FORMAT PENILAIAN KINERJA TENAGA KESEHATAN

PADA PUSKESMAS KERONGKONG BULAN DESEMBER 2018

INDIKATOR KINERJA (Total skor indikator 100)
Bobot penilaian kinerja 40%
PELAKSANAAN TUGAS (25) PRODUKTIVITAS (75) NILAI
Sikap & Perilaku Kerja KINERJA
NO NAMA Kerjasama (10) kelengkapan JUMLAH
(15) data
(Jml x
Capaian 40/100)
Tangg Moti advokasi & Hub. pelaksanaan
Loya kegiatan (60)
jawab vasi koordinasi Harmonis Kegiatan
litas (5) (15)
(5) (5) (5) (5)
1 Abdul Mu'in,S.Kep 3 3 3 3 5 30 5 52 20.8
2 Wahyuni Kunayarti,S.Gz.MPH. 5 5 5 5 5 60 15 100 40
3 Irish Arisandi,SP 5 5 5 5 5 60 15 100 40
4 Haryani, A.Md.Kep 3 3 5 3 3 40 10 67 26.8
5 drg. Ni Made Suardi 5 5 5 5 5 50 15 90 36
6 Bq. Mahyuni 5 5 5 5 5 40 10 75 30
7 Hj. Kusmiati, S.S.T 3 3 3 3 5 40 10 67 26.8
8 Junaidi 5 5 5 5 5 40 10 75 30
9 Subhi,S.Kep 5 5 5 5 5 30 15 70 28
10 Rehan Bakti, A.Md.Keb 3 3 3 3 3 40 10 65 26
11 Rohyatul Ain,A.Md.Keb 3 3 3 3 3 30 10 55 22
12 L. Taswir. S.Kep 5 5 5 5 5 60 15 100 40
13 L. Sahri 5 5 5 5 5 40 10 75 30
14 Warda Ningsih,Amd.Keb 5 5 5 5 5 40 10 75 30
15 Mariana Ulfaini, SKM 5 5 4 5 5 40 10 74 29.6
16 Saruni, A.Md.G 5 5 5 5 5 50 10 85 34
17 Farida Herlina, S.Kep 4 4 3 4 5 30 10 60 24
18 Tajudin Noor,S.IP 4 4 3 3 5 30 15 64 25.6
19 Bq. Nurida Marliana,S.Kep.Ns 3 3 5 3 3 40 10 67 26.8
20 Henny Puji Astuti, S.Kep 5 5 5 5 5 50 15 90 36
21 Husniati, A.M.Kl 3 3 3 5 3 50 10 77 30.8
22 Astuti Zamroni, Amd.A.K 5 5 5 5 5 50 15 90 36
23 Uluwaturrakyi, Amd.Kep 3 5 3 5 5 35 10 66 26.4
24 Baiq Maulida Maya Sanggu,Amd.Keb 5 3 5 5 5 40 15 78 31.2
25 Sri Husniati, Amd.Kep 5 5 5 5 5 30 10 65 26
26 H. Mahderum 3 3 5 3 3 30 5 52 20.8
27 Murni Nurhayati, Amd.Kep 3 3 3 3 3 30 5 50 20
28 Zulfitri,S.Kep 3 3 5 3 5 30 10 59 23.6
29 Suffi Siska Marlinda,S.Ap 5 5 4 5 5 40 15 79 31.6
30 Buhaeriadi 3 3 5 3 3 30 5 52 20.8
31 Yusuf 3 3 3 3 3 30 5 50 20
32 Baiq Mislah, Amd.Kep 3 3 3 3 5 30 5 52 20.8
33 Yuli Ernaningsih, Amd.Keb 5 5 5 5 5 40 10 75 30
34 Nurul Aini, A.Md.Keb 3 5 5 5 5 40 10 73 29.2
35 Candra Hidayati, AMKL 5 5 5 5 5 30 10 65 26
36 Bq. Jayanti Rita H. Amd.Kep 5 5 5 5 5 50 15 90 36
37 Haziz Habib'an, AMKG 5 5 5 5 5 50 15 90 36
38 Kamariah 5 5 5 5 5 50 15 90 36
39 Sri Susilawati H, Amd.Keb 5 5 5 5 5 50 15 90 36
40 Nasiratun Nisa, A.Md.Keb 5 5 5 5 5 40 10 75 30
41 Baiq Laila Febriana,Amd.Keb 3 3 5 3 5 40 10 69 27.6
42 Johareni, Amd.Keb 5 5 5 5 5 40 10 75 30
43 Harianti, A.Md.Keb 5 5 5 5 5 40 10 75 30
 INDIKATOR KINERJA (Total skor indikator 100)
Bobot penilaian kinerja 40%
PELAKSANAAN TUGAS (25) PRODUKTIVITAS (75) NILAI
Sikap & Perilaku Kerja KINERJA
NO NAMA Kerjasama (10) kelengkapan JUMLAH
(15) (Jml x
data
Capaian 40/100)
Tangg Moti advokasi & Hub. pelaksanaan
Loya kegiatan (60)
jawab vasi koordinasi Harmonis Kegiatan
litas (5) (15)
(5) (5) (5) (5)
44 Siti Hidayati, Amd.Keb 5 5 5 5 5 50 15 90 36
45 Nuny Gushak M,A.Md.Keb 5 5 5 5 5 50 15 90 36
46 ST. Srimuliati, A.Md.Keb 5 5 5 5 5 50 15 90 36
47 Nur'aini 3 3 3 3 5 40 5 62 24.8
48 Emmy Hasruniawati, Amd.Kep 3 5 5 3 5 30 5 56 22.4
49 Sri Puji Asnuriati, AMKL 4 4 4 4 5 30 10 61 24.4
50 Ilia Maida, AMKL 4 3 3 3 5 30 10 58 23.2
51 Ihsan Alwi, S.Kep.Ns 1 1 3 3 1 30 5 44 17.6
52 Sundoyo Sudarso 5 5 5 5 5 50 15 90 36
53 Muh. Rusli 5 5 5 5 5 50 15 90 36
54 Neli Rosdiana S., SKM 3 3 3 5 5 40 10 69 27.6
55 Itri Jayanti, S.Kep 5 5 3 5 5 50 10 83 33.2
56 Risdayanti, S.Kep 5 5 5 5 5 50 15 90 36
57 Rani Dwi Cahya, S.Kep 5 5 5 5 5 50 15 90 36
58 Khaerunnisah, AmdG 5 5 5 4 5 30 10 64 25.6
59 Muhammad Sulhan H, Amd.Kep 5 5 5 5 5 50 10 85 34
60 Inayatussolihah, S.Kep 5 5 5 4 5 30 10 64 25.6
61 Jihan Fitriati, S.Kep 5 5 5 4 5 40 10 74 29.6
62 Nofera Rezza Nerita, S.Kep 5 5 4 4 5 30 10 63 25.2
63 Muh. Lukmanul H,S.Kep.NS 5 5 5 5 5 50 15 90 36
64 Muhammad Salihin, Amd.Kep 3 3 3 5 5 40 10 69 27.6
65 Nurdiana, Amd.Kep 3 3 5 3 3 30 5 52 20.8
66 Nuriatul Ain, Amd.Kep 3 3 3 3 3 30 5 50 20
67 Lalu Roni Kuswandi, S.IP 5 5 5 5 5 50 15 90 36
68 Sustina Elyasani, Amd.Keb 5 5 5 3 3 40 10 71 28.4
69 L. Yanuar Hari, Amd.Kep 5 5 5 3 5 40 10 73 29.2
70 Juandi Sunantana, S.Kep.Ns 5 5 5 3 5 40 10 73 29.2
71 Ami Zaturrahmi, Amd.Ak 3 5 5 5 3 40 10 71 28.4
72 Sulihan Nur H., A.Md.Kep. 5 5 5 4 5 40 10 74 29.6
73 Sanawati, Amd.Kep 5 5 5 5 5 50 15 90 36
74 Bq. Dina Apriani, Amd.Keb 5 5 5 3 5 40 10 73 29.2
75 Irna Yuniarti, Amd.Keb 5 5 5 5 5 30 15 70 28
76 Nita Febrianti, Amd.Keb 5 5 5 5 5 50 15 90 36
77 Dini Purna Ayu, Amd.Keb 5 5 5 5 5 50 15 90 36
78 Hasna Befalia R, A.Md.Keb 4 5 4 5 5 50 10 83 33.2
79 Sari Aida Fitri, A.Md.Keb 5 5 5 5 5 40 10 75 30
80 Armita Pebriana, A.Md.Keb 5 5 5 5 5 40 10 75 30
81 Bq. Ridha Handayani, A.Md.Keb 3 3 5 3 5 40 10 69 27.6
82 Bq. Eni Kusrini, A.Md.Keb 5 5 5 3 5 40 15 78 31.2
83 Yuniarti Diah Lestari,A.Md.Keb 5 5 5 5 5 50 10 85 34
84 dr. Nurul Ahyani 5 5 5 5 5 60 15 100 40
85 dr. Edo Kristiawan N. 5 5 5 5 5 50 15 90 36
86 Baiq Suriani, Amd.Keb 5 5 5 5 5 40 10 75 30
87 Samiatul Hayati, Amd.Keb 5 3 3 4 5 40 10 70 28
88 Nirliana, Amd.Keb 5 5 3 4 3 40 10 70 28
 INDIKATOR KINERJA (Total skor indikator 100)
Bobot penilaian kinerja 40%
PELAKSANAAN TUGAS (25) PRODUKTIVITAS (75) NILAI
Sikap & Perilaku Kerja KINERJA
NO NAMA Kerjasama (10) kelengkapan JUMLAH
(15) (Jml x
data
Capaian 40/100)
Tangg Moti advokasi & Hub. pelaksanaan
Loya kegiatan (60)
jawab vasi koordinasi Harmonis Kegiatan
litas (5) (15)
(5) (5) (5) (5)
89 Widia Herlina, Amd.Keb 5 5 5 5 5 40 10 75 30
90 Fitriah, S.Kep.Ns 5 5 5 5 5 40 10 75 30
91 Hidayatullah,Amd.Keb 5 5 5 3 5 30 10 63 25.2
92 Kamariah, S.Kep.NS 5 5 5 3 5 40 10 73 29.2
93 Rizaliana, Amd.Keb 5 5 5 5 5 40 15 80 32
94 Husnul Faizah, Amd.Kep 3 3 3 5 3 40 10 67 26.8
95 Muhammad Arsani,S.Kep.NS 3 3 3 5 3 30 10 57 22.8
JUMLAH 2816.8

