DAFTAR PENERIMAAN JASA PELAYANAN KESEHATAN PUSKESMAS CIKAKAK

PADA BULAN : Maret 2020

JUMLAH NOMINAL 117,687,047

kinerja Variab
jasa point kinerja manajemen peningk status masa kehad hari el total jasa pelayanan
NO nama NIP point flat flat jasa tambahan jumlah penerimaan Pajak Jumlah diterima TANDA TANGAN
dasar ketenagaan umum blud atan pegawai kerja iran kerja Lainny poin khusus
mutu a

1 dr. Suhartono 197809032009041002 6 6 5,748,991 150 110 700,000 11 100 11 25 25 24 431 1,442,604 3,119,214 11,010,810 1,651,621 9,359,188 1
2 Dedeh Kartina 196408041986032015 1.65 1.65 1,580,973 48 15 60 34 24 25 21 202 676,116 2,257,089 112,854 2,144,234 2
3 Harnasih,Am.Keb 197010231990032003 1.65 1.65 1,580,973 57.6 66 6 60 30 24 25 27 270.6 905,728 2,486,700 124,335 2,362,365 3
4 Tarliah,Am.Keb 196806051989032007 1.65 1.65 1,580,973 55.2 46 60 31 23 25 23 238.2 797,281 2,378,254 118,913 2,259,341 4
5 Hj.Nurfasihah,Am.Keb 196908291990032004 1.65 1.65 1,580,973 60 15 60 30 25 25 39 229 766,488 2,347,460 117,373 2,230,087 5
6 Hj.Nafsiatun,SST 197109121993012001 1.65 1.65 1,580,973 80 15 60 27 25 25 37 244 816,695 2,397,667 119,883 2,277,784 6
7 Marsini,SKM 197507242000032003 1.65 1.65 1,580,973 70.4 61 175,000 60 20 22 25 37 270.4 905,058 2,661,031 133,052 2,527,979 7
8 H.TawabS.Kep. 197306201998031005 1.25 1.25 1,197,707 50 15 60 22 25 25 4 176 589,091 - 1,786,798 89,340 1,697,458 8
9 Siti Maesaroh,SST 197411132007012009 1.65 1.65 1,580,973 80 19 60 25 25 25 25 234 783,223 2,364,196 118,210 2,245,986 9
10 Sri Lilya Susanti,SST 198007032008012008 1.65 1.65 1,580,973 76.8 19 60 15.9 24 25 40 235.7 788,914 2,369,886 118,494 2,251,392 10
11 Taufik Himawan,Am.F 198508102010011024 1.65 1.65 1,580,973 60 36 150,000 6 60 10 25 25 36 233 779,876 142,430 2,653,279 132,664 2,520,615 11
12 Erwan Munandar,SST 198510102010011017 1.65 1.65 1,580,973 76.8 15 8 60 10 24 25 23 216.8 725,653 21,100 2,327,726 116,386 2,211,339 12
13 Sri Yuliati Andayani,SST 196507282006042001 1.65 1.65 1,580,973 60.8 15 60 26 19 25 27 207.8 695,529 2,276,502 113,825 2,162,677 13
14 Nur Rohmah,Am.Keb 197207102006042018 1.65 1.65 1,580,973 60 19 60 26 25 25 40 230 769,835 2,350,808 117,540 2,233,267 14
15 Sri Murtini,Am.Keb 197406032006042015 1.65 1.65 1,580,973 60 15 20 26 25 25 34 180 602,480 2,183,452 2,183,452 15
16 Hamidah,Am.Keb 197508132007012009 1.65 1.65 1,580,973 60 19 20 25 25 25 37 186 622,562 2,203,535 2,203,535 16
17 Ropiah,Am.Keb 197505252008012004 1.65 1.65 1,580,973 60 15 60 18 25 25 38 216 722,975 2,303,948 115,197 2,188,751 17
18 Aan Daryanti,Am.K 197907072014092001 1.65 1.65 1,580,973 73.6 5 20 18 23 25 19 158.6 530,851 640,107 2,751,931 2,751,931 18
19 Eva Marini,Am.Keb 198609182017042004 1.65 1.65 1,580,973 60 15 20 14.6 25 25 27 161.6 540,893 2,121,865 2,121,865 19
20 Urip Sri Rahayu 198106122014092001 1.65 1.65 1,580,973 76.8 5 20 18.6 24 25 37 181.4 607,166 2,188,138 2,188,138 20
