,000
6 8/18/2014 mardiyono 50,000
7 8/19/2014 mamat s 30,000
8 8/22/2014 udin 30,000 30,000
9 m abdul 70,000 35,000 35,000 70,000
10 8/26/2014 mamat 60,000 30,000 30,000 60,000
11 8/27/2014 uden 30,000 15,000 15,000 30,000
12 8/29/2014 mamat 60,000 30,000 30,000 60,000
13 8/30/2014 udin 30,000 15,000 15,000 30,000
14 8/30/2014 sri wahyuni 70,000 35,000 35,000 70,000
15 abil 40,000 20,000 20,000 40,000
11,940,000 1,387,000 5,721,500 5,721,500 12,810,000

JASA ALAT &

DOKTER BAHAN
1 9/1/2014 ardi wibowo 50,000 3,000 23,500 23,500 50,000
2 siti n 50,000 3,000 23,500 23,500 50,000
3 marvel 80,000 3,000 38,500 38,500 80,000
4 eko 50,000 3,000 23,500 23,500 50,000
5 siti s 50,000 3,000 23,500 23,500 50,000
6 heru 20,000 3,000 8,500 8,500 20,000
7 wawan 100,000 3,000 48,500 48,500 100,000
8 9/2/2014 wawat 50,000 3,000 23,500 23,500 50,000
9 ayu nita 50,000 3,000 23,500 23,500 50,000
10 jaja 50,000 3,000 23,500 23,500 50,000
11 9/3/2014 tati 40,000 3,000 18,500 18,500 40,000
8 dani 50,000 3,000 23,500 23,500 50,000
13 suwarni 20,000 3,000 8,500 8,500 20,000
14 rini 30,000 3,000 13,500 13,500 30,000
15 ilyas 20,000 3,000 8,500 8,500 20,000
16 yusni 50,000 3,000 23,500 23,500 50,000
17 fitria 20,000 3,000 8,500 8,500 20,000
18 9/5/2014 eko 100,000 3,000 48,500 48,500 100,000
19 9/6/2014 andi 50,000 3,000 23,500 23,500 50,000
20 azka 70,000 3,000 33,500 33,500 70,000
21 9/8/2014 lina 30,000 3,000 13,500 13,500 30,000
22 siti s 50,000 3,000 23,500 23,500 50,000
23 yasmin 50,000 3,000 23,500 23,500 50,000
24 9/9/2014 vriska 50,000 3,000 23,500 23,500 50,000
25 inas 40,000 3,000 18,500 18,500 40,000
26 listia 250,000 3,000 123,500 123,500 250,000
27 erlin 50,000 3,000 23,500 23,500 50,000
28 rodiah 20,000 3,000 8,500 8,500 20,000
29 9/12/2014 tuniyah 100,000 3,000 48,500 48,500 100,000
30 siti s 50,000 3,000 23,500 23,500 50,000
31 13/09/2014 ana sri 80,000 3,000 38,500 38,500 80,000
32 sulistiono 20,000 3,000 8,500 8,500 20,000
33 imam s 20,000 3,000 8,500 8,500 20,000
34 eko r 150,000 3,000 73,500 73,500 150,000
35 14/09/2014 rizal 300,000 3,000 148,500 148,500 300,000
36 15/09/2014 atang s 40,000 3,000 18,500 18,500 40,000
37 nina 100,000 3,000 48,500 48,500 100,000
38 16/09/2014 yasmin 40,000 3,000 18,500 18,500 40,000
39 rani 30,000 3,000 13,500 13,500 30,000
40 17/09/2014 leni 20,000 3,000 8,500 8,500 20,000
41 rahmawati 100,000 3,000 48,500 48,500 100,000
42 dani 120,000 3,000 58,500 58,500 120,000
43 inas 50,000 3,000 23,500 23,500 50,000
44 faiza 100,000 3,000 48,500 48,500 100,000
45 andri 50,000 3,000 23,500 23,500 50,000
46 nurita 20,000 3,000 8,500 8,500 20,000
47 raihan 100,000 3,000 48,500 48,500 100,000
48 19/09/2014 gilang 100,000 3,000 48,500 48,500 100,000
49 hadi 210,000 3,000 103,500 103,500 210,000
50 m fajar 30,000 3,000 13,500 13,500 30,000
51 20/09/2014 endang 60,000 3,000 28,500 28,500 60,000
52 22/09/2014 arya 40,000 3,000 18,500 18,500 40,000
53 diki 30,000 3,000 13,500 13,500 30,000
54 intan 200,000 3,000 98,500 98,500 200,000
55 nurita 50,000 3,000 23,500 23,500 50,000
56 andi 50,000 3,000 23,500 23,500 50,000
57 farida 20,000 3,000 8,500 8,500 20,000
58 23/09/2014 endang 50,000 3,000 23,500 23,500 50,000
59 24/09/2014 rahmawati 85,000 3,000 41,000 41,000 85,000
60 esti 50,000 3,000 23,500 23,500 50,000
61 yusuf 50,000 3,000 23,500 23,500 50,000
62 hadi 60,000 3,000 28,500 28,500 60,000
63 andy 50,000 3,000 23,500 23,500 50,000
64 26/09/2014 kartika 50,000 3,000 23,500 23,500 50,000
65 samudra 20,000 3,000 8,500 8,500 20,000
66 yusni 50,000 3,000 23,500 23,500 50,000
67 27/09/2014 yusuf 60,000 3,000 28,500 28,500 60,000
68 andy lestiano 60,000 3,000 28,500 28,500 60,000
69 indriyani 100,000 3,000 48,500 48,500 100,000
70 fitri 600,000 3,000 298,500 298,500 600,000
71 gilas 120,000 3,000 58,500 58,500 120,000
72 endang 60,000 3,000 28,500 28,500 60,000
73 28/09/2014 rizal 50,000 3,000 23,500 23,500 50,000
74 30/09/2014 asyifa 240,000 3,000 118,500 118,500 240,000
75 aan 40,000 3,000 18,500 18,500 40,000
5,615,000 225,000 2,695,000 2,695,000 5,615,000

JASA ALAT &

DOKTER BAHAN
1 9/1/2014 ari purnamasari 60,000 10,000 30,000 30,000 70,000
2 aminah 30,000 10,000 15,000 15,000 40,000
3 elih 30,000 15,000 15,000 30,000
4 candra 70,000 35,000 35,000 70,000
5 yuli y 40,000 20,000 20,000 40,000
6 heppi s 30,000 15,000 15,000 30,000
7 rafi b 30,000 15,000 15,000 30,000
8 rehani 30,000 15,000 15,000 30,000
9 siti 30,000 15,000 15,000 30,000
10 mubarod 30,000 15,000 15,000 30,000
11 resnawati 15,000 10,000 7,500 7,500 25,000
12 sharil 70,000 35,000 35,000 70,000
13 jomuk 30,000 15,000 15,000 30,000
14 rusmana 30,000 10,000 15,000 15,000 40,000
15 9/2/2014 ari purnamasari 35,000 17,500 17,500 35,000
16 rahman 25,000 12,500 12,500 25,000
17 tia 15,000 7,500 7,500 15,000
18 yoza 35,000 17,500 17,500 35,000
19 m dafi 30,000 10,000 15,000 15,000 40,000
20 nurlatipah 30,000 15,000 15,000 30,000
21 kanti 30,000 15,000 15,000 30,000
22 ani puspita 15,000 7,500 7,500 15,000
23 tresni 30,000 15,000 15,000 30,000
24 asri 15,000 7,500 7,500 15,000
25 9/3/2014 rena a 15,000 10,000 7,500 7,500 25,000
26 theresia 30,000 15,000 15,000 30,000
27 ace 15,000 10,000 7,500 7,500 25,000
28 ela 25,000 12,500 12,500 25,000
29 syachril 30,000 15,000 15,000 30,000
30 trinengsih 15,000 10,000 7,500 7,500 25,000
31 dadi 15,000 10,000 7,500 7,500 25,000
32 siti 30,000 15,000 15,000 30,000
33 iim 15,000 10,000 7,500 7,500 25,000
34 9/4/2014 salwa 15,000 7,500 7,500 15,000
35 rena 15,000 10,000 7,500 7,500 25,000
36 tri s 15,000 10,000 7,500 7,500 25,000
37 9/5/2014 sri s 60,000 10,000 30,000 30,000 70,000
38 aris m 60,000 10,000 30,000 30,000 70,000
39 9/6/2014 sadiah 70,000 10,000 35,000 35,000 80,000
40 teguh 60,000 10,000 30,000 30,000 70,000
41 trinengsih 60,000 30,000 30,000 60,000
42 iar s 30,000 15,000 15,000 30,000
43 9/8/2014 indra 25,000 12,500 12,500 25,000
44 slamet 15,000 10,000 7,500 7,500 25,000
45 9/9/2014 rini 15,000 10,000 7,500 7,500 25,000
46 refiani 30,000 10,000 15,000 15,000 40,000
47 elis 30,000 15,000 15,000 30,000
48 rusmana 30,000 15,000 15,000 30,000
49 tri s 30,000 15,000 15,000 30,000
50 aminah 30,000 15,000 15,000 30,000
51 kustiana 15,000 7,500 7,500 15,000
52 maman 70,000 35,000 35,000 70,000
53 tresni 30,000 15,000 15,000 30,000
54 syahril 70,000 35,000 35,000 70,000
55 mira 15,000 10,000 7,500 7,500 25,000
56 kanti 30,000 15,000 15,000 30,000
57 eni 15,000 10,000 7,500 7,500 25,000
58 yulianti 30,000 10,000 15,000 15,000 40,000
59 ade ridwan 30,000 15,000 15,000 -
60 nurlatifah 30,000 15,000 15,000 30,000
61 9/10/2014 fauzan 30,000 10,000 15,000 15,000 40,000
62 herinomo 15,000 10,000 7,500 7,500 25,000
63 theresia 30,000 15,000 15,000 30,000
64 heppi s 30,000 15,000 15,000 30,000
65 mubarod 35,000 17,500 17,500 35,000
66 nanik 15,000 10,000 7,500 7,500 25,000
67 tarsem 15,000 10,000 7,500 7,500 25,000
68 indah 15,000 10,000 7,500 7,500 25,000
69 rostini 15,000 10,000 7,500 7,500 25,000
70 sri s 30,000 15,000 15,000 30,000
71 biduri 30,000 15,000 15,000 30,000
72 9/11/2014 refan 15,000 7,500 7,500 15,000
73 wagimin 70,000 35,000 35,000 70,000
74 9/12/2014 qanesya 15,000 7,500 7,500 15,000
75 laeli 70,000 35,000 35,000 70,000
76 meri 15,000 10,000 7,500 7,500 25,000
77 mulyani 15,000 10,000 7,500 7,500 25,000
78 ditha 30,000 15,000 15,000 30,000
79 mulan 70,000 35,000 35,000 70,000
80 yati s 15,000 10,000 7,500 7,500 25,000
81 13/09/2014 andy 30,000 15,000 15,000 30,000
82 rondothul 100,000 50,000 50,000 100,000
83 elytas 110,000 55,000 55,000 110,000
84 fauziah 15,000 7,500 7,500 15,000
85 shafila 75,000 37,500 37,500 75,000
86 karmini 50,000 25,000 25,000 50,000
87 andika 50,000 25,000 25,000 50,000
88 sumira 15,000 10,000 7,500 7,500 25,000
89 sriayu s 15,000 10,000 7,500 7,500 25,000
90 leo 60,000 10,000 30,000 30,000 70,000
91 juju endang 70,000 35,000 35,000 70,000
92 arini 25,000 12,500 12,500 25,000
93 fauzan 30,000 15,000 15,000 30,000
94 15/09/2014 lisnawati 15,000 10,000 7,500 7,500 25,000
95 nina h 30,000 15,000 15,000 30,000
96 heppi s 40,000 20,000 20,000 40,000
97 aminah 40,000 20,000 20,000 40,000
98 16/09/2014 tati k 30,000 15,000 15,000 30,000
99 ayep 70,000 35,000 35,000 70,000
100 nurmeilisa 105,000 52,500 52,500 105,000
101 wiwin 15,000 10,000 7,500 7,500 25,000
102 jomuk 30,000 15,000 15,000 30,000
103 17/09/2014 theresia 30,000 15,000 15,000 30,000
104 tresni 30,000 15,000 15,000 30,000
105 kanti 30,000 15,000 15,000 30,000
106 irman 15,000 10,000 7,500 7,500 25,000
107 hanayaka 5,000 2,500 2,500 5,000
108 sena 15,000 7,500 7,500 15,000
109 fauziah 15,000 10,000 7,500 7,500 25,000
110 aminah 15,000 10,000 7,500 7,500 25,000
111 salma 70,000 35,000 35,000 70,000
112 neti 30,000 15,000 15,000 30,000
113 ade 30,000 15,000 15,000 30,000
114 refiani 35,000 17,500 17,500 35,000
115 arini 25,000 12,500 12,500 25,000
116 juju 15,000 10,000 7,500 7,500 25,000
117 18/09/2014 surami 15,000 10,000 7,500 7,500 25,000
118 ditha 70,000 35,000 35,000 70,000
119 ajeng 15,000 7,500 7,500 15,000
120 aisya 15,000 7,500 7,500 15,000
121 sugiati 30,000 10,000 15,000 15,000 40,000
122 julan 50,000 10,000 25,000 25,000 60,000
123 siti 50,000 25,000 25,000 50,000
124 mulyani 60,000 10,000 30,000 30,000 70,000
125 sri s 30,000 15,000 15,000 30,000
126 indah 30,000 15,000 15,000 30,000
127 iar 30,000 15,000 15,000 30,000
128 19/09/2014 syaril 70,000 35,000 35,000 70,000
129 mayesri 25,000 12,500 12,500 25,000
130 biduri 30,000 15,000 15,000 30,000
131 evi 25,000 12,500 12,500 25,000
132 ade mulyadi 70,000 35,000 35,000 70,000
133 yuni 25,000 12,500 12,500 25,000
134 rineu 25,000 12,500 12,500 25,000
135 mubarod 3,000 1,500 1,500 3,000
136 mazaya 25,000 12,500 12,500 25,000
137 mulyadi 50,000 25,000 25,000 50,000
138 20/09/2014 dafin 25,000 12,500 12,500 25,000
139 elih 30,000 15,000 15,000 30,000
140 syachril 35,000 17,500 17,500 35,000
141 nurlatifah 30,000 15,000 15,000 30,000
142 22/09/2014 iyam m 30,000 10,000 15,000 15,000 40,000
143 titin s 15,000 10,000 7,500 7,500 25,000
144 neng yuyun 15,000 10,000 7,500 7,500 25,000
145 haikal 15,000 10,000 7,500 7,500 25,000
146 ayep z 60,000 10,000 30,000 30,000 70,000
147 tati k 30,000 10,000 15,000 15,000 40,000
148 abbot 30,000 15,000 15,000 30,000
149 aminah 70,000 35,000 35,000 70,000
150 heppi s 70,000 35,000 35,000 70,000
151 teten t 70,000 35,000 35,000 70,000
152 m ramdan 25,000 12,500 12,500 25,000
153 ade 30,000 15,000 15,000 30,000
154 iwan 15,000 10,000 7,500 7,500 25,000
155 denia 15,000 10,000 7,500 7,500 25,000
156 nanik 15,000 10,000 7,500 7,500 25,000
157 rini 15,000 10,000 7,500 7,500 25,000
158 refiandi 15,000 10,000 7,500 7,500 25,000
159 refiani 70,000 35,000 35,000 70,000
160 24/09/2014 titin s 15,000 10,000 7,500 7,500 25,000
161 edi 60,000 10,000 30,000 30,000 70,000
162 theresia 40,000 20,000 20,000 40,000
163 tresni 30,000 15,000 15,000 30,000
164 kanti 40,000 20,000 20,000 40,000
165 laeli 70,000 35,000 35,000 70,000
166 hayanaka 15,000 7,500 7,500 15,000
167 razka 15,000 10,000 7,500 7,500 25,000
168 sri 30,000 15,000 15,000 30,000
169 indah 70,000 35,000 35,000 70,000
170 fauziah 25,000 12,500 12,500 25,000
171 juju 15,000 10,000 7,500 7,500 25,000
172 arini 25,000 12,500 12,500 25,000
173 25/09/2014 wiwit 25,000 10,000 12,500 12,500 35,000
174 yuyun m 70,000 10,000 35,000 35,000 80,000
175 tutisah 100,000 50,000 50,000 100,000
176 meike 15,000 7,500 7,500 15,000
177 atikah 15,000 7,500 7,500 15,000
178 nanang s 15,000 7,500 7,500 15,000
179 siti k 30,000 15,000 15,000 30,000
180 suparman 70,000 35,000 35,000 70,000
181 m hisyamar 25,000 12,500 12,500 25,000
182 nenti 15,000 10,000 7,500 7,500 25,000
183 haura 15,000 7,500 7,500 15,000
184 iar 35,000 17,500 17,500 35,000
185 cepi 15,000 10,000 7,500 7,500 25,000
186 26/09/2014 lily 15,000 7,500 7,500 15,000
187 iwan 30,000 15,000 15,000 30,000
188 defi 15,000 7,500 7,500 15,000
189 refan 15,000 7,500 7,500 15,000
190 27/09/2014 elly r 70,000 35,000 35,000 70,000
191 siti romlah 60,000 30,000 30,000 60,000
192 29/09/2014 berta 30,000 10,000 15,000 15,000 40,000
193 rella 15,000 10,000 7,500 7,500 25,000
194 iin k 60,000 10,000 30,000 30,000 70,000
195 rilian 15,000 7,500 7,500 15,000
196 slamat s 15,000 7,500 7,500 15,000
197 maman 70,000 35,000 35,000 70,000
198 kaisar 35,000 17,500 17,500 35,000
199 kanti 70,000 35,000 35,000 70,000
200 darito 15,000 10,000 7,500 7,500 25,000
201 ade 30,000 15,000 15,000 30,000
202 biduri 60,000 30,000 30,000 60,000
203 nuraeni 15,000 10,000 7,500 7,500 25,000
204 denia 140,000 10,000 70,000 70,000 150,000
205 akasya 15,000 10,000 7,500 7,500 25,000
206 suryani 15,000 10,000 7,500 7,500 25,000
207 muhara 140,000 70,000 70,000 140,000
208 eva 15,000 10,000 7,500 7,500 25,000
209 siman 15,000 10,000 7,500 7,500 25,000
210 elis 30,000 15,000 15,000 30,000
211 asep 30,000 10,000 15,000 15,000 40,000
212 30/09/2014 meike 15,000 7,500 7,500 15,000
213 eloh 40,000 10,000 20,000 20,000 50,000
214 neneng 70,000 35,000 35,000 70,000
215 haisya 40,000 20,000 20,000 40,000
216 gojali 15,000 7,500 7,500 15,000
217 david 15,000 10,000 7,500 7,500 25,000
218 aris m 60,000 10,000 30,000 30,000 70,000
219 tresni 30,000 15,000 15,000 30,000
220 tasya 15,000 7,500 7,500 15,000
221 elyta 40,000 20,000 20,000 40,000
222 riska 30,000 15,000 15,000 30,000
223 neneng 15,000 7,500 7,500 15,000
224 agung sulaeman 15,000 7,500 7,500 15,000
13,268,000 995,000 6,521,500 6,521,500 14,008,000

JASA ALAT &

DOKTER BAHAN
1 9/1/2014 mardiyono 70,000 35,000 35,000 70,000
2 9/2/2014 mamat 70,000 35,000 35,000 70,000
3 9/3/2014 ace 30,000 10,000 15,000 15,000 40,000
4 ela 30,000 15,000 15,000 30,000
5 9/5/2014 mamat 120,000 10,000 60,000 60,000 130,000
6 mulyadi 60,000 10,000 30,000 30,000 70,000
7 9/9/2014 pungut 50,000 10,000 25,000 25,000 60,000
8 9/9/2014 udin 50,000 25,000 25,000 50,000
9 9/10/2014 rostini 30,000 10,000 15,000 15,000 40,000
10 mamat 30,000 15,000 15,000 30,000
11 9/11/2014 pungut 50,000 25,000 25,000 50,000
12 nani 30,000 10,000 15,000 15,000 40,000
13 susilawati 30,000 10,000 15,000 15,000 40,000
14 9/12/2014 mamat s 30,000 15,000 15,000
15 16/09/2014 mamat 50,000 25,000 25,000 50,000
16 pungut 50,000 25,000 25,000 50,000
17 9/19/2014 udin 50,000 25,000 25,000 50,000
18 18/09/2014 pungut 50,000 25,000 25,000 50,000
19 23/09/2014 pungut 50,000 25,000 25,000 50,000
20 24/09/2014 mamat 30,000 10,000 15,000 15,000 40,000
21 29/09/2014 surya bhakti 30,000 10,000 15,000 15,000 40,000
22 30/09/2014 pungut 95,000 47,500 47,500 95,000
23 mamat 50,000 25,000 25,000 50,000
24 dewi rahmawati 30,000 15,000 15,000 30,000
21,421,000 1,805,000 10,598,000 10,598,000 22,911,000

JASA ALAT &

DOKTER BAHAN
1 10/1/2014 yusuf 70,000 3,000 33,500 33,500 70,000
2 andy 50,000 3,000 23,500 23,500 50,000
3 10/2/2014 endang 50,000 3,000 23,500 23,500 50,000
4 lina 20,000 3,000 8,500 8,500 20,000
5 elnani 50,000 3,000 23,500 23,500 50,000
6 10/3/2014 andy 30,000 3,000 13,500 13,500 30,000
7 yusni 70,000 3,000 33,500 33,500 70,000
8 hadi 50,000 3,000 23,500 23,500 50,000
9 10/4/2014 maya 200,000 3,000 98,500 98,500 200,000
10 wasfa 50,000 3,000 23,500 23,500 50,000
11 syifa arrohmah 100,000 3,000 48,500 48,500 100,000
8 10/6/2014 nina 100,000 3,000 48,500 48,500 100,000
13 lestia 60,000 3,000 28,500 28,500 60,000
14 renu 60,000 3,000 28,500 28,500 60,000
15 dintu 50,000 3,000 23,500 23,500 50,000
16 10/8/2014 renu 100,000 3,000 48,500 48,500 100,000
17 reza 20,000 3,000 8,500 8,500 20,000
18 yasy 100,000 3,000 48,500 48,500 100,000
19 nani 20,000 3,000 8,500 8,500 20,000
20 dewi napsiah 50,000 3,000 23,500 23,500 50,000
21 10/9/2014 intan 200,000 3,000 98,500 98,500 200,000
22 10/10/2014 andy l 100,000 3,000 48,500 48,500 100,000
23 10/11/2014 nalita 60,000 3,000 28,500 28,500 60,000
24 yusni 120,000 3,000 58,500 58,500 120,000
25 10/12/2014 rizal 50,000 3,000 23,500 23,500 50,000
26 10/13/2014 renu 150,000 3,000 73,500 73,500 150,000
27 januar 20,000 3,000 8,500 8,500 20,000
28 listiana 160,000 3,000 78,500 78,500 160,000
29 10/14/2014 aca 50,000 3,000 23,500 23,500 50,000
30 endang 50,000 3,000 23,500 23,500 50,000
31 nalita 50,000 3,000 23,500 23,500 50,000
32 eli 20,000 3,000 8,500 8,500 20,000
33 fauzi 100,000 3,000 48,500 48,500 100,000
34 dinta 50,000 3,000 23,500 23,500 50,000
35 10/15/2014 wawan 20,000 3,000 8,500 8,500 20,000
36 yusuf 100,000 3,000 48,500 48,500 100,000
37 dewi napsiah 50,000 3,000 23,500 23,500 50,000
38 cheriya 150,000 3,000 73,500 73,500 150,000
39 10/16/2014 yadi cahyadi 30,000 3,000 13,500 13,500 30,000
40 ropi 50,000 3,000 23,500 23,500 50,000
41 roswati 50,000 3,000 23,500 23,500 50,000
42 diana 20,000 3,000 8,500 8,500 20,000
43 daffa 50,000 3,000 23,500 23,500 50,000
44 andy 70,000 3,000 33,500 33,500 70,000
45 10/17/2014 alifya 100,000 3,000 48,500 48,500 100,000
46 mira 60,000 3,000 28,500 28,500 60,000
47 yusni 150,000 3,000 73,500 73,500 150,000
48 risna 50,000 3,000 23,500 23,500 50,000
49 andy 70,000 3,000 33,500 33,500 70,000
50 10/18/2014 dewi 60,000 3,000 28,500 28,500 60,000
51 syifa arrohmah 100,000 3,000 48,500 48,500 100,000
52 syifa 100,000 3,000 48,500 48,500 100,000
53 yusni 150,000 3,000 73,500 73,500 150,000
54 mira 100,000 3,000 48,500 48,500 100,000
55 koswara 100,000 3,000 48,500 48,500 100,000
56 encum 20,000 3,000 8,500 8,500 20,000
57 10/20/2014 roswati 30,000 3,000 13,500 13,500 30,000
58 nalita 100,000 3,000 48,500 48,500 100,000
59 aca 50,000 3,000 23,500 23,500 50,000
60 dewi 225,000 3,000 111,000 111,000 225,000
61 rizki 20,000 3,000 8,500 8,500 20,000
62 10/23/2014 yuli y 30,000 3,000 13,500 13,500 30,000
63 tri nengsih 200,000 3,000 98,500 98,500 200,000
64 tatang 100,000 3,000 48,500 48,500 100,000
65 alisia 50,000 3,000 23,500 23,500 50,000
66 andy 70,000 3,000 33,500 33,500 70,000
67 10/24/2014 ridwan 100,000 3,000 48,500 48,500 100,000
68 samudra 100,000 3,000 48,500 48,500 100,000
69 rian 70,000 3,000 33,500 33,500 70,000
70 10/27/2014 choirunnisa 120,000 3,000 58,500 58,500 120,000
71 regina 20,000 3,000 8,500 8,500 20,000
72 yadi 50,000 3,000 23,500 23,500 50,000
73 10/28/2014 esti 70,000 3,000 33,500 33,500 70,000
74 exla 50,000 3,000 23,500 23,500 50,000
75 mahmud 40,000 3,000 18,500 18,500 40,000
76 karmini 200,000 3,000 98,500 98,500 200,000
77 siti 20,000 3,000 8,500 8,500 20,000
78 wawan 20,000 3,000 8,500 8,500 20,000
79 10/29/2014 githa 40,000 3,000 18,500 18,500 40,000
80 dinta 80,000 3,000 38,500 38,500 80,000
81 irma 40,000 3,000 18,500 18,500 40,000
82 irmayanti 50,000 3,000 23,500 23,500 50,000
83 10/30/2014 deni 50,000 3,000 23,500 23,500 50,000
84 nalita 100,000 3,000 48,500 48,500 100,000
85 10/31/2014 rudi 30,000 3,000 13,500 13,500 30,000
86 gema 20,000 3,000 8,500 8,500 20,000
87 ropi hayudi 30,000 3,000 13,500 13,500 30,000
88 3,000 (1,500) (1,500) -
6,305,000 264,000 3,020,500 3,020,500 6,305,000

JASA ALAT &

DOKTER BAHAN
1 10/1/2014 eem suhaemi 60,000 10,000 30,000 30,000 70,000
2 neni s 15,000 10,000 7,500 7,500 25,000
3 muftiah 15,000 7,500 7,500 15,000
4 theresia 70,000 35,000 35,000 70,000
5 kanti d 70,000 35,000 35,000 70,000
6 fauzan s 30,000 15,000 15,000 30,000
7 maryanto 15,000 10,000 7,500 7,500 25,000
8 iwan bahrudin 15,000 10,000 7,500 7,500 25,000
9 mubarod 30,000 15,000 15,000 30,000
10 tresni 40,000 20,000 20,000 40,000
11 keisya 15,000 7,500 7,500 15,000
12 10/2/2014 dian 15,000 10,000 7,500 7,500 25,000
13 astri 15,000 10,000 7,500 7,500 25,000
14 sugiarti 30,000 15,000 15,000 30,000
15 jilan 70,000 35,000 35,000 70,000
16 siti k 40,000 20,000 20,000 40,000
17 juju 30,000 15,000 15,000 30,000
18 maryam 70,000 35,000 35,000 70,000
19 iar 70,000 35,000 35,000 70,000
20 tati 15,000 10,000 7,500 7,500 25,000
21 10/3/2014 siti 30,000 15,000 15,000 30,000
22 laeli 70,000 35,000 35,000 70,000
23 biduri 70,000 10,000 35,000 35,000 80,000
24 yayat 15,000 7,500 7,500 15,000
25 refan 25,000 12,500 12,500 25,000
26 refiani 70,000 35,000 35,000 70,000
27 10/4/2014 elly r 70,000 35,000 35,000 70,000
28 mustopa 30,000 15,000 15,000 30,000
29 fanyshya 30,000 15,000 15,000 30,000
30 faisya 30,000 15,000 15,000 30,000
31 adin zaenudin 60,000 10,000 30,000 30,000 70,000
32 10/6/2014 alfi 25,000 12,500 12,500 25,000
33 berta 15,000 10,000 7,500 7,500 25,000
34 sri s 30,000 15,000 15,000 30,000
35 nina 15,000 7,500 7,500 15,000
36 nuraeni 30,000 10,000 15,000 15,000 40,000
37 rini 15,000 10,000 7,500 7,500 25,000
38 suparman 70,000 35,000 35,000 70,000
39 biduri 30,000 15,000 15,000 30,000
40 ana r 15,000 10,000 7,500 7,500 25,000
41 asep s 70,000 35,000 35,000 70,000
42 elis 30,000 15,000 15,000 30,000
43 asep a 15,000 10,000 7,500 7,500 25,000
44 neneng 15,000 10,000 7,500 7,500 25,000
45 yayan 15,000 10,000 7,500 7,500 25,000
46 hasya 25,000 12,500 12,500 25,000
47 10/7/2014 syakira 30,000 15,000 15,000 30,000
48 darito 15,000 10,000 7,500 7,500 25,000
49 riska utami 30,000 15,000 15,000 30,000
50 dodi 40,000 20,000 20,000 40,000
51 m yusuf 30,000 15,000 15,000 30,000
52 tresni 70,000 35,000 35,000 70,000
53 siti jamilah 15,000 7,500 7,500 15,000
54 dara 30,000 15,000 15,000 30,000
55 elyta 70,000 35,000 35,000 70,000
56 widi 30,000 10,000 15,000 15,000 40,000
57 iwan 30,000 15,000 15,000 30,000
58 10/8/2014 ade 15,000 10,000 7,500 7,500 25,000
59 fauzan 15,000 10,000 7,500 7,500 -
60 deni 15,000 10,000 7,500 7,500 25,000
61 suratno 15,000 10,000 7,500 7,500 25,000
62 ade ridwan 40,000 20,000 20,000 40,000
63 marshela 15,000 10,000 7,500 7,500 25,000
64 imas 15,000 10,000 7,500 7,500 25,000
65 siti k 70,000 35,000 35,000 70,000
66 widy 15,000 7,500 7,500 15,000
67 mubarod 30,000 15,000 15,000 30,000
68 m ilham 30,000 15,000 15,000 30,000
69 rena 15,000 7,500 7,500 15,000
70 lulienti 35,000 17,500 17,500 35,000
71 dara 35,000 17,500 17,500 35,000
72 juju 35,000 17,500 17,500 35,000
73 10/9/2014 qyuara a 15,000 7,500 7,500 15,000
74 imas s 15,000 7,500 7,500 15,000
75 ati 15,000 7,500 7,500 15,000
76 tasya 30,000 15,000 15,000 30,000
77 lulianti 15,000 10,000 7,500 7,500 25,000
78 sugiarti 30,000 15,000 15,000 30,000
79 jilan 70,000 35,000 35,000 70,000
80 eloh 30,000 15,000 15,000 30,000
81 10/10/2014 muftiah 60,000 30,000 30,000 60,000
82 dasmi 60,000 30,000 30,000 60,000
83 siti 30,000 10,000 15,000 15,000 40,000
84 siti a 30,000 10,000 15,000 15,000 40,000
85 wawan 15,000 7,500 7,500 15,000
86 titin 15,000 10,000 7,500 7,500 25,000
87 10/11/2014 abbot 30,000 15,000 15,000 30,000
88 fanysya ayu 30,000 15,000 15,000 30,000
89 futuh 15,000 7,500 7,500 15,000
90 wiwi 30,000 15,000 15,000 30,000
91 krisnon 35,000 17,500 17,500 35,000
92 mustopa 30,000 15,000 15,000 30,000
93 rena 15,000 10,000 7,500 7,500 25,000
94 elly r 70,000 35,000 35,000 70,000
95 haisya 30,000 15,000 15,000 30,000
96 febby nurul 15,000 10,000 7,500 7,500 25,000
97 10/13/2014 lilis 15,000 10,000 7,500 7,500 25,000
98 elis 35,000 17,500 17,500 35,000
99 tini 15,000 10,000 7,500 7,500 25,000
100 alex 25,000 12,500 12,500 25,000
101 dadang 30,000 15,000 15,000 30,000
102 febby 15,000 7,500 7,500 15,000
103 10/14/2014 tajudin 15,000 10,000 7,500 7,500 25,000
104 fauzan 15,000 10,000 7,500 7,500 25,000
105 refiani 70,000 35,000 35,000 70,000
106 supriyadi 15,000 10,000 7,500 7,500 25,000
107 ade ridwan 70,000 35,000 35,000 70,000
108 nabil s 30,000 15,000 15,000 30,000
109 dadi 40,000 15,000 20,000 20,000 55,000
110 ira aprilia 30,000 15,000 15,000 30,000
111 gina rahmalia 30,000 15,000 15,000 30,000
112 widy kristinayanti 60,000 10,000 30,000 30,000 70,000
113 iwan kuswandi 30,000 15,000 15,000 30,000
114 10/15/2014 satriya 70,000 35,000 35,000 70,000
115 siti 30,000 15,000 15,000 30,000
116 nia 15,000 10,000 7,500 7,500 25,000
117 mira 15,000 10,000 7,500 7,500 25,000
118 siti a 15,000 10,000 7,500 7,500 25,000
119 rena 15,000 10,000 7,500 7,500 25,000
120 tasya islami 30,000 15,000 15,000 30,000
121 asep suherman 70,000 35,000 35,000 70,000
122 suhada 15,000 10,000 7,500 7,500 25,000
123 riska utami 40,000 20,000 20,000 40,000
124 m yusuf 30,000 15,000 15,000 30,000
125 ojasmet 60,000 10,000 30,000 30,000 70,000
126 10/16/2014 wastini 35,000 17,500 17,500 35,000
127 epi 15,000 7,500 7,500 15,000
128 suratno 15,000 7,500 7,500 15,000
129 irma 15,000 7,500 7,500 15,000
130 sujana 15,000 10,000 7,500 7,500 25,000
131 elah 30,000 15,000 15,000 30,000
132 biduri 35,000 17,500 17,500 35,000
133 fadhilah 25,000 12,500 12,500 25,000
134 iyan 15,000 10,000 7,500 7,500 25,000
135 10/17/2014 epi 25,000 10,000 12,500 12,500 35,000
136 suparman 30,000 15,000 15,000 30,000
137 silmi 30,000 15,000 15,000 30,000
138 siti a 15,000 7,500 7,500 15,000
139 winda 15,000 10,000 7,500 7,500 25,000
140 yuliyanti 15,000 10,000 7,500 7,500 25,000
141 10/18/2014 mustopa 30,000 15,000 15,000 30,000
142 maudy a 35,000 17,500 17,500 35,000
143 elly r 70,000 35,000 35,000 70,000
144 haisya 30,000 15,000 15,000 30,000
145 tajudin 30,000 10,000 15,000 15,000 40,000
146 krisnan 35,000 17,500 17,500 35,000
147 annisa 15,000 7,500 7,500 15,000
148 widiawan 15,000 7,500 7,500 15,000
149 djeng sri 70,000 35,000 35,000 70,000
150 sugiran 15,000 7,500 7,500 15,000
151 10/20/2014 refiana 25,000 12,500 12,500 25,000
152 nia 15,000 10,000 7,500 7,500 25,000
153 rena 15,000 10,000 7,500 7,500 25,000
154 haisya 15,000 10,000 7,500 7,500 25,000
155 alfi 25,000 12,500 12,500 25,000
156 nuraeni 30,000 10,000 15,000 15,000 40,000
157 sri s 30,000 15,000 15,000 30,000
158 alea 25,000 12,500 12,500 25,000
159 sugiri 15,000 7,500 7,500 15,000
160 fanysya 30,000 10,000 15,000 15,000 40,000
161 haidar 15,000 10,000 7,500 7,500 25,000
162 mamat 15,000 10,000 7,500 7,500 25,000
163 10/21/2014 fauzan 30,000 15,000 15,000 30,000
164 10/22/2014 theresia 70,000 35,000 35,000 70,000
165 nenti 15,000 10,000 7,500 7,500 25,000
166 10/23/2014 komarudin 25,000 10,000 12,500 12,500 35,000
167 wawan g 25,000 10,000 12,500 12,500 35,000
168 heppy s 70,000 35,000 35,000 70,000
169 fabian 30,000 15,000 15,000 30,000
170 iyam m 35,000 10,000 17,500 17,500 45,000
171 wastini 70,000 35,000 35,000 70,000
172 tri nengsih 15,000 7,500 7,500 15,000
173 indah s 25,000 10,000 12,500 12,500 35,000
174 yuli y 30,000 10,000 15,000 15,000 40,000
175 wawan 25,000 12,500 12,500 25,000
176 tatang 15,000 7,500 7,500 15,000
177 fadhilah 25,000 12,500 12,500 25,000
178 tasya 30,000 15,000 15,000 30,000
179 biduri 70,000 35,000 35,000 70,000
180 ujang 15,000 10,000 7,500 7,500 25,000
181 nurmalasari 15,000 10,000 7,500 7,500 25,000
182 eloh 30,000 15,000 15,000 30,000
183 10/24/2014 agus k 30,000 15,000 15,000 30,000
184 winda 30,000 15,000 15,000 30,000
185 rudi 30,000 15,000 15,000 30,000
186 siti atikah 30,000 15,000 15,000 30,000
187 hesti 25,000 10,000 12,500 12,500 35,000
188 agus w 60,000 10,000 30,000 30,000 70,000
189 haisya 25,000 12,500 12,500 25,000
190 rayyandra 30,000 15,000 15,000 30,000
191 yuliyanti 30,000 15,000 15,000 30,000
192 subiati 60,000 30,000 30,000 60,000
193 10/27/2014 suratno 60,000 30,000 30,000 60,000
194 iyam maryam 25,000 10,000 12,500 12,500 35,000
195 sri yani 30,000 15,000 15,000 30,000
196 mahendra 30,000 15,000 15,000 30,000
197 lasma 30,000 15,000 15,000 30,000
198 indra cahya 60,000 30,000 30,000 60,000
199 salwa aulia 25,000 10,000 12,500 12,500 35,000
200 defri 15,000 7,500 7,500 15,000
201 fauzi 25,000 12,500 12,500 25,000
202 egie 25,000 12,500 12,500 25,000
203 fahri 25,000 12,500 12,500 25,000
204 amira 15,000 10,000 7,500 7,500 25,000
205 siti m 30,000 15,000 15,000 30,000
206 fitri 25,000 12,500 12,500 25,000
207 m nurdin 15,000 10,000 7,500 7,500 25,000
208 ivana 15,000 10,000 7,500 7,500 25,000
209 haisya 30,000 15,000 15,000 30,000
210 dedi 15,000 10,000 7,500 7,500 25,000
211 10/28/2014 tata s 15,000 10,000 7,500 7,500 25,000
212 siti suci 15,000 10,000 7,500 7,500 25,000
213 winda 30,000 15,000 15,000 30,000
214 nuraeni 30,000 15,000 15,000 30,000
215 nita 30,000 15,000 15,000 30,000
216 mira 15,000 7,500 7,500 15,000
217 eli 15,000 10,000 7,500 7,500 25,000
218 fauzan 30,000 15,000 15,000 30,000
219 dadi r 30,000 10,000 15,000 15,000 40,000
220 rudi 30,000 15,000 15,000 30,000
221 dewi sartika 30,000 15,000 15,000 30,000
222 10/29/2014 deni 15,000 10,000 7,500 7,500 25,000
223 endri 15,000 10,000 7,500 7,500 25,000
224 imas 15,000 10,000 7,500 7,500 25,000
225 lulienti 70,000 35,000 35,000 70,000
226 nurlatifah 30,000 15,000 15,000 30,000
227 rizqi 30,000 15,000 15,000 30,000
228 a shabrina 35,000 17,500 17,500 35,000
229 m raidul 35,000 17,500 17,500 35,000
230 10/30/2014 dani m 70,000 35,000 35,000 70,000
231 sukarti 15,000 7,500 7,500 15,000
232 nurdiana 30,000 15,000 15,000 30,000
233 ida 15,000 10,000 7,500 7,500 25,000
234 enok 15,000 10,000 7,500 7,500 25,000
235 tisna 30,000 15,000 15,000 30,000
236 tasya 30,000 10,000 15,000 15,000 40,000
237 sri s 30,000 15,000 15,000 30,000
238 edy 15,000 10,000 7,500 7,500 25,000
239 ujang 30,000 15,000 15,000 30,000
240 heru 15,000 10,000 7,500 7,500 25,000
241 tati 70,000 35,000 35,000 70,000
242 sugiarni 30,000 15,000 15,000 30,000
243 jilan 70,000 35,000 35,000 70,000
244 refiani 70,000 35,000 35,000 70,000
245 yongki 15,000 10,000 7,500 7,500 25,000
246 rendi 15,000 10,000 7,500 7,500 25,000
247 irmayani 15,000 10,000 7,500 7,500 25,000
248 10/31/2014 nining 15,000 7,500 7,500 15,000
249 lasma 30,000 15,000 15,000 30,000
250 siti atikah 30,000 15,000 15,000 30,000
251 wilya 70,000 35,000 35,000 70,000
252 salma 15,000 10,000 7,500 7,500 25,000
253 agus 70,000 35,000 35,000 70,000
254 ayep 60,000 30,000 30,000 60,000
255 ika 30,000 15,000 15,000 30,000
256 aminah 15,000 10,000 7,500 7,500 25,000
257 naufal 25,000 12,500 12,500 25,000
258 - - -
14,305,000 1,159,000 7,020,500 7,020,500 15,175,000
JASA ALAT &

DOKTER BAHAN
1 10/3/2014 pungut 70,000 35,000 35,000 70,000
2 10/8/2014 mamat 50,000 25,000 25,000 50,000
3 10/9/2014 esti 30,000 15,000 15,000 30,000
4 10/11/2014 noer 30,000 10,000 15,000 15,000 40,000
5 10/13/2014 zidan 30,000 15,000 15,000 30,000
6 dadang 30,000 15,000 15,000 30,000
7 10/14/2014 engkos 30,000 15,000 15,000 30,000
8 hendriana 50,000 25,000 25,000 50,000
9 10/17/2014 mamat 70,000 35,000 35,000 70,000
10 10/18/2014 rahmat 50,000 25,000 25,000 50,000
11 10/20/2014 noer 30,000 15,000 15,000 30,000
12 10/22/2014 mamat 70,000 35,000 35,000 70,000
13 maryati 30,000 15,000 15,000 30,000
14 10/27/2014 noer 50,000 25,000 25,000
15 10/28/2014 mamat 70,000 35,000 35,000 70,000
16 engkos 30,000 10,000 15,000 15,000 40,000
17 asep 50,000 25,000 25,000 50,000
18 10/29/2014 asep 50,000 10,000 25,000 25,000 60,000
19 10/31/2014 ace tarkana 30,000 15,000 15,000 30,000
20 noer 50,000 25,000 25,000 50,000
21 - - -
22 - - -
22,490,000 2,024,000 11,113,000 11,113,000 24,150,000

JASA ALAT &

NO TANGGAL NAMA PASIEN TARIF ADM
DOKTER BAHAN
1 11/1/2014 komariah 100,000 3,000 48,500 48,500
2 nining 20,000 3,000 8,500 8,500
3 lukman 20,000 3,000 8,500 8,500
4 11/2/2014 rizal 50,000 3,000 23,500 23,500
5 11/4/2014 rana 20,000 3,000 8,500 8,500
6 siti n 20,000 3,000 8,500 8,500
7 11/5/2014 endang 60,000 3,000 28,500 28,500
8 akbar 150,000 3,000 73,500 73,500
9 dinta 100,000 3,000 48,500 48,500
10 11/6/2014 nalita 200,000 3,000 98,500 98,500
11 kris 200,000 3,000 98,500 98,500
12 deni 50,000 3,000 23,500 23,500
13 11/7/2014 ning 20,000 3,000 8,500 8,500
14 bambang 200,000 3,000 98,500 98,500
15 ika w 150,000 3,000 73,500 73,500
16 agnes 150,000 3,000 73,500 73,500
17 11/10/2014 rahmadi 20,000 3,000 8,500 8,500
18 lukman 20,000 3,000 8,500 8,500
19 silvi 200,000 3,000 98,500 98,500
20 11/11/2014 iyne 20,000 3,000 8,500 8,500
21 dedi 50,000 3,000 23,500 23,500
22 rukmaya 20,000 3,000 8,500 8,500
23 11/12/2014 hadi 60,000 3,000 28,500 28,500
24 dedi s 50,000 3,000 23,500 23,500
25 asep r 30,000 3,000 13,500 13,500
26 solihin 200,000 3,000 98,500 98,500
27 yeti 80,000 3,000 38,500 38,500
28 11/14/2014 nur fitri 30,000 3,000 13,500 13,500
29 tri wahyuni 100,000 3,000 48,500 48,500
30 aminton 20,000 3,000 8,500 8,500
31 solhawati 100,000 3,000 48,500 48,500
32 11/15/2014 narisa 70,000 5,000 32,500 32,500
33 soleh 200,000 5,000 97,500 97,500
34 dedi 40,000 5,000 17,500 17,500
35 11/16/2014 rizal 50,000 5,000 22,500 22,500
36 11/17/2014 wawan 20,000 5,000 7,500 7,500
37 yusni 20,000 5,000 7,500 7,500
38 keysa 50,000 5,000 22,500 22,500
39 dewi 50,000 5,000 22,500 22,500
40 erza 20,000 5,000 7,500 7,500
41 11/18/2014 lulienti 145,000 5,000 70,000 70,000
42 neng irma 64,000 5,000 29,500 29,500
43 11/20/2014 puput 20,000 5,000 7,500 7,500
44 ita 200,000 5,000 97,500 97,500
45 ardi 100,000 5,000 47,500 47,500
46 11/21/2014 meilina 20,000 5,000 7,500 7,500
47 11/22/2014 timotius 40,000 5,000 17,500 17,500
48 andri 50,000 5,000 22,500 22,500
49 11/24/2014 nuraini 200,000 5,000 97,500 97,500
50 riani 200,000 5,000 97,500 97,500
51 wawan 20,000 5,000 7,500 7,500
52 11/25/2014 keisya 70,000 5,000 32,500 32,500
53 lilis 50,000 5,000 22,500 22,500
54 teti 20,000 5,000 7,500 7,500
55 11/26/2014 nurul 50,000 5,000 22,500 22,500
56 dadang 50,000 5,000 22,500 22,500
57 11/27/2014 asep 100,000 5,000 47,500 47,500
58 santi 30,000 5,000 12,500 12,500
59 deni 50,000 5,000 22,500 22,500
60 neni 20,000 5,000 7,500 7,500
61 11/28/2014 yayah 20,000 5,000 7,500 7,500
62 endang 50,000 5,000 22,500 22,500
63 11/29/2014 marsha 60,000 5,000 27,500 27,500
64 iqbal 150,000 5,000 72,500 72,500
65 akhtar 120,000 5,000 57,500 57,500
66 tasya 80,000 5,000 37,500 37,500
67 siti n 50,000 5,000 22,500 22,500
68 rizal 50,000 5,000 22,500 22,500
5,000 (2,500) (2,500)
5,000 (2,500) (2,500)
5,000 (2,500) (2,500)
5,109,000 293,000 2,408,000 2,408,000

JASA ALAT &

TGL NAMA PASIEN TARIF OBAT
DOKTER BAHAN
1 11/1/2014 abbot 30,000 15,000 15,000
2 reggina 70,000 35,000 35,000
3 sri sudaryati 60,000 30,000 30,000
4 mustopa 70,000 35,000 35,000
5 fauzan 30,000 15,000 15,000
6 aris 30,000 15,000 15,000
7 elly 70,000 35,000 35,000
8 agus kurniawan 70,000 35,000 35,000
9 m zufar 30,000 10,000 15,000 15,000
10 galang 25,000 12,500 12,500
11 amin 15,000 7,500 7,500
12 fanysya 30,000 15,000 15,000
13 adin 15,000 7,500 7,500
14 11/3/2014 reni m 15,000 10,000 7,500 7,500
15 eulis 15,000 10,000 7,500 7,500
16 siti r 30,000 15,000 15,000
17 andini 15,000 10,000 7,500 7,500
18 lasam 15,000 10,000 7,500 7,500
19 raisya 15,000 10,000 7,500 7,500
20 alfi 25,000 12,500 12,500
21 nuraeni 35,000 17,500 17,500
22 siti 30,000 15,000 15,000
23 deti 15,000 10,000 7,500 7,500
24 rizal 15,000 7,500 7,500
25 11/4/2014 siti sari 30,000 15,000 15,000
26 winda 30,000 15,000 15,000
27 dasmi 15,000 10,000 7,500 7,500
28 nita 30,000 15,000 15,000
29 tini 30,000 15,000 15,000
30 riska 70,000 35,000 35,000
31 rudi tamtomo 30,000 15,000 15,000
32 hermawan 30,000 15,000 15,000
33 qoniah 35,000 17,500 17,500
34 zasna 15,000 7,500 7,500
35 m hajiz 15,000 7,500 7,500
36 haisya 30,000 15,000 15,000
37 anita 30,000 15,000 15,000
38 nurlatifah 40,000 20,000 20,000
39 rizqi 70,000 35,000 35,000
40 yadi a 15,000 10,000 7,500 7,500
41 rachel 15,000 7,500 7,500
42 irmayanti 15,000 10,000 7,500 7,500
43 dadi 30,000 15,000 15,000
44 11/5/2014 nendah 30,000 15,000 15,000
45 dimas 30,000 15,000 15,000
46 imas 30,000 15,000 15,000
47 ujang 30,000 15,000 15,000
48 anita 30,000 15,000 15,000
49 haisya 30,000 15,000 15,000
50 irmayanti 15,000 7,500 7,500
51 11/6/2014 dani m 30,000 15,000 15,000
52 indah 15,000 7,500 7,500
53 sabrina 25,000 12,500 12,500
54 sugiarti 30,000 15,000 15,000
55 dara 25,000 12,500 12,500
56 sri s 40,000 20,000 20,000
57 fahira 25,000 12,500 12,500
58 tasya 30,000 15,000 15,000
59 eloh 30,000 15,000 15,000
60 andini 30,000 15,000 15,000
61 11/7/2014 eulis 50,000 10,000 25,000 25,000
62 ika warsita 30,000 15,000 15,000
63 lasma 30,000 10,000 15,000 15,000
64 ujang 30,000 10,000 15,000 15,000
65 fauzan 30,000 10,000 15,000 15,000
66 ida 30,000 15,000 15,000
67 shena 15,000 7,500 7,500
68 tresna 30,000 15,000 15,000
69 epa 30,000 15,000 15,000
70 syafrudin 30,000 15,000 15,000
71 11/10/2014 ratna 70,000 35,000 35,000
72 ramlan 15,000 10,000 7,500 7,500
73 syifa 15,000 7,500 7,500
74 slamet 15,000 10,000 7,500 7,500
75 siti r 15,000 10,000 7,500 7,500
76 siti 30,000 15,000 15,000
77 ari 30,000 15,000 15,000
78 andini 30,000 15,000 15,000
79 rofi 50,000 25,000 25,000
80 towati 15,000 7,500 7,500
81 siti j 25,000 12,500 12,500
82 11/11/2014 agus 15,000 10,000 7,500 7,500
83 adin 15,000 10,000 7,500 7,500
84 siti suci 30,000 15,000 15,000
85 siti r 30,000 15,000 15,000
86 nita 30,000 15,000 15,000
87 fauzan 15,000 10,000 7,500 7,500
88 yadi 15,000 10,000 7,500 7,500
89 komarudin 15,000 10,000 7,500 7,500
90 bagus indra 30,000 15,000 15,000
91 haisya 70,000 35,000 35,000
92 lulieti 70,000 35,000 35,000
93 tini 70,000 35,000 35,000
94 nurlatifah 70,000 35,000 35,000
95 rizqi 30,000 15,000 15,000
96 gita permata 30,000 15,000 15,000
97 11/12/2014 neneng 30,000 10,000 15,000 15,000
98 haisya 70,000 35,000 35,000
99 11/13/2014 winda 30,000 15,000 15,000
100 lidia 15,000 10,000 7,500 7,500
101 subkan 15,000 10,000 7,500 7,500
102 akbar 15,000 10,000 7,500 7,500
103 tasya 30,000 15,000 15,000
104 brian 25,000 12,500 12,500
105 susi 70,000 35,000 35,000
106 ita 30,000 15,000 15,000
107 11/14/2014 anisa 35,000 17,500 17,500
108 siti atikah 30,000 15,000 15,000
109 warni m 70,000 35,000 35,000
110 niken 70,000 35,000 35,000
111 wilya 70,000 35,000 35,000
112 rahmat hidayat 60,000 30,000 30,000
113 agus solihin 60,000 30,000 30,000
114 dina 25,000 12,500 12,500
115 ida i 30,000 10,000 15,000 15,000
116 mazaya 25,000 12,500 12,500
117 dani 15,000 10,000 7,500 7,500
118 rifki 15,000 10,000 7,500 7,500
119 efa 70,000 35,000 35,000
120 11/15/2014 mustopa 70,000 35,000 35,000
121 lasma 30,000 15,000 15,000
122 syifa 15,000 7,500 7,500
123 elly 30,000 15,000 15,000
124 abbot 35,000 10,000 17,500 17,500
125 nani 15,000 7,500 7,500
126 m zufar 30,000 15,000 15,000
127 ditha 15,000 7,500 7,500
128 rahmat hidayat 60,000 30,000 30,000
129 eko waluyo 30,000 10,000 15,000 15,000
130 11/17/2014 sansan 15,000 10,000 7,500 7,500
131 saripudin 15,000 10,000 7,500 7,500
132 rudi 15,000 10,000 7,500 7,500
133 ramlan 15,000 10,000 7,500 7,500
134 siti r 15,000 10,000 7,500 7,500
135 abdul r 15,000 10,000 7,500 7,500
136 siti m 30,000 15,000 15,000
137 evi 15,000 10,000 7,500 7,500
138 kanza 15,000 7,500 7,500
139 ratna 70,000 35,000 35,000
140 nunung 30,000 15,000 15,000
141 nuraeni 70,000 35,000 35,000
142 ade 15,000 10,000 7,500 7,500
143 heru 15,000 10,000 7,500 7,500
144 aldo 50,000 25,000 25,000
145 andini 30,000 15,000 15,000
146 11/18/2014 nabila 25,000 12,500 12,500
147 siti r 30,000 15,000 15,000
148 hendra 70,000 35,000 35,000
149 siti r 30,000 15,000 15,000
150 neti 40,000 20,000 20,000
151 imas 35,000 17,500 17,500
152 lulienti 15,000 7,500 7,500
153 tita 70,000 35,000 35,000
154 haisya 70,000 35,000 35,000
155 agus 15,000 10,000 7,500 7,500
156 syakira 15,000 10,000 7,500 7,500
157 rizki 35,000 17,500 17,500
158 nurlatifah 30,000 15,000 15,000
159 11/19/2014 rahma 25,000 12,500 12,500
160 theresia 70,000 35,000 35,000
161 yudi 50,000 25,000 25,000
162 tita 70,000 35,000 35,000
163 saedy 60,000 10,000 30,000 30,000
164 mega sari 70,000 35,000 35,000
165 11/20/2014 tasya 30,000 15,000 15,000
166 kella 15,000 10,000 7,500 7,500
167 entin 30,000 15,000 15,000
168 bagus 15,000 10,000 7,500 7,500
169 siti sadiah 30,000 15,000 15,000
170 susanti 40,000 20,000 20,000
171 trisna 30,000 10,000 15,000 15,000
172 dhafi 50,000 25,000 25,000
173 ita l 70,000 35,000 35,000
174 11/21/2014 ong tjuilan 30,000 15,000 15,000
175 lasma 70,000 35,000 35,000
176 wilya rosi 70,000 35,000 35,000
177 nanisumarni 15,000 7,500 7,500
178 ernita 30,000 15,000 15,000
179 siti atikah 30,000 15,000 15,000
180 tuniyah 30,000 15,000 15,000
181 ida 30,000 15,000 15,000
182 herni 15,000 10,000 7,500 7,500
183 rudi 15,000 10,000 7,500 7,500
184 dadi 30,000 15,000 15,000
185 ade w 30,000 15,000 15,000
186 koswati 30,000 15,000 15,000
187 siti s 30,000 15,000 15,000
188 efa 30,000 15,000 15,000
189 11/22/2014 m zufar 30,000 15,000 15,000
190 egie 35,000 17,500 17,500
191 sumarni 30,000 15,000 15,000
192 m ilham 30,000 15,000 15,000
193 nabila nur 35,000 17,500 17,500
194 abbot 35,000 17,500 17,500
195 elly romayani 30,000 15,000 15,000
196 ratnasih 15,000 10,000 7,500 7,500
197 siti hadijah 30,000 15,000 15,000
198 agus setiawan 30,000 15,000 15,000
199 tri wahyuni 30,000 15,000 15,000
200 rizki l 30,000 15,000 15,000
201 11/24/2014 dety 30,000 15,000 15,000
202 11/25/2014 nufa 70,000 35,000 35,000
203 iis r 15,000 10,000 7,500 7,500
204 siti r 40,000 20,000 20,000
205 nurma 30,000 15,000 15,000
206 nur h 15,000 10,000 7,500 7,500
207 nuraeni 70,000 35,000 35,000
208 dodo 15,000 10,000 7,500 7,500
209 fikri 25,000 12,500 12,500
210 siti rosyat 30,000 15,000 15,000
211 hendi 30,000 15,000 15,000
212 m tezar 25,000 12,500 12,500
213 quntari 30,000 15,000 15,000
214 tony 15,000 10,000 7,500 7,500
215 adiansyah 15,000 10,000 7,500 7,500
216 ririn p 25,000 12,500 12,500
217 dwi 15,000 10,000 7,500 7,500
218 m syahrul 15,000 10,000 7,500 7,500
219 pandu 15,000 7,500 7,500
220 ewin 15,000 7,500 7,500
221 haisyah 40,000 20,000 20,000
222 titis 70,000 35,000 35,000
223 nurlatifah 30,000 15,000 15,000
224 rizqi 70,000 35,000 35,000
225 11/26/2014 eko 15,000 10,000 7,500 7,500
226 lulu 15,000 7,500 7,500
227 wilya 15,000 7,500 7,500
228 theresia 70,000 35,000 35,000
229 sulastri 15,000 10,000 7,500 7,500
230 ahmad hidayat 15,000 10,000 7,500 7,500
231 dewi 70,000 35,000 35,000
232 dadang iriana 70,000 35,000 35,000
233 mega sari 70,000 35,000 35,000
234 11/27/2014 oki 15,000 10,000 7,500 7,500
235 m rizki 30,000 15,000 15,000
236 anin 15,000 7,500 7,500
237 lisnawati 15,000 7,500 7,500
238 neni 15,000 10,000 7,500 7,500
239 hari 30,000 10,000 15,000 15,000
240 herawati 15,000 10,000 7,500 7,500
241 tasya 40,000 10,000 20,000 20,000
242 agus 30,000 15,000 15,000
243 ita l 70,000 35,000 35,000
244 sukaesih 15,000 10,000 7,500 7,500
245 sulastri 15,000 10,000 7,500 7,500
246 mulyani 15,000 10,000 7,500 7,500
247 11/28/2014 sumira 60,000 30,000 30,000
248 fitri 30,000 15,000 15,000
249 tuniyah 30,000 15,000 15,000
250 tia 25,000 10,000 12,500 12,500
251 siti atikah 70,000 35,000 35,000
252 ida 30,000 15,000 15,000
253 tasna 30,000 15,000 15,000
254 eka 15,000 10,000 7,500 7,500
255 ade 15,000 10,000 7,500 7,500
256 tasya 70,000 35,000 35,000
257 desi 15,000 10,000 7,500 7,500
258 kuraesin 30,000 15,000 15,000
259 11/29/2014 zufar 70,000 35,000 35,000
260 elly 30,000 15,000 15,000
261 hendri 30,000 15,000 15,000
262 m ilham 30,000 15,000 15,000
263 wati karlina 30,000 15,000 15,000
264 r tony 30,000 15,000 15,000
265 adiansyah 30,000 15,000 15,000
266 fitri a 30,000 15,000 15,000
267 abbot 30,000 15,000 15,000
268 m tezar 25,000 12,500 12,500
269 siti hodijah 30,000 15,000 15,000
270 rusgandi 15,000 7,500 7,500
271 lisnina 30,000 15,000 15,000
272 refiani 70,000 35,000 35,000
273 supriyadi 15,000 7,500 7,500
274 sgus setiawan 30,000 15,000 15,000
275 rizki l 30,000 15,000 15,000
- -
14,124,000 1,003,000 6,915,500 6,915,500

JASA ALAT &

NO TGL NAMA PASIEN TARIF OBAT
DOKTER BAHAN
1 11/1/2014 subur supriatna 80,000 40,000 40,000
2 11/3/2014 dewi 30,000 15,000 15,000
3 asep 50,000 25,000 25,000
4 11/4/2014 deni korsal 30,000 10,000 15,000 15,000
5 11/5/2014 mamat sudrajat 50,000 25,000 25,000
6 11/7/2014 noer r 50,000 25,000 25,000
7 asep 50,000 25,000 25,000
8 11/10/2014 noer 50,000 25,000 25,000
9 11/11/2014 naufal 50,000 25,000 25,000
10 11/13/2014 dadang 50,000 25,000 25,000
11 siti n 30,000 10,000 15,000 15,000
12 11/14/2014 mamat 50,000 25,000 25,000
13 11/15/2014 subur supriatna 50,000 25,000 25,000
14 11/17/2014 noer 70,000 35,000 35,000
15 11/18/2014 asep 50,000 25,000 25,000
16 11/19/2014 mamat 70,000 35,000 35,000
17 11/20/2014 dadang 50,000 25,000 25,000
18 siti 50,000 10,000 25,000 25,000
19 11/25/2014 mamat 70,000 35,000 35,000
20 asep 50,000 25,000 25,000
21 11/27/2014 siti 50,000 25,000 25,000
22 11/29/2014 subur 50,000 25,000 25,000
23,619,000 1,683,000 11,663,000 11,663,000

JASA ALAT &

DOKTER BAHAN
1 12/1/2014 nandar 100,000 5,000 47,500 47,500
2 noni 100,000 5,000 47,500 47,500
3 fitria 150,000 5,000 72,500 72,500
4 tresnawati 120,000 5,000 57,500 57,500
5 anisa gina 30,000 5,000 12,500 12,500
6 damai 30,000 5,000 12,500 12,500
7 rian 70,000 5,000 32,500 32,500
8 12/2/2014 lestio 105,000 5,000 50,000 50,000
9 12/3/2014 nanda 200,000 5,000 97,500 97,500
10 akbar 120,000 5,000 57,500 57,500
11 rini 70,000 5,000 32,500 32,500
12 nurul yunita 70,000 5,000 32,500 32,500
13 12/4/2014 dewi 100,000 5,000 47,500 47,500
14 istiana 30,000 5,000 12,500 12,500
15 12/5/2014 lasma 120,000 5,000 57,500 57,500
16 ernita 250,000 5,000 122,500 122,500
17 12/6/2014 tasya 100,000 5,000 47,500 47,500
18 zahra 50,000 5,000 22,500 22,500
19 12/8/2014 suwarni 20,000 5,000 7,500 7,500
20 yazid 100,000 5,000 47,500 47,500
21 sarimanah 20,000 5,000 7,500 7,500
22 istiana 20,000 5,000 7,500 7,500
23 12/9/2014 rini 50,000 5,000 22,500 22,500
24 komariah 100,000 5,000 47,500 47,500
25 12/10/2014 keisha 90,000 5,000 42,500 42,500
26 iceu 20,000 5,000 7,500 7,500
27 nurul yunita 75,000 5,000 35,000 35,000
28 dewi 100,000 5,000 47,500 47,500
29 santi 30,000 5,000 12,500 12,500
30 12/13/2014 subur 100,000 5,000 47,500 47,500
31 neni 100,000 5,000 47,500 47,500
32 kal el 25,000 5,000 10,000 10,000
33 zahra 45,000 5,000 20,000 20,000
34 rahmat 20,000 5,000 7,500 7,500
35 suyitno 50,000 5,000 22,500 22,500
36 febi 100,000 5,000 47,500 47,500
37 12/14/2014 rizal 50,000 5,000 22,500 22,500
38 12/15/2014 radi 40,000 5,000 17,500 17,500
39 iceu 25,000 5,000 10,000 10,000
40 12/16/2014 lanny 100,000 5,000 47,500 47,500
41 asep mulyana 200,000 5,000 97,500 97,500
42 12/17/2014 dafita 80,000 5,000 37,500 37,500
43 rini 70,000 5,000 32,500 32,500
44 yarid 100,000 5,000 47,500 47,500
45 12/18/2014 ani nuryani 100,000 5,000 47,500 47,500
46 zahra 60,000 5,000 27,500 27,500
47 eko 50,000 5,000 22,500 22,500
48 rindi 25,000 5,000 10,000 10,000
49 aca 50,000 5,000 22,500 22,500
50 12/19/2014 yayah 100,000 5,000 47,500 47,500
51 zalfa 60,000 5,000 27,500 27,500
52 safira 50,000 5,000 22,500 22,500
53 belfa 30,000 5,000 12,500 12,500
54 ahnaf 50,000 5,000 22,500 22,500
55 radi 40,000 5,000 17,500 17,500
56 inten 200,000 5,000 97,500 97,500
57 nurul 55,000 5,000 25,000 25,000
58 dadan 100,000 5,000 47,500 47,500
59 iceu 50,000 5,000 22,500 22,500
60 12/20/2014 zahra 50,000 5,000 22,500 22,500
61 rakha 100,000 5,000 47,500 47,500
62 rini 520,000 5,000 257,500 257,500
63 12/22/2014 hikari 40,000 5,000 17,500 17,500
64 fidli 25,000 5,000 10,000 10,000
65 heryanto 25,000 5,000 10,000 10,000
66 iceu 200,000 5,000 97,500 97,500
67 yunita 50,000 5,000 22,500 22,500
68 12/23/2014 komariah 20,000 5,000 7,500 7,500
69 seina 20,000 5,000 7,500 7,500
70 12/24/2014 ali 20,000 5,000 7,500 7,500
71 astri 100,000 5,000 47,500 47,500
72 asep 100,000 5,000 47,500 47,500
73 dafita 80,000 5,000 37,500 37,500
74 rini nuraeni 90,000 5,000 42,500 42,500
75 nurul 90,000 5,000 42,500 42,500
76 12/26/2014 tati 30,000 5,000 12,500 12,500
77 12/27/2014 mely 60,000 5,000 27,500 27,500
78 susi 160,000 5,000 77,500 77,500
79 12/29/2014 komariah 100,000 5,000 47,500 47,500
80 12/31/2014 exza 120,000 5,000 57,500 57,500
81 nurul yunita 200,000 5,000 97,500 97,500
82 alfin 20,000 5,000 7,500 7,500
83 dafita 100,000 5,000 47,500 47,500
6,885,000 415,000 3,235,000 3,235,000

JASA ALAT &

DOKTER BAHAN
1 12/1/2014 farhan 15,000 10,000 7,500 7,500
2 hendri 70,000 35,000 35,000
3 erni 30,000 10,000 15,000 15,000
4 m rizky 15,000 7,500 7,500
5 nur'aeni 70,000 35,000 35,000
6 risky 30,000 15,000 15,000
7 siti a 15,000 10,000 7,500 7,500
8 efa s 30,000 15,000 15,000
9 12/2/2014 hendri 30,000 15,000 15,000
10 winda r 30,000 15,000 15,000
11 siti rosyah 30,000 15,000 15,000
12 12/3/2014 sulastri 60,000 30,000 30,000
13 winda 60,000 10,000 30,000 30,000
14 yuli 30,000 10,000 15,000 15,000
15 deti 35,000 17,500 17,500
16 glorie 15,000 10,000 7,500 7,500
17 ardiansyah 60,000 10,000 30,000 30,000
18 ujang 15,000 10,000 7,500 7,500
19 mita 60,000 10,000 30,000 30,000
20 dwiwanti 15,000 7,500 7,500
21 sukaesih 60,000 10,000 30,000 30,000
22 haidar 15,000 10,000 7,500 7,500
23 dadang 70,000 35,000 35,000
24 m syahrul 30,000 15,000 15,000
25 ratnasih 40,000 20,000 20,000
26 agus permana 30,000 15,000 15,000
27 nuke astria 15,000 10,000 7,500 7,500
28 12/4/2014 desy sr 15,000 10,000 7,500 7,500
29 hari 30,000 15,000 15,000
30 ita 70,000 35,000 35,000
31 rosanti 15,000 10,000 7,500 7,500
32 ririn 25,000 12,500 12,500
33 faiz 25,000 12,500 12,500
34 12/5/2014 sumira 60,000 30,000 30,000
35 nabila 35,000 17,500 17,500
36 siti atikah 70,000 35,000 35,000
37 elly romayani 30,000 15,000 15,000
38 lulu 35,000 17,500 17,500
39 elistien 15,000 7,500 7,500
40 dwi joko 70,000 35,000 35,000
41 tuniyah 70,000 35,000 35,000
42 ida 40,000 20,000 20,000
43 mulyani 15,000 10,000 7,500 7,500
44 tin k 15,000 10,000 7,500 7,500
45 tasya 70,000 35,000 35,000
46 siti 40,000 20,000 20,000
47 aa 15,000 10,000 7,500 7,500
48 12/6/2014 fanysya 15,000 10,000 7,500 7,500
49 yuli 30,000 15,000 15,000
50 mita 15,000 10,000 7,500 7,500
51 tezar 35,000 17,500 17,500
52 suherlihah 15,000 10,000 7,500 7,500
53 m zufar 70,000 35,000 35,000
54 r tony 30,000 15,000 15,000
55 sumira 60,000 30,000 30,000
56 sulastri 60,000 30,000 30,000
57 ai nurhayati 30,000 15,000 15,000
58 12/8/2014 rohmat 30,000 10,000 15,000 15,000
59 aa suarsa 60,000 10,000 30,000 30,000
60 atiqah 30,000 10,000 15,000 15,000
61 siti hodijah 30,000 10,000 15,000 15,000
62 dwi joko 70,000 35,000 35,000
63 abbot 30,000 15,000 15,000
64 ratna 70,000 35,000 35,000
65 lulu n 25,000 12,500 12,500
66 sulastri 60,000 30,000 30,000
67 yani 15,000 10,000 7,500 7,500
68 hari 30,000 15,000 15,000
69 agus 30,000 15,000 15,000
70 efa s 30,000 15,000 15,000
71 lismia 30,000 15,000 15,000
72 mia 15,000 10,000 7,500 7,500
73 siti m 15,000 10,000 7,500 7,500
74 theresia 15,000 10,000 7,500 7,500
75 dian r 15,000 10,000 7,500 7,500
76 12/9/2014 george 15,000 10,000 7,500 7,500
77 nadza 15,000 7,500 7,500
78 isna 15,000 7,500 7,500
79 siti 70,000 35,000 35,000
80 wati 30,000 15,000 15,000
81 pandu 35,000 17,500 17,500
82 tita 15,000 10,000 7,500 7,500
83 dian eka 70,000 35,000 35,000
84 dadang 70,000 35,000 35,000
85 tiara 15,000 10,000 7,500 7,500
86 12/10/2014 sansan 15,000 10,000 7,500 7,500
87 ismail 60,000 10,000 30,000 30,000
88 asep mulyana 60,000 10,000 30,000 30,000
89 ahmad taufik 30,000 10,000 15,000 15,000
90 atiqoh 30,000 15,000 15,000
91 heppi s 20,000 10,000 10,000
92 yanti 30,000 15,000 15,000
93 12/11/2014 sri 15,000 7,500 7,500
94 kardi 30,000 15,000 15,000
95 dadang 70,000 35,000 35,000
96 permana 30,000 15,000 15,000
97 nugraha 15,000 10,000 7,500 7,500
98 sudartik 30,000 10,000 15,000 15,000
99 ujang 15,000 10,000 7,500 7,500
100 atiqoh 15,000 10,000 7,500 7,500
101 ita l 30,000 15,000 15,000
102 alfandi 15,000 10,000 7,500 7,500
103 sugiati 70,000 35,000 35,000
104 surya 15,000 10,000 7,500 7,500
105 supriyadi 15,000 7,500 7,500
106 suciati 70,000 35,000 35,000
107 feni 70,000 35,000 35,000
108 12/12/2014 yaya permana 15,000 7,500 7,500
109 tuniyah 70,000 35,000 35,000
110 widianingsih 70,000 35,000 35,000
111 dodo suparman 30,000 15,000 15,000
112 sulastri 60,000 30,000 30,000
113 imas 15,000 10,000 7,500 7,500
114 eka 30,000 10,000 15,000 15,000
115 kandi 30,000 10,000 15,000 15,000
116 siti a 70,000 35,000 35,000
117 12/13/2014 m abdul 60,000 30,000 30,000
118 fauzan 30,000 15,000 15,000
119 yuli y 30,000 15,000 15,000
120 sumira 30,000 15,000 15,000
121 elly romayani 70,000 35,000 35,000
122 ai nurhayati 70,000 35,000 35,000
123 tony kusumah 30,000 15,000 15,000
124 winda 30,000 15,000 15,000
125 nabila 30,000 15,000 15,000
126 rosanti 15,000 10,000 7,500 7,500
127 adin z 60,000 10,000 30,000 30,000
128 yudi 30,000 15,000 15,000
129 yovi 15,000 7,500 7,500
130 siti h 70,000 35,000 35,000
131 ida i 70,000 35,000 35,000
132 12/15/2014 rohmat 30,000 15,000 15,000
133 atiqoh 30,000 15,000 15,000
134 abboth 70,000 35,000 35,000
135 h sabtu 60,000 10,000 30,000 30,000
136 sri nengsih 30,000 10,000 15,000 15,000
137 ani n 30,000 10,000 15,000 15,000
138 tintin s 15,000 10,000 7,500 7,500
139 hendri 70,000 10,000 35,000 35,000
140 siti h 30,000 10,000 15,000 15,000
141 maryati 15,000 10,000 7,500 7,500
142 entin 15,000 10,000 7,500 7,500
143 agus 15,000 10,000 7,500 7,500
144 yohanes 15,000 10,000 7,500 7,500
145 reni 15,000 10,000 7,500 7,500
146 esti 15,000 10,000 7,500 7,500
147 fikri 70,000 35,000 35,000
148 efa 15,000 10,000 7,500 7,500
149 renal 40,000 20,000 20,000
150 12/16/2014 guntari 70,000 35,000 35,000
151 lanny 30,000 15,000 15,000
152 tita 60,000 30,000 30,000
153 m ari 15,000 7,500 7,500
154 siti rosyati 70,000 35,000 35,000
155 anita yusuf 15,000 10,000 7,500 7,500
156 githa 30,000 15,000 15,000
157 george 15,000 7,500 7,500
158 yanti 15,000 10,000 7,500 7,500
159 siti annisa 30,000 15,000 15,000
160 sabrina 35,000 17,500 17,500
161 shafira 15,000 7,500 7,500
162 sudartik 30,000 15,000 15,000
163 titin 15,000 10,000 7,500 7,500
164 isna 35,000 17,500 17,500
165 nafidza 15,000 10,000 7,500 7,500
166 dadang 70,000 35,000 35,000
167 12/17/2014 theresia 70,000 10,000 35,000 35,000
168 ningrum 15,000 10,000 7,500 7,500
169 ika 15,000 10,000 7,500 7,500
170 rohmayati 30,000 15,000 15,000
171 ganjar 30,000 10,000 15,000 15,000
172 nuraeni 15,000 7,500 7,500
173 haysa 15,000 7,500 7,500
174 abdul rohman 30,000 10,000 15,000 15,000
175 agus p 30,000 15,000 15,000
176 12/18/2014 karyono 30,000 15,000 15,000
177 deli djohan 70,000 35,000 35,000
178 nur meilisa 15,000 7,500 7,500
179 naifa 35,000 17,500 17,500
180 m hibban 35,000 17,500 17,500
181 sumira 30,000 15,000 15,000
182 dodo suparman 30,000 15,000 15,000
183 yola 60,000 30,000 30,000
184 jajang 60,000 30,000 30,000
185 dadan abdul 60,000 30,000 30,000
186 shaya 35,000 17,500 17,500
187 ani nuryani 60,000 30,000 30,000
188 supriyadi 15,000 10,000 7,500 7,500
189 yanti 15,000 7,500 7,500
190 suharti 15,000 10,000 7,500 7,500
191 ita l 30,000 10,000 15,000 15,000
192 afi 15,000 10,000 7,500 7,500
193 iis k 15,000 10,000 7,500 7,500
194 lia 25,000 12,500 12,500
195 sahala 30,000 15,000 15,000
196 surya 30,000 15,000 15,000
197 asep 15,000 7,500 7,500
198 axel 15,000 10,000 7,500 7,500
199 12/19/2014 yussi sozia 30,000 15,000 15,000
200 yola anggraena 60,000 30,000 30,000
201 ivana 30,000 15,000 15,000
202 asrofiatun 15,000 10,000 7,500 7,500
203 m ramdan 35,000 17,500 17,500
204 inten 15,000 10,000 7,500 7,500
205 eka 30,000 15,000 15,000
206 fini 25,000 12,500 12,500
207 nabila 15,000 7,500 7,500
208 defina 70,000 35,000 35,000
209 reti 15,000 10,000 7,500 7,500
210 deni 70,000 35,000 35,000
211 sriyani 15,000 10,000 7,500 7,500
212 kandi 30,000 15,000 15,000
213 esti 30,000 15,000 15,000
214 12/20/2014 nurjaman 30,000 15,000 15,000
215 yuli ulianti 15,000 7,500 7,500
216 winda 30,000 15,000 15,000
217 elly romayani 70,000 35,000 35,000
218 alfaruk 30,000 15,000 15,000
219 juju 70,000 35,000 35,000
220 irawan 30,000 15,000 15,000
221 fauzan 30,000 15,000 15,000
222 siti hodijah 30,000 15,000 15,000
223 yudi cahyana 30,000 15,000 15,000
224 agus setiawan 30,000 15,000 15,000
225 lilis komalasari 30,000 15,000 15,000
226 hamid hidayat 70,000 35,000 35,000
227 12/22/2014 alfaruk 25,000 12,500 12,500
228 atiqoh 30,000 15,000 15,000
229 virgy 30,000 15,000 15,000
230 rohmayati 30,000 15,000 15,000
231 fahril 25,000 10,000 12,500 12,500
232 ai anggraeni 15,000 10,000 7,500 7,500
233 ai sari 60,000 10,000 30,000 30,000
234 hendri 30,000 10,000 15,000 15,000
235 wati 30,000 10,000 15,000 15,000
236 lintang 15,000 10,000 7,500 7,500
237 nur aisah 15,000 10,000 7,500 7,500
238 hidayat 15,000 7,500 7,500
239 fikri 70,000 35,000 35,000
240 12/23/2014 ganjar 30,000 15,000 15,000
241 mimin 20,000 10,000 10,000
242 efa susanti 30,000 15,000 15,000
243 puan p 35,000 17,500 17,500
244 atiqoh 35,000 17,500 17,500
245 12/24/2014 siti hodijah 30,000 10,000 15,000 15,000
246 ibrahim 30,000 10,000 15,000 15,000
247 rohmayati 60,000 10,000 30,000 30,000
248 siti r 70,000 35,000 35,000
249 virgy 15,000 7,500 7,500
250 ani m 15,000 7,500 7,500
251 siti anisa 30,000 15,000 15,000
252 agus p 30,000 15,000 15,000
253 agus k 35,000 17,500 17,500
254 mutiara 70,000 35,000 35,000
255 eva dahliasari 30,000 15,000 15,000
256 celia 15,000 10,000 7,500 7,500
257 reka dwi 35,000 17,500 17,500
258 yudi cahyana 30,000 15,000 15,000
259 sarbini 30,000 10,000 15,000 15,000
260 12/26/2014 sumira 60,000 30,000 30,000
261 sulastri 60,000 30,000 30,000
262 lexa 15,000 10,000 7,500 7,500
263 danil 30,000 15,000 15,000
264 dodo suparman 60,000 30,000 30,000
265 euis nurjanah 40,000 20,000 20,000
266 septian 60,000 30,000 30,000
267 eko m 30,000 15,000 15,000
268 s ruhiyat 15,000 10,000 7,500 7,500
269 m rizky 30,000 10,000 15,000 15,000
270 esti 30,000 15,000 15,000
271 efa susanti 30,000 15,000 15,000
272 reni h 15,000 10,000 7,500 7,500
273 patimah 30,000 15,000 15,000
274 siti hodijah 70,000 35,000 35,000
275 chepi 70,000 35,000 35,000
276 evi s 15,000 7,500 7,500
277 devira 70,000 35,000 35,000
278 ita lianti 30,000 15,000 15,000
279 hari 70,000 35,000 35,000
280 hari n 70,000 35,000 35,000
281 12/27/2014 sulastri 60,000 30,000 30,000
282 fanysya 30,000 15,000 15,000
283 elly romayani 60,000 10,000 30,000 30,000
284 wati karlina 30,000 15,000 15,000
285 m hibban 35,000 17,500 17,500
286 warny 30,000 10,000 15,000 15,000
287 umar setiawan 70,000 35,000 35,000
288 niken jiwa 70,000 35,000 35,000
289 dodo suparman 70,000 35,000 35,000
290 iis rustini 30,000 15,000 15,000
291 nisrina 35,000 17,500 17,500
292 ernita 30,000 15,000 15,000
293 yudi cahyana 30,000 15,000 15,000
294 muhara 25,000 12,500 12,500
295 lilis k 30,000 15,000 15,000
296 reka dwi 70,000 35,000 35,000
297 tanya aulia 35,000 17,500 17,500
298 12/29/2014 siti hodijah 30,000 10,000 15,000 15,000
299 s ruhiyat 30,000 10,000 15,000 15,000
300 ligar f 40,000 10,000 20,000 20,000
301 sansan 15,000 10,000 7,500 7,500
302 virgy 30,000 10,000 15,000 15,000
303 ida 60,000 10,000 30,000 30,000
304 eli 15,000 10,000 7,500 7,500
305 rohmayati 30,000 10,000 15,000 15,000
306 mutiara a 70,000 35,000 35,000
307 rafli 35,000 17,500 17,500
308 agus k 70,000 35,000 35,000
309 putra 30,000 15,000 15,000
310 hendri m 40,000 20,000 20,000
311 euis n 70,000 35,000 35,000
312 dian eka 70,000 35,000 35,000
313 fikri 70,000 35,000 35,000
314 widiawan 15,000 7,500 7,500
315 kartini 15,000 10,000 7,500 7,500
316 ganjar 40,000 10,000 20,000 20,000
317 yohanes 30,000 10,000 15,000 15,000
318 yanti m 30,000 10,000 15,000 15,000
319 yuliani 60,000 10,000 30,000 30,000
320 12/31/2014 ade aziz 30,000 10,000 15,000 15,000
321 ade r 15,000 10,000 7,500 7,500
322 agus p 40,000 20,000 20,000
323 siti anisa 30,000 10,000 15,000 15,000
324 febrian 15,000 10,000 7,500 7,500
325 siti hodijah 70,000 35,000 35,000
326 lintang d 70,000 35,000 35,000
- -
- -
18,695,000 1,555,000 9,140,000 9,140,000

JASA ALAT &

NO TGL NAMA PASIEN TARIF OBAT
DOKTER BAHAN
1 12/1/2014 dewi rahmawati 30,000 15,000 15,000
2 dadang 50,000 25,000 25,000
3 siti nurjanah 50,000 25,000 25,000
4 12/2/2014 asep saripudin 70,000 35,000 35,000
5 12/5/2014 dadang 50,000 25,000 25,000
6 siti nurjanah 50,000 25,000 25,000
7 12/9/2014 susilawati 30,000 10,000 15,000 15,000
8 dadang komarudin 50,000 25,000 25,000
9 12/12/2014 dadang 70,000 35,000 35,000
10 12/13/2014 subur 50,000 25,000 25,000
11 12/15/2014 siti 70,000 35,000 35,000
12 12/18/2014 surya 30,000 15,000 15,000
13 12/23/2014 surya 50,000 25,000 25,000
14 12/27/2014 neni s 70,000 35,000 35,000
15 12/29/2014 susilawati 30,000 10,000 15,000 15,000
16 - -
30,555,000 2,625,000 15,070,000 15,070,000

JASA ALAT &

DOKTER BAHAN
1 1/7/2015 iceu 80,000 5,000 37,500 37,500
2 listia 100,000 5,000 47,500 47,500
3 rini nuraeni 100,000 5,000 47,500 47,500
4 risna 50,000 5,000 22,500 22,500
5 1/8/2015 rahayu 150,000 5,000 72,500 72,500
6 jaka 50,000 5,000 22,500 22,500
7 1/10/2015 edi supriatna 100,000 5,000 47,500 47,500
8 endang kusmayana 70,000 5,000 32,500 32,500
9 gunawan b 150,000 5,000 72,500 72,500
10 rakha 50,000 5,000 22,500 22,500
11 dadan 180,000 5,000 87,500 87,500
12 iceu 100,000 5,000 47,500 47,500
13 exza 40,000 5,000 17,500 17,500
14 1/11/2015 rizal 50,000 5,000 22,500 22,500
15 1/12/2015 eko 50,000 5,000 22,500 22,500
16 santi 50,000 5,000 22,500 22,500
17 bertik 25,000 5,000 10,000 10,000
18 rani 60,000 5,000 27,500 27,500
19 tasya 25,000 5,000 10,000 10,000
20 iwan 20,000 5,000 7,500 7,500
21 1/13/2015 ergina 20,000 5,000 7,500 7,500
22 1/14/2015 exza 320,000 5,000 157,500 157,500
23 yuni 20,000 5,000 7,500 7,500
24 irwan 70,000 5,000 32,500 32,500
25 1/15/2015 komariah 30,000 5,000 12,500 12,500
26 marsha 50,000 5,000 22,500 22,500
27 1/16/2015 sri maryani 100,000 5,000 47,500 47,500
28 cecep 100,000 5,000 47,500 47,500
29 endang kusmayana 120,000 5,000 57,500 57,500
30 samsudin 25,000 5,000 10,000 10,000
31 melani 25,000 5,000 10,000 10,000
32 1/17/2015 komariah 20,000 5,000 7,500 7,500
33 rondhotul 30,000 5,000 12,500 12,500
34 yusni 150,000 5,000 72,500 72,500
35 deni ayu 170,000 5,000 82,500 82,500
36 yeni 60,000 5,000 27,500 27,500
37 nazwa 50,000 5,000 22,500 22,500
38 1/19/2015 exzep 80,000 5,000 37,500 37,500
39 kusmati 60,000 5,000 27,500 27,500
40 yeni 60,000 5,000 27,500 27,500
41 santi 70,000 5,000 32,500 32,500
42 agnia 100,000 5,000 47,500 47,500
43 dadi 60,000 5,000 27,500 27,500
44 1/21/2015 rizqi 50,000 5,000 22,500 22,500
45 andi 30,000 5,000 12,500 12,500
46 1/22/2015 ergina 30,000 5,000 12,500 12,500
47 rani 55,000 5,000 25,000 25,000
48 nana 60,000 5,000 27,500 27,500
49 kurnia 25,000 5,000 10,000 10,000
50 yayah 25,000 5,000 10,000 10,000
51 dapit 25,000 5,000 10,000 10,000
52 peni ayu 55,000 5,000 25,000 25,000
53 kusmiati 120,000 5,000 57,500 57,500
54 1/24/2015 sri suwarti 100,000 5,000 47,500 47,500
55 1/25/2015 rizal 50,000 5,000 22,500 22,500
56 1/26/2015 iceu 50,000 5,000 22,500 22,500
57 kustinawati 20,000 5,000 7,500 7,500
58 jajang k 100,000 5,000 47,500 47,500
59 sandi k 200,000 5,000 97,500 97,500
60 yeni 20,000 5,000 7,500 7,500
61 santi 50,000 5,000 22,500 22,500
62 fitri 20,000 5,000 7,500 7,500
63 sumarni 200,000 5,000 97,500 97,500
64 rani 60,000 5,000 27,500 27,500
65 susi 60,000 5,000 27,500 27,500
66 1/28/2015 iceu 50,000 5,000 22,500 22,500
67 mattry 50,000 5,000 22,500 22,500
68 1/29/2015 dessi 250,000 5,000 122,500 122,500
69 1/30/2015 agus setiadi 200,000 5,000 97,500 97,500
70 1/31/2015 roudhotul 400,000 5,000 197,500 197,500
71 jamaludin 120,000 5,000 57,500 57,500
72 herdiyana 150,000 5,000 72,500 72,500
73 titin m 50,000 5,000 22,500 22,500
74 nirma 20,000 5,000 7,500 7,500
5,000 (2,500) (2,500)
5,000 (2,500) (2,500)
5,985,000 380,000 2,802,500 2,802,500

JASA ALAT &

DOKTER BAHAN
1 1/2/2015 andini 30,000 15,000 15,000
2 esti jumarni 30,000 15,000 15,000
3 sofiana 15,000 10,000 7,500 7,500
4 sahril 15,000 10,000 7,500 7,500
5 euis 60,000 30,000 30,000
6 tyas 35,000 17,500 17,500
7 ibrahim a 30,000 15,000 15,000
8 fathia 35,000 17,500 17,500
9 1/5/2015 atiqoh 40,000 20,000 20,000
10 anita f 15,000 10,000 7,500 7,500
11 tyas 25,000 10,000 12,500 12,500
12 rohmayanti 30,000 10,000 15,000 15,000
13 maman 70,000 35,000 35,000
14 siti h 30,000 10,000 15,000 15,000
15 zacky 15,000 7,500 7,500
16 sulastri 15,000 10,000 7,500 7,500
17 hendri m 70,000 35,000 35,000
18 elis s 15,000 10,000 7,500 7,500
19 ade 40,000 10,000 20,000 20,000
20 deliya 25,000 10,000 12,500 12,500
21 ruhiyat 30,000 15,000 15,000
22 ganjar 70,000 35,000 35,000
23 yudi 30,000 15,000 15,000
24 tika 30,000 10,000 15,000 15,000
25 susi 15,000 10,000 7,500 7,500
26 nini 15,000 10,000 7,500 7,500
27 neneng 15,000 10,000 7,500 7,500
28 siti a 15,000 10,000 7,500 7,500
29 rini 15,000 10,000 7,500 7,500
30 lulienty 15,000 10,000 7,500 7,500
31 azka 15,000 10,000 7,500 7,500
32 endah 15,000 10,000 7,500 7,500
33 rustini 30,000 15,000 15,000
34 efa 30,000 15,000 15,000
35 1/6/2015 eli 15,000 10,000 7,500 7,500
36 nuraeni 30,000 15,000 15,000
37 danil 30,000 15,000 15,000
38 1/7/2015 siti h 40,000 20,000 20,000
39 lisnawati 15,000 10,000 7,500 7,500
40 annisa nur latifah 15,000 7,500 7,500
41 siti annisa 30,000 15,000 15,000
42 reni 15,000 10,000 7,500 7,500
43 nisrina 15,000 7,500 7,500
44 resinta 70,000 35,000 35,000
45 abbot 30,000 10,000 15,000 15,000
46 dadang 70,000 35,000 35,000
47 wawang 30,000 15,000 15,000
48 zaina 15,000 7,500 7,500
49 qoniah 15,000 7,500 7,500
50 elshe 70,000 35,000 35,000
51 marsha 15,000 10,000 7,500 7,500
52 kandi 40,000 20,000 20,000
53 azka 15,000 7,500 7,500
54 agus permana 70,000 35,000 35,000
55 irawan 30,000 10,000 15,000 15,000
56 agus s 30,000 15,000 15,000
57 indra aditya 30,000 10,000 15,000 15,000
58 1/8/2015 rahayu 15,000 7,500 7,500
59 ayesa silmi 30,000 15,000 15,000
60 m hibbah 35,000 17,500 17,500
61 nur meilisa 70,000 35,000 35,000
62 siti komala 70,000 35,000 35,000
63 risman 30,000 15,000 15,000
64 candra sri 70,000 35,000 35,000
65 sani 15,000 10,000 7,500 7,500
66 nafidza 20,000 10,000 10,000
67 widiawan 15,000 7,500 7,500
68 ria 70,000 35,000 35,000
69 s ruhiyat 15,000 10,000 7,500 7,500
70 derry d 15,000 10,000 7,500 7,500
71 deni k 15,000 7,500 7,500
72 neni 15,000 10,000 7,500 7,500
73 1/9/2015 ong tjuilan 60,000 30,000 30,000
74 shania 35,000 17,500 17,500
75 salma rizka 35,000 17,500 17,500
76 susila 30,000 15,000 15,000
77 azka hanif 70,000 35,000 35,000
78 lina lestari 60,000 30,000 30,000
79 ibrahim 30,000 15,000 15,000
80 tyas 70,000 35,000 35,000
81 hadiah 30,000 15,000 15,000
82 myshella 35,000 17,500 17,500
83 josua 15,000 10,000 7,500 7,500
84 sriyani 30,000 15,000 15,000
85 nia 15,000 10,000 7,500 7,500
86 neni 15,000 10,000 7,500 7,500
87 ade a 30,000 15,000 15,000
88 siti a 30,000 15,000 15,000
89 laeli 70,000 35,000 35,000
90 karwati 30,000 15,000 15,000
91 tin 15,000 7,500 7,500
92 yanti 15,000 7,500 7,500
93 susi d 15,000 10,000 7,500 7,500
94 trisna 30,000 15,000 15,000
95 1/10/2015 yussi 30,000 15,000 15,000
96 kanti 70,000 35,000 35,000
97 luri 30,000 15,000 15,000
98 evelin 70,000 35,000 35,000
99 zara 70,000 35,000 35,000
100 nurul 30,000 10,000 15,000 15,000
101 viona 30,000 10,000 15,000 15,000
102 abbot 70,000 35,000 35,000
103 saskia 30,000 15,000 15,000
104 s ruhiyat 60,000 30,000 30,000
105 reka 60,000 30,000 30,000
106 lilis 30,000 15,000 15,000
107 1/12/2015 esti jumarni 30,000 10,000 15,000 15,000
108 satriya 70,000 35,000 35,000
109 m ramdan 25,000 12,500 12,500
110 enceng 15,000 10,000 7,500 7,500
111 anda 15,000 10,000 7,500 7,500
112 ade sunarya 70,000 35,000 35,000
113 siti khodijah 30,000 15,000 15,000
114 elis u 70,000 35,000 35,000
115 widiya 30,000 15,000 15,000
116 refiana 20,000 10,000 10,000
117 ai 15,000 10,000 7,500 7,500
118 rifan 15,000 10,000 7,500 7,500
119 putra 30,000 15,000 15,000
120 febriani 15,000 7,500 7,500
121 kania 40,000 20,000 20,000
122 ganjar 70,000 35,000 35,000
123 razka 15,000 10,000 7,500 7,500
124 1/13/2015 laeli 70,000 35,000 35,000
125 sari 15,000 10,000 7,500 7,500
126 anita f 15,000 7,500 7,500
127 ayi 15,000 7,500 7,500
128 widanengsih 30,000 15,000 15,000
129 mega 70,000 35,000 35,000
130 ervan 15,000 10,000 7,500 7,500
131 gita p 30,000 15,000 15,000
132 holisoh 15,000 10,000 7,500 7,500
133 dadang 30,000 15,000 15,000
134 danil 30,000 15,000 15,000
135 epa susanti 30,000 15,000 15,000
136 dafin 30,000 15,000 15,000
137 irawan 30,000 10,000 15,000 15,000
138 sri wahyuni 15,000 10,000 7,500 7,500
139 lulienty 70,000 35,000 35,000
140 siti jamilah 30,000 15,000 15,000
141 haidar 35,000 17,500 17,500
142 haisya 30,000 15,000 15,000
143 ica 40,000 20,000 20,000
144 1/14/2015 djenab 30,000 10,000 15,000 15,000
145 dadang 30,000 15,000 15,000
146 teti 35,000 17,500 17,500
147 nursidiq 15,000 7,500 7,500
148 ani nur 15,000 7,500 7,500
149 siti hodijah 70,000 10,000 35,000 35,000
150 agus s 40,000 20,000 20,000
151 kandi 70,000 35,000 35,000
152 syachril 70,000 35,000 35,000
153 sopiyan 30,000 10,000 15,000 15,000
154 r anisa 30,000 15,000 15,000
155 qoniah 35,000 10,000 17,500 17,500
156 wawang 30,000 15,000 15,000
157 ririn 15,000 7,500 7,500
158 rahmadhani 30,000 15,000 15,000
159 1/15/2015 wastini 60,000 30,000 30,000
160 teti 30,000 15,000 15,000
161 rifa 15,000 10,000 7,500 7,500
162 marsha 35,000 17,500 17,500
163 titin 60,000 30,000 30,000
164 ratna 70,000 35,000 35,000
165 dery 15,000 10,000 7,500 7,500
166 yanti 15,000 10,000 7,500 7,500
167 arine 20,000 10,000 10,000
168 nurul 30,000 15,000 15,000
169 nia 15,000 10,000 7,500 7,500
170 ita 30,000 15,000 15,000
171 1/16/2015 ratna 15,000 10,000 7,500 7,500
172 linggar 15,000 10,000 7,500 7,500
173 rasa 15,000 10,000 7,500 7,500
174 azka 70,000 35,000 35,000
175 febrian 60,000 30,000 30,000
176 nisrina 15,000 7,500 7,500
177 rosinta 70,000 35,000 35,000
178 refana 70,000 35,000 35,000
179 wastini 60,000 30,000 30,000
180 tjiji 30,000 15,000 15,000
181 warny 70,000 35,000 35,000
182 sri yani 30,000 15,000 15,000
183 siti a 30,000 15,000 15,000
184 ernawati 15,000 7,500 7,500
185 tresna 30,000 15,000 15,000
186 karwati 30,000 15,000 15,000
187 1/17/2015 nurul 35,000 17,500 17,500
188 ade aziz 30,000 15,000 15,000
189 fahira 35,000 17,500 17,500
190 luri 40,000 20,000 20,000
191 irawan 30,000 15,000 15,000
192 irfan 35,000 17,500 17,500
193 agus gunawan 60,000 30,000 30,000
194 nazwa 50,000 25,000 25,000
195 lilis 30,000 15,000 15,000
196 saskia 30,000 15,000 15,000
197 wiwi 30,000 15,000 15,000
198 azka 50,000 25,000 25,000
199 rizki 30,000 15,000 15,000
200 ences 30,000 15,000 15,000
201 johanes 30,000 15,000 15,000
202 1/19/2015 widanengsih 30,000 10,000 15,000 15,000
203 riamah 30,000 10,000 15,000 15,000
204 ririn 15,000 10,000 7,500 7,500
205 titin 35,000 17,500 17,500
206 rohmayanti 30,000 10,000 15,000 15,000
207 dodin 15,000 7,500 7,500
208 siska j 25,000 12,500 12,500
209 nurul 25,000 12,500 12,500
210 esti jumarni 30,000 15,000 15,000
211 m temmy 25,000 12,500 12,500
212 ani iriani 60,000 10,000 30,000 30,000
213 nisrina 25,000 12,500 12,500
214 raisya 25,000 10,000 12,500 12,500
215 siti h 30,000 15,000 15,000
216 euis 15,000 10,000 7,500 7,500
217 karyani 15,000 10,000 7,500 7,500
218 putra 30,000 15,000 15,000
219 dadang 15,000 10,000 7,500 7,500
220 siti m 15,000 10,000 7,500 7,500
221 kania 30,000 15,000 15,000
222 1/20/2015 eros 15,000 7,500 7,500
223 jajang 15,000 10,000 7,500 7,500
224 sadri 15,000 10,000 7,500 7,500
225 ong 70,000 35,000 35,000
226 adin 15,000 10,000 7,500 7,500
227 lulienty 70,000 35,000 35,000
228 siti anisa 70,000 35,000 35,000
229 dewi 70,000 35,000 35,000
230 syachril 70,000 35,000 35,000
231 gita p 40,000 20,000 20,000
232 ibrahim 30,000 10,000 15,000 15,000
233 reka 30,000 15,000 15,000
234 revi 30,000 15,000 15,000
235 neneng 15,000 10,000 7,500 7,500
236 titin 15,000 10,000 7,500 7,500
237 1/21/2015 m ramdan 25,000 10,000 12,500 12,500
238 gilang 35,000 10,000 17,500 17,500
239 irma 60,000 10,000 30,000 30,000
240 djenab 30,000 15,000 15,000
241 tyas 30,000 15,000 15,000
242 ibrahim 30,000 15,000 15,000
243 nurlatifah 30,000 15,000 15,000
244 rizqi 15,000 10,000 7,500 7,500
245 danil 30,000 15,000 15,000
246 nafidza 15,000 7,500 7,500
247 enton 15,000 10,000 7,500 7,500
248 sopiyan 70,000 35,000 35,000
249 m rendi 15,000 7,500 7,500
250 agus 70,000 35,000 35,000
251 1/22/2015 efrida 70,000 35,000 35,000
252 wastini 15,000 7,500 7,500
253 irfan 70,000 35,000 35,000
254 zelly 60,000 30,000 30,000
255 suwito 15,000 10,000 7,500 7,500
256 m hibban 70,000 35,000 35,000
257 afni 25,000 12,500 12,500
258 wargiatun 15,000 10,000 7,500 7,500
259 roliyah 15,000 10,000 7,500 7,500
260 ade r 70,000 35,000 35,000
261 niar 70,000 35,000 35,000
262 ita 30,000 15,000 15,000
263 syachril 70,000 35,000 35,000
264 ridwan 15,000 7,500 7,500
265 1/23/2015 dedih 60,000 30,000 30,000
266 irfan 30,000 10,000 15,000 15,000
267 silmi 30,000 15,000 15,000
268 neni 70,000 35,000 35,000
269 azka 15,000 7,500 7,500
270 riamah 30,000 15,000 15,000
271 nadza 25,000 12,500 12,500
272 sriyani 30,000 15,000 15,000
273 neng 30,000 10,000 15,000 15,000
274 adin 15,000 10,000 7,500 7,500
275 sandie 30,000 15,000 15,000
276 kandi 30,000 15,000 15,000
277 trisna 30,000 15,000 15,000
278 1/24/2015 wiarsih 60,000 30,000 30,000
279 winda 40,000 20,000 20,000
280 yuningsih 15,000 10,000 7,500 7,500
281 sri suwarti 70,000 35,000 35,000
282 hadijah 60,000 30,000 30,000
283 esti jumarini 40,000 20,000 20,000
284 dadang 30,000 15,000 15,000
285 wastini 60,000 30,000 30,000
286 fahira 35,000 17,500 17,500
287 luri 70,000 35,000 35,000
288 silmi 30,000 15,000 15,000
289 lilis k 70,000 35,000 35,000
290 widanengsih 30,000 15,000 15,000
291 derry 30,000 15,000 15,000
292 siti h 30,000 15,000 15,000
293 enceng 15,000 7,500 7,500
294 rizki 30,000 15,000 15,000
295 saskia 30,000 15,000 15,000
296 saerul 25,000 12,500 12,500
297 johanes 30,000 15,000 15,000
298 abbot 30,000 15,000 15,000
299 1/26/2015 sandi k 70,000 35,000 35,000
300 rohmayanti 40,000 20,000 20,000
301 irpan 30,000 15,000 15,000
302 m rizki 30,000 10,000 15,000 15,000
303 ade aziz 30,000 15,000 15,000
304 riamah 30,000 10,000 15,000 15,000
305 sri m 15,000 10,000 7,500 7,500
306 putra 40,000 20,000 20,000
307 tugni 15,000 10,000 7,500 7,500
308 euis 15,000 10,000 7,500 7,500
309 nida 35,000 17,500 17,500
310 kania 30,000 15,000 15,000
311 nila 15,000 10,000 7,500 7,500
312 maya 15,000 10,000 7,500 7,500
313 hilman 30,000 10,000 15,000 15,000
314 refana 70,000 35,000 35,000
315 widia 30,000 15,000 15,000
316 entar 15,000 10,000 7,500 7,500
317 atiqoh 70,000 35,000 35,000
318 iyan 70,000 35,000 35,000
319 hoeriah 70,000 10,000 35,000 35,000
320 1/27/2015 reka dwi 70,000 35,000 35,000
321 titin 15,000 7,500 7,500
322 ratna 15,000 10,000 7,500 7,500
323 vera 15,000 7,500 7,500
324 syachril 70,000 35,000 35,000
325 danil 40,000 20,000 20,000
326 epa 30,000 15,000 15,000
327 wiwin 70,000 35,000 35,000
328 haisya 70,000 35,000 35,000
329 nia 70,000 35,000 35,000
330 lisnawati 60,000 10,000 30,000 30,000
331 1/28/2015 dodo suparman 30,000 10,000 15,000 15,000
332 irma 30,000 10,000 15,000 15,000
333 cicin 70,000 35,000 35,000
334 tini 15,000 7,500 7,500
335 hani 35,000 10,000 17,500 17,500
336 mugi 15,000 10,000 7,500 7,500
337 tuty 35,000 17,500 17,500
338 revi 35,000 17,500 17,500
339 josua 30,000 10,000 15,000 15,000
340 ibut 30,000 15,000 15,000
341 ica 35,000 17,500 17,500
342 m akmal 15,000 7,500 7,500
343 29/01/215 munawar 60,000 30,000 30,000
344 wiarsih 60,000 30,000 30,000
345 siti zulleila 30,000 15,000 15,000
346 fitri 30,000 15,000 15,000
347 dessi 15,000 7,500 7,500
348 karyani 70,000 35,000 35,000
349 suwito 30,000 15,000 15,000
350 1/30/2015 neneng 30,000 15,000 15,000
351 tyas 30,000 15,000 15,000
352 ibrahim 30,000 15,000 15,000
353 dadang 30,000 15,000 15,000
354 rina herlina 30,000 15,000 15,000
355 wiarsih 60,000 30,000 30,000
356 suwito 15,000 7,500 7,500
357 rina 35,000 17,500 17,500
358 siti nurjanah 70,000 35,000 35,000
359 azka hanif 70,000 35,000 35,000
360 agus setiadi 30,000 15,000 15,000
361 yuniadi 15,000 10,000 7,500 7,500
362 rika 15,000 10,000 7,500 7,500
363 rendi 15,000 10,000 7,500 7,500
364 esti 70,000 35,000 35,000
365 evelyn 70,000 35,000 35,000
366 biduri 20,000 10,000 10,000
367 sri yani 40,000 20,000 20,000
368 dedi s 30,000 15,000 15,000
369 siti a 30,000 15,000 15,000
370 josua 30,000 15,000 15,000
371 oom 15,000 10,000 7,500 7,500
372 1/31/2015 winda 70,000 35,000 35,000
373 hoeriah 60,000 30,000 30,000
374 enok 15,000 7,500 7,500
375 lilis 15,000 7,500 7,500
376 siti 60,000 30,000 30,000
377 saskia 30,000 10,000 15,000 15,000
378 s ruhiyat 70,000 35,000 35,000
379 nendah 30,000 10,000 15,000 15,000
380 lilis 40,000 20,000 20,000
381 karina 30,000 10,000 15,000 15,000
382 dedi 15,000 10,000 7,500 7,500
383 - -
384 - -
385 - -
386 - -
19,475,000 1,490,000 9,547,500 9,547,500

PERIODE FEBRUARI 2015
JASA ALAT &

DOKTER BAHAN
1 2/2/2015 jajang 20,000 5,000 7,500 7,500
2 lesita 20,000 5,000 7,500 7,500
3 jumin 25,000 5,000 10,000 10,000
4 rani 100,000 5,000 47,500 47,500
5 santi 50,000 5,000 22,500 22,500
6 yayah 200,000 5,000 97,500 97,500
7 3/2/2015 rayzal 300,000 5,000 147,500 147,500
8 rizki 100,000 5,000 47,500 47,500
9 4/2/2015 deliyana 20,000 5,000 7,500 7,500
10 iceu 130,000 5,000 62,500 62,500
11 ayu 125,000 5,000 60,000 60,000
12 ridho 30,000 5,000 12,500 12,500
13 rasyad 50,000 5,000 22,500 22,500
14 5/2/2015 suwito 200,000 5,000 97,500 97,500
15 asti 200,000 5,000 97,500 97,500
16 kokom 200,000 5,000 97,500 97,500
17 yaya 125,000 5,000 60,000 60,000
18 6/2/2015 yani 100,000 5,000 47,500 47,500
19 7/2/2015 herdiyana 150,000 5,000 72,500 72,500
20 yessi 100,000 5,000 47,500 47,500
21 gigih 75,000 5,000 35,000 35,000
22 euis 225,000 5,000 110,000 110,000
23 8/2/2015 rizal 50,000 5,000 22,500 22,500
24 9/2/2015 roni 25,000 5,000 10,000 10,000
25 iceu 200,000 5,000 97,500 97,500
26 dadan 20,000 5,000 7,500 7,500
27 galih 20,000 5,000 7,500 7,500
28 rani 100,000 5,000 47,500 47,500
29 10/2/2015 nita 50,000 5,000 22,500 22,500
30 yayah 50,000 5,000 22,500 22,500
31 hoeriah 25,000 5,000 10,000 10,000
32 siti 165,000 5,000 80,000 80,000
33 jaja 50,000 5,000 22,500 22,500
34 12/2/2015 dhian 200,000 5,000 97,500 97,500
35 juariyah 75,000 5,000 35,000 35,000
36 rina 200,000 5,000 97,500 97,500
37 clarisa 75,000 5,000 35,000 35,000
38 rani 150,000 5,000 72,500 72,500
39 13/02/2015 zahra 50,000 5,000 22,500 22,500
40 ernita 150,000 5,000 72,500 72,500
41 14/02/2015 roudhotul 200,000 5,000 97,500 97,500
42 ana susana 300,000 5,000 147,500 147,500
43 herdiyana 100,000 5,000 47,500 47,500
44 16/02/2015 dadan 100,000 5,000 47,500 47,500
45 parto 50,000 5,000 22,500 22,500
46 yaya 785,000 5,000 390,000 390,000
47 permono 25,000 5,000 10,000 10,000
48 nita 60,000 5,000 27,500 27,500
49 17/02/2015 angga 200,000 5,000 97,500 97,500
50 jaja 70,000 5,000 32,500 32,500
51 18/02/2015 sumiati 300,000 5,000 147,500 147,500
52 supriyono 100,000 5,000 47,500 47,500
53 20/02/2015 iin kurniati 50,000 5,000 22,500 22,500
54 alfin 60,000 5,000 27,500 27,500
55 nani 70,000 5,000 32,500 32,500
56 21/02/2015 husniati 200,000 5,000 97,500 97,500
57 dani 200,000 5,000 97,500 97,500
58 yuyun 200,000 5,000 97,500 97,500
59 dude 100,000 5,000 47,500 47,500
60 alifa 50,000 5,000 22,500 22,500
61 23/02/2015 clarissa 40,000 5,000 17,500 17,500
62 nita 60,000 5,000 27,500 27,500
63 egi 100,000 5,000 47,500 47,500
64 akmal 230,000 5,000 112,500 112,500
65 26/02/2015 nani 200,000 5,000 97,500 97,500
66 susi 100,000 5,000 47,500 47,500
67 berlina 20,000 5,000 7,500 7,500
68 rineta 20,000 5,000 7,500 7,500
69 27/02/2015 rifki 50,000 5,000 22,500 22,500
70 maulana 150,000 5,000 72,500 72,500
71 28/02/2015 susi 350,000 5,000 172,500 172,500
72 herdiyana 150,000 5,000 72,500 72,500
73 marlina 100,000 5,000 47,500 47,500
8,990,000 365,000 4,312,500 4,312,500

JASA ALAT &

DOKTER BAHAN
1 2/2/2015 cicih rosmawati 70,000 35,000 35,000
2 rohmayanti 70,000 35,000 35,000
3 irma y 30,000 15,000 15,000
4 yuli 15,000 10,000 7,500 7,500
5 m ramdan 25,000 12,500 12,500
6 riamah 30,000 15,000 15,000
7 siti h 40,000 20,000 20,000
8 neni 60,000 10,000 30,000 30,000
9 m rizki 30,000 15,000 15,000
10 ujang 15,000 10,000 7,500 7,500
11 putra 70,000 35,000 35,000
12 rina 30,000 15,000 15,000
13 alliya 70,000 35,000 35,000
14 raisa 15,000 10,000 7,500 7,500
15 iis 15,000 10,000 7,500 7,500
16 nida 25,000 12,500 12,500
17 3/2/2015 siska 25,000 12,500 12,500
18 komariah 15,000 10,000 7,500 7,500
19 abdul k 15,000 10,000 7,500 7,500
20 euis 30,000 15,000 15,000
21 zaelani 15,000 10,000 7,500 7,500
22 harum 15,000 10,000 7,500 7,500
23 siti a 15,000 10,000 7,500 7,500
24 neni 15,000 10,000 7,500 7,500
25 hendra 30,000 15,000 15,000
26 atiqoh 30,000 15,000 15,000
27 sansan 15,000 7,500 7,500
28 m ilham 15,000 7,500 7,500
29 imas h 60,000 30,000 30,000
30 danil 70,000 35,000 35,000
31 armal 70,000 35,000 35,000
32 eli sofian 70,000 35,000 35,000
33 nurlatifah 35,000 - 17,500 17,500
34 riza 15,000 7,500 7,500
35 4/2/2015 ai nurhayati 70,000 35,000 35,000
36 ade juanda 30,000 10,000 15,000 15,000
37 abbot 30,000 15,000 15,000
38 ibut 35,000 17,500 17,500
39 rendi 30,000 15,000 15,000
40 rengli 30,000 15,000 15,000
41 nengsi 70,000 35,000 35,000
42 rohmayanti 70,000 35,000 35,000
43 siti 15,000 10,000 7,500 7,500
44 neni 15,000 10,000 7,500 7,500
45 revi 70,000 35,000 35,000
46 tuty sadyah 70,000 35,000 35,000
47 mugi insani 35,000 17,500 17,500
48 nurul hasanah 30,000 15,000 15,000
49 theresia 70,000 35,000 35,000
50 rasyad 35,000 17,500 17,500
51 m ridwan 35,000 17,500 17,500
52 wiwik ratnawati 70,000 35,000 35,000
53 vera 15,000 7,500 7,500
54 efa 30,000 15,000 15,000
55 5/2/2015 suwito 30,000 15,000 15,000
56 asri 15,000 7,500 7,500
57 reka 30,000 15,000 15,000
58 kokom 60,000 30,000 30,000
59 entar 60,000 30,000 30,000
60 karyani 60,000 30,000 30,000
61 asep mulyana 70,000 35,000 35,000
62 tita 30,000 15,000 15,000
63 susi 30,000 15,000 15,000
64 tata 15,000 10,000 7,500 7,500
65 irfan 25,000 12,500 12,500
66 aep 30,000 15,000 15,000
67 herdi 30,000 15,000 15,000
68 nuraeni 25,000 12,500 12,500
69 eva 15,000 10,000 7,500 7,500
70 ratna 70,000 35,000 35,000
71 galang 30,000 15,000 15,000
72 siti s 30,000 15,000 15,000
73 sri 15,000 10,000 7,500 7,500
74 rizky 25,000 12,500 12,500
75 nia 70,000 35,000 35,000
76 6/2/2015 dargan 60,000 30,000 30,000
77 wiarsih 60,000 30,000 30,000
78 dian r 15,000 10,000 7,500 7,500
79 karina 30,000 15,000 15,000
80 panji 70,000 35,000 35,000
81 fanysya 30,000 15,000 15,000
82 lucky 30,000 15,000 15,000
83 azka 30,000 15,000 15,000
84 harun 70,000 35,000 35,000
85 silmi 15,000 15,000 7,500 7,500
86 josua 30,000 15,000 15,000
87 ibrahim 30,000 15,000 15,000
88 tyas 30,000 15,000 15,000
89 afni 25,000 12,500 12,500
90 kania 30,000 15,000 15,000
91 siti a 70,000 35,000 35,000
92 hendro 15,000 10,000 7,500 7,500
93 nafidza 25,000 12,500 12,500
94 7/2/2015 theresia 30,000 15,000 15,000
95 sudarsih 15,000 10,000 7,500 7,500
96 rina herlina 30,000 15,000 15,000
97 komariah 60,000 30,000 30,000
98 winda 60,000 30,000 30,000
99 nabila 30,000 15,000 15,000
100 siti soleh 30,000 15,000 15,000
101 dedi s 30,000 15,000 15,000
102 siti aisyah 30,000 15,000 15,000
103 ruhiyat 30,000 15,000 15,000
104 santi 70,000 35,000 35,000
105 saskia 30,000 15,000 15,000
106 nurjaman 30,000 15,000 15,000
107 lilis 70,000 35,000 35,000
108 agus 30,000 15,000 15,000
109 somardi 15,000 7,500 7,500
110 sri yani 70,000 35,000 35,000
111 9/2/2015 doni 25,000 12,500 12,500
112 siti 30,000 15,000 15,000
113 ika 15,000 10,000 7,500 7,500
114 neny 15,000 10,000 7,500 7,500
115 keiren 70,000 35,000 35,000
116 rizki 30,000 15,000 15,000
117 irma y 30,000 15,000 15,000
118 bambang 15,000 10,000 7,500 7,500
119 m abdul 30,000 15,000 15,000
120 ai nurhayati 30,000 15,000 15,000
121 ade azki 40,000 20,000 20,000
122 nillennia 15,000 10,000 7,500 7,500
123 nining p 15,000 10,000 7,500 7,500
124 m rizal 15,000 10,000 7,500 7,500
125 siti a 30,000 15,000 15,000
126 dery 30,000 15,000 15,000
127 dedi 15,000 7,500 7,500
128 ibrahim 40,000 20,000 20,000
129 10/2/2015 hendra 30,000 15,000 15,000
130 atiqoh 70,000 35,000 35,000
131 ismail 15,000 10,000 7,500 7,500
132 sri s 15,000 10,000 7,500 7,500
133 neng 15,000 10,000 7,500 7,500
134 tatiya 35,000 17,500 17,500
135 rendi 30,000 10,000 15,000 15,000
136 fanysya 70,000 35,000 35,000
137 lucky 30,000 15,000 15,000
138 efa 30,000 15,000 15,000
139 melinda 35,000 17,500 17,500
140 naura 35,000 17,500 17,500
141 andi 15,000 7,500 7,500
142 maya 15,000 7,500 7,500
143 rosmaya 15,000 7,500 7,500
144 11/2/2015 m sopian 15,000 7,500 7,500
145 dafita 50,000 25,000 25,000
146 yussi sofia 70,000 35,000 35,000
147 viona 15,000 10,000 7,500 7,500
148 chepi supriadi 15,000 7,500 7,500
149 yana sutisna 70,000 35,000 35,000
150 febrian 15,000 7,500 7,500
151 hamsyiah 15,000 7,500 7,500
152 djasmet 15,000 7,500 7,500
153 ate rusdianto 15,000 10,000 7,500 7,500
154 dadang 70,000 35,000 35,000
155 siti k 30,000 15,000 15,000
156 nurul hasanah 70,000 35,000 35,000
157 renata 30,000 15,000 15,000
158 nurfitri 30,000 10,000 15,000 15,000
159 siti nurjanah 30,000 10,000 15,000 15,000
160 dafian 15,000 10,000 7,500 7,500
161 didin 15,000 10,000 7,500 7,500
162 atiqoh 30,000 15,000 15,000
163 12/2/2015 suwito 30,000 15,000 15,000
164 resnawati 30,000 15,000 15,000
165 tarwin 60,000 30,000 30,000
166 refani 30,000 15,000 15,000
167 yuli yulianti 30,000 15,000 15,000
168 komariah 60,000 30,000 30,000
169 rendi 25,000 12,500 12,500
170 karwati 30,000 15,000 15,000
171 tresna 30,000 15,000 15,000
172 yasman 25,000 12,500 12,500
173 reka 30,000 15,000 15,000
174 titin 30,000 15,000 15,000
175 aep 30,000 15,000 15,000
176 susi 30,000 15,000 15,000
177 herdi 30,000 15,000 15,000
178 13/02/2015 siti aisyah 40,000 20,000 20,000
179 iis sopiah 30,000 15,000 15,000
180 vio alviyono 60,000 30,000 30,000
181 suwito 30,000 15,000 15,000
182 chepi 15,000 7,500 7,500
183 sudarsih 15,000 7,500 7,500
184 azka 30,000 15,000 15,000
185 ernita 15,000 7,500 7,500
186 rina sopian 60,000 30,000 30,000
187 weni 30,000 15,000 15,000
188 imas 15,000 10,000 7,500 7,500
189 panji 70,000 10,000 35,000 35,000
190 tuti 15,000 10,000 7,500 7,500
191 karina 30,000 10,000 15,000 15,000
192 silmi 30,000 10,000 15,000 15,000
193 rosita 70,000 35,000 35,000
194 josua 30,000 15,000 15,000
195 sandi 70,000 35,000 35,000
196 asep k 15,000 10,000 7,500 7,500
197 siti s 70,000 35,000 35,000
198 rina 30,000 15,000 15,000
199 14/02/015 yuyun yuliawati 30,000 15,000 15,000
200 agus setiadi 30,000 15,000 15,000
201 winda rissalati 30,000 15,000 15,000
202 nabila 30,000 15,000 15,000
203 riski 35,000 17,500 17,500
204 refiani 30,000 15,000 15,000
205 theresia 30,000 15,000 15,000
206 susila 30,000 10,000 15,000 15,000
207 efa susanti 30,000 15,000 15,000
208 saskia 30,000 15,000 15,000
209 yudi 30,000 15,000 15,000
210 manasye 30,000 15,000 15,000
211 gabriel 70,000 35,000 35,000
212 abil 35,000 10,000 17,500 17,500
213 nurjaman 30,000 10,000 15,000 15,000
214 susi budiwati 30,000 15,000 15,000
215 16/02/2015 yaya 70,000 35,000 35,000
216 mega 70,000 35,000 35,000
217 kesya 25,000 12,500 12,500
218 siti hodijah 70,000 35,000 35,000
219 irma 30,000 15,000 15,000
220 sutowo 30,000 15,000 15,000
221 siti salamah 30,000 15,000 15,000
222 asep s 30,000 10,000 15,000 15,000
223 atiqoh 30,000 10,000 15,000 15,000
224 raisa 15,000 10,000 7,500 7,500
225 anggia 70,000 35,000 35,000
226 aliya 70,000 35,000 35,000
227 lusni 30,000 10,000 15,000 15,000
228 tyas 30,000 15,000 15,000
229 ibrahim 70,000 35,000 35,000
230 lucky 30,000 15,000 15,000
231 fanisya 30,000 15,000 15,000
232 siti s 15,000 10,000 7,500 7,500
233 deni 15,000 10,000 7,500 7,500
234 17/02/2015 iis s 30,000 10,000 15,000 15,000
235 akbar 25,000 12,500 12,500
236 siti suci 30,000 15,000 15,000
237 siti z 30,000 15,000 15,000
238 angga 30,000 10,000 15,000 15,000
239 neneng 70,000 35,000 35,000
240 defie 70,000 35,000 35,000
241 ade aziz 70,000 35,000 35,000
242 atiqoh 30,000 15,000 15,000
243 titin s 15,000 10,000 7,500 7,500
244 naura 35,000 17,500 17,500
245 m djunaedi 30,000 10,000 15,000 15,000
246 m syahrul 15,000 10,000 7,500 7,500
247 nuryanti 30,000 10,000 15,000 15,000
248 ismail 60,000 10,000 30,000 30,000
249 18/02/2015 suprayetno 70,000 35,000 35,000
250 hendra s 30,000 15,000 15,000
251 ade juanda 30,000 15,000 15,000
252 iskandar 70,000 35,000 35,000
253 kokom k 15,000 10,000 7,500 7,500
254 dafian 30,000 15,000 15,000
255 galang 30,000 10,000 15,000 15,000
256 haidar 35,000 17,500 17,500
257 gefitri 30,000 15,000 15,000
258 tuty 30,000 15,000 15,000
259 revi 70,000 35,000 35,000
260 titin 30,000 15,000 15,000
261 egi prayoga 30,000 15,000 15,000
262 asti 30,000 15,000 15,000
263 nurul 30,000 15,000 15,000
264 chepi 30,000 15,000 15,000
265 sri 30,000 15,000 15,000
266 2/20/2015 suwito 40,000 20,000 20,000
267 siti mariam 15,000 7,500 7,500
268 hamsiyah 60,000 30,000 30,000
269 abdurrasyid 35,000 17,500 17,500
270 mila 30,000 15,000 15,000
271 winda 30,000 15,000 15,000
272 iin 60,000 30,000 30,000
273 lucky 30,000 15,000 15,000
274 fanisya 30,000 15,000 15,000
275 siti 40,000 20,000 20,000
276 m hibban 25,000 12,500 12,500
277 rosidin 70,000 35,000 35,000
278 josua 40,000 20,000 20,000
279 derry 30,000 15,000 15,000
280 mulus 15,000 10,000 7,500 7,500
281 rizky 40,000 20,000 20,000
282 mina 15,000 10,000 7,500 7,500
283 rosmaya 15,000 10,000 7,500 7,500
284 2/21/2015 dude 35,000 17,500 17,500
285 yuyun yuliawati 70,000 35,000 35,000
286 husniati 70,000 35,000 35,000
287 theresia 70,000 35,000 35,000
288 siti 70,000 35,000 35,000
289 agus setiadi 40,000 20,000 20,000
290 siti 60,000 30,000 30,000
291 maya 30,000 15,000 15,000
292 emmy 70,000 35,000 35,000
293 atiqoh 30,000 15,000 15,000
294 nurjaman 30,000 15,000 15,000
295 yudi 30,000 15,000 15,000
296 riyani 70,000 35,000 35,000
297 thirza 25,000 12,500 12,500
298 thasya 25,000 12,500 12,500
299 cicih 15,000 10,000 7,500 7,500
300 yaya 70,000 35,000 35,000
301 raden 70,000 35,000 35,000
302 teja 70,000 35,000 35,000
303 zulfaa 70,000 35,000 35,000
304 dedi 60,000 10,000 30,000 30,000
305 2/23/2015 hendra 30,000 15,000 15,000
306 ratna 70,000 35,000 35,000
307 virgy 60,000 30,000 30,000
308 resnawati 30,000 10,000 15,000 15,000
309 herman 30,000 10,000 15,000 15,000
310 irma 40,000 20,000 20,000
311 tyas 30,000 15,000 15,000
312 mulyati 15,000 10,000 7,500 7,500
313 kurnia 30,000 10,000 15,000 15,000
314 herman 15,000 10,000 7,500 7,500
315 nillenia 15,000 10,000 7,500 7,500
316 siti s 25,000 12,500 12,500
317 kania 30,000 15,000 15,000
318 mamat 15,000 10,000 7,500 7,500
319 2/24/2015 sri syam 30,000 15,000 15,000
320 deni 15,000 10,000 7,500 7,500
321 saskia 30,000 15,000 15,000
322 imas 15,000 7,500 7,500
323 aep 30,000 15,000 15,000
324 uwas 15,000 10,000 7,500 7,500
325 angelica 25,000 12,500 12,500
326 ai m 15,000 10,000 7,500 7,500
327 angga 30,000 15,000 15,000
328 m luthfi 25,000 12,500 12,500
329 rina 30,000 15,000 15,000
330 azka 15,000 7,500 7,500
331 hafiya 15,000 7,500 7,500
332 biduri 50,000 25,000 25,000
333 febrian 30,000 15,000 15,000
334 naura 50,000 25,000 25,000
335 egi 30,000 10,000 15,000 15,000
336 efa 30,000 10,000 15,000 15,000
337 sri 60,000 30,000 30,000
338 ismail 60,000 30,000 30,000
339 siti z 30,000 15,000 15,000
340 lukman 30,000 15,000 15,000
341 2/25/2015 h salimah 60,000 10,000 30,000 30,000
342 sri nengsih 30,000 10,000 15,000 15,000
343 tarwilah 30,000 10,000 15,000 15,000
344 aira s 30,000 10,000 15,000 15,000
345 maryan 30,000 10,000 15,000 15,000
346 imas h 15,000 10,000 7,500 7,500
347 dewi 15,000 10,000 7,500 7,500
348 abbot 30,000 15,000 15,000
349 sumaeti 15,000 10,000 7,500 7,500
350 yussi 15,000 7,500 7,500
351 arzia 35,000 10,000 17,500 17,500
352 tin kartini 15,000 7,500 7,500
353 risti 15,000 10,000 7,500 7,500
354 dewi 70,000 10,000 35,000 35,000
355 dafian 30,000 10,000 15,000 15,000
356 raisya 30,000 15,000 15,000
357 lilis n 30,000 15,000 15,000
358 nur a 30,000 15,000 15,000
359 rangga 35,000 17,500 17,500
360 chika 30,000 10,000 15,000 15,000
361 herdi 30,000 15,000 15,000
362 2/26/2015 ibut 7,000 3,500 3,500
363 nurmala 70,000 35,000 35,000
364 uken 70,000 35,000 35,000
365 aep 40,000 20,000 20,000
366 haidar 25,000 12,500 12,500
367 titin 30,000 15,000 15,000
368 suyanto 70,000 35,000 35,000
369 ratnasih 30,000 15,000 15,000
370 ita 30,000 15,000 15,000
371 mulyati 15,000 10,000 7,500 7,500
372 rosmaya 15,000 10,000 7,500 7,500
373 2/27/2015 nurmala 60,000 30,000 30,000
374 siti a 30,000 15,000 15,000
375 niawati 70,000 35,000 35,000
376 wiwi robiatul 70,000 35,000 35,000
377 febrian 15,000 7,500 7,500
378 m amin 70,000 35,000 35,000
379 uken 60,000 30,000 30,000
380 suwito 70,000 35,000 35,000
381 theresia 70,000 35,000 35,000
382 atiqoh 30,000 15,000 15,000
383 rosinta 70,000 35,000 35,000
384 josua 70,000 35,000 35,000
385 mulus 30,000 15,000 15,000
386 hasna 15,000 10,000 7,500 7,500
387 hasanah 30,000 15,000 15,000
388 angga 70,000 35,000 35,000
389 derry 40,000 20,000 20,000
390 desy 25,000 12,500 12,500
391 2/28/2015 mona 60,000 30,000 30,000
392 keisya 35,000 17,500 17,500
393 sri 30,000 15,000 15,000
394 rizki 70,000 35,000 35,000
395 chika 30,000 15,000 15,000
396 toto 15,000 10,000 7,500 7,500
397 m amin 30,000 15,000 15,000
398 yuyun 70,000 35,000 35,000
399 tanya 35,000 17,500 17,500
400 enis 30,000 15,000 15,000
401 irma 70,000 35,000 35,000
402 mia s 70,000 35,000 35,000
403 ibut 70,000 35,000 35,000
404 saskia 40,000 20,000 20,000
405 ai mimin 60,000 10,000 30,000 30,000
406 raisya 25,000 12,500 12,500
407 imas k 30,000 15,000 15,000
408 yaya 70,000 35,000 35,000
- -
23,962,000 1,330,000 11,798,500 11,798,500
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KET
KET
KET
KET
r 2013
KET
KET
KET
KET
-
KET
KET
KET
KET
-
KET
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
ALFA
ALFA
ALFA
alfa
alfa
big
KET
KET
KET
-
KET
tegar
alfa
alfa
tegar
tegar
alfa
disc stiikes
disc stikes
disc stikes
disc stikes
free
alfa
free
alfa
KET
#REF!
KET
alfa
alfa
disc stikes
alfa
disc stikes
disc stikes
alfa
tegar
free sdr dr pandit
free sdr dr pandit

KET
#REF!
KET
alfa
alfa
big
big
big
alfa
KET
#REF!
KET
#REF!
KET
tegar
alfa
alfa
alfa
alfa
tegar
alfa
alfa
tegar
alfa
KET
#REF!
KET
#REF!
KET
alfa
alfa
tegar
heatlh care
heatlh care
alfa
alfa
alfa
alfa
alfa
alfa
alfa
KET
#REF!
KET
#REF!
KET
alfa
alfa
tegar
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
KET
#REF!
KET
#REF!
KET
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
big
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
alfa
big
KET
#REF!
KET
#REF!
JML KET
100,000
20,000
20,000
50,000
20,000
20,000
60,000 alfa
150,000
100,000
200,000
200,000
50,000
20,000
200,000
150,000
150,000
20,000
20,000
200,000
20,000
50,000
20,000
60,000
50,000
30,000
200,000
80,000 alfa
30,000
100,000
20,000 alfa
100,000
70,000
200,000
40,000
50,000
20,000
20,000 alfa
50,000 alfa
50,000
20,000
145,000
64,000 dic 20%
20,000
200,000
100,000
20,000 alfa
40,000
50,000
200,000
200,000
20,000
70,000 alfa
50,000 alfa
20,000
50,000
50,000
100,000
30,000
50,000
20,000
20,000
50,000 alfa
60,000
150,000
120,000
80,000
50,000
50,000
-
-
-
5,109,000
JML KET
30,000
70,000
60,000
70,000
30,000
30,000
70,000
70,000
40,000
25,000
15,000
30,000
15,000
25,000
25,000
30,000
25,000
25,000
25,000
25,000
35,000
30,000
25,000
15,000
30,000
30,000
25,000
30,000
30,000
70,000
30,000
30,000
35,000
15,000
15,000
30,000
30,000
40,000
70,000
25,000
15,000
25,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
15,000
30,000
15,000
25,000
30,000
25,000
40,000
25,000
30,000
-
30,000
60,000
30,000
40,000
40,000
40,000
30,000
15,000
30,000
30,000
30,000
70,000
25,000
15,000
25,000
25,000
30,000
30,000
30,000
50,000
15,000
25,000
25,000
25,000
30,000
30,000
30,000
25,000
25,000
25,000
30,000
70,000
70,000
70,000
70,000
30,000
30,000
40,000
70,000
30,000
25,000
25,000
25,000
30,000
25,000
70,000
30,000
35,000
30,000
70,000
70,000
70,000
60,000
60,000
25,000
40,000
25,000
25,000
25,000
70,000
70,000
30,000
15,000
30,000
45,000
15,000
30,000
15,000
60,000
40,000
25,000
25,000
25,000
25,000
25,000
25,000
30,000
25,000
15,000
70,000
30,000
70,000
25,000
25,000
50,000
30,000
25,000
30,000
70,000
30,000
40,000
35,000
15,000
70,000
70,000
25,000
25,000
35,000
30,000
25,000
70,000
50,000
70,000
70,000
70,000
30,000
25,000
30,000
25,000
30,000
40,000
40,000
50,000
70,000
30,000
70,000
70,000
15,000
30,000
30,000
30,000
30,000
25,000
25,000
30,000
30,000
30,000
30,000
30,000
30,000
35,000
30,000
30,000
35,000
35,000
30,000
25,000
30,000
30,000
30,000
30,000
30,000
70,000
25,000
40,000
30,000
25,000
70,000
25,000
25,000
30,000
30,000
25,000
30,000
25,000
25,000
25,000
25,000
25,000
15,000
15,000
40,000
70,000
30,000
70,000
25,000
15,000
15,000
70,000
25,000
25,000
70,000
70,000
70,000
25,000
30,000
15,000
15,000
25,000
40,000
25,000
50,000
30,000
70,000
25,000
25,000
25,000
60,000
30,000
30,000
35,000
70,000
30,000
30,000
25,000
25,000
70,000
25,000
30,000
70,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
25,000
30,000
15,000
30,000
70,000
15,000
30,000
30,000
-
14,804,000 #REF!
JML KET
80,000
30,000
50,000
40,000
50,000
50,000
50,000
50,000
50,000
50,000
40,000
50,000
50,000
50,000
70,000
50,000
60,000
70,000
50,000
50,000
50,000
24,879,000 #REF!
JML KET
100,000
100,000
150,000
120,000
30,000
30,000
70,000
105,000
200,000
120,000
70,000
70,000
100,000
30,000
120,000
250,000
100,000
50,000
20,000
100,000
20,000
20,000
50,000
100,000
90,000 alfa
20,000
75,000
100,000
30,000
100,000
100,000
25,000
45,000
20,000
50,000
100,000
50,000
40,000
25,000
100,000
200,000
80,000 alfa
70,000
100,000
100,000
60,000
50,000 ALFA
25,000
50,000
100,000 alfa
60,000 alfa
50,000
30,000
50,000
40,000
200,000
55,000
100,000
50,000
50,000
100,000
520,000
40,000
25,000
25,000
200,000
50,000
20,000
20,000 alfa
20,000
100,000
100,000
80,000 alfa
90,000
90,000
30,000
60,000
160,000
100,000
120,000
200,000
20,000
100,000 alfa
6,885,000
JML KET
25,000
70,000
40,000
15,000
70,000
30,000
25,000
30,000
30,000
30,000
30,000
60,000
70,000
40,000
35,000
25,000
70,000
25,000
70,000
15,000
70,000
25,000
70,000
30,000
40,000
30,000
25,000
25,000
30,000
70,000
25,000
25,000
25,000
60,000
35,000
70,000
30,000
35,000
15,000
70,000
70,000
40,000
25,000
25,000
70,000
40,000
25,000
25,000
30,000
25,000
35,000
25,000
70,000
30,000
60,000
60,000
30,000
40,000
-
40,000
40,000
70,000
30,000
70,000
25,000
60,000
25,000
30,000
30,000
30,000
30,000
25,000
25,000
25,000
25,000
25,000
15,000
15,000
70,000
30,000
35,000
25,000
70,000
70,000
25,000
25,000
70,000
70,000
40,000
30,000
20,000
30,000
15,000
30,000
70,000
30,000
25,000
40,000
25,000
25,000
30,000
25,000
70,000
25,000
15,000
70,000
70,000
15,000
70,000
70,000
30,000
60,000
25,000
40,000
40,000
70,000
60,000
30,000
30,000
30,000
70,000
70,000
30,000
30,000
30,000
25,000
70,000
30,000
15,000
70,000
70,000
30,000
30,000
70,000
70,000
40,000
40,000
25,000
80,000
40,000
25,000
25,000
25,000
25,000
25,000
25,000
70,000
25,000
40,000
70,000
30,000
60,000
15,000
70,000
25,000
30,000
15,000
25,000
30,000
35,000
15,000
30,000
25,000
35,000
25,000
70,000
80,000
25,000
25,000
30,000
40,000
15,000
15,000
40,000
30,000
30,000
70,000
15,000
35,000
35,000
30,000
30,000
60,000
60,000
60,000
35,000
60,000
25,000
15,000
25,000
40,000
25,000
25,000
25,000
30,000
30,000
15,000
25,000
30,000
60,000
30,000
25,000
35,000
25,000
30,000
25,000
15,000
70,000
25,000
70,000
25,000
30,000
30,000
30,000
15,000
30,000
70,000
30,000
70,000
30,000
30,000
30,000
30,000
30,000
30,000
70,000
25,000
30,000
30,000
30,000
35,000
25,000
70,000
40,000
40,000
25,000
25,000
15,000
70,000
30,000
20,000
30,000
35,000
35,000
40,000
40,000
70,000
70,000
15,000
15,000
30,000
30,000
35,000
70,000
30,000
25,000
35,000
30,000
40,000
60,000
60,000
25,000
30,000
60,000
40,000
60,000
30,000
25,000
40,000
30,000
30,000
25,000
30,000
70,000
70,000
15,000
70,000
30,000
70,000
70,000
60,000
30,000
70,000
30,000
35,000
40,000
70,000
70,000
70,000
30,000
35,000
30,000
30,000
25,000
30,000
70,000
35,000
40,000
40,000
50,000
25,000
40,000
70,000
25,000
40,000
70,000
35,000
70,000
30,000
40,000
70,000
70,000
70,000
15,000
25,000
50,000
40,000
40,000
70,000
40,000
25,000
40,000
40,000
25,000
70,000
70,000
-
-
19,765,000 #REF!
JML KET
30,000
50,000
50,000
70,000
50,000
50,000
40,000
50,000
70,000
50,000
70,000
30,000
50,000
40,000
-
32,555,000 #REF!
JML KET
80,000
100,000
100,000
50,000
150,000
50,000 alfa
100,000 alfa
70,000 alfa
150,000 alfa
50,000
180,000
100,000
40,000
50,000
50,000 alfa
50,000 alfa
25,000
60,000
25,000
20,000 alfa
20,000 alfa
320,000
20,000 yayasan bl
70,000
30,000
50,000
100,000
100,000 alfa
120,000 alfa
25,000
25,000
20,000
30,000
150,000 alfa
170,000
60,000
50,000
80,000
60,000
60,000
70,000
100,000
60,000
50,000
30,000 alfa
30,000 alfa
55,000
60,000
25,000
25,000
25,000
55,000
120,000
100,000
50,000
50,000
20,000
100,000
200,000
20,000
50,000
20,000
200,000
60,000
60,000
50,000
50,000 alfa
250,000
200,000
400,000
120,000
150,000 alfa
50,000
20,000
-
-
5,985,000
JML KET
30,000
30,000
25,000
25,000
60,000
35,000
30,000
35,000
40,000
25,000
35,000
40,000
70,000
40,000
15,000
25,000
70,000
25,000
50,000
35,000
30,000
70,000
30,000
40,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
30,000
30,000
25,000
30,000
30,000
40,000
25,000
15,000
30,000
25,000
15,000
70,000
40,000
70,000
30,000
15,000
15,000
70,000
25,000
40,000
15,000
70,000
40,000
30,000
40,000
15,000
-
35,000
70,000
70,000
30,000
70,000
25,000
20,000
15,000
70,000
25,000
25,000
15,000
25,000
60,000
35,000
35,000
30,000
70,000
60,000
30,000
70,000
30,000
35,000
25,000
30,000
25,000
25,000
30,000
30,000
70,000
30,000
15,000
15,000
25,000
30,000
30,000
70,000
30,000
70,000
70,000
40,000
40,000
70,000
30,000
60,000
60,000
30,000
40,000
70,000
25,000
25,000
25,000
70,000
30,000
70,000
30,000
20,000
25,000
25,000
30,000
15,000
40,000
70,000
25,000
70,000
25,000
15,000
15,000
30,000
70,000
25,000
30,000
25,000
30,000
30,000
30,000
30,000
40,000
25,000
70,000
30,000
35,000
30,000
40,000
40,000
30,000
35,000
15,000
15,000
80,000
40,000
70,000
70,000
40,000
30,000
45,000
30,000
15,000
30,000
60,000
30,000
25,000
35,000
60,000
70,000
25,000
25,000
20,000
30,000
25,000
30,000
25,000
25,000
25,000
70,000
60,000
15,000
70,000
70,000
60,000
30,000
70,000
30,000
30,000
15,000
30,000
30,000
35,000
30,000
35,000
40,000
30,000
35,000
60,000
50,000
30,000
30,000
30,000
50,000
30,000
30,000
30,000
40,000
40,000
25,000
35,000
40,000
15,000
25,000
25,000
30,000
25,000
70,000
25,000
35,000
30,000
25,000
25,000
30,000
25,000
25,000
30,000
15,000
25,000
25,000
70,000
25,000
70,000
70,000
70,000
70,000
40,000
40,000
30,000
30,000
25,000
25,000
35,000
45,000
70,000
30,000
30,000
30,000
30,000
25,000
30,000
15,000
25,000
70,000
15,000
70,000
70,000
15,000
70,000
60,000
25,000
70,000
25,000
25,000
25,000
70,000
70,000
30,000
70,000
15,000
60,000
40,000
30,000
70,000
15,000
30,000
25,000
30,000
40,000
25,000
30,000
30,000
30,000
60,000
40,000
25,000
70,000
60,000
40,000
30,000
60,000
35,000
70,000
30,000
70,000
30,000
30,000
30,000
15,000
30,000
30,000
25,000
30,000
30,000
70,000
40,000
30,000
40,000
30,000
40,000
25,000
40,000
25,000
25,000
35,000
30,000
25,000
25,000
40,000
70,000
30,000
25,000
70,000
70,000
80,000
70,000
15,000
25,000
15,000
70,000
40,000
30,000
70,000
70,000
70,000
70,000
40,000
40,000
70,000
15,000
45,000
25,000
35,000
35,000
40,000
30,000
35,000
15,000
60,000
60,000
30,000
30,000
15,000
70,000
30,000
30,000
30,000
30,000
30,000
30,000
60,000
15,000
35,000
70,000
70,000
30,000
25,000
25,000
25,000
70,000
70,000
20,000
40,000
30,000
30,000
30,000
25,000
70,000
60,000
15,000
15,000
60,000
40,000
70,000
40,000
40,000
40,000
25,000
-
-
-
-
20,555,000 #REF!
JML KET
20,000
20,000
25,000
100,000
50,000 alfa
200,000
300,000
100,000
20,000
130,000
125,000
30,000
50,000
200,000
200,000
200,000
125,000
100,000
150,000
100,000
75,000
225,000
50,000
25,000
200,000
20,000
20,000
100,000
50,000
50,000
25,000
165,000
50,000 alfa
200,000
75,000
200,000
75,000 alfa
150,000
50,000
150,000
200,000
300,000
100,000
100,000
50,000
785,000
25,000
60,000
200,000
70,000 alfa
300,000
100,000
50,000
60,000
70,000
200,000
200,000
200,000
100,000
50,000
40,000 alfa
60,000
100,000
230,000
200,000
100,000
20,000
20,000
50,000
150,000
350,000
150,000 alfa
100,000
8,990,000
JML KET
70,000
70,000
30,000
25,000
25,000
30,000
40,000
70,000
30,000
25,000
70,000
30,000
70,000
25,000
25,000
25,000
25,000
25,000
25,000
30,000
25,000
25,000
25,000
25,000
30,000
30,000
15,000
15,000
60,000
70,000
70,000
70,000
35,000
15,000
70,000
40,000
30,000
35,000
30,000
30,000
70,000
70,000
25,000
25,000
70,000
70,000
35,000
30,000
70,000
35,000
35,000
70,000
15,000
30,000
30,000
15,000
30,000
60,000
-
60,000
70,000
30,000
30,000
25,000
25,000
30,000
30,000
25,000
25,000
70,000
30,000
30,000
25,000
25,000
70,000
60,000
60,000
25,000
30,000
70,000
30,000
30,000
30,000
70,000
30,000
30,000
30,000
30,000
25,000
30,000
70,000
25,000
25,000
30,000
25,000
30,000
60,000
60,000
30,000
30,000
30,000
30,000
30,000
70,000
30,000
30,000
70,000
30,000
15,000
70,000
25,000
30,000
25,000
25,000
70,000
30,000
30,000
25,000
30,000
30,000
40,000
25,000
25,000
25,000
30,000
30,000
15,000
40,000
30,000
70,000
25,000
25,000
25,000
35,000
40,000
70,000
30,000
30,000
35,000
35,000
15,000
15,000
15,000
15,000
50,000
70,000
25,000
15,000
70,000
15,000
15,000
15,000
25,000
70,000
30,000
70,000
30,000
40,000
40,000
25,000
25,000
30,000
30,000
30,000
60,000
30,000
30,000
60,000
25,000
30,000
30,000
25,000
30,000
30,000
30,000
30,000
30,000
40,000
30,000
60,000
30,000
15,000
15,000
30,000
15,000
60,000
30,000
25,000
80,000
25,000
40,000
40,000
70,000
30,000
70,000
25,000
70,000
30,000
30,000
30,000
30,000
30,000
35,000
30,000
30,000
40,000
30,000
30,000
30,000
30,000
70,000
45,000
40,000
30,000
70,000
70,000
25,000
70,000
30,000
30,000
30,000
40,000
40,000
25,000
70,000
70,000
40,000
30,000
70,000
30,000
30,000
25,000
25,000
40,000
25,000
30,000
30,000
40,000
70,000
70,000
70,000
30,000
25,000
35,000
40,000
25,000
40,000
70,000
70,000
30,000
30,000
70,000
25,000
30,000
40,000
35,000
30,000
30,000
70,000
30,000
30,000
30,000
30,000
30,000
30,000
40,000
15,000
60,000
35,000
30,000
30,000
60,000
30,000
30,000
40,000
25,000
70,000
40,000
30,000
25,000
40,000
25,000
25,000
35,000
70,000
70,000
70,000
70,000
40,000
60,000
30,000
70,000
30,000
30,000
30,000
70,000
25,000
25,000
25,000
70,000
70,000
70,000
70,000
70,000
30,000
70,000
60,000
40,000
40,000
40,000
30,000
25,000
40,000
25,000
25,000
25,000
30,000
25,000
30,000
25,000
30,000
15,000
30,000
25,000
25,000
25,000
30,000
25,000
30,000
15,000
15,000
50,000
30,000
50,000
40,000
40,000
60,000
60,000
30,000
30,000
70,000
40,000
40,000
40,000
40,000
25,000
25,000
30,000
25,000
15,000
45,000
15,000
25,000
80,000
40,000
30,000
30,000
30,000
35,000
40,000
30,000
7,000
70,000
70,000
40,000
25,000
30,000
70,000
30,000
30,000
25,000
25,000
60,000
30,000
70,000
70,000
15,000
70,000
60,000
70,000
70,000
30,000
70,000
70,000
30,000
25,000
30,000
70,000
40,000
25,000
60,000
35,000
30,000
70,000
30,000
25,000
30,000
70,000
35,000
30,000
70,000
70,000
70,000
40,000
70,000
25,000
30,000
70,000
-
24,867,000 #REF!
JASA ALAT &