Kerongkong, Desember 2018

Kepala Puskesmas Kerongkong

H. Lalu Taswir, S.Kep

NIP. 19680116 198903 1 008
 PENGHITUNGAN JASA PELAYANAN PROGRAM JAMINAN KESEHATAN NASIONAL
DINAS KESEHATAN KABUPATEN LOMBOK TIMUR TAHUN 2018
PUSKESMAS : KERONGKONG
BULAN : DESEMBER 2018

PERHITUNGAN VARIABEL NON KINERJA (KETENAGAAN DAN HARI KERJA EFEKTIF) PERHITUNGAN POIN SELURUH VARIABEL

KETENAGAAN & HARI KINERJA

VARIABEL KETENAGAAN HARI KERJA PENGURANGAN POIN HARI KERJA EFEKTIF (BOBOT 60) (BOBOT 40) HARGA JUMLAH
JUMLAH
NO NAMA GOL PENDIDIKAN
PROSEN
PER
(Rp)
PAJAK DITERIMA TANDA TANGAN
TOTAL POIN
TASE
BEBAN KERJA/
IJIN TIDAK APEL
TIDAK APEL
KEHADIRAN POIN
PENDIDIKA RANGKAP TANGGUNG MASA STATUS JML HR POIN IJIN TIDAK APEL TIDAK APEL PAGI/TELAT SIANG/PULANG JML JML HARI TDK
N TGS/JABATAN JAWAB KERJA KEPEG
JML POIN
KERJA PERHARI PAGI/TELAT PIKET PIKET TANPA KET
SIANG/ PULANG
DULUAN TANPA
TIDAK MASUK
PEMOT. POIN MASUK JML NILAI NILAI
DULUAN
PROGRAM KET

10=5+ sd 12= 18= 19= 21= 22= 24=

1 2 3 4 5 6 7 8 9 11 13 14 15 16 17 13+14+15+1 20 = (11-
23 23 24 25 26 = 24-25 27
9 10/11 6 18/12 19) / 11 x100 20 x10 21x60% 22+23

1 Abdul Mu'in,S.Kep IV S1 KES 80 25 50 155 24 6.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 155.00 93.00 20.8 113.8 14021.7 1,595,665 239,350 1,356,315 1

2 Wahyuni Kunayarti,S.Gz.MPH. IV S2 80 16 25 50 171 24 7.13 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 171.00 102.60 40.0 142.6 14021.7 1,999,489 299,923 1,699,565 2

3 Irish Arisandi,SP III S1 Non Kes 50 30 60 15 50 205 24 8.54 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 205.00 123.00 40.0 163.0 14021.7 2,285,530 114,277 2,171,254 3

4 Haryani, A.Md.Kep III DIII 60 10 25 50 145 24 6.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 145.00 87.00 26.8 113.8 14021.7 1,595,665 79,783 1,515,882 4

5 drg. Ni Made Suardi IV Dokter Gigi 150 10 50 210 24 8.75 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 210.00 126.00 36.0 162.0 14021.7 2,271,509 340,726 1,930,782 5

6 Bq. Mahyuni III DI 50 25 50 125 24 5.21 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 125.00 75.00 30.0 105.0 14021.7 1,472,274 73,614 1,398,660 6

7 Hj. Kusmiati, S.S.T IV DIV Kes 80 25 50 155 24 6.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 155.00 93.00 26.8 119.8 14021.7 1,679,795 251,969 1,427,826 7

8 Junaidi III SPRG 50 20 25 50 145 24 6.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 145.00 87.00 30.0 117.0 14021.7 1,640,534 82,027 1,558,507 8

9 Subhi,S.Kep III S1 KES 80 25 50 155 24 6.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 155.00 93.00 28.0 121.0 14021.7 1,696,621 84,831 1,611,790 9

10 Rehan Bakti, A.Md.Keb III DIII 60 10 25 50 145 24 6.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 145.00 87.00 26.0 113.0 14021.7 1,584,447 79,222 1,505,225 10

11 Rohyatul Ain,A.Md.Keb III DIII 60 25 50 135 24 5.63 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 135.00 81.00 22.0 103.0 14021.7 1,444,231 72,212 1,372,019 11

12 L. Taswir. S.Kep IV S1 KES 80 64 20 25 50 239 24 9.96 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 239.00 143.40 40.0 183.4 14021.7 2,571,572 385,736 2,185,836 12

13 L. Sahri III SMA 25 25 50 100 24 4.17 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 100.00 60.00 30.0 90.0 14021.7 1,261,949 63,097 1,198,852 13

14 Warda Ningsih,Amd.Keb II DIII 60 5 50 115 24 4.79 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 115.00 69.00 30.0 99.0 14021.7 1,388,144 - 1,388,144 14

15 Mariana Ulfaini, SKM III S1 KES 80 15 50 145 24 6.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 145.00 87.00 29.6 116.6 14021.7 1,634,925 81,746 1,553,179 15

16 Saruni, A.Md.G III DIII 60 10 25 50 145 24 6.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 145.00 87.00 34.0 121.0 14021.7 1,696,621 84,831 1,611,790 16

17 Farida Herlina, S.Kep III S1 KES 80 15 15 50 160 24 6.67 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 160.00 96.00 24.0 120.0 14021.7 1,682,599 84,130 1,598,469 17