21 Andhy Kusuma W 199211302019031006 1.65 1.65 1,580,973 57.6 19 20 1 24 25 23 144.6 483,992 868,100 2,933,065 2,933,065 21
22 Dwi Harwati 19881122219032009 1.65 1.65 1,580,973 48 15 20 1 20 25 9 113 378,223 1,959,196 1,959,196 22
23 Umi Salamah 198005202019052004 1.65 1.65 1,580,973 57.6 15 20 16 24 25 31 163.6 547,587 2,128,560 2,128,560 23
24 Sodik L 196301041986121002 1.25 1.25 1,197,707 18 15 60 34 18 25 31 176 589,091 1,786,798 89,340 1,697,458 24
25 H.T o t o 196309071988031009 1.25 1.25 1,197,707 25 15 60 32 25 25 36 193 645,992 1,843,698 92,185 1,751,514 25
26 Kamim 196304171991031003 1.25 1.25 1,197,707 25 30 150,000 60 29 25 25 46 215 719,628 85,458 2,152,793 107,640 2,045,153 26
27 Euis Widaningsih 196808111992032006 1.25 1.25 1,197,707 25 54 175,000 60 28 25 25 42 234 783,223 85,458 2,241,388 112,069 2,129,318 27
28 Casipan 196409081987031008 1.25 1.25 1,197,707 25 40 60 33 25 25 47 230 769,835 1,967,542 98,377 1,869,164 28
29 Sahrudi 196915062007011021 1.25 1.25 1,197,707 24 5 20 15 24 25 32 120 401,653 85,458 1,684,817 1,684,817 29
30 Wahyo K2 0.5 0.5 479,083 15 20 5 22 25 25 46 133 445,165 170,916 1,095,164 1,095,164 30
31 Toni Wartoni K2 0.5 0.5 479,083 15 5 5 19 25 25 35 104 348,099 170,916 998,098 998,098 31
32 Sukilah,Am.Kep K2 0.5 0.5 479,083 14.4 5 5 19 24 25 26 93.4 312,620 791,703 791,703 32
33 Heni Marlinah,Am.Kep BLUD 0.5 0.5 479,083 15 30 5 15 25 25 28 118 394,959 874,041 874,041 33
34 Ahmad Am.Kep BLUD 0.5 0.5 479,083 13.2 15 5 15 22 25 30 100.2 335,380 814,463 814,463 34
35 dr. Nur Asiyah BLUD 1.25 1.25 1,197,707 13.2 31 5 3 22 25 8 82.2 275,132 3,660,448 5,133,287 5,133,287 35
36 dr. Ayu Fitrotun Nisa BLUD 1.25 1.25 1,197,707 12 15 5 0.8 20 25 14 66.8 223,587 1,025,495 2,446,789 2,446,789 36
37 Leli Marlinah BLUD 0.4 0.4 383,266 14.4 5 5 4.5 24 25 0 52.9 177,062 560,328 560,328 37
38 Nia Agus Farida BLUD 0.4 0.4 383,266 13.2 9 5 4.5 22 25 5 58.7 196,475 227,888 807,629 807,629 38
39 Sifa Fauziyah BLUD 0.4 0.4 383,266 15 15 5 4.5 25 25 17 81.5 272,789 656,055 656,055 39
40 Tati Hartati BLUD 0.4 0.4 383,266 0 0 0 5 4.5 0 25 0 9.5 31,798 415,064 415,064 40
41 Dahliati BLUD 0.4 0.4 383,266 13.8 5 5 4.5 23 25 0 51.3 171,707 554,973 554,973 41
42 Linda Amalia C BLUD 0.4 0.4 383,266 13.8 15 5 4.5 23 25 5 66.3 221,913 113,944 719,123 719,123 42
43 Widya Dian Permani BLUD 0.4 0.4 383,266 13.8 5 5 4.5 23 25 0 51.3 171,707 554,973 554,973 43
44 Lilis Samrotul Fuadah BLUD 0.4 0.4 383,266 13.8 5 5 3.9 23 25 0 50.7 169,698 552,964 552,964 44
45 Niken Isnaeni H R BLUD 0.4 0.4 383,266 13.2 5 5 4.5 22 25 5 54.7 183,087 566,353 566,353 45
 kinerja Variab
NO nama NIP point flat jasa flat point kinerja manajemen peningk status masa kehad hari el total jasa tambahan jasa pelayanan jumlah penerimaan Pajak Jumlah diterima TANDA TANGAN
dasar ketenagaan umum blud atan pegawai kerja iran kerja Lainny poin khusus
mutu a