DOKTER BAHAN
1 1/7/2015 iceu 80,000 5,000 37,500 37,500 80,000
2 listia 100,000 5,000 47,500 47,500 100,000
3 rini nuraeni 100,000 5,000 47,500 47,500 100,000
4 risna 50,000 5,000 22,500 22,500 50,000
5 1/8/2015 rahayu 150,000 5,000 72,500 72,500 150,000
6 jaka 50,000 5,000 22,500 22,500 50,000
7 1/10/2015 edi supriatna 100,000 5,000 47,500 47,500 100,000
8 endang kusmayana 70,000 5,000 32,500 32,500 70,000
9 gunawan b 150,000 5,000 72,500 72,500 150,000
10 rakha 50,000 5,000 22,500 22,500 50,000
11 dadan 180,000 5,000 87,500 87,500 180,000
12 iceu 100,000 5,000 47,500 47,500 100,000
13 exza 40,000 5,000 17,500 17,500 40,000
14 1/11/2015 rizal 50,000 5,000 22,500 22,500 50,000
15 1/12/2015 eko 50,000 5,000 22,500 22,500 50,000
16 santi 50,000 5,000 22,500 22,500 50,000
17 bertik 25,000 5,000 10,000 10,000 25,000
18 rani 60,000 5,000 27,500 27,500 60,000
19 tasya 25,000 5,000 10,000 10,000 25,000
20 iwan 20,000 5,000 7,500 7,500 20,000
21 1/13/2015 ergina 20,000 5,000 7,500 7,500 20,000
22 1/14/2015 exza 320,000 5,000 157,500 157,500 320,000
23 yuni 20,000 5,000 7,500 7,500 20,000
24 irwan 70,000 5,000 32,500 32,500 70,000
25 1/15/2015 komariah 30,000 5,000 12,500 12,500 30,000
26 marsha 50,000 5,000 22,500 22,500 50,000
27 1/16/2015 sri maryani 100,000 5,000 47,500 47,500 100,000
28 cecep 100,000 5,000 47,500 47,500 100,000
29 endang kusmayana 120,000 5,000 57,500 57,500 120,000
30 samsudin 25,000 5,000 10,000 10,000 25,000
31 melani 25,000 5,000 10,000 10,000 25,000
32 1/17/2015 komariah 20,000 5,000 7,500 7,500 20,000
33 rondhotul 30,000 5,000 12,500 12,500 30,000
34 yusni 150,000 5,000 72,500 72,500 150,000
35 deni ayu 170,000 5,000 82,500 82,500 170,000
36 yeni 60,000 5,000 27,500 27,500 60,000
37 nazwa 50,000 5,000 22,500 22,500 50,000
38 1/19/2015 exzep 80,000 5,000 37,500 37,500 80,000
39 kusmati 60,000 5,000 27,500 27,500 60,000
40 yeni 60,000 5,000 27,500 27,500 60,000
41 santi 70,000 5,000 32,500 32,500 70,000
42 agnia 100,000 5,000 47,500 47,500 100,000
43 dadi 60,000 5,000 27,500 27,500 60,000
44 1/21/2015 rizqi 50,000 5,000 22,500 22,500 50,000
45 andi 30,000 5,000 12,500 12,500 30,000
46 1/22/2015 ergina 30,000 5,000 12,500 12,500 30,000
47 rani 55,000 5,000 25,000 25,000 55,000
48 nana 60,000 5,000 27,500 27,500 60,000
49 kurnia 25,000 5,000 10,000 10,000 25,000
50 yayah 25,000 5,000 10,000 10,000 25,000
51 dapit 25,000 5,000 10,000 10,000 25,000
52 peni ayu 55,000 5,000 25,000 25,000 55,000
53 kusmiati 120,000 5,000 57,500 57,500 120,000
54 1/24/2015 sri suwarti 100,000 5,000 47,500 47,500 100,000
55 1/25/2015 rizal 50,000 5,000 22,500 22,500 50,000
56 1/26/2015 iceu 50,000 5,000 22,500 22,500 50,000
57 kustinawati 20,000 5,000 7,500 7,500 20,000
58 jajang k 100,000 5,000 47,500 47,500 100,000
59 sandi k 200,000 5,000 97,500 97,500 200,000
60 yeni 20,000 5,000 7,500 7,500 20,000
61 santi 50,000 5,000 22,500 22,500 50,000
62 fitri 20,000 5,000 7,500 7,500 20,000
63 sumarni 200,000 5,000 97,500 97,500 200,000
64 rani 60,000 5,000 27,500 27,500 60,000
65 susi 60,000 5,000 27,500 27,500 60,000
66 1/28/2015 iceu 50,000 5,000 22,500 22,500 50,000
67 mattry 50,000 5,000 22,500 22,500 50,000
68 1/29/2015 dessi 250,000 5,000 122,500 122,500 250,000
69 1/30/2015 agus setiadi 200,000 5,000 97,500 97,500 200,000
70 1/31/2015 roudhotul 400,000 5,000 197,500 197,500 400,000
71 jamaludin 120,000 5,000 57,500 57,500 120,000
72 herdiyana 150,000 5,000 72,500 72,500 150,000
73 titin m 50,000 5,000 22,500 22,500 50,000
74 nirma 20,000 5,000 7,500 7,500 20,000
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,985,000 380,000 2,802,500 2,802,500 5,985,000

JASA ALAT &

DOKTER BAHAN
1 1/2/2015 andini 30,000 15,000 15,000 30,000
2 esti jumarni 30,000 15,000 15,000 30,000
3 sofiana 15,000 10,000 7,500 7,500 25,000
4 sahril 15,000 10,000 7,500 7,500 25,000
5 euis 60,000 30,000 30,000 60,000
6 tyas 35,000 17,500 17,500 35,000
7 ibrahim a 30,000 15,000 15,000 30,000
8 fathia 35,000 17,500 17,500 35,000
9 1/5/2015 atiqoh 40,000 20,000 20,000 40,000
10 anita f 15,000 10,000 7,500 7,500 25,000
11 tyas 25,000 10,000 12,500 12,500 35,000
12 rohmayanti 30,000 10,000 15,000 15,000 40,000
13 maman 70,000 35,000 35,000 70,000
14 siti h 30,000 10,000 15,000 15,000 40,000
15 zacky 15,000 7,500 7,500 15,000
16 sulastri 15,000 10,000 7,500 7,500 25,000
17 hendri m 70,000 35,000 35,000 70,000
18 elis s 15,000 10,000 7,500 7,500 25,000
19 ade 40,000 10,000 20,000 20,000 50,000
20 deliya 25,000 10,000 12,500 12,500 35,000
21 ruhiyat 30,000 15,000 15,000 30,000
22 ganjar 70,000 35,000 35,000 70,000
23 yudi 30,000 15,000 15,000 30,000
24 tika 30,000 10,000 15,000 15,000 40,000
25 susi 15,000 10,000 7,500 7,500 25,000
26 nini 15,000 10,000 7,500 7,500 25,000
27 neneng 15,000 10,000 7,500 7,500 25,000
28 siti a 15,000 10,000 7,500 7,500 25,000
29 rini 15,000 10,000 7,500 7,500 25,000
30 lulienty 15,000 10,000 7,500 7,500 25,000
31 azka 15,000 10,000 7,500 7,500 25,000
32 endah 15,000 10,000 7,500 7,500 25,000
33 rustini 30,000 15,000 15,000 30,000
34 efa 30,000 15,000 15,000 30,000
35 1/6/2015 eli 15,000 10,000 7,500 7,500 25,000
36 nuraeni 30,000 15,000 15,000 30,000
37 danil 30,000 15,000 15,000 30,000
38 1/7/2015 siti h 40,000 20,000 20,000 40,000
39 lisnawati 15,000 10,000 7,500 7,500 25,000
40 annisa nur latifah 15,000 7,500 7,500 15,000
41 siti annisa 30,000 15,000 15,000 30,000
42 reni 15,000 10,000 7,500 7,500 25,000
43 nisrina 15,000 7,500 7,500 15,000
44 resinta 70,000 35,000 35,000 70,000
45 abbot 30,000 10,000 15,000 15,000 40,000
46 dadang 70,000 35,000 35,000 70,000
47 wawang 30,000 15,000 15,000 30,000
48 zaina 15,000 7,500 7,500 15,000
49 qoniah 15,000 7,500 7,500 15,000
50 elshe 70,000 35,000 35,000 70,000
51 marsha 15,000 10,000 7,500 7,500 25,000
52 kandi 40,000 20,000 20,000 40,000
53 azka 15,000 7,500 7,500 15,000
54 agus permana 70,000 35,000 35,000 70,000
55 irawan 30,000 10,000 15,000 15,000 40,000
56 agus s 30,000 15,000 15,000 30,000
57 indra aditya 30,000 10,000 15,000 15,000 40,000
58 1/8/2015 rahayu 15,000 7,500 7,500 15,000
59 ayesa silmi 30,000 15,000 15,000 -
60 m hibbah 35,000 17,500 17,500 35,000
61 nur meilisa 70,000 35,000 35,000 70,000
62 siti komala 70,000 35,000 35,000 70,000
63 risman 30,000 15,000 15,000 30,000
64 candra sri 70,000 35,000 35,000 70,000
65 sani 15,000 10,000 7,500 7,500 25,000
66 nafidza 20,000 10,000 10,000 20,000
67 widiawan 15,000 7,500 7,500 15,000
68 ria 70,000 35,000 35,000 70,000
69 s ruhiyat 15,000 10,000 7,500 7,500 25,000
70 derry d 15,000 10,000 7,500 7,500 25,000
71 deni k 15,000 7,500 7,500 15,000
72 neni 15,000 10,000 7,500 7,500 25,000
73 1/9/2015 ong tjuilan 60,000 30,000 30,000 60,000
74 shania 35,000 17,500 17,500 35,000
75 salma rizka 35,000 17,500 17,500 35,000
76 susila 30,000 15,000 15,000 30,000
77 azka hanif 70,000 35,000 35,000 70,000
78 lina lestari 60,000 30,000 30,000 60,000
79 ibrahim 30,000 15,000 15,000 30,000
80 tyas 70,000 35,000 35,000 70,000
81 hadiah 30,000 15,000 15,000 30,000
82 myshella 35,000 17,500 17,500 35,000
83 josua 15,000 10,000 7,500 7,500 25,000
84 sriyani 30,000 15,000 15,000 30,000
85 nia 15,000 10,000 7,500 7,500 25,000
86 neni 15,000 10,000 7,500 7,500 25,000
87 ade a 30,000 15,000 15,000 30,000
88 siti a 30,000 15,000 15,000 30,000
89 laeli 70,000 35,000 35,000 70,000
90 karwati 30,000 15,000 15,000 30,000
91 tin 15,000 7,500 7,500 15,000
92 yanti 15,000 7,500 7,500 15,000
93 susi d 15,000 10,000 7,500 7,500 25,000
94 trisna 30,000 15,000 15,000 30,000
95 1/10/2015 yussi 30,000 15,000 15,000 30,000
96 kanti 70,000 35,000 35,000 70,000
97 luri 30,000 15,000 15,000 30,000
98 evelin 70,000 35,000 35,000 70,000
99 zara 70,000 35,000 35,000 70,000
100 nurul 30,000 10,000 15,000 15,000 40,000
101 viona 30,000 10,000 15,000 15,000 40,000
102 abbot 70,000 35,000 35,000 70,000
103 saskia 30,000 15,000 15,000 30,000
104 s ruhiyat 60,000 30,000 30,000 60,000
105 reka 60,000 30,000 30,000 60,000
106 lilis 30,000 15,000 15,000 30,000
107 1/12/2015 esti jumarni 30,000 10,000 15,000 15,000 40,000
108 satriya 70,000 35,000 35,000 70,000
109 m ramdan 25,000 12,500 12,500 25,000
110 enceng 15,000 10,000 7,500 7,500 25,000
111 anda 15,000 10,000 7,500 7,500 25,000
112 ade sunarya 70,000 35,000 35,000 70,000
113 siti khodijah 30,000 15,000 15,000 30,000
114 elis u 70,000 35,000 35,000 70,000
115 widiya 30,000 15,000 15,000 30,000
116 refiana 20,000 10,000 10,000 20,000
117 ai 15,000 10,000 7,500 7,500 25,000
118 rifan 15,000 10,000 7,500 7,500 25,000
119 putra 30,000 15,000 15,000 30,000
120 febriani 15,000 7,500 7,500 15,000
121 kania 40,000 20,000 20,000 40,000
122 ganjar 70,000 35,000 35,000 70,000
123 razka 15,000 10,000 7,500 7,500 25,000
124 1/13/2015 laeli 70,000 35,000 35,000 70,000
125 sari 15,000 10,000 7,500 7,500 25,000
126 anita f 15,000 7,500 7,500 15,000
127 ayi 15,000 7,500 7,500 15,000
128 widanengsih 30,000 15,000 15,000 30,000
129 mega 70,000 35,000 35,000 70,000
130 ervan 15,000 10,000 7,500 7,500 25,000
131 gita p 30,000 15,000 15,000 30,000
132 holisoh 15,000 10,000 7,500 7,500 25,000
133 dadang 30,000 15,000 15,000 30,000
134 danil 30,000 15,000 15,000 30,000
135 epa susanti 30,000 15,000 15,000 30,000
136 dafin 30,000 15,000 15,000 30,000
137 irawan 30,000 10,000 15,000 15,000 40,000
138 sri wahyuni 15,000 10,000 7,500 7,500 25,000
139 lulienty 70,000 35,000 35,000 70,000
140 siti jamilah 30,000 15,000 15,000 30,000
141 haidar 35,000 17,500 17,500 35,000
142 haisya 30,000 15,000 15,000 30,000
143 ica 40,000 20,000 20,000 40,000
144 1/14/2015 djenab 30,000 10,000 15,000 15,000 40,000
145 dadang 30,000 15,000 15,000 30,000
146 teti 35,000 17,500 17,500 35,000
147 nursidiq 15,000 7,500 7,500 15,000
148 ani nur 15,000 7,500 7,500 15,000
149 siti hodijah 70,000 10,000 35,000 35,000 80,000
150 agus s 40,000 20,000 20,000 40,000
151 kandi 70,000 35,000 35,000 70,000
152 syachril 70,000 35,000 35,000 70,000
153 sopiyan 30,000 10,000 15,000 15,000 40,000
154 r anisa 30,000 15,000 15,000 30,000
155 qoniah 35,000 10,000 17,500 17,500 45,000
156 wawang 30,000 15,000 15,000 30,000
157 ririn 15,000 7,500 7,500 15,000
158 rahmadhani 30,000 15,000 15,000 30,000
159 1/15/2015 wastini 60,000 30,000 30,000 60,000
160 teti 30,000 15,000 15,000 30,000
161 rifa 15,000 10,000 7,500 7,500 25,000
162 marsha 35,000 17,500 17,500 35,000
163 titin 60,000 30,000 30,000 60,000
164 ratna 70,000 35,000 35,000 70,000
165 dery 15,000 10,000 7,500 7,500 25,000
166 yanti 15,000 10,000 7,500 7,500 25,000
167 arine 20,000 10,000 10,000 20,000
168 nurul 30,000 15,000 15,000 30,000
169 nia 15,000 10,000 7,500 7,500 25,000
170 ita 30,000 15,000 15,000 30,000
171 1/16/2015 ratna 15,000 10,000 7,500 7,500 25,000
172 linggar 15,000 10,000 7,500 7,500 25,000
173 rasa 15,000 10,000 7,500 7,500 25,000
174 azka 70,000 35,000 35,000 70,000
175 febrian 60,000 30,000 30,000 60,000
176 nisrina 15,000 7,500 7,500 15,000
177 rosinta 70,000 35,000 35,000 70,000
178 refana 70,000 35,000 35,000 70,000
179 wastini 60,000 30,000 30,000 60,000
180 tjiji 30,000 15,000 15,000 30,000
181 warny 70,000 35,000 35,000 70,000
182 sri yani 30,000 15,000 15,000 30,000
183 siti a 30,000 15,000 15,000 30,000
184 ernawati 15,000 7,500 7,500 15,000
185 tresna 30,000 15,000 15,000 30,000
186 karwati 30,000 15,000 15,000 30,000
187 1/17/2015 nurul 35,000 17,500 17,500 35,000
188 ade aziz 30,000 15,000 15,000 30,000
189 fahira 35,000 17,500 17,500 35,000
190 luri 40,000 20,000 20,000 40,000
191 irawan 30,000 15,000 15,000 30,000
192 irfan 35,000 17,500 17,500 35,000
193 agus gunawan 60,000 30,000 30,000 60,000
194 nazwa 50,000 25,000 25,000 50,000
195 lilis 30,000 15,000 15,000 30,000
196 saskia 30,000 15,000 15,000 30,000
197 wiwi 30,000 15,000 15,000 30,000
198 azka 50,000 25,000 25,000 50,000
199 rizki 30,000 15,000 15,000 30,000
200 ences 30,000 15,000 15,000 30,000
201 johanes 30,000 15,000 15,000 30,000
202 1/19/2015 widanengsih 30,000 10,000 15,000 15,000 40,000
203 riamah 30,000 10,000 15,000 15,000 40,000
204 ririn 15,000 10,000 7,500 7,500 25,000
205 titin 35,000 17,500 17,500 35,000
206 rohmayanti 30,000 10,000 15,000 15,000 40,000
207 dodin 15,000 7,500 7,500 15,000
208 siska j 25,000 12,500 12,500 25,000
209 nurul 25,000 12,500 12,500 25,000
210 esti jumarni 30,000 15,000 15,000 30,000
211 m temmy 25,000 12,500 12,500 25,000
212 ani iriani 60,000 10,000 30,000 30,000 70,000
213 nisrina 25,000 12,500 12,500 25,000
214 raisya 25,000 10,000 12,500 12,500 35,000
215 siti h 30,000 15,000 15,000 30,000
216 euis 15,000 10,000 7,500 7,500 25,000
217 karyani 15,000 10,000 7,500 7,500 25,000
218 putra 30,000 15,000 15,000 30,000
219 dadang 15,000 10,000 7,500 7,500 25,000
220 siti m 15,000 10,000 7,500 7,500 25,000
221 kania 30,000 15,000 15,000 30,000
222 1/20/2015 eros 15,000 7,500 7,500 15,000
223 jajang 15,000 10,000 7,500 7,500 25,000
224 sadri 15,000 10,000 7,500 7,500 25,000
225 ong 70,000 35,000 35,000 70,000
226 adin 15,000 10,000 7,500 7,500 25,000
227 lulienty 70,000 35,000 35,000 70,000
228 siti anisa 70,000 35,000 35,000 70,000
229 dewi 70,000 35,000 35,000 70,000
230 syachril 70,000 35,000 35,000 70,000
231 gita p 40,000 20,000 20,000 40,000
232 ibrahim 30,000 10,000 15,000 15,000 40,000
233 reka 30,000 15,000 15,000 30,000
234 revi 30,000 15,000 15,000 30,000
235 neneng 15,000 10,000 7,500 7,500 25,000
236 titin 15,000 10,000 7,500 7,500 25,000
237 1/21/2015 m ramdan 25,000 10,000 12,500 12,500 35,000
238 gilang 35,000 10,000 17,500 17,500 45,000
239 irma 60,000 10,000 30,000 30,000 70,000
240 djenab 30,000 15,000 15,000 30,000
241 tyas 30,000 15,000 15,000 30,000
242 ibrahim 30,000 15,000 15,000 30,000
243 nurlatifah 30,000 15,000 15,000 30,000
244 rizqi 15,000 10,000 7,500 7,500 25,000
245 danil 30,000 15,000 15,000 30,000
246 nafidza 15,000 7,500 7,500 15,000
247 enton 15,000 10,000 7,500 7,500 25,000
248 sopiyan 70,000 35,000 35,000 70,000
249 m rendi 15,000 7,500 7,500 15,000
250 agus 70,000 35,000 35,000 70,000
251 1/22/2015 efrida 70,000 35,000 35,000 70,000
252 wastini 15,000 7,500 7,500 15,000
253 irfan 70,000 35,000 35,000 70,000
254 zelly 60,000 30,000 30,000 60,000
255 suwito 15,000 10,000 7,500 7,500 25,000
256 m hibban 70,000 35,000 35,000 70,000
257 afni 25,000 12,500 12,500 25,000
258 wargiatun 15,000 10,000 7,500 7,500 25,000
259 roliyah 15,000 10,000 7,500 7,500 25,000
260 ade r 70,000 35,000 35,000 70,000
261 niar 70,000 35,000 35,000 70,000
262 ita 30,000 15,000 15,000 30,000
263 syachril 70,000 35,000 35,000 70,000
264 ridwan 15,000 7,500 7,500 15,000
265 1/23/2015 dedih 60,000 30,000 30,000 60,000
266 irfan 30,000 10,000 15,000 15,000 40,000
267 silmi 30,000 15,000 15,000 30,000
268 neni 70,000 35,000 35,000 70,000
269 azka 15,000 7,500 7,500 15,000
270 riamah 30,000 15,000 15,000 30,000
271 nadza 25,000 12,500 12,500 25,000
272 sriyani 30,000 15,000 15,000 30,000
273 neng 30,000 10,000 15,000 15,000 40,000
274 adin 15,000 10,000 7,500 7,500 25,000
275 sandie 30,000 15,000 15,000 30,000
276 kandi 30,000 15,000 15,000 30,000
277 trisna 30,000 15,000 15,000 30,000
278 1/24/2015 wiarsih 60,000 30,000 30,000 60,000
279 winda 40,000 20,000 20,000 40,000
280 yuningsih 15,000 10,000 7,500 7,500 25,000
281 sri suwarti 70,000 35,000 35,000 70,000
282 hadijah 60,000 30,000 30,000 60,000
283 esti jumarini 40,000 20,000 20,000 40,000
284 dadang 30,000 15,000 15,000 30,000
285 wastini 60,000 30,000 30,000 60,000
286 fahira 35,000 17,500 17,500 35,000
287 luri 70,000 35,000 35,000 70,000
288 silmi 30,000 15,000 15,000 30,000
289 lilis k 70,000 35,000 35,000 70,000
290 widanengsih 30,000 15,000 15,000 30,000
291 derry 30,000 15,000 15,000 30,000
292 siti h 30,000 15,000 15,000 30,000
293 enceng 15,000 7,500 7,500 15,000
294 rizki 30,000 15,000 15,000 30,000
295 saskia 30,000 15,000 15,000 30,000
296 saerul 25,000 12,500 12,500 25,000
297 johanes 30,000 15,000 15,000 30,000
298 abbot 30,000 15,000 15,000 30,000
299 1/26/2015 sandi k 70,000 35,000 35,000 70,000
300 rohmayanti 40,000 20,000 20,000 40,000
301 irpan 30,000 15,000 15,000 30,000
302 m rizki 30,000 10,000 15,000 15,000 40,000
303 ade aziz 30,000 15,000 15,000 30,000
304 riamah 30,000 10,000 15,000 15,000 40,000
305 sri m 15,000 10,000 7,500 7,500 25,000
306 putra 40,000 20,000 20,000 40,000
307 tugni 15,000 10,000 7,500 7,500 25,000
308 euis 15,000 10,000 7,500 7,500 25,000
309 nida 35,000 17,500 17,500 35,000
310 kania 30,000 15,000 15,000 30,000
311 nila 15,000 10,000 7,500 7,500 25,000
312 maya 15,000 10,000 7,500 7,500 25,000
313 hilman 30,000 10,000 15,000 15,000 40,000
314 refana 70,000 35,000 35,000 70,000
315 widia 30,000 15,000 15,000 30,000
316 entar 15,000 10,000 7,500 7,500 25,000
317 atiqoh 70,000 35,000 35,000 70,000
318 iyan 70,000 35,000 35,000 70,000
319 hoeriah 70,000 10,000 35,000 35,000 80,000
320 1/27/2015 reka dwi 70,000 35,000 35,000 70,000
321 titin 15,000 7,500 7,500 15,000
322 ratna 15,000 10,000 7,500 7,500 25,000
323 vera 15,000 7,500 7,500 15,000
324 syachril 70,000 35,000 35,000 70,000
325 danil 40,000 20,000 20,000 40,000
326 epa 30,000 15,000 15,000 30,000
327 wiwin 70,000 35,000 35,000 70,000
328 haisya 70,000 35,000 35,000 70,000
329 nia 70,000 35,000 35,000 70,000
330 lisnawati 60,000 10,000 30,000 30,000 70,000
331 1/28/2015 dodo suparman 30,000 10,000 15,000 15,000 40,000
332 irma 30,000 10,000 15,000 15,000 40,000
333 cicin 70,000 35,000 35,000 70,000
334 tini 15,000 7,500 7,500 15,000
335 hani 35,000 10,000 17,500 17,500 45,000
336 mugi 15,000 10,000 7,500 7,500 25,000
337 tuty 35,000 17,500 17,500 35,000
338 revi 35,000 17,500 17,500 35,000
339 josua 30,000 10,000 15,000 15,000 40,000
340 ibut 30,000 15,000 15,000 30,000
341 ica 35,000 17,500 17,500 35,000
342 m akmal 15,000 7,500 7,500 15,000
343 29/01/215 munawar 60,000 30,000 30,000 60,000
344 wiarsih 60,000 30,000 30,000 60,000
345 siti zulleila 30,000 15,000 15,000 30,000
346 fitri 30,000 15,000 15,000 30,000
347 dessi 15,000 7,500 7,500 15,000
348 karyani 70,000 35,000 35,000 70,000
349 suwito 30,000 15,000 15,000 30,000
350 1/30/2015 neneng 30,000 15,000 15,000 30,000
351 tyas 30,000 15,000 15,000 30,000
352 ibrahim 30,000 15,000 15,000 30,000
353 dadang 30,000 15,000 15,000 30,000
354 rina herlina 30,000 15,000 15,000 30,000
355 wiarsih 60,000 30,000 30,000 60,000
356 suwito 15,000 7,500 7,500 15,000
357 rina 35,000 17,500 17,500 35,000
358 siti nurjanah 70,000 35,000 35,000 70,000
359 azka hanif 70,000 35,000 35,000 70,000
360 agus setiadi 30,000 15,000 15,000 30,000
361 yuniadi 15,000 10,000 7,500 7,500 25,000
362 rika 15,000 10,000 7,500 7,500 25,000
363 rendi 15,000 10,000 7,500 7,500 25,000
364 esti 70,000 35,000 35,000 70,000
365 evelyn 70,000 35,000 35,000 70,000
366 biduri 20,000 10,000 10,000 20,000
367 sri yani 40,000 20,000 20,000 40,000
368 dedi s 30,000 15,000 15,000 30,000
369 siti a 30,000 15,000 15,000 30,000
370 josua 30,000 15,000 15,000 30,000
371 oom 15,000 10,000 7,500 7,500 25,000
372 1/31/2015 winda 70,000 35,000 35,000 70,000
373 hoeriah 60,000 30,000 30,000 60,000
374 enok 15,000 7,500 7,500 15,000
375 lilis 15,000 7,500 7,500 15,000
376 siti 60,000 30,000 30,000 60,000
377 saskia 30,000 10,000 15,000 15,000 40,000
378 s ruhiyat 70,000 35,000 35,000 70,000
379 nendah 30,000 10,000 15,000 15,000 40,000
380 lilis 40,000 20,000 20,000 40,000
381 karina 30,000 10,000 15,000 15,000 40,000
382 dedi 15,000 10,000 7,500 7,500 25,000
383 - - -
384 - - -
385 - - -
386 - - -
19,475,000 1,490,000 9,547,500 9,547,500 20,555,000

JASA ALAT &

DOKTER BAHAN
1 2/2/2015 jajang 20,000 5,000 7,500 7,500 20,000
2 lesita 20,000 5,000 7,500 7,500 20,000
3 jumin 25,000 5,000 10,000 10,000 25,000
4 rani 100,000 5,000 47,500 47,500 100,000
5 santi 50,000 5,000 22,500 22,500 50,000
6 yayah 200,000 5,000 97,500 97,500 200,000
7 3/2/2015 rayzal 300,000 5,000 147,500 147,500 300,000
8 rizki 100,000 5,000 47,500 47,500 100,000
9 4/2/2015 deliyana 20,000 5,000 7,500 7,500 20,000
10 iceu 130,000 5,000 62,500 62,500 130,000
11 ayu 125,000 5,000 60,000 60,000 125,000
12 ridho 30,000 5,000 12,500 12,500 30,000
13 rasyad 50,000 5,000 22,500 22,500 50,000
14 5/2/2015 suwito 200,000 5,000 97,500 97,500 200,000
15 asti 200,000 5,000 97,500 97,500 200,000
16 kokom 200,000 5,000 97,500 97,500 200,000
17 yaya 125,000 5,000 60,000 60,000 125,000
18 6/2/2015 yani 100,000 5,000 47,500 47,500 100,000
19 7/2/2015 herdiyana 150,000 5,000 72,500 72,500 150,000
20 yessi 100,000 5,000 47,500 47,500 100,000
21 gigih 75,000 5,000 35,000 35,000 75,000
22 euis 225,000 5,000 110,000 110,000 225,000
23 8/2/2015 rizal 50,000 5,000 22,500 22,500 50,000
24 9/2/2015 roni 25,000 5,000 10,000 10,000 25,000
25 iceu 200,000 5,000 97,500 97,500 200,000
26 dadan 20,000 5,000 7,500 7,500 20,000
27 galih 20,000 5,000 7,500 7,500 20,000
28 rani 100,000 5,000 47,500 47,500 100,000
29 10/2/2015 nita 50,000 5,000 22,500 22,500 50,000
30 yayah 50,000 5,000 22,500 22,500 50,000
31 hoeriah 25,000 5,000 10,000 10,000 25,000
32 siti 165,000 5,000 80,000 80,000 165,000
33 jaja 50,000 5,000 22,500 22,500 50,000
34 12/2/2015 dhian 200,000 5,000 97,500 97,500 200,000
35 juariyah 75,000 5,000 35,000 35,000 75,000
36 rina 200,000 5,000 97,500 97,500 200,000
37 clarisa 75,000 5,000 35,000 35,000 75,000
38 rani 150,000 5,000 72,500 72,500 150,000
39 13/02/2015 zahra 50,000 5,000 22,500 22,500 50,000
40 ernita 150,000 5,000 72,500 72,500 150,000
41 14/02/2015 roudhotul 200,000 5,000 97,500 97,500 200,000
42 ana susana 300,000 5,000 147,500 147,500 300,000
43 herdiyana 100,000 5,000 47,500 47,500 100,000
44 16/02/2015 dadan 100,000 5,000 47,500 47,500 100,000
45 parto 50,000 5,000 22,500 22,500 50,000
46 yaya 785,000 5,000 390,000 390,000 785,000
47 permono 25,000 5,000 10,000 10,000 25,000
48 nita 60,000 5,000 27,500 27,500 60,000
49 17/02/2015 angga 200,000 5,000 97,500 97,500 200,000
50 jaja 70,000 5,000 32,500 32,500 70,000
51 18/02/2015 sumiati 300,000 5,000 147,500 147,500 300,000
52 supriyono 100,000 5,000 47,500 47,500 100,000
53 20/02/2015 iin kurniati 50,000 5,000 22,500 22,500 50,000
54 alfin 60,000 5,000 27,500 27,500 60,000
55 nani 70,000 5,000 32,500 32,500 70,000
56 21/02/2015 husniati 200,000 5,000 97,500 97,500 200,000
57 dani 200,000 5,000 97,500 97,500 200,000
58 yuyun 200,000 5,000 97,500 97,500 200,000
59 dude 100,000 5,000 47,500 47,500 100,000
60 alifa 50,000 5,000 22,500 22,500 50,000
61 23/02/2015 clarissa 40,000 5,000 17,500 17,500 40,000
62 nita 60,000 5,000 27,500 27,500 60,000
63 egi 100,000 5,000 47,500 47,500 100,000
64 akmal 230,000 5,000 112,500 112,500 230,000
65 26/02/2015 nani 200,000 5,000 97,500 97,500 200,000
66 susi 100,000 5,000 47,500 47,500 100,000
67 berlina 20,000 5,000 7,500 7,500 20,000
68 rineta 20,000 5,000 7,500 7,500 20,000
69 27/02/2015 rifki 50,000 5,000 22,500 22,500 50,000
70 maulana 150,000 5,000 72,500 72,500 150,000
71 28/02/2015 susi 350,000 5,000 172,500 172,500 350,000
72 herdiyana 150,000 5,000 72,500 72,500 150,000
73 marlina 100,000 5,000 47,500 47,500 100,000
8,990,000 365,000 4,312,500 4,312,500 8,990,000

JASA ALAT &

DOKTER BAHAN
1 2/2/2015 cicih rosmawati 70,000 35,000 35,000 70,000
2 rohmayanti 70,000 35,000 35,000 70,000
3 irma y 30,000 15,000 15,000 30,000
4 yuli 15,000 10,000 7,500 7,500 25,000
5 m ramdan 25,000 12,500 12,500 25,000
6 riamah 30,000 15,000 15,000 30,000
7 siti h 40,000 20,000 20,000 40,000
8 neni 60,000 10,000 30,000 30,000 70,000
9 m rizki 30,000 15,000 15,000 30,000
10 ujang 15,000 10,000 7,500 7,500 25,000
11 putra 70,000 35,000 35,000 70,000
12 rina 30,000 15,000 15,000 30,000
13 alliya 70,000 35,000 35,000 70,000
14 raisa 15,000 10,000 7,500 7,500 25,000
15 iis 15,000 10,000 7,500 7,500 25,000
16 nida 25,000 12,500 12,500 25,000
17 3/2/2015 siska 25,000 12,500 12,500 25,000
18 komariah 15,000 10,000 7,500 7,500 25,000
19 abdul k 15,000 10,000 7,500 7,500 25,000
20 euis 30,000 15,000 15,000 30,000
21 zaelani 15,000 10,000 7,500 7,500 25,000
22 harum 15,000 10,000 7,500 7,500 25,000
23 siti a 15,000 10,000 7,500 7,500 25,000
24 neni 15,000 10,000 7,500 7,500 25,000
25 hendra 30,000 15,000 15,000 30,000
26 atiqoh 30,000 15,000 15,000 30,000
27 sansan 15,000 7,500 7,500 15,000
28 m ilham 15,000 7,500 7,500 15,000
29 imas h 60,000 30,000 30,000 60,000
30 danil 70,000 35,000 35,000 70,000
31 armal 70,000 35,000 35,000 70,000
32 eli sofian 70,000 35,000 35,000 70,000
33 nurlatifah 35,000 - 17,500 17,500 35,000
34 riza 15,000 7,500 7,500 15,000
35 4/2/2015 ai nurhayati 70,000 35,000 35,000 70,000
36 ade juanda 30,000 10,000 15,000 15,000 40,000
37 abbot 30,000 15,000 15,000 30,000
38 ibut 35,000 17,500 17,500 35,000
39 rendi 30,000 15,000 15,000 30,000
40 rengli 30,000 15,000 15,000 30,000
41 nengsi 70,000 35,000 35,000 70,000
42 rohmayanti 70,000 35,000 35,000 70,000
43 siti 15,000 10,000 7,500 7,500 25,000
44 neni 15,000 10,000 7,500 7,500 25,000
45 revi 70,000 35,000 35,000 70,000
46 tuty sadyah 70,000 35,000 35,000 70,000
47 mugi insani 35,000 17,500 17,500 35,000
48 nurul hasanah 30,000 15,000 15,000 30,000
49 theresia 70,000 35,000 35,000 70,000
50 rasyad 35,000 17,500 17,500 35,000
51 m ridwan 35,000 17,500 17,500 35,000
52 wiwik ratnawati 70,000 35,000 35,000 70,000
53 vera 15,000 7,500 7,500 15,000
54 efa 30,000 15,000 15,000 30,000
55 5/2/2015 suwito 30,000 15,000 15,000 30,000
56 asri 15,000 7,500 7,500 15,000
57 reka 30,000 15,000 15,000 30,000
58 kokom 60,000 30,000 30,000 60,000
59 entar 60,000 30,000 30,000 60,000
60 karyani 60,000 30,000 30,000 60,000
61 asep mulyana 70,000 35,000 35,000 70,000
62 tita 30,000 15,000 15,000 30,000
63 susi 30,000 15,000 15,000 30,000
64 tata 15,000 10,000 7,500 7,500 25,000
65 irfan 25,000 12,500 12,500 25,000
66 aep 30,000 15,000 15,000 30,000
67 herdi 30,000 15,000 15,000 30,000
68 nuraeni 25,000 12,500 12,500 25,000
69 eva 15,000 10,000 7,500 7,500 25,000
70 ratna 70,000 35,000 35,000 70,000
71 galang 30,000 15,000 15,000 30,000
72 siti s 30,000 15,000 15,000 30,000
73 sri 15,000 10,000 7,500 7,500 25,000
74 rizky 25,000 12,500 12,500 25,000
75 nia 70,000 35,000 35,000 70,000
76 6/2/2015 dargan 60,000 30,000 30,000 60,000
77 wiarsih 60,000 30,000 30,000 60,000
78 dian r 15,000 10,000 7,500 7,500 25,000
79 karina 30,000 15,000 15,000 30,000
80 panji 70,000 35,000 35,000 70,000
81 fanysya 30,000 15,000 15,000 30,000
82 lucky 30,000 15,000 15,000 30,000
83 azka 30,000 15,000 15,000 30,000
84 harun 70,000 35,000 35,000 70,000
85 silmi 15,000 15,000 7,500 7,500 30,000
86 josua 30,000 15,000 15,000 30,000
87 ibrahim 30,000 15,000 15,000 30,000
88 tyas 30,000 15,000 15,000 30,000
89 afni 25,000 12,500 12,500 25,000
90 kania 30,000 15,000 15,000 30,000
91 siti a 70,000 35,000 35,000 70,000
92 hendro 15,000 10,000 7,500 7,500 25,000
93 nafidza 25,000 12,500 12,500 25,000
94 7/2/2015 theresia 30,000 15,000 15,000 30,000
95 sudarsih 15,000 10,000 7,500 7,500 25,000
96 rina herlina 30,000 15,000 15,000 30,000
97 komariah 60,000 30,000 30,000 60,000
98 winda 60,000 30,000 30,000 60,000
99 nabila 30,000 15,000 15,000 30,000
100 siti soleh 30,000 15,000 15,000 30,000
101 dedi s 30,000 15,000 15,000 30,000
102 siti aisyah 30,000 15,000 15,000 30,000
103 ruhiyat 30,000 15,000 15,000 30,000
104 santi 70,000 35,000 35,000 70,000
105 saskia 30,000 15,000 15,000 30,000
106 nurjaman 30,000 15,000 15,000 30,000
107 lilis 70,000 35,000 35,000 70,000
108 agus 30,000 15,000 15,000 30,000
109 somardi 15,000 7,500 7,500 15,000
110 sri yani 70,000 35,000 35,000 70,000
111 9/2/2015 doni 25,000 12,500 12,500 25,000
112 siti 30,000 15,000 15,000 30,000
113 ika 15,000 10,000 7,500 7,500 25,000
114 neny 15,000 10,000 7,500 7,500 25,000
115 keiren 70,000 35,000 35,000 70,000
116 rizki 30,000 15,000 15,000 30,000
117 irma y 30,000 15,000 15,000 30,000
118 bambang 15,000 10,000 7,500 7,500 25,000
119 m abdul 30,000 15,000 15,000 30,000
120 ai nurhayati 30,000 15,000 15,000 30,000
121 ade azki 40,000 20,000 20,000 40,000
122 nillennia 15,000 10,000 7,500 7,500 25,000
123 nining p 15,000 10,000 7,500 7,500 25,000
124 m rizal 15,000 10,000 7,500 7,500 25,000
125 siti a 30,000 15,000 15,000 30,000
126 dery 30,000 15,000 15,000 30,000
127 dedi 15,000 7,500 7,500 15,000
128 ibrahim 40,000 20,000 20,000 40,000
129 10/2/2015 hendra 30,000 15,000 15,000 30,000
130 atiqoh 70,000 35,000 35,000 70,000
131 ismail 15,000 10,000 7,500 7,500 25,000
132 sri s 15,000 10,000 7,500 7,500 25,000
133 neng 15,000 10,000 7,500 7,500 25,000
134 tatiya 35,000 17,500 17,500 35,000
135 rendi 30,000 10,000 15,000 15,000 40,000
136 fanysya 70,000 35,000 35,000 70,000
137 lucky 30,000 15,000 15,000 30,000
138 efa 30,000 15,000 15,000 30,000
139 melinda 35,000 17,500 17,500 35,000
140 naura 35,000 17,500 17,500 35,000
141 andi 15,000 7,500 7,500 15,000
142 maya 15,000 7,500 7,500 15,000
143 rosmaya 15,000 7,500 7,500 15,000
144 11/2/2015 m sopian 15,000 7,500 7,500 15,000
145 dafita 50,000 25,000 25,000 50,000
146 yussi sofia 70,000 35,000 35,000 70,000
147 viona 15,000 10,000 7,500 7,500 25,000
148 chepi supriadi 15,000 7,500 7,500 15,000
149 yana sutisna 70,000 35,000 35,000 70,000
150 febrian 15,000 7,500 7,500 15,000
151 hamsyiah 15,000 7,500 7,500 15,000
152 djasmet 15,000 7,500 7,500 15,000
153 ate rusdianto 15,000 10,000 7,500 7,500 25,000
154 dadang 70,000 35,000 35,000 70,000
155 siti k 30,000 15,000 15,000 30,000
156 nurul hasanah 70,000 35,000 35,000 70,000
157 renata 30,000 15,000 15,000 30,000
158 nurfitri 30,000 10,000 15,000 15,000 40,000
159 siti nurjanah 30,000 10,000 15,000 15,000 40,000
160 dafian 15,000 10,000 7,500 7,500 25,000
161 didin 15,000 10,000 7,500 7,500 25,000
162 atiqoh 30,000 15,000 15,000 30,000
163 12/2/2015 suwito 30,000 15,000 15,000 30,000
164 resnawati 30,000 15,000 15,000 30,000
165 tarwin 60,000 30,000 30,000 60,000
166 refani 30,000 15,000 15,000 30,000
167 yuli yulianti 30,000 15,000 15,000 30,000
168 komariah 60,000 30,000 30,000 60,000
169 rendi 25,000 12,500 12,500 25,000
170 karwati 30,000 15,000 15,000 30,000
171 tresna 30,000 15,000 15,000 30,000
172 yasman 25,000 12,500 12,500 25,000
173 reka 30,000 15,000 15,000 30,000
174 titin 30,000 15,000 15,000 30,000
175 aep 30,000 15,000 15,000 30,000
176 susi 30,000 15,000 15,000 30,000
177 herdi 30,000 15,000 15,000 30,000
178 13/02/2015 siti aisyah 40,000 20,000 20,000 40,000
179 iis sopiah 30,000 15,000 15,000 30,000
180 vio alviyono 60,000 30,000 30,000 60,000
181 suwito 30,000 15,000 15,000 30,000
182 chepi 15,000 7,500 7,500 15,000
183 sudarsih 15,000 7,500 7,500 15,000
184 azka 30,000 15,000 15,000 30,000
185 ernita 15,000 7,500 7,500 15,000
186 rina sopian 60,000 30,000 30,000 60,000
187 weni 30,000 15,000 15,000 30,000
188 imas 15,000 10,000 7,500 7,500 25,000
189 panji 70,000 10,000 35,000 35,000 80,000
190 tuti 15,000 10,000 7,500 7,500 25,000
191 karina 30,000 10,000 15,000 15,000 40,000
192 silmi 30,000 10,000 15,000 15,000 40,000
193 rosita 70,000 35,000 35,000 70,000
194 josua 30,000 15,000 15,000 30,000
195 sandi 70,000 35,000 35,000 70,000
196 asep k 15,000 10,000 7,500 7,500 25,000
197 siti s 70,000 35,000 35,000 70,000
198 rina 30,000 15,000 15,000 30,000
199 14/02/015 yuyun yuliawati 30,000 15,000 15,000 30,000
200 agus setiadi 30,000 15,000 15,000 30,000
201 winda rissalati 30,000 15,000 15,000 30,000
202 nabila 30,000 15,000 15,000 30,000
203 riski 35,000 17,500 17,500 35,000
204 refiani 30,000 15,000 15,000 30,000
205 theresia 30,000 15,000 15,000 30,000
206 susila 30,000 10,000 15,000 15,000 40,000
207 efa susanti 30,000 15,000 15,000 30,000
208 saskia 30,000 15,000 15,000 30,000
209 yudi 30,000 15,000 15,000 30,000
210 manasye 30,000 15,000 15,000 30,000
211 gabriel 70,000 35,000 35,000 70,000
212 abil 35,000 10,000 17,500 17,500 45,000
213 nurjaman 30,000 10,000 15,000 15,000 40,000
214 susi budiwati 30,000 15,000 15,000 30,000
215 16/02/2015 yaya 70,000 35,000 35,000 70,000
216 mega 70,000 35,000 35,000 70,000
217 kesya 25,000 12,500 12,500 25,000
218 siti hodijah 70,000 35,000 35,000 70,000
219 irma 30,000 15,000 15,000 30,000
220 sutowo 30,000 15,000 15,000 30,000
221 siti salamah 30,000 15,000 15,000 30,000
222 asep s 30,000 10,000 15,000 15,000 40,000
223 atiqoh 30,000 10,000 15,000 15,000 40,000
224 raisa 15,000 10,000 7,500 7,500 25,000
225 anggia 70,000 35,000 35,000 70,000
226 aliya 70,000 35,000 35,000 70,000
227 lusni 30,000 10,000 15,000 15,000 40,000
228 tyas 30,000 15,000 15,000 30,000
229 ibrahim 70,000 35,000 35,000 70,000
230 lucky 30,000 15,000 15,000 30,000
231 fanisya 30,000 15,000 15,000 30,000
232 siti s 15,000 10,000 7,500 7,500 25,000
233 deni 15,000 10,000 7,500 7,500 25,000
234 17/02/2015 iis s 30,000 10,000 15,000 15,000 40,000
235 akbar 25,000 12,500 12,500 25,000
236 siti suci 30,000 15,000 15,000 30,000
237 siti z 30,000 15,000 15,000 30,000
238 angga 30,000 10,000 15,000 15,000 40,000
239 neneng 70,000 35,000 35,000 70,000
240 defie 70,000 35,000 35,000 70,000
241 ade aziz 70,000 35,000 35,000 70,000
242 atiqoh 30,000 15,000 15,000 30,000
243 titin s 15,000 10,000 7,500 7,500 25,000
244 naura 35,000 17,500 17,500 35,000
245 m djunaedi 30,000 10,000 15,000 15,000 40,000
246 m syahrul 15,000 10,000 7,500 7,500 25,000
247 nuryanti 30,000 10,000 15,000 15,000 40,000
248 ismail 60,000 10,000 30,000 30,000 70,000
249 18/02/2015 suprayetno 70,000 35,000 35,000 70,000
250 hendra s 30,000 15,000 15,000 30,000
251 ade juanda 30,000 15,000 15,000 30,000
252 iskandar 70,000 35,000 35,000 70,000
253 kokom k 15,000 10,000 7,500 7,500 25,000
254 dafian 30,000 15,000 15,000 30,000
255 galang 30,000 10,000 15,000 15,000 40,000
256 haidar 35,000 17,500 17,500 35,000
257 gefitri 30,000 15,000 15,000 30,000
258 tuty 30,000 15,000 15,000 30,000
259 revi 70,000 35,000 35,000 70,000
260 titin 30,000 15,000 15,000 30,000
261 egi prayoga 30,000 15,000 15,000 30,000
262 asti 30,000 15,000 15,000 30,000
263 nurul 30,000 15,000 15,000 30,000
264 chepi 30,000 15,000 15,000 30,000
265 sri 30,000 15,000 15,000 30,000
266 2/20/2015 suwito 40,000 20,000 20,000 40,000
267 siti mariam 15,000 7,500 7,500 15,000
268 hamsiyah 60,000 30,000 30,000 60,000
269 abdurrasyid 35,000 17,500 17,500 35,000
270 mila 30,000 15,000 15,000 30,000
271 winda 30,000 15,000 15,000 30,000
272 iin 60,000 30,000 30,000 60,000
273 lucky 30,000 15,000 15,000 30,000
274 fanisya 30,000 15,000 15,000 30,000
275 siti 40,000 20,000 20,000 40,000
276 m hibban 25,000 12,500 12,500 25,000
277 rosidin 70,000 35,000 35,000 70,000
278 josua 40,000 20,000 20,000 40,000
279 derry 30,000 15,000 15,000 30,000
280 mulus 15,000 10,000 7,500 7,500 25,000
281 rizky 40,000 20,000 20,000 40,000
282 mina 15,000 10,000 7,500 7,500 25,000
283 rosmaya 15,000 10,000 7,500 7,500 25,000
284 2/21/2015 dude 35,000 17,500 17,500 35,000
285 yuyun yuliawati 70,000 35,000 35,000 70,000
286 husniati 70,000 35,000 35,000 70,000
287 theresia 70,000 35,000 35,000 70,000
288 siti 70,000 35,000 35,000 70,000
289 agus setiadi 40,000 20,000 20,000 40,000
290 siti 60,000 30,000 30,000 60,000
291 maya 30,000 15,000 15,000 30,000
292 emmy 70,000 35,000 35,000 70,000
293 atiqoh 30,000 15,000 15,000 30,000
294 nurjaman 30,000 15,000 15,000 30,000
295 yudi 30,000 15,000 15,000 30,000
296 riyani 70,000 35,000 35,000 70,000
297 thirza 25,000 12,500 12,500 25,000
298 thasya 25,000 12,500 12,500 25,000
299 cicih 15,000 10,000 7,500 7,500 25,000
300 yaya 70,000 35,000 35,000 70,000
301 raden 70,000 35,000 35,000 70,000
302 teja 70,000 35,000 35,000 70,000
303 zulfaa 70,000 35,000 35,000 70,000
304 dedi 60,000 10,000 30,000 30,000 70,000
305 2/23/2015 hendra 30,000 15,000 15,000 30,000
306 ratna 70,000 35,000 35,000 70,000
307 virgy 60,000 30,000 30,000 60,000
308 resnawati 30,000 10,000 15,000 15,000 40,000
309 herman 30,000 10,000 15,000 15,000 40,000
310 irma 40,000 20,000 20,000 40,000
311 tyas 30,000 15,000 15,000 30,000
312 mulyati 15,000 10,000 7,500 7,500 25,000
313 kurnia 30,000 10,000 15,000 15,000 40,000
314 herman 15,000 10,000 7,500 7,500 25,000
315 nillenia 15,000 10,000 7,500 7,500 25,000
316 siti s 25,000 12,500 12,500 25,000
317 kania 30,000 15,000 15,000 30,000
318 mamat 15,000 10,000 7,500 7,500 25,000
319 2/24/2015 sri syam 30,000 15,000 15,000 30,000
320 deni 15,000 10,000 7,500 7,500 25,000
321 saskia 30,000 15,000 15,000 30,000
322 imas 15,000 7,500 7,500 15,000
323 aep 30,000 15,000 15,000 30,000
324 uwas 15,000 10,000 7,500 7,500 25,000
325 angelica 25,000 12,500 12,500 25,000
326 ai m 15,000 10,000 7,500 7,500 25,000
327 angga 30,000 15,000 15,000 30,000
328 m luthfi 25,000 12,500 12,500 25,000
329 rina 30,000 15,000 15,000 30,000
330 azka 15,000 7,500 7,500 15,000
331 hafiya 15,000 7,500 7,500 15,000
332 biduri 50,000 25,000 25,000 50,000
333 febrian 30,000 15,000 15,000 30,000
334 naura 50,000 25,000 25,000 50,000
335 egi 30,000 10,000 15,000 15,000 40,000
336 efa 30,000 10,000 15,000 15,000 40,000
337 sri 60,000 30,000 30,000 60,000
338 ismail 60,000 30,000 30,000 60,000
339 siti z 30,000 15,000 15,000 30,000
340 lukman 30,000 15,000 15,000 30,000
341 2/25/2015 h salimah 60,000 10,000 30,000 30,000 70,000
342 sri nengsih 30,000 10,000 15,000 15,000 40,000
343 tarwilah 30,000 10,000 15,000 15,000 40,000
344 aira s 30,000 10,000 15,000 15,000 40,000
345 maryan 30,000 10,000 15,000 15,000 40,000
346 imas h 15,000 10,000 7,500 7,500 25,000
347 dewi 15,000 10,000 7,500 7,500 25,000
348 abbot 30,000 15,000 15,000 30,000
349 sumaeti 15,000 10,000 7,500 7,500 25,000
350 yussi 15,000 7,500 7,500 15,000
351 arzia 35,000 10,000 17,500 17,500 45,000
352 tin kartini 15,000 7,500 7,500 15,000
353 risti 15,000 10,000 7,500 7,500 25,000
354 dewi 70,000 10,000 35,000 35,000 80,000
355 dafian 30,000 10,000 15,000 15,000 40,000
356 raisya 30,000 15,000 15,000 30,000
357 lilis n 30,000 15,000 15,000 30,000
358 nur a 30,000 15,000 15,000 30,000
359 rangga 35,000 17,500 17,500 35,000
360 chika 30,000 10,000 15,000 15,000 40,000
361 herdi 30,000 15,000 15,000 30,000
362 2/26/2015 ibut 7,000 3,500 3,500 7,000
363 nurmala 70,000 35,000 35,000 70,000
364 uken 70,000 35,000 35,000 70,000
365 aep 40,000 20,000 20,000 40,000
366 haidar 25,000 12,500 12,500 25,000
367 titin 30,000 15,000 15,000 30,000
368 suyanto 70,000 35,000 35,000 70,000
369 ratnasih 30,000 15,000 15,000 30,000
370 ita 30,000 15,000 15,000 30,000
371 mulyati 15,000 10,000 7,500 7,500 25,000
372 rosmaya 15,000 10,000 7,500 7,500 25,000
373 2/27/2015 nurmala 60,000 30,000 30,000 60,000
374 siti a 30,000 15,000 15,000 30,000
375 niawati 70,000 35,000 35,000 70,000
376 wiwi robiatul 70,000 35,000 35,000 70,000
377 febrian 15,000 7,500 7,500 15,000
378 m amin 70,000 35,000 35,000 70,000
379 uken 60,000 30,000 30,000 60,000
380 suwito 70,000 35,000 35,000 70,000
381 theresia 70,000 35,000 35,000 70,000
382 atiqoh 30,000 15,000 15,000 30,000
383 rosinta 70,000 35,000 35,000 70,000
384 josua 70,000 35,000 35,000 70,000
385 mulus 30,000 15,000 15,000 30,000
386 hasna 15,000 10,000 7,500 7,500 25,000
387 hasanah 30,000 15,000 15,000 30,000
388 angga 70,000 35,000 35,000 70,000
389 derry 40,000 20,000 20,000 40,000
390 desy 25,000 12,500 12,500 25,000
391 2/28/2015 mona 60,000 30,000 30,000 60,000
392 keisya 35,000 17,500 17,500 35,000
393 sri 30,000 15,000 15,000 30,000
394 rizki 70,000 35,000 35,000 70,000
395 chika 30,000 15,000 15,000 30,000
396 toto 15,000 10,000 7,500 7,500 25,000
397 m amin 30,000 15,000 15,000 30,000
398 yuyun 70,000 35,000 35,000 70,000
399 tanya 35,000 17,500 17,500 35,000
400 enis 30,000 15,000 15,000 30,000
401 irma 70,000 35,000 35,000 70,000
402 mia s 70,000 35,000 35,000 70,000
403 ibut 70,000 35,000 35,000 70,000
404 saskia 40,000 20,000 20,000 40,000
405 ai mimin 60,000 10,000 30,000 30,000 70,000
406 raisya 25,000 12,500 12,500 25,000
407 imas k 30,000 15,000 15,000 30,000
408 yaya 70,000 35,000 35,000 70,000
- - -
23,962,000 1,330,000 11,798,500 11,798,500 24,927,000
PERIODE MARET 2015
JASA ALAT &

DOKTER BAHAN
1 1/3/2015 RIZAL 50,000 5,000 22,500 22,500 50,000
2 2/3/2015 ICEU 80,000 5,000 37,500 37,500 80,000
3 YAYAN 100,000 5,000 47,500 47,500 100,000
4 ZALFA 40,000 5,000 17,500 17,500 40,000
5 ASEP CANDRA 100,000 5,000 47,500 47,500 100,000
6 NITA 100,000 5,000 47,500 47,500 100,000
7 3/3/2015 AEP 250,000 5,000 122,500 122,500 250,000
8 4/3/2015 MILKI 100,000 5,000 47,500 47,500 100,000
9 MILKI 20,000 5,000 7,500 7,500 20,000
10 PEPI 20,000 5,000 7,500 7,500 20,000
11 5/3/2015 ANGGA N 100,000 5,000 47,500 47,500 100,000
12 HERDYANA NUGRAHA 150,000 5,000 72,500 72,500 150,000
13 YANA JUNAEDI 200,000 5,000 97,500 97,500 200,000
14 HERDYANA NUGRAHA 25,000 5,000 10,000 10,000 25,000
15 YANA JUNAEDI 25,000 5,000 10,000 10,000 25,000
16 6/3/2015 SRI SUWARTI 200,000 5,000 97,500 97,500 200,000
17 TUNIYAH 75,000 5,000 35,000 35,000 75,000
18 WILYA ROSI 50,000 5,000 22,500 22,500 50,000
19 7/3/2015 FARAH NURFADILLAH 70,000 5,000 32,500 32,500 70,000
20 MONA MEGA 200,000 5,000 97,500 97,500 200,000
21 ZALFA 60,000 5,000 27,500 27,500 60,000
22 9/3/2015 CICIN R 200,000 5,000 97,500 97,500 200,000
23 NITA 60,000 5,000 27,500 27,500 60,000
24 DEWI 25,000 5,000 10,000 10,000 25,000
25 UMAS 25,000 5,000 10,000 10,000 25,000
26 RITA 60,000 5,000 27,500 27,500 60,000
27 DEDI 25,000 5,000 10,000 10,000 25,000
28 MERI 25,000 5,000 10,000 10,000 25,000
29 ANGGA 205,000 5,000 100,000 100,000 205,000
30 11/3/2015 AGUS P 20,000 5,000 7,500 7,500 20,000
31 12/3/2015 TONI SAHRONI 100,000 5,000 47,500 47,500 100,000
32 SANTI 50,000 5,000 22,500 22,500 50,000
33 13/3/2015 ENOK AISYAH 200,000 5,000 97,500 97,500 200,000
34 JULIA 60,000 5,000 27,500 27,500 60,000
35 14/3/2015 ICEU 80,000 5,000 37,500 37,500 80,000
36 DJUNAEDI 200,000 5,000 97,500 97,500 200,000
37 16/3/2015 SUSI 200,000 5,000 97,500 97,500 200,000
38 DJUNAEDI 200,000 5,000 97,500 97,500 200,000
39 NITA 80,000 5,000 37,500 37,500 80,000
40 17/3/2015 RENA 60,000 5,000 27,500 27,500 60,000
41 RITA 60,000 5,000 27,500 27,500 60,000
42 18/3/2015 WARISMAN 150,000 5,000 72,500 72,500 150,000
43 FAHMI 40,000 5,000 17,500 17,500 40,000
44 ALDI 40,000 5,000 17,500 17,500 40,000
45 AGUS PURNAMA 100,000 5,000 47,500 47,500 100,000
46 19/3/2015 NY WIDA 30,000 5,000 12,500 12,500 30,000
47 20/3/2015 ENOK AISYAH 100,000 5,000 47,500 47,500 100,000
48 NURAHMAYATI 60,000 5,000 27,500 27,500 60,000
49 EDDY SUSIANTO 70,000 5,000 32,500 32,500 70,000
50 PURWADI JUNAEDI 100,000 5,000 47,500 47,500 100,000
51 21/3/2015 RIZAL 50,000 5,000 22,500 22,500 50,000
52 23/3/2015 SUSI 100,000 5,000 47,500 47,500 100,000
53 JUMIN 25,000 5,000 10,000 10,000 25,000
54 24/3/2015 NIRMA A 120,000 5,000 57,500 57,500 120,000
55 RENA 60,000 5,000 27,500 27,500 60,000
56 25/3/2015 MARIAM 50,000 5,000 22,500 22,500 50,000
57 26/3/2015 SANDRA 100,000 5,000 47,500 47,500 100,000
58 TRIMURTI 100,000 5,000 47,500 47,500 100,000
59 NUR R 60,000 5,000 27,500 27,500 60,000
60 27/3/2015 ENOK 100,000 5,000 47,500 47,500 100,000
61 JUMIN 200,000 5,000 97,500 97,500 200,000
62 M APIP 150,000 5,000 72,500 72,500 150,000
63 SAVA 110,000 5,000 52,500 52,500 110,000
64 SENA 60,000 5,000 27,500 27,500 60,000
65 28/3/2015 EDI KUSWANTO 70,000 5,000 32,500 32,500 70,000
66 MARYAM 50,000 5,000 22,500 22,500 50,000
67 MARYAM 100,000 5,000 47,500 47,500 100,000
68 30/3/2015 NITA 60,000 5,000 27,500 27,500 60,000
69 31/3/2015 RITA 60,000 5,000 27,500 27,500 60,000
70 RENA 60,000 5,000 27,500 27,500 60,000
71 HARIYANTO 70,000 5,000 32,500 32,500 70,000
6,395,000 355,000 3,020,000 3,020,000 6,395,000

PERIODE MARET 2015
JASA ALAT &

DOKTER BAHAN
1 2/3/2015 HENDRA 30,000 15,000 15,000 30,000
2 NOVEN 30,000 15,000 15,000 30,000
3 MANASYE 30,000 15,000 15,000 30,000
4 RFEBRYAN 30,000 15,000 15,000 30,000
5 RESNAWATI 30,000 10,000 15,000 15,000 40,000
6 TARWILAH 30,000 15,000 15,000 30,000
7 JILAN 15,000 10,000 7,500 7,500 25,000
8 SITI 30,000 15,000 15,000 30,000
9 DADANG 70,000 35,000 35,000 70,000
10 NILLENIA 15,000 7,500 7,500 15,000
11 ASTRI 70,000 35,000 35,000 70,000
12 NURUL 30,000 15,000 15,000 30,000
13 YUDI 30,000 15,000 15,000 30,000
14 RIYANI 70,000 35,000 35,000 70,000
15 ASEP 30,000 15,000 15,000 30,000
16 3/3/2015 MARYAM 15,000 10,000 7,500 7,500 25,000
17 IMAS H 15,000 10,000 7,500 7,500 25,000
18 MULYATI 15,000 10,000 7,500 7,500 25,000
19 KARINA 30,000 15,000 15,000 30,000
20 PANJI 75,000 10,000 37,500 37,500 85,000
21 RINA 40,000 20,000 20,000 40,000
22 HERAWATI 15,000 10,000 7,500 7,500 25,000
23 SITI SRI 15,000 10,000 7,500 7,500 25,000
24 AISYAH 30,000 15,000 15,000 30,000
25 DWI 15,000 7,500 7,500 15,000
26 ROSMAWANTI 25,000 10,000 12,500 12,500 35,000
27 RIZQI 15,000 10,000 7,500 7,500 25,000
28 SRI S 30,000 15,000 15,000 30,000
29 SITI Z 30,000 15,000 15,000 30,000
30 ARI 15,000 10,000 7,500 7,500 25,000
31 ANGGA 30,000 15,000 15,000 30,000
32 YANTI M 30,000 15,000 15,000 30,000
33 SRI U 60,000 30,000 30,000 60,000
34 ARIS P 30,000 15,000 15,000 30,000
35 RIZKY 30,000 15,000 15,000 30,000
36 SUMIRAH 15,000 10,000 7,500 7,500 25,000
37 ATE R 15,000 10,000 7,500 7,500 25,000
38 SRI M 20,000 10,000 10,000 20,000
39 4/3/2015 RINRIN 60,000 30,000 30,000 60,000
40 SUMARNI 30,000 15,000 15,000 30,000
41 AI N 70,000 35,000 35,000 70,000
42 FITRIYANI 70,000 35,000 35,000 70,000
43 SRI NENGSIH 60,000 30,000 30,000 60,000
44 REFAL 15,000 10,000 7,500 7,500 25,000
45 RANGGA DWI 70,000 35,000 35,000 70,000
46 EGI PRAYOGA 30,000 10,000 15,000 15,000 40,000
47 TUTY 70,000 35,000 35,000 70,000
48 DEWI 70,000 35,000 35,000 70,000
49 DAFIAN 30,000 15,000 15,000 30,000
50 AZRI 15,000 10,000 7,500 7,500 25,000
51 5/3/2015 ANGGA 70,000 35,000 35,000 70,000
52 ZULFAA 70,000 35,000 35,000 70,000
53 TSALITSA 70,000 35,000 35,000 70,000
54 LADIANA 30,000 15,000 15,000 30,000
55 RATNA 15,000 10,000 7,500 7,500 25,000
56 AI 15,000 7,500 7,500 15,000
57 RASTI 15,000 7,500 7,500 15,000
58 AEP 40,000 20,000 20,000 40,000
59 TITIN 30,000 15,000 15,000 30,000
60 EDI S 15,000 10,000 7,500 7,500 25,000
61 ITA 40,000 20,000 20,000 40,000
62 NENG 15,000 10,000 7,500 7,500 25,000
63 RATNASIH 40,000 20,000 20,000 40,000
64 MELITZA 15,000 10,000 7,500 7,500 25,000
65 REVA 25,000 12,500 12,500 25,000
66 6/3/2015 NANIH 15,000 10,000 7,500 7,500 25,000
67 WILYA ROSI 15,000 10,000 7,500 7,500 25,000
68 SITI ZUILEILA 30,000 15,000 15,000 30,000
69 TUNIYAH 70,000 10,000 35,000 35,000 80,000
70 SITI SOLEHAH 30,000 15,000 15,000 30,000
71 SRI SUWARTI 15,000 7,500 7,500 15,000
72 MADY P 30,000 15,000 15,000 30,000
73 ANGGA 40,000 20,000 20,000 40,000
74 RIZKY 15,000 10,000 7,500 7,500 25,000
75 SELI ANA F 15,000 10,000 7,500 7,500 25,000
76 TITIN S 15,000 10,000 7,500 7,500 25,000
77 DERRY 15,000 7,500 7,500 15,000
78 KAMIL 15,000 10,000 7,500 7,500 25,000
79 SUTONO 30,000 15,000 15,000 30,000
80 MAYA 30,000 15,000 15,000 30,000
81 DEPA 15,000 10,000 7,500 7,500 25,000
82 7/3/2015 NOVI ANGGRAENI 60,000 30,000 30,000 60,000
83 AGUS SETIADI 70,000 35,000 35,000 70,000
84 YULI YULIANTI 30,000 15,000 15,000 30,000
85 SALIMAH 70,000 15,000 35,000 35,000 85,000
86 SURATNO 60,000 30,000 30,000 60,000
87 TUNIYAH 30,000 15,000 15,000 30,000
88 KEISYA 25,000 12,500 12,500 25,000
89 MONA 15,000 7,500 7,500 15,000
90 FARAH 70,000 35,000 35,000 70,000
91 EDDY 30,000 15,000 15,000 30,000
92 HASANAH PRATIWI 30,000 15,000 15,000 30,000
93 ENIS 30,000 15,000 15,000 30,000
94 ENOK 15,000 10,000 7,500 7,500 25,000
95 ATIQAH NUR 30,000 15,000 15,000 30,000
96 KHOERUNISA 70,000 35,000 35,000 70,000
97 NUR AINI 70,000 35,000 35,000 70,000
98 YAYA 70,000 35,000 35,000 70,000
99 ANI N 15,000 7,500 7,500 15,000
100 CHIKA A 30,000 15,000 15,000 30,000
101 ZULFAA 70,000 35,000 35,000 70,000
102 8/3/2015 HENDRA S 30,000 15,000 15,000 30,000
103 CICIN R 15,000 7,500 7,500 15,000
104 AI MIMIN 60,000 30,000 30,000 60,000
105 NOVEN 30,000 15,000 15,000 30,000
106 MANASYE 30,000 15,000 15,000 30,000
107 TARWILAH 40,000 20,000 20,000 40,000
108 M ILHAM 30,000 10,000 15,000 15,000 40,000
109 ZULFAA 70,000 35,000 35,000 70,000
110 HARYONO 70,000 35,000 35,000 70,000
111 IKBALUDIN 25,000 12,500 12,500 25,000
112 ROSMAWATI 70,000 35,000 35,000 70,000
113 MELINDA 30,000 15,000 15,000 30,000
114 SUSI N 30,000 10,000 15,000 15,000 40,000
115 SUSI SARAH 25,000 12,500 12,500 25,000
116 DEWI T 30,000 15,000 15,000 30,000
117 YUDI 30,000 15,000 15,000 30,000
118 RIYANI 70,000 10,000 35,000 35,000 80,000
119 SASKIA 70,000 35,000 35,000 70,000
120 ASEP S 30,000 15,000 15,000 30,000
121 10/3/2015 KANIA 30,000 15,000 15,000 30,000
122 ARIS P 30,000 12,500 12,500 25,000
123 RINA 70,000 35,000 35,000 70,000
124 AGUS 15,000 10,000 7,500 7,500 25,000
125 LISNA 30,000 15,000 15,000 30,000
126 CHIKA A 30,000 15,000 15,000 30,000
127 ANGGA 70,000 35,000 35,000 70,000
128 SRI S 30,000 15,000 15,000 30,000
129 ATIQOH 30,000 15,000 15,000 30,000
130 ANNI 60,000 30,000 30,000 60,000
131 EFA S 30,000 15,000 15,000 30,000
132 SYAFUDIN 70,000 12,500 35,000 35,000 82,500
133 SRI U 60,000 30,000 30,000 60,000
134 JAQULILINE 15,000 10,000 7,500 7,500 25,000
135 NENG RINA 60,000 10,000 30,000 30,000 70,000
136 TRI W 30,000 15,000 15,000 30,000
137 DHEA 30,000 15,000 15,000 30,000
138 ASTRI F 70,000 35,000 35,000 70,000
139 NURUL 30,000 15,000 15,000 30,000
140 11/3/2015 SRI M 70,000 35,000 35,000 70,000
141 DIANA 25,000 10,000 12,500 12,500 35,000
142 ENI 15,000 10,000 7,500 7,500 25,000
143 FEBRYAN 30,000 15,000 15,000 30,000
144 TIA 25,000 12,500 12,500 25,000
145 SUMARNI 30,000 15,000 15,000 30,000
146 FARID 15,000 7,500 7,500 15,000
147 CICI S 60,000 30,000 30,000 60,000
148 SITI ROSYATI 70,000 35,000 35,000 70,000
149 SITI ROMLAH 60,000 30,000 30,000 60,000
150 ZULFAA 70,000 35,000 35,000 70,000
151 DEWI 70,000 35,000 35,000 70,000
152 DAFIAN 20,000 10,000 10,000 20,000
153 CELIA 25,000 10,000 12,500 12,500 35,000
154 JOKO 60,000 30,000 30,000 60,000
155 SITI A 30,000 15,000 15,000 30,000
156 EGI 40,000 20,000 20,000 40,000
157 RIA 70,000 35,000 35,000 70,000
158 MONITA 140,000 70,000 70,000 140,000
159 DEDE T 30,000 15,000 15,000 30,000
160 YUDI A 60,000 30,000 30,000 60,000
161 YULIANTI 60,000 30,000 30,000 60,000
162 DEDE 60,000 30,000 30,000 60,000
163 12/3/2015 HERLINA 70,000 35,000 35,000 70,000
164 EUIS JUARIYAH 60,000 30,000 30,000 60,000
165 ENIS 30,000 15,000 15,000 30,000
166 NUNUNG SUMARNI 70,000 35,000 35,000 70,000
167 IRFAN MARUF 70,000 35,000 35,000 70,000
168 SITI SOLEHA 30,000 15,000 15,000 30,000
169 BUMI N 70,000 35,000 35,000 70,000
170 TONI SAHRONI 70,000 35,000 35,000 70,000
171 AI S 15,000 7,500 7,500 15,000
172 RIHAN F 15,000 10,000 7,500 7,500 25,000
173 ENTAR S 15,000 10,000 7,500 7,500 25,000
174 TITIN 30,000 15,000 15,000 30,000
175 ITA 70,000 35,000 35,000 70,000
176 AEP 70,000 35,000 35,000 70,000
177 13/3/2015 EMIYATI 30,000 15,000 15,000 30,000
178 MUGI RAHAYU 15,000 10,000 7,500 7,500 25,000
179 TUNIYAH 30,000 15,000 15,000 30,000
180 ENOK 30,000 15,000 15,000 30,000
181 HASANAH 30,000 15,000 15,000 30,000
182 NURMEILISA 30,000 15,000 15,000 30,000
183 DEWI NOVIYANI 70,000 35,000 35,000 70,000
184 SALWA 70,000 35,000 35,000 70,000
185 SITI WULANDARI 30,000 10,000 15,000 15,000 40,000
186 TUTY SADIAH 70,000 35,000 35,000 70,000
187 ZULFAA 70,000 35,000 35,000 70,000
188 SITI ZULLEILA 40,000 20,000 20,000 40,000
189 JOSUA 30,000 15,000 15,000 30,000
190 ATIQAH 30,000 15,000 15,000 30,000
191 SITI A 70,000 35,000 35,000 70,000
192 ADE W 15,000 10,000 7,500 7,500 25,000
193 MULUS 30,000 15,000 15,000 30,000
194 ZAHARA 15,000 7,500 7,500 15,000
195 NANIN 15,000 10,000 7,500 7,500 25,000
196 IBRAHIM 70,000 35,000 35,000 70,000
197 TYAS 30,000 15,000 15,000 30,000
198 DERRY D 70,000 35,000 35,000 70,000
199 14/3/2015 RAHMAT ABDILLAH 60,000 30,000 30,000 60,000
200 M ZUFAR 70,000 35,000 35,000 70,000
201 TONI SAHRONI 30,000 15,000 15,000 30,000
202 ROSMAWATI 70,000 35,000 35,000 70,000
203 SITI SOLEHAH 30,000 15,000 15,000 30,000
204 M RAJIB 25,000 12,500 12,500 25,000
205 SURTANTI 30,000 15,000 15,000 30,000
206 TARWILAH 70,000 35,000 35,000 70,000
207 AGUS IRWAN 70,000 35,000 35,000 70,000
208 FARAH 30,000 15,000 15,000 30,000
209 HANIFAH 30,000 15,000 15,000 30,000
210 EDDY 30,000 15,000 15,000 30,000
211 NURJAMAN 30,000 15,000 15,000 30,000
212 SITI HALIMAH 70,000 35,000 35,000 70,000
213 DEWI DERAWATI 15,000 7,500 7,500 15,000
214 IBUT S 70,000 35,000 35,000 70,000
215 YAYA 15,000 10,000 7,500 7,500 25,000
216 ALYA 25,000 12,500 12,500 25,000
217 IMAS KOMARIAH 30,000 15,000 15,000 30,000
218 MAYA 30,000 15,000 15,000 30,000
219 16/3/2015 RAISYA 30,000 15,000 15,000 30,000
220 DINDA 25,000 12,500 12,500 25,000
221 M RAMDAN 25,000 12,500 12,500 25,000
222 SUHARTI 15,000 10,000 7,500 7,500 25,000
223 ENTIN 15,000 10,000 7,500 7,500 25,000
224 SUMARNI 30,000 15,000 15,000 30,000
225 AGUS B 70,000 35,000 35,000 70,000
226 M DEPA 30,000 15,000 15,000 30,000
227 SITI NURJANAH 30,000 10,000 15,000 15,000 40,000
228 MAMAN 30,000 15,000 15,000 30,000
229 SASKIA 70,000 35,000 35,000 70,000
230 DADANG R 70,000 35,000 35,000 70,000
231 NURUL HASANAH 30,000 15,000 15,000 30,000
232 DEWI 30,000 10,000 15,000 15,000 40,000
233 SITI S 60,000 10,000 30,000 30,000 70,000
234 ACEP 30,000 10,000 15,000 15,000 40,000
235 H SABTU 60,000 30,000 30,000 60,000
236 17/3/2015 RISNAWATI 30,000 15,000 15,000 30,000
237 ANNISA 30,000 15,000 15,000 30,000
238 SABANAH 15,000 10,000 7,500 7,500 25,000
239 ATIQOH 40,000 20,000 20,000 40,000
240 NANIN 30,000 15,000 15,000 30,000
241 SRI S 40,000 20,000 20,000 40,000
242 LISNA 30,000 15,000 15,000 30,000
243 MONITA 30,000 15,000 15,000 30,000
244 YUDI C 30,000 15,000 15,000 30,000
245 TANYA 15,000 7,500 7,500 15,000
246 YASMIN 35,000 17,500 17,500 35,000
247 FENI 30,000 15,000 15,000 30,000
248 TETI H 15,000 10,000 7,500 7,500 25,000
249 ADARA 35,000 17,500 17,500 35,000
250 TATA 30,000 15,000 15,000 30,000
251 DEWI 30,000 15,000 15,000 30,000
252 DEDE TAUFIK 15,000 10,000 7,500 7,500 25,000
253 DAFIAN 30,000 10,000 15,000 15,000 40,000
254 GITA 30,000 15,000 15,000 30,000
255 NOVEN 30,000 15,000 15,000 30,000
256 MENASYE 30,000 15,000 15,000 30,000
257 18/3/2015 RIFA 15,000 10,000 7,500 7,500 25,000
258 TITIN 15,000 10,000 7,500 7,500 25,000
259 RILIAN 30,000 15,000 15,000 30,000
260 IRAWAN 30,000 15,000 15,000 30,000
261 HENDRA 70,000 35,000 35,000 70,000
262 KARINA 30,000 15,000 15,000 30,000
263 IMAS K 30,000 15,000 15,000 30,000
264 SUTONO 30,000 15,000 15,000 30,000
265 FARHA 15,000 10,000 7,500 7,500 25,000
266 YUYUN 15,000 10,000 7,500 7,500 25,000
267 GINANJAR 35,000 17,500 17,500 35,000
268 TRI 30,000 15,000 15,000 30,000
269 MIZKA 15,000 10,000 7,500 7,500 25,000
270 SRI ULINA 15,000 10,000 7,500 7,500 25,000
271 SALIMAH 70,000 35,000 35,000 70,000
272 19/3/2015 M AMIN 60,000 30,000 30,000 60,000
273 SYAWALIQNA 70,000 35,000 35,000 70,000
274 NUR MEILISA 30,000 15,000 15,000 30,000
275 SHAKILA AULIA 70,000 35,000 35,000 70,000
276 DEVI WAHYU 15,000 10,000 7,500 7,500 25,000
277 SITI NURJANAH 25,000 12,500 12,500 25,000
278 RIZKI ARDIANSYAH 30,000 15,000 15,000 30,000
279 FEBRIAN 30,000 10,000 15,000 15,000 40,000
280 SUPIAN 70,000 35,000 35,000 70,000
281 RIFKY 35,000 17,500 17,500 35,000
282 FINNA AISHA 35,000 17,500 17,500 35,000
283 M MUZHAFFARUDIN 25,000 12,500 12,500 25,000
284 RATNASARI 70,000 35,000 35,000 70,000
285 YADI 30,000 15,000 15,000 30,000
286 TITIN 30,000 15,000 15,000 30,000
287 NENI 30,000 15,000 15,000 30,000
288 MEIKE 25,000 12,500 12,500 25,000
289 AGUS 30,000 15,000 15,000 30,000
290 20/3/2015 TUNIYAH 40,000 20,000 20,000 40,000
291 DELA 30,000 15,000 15,000 30,000
292 HASANAH 30,000 15,000 15,000 30,000
293 FARAH 30,000 15,000 15,000 30,000
294 ENOK AISYAH 30,000 15,000 15,000 30,000
295 EDDY SUSIANTO 40,000 20,000 20,000 40,000
296 PURWADI JUNAEDI 15,000 10,000 7,500 7,500 25,000
297 ASMA NUR 30,000 15,000 15,000 30,000
298 RAWAHAH ABDULAH 30,000 15,000 15,000 30,000
299 MULUS 30,000 10,000 15,000 15,000 40,000
300 SRI U 15,000 10,000 7,500 7,500 25,000
301 SASKIA 70,000 35,000 35,000 70,000
302 SETIONO 15,000 10,000 7,500 7,500 25,000
303 SIFA 30,000 15,000 15,000 30,000
304 RATNA 70,000 10,000 35,000 35,000 80,000
305 MELINDA 30,000 15,000 15,000 30,000
306 KANIA 40,000 20,000 20,000 40,000
307 YAYAN 15,000 10,000 7,500 7,500 25,000
308 23/3/2015 TRI MURTI 30,000 10,000 15,000 15,000 40,000
309 LENI MARLINA 30,000 10,000 15,000 15,000 40,000
310 SUMARNI 40,000 20,000 20,000 40,000
311 SITI ALPIAH 30,000 10,000 15,000 15,000 40,000
312 EUIS JUARIYAH 15,000 10,000 7,500 7,500 25,000
313 AI NURHAYATI 70,000 35,000 35,000 70,000
314 M AMIR 15,000 10,000 7,500 7,500 25,000
315 RENI 15,000 10,000 7,500 7,500 25,000
316 M MUZHAFARUDIN 25,000 12,500 12,500 25,000
317 DENI T 30,000 15,000 15,000 30,000
318 SITI S 30,000 15,000 15,000 30,000
319 M DEPA 30,000 15,000 15,000 30,000
320 FABIAN 50,000 25,000 25,000 50,000
321 SRI S 70,000 35,000 35,000 70,000
322 ALTIYAH 15,000 10,000 7,500 7,500 25,000
323 24/3/2015 NANIN HAPSARI 30,000 15,000 15,000 30,000
324 FANYSYA 30,000 15,000 15,000 30,000
325 RESNAWATI 30,000 10,000 15,000 15,000 40,000
326 FIQRI 35,000 17,500 17,500 35,000
327 ATIQOH 15,000 7,500 7,500 15,000
328 FINNA AISHA 35,000 17,500 17,500 35,000
329 ADARA 35,000 10,000 17,500 17,500 45,000
330 MONITA 40,000 20,000 20,000 40,000
331 GITA PERMATA 30,000 15,000 15,000 30,000
332 SRI ULINA 15,000 10,000 7,500 7,500 25,000
333 SITI NURJANAH 30,000 15,000 15,000 30,000
334 RAISA 40,000 20,000 20,000 40,000
335 SITI WULANDARI 30,000 10,000 15,000 15,000 40,000
336 IRAWAN 30,000 10,000 15,000 15,000 40,000
337 ATIQOH 30,000 15,000 15,000 30,000
338 MENASYE 30,000 15,000 15,000 30,000
339 NOVEN 40,000 20,000 20,000 40,000
340 25/3/2015 TYAS 70,000 35,000 35,000 70,000
341 NUR ALFIANTI 30,000 10,000 15,000 15,000 40,000
342 H SALIMAH 60,000 10,000 30,000 30,000 70,000
343 SURYATI 15,000 10,000 7,500 7,500 25,000
344 ARIS PURWOKO 30,000 15,000 15,000 30,000
345 M HUSNI 30,000 10,000 15,000 15,000 40,000
346 LENI MARLINA 60,000 10,000 30,000 30,000 70,000
347 POPON 15,000 7,500 7,500 15,000
348 SRI NURHAYATI 70,000 35,000 35,000 70,000
349 DHEA 30,000 10,000 15,000 15,000 40,000
350 M HIBBAN 35,000 10,000 17,500 17,500 45,000
351 DAFIAN 40,000 10,000 20,000 20,000 50,000
352 GINANJAR 70,000 35,000 35,000 70,000
353 NENI 30,000 15,000 15,000 30,000
354 NURUL 40,000 20,000 20,000 40,000
355 SITI NUR 30,000 10,000 15,000 15,000 40,000
356 KARSINAH 35,000 17,500 17,500 35,000
357 SRI ULINA 30,000 10,000 15,000 15,000 40,000
358 IMAS 30,000 10,000 15,000 15,000 40,000
359 26/3/2015 TRI MURTI 15,000 10,000 7,500 7,500 25,000
360 E KOSASIH 15,000 7,500 7,500 15,000
361 NURMEILISA 30,000 15,000 15,000 30,000
362 IMAS T 30,000 10,000 15,000 15,000 40,000
363 PRAPASTO 70,000 35,000 35,000 70,000
364 AGUS S 70,000 35,000 35,000 70,000
365 FINNA A 35,000 17,500 17,500 35,000
366 SOBARIAH 30,000 15,000 15,000 30,000
367 AI 30,000 15,000 15,000 30,000
368 ANNISA 30,000 15,000 15,000 30,000
369 ILHAM 15,000 10,000 7,500 7,500 25,000
370 ANDRI 15,000 7,500 7,500 15,000
371 CHUSUL 15,000 10,000 7,500 7,500 25,000
372 KANIA 70,000 35,000 35,000 70,000
373 TRI W 30,000 15,000 15,000 30,000
374 27/3/2015 ENOK AISYAH 40,000 20,000 20,000 40,000
375 TUNIYAH 70,000 35,000 35,000 70,000
376 DEFA 30,000 15,000 15,000 30,000
377 IBRAHIM 70,000 35,000 35,000 70,000
378 TYAS ASMARA 70,000 35,000 35,000 70,000
379 FARAH 30,000 15,000 15,000 30,000
380 HASANAH 40,000 20,000 20,000 40,000
381 EDDY 30,000 15,000 15,000 30,000
382 JOSUA 70,000 35,000 35,000 70,000
383 MELINDA 30,000 15,000 15,000 30,000
384 FARHA 25,000 12,500 12,500 25,000
385 IRAWAN 15,000 10,000 7,500 7,500 25,000
386 GHINA 15,000 10,000 7,500 7,500 25,000
387 ANGGA 15,000 7,500 7,500 15,000
388 28/3/2015 SRI HERAWATI 30,000 15,000 15,000 30,000
389 RUSLAN 30,000 15,000 15,000 30,000
390 SITI ALFIAH 30,000 15,000 15,000 30,000
391 TARWIYAH 60,000 30,000 30,000 60,000
392 HANIFAH 30,000 15,000 15,000 30,000
393 ANDI 60,000 30,000 30,000 60,000
394 YETTI 15,000 7,500 7,500 15,000
395 VIRGY 15,000 7,500 7,500 15,000
396 RAISYA 30,000 15,000 15,000 30,000
397 WIWIN 30,000 10,000 15,000 15,000 40,000
398 TRI MURTI 30,000 15,000 15,000 30,000
399 IMAS K 30,000 15,000 15,000 30,000
400 NIA 15,000 7,500 7,500 15,000
401 YUYUN T 60,000 10,000 30,000 30,000 70,000
402 SUTOWO 30,000 15,000 15,000 30,000
403 MAYA 70,000 35,000 35,000 70,000
404 30/3/2015 ALISHA 35,000 10,000 17,500 17,500 45,000
405 ANDINI 35,000 10,000 17,500 17,500 45,000
406 SUSI 30,000 10,000 15,000 15,000 40,000
407 ERNAWATI 70,000 10,000 35,000 35,000 80,000
408 YUSSI 30,000 10,000 15,000 15,000 40,000
409 WIDIYAH 30,000 10,000 15,000 15,000 40,000
410 HENDRA 40,000 20,000 20,000 40,000
411 RUSLAN 30,000 15,000 15,000 30,000
412 SUMARNI 70,000 35,000 35,000 70,000
413 ENTIN 15,000 7,500 7,500 15,000
414 SLAMAT 30,000 10,000 15,000 15,000 40,000
415 KAL EL 15,000 10,000 7,500 7,500 25,000
416 RENI 30,000 15,000 15,000 30,000
417 SITI S 30,000 15,000 15,000 30,000
418 RIZKI 15,000 10,000 7,500 7,500 25,000
419 CAHYONO 15,000 10,000 7,500 7,500 25,000
420 SIFA 30,000 15,000 15,000 30,000
421 SIMON 15,000 10,000 7,500 7,500 25,000
422 IRWAN 15,000 7,500 7,500 15,000
423 31/3/2015 AIRA 15,000 7,500 7,500 15,000
424 YANI 15,000 10,000 7,500 7,500 25,000
425 WAWAN 15,000 10,000 7,500 7,500 25,000
426 SUSI 15,000 10,000 7,500 7,500 25,000
427 TINI 40,000 20,000 20,000 40,000
428 ALMIRA 15,000 10,000 7,500 7,500 25,000
429 SRI S 70,000 35,000 35,000 70,000
430 DEA 30,000 10,000 15,000 15,000 40,000
431 RIYANA 15,000 7,500 7,500 15,000
432 IDHATA DEWA 30,000 15,000 15,000 30,000
433 EVI 30,000 15,000 15,000 30,000
434 DHEA 30,000 15,000 15,000 30,000
435 NOVEN 70,000 35,000 35,000 70,000
436 MANASYE 40,000 20,000 20,000 40,000
437 TRI 30,000 10,000 15,000 15,000 40,000
438 SITI WULANDARI 30,000 10,000 15,000 15,000 40,000
439 MONITA 70,000 35,000 35,000 70,000
440 GITA 30,000 15,000 15,000 30,000
441 ATIQOH 40,000 20,000 20,000 40,000
442 DAFIAN 70,000 35,000 35,000 70,000
16,305,000 1,207,500 8,150,000 8,150,000 17,507,500
PERIODE APRIL 2015
JASA ALAT &

DOKTER BAHAN
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
5,000 (2,500) (2,500) -
- 355,000 (177,500) (177,500) -
PERIODE MARET 2015
JASA ALAT &

DOKTER BAHAN
1 2/3/2015 HENDRA 30,000 15,000 15,000 30,000
2 NOVEN 30,000 15,000 15,000 30,000
3 MANASYE 30,000 15,000 15,000 30,000
4 RFEBRYAN 30,000 15,000 15,000 30,000
5 RESNAWATI 30,000 10,000 15,000 15,000 40,000
6 TARWILAH 30,000 15,000 15,000 30,000
7 JILAN 15,000 10,000 7,500 7,500 25,000
8 SITI 30,000 15,000 15,000 30,000
9 DADANG 70,000 35,000 35,000 70,000
10 NILLENIA 15,000 7,500 7,500 15,000
11 ASTRI 70,000 35,000 35,000 70,000
12 NURUL 30,000 15,000 15,000 30,000
13 YUDI 30,000 15,000 15,000 30,000
14 RIYANI 70,000 35,000 35,000 70,000
15 ASEP 30,000 15,000 15,000 30,000
16 3/3/2015 MARYAM 15,000 10,000 7,500 7,500 25,000
17 IMAS H 15,000 10,000 7,500 7,500 25,000
18 MULYATI 15,000 10,000 7,500 7,500 25,000
19 KARINA 30,000 15,000 15,000 30,000
20 PANJI 75,000 10,000 37,500 37,500 85,000
21 RINA 40,000 20,000 20,000 40,000
22 HERAWATI 15,000 10,000 7,500 7,500 25,000
23 SITI SRI 15,000 10,000 7,500 7,500 25,000
24 AISYAH 30,000 15,000 15,000 30,000
25 DWI 15,000 7,500 7,500 15,000
26 ROSMAWANTI 25,000 10,000 12,500 12,500 35,000
27 RIZQI 15,000 10,000 7,500 7,500 25,000
28 SRI S 30,000 15,000 15,000 30,000
29 SITI Z 30,000 15,000 15,000 30,000
30 ARI 15,000 10,000 7,500 7,500 25,000
31 ANGGA 30,000 15,000 15,000 30,000
32 YANTI M 30,000 15,000 15,000 30,000
33 SRI U 60,000 30,000 30,000 60,000
34 ARIS P 30,000 15,000 15,000 30,000
35 RIZKY 30,000 15,000 15,000 30,000
36 SUMIRAH 15,000 10,000 7,500 7,500 25,000
37 ATE R 15,000 10,000 7,500 7,500 25,000
38 SRI M 20,000 10,000 10,000 20,000
39 4/3/2015 RINRIN 60,000 30,000 30,000 60,000
40 SUMARNI 30,000 15,000 15,000 30,000
41 AI N 70,000 35,000 35,000 70,000
42 FITRIYANI 70,000 35,000 35,000 70,000
43 SRI NENGSIH 60,000 30,000 30,000 60,000
44 REFAL 15,000 10,000 7,500 7,500 25,000
45 RANGGA DWI 70,000 35,000 35,000 70,000
46 EGI PRAYOGA 30,000 10,000 15,000 15,000 40,000
47 TUTY 70,000 35,000 35,000 70,000
48 DEWI 70,000 35,000 35,000 70,000
49 DAFIAN 30,000 15,000 15,000 30,000
50 AZRI 15,000 10,000 7,500 7,500 25,000
51 5/3/2015 ANGGA 70,000 35,000 35,000 70,000
52 ZULFAA 70,000 35,000 35,000 70,000
53 TSALITSA 70,000 35,000 35,000 70,000
54 LADIANA 30,000 15,000 15,000 30,000
55 RATNA 15,000 10,000 7,500 7,500 25,000
56 AI 15,000 7,500 7,500 15,000
57 RASTI 15,000 7,500 7,500 15,000
58 AEP 40,000 20,000 20,000 40,000
59 TITIN 30,000 15,000 15,000 30,000
60 EDI S 15,000 10,000 7,500 7,500 25,000
61 ITA 40,000 20,000 20,000 40,000
62 NENG 15,000 10,000 7,500 7,500 25,000
63 RATNASIH 40,000 20,000 20,000 40,000
64 MELITZA 15,000 10,000 7,500 7,500 25,000
65 REVA 25,000 12,500 12,500 25,000
66 6/3/2015 NANIH 15,000 10,000 7,500 7,500 25,000
67 WILYA ROSI 15,000 10,000 7,500 7,500 25,000
68 SITI ZUILEILA 30,000 15,000 15,000 30,000
69 TUNIYAH 70,000 10,000 35,000 35,000 80,000
70 SITI SOLEHAH 30,000 15,000 15,000 30,000
71 SRI SUWARTI 15,000 7,500 7,500 15,000
72 MADY P 30,000 15,000 15,000 30,000
73 ANGGA 40,000 20,000 20,000 40,000
74 RIZKY 15,000 10,000 7,500 7,500 25,000
75 SELI ANA F 15,000 10,000 7,500 7,500 25,000
76 TITIN S 15,000 10,000 7,500 7,500 25,000
77 DERRY 15,000 7,500 7,500 15,000
78 KAMIL 15,000 10,000 7,500 7,500 25,000
79 SUTONO 30,000 15,000 15,000 30,000
80 MAYA 30,000 15,000 15,000 30,000
81 DEPA 15,000 10,000 7,500 7,500 25,000
82 7/3/2015 NOVI ANGGRAENI 60,000 30,000 30,000 60,000
83 AGUS SETIADI 70,000 35,000 35,000 70,000
84 YULI YULIANTI 30,000 15,000 15,000 30,000
85 SALIMAH 70,000 15,000 35,000 35,000 85,000
86 SURATNO 60,000 30,000 30,000 60,000
87 TUNIYAH 30,000 15,000 15,000 30,000
88 KEISYA 25,000 12,500 12,500 25,000
89 MONA 15,000 7,500 7,500 15,000
90 FARAH 70,000 35,000 35,000 70,000
91 EDDY 30,000 15,000 15,000 30,000
92 HASANAH PRATIWI 30,000 15,000 15,000 30,000
93 ENIS 30,000 15,000 15,000 30,000
94 ENOK 15,000 10,000 7,500 7,500 25,000
95 ATIQAH NUR 30,000 15,000 15,000 30,000
96 KHOERUNISA 70,000 35,000 35,000 70,000
97 NUR AINI 70,000 35,000 35,000 70,000
98 YAYA 70,000 35,000 35,000 70,000
99 ANI N 15,000 7,500 7,500 15,000
100 CHIKA A 30,000 15,000 15,000 30,000
101 ZULFAA 70,000 35,000 35,000 70,000
102 8/3/2015 HENDRA S 30,000 15,000 15,000 30,000
103 CICIN R 15,000 7,500 7,500 15,000
104 AI MIMIN 60,000 30,000 30,000 60,000
105 NOVEN 30,000 15,000 15,000 30,000
106 MANASYE 30,000 15,000 15,000 30,000
107 TARWILAH 40,000 20,000 20,000 40,000
108 M ILHAM 30,000 10,000 15,000 15,000 40,000
109 ZULFAA 70,000 35,000 35,000 70,000
110 HARYONO 70,000 35,000 35,000 70,000
111 IKBALUDIN 25,000 12,500 12,500 25,000
112 ROSMAWATI 70,000 35,000 35,000 70,000
113 MELINDA 30,000 15,000 15,000 30,000
114 SUSI N 30,000 10,000 15,000 15,000 40,000
115 SUSI SARAH 25,000 12,500 12,500 25,000
116 DEWI T 30,000 15,000 15,000 30,000
117 YUDI 30,000 15,000 15,000 30,000
118 RIYANI 70,000 10,000 35,000 35,000 80,000
119 SASKIA 70,000 35,000 35,000 70,000
120 ASEP S 30,000 15,000 15,000 30,000
121 10/3/2015 KANIA 30,000 15,000 15,000 30,000
122 ARIS P 30,000 12,500 12,500 25,000
123 RINA 70,000 35,000 35,000 70,000
124 AGUS 15,000 10,000 7,500 7,500 25,000
125 LISNA 30,000 15,000 15,000 30,000
126 CHIKA A 30,000 15,000 15,000 30,000
127 ANGGA 70,000 35,000 35,000 70,000
128 SRI S 30,000 15,000 15,000 30,000
129 ATIQOH 30,000 15,000 15,000 30,000
130 ANNI 60,000 30,000 30,000 60,000
131 EFA S 30,000 15,000 15,000 30,000
132 SYAFUDIN 70,000 12,500 35,000 35,000 82,500
133 SRI U 60,000 30,000 30,000 60,000
134 JAQULILINE 15,000 10,000 7,500 7,500 25,000
135 NENG RINA 60,000 10,000 30,000 30,000 70,000
136 TRI W 30,000 15,000 15,000 30,000
137 DHEA 30,000 15,000 15,000 30,000
138 ASTRI F 70,000 35,000 35,000 70,000
139 NURUL 30,000 15,000 15,000 30,000
140 11/3/2015 SRI M 70,000 35,000 35,000 70,000
141 DIANA 25,000 10,000 12,500 12,500 35,000
142 ENI 15,000 10,000 7,500 7,500 25,000
143 FEBRYAN 30,000 15,000 15,000 30,000
144 TIA 25,000 12,500 12,500 25,000
145 SUMARNI 30,000 15,000 15,000 30,000
146 FARID 15,000 7,500 7,500 15,000
147 CICI S 60,000 30,000 30,000 60,000
148 SITI ROSYATI 70,000 35,000 35,000 70,000
149 SITI ROMLAH 60,000 30,000 30,000 60,000
150 ZULFAA 70,000 35,000 35,000 70,000
151 DEWI 70,000 35,000 35,000 70,000
152 DAFIAN 20,000 10,000 10,000 20,000
153 CELIA 25,000 10,000 12,500 12,500 35,000
154 JOKO 60,000 30,000 30,000 60,000
155 SITI A 30,000 15,000 15,000 30,000
156 EGI 40,000 20,000 20,000 40,000
157 RIA 70,000 35,000 35,000 70,000
158 MONITA 140,000 70,000 70,000 140,000
159 DEDE T 30,000 15,000 15,000 30,000
160 YUDI A 60,000 30,000 30,000 60,000
161 YULIANTI 60,000 30,000 30,000 60,000
162 DEDE 60,000 30,000 30,000 60,000
163 12/3/2015 HERLINA 70,000 35,000 35,000 70,000
164 EUIS JUARIYAH 60,000 30,000 30,000 60,000
165 ENIS 30,000 15,000 15,000 30,000
166 NUNUNG SUMARNI 70,000 35,000 35,000 70,000
167 IRFAN MARUF 70,000 35,000 35,000 70,000
168 SITI SOLEHA 30,000 15,000 15,000 30,000
169 BUMI N 70,000 35,000 35,000 70,000
170 TONI SAHRONI 70,000 35,000 35,000 70,000
171 AI S 15,000 7,500 7,500 15,000
172 RIHAN F 15,000 10,000 7,500 7,500 25,000
173 ENTAR S 15,000 10,000 7,500 7,500 25,000
174 TITIN 30,000 15,000 15,000 30,000
175 ITA 70,000 35,000 35,000 70,000
176 AEP 70,000 35,000 35,000 70,000
177 13/3/2015 EMIYATI 30,000 15,000 15,000 30,000
178 MUGI RAHAYU 15,000 10,000 7,500 7,500 25,000
179 TUNIYAH 30,000 15,000 15,000 30,000
180 ENOK 30,000 15,000 15,000 30,000
181 HASANAH 30,000 15,000 15,000 30,000
182 NURMEILISA 30,000 15,000 15,000 30,000
183 DEWI NOVIYANI 70,000 35,000 35,000 70,000
184 SALWA 70,000 35,000 35,000 70,000
185 SITI WULANDARI 30,000 10,000 15,000 15,000 40,000
186 TUTY SADIAH 70,000 35,000 35,000 70,000
187 ZULFAA 70,000 35,000 35,000 70,000
188 SITI ZULLEILA 40,000 20,000 20,000 40,000
189 JOSUA 30,000 15,000 15,000 30,000
190 ATIQAH 30,000 15,000 15,000 30,000
191 SITI A 70,000 35,000 35,000 70,000
192 ADE W 15,000 10,000 7,500 7,500 25,000
193 MULUS 30,000 15,000 15,000 30,000
194 ZAHARA 15,000 7,500 7,500 15,000
195 NANIN 15,000 10,000 7,500 7,500 25,000
196 IBRAHIM 70,000 35,000 35,000 70,000
197 TYAS 30,000 15,000 15,000 30,000
198 DERRY D 70,000 35,000 35,000 70,000
199 14/3/2015 RAHMAT ABDILLAH 60,000 30,000 30,000 60,000
200 M ZUFAR 70,000 35,000 35,000 70,000
201 TONI SAHRONI 30,000 15,000 15,000 30,000
202 ROSMAWATI 70,000 35,000 35,000 70,000
203 SITI SOLEHAH 30,000 15,000 15,000 30,000
204 M RAJIB 25,000 12,500 12,500 25,000
205 SURTANTI 30,000 15,000 15,000 30,000
206 TARWILAH 70,000 35,000 35,000 70,000
207 AGUS IRWAN 70,000 35,000 35,000 70,000
208 FARAH 30,000 15,000 15,000 30,000
209 HANIFAH 30,000 15,000 15,000 30,000
210 EDDY 30,000 15,000 15,000 30,000
211 NURJAMAN 30,000 15,000 15,000 30,000
212 SITI HALIMAH 70,000 35,000 35,000 70,000
213 DEWI DERAWATI 15,000 7,500 7,500 15,000
214 IBUT S 70,000 35,000 35,000 70,000
215 YAYA 15,000 10,000 7,500 7,500 25,000
216 ALYA 25,000 12,500 12,500 25,000
217 IMAS KOMARIAH 30,000 15,000 15,000 30,000
218 MAYA 30,000 15,000 15,000 30,000
219 16/3/2015 RAISYA 30,000 15,000 15,000 30,000
220 DINDA 25,000 12,500 12,500 25,000
221 M RAMDAN 25,000 12,500 12,500 25,000
222 SUHARTI 15,000 10,000 7,500 7,500 25,000
223 ENTIN 15,000 10,000 7,500 7,500 25,000
224 SUMARNI 30,000 15,000 15,000 30,000
225 AGUS B 70,000 35,000 35,000 70,000
226 M DEPA 30,000 15,000 15,000 30,000
227 SITI NURJANAH 30,000 10,000 15,000 15,000 40,000
228 MAMAN 30,000 15,000 15,000 30,000
229 SASKIA 70,000 35,000 35,000 70,000
230 DADANG R 70,000 35,000 35,000 70,000
231 NURUL HASANAH 30,000 15,000 15,000 30,000
232 DEWI 30,000 10,000 15,000 15,000 40,000
233 SITI S 60,000 10,000 30,000 30,000 70,000
234 ACEP 30,000 10,000 15,000 15,000 40,000
235 H SABTU 60,000 30,000 30,000 60,000
236 17/3/2015 RISNAWATI 30,000 15,000 15,000 30,000
237 ANNISA 30,000 15,000 15,000 30,000
238 SABANAH 15,000 10,000 7,500 7,500 25,000
239 ATIQOH 40,000 20,000 20,000 40,000
240 NANIN 30,000 15,000 15,000 30,000
241 SRI S 40,000 20,000 20,000 40,000
242 LISNA 30,000 15,000 15,000 30,000
243 MONITA 30,000 15,000 15,000 30,000
244 YUDI C 30,000 15,000 15,000 30,000
245 TANYA 15,000 7,500 7,500 15,000
246 YASMIN 35,000 17,500 17,500 35,000
247 FENI 30,000 15,000 15,000 30,000
248 TETI H 15,000 10,000 7,500 7,500 25,000
249 ADARA 35,000 17,500 17,500 35,000
250 TATA 30,000 15,000 15,000 30,000
251 DEWI 30,000 15,000 15,000 30,000
252 DEDE TAUFIK 15,000 10,000 7,500 7,500 25,000
253 DAFIAN 30,000 10,000 15,000 15,000 40,000
254 GITA 30,000 15,000 15,000 30,000
255 NOVEN 30,000 15,000 15,000 30,000
256 MENASYE 30,000 15,000 15,000 30,000
257 18/3/2015 RIFA 15,000 10,000 7,500 7,500 25,000
258 TITIN 15,000 10,000 7,500 7,500 25,000
259 RILIAN 30,000 15,000 15,000 30,000
260 IRAWAN 30,000 15,000 15,000 30,000
261 HENDRA 70,000 35,000 35,000 70,000
262 KARINA 30,000 15,000 15,000 30,000
263 IMAS K 30,000 15,000 15,000 30,000
264 SUTONO 30,000 15,000 15,000 30,000
265 FARHA 15,000 10,000 7,500 7,500 25,000
266 YUYUN 15,000 10,000 7,500 7,500 25,000
267 GINANJAR 35,000 17,500 17,500 35,000
268 TRI 30,000 15,000 15,000 30,000
269 MIZKA 15,000 10,000 7,500 7,500 25,000
270 SRI ULINA 15,000 10,000 7,500 7,500 25,000
271 SALIMAH 70,000 35,000 35,000 70,000
272 19/3/2015 M AMIN 60,000 30,000 30,000 60,000
273 SYAWALIQNA 70,000 35,000 35,000 70,000
274 NUR MEILISA 30,000 15,000 15,000 30,000
275 SHAKILA AULIA 70,000 35,000 35,000 70,000
276 DEVI WAHYU 15,000 10,000 7,500 7,500 25,000
277 SITI NURJANAH 25,000 12,500 12,500 25,000
278 RIZKI ARDIANSYAH 30,000 15,000 15,000 30,000
279 FEBRIAN 30,000 10,000 15,000 15,000 40,000
280 SUPIAN 70,000 35,000 35,000 70,000
281 RIFKY 35,000 17,500 17,500 35,000
282 FINNA AISHA 35,000 17,500 17,500 35,000
283 M MUZHAFFARUDIN 25,000 12,500 12,500 25,000
284 RATNASARI 70,000 35,000 35,000 70,000
285 YADI 30,000 15,000 15,000 30,000
286 TITIN 30,000 15,000 15,000 30,000
287 NENI 30,000 15,000 15,000 30,000
288 MEIKE 25,000 12,500 12,500 25,000
289 AGUS 30,000 15,000 15,000 30,000
290 20/3/2015 TUNIYAH 40,000 20,000 20,000 40,000
291 DELA 30,000 15,000 15,000 30,000
292 HASANAH 30,000 15,000 15,000 30,000
293 FARAH 30,000 15,000 15,000 30,000
294 ENOK AISYAH 30,000 15,000 15,000 30,000
295 EDDY SUSIANTO 40,000 20,000 20,000 40,000
296 PURWADI JUNAEDI 15,000 10,000 7,500 7,500 25,000
297 ASMA NUR 30,000 15,000 15,000 30,000
298 RAWAHAH ABDULAH 30,000 15,000 15,000 30,000
299 MULUS 30,000 10,000 15,000 15,000 40,000
300 SRI U 15,000 10,000 7,500 7,500 25,000
301 SASKIA 70,000 35,000 35,000 70,000
302 SETIONO 15,000 10,000 7,500 7,500 25,000
303 SIFA 30,000 15,000 15,000 30,000
304 RATNA 70,000 10,000 35,000 35,000 80,000
305 MELINDA 30,000 15,000 15,000 30,000
306 KANIA 40,000 20,000 20,000 40,000
307 YAYAN 15,000 10,000 7,500 7,500 25,000
308 23/3/2015 TRI MURTI 30,000 10,000 15,000 15,000 40,000
309 LENI MARLINA 30,000 10,000 15,000 15,000 40,000
310 SUMARNI 40,000 20,000 20,000 40,000
311 SITI ALPIAH 30,000 10,000 15,000 15,000 40,000
312 EUIS JUARIYAH 15,000 10,000 7,500 7,500 25,000
313 AI NURHAYATI 70,000 35,000 35,000 70,000
314 M AMIR 15,000 10,000 7,500 7,500 25,000
315 RENI 15,000 10,000 7,500 7,500 25,000
316 M MUZHAFARUDIN 25,000 12,500 12,500 25,000
317 DENI T 30,000 15,000 15,000 30,000
318 SITI S 30,000 15,000 15,000 30,000
319 M DEPA 30,000 15,000 15,000 30,000
320 FABIAN 50,000 25,000 25,000 50,000
321 SRI S 70,000 35,000 35,000 70,000
322 ALTIYAH 15,000 10,000 7,500 7,500 25,000
323 24/3/2015 NANIN HAPSARI 30,000 15,000 15,000 30,000
324 FANYSYA 30,000 15,000 15,000 30,000
325 RESNAWATI 30,000 10,000 15,000 15,000 40,000
326 FIQRI 35,000 17,500 17,500 35,000
327 ATIQOH 15,000 7,500 7,500 15,000
328 FINNA AISHA 35,000 17,500 17,500 35,000
329 ADARA 35,000 10,000 17,500 17,500 45,000
330 MONITA 40,000 20,000 20,000 40,000
331 GITA PERMATA 30,000 15,000 15,000 30,000
332 SRI ULINA 15,000 10,000 7,500 7,500 25,000
333 SITI NURJANAH 30,000 15,000 15,000 30,000
334 RAISA 40,000 20,000 20,000 40,000
335 SITI WULANDARI 30,000 10,000 15,000 15,000 40,000
336 IRAWAN 30,000 10,000 15,000 15,000 40,000
337 ATIQOH 30,000 15,000 15,000 30,000
338 MENASYE 30,000 15,000 15,000 30,000
339 NOVEN 40,000 20,000 20,000 40,000
340 25/3/2015 TYAS 70,000 35,000 35,000 70,000
341 NUR ALFIANTI 30,000 10,000 15,000 15,000 40,000
342 H SALIMAH 60,000 10,000 30,000 30,000 70,000
343 SURYATI 15,000 10,000 7,500 7,500 25,000
344 ARIS PURWOKO 30,000 15,000 15,000 30,000
345 M HUSNI 30,000 10,000 15,000 15,000 40,000
346 LENI MARLINA 60,000 10,000 30,000 30,000 70,000
347 POPON 15,000 7,500 7,500 15,000
348 SRI NURHAYATI 70,000 35,000 35,000 70,000
349 DHEA 30,000 10,000 15,000 15,000 40,000
350 M HIBBAN 35,000 10,000 17,500 17,500 45,000
351 DAFIAN 40,000 10,000 20,000 20,000 50,000
352 GINANJAR 70,000 35,000 35,000 70,000
353 NENI 30,000 15,000 15,000 30,000
354 NURUL 40,000 20,000 20,000 40,000
355 SITI NUR 30,000 10,000 15,000 15,000 40,000
356 KARSINAH 35,000 17,500 17,500 35,000
357 SRI ULINA 30,000 10,000 15,000 15,000 40,000
358 IMAS 30,000 10,000 15,000 15,000 40,000
359 26/3/2015 TRI MURTI 15,000 10,000 7,500 7,500 25,000
360 E KOSASIH 15,000 7,500 7,500 15,000
361 NURMEILISA 30,000 15,000 15,000 30,000
362 IMAS T 30,000 10,000 15,000 15,000 40,000
363 PRAPASTO 70,000 35,000 35,000 70,000
364 AGUS S 70,000 35,000 35,000 70,000
365 FINNA A 35,000 17,500 17,500 35,000
366 SOBARIAH 30,000 15,000 15,000 30,000
367 AI 30,000 15,000 15,000 30,000
368 ANNISA 30,000 15,000 15,000 30,000
369 ILHAM 15,000 10,000 7,500 7,500 25,000
370 ANDRI 15,000 7,500 7,500 15,000
371 CHUSUL 15,000 10,000 7,500 7,500 25,000
372 KANIA 70,000 35,000 35,000 70,000
373 TRI W 30,000 15,000 15,000 30,000
374 27/3/2015 ENOK AISYAH 40,000 20,000 20,000 40,000
375 TUNIYAH 70,000 35,000 35,000 70,000
376 DEFA 30,000 15,000 15,000 30,000
377 IBRAHIM 70,000 35,000 35,000 70,000
378 TYAS ASMARA 70,000 35,000 35,000 70,000
379 FARAH 30,000 15,000 15,000 30,000
380 HASANAH 40,000 20,000 20,000 40,000
381 EDDY 30,000 15,000 15,000 30,000
382 JOSUA 70,000 35,000 35,000 70,000
383 MELINDA 30,000 15,000 15,000 30,000
384 FARHA 25,000 12,500 12,500 25,000
385 IRAWAN 15,000 10,000 7,500 7,500 25,000
386 GHINA 15,000 10,000 7,500 7,500 25,000
387 ANGGA 15,000 7,500 7,500 15,000
388 28/3/2015 SRI HERAWATI 30,000 15,000 15,000 30,000
389 RUSLAN 30,000 15,000 15,000 30,000
390 SITI ALFIAH 30,000 15,000 15,000 30,000
391 TARWIYAH 60,000 30,000 30,000 60,000
392 HANIFAH 30,000 15,000 15,000 30,000
393 ANDI 60,000 30,000 30,000 60,000
394 YETTI 15,000 7,500 7,500 15,000
395 VIRGY 15,000 7,500 7,500 15,000
396 RAISYA 30,000 15,000 15,000 30,000
397 WIWIN 30,000 10,000 15,000 15,000 40,000
398 TRI MURTI 30,000 15,000 15,000 30,000
399 IMAS K 30,000 15,000 15,000 30,000
400 NIA 15,000 7,500 7,500 15,000
401 YUYUN T 60,000 10,000 30,000 30,000 70,000
402 SUTOWO 30,000 15,000 15,000 30,000
403 MAYA 70,000 35,000 35,000 70,000
404 30/3/2015 ALISHA 35,000 10,000 17,500 17,500 45,000
405 ANDINI 35,000 10,000 17,500 17,500 45,000
406 SUSI 30,000 10,000 15,000 15,000 40,000
407 ERNAWATI 70,000 10,000 35,000 35,000 80,000
408 YUSSI 30,000 10,000 15,000 15,000 40,000
409 WIDIYAH 30,000 10,000 15,000 15,000 40,000
410 HENDRA 40,000 20,000 20,000 40,000
411 RUSLAN 30,000 15,000 15,000 30,000
412 SUMARNI 70,000 35,000 35,000 70,000
413 ENTIN 15,000 7,500 7,500 15,000
414 SLAMAT 30,000 10,000 15,000 15,000 40,000
415 KAL EL 15,000 10,000 7,500 7,500 25,000
416 RENI 30,000 15,000 15,000 30,000
417 SITI S 30,000 15,000 15,000 30,000
418 RIZKI 15,000 10,000 7,500 7,500 25,000
419 CAHYONO 15,000 10,000 7,500 7,500 25,000
420 SIFA 30,000 15,000 15,000 30,000
421 SIMON 15,000 10,000 7,500 7,500 25,000
422 IRWAN 15,000 7,500 7,500 15,000
423 31/3/2015 AIRA 15,000 7,500 7,500 15,000
424 YANI 15,000 10,000 7,500 7,500 25,000
425 WAWAN 15,000 10,000 7,500 7,500 25,000
426 SUSI 15,000 10,000 7,500 7,500 25,000
427 TINI 40,000 20,000 20,000 40,000
428 ALMIRA 15,000 10,000 7,500 7,500 25,000
429 SRI S 70,000 35,000 35,000 70,000
430 DEA 30,000 10,000 15,000 15,000 40,000
431 RIYANA 15,000 7,500 7,500 15,000
432 IDHATA DEWA 30,000 15,000 15,000 30,000
433 EVI 30,000 15,000 15,000 30,000
434 DHEA 30,000 15,000 15,000 30,000
435 NOVEN 70,000 35,000 35,000 70,000
436 MANASYE 40,000 20,000 20,000 40,000
437 TRI 30,000 10,000 15,000 15,000 40,000
438 SITI WULANDARI 30,000 10,000 15,000 15,000 40,000
439 MONITA 70,000 35,000 35,000 70,000
440 GITA 30,000 15,000 15,000 30,000
441 ATIQOH 40,000 20,000 20,000 40,000
442 DAFIAN 70,000 35,000 35,000 70,000
16,305,000 1,207,500 8,150,000 8,150,000 17,507,500
KET
alfa
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yayasan bl
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#REF!
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#REF!
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ALFA
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PERIODE APRIL 2015
JASA ALAT &

DOKTER BAHAN
1 1/4/2015 DJUNAEDI 20,000 5,000 7,500 7,500
2 OMG MEI 50,000 5,000 22,500 22,500
3 SITI 100,000 5,000 47,500 47,500
4 NURHAYATI 100,000 5,000 47,500 47,500
5 2/4/2015 DIAH 80,000 5,000 37,500 37,500
6 SANTI 60,000 5,000 27,500 27,500
7 NOER 100,000 5,000 47,500 47,500
8 6/4/2015 BLESSKA 40,000 5,000 17,500 17,500
9 SARI 200,000 5,000 97,500 97,500
10 IFA 250,000 5,000 122,500 122,500
11 7/4/2015 IKBAL 100,000 5,000 47,500 47,500
12 NITA 20,000 5,000 7,500 7,500
13 8/4/2015 ONGMEI 120,000 5,000 57,500 57,500
14 RENA 60,000 5,000 27,500 27,500
15 9/4/215 NURACHMAYATI 60,000 5,000 27,500 27,500
16 10/4/2015 SHAFFA 100,000 5,000 47,500 47,500
17 AFIKA 20,000 5,000 7,500 7,500
18 11/4/2015 RIKMA 150,000 5,000 72,500 72,500
19 NIRMA 50,000 5,000 22,500 22,500
20 VIRGY 225,000 5,000 110,000 110,000
21 FENTI 20,000 5,000 7,500 7,500
22 RENA 60,000 5,000 27,500 27,500
23 14/4/2015 NITA 50,000 5,000 22,500 22,500
24 ARIYANTO 80,000 5,000 37,500 37,500
25 OJI 20,000 5,000 7,500 7,500
26 15/4/2015 JULIA ISTIQOMAH 50,000 5,000 22,500 22,500
27 TUTI N 80,000 5,000 37,500 37,500
28 16/4/2015 KAILA 25,000 5,000 10,000 10,000
29 17/4/2015 SRI SUWARTI 50,000 5,000 22,500 22,500
30 SHAFFA 100,000 5,000 47,500 47,500
31 SITI MARYANI 150,000 5,000 72,500 72,500
32 18/4/2015 HIKMAT 20,000 5,000 7,500 7,500
33 19/4/2015 RIZAL 100,000 5,000 47,500 47,500
34 20/4/2015 ANDI 100,000 5,000 47,500 47,500
35 20/4/2015 NIRMA 50,000 5,000 22,500 22,500
36 21/4/2015 NITA 70,000 5,000 32,500 32,500
37 SUSI 50,000 5,000 22,500 22,500
38 23/4/2015 SRI WAHYUNI 70,000 5,000 32,500 32,500
39 24/4/2015 TRI LESTARI 200,000 5,000 97,500 97,500
40 SHAFFA 100,000 5,000 47,500 47,500
41 SAFIRA 50,000 5,000 22,500 22,500
42 DAFITA 120,000 5,000 57,500 57,500
43 HIKMAT 60,000 5,000 27,500 27,500
44 AMINTON 60,000 5,000 27,500 27,500
45 SITI 100,000 5,000 47,500 47,500
46 25/4/2015 YASMIN 50,000 5,000 22,500 22,500
47 ALDI 100,000 5,000 47,500 47,500
48 FAHMI 50,000 5,000 22,500 22,500
49 NAZWAR 50,000 5,000 22,500 22,500
50 27/4/2015 RAHMAWATI 100,000 5,000 47,500 47,500
51 NIRMA 60,000 5,000 27,500 27,500
52 NURITA 60,000 5,000 27,500 27,500
28/4/2015 TIGOR 60,000 5,000 27,500 27,500
SITI WULANDARI 200,000 5,000 97,500 97,500
DINI 20,000 5,000 7,500 7,500
NITA 20,000 5,000 7,500 7,500
29/04/15 ASEP WAHYUDIN 60,000 5,000 27,500 27,500
NURMAN 60,000 5,000 27,500 27,500
RENA 60,000 5,000 27,500 27,500
30/04/15 MEGA 200,000 5,000 97,500 97,500
SRI MARYANI 160,000 5,000 77,500 77,500
HIKMAT 60,000 5,000 27,500 27,500
LINA 150,000 5,000 72,500 72,500
KEYSA 150,000 5,000 72,500 72,500
OKTAVIANA 25,000 5,000 10,000 10,000
RODHOTUL 25,000 5,000 10,000 10,000
NUR RACHMAYATI 60,000 5,000 27,500 27,500
5,520,000 335,000 2,592,500 2,592,500

PERIODE APRIL 2015
JASA ALAT &

DOKTER BAHAN
1 1/4/2015 SUSI 15,000 10,000 7,500 7,500
2 ARIS P 30,000 15,000 15,000
3 ENOK 35,000 17,500 17,500
4 ITO 60,000 10,000 30,000 30,000
5 KARINA 30,000 15,000 15,000
6 SUPIAN 70,000 35,000 35,000
7 DEVI 15,000 7,500 7,500
8 EDDY 30,000 15,000 15,000
9 RESNAWATI 30,000 15,000 15,000
10 NURHAYATI 70,000 35,000 35,000
11 SRI ULINA 60,000 30,000 30,000
12 NURUL HASANAH 70,000 35,000 35,000
13 KHANSA 30,000 15,000 15,000
14 NENENG O 60,000 10,000 30,000 30,000
15 GALANG 15,000 10,000 7,500 7,500
16 FAUZAN 30,000 15,000 15,000
17 SITI NURFADILLAH 30,000 15,000 15,000
18 KARSINAH 70,000 35,000 35,000
19 FANYSYA 30,000 15,000 15,000
20 2/4/2015 NURMEILISA 30,000 15,000 15,000
21 DIAH 70,000 35,000 35,000
22 WAHYUDI 35,000 17,500 17,500
23 DINA 35,000 17,500 17,500
24 NANIN 30,000 15,000 15,000
25 EDDY 70,000 35,000 35,000
26 HASANAH 70,000 35,000 35,000
27 HANIFAH 30,000 15,000 15,000
28 WIWIN 15,000 10,000 7,500 7,500
29 M FAHRI 15,000 10,000 7,500 7,500
30 AHMAD 15,000 10,000 7,500 7,500
31 ADE 15,000 10,000 7,500 7,500
32 ANNISA 30,000 15,000 15,000
33 M LUTFI 25,000 12,500 12,500
34 NUR 30,000 15,000 15,000
35 MEGA 15,000 10,000 7,500 7,500
36 FENI AYU 30,000 15,000 15,000
37 RENI 30,000 15,000 15,000
38 4/4/2015 ANDI B 60,000 10,000 30,000 30,000
39 WIWIN 30,000 15,000 15,000
40 SRI S 15,000 10,000 7,500 7,500
41 VIRGY 15,000 7,500 7,500
42 SITI HALIMAH 70,000 35,000 35,000
43 SITI KHODIJAH 70,000 35,000 35,000
44 AUNA 30,000 15,000 15,000
45 SAFA 35,000 10,000 17,500 17,500
46 RUSLAN 30,000 15,000 15,000
47 TRI WAHYUNI 30,000 15,000 15,000
48 6/4/2015 TRI MURTI 40,000 20,000 20,000
49 ABBOT ADI 70,000 35,000 35,000
50 MOHAMAD EKO 30,000 10,000 15,000 15,000
51 SUKRIAH 30,000 15,000 15,000
52 NIA 15,000 7,500 7,500
53 SUTOWO 30,000 15,000 15,000
54 IRMA 30,000 10,000 15,000 15,000
55 EDDY S 30,000 15,000 15,000
56 MELINDA 15,000 10,000 7,500 7,500
57 RAISA 15,000 10,000 7,500 7,500
58 KAMIL 15,000 10,000 7,500 7,500
59 JAMALUDIN 15,000 10,000 7,500 7,500
60 GHINA 30,000 10,000 15,000 15,000
61 IRA 70,000 35,000 35,000
62 SUSI 30,000 15,000 15,000
63 ASEP 15,000 7,500 7,500
64 7/4/2015 RIZQI 30,000 15,000 15,000
65 RAHMAT ABDULLAH 30,000 15,000 15,000
66 MANASYE 70,000 35,000 35,000
67 DHEA 40,000 20,000 20,000
68 AI NURHAYATI 15,000 10,000 7,500 7,500
69 KARSINAH 70,000 35,000 35,000
70 SITI N 30,000 15,000 15,000
71 EVI 70,000 35,000 35,000
72 WIWIN W 15,000 7,500 7,500
73 DAFIAN 30,000 15,000 15,000
74 GITA 40,000 10,000 20,000 20,000
75 8/4/2015 SITI WULANDARI 30,000 10,000 15,000 15,000
76 RUSTANDI 70,000 10,000 35,000 35,000
77 SRI MULYATI 35,000 10,000 17,500 17,500
78 DAFIN 25,000 10,000 12,500 12,500
79 SITI H 70,000 35,000 35,000
80 JUARSIH 15,000 10,000 7,500 7,500
81 RAKHA 35,000 17,500 17,500
82 MYSELLA 25,000 12,500 12,500
83 SUSILAWATY 30,000 10,000 15,000 15,000
84 HENDRA 70,000 35,000 35,000
85 NENI 30,000 15,000 15,000
86 NURUL HASANAH 70,000 35,000 35,000
87 MIEKE INDI 15,000 10,000 7,500 7,500
88 DHINI 30,000 15,000 15,000
89 IDHATA DEWA 70,000 35,000 35,000
90 SRI NURHAYATIK 70,000 35,000 35,000
91 SRI ULINA 60,000 10,000 30,000 30,000
92 ATIQOH 70,000 35,000 35,000
93 AULIA 15,000 7,500 7,500
94 SASKIA 30,000 15,000 15,000
95 9/4/2015 LANNY 30,000 15,000 15,000
96 ZHULAEHA 15,000 7,500 7,500
97 LILIS 30,000 15,000 15,000
98 ADE JUANDA 30,000 15,000 15,000
99 IMAS TIWI 30,000 15,000 15,000
100 NURMEILISA 30,000 15,000 15,000
101 ROSA 30,000 15,000 15,000
102 FAIZ 30,000 15,000 15,000
103 ENTIN 30,000 15,000 15,000
104 RAISYA 30,000 15,000 15,000
105 NENI 70,000 35,000 35,000
106 HAFIZ 15,000 10,000 7,500 7,500
107 GALANG 15,000 10,000 7,500 7,500
108 MAYA 30,000 15,000 15,000
109 FATIMAH 15,000 10,000 7,500 7,500
110 ILMAN 25,000 12,500 12,500
111 RAISA 15,000 10,000 7,500 7,500
112 YENI 15,000 10,000 7,500 7,500
113 KHOIRUNNISA 70,000 35,000 35,000
114 ANISA 30,000 15,000 15,000
115 10/4/2015 FANYSYA 30,000 15,000 15,000
116 HENI 30,000 15,000 15,000
117 EKO 30,000 15,000 15,000
118 SITI NURJANAH 40,000 20,000 20,000
119 NANIN 30,000 15,000 15,000
120 SITI HALIMATUSADIA 70,000 35,000 35,000
121 CHURUN 15,000 10,000 7,500 7,500
122 KARINA 30,000 12,500 12,500
123 SETIYONO 15,000 10,000 7,500 7,500
124 SIFA 30,000 15,000 15,000
125 MEITA 15,000 10,000 7,500 7,500
126 MELINDA 30,000 15,000 15,000
127 KAMIL 15,000 10,000 7,500 7,500
128 ASEP A 30,000 15,000 15,000
129 11/4/2015 MUUS P 30,000 15,000 15,000
130 SRI HERAWATI 30,000 15,000 15,000
131 FARAH 40,000 20,000 20,000
132 HANIFAH 40,000 20,000 20,000
133 AGUS IRWAN 70,000 35,000 35,000
134 NURHAYATI 70,000 35,000 35,000
135 LISNAWATI 30,000 15,000 15,000
136 SITI WULANDARI 30,000 10,000 15,000 15,000
137 HASANAH PRATIWI 30,000 15,000 15,000
138 NAZLA 70,000 35,000 35,000
139 SITI HOTJAH 70,000 35,000 35,000
140 ANNISA 35,000 17,500 17,500
141 EKA 30,000 10,000 15,000 15,000
142 IMAS K 40,000 20,000 20,000
143 IBUT 70,000 35,000 35,000
144 WIDIYAH 30,000 15,000 15,000
145 TRI WAHYUNI 30,000 15,000 15,000
146 13/4/2015 RESNAWATI 30,000 15,000 15,000
147 IVA 30,000 10,000 15,000 15,000
148 RUSTANDI 70,000 35,000 35,000
149 TEMMY 25,000 12,500 12,500
150 YOKKE 60,000 10,000 30,000 30,000
151 MURTI I 70,000 35,000 35,000
152 SITI HOTJAH 70,000 35,000 35,000
153 EDDY S 40,000 10,000 20,000 20,000
154 ELLY 15,000 7,500 7,500
155 WAHYUNI 15,000 10,000 7,500 7,500
156 MARIAH 15,000 10,000 7,500 7,500
157 AJENG 15,000 7,500 7,500
158 PUTRI 15,000 10,000 7,500 7,500
159 KARTIKA 30,000 15,000 15,000
160 SASKIA 30,000 30,000 15,000
161 SRI S 70,000 35,000 35,000
162 BAGUS 15,000 10,000 7,500 7,500
163 TITIN S 70,000 35,000 35,000
164 DJENAB 15,000 7,500 7,500
165 RAISA 70,000 35,000 35,000
166 BUNGA 70,000 10,000 35,000 35,000
167 14/4/2015 DAFIAN 70,000 35,000 35,000
168 EVI 30,000 15,000 15,000
169 AI 60,000 10,000 30,000 30,000
170 DADANG 70,000 35,000 35,000
171 DEWI 15,000 10,000 7,500 7,500
172 SITI N 70,000 35,000 35,000
173 GITA PERMATA 70,000 10,000 35,000 35,000
174 EKA SUSANTI 40,000 20,000 20,000
175 HAISYA 70,000 35,000 35,000
176 TITA F 70,000 35,000 35,000
177 ARIS 40,000 20,000 20,000
178 SUTOWO 40,000 20,000 20,000
179 IKHSAN 35,000 17,500 17,500
180 IBUT 70,000 35,000 35,000
181 WIWI 70,000 35,000 35,000
182 HUDA 35,000 17,500 17,500
183 RIFKY 25,000 12,500 12,500
184 NURUL A 35,000 17,500 17,500
185 M HUSNI 30,000 15,000 15,000
186 IRMA R 30,000 15,000 15,000
187 15/4/2015 RAHMAT ABDULLAH 70,000 35,000 35,000
188 M RIDWAN 30,000 15,000 15,000
189 RAISYA 30,000 15,000 15,000
190 ENTIN 30,000 15,000 15,000
191 DHEA 70,000 35,000 35,000
192 AI 15,000 10,000 7,500 7,500
193 SRI ULINA 60,000 10,000 30,000 30,000
194 DHINI 70,000 35,000 35,000
195 NENI H 40,000 20,000 20,000
196 SITI 30,000 15,000 15,000
197 ARIEF 30,000 15,000 15,000
198 16/4/2015 WIDIYAH 30,000 15,000 15,000
199 SAEPUDIN N 15,000 10,000 7,500 7,500
200 DWI 35,000 17,500 17,500
201 NURMEILISA 40,000 20,000 20,000
202 DESI 30,000 15,000 15,000
203 ENGKUS 60,000 30,000 30,000
204 IMAS 40,000 20,000 20,000
205 NAZLA 15,000 7,500 7,500
206 ROSA 30,000 15,000 15,000
207 ANDRI 70,000 35,000 35,000
208 MULUS 30,000 15,000 15,000
209 KHOIRUNNISA 70,000 35,000 35,000
210 GALANG 15,000 10,000 7,500 7,500
211 ANIS 25,000 12,500 12,500
212 ANISSA 30,000 15,000 15,000
213 TUTI 15,000 10,000 7,500 7,500
214 JAMALUDIN 15,000 10,000 7,500 7,500
215 17/4/2015 FITRI APRILIANA 30,000 10,000 15,000 15,000
216 NANIN 30,000 15,000 15,000
217 HENDRI M 70,000 35,000 35,000
218 NAZLA 70,000 35,000 35,000
219 SRI SUWARTI 70,000 35,000 35,000
220 FANYSYA 30,000 15,000 15,000
221 SAEPUDIN 60,000 30,000 30,000
222 IVA 30,000 15,000 15,000
223 NENI T 30,000 15,000 15,000
224 FAIZ 30,000 15,000 15,000
225 ILHAM 70,000 35,000 35,000
226 HAYANAKA 50,000 25,000 25,000
227 SETYONO 70,000 35,000 35,000
228 TIFA P 30,000 15,000 15,000
229 ANDINI 70,000 35,000 35,000
230 LILIS 30,000 15,000 15,000
231 TRI Y 70,000 35,000 35,000
232 LINA 70,000 35,000 35,000
233 RISA 70,000 35,000 35,000
234 18/4/2015 SUSILAWATI 30,000 15,000 15,000
235 NURJAMAN 30,000 15,000 15,000
236 WIWI W 30,000 15,000 15,000
237 PUTRI 30,000 10,000 15,000 15,000
238 KARTIKA 30,000 15,000 15,000
239 ARIEF 30,000 15,000 15,000
240 ANNE K 70,000 35,000 35,000
241 EDDY S 70,000 35,000 35,000
242 SITI WULANDARI 30,000 15,000 15,000
243 AMIR 25,000 12,500 12,500
244 SUTOWO 70,000 35,000 35,000
245 ESTI 30,000 15,000 15,000
246 TRI MURTI 70,000 35,000 35,000
247 SITI SADIAH 70,000 35,000 35,000
248 GHIYAS 35,000 17,500 17,500
249 MAYA 40,000 20,000 20,000
250 GHINA 30,000 15,000 15,000
251 KANIA 40,000 20,000 20,000
252 MAUDY 15,000 10,000 7,500 7,500
253 DADANG 15,000 10,000 7,500 7,500
254 TUTY 15,000 10,000 7,500 7,500
255 21/4/2015 JULPRIANTO 60,000 30,000 30,000
256 RUT.A 70,000 35,000 35,000
257 HERMAN 15,000 10,000 7,500 7,500
258 HILDAN 70,000 35,000 35,000
259 PATIMAH 70,000 35,000 35,000
260 WAHYUNI 30,000 15,000 15,000
261 MARYATI 15,000 10,000 7,500 7,500
262 KANIA 30,000 15,000 15,000
263 TRI 40,000 20,000 20,000
264 EVA 70,000 35,000 35,000
265 SITI 40,000 20,000 20,000
266 RIZKI 30,000 15,000 15,000
267 SARIYAH 15,000 10,000 7,500 7,500
268 TUTI 30,000 10,000 15,000 15,000
269 RAHMAT A 70,000 35,000 35,000
270 HAISYA 15,000 10,000 7,500 7,500
271 TITA 70,000 35,000 35,000
272 22/4/2015 HENDRA 35,000 17,500 17,500
273 IRMA R 30,000 15,000 15,000
274 MARYAM 30,000 10,000 15,000 15,000
275 BUNGA 30,000 15,000 15,000
276 WIDIYAH 40,000 20,000 20,000
277 SUSI 30,000 15,000 15,000
278 SUSILAWATI 30,000 15,000 15,000
279 PUNGUT 60,000 10,000 30,000 30,000
280 YOKE 60,000 10,000 30,000 30,000
281 RUSLAN 30,000 15,000 15,000
282 SRI ULINA 70,000 35,000 35,000
283 ARIEF AL R 30,000 15,000 15,000
284 AI 15,000 7,500 7,500
285 DEWI 70,000 35,000 35,000
286 EVI 15,000 10,000 7,500 7,500
287 WIWIK 70,000 35,000 35,000
288 NENI HARYANI 70,000 35,000 35,000
289 DHINI 35,000 17,500 17,500
290 IKHSAN 35,000 17,500 17,500
291 KARTIKA 30,000 15,000 15,000
292 SITI N 70,000 35,000 35,000
293 RAHMAT S 35,000 17,500 17,500
294 YASMIN 30,000 15,000 15,000
295 23/4/2015 ROSA 30,000 15,000 15,000
296 SILMI 30,000 15,000 15,000
297 TARWIYAH 30,000 15,000 15,000
298 NURMEILISA 70,000 35,000 35,000
299 DWI A 35,000 17,500 17,500
300 YENI 15,000 10,000 7,500 7,500
301 ANNISA 40,000 20,000 20,000
302 AYU 15,000 10,000 7,500 7,500
303 TRI 30,000 10,000 15,000 15,000
304 DADAN 15,000 10,000 7,500 7,500
305 SRI NURHAYATIK 70,000 35,000 35,000
306 SRI S 70,000 35,000 35,000
307 KHAIRUNNISA 70,000 35,000 35,000
308 KHOIRUNNISA 70,000 35,000 35,000
309 24/4/2015 NANIN 30,000 15,000 15,000
310 AGUNG RIADI 30,000 15,000 15,000
311 DEFA 60,000 30,000 30,000
312 DEWI 70,000 35,000 35,000
313 ENOK 70,000 35,000 35,000
314 RUT A 35,000 17,500 17,500
315 DJENAB 30,000 15,000 15,000
316 MULUS 70,000 35,000 35,000
317 TEGUH 15,000 10,000 7,500 7,500
318 WAHYU 15,000 7,500 7,500
319 UJANG 15,000 7,500 7,500
320 ENTIN 15,000 7,500 7,500
321 MIRA 120,000 60,000 60,000
322 MARIANA 30,000 15,000 15,000
323 FARIZ 70,000 35,000 35,000
324 IRMA 70,000 35,000 35,000
325 DEWI 30,000 15,000 15,000
326 SITI SARAH 70,000 35,000 35,000
327 25/4/2015 NAZLA 70,000 35,000 35,000
328 IMAS 70,000 35,000 35,000
329 ELLY 60,000 30,000 30,000
330 ZUFAR 35,000 17,500 17,500
331 NURHAYATI 30,000 15,000 15,000
332 AGUS IRWAN 70,000 35,000 35,000
333 NURUL 30,000 15,000 15,000
334 LAILATUL 30,000 15,000 15,000
335 HERMAN 30,000 15,000 15,000
336 MELINDA 30,000 15,000 15,000
337 KARTIKA 70,000 35,000 35,000
338 PUTRI 35,000 17,500 17,500
339 RUSLAN 30,000 15,000 15,000
340 SASKIA 30,000 10,000 15,000 15,000
341 RAKAI 15,000 10,000 7,500 7,500
342 RUMYATI 15,000 10,000 7,500 7,500
343 IMAS 70,000 10,000 35,000 35,000
344 TRIMUKTI 70,000 35,000 35,000
345 EKA G 30,000 15,000 15,000
346 27/4/2015 SULASTRI 60,000 10,000 30,000 30,000
347 ARIS 70,000 35,000 35,000
348 M FAJAR 30,000 15,000 15,000
349 NANI S 15,000 10,000 7,500 7,500
350 EDDY S 30,000 15,000 15,000
351 ESTI 30,000 10,000 15,000 15,000
352 YANI 30,000 10,000 15,000 15,000
353 E KOSASIH 60,000 10,000 30,000 30,000
354 HERLINA 70,000 35,000 35,000
355 MARYANI 30,000 10,000 15,000 15,000
356 WITA 15,000 10,000 7,500 7,500
357 MALVIN 15,000 10,000 7,500 7,500
358 AGUS 15,000 10,000 7,500 7,500
359 WAHYUNI 15,000 10,000 7,500 7,500
360 28/4/2015 SITI WULANDARI 40,000 20,000 20,000
361 BUNGA K 70,000 35,000 35,000
362 HENI DARYANTI 60,000 30,000 30,000
363 ATI SUMIATI 30,000 15,000 15,000
364 BUNGA OLIVIA 30,000 15,000 15,000
365 KOMARIAH 60,000 30,000 30,000
366 WAWAN S 30,000 15,000 15,000
367 DINA 25,000 12,500 12,500
368 MIRA 15,000 10,000 7,500 7,500
369 OCA S 60,000 30,000 30,000
370 WIWIN 60,000 30,000 30,000
371 TUTI 30,000 15,000 15,000
372 RIZQI 40,000 20,000 20,000
373 TRI 70,000 35,000 35,000
374 DADANG 70,000 35,000 35,000
375 EVI 30,000 15,000 15,000
376 SITI H 70,000 35,000 35,000
377 DHEA 30,000 15,000 15,000
378 ILMAN 15,000 7,500 7,500
379 JON K 60,000 10,000 30,000 30,000
380 GITA PERMATA 15,000 7,500 7,500
381 29/04/15 WIDIYAH 70,000 35,000 35,000
382 ABDUL 15,000 10,000 7,500 7,500
383 TETI 60,000 10,000 30,000 30,000
384 TETEN 60,000 10,000 30,000 30,000
385 M RAMDAN 35,000 10,000 17,500 17,500
386 SUSILAWATY 40,000 20,000 20,000
387 IRMA R 40,000 20,000 20,000
388 MARYAM 30,000 15,000 15,000
389 M HUSNI 30,000 15,000 15,000
390 HERLINA 35,000 17,500 17,500
391 HENDRA 70,000 35,000 35,000
392 SITI NUR F 70,000 35,000 35,000
393 SRI ULIANA 70,000 35,000 35,000
394 NURUL 35,000 17,500 17,500
395 MIEKE 15,000 10,000 7,500 7,500
396 DHINI 70,000 35,000 35,000
397 NENI 35,000 17,500 17,500
398 PUTRI 30,000 15,000 15,000
399 KARTIKA 30,000 15,000 15,000
400 RACHMAT 70,000 35,000 35,000
401 ARIEF 40,000 20,000 20,000
402 30/04/15 MEGA 30,000 15,000 15,000
403 ATI SUMIATI 70,000 35,000 35,000
404 WARNY 70,000 35,000 35,000
405 NIKEN 30,000 15,000 15,000
406 TARWILAH 30,000 15,000 15,000
407 BUDI SETIONO 30,000 15,000 15,000
408 ROSA 30,000 15,000 15,000
409 ANDANAWARI 15,000 7,500 7,500
410 SIFA 30,000 15,000 15,000
411 FINI 35,000 17,500 17,500
412 MELIYANI 15,000 10,000 7,500 7,500
413 AGUNG RIADI 30,000 15,000 15,000
414 YENI 15,000 10,000 7,500 7,500
415 FARUDI 15,000 10,000 7,500 7,500
416 MAYA 70,000 35,000 35,000
16,725,000 1,000,000 8,375,000 8,360,000
JML KET
20,000
50,000
100,000
100,000
80,000
60,000 ALFA
100,000
40,000
200,000
250,000
100,000
20,000
120,000
60,000 ALFA
60,000 ALFA
100,000
20,000
150,000
50,000
225,000
20,000 ALFA
60,000
50,000
80,000
20,000
50,000
80,000
25,000
50,000
100,000
150,000
20,000 ALFA
100,000
100,000 ALFA
50,000
70,000
50,000
70,000
200,000
100,000
50,000
120,000 ALFA
60,000 ALFA
60,000 ALFA
100,000
50,000
100,000
50,000
50,000
100,000
60,000
60,000 ALFA
60,000 ALFA
200,000
20,000
20,000
60,000
60,000
60,000 ALFA
200,000
160,000
60,000 ALFA
150,000 ALFA
150,000 ALFA
25,000
25,000
60,000 ALFA
5,520,000
JML KET
25,000
30,000
35,000
70,000
30,000
70,000
15,000
30,000
30,000
70,000
60,000
70,000
30,000
70,000
25,000
30,000
30,000
70,000
30,000
30,000
70,000
35,000
35,000
30,000
70,000
70,000
30,000
25,000
25,000
25,000
25,000
30,000
25,000
30,000
25,000
30,000
30,000
70,000
30,000
25,000
15,000
70,000
70,000
30,000
45,000
30,000
30,000
40,000
70,000
40,000
30,000
15,000
30,000
40,000
30,000
25,000
25,000
25,000
25,000
40,000
70,000
30,000
15,000
30,000
30,000
70,000
40,000
25,000
70,000
30,000
70,000
15,000
30,000
50,000
40,000
80,000
45,000
35,000
70,000
25,000
35,000
25,000
40,000
70,000
30,000
70,000
25,000
30,000
70,000
70,000
70,000
70,000
15,000
30,000
30,000
15,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
70,000
25,000
25,000
30,000
25,000
25,000
25,000
25,000
70,000
30,000
30,000
30,000
30,000
40,000
30,000
70,000
25,000
25,000
25,000
30,000
25,000
30,000
25,000
30,000
30,000
30,000
40,000
40,000
70,000
70,000
30,000
40,000
30,000
70,000
70,000
35,000
40,000
40,000
70,000
30,000
30,000
30,000
40,000
70,000
25,000
70,000
70,000
70,000
50,000
15,000
25,000
25,000
15,000
25,000
30,000
45,000
70,000
25,000
70,000
15,000
70,000
80,000
70,000
30,000
70,000
70,000
25,000
70,000
80,000
40,000
70,000
70,000
40,000
40,000
35,000
70,000
70,000
35,000
25,000
35,000
30,000
30,000
70,000
30,000
30,000
30,000
70,000
25,000
70,000
70,000
40,000
30,000
30,000
30,000
25,000
35,000
40,000
30,000
60,000
40,000
15,000
30,000
70,000
30,000
70,000
25,000
25,000
30,000
25,000
25,000
40,000
30,000
70,000
70,000
70,000
30,000
60,000
30,000
30,000
30,000
70,000
50,000
70,000
30,000
70,000
30,000
70,000
70,000
70,000
30,000
30,000
30,000
40,000
30,000
30,000
70,000
70,000
30,000
25,000
70,000
30,000
70,000
70,000
35,000
40,000
30,000
40,000
25,000
25,000
25,000
60,000
70,000
25,000
70,000
70,000
30,000
25,000
30,000
40,000
70,000
40,000
30,000
25,000
40,000
70,000
25,000
70,000
35,000
30,000
40,000
30,000
40,000
30,000
30,000
70,000
70,000
30,000
70,000
30,000
15,000
70,000
25,000
70,000
70,000
35,000
35,000
30,000
70,000
35,000
30,000
30,000
30,000
30,000
70,000
35,000
25,000
40,000
25,000
40,000
25,000
70,000
70,000
70,000
70,000
30,000
30,000
60,000
70,000
70,000
35,000
30,000
70,000
25,000
15,000
15,000
15,000
120,000
30,000
70,000
70,000
30,000
70,000
70,000
70,000
60,000
35,000
30,000
70,000
30,000
30,000
30,000
30,000
70,000
35,000
30,000
40,000
25,000
25,000
80,000
70,000
30,000
70,000
70,000
30,000
25,000
30,000
40,000
40,000
70,000
70,000
40,000
25,000
25,000
25,000
25,000
40,000
70,000
60,000
30,000
30,000
60,000
30,000
25,000
25,000
60,000
60,000
30,000
40,000
70,000
70,000
30,000
70,000
30,000
15,000
70,000
15,000
70,000
25,000
70,000
70,000
45,000
40,000
40,000
30,000
30,000
35,000
70,000
70,000
70,000
35,000
25,000
70,000
35,000
30,000
30,000
70,000
40,000
30,000
70,000
70,000
30,000
30,000
30,000
30,000
15,000
30,000
35,000
25,000
30,000
25,000
25,000
70,000
16,725,000 -
PERIODE MEI 2015
JASA ALAT &

DOKTER BAHAN
1 2/5/2015 WIDYA 100,000 5,000 47,500 47,500
2 SHAFFA 200,000 5,000 97,500 97,500
3 TRI LESTARI 200,000 5,000 97,500 97,500
4 OVVY 50,000 5,000 22,500 22,500
5 4/5/2015 TIGOR 60,000 5,000 27,500 27,500
6 FITRI 60,000 5,000 27,500 27,500
7 NIRMA 60,000 5,000 27,500 27,500
8 ANDY 60,000 5,000 27,500 27,500
9 5/5/2015 KANTI 160,000 5,000 77,500 77,500
10 RINI 70,000 5,000 32,500 32,500
11 7/2/2015 EUIS 75,000 5,000 35,000 35,000
12 8/5/2015 SRI LASWANTI 200,000 5,000 97,500 97,500
13 CUCU KURNIATI 200,000 5,000 97,500 97,500
14 9/5/2015 INDRA KUSUMAH 100,000 5,000 47,500 47,500
15 SRI LASWANTI 200,000 5,000 97,500 97,500
16 ARYANTO 70,000 5,000 32,500 32,500
17 11/5/2015 NIRMA 100,000 5,000 47,500 47,500
18 SANTI 60,000 5,000 27,500 27,500
19 12/5/2015 DINI 20,000 5,000 7,500 7,500
20 RURI 20,000 5,000 7,500 7,500
21 NITA 50,000 5,000 22,500 22,500
22 FITRI 150,000 5,000 72,500 72,500
23 RESTY 20,000 5,000 7,500 7,500
24 13/5/2015 INDRA KUSUMAH 40,000 5,000 17,500 17,500
25 15/5/2015 RIZAL 50,000 5,000 22,500 22,500
26 YAYAH 100,000 5,000 47,500 47,500
27 MUHAJID 300,000 5,000 147,500 147,500
28 18/5/2015 ANINDIYA 100,000 5,000 47,500 47,500
29 MEILING 40,000 5,000 17,500 17,500
30 19/5/2015 NIRMA 100,000 5,000 47,500 47,500
31 ENNUR 200,000 5,000 97,500 97,500
32 ANNE 150,000 5,000 72,500 72,500
33 NITA O 100,000 5,000 47,500 47,500
34 20/5/2015 FEIDHAR 300,000 5,000 147,500 147,500
35 RURI 200,000 5,000 97,500 97,500
36 NIA 150,000 5,000 72,500 72,500
37 21/5/2015 SITI HARISAH 150,000 5,000 72,500 72,500
38 SANTI 70,000 5,000 32,500 32,500
39 NUR 60,000 5,000 27,500 27,500
40 22/5/2015 SINTAWATI 100,000 5,000 47,500 47,500
41 23/5/2015 ANDREAS 200,000 5,000 97,500 97,500
42 RURI 200,000 5,000 97,500 97,500
43 27/5/2015 MEILING BAHAN DAR DR P 5,000 #VALUE! #VALUE!
44 OVVY 100,000 5,000 47,500 47,500
45 ROSINTA 100,000 5,000 47,500 47,500
46 FARIS 60,000 5,000 27,500 27,500
47 28/5/2015 RATU 25,000 5,000 10,000 10,000
48 30/5/2015 DEWI 100,000 5,000 47,500 47,500
49 ENENG 70,000 5,000 32,500 32,500
100,000 5,000 47,500 47,500
60,000 5,000 27,500 27,500
60,000 5,000 27,500 27,500
60,000 5,000 27,500 27,500
200,000 5,000 97,500 97,500
20,000 5,000 7,500 7,500
20,000 5,000 7,500 7,500
60,000 5,000 27,500 27,500
60,000 5,000 27,500 27,500
60,000 5,000 27,500 27,500
200,000 5,000 97,500 97,500
160,000 5,000 77,500 77,500
60,000 5,000 27,500 27,500
150,000 5,000 72,500 72,500
150,000 5,000 72,500 72,500
25,000 5,000 10,000 10,000
25,000 5,000 10,000 10,000
60,000 5,000 27,500 27,500
6,880,000 335,000 #VALUE! #VALUE!