18 Tajudin Noor,S.IP III S1 Non Kes 50 25 25 50 150 24 6.25 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 150.00 90.00 25.6 115.6 14021.7 1,620,904 81,045 1,539,859 18

19 Bq. Nurida Marliana,S.Kep.Ns III S1 Ners 100 10 15 50 175 24 7.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 175.00 105.00 26.8 131.8 14021.7 1,848,055 92,403 1,755,652 19

20 Henny Puji Astuti, S.Kep III S1 KES 80 40 15 50 185 24 7.71 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 185.00 111.00 36.0 147.0 14021.7 2,061,184 103,059 1,958,125 20

21 Husniati, A.M.Kl III DIII 60 10 50 120 24 5.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 120.00 72.00 30.8 102.8 14021.7 1,441,427 72,071 1,369,355 21

22 Astuti Zamroni, Amd.A.K III DIII 60 10 15 50 135 24 5.63 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 135.00 81.00 36.0 117.0 14021.7 1,640,534 82,027 1,558,507 22

23 Uluwaturrakyi, Amd.Kep III DIII 60 25 15 50 150 24 6.25 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 150.00 90.00 26.4 116.4 14021.7 1,632,121 81,606 1,550,515 23

24 Baiq Maulida Maya Sanggu,Amd.Keb III DIII 60 20 20 50 150 24 6.25 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 150.00 90.00 31.2 121.2 14021.7 1,699,425 84,971 1,614,454 24
 PERHITUNGAN VARIABEL NON KINERJA (KETENAGAAN DAN HARI KERJA EFEKTIF) PERHITUNGAN POIN SELURUH VARIABEL

KETENAGAAN & HARI KINERJA

VARIABEL KETENAGAAN HARI KERJA PENGURANGAN POIN HARI KERJA EFEKTIF (BOBOT 60) (BOBOT 40) HARGA JUMLAH
JUMLAH
NO NAMA GOL PENDIDIKAN
PROSEN
PER
(Rp)
PAJAK DITERIMA TANDA TANGAN
TASE
TOTAL POIN
BEBAN KERJA/
IJIN TIDAK APEL
TIDAK APEL
KEHADIRAN POIN
PENDIDIKA RANGKAP TANGGUNG MASA STATUS JML HR POIN IJIN TIDAK APEL TIDAK APEL PAGI/TELAT SIANG/PULANG JML JML HARI TDK
N TGS/JABATAN JAWAB KERJA KEPEG
JML POIN
KERJA PERHARI PAGI/TELAT PIKET PIKET TANPA KET
SIANG/ PULANG
DULUAN TANPA
TIDAK MASUK
PEMOT. POIN MASUK JML NILAI NILAI
DULUAN
PROGRAM KET

10=5+ sd 12= 18= 19= 21= 22= 24=

1 2 3 4 5 6 7 8 9 11 13 14 15 16 17 13+14+15+1 20 = (11-
23 23 24 25 26 = 24-25 27
9 10/11 6 18/12 19) / 11 x100 20 x10 21x60% 22+23

25 Sri Husniati, Amd.Kep III DIII 60 15 15 50 140 24 5.83 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 140.00 84.00 26.0 110.0 14021.7 1,542,382 77,119 1,465,263 25

26 H. Mahderum III SMA 25 25 50 100 24 4.17 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 100.00 60.00 20.8 80.8 14021.7 1,132,950 56,648 1,076,303 26

27 Murni Nurhayati, Amd.Kep II DIII 60 10 50 120 24 5.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 120.00 72.00 20.0 92.0 14021.7 1,289,993 - 1,289,993 27

28 Zulfitri,S.Kep III S1 KES 80 10 50 140 24 5.83 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 140.00 84.00 23.6 107.6 14021.7 1,508,730 75,437 1,433,294 28

29 Suffi Siska Marlinda,S.Ap II S1 Non Kes 50 5 50 105 24 4.38 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 105.00 63.00 31.6 94.6 14021.7 1,326,449 - 1,326,449 29

30 Buhaeriadi II SMA 25 5 50 80 24 3.33 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 80.00 48.00 20.8 68.8 14021.7 964,690 - 964,690 30

31 Yusuf II SMA 25 25 50 100 24 4.17 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 100.00 60.00 20.0 80.0 14021.7 1,121,733 - 1,121,733 31

32 Baiq Mislah, Amd.Kep II DIII 60 15 50 125 24 5.21 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 125.00 75.00 20.8 95.8 14021.7 1,343,275 - 1,343,275 32

33 Yuli Ernaningsih, Amd.Keb III DIII 60 25 50 135 24 5.63 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 135.00 81.00 30.0 111.0 14021.7 1,556,404 77,820 1,478,584 33

34 Nurul Aini, A.Md.Keb II DIII 60 10 20 50 140 24 5.83 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 140.00 84.00 29.2 113.2 14021.7 1,587,252 - 1,587,252 34

35 Candra Hidayati, AMKL II DIII 60 10 15 50 135 24 5.63 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 135.00 81.00 26.0 107.0 14021.7 1,500,317 - 1,500,317 35

36 Bq. Jayanti Rita H. Amd.Kep II DIII 60 50 10 10 50 180 24 7.50 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 180.00 108.00 36.0 144.0 14021.7 2,019,119 - 2,019,119 36

37 Haziz Habib'an, AMKG II DIII 60 25 15 50 150 24 6.25 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 150.00 90.00 36.0 126.0 14021.7 1,766,729 - 1,766,729 37

38 Kamariah II SMA 25 10 50 85 24 3.54 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 85.00 51.00 36.0 87.0 14021.7 1,219,884 - 1,219,884 38

39 Sri Susilawati H, Amd.Keb II DIII 60 10 50 120 24 5.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 120.00 72.00 36.0 108.0 14021.7 1,514,339 - 1,514,339 39

40 Nasiratun Nisa, A.Md.Keb II DIII 60 10 50 120 24 5.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 120.00 72.00 30.0 102.0 14021.7 1,430,209 - 1,430,209 40

41 Baiq Laila Febriana,Amd.Keb II DIII 60 5 50 115 24 4.79 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 115.00 69.00 27.6 96.6 14021.7 1,354,492 - 1,354,492 41

42 Johareni, Amd.Keb II DIII 60 10 50 120 24 5.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 120.00 72.00 30.0 102.0 14021.7 1,430,209 - 1,430,209 42

43 Harianti, A.Md.Keb II DIII 60 10 50 120 24 5.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 120.00 72.00 30.0 102.0 14021.7 1,430,209 - 1,430,209 43

44 Siti Hidayati, Amd.Keb II DIII 60 5 50 115 24 4.79 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 115.00 69.00 36.0 105.0 14021.7 1,472,274 - 1,472,274 44

45 Nuny Gushak M,A.Md.Keb II DIII 60 5 50 115 24 4.79 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 115.00 69.00 36.0 105.0 14021.7 1,472,274 - 1,472,274 45

46 ST. Srimuliati, A.Md.Keb II DIII 60 5 50 115 24 4.79 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 115.00 69.00 36.0 105.0 14021.7 1,472,274 - 1,472,274 46

47 Nur'aini JOB SMA 25 3 20 48 24 2.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 48.00 28.80 24.8 53.6 14021.7 751,561 - 751,561 47

48 Emmy Hasruniawati, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 22.4 72.2 14021.7 1,012,364 - 1,012,364 48

49 Sri Puji Asnuriati, AMKL JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 24.4 74.2 14021.7 1,040,407 - 1,040,407 49

50 Ilia Maida, AMKL JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 23.2 73.0 14021.7 1,023,581 - 1,023,581 50
 PERHITUNGAN VARIABEL NON KINERJA (KETENAGAAN DAN HARI KERJA EFEKTIF) PERHITUNGAN POIN SELURUH VARIABEL