46 Cipta Nurjanah BLUD 0.4 0.4 383,266 13.8 5 5 4.5 23 25 0 51.3 171,707 113,944 668,917 668,917 46
47 Solidah BLUD 0.4 0.4 383,266 13.2 5 5 4.5 22 25 12 61.7 206,517 782,537 1,372,320 1,372,320 47
48 Ade Wahyudin BLUD 0.4 0.4 383,266 13.8 5 5 4.5 23 25 18 69.3 231,955 640,107 1,255,328 1,255,328 48
49 Asep Kurniawan BLUD 0.4 0.4 383,266 13.8 9 5 4.5 23 25 18 73.3 245,343 640,107 1,268,716 1,268,716 49
50 Hermawan Fuady BLUD 0.4 0.4 383,266 12.6 30 9 5 4.5 21 25 32 114.1 381,905 867,995 1,633,166 1,633,166 50
51 ELOK TRI S BLUD 0.4 0.4 383,266 13.8 5 5 2.1 23 25 18 66.9 223,922 640,107 1,247,295 1,247,295 51
52 Wulan Oktavia S BLUD 0.4 0.4 383,266 14.4 15 5 2.1 24 25 33 93.5 312,955 - 696,221 696,221 52
53 Titin Tri Murtini BLUD 0.4 0.4 383,266 13.8 5 5 4.5 23 25 12 63.3 211,872 640,107 1,235,245 1,235,245 53
54 Maulana Egy Prayoga BLUD 0.35 0.35 335,358 14.4 20 5 4.5 24 25 28 95.9 320,988 656,346 656,346 54
55 Sukeri BLUD 0.35 0.35 335,358 15 5 5 4.5 25 25 40 94.5 316,302 651,660 651,660 55
56 Rica Erlina Afriyani BLUD 0.4 0.4 383,266 6.9 15 5 0.3 23 25 36 86.2 288,521 142,430 814,217 814,217 56
57 Siti Aminah BLUD 0.4 0.4 383,266 13.8 19 5 3 23 25 12 75.8 253,711 868,100 1,505,077 1,505,077 57
58 Dede Supriatna BLUD 0.35 0.35 335,358 15 48 150,000 8 5 2 25 25 38 141 471,942 957,300 957,300 58
59 Hernawati BLUD 0.4 0.4 383,266 14.4 5 5 3.7 24 25 0 52.1 174,384 557,650 557,650 59
60 Caslam PHL 0.3 0.3 287,450 7.5 5 3 3 25 25 7 50.5 169,029 113,944 570,422 570,422 60
61 Danang PHL 0.3 0.3 287,450 7.5 5 3 2.5 25 25 9 52 174,050 461,499 461,499 61
62 Amin PHL 0.3 0.3 287,450 7.2 5 3 2 24 25 30 71.2 238,314 525,764 525,764 62
63 Oktaviyani PHL 0.3 0.3 287,450 7.5 19 6 3 2.3 25 25 31 93.8 313,959 - 601,408 601,408 63
64 Meina Wulan PHL 0.3 0.3 287,450 6.6 23 150,000 3 2.1 22 25 14 70.7 236,641 674,090 674,090 64
65 Uun Baedah PHL 0.3 0.3 287,450 7.2 5 3 2.1 24 25 33 74.3 248,690 536,140 536,140 65
66 Sukiah PHL 0.3 0.3 287,450 7.5 5 3 3 25 25 13 56.5 189,112 113,944 590,505 590,505 66
67 Hadis Tohandi BLUD 0.4 0.4 383,266 5.4 30 3 3 18 25 4 63.4 212,207 595,473 595,473 67
68 Dwi Sepriatna BLUD 0.4 0.4 383,266 7.2 5 3 1 24 25 23 63.2 211,537 640,107 1,234,911 1,234,911 68
69 Wihayati PHL 0.3 0.3 287,450 7.5 5 3 1 25 25 17 58.5 195,806 113,944 597,199 597,199 69
70 Wiwin Winaeni PHL 0.3 0.3 287,450 7.2 5 3 1 24 25 39 79.2 265,091 552,541 552,541 70
71 Wiharti PHL 0.3 0.3 287,450 7.5 13 3 1 25 25 39 88.5 296,219 583,669 583,669 71
72 Nanda Fahlepi PHL 0.3 0.3 287,450 7.2 5 3 1 24 25 25 65.2 218,231 640,107 1,145,788 1,145,788 72
73 Waeti PHL 0.3 0.3 287,450 7.5 5 3 1 25 25 10 51.5 172,376 113,944 573,770 573,770 73
74 Chelly S.V PHL 0.3 0.3 287,450 7.2 15 3 0.2 24 25 30 79.4 265,760 553,210 553,210 74
75 Depi Yunia A. PHL 0.3 0.3 287,450 7.5 19 3 0.2 25 25 44 98.7 330,360 617,809 617,809 75
76 Tina Sahrina PHL 0.3 0.3 287,450 6.9 5 3 0.1 23 25 26 64 214,215 501,665 501,665 76
77 Cici Rahmawati PHL 0.4 0.4 383,266 7.2 5 3 0.1 24 25 23 62.3 208,525 591,791 591,791 77
JUMLAH 69.15 69.15 66,257,124 1,650,000 1825 9647.6 32,291,566 17,488,357 117,687,047 3,799,299 113,887,748
9647.6
jumlah flat 66,257,124 97123577
jumlah point flat 958,165 17,488,357
JUMLAH TAMBAHAN 51,429,923 : 91,657,641 Cikakak, Maret 2020
JUMLAH MANAJEMEN 1,650,000 Kepala Puskesmas Cikakak
JASA RESIKO 17,488,357
poin jasa tambahan 32,291,566
nilai 1 point 3,347 dr. SUHARTONO,SH
NIP. 19780903 200904 1 002
 umum 16,723,953