PERIODE MEI 2015
JASA ALAT &

TGL NAMA TARIF OBAT
DOKTER BAHAN
1 2/5/2015 ANI SUMIATI 70,000 35,000 35,000
2 YUYUN 30,000 15,000 15,000
3 HERMAN 30,000 15,000 15,000
4 RUT A 35,000 17,500 17,500
5 AGUS IRWAN 70,000 35,000 35,000
6 NURHAYATI 30,000 15,000 15,000
7 IMAS TIWI 60,000 30,000 30,000
8 NURUL 30,000 15,000 15,000
9 LAILATUL 30,000 15,000 15,000
10 YETI 15,000 10,000 7,500 7,500
11 SARBINI 30,000 10,000 15,000 15,000
12 KARTIKA 30,000 15,000 15,000
13 PUTRI 15,000 7,500 7,500
14 IRA F 15,000 10,000 7,500 7,500
15 WIWIN 30,000 15,000 15,000
16 MELIYANI 30,000 15,000 15,000
17 GUSTIAN 35,000 17,500 17,500
18 4/5/2015 AGUS 60,000 10,000 30,000 30,000
19 LULU 25,000 12,500 12,500
20 TINTIN 60,000 10,000 30,000 30,000
21 SITI HODIJAH 70,000 35,000 35,000
22 IVA 30,000 15,000 15,000
23 SURYA 15,000 7,500 7,500
24 ANE 30,000 15,000 15,000
25 FEBBY 15,000 7,500 7,500
26 RAFI 50,000 25,000 25,000
27 RIFAN 15,000 7,500 7,500
28 RITA 70,000 35,000 35,000
29 RIPAN 15,000 7,500 7,500
30 5/5/2015 HILMAN 15,000 7,500 7,500
31 HADIJAH 15,000 7,500 7,500
32 NANI 15,000 10,000 7,500 7,500
33 WIWI 15,000 10,000 7,500 7,500
34 ASEP 15,000 10,000 7,500 7,500
35 NANIN 15,000 10,000 7,500 7,500
36 MUSILAH 15,000 10,000 7,500 7,500
37 TURNI 70,000 35,000 35,000
38 FARID 15,000 10,000 7,500 7,500
39 ZAKI 15,000 10,000 7,500 7,500
40 SITI N 70,000 35,000 35,000
41 TUTI 30,000 15,000 15,000
42 LULIENTI 70,000 35,000 35,000
43 GINA 30,000 15,000 15,000
44 IRA F 15,000 10,000 7,500 7,500
45 DHEA 35,000 17,500 17,500
46 M DONI 30,000 10,000 15,000 15,000
47 DESSY 70,000 35,000 35,000
48 EVI 30,000 15,000 15,000
49 DAFIAN 70,000 10,000 35,000 35,000
50 DEWI 30,000 15,000 15,000
51 KARTIKA 30,000 10,000 15,000 15,000
52 6/5/2015 MURNI 60,000 10,000 30,000 30,000
53 KUSMIATI 35,000 17,500 17,500
54 SUMIATI 30,000 15,000 15,000
55 IMAS 15,000 10,000 7,500 7,500
56 RATNA 30,000 10,000 15,000 15,000
57 ESTI J 30,000 15,000 15,000
58 TRIMURTI 70,000 35,000 35,000
59 SUSILAWATI 70,000 35,000 35,000
60 NENI 70,000 35,000 35,000
61 DEFIRA 60,000 30,000 30,000
62 ARIEF 70,000 35,000 35,000
63 SITI 35,000 17,500 17,500
64 NURUL 70,000 35,000 35,000
65 SRI ULINA 60,000 10,000 30,000 30,000
66 ASEP 35,000 17,500 17,500
67 TRIMURTI 70,000 35,000 35,000
68 LARISA 15,000 7,500 7,500
69 N NIA 15,000 10,000 7,500 7,500
70 DADANG 70,000 35,000 35,000
71 PUTRI 30,000 10,000 15,000 15,000
72 KARTIKA 30,000 15,000 15,000
73 7/5/2015 MALVIN 35,000 17,500 17,500
74 RAMDAN 25,000 12,500 12,500
75 MAINAH 60,000 30,000 30,000
76 EUIS 60,000 30,000 30,000
77 TETEH 60,000 30,000 30,000
78 KIKI S 30,000 15,000 15,000
79 NAJLA 70,000 35,000 35,000
80 SOPIYAN 70,000 35,000 35,000
81 SRI SUDARYATI 15,000 7,500 7,500
82 YENI 15,000 10,000 7,500 7,500
83 TRI H 30,000 15,000 15,000
84 AYU 15,000 10,000 7,500 7,500
85 SUHERLAN 15,000 10,000 7,500 7,500
86 SULASTRI 70,000 10,000 35,000 35,000
87 RISMA 30,000 15,000 15,000
88 BUNGA 30,000 10,000 15,000 15,000
89 UJANG 15,000 10,000 7,500 7,500
90 8/5/2015 SRI LASWANTI 15,000 10,000 7,500 7,500
91 CUCU KURNIATI 15,000 7,500 7,500
92 TARWILAH 40,000 20,000 20,000
93 SYIFA RIZKI 35,000 17,500 17,500
94 NANIN 40,000 20,000 20,000
95 SITI WULANDARI 70,000 35,000 35,000
96 IMAS TIWI 30,000 15,000 15,000
97 DONI 35,000 17,500 17,500
98 RANAH 15,000 10,000 7,500 7,500
99 DJENAB 30,000 15,000 15,000
100 BUDI SETIONO 30,000 15,000 15,000
101 SIFA 30,000 15,000 15,000
102 YULIANTI 30,000 15,000 15,000
103 YULIANI 15,000 10,000 7,500 7,500
104 TRI YUDI 15,000 10,000 7,500 7,500
105 DINAR 70,000 35,000 35,000
106 KHOERUNISA 70,000 35,000 35,000
107 EGI 25,000 12,500 12,500
108 KARINA 70,000 35,000 35,000
109 M RIZKI 15,000 10,000 7,500 7,500
110 YAYAH 30,000 15,000 15,000
111 WAHYUNI 30,000 10,000 15,000 15,000
112 RIFANA 15,000 10,000 7,500 7,500
113 9/5/2015 ARINI NURFADILLAH 25,000 12,500 12,500
114 ROSA 40,000 20,000 20,000
115 AGUSTINI 15,000 10,000 7,500 7,500
116 UJANG 30,000 15,000 15,000
117 MEGA 30,000 15,000 15,000
118 HERMAN 30,000 15,000 15,000
119 YUYUN 30,000 15,000 15,000
120 ARI RAHMADI 15,000 10,000 7,500 7,500
121 JUANGSIH 60,000 30,000 30,000
122 SALAMAH 30,000 15,000 15,000
123 HASNA 25,000 12,500 12,500
124 ARIF SALMAN 30,000 15,000 15,000
125 ASEP WAHYU 30,000 15,000 15,000
126 SRI LASWANTI 15,000 7,500 7,500
127 FARAH 70,000 35,000 35,000
128 HASANAH 30,000 15,000 15,000
129 PUTRI 30,000 10,000 15,000 15,000
130 SITI 70,000 35,000 35,000
131 HAMSYAH 60,000 30,000 30,000
132 KARLHA 30,000 15,000 15,000
133 RIFAN 35,000 17,500 17,500
134 MELYKA 70,000 35,000 35,000
135 HERLINA 70,000 35,000 35,000
136 11/5/2015 TINTIN 70,000 35,000 35,000
137 SISMITIN 15,000 10,000 7,500 7,500
138 SYIFA 15,000 7,500 7,500
139 MARYANI 30,000 15,000 15,000
140 ODANG 15,000 10,000 7,500 7,500
141 SARBINI 30,000 15,000 15,000
142 IRMA 70,000 35,000 35,000
143 ZHALAILA 15,000 10,000 7,500 7,500
144 LANNY 30,000 10,000 15,000 15,000
145 SRI 15,000 10,000 7,500 7,500
146 RITA A 70,000 35,000 35,000
147 SHINTA D 70,000 35,000 35,000
148 RINI 15,000 7,500 7,500
149 SASKIA 40,000 20,000 20,000
150 SURYA 15,000 10,000 7,500 7,500
151 ANDRI 30,000 15,000 15,000
152 DHIMAS 70,000 10,000 35,000 35,000
153 HUSEN 15,000 7,500 7,500
154 12/5/2015 NY SUSI 30,000 15,000 15,000
155 MUSILAH 15,000 10,000 7,500 7,500
156 ENTIN 15,000 10,000 7,500 7,500
157 JUMALDI 15,000 7,500 7,500
158 PUNGUT 15,000 10,000 7,500 7,500
159 SRI S 15,000 7,500 7,500
160 NASHITA 25,000 30,000 12,500
161 ESTI 30,000 15,000 15,000
162 SURYATIMAH 15,000 10,000 7,500 7,500
163 KESYA 15,000 7,500 7,500
164 BUNGA 30,000 15,000 15,000
165 EVI 30,000 15,000 15,000
166 FATHIA 30,000 15,000 15,000
167 RAISYA 30,000 15,000 15,000
168 ANISSA 35,000 17,500 17,500
169 SUHERLAN 30,000 15,000 15,000
170 RATNA S 30,000 10,000 15,000 15,000
171 ELIS SUMINAR 30,000 15,000 15,000
172 MELIYANI 30,000 15,000 15,000
173 SHAKILA 15,000 10,000 7,500 7,500
174 13/5/2015 EDDY S 30,000 15,000 15,000
175 LIA 30,000 15,000 15,000
176 NITA 15,000 10,000 7,500 7,500
177 TINTIN 70,000 35,000 35,000
178 RATNA 30,000 15,000 15,000
179 SUMIATI 30,000 15,000 15,000
180 SRI M 30,000 15,000 15,000
181 TRI MURTI 30,000 15,000 15,000
182 IMAS 15,000 10,000 7,500 7,500
183 IIS N 30,000 15,000 15,000
184 FEBBY 70,000 35,000 35,000
185 M DONI FAISAL 30,000 15,000 15,000
186 HANA DEVINA 35,000 17,500 17,500
187 RIZKI 70,000 35,000 35,000
188 TETI HARYATI 60,000 30,000 30,000
189 YASMIN 35,000 17,500 17,500
190 PUTRI DIKHA 30,000 15,000 15,000
191 KARTIKA 40,000 20,000 20,000
192 15/5/2015 BUDI SETIONO 30,000 15,000 15,000
193 TESSA ELVINA 25,000 12,500 12,500
194 DJENAB 30,000 15,000 15,000
195 TURNI 70,000 35,000 35,000
196 MALVIN 35,000 17,500 17,500
197 YUYUN Y 30,000 15,000 15,000
198 HERMAN 40,000 20,000 20,000
199 DONI FAISHAL 70,000 35,000 35,000
200 ALISHA 35,000 17,500 17,500
201 CUCU KURNIATI 30,000 15,000 15,000
202 YAYAH K 30,000 15,000 15,000
203 WAHYUNI 30,000 15,000 15,000
204 NINNG 70,000 35,000 35,000
205 ANE 30,000 15,000 15,000
206 MELINDA 30,000 15,000 15,000
207 MAYA TIRTA 40,000 20,000 20,000
208 ANDRY 70,000 35,000 35,000
209 HADIJAH 30,000 15,000 15,000
210 FATHIA 30,000 15,000 15,000
211 M REVANTA 60,000 30,000 30,000
212 18/5/2015 ENTIN HARYANI 60,000 30,000 30,000
213 LURI 30,000 10,000 15,000 15,000
214 NITA 60,000 10,000 30,000 30,000
215 SRI HATI 15,000 10,000 7,500 7,500
216 NABILA 30,000 10,000 15,000 15,000
217 SRI M 30,000 10,000 15,000 15,000
218 ROSINTA 70,000 35,000 35,000
219 HERLINA 30,000 15,000 15,000
220 SARBINI 30,000 15,000 15,000
221 19/5/2015 LINA 25,000 12,500 12,500
222 MARYANI 30,000 15,000 15,000
223 IWAN K 15,000 10,000 7,500 7,500
224 ADITYA 30,000 15,000 15,000
225 YUNI 15,000 10,000 7,500 7,500
226 ADNAN 15,000 10,000 7,500 7,500
227 SITI ARINA 15,000 10,000 7,500 7,500
228 RERY 30,000 15,000 15,000
229 KHOERUNISSA 70,000 35,000 35,000
230 SUHERLAN 30,000 15,000 15,000
231 AHANI 25,000 12,500 12,500
232 SALAMAH 30,000 15,000 15,000
233 AGUS 15,000 7,500 7,500
234 FIKRI 15,000 7,500 7,500
235 MALIK 70,000 35,000 35,000
236 LIA Y 30,000 15,000 15,000
237 HANUM 25,000 12,500 12,500
238 ENUR 70,000 35,000 35,000
239 HERMAWATI 15,000 10,000 7,500 7,500
240 IIS N 30,000 15,000 15,000
241 HERA 70,000 35,000 35,000
242 ANDI 30,000 15,000 15,000
243 JEPRI 35,000 10,000 17,500 17,500
244 MADINA 15,000 7,500 7,500
245 SHAKILA 35,000 17,500 17,500
246 SYIFA 35,000 17,500 17,500
247 KUSHANDAYANI 30,000 15,000 15,000
248 RISMA A 30,000 15,000 15,000
249 BUNGA 30,000 15,000 15,000
250 ELIS 70,000 35,000 35,000
251 20/5/2015 ENTIN 15,000 10,000 7,500 7,500
252 KUSMIATI 70,000 35,000 35,000
253 MUSILAH 60,000 30,000 30,000
254 SUMIATI 30,000 15,000 15,000
255 SUMAETIH 60,000 10,000 30,000 30,000
256 TRI MURTI 70,000 35,000 35,000
257 RATNA NENGSIH 30,000 15,000 15,000
258 MEYSKA 70,000 35,000 35,000
259 IMAS H 15,000 10,000 7,500 7,500
260 SARBINI 70,000 35,000 35,000
261 KOSASIH 60,000 10,000 30,000 30,000
262 M RAMDAN 70,000 35,000 35,000
263 EFA SUSANTI 70,000 35,000 35,000
264 SRI MULYANI 30,000 15,000 15,000
265 NADIA O 35,000 17,500 17,500
266 FARHAN 30,000 15,000 15,000
267 GHINA 30,000 15,000 15,000
268 TARWILAH 70,000 35,000 35,000
269 EVI S 30,000 15,000 15,000
270 NIA 15,000 7,500 7,500
271 KARTIKA SAPTA 70,000 35,000 35,000
272 PUTRI DIKHA 30,000 15,000 15,000
273 21/5/2015 DJENAB 30,000 15,000 15,000
274 MYSHELLA 30,000 15,000 15,000
275 DADANG 30,000 15,000 15,000
276 INDAH 30,000 10,000 15,000 15,000
277 RAISSA 35,000 17,500 17,500
278 ALLIYA 70,000 35,000 35,000
279 SITI SOLEHAH 30,000 15,000 15,000
280 DONI FAISHAL 70,000 35,000 35,000
281 EKO 30,000 15,000 15,000
282 BUDI SETIONO 30,000 15,000 15,000
283 KIKY S 70,000 35,000 35,000
284 NAZLA 70,000 35,000 35,000
285 RIA 15,000 10,000 7,500 7,500
286 ANNISSA 70,000 35,000 35,000
287 FEBBY 70,000 35,000 35,000
288 YENI 15,000 10,000 7,500 7,500
289 ASEP 70,000 35,000 35,000
290 WIWI 15,000 10,000 7,500 7,500
291 TITA 70,000 35,000 35,000
292 GALIH 25,000 12,500 12,500
293 FIONITA 30,000 15,000 15,000
294 TRI H 30,000 15,000 15,000
295 22/5/2015 DJUNAEDI 30,000 15,000 15,000
296 ESTI 40,000 20,000 20,000
297 M AMIN 60,000 30,000 30,000
298 HERMAN 70,000 35,000 35,000
299 ZHULAEHA 15,000 7,500 7,500
300 LILIS RISTIYANI 60,000 30,000 30,000
301 FATHIA 30,000 15,000 15,000
302 DIAH ALMIRA 15,000 7,500 7,500
303 RATNA SULISTIAN 30,000 15,000 15,000
304 LANNY 30,000 15,000 15,000
305 DENI SETIAWAN 15,000 7,500 7,500
306 WAHYUNI 30,000 15,000 15,000
307 REFAN 35,000 17,500 17,500
308 MELINDA 40,000 20,000 20,000
309 YESSI 15,000 7,500 7,500
310 DINAR 70,000 35,000 35,000
311 M FAUZAN 35,000 17,500 17,500
312 M FAUZI 70,000 35,000 35,000
313 YUNINGSIH 30,000 15,000 15,000
314 YAYAN 40,000 20,000 20,000
315 MELINDA 30,000 15,000 15,000
316 CUCU 30,000 15,000 15,000
317 RENA 70,000 35,000 35,000
318 TUTI 60,000 30,000 30,000
319 23/5/2015 ENI 70,000 35,000 35,000
320 RISMA 35,000 17,500 17,500
321 NADIA 35,000 17,500 17,500
322 RAHMAWATI 30,000 15,000 15,000
323 HILAL 70,000 35,000 35,000
324 YUYUN Y 30,000 15,000 15,000
325 NADIA PUTRI 35,000 17,500 17,500
326 NUNUNG 15,000 10,000 7,500 7,500
327 DAFIN 35,000 17,500 17,500
328 DINA NUR 35,000 17,500 17,500
329 SISMITIN 70,000 35,000 35,000
330 ANDREAS 15,000 10,000 7,500 7,500
331 EUIS DWI 30,000 10,000 15,000 15,000
332 EDDY S 30,000 15,000 15,000
333 NURJAMAN 30,000 15,000 15,000
334 RUSLAN 30,000 15,000 15,000
335 ENENG N 15,000 7,500 7,500
336 WIWIN 30,000 15,000 15,000
337 RIZKI 30,000 10,000 15,000 15,000
338 HERLINA 30,000 15,000 15,000
339 25/5/2015 KEMAL 35,000 17,500 17,500
340 LURI 30,000 10,000 15,000 15,000
341 SRI MULYANI 30,000 10,000 15,000 15,000
342 AJENG DWI 30,000 10,000 15,000 15,000
343 RATNA NENGSIH 30,000 10,000 15,000 15,000
344 SARBINI 30,000 15,000 15,000
345 IVA 30,000 15,000 15,000
346 MAHASA 70,000 35,000 35,000
347 EVA 30,000 15,000 15,000
348 ASEP S 30,000 15,000 15,000
349 ANDRI 40,000 20,000 20,000
350 BANI 15,000 7,500 7,500
351 RITA 70,000 35,000 35,000
352 UJANG 15,000 10,000 7,500 7,500
353 MARYANI 30,000 15,000 15,000
354 TITIN 15,000 10,000 7,500 7,500
355 DETI 30,000 15,000 15,000
356 NERY 70,000 35,000 35,000
357 26/5/2015 SALAMAH 30,000 15,000 15,000
358 GANJAR 30,000 15,000 15,000
359 HADIJAH 30,000 15,000 15,000
360 HERRA 70,000 35,000 35,000
361 IIS 30,000 15,000 15,000
362 DJENAB 30,000 15,000 15,000
363 AMIR 15,000 7,500 7,500
364 KHOIRUNISSA 70,000 35,000 35,000
365 SUHERLAN 60,000 30,000 30,000
366 NENG REFI 60,000 30,000 30,000
367 RISMA 30,000 15,000 15,000
368 DUDU 60,000 30,000 30,000
369 IREN 35,000 17,500 17,500
370 BUNGA 30,000 15,000 15,000
371 MEDINA 35,000 17,500 17,500
372 ZAINA 35,000 17,500 17,500
373 QONIAH 35,000 17,500 17,500
374 TUTY 70,000 35,000 35,000
375 27/5/2015 DINI 60,000 10,000 30,000 30,000
376 MURNI 60,000 10,000 30,000 30,000
377 TRI MURTI 15,000 10,000 7,500 7,500
378 TINTIN 60,000 10,000 30,000 30,000
379 IMAS 60,000 10,000 30,000 30,000
380 HERLINA 30,000 15,000 15,000
381 RATNA NENGSIH 30,000 15,000 15,000
382 MUSILAH 15,000 7,500 7,500
383 SULASTRI 30,000 10,000 15,000 15,000
384 NONOH 15,000 7,500 7,500
385 DADANG ROMANSYA 70,000 35,000 35,000
386 NURJANAH 60,000 30,000 30,000
387 RENITA 30,000 15,000 15,000
388 FENI AYU 30,000 15,000 15,000
389 ENTIN 30,000 15,000 15,000
390 NABILA 30,000 10,000 15,000 15,000
391 SUMAINI 30,000 15,000 15,000
392 DEWI SHANTY 70,000 35,000 35,000
393 DAFIAN 70,000 35,000 35,000
394 RAISYA 30,000 15,000 15,000
395 EVI 40,000 20,000 20,000
396 WIDYA 60,000 30,000 30,000
397 28/5/2015 KUSHANDAYANI 30,000 15,000 15,000
398 NADIA 35,000 17,500 17,500
399 IHSAN 30,000 15,000 15,000
400 SITI S 30,000 15,000 15,000
401 DADANG 30,000 15,000 15,000
402 MAINAH 60,000 30,000 30,000
403 LIA YULIAWATI 30,000 15,000 15,000
404 NAZLA 70,000 35,000 35,000
405 FIONITA 60,000 10,000 30,000 30,000
406 UMSIATI 15,000 10,000 7,500 7,500
407 NURAENI 15,000 10,000 7,500 7,500
408 SITI ARINA 70,000 35,000 35,000
409 DEWI 25,000 12,500 12,500
410 ANNISA 70,000 35,000 35,000
411 SHAFIRA 25,000 12,500 12,500
412 NENGSIH 25,000 12,500 12,500
413 REFANA 30,000 15,000 15,000
414 M ACHMAL 30,000 15,000 15,000
415 29/5/2015 ESTI 70,000 35,000 35,000
416 BUDI SETIONO 30,000 15,000 15,000
417 HASANAH 40,000 20,000 20,000
418 HOLISAH 30,000 15,000 15,000
419 DIAH ALMIRA 25,000 12,500 12,500
420 SRI HANDAYANI 60,000 30,000 30,000
421 AGUS IRWAN 70,000 35,000 35,000
422 NURHAYATI 30,000 15,000 15,000
423 AAT ATIKAH 30,000 15,000 15,000
424 WIDA S 15,000 10,000 7,500 7,500
425 LINA R 60,000 10,000 30,000 30,000
426 PRIATNA 15,000 10,000 7,500 7,500
427 SITI V 15,000 10,000 7,500 7,500
428 ENDAH 15,000 10,000 7,500 7,500
429 YANI 15,000 10,000 7,500 7,500
430 YAYAH 70,000 35,000 35,000
431 MELINDA 70,000 35,000 35,000
432 QIZA 70,000 35,000 35,000
433 TITA 70,000 35,000 35,000
434 ENOK 70,000 10,000 35,000 35,000
435 RINI 70,000 35,000 35,000
436 MEILINDA 30,000 15,000 15,000
437 FATHIA 30,000 10,000 15,000 15,000
438 WAHYUNI 30,000 15,000 15,000
439 30/5/2015 RATNA S 30,000 15,000 15,000
440 YUYUN 30,000 15,000 15,000
441 FURADILLAH 70,000 35,000 35,000
442 RACHMAWATI 30,000 15,000 15,000
443 HYLAL 70,000 35,000 35,000
444 DEDE SOLIHIN 35,000 17,500 17,500
445 ENI 70,000 35,000 35,000
446 NANI 30,000 15,000 15,000
447 DJENAB 30,000 15,000 15,000
448 NURJAMAN 40,000 20,000 20,000
449 SUMIATI 40,000 20,000 20,000
450 TN RUSLAN 40,000 20,000 20,000
451 YUNI I 15,000 10,000 7,500 7,500
452 NANI 30,000 10,000 15,000 15,000
453 HERRY 60,000 10,000 30,000 30,000
454 MEYSKA 70,000 35,000 35,000
455 AJENG DWI 30,000 15,000 15,000
456 RIZKI 30,000 15,000 15,000
457 SASKIA 30,000 15,000 15,000
17,365,000 1,030,000 8,700,000 8,682,500
JML KET
100,000
200,000
200,000
50,000
60,000 ALFA
60,000
60,000
60,000
160,000
70,000
75,000
200,000
200,000
100,000
200,000
70,000
100,000
60,000 ALFA
20,000
20,000
50,000
150,000
20,000
40,000
50,000
100,000
300,000
100,000
40,000
100,000
200,000
150,000
100,000
300,000
200,000
150,000
150,000
70,000 ALFA
60,000 ALFA
100,000
200,000
200,000
DR PURI
100,000
100,000
60,000
25,000
100,000
70,000
100,000
60,000
60,000
60,000
200,000
20,000
20,000
60,000
60,000
60,000
200,000
160,000
60,000
150,000
150,000
25,000
25,000
60,000
6,880,000
JML KET
70,000
30,000
30,000
35,000
70,000
30,000
60,000
30,000
30,000
25,000
40,000
30,000
15,000
25,000
30,000
30,000
35,000
70,000
25,000
70,000
70,000
30,000
15,000
30,000
15,000
50,000
15,000
70,000
15,000
15,000
15,000
25,000
25,000
25,000
25,000
25,000
70,000
25,000
25,000
70,000
30,000
70,000
30,000
25,000
35,000
40,000
70,000
30,000
80,000
30,000
40,000
70,000
35,000
30,000
25,000
40,000
30,000
70,000
70,000
70,000
60,000
70,000
35,000
70,000
70,000
35,000
70,000
15,000
25,000
70,000
40,000
30,000
35,000
25,000
60,000
60,000
60,000
30,000
70,000
70,000
15,000
25,000
30,000
25,000
25,000
80,000
30,000
40,000
25,000
25,000
15,000
40,000
35,000
40,000
70,000
30,000
35,000
25,000
30,000
30,000
30,000
30,000
25,000
25,000
70,000
70,000
25,000
70,000
25,000
30,000
40,000
25,000
25,000
40,000
25,000
30,000
30,000
30,000
30,000
25,000
60,000
30,000
25,000
30,000
30,000
15,000
70,000
30,000
40,000
70,000
60,000
30,000
35,000
70,000
70,000
70,000
25,000
15,000
30,000
25,000
30,000
70,000
25,000
40,000
25,000
70,000
70,000
15,000
40,000
25,000
30,000
80,000
15,000
30,000
25,000
25,000
15,000
25,000
15,000
42,500
30,000
25,000
15,000
30,000
30,000
30,000
30,000
35,000
30,000
40,000
30,000
30,000
25,000
30,000
30,000
25,000
70,000
30,000
30,000
30,000
30,000
25,000
30,000
70,000
30,000
35,000
70,000
60,000
35,000
30,000
40,000
30,000
25,000
30,000
70,000
35,000
30,000
40,000
70,000
35,000
30,000
30,000
30,000
70,000
30,000
30,000
40,000
70,000
30,000
30,000
60,000
60,000
40,000
70,000
25,000
40,000
40,000
70,000
30,000
30,000
25,000
30,000
25,000
30,000
25,000
25,000
25,000
30,000
70,000
30,000
25,000
30,000
15,000
15,000
70,000
30,000
25,000
70,000
25,000
30,000
70,000
30,000
45,000
15,000
35,000
35,000
30,000
30,000
30,000
70,000
25,000
70,000
60,000
30,000
70,000
70,000
30,000
70,000
25,000
70,000
70,000
70,000
70,000
30,000
35,000
30,000
30,000
70,000
30,000
15,000
70,000
30,000
30,000
30,000
30,000
40,000
35,000
70,000
30,000
70,000
30,000
30,000
70,000
70,000
25,000
70,000
70,000
25,000
70,000
25,000
70,000
25,000
30,000
30,000
30,000
40,000
60,000
70,000
15,000
60,000
30,000
15,000
30,000
30,000
15,000
30,000
35,000
40,000
15,000
70,000
35,000
70,000
30,000
40,000
30,000
30,000
70,000
60,000
70,000
35,000
35,000
30,000
70,000
30,000
35,000
25,000
35,000
35,000
70,000
25,000
40,000
30,000
30,000
30,000
15,000
30,000
40,000
30,000
35,000
40,000
40,000
40,000
40,000
30,000
30,000
70,000
30,000
30,000
40,000
15,000
70,000
25,000
30,000
25,000
30,000
70,000
30,000
30,000
30,000
70,000
30,000
30,000
15,000
70,000
60,000
60,000
30,000
60,000
35,000
30,000
35,000
35,000
35,000
70,000
70,000
70,000
25,000
70,000
70,000
30,000
30,000
15,000
40,000
15,000
70,000
60,000
30,000
30,000
30,000
40,000
30,000
70,000
70,000
30,000
40,000
60,000
30,000
35,000
30,000
30,000
30,000
60,000
30,000
70,000
70,000
25,000
25,000
70,000
25,000
70,000
25,000
25,000
30,000
30,000
70,000
30,000
40,000
30,000
25,000
60,000
70,000
30,000
30,000
25,000
70,000
25,000
25,000
25,000
25,000
70,000
70,000
70,000
70,000
80,000
70,000
30,000
40,000
30,000
30,000
30,000
70,000
30,000
70,000 -
35,000 -
70,000 -
30,000 -
30,000 -
40,000 -
40,000 -
40,000 -
25,000 -
40,000 -
70,000 -
70,000 -
30,000 -
30,000 -
30,000 -
18,412,500 -
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PERIODE JUNI 2015
JASA ALAT &

DOKTER BAHAN
1 SASKIA 20,000 5,000 7,500 7,500
2 TOMMY 200,000 5,000 97,500 97,500
3 3/6/2015 ERNA 190,000 5,000 92,500 92,500
4 4/6/2015 LASMIA 200,000 5,000 97,500 97,500
5 5/6/2015 KARLINA 200,000 5,000 97,500 97,500
6 NURHANIFAH 200,000 5,000 97,500 97,500
7 RATIH 60,000 5,000 27,500 27,500
8 7/6/2015 NITA 100,000 5,000 47,500 47,500
9 RIZAL 100,000 5,000 47,500 47,500
10 8/6/2015 TN DADAN 100,000 5,000 47,500 47,500
11 NY ICEU 200,000 5,000 97,500 97,500
12 9/6/2015 NY RINA 200,000 5,000 97,500 97,500
13 10/6/2015 KALISA 200,000 5,000 97,500 97,500
14 PUTRI 200,000 5,000 97,500 97,500
15 11/6/2015 ARIFIN 200,000 5,000 97,500 97,500
16 FARIS 200,000 5,000 97,500 97,500
17 NUR 60,000 5,000 27,500 27,500
18 LISNA 20,000 5,000 7,500 7,500
19 LISNAWATY 200,000 5,000 97,500 97,500
20 12/6/2015 NY YUSNI 120,000 5,000 57,500 57,500
21 IRFAN 20,000 5,000 7,500 7,500
22 13/6/2015 KIKY 100,000 5,000 47,500 47,500
23 15/6/2015 MARIO 200,000 5,000 97,500 97,500
24 RATIH 50,000 5,000 22,500 22,500
25 16/6/2015 NY RENI 95,000 5,000 45,000 45,000
26 NY MINI 25,000 5,000 10,000 10,000
27 17/6/2015 DINDA 20,000 5,000 7,500 7,500
28 MUFRIN 45,000 5,000 20,000 20,000
29 ARIFIN 200,000 5,000 97,500 97,500
30 18/6/2015 NUR 70,000 5,000 32,500 32,500
31 MARSITI 60,000 5,000 27,500 27,500
32 20/6/2015 NOVARIYANI 20,000 5,000 7,500 7,500
33 22/6/2015 RATIH 50,000 5,000 22,500 22,500
34 23/6/2015 NAIFA 45,000 5,000 20,000 20,000
35 24/6/2015 M TAUFIK 20,000 5,000 7,500 7,500
36 ASEP SWARNA 25,000 5,000 10,000 10,000
37 ARIFIN 110,000 5,000 52,500 52,500
38 TRIALDI 60,000 5,000 27,500 27,500
39 25/6/2015 IIS YULIAH 100,000 5,000 47,500 47,500
40 DERI 250,000 5,000 122,500 122,500
41 NUR 70,000 5,000 32,500 32,500
42 ENDANG 20,000 5,000 7,500 7,500
43 27/6/2015 DEBORAH 200,000 5,000 97,500 97,500
44 HJ IIS 20,000 5,000 7,500 7,500
45 IKHSAN 40,000 5,000 17,500 17,500
46 AJENG 100,000 5,000 47,500 47,500
47 29/6/2015 HJ IIS 50,000 5,000 22,500 22,500
48 ARIFIN 110,000 5,000 52,500 52,500
49 SITI SALAMAH 260,000 5,000 127,500 127,500
50 30/6/2015 AYU 50,000 5,000 22,500 22,500
51 RITA 200,000 5,000 97,500 97,500
52 ASEP SWARNA 80,000 5,000 37,500 37,500
5,735,000 260,000 2,737,500 2,737,500

PERIODE juni 2015
JASA ALAT &

TGL NAMA TARIF OBAT
DOKTER BAHAN
1 1/6/2015 SUYANTO 70,000 35,000 35,000
2 EDDY 30,000 15,000 15,000
3 LURY 30,000 15,000 15,000
4 SRI MULYANI 30,000 15,000 15,000
5 MAMAN 70,000 35,000 35,000
6 ANDRI 40,000 20,000 20,000
7 EVA 70,000 35,000 35,000
8 MUHARAN 70,000 35,000 35,000
9 IVA 30,000 15,000 15,000
10 UJANG 60,000 30,000 30,000
11 GALANG 25,000 12,500 12,500
12 SIFA 40,000 20,000 20,000
13 DETI 30,000 15,000 15,000
14 MARYANI 40,000 20,000 20,000
15 IWAN 15,000 10,000 7,500 7,500
16 SURANI 70,000 35,000 35,000
17 3/6/2015 LATIFAH 30,000 10,000 15,000 15,000
18 LILIS A 15,000 7,500 7,500
19 IMAS H 60,000 10,000 30,000 30,000
20 LIDIA NADI 15,000 7,500 7,500
21 YUNI 60,000 10,000 30,000 30,000
22 ENTIN 15,000 7,500 7,500
23 ESTI J 70,000 35,000 35,000
24 KEMAL 25,000 12,500 12,500
25 ADNAN 25,000 12,500 12,500
26 SRI SULSTRI 30,000 15,000 15,000
27 ERNA 60,000 30,000 30,000
28 NURBILAL 70,000 35,000 35,000
29 SUMARNI 30,000 15,000 15,000
30 THERESIA 30,000 15,000 15,000
31 EVI 70,000 35,000 35,000
32 GINA R 40,000 20,000 20,000
33 4/6/2015 JUMALAH 30,000 15,000 15,000
34 KIKI 70,000 35,000 35,000
35 NAZLA 70,000 35,000 35,000
36 LIA Y 40,000 20,000 20,000
37 IHSAN 30,000 15,000 15,000
38 NADIA 30,000 15,000 15,000
39 M RIDWAN 70,000 35,000 35,000
40 BUNGA 70,000 35,000 35,000
41 BUDI 30,000 15,000 15,000
42 SALAMAH 30,000 15,000 15,000
43 SURYA 15,000 7,500 7,500
44 SUROSO 15,000 7,500 7,500
45 REFANA 30,000 15,000 15,000
46 TRI 30,000 15,000 15,000
47 ANNISA 70,000 35,000 35,000
48 YENI 15,000 7,500 7,500
49 ARI S 70,000 35,000 35,000
50 RISMA 30,000 15,000 15,000
51 ANISA 15,000 10,000 7,500 7,500
52 TITA 70,000 35,000 35,000
53 ADIN 15,000 7,500 7,500
54 RIZKI 30,000 15,000 15,000
55 FIONITA 30,000 15,000 15,000
56 5/6/2015 EVY S 70,000 35,000 35,000
57 HASFAN 15,000 7,500 7,500
58 WIWI 15,000 7,500 7,500
59 ROHAYATI 30,000 15,000 15,000
60 VIRGIE 35,000 17,500 17,500
61 HOLISOH 70,000 35,000 35,000
62 NURHANIFAH 70,000 35,000 35,000
63 KARLINA 30,000 15,000 15,000
64 IVA 30,000 15,000 15,000
65 ITA 15,000 7,500 7,500
66 RAFI 25,000 12,500 12,500
67 MELINDA 30,000 15,000 15,000
68 YANI 30,000 15,000 15,000
69 6/6/2015 ROCHMAWATI 30,000 15,000 15,000
70 ALLIYA 30,000 10,000 15,000 15,000
71 RAISA 70,000 35,000 35,000
72 RATNA 40,000 20,000 20,000
73 NAZLA 70,000 35,000 35,000
74 KIKY 70,000 35,000 35,000
75 TONI 60,000 30,000 30,000
76 DADANG 30,000 10,000 15,000 15,000
77 BUNGA 40,000 20,000 20,000
78 NANI 70,000 35,000 35,000
79 DJENAB 40,000 20,000 20,000
80 8/6/2015 JULPRIANTO 15,000 7,500 7,500
81 EDDY 40,000 20,000 20,000
82 NIKE F 30,000 10,000 15,000 15,000
83 NITA NUR 60,000 10,000 30,000 30,000
84 LURI 40,000 20,000 20,000
85 HAERUDIN 15,000 10,000 7,500 7,500
86 DINA 35,000 17,500 17,500
87 SARBINI 30,000 10,000 15,000 15,000
88 MARYANI 70,000 35,000 35,000
89 DEBI 30,000 15,000 15,000
90 ALVITO 15,000 7,500 7,500
91 FADLAN 25,000 12,500 12,500
92 FATHIA 25,000 12,500 12,500
93 ENDAH 15,000 10,000 7,500 7,500
94 UJANG 40,000 20,000 20,000
95 GANJAR 30,000 15,000 15,000
96 HADIJAH 30,000 15,000 15,000
97 SIFA 70,000 35,000 35,000
98 9/6/2015 ANDRI GUNAWAN 70,000 35,000 35,000
99 WAHYUNI 70,000 35,000 35,000
100 DJENG SRI 70,000 35,000 35,000
101 DJAMILAH 30,000 15,000 15,000
102 FEBRIANTI 35,000 17,500 17,500
103 RINA 15,000 7,500 7,500
104 M FAUZI 30,000 10,000 15,000 15,000
105 ASEP 15,000 7,500 7,500
106 DIMAS 15,000 10,000 7,500 7,500
107 SRI MULYANI 60,000 30,000 30,000
108 MARSITI 15,000 10,000 7,500 7,500
109 IWAN K 30,000 15,000 15,000
110 RISTI 35,000 10,000 17,500 17,500
111 ELCHA 30,000 15,000 15,000
112 BUDI 40,000 20,000 20,000
113 ERNI 15,000 7,500 7,500
114 SALMA 15,000 7,500 7,500
115 UJANG R 30,000 15,000 15,000
116 ELIS S 35,000 17,500 17,500
117 WULANSARI 15,000 10,000 7,500 7,500
118 10/6/2015 LATIFAH 30,000 10,000 15,000 15,000
119 RUSLAN 70,000 35,000 35,000
120 HERLINA 40,000 20,000 20,000
121 AJENG DWI 40,000 20,000 20,000
122 TURNI 60,000 10,000 30,000 30,000
123 IMMANUEL 15,000 7,500 7,500
124 MUSILAH 60,000 10,000 30,000 30,000
125 IYAM 15,000 10,000 7,500 7,500
126 HANDAYANI 20,000 10,000 10,000 10,000
127 NENI 30,000 10,000 15,000 15,000
128 MEIKE 25,000 12,500 12,500
129 SUHERLAN 30,000 10,000 15,000 15,000
130 REVI 70,000 35,000 35,000
131 TUTY SADYAH 30,000 15,000 15,000
132 SUMAINI 30,000 15,000 15,000
133 LARISSA 25,000 12,500 12,500
134 KHASAN 30,000 15,000 15,000
135 IKA 30,000 15,000 15,000
136 11/6/2015 RAHMAWATI 30,000 15,000 15,000
137 HOLISOH 30,000 15,000 15,000
138 IMAS 60,000 30,000 30,000
139 SALAMAH 40,000 20,000 20,000
140 NURHAYATI 40,000 20,000 20,000
141 NURHANIFAH 30,000 15,000 15,000
142 SUROSO 15,000 7,500 7,500
143 YENI 15,000 7,500 7,500
144 ANIS 15,000 7,500 7,500
145 GALANG 25,000 12,500 12,500
146 KHOIRUMA 70,000 35,000 35,000
147 AGUS 15,000 7,500 7,500
148 TITA 70,000 35,000 35,000
149 DIKA 15,000 7,500 7,500
150 12/6/2015 EVY S 70,000 35,000 35,000
151 OMIH 60,000 30,000 30,000
152 M.FARID 30,000 10,000 15,000 15,000
153 DIAH ALMIRA 25,000 12,500 12,500
154 M.AMIH 15,000 7,500 7,500
155 BUDI SETIONO 30,000 15,000 15,000
156 M.SATRIA 35,000 17,500 17,500
157 TN AGUS 60,000 30,000 30,000
158 FARAH 70,000 35,000 35,000
159 HASANAH 70,000 35,000 35,000
160 CHASA O 30,000 15,000 15,000
161 ROHAYATI 15,000 7,500 7,500
162 LURI 40,000 20,000 20,000
163 RAISA 30,000 15,000 15,000
164 ALLIYA 15,000 7,500 7,500
165 JUJU 70,000 35,000 35,000
166 YANI 30,000 15,000 15,000
167 MARSILI 15,000 7,500 7,500
168 DJENAB 15,000 7,500 7,500
169 13/06/2015 RATNA SULISTIANI 70,000 35,000 35,000
170 YUYUN 40,000 20,000 20,000
171 ELAH 30,000 15,000 15,000
172 KIKI 70,000 35,000 35,000
173 ATE 60,000 30,000 30,000
174 TONI HIDAYAT 70,000 35,000 35,000
175 NAZLA 70,000 35,000 35,000
176 SUPIAN 70,000 35,000 35,000
177 RIFKY 30,000 15,000 15,000
178 BUNGA 70,000 35,000 35,000
179 M.FADHILOH 30,000 15,000 15,000
180 DEFI ANGGRAENI 30,000 15,000 15,000
181 TATI SUMIATI 60,000 30,000 30,000
182 NENENG 15,000 7,500 7,500
183 13/06/2015 RAHMA 25,000 10,000 12,500 12,500
184 TN NURJAMAN 70,000 35,000 35,000
185 SASKIA 30,000 15,000 15,000
186 NY ENTIN 60,000 10,000 30,000 30,000
187 MEISA 15,000 10,000 7,500 7,500
188 NY DWI A 60,000 10,000 30,000 30,000
189 ROSMAWATI 30,000 10,000 15,000 15,000
190 15/06/2015 MARIO 15,000 7,500 7,500
191 CUCU 70,000 35,000 35,000
192 ASRI N 70,000 35,000 35,000
193 TN EDDY S 70,000 35,000 35,000
194 NURJANAH 60,000 10,000 30,000 30,000
195 RENATA 30,000 15,000 15,000
196 TN DADANG 30,000 15,000 15,000
197 TN AHMAD 35,000 10,000 17,500 17,500
198 M HUDA 35,000 10,000 17,500 17,500
199 NY AGUSTINI 60,000 10,000 30,000 30,000
200 NAWRA 15,000 7,500 7,500
201 15/06/2015 VERA N 25,000 12,500 12,500
202 ENDAH 15,000 7,500 7,500
203 SRI M 30,000 15,000 15,000
204 SALMA 25,000 12,500 12,500
205 WILYA 15,000 10,000 7,500 7,500
206 YENI 40,000 10,000 20,000 20,000
207 ARVIN 30,000 15,000 15,000
208 REFANA 25,000 12,500 12,500
209 WIDIYA 30,000 15,000 15,000
210 ANISA 15,000 10,000 7,500 7,500
211 HARTO 15,000 10,000 7,500 7,500
212 16/06/2015 AGHI 30,000 15,000 15,000
213 LADIYA 30,000 15,000 15,000
214 REFIANI 70,000 35,000 35,000
215 SRI HASANI 15,000 7,500 7,500
216 IWAN KUSWANDI 30,000 15,000 15,000
217 LALAN 30,000 15,000 15,000
218 HADIJAH 40,000 20,000 20,000
219 TURNI 60,000 30,000 30,000
220 GANJAR 40,000 20,000 20,000
221 RENI 15,000 7,500 7,500
222 16/06/2015 REZA 35,000 17,500 17,500
223 M RIDHO 25,000 12,500 12,500
224 NENGSIH 70,000 35,000 35,000
225 UJANG 70,000 35,000 35,000
226 MELINDA 70,000 35,000 35,000
227 AGUS 60,000 30,000 30,000
228 BUDI 30,000 15,000 15,000
229 MONITA 70,000 35,000 35,000
230 RAHMAH 35,000 17,500 17,500
231 FITRIANSYAH 60,000 30,000 30,000
232 ELIS S 30,000 15,000 15,000
233 17/6/2015 FARID 35,000 17,500 17,500
234 TN ICHSAN 30,000 10,000 15,000 15,000
235 NY YUYUN 30,000 15,000 15,000
236 YUNI S 60,000 10,000 30,000 30,000
237 LURI 70,000 35,000 35,000
238 NY MARSITI 60,000 30,000 30,000
239 RIKA H 30,000 10,000 15,000 15,000
240 NY IMAS 60,000 10,000 30,000 30,000
241 NY HERLINA 70,000 35,000 35,000
242 SITI H 70,000 35,000 35,000
243 17/6/2015 IWAN B 70,000 35,000 35,000
244 ALVITO L 30,000 15,000 15,000
245 SUMAINI 30,000 15,000 15,000
246 AJENG 70,000 35,000 35,000
247 SRI H 30,000 15,000 15,000
248 TUTY S 40,000 20,000 20,000
249 REVI N 30,000 15,000 15,000
250 SMARYATI 60,000 30,000 30,000
251 RABBANI 35,000 17,500 17,500
252 NANI R 60,000 30,000 30,000
253 18/6/2015 NAYLA 15,000 7,500 7,500
254 M ZAKY 35,000 17,500 17,500
255 IIS YULIA 30,000 15,000 15,000
256 NIDA 70,000 35,000 35,000
257 SALAMAH 70,000 35,000 35,000
258 M HYLAL 70,000 35,000 35,000
259 RACHMAWATI 30,000 15,000 15,000
260 EPI NS 30,000 15,000 15,000
261 EGIE 25,000 12,500 12,500
262 DEVI WAHYU 30,000 10,000 15,000 15,000
263 M SAFRI 35,000 17,500 17,500
264 18/6/2015 TN ROCHMAT 15,000 10,000 7,500 7,500
265 ANNISA 25,000 12,500 12,500
266 SRI S 15,000 10,000 7,500 7,500
267 TRI 15,000 10,000 7,500 7,500
268 TITA 70,000 35,000 35,000
269 QIRA 15,000 10,000 7,500 7,500
270 19/6/2015 NURSANTI 15,000 10,000 7,500 7,500
271 LUKMAN 25,000 12,500 12,500
272 RISMA 30,000 15,000 15,000
273 IVA 70,000 35,000 35,000
274 YANI 30,000 15,000 15,000
275 KEMAL 25,000 12,500 12,500
276 20/6/2015 WINDA 30,000 15,000 15,000
277 IKA 70,000 10,000 35,000 35,000
278 NASHITA 35,000 10,000 17,500 17,500
279 YUYUN 70,000 35,000 35,000
280 ALIYA 30,000 15,000 15,000
281 RAISSA 25,000 12,500 12,500
282 AURELLIA 15,000 7,500 7,500
283 MARYATI 30,000 10,000 15,000 15,000
284 ROHAENI 60,000 10,000 30,000 30,000
285 WIWIN 40,000 20,000 20,000
286 AJENG 30,000 15,000 15,000
287 MELIYANI 30,000 15,000 15,000
288 NANI 30,000 10,000 15,000 15,000
289 M ADNAN 25,000 12,500 12,500
290 SASKIA 70,000 35,000 35,000
291 22/6/2015 EDDY 70,000 35,000 35,000
292 RENATA 30,000 15,000 15,000
293 DADANG 30,000 15,000 15,000
294 MUTIA 30,000 10,000 15,000 15,000
295 ICHSAN 70,000 35,000 35,000
296 BUDI 30,000 15,000 15,000
297 HERNI 70,000 35,000 35,000
298 UBI DARSONO 15,000 7,500 7,500
299 AJENG 30,000 15,000 15,000
300 SETIANTO 70,000 35,000 35,000
301 M SYAHID 25,000 10,000 12,500 12,500
302 SALWA F 35,000 10,000 17,500 17,500
303 22/6/2015 IWAN 40,000 20,000 20,000
304 POPON 30,000 15,000 15,000
305 ENDAH 70,000 35,000 35,000
306 HADIJAH 40,000 20,000 20,000
307 GANJAR 40,000 20,000 20,000
308 AHMAD 70,000 35,000 35,000
309 23/6/2015 NAIFA 35,000 17,500 17,500
310 ALFIN 25,000 12,500 12,500
311 MISCHA 15,000 10,000 7,500 7,500
312 23/6/2015 QONIAH 35,000 17,500 17,500
313 DEFI ANGGRAENI 30,000 15,000 15,000
314 VERA N 15,000 7,500 7,500
315 NY ELIS 30,000 15,000 15,000
316 RIFAN 15,000 10,000 7,500 7,500
317 NY AI MIMIN 15,000 10,000 7,500 7,500
318 24/6/2015 SABRINI 30,000 10,000 15,000 15,000
319 LATIFAH 30,000 15,000 15,000
320 NY SUMIRAT 30,000 10,000 15,000 15,000
321 AYANG A 30,000 10,000 15,000 15,000
322 SRI H 30,000 10,000 15,000 15,000
323 M CHANDRA 15,000 7,500 7,500
324 NY SITI S 15,000 10,000 7,500 7,500
325 R HENI 30,000 10,000 15,000 15,000
326 NY SITI H 70,000 10,000 35,000 35,000
327 AISHA 70,000 10,000 35,000 35,000
328 SHABRINA 30,000 10,000 15,000 15,000
329 JUJU 70,000 35,000 35,000
330 TUTY 70,000 35,000 35,000
331 REVI 30,000 15,000 15,000
332 M FEBRIANA 30,000 15,000 15,000
333 SUNAINI 40,000 20,000 20,000
334 KHANSA 30,000 15,000 15,000
335 RATNA SULISTIANI 30,000 15,000 15,000
336 25/6/2015 NIDA 70,000 35,000 35,000
337 M ZAKI 25,000 12,500 12,500
338 SUSANTI 30,000 15,000 15,000
339 M HYLAL 70,000 35,000 35,000
340 ROCHMAWATI 40,000 20,000 20,000
341 IIS YULIAH 15,000 7,500 7,500
342 GABRIEL 70,000 35,000 35,000
343 OKKE 70,000 35,000 35,000
344 RIANI 70,000 35,000 35,000
345 SRI S 15,000 10,000 7,500 7,500
346 RISMA 70,000 35,000 35,000
347 SURANI 70,000 35,000 35,000
348 YENI 15,000 10,000 7,500 7,500
349 IWAN 70,000 35,000 35,000
350 26/6/2015 LINDA 70,000 35,000 35,000
351 TUTY S 15,000 7,500 7,500
352 LADIYA 35,000 17,500 17,500
353 LALAN 40,000 20,000 20,000
354 YANI 40,000 20,000 20,000
355 DEA 30,000 15,000 15,000
356 DIAN 15,000 7,500 7,500
357 27/6/20156 DIANA HANDAYANI 70,000 35,000 35,000
358 ANDI 60,000 30,000 30,000
359 ALIYYA 70,000 35,000 35,000
360 DEBORAH 70,000 35,000 35,000
361 WIWK 70,000 35,000 35,000
362 NAIFA 70,000 35,000 35,000
363 HERIYATNO 70,000 35,000 35,000
364 FABIAN 30,000 15,000 15,000
365 WINDA 40,000 20,000 20,000
366 RAISA 30,000 15,000 15,000
367 27/6/2015 AJENG 30,000 15,000 15,000
368 M CHANDRA 15,000 7,500 7,500
369 NANI 30,000 15,000 15,000
370 WIWIN 60,000 30,000 30,000
371 DADANG 15,000 10,000 7,500 7,500
372 WIWIN W 70,000 35,000 35,000
373 IKA 70,000 35,000 35,000
374 AISYA 35,000 17,500 17,500
375 RATNA 35,000 17,500 17,500
376 YULIYANTO 30,000 10,000 15,000 15,000
377 29/6/2015 SUKAMAYA 60,000 10,000 30,000 30,000
378 SITI S 60,000 10,000 30,000 30,000
379 BUDI 30,000 15,000 15,000
380 GABRIEL DWI 30,000 10,000 15,000 15,000
381 MULIANTORO 30,000 10,000 15,000 15,000
382 KANTI 35,000 10,000 17,500 17,500
383 ANNE 35,000 17,500 17,500
384 AJENG 35,000 17,500 17,500
385 FENI AYU 30,000 15,000 15,000
386 EDDY 70,000 35,000 35,000
387 YUYUN 30,000 15,000 15,000
388 AYANG 30,000 15,000 15,000
389 AI MIMI 15,000 10,000 7,500 7,500
390 YENI 70,000 35,000 35,000
391 MARSHA 15,000 7,500 7,500
392 IWAN 70,000 35,000 35,000
393 IVA 30,000 15,000 15,000
394 GANJAR 70,000 35,000 35,000
395 HODIJAH 70,000 35,000 35,000
396 30/6/2015 TRIYUII 70,000 35,000 35,000
397 PUTRI 60,000 30,000 30,000
398 M HASAN 30,000 15,000 15,000
399 ASEP 15,000 10,000 7,500 7,500
400 HARUN 60,000 30,000 30,000
401 ELIS S 70,000 35,000 35,000
402 EVI 70,000 35,000 35,000
403 KANIA 30,000 10,000 15,000 15,000
404 DEFI 30,000 15,000 15,000
405 ASRI 70,000 35,000 35,000
406 RATNA 30,000 15,000 15,000
407 DADANG 30,000 15,000 15,000
408 DIDIK 30,000 15,000 15,000
409 30,000 10,000 15,000 15,000
410 60,000 10,000 30,000 30,000
411 15,000 10,000 7,500 7,500
412 30,000 15,000 15,000
413 70,000 35,000 35,000
414 30,000 10,000 15,000 15,000
415 30,000 15,000 15,000
416 25,000 12,500 12,500
417 30,000 15,000 15,000
418 15,000 10,000 7,500 7,500
419 70,000 35,000 35,000
420 30,000 10,000 15,000 15,000
421 15,000 10,000 7,500 7,500
422 30,000 15,000 15,000
423 30,000 15,000 15,000
424 15,000 10,000 7,500 7,500
425 60,000 10,000 30,000 30,000
426 15,000 10,000 7,500 7,500
427 15,000 10,000 7,500 7,500
428 15,000 10,000 7,500 7,500
429 15,000 10,000 7,500 7,500
430 70,000 35,000 35,000
431 70,000 35,000 35,000
432 70,000 35,000 35,000
433 70,000 35,000 35,000
434 70,000 10,000 35,000 35,000
435 70,000 35,000 35,000
436 30,000 15,000 15,000
437 30,000 10,000 15,000 15,000
438 30,000 15,000 15,000
439 30,000 15,000 15,000
440 30,000 15,000 15,000
441 70,000 35,000 35,000
442 30,000 15,000 15,000
443 70,000 35,000 35,000
444 35,000 17,500 17,500
445 70,000 35,000 35,000
446 30,000 15,000 15,000
447 30,000 15,000 15,000
448 40,000 20,000 20,000
449 40,000 20,000 20,000
450 40,000 20,000 20,000
451 15,000 10,000 7,500 7,500
452 30,000 10,000 15,000 15,000
453 60,000 10,000 30,000 30,000
454 70,000 35,000 35,000
455 30,000 15,000 15,000
456 30,000 15,000 15,000
457 30,000 15,000 15,000
18,390,000 980,000 9,195,000 9,195,000
JML KET
20,000
200,000
190,000
200,000
200,000
200,000
60,000
100,000
100,000
100,000
200,000
200,000
200,000
200,000
200,000
200,000
60,000 ALFA
20,000
20,000
120,000 ALFA
20,000
100,000
200,000
50,000
95,000
25,000
20,000
45,000
200,000
70,000 ALFA
60,000
20,000
50,000
45,000
20,000
25,000
110,000
60,000 YYSN
100,000
250,000
70,000 ALFA
20,000
200,000
20,000
40,000
100,000
50,000
110,000
260,000
50,000
200,000
80,000
5,555,000
JML KET
70,000
30,000
30,000
30,000
70,000
40,000
70,000
70,000
30,000
60,000
25,000
40,000
30,000
40,000
25,000
70,000
40,000
15,000
70,000
15,000
70,000
15,000
70,000
25,000
25,000
30,000
60,000
70,000
30,000
30,000
70,000
40,000
30,000
70,000
70,000
40,000
30,000
30,000
70,000
70,000
30,000
30,000
15,000
15,000
30,000
30,000
70,000
15,000
70,000
30,000
25,000
70,000
15,000
30,000
30,000
70,000
15,000
15,000
30,000
35,000
70,000
70,000
30,000
30,000
15,000
25,000
30,000
30,000
30,000
40,000
70,000
40,000
70,000
70,000
60,000
40,000
40,000
70,000
40,000
15,000
40,000
40,000
70,000
40,000
25,000
35,000
40,000
70,000
30,000
15,000
25,000
25,000
25,000
40,000
30,000
30,000
70,000
70,000
70,000
70,000
30,000
35,000
15,000
40,000
15,000
25,000
60,000
25,000
30,000
45,000
30,000
40,000
15,000
15,000
30,000
35,000
25,000
40,000
70,000
40,000
40,000
70,000
15,000
70,000
25,000
30,000
40,000
25,000
40,000
70,000
30,000
30,000
25,000
30,000
30,000
30,000
30,000
60,000
40,000
40,000
30,000
15,000
15,000
15,000
25,000
70,000
15,000
70,000
15,000
70,000
60,000
40,000
25,000
15,000
30,000
35,000
60,000
70,000
70,000
30,000
15,000
40,000
30,000
15,000
70,000
30,000
15,000
15,000
70,000
40,000
30,000
70,000
60,000
70,000
70,000
70,000
30,000
70,000
30,000
30,000
60,000
15,000
35,000
70,000
30,000
70,000
25,000
70,000
40,000
15,000
70,000
70,000
70,000
70,000
30,000
30,000
45,000
45,000
70,000
15,000
25,000
15,000
30,000
25,000
25,000
50,000
30,000
25,000
30,000
25,000
25,000
30,000
30,000
70,000
15,000
30,000
30,000
40,000
60,000
40,000
15,000
35,000
25,000
70,000
70,000
70,000
60,000
30,000
70,000
35,000
60,000
30,000
35,000
40,000
30,000
70,000
70,000
60,000
40,000
70,000
70,000
70,000
70,000
30,000
30,000
70,000
30,000
40,000
30,000
60,000
35,000
60,000
15,000
35,000
30,000
70,000
70,000
70,000
30,000
30,000
25,000
40,000
35,000
25,000
25,000
25,000
25,000
70,000
25,000
25,000
25,000
30,000
70,000
30,000
25,000
30,000
80,000
45,000
70,000
30,000
25,000
15,000
40,000
70,000
40,000
30,000
30,000
40,000
25,000
70,000
70,000
30,000
30,000
40,000
70,000
30,000
70,000
15,000
30,000
70,000
35,000
45,000
40,000
30,000
70,000
40,000
40,000
70,000
35,000
25,000
25,000
35,000
30,000
15,000
30,000
25,000
25,000
40,000
30,000
40,000
40,000
40,000
15,000
25,000
40,000
80,000
80,000
40,000
70,000
70,000
30,000
30,000
40,000
30,000
30,000
70,000
25,000
30,000
70,000
40,000
15,000
70,000
70,000
70,000
25,000
70,000
70,000
25,000
70,000
70,000
15,000
35,000
40,000
40,000
30,000
15,000
70,000
60,000
70,000
70,000
70,000
70,000
70,000
30,000
40,000
30,000
30,000
15,000
30,000
60,000
25,000
70,000
70,000
35,000
35,000
40,000
70,000
70,000
30,000
40,000
40,000
45,000
35,000
35,000
30,000
70,000
30,000
30,000
25,000
70,000
15,000
70,000
30,000
70,000
70,000
70,000
60,000
30,000
25,000
60,000
70,000
70,000
40,000
30,000
70,000
30,000
30,000
30,000
40,000
70,000
25,000
30,000
70,000
40,000
30,000
25,000
30,000
25,000
70,000
40,000
25,000
30,000
30,000
25,000
70,000
25,000
25,000
25,000
25,000
70,000
70,000
70,000
70,000
80,000
70,000
30,000
40,000
30,000
30,000
30,000
70,000
30,000
70,000 -
35,000 -
70,000 -
30,000 -
30,000 -
40,000 -
40,000 -
40,000 -
25,000 -
40,000 -
70,000 -
70,000 -
30,000 -
30,000 -
30,000 -
19,370,000 -
PERIODE JUlI 2015
JASA ALAT &

DOKTER BAHAN
1 2/7/2015 TRI LESTARI 50,000 5,000 22,500 22,500
2 RIANA 20,000 5,000 7,500 7,500
3 MARSITI 150,000 5,000 72,500 72,500
4 ENDAH 200,000 5,000 97,500 97,500
5 AYU 60,000 5,000 27,500 27,500
6 TRI ALDI 20,000 5,000 7,500 7,500
7 MONI 200,000 5,000 97,500 97,500
8 4/7/2015 RIDA 55,000 5,000 25,000 25,000
9 ALDI 55,000 5,000 25,000 25,000
10 USEP S 200,000 5,000 97,500 97,500
11 DIYAR GINANJAR 200,000 5,000 97,500 97,500
12 5/7/2015 RIZAL 50,000 5,000 22,500 22,500
13 6/7/2015 SRI H 320,000 5,000 157,500 157,500
14 MORIS 200,000 5,000 97,500 97,500
15 ANGGA 20,000 5,000 7,500 7,500
16 7/7/2015 DONI 200,000 5,000 97,500 97,500
17 M CHANDRA 1,000,000 5,000 497,500 497,500
18 8/7/2015 AYU 280,000 5,000 137,500 137,500
19 ASEP 150,000 5,000 72,500 72,500
20 9/7/2015 IRFAN 50,000 5,000 22,500 22,500
21 NITA 350,000 5,000 172,500 172,500
22 11/7/2015 NITA 300,000 5,000 147,500 147,500
23 NY SUNARTI 200,000 5,000 97,500 97,500
24 13/7/2015 RUDI S 100,000 5,000 47,500 47,500
25 23/7/2015 YASMIN 100,000 5,000 47,500 47,500
26 ARGI 250,000 5,000 122,500 122,500
27 NISYAN 80,000 5,000 37,500 37,500
28 24/7/2015 YAYAH 200,000 5,000 97,500 97,500
29 25/7/2015 GULAM 100,000 5,000 47,500 47,500
30 CICIH 300,000 5,000 147,500 147,500
31 YUNITA 40,000 5,000 17,500 17,500
32 27/7/2015 ARDANESIA 70,000 5,000 32,500 32,500
33 SOLAM 25,000 5,000 10,000 10,000
34 28/7/2015 WIDIYAH 100,000 5,000 47,500 47,500
35 30/7/2015 RATIH 200,000 5,000 97,500 97,500
36 31/7/2015 SUPRAYETNO 400,000 5,000 197,500 197,500
37 NY DAHLIA 45,000 5,000 20,000 20,000
38 ANJUN 20,000 5,000 7,500 7,500
6,360,000 190,000 3,085,000 3,085,000

PERIODE JULI 2015
JASA ALAT &

TGL NAMA TARIF OBAT
DOKTER BAHAN
1 1/7/2015 NIKEN 30,000 10,000 15,000 15,000
2 WAWAN 60,000 10,000 30,000 30,000
3 GEUGEU 15,000 10,000 7,500 7,500
4 HENI 30,000 15,000 15,000
5 WARNY 70,000 35,000 35,000
6 KATHERINE 30,000 15,000 15,000
7 SRI HANDAYANI 30,000 10,000 15,000 15,000
8 ALIIYYA 25,000 12,500 12,500
9 RAISSA 30,000 15,000 15,000
10 YASMIN 15,000 10,000 7,500 7,500
11 SUMAINI 70,000 35,000 35,000
12 KHANSA 30,000 10,000 15,000 15,000
13 ZASA 15,000 10,000 7,500 7,500
14 LILIS 30,000 10,000 15,000 15,000
15 TUTY 15,000 7,500 7,500
16 REVI 40,000 20,000 20,000
17 SHOBRINA 30,000 10,000 15,000 15,000
18 JUJU 70,000 35,000 35,000
19 SUSI 70,000 10,000 35,000 35,000
20 NENI 30,000 10,000 15,000 15,000
21 2/7/2015 SUSANTI DEWI 30,000 15,000 15,000
22 HYLAL 70,000 35,000 35,000
23 ROCHMAWATI 70,000 35,000 35,000
24 FEMMY 35,000 17,500 17,500
25 TUTY 15,000 7,500 7,500
26 M SYABANI 35,000 17,500 17,500
27 MARETA NOVI 70,000 35,000 35,000
28 RISMA 70,000 35,000 35,000
29 KHAIRUNNISA 70,000 35,000 35,000
30 ASEP S 15,000 10,000 7,500 7,500
31 RITA 70,000 35,000 35,000
32 KUNTO 15,000 10,000 7,500 7,500
33 IVA 30,000 15,000 15,000
34 SOPI 70,000 35,000 35,000
35 SRI S 15,000 10,000 7,500 7,500
36 3/7/2015 CECE 60,000 30,000 30,000
37 SITI NURJANAH 70,000 35,000 35,000
38 KEMAL 70,000 35,000 35,000
39 SINATRYA 30,000 15,000 15,000
40 ANNE 70,000 35,000 35,000
41 SULTAN 70,000 35,000 35,000
42 ENDAH 70,000 35,000 35,000
43 TINI 70,000 35,000 35,000
44 RISTON 15,000 7,500 7,500
45 USEP 70,000 35,000 35,000
46 4/7/2015 BUDIONO 15,000 10,000 7,500 7,500
47 ETY 30,000 15,000 15,000
48 NURAINA 30,000 15,000 15,000
49 KEMAL 70,000 35,000 35,000
50 SULTAN 70,000 35,000 35,000
51 SINATRYA 70,000 35,000 35,000
52 USEP SAEPUDIN 70,000 35,000 35,000
53 DIYAR GINANJAR 70,000 35,000 35,000
54 SOBO 15,000 10,000 7,500 7,500
55 DINI 60,000 10,000 30,000 30,000
56 ANJAR 15,000 7,500 7,500
57 YANI 70,000 35,000 35,000
58 RATNA DEWI 30,000 10,000 15,000 15,000
59 NANI 30,000 10,000 15,000 15,000
60 AJENG 30,000 15,000 15,000
61 SLAMAT 30,000 10,000 15,000 15,000
62 DADANG 30,000 10,000 15,000 15,000
63 6/7/2015 FENI AYU 30,000 15,000 15,000
64 ALIYYA 30,000 15,000 15,000
65 RAISA 30,000 15,000 15,000
66 SRI HANDAYANI 30,000 10,000 15,000 15,000
67 EDDY 70,000 35,000 35,000
68 ANDHIKA 15,000 7,500 7,500
69 ANNE K 70,000 35,000 35,000
70 RUSLANA 15,000 10,000 7,500 7,500
71 SARBINI 30,000 15,000 15,000
72 KANTI 70,000 35,000 35,000
73 TRI Y 70,000 35,000 35,000
74 RUDI S 15,000 10,000 7,500 7,500
75 YENI 70,000 35,000 35,000
76 DUKEN 30,000 15,000 15,000
77 ALTHAE 30,000 15,000 15,000
78 MONA 30,000 15,000 15,000
79 7/7/2015 DONI 15,000 7,500 7,500
80 JENI 35,000 17,500 17,500
81 NADIA 35,000 17,500 17,500
82 HENDI S 15,000 10,000 7,500 7,500
83 EMA A 40,000 20,000 20,000
84 EVAN 15,000 10,000 7,500 7,500
85 DEFI 30,000 15,000 15,000
86 ELIS 30,000 10,000 15,000 15,000
87 NENO 15,000 10,000 7,500 7,500
88 8/7/2015 SLAMAT 15,000 10,000 7,500 7,500
89 DARNI 60,000 10,000 30,000 30,000
90 GABRIEL 70,000 35,000 35,000
91 CANDRA 70,000 35,000 35,000
92 SUNARTO 70,000 10,000 35,000 35,000
93 M SEPTIAN 70,000 35,000 35,000
94 ASTI 70,000 35,000 35,000
95 M RAMDAN 35,000 17,500 17,500
96 LILIS 60,000 10,000 30,000 30,000
97 UBI 60,000 10,000 30,000 30,000
98 ARINI 15,000 7,500 7,500
99 SHOBRINA 30,000 15,000 15,000
100 JUJU 70,000 35,000 35,000
101 ARAN 60,000 30,000 30,000
102 GINA 15,000 10,000 7,500 7,500
103 REVI 70,000 35,000 35,000
104 TUTI 15,000 10,000 7,500 7,500
105 KHANSA 40,000 20,000 20,000
106 9/7/2015 SUSANTI 30,000 15,000 15,000
107 ROCHMAWATI 30,000 15,000 15,000
108 KEMAL 70,000 35,000 35,000
109 REFA 15,000 10,000 7,500 7,500
110 RAGA 15,000 10,000 7,500 7,500
111 NIKEN 30,000 15,000 15,000
112 M SYABANI 35,000 17,500 17,500
113 JEMI 35,000 17,500 17,500
114 SRI S 70,000 35,000 35,000
115 TARSINAH 70,000 35,000 35,000
116 PUAN 25,000 12,500 12,500
117 CHOLI 30,000 15,000 15,000
118 IVA 70,000 35,000 35,000
119 NOVEN 70,000 35,000 35,000
120 MERA 70,000 35,000 35,000
121 TITIN 70,000 35,000 35,000
122 SAMSUL 15,000 7,500 7,500
123 TRI Y 30,000 15,000 15,000
124 GIZA 30,000 15,000 15,000
125 10/7/2015 IRFAN 35,000 17,500 17,500
126 MARETA 70,000 35,000 35,000
127 AFIANI 70,000 35,000 35,000
128 RIA KUSUMA 60,000 30,000 30,000
129 SAERUL 35,000 17,500 17,500
130 ANNE 70,000 35,000 35,000
131 INTAN 30,000 10,000 15,000 15,000
132 KEMAL 70,000 35,000 35,000
133 10/7/2015 IWAN 70,000 35,000 35,000
134 11/7/2015 RIA KUSUMA 60,000 30,000 30,000
135 AFIANI 70,000 35,000 35,000
136 NURAINI 30,000 15,000 15,000
137 IVA RAIVNI 30,000 15,000 15,000
138 ETY KUSTIANI 30,000 15,000 15,000
139 INTAN 30,000 15,000 15,000
140 SRI HANDAYANI 30,000 15,000 15,000
141 ANNE KRISTIATI 70,000 35,000 35,000
142 11/7/2015 RIZLA A 35,000 10,000 17,500 17,500
143 TN DADANG 30,000 15,000 15,000
144 NY MELIYANI 30,000 10,000 15,000 15,000
145 R HENI 30,000 15,000 15,000
146 13/7/2015 FENI AYU 30,000 15,000 15,000
147 ANISA V 35,000 17,500 17,500
148 M AZRA 70,000 10,000 35,000 35,000
149 RUDI S 30,000 10,000 15,000 15,000
150 TN EDDY 70,000 35,000 35,000
151 NY AI S 70,000 35,000 35,000
152 AYANG A 30,000 10,000 15,000 15,000
153 SARBINI 40,000 20,000 20,000
154 WIWIN H 30,000 10,000 15,000 15,000
155 13/7/2015 ANF TAUFIH 70,000 35,000 35,000
156 ANIDHA 30,000 15,000 15,000
157 RISTI 35,000 17,500 17,500
158 REFANA 50,000 25,000 25,000
159 WIDYA 60,000 30,000 30,000
160 SUMARYO 70,000 35,000 35,000
161 CELIA 35,000 17,500 17,500
162 14/7/2015 NOVIA 70,000 35,000 35,000
163 NAJWA 70,000 35,000 35,000
164 SOPANDI 70,000 35,000 35,000
165 MUTIA 30,000 15,000 15,000
166 TENDI RIZALDI 70,000 35,000 35,000
167 PUTRI 70,000 35,000 35,000
168 BUDI SETIONO 30,000 15,000 15,000
169 TJETJE 70,000 35,000 35,000
170 23/7/2015 M RAIS W 30,000 10,000 15,000 15,000
171 SINTIA 30,000 15,000 15,000
172 ANI SUMARNI 60,000 30,000 30,000
173 AHDIYAT 70,000 35,000 35,000
174 NAYRA 70,000 35,000 35,000
175 24/7/2015 M TESSAR 30,000 15,000 15,000
176 SRI S 70,000 35,000 35,000
177 LUKMAN 35,000 10,000 17,500 17,500
178 SITI A 60,000 30,000 30,000
179 NUR A 30,000 15,000 15,000
180 PUTRI DIKHA 35,000 17,500 17,500
181 25/7/2015 M ZAFAR RI 70,000 35,000 35,000
182 ADEN R 35,000 17,500 17,500
183 TUNIYAH 70,000 35,000 35,000
184 SUMARDI 30,000 15,000 15,000
185 FAISAL 35,000 17,500 17,500
186 WIWI W 70,000 35,000 35,000
187 ASHI P 30,000 15,000 15,000
188 SUGIYONO 15,000 10,000 7,500 7,500
189 27/5/2015 NY SUMIYATI 30,000 10,000 15,000 15,000
190 NIKEN 30,000 10,000 15,000 15,000
191 WIDANINGSIH 15,000 10,000 7,500 7,500
192 TN DWIYANTO 60,000 10,000 30,000 30,000
193 AN N AMIR 35,000 17,500 17,500
194 NOVEN 30,000 10,000 15,000 15,000
195 AN GABRIEL 70,000 35,000 35,000
196 27/7/2015 QUINSHA 70,000 35,000 35,000
197 SALWA 15,000 7,500 7,500
198 IRFAN 15,000 10,000 7,500 7,500
199 ALFI 25,000 12,500 12,500
200 WAHID 15,000 100,000 7,500 7,500
201 DEDI 30,000 15,000 15,000
202 NANDHITA 30,000 15,000 15,000
203 FERI 30,000 15,000 15,000
204 28/7/2015 DJENAB 30,000 15,000 15,000
205 ADE AZIS 70,000 35,000 35,000
206 RATIH 70,000 35,000 35,000
207 NURAINI 30,000 15,000 15,000
208 WIDIYAH 30,000 15,000 15,000
209 ABBY 15,000 7,500 7,500
210 HANIPAH 15,000 10,000 7,500 7,500
211 BUNGA OLIVIA 70,000 35,000 35,000
212 YAMARDI 70,000 35,000 35,000
213 WENI 70,000 35,000 35,000
214 28/72015 MOCH AZRA 30,000 10,000 15,000 15,000
215 AJENG DWI 30,000 15,000 15,000
216 RANGGA MAULANA 15,000 10,000 7,500 7,500
217 JAHJA ANWAR 70,000 35,000 35,000
218 DARMAN RAHIMAT 15,000 10,000 7,500 7,500
219 LANIWAH 70,000 35,000 35,000
220 DIDIK 40,000 20,000 20,000
221 HERMAN 15,000 10,000 7,500 7,500
222 NY AI 70,000 35,000 35,000
223 29/7/2015 NY ELAH 70,000 35,000 35,000
224 TN IWAN H 15,000 10,000 7,500 7,500
225 NY VICTORIA 70,000 35,000 35,000
226 NAZIHAN M P 60,000 10,000 30,000 30,000
227 SUMARNI 60,000 10,000 30,000 30,000
228 TN ANDI 60,000 10,000 30,000 30,000
229 RIANI K 30,000 10,000 15,000 15,000
230 ELA HAYATI 60,000 10,000 30,000 30,000
231 ASEP S 15,000 7,500 7,500
232 AN YAFFI 30,000 10,000 15,000 15,000
233 29/7/2015 YUSUF AFANDI 15,000 7,500 7,500
234 KIRANA 30,000 15,000 15,000
235 EPI 30,000 15,000 15,000
236 WENI 70,000 35,000 35,000
237 NASHITA 30,000 10,000 15,000 15,000
238 NOVI 70,000 35,000 35,000
239 DEWI 30,000 15,000 15,000
240 NISRINA 25,000 12,500 12,500
241 POPON 70,000 35,000 35,000
242 ELA 70,000 35,000 35,000
243 JUJU 30,000 15,000 15,000
244 SHOBRINA 40,000 20,000 20,000
245 WIWI 30,000 15,000 15,000
246 30/7/2015 WIDIYAH 30,000 15,000 15,000
247 MISCA 15,000 10,000 7,500 7,500
248 DADANG 30,000 15,000 15,000
249 SUMIATY 60,000 30,000 30,000
250 HASNA 25,000 12,500 12,500
251 ABBY 30,000 15,000 15,000
252 RATIH 15,000 7,500 7,500
253 NANI 30,000 15,000 15,000
254 NENENG 60,000 30,000 30,000
255 NISRINA 25,000 12,500 12,500
256 HANIPAH 30,000 15,000 15,000
257 31/7/2015 SUPRAYETNO 15,000 7,500 7,500
258 GEIFHAN 15,000 10,000 7,500 7,500
259 HASNA AGILA 25,000 12,500 12,500
260 INDAH DIANA 15,000 7,500 7,500
261 WIDIYAH 30,000 15,000 15,000
262 MULYATI 15,000 7,500 7,500
263 ARIS MUJIASTIKO 30,000 15,000 15,000
264 WINDA 60,000 30,000 30,000
265 IMAS TIWI 70,000 35,000 35,000
266 31/7/2015 JOSUA 15,000 10,000 7,500 7,500
267 YULI 15,000 10,000 7,500 7,500
268 SRI 30,000 15,000 15,000
269 WASTINI 30,000 15,000 15,000
270 DEWI 15,000 7,500 7,500
271 TUTI 15,000 10,000 7,500 7,500
272 NERMA 30,000 15,000 15,000
273 TARMIJI 15,000 10,000 7,500 7,500
274 ILHAM 15,000 7,500 7,500
275 ILMAN 25,000 12,500 12,500
11,575,000 820,000 5,787,500 5,787,500
JML KET
55,000
25,000
155,000
205,000
65,000
25,000 YYS
205,000
60,000
60,000
205,000
205,000
55,000
325,000
205,000
25,000
205,000
1,005,000
285,000
155,000
55,000
355,000
305,000
205,000
105,000
105,000
255,000
85,000
205,000
105,000
305,000
45,000
75,000
30,000
105,000
205,000
405,000
50,000
25,000
6,550,000
JML KET
40,000
70,000
25,000
30,000
70,000
30,000
40,000
25,000
30,000
25,000
70,000
40,000
25,000
40,000
15,000
40,000
40,000
70,000
80,000
40,000
30,000
70,000
70,000
35,000
15,000
35,000
70,000
70,000
70,000
25,000
70,000
25,000
30,000
70,000
25,000
60,000
70,000
70,000
30,000
70,000
70,000
70,000
70,000
15,000
70,000
25,000
30,000
30,000
70,000
70,000
70,000
70,000
70,000
25,000
70,000
15,000
70,000
40,000
40,000
30,000
40,000
40,000
30,000
30,000
30,000
40,000
70,000
15,000
70,000
25,000
30,000
70,000
70,000
25,000
70,000
30,000
30,000
30,000
15,000
35,000
35,000
25,000
40,000
25,000
30,000
40,000
25,000
25,000
70,000
70,000
70,000
80,000
70,000
70,000
35,000
70,000
70,000
15,000
30,000
70,000
60,000
25,000
70,000
25,000
40,000
30,000
30,000
70,000
25,000
25,000
30,000
35,000
35,000
70,000
70,000
25,000
30,000
70,000
70,000
70,000
70,000
15,000
30,000
30,000
35,000
70,000
70,000
60,000
35,000
70,000
40,000
70,000
70,000
60,000
70,000
30,000
30,000
30,000
30,000
30,000
70,000
45,000
30,000
40,000
30,000
30,000
35,000
80,000
40,000
70,000
70,000
40,000
40,000
40,000
70,000
30,000
35,000
50,000
60,000
70,000
35,000
70,000
70,000
70,000
30,000
70,000
70,000
30,000
70,000
40,000
30,000
60,000
70,000
70,000
30,000
70,000
45,000
60,000
30,000
35,000
70,000
35,000
70,000
30,000
35,000
70,000
30,000
25,000
40,000
40,000
25,000
70,000
35,000
40,000
70,000
70,000
15,000
25,000
25,000
115,000
30,000
30,000
30,000
30,000
70,000
70,000
30,000
30,000
15,000
25,000
70,000
70,000
70,000
40,000
30,000
25,000
70,000
25,000
70,000
40,000
25,000
70,000
70,000
25,000
70,000
70,000
70,000
70,000
40,000
70,000
15,000
40,000
15,000
30,000
30,000
70,000
40,000
70,000
30,000
25,000
70,000
70,000
30,000
40,000
30,000
30,000
25,000
30,000
60,000
25,000
30,000
15,000
30,000
60,000
25,000
30,000
15,000
25,000
25,000
15,000
30,000
15,000
30,000
60,000
70,000
25,000
25,000
30,000
30,000
15,000
25,000
30,000
25,000
15,000
25,000
12,395,000 -
JASA ALAT &

DOKTER BAHAN
1 1/8/2015 RATIH RAHMAWATI 100,000 5,000 47,500 47,500 105,000
2 3/8/2015 TN SALEH 100,000 5,000 47,500 47,500 100,000
3 BAMBANG 350,000 5,000 172,500 172,500 350,000
4 TN S SUJARNA 50,000 5,000 22,500 22,500 50,000
5 5/8/2015 NY NENI ISNAENI 100,000 5,000 47,500 47,500 100,000
6 ASRI 60,000 5,000 27,500 27,500 60,000
7 7/8/2015 ASEP 200,000 5,000 97,500 97,500 200,000
8 8/8/2015 LUTFHIA 150,000 5,000 72,500 72,500 150,000
9 TN HENDI 20,000 5,000 7,500 7,500 20,000
10 YEYEN 30,000 5,000 12,500 12,500 30,000
11 AN AINA 90,000 5,000 42,500 42,500 90,000
12 9/8/2015 RIZAL 200,000 5,000 97,500 97,500 200,000
13 10/8/2015 TN WAHYUDIN 100,000 5,000 47,500 47,500 100,000
14 AISYAH 20,000 5,000 7,500 7,500 20,000
15 ANITA FUJI 50,000 5,000 22,500 22,500 50,000
16 TN S SUJARNA 100,000 5,000 47,500 47,500 100,000
17 10/8/2015 DEWI 200,000 5,000 97,500 97,500 200,000
18 11/8/2015 DINI 20,000 5,000 7,500 7,500 20,000
19 12/8/2015 OVVY 50,000 5,000 22,500 22,500 20,000
20 12/8/2015 NANAN 100,000 5,000 47,500 47,500 100,000
21 13/8/2015 SELLY 60,000 5,000 27,500 27,500 60,000
22 YATI 25,000 5,000 10,000 10,000 25,000
23 14/8/2015 TN JAINUDIN 25,000 5,000 10,000 10,000 25,000
24 15/8/2015 DADANG 20,000 5,000 7,500 7,500 20,000
25 RESTY 300,000 5,000 147,500 147,500 300,000
26 15/8/2015 HENDRA 20,000 5,000 7,500 7,500 20,000
27 TN YANTO 100,000 5,000 47,500 47,500 100,000
28 18/8/2015 NY ELA 200,000 5,000 97,500 97,500 200,000
29 TN VINO 50,000 5,000 22,500 22,500 50,000
30 ANGGUN 20,000 5,000 7,500 7,500 20,000
31 19/8/2015 NY ANI 500,000 5,000 247,500 247,500 500,000
32 20/8/2015 YAYAH 20,000 5,000 7,500 7,500 20,000
33 RIDA 20,000 5,000 7,500 7,500 20,000
34 24/8/2015 YAYAH 20,000 5,000 7,500 7,500 20,000
35 25/8/2015 TN VINO 100,000 5,000 47,500 47,500 100,000
36 ANGGUN 200,000 5,000 97,500 97,500 200,000
37 26/8/2015 NY MIMIN 100,000 5,000 47,500 47,500 100,000
38 26/8/2015 NY YAYAH 50,000 5,000 22,500 22,500 60,000
39 27/8/2015 SELY 60,000 5,000 27,500 27,500 100,000
40 28/8/2015 YAYAH 120,000 5,000 57,500 57,500 120,000
41 IYAN 20,000 5,000 7,500 7,500 20,000
42 MUNIATI 100,000 5,000 47,500 47,500 100,000
43 29/8/2015 RESTI W 300,000 5,000 147,500 147,500 200,000
44 29/8/2015 ALISA DWI 20,000 5,000 7,500 7,500 20,000
45 SETIANTO 100,000 5,000 47,500 47,500 100,000
TOTAL 4,640,000 225,000 2,207,500 2,207,500 4,565,000
JASA ALAT &

TGL NAMA TARIF OBAT JML
DOKTER BAHAN
1 1/8/2015 DADANG 70,000 35,000 35,000 70,000
2 RENATA 70,000 35,000 35,000 70,000
3 WIDANINGSIH 60,000 30,000 30,000 60,000
4 MISCHA 30,000 10,000 15,000 15,000 40,000
5 RATIH R 30,000 15,000 15,000 30,000
6 ARIS MUJIASTIKO 60,000 30,000 30,000 60,000
7 BETSIE 60,000 30,000 30,000 60,000
8 MARYATI 30,000 15,000 15,000 30,000
9 NANI HERLINA 60,000 30,000 30,000 60,000
10 1/8/2015 TN MUHID 60,000 10,000 30,000 30,000 70,000
11 SEPTIAN 70,000 35,000 35,000 70,000
12 ASTI Y 60,000 10,000 30,000 30,000 70,000
13 AJENG D 40,000 20,000 20,000 40,000
14 TN DADANG 30,000 15,000 15,000 30,000
15 NY ELA H 15,000 10,000 7,500 7,500 25,000
16 ROSMAYA 15,000 10,000 7,500 7,500 25,000
17 SARMINI 70,000 35,000 35,000 70,000
18 SRI SURYANTI 30,000 15,000 15,000 30,000
19 ANIS A 15,000 10,000 7,500 7,500 25,000
20 YARMADI 30,000 10,000 15,000 15,000 40,000
21 SRI HANDAYANI 40,000 20,000 20,000 40,000
22 IVA R 60,000 10,000 30,000 30,000 70,000
23 NURAINI 30,000 10,000 15,000 15,000 40,000
24 YUNI S 30,000 15,000 15,000 30,000
25 3/8/2015 BAYU R 15,000 10,000 7,500 7,500 25,000
26 QUINSHA 70,000 35,000 35,000 70,000
27 NAIFA 25,000 12,500 12,500 25,000
28 AGUNG 70,000 35,000 35,000 70,000
29 DADI K 70,000 35,000 35,000 70,000
30 DETI 30,000 10,000 15,000 15,000 40,000
31 NADHITA 30,000 10,000 15,000 15,000 40,000
32 4/8/2015 SRI 15,000 7,500 7,500 15,000
33 SARMINI 30,000 10,000 15,000 15,000 40,000
34 REVAN 30,000 10,000 15,000 15,000 40,000
35 KASMA 30,000 10,000 15,000 15,000 40,000
36 KHOTIMAH 40,000 20,000 20,000 40,000
37 ENENG SRI 30,000 10,000 15,000 15,000 40,000
38 MULYADI 15,000 10,000 7,500 7,500 25,000
39 MAULIDA 25,000 12,500 12,500 25,000
40 NURHAYATI 15,000 10,000 7,500 7,500 25,000
41 ENING 15,000 10,000 7,500 7,500 25,000
42 4/8/2015 NY AI 70,000 35,000 35,000 70,000
43 ASEP KUSNADI 70,000 35,000 35,000 70,000
44 NY YULI 30,000 15,000 15,000 30,000
45 RAIHAN 30,000 10,000 15,000 15,000 40,000
46 NY ELIS 30,000 10,000 15,000 15,000 40,000
47 BERNADETA 35,000 17,500 17,500 35,000
48 JAHJA 70,000 35,000 35,000 70,000
49 NY DEWI 15,000 10,000 7,500 7,500 25,000
50 CHAIRYLY 15,000 10,000 7,500 7,500 25,000
51 SUPRIADI 15,000 10,000 7,500 7,500 25,000
52 NAUFAL 15,000 7,500 7,500 15,000
53 5/8/2015 WIDYA P 15,000 10,000 7,500 7,500 25,000
54 FAIZ 30,000 10,000 15,000 15,000 40,000
55 VICTORIA 30,000 10,000 15,000 15,000 40,000
56 SITI 70,000 35,000 35,000 70,000
57 NY OOM 30,000 10,000 15,000 15,000 40,000
58 TN M NURDIN 15,000 10,000 7,500 7,500 25,000
59 AN YAFFI 30,000 15,000 15,000 30,000
60 TN ARIN 30,000 10,000 15,000 15,000 40,000
61 KHOTIMAH 30,000 15,000 15,000 30,000
62 5/8/2015 RASID 70,000 35,000 35,000 70,000
63 NUNU AHMAD 70,000 35,000 35,000 70,000
64 AN KARTIKA SYAH 15,000 7,500 7,500 15,000
65 NY EUIS 30,000 10,000 15,000 15,000 40,000
66 RAFIF 70,000 35,000 35,000 70,000
67 YAYAN 15,000 10,000 7,500 7,500 25,000
68 NENI 35,000 17,500 17,500 35,000
69 PUSPA SEPTI 35,000 17,500 17,500 35,000
70 HASBI 30,000 15,000 15,000 30,000
71 NY ELA 70,000 35,000 35,000 70,000
72 6/8/2015 ZAENAL M 60,000 30,000 30,000 60,000
73 APRIZAL 35,000 17,500 17,500 35,000
74 M SOLIHIN 60,000 30,000 30,000 60,000
75 DARMAYATI 60,000 30,000 30,000 60,000
76 SUSI B 60,000 30,000 30,000 60,000
77 ULIS 30,000 15,000 15,000 30,000
78 NANI 60,000 30,000 30,000 60,000
79 MISCHA 30,000 15,000 15,000 30,000
80 SUHAMAJA 60,000 30,000 30,000 60,000
81 WIDHYA 30,000 15,000 15,000 30,000
82 6/8/2015 MARYATI 30,000 15,000 15,000 30,000
83 ETY K 30,000 15,000 15,000 30,000
84 TITIN 15,000 7,500 7,500 15,000
85 WINDA 70,000 35,000 35,000 70,000
86 TRI H 40,000 20,000 20,000 40,000
87 KANIA 15,000 10,000 7,500 7,500 25,000
88 TITA 70,000 35,000 35,000 70,000
89 KOMARIAH 15,000 10,000 7,500 7,500 25,000
90 MYSHELLA 30,000 10,000 15,000 15,000 40,000
91 UCU 30,000 15,000 15,000 30,000
92 JUJU 30,000 15,000 15,000 30,000
93 SHOBRINA 30,000 15,000 15,000 30,000
94 SUKARNA 70,000 35,000 35,000 70,000
95 7/8/2015 IMAS MASTUTI 30,000 10,000 15,000 15,000 40,000
96 ADE MULYANA 15,000 7,500 7,500 15,000
97 FRANULUS 70,000 35,000 35,000 70,000
98 RATIH R 30,000 15,000 15,000 30,000
99 FAREL 25,000 12,500 12,500 25,000
100 NISRINA 15,000 7,500 7,500 15,000
101 RENI 15,000 7,500 7,500 15,000
102 REFANA 40,000 20,000 20,000 35,000
103 SUSI 20,000 10,000 10,000 20,000
104 7/8/2015 ASEP W 15,000 10,000 7,500 7,500 25,000
105 SRI 30,000 15,000 15,000 30,000
106 NENG 15,000 7,500 7,500 15,000
107 RAIHAN 30,000 15,000 15,000 30,000
108 YULI 15,000 7,500 7,500 15,000
109 PURI 15,000 7,500 7,500 15,000
110 MISCHA 15,000 7,500 7,500 15,000
111 ASEPS 30,000 15,000 15,000 30,000
112 RISNA 30,000 15,000 15,000 30,000
113 KIRANA 40,000 20,000 20,000 40,000
114 BUDI 15,000 7,500 7,500 15,000
115 8/8/2015 NURAENI 30,000 15,000 15,000 30,000
116 ETY 30,000 15,000 15,000 30,000
117 TITIN 15,000 7,500 7,500 15,000
118 MARYATI 30,000 15,000 15,000 30,000
119 WINDA 70,000 35,000 35,000 70,000
120 MISCHA 30,000 15,000 15,000 30,000
121 8/8/2015 NUR ALFIANTI 30,000 10,000 15,000 15,000 40,000
122 RESTI F 35,000 17,500 17,500 35,000
123 CHESYA T 25,000 12,500 12,500 25,000
124 P DIDIK 30,000 10,000 15,000 15,000 40,000
125 FAIZ 30,000 15,000 15,000 30,000
126 TN DADANG 40,000 20,000 20,000 40,000
127 10/8/2015 NY SALIMAH 30,000 15,000 15,000 30,000
128 ASTI Y 30,000 15,000 15,000 30,000
129 SOBIRIN 30,000 10,000 15,000 15,000 40,000
130 JOHANES 30,000 15,000 15,000 30,000
131 TN EVAN 30,000 10,000 15,000 15,000 40,000
132 NY KOMARIAH 60,000 10,000 30,000 30,000 70,000
133 NY TINI 70,000 35,000 35,000 70,000
134 FAIZ 30,000 10,000 15,000 15,000 40,000
135 NY NANI 30,000 10,000 15,000 15,000 40,000
136 10/8/2015 M RAIS 15,000 10,000 7,500 7,500 25,000
137 NANDHITA 30,000 15,000 15,000 30,000
138 QUINSHA 70,000 35,000 35,000 70,000
139 DELI 30,000 15,000 15,000 30,000
140 RICKY 30,000 15,000 15,000 30,000
141 DEWI M 70,000 35,000 35,000 70,000
142 AULIA 25,000 12,500 12,500 25,000
143 KANIA 30,000 15,000 15,000 30,000
144 RIDANI 25,000 12,500 12,500 25,000
145 11/8/2015 YADI 15,000 10,000 7,500 7,500 25,000
146 TRI H 70,000 35,000 35,000 70,000
147 AYU 30,000 15,000 15,000 30,000
148 SAERUL 15,000 10,000 7,500 7,500 25,000
149 FX 70,000 35,000 35,000 70,000
150 ADITYA 70,000 35,000 35,000 70,000
151 SUSI 30,000 15,000 15,000 30,000
152 KIRAN 15,000 10,000 7,500 7,500 25,000
153 AJENG 70,000 35,000 35,000 70,000
154 KARINA 30,000 15,000 15,000 30,000
155 A SUMARNA 15,000 10,000 7,500 7,500 25,000
156 ENENG 30,000 15,000 15,000 30,000
157 WARTINI 70,000 35,000 35,000 70,000
158 SARANI 30,000 15,000 15,000 30,000
159 11/8/2015 NY ELIS SUINAR 30,000 15,000 15,000 30,000
160 BP JAHJA ANWAR 70,000 35,000 35,000 70,000
161 HASBI 30,000 15,000 15,000 30,000
162 NY ELA 70,000 35,000 35,000 70,000
163 RASID 70,000 35,000 35,000 70,000
164 FENI AYU 30,000 15,000 15,000 30,000
165 NY AI 70,000 35,000 35,000 70,000
166 TN DADANG 70,000 35,000 35,000 70,000
167 NOVIA 70,000 35,000 35,000 70,000
168 12/8/2015 TN BUDI 30,000 15,000 15,000 30,000
169 NURAINI 30,000 15,000 15,000 30,000
170 IRNA F 30,000 10,000 15,000 15,000 40,000
171 SAERUL 35,000 17,500 17,500 35,000
172 TN MULYADI 70,000 35,000 35,000 70,000
173 TN ARIN 15,000 10,000 7,500 7,500 25,000
174 NURDIANA 15,000 7,500 7,500 15,000
175 SHELLY S 70,000 35,000 35,000 70,000
176 JOHANES 70,000 35,000 35,000 70,000
177 WINA 60,000 10,000 30,000 30,000 70,000
178 SARBINI 70,000 35,000 35,000 70,000
179 12/8/2015 NANAN RIANA 70,000 35,000 35,000 70,000
180 TITO RIONI 70,000 35,000 35,000 70,000
181 M FADLIN 70,000 35,000 35,000 70,000
182 WIWI 30,000 15,000 15,000 30,000
183 WAHYUNINGSIH 35,000 17,500 17,500 35,000
184 AI SUHAETI 30,000 15,000 15,000 30,000
185 RURI 15,000 7,500 7,500 15,000
186 AI SONIA 70,000 35,000 35,000 70,000
187 13/8/2015 FX 70,000 35,000 35,000 70,000
188 SUKAESIH 15,000 10,000 7,500 7,500 25,000
189 DINA 70,000 35,000 35,000 70,000
190 TITIN 15,000 10,000 7,500 7,500 25,000
191 NANI 30,000 15,000 15,000 30,000
192 ZAENAL 70,000 35,000 35,000 70,000
193 TANIA 15,000 10,000 7,500 7,500 25,000
194 VICTORIA 30,000 15,000 15,000 30,000
195 13/8/2015 SYAHTORI 25,000 12,500 12,500 25,000
196 FADHILA 25,000 12,500 12,500 25,000
197 IMAS 15,000 10,000 7,500 7,500 25,000
198 RICKY 30,000 10,000 15,000 15,000 40,000
199 IKBAL 25,000 12,500 12,500 25,000
200 TITA 70,000 35,000 35,000 70,000
201 ZAHRA 25,000 12,500 12,500 25,000
202 NANDHITA 25,000 10,000 12,500 12,500 35,000
203 RIFAN 25,000 12,500 12,500 25,000
204 14/8/2015 VIONA 30,000 15,000 15,000 30,000
205 DYASMET 15,000 7,500 7,500 15,000
206 SAEPUDIN 70,000 35,000 35,000 70,000
207 FITRIA 30,000 10,000 15,000 15,000 40,000
208 KHORIMAH 70,000 35,000 35,000 70,000
209 WIDIYA 15,000 7,500 7,500 15,000
210 OOM S 30,000 15,000 15,000 30,000
211 EKO W 30,000 15,000 15,000 30,000
212 MURNI 15,000 7,500 7,500 15,000
213 PUNGUT 15,000 7,500 7,500 15,000
214 ANDINI 15,000 7,500 7,500 15,000
215 TUTI S 70,000 35,000 35,000 70,000
216 REFANA 70,000 35,000 35,000 70,000
217 WIDIYAH 30,000 15,000 15,000 30,000
218 14/8/2015 IYAN 15,000 10,000 7,500 7,500 25,000
219 KIRANA 70,000 35,000 35,000 70,000
220 ASEP 30,000 15,000 15,000 30,000
221 SRI 30,000 15,000 15,000 30,000
222 ASEP S 30,000 15,000 15,000 30,000
223 DETI 40,000 10,000 20,000 20,000 50,000
224 EVA 30,000 15,000 15,000 30,000
225 15/8/2015 LENI 30,000 15,000 15,000 30,000
226 YUYUN 70,000 35,000 35,000 70,000
227 M AZRA 35,000 17,500 17,500 35,000
228 RATIH 30,000 15,000 15,000 30,000
229 ROSTIYANTI 15,000 7,500 7,500 15,000
230 ASTI Y 30,000 15,000 15,000 30,000
231 MAYATI 30,000 15,000 15,000 30,000
232 RIKA 30,000 15,000 15,000 30,000
233 TIARA 30,000 15,000 15,000 30,000
234 15/8/2015 SITI H 30,000 15,000 15,000 30,000
235 NY SARMINI 70,000 10,000 35,000 35,000 80,000
236 TN DADANG 70,000 35,000 35,000 70,000
237 TN AGUS 30,000 15,000 15,000 30,000
238 TN YUSLAN 15,000 7,500 7,500 15,000
239 NOVIA 30,000 10,000 15,000 15,000 40,000
240 SASKIA 35,000 10,000 17,500 17,500 45,000
241 18/8/2015 RUDI 30,000 15,000 15,000 70,000
242 SARI 70,000 35,000 35,000 70,000
243 SRI 30,000 15,000 15,000 30,000
244 ENENG 30,000 15,000 15,000 30,000
245 ZAYN 15,000 7,500 7,500 15,000
246 KARUNIA 30,000 15,000 15,000 30,000
247 WAHYUDI 15,000 10,000 7,500 7,500 25,000
248 18/8/2015 NY HJ SALAMAH 70,000 35,000 35,000 70,000
249 NY SRI ULINA 70,000 35,000 35,000 70,000
250 HASBI 70,000 35,000 35,000 70,000
251 NY NENI 70,000 35,000 35,000 70,000
252 ASEP CAHYADI 15,000 10,000 7,500 7,500 25,000
253 NY AI 70,000 35,000 35,000 70,000
254 RASID 70,000 35,000 35,000 70,000
255 FATIMAH 35,000 17,500 17,500 35,000
256 WAHYUNINGSIH 70,000 35,000 35,000 70,000
257 AEK 15,000 10,000 7,500 7,500 25,000
258 ELIS 30,000 15,000 15,000 30,000
259 JAHJA 70,000 35,000 35,000 70,000
260 ELA 15,000 10,000 7,500 7,500 25,000
261 19/8/2015 NY SITI Z 15,000 10,000 7,500 7,500 25,000
262 SRI YAMAH 15,000 10,000 7,500 7,500 25,000
263 RATNA 70,000 35,000 35,000 70,000
264 NY AI 30,000 15,000 15,000 30,000
265 TN AA 35,000 17,500 17,500 35,000
266 RINA 30,000 10,000 15,000 15,000 40,000
267 FAIZ 30,000 15,000 15,000 30,000
268 ZAYN 15,000 7,500 7,500 15,000
269 ANNISA H 30,000 15,000 15,000 30,000
270 ANDRES 70,000 10,000 35,000 35,000 80,000
271 YAFFI 30,000 15,000 15,000 30,000
272 19/8/2015 TN SOBO 15,000 7,500 7,500 15,000
273 SYANTI 15,000 10,000 7,500 7,500 25,000
274 NY LIM 70,000 35,000 35,000 70,000
275 BISMA 15,000 10,000 7,500 7,500 25,000
276 M HILMI 35,000 17,500 17,500 35,000
277 EGIE 35,000 17,500 17,500 35,000
278 NY ELA 70,000 35,000 35,000 70,000
279 HASBI 70,000 35,000 35,000 70,000
280 IWAN 30,000 10,000 15,000 15,000 40,000
281 LULU 35,000 17,500 17,500 35,000
282 NUR AISAH 35,000 17,500 17,500 35,000
283 NY RITA 30,000 10,000 15,000 15,000 40,000
284 20/8/2015 FX T 70,000 35,000 35,000 70,000
285 BUDI 40,000 20,000 20,000 40,000
286 FARHAN 30,000 15,000 15,000 30,000
287 RAIHAN 70,000 35,000 35,000 70,000
288 NIDYA 15,000 10,000 7,500 7,500 25,000
289 NORADAN 30,000 10,000 15,000 15,000 40,000
290 NORMA 30,000 15,000 15,000 30,000
291 20/8/2015 NADHITA 30,000 10,000 15,000 15,000 40,000
292 DETI 15,000 10,000 7,500 7,500 25,000
293 IVA 30,000 10,000 15,000 15,000 40,000
294 YUNINGSIH 70,000 35,000 35,000 70,000
295 RATU 30,000 15,000 15,000 30,000
296 SURYANI 30,000 15,000 15,000 30,000
297 RICKY 70,000 35,000 35,000 70,000
298 AFIAN 15,000 7,500 7,500 15,000
299 21/8/2015 TUTI 70,000 35,000 35,000 70,000
300 ENTIN 15,000 7,500 7,500 15,000
301 PUNGUT 70,000 35,000 35,000 70,000
302 FITRIA A 30,000 15,000 15,000 45,000
303 FRANCISCUS 70,000 35,000 35,000 70,000
304 SHERLY 30,000 15,000 15,000 30,000
305 RATIH 30,000 15,000 15,000 30,000
306 ANDINI 70,000 35,000 35,000 70,000
307 ASTI Y 30,000 15,000 15,000 30,000
308 ROSYANTI 15,000 7,500 7,500 15,000
309 21/8/2015 FENI 30,000 15,000 15,000 30,000
310 EVAN 40,000 20,000 20,000 40,000
311 ASEP 70,000 35,000 35,000 70,000
312 AGUNG S 30,000 15,000 15,000 30,000
313 SUMIRAH 15,000 10,000 7,500 7,500 25,000
314 ASEP S 30,000 15,000 15,000 30,000
315 TARYANA 15,000 10,000 7,500 7,500 25,000
316 LILIS 70,000 35,000 35,000 70,000
317 FADLI 25,000 12,500 12,500 25,000
318 LULU 15,000 7,500 7,500 15,000
319 ROSANTI 25,000 10,000 12,500 12,500 35,000
320 TANIA 70,000 35,000 35,000 70,000
321 22/8/2015 FADILA 15,000 7,500 7,500 15,000
322 IVANA 25,000 12,500 12,500 25,000
323 RIKA 30,000 15,000 15,000 30,000
324 FADIL 15,000 7,500 7,500 15,000
325 SARTIKA 15,000 7,500 7,500 15,000
326 ETI K 30,000 15,000 15,000 30,000
327 MARYATI 40,000 20,000 20,000 40,000
328 DIDIK 30,000 15,000 15,000 30,000
329 TUTUY 15,000 10,000 7,500 7,500 25,000
330 MEISYA 25,000 12,500 12,500 25,000
331 VANIA SITI 70,000 35,000 35,000 70,000
332 KANIA 30,000 15,000 15,000 30,000
333 ENDANG 15,000 7,500 7,500 15,000
334 22/8/2015 SITI HODIJAH 70,000 35,000 35,000 70,000
335 ANNISA 70,000 35,000 35,000 70,000
336 NY AINUN 30,000 10,000 15,000 15,000 40,000
337 TN JOHANES 30,000 15,000 15,000 30,000
338 NAURIN 70,000 35,000 35,000 70,000
339 MAWAR 15,000 7,500 7,500 15,000
340 SITI ALIMAH 70,000 35,000 35,000 70,000
341 NENG WULANDARI 60,000 10,000 30,000 30,000 70,000
342 TN ALDI 60,000 10,000 30,000 30,000 70,000
343 24/8/2015 NY IVA R 30,000 15,000 15,000 30,000
344 FAIZ 30,000 15,000 15,000 30,000
345 YUNI S 30,000 15,000 15,000 30,000
346 NY RINA 70,000 35,000 35,000 70,000
347 NOVIA 70,000 35,000 35,000 70,000
348 SHERLY S 30,000 15,000 15,000 30,000
349 NANI 30,000 15,000 15,000 30,000
350 NANI HERLINA 30,000 15,000 15,000 30,000
351 SUSYANI 70,000 35,000 35,000 70,000
352 SARMINAH 15,000 10,000 7,500 7,500 25,000
353 NY TIN K 15,000 10,000 7,500 7,500 25,000
354 DEWI M 30,000 10,000 15,000 15,000 40,000
355 24/8/2015 ERNI 30,000 15,000 15,000 30,000
356 REZA 25,000 12,500 12,500 25,000
357 TIARA 30,000 15,000 15,000 30,000
358 ERVA 15,000 10,000 7,500 7,500 25,000
359 LELI 30,000 15,000 15,000 30,000
360 KANIA 30,000 15,000 15,000 30,000
361 VANIA 15,000 7,500 7,500 15,000
362 KOMALA 15,000 7,500 7,500 15,000
363 RAFI 25,000 12,500 12,500 25,000
364 NADYA 25,000 12,500 12,500 25,000
365 RUSLI 15,000 7,500 7,500 15,000
366 25/8/2015 SRI 30,000 15,000 15,000 30,000
367 RUDI 30,000 15,000 15,000 30,000
368 AYU N 70,000 35,000 35,000 70,000
369 ENENG 30,000 15,000 15,000 30,000
370 KANIA 30,000 15,000 15,000 30,000
371 HERI 70,000 35,000 35,000 70,000
372 RIPULA 15,000 7,500 7,500 15,000
373 TIWI 30,000 15,000 15,000 30,000
374 25/8/2015 M FARIDZI 15,000 10,000 7,500 7,500 25,000
375 NY NURYANTI 35,000 17,500 17,500 35,000
376 AEK SETIAWAN 60,000 10,000 30,000 30,000 70,000
377 TITIN 15,000 10,000 7,500 7,500 25,000
378 IRMA 30,000 15,000 15,000 30,000
379 MIZPA 15,000 10,000 7,500 7,500 25,000
380 NY DEWI 30,000 15,000 15,000 30,000
381 NAZWA 15,000 7,500 7,500 15,000
382 LULU 70,000 35,000 35,000 70,000
383 NUR AISAH 70,000 35,000 35,000 70,000
384 NY AI 70,000 35,000 35,000 70,000
385 26/8/2015 WIDIYAH 30,000 15,000 15,000 30,000
386 SYIFA 35,000 17,500 17,500 35,000
387 SRI S 15,000 7,500 7,500 15,000
388 FAUZAN 30,000 10,000 15,000 15,000 40,000
389 ASTI Y 30,000 15,000 15,000 30,000
390 NY POPON 30,000 15,000 15,000 30,000
391 AINA 30,000 15,000 15,000 30,000
392 TN EKA 15,000 10,000 7,500 7,500 25,000
393 TN SJAH D 15,000 10,000 7,500 7,500 25,000
394 KARYONO 15,000 10,000 7,500 7,500 25,000
395 NY AINUN 35,000 17,500 17,500 35,000
396 26/8/2015 NY WIWIK 35,000 10,000 17,500 17,500 45,000
397 NURHAYATI 30,000 10,000 15,000 15,000 40,000
398 M RIDWAN 35,000 17,500 17,500 35,000
399 ADHIE AKBAR 30,000 10,000 15,000 15,000 40,000
400 FINI 35,000 17,500 17,500 35,000
401 NY TINTIN 30,000 15,000 15,000 30,000
402 TASYA 15,000 10,000 7,500 7,500 25,000
403 RURI AGNES A 15,000 7,500 7,500 15,000
404 27/8/2015 ABDUL R 30,000 15,000 15,000 30,000
405 AGUNG S 30,000 15,000 15,000 30,000
406 RESNAWATI 70,000 35,000 35,000 70,000
407 M NURDIN 60,000 30,000 30,000 60,000
408 IWAN H 30,000 15,000 15,000 30,000
409 YULI EKA 60,000 30,000 30,000 60,000
410 YULI ASHI 60,000 30,000 30,000 60,000
411 NURMESHA 70,000 35,000 35,000 70,000
412 27/8/2015 MARYAM 15,000 10,000 7,500 7,500 25,000
413 JASMINE 25,000 12,500 12,500 25,000
414 RICKY 30,000 15,000 15,000 30,000
415 LILIS 70,000 35,000 35,000 70,000
416 QUENSHA 15,000 7,500 7,500 15,000
417 NABILA 50,000 25,000 25,000 50,000
418 KANIA 30,000 15,000 15,000 30,000
419 NADHITA 30,000 15,000 15,000 30,000
420 28/8/2015 LYRA 25,000 12,500 12,500 25,000
421 ASEP S 40,000 20,000 20,000 40,000
422 M ADNAN 15,000 7,500 7,500 15,000
423 TARYANA 15,000 7,500 7,500 15,000
424 SUHARJO 70,000 10,000 35,000 35,000 80,000
425 EVAN 70,000 35,000 35,000 70,000
426 29/8/2015 PUTRI 30,000 10,000 15,000 15,000 25,000
427 M ABDUL 70,000 10,000 35,000 35,000 25,000
428 MARYAM 30,000 15,000 15,000 25,000
429 DEDE 70,000 35,000 35,000 25,000
430 RINI M 60,000 10,000 30,000 30,000 70,000
431 MARYATI 30,000 15,000 15,000 70,000
432 AL FATIH 35,000 10,000 17,500 17,500 70,000
433 KIRAN 70,000 35,000 35,000 70,000
434 ENI 60,000 10,000 30,000 30,000 80,000
435 29/8/2015 SITI Z 70,000 35,000 35,000 70,000
436 MILDAN 30,000 10,000 15,000 15,000 30,000
437 FAIZ 35,000 10,000 17,500 17,500 40,000
438 AINA 30,000 15,000 15,000 30,000
439 LUTFIANI 30,000 10,000 15,000 15,000 30,000
440 SUDARSIH 60,000 10,000 30,000 30,000 30,000
441 31/8/2015 NY IVA R 30,000 15,000 15,000 70,000
442 ANNISA 30,000 15,000 15,000 30,000
443 FAIZ 40,000 20,000 20,000 70,000
444 UMAR 60,000 10,000 30,000 30,000 35,000
445 TN AE 15,000 10,000 7,500 7,500 70,000
446 NANI S 40,000 20,000 20,000 30,000
447 FENI AYU 60,000 10,000 30,000 30,000 30,000
448 31/8/2015 YUNISA 30,000 15,000 15,000 40,000
449 DWI 15,000 10,000 7,500 7,500 40,000
450 NELA 70,000 35,000 35,000 40,000
451 ANE 15,000 10,000 7,500 7,500 25,000
452 TINI 30,000 15,000 15,000 40,000
453 QUINSHA 25,000 10,000 12,500 12,500 70,000
454 LELI H 30,000 15,000 15,000 70,000
455 DEDI D 30,000 15,000 15,000 30,000
456 TIARA 30,000 15,000 15,000 30,000
457 FENI 15,000 10,000 7,500 7,500 30,000
458 ROPI 15,000 10,000 7,500 7,500 25,000
459 DEWI M 30,000 15,000 15,000 30,000
460 KANIA 30,000 15,000 15,000 30,000
461 SUHARSONO 15,000 7,500 7,500 15,000
TOTAL 17,330,000 1,230,000 8,665,000 8,665,000 18,615,000
KET
MEGACOIL
HEALTH CARE
KET
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
JASA ALAT &

DOKTER BAHAN
1 1/9/2015 TN REDY 300,000 5,000 147,500 147,500 305,000
2 2/9/2015 NY MIMIN 100,000 5,000 47,500 47,500 105,000
3 FRASTA 40,000 5,000 17,500 17,500 45,000
4 2//2015 SITI 200,000 5,000 97,500 97,500 205,000
5 YAYAH 75,000 5,000 35,000 35,000 80,000
6 WATI 150,000 5,000 72,500 72,500 155,000
7 3/9/2015 YEYET SITI 200,000 5,000 97,500 97,500 205,000
8 3/9/2015 SELLY 70,000 5,000 32,500 32,500 70,000
9 ANI 370,000 5,000 182,500 182,500 370,000
10 MERNALI 70,000 5,000 32,500 32,500 70,000
11 5/9/2015 TN SOLEH 100,000 5,000 47,500 47,500 100,000
12 ALISA 100,000 5,000 47,500 47,500 100,000
13 6//2015 RIZAL 50,000 5,000 22,500 22,500 50,000
14 ANGGUN 690,000 5,000 342,500 342,500 690,000
15 7/9/2015 FRASTA 40,000 5,000 17,500 17,500 40,000
16 9/9/2015 MIMIN 150,000 5,000 72,500 72,500 150,000
17 9/9/2015 WIDYA 100,000 5,000 47,500 47,500 100,000
18 9/9/2015 MELLY 100,000 5,000 47,500 47,500 100,000
19 12/9/2015 DIANA 50,000 5,000 22,500 22,500 20,000
20 NOVANI 50,000 5,000 22,500 22,500 50,000
21 12/9/2015 OPUNG 20,000 5,000 7,500 7,500 20,000
22 14/9/2015 MUKHSIN 20,000 5,000 7,500 7,500 20,000
23 NOVANI 50,000 5,000 22,500 22,500 50,000
24 14/9/2015 FRANS 100,000 5,000 47,500 47,500 100,000
25 15/9/2015 ANI 100,000 5,000 47,500 47,500 100,000
26 DESTI 100,000 5,000 47,500 47,500 100,000
27 16/9/2015 ARDI 20,000 5,000 7,500 7,500 20,000
28 RAHMAWATI 150,000 5,000 72,500 72,500 150,000
29 PALA N 100,000 5,000 47,500 47,500 100,000
30 MIMIN 225,000 5,000 110,000 110,000 225,000
31 16/9/2015 DEDE 50,000 5,000 22,500 22,500 50,000
32 17/9/2015 SELLY 120,000 5,000 57,500 57,500 120,000
33 DINI 20,000 5,000 7,500 7,500 20,000
34 FRANS 70,000 5,000 32,500 32,500 70,000
35 NURMALI 100,000 5,000 47,500 47,500 100,000
36 RIDYA 120,000 5,000 57,500 57,500 120,000
37 20/9/2015 ANGGUN 55,000 5,000 25,000 25,000 55,000
38 21/9/2015 NOVANI 50,000 5,000 22,500 22,500 60,000
39 UUM U 100,000 5,000 47,500 47,500 100,000
40 22/9/2015 ADI 20,000 5,000 7,500 7,500 20,000
41 23/9/2015 CRISTIAN 50,000 5,000 22,500 22,500 50,000
42 SELLY 350,000 5,000 172,500 172,500 350,000
43 26/9/2015 DWI 200,000 5,000 97,500 97,500 200,000
44 28/9/2015 FRANS 70,000 5,000 32,500 32,500 70,000
45 NURMALI 70,000 5,000 32,500 32,500 70,000
46 29/9/2015 ANI 70,000 5,000 32,500 32,500 70,000
TOTAL 5,405,000 230,000 2,587,500 2,587,500 5,420,000
JASA ALAT &

TGL TARIF OBAT JML
DOKTER BAHAN
1 1/9/2015 HANUM 25,000 12,500 12,500 25,000
2 ENENG 40,000 20,000 20,000 40,000
3 KANIA 30,000 15,000 15,000 30,000
4 BUDI 70,000 35,000 35,000 70,000
5 SALINAH 15,000 10,000 7,500 7,500 25,000
6 AI 30,000 15,000 15,000 30,000
7 ERNI 30,000 15,000 15,000 30,000
8 YAYAH 30,000 15,000 15,000 30,000
9 FIRMAN 30,000 15,000 15,000 30,000
10 LOVELY 25,000 12,500 12,500 25,000
11 1/9/2015 LILIS 15,000 7,500 7,500 15,000
12 KANIA 30,000 15,000 15,000 30,000
13 VANIA 30,000 15,000 15,000 30,000
14 SHERLY 30,000 15,000 15,000 30,000
15 MIZFA 15,000 10,000 7,500 7,500 25,000
16 ROSINTA 70,000 35,000 35,000 70,000
17 SRI ULINA 70,000 35,000 35,000 70,000
18 YUYUN 70,000 35,000 35,000 70,000
19 NURYANTI 70,000 35,000 35,000 70,000
20 2/9/2015 SARMINI 30,000 15,000 15,000 30,000
21 AISYAH 30,000 10,000 15,000 15,000 40,000
22 NOVIA 30,000 15,000 15,000 30,000
23 VICTORIA 30,000 15,000 15,000 30,000
24 ASTI Y 40,000 20,000 20,000 40,000
25 P DIDIK 30,000 10,000 15,000 15,000 40,000
26 AINA 30,000 15,000 15,000 30,000
27 SUKARNI 15,000 10,000 7,500 7,500 25,000
28 NAILA 15,000 10,000 7,500 7,500 25,000
29 2/9/2015 SRI ELVA 30,000 15,000 15,000 30,000
30 WIWIK 70,000 35,000 35,000 70,000
31 BAMBANG 15,000 10,000 7,500 7,500 25,000
32 SITI NURJANAH 15,000 10,000 7,500 7,500 25,000
33 RIDWAN 70,000 35,000 35,000 70,000
34 DEWI 30,000 15,000 15,000 30,000
35 SITI AISAH 15,000 7,500 7,500 15,000
36 3/9/2015 SITI AISAH 30,000 15,000 15,000 30,000
37 RIPUALDI 30,000 15,000 15,000 30,000
38 YEYET 15,000 7,500 7,500 15,000
39 AGUNG RIADI 30,000 15,000 15,000 30,000
40 PUNGUT 70,000 35,000 35,000 70,000
41 TITIN 70,000 35,000 35,000 70,000
42 FX 70,000 35,000 35,000 70,000
43 HENI 70,000 35,000 35,000 70,000
44 NAZWA 25,000 12,500 12,500 25,000
45 FAUZAN 30,000 15,000 15,000 30,000
46 SARTANTI 15,000 7,500 7,500 15,000
47 3/9/2015 NANDHITA 30,000 15,000 15,000 30,000
48 MARYANA 15,000 10,000 7,500 7,500 25,000
49 AYU 40,000 20,000 20,000 40,000
50 FARIS 25,000 12,500 12,500 25,000
51 WIDANINGSIH 70,000 35,000 35,000 70,000
52 AIMAR 25,000 12,500 12,500 25,000
53 LILIS 30,000 15,000 15,000 30,000
54 ANIA 25,000 12,500 12,500 25,000
55 TITA 70,000 35,000 35,000 70,000
56 FENI 30,000 15,000 15,000 30,000
57 GEORGE 25,000 12,500 12,500 25,000
58 SUHARSONO 30,000 15,000 15,000 30,000
59 4/9/2015 BAYU 70,000 35,000 35,000 70,000
60 RATIH 30,000 15,000 15,000 30,000
61 WIDYA 30,000 15,000 15,000 30,000
62 YUYUN 30,000 15,000 15,000 30,000
63 TINI 70,000 35,000 35,000 70,000
64 IMAN SOFYAN 30,000 15,000 15,000 30,000
65 4/9/2015 IRFAN 15,000 10,000 7,500 7,500 25,000
66 MELI 15,000 7,500 7,500 15,000
67 CHELSEA 25,000 12,500 12,500 25,000
68 AFRIZAL 25,000 12,500 12,500 25,000
69 ENENG 15,000 7,500 7,500 15,000
70 SELLY 30,000 15,000 15,000 30,000
71 SUMARYAM 15,000 10,000 7,500 7,500 25,000
72 ARINA 25,000 12,500 12,500 25,000
73 LYRA 25,000 12,500 12,500 25,000
74 RINI 70,000 35,000 35,000 70,000
75 5/9/2015 RATIH 15,000 10,000 7,500 7,500 25,000
76 MILDAN 30,000 15,000 15,000 30,000
77 SHAKIRA 15,000 7,500 7,500 15,000
78 SRI N 70,000 35,000 35,000 70,000
79 7/9/2015 NAZWA 25,000 12,500 12,500 25,000
80 SARMINI 30,000 15,000 15,000 30,000
81 SITI 70,000 35,000 35,000 70,000
82 YUNINGSIH 60,000 10,000 30,000 30,000 70,000
83 RAIS 60,000 10,000 30,000 30,000 70,000
84 NANI 70,000 35,000 35,000 70,000
85 RISKA 15,000 7,500 7,500 15,000
86 VICTORIA 30,000 15,000 15,000 30,000
87 NOVIA 70,000 35,000 35,000 70,000
88 IVANA AYU 25,000 12,500 12,500 25,000
89 FAIZ 70,000 35,000 35,000 70,000
90 8/9/2015 APRIZAL 25,000 12,500 12,500 25,000
91 MARA M 15,000 10,000 7,500 7,500 25,000
92 NANI H 15,000 10,000 7,500 7,500 25,000
93 SUNARSIH 70,000 35,000 35,000 70,000
94 HAISYA 35,000 17,500 17,500 35,000
95 NY TITA 30,000 10,000 15,000 15,000 40,000
96 CARISSA P 30,000 15,000 15,000 30,000
97 PALA N 15,000 10,000 7,500 7,500 25,000
98 RATIH 15,000 10,000 7,500 7,500 25,000
99 TURNI 70,000 35,000 35,000 70,000
100 8/9/2015 NANDHITA 25,000 12,500 12,500 25,000
101 RITA 30,000 15,000 15,000 30,000
102 AI RITA 30,000 15,000 15,000 35,000
103 TRI H 30,000 15,000 15,000 30,000
104 ASTI 70,000 35,000 35,000 70,000
105 SHERLY 30,000 15,000 15,000 30,000
106 ENENG 70,000 35,000 35,000 70,000
107 KARINA 30,000 15,000 15,000 30,000
108 NENG 15,000 7,500 7,500 15,000
109 9/9/2015 WIHERNI 30,000 15,000 15,000 30,000
110 SRI ELVA 25,000 12,500 12,500 25,000
111 FEBY 30,000 15,000 15,000 30,000
112 RIDWAN 70,000 35,000 35,000 70,000
113 WIDYA 15,000 7,500 7,500 15,000
114 ALDA 35,000 17,500 17,500 35,000
115 DIDIN 15,000 10,000 7,500 7,500 25,000
116 HANA 35,000 17,500 17,500 35,000
117 AINA 30,000 15,000 15,000 30,000
118 FX 70,000 35,000 35,000 70,000
119 BUNGA 30,000 15,000 15,000 30,000
120 RICKY 30,000 15,000 15,000 30,000
121 ROPI 70,000 35,000 35,000 70,000
122 DEWI 30,000 15,000 15,000 30,000
123 PUNGUT 70,000 35,000 35,000 70,000
124 11/9/2015 FITRI A 30,000 15,000 15,000 30,000
125 SUTRISNO 70,000 35,000 35,000 70,000
126 ETY 70,000 35,000 35,000 70,000
127 TIA 15,000 7,500 7,500 15,000
128 DADANG 70,000 35,000 35,000 70,000
129 FX 70,000 35,000 35,000 70,000
130 RIVALDI 30,000 15,000 15,000 30,000
131 UUM 70,000 35,000 35,000 70,000
132 11/9/2015 FAUZAN 30,000 15,000 15,000 30,000
133 NANDHITA 30,000 15,000 15,000 30,000
134 MARYONO 15,000 10,000 7,500 7,500 25,000
135 REZA 15,000 10,000 7,500 7,500 25,000
136 SELLY 40,000 20,000 20,000 40,000
137 LIA 30,000 15,000 15,000 30,000
138 ENENG 30,000 15,000 15,000 30,000
139 BELLA 30,000 15,000 15,000 30,000
140 KANIA 70,000 35,000 35,000 70,000
141 IYAN 15,000 7,500 7,500 15,000
142 12/9/2015 NANAG 70,000 35,000 35,000 70,000
143 NANI HERLINA 60,000 30,000 30,000 60,000
144 M JOEY SATRIAN 15,000 7,500 7,500 15,000
145 KARYONO 15,000 7,500 7,500 15,000
146 KIRANA 70,000 35,000 35,000 70,000
147 AMELYA 30,000 10,000 15,000 15,000 40,000
148 BUDI DARMA 70,000 35,000 35,000 70,000
149 ASEP SAWARNA 70,000 35,000 35,000 70,000
150 NENAH 60,000 30,000 30,000 60,000
151 HAISYA 30,000 15,000 15,000 30,000
152 TITA FATIMAH 70,000 35,000 35,000 70,000
153 TATI ROHAYATI 30,000 15,000 15,000 30,000
154 12/9/2015 PUTRI A 35,000 10,000 17,500 17,500 45,000
155 RITA 15,000 10,000 7,500 7,500 25,000
156 MILDAN 30,000 15,000 15,000 30,000
157 MATNAR 15,000 7,500 7,500 15,000
158 IDA S 60,000 10,000 30,000 30,000 70,000
159 YUSUF IBRAHIM 15,000 7,500 7,500 15,000
160 RIZQI 70,000 35,000 35,000 70,000
161 DEWI 15,000 10,000 7,500 7,500 25,000
162 M RIZQIA 70,000 10,000 35,000 35,000 80,000
163 NADIA O 15,000 7,500 7,500 15,000
164 NOVIA 70,000 35,000 35,000 70,000
165 14/9/2015 FX 70,000 35,000 35,000 70,000
166 YENNY 15,000 10,000 7,500 7,500 25,000
167 SARMINI 40,000 20,000 20,000 40,000
168 AHMAD S 30,000 10,000 15,000 15,000 40,000
169 DEVI 30,000 10,000 15,000 15,000 40,000
170 TRI YULI 70,000 35,000 35,000 70,000
171 AINA A 30,000 15,000 15,000 30,000
172 NARSIH 15,000 10,000 7,500 7,500 25,000
173 YASMI 15,000 10,000 7,500 7,500 25,000
174 ANIS 35,000 10,000 17,500 17,500 45,000
175 JUMIYATI 70,000 35,000 35,000 70,000
176 14/9/2015 TIARA 30,000 15,000 15,000 30,000
177 DIDIT 15,000 7,500 7,500 15,000
178 AZKA 70,000 35,000 35,000 70,000
179 SUHARSONO 30,000 15,000 15,000 30,000
180 TRI 30,000 15,000 15,000 30,000
181 SHERLY 30,000 15,000 15,000 30,000
182 TITA FATIMAH 70,000 35,000 35,000 70,000
183 LELI 70,000 35,000 35,000 70,000
184 KANIA 30,000 15,000 15,000 30,000
185 15/9/2015 AGNI 25,000 12,500 12,500 25,000
186 ENENG 70,000 35,000 35,000 70,000
187 RISKA 30,000 15,000 15,000 30,000
188 DZAHFAR 25,000 12,500 12,500 25,000
189 SULASTRI 70,000 35,000 35,000 70,000
190 NERMA 100,000 50,000 50,000 100,000
191 KARINA 30,000 15,000 15,000 30,000
192 AI RITA 30,000 15,000 15,000 30,000
193 15/9/2015 RAFIF 25,000 12,500 12,500 25,000
194 SRI ELVA 30,000 15,000 15,000 30,000
195 AI HUSNIATI 70,000 35,000 35,000 70,000
196 EVI SYANTI 30,000 15,000 15,000 30,000
197 RAMDAN 25,000 12,500 12,500 25,000
198 SAERUL 35,000 17,500 17,500 35,000
199 PANCA 15,000 10,000 7,500 7,500 25,000
200 DESTI 70,000 35,000 35,000 70,000
201 AI SUHAETI 30,000 15,000 15,000 30,000
202 ELIS SITI 70,000 35,000 35,000 70,000
203 DARNO 15,000 10,000 7,500 7,500 25,000
204 GEORGE 35,000 17,500 17,500 35,000
205 16/9/2015 DADANG 70,000 35,000 35,000 70,000
206 JOHANES 40,000 20,000 20,000 40,000
207 APRIZAL 35,000 17,500 17,500 35,000
208 IMAS 15,000 10,000 7,500 7,500 25,000
209 FAUZAN 30,000 10,000 15,000 15,000 40,000
210 TURNI 70,000 35,000 35,000 70,000
211 PALA 15,000 7,500 7,500 15,000
212 16/9/2015 KARTIKA CANDRA 30,000 15,000 15,000 30,000
213 DARA 25,000 12,500 12,500 25,000
214 RATNA 30,000 15,000 15,000 30,000
215 NURHAYATI 15,000 10,000 7,500 7,500 25,000
216 MARYONO 60,000 30,000 30,000 60,000
217 REZA 30,000 15,000 15,000 30,000
218 REFIANI 70,000 35,000 35,000 70,000
219 DEASY 70,000 35,000 35,000 70,000
220 BUNGA 30,000 15,000 15,000 30,000
221 FEBY 30,000 15,000 15,000 30,000
222 17/9/2015 FX 70,000 35,000 35,000 70,000
223 DADANG 15,000 10,000 7,500 7,500 25,000
224 SITI ZULEILA 70,000 35,000 35,000 70,000
225 SARMINI 70,000 35,000 35,000 70,000
226 RATIH 30,000 15,000 15,000 30,000
227 SETIANTO 70,000 35,000 35,000 70,000
228 HANI 15,000 10,000 7,500 7,500 25,000
229 LIBEDELA 30,000 15,000 15,000 30,000
230 SUPRIATNA 30,000 15,000 15,000 30,000
231 17/9/2015 TRI 25,000 12,500 12,500 25,000
232 MIRBAN 25,000 12,500 12,500 25,000
233 WAHYU 30,000 15,000 15,000 30,000
234 IIM 30,000 15,000 15,000 30,000
235 HALMA 30,000 15,000 15,000 30,000
236 JAMALUDIN 15,000 10,000 7,500 7,500 25,000
237 18/9/2015 DEDE 30,000 15,000 15,000 30,000
238 ANNY 60,000 30,000 30,000 60,000
239 RIFKY 25,000 12,500 12,500 25,000
240 EVY SYANTI 70,000 35,000 35,000 70,000
241 SHAFA 15,000 10,000 7,500 7,500 70,000
242 NISRINA 25,000 12,500 12,500 25,000
243 18/9/2015 YENI 30,000 15,000 15,000 30,000
244 RICKY 30,000 15,000 15,000 30,000
245 SELLY 70,000 35,000 35,000 70,000
246 KANIA 30,000 15,000 15,000 30,000
247 BELLA 30,000 15,000 15,000 30,000
248 SURASIN 30,000 15,000 15,000 30,000
249 ENENG 30,000 15,000 15,000 30,000
250 LYRA 15,000 7,500 7,500 15,000
251 OMAH 30,000 15,000 15,000 30,000
252 19/9/2015 DESSANI 35,000 17,500 17,500 35,000
253 WIDIYAH 70,000 35,000 35,000 70,000
254 HAISYA 30,000 15,000 15,000 30,000
255 TITA 30,000 15,000 15,000 30,000
256 SITI MARFUAH 70,000 35,000 35,000 70,000
257 BUDI DARMA 70,000 35,000 35,000 70,000
258 KIRANA 70,000 35,000 35,000 70,000
259 DEDE 30,000 15,000 15,000 30,000
260 19/9/2015 IDA S 60,000 10,000 30,000 30,000 70,000
261 SUMIATI 70,000 35,000 35,000 70,000
262 KAMA 60,000 10,000 30,000 30,000 70,000
263 MILDAN 70,000 35,000 35,000 70,000
264 AGNI 35,000 10,000 17,500 17,500 45,000
265 SARMINI 70,000 35,000 35,000 70,000
266 VICTORIA 40,000 20,000 20,000 40,000
267 NANI HERLINA 15,000 7,500 7,500 15,000
268 AINA A 30,000 15,000 15,000 30,000
269 FAIZ 35,000 10,000 17,500 17,500 45,000
270 IRFAN 25,000 12,500 12,500 25,000
271 21/9/2015 SARMINI 70,000 35,000 35,000 70,000
272 NIKEN 35,000 10,000 17,500 17,500 45,000
273 YASMI 60,000 10,000 30,000 30,000 70,000
274 SUMARNA 30,000 10,000 15,000 15,000 40,000
275 UBI D 30,000 15,000 15,000 30,000
276 ASEP K 70,000 35,000 35,000 70,000
277 JUMIYATI 70,000 35,000 35,000 70,000
278 HANIFAH 35,000 17,500 17,500 35,000
279 21/9/2015 KARLINA 30,000 15,000 15,000 30,000
280 DEDI 30,000 15,000 15,000 30,000
281 SHERLY 30,000 15,000 15,000 30,000
282 DARNO 30,000 15,000 15,000 30,000
283 AZMI 70,000 35,000 35,000 70,000
284 PURI 15,000 7,500 7,500 15,000
285 ALYA 30,000 15,000 15,000 30,000
286 PUTRI A 15,000 7,500 7,500 15,000
287 22/9/2015 YOYO 70,000 35,000 35,000 70,000
288 YANTI 15,000 10,000 7,500 7,500 25,000
289 M SATRIA 25,000 12,500 12,500 25,000
290 DWI A 15,000 10,000 7,500 7,500 25,000
291 AI RITA 30,000 15,000 15,000 30,000
292 ENENG 70,000 35,000 35,000 70,000
293 YUYUN 15,000 10,000 7,500 7,500 25,000
294 RIKA 40,000 20,000 20,000 40,000
295 SRI S 30,000 15,000 15,000 30,000
296 NANDHITA 30,000 15,000 15,000 30,000
297 TRI 30,000 15,000 15,000 30,000
298 22/9/2015 MELIYANI 30,000 15,000 15,000 30,000
299 LANI 30,000 15,000 15,000 30,000
300 JUDI 70,000 35,000 35,000 70,000
301 SRI ELVA 30,000 15,000 15,000 30,000
302 KARTIKA CANDRA 30,000 15,000 15,000 45,000
303 IRFAN 30,000 15,000 15,000 30,000
304 ELIS SITI 70,000 35,000 35,000 70,000
305 EDDY 70,000 35,000 35,000 70,000
306 HASANAH 70,000 35,000 35,000 70,000
307 23/9/2015 RINI MULYANI 15,000 10,000 7,500 7,500 25,000
308 FARA 15,000 10,000 7,500 7,500 25,000
309 FAIZ 15,000 7,500 7,500 15,000
310 II KURNIA 30,000 10,000 15,000 15,000 40,000
311 ADANG S 15,000 7,500 7,500 15,000
312 FAUZAN 30,000 15,000 15,000 30,000
313 FANCISCUS 70,000 35,000 35,000 70,000
314 23/9/2015 ENDANG 30,000 15,000 15,000 30,000
315 REZA 30,000 15,000 15,000 30,000
316 SUSMIYANI 30,000 10,000 15,000 15,000 40,000
317 PAIKUN 15,000 7,500 7,500 15,000
318 NURANCHMADITA 30,000 15,000 15,000 30,000
319 RAHMA TSANIA 35,000 17,500 17,500 35,000
320 DEASY 70,000 35,000 35,000 70,000
321 25/9/2015 WULAN 15,000 7,500 7,500 15,000
322 JUHRIAH 70,000 35,000 35,000 70,000
323 RATIH 30,000 15,000 15,000 30,000
324 OMAH 30,000 15,000 15,000 30,000
325 RIPUALDI 30,000 15,000 15,000 30,000
326 FEBY 30,000 15,000 15,000 30,000
327 PARTIWEN 70,000 35,000 35,000 70,000
328 25/9/2015 BELLA 30,000 15,000 15,000 30,000
329 FENI 30,000 15,000 15,000 30,000
330 HELENA 30,000 10,000 15,000 15,000 40,000
331 ATIQAH 30,000 15,000 15,000 30,000
332 RICKY 30,000 15,000 15,000 30,000
333 SUNANTO 30,000 15,000 15,000 30,000
334 26/9/2015 DEDE H 30,000 15,000 15,000 30,000
335 RATIH 30,000 15,000 15,000 30,000
336 SUSMIYANI 30,000 15,000 15,000 30,000
337 RAHMA TSANIA 35,000 17,500 17,500 35,000
338 CARRISA 30,000 15,000 15,000 30,000
339 ADITYA 15,000 10,000 7,500 7,500 25,000
340 HERRA 15,000 7,500 7,500 15,000
341 ADE MULYANA 70,000 35,000 35,000 70,000
342 26/9/2015 DEVI JAITRA 30,000 10,000 15,000 15,000 40,000
343 BERLIANA 35,000 17,500 17,500 35,000
344 MILDAN 30,000 15,000 15,000 30,000
345 AINA A 30,000 15,000 15,000 30,000
346 KAMA 60,000 10,000 30,000 30,000 70,000
347 TITA 30,000 15,000 15,000 30,000
348 HAIDAR 35,000 17,500 17,500 35,000
349 HAISYA 30,000 15,000 15,000 30,000
350 IDA S 60,000 10,000 30,000 30,000 70,000
351 SUNARSIH 70,000 35,000 35,000 70,000
352 DARNO 30,000 10,000 15,000 15,000 40,000
353 28/9/2015 FARA 15,000 10,000 7,500 7,500 25,000
354 FANCISCUS 70,000 35,000 35,000 70,000
355 LAZIMATUN 35,000 17,500 17,500 35,000
356 IMAN S 30,000 10,000 15,000 15,000 40,000
357 JUHRIAH 60,000 10,000 30,000 30,000 70,000
358 ARYANI 70,000 10,000 35,000 35,000 80,000
359 PURI 15,000 10,000 7,500 7,500 25,000
360 28/9/2015 NURANCHMADITA 30,000 15,000 15,000 30,000
361 DEDI 30,000 10,000 15,000 15,000 40,000
362 M AZMI 70,000 35,000 35,000 70,000
363 IRFAN 30,000 15,000 15,000 30,000
364 SHERLY 30,000 15,000 15,000 30,000
365 KANIA 30,000 15,000 15,000 30,000
366 TIARA 30,000 15,000 15,000 30,000
367 KARLINA 40,000 20,000 20,000 40,000
368 29/9/2015 AGNESYA 35,000 17,500 17,500 35,000
369 YAYAH 30,000 15,000 15,000 30,000
370 YANTI 70,000 35,000 35,000 70,000
371 29/9/2015 SRI ELVA 30,000 15,000 15,000 30,000
372 IRFAN 30,000 15,000 15,000 30,000
373 JUDI 70,000 35,000 35,000 70,000
374 LANI HANIFAH 30,000 15,000 15,000 30,000
375 SUYANTO 70,000 35,000 35,000 70,000
376 OMAH 30,000 15,000 15,000 30,000
377 AHMAD S 30,000 15,000 15,000 30,000
378 SUHARYOTO 30,000 15,000 15,000 30,000
379 ARINI 25,000 12,500 12,500 25,000
380 JUJU 30,000 15,000 15,000 30,000
381 SHOBRINA 30,000 15,000 15,000 30,000
382 M SATRIA 25,000 12,500 12,500 25,000
383 30/9/2015 SILVESTER 30,000 10,000 15,000 15,000 40,000
384 FAUZAN 30,000 15,000 15,000 30,000
385 SITI A 30,000 15,000 15,000 30,000
386 DEVI JAITRA 30,000 15,000 15,000 30,000
387 ADITYA 35,000 10,000 17,500 17,500 45,000
388 ABDUL KOHAR 15,000 10,000 7,500 7,500 25,000
389 RINI MULYANI 35,000 10,000 17,500 17,500 45,000
390 ASEP SAWARNA 15,000 10,000 7,500 7,500 25,000
391 YUSSI 70,000 35,000 35,000 70,000
392 II KURNIA 30,000 15,000 15,000 30,000
393 IIS 60,000 10,000 30,000 30,000 70,000
394 30/9/2015 JUMIRAH 30,000 15,000 15,000 30,000
395 AHMAD S 30,000 15,000 15,000 30,000
396 KIKI KARSONO 70,000 35,000 35,000 70,000
397 ENOK 30,000 15,000 15,000 30,000
398 RAHMA TSANIA 35,000 17,500 17,500 35,000
399 CARRISA 30,000 15,000 15,000 30,000
400 ENDANG 30,000 15,000 15,000 30,000
401 BUNG DWI 30,000 15,000 15,000 30,000
TOTAL 15,355,000 750,000 7,677,500 7,677,500 16,170,000
KET
KET
-
JASA ALAT &

