LAPORAN RETRIBUSI PELAYANAN KESEHATAN DASAR

PUSKESMAS PEMBANTU : Sawangan

PUSKESMAS : Cipeundeuy
Bulan : Nov, 2016

PASIEN
NO NAMA PASIEN UMUR Tanggal Pelayanan UMUM BPJS JAMKESDA ASKES
1 sdr.andriansyah 17 1-Jul-20
2 ny.oti 45 1-Jul-20
3 ny.ropiah 35 1-Jul-20
4 ny.amih 50 1-Jul-20
5 tn.enda 40 1-Jul-20
6 an.shakila 5 1-Jul-20
7 NY.NUR 28 1-Jul-20
8 TN.PENDI 37 1-Jul-20
9 NY.YEYET 45 1-Jul-20
10 NY.ROHYATI 55 1-Jul-20
11 TN.ENDANG 55 1-Jul-20
12 TN.ENCAD 50 1-Jul-20
13 NY.ROSMIATI 53 1-Jul-20
14 TN.BIING 60 1-Jul-20
15 AN.FIRMAN 3 1-Jul-20
16 NY.SAYU 21 1-Jul-20
17 NY.YENI 25 1-Jul-20
18 NN.LISNA 22 1-Jul-20
19 NY.RATNA 27 1-Jul-20
20 AN.ZASKIA AMELIA 7 1-Jul-20
21 NY.ARTI ROSMIATI 61 1-Jul-20
22 SDR.DIAN 20 1-Jul-20
23 NY.IMAS MUTIARA 32 2-Jul-20
24 TN.OTA 60 2-Jul-20
25 NY.YETI 34 2-Jul-20
26 AN.FIRMAN GANI 3 2-Jul-20
27 NY.TINI 25 2-Jul-20
28 NY.NANI 57 2-Jul-20
29 NY.SUMIATI 27 2-Jul-20
30 NY.NUR 28 2-Jul-20
31 NY.ILAH JAMILAH 36 2-Jul-20
32 SDR.ADRYAN 18 2-Jul-20
33 AN.ALBYAN 5 2-Jul-20
34 NY.PERA 34 2-Jul-20
35 NY.SITI KARWATI 19 2-Jul-20
36 NY.ENYIH 72 2-Jul-20
37 TN.AJAM 42 2-Jul-20
38 NY.ROHAYATI 48 2-Jul-20
39 NY.SITI NURHASANAH 30 2-Jul-20
40 NY.NURUL HULASO 27 2-Jul-20
41 NY.NURCAHYATI 25 2-Jul-20
42 AN.NAURA 6 2-Jul-20
43 TN.HUSADA 27 2-Jul-20
44 NY.NGKES 50 2-Jul-20
45 NN.JUJU JUARSIH 22 2-Jul-20
46 AN.FIRMAN GANI 3 2-Jul-20
47 TN.HENDI 45 3-Jul-20
48 NN. ERNA 18 3-Jul-20
49 NY.ATI UMYATI 61 3-Jul-20
50 SDR. YOGI 23 3-Jul-20
51 NN. HANIFAH 18 3-Jul-20
52 NY.RITA 35 3-Jul-20
53 NN. SITI NURYANI 22 3-Jul-20
54 M. FAIZ RAINA 6 3-Jul-20
55 NY. NINA KURNIAWATI 37 3-Jul-20
56 NY. NESAH 70 3-Jul-20
57 SDR. DEDEN MULYADI 13 3-Jul-20
58 NY. NENG SRI 22 3-Jul-20
59 NN.ANI 19 3-Jul-20
60 TN. DAMOR 49 3-Jul-20
61 NN.LENA 23 4-Jul-20
62 NY.TATI KURNIA 26 4-Jul-20
63 NY.MULYANI 44 4-Jul-20
64 NY.EMAY 42 4-Jul-20
65 NY.ENTIN 50 4-Jul-20
66 NN.TARMI 12 4-Jul-20
67 NY.ELA WULANDARI 24 4-Jul-20
68 NY.NANA 25 4-Jul-20
69 NY.RATIH 24 4-Jul-20
70 NY.ESTI 23 4-Jul-20
ASAR

KET
COMMON COLD
THYPOID FEVER
MYALGIA
COMMON COLD
CEPHALGIA
DISPEPSIA
ISPA
HYPERTENSION
DISPEPSIA
HYPERTENSION
HYPERTENSION
HYPERTENSION
COMMON COLD
HYPERTENSION
OBSERVASI FEBRIS
DISPEPSIA
COMMON COLD
COMMON COLD
COMMON COLD
THYPOID FEVER
HYPERTENSION
MYALGIA
DISPEPSIA
HYPERTENSION
HYPERTENSION
OBSERVASI FEBRIS
DISPEPSIA
LOW BACK PAIN
OBSERVASI FEBRIS
DISPEPSIA
ABDOMINAL PAIN
DISPEPSIA
COMMON COLD
VERTIGO
DISPEPSIA
HYPERTENSION
DISPEPSIA
COMMON COLD
MYALGIA
MYALGIA
COMMON COLD
THYPOID FEVER
MYALGIA
HYPERTENSION
VERTIGO
OBSERVASI FEBRIS
COMMON COLD
DISPEPSIA
HYPERTENSION
DISPEPSIA
DISPEPSIA
ASMA BRONHIAL
COMMON COLD
COMMON COLD
VERTIGO
HYPERTENSION
COMMON COLD
COMMON COLD
DISPEPSIA
HYPERTENSION
DISPEPSIA
DISPEPSIA
MYALGIA
DERMATITIS KONTAK ALERGY
HYPERTENSION
DISPEPSIA
GASTRO ENTRITIS ACUT
DISPEPSIA
DISPEPSIA
COMMON COLD
 SETORAN RETRIBUSI PELAYANAN KESEHATAN DASAR
PUSKESMAS PEMBANTU :
PUSKESMAS PEMBANTU :
TANGGAL SETOR KE PUSKESMAS :
PASIEN UMUM
NO NAMA PASIEN TANGGAL PELAYANAN nomor karcis keterangan
(Rp)
REKAPITULASI SETORAN RETRIBUSI PUSKESMAS PEMBANTU KE PUSKESMAS
DINAS KESEHATAN KAB SUBANG
NAMA PUSTU :
NAMA PUSKESMAS :
BULAN :
NO TANGGAL SETOR URAIAN JUMLAH