pencairan 40,248,000

Perhitungan jasa pelayanan khusus

rawat inap =
pendapatan 56,971,953
umum + klaim
bpjs
manajemen 2,848,598 nama- nama yang tertera disesuaikan dengan sk
dr Suhartono 341,832 12
Hermawan 227,888 8
dr Ayu F 170,916 6
dr. Nur Asiyah 170,916 6
Rica 142,430 5
Nia Ag 227,888 8
Taufik 142,430 5
Solidah 142,430 5
Wihayati 113,944 4
Waeti 113,944 4
Caslam 113,944 4
Sahrudi 85,458 3
Wahyo 170,916 6
Linda Ac 113,944 4
Cipta N 113,944 4
Euis W 85,458 3
Kamim 85,458 3
Toni 170,916 6
Sukiah 113,944 4
- 0

2,848,598 100

dokter 7,121,494 ada 3 dokter yang visit

dr. Suhartono 39 2,777,383
dr.Nur Asiyah 49 3,489,532
dr.Ayu Fitotun nisa 12 854,579
7,121,494

paramedis / pera 5,697,195 jika ada 9 orang

per orang 633,022

Hermawan 640,107 633,022

Ade Wahyudi 640,107 633,022
Asep Kurniawan 640,107 633,022
Nanda F 640,107 633,022
Dwi Sepriatna 640,107 633,022
Solidah 640,107 633,022
Elok 640,107 633,022
Aan Daryanti 640,107 633,022
Perhitungan jasa pelayanan khusus
rawat inap =
pendapatan 56,971,953
umum + klaim
bpjs
Titin Tri M 640,107 633,022
5,697,195

analis 10% umum 10,423,000

bpjs 6,939,000
1,736,200 17,362,000
Siti Aminah 868,100 50 868,100
Andhy Kusuma W 868,100 50 868,100
MPM umum 63,770 MPM 637,700
7,086