DOKTER BAHAN
1 4/10/2015 FRANS 70,000 5,000 32,500 32,500 75,000
2 MARNIATI 30,000 5,000 12,500 12,500 35,000
3 DENI 25,000 5,000 10,000 10,000 30,000
4 6/10/2015 DIMYATI 300,000 5,000 147,500 147,500 305,000
5 8/10/2015 ROPI 70,000 5,000 32,500 32,500 75,000
6 NANDHITA 70,000 5,000 32,500 32,500 75,000
7 10/10/2015 AGUS SOMANTRI 300,000 5,000 147,500 147,500 305,000
8 FARAH 50,000 5,000 22,500 22,500 50,000
9 10/10/2015 DENI 100,000 5,000 47,500 47,500 100,000
10 12/10/2015 ZILAN 20,000 5,000 7,500 7,500 20,000
11 YATI 60,000 5,000 27,500 27,500 60,000
12 DIAH 20,000 5,000 7,500 7,500 20,000
13 12/10/2015 RENDY 200,000 5,000 97,500 97,500 200,000
14 MURNIATI 200,000 5,000 97,500 97,500 200,000
15 YOS 200,000 5,000 97,500 97,500 200,000
16 ABAN 70,000 5,000 32,500 32,500 70,000
17 ROPI 100,000 5,000 47,500 47,500 100,000
18 17/10/2015 AGUS SOMANTRI 100,000 5,000 47,500 47,500 100,000
19 17/10/2015 YATI 60,000 5,000 27,500 27,500 20,000
20 PRIATNA 100,000 5,000 47,500 47,500 100,000
21 18/10/2015 RIZAL 50,000 5,000 22,500 22,500 50,000
22 20/10/2015 ANA 70,000 5,000 32,500 32,500 70,000
23 SRI 200,000 5,000 97,500 97,500 200,000
24 21/10/2015 AGUS SOMANTRI 200,000 5,000 97,500 97,500 200,000
25 23/10/2015 DANI 300,000 5,000 147,500 147,500 300,000
26 24/10/2015 TITI 150,000 5,000 72,500 72,500 150,000
27 26/10/2015 N YATI 60,000 5,000 27,500 27,500 60,000
28 AGUS SOMANTRI 20,000 5,000 7,500 7,500 20,000
29 SITI H 230,000 5,000 112,500 112,500 230,000
30 26/10/2015 FRANS 70,000 5,000 32,500 32,500 70,000
31 ABAN 100,000 5,000 47,500 47,500 100,000
32 JUMATI 150,000 5,000 72,500 72,500 150,000
TOTAL 3,745,000 160,000 1,792,500 1,792,500 3,740,000

JASA ALAT &

TGL TARIF OBAT JML
DOKTER BAHAN
1 1/10/2015 PUTRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
2 RENI 70,000.00 35,000.00 35,000.00 70,000.00
3 ASEP SUWARNA 30,000.00 15,000.00 15,000.00 30,000.00
4 USWATUN 30,000.00 15,000.00 15,000.00 30,000.00
5 AIDAH 30,000.00 15,000.00 15,000.00 30,000.00
6 FX 70,000.00 35,000.00 35,000.00 70,000.00
7 SUNARSIH 30,000.00 15,000.00 15,000.00 30,000.00
8 AI 30,000.00 15,000.00 15,000.00 30,000.00
9 SANTI 70,000.00 35,000.00 35,000.00 70,000.00
10 S RUHIYAT 30,000.00 15,000.00 15,000.00 30,000.00
11 DIAN 30,000.00 15,000.00 15,000.00 30,000.00
12 1/10/2015 LILIS 30,000.00 15,000.00 15,000.00 30,000.00
13 FATHIA 25,000.00 12,500.00 12,500.00 25,000.00
14 SHERLY 30,000.00 15,000.00 15,000.00 30,000.00
15 SAEFUL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
16 SUPRIADI 30,000.00 15,000.00 15,000.00 30,000.00
17 ROSITA 70,000.00 35,000.00 35,000.00 70,000.00
18 FENY 25,000.00 12,500.00 12,500.00 25,000.00
19 NANDHITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
20 WAWAN 30,000.00 15,000.00 15,000.00 30,000.00
21 LUTFIA 30,000.00 15,000.00 15,000.00 30,000.00
22 SITI KOMALA 15,000.00 7,500.00 7,500.00 15,000.00
23 MAULIDI 30,000.00 15,000.00 15,000.00 30,000.00
24 AIYLA 30,000.00 15,000.00 15,000.00 30,000.00
25 SUHARSONO 70,000.00 35,000.00 35,000.00 70,000.00
26 2/10/2015 HELENA 30,000.00 15,000.00 15,000.00 30,000.00
27 HANNY 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
28 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
29 REZA 30,000.00 15,000.00 15,000.00 30,000.00
30 RICKY 40,000.00 20,000.00 20,000.00 40,000.00
31 RAFI 25,000.00 12,500.00 12,500.00 25,000.00
32 DEDE 70,000.00 35,000.00 35,000.00 70,000.00
33 SUSYANI 30,000.00 15,000.00 15,000.00 30,000.00
34 ALFATH 25,000.00 12,500.00 12,500.00 25,000.00
35 DEASY 70,000.00 35,000.00 35,000.00 70,000.00
36 2/10/2015 TITO 70,000.00 35,000.00 35,000.00 70,000.00
37 M FADLIN 70,000.00 35,000.00 35,000.00 70,000.00
38 KIKY 70,000.00 35,000.00 35,000.00 70,000.00
39 NAZLA 70,000.00 35,000.00 35,000.00 70,000.00
40 ALI SONIA 30,000.00 15,000.00 15,000.00 30,000.00
41 FEBBY 30,000.00 15,000.00 15,000.00 30,000.00
42 KAMALUDIN 70,000.00 35,000.00 35,000.00 70,000.00
43 3/10/2015 PARTIWEN 70,000.00 35,000.00 35,000.00 70,000.00
44 M ILHAM 35,000.00 17,500.00 17,500.00 35,000.00
45 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
46 ANDY 70,000.00 35,000.00 35,000.00 70,000.00
47 SITI KOMALA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
48 WINDA 35,000.00 17,500.00 17,500.00 35,000.00
49 SUSIYANI 30,000.00 15,000.00 15,000.00 30,000.00
50 SITI KOMALA 35,000.00 17,500.00 17,500.00 35,000.00
51 RAHMA 15,000.00 7,500.00 7,500.00 15,000.00
52 3/10/2015 DICKY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
53 RAMA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
54 RIKA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
55 NOVIA 30,000.00 15,000.00 15,000.00 30,000.00
56 TITA 35,000.00 17,500.00 17,500.00 35,000.00
57 HAISYA 30,000.00 15,000.00 15,000.00 30,000.00
58 AINA 30,000.00 15,000.00 15,000.00 30,000.00
59 JUHRIAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
60 MILDAN 30,000.00 15,000.00 15,000.00 30,000.00
61 5/10/2015 NAJWA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
62 RATNA 70,000.00 35,000.00 35,000.00 70,000.00
63 TRI 70,000.00 35,000.00 35,000.00 70,000.00
64 YUSSI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
65 WIDA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
66 SITI KOMALA 70,000.00 35,000.00 35,000.00 70,000.00
67 5/10/2015 AISYAH 25,000.00 12,500.00 12,500.00 25,000.00
68 DEDI 30,000.00 15,000.00 15,000.00 30,000.00
69 NURASANAH 30,000.00 15,000.00 15,000.00 30,000.00
70 IRFAN 30,000.00 15,000.00 15,000.00 30,000.00
71 AINI 70,000.00 35,000.00 35,000.00 70,000.00
72 ALFATH 70,000.00 35,000.00 35,000.00 70,000.00
73 NANDITA 70,000.00 35,000.00 35,000.00 70,000.00
74 KARLINA 70,000.00 35,000.00 35,000.00 70,000.00
75 TIARA 40,000.00 20,000.00 20,000.00 40,000.00
76 LANIWATI 15,000.00 7,500.00 7,500.00 15,000.00
77 6/10/2015 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
78 ASEP 70,000.00 35,000.00 35,000.00 70,000.00
79 JIHAN 50,000.00 25,000.00 25,000.00 50,000.00
80 DEVI 30,000.00 15,000.00 15,000.00 30,000.00
81 RINI 30,000.00 15,000.00 15,000.00 30,000.00
82 AQASI 30,000.00 15,000.00 15,000.00 30,000.00
83 6/10/2015 ANGGITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
84 YANTI 30,000.00 15,000.00 15,000.00 30,000.00
85 ZONI 30,000.00 15,000.00 15,000.00 30,000.00
86 HANRU 15,000.00 7,500.00 7,500.00 15,000.00
87 JUDI 70,000.00 35,000.00 35,000.00 70,000.00
88 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
89 SULASTRI 15,000.00 7,500.00 7,500.00 15,000.00
90 NUR MEILISA 30,000.00 15,000.00 15,000.00 30,000.00
91 SATRIIA 30,000.00 15,000.00 15,000.00 30,000.00
92 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
93 SHOBRINA 30,000.00 15,000.00 15,000.00 30,000.00
94 7/10/2015 WIDANINGSIH 15,000.00 7,500.00 7,500.00 15,000.00
95 LULU 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
96 SRI M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
97 FAUZAN 70,000.00 35,000.00 35,000.00 70,000.00
98 SITI NUR I 15,000.00 7,500.00 7,500.00 15,000.00
99 HAFIYA 15,000.00 7,500.00 7,500.00 15,000.00
100 II 40,000.00 20,000.00 20,000.00 40,000.00
101 SILVESTER 30,000.00 15,000.00 15,000.00 30,000.00
102 AYEP 60,000.00 30,000.00 30,000.00 35,000.00
103 PUNGUT 15,000.00 7,500.00 7,500.00 15,000.00
104 IIS 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
105 SUNARSIH 30,000.00 15,000.00 15,000.00 30,000.00
106 7/10/2015 ARIEF 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
107 RUDI 30,000.00 15,000.00 15,000.00 30,000.00
108 ANDI 30,000.00 15,000.00 15,000.00 30,000.00
109 RUHIYAT 30,000.00 15,000.00 15,000.00 30,000.00
110 CARISSA 30,000.00 15,000.00 15,000.00 30,000.00
111 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
112 HENNY 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
113 NINA 30,000.00 15,000.00 15,000.00 30,000.00
114 SEPTI 30,000.00 15,000.00 15,000.00 30,000.00
115 8/10/2015 TANIA 70,000.00 35,000.00 35,000.00 70,000.00
116 USWATUN 30,000.00 15,000.00 15,000.00 30,000.00
117 SALWA 25,000.00 12,500.00 12,500.00 25,000.00
118 FX 70,000.00 35,000.00 35,000.00 70,000.00
119 SITI AMINAH 30,000.00 15,000.00 15,000.00 30,000.00
120 AIDAH 30,000.00 15,000.00 15,000.00 30,000.00
121 SOPI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
122 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
123 8/10/2015 FENI 40,000.00 20,000.00 20,000.00 40,000.00
124 WAWAN 30,000.00 15,000.00 15,000.00 30,000.00
125 MULIDINA 15,000.00 7,500.00 7,500.00 15,000.00
126 ANANDA 30,000.00 15,000.00 15,000.00 30,000.00
127 SUHARSONO 30,000.00 15,000.00 15,000.00 30,000.00
128 9/10/2015 DURRAH 30,000.00 15,000.00 15,000.00 30,000.00
129 TETI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
130 RATIH 40,000.00 20,000.00 20,000.00 40,000.00
131 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
132 KIKY 70,000.00 35,000.00 35,000.00 70,000.00
133 NAZLA 35,000.00 17,500.00 17,500.00 35,000.00
134 FEBBY 30,000.00 15,000.00 15,000.00 30,000.00
135 9/10/2015 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
136 FINI 25,000.00 12,500.00 12,500.00 25,000.00
137 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
138 FARIZ 15,000.00 7,500.00 7,500.00 15,000.00
139 FATHIA 70,000.00 35,000.00 35,000.00 70,000.00
140 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
141 RIKA 30,000.00 15,000.00 15,000.00 30,000.00
142 RICKY 70,000.00 35,000.00 35,000.00 70,000.00
143 REZA 30,000.00 15,000.00 15,000.00 30,000.00
144 HALENA 30,000.00 15,000.00 15,000.00 30,000.00
145 SUSYANI 30,000.00 15,000.00 15,000.00 30,000.00
146 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
147 ELIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
148 10/10/2015 DEBORAH 70,000.00 35,000.00 35,000.00 70,000.00
149 WIDANINGSIH 3,000.00 1,500.00 1,500.00 3,000.00
150 M ILHAM 25,000.00 12,500.00 12,500.00 25,000.00
151 HENNY 15,000.00 7,500.00 7,500.00 15,000.00
152 AURELIA 35,000.00 17,500.00 17,500.00 35,000.00
153 WINDA 15,000.00 7,500.00 7,500.00 15,000.00
154 MARYATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
155 SUSMIYANI 40,000.00 20,000.00 20,000.00 40,000.00
156 JUMIRAH 30,000.00 15,000.00 15,000.00 30,000.00
157 EKA GANTARA 30,000.00 15,000.00 15,000.00 30,000.00
158 10/10/2015 SITI 70,000.00 35,000.00 35,000.00 70,000.00
159 MILDAN 40,000.00 20,000.00 20,000.00 40,000.00
160 TITING 70,000.00 35,000.00 35,000.00 70,000.00
161 LAZIMATUN 35,000.00 17,500.00 17,500.00 35,000.00
162 TITA 70,000.00 35,000.00 35,000.00 70,000.00
163 HAISYA 40,000.00 20,000.00 20,000.00 40,000.00
164 IRNA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
165 STEVANIE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
166 RAYNALD 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
167 AINA 40,000.00 20,000.00 20,000.00 40,000.00
168 12/10/2015 VICTORIA 70,000.00 35,000.00 35,000.00 70,000.00
169 RIFAN 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
170 ABDURASYID 35,000.00 17,500.00 17,500.00 35,000.00
171 SITI HODIJAH 70,000.00 35,000.00 35,000.00 70,000.00
172 IIS 60,000.00 30,000.00 30,000.00 60,000.00
173 12/10/2015 M SAEFUL 15,000.00 7,500.00 7,500.00 15,000.00
174 SALWA 25,000.00 12,500.00 12,500.00 25,000.00
175 ALWA 70,000.00 35,000.00 35,000.00 70,000.00
176 ANE 15,000.00 7,500.00 7,500.00 15,000.00
177 DEDI 30,000.00 15,000.00 15,000.00 30,000.00
178 NURAHMADITA 30,000.00 15,000.00 15,000.00 30,000.00
179 LINA 30,000.00 15,000.00 15,000.00 30,000.00
180 IRFAN 40,000.00 20,000.00 20,000.00 40,000.00
181 TIARA 40,000.00 20,000.00 20,000.00 40,000.00
182 KARIN 70,000.00 35,000.00 35,000.00 70,000.00
183 13/10/2015 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
184 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
185 SUCIYANTI 70,000.00 35,000.00 35,000.00 70,000.00
186 JUDI 15,000.00 7,500.00 7,500.00 15,000.00
187 MARTHA 50,000.00 25,000.00 25,000.00 50,000.00
188 MURNIATI 15,000.00 7,500.00 7,500.00 15,000.00
189 RENDY 15,000.00 7,500.00 7,500.00 15,000.00
190 JIHAN 15,000.00 7,500.00 7,500.00 15,000.00
191 15/10/2015 REYHAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
192 NIDYA 25,000.00 12,500.00 12,500.00 25,000.00
193 SAPTA 70,000.00 35,000.00 35,000.00 70,000.00
194 M SUPRIATO 15,000.00 7,500.00 7,500.00 15,000.00
195 IRNA 30,000.00 15,000.00 15,000.00 30,000.00
196 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
197 TETI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
198 RIAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
199 15/10/2015 WAWAN 30,000.00 15,000.00 15,000.00 30,000.00
200 YOS 15,000.00 7,500.00 7,500.00 15,000.00
201 SHELOMITA 25,000.00 12,500.00 12,500.00 25,000.00
202 FENI 30,000.00 15,000.00 15,000.00 30,000.00
203 SITI 70,000.00 35,000.00 35,000.00 70,000.00
204 ALPANI 30,000.00 15,000.00 15,000.00 30,000.00
205 DADANG 25,000.00 12,500.00 12,500.00 25,000.00
206 DENATA 30,000.00 15,000.00 15,000.00 30,000.00
207 ETI 25,000.00 12,500.00 12,500.00 25,000.00
208 NURMELISA 15,000.00 7,500.00 7,500.00 15,000.00
209 KANIA 30,000.00 15,000.00 15,000.00 30,000.00
210 MAULIDINI 30,000.00 15,000.00 15,000.00 30,000.00
211 16/10/2015 DELFI 30,000.00 15,000.00 15,000.00 30,000.00
212 SUKARTI 70,000.00 35,000.00 35,000.00 70,000.00
213 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
214 TATI 70,000.00 35,000.00 35,000.00 70,000.00
215 FEBBY 20,000.00 10,000.00 10,000.00 20,000.00
216 16/10/2015 KARLAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
217 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
218 SHOBRINA 30,000.00 15,000.00 15,000.00 30,000.00
219 MURNIATI 30,000.00 15,000.00 15,000.00 30,000.00
220 ISMAIL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
221 HALENA 40,000.00 20,000.00 20,000.00 40,000.00
222 AEP 25,000.00 12,500.00 12,500.00 25,000.00
223 SUSYANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
224 RUDI 40,000.00 20,000.00 20,000.00 40,000.00
225 ELIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
226 BUNGA 25,000.00 12,500.00 12,500.00 25,000.00
227 17/10/2015 RIZKY 70,000.00 35,000.00 35,000.00 70,000.00
228 SUNARSIH 70,000.00 35,000.00 35,000.00 70,000.00
229 DEBORAH 50,000.00 25,000.00 25,000.00 50,000.00
230 ILHAM 35,000.00 17,500.00 17,500.00 35,000.00
231 SINTA DEWI 60,000.00 30,000.00 30,000.00 60,000.00
232 SUKARYATI 60,000.00 30,000.00 30,000.00 60,000.00
233 WIDANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
234 SAEPUL AHMAD 15,000.00 7,500.00 7,500.00 15,000.00
235 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
236 AURELIA 30,000.00 15,000.00 15,000.00 30,000.00
237 AGUS 100,000.00 50,000.00 50,000.00 100,000.00
238 SUSMIYANI 70,000.00 35,000.00 35,000.00 70,000.00
239 IHSAN L A 35,000.00 17,500.00 17,500.00 35,000.00
240 17/10/2015 SYLVIA A M 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
241 REZA 30,000.00 15,000.00 15,000.00 70,000.00
242 IDA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
243 RIKA 30,000.00 15,000.00 15,000.00 30,000.00
244 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
245 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
246 FITRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
247 ERVINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
248 RAMDAN 15,000.00 7,500.00 7,500.00 15,000.00
249 FRICILIA 70,000.00 35,000.00 35,000.00 70,000.00
250 19/10/2015 AA S 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
251 HAISYA 70,000.00 35,000.00 35,000.00 70,000.00
252 IIS 60,000.00 30,000.00 30,000.00 60,000.00
253 ABDURASYID 25,000.00 12,500.00 12,500.00 25,000.00
254 TANIA 70,000.00 35,000.00 35,000.00 70,000.00
255 LUCKY 70,000.00 35,000.00 35,000.00 70,000.00
256 19/10/2015 SHERLY 30,000.00 15,000.00 15,000.00 30,000.00
257 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
258 SABRINA 50,000.00 25,000.00 25,000.00 50,000.00
259 TEGUH 25,000.00 12,500.00 12,500.00 25,000.00
260 TUTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
261 ROPI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
262 DENI 25,000.00 12,500.00 12,500.00 25,000.00
263 HASAN 15,000.00 7,500.00 7,500.00 15,000.00
264 KARLINA 70,000.00 35,000.00 35,000.00 70,000.00
265 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
266 DEDI 30,000.00 15,000.00 15,000.00 30,000.00
267 SOBRINI 30,000.00 15,000.00 15,000.00 30,000.00
268 20/10/2015 SISKA 30,000.00 15,000.00 15,000.00 30,000.00
269 JUMIYATI 30,000.00 15,000.00 15,000.00 30,000.00
270 ITO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
271 SRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
272 20/10/2015 RIVGINATI 25,000.00 12,500.00 12,500.00 25,000.00
273 LAZIMATUN 30,000.00 15,000.00 15,000.00 30,000.00
274 SULAEMAN 30,000.00 15,000.00 15,000.00 30,000.00
275 CARISSA 30,000.00 15,000.00 15,000.00 30,000.00
276 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
277 WAHYU 25,000.00 12,500.00 12,500.00 25,000.00
278 SULASTRI 70,000.00 35,000.00 35,000.00 70,000.00
279 SRI MARYANI 60,000.00 30,000.00 30,000.00 60,000.00
280 SEPTI 30,000.00 15,000.00 15,000.00 30,000.00
281 DICKY 30,000.00 15,000.00 15,000.00 30,000.00
282 21/10/2015 SILVESRTER 30,000.00 15,000.00 15,000.00 30,000.00
283 SITI HODIJAH 15,000.00 7,500.00 7,500.00 15,000.00
284 LANNY 30,000.00 15,000.00 15,000.00 15,000.00 45,000.00
285 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
286 WENI 15,000.00 7,500.00 7,500.00 15,000.00
287 SUMIATI 30,000.00 15,000.00 15,000.00 15,000.00 45,000.00
288 VICTORIA 70,000.00 35,000.00 35,000.00 70,000.00
289 DEVI J 30,000.00 15,000.00 15,000.00 30,000.00
290 ELISA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
291 DURRAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
292 HERMANSYAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
293 RAISYA 25,000.00 12,500.00 12,500.00 25,000.00
294 II K 70,000.00 35,000.00 35,000.00 70,000.00
295 SITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
296 MILDAN 70,000.00 35,000.00 35,000.00 70,000.00
297 DEFI 30,000.00 15,000.00 15,000.00 30,000.00
298 21/10/2015 FINI 35,000.00 17,500.00 17,500.00 35,000.00
299 NABILA 70,000.00 35,000.00 35,000.00 70,000.00
300 ALMAIDA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
301 ROSMAWATI 30,000.00 15,000.00 15,000.00 30,000.00
302 WIDANINGSIH 30,000.00 15,000.00 15,000.00 45,000.00
303 RIFKI 35,000.00 17,500.00 17,500.00 35,000.00
304 FUJITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
305 DEDE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
306 ISMAIL 30,000.00 15,000.00 15,000.00 30,000.00
307 22/10/2015 YANTI 30,000.00 15,000.00 15,000.00 30,000.00
308 NAJWA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
309 MIRSAD 30,000.00 15,000.00 15,000.00 30,000.00
310 TETI 30,000.00 15,000.00 15,000.00 30,000.00
311 SAHNA 25,000.00 12,500.00 12,500.00 25,000.00
312 RIDHO NUR 15,000.00 7,500.00 7,500.00 15,000.00
313 NAYRA 30,000.00 15,000.00 15,000.00 30,000.00
314 SITI KOMALA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
315 EVY SYANTI 70,000.00 35,000.00 35,000.00 70,000.00
316 22/10/2015 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
317 NURMELISA 40,000.00 20,000.00 20,000.00 40,000.00
318 ETI 30,000.00 15,000.00 15,000.00 30,000.00
319 KANIA 40,000.00 20,000.00 20,000.00 40,000.00
320 IRNA 30,000.00 15,000.00 15,000.00 30,000.00
321 IRPAN 70,000.00 35,000.00 35,000.00 70,000.00
322 SITI 30,000.00 15,000.00 15,000.00 30,000.00
323 AZMI 70,000.00 35,000.00 35,000.00 70,000.00
324 23/10/2015 MARYATI 70,000.00 35,000.00 35,000.00 70,000.00
325 SUMARNA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
326 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
327 FEBBY 30,000.00 15,000.00 15,000.00 30,000.00
328 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
329 DANI 140,000.00 70,000.00 70,000.00 140,000.00
330 RATIH 30,000.00 15,000.00 15,000.00 30,000.00
331 ASMI 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
332 TATI 70,000.00 35,000.00 35,000.00 70,000.00
333 23/10/2015 NIDYA 15,000.00 7,500.00 7,500.00 15,000.00
334 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
335 DETI 70,000.00 35,000.00 35,000.00 70,000.00
336 RUDI 30,000.00 15,000.00 15,000.00 30,000.00
337 ELIS 15,000.00 7,500.00 7,500.00 15,000.00
338 SUSYANI 70,000.00 35,000.00 35,000.00 70,000.00
339 24/10/2015 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
340 DIAH 70,000.00 35,000.00 35,000.00 70,000.00
341 SITI 25,000.00 12,500.00 12,500.00 25,000.00
342 TITI 150,000.00 75,000.00 75,000.00 150,000.00
343 YULIANTI 60,000.00 30,000.00 30,000.00 60,000.00
344 TUTI 60,000.00 30,000.00 30,000.00 60,000.00
345 DIDA W 35,000.00 17,500.00 17,500.00 35,000.00
346 24/10/2015 AINA 70,000.00 35,000.00 35,000.00 70,000.00
347 IDA S 70,000.00 35,000.00 35,000.00 70,000.00
348 RIKA R 30,000.00 15,000.00 15,000.00 30,000.00
349 ALVIA 70,000.00 35,000.00 35,000.00 70,000.00
350 FATHIA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
351 M FADLAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
352 REZA 30,000.00 15,000.00 15,000.00 30,000.00
353 HALENA 70,000.00 35,000.00 35,000.00 70,000.00
354 26/10/2015 AA S 70,000.00 35,000.00 35,000.00 70,000.00
355 ITO K 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
356 ANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
357 NONA 70,000.00 35,000.00 35,000.00 70,000.00
358 RAMDAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
359 IRWAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
360 SOBO 15,000.00 7,500.00 7,500.00 15,000.00
361 YULIANTI 70,000.00 35,000.00 35,000.00 70,000.00
362 SITI HODIJAH 15,000.00 7,500.00 7,500.00 15,000.00
363 26/10/2015 ILHAM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
364 DEDI 30,000.00 15,000.00 15,000.00 30,000.00
365 SUHARSONO 30,000.00 15,000.00 15,000.00 30,000.00
366 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
367 DENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
368 NURMALI 30,000.00 15,000.00 15,000.00 30,000.00
369 HORA 70,000.00 35,000.00 35,000.00 70,000.00
370 SABRINA 25,000.00 12,500.00 12,500.00 25,000.00
371 SHAFIRA 25,000.00 12,500.00 12,500.00 25,000.00
372 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
373 27/10/2015 SAPTA 30,000.00 15,000.00 15,000.00 30,000.00
374 ADITYA 15,000.00 7,500.00 7,500.00 15,000.00
375 SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
376 HERMANSYAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
377 ROSITA 70,000.00 35,000.00 35,000.00 70,000.00
378 BUDHI 30,000.00 15,000.00 15,000.00 30,000.00
379 YUYUM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
380 INA 30,000.00 15,000.00 15,000.00 30,000.00
381 JUMYATI 70,000.00 35,000.00 35,000.00 70,000.00
382 KANIA 70,000.00 35,000.00 35,000.00 70,000.00
383 IRNA 30,000.00 15,000.00 15,000.00 30,000.00
384 KUN 70,000.00 35,000.00 35,000.00 70,000.00
385 27/10/2015 AGUS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
386 SEPTI 30,000.00 15,000.00 15,000.00 30,000.00
387 EVY SYANTI 70,000.00 35,000.00 35,000.00 70,000.00
388 DEFI 30,000.00 15,000.00 15,000.00 30,000.00
389 FAISHAL 70,000.00 35,000.00 35,000.00 70,000.00
390 ZAYN 15,000.00 7,500.00 7,500.00 15,000.00
391 RIDWAN 15,000.00 7,500.00 7,500.00 15,000.00
392 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
393 KARTIKA 30,000.00 15,000.00 15,000.00 30,000.00
394 SULASTRI 70,000.00 35,000.00 35,000.00 70,000.00
395 28/10/2015 LANNY 30,000.00 15,000.00 15,000.00 30,000.00
396 EKA 70,000.00 35,000.00 35,000.00 70,000.00
397 VICTORIA 30,000.00 15,000.00 15,000.00 30,000.00
398 SUMIATI 35,000.00 17,500.00 17,500.00 35,000.00
399 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
400 EMELIA 30,000.00 15,000.00 15,000.00 30,000.00
401 SITI 40,000.00 20,000.00 20,000.00 40,000.00
402 SUNARSIH 40,000.00 20,000.00 20,000.00 40,000.00
403 28/10/2015 WIDANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
404 REZA 30,000.00 15,000.00 15,000.00 30,000.00
405 FATIH 70,000.00 35,000.00 35,000.00 70,000.00
406 WAHYU 70,000.00 35,000.00 35,000.00 70,000.00
407 ENDANG T 70,000.00 35,000.00 35,000.00 70,000.00
408 DURRAH 30,000.00 15,000.00 15,000.00 30,000.00
409 YANTI 70,000.00 35,000.00 35,000.00 70,000.00
410 ANGGITA 30,000.00 15,000.00 15,000.00 30,000.00
411 ISMAIL 70,000.00 35,000.00 35,000.00 70,000.00
412 DARA 30,000.00 15,000.00 15,000.00 30,000.00
413 GEORGE 15,000.00 7,500.00 7,500.00 15,000.00
414 29/10/2015 RASYAD 25,000.00 12,500.00 12,500.00 25,000.00
415 RAVEL 30,000.00 15,000.00 15,000.00 30,000.00
416 LILIS 30,000.00 15,000.00 15,000.00 30,000.00
417 THIA 35,000.00 17,500.00 17,500.00 35,000.00
418 IIS WARKILAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
419 ASMA 25,000.00 12,500.00 12,500.00 25,000.00
420 29/10/2015 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
421 SALWA 25,000.00 12,500.00 12,500.00 25,000.00
422 RAJWA 25,000.00 12,500.00 12,500.00 25,000.00
423 NENDEN 30,000.00 15,000.00 15,000.00 30,000.00
424 AGUS 15,000.00 7,500.00 7,500.00 15,000.00
425 ENTIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
426 SITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
427 ELI 30,000.00 15,000.00 15,000.00 30,000.00
428 NURMEILISA 70,000.00 35,000.00 35,000.00 70,000.00
429 30/10/2015 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
430 HESTY 15,000.00 7,500.00 7,500.00 15,000.00
431 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
432 RINI 70,000.00 35,000.00 35,000.00 70,000.00
433 ABIE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
434 SRI SUDARYATI 15,000.00 7,500.00 7,500.00 15,000.00
435 FEBBY 30,000.00 15,000.00 15,000.00 30,000.00
436 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
437 30/10/2015 AEP 30,000.00 15,000.00 15,000.00 30,000.00
438 SUPARNI 30,000.00 15,000.00 15,000.00 30,000.00
439 ASEP W 70,000.00 35,000.00 35,000.00 70,000.00
440 ASTI 30,000.00 15,000.00 15,000.00 30,000.00
441 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
442 ADE 15,000.00 7,500.00 7,500.00 15,000.00
443 ALI 15,000.00 7,500.00 7,500.00 15,000.00
444 RUDI 30,000.00 15,000.00 15,000.00 30,000.00
445 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
446 ELIS 15,000.00 7,500.00 7,500.00 15,000.00
447 31/10/2015 KEVIN 70,000.00 35,000.00 35,000.00 70,000.00
448 HERMANSYAH 15,000.00 7,500.00 7,500.00 15,000.00
449 DAFA 15,000.00 7,500.00 7,500.00 15,000.00
450 RESNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
451 DIDAH 70,000.00 35,000.00 35,000.00 70,000.00
452 ELIS 30,000.00 15,000.00 15,000.00 30,000.00
453 31/10/2015 LAZIMATUN 15,000.00 7,500.00 7,500.00 15,000.00
454 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
455 M FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
456 ZULFA 70,000.00 35,000.00 35,000.00 70,000.00
457 BUNGA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
458 RIZKIA 30,000.00 15,000.00 15,000.00 30,000.00
17,313,000 750,000 8,656,500 8,656,500 18,093,000
KET
KET
-
JASA ALAT &

NO TANGGAL NAMA PASIEN TARIF ADM JML KET
DOKTER BAHAN
1 1/11/2015 ANGGUN 50,000 5,000 22,500 22,500 55,000
2 2/11/2015 FRANS 100,000 5,000 47,500 47,500 105,000
3 AAN 140,000 5,000 67,500 67,500 145,000
4 4/11/2015 HANI 100,000 5,000 47,500 47,500 105,000
5 7/11/2015 ASEP 200,000 5,000 97,500 97,500 205,000
6 DUDI 70,000 5,000 32,500 32,500 75,000
7 9/11/2015 FRANS 150,000 5,000 72,500 72,500 155,000
8 10/11/2015 MIRAN 30,000 5,000 12,500 12,500 30,000
9 11/11/2015 DURRAH 150,000 5,000 72,500 72,500 150,000
10 12/11/2015 SUPRAYETNO 100,000 5,000 47,500 47,500 100,000
11 14/11/2015 SUCI R 200,000 5,000 97,500 97,500 200,000
12 EKA G 100,000 5,000 47,500 47,500 100,000
13 16/11/2015 GUGUN 50,000 5,000 22,500 22,500 50,000
14 TATANG 100,000 5,000 47,500 47,500 100,000
15 17/11/2015 DADANG 200,000 5,000 97,500 97,500 200,000
16 KIKI 200,000 5,000 97,500 97,500 200,000
17 21/11/2015 SUMARNI 30,000 5,000 12,500 12,500 30,000
18 SELLY 50,000 5,000 22,500 22,500 50,000
19 22/11/2015 DANA 70,000 5,000 32,500 32,500 20,000
20 ANGGUN 55,000 5,000 25,000 25,000 55,000
21 23/11/2015 DADAN 20,000 5,000 7,500 7,500 20,000
22 GUGUN 220,000 5,000 107,500 107,500 220,000
23 AAN 200,000 5,000 97,500 97,500 200,000
24 RIZKY 20,000 5,000 7,500 7,500 20,000
25 28/11/2015 RAHMAT 250,000 5,000 122,500 122,500 250,000
26 30/11/2015 YULING 45,000 5,000 20,000 20,000 45,000
27 ANI 70,000 5,000 32,500 32,500 70,000
TOTAL 2,970,000 135,000 1,417,500 1,417,500 2,955,000

JASA ALAT &

TGL TARIF OBAT JML KET
DOKTER BAHAN
1 2/11/2015 AI 70,000.00 35,000.00 35,000.00 70,000.00
2 NITA 35,000.00 17,500.00 17,500.00 35,000.00
3 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
4 SAFTA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
5 RIKA 40,000.00 20,000.00 20,000.00 40,000.00
6 SUNARSIH 70,000.00 35,000.00 35,000.00 70,000.00
7 RAMDAN 30,000.00 15,000.00 15,000.00 30,000.00
8 2/11/2015 MURNIATI 30,000.00 15,000.00 15,000.00 30,000.00
9 LURI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
10 TUNI 70,000.00 35,000.00 35,000.00 70,000.00
11 AHMAD 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
12 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
13 RAFIF 25,000.00 12,500.00 12,500.00 25,000.00
14 DENI 30,000.00 15,000.00 15,000.00 30,000.00
15 WAWAN 40,000.00 20,000.00 20,000.00 40,000.00
16 EPI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
17 RIFAN 25,000.00 12,500.00 12,500.00 25,000.00
18 TIARA 70,000.00 35,000.00 35,000.00 70,000.00
19 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
20 3/11/2015 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
21 ASEP 70,000.00 35,000.00 35,000.00 70,000.00
22 INA 30,000.00 15,000.00 15,000.00 30,000.00
23 SRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
24 ROSINTA 70,000.00 35,000.00 35,000.00 70,000.00
25 IBUT 30,000.00 15,000.00 15,000.00 30,000.00
26 RINA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
27 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
28 3/11/2015 LANIWATI 40,000.00 20,000.00 20,000.00 40,000.00
29 PONIMAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
30 DEFI 40,000.00 20,000.00 20,000.00 40,000.00
31 DUDU 30,000.00 15,000.00 15,000.00 30,000.00
32 IREN 25,000.00 12,500.00 12,500.00 25,000.00
33 SYAHID 25,000.00 12,500.00 12,500.00 25,000.00
34 SEPTI 30,000.00 15,000.00 15,000.00 30,000.00
35 KANIA 35,000.00 17,500.00 17,500.00 35,000.00
36 DICKY 40,000.00 20,000.00 20,000.00 40,000.00
37 4/11/2015 SILVESTER 30,000.00 15,000.00 15,000.00 30,000.00
38 LANNY 70,000.00 35,000.00 35,000.00 70,000.00
39 RINI 30,000.00 15,000.00 15,000.00 30,000.00
40 SUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
41 ADHIE 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
42 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
43 ALYA 35,000.00 17,500.00 17,500.00 35,000.00
44 DURRAH 30,000.00 15,000.00 15,000.00 30,000.00
45 DETI 70,000.00 35,000.00 35,000.00 70,000.00
46 SITI 15,000.00 7,500.00 7,500.00 15,000.00
47 4/11/2015 REZA 30,000.00 15,000.00 15,000.00 30,000.00
48 ISMAIL N 30,000.00 15,000.00 15,000.00 30,000.00
49 SOPIYAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
50 YANTI 30,000.00 15,000.00 15,000.00 30,000.00
51 ANGGITA 30,000.00 15,000.00 15,000.00 30,000.00
52 FATIH 30,000.00 15,000.00 15,000.00 30,000.00
53 WAHYU 70,000.00 35,000.00 35,000.00 70,000.00
54 ENDANG 70,000.00 35,000.00 35,000.00 70,000.00
55 REZA 30,000.00 15,000.00 15,000.00 30,000.00
56 EMMELI 30,000.00 15,000.00 15,000.00 30,000.00
57 WIDA 40,000.00 20,000.00 20,000.00 40,000.00
58 5/11/2015 ZAYA 70,000.00 35,000.00 35,000.00 70,000.00
59 HERU 30,000.00 15,000.00 15,000.00 30,000.00
60 ELIS 60,000.00 30,000.00 30,000.00 60,000.00
61 PUNGUT 30,000.00 15,000.00 15,000.00 30,000.00
62 YAYAH 40,000.00 20,000.00 20,000.00 40,000.00
63 5/11/2015 AGUNG 30,000.00 15,000.00 15,000.00 30,000.00
64 NURACJMADITA 30,000.00 15,000.00 15,000.00 30,000.00
65 YENI 30,000.00 15,000.00 15,000.00 30,000.00
66 SITI 30,000.00 15,000.00 15,000.00 30,000.00
67 IRPAN 70,000.00 35,000.00 35,000.00 70,000.00
68 DEDI 30,000.00 15,000.00 15,000.00 30,000.00
69 ASMA 25,000.00 12,500.00 12,500.00 25,000.00
70 REYHAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
71 ROPI 30,000.00 15,000.00 15,000.00 30,000.00
72 DENI 30,000.00 15,000.00 15,000.00 30,000.00
73 ILHAM 25,000.00 12,500.00 12,500.00 25,000.00
74 IRNA 30,000.00 15,000.00 15,000.00 30,000.00
75 SULAEMAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
76 SUHARSONO 40,000.00 20,000.00 20,000.00 40,000.00
77 6/11/2015 KHOTIMAH 70,000.00 35,000.00 35,000.00 70,000.00
78 M HAERUDIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
79 NIKEN JIWA 70,000.00 35,000.00 35,000.00 70,000.00
80 ANDI TIRTA 30,000.00 15,000.00 15,000.00 30,000.00
81 FANYSYA 30,000.00 15,000.00 15,000.00 30,000.00
82 RINI 30,000.00 15,000.00 15,000.00 30,000.00
83 FHEYLECIA 70,000.00 35,000.00 35,000.00 70,000.00
84 DEFIAR 70,000.00 35,000.00 35,000.00 70,000.00
85 6/11/2015 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
86 FENI 70,000.00 35,000.00 35,000.00 70,000.00
87 FADLAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
88 SITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
89 ENTIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
90 RUDI 30,000.00 15,000.00 15,000.00 30,000.00
91 BELA 30,000.00 15,000.00 15,000.00 30,000.00
92 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
93 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
94 7/11/2015 HOLISOH 30,000.00 15,000.00 15,000.00 30,000.00
95 LISNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
96 KEVIN 70,000.00 35,000.00 35,000.00 70,000.00
97 ELIS 30,000.00 15,000.00 15,000.00 30,000.00
98 ASEP 15,000.00 7,500.00 7,500.00 15,000.00
99 CARISSA 30,000.00 15,000.00 15,000.00 30,000.00
100 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
101 7/11/2015 ASEP WAHYU 30,000.00 15,000.00 15,000.00 30,000.00
102 M SEPTIAN 60,000.00 30,000.00 30,000.00 35,000.00
103 FITRI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
104 TUTI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
105 RUSTIANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
106 SITI H 70,000.00 35,000.00 35,000.00 70,000.00
107 SASKIA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
108 SITI A 70,000.00 35,000.00 35,000.00 70,000.00
109 SUMIATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
110 AINA 30,000.00 15,000.00 15,000.00 30,000.00
111 9/11/2015 DEWI JATRA 30,000.00 15,000.00 15,000.00 30,000.00
112 LAZIMATUN 70,000.00 35,000.00 35,000.00 70,000.00
113 DWI S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
114 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
115 AGUS 70,000.00 35,000.00 35,000.00 70,000.00
116 NISRINA 70,000.00 35,000.00 35,000.00 70,000.00
117 SYAHWA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
118 RIKA 70,000.00 35,000.00 35,000.00 70,000.00
119 SUNARSIH 70,000.00 35,000.00 35,000.00 70,000.00
120 9/11/2015 FEBY 30,000.00 15,000.00 15,000.00 30,000.00
121 NASWA 15,000.00 7,500.00 7,500.00 15,000.00
122 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
123 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
124 M FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
125 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
126 WAWAN 70,000.00 35,000.00 35,000.00 70,000.00
127 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
128 10/11/2015 SRI 15,000.00 7,500.00 7,500.00 15,000.00
129 HOLISOH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
130 HADIYANSYAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
131 IBUT S 70,000.00 35,000.00 35,000.00 70,000.00
132 SURATA 30,000.00 15,000.00 15,000.00 30,000.00
133 IRNA 30,000.00 15,000.00 15,000.00 30,000.00
134 JUMALI 70,000.00 35,000.00 35,000.00 70,000.00
135 IWAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
136 CANDRA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
137 LYRA 15,000.00 7,500.00 7,500.00 15,000.00
138 MURNIATI 40,000.00 20,000.00 20,000.00 40,000.00
139 DEASY 70,000.00 35,000.00 35,000.00 70,000.00
140 10/11/2015 SEPTI 40,000.00 20,000.00 20,000.00 40,000.00
141 DICKY 70,000.00 35,000.00 35,000.00 70,000.00
142 PONIMAN 70,000.00 35,000.00 35,000.00 70,000.00
143 NADHIRA 30,000.00 15,000.00 15,000.00 30,000.00
144 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
145 NAYLA 35,000.00 17,500.00 17,500.00 35,000.00
146 DEFI 70,000.00 35,000.00 35,000.00 70,000.00
147 LILIS 40,000.00 20,000.00 20,000.00 40,000.00
148 ARINI 25,000.00 12,500.00 12,500.00 25,000.00
149 SHOBRINA 30,000.00 15,000.00 15,000.00 30,000.00
150 M RAMDAN 35,000.00 17,500.00 17,500.00 35,000.00
151 TETEN 70,000.00 35,000.00 35,000.00 70,000.00
152 DUDU 70,000.00 35,000.00 35,000.00 70,000.00
153 IREN 35,000.00 17,500.00 17,500.00 35,000.00
154 IRWAN 60,000.00 30,000.00 30,000.00 60,000.00
155 11/11/2015 HAFIYA 30,000.00 15,000.00 15,000.00 30,000.00
156 DELI 70,000.00 35,000.00 35,000.00 70,000.00
157 ADHIE 30,000.00 15,000.00 15,000.00 30,000.00
158 NOVI 70,000.00 35,000.00 35,000.00 70,000.00
159 EMELIA 30,000.00 15,000.00 15,000.00 30,000.00
160 SITI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
161 SUIATI 40,000.00 20,000.00 20,000.00 40,000.00
162 IMAS J 70,000.00 35,000.00 35,000.00 70,000.00
163 RATIH 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
164 NURSALAMAH 30,000.00 15,000.00 15,000.00 30,000.00
165 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
166 SITI 70,000.00 35,000.00 35,000.00 70,000.00
167 11/11/2015 MIRHAN 25,000.00 12,500.00 12,500.00 25,000.00
168 DURROH 70,000.00 35,000.00 35,000.00 70,000.00
169 REZA 70,000.00 35,000.00 35,000.00 70,000.00
170 USWATUN 60,000.00 30,000.00 30,000.00 60,000.00
171 ENDANG 70,000.00 35,000.00 35,000.00 70,000.00
172 DYAH 70,000.00 35,000.00 35,000.00 70,000.00
173 WIDANINGSIH 70,000.00 35,000.00 35,000.00 70,000.00
174 ZILANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
175 M REZA 30,000.00 15,000.00 15,000.00 30,000.00
176 12/11/2015 IRENE 25,000.00 12,500.00 12,500.00 25,000.00
177 TETI 30,000.00 15,000.00 15,000.00 30,000.00
178 DINA 25,000.00 12,500.00 12,500.00 25,000.00
179 LISWATI 70,000.00 35,000.00 35,000.00 70,000.00
180 PUNGUT 30,000.00 15,000.00 15,000.00 30,000.00
181 DEWI JATRA 30,000.00 15,000.00 15,000.00 30,000.00
182 IRMA L 30,000.00 15,000.00 15,000.00 30,000.00
183 FEBBY N 40,000.00 20,000.00 20,000.00 40,000.00
184 12/11/2015 NURFANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
185 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
186 DILLA 15,000.00 7,500.00 7,500.00 15,000.00
187 YENI 70,000.00 35,000.00 35,000.00 70,000.00
188 SITI 30,000.00 15,000.00 15,000.00 30,000.00
189 ELIS 30,000.00 15,000.00 15,000.00 30,000.00
190 13/11/2015 FHEYLECIA 70,000.00 35,000.00 35,000.00 70,000.00
191 HELMAN 30,000.00 15,000.00 15,000.00 30,000.00
192 ANNE K 70,000.00 35,000.00 35,000.00 70,000.00
193 RINI M 70,000.00 35,000.00 35,000.00 70,000.00
194 FAHIRA 25,000.00 12,500.00 12,500.00 25,000.00
195 NIKEN JIWA 70,000.00 35,000.00 35,000.00 70,000.00
196 ASMA 25,000.00 12,500.00 12,500.00 25,000.00
197 RANO 70,000.00 35,000.00 35,000.00 70,000.00
198 MYSHELLA P 35,000.00 17,500.00 17,500.00 35,000.00
199 SUPRIATIN 30,000.00 15,000.00 15,000.00 30,000.00
200 EUIS 30,000.00 15,000.00 15,000.00 30,000.00
201 SUPRAYETNO 70,000.00 35,000.00 35,000.00 70,000.00
202 FANYSYA 25,000.00 12,500.00 12,500.00 25,000.00
203 13/11/2015 SULAEMAN 30,000.00 15,000.00 15,000.00 30,000.00
204 ADE M 70,000.00 35,000.00 35,000.00 70,000.00
205 RUDI 40,000.00 20,000.00 20,000.00 40,000.00
206 14/11/2015 ANNISA 30,000.00 15,000.00 15,000.00 30,000.00
207 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
208 SUKAESIH 60,000.00 30,000.00 30,000.00 60,000.00
209 KEVIN 70,000.00 35,000.00 35,000.00 70,000.00
210 AI SUHAETI 30,000.00 15,000.00 15,000.00 30,000.00
211 GINA 70,000.00 35,000.00 35,000.00 70,000.00
212 SYAFA 35,000.00 17,500.00 17,500.00 35,000.00
213 WIDANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
214 FX 70,000.00 35,000.00 35,000.00 70,000.00
215 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
216 CARISSA P 30,000.00 15,000.00 15,000.00 30,000.00
217 SUCI 60,000.00 30,000.00 30,000.00 60,000.00
218 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
219 14/11/2015 ANWAR 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
220 DAVINA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
221 NITA 70,000.00 35,000.00 35,000.00 70,000.00
222 IDA 70,000.00 35,000.00 35,000.00 70,000.00
223 EKA 30,000.00 15,000.00 15,000.00 30,000.00
224 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
225 RAFIF 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
226 ZULFA 70,000.00 35,000.00 35,000.00 70,000.00
227 16/11/2015 SAFTA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
228 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
229 YAYA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
230 16/11/2015 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
231 AHMAD M 25,000.00 12,500.00 12,500.00 25,000.00
232 DENDI 15,000.00 7,500.00 7,500.00 15,000.00
233 FAHMI 30,000.00 15,000.00 15,000.00 30,000.00
234 FADHAN 30,000.00 15,000.00 15,000.00 30,000.00
235 KEYLA 15,000.00 7,500.00 7,500.00 15,000.00
236 RIZKI 15,000.00 7,500.00 7,500.00 15,000.00
237 RESNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
238 ADITYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
239 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
240 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
241 17/11/2015 MURNIATI 70,000.00 35,000.00 35,000.00 70,000.00
242 CANDRA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
243 IBUT 7,000.00 3,500.00 3,500.00 7,000.00
244 FADILA 15,000.00 7,500.00 7,500.00 15,000.00
245 KOLIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
246 LAW TONG 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
247 SUKAESIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
248 NABELJAH 25,000.00 12,500.00 12,500.00 25,000.00
249 TEMMY 30,000.00 15,000.00 15,000.00 30,000.00
250 ANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
251 SUMITA 30,000.00 15,000.00 15,000.00 30,000.00
252 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
253 TANYA 25,000.00 12,500.00 12,500.00 25,000.00
254 17/11/2015 NAYLA 25,000.00 12,500.00 12,500.00 25,000.00
255 KIKI 30,000.00 15,000.00 15,000.00 30,000.00
256 PONIMAN 30,000.00 15,000.00 15,000.00 30,000.00
257 UJANG 30,000.00 15,000.00 15,000.00 30,000.00
258 DEFI 70,000.00 35,000.00 35,000.00 70,000.00
259 FEBBY N 70,000.00 35,000.00 35,000.00 70,000.00
260 18/11/2015 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
261 SALAMAH 30,000.00 15,000.00 15,000.00 30,000.00
262 WINARNO 35,000.00 17,500.00 17,500.00 35,000.00
263 INDRI 30,000.00 15,000.00 15,000.00 30,000.00
264 SITI M 30,000.00 15,000.00 15,000.00 30,000.00
265 SUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
266 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
267 18/11/2015 WIDANGSIH 70,000.00 35,000.00 35,000.00 70,000.00
268 ALI 35,000.00 17,500.00 17,500.00 35,000.00
269 EMELIA 70,000.00 35,000.00 35,000.00 70,000.00
270 DYAH 30,000.00 15,000.00 15,000.00 30,000.00
271 IIS 60,000.00 30,000.00 30,000.00 60,000.00
272 MUTMAINAH 60,000.00 30,000.00 30,000.00 60,000.00
273 WAHYUNI 30,000.00 15,000.00 15,000.00 30,000.00
274 M REZA 30,000.00 15,000.00 15,000.00 30,000.00
275 ZULIANA 60,000.00 30,000.00 30,000.00 60,000.00
276 AULIA 30,000.00 15,000.00 15,000.00 30,000.00
277 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
278 KOMARIAH 60,000.00 30,000.00 30,000.00 60,000.00
279 19/11/2015 PUNGUT 30,000.00 15,000.00 15,000.00 30,000.00
280 RINI M 70,000.00 35,000.00 35,000.00 70,000.00
281 IRMA L 70,000.00 35,000.00 35,000.00 70,000.00
282 HASNA 25,000.00 12,500.00 12,500.00 25,000.00
283 DILLA 30,000.00 15,000.00 15,000.00 30,000.00
284 USWATUN 30,000.00 15,000.00 15,000.00 30,000.00
285 TETI 30,000.00 15,000.00 15,000.00 30,000.00
286 YULIANA 70,000.00 35,000.00 35,000.00 70,000.00
287 SAFIRA 35,000.00 17,500.00 17,500.00 35,000.00
288 LISWATI 70,000.00 35,000.00 35,000.00 70,000.00
289 ABBOT 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
290 19/11/2015 SITI 30,000.00 15,000.00 15,000.00 30,000.00
291 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
292 YENI 70,000.00 35,000.00 35,000.00 70,000.00
293 AEP 70,000.00 35,000.00 35,000.00 70,000.00
294 ANGGA 15,000.00 7,500.00 7,500.00 15,000.00
295 AHMAD M 30,000.00 15,000.00 15,000.00 30,000.00
296 NURFITRI 70,000.00 35,000.00 35,000.00 70,000.00
297 ANGGITA 30,000.00 15,000.00 15,000.00 30,000.00
298 YANTI 30,000.00 15,000.00 15,000.00 30,000.00
299 AINA 35,000.00 17,500.00 17,500.00 35,000.00
300 20/11/2015 DEFIAR 35,000.00 17,500.00 17,500.00 35,000.00
301 NIKEN JIWA 70,000.00 35,000.00 35,000.00 70,000.00
302 FANSYA 30,000.00 15,000.00 15,000.00 45,000.00
303 CUCUN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
304 ANNE 70,000.00 35,000.00 35,000.00 70,000.00
305 EUIS 70,000.00 35,000.00 35,000.00 70,000.00
306 EUIS 60,000.00 30,000.00 30,000.00 60,000.00
307 ROSINTA 70,000.00 35,000.00 35,000.00 70,000.00
308 RINI M 70,000.00 35,000.00 35,000.00 70,000.00
309 RANO 70,000.00 35,000.00 35,000.00 70,000.00
310 SALWA 70,000.00 35,000.00 35,000.00 70,000.00
311 20/11/2015 ERVINA 30,000.00 15,000.00 15,000.00 30,000.00
312 ENTIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
313 FADLAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
314 CICILIA 25,000.00 12,500.00 12,500.00 25,000.00
315 CILIA 25,000.00 12,500.00 12,500.00 25,000.00
316 FENI 70,000.00 35,000.00 35,000.00 70,000.00
317 AI H 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
318 YATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
319 NURDIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
320 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
321 ADE 70,000.00 35,000.00 35,000.00 70,000.00
322 RUDI 40,000.00 20,000.00 20,000.00 40,000.00
323 ROSMALI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
324 FRICILLIA 70,000.00 35,000.00 35,000.00 70,000.00
325 21/11/2015 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
326 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
327 RINI M 70,000.00 35,000.00 35,000.00 70,000.00
328 LUTHFI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
329 KEVIN 70,000.00 35,000.00 35,000.00 70,000.00
330 SUCI 30,000.00 15,000.00 15,000.00 30,000.00
331 YUYUN 15,000.00 7,500.00 7,500.00 15,000.00
332 FITRI 30,000.00 15,000.00 15,000.00 30,000.00
333 HOLISOH 30,000.00 15,000.00 15,000.00 30,000.00
334 EGIE 35,000.00 17,500.00 17,500.00 35,000.00
335 BUNGA 25,000.00 12,500.00 12,500.00 25,000.00
336 AI SUHAETI 40,000.00 20,000.00 20,000.00 40,000.00
337 WIDANINGSIH 70,000.00 35,000.00 35,000.00 70,000.00
338 LISNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
339 RACHMA 35,000.00 17,500.00 17,500.00 35,000.00
340 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
341 21/11/2015 RIDWAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
342 AINA 30,000.00 15,000.00 15,000.00 30,000.00
343 RUSTIANI 30,000.00 15,000.00 15,000.00 30,000.00
344 TUTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
345 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
346 REVI 70,000.00 35,000.00 35,000.00 70,000.00
347 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
348 SOPIYAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
349 23/11/2015 ANDANG 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
350 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
351 ODANG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
352 ANIS 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
353 NENG YANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
354 FEBRIANA 70,000.00 35,000.00 35,000.00 70,000.00
355 TIN K 15,000.00 7,500.00 7,500.00 15,000.00
356 RIYANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
357 SITI H 70,000.00 35,000.00 35,000.00 70,000.00
358 SHAKIRA 15,000.00 7,500.00 7,500.00 15,000.00
359 23/11/2015 SUKAESIH 30,000.00 15,000.00 15,000.00 30,000.00
360 SONIA 15,000.00 7,500.00 7,500.00 15,000.00
361 YENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
362 ASMA 70,000.00 35,000.00 35,000.00 70,000.00
363 SUTANTO 70,000.00 35,000.00 35,000.00 70,000.00
364 WIDA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
365 RICKY 40,000.00 20,000.00 20,000.00 40,000.00
366 RAFIF 30,000.00 15,000.00 15,000.00 30,000.00
367 AHMAD M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
368 KANTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
369 SUPRIADI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
370 ROSITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
371 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
372 24/11/2015 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
373 SYAHWA 30,000.00 15,000.00 15,000.00 30,000.00
374 DWI 70,000.00 35,000.00 35,000.00 70,000.00
375 CANDRA 70,000.00 35,000.00 35,000.00 70,000.00
376 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
377 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
378 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
379 KOLIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
380 SINTA 30,000.00 15,000.00 15,000.00 30,000.00
381 TEMAY 30,000.00 15,000.00 15,000.00 30,000.00
382 SUPRIATNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
383 24/11/2015 PONIMAN 30,000.00 15,000.00 15,000.00 30,000.00
384 SUWITA 70,000.00 35,000.00 35,000.00 70,000.00
385 RESNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
386 TATI 30,000.00 15,000.00 15,000.00 30,000.00
387 SANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
388 FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
389 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
390 KHALIMAH 70,000.00 35,000.00 35,000.00 70,000.00
391 KIKI 30,000.00 15,000.00 15,000.00 30,000.00
392 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
393 NAYLA 70,000.00 35,000.00 35,000.00 70,000.00
394 25/11/2015 NUR SALAMAH 30,000.00 15,000.00 15,000.00 30,000.00
395 RATIH 30,000.00 15,000.00 15,000.00 30,000.00
396 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
397 SITI M 30,000.00 15,000.00 15,000.00 30,000.00
398 TUTY 30,000.00 15,000.00 15,000.00 30,000.00
399 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
400 JIMMY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
401 INDRY 30,000.00 15,000.00 15,000.00 30,000.00
402 ASTRI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
403 SAFTA 30,000.00 15,000.00 15,000.00 30,000.00
404 26/11/2015 AZIZAL 25,000.00 12,500.00 12,500.00 25,000.00
405 YANTI 30,000.00 15,000.00 15,000.00 30,000.00
406 SILVESTER 30,000.00 15,000.00 15,000.00 30,000.00
407 BINTANG 60,000.00 30,000.00 30,000.00 60,000.00
408 MARSINI 30,000.00 15,000.00 15,000.00 30,000.00
409 TETI 30,000.00 15,000.00 15,000.00 30,000.00
410 RINI M 70,000.00 35,000.00 35,000.00 70,000.00
411 USWATUN H 30,000.00 15,000.00 15,000.00 30,000.00
412 YULIANA 70,000.00 35,000.00 35,000.00 70,000.00
413 IFDAN 30,000.00 15,000.00 15,000.00 30,000.00
414 TAUFIKA 70,000.00 35,000.00 35,000.00 70,000.00
415 SOPI 30,000.00 15,000.00 15,000.00 30,000.00
416 PUNGUT 70,000.00 35,000.00 35,000.00 70,000.00
417 EVI 70,000.00 35,000.00 35,000.00 70,000.00
418 26/11/2015 DERI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
419 RESKA 15,000.00 7,500.00 7,500.00 15,000.00
420 TINTIN 30,000.00 15,000.00 15,000.00 30,000.00
421 SAFRIN 25,000.00 12,500.00 12,500.00 25,000.00
422 IIS 15,000.00 7,500.00 7,500.00 15,000.00
423 AHMAD M 15,000.00 7,500.00 7,500.00 15,000.00
424 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
425 YENI 30,000.00 15,000.00 15,000.00 30,000.00
426 WAHYUNI 30,000.00 15,000.00 15,000.00 30,000.00
427 RATNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
428 27/11/2015 UJANG 30,000.00 15,000.00 15,000.00 30,000.00
429 RINI M 70,000.00 35,000.00 35,000.00 70,000.00
430 TINI 70,000.00 35,000.00 35,000.00 70,000.00
431 FANYSYA 30,000.00 15,000.00 15,000.00 30,000.00
432 FAHIRA 25,000.00 12,500.00 12,500.00 25,000.00
433 DAVIAN 70,000.00 35,000.00 35,000.00 70,000.00
434 TIARA 25,000.00 12,500.00 12,500.00 25,000.00
435 EUIS 60,000.00 30,000.00 30,000.00 60,000.00
436 INDRA 30,000.00 15,000.00 15,000.00 30,000.00
437 FX 70,000.00 35,000.00 35,000.00 70,000.00
438 NIKEN JIWA 70,000.00 35,000.00 35,000.00 70,000.00
439 ALI 35,000.00 17,500.00 17,500.00 35,000.00
440 ANNE 60,000.00 30,000.00 30,000.00 60,000.00
441 RANO 70,000.00 35,000.00 35,000.00 70,000.00
442 DEFIAR 35,000.00 17,500.00 17,500.00 35,000.00
443 27/11/2015 AHMAD M 30,000.00 15,000.00 15,000.00 30,000.00
444 YUSUF 30,000.00 15,000.00 15,000.00 30,000.00
445 ALVITA 30,000.00 15,000.00 15,000.00 30,000.00
446 ROSMAWATI 30,000.00 15,000.00 15,000.00 30,000.00
447 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
448 DEVI 30,000.00 15,000.00 15,000.00 30,000.00
449 RUDI 70,000.00 35,000.00 35,000.00 70,000.00
450 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
451 28/11/2015 DEDEN 70,000.00 35,000.00 35,000.00 70,000.00
452 WIDANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
453 WINARNO 15,000.00 7,500.00 7,500.00 15,000.00
454 SAEPUL 70,000.00 35,000.00 35,000.00 70,000.00
455 SUTISNO 30,000.00 15,000.00 15,000.00 30,000.00
456 ABBOT 70,000.00 35,000.00 35,000.00 70,000.00
457 DIDI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
458 SUCI 30,000.00 15,000.00 15,000.00 30,000.00
459 ANDRIANA 70,000.00 35,000.00 35,000.00 70,000.00
460 HOLISOH 30,000.00 15,000.00 15,000.00 30,000.00
461 28/11/2015 NITA 70,000.00 35,000.00 35,000.00 70,000.00
462 ENTIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
463 RINI M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
464 TUTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
465 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
466 RUSTIANI 30,000.00 15,000.00 15,000.00 30,000.00
467 AINA 30,000.00 15,000.00 15,000.00 30,000.00
458 ZULFA 70,000.00 35,000.00 35,000.00 70,000.00
469 IDA 70,000.00 35,000.00 35,000.00 70,000.00
470 30/11/2015 SUPIYAN 15,000.00 7,500.00 7,500.00 15,000.00
471 KEISHA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
472 SRI 70,000.00 35,000.00 35,000.00 70,000.00
473 ABIL 70,000.00 35,000.00 35,000.00 70,000.00
474 MUSILAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
475 ROPI 30,000.00 15,000.00 15,000.00 30,000.00
476 USMIATI 15,000.00 7,500.00 7,500.00 15,000.00
477 DEVI 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
478 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
479 ANDIK 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
480 YULING 15,000.00 7,500.00 7,500.00 15,000.00
481 CUCUN 35,000.00 17,500.00 17,500.00 35,000.00
482 SAFTA 15,000.00 7,500.00 7,500.00 15,000.00
483 ODANG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
484 30/11/2015 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
485 RIMA 30,000.00 15,000.00 15,000.00 30,000.00
486 PRICILIA 70,000.00 35,000.00 35,000.00 70,000.00
487 ERVINA 30,000.00 15,000.00 15,000.00 30,000.00
488 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
489 NURMEILISA 70,000.00 35,000.00 35,000.00 70,000.00
490 ELI 30,000.00 15,000.00 15,000.00 30,000.00
491 SALMA 25,000.00 12,500.00 12,500.00 25,000.00
19,722,000 830,000 9,861,000 9,861,000 20,542,000 -
JASA ALAT &

DOKTER BAHAN
1 3/12/2015 ANTON 50,000 5,000 22,500 22,500 55,000
2 TAUFIKA 200,000 5,000 97,500 97,500 205,000
3 DELLA 25,000 5,000 10,000 10,000 30,000
4 INDRI 20,000 5,000 7,500 7,500 25,000
5 4/12/2015 IYA KOMARIAH 150,000 5,000 72,500 72,500 155,000
6 5/12/2015 SAFTA 825,000 5,000 410,000 410,000 830,000
7 HANIFAH 50,000 5,000 22,500 22,500 55,000
8 8/12/2015 ANI 70,000 5,000 32,500 32,500 75,000
9 ELIS 40,000 5,000 17,500 17,500 45,000
10 HANIFAH 50,000 5,000 22,500 22,500 55,000
11 10/12/2015 MEDINA 20,000 5,000 7,500 7,500 25,000
12 12/12/2015 DODI 150,000 5,000 72,500 72,500 155,000
13 13/12/2015 ANGGUN 50,000 5,000 22,500 22,500 55,000
14 14/12/2015 LUSITA 20,000 5,000 7,500 7,500 25,000
15 15/12/2015 KARIM 50,000 5,000 22,500 22,500 55,000
16 AMELIA 150,000 5,000 72,500 72,500 155,000
17 16/12/2015 ELVINA 300,000 5,000 147,500 147,500 305,000
18 17/12/2015 ANI 100,000 5,000 47,500 47,500 105,000
19 18/12/2015 YUHANA 100,000 5,000 47,500 47,500 105,000
20 SITI M 20,000 5,000 7,500 7,500 25,000
21 NUME 200,000 5,000 97,500 97,500 205,000
22 19/12/2015 AI RITA 200,000 5,000 97,500 97,500 205,000
23 TJETJE 365,000 5,000 180,000 180,000 370,000
24 21/12/2015 SUNARDI 100,000 5,000 47,500 47,500 105,000
25 TITI 70,000 5,000 32,500 32,500 75,000
26 22/12/2015 DODI 50,000 5,000 22,500 22,500 55,000
27 ICA 50,000 5,000 22,500 22,500 55,000
28 HANIFAH 50,000 5,000 22,500 22,500 55,000
29 23/12/2015 LISNAWATI 100,000 5,000 47,500 47,500 105,000
30 26/12/2015 EPONG 195,000 5,000 95,000 95,000 200,000
31 DODI 50,000 5,000 22,500 22,500 55,000
32 SOBIRIN 35,000 5,000 15,000 15,000 40,000
33 29/12/2015 ANI 150,000 5,000 72,500 72,500 155,000
34 30/12/2015 TJETJE 300,000 5,000 147,500 147,500 305,000
35 CANDRA 150,000 5,000 72,500 72,500 155,000
36 31/12/2015 IYA KOMARIAH 150,000 5,000 72,500 72,500 155,000
37 WAWAN 100,000 5,000 47,500 47,500 105,000
KARTINI 150,000 5,000 72,500 72,500 155,000
TOTAL 4,905,000 165,000 1,945,000 1,945,000 4,220,000

JASA ALAT &
TGL TARIF OBAT JML KET
DOKTER BAHAN
1 1/12/2015 DWI M 70,000.00 35,000.00 35,000.00 70,000.00
2 RUSMANAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
3 YUYUN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
4 TANYA 70,000.00 35,000.00 35,000.00 70,000.00
5 SUKAESIH 30,000.00 15,000.00 15,000.00 30,000.00
6 SUKARTI 70,000.00 35,000.00 35,000.00 70,000.00
7 SITA 40,000.00 20,000.00 20,000.00 40,000.00
8 CANDRA 30,000.00 15,000.00 15,000.00 30,000.00
9 TEMMY 30,000.00 15,000.00 15,000.00 30,000.00
10 SAEFUL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
11 JUMIYATI 70,000.00 35,000.00 35,000.00 70,000.00
12 ASEP K 70,000.00 35,000.00 35,000.00 70,000.00
13 YENI 30,000.00 15,000.00 15,000.00 30,000.00
14 KANTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
15 1/12/2015 RESNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
16 RAGA BENTA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
17 LING H 70,000.00 35,000.00 35,000.00 70,000.00
18 RINI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
19 TRI 30,000.00 15,000.00 15,000.00 30,000.00
20 PONIMAN 35,000.00 17,500.00 17,500.00 35,000.00
21 2/12/2015 DEVI J 30,000.00 15,000.00 15,000.00 30,000.00
22 NUR SALAMAH 40,000.00 20,000.00 20,000.00 40,000.00
23 NASYILA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
24 TUTY 30,000.00 15,000.00 15,000.00 30,000.00
25 ASIKIN 30,000.00 15,000.00 15,000.00 30,000.00
26 IDING 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
27 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
28 SANI M 70,000.00 35,000.00 35,000.00 70,000.00
29 RONI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
30 HENDRA 70,000.00 35,000.00 35,000.00 70,000.00
31 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
32 2/12/2015 FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
33 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
34 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
35 KHANSHA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
36 KIKI 30,000.00 15,000.00 15,000.00 30,000.00
37 SYAHWA 30,000.00 15,000.00 15,000.00 30,000.00
38 NAYLA 70,000.00 35,000.00 35,000.00 70,000.00
39 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
40 SETIANTO 15,000.00 7,500.00 7,500.00 15,000.00
41 SANTI 70,000.00 35,000.00 35,000.00 70,000.00
42 3/12/2015 MARSINI 30,000.00 15,000.00 15,000.00 30,000.00
43 PUNGUT 70,000.00 35,000.00 35,000.00 70,000.00
44 TAUFIKA 30,000.00 15,000.00 15,000.00 30,000.00
45 ISNUR 30,000.00 15,000.00 15,000.00 30,000.00
46 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
47 TATI 30,000.00 15,000.00 15,000.00 30,000.00
48 RINI 70,000.00 35,000.00 35,000.00 70,000.00
49 YULIANA 70,000.00 35,000.00 35,000.00 70,000.00
50 USWANTUN 30,000.00 15,000.00 15,000.00 30,000.00
51 TETI 30,000.00 15,000.00 15,000.00 30,000.00
52 3/12/2015 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
53 ALYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
54 NAJWA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
55 ALIMA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
56 IIS 70,000.00 35,000.00 35,000.00 70,000.00
57 SITI U 30,000.00 15,000.00 15,000.00 30,000.00
58 ELA 30,000.00 15,000.00 15,000.00 30,000.00
59 ILMAN 25,000.00 12,500.00 12,500.00 25,000.00
60 RAFIF 30,000.00 15,000.00 15,000.00 30,000.00
61 YENI 30,000.00 15,000.00 15,000.00 30,000.00
62 4/12/2015 ADNAN 25,000.00 12,500.00 12,500.00 25,000.00
63 SHITA 25,000.00 12,500.00 12,500.00 25,000.00
64 ALVITO 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
65 EUIS 70,000.00 35,000.00 35,000.00 70,000.00
66 EUIS S 30,000.00 15,000.00 15,000.00 30,000.00
67 SRI A 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
68 NIKEN 70,000.00 35,000.00 35,000.00 70,000.00
69 AMINAH 15,000.00 7,500.00 7,500.00 15,000.00
70 FANSYA 30,000.00 15,000.00 15,000.00 30,000.00
71 DEFICA 70,000.00 35,000.00 35,000.00 70,000.00
72 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
73 RINI 70,000.00 35,000.00 35,000.00 70,000.00
74 4/12/2015 CICILIA 15,000.00 7,500.00 7,500.00 15,000.00
75 CICILA 25,000.00 12,500.00 12,500.00 25,000.00
76 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
77 IIM 30,000.00 15,000.00 15,000.00 30,000.00
78 ZAKY 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
79 AE 30,000.00 15,000.00 15,000.00 30,000.00
80 RICKY 70,000.00 35,000.00 35,000.00 70,000.00
81 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
82 ROSMAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
83 ILHAM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
84 BAGAS 30,000.00 15,000.00 15,000.00 30,000.00
85 CATUR 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
86 5/12/2015 MELINDA 35,000.00 17,500.00 17,500.00 35,000.00
87 CARISSA 30,000.00 15,000.00 15,000.00 30,000.00
88 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
89 RIFA 70,000.00 35,000.00 35,000.00 70,000.00
90 TITIN 70,000.00 35,000.00 35,000.00 70,000.00
91 HERU 30,000.00 15,000.00 15,000.00 30,000.00
92 KEVIN 70,000.00 35,000.00 35,000.00 70,000.00
93 UJANG 30,000.00 15,000.00 15,000.00 30,000.00
94 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
95 SUCI 30,000.00 15,000.00 15,000.00 30,000.00
96 ASIKIN 30,000.00 15,000.00 15,000.00 30,000.00
97 NAJWA 35,000.00 17,500.00 17,500.00 35,000.00
98 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
99 HOLISOH 40,000.00 20,000.00 20,000.00 40,000.00
100 5/12/2015 SITI M 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
101 FITRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
102 IRWAN 60,000.00 10,000.00 30,000.00 30,000.00 35,000.00
103 IDA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
104 ANISA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
105 RATIH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
106 SAFTA 15,000.00 7,500.00 7,500.00 15,000.00
107 7/12/2015 NASYILA 30,000.00 15,000.00 15,000.00 30,000.00
108 ANISA 30,000.00 15,000.00 15,000.00 30,000.00
109 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
110 ETTY 35,000.00 17,500.00 17,500.00 35,000.00
111 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
112 ODANG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
113 SRI W 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
114 ROSADI 15,000.00 7,500.00 7,500.00 15,000.00
115 CUCUN 30,000.00 15,000.00 15,000.00 30,000.00
116 TUTY 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
117 ELIS 30,000.00 15,000.00 15,000.00 30,000.00
118 ASRI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
119 ROPI 40,000.00 20,000.00 20,000.00 40,000.00
120 7/12/2015 YUNITA 30,000.00 15,000.00 15,000.00 30,000.00
121 LANIWATI 40,000.00 20,000.00 20,000.00 40,000.00
122 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
123 KENSYA 25,000.00 12,500.00 12,500.00 25,000.00
124 TINTIN 30,000.00 15,000.00 15,000.00 30,000.00
125 RANSYA 25,000.00 12,500.00 12,500.00 25,000.00
126 8/12/2015 SINTIA 70,000.00 35,000.00 35,000.00 70,000.00
127 FENY 30,000.00 15,000.00 15,000.00 30,000.00
128 DEWI 30,000.00 15,000.00 15,000.00 30,000.00
129 KELI 30,000.00 15,000.00 15,000.00 30,000.00
130 ARZIA 25,000.00 12,500.00 12,500.00 25,000.00
131 BAYU 30,000.00 15,000.00 15,000.00 30,000.00
132 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
133 8/12/2015 LING H 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
134 RESMAWATI 40,000.00 20,000.00 20,000.00 40,000.00
135 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
136 LINDA 30,000.00 15,000.00 15,000.00 30,000.00
137 SALWA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
138 ALVITO 30,000.00 15,000.00 15,000.00 30,000.00
139 PONIMAN 30,000.00 15,000.00 15,000.00 30,000.00
140 TRI 70,000.00 35,000.00 35,000.00 70,000.00
141 10/12/2015 KIKI 30,000.00 15,000.00 15,000.00 30,000.00
142 ISNUR 30,000.00 15,000.00 15,000.00 30,000.00
143 TAUFIKA 30,000.00 15,000.00 15,000.00 30,000.00
144 SYARIFAH 15,000.00 7,500.00 7,500.00 15,000.00
145 FAUZAN 25,000.00 12,500.00 12,500.00 25,000.00
146 YULIANA 70,000.00 35,000.00 35,000.00 70,000.00
147 TATI 30,000.00 15,000.00 15,000.00 30,000.00
148 SUPRIYANTO 15,000.00 7,500.00 7,500.00 15,000.00
149 MARSINI 30,000.00 15,000.00 15,000.00 30,000.00
150 USWATUN 70,000.00 35,000.00 35,000.00 70,000.00
151 WAWAN 60,000.00 30,000.00 30,000.00 60,000.00
152 IDAS 30,000.00 15,000.00 15,000.00 30,000.00
153 NAJWA 25,000.00 12,500.00 12,500.00 25,000.00
154 10/12/2015 AHDIAT 40,000.00 20,000.00 20,000.00 40,000.00
155 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
156 DYAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
157 IIS 70,000.00 35,000.00 35,000.00 70,000.00
158 IIM 30,000.00 15,000.00 15,000.00 30,000.00
159 FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
160 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
161 BELA 40,000.00 20,000.00 20,000.00 40,000.00
162 RAFLI 25,000.00 12,500.00 12,500.00 25,000.00
163 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
164 ROSMAWATI 15,000.00 7,500.00 7,500.00 15,000.00
165 12/12/2015 ROYANDRA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
166 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
167 HAYANAKA 25,000.00 12,500.00 12,500.00 25,000.00
168 SANTI 70,000.00 35,000.00 35,000.00 70,000.00
169 NAJWA 35,000.00 17,500.00 17,500.00 35,000.00
170 WIDA 30,000.00 15,000.00 15,000.00 30,000.00
171 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
172 CARISSA 70,000.00 35,000.00 35,000.00 70,000.00
173 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
174 LUCKY 30,000.00 15,000.00 15,000.00 30,000.00
175 SUCI R 40,000.00 20,000.00 20,000.00 40,000.00
176 SRI W 70,000.00 35,000.00 35,000.00 70,000.00
177 INDRI 30,000.00 15,000.00 15,000.00 30,000.00
178 RADJA 25,000.00 12,500.00 12,500.00 25,000.00
179 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
180 12/12/2015 HOLISOH 70,000.00 35,000.00 35,000.00 70,000.00
181 GHOZALI 30,000.00 15,000.00 15,000.00 30,000.00
182 TJETJE 30,000.00 15,000.00 15,000.00 30,000.00
183 AINA 30,000.00 15,000.00 15,000.00 30,000.00
184 IDA S 70,000.00 35,000.00 35,000.00 70,000.00
185 14/12/2015 NASYILA 30,000.00 15,000.00 15,000.00 30,000.00
186 ODANG 30,000.00 15,000.00 15,000.00 30,000.00
187 ADITYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
188 AMINAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
189 CUCUN 70,000.00 35,000.00 35,000.00 70,000.00
190 WIDA 15,000.00 7,500.00 7,500.00 15,000.00
191 SRI W 30,000.00 15,000.00 15,000.00 30,000.00
192 CUCU K 30,000.00 15,000.00 15,000.00 30,000.00
193 OMOH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
194 ELIS 40,000.00 20,000.00 20,000.00 40,000.00
195 14/12/2015 RISYA 30,000.00 15,000.00 15,000.00 30,000.00
196 FENI 70,000.00 35,000.00 35,000.00 70,000.00
197 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
198 YENI 30,000.00 15,000.00 15,000.00 30,000.00
199 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
200 LUTHFI 70,000.00 35,000.00 35,000.00 70,000.00
201 ZAKI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
202 DENI 30,000.00 15,000.00 15,000.00 30,000.00
203 ROPI 70,000.00 35,000.00 35,000.00 70,000.00
204 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
205 15/12/2015 DINA 70,000.00 35,000.00 35,000.00 70,000.00
206 TINTIN 40,000.00 20,000.00 20,000.00 40,000.00
207 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
208 LALAN 30,000.00 15,000.00 15,000.00 30,000.00
209 JUMIYATI 70,000.00 35,000.00 35,000.00 70,000.00
210 TANYA 25,000.00 12,500.00 12,500.00 25,000.00
211 IDA 30,000.00 15,000.00 15,000.00 30,000.00
212 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
213 15/12/2015 TRI 70,000.00 35,000.00 35,000.00 70,000.00
214 LINDA 70,000.00 35,000.00 35,000.00 70,000.00
215 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
216 DEASY 70,000.00 35,000.00 35,000.00 70,000.00
217 KHALIMAH 15,000.00 7,500.00 7,500.00 15,000.00
218 SALWA 35,000.00 17,500.00 17,500.00 35,000.00
219 ASILIN 30,000.00 15,000.00 15,000.00 30,000.00
220 M ALVIEN 30,000.00 15,000.00 15,000.00 30,000.00
221 ERVINA 30,000.00 15,000.00 15,000.00 30,000.00
222 16/12/2015 ETTY 70,000.00 35,000.00 35,000.00 70,000.00
223 SALDINI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
224 TITA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
225 E KARTINI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
226 SAFTA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
227 TURGANA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
228 LANI H 30,000.00 15,000.00 15,000.00 30,000.00
229 INDRY 30,000.00 15,000.00 15,000.00 30,000.00
230 CARISSA 15,000.00 15,000.00 7,500.00 7,500.00 30,000.00
231 16/12/2015 AI KOMALA 30,000.00 15,000.00 15,000.00 30,000.00
232 HENI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
233 HERMAWAN 35,000.00 17,500.00 17,500.00 35,000.00
234 SYAHWA 30,000.00 15,000.00 15,000.00 30,000.00
235 DHIA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
236 SRI W 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
237 SULASTRI 70,000.00 35,000.00 35,000.00 70,000.00
238 17/12/2015 TATI S 40,000.00 20,000.00 20,000.00 40,000.00
239 SITI H 15,000.00 7,500.00 7,500.00 15,000.00
240 BELVA 35,000.00 17,500.00 17,500.00 35,000.00
241 MARSINI 30,000.00 15,000.00 15,000.00 70,000.00
242 NURISA 30,000.00 15,000.00 15,000.00 30,000.00
243 KIKI MULYA 30,000.00 15,000.00 15,000.00 30,000.00
244 TAUFIKA 40,000.00 20,000.00 20,000.00 40,000.00
245 SITI N 70,000.00 35,000.00 35,000.00 70,000.00
246 IRFAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
247 NAJWA 25,000.00 12,500.00 12,500.00 25,000.00
248 TIARA 35,000.00 17,500.00 17,500.00 35,000.00
249 USWATUN 30,000.00 15,000.00 15,000.00 30,000.00
250 RAFLY 25,000.00 12,500.00 12,500.00 25,000.00
251 SUPRAYETNO 70,000.00 35,000.00 35,000.00 70,000.00
252 17/12/2015 RESA 25,000.00 12,500.00 12,500.00 25,000.00
253 SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
254 RAFIF 30,000.00 15,000.00 15,000.00 30,000.00
255 SITI U 30,000.00 15,000.00 15,000.00 30,000.00
256 EPI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
257 EUIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
258 LILIS 30,000.00 15,000.00 15,000.00 30,000.00
259 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
260 PUSPITA 30,000.00 15,000.00 15,000.00 30,000.00
261 YENI 30,000.00 15,000.00 15,000.00 30,000.00
262 18/12/2015 ANDINI 30,000.00 15,000.00 15,000.00 30,000.00
263 ANIS W 35,000.00 17,500.00 17,500.00 35,000.00
264 QUINSYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
265 FANYSYA 25,000.00 12,500.00 12,500.00 25,000.00
266 PUNGUT 70,000.00 35,000.00 35,000.00 70,000.00
267 AFIANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
268 DEFIAR 70,000.00 35,000.00 35,000.00 70,000.00
269 YUHANA 70,000.00 35,000.00 35,000.00 70,000.00
270 MAUTINE 70,000.00 35,000.00 35,000.00 70,000.00
271 OMOH 30,000.00 15,000.00 15,000.00 30,000.00
272 SITI S 30,000.00 15,000.00 15,000.00 30,000.00
273 18/12/2015 IIS 70,000.00 35,000.00 35,000.00 70,000.00
274 AHDIAT 70,000.00 35,000.00 35,000.00 70,000.00
275 IIM 30,000.00 15,000.00 15,000.00 30,000.00
276 FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
277 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
278 DYAH 30,000.00 15,000.00 15,000.00 30,000.00
279 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
280 AE S 70,000.00 35,000.00 35,000.00 70,000.00
281 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
282 FATHIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
283 19/12/2015 WIDANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
284 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
285 DJENG 30,000.00 15,000.00 15,000.00 30,000.00
286 DARGAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
287 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
288 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
289 SRI S 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
290 M RAMDAN 35,000.00 17,500.00 17,500.00 35,000.00
291 CARRISA 70,000.00 35,000.00 35,000.00 70,000.00
292 M IRFAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
293 SUCI R 70,000.00 35,000.00 35,000.00 70,000.00
294 NISRINA 70,000.00 35,000.00 35,000.00 70,000.00
295 19/12/2015 SALMA 30,000.00 15,000.00 15,000.00 30,000.00
296 SITI M 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
297 AINA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
298 SUMIATI 15,000.00 7,500.00 7,500.00 15,000.00
299 CHELY 30,000.00 15,000.00 15,000.00 30,000.00
300 TJETJE 30,000.00 15,000.00 15,000.00 30,000.00
301 21/12/2015 DEVI 40,000.00 20,000.00 20,000.00 40,000.00
302 NASYILA 70,000.00 35,000.00 35,000.00 45,000.00
303 ASIKIN 30,000.00 15,000.00 15,000.00 30,000.00
304 NENENG 40,000.00 20,000.00 20,000.00 40,000.00
305 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
306 DEDE 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
307 TANIA 70,000.00 35,000.00 35,000.00 70,000.00
308 AMINAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
309 DHINI 35,000.00 17,500.00 17,500.00 35,000.00
310 SRI W 30,000.00 15,000.00 15,000.00 30,000.00
311 ANISA 70,000.00 35,000.00 35,000.00 70,000.00
312 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
313 21/12/2015 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
314 NURFITRI 15,000.00 7,500.00 7,500.00 15,000.00
315 RASTI 25,000.00 12,500.00 12,500.00 25,000.00
316 ASEP S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
317 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
318 22/12/2015 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
319 RIANI 30,000.00 15,000.00 15,000.00 30,000.00
320 ETTY 60,000.00 30,000.00 30,000.00 60,000.00
321 NUNU 70,000.00 35,000.00 35,000.00 70,000.00
322 DWI 60,000.00 30,000.00 30,000.00 60,000.00
323 ELISA 60,000.00 30,000.00 30,000.00 60,000.00
324 NOVITA 70,000.00 35,000.00 35,000.00 70,000.00
325 22/12/2015 LING 70,000.00 35,000.00 35,000.00 70,000.00
326 RESMAWATI 40,000.00 20,000.00 20,000.00 40,000.00
327 RHAYA 70,000.00 35,000.00 35,000.00 70,000.00
328 ITA 70,000.00 35,000.00 35,000.00 70,000.00
329 AI KOMALA 30,000.00 15,000.00 15,000.00 30,000.00
330 ZAKI 35,000.00 17,500.00 17,500.00 35,000.00
331 KEYVIEN 30,000.00 15,000.00 15,000.00 30,000.00
332 ERVINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
333 FRICILIA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
334 YUDA 35,000.00 17,500.00 17,500.00 35,000.00
335 23/12/2015 NUR SALAMAH 70,000.00 35,000.00 35,000.00 70,000.00
336 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
337 KHOIRIL 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
338 RUSTIANI 30,000.00 15,000.00 15,000.00 30,000.00
339 TUTI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
340 DENA 70,000.00 35,000.00 35,000.00 70,000.00
341 SELDINI 30,000.00 15,000.00 15,000.00 30,000.00
342 23/12/2015 EMA 30,000.00 15,000.00 15,000.00 30,000.00
343 SYAHWA 30,000.00 15,000.00 15,000.00 30,000.00
344 AL GOZALI 15,000.00 7,500.00 7,500.00 15,000.00
345 ALVITO 30,000.00 15,000.00 15,000.00 30,000.00
346 BAYU 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
347 ARYANTO 60,000.00 30,000.00 30,000.00 60,000.00
348 EVA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
349 DESI 15,000.00 7,500.00 7,500.00 15,000.00
350 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
351 KIKI MULYA 30,000.00 15,000.00 15,000.00 30,000.00
352 RASID 60,000.00 30,000.00 30,000.00 60,000.00
353 DESSY A 30,000.00 15,000.00 15,000.00 30,000.00
354 26/12/2015 RATIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
355 TURNI 60,000.00 30,000.00 30,000.00 60,000.00
356 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
357 TAUFIKA 70,000.00 35,000.00 35,000.00 70,000.00
358 MARSINI 40,000.00 20,000.00 20,000.00 40,000.00
359 CARISSA 70,000.00 35,000.00 35,000.00 70,000.00
360 RAHMA 25,000.00 12,500.00 12,500.00 25,000.00
361 AGUS 70,000.00 35,000.00 35,000.00 70,000.00
362 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
363 DEWI S 70,000.00 35,000.00 35,000.00 70,000.00
364 DAFIAN 70,000.00 35,000.00 35,000.00 70,000.00
365 26/12/2015 HAYANAKA 25,000.00 12,500.00 12,500.00 25,000.00
366 RAYANANDRA 15,000.00 7,500.00 7,500.00 15,000.00
367 RAFIF 30,000.00 15,000.00 15,000.00 30,000.00
368 DEBY 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
369 QUINSYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
370 CATUR 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
371 OMAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
372 EMPONG 15,000.00 7,500.00 7,500.00 15,000.00
373 TJETJE 40,000.00 20,000.00 20,000.00 40,000.00
374 28/12/2015 CHERLY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
375 DADANG 30,000.00 15,000.00 15,000.00 30,000.00
376 WAHYUNI 40,000.00 20,000.00 20,000.00 40,000.00
377 NUR RAHMA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
378 SUKARYATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
379 MEIKE 25,000.00 12,500.00 12,500.00 25,000.00
380 SYLVIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
381 M FADHILAH 70,000.00 35,000.00 35,000.00 70,000.00
382 28/12/2015 YUSUF 15,000.00 7,500.00 7,500.00 15,000.00
383 SELIA 15,000.00 7,500.00 7,500.00 15,000.00
384 INDAH 15,000.00 7,500.00 7,500.00 15,000.00
385 WIDANINGSIH 15,000.00 7,500.00 7,500.00 15,000.00
386 FANITA 25,000.00 12,500.00 12,500.00 25,000.00
387 ENDAH 15,000.00 7,500.00 7,500.00 15,000.00
388 MYSHELA 15,000.00 7,500.00 7,500.00 15,000.00
389 AULIA 15,000.00 7,500.00 7,500.00 15,000.00
390 29/12/2015 MUSTOFA 70,000.00 35,000.00 35,000.00 70,000.00
391 HAFID 25,000.00 12,500.00 12,500.00 25,000.00
392 IRMA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
393 SUMARNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
394 NAYLA 25,000.00 12,500.00 12,500.00 25,000.00
395 EUIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
396 TANYA 25,000.00 12,500.00 12,500.00 25,000.00
397 IDA 30,000.00 15,000.00 15,000.00 30,000.00
398 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
399 DWI 70,000.00 35,000.00 35,000.00 70,000.00
400 29/12/2015 YUDA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
401 LANI 30,000.00 15,000.00 15,000.00 30,000.00
402 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
403 FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
404 RUHIAT 30,000.00 15,000.00 15,000.00 30,000.00
405 HENI 30,000.00 15,000.00 15,000.00 30,000.00
406 SURANI 70,000.00 35,000.00 35,000.00 70,000.00
407 30/12/2015 TJETJE 70,000.00 35,000.00 35,000.00 70,000.00
408 ELISA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
409 SELDINI 30,000.00 15,000.00 15,000.00 30,000.00
410 MAMAN 70,000.00 35,000.00 35,000.00 70,000.00
411 SITI N 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
412 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
413 ADHIE 30,000.00 15,000.00 15,000.00 30,000.00
414 RUSTIANI 40,000.00 20,000.00 20,000.00 40,000.00
415 TUTI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
416 CATUR 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
417 30/12/2015 LALAN 30,000.00 15,000.00 15,000.00 30,000.00
418 ALVITO 30,000.00 15,000.00 15,000.00 30,000.00
419 SYAHWA 30,000.00 15,000.00 15,000.00 30,000.00
420 LISA 70,000.00 35,000.00 35,000.00 70,000.00
421 ALVIEN 30,000.00 15,000.00 15,000.00 30,000.00
422 ERVINA 30,000.00 15,000.00 15,000.00 30,000.00
423 NINUH 30,000.00 15,000.00 15,000.00 30,000.00
424 GEORGE 15,000.00 7,500.00 7,500.00 15,000.00
425 SYGA 60,000.00 30,000.00 30,000.00 60,000.00
426 VAOLS 15,000.00 7,500.00 7,500.00 15,000.00
427 RUSHINI 15,000.00 7,500.00 7,500.00 15,000.00
428 31/12/2015 DJENG 30,000.00 15,000.00 15,000.00 30,000.00
429 IIS Y 15,000.00 7,500.00 7,500.00 15,000.00
430 RAFIF 30,000.00 15,000.00 15,000.00 30,000.00
431 NIAR 60,000.00 30,000.00 30,000.00 60,000.00
432 SITI H 15,000.00 7,500.00 7,500.00 15,000.00
433 MARSINI 70,000.00 35,000.00 35,000.00 70,000.00
434 SITI A 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
435 31/12/2015 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
436 FADHILAH 15,000.00 7,500.00 7,500.00 15,000.00
437 NITA 35,000.00 17,500.00 17,500.00 35,000.00
438 TITIN 70,000.00 35,000.00 35,000.00 70,000.00
17,025,000 855,000 8,512,500 8,512,500 17,860,000 -
JASA ALAT &

DOKTER BAHAN
1 2/1/2016 DEA 50,000 5,000 22,500 22,500 55,000
2 FIKRY 100,000 5,000 47,500 47,500 105,000
3 DODI 50,000 5,000 22,500 22,500 55,000
4 4/1/2016 RAHMAWATI 150,000 5,000 72,500 72,500 155,000
5 6/1/2016 SINTA 100,000 5,000 47,500 47,500 105,000
6 DINI 100,000 5,000 47,500 47,500 105,000
7 DANA 350,000 5,000 172,500 172,500 355,000
8 8/1/2016 MIKO 60,000 5,000 27,500 27,500 65,000
9 DEWI 100,000 5,000 47,500 47,500 105,000
10 9/1/2016 SRI HANDAYANI 300,000 5,000 147,500 147,500 305,000
11 DEA 70,000 5,000 32,500 32,500 75,000
12 SUMARYOTO 200,000 5,000 97,500 97,500 205,000
13 10/1/2016 RIZAL 50,000 5,000 22,500 22,500 55,000
14 ANGGUN 50,000 5,000 22,500 22,500 55,000
15 11/1/2016 ENTIN 50,000 5,000 22,500 22,500 55,000
16 TITI 100,000 5,000 47,500 47,500 105,000
17 SETYANI 200,000 5,000 97,500 97,500 205,000
18 12/1/2016 KARIN 150,000 5,000 72,500 72,500 155,000
19 14/1/16 MIA 400,000 5,000 197,500 197,500 405,000
20 CUCU 100,000 5,000 47,500 47,500 105,000
21 SRI L 200,000 5,000 97,500 97,500 205,000
22 TUTI 200,000 5,000 97,500 97,500 205,000
23 15/1/16 ROHAETI 30,000 5,000 12,500 12,500 35,000
24 16/1/16 DEA 150,000 5,000 72,500 72,500 155,000
25 18/1/16 MIRNA 20,000 5,000 7,500 7,500 25,000
26 TITI 70,000 5,000 32,500 32,500 75,000
27 20/1/16 MISBAH 70,000 5,000 32,500 32,500 75,000
28 ARIF P 65,000 5,000 30,000 30,000 70,000
29 CHRISTINA 150,000 5,000 72,500 72,500 155,000
30 21/1/16 RIHA 45,000 5,000 20,000 20,000 50,000
31 JERU 500,000 5,000 247,500 247,500 505,000
32 LUTFHIAH 20,000 5,000 7,500 7,500 25,000
33 AKMAL 20,000 5,000 7,500 7,500 25,000
34 25/1/16 DZAKY 60,000 5,000 27,500 27,500 65,000
35 DODI 50,000 5,000 22,500 22,500 55,000
36 YAYAN 35,000 5,000 15,000 15,000 40,000
37 ACU 75,000 5,000 35,000 35,000 80,000
38 26/1/16 TUTI 75,000 5,000 35,000 35,000 80,000
39 PUTRA 60,000 5,000 27,500 27,500 65,000
40 27/1/16 HANI 70,000 5,000 32,500 32,500 75,000
41 MISBAH 200,000 5,000 97,500 97,500 205,000
42 SUCI 150,000 5,000 72,500 72,500 155,000
43 SUMIYATI 150,000 5,000 72,500 72,500 155,000
44 DAFA 150,000 5,000 72,500 72,500 155,000
45 29/1/16 LUTFIAH 20,000 5,000 7,500 7,500 25,000
TOTAL 5,365,000 225,000 2,570,000 2,570,000 5,590,000
JASA ALAT &

TGL NAMA TARIF OBAT JML KET
DOKTER BAHAN
1 2/1/2016 SEPTI 70,000.00 35,000.00 35,000.00 70,000.00
2 EVA 70,000.00 35,000.00 35,000.00 70,000.00
3 M CATUR 15,000.00 7,500.00 7,500.00 15,000.00
4 SITI 30,000.00 15,000.00 15,000.00 30,000.00
5 DESSANI 35,000.00 17,500.00 17,500.00 35,000.00
6 BUNGA 70,000.00 35,000.00 35,000.00 70,000.00
7 RIKA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
8 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
9 NENENG 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
10 2/1/2016 CHERLY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
11 ASEP 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
12 NAZRIL 25,000.00 12,500.00 12,500.00 25,000.00
13 4/1/2016 JAMALUDIN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
14 NAJMI 15,000.00 7,500.00 7,500.00 15,000.00
15 SITI K 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
16 II K 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
17 SRI W 70,000.00 35,000.00 35,000.00 70,000.00
18 DEVI 70,000.00 35,000.00 35,000.00 70,000.00
19 MARYATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
20 4/1/2016 SRI W 30,000.00 15,000.00 15,000.00 30,000.00
21 EVA 70,000.00 35,000.00 35,000.00 70,000.00
22 FENI 70,000.00 35,000.00 35,000.00 70,000.00
23 INDAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
24 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
25 SAFIRA 25,000.00 12,500.00 12,500.00 25,000.00
26 RAKHA 25,000.00 12,500.00 12,500.00 25,000.00
27 ENDAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
28 NENGSIH 30,000.00 15,000.00 15,000.00 30,000.00
29 DEDE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
30 5/1/2016 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
31 SLAMET 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
32 AHMAD J 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
33 AINUN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
34 REISYA 30,000.00 15,000.00 15,000.00 30,000.00
35 IDA 30,000.00 15,000.00 15,000.00 30,000.00
36 RINI 70,000.00 35,000.00 35,000.00 70,000.00
37 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
38 5/1/2016 HERA 30,000.00 15,000.00 15,000.00 30,000.00
39 ITA 70,000.00 35,000.00 35,000.00 70,000.00
40 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
41 M RAMDAN 15,000.00 7,500.00 7,500.00 15,000.00
42 TETE 30,000.00 15,000.00 15,000.00 30,000.00
43 DESSY 15,000.00 7,500.00 7,500.00 15,000.00
44 DADANG 40,000.00 20,000.00 20,000.00 40,000.00
45 KARINA 35,000.00 17,500.00 17,500.00 35,000.00
46 SUPRIATNA 15,000.00 7,500.00 7,500.00 15,000.00
47 PENQ 15,000.00 7,500.00 7,500.00 15,000.00
48 RESNAWATI 70,000.00 35,000.00 35,000.00 70,000.00
49 6/1/2016 SYAHWA 30,000.00 15,000.00 15,000.00 30,000.00
50 RINI 70,000.00 35,000.00 35,000.00 70,000.00
51 SITI 70,000.00 35,000.00 35,000.00 70,000.00
52 INDRI 30,000.00 15,000.00 15,000.00 30,000.00
53 YULI 70,000.00 35,000.00 35,000.00 70,000.00
54 AGUSTINI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
55 SITI M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
56 LILIS 30,000.00 15,000.00 15,000.00 30,000.00
57 SINTA 15,000.00 7,500.00 7,500.00 15,000.00
58 TUTI 15,000.00 7,500.00 7,500.00 15,000.00
59 NINDIA 15,000.00 7,500.00 7,500.00 15,000.00
60 IDRIS M 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
61 LALAN 15,000.00 7,500.00 7,500.00 15,000.00
62 NUNUNG SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
63 MAMAN 70,000.00 35,000.00 35,000.00 70,000.00
64 6/1/2016 DINI 70,000.00 35,000.00 35,000.00 70,000.00
65 HANDILA 35,000.00 17,500.00 17,500.00 35,000.00
66 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
67 TIRTA 70,000.00 35,000.00 35,000.00 70,000.00
68 NENDEN 70,000.00 35,000.00 35,000.00 70,000.00
69 ANI R 70,000.00 35,000.00 35,000.00 70,000.00
70 M ATTA 30,000.00 15,000.00 15,000.00 30,000.00
71 DEDE 60,000.00 30,000.00 30,000.00 60,000.00
72 HILMA 60,000.00 30,000.00 30,000.00 60,000.00
73 DIAH 35,000.00 17,500.00 17,500.00 35,000.00
74 7/1/2016 YANTI 30,000.00 15,000.00 15,000.00 30,000.00
75 HAFIDZ 70,000.00 35,000.00 35,000.00 70,000.00
76 DJENG SRI 30,000.00 15,000.00 15,000.00 30,000.00
77 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
78 TATI 70,000.00 35,000.00 35,000.00 70,000.00
79 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
80 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
81 EVY 70,000.00 35,000.00 35,000.00 70,000.00
82 ANDI 30,000.00 15,000.00 15,000.00 30,000.00
83 TIA 15,000.00 7,500.00 7,500.00 15,000.00
84 7/1/2016 M AYAR 70,000.00 35,000.00 35,000.00 70,000.00
85 ADHIE 30,000.00 15,000.00 15,000.00 30,000.00
86 YAYAT 30,000.00 15,000.00 15,000.00 30,000.00
87 EVHI 70,000.00 35,000.00 35,000.00 70,000.00
88 TINTIN 25,000.00 12,500.00 12,500.00 25,000.00
89 NUNUNG 30,000.00 15,000.00 15,000.00 30,000.00
90 M AKBAR 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
91 RAFIF 30,000.00 15,000.00 15,000.00 30,000.00
92 SITI U 30,000.00 15,000.00 15,000.00 30,000.00
93 8/1/2016 NAUFAL 30,000.00 15,000.00 15,000.00 30,000.00
94 ELCHA 30,000.00 15,000.00 15,000.00 30,000.00
95 FANYSYA 70,000.00 35,000.00 35,000.00 70,000.00
96 IDAH 60,000.00 30,000.00 30,000.00 60,000.00
97 YUYUN 30,000.00 15,000.00 15,000.00 30,000.00
98 SRI M 15,000.00 7,500.00 7,500.00 15,000.00
99 JAMALUDIN 60,000.00 30,000.00 30,000.00 60,000.00
100 YULIANTI 70,000.00 35,000.00 35,000.00 70,000.00
101 NIKEN 30,000.00 15,000.00 15,000.00 30,000.00
102 DEWI 15,000.00 7,500.00 7,500.00 35,000.00
103 8/7/2016 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
104 AHMAD 25,000.00 12,500.00 12,500.00 25,000.00
105 FADLAN 70,000.00 35,000.00 35,000.00 70,000.00
106 IIS 70,000.00 35,000.00 35,000.00 70,000.00
107 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
108 IMAS 30,000.00 15,000.00 15,000.00 30,000.00
109 ENDAH 30,000.00 15,000.00 15,000.00 30,000.00
110 DYAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
111 MARIAM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
112 BELLA 70,000.00 35,000.00 35,000.00 70,000.00
113 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
114 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
115 9/1/2016 M IHSAN 25,000.00 12,500.00 12,500.00 25,000.00
116 AIMAR 35,000.00 17,500.00 17,500.00 35,000.00
117 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
118 ALIYA 70,000.00 35,000.00 35,000.00 70,000.00
119 RAISA 70,000.00 35,000.00 35,000.00 70,000.00
120 WIDA 30,000.00 15,000.00 15,000.00 30,000.00
121 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
122 NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
123 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
124 FARHAN 70,000.00 35,000.00 35,000.00 70,000.00
125 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
126 SRI HANDAYANI 30,000.00 15,000.00 15,000.00 30,000.00
127 9/1/2016 IDA 70,000.00 35,000.00 35,000.00 70,000.00
128 SALAMAH 70,000.00 35,000.00 35,000.00 70,000.00
129 AFIANI 15,000.00 7,500.00 7,500.00 15,000.00
130 HAURA 30,000.00 15,000.00 15,000.00 30,000.00
131 AINA AHMAD 25,000.00 12,500.00 12,500.00 25,000.00
132 NOVI 15,000.00 7,500.00 7,500.00 15,000.00
133 SITI H 70,000.00 35,000.00 35,000.00 70,000.00
134 11/1/2016 ICRSYAD 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
135 SELDINI 40,000.00 20,000.00 20,000.00 40,000.00
136 WARMIN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
137 SITI N 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
138 DESSANI 15,000.00 7,500.00 7,500.00 15,000.00
139 SRI W 70,000.00 35,000.00 35,000.00 70,000.00
140 SUKARNI 30,000.00 15,000.00 15,000.00 30,000.00
141 TRI YULI 30,000.00 15,000.00 15,000.00 30,000.00
142 11/1/2016 RESYA 70,000.00 35,000.00 35,000.00 70,000.00
143 RINI 30,000.00 15,000.00 15,000.00 30,000.00
144 ETI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
145 NY SRI 30,000.00 15,000.00 15,000.00 30,000.00
146 DEDE H 30,000.00 15,000.00 15,000.00 30,000.00
147 ALIA 30,000.00 15,000.00 15,000.00 30,000.00
148 ATNAN 15,000.00 7,500.00 7,500.00 15,000.00
149 FENI 30,000.00 15,000.00 15,000.00 30,000.00
150 NERMA 100,000.00 50,000.00 50,000.00 100,000.00
151 12/1/2016 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
152 ANNISA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
153 SETYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
154 ASRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
155 VIOLA 30,000.00 15,000.00 15,000.00 30,000.00
156 IDAWATI 30,000.00 15,000.00 15,000.00 30,000.00
157 SILFI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
158 RINI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
159 MEGA 70,000.00 35,000.00 35,000.00 70,000.00
160 YENI 30,000.00 15,000.00 15,000.00 30,000.00
161 ASEP 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
162 SALWA 40,000.00 20,000.00 20,000.00 40,000.00
163 EVA 70,000.00 35,000.00 35,000.00 70,000.00
164 12/1/2016 APRILIA 35,000.00 17,500.00 17,500.00 35,000.00
165 HERA 70,000.00 35,000.00 35,000.00 70,000.00
166 SILMA 30,000.00 15,000.00 15,000.00 30,000.00
167 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
168 FRICILIA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
169 SETIA 70,000.00 35,000.00 35,000.00 70,000.00
170 NADHIRA 30,000.00 15,000.00 15,000.00 30,000.00
171 LANI H 40,000.00 20,000.00 20,000.00 40,000.00
172 ALVIEN 30,000.00 15,000.00 15,000.00 30,000.00
173 RESMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
174 ERVIENA S 30,000.00 15,000.00 15,000.00 30,000.00
175 13/1/16 DAFIAN 70,000.00 35,000.00 35,000.00 70,000.00
176 JAMALUDIN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
177 DEVI 70,000.00 35,000.00 35,000.00 70,000.00
178 ALVINTO 30,000.00 15,000.00 15,000.00 30,000.00
179 LILIS 30,000.00 15,000.00 15,000.00 30,000.00
180 SITI M 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
181 INDRI 40,000.00 20,000.00 20,000.00 40,000.00
182 AGUSTINI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
183 CATUR 30,000.00 15,000.00 15,000.00 30,000.00
184 NUNUNG 15,000.00 7,500.00 7,500.00 15,000.00
185 13/1/16 RIMA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
186 CHIRTINA 70,000.00 35,000.00 35,000.00 70,000.00
187 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
188 FIKRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
189 DADAN 30,000.00 15,000.00 15,000.00 30,000.00
190 ETI R 40,000.00 20,000.00 20,000.00 40,000.00
191 SALWA 70,000.00 35,000.00 35,000.00 70,000.00
192 BEKTI 15,000.00 7,500.00 7,500.00 15,000.00
193 14/1/16 SRI 15,000.00 7,500.00 7,500.00 15,000.00
194 YETTY 15,000.00 7,500.00 7,500.00 15,000.00
195 KIKI 40,000.00 20,000.00 20,000.00 40,000.00
196 CUCU 15,000.00 7,500.00 7,500.00 15,000.00
197 AE S 30,000.00 15,000.00 15,000.00 30,000.00
198 EVY 70,000.00 35,000.00 35,000.00 70,000.00
199 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
200 RINA 30,000.00 15,000.00 15,000.00 30,000.00
201 ANDRI A 30,000.00 15,000.00 15,000.00 30,000.00
202 AGUNG 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
203 CANDRA 30,000.00 15,000.00 15,000.00 30,000.00
204 14/1/16 ADHIE 30,000.00 15,000.00 15,000.00 30,000.00
205 DWI 25,000.00 12,500.00 12,500.00 25,000.00
206 NASYA 25,000.00 12,500.00 12,500.00 25,000.00
207 FATMA 25,000.00 12,500.00 12,500.00 25,000.00
208 AKBAR 25,000.00 12,500.00 12,500.00 25,000.00
209 RAFIF 40,000.00 20,000.00 20,000.00 40,000.00
210 REISYA 30,000.00 15,000.00 15,000.00 30,000.00
211 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
212 SITI U 30,000.00 15,000.00 15,000.00 30,000.00
213 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
214 YANI 30,000.00 15,000.00 15,000.00 30,000.00
215 YAYAN 30,000.00 15,000.00 15,000.00 30,000.00
216 15/1/16 YASMI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
217 FANYSYA 70,000.00 35,000.00 35,000.00 70,000.00
218 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
219 IDRIS 30,000.00 15,000.00 15,000.00 30,000.00
220 ANDREAS 30,000.00 15,000.00 15,000.00 30,000.00
221 YUYUN 70,000.00 35,000.00 35,000.00 70,000.00
222 BUDIANTO 70,000.00 35,000.00 35,000.00 70,000.00
223 ELCHA 30,000.00 15,000.00 15,000.00 30,000.00
224 NIKEN 30,000.00 15,000.00 15,000.00 30,000.00
225 NAUFAL 30,000.00 15,000.00 15,000.00 30,000.00
226 IDAN 60,000.00 30,000.00 30,000.00 60,000.00
227 FAIZ 15,000.00 7,500.00 7,500.00 15,000.00
228 15/1/16 SELLY 40,000.00 20,000.00 20,000.00 40,000.00
229 UCU 30,000.00 15,000.00 15,000.00 30,000.00
230 INA 30,000.00 15,000.00 15,000.00 30,000.00
231 SUHARYANTO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
232 ZAHRA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
233 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
234 DYAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
235 DIAGO 70,000.00 35,000.00 35,000.00 70,000.00
236 BELLA 70,000.00 35,000.00 35,000.00 70,000.00
237 MANDIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
238 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
239 16/1/16 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
240 PUTRI 25,000.00 12,500.00 12,500.00 25,000.00
241 DADANG 70,000.00 35,000.00 35,000.00 70,000.00
242 YUSUF 35,000.00 17,500.00 17,500.00 35,000.00
243 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
244 HANDIKA 35,000.00 17,500.00 17,500.00 35,000.00
245 ADITYA 70,000.00 35,000.00 35,000.00 70,000.00
246 SUPRIHATIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
247 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
248 SRI 15,000.00 7,500.00 7,500.00 15,000.00
249 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
250 LUCKY 70,000.00 35,000.00 35,000.00 70,000.00
251 FARHAN 30,000.00 15,000.00 15,000.00 30,000.00
252 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
253 SUPRIYADI 70,000.00 35,000.00 35,000.00 70,000.00
254 16/1/16 AEP KOSWARA 15,000.00 7,500.00 7,500.00 15,000.00
255 TUTY 70,000.00 35,000.00 35,000.00 70,000.00
256 SITI HALIMAH 70,000.00 35,000.00 35,000.00 70,000.00
257 YUSUF IBRAHIM 35,000.00 17,500.00 17,500.00 35,000.00
258 EMA ADE 30,000.00 15,000.00 15,000.00 30,000.00
259 AINA AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
260 KACHFI 35,000.00 17,500.00 17,500.00 35,000.00
261 SUHARSONO 30,000.00 15,000.00 15,000.00 30,000.00
262 18/1/16 ARIF BUDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
263 TRI YULI 30,000.00 15,000.00 15,000.00 30,000.00
264 AZZIZAL 25,000.00 12,500.00 12,500.00 25,000.00
265 ONG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
266 SELDIMEILANI 70,000.00 35,000.00 35,000.00 70,000.00
267 WARMIN 30,000.00 15,000.00 15,000.00 30,000.00
268 18/1/16 NOVIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
269 FENI 30,000.00 15,000.00 15,000.00 30,000.00
270 ALHANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
271 RIAN 30,000.00 15,000.00 15,000.00 30,000.00
272 NENGSIH 70,000.00 35,000.00 35,000.00 70,000.00
273 SULAEMAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
274 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
275 19/1/16 RAFKA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
276 SONIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
277 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
278 NERMA 30,000.00 15,000.00 15,000.00 30,000.00
279 JAMALUDIN 30,000.00 15,000.00 15,000.00 30,000.00
280 RINI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
281 IDA 70,000.00 35,000.00 35,000.00 70,000.00
282 ELIS 30,000.00 15,000.00 15,000.00 30,000.00
283 QIYANTO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
284 YENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
285 19/1/16 SURANI 70,000.00 35,000.00 35,000.00 70,000.00
286 ALVIEN 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
287 ERVINA 40,000.00 10,000.00 20,000.00 20,000.00 50,000.00
288 FRICILIA 15,000.00 7,500.00 7,500.00 15,000.00
289 NUNU 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
290 NOVI 70,000.00 35,000.00 35,000.00 70,000.00
291 NASHITA 30,000.00 15,000.00 15,000.00 30,000.00
292 RIMA A 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
293 NADHIRA 30,000.00 15,000.00 15,000.00 30,000.00
294 LANI 70,000.00 35,000.00 35,000.00 70,000.00
295 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
296 ISMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
297 20/1/16 OMOH 15,000.00 7,500.00 7,500.00 15,000.00
298 NAFISHA 25,000.00 12,500.00 12,500.00 25,000.00
299 EPPY 70,000.00 35,000.00 35,000.00 70,000.00
300 AHMAD 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
301 RAMDAN 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
302 SILMA 30,000.00 15,000.00 15,000.00 45,000.00
303 RESTI 35,000.00 17,500.00 17,500.00 35,000.00
304 ELLY 60,000.00 30,000.00 30,000.00 60,000.00
305 20/1/16 CRISTINA 15,000.00 7,500.00 7,500.00 15,000.00
306 ALVITO 40,000.00 20,000.00 20,000.00 40,000.00
307 RESMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
308 ATHALLAH 35,000.00 17,500.00 17,500.00 35,000.00
309 HENI 30,000.00 15,000.00 15,000.00 30,000.00
310 SALWA 70,000.00 35,000.00 35,000.00 70,000.00
311 NURMEILISA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
312 ETI 70,000.00 35,000.00 35,000.00 70,000.00
313 RUSTIANTI 70,000.00 35,000.00 35,000.00 70,000.00
314 ANISHA 15,000.00 7,500.00 7,500.00 15,000.00
315 VISTO 70,000.00 35,000.00 35,000.00 70,000.00
316 21/1/16 BINTANG 70,000.00 35,000.00 35,000.00 70,000.00
317 YASMI 70,000.00 35,000.00 35,000.00 70,000.00
318 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
319 KIKI M 70,000.00 35,000.00 35,000.00 70,000.00
320 NISRINA 30,000.00 15,000.00 15,000.00 30,000.00
321 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
322 RINA 70,000.00 35,000.00 35,000.00 70,000.00
323 CHANDRA 30,000.00 15,000.00 15,000.00 30,000.00
324 EVI 30,000.00 15,000.00 15,000.00 30,000.00
325 ARIF 60,000.00 30,000.00 30,000.00 60,000.00
326 RESMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
327 FITRI 70,000.00 35,000.00 35,000.00 70,000.00
328 21/1/16 CAHYA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
329 MASHA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
330 ARIF 30,000.00 15,000.00 15,000.00 30,000.00
331 CURNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
332 IHUN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
333 MULYANI 30,000.00 15,000.00 15,000.00 30,000.00
334 NENENG 15,000.00 7,500.00 7,500.00 15,000.00
335 AHMAD 70,000.00 35,000.00 35,000.00 70,000.00
336 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
337 YENI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
338 FEBYAN 30,000.00 15,000.00 15,000.00 30,000.00
339 RAFIF 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
340 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
341 22/1/16 ZUFAR 35,000.00 17,500.00 17,500.00 35,000.00
342 AGUS I 70,000.00 35,000.00 35,000.00 70,000.00
343 NILLENIA 70,000.00 35,000.00 35,000.00 70,000.00
344 ELCHA 70,000.00 35,000.00 35,000.00 70,000.00
345 PAIJAN 30,000.00 15,000.00 15,000.00 30,000.00
346 FANYSYA 70,000.00 35,000.00 35,000.00 70,000.00
347 YUYUN 70,000.00 35,000.00 35,000.00 70,000.00
348 SUTRISNO 70,000.00 35,000.00 35,000.00 70,000.00
349 DESY 70,000.00 35,000.00 35,000.00 70,000.00
350 22/1/16 DARMAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
351 REISYA 25,000.00 12,500.00 12,500.00 25,000.00
352 ZIRA 15,000.00 7,500.00 7,500.00 15,000.00
353 NASYAN 25,000.00 12,500.00 12,500.00 25,000.00
354 DIAGO 70,000.00 35,000.00 35,000.00 70,000.00
355 ENDANG 70,000.00 35,000.00 35,000.00 70,000.00
356 DYAH 70,000.00 35,000.00 35,000.00 70,000.00
357 ADHIE 40,000.00 20,000.00 20,000.00 40,000.00
358 KARINA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
359 IIM 30,000.00 15,000.00 15,000.00 30,000.00
360 MARIAM 70,000.00 35,000.00 35,000.00 70,000.00
361 SITI U 30,000.00 15,000.00 15,000.00 30,000.00
362 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
363 BELLA 70,000.00 35,000.00 35,000.00 70,000.00
364 23/1/16 SUYANTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
365 AE S 30,000.00 15,000.00 15,000.00 30,000.00
366 REVI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
367 TUTY 70,000.00 35,000.00 35,000.00 70,000.00
368 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
369 SITI H 70,000.00 35,000.00 35,000.00 70,000.00
370 AINA AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
371 ANNISA 30,000.00 15,000.00 15,000.00 30,000.00
372 RATIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
373 AINA AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
374 UCU S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
375 RENI N 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
376 IDA 70,000.00 35,000.00 35,000.00 70,000.00
377 25/1/16 GIYANTO 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
378 RYAN 35,000.00 17,500.00 17,500.00 35,000.00
379 ASIKIN 30,000.00 15,000.00 15,000.00 30,000.00
380 TINA N 70,000.00 35,000.00 35,000.00 70,000.00
381 JAMALUDIN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
382 WARMIN 30,000.00 15,000.00 15,000.00 30,000.00
383 JOHANES 70,000.00 35,000.00 35,000.00 70,000.00
384 SITI N 30,000.00 15,000.00 15,000.00 30,000.00
385 LILIS 30,000.00 15,000.00 15,000.00 30,000.00
386 SUKAESIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
387 IDRIS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
388 YOKE 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
389 TRI YULI 40,000.00 20,000.00 20,000.00 40,000.00
390 HANDIKA 35,000.00 17,500.00 17,500.00 35,000.00
391 25/1/16 M YUSUF 25,000.00 12,500.00 12,500.00 25,000.00
392 RAFFI 25,000.00 12,500.00 12,500.00 25,000.00
393 RIAN 30,000.00 15,000.00 15,000.00 30,000.00
394 SYAFIRA 70,000.00 35,000.00 35,000.00 70,000.00
395 EVA 70,000.00 35,000.00 35,000.00 70,000.00
396 SELLY 70,000.00 35,000.00 35,000.00 70,000.00
397 AFIANI 70,000.00 35,000.00 35,000.00 70,000.00
398 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
399 FENI A 30,000.00 15,000.00 15,000.00 30,000.00
400 26/1/16 NERMA 100,000.00 50,000.00 50,000.00 100,000.00
401 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
402 IDAWATI 30,000.00 15,000.00 15,000.00 30,000.00
403 ONG T 30,000.00 15,000.00 15,000.00 30,000.00
404 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
405 SITI 70,000.00 35,000.00 35,000.00 70,000.00
406 EPING 15,000.00 7,500.00 7,500.00 15,000.00
407 DJENG S 30,000.00 15,000.00 15,000.00 30,000.00
408 26/1/16 REFIANI 70,000.00 35,000.00 35,000.00 70,000.00
409 RHAYA 30,000.00 15,000.00 15,000.00 30,000.00
410 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
411 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
412 RIMA A 30,000.00 15,000.00 15,000.00 30,000.00
413 YAFI 30,000.00 15,000.00 15,000.00 30,000.00
414 KEYVIEN 30,000.00 15,000.00 15,000.00 30,000.00
415 ERVINA 70,000.00 35,000.00 35,000.00 70,000.00
416 ALVIEN 30,000.00 15,000.00 15,000.00 30,000.00
417 VISTO 70,000.00 35,000.00 35,000.00 70,000.00
418 NINGSIH 70,000.00 35,000.00 35,000.00 70,000.00
419 LUKMAN 30,000.00 15,000.00 15,000.00 30,000.00
420 27/1/16 EPPY 70,000.00 35,000.00 35,000.00 70,000.00
421 SILMA 30,000.00 15,000.00 15,000.00 30,000.00
422 ARZIA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
423 YUYUN 70,000.00 35,000.00 35,000.00 70,000.00
424 ADE M 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
425 AFIQ R 35,000.00 17,500.00 17,500.00 35,000.00
426 27/1/16 SRIYANI 60,000.00 30,000.00 30,000.00 60,000.00
427 M RIZKI 30,000.00 15,000.00 15,000.00 30,000.00
428 QONIA 35,000.00 17,500.00 17,500.00 35,000.00
429 WAWANG 35,000.00 17,500.00 17,500.00 35,000.00
430 ZANNA 30,000.00 15,000.00 15,000.00 30,000.00
431 DADAN 70,000.00 35,000.00 35,000.00 70,000.00
432 RULLI 70,000.00 35,000.00 35,000.00 70,000.00
433 ANNYA 15,000.00 7,500.00 7,500.00 15,000.00
434 ZONI 30,000.00 15,000.00 15,000.00 30,000.00
435 DHEA 30,000.00 15,000.00 15,000.00 30,000.00
436 INDARTI 15,000.00 7,500.00 7,500.00 15,000.00
437 AHMAD 60,000.00 30,000.00 30,000.00 60,000.00
438 28/1/16 CAHYONO 30,000.00 15,000.00 15,000.00 30,000.00
439 USWATUN 30,000.00 15,000.00 15,000.00 30,000.00
440 UJANG 40,000.00 20,000.00 20,000.00 40,000.00
441 FX 70,000.00 35,000.00 35,000.00 70,000.00
442 KIKI M 60,000.00 30,000.00 30,000.00 60,000.00
443 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
444 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
445 RIDWAN 30,000.00 15,000.00 15,000.00 30,000.00
446 EMIYATI 60,000.00 30,000.00 30,000.00 60,000.00
447 CHANDRA 30,000.00 15,000.00 15,000.00 30,000.00
448 EVI S 70,000.00 35,000.00 35,000.00 70,000.00
449 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
450 NILLENIA 30,000.00 15,000.00 15,000.00 30,000.00
451 28/1/16 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
452 MERISKA 70,000.00 35,000.00 35,000.00 70,000.00
453 RYAN 30,000.00 15,000.00 15,000.00 30,000.00
454 RAVANIA 70,000.00 35,000.00 35,000.00 70,000.00
455 ARIF 70,000.00 35,000.00 35,000.00 70,000.00
456 AYLA 50,000.00 25,000.00 25,000.00 50,000.00
457 KAFIS 70,000.00 35,000.00 35,000.00 70,000.00
458 AHMAD S 30,000.00 15,000.00 15,000.00 30,000.00
459 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
460 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
461 YENI 30,000.00 15,000.00 15,000.00 30,000.00
462 29/1/16 ELCHA 70,000.00 35,000.00 35,000.00 70,000.00
463 FANYSYA 15,000.00 7,500.00 7,500.00 15,000.00
464 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
465 SUKAESIH 60,000.00 30,000.00 30,000.00 60,000.00
466 NURSALAMAH 25,000.00 12,500.00 12,500.00 25,000.00
467 EKA 70,000.00 35,000.00 35,000.00 70,000.00
468 RIAHMAN 30,000.00 15,000.00 15,000.00 30,000.00
469 POPON 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
470 JAMALUDIN 60,000.00 30,000.00 30,000.00 60,000.00
471 RAFI 15,000.00 7,500.00 7,500.00 15,000.00
472 HILMAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
473 29/1/16 ADHIE 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
474 NINA 30,000.00 15,000.00 15,000.00 30,000.00
475 ZAKI 70,000.00 35,000.00 35,000.00 70,000.00
476 DEWI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
477 HESTI 30,000.00 15,000.00 15,000.00 30,000.00
478 DENDY 70,000.00 35,000.00 35,000.00 70,000.00
479 BUNGA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
480 SITI 70,000.00 35,000.00 35,000.00 70,000.00
481 KARINA 70,000.00 35,000.00 35,000.00 70,000.00
482 BELLA 40,000.00 20,000.00 20,000.00 40,000.00
483 SYAHWA 70,000.00 35,000.00 35,000.00 70,000.00
484 MARIAM 15,000.00 7,500.00 7,500.00 15,000.00
485 DEKASTA 30,000.00 15,000.00 15,000.00 30,000.00
486 LENY 25,000.00 12,500.00 12,500.00 25,000.00
487 30/1/16 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
488 AURELIA 35,000.00 17,500.00 17,500.00 35,000.00
489 MILANIS 70,000.00 35,000.00 35,000.00 70,000.00
490 RAKHA 35,000.00 17,500.00 17,500.00 35,000.00
491 SUCI 70,000.00 35,000.00 35,000.00 70,000.00
492 AGATHA 70,000.00 35,000.00 35,000.00 70,000.00
493 30/1/16 EMA ADE 30,000.00 15,000.00 15,000.00 30,000.00
494 REVI 30,000.00 15,000.00 15,000.00 30,000.00
495 ENDANG 35,000.00 17,500.00 17,500.00 35,000.00
496 DYAH AYU 70,000.00 35,000.00 35,000.00 70,000.00
497 ICU S 30,000.00 15,000.00 15,000.00 30,000.00
498 IDA 70,000.00 35,000.00 35,000.00 70,000.00
20,365,000 880,000 10,182,500 10,182,500 21,280,000 -
JASA ALAT &

DOKTER BAHAN
1 1/2/2016 HANI 140,000 5,000 67,500 67,500 145,000
2 BAGUS 20,000 5,000 7,500 7,500 25,000
3 2/2/2016 ELIS 45,000 5,000 20,000 20,000 50,000
4 WAWANG 100,000 5,000 47,500 47,500 105,000
5 VISTO 150,000 5,000 72,500 72,500 155,000
6 4/2/2016 LUTFAN 50,000 5,000 22,500 22,500 55,000
7 5/2/2016 SUWARTO 100,000 5,000 47,500 47,500 105,000
8 6/2/2016 TAUFIK 300,000 5,000 147,500 147,500 305,000
9 SUDARMAN 200,000 5,000 97,500 97,500 205,000
10 SINTA 260,000 5,000 127,500 127,500 265,000
11 SAHIH 100,000 5,000 47,500 47,500 105,000
12 NETTY 100,000 5,000 47,500 47,500 105,000
13 9/2/2016 DANA 25,000 5,000 10,000 10,000 30,000
14 YOGA 200,000 5,000 97,500 97,500 205,000
15 ADINDA 50,000 5,000 22,500 22,500 55,000
16 NURAENI 65,000 5,000 30,000 30,000 70,000
17 10/2/2016 ULE 100,000 5,000 47,500 47,500 105,000
18 ICEU 100,000 5,000 47,500 47,500 105,000
19 ROSMAYA 30,000 5,000 12,500 12,500 35,000
20 11/2/2016 RAMADHAN 175,000 5,000 85,000 85,000 180,000
21 LINDA 100,000 5,000 47,500 47,500 105,000
22 SUCI 200,000 5,000 97,500 97,500 205,000
23 13/2/2016 WIDYA 400,000 5,000 197,500 197,500 405,000
24 LANNY 200,000 5,000 97,500 97,500 205,000
25 NIA 150,000 5,000 72,500 72,500 155,000
26 15/2/2016 DODI 75,000 5,000 35,000 35,000 80,000
27 16/2/2016 DIMYATI 150,000 5,000 72,500 72,500 155,000
28 17/2/2016 LILIS R 200,000 5,000 97,500 97,500 205,000
29 ICEU 325,000 5,000 160,000 160,000 330,000
30 SIDIK 300,000 5,000 147,500 147,500 305,000
31 NENG TINI 150,000 5,000 72,500 72,500 155,000
32 ANDI 100,000 5,000 47,500 47,500 105,000
33 18/2/2016 AZ ZAHRA 100,000 5,000 47,500 47,500 105,000
34 LINDA 100,000 5,000 47,500 47,500 105,000
35 21/2/2016 ANGGUN 50,000 5,000 22,500 22,500 55,000
36 22/2/2016 PERMANA 200,000 5,000 97,500 97,500 205,000
37 PERI 200,000 5,000 97,500 97,500 205,000
38 27/2/2016 BERNANDETA 100,000 5,000 47,500 47,500 105,000
39 29/2/2016 HANI 70,000 5,000 32,500 32,500 75,000
40 NIRMA 120,000 5,000 57,500 57,500 125,000
TOTAL 5,600,000 200,000 2,700,000 2,700,000 5,800,000