KETENAGAAN & HARI KINERJA

VARIABEL KETENAGAAN HARI KERJA PENGURANGAN POIN HARI KERJA EFEKTIF (BOBOT 60) (BOBOT 40) HARGA JUMLAH
JUMLAH
NO NAMA GOL PENDIDIKAN
PROSEN
PER
(Rp)
PAJAK DITERIMA TANDA TANGAN
TASE
TOTAL POIN
BEBAN KERJA/
IJIN TIDAK APEL
TIDAK APEL
KEHADIRAN POIN
PENDIDIKA RANGKAP TANGGUNG MASA STATUS JML HR POIN IJIN TIDAK APEL TIDAK APEL PAGI/TELAT SIANG/PULANG JML JML HARI TDK
N TGS/JABATAN JAWAB KERJA KEPEG
JML POIN
KERJA PERHARI PAGI/TELAT PIKET PIKET TANPA KET
SIANG/ PULANG
DULUAN TANPA
TIDAK MASUK
PEMOT. POIN MASUK JML NILAI NILAI
DULUAN
PROGRAM KET

10=5+ sd 12= 18= 19= 21= 22= 24=

1 2 3 4 5 6 7 8 9 11 13 14 15 16 17 13+14+15+1 20 = (11-
23 23 24 25 26 = 24-25 27
9 10/11 6 18/12 19) / 11 x100 20 x10 21x60% 22+23

51 Ihsan Alwi, S.Kep.Ns JOB S1 Ners 100 3 20 123 24 5.13 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 123.00 73.80 17.6 91.4 14021.7 1,281,580 - 1,281,580 51

52 Sundoyo Sudarso JOB SMK 25 3 20 48 24 2.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 48.00 28.80 36.0 64.8 14021.7 908,603 45,430 863,173 52

53 Muh. Rusli JOB SMA 25 3 20 48 24 2.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 48.00 28.80 36.0 64.8 14021.7 908,603 45,430 863,173 53

54 Neli Rosdiana S., SKM JOB S1 KES 80 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 27.6 89.4 14021.7 1,253,536 - 1,253,536 54

55 Itri Jayanti, S.Kep JOB S1 KES 80 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 33.2 95.0 14021.7 1,332,058 - 1,332,058 55

56 Risdayanti, S.Kep JOB S1 KES 80 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 36.0 97.8 14021.7 1,371,318 - 1,371,318 56

57 Rani Dwi Cahya, S.Kep JOB S1 KES 80 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 36.0 97.8 14021.7 1,371,318 - 1,371,318 57

58 Khaerunnisah, AmdG JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 25.6 75.4 14021.7 1,057,233 - 1,057,233 58

59 Muhammad Sulhan H, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 34.0 83.8 14021.7 1,175,015 - 1,175,015 59

60 Inayatussolihah, S.Kep JOB S1 KES 80 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 25.6 87.4 14021.7 1,225,493 - 1,225,493 60

61 Jihan Fitriati, S.Kep JOB S1 KES 80 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 29.6 91.4 14021.7 1,281,580 - 1,281,580 61

62 Nofera Rezza Nerita, S.Kep JOB S1 KES 80 3 20 103 24 4.29 0 6.00 0 0.00 0 0.00 0 0.00 0 0.00 6.00 1.40 94.17 97.00 58.20 25.2 83.4 14021.7 1,169,406 - 1,169,406 62

63 Muh. Lukmanul H,S.Kep.NS JOB SI NERS 100 45 3 20 168 24 7.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 168.00 100.80 36.0 136.8 14021.7 1,918,163 95,908 1,822,255 63

64 Muhammad Salihin, Amd.Kep JOB DIII 60 10 3 20 93 24 3.88 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 93.00 55.80 27.6 83.4 14021.7 1,169,406 - 1,169,406 64

65 Nurdiana, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 20.8 70.6 14021.7 989,929 - 989,929 65

66 Nuriatul Ain, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 20.0 69.8 14021.7 978,712 - 978,712 66

67 Lalu Roni Kuswandi, S.IP JOB S1 Non Kes 50 30 3 20 103 24 4.29 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 103.00 61.80 36.0 97.8 14021.7 1,371,318 - 1,371,318 67

68 Sustina Elyasani, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 28.4 78.2 14021.7 1,096,494 54,825 1,041,669 68

69 L. Yanuar Hari, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 29.2 79.0 14021.7 1,107,711 - 1,107,711 69

70 Juandi Sunantana, S.Kep.Ns JOB SI NERS 100 3 20 123 24 5.13 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 123.00 73.80 29.2 103.0 14021.7 1,444,231 72,212 1,372,019 70

71 Ami Zaturrahmi, Amd.Ak JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 28.4 78.2 14021.7 1,096,494 54,825 1,041,669 71

72 Sulihan Nur H., A.Md.Kep. JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 29.6 79.4 14021.7 1,113,320 - 1,113,320 72

73 Sanawati, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 36.0 85.8 14021.7 1,203,058 - 1,203,058 73

74 Bq. Dina Apriani, Amd.Keb JOB D III 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 29.2 79.0 14021.7 1,107,711 - 1,107,711 74

75 Irna Yuniarti, Amd.Keb JOB D III 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 28.0 77.8 14021.7 1,090,885 - 1,090,885 75

76 Nita Febrianti, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 36.0 85.8 14021.7 1,203,058 - 1,203,058 76
 PERHITUNGAN VARIABEL NON KINERJA (KETENAGAAN DAN HARI KERJA EFEKTIF) PERHITUNGAN POIN SELURUH VARIABEL

KETENAGAAN & HARI KINERJA

VARIABEL KETENAGAAN HARI KERJA PENGURANGAN POIN HARI KERJA EFEKTIF (BOBOT 60) (BOBOT 40) HARGA JUMLAH
JUMLAH
NO NAMA GOL PENDIDIKAN
PROSEN
PER
(Rp)
PAJAK DITERIMA TANDA TANGAN
TASE
TOTAL POIN
BEBAN KERJA/
IJIN TIDAK APEL
TIDAK APEL
KEHADIRAN POIN
PENDIDIKA RANGKAP TANGGUNG MASA STATUS JML HR POIN IJIN TIDAK APEL TIDAK APEL PAGI/TELAT SIANG/PULANG JML JML HARI TDK
N TGS/JABATAN JAWAB KERJA KEPEG
JML POIN
KERJA PERHARI PAGI/TELAT PIKET PIKET TANPA KET
SIANG/ PULANG
DULUAN TANPA
TIDAK MASUK
PEMOT. POIN MASUK JML NILAI NILAI
DULUAN
PROGRAM KET

10=5+ sd 12= 18= 19= 21= 22= 24=

1 2 3 4 5 6 7 8 9 11 13 14 15 16 17 13+14+15+1 20 = (11-
23 23 24 25 26 = 24-25 27
9 10/11 6 18/12 19) / 11 x100 20 x10 21x60% 22+23

77 Dini Purna Ayu, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 36.0 85.8 14021.7 1,203,058 - 1,203,058 77

78 Hasna Befalia R, A.Md.Keb JOB DIII 60 10 3 20 93 24 3.88 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 93.00 55.80 33.2 89.0 14021.7 1,247,928 - 1,247,928 78

79 Sari Aida Fitri, A.Md.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 30.0 79.8 14021.7 1,118,928 55,946 1,062,982 79

80 Armita Pebriana, A.Md.Keb JOB D III 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 30.0 79.8 14021.7 1,118,928 55,946 1,062,982 80

81 Bq. Ridha Handayani, A.Md.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 27.6 77.4 14021.7 1,085,276 1,085,276 81

82 Bq. Eni Kusrini, A.Md.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 31.2 81.0 14021.7 1,135,754 1,135,754 82

83 Yuniarti Diah Lestari,A.Md.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 34.0 83.8 14021.7 1,175,015 - 1,175,015 83

84 dr. Nurul Ahyani JOB S1 Dokter 150 3 20 173 24 7.21 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 173.00 103.80 40.0 143.8 14021.7 2,016,315 100,816 1,915,499 84

85 dr. Edo Kristiawan N. JOB S1 Dokter 150 20 3 20 193 24 8.04 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 193.00 115.80 36.0 151.8 14021.7 2,128,488 106,424 2,022,063 85