GIGI umum 211,000

Erwan BPJS 0
BPJS -
10% 21,100

haji 50%
-

kepala Puskesmas 3 - dr. SUHARTONO

PJ 1 - TAWAB
Pemeriksa 2 - dr. Nurasiyah
promkes 1 - Oktaviyani
pemeriksa 1 - Wulan Okta
Lab 1 - Andhy
1 - Ami
- -

jumlah total jasa khusus

17,488,357 -
- 17,488,357

117,687,047

17,488,357 - 17,488,357
 FORMAT JASPEL PUSKESMAS CIKAKAK BULAN JANUARI 2020
NO NAMA NIP JABATAN JENIS ETENAGAAN
1 dr. Suhartono 197809032009041002 Ka Puskesmas PNS
2 Dedeh Kartina 196408041986032015 Pelk Perawat PNS
3 Harnasih,Am.Keb 197010231990032003 Pelk Bidan PNS
4 Tarliah,Am.Keb 196806051989032007 Pelk Bidan PNS
5 Hj.Nurfasihah,Am.Keb 196908291990032004 Pelk Bidan PNS
6 Hj.Nafsiatun,SST 197109121993012001 Pelk Bidan PNS
7 Marsini,SKM 197507242000032003 Pelk Perawat PNS
8 H.TawabS.Kep. 197306201998031005 Pelk Perawat PNS
9 Siti Maesaroh,SST 197411132007012009 Pelk Bidan PNS
10 Sri Lilya Susanti,SST 198007032008012008 Pelk Bidan PNS
11 Taufik Himawan,Am.F 198508102010011024 Ass Apoteker PNS
12 Erwan Munandar,AmKG 198510102010011017 Prwt Gigi PNS
13 Sri Yuliati Andayani,SST 196507282006042001 Pelk Bidan PNS
14 Nur Rohmah,Am.Keb 197207102006042018 Pelk Bidan PNS
15 Sri Murtini,Am.Keb 197406032006042015 Pelk Bidan PNS
16 Hamidah,Am.Keb 197508132007012009 Pelk Bidan PNS
17 Ropiah,Am.Keb 197505252008012004 Pelk Bidan PNS
18 Aan Daryanti,Am.K 197907072014092001 Perawat PNS
19 Eva Marini,Am.Keb 198609182017042004 Pelk Bidan PNS
20 Urip Sri Rahayu 198106122014092001 Perawat PNS
21 Andhy Kusuma W 199211302019031006 Analis CPNS
22 Dwi Harwati 19881122219032009 Kesling CPNS
23 Umi Salamah 198005202019052004 Pelk Bidan CPNS
24 Sodik L 196301041986121002 Administrasi PNS
25 H.T o t o 196309071988031009 Administrasi PNS
26 Kamim 196304171991031003 Administrasi PNS
27 Euis Widaningsih 196808111992032006 Administrasi PNS
28 Casipan 196409081987031008 Administrasi PNS
29 Sahrudi 196915062007011021 Administrasi PNS
30 Wahyo K2 Staf K2
31 Toni Wartoni K2 Staf K2
32 Sukilah,Am.Kep K2 Perawat K2
33 Heni Marlinah,Am.Kep BLUD Perawat BLUD
34 Ahmad Am.Kep BLUD Perawat BLUD
35 dr. Nur Asiyah BLUD Dokter Umum BLUD
36 dr. Ayu Fitrotun Nisa BLUD Dokter Umum BLUD
37 Leli Marlinah BLUD Bidan BLUD
38 Nia Agus Farida BLUD Bidan BLUD
39 Sifa Fauziyah BLUD Bidan BLUD
40 Tati Hartati BLUD Bidan BLUD
41 Dahliati BLUD Bidan BLUD
42 Linda Amalia C BLUD Bidan BLUD
43 Widya Dian Permani BLUD Bidan BLUD
44 Lilis Samrotul Fuadah BLUD Bidan BLUD
45 Niken Isnaeni BLUD Bidan BLUD
46 Cipta Nurjanah BLUD Bidan BLUD
47 Solidah BLUD Perawat BLUD
48 Ade Wahyudin BLUD Perawat BLUD
49 Asep Kurniawan BLUD Perawat BLUD
50 Hermawan Fuady BLUD Perawat BLUD