JASA ALAT &
DOKTER BAHAN
1 1/2/2016 TINA 70,000.00 35,000.00 35,000.00 70,000.00
2 WARMIN 30,000.00 15,000.00 15,000.00 30,000.00
3 ASIKIN 30,000.00 15,000.00 15,000.00 30,000.00
4 YULI 70,000.00 35,000.00 35,000.00 70,000.00
5 ELI 15,000.00 7,500.00 7,500.00 15,000.00
6 ZULFA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
7 RATNA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
8 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
9 NURAENI 25,000.00 12,500.00 12,500.00 25,000.00
10 NISRINA 30,000.00 15,000.00 15,000.00 30,000.00
11 AFIANI 70,000.00 35,000.00 35,000.00 70,000.00
12 RIAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
13 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
14 SYAFA 15,000.00 7,500.00 7,500.00 15,000.00
15 RAFFI 25,000.00 12,500.00 12,500.00 25,000.00
16 SYAFIA 70,000.00 35,000.00 35,000.00 70,000.00
17 YESI 70,000.00 35,000.00 35,000.00 70,000.00
18 SULAEMAN 30,000.00 15,000.00 15,000.00 30,000.00
19 PERI 15,000.00 7,500.00 7,500.00 15,000.00
20 RAHMAT 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
21 2/2/2016 ARZIA 25,000.00 12,500.00 12,500.00 25,000.00
22 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
23 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
24 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
25 YENI 30,000.00 15,000.00 15,000.00 30,000.00
26 IDA 30,000.00 15,000.00 15,000.00 30,000.00
27 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
28 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
29 DJENG 30,000.00 15,000.00 15,000.00 30,000.00
30 NOVIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
31 RIVGIANA 30,000.00 15,000.00 15,000.00 30,000.00
32 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
33 KHOIRUNISA 70,000.00 35,000.00 35,000.00 70,000.00
34 M ALVIEN 30,000.00 15,000.00 15,000.00 30,000.00
35 RAFFA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
36 LANI 70,000.00 35,000.00 35,000.00 70,000.00
37 NADHIRA 40,000.00 20,000.00 20,000.00 40,000.00
38 ISMAWATI 35,000.00 17,500.00 17,500.00 35,000.00
39 RENI 30,000.00 15,000.00 15,000.00 30,000.00
40 NURFADHILAH 35,000.00 17,500.00 17,500.00 35,000.00
41 3/2/2016 INDRY 70,000.00 35,000.00 35,000.00 70,000.00
42 SUKAESIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
43 AZKA 30,000.00 15,000.00 15,000.00 30,000.00
44 POPON 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
45 DEDE H 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
46 NAIFA 25,000.00 12,500.00 12,500.00 25,000.00
47 ANISHA 25,000.00 12,500.00 12,500.00 25,000.00
48 EPPY 70,000.00 35,000.00 35,000.00 70,000.00
49 ENTAR 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
50 JAMALUDIN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
51 ANGGUN 70,000.00 35,000.00 35,000.00 70,000.00
52 QONIAH 35,000.00 17,500.00 17,500.00 35,000.00
53 WAWANG 70,000.00 35,000.00 35,000.00 70,000.00
54 VISHO 70,000.00 35,000.00 35,000.00 70,000.00
55 RULLY 60,000.00 30,000.00 30,000.00 60,000.00
56 ERVINA 30,000.00 15,000.00 15,000.00 30,000.00
57 KEVIEN 70,000.00 35,000.00 35,000.00 70,000.00
58 SRI 60,000.00 30,000.00 30,000.00 60,000.00
59 SOBRINA 30,000.00 15,000.00 15,000.00 30,000.00
60 INDAH 60,000.00 30,000.00 30,000.00 60,000.00
61 4/2/2016 YETI 15,000.00 7,500.00 7,500.00 15,000.00
62 GINA 30,000.00 15,000.00 15,000.00 30,000.00
63 ANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
64 FX 70,000.00 35,000.00 35,000.00 70,000.00
65 KIKI 70,000.00 35,000.00 35,000.00 70,000.00
66 HANIFA 30,000.00 15,000.00 15,000.00 30,000.00
67 SUTRISNO 30,000.00 15,000.00 15,000.00 30,000.00
68 CANDRA 30,000.00 15,000.00 15,000.00 30,000.00
69 HADI 70,000.00 35,000.00 35,000.00 70,000.00
70 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
71 ANDRI 30,000.00 15,000.00 15,000.00 30,000.00
72 EVY 70,000.00 35,000.00 35,000.00 70,000.00
73 MAMAT 70,000.00 35,000.00 35,000.00 70,000.00
74 M IKBAL 25,000.00 12,500.00 12,500.00 25,000.00
75 SRI 30,000.00 15,000.00 15,000.00 30,000.00
76 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
77 BUDI 15,000.00 7,500.00 7,500.00 15,000.00
78 RIAN 15,000.00 7,500.00 7,500.00 15,000.00
79 IDA 70,000.00 35,000.00 35,000.00 70,000.00
80 DADAN 70,000.00 35,000.00 35,000.00 70,000.00
81 YENI 70,000.00 35,000.00 35,000.00 70,000.00
82 5/2/2016 TRI RATNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
83 MILANIS 70,000.00 35,000.00 35,000.00 70,000.00
84 AI GHOZALI 25,000.00 12,500.00 12,500.00 25,000.00
85 FATIHA 60,000.00 30,000.00 30,000.00 60,000.00
86 PUNGUT 15,000.00 7,500.00 7,500.00 15,000.00
87 MUSA 30,000.00 15,000.00 15,000.00 30,000.00
88 INDAH 60,000.00 30,000.00 30,000.00 60,000.00
89 SEPTI 70,000.00 35,000.00 35,000.00 70,000.00
90 JULEHA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
91 SITI 30,000.00 15,000.00 15,000.00 30,000.00
92 M FAUZAN 30,000.00 15,000.00 15,000.00 30,000.00
93 SUWARTO 15,000.00 7,500.00 7,500.00 15,000.00
94 ENENG 30,000.00 15,000.00 15,000.00 30,000.00
95 RIAHMAN 30,000.00 15,000.00 15,000.00 30,000.00
96 EKA 70,000.00 35,000.00 35,000.00 70,000.00
97 SITI M 30,000.00 15,000.00 15,000.00 30,000.00
98 MUSTIKA 30,000.00 15,000.00 15,000.00 30,000.00
99 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
100 FEBYAN 30,000.00 15,000.00 15,000.00 30,000.00
101 ASEP W 30,000.00 15,000.00 15,000.00 30,000.00
102 RAFIF 25,000.00 12,500.00 12,500.00 35,000.00
103 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
104 ASEP 30,000.00 15,000.00 15,000.00 30,000.00
105 MULYADI 30,000.00 15,000.00 15,000.00 30,000.00
106 DESSYANA 70,000.00 35,000.00 35,000.00 70,000.00
107 INTAN 70,000.00 35,000.00 35,000.00 70,000.00
108 6/2/2016 AJENG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
109 AISYA 35,000.00 17,500.00 17,500.00 35,000.00
110 SUCI 60,000.00 30,000.00 30,000.00 60,000.00
111 UCU 30,000.00 15,000.00 15,000.00 30,000.00
112 SITI 60,000.00 30,000.00 30,000.00 60,000.00
113 SYARIF 30,000.00 15,000.00 15,000.00 30,000.00
114 SUDARMAN 70,000.00 35,000.00 35,000.00 70,000.00
115 SUSI 30,000.00 15,000.00 15,000.00 30,000.00
116 QUEEN 25,000.00 12,500.00 12,500.00 25,000.00
117 AGATHA 70,000.00 35,000.00 35,000.00 70,000.00
118 NILLENA 30,000.00 15,000.00 15,000.00 30,000.00
119 SAEPUDIN 70,000.00 35,000.00 35,000.00 70,000.00
120 REVI 70,000.00 35,000.00 35,000.00 70,000.00
121 TUTY 70,000.00 35,000.00 35,000.00 70,000.00
122 NETI K 60,000.00 30,000.00 30,000.00 60,000.00
123 9/2/2016 ANI 30,000.00 15,000.00 15,000.00 30,000.00
124 DWI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
125 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
126 DELISTA 70,000.00 35,000.00 35,000.00 70,000.00
127 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
128 IDAWATI 40,000.00 20,000.00 20,000.00 40,000.00
129 IMAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
130 PAIJUN 30,000.00 15,000.00 15,000.00 30,000.00
131 ANGGUN 70,000.00 35,000.00 35,000.00 70,000.00
132 SUTARDI 70,000.00 35,000.00 35,000.00 70,000.00
133 JUMIRAH 70,000.00 35,000.00 35,000.00 70,000.00
134 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
135 SUWARTO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
136 SRI 30,000.00 15,000.00 15,000.00 30,000.00
137 RENATA 35,000.00 17,500.00 17,500.00 35,000.00
138 SYAFA 30,000.00 15,000.00 15,000.00 30,000.00
139 YESI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
140 VISTO 15,000.00 7,500.00 7,500.00 15,000.00
141 GINA 70,000.00 35,000.00 35,000.00 70,000.00
142 IRSYAD 30,000.00 15,000.00 15,000.00 30,000.00
143 NASYWA 30,000.00 15,000.00 15,000.00 30,000.00
144 BRYAN 35,000.00 17,500.00 17,500.00 35,000.00
145 NURWITA 15,000.00 7,500.00 7,500.00 15,000.00
146 RIMA 30,000.00 15,000.00 15,000.00 30,000.00
147 RAFFI 35,000.00 17,500.00 17,500.00 35,000.00
148 10/2/2016 NISRINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
149 RENI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
150 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
151 ANDRI 30,000.00 15,000.00 15,000.00 30,000.00
152 AZKA 30,000.00 15,000.00 15,000.00 30,000.00
153 NOVIA 70,000.00 35,000.00 35,000.00 70,000.00
154 EPPY 70,000.00 35,000.00 35,000.00 70,000.00
155 ADE M 30,000.00 15,000.00 15,000.00 30,000.00
156 WARMIN 40,000.00 20,000.00 20,000.00 40,000.00
157 NUR S 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
158 ASIKIN 40,000.00 20,000.00 20,000.00 40,000.00
159 HENI 40,000.00 20,000.00 20,000.00 40,000.00
160 SRI 40,000.00 20,000.00 20,000.00 40,000.00
161 HERA 70,000.00 35,000.00 35,000.00 70,000.00
162 M ATHALLAH 70,000.00 35,000.00 35,000.00 70,000.00
163 IDA 30,000.00 15,000.00 15,000.00 30,000.00
164 KACHFI 70,000.00 35,000.00 35,000.00 70,000.00
165 ABIL 70,000.00 35,000.00 35,000.00 70,000.00
166 INDRA 70,000.00 35,000.00 35,000.00 70,000.00
167 11/2/2016 LATIFAH 70,000.00 35,000.00 35,000.00 70,000.00
168 ADNAN 35,000.00 17,500.00 17,500.00 35,000.00
169 WIRMAN 30,000.00 15,000.00 15,000.00 30,000.00
170 GINA 30,000.00 15,000.00 15,000.00 30,000.00
171 KRISNA 30,000.00 15,000.00 15,000.00 30,000.00
172 ASEP W 70,000.00 35,000.00 35,000.00 70,000.00
173 RINI 30,000.00 15,000.00 15,000.00 30,000.00
174 USI 70,000.00 35,000.00 35,000.00 70,000.00
175 CANDRA 30,000.00 15,000.00 15,000.00 30,000.00
176 HADI 70,000.00 35,000.00 35,000.00 70,000.00
177 ROSMAYANTI 70,000.00 35,000.00 35,000.00 70,000.00
178 ZALFA 15,000.00 7,500.00 7,500.00 15,000.00
179 FELYAN 40,000.00 20,000.00 20,000.00 40,000.00
180 CAHYA 70,000.00 35,000.00 35,000.00 70,000.00
181 MISHA 70,000.00 35,000.00 35,000.00 70,000.00
182 RESITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
183 INDAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
184 KEYVIEN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
185 SUTISNA 70,000.00 35,000.00 35,000.00 70,000.00
186 RIAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
187 ROBBY 70,000.00 35,000.00 35,000.00 70,000.00
188 NASWA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
189 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
190 UUM 70,000.00 35,000.00 35,000.00 70,000.00
191 ARHAM 70,000.00 35,000.00 35,000.00 70,000.00
192 DARA 25,000.00 12,500.00 12,500.00 25,000.00
193 LISDA 70,000.00 35,000.00 35,000.00 70,000.00
194 12/2/2016 ROMDON 60,000.00 30,000.00 30,000.00 60,000.00
195 FADILA 70,000.00 35,000.00 35,000.00 70,000.00
196 DAMARA 70,000.00 35,000.00 35,000.00 70,000.00
197 BANGUN 70,000.00 35,000.00 35,000.00 70,000.00
198 SUJILAH 70,000.00 35,000.00 35,000.00 70,000.00
199 SUTRISNO 70,000.00 35,000.00 35,000.00 70,000.00
200 ENENG 70,000.00 35,000.00 35,000.00 70,000.00
201 DEFIANA 70,000.00 35,000.00 35,000.00 70,000.00
202 DAFIAN 70,000.00 35,000.00 35,000.00 70,000.00
203 TRIYA 30,000.00 15,000.00 15,000.00 30,000.00
204 DERI 70,000.00 35,000.00 35,000.00 70,000.00
205 KARINA 30,000.00 15,000.00 15,000.00 30,000.00
206 SYAFINA 70,000.00 35,000.00 35,000.00 70,000.00
207 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
208 DZAKY 70,000.00 35,000.00 35,000.00 70,000.00
209 IIM 30,000.00 15,000.00 15,000.00 30,000.00
210 ADHIE 70,000.00 35,000.00 35,000.00 70,000.00
211 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
212 ANEF 70,000.00 35,000.00 35,000.00 70,000.00
213 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
214 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
215 SITI U 70,000.00 35,000.00 35,000.00 70,000.00
216 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
217 RAFIF 70,000.00 35,000.00 35,000.00 70,000.00
218 13/2/16 AJENG 30,000.00 15,000.00 15,000.00 30,000.00
219 AISYA 30,000.00 15,000.00 15,000.00 30,000.00
220 SUCI 30,000.00 15,000.00 15,000.00 30,000.00
221 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
222 UCU 30,000.00 15,000.00 15,000.00 30,000.00
223 LANNY 30,000.00 15,000.00 15,000.00 30,000.00
224 JAMALUDIN 15,000.00 7,500.00 7,500.00 15,000.00
225 SYAMIL 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
226 MELLENIA 30,000.00 15,000.00 15,000.00 30,000.00
227 ESIH 60,000.00 30,000.00 30,000.00 60,000.00
228 FEBBY 70,000.00 35,000.00 35,000.00 70,000.00
229 ROHMAH 60,000.00 30,000.00 30,000.00 60,000.00
230 SINTA 70,000.00 35,000.00 35,000.00 70,000.00
231 IDA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
232 NINA SITI 70,000.00 35,000.00 35,000.00 70,000.00
233 HILMAN 15,000.00 7,500.00 7,500.00 15,000.00
234 SUTRISNO 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
235 HERDIRAMDANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
236 BERNANDO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
237 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00 30,000.00
238 AINA AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
239 15/2/16 WINARNO 70,000.00 35,000.00 35,000.00 70,000.00
240 MARNAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
241 SANI 35,000.00 10,000.00 17,500.00 17,500.00 70,000.00
242 WARMIN 30,000.00 15,000.00 15,000.00 30,000.00
243 AGUS H 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
244 ENAT 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
245 ADE 40,000.00 20,000.00 20,000.00 40,000.00
246 MAMAT 70,000.00 35,000.00 35,000.00 70,000.00
247 NISRINA 35,000.00 17,500.00 17,500.00 35,000.00
248 RENI 30,000.00 15,000.00 15,000.00 30,000.00
249 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
250 SITI A 15,000.00 7,500.00 7,500.00 15,000.00
251 WISNU 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
252 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
253 ALEX 25,000.00 12,500.00 12,500.00 25,000.00
254 NERY 25,000.00 12,500.00 12,500.00 25,000.00
255 LELY 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
256 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
257 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
258 ADMAN 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
259 DJENG 30,000.00 15,000.00 15,000.00 30,000.00
260 NAZWA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
261 16/2/16 HILMAN 15,000.00 7,500.00 7,500.00 15,000.00
262 M ANGGAR 70,000.00 35,000.00 35,000.00 70,000.00
263 IDA 70,000.00 35,000.00 35,000.00 70,000.00
264 SUTARDI 70,000.00 35,000.00 35,000.00 70,000.00
265 M SUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
266 SYAHWA 70,000.00 35,000.00 35,000.00 70,000.00
267 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
268 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
269 NERMA 30,000.00 15,000.00 15,000.00 30,000.00
270 RESNAWATI 70,000.00 35,000.00 35,000.00 70,000.00
271 RIZKI RAIDAN 35,000.00 17,500.00 17,500.00 35,000.00
272 ANNE 70,000.00 35,000.00 35,000.00 70,000.00
273 VISTO 70,000.00 35,000.00 35,000.00 70,000.00
274 BEKTI 15,000.00 7,500.00 7,500.00 15,000.00
275 SITI 30,000.00 15,000.00 15,000.00 30,000.00
276 SONJAYA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
277 APRILIA AZAHRA 25,000.00 12,500.00 12,500.00 25,000.00
278 RENATA 70,000.00 35,000.00 35,000.00 70,000.00
279 DEWI 35,000.00 17,500.00 17,500.00 35,000.00
280 SUSIATUN 30,000.00 15,000.00 15,000.00 30,000.00
281 IDA 35,000.00 17,500.00 17,500.00 35,000.00
282 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
283 BRYAN 70,000.00 35,000.00 35,000.00 70,000.00
284 NADHIRA 70,000.00 35,000.00 35,000.00 70,000.00
285 SANTI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
286 17/2/16 FREDY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
287 LILIS R 15,000.00 7,500.00 7,500.00 15,000.00
288 SHIDIQ 15,000.00 7,500.00 7,500.00 15,000.00
289 ASIKIN 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
290 HAFIYA 15,000.00 7,500.00 7,500.00 15,000.00
291 AZKA H 70,000.00 35,000.00 35,000.00 70,000.00
292 TATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
293 EPONG 70,000.00 35,000.00 35,000.00 70,000.00
294 DINDA 70,000.00 35,000.00 35,000.00 70,000.00
295 SULASTRI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
296 SITU HENI 70,000.00 35,000.00 35,000.00 70,000.00
297 HENI 70,000.00 35,000.00 35,000.00 70,000.00
298 ABIL 70,000.00 35,000.00 35,000.00 70,000.00
299 IKHSAN 35,000.00 17,500.00 17,500.00 35,000.00
300 HENA 15,000.00 7,500.00 7,500.00 15,000.00
301 SUPRIATNA 70,000.00 35,000.00 35,000.00 70,000.00
302 TUTI 70,000.00 35,000.00 35,000.00 45,000.00
303 JULIA 70,000.00 35,000.00 35,000.00 70,000.00
304 SUCITHA 30,000.00 15,000.00 15,000.00 30,000.00
305 NASITHA 35,000.00 17,500.00 17,500.00 35,000.00
306 NOVI 70,000.00 35,000.00 35,000.00 70,000.00
307 ERVIANA 70,000.00 35,000.00 35,000.00 70,000.00
308 18/2/16 KRISTINA 30,000.00 15,000.00 15,000.00 30,000.00
309 CANDRA 30,000.00 15,000.00 15,000.00 30,000.00
310 RIDIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
311 TIN 15,000.00 7,500.00 7,500.00 15,000.00
312 ADANG 15,000.00 7,500.00 7,500.00 15,000.00
313 HERU 70,000.00 35,000.00 35,000.00 70,000.00
314 AINA AHMAD 70,000.00 35,000.00 35,000.00 70,000.00
315 ALDI 70,000.00 35,000.00 35,000.00 70,000.00
316 SYAKILA 70,000.00 35,000.00 35,000.00 70,000.00
317 MUTHIA 70,000.00 35,000.00 35,000.00 70,000.00
318 MUSTIKA 30,000.00 15,000.00 15,000.00 30,000.00
319 DELISTA 70,000.00 35,000.00 35,000.00 70,000.00
320 ENDANG 70,000.00 35,000.00 35,000.00 70,000.00
321 DYAH 70,000.00 35,000.00 35,000.00 70,000.00
322 WAHYU 70,000.00 35,000.00 35,000.00 70,000.00
323 RIPAN 70,000.00 35,000.00 35,000.00 70,000.00
324 UUM 30,000.00 15,000.00 15,000.00 30,000.00
325 PAIJAN 30,000.00 15,000.00 15,000.00 30,000.00
326 AIDA 70,000.00 35,000.00 35,000.00 70,000.00
327 RAFIF 25,000.00 12,500.00 12,500.00 25,000.00
328 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
329 RIAN 30,000.00 15,000.00 15,000.00 30,000.00
330 ANDRI 30,000.00 15,000.00 15,000.00 30,000.00
331 19/2/16 RACHMAT 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
332 YUDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
333 SUTISNA 30,000.00 15,000.00 15,000.00 30,000.00
334 SRI S 15,000.00 7,500.00 7,500.00 15,000.00
335 SUCI 70,000.00 35,000.00 35,000.00 70,000.00
336 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
337 MULYATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
338 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
339 20/2/16 NAFISHA 35,000.00 17,500.00 17,500.00 35,000.00
340 M IRSYAD 15,000.00 7,500.00 7,500.00 15,000.00
341 MARYATI 70,000.00 35,000.00 35,000.00 70,000.00
342 SUMIATI 30,000.00 15,000.00 15,000.00 30,000.00
343 AZ HAR 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
344 SAMAN 60,000.00 30,000.00 30,000.00 60,000.00
345 AISYA 30,000.00 15,000.00 15,000.00 30,000.00
346 AJENG D 30,000.00 15,000.00 15,000.00 30,000.00
347 SUSI 35,000.00 17,500.00 17,500.00 35,000.00
348 FAIZ 70,000.00 35,000.00 35,000.00 70,000.00
349 AINA 30,000.00 15,000.00 15,000.00 30,000.00
350 DINAS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
351 WINNA 15,000.00 7,500.00 7,500.00 15,000.00
352 REVI 70,000.00 35,000.00 35,000.00 70,000.00
353 TUTY 70,000.00 35,000.00 35,000.00 70,000.00
354 22/2/16 SITI K 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
355 ADE 70,000.00 35,000.00 35,000.00 70,000.00
356 LILIS R 40,000.00 20,000.00 20,000.00 40,000.00
357 BERNANDO 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
358 JOHANES 30,000.00 15,000.00 15,000.00 30,000.00
359 SUHAESITI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
360 HATI 60,000.00 30,000.00 30,000.00 60,000.00
361 SHAFRINA 70,000.00 35,000.00 35,000.00 70,000.00
362 NISRINA 70,000.00 35,000.00 35,000.00 70,000.00
363 RENI 70,000.00 35,000.00 35,000.00 70,000.00
364 SHAFA 30,000.00 15,000.00 15,000.00 30,000.00
365 NURAENI 70,000.00 35,000.00 35,000.00 70,000.00
366 M IRPAN 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
367 SUHARTI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
368 NANNY 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
369 WARMIN 15,000.00 7,500.00 7,500.00 15,000.00
370 YENNY 70,000.00 35,000.00 35,000.00 70,000.00
371 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
372 ADNAN 70,000.00 35,000.00 35,000.00 70,000.00
373 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
374 ADHIE 70,000.00 35,000.00 35,000.00 70,000.00
375 AHMAD 40,000.00 20,000.00 20,000.00 40,000.00
376 INDAH 40,000.00 20,000.00 20,000.00 40,000.00
377 PERMANA 70,000.00 35,000.00 35,000.00 70,000.00
378 RINA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
379 UCU 30,000.00 15,000.00 15,000.00 30,000.00
380 PERI 70,000.00 35,000.00 35,000.00 70,000.00
381 BUDIAWAN 30,000.00 15,000.00 15,000.00 30,000.00
382 23/2/16 CAHYENI 70,000.00 35,000.00 35,000.00 70,000.00
383 RESNAWATI 70,000.00 35,000.00 35,000.00 70,000.00
384 IDA 70,000.00 35,000.00 35,000.00 70,000.00
385 SINTA 30,000.00 15,000.00 15,000.00 30,000.00
386 DJENG SRI 30,000.00 15,000.00 15,000.00 30,000.00
387 RESYA 30,000.00 15,000.00 15,000.00 30,000.00
388 RIAN 70,000.00 35,000.00 35,000.00 70,000.00
389 BUNGA 30,000.00 15,000.00 15,000.00 30,000.00
390 SITI 30,000.00 15,000.00 15,000.00 30,000.00
391 SUMIATI 30,000.00 15,000.00 15,000.00 30,000.00
392 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
393 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
394 ANIS 15,000.00 7,500.00 7,500.00 15,000.00
395 VISTO 70,000.00 35,000.00 35,000.00 70,000.00
396 IKHSAN 15,000.00 7,500.00 7,500.00 15,000.00
397 IDA 70,000.00 35,000.00 35,000.00 70,000.00
398 MINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
399 SANTI 35,000.00 17,500.00 17,500.00 35,000.00
400 DEWI 35,000.00 17,500.00 17,500.00 35,000.00
401 WISNU 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
402 DEWI 35,000.00 17,500.00 17,500.00 35,000.00
403 LANI 70,000.00 35,000.00 35,000.00 70,000.00
404 WISNO 35,000.00 17,500.00 17,500.00 35,000.00
405 24/2/16 JOKO 70,000.00 35,000.00 35,000.00 70,000.00
406 SUSI 30,000.00 15,000.00 15,000.00 30,000.00
407 SOFI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
408 AZKA H 70,000.00 35,000.00 35,000.00 70,000.00
409 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
410 SUNARNI 70,000.00 35,000.00 35,000.00 70,000.00
411 HENI 30,000.00 15,000.00 15,000.00 30,000.00
412 EPPY 70,000.00 35,000.00 35,000.00 70,000.00
413 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
414 TERRA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
415 NURUL F 70,000.00 35,000.00 35,000.00 70,000.00
416 M FAHRUL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
417 TETRANIA 35,000.00 17,500.00 17,500.00 35,000.00
418 RYUGA 30,000.00 15,000.00 15,000.00 30,000.00
419 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
420 TAUFIQ 15,000.00 7,500.00 7,500.00 15,000.00
421 FAIQ 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
422 RIZKI RAIDAN 70,000.00 35,000.00 35,000.00 70,000.00
423 NURJANAH 70,000.00 35,000.00 35,000.00 70,000.00
424 25/2/16 SUSANA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
425 MARJAN 15,000.00 7,500.00 7,500.00 15,000.00
426 HARTONI 15,000.00 7,500.00 7,500.00 15,000.00
427 DEVI 25,000.00 12,500.00 12,500.00 25,000.00
428 UMSIATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
429 KRISTIA 15,000.00 7,500.00 7,500.00 15,000.00
430 NGADIYA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
431 ADE AZIS 70,000.00 35,000.00 35,000.00 70,000.00
432 UUM 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
433 ANDRI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
434 CHANDRA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
435 DZAKY 70,000.00 35,000.00 35,000.00 70,000.00
436 ALYA 40,000.00 20,000.00 20,000.00 40,000.00
437 ITA 70,000.00 35,000.00 35,000.00 70,000.00
438 NUR 30,000.00 15,000.00 15,000.00 30,000.00
439 JAMILAH 70,000.00 35,000.00 35,000.00 70,000.00
440 SUDARSIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
441 DEDE 40,000.00 20,000.00 20,000.00 40,000.00
442 FELYAN 70,000.00 35,000.00 35,000.00 70,000.00
443 26/2/16 AINA 70,000.00 35,000.00 35,000.00 70,000.00
444 SYAFA 25,000.00 12,500.00 12,500.00 25,000.00
445 RICKY 70,000.00 35,000.00 35,000.00 70,000.00
446 MARSHA 70,000.00 35,000.00 35,000.00 70,000.00
447 DELISTA 70,000.00 35,000.00 35,000.00 70,000.00
448 IIN 30,000.00 15,000.00 15,000.00 30,000.00
449 KARINA 30,000.00 15,000.00 15,000.00 30,000.00
450 PAIJAN 30,000.00 15,000.00 15,000.00 30,000.00
451 RIAN 30,000.00 15,000.00 15,000.00 30,000.00
452 KAHFI 25,000.00 12,500.00 12,500.00 25,000.00
453 ANGGA 70,000.00 35,000.00 35,000.00 70,000.00
454 JIHAD 30,000.00 15,000.00 15,000.00 30,000.00
455 ADAM 25,000.00 12,500.00 12,500.00 25,000.00
456 WISNO 30,000.00 15,000.00 15,000.00 30,000.00
457 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
458 DAFIAN 25,000.00 12,500.00 12,500.00 25,000.00
459 DESI 70,000.00 35,000.00 35,000.00 70,000.00
460 27/2/16 PUTRI DIKHA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
461 RATIH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
462 ANISA 15,000.00 7,500.00 7,500.00 15,000.00
463 BERNANDO 30,000.00 15,000.00 15,000.00 30,000.00
464 HENDIRAMDANI 30,000.00 15,000.00 15,000.00 30,000.00
465 EMA 30,000.00 15,000.00 15,000.00 30,000.00
466 AINA 70,000.00 35,000.00 35,000.00 70,000.00
467 29/2/16 WARMIN 40,000.00 20,000.00 20,000.00 40,000.00
468 NISRINA 70,000.00 35,000.00 35,000.00 70,000.00
469 RENI 40,000.00 20,000.00 20,000.00 40,000.00
470 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
471 SUHARTI 30,000.00 15,000.00 15,000.00 30,000.00
472 IRFAN 30,000.00 15,000.00 15,000.00 30,000.00
473 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
474 EVI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
475 29/2/16 RACHMAT 70,000.00 35,000.00 35,000.00 70,000.00
476 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
477 MUSTIKA 40,000.00 20,000.00 20,000.00 40,000.00
478 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
479 ADHIE 30,000.00 15,000.00 15,000.00 30,000.00
480 NOVI 30,000.00 15,000.00 15,000.00 30,000.00
481 NASRUL 25,000.00 12,500.00 12,500.00 25,000.00
482 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
483 WORO 25,000.00 12,500.00 12,500.00 25,000.00
484 EVI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
485 CAHYA 40,000.00 20,000.00 20,000.00 40,000.00
21,275,000 770,000 10,637,500 10,637,500 22,055,000 -
PERIODE MARET 2016
ALAT &
NO TANGGAL NAMA PASIEN TARIF ADM JASA DOKTER JML KET
BAHAN
1 1/3/2016 HENI 300,000 5,000 147,500 147,500 305,000
2 2/3/2016 HARTINI 100,000 5,000 47,500 47,500 105,000
3 RINI 150,000 5,000 72,500 72,500 155,000
4 4/3/2016 RIDA 150,000 5,000 72,500 72,500 155,000
5 5/3/2016 YULIANTI 100,000 5,000 47,500 47,500 105,000
6 BERNANDO 100,000 5,000 47,500 47,500 105,000
7 7/3/2016 HANI 70,000 5,000 32,500 32,500 75,000
8 NINA 300,000 5,000 147,500 147,500 305,000
9 10/3/2016 HASNA 20,000 5,000 7,500 7,500 25,000
10 11/3/2016 YADI 60,000 5,000 27,500 27,500 65,000
11 RINA 20,000 5,000 7,500 7,500 25,000
12 14/3/16 HARTINI 100,000 5,000 47,500 47,500 105,000
13 HANI 100,000 5,000 47,500 47,500 105,000
14 16/3/16 LULU 250,000 5,000 122,500 122,500 255,000
15 TANSYA 100,000 5,000 47,500 47,500 105,000
16 17/3/16 NIRMA 100,000 5,000 47,500 47,500 105,000
17 18/3/16 RINDRIYANTI 200,000 5,000 97,500 97,500 205,000
18 19/3/16 NANAH 100,000 5,000 47,500 47,500 105,000
19 ROSINTA 100,000 5,000 47,500 47,500 105,000
20 23/3/16 LUSI 80,000 5,000 37,500 37,500 85,000
21 M YAZID 100,000 5,000 47,500 47,500 105,000
22 24/3/16 LIES S 100,000 5,000 47,500 47,500 105,000
23 30/3/16 M FIRMANDIYA 20,000 5,000 7,500 7,500 25,000
24 31/3/16 NUNUNG 250,000 5,000 122,500 122,500 255,000
TOTAL 2,970,000 120,000 1,425,000 1,425,000 3,090,000

PERIODE MARET 2016
ALAT &
TGL NAMA TARIF OBAT JASA DOKTER JML KET
BAHAN
1 1/3/2016 RIA 70,000.00 35,000.00 35,000.00 70,000.00
2 ASEP J 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
3 SUMIATI 30,000.00 15,000.00 15,000.00 30,000.00
4 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
5 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
6 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
7 FITRI 70,000.00 35,000.00 35,000.00 70,000.00
8 DJENG SRI 30,000.00 15,000.00 15,000.00 30,000.00
9 ANGGA 70,000.00 35,000.00 35,000.00 70,000.00
10 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
11 FAHRIZAL 70,000.00 35,000.00 35,000.00 70,000.00
12 DADANG 70,000.00 35,000.00 35,000.00 70,000.00
13 PAIJAN 30,000.00 15,000.00 15,000.00 30,000.00
14 ALMAULIDYA 30,000.00 15,000.00 15,000.00 30,000.00
15 WISNU 70,000.00 35,000.00 35,000.00 70,000.00
16 DEWI TRI 35,000.00 17,500.00 17,500.00 35,000.00
17 SURANI 70,000.00 35,000.00 35,000.00 70,000.00
18 DHINI 15,000.00 7,500.00 7,500.00 15,000.00
19 APRILIA 15,000.00 7,500.00 7,500.00 15,000.00
20 HENI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
21 MYSHELLA 30,000.00 15,000.00 15,000.00 30,000.00
22 2/3/2016 YULI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
23 APANDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
24 NANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
25 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
26 NURUL 35,000.00 17,500.00 17,500.00 35,000.00
27 SUSI 30,000.00 15,000.00 15,000.00 30,000.00
28 ANDRI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
29 SUDARSIH 15,000.00 7,500.00 7,500.00 15,000.00
30 TRIA AJI 70,000.00 35,000.00 35,000.00 70,000.00
31 SLAMAT 30,000.00 15,000.00 15,000.00 30,000.00
32 SELDINI 30,000.00 15,000.00 15,000.00 30,000.00
33 SOFI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
34 FAIQ 30,000.00 15,000.00 15,000.00 30,000.00
35 YUSUF I 35,000.00 17,500.00 17,500.00 35,000.00
36 USIN 60,000.00 30,000.00 30,000.00 60,000.00
37 RAFLI 70,000.00 35,000.00 35,000.00 70,000.00
38 SUPRIATNA 60,000.00 30,000.00 30,000.00 60,000.00
39 DEWI TRI 70,000.00 35,000.00 35,000.00 70,000.00
40 M IRSYAD 70,000.00 35,000.00 35,000.00 70,000.00
41 NASYA 35,000.00 17,500.00 17,500.00 35,000.00
42 M FAHIL 60,000.00 30,000.00 30,000.00 60,000.00
43 3/3/2016 ASTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
44 SUSANA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
45 NADITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
46 EMI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
47 RAIHANA 25,000.00 12,500.00 12,500.00 25,000.00
48 NENG 30,000.00 15,000.00 15,000.00 30,000.00
49 SAMSUDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
50 CHANDRA 30,000.00 15,000.00 15,000.00 30,000.00
51 UUM 30,000.00 15,000.00 15,000.00 30,000.00
52 KASMINI 30,000.00 15,000.00 15,000.00 30,000.00
53 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
54 ALYA 70,000.00 35,000.00 35,000.00 70,000.00
55 RYUGA 15,000.00 7,500.00 7,500.00 15,000.00
56 TETRANIA 30,000.00 15,000.00 15,000.00 30,000.00
57 NUR AFIFAH 30,000.00 15,000.00 15,000.00 30,000.00
58 RESYA 70,000.00 35,000.00 35,000.00 70,000.00
59 AHMAD 70,000.00 35,000.00 35,000.00 70,000.00
60 INDAH 70,000.00 35,000.00 35,000.00 70,000.00
61 ETI 70,000.00 35,000.00 35,000.00 70,000.00
62 SALMA 70,000.00 35,000.00 35,000.00 70,000.00
63 UCU 40,000.00 20,000.00 20,000.00 40,000.00
64 BUNGA 40,000.00 20,000.00 20,000.00 40,000.00
65 4/3/2016 RAFIF 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
66 JIHAD 30,000.00 15,000.00 15,000.00 30,000.00
67 FANSYA 30,000.00 15,000.00 15,000.00 30,000.00
68 RIZKI 30,000.00 15,000.00 15,000.00 30,000.00
69 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
70 ENCUM 30,000.00 15,000.00 15,000.00 30,000.00
71 RIZKA 70,000.00 35,000.00 35,000.00 70,000.00
72 MASHA 70,000.00 35,000.00 35,000.00 70,000.00
73 WIWIN 30,000.00 15,000.00 15,000.00 30,000.00
74 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
75 FELYAN 70,000.00 35,000.00 35,000.00 70,000.00
76 RIAN 30,000.00 15,000.00 15,000.00 30,000.00
77 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
78 SHOBRINA 70,000.00 35,000.00 35,000.00 70,000.00
79 POPON 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
80 FAHIRA 70,000.00 35,000.00 35,000.00 70,000.00
81 SRI S 40,000.00 20,000.00 20,000.00 40,000.00
82 DEDE 70,000.00 35,000.00 35,000.00 70,000.00
83 IRVAN 70,000.00 35,000.00 35,000.00 70,000.00
84 DANIA 70,000.00 35,000.00 35,000.00 70,000.00
85 DERI 70,000.00 35,000.00 35,000.00 70,000.00
86 MULYATI 40,000.00 20,000.00 20,000.00 40,000.00
87 ERNAWATI 15,000.00 7,500.00 7,500.00 15,000.00
88 5/3/2016 RATIH 30,000.00 15,000.00 15,000.00 30,000.00
89 YULIANTI 70,000.00 35,000.00 35,000.00 70,000.00
90 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
91 MARYATI 70,000.00 35,000.00 35,000.00 70,000.00
92 SYAMIL 30,000.00 15,000.00 15,000.00 30,000.00
93 SYARIF 30,000.00 15,000.00 15,000.00 30,000.00
94 IHSAN 70,000.00 35,000.00 35,000.00 70,000.00
95 YUDI 60,000.00 30,000.00 30,000.00 60,000.00
96 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
97 IMELDA 15,000.00 7,500.00 7,500.00 15,000.00
98 LINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
99 ERNASARI 30,000.00 15,000.00 15,000.00 30,000.00
100 IDA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
101 TUTY 70,000.00 35,000.00 35,000.00 70,000.00
102 REVI 15,000.00 7,500.00 7,500.00 35,000.00
103 BERNANDO 30,000.00 15,000.00 15,000.00 30,000.00
104 IYAN 15,000.00 7,500.00 7,500.00 15,000.00
105 DADAN 30,000.00 15,000.00 15,000.00 30,000.00
106 SASKIA 70,000.00 35,000.00 35,000.00 70,000.00
107 7/3/2016 WARMIN 70,000.00 35,000.00 35,000.00 70,000.00
108 NUGRAHA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
109 RUSMANA 30,000.00 15,000.00 15,000.00 30,000.00
110 SUHARTI 30,000.00 15,000.00 15,000.00 30,000.00
111 IRFAN 70,000.00 35,000.00 35,000.00 70,000.00
112 SELDINI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
113 DINA 70,000.00 35,000.00 35,000.00 70,000.00
114 MARJAN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
115 YASMI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
116 FEBRIANA 25,000.00 12,500.00 12,500.00 25,000.00
117 REVA 70,000.00 35,000.00 35,000.00 70,000.00
118 MASHA 70,000.00 35,000.00 35,000.00 70,000.00
119 YATNO 30,000.00 15,000.00 15,000.00 30,000.00
120 CAHYA 70,000.00 35,000.00 35,000.00 70,000.00
121 IYAM 30,000.00 15,000.00 15,000.00 30,000.00
122 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
123 YADI 30,000.00 15,000.00 15,000.00 30,000.00
124 PERMANA 30,000.00 15,000.00 15,000.00 30,000.00
125 DENI 15,000.00 7,500.00 7,500.00 15,000.00
126 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
127 8/3/2016 SUMIATY 30,000.00 15,000.00 15,000.00 30,000.00
128 SLAMET 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
129 JUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
130 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
131 ENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
132 RIA 70,000.00 35,000.00 35,000.00 70,000.00
133 ASEP J 30,000.00 15,000.00 15,000.00 30,000.00
134 JOY 15,000.00 7,500.00 7,500.00 15,000.00
135 MAMAT 15,000.00 7,500.00 7,500.00 15,000.00
136 WITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
137 SUPRIYANTO 70,000.00 35,000.00 35,000.00 70,000.00
138 SINTA 30,000.00 15,000.00 15,000.00 30,000.00
139 DJENG SRI 40,000.00 20,000.00 20,000.00 40,000.00
140 M ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
141 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
142 AGUS 70,000.00 35,000.00 35,000.00 70,000.00
143 NURHAYATI 70,000.00 35,000.00 35,000.00 70,000.00
144 SURANI 70,000.00 35,000.00 35,000.00 70,000.00
145 WISNU 30,000.00 15,000.00 15,000.00 30,000.00
146 HANI 30,000.00 15,000.00 15,000.00 30,000.00
147 IIM 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
148 DEWI TRI 30,000.00 15,000.00 15,000.00 30,000.00
149 GHINA 70,000.00 35,000.00 35,000.00 70,000.00
150 SELLY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
151 ANGGI 30,000.00 15,000.00 15,000.00 30,000.00
152 RAMADHANI 30,000.00 15,000.00 15,000.00 30,000.00
153 YANTI 70,000.00 35,000.00 35,000.00 70,000.00
154 ALMAULIDYA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
155 10/3/2016 TANIA 70,000.00 35,000.00 35,000.00 70,000.00
156 IBRAHIM 30,000.00 15,000.00 15,000.00 30,000.00
157 ANNISA 70,000.00 35,000.00 35,000.00 70,000.00
158 SAMSUDIN 70,000.00 35,000.00 35,000.00 70,000.00
159 NIKITA 25,000.00 12,500.00 12,500.00 25,000.00
160 METI 70,000.00 35,000.00 35,000.00 70,000.00
161 DIDIK 30,000.00 15,000.00 15,000.00 30,000.00
162 NGADIYA 30,000.00 15,000.00 15,000.00 30,000.00
163 SALWA 30,000.00 15,000.00 15,000.00 30,000.00
164 RATNA 60,000.00 30,000.00 30,000.00 60,000.00
165 UUM 40,000.00 20,000.00 20,000.00 40,000.00
166 USIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
167 RIZKI 70,000.00 35,000.00 35,000.00 70,000.00
168 PAIJAN 40,000.00 20,000.00 20,000.00 40,000.00
169 SRI S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
170 PRATAMA 30,000.00 15,000.00 15,000.00 30,000.00
171 DIJAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
172 RISKI 70,000.00 35,000.00 35,000.00 70,000.00
173 METTA 70,000.00 35,000.00 35,000.00 70,000.00
174 ASTI 30,000.00 15,000.00 15,000.00 30,000.00
175 NENGSIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
176 11/3/2016 NIKEN 30,000.00 15,000.00 15,000.00 30,000.00
177 PERAWATI 60,000.00 30,000.00 30,000.00 60,000.00
178 QUENNSYA 30,000.00 15,000.00 15,000.00 30,000.00
179 AZZAHRA 25,000.00 12,500.00 12,500.00 25,000.00
180 MEDYAWATI 70,000.00 35,000.00 35,000.00 70,000.00
181 FANYSYA 30,000.00 15,000.00 15,000.00 30,000.00
182 AISYA 30,000.00 15,000.00 15,000.00 30,000.00
183 AJENG 40,000.00 20,000.00 20,000.00 40,000.00
184 BUNGA 70,000.00 35,000.00 35,000.00 70,000.00
185 MULYATI 70,000.00 35,000.00 35,000.00 70,000.00
186 UCU 70,000.00 35,000.00 35,000.00 70,000.00
187 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
188 AHMAD 70,000.00 35,000.00 35,000.00 70,000.00
189 KANIA 30,000.00 15,000.00 15,000.00 30,000.00
190 IIM 30,000.00 15,000.00 15,000.00 30,000.00
191 NUR 30,000.00 15,000.00 15,000.00 30,000.00
192 DYAH 70,000.00 35,000.00 35,000.00 70,000.00
193 RIPAN 70,000.00 35,000.00 35,000.00 70,000.00
194 12/3/2016 NURUL 70,000.00 35,000.00 35,000.00 70,000.00
195 PUTRI 25,000.00 12,500.00 12,500.00 25,000.00
196 NILLENIA 40,000.00 20,000.00 20,000.00 40,000.00
197 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
198 CECEP 60,000.00 30,000.00 30,000.00 60,000.00
199 SLAMET 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
200 MARYATI 70,000.00 35,000.00 35,000.00 70,000.00
201 AURELIA 70,000.00 35,000.00 35,000.00 70,000.00
202 DEFIE 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
203 RANU 70,000.00 35,000.00 35,000.00 70,000.00
204 SYAMIL 40,000.00 20,000.00 20,000.00 40,000.00
205 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
206 DJENG SRI 70,000.00 35,000.00 35,000.00 70,000.00
207 ANITA 30,000.00 15,000.00 15,000.00 30,000.00
208 HERDI 30,000.00 15,000.00 15,000.00 30,000.00
209 BERNANDO 30,000.00 15,000.00 15,000.00 30,000.00
210 DADAN 30,000.00 15,000.00 15,000.00 30,000.00
211 ERNASARI 30,000.00 15,000.00 15,000.00 30,000.00
212 EMA 30,000.00 15,000.00 15,000.00 30,000.00
213 RAFIF 35,000.00 17,500.00 17,500.00 35,000.00
214 IDA 70,000.00 35,000.00 35,000.00 70,000.00
215 NIZZAR 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
216 OVTARINA 70,000.00 35,000.00 35,000.00 70,000.00
217 HERMANSYAH 70,000.00 35,000.00 35,000.00 70,000.00
218 14/3/16 SUHARTI 40,000.00 20,000.00 20,000.00 40,000.00
219 IRFAN 70,000.00 35,000.00 35,000.00 70,000.00
220 SITI K 70,000.00 35,000.00 35,000.00 70,000.00
221 SELDINI 30,000.00 15,000.00 15,000.00 30,000.00
222 YASMI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
223 JOHANES 30,000.00 15,000.00 15,000.00 30,000.00
224 ALVIA 70,000.00 35,000.00 35,000.00 70,000.00
225 SITI H 70,000.00 35,000.00 35,000.00 70,000.00
226 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
227 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
228 IQBAL 25,000.00 12,500.00 12,500.00 25,000.00
229 SARUMINI 70,000.00 35,000.00 35,000.00 70,000.00
230 ALEX 25,000.00 12,500.00 12,500.00 25,000.00
231 MUFTI 30,000.00 15,000.00 15,000.00 30,000.00
232 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
233 RIAN 40,000.00 20,000.00 20,000.00 40,000.00
234 M FAUZAN 30,000.00 15,000.00 15,000.00 30,000.00
235 LULU 70,000.00 35,000.00 35,000.00 70,000.00
236 BIDA 25,000.00 12,500.00 12,500.00 25,000.00
237 DENI A 30,000.00 15,000.00 15,000.00 30,000.00
238 15/3/16 JOEY 15,000.00 7,500.00 7,500.00 15,000.00
239 ANDININTA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
240 ASEP J 30,000.00 15,000.00 15,000.00 30,000.00
241 YAYAH 40,000.00 20,000.00 20,000.00 70,000.00
242 ENI 70,000.00 35,000.00 35,000.00 70,000.00
243 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
244 MAMAT 15,000.00 7,500.00 7,500.00 15,000.00
245 SUMIATY 30,000.00 15,000.00 15,000.00 30,000.00
246 RAIHANA 25,000.00 12,500.00 12,500.00 25,000.00
247 SINTA 30,000.00 15,000.00 15,000.00 30,000.00
248 15/3/16 YAHNO 70,000.00 35,000.00 35,000.00 70,000.00
249 LISMAYANTI 60,000.00 30,000.00 30,000.00 60,000.00
250 16/3/16 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
251 AZKA 30,000.00 15,000.00 15,000.00 30,000.00
252 DARIYAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
253 ABDUL 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
254 SUKAESIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
255 AINA 25,000.00 12,500.00 12,500.00 25,000.00
256 NAFIA 70,000.00 35,000.00 35,000.00 70,000.00
257 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
258 TINI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
259 IIM 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
260 EMMELIA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
261 IRWANTO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
262 LULU 70,000.00 35,000.00 35,000.00 70,000.00
263 REENA 30,000.00 15,000.00 15,000.00 30,000.00
264 USIN 60,000.00 30,000.00 30,000.00 60,000.00
265 TERANIA 70,000.00 35,000.00 35,000.00 70,000.00
266 ERNA 30,000.00 15,000.00 15,000.00 30,000.00
267 RUSTIANTI 60,000.00 30,000.00 30,000.00 60,000.00
268 LIONI 30,000.00 15,000.00 15,000.00 30,000.00
269 ALMAULIDYA 70,000.00 35,000.00 35,000.00 70,000.00
270 SURANI 70,000.00 35,000.00 35,000.00 70,000.00
271 RYUGA 70,000.00 35,000.00 35,000.00 70,000.00
272 WISNU 70,000.00 35,000.00 35,000.00 70,000.00
273 DEWITRI 30,000.00 15,000.00 15,000.00 30,000.00
274 17/3/16 SALAMAH 70,000.00 35,000.00 35,000.00 70,000.00
275 ANEN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
276 CANDRA 30,000.00 15,000.00 15,000.00 30,000.00
277 DHINI 25,000.00 12,500.00 12,500.00 25,000.00
278 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
279 RIDIN 30,000.00 15,000.00 15,000.00 30,000.00
280 M REZA 35,000.00 17,500.00 17,500.00 35,000.00
281 SALWA 30,000.00 15,000.00 15,000.00 30,000.00
282 SUSYANI 30,000.00 15,000.00 15,000.00 30,000.00
283 EVY 70,000.00 35,000.00 35,000.00 70,000.00
284 PRATAMA 30,000.00 15,000.00 15,000.00 30,000.00
285 ESIH 30,000.00 15,000.00 15,000.00 30,000.00
286 PUTRI 25,000.00 12,500.00 12,500.00 25,000.00
287 IYAM 30,000.00 15,000.00 15,000.00 30,000.00
288 MONITA 70,000.00 35,000.00 35,000.00 70,000.00
289 IKHWAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
290 METTA 70,000.00 35,000.00 35,000.00 70,000.00
291 PAIJAN 70,000.00 35,000.00 35,000.00 70,000.00
292 NURUL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
293 DIKHA 30,000.00 15,000.00 15,000.00 30,000.00
294 FELYAN 30,000.00 15,000.00 15,000.00 30,000.00
295 UCU 70,000.00 35,000.00 35,000.00 70,000.00
296 RADITYA 30,000.00 15,000.00 15,000.00 30,000.00
297 MUSHA 70,000.00 35,000.00 35,000.00 70,000.00
298 CAHYA 70,000.00 35,000.00 35,000.00 70,000.00
299 YENNI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
300 18/3/16 SITI MARIAH 30,000.00 15,000.00 15,000.00 30,000.00
301 DAFINAH 25,000.00 12,500.00 12,500.00 25,000.00
302 IDAH 60,000.00 30,000.00 30,000.00 45,000.00
303 AISYA 40,000.00 20,000.00 20,000.00 40,000.00
304 RINDRIYANTI 70,000.00 35,000.00 35,000.00 70,000.00
305 FANYSYA 30,000.00 15,000.00 15,000.00 30,000.00
306 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
307 LIES 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
308 FRANCISCUS 70,000.00 35,000.00 35,000.00 70,000.00
309 EVY 30,000.00 15,000.00 15,000.00 30,000.00
310 FENY 30,000.00 15,000.00 15,000.00 30,000.00
311 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
312 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
313 SHOBRINA 25,000.00 12,500.00 12,500.00 25,000.00
314 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
315 MASHA 25,000.00 12,500.00 12,500.00 25,000.00
316 ANGGUN 40,000.00 20,000.00 20,000.00 40,000.00
317 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
318 AHMAD 70,000.00 35,000.00 35,000.00 70,000.00
319 DERI 70,000.00 35,000.00 35,000.00 70,000.00
320 BUNGA 70,000.00 35,000.00 35,000.00 70,000.00
321 M RIZKI 70,000.00 35,000.00 35,000.00 70,000.00
322 DAFFA 30,000.00 15,000.00 15,000.00 30,000.00
323 MULYATI 70,000.00 35,000.00 35,000.00 70,000.00
324 19/3/16 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
325 RANU 70,000.00 35,000.00 35,000.00 70,000.00
326 ISNUR 30,000.00 15,000.00 15,000.00 30,000.00
327 DEFIE 70,000.00 35,000.00 35,000.00 70,000.00
328 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
329 SYAMIL 70,000.00 35,000.00 35,000.00 70,000.00
330 CELIA 35,000.00 17,500.00 17,500.00 35,000.00
331 CAMILA 35,000.00 17,500.00 17,500.00 35,000.00
332 RAFLI 25,000.00 12,500.00 12,500.00 25,000.00
333 NANAN 70,000.00 35,000.00 35,000.00 70,000.00
334 ROSINTA 70,000.00 35,000.00 35,000.00 70,000.00
335 SAEFUDIN 30,000.00 15,000.00 15,000.00 30,000.00
336 HELPI 30,000.00 15,000.00 15,000.00 30,000.00
337 NILLENIA 70,000.00 35,000.00 35,000.00 70,000.00
338 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
339 BERNANDO 70,000.00 35,000.00 35,000.00 70,000.00
340 EMA 30,000.00 15,000.00 15,000.00 30,000.00
341 TUTY 70,000.00 35,000.00 35,000.00 70,000.00
342 DADAN 30,000.00 15,000.00 15,000.00 30,000.00
343 SASKIA 70,000.00 35,000.00 35,000.00 70,000.00
344 OVTINA 70,000.00 35,000.00 35,000.00 70,000.00
345 NIZZAR 30,000.00 15,000.00 15,000.00 30,000.00
346 IDA 60,000.00 30,000.00 30,000.00 60,000.00
347 HENDRY 30,000.00 15,000.00 15,000.00 30,000.00
348 21/3/16 SELDINI 40,000.00 20,000.00 20,000.00 40,000.00
349 ARNI 30,000.00 15,000.00 15,000.00 30,000.00
350 JOHANES 40,000.00 20,000.00 20,000.00 40,000.00
351 SUHARTINI 70,000.00 35,000.00 35,000.00 70,000.00
352 M IRFAN 70,000.00 35,000.00 35,000.00 70,000.00
353 NISRINA 70,000.00 35,000.00 35,000.00 70,000.00
354 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
355 RENI 70,000.00 35,000.00 35,000.00 70,000.00
356 SITI H 30,000.00 15,000.00 15,000.00 30,000.00
357 DENI A 30,000.00 15,000.00 15,000.00 30,000.00
358 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
359 FIKRI 70,000.00 35,000.00 35,000.00 70,000.00
360 ALMIRA 70,000.00 35,000.00 35,000.00 70,000.00
361 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
362 MUKTI 30,000.00 15,000.00 15,000.00 30,000.00
363 RIZKI 30,000.00 15,000.00 15,000.00 30,000.00
364 22/3/16 NURAHMA 70,000.00 35,000.00 35,000.00 70,000.00
365 SUSANTI 70,000.00 35,000.00 35,000.00 70,000.00
366 RESYA 30,000.00 15,000.00 15,000.00 30,000.00
367 M ANGGAR 70,000.00 35,000.00 35,000.00 70,000.00
368 YAYAH 70,000.00 35,000.00 35,000.00 70,000.00
369 NENAH 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
370 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
371 RINI 70,000.00 35,000.00 35,000.00 70,000.00
372 SUMIATI 30,000.00 15,000.00 15,000.00 30,000.00
373 NURHAYATI 70,000.00 35,000.00 35,000.00 70,000.00
374 SINTA 40,000.00 20,000.00 20,000.00 40,000.00
375 RISKI 70,000.00 35,000.00 35,000.00 70,000.00
376 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
377 GHINA 15,000.00 7,500.00 7,500.00 15,000.00
378 ALMIRA 35,000.00 17,500.00 17,500.00 35,000.00
379 ANGGI 30,000.00 15,000.00 15,000.00 30,000.00
380 DEVITRI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
381 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
382 WISNU 30,000.00 15,000.00 15,000.00 30,000.00
383 DENI A 70,000.00 35,000.00 35,000.00 70,000.00
384 FEBIAN 35,000.00 17,500.00 17,500.00 35,000.00
385 23/3/16 SUPRIATNA 15,000.00 7,500.00 7,500.00 15,000.00
386 ERPI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
387 QUINSHA 15,000.00 7,500.00 7,500.00 15,000.00
388 MARRIZA 25,000.00 12,500.00 12,500.00 25,000.00
389 RIANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
390 LINAWATI 35,000.00 17,500.00 17,500.00 35,000.00
391 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
392 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
393 LILIS 70,000.00 35,000.00 35,000.00 70,000.00
394 RIKA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
395 SRI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
396 YOKE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
397 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
398 EMMELIA 70,000.00 35,000.00 35,000.00 70,000.00
399 SARMINI 30,000.00 15,000.00 15,000.00 30,000.00
400 YANTO 70,000.00 35,000.00 35,000.00 70,000.00
401 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
402 MELINDA 70,000.00 35,000.00 35,000.00 70,000.00
403 DIMAS 30,000.00 15,000.00 15,000.00 30,000.00
404 24/3/16 SUSYANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
405 SALWA 30,000.00 15,000.00 15,000.00 30,000.00
406 EVI 30,000.00 15,000.00 15,000.00 30,000.00
407 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
408 ALFA 30,000.00 15,000.00 15,000.00 30,000.00
409 DAFIAN 70,000.00 35,000.00 35,000.00 70,000.00
410 AFTHIA 70,000.00 35,000.00 35,000.00 70,000.00
411 FANYSYA 30,000.00 15,000.00 15,000.00 30,000.00
412 ADI 30,000.00 15,000.00 15,000.00 30,000.00
413 CHANDRA 30,000.00 15,000.00 15,000.00 30,000.00
414 NONI 15,000.00 7,500.00 7,500.00 15,000.00
415 INDAH 60,000.00 30,000.00 30,000.00 60,000.00
416 LIES 70,000.00 35,000.00 35,000.00 70,000.00
417 RATNA 60,000.00 30,000.00 30,000.00 60,000.00
418 HENDRA 30,000.00 15,000.00 15,000.00 30,000.00
419 METTA 70,000.00 35,000.00 35,000.00 70,000.00
420 KARINA 30,000.00 15,000.00 15,000.00 30,000.00
421 IIM 40,000.00 20,000.00 20,000.00 40,000.00
422 AISHA 30,000.00 15,000.00 15,000.00 30,000.00
423 IRMA 30,000.00 15,000.00 15,000.00 30,000.00
424 FELYAN 30,000.00 15,000.00 15,000.00 30,000.00
425 ETI 30,000.00 15,000.00 15,000.00 30,000.00
426 SHAKILA 25,000.00 12,500.00 12,500.00 25,000.00
427 TUTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
428 26/3/16 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
429 RAFLI 35,000.00 17,500.00 17,500.00 35,000.00
430 NINA 60,000.00 30,000.00 30,000.00 60,000.00
431 NIKEN 70,000.00 35,000.00 35,000.00 70,000.00
432 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
433 REISYA 25,000.00 12,500.00 12,500.00 25,000.00
434 RANU AZKA 70,000.00 35,000.00 35,000.00 70,000.00
435 RANU A D 70,000.00 35,000.00 35,000.00 70,000.00
436 RANU P 70,000.00 35,000.00 35,000.00 70,000.00
437 DEFIE 70,000.00 35,000.00 35,000.00 70,000.00
438 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
439 WIDANINGSIH 70,000.00 35,000.00 35,000.00 70,000.00
440 HEPPI 70,000.00 35,000.00 35,000.00 70,000.00
441 SITI 30,000.00 15,000.00 15,000.00 30,000.00
442 HERMANSYAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
443 BERNANDO 70,000.00 35,000.00 35,000.00 70,000.00
444 MULYANI 15,000.00 7,500.00 7,500.00 15,000.00
445 HENDRY 70,000.00 35,000.00 35,000.00 70,000.00
446 SAEPUDIN 30,000.00 15,000.00 15,000.00 30,000.00
447 28/3/16 IRMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
448 TRI YULI 70,000.00 35,000.00 35,000.00 70,000.00
449 CANDRA 70,000.00 35,000.00 35,000.00 70,000.00
450 AFIKA 70,000.00 35,000.00 35,000.00 70,000.00
451 SUHARTI 70,000.00 35,000.00 35,000.00 70,000.00
452 IRFAN 70,000.00 35,000.00 35,000.00 70,000.00
453 DHIA 35,000.00 17,500.00 17,500.00 35,000.00
454 SITI N 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
455 SELDINI 70,000.00 35,000.00 35,000.00 70,000.00
456 JOHANES 70,000.00 35,000.00 35,000.00 70,000.00
457 DINI A 25,000.00 12,500.00 12,500.00 25,000.00
458 RESYA 70,000.00 35,000.00 35,000.00 70,000.00
459 RADITHYA 40,000.00 20,000.00 20,000.00 40,000.00
460 SUWANTO 70,000.00 35,000.00 35,000.00 70,000.00
461 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
462 IWAN 70,000.00 35,000.00 35,000.00 70,000.00
463 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
464 MIFHTAH 30,000.00 15,000.00 15,000.00 30,000.00
465 29/3/16 M IRFAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
466 SUMIATY 30,000.00 15,000.00 15,000.00 30,000.00
467 HUMAM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
468 SHOFI 70,000.00 35,000.00 35,000.00 70,000.00
469 BISMA 70,000.00 35,000.00 35,000.00 70,000.00
470 M ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
471 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
472 RESYA 30,000.00 15,000.00 15,000.00 30,000.00
473 NENAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
474 SINTA 70,000.00 35,000.00 35,000.00 70,000.00
475 YAYAH 30,000.00 15,000.00 15,000.00 30,000.00
476 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
477 DIDIK 40,000.00 20,000.00 20,000.00 40,000.00
478 YAYAT 30,000.00 15,000.00 15,000.00 30,000.00
479 RACHEL 30,000.00 15,000.00 15,000.00 30,000.00
480 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
481 WISNU 40,000.00 20,000.00 20,000.00 40,000.00
482 DEWITRI 70,000.00 35,000.00 35,000.00 70,000.00
483 ARNI 30,000.00 15,000.00 15,000.00 30,000.00
484 AGUS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
485 SUPRIYADI 70,000.00 35,000.00 35,000.00 70,000.00
486 30/3/16 MARITZA 25,000.00 12,500.00 12,500.00 25,000.00
487 ARI 30,000.00 15,000.00 15,000.00 30,000.00
488 TURNI 70,000.00 35,000.00 35,000.00 70,000.00
489 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
490 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
491 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
492 LINA 30,000.00 15,000.00 15,000.00 30,000.00
493 ENCUM 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
494 SITA TITA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
495 LINTONG 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
496 IMAS 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
497 EMELIA 70,000.00 35,000.00 35,000.00 70,000.00
498 RACHMAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
499 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
500 UUM 70,000.00 35,000.00 35,000.00 70,000.00
501 RIFAN 70,000.00 35,000.00 35,000.00 70,000.00
502 WIDYA 15,000.00 7,500.00 7,500.00 15,000.00
503 MIRSA 30,000.00 15,000.00 15,000.00 30,000.00
504 YUSUP 60,000.00 30,000.00 30,000.00 60,000.00
505 MELINDA 35,000.00 17,500.00 17,500.00 35,000.00
506 FEBY 30,000.00 15,000.00 15,000.00 30,000.00
507 M RIDWAN 70,000.00 35,000.00 35,000.00 70,000.00
508 DIMAS 70,000.00 35,000.00 35,000.00 70,000.00
509 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
510 31/3/16 SALWA 30,000.00 15,000.00 15,000.00 30,000.00
511 TURLAN 15,000.00 7,500.00 7,500.00 15,000.00
512 CANDRA 70,000.00 35,000.00 35,000.00 70,000.00
513 METI 70,000.00 35,000.00 35,000.00 70,000.00
514 CLARISA 25,000.00 12,500.00 12,500.00 25,000.00
515 RANI 60,000.00 30,000.00 30,000.00 60,000.00
516 POPON 30,000.00 15,000.00 15,000.00 30,000.00
517 NUNUNG 15,000.00 7,500.00 7,500.00 15,000.00
518 SRI L 30,000.00 15,000.00 15,000.00 30,000.00
519 SUSYANI 70,000.00 35,000.00 35,000.00 70,000.00
520 SRI 70,000.00 35,000.00 35,000.00 70,000.00
521 EVI 70,000.00 35,000.00 35,000.00 70,000.00
522 AMIN 30,000.00 15,000.00 15,000.00 30,000.00
523 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
524 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
525 ALISA 15,000.00 7,500.00 7,500.00 15,000.00
526 ANISA 25,000.00 12,500.00 12,500.00 25,000.00
527 FELYAN 70,000.00 35,000.00 35,000.00 70,000.00
528 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
529 SHAKILA 30,000.00 15,000.00 15,000.00 30,000.00
530 ETI 70,000.00 35,000.00 35,000.00 70,000.00
24,060,000 680,000 12,030,000 12,030,000 24,775,000 -
PERIODE APRIL 2016
JASA ALAT &

DOKTER BAHAN
1 1/4/2016 LIES 100,000 5,000 47,500 47,500 105,000
2 4/4/2016 SANDI 48,000 5,000 21,500 21,500 53,000
3 5/6/2016 MAYA 170,000 5,000 82,500 82,500 175,000
4 7/4/2016 AZALIA 80,000 5,000 37,500 37,500 85,000
5 8/4/2016 YADI 100,000 5,000 47,500 47,500 105,000
6 10/4/2016 ANGGUN 50,000 5,000 22,500 22,500 55,000
7 NITA 50,000 5,000 22,500 22,500 55,000
8 RIZAL 50,000 5,000 22,500 22,500 55,000
9 SITI N 80,000 5,000 37,500 37,500 85,000
10 ANGGUN 50,000 5,000 22,500 22,500 55,000
11 11/4/2016 ERLI 20,000 5,000 7,500 7,500 25,000
12 NENI 200,000 5,000 97,500 97,500 205,000
13 13/4/16 ROSINTA 100,000 5,000 47,500 47,500 105,000
14 14/4/16 MEGA 300,000 5,000 147,500 147,500 305,000
15 VADYA 160,000 5,000 77,500 77,500 165,000
16 IRWAN 20,000 5,000 7,500 7,500 25,000
17 15/4/16 PANDU 160,000 5,000 77,500 77,500 165,000
18 16/4/16 KARTIKA 100,000 5,000 47,500 47,500 105,000
19 19/4/16 HASAN 150,000 5,000 72,500 72,500 155,000
20 21/4/16 RAMOZ 20,000 5,000 7,500 7,500 25,000
21 22/4/16 LANI 200,000 5,000 97,500 97,500 205,000
22 27/4/16 DESI 300,000 5,000 147,500 147,500 305,000
23 VERA 100,000 5,000 47,500 47,500 105,000
24 28/4/16 MISBAH 300,000 5,000 147,500 147,500 305,000
25 29/4/16 ELIS 200,000 5,000 97,500 97,500 205,000
26 30/4/16 MISBAH 50,000 5,000 22,500 22,500 55,000
27 ANDI 70,000 5,000 32,500 32,500 75,000
28 FAIZA 50,000 5,000 22,500 22,500 55,000
TOTAL 3,278,000 140,000 1,569,000 1,569,000 3,418,000

PERIODE APRIL 2016
JASA ALAT &

DOKTER BAHAN
1 1/4/2016 HERU 70,000.00 35,000.00 35,000.00 70,000.00
2 SUWITO 70,000.00 35,000.00 35,000.00 70,000.00
3 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
4 SUJARWO 15,000.00 7,500.00 7,500.00 15,000.00
5 LIES 70,000.00 35,000.00 35,000.00 70,000.00
6 SRI 30,000.00 15,000.00 15,000.00 30,000.00
7 WIWI 30,000.00 15,000.00 15,000.00 30,000.00
8 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
9 KIKI 70,000.00 35,000.00 35,000.00 70,000.00
10 NAZLA 30,000.00 15,000.00 15,000.00 30,000.00
11 ROSA 70,000.00 35,000.00 35,000.00 70,000.00
12 DWI 15,000.00 7,500.00 7,500.00 15,000.00
13 FANYSYA 70,000.00 35,000.00 35,000.00 70,000.00
14 1/4/2016 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
15 BUNGA 70,000.00 35,000.00 35,000.00 70,000.00
16 PRATAMA 30,000.00 15,000.00 15,000.00 30,000.00
17 IIM 70,000.00 35,000.00 35,000.00 70,000.00
18 KARINA 30,000.00 15,000.00 15,000.00 30,000.00
19 SAEFUL 70,000.00 35,000.00 35,000.00 70,000.00
20 SALAM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
21 FATHIA 40,000.00 20,000.00 20,000.00 40,000.00
22 METTA 70,000.00 35,000.00 35,000.00 70,000.00
23 MAHESA 70,000.00 35,000.00 35,000.00 70,000.00
24 RAFIF 70,000.00 35,000.00 35,000.00 70,000.00
25 DENI 70,000.00 35,000.00 35,000.00 70,000.00
26 DAFFA 30,000.00 15,000.00 15,000.00 30,000.00
27 NULYATI 30,000.00 15,000.00 15,000.00 30,000.00
28 2/4/2016 SITI 30,000.00 15,000.00 15,000.00 30,000.00
29 PUTRI 35,000.00 17,500.00 17,500.00 35,000.00
30 YULI 70,000.00 35,000.00 35,000.00 70,000.00
31 SRI 70,000.00 35,000.00 35,000.00 70,000.00
32 ZAIDAN 70,000.00 35,000.00 35,000.00 70,000.00
33 HENDRA 70,000.00 35,000.00 35,000.00 70,000.00
34 TIKA 30,000.00 15,000.00 15,000.00 30,000.00
35 KEYLA 30,000.00 15,000.00 15,000.00 30,000.00
36 SUCI 30,000.00 15,000.00 15,000.00 30,000.00
37 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
38 NAJWA 70,000.00 35,000.00 35,000.00 70,000.00
39 AISYA 40,000.00 20,000.00 20,000.00 40,000.00
40 AJENG 30,000.00 15,000.00 15,000.00 30,000.00
41 RAFLI 30,000.00 15,000.00 15,000.00 30,000.00
42 NINA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
43 ROLINE 70,000.00 35,000.00 35,000.00 70,000.00
44 4/4/2016 LINTANG 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
45 NIKEN 30,000.00 15,000.00 15,000.00 30,000.00
46 U DJUNAEDI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
47 NINA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
48 HENI 70,000.00 35,000.00 35,000.00 70,000.00
49 ATTHALLAH 30,000.00 15,000.00 15,000.00 30,000.00
50 NURZANAH 30,000.00 15,000.00 15,000.00 30,000.00
51 RINJANI 30,000.00 15,000.00 15,000.00 30,000.00
52 ROHMAN 70,000.00 35,000.00 35,000.00 70,000.00
53 4/4/2016 MULYANI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
54 SISKA 70,000.00 35,000.00 35,000.00 70,000.00
55 WAWAN 70,000.00 35,000.00 35,000.00 70,000.00
56 AL FAZRI 70,000.00 35,000.00 35,000.00 70,000.00
57 LIONI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
58 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
59 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
60 SUSILAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
61 IWAN 30,000.00 15,000.00 15,000.00 30,000.00
62 SARBINI 30,000.00 15,000.00 15,000.00 30,000.00
63 5/4/2016 SARMIN 30,000.00 15,000.00 15,000.00 30,000.00
64 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
65 MAMAD 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
66 SINTA 30,000.00 15,000.00 15,000.00 30,000.00
67 TEMAY 30,000.00 15,000.00 15,000.00 30,000.00
68 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
69 LUSI 70,000.00 35,000.00 35,000.00 70,000.00
70 SUNARNI 70,000.00 35,000.00 35,000.00 70,000.00
71 SUMIATY 30,000.00 15,000.00 15,000.00 30,000.00
72 6/4/2016 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
73 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
74 MARITZA 25,000.00 12,500.00 12,500.00 25,000.00
75 SITI MARIAM 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
76 LINA 30,000.00 15,000.00 15,000.00 30,000.00
77 ENCUM 30,000.00 15,000.00 15,000.00 30,000.00
78 VICTORIA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
79 DIMAS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
80 KAMA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
81 SUSILAWATI 40,000.00 20,000.00 20,000.00 40,000.00
82 NANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
83 LULU 70,000.00 35,000.00 35,000.00 70,000.00
84 RIZQI 70,000.00 35,000.00 35,000.00 70,000.00
85 FEBI 70,000.00 35,000.00 35,000.00 70,000.00
86 M RIDWAN 70,000.00 35,000.00 35,000.00 70,000.00
87 ZELLY 60,000.00 30,000.00 30,000.00 60,000.00
88 MIRSAD 30,000.00 15,000.00 15,000.00 30,000.00
89 NENENG TETI 60,000.00 30,000.00 30,000.00 60,000.00
90 SUMINAH 70,000.00 35,000.00 35,000.00 70,000.00
91 TANA 70,000.00 35,000.00 35,000.00 70,000.00
92 RIPAN 30,000.00 15,000.00 15,000.00 30,000.00
93 UUM UMIYATI 70,000.00 35,000.00 35,000.00 70,000.00
94 RIMA 70,000.00 35,000.00 35,000.00 70,000.00
95 AI GOJALI 35,000.00 17,500.00 17,500.00 35,000.00
96 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
97 YULI 70,000.00 35,000.00 35,000.00 70,000.00
98 7/4/2016 DERU 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
99 SITI 70,000.00 35,000.00 35,000.00 70,000.00
100 SALWA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
101 CHANDRA 70,000.00 35,000.00 35,000.00 70,000.00
102 NERMA 30,000.00 15,000.00 15,000.00 35,000.00
103 SUSYANI 40,000.00 20,000.00 20,000.00 40,000.00
104 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
105 RANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
106 SUMIATY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
107 ASEP 30,000.00 15,000.00 15,000.00 30,000.00
108 RAMDAN 30,000.00 15,000.00 15,000.00 30,000.00
109 QIZA 70,000.00 35,000.00 35,000.00 70,000.00
110 EVI 30,000.00 15,000.00 15,000.00 30,000.00
111 RADITYA 30,000.00 15,000.00 15,000.00 30,000.00
112 MARSHA 70,000.00 35,000.00 35,000.00 70,000.00
113 BELA 30,000.00 15,000.00 15,000.00 30,000.00
114 YAYAH 70,000.00 35,000.00 35,000.00 70,000.00
115 ANNISA 70,000.00 35,000.00 35,000.00 70,000.00
116 AGUS 70,000.00 35,000.00 35,000.00 70,000.00
117 ZALFAR 70,000.00 35,000.00 35,000.00 70,000.00
118 RIZKY 70,000.00 35,000.00 35,000.00 70,000.00
119 8/4/2016 RAHMAN 30,000.00 15,000.00 15,000.00 30,000.00
120 ATIQAH 30,000.00 15,000.00 15,000.00 30,000.00
121 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
122 NAZLA 70,000.00 35,000.00 35,000.00 70,000.00
123 DANNY 70,000.00 35,000.00 35,000.00 70,000.00
124 HERU 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
125 EUIS 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
126 CECEP 30,000.00 15,000.00 15,000.00 30,000.00
127 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
128 FANISYA 30,000.00 15,000.00 15,000.00 30,000.00
129 M YUNI 70,000.00 35,000.00 35,000.00 70,000.00
130 M ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
131 CAHYA 70,000.00 35,000.00 35,000.00 70,000.00
132 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
133 SHOBRINA 25,000.00 12,500.00 12,500.00 25,000.00
134 ARINI 70,000.00 35,000.00 35,000.00 70,000.00
135 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
136 ARSYA 30,000.00 15,000.00 15,000.00 30,000.00
137 FITRI 30,000.00 15,000.00 15,000.00 30,000.00
138 FANI 70,000.00 35,000.00 35,000.00 70,000.00
139 IIM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
140 DAFA 30,000.00 15,000.00 15,000.00 30,000.00
141 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
142 9/4/2016 LANI 30,000.00 15,000.00 15,000.00 30,000.00
143 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
144 AMIN A 30,000.00 15,000.00 15,000.00 30,000.00
145 HENDRA 30,000.00 15,000.00 15,000.00 30,000.00
146 GLADYS 30,000.00 15,000.00 15,000.00 30,000.00
147 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
148 WIWI 30,000.00 15,000.00 15,000.00 30,000.00
149 SAEFUDIN 70,000.00 35,000.00 35,000.00 70,000.00
150 DHIA 70,000.00 35,000.00 35,000.00 70,000.00
151 NAIFA 35,000.00 17,500.00 17,500.00 35,000.00
152 SUCI 70,000.00 35,000.00 35,000.00 70,000.00
153 YOGI 30,000.00 15,000.00 15,000.00 30,000.00
154 RASHMANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
155 LENI 15,000.00 7,500.00 7,500.00 15,000.00
156 DYAH AYU 70,000.00 35,000.00 35,000.00 70,000.00
157 WAHYU 70,000.00 35,000.00 35,000.00 70,000.00
158 EMA 30,000.00 15,000.00 15,000.00 30,000.00
159 SISKA 15,000.00 7,500.00 7,500.00 15,000.00
160 SARBINI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
161 BERNANDO 15,000.00 7,500.00 7,500.00 15,000.00
162 11/4/2016 NIKEN 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
163 HANI 70,000.00 35,000.00 35,000.00 70,000.00
164 AJENG 30,000.00 15,000.00 15,000.00 30,000.00
165 CITRA 25,000.00 12,500.00 12,500.00 25,000.00
166 IDA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
167 HENI 30,000.00 15,000.00 15,000.00 30,000.00
168 NITA 70,000.00 35,000.00 35,000.00 70,000.00
169 SUMARYATI 70,000.00 35,000.00 35,000.00 70,000.00
170 RAFI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
171 DEDE 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
172 SISKA R 30,000.00 15,000.00 15,000.00 30,000.00
173 TINI 30,000.00 15,000.00 15,000.00 30,000.00
174 FELYAN 70,000.00 35,000.00 35,000.00 70,000.00
175 SITI 70,000.00 35,000.00 35,000.00 70,000.00
176 QIZA 30,000.00 15,000.00 15,000.00 30,000.00
177 RAFIF 70,000.00 35,000.00 35,000.00 70,000.00
178 ASIKIN 70,000.00 35,000.00 35,000.00 70,000.00
179 IIM 70,000.00 35,000.00 35,000.00 70,000.00
180 PRATAMA 30,000.00 15,000.00 15,000.00 30,000.00
181 NUNU 15,000.00 7,500.00 7,500.00 15,000.00
182 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
183 DESI 70,000.00 35,000.00 35,000.00 70,000.00
184 12/4/2016 SRI 70,000.00 35,000.00 35,000.00 70,000.00
185 SITI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
186 DHIA 70,000.00 35,000.00 35,000.00 70,000.00
187 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
188 ANGGUN 40,000.00 20,000.00 20,000.00 40,000.00
189 NANDA 70,000.00 35,000.00 35,000.00 70,000.00
190 IIM 30,000.00 15,000.00 15,000.00 30,000.00
191 SISKA 70,000.00 35,000.00 35,000.00 70,000.00
192 TETI 30,000.00 15,000.00 15,000.00 30,000.00
193 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
194 DINI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
195 KIRANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
196 MALIK 70,000.00 35,000.00 35,000.00 70,000.00
197 LILIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
198 ARNI 30,000.00 15,000.00 15,000.00 30,000.00
199 APRILIA 35,000.00 17,500.00 17,500.00 35,000.00
200 AGUS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
201 YULIA R 70,000.00 35,000.00 35,000.00 70,000.00
202 13/4/16 TURNI 70,000.00 35,000.00 35,000.00 70,000.00
203 ENCUM 30,000.00 15,000.00 15,000.00 30,000.00
204 ROSINTA 70,000.00 35,000.00 35,000.00 70,000.00
205 SUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
206 IKAH 35,000.00 17,500.00 17,500.00 35,000.00
207 FRANSISCO 70,000.00 35,000.00 35,000.00 70,000.00
208 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
209 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
210 IMAS 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
211 DIMAS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
212 IRNAWATI 70,000.00 35,000.00 35,000.00 70,000.00
213 RAMDANI 70,000.00 35,000.00 35,000.00 70,000.00
214 SUSI 70,000.00 35,000.00 35,000.00 70,000.00
215 NENENG TETI 70,000.00 35,000.00 35,000.00 70,000.00
216 DANIEL 35,000.00 17,500.00 17,500.00 35,000.00
217 MALISYA 55,000.00 27,500.00 27,500.00 55,000.00
218 LANWATI 30,000.00 15,000.00 15,000.00 30,000.00
219 RIDWAN 70,000.00 35,000.00 35,000.00 70,000.00
220 FEBI 70,000.00 35,000.00 35,000.00 70,000.00
221 M RIDZKI 70,000.00 35,000.00 35,000.00 70,000.00
222 MIRSAD 70,000.00 35,000.00 35,000.00 70,000.00
223 MUFI 70,000.00 35,000.00 35,000.00 70,000.00
224 SUWANTO 60,000.00 30,000.00 30,000.00 60,000.00
225 YUSUF 60,000.00 30,000.00 30,000.00 60,000.00
226 YULIA R 60,000.00 30,000.00 30,000.00 60,000.00
227 TANIA 70,000.00 35,000.00 35,000.00 70,000.00
228 ILHAM 15,000.00 7,500.00 7,500.00 15,000.00
229 SELLY 30,000.00 15,000.00 15,000.00 30,000.00
230 14/4/16 RONI 70,000.00 35,000.00 35,000.00 70,000.00
231 DANNY 70,000.00 35,000.00 35,000.00 70,000.00
232 FENY 70,000.00 35,000.00 35,000.00 70,000.00
233 ERNAWATI 70,000.00 35,000.00 35,000.00 70,000.00
234 YEPI 70,000.00 35,000.00 35,000.00 70,000.00
235 SALWA 30,000.00 15,000.00 15,000.00 30,000.00
236 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
237 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
238 SARBINI 30,000.00 15,000.00 15,000.00 30,000.00
239 ROBBY 70,000.00 35,000.00 35,000.00 70,000.00
240 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
241 KARENDRA 70,000.00 35,000.00 35,000.00 70,000.00
242 DIAH 70,000.00 35,000.00 35,000.00 70,000.00
243 EVI M 30,000.00 15,000.00 15,000.00 30,000.00
244 RIAN 70,000.00 35,000.00 35,000.00 70,000.00
245 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
246 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
247 AISYA 30,000.00 15,000.00 15,000.00 30,000.00
248 RASHA 30,000.00 15,000.00 15,000.00 30,000.00
249 15/4/16 ALAMANDA 70,000.00 35,000.00 35,000.00 70,000.00
250 OOM 70,000.00 35,000.00 35,000.00 70,000.00
251 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
252 AMANDA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
253 LIES 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
254 FANYSYA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
255 FABIAN 25,000.00 12,500.00 12,500.00 25,000.00
256 NIKEN 70,000.00 35,000.00 35,000.00 70,000.00
257 TRIANDI 70,000.00 35,000.00 35,000.00 70,000.00
258 SEGER 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
259 ANDINI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
260 SRI S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
261 DZAKI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
262 RANGGA 30,000.00 15,000.00 15,000.00 30,000.00
263 METTA 70,000.00 35,000.00 35,000.00 70,000.00
264 MAHESA 70,000.00 35,000.00 35,000.00 70,000.00
265 RATNA 70,000.00 35,000.00 35,000.00 70,000.00
266 FITRI 70,000.00 35,000.00 35,000.00 70,000.00
267 TETRANIA 30,000.00 15,000.00 15,000.00 30,000.00
268 KEYLA 70,000.00 35,000.00 35,000.00 70,000.00
269 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
270 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
271 DAFFA 40,000.00 20,000.00 20,000.00 40,000.00
272 16/4/16 SEPTIA 70,000.00 35,000.00 35,000.00 70,000.00
273 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
274 WINI 30,000.00 15,000.00 15,000.00 30,000.00
275 HENDRA 60,000.00 30,000.00 30,000.00 60,000.00
276 SUKAESIH 60,000.00 30,000.00 30,000.00 60,000.00
277 NURLAELA 30,000.00 15,000.00 15,000.00 30,000.00
278 AMIN A 30,000.00 15,000.00 15,000.00 30,000.00
279 MAHIRA 35,000.00 17,500.00 17,500.00 35,000.00
280 MYOGI 30,000.00 15,000.00 15,000.00 30,000.00
281 SUCI 60,000.00 30,000.00 30,000.00 60,000.00
282 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
283 M ZULFAR 70,000.00 35,000.00 35,000.00 70,000.00
284 AGUS 70,000.00 35,000.00 35,000.00 70,000.00
285 DIYAH AYU 70,000.00 35,000.00 35,000.00 70,000.00
286 WAHYU 35,000.00 17,500.00 17,500.00 35,000.00
287 EMA 30,000.00 15,000.00 15,000.00 30,000.00
288 IDA 70,000.00 35,000.00 35,000.00 70,000.00
289 ARIFIN 70,000.00 35,000.00 35,000.00 70,000.00
290 DIYAN PURI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
291 KARTIKA 15,000.00 7,500.00 7,500.00 15,000.00
292 18/4/16 AGNA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
293 TIGAR 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
294 KEYLA 30,000.00 15,000.00 15,000.00 30,000.00
295 LISNA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
296 HANI 35,000.00 17,500.00 17,500.00 35,000.00
297 HENI 30,000.00 15,000.00 15,000.00 30,000.00
298 RAHMAH 25,000.00 12,500.00 12,500.00 25,000.00
299 FITRIANINGSIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
300 LIES 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
301 NOER K 70,000.00 35,000.00 35,000.00 70,000.00
302 AJENG DWI 70,000.00 35,000.00 35,000.00 45,000.00
303 NITA 70,000.00 35,000.00 35,000.00 70,000.00
304 NABILA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
305 IRKHAM 30,000.00 15,000.00 15,000.00 30,000.00
306 RIA 30,000.00 15,000.00 15,000.00 30,000.00
307 MUSTIKA 70,000.00 35,000.00 35,000.00 70,000.00
308 RADITYA 30,000.00 15,000.00 15,000.00 30,000.00
309 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
310 DIYAH AYU 30,000.00 15,000.00 15,000.00 30,000.00
311 WIDA 70,000.00 35,000.00 35,000.00 70,000.00
312 SEPTIANI 70,000.00 35,000.00 35,000.00 70,000.00
313 NUNU 30,000.00 15,000.00 15,000.00 30,000.00
314 FADLAN 30,000.00 15,000.00 15,000.00 30,000.00
315 19/4/16 ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
316 SARAMIN 30,000.00 15,000.00 15,000.00 30,000.00
317 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
318 NANI 70,000.00 35,000.00 35,000.00 70,000.00
319 TANYA 25,000.00 12,500.00 12,500.00 25,000.00
320 TEMY 30,000.00 15,000.00 15,000.00 30,000.00
321 ANGGA 70,000.00 35,000.00 35,000.00 70,000.00
322 RETNO 70,000.00 35,000.00 35,000.00 70,000.00
323 DESI 70,000.00 35,000.00 35,000.00 70,000.00
324 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
325 YUNI 30,000.00 15,000.00 15,000.00 30,000.00
326 SUSYANI 70,000.00 35,000.00 35,000.00 70,000.00
327 RIZKY 70,000.00 35,000.00 35,000.00 70,000.00
328 NAZLA 70,000.00 35,000.00 35,000.00 70,000.00
329 EMAH 70,000.00 35,000.00 35,000.00 70,000.00
330 RAFIF 70,000.00 35,000.00 35,000.00 70,000.00
331 BERNANDO 70,000.00 35,000.00 35,000.00 70,000.00
332 PRATAMA 30,000.00 15,000.00 15,000.00 30,000.00
333 M YUSUF 35,000.00 17,500.00 17,500.00 35,000.00
334 HILMI 35,000.00 17,500.00 17,500.00 35,000.00
335 20/4/16 DHIA 30,000.00 15,000.00 15,000.00 30,000.00
336 MAURINE 70,000.00 35,000.00 35,000.00 70,000.00
337 LISNAWATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
338 KIREI 70,000.00 35,000.00 35,000.00 70,000.00
339 RANO 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
340 ENCUM 70,000.00 35,000.00 35,000.00 70,000.00
341 ATHALLAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
342 DIMAS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
343 VICTORIA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
344 HERU 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
345 RIDZKY 70,000.00 35,000.00 35,000.00 70,000.00
346 NENENG TETI 70,000.00 35,000.00 35,000.00 70,000.00
347 FEBI 70,000.00 35,000.00 35,000.00 70,000.00
348 MAMAN 70,000.00 35,000.00 35,000.00 70,000.00
349 CHELSEA 70,000.00 35,000.00 35,000.00 70,000.00
350 KIRANI 30,000.00 15,000.00 15,000.00 30,000.00
351 LANIWATI 30,000.00 15,000.00 15,000.00 30,000.00
352 MALIK 70,000.00 35,000.00 35,000.00 70,000.00
353 SURATMI 70,000.00 35,000.00 35,000.00 70,000.00
354 MIRSYAD 70,000.00 35,000.00 35,000.00 70,000.00
355 SUWANTO 30,000.00 15,000.00 15,000.00 30,000.00
356 NENI 30,000.00 15,000.00 15,000.00 30,000.00
357 ARNI 30,000.00 15,000.00 15,000.00 30,000.00
358 21/4/16 YUNITO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
359 RAVEL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
360 PIPIT K 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
361 DANNY 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
362 ENENG SRI 35,000.00 17,500.00 17,500.00 35,000.00
363 ELA M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
364 FITRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
365 WITA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
366 SELWA 30,000.00 15,000.00 15,000.00 30,000.00
367 WILDAN 30,000.00 15,000.00 15,000.00 30,000.00
368 HASBI 25,000.00 12,500.00 12,500.00 25,000.00
369 QIZA 30,000.00 15,000.00 15,000.00 30,000.00
370 IKHSAN 70,000.00 35,000.00 35,000.00 70,000.00
371 NOVARKA 70,000.00 35,000.00 35,000.00 70,000.00
372 TYAS 70,000.00 35,000.00 35,000.00 70,000.00
373 NANIN 70,000.00 35,000.00 35,000.00 70,000.00
374 YAYAH 70,000.00 35,000.00 35,000.00 70,000.00
375 KEVIN 30,000.00 15,000.00 15,000.00 30,000.00
376 KARIN 30,000.00 15,000.00 15,000.00 30,000.00
377 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
378 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
379 22/4/16 LIES 70,000.00 35,000.00 35,000.00 70,000.00
380 OOM 70,000.00 35,000.00 35,000.00 70,000.00
381 NOER K 70,000.00 35,000.00 35,000.00 70,000.00
382 ASIKIN 70,000.00 35,000.00 35,000.00 70,000.00
383 ADE 70,000.00 35,000.00 35,000.00 70,000.00
384 SEGER 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
385 PUNGUT 70,000.00 35,000.00 35,000.00 70,000.00
386 BERLIANA 30,000.00 15,000.00 15,000.00 30,000.00
387 ROBBY 30,000.00 15,000.00 15,000.00 30,000.00
388 RAISYA 30,000.00 15,000.00 15,000.00 30,000.00
389 AISHA 30,000.00 15,000.00 15,000.00 30,000.00
390 MULYATI 30,000.00 15,000.00 15,000.00 30,000.00
391 DAFFA 30,000.00 15,000.00 15,000.00 30,000.00
392 RIAN 70,000.00 35,000.00 35,000.00 70,000.00
393 TATI 70,000.00 35,000.00 35,000.00 70,000.00
394 25/4/16 SANDY 70,000.00 35,000.00 35,000.00 70,000.00
395 AJENG 40,000.00 20,000.00 20,000.00 40,000.00
396 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
397 DEVIA 30,000.00 15,000.00 15,000.00 30,000.00
398 KEYLA 30,000.00 15,000.00 15,000.00 30,000.00
399 NURZANAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
400 FITRIANINGSIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
401 TATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
402 USWATI 70,000.00 35,000.00 35,000.00 70,000.00
403 HANI 70,000.00 35,000.00 35,000.00 70,000.00
404 HENI 40,000.00 20,000.00 20,000.00 40,000.00
405 RIA 30,000.00 15,000.00 15,000.00 30,000.00
406 BELLA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
407 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
408 DEDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
409 TITIN S 30,000.00 15,000.00 15,000.00 30,000.00
410 M FAKHRI 30,000.00 15,000.00 15,000.00 30,000.00
411 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
412 NUNU 15,000.00 7,500.00 7,500.00 15,000.00
413 DAFFA 30,000.00 15,000.00 15,000.00 30,000.00
414 TETRANIA 30,000.00 15,000.00 15,000.00 30,000.00
415 RYUGA 30,000.00 15,000.00 15,000.00 30,000.00
416 26/4/16 NAZLA 70,000.00 35,000.00 35,000.00 70,000.00
417 SURYANI 70,000.00 35,000.00 35,000.00 70,000.00
418 SAMINI 70,000.00 35,000.00 35,000.00 70,000.00
419 DESI 70,000.00 35,000.00 35,000.00 70,000.00
420 DELI J 70,000.00 35,000.00 35,000.00 70,000.00
421 MULYATI 70,000.00 35,000.00 35,000.00 70,000.00
422 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
423 YUNI I 30,000.00 15,000.00 15,000.00 30,000.00
424 RETNO 30,000.00 15,000.00 15,000.00 30,000.00
425 YAYAH 70,000.00 35,000.00 35,000.00 70,000.00
426 MAYENDRA 70,000.00 35,000.00 35,000.00 70,000.00
427 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
428 PRATAMA 30,000.00 15,000.00 15,000.00 30,000.00
429 PUTRI 35,000.00 17,500.00 17,500.00 35,000.00
430 RINJANI 30,000.00 15,000.00 15,000.00 30,000.00
431 NABILA 35,000.00 17,500.00 17,500.00 35,000.00
432 RAFIF 35,000.00 17,500.00 17,500.00 35,000.00
433 YUDA 35,000.00 17,500.00 17,500.00 35,000.00
434 AGUS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
435 27/4/16 VERA 15,000.00 7,500.00 7,500.00 15,000.00
436 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
437 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
438 ALEX 15,000.00 7,500.00 7,500.00 15,000.00
439 MISDWI 35,000.00 17,500.00 17,500.00 35,000.00
440 SRI K 70,000.00 35,000.00 35,000.00 70,000.00
441 SETIANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
442 TSANIA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
443 M ATTALLAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
444 KOMARNA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
445 M DIMAS 70,000.00 35,000.00 35,000.00 70,000.00
446 DHIA 35,000.00 17,500.00 17,500.00 35,000.00
447 INZAGHI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
448 CHELSEA 70,000.00 35,000.00 35,000.00 70,000.00
449 FEBY 70,000.00 35,000.00 35,000.00 70,000.00
450 SITI 60,000.00 30,000.00 30,000.00 60,000.00
451 LANI 70,000.00 35,000.00 35,000.00 70,000.00
452 ALDO 70,000.00 35,000.00 35,000.00 70,000.00
453 SITI 30,000.00 15,000.00 15,000.00 30,000.00
454 ALIF 70,000.00 35,000.00 35,000.00 70,000.00
455 NURFADHILA 30,000.00 15,000.00 15,000.00 30,000.00
456 RENI 30,000.00 15,000.00 15,000.00 30,000.00
457 KIRANI 35,000.00 17,500.00 17,500.00 35,000.00
458 SELLY 35,000.00 17,500.00 17,500.00 35,000.00
459 MIRSAD 70,000.00 35,000.00 35,000.00 70,000.00
460 28/4/16 ELLY 70,000.00 35,000.00 35,000.00 70,000.00
461 ANNA 60,000.00 30,000.00 30,000.00 60,000.00
462 SALWA 70,000.00 35,000.00 35,000.00 70,000.00
463 RIDHI 70,000.00 35,000.00 35,000.00 70,000.00
464 SUTARDI 70,000.00 35,000.00 35,000.00 70,000.00
465 ELISABETH 30,000.00 15,000.00 15,000.00 30,000.00
466 ELA 30,000.00 15,000.00 15,000.00 30,000.00
467 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
468 WITA 60,000.00 30,000.00 30,000.00 60,000.00
469 WILDAN 30,000.00 15,000.00 15,000.00 30,000.00
470 IDAH 60,000.00 30,000.00 30,000.00 60,000.00
471 RAISYA 25,000.00 12,500.00 12,500.00 25,000.00
472 SYIFA 70,000.00 35,000.00 35,000.00 70,000.00
473 DIDIK 70,000.00 35,000.00 35,000.00 70,000.00
474 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
475 MUSTIKA 70,000.00 35,000.00 35,000.00 70,000.00
476 RADITYA 70,000.00 35,000.00 35,000.00 70,000.00
477 SITI MAEMUNAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
478 AMIR 35,000.00 17,500.00 17,500.00 35,000.00
479 RACHEL 35,000.00 17,500.00 17,500.00 35,000.00
480 EDWARD 70,000.00 35,000.00 35,000.00 70,000.00
481 M FEBRIANA 25,000.00 12,500.00 12,500.00 25,000.00
482 M BAHRUN 30,000.00 15,000.00 15,000.00 30,000.00
483 HILMI 35,000.00 17,500.00 17,500.00 35,000.00
484 29/4/16 AYI 70,000.00 35,000.00 35,000.00 70,000.00
485 USI 15,000.00 7,500.00 7,500.00 15,000.00
486 LIES 70,000.00 35,000.00 35,000.00 70,000.00
487 CUCU 15,000.00 7,500.00 7,500.00 15,000.00
488 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
489 FANYSYA 40,000.00 20,000.00 20,000.00 40,000.00
490 PUNGUT 70,000.00 35,000.00 35,000.00 70,000.00
491 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
492 KANTI 30,000.00 15,000.00 15,000.00 30,000.00
493 VERRA 70,000.00 35,000.00 35,000.00 70,000.00
494 ALFI 15,000.00 7,500.00 7,500.00 15,000.00
495 NURZANAH 30,000.00 15,000.00 15,000.00 30,000.00
496 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
497 YAYAN 30,000.00 15,000.00 15,000.00 30,000.00
498 ROBBY 30,000.00 15,000.00 15,000.00 30,000.00
499 TUTI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
500 M ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
501 FATHIA 70,000.00 35,000.00 35,000.00 70,000.00
502 EUIS ULAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
503 NENI 70,000.00 35,000.00 35,000.00 70,000.00
504 RENI 60,000.00 30,000.00 30,000.00 60,000.00
505 30/4/16 TIGOR 30,000.00 15,000.00 15,000.00 30,000.00
506 HENDRA 70,000.00 35,000.00 35,000.00 70,000.00
507 ALIKA 70,000.00 35,000.00 35,000.00 70,000.00
508 ARIFIN 70,000.00 35,000.00 35,000.00 70,000.00
509 CUCU 30,000.00 15,000.00 15,000.00 30,000.00
510 FEBBY 70,000.00 35,000.00 35,000.00 70,000.00
511 NILENNIA 70,000.00 35,000.00 35,000.00 70,000.00
512 AMIN A 70,000.00 35,000.00 35,000.00 70,000.00
513 RIZKIA 30,000.00 15,000.00 15,000.00 30,000.00
514 TUTY 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
515 M YUSUF 15,000.00 7,500.00 7,500.00 15,000.00
516 ACEP 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
517 MAHARANI 15,000.00 7,500.00 7,500.00 15,000.00
518 AGUS I 70,000.00 35,000.00 35,000.00 70,000.00
519 NENI 70,000.00 35,000.00 35,000.00 70,000.00
520 M ZUFAR 70,000.00 35,000.00 35,000.00 70,000.00
521 EMA 70,000.00 35,000.00 35,000.00 70,000.00
25,175,000 770,000 12,587,500 12,587,500 25,925,000 -
PERIODE MEI 2016
JASA ALAT &

DOKTER BAHAN
1 4/5/2016 AYU 70,000 5,000 32,500 32,500 75,000
2 YENI 150,000 5,000 72,500 72,500 155,000
3 7/5/2016 KIKI 100,000 5,000 47,500 47,500 105,000
4 YEYEN 200,000 5,000 97,500 97,500 205,000
5 9/5/2016 AYU 50,000 5,000 22,500 22,500 55,000
6 YANUAR 70,000 5,000 32,500 32,500 75,000
7 11/5/2016 EULIS 300,000 5,000 147,500 147,500 305,000
7 ANGGA 95,000 5,000 45,000 45,000 100,000
8 12/5/2016 ANGGUN 100,000 5,000 47,500 47,500 105,000
9 14/5/16 NILLENIA 150,000 5,000 72,500 72,500 155,000
10 SRI SURYANTI 150,000 5,000 72,500 72,500 155,000
11 ZAHRA 70,000 5,000 32,500 32,500 75,000
12 16/5/16 AYU 50,000 5,000 22,500 22,500 55,000
13 18/5/16 YANTI 70,000 5,000 32,500 32,500 75,000
14 19/5/16 ELSA 65,000 5,000 30,000 30,000 70,000
15 23/5/16 LISDA 70,000 5,000 32,500 32,500 75,000
16 NIKO 100,000 5,000 47,500 47,500 105,000
17 24/5/16 IDA 400,000 5,000 197,500 197,500 405,000
18 26/5/16 YUNI 200,000 5,000 97,500 97,500 205,000
19 SARLI 100,000 5,000 47,500 47,500 105,000
20 27/5/16 SITI SOIMAH 150,000 5,000 72,500 72,500 155,000
21 RISNALIA 150,000 5,000 72,500 72,500 155,000
22 28/5/16 TRI P 25,000 5,000 10,000 10,000 30,000
23 30/5/16 HAMIDAH 70,000 5,000 32,500 32,500 75,000
24 ALFIAN 20,000 5,000 7,500 7,500 25,000
25 ADINDA 60,000 5,000 27,500 27,500 65,000
TOTAL 3,035,000 130,000 1,452,500 1,452,500 3,165,000

PERIODE MEI 2016
JASA ALAT &

DOKTER BAHAN
1 2/5/2016 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
2 HANI 70,000.00 35,000.00 35,000.00 70,000.00
3 YUNI I 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
4 INTAN NUR 15,000.00 7,500.00 7,500.00 15,000.00
5 KEYLA 70,000.00 35,000.00 35,000.00 70,000.00
6 EUIS ULAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
7 ZHAFIRA 25,000.00 12,500.00 12,500.00 25,000.00
8 AJID 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
9 IWAN K 30,000.00 15,000.00 15,000.00 30,000.00
10 M ATTALAH 30,000.00 15,000.00 15,000.00 30,000.00
11 HENI 70,000.00 35,000.00 35,000.00 70,000.00
12 IKHSAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
13 ARIFIN A 70,000.00 35,000.00 35,000.00 70,000.00
14 ROHMAN 70,000.00 35,000.00 35,000.00 70,000.00
15 RAMDAN 35,000.00 17,500.00 17,500.00 35,000.00
16 NASHITA 30,000.00 15,000.00 15,000.00 30,000.00
17 NOVI 15,000.00 7,500.00 7,500.00 15,000.00
18 AZHAR 70,000.00 35,000.00 35,000.00 70,000.00
19 YAYAN 30,000.00 15,000.00 15,000.00 30,000.00
20 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
21 M FAKHRY 30,000.00 15,000.00 15,000.00 30,000.00
22 AFIANI 70,000.00 35,000.00 35,000.00 70,000.00
23 MULYATI 70,000.00 35,000.00 35,000.00 70,000.00
24 DAFA WIBI 40,000.00 20,000.00 20,000.00 40,000.00
25 3/5/2016 SARMINI 30,000.00 15,000.00 15,000.00 30,000.00
26 TEMMY 30,000.00 15,000.00 15,000.00 30,000.00
27 PUNGKY 15,000.00 7,500.00 7,500.00 15,000.00
28 RETNO 30,000.00 15,000.00 15,000.00 30,000.00
29 TATA 30,000.00 15,000.00 15,000.00 30,000.00
30 SRI 70,000.00 35,000.00 35,000.00 70,000.00
31 KIKI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
32 PRATAMA 70,000.00 35,000.00 35,000.00 70,000.00
33 WISNU 30,000.00 15,000.00 15,000.00 30,000.00
34 DEWI 30,000.00 15,000.00 15,000.00 30,000.00
35 SITI ALFIAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
36 ANGGI 30,000.00 15,000.00 15,000.00 30,000.00
37 MATAHARI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
38 ARKA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
39 RAISHA 30,000.00 15,000.00 15,000.00 30,000.00
40 YULIA R 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
41 4/5/2016 YUSUF 70,000.00 35,000.00 35,000.00 70,000.00
42 DELI 70,000.00 35,000.00 35,000.00 70,000.00
43 MISDURI 70,000.00 35,000.00 35,000.00 70,000.00
44 SRI Y 30,000.00 15,000.00 15,000.00 30,000.00
45 SETIANINGSIH 15,000.00 7,500.00 7,500.00 15,000.00
46 PEPEN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
47 TINA AGUSTINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
48 M FADHILAH 15,000.00 7,500.00 7,500.00 15,000.00
49 KOMARNA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
50 RIA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
51 ENENG S 70,000.00 35,000.00 35,000.00 70,000.00
52 M DIMAS 30,000.00 15,000.00 15,000.00 30,000.00
53 TATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
54 TITIN 30,000.00 15,000.00 15,000.00 30,000.00
55 INTAN NUR 70,000.00 35,000.00 35,000.00 70,000.00
56 SILA 60,000.00 30,000.00 30,000.00 60,000.00
57 RAFIF 75,000.00 37,500.00 37,500.00 75,000.00
58 CHELSEA 70,000.00 35,000.00 35,000.00 70,000.00
59 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
60 FIKI 30,000.00 15,000.00 15,000.00 30,000.00
61 LANI 30,000.00 15,000.00 15,000.00 30,000.00
62 HARYONO 70,000.00 35,000.00 35,000.00 70,000.00
63 IDA J 30,000.00 15,000.00 15,000.00 30,000.00
64 LINTANG 30,000.00 15,000.00 15,000.00 30,000.00
65 KASMINI 30,000.00 15,000.00 15,000.00 30,000.00
66 7/5/2016 NAZLA 35,000.00 17,500.00 17,500.00 35,000.00
67 TIGOR 40,000.00 20,000.00 20,000.00 40,000.00
68 AURORA 25,000.00 12,500.00 12,500.00 25,000.00
69 ALIKA 70,000.00 35,000.00 35,000.00 70,000.00
70 RATNASARI 70,000.00 35,000.00 35,000.00 70,000.00
71 YOGI 30,000.00 15,000.00 15,000.00 30,000.00
72 SURYATI 30,000.00 15,000.00 15,000.00 30,000.00
73 SRI SURYANTI 30,000.00 15,000.00 15,000.00 30,000.00
74 AL DAFFA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
75 KANTI 30,000.00 15,000.00 15,000.00 30,000.00
76 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
77 9/5/2016 SUJARMO 60,000.00 30,000.00 30,000.00 60,000.00
78 HENDRO 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
79 NURZANAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
80 ENTANG 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
81 YUNI I 40,000.00 20,000.00 20,000.00 40,000.00
82 EPPY HARIS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
83 RIA F 30,000.00 15,000.00 15,000.00 30,000.00
84 MIRA 30,000.00 15,000.00 15,000.00 30,000.00
85 RATNAWIYAH 15,000.00 7,500.00 7,500.00 15,000.00
86 KEYLA 30,000.00 15,000.00 15,000.00 30,000.00
87 M RAMDAN 25,000.00 12,500.00 12,500.00 25,000.00
88 ALIYA 70,000.00 35,000.00 35,000.00 70,000.00
89 NAYLA 70,000.00 35,000.00 35,000.00 70,000.00
90 SHYNTYA 25,000.00 12,500.00 12,500.00 25,000.00
91 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
92 KAVENDRA 30,000.00 15,000.00 15,000.00 30,000.00
93 JEJEN 30,000.00 15,000.00 15,000.00 30,000.00
94 ATIQAH 30,000.00 15,000.00 15,000.00 30,000.00
95 ESTI 40,000.00 20,000.00 20,000.00 40,000.00
96 M ATTALAH 30,000.00 15,000.00 15,000.00 30,000.00
97 10/5/2016 SUSIANI 70,000.00 35,000.00 35,000.00 70,000.00
98 HUGA 35,000.00 17,500.00 17,500.00 35,000.00
99 IDA J 70,000.00 35,000.00 35,000.00 70,000.00
100 IMAS 70,000.00 35,000.00 35,000.00 70,000.00
101 M TEMMY 70,000.00 35,000.00 35,000.00 70,000.00
102 M ANGGAR 70,000.00 35,000.00 35,000.00 35,000.00
103 SRI SURYANTI 70,000.00 35,000.00 35,000.00 70,000.00
104 SITI K 70,000.00 35,000.00 35,000.00 70,000.00
105 ELIS 70,000.00 35,000.00 35,000.00 70,000.00
106 YAYAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
107 ROBBI 30,000.00 15,000.00 15,000.00 30,000.00
108 ERIZIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
109 YANTO 70,000.00 35,000.00 35,000.00 70,000.00
110 RENI 15,000.00 7,500.00 7,500.00 15,000.00
111 NENI 15,000.00 7,500.00 7,500.00 15,000.00
112 MIRSAD 70,000.00 35,000.00 35,000.00 70,000.00
113 AGUS 15,000.00 7,500.00 7,500.00 15,000.00
114 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
115 CEPPI 70,000.00 35,000.00 35,000.00 70,000.00
116 FITRI 70,000.00 35,000.00 35,000.00 70,000.00
117 MIRSAD 70,000.00 35,000.00 35,000.00 70,000.00
118 SARMINI 30,000.00 15,000.00 15,000.00 30,000.00
119 11/5/2016 ASIKIN 70,000.00 35,000.00 35,000.00 70,000.00
120 TATI S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
121 LISNAWATI 70,000.00 35,000.00 35,000.00 70,000.00
122 M DIMAS 70,000.00 35,000.00 35,000.00 70,000.00
123 M MUSILAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
124 GALIH EKA 70,000.00 35,000.00 35,000.00 70,000.00
125 SRI YULIANTI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
126 SETIANINGSIH 40,000.00 20,000.00 20,000.00 40,000.00
127 MISDWI 70,000.00 35,000.00 35,000.00 70,000.00
128 SITI H 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
129 TINA AGUSTINA 70,000.00 35,000.00 35,000.00 70,000.00
130 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
131 ENDAH 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
132 ALIYYA 30,000.00 15,000.00 15,000.00 30,000.00
133 RAISA 35,000.00 17,500.00 17,500.00 35,000.00
134 TITIN 70,000.00 35,000.00 35,000.00 70,000.00
135 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
136 ARKA ADI 30,000.00 15,000.00 15,000.00 30,000.00
137 M FIKRI 30,000.00 15,000.00 15,000.00 30,000.00
138 LELY 15,000.00 7,500.00 7,500.00 15,000.00
139 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00 30,000.00
140 SELLY 70,000.00 35,000.00 35,000.00 70,000.00
141 13/5/16 ENTAR 60,000.00 30,000.00 30,000.00 60,000.00
142 KAVENDRA 30,000.00 15,000.00 15,000.00 30,000.00
143 AI SAHADAH 30,000.00 15,000.00 15,000.00 30,000.00
144 GINA 30,000.00 15,000.00 15,000.00 30,000.00
145 BINTANG 70,000.00 35,000.00 35,000.00 70,000.00
146 ELISABETH 30,000.00 15,000.00 15,000.00 30,000.00
147 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
148 IRA 30,000.00 15,000.00 15,000.00 30,000.00
149 SRI K 70,000.00 35,000.00 35,000.00 70,000.00
150 EMIYATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
151 LISDA 30,000.00 15,000.00 15,000.00 30,000.00
152 KIKI 70,000.00 35,000.00 35,000.00 70,000.00
153 NAZLA 70,000.00 35,000.00 35,000.00 70,000.00
154 YUYUN 30,000.00 15,000.00 15,000.00 30,000.00
155 DAFA 70,000.00 35,000.00 35,000.00 70,000.00
156 MULYATI 60,000.00 30,000.00 30,000.00 60,000.00
157 FITHRI 30,000.00 15,000.00 15,000.00 30,000.00
158 ATTAHIA 30,000.00 15,000.00 15,000.00 30,000.00
159 RAFIF 70,000.00 35,000.00 35,000.00 70,000.00
160 NABILA 70,000.00 35,000.00 35,000.00 70,000.00
161 YUNI I 30,000.00 15,000.00 15,000.00 30,000.00
162 LUTHFI 30,000.00 15,000.00 15,000.00 30,000.00
163 LINTANG 70,000.00 35,000.00 35,000.00 70,000.00
164 INGE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
165 14/5/16 KANTI 70,000.00 35,000.00 35,000.00 70,000.00
166 NILLENIA 70,000.00 35,000.00 35,000.00 70,000.00
167 AUREN 35,000.00 17,500.00 17,500.00 35,000.00
168 ASEP 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
169 JAENUDIN 30,000.00 15,000.00 15,000.00 30,000.00
170 SRI SUYANTI 40,000.00 20,000.00 20,000.00 40,000.00
171 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
172 MARYATI 30,000.00 15,000.00 15,000.00 30,000.00
173 HENDRA 70,000.00 35,000.00 35,000.00 70,000.00
174 FAUZAN 30,000.00 15,000.00 15,000.00 30,000.00
175 SUKARYATI 30,000.00 15,000.00 15,000.00 30,000.00
176 TIGOR 70,000.00 35,000.00 35,000.00 70,000.00
177 KIRANA 70,000.00 35,000.00 35,000.00 70,000.00
178 AURORA 35,000.00 17,500.00 17,500.00 35,000.00
179 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
180 SASKIA 70,000.00 35,000.00 35,000.00 70,000.00
181 GANJAR 30,000.00 15,000.00 15,000.00 30,000.00
182 RINJANI 30,000.00 15,000.00 15,000.00 30,000.00
183 RADITYA 70,000.00 35,000.00 35,000.00 70,000.00
184 MUSTIKA 70,000.00 35,000.00 35,000.00 70,000.00
185 RENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
186 NENI 30,000.00 15,000.00 15,000.00 30,000.00
187 EUIS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
188 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
189 16/5/16 AJENG 70,000.00 35,000.00 35,000.00 70,000.00
190 SRI M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
191 DEDE 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
192 UMSIYATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
193 DEVI 35,000.00 17,500.00 17,500.00 35,000.00
194 YOKE 15,000.00 7,500.00 7,500.00 15,000.00
195 IDA 15,000.00 7,500.00 7,500.00 15,000.00
196 HUGA 15,000.00 7,500.00 7,500.00 15,000.00
197 YOYOH 15,000.00 7,500.00 7,500.00 15,000.00
198 YUNI I 70,000.00 35,000.00 35,000.00 70,000.00
199 YUYUN S 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
200 HANI N 70,000.00 35,000.00 35,000.00 70,000.00
201 KAYLA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
202 IRKHAM 30,000.00 15,000.00 15,000.00 30,000.00
203 ZAHRA 25,000.00 12,500.00 12,500.00 25,000.00
204 ALDO 30,000.00 15,000.00 15,000.00 30,000.00
205 IWAN 30,000.00 15,000.00 15,000.00 30,000.00
206 ESTI 70,000.00 35,000.00 35,000.00 70,000.00
207 TIULAN 15,000.00 7,500.00 7,500.00 15,000.00
208 BELLA 30,000.00 15,000.00 15,000.00 30,000.00
209 FIRMANSYAH 70,000.00 35,000.00 35,000.00 70,000.00
210 P DIDIK 70,000.00 35,000.00 35,000.00 70,000.00
211 KASMINI 30,000.00 15,000.00 15,000.00 30,000.00
212 ARNI 30,000.00 15,000.00 15,000.00 30,000.00
213 17/5/16 NINDI 35,000.00 17,500.00 17,500.00 35,000.00
214 SUSYANI 70,000.00 35,000.00 35,000.00 70,000.00
215 EMAH 60,000.00 30,000.00 30,000.00 60,000.00
216 EMAN 60,000.00 30,000.00 30,000.00 60,000.00
217 SUNARDINI 60,000.00 30,000.00 30,000.00 60,000.00
218 ASEP M 30,000.00 15,000.00 15,000.00 30,000.00
219 NELI 70,000.00 35,000.00 35,000.00 70,000.00
220 YUSSI 70,000.00 35,000.00 35,000.00 70,000.00
221 ELIS R 70,000.00 35,000.00 35,000.00 70,000.00
222 M ANGGAR 70,000.00 35,000.00 35,000.00 70,000.00
223 DEWI 60,000.00 30,000.00 30,000.00 60,000.00
224 YANI 15,000.00 7,500.00 7,500.00 15,000.00
225 NAYLA 70,000.00 35,000.00 35,000.00 70,000.00
226 ALYA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
227 JEJEH 40,000.00 20,000.00 20,000.00 40,000.00
228 DEWI 30,000.00 15,000.00 15,000.00 30,000.00
229 WISNU 30,000.00 15,000.00 15,000.00 30,000.00
230 PRATAMA 70,000.00 35,000.00 35,000.00 70,000.00
231 RELY 15,000.00 7,500.00 7,500.00 15,000.00
232 M YUSUF 30,000.00 15,000.00 15,000.00 30,000.00
233 ANGGI 30,000.00 15,000.00 15,000.00 30,000.00
234 18/5/16 ALIYYA 35,000.00 17,500.00 17,500.00 35,000.00
235 MISDWI 70,000.00 35,000.00 35,000.00 70,000.00
236 SITI S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
237 RELY 25,000.00 12,500.00 12,500.00 25,000.00
238 TATA 30,000.00 15,000.00 15,000.00 30,000.00
239 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
240 BUDI 70,000.00 35,000.00 35,000.00 70,000.00
241 SALWA 25,000.00 12,500.00 12,500.00 70,000.00
242 SITI H 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
243 GALIH EKA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
244 RUSLAN 30,000.00 15,000.00 15,000.00 30,000.00
245 DEVINA 30,000.00 15,000.00 15,000.00 30,000.00
246 NOVI A 70,000.00 35,000.00 35,000.00 70,000.00
247 CUCU 60,000.00 30,000.00 30,000.00 60,000.00
248 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
249 SURATMI 70,000.00 35,000.00 35,000.00 70,000.00
250 M TAUFIQ 35,000.00 17,500.00 17,500.00 35,000.00
251 SITI 70,000.00 35,000.00 35,000.00 70,000.00
252 IMAS ATIKAH 60,000.00 30,000.00 30,000.00 60,000.00
253 M DZAKI 30,000.00 15,000.00 15,000.00 30,000.00
254 WIWI 70,000.00 35,000.00 35,000.00 70,000.00
255 CHELSEA 70,000.00 35,000.00 35,000.00 70,000.00
256 ROBBY 70,000.00 35,000.00 35,000.00 70,000.00
257 MIRSAD 70,000.00 35,000.00 35,000.00 70,000.00
258 IDA 70,000.00 35,000.00 35,000.00 70,000.00
259 ANISA 35,000.00 17,500.00 17,500.00 35,000.00
260 19/5/16 CHOYRE 30,000.00 15,000.00 15,000.00 30,000.00
261 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
262 DED RIDWAN 30,000.00 15,000.00 15,000.00 30,000.00
263 CUCU 30,000.00 15,000.00 15,000.00 30,000.00
264 SUPRIYATNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
265 IDRIS 70,000.00 35,000.00 35,000.00 70,000.00
266 AI SUPRIATI 30,000.00 15,000.00 15,000.00 30,000.00
267 ATENG 30,000.00 15,000.00 15,000.00 30,000.00
268 MYSHELLA 35,000.00 17,500.00 17,500.00 35,000.00
269 YUNI I 70,000.00 35,000.00 35,000.00 70,000.00
270 NABILA 70,000.00 35,000.00 35,000.00 70,000.00
271 ELISABETH 70,000.00 35,000.00 35,000.00 70,000.00
272 LATIFAH 70,000.00 35,000.00 35,000.00 70,000.00
273 LINA 70,000.00 35,000.00 35,000.00 70,000.00
274 NADYA 30,000.00 15,000.00 15,000.00 30,000.00
275 ANI 35,000.00 17,500.00 17,500.00 35,000.00
276 AFIANI 70,000.00 35,000.00 35,000.00 70,000.00
277 RAISHA 30,000.00 15,000.00 15,000.00 30,000.00
278 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
279 AGUS 30,000.00 15,000.00 15,000.00 30,000.00
280 RACHMADITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
281 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
282 SISKA 70,000.00 35,000.00 35,000.00 70,000.00
283 20/5/16 BAGAS 30,000.00 15,000.00 15,000.00 30,000.00
284 MADINA 70,000.00 35,000.00 35,000.00 70,000.00
285 ISNA 25,000.00 12,500.00 12,500.00 25,000.00
286 SABRINA 70,000.00 35,000.00 35,000.00 70,000.00
287 FANYSYA 30,000.00 15,000.00 15,000.00 30,000.00
288 NENI 70,000.00 35,000.00 35,000.00 70,000.00
289 BINTANG 70,000.00 35,000.00 35,000.00 70,000.00
290 SRI K 35,000.00 17,500.00 17,500.00 35,000.00
291 ELBY 30,000.00 15,000.00 15,000.00 30,000.00
292 RAFLY 35,000.00 17,500.00 17,500.00 35,000.00
293 YOGO 70,000.00 35,000.00 35,000.00 70,000.00
294 WASHFA 70,000.00 35,000.00 35,000.00 70,000.00
295 CAKRADARA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
296 MAYA 70,000.00 35,000.00 35,000.00 70,000.00
297 IRA 30,000.00 15,000.00 15,000.00 30,000.00
298 AISYA 30,000.00 15,000.00 15,000.00 30,000.00
299 DHIYANA 35,000.00 17,500.00 17,500.00 35,000.00
300 ALIF 35,000.00 17,500.00 17,500.00 35,000.00
301 RAMDLAN 30,000.00 15,000.00 15,000.00 30,000.00
302 NURFADHILAH 30,000.00 15,000.00 15,000.00 45,000.00
303 RENI 30,000.00 15,000.00 15,000.00 30,000.00
304 TUTI N 30,000.00 15,000.00 15,000.00 30,000.00
305 MULYATI 60,000.00 30,000.00 30,000.00 60,000.00
306 FELYAN 15,000.00 7,500.00 7,500.00 15,000.00
307 AGUS 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
308 MELTA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
309 LISDA 30,000.00 15,000.00 15,000.00 30,000.00
310 21/5/16 RAFIF 35,000.00 17,500.00 17,500.00 35,000.00
311 ABIDIN 70,000.00 35,000.00 35,000.00 70,000.00
312 YOGI 30,000.00 15,000.00 15,000.00 30,000.00
313 ALIKA 70,000.00 35,000.00 35,000.00 70,000.00
314 KIRANA 70,000.00 35,000.00 35,000.00 70,000.00
315 JAENUDIN 30,000.00 15,000.00 15,000.00 30,000.00
316 MARYATI 60,000.00 30,000.00 30,000.00 60,000.00
317 MAWA 70,000.00 35,000.00 35,000.00 70,000.00
318 SUKARYATI 30,000.00 15,000.00 15,000.00 30,000.00
319 IRKHAM 30,000.00 15,000.00 15,000.00 30,000.00
320 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
321 CEPPI 70,000.00 35,000.00 35,000.00 70,000.00
322 ALFARIZKI 70,000.00 35,000.00 35,000.00 70,000.00
323 SASKIA 35,000.00 17,500.00 17,500.00 35,000.00
324 EMA A 70,000.00 35,000.00 35,000.00 70,000.00
325 ZAKI 70,000.00 35,000.00 35,000.00 70,000.00
326 FATHIA 30,000.00 15,000.00 15,000.00 30,000.00
327 GINA 70,000.00 35,000.00 35,000.00 70,000.00
328 DZAKI 30,000.00 15,000.00 15,000.00 30,000.00
329 FHITRI 70,000.00 35,000.00 35,000.00 70,000.00
330 23/5/16 DEVINA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
331 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
332 AJENG 70,000.00 35,000.00 35,000.00 70,000.00
333 KOMARIAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
334 WIDANINGSIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
335 DADANG 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
336 TRI YULI 70,000.00 35,000.00 35,000.00 70,000.00
337 M ATTHALAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
338 JUDI 70,000.00 35,000.00 35,000.00 70,000.00
339 KEYLA 30,000.00 15,000.00 15,000.00 30,000.00
340 YOYOH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
341 IRKHAM 30,000.00 15,000.00 15,000.00 30,000.00
342 RINI P 15,000.00 7,500.00 7,500.00 15,000.00
343 P DIDIK 35,000.00 17,500.00 17,500.00 35,000.00
344 NOVARKA 70,000.00 35,000.00 35,000.00 70,000.00
345 AGUS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
346 ASEP YUSUF 35,000.00 17,500.00 17,500.00 35,000.00
347 ARNI G 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
348 ALDO 30,000.00 15,000.00 15,000.00 30,000.00
349 24/5/16 HUGA 35,000.00 17,500.00 17,500.00 35,000.00
350 IDA 70,000.00 35,000.00 35,000.00 70,000.00
351 NGADIYONO 60,000.00 30,000.00 30,000.00 60,000.00
352 NENI 70,000.00 35,000.00 35,000.00 70,000.00
353 NINDI 35,000.00 17,500.00 17,500.00 35,000.00
354 CHELSEA 70,000.00 35,000.00 35,000.00 70,000.00
355 IMAS ATIKAH 60,000.00 30,000.00 30,000.00 60,000.00
356 ELY 70,000.00 35,000.00 35,000.00 70,000.00
357 DEWI 70,000.00 35,000.00 35,000.00 70,000.00
358 RINJANI 30,000.00 15,000.00 15,000.00 30,000.00
359 ERISKA 30,000.00 15,000.00 15,000.00 30,000.00
360 IQBAL 70,000.00 35,000.00 35,000.00 70,000.00
361 NENI 30,000.00 15,000.00 15,000.00 30,000.00
362 RENI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
363 FHITRI 15,000.00 7,500.00 7,500.00 15,000.00
364 PRATAMA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
365 25/5/16 ASRI 70,000.00 35,000.00 35,000.00 70,000.00
366 MISDWI 30,000.00 15,000.00 15,000.00 30,000.00
367 FATHIR 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
368 DEWITRI 30,000.00 15,000.00 15,000.00 30,000.00
369 SETIANINGSIH 70,000.00 35,000.00 35,000.00 70,000.00
370 DADANG 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
371 NENGSIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
372 SRI M 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
373 SITI H 30,000.00 15,000.00 15,000.00 30,000.00
374 ESTI 30,000.00 15,000.00 15,000.00 30,000.00
375 HERU 15,000.00 7,500.00 7,500.00 15,000.00
376 IWAN K 30,000.00 15,000.00 15,000.00 30,000.00
377 ATENG 60,000.00 30,000.00 30,000.00 60,000.00
378 AJENG 60,000.00 30,000.00 30,000.00 60,000.00
379 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
380 CUCU 15,000.00 7,500.00 7,500.00 15,000.00
381 MUFI 70,000.00 35,000.00 35,000.00 70,000.00
382 NGADIYONO 15,000.00 7,500.00 7,500.00 15,000.00
383 RISHA 70,000.00 35,000.00 35,000.00 70,000.00
384 PONIMAN 15,000.00 7,500.00 7,500.00 15,000.00
385 RISHA 30,000.00 15,000.00 15,000.00 30,000.00
386 ROHMAN 70,000.00 35,000.00 35,000.00 70,000.00
387 FIRMANSYAH 70,000.00 35,000.00 35,000.00 70,000.00
388 AMANDA 70,000.00 35,000.00 35,000.00 70,000.00
389 SULISTIANI 70,000.00 35,000.00 35,000.00 70,000.00
390 26/5/16 YUNI 70,000.00 35,000.00 35,000.00 70,000.00
391 NABILA 30,000.00 15,000.00 15,000.00 30,000.00
392 SARMINI 40,000.00 20,000.00 20,000.00 40,000.00
393 JUBAEDAH 15,000.00 7,500.00 7,500.00 15,000.00
394 HERMANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
395 SANDY 70,000.00 35,000.00 35,000.00 70,000.00
396 CAESAR 70,000.00 35,000.00 35,000.00 70,000.00
397 KURNIAWAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
398 IIS 15,000.00 7,500.00 7,500.00 15,000.00
399 YUYUN 30,000.00 15,000.00 15,000.00 30,000.00
400 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
401 AI SUPRIATI 30,000.00 15,000.00 15,000.00 30,000.00
402 ADITHYA 25,000.00 12,500.00 12,500.00 25,000.00
403 CHOYRE 40,000.00 20,000.00 20,000.00 40,000.00
404 SUHARDI 30,000.00 15,000.00 15,000.00 30,000.00
405 YANA 30,000.00 15,000.00 15,000.00 30,000.00
406 NINA 30,000.00 15,000.00 15,000.00 30,000.00
407 YADI 30,000.00 15,000.00 15,000.00 30,000.00
408 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
409 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
410 ROBBY 35,000.00 17,500.00 17,500.00 35,000.00
411 TINI 60,000.00 30,000.00 30,000.00 60,000.00
412 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
413 ENDAH 30,000.00 15,000.00 15,000.00 30,000.00
414 SURATMI 70,000.00 35,000.00 35,000.00 70,000.00
415 YOGA 35,000.00 17,500.00 17,500.00 35,000.00
416 IRAWAN 70,000.00 35,000.00 35,000.00 70,000.00
417 27/5/16 EMIYATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
418 SITI SOIMAH 15,000.00 7,500.00 7,500.00 15,000.00
419 BUNGA 70,000.00 35,000.00 35,000.00 70,000.00
420 RISKALIA 70,000.00 35,000.00 35,000.00 70,000.00
421 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
422 OKTA 35,000.00 17,500.00 17,500.00 35,000.00
423 AYU 70,000.00 35,000.00 35,000.00 70,000.00
424 HALIMATU 60,000.00 30,000.00 30,000.00 60,000.00
425 LIES 70,000.00 35,000.00 35,000.00 70,000.00
426 PAIDAH 70,000.00 35,000.00 35,000.00 70,000.00
427 WULAN 70,000.00 35,000.00 35,000.00 70,000.00
428 NOVI INTAN 70,000.00 35,000.00 35,000.00 70,000.00
429 NASHITA 35,000.00 17,500.00 17,500.00 35,000.00
430 RSATI 35,000.00 17,500.00 17,500.00 35,000.00
431 NENI 70,000.00 35,000.00 35,000.00 70,000.00
432 ACEP 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
433 YULIANA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
434 AUREN 35,000.00 17,500.00 17,500.00 35,000.00
435 TUTI N 30,000.00 15,000.00 15,000.00 30,000.00
436 MULYATI 70,000.00 35,000.00 35,000.00 70,000.00
437 28/5/16 RADITYA 25,000.00 12,500.00 12,500.00 25,000.00
438 LANNY 30,000.00 15,000.00 15,000.00 30,000.00
439 ZHULAEKA 25,000.00 12,500.00 12,500.00 25,000.00
440 ALTIO 35,000.00 17,500.00 17,500.00 35,000.00
441 IIS 70,000.00 35,000.00 35,000.00 70,000.00
442 KEMAL 70,000.00 35,000.00 35,000.00 70,000.00
443 DIYAR 60,000.00 30,000.00 30,000.00 60,000.00
444 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
445 ALIKA 30,000.00 15,000.00 15,000.00 30,000.00
446 NAWAAL 70,000.00 35,000.00 35,000.00 70,000.00
447 CUCU 30,000.00 15,000.00 15,000.00 30,000.00
448 SUKARYATI 40,000.00 20,000.00 20,000.00 40,000.00
449 JAENUDIN 30,000.00 15,000.00 15,000.00 30,000.00
450 ENDANG 70,000.00 35,000.00 35,000.00 70,000.00
451 IRKHAM 40,000.00 20,000.00 20,000.00 40,000.00
452 EUIS ULAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
453 ATTHIA 30,000.00 15,000.00 15,000.00 30,000.00
454 FHITRI 15,000.00 7,500.00 7,500.00 15,000.00
455 RIANA 3,000.00 1,500.00 1,500.00 3,000.00
456 ZAKIN 35,000.00 17,500.00 17,500.00 35,000.00
457 30/5/16 IRKHAM 30,000.00 15,000.00 15,000.00 30,000.00
458 IRAWAN 15,000.00 7,500.00 7,500.00 15,000.00
459 KEYLA 70,000.00 35,000.00 35,000.00 70,000.00
460 NONENG 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
461 TRI YULI 70,000.00 35,000.00 35,000.00 70,000.00
462 FAIZA 70,000.00 35,000.00 35,000.00 70,000.00
463 EKO 70,000.00 35,000.00 35,000.00 70,000.00
464 SITI 70,000.00 35,000.00 35,000.00 70,000.00
465 INDA 70,000.00 35,000.00 35,000.00 70,000.00
466 NAJWA 25,000.00 12,500.00 12,500.00 25,000.00
467 FAIZAL 25,000.00 12,500.00 12,500.00 25,000.00
468 FAINSHA 70,000.00 35,000.00 35,000.00 70,000.00
469 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
470 ASEP YUSUF 70,000.00 35,000.00 35,000.00 70,000.00
471 TASYA 25,000.00 12,500.00 12,500.00 25,000.00
472 DESI 70,000.00 35,000.00 35,000.00 70,000.00
473 IKHSAN 40,000.00 20,000.00 20,000.00 40,000.00
474 31/5/16 RINJANI 70,000.00 35,000.00 35,000.00 70,000.00
475 SURATMI 70,000.00 35,000.00 35,000.00 70,000.00
476 DIDIN 15,000.00 7,500.00 7,500.00 15,000.00
477 SRI Y 70,000.00 35,000.00 35,000.00 70,000.00
478 ATIN 60,000.00 30,000.00 30,000.00 60,000.00
479 GALIH EKA 70,000.00 35,000.00 35,000.00 70,000.00
480 SARI 60,000.00 30,000.00 30,000.00 60,000.00
481 NAURA 70,000.00 35,000.00 35,000.00 70,000.00
482 SITI 30,000.00 15,000.00 15,000.00 30,000.00
483 IDA 70,000.00 35,000.00 35,000.00 70,000.00
484 ALYA 30,000.00 15,000.00 15,000.00 30,000.00
485 DZAKY 70,000.00 35,000.00 35,000.00 70,000.00
486 JEJEN 70,000.00 35,000.00 35,000.00 70,000.00
487 MELTA 15,000.00 7,500.00 7,500.00 15,000.00
488 WISNU 40,000.00 20,000.00 20,000.00 40,000.00
489 DZAKIR 15,000.00 7,500.00 7,500.00 15,000.00
490 YAZID 70,000.00 35,000.00 35,000.00 70,000.00
491 ERNI 15,000.00 7,500.00 7,500.00 15,000.00
492 ITA L 15,000.00 7,500.00 7,500.00 15,000.00
493 ANINDIA 35,000.00 17,500.00 17,500.00 35,000.00
22,083,000 660,000 11,041,500 11,041,500 22,768,000 -
PERIODE JUNI 2016
JASA ALAT &

DOKTER BAHAN
1 6/1/2016 ASMAWATI 20,000 5,000 7,500 7,500 25,000
2 INDRA 300,000 5,000 147,500 147,500 305,000
3 6/3/2016 IRKHAM 100,000 5,000 47,500 47,500 105,000
4 DEKI 50,000 5,000 22,500 22,500 55,000
5 RENI 150,000 5,000 72,500 72,500 155,000
6 AYU 200,000 5,000 97,500 97,500 205,000
7 6/4/2016 LIES 50,000 5,000 22,500 22,500 55,000
7 BASIMIN 20,000 5,000 7,500 7,500 25,000
8 ANDRI 20,000 5,000 7,500 7,500 25,000
9 ARIFIN 20,000 5,000 7,500 7,500 25,000
10 6/6/2016 HAMIDAH 100,000 5,000 47,500 47,500 105,000
11 DESI 200,000 5,000 97,500 97,500 205,000
12 6/7/2016 DEDE 200,000 5,000 97,500 97,500 205,000
13 MONA 40,000 5,000 17,500 17,500 45,000
14 6/8/2016 VERONICA 100,000 5,000 47,500 47,500 105,000
15 6/9/2016 RANI 200,000 5,000 97,500 97,500 205,000
16 6/10/2016 NAJWA 75,000 5,000 35,000 35,000 80,000
17 6/13/2016 UCI 200,000 5,000 97,500 97,500 205,000
18 YANUAR 60,000 5,000 27,500 27,500 65,000
19 SRI 20,000 5,000 7,500 7,500 25,000
20 6/15/2016 INA 120,000 5,000 57,500 57,500 125,000
21 6/16/2016 RANI 20,000 5,000 7,500 7,500 25,000
22 IDA 20,000 5,000 7,500 7,500 25,000
23 6/17/2016 INA 60,000 5,000 27,500 27,500 65,000
24 WAWAN 100,000 5,000 47,500 47,500 105,000
25 IDA F 20,000 5,000 7,500 7,500 25,000
26 6/18/2016 WULAN 70,000 5,000 32,500 32,500 75,000
27 6/20/2016 PUTRI 50,000 5,000 22,500 22,500 55,000
28 6/21/2016 SRI S 200,000 5,000 97,500 97,500 205,000
29 6/22/2016 ASIH S 80,000 5,000 37,500 37,500 85,000
30 6/23/2016 INA 60,000 5,000 27,500 27,500 65,000
31 6/24/2016 NITA 300,000 5,000 147,500 147,500 305,000
32 6/25/2016 ISMI 20,000 5,000 7,500 7,500 25,000
33 6/26/2016 ANGGUN 50,000 5,000 22,500 22,500 55,000
34 6/28/2016 ANDRI 100,000 5,000 47,500 47,500 105,000
35 ASEP 25,000 5,000 10,000 10,000 30,000
36 ENDAH 120,000 5,000 57,500 57,500 125,000
37 ADI 25,000 5,000 10,000 10,000 30,000
38 6/29/2016 SUSI 100,000 5,000 47,500 47,500 105,000
39 KIKI 60,000 5,000 27,500 27,500 65,000
40 6/30/2016 ENDAH 120,000 5,000 57,500 57,500 125,000
TOTAL 3,845,000 205,000 1,820,000 1,820,000 4,050,000