86 Baiq Suriani, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 30.0 79.8 14021.7 1,118,928 - 1,118,928 86

87 Samiatul Hayati, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 28.0 77.8 14021.7 1,090,885 - 1,090,885 87

88 Nirliana, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 28.0 77.8 14021.7 1,090,885 - 1,090,885 88

89 Widia Herlina, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 30.0 79.8 14021.7 1,118,928 - 1,118,928 89

90 Fitriah, S.Kep.Ns JOB SI NERS 100 3 20 123 24 5.13 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 123.00 73.80 30.0 103.8 14021.7 1,455,448 - 1,455,448 90

91 Hidayatullah,Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 25.2 75.0 14021.7 1,051,624 - 1,051,624 91

92 Kamariah, S.Kep.NS JOB SI NERS 100 3 20 123 24 5.13 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 123.00 73.80 29.2 103.0 14021.7 1,444,231 - 1,444,231 92

93 Rizaliana, Amd.Keb JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 32.0 81.8 14021.7 1,146,972 - 1,146,972 93

94 Husnul Faizah, Amd.Kep JOB DIII 60 3 20 83 24 3.46 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 83.00 49.80 26.8 76.6 14021.7 1,074,059 - 1,074,059 94

95 Muhammad Arsani,S.Kep.NS JOB SI NERS 100 3 20 123 24 5.13 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 0.00 100.00 123.00 73.80 22.8 96.6 14021.7 1,354,492 - 1,354,492 95

TOTAL 6,230 160 460 887 3,280 11,017 24 459.04 0 6.00 0.00 0.00 0 0.00 0 0.00 0 0.00 6.00 1.40 9494.17 11011.00 6606.60 2816.8 9423.40 14021.7 132,131,700 3,989,442 128,142,258

Kerongkong, Desember 2018

Jumlah Dana Kapitasi 100% : Rp. 220219500 MENGETAHUI,
Jumlah Dana Jasa Pelayanan 60% : Rp. 132131700 KEPALA DINAS KESEHATAN KEPALA PUSKESMAS KERONGKONG BENDAHARA JKN
poin peroarangan
X Jumlah Dana Jasa Pelayanan (60%)
KABUPATEN LOMBOK TIMUR
Jumlah Poin Seluruh Tenaga
 PERHITUNGAN VARIABEL NON KINERJA (KETENAGAAN DAN HARI KERJA EFEKTIF) PERHITUNGAN POIN SELURUH VARIABEL

KETENAGAAN & HARI KINERJA

VARIABEL KETENAGAAN HARI KERJA PENGURANGAN POIN HARI KERJA EFEKTIF (BOBOT 60) (BOBOT 40) HARGA JUMLAH
JUMLAH
NO NAMA GOL PENDIDIKAN
PROSEN
PER
(Rp)
PAJAK DITERIMA TANDA TANGAN
TASE
TOTAL POIN
BEBAN KERJA/
IJIN TIDAK APEL
TIDAK APEL
KEHADIRAN POIN
PENDIDIKA RANGKAP TANGGUNG MASA STATUS JML HR POIN IJIN TIDAK APEL TIDAK APEL PAGI/TELAT SIANG/PULANG JML JML HARI TDK
N TGS/JABATAN JAWAB KERJA KEPEG
JML POIN
KERJA PERHARI PAGI/TELAT PIKET PIKET TANPA KET
SIANG/ PULANG
DULUAN TANPA
TIDAK MASUK
PEMOT. POIN MASUK JML NILAI NILAI
DULUAN
PROGRAM KET

10=5+ sd 12= 18= 19= 21= 22= 24=

1 2 3 4 5 6 7 8 9 11 13 14 15 16 17 13+14+15+1 20 = (11-
23 23 24 25 26 = 24-25 27
9 10/11 6 18/12 19) / 11 x100 20 x10 21x60% 22+23

drg. Asrul Sani, M.Kes H. Lalu Taswir, S.Kep Baiq Jayanti Rita H.,Amd.Kep
NIP. 19750823 200112 1 002 NIP. 19680116 198903 1 008 NIP. 19850818201406 2 003
 DAFTAR RINCIAN PEMBAGIAN JASA PELAYANAN DANA KAPITASI JAMINAN KESEHATAN NASIONAL BULAN DESEMBER 2018
PUSKESMAS KERONGKONG

JUMLAH Untuk
TOTAL JUMLAH IURAN IURAN IURAN Iuran IBI & JUMLAH REAL
NO NAMA HARGA POIN PAJAK TERIMA SESUAI Tenaga Baju PPNI BON TANDA TANGAN
POIN (RUPIAH) ZAKAT KESRA TAKTIS PPNI DI TERIMA
SPJ Magang

1 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18

1 Abdul Mu'in,S.Kep 113.8 14,022 1,595,665 239,350 1,356,315 33,908 55,848 55,848 33,908 - - - 1,176,803 1

2 Wahyuni Kunayarti,S.Gz.MPH. 142.6 14,022 1,999,489 299,923 1,699,565 42,489 69,982 69,982 42,489 - - - 1,474,623 2

3 Irish Arisandi,SP 163.0 14,022 2,285,530 114,277 2,171,254 54,281 79,994 79,994 54,281 - - - 1,902,704 3

4 Haryani, A.Md.Kep 113.8 14,022 1,595,665 79,783 1,515,882 37,897 55,848 55,848 37,897 - - 240,000 1,088,391 4

5 drg. Ni Made Suardi 162.0 14,022 2,271,509 340,726 1,930,782 48,270 79,503 79,503 48,270 - - - 1,675,238 5

6 Bq. Mahyuni 105.0 14,022 1,472,274 73,614 1,398,660 34,967 51,530 51,530 34,967 - - 830,000 395,668 6

7 Hj. Kusmiati, S.S.T 119.8 14,022 1,679,795 251,969 1,427,826 35,696 58,793 58,793 35,696 - - - 1,238,849 7

8 Junaidi 117.0 14,022 1,640,534 82,027 1,558,507 38,963 57,419 57,419 38,963 - - 168,000 1,197,745 8

9 Subhi,S.Kep 121.0 14,022 1,696,621 84,831 1,611,790 40,295 59,382 59,382 40,295 - - - 1,412,437 9

10 Rehan Bakti, A.Md.Keb 113.0 14,022 1,584,447 79,222 1,505,225 37,631 55,456 55,456 37,631 - - - 1,319,053 10

11 Rohyatul Ain,A.Md.Keb 103.0 14,022 1,444,231 72,212 1,372,019 34,300 50,548 50,548 34,300 - - - 1,202,322 11

12 L. Taswir. S.Kep 183.4 14,022 2,571,572 385,736 2,185,836 54,646 90,005 90,005 54,646 - - 444,000 1,452,535 12

13 L. Sahri 90.0 14,022 1,261,949 63,097 1,198,852 29,971 44,168 44,168 29,971 - - - 1,050,573 13

14 Warda Ningsih,Amd.Keb 99.0 14,022 1,388,144 - 1,388,144 34,704 48,585 48,585 34,704 - - - 1,221,567 14

15 Mariana Ulfaini, SKM 116.6 14,022 1,634,925 81,746 1,553,179 38,829 57,222 57,222 38,829 - - - 1,361,075 15

16 Saruni, A.Md.G 121.0 14,022 1,696,621 84,831 1,611,790 40,295 59,382 59,382 40,295 - - - 1,412,437 16

17 Farida Herlina, S.Kep 120.0 14,022 1,682,599 84,130 1,598,469 39,962 58,891 58,891 39,962 - - - 1,400,764 17

18 Tajudin Noor,S.IP 115.6 14,022 1,620,904 81,045 1,539,859 38,496 56,732 56,732 38,496 - - 240,000 1,109,402 18

19 Bq. Nurida Marliana,S.Kep.Ns 131.8 14,022 1,848,055 92,403 1,755,652 43,891 64,682 64,682 43,891 - - 240,000 1,298,505 19

