FORM DATA KLAIM FKTP

NAMA FKTP BULAN JUMLAH NOMINAL TANGGAL

JENIS KLAIM NO FPK
(PUSKESMAS) PELAYANAN KLAIM BIAYA PENGAJUAN
SANGKUB RITP 4 Rp 1,920,000 P1906000044144
JUNI 2019
PERSALINAN 1 Rp 700,000 P1906000044146

RITP 12 Rp 3,240,000 P1907000036139

PERSALINAN JULI 2019 2 Rp 1,400,000 P1907000036855
ANC//PNC 3 Rp 650,000 P1907000036856

RITP 9 Rp 1,680,000 P1909000061433

PERSALINAN SEP 2019 2 Rp 1,400,000 P1909000061501 2/3/2020
ANC/PNC 6 Rp 300,000 P1909000061502

RITP 2 Rp 360,000 P1910000056455

PERSALINAN OKT 2019 2 Rp 1,400,000 P1910000056526 2/3/2020
ANC/PNC 7 Rp 350,000 P1910000056527

PERSALINAN 1 Rp 700,000 P1911000051999

NOV 2019
ANC/PNC 7 Rp 350,000 P1911000052000 2/3/2020

PERSALINAN 3 Rp 2,100,000 P1912000045083

DES 2019 2/3/2020
ANC/PNC 7 Rp 350,000 P1912000045084

RITP 13 Rp 2,280,000 P2001000037496

PERSALINAN JAN 2020 3 Rp 2,100,000 P2001000038294 2/3/2020
PNC 6 Rp 300,000 P2001000038297

RITP 15 Rp 3,960,000 P2002000038928

PERSALINAN FEB 2020 1 Rp 700,000 P2002000038930 26/3/2020
AMBULANS 2 Rp 1,344,000 P2002000039068

RITP 10 Rp 2,160,000 P2003000007691

PERSALINAN 2 Rp 1,400,000 P2003000007692
MARET 2020 8/4/2020
AMBULANS 2 Rp 1,344,000 P2003000007684
ANC/PNC 3 Rp 150,000 P2003000007681

RITP 4 Rp 720,000 P2004000028717

AMBULANS APRIL 2020 2 Rp 1,344,000 P2004000028718 5/6/2020
ANC 2 Rp 100,000 P2004000028719

RITP 3 Rp 480,000 P2005000003707

MEI 2020 5/6/2020
AMBULANS 1 Rp 672,000 P2005000003709

Kepala Puskesmas Sangkub

Yunitha Pontoh, SKM, M.Kes

NIP: 19810614 200701 2 008