PERIODE JUNI 2016
JASA ALAT &

DOKTER BAHAN
1 6/1/2016 M ATHALLAH 30,000.00 15,000.00 15,000.00 30,000.00
2 KOMAR 15,000.00 7,500.00 7,500.00 15,000.00
3 LISDA 30,000.00 15,000.00 15,000.00 30,000.00
4 QUINSYA 25,000.00 12,500.00 12,500.00 25,000.00
5 HERU 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
6 WISDANI 30,000.00 15,000.00 15,000.00 30,000.00
7 FATHIR 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
8 IDRIS 15,000.00 7,500.00 7,500.00 15,000.00
9 DEWITRI 35,000.00 17,500.00 17,500.00 35,000.00
10 IRYANTO 70,000.00 35,000.00 35,000.00 70,000.00
11 RISKA 30,000.00 15,000.00 15,000.00 30,000.00
12 SITI H 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00 S
13 ESTI 70,000.00 35,000.00 35,000.00 70,000.00
14 HUGA 35,000.00 17,500.00 17,500.00 35,000.00
15 IDA 70,000.00 35,000.00 35,000.00 70,000.00
16 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
17 AGUS 30,000.00 15,000.00 15,000.00 30,000.00
18 M TAUFIQ 35,000.00 17,500.00 17,500.00 35,000.00
19 CHELSEA 70,000.00 35,000.00 35,000.00 70,000.00
20 SITI W 70,000.00 35,000.00 35,000.00 70,000.00
21 NINDI SALWA 35,000.00 17,500.00 17,500.00 35,000.00
22 MIRSAD 70,000.00 35,000.00 35,000.00 70,000.00
23 IRAWAN 70,000.00 35,000.00 35,000.00 70,000.00
24 KAVENDRA 70,000.00 35,000.00 35,000.00 70,000.00
25 KANIA 70,000.00 35,000.00 35,000.00 70,000.00
26 YUYUN 60,000.00 30,000.00 30,000.00 60,000.00
27 SUTISNA 30,000.00 15,000.00 15,000.00 30,000.00
28 SRI 70,000.00 35,000.00 35,000.00 70,000.00
29 MIZZAR 15,000.00 7,500.00 7,500.00 15,000.00
30 6/2/2016 SARMINI 70,000.00 35,000.00 35,000.00 70,000.00
31 DANI 60,000.00 30,000.00 30,000.00 60,000.00
32 ANGGI 15,000.00 7,500.00 7,500.00 15,000.00
33 HERMANSYAH 40,000.00 20,000.00 20,000.00 40,000.00
34 HALIMAH 70,000.00 35,000.00 35,000.00 70,000.00
35 WIDA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
36 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
37 YUYUN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
38 HELMI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
39 AI 30,000.00 15,000.00 15,000.00 30,000.00
40 ECIN 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
41 IBUT 70,000.00 35,000.00 35,000.00 70,000.00
42 EVI 30,000.00 15,000.00 15,000.00 30,000.00
43 KASIM 30,000.00 15,000.00 15,000.00 30,000.00
44 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
45 MULYANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
46 FENI A 30,000.00 15,000.00 15,000.00 30,000.00
47 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
48 LISDA 30,000.00 15,000.00 15,000.00 30,000.00
49 YUDI 15,000.00 7,500.00 7,500.00 15,000.00
50 LUKMAN 25,000.00 12,500.00 12,500.00 25,000.00
51 RADITYA 25,000.00 12,500.00 12,500.00 25,000.00
52 6/3/2016 DIYAR 30,000.00 15,000.00 15,000.00 30,000.00
53 ELISABET 30,000.00 15,000.00 15,000.00 30,000.00
54 AHMAD 30,000.00 15,000.00 15,000.00 30,000.00
55 AYU 30,000.00 15,000.00 15,000.00 30,000.00
56 KEMAL 70,000.00 35,000.00 35,000.00 70,000.00
57 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
58 LIES 70,000.00 35,000.00 35,000.00 70,000.00
59 YOSIDA 70,000.00 35,000.00 35,000.00 70,000.00
60 KOMARIAH 60,000.00 30,000.00 30,000.00 60,000.00
61 SITI 70,000.00 35,000.00 35,000.00 70,000.00
62 BERLIANA 25,000.00 12,500.00 12,500.00 25,000.00
63 KOSWARA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
64 IWAN K 30,000.00 15,000.00 15,000.00 30,000.00
65 MULYANI 30,000.00 15,000.00 15,000.00 30,000.00
66 GITA 15,000.00 7,500.00 7,500.00 15,000.00
67 ADE K 15,000.00 7,500.00 7,500.00 15,000.00
68 6/4/2016 YUYUN 60,000.00 30,000.00 30,000.00 60,000.00
69 LIES 70,000.00 35,000.00 35,000.00 70,000.00
70 NINA 30,000.00 15,000.00 15,000.00 30,000.00
71 YANA 30,000.00 15,000.00 15,000.00 30,000.00
72 YOGI 30,000.00 15,000.00 15,000.00 30,000.00
73 RIFA 70,000.00 35,000.00 35,000.00 70,000.00
74 TITIN 30,000.00 15,000.00 15,000.00 30,000.00
75 HENDRA 30,000.00 15,000.00 15,000.00 30,000.00
76 SUKARYATI 70,000.00 35,000.00 35,000.00 70,000.00
77 SANTI 70,000.00 35,000.00 35,000.00 70,000.00
78 NILLENIA 70,000.00 35,000.00 35,000.00 70,000.00
79 SUNARDI 30,000.00 15,000.00 15,000.00 30,000.00
80 JAENUDIN 40,000.00 20,000.00 20,000.00 40,000.00
81 KIKI 70,000.00 35,000.00 35,000.00 70,000.00
82 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
83 DZAKI 70,000.00 35,000.00 35,000.00 70,000.00
84 RENI 15,000.00 7,500.00 7,500.00 15,000.00
85 NENI 30,000.00 15,000.00 15,000.00 30,000.00
86 DEWI 30,000.00 15,000.00 15,000.00 30,000.00
87 FITHRI 15,000.00 7,500.00 7,500.00 15,000.00
88 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
89 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
90 PRATAMA 60,000.00 30,000.00 30,000.00 60,000.00
91 RINA S 60,000.00 30,000.00 30,000.00 60,000.00
92 ATTHIA 35,000.00 17,500.00 17,500.00 35,000.00
93 6/6/2016 TONNY 15,000.00 7,500.00 7,500.00 15,000.00
94 SANDY 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
95 IDRIS 15,000.00 7,500.00 7,500.00 15,000.00
96 YAYAH 15,000.00 7,500.00 7,500.00 15,000.00
97 NONENG 30,000.00 15,000.00 15,000.00 30,000.00
98 RIAN 60,000.00 30,000.00 30,000.00 60,000.00
99 ZAYN 70,000.00 35,000.00 35,000.00 70,000.00
100 ANNISA 70,000.00 35,000.00 35,000.00 70,000.00
101 ADI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
102 ELINA 70,000.00 35,000.00 35,000.00 35,000.00
103 UCI 70,000.00 35,000.00 35,000.00 70,000.00
104 WATI 70,000.00 35,000.00 35,000.00 70,000.00
105 ASEP J 70,000.00 35,000.00 35,000.00 70,000.00
106 DESI 15,000.00 7,500.00 7,500.00 15,000.00
107 JUBAEDAH 15,000.00 7,500.00 7,500.00 15,000.00
108 6/7/2016 DIDIN 15,000.00 7,500.00 7,500.00 15,000.00
109 RIZKY 15,000.00 7,500.00 7,500.00 15,000.00
110 RAZZAK 70,000.00 35,000.00 35,000.00 70,000.00
111 DEDE 70,000.00 35,000.00 35,000.00 70,000.00
112 LUCKY 15,000.00 7,500.00 7,500.00 15,000.00
113 YULIANI 70,000.00 35,000.00 35,000.00 70,000.00
114 TONNY 15,000.00 7,500.00 7,500.00 15,000.00
115 SUCIATI 70,000.00 35,000.00 35,000.00 70,000.00
116 DWI 70,000.00 35,000.00 35,000.00 70,000.00
117 INTAN 70,000.00 35,000.00 35,000.00 70,000.00
118 VIDI 25,000.00 12,500.00 12,500.00 25,000.00
119 IRMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
120 DINAR 30,000.00 15,000.00 15,000.00 30,000.00
121 KEISHA 35,000.00 17,500.00 17,500.00 35,000.00
122 RIANA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
123 SOBARIAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
124 TEOBALD 30,000.00 15,000.00 15,000.00 30,000.00
125 HAMDAN 30,000.00 15,000.00 15,000.00 30,000.00
126 KOSWARA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
127 6/8/2016 RAISSA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
128 MARLINA 60,000.00 30,000.00 30,000.00 60,000.00
129 DAYAT 15,000.00 7,500.00 7,500.00 15,000.00
130 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
131 MISDWI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
132 YAYAH 15,000.00 7,500.00 7,500.00 15,000.00
133 ELISABET 35,000.00 17,500.00 17,500.00 35,000.00
134 ROSDIANA 15,000.00 7,500.00 7,500.00 15,000.00
135 FATHIR 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
136 SITI H 30,000.00 15,000.00 15,000.00 30,000.00
137 ESTI J 40,000.00 20,000.00 20,000.00 40,000.00
138 IRMAWATI 30,000.00 15,000.00 15,000.00 30,000.00
139 AGUS 35,000.00 17,500.00 17,500.00 35,000.00
140 AGUS P 30,000.00 15,000.00 15,000.00 30,000.00
141 SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
142 CHELSEA 30,000.00 15,000.00 15,000.00 30,000.00
143 HILMI 30,000.00 15,000.00 15,000.00 30,000.00
144 ASRI 30,000.00 15,000.00 15,000.00 30,000.00
145 NIZZAR 30,000.00 15,000.00 15,000.00 30,000.00
146 OVTINA 30,000.00 15,000.00 15,000.00 30,000.00
147 6/9/2016 NIKEN 30,000.00 15,000.00 15,000.00 30,000.00
148 HERMANSYAH 70,000.00 35,000.00 35,000.00 70,000.00
149 NUNU 15,000.00 7,500.00 7,500.00 15,000.00
150 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
151 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
152 DANNI 70,000.00 35,000.00 35,000.00 70,000.00
153 RANI 30,000.00 15,000.00 15,000.00 30,000.00
154 LESTARI 30,000.00 15,000.00 15,000.00 30,000.00
155 MYSELLA 70,000.00 35,000.00 35,000.00 70,000.00
156 SHAFA 25,000.00 12,500.00 12,500.00 25,000.00
157 EVI 40,000.00 20,000.00 20,000.00 40,000.00
158 AI S 30,000.00 15,000.00 15,000.00 30,000.00
159 IDRIS 15,000.00 7,500.00 7,500.00 15,000.00
160 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
161 ABDULLAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
162 ASTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
163 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
164 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
165 NENG 30,000.00 15,000.00 15,000.00 30,000.00
166 SRI S 70,000.00 35,000.00 35,000.00 70,000.00
167 GO LIOK 70,000.00 35,000.00 35,000.00 70,000.00
168 6/10/2016 ARLAN 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
169 AYU 30,000.00 15,000.00 15,000.00 30,000.00
170 MULYO 30,000.00 15,000.00 15,000.00 30,000.00
171 NAILA 70,000.00 35,000.00 35,000.00 70,000.00
172 DEWIAN 70,000.00 35,000.00 35,000.00 70,000.00
173 SUNARIAH 30,000.00 15,000.00 15,000.00 30,000.00
174 WARTINI 15,000.00 7,500.00 7,500.00 15,000.00
175 TIEN 30,000.00 15,000.00 15,000.00 30,000.00
176 RANI 30,000.00 15,000.00 15,000.00 30,000.00
177 MEYLA 30,000.00 15,000.00 15,000.00 30,000.00
178 NENENG 30,000.00 15,000.00 15,000.00 30,000.00
179 HERU 70,000.00 35,000.00 35,000.00 70,000.00
180 RENATA 70,000.00 35,000.00 35,000.00 70,000.00
181 RIANA 30,000.00 15,000.00 15,000.00 30,000.00
182 SITI 15,000.00 7,500.00 7,500.00 15,000.00
183 ARIEL 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
184 SUCIATI 15,000.00 7,500.00 7,500.00 15,000.00
185 IWAN K 40,000.00 20,000.00 20,000.00 40,000.00
186 MULYADI 70,000.00 35,000.00 35,000.00 70,000.00
187 FENI A 70,000.00 35,000.00 35,000.00 70,000.00
188 WILDAN 25,000.00 12,500.00 12,500.00 25,000.00
189 6/11/2016 LASEANA 15,000.00 7,500.00 7,500.00 15,000.00
190 LINA 30,000.00 15,000.00 15,000.00 30,000.00
191 TUTI W 15,000.00 7,500.00 7,500.00 15,000.00
192 ALIKA 30,000.00 15,000.00 15,000.00 30,000.00
193 RIFA 70,000.00 35,000.00 35,000.00 70,000.00
194 TITIN 30,000.00 15,000.00 15,000.00 30,000.00
195 DIYAR 60,000.00 30,000.00 30,000.00 60,000.00
196 KEMAL 70,000.00 35,000.00 35,000.00 70,000.00
197 SUKARYATI 70,000.00 35,000.00 35,000.00 70,000.00
198 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
199 KIKI 70,000.00 35,000.00 35,000.00 70,000.00
200 NILLENIA 70,000.00 35,000.00 35,000.00 70,000.00
201 SALWA 70,000.00 35,000.00 35,000.00 70,000.00
202 MUNIATI 70,000.00 35,000.00 35,000.00 70,000.00
203 TUTI W 30,000.00 15,000.00 15,000.00 30,000.00
204 ATTHIA 30,000.00 15,000.00 15,000.00 30,000.00
205 NENI 30,000.00 15,000.00 15,000.00 30,000.00
206 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
207 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
208 LINTANG 70,000.00 35,000.00 35,000.00 70,000.00
209 6/13/2016 AJENG 30,000.00 15,000.00 15,000.00 30,000.00
210 M SALAM 25,000.00 12,500.00 12,500.00 25,000.00
211 NANAN 15,000.00 7,500.00 7,500.00 15,000.00
212 NABILA 25,000.00 12,500.00 12,500.00 25,000.00
213 NUR KHASANAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
214 EKA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
215 ZONI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
216 RUSLAN 70,000.00 35,000.00 35,000.00 70,000.00
217 NONENG 30,000.00 15,000.00 15,000.00 30,000.00
218 WAWANG 30,000.00 15,000.00 15,000.00 30,000.00
219 HIJAN 70,000.00 35,000.00 35,000.00 70,000.00
220 ZAINA 70,000.00 35,000.00 35,000.00 70,000.00
221 WATI 70,000.00 35,000.00 35,000.00 70,000.00
222 QONIAH 70,000.00 35,000.00 35,000.00 70,000.00
223 ALEX 60,000.00 30,000.00 30,000.00 60,000.00
224 ASEP J 15,000.00 7,500.00 7,500.00 15,000.00
225 BAYU 70,000.00 35,000.00 35,000.00 70,000.00
226 6/14/2016 ROSTINI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
227 DEDE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
228 ELINA 70,000.00 35,000.00 35,000.00 70,000.00
229 ONI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
230 YULLIANI 70,000.00 35,000.00 35,000.00 70,000.00
231 ELISABET 30,000.00 15,000.00 15,000.00 30,000.00
232 DINAR 30,000.00 15,000.00 15,000.00 30,000.00
233 DAFA 25,000.00 12,500.00 12,500.00 25,000.00
234 SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
235 SRI S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
236 M ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
237 DEWITRI 70,000.00 35,000.00 35,000.00 70,000.00
238 REZA 30,000.00 15,000.00 15,000.00 30,000.00
239 ENDANG 30,000.00 15,000.00 15,000.00 30,000.00
240 HAMDAN 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
241 DINAR 30,000.00 15,000.00 15,000.00 70,000.00
242 ANGGI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
243 KOSWARA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
244 6/15/2016 IRMA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
245 FATHIR 70,000.00 35,000.00 35,000.00 70,000.00
246 ESTI J 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
247 EPPY 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
248 HEPPI 70,000.00 35,000.00 35,000.00 70,000.00
249 RINA 15,000.00 7,500.00 7,500.00 15,000.00
250 ROHIKA 70,000.00 35,000.00 35,000.00 70,000.00
251 IDJAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
252 YUYUN 35,000.00 17,500.00 17,500.00 35,000.00
253 MISDWI 30,000.00 15,000.00 15,000.00 30,000.00
254 TONNY CH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
255 NURDIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
256 ANHAR 15,000.00 7,500.00 7,500.00 15,000.00
257 NIZZAR 70,000.00 35,000.00 35,000.00 70,000.00
258 OVTINA 40,000.00 20,000.00 20,000.00 40,000.00
259 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
260 AGUS P 40,000.00 20,000.00 20,000.00 40,000.00
261 ZAHWA 30,000.00 15,000.00 15,000.00 30,000.00
262 WILDAN 30,000.00 15,000.00 15,000.00 30,000.00
263 DEWITRI 70,000.00 35,000.00 35,000.00 70,000.00
264 HILMI 35,000.00 17,500.00 17,500.00 35,000.00
265 AGUS P 70,000.00 35,000.00 35,000.00 70,000.00
266 IHSAN 35,000.00 17,500.00 17,500.00 35,000.00
267 YUSTI 15,000.00 7,500.00 7,500.00 15,000.00
268 ANGGI 60,000.00 30,000.00 30,000.00 60,000.00
269 6/16/2016 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
270 KEMAL 25,000.00 12,500.00 12,500.00 25,000.00
271 LINA 30,000.00 15,000.00 15,000.00 30,000.00
272 SYAHLEVI 30,000.00 15,000.00 15,000.00 30,000.00
273 KOSAM 30,000.00 15,000.00 15,000.00 30,000.00
274 RINRIN 30,000.00 15,000.00 15,000.00 30,000.00
275 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
276 ECIN 70,000.00 35,000.00 35,000.00 70,000.00
277 SAMRI 60,000.00 30,000.00 30,000.00 60,000.00
278 NIKEN 30,000.00 15,000.00 15,000.00 30,000.00
279 LISDA 40,000.00 20,000.00 20,000.00 40,000.00
280 EVI SYANTI 70,000.00 35,000.00 35,000.00 70,000.00
281 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
282 ACHMAT 30,000.00 15,000.00 15,000.00 30,000.00
283 DIAN 15,000.00 7,500.00 7,500.00 15,000.00
284 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
285 GO GIOK 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
286 CUCU K 70,000.00 35,000.00 35,000.00 70,000.00
287 WIDYANTI 30,000.00 15,000.00 15,000.00 30,000.00
288 INSAN 70,000.00 35,000.00 35,000.00 70,000.00
289 RIANA 30,000.00 15,000.00 15,000.00 30,000.00
290 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
291 IMAN 30,000.00 15,000.00 15,000.00 30,000.00
292 6/17/2016 EMAN 70,000.00 35,000.00 35,000.00 70,000.00
293 MULYO 70,000.00 35,000.00 35,000.00 70,000.00
294 SUNARIAH 30,000.00 15,000.00 15,000.00 30,000.00
295 AI S 30,000.00 15,000.00 15,000.00 30,000.00
296 NENENG 70,000.00 35,000.00 35,000.00 70,000.00
297 IWAN 70,000.00 35,000.00 35,000.00 70,000.00
298 ETI 60,000.00 30,000.00 30,000.00 60,000.00
299 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
300 ARIF 30,000.00 15,000.00 15,000.00 30,000.00
301 SUMIDI 70,000.00 35,000.00 35,000.00 70,000.00
302 AISYAH 70,000.00 35,000.00 35,000.00 45,000.00
303 SRI H 30,000.00 15,000.00 15,000.00 30,000.00
304 NADIA 70,000.00 35,000.00 35,000.00 70,000.00
305 MULYATI 40,000.00 20,000.00 20,000.00 40,000.00
306 FENI AYU 30,000.00 15,000.00 15,000.00 30,000.00
307 6/18/2016 HENDRA 30,000.00 15,000.00 15,000.00 30,000.00
308 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
309 TITIN 70,000.00 35,000.00 35,000.00 70,000.00
310 RIFA 70,000.00 35,000.00 35,000.00 70,000.00
311 JUJU 30,000.00 15,000.00 15,000.00 30,000.00
312 DEDE 30,000.00 15,000.00 15,000.00 30,000.00
313 KIKY 70,000.00 35,000.00 35,000.00 70,000.00
314 SEPTI 15,000.00 7,500.00 7,500.00 15,000.00
315 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
316 NILENIA 70,000.00 35,000.00 35,000.00 70,000.00
317 SITI H 15,000.00 7,500.00 7,500.00 15,000.00
318 ERNI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
319 CAHYA 30,000.00 15,000.00 15,000.00 30,000.00
320 TUTI 40,000.00 20,000.00 20,000.00 40,000.00
321 JULIA 30,000.00 15,000.00 15,000.00 30,000.00
322 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
323 ATTHIA 70,000.00 35,000.00 35,000.00 70,000.00
324 SITI M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
325 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
326 6/20/2016 RAHAWAH 25,000.00 12,500.00 12,500.00 25,000.00
327 AHMAD 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
328 DADANG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
329 AJENG 30,000.00 15,000.00 15,000.00 30,000.00
330 RUSLAN 30,000.00 15,000.00 15,000.00 30,000.00
331 NONENG A 30,000.00 15,000.00 15,000.00 30,000.00
332 TARTILAH 35,000.00 17,500.00 17,500.00 35,000.00
333 AI 60,000.00 30,000.00 30,000.00 60,000.00
334 NABILA 25,000.00 10,000.00 12,500.00 12,500.00 35,000.00
335 IRMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
336 MULYANI 70,000.00 35,000.00 35,000.00 70,000.00
337 UCI 70,000.00 35,000.00 35,000.00 70,000.00
338 NINGSIH 40,000.00 20,000.00 20,000.00 40,000.00
339 SUPARSI 70,000.00 35,000.00 35,000.00 70,000.00
340 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
341 ERNI 70,000.00 35,000.00 35,000.00 70,000.00
342 YOGETA 30,000.00 15,000.00 15,000.00 30,000.00
343 6/21/2016 SURI 40,000.00 20,000.00 20,000.00 40,000.00
344 ASEP J 70,000.00 35,000.00 35,000.00 70,000.00
345 WINDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
346 DIDI 40,000.00 20,000.00 20,000.00 40,000.00
347 ELSA 70,000.00 35,000.00 35,000.00 70,000.00
348 DINAR 30,000.00 15,000.00 15,000.00 30,000.00
349 NERMA 30,000.00 15,000.00 15,000.00 30,000.00
350 SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
351 KHOIRUNISSA 70,000.00 35,000.00 35,000.00 70,000.00
352 DHOFU 25,000.00 12,500.00 12,500.00 25,000.00
353 LOSEANA 70,000.00 35,000.00 35,000.00 70,000.00
354 SRI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
355 NIZZAR 35,000.00 17,500.00 17,500.00 35,000.00
356 OVTINA 35,000.00 17,500.00 17,500.00 35,000.00
357 ATIQAH 30,000.00 15,000.00 15,000.00 30,000.00
358 WISNU 70,000.00 35,000.00 35,000.00 70,000.00
359 TAUFIQ 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
360 HAMDAN 35,000.00 17,500.00 17,500.00 35,000.00
361 GO GIOK 15,000.00 7,500.00 7,500.00 15,000.00
362 NINA 30,000.00 15,000.00 15,000.00 30,000.00
363 ANGGI 60,000.00 30,000.00 30,000.00 60,000.00
364 6/22/2016 SITI 40,000.00 10,000.00 20,000.00 20,000.00 50,000.00
365 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
366 AZKA 70,000.00 35,000.00 35,000.00 70,000.00
367 RUSLAN 70,000.00 35,000.00 35,000.00 70,000.00
368 MISDWI 40,000.00 20,000.00 20,000.00 40,000.00
369 KUSMIATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
370 SITI NUR 70,000.00 35,000.00 35,000.00 70,000.00
371 SUCI 15,000.00 7,500.00 7,500.00 15,000.00
372 SJAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
373 SUDARTI 30,000.00 15,000.00 15,000.00 30,000.00
374 SRI M 70,000.00 35,000.00 35,000.00 70,000.00
375 LANIWATI 70,000.00 35,000.00 35,000.00 70,000.00
376 AGUS P 70,000.00 35,000.00 35,000.00 70,000.00
377 REZA 70,000.00 35,000.00 35,000.00 70,000.00
378 DZAKI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
379 6/23/2016 SUDARMAJI 70,000.00 35,000.00 35,000.00 70,000.00
380 NIKEN JIWA 70,000.00 35,000.00 35,000.00 70,000.00
381 SHAFA 70,000.00 35,000.00 35,000.00 70,000.00
382 RATIH 70,000.00 35,000.00 35,000.00 70,000.00
383 INDAH 30,000.00 15,000.00 15,000.00 30,000.00
384 M HIBBAN 35,000.00 17,500.00 17,500.00 35,000.00
385 LINA K 70,000.00 35,000.00 35,000.00 70,000.00
386 ECIN 30,000.00 15,000.00 15,000.00 30,000.00
387 KOMARUDIN 15,000.00 7,500.00 7,500.00 15,000.00
388 ELISABETH 70,000.00 35,000.00 35,000.00 70,000.00
389 ENENG 70,000.00 35,000.00 35,000.00 70,000.00
390 RIANA 30,000.00 15,000.00 15,000.00 30,000.00
391 NENDEN 70,000.00 35,000.00 35,000.00 70,000.00
392 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
393 6/24/2016 AI 30,000.00 15,000.00 15,000.00 30,000.00
394 DWI 30,000.00 15,000.00 15,000.00 30,000.00
395 SUNARIAH 30,000.00 15,000.00 15,000.00 30,000.00
396 SURI 70,000.00 35,000.00 35,000.00 70,000.00
397 NENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
398 RATNA SARI 70,000.00 35,000.00 35,000.00 70,000.00
399 EMIYATI 15,000.00 7,500.00 7,500.00 15,000.00
400 AYU 70,000.00 35,000.00 35,000.00 70,000.00
401 SRI 15,000.00 7,500.00 7,500.00 15,000.00
402 ARIEF 30,000.00 15,000.00 15,000.00 30,000.00
403 FENI AYU 30,000.00 15,000.00 15,000.00 30,000.00
404 ENOK 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
405 UCI 70,000.00 35,000.00 35,000.00 70,000.00
406 6/25/2016 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
407 NILLENIA 15,000.00 7,500.00 7,500.00 15,000.00
408 HENDRA 30,000.00 15,000.00 15,000.00 30,000.00
409 SAKTI ARI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
410 DEDE 70,000.00 35,000.00 35,000.00 70,000.00
411 KIRANA 70,000.00 35,000.00 35,000.00 70,000.00
412 SRI S 30,000.00 15,000.00 15,000.00 30,000.00
413 SURI 15,000.00 7,500.00 7,500.00 15,000.00
414 SUPRIYADI 30,000.00 15,000.00 15,000.00 30,000.00
415 ALIKA 70,000.00 35,000.00 35,000.00 70,000.00
416 FATTAH 70,000.00 35,000.00 35,000.00 70,000.00
417 TUTI 70,000.00 35,000.00 35,000.00 70,000.00
418 JULIA 70,000.00 35,000.00 35,000.00 70,000.00
419 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
420 ATTHIA 70,000.00 35,000.00 35,000.00 70,000.00
421 LINTANG 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
422 QIZA 30,000.00 15,000.00 15,000.00 30,000.00
423 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
424 CAHYA 15,000.00 7,500.00 7,500.00 15,000.00
425 ANGGI 30,000.00 15,000.00 15,000.00 30,000.00
426 YUDI 30,000.00 15,000.00 15,000.00 30,000.00
427 6/27/2016 IRMAWATI 40,000.00 20,000.00 20,000.00 40,000.00
428 RUSLAN 70,000.00 35,000.00 35,000.00 70,000.00
429 UCI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
430 AJENG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
431 ACHMAD 35,000.00 17,500.00 17,500.00 35,000.00
432 RINTAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
433 ASEP J 70,000.00 35,000.00 35,000.00 70,000.00
434 FENI 30,000.00 15,000.00 15,000.00 30,000.00
435 NERMA 30,000.00 15,000.00 15,000.00 30,000.00
436 IDA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
437 IWAN 30,000.00 15,000.00 15,000.00 30,000.00
438 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
439 YUGETA 30,000.00 15,000.00 15,000.00 30,000.00
440 6/28/2016 SUDRAJAT 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
441 AMIR 25,000.00 12,500.00 12,500.00 25,000.00
442 ASEP 70,000.00 35,000.00 35,000.00 70,000.00
443 YAYAH 70,000.00 35,000.00 35,000.00 70,000.00
444 RENI 70,000.00 35,000.00 35,000.00 70,000.00
445 ELSA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
446 DHAFA 15,000.00 7,500.00 7,500.00 15,000.00
447 FABRIAN 70,000.00 35,000.00 35,000.00 70,000.00
448 IHSAN 70,000.00 35,000.00 35,000.00 70,000.00
449 NIZZAR 70,000.00 35,000.00 35,000.00 70,000.00
450 OVTINA 40,000.00 20,000.00 20,000.00 40,000.00
451 NENI 30,000.00 15,000.00 15,000.00 30,000.00
452 NURDIN 30,000.00 15,000.00 15,000.00 30,000.00
453 HILMI 30,000.00 15,000.00 15,000.00 30,000.00
454 E SURYANA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
455 RAHMADANI 70,000.00 35,000.00 35,000.00 70,000.00
456 YADI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
457 6/29/2016 IRMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
458 ENGKUS 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
459 DIAN 35,000.00 17,500.00 17,500.00 35,000.00
460 ASYFA 30,000.00 15,000.00 15,000.00 30,000.00
461 KOMARUDIN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
462 P DIDIK 70,000.00 35,000.00 35,000.00 70,000.00
463 YUYUN 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
464 HAFIYA 70,000.00 35,000.00 35,000.00 70,000.00
465 LINTANG 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
466 MISDWI 70,000.00 35,000.00 35,000.00 70,000.00
467 REKA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
468 SURI 70,000.00 35,000.00 35,000.00 70,000.00
469 MULYO 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
470 TUTI 30,000.00 15,000.00 15,000.00 30,000.00
471 SEKAR 70,000.00 35,000.00 35,000.00 70,000.00
472 RIZKY 35,000.00 17,500.00 17,500.00 35,000.00
473 RISA 30,000.00 15,000.00 15,000.00 30,000.00
474 ILHAM 70,000.00 35,000.00 35,000.00 70,000.00
475 SUPARMI 30,000.00 15,000.00 15,000.00 30,000.00
476 6/30/2016 INDAH 70,000.00 35,000.00 35,000.00 70,000.00
477 HENI 70,000.00 35,000.00 35,000.00 70,000.00
478 YUDA 70,000.00 35,000.00 35,000.00 70,000.00
479 NIKEN 70,000.00 35,000.00 35,000.00 70,000.00
480 ECIH 70,000.00 35,000.00 35,000.00 70,000.00
481 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
482 UCI 70,000.00 35,000.00 35,000.00 70,000.00
483 DINAR 70,000.00 35,000.00 35,000.00 70,000.00
484 SHAFA 30,000.00 15,000.00 15,000.00 30,000.00
485 WISNU 30,000.00 15,000.00 15,000.00 30,000.00
486 NINGSIH 70,000.00 35,000.00 35,000.00 70,000.00
487 RICKY 30,000.00 15,000.00 15,000.00 30,000.00
488 TRIAWAN 15,000.00 7,500.00 7,500.00 15,000.00
489 NERMA 30,000.00 15,000.00 15,000.00 30,000.00
490 YUDI 15,000.00 7,500.00 7,500.00 15,000.00
491 NENDA 70,000.00 35,000.00 35,000.00 70,000.00
492 RIANA 30,000.00 15,000.00 15,000.00 30,000.00
493 LISDA 70,000.00 35,000.00 35,000.00 70,000.00
21,230,000 710,000 10,615,000 10,615,000 21,920,000 -
PERIODE JULI 2016
JASA ALAT &

DOKTER BAHAN
1 7/2/2016 AYI NURZAMAN 200,000 5,000 100,000 100,000 205,000
2 7/4/2016 ZAHRA N J 70,000 5,000 35,000 35,000 75,000
3 FERDINAND 200,000 5,000 100,000 100,000 205,000
4 7/11/2016 AZKA 20,000 5,000 10,000 10,000 25,000
5 FINA 100,000 5,000 50,000 50,000 105,000
6 NINDES TRIYANTI 60,000 5,000 30,000 30,000 65,000
7 RISKA 20,000 5,000 10,000 10,000 25,000
7 MARTIN 200,000 5,000 100,000 100,000 205,000
8 7/12/2016 MIFTAHUDIN 25,000 5,000 12,500 12,500 30,000
9 7/15/2016 DZAHRA 95,000 5,000 47,500 47,500 100,000
10 SUCI 150,000 5,000 75,000 75,000 155,000
11 7/16/2016 TATI 70,000 5,000 35,000 35,000 75,000
12 AHMAD 100,000 5,000 50,000 50,000 105,000
13 WULAN 50,000 5,000 25,000 25,000 55,000
14 AISKA 200,000 5,000 100,000 100,000 205,000
15 7/18/2016 NENG FATIMAH 240,000 5,000 120,000 120,000 245,000
16 TABITHA 450,000 5,000 225,000 225,000 455,000
17 7/20/2016 TABITHA 20,000 5,000 10,000 10,000 25,000
18 7/21/2016 INA N 100,000 5,000 50,000 50,000 105,000
19 HABIBI 30,000 5,000 15,000 15,000 35,000
20 SITI A 100,000 5,000 50,000 50,000 105,000
21 7/22/2016 NISA 250,000 5,000 125,000 125,000 255,000
22 7/23/2016 YANTI 200,000 5,000 100,000 100,000 205,000
23 AGNES CANDRA 50,000 5,000 25,000 25,000 55,000
24 WULAN 80,000 5,000 40,000 40,000 85,000
25 NENDEN 180,000 5,000 90,000 90,000 185,000
26 7/24/2016 RIZAL 50,000 5,000 25,000 25,000 55,000
27 ANGGUN 50,000 5,000 25,000 25,000 55,000
28 7/25/2016 TRISANDI EFENDI 70,000 5,000 35,000 35,000 75,000
29 M CAHYADI 200,000 5,000 100,000 100,000 205,000
30 7/27/2016 RINI W 20,000 5,000 10,000 10,000 25,000
31 RINA 200,000 5,000 100,000 100,000 205,000
32 FINA 120,000 5,000 60,000 60,000 125,000
33 7/28/2016 SURI 445,000 5,000 222,500 222,500 450,000
34 7/29/2016 EUIS 250,000 5,000 125,000 125,000 255,000
35 7/30/2016 DEVITA 60,000 5,000 30,000 30,000 65,000
36 WULAN 60,000 5,000 30,000 30,000 65,000
37 NENDEN 80,000 5,000 40,000 40,000 85,000
38 APRIAN W 50,000 5,000 25,000 25,000 55,000
39 ISUM S 150,000 5,000 75,000 75,000 155,000
TOTAL 5,065,000 200,000 2,532,500 2,532,500 5,265,000

PERIODE JULI 2016
JASA ALAT &
DOKTER BAHAN
1 7/1/2016 SUPRIYADI 70,000.00 35,000.00 35,000.00 70,000.00
2 SUNARIAH 30,000.00 15,000.00 15,000.00 30,000.00
3 MIA 70,000.00 35,000.00 35,000.00 70,000.00
4 DWI 30,000.00 15,000.00 15,000.00 30,000.00
5 REFAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
6 AI S 30,000.00 15,000.00 15,000.00 30,000.00
7 DIYAR 70,000.00 35,000.00 35,000.00 70,000.00
8 CERIA 70,000.00 35,000.00 35,000.00 70,000.00
9 ASEP 70,000.00 35,000.00 35,000.00 70,000.00
10 RATNASARI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
11 ENOK 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
12 NIZZAR 70,000.00 35,000.00 35,000.00 70,000.00
13 OVTINA 70,000.00 35,000.00 35,000.00 70,000.00
14 ARIF 30,000.00 15,000.00 15,000.00 30,000.00
15 SUSILO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
16 NENI H 40,000.00 20,000.00 20,000.00 40,000.00
17 CAHYA S 30,000.00 15,000.00 15,000.00 30,000.00
18 ANGGI P F 40,000.00 20,000.00 20,000.00 40,000.00
19 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
20 SISKA LAILA 30,000.00 15,000.00 15,000.00 30,000.00
21 ANI SUMARNI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
22 7/2/2016 AYI NURZAMAN 30,000.00 15,000.00 15,000.00 30,000.00
23 HENDRA H 30,000.00 15,000.00 15,000.00 30,000.00
24 KICKY 15,000.00 7,500.00 7,500.00 15,000.00
25 AMANDA 35,000.00 17,500.00 17,500.00 35,000.00
26 ALIKA 70,000.00 35,000.00 35,000.00 70,000.00
27 FREDY 60,000.00 30,000.00 30,000.00 60,000.00
28 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
29 SRI SUYANTI 30,000.00 15,000.00 15,000.00 30,000.00
30 7/4/2016 MAMAN W 70,000.00 35,000.00 35,000.00 70,000.00
31 SLAMET 70,000.00 35,000.00 35,000.00 70,000.00
32 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
33 JULIANA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
34 YUDI C 30,000.00 15,000.00 15,000.00 30,000.00
35 NENI ISNAENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
36 AJENG D 30,000.00 15,000.00 15,000.00 30,000.00
37 SUMALYO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
38 IMAS KOMARIAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
39 ZAHWA A 70,000.00 35,000.00 35,000.00 70,000.00
40 EVA D 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
41 7/11/2016 ROSMAYANTI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
42 SLAMET S 70,000.00 35,000.00 35,000.00 70,000.00
43 AISYA GINA 70,000.00 35,000.00 35,000.00 70,000.00
44 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
45 IIS ISMAIL 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
46 AJENG 40,000.00 20,000.00 20,000.00 40,000.00
47 ISNAENI 70,000.00 35,000.00 35,000.00 70,000.00
48 SEPTIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
49 EVA D 25,000.00 12,500.00 12,500.00 25,000.00
50 MARTIN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
51 CINTA 70,000.00 35,000.00 35,000.00 70,000.00
52 IWAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
53 NURDIN 70,000.00 35,000.00 35,000.00 70,000.00
54 YUDI C 40,000.00 20,000.00 20,000.00 40,000.00
55 ENDANG 70,000.00 35,000.00 35,000.00 70,000.00
56 RIYANI 25,000.00 12,500.00 12,500.00 25,000.00
57 YUDI C 30,000.00 15,000.00 15,000.00 30,000.00
58 7/12/2016 MARIAM 15,000.00 7,500.00 7,500.00 15,000.00
59 LINTANG 70,000.00 35,000.00 35,000.00 70,000.00
60 DINAR 30,000.00 15,000.00 15,000.00 30,000.00
61 ALAM 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
62 DHAFA 15,000.00 7,500.00 7,500.00 15,000.00
63 SURATMI 15,000.00 7,500.00 7,500.00 15,000.00
64 FITHRI 15,000.00 7,500.00 7,500.00 15,000.00
65 ANI 30,000.00 15,000.00 15,000.00 30,000.00
66 AIDA 15,000.00 7,500.00 7,500.00 15,000.00
67 UCI 70,000.00 35,000.00 35,000.00 70,000.00
68 FATIMAH 15,000.00 7,500.00 7,500.00 15,000.00
69 TUTI NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
70 JULIA I 70,000.00 35,000.00 35,000.00 70,000.00
71 ASEP YUSUF 70,000.00 35,000.00 35,000.00 70,000.00
72 RINA M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
73 ZENAL A 15,000.00 7,500.00 7,500.00 15,000.00
74 SURI A 70,000.00 35,000.00 35,000.00 70,000.00
75 ARIF I 30,000.00 15,000.00 15,000.00 30,000.00
76 NENI H 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
77 RAFI 35,000.00 17,500.00 17,500.00 35,000.00
78 CAHYA S 30,000.00 15,000.00 15,000.00 30,000.00
79 SELMANIA 70,000.00 35,000.00 35,000.00 70,000.00
80 7/13/2016 IMAS KOMARIAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
81 SITI S 35,000.00 17,500.00 17,500.00 35,000.00
82 WAHYUNI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
83 WIDA NINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
84 AI RITA 70,000.00 35,000.00 35,000.00 70,000.00
85 DHENISA 15,000.00 7,500.00 7,500.00 15,000.00
86 TARTILAH 70,000.00 35,000.00 35,000.00 70,000.00
87 FERUZI 25,000.00 12,500.00 12,500.00 25,000.00
88 SUHARTINI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
89 NIZZAR 70,000.00 35,000.00 35,000.00 70,000.00
90 SRI L 30,000.00 15,000.00 15,000.00 30,000.00
91 RELY 30,000.00 15,000.00 15,000.00 30,000.00
92 ENCUNG 30,000.00 15,000.00 15,000.00 30,000.00
93 YAYAN 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
94 SARBINI 30,000.00 15,000.00 15,000.00 30,000.00
95 YOGA 35,000.00 17,500.00 17,500.00 35,000.00
96 ARIF I 15,000.00 7,500.00 7,500.00 15,000.00
97 7/14/2016 RIAN S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
98 MELY M 70,000.00 35,000.00 35,000.00 70,000.00
99 R MAYA 70,000.00 35,000.00 35,000.00 70,000.00
100 M YOGI 30,000.00 15,000.00 15,000.00 30,000.00
101 EVA T 15,000.00 7,500.00 7,500.00 15,000.00
102 ASEP 35,000.00 10,000.00 17,500.00 17,500.00 35,000.00
103 M SATRIA 15,000.00 7,500.00 7,500.00 15,000.00
104 NANIN H 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
105 TUNIYAH 70,000.00 35,000.00 35,000.00 70,000.00
106 M RIFKI 15,000.00 7,500.00 7,500.00 15,000.00
107 DESTIANA 25,000.00 12,500.00 12,500.00 25,000.00
108 ZAHWA A 70,000.00 35,000.00 35,000.00 70,000.00
109 NINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
110 AISAH 25,000.00 12,500.00 12,500.00 25,000.00
111 AFIANI 40,000.00 20,000.00 20,000.00 40,000.00
112 TONI 30,000.00 15,000.00 15,000.00 30,000.00
113 AKHNAF 25,000.00 12,500.00 12,500.00 25,000.00
114 RIANA 40,000.00 20,000.00 20,000.00 40,000.00
115 SAEFUL 70,000.00 35,000.00 35,000.00 70,000.00
116 RANI 70,000.00 35,000.00 35,000.00 70,000.00
117 JUJU 40,000.00 20,000.00 20,000.00 40,000.00
118 SHABRINA 25,000.00 12,500.00 12,500.00 25,000.00
119 7/15/2016 ROWDOH 35,000.00 17,500.00 17,500.00 35,000.00
120 DZIKRA 70,000.00 35,000.00 35,000.00 70,000.00
121 SABILA 70,000.00 35,000.00 35,000.00 70,000.00
122 M ARIF 60,000.00 30,000.00 30,000.00 60,000.00
123 KOMANAH 60,000.00 30,000.00 30,000.00 60,000.00
124 ANI S 60,000.00 30,000.00 30,000.00 60,000.00
125 UCI 70,000.00 35,000.00 35,000.00 70,000.00
126 SUCI 70,000.00 35,000.00 35,000.00 70,000.00
127 SUPRI 30,000.00 15,000.00 15,000.00 30,000.00
128 DWI S 30,000.00 15,000.00 15,000.00 30,000.00
129 KOZANANGSAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
130 RATNA SARI 70,000.00 35,000.00 35,000.00 70,000.00
131 ERIYANTI 70,000.00 35,000.00 35,000.00 70,000.00
132 ADE AHMAD 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
133 IRFAN M 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
134 CAHYA S 30,000.00 15,000.00 15,000.00 30,000.00
135 NURM,AN R 15,000.00 7,500.00 7,500.00 15,000.00
136 FRILIANA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
137 YAYAN S 30,000.00 15,000.00 15,000.00 30,000.00
138 M BAHRUN 30,000.00 15,000.00 15,000.00 30,000.00
139 EVA D S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
140 RD DIKKI D 30,000.00 15,000.00 15,000.00 30,000.00
141 7/16/2016 SURI A 30,000.00 15,000.00 15,000.00 30,000.00
142 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
143 HENDRA H 30,000.00 15,000.00 15,000.00 30,000.00
144 KARTINI 70,000.00 35,000.00 35,000.00 70,000.00
145 RINI M 15,000.00 7,500.00 7,500.00 15,000.00
146 DEWI A 30,000.00 15,000.00 15,000.00 30,000.00
147 SRI SUYANTI 15,000.00 7,500.00 7,500.00 15,000.00
148 YUDI H 70,000.00 35,000.00 35,000.00 70,000.00
149 ILHAM A 70,000.00 35,000.00 35,000.00 70,000.00
150 M ZUFAR 30,000.00 15,000.00 15,000.00 30,000.00
151 AGUS I 70,000.00 35,000.00 35,000.00 70,000.00
152 KASMINI 15,000.00 7,500.00 7,500.00 15,000.00
153 QIZA R 30,000.00 15,000.00 15,000.00 30,000.00
154 FATTAH M P 70,000.00 35,000.00 35,000.00 70,000.00
155 7/18/2016 AI RITA 30,000.00 15,000.00 15,000.00 30,000.00
156 DIAN P 70,000.00 35,000.00 35,000.00 70,000.00
157 SURI A 15,000.00 7,500.00 7,500.00 15,000.00
158 AHMAD 70,000.00 35,000.00 35,000.00 70,000.00
159 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
160 ISUM 35,000.00 17,500.00 17,500.00 35,000.00
161 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
162 CEINA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
163 EULIS 15,000.00 7,500.00 7,500.00 15,000.00
164 SARININGSIH 30,000.00 15,000.00 15,000.00 30,000.00
165 FIKI 15,000.00 7,500.00 7,500.00 15,000.00
166 FAHMI 35,000.00 17,500.00 17,500.00 35,000.00
167 IWAN K 30,000.00 15,000.00 15,000.00 30,000.00
168 M FAISAL 70,000.00 35,000.00 35,000.00 70,000.00
169 ASEP 70,000.00 35,000.00 35,000.00 70,000.00
170 DEVI 60,000.00 30,000.00 30,000.00 60,000.00
171 7/19/2016 WAHYUNI 70,000.00 35,000.00 35,000.00 70,000.00
172 DIANR 70,000.00 35,000.00 35,000.00 70,000.00
173 AI S 30,000.00 15,000.00 15,000.00 30,000.00
174 RATNA SARI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
175 INTAN 70,000.00 35,000.00 35,000.00 70,000.00
176 ANI N 70,000.00 35,000.00 35,000.00 70,000.00
177 SLAMAT 70,000.00 35,000.00 35,000.00 70,000.00
178 NERMA 30,000.00 15,000.00 15,000.00 30,000.00
179 KOMARIAH 60,000.00 30,000.00 30,000.00 60,000.00
180 ANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
181 ABAD 30,000.00 15,000.00 15,000.00 30,000.00
182 ZAHRA 30,000.00 15,000.00 15,000.00 30,000.00
183 PUJIATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
184 INDRA S 30,000.00 15,000.00 15,000.00 30,000.00
185 CINIA 15,000.00 7,500.00 7,500.00 15,000.00
186 YUDI H 40,000.00 20,000.00 20,000.00 40,000.00
187 PANIDJO 70,000.00 35,000.00 35,000.00 70,000.00
188 SRI W 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
189 ENCUM 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
190 ANDIKA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
191 7/20/2016 SURI A 15,000.00 7,500.00 7,500.00 15,000.00
192 YAYAN 15,000.00 7,500.00 7,500.00 15,000.00
193 SRI SUYANTI 40,000.00 20,000.00 20,000.00 40,000.00
194 WIDA 40,000.00 20,000.00 20,000.00 40,000.00
195 ASEP 70,000.00 35,000.00 35,000.00 70,000.00
196 DHIA 15,000.00 7,500.00 7,500.00 15,000.00
197 SITI K 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
198 IBUT 15,000.00 7,500.00 7,500.00 15,000.00
199 SITI HODIJAH 70,000.00 35,000.00 35,000.00 70,000.00
200 IMAS KOMARIAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
201 SITI K 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
202 NAJMI 15,000.00 7,500.00 7,500.00 15,000.00
203 MUBAROD 30,000.00 15,000.00 15,000.00 30,000.00
204 BUDI 30,000.00 15,000.00 15,000.00 30,000.00
205 SITI R 35,000.00 17,500.00 17,500.00 35,000.00
206 M BAHRUN 35,000.00 17,500.00 17,500.00 35,000.00
207 RELY S 70,000.00 35,000.00 35,000.00 70,000.00
208 AMIRA R 30,000.00 15,000.00 15,000.00 30,000.00
209 YAYAN S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
210 SARBINI 70,000.00 35,000.00 35,000.00 70,000.00
211 7/21/2016 ANI S 30,000.00 15,000.00 15,000.00 30,000.00
212 AHMAD S 30,000.00 15,000.00 15,000.00 30,000.00
213 TARTILAH 70,000.00 35,000.00 35,000.00 70,000.00
214 ENDANG S 30,000.00 15,000.00 15,000.00 30,000.00
215 DEDE K 70,000.00 35,000.00 35,000.00 70,000.00
216 NENI S 70,000.00 35,000.00 35,000.00 70,000.00
217 SAKTI ARI 30,000.00 15,000.00 15,000.00 30,000.00
218 NANIN H 30,000.00 15,000.00 15,000.00 30,000.00
219 IBRAHIM 70,000.00 35,000.00 35,000.00 70,000.00
220 SYABANI 25,000.00 12,500.00 12,500.00 25,000.00
221 MUZAFFARUDDIN 70,000.00 35,000.00 35,000.00 70,000.00
222 AA SUARSA 30,000.00 15,000.00 15,000.00 30,000.00
223 RATNA Y 70,000.00 35,000.00 35,000.00 70,000.00
224 KANIA Z 70,000.00 35,000.00 35,000.00 70,000.00
225 NINGSIH S 35,000.00 17,500.00 17,500.00 35,000.00
226 MINA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
227 FAKHRI 15,000.00 7,500.00 7,500.00 15,000.00
228 7/22/2016 SUNARDI 30,000.00 15,000.00 15,000.00 30,000.00
229 OMAN 70,000.00 35,000.00 35,000.00 70,000.00
230 SITI W 15,000.00 7,500.00 7,500.00 15,000.00
231 EVA T 35,000.00 17,500.00 17,500.00 35,000.00
232 SAFRINA 70,000.00 35,000.00 35,000.00 70,000.00
233 PUNGUT 70,000.00 35,000.00 35,000.00 70,000.00
234 ANITA SUSANTI 15,000.00 7,500.00 7,500.00 15,000.00
235 ABDUL R 70,000.00 35,000.00 35,000.00 70,000.00
236 M ANGGAR 30,000.00 15,000.00 15,000.00 30,000.00
237 RISMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
238 KANIA Z 70,000.00 35,000.00 35,000.00 70,000.00
239 RD DIKKI D 30,000.00 15,000.00 15,000.00 30,000.00
240 7/23/2016 BUDI S 30,000.00 15,000.00 15,000.00 30,000.00
241 ANGGARA 70,000.00 35,000.00 35,000.00 70,000.00
242 HASANAH 70,000.00 35,000.00 35,000.00 70,000.00
243 SHAFRINA 70,000.00 35,000.00 35,000.00 70,000.00
244 HATI R 70,000.00 35,000.00 35,000.00 70,000.00
245 KIKI K 30,000.00 15,000.00 15,000.00 30,000.00
246 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
247 SARMINI 30,000.00 15,000.00 15,000.00 30,000.00
248 NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
249 AGUS I 70,000.00 35,000.00 35,000.00 70,000.00
250 M ZUFAR 70,000.00 35,000.00 35,000.00 70,000.00
251 NENI H 70,000.00 35,000.00 35,000.00 70,000.00
252 NAJWA 30,000.00 15,000.00 15,000.00 30,000.00
253 SASKIA 35,000.00 17,500.00 17,500.00 35,000.00
254 JULIA 70,000.00 35,000.00 35,000.00 70,000.00
255 TUTI 40,000.00 20,000.00 20,000.00 40,000.00
256 YUDI H 30,000.00 15,000.00 15,000.00 30,000.00
257 SELMANIA 70,000.00 35,000.00 35,000.00 70,000.00
258 CAHYA S 40,000.00 20,000.00 20,000.00 40,000.00
259 DEWI A 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
260 7/25/2016 SUPARTI 70,000.00 35,000.00 35,000.00 70,000.00
261 IBUT S 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
262 ASEP R 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
263 ROSMAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
264 AMINAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
265 ASEP SOBANA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
266 SURYA 70,000.00 35,000.00 35,000.00 70,000.00
267 IIS H 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
268 EVI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
269 AHMAD S 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
270 SURI A 15,000.00 7,500.00 7,500.00 15,000.00
271 IAMAN S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
272 M FAISAL 70,000.00 35,000.00 35,000.00 70,000.00
273 IWAN K 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
274 DINAR 40,000.00 20,000.00 20,000.00 40,000.00
275 AFIANI 30,000.00 15,000.00 15,000.00 30,000.00
276 SITI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
277 U SUTISNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
278 LULU 70,000.00 35,000.00 35,000.00 70,000.00
279 UCI 70,000.00 35,000.00 35,000.00 70,000.00
280 7/26/2016 RIA 70,000.00 35,000.00 35,000.00 70,000.00
281 NUNU 15,000.00 7,500.00 7,500.00 15,000.00
282 ARDAH 30,000.00 15,000.00 15,000.00 30,000.00
283 RATNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
284 NANNY 15,000.00 7,500.00 7,500.00 15,000.00
285 ADE 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
286 AI S 15,000.00 7,500.00 7,500.00 15,000.00
287 SUSI 30,000.00 15,000.00 15,000.00 30,000.00
288 RIZKY 30,000.00 15,000.00 15,000.00 30,000.00
289 ASEP Y 30,000.00 15,000.00 15,000.00 30,000.00
290 ZAHRA 70,000.00 35,000.00 35,000.00 70,000.00
291 PUJIATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
292 NAFFICHA 15,000.00 7,500.00 7,500.00 15,000.00
293 NIZZAR 35,000.00 17,500.00 17,500.00 35,000.00
294 OVTINA 70,000.00 35,000.00 35,000.00 70,000.00
295 ANGGI 70,000.00 35,000.00 35,000.00 70,000.00
296 ASIKIN 30,000.00 15,000.00 15,000.00 30,000.00
297 7/27/2016 FITHRI 15,000.00 7,500.00 7,500.00 15,000.00
298 YANTI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
299 WIDA N 70,000.00 35,000.00 35,000.00 70,000.00
300 AI RITA 70,000.00 35,000.00 35,000.00 70,000.00
301 INDRA S 30,000.00 15,000.00 15,000.00 30,000.00
302 NURRI 25,000.00 12,500.00 12,500.00 45,000.00
303 ASEP B S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
304 HARTANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
305 FAISHAL 35,000.00 17,500.00 17,500.00 35,000.00
306 NIRA 30,000.00 15,000.00 15,000.00 30,000.00
307 MINA 30,000.00 15,000.00 15,000.00 30,000.00
308 ANDIKA 70,000.00 35,000.00 35,000.00 70,000.00
309 SEPTI 70,000.00 35,000.00 35,000.00 70,000.00
310 YAYAN 30,000.00 15,000.00 15,000.00 30,000.00
311 SITI J 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
312 NINA J 30,000.00 15,000.00 15,000.00 30,000.00
313 7/28/2016 NINGSIH S 30,000.00 15,000.00 15,000.00 30,000.00
314 ASEP 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
315 AA 30,000.00 15,000.00 15,000.00 30,000.00
316 MAMAN 15,000.00 7,500.00 7,500.00 15,000.00
317 SUMARYO 30,000.00 15,000.00 15,000.00 30,000.00
318 METHA 70,000.00 35,000.00 35,000.00 70,000.00
319 RISKA 70,000.00 35,000.00 35,000.00 70,000.00
320 WIDAYANTI 70,000.00 35,000.00 35,000.00 70,000.00
321 DADANG 70,000.00 35,000.00 35,000.00 70,000.00
322 KEISHA 25,000.00 12,500.00 12,500.00 25,000.00
323 RETNO 15,000.00 7,500.00 7,500.00 15,000.00
324 OKTA 35,000.00 17,500.00 17,500.00 35,000.00
325 ISMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
326 RIANA 70,000.00 35,000.00 35,000.00 70,000.00
327 OKI M 30,000.00 15,000.00 15,000.00 30,000.00
328 YUYUN 30,000.00 15,000.00 15,000.00 30,000.00
329 YUDI C 70,000.00 35,000.00 35,000.00 70,000.00
330 MAESAROH 70,000.00 35,000.00 35,000.00 70,000.00
331 IKSAN SADIKIN 30,000.00 15,000.00 15,000.00 30,000.00
332 TSANI SITI 35,000.00 17,500.00 17,500.00 35,000.00
333 GEMA H 30,000.00 15,000.00 15,000.00 30,000.00
334 7/29/2016 ASEP S 30,000.00 15,000.00 15,000.00 30,000.00
335 NENENG S 70,000.00 35,000.00 35,000.00 70,000.00
336 SITI S 30,000.00 15,000.00 15,000.00 30,000.00
337 LINA M 60,000.00 30,000.00 30,000.00 60,000.00
338 SAKTI ARI 30,000.00 15,000.00 15,000.00 30,000.00
339 TARTILAH 70,000.00 35,000.00 35,000.00 70,000.00
340 ABDUL FATAH 30,000.00 15,000.00 15,000.00 30,000.00
341 SYURDA 30,000.00 15,000.00 15,000.00 30,000.00
342 NIKEN JIWA 30,000.00 15,000.00 15,000.00 30,000.00
343 FENI AYU 30,000.00 15,000.00 15,000.00 30,000.00
344 ASEP R 15,000.00 7,500.00 7,500.00 15,000.00
345 REZA A 30,000.00 15,000.00 15,000.00 30,000.00
346 CAHYA S 70,000.00 35,000.00 35,000.00 70,000.00
347 AGUS IRWAN 70,000.00 35,000.00 35,000.00 70,000.00
348 NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
349 M ZUFAR 70,000.00 35,000.00 35,000.00 70,000.00
350 RD DIKKI D 40,000.00 20,000.00 20,000.00 40,000.00
351 7/30/2011 HASANAH 70,000.00 35,000.00 35,000.00 70,000.00
352 LIES S 70,000.00 35,000.00 35,000.00 70,000.00
353 FARHAN 30,000.00 15,000.00 15,000.00 30,000.00
354 BANYU 70,000.00 35,000.00 35,000.00 70,000.00
355 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
356 KIKI K 70,000.00 35,000.00 35,000.00 70,000.00
357 ISUM S 70,000.00 35,000.00 35,000.00 70,000.00
358 LORINE 70,000.00 35,000.00 35,000.00 70,000.00
359 HADI 15,000.00 7,500.00 7,500.00 15,000.00
360 HENDRA 30,000.00 15,000.00 15,000.00 30,000.00
361 YATNO 70,000.00 35,000.00 35,000.00 70,000.00
362 SARMINI 30,000.00 15,000.00 15,000.00 30,000.00
363 SASKIA 70,000.00 35,000.00 35,000.00 70,000.00
364 JULIA 70,000.00 35,000.00 35,000.00 70,000.00
365 TUTI 70,000.00 35,000.00 35,000.00 70,000.00
366 YUDI H 30,000.00 15,000.00 15,000.00 30,000.00
367 EVI S 30,000.00 15,000.00 15,000.00 30,000.00
368 M FAUZAN 30,000.00 15,000.00 15,000.00 30,000.00
369 NIRA 30,000.00 15,000.00 15,000.00 30,000.00
370 QIZA 30,000.00 15,000.00 15,000.00 30,000.00
371 SELMANIA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
15,635,000 620,000 7,817,500 7,817,500 16,265,000 -
NO TANGGAL NAMA PASIEN TARIF ADM JASA DOKTER ALAT & BAHAN
1 8/1/2016 FERDINAN 80,000 5,000 40,000 40,000
2 ASYIFA 20,000 5,000 10,000 10,000
3 2/8/2016 AISKA 100,000 5,000 50,000 50,000
4 NY MERI 100,000 5,000 50,000 50,000
5 3/8/2016 RIMA 50,000 5,000 25,000 25,000
6 4/8/2016 AN ROVA 60,000 5,000 30,000 30,000
7 SRI YUNIAR 60,000 5,000 30,000 30,000
8 NOOR CHOTIMAH 200,000 5,000 100,000 100,000
9 5/8/2016 DWI DEVITA 60,000 5,000 30,000 30,000
10 NY WULAN 20,000 5,000 10,000 10,000
11 ASYIKA 50,000 5,000 25,000 25,000
12 6/8/2016 ESTERINA B 100,000 5,000 50,000 50,000
13 RIMA 950,000 5,000 475,000 475,000
14 AHMAD R 60,000 5,000 30,000 30,000
15 7/8/2016 ANGGI 2,000,000 5,000 1,000,000 1,000,000
16 8/8/2016 NY ENUNG 20,000 5,000 10,000 10,000
17 NY SUCI 140,000 5,000 70,000 70,000
18 MERIA SURYANI 20,000 5,000 10,000 10,000
19 10/8/2016 RIMA 625,000 5,000 312,500 312,500
20 UNDANG 20,000 5,000 10,000 10,000
21 11/8/2016 RIMA 400,000 5,000 200,000 200,000
22 NOOR CHOTIMAH 100,000 5,000 50,000 50,000
23 12/8/2016 ADE EFENDI 60,000 5,000 30,000 30,000
24 TN DIDING 60,000 5,000 30,000 30,000
25 08/13/2016 YUSTIRA 100,000 5,000 50,000 50,000
26 DWI DEVITA 60,000 5,000 30,000 30,000
27 08/15/2016 MERIA S 65,000 5,000 32,500 32,500
28 ADE EFENDI 60,000 5,000 30,000 30,000
29 NY SUCI 70,000 5,000 35,000 35,000
30 RISKA NOVIANTI 100,000 5,000 50,000 50,000
31 FINA 320,000 5,000 160,000 160,000
32 08/19/2016 SARI AMANAH 60,000 5,000 30,000 30,000
33 SRI YUNIAR 60,000 5,000 30,000 30,000
34 08/20/2016 MORIS 120,000 5,000 60,000 60,000
35 MERI 100,000 5,000 50,000 50,000
36 YOGA B 200,000 5,000 100,000 100,000
37 08/21/2016 ANGGUN 50,000 5,000 25,000 25,000
38 ANGGI 50,000 5,000 25,000 25,000
39 08/22/2016 SUCI 180,000 5,000 90,000 90,000
40 DWI DEVITA 60,000 5,000 30,000 30,000
41 08/27/2016 NOVA FIRANHIKA 200,000 5,000 100,000 100,000
42 RAISA 50,000 5,000 25,000 25,000
43 IRWAN SUTANTO 60,000 5,000 30,000 30,000
44 AHMAD R 60,000 5,000 30,000 30,000
45 TN ASEP 20,000 5,000 10,000 10,000
46 08/29/2016 NY SUCI 80,000 5,000 40,000 40,000
47 DWI DEVITA 80,000 5,000 40,000 40,000
48 WIDIA 20,000 5,000 10,000 10,000
49 AGUNG 60,000 5,000 30,000 30,000
50 HIDAYAH 200,000 5,000 100,000 100,000
TOTAL 7,010,000 200,000 3,505,000 3,505,000

TGL NAMA TARIF OBAT JASA DOKTER ALAT & BAHAN

1 1/8/2016 SOFIAN 70,000.00 35,000.00 35,000.00
2 RISKA 30,000.00 15,000.00 15,000.00
3 E. KARTINI 60,000.00 10,000.00 30,000.00 30,000.00
4 NENI 60,000.00 30,000.00 30,000.00
5 NAJWA 15,000.00 7,500.00 7,500.00
6 AHMAD 30,000.00 10,000.00 15,000.00 15,000.00
7 JUJU 15,000.00 10,000.00 7,500.00 7,500.00
8 IIS 30,000.00 15,000.00 15,000.00
9 ADNIA 25,000.00 12,500.00 12,500.00
10 ANGGIA 15,000.00 10,000.00 7,500.00 7,500.00
11 NENGSIH 30,000.00 15,000.00 15,000.00
12 LULU 70,000.00 35,000.00 35,000.00
13 IIS 15,000.00 10,000.00 7,500.00 7,500.00
14 ARIF 30,000.00 15,000.00 15,000.00
15 AFIANI 30,000.00 15,000.00 15,000.00
16 YANI 70,000.00 35,000.00 35,000.00
17 SANDRA 25,000.00 12,500.00 12,500.00
18 IDA 30,000.00 15,000.00 15,000.00
19 2/8/2016 RIZKY 15,000.00 10,000.00 7,500.00 7,500.00
20 AI S 30,000.00 15,000.00 15,000.00
21 IWAN 30,000.00 15,000.00 15,000.00
22 AHAD 40,000.00 20,000.00 20,000.00
23 SUSILAWATI 70,000.00 35,000.00 35,000.00
24 AIDAH 30,000.00 15,000.00 15,000.00
25 RIA 70,000.00 35,000.00 35,000.00
26 ADE 70,000.00 35,000.00 35,000.00
27 RIZKY 40,000.00 20,000.00 20,000.00
28 APONG NURUL H 30,000.00 10,000.00 15,000.00 15,000.00
29 JAHRAH 15,000.00 7,500.00 7,500.00
30 ESTI ANISASI N 30,000.00 15,000.00 15,000.00
31 PONIMAN 30,000.00 10,000.00 15,000.00 15,000.00
32 IVA KANIA ZULFA 70,000.00 35,000.00 35,000.00
33 SABRINA ALMA 35,000.00 17,500.00 17,500.00
34 SHAFIRA INDANA 30,000.00 15,000.00 15,000.00
35 SUDARTIK 30,000.00 15,000.00 15,000.00
36 ALIYYA R.D 30,000.00 15,000.00 15,000.00
37 NY WATI 70,000.00 35,000.00 35,000.00
38 RAISA 70,000.00 35,000.00 35,000.00
39 3/8/2016 TINA AGUSTIN 30,000.00 15,000.00 15,000.00
40 EUIS JUARIAH 15,000.00 7,500.00 7,500.00
41 HEPPI SEPTIAN 70,000.00 35,000.00 35,000.00
42 AI RITA SOFIA 30,000.00 15,000.00 15,000.00
43 GALIH EKA PUTRA 70,000.00 35,000.00 35,000.00
44 AMINAH 30,000.00 15,000.00 15,000.00
45 INDRA ABDAL H 30,000.00 15,000.00 15,000.00
46 NURMALA M 15,000.00 7,500.00 7,500.00
47 RAHMAH 25,000.00 12,500.00 12,500.00
48 SUPARSI 30,000.00 15,000.00 15,000.00
49 IRAWAN 15,000.00 10,000.00 7,500.00 7,500.00
50 MINA SARIATI H 30,000.00 15,000.00 15,000.00
51 RELLY SUGIARTI 35,000.00 17,500.00 17,500.00
52 SELLY J 70,000.00 35,000.00 35,000.00
53 IMAS N 15,000.00 10,000.00 7,500.00 7,500.00
54 MUHAMAD B 70,000.00 35,000.00 35,000.00
55 HANI MULYANI 70,000.00 35,000.00 35,000.00
56 POPON JULAENI 30,000.00 10,000.00 15,000.00 15,000.00
57 IKHSAN SADIKIN 35,000.00 17,500.00 17,500.00
58 YAYAN SETIAWAN 35,000.00 17,500.00 17,500.00
59 4/8/2106 NERMA 30,000.00 10,000.00 15,000.00 15,000.00
60 SLAMET 70,000.00 10,000.00 35,000.00 35,000.00
61 DINAR 30,000.00 15,000.00 15,000.00
62 DARNIANI 15,000.00 10,000.00 7,500.00 7,500.00
63 SUMARYA 30,000.00 15,000.00 15,000.00
64 DADANG 70,000.00 35,000.00 35,000.00
65 NELISA 70,000.00 35,000.00 35,000.00
66 ELISABETH 30,000.00 15,000.00 15,000.00
67 YULIANA 70,000.00 35,000.00 35,000.00
68 TSANI SITI R 35,000.00 17,500.00 17,500.00
69 DEWI FATIMAH 30,000.00 15,000.00 15,000.00
70 OKI MARTHA TRI L 30,000.00 15,000.00 15,000.00
71 GEMA HARTANI 30,000.00 15,000.00 15,000.00
72 ABIL ASYUDZILY 35,000.00 17,500.00 17,500.00
73 NANA ADRIANI 60,000.00 30,000.00 30,000.00
74 NOOR CHOTIMAH 70,000.00 35,000.00 35,000.00
75 ERNI 70,000.00 35,000.00 35,000.00
76 SUHARSONO 70,000.00 35,000.00 35,000.00
77 5/8/2016 NENENG SULASMI 70,000.00 35,000.00 35,000.00
78 SRI SUWARTI 70,000.00 35,000.00 35,000.00
79 RIZKI UTAMA 15,000.00 7,500.00 7,500.00
80 SITI ROHANI 30,000.00 15,000.00 15,000.00
81 LIS KOMALA 70,000.00 35,000.00 35,000.00
82 JAKA TARYANA 35,000.00 17,500.00 17,500.00
83 EVA DAHLIA SARI 70,000.00 35,000.00 35,000.00
84 LASEANA GRACELA 30,000.00 15,000.00 15,000.00
85 SYURDA 30,000.00 15,000.00 15,000.00
86 LIES SUARTI 70,000.00 35,000.00 35,000.00
87 DWI SUMARNI 30,000.00 15,000.00 15,000.00
88 FARHAN F 70,000.00 35,000.00 35,000.00
89 TUTI NURHAYATI 70,000.00 35,000.00 35,000.00
90 ABDUL PATAH 30,000.00 15,000.00 15,000.00
91 REFAN ANZANYAR 30,000.00 15,000.00 15,000.00
92 SYAHRAN HARTA 40,000.00 20,000.00 20,000.00
93 WIWI WINANGSIH 70,000.00 35,000.00 35,000.00
94 RIZKI ADIYANTO 30,000.00 15,000.00 15,000.00
95 CAHYA SUBAKTI 70,000.00 35,000.00 35,000.00
96 RD DIKKI DERMA C 70,000.00 35,000.00 35,000.00
97 NAJWA NUR AULIA 70,000.00 35,000.00 35,000.00
98 6/8/2016 SUNARDI DIANSAH 40,000.00 20,000.00 20,000.00
99 HASANAH 70,000.00 35,000.00 35,000.00
100 YUYUN YUNINGSIH 30,000.00 15,000.00 15,000.00
101 ADE MULYANA 30,000.00 15,000.00 15,000.00
102 INDARTI B 15,000.00 7,500.00 7,500.00
103 M. YOGI A 30,000.00 15,000.00 15,000.00
104 BANYU DARMA S 70,000.00 35,000.00 35,000.00
105 KIRANA AURELIA Z 40,000.00 20,000.00 20,000.00
106 SAKTI ARI 70,000.00 35,000.00 35,000.00
107 LORINE LIDWINA L 70,000.00 35,000.00 35,000.00
108 SITI RIDHA I 35,000.00 17,500.00 17,500.00
109 SAFRINA AINI I 25,000.00 12,500.00 12,500.00
110 HATI ROHAETI 70,000.00 35,000.00 35,000.00
111 YUDI HERMAWAN 30,000.00 10,000.00 15,000.00 15,000.00
112 UCI SUCIAWATI 70,000.00 35,000.00 35,000.00
113 NURHAYATI 70,000.00 35,000.00 35,000.00
114 M ZUFAR R 70,000.00 35,000.00 35,000.00
115 AGUS IRWAN K 70,000.00 35,000.00 35,000.00
116 ZAKIN RIDWAN N 35,000.00 17,500.00 17,500.00
117 ATTHIA SHILA G 70,000.00 35,000.00 35,000.00
118 8/8/2106 EPI ROBIAT 60,000.00 10,000.00 30,000.00 30,000.00
119 TARTILAH 60,000.00 10,000.00 30,000.00 30,000.00
120 Aa SUARSA 40,000.00 20,000.00 20,000.00
121 NY E KARTINI 15,000.00 7,500.00 7,500.00
122 RISKA NOVIANTI 30,000.00 15,000.00 15,000.00
123 DELI DJOHAN 70,000.00 35,000.00 35,000.00
124 ROSMAYANTI 30,000.00 15,000.00 15,000.00
125 AHMAD SALMAN 30,000.00 15,000.00 15,000.00
126 ANDRI 15,000.00 7,500.00 7,500.00
127 NERMA 30,000.00 15,000.00 15,000.00
128 IWAN 30,000.00 15,000.00 15,000.00
129 NENGSIH 30,000.00 15,000.00 15,000.00
130 DADANG 70,000.00 35,000.00 35,000.00
131 AFIANI 70,000.00 35,000.00 35,000.00
132 ARIF 40,000.00 20,000.00 20,000.00
133 RINA 15,000.00 7,500.00 7,500.00
134 LUTFIANI 30,000.00 15,000.00 15,000.00
135 SUDARJAT 30,000.00 15,000.00 15,000.00
136 KIKIN 70,000.00 35,000.00 35,000.00
137 M.IGRA 70,000.00 35,000.00 35,000.00
138 9/8/2016 SLAMET 70,000.00 10,000.00 35,000.00 35,000.00
139 AYI 30,000.00 10,000.00 15,000.00 15,000.00
140 RIAN 70,000.00 35,000.00 35,000.00
141 INA 70,000.00 35,000.00 35,000.00
142 AIDAH 30,000.00 15,000.00 15,000.00
143 AHAD 70,000.00 35,000.00 35,000.00
144 RIZKY 70,000.00 35,000.00 35,000.00
145 ROSA 70,000.00 35,000.00 35,000.00
146 ARIFIN 70,000.00 10,000.00 35,000.00 35,000.00
147 WIDYAWATI 70,000.00 10,000.00 35,000.00 35,000.00
148 LANIWATI 70,000.00 35,000.00 35,000.00
149 M.AKBAR NURIL A 70,000.00 35,000.00 35,000.00
150 NY SUCI ROHAETI 70,000.00 35,000.00 35,000.00
151 GITA AMBARWATI 15,000.00 10,000.00 7,500.00 7,500.00
152 JAHRAH 30,000.00 10,000.00 15,000.00 15,000.00
153 SURYA MULYANA 60,000.00 10,000.00 30,000.00 30,000.00
154 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00
155 ERIKA M ALFA 30,000.00 15,000.00 15,000.00
156 SARBINI RAIS Drs 70,000.00 35,000.00 35,000.00
157 ABDUR RAHMAN S 15,000.00 7,500.00 7,500.00
158 SALMA 30,000.00 15,000.00 15,000.00
159 BERLIANA INDRI 30,000.00 15,000.00 15,000.00
160 10/8/2016 EMAH NURHAYATI 60,000.00 30,000.00 30,000.00
161 AMINAH 30,000.00 15,000.00 15,000.00
162 LIS KOMALA 60,000.00 30,000.00 30,000.00
163 SISMITIN 15,000.00 10,000.00 7,500.00 7,500.00
164 NENIH NURAENI 70,000.00 35,000.00 35,000.00
165 MAMAN WARMANA 70,000.00 35,000.00 35,000.00
166 IIS HANDAYANI 40,000.00 20,000.00 20,000.00
167 BISMA E 15,000.00 10,000.00 7,500.00 7,500.00
168 INDRA ABDUL H 40,000.00 20,000.00 20,000.00
169 NY APONG 35,000.00 10,000.00 17,500.00 17,500.00
170 PONIMAN 30,000.00 15,000.00 15,000.00
171 IMAS NURHAYATI 60,000.00 10,000.00 30,000.00 30,000.00
172 RELY SUGIARTI P.L 70,000.00 35,000.00 35,000.00
173 BETHISE A 70,000.00 35,000.00 35,000.00
174 IDA SOIDAH 30,000.00 15,000.00 15,000.00
175 SELY J 30,000.00 10,000.00 15,000.00 15,000.00
176 SABINA DEWI 15,000.00 7,500.00 7,500.00
177 MUBAROD 30,000.00 10,000.00 15,000.00 15,000.00
178 YAYAN SETIAWAN 70,000.00 35,000.00 35,000.00
179 ALIYYA R 70,000.00 35,000.00 35,000.00
180 WATI SETIAWATI Spd 35,000.00 17,500.00 17,500.00
181 11/8/2016 RIA S R 70,000.00 35,000.00 35,000.00
182 NELITA 70,000.00 35,000.00 35,000.00
183 DINAN 30,000.00 15,000.00 15,000.00
184 ELISABETH 30,000.00 15,000.00 15,000.00
185 IRA 15,000.00 7,500.00 7,500.00
186 SUMARYO 30,000.00 15,000.00 15,000.00
187 YULIANA 70,000.00 35,000.00 35,000.00
188 JIMY 70,000.00 35,000.00 35,000.00
189 NURZANDI 15,000.00 10,000.00 7,500.00 7,500.00
190 ZACKY 70,000.00 35,000.00 35,000.00
191 LINAWATI 70,000.00 35,000.00 35,000.00
192 ENI SUMIATI 30,000.00 15,000.00 15,000.00
193 YUYUN YUNINGSIH 30,000.00 15,000.00 15,000.00
194 IKA Y 15,000.00 7,500.00 7,500.00
195 NOOR CHOTIMAH T 15,000.00 7,500.00 7,500.00
196 M MUZHAFFARUDIN 30,000.00 15,000.00 15,000.00
197 ABIL A 35,000.00 17,500.00 17,500.00
198 GEMA HARTANI 30,000.00 15,000.00 15,000.00
199 EVA MARDIANA 70,000.00 35,000.00 35,000.00
200 ALIYA N M 25,000.00 12,500.00 12,500.00
201 DEWI PATIMAH 30,000.00 15,000.00 15,000.00
202 HAIKAL I 30,000.00 15,000.00 15,000.00
203 SUHARSONO 70,000.00 35,000.00 35,000.00
204 HASNI FEBRIYANI 30,000.00 15,000.00 15,000.00
205 12/8/2016 YOPI ISKANDAR 70,000.00 35,000.00 35,000.00
206 ADE MULYANA 30,000.00 15,000.00 15,000.00
207 NIKE PURNAMASARI 30,000.00 15,000.00 15,000.00
208 RUSMINIATI 15,000.00 10,000.00 7,500.00 7,500.00
209 M RIDHO P 35,000.00 17,500.00 17,500.00
210 ADINDA R A 15,000.00 7,500.00 7,500.00
211 KEISYA INTANIA N 30,000.00 15,000.00 15,000.00
212 HOERIAH 30,000.00 15,000.00 15,000.00
213 EVA DAHLIASARI 70,000.00 35,000.00 35,000.00
214 SYURDA O 30,000.00 15,000.00 15,000.00
215 TUTI NURHAYATI 70,000.00 35,000.00 35,000.00
216 DHINI NURUL B 35,000.00 17,500.00 17,500.00
217 SUPARTI 30,000.00 15,000.00 15,000.00
218 JUJU ENDANG W 30,000.00 15,000.00 15,000.00
219 FARHAN F 70,000.00 35,000.00 35,000.00
220 EVIS ULAN 60,000.00 30,000.00 30,000.00
221 MULYATI 70,000.00 35,000.00 35,000.00
222 ARKA ADRY P 70,000.00 35,000.00 35,000.00
223 FENI AYU A 70,000.00 35,000.00 35,000.00
224 REDHAN KUSUMA P 30,000.00 15,000.00 15,000.00
225 QIZA RIZQI P 15,000.00 7,500.00 7,500.00
226 FATTAH MAKI P 15,000.00 7,500.00 7,500.00
227 HUGA AHMAD K 70,000.00 35,000.00 35,000.00
228 08/13/2016 YUSTIRA 15,000.00 7,500.00 7,500.00
229 SITI ROHANI 30,000.00 15,000.00 15,000.00
230 ACHMAD SUMARDI 15,000.00 7,500.00 7,500.00
231 NIA LESTARI 30,000.00 15,000.00 15,000.00
232 KIRANA A Z 70,000.00 35,000.00 35,000.00
233 SHAFRINA AINI 35,000.00 17,500.00 17,500.00
234 HATI ROHAETI 70,000.00 35,000.00 35,000.00
236 ANGGARA R F 70,000.00 35,000.00 35,000.00
237 DICKY JANUAR S 15,000.00 7,500.00 7,500.00
238 NUR SALAMAH 35,000.00 17,500.00 17,500.00
239 AKMAL SYUKUR Z 30,000.00 15,000.00 15,000.00
240 FINI P 15,000.00 10,000.00 7,500.00 7,500.00
241 TITIK S 70,000.00 35,000.00 35,000.00
242 NAJWA NUR AULIA 70,000.00 35,000.00 35,000.00
243 08/15/2016 AA SUARSA 70,000.00 35,000.00 35,000.00
244 KORNELIUS B. S 70,000.00 10,000.00 35,000.00 35,000.00
245 RISKA NOVIANTI 30,000.00 10,000.00 15,000.00 15,000.00
246 SUSI IRMA SARI 30,000.00 15,000.00 15,000.00
247 ANDRIANA 30,000.00 10,000.00 15,000.00 15,000.00
248 LUTFIANI 30,000.00 15,000.00 15,000.00
249 SUDARSIH 30,000.00 15,000.00 15,000.00
250 NERMA 30,000.00 15,000.00 15,000.00
251 IWAN 30,000.00 15,000.00 15,000.00
252 SALAMAH 15,000.00 10,000.00 7,500.00 7,500.00
253 ARIF I 70,000.00 35,000.00 35,000.00
254 YULIYANTI 15,000.00 10,000.00 7,500.00 7,500.00
255 AI HAYATI 25,000.00 12,500.00 12,500.00
256 08/16/2016 WIDYANTI 70,000.00 35,000.00 35,000.00
257 JIMMY 70,000.00 35,000.00 35,000.00
258 AKBAR 30,000.00 15,000.00 15,000.00
259 ROSA 70,000.00 35,000.00 35,000.00
260 ADE S 30,000.00 15,000.00 15,000.00
261 TITIN R 70,000.00 35,000.00 35,000.00
262 SRI S 30,000.00 15,000.00 15,000.00
263 NINGSIH 40,000.00 20,000.00 20,000.00
264 INA 70,000.00 35,000.00 35,000.00
265 AIDAH 30,000.00 15,000.00 15,000.00
266 08/18/2016 SITI 15,000.00 7,500.00 7,500.00
267 SELY 30,000.00 15,000.00 15,000.00
268 AMINAH 30,000.00 15,000.00 15,000.00
269 SUMARYO 30,000.00 15,000.00 15,000.00
270 SRI R 30,000.00 15,000.00 15,000.00
271 YULIANA 70,000.00 35,000.00 35,000.00
272 WIDANINGSIH 70,000.00 35,000.00 35,000.00
273 GINA SILVIA 70,000.00 35,000.00 35,000.00
274 SYAFA NUR A 35,000.00 17,500.00 17,500.00
275 TITIN SUPRIATIN 70,000.00 35,000.00 35,000.00
276 OKI MARTHA T.L 30,000.00 15,000.00 15,000.00
277 PONIMAN 30,000.00 15,000.00 15,000.00
278 YUDHA G 30,000.00 15,000.00 15,000.00
279 08/19/2016 NUNUNG 60,000.00 30,000.00 30,000.00
280 ADE MULYANA 70,000.00 35,000.00 35,000.00
281 KOMARIAH 60,000.00 30,000.00 30,000.00
282 DIAN HANIFAH 30,000.00 15,000.00 15,000.00
283 DEWI FATIMAH 30,000.00 15,000.00 15,000.00
284 KEISYA INTANIA N 30,000.00 15,000.00 15,000.00
285 NIKEN JIWA N 25,000.00 12,500.00 12,500.00
286 YUYUN YUNINGSIH 70,000.00 35,000.00 35,000.00
287 SITI ISTIYANI 15,000.00 7,500.00 7,500.00
288 SUPARSI 40,000.00 20,000.00 20,000.00
289 THIERRY DAFFA A 70,000.00 35,000.00 35,000.00
290 JUJU ENDANG WIATI 30,000.00 15,000.00 15,000.00
291 MULYATI 70,000.00 35,000.00 35,000.00
292 DHINI NURUL B 70,000.00 35,000.00 35,000.00
293 SUPARTI 30,000.00 10,000.00 15,000.00 15,000.00
294 NAIFA KHAIRUNISA 70,000.00 35,000.00 35,000.00
295 FARHAN F 30,000.00 15,000.00 15,000.00
296 NAJWA NUR AULIA 30,000.00 15,000.00 15,000.00
297 MUBAROD 15,000.00 7,500.00 7,500.00
298 BETHISE A 70,000.00 35,000.00 35,000.00
299 YAYAN SETIAWAN 30,000.00 15,000.00 15,000.00
300 08/20/2016 PATIH BIRU 70,000.00 35,000.00 35,000.00
301 SARBINI RAIS Drs 70,000.00 35,000.00 35,000.00
302 REDHAN KUSUMA P 70,000.00 35,000.00 35,000.00
303 SUNARDI DIANSAH 70,000.00 35,000.00 35,000.00
304 ARIYANTO 70,000.00 35,000.00 35,000.00
305 PUTRI NAZWA A 70,000.00 35,000.00 35,000.00
306 LORINE LIDWINA L 70,000.00 35,000.00 35,000.00
307 SYURDA O 40,000.00 20,000.00 20,000.00
308 SASKIA HERMANSYAH 35,000.00 17,500.00 17,500.00
309 ATTHIA SHILA G 70,000.00 35,000.00 35,000.00
310 KASMINI 70,000.00 35,000.00 35,000.00
311 ARIFIN ALZAM H.P 70,000.00 35,000.00 35,000.00
312 M ZUFAR RASYID I 70,000.00 35,000.00 35,000.00
313 GITA AMBARWATI 15,000.00 10,000.00 7,500.00 7,500.00
314 AGUS IRWAN K 70,000.00 35,000.00 35,000.00
315 NURHAYATI 30,000.00 15,000.00 15,000.00
316 HAZNI FEBRIYANI 30,000.00 15,000.00 15,000.00
317 08/22/2016 TARTILAH 60,000.00 10,000.00 30,000.00 30,000.00
318 SUSI IRMA SARI 70,000.00 35,000.00 35,000.00
319 IIS HANDAYANI 70,000.00 35,000.00 35,000.00
320 RISKA NOVIANTI 40,000.00 20,000.00 20,000.00
321 TETEN TETILAWATI 70,000.00 35,000.00 35,000.00
322 AA SUARSA 35,000.00 17,500.00 17,500.00
323 MARLINA 60,000.00 10,000.00 30,000.00 30,000.00
324 LINDA 30,000.00 15,000.00 15,000.00
325 IRA 30,000.00 15,000.00 15,000.00
326 TESDAN 15,000.00 10,000.00 7,500.00 7,500.00
327 YULIANTI 70,000.00 35,000.00 35,000.00
328 IKHSAN 30,000.00 15,000.00 15,000.00
329 ARIF 70,000.00 35,000.00 35,000.00
330 NELIFA 70,000.00 35,000.00 35,000.00
331 RELY 30,000.00 15,000.00 15,000.00
332 ROSTINI 15,000.00 10,000.00 7,500.00 7,500.00
333 AGUNG 15,000.00 7,500.00 7,500.00
334 LIUTHFIANI 30,000.00 15,000.00 15,000.00
335 SUDARSIH 30,000.00 15,000.00 15,000.00
336 EFA 15,000.00 7,500.00 7,500.00
337 08/23/2016 RIA 70,000.00 35,000.00 35,000.00
338 SRI N 70,000.00 35,000.00 35,000.00
339 AKBAR 40,000.00 20,000.00 20,000.00
340 NAURA 70,000.00 35,000.00 35,000.00
341 ROSA 70,000.00 35,000.00 35,000.00
342 ADE 30,000.00 15,000.00 15,000.00
343 TAUFIK 70,000.00 35,000.00 35,000.00
344 SUBIATI 30,000.00 15,000.00 15,000.00
345 KORNELIUS 15,000.00 7,500.00 7,500.00
346 YULYANA 15,000.00 10,000.00 7,500.00 7,500.00
347 AIDAH 40,000.00 20,000.00 20,000.00
348 JIMY 70,000.00 35,000.00 35,000.00
349 IWAN 30,000.00 15,000.00 15,000.00
350 ZAIDAN 70,000.00 35,000.00 35,000.00
351 INA K 70,000.00 35,000.00 35,000.00
352 LEONINDA C.A 70,000.00 35,000.00 35,000.00
353 M AKBAR N.A 70,000.00 35,000.00 35,000.00
354 SUCI ROHAETI 60,000.00 10,000.00 30,000.00 30,000.00
355 ESTI JUMARNI 70,000.00 35,000.00 35,000.00
356 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00
357 SABRINA ALMA 35,000.00 17,500.00 17,500.00
358 SHAFIRA INDANA 35,000.00 17,500.00 17,500.00
359 ASTRI PUJI A 60,000.00 10,000.00 30,000.00 30,000.00
360 SUDARTIK 30,000.00 15,000.00 15,000.00
361 ALIYYA R 30,000.00 15,000.00 15,000.00
362 WATI SETIAWATI 70,000.00 35,000.00 35,000.00
363 08/24/2016 IBUT SUKARTI 70,000.00 35,000.00 35,000.00
364 IIS ISMAIL 60,000.00 10,000.00 30,000.00 30,000.00
365 MIMIN AMINAH 60,000.00 10,000.00 30,000.00 30,000.00
366 ACENG TURGANDA 70,000.00 10,000.00 35,000.00 35,000.00
367 TUTI ARIANI 60,000.00 10,000.00 30,000.00 30,000.00
368 DADANG I 70,000.00 35,000.00 35,000.00
369 WULAN WIDIA W 35,000.00 17,500.00 17,500.00
370 AMINAH 40,000.00 20,000.00 20,000.00
371 M FAKHRIAL R 15,000.00 7,500.00 7,500.00
372 SITI FATIMAH 15,000.00 10,000.00 7,500.00 7,500.00
373 NY YAYAH S 15,000.00 7,500.00 7,500.00
374 ALDI ARDIYANSAH W 70,000.00 10,000.00 35,000.00 35,000.00
375 LANIWATI 70,000.00 35,000.00 35,000.00
376 TESA APRIANI 70,000.00 10,000.00 35,000.00 35,000.00
377 SELLY JEDDAYANTI 30,000.00 15,000.00 15,000.00
378 M ROMI R 35,000.00 17,500.00 17,500.00
379 MUTIARA MAYANG S 35,000.00 17,500.00 17,500.00
380 08/25/2016 NERMA 30,000.00 15,000.00 15,000.00
381 JIMY 70,000.00 35,000.00 35,000.00
382 SARBINI 70,000.00 35,000.00 35,000.00
383 SARBINI 70,000.00 35,000.00 35,000.00
384 AYI 30,000.00 15,000.00 15,000.00
385 SRI H 70,000.00 35,000.00 35,000.00
386 SUMARYO 40,000.00 20,000.00 20,000.00
387 IDAH J 15,000.00 10,000.00 7,500.00 7,500.00
388 SRI S 30,000.00 15,000.00 15,000.00
389 WIWIN K 70,000.00 35,000.00 35,000.00
390 NAFIDA 15,000.00 10,000.00 7,500.00 7,500.00
391 MARLIA 30,000.00 15,000.00 15,000.00
392 RIFANI 15,000.00 7,500.00 7,500.00
393 YULIANA 70,000.00 35,000.00 35,000.00
394 WIWI 70,000.00 35,000.00 35,000.00
395 CECEP 30,000.00 15,000.00 15,000.00
396 SRI 30,000.00 15,000.00 15,000.00
397 DYAN DYANNG R 30,000.00 15,000.00 15,000.00
398 SITI ROHAENI 70,000.00 35,000.00 35,000.00
400 SYURDA OR 70,000.00 35,000.00 35,000.00
401 UDIN 70,000.00 35,000.00 35,000.00
402 WIWIN WININGSIH 30,000.00 15,000.00 15,000.00
403 PONIMAN 30,000.00 15,000.00 15,000.00
404 08/26/2016 NIKEN 30,000.00 15,000.00 15,000.00
405 DENI 30,000.00 15,000.00 15,000.00
406 ADE 70,000.00 35,000.00 35,000.00
407 JUJU 70,000.00 35,000.00 35,000.00
408 YAFI 70,000.00 35,000.00 35,000.00
409 SRI R 30,000.00 15,000.00 15,000.00
410 NITA NUR ANITA 70,000.00 35,000.00 35,000.00
411 NUR SALAMAH 35,000.00 17,500.00 17,500.00
412 FARHAN FAHRUROZI 30,000.00 15,000.00 15,000.00
414 JUJU ENDANG W 30,000.00 15,000.00 15,000.00
415 QIZA RIZQI P 30,000.00 15,000.00 15,000.00
416 YAYAN 30,000.00 15,000.00 15,000.00
417 FENI 30,000.00 15,000.00 15,000.00
418 08/27/2016 NOVA FIERANIKA 15,000.00 7,500.00 7,500.00
419 SUNARDI DIANSAH 70,000.00 35,000.00 35,000.00
420 HATI ROHAETI 70,000.00 35,000.00 35,000.00
421 SAFRINA AINI I 70,000.00 35,000.00 35,000.00
422 IKHSAN SADIKIN M 70,000.00 35,000.00 35,000.00
423 ARIF IRWANSYAH 15,000.00 7,500.00 7,500.00
424 SEFANITA S 30,000.00 15,000.00 15,000.00
425 IQBAL Y 35,000.00 17,500.00 17,500.00
426 M YOGI ABDULLAH 30,000.00 15,000.00 15,000.00
427 ARIFIN ALZAM H.P 30,000.00 15,000.00 15,000.00
428 NAJWA NUR AULIA 70,000.00 35,000.00 35,000.00
429 FANI AFNAN J 70,000.00 35,000.00 35,000.00
430 YUDI HERMAWAN 30,000.00 15,000.00 15,000.00
431 K SITI KONA"AH 15,000.00 10,000.00 7,500.00 7,500.00
432 ASOP SOFIAH 30,000.00 15,000.00 15,000.00
433 SARMINI 30,000.00 15,000.00 15,000.00
434 YATNO 70,000.00 35,000.00 35,000.00
435 NENENG 30,000.00 15,000.00 15,000.00
436 NURUL HASANAH 30,000.00 15,000.00 15,000.00
437 SUDARTIK 30,000.00 10,000.00 15,000.00 15,000.00
438 AKMAL SYUKUR Z 30,000.00 15,000.00 15,000.00
439 08/29/2016 IRMAWATI 70,000.00 35,000.00 35,000.00
440 TINI RINJANI 70,000.00 35,000.00 35,000.00
441 HENDRA M 15,000.00 7,500.00 7,500.00
442 IKAH ATIKAH 30,000.00 15,000.00 15,000.00
443 IRFAN MAULANA 60,000.00 30,000.00 30,000.00
444 RISKA NOVIANTI 70,000.00 35,000.00 35,000.00
445 ETI HERAWATI 60,000.00 10,000.00 30,000.00 30,000.00
446 REDHAN KUSUMA P 30,000.00 15,000.00 15,000.00
447 TIARA 70,000.00 35,000.00 35,000.00
448 NINGSIH 70,000.00 35,000.00 35,000.00
449 SUDARSIH 30,000.00 15,000.00 15,000.00
450 LUTHFI 30,000.00 15,000.00 15,000.00
451 AFIANI 30,000.00 15,000.00 15,000.00
452 EMPONG 15,000.00 10,000.00 7,500.00 7,500.00
453 RELY 30,000.00 15,000.00 15,000.00
454 ALHASNI 70,000.00 35,000.00 35,000.00
455 RIDY 30,000.00 15,000.00 15,000.00
456 08/30/2016 AIDAH 70,000.00 35,000.00 35,000.00
457 RIA 70,000.00 35,000.00 35,000.00
458 ROSA 70,000.00 35,000.00 35,000.00
459 RESTU 15,000.00 10,000.00 7,500.00 7,500.00
460 ADE S 30,000.00 15,000.00 15,000.00
461 SRI M 70,000.00 35,000.00 35,000.00
462 MIA 30,000.00 15,000.00 15,000.00
463 NURCAHYO 30,000.00 15,000.00 15,000.00
464 AIP 15,000.00 7,500.00 7,500.00
465 DINAR 30,000.00 15,000.00 15,000.00
466 WIDANINGSIH 15,000.00 10,000.00 7,500.00 7,500.00
467 INA K 30,000.00 15,000.00 15,000.00
468 JIMY 70,000.00 35,000.00 35,000.00
469 ALVITO L.H 30,000.00 15,000.00 15,000.00
470 LINTANG DIRGAHAYU 70,000.00 35,000.00 35,000.00
471 AGUS PERMANA 70,000.00 35,000.00 35,000.00
472 BETHISE ADDU 70,000.00 35,000.00 35,000.00
473 RIYANI SUKMA 70,000.00 35,000.00 35,000.00
474 ZAHRA PUSPITA DEWI 35,000.00 17,500.00 17,500.00
475 ERLAN KANDANI 30,000.00 15,000.00 15,000.00
476 RAHMAN ABDUR 35,000.00 17,500.00 17,500.00
477 NY RENI NURAENI 70,000.00 35,000.00 35,000.00
478 TN DERRY 15,000.00 10,000.00 7,500.00 7,500.00
479 08/31/2016 IRMAWATI 15,000.00 7,500.00 7,500.00
480 HEPPY SEPTIAN 70,000.00 35,000.00 35,000.00
481 SITI SOLEHAH 15,000.00 7,500.00 7,500.00
482 ZULFA NUR FAUZIYAH 35,000.00 17,500.00 17,500.00
483 EVI SYANTI V 70,000.00 35,000.00 35,000.00
484 VINA KHOLIFATUL H 30,000.00 15,000.00 15,000.00
485 MURNIATI 30,000.00 15,000.00 15,000.00
486 AMINAH 70,000.00 35,000.00 35,000.00
487 HENI HERLINA 70,000.00 35,000.00 35,000.00
488 M ATHALLAH NAUFAL 30,000.00 15,000.00 15,000.00
489 NABIL N M 25,000.00 12,500.00 12,500.00
490 FAHIRA 25,000.00 12,500.00 12,500.00
491 M AKBAR N.A 70,000.00 35,000.00 35,000.00
492 LEONINDA CINDY A 70,000.00 35,000.00 35,000.00
493 SUCI ROHAETI 60,000.00 10,000.00 30,000.00 30,000.00
494 HERLIN SUMARLINA 30,000.00 15,000.00 15,000.00
495 RUSLI WARDIAWAN 30,000.00 15,000.00 15,000.00
496 NAURA ASKADINA R 30,000.00 15,000.00 15,000.00
497 SUDARTIK 30,000.00 10,000.00 15,000.00 15,000.00
498 IWAN KUSWANDI 40,000.00 20,000.00 20,000.00
499 LANIWATI 70,000.00 10,000.00 35,000.00 35,000.00
500 NINA JUMAROH 70,000.00 35,000.00 35,000.00
501 FINA GISHA R 35,000.00 17,500.00 17,500.00
502 ESTI JUMARNI 15,000.00 7,500.00 7,500.00
503 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00
504 RAISA Z 70,000.00 35,000.00 35,000.00
505 ALIYA R 40,000.00 20,000.00 20,000.00
506 ARIPUDIN 30,000.00 15,000.00 15,000.00
22,750,000 660,000 11,375,000 11,375,000
JML KET
85,000
25,000
105,000
105,000
55,000
65,000
65,000
205,000
65,000
25,000
55,000
105,000
955,000
65,000
2,005,000
25,000
145,000
25,000
630,000
25,000
405,000
105,000
65,000
65,000
105,000
65,000
70,000
65,000
75,000
105,000
325,000
65,000
65,000
125,000
105,000
205,000
55,000
55,000
185,000
65,000
205,000
55,000
65,000
65,000
25,000
85,000
85,000
25,000
65,000
205,000
7,210,000
JML KET
70,000.00
30,000.00
70,000.00
60,000.00
15,000.00
40,000.00
25,000.00
30,000.00
25,000.00
25,000.00
30,000.00
70,000.00
25,000.00
30,000.00
30,000.00
70,000.00
25,000.00
30,000.00
25,000.00
30,000.00
30,000.00
40,000.00
70,000.00
30,000.00
70,000.00
70,000.00
40,000.00
40,000.00
15,000.00
30,000.00
40,000.00
70,000.00
35,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
30,000.00
15,000.00
70,000.00
30,000.00
70,000.00
30,000.00
30,000.00
15,000.00
25,000.00
30,000.00
25,000.00
30,000.00
35,000.00
70,000.00
25,000.00
70,000.00
70,000.00
40,000.00
35,000.00
35,000.00
40,000.00
80,000.00
30,000.00
25,000.00
30,000.00
70,000.00
70,000.00
30,000.00
70,000.00
35,000.00
30,000.00
30,000.00
30,000.00
35,000.00
60,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
15,000.00
30,000.00
70,000.00
35,000.00
70,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
40,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
40,000.00
70,000.00
30,000.00
30,000.00
35,000.00
30,000.00
70,000.00
40,000.00
70,000.00
70,000.00
35,000.00
25,000.00
70,000.00
40,000.00
70,000.00
70,000.00
70,000.00
70,000.00
35,000.00
70,000.00
70,000.00
70,000.00
40,000.00
15,000.00
30,000.00
70,000.00
30,000.00
30,000.00
15,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
40,000.00
15,000.00
30,000.00
30,000.00
70,000.00
70,000.00
80,000.00
40,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
80,000.00
80,000.00
70,000.00
70,000.00
70,000.00
25,000.00
40,000.00
70,000.00
30,000.00
30,000.00
70,000.00
15,000.00
30,000.00
30,000.00
60,000.00
30,000.00
60,000.00
25,000.00
70,000.00
70,000.00
40,000.00
25,000.00
40,000.00
45,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
40,000.00
15,000.00
40,000.00
70,000.00
70,000.00
35,000.00
70,000.00
70,000.00
30,000.00
30,000.00
15,000.00
30,000.00
70,000.00
70,000.00
25,000.00
70,000.00
70,000.00
30,000.00
30,000.00
15,000.00
15,000.00
30,000.00
35,000.00
30,000.00
70,000.00
25,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
30,000.00
30,000.00
25,000.00
35,000.00
15,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
35,000.00
30,000.00
30,000.00
70,000.00
60,000.00
70,000.00
70,000.00
70,000.00
30,000.00
15,000.00
15,000.00
70,000.00
15,000.00
30,000.00
15,000.00
30,000.00
70,000.00
35,000.00
70,000.00
70,000.00
70,000.00
15,000.00
35,000.00
30,000.00
25,000.00
70,000.00
70,000.00
70,000.00
80,000.00
40,000.00
30,000.00
40,000.00
30,000.00
30,000.00
30,000.00
30,000.00
25,000.00
70,000.00
25,000.00
25,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
70,000.00
30,000.00
40,000.00
70,000.00
30,000.00
15,000.00
30,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
35,000.00
70,000.00
30,000.00
30,000.00
30,000.00
60,000.00
70,000.00
60,000.00
30,000.00
30,000.00
30,000.00
25,000.00
70,000.00
15,000.00
40,000.00
70,000.00
30,000.00
70,000.00
70,000.00
40,000.00
70,000.00
30,000.00
30,000.00
15,000.00
70,000.00
30,000.00
70,000.00
70,000.00
45,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
35,000.00
70,000.00
70,000.00
70,000.00
70,000.00
25,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
40,000.00
70,000.00
35,000.00
70,000.00
30,000.00
30,000.00
25,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
25,000.00
15,000.00
30,000.00
30,000.00
15,000.00
70,000.00
70,000.00
40,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
15,000.00
25,000.00
40,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
35,000.00
35,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
80,000.00
70,000.00
70,000.00
35,000.00
40,000.00
15,000.00
25,000.00
15,000.00
80,000.00
70,000.00
80,000.00
30,000.00
35,000.00
35,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
40,000.00
25,000.00
30,000.00
70,000.00
25,000.00
30,000.00
15,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
35,000.00
30,000.00
70,000.00
30,000.00
30,000.00
30,000.00
30,000.00
15,000.00
70,000.00
70,000.00
70,000.00
70,000.00
15,000.00
30,000.00
35,000.00
30,000.00
30,000.00
70,000.00
70,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
40,000.00
30,000.00
70,000.00
70,000.00
15,000.00
30,000.00
60,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
25,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
25,000.00
30,000.00
70,000.00
30,000.00
30,000.00
15,000.00
30,000.00
25,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
35,000.00
30,000.00
35,000.00
70,000.00
25,000.00
15,000.00
70,000.00
15,000.00
35,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
30,000.00
25,000.00
25,000.00
70,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
40,000.00
40,000.00
80,000.00
70,000.00
35,000.00
15,000.00
30,000.00
70,000.00
40,000.00
30,000.00
23,405,000 -
JASA ALAT &

DOKTER BAHAN
1 9/1/2016 NURPALAH 20,000 5,000 10,000 10,000
2 TITIK S 200,000 5,000 100,000 100,000
3 9/2/2016 NY DESTI 50,000 5,000 25,000 25,000
4 9/3/2016 NY EUIS 60,000 5,000 30,000 30,000
5 9/5/2016 NURPALAH 120,000 5,000 60,000 60,000
6 9/6/2016 WAHYUNINGSIH 20,000 5,000 10,000 10,000
7 ARI 20,000 5,000 10,000 10,000
8 DWI D 300,000 5,000 150,000 150,000
9 9/7/2016 TN ADE EFENDI 150,000 5,000 75,000 75,000
10 9/10/2016 TN CAHYANA 20,000 5,000 10,000 10,000
11 ARINA 50,000 5,000 25,000 25,000
12 USEP JUNAEDI 160,000 5,000 80,000 80,000
13 9/14/2016 TN ARIFIN 20,000 5,000 10,000 10,000
14 NY SUCI 100,000 5,000 50,000 50,000
15 YOGI TRI S 100,000 5,000 50,000 50,000
16 NY EUIS 60,000 5,000 30,000 30,000
17 NY SARMINI 100,000 5,000 50,000 50,000
18 9/16/2016 NY WULAN 50,000 5,000 25,000 25,000
19 9/17/2016 NITA 200,000 5,000 100,000 100,000
20 TABITA 60,000 5,000 30,000 30,000
21 9/18/2016 ANGGI 50,000 5,000 25,000 25,000
22 ANGGUN 50,000 5,000 25,000 25,000
23 9/20/2016 NURAINI 750,000 5,000 375,000 375,000
24 9/21/2016 RANI K 20,000 5,000 10,000 10,000
25 DAMAR 80,000 5,000 40,000 40,000
26 KAKA K 120,000 5,000 60,000 60,000
27 9/24/2016 UMI YUNIARTI 60,000 5,000 30,000 30,000
28 HENI 360,000 5,000 180,000 180,000
29 9/26/2016 TN SUDIH 70,000 5,000 35,000 35,000
30 TN ASEP N 20,000 5,000 10,000 10,000
31 SALSABILA 20,000 5,000 10,000 10,000
32 9/27/2106 INA KUSTIANA 150,000 5,000 75,000 75,000
33 GITA NURAINI 20,000 5,000 10,000 10,000
34 NY EUIS 60,000 5,000 30,000 30,000
35 9/28/2016 KAKA K 60,000 5,000 30,000 30,000
36 9/30/2016 SANIA 100,000 5,000 50,000 50,000
37 HARSINI 200,000 5,000 100,000 100,000
38 SALSABILA 60,000 5,000 30,000 30,000
4,110,000 190,000 2,055,000 2,055,000

JASA ALAT &
TGL NAMA TARIF OBAT
DOKTER BAHAN
1 1/9/2016 WIDIAH H 30,000.00 15,000.00 15,000.00
2 SRI RUSMIATI 30,000.00 15,000.00 15,000.00
3 NELITA SRI SUSANTI 70,000.00 35,000.00 35,000.00
4 SRI SUSANTI 30,000.00 15,000.00 15,000.00
5 SUMARYA 70,000.00 35,000.00 35,000.00
6 SITI NURJANA 30,000.00 15,000.00 15,000.00
7 AKBAR N 30,000.00 15,000.00 15,000.00
8 YULIANA 70,000.00 35,000.00 35,000.00
9 NANNY SUMARNI 15,000.00 7,500.00 7,500.00
10 ANITA YUSUF 15,000.00 7,500.00 7,500.00
11 SRI HIDAYATI 30,000.00 15,000.00 15,000.00
12 WIWIN K 70,000.00 35,000.00 35,000.00
13 TATANG H 70,000.00 35,000.00 35,000.00
14 JIMMY 70,000.00 35,000.00 35,000.00
15 SELY J 30,000.00 15,000.00 15,000.00
16 ELIS M 30,000.00 15,000.00 15,000.00
17 DYAN DYANING R 30,000.00 15,000.00 15,000.00
18 MUTIARA M S 30,000.00 15,000.00 15,000.00
19 PONIMAN 30,000.00 15,000.00 15,000.00
20 BERLIANA AZARI 30,000.00 15,000.00 15,000.00
21 ALDI ARDIANSYAH N 60,000.00 10,000.00 30,000.00 30,000.00
22 TESA APRIANI 30,000.00 15,000.00 15,000.00
23 ABDUR RAHMAN S 30,000.00 10,000.00 15,000.00 15,000.00
24 LISDA MAGDALENA 30,000.00 15,000.00 15,000.00
25 KASMINI 35,000.00 17,500.00 17,500.00
26 TITIK SUSILONINGSIH 15,000.00 7,500.00 7,500.00
27 2/9/2016 AI RITA S 30,000.00 15,000.00 15,000.00
28 ALMAIDA N 15,000.00 10,000.00 7,500.00 7,500.00
29 SRI RUSMIATI 30,000.00 15,000.00 15,000.00
30 SRI L 70,000.00 35,000.00 35,000.00
31 SRIWATI 15,000.00 7,500.00 7,500.00
32 HOERIAH 15,000.00 7,500.00 7,500.00
33 FANSY 30,000.00 15,000.00 15,000.00
34 EKO 15,000.00 7,500.00 7,500.00
35 YATI 30,000.00 15,000.00 15,000.00
36 TONNY 70,000.00 35,000.00 35,000.00
38 FARHAN F 40,000.00 20,000.00 20,000.00
39 NUR SALAMAH 35,000.00 17,500.00 17,500.00
40 AGUS IRWAN 70,000.00 35,000.00 35,000.00
41 M AGUNG P P 30,000.00 15,000.00 15,000.00
42 DESI 70,000.00 35,000.00 35,000.00
43 ERIYANTI 70,000.00 35,000.00 35,000.00
44 M ZUFAR R 70,000.00 35,000.00 35,000.00
45 NURHAYATI 30,000.00 15,000.00 15,000.00
46 BUNGA DWI A P 70,000.00 35,000.00 35,000.00
47 NUNUNG 15,000.00 10,000.00 7,500.00 7,500.00
48 YUDHA G 30,000.00 15,000.00 15,000.00
49 SYAFA NUR A 35,000.00 17,500.00 17,500.00
50 GINA SILVIA 70,000.00 35,000.00 35,000.00
51 NURUL HASANAH 30,000.00 15,000.00 15,000.00
52 3/9/2016 KOSIM DIMYATI 30,000.00 15,000.00 15,000.00
53 ELCHASABRINA 30,000.00 15,000.00 15,000.00
54 GILANG P GUMELAR 30,000.00 15,000.00 15,000.00
55 INTAN NUR AENIE 15,000.00 10,000.00 7,500.00 7,500.00
56 NABILA W 30,000.00 15,000.00 15,000.00
57 HATI ROHAETI 30,000.00 15,000.00 15,000.00
58 SHAFRINA A I 70,000.00 35,000.00 35,000.00
59 YUDI HERMAWAN 30,000.00 15,000.00 15,000.00
60 ATHIA SHILA 35,000.00 17,500.00 17,500.00
61 M FAUZAN A 30,000.00 15,000.00 15,000.00
62 MARLINA 15,000.00 10,000.00 7,500.00 7,500.00
63 RUSMANA 30,000.00 15,000.00 15,000.00
64 FITHRI N 30,000.00 15,000.00 15,000.00
65 ROS AMINAH 70,000.00 35,000.00 35,000.00
66 5/9/2016 HANI NURHAENI 70,000.00 35,000.00 35,000.00
67 ABNUN BURAMIN 30,000.00 10,000.00 15,000.00 15,000.00
68 SARWOKO 30,000.00 15,000.00 15,000.00
69 DEWI CANTIKA 60,000.00 10,000.00 30,000.00 30,000.00
70 ESTI JUMARNI 60,000.00 10,000.00 30,000.00 30,000.00
71 EPI ROBIATI 60,000.00 10,000.00 30,000.00 30,000.00
72 INDRA ABDAL H 70,000.00 35,000.00 35,000.00
73 AA SUARSA 30,000.00 10,000.00 15,000.00 15,000.00
74 M LUTHFI YASIN 70,000.00 35,000.00 35,000.00
75 AISHA 15,000.00 7,500.00 7,500.00
76 MILANIS 70,000.00 35,000.00 35,000.00
77 DANIA 70,000.00 35,000.00 35,000.00
78 DANIA 70,000.00 35,000.00 35,000.00
79 IRVAN 70,000.00 35,000.00 35,000.00
80 TIARA 70,000.00 35,000.00 35,000.00
81 SUDARSIH 30,000.00 15,000.00 15,000.00
82 LUTHFI 30,000.00 15,000.00 15,000.00
83 RELY 30,000.00 15,000.00 15,000.00
84 HASBY 70,000.00 35,000.00 35,000.00
85 PONIDJO 70,000.00 35,000.00 35,000.00
86 6/9/2016 INA 30,000.00 15,000.00 15,000.00
87 JIMMY 70,000.00 35,000.00 35,000.00
88 RAFA 25,000.00 12,500.00 12,500.00
89 WIDAYUDI 70,000.00 35,000.00 35,000.00
90 DINAR 30,000.00 15,000.00 15,000.00
91 ADI 30,000.00 15,000.00 15,000.00
92 CECEP 30,000.00 15,000.00 15,000.00
93 NURCAHYO 70,000.00 35,000.00 35,000.00
94 SRI M 70,000.00 35,000.00 35,000.00
95 KESTO 30,000.00 15,000.00 15,000.00
96 RIA 70,000.00 35,000.00 35,000.00
97 WIWIN 30,000.00 15,000.00 15,000.00
98 RICKY 30,000.00 15,000.00 15,000.00
99 APONG NURUL H 70,000.00 35,000.00 35,000.00
100 FARHAN F 70,000.00 35,000.00 35,000.00
101 ALYSSA T.P 35,000.00 17,500.00 17,500.00
102 RIZKI Z A S 30,000.00 15,000.00 15,000.00
103 ASOP SOFIAH 30,000.00 15,000.00 15,000.00
104 BUNGA OLIVIA R 35,000.00 17,500.00 17,500.00
105 DEWITRI JAYA 70,000.00 35,000.00 35,000.00
106 ERLAN KANDANI 30,000.00 15,000.00 15,000.00
107 ANGGI PRIATNA F 70,000.00 35,000.00 35,000.00
108 SUPARSI 30,000.00 15,000.00 15,000.00
109 7/9/2016 AHMAD YUSUF 70,000.00 35,000.00 35,000.00
110 MURNIATI 30,000.00 15,000.00 15,000.00
111 SISMITIN 15,000.00 10,000.00 7,500.00 7,500.00
112 HERLIN SUMARLINA 60,000.00 10,000.00 30,000.00 30,000.00
113 HENDRA MAHDAR 60,000.00 10,000.00 30,000.00 30,000.00
114 ALEXA COREN I 70,000.00 35,000.00 35,000.00
115 RENI NURAENI 30,000.00 15,000.00 15,000.00
116 BISMA EIRLANGGA 70,000.00 35,000.00 35,000.00
117 KELLI ARIFAN S 70,000.00 35,000.00 35,000.00
118 PRIYADI 70,000.00 35,000.00 35,000.00
119 SHOBRINA A N H 35,000.00 17,500.00 17,500.00
120 JUJU ENDANG W 40,000.00 20,000.00 20,000.00
121 KANIA 70,000.00 35,000.00 35,000.00
122 LANIWATI 70,000.00 35,000.00 35,000.00
123 IDA JUBAEDA 30,000.00 15,000.00 15,000.00
124 8/9/2016 NERMA 30,000.00 15,000.00 15,000.00
125 SRI HIDAYATI 30,000.00 15,000.00 15,000.00
126 YAYA 15,000.00 7,500.00 7,500.00
127 JIMMY 70,000.00 35,000.00 35,000.00
128 WIDYAH 30,000.00 15,000.00 15,000.00
129 YULIANA 70,000.00 35,000.00 35,000.00
130 ANI N 15,000.00 7,500.00 7,500.00
131 SUMARYO 70,000.00 35,000.00 35,000.00
132 MARLIA 30,000.00 15,000.00 15,000.00
133 SELY J 30,000.00 15,000.00 15,000.00
134 ROSA 30,000.00 15,000.00 15,000.00
135 REFLY 15,000.00 7,500.00 7,500.00
136 SRI SUSANTI 30,000.00 15,000.00 15,000.00
137 UJANG 15,000.00 10,000.00 7,500.00 7,500.00
138 SRI R 30,000.00 15,000.00 15,000.00
139 RADJA JORDAN 35,000.00 17,500.00 17,500.00
140 ALVITO L H 30,000.00 15,000.00 15,000.00
141 AKBAR NUGRAHA 30,000.00 15,000.00 15,000.00
142 REDHAN KUSUMA P 30,000.00 15,000.00 15,000.00
143 RIZKI DWI N 70,000.00 35,000.00 35,000.00
144 KASMINI 70,000.00 35,000.00 35,000.00
145 DEDE J 15,000.00 10,000.00 7,500.00 7,500.00
146 NELLY SYARIFAH 70,000.00 35,000.00 35,000.00
147 9/9/2016 SRI R 30,000.00 15,000.00 15,000.00
148 NIKEN 30,000.00 15,000.00 15,000.00
149 NURSIDA 15,000.00 10,000.00 7,500.00 7,500.00
150 MIFTAHUL H 70,000.00 35,000.00 35,000.00
151 DWI F 30,000.00 15,000.00 15,000.00
152 SALWA 15,000.00 7,500.00 7,500.00
153 NY TETI 70,000.00 10,000.00 35,000.00 35,000.00
154 TRIAWAN 70,000.00 10,000.00 35,000.00 35,000.00
155 PUNGUT 70,000.00 35,000.00 35,000.00
156 M RAYAN 70,000.00 35,000.00 35,000.00
157 YATI 30,000.00 15,000.00 15,000.00
158 VANNYA 30,000.00 15,000.00 15,000.00
159 IDAH J 70,000.00 35,000.00 35,000.00
160 YUYUN N 30,000.00 15,000.00 15,000.00
161 FENI 30,000.00 15,000.00 15,000.00
162 NADZAR N 15,000.00 7,500.00 7,500.00
163 LISDA 30,000.00 10,000.00 15,000.00 15,000.00
164 QIZA 70,000.00 35,000.00 35,000.00
165 ARIFIN 30,000.00 15,000.00 15,000.00
166 TUTI N 70,000.00 35,000.00 35,000.00
167 MUFI 30,000.00 15,000.00 15,000.00
168 FENI A 30,000.00 15,000.00 15,000.00
169 RISJA 30,000.00 15,000.00 15,000.00
170 ISNAWATI 70,000.00 35,000.00 35,000.00
171 10/9/2016 ASOP SOFIYAH 30,000.00 15,000.00 15,000.00
172 ABUN BUNAMIN 30,000.00 15,000.00 15,000.00
173 OKSILIA A B 30,000.00 15,000.00 15,000.00
174 NABIL W 30,000.00 15,000.00 15,000.00
175 HATI ROHAETI 30,000.00 15,000.00 15,000.00
176 SHAFRINA AINI I 70,000.00 35,000.00 35,000.00
177 SISMITIN 15,000.00 10,000.00 7,500.00 7,500.00
178 KOSIM DIMYATI 70,000.00 35,000.00 35,000.00
179 GILANG P GUMELAR 30,000.00 15,000.00 15,000.00
180 SUKMAYA 15,000.00 10,000.00 7,500.00 7,500.00
181 ARIF IRWANSYAH 15,000.00 7,500.00 7,500.00
182 SRI LESTARI 70,000.00 35,000.00 35,000.00
183 INTAN NUR AENIE 15,000.00 10,000.00 7,500.00 7,500.00
184 K SITI KONA'AH 60,000.00 30,000.00 30,000.00
185 MUDJIATI 30,000.00 10,000.00 15,000.00 15,000.00
186 AKMAL SYUKUR Z 30,000.00 15,000.00 15,000.00
187 MEILIANA KARUNIA D 70,000.00 35,000.00 35,000.00
188 DINA N 35,000.00 17,500.00 17,500.00
189 USEP JUNAEDI 15,000.00 7,500.00 7,500.00
190 TN YATNO 70,000.00 35,000.00 35,000.00
191 NY SARMINI 30,000.00 15,000.00 15,000.00
192 SUDARTIK 30,000.00 15,000.00 15,000.00
193 RUSMANA 15,000.00 7,500.00 7,500.00
194 FITHRI N 30,000.00 15,000.00 15,000.00
195 09/13/2016 LIA 30,000.00 15,000.00 15,000.00
196 RESTU 30,000.00 15,000.00 15,000.00
197 WIDANINGSIH 70,000.00 35,000.00 35,000.00
198 ANI 30,000.00 15,000.00 15,000.00
199 LYONI 30,000.00 15,000.00 15,000.00
200 ADE S 40,000.00 20,000.00 20,000.00
201 TURGANA 15,000.00 10,000.00 7,500.00 7,500.00
202 WIDYANTI 70,000.00 35,000.00 35,000.00
203 EVI SRI MARTINI 70,000.00 35,000.00 35,000.00
204 NURCAHYO 30,000.00 15,000.00 15,000.00
205 RIA SRI RAHAYU 70,000.00 35,000.00 35,000.00
206 NABIL N M 25,000.00 12,500.00 12,500.00
207 NUR HANIFAH 15,000.00 7,500.00 7,500.00
208 SRI SYARIFAH 30,000.00 10,000.00 15,000.00 15,000.00
209 INA 40,000.00 20,000.00 20,000.00
210 IRVAN VASTIANA S 70,000.00 35,000.00 35,000.00
211 HERLINDA SEPTIANTI 70,000.00 35,000.00 35,000.00
212 ALEXA COREN I 35,000.00 17,500.00 17,500.00
213 YUDI HERMAWAN 30,000.00 15,000.00 15,000.00
214 JUARIAH 70,000.00 35,000.00 35,000.00
215 SIAWANTO NUGROHO 70,000.00 35,000.00 35,000.00
216 MILANIS BITUING H 70,000.00 35,000.00 35,000.00
217 DYAN DYANING P 30,000.00 15,000.00 15,000.00
218 M ZUFAR R I 30,000.00 15,000.00 15,000.00
219 NURHAYATI 30,000.00 15,000.00 15,000.00
220 AGUS IRWAN 70,000.00 35,000.00 35,000.00
221 SURYONO 15,000.00 10,000.00 7,500.00 7,500.00
222 ERWIN ADI SANTOSO 70,000.00 35,000.00 35,000.00
223 WILDAN ALFI G 35,000.00 17,500.00 17,500.00
224 ERLAN KANDANI 40,000.00 20,000.00 20,000.00
225 NUR SALAMAH 35,000.00 17,500.00 17,500.00
226 09/14/2016 HERLIN SUMARLINA 30,000.00 15,000.00 15,000.00
227 SITI HODIJAH 70,000.00 35,000.00 35,000.00
228 NENI HERLINA D 15,000.00 7,500.00 7,500.00
229 VINA KHOLIFATUL H 70,000.00 35,000.00 35,000.00
230 IIM HALIMAH 70,000.00 35,000.00 35,000.00
231 SISMITIN 15,000.00 7,500.00 7,500.00
232 MURNIATI 40,000.00 20,000.00 20,000.00
233 SAHALA OBAN S 35,000.00 17,500.00 17,500.00
234 AI RITA SOFIA 30,000.00 15,000.00 15,000.00
235 LINA MARLINA 15,000.00 10,000.00 7,500.00 7,500.00
236 SOFI MARIAWATI 15,000.00 10,000.00 7,500.00 7,500.00
237 LURI RAHMAWATI 30,000.00 15,000.00 15,000.00
239 ELCHA SABRINA 30,000.00 15,000.00 15,000.00
240 AI OKA 15,000.00 10,000.00 7,500.00 7,500.00
241 MUTIARA H.P 35,000.00 17,500.00 17,500.00
242 RISA AFRIANI 70,000.00 35,000.00 35,000.00
243 LANIWATI 15,000.00 10,000.00 7,500.00 7,500.00
244 RINI SURYANI 15,000.00 10,000.00 7,500.00 7,500.00
245 ERVINA A.P 30,000.00 15,000.00 15,000.00
246 ROS AMINAH 15,000.00 10,000.00 7,500.00 7,500.00
247 ASEP B.SUDARSONO 30,000.00 15,000.00 15,000.00
248 09/15/2016 NERMA FEBRIYANTI 40,000.00 20,000.00 20,000.00
249 SRI HIDAYATI 30,000.00 15,000.00 15,000.00
250 AZAHRA ANANDA P 30,000.00 15,000.00 15,000.00
251 WIWIN W 30,000.00 15,000.00 15,000.00
252 REDJEKI BOEDHI 70,000.00 35,000.00 35,000.00
253 SELY JEDAYANTI 30,000.00 15,000.00 15,000.00
254 YULIANA LESTARI 70,000.00 35,000.00 35,000.00
255 YAYA MS 15,000.00 10,000.00 7,500.00 7,500.00
256 FAKHRI PRATAMA 25,000.00 12,500.00 12,500.00
257 DEDE RAKIB 70,000.00 10,000.00 35,000.00 35,000.00
258 SUMARYO 70,000.00 35,000.00 35,000.00
259 UJANG 30,000.00 15,000.00 15,000.00
260 WIDYAH 40,000.00 20,000.00 20,000.00
261 SOEYADI 15,000.00 7,500.00 7,500.00
262 MEITA 15,000.00 10,000.00 7,500.00 7,500.00
263 ILHAM MULYANA 35,000.00 17,500.00 17,500.00
264 FATHIR HASAN AL.M 30,000.00 10,000.00 15,000.00 15,000.00
265 PONIMAN 30,000.00 10,000.00 15,000.00 15,000.00
266 JULIANA 15,000.00 7,500.00 7,500.00
267 RELY SUGIARTI 30,000.00 10,000.00 15,000.00 15,000.00
268 PUTRA WAHYU RAMADAN 70,000.00 35,000.00 35,000.00
269 NAYLA T.N 70,000.00 35,000.00 35,000.00
270 ALYA SITI N 30,000.00 10,000.00 15,000.00 15,000.00
271 JEJEH JUMIYATI 70,000.00 35,000.00 35,000.00
272 ESTI A.N 15,000.00 10,000.00 7,500.00 7,500.00
273 09/16/2016 MIFTAHUL HUSNA 70,000.00 35,000.00 35,000.00
274 SRI RAHAYU 30,000.00 15,000.00 15,000.00
275 IWAN KUSWANDI 70,000.00 35,000.00 35,000.00
276 SRI SUSANTI 30,000.00 15,000.00 15,000.00
277 PUNGUT 70,000.00 35,000.00 35,000.00
278 IRMAYANTI 15,000.00 10,000.00 7,500.00 7,500.00
279 GLADYSA M.S 15,000.00 7,500.00 7,500.00
280 ELIS J 70,000.00 35,000.00 35,000.00
281 YAFI ALIFUDIN 40,000.00 20,000.00 20,000.00
282 ENDANG SUPRIATNA 30,000.00 15,000.00 15,000.00
283 SRI RUSMIATI 30,000.00 15,000.00 15,000.00
285 DADANG ROMANSYAH 70,000.00 35,000.00 35,000.00
286 DEWITRI JAYA 70,000.00 35,000.00 35,000.00
287 HUSNA SHOFIA A 70,000.00 35,000.00 35,000.00
288 MUBAROD 30,000.00 15,000.00 15,000.00
289 RICKY M.R 30,000.00 15,000.00 15,000.00
290 M.AGUNG P.P 35,000.00 17,500.00 17,500.00
291 HANIFA FATIYA A 15,000.00 7,500.00 7,500.00
292 INA F 15,000.00 10,000.00 7,500.00 7,500.00
293 MASRINGSIH 15,000.00 10,000.00 7,500.00 7,500.00
294 YAYAN S 30,000.00 15,000.00 15,000.00
295 09/17/2016 AKBAR N 30,000.00 15,000.00 15,000.00
296 ASOP SOFYAH 30,000.00 15,000.00 15,000.00
297 DE FATHAN N 35,000.00 17,500.00 17,500.00
298 SUHARSONO 70,000.00 35,000.00 35,000.00
299 MARLINA 15,000.00 10,000.00 7,500.00 7,500.00
300 LORINE L.L 70,000.00 35,000.00 35,000.00
301 REDHAN KUSUMA P 30,000.00 15,000.00 15,000.00
302 IKA BUDI U 15,000.00 7,500.00 7,500.00
303 MINA SARIATI 30,000.00 15,000.00 15,000.00
304 ARIFIN A.H.P 30,000.00 15,000.00 15,000.00
305 BUNGA O.R 35,000.00 17,500.00 17,500.00
306 GILANG P.GUMELAR 30,000.00 15,000.00 15,000.00
307 LISDA 40,000.00 20,000.00 20,000.00
308 M.ALFAUZAN 15,000.00 10,000.00 7,500.00 7,500.00
309 ATHIA SHILA G 35,000.00 17,500.00 17,500.00
310 BAYU SOLAHUDIN 35,000.00 17,500.00 17,500.00
311 ELSA AGUSTIN 35,000.00 17,500.00 17,500.00
312 DIDARIKA 70,000.00 35,000.00 35,000.00
313 KASMINI 70,000.00 35,000.00 35,000.00
314 DELIA SALSADILA 30,000.00 15,000.00 15,000.00
315 SITA ALIF FATONAH 70,000.00 10,000.00 35,000.00 35,000.00
316 SELLY AYUNDA P 30,000.00 15,000.00 15,000.00
317 WIDIYA H 15,000.00 10,000.00 7,500.00 7,500.00
318 09/19/2016 MUDIJAH 60,000.00 30,000.00 30,000.00
319 KASIYEM 70,000.00 35,000.00 35,000.00
320 ABUN BUNYAMIN 70,000.00 35,000.00 35,000.00
321 LUTFIANI NUR SHAFA 40,000.00 20,000.00 20,000.00
322 SUDARSIH 40,000.00 20,000.00 20,000.00
323 AFIANI A.S 70,000.00 35,000.00 35,000.00
324 ELA K 70,000.00 35,000.00 35,000.00
325 ALHABSI R 70,000.00 35,000.00 35,000.00
326 FAUZIAN S 35,000.00 17,500.00 17,500.00
327 DIDI R 30,000.00 15,000.00 15,000.00
328 09/20/2016 LIA R.D 70,000.00 35,000.00 35,000.00
329 ANTONIUS S 30,000.00 15,000.00 15,000.00
330 ADE S 70,000.00 35,000.00 35,000.00
331 SRI S 30,000.00 15,000.00 15,000.00
332 SRI W 30,000.00 15,000.00 15,000.00
333 THERENA 70,000.00 35,000.00 35,000.00
334 WIDANINGSIH 70,000.00 35,000.00 35,000.00
335 RETNO N 70,000.00 35,000.00 35,000.00
336 RIA 70,000.00 35,000.00 35,000.00
337 NURCAHYA 30,000.00 15,000.00 15,000.00
338 ATANG 60,000.00 30,000.00 30,000.00
339 LISDA 15,000.00 10,000.00 7,500.00 7,500.00
340 SUPARSI 30,000.00 15,000.00 15,000.00
341 SRI LESTARI 70,000.00 35,000.00 35,000.00
342 HATI ROHAETI 40,000.00 20,000.00 20,000.00
343 SHAFRINA A.I 70,000.00 35,000.00 35,000.00
344 NABILA W 30,000.00 15,000.00 15,000.00
345 DEDE JATNIKA 30,000.00 15,000.00 15,000.00
346 ALYA NUR M 35,000.00 17,500.00 17,500.00
347 ERLAN KANDANI 70,000.00 35,000.00 35,000.00
348 FENI AYU 30,000.00 15,000.00 15,000.00
350 TURGANA 15,000.00 10,000.00 7,500.00 7,500.00
351 LURI RAHMAWATI 40,000.00 20,000.00 20,000.00
352 ANI JUARNI 60,000.00 10,000.00 30,000.00 30,000.00
353 SITI HODIJAH 15,000.00 10,000.00 7,500.00 7,500.00
354 NENI HERLINA 30,000.00 15,000.00 15,000.00
355 IIM HALIMAH 70,000.00 35,000.00 35,000.00
356 MURNIATI 70,000.00 35,000.00 35,000.00
357 RAISA AZZAHRA 30,000.00 15,000.00 15,000.00
359 NURHAYATI 30,000.00 15,000.00 15,000.00
360 AGUS IQWAN K 70,000.00 35,000.00 35,000.00
361 LANIWATI 30,000.00 15,000.00 15,000.00
362 BERLIANA AZARI 30,000.00 15,000.00 15,000.00
363 KANIA I 30,000.00 10,000.00 15,000.00 15,000.00
364 MIMING M 15,000.00 10,000.00 7,500.00 7,500.00
365 AHMAD YUSUF 70,000.00 35,000.00 35,000.00
366 ELIS SUPARTINI 70,000.00 35,000.00 35,000.00
367 ROS AMINAH 30,000.00 15,000.00 15,000.00
368 SANDI 15,000.00 10,000.00 7,500.00 7,500.00
369 ANAK BP SANDI 30,000.00 15,000.00 15,000.00
370 TONNY C.H 70,000.00 35,000.00 35,000.00
371 09/22/2016 SUBARDI 60,000.00 30,000.00 30,000.00
372 SRI HIDAYATI 40,000.00 20,000.00 20,000.00
373 HADI HIDAYAT 30,000.00 15,000.00 15,000.00
374 SELY JEDAYANTI 30,000.00 15,000.00 15,000.00
375 SEPTIA H 25,000.00 12,500.00 12,500.00
376 WIWIN K 15,000.00 7,500.00 7,500.00
377 DEVI ANDRIYANA 60,000.00 10,000.00 30,000.00 30,000.00
378 MUTIARA MAYANG S 30,000.00 15,000.00 15,000.00
379 SUNARIAH NURUL 30,000.00 10,000.00 15,000.00 15,000.00
380 UJANG R 30,000.00 15,000.00 15,000.00
381 FATHIR HASAN AL 30,000.00 10,000.00 15,000.00 15,000.00
382 RACHEL Z.H 25,000.00 12,500.00 12,500.00
383 DIYAN DYANING R 30,000.00 15,000.00 15,000.00
384 YESI N 60,000.00 10,000.00 30,000.00 30,000.00
385 09/23/2016 VIRNI 35,000.00 17,500.00 17,500.00
386 EUIS NELA 15,000.00 7,500.00 7,500.00
387 SRI RAHAYU 70,000.00 35,000.00 35,000.00
388 MULYADI 70,000.00 35,000.00 35,000.00
389 RAHTI R 70,000.00 35,000.00 35,000.00
390 DEWI F 70,000.00 35,000.00 35,000.00
391 SRI S 70,000.00 35,000.00 35,000.00
392 TAHTIK 70,000.00 35,000.00 35,000.00
393 DANIA 15,000.00 7,500.00 7,500.00
394 YAFI A 30,000.00 15,000.00 15,000.00
395 SITI ALFIDI 60,000.00 30,000.00 30,000.00
396 M.ALFAUZAN 70,000.00 35,000.00 35,000.00
397 KIRANI AHSANA R 40,000.00 20,000.00 20,000.00
398 MIRHAN AULIA 35,000.00 17,500.00 17,500.00
399 SHERINE A.A.H 70,000.00 35,000.00 35,000.00
400 MILANIS BITUING H 70,000.00 35,000.00 35,000.00
401 ELCHA SABRINA 30,000.00 15,000.00 15,000.00
402 DADANG ROMANSYAH 70,000.00 35,000.00 35,000.00
404 BETHISE ADU 70,000.00 35,000.00 35,000.00
405 ALEXA CAREN I 35,000.00 17,500.00 17,500.00
406 MEISYA DAMAYANTI 35,000.00 17,500.00 17,500.00
407 PONIMAN 30,000.00 15,000.00 15,000.00
408 NABILA SYIFA 30,000.00 15,000.00 15,000.00
409 YUNI APRIDA 30,000.00 15,000.00 15,000.00
410 AKBAR NUGRAHA 30,000.00 15,000.00 15,000.00
411 09/24/2016 NOVI ANGGRAENI 15,000.00 10,000.00 7,500.00 7,500.00
412 ASOP SOFIYAH 30,000.00 15,000.00 15,000.00
413 JUJU ENDANG W 70,000.00 35,000.00 35,000.00
414 SHOBRINA A N H 35,000.00 17,500.00 17,500.00
415 SUNARIDA NURUL 30,000.00 15,000.00 15,000.00
416 HOERIAH 15,000.00 7,500.00 7,500.00
417 SISMITIN 35,000.00 10,000.00 17,500.00 17,500.00
418 RIA FRETIANI 30,000.00 15,000.00 15,000.00
419 YUSUP HIDAYAT 15,000.00 7,500.00 7,500.00
420 ELIS JUNIANINGSIH 70,000.00 35,000.00 35,000.00
421 NURHAYATI 30,000.00 15,000.00 15,000.00
422 AIRA S.H 15,000.00 7,500.00 7,500.00
423 SUPRIATNA 60,000.00 10,000.00 30,000.00 30,000.00
424 YUDI HERMAWAN 40,000.00 20,000.00 20,000.00
425 MEILANA K.D 70,000.00 35,000.00 35,000.00
426 AKMAL SYUKUR Z 70,000.00 35,000.00 35,000.00
427 HATI ROHAETI 70,000.00 35,000.00 35,000.00
428 SHAFRINA AINI I 70,000.00 35,000.00 35,000.00
429 YATNO 70,000.00 35,000.00 35,000.00
430 SARMINI 40,000.00 10,000.00 20,000.00 20,000.00
431 M ELBY SEBASTIAN 30,000.00 15,000.00 15,000.00
432 FITHRI N 15,000.00 7,500.00 7,500.00
433 ESTI 15,000.00 10,000.00 7,500.00 7,500.00
434 09/26/2016 M RIDHO 25,000.00 12,500.00 12,500.00
435 FAUZIAH P 15,000.00 7,500.00 7,500.00
436 SITI ROHANI 30,000.00 10,000.00 15,000.00 15,000.00
437 IIS KOMALA 70,000.00 35,000.00 35,000.00
438 RUSLI WARDIAWAN 30,000.00 15,000.00 15,000.00
439 SITI H 15,000.00 10,000.00 7,500.00 7,500.00
440 BILQIS A.P.G 15,000.00 7,500.00 7,500.00
441 RIA PUSPITASARI 15,000.00 10,000.00 7,500.00 7,500.00
442 RUHIAT 15,000.00 10,000.00 7,500.00 7,500.00
443 POPON SULAEMI 70,000.00 35,000.00 35,000.00
444 ARYANI 35,000.00 17,500.00 17,500.00
445 NY ENOK 15,000.00 7,500.00 7,500.00
446 HERI HENDRO 15,000.00 10,000.00 7,500.00 7,500.00
447 REDHAN K 70,000.00 35,000.00 35,000.00
448 SUDARSIH 70,000.00 35,000.00 35,000.00
449 LUTFIANI N.F 70,000.00 35,000.00 35,000.00
450 SALWA H 25,000.00 12,500.00 12,500.00
451 RELY S.P.L 30,000.00 15,000.00 15,000.00
452 NIA LESTARI 30,000.00 15,000.00 15,000.00
453 DIANA L 30,000.00 15,000.00 15,000.00
454 GILANG P GUMELAR 30,000.00 15,000.00 15,000.00
455 MARLINA 15,000.00 10,000.00 7,500.00 7,500.00
456 09/27/2016 INA KUSTIANA 15,000.00 7,500.00 7,500.00
457 NINDI SALWA A 30,000.00 15,000.00 15,000.00
458 M FIKRI TAUFIQAL H 15,000.00 10,000.00 7,500.00 7,500.00
459 ANTONIUS S 30,000.00 15,000.00 15,000.00
460 WIDANINGSIH 70,000.00 35,000.00 35,000.00
461 NURLAELA 70,000.00 35,000.00 35,000.00
462 SRI SYARIFAH 30,000.00 10,000.00 15,000.00 15,000.00
463 SRI RUSMIATI 40,000.00 20,000.00 20,000.00
464 ISMAIL 15,000.00 10,000.00 7,500.00 7,500.00
465 SRI WIGATI 30,000.00 15,000.00 15,000.00
466 THERESIA S.N 15,000.00 7,500.00 7,500.00
467 NY EVI 15,000.00 10,000.00 7,500.00 7,500.00
468 M.RASYID Z 15,000.00 10,000.00 7,500.00 7,500.00
469 EERVINA A.P 30,000.00 15,000.00 15,000.00
470 DIDRIKA R.D 30,000.00 15,000.00 15,000.00
471 MASRINGAH 60,000.00 10,000.00 30,000.00 30,000.00
472 ARIFIN ALZAM H.P 30,000.00 10,000.00 15,000.00 15,000.00
473 M.YOGI 30,000.00 15,000.00 15,000.00
474 ASOP SOFIYAH 30,000.00 15,000.00 15,000.00
475 AYU NABILA 30,000.00 15,000.00 15,000.00
476 YAYAN SETIAWAN 30,000.00 10,000.00 15,000.00 15,000.00
477 ENTIN K 70,000.00 35,000.00 35,000.00
478 09/28/2016 HERLIN SUMARLINA 30,000.00 10,000.00 15,000.00 15,000.00
479 SITI HODIJAH 70,000.00 35,000.00 35,000.00
480 NENI HERLINA DEWI 30,000.00 15,000.00 15,000.00
481 YUDI AMBAR P 15,000.00 7,500.00 7,500.00
482 RAFA RIKIANSYAH 25,000.00 12,500.00 12,500.00
483 MURNIATI 15,000.00 10,000.00 7,500.00 7,500.00
484 LURI RAHMAWATI 70,000.00 35,000.00 35,000.00
485 RATIH KOSASIH 15,000.00 7,500.00 7,500.00
486 NURHAYATI 15,000.00 10,000.00 7,500.00 7,500.00
487 RAISA AZZAHRA 30,000.00 15,000.00 15,000.00
488 PUNGKI MERITA N 15,000.00 7,500.00 7,500.00
489 SHAFRINA AINI I 70,000.00 35,000.00 35,000.00
490 HATI ROHAETI 70,000.00 35,000.00 35,000.00
491 EUIS ASIAH 70,000.00 35,000.00 35,000.00
492 TUTISAH 30,000.00 15,000.00 15,000.00
493 DHINI ADELIA S 35,000.00 17,500.00 17,500.00
494 RENALD R 30,000.00 15,000.00 15,000.00
495 DELIA SALSADILA 30,000.00 10,000.00 15,000.00 15,000.00
496 AFIANI AULIA S 70,000.00 35,000.00 35,000.00
497 ASEP B.SUDARSONO 30,000.00 15,000.00 15,000.00
498 MARSELA W 70,000.00 35,000.00 35,000.00
499 WAHYUNINGSIH 15,000.00 10,000.00 7,500.00 7,500.00
500 M.MUZHAFFARUDDIN 30,000.00 15,000.00 15,000.00
501 LANIWATI 40,000.00 20,000.00 20,000.00
502 IRFAN SUKANDAR 15,000.00 7,500.00 7,500.00
503 09/29/2016 MEITA SOFIANI 40,000.00 20,000.00 20,000.00
504 SONY HERMANTO 70,000.00 35,000.00 35,000.00
505 NURMELISA 70,000.00 35,000.00 35,000.00
506 ANE KRISTIANI 70,000.00 35,000.00 35,000.00
507 UJANG R 30,000.00 15,000.00 15,000.00
508 SRI HIDAYATI 70,000.00 35,000.00 35,000.00
509 YULIANA LESTARI 70,000.00 35,000.00 35,000.00
510 PANJI PERMANA 70,000.00 35,000.00 35,000.00
511 REVI NURYANTI 30,000.00 15,000.00 15,000.00
512 TUTI SADYAH 70,000.00 35,000.00 35,000.00
513 ANITA YUSUF 15,000.00 7,500.00 7,500.00
514 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00
515 TRI LESTARI 70,000.00 10,000.00 35,000.00 35,000.00
516 FATIR HASAN AL.M 30,000.00 10,000.00 15,000.00 15,000.00
517 ILHAM MULYANA 70,000.00 35,000.00 35,000.00
518 BERLIANA INDY N 35,000.00 17,500.00 17,500.00
519 YULIA RAHMAN 35,000.00 17,500.00 17,500.00
520 M.WAHYUDI 15,000.00 10,000.00 7,500.00 7,500.00
521 09/30/2016 TITIN ROSMAWATI 70,000.00 10,000.00 35,000.00 35,000.00
522 FAUZIAH PRIATIN 15,000.00 10,000.00 7,500.00 7,500.00
523 MUSTOPA 30,000.00 15,000.00 15,000.00
524 GIMNASTIAR M 15,000.00 10,000.00 7,500.00 7,500.00
525 JUWITA NUR LESTARI 35,000.00 17,500.00 17,500.00
526 RITA RIANTI 70,000.00 35,000.00 35,000.00
527 SRI SUSANTI 30,000.00 15,000.00 15,000.00
528 KOMARUDIN 15,000.00 10,000.00 7,500.00 7,500.00
529 YAFI ALIFUDIN 15,000.00 10,000.00 7,500.00 7,500.00
530 HENNY WIDYAWATI 70,000.00 35,000.00 35,000.00
531 MUTIARA MAYANG 30,000.00 15,000.00 15,000.00
532 NURI RAISYA M 15,000.00 7,500.00 7,500.00
533 RAGA PRATAMA 15,000.00 10,000.00 7,500.00 7,500.00
535 MUBAROD 30,000.00 15,000.00 15,000.00
536 AI OKA 15,000.00 10,000.00 7,500.00 7,500.00
537 NAJWA NUR AULIA 70,000.00 35,000.00 35,000.00
538 HUSNA SHOFIA A 70,000.00 35,000.00 35,000.00
539 BERLIANA AZARI 40,000.00 20,000.00 20,000.00
540 NABILA WIDIYARIZKI 30,000.00 15,000.00 15,000.00
541 ROS AMINAH 30,000.00 15,000.00 15,000.00
542 RANI YULIANI 30,000.00 15,000.00 15,000.00
543 M.RAFLI 30,000.00 15,000.00 15,000.00
544 TRI HANDAYANI 15,000.00 10,000.00 7,500.00 7,500.00
22,320,000 940,000 11,160,000 11,160,000
JML KET
25,000
205,000
55,000
65,000
125,000
25,000
25,000
305,000
155,000
25,000
55,000
165,000
25,000
105,000
105,000
65,000
105,000
55,000
205,000
65,000
55,000
55,000
755,000
25,000
85,000
125,000
65,000
365,000
75,000
25,000
25,000
155,000
25,000
65,000
65,000
105,000
205,000
65,000
4,300,000
JML KET
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
30,000.00
30,000.00
70,000.00
15,000.00
15,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
40,000.00
30,000.00
35,000.00
15,000.00
30,000.00
25,000.00
30,000.00
70,000.00
15,000.00
15,000.00
30,000.00
15,000.00
30,000.00
70,000.00
35,000.00
40,000.00
35,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
25,000.00
30,000.00
35,000.00
70,000.00
30,000.00
30,000.00
30,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
30,000.00
35,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
70,000.00
40,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
70,000.00
15,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
30,000.00
70,000.00
25,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
35,000.00
35,000.00
30,000.00
35,000.00
70,000.00
30,000.00
70,000.00
30,000.00
70,000.00
30,000.00
25,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
35,000.00
40,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
15,000.00
70,000.00
30,000.00
70,000.00
15,000.00
70,000.00
30,000.00
30,000.00
30,000.00
15,000.00
30,000.00
25,000.00
30,000.00
35,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
25,000.00
70,000.00
30,000.00
30,000.00
25,000.00
70,000.00
30,000.00
15,000.00
80,000.00
80,000.00
70,000.00
70,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
15,000.00
40,000.00
70,000.00
30,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
30,000.00
30,000.00
30,000.00
70,000.00
25,000.00
70,000.00
30,000.00
25,000.00
15,000.00
70,000.00
25,000.00
60,000.00
40,000.00
30,000.00
70,000.00
35,000.00
15,000.00
70,000.00
30,000.00
30,000.00
15,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
40,000.00
25,000.00
70,000.00
70,000.00
30,000.00
70,000.00
25,000.00
15,000.00
40,000.00
40,000.00
70,000.00
70,000.00
35,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
25,000.00
70,000.00
35,000.00
40,000.00
35,000.00
30,000.00
70,000.00
15,000.00
70,000.00
70,000.00
15,000.00
40,000.00
35,000.00
30,000.00
25,000.00
25,000.00
30,000.00
70,000.00
30,000.00
25,000.00
70,000.00
70,000.00
25,000.00
25,000.00
30,000.00
25,000.00
30,000.00
40,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
25,000.00
25,000.00
80,000.00
70,000.00
30,000.00
40,000.00
15,000.00
25,000.00
35,000.00
40,000.00
40,000.00
15,000.00
40,000.00
70,000.00
70,000.00
40,000.00
70,000.00
25,000.00
70,000.00
30,000.00
70,000.00
30,000.00
70,000.00
25,000.00
15,000.00
70,000.00
40,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
30,000.00
35,000.00
15,000.00
25,000.00
25,000.00
30,000.00
30,000.00
30,000.00
35,000.00
70,000.00
25,000.00
70,000.00
30,000.00
45,000.00
30,000.00
30,000.00
35,000.00
30,000.00
40,000.00
25,000.00
35,000.00
35,000.00
35,000.00
70,000.00
70,000.00
30,000.00
80,000.00
30,000.00
25,000.00
60,000.00
70,000.00
70,000.00
40,000.00
40,000.00
70,000.00
70,000.00
70,000.00
35,000.00
30,000.00
70,000.00
30,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
60,000.00
25,000.00
30,000.00
70,000.00
40,000.00
70,000.00
30,000.00
30,000.00
35,000.00
70,000.00
30,000.00
30,000.00
25,000.00
40,000.00
70,000.00
25,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
40,000.00
25,000.00
70,000.00
70,000.00
30,000.00
25,000.00
30,000.00
70,000.00
60,000.00
40,000.00
30,000.00
30,000.00
25,000.00
15,000.00
70,000.00
30,000.00
40,000.00
30,000.00
40,000.00
25,000.00
30,000.00
70,000.00
35,000.00
15,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
15,000.00
30,000.00
60,000.00
70,000.00
40,000.00
35,000.00
70,000.00
70,000.00
30,000.00
70,000.00
35,000.00
70,000.00
35,000.00
35,000.00
30,000.00
30,000.00
30,000.00
30,000.00
25,000.00
30,000.00
70,000.00
35,000.00
30,000.00
15,000.00
45,000.00
30,000.00
15,000.00
70,000.00
30,000.00
15,000.00
70,000.00
40,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
50,000.00
30,000.00
15,000.00
25,000.00
25,000.00
15,000.00
40,000.00
70,000.00
30,000.00
25,000.00
15,000.00
25,000.00
25,000.00
70,000.00
35,000.00
15,000.00
25,000.00
70,000.00
70,000.00
70,000.00
25,000.00
30,000.00
30,000.00
30,000.00
30,000.00
25,000.00
15,000.00
30,000.00
25,000.00
30,000.00
70,000.00
70,000.00
40,000.00
40,000.00
25,000.00
30,000.00
15,000.00
25,000.00
25,000.00
30,000.00
30,000.00
70,000.00
40,000.00
30,000.00
30,000.00
30,000.00
40,000.00
70,000.00
40,000.00
70,000.00
30,000.00
15,000.00
25,000.00
25,000.00
70,000.00
15,000.00
25,000.00
30,000.00
15,000.00
70,000.00
70,000.00
70,000.00
30,000.00
35,000.00
30,000.00
40,000.00
70,000.00
30,000.00
70,000.00
25,000.00
30,000.00
40,000.00
15,000.00
40,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
15,000.00
30,000.00
80,000.00
40,000.00
70,000.00
35,000.00
35,000.00
25,000.00
80,000.00
25,000.00
30,000.00
25,000.00
35,000.00
70,000.00
30,000.00
25,000.00
25,000.00
70,000.00
30,000.00
15,000.00
25,000.00
30,000.00
30,000.00
25,000.00
70,000.00
70,000.00
40,000.00
30,000.00
30,000.00
30,000.00
30,000.00
25,000.00
23,330,000 -
NO TANGGAL NAMA PASIEN TARIF ADM JASA DOKTER

1 10/1/2016 YANI 240,000 5,000 120,000
2 10/4/2016 GITA NURANI 260,000 5,000 130,000
3 10/4/2016 PUTRI 60,000 5,000 30,000
4 PUTRA 20,000 5,000 10,000
5 10/5/2016 SISCA 20,000 5,000 10,000
6 SALSABILA 210,000 5,000 105,000
7 10/6/2016 ARYAGA 20,000 5,000 10,000
8 10/8/2016 M MUZAFARUDIN 60,000 5,000 30,000
9 10/9/2016 RIZAL 50,000 5,000 25,000
10 ANGGA 50,000 5,000 25,000
11 10/10/2016 AN TANIA 20,000 5,000 10,000
12 10/11/2016 GITA NURANI 445,000 5,000 222,500
13 ELISABETH L 70,000 5,000 35,000
14 NY EUIS 60,000 5,000 30,000
15 KANIA ISLAMI DEWI 100,000 5,000 50,000
16 ROYANDI 20,000 5,000 10,000
17 10/12/2016 RISKA 200,000 5,000 100,000
18 10/13/2016 TN ADE EFENDI 25,000 5,000 12,500
19 ANISA FAUZIAH 25,000 5,000 12,500
20 10/14/2016 TN DAMAR 100,000 5,000 50,000
21 NELY H 100,000 5,000 50,000
22 10/19/2016 BUNGA 120,000 5,000 60,000
23 10/20/2016 SHELLA AURELIA 60,000 5,000 30,000
24 10/22/2016 ASOP SOFIYAH 45,000 5,000 22,500
25 EVA MARDIANA 200,000 5,000 100,000
26 ANISYA 20,000 5,000 10,000
27 10/24/2016 FITRI 240,000 5,000 120,000
28 DODI 200,000 5,000 100,000
29 10/25/2016 WULAN 20,000 5,000 10,000
30 TITI 350,000 5,000 175,000
31 ALI MAWARDI 20,000 5,000 10,000
32 HANIF AKBAR 20,000 5,000 10,000
33 EUIS 60,000 5,000 30,000
34 10/27/2016 FITRI 20,000 5,000 10,000
35 28/20/2016 EKO TRISTIANTO 200,000 5,000 100,000
36 10/31/2016 WILDAN 200,000 5,000 100,000
37 DEWI RAHAYU 250,000 5,000 125,000
4,180,000 185,000 2,090,000