20 Henny Puji Astuti, S.Kep 147.0 14,022 2,061,184 103,059 1,958,125 48,953 72,141 72,141 48,953 - - - 1,715,936 20

21 Husniati, A.M.Kl 102.8 14,022 1,441,427 72,071 1,369,355 34,234 50,450 50,450 34,234 - - - 1,199,988 21

22 Astuti Zamroni, Amd.A.K 117.0 14,022 1,640,534 82,027 1,558,507 38,963 57,419 57,419 38,963 - - - 1,365,745 22

23 Uluwaturrakyi, Amd.Kep 116.4 14,022 1,632,121 81,606 1,550,515 38,763 57,124 57,124 38,763 55,000 - - 1,303,741 23

24 Baiq Maulida Maya Sanggu,Amd.Ke 121.2 14,022 1,699,425 84,971 1,614,454 40,361 59,480 59,480 40,361 - - 360,000 1,054,771 24
 JUMLAH Untuk
TOTAL JUMLAH IURAN IURAN IURAN Iuran IBI & JUMLAH REAL
NO NAMA HARGA POIN PAJAK TERIMA SESUAI Tenaga Baju PPNI BON TANDA TANGAN
POIN (RUPIAH) ZAKAT KESRA TAKTIS PPNI DI TERIMA
SPJ Magang

1 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18

25 Sri Husniati, Amd.Kep 110.0 14,022 1,542,382 77,119 1,465,263 36,632 53,983 53,983 36,632 - - - 1,284,033 25

26 H. Mahderum 80.8 14,022 1,132,950 56,648 1,076,303 26,908 39,653 39,653 26,908 - - - 943,181 26

27 Murni Nurhayati, Amd.Kep 92.0 14,022 1,289,993 - 1,289,993 32,250 45,150 45,150 32,250 - - - 1,135,194 27

28 Zulfitri,S.Kep 107.6 14,022 1,508,730 75,437 1,433,294 35,832 52,806 52,806 35,832 - - - 1,256,018 28

29 Suffi Siska Marlinda,S.Ap 94.6 14,022 1,326,449 - 1,326,449 33,161 46,426 46,426 33,161 - - 462,000 705,275 29

30 Buhaeriadi 68.8 14,022 964,690 - 964,690 24,117 33,764 33,764 24,117 - - 280,000 568,927 30

31 Yusuf 80.0 14,022 1,121,733 - 1,121,733 28,043 39,261 39,261 28,043 - - - 987,125 31

32 Baiq Mislah, Amd.Kep 95.8 14,022 1,343,275 - 1,343,275 33,582 47,015 47,015 33,582 - - - 1,182,082 32

33 Yuli Ernaningsih, Amd.Keb 111.0 14,022 1,556,404 77,820 1,478,584 36,965 54,474 54,474 36,965 - - - 1,295,706 33

34 Nurul Aini, A.Md.Keb 113.2 14,022 1,587,252 - 1,587,252 39,681 55,554 55,554 39,681 - - - 1,396,782 34

35 Candra Hidayati, AMKL 107.0 14,022 1,500,317 - 1,500,317 37,508 52,511 52,511 37,508 - - - 1,320,279 35

36 Bq. Jayanti Rita H. Amd.Kep 144.0 14,022 2,019,119 - 2,019,119 50,478 70,669 70,669 50,478 - - - 1,776,825 36

37 Haziz Habib'an, AMKG 126.0 14,022 1,766,729 - 1,766,729 44,168 61,836 61,836 44,168 - - - 1,554,722 37

38 Kamariah 87.0 14,022 1,219,884 - 1,219,884 30,497 42,696 42,696 30,497 - - - 1,073,498 38

39 Sri Susilawati H, Amd.Keb 108.0 14,022 1,514,339 - 1,514,339 37,858 53,002 53,002 37,858 - - 360,000 972,618 39

40 Nasiratun Nisa, A.Md.Keb 102.0 14,022 1,430,209 - 1,430,209 35,755 50,057 50,057 35,755 - - - 1,258,584 40

41 Baiq Laila Febriana,Amd.Keb 96.6 14,022 1,354,492 - 1,354,492 33,862 47,407 47,407 33,862 - - - 1,191,953 41

42 Johareni, Amd.Keb 102.0 14,022 1,430,209 - 1,430,209 35,755 50,057 50,057 35,755 - - 276,000 982,584 42

43 Harianti, A.Md.Keb 102.0 14,022 1,430,209 - 1,430,209 35,755 50,057 50,057 35,755 - - - 1,258,584 43

44 Siti Hidayati, Amd.Keb 105.0 14,022 1,472,274 - 1,472,274 36,807 51,530 51,530 36,807 - - - 1,295,601 44

45 Nuny Gushak M,A.Md.Keb 105.0 14,022 1,472,274 - 1,472,274 36,807 51,530 51,530 36,807 - - 168,000 1,127,601 45

46 ST. Srimuliati, A.Md.Keb 105.0 14,022 1,472,274 - 1,472,274 36,807 51,530 51,530 36,807 - - 168,000 1,127,601 46

47 Nur'aini 53.6 14,022 751,561 - 751,561 18,789 26,305 26,305 18,789 - - 300,000 361,374 47

48 Emmy Hasruniawati, Amd.Kep 72.2 14,022 1,012,364 - 1,012,364 25,309 35,433 35,433 25,309 - 25,000 - 865,880 48

49 Sri Puji Asnuriati, AMKL 74.2 14,022 1,040,407 - 1,040,407 26,010 36,414 36,414 26,010 - - - 915,558 49

50 Ilia Maida, AMKL 73.0 14,022 1,023,581 - 1,023,581 25,590 35,825 35,825 25,590 - - - 900,751 50
 JUMLAH Untuk
TOTAL JUMLAH IURAN IURAN IURAN Iuran IBI & JUMLAH REAL
NO NAMA HARGA POIN PAJAK TERIMA SESUAI Tenaga Baju PPNI BON TANDA TANGAN
POIN (RUPIAH) ZAKAT KESRA TAKTIS PPNI DI TERIMA
SPJ Magang

1 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18

51 Ihsan Alwi, S.Kep.Ns 91.4 14,022 1,281,580 - 1,281,580 32,039 44,855 44,855 32,039 - 25,000 - 1,102,790 51

52 Sundoyo Sudarso 64.8 14,022 908,603 45,430 863,173 21,579 31,801 31,801 21,579 - - - 756,412 52

53 Muh. Rusli 64.8 14,022 908,603 45,430 863,173 21,579 31,801 31,801 21,579 - - - 756,412 53

54 Neli Rosdiana S., SKM 89.4 14,022 1,253,536 - 1,253,536 31,338 43,874 43,874 31,338 - - - 1,103,112 54

55 Itri Jayanti, S.Kep 95.0 14,022 1,332,058 - 1,332,058 33,301 46,622 46,622 33,301 - 25,000 - 1,147,211 55

56 Risdayanti, S.Kep 97.8 14,022 1,371,318 - 1,371,318 34,283 47,996 47,996 34,283 - 25,000 360,000 821,760 56

57 Rani Dwi Cahya, S.Kep 97.8 14,022 1,371,318 - 1,371,318 34,283 47,996 47,996 34,283 - 25,000 - 1,181,760 57

58 Khaerunnisah, AmdG 75.4 14,022 1,057,233 - 1,057,233 26,431 37,003 37,003 26,431 - - 678,000 252,365 58

59 Muhammad Sulhan H, Amd.Kep 83.8 14,022 1,175,015 - 1,175,015 29,375 41,126 41,126 29,375 - 25,000 - 1,009,013 59

60 Inayatussolihah, S.Kep 87.4 14,022 1,225,493 - 1,225,493 30,637 42,892 42,892 30,637 - 25,000 240,000 813,434 60

61 Jihan Fitriati, S.Kep 91.4 14,022 1,281,580 - 1,281,580 32,039 44,855 44,855 32,039 - 25,000 - 1,102,790 61

62 Nofera Rezza Nerita, S.Kep 83.4 14,022 1,169,406 - 1,169,406 29,235 40,929 40,929 29,235 - 25,000 864,000 140,078 62

63 Muh. Lukmanul H,S.Kep.NS 136.8 14,022 1,918,163 95,908 1,822,255 45,556 67,136 67,136 45,556 - 25,000 294,000 1,277,871 63