51 ELOK TRI S BLUD Perawat BLUD
52 Wulan Oktavia S BLUD Perawat BLUD
53 Titin Tri M BLUD Perawat BLUD
54 Maulana Egy Prayoga BLUD Administrasi BLUD
55 Sukeri BLUD Pramu KANTOR BLUD
56 Rica Erlina Afriyani PHL Apoteker BLUD
57 Siti Aminah BLUD Analis BLUD
58 Dede Supriatna BLUD Akuntan BLUD
59 Hernawati BLUD Bidan BLUD
60 Caslam PHL satpam PHL
61 Danang PHL Administrasi PHL
62 Amin PHL Administrasi PHL
63 Oktaviyani PHL Promkes PHL
64 Meina Wulan PHL Administrasi PHL
65 Uun Baedah PHL Administrasi PHL
66 Sukiah PHL Pramusaji PHL
67 Hadis Tohandi PHL Perawat PHL
68 Dwi Sepriatna PHL Perawat PHL
69 Wihayati PHL Pramusaji PHL
70 Wiwin Winaeni PHL Administrasi PHL
71 Wiharti PHL Administrasi PHL
72 Nanda Fahlepi PHL Perawat PHL
73 Waeti PHL Pramu KANTOR PHL
74 Chelly S. V. PHL Reka Medis PHL
75 Depi Yunia Aa. PHL Gizi PHL
76 Tina sahrina PHL Perawat PHL
77 Cici Rahmawati BLUD Bidan BLUD
JUMLAH
AN JANUARI 2020
NO REKENING JUMLAH DITERIMA
3-028-10353-0 9,359,188
3-028-10475-7 2,144,234
3-028-10472-2 2,362,365
3-028-10478-1 2,259,341
3-028-10469-2 2,230,087
3-126-03839-8 2,277,784
3-028-10488-9 2,527,979
3-028-10510-9 1,697,458
3-028-10489-7 2,245,986
3-028-10464-1 2,251,392
3-028-10479-0 2,520,615
3-028-10480-3 2,211,339
3-028-10468-4 2,162,677
3-028-10462-5 2,233,267
3-028-10492-7 2,183,452
3-028-10465-0 2,203,535
3-028-10466-8 2,188,751
3-028-17052-1 2,751,931
3-028-21631-8 2,121,865
3-028-17384-8 2,188,138
3-070-17370-0 2,933,065
3-126-10139-1 1,959,196
3-126-10197-9 2,128,560
3-028-10476-5 1,697,458
3-028-10487-1 1,751,514
3-028-10473-1 2,045,153
3-028-10481-1 2,129,318
3-028-10477-3 1,869,164
3126070208 1,684,817
3-126-09907-9 1,095,164
3-126-09905-2 998,098
3-126-09906-1 791,703
3126103751 874,041
3126103777 814,463
3126103742 5,133,287
2126041066 2,446,789
3126104404 560,328
3126103823 807,629
3126103912 656,055
3126103891 415,064
3126103840 554,973
3126103874 719,123
3126103866 554,973
3126103815 552,964
3126103807 566,353
3126103904 668,917
3126103858 1,372,320
3126104021 1,255,328
3126103793 1,268,716
3126103947 1,633,166
3126105915 1,247,295
3126105613 696,221
3126103971 1,235,245
3126103955 656,346
3126103939 651,660
3126114841 814,217
3126104005 1,505,077
3126108167 957,300
3126101561 557,650
3126103882 570,422
3126105893 461,499
3126105907 525,764
3126104463 601,408
3126105877 674,090
3126105885 536,140
3126103831 590,505
3126102592 595,473
3126110072 1,234,911
3126110412 597,199
3126112644 552,541
3126109848 583,669
3126112717 1,145,788
3126113187 573,770
3126119223 553,210
3126119215 617,809
3126123972 501,665
3126102703 591,791
113,887,748