TGL NAMA TARIF OBAT JASA DOKTER

1 1/10/2016 MYSHELLA P.R.P 30,000.00 15,000.00
2 FADHILAH N.P 70,000.00 35,000.00
3 LORINE L.L 70,000.00 35,000.00
4 ALMIRA NAJMI 35,000.00 17,500.00
5 ASOP SOFIAH 30,000.00 15,000.00
6 KANIA ISLAMI DEWI 30,000.00 15,000.00
7 IBRAHIM ADITYA G 30,000.00 15,000.00
8 SELMANIA OKTAVIANI Y 70,000.00 35,000.00
9 ARIESTYA NUGRAHA P 15,000.00 10,000.00 7,500.00
10 YATNA DWI NUGRAHA 70,000.00 35,000.00
11 MIRA LESTARI S 70,000.00 35,000.00
12 DINA NUR OKTAVIANI 35,000.00 17,500.00
13 SELLY AYUNDA P 30,000.00 15,000.00
14 YATNO 70,000.00 35,000.00
15 SARMINI 70,000.00 35,000.00
16 3/10/2016 VALEN DIAZ R 35,000.00 17,500.00
17 AI RITA SOFIA 40,000.00 20,000.00
18 SUMIATI 70,000.00 35,000.00
19 KORNELIUS 15,000.00 7,500.00
20 SITI ROHANI 30,000.00 15,000.00
21 IVA RAIVANY Y 60,000.00 10,000.00 30,000.00
22 ARYANI 70,000.00 35,000.00
23 GENTA N 15,000.00 7,500.00
24 RUSLI W 30,000.00 15,000.00
25 SITI HALIMATUS S 60,000.00 10,000.00 30,000.00
26 YUYUN Y 30,000.00 10,000.00 15,000.00
27 SILVI AVIANTI 35,000.00 17,500.00
28 HENI RAHMAWATI 30,000.00 15,000.00
29 SALWA H 35,000.00 17,500.00
30 YARA ALQISTIANA 35,000.00 17,500.00
31 DELIA SALSADILA 30,000.00 15,000.00
32 GILANG P.GUMELAR 70,000.00 35,000.00
33 AHMAD YUSUF 30,000.00 15,000.00
34 RELY SUGIARTI P.L 30,000.00 15,000.00
35 M.FAIZAL 35,000.00 17,500.00
36 QUINSHA SYIFA C 15,000.00 10,000.00 7,500.00
37 DIANA LISMAWATI 70,000.00 35,000.00
38 ABIL A 15,000.00 10,000.00 7,500.00
39 4/10/2016 ANTONIUS SEMIN 30,000.00 15,000.00
40 INA KUSTIANA 70,000.00 35,000.00
41 WIDANINGSIH 70,000.00 35,000.00
42 AYI PRATAMA P 30,000.00 10,000.00 15,000.00
43 SRI WIGATI 40,000.00 20,000.00
44 M.RASYID 40,000.00 20,000.00
45 NURLAELA 70,000.00 35,000.00
46 SRI SYARIFAH 30,000.00 15,000.00
47 THERESIA S.N 70,000.00 35,000.00
48 JUDI BUDIARJO 30,000.00 15,000.00
49 DIAN N.A 30,000.00 15,000.00
50 WIDIAH A 70,000.00 35,000.00
51 IDA NURHAYATI 70,000.00 35,000.00
52 MURNIATI 75,000.00 37,500.00
53 SRI RUSMIATI 70,000.00 35,000.00
54 NURHAYATI 35,000.00 17,500.00
55 AGUS IRWAN K 70,000.00 35,000.00
56 ELCHA SABRINA 70,000.00 35,000.00
57 AKBAR N 30,000.00 15,000.00
58 SUPARSI 30,000.00 15,000.00
59 ERLAN KANDANI 30,000.00 15,000.00
60 REKA D.P 30,000.00 15,000.00
61 KARWATI 60,000.00 10,000.00 30,000.00
62 ZILDAN AHMAD M 30,000.00 10,000.00 15,000.00
63 NUR AISAH 15,000.00 7,500.00
64 ANI HARYATI 70,000.00 35,000.00
65 5/10/2016 NENI HERLINA D 40,000.00 20,000.00
66 M RAYYAN AL AZAM 15,000.00 7,500.00
67 M SANDI D 15,000.00 10,000.00 7,500.00
68 AI SUPRIATI 30,000.00 10,000.00 15,000.00
69 LURI RAHMAWATI 30,000.00 15,000.00
70 FRANCISCUS X.T 30,000.00 15,000.00
71 DARATUL HIKMSH H 30,000.00 10,000.00 15,000.00
72 IRMAWATI 70,000.00 35,000.00
73 BINTANG PURBA 30,000.00 15,000.00
74 LANIWATI 30,000.00 15,000.00
75 PONIDJO B S 70,000.00 35,000.00
76 MARLINA 60,000.00 30,000.00
77 IKHSAN M 70,000.00 35,000.00
78 NABILA W.R 30,000.00 15,000.00
79 HENI ROSYANA 60,000.00 30,000.00
80 ASEP B S 40,000.00 20,000.00
81 6/10/2016 TN USIN 15,000.00 10,000.00 7,500.00
82 SRI HIDAYATI 70,000.00 35,000.00
83 NURMEILISA 30,000.00 15,000.00
84 SURYATI 30,000.00 15,000.00
85 RIMA SURYANI 70,000.00 35,000.00
86 MEITA SOFIANI 70,000.00 35,000.00
87 UJANG R 40,000.00 20,000.00
88 NURHAYATI 30,000.00 10,000.00 15,000.00
89 DYAN DIANING R 30,000.00 15,000.00
90 NAZAR S A 35,000.00 17,500.00
91 MUTIARA H P 25,000.00 12,500.00
92 NUR AISAH 15,000.00 10,000.00 7,500.00
93 REDHAN KUSUMA P 70,000.00 35,000.00
94 ANITA BUDI RAHAYU 70,000.00 35,000.00
95 7/10/2016 MIFTAHUL HUSNA 70,000.00 35,000.00
96 MUKIMIN 70,000.00 35,000.00
97 SRI SUSANTI 40,000.00 20,000.00
98 TUTSIAH 30,000.00 15,000.00
99 TENNY C H 70,000.00 35,000.00
100 ELYSIA S H 15,000.00 7,500.00
101 MUTIARA MAYANG S 30,000.00 15,000.00
102 FANYSYA A P H 35,000.00 17,500.00
103 KARINA 30,000.00 10,000.00 15,000.00
104 ERVINA A.P 30,000.00 15,000.00
105 YUDI HERMAWAN 70,000.00 35,000.00
106 PONIMAN 30,000.00 15,000.00
107 MEISYA DAMAYANTI 35,000.00 17,500.00
108 NUR AISYAH 70,000.00 35,000.00
109 ARIFIN ALZAM H.P 70,000.00 35,000.00
110 SEKAR A I P 70,000.00 35,000.00
111 PREDDI S 15,000.00 7,500.00
112 NADZAR N A 30,000.00 10,000.00 15,000.00
113 NABILA SYIFA 30,000.00 15,000.00
114 YUNI APRIDA 30,000.00 15,000.00
115 8/10/2016 SUNARDI DIANSAH 30,000.00 15,000.00
116 ALHANA S 30,000.00 15,000.00
117 MYSHELLA P.R.P 70,000.00 35,000.00
118 ASOP SOFIYAH 40,000.00 10,000.00 20,000.00
119 RIA FENTIANA 30,000.00 15,000.00
120 TUTI SADIYAH 70,000.00 35,000.00
121 REVI NURYUNITA 30,000.00 15,000.00
122 SUNARIYAH N H 30,000.00 15,000.00
123 FRILIYANA R 30,000.00 15,000.00
124 NGADIYA 70,000.00 10,000.00 35,000.00
125 HENI WIDIAWATI 70,000.00 35,000.00
126 NENENG MINTARSIH 70,000.00 35,000.00
127 LORINE L.L 70,000.00 35,000.00
128 AMIRA N 35,000.00 17,500.00
129 BUNGA OLIVIA R 35,000.00 10,000.00 17,500.00
130 MEILINA 30,000.00 10,000.00 15,000.00
131 HATI ROHAETI 70,000.00 35,000.00
132 SHAFRINA AINI I 15,000.00 7,500.00
133 AKMAL SYUKUR Z 70,000.00 35,000.00
134 M FAUZAN AL FATIH 30,000.00 15,000.00
135 M MUZZAFARUDIN 30,000.00 15,000.00
136 JUJU ENDANG W 30,000.00 10,000.00 15,000.00
137 FADILAH NUR P 30,000.00 15,000.00
138 M ELBY SEBASTIAN 30,000.00 10,000.00 15,000.00
139 10/10/2016 NAFISA ANINDA S 70,000.00 35,000.00
140 TN USIN 60,000.00 10,000.00 30,000.00
141 F RATIKA W 70,000.00 35,000.00
142 AI RITA SOFIA 70,000.00 35,000.00
143 YUYUN Y 30,000.00 15,000.00
144 SITI ROHANI 30,000.00 15,000.00
145 WAHYU AMALUDIN 30,000.00 15,000.00
146 IVA RAIVANY Y 30,000.00 15,000.00
147 SAHRI 15,000.00 10,000.00 7,500.00
148 NADHIRA L 70,000.00 10,000.00 35,000.00
149 LANI HANIFAH 70,000.00 35,000.00
150 YUNIAR R 70,000.00 35,000.00
151 M ARIFIN 30,000.00 15,000.00
152 JAMILAH 15,000.00 10,000.00 7,500.00
153 TITA SUGIHARTI 70,000.00 35,000.00
154 BETHISE ADU 70,000.00 35,000.00
155 ZAHRA PUSPITA D 35,000.00 17,500.00
156 TITIK SUSILONINGSIH 70,000.00 35,000.00
157 SYAFA NUR A 35,000.00 17,500.00
158 11/10/2016 INA KUSTIANA 70,000.00 35,000.00
159 ANTONIUS SEMIN 40,000.00 20,000.00
160 ENOK ANI H 70,000.00 35,000.00
161 M RASYID Z 70,000.00 10,000.00 35,000.00
162 SRI SYARIFAH 30,000.00 15,000.00
163 ROESTIANY EKA W 70,000.00 35,000.00
164 BERLIANA INDY N 35,000.00 17,500.00
165 JUDI BUDIARJO 30,000.00 15,000.00
166 ENDANG MUJI A 15,000.00 10,000.00 7,500.00
167 SRI WIGATI 70,000.00 35,000.00
168 THERESIA S.N 15,000.00 10,000.00 7,500.00
169 ALISHA K R 70,000.00 35,000.00
171 REKA DWI P 30,000.00 15,000.00
172 SUPARSI 40,000.00 20,000.00
173 M YOGI D P 15,000.00 7,500.00
174 RICKY M.R 70,000.00 35,000.00
175 M FAISAL 70,000.00 35,000.00
176 NAJWA NUR AULIA 70,000.00 35,000.00
177 FADILAH R S 30,000.00 10,000.00 15,000.00
178 ENTIN K 15,000.00 7,500.00
179 12/10/2016 SOKHIBUL IKHSAN 70,000.00 35,000.00
180 LORI R 30,000.00 15,000.00
181 RISKA 15,000.00 7,500.00
182 AI S 30,000.00 15,000.00
183 HENI 30,000.00 15,000.00
184 NURYANA T 70,000.00 35,000.00
185 NENI 70,000.00 35,000.00
186 HERLIN 30,000.00 15,000.00
187 GILANG 70,000.00 10,000.00 35,000.00
188 DELIA SALSADILA 30,000.00 10,000.00 15,000.00
189 MAESAROH 70,000.00 10,000.00 35,000.00
190 RANGGA P 30,000.00 10,000.00 15,000.00
191 ALICIA 15,000.00 7,500.00
192 MELIYANI 70,000.00 35,000.00
193 SILVI AVIANTI 70,000.00 35,000.00
194 HENI R 30,000.00 10,000.00 15,000.00
195 RATNA SUMINAR 30,000.00 15,000.00
196 10/13/2016 D SUKIMAN 15,000.00 7,500.00
197 WIDANINGSIH 70,000.00 35,000.00
198 ANDRI IRAWAN 70,000.00 35,000.00
199 RIMA SURYANI 70,000.00 35,000.00
200 MEITA SOFIANI 30,000.00 10,000.00 15,000.00
201 NINING ROHAENI 30,000.00 10,000.00 15,000.00
202 SITI AISYAH 15,000.00 10,000.00 7,500.00
203 NURMEILISA 30,000.00 15,000.00
204 NURHAYATI 30,000.00 15,000.00
205 AGUS IRWAN 70,000.00 35,000.00
206 IDA JUBAEDAH 70,000.00 35,000.00
207 DYAN DYANING R 40,000.00 20,000.00
208 MUTIARA HADIA P 35,000.00 17,500.00
209 M RAIHAN P A 30,000.00 15,000.00
210 YUSNI ANDALIA 70,000.00 35,000.00
211 ANAKNYA BP SANDI 30,000.00 15,000.00
212 RAISYA APRILIA 35,000.00 17,500.00
213 SANDI 60,000.00 10,000.00 30,000.00
214 10/14/2016 RITA RIANTI 70,000.00 35,000.00
215 EPI RUKMANA 70,000.00 35,000.00
216 JUWITA NUR LESTARI 35,000.00 17,500.00
217 KUSMIATI 15,000.00 10,000.00 7,500.00
218 SLAMAT SILITONGA 30,000.00 15,000.00
219 MIFTAHUL HUSNA F 30,000.00 15,000.00
220 DADAN AHMAD F 70,000.00 35,000.00
221 NENG RITA 70,000.00 10,000.00 35,000.00
222 AZKI M 70,000.00 35,000.00
223 AZZKA 70,000.00 35,000.00
224 NURHAYATI 30,000.00 15,000.00
225 ENDANG MUJI A 15,000.00 10,000.00 7,500.00
226 M ANGGAR 30,000.00 15,000.00
227 M SANDI D 15,000.00 10,000.00 7,500.00
228 LANIWATI 40,000.00 20,000.00
229 REKA DWI PUTRI 30,000.00 15,000.00
230 AYU NABILA F 40,000.00 20,000.00
231 TRI HANDAYANTI 60,000.00 10,000.00 30,000.00
232 HERLINDA 30,000.00 15,000.00
233 NELLY HUTABARAT 15,000.00 7,500.00
234 10/15/2016 YUDI HERMAWAN 70,000.00 35,000.00
235 PONIIDJO B S 70,000.00 35,000.00
236 YATNA DWI N 70,000.00 35,000.00
237 ARIESTYA NUGRAHA P 15,000.00 7,500.00
238 PUSPA LILIANA R 70,000.00 10,000.00 35,000.00
239 M ANINDRAUL H S M 30,000.00 10,000.00 15,000.00
240 KIRANA AURELIA Z 70,000.00 35,000.00
241 ZILDAN AHMAD M 30,000.00 15,000.00
242 SELMANIA OKTAVIANI Y 70,000.00 35,000.00
243 YATNO 70,000.00 35,000.00
244 SARMINI 70,000.00 35,000.00
245 SELY AYUNDIA P 30,000.00 15,000.00
246 10/17/2016 ARLAN KHARIS 35,000.00 17,500.00
247 AI RITA SOFIA 70,000.00 35,000.00
248 NENENG S 70,000.00 10,000.00 35,000.00
249 MUKIMIA 30,000.00 15,000.00
250 YUYUN Y 30,000.00 15,000.00
251 F RATIKA W 70,000.00 35,000.00
252 SITI ROHANI 30,000.00 15,000.00
253 AHMAD F S 35,000.00 17,500.00
254 IVA R Y 30,000.00 15,000.00
255 NASYILA L 15,000.00 7,500.00
256 SOEYADI 15,000.00 7,500.00
257 FRANSISCUS X T 30,000.00 15,000.00
258 DJENG SRI N 70,000.00 35,000.00
259 WAHYU AWALUDIN 30,000.00 15,000.00
260 NABIL NAUVASITA M 70,000.00 35,000.00
261 RUSLI W 30,000.00 15,000.00
262 IKAH ATIKAH 30,000.00 15,000.00
263 ALI AL FARUE 35,000.00 17,500.00
264 YUYU ROSMAWATI 70,000.00 10,000.00 35,000.00
265 NIKE PURNAMASARI 30,000.00 15,000.00
266 DIYAH AYU P 70,000.00 10,000.00 35,000.00
267 ENDANG TATIK Z 70,000.00 35,000.00
268 SALWA APRILIA 30,000.00 15,000.00
269 RELLY SUGIARTI P L 40,000.00 20,000.00
270 NABILA W.R 30,000.00 10,000.00 15,000.00
271 DAHLIA 35,000.00 17,500.00
272 10/18/2016 NERMA F 70,000.00 35,000.00
273 NERMA F 70,000.00 35,000.00
274 ANTONIUS SEMIN 70,000.00 10,000.00 35,000.00
275 ARIYANTO 15,000.00 7,500.00
276 ASEP WAHYUDIN 30,000.00 10,000.00 15,000.00
277 LIA KAMELA DEWI 70,000.00 35,000.00
278 TUTISAH 30,000.00 15,000.00
279 INA KUSTIANA 70,000.00 35,000.00
280 CHRISTINA I M 70,000.00 35,000.00
281 SRI SYARIFAH 40,000.00 20,000.00
282 SRI WIGATI 30,000.00 15,000.00
283 THERESIA S N 70,000.00 10,000.00 35,000.00
284 SRI SUSANTI 30,000.00 15,000.00
285 SHELENA SALMA A 70,000.00 35,000.00
286 JUDI BUDIARJO 30,000.00 15,000.00
287 DIAH A C A 15,000.00 7,500.00
288 MASLIAH 70,000.00 35,000.00
289 QONI'AH M N 35,000.00 10,000.00 17,500.00
290 DELIA SALSADILA 30,000.00 15,000.00
291 GILANG P GUMILAR 70,000.00 35,000.00
292 M FAUZAN AL FATIH 70,000.00 35,000.00
293 HATI ROHAETI 70,000.00 35,000.00
294 ERVINA A P 30,000.00 15,000.00
295 ARIFIN ALZAM H P 70,000.00 35,000.00
296 10/19/2016 SUMINEM 70,000.00 35,000.00
297 AA SUARSA 70,000.00 35,000.00
298 FAIRUZ NABIL 30,000.00 15,000.00
299 KARTIKA S P I 15,000.00 10,000.00 7,500.00
300 PUTRI DIKHA A 15,000.00 7,500.00
301 SITI ALIFAH 15,000.00 10,000.00 7,500.00
302 ALISHA K R 70,000.00 35,000.00
303 RICKY M R 40,000.00 20,000.00
304 NIA LESTARI 30,000.00 15,000.00
305 NAFISHA S 35,000.00 17,500.00
306 DEWI SOLIHAT 15,000.00 10,000.00 7,500.00
307 ENDANG M A 15,000.00 10,000.00 7,500.00
308 LANIWATI 40,000.00 20,000.00
309 HENI RAHMAWATI 70,000.00 35,000.00
310 R HENI SULISTIANI 30,000.00 15,000.00
311 M RASYID Z 30,000.00 15,000.00
312 DJENG SRI N 70,000.00 35,000.00
313 JAMILAH 15,000.00 10,000.00 7,500.00
314 ROS AMINAH 30,000.00 10,000.00 15,000.00
315 SITI NUR I 70,000.00 35,000.00
316 M IFDAR N 30,000.00 15,000.00
317 TRIYANTO S 30,000.00 15,000.00
318 TITA SUGIHARTI 70,000.00 35,000.00
319 NABILAH 30,000.00 10,000.00 15,000.00
320 EMPONG KARTINI 70,000.00 35,000.00
321 SYAFA NUR A 35,000.00 17,500.00
322 10/20/2016 HERLIN SUMARLINA 40,000.00 20,000.00
323 YULIANA LESTARI 70,000.00 35,000.00
324 NINING ROHAENI 30,000.00 10,000.00 15,000.00
325 ARIYANTO 15,000.00 10,000.00 7,500.00
326 SETYO BUDI P 15,000.00 10,000.00 7,500.00
327 AI SUPRIATI 30,000.00 15,000.00
328 WIDANINGSIH 70,000.00 35,000.00
329 M NURYANA R 30,000.00 10,000.00 15,000.00
330 RISKA N 70,000.00 35,000.00
331 LURI R 30,000.00 15,000.00
332 ANDRI IRAWAN 70,000.00 35,000.00
333 MEITA SOFIANI 30,000.00 15,000.00
334 NURMEILISA 40,000.00 20,000.00
335 RAHMADANI K 30,000.00 15,000.00
336 M AIMAR PUTRA P 35,000.00 17,500.00
337 SHAFA LATIFAH A 30,000.00 15,000.00
338 NISRINA AULIA R A 70,000.00 10,000.00 35,000.00
339 M FAISAL 70,000.00 35,000.00
340 DEDE HERMANSYAH 15,000.00 10,000.00 7,500.00
341 PIPIT FITRIA 15,000.00 10,000.00 7,500.00
342 ASEP B SUDARSONO 70,000.00 35,000.00
343 TITIK SUSILONINGSIH 30,000.00 15,000.00
344 NUNUNG N 30,000.00 10,000.00 15,000.00
345 10/21/2016 MIFTAHUL HUSNA 30,000.00 15,000.00
346 TATA SUHAYA 15,000.00 7,500.00
347 ISNANIA HAULIYA P 70,000.00 35,000.00
349 SARI NINGSIH 70,000.00 10,000.00 35,000.00
350 SHAFA KARINA N 70,000.00 10,000.00 35,000.00
351 ZUBAEDAH KARMILA 70,000.00 35,000.00
352 YAYAT SURYATI 70,000.00 35,000.00
353 TONNY C H 70,000.00 35,000.00
354 RIMA SURYANI 70,000.00 35,000.00
355 M ANGGAR 30,000.00 15,000.00
356 NENG RITA 30,000.00 15,000.00
357 NURHAYATI 30,000.00 15,000.00
358 SRI SUWARTI 30,000.00 15,000.00
359 RINI MULYANI 15,000.00 7,500.00
360 KANIA ISLAMIDEWI 30,000.00 15,000.00
361 AKBAR NUGRAHA 30,000.00 15,000.00
362 TASYA 35,000.00 17,500.00
363 TITIN KHOTIMAH 70,000.00 35,000.00
364 DEWITRI JAYA 30,000.00 15,000.00
365 RENALD R 30,000.00 15,000.00
366 NADZAR 40,000.00 10,000.00 20,000.00
367 ZAHRA PUSPITA D 35,000.00 10,000.00 17,500.00
368 PONIMAN 40,000.00 20,000.00
369 ELIS SITI P 70,000.00 35,000.00
370 REKA DWI P 30,000.00 15,000.00
371 FADILAH R S 70,000.00 10,000.00 35,000.00
372 SILVI AVIANTI 70,000.00 35,000.00
373 NADZAR 35,000.00 17,500.00
374 10/22/2016 SUNARDI DIANSAH 30,000.00 15,000.00
375 ASOP SOFIYAH 70,000.00 35,000.00
376 ALHANA SALSABILA N 30,000.00 15,000.00
377 SUNARIAH NURUL H 30,000.00 15,000.00
378 NGADIYA 70,000.00 35,000.00
379 OMAN 30,000.00 15,000.00
380 PUNGUT 70,000.00 35,000.00
381 IIN ROSMANAH 15,000.00 10,000.00 7,500.00
382 EVA MARDIANA 15,000.00 7,500.00
383 REVI N 30,000.00 15,000.00
384 TUTY SADYAH 15,000.00 7,500.00
385 NUR FITRIA A 70,000.00 35,000.00
386 NUR MELIFEBRIANI 15,000.00 10,000.00 7,500.00
387 DJENG SRI N 15,000.00 10,000.00 7,500.00
388 NAUREL Z 30,000.00 10,000.00 15,000.00
389 AZKA QIANU 70,000.00 35,000.00
390 JUJU ENDANG WATI 70,000.00 35,000.00
391 SHOBRINA AULIA N H 15,000.00 7,500.00
392 MEILIANA KARUNIA D 30,000.00 10,000.00 15,000.00
393 SITI HALIMAH 70,000.00 35,000.00
394 ROS AMINAH 70,000.00 35,000.00
395 M ELBY SEBASTIAN 30,000.00 15,000.00
396 NAJWA NUR AULIA 35,000.00 17,500.00
397 DEWI ANDINI 30,000.00 10,000.00 15,000.00
398 RISNAWATI 70,000.00 35,000.00
399 10/24/2016 F RATIKA W 70,000.00 35,000.00
400 TATI TARWATI 60,000.00 10,000.00 30,000.00
401 YUYUN Y 30,000.00 10,000.00 15,000.00
402 SARWOKO 60,000.00 30,000.00
403 SITI ROHANI 40,000.00 20,000.00
404 IVA RAIVANY Y 30,000.00 15,000.00
405 ELIS 35,000.00 17,500.00
406 SITI ASIAH 60,000.00 30,000.00
407 AI RITA SOFIA 70,000.00 35,000.00
408 RATIH KOSASIH 15,000.00 7,500.00
409 WAHYU AWALUDIN 30,000.00 15,000.00
410 AHMAD SUMARDI 15,000.00 7,500.00
411 WULANI 35,000.00 17,500.00
412 FRANSISCUS X T 60,000.00 30,000.00
413 PUNGKY M N 15,000.00 7,500.00
414 M FAISAL 70,000.00 35,000.00
415 MUTIARA MAYANG S 40,000.00 20,000.00
416 MAYLIA S 70,000.00 35,000.00
417 RIZKI OKTAVIANI 15,000.00 7,500.00
418 RIA FRENTIANI 30,000.00 15,000.00
419 TATANG R 30,000.00 15,000.00
420 TIFANY AYU L 30,000.00 10,000.00 15,000.00
421 M ANGGAR 30,000.00 15,000.00
422 ALHASBI REYHAN 70,000.00 35,000.00
423 10/25/2016 INA KUSTIANA 70,000.00 35,000.00
424 TITIN KHOTIMAH 15,000.00 7,500.00
425 ANTONIUS SEMIN 70,000.00 35,000.00
426 WITRI W 30,000.00 15,000.00
427 FAIRUZ NABIL 30,000.00 15,000.00
428 WAWAN JUANDA 15,000.00 7,500.00
429 KEYRA Z 70,000.00 35,000.00
430 SRI WIGATI 30,000.00 15,000.00
431 THERESIA S N 30,000.00 15,000.00
432 SRI SUSANTI 40,000.00 20,000.00
433 IKAH ATIKAH 30,000.00 15,000.00
434 TITA FATIMAH 15,000.00 7,500.00
435 NAURA A R 30,000.00 15,000.00
436 TONNY C H 70,000.00 35,000.00
437 IMAN S 30,000.00 15,000.00
438 KNIKE P 30,000.00 15,000.00
439 ERLANGGA A 35,000.00 17,500.00
440 MUKIMIN 30,000.00 15,000.00
441 NURHAYATI 30,000.00 15,000.00
442 AGUS IRAWAN 70,000.00 35,000.00
443 DYAN DIANING R 70,000.00 35,000.00
444 RAFLI ADITIA 35,000.00 17,500.00
445 M ANYNDRAUL 70,000.00 35,000.00
446 BETHISE ADU 70,000.00 35,000.00
447 AGUS JUHANA 70,000.00 35,000.00
448 DEWITRI JAYA 70,000.00 35,000.00
449 ASEP WAHYUDIN 30,000.00 15,000.00
450 ESTI P 15,000.00 7,500.00
451 KASMINI 70,000.00 35,000.00
452 SURYANA 70,000.00 10,000.00 35,000.00
453 10/26/2016 M RIFKI ZAMHARI 35,000.00 10,000.00 17,500.00
454 DEWI SOLIHAT 60,000.00 10,000.00 30,000.00
455 SUBIATI 15,000.00 7,500.00
456 IPAH SARIPAH 60,000.00 10,000.00 30,000.00
457 NIA LESTARI 30,000.00 15,000.00
458 NENG TINI R D 60,000.00 10,000.00 30,000.00
459 SILVI PUTRI A 15,000.00 7,500.00
460 YETI MARYATI 30,000.00 10,000.00 15,000.00
461 ALI AL FARUQ 35,000.00 17,500.00
462 YUYU ROSMAWATI 70,000.00 10,000.00 35,000.00
463 LANIWATI 30,000.00 15,000.00
464 LANIWATI 30,000.00 15,000.00
465 DIDI R 30,000.00 10,000.00 15,000.00
466 FAUZAN S 30,000.00 15,000.00
467 MIA N 15,000.00 7,500.00
468 MAESAROH 60,000.00 10,000.00 30,000.00
469 RANGGA PRASETYO 30,000.00 15,000.00
470 IDA JUBAEDAH 70,000.00 35,000.00
471 ROS AMINAH 30,000.00 15,000.00
472 TRI LESTARI 60,000.00 10,000.00 30,000.00
473 RATNA SUMINAR 30,000.00 15,000.00
474 ZULFA 50,000.00 25,000.00
475 10/27/2016 HERLIN SUMARLINA 70,000.00 35,000.00
476 JUDI BUDIARJO 30,000.00 10,000.00 15,000.00
477 NINING ROHAENI 30,000.00 15,000.00
478 SETYO BUDI P 60,000.00 30,000.00
479 RITA RIANTI 70,000.00 35,000.00
480 WIDANINGSIH 70,000.00 35,000.00
481 M RASYID Z 30,000.00 15,000.00
482 MEITA SOFIANI 30,000.00 15,000.00
483 M NURYANA T 30,000.00 15,000.00
484 FITHRI N 15,000.00 7,500.00
485 LURI R 40,000.00 20,000.00
486 SONY HERMANTO 70,000.00 35,000.00
487 FITRI NURAENI 70,000.00 35,000.00
488 ANIQOTUL UMMAH 15,000.00 7,500.00
489 SITI HENI A 70,000.00 35,000.00
490 AI SUPRIATI 30,000.00 15,000.00
491 ENDANG MUJI A 30,000.00 15,000.00
492 UJANG R 70,000.00 35,000.00
493 DINAS SURYANI 30,000.00 15,000.00
494 TUTISAH 30,000.00 15,000.00
495 DYAH AYU PUSPITA 30,000.00 15,000.00
496 NURMELISA 70,000.00 35,000.00
497 SALWA APRILIA 70,000.00 35,000.00
498 RELLY SUGIARTI P L 70,000.00 35,000.00
499 NABILA W 30,000.00 15,000.00
500 10/28/2016 MIFTAHUL HUSNA 30,000.00 15,000.00
501 ISNANIA HAULIYA P 70,000.00 35,000.00
502 NIKEN JIWA A 35,000.00 17,500.00
503 INTAN KARTIKASARI 15,000.00 7,500.00
504 NURMEILISA 70,000.00 35,000.00
505 SRI SUWARTI 30,000.00 15,000.00
506 NINGSIH SUSILAWATI 70,000.00 35,000.00
508 NURUL AFIFAH M 70,000.00 35,000.00
509 NADZA AMIRO 35,000.00 17,500.00
510 REKA DWI PUTRI 40,000.00 20,000.00
511 NENENG MINTARSIH 70,000.00 35,000.00
512 NISRINA AULIA R A 30,000.00 15,000.00
513 SHAFA LATIEFAH 30,000.00 10,000.00 15,000.00
514 PRIYADI 30,000.00 15,000.00
515 MUBAROD 30,000.00 15,000.00
516 M MUZHAFFARUDIN 70,000.00 35,000.00
517 SARBIBI RAIS 70,000.00 35,000.00
518 OVTINA KUSUMAWATI W 70,000.00 35,000.00
519 DELIA SALSADILA 70,000.00 35,000.00
520 GILANG P GUMILAR 70,000.00 35,000.00
521 ENDARWATI S N 70,000.00 35,000.00
522 10/29/2016 BUDI SUCAHYO 30,000.00 10,000.00 15,000.00
523 SUJANA 30,000.00 10,000.00 15,000.00
524 SUKARYATI 15,000.00 10,000.00 7,500.00
525 FIRDHA AMELIA N 35,000.00 17,500.00
526 SUNADI D 30,000.00 15,000.00
527 ADITYA F 15,000.00 7,500.00
528 DESI 70,000.00 35,000.00
529 HEPPI SEPTIAN 70,000.00 35,000.00
530 AURELIA N 30,000.00 10,000.00 15,000.00
531 AIRA AHMAD F 35,000.00 17,500.00
532 DEDE RIDWAN 30,000.00 15,000.00
533 ARYA AHMAD F 70,000.00 35,000.00
534 HENI RAHMAWATI 30,000.00 15,000.00
535 MELIYANI 30,000.00 15,000.00
536 AIDA SYAFIRA N 35,000.00 17,500.00
537 AIDA SYAFIRA N 35,000.00 17,500.00
538 IYAN TARYANA 30,000.00 10,000.00 15,000.00
539 ROS AMINAH 15,000.00 7,500.00
540 ARIPUDIN 30,000.00 15,000.00
541 SELLY AYUANDA P 40,000.00 20,000.00
542 10/31/2016 IVA RAIVANY Y 40,000.00 20,000.00
543 SITI ROHANI 70,000.00 35,000.00
544 IDAH JUBAEDAH 15,000.00 10,000.00 7,500.00
545 FRANSISCUS X T 30,000.00 15,000.00
546 LINA KARLINA 15,000.00 7,500.00
547 YULIANI 15,000.00 10,000.00 7,500.00
548 WAHYU AWALUDIN 70,000.00 35,000.00
549 FITRAH 70,000.00 35,000.00
550 M AIMAR PUTRA P 70,000.00 35,000.00
551 FAIRUS NABIL 30,000.00 15,000.00
552 LIN ROSMANAH 15,000.00 10,000.00 7,500.00
554 MAYLA S 70,000.00 35,000.00
555 ENDAH DIDIN I 15,000.00 10,000.00 7,500.00
556 DJAPAR 30,000.00 10,000.00 15,000.00
557 TITA SUGIHARTI 70,000.00 35,000.00
558 M FAISAL 70,000.00 35,000.00
559 IMAN S 30,000.00 10,000.00 15,000.00
24,585,000 1,070,000 12,292,500
I
ALAT &
JML KET
BAHAN
120,000 245,000
130,000 265,000
30,000 65,000
10,000 25,000
10,000 25,000
105,000 215,000
10,000 25,000
30,000 65,000
25,000 55,000
25,000 55,000
10,000 25,000
222,500 450,000
35,000 75,000
30,000 65,000
50,000 105,000
10,000 25,000
100,000 205,000
12,500 30,000
12,500 30,000
50,000 105,000
50,000 105,000
60,000 125,000
30,000 65,000
22,500 50,000
100,000 205,000
10,000 25,000
120,000 245,000
100,000 205,000
10,000 25,000
175,000 355,000
10,000 25,000
10,000 25,000
30,000 65,000
10,000 25,000
100,000 205,000
100,000 205,000
125,000 255,000
2,090,000 4,365,000
ESEHATAN
ALAT &
JML KET
BAHAN
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
7,500.00 25,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
20,000.00 40,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 30,000.00
30,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 30,000.00
30,000.00 70,000.00
15,000.00 40,000.00
17,500.00 35,000.00
15,000.00 30,000.00
17,500.00 35,000.00
17,500.00 35,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
17,500.00 35,000.00
7,500.00 25,000.00
35,000.00 70,000.00
7,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
20,000.00 40,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
37,500.00 75,000.00
35,000.00 70,000.00
17,500.00 35,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
30,000.00 70,000.00
15,000.00 40,000.00
7,500.00 15,000.00
35,000.00 70,000.00
20,000.00 40,000.00
7,500.00 15,000.00
7,500.00 25,000.00
15,000.00 40,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
30,000.00 60,000.00
35,000.00 70,000.00
15,000.00 30,000.00
30,000.00 60,000.00
20,000.00 40,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
20,000.00 40,000.00
15,000.00 40,000.00
15,000.00 30,000.00
17,500.00 35,000.00
12,500.00 25,000.00
7,500.00 25,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
20,000.00 40,000.00
15,000.00 30,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 30,000.00
17,500.00 35,000.00
15,000.00 40,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
17,500.00 35,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 40,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
20,000.00 50,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 80,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
17,500.00 45,000.00
15,000.00 40,000.00
35,000.00 70,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 40,000.00
15,000.00 30,000.00
15,000.00 40,000.00
35,000.00 70,000.00
30,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
7,500.00 25,000.00
35,000.00 80,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
35,000.00 70,000.00
17,500.00 35,000.00
35,000.00 70,000.00
20,000.00 40,000.00
35,000.00 70,000.00
35,000.00 80,000.00
15,000.00 30,000.00
35,000.00 70,000.00
17,500.00 35,000.00
15,000.00 30,000.00
7,500.00 25,000.00
35,000.00 70,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
20,000.00 40,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 15,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 80,000.00
15,000.00 40,000.00
35,000.00 80,000.00
15,000.00 40,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
15,000.00 40,000.00
7,500.00 25,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
20,000.00 40,000.00
17,500.00 35,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
17,500.00 35,000.00
30,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
7,500.00 25,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 80,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
15,000.00 30,000.00
7,500.00 25,000.00
20,000.00 40,000.00
15,000.00 30,000.00
20,000.00 40,000.00
30,000.00 70,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
35,000.00 80,000.00
15,000.00 40,000.00
35,000.00 70,000.00
15,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
17,500.00 35,000.00
35,000.00 70,000.00
35,000.00 80,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
17,500.00 35,000.00
15,000.00 30,000.00
7,500.00 15,000.00
7,500.00 15,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
17,500.00 35,000.00
35,000.00 80,000.00
15,000.00 30,000.00
35,000.00 80,000.00
35,000.00 70,000.00
15,000.00 30,000.00
20,000.00 40,000.00
15,000.00 40,000.00
17,500.00 35,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 80,000.00
7,500.00 15,000.00
15,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
20,000.00 40,000.00
15,000.00 30,000.00
35,000.00 80,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
17,500.00 45,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
7,500.00 15,000.00
7,500.00 25,000.00
35,000.00 45,000.00
20,000.00 40,000.00
15,000.00 30,000.00
17,500.00 35,000.00
7,500.00 25,000.00
7,500.00 25,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
7,500.00 25,000.00
15,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 40,000.00
35,000.00 70,000.00
17,500.00 35,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 40,000.00
7,500.00 25,000.00
7,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
20,000.00 40,000.00
15,000.00 30,000.00
17,500.00 35,000.00
15,000.00 30,000.00
35,000.00 80,000.00
35,000.00 70,000.00
7,500.00 25,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 40,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 80,000.00
35,000.00 80,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
7,500.00 15,000.00
15,000.00 30,000.00
15,000.00 30,000.00
17,500.00 35,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
20,000.00 50,000.00
17,500.00 45,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 80,000.00
35,000.00 70,000.00
17,500.00 35,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
7,500.00 25,000.00
7,500.00 15,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
7,500.00 25,000.00
7,500.00 25,000.00
15,000.00 40,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 40,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
17,500.00 35,000.00
15,000.00 40,000.00
35,000.00 70,000.00
35,000.00 70,000.00
30,000.00 70,000.00
15,000.00 40,000.00
30,000.00 60,000.00
20,000.00 40,000.00
15,000.00 30,000.00
17,500.00 35,000.00
30,000.00 60,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 30,000.00
7,500.00 15,000.00
17,500.00 35,000.00
30,000.00 60,000.00
7,500.00 15,000.00
35,000.00 70,000.00
20,000.00 40,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 40,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
20,000.00 40,000.00
15,000.00 30,000.00
7,500.00 15,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
17,500.00 35,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
17,500.00 35,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 80,000.00
17,500.00 45,000.00
30,000.00 70,000.00
7,500.00 15,000.00
30,000.00 70,000.00
15,000.00 30,000.00
30,000.00 70,000.00
7,500.00 15,000.00
15,000.00 40,000.00
17,500.00 35,000.00
35,000.00 80,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 40,000.00
15,000.00 30,000.00
7,500.00 15,000.00
30,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
30,000.00 70,000.00
15,000.00 30,000.00
25,000.00 50,000.00
35,000.00 70,000.00
15,000.00 40,000.00
15,000.00 30,000.00
30,000.00 60,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
7,500.00 15,000.00
20,000.00 40,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
17,500.00 35,000.00
7,500.00 15,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
35,000.00 70,000.00
17,500.00 35,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 40,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
15,000.00 40,000.00
7,500.00 25,000.00
17,500.00 35,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
17,500.00 35,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
17,500.00 35,000.00
17,500.00 35,000.00
15,000.00 40,000.00
7,500.00 15,000.00
15,000.00 30,000.00
20,000.00 40,000.00
20,000.00 40,000.00
35,000.00 70,000.00
7,500.00 25,000.00
15,000.00 30,000.00
7,500.00 15,000.00
7,500.00 25,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
7,500.00 25,000.00
15,000.00 40,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
12,292,500 25,670,000 -
JASA ALAT &

DOKTER BAHAN
1 11/1/2016 SILVIA 20,000 5,000 10,000 10,000
2 11/2/2016 ADE EFENDI 80,000 5,000 40,000 40,000
3 FITRI 80,000 5,000 40,000 40,000
4 KAKA K 20,000 5,000 10,000 10,000
5 11/3/2016 MULUS 70,000 5,000 35,000 35,000
6 11/5/2016 PRIYANTO 150,000 5,000 75,000 75,000
7 HASNA 20,000 5,000 10,000 10,000
8 DIO 250,000 5,000 125,000 125,000
9 11/7/2016 NN FITRI 200,000 5,000 100,000 100,000
10 11/8/2016 MARSHA 20,000 5,000 10,000 10,000
11 F RATIKA WULANDARI 200,000 5,000 100,000 100,000
12 VADYA 270,000 5,000 135,000 135,000
13 RISKA 80,000 5,000 40,000 40,000
14 SUHAETI 20,000 5,000 10,000 10,000
15 FITRI 140,000 5,000 70,000 70,000
16 11/9/2016 DEWI ANDINI 180,000 5,000 90,000 90,000
17 LINDA 60,000 5,000 30,000 30,000
18 11/10/2016 TIN KUSTINI 250,000 5,000 125,000 125,000
19 SRI SUSANTI 250,000 5,000 125,000 125,000
20 ANANG 120,000 5,000 60,000 60,000
21 M SITUMARUNG 20,000 5,000 10,000 10,000
22 11/11/2016 DENDI 20,000 5,000 10,000 10,000
23 DESTA 20,000 5,000 10,000 10,000
24 OVTINA K W 95,000 5,000 47,500 47,500
25 SUCI AYU S 200,000 5,000 100,000 100,000
26 11/13/2016 ANGGI 50,000 5,000 25,000 25,000
27 11/14/2016 FITRI 80,000 5,000 40,000 40,000
28 KEYSA 60,000 5,000 30,000 30,000
29 11/15/2016 VADYA 90,000 5,000 45,000 45,000
30 INA 70,000 5,000 35,000 35,000
31 NY EUIS 250,000 5,000 125,000 125,000
32 11/17/2016 ANNA ROHANAH 250,000 5,000 125,000 125,000
33 11/19/2016 RIZKI 80,000 5,000 40,000 40,000
34 11/22/2016 VADYA 70,000 5,000 35,000 35,000
35 11/23/2016 NN FITRI 60,000 5,000 30,000 30,000
36 SUKNAH 100,000 5,000 50,000 50,000
37 FINA 120,000 5,000 60,000 60,000
38 11/25/2016 FRIZA 20,000 5,000 10,000 10,000
39 IMEY 20,000 5,000 10,000 10,000
40 11/26/2016 M RIZKY 30,000 5,000 15,000 15,000
41 POPPI 20,000 5,000 10,000 10,000
42 YULIA YULIANTI 270,000 5,000 135,000 135,000
43 AKBAR 20,000 5,000 10,000 10,000
44 YAYAH 20,000 5,000 10,000 10,000
45 11/28/2016 AN LUTFAN 70,000 5,000 35,000 35,000
46 ARIF 200,000 5,000 100,000 100,000
47 11/29/2016 VADYA 100,000 5,000 50,000 50,000
48 11/30/2016 YUSEP 120,000 5,000 60,000 60,000
5,005,000 240,000 2,502,500 2,502,500

JASA ALAT &

TGL NAMA TARIF OBAT
DOKTER BAHAN
1 1/11/2016 INA KUSTIANA 70,000.00 35,000.00 35,000.00
2 RIA FRENTIANA 30,000.00 15,000.00 15,000.00
3 F RATIKA W 70,000.00 35,000.00 35,000.00
4 THERESIA S.N 30,000.00 15,000.00 15,000.00
5 SRI WIGATI 40,000.00 20,000.00 20,000.00
6 WIDANINGSIH 30,000.00 15,000.00 15,000.00
7 AHMAD F S 70,000.00 35,000.00 35,000.00
8 WIDANINGSIH 70,000.00 35,000.00 35,000.00
9 IKAH ATIKAH 40,000.00 20,000.00 20,000.00
11 ANI NURAENI 30,000.00 10,000.00 15,000.00 15,000.00
12 MARYAM 15,000.00 10,000.00 7,500.00 7,500.00
13 YIYI ROKAYAH 15,000.00 10,000.00 7,500.00 7,500.00
14 SRI SYARIFAH 70,000.00 35,000.00 35,000.00
15 M ANGGAR 30,000.00 15,000.00 15,000.00
16 SRI SUSANTI 70,000.00 35,000.00 35,000.00
17 TONNY C H 70,000.00 35,000.00 35,000.00
18 ELIS SITI P 30,000.00 15,000.00 15,000.00
19 ERVINA A P 30,000.00 15,000.00 15,000.00
20 DIKA PURWADIANSYAH 70,000.00 35,000.00 35,000.00
21 ZAKI SYARIFUDIN 35,000.00 17,500.00 17,500.00
22 DEWITRI JAYA 70,000.00 35,000.00 35,000.00
23 RENALD R 40,000.00 20,000.00 20,000.00
24 AKBAR NUGRAHA 40,000.00 20,000.00 20,000.00
25 NAJWA NUR AULIA 70,000.00 35,000.00 35,000.00
26 RAHMADANI K 40,000.00 10,000.00 20,000.00 20,000.00
27 IYAN TARYANA 30,000.00 15,000.00 15,000.00
28 2/11/2016 HERLINDA SEPTIANTI 30,000.00 15,000.00 15,000.00
29 ISMAWATI 60,000.00 10,000.00 30,000.00 30,000.00
30 TIARA S S 25,000.00 12,500.00 12,500.00
31 JUDI BUDIARJO 30,000.00 10,000.00 15,000.00 15,000.00
32 WIDIYA HARTAYANTI 35,000.00 17,500.00 17,500.00
33 REFARA A 35,000.00 10,000.00 17,500.00 17,500.00
34 TUTISAH 70,000.00 35,000.00 35,000.00
35 SETIANINGSIH 60,000.00 30,000.00 30,000.00
36 GILANG PERMADI 15,000.00 7,500.00 7,500.00
37 YETI MARYATI 30,000.00 15,000.00 15,000.00
38 PONIDJO BUDI S 15,000.00 7,500.00 7,500.00
39 RIMA SURYANI 70,000.00 35,000.00 35,000.00
40 KAREN RENA L 25,000.00 12,500.00 12,500.00
41 LANIWATI 40,000.00 20,000.00 20,000.00
42 SARBINI RAIS 70,000.00 35,000.00 35,000.00
43 ADRIEL CHRISTIAN S 35,000.00 17,500.00 17,500.00
44 ADRIAN DEARLY S 30,000.00 15,000.00 15,000.00
45 APRILIA AZAHIA 70,000.00 35,000.00 35,000.00
46 EVI SYANTI WINIARTI 30,000.00 10,000.00 15,000.00 15,000.00
47 IDA JUBAEDAH 30,000.00 15,000.00 15,000.00
48 MELINDA RAHMAWATI 30,000.00 10,000.00 15,000.00 15,000.00
49 ROS AMINAH 15,000.00 10,000.00 7,500.00 7,500.00
50 ASEP B SUDARSONO 70,000.00 35,000.00 35,000.00
51 YUNI APRIDA 70,000.00 35,000.00 35,000.00
52 NABILA SYIFA 30,000.00 15,000.00 15,000.00
53 HENI RAHMAWATI 40,000.00 20,000.00 20,000.00
55 SAMBAS 15,000.00 10,000.00 7,500.00 7,500.00
56 LEXA NURHALIMATUL S 35,000.00 10,000.00 17,500.00 17,500.00
57 WITRI W 30,000.00 15,000.00 15,000.00
58 NINING ROHAENI 30,000.00 15,000.00 15,000.00
59 ABDUL RACHMAN 70,000.00 35,000.00 35,000.00
60 AI SUPRIATI 30,000.00 15,000.00 15,000.00
61 DENI A 15,000.00 10,000.00 7,500.00 7,500.00
62 LURI R 70,000.00 35,000.00 35,000.00
63 SONY HERMANTO 70,000.00 35,000.00 35,000.00
64 AGUS WAHYUDIN 15,000.00 10,000.00 7,500.00 7,500.00
65 M TARYANA 30,000.00 10,000.00 15,000.00 15,000.00
66 FITRI N 70,000.00 35,000.00 35,000.00
67 RUSLI W 40,000.00 20,000.00 20,000.00
68 NAURA ASKADINA R 30,000.00 15,000.00 15,000.00
69 HANIFA RASYIDIN 70,000.00 35,000.00 35,000.00
70 DITA WILIANTI 30,000.00 15,000.00 15,000.00
71 ALVIA ANGGRAENI 70,000.00 35,000.00 35,000.00
72 SITI HALIMAH 70,000.00 35,000.00 35,000.00
73 RATNA K 70,000.00 35,000.00 35,000.00
74 NANNY SUMARNI 15,000.00 7,500.00 7,500.00
75 KEYRA Z 70,000.00 35,000.00 35,000.00
76 NASHITA N D 30,000.00 10,000.00 15,000.00 15,000.00
77 NOVI INTAN LESTARI 30,000.00 10,000.00 15,000.00 15,000.00
78 4/11/2016 ENTAR SUTARIAH 15,000.00 7,500.00 7,500.00
79 SRI SUWARTI 40,000.00 20,000.00 20,000.00
80 MIFTAHUL HUSNA 30,000.00 15,000.00 15,000.00
81 ISNANA HAULYA P 70,000.00 35,000.00 35,000.00
82 KIKI MUJAKI 15,000.00 10,000.00 7,500.00 7,500.00
83 SLAMAT SILITONGA 40,000.00 20,000.00 20,000.00
84 NURMEILISA 30,000.00 15,000.00 15,000.00
85 DAFIN ALBRIAN I 35,000.00 17,500.00 17,500.00
86 CATURNINGSIH 15,000.00 7,500.00 7,500.00
87 SUNARDI DIANSAH 30,000.00 15,000.00 15,000.00
88 HENDRA GUNAWAN 70,000.00 35,000.00 35,000.00
89 NURUL AFIFAH M 70,000.00 35,000.00 35,000.00
90 YULIANA LESTARI 70,000.00 35,000.00 35,000.00
91 ANI SUMARNI 15,000.00 10,000.00 7,500.00 7,500.00
92 PRIYADI 40,000.00 20,000.00 20,000.00
93 NISRINA AULIA R A 70,000.00 35,000.00 35,000.00
94 SHAFA LATIEFAH 70,000.00 35,000.00 35,000.00
95 RENI SURYANI 15,000.00 10,000.00 7,500.00 7,500.00
96 ALIFA N 35,000.00 17,500.00 17,500.00
97 NIZZAR AKHDAN P 70,000.00 35,000.00 35,000.00
98 OVTINA KUSUMAWATI W 70,000.00 35,000.00 35,000.00
99 PONIMAN 70,000.00 35,000.00 35,000.00
100 RANI YULIANA 70,000.00 35,000.00 35,000.00
101 TASYA K 35,000.00 17,500.00 17,500.00
102 LANIWATI 30,000.00 15,000.00 15,000.00
103 ANDIKA DWI RIZKI 70,000.00 35,000.00 35,000.00
104 REKA DWI PUTRI 70,000.00 35,000.00 35,000.00
105 5/11/2016 NINGSIH SUSILAWATI 30,000.00 15,000.00 15,000.00
106 SUNARSIH NURUL H 70,000.00 35,000.00 35,000.00
107 NUR FITRI AISYAH 70,000.00 35,000.00 35,000.00
108 SUKARYATI 60,000.00 30,000.00 30,000.00
109 ELI SAHLINA 15,000.00 10,000.00 7,500.00 7,500.00
110 SUHARSONO 15,000.00 7,500.00 7,500.00
111 AURELIA N 30,000.00 15,000.00 15,000.00
112 RATNA SUMINAR 30,000.00 15,000.00 15,000.00
113 ALHANA SHALSABILA N 30,000.00 15,000.00 15,000.00
114 REVI MARYUNITA 70,000.00 35,000.00 35,000.00
115 MEILIANA 30,000.00 15,000.00 15,000.00
116 HENI RAHMAWATI 70,000.00 35,000.00 35,000.00
117 HATI ROHAETI 70,000.00 10,000.00 35,000.00 35,000.00
118 M ELBY SEBASTIAN 30,000.00 15,000.00 15,000.00
119 EVI SYANTI VINIARTI 30,000.00 15,000.00 15,000.00
120 HERMAN SULAEMAN 15,000.00 10,000.00 7,500.00 7,500.00
121 AZKA QIANU 70,000.00 35,000.00 35,000.00
122 KASMINI 70,000.00 35,000.00 35,000.00
123 7/11/2016 ELIS 70,000.00 35,000.00 35,000.00
124 AHMAD NURADIN 60,000.00 10,000.00 30,000.00 30,000.00
125 YANU SUPRIHANDOKO 30,000.00 10,000.00 15,000.00 15,000.00
126 HEPPI SEPTIAN 30,000.00 10,000.00 15,000.00 15,000.00
127 IVA RAIVANY Y 70,000.00 35,000.00 35,000.00
128 YUYUN Y 30,000.00 15,000.00 15,000.00
129 RARASATI 60,000.00 10,000.00 30,000.00 30,000.00
130 LINA KARLINA 15,000.00 7,500.00 7,500.00
131 SUYATMI 30,000.00 10,000.00 15,000.00 15,000.00
132 RITA RIANTI 70,000.00 35,000.00 35,000.00
133 EDI RAMDANI 60,000.00 10,000.00 30,000.00 30,000.00
134 SADIAH 15,000.00 10,000.00 7,500.00 7,500.00
135 CHANDRA SRI H 70,000.00 35,000.00 35,000.00
136 WAHYU AWALUDIN 30,000.00 15,000.00 15,000.00
137 MELIYANI 15,000.00 10,000.00 7,500.00 7,500.00
138 ABDUL RACHMAN 70,000.00 35,000.00 35,000.00
139 FAIRUS NABIL 30,000.00 15,000.00 15,000.00
140 ARIFIN ALZAM H P 15,000.00 10,000.00 7,500.00 7,500.00
141 DIDRIKA R D 30,000.00 10,000.00 15,000.00 15,000.00
142 SALWA APRILIA 30,000.00 15,000.00 15,000.00
143 NURMEILISA 70,000.00 35,000.00 35,000.00
144 M AIMAR PUTRA P 70,000.00 35,000.00 35,000.00
145 DINI S SURYANI 30,000.00 15,000.00 15,000.00
146 IWAN KUSWANDI 30,000.00 15,000.00 15,000.00
147 8/11/2016 KANTI DARMINI 30,000.00 15,000.00 15,000.00
148 WIDANINGSIH 30,000.00 15,000.00 15,000.00
149 F RATIKA W 70,000.00 35,000.00 35,000.00
150 DJAFAR 70,000.00 35,000.00 35,000.00
151 SRI WIGATI 30,000.00 15,000.00 15,000.00
152 THERESIA S N 30,000.00 15,000.00 15,000.00
153 ABDUL RACHMAN 15,000.00 10,000.00 7,500.00 7,500.00
154 ANINDIA RAFA 70,000.00 35,000.00 35,000.00
155 TONNY C H 70,000.00 35,000.00 35,000.00
156 NANI SURYANI 15,000.00 10,000.00 7,500.00 7,500.00
157 HILMAN ALIFIA A 15,000.00 7,500.00 7,500.00
158 RICKY M R 70,000.00 35,000.00 35,000.00
159 ENDANG MUJI A 30,000.00 15,000.00 15,000.00
160 DIAN H 30,000.00 10,000.00 15,000.00 15,000.00
161 AGUS WAHYUDIN 15,000.00 7,500.00 7,500.00
163 KANIA ISLAMIDEWI 40,000.00 20,000.00 20,000.00
164 DYAN DIANING R 30,000.00 15,000.00 15,000.00
165 DELIA SALSA DILA 70,000.00 35,000.00 35,000.00
166 KARTIKA SYAH N 35,000.00 17,500.00 17,500.00
167 GILANG P GUMELAR 70,000.00 35,000.00 35,000.00
168 ERVINA 40,000.00 20,000.00 20,000.00
169 SYAFRUDIN 70,000.00 35,000.00 35,000.00
170 NABILAH CHANDRA L 35,000.00 17,500.00 17,500.00
171 IYAN TARYANA 40,000.00 20,000.00 20,000.00
172 9/11/2016 DIDI 60,000.00 10,000.00 30,000.00 30,000.00
173 SUSILAWATY 15,000.00 10,000.00 7,500.00 7,500.00
174 TUTISAH 70,000.00 10,000.00 35,000.00 35,000.00
175 SETIANINGSIH 60,000.00 10,000.00 30,000.00 30,000.00
176 RONALD DANIEL L 15,000.00 7,500.00 7,500.00
177 TATA TRIANA 30,000.00 10,000.00 15,000.00 15,000.00
178 ASIKIN H 15,000.00 10,000.00 7,500.00 7,500.00
179 YETI MARYATI 30,000.00 15,000.00 15,000.00
180 FRANSISCUS X T 40,000.00 20,000.00 20,000.00
181 DITA W 35,000.00 17,500.00 17,500.00
182 RANGGA PRASETYA 30,000.00 15,000.00 15,000.00
183 MAESAROH 60,000.00 30,000.00 30,000.00
184 NAILA L 70,000.00 35,000.00 35,000.00
185 AKBAR NUGRAHA 70,000.00 35,000.00 35,000.00
186 RUSGANDI OJAK M 70,000.00 35,000.00 35,000.00
187 NIRA SALEHA 30,000.00 10,000.00 15,000.00 15,000.00
188 ROS AMINAH 30,000.00 15,000.00 15,000.00
189 LANIWATI 30,000.00 10,000.00 15,000.00 15,000.00
190 LANIWATI 70,000.00 35,000.00 35,000.00
191 FHIZYA A D 70,000.00 35,000.00 35,000.00
192 10/11/2016 ABDUL RAHMAN 70,000.00 35,000.00 35,000.00
193 ANNA ROHANAH 70,000.00 35,000.00 35,000.00
194 SAMBAS 30,000.00 10,000.00 15,000.00 15,000.00
196 NINING ROHAENI 30,000.00 15,000.00 15,000.00
197 HERAWATI 15,000.00 10,000.00 7,500.00 7,500.00
198 IKAH ATIKAH 70,000.00 35,000.00 35,000.00
199 M AZKA FALIH P 70,000.00 35,000.00 35,000.00
200 LURI R 70,000.00 35,000.00 35,000.00
201 AI SUPRIATI 30,000.00 15,000.00 15,000.00
202 FITRI NURAENI 70,000.00 35,000.00 35,000.00
203 SRI SUSANTI 70,000.00 35,000.00 35,000.00
204 ENUM HADISUMITRA 15,000.00 10,000.00 7,500.00 7,500.00
205 M ANGGAR 30,000.00 15,000.00 15,000.00
206 M NURYANA T 30,000.00 15,000.00 15,000.00
207 IYAM MARYAM 30,000.00 10,000.00 15,000.00 15,000.00
208 ANCI RIANSIH 30,000.00 10,000.00 15,000.00 15,000.00
209 ZAHRA 30,000.00 10,000.00 15,000.00 15,000.00
210 R HENI SULISTIANI 30,000.00 15,000.00 15,000.00
211 DEWITRI JAYA 35,000.00 17,500.00 17,500.00
212 SITI HALIMAH 70,000.00 35,000.00 35,000.00
213 DHENISA Q 25,000.00 12,500.00 12,500.00
214 DYAH AYU PUSPITA 30,000.00 10,000.00 15,000.00 15,000.00
215 WIDA 30,000.00 15,000.00 15,000.00
216 FADILAN R S 30,000.00 15,000.00 15,000.00
217 11/11/2016 AI RITA SOFIA 30,000.00 15,000.00 15,000.00
218 RAFKI PUTRA A 15,000.00 10,000.00 7,500.00 7,500.00
219 SONY HERMANTO 70,000.00 35,000.00 35,000.00
220 MIRA MARYATI 15,000.00 10,000.00 7,500.00 7,500.00
221 MIFTAHUL HUSNA 30,000.00 15,000.00 15,000.00
222 NAURA ASKADINA 30,000.00 15,000.00 15,000.00
223 RUSLI WARDIAWAN 70,000.00 35,000.00 35,000.00
224 NANI HERLANI 15,000.00 10,000.00 7,500.00 7,500.00
225 WIDANINGSIH 70,000.00 35,000.00 35,000.00
226 ENTAR SUTARIAH 60,000.00 10,000.00 30,000.00 30,000.00
227 JUDI BUDIARJO 30,000.00 10,000.00 15,000.00 15,000.00
228 MOH KHASAN 15,000.00 10,000.00 7,500.00 7,500.00
229 NURMEILISA 70,000.00 35,000.00 35,000.00
230 FITRAH ITSNI A 70,000.00 35,000.00 35,000.00
231 NURUL AFIFAH M 70,000.00 35,000.00 35,000.00
232 RENI SURYANI 15,000.00 10,000.00 7,500.00 7,500.00
233 SHAFA LATIEFAH A 30,000.00 15,000.00 15,000.00
234 NIZZAR AKHDAN P 70,000.00 35,000.00 35,000.00
235 OVTINA KUSUMAWATI W 15,000.00 7,500.00 7,500.00
236 NAILA L 35,000.00 17,500.00 17,500.00
237 SUCI AYU S 15,000.00 7,500.00 7,500.00
238 YUYUN Y 30,000.00 15,000.00 15,000.00
239 PIPIH SOPIAH 70,000.00 35,000.00 35,000.00
240 CAHYA SUBAKTI 70,000.00 35,000.00 35,000.00
241 KHEYLECIA C 30,000.00 15,000.00 15,000.00
242 ASEP WAHYUDIN 30,000.00 15,000.00 15,000.00
243 YUNI APRIDA 70,000.00 35,000.00 35,000.00
244 NABILA SYIFA 35,000.00 10,000.00 17,500.00 17,500.00
245 PIPIT FITRIYA 60,000.00 10,000.00 30,000.00 30,000.00
246 12/11/2016 WITA N 70,000.00 10,000.00 35,000.00 35,000.00
247 SUJANA 70,000.00 35,000.00 35,000.00
248 REVI 70,000.00 35,000.00 35,000.00
249 SUNARDI DIANSAH 30,000.00 15,000.00 15,000.00
250 RATNA SUMINAR 30,000.00 15,000.00 15,000.00
251 ISMAYANTI 30,000.00 10,000.00 15,000.00 15,000.00
252 AIRA AHMAD F 35,000.00 17,500.00 17,500.00
253 ARYA AHMAD F 70,000.00 35,000.00 35,000.00
254 NUR FITRI AISYAH 70,000.00 35,000.00 35,000.00
255 ASEP N 30,000.00 10,000.00 15,000.00 15,000.00
256 SULISTYAWATI 70,000.00 10,000.00 35,000.00 35,000.00
257 HEPPI SEPTIAN 30,000.00 10,000.00 15,000.00 15,000.00
258 NABILA 30,000.00 15,000.00 15,000.00
259 NADIA SYABILA O 35,000.00 17,500.00 17,500.00
260 ESTI RIYANTI W 30,000.00 15,000.00 15,000.00
261 SHAFA LATIEFAH A 15,000.00 10,000.00 7,500.00 7,500.00
262 ALHANA SHALSABILA N 30,000.00 15,000.00 15,000.00
263 RENALD 70,000.00 35,000.00 35,000.00
264 LANIWATI 30,000.00 15,000.00 15,000.00
265 M FAUZAN A 70,000.00 35,000.00 35,000.00
266 AMIRA AZIZAH Z 15,000.00 10,000.00 7,500.00 7,500.00
267 LUSI LUSMIATI 15,000.00 7,500.00 7,500.00
268 AURELIA NAUFAH 35,000.00 17,500.00 17,500.00
269 NURINA NURBAITI 15,000.00 7,500.00 7,500.00
270 MEILIANA 40,000.00 10,000.00 20,000.00 20,000.00
271 ASOP SOFIAH 70,000.00 35,000.00 35,000.00
272 SELLY AYUNDA PUTRI 40,000.00 10,000.00 20,000.00 20,000.00
273 M DAFFA S 70,000.00 35,000.00 35,000.00
274 11/14/2016 ELIS 70,000.00 35,000.00 35,000.00
275 YANU SUPRIHANDOKO 30,000.00 15,000.00 15,000.00
276 SUSI IRMA SARI 30,000.00 10,000.00 15,000.00 15,000.00
277 SUYATMI 30,000.00 15,000.00 15,000.00
278 SAFIRA B A 70,000.00 35,000.00 35,000.00
279 IVA ROVIANY Y 35,000.00 10,000.00 17,500.00 17,500.00
280 SITI HODIJAH 60,000.00 30,000.00 30,000.00
281 TEDY SETIADI 60,000.00 10,000.00 30,000.00 30,000.00
282 ASIKIN HANASUPRIATNA 30,000.00 10,000.00 15,000.00 15,000.00
283 PUNGUT 70,000.00 35,000.00 35,000.00
284 SRI KARMILAH 70,000.00 35,000.00 35,000.00
285 YUYUN Y 30,000.00 15,000.00 15,000.00
286 M ADNAN SYAFIZ A N 35,000.00 17,500.00 17,500.00
287 QUINSHA SYIFA C 15,000.00 10,000.00 7,500.00 7,500.00
288 SRI SUWARTI 70,000.00 35,000.00 35,000.00
289 JUHRIAH 15,000.00 10,000.00 7,500.00 7,500.00
290 NINGSIH 70,000.00 35,000.00 35,000.00
291 FAIZUZ NABIL 40,000.00 20,000.00 20,000.00
292 M AIMAR PUTRA P 70,000.00 35,000.00 35,000.00
293 M RIDZKY AKBAR 30,000.00 15,000.00 15,000.00
294 MAYLA SURFIASIH 70,000.00 35,000.00 35,000.00
295 M TAUFIK A 35,000.00 17,500.00 17,500.00
296 ASEP IRFAN BAHARI 15,000.00 10,000.00 7,500.00 7,500.00
297 VINA KHALIFATUL H 15,000.00 7,500.00 7,500.00
298 11/15/2016 KANTI DARMINI 30,000.00 10,000.00 15,000.00 15,000.00
299 IWAN KUSWANDI 70,000.00 35,000.00 35,000.00
300 DJAFAR 70,000.00 35,000.00 35,000.00
301 TONNY CH 70,000.00 35,000.00 35,000.00
302 WIDANINGSIH 30,000.00 15,000.00 15,000.00
303 KANIA ISLAMIDEVI 70,000.00 35,000.00 35,000.00
304 WIDIA ASTUTI 30,000.00 10,000.00 15,000.00 15,000.00
305 SRI WIGATI 30,000.00 15,000.00 15,000.00
306 THERESIA 30,000.00 15,000.00 15,000.00
307 ETI ROSTIAWATI 30,000.00 10,000.00 15,000.00 15,000.00
308 HENDRA GUNAWAN 70,000.00 10,000.00 35,000.00 35,000.00
309 ARIFIN 15,000.00 10,000.00 7,500.00 7,500.00
310 YULIANA LESTARI 70,000.00 35,000.00 35,000.00
311 ENDANG MUJI A 30,000.00 15,000.00 15,000.00
312 MUGIARTI 15,000.00 7,500.00 7,500.00
313 SYAFRUDIN 70,000.00 35,000.00 35,000.00
314 RANGGA PRASETYA 30,000.00 15,000.00 15,000.00
315 RATNASIH 15,000.00 10,000.00 7,500.00 7,500.00
316 ZAHRA PUSPITA DEWI 35,000.00 17,500.00 17,500.00
317 AKBAR N 60,000.00 10,000.00 30,000.00 30,000.00
318 DYAN DIANING R 30,000.00 15,000.00 15,000.00
319 DINA S SURYANI 30,000.00 15,000.00 15,000.00
320 SALWA APRILIA 70,000.00 35,000.00 35,000.00
321 DIDRIKA RD 30,000.00 15,000.00 15,000.00
322 ALVIN RASYIANA 70,000.00 35,000.00 35,000.00
323 DEDI KURNIA 30,000.00 10,000.00 15,000.00 15,000.00
324 HERMAN SULAEMAN 30,000.00 10,000.00 15,000.00 15,000.00
325 11/16/2016 HENI RAHMAWATI 35,000.00 10,000.00 17,500.00 17,500.00
326 RIA FRENTIANI 30,000.00 15,000.00 15,000.00
327 WIDYA HARTAYANTI 70,000.00 35,000.00 35,000.00
328 WAHYU AWALUDIN 30,000.00 15,000.00 15,000.00
329 IIN ROSMANAH 15,000.00 10,000.00 7,500.00 7,500.00
330 AHMAD NURODIN 30,000.00 15,000.00 15,000.00
331 HEPPI SEPTIAN 30,000.00 15,000.00 15,000.00
332 ELIYS NOVIANTI DRA 60,000.00 10,000.00 30,000.00 30,000.00
333 TATA TRIANA 30,000.00 15,000.00 15,000.00
334 SRI RAHAYU 30,000.00 15,000.00 15,000.00
335 MULYANAH 60,000.00 10,000.00 30,000.00 30,000.00
336 NURYANTI 35,000.00 17,500.00 17,500.00
337 YETI MARYATI 30,000.00 15,000.00 15,000.00
338 ADRIAN DEARLY S 30,000.00 15,000.00 15,000.00
339 ADRIEL CHRISTIAN S 30,000.00 10,000.00 15,000.00 15,000.00
340 NAZMI 30,000.00 15,000.00 15,000.00
341 IMAS ATIKAH 70,000.00 35,000.00 35,000.00
342 SHINTA 15,000.00 7,500.00 7,500.00
343 BEKTI TUTUR ARUM 15,000.00 10,000.00 7,500.00 7,500.00
344 IDA JUBAEDAH 30,000.00 10,000.00 15,000.00 15,000.00
345 REZA A 70,000.00 35,000.00 35,000.00
346 LANIWATI 30,000.00 15,000.00 15,000.00
347 LANIWATI 70,000.00 35,000.00 35,000.00
348 ASEP WAHYUDIN 40,000.00 20,000.00 20,000.00
349 M IKHBALUDIN N A 15,000.00 7,500.00 7,500.00
350 DERRY DERMAWAN 70,000.00 35,000.00 35,000.00
351 ASEP B SUDARSONO 70,000.00 35,000.00 35,000.00
353 ANNA ROHANAH 70,000.00 35,000.00 35,000.00
354 AI SUPRIATI 30,000.00 10,000.00 15,000.00 15,000.00
355 TONNY ADRIWIJAYA 30,000.00 15,000.00 15,000.00
356 ASRI JULIAWATI 15,000.00 7,500.00 7,500.00
357 AGUNG DJUNARDIYANTO 70,000.00 35,000.00 35,000.00
358 NINING ROHAENI 40,000.00 20,000.00 20,000.00
359 HARNI SETIAWATI 30,000.00 15,000.00 15,000.00
360 ADE MULYANA 70,000.00 35,000.00 35,000.00
361 EVA AKMALATI S 35,000.00 17,500.00 17,500.00
362 ANDRIAN PURWANTO 35,000.00 17,500.00 17,500.00
363 FITRI NURAENI 30,000.00 10,000.00 15,000.00 15,000.00
364 LIRA ROBIATUL A 15,000.00 10,000.00 7,500.00 7,500.00
365 ERIK PURABITA 15,000.00 10,000.00 7,500.00 7,500.00
366 NESSA ELRA PUROHITA 70,000.00 35,000.00 35,000.00
367 IYAM MARYAM 30,000.00 15,000.00 15,000.00
368 SILVI AVIANTI 70,000.00 35,000.00 35,000.00
369 HENI RAHMAWATI 35,000.00 17,500.00 17,500.00
371 MELA RESTI L 30,000.00 10,000.00 15,000.00 15,000.00
372 ERLAN RENALDY 60,000.00 10,000.00 30,000.00 30,000.00
373 SUPARSI 30,000.00 15,000.00 15,000.00
374 SITI HALIMAH 70,000.00 35,000.00 35,000.00
375 ABUN BUNAMIN 15,000.00 7,500.00 7,500.00
376 11/18/2016 HANI NURHAENI 70,000.00 35,000.00 35,000.00
377 SINTA DWI RIANTI 15,000.00 10,000.00 7,500.00 7,500.00
378 TINA INTAN P 30,000.00 10,000.00 15,000.00 15,000.00
379 NURHAYATI 30,000.00 15,000.00 15,000.00
380 MIFTAHUL HUSNA 40,000.00 20,000.00 20,000.00
381 NABILAH CHANDRA L 30,000.00 15,000.00 15,000.00
382 YENNY DELILAH 15,000.00 10,000.00 7,500.00 7,500.00
383 NURYANTI 30,000.00 15,000.00 15,000.00
384 NANI NERLANI 15,000.00 10,000.00 7,500.00 7,500.00
385 WIDANINGSIH 70,000.00 35,000.00 35,000.00
386 ANI NURAENI 30,000.00 15,000.00 15,000.00
387 RAFKI PUTRA A 25,000.00 10,000.00 12,500.00 12,500.00
388 ASEP RAMADHAN 15,000.00 10,000.00 7,500.00 7,500.00
389 SITI NUR I 15,000.00 7,500.00 7,500.00
390 FITRAH ITSNI A 70,000.00 35,000.00 35,000.00
391 FANYSYA AYU P H 25,000.00 12,500.00 12,500.00
393 SYAFA LATIEFAH 70,000.00 35,000.00 35,000.00
394 IMAS ATIKAH 70,000.00 35,000.00 35,000.00
395 NAILA L 35,000.00 17,500.00 17,500.00
396 PIPIH SOPIAH 15,000.00 7,500.00 7,500.00
397 M AGUNG P P 70,000.00 35,000.00 35,000.00
398 SAMBAS 30,000.00 15,000.00 15,000.00
399 DYAH AYU PUSPITA 30,000.00 15,000.00 15,000.00
400 11/19/2016 IRMAWATI 15,000.00 10,000.00 7,500.00 7,500.00
401 NIRA SALEHA 30,000.00 10,000.00 15,000.00 15,000.00
402 NABILA W 30,000.00 15,000.00 15,000.00
403 SUNARDI DIANSYAH 30,000.00 15,000.00 15,000.00
404 ESTI RIANTI W 30,000.00 15,000.00 15,000.00
405 RATNA SUMINAR 40,000.00 20,000.00 20,000.00
406 AINA AHMAD FIRDAUS 35,000.00 17,500.00 17,500.00
407 ARYA AHMAD FIRDAUS 70,000.00 35,000.00 35,000.00
408 NUR FITRI AISYAH 70,000.00 35,000.00 35,000.00
409 JUHRIAH 15,000.00 7,500.00 7,500.00
410 LORINE LIDWINA L 70,000.00 35,000.00 35,000.00
411 SUPRIYATI 15,000.00 10,000.00 7,500.00 7,500.00
412 FHIZYA A D 30,000.00 15,000.00 15,000.00
413 FHELECIA C 30,000.00 15,000.00 15,000.00
414 MADINA A 70,000.00 10,000.00 35,000.00 35,000.00
415 AMIRA AZIZAH Z 30,000.00 10,000.00 15,000.00 15,000.00
416 QZKA QIANU 70,000.00 35,000.00 35,000.00
417 NURA AULIA W 70,000.00 35,000.00 35,000.00
418 DEWITRI JAYA 70,000.00 35,000.00 35,000.00
419 EPI 15,000.00 10,000.00 7,500.00 7,500.00
420 M ELBY SEBASTIAN 40,000.00 20,000.00 20,000.00
421 AURELIA NAUFAH 35,000.00 17,500.00 17,500.00
422 YATNO 70,000.00 35,000.00 35,000.00
423 SARMINI 15,000.00 7,500.00 7,500.00
424 11/21/2016 YANU SUPRIHANDOKO 30,000.00 10,000.00 15,000.00 15,000.00
425 SUSI IRMA SARI 30,000.00 10,000.00 15,000.00 15,000.00
426 EUIS SUKAESIH 30,000.00 10,000.00 15,000.00 15,000.00
427 RAHMA NUR AISYAH 30,000.00 10,000.00 15,000.00 15,000.00
428 IIS HANDAYANI 70,000.00 35,000.00 35,000.00
429 NUR TRI YANI 30,000.00 15,000.00 15,000.00
430 DIAN N A 30,000.00 10,000.00 15,000.00 15,000.00
431 ARIFIN 60,000.00 10,000.00 30,000.00 30,000.00
432 ANCI RIANSIH 30,000.00 10,000.00 15,000.00 15,000.00
433 IVA ROIVANY 30,000.00 10,000.00 15,000.00 15,000.00
434 HAURA M 30,000.00 10,000.00 15,000.00 15,000.00
435 DIAH TRISTIYAWATI 70,000.00 35,000.00 35,000.00
436 PRAISCA SARA 70,000.00 35,000.00 35,000.00
437 DEBORA K G 35,000.00 17,500.00 17,500.00
438 TUTISAH 70,000.00 35,000.00 35,000.00
439 YUYUN Y 40,000.00 10,000.00 20,000.00 20,000.00
440 RATNA WATI 15,000.00 7,500.00 7,500.00
441 SAFIRA B A 30,000.00 10,000.00 15,000.00 15,000.00
442 KURNIA R 25,000.00 12,500.00 12,500.00
443 M RIDZKY AKBAR 30,000.00 15,000.00 15,000.00
444 M AIMAR PUTRA F 70,000.00 35,000.00 35,000.00
445 AGUS DWI YANA 15,000.00 10,000.00 7,500.00 7,500.00
446 FAIRUS NABIL 70,000.00 35,000.00 35,000.00
447 M AKHSAN 30,000.00 10,000.00 15,000.00 15,000.00
448 WULAN WIDIA WATI 30,000.00 15,000.00 15,000.00
449 RATNA YUNINGSIH 30,000.00 10,000.00 15,000.00 15,000.00
450 M RAIHAN PUTRA ARYAN 15,000.00 10,000.00 7,500.00 7,500.00
451 M RUDI USMAN N 15,000.00 10,000.00 7,500.00 7,500.00
452 SHAFA LUTFI K 30,000.00 15,000.00 15,000.00
453 WITRI W 30,000.00 15,000.00 15,000.00
454 WITRI W 30,000.00 10,000.00 15,000.00 15,000.00
455 11/22/2016 DJAFAR 30,000.00 10,000.00 15,000.00 15,000.00
456 KANTI DARMINI 30,000.00 10,000.00 15,000.00 15,000.00
457 DIDIK R D 70,000.00 35,000.00 35,000.00
458 SITI Q 15,000.00 10,000.00 7,500.00 7,500.00
459 AHMAD TYSUF F 70,000.00 10,000.00 35,000.00 35,000.00
460 WIDANINGSIH 30,000.00 15,000.00 15,000.00
461 AHMAD N 30,000.00 15,000.00 15,000.00
462 NAZMI N S 30,000.00 15,000.00 15,000.00
463 HERAWATI 15,000.00 10,000.00 7,500.00 7,500.00
464 THERESIA STELLA N 30,000.00 10,000.00 15,000.00 15,000.00
465 SRI WIGATI 40,000.00 20,000.00 20,000.00
466 ENDANG MUJI A 40,000.00 20,000.00 20,000.00
467 DYAN DIANING R 30,000.00 10,000.00 15,000.00 15,000.00
468 ELCHASABRINA 30,000.00 15,000.00 15,000.00
469 TATI ROHAYATI 70,000.00 10,000.00 35,000.00 35,000.00
470 SYARIFUDIN 70,000.00 10,000.00 35,000.00 35,000.00
471 CAHYA SUBAKTI 70,000.00 35,000.00 35,000.00
472 SUNARIAH NURUL H 70,000.00 35,000.00 35,000.00
473 AKBAR N 70,000.00 35,000.00 35,000.00
474 MELINDA RAHMAWATI 30,000.00 15,000.00 15,000.00
475 DINA S SURYANI 40,000.00 20,000.00 20,000.00
476 NOVI INTAN LESTARI 30,000.00 15,000.00 15,000.00
477 NASHITA NAURA D 35,000.00 17,500.00 17,500.00
478 YUYUN Y 30,000.00 15,000.00 15,000.00
479 RATNASIH 30,000.00 10,000.00 15,000.00 15,000.00
480 M CATUR NUGRAHA 70,000.00 35,000.00 35,000.00
481 11/23/2016 PRIYADI 70,000.00 35,000.00 35,000.00
482 TATA TRIANA 30,000.00 15,000.00 15,000.00
483 RIA FRENTIANI 40,000.00 20,000.00 20,000.00
484 SRI RAHAYU 30,000.00 15,000.00 15,000.00
485 WAHYU AWALUDIN 70,000.00 35,000.00 35,000.00
486 SETIANINGSIH 70,000.00 35,000.00 35,000.00
487 SUMINEM 35,000.00 17,500.00 17,500.00
489 JUDI BUDIARJO 70,000.00 10,000.00 35,000.00 35,000.00
490 JUHRIAH 60,000.00 10,000.00 30,000.00 30,000.00
491 SUKNAH 15,000.00 10,000.00 7,500.00 7,500.00
492 IMAS SUMIATI 70,000.00 35,000.00 35,000.00
493 YETI MARYATI 70,000.00 35,000.00 35,000.00
494 WILDAN ALFI G 30,000.00 15,000.00 15,000.00
495 HENI RAHMAWATI 70,000.00 35,000.00 35,000.00
496 DIDRIKA R D 30,000.00 15,000.00 15,000.00
497 REYHAN ARGA P 70,000.00 10,000.00 35,000.00 35,000.00
498 REZA AINUNISYA 70,000.00 35,000.00 35,000.00
499 ADITYA F 35,000.00 17,500.00 17,500.00
500 ASEP WAHYUDIN 70,000.00 35,000.00 35,000.00
501 ALVIN RASYIANA 70,000.00 35,000.00 35,000.00
502 LANIWATI 40,000.00 10,000.00 20,000.00 20,000.00
503 HERMAN SULAEMAN 30,000.00 15,000.00 15,000.00
504 ANITA B 70,000.00 35,000.00 35,000.00
505 SELLY AYUNDA PUTRI 30,000.00 10,000.00 15,000.00 15,000.00
506 11/24/2016 HERLIN SUMARLINA 70,000.00 10,000.00 35,000.00 35,000.00
507 ANNA ROHANAH 70,000.00 35,000.00 35,000.00
508 TONNY ADRIWI JAYA 30,000.00 10,000.00 15,000.00 15,000.00
509 AGUNG D 70,000.00 35,000.00 35,000.00
510 NINING ROHAENI 70,000.00 35,000.00 35,000.00
511 FITRAH ITSNI A 70,000.00 35,000.00 35,000.00
512 ROHIMAH 15,000.00 10,000.00 7,500.00 7,500.00
513 TATANG S 15,000.00 7,500.00 7,500.00
514 SULASTRI 70,000.00 10,000.00 35,000.00 35,000.00
515 AI SUPRIATI 30,000.00 15,000.00 15,000.00
516 NANI HERLANI 15,000.00 10,000.00 7,500.00 7,500.00
517 M NURYANA T 40,000.00 20,000.00 20,000.00
518 FREDY M H S 30,000.00 15,000.00 15,000.00
519 IDAH JUBAEDAH 15,000.00 10,000.00 7,500.00 7,500.00
520 IRWANTO 15,000.00 10,000.00 7,500.00 7,500.00
521 HANIS YULI A 15,000.00 7,500.00 7,500.00
522 YANA RUSTIANA 30,000.00 15,000.00 15,000.00
523 ASEP RAMADAN 30,000.00 10,000.00 15,000.00 15,000.00
524 SITI AISAH 60,000.00 10,000.00 30,000.00 30,000.00
525 IYAM MARYAM 30,000.00 10,000.00 15,000.00 15,000.00
526 NABILAH N 30,000.00 10,000.00 15,000.00 15,000.00
527 MULYANAH 30,000.00 10,000.00 15,000.00 15,000.00
529 HANI NURHAENI 70,000.00 35,000.00 35,000.00
530 POPON JULAEMI 30,000.00 10,000.00 15,000.00 15,000.00
531 NANI HERAWATI 70,000.00 35,000.00 35,000.00
532 ENDANG NUR ARI P 60,000.00 10,000.00 30,000.00 30,000.00
533 TITIK S 30,000.00 15,000.00 15,000.00
534 M IKDAR N 30,000.00 15,000.00 15,000.00
535 TRIYANTO S 30,000.00 10,000.00 15,000.00 15,000.00
536 ERLAN RENALDY 70,000.00 35,000.00 35,000.00
537 FITRI NURAENI 30,000.00 15,000.00 15,000.00
538 NASYWA M 35,000.00 10,000.00 17,500.00 17,500.00
539 11/25/2016 SUNARDI D 30,000.00 15,000.00 15,000.00
540 MIFTAHUL HUSNA 70,000.00 35,000.00 35,000.00
541 NURYANTI 30,000.00 10,000.00 15,000.00 15,000.00
542 YADI 15,000.00 10,000.00 7,500.00 7,500.00
543 TINA INTAN P 30,000.00 15,000.00 15,000.00
544 NURHAYATI 15,000.00 10,000.00 7,500.00 7,500.00
545 SALSA DEVIRA P 25,000.00 12,500.00 12,500.00
546 OMAH KOMARIAH 15,000.00 10,000.00 7,500.00 7,500.00
547 DIKI HERMAWAN 15,000.00 10,000.00 7,500.00 7,500.00
548 SRI SURYATI 70,000.00 35,000.00 35,000.00
549 FRANSISCUS X T 70,000.00 35,000.00 35,000.00
550 ANI NURAENI 40,000.00 20,000.00 20,000.00
551 YUHANA L 70,000.00 35,000.00 35,000.00
552 SEPTI H 70,000.00 35,000.00 35,000.00
553 ARYA NOVALDI 15,000.00 7,500.00 7,500.00
554 QUINSHA S C 35,000.00 17,500.00 17,500.00
555 NIZZAR A P 70,000.00 35,000.00 35,000.00
556 DEDI KURNIA 30,000.00 10,000.00 15,000.00 15,000.00
557 SAMBAS 30,000.00 10,000.00 15,000.00 15,000.00
558 IVA REVANY P 30,000.00 10,000.00 15,000.00 15,000.00
559 TARTILAH 15,000.00 7,500.00 7,500.00
560 CHANA YUDA S 35,000.00 17,500.00 17,500.00
561 SUMINAR 15,000.00 10,000.00 7,500.00 7,500.00
562 SHAFA L A 30,000.00 15,000.00 15,000.00
563 TIKA JULIATI 70,000.00 35,000.00 35,000.00
564 DYAH AYU PUSPITA 70,000.00 35,000.00 35,000.00
565 11/26/2016 WIDANINGSIH 70,000.00 35,000.00 35,000.00
566 RATNA SUMINAR 70,000.00 35,000.00 35,000.00
567 ASRI YULIAWATI 70,000.00 35,000.00 35,000.00
568 ASEP N 30,000.00 15,000.00 15,000.00
569 EKO WIDHI NUR C 70,000.00 35,000.00 35,000.00
570 NIRA SALEHA 30,000.00 15,000.00 15,000.00
571 FAIZA AKMALUNNISA 70,000.00 35,000.00 35,000.00
572 LAELI RUKMINI 30,000.00 15,000.00 15,000.00
573 ALHANA 40,000.00 10,000.00 20,000.00 20,000.00
574 FENY AYU 30,000.00 15,000.00 15,000.00
575 ARIFIN ALZAM H P 70,000.00 35,000.00 35,000.00
576 ESTI RIYANTI W 30,000.00 15,000.00 15,000.00
577 M FADHLAN K 40,000.00 20,000.00 20,000.00
578 MEILIANA 70,000.00 35,000.00 35,000.00
579 FHEYLOSIA C 70,000.00 10,000.00 35,000.00 35,000.00
580 M RIVAN F 35,000.00 17,500.00 17,500.00
581 AMIRA AZIZAH Z 30,000.00 15,000.00 15,000.00
582 MELINDA RAHMAWATI 70,000.00 35,000.00 35,000.00
583 AURELIA NAUFAH 35,000.00 17,500.00 17,500.00
584 SARMINI 15,000.00 10,000.00 7,500.00 7,500.00
585 YATNO 70,000.00 35,000.00 35,000.00
586 ARIS WAHYU S 30,000.00 10,000.00 15,000.00 15,000.00
587 REYANDRA 70,000.00 35,000.00 35,000.00
588 EPI 60,000.00 30,000.00 30,000.00
589 M ELBY SEBASTIAN 70,000.00 35,000.00 35,000.00
590 YUYUN Y 30,000.00 15,000.00 15,000.00
591 AYANG 30,000.00 15,000.00 15,000.00
592 11/28/2016 DIAN NURINSANI 30,000.00 15,000.00 15,000.00
593 NAURA 40,000.00 20,000.00 20,000.00
594 NY LIS HANDAYANI 70,000.00 35,000.00 35,000.00
595 TN AGUS 60,000.00 10,000.00 30,000.00 30,000.00
596 SUYATMI 30,000.00 15,000.00 15,000.00
597 ANCI RIANSIH 30,000.00 15,000.00 15,000.00
598 IRA 30,000.00 10,000.00 15,000.00 15,000.00
599 ADI P 15,000.00 10,000.00 7,500.00 7,500.00
600 EUIS 70,000.00 35,000.00 35,000.00
601 SASKIA 25,000.00 12,500.00 12,500.00
602 HAURA M 35,000.00 17,500.00 17,500.00
603 M HISYAM 70,000.00 35,000.00 35,000.00
604 M HAFIZ 30,000.00 15,000.00 15,000.00
605 SRI SUWALSI 70,000.00 35,000.00 35,000.00
606 KURNIA 35,000.00 17,500.00 17,500.00
607 SAFIRA B A 30,000.00 15,000.00 15,000.00
608 ASEP 15,000.00 10,000.00 7,500.00 7,500.00
609 SITI 15,000.00 7,500.00 7,500.00
610 AZAHRA 35,000.00 17,500.00 17,500.00
611 DARIYAH 15,000.00 10,000.00 7,500.00 7,500.00
612 NUR 30,000.00 15,000.00 15,000.00
613 TITIN 70,000.00 35,000.00 35,000.00
614 11/29/2016 DJAFAR 30,000.00 15,000.00 15,000.00
615 USEP D 15,000.00 10,000.00 7,500.00 7,500.00
616 KANTI DARMINI 30,000.00 15,000.00 15,000.00
617 WIDANINGSIH 30,000.00 15,000.00 15,000.00
618 DIDIK R D 70,000.00 35,000.00 35,000.00
619 AHMAD NURADIN 30,000.00 15,000.00 15,000.00
620 FENY AYU A 30,000.00 15,000.00 15,000.00
621 NENENG SRI ATI 30,000.00 15,000.00 15,000.00
622 TIURLANG MANULANG 35,000.00 17,500.00 17,500.00
623 TONNY CH 70,000.00 35,000.00 35,000.00
624 DEDEH ROKAYAH 15,000.00 7,500.00 7,500.00
625 HERU WAWAN 30,000.00 15,000.00 15,000.00
626 KEYSA KAIL A D 15,000.00 7,500.00 7,500.00
627 DADAN SETIAWAN 70,000.00 35,000.00 35,000.00
628 ENDANG 70,000.00 35,000.00 35,000.00
629 THERESIA S N 30,000.00 15,000.00 15,000.00
630 SRI WIGATI 70,000.00 35,000.00 35,000.00
631 EVI SYANTI 30,000.00 15,000.00 15,000.00
632 MAESROH 70,000.00 35,000.00 35,000.00
633 RANGGA PRASETYA 40,000.00 20,000.00 20,000.00
634 RATNA YUNINGSIH 30,000.00 15,000.00 15,000.00
635 WULAN WIDIA WATI 70,000.00 35,000.00 35,000.00
636 DEWITRI JAYA 40,000.00 20,000.00 20,000.00
637 SYARIFUDIN 70,000.00 35,000.00 35,000.00
638 TITA SUGIHARTI 70,000.00 35,000.00 35,000.00
639 AHMAD YUSUF 70,000.00 10,000.00 35,000.00 35,000.00
640 KANIA DWI A 35,000.00 17,500.00 17,500.00
641 DIKI HERMAWAN 30,000.00 10,000.00 15,000.00 15,000.00
642 NAZMI N S 30,000.00 15,000.00 15,000.00
643 MINA SARIATI 30,000.00 15,000.00 15,000.00
644 YUSNI ANDALIA 70,000.00 10,000.00 35,000.00 35,000.00
645 M RUDI USMAN N 15,000.00 10,000.00 7,500.00 7,500.00
646 SHAFA LUTFI F 70,000.00 35,000.00 35,000.00
647 NIRA SALEHA 40,000.00 10,000.00 20,000.00 20,000.00
648 M KHASAN 30,000.00 15,000.00 15,000.00
649 M CATUR NUGRAHA 70,000.00 35,000.00 35,000.00
650 11/30/2016 RIA FRENTIANI 70,000.00 10,000.00 35,000.00 35,000.00
651 YUYUN Y 70,000.00 35,000.00 35,000.00
652 RIA SRI RAHAYU 30,000.00 10,000.00 15,000.00 15,000.00
653 SRI WAHYUNI 70,000.00 35,000.00 35,000.00
654 SITI AMINAH 70,000.00 10,000.00 35,000.00 35,000.00
655 TUTISAH 30,000.00 15,000.00 15,000.00
656 ANDINI A P 15,000.00 10,000.00 7,500.00 7,500.00
657 LUSIANA JULIANTI 25,000.00 12,500.00 12,500.00
658 PEBRIANTI P 30,000.00 10,000.00 15,000.00 15,000.00
659 RINA S 30,000.00 10,000.00 15,000.00 15,000.00
660 SRI RAHAYU 40,000.00 20,000.00 20,000.00
661 WIDANINGSIH 70,000.00 35,000.00 35,000.00
662 WILDAN ALFI G 70,000.00 35,000.00 35,000.00
663 HERMAN SULAEMAN 40,000.00 20,000.00 20,000.00
664 HENI RAHMAWATI 70,000.00 35,000.00 35,000.00
665 LANIWATI 70,000.00 35,000.00 35,000.00
666 YETTY SUMIATI 15,000.00 7,500.00 7,500.00
667 SELLY AYUNDA PUTRI 40,000.00 20,000.00 20,000.00
668 DINA S SURYANI 70,000.00 35,000.00 35,000.00
669 M NURYANA T 70,000.00 35,000.00 35,000.00
670 DIDRIKA R D 30,000.00 15,000.00 15,000.00
671 TARI ROHAYATI 30,000.00 15,000.00 15,000.00
672 M BAHRUN 30,000.00 15,000.00 15,000.00
673 MARSHELA 15,000.00 7,500.00 7,500.00
674 WAHYUNINGSIH 30,000.00 10,000.00 15,000.00 15,000.00
675 ASEP B SUDARSONO 70,000.00 35,000.00 35,000.00
676 RAHMA NUR AISYAH 30,000.00 15,000.00 15,000.00
677 RATNASIH 30,000.00 10,000.00 15,000.00 15,000.00
29,105,000 1,910,000 14,552,500 14,552,500
JML KET
25,000
85,000
85,000
25,000
75,000
155,000
25,000
255,000
205,000
25,000
205,000
275,000
85,000
25,000
145,000
185,000
65,000
255,000
255,000
125,000
25,000
25,000
25,000
100,000
205,000
55,000
85,000
65,000
95,000
75,000
255,000
255,000
85,000
75,000
65,000
105,000
125,000
25,000
25,000
35,000
25,000
275,000
25,000
25,000
75,000
205,000
105,000
125,000
5,245,000
JML KET
70,000.00
30,000.00
70,000.00
30,000.00
40,000.00
30,000.00
70,000.00
70,000.00
40,000.00
30,000.00
40,000.00
25,000.00
25,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
70,000.00
35,000.00
70,000.00
40,000.00
40,000.00
70,000.00
50,000.00
30,000.00
30,000.00
70,000.00
25,000.00
40,000.00
35,000.00
45,000.00
70,000.00
60,000.00
15,000.00
30,000.00
15,000.00
70,000.00
25,000.00
40,000.00
70,000.00
35,000.00
30,000.00
70,000.00
40,000.00
30,000.00
40,000.00
25,000.00
70,000.00
70,000.00
30,000.00
40,000.00
70,000.00
25,000.00
45,000.00
30,000.00
30,000.00
70,000.00
30,000.00
25,000.00
70,000.00
70,000.00
25,000.00
40,000.00
70,000.00
40,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
15,000.00
70,000.00
40,000.00
40,000.00
15,000.00
40,000.00
30,000.00
70,000.00
25,000.00
40,000.00
30,000.00
35,000.00
15,000.00
30,000.00
70,000.00
70,000.00
70,000.00
25,000.00
40,000.00
70,000.00
70,000.00
25,000.00
35,000.00
70,000.00
70,000.00
70,000.00
70,000.00
35,000.00
35,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
60,000.00
25,000.00
15,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
80,000.00
30,000.00
30,000.00
25,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
40,000.00
70,000.00
30,000.00
70,000.00
15,000.00
40,000.00
70,000.00
70,000.00
25,000.00
70,000.00
30,000.00
25,000.00
70,000.00
30,000.00
25,000.00
40,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
25,000.00
70,000.00
70,000.00
25,000.00
15,000.00
70,000.00
30,000.00
40,000.00
15,000.00
30,000.00
40,000.00
30,000.00
70,000.00
35,000.00
70,000.00
40,000.00
70,000.00
35,000.00
40,000.00
70,000.00
25,000.00
80,000.00
70,000.00
15,000.00
40,000.00
25,000.00
30,000.00
40,000.00
35,000.00
30,000.00
60,000.00
70,000.00
70,000.00
70,000.00
40,000.00
30,000.00
40,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
70,000.00
30,000.00
25,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
25,000.00
30,000.00
30,000.00
40,000.00
40,000.00
40,000.00
30,000.00
35,000.00
70,000.00
25,000.00
40,000.00
30,000.00
30,000.00
30,000.00
25,000.00
70,000.00
25,000.00
30,000.00
30,000.00
70,000.00
25,000.00
70,000.00
70,000.00
40,000.00
25,000.00
70,000.00
70,000.00
70,000.00
25,000.00
30,000.00
70,000.00
15,000.00
35,000.00
15,000.00
30,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
45,000.00
70,000.00
80,000.00
70,000.00
70,000.00
30,000.00
30,000.00
40,000.00
35,000.00
70,000.00
70,000.00
40,000.00
80,000.00
40,000.00
30,000.00
35,000.00
30,000.00
25,000.00
30,000.00
70,000.00
30,000.00
70,000.00
25,000.00
15,000.00
35,000.00
15,000.00
50,000.00
70,000.00
50,000.00
70,000.00
70,000.00
30,000.00
40,000.00
30,000.00
70,000.00
45,000.00
60,000.00
70,000.00
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30,000.00
70,000.00
35,000.00
25,000.00
15,000.00
40,000.00
70,000.00
70,000.00
70,000.00
45,000.00
70,000.00
40,000.00
30,000.00
30,000.00
40,000.00
80,000.00
25,000.00
70,000.00
30,000.00
15,000.00
70,000.00
30,000.00
25,000.00
35,000.00
70,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
40,000.00
40,000.00
45,000.00
30,000.00
70,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
70,000.00
35,000.00
30,000.00
30,000.00
40,000.00
30,000.00
70,000.00
15,000.00
25,000.00
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70,000.00
30,000.00
70,000.00
40,000.00
15,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
30,000.00
15,000.00
70,000.00
40,000.00
30,000.00
70,000.00
35,000.00
35,000.00
40,000.00
25,000.00
25,000.00
70,000.00
30,000.00
70,000.00
35,000.00
40,000.00
40,000.00
70,000.00
30,000.00
70,000.00
15,000.00
70,000.00
25,000.00
40,000.00
30,000.00
40,000.00
30,000.00
25,000.00
30,000.00
25,000.00
70,000.00
30,000.00
35,000.00
25,000.00
15,000.00
70,000.00
25,000.00
40,000.00
70,000.00
70,000.00
35,000.00
15,000.00
70,000.00
30,000.00
30,000.00
25,000.00
40,000.00
30,000.00
30,000.00
30,000.00
40,000.00
35,000.00
70,000.00
70,000.00
15,000.00
70,000.00
25,000.00
30,000.00
30,000.00
80,000.00
40,000.00
70,000.00
70,000.00
70,000.00
25,000.00
40,000.00
35,000.00
70,000.00
15,000.00
40,000.00
40,000.00
40,000.00
40,000.00
70,000.00
30,000.00
40,000.00
70,000.00
40,000.00
40,000.00
40,000.00
70,000.00
70,000.00
35,000.00
70,000.00
50,000.00
15,000.00
40,000.00
25,000.00
30,000.00
70,000.00
25,000.00
70,000.00
40,000.00
30,000.00
40,000.00
25,000.00
25,000.00
30,000.00
30,000.00
40,000.00
40,000.00
40,000.00
70,000.00
25,000.00
80,000.00
30,000.00
30,000.00
30,000.00
25,000.00
40,000.00
40,000.00
40,000.00
40,000.00
30,000.00
80,000.00
80,000.00
70,000.00
70,000.00
70,000.00
30,000.00
40,000.00
30,000.00
35,000.00
30,000.00
40,000.00
70,000.00
70,000.00
30,000.00
40,000.00
30,000.00
70,000.00
70,000.00
35,000.00
70,000.00
80,000.00
70,000.00
25,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
80,000.00
70,000.00
35,000.00
70,000.00
70,000.00
50,000.00
30,000.00
70,000.00
40,000.00
80,000.00
70,000.00
40,000.00
70,000.00
70,000.00
70,000.00
25,000.00
15,000.00
80,000.00
30,000.00
25,000.00
40,000.00
30,000.00
25,000.00
25,000.00
15,000.00
30,000.00
40,000.00
70,000.00
40,000.00
40,000.00
40,000.00
70,000.00
70,000.00
40,000.00
70,000.00
70,000.00
30,000.00
30,000.00
40,000.00
70,000.00
30,000.00
45,000.00
30,000.00
70,000.00
40,000.00
25,000.00
30,000.00
25,000.00
25,000.00
25,000.00
25,000.00
70,000.00
70,000.00
40,000.00
70,000.00
70,000.00
15,000.00
35,000.00
70,000.00
40,000.00
40,000.00
40,000.00
15,000.00
35,000.00
25,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
70,000.00
30,000.00
50,000.00
30,000.00
70,000.00
30,000.00
40,000.00
70,000.00
80,000.00
35,000.00
30,000.00
70,000.00
35,000.00
25,000.00
70,000.00
40,000.00
70,000.00
60,000.00
70,000.00
30,000.00
30,000.00
30,000.00
40,000.00
70,000.00
70,000.00
30,000.00
30,000.00
40,000.00
25,000.00
70,000.00
25,000.00
35,000.00
70,000.00
30,000.00
70,000.00
35,000.00
30,000.00
25,000.00
15,000.00
35,000.00
25,000.00
30,000.00
70,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
30,000.00
35,000.00
70,000.00
15,000.00
30,000.00
15,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
70,000.00
40,000.00
30,000.00
70,000.00
40,000.00
70,000.00
70,000.00
80,000.00
35,000.00
40,000.00
30,000.00
30,000.00
80,000.00
25,000.00
70,000.00
50,000.00
30,000.00
70,000.00
80,000.00
70,000.00
40,000.00
70,000.00
80,000.00
30,000.00
25,000.00
25,000.00
40,000.00
40,000.00
40,000.00
70,000.00
70,000.00
40,000.00
70,000.00
70,000.00
15,000.00
40,000.00
70,000.00
70,000.00
30,000.00
30,000.00
30,000.00
15,000.00
40,000.00
70,000.00
30,000.00
40,000.00
31,075,000 -
JASA ALAT &

DOKTER BAHAN
1 12/1/2016 DIANA 250,000 5,000 125,000 125,000
2 UMI KULSUM 20,000 5,000 10,000 10,000
3 12/2/2016 VINA KHALIFATUL 250,000 5,000 125,000 125,000
4 PUTRA 70,000 5,000 35,000 35,000
5 12/3/2016 TN ASEP 80,000 5,000 40,000 40,000
6 KANIA 20,000 5,000 10,000 10,000
7 RAIHAN 70,000 5,000 35,000 35,000
8 12/4/2016 ANGGI 50,000 5,000 25,000 25,000
9 ANGGUN 50,000 5,000 25,000 25,000
10 12/6/2016 RAISU 30,000 5,000 15,000 15,000
11 TIGOR 150,000 5,000 75,000 75,000
12 WULAN 300,000 5,000 150,000 150,000
13 LUTFAN 70,000 5,000 35,000 35,000
14 RUSITAWATI 20,000 5,000 10,000 10,000
15 12/7/2016 INA NURJANAH 80,000 5,000 40,000 40,000
16 12/9/2016 LISNA LAELANTI 250,000 5,000 125,000 125,000
17 TN KURNIA 20,000 5,000 10,000 10,000
18 12/10/2016 TN ASEP 80,000 5,000 40,000 40,000
19 12/14/2016 BUDI SANTOSO 20,000 5,000 10,000 10,000
20 VIKA 70,000 5,000 35,000 35,000
21 12/15/2016 AAN 100,000 5,000 50,000 50,000
22 12/16/2016 VERONIKA 20,000 5,000 10,000 10,000
23 12/17/2016 RUMINTO 80,000 5,000 40,000 40,000
24 SELLA AURELIA 80,000 5,000 40,000 40,000
25 AN RAVA 100,000 5,000 50,000 50,000
26 12/19/2016 KARINA 50,000 5,000 25,000 25,000
27 RINDI ATIKA 80,000 5,000 40,000 40,000
28 12/20/2016 RIA 100,000 5,000 50,000 50,000
29 WILDAN P 200,000 5,000 100,000 100,000
30 12/23/2016 TN ADE S (IURAJUT) 20,000 5,000 10,000 10,000
31 12/24/2016 PUTRI ULIYA S 70,000 5,000 35,000 35,000
32 WIWIN 150,000 5,000 75,000 75,000
33 RIA 100,000 5,000 50,000 50,000
34 12/26/2016 TN SANDI 20,000 5,000 10,000 10,000
35 TN DIMAS 20,000 5,000 10,000 10,000
36 TN ROHENDI 80,000 5,000 40,000 40,000
37 12/27/2016 ADE S (IURAJUT) 20,000 5,000 10,000 10,000
38 12/28/2016 AAN HARDAYANTI 100,000 5,000 50,000 50,000
39 PURSANTI 155,000 5,000 77,500 77,500
40 12/29/2016 JAHRAH 250,000 5,000 125,000 125,000
41 12/30/2016 DIMAS 20,000 5,000 10,000 10,000
42 RIA 100,000 5,000 50,000 50,000
43 12/31/2016 TIKA 150,000 5,000 75,000 75,000
44 ROHENDI 80,000 5,000 40,000 40,000
45 RIVI 80,000 5,000 40,000 40,000
4,175,000 225,000 2,087,500 2,087,500
JASA ALAT &

TGL NAMA TARIF OBAT
DOKTER BAHAN
2 ANNA ROHANAH 70,000.00 35,000.00 35,000.00
3 WIHARDJA 15,000.00 10,000.00 7,500.00 7,500.00
4 FITHRI NURLAELASARI 15,000.00 7,500.00 7,500.00
5 ADISTI A 30,000.00 15,000.00 15,000.00
6 YADI TRIYADI 70,000.00 35,000.00 35,000.00
7 WILDAN FAUZAN 15,000.00 10,000.00 7,500.00 7,500.00
8 CECEP EDIAWAN 15,000.00 10,000.00 7,500.00 7,500.00
9 HERDIAWAN ABDUL H 15,000.00 10,000.00 7,500.00 7,500.00
10 MULYANAH 30,000.00 15,000.00 15,000.00
11 AI SUPRIATI 30,000.00 15,000.00 15,000.00
13 FREDDY MULA HARAS 70,000.00 35,000.00 35,000.00
14 RADEN ANNE S 15,000.00 10,000.00 7,500.00 7,500.00
15 TONNY ANDRIWIJAYA 30,000.00 10,000.00 15,000.00 15,000.00
16 NABILAH N 30,000.00 15,000.00 15,000.00
17 AGUNG DJUNARDIYANTO 70,000.00 10,000.00 35,000.00 35,000.00
18 TANYA AULIA S 25,000.00 12,500.00 12,500.00
19 NANI HERAWATI 35,000.00 17,500.00 17,500.00
20 HANI NURHAENI 70,000.00 35,000.00 35,000.00
21 ANA RIANSIH 40,000.00 20,000.00 20,000.00
22 DESSANI M AL-NUR 25,000.00 12,500.00 12,500.00
23 IVA RAIVANY Y 30,000.00 15,000.00 15,000.00
24 DITA WILIANTI 70,000.00 35,000.00 35,000.00
25 HANIFA RASYIDIN 70,000.00 35,000.00 35,000.00
26 YANA RUSTIANA 70,000.00 35,000.00 35,000.00
27 YARA A 70,000.00 35,000.00 35,000.00
28 NAUREL J 30,000.00 10,000.00 15,000.00 15,000.00
29 SITI HALIMAH 70,000.00 35,000.00 35,000.00
30 2/12/2016 NURYANTI 30,000.00 15,000.00 15,000.00
31 MIFTAHUL HUSNA 70,000.00 35,000.00 35,000.00
32 NURYAHATI 30,000.00 15,000.00 15,000.00
33 RIDWAN LESMANA 30,000.00 10,000.00 15,000.00 15,000.00
34 TIWI SAHLA 15,000.00 10,000.00 7,500.00 7,500.00
35 ROHANDI 15,000.00 7,500.00 7,500.00
36 WULAN SETIANI 70,000.00 35,000.00 35,000.00
37 NURUSIA RUTH H 15,000.00 10,000.00 7,500.00 7,500.00
38 ESTI RIYANTI W 30,000.00 15,000.00 15,000.00
40 IDA NURHAYATI 70,000.00 35,000.00 35,000.00
41 LUKFIYANA 15,000.00 10,000.00 7,500.00 7,500.00
42 SANDI 15,000.00 10,000.00 7,500.00 7,500.00
43 FHIZA A D 70,000.00 35,000.00 35,000.00
44 FITRI NURAENI 30,000.00 10,000.00 15,000.00 15,000.00
45 NABILA NURSADINAH 35,000.00 17,500.00 17,500.00
46 DEDI KURNIA 30,000.00 15,000.00 15,000.00
47 YUYUN Y 40,000.00 20,000.00 20,000.00
48 SILVI AVIANTI 70,000.00 35,000.00 35,000.00
49 WILDAN ALFI G 30,000.00 15,000.00 15,000.00
50 JAHJA AHWAR 15,000.00 10,000.00 7,500.00 7,500.00
51 HENI ROHMAWATI 30,000.00 15,000.00 15,000.00
52 TITIK S 30,000.00 15,000.00 15,000.00
53 3/12/2016 SUNARDI DIANSAH 70,000.00 35,000.00 35,000.00
54 RADJA JORDAN 35,000.00 17,500.00 17,500.00
55 RATNA SUMINAR 30,000.00 15,000.00 15,000.00
56 ASRI YULIAWATI 70,000.00 35,000.00 35,000.00
57 SLAMET EFENDI 15,000.00 10,000.00 7,500.00 7,500.00
58 JUHRIAH 15,000.00 7,500.00 7,500.00
59 ELI SAHLINA 15,000.00 7,500.00 7,500.00
60 RIMA SUTYANI 70,000.00 35,000.00 35,000.00
61 MUHAMMAD RIZAL 30,000.00 15,000.00 15,000.00
62 TIKA JULIANTI 30,000.00 15,000.00 15,000.00
63 TEDY SETIADI 60,000.00 30,000.00 30,000.00
64 LORINE 70,000.00 35,000.00 35,000.00
65 SARMINI 70,000.00 35,000.00 35,000.00
66 YATNO 70,000.00 35,000.00 35,000.00
67 ALISAH 15,000.00 10,000.00 7,500.00 7,500.00
68 AYANG A W 30,000.00 15,000.00 15,000.00
69 AMIRA AZIZAH Z 30,000.00 15,000.00 15,000.00
70 SRI HANDAYANI 70,000.00 35,000.00 35,000.00
71 5/12/2016 YANU SUPRIHANDOKO 40,000.00 20,000.00 20,000.00
72 SUSI IRMA SARI 30,000.00 15,000.00 15,000.00
73 SUYATMI 40,000.00 20,000.00 20,000.00
74 RIA SRI RAHAYU 30,000.00 15,000.00 15,000.00
75 EULIS SUKAESIH 30,000.00 10,000.00 15,000.00 15,000.00
76 LINA KARLINA 15,000.00 7,500.00 7,500.00
77 MARYAM 15,000.00 7,500.00 7,500.00
78 NAURA ASKADINA 70,000.00 10,000.00 35,000.00 35,000.00
79 DIAN H 40,000.00 20,000.00 20,000.00
80 HJ ZULFAH 15,000.00 10,000.00 7,500.00 7,500.00
81 TITA S 30,000.00 10,000.00 15,000.00 15,000.00
82 NURI FITRIAN 15,000.00 7,500.00 7,500.00
83 IVA RAIVANY Y 30,000.00 10,000.00 15,000.00 15,000.00
84 IIS HANDAYANI 30,000.00 15,000.00 15,000.00
85 FAKHRI PRATAMA 25,000.00 12,500.00 12,500.00
86 MAMAM WARMANA 70,000.00 35,000.00 35,000.00
87 INSAN HAMBALI 35,000.00 10,000.00 17,500.00 17,500.00
88 AZHAHRA AULIYA P 35,000.00 17,500.00 17,500.00
89 AGUS S 70,000.00 35,000.00 35,000.00
90 SAFIRA B A 30,000.00 15,000.00 15,000.00
91 MUTIARA HADIA 35,000.00 17,500.00 17,500.00
92 RATNASIH 30,000.00 15,000.00 15,000.00
93 SHYINTA MAHARANI 35,000.00 17,500.00 17,500.00
94 NIRA SITI BADRIAH 30,000.00 15,000.00 15,000.00
95 TITIN S 70,000.00 35,000.00 35,000.00
96 6/12/2016 WIHARDJA 60,000.00 30,000.00 30,000.00
97 YADI 70,000.00 35,000.00 35,000.00
98 UMAR 60,000.00 30,000.00 30,000.00
99 NENENG 70,000.00 35,000.00 35,000.00
100 CECEP 60,000.00 30,000.00 30,000.00
101 RAHMAT 15,000.00 7,500.00 7,500.00
102 DAYAT 30,000.00 15,000.00 15,000.00
103 WIDYA 70,000.00 35,000.00 35,000.00
104 TIGOR 70,000.00 35,000.00 35,000.00
105 SARMINI 60,000.00 30,000.00 30,000.00
106 SYAFRUDIN 70,000.00 35,000.00 35,000.00
107 H ENUM HADISUMITRA 70,000.00 35,000.00 35,000.00
108 AKBAR NUGRAHA 70,000.00 35,000.00 35,000.00
109 DEWITRI JAYA 70,000.00 35,000.00 35,000.00
111 NUNUNG 15,000.00 10,000.00 7,500.00 7,500.00
112 NAZMI N S 40,000.00 20,000.00 20,000.00
113 SALMA S 30,000.00 15,000.00 15,000.00
114 M IKDAR N 70,000.00 35,000.00 35,000.00
115 TRIYANTO S 30,000.00 15,000.00 15,000.00
116 NABILA W 30,000.00 15,000.00 15,000.00
117 DYAN DIANING R 70,000.00 35,000.00 35,000.00
118 7/12/2016 ZINAN RAFIF H 25,000.00 12,500.00 12,500.00
119 SUMINEM 70,000.00 35,000.00 35,000.00
120 HEPPY SEPTIAN 30,000.00 15,000.00 15,000.00
121 WIDANINGSIH 70,000.00 35,000.00 35,000.00
122 WINA GANITA 15,000.00 10,000.00 7,500.00 7,500.00
123 UMAR SETIAWAN C 30,000.00 15,000.00 15,000.00
124 MIA LISNAWATI 30,000.00 10,000.00 15,000.00 15,000.00
125 NANI H 70,000.00 35,000.00 35,000.00
126 YUYUN Y 30,000.00 10,000.00 15,000.00 15,000.00
127 SALWA 70,000.00 35,000.00 35,000.00
128 HERU 35,000.00 17,500.00 17,500.00
129 SUMINEM 30,000.00 10,000.00 15,000.00 15,000.00
130 TUTISAH 30,000.00 15,000.00 15,000.00
131 WIDYANTI 15,000.00 7,500.00 7,500.00
132 SUBIATI 60,000.00 10,000.00 30,000.00 30,000.00
133 SRI RAHAYU 70,000.00 35,000.00 35,000.00
134 CAHYA SUBAKTI 70,000.00 35,000.00 35,000.00
135 ALI AL FARUQ 30,000.00 15,000.00 15,000.00
136 FHEYLECIA C 30,000.00 15,000.00 15,000.00
137 RIZKY NAZAL 15,000.00 7,500.00 7,500.00
138 IDA JUBAEDAH 70,000.00 35,000.00 35,000.00
139 8/12/2016 TONNY ADRIWIJAYA 30,000.00 15,000.00 15,000.00
140 ELI HALIMAH 60,000.00 10,000.00 30,000.00 30,000.00
141 IVA RAIVANY Y 30,000.00 15,000.00 15,000.00
142 BAMBANG PRAYITNO 30,000.00 10,000.00 15,000.00 15,000.00
143 FRANSISCUS X T 70,000.00 35,000.00 35,000.00
144 SHELENA SALMA A 70,000.00 35,000.00 35,000.00
145 LANI HANIFAH 60,000.00 10,000.00 30,000.00 30,000.00
146 MULYANAH 30,000.00 15,000.00 15,000.00
147 DARIYAH 60,000.00 10,000.00 30,000.00 30,000.00
149 ANI N 70,000.00 35,000.00 35,000.00
150 SALWA APRILIA 25,000.00 12,500.00 12,500.00
151 SHAKILA AULIA N R 25,000.00 12,500.00 12,500.00
152 ASEP S 30,000.00 10,000.00 15,000.00 15,000.00
153 9/12/2016 HANI NURHAENI 30,000.00 15,000.00 15,000.00
154 NURYANTI 30,000.00 15,000.00 15,000.00
155 KARWATI 15,000.00 10,000.00 7,500.00 7,500.00
156 NIKEN JIWO A 25,000.00 12,500.00 12,500.00
157 SASMITA W 15,000.00 10,000.00 7,500.00 7,500.00
158 TITIK S 30,000.00 15,000.00 15,000.00
159 RANI YULIANI 15,000.00 10,000.00 7,500.00 7,500.00
160 WULAN 30,000.00 15,000.00 15,000.00
161 RIJAH 70,000.00 35,000.00 35,000.00
162 YULIA 70,000.00 35,000.00 35,000.00
163 RUTH 60,000.00 30,000.00 30,000.00
164 LANIWATI 70,000.00 35,000.00 35,000.00
165 FITRI NURAENI 70,000.00 35,000.00 35,000.00
166 WILDAN ALFI G 30,000.00 15,000.00 15,000.00
167 HENI ROHMAWATI 70,000.00 35,000.00 35,000.00
168 DIDRIKA RD 70,000.00 35,000.00 35,000.00
169 NENG RINA N 30,000.00 10,000.00 15,000.00 15,000.00
170 TATI ROHAYATI 30,000.00 15,000.00 15,000.00
171 M ANGGAR 25,000.00 12,500.00 12,500.00
172 ALYA NUR M 15,000.00 7,500.00 7,500.00
173 M IRSYAD JULIANSAH 30,000.00 15,000.00 15,000.00
174 YANA RUSTIANA 40,000.00 20,000.00 20,000.00
175 RATNASIH 30,000.00 15,000.00 15,000.00
176 JAHJA AHWAR 15,000.00 7,500.00 7,500.00
177 RIZKI OKTAVIANI 15,000.00 7,500.00 7,500.00
178 HANI MULYANI 70,000.00 35,000.00 35,000.00
179 SUHARTI 15,000.00 10,000.00 7,500.00 7,500.00
180 NISRINA AULIA R A 15,000.00 10,000.00 7,500.00 7,500.00
181 10/12/2016 SUNARDI DIANSAH 30,000.00 15,000.00 15,000.00
182 ESTI RIYANTI W 40,000.00 20,000.00 20,000.00
183 NABILA W 70,000.00 35,000.00 35,000.00
184 ASEP N 30,000.00 15,000.00 15,000.00
185 AMIRA NAJMI 70,000.00 35,000.00 35,000.00
186 DINI ANGGRAENI R 30,000.00 10,000.00 15,000.00 15,000.00
187 RADJA JORDAN 25,000.00 12,500.00 12,500.00
188 RADEN ANNE R 70,000.00 10,000.00 35,000.00 35,000.00
189 NADHIFA A R 30,000.00 10,000.00 15,000.00 15,000.00
190 RATNA SUMINAR 70,000.00 35,000.00 35,000.00
191 LOURINE LIDWINA L 70,000.00 35,000.00 35,000.00
192 12/13/2016 AYESHA 70,000.00 35,000.00 35,000.00
193 DJAFAR 70,000.00 35,000.00 35,000.00
194 KANIH 30,000.00 15,000.00 15,000.00
195 WIDIANINGSIH 70,000.00 35,000.00 35,000.00
196 TIURLAN 70,000.00 35,000.00 35,000.00
197 DAURE 70,000.00 35,000.00 35,000.00
198 DHIDA 35,000.00 17,500.00 17,500.00
199 HERMAN SULAEMAN 70,000.00 35,000.00 35,000.00
200 THERESIA 40,000.00 20,000.00 20,000.00
201 SAMBAS 70,000.00 35,000.00 35,000.00
202 UMAR 70,000.00 35,000.00 35,000.00
203 DINAR 30,000.00 15,000.00 15,000.00
204 SUPARSI 15,000.00 7,500.00 7,500.00
205 WAHYU 70,000.00 35,000.00 35,000.00
206 AMBAR 70,000.00 35,000.00 35,000.00
207 DIKI 30,000.00 15,000.00 15,000.00
208 TN AGUS 15,000.00 7,500.00 7,500.00
209 SAFIRA B A 30,000.00 15,000.00 15,000.00
211 JURIAH 70,000.00 35,000.00 35,000.00
212 ERVINA 30,000.00 10,000.00 15,000.00 15,000.00
213 NAZMI NADDIRAH S 70,000.00 35,000.00 35,000.00
214 M MUZAFARUDIN 30,000.00 10,000.00 15,000.00 15,000.00
215 DYAN DIANING R 30,000.00 10,000.00 15,000.00 15,000.00
216 AZHAHRA AULIYA P 35,000.00 17,500.00 17,500.00
217 RATNA S 30,000.00 10,000.00 15,000.00 15,000.00
218 TITA SUGIARTI 70,000.00 35,000.00 35,000.00
219 AYANG A W 40,000.00 20,000.00 20,000.00
220 M INDRA 15,000.00 10,000.00 7,500.00 7,500.00
221 SITI FAHMI 15,000.00 10,000.00 7,500.00 7,500.00
222 RANGGA PRASETYA 30,000.00 15,000.00 15,000.00
223 NUR TRI YANI 30,000.00 15,000.00 15,000.00
224 12/14/2016 RIA FRENTIANI 15,000.00 10,000.00 7,500.00 7,500.00
225 HEPPY SEPTIAN 40,000.00 10,000.00 20,000.00 20,000.00
226 WIDANINGSIH 70,000.00 35,000.00 35,000.00
227 SUBIATI 60,000.00 10,000.00 30,000.00 30,000.00
228 DIAN NURINSANI A 70,000.00 35,000.00 35,000.00
229 MIA LISNAWATI 30,000.00 15,000.00 15,000.00
230 YUYUN N 30,000.00 10,000.00 15,000.00 15,000.00
231 IVA RAIVANY Y 30,000.00 15,000.00 15,000.00
232 HUMAM M 70,000.00 35,000.00 35,000.00
233 TUTISAH 30,000.00 15,000.00 15,000.00
234 NINA S 30,000.00 15,000.00 15,000.00
235 INSAN HAMBALI 70,000.00 35,000.00 35,000.00
236 MONITA TRI P 70,000.00 35,000.00 35,000.00
237 LANIWATI 70,000.00 35,000.00 35,000.00
238 NANDANG S 15,000.00 10,000.00 7,500.00 7,500.00
239 IDA JUBAEDAH 70,000.00 35,000.00 35,000.00
240 HATI ROHAETI 70,000.00 35,000.00 35,000.00
241 ESTI P 15,000.00 7,500.00 7,500.00
242 SUDARTIK 30,000.00 10,000.00 15,000.00 15,000.00
243 DIKI ISKANDAR 15,000.00 10,000.00 7,500.00 7,500.00
244 FHEYLECIA C 30,000.00 15,000.00 15,000.00
246 TONI 40,000.00 20,000.00 20,000.00
247 M RIZKI ZAMHARI 15,000.00 7,500.00 7,500.00
248 LUSI LUSMIATI 15,000.00 7,500.00 7,500.00
249 SRI SUWARTI 70,000.00 35,000.00 35,000.00
250 TURISNO 15,000.00 7,500.00 7,500.00
251 AI SUPRIATI 30,000.00 15,000.00 15,000.00
252 FITRAH ITSNI A 70,000.00 35,000.00 35,000.00
254 KARINA A P 25,000.00 12,500.00 12,500.00
255 SUYATMI 70,000.00 35,000.00 35,000.00
256 SRI LESTARI 30,000.00 15,000.00 15,000.00
257 WIHARDJA 30,000.00 15,000.00 15,000.00
258 DYAH AYU PUSPITA 15,000.00 10,000.00 7,500.00 7,500.00
259 SUPARSI 30,000.00 15,000.00 15,000.00
260 BAMBANG PRAYITNO 30,000.00 15,000.00 15,000.00
261 WAHYUNINGSIH 30,000.00 15,000.00 15,000.00
262 NANA ANDRIANA 30,000.00 15,000.00 15,000.00
263 HANIFA RASYIDIN 70,000.00 35,000.00 35,000.00
264 KARTIKA SYAH N 25,000.00 12,500.00 12,500.00
265 ENCUNG TOSHUA S 70,000.00 35,000.00 35,000.00
266 PAIJAN 30,000.00 15,000.00 15,000.00
267 ANCI RIANSIH 70,000.00 10,000.00 35,000.00 35,000.00
268 12/16/2016 IMAS MAEMUNAH 30,000.00 10,000.00 15,000.00 15,000.00
269 HANI NURHAENI 30,000.00 15,000.00 15,000.00
270 TETEN YANA S 15,000.00 10,000.00 7,500.00 7,500.00
271 NURYANTI 40,000.00 20,000.00 20,000.00
272 MIFTAHUL HUSNA 70,000.00 35,000.00 35,000.00
273 WIWIE Y 15,000.00 10,000.00 7,500.00 7,500.00
274 DWI SUMARNI 15,000.00 10,000.00 7,500.00 7,500.00
275 WULAN SETIANI 30,000.00 15,000.00 15,000.00
276 TITIK 40,000.00 20,000.00 20,000.00
277 SALMAN FATHIN N 15,000.00 7,500.00 7,500.00
278 RENI HURHAYATI 15,000.00 10,000.00 7,500.00 7,500.00
279 QIZA RIZQI P 30,000.00 15,000.00 15,000.00
280 PRIATNA RUMBAYAN 15,000.00 10,000.00 7,500.00 7,500.00
281 BUDI RIANTO 15,000.00 10,000.00 7,500.00 7,500.00
282 LUKFIYANA 15,000.00 10,000.00 7,500.00 7,500.00
284 HENI RAHMAWATI 70,000.00 35,000.00 35,000.00
285 WILDAN ALFI G 70,000.00 35,000.00 35,000.00
286 KASMINI 70,000.00 35,000.00 35,000.00
287 EVI SUKAESIH 60,000.00 10,000.00 30,000.00 30,000.00
288 NIZZAR AKHDAN P 70,000.00 35,000.00 35,000.00
289 SRI LIANAWATI 15,000.00 10,000.00 7,500.00 7,500.00
290 ASEP N 40,000.00 20,000.00 20,000.00
291 NISRINA AULIA R A 25,000.00 12,500.00 12,500.00
292 SHAFA LATIEFAH 30,000.00 15,000.00 15,000.00
293 YANA RUSTIANA 70,000.00 35,000.00 35,000.00
294 RANI YULIANI 15,000.00 10,000.00 7,500.00 7,500.00
295 12/17/2016 ALHANA 70,000.00 35,000.00 35,000.00
296 NANI HERAWATI 30,000.00 15,000.00 15,000.00
297 TENTI R P 15,000.00 10,000.00 7,500.00 7,500.00
298 CEE AHMAD 15,000.00 10,000.00 7,500.00 7,500.00
299 NENG FITRI R A 30,000.00 10,000.00 15,000.00 15,000.00
300 WULAN PURNAMA SARI 30,000.00 10,000.00 15,000.00 15,000.00
301 NADHIFA A R 30,000.00 15,000.00 15,000.00
302 RAFI ANABIL A 30,000.00 15,000.00 15,000.00
303 SINTA HARTY 30,000.00 15,000.00 15,000.00
304 SITI NURHAYATI 30,000.00 10,000.00 15,000.00 15,000.00
305 HANIF ABAAD H 15,000.00 10,000.00 7,500.00 7,500.00
306 TIKA JULIATI 15,000.00 7,500.00 7,500.00
307 MEILIANA 70,000.00 35,000.00 35,000.00
308 AMIRA AJIZAH Z 30,000.00 10,000.00 15,000.00 15,000.00
309 NAUREL JAHIRAH 30,000.00 10,000.00 15,000.00 15,000.00
310 YATNO 70,000.00 35,000.00 35,000.00
311 SUHARTI 70,000.00 35,000.00 35,000.00
312 AZKA QIANA 70,000.00 35,000.00 35,000.00
313 ESTI RIYANTI W 70,000.00 35,000.00 35,000.00
314 IRA WININGSIH 30,000.00 15,000.00 15,000.00
315 M IKHSAN 40,000.00 20,000.00 20,000.00
316 RATNASIH 30,000.00 15,000.00 15,000.00
317 12/19/2016 YANU SUPRIHANDOKO 70,000.00 35,000.00 35,000.00
318 PRIATNA 30,000.00 10,000.00 15,000.00 15,000.00
319 M NURUL M 15,000.00 7,500.00 7,500.00
320 RASYANTI 15,000.00 7,500.00 7,500.00
321 RIA SRI RAHAYU 30,000.00 15,000.00 15,000.00
322 DIAN NURINSANI 30,000.00 10,000.00 15,000.00 15,000.00
324 NADZAR N A 25,000.00 12,500.00 12,500.00
325 RATIH KOSASIH 35,000.00 17,500.00 17,500.00
326 PAIJAN 30,000.00 15,000.00 15,000.00
327 MULYANAH 30,000.00 15,000.00 15,000.00
328 JAFHA M RIESTA 15,000.00 7,500.00 7,500.00
329 M TAUFIK 25,000.00 12,500.00 12,500.00
330 SAFIRA B A 30,000.00 15,000.00 15,000.00
331 MARYANA 15,000.00 10,000.00 7,500.00 7,500.00
332 NETI HERAWATI 15,000.00 7,500.00 7,500.00
333 ENDANG TATIK Z 70,000.00 35,000.00 35,000.00
334 DYAH AYU PUSPITA 15,000.00 10,000.00 7,500.00 7,500.00
335 ASEP MULYANA 70,000.00 35,000.00 35,000.00
336 ENDAH DUDIN I 15,000.00 10,000.00 7,500.00 7,500.00
337 NURWAHYUNI 25,000.00 12,500.00 12,500.00
338 MISCHA 25,000.00 12,500.00 12,500.00
339 12/20/2016 KOWI 70,000.00 35,000.00 35,000.00
340 ERNALDI 30,000.00 15,000.00 15,000.00
341 ALI M 15,000.00 7,500.00 7,500.00
342 HUNAN M 70,000.00 35,000.00 35,000.00
343 ROHMAT S 30,000.00 15,000.00 15,000.00
344 EMI 60,000.00 30,000.00 30,000.00
345 RAMA 30,000.00 15,000.00 15,000.00
346 SOEYADI 60,000.00 30,000.00 30,000.00
347 ETY 60,000.00 30,000.00 30,000.00
348 SINFAHMI 15,000.00 7,500.00 7,500.00
349 SUPATMI 15,000.00 7,500.00 7,500.00
350 WIDIN ASTUTI 60,000.00 30,000.00 30,000.00
351 ERVINA A P 30,000.00 15,000.00 15,000.00
352 AZAHRA AULIYA P 35,000.00 17,500.00 17,500.00
353 RUDI HADIAN W 15,000.00 10,000.00 7,500.00 7,500.00
354 DYAN DIANING R 30,000.00 15,000.00 15,000.00
355 MUBAROD 70,000.00 35,000.00 35,000.00
356 ARIFIN ALZAM H P 70,000.00 35,000.00 35,000.00
357 IYUS SANTOSO 15,000.00 7,500.00 7,500.00
358 MAMAH TARYAMAH 15,000.00 10,000.00 7,500.00 7,500.00
359 SRI SUWARTI 70,000.00 35,000.00 35,000.00
360 AYANG A W 70,000.00 35,000.00 35,000.00
361 JULIA ISTIQOMAHH 70,000.00 35,000.00 35,000.00
362 ERLAN KANDANI 70,000.00 35,000.00 35,000.00
363 12/21/2016 SUSI IRMA SARI 40,000.00 20,000.00 20,000.00
364 LELA MAYASARI 30,000.00 10,000.00 15,000.00 15,000.00
365 KIA AULIA A 15,000.00 10,000.00 7,500.00 7,500.00
366 SUBIATI 30,000.00 15,000.00 15,000.00
367 NAURA ASKADINA 30,000.00 15,000.00 15,000.00
368 FAUZIAH NUR SYIFA 15,000.00 7,500.00 7,500.00
369 HEPY SEPTIAN 70,000.00 35,000.00 35,000.00
370 NANA ANDRIANA 30,000.00 10,000.00 15,000.00 15,000.00
371 IFA FATMAWATI 15,000.00 10,000.00 7,500.00 7,500.00
372 WIDANINGSIH 70,000.00 35,000.00 35,000.00
373 WAHYU R 70,000.00 35,000.00 35,000.00
374 SINTA HARTY 30,000.00 15,000.00 15,000.00
375 RAFI ANABIL A 30,000.00 15,000.00 15,000.00
376 TUTISAH 40,000.00 20,000.00 20,000.00
377 YOGI 70,000.00 35,000.00 35,000.00
378 SALWA 35,000.00 17,500.00 17,500.00
379 TANIA 70,000.00 35,000.00 35,000.00
380 12/22/2016 DEDE JUARSIH 15,000.00 10,000.00 7,500.00 7,500.00
381 NISA GUSTINA 25,000.00 12,500.00 12,500.00
382 TUTI HARYATI 70,000.00 35,000.00 35,000.00
383 GO GIOK LIE 15,000.00 7,500.00 7,500.00
384 DEDE S 15,000.00 10,000.00 7,500.00 7,500.00
385 FHEYLECYA 70,000.00 35,000.00 35,000.00
386 RINAYATI 60,000.00 10,000.00 30,000.00 30,000.00
387 ENDANG S 30,000.00 10,000.00 15,000.00 15,000.00
388 IMAM N 60,000.00 10,000.00 30,000.00 30,000.00
389 SURADI 15,000.00 10,000.00 7,500.00 7,500.00
390 DAFA YUANDA 30,000.00 10,000.00 15,000.00 15,000.00
391 TONY ADRIWIJAYA 70,000.00 35,000.00 35,000.00
392 ALFALIH RAMADHAN 15,000.00 7,500.00 7,500.00
393 WIHARDJA 30,000.00 15,000.00 15,000.00
394 BAMBANG PRAYITNO 70,000.00 35,000.00 35,000.00
395 SIRI HALIMAH 15,000.00 7,500.00 7,500.00
396 FENI AYU A 30,000.00 15,000.00 15,000.00
397 IVA ROIVANY 40,000.00 20,000.00 20,000.00
398 ENCUNG YOSHUA S 70,000.00 10,000.00 35,000.00 35,000.00
399 NANI HERAWATI 35,000.00 17,500.00 17,500.00
400 12/23/2016 MIFTAHUL HUSNA F 70,000.00 35,000.00 35,000.00
401 HANI NURHAENI 30,000.00 15,000.00 15,000.00
402 IMAS MAEMUNAH 30,000.00 15,000.00 15,000.00
403 NURYANTI 70,000.00 35,000.00 35,000.00
404 DEVI ANDRIYANA 15,000.00 10,000.00 7,500.00 7,500.00
405 FITRI NURAENI 70,000.00 35,000.00 35,000.00
406 YULI PARDININGSIH 15,000.00 10,000.00 7,500.00 7,500.00
407 IVA KANIA ZULFA 30,000.00 15,000.00 15,000.00
408 RENI NURHAYATI 70,000.00 35,000.00 35,000.00
409 SALSABILA L H 70,000.00 35,000.00 35,000.00
410 ALVITA L H 30,000.00 15,000.00 15,000.00
411 ROS AMINAH 30,000.00 15,000.00 15,000.00
412 TITIK 70,000.00 35,000.00 35,000.00
413 TITIK 70,000.00 35,000.00 35,000.00
414 SITI KOMALA 15,000.00 10,000.00 7,500.00 7,500.00
415 ISTIANA NOVITA 15,000.00 10,000.00 7,500.00 7,500.00
416 SODIK MUTAKIN 15,000.00 10,000.00 7,500.00 7,500.00
417 DEWITRI JAYA 30,000.00 15,000.00 15,000.00
418 SHAFA LATIEFA A 30,000.00 10,000.00 15,000.00 15,000.00
419 NISRINA AULIA R A 15,000.00 10,000.00 7,500.00 7,500.00
420 RENI ANGGREAENI 15,000.00 10,000.00 7,500.00 7,500.00
421 FAHIRA RAMADHAN P 15,000.00 7,500.00 7,500.00
422 YANA RUSTIANA 70,000.00 35,000.00 35,000.00
423 TN KUSNADI 60,000.00 30,000.00 30,000.00
424 TRIYANTO 30,000.00 15,000.00 15,000.00
425 MARSHELA W 25,000.00 12,500.00 12,500.00
426 ADE R 15,000.00 7,500.00 7,500.00
427 BINARTO 15,000.00 10,000.00 7,500.00 7,500.00
428 M IFDAN N 30,000.00 15,000.00 15,000.00
429 WAHYUNINGSIH 30,000.00 15,000.00 15,000.00
430 SITI NUR I 15,000.00 7,500.00 7,500.00
431 12/24/2016 ASWI DAYANTI 30,000.00 10,000.00 15,000.00 15,000.00
432 WULAN PURNAMA SARI 30,000.00 15,000.00 15,000.00
433 ASEP N 70,000.00 10,000.00 35,000.00 35,000.00
434 SITI NURDIAH 30,000.00 10,000.00 15,000.00 15,000.00
435 ISTIANA NOVITA 15,000.00 10,000.00 7,500.00 7,500.00
436 REIZAL N A 30,000.00 15,000.00 15,000.00
437 SYIFA OKAVIA 70,000.00 10,000.00 35,000.00 35,000.00
438 SITI NURHAYATI 30,000.00 15,000.00 15,000.00
439 MEILIANA 70,000.00 35,000.00 35,000.00
440 IRA WININGSIH 30,000.00 15,000.00 15,000.00
441 HANA DEVINA YOLANDA 35,000.00 10,000.00 17,500.00 17,500.00
442 WISNU FITRIADY 70,000.00 35,000.00 35,000.00
443 AZKA QIANU 70,000.00 35,000.00 35,000.00
444 ANI HARYATI 70,000.00 35,000.00 35,000.00
445 NURHAYATI 40,000.00 10,000.00 20,000.00 20,000.00
446 RATNASIH 30,000.00 15,000.00 15,000.00
447 12/26/2016 SUSI IRMA SARI 70,000.00 35,000.00 35,000.00
448 LELA MAYASARI 30,000.00 15,000.00 15,000.00
449 KIA AULIA A 25,000.00 12,500.00 12,500.00
450 PRIATNA 30,000.00 15,000.00 15,000.00
451 DIAN NURINSANI 60,000.00 30,000.00 30,000.00
453 PURMINAH 30,000.00 15,000.00 15,000.00
454 PAIJAN 30,000.00 15,000.00 15,000.00
455 NASYILA V 25,000.00 12,500.00 12,500.00
456 IVA RAIVANI Y 30,000.00 15,000.00 15,000.00
457 TATA SUHAYA 60,000.00 10,000.00 30,000.00 30,000.00
458 FRANSISCUS X T 70,000.00 35,000.00 35,000.00
459 OKKY AHMAD S D 15,000.00 7,500.00 7,500.00
460 NILLENIA 70,000.00 35,000.00 35,000.00
461 EVELIN YUNITA W 70,000.00 35,000.00 35,000.00
462 ZARA DIPTA A 70,000.00 35,000.00 35,000.00
463 MAMAN WARMANA 70,000.00 35,000.00 35,000.00
464 12/27/2016 EROS 30,000.00 10,000.00 15,000.00 15,000.00
465 RAHMAT S 30,000.00 15,000.00 15,000.00
466 PATIMAH AZ ZAHRA 25,000.00 12,500.00 12,500.00
467 AZ ZAHRA DIAN R 25,000.00 10,000.00 12,500.00 12,500.00
468 SITI PUPUT N A 15,000.00 7,500.00 7,500.00
469 ERNAWATI 30,000.00 15,000.00 15,000.00
470 HUMAM M 70,000.00 35,000.00 35,000.00
471 NABILA S A 25,000.00 12,500.00 12,500.00
472 SAFIRA B A 30,000.00 15,000.00 15,000.00
473 DINAR KURNIAWAN 30,000.00 15,000.00 15,000.00
474 YATNO 70,000.00 35,000.00 35,000.00
475 SURADI 15,000.00 10,000.00 7,500.00 7,500.00
476 IWARSIH 15,000.00 10,000.00 7,500.00 7,500.00
477 JUJU ENDANG W 70,000.00 35,000.00 35,000.00
478 SHABRINA AULIA N H 25,000.00 12,500.00 12,500.00
479 ASEP SARIPUDIN 70,000.00 35,000.00 35,000.00
480 BINARTO 15,000.00 10,000.00 7,500.00 7,500.00
481 SEPHIA R P 15,000.00 7,500.00 7,500.00
482 RATNA SULISTIANI 30,000.00 10,000.00 15,000.00 15,000.00
483 MISCHA A 25,000.00 12,500.00 12,500.00
484 M TAUFIK 25,000.00 12,500.00 12,500.00
485 ATIQAH NUR A 30,000.00 10,000.00 15,000.00 15,000.00
486 MARYONO 15,000.00 10,000.00 7,500.00 7,500.00
487 NETI HERAWATI 15,000.00 7,500.00 7,500.00
488 DYAH AYU 70,000.00 10,000.00 35,000.00 35,000.00
489 DEWITRI JAYA 30,000.00 15,000.00 15,000.00
490 MILA KAMILATAN 15,000.00 7,500.00 7,500.00
491 RONNY S FAISAL 70,000.00 35,000.00 35,000.00
492 KHALIFA SHAKI F 15,000.00 7,500.00 7,500.00
493 TITA SUGIHARTI 70,000.00 35,000.00 35,000.00
494 RESNAWATI 70,000.00 35,000.00 35,000.00
495 BERNANDA BIMA 15,000.00 7,500.00 7,500.00
496 ARIFIN ALZAM H P 70,000.00 35,000.00 35,000.00
497 ERLAN KANDANI 30,000.00 15,000.00 15,000.00
498 EUIS DWI ANGGRAENI 30,000.00 10,000.00 15,000.00 15,000.00
499 MAMAH TARYAMAH 15,000.00 7,500.00 7,500.00
500 12/28/2016 INDRIATI 60,000.00 10,000.00 30,000.00 30,000.00
501 RIZKI DWI N 70,000.00 35,000.00 35,000.00
502 SARMI HERY S 30,000.00 10,000.00 15,000.00 15,000.00
503 M AHLAM T 15,000.00 10,000.00 7,500.00 7,500.00
504 WIDANINGSIH 70,000.00 35,000.00 35,000.00
505 ANI NURYANI 60,000.00 10,000.00 30,000.00 30,000.00
506 ISTIANA NOVITA 60,000.00 10,000.00 30,000.00 30,000.00
507 NANA ANDRIANA 40,000.00 20,000.00 20,000.00
508 TUTISAH 70,000.00 35,000.00 35,000.00
509 NANI HERAWATI 30,000.00 10,000.00 15,000.00 15,000.00
510 RATIH KOSASIH 30,000.00 15,000.00 15,000.00
511 MAESAROH 70,000.00 35,000.00 35,000.00
512 RANGGA PRASETYA 30,000.00 15,000.00 15,000.00
513 DEDE SUPRIYATNA 15,000.00 10,000.00 7,500.00 7,500.00
514 EMILIA 30,000.00 15,000.00 15,000.00
515 ROSMAWATI 30,000.00 15,000.00 15,000.00
516 NADIA 25,000.00 12,500.00 12,500.00
517 SILVA ZEFENDI 30,000.00 15,000.00 15,000.00
518 NADZAR N A 25,000.00 12,500.00 12,500.00
519 FIAN SHAFANI 15,000.00 10,000.00 7,500.00 7,500.00
520 ARIANI SYIFA 25,000.00 12,500.00 12,500.00
521 TATI ROHAYATI 30,000.00 15,000.00 15,000.00
522 NAIMA A S R 15,000.00 10,000.00 7,500.00 7,500.00
523 KASMINI 70,000.00 35,000.00 35,000.00
524 12/29/2016 IMAS MAEMUNAH 30,000.00 10,000.00 15,000.00 15,000.00
525 TUTI HARYATI 15,000.00 10,000.00 7,500.00 7,500.00
526 ASEP MULYANA 30,000.00 15,000.00 15,000.00
527 WIHARDJA 30,000.00 15,000.00 15,000.00
528 FANYSYA AYU P H 25,000.00 12,500.00 12,500.00
530 DWI ISWATI 15,000.00 10,000.00 7,500.00 7,500.00
531 FITRI NURAENI 30,000.00 15,000.00 15,000.00
532 JAHRAH 70,000.00 35,000.00 35,000.00
533 MULYANAH 40,000.00 20,000.00 20,000.00
534 IMAM NUGROHO 15,000.00 10,000.00 7,500.00 7,500.00
535 TITIN S 30,000.00 15,000.00 15,000.00
536 NUKE 30,000.00 15,000.00 15,000.00
537 ENDANG SUPRIATNA 30,000.00 15,000.00 15,000.00
538 ZAHWA ALYA K 30,000.00 10,000.00 15,000.00 15,000.00
539 MONITA TRI P 70,000.00 35,000.00 35,000.00
540 P SITANGGANG 35,000.00 10,000.00 17,500.00 17,500.00
541 LANIWATI 70,000.00 35,000.00 35,000.00
542 NANA ANDRIANA 30,000.00 15,000.00 15,000.00
543 NOVI INTAN LESTARI 35,000.00 17,500.00 17,500.00
544 MIWARNI 60,000.00 10,000.00 30,000.00 30,000.00
545 IVA RAIVANI Y 70,000.00 35,000.00 35,000.00
546 RAHMAT 15,000.00 10,000.00 7,500.00 7,500.00
547 12/30/2016 WITRI W 70,000.00 35,000.00 35,000.00
548 WITRI W 70,000.00 10,000.00 35,000.00 35,000.00
549 HANI NURHAENI 40,000.00 20,000.00 20,000.00
550 MIFTAHUL HUSNA 70,000.00 35,000.00 35,000.00
551 AI SUPRIATI 30,000.00 15,000.00 15,000.00
552 SULIS PUTRI W 15,000.00 10,000.00 7,500.00 7,500.00
553 TITIK 70,000.00 10,000.00 35,000.00 35,000.00
554 ADI A SYAHPUTRA 15,000.00 10,000.00 7,500.00 7,500.00
555 NABILA PUTRI A 30,000.00 10,000.00 15,000.00 15,000.00
556 RENI NURHAYATI 70,000.00 35,000.00 35,000.00
557 SALMAN FATHY N 25,000.00 12,500.00 12,500.00
558 FIRIAH ITSNI 70,000.00 35,000.00 35,000.00
559 DWI RAHAYU P 70,000.00 35,000.00 35,000.00
560 ROS AMINAH 30,000.00 15,000.00 15,000.00
561 NINING S 15,000.00 10,000.00 7,500.00 7,500.00
562 SRI SUWARTI 70,000.00 35,000.00 35,000.00
563 SHANA YUDA S 25,000.00 12,500.00 12,500.00
564 TARTILAH 15,000.00 10,000.00 7,500.00 7,500.00
565 SUNARDI D 30,000.00 15,000.00 15,000.00
566 SITI NUR I 70,000.00 35,000.00 35,000.00
567 M IFDAN N 40,000.00 20,000.00 20,000.00
568 TRIYANTO S 40,000.00 20,000.00 20,000.00
569 ARIF HIDAYAT 30,000.00 10,000.00 15,000.00 15,000.00
570 YANA RUSTIANA 70,000.00 35,000.00 35,000.00
571 ALVITO L H 40,000.00 20,000.00 20,000.00
572 EVELIN YUNITA W 70,000.00 35,000.00 35,000.00
573 ARIFIN YUNITA H P 70,000.00 35,000.00 35,000.00
574 SRI LIANAWATI 70,000.00 35,000.00 35,000.00
575 NIZAR A P 70,000.00 35,000.00 35,000.00
576 ASEP N 30,000.00 10,000.00 15,000.00 15,000.00
577 12/31/2016 WULAN PURNAMA SARI 30,000.00 15,000.00 15,000.00
578 INTAN KARTIKA SARI 15,000.00 7,500.00 7,500.00
579 TIKA J 15,000.00 10,000.00 7,500.00 7,500.00
580 M LUKMAN L 30,000.00 10,000.00 15,000.00 15,000.00
581 ASWI DAYANTI 30,000.00 15,000.00 15,000.00
582 NOVI RESTIANI 60,000.00 10,000.00 30,000.00 30,000.00
583 YULIA 60,000.00 10,000.00 30,000.00 30,000.00
584 ALDI RIDWAN S 30,000.00 10,000.00 15,000.00 15,000.00
585 QIZA RIZQI P 30,000.00 15,000.00 15,000.00
587 SITI NURHAYATI 30,000.00 15,000.00 15,000.00
588 YANA FEBRIANA 60,000.00 10,000.00 30,000.00 30,000.00
589 NINA OKTIANA 30,000.00 10,000.00 15,000.00 15,000.00
590 DEDE RIDWAN 30,000.00 15,000.00 15,000.00
591 PANDI S 30,000.00 10,000.00 15,000.00 15,000.00
592 MARYONO 15,000.00 7,500.00 7,500.00
593 BERNANDA BIMA 15,000.00 7,500.00 7,500.00
594 KOKOM KOMARIAH 70,000.00 35,000.00 35,000.00
595 SUGIYARTI 70,000.00 35,000.00 35,000.00
596 ALYA RAHMA P 35,000.00 17,500.00 17,500.00
597 ELSA AGUSTINA 70,000.00 35,000.00 35,000.00
598 EVA NURANI 30,000.00 10,000.00 15,000.00 15,000.00
599 MEGAWATI 15,000.00 10,000.00 7,500.00 7,500.00
600 M RIZKI 70,000.00 10,000.00 35,000.00 35,000.00
601 AMIRA AJIZAH Z 70,000.00 10,000.00 35,000.00 35,000.00
602 NURHAYATI 40,000.00 20,000.00 20,000.00
603 NURHAYATI 40,000.00 20,000.00 20,000.00
24,585,000 1,620,000 12,292,500 12,292,500
JML KET
255,000
25,000
255,000
75,000
85,000
25,000
75,000
55,000
55,000
35,000
155,000
305,000
75,000
25,000
85,000
255,000
25,000
85,000
25,000
75,000
105,000
25,000
85,000
85,000
105,000
55,000
85,000
105,000
205,000
25,000
75,000
155,000
105,000
25,000
25,000
85,000
25,000
105,000
160,000
255,000
25,000
105,000
155,000
85,000
85,000
4,400,000
N
JML KET
70,000.00
70,000.00
25,000.00
15,000.00
30,000.00
70,000.00
25,000.00
25,000.00
25,000.00
30,000.00
30,000.00
70,000.00
70,000.00
25,000.00
40,000.00
30,000.00
80,000.00
25,000.00
35,000.00
70,000.00
40,000.00
25,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
70,000.00
30,000.00
70,000.00
30,000.00
40,000.00
25,000.00
15,000.00
70,000.00
25,000.00
30,000.00
15,000.00
70,000.00
25,000.00
25,000.00
70,000.00
40,000.00
35,000.00
30,000.00
40,000.00
70,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
35,000.00
30,000.00
70,000.00
25,000.00
15,000.00
15,000.00
70,000.00
30,000.00
30,000.00
60,000.00
70,000.00
70,000.00
70,000.00
25,000.00
30,000.00
30,000.00
70,000.00
40,000.00
30,000.00
40,000.00
30,000.00
40,000.00
15,000.00
15,000.00
80,000.00
40,000.00
25,000.00
40,000.00
15,000.00
40,000.00
30,000.00
25,000.00
70,000.00
45,000.00
35,000.00
70,000.00
30,000.00
35,000.00
30,000.00
35,000.00
30,000.00
70,000.00
60,000.00
70,000.00
60,000.00
70,000.00
60,000.00
15,000.00
35,000.00
70,000.00
70,000.00
60,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
25,000.00
40,000.00
30,000.00
70,000.00
30,000.00
30,000.00
70,000.00
25,000.00
70,000.00
30,000.00
70,000.00
25,000.00
30,000.00
40,000.00
70,000.00
40,000.00
70,000.00
35,000.00
40,000.00
30,000.00
15,000.00
70,000.00
70,000.00
70,000.00
30,000.00
30,000.00
15,000.00
70,000.00
30,000.00
70,000.00
30,000.00
40,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
25,000.00
25,000.00
40,000.00
30,000.00
30,000.00
25,000.00
25,000.00
25,000.00
30,000.00
25,000.00
30,000.00
70,000.00
70,000.00
60,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
40,000.00
30,000.00
25,000.00
15,000.00
30,000.00
40,000.00
30,000.00
15,000.00
15,000.00
70,000.00
25,000.00
25,000.00
30,000.00
40,000.00
70,000.00
30,000.00
70,000.00
40,000.00
25,000.00
80,000.00
40,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
35,000.00
70,000.00
40,000.00
70,000.00
70,000.00
30,000.00
15,000.00
70,000.00
70,000.00
30,000.00
15,000.00
30,000.00
30,000.00
70,000.00
40,000.00
70,000.00
40,000.00
40,000.00
35,000.00
40,000.00
70,000.00
40,000.00
25,000.00
25,000.00
30,000.00
30,000.00
25,000.00
50,000.00
70,000.00
70,000.00
70,000.00
30,000.00
40,000.00
30,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
25,000.00
70,000.00
70,000.00
70,000.00
40,000.00
25,000.00
30,000.00
70,000.00
40,000.00
15,000.00
15,000.00
70,000.00
15,000.00
30,000.00
70,000.00
70,000.00
25,000.00
70,000.00
30,000.00
30,000.00
25,000.00
30,000.00
30,000.00
30,000.00
30,000.00
70,000.00
25,000.00
70,000.00
30,000.00
80,000.00
40,000.00
30,000.00
25,000.00
40,000.00
70,000.00
25,000.00
25,000.00
30,000.00
40,000.00
15,000.00
25,000.00
30,000.00
25,000.00
25,000.00
25,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
70,000.00
25,000.00
40,000.00
25,000.00
30,000.00
70,000.00
25,000.00
70,000.00
30,000.00
25,000.00
25,000.00
40,000.00
40,000.00
30,000.00
45,000.00
30,000.00
40,000.00
25,000.00
15,000.00
70,000.00
40,000.00
40,000.00
70,000.00
70,000.00
70,000.00
70,000.00
30,000.00
40,000.00
30,000.00
70,000.00
40,000.00
15,000.00
15,000.00
30,000.00
40,000.00
40,000.00
25,000.00
35,000.00
30,000.00
30,000.00
15,000.00
25,000.00
30,000.00
25,000.00
15,000.00
70,000.00
25,000.00
70,000.00
25,000.00
25,000.00
25,000.00
70,000.00
30,000.00
15,000.00
70,000.00
30,000.00
60,000.00
30,000.00
60,000.00
60,000.00
15,000.00
15,000.00
60,000.00
30,000.00
35,000.00
25,000.00
30,000.00
70,000.00
70,000.00
15,000.00
25,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
40,000.00
25,000.00
30,000.00
30,000.00
15,000.00
70,000.00
40,000.00
25,000.00
70,000.00
70,000.00
30,000.00
30,000.00
40,000.00
70,000.00
35,000.00
70,000.00
25,000.00
25,000.00
70,000.00
15,000.00
25,000.00
70,000.00
70,000.00
40,000.00
70,000.00
25,000.00
40,000.00
70,000.00
15,000.00
30,000.00
70,000.00
15,000.00
30,000.00
40,000.00
80,000.00
35,000.00
70,000.00
30,000.00
30,000.00
70,000.00
25,000.00
70,000.00
25,000.00
30,000.00
70,000.00
70,000.00
30,000.00
30,000.00
70,000.00
70,000.00
25,000.00
25,000.00
25,000.00
30,000.00
40,000.00
25,000.00
25,000.00
15,000.00
70,000.00
60,000.00
30,000.00
25,000.00
15,000.00
25,000.00
30,000.00
30,000.00
15,000.00
40,000.00
30,000.00
80,000.00
40,000.00
25,000.00
30,000.00
80,000.00
30,000.00
70,000.00
30,000.00
45,000.00
70,000.00
70,000.00
70,000.00
50,000.00
30,000.00
70,000.00
30,000.00
25,000.00
30,000.00
60,000.00
70,000.00
30,000.00
30,000.00
25,000.00
30,000.00
70,000.00
70,000.00
15,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
30,000.00
25,000.00
35,000.00
15,000.00
30,000.00
70,000.00
25,000.00
30,000.00
30,000.00
70,000.00
25,000.00
25,000.00
70,000.00
25,000.00
70,000.00
25,000.00
15,000.00
40,000.00
25,000.00
25,000.00
40,000.00
25,000.00
15,000.00
80,000.00
30,000.00
15,000.00
70,000.00
15,000.00
70,000.00
70,000.00
15,000.00
70,000.00
30,000.00
40,000.00
15,000.00
70,000.00
70,000.00
40,000.00
25,000.00
70,000.00
70,000.00
70,000.00
40,000.00
70,000.00
40,000.00
30,000.00
70,000.00
30,000.00
25,000.00
30,000.00
30,000.00
25,000.00
30,000.00
25,000.00
25,000.00
25,000.00
30,000.00
25,000.00
70,000.00
40,000.00
25,000.00
30,000.00
30,000.00
25,000.00
70,000.00
25,000.00
30,000.00
70,000.00
40,000.00
25,000.00
30,000.00
30,000.00
30,000.00
40,000.00
70,000.00
45,000.00
70,000.00
30,000.00
35,000.00
70,000.00
70,000.00
25,000.00
70,000.00
80,000.00
40,000.00
70,000.00
30,000.00
25,000.00
80,000.00
25,000.00
40,000.00
70,000.00
25,000.00
70,000.00
70,000.00
30,000.00
25,000.00
70,000.00
25,000.00
25,000.00
30,000.00
70,000.00
40,000.00
40,000.00
40,000.00
70,000.00
40,000.00
70,000.00
70,000.00
70,000.00
70,000.00
40,000.00
30,000.00
15,000.00
25,000.00
40,000.00
30,000.00
70,000.00
70,000.00
40,000.00
30,000.00
40,000.00
30,000.00
70,000.00
40,000.00
30,000.00
40,000.00
15,000.00
15,000.00
70,000.00
70,000.00
35,000.00
70,000.00
40,000.00
25,000.00
80,000.00
80,000.00
40,000.00
40,000.00
26,280,000 -
JASA ALAT &