64 Muhammad Salihin, Amd.Kep 83.4 14,022 1,169,406 - 1,169,406 29,235 40,929 40,929 29,235 55,000 25,000 - 949,078 64

65 Nurdiana, Amd.Kep 70.6 14,022 989,929 - 989,929 24,748 34,648 34,648 24,748 - 25,000 - 846,138 65

66 Nuriatul Ain, Amd.Kep 69.8 14,022 978,712 - 978,712 24,468 34,255 34,255 24,468 - 25,000 - 836,266 66

67 Lalu Roni Kuswandi, S.IP 97.8 14,022 1,371,318 - 1,371,318 34,283 47,996 47,996 34,283 - - - 1,206,760 67

68 Sustina Elyasani, Amd.Keb 78.2 14,022 1,096,494 54,825 1,041,669 26,042 38,377 38,377 26,042 - 25,000 720,000 167,831 68

69 L. Yanuar Hari, Amd.Kep 79.0 14,022 1,107,711 - 1,107,711 27,693 38,770 38,770 27,693 - 25,000 - 949,786 69

70 Juandi Sunantana, S.Kep.Ns 103.0 14,022 1,444,231 72,212 1,372,019 34,300 50,548 50,548 34,300 - 25,000 - 1,177,322 70

71 Ami Zaturrahmi, Amd.Ak 78.2 14,022 1,096,494 54,825 1,041,669 26,042 38,377 38,377 26,042 - - - 912,831 71

72 Sulihan Nur H., A.Md.Kep. 79.4 14,022 1,113,320 - 1,113,320 27,833 38,966 38,966 27,833 - 25,000 - 954,721 72

73 Sanawati, Amd.Kep 85.8 14,022 1,203,058 - 1,203,058 30,076 42,107 42,107 30,076 - 25,000 - 1,033,691 73

74 Bq. Dina Apriani, Amd.Keb 79.0 14,022 1,107,711 - 1,107,711 27,693 38,770 38,770 27,693 - 25,000 - 949,786 74

75 Irna Yuniarti, Amd.Keb 77.8 14,022 1,090,885 - 1,090,885 27,272 38,181 38,181 27,272 - 25,000 - 934,979 75

76 Nita Febrianti, Amd.Keb 85.8 14,022 1,203,058 - 1,203,058 30,076 42,107 42,107 30,076 - 25,000 - 1,033,691 76
 JUMLAH Untuk
TOTAL JUMLAH IURAN IURAN IURAN Iuran IBI & JUMLAH REAL
NO NAMA HARGA POIN PAJAK TERIMA SESUAI Tenaga Baju PPNI BON TANDA TANGAN
POIN (RUPIAH) ZAKAT KESRA TAKTIS PPNI DI TERIMA
SPJ Magang

1 2 3 4 5 6 7 8 9 10 11 12 13 16 17 18

77 Dini Purna Ayu, Amd.Keb 85.8 14,022 1,203,058 - 1,203,058 30,076 42,107 42,107 30,076 - 25,000 - 1,033,691 77

78 Hasna Befalia R, A.Md.Keb 89.0 14,022 1,247,928 - 1,247,928 31,198 43,677 43,677 31,198 - 25,000 - 1,073,176 78

79 Sari Aida Fitri, A.Md.Keb 79.8 14,022 1,118,928 55,946 1,062,982 26,575 39,162 39,162 26,575 - 25,000 - 906,508 79

80 Armita Pebriana, A.Md.Keb 79.8 14,022 1,118,928 55,946 1,062,982 26,575 39,162 39,162 26,575 - 25,000 - 906,508 80

81 Bq. Ridha Handayani, A.Md.Keb 77.4 14,022 1,085,276 - 1,085,276 27,132 37,985 37,985 27,132 - 25,000 - 930,043 81

82 Bq. Eni Kusrini, A.Md.Keb 81.0 14,022 1,135,754 - 1,135,754 28,394 39,751 39,751 28,394 - 25,000 - 974,464 82

83 Yuniarti Diah Lestari,A.Md.Keb 83.8 14,022 1,175,015 - 1,175,015 29,375 41,126 41,126 29,375 - 25,000 - 1,009,013 83

84 dr. Nurul Ahyani 143.8 14,022 2,016,315 100,816 1,915,499 47,887 70,571 70,571 47,887 - - - 1,678,582 84

85 dr. Edo Kristiawan N. 151.8 14,022 2,128,488 106,424 2,022,063 50,552 74,497 74,497 50,552 - - - 1,771,966 85

86 Baiq Suriani, Amd.Keb 79.8 14,022 1,118,928 - 1,118,928 27,973 39,162 39,162 27,973 - 25,000 - 959,657 86

87 Samiatul Hayati, Amd.Keb 77.8 14,022 1,090,885 - 1,090,885 27,272 38,181 38,181 27,272 - 25,000 180,000 754,979 87

88 Nirliana, Amd.Keb 77.8 14,022 1,090,885 - 1,090,885 27,272 38,181 38,181 27,272 - 25,000 120,000 814,979 88

89 Widia Herlina, Amd.Keb 79.8 14,022 1,118,928 - 1,118,928 27,973 39,162 39,162 27,973 - 25,000 600,000 359,657 89

90 Fitriah, S.Kep.Ns 103.8 14,022 1,455,448 - 1,455,448 36,386 50,941 50,941 36,386 - 25,000 360,000 895,794 90

91 Hidayatullah,Amd.Keb 75.0 14,022 1,051,624 - 1,051,624 26,291 36,807 36,807 26,291 - 25,000 - 900,429 91

92 Kamariah, S.Kep.NS 103.0 14,022 1,444,231 - 1,444,231 36,106 50,548 50,548 36,106 - 25,000 - 1,245,923 92

93 Rizaliana, Amd.Keb 81.8 14,022 1,146,972 - 1,146,972 28,674 40,144 40,144 28,674 - 25,000 240,000 744,335 93

94 Husnul Faizah, Amd.Kep 76.6 14,022 1,074,059 - 1,074,059 26,851 37,592 37,592 26,851 - 25,000 - 920,172 94

95 Muhammad Arsani,S.Kep.NS 96.6 14,022 1,354,492 - 1,354,492 33,862 47,407 47,407 33,862 55,000 25,000 718,000 393,953 95

9423.4 14,022 132,131,700 3,989,442 128,142,258 3,203,556 4,624,610 4,624,610 3,203,556 165,000 950,000 9,910,000 101,460,926

KEPALA PUSKESMAS KERONGKONG BENDAHARA JKN

H. Lalu Taswir, S.Kep Baiq Jayanti Rita H.,Amd.Kep

NIP. 19680116 198903 1 008 NIP. 19850818201406 2 003
 DAFTAR PENERIMAAN JASA PELAYANAN PROGRAM JAMINAN KESEHATAN NASIONAL
PUSKESMAS KERONGKONG KABUPATEN LOMBOK TIMUR
BULAN DESEMBER TAHUN 2018

NO NAMA NO REKENING JUMLAH TRANSFER ( Rp. )