DOKTER BAHAN
1 1/3/2017 ANGGI 250,000 5,000 125,000 125,000 255,000
2 ANAS 250,000 5,000 125,000 125,000 255,000
3 GITA NURANI 20,000 5,000 10,000 10,000 25,000
4 INA NURJANAH 100,000 5,000 50,000 50,000 105,000
5 NILA PUTRI B 100,000 5,000 50,000 50,000 105,000
6 1/4/2017 AAN HARDAYANTI 80,000 5,000 40,000 40,000 85,000
7 RIFAD N R 70,000 5,000 35,000 35,000 75,000
8 1/5/2017 M RIZWAN 20,000 5,000 10,000 10,000 25,000
9 1/6/2017 YASIN 70,000 5,000 35,000 35,000 75,000
10 IRHAS 20,000 5,000 10,000 10,000 25,000
11 WIDAD 200,000 5,000 100,000 100,000 205,000
12 AKHSAN 20,000 5,000 10,000 10,000 25,000
13 RAZIBLAL 20,000 5,000 10,000 10,000 25,000
14 NY TIKA 80,000 5,000 40,000 40,000 85,000
15 1/7/2017 KEISYA 70,000 5,000 35,000 35,000 75,000
16 NY TIKA 50,000 5,000 25,000 25,000 55,000
17 NY RIA 100,000 5,000 50,000 50,000 105,000
18 GILANG ERLANGGA J 30,000 5,000 15,000 15,000 35,000
19 1/8/2017 PERDANA 100,000 5,000 50,000 50,000 105,000
20 ANGGI 50,000 5,000 25,000 25,000 55,000
21 1/9/2017 RUDI SUTANDI 80,000 5,000 40,000 40,000 85,000
22 NY DITA 20,000 5,000 10,000 10,000 25,000
23 1/10/2017 DIAN 250,000 5,000 125,000 125,000 255,000
24 1/11/2017 AAN HARDAYANI 100,000 5,000 50,000 50,000 105,000
25 ELSA AJIZAH 380,000 5,000 190,000 190,000 385,000
26 1/12/2017 NILA PUTRI B 80,000 5,000 40,000 40,000 85,000
27 1/14/2017 M RESKI 100,000 5,000 50,000 50,000 105,000
28 NY LELA 160,000 5,000 80,000 80,000 165,000
29 RANU DWIPA 70,000 5,000 35,000 35,000 75,000
30 RIA 100,000 5,000 50,000 50,000 105,000
31 1/16/2017 RAIHAN 20,000 5,000 10,000 10,000 25,000
32 1/17/2017 HARPER EDSEL T 20,000 5,000 10,000 10,000 25,000
33 ANISA FAUZIAH 70,000 5,000 35,000 35,000 75,000
34 1/18/2017 LUSI SEPTIANI 200,000 5,000 100,000 100,000 205,000
35 SHAQULE R A 20,000 5,000 10,000 10,000 25,000
36 NY AYI 20,000 5,000 10,000 10,000 25,000
37 SITI ISTIQOMAH 80,000 5,000 40,000 40,000 85,000
38 1/19/2017 NY EMI 80,000 5,000 40,000 40,000 85,000
39 YANI 20,000 5,000 10,000 10,000 25,000
40 YOZA HERWINA 200,000 5,000 100,000 100,000 205,000
41 1/20/2017 M RIZWAN 140,000 5,000 70,000 70,000 145,000
42 DIAN FATONAH 45,000 5,000 22,500 22,500 50,000
43 NY RIA 100,000 5,000 50,000 50,000 105,000
44 1/21/2017 NY DIAN 430,000 5,000 215,000 215,000 435,000
45 1/24/2017 TN ZULKIFLI 150,000 5,000 75,000 75,000 155,000
46 1/25/2017 IBU ANI 200,000 5,000 100,000 100,000 205,000
47 RAISA 60,000 5,000 30,000 30,000 65,000
48 1/26/2017 TN DEDE R 20,000 5,000 10,000 10,000 25,000
49 MENTARI 20,000 5,000 10,000 10,000 25,000
50 1/27/2017 SUKANAH 250,000 5,000 125,000 125,000 255,000
51 150,000 5,000 75,000 75,000 155,000
52 80,000 5,000 40,000 40,000 85,000
53 80,000 5,000 40,000 40,000 85,000
5,495,000 265,000 2,747,500 2,747,500 5,760,000

JASA ALAT &

TGL NAMA TARIF OBAT JML
DOKTER BAHAN
1 3/1/2017 ERNAWATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
2 HUMAM MUZAKI 70,000.00 35,000.00 35,000.00 70,000.00
3 EROS 30,000.00 15,000.00 15,000.00 30,000.00
4 RAHMAT 30,000.00 15,000.00 15,000.00 30,000.00
5 NANI MULYANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
6 SHERLY SALSABILA 25,000.00 12,500.00 12,500.00 25,000.00
7 FANYSYA AYU P H 30,000.00 15,000.00 15,000.00 30,000.00
8 SAFIRA B A 30,000.00 15,000.00 15,000.00 30,000.00
9 AZZAHRA DIAN R 25,000.00 12,500.00 12,500.00 25,000.00
10 NONENG 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
11 IVA KANIA ZULFA 30,000.00 15,000.00 15,000.00 30,000.00
12 FRANSISCUS X T 70,000.00 35,000.00 35,000.00 70,000.00
13 TITIK 30,000.00 15,000.00 15,000.00 30,000.00
14 YULI PARDININGSIH 15,000.00 7,500.00 7,500.00 15,000.00
15 JAHRAH 70,000.00 35,000.00 35,000.00 70,000.00
16 ADHKIYA F R 35,000.00 17,500.00 17,500.00 35,000.00
17 SILVA ZEFENDI 30,000.00 15,000.00 15,000.00 30,000.00
18 ROSMAWATI 30,000.00 15,000.00 15,000.00 30,000.00
19 NADIA DWI E 25,000.00 12,500.00 12,500.00 25,000.00
20 ITALIANTI 70,000.00 35,000.00 35,000.00 70,000.00
21 DEWITRI JAYA 70,000.00 35,000.00 35,000.00 70,000.00
22 RONNY S FAISAL 70,000.00 35,000.00 35,000.00 70,000.00
23 DESI 70,000.00 35,000.00 35,000.00 70,000.00
24 NAURA YASMINA A 70,000.00 35,000.00 35,000.00 70,000.00
25 PUSPITA 30,000.00 15,000.00 15,000.00 30,000.00
26 DIYAH AYU PUSPITA 30,000.00 15,000.00 15,000.00 30,000.00
27 ZANA 70,000.00 35,000.00 35,000.00 70,000.00
28 ERLAN KANDANI 30,000.00 15,000.00 15,000.00 30,000.00
29 4/1/2017 RIA SRI RAHAYU 40,000.00 20,000.00 20,000.00 40,000.00
30 IMAS MAEMUNAH 30,000.00 15,000.00 15,000.00 30,000.00
31 PUTRI NURUL H 30,000.00 15,000.00 15,000.00 30,000.00
32 RATIH KOSASIH 15,000.00 7,500.00 7,500.00 15,000.00
33 RESYA P W 30,000.00 15,000.00 15,000.00 30,000.00
34 NANI HERAWATI 30,000.00 15,000.00 15,000.00 30,000.00
35 TIHANA SITI H 15,000.00 7,500.00 7,500.00 15,000.00
36 RATNA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
37 HUGA AHMAD K 70,000.00 35,000.00 35,000.00 70,000.00
38 IDA NURHAYATI 70,000.00 35,000.00 35,000.00 70,000.00
39 SARMI HERU S 30,000.00 15,000.00 15,000.00 30,000.00
40 ANI NURYANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
41 RANGGA PRASETYA 30,000.00 15,000.00 15,000.00 30,000.00
42 TATI 30,000.00 15,000.00 15,000.00 30,000.00
43 RIRIN RAHMA 25,000.00 12,500.00 12,500.00 25,000.00
44 TIARA R S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
45 AMBROSIUS ODJA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
46 MARSHELA W 25,000.00 12,500.00 12,500.00 25,000.00
47 WAHYUNINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
48 5/1/2017 MARYONO 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
49 NISRINA AULIYA 70,000.00 35,000.00 35,000.00 70,000.00
50 SHAFA LATIEFAH 70,000.00 35,000.00 35,000.00 70,000.00
51 RENI SURYANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
52 THERESIA STELLA N 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
53 YULI EKA P 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
54 FITRIYANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
55 M AMIR ABDULAH S 25,000.00 12,500.00 12,500.00 25,000.00
56 DWITA PRAGUTA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
57 HERLIN SUMARLINA 30,000.00 15,000.00 15,000.00 30,000.00
58 JAHRAH 70,000.00 35,000.00 35,000.00 70,000.00
59 FITRI NURAENI 30,000.00 15,000.00 15,000.00 30,000.00
60 M YOGI D P 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
61 TITA S 40,000.00 20,000.00 20,000.00 40,000.00
62 YAYA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
63 ENDANG SUPRIATNA 30,000.00 15,000.00 15,000.00 30,000.00
64 AZALINA A 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
65 ANITA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
66 PAIJAN 40,000.00 20,000.00 20,000.00 40,000.00
67 WIHARDJA 40,000.00 20,000.00 20,000.00 40,000.00
68 EMILIA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
69 SUMIATI 70,000.00 35,000.00 35,000.00 70,000.00
70 FITRIA NURHAYATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
71 ALYA MUKHBITA F 25,000.00 12,500.00 12,500.00 25,000.00
72 AGUS KUSNADI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
73 NASYILA V 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
74 IVA RAIVANY Y 30,000.00 15,000.00 15,000.00 30,000.00
75 MULYANAH 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
76 ZARA DIPTA A 70,000.00 35,000.00 35,000.00 70,000.00
77 6/1/2017 HANI 70,000.00 35,000.00 35,000.00 70,000.00
78 PRIATNA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
79 SULIS PUTRI N 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
80 RISTIA KURNIAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
81 BUNGA DITA N A 25,000.00 12,500.00 12,500.00 25,000.00
82 HUSEN SUPRIADI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
83 KURNIA RAHMAWATI 15,000.00 7,500.00 7,500.00 15,000.00
84 RIDWAN LESMANA S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
85 KASMINI 30,000.00 15,000.00 15,000.00 30,000.00
86 ROS AMINAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
87 NABILA PUTRI A 70,000.00 35,000.00 35,000.00 70,000.00
88 ALMA IKRAMINA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
89 WITA 15,000.00 7,500.00 7,500.00 15,000.00
90 WILDAN ALFI G 70,000.00 35,000.00 35,000.00 70,000.00
91 HENI RAHMAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
92 NAIMA A S R 35,000.00 17,500.00 17,500.00 35,000.00
93 ENDAH YUNI ASTUTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
94 ALVITO L H 70,000.00 35,000.00 35,000.00 70,000.00
95 SITI NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
96 7/1/2017 AMAH 70,000.00 35,000.00 35,000.00 70,000.00
97 DEWITRI JAYA 70,000.00 35,000.00 35,000.00 70,000.00
98 WULAN 40,000.00 20,000.00 20,000.00 40,000.00
99 SYAHLA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
100 ROSIANA R 25,000.00 12,500.00 12,500.00 25,000.00
101 DZALA S 70,000.00 35,000.00 35,000.00 70,000.00
102 LIES SUARTI 70,000.00 35,000.00 35,000.00 35,000.00
103 ANDIKA DWI PUTRI 70,000.00 35,000.00 35,000.00 70,000.00
104 HENI ROSYANA 70,000.00 35,000.00 35,000.00 70,000.00
105 FANSYA AYU P H 30,000.00 15,000.00 15,000.00 30,000.00
106 ETI ROHAETI 30,000.00 15,000.00 15,000.00 30,000.00
107 LORINE LIDWINA L 70,000.00 35,000.00 35,000.00 70,000.00
108 ALDI RIDWAN S 30,000.00 15,000.00 15,000.00 30,000.00
109 DANDI S 30,000.00 15,000.00 15,000.00 30,000.00
110 ROSMAWATI 30,000.00 15,000.00 15,000.00 30,000.00
111 ELSA AGUSTINA 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
112 AMIRA AZIZAH Z 30,000.00 15,000.00 15,000.00 30,000.00
113 NIRA SITI BADRIAH 30,000.00 15,000.00 15,000.00 30,000.00
114 ARIF HIDAYAT 30,000.00 15,000.00 15,000.00 30,000.00
115 AERIYANTI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
116 ELA NURAENI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
117 SUGIYARTI 70,000.00 35,000.00 35,000.00 70,000.00
118 TRIYANTO 70,000.00 35,000.00 35,000.00 70,000.00
119 NUKE 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
120 9/1/2017 MIKAYLA M YUSUF 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
121 MAMAN SUHERMAN 15,000.00 7,500.00 7,500.00 15,000.00
122 LELA MAYASARI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
123 KIA AULIA ANGGRAENI 25,000.00 12,500.00 12,500.00 25,000.00
124 DEDE SUPARLAN 70,000.00 35,000.00 35,000.00 70,000.00
125 DIAN NURINSANI 30,000.00 15,000.00 15,000.00 30,000.00
126 RIA SRI RAHAYU 70,000.00 35,000.00 35,000.00 70,000.00
127 FRANSISCUS X T 70,000.00 35,000.00 35,000.00 70,000.00
128 M ANGGAR 25,000.00 12,500.00 12,500.00 25,000.00
129 SRI LASWANTI 15,000.00 7,500.00 7,500.00 15,000.00
130 NILLENIA 70,000.00 35,000.00 35,000.00 70,000.00
131 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
132 YATNO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
133 NAZWA 30,000.00 15,000.00 15,000.00 30,000.00
134 M SOFIAN LUTFI 70,000.00 35,000.00 35,000.00 70,000.00
135 RUDI HADIAN W 15,000.00 7,500.00 7,500.00 15,000.00
136 ANGGUN 15,000.00 7,500.00 7,500.00 15,000.00
137 SAFIRA B A 30,000.00 15,000.00 15,000.00 30,000.00
138 BIDA NINGSIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
139 AUREN DWI AROFAH 25,000.00 12,500.00 12,500.00 25,000.00
140 ADITYA FIRMANSYAH 25,000.00 12,500.00 12,500.00 25,000.00
141 TATI ROHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
142 AE SAEPUDIN 30,000.00 15,000.00 15,000.00 30,000.00
143 RENI NURHAYATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
144 IVA KANIA ZULFA 30,000.00 15,000.00 15,000.00 30,000.00
145 IMAM NUGROHO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
146 MYSHELLA PUTRI R P 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
147 AGNESIA 35,000.00 17,500.00 17,500.00 35,000.00
148 10/1/2017 ERNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
149 HUMAM MUZAKI 30,000.00 15,000.00 15,000.00 30,000.00
150 NENENG SULASMI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
151 SUMIDI 15,000.00 7,500.00 7,500.00 15,000.00
152 EROS ROSITA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
153 SHERLY SALSABILA 25,000.00 12,500.00 12,500.00 25,000.00
154 JUMIYANI 70,000.00 35,000.00 35,000.00 70,000.00
155 WIDANINGSIH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
156 EROS 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
157 RAHMAT S 30,000.00 15,000.00 15,000.00 30,000.00
158 TATI NURHAYATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
159 SITA DEWI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
160 SRI NURHAYATIK 70,000.00 35,000.00 35,000.00 70,000.00
161 SRI WARTINI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
162 TENI RUMITJA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
163 NONENG SUMARTINI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
164 FITRAH ITSNI A 70,000.00 35,000.00 35,000.00 70,000.00
165 11/1/2017 IMAS MAEMUNAH 30,000.00 15,000.00 15,000.00 30,000.00
166 SARMI HERA S 30,000.00 15,000.00 15,000.00 30,000.00
167 NANI HERAWATI 30,000.00 15,000.00 15,000.00 30,000.00
168 PAIJAN 70,000.00 35,000.00 35,000.00 70,000.00
169 BUNGA DITA N A 30,000.00 15,000.00 15,000.00 30,000.00
170 RESYA P W 30,000.00 15,000.00 15,000.00 30,000.00
171 TN PRIYADI 70,000.00 35,000.00 35,000.00 70,000.00
172 PUSPITA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
173 SOEYADI 70,000.00 35,000.00 35,000.00 70,000.00
174 ANI NURYANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
175 RATNA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
176 DJOKO SUPRIYANTO 30,000.00 15,000.00 15,000.00 30,000.00
177 RANGGA PRASETYA 30,000.00 15,000.00 15,000.00 30,000.00
178 DEDE RIDWAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
179 BEJO SUPRIANTO 70,000.00 35,000.00 35,000.00 70,000.00
180 ASEP D 30,000.00 15,000.00 15,000.00 30,000.00
181 SABAR SENTOSA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
182 YANA RUSTIANA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
183 ERLAN KANDANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
184 DZAKI S 25,000.00 12,500.00 12,500.00 25,000.00
185 MARCELITA K 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
186 FRISKA DIANA NUR A 70,000.00 35,000.00 35,000.00 70,000.00
187 FIHMI COMANA R 25,000.00 12,500.00 12,500.00 25,000.00
188 SALMA ISTIQOMAH 70,000.00 35,000.00 35,000.00 70,000.00
189 NETI K HADIJAH 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
190 JAHRAH 70,000.00 35,000.00 35,000.00 70,000.00
191 ARIMBI KHOLIFI T 35,000.00 17,500.00 17,500.00 35,000.00
192 DIAN SUTRISNA 70,000.00 35,000.00 35,000.00 70,000.00
193 NAURA YASMINA A 70,000.00 35,000.00 35,000.00 70,000.00
194 DESI 15,000.00 7,500.00 7,500.00 15,000.00
195 12/1/2017 NUKE 70,000.00 35,000.00 35,000.00 70,000.00
196 FITRIYANI 70,000.00 35,000.00 35,000.00 70,000.00
197 MARCUS REBECA 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
198 DINAR KURNIAWAN 35,000.00 17,500.00 17,500.00 35,000.00
199 TENTI R P 70,000.00 35,000.00 35,000.00 70,000.00
200 DWITA PRAGUSTA AMD 40,000.00 20,000.00 20,000.00 40,000.00
201 ENDANG SUPRIATNA 70,000.00 35,000.00 35,000.00 70,000.00
202 LALAN WULANDARI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
203 ANANDA DWI KIANA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
204 NABILA PUTRI A 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
205 MELIYANI 70,000.00 35,000.00 35,000.00 70,000.00
206 PURI WIGATI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
207 WIHARDJA 30,000.00 15,000.00 15,000.00 30,000.00
208 NAURA AKADINA R 15,000.00 7,500.00 7,500.00 15,000.00
209 MUTIA FITRAH 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
210 RESNAWATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
211 SODIK MUTAKIN 70,000.00 35,000.00 35,000.00 70,000.00
212 SITI HALIMAH 30,000.00 15,000.00 15,000.00 30,000.00
213 ROHENDI 70,000.00 35,000.00 35,000.00 70,000.00
214 HARTINI 30,000.00 15,000.00 15,000.00 30,000.00
215 ISMAIL NASUTION 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
216 CHAISAR SYAKTI 35,000.00 17,500.00 17,500.00 35,000.00
217 PUTRI NURUL H 30,000.00 15,000.00 15,000.00 30,000.00
218 NOVI INTAN LESTARI 70,000.00 35,000.00 35,000.00 70,000.00
219 IVA RAIVANY Y 40,000.00 20,000.00 20,000.00 40,000.00
220 AMAURE Z G 15,000.00 7,500.00 7,500.00 15,000.00
221 SELVIA RATU A 15,000.00 7,500.00 7,500.00 15,000.00
222 TITIK S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
223 01/13/2017 M LUQMAN L 30,000.00 15,000.00 15,000.00 30,000.00
224 WULAN SETIANI 30,000.00 15,000.00 15,000.00 30,000.00
225 RIDWAN LESMANA S 30,000.00 15,000.00 15,000.00 30,000.00
226 TENI RUMITJA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
227 FENG AYU 30,000.00 15,000.00 15,000.00 30,000.00
228 OGAY H 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
229 KARTIKAH 15,000.00 7,500.00 7,500.00 15,000.00
230 NADIA DWI E 25,000.00 12,500.00 12,500.00 25,000.00
231 SILVA ZEFENDI 30,000.00 15,000.00 15,000.00 30,000.00
232 ROSMAWATI 40,000.00 20,000.00 20,000.00 40,000.00
233 NOVI R 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
234 FITRI NURAENI 30,000.00 15,000.00 15,000.00 30,000.00
235 DEWITRI 70,000.00 35,000.00 35,000.00 70,000.00
236 LADIYA KIRANI 25,000.00 12,500.00 12,500.00 25,000.00
237 ROS AMINAH 30,000.00 15,000.00 15,000.00 30,000.00
238 TARTILAH 15,000.00 7,500.00 7,500.00 15,000.00
239 YULI TIKA S 15,000.00 7,500.00 7,500.00 15,000.00
240 WILDAN ALFI G 70,000.00 35,000.00 35,000.00 70,000.00
241 HENI RAHMAWATI 15,000.00 10,000.00 7,500.00 7,500.00 70,000.00
242 SITI N 40,000.00 10,000.00 20,000.00 20,000.00 50,000.00
243 01/14/2017 AGUNG D 70,000.00 35,000.00 35,000.00 70,000.00
244 LIN ROSMANAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
245 LENI MARLINA 70,000.00 35,000.00 35,000.00 70,000.00
246 NAJWA K 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
247 RISTIA KURNIAWATI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
248 JUMIATIN 30,000.00 15,000.00 15,000.00 30,000.00
249 ASEP NUROCHIM 30,000.00 15,000.00 15,000.00 30,000.00
250 WULAN PURNAMA SARI 70,000.00 35,000.00 35,000.00 70,000.00
251 ROSIANA R 25,000.00 12,500.00 12,500.00 25,000.00
252 SYAHLA WIDHI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
253 TIA APRILIANI 70,000.00 35,000.00 35,000.00 70,000.00
254 FANFSYA AYU 25,000.00 12,500.00 12,500.00 25,000.00
255 MYSHELA 35,000.00 17,500.00 17,500.00 35,000.00
256 LOURINE L 70,000.00 35,000.00 35,000.00 70,000.00
257 SUNARDI DIANSYAH 30,000.00 15,000.00 15,000.00 30,000.00
258 EVA NURANI 30,000.00 15,000.00 15,000.00 30,000.00
259 DANDI 40,000.00 20,000.00 20,000.00 40,000.00
260 HASNA HANIYAH H 25,000.00 12,500.00 12,500.00 25,000.00
261 ISNANIA HAULIYA P 70,000.00 35,000.00 35,000.00 70,000.00
262 MAMAN SUHERMAN 50,000.00 25,000.00 25,000.00 50,000.00
263 KIKI K 70,000.00 35,000.00 35,000.00 70,000.00
264 ARIF HIDAYAT 30,000.00 15,000.00 15,000.00 30,000.00
265 WILDAN ALFI G 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
266 AMIRA AZIZAH Z 30,000.00 15,000.00 15,000.00 30,000.00
267 ZHAFIRAH 15,000.00 7,500.00 7,500.00 15,000.00
268 01/16/2017 EROS ROSITA 60,000.00 30,000.00 30,000.00 60,000.00
269 MIKAYLA M YUSUF 30,000.00 15,000.00 15,000.00 30,000.00
270 TIURLAN MANULANG 15,000.00 7,500.00 7,500.00 15,000.00
271 IMAS MAEMUNAH 30,000.00 15,000.00 15,000.00 30,000.00
272 WIDA NOVIANTINI 35,000.00 17,500.00 17,500.00 35,000.00
273 KRISTIANUS ZAMASI 15,000.00 7,500.00 7,500.00 15,000.00
274 RESYA PAHIM W 40,000.00 20,000.00 20,000.00 40,000.00
275 DIAN NURINSANI 30,000.00 15,000.00 15,000.00 30,000.00
276 ANDRI T 60,000.00 30,000.00 30,000.00 60,000.00
277 AE SAEPUDIN 40,000.00 20,000.00 20,000.00 40,000.00
278 FRANSISCUS X T 70,000.00 35,000.00 35,000.00 70,000.00
279 MARJAN 15,000.00 7,500.00 7,500.00 15,000.00
280 AI SUMARNI 30,000.00 15,000.00 15,000.00 30,000.00
281 RAHARDIYAN N 30,000.00 15,000.00 15,000.00 30,000.00
282 SUSAN S 30,000.00 15,000.00 15,000.00 30,000.00
283 OGAY H 15,000.00 7,500.00 7,500.00 15,000.00
284 IVA KANIA ZULFA 30,000.00 15,000.00 15,000.00 30,000.00
285 TATI ROHAYATI 40,000.00 20,000.00 20,000.00 40,000.00
286 DEDE RIDWAN 30,000.00 15,000.00 15,000.00 30,000.00
287 DEWI N 70,000.00 35,000.00 35,000.00 70,000.00
288 LENI MAULIYANI 15,000.00 7,500.00 7,500.00 15,000.00
289 RAISYA APRILIA 25,000.00 12,500.00 12,500.00 25,000.00
290 M IIRSYAD J 70,000.00 35,000.00 35,000.00 70,000.00
291 EROS 40,000.00 20,000.00 20,000.00 40,000.00
292 MAYA SARI 15,000.00 7,500.00 7,500.00 15,000.00
293 RAHMAT S 40,000.00 20,000.00 20,000.00 40,000.00
294 SITI SUCI CAHYATI 15,000.00 7,500.00 7,500.00 15,000.00
295 SANTI R 70,000.00 35,000.00 35,000.00 70,000.00
296 01/17/2017 NENENG SULASMI 30,000.00 15,000.00 15,000.00 30,000.00
297 DEDE SUPARLAN 70,000.00 35,000.00 35,000.00 70,000.00
298 JUMIYATI 70,000.00 35,000.00 35,000.00 70,000.00
299 WIDANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
300 DINAR KURNIAWAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
301 BAMBANG PRAYITNO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
302 SRI WARTINI 30,000.00 15,000.00 15,000.00 45,000.00
303 ANTHONY 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
304 TRESNI AMALIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
305 MARCUS REBECA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
306 HUMAM M 30,000.00 15,000.00 15,000.00 30,000.00
307 ERNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
308 DWI SETIAWAN 70,000.00 35,000.00 35,000.00 70,000.00
309 WILDAN ALFI G 30,000.00 15,000.00 15,000.00 30,000.00
310 HENI RAHMAWATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
311 SAFIRA B A 30,000.00 15,000.00 15,000.00 30,000.00
312 DYAN DIANING R 30,000.00 15,000.00 15,000.00 30,000.00
313 DZAKI S 30,000.00 15,000.00 15,000.00 30,000.00
314 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
315 YANA RUSTIANA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
316 DEWITRI JAYA 30,000.00 15,000.00 15,000.00 30,000.00
317 YATNO 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
318 01/18/2017 KUSHANDAYANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
319 NANI HERAWATI 40,000.00 20,000.00 20,000.00 40,000.00
320 LELA MAYASARI 30,000.00 15,000.00 15,000.00 30,000.00
321 SITI AMINAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
322 TITA SUGIHARTI 70,000.00 35,000.00 35,000.00 70,000.00
323 SINTA HATTY 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
324 RAFI ANABIL AZHAR 70,000.00 35,000.00 35,000.00 70,000.00
325 ALIFYA PUTRI 70,000.00 35,000.00 35,000.00 70,000.00
326 LUSI SEPTIANI 15,000.00 7,500.00 7,500.00 15,000.00
327 SODIK MUTAKIN 30,000.00 15,000.00 15,000.00 30,000.00
328 SARMI HERU SARDJANA 40,000.00 20,000.00 20,000.00 40,000.00
329 ANI NURYANI 70,000.00 35,000.00 35,000.00 70,000.00
330 SUNARIYAH 40,000.00 20,000.00 20,000.00 40,000.00
331 ANANDA DWI KIANA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
332 LADIYA KIRANI 15,000.00 7,500.00 7,500.00 15,000.00
333 LALAN WULANDARI 40,000.00 20,000.00 20,000.00 40,000.00
335 EMILIA A 30,000.00 15,000.00 15,000.00 30,000.00
336 BEJO SUPRIANTO 30,000.00 15,000.00 15,000.00 30,000.00
337 SYAHIA WIDHI O 25,000.00 12,500.00 12,500.00 25,000.00
338 BUNGA DITA N A 30,000.00 15,000.00 15,000.00 30,000.00
339 FIMBI CAMANA R 25,000.00 12,500.00 12,500.00 25,000.00
340 SABAR SANTOSA 15,000.00 7,500.00 7,500.00 15,000.00
341 DIAN SUTRISNO 70,000.00 35,000.00 35,000.00 70,000.00
342 RANGGA PRASETYA 40,000.00 10,000.00 20,000.00 20,000.00 50,000.00
343 M MUZHAFARUDIN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
344 SALSABILA 15,000.00 7,500.00 7,500.00 15,000.00
345 KASMINI 70,000.00 35,000.00 35,000.00 70,000.00
346 01/19/2017 NUKE 30,000.00 15,000.00 15,000.00 30,000.00
347 DWITA 30,000.00 15,000.00 15,000.00 30,000.00
348 RIZAL HASAN 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
349 ANI SUMARNI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
350 NOVAL TRIANTO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
351 ICAH CARISAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
352 NONENG SUMARTINI 30,000.00 15,000.00 15,000.00 30,000.00
353 THERESIA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
354 FITRIYANI 30,000.00 15,000.00 15,000.00 30,000.00
355 ENDANG 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
356 SOVIA 15,000.00 7,500.00 7,500.00 15,000.00
357 HERLINDA S 40,000.00 20,000.00 20,000.00 40,000.00
358 MEISYA D 25,000.00 12,500.00 12,500.00 25,000.00
359 YOZA HERWINA 70,000.00 35,000.00 35,000.00 70,000.00
360 MEYSKA PUTRI Z 25,000.00 12,500.00 12,500.00 25,000.00
361 IVA RAIVANY Y 70,000.00 35,000.00 35,000.00 70,000.00
362 NAURA YASMINA A 70,000.00 35,000.00 35,000.00 70,000.00
363 IRMA WATI 70,000.00 35,000.00 35,000.00 70,000.00
364 01/20/2017 WULAN SETIANI 15,000.00 7,500.00 7,500.00 15,000.00
365 TURNI 70,000.00 35,000.00 35,000.00 70,000.00
366 NIKEN JIWA A 25,000.00 12,500.00 12,500.00 25,000.00
367 TENI RAMTIJA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
368 PONIYAH 70,000.00 35,000.00 35,000.00 70,000.00
369 TONO RATNO 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
370 FENY AYU 30,000.00 15,000.00 15,000.00 30,000.00
371 RIDWAN LESMANA S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
372 ROMY ARAVENA 25,000.00 12,500.00 12,500.00 25,000.00
373 RATNASIH 30,000.00 15,000.00 15,000.00 30,000.00
374 SILVA ZEFENDI 40,000.00 20,000.00 20,000.00 40,000.00
375 NADIA DWI E 70,000.00 35,000.00 35,000.00 70,000.00
376 ROSMAWATI 70,000.00 35,000.00 35,000.00 70,000.00
377 WARNATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
378 M MUZHAFARUDIN 35,000.00 17,500.00 17,500.00 35,000.00
379 ROHENDI 30,000.00 15,000.00 15,000.00 30,000.00
380 FITRI NURAENI 70,000.00 35,000.00 35,000.00 70,000.00
381 PUTRI NURUL H 30,000.00 15,000.00 15,000.00 30,000.00
382 DIAN FATONAH 15,000.00 7,500.00 7,500.00 15,000.00
383 M FADLAN F 25,000.00 12,500.00 12,500.00 25,000.00
384 YULI YULIANTI 15,000.00 7,500.00 7,500.00 15,000.00
385 RESNAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
386 ALHABSI REYHAN 25,000.00 12,500.00 12,500.00 25,000.00
387 SITI NURHAYATI 70,000.00 35,000.00 35,000.00 70,000.00
388 01/21/2017 RISTIA KURNIAWATI 30,000.00 15,000.00 15,000.00 30,000.00
389 LENI MAULIYANI 30,000.00 15,000.00 15,000.00 30,000.00
390 AL HANA 15,000.00 7,500.00 7,500.00 15,000.00
391 ASEP NUROHIM 30,000.00 15,000.00 15,000.00 30,000.00
392 TANIA S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
393 FANYSYA AYU P H 30,000.00 15,000.00 15,000.00 30,000.00
394 SARI NINGSIH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
395 DANDI 70,000.00 35,000.00 35,000.00 70,000.00
396 ETI ROSTIAWATI 30,000.00 15,000.00 15,000.00 30,000.00
397 RAFI MAULANA 30,000.00 15,000.00 15,000.00 30,000.00
398 SYAHLA 15,000.00 7,500.00 7,500.00 15,000.00
399 LORIN LIDWINA 70,000.00 35,000.00 35,000.00 70,000.00
400 AL GOZALI 25,000.00 12,500.00 12,500.00 25,000.00
401 DEDE RIDWAN 40,000.00 20,000.00 20,000.00 40,000.00
402 NUR RAHMA H 30,000.00 15,000.00 15,000.00 30,000.00
403 SUKARYATI 60,000.00 30,000.00 30,000.00 60,000.00
404 VINA KHALIFATUL H 70,000.00 35,000.00 35,000.00 70,000.00
405 M ANYDRAUL 30,000.00 15,000.00 15,000.00 30,000.00
406 AN NASSER BAYU A 30,000.00 15,000.00 15,000.00 30,000.00
407 EVA NURANI 30,000.00 15,000.00 15,000.00 30,000.00
408 TIARA S S 25,000.00 12,500.00 12,500.00 25,000.00
409 IIS 15,000.00 7,500.00 7,500.00 15,000.00
410 AMIRA AZIZAH Z 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
411 ARIF HIDAYAT 30,000.00 15,000.00 15,000.00 30,000.00
412 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
413 KIKI 15,000.00 7,500.00 7,500.00 15,000.00
414 MAYASARI 15,000.00 7,500.00 7,500.00 15,000.00
415 NIRA SITI BADRIAH 30,000.00 15,000.00 15,000.00 30,000.00
416 ONI ROHANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
417 01/23/2017 TETEN T 70,000.00 35,000.00 35,000.00 70,000.00
418 UTIN HARTINI 70,000.00 35,000.00 35,000.00 70,000.00
419 NISA GUSTINA 25,000.00 12,500.00 12,500.00 25,000.00
420 MIKAYLA M YUSUF 30,000.00 15,000.00 15,000.00 30,000.00
421 YUNI SETIAWAN 15,000.00 7,500.00 7,500.00 15,000.00
422 EROS ROSITA 15,000.00 7,500.00 7,500.00 15,000.00
423 RAHADYAN NUGRAHA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
424 NITA NURATIFAH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
425 TN RUSLAN 70,000.00 35,000.00 35,000.00 70,000.00
427 FATTAH MAKI P 30,000.00 15,000.00 15,000.00 30,000.00
428 INSAN HA,BALI 70,000.00 35,000.00 35,000.00 70,000.00
429 RESNAWATI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
430 SANTY SARASWATY 30,000.00 15,000.00 15,000.00 30,000.00
431 WIDA NOVIANTINI 70,000.00 35,000.00 35,000.00 70,000.00
432 SUSAN SUSANTY 70,000.00 35,000.00 35,000.00 70,000.00
433 RIFA LUTHFIYAH 30,000.00 15,000.00 15,000.00 30,000.00
434 JUHRIAH 15,000.00 7,500.00 7,500.00 15,000.00
435 IVA KANIA ZULFA 15,000.00 7,500.00 7,500.00 15,000.00
436 YANA KUSTIANA 70,000.00 35,000.00 35,000.00 70,000.00
437 EROS GI 70,000.00 35,000.00 35,000.00 70,000.00
438 01/24/2017 RIKE ANGGRAENI 70,000.00 35,000.00 35,000.00 70,000.00
439 UMI SUPIAH S 30,000.00 15,000.00 15,000.00 30,000.00
440 RAHMAT S 70,000.00 35,000.00 35,000.00 70,000.00
441 ROHMAT 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
442 NENENG SULASMI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
443 WIDIANINGSIH 30,000.00 15,000.00 15,000.00 30,000.00
444 VINA KHALIFATUL H 70,000.00 35,000.00 35,000.00 70,000.00
445 MARCUS REBECA 15,000.00 7,500.00 7,500.00 15,000.00
446 NURJANAH 30,000.00 15,000.00 15,000.00 30,000.00
447 ALEXANDER S 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
448 SRI WARTINI 30,000.00 15,000.00 15,000.00 30,000.00
449 ONI ROHANI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
450 IKA RASTIKA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
451 BAMBANG H 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
452 MAYA SARI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
453 SRI SYARIFAH 30,000.00 15,000.00 15,000.00 30,000.00
454 ANISA N 25,000.00 12,500.00 12,500.00 25,000.00
455 ERNAWATI 30,000.00 15,000.00 15,000.00 30,000.00
456 RINI LESTARI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
457 M SATRIA FAJAR 25,000.00 12,500.00 12,500.00 25,000.00
458 SAFIRA B A 40,000.00 20,000.00 20,000.00 40,000.00
459 KIYO HAYADI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
460 DYAN DIANING R 40,000.00 20,000.00 20,000.00 40,000.00
461 ENDAH DUDIN I 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
463 ESTI JUMARINI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
464 NURUL ANGGRAENI 35,000.00 10,000.00 17,500.00 17,500.00 45,000.00
465 SODIK MUTAKIN 40,000.00 20,000.00 20,000.00 40,000.00
466 ROSINTA DIARA 70,000.00 35,000.00 35,000.00 70,000.00
467 WILDAN ALFI G 30,000.00 15,000.00 15,000.00 30,000.00
468 DIAN SUTRISNO 70,000.00 35,000.00 35,000.00 70,000.00
469 01/25/2017 SUNARSIH 70,000.00 35,000.00 35,000.00 70,000.00
470 LELA MAYASARI 70,000.00 35,000.00 35,000.00 70,000.00
471 SITI AMINAH 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
472 DIAN NURINSANI A 30,000.00 15,000.00 15,000.00 30,000.00
473 RESYA PAHIM W 70,000.00 35,000.00 35,000.00 70,000.00
474 RUSLAN 70,000.00 35,000.00 35,000.00 70,000.00
476 M AKMAL SM 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
477 SINTA HATTY 30,000.00 15,000.00 15,000.00 30,000.00
478 SUPATMI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
479 AMIRA AZIZAH Z 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
480 SARMI HERU S 70,000.00 35,000.00 35,000.00 70,000.00
481 DWI ISWATI 15,000.00 7,500.00 7,500.00 15,000.00
482 KHAFA 25,000.00 12,500.00 12,500.00 25,000.00
483 ANI NURYANI 70,000.00 35,000.00 35,000.00 70,000.00
484 IWAN 30,000.00 15,000.00 15,000.00 30,000.00
485 TINI YUNINGSIH 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
486 IRA FEBRIANTI 25,000.00 12,500.00 12,500.00 25,000.00
487 M ASEP MULYANA 30,000.00 15,000.00 15,000.00 30,000.00
488 AKBAR NUGRAHA 30,000.00 15,000.00 15,000.00 30,000.00
489 FIMBI CAMANA R 15,000.00 7,500.00 7,500.00 15,000.00
490 SALWA NABIL F R 15,000.00 7,500.00 7,500.00 15,000.00
491 BEJO SUPRIANTO 30,000.00 15,000.00 15,000.00 30,000.00
492 01/26/2017 NUKE 30,000.00 15,000.00 15,000.00 30,000.00
493 IWAN KESUMA 70,000.00 35,000.00 35,000.00 70,000.00
494 ANNA ROHANAH 70,000.00 35,000.00 35,000.00 70,000.00
495 SEPTIA H 25,000.00 12,500.00 12,500.00 25,000.00
496 VINA MUTIARA 30,000.00 15,000.00 15,000.00 30,000.00
497 ANI SUMARNI 30,000.00 15,000.00 15,000.00 30,000.00
498 NUNUNG N 30,000.00 15,000.00 15,000.00 30,000.00
499 GLADIES K 70,000.00 35,000.00 35,000.00 70,000.00
500 DWITA PRAGUSTA 40,000.00 20,000.00 20,000.00 40,000.00
501 RATU LINDA 70,000.00 35,000.00 35,000.00 70,000.00
502 NONENG SUMARTINI 30,000.00 15,000.00 15,000.00 30,000.00
503 AA SUARSA 70,000.00 35,000.00 35,000.00 70,000.00
504 TITIH HAMIDAH 30,000.00 15,000.00 15,000.00 30,000.00
505 ANDI ANDRIYANSAH 70,000.00 35,000.00 35,000.00 70,000.00
506 FITRIYANI 30,000.00 15,000.00 15,000.00 30,000.00
507 SOVIA 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
508 TANIA 15,000.00 7,500.00 7,500.00 15,000.00
509 EVA NURANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
510 NANI HERAWATI 70,000.00 35,000.00 35,000.00 70,000.00
511 IIS ISMAIL 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
512 AN NASSER 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
513 PUTRI NURUL H 30,000.00 15,000.00 15,000.00 30,000.00
514 ROS AMINAH 30,000.00 15,000.00 15,000.00 30,000.00
515 NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
516 M ZUFAR RASYD I 30,000.00 15,000.00 15,000.00 30,000.00
517 KIRANA 30,000.00 15,000.00 15,000.00 30,000.00
518 01/27/2017 LENI MARLINA 30,000.00 15,000.00 15,000.00 30,000.00
519 IDHATA DEWA P 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
520 SUKANAH 70,000.00 35,000.00 35,000.00 70,000.00
521 ROMY ARAVENA 15,000.00 7,500.00 7,500.00 15,000.00
522 MAYA ROSITA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
523 KASMINI 30,000.00 15,000.00 15,000.00 30,000.00
524 MARCUS REBESA 15,000.00 7,500.00 7,500.00 15,000.00
525 RENI NURHAYATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
526 RIDWAN LESMANA S 30,000.00 15,000.00 15,000.00 30,000.00
527 M ROQI IBRAHIM K 25,000.00 12,500.00 12,500.00 25,000.00
528 KHALIFA SHAKI F 15,000.00 7,500.00 7,500.00 15,000.00
529 MILA KAMILATAN 15,000.00 7,500.00 7,500.00 15,000.00
530 TURNI 70,000.00 35,000.00 35,000.00 70,000.00
531 ETI ROSTIAWATI 30,000.00 15,000.00 15,000.00 30,000.00
532 RATNASIH 30,000.00 15,000.00 15,000.00 30,000.00
533 RISTIA 40,000.00 20,000.00 20,000.00 40,000.00
534 NADIA DWI E 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
536 NINDYA KIRANI 25,000.00 12,500.00 12,500.00 25,000.00
537 PRIYADI 30,000.00 15,000.00 15,000.00 30,000.00
538 FITRI NURAENI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
539 RIFA LUTHFIYAH 30,000.00 15,000.00 15,000.00 30,000.00
540 RAFI M AL FAZIZI 30,000.00 15,000.00 15,000.00 30,000.00
541 ASEP NUROHIM 30,000.00 15,000.00 15,000.00 30,000.00
542 FATHIA R D 30,000.00 15,000.00 15,000.00 30,000.00
543 SILVA ZEFENDI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
544 01/30/2017 60,000.00 30,000.00 30,000.00 60,000.00
545 70,000.00 35,000.00 35,000.00 70,000.00
546 15,000.00 7,500.00 7,500.00 15,000.00
547 70,000.00 35,000.00 35,000.00 70,000.00
548 70,000.00 35,000.00 35,000.00 70,000.00
549 40,000.00 20,000.00 20,000.00 40,000.00
550 70,000.00 35,000.00 35,000.00 70,000.00
551 30,000.00 15,000.00 15,000.00 30,000.00
552 15,000.00 7,500.00 7,500.00 15,000.00
553 70,000.00 35,000.00 35,000.00 70,000.00
554 15,000.00 7,500.00 7,500.00 15,000.00
555 30,000.00 15,000.00 15,000.00 30,000.00
556 70,000.00 35,000.00 35,000.00 70,000.00
557 25,000.00 12,500.00 12,500.00 25,000.00
558 70,000.00 35,000.00 35,000.00 70,000.00
559 70,000.00 35,000.00 35,000.00 70,000.00
560 30,000.00 15,000.00 15,000.00 30,000.00
561 15,000.00 7,500.00 7,500.00 15,000.00
562 70,000.00 35,000.00 35,000.00 70,000.00
563 25,000.00 12,500.00 12,500.00 25,000.00
564 15,000.00 7,500.00 7,500.00 15,000.00
565 30,000.00 15,000.00 15,000.00 30,000.00
566 70,000.00 35,000.00 35,000.00 70,000.00
567 40,000.00 20,000.00 20,000.00 40,000.00
568 40,000.00 20,000.00 20,000.00 40,000.00
569 30,000.00 15,000.00 15,000.00 30,000.00
570 70,000.00 35,000.00 35,000.00 70,000.00
571 40,000.00 20,000.00 20,000.00 40,000.00
572 70,000.00 35,000.00 35,000.00 70,000.00
573 70,000.00 35,000.00 35,000.00 70,000.00
574 70,000.00 35,000.00 35,000.00 70,000.00
575 70,000.00 35,000.00 35,000.00 70,000.00
576 30,000.00 15,000.00 15,000.00 30,000.00
577 12/31/2016 30,000.00 15,000.00 15,000.00 30,000.00
578 15,000.00 7,500.00 7,500.00 15,000.00
579 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
580 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
581 ASWI DAYANTI 30,000.00 15,000.00 15,000.00 30,000.00
582 NOVI RESTIANI 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
583 YULIA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
584 ALDI RIDWAN S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
585 QIZA RIZQI P 30,000.00 15,000.00 15,000.00 30,000.00
586 PRIATNA RUMBAYAN 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
587 SITI NURHAYATI 30,000.00 15,000.00 15,000.00 30,000.00
588 YANA FEBRIANA 60,000.00 10,000.00 30,000.00 30,000.00 70,000.00
589 NINA OKTIANA 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
590 DEDE RIDWAN 30,000.00 15,000.00 15,000.00 30,000.00
591 PANDI S 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
592 MARYONO 15,000.00 7,500.00 7,500.00 15,000.00
593 BERNANDA BIMA 15,000.00 7,500.00 7,500.00 15,000.00
594 KOKOM KOMARIAH 70,000.00 35,000.00 35,000.00 70,000.00
595 SUGIYARTI 70,000.00 35,000.00 35,000.00 70,000.00
596 ALYA RAHMA P 35,000.00 17,500.00 17,500.00 35,000.00
597 ELSA AGUSTINA 70,000.00 35,000.00 35,000.00 70,000.00
598 EVA NURANI 30,000.00 10,000.00 15,000.00 15,000.00 40,000.00
599 MEGAWATI 15,000.00 10,000.00 7,500.00 7,500.00 25,000.00
600 M RIZKI 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
601 AMIRA AJIZAH Z 70,000.00 10,000.00 35,000.00 35,000.00 80,000.00
602 NURHAYATI 40,000.00 20,000.00 20,000.00 40,000.00
603 NURHAYATI 40,000.00 20,000.00 20,000.00 40,000.00
23,070,000 1,530,000 11,535,000 11,535,000 24,625,000
KET
KET
-
JASA ALAT &

DOKTER BAHAN
1 2/1/2017 AN CANDIKA 85,000 5,000 42,500 42,500
2 2/2/2017 NY SAMSY 250,000 5,000 125,000 125,000
3 NY LERICI 120,000 5,000 60,000 60,000
4 2/3/2017 ELVINA 20,000 5,000 10,000 10,000
5 2/4/2017 SAFARAZ 100,000 5,000 50,000 50,000
6 MAYA A 80,000 5,000 40,000 40,000
7 2/6/2017 BAGAS 100,000 5,000 50,000 50,000
8 ARMI T 80,000 5,000 40,000 40,000
9 EUIS LESMINI DJUANDA 150,000 5,000 75,000 75,000
10 2/7/2017 JENI 20,000 5,000 10,000 10,000
11 HENDRIK 20,000 5,000 10,000 10,000
12 2/8/2017 RAHMAWATI 80,000 5,000 40,000 40,000
13 NADILA 80,000 5,000 40,000 40,000
14 2/9/2017 NY WULAN 20,000 5,000 10,000 10,000
15 2/10/2017 FAUZAN 80,000 5,000 40,000 40,000
16 2/11/2017 INDAH R 60,000 5,000 30,000 30,000
17 SAFARAZ 100,000 5,000 50,000 50,000
18 MAYA A 80,000 5,000 40,000 40,000
19 2/13/2017 DARIAH 20,000 5,000 10,000 10,000
20 2/14/2017 WULAN 100,000 5,000 50,000 50,000
21 AFRIZAL 20,000 5,000 10,000 10,000
22 2/15/2017 ANGGUN 50,000 5,000 25,000 25,000
23 ANGGI 50,000 5,000 25,000 25,000
24 2/16/2017 FARIS 250,000 5,000 125,000 125,000
25 2/17/2017 AI DINI 20,000 5,000 10,000 10,000
26 MAYA A 80,000 5,000 40,000 40,000
27 2/18/2017 SAFARAS 50,000 5,000 25,000 25,000
28 2/20/2017 KEVIN 100,000 5,000 50,000 50,000
29 RAHMAWATI 180,000 5,000 90,000 90,000
30 2/21/2017 RADEN TEDJA 250,000 5,000 125,000 125,000
31 2/22/2017 WISKA 20,000 5,000 10,000 10,000
32 RAHMA DINA 20,000 5,000 10,000 10,000
33 2/23/2017 DINI ANDRIANI 250,000 5,000 125,000 125,000
34 2/25/2017 MAYA A 80,000 5,000 40,000 40,000
35 ODAH DAHLIANI 120,000 5,000 60,000 60,000
36 2/27/2017 ALMA TSANA DESTIANI 200,000 5,000 100,000 100,000
37 2/28/2017 ENOK ANI 250,000 5,000 125,000 125,000
38 NY TITI 20,000 5,000 10,000 10,000
39 AISYAH 20,000 5,000 10,000 10,000
40 NY WULAN 100,000 5,000 50,000 50,000
41 LASMA 20,000 5,000 10,000 10,000
3,795,000 205,000 1,897,500 1,897,500
JASA ALAT &

TGL NAMA TARIF OBAT
DOKTER BAHAN
1 1/2/2017 IMAS MAEMUNAH 40,000.00 20,000.00 20,000.00
2 DINI ENDAH 35,000.00 10,000.00 17,500.00 17,500.00
3 TATANG 60,000.00 10,000.00 30,000.00 30,000.00
4 SUAMRNA 15,000.00 10,000.00 7,500.00 7,500.00
5 PRIYADI 30,000.00 10,000.00 15,000.00 15,000.00
6 NANI HERAWATI 70,000.00 35,000.00 35,000.00
7 ANDRI SAPUTRA 15,000.00 10,000.00 7,500.00 7,500.00
8 BAMBANG H 15,000.00 7,500.00 7,500.00
9 DIAN NURINSANI 40,000.00 20,000.00 20,000.00
10 ABDUL RONI 15,000.00 10,000.00 7,500.00 7,500.00
11 ELIS RAHMAWATI 30,000.00 15,000.00 15,000.00
12 MULYA SARI 70,000.00 35,000.00 35,000.00
13 RAHMAT F 15,000.00 7,500.00 7,500.00
14 SRI HENI 15,000.00 7,500.00 7,500.00
15 ALIF 15,000.00 10,000.00 7,500.00 7,500.00
16 NISA GUSTI 30,000.00 10,000.00 15,000.00 15,000.00
17 ANI NURYANI 15,000.00 7,500.00 7,500.00
18 ANISA 30,000.00 15,000.00 15,000.00
19 THIANA TESARINDRI 15,000.00 7,500.00 7,500.00
20 LUKFIYANA 15,000.00 10,000.00 7,500.00 7,500.00
21 RHISMIA 70,000.00 35,000.00 35,000.00
22 WAHYUNINGSIH 30,000.00 15,000.00 15,000.00
23 AKBAR NUGRAHA 30,000.00 15,000.00 15,000.00
24 FREDY CANDRA N 15,000.00 7,500.00 7,500.00
25 2/2/2017 NUKE 30,000.00 15,000.00 15,000.00
26 ANNA 70,000.00 35,000.00 35,000.00
27 NENENG SRI ATI 30,000.00 15,000.00 15,000.00
28 HERA NABIHAH P 25,000.00 12,500.00 12,500.00
29 VINA MUTIARA 30,000.00 15,000.00 15,000.00
30 AA SUARSA 70,000.00 35,000.00 35,000.00
31 DWITA PRAGUSTA 70,000.00 35,000.00 35,000.00
32 NURJANAH 70,000.00 35,000.00 35,000.00
33 SRI MULYATI NENGSIH 15,000.00 10,000.00 7,500.00 7,500.00
34 FARIS A 15,000.00 10,000.00 7,500.00 7,500.00
35 ROHMAN 70,000.00 10,000.00 35,000.00 35,000.00
36 RAHADYAN NUGRAHA 30,000.00 15,000.00 15,000.00
37 NONENG SUMARTINI 40,000.00 20,000.00 20,000.00
38 ANDI ANDRIYANSAH 70,000.00 35,000.00 35,000.00
39 TITIH 30,000.00 15,000.00 15,000.00
40 MELY NOVIAN 15,000.00 10,000.00 7,500.00 7,500.00
41 SRI WAHYUNINGSIH 15,000.00 10,000.00 7,500.00 7,500.00
42 RINI PURWANTI 70,000.00 35,000.00 35,000.00
43 ILAH JULIAH 15,000.00 7,500.00 7,500.00
44 HENI R 60,000.00 30,000.00 30,000.00
45 WILDAN ALFI G 30,000.00 15,000.00 15,000.00
46 SILVI AVIANTI 25,000.00 12,500.00 12,500.00
47 KIRANA AURELIA Z 40,000.00 20,000.00 20,000.00
48 AN NASSER BAYU A 30,000.00 15,000.00 15,000.00
49 IIS ISMAIL 60,000.00 10,000.00 30,000.00 30,000.00
50 FITRIYANI 30,000.00 15,000.00 15,000.00
51 FENNY AYU A 30,000.00 15,000.00 15,000.00
52 PUTRI NURUL H 30,000.00 15,000.00 15,000.00
53 FATIAH MAKI P 70,000.00 35,000.00 35,000.00
54 QIZA RIZQI P 30,000.00 15,000.00 15,000.00
55 3/2/2017 UMI SUPIAH S 30,000.00 15,000.00 15,000.00
56 LENI MARLINA 30,000.00 15,000.00 15,000.00
57 SITI RODIAH 70,000.00 10,000.00 35,000.00 35,000.00
58 ANI SUMARNI 30,000.00 15,000.00 15,000.00
59 KASMINI 70,000.00 35,000.00 35,000.00
60 SLAMAT SILITONGA 70,000.00 10,000.00 35,000.00 35,000.00
61 INA KUSTIANA 30,000.00 15,000.00 15,000.00
62 RIDWAN LESMANA S 30,000.00 15,000.00 15,000.00
63 MAYA ROSITA 30,000.00 15,000.00 15,000.00
64 HENI MULYANA 70,000.00 35,000.00 35,000.00
65 TONY CH 70,000.00 35,000.00 35,000.00
66 TURNI 70,000.00 35,000.00 35,000.00
67 ABDUL RONI 70,000.00 10,000.00 35,000.00 35,000.00
68 M ROQI IBRAHIM K 15,000.00 7,500.00 7,500.00
69 RINI PURWANTI 70,000.00 35,000.00 35,000.00
70 NUR AISAH 30,000.00 15,000.00 15,000.00
71 FITRIA N 15,000.00 10,000.00 7,500.00 7,500.00
72 SODIK MUTAKIN 70,000.00 35,000.00 35,000.00
73 RATNASIH 40,000.00 20,000.00 20,000.00
74 SUBHAN M ARSIL 15,000.00 7,500.00 7,500.00
75 FITRI NURAENI 70,000.00 35,000.00 35,000.00
76 NADIA DWI E 70,000.00 35,000.00 35,000.00
77 SILVA ZEFENDI 15,000.00 7,500.00 7,500.00
78 FATHIA R D 30,000.00 15,000.00 15,000.00
79 DHENISA Q 25,000.00 12,500.00 12,500.00
80 IMAS TIWI H 30,000.00 15,000.00 15,000.00
81 4/2/2017 M LUKMAN 30,000.00 10,000.00 15,000.00 15,000.00
82 MINA SARIATII 30,000.00 15,000.00 15,000.00
83 NURJANAH 30,000.00 15,000.00 15,000.00
84 ENI 30,000.00 15,000.00 15,000.00
85 RIFA LUTFIAH A 30,000.00 15,000.00 15,000.00
86 ANDIKA DWI RIZKI 30,000.00 15,000.00 15,000.00
87 SITI FATIMAH A 30,000.00 10,000.00 15,000.00 15,000.00
88 ETI R 40,000.00 20,000.00 20,000.00
89 LOURINE LIDWINA 70,000.00 35,000.00 35,000.00
90 SHARUL FIRDAUS 15,000.00 10,000.00 7,500.00 7,500.00
91 SUSAN SUSANTI 30,000.00 15,000.00 15,000.00
92 NURAHYATI 30,000.00 15,000.00 15,000.00
93 EVA NURANI 30,000.00 15,000.00 15,000.00
94 ERLAN KANDANI 15,000.00 7,500.00 7,500.00
95 DANDI S 15,000.00 10,000.00 7,500.00 7,500.00
96 ARIF HIDAYAT 15,000.00 7,500.00 7,500.00
97 SUDARSIH 70,000.00 35,000.00 35,000.00
98 ROHENDI 15,000.00 10,000.00 7,500.00 7,500.00
99 NAIMA 15,000.00 10,000.00 7,500.00 7,500.00
100 AURELIA 15,000.00 7,500.00 7,500.00
101 AMIRA AZIZAH Z 30,000.00 15,000.00 15,000.00
102 KEVIN YULENSA 15,000.00 7,500.00 7,500.00
103 ALWAN W 25,000.00 12,500.00 12,500.00
104 ZULFA R 35,000.00 10,000.00 17,500.00 17,500.00
105 6/2/2017 SINTA HATTY 30,000.00 15,000.00 15,000.00
106 RAFI ANABIL AZHAR 30,000.00 15,000.00 15,000.00
107 SUPATMI 30,000.00 15,000.00 15,000.00
108 ZAENAL ARIFIN 70,000.00 10,000.00 35,000.00 35,000.00
109 HENI D 60,000.00 10,000.00 30,000.00 30,000.00
110 ANI NUTYANI 15,000.00 7,500.00 7,500.00
111 DIAN NURINSANI 70,000.00 10,000.00 35,000.00 35,000.00
112 M RIZKI ADITYA 25,000.00 12,500.00 12,500.00
113 KUSBANDIYAH 30,000.00 15,000.00 15,000.00
114 RAHADIYAN NUGRAHA 30,000.00 15,000.00 15,000.00
115 SALMA RIZKI 30,000.00 10,000.00 15,000.00 15,000.00
116 IYAM MARYAM 15,000.00 10,000.00 7,500.00 7,500.00
117 EUIS LESMINI D 70,000.00 35,000.00 35,000.00
118 MELA RESTI L 30,000.00 15,000.00 15,000.00
119 EMILIA A 30,000.00 15,000.00 15,000.00
120 ZAHIRA PUTRI P 15,000.00 7,500.00 7,500.00
121 SANTY SARASWATY 15,000.00 10,000.00 7,500.00 7,500.00
122 DESI 70,000.00 35,000.00 35,000.00
123 NAURA YASMINE A 70,000.00 35,000.00 35,000.00
124 SHAFA LUTFI F 30,000.00 10,000.00 15,000.00 15,000.00
125 7/2/2017 M LUQMAN L 30,000.00 15,000.00 15,000.00
126 WIDIANINGSIH 70,000.00 35,000.00 35,000.00
127 NENENG S 30,000.00 15,000.00 15,000.00
128 HERI K 15,000.00 10,000.00 7,500.00 7,500.00
129 ARYATI P 15,000.00 10,000.00 7,500.00 7,500.00
130 TYA ALISYA 30,000.00 15,000.00 15,000.00
131 SRI WARTINI 40,000.00 20,000.00 20,000.00
132 SRI SYARIFAH 30,000.00 15,000.00 15,000.00
133 ERNAWATI 70,000.00 35,000.00 35,000.00
134 SRI WAHYUNINGSIH 70,000.00 10,000.00 35,000.00 35,000.00
135 JUMIYATI 70,000.00 35,000.00 35,000.00
136 ERNI H 30,000.00 10,000.00 15,000.00 15,000.00
137 H IWAN KESUMA 70,000.00 35,000.00 35,000.00
138 TIKA CAHYANI 30,000.00 10,000.00 15,000.00 15,000.00
139 ERNAWATI SOLINA 35,000.00 17,500.00 17,500.00
140 NAIMA AS R 30,000.00 10,000.00 15,000.00 15,000.00
141 SALWA APRILIA 25,000.00 12,500.00 12,500.00
142 SONY H 30,000.00 15,000.00 15,000.00
143 DYAN DIANING RATRI 70,000.00 35,000.00 35,000.00
144 TETEN Y 60,000.00 10,000.00 30,000.00 30,000.00
145 AGUS SETIAWAN 15,000.00 10,000.00 7,500.00 7,500.00
146 M IBNU S 30,000.00 10,000.00 15,000.00 15,000.00
147 QIZA RIZQI P 40,000.00 20,000.00 20,000.00
148 8/2/2017 H IWAN KESUMA 70,000.00 35,000.00 35,000.00
149 IMAS MAEMUNAH 70,000.00 35,000.00 35,000.00
150 NANI HERAWATI 70,000.00 35,000.00 35,000.00
151 PRIYADI 15,000.00 7,500.00 7,500.00
152 IWAN K 30,000.00 10,000.00 15,000.00 15,000.00
153 DWI ASNANI 15,000.00 7,500.00 7,500.00
154 ENI 60,000.00 10,000.00 30,000.00 30,000.00
155 FREEDY MULA 15,000.00 10,000.00 7,500.00 7,500.00
156 ANDRI SAPUTRA 60,000.00 10,000.00 30,000.00 30,000.00
157 NANDANG 30,000.00 10,000.00 15,000.00 15,000.00
158 ANI NURYANI 70,000.00 10,000.00 35,000.00 35,000.00
159 ANDRI PRANATA 60,000.00 10,000.00 30,000.00 30,000.00
160 SYAHRUL FIRDAUS 60,000.00 10,000.00 30,000.00 30,000.00
161 LUKFIYANA 60,000.00 10,000.00 30,000.00 30,000.00
162 DANDI S 15,000.00 10,000.00 7,500.00 7,500.00
163 NOPI APALIA 60,000.00 10,000.00 30,000.00 30,000.00
164 ABIDIN AHMAD 30,000.00 15,000.00 15,000.00
165 HODIDJAH 15,000.00 10,000.00 7,500.00 7,500.00
166 AKBAR NUGRAHA 30,000.00 15,000.00 15,000.00
167 JAHRAH 70,000.00 35,000.00 35,000.00
168 DIAN S 70,000.00 35,000.00 35,000.00
169 9/2/2017 NUKE 30,000.00 15,000.00 15,000.00
170 NENENG 30,000.00 10,000.00 15,000.00 15,000.00
171 VINA MUTIARA 30,000.00 15,000.00 15,000.00
172 UMI SUPIAH S 30,000.00 15,000.00 15,000.00
173 ANNA ROHANAH 70,000.00 35,000.00 35,000.00
174 FARIS A 70,000.00 10,000.00 35,000.00 35,000.00
175 KUSMIATI 15,000.00 10,000.00 7,500.00 7,500.00
176 AHMAD NURADIN 30,000.00 10,000.00 15,000.00 15,000.00
177 ENI 15,000.00 10,000.00 7,500.00 7,500.00
178 WILDAN RATNA P 15,000.00 10,000.00 7,500.00 7,500.00
179 RINI PURNAWANTI 70,000.00 35,000.00 35,000.00
180 HENI DIYANI 70,000.00 35,000.00 35,000.00
181 FITRIYANI 30,000.00 15,000.00 15,000.00
182 NONENG SUMARNI 70,000.00 35,000.00 35,000.00
183 ROHMAN 70,000.00 35,000.00 35,000.00
184 NENI NURAENI 70,000.00 35,000.00 35,000.00
185 AA SUARSA 70,000.00 35,000.00 35,000.00
186 SARI NINGSIH 15,000.00 10,000.00 7,500.00 7,500.00
187 FRANSISCUS 30,000.00 15,000.00 15,000.00
188 WILDAN 15,000.00 7,500.00 7,500.00
189 AN NASSER BAYU A 30,000.00 15,000.00 15,000.00
190 FAIRUS NABIL 25,000.00 12,500.00 12,500.00
191 KIRANA AURELIA Z 70,000.00 35,000.00 35,000.00
192 SITI HALIMAH 15,000.00 7,500.00 7,500.00
193 PUTRI NURUL H 30,000.00 15,000.00 15,000.00
194 ROS AMINAH 30,000.00 15,000.00 15,000.00
195 10/2/2017 SULI TANTIONO 70,000.00 35,000.00 35,000.00
196 ROMI ARAVENA 15,000.00 7,500.00 7,500.00
198 KASMINI 15,000.00 10,000.00 7,500.00 7,500.00
199 ANI SUMARNI 30,000.00 15,000.00 15,000.00
200 MAYA ROSITA 30,000.00 15,000.00 15,000.00
201 DEWI NURANISYAH 70,000.00 10,000.00 35,000.00 35,000.00
202 SITI RODIAH 70,000.00 35,000.00 35,000.00
203 NENENG SARWISAH 70,000.00 10,000.00 35,000.00 35,000.00
204 RIFKI LUKMANUL H 25,000.00 10,000.00 12,500.00 12,500.00
205 WIDIANINGSIH 70,000.00 35,000.00 35,000.00
206 TURNI 70,000.00 35,000.00 35,000.00
207 MARYANTO 15,000.00 10,000.00 7,500.00 7,500.00
208 RICKA HANDRIYANI 30,000.00 10,000.00 15,000.00 15,000.00
209 INTAN KARTIKASARI 15,000.00 7,500.00 7,500.00
210 RIDWAN LESMANA S 40,000.00 20,000.00 20,000.00
211 SYAFIRA KHAIRAN P 25,000.00 12,500.00 12,500.00
212 SALMA RIZKA 15,000.00 10,000.00 7,500.00 7,500.00
213 HAFIDS N 25,000.00 12,500.00 12,500.00
214 HAFIDS N 25,000.00 12,500.00 12,500.00
215 TIKA JULIATI 15,000.00 10,000.00 7,500.00 7,500.00
216 SINTA M O 70,000.00 35,000.00 35,000.00
217 RATNASIH 70,000.00 35,000.00 35,000.00
218 SITI NURBAETI 15,000.00 10,000.00 7,500.00 7,500.00
219 BUNGA DWI AMANDA P 70,000.00 35,000.00 35,000.00
220 LENI MARLINA 30,000.00 10,000.00 15,000.00 15,000.00
221 ROSMAWATI 30,000.00 10,000.00 15,000.00 15,000.00
222 NADIA DWI E 70,000.00 35,000.00 35,000.00
223 M LUQMAN C 15,000.00 10,000.00 7,500.00 7,500.00
224 FITRI NURAENI 70,000.00 35,000.00 35,000.00
225 FATHIA R D 30,000.00 15,000.00 15,000.00
226 NUR AISAH 70,000.00 35,000.00 35,000.00
227 AHMAD AGUNG M 30,000.00 10,000.00 15,000.00 15,000.00
228 IMAS TIWI H 30,000.00 15,000.00 15,000.00
229 11/2/2017 M ATALAH NAUFAL 25,000.00 12,500.00 12,500.00
230 M LUQMAN C 40,000.00 20,000.00 20,000.00
231 ASEP NURDIN 30,000.00 15,000.00 15,000.00
232 SUPATMI 30,000.00 15,000.00 15,000.00
233 RISTIA KURNIAWATI 70,000.00 35,000.00 35,000.00
234 ANITA YUNITA 30,000.00 15,000.00 15,000.00
235 LUSI LUSMIATI 15,000.00 10,000.00 7,500.00 7,500.00
236 NURJANAH 30,000.00 15,000.00 15,000.00
237 RIFA LUTFIYAH A 30,000.00 15,000.00 15,000.00
238 ETI ROSTIAWATI 70,000.00 35,000.00 35,000.00
239 LAELI RUKMINI 30,000.00 15,000.00 15,000.00
240 LINDA 70,000.00 35,000.00 35,000.00
241 MEILINA 70,000.00 35,000.00 35,000.00
243 SUDARSIH 70,000.00 35,000.00 35,000.00
244 AMIRA AJIJAH Z 30,000.00 15,000.00 15,000.00
245 ARIF HIDAYAT 40,000.00 20,000.00 20,000.00
246 EVA NURANI 30,000.00 10,000.00 15,000.00 15,000.00
247 ALWAN WIGUNA 25,000.00 12,500.00 12,500.00
248 ZULFA RAHMAN 25,000.00 12,500.00 12,500.00
249 ERNI HERMAWATI 30,000.00 15,000.00 15,000.00
250 NUR FITRI AISYAH 70,000.00 35,000.00 35,000.00
251 YULIA RACHMAN 25,000.00 12,500.00 12,500.00
252 KUSTIYAH 70,000.00 35,000.00 35,000.00
253 02/13/2017 H IWAN KESUMA 70,000.00 35,000.00 35,000.00
254 HENI HERLINA 30,000.00 10,000.00 15,000.00 15,000.00
255 NENENG CUCU S 15,000.00 7,500.00 7,500.00
256 MIKAYLA M YUSUF 70,000.00 35,000.00 35,000.00
257 RIA FRENTIANI 15,000.00 10,000.00 7,500.00 7,500.00
258 WIDYANTI 15,000.00 7,500.00 7,500.00
259 SITA HATTY 40,000.00 20,000.00 20,000.00
261 WIGATI SRI R 15,000.00 10,000.00 7,500.00 7,500.00
262 INSAN HAMBALI 70,000.00 35,000.00 35,000.00
263 TN AGUS GUNTARA 15,000.00 10,000.00 7,500.00 7,500.00
264 RESTU RIAWAN 30,000.00 15,000.00 15,000.00
265 IYAM MARYAM 60,000.00 10,000.00 30,000.00 30,000.00
266 ROSTINI 35,000.00 17,500.00 17,500.00
267 NONENG ASTRIA 30,000.00 15,000.00 15,000.00
268 EMILIA A 30,000.00 15,000.00 15,000.00
269 ROHENDI 30,000.00 15,000.00 15,000.00
270 MERIAM NURSANTRI 70,000.00 35,000.00 35,000.00
271 KUSBANDIYAH 30,000.00 15,000.00 15,000.00
272 HARNI SETIAWATI 15,000.00 10,000.00 7,500.00 7,500.00
273 DZAKI SYARIFUDIN 15,000.00 7,500.00 7,500.00
274 IWAN K 30,000.00 15,000.00 15,000.00
275 FAIRUS NABIL 30,000.00 10,000.00 15,000.00 15,000.00
276 MELA RESTI L 30,000.00 10,000.00 15,000.00 15,000.00
277 NIZA SETIAWAN 25,000.00 12,500.00 12,500.00
278 WAHYUNINGSIH 40,000.00 20,000.00 20,000.00
279 SHAFA 30,000.00 15,000.00 15,000.00
280 02/14/2017 ARYATI P 30,000.00 10,000.00 15,000.00 15,000.00
281 JUMIYATI 70,000.00 35,000.00 35,000.00
282 NENENG 30,000.00 15,000.00 15,000.00
283 ENTAR SUTARUYAH 15,000.00 10,000.00 7,500.00 7,500.00
284 SRI WARTINI 70,000.00 35,000.00 35,000.00
285 KUSMIATI 15,000.00 10,000.00 7,500.00 7,500.00
286 REVA A 15,000.00 10,000.00 7,500.00 7,500.00
287 ELIS SITI P 70,000.00 10,000.00 35,000.00 35,000.00
288 SRI SYARIFAH 30,000.00 15,000.00 15,000.00
289 AHMAD NURADIN 40,000.00 20,000.00 20,000.00
290 YESSI SUSILAWATI 70,000.00 35,000.00 35,000.00
291 WASTINI 15,000.00 10,000.00 7,500.00 7,500.00
292 TYA ALISYA 30,000.00 15,000.00 15,000.00
293 ANDRES A 15,000.00 10,000.00 7,500.00 7,500.00
294 RINI PURNAWANTI 15,000.00 10,000.00 7,500.00 7,500.00
295 ANISA RAHMAWATI 25,000.00 12,500.00 12,500.00
296 NAOMI 15,000.00 10,000.00 7,500.00 7,500.00
297 RAISA AZZAHRA 15,000.00 7,500.00 7,500.00
298 NAIMA A S R 30,000.00 15,000.00 15,000.00
299 TIKA CAHYANI 30,000.00 15,000.00 15,000.00
300 PUTRI NUR AFIFAH 25,000.00 12,500.00 12,500.00
301 WILDAN ALFI G 70,000.00 35,000.00 35,000.00
302 ROMY ARAVENA 25,000.00 10,000.00 12,500.00 12,500.00
303 ENDAH FAJAR M 15,000.00 7,500.00 7,500.00
304 QIZA RIZQI P 70,000.00 35,000.00 35,000.00
305 SONY HERMANTO 30,000.00 15,000.00 15,000.00
306 DIAN SUTRISNO 70,000.00 35,000.00 35,000.00
307 SITI VALIANTY R 15,000.00 7,500.00 7,500.00
308 02/16/2017 NUKE 30,000.00 15,000.00 15,000.00
309 AZMI RAHMADANY 30,000.00 15,000.00 15,000.00
310 VINA MUTIARA 30,000.00 10,000.00 15,000.00 15,000.00
311 NENENG SRI ATI 30,000.00 15,000.00 15,000.00
312 TAGINA ANASTASYA 15,000.00 10,000.00 7,500.00 7,500.00
313 FARIS A 70,000.00 10,000.00 35,000.00 35,000.00
314 SURYATI 15,000.00 10,000.00 7,500.00 7,500.00
315 AA SUARSA 70,000.00 35,000.00 35,000.00
316 SRI SULASTRI 15,000.00 10,000.00 7,500.00 7,500.00
317 H IWAN KESUMA 70,000.00 35,000.00 35,000.00
318 SITI ROBIAH A 25,000.00 12,500.00 12,500.00
319 FRANSISCUS X T 70,000.00 35,000.00 35,000.00
320 RINA KUSWANTI 15,000.00 10,000.00 7,500.00 7,500.00
321 TITIH MARDIAH 40,000.00 20,000.00 20,000.00
322 ANDI ANRIANSYAH 70,000.00 35,000.00 35,000.00
323 SARBNI 15,000.00 7,500.00 7,500.00
324 YADI 60,000.00 10,000.00 30,000.00 30,000.00
325 ANI NURYANI 70,000.00 35,000.00 35,000.00
326 AN NASSER BAYU A 30,000.00 15,000.00 15,000.00
327 IMAS MAEMUNAH 15,000.00 10,000.00 7,500.00 7,500.00
328 ANDREAS A 15,000.00 7,500.00 7,500.00
329 DANDI S 30,000.00 10,000.00 15,000.00 15,000.00
330 ENDAH DUDIN I 15,000.00 10,000.00 7,500.00 7,500.00
331 ROS AMINAH 30,000.00 15,000.00 15,000.00
332 GUNAWAN 15,000.00 10,000.00 7,500.00 7,500.00
333 YANA MARYANA 60,000.00 10,000.00 30,000.00 30,000.00
334 AKBAR NUGRAHA 30,000.00 15,000.00 15,000.00
335 KIRANA AULIA 35,000.00 17,500.00 17,500.00
336 NANDANG 30,000.00 15,000.00 15,000.00
337 HENI R 70,000.00 35,000.00 35,000.00
338 02/17/2017 LENI MARLINA 30,000.00 15,000.00 15,000.00
339 SULI TANTIONO 70,000.00 35,000.00 35,000.00
341 ANI SUMARNI 40,000.00 20,000.00 20,000.00
342 SUMARNA 15,000.00 10,000.00 7,500.00 7,500.00
343 MAYA ROSITA 30,000.00 15,000.00 15,000.00
345 LISNAWATI 15,000.00 10,000.00 7,500.00 7,500.00
346 NY RP TEDJA B 70,000.00 35,000.00 35,000.00
347 CHERYL FAZILA A 15,000.00 10,000.00 7,500.00 7,500.00
348 TINI SUMARTINI 30,000.00 15,000.00 15,000.00
349 NENENG DEDEH 15,000.00 10,000.00 7,500.00 7,500.00
350 DEWI NURANISYAH 70,000.00 35,000.00 35,000.00
351 ROHMAN 70,000.00 35,000.00 35,000.00
352 WILYA ROSI 70,000.00 10,000.00 35,000.00 35,000.00
353 RIDWAN LESMANA S 70,000.00 35,000.00 35,000.00
354 ASEP NURDIN 30,000.00 15,000.00 15,000.00
355 NUR AISAH 70,000.00 35,000.00 35,000.00
356 LULU NUR S 70,000.00 35,000.00 35,000.00
357 EVIS LESMINI DJUANDA 70,000.00 35,000.00 35,000.00
358 SUMINAR 15,000.00 7,500.00 7,500.00
359 HENDAR SUPRIATNA 15,000.00 10,000.00 7,500.00 7,500.00
360 FATHIA R DS 30,000.00 15,000.00 15,000.00
361 YULI TIKA S 15,000.00 7,500.00 7,500.00
362 FATTAH MAKI 30,000.00 10,000.00 15,000.00 15,000.00
363 AHMAD AGUNG M 70,000.00 35,000.00 35,000.00
364 SITI NURHAYATI 70,000.00 35,000.00 35,000.00
365 02/18/2017 IIS ISMAIL 15,000.00 10,000.00 7,500.00 7,500.00
366 ALIFAH NADYA S 15,000.00 7,500.00 7,500.00
367 KUSBANDIYAH 15,000.00 7,500.00 7,500.00
368 M LUQMAN 70,000.00 35,000.00 35,000.00
369 SUPATMI 30,000.00 15,000.00 15,000.00
370 NURJANAH 30,000.00 15,000.00 15,000.00
371 EKA PUSPA DEWI 30,000.00 15,000.00 15,000.00
372 HADIDJAH 15,000.00 10,000.00 7,500.00 7,500.00
373 RIFA LUTFIAYAH 40,000.00 20,000.00 20,000.00
374 HEPPY SEPTIAN 30,000.00 15,000.00 15,000.00
375 ADIL KHALILUL R 70,000.00 35,000.00 35,000.00
376 NUR RAHMA H 30,000.00 15,000.00 15,000.00
378 ARIF HIDAYAT 70,000.00 35,000.00 35,000.00
379 SUDARSIH 70,000.00 10,000.00 35,000.00 35,000.00
380 KASMINI 60,000.00 30,000.00 30,000.00
381 ANISA YUNITA 30,000.00 15,000.00 15,000.00
382 H IWAN KESUMA 70,000.00 35,000.00 35,000.00
383 SHAFA LUTFI FATIMAH 30,000.00 10,000.00 15,000.00 15,000.00
384 LUSI LUSMIATI 15,000.00 10,000.00 7,500.00 7,500.00
385 AMIRA AZIZAH Z 15,000.00 7,500.00 7,500.00
386 KUSTIYATI 70,000.00 35,000.00 35,000.00
387 NUR FITRI AISYAH 70,000.00 35,000.00 35,000.00
388 02/20/2017 ENTIN H 60,000.00 10,000.00 30,000.00 30,000.00
389 KIKI KUSUMAWATY 15,000.00 7,500.00 7,500.00
390 WIGATI SRI R 60,000.00 10,000.00 30,000.00 30,000.00
391 NONENG ASTRIA 40,000.00 20,000.00 20,000.00
392 SRI SULASTRI 60,000.00 10,000.00 30,000.00 30,000.00
393 TEGUH IMAM J 15,000.00 10,000.00 7,500.00 7,500.00
394 AGUS GUNTARA 60,000.00 10,000.00 30,000.00 30,000.00
395 SOPI RIANI S 15,000.00 10,000.00 7,500.00 7,500.00
396 KURNADI 30,000.00 10,000.00 15,000.00 15,000.00
397 NANI HERAWATI 70,000.00 35,000.00 35,000.00
398 M FARIS PRAYOGA 70,000.00 35,000.00 35,000.00
399 RESTU RIAWAN 30,000.00 15,000.00 15,000.00
400 ARMI TRISNAWATI 15,000.00 10,000.00 7,500.00 7,500.00
401 DWI ISWATI 15,000.00 7,500.00 7,500.00
402 IWAN K 30,000.00 15,000.00 15,000.00
403 M MUZZAFARUDIN 30,000.00 15,000.00 15,000.00
404 REVA A 15,000.00 10,000.00 7,500.00 7,500.00
405 INTAN NUR AENI 70,000.00 35,000.00 35,000.00
406 NINDYA KIRANI ZAHRA 35,000.00 10,000.00 17,500.00 17,500.00
407 EMILIA A 30,000.00 15,000.00 15,000.00
408 SITI KHODIJAH 15,000.00 10,000.00 7,500.00 7,500.00
409 MAMAN SUHERMAN 30,000.00 10,000.00 15,000.00 15,000.00
410 JILAN AQILAH 25,000.00 12,500.00 12,500.00
411 LENI MAULIANI 15,000.00 10,000.00 7,500.00 7,500.00
412 MULYANA SUHERMAN 15,000.00 10,000.00 7,500.00 7,500.00
413 ATIQAH MAQSUDI 30,000.00 10,000.00 15,000.00 15,000.00
414 02/21/2017 NY RADEN TEDJA 70,000.00 35,000.00 35,000.00
415 AHMAD NURODIN 70,000.00 35,000.00 35,000.00
416 UMI SUPIAH S 30,000.00 15,000.00 15,000.00
417 NENENG SULASMI 40,000.00 20,000.00 20,000.00
418 HARNI SETIAWATI 70,000.00 35,000.00 35,000.00
419 ELIS SITI P 70,000.00 35,000.00 35,000.00
420 IKA BUDI UTAMI 15,000.00 7,500.00 7,500.00
421 RINA KUSWANTI 15,000.00 7,500.00 7,500.00
422 KUSMIATI 30,000.00 15,000.00 15,000.00
423 SRI SYARIFAH 30,000.00 10,000.00 15,000.00 15,000.00
424 YESI 70,000.00 35,000.00 35,000.00
425 CHERYL FAZILA A 15,000.00 10,000.00 7,500.00 7,500.00
426 SINTA HATTY 70,000.00 35,000.00 35,000.00
428 RIZKY AFRIZAL P T 70,000.00 35,000.00 35,000.00
429 IMAS MAEMUNAH 60,000.00 10,000.00 30,000.00 30,000.00
430 TIKA CAHYANI 30,000.00 15,000.00 15,000.00
431 ADVENTSIUS VITA V S 25,000.00 10,000.00 12,500.00 12,500.00
432 HAFIYA HALWA C 70,000.00 35,000.00 35,000.00
433 AZKA 70,000.00 35,000.00 35,000.00
434 ERLAN KANDANI 40,000.00 20,000.00 20,000.00
435 SONY HERMANTO 30,000.00 15,000.00 15,000.00
436 TETEN YANA S 30,000.00 15,000.00 15,000.00
437 ABDUL LATIF R 30,000.00 15,000.00 15,000.00
438 02/22/2017 IIS ISMAIL 15,000.00 10,000.00 7,500.00 7,500.00
439 ROSIANA R 25,000.00 12,500.00 12,500.00
440 TANIA SUPARLAN 30,000.00 15,000.00 15,000.00
441 ENOK ANI H 15,000.00 7,500.00 7,500.00
442 ENI 60,000.00 10,000.00 30,000.00 30,000.00
443 LANANGKU HUSAIN 30,000.00 10,000.00 15,000.00 15,000.00
444 HEPPY SEPTIAN 30,000.00 15,000.00 15,000.00
445 NANDANG MULYANA 15,000.00 7,500.00 7,500.00
446 NENI PUSPANINGSIH 60,000.00 10,000.00 30,000.00 30,000.00
447 RITA RUSMIANTHI 15,000.00 10,000.00 7,500.00 7,500.00
448 WANDY J 15,000.00 10,000.00 7,500.00 7,500.00
449 RAHMANDHANI K 70,000.00 35,000.00 35,000.00
450 NANDANG 30,000.00 15,000.00 15,000.00
451 ASIATUN 30,000.00 15,000.00 15,000.00
452 EMILIA P 30,000.00 15,000.00 15,000.00
453 ROHAETI 15,000.00 7,500.00 7,500.00
454 AZZAHRA W 30,000.00 15,000.00 15,000.00
455 LINDA 30,000.00 15,000.00 15,000.00
456 ILAH JULIAH 15,000.00 7,500.00 7,500.00
457 JAM JAM N 15,000.00 10,000.00 7,500.00 7,500.00
458 M FAUZAN NURZAKI 25,000.00 12,500.00 12,500.00
459 FENY AYU 30,000.00 15,000.00 15,000.00
460 AMIRA 15,000.00 7,500.00 7,500.00
461 02/23/2017 NUKE 30,000.00 15,000.00 15,000.00
462 HADIDJAH 15,000.00 10,000.00 7,500.00 7,500.00
463 PRIATNA 30,000.00 15,000.00 15,000.00
464 AZMI RAHMADHANI 30,000.00 15,000.00 15,000.00
465 WULAN WIDIA WATI 15,000.00 10,000.00 7,500.00 7,500.00
466 RATNA YUNINGSIH 30,000.00 15,000.00 15,000.00
467 DINAR 30,000.00 15,000.00 15,000.00
468 ADARA PAMELA 25,000.00 12,500.00 12,500.00
469 PERMANA 15,000.00 10,000.00 7,500.00 7,500.00
470 DINI ANDRIANI 70,000.00 35,000.00 35,000.00
471 FRANSISCUS X T 70,000.00 35,000.00 35,000.00
472 TITIH MARDAH 70,000.00 35,000.00 35,000.00
473 VINA 40,000.00 20,000.00 20,000.00
474 FITRIANI 40,000.00 20,000.00 20,000.00
475 LANIWATI 30,000.00 10,000.00 15,000.00 15,000.00
476 WILDAN ALFI G 30,000.00 15,000.00 15,000.00
477 SARBINI RAIS 60,000.00 10,000.00 30,000.00 30,000.00
478 AN NASSER BAYU A 30,000.00 15,000.00 15,000.00
479 M RIZKY N 15,000.00 10,000.00 7,500.00 7,500.00
480 MUTMAINAH 60,000.00 10,000.00 30,000.00 30,000.00
481 DANDI S 30,000.00 15,000.00 15,000.00
482 YUNUS 60,000.00 10,000.00 30,000.00 30,000.00
483 ROS AMINAH 40,000.00 20,000.00 20,000.00
484 02/24/2017 LENI MARLINA 30,000.00 10,000.00 15,000.00 15,000.00
485 SULI TANTIONO 70,000.00 35,000.00 35,000.00
486 HEPPY SEPTIAN 30,000.00 15,000.00 15,000.00
487 ATENG WAHYUDI 15,000.00 7,500.00 7,500.00
488 KUSBANDIYAH 15,000.00 10,000.00 7,500.00 7,500.00
489 ANI SUMARNI 70,000.00 35,000.00 35,000.00
491 SARTIKA SULASTRI 70,000.00 35,000.00 35,000.00
492 NENENG DEDEH R 15,000.00 10,000.00 7,500.00 7,500.00
493 TINI SUMARTINI 30,000.00 15,000.00 15,000.00
494 MAYA ROSITA 30,000.00 15,000.00 15,000.00
495 LISNAWATI 30,000.00 15,000.00 15,000.00
496 WILYA ROSI 70,000.00 10,000.00 35,000.00 35,000.00
497 ARI SUPRIANTO 15,000.00 7,500.00 7,500.00
498 RIDWAN LESMANA S 30,000.00 10,000.00 15,000.00 15,000.00
499 DADANG ALI K 70,000.00 35,000.00 35,000.00
500 ASEP KURNIAWAN SANDI 30,000.00 10,000.00 15,000.00 15,000.00
501 M AZKA 30,000.00 10,000.00 15,000.00 15,000.00
502 AHMAD 15,000.00 7,500.00 7,500.00
504 DIAN WIDIANINGSIH 70,000.00 35,000.00 35,000.00
505 SUMARTINI 30,000.00 15,000.00 15,000.00
506 NOPI OPAKA 15,000.00 10,000.00 7,500.00 7,500.00
507 AHDIAT 15,000.00 10,000.00 7,500.00 7,500.00
508 02/25/2017 ALIFA 15,000.00 10,000.00 7,500.00 7,500.00
509 SUTRISNO 70,000.00 35,000.00 35,000.00
510 ASEP NURDIN 40,000.00 10,000.00 20,000.00 20,000.00
511 SUPATMI 30,000.00 15,000.00 15,000.00
512 NURJANAH 40,000.00 20,000.00 20,000.00
513 M LUTPI ANDRIAN 25,000.00 12,500.00 12,500.00
514 RIFA LUTFIYAH A 70,000.00 35,000.00 35,000.00
515 AHMAD MURDANI 15,000.00 10,000.00 7,500.00 7,500.00
516 IWAN KESUMA 70,000.00 35,000.00 35,000.00
517 SUDARSIH 70,000.00 35,000.00 35,000.00
518 EVA NURANI 30,000.00 10,000.00 15,000.00 15,000.00
519 ANISA YUNITA 30,000.00 15,000.00 15,000.00
520 M ILHAM GHOZALI 70,000.00 35,000.00 35,000.00
521 SITI KHODIJAH 15,000.00 10,000.00 7,500.00 7,500.00
522 ERNI FEBRINA 30,000.00 15,000.00 15,000.00
523 AUREN DWI AROFAH 35,000.00 17,500.00 17,500.00
524 ATTHIA SHILA G 25,000.00 12,500.00 12,500.00
525 MELA RESTI L 30,000.00 15,000.00 15,000.00
526 LINDA 70,000.00 35,000.00 35,000.00
527 NURHAYATI 30,000.00 15,000.00 15,000.00
528 02/27/2017 SRIYANI 30,000.00 10,000.00 15,000.00 15,000.00
529 IWAN KUSWANDI 30,000.00 15,000.00 15,000.00
530 FADHIL SWI A 30,000.00 10,000.00 15,000.00 15,000.00
531 HENI NURHAENI 70,000.00 35,000.00 35,000.00
532 NONENG ASTRIA 70,000.00 35,000.00 35,000.00
533 HARNI SETIAWATI 15,000.00 7,500.00 7,500.00
534 LINA MARLINA 30,000.00 10,000.00 15,000.00 15,000.00
535 IWAN KESUMA 70,000.00 35,000.00 35,000.00
536 ILAH JULIAH 15,000.00 7,500.00 7,500.00
537 MULYANAH 60,000.00 10,000.00 30,000.00 30,000.00
538 ROSTINI 70,000.00 35,000.00 35,000.00
539 ALMA TSANA D 15,000.00 7,500.00 7,500.00
540 ATI SRIWATI 35,000.00 17,500.00 17,500.00
541 LUKMAN ASRI 15,000.00 7,500.00 7,500.00
542 SITI ASMAYA 70,000.00 35,000.00 35,000.00
543 M ASEP MULYANA 35,000.00 17,500.00 17,500.00
544 DADANG ALI KURNIA 30,000.00 10,000.00 15,000.00 15,000.00
545 ROHENDI 40,000.00 20,000.00 20,000.00
546 ALYA TSIYA FAUZIAH R 15,000.00 10,000.00 7,500.00 7,500.00
547 HARY HARDIANSYAH 70,000.00 35,000.00 35,000.00
548 SITI HODIJAH 70,000.00 35,000.00 35,000.00
549 RIEKA FAUZA R 30,000.00 10,000.00 15,000.00 15,000.00
550 EMILIA 40,000.00 20,000.00 20,000.00
551 AHDIAT 30,000.00 15,000.00 15,000.00
552 VOPPY SYAEFI 30,000.00 10,000.00 15,000.00 15,000.00
553 LUKMAN SARI 25,000.00 12,500.00 12,500.00
554 TEOBALD ADIO ANGGARA 70,000.00 35,000.00 35,000.00
555 DIAN WIDIANINGSIH 15,000.00 7,500.00 7,500.00
556 SITI HALIMAH 70,000.00 35,000.00 35,000.00
557 02/28/2017 NENENG SULASMI 70,000.00 35,000.00 35,000.00
558 DASAR 15,000.00 10,000.00 7,500.00 7,500.00
559 EKO M 15,000.00 10,000.00 7,500.00 7,500.00
560 ENOK ANI H 70,000.00 35,000.00 35,000.00
561 BUDI SUCAHYO 15,000.00 10,000.00 7,500.00 7,500.00
562 KUSMIATI 70,000.00 35,000.00 35,000.00
563 ELIS SITI P 70,000.00 35,000.00 35,000.00
564 LIA KAMELIA DEWI 70,000.00 35,000.00 35,000.00
565 AHMAD 15,000.00 10,000.00 7,500.00 7,500.00
566 SRI SYARIFAH 40,000.00 20,000.00 20,000.00
567 DINI ANDRIANI 35,000.00 17,500.00 17,500.00
568 PARNI KASANAH 15,000.00 10,000.00 7,500.00 7,500.00
569 SURAMI 15,000.00 10,000.00 7,500.00 7,500.00
570 IBRAHIM ADITIYA G 25,000.00 12,500.00 12,500.00
571 YUYUN T 15,000.00 10,000.00 7,500.00 7,500.00
572 NANIM SUAMRNI 70,000.00 35,000.00 35,000.00
573 GINA NURFADILAH 15,000.00 7,500.00 7,500.00
574 TIKA CAHYANI 30,000.00 15,000.00 15,000.00
575 DAFIAN RIZQI S W 70,000.00 35,000.00 35,000.00
576 DEWI SHANTYANA 70,000.00 35,000.00 35,000.00
577 AZKA 15,000.00 7,500.00 7,500.00
578 HAFIYA HALWA C 70,000.00 35,000.00 35,000.00
579 ENDAH DUDIN I 35,000.00 10,000.00 17,500.00 17,500.00
580 PARIS 25,000.00 10,000.00 12,500.00 12,500.00
22,430,000 1,850,000 11,215,000 11,215,000
JML KET
90,000
255,000
125,000
25,000
105,000
85,000
105,000
85,000
155,000
25,000
25,000
85,000
85,000
25,000
85,000
65,000
105,000
85,000
25,000
105,000
25,000
55,000
55,000
255,000
25,000
85,000
55,000
105,000
185,000
255,000
25,000
25,000
255,000
85,000
125,000
205,000
255,000
25,000
25,000
105,000
25,000
4,000,000
JML KET
40,000.00
45,000.00
70,000.00
25,000.00
40,000.00
70,000.00
25,000.00
15,000.00
40,000.00
25,000.00
30,000.00
70,000.00
15,000.00
15,000.00
25,000.00
40,000.00
15,000.00
30,000.00
15,000.00
25,000.00
70,000.00
30,000.00
30,000.00
15,000.00
30,000.00
70,000.00
30,000.00
25,000.00
30,000.00
70,000.00
70,000.00
70,000.00
25,000.00
25,000.00
80,000.00
30,000.00
40,000.00
70,000.00
30,000.00
25,000.00
25,000.00
70,000.00
15,000.00
60,000.00
30,000.00
25,000.00
40,000.00
30,000.00
70,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
30,000.00
30,000.00
80,000.00
30,000.00
70,000.00
80,000.00
30,000.00
30,000.00
30,000.00
70,000.00
70,000.00
70,000.00
80,000.00
15,000.00
70,000.00
30,000.00
25,000.00
70,000.00
40,000.00
15,000.00
70,000.00
70,000.00
15,000.00
30,000.00
25,000.00
30,000.00
40,000.00
30,000.00
30,000.00
30,000.00
30,000.00
30,000.00
40,000.00
40,000.00
70,000.00
25,000.00
30,000.00
30,000.00
30,000.00
15,000.00
25,000.00
15,000.00
70,000.00
25,000.00
25,000.00
15,000.00
30,000.00
35,000.00
25,000.00
45,000.00
30,000.00
30,000.00
30,000.00
80,000.00
70,000.00
15,000.00
80,000.00
25,000.00
30,000.00
30,000.00
40,000.00
25,000.00
70,000.00
30,000.00
30,000.00
15,000.00
25,000.00
70,000.00
70,000.00
40,000.00
30,000.00
70,000.00
30,000.00
25,000.00
25,000.00
30,000.00
40,000.00
30,000.00
70,000.00
80,000.00
70,000.00
40,000.00
70,000.00
40,000.00
35,000.00
40,000.00
25,000.00
30,000.00
70,000.00
70,000.00
25,000.00
40,000.00
40,000.00
70,000.00
70,000.00
70,000.00
15,000.00
40,000.00
15,000.00
70,000.00
25,000.00
70,000.00
40,000.00
80,000.00
70,000.00
70,000.00
70,000.00
25,000.00
70,000.00
30,000.00
25,000.00
30,000.00
70,000.00
70,000.00
30,000.00
40,000.00
30,000.00
30,000.00
70,000.00
80,000.00
25,000.00
40,000.00
25,000.00
25,000.00
70,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
70,000.00
25,000.00
30,000.00
15,000.00
30,000.00
25,000.00
70,000.00
15,000.00
30,000.00
30,000.00
70,000.00
15,000.00
70,000.00
25,000.00
30,000.00
30,000.00
80,000.00
70,000.00
80,000.00
35,000.00
70,000.00
70,000.00
25,000.00
40,000.00
15,000.00
40,000.00
25,000.00
25,000.00
25,000.00
25,000.00
25,000.00
70,000.00
70,000.00
25,000.00
70,000.00
40,000.00
40,000.00
70,000.00
25,000.00
70,000.00
30,000.00
70,000.00
40,000.00
30,000.00
25,000.00
40,000.00
30,000.00
30,000.00
70,000.00
30,000.00
25,000.00
30,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
70,000.00
30,000.00
40,000.00
40,000.00
25,000.00
25,000.00
30,000.00
70,000.00
25,000.00
70,000.00
70,000.00
40,000.00
15,000.00
70,000.00
25,000.00
15,000.00
40,000.00
30,000.00
25,000.00
70,000.00
25,000.00
30,000.00
70,000.00
35,000.00
30,000.00
30,000.00
30,000.00
70,000.00
30,000.00
25,000.00
15,000.00
30,000.00
40,000.00
40,000.00
25,000.00
40,000.00
30,000.00
40,000.00
70,000.00
30,000.00
25,000.00
70,000.00
25,000.00
25,000.00
80,000.00
30,000.00
40,000.00
70,000.00
25,000.00
30,000.00
25,000.00
25,000.00
25,000.00
25,000.00
15,000.00
30,000.00
30,000.00
25,000.00
70,000.00
45,000.00
15,000.00
70,000.00
30,000.00
70,000.00
15,000.00
30,000.00
30,000.00
40,000.00
30,000.00
25,000.00
80,000.00
25,000.00
70,000.00
25,000.00
70,000.00
25,000.00
70,000.00
25,000.00
40,000.00
70,000.00
15,000.00
70,000.00
70,000.00
30,000.00
25,000.00
15,000.00
40,000.00
25,000.00
30,000.00
25,000.00
70,000.00
30,000.00
35,000.00
30,000.00
70,000.00
30,000.00
70,000.00
70,000.00
40,000.00
25,000.00
30,000.00
70,000.00
25,000.00
70,000.00
25,000.00
30,000.00
25,000.00
70,000.00
70,000.00
80,000.00
70,000.00
30,000.00
70,000.00
70,000.00
70,000.00
15,000.00
25,000.00
30,000.00
15,000.00
40,000.00
70,000.00
70,000.00
25,000.00
15,000.00
15,000.00
70,000.00
30,000.00
30,000.00
30,000.00
25,000.00
40,000.00
30,000.00
70,000.00
30,000.00
50,000.00
70,000.00
80,000.00
60,000.00
30,000.00
70,000.00
40,000.00
25,000.00
15,000.00
70,000.00
70,000.00
70,000.00
15,000.00
70,000.00
40,000.00
70,000.00
25,000.00
70,000.00
25,000.00
40,000.00
70,000.00
70,000.00
30,000.00
25,000.00
15,000.00
30,000.00
30,000.00
25,000.00
70,000.00
45,000.00
30,000.00
25,000.00
40,000.00
25,000.00
25,000.00
25,000.00
40,000.00
70,000.00
70,000.00
30,000.00
40,000.00
70,000.00
70,000.00
15,000.00
15,000.00
30,000.00
40,000.00
70,000.00
25,000.00
70,000.00
30,000.00
70,000.00
70,000.00
30,000.00
35,000.00
70,000.00
70,000.00
40,000.00
30,000.00
30,000.00
30,000.00
25,000.00
25,000.00
30,000.00
15,000.00
70,000.00
40,000.00
30,000.00
15,000.00
70,000.00
25,000.00
25,000.00
70,000.00
30,000.00
30,000.00
30,000.00
15,000.00
30,000.00
30,000.00
15,000.00
25,000.00
25,000.00
30,000.00
15,000.00
30,000.00
25,000.00
30,000.00
30,000.00
25,000.00
30,000.00
30,000.00
25,000.00
25,000.00
70,000.00
70,000.00
70,000.00
40,000.00
40,000.00
40,000.00
30,000.00
70,000.00
30,000.00
25,000.00
70,000.00
30,000.00
70,000.00
40,000.00
40,000.00
70,000.00
30,000.00
15,000.00
25,000.00
70,000.00
70,000.00
70,000.00
25,000.00
30,000.00
30,000.00
30,000.00
80,000.00
15,000.00
40,000.00
70,000.00
40,000.00
40,000.00
15,000.00
30,000.00
70,000.00
30,000.00
25,000.00
25,000.00
25,000.00
70,000.00
50,000.00
30,000.00
40,000.00
25,000.00
70,000.00
25,000.00
70,000.00
70,000.00
40,000.00
30,000.00
70,000.00
25,000.00
30,000.00
35,000.00
25,000.00
30,000.00
70,000.00
30,000.00
40,000.00
30,000.00
40,000.00
70,000.00
70,000.00
15,000.00
40,000.00
70,000.00
15,000.00
70,000.00
70,000.00
15,000.00
35,000.00
15,000.00
70,000.00
35,000.00
40,000.00
40,000.00
25,000.00
70,000.00
70,000.00
40,000.00
40,000.00
30,000.00
40,000.00
25,000.00
70,000.00
15,000.00
70,000.00
70,000.00
25,000.00
25,000.00
70,000.00
25,000.00
70,000.00
70,000.00
70,000.00
25,000.00
40,000.00
35,000.00
25,000.00
25,000.00
25,000.00
25,000.00
70,000.00
15,000.00
30,000.00
70,000.00
70,000.00
15,000.00
70,000.00
45,000.00
35,000.00
25,000.00
24,310,000 -
JASA
DOKTER
1 01/'03/2017 VADYA 20,000 5,000 10,000
2 DINI ANDRIYANI 250,000 5,000 125,000
3 03/'03/2017 CICI 300,000 5,000 150,000
4 06/'03/2017 AN KEVIN 80,000 5,000 40,000
5 NY WIWIT 350,000 5,000 175,000
6 07/'03/2017 NY RD TEDJA B 250,000 5,000 125,000
7 AISYAH 50,000 5,000 25,000
8 80,000 5,000 40,000
9 150,000 5,000 75,000
10 20,000 5,000 10,000
11 20,000 5,000 10,000
12 80,000 5,000 40,000
13 80,000 5,000 40,000
14 20,000 5,000 10,000
15 80,000 5,000 40,000
16 60,000 5,000 30,000
17 100,000 5,000 50,000
18 80,000 5,000 40,000
19 20,000 5,000 10,000
20 100,000 5,000 50,000
21 20,000 5,000 10,000
22 50,000 5,000 25,000
23 50,000 5,000 25,000
24 250,000 5,000 125,000
25 20,000 5,000 10,000
26 80,000 5,000 40,000
27 50,000 5,000 25,000
28 100,000 5,000 50,000
29 180,000 5,000 90,000
30 250,000 5,000 125,000
31 20,000 5,000 10,000
32 20,000 5,000 10,000
33 250,000 5,000 125,000
34 80,000 5,000 40,000
35 120,000 5,000 60,000
36 200,000 5,000 100,000
37 250,000 5,000 125,000
38 20,000 5,000 10,000
39 20,000 5,000 10,000
40 100,000 5,000 50,000
41 20,000 5,000 10,000
4,340,000 205,000 2,170,000
JASA
TGL NAMA TARIF OBAT
DOKTER
1 03/01/2017 HEPPY SEPTIAN 40,000.00 20,000.00
2 SYAHLA HANIFAH 25,000.00 12,500.00
3 ASEP RAMADHAN 30,000.00 15,000.00
4 SITI AISAH 60,000.00 10,000.00 30,000.00
5 NANI HERAWATI 70,000.00 35,000.00
6 SURYANA 15,000.00 10,000.00 7,500.00
7 ASTRID Y 30,000.00 15,000.00
8 NANDANG 40,000.00 20,000.00
9 EMMELIA P 30,000.00 15,000.00
10 ANISA RAHMAWATI 25,000.00 12,500.00
11 ALVIN RASYINA 15,000.00 7,500.00
12 M KHASAN 30,000.00 15,000.00
13 LINDA 30,000.00 15,000.00
14 AZZAHRA N 30,000.00 15,000.00
15 VIRNI PUTRI R 25,000.00 12,500.00
16 M FUZAN NURZAZI 25,000.00 10,000.00 12,500.00
17 03/02/2017 NUKE 40,000.00 20,000.00
18 HEPPI SEPTIAN 70,000.00 35,000.00
19 MARIANA 30,000.00 15,000.00
20 IIS SIMAIL 15,000.00 10,000.00 7,500.00
21 VINA MUTIARA 70,000.00 35,000.00
22 AI HAMIDAH 15,000.00 10,000.00 7,500.00
23 HADIDJAH 15,000.00 10,000.00 7,500.00
24 FENI AYU A 30,000.00 15,000.00
25 NENI 70,000.00 35,000.00
26 ROHIMAH 15,000.00 10,000.00 7,500.00
27 WULAN WIDIA WATI 70,000.00 35,000.00
28 RATNA YUNINGIH 30,000.00 10,000.00 15,000.00
29 DINI ANDRIANI 70,000.00 35,000.00
30 UMI SUPIAH S 40,000.00 20,000.00
31 TIARA SITI LATHIFA 15,000.00 10,000.00 7,500.00
32 FITRIANI 70,000.00 35,000.00
33 KIRANA AURELA 70,000.00 35,000.00
34 SITI KHODIJAH 70,000.00 35,000.00
35 AN NASER BAYU A 40,000.00 20,000.00
36 DANDI S 30,000.00 10,000.00 15,000.00
37 FREDY CANDRA N 25,000.00 12,500.00
38 LANIWATI 30,000.00 15,000.00
39 ROS AMINAH 70,000.00 35,000.00
40 AKBAR N 40,000.00 20,000.00
41 DITA WILIATI 35,000.00 17,500.00
42 WILDAN ALFI G 30,000.00 15,000.00
43 03/03/2017 LENI MARLINA 30,000.00 15,000.00
44 SULI TANTIONO 70,000.00 10,000.00 35,000.00
45 DE FATHAN N 25,000.00 12,500.00
46 MAYSTI ANISA FITRI 15,000.00 7,500.00
47 RINI PURWANTI 70,000.00 35,000.00
49 MAYA ROSITA 40,000.00 20,000.00
50 KUSBANDIYAH 15,000.00 10,000.00 7,500.00
51 LISNAWATI 30,000.00 10,000.00 15,000.00
52 DADANG ALI KURNIA 15,000.00 10,000.00 7,500.00
53 FRANSISCUS XT 70,000.00 35,000.00
54 RIDWAN LESMANA SARI 30,000.00 10,000.00 15,000.00
55 AGUS SETIAWAN 15,000.00 10,000.00 7,500.00
56 DEWI SHANTIYANA 70,000.00 35,000.00
57 SITI KHODIJAH 15,000.00 10,000.00 7,500.00
58 ANGGIT EKA P 15,000.00 10,000.00 7,500.00
59 DIANDA NASYA P 15,000.00 10,000.00 7,500.00
60 ASEP LURNIOAWAN SANDI 30,000.00 15,000.00
61 GITA PERMATA E P 15,000.00 7,500.00
62 SODIK MUTAKIN 70,000.00 35,000.00
63 ERLANGGA SAPUTRA H 15,000.00 10,000.00 7,500.00
64 IRMA NURI I 25,000.00 12,500.00
65 FITRI NURAENI 30,000.00 15,000.00
66 03/04/2017 M LUTFI ANDRIAN 25,000.00 12,500.00
67 SUPATMI 40,000.00 20,000.00
68 NURJANAH 70,000.00 35,000.00
69 RESTU RIAWAN 30,000.00 15,000.00
70 SUTRISNO 30,000.00 15,000.00
71 ASEP N 70,000.00 35,000.00
72 IIS WIDANINGSIH 70,000.00 35,000.00
73 LOURINE 70,000.00 35,000.00
74 IWAN KESUMA 70,000.00 35,000.00
75 03/06/2017 SRIYANI 30,000.00 10,000.00 15,000.00
76 MAHENDRA NUR P 15,000.00 10,000.00 7,500.00
77 ATENG WAHYUDI 15,000.00 7,500.00
78 RACHELIA NISA F 25,000.00 12,500.00
79 IMAS MAEMUNAH 15,000.00 10,000.00 7,500.00
80 ALIF ABDUR RAFI 70,000.00 35,000.00
81 LINA MARLINA 30,000.00 15,000.00
82 ANI NURAENI 15,000.00 10,000.00 7,500.00
83 ROHIMAH 60,000.00 10,000.00 30,000.00
84 NAZLA SALSABILA 30,000.00 10,000.00 15,000.00
85 SRI SUSANTI 30,000.00 10,000.00 15,000.00
86 ADITYA F 25,000.00 12,500.00
87 WIDIA ASTUTI 60,000.00 10,000.00 30,000.00
88 VIDICA FITRIA 15,000.00 7,500.00
89 NOVAN 70,000.00 35,000.00
90 H IWAN KESUMA 70,000.00 35,000.00
91 EKA FAHMI R H 15,000.00 7,500.00
92 HARRY HARDIANSAH 70,000.00 35,000.00
93 FATHIA R D 70,000.00 35,000.00
94 EMILIA A 70,000.00 35,000.00
95 VOPPY SYAEFI 30,000.00 15,000.00
96 ROSMAWATI 15,000.00 7,500.00
97 SUDARSIH 70,000.00 35,000.00
98 AISYA TISHA FAUZIYAH R 70,000.00 35,000.00
99 HILMAN ALIFA A 25,000.00 12,500.00
100 HENY ROSYANA 15,000.00 7,500.00
101 SITI HALIMAH 30,000.00 15,000.00
102 M HAMDAN ANN NUR 30,000.00 10,000.00 15,000.00
103 MELA RESTI 30,000.00 15,000.00
104 03/07/2017 35,000.00 17,500.00
105 30,000.00 15,000.00
106 30,000.00 15,000.00
107 30,000.00 15,000.00
108 70,000.00 35,000.00
109 60,000.00 30,000.00
110 15,000.00 7,500.00
111 70,000.00 35,000.00
112 25,000.00 12,500.00
113 30,000.00 15,000.00
114 30,000.00 15,000.00
115 30,000.00 15,000.00
116 15,000.00 10,000.00 7,500.00
117 70,000.00 35,000.00
118 30,000.00 15,000.00
119 30,000.00 15,000.00
120 15,000.00 7,500.00
121 15,000.00 10,000.00 7,500.00
122 70,000.00 35,000.00
123 70,000.00 35,000.00
124 30,000.00 10,000.00 15,000.00
125 7/2/2017 30,000.00 15,000.00
126 70,000.00 35,000.00
127 30,000.00 15,000.00
128 15,000.00 10,000.00 7,500.00
129 15,000.00 10,000.00 7,500.00
130 30,000.00 15,000.00
131 40,000.00 20,000.00
132 30,000.00 15,000.00
133 70,000.00 35,000.00
134 70,000.00 10,000.00 35,000.00
135 70,000.00 35,000.00
136 30,000.00 10,000.00 15,000.00
137 70,000.00 35,000.00
138 30,000.00 10,000.00 15,000.00
139 35,000.00 17,500.00
140 30,000.00 10,000.00 15,000.00
141 25,000.00 12,500.00
142 30,000.00 15,000.00
143 70,000.00 35,000.00
144 60,000.00 10,000.00 30,000.00
145 15,000.00 10,000.00 7,500.00
146 30,000.00 10,000.00 15,000.00
147 40,000.00 20,000.00
148 8/2/2017 70,000.00 35,000.00
149 70,000.00 35,000.00
150 70,000.00 35,000.00
151 15,000.00 7,500.00
152 30,000.00 10,000.00 15,000.00
153 15,000.00 7,500.00
154 60,000.00 10,000.00 30,000.00
155 15,000.00 10,000.00 7,500.00
156 60,000.00 10,000.00 30,000.00
157 30,000.00 10,000.00 15,000.00
158 70,000.00 10,000.00 35,000.00
159 60,000.00 10,000.00 30,000.00
160 60,000.00 10,000.00 30,000.00
161 60,000.00 10,000.00 30,000.00
162 15,000.00 10,000.00 7,500.00
163 60,000.00 10,000.00 30,000.00
164 30,000.00 15,000.00
165 15,000.00 10,000.00 7,500.00
166 30,000.00 15,000.00
167 70,000.00 35,000.00
168 70,000.00 35,000.00
169 9/2/2017 30,000.00 15,000.00
170 30,000.00 10,000.00 15,000.00
171 30,000.00 15,000.00
172 30,000.00 15,000.00
173 70,000.00 35,000.00
174 70,000.00 10,000.00 35,000.00
175 15,000.00 10,000.00 7,500.00
176 30,000.00 10,000.00 15,000.00
177 15,000.00 10,000.00 7,500.00
178 15,000.00 10,000.00 7,500.00
179 70,000.00 35,000.00
180 70,000.00 35,000.00
181 30,000.00 15,000.00
182 70,000.00 35,000.00
183 70,000.00 35,000.00
184 70,000.00 35,000.00
185 70,000.00 35,000.00
186 15,000.00 10,000.00 7,500.00
187 30,000.00 15,000.00
188 15,000.00 7,500.00
189 30,000.00 15,000.00
190 25,000.00 12,500.00
191 70,000.00 35,000.00
192 15,000.00 7,500.00
193 30,000.00 15,000.00
194 30,000.00 15,000.00
195 10/2/2017 70,000.00 35,000.00
196 15,000.00 7,500.00
197 70,000.00 35,000.00
198 15,000.00 10,000.00 7,500.00
199 30,000.00 15,000.00
200 30,000.00 15,000.00
201 70,000.00 10,000.00 35,000.00
202 70,000.00 35,000.00
203 70,000.00 10,000.00 35,000.00
204 25,000.00 10,000.00 12,500.00
205 70,000.00 35,000.00
206 70,000.00 35,000.00
207 15,000.00 10,000.00 7,500.00
208 30,000.00 10,000.00 15,000.00
209 15,000.00 7,500.00
210 40,000.00 20,000.00
211 25,000.00 12,500.00
212 15,000.00 10,000.00 7,500.00
213 25,000.00 12,500.00
214 25,000.00 12,500.00
215 15,000.00 10,000.00 7,500.00
216 70,000.00 35,000.00
217 70,000.00 35,000.00
218 15,000.00 10,000.00 7,500.00
219 70,000.00 35,000.00
220 30,000.00 10,000.00 15,000.00
221 30,000.00 10,000.00 15,000.00
222 70,000.00 35,000.00
223 15,000.00 10,000.00 7,500.00
224 70,000.00 35,000.00
225 30,000.00 15,000.00
226 70,000.00 35,000.00
227 30,000.00 10,000.00 15,000.00
228 30,000.00 15,000.00
229 11/2/2017 25,000.00 12,500.00
230 40,000.00 20,000.00
231 30,000.00 15,000.00
232 30,000.00 15,000.00
233 70,000.00 35,000.00
234 30,000.00 15,000.00
235 15,000.00 10,000.00 7,500.00
236 30,000.00 15,000.00
237 30,000.00 15,000.00
238 70,000.00 35,000.00
239 30,000.00 15,000.00
240 70,000.00 35,000.00
241 70,000.00 35,000.00
242 30,000.00 15,000.00
243 70,000.00 35,000.00
244 30,000.00 15,000.00
245 40,000.00 20,000.00
246 30,000.00 10,000.00 15,000.00
247 25,000.00 12,500.00
248 25,000.00 12,500.00
249 30,000.00 15,000.00
250 70,000.00 35,000.00
251 25,000.00 12,500.00
252 70,000.00 35,000.00
253 02/13/2017 70,000.00 35,000.00
254 30,000.00 10,000.00 15,000.00
255 15,000.00 7,500.00
256 70,000.00 35,000.00
257 15,000.00 10,000.00 7,500.00
258 15,000.00 7,500.00
259 40,000.00 20,000.00
260 30,000.00 15,000.00
261 15,000.00 10,000.00 7,500.00
262 70,000.00 35,000.00
263 15,000.00 10,000.00 7,500.00
264 30,000.00 15,000.00
265 60,000.00 10,000.00 30,000.00
266 35,000.00 17,500.00
267 30,000.00 15,000.00
268 30,000.00 15,000.00
269 30,000.00 15,000.00
270 70,000.00 35,000.00
271 30,000.00 15,000.00
272 15,000.00 10,000.00 7,500.00
273 15,000.00 7,500.00
274 30,000.00 15,000.00
275 30,000.00 10,000.00 15,000.00
276 30,000.00 10,000.00 15,000.00
277 25,000.00 12,500.00
278 40,000.00 20,000.00
279 30,000.00 15,000.00
280 02/14/2017 30,000.00 10,000.00 15,000.00
281 70,000.00 35,000.00
282 30,000.00 15,000.00
283 15,000.00 10,000.00 7,500.00
284 70,000.00 35,000.00
285 15,000.00 10,000.00 7,500.00
286 15,000.00 10,000.00 7,500.00
287 70,000.00 10,000.00 35,000.00
288 30,000.00 15,000.00
289 40,000.00 20,000.00
290 70,000.00 35,000.00
291 15,000.00 10,000.00 7,500.00
292 30,000.00 15,000.00
293 15,000.00 10,000.00 7,500.00
294 15,000.00 10,000.00 7,500.00
295 25,000.00 12,500.00
296 15,000.00 10,000.00 7,500.00
297 15,000.00 7,500.00
298 30,000.00 15,000.00
299 30,000.00 15,000.00
300 25,000.00 12,500.00
301 70,000.00 35,000.00
302 25,000.00 10,000.00 12,500.00
303 15,000.00 7,500.00
304 70,000.00 35,000.00
305 30,000.00 15,000.00
306 70,000.00 35,000.00
307 15,000.00 7,500.00
308 02/16/2017 30,000.00 15,000.00
309 30,000.00 15,000.00
310 30,000.00 10,000.00 15,000.00
311 30,000.00 15,000.00
312 15,000.00 10,000.00 7,500.00
313 70,000.00 10,000.00 35,000.00
314 15,000.00 10,000.00 7,500.00
315 70,000.00 35,000.00
316 15,000.00 10,000.00 7,500.00
317 70,000.00 35,000.00
318 25,000.00 12,500.00
319 70,000.00 35,000.00
320 15,000.00 10,000.00 7,500.00
321 40,000.00 20,000.00
322 70,000.00 35,000.00
323 15,000.00 7,500.00
324 60,000.00 10,000.00 30,000.00
325 70,000.00 35,000.00
326 30,000.00 15,000.00
327 15,000.00 10,000.00 7,500.00
328 15,000.00 7,500.00
329 30,000.00 10,000.00 15,000.00
330 15,000.00 10,000.00 7,500.00
331 30,000.00 15,000.00
332 15,000.00 10,000.00 7,500.00
333 60,000.00 10,000.00 30,000.00
334 30,000.00 15,000.00
335 35,000.00 17,500.00
336 30,000.00 15,000.00
337 70,000.00 35,000.00
338 02/17/2017 30,000.00 15,000.00
339 70,000.00 35,000.00
340 70,000.00 35,000.00
341 40,000.00 20,000.00
342 15,000.00 10,000.00 7,500.00
343 30,000.00 15,000.00
344 70,000.00 35,000.00
345 15,000.00 10,000.00 7,500.00
346 70,000.00 35,000.00
347 15,000.00 10,000.00 7,500.00
348 30,000.00 15,000.00
349 15,000.00 10,000.00 7,500.00
350 70,000.00 35,000.00
351 70,000.00 35,000.00
352 70,000.00 10,000.00 35,000.00
353 70,000.00 35,000.00
354 30,000.00 15,000.00
355 70,000.00 35,000.00
356 70,000.00 35,000.00
357 70,000.00 35,000.00
358 15,000.00 7,500.00
359 15,000.00 10,000.00 7,500.00
360 30,000.00 15,000.00
361 15,000.00 7,500.00
362 30,000.00 10,000.00 15,000.00
363 70,000.00 35,000.00
364 70,000.00 35,000.00
365 02/18/2017 15,000.00 10,000.00 7,500.00
366 15,000.00 7,500.00
367 15,000.00 7,500.00
368 70,000.00 35,000.00
369 30,000.00 15,000.00
370 30,000.00 15,000.00
371 30,000.00 15,000.00
372 15,000.00 10,000.00 7,500.00
373 40,000.00 20,000.00
374 30,000.00 15,000.00
375 70,000.00 35,000.00
376 30,000.00 15,000.00
377 40,000.00 10,000.00 20,000.00
378 70,000.00 35,000.00
379 70,000.00 10,000.00 35,000.00
380 60,000.00 30,000.00
381 30,000.00 15,000.00
382 70,000.00 35,000.00
383 30,000.00 10,000.00 15,000.00
384 15,000.00 10,000.00 7,500.00
385 15,000.00 7,500.00
386 70,000.00 35,000.00
387 70,000.00 35,000.00
388 02/20/2017 60,000.00 10,000.00 30,000.00
389 15,000.00 7,500.00
390 60,000.00 10,000.00 30,000.00
391 40,000.00 20,000.00
392 60,000.00 10,000.00 30,000.00
393 15,000.00 10,000.00 7,500.00
394 60,000.00 10,000.00 30,000.00
395 15,000.00 10,000.00 7,500.00
396 30,000.00 10,000.00 15,000.00
397 70,000.00 35,000.00
398 70,000.00 35,000.00
399 30,000.00 15,000.00
400 15,000.00 10,000.00 7,500.00
401 15,000.00 7,500.00
402 30,000.00 15,000.00
403 30,000.00 15,000.00
404 15,000.00 10,000.00 7,500.00
405 70,000.00 35,000.00
406 35,000.00 10,000.00 17,500.00
407 30,000.00 15,000.00
408 15,000.00 10,000.00 7,500.00
409 30,000.00 10,000.00 15,000.00
410 25,000.00 12,500.00
411 15,000.00 10,000.00 7,500.00
412 15,000.00 10,000.00 7,500.00
413 30,000.00 10,000.00 15,000.00
414 02/21/2017 70,000.00 35,000.00
415 70,000.00 35,000.00
416 30,000.00 15,000.00
417 40,000.00 20,000.00
418 70,000.00 35,000.00
419 70,000.00 35,000.00
420 15,000.00 7,500.00
421 15,000.00 7,500.00
422 30,000.00 15,000.00
423 30,000.00 10,000.00 15,000.00
424 70,000.00 35,000.00
425 15,000.00 10,000.00 7,500.00
426 70,000.00 35,000.00
427 30,000.00 15,000.00
428 70,000.00 35,000.00
429 60,000.00 10,000.00 30,000.00
430 30,000.00 15,000.00
431 25,000.00 10,000.00 12,500.00
432 70,000.00 35,000.00
433 70,000.00 35,000.00
434 40,000.00 20,000.00
435 30,000.00 15,000.00
436 30,000.00 15,000.00
437 30,000.00 15,000.00
438 02/22/2017 15,000.00 10,000.00 7,500.00
439 25,000.00 12,500.00
440 30,000.00 15,000.00
441 15,000.00 7,500.00
442 60,000.00 10,000.00 30,000.00
443 30,000.00 10,000.00 15,000.00
444 30,000.00 15,000.00
445 15,000.00 7,500.00
446 60,000.00 10,000.00 30,000.00
447 15,000.00 10,000.00 7,500.00
448 15,000.00 10,000.00 7,500.00
449 70,000.00 35,000.00
450 30,000.00 15,000.00
451 30,000.00 15,000.00
452 30,000.00 15,000.00
453 15,000.00 7,500.00
454 30,000.00 15,000.00
455 30,000.00 15,000.00
456 15,000.00 7,500.00
457 15,000.00 10,000.00 7,500.00
458 25,000.00 12,500.00
459 30,000.00 15,000.00
460 15,000.00 7,500.00
461 02/23/2017 30,000.00 15,000.00
462 15,000.00 10,000.00 7,500.00
463 30,000.00 15,000.00
464 30,000.00 15,000.00
465 15,000.00 10,000.00 7,500.00
466 30,000.00 15,000.00
467 30,000.00 15,000.00
468 25,000.00 12,500.00
469 15,000.00 10,000.00 7,500.00
470 70,000.00 35,000.00
471 70,000.00 35,000.00
472 70,000.00 35,000.00
473 40,000.00 20,000.00
474 40,000.00 20,000.00
475 30,000.00 10,000.00 15,000.00
476 30,000.00 15,000.00
477 60,000.00 10,000.00 30,000.00
478 30,000.00 15,000.00
479 15,000.00 10,000.00 7,500.00
480 60,000.00 10,000.00 30,000.00
481 30,000.00 15,000.00
482 60,000.00 10,000.00 30,000.00
483 40,000.00 20,000.00
484 02/24/2017 30,000.00 10,000.00 15,000.00
485 70,000.00 35,000.00
486 30,000.00 15,000.00
487 15,000.00 7,500.00
488 15,000.00 10,000.00 7,500.00
489 70,000.00 35,000.00
490 70,000.00 35,000.00
491 70,000.00 35,000.00
492 15,000.00 10,000.00 7,500.00
493 30,000.00 15,000.00
494 30,000.00 15,000.00
495 30,000.00 15,000.00
496 70,000.00 10,000.00 35,000.00
497 15,000.00 7,500.00
498 30,000.00 10,000.00 15,000.00
499 70,000.00 35,000.00
500 30,000.00 10,000.00 15,000.00
501 30,000.00 10,000.00 15,000.00
502 15,000.00 7,500.00
503 30,000.00 15,000.00
504 70,000.00 35,000.00
505 30,000.00 15,000.00
506 15,000.00 10,000.00 7,500.00
507 15,000.00 10,000.00 7,500.00
508 02/25/2017 15,000.00 10,000.00 7,500.00
509 70,000.00 35,000.00
510 40,000.00 10,000.00 20,000.00
511 30,000.00 15,000.00
512 40,000.00 20,000.00
513 25,000.00 12,500.00
514 70,000.00 35,000.00
515 15,000.00 10,000.00 7,500.00
516 70,000.00 35,000.00
517 70,000.00 35,000.00
518 30,000.00 10,000.00 15,000.00
519 30,000.00 15,000.00
520 70,000.00 35,000.00
521 15,000.00 10,000.00 7,500.00
522 30,000.00 15,000.00
523 35,000.00 17,500.00
524 25,000.00 12,500.00
525 30,000.00 15,000.00
526 70,000.00 35,000.00
527 30,000.00 15,000.00
528 02/27/2017 30,000.00 10,000.00 15,000.00
529 30,000.00 15,000.00
530 30,000.00 10,000.00 15,000.00
531 70,000.00 35,000.00
532 70,000.00 35,000.00
533 15,000.00 7,500.00
534 30,000.00 10,000.00 15,000.00
535 70,000.00 35,000.00
536 15,000.00 7,500.00
537 60,000.00 10,000.00 30,000.00
538 70,000.00 35,000.00
539 15,000.00 7,500.00
540 35,000.00 17,500.00
541 15,000.00 7,500.00
542 70,000.00 35,000.00
543 35,000.00 17,500.00
544 30,000.00 10,000.00 15,000.00
545 40,000.00 20,000.00
546 15,000.00 10,000.00 7,500.00
547 70,000.00 35,000.00
548 70,000.00 35,000.00
549 30,000.00 10,000.00 15,000.00
550 40,000.00 20,000.00
551 30,000.00 15,000.00
552 30,000.00 10,000.00 15,000.00
553 25,000.00 12,500.00
554 70,000.00 35,000.00
555 15,000.00 7,500.00
556 70,000.00 35,000.00
557 70,000.00 35,000.00
558 15,000.00 10,000.00 7,500.00
559 15,000.00 10,000.00 7,500.00
560 70,000.00 35,000.00
561 15,000.00 10,000.00 7,500.00
562 70,000.00 35,000.00
563 70,000.00 35,000.00
564 70,000.00 35,000.00
565 15,000.00 10,000.00 7,500.00
566 40,000.00 20,000.00
567 35,000.00 17,500.00
568 15,000.00 10,000.00 7,500.00
569 15,000.00 10,000.00 7,500.00
570 25,000.00 12,500.00
571 15,000.00 10,000.00 7,500.00
572 70,000.00 35,000.00
573 15,000.00 7,500.00
574 30,000.00 15,000.00
575 70,000.00 35,000.00
576 70,000.00 35,000.00
577 15,000.00 7,500.00
578 70,000.00 35,000.00
579 35,000.00 10,000.00 17,500.00
580 25,000.00 10,000.00 12,500.00
581 15,000.00 10,000.00 7,500.00
22,675,000 1,840,000 11,337,500
I
ALAT &
JML KET
BAHAN
10,000 25,000
125,000 255,000
150,000 305,000
40,000 85,000
175,000 355,000
125,000 255,000
25,000 55,000
40,000 85,000
75,000 155,000
10,000 25,000
10,000 25,000
40,000 85,000
40,000 85,000
10,000 25,000
40,000 85,000
30,000 65,000
50,000 105,000
40,000 85,000
10,000 25,000
50,000 105,000
10,000 25,000
25,000 55,000
25,000 55,000
125,000 255,000
10,000 25,000
40,000 85,000
25,000 55,000
50,000 105,000
90,000 185,000
125,000 255,000
10,000 25,000
10,000 25,000
125,000 255,000
40,000 85,000
60,000 125,000
100,000 205,000
125,000 255,000
10,000 25,000
10,000 25,000
50,000 105,000
10,000 25,000
2,170,000 4,545,000
ESEHATAN
ALAT &
JML KET
BAHAN
20,000.00 40,000.00
12,500.00 25,000.00
15,000.00 30,000.00
30,000.00 70,000.00
35,000.00 70,000.00
7,500.00 25,000.00
15,000.00 30,000.00
20,000.00 40,000.00
15,000.00 30,000.00
12,500.00 25,000.00
7,500.00 15,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
12,500.00 25,000.00
12,500.00 35,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
35,000.00 70,000.00
7,500.00 25,000.00
7,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 40,000.00
35,000.00 70,000.00
20,000.00 40,000.00
7,500.00 25,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
20,000.00 40,000.00
15,000.00 40,000.00
12,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
20,000.00 40,000.00
17,500.00 35,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 80,000.00
12,500.00 25,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
20,000.00 40,000.00
7,500.00 25,000.00
15,000.00 40,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 40,000.00
7,500.00 25,000.00
35,000.00 70,000.00
7,500.00 25,000.00
7,500.00 25,000.00
7,500.00 25,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
7,500.00 25,000.00
12,500.00 25,000.00
15,000.00 30,000.00
12,500.00 25,000.00
20,000.00 40,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
7,500.00 25,000.00
7,500.00 15,000.00
12,500.00 25,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
30,000.00 70,000.00
15,000.00 40,000.00
15,000.00 40,000.00
12,500.00 25,000.00
30,000.00 70,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 15,000.00
35,000.00 70,000.00
35,000.00 70,000.00
12,500.00 25,000.00
7,500.00 15,000.00
15,000.00 30,000.00
15,000.00 35,000.00
15,000.00 30,000.00
17,500.00 35,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
30,000.00 60,000.00
7,500.00 15,000.00
35,000.00 70,000.00
12,500.00 25,000.00
15,000.00 30,000.00
15,000.00 30,000.00
15,000.00 30,000.00
7,500.00 25,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 30,000.00
7,500.00 15,000.00
7,500.00 25,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 40,000.00
15,000.00 30,000.00
35,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
7,500.00 25,000.00
15,000.00 30,000.00
20,000.00 40,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 80,000.00
35,000.00 70,000.00
15,000.00 40,000.00
35,000.00 70,000.00
15,000.00 40,000.00
17,500.00 35,000.00
15,000.00 40,000.00
12,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
30,000.00 70,000.00
7,500.00 25,000.00
15,000.00 40,000.00
20,000.00 40,000.00
35,000.00 70,000.00
35,000.00 70,000.00
35,000.00 70,000.00
7,500.00 15,000.00
15,000.00 40,000.00
7,500.00 15,000.00
30,000.00 70,000.00
7,500.00 25,000.00
30,000.00 70,000.00
15,000.00 40,000.00
35,000.00 80,000.00
30,000.00 70,000.00
30,000.00 70,000.00
30,000.00 70,000.00
7,500.00 25,000.00
30,000.00 70,000.00
15,000.00 30,000.00
7,500.00 25,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 70,000.00
15,000.00 30,000.00
15,000.00 40,000.00
15,000.00 30,000.00
15,000.00 30,000.00
35,000.00 70,000.00
35,000.00 80,000.00
7,500.00 25,000.00
15,000.00 40,000.00
7,500.00 25,000.00
7,500.00 25,000.00
35,000.00 70,000.00
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12,500.00 35,000.00
7,500.00 25,000.00
11,337,500 24,520,000 -

LAp Kunjungan PX Gigi FEBRUARI 20177

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LAPORAN KUNJUNGAN PASIEN GIGI

PERIODE APRIL 2007

JASA ALAT &

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

4 30/4/07 Insentif drg. Sonya 250,000

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI APRIL 2007

Cimahi, 5 Mei 2007

Drg. Dewi Muntiatun

dr. H. Pandith. A. Arismunandar, MM

JASA ALAT &

JASA ALAT &

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI MEI 2007

Cimahi, 5 Juni 2007

Drg. Dewi Muntiatun

dr. H. Pandith. A. Arismunandar, MM

JASA ALAT &

JASA ALAT &

PENGELUARAN JUNI 2007

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI JUNI 2007

Cimahi, 3 Juli 2007

Drg. Dewi Muntiatun

dr. H. Pandith. A. Arismunandar, MM

JASA ALAT &

LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA

JASA ALAT &

PENGELUARAN JULI 2007

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI JULI 2007

Cimahi, 3 Agustus 2007

Drg. Dewi Muntiatun

dr. H. Pandith. A. Arismunandar, MM

JASA ALAT &

LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA

PENGELUARAN AGUSTUS 2007

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI AGUSTUS 2007

Cimahi, 5 September 2007

Drg. Dewi Muntiatun

dr. H. Pandith. A. Arismunandar, MM

JASA ALAT &

LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA

JASA ALAT &

PENGELUARAN SEPTEMBER 2007

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI SEPTEMBER 2007

Cimahi, 5 Oktober 2007

dr. H. Pandith. A. Arismunandar, MM

LAPORAN KUNJUNGAN PASIEN GIGI

JASA ALAT &

JASA ALAT &

PENGELUARAN OKTOBER 2007

NO TGL NAMA OBAT & BAHAN QTY JUMLAH

PENERIMAAN DAN PENGELUARAN ALAT BAHAN POLI GIGI OKTOBER 2007

Cimahi, 2 November 2007

Siti Nur Yulia Drg. Dewi Muntiatun

dr. H. Pandith. A. Arismunandar, MM

LAPORAN KUNJUNGAN PASIEN GIGI

JASA ALAT &

LAPORAN KUNJUNGAN PASIEN GIGI MEDIKA

JASA ALAT &

PENGELUARAN NOVEMBER 2007