1 2 3 4
1 Abdul Mu'in,S.Kep 0157-01-066872-50-7 1,176,803
2 Wahyuni Kunayarti,S.Gz.MM 0157-01-060107-50-6 1,474,623
3 Irish Arisandi,SP 0157-01-059508-50-7 1,902,704
4 Haryani, A.Md.Kep 0157-01-059509-50-3 1,088,391
5 drg. Ni Made Suardi 0157-01-059510-50-4 1,675,238
6 Bq. Mahyuni 0157-01-059511-50-0 395,668
7 Hj. Kusmiati, S.S.T 0157-01-059804-50-5 1,238,849
8 Junaidi 0157-01-059512-50-6 1,197,745
9 Subhi,S.Kep 0157-01-059514-50-8 1,412,437
10 Rehan Bakti, A.Md.Keb 0157-01-061319-50-4 1,319,053
11 Rohyatul Ain,A.Md.Keb 0157-01-059515-50-4 1,202,322
12 L. Taswir. S.Kep 0157-01-061317-50-2 1,452,535
13 L. Sahri 0157-01-059516-50-0 1,050,573
14 Warda Ningsih,Amd.Keb 4739-01-013536-53-2 1,221,567
15 Mariana Ulfaini, SKM 0157-01-059519-50-8 1,361,075
16 Saruni, A.Md.G 0157-01-059521-50-5 1,412,437
17 Farida Herlina, S.Kep 0157-01-059522-50-1 1,400,764
18 Tajudin Noor,S.IP 0157-01-036264-50-6 1,109,402
19 Bq. Nurida Marliana, S.Kep.Ns 0157-01-059523-50-7 1,298,505
20 Henny Puji Astuti,S.Kep 0157-01-059524-50-3 1,715,936
21 Husniati, A.M.Kl 0157-01-059525-50-9 1,199,988
22 Astuti Zamroni, Amd.A.K 0157-01-059526-50-5 1,365,745
23 Uluwaturrakyi, Amd.Kep 0157-01-059527-50-1 1,303,741
24 Baiq Maulida Maya Sanggu,Amd.Keb 7598-01-000893-53-8 1,054,771
25 Sri Husniati, Amd.Kep 0157-01-059529-50-3 1,284,033
26 H. Mahderum 0157-01-059532-50-6 943,181
27 Murni Nurhayati, Amd.Kep 0157-01-059533-50-2 1,135,194
28 Zulfitri,S.Kep 0157-01-051772-50-0 1,256,018
29 Suffi Siska Marlinda,S.Ap 0157-01-059534-50-8 705,275
30 Buhaeriadi 0157-01-059535-50-4 568,927
31 Yusuf 0157-01-059536-50-0 987,125
32 Baiq Mislah, Amd.Kep 0157-01-070832-50-7 1,182,082
33 Yuli Ernaningsih, Amd.Keb 0157-01-061316-50-6 1,295,706
34 Nurul Aini, A.Md.Keb 0157-01-059590-50-4 1,396,782
35 Candra Hidayati, AMKL 0157-01-059593-50-2 1,320,279
36 Bq. Jayanti Rita H., Amd.Kep 0157-01-059594-50-8 32,447,599
NO NAMA
1 2
37 Haziz Habib'an, AMKG
38 Kamariah
39 Sri Susilawati H, Amd.Keb
40 Nasiratun Nisa, A.Md.Keb
41 Baiq Laila Febriana,Amd.Keb
42 Johareni, Amd.Keb
43 Harianti, A.Md.Keb
44 Siti Hidayati, Amd.Keb
45 Nuny Gushak M,A.Md.Keb
46 ST. Srimuliati, A.Md.Keb
47 Nur'aini
48 Emmy Hasruniawati, Amd.Kep
49 Sri Puji Asnuriati, AMKL
50 Ilia Maida, AMKL
51 Ihsan Alwi,S.Kep.,Ns
52 Sundoyo Sudarso
53 Muh. Rusli
54 Neli Rosdiana S., SKM
55 Itri Jayanti,S.Kep
56 Risdayanti,S.Kep
57 Rani Dwi Cahya,S.Kep
58 Khaerunnisah, AmdG
59 Muhammad Sulhan H, Amd.Kep
60 Inayatussolihah,S.Kep
61 Jihan Fitriati, S.Kep
62 Nofera Rezza Nerita,S.Kep
63 Muh. Lukmanul H,S.Kep.,Ns
64 Muhammad Solihin, Amd.Kep
65 Nurdiana, Amd.Kep
66 Nuriatul Ain, Amd.Kep
67 Lalu Roni Kuswandi, S.IP
68 Sustina Elyasani, Amd.Keb
69 L. Yanuar Hari, Amd.Kep
70 Juandi Sunantana, S.Kep.Ns
71 Ami Zaturrahmi, Amd.Ak
72 Sulihan Nur H., A.Md.Kep.
73 Sanawati, Amd.Kep
74 Bq. Dina Apriani, Amd.Keb
75 Irna Yuniarti, Amd.Keb
NO REKENING JUMLAH TRANSFER ( Rp. )
3 4
0157-01-059595-50-4 1,554,722
0157-01-059834-50-0 1,073,498
0157-01-059637-50-0 972,618
0157-01-061320-50-5 1,258,584
0157-01-049601-50-1 1,191,953
0157-01-059630-50-8 982,584
0157-01-062213-50-7 1,258,584
0157-01-059759-50-6 1,295,601
0157-01-061318-50-8 1,127,601
0157-01-062176-50-1 1,127,601
0157-01-059597-50-6 361,374
0157-01-059598-50-2 865,880
0157-01-059599-50-8 915,558
0157-01-059600-50-3 900,751
0157-01-059601-50-9 1,102,790
0157-01-059602-50-5 756,412
0157-01-059603-50-1 756,412
0157-01-059761-50-3 1,103,112
0157-01-059613-50-6 1,147,211
0157-01-059614-50-2 821,760
0157-01-059616-50-4 1,181,760
0157-01-059618-50-6 252,365
0157-01-059619-50-2 1,009,013
0157-01-059622-50-5 813,434
0157-01-059623-50-1 1,102,790
0157-01-059624-50-7 140,078
0157-01-059625-50-3 1,277,871
0157-01-059626-50-9 949,078
0157-01-059790-50-2 846,138
0157-01-059627-50-5 836,266
0157-01-059628-50-1 1,206,760
0157-01-066899-50-9 167,831
0157-01-059758-50-0 949,786
0157-01-059639-50-2 1,177,322
0157-01-059642-50-5 912,831
0157-01-059838-50-4 954,721
0157-01-059635-50-8 1,033,691
0157-01-059752-50-4 949,786
0157-01-059780-50-7 934,979
NO NAMA NO REKENING JUMLAH TRANSFER ( Rp. )
1 2 3 4
76 Nita Febrianti, Amd.Keb 0157-01-059781-50-3 1,033,691
77 Dini Purna Ayu, Amd.Keb 0157-01-059788-50-5 1,033,691
78 Hasna Befalia R, A.Md.Keb 0157-01-061307-50-7 1,073,176
79 Sari Aida Fitri, A.Md.Keb 0157-01-061308-503 906,508
80 Armita Pebriana, A.Md.Keb 0157-01-061323-50-3 906,508
81 Bq. Ridha Handayani, A.Md.Keb 0157-01-061334-50-4 930,043
82 Bq. Eni Kusrini, A.Md.Keb 0157-01-061321-50-1 974,464
83 Yuniarti Diah Lestari,A.Md.Keb 0157-01-062175-50-5 1,009,013
84 dr. Nurul Ahyani 4737-01-017230-53-8 1,678,582
85 dr. Edo Kristiawan N. 0157-01-062295-50-9 1,771,966
86 Baiq Suriani, Amd.Keb 0157-01-059782-50-9 959,657
87 Samiatul Hayati, Amd.Keb 0157-01-059789-50-1 754,979
88 Nirliana, Amd.Keb 0157-01-059631-50-4 814,979
89 Widia Herlina, Amd.Keb 4735-01-013924-53-5 359,657
90 Fitriah, S.Kep.Ns 0157-01-059754-50-6 895,794
91 Hidayatullah,Amd.Keb 0157-01-059753-50-0 900,429
92 Kamariah, S.Kep.NS 0157-01-059641-50-9 1,245,923
93 Rizaliana, Amd.Keb 7950-01-001304-53-0 744,335
94 Husnul Faizah, Amd.Kep 0157-01-056302-50-4 920,172
95 Muhammad Arsani,S.Kep.NS 0157-01-066874-50-9 393,953
132,131,700

Kerongkong, Desember 2018

Kepala Puskesmas Kerongkong

H. Lalu Taswir, S.Kep

NIP. 19680116 198903 1 008