REKAPITULASI PELAYANAN

IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN APRIL TAHUN 2018

TANGGAL
NO NAMA PESERTA NOMOR IDENTITAS BPJS ALAMAT PESERTA NO TELEPON/ HP DOAGNOSA PELAYANAN

1 TN.ABD. RAUF THALIB 0000201090396 BULADU 081356761555 DM

2 NY.ADRIAN LAJOMPO 0001236808618 TENILO DM
3 TN.AHMAD GULA 0000139775591 TENILO DM
4 NY.AISARI KASIM 0001236808631 TENILO DM
5 NY. DJAMI HARIS 0000960938019
6 NY.FATMA UMAR 0001237989385 TENILO DM
7 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM
8 TN. FARIS TAHA 0001838836822 BULADU DM
9 TN. ISWAN LATJENGKE 0001236779998 DM
10 TN.IBRAHIM PAATO 0000139667433 TENILO DM
11 TN.ISHAK KONILI 0001237543547 BULADU DM
12 NY.KARDINA ADIKO 0000959459398 BUIIDE 081342994481 DM
13 NY.MASTIN DAMA 0000960788709 TENILO 085240290119 DM
14 NY RITA HASAN 0000163525511 BULADU 085298414222 DM
15 NY.RISNA LATJENGKE 0001237946793 MOLOSIFAT W 085256122615 DM
16 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM
17 NY.SURIYATI DJAFAR 0000960525134 BULIIDE DM
18 TN.SALIM MOHAMAD 0001249532605 BULIIDE 085240011675 DM
1 TN. SYARIF ILIMULLAH 0000136769196 BULADU 082394686789 DM
20 NY. SAURIN LATJENGKE 00001315120645 DM

21 NY.VIBRIYANTI D.TUI 0000139685095 DM

22 NY. WIRNA TANIYO 0001236267832 DM

23 NY.AISA MUSTAFA 0001249523087 BULADU DM+HT
24 TN.ARDIN JAHJA 0001797584332 BULADU 085256539645 DM+HT
25 NY.ERVINA NING DJAFAR 0001249515606 BULADU DM
26 NY. FARIDA NANI 0001249526338 HT
27 NY. HADIJAH DATAU 0001249548208 MOLOSIFAT W DM
28 TN. ISA IBRAHIM 0000139649499 BULIIDE DM
29 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT
30 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM
31 NY KULSUM TANGAHU 0001267509115 MOLOSIFAT W 08534177211 DM
32 TN. KARIM BAHTIAR 0000139844698 BULADU DM
33 NY. LATIPA PADU 0000139651626 BULIIDE DM
34 NY. LENA MOHAMAD 0000137951032 DM
35 NY LUNCE TAIB 0001236814637 BULADU 081527504855 DM
36 TN. MUCHTAR PANTU 0002220283484 TOMULABUTAO 085240324918 DM
37 NY.NURSEHA MAKRUN 0000139796335 TULADENGGI DM + HT
38 NY.RAHIMA SALILO 0001249518857 BULIIDE DM+HT
3 NY.ROSITA UMAR 0001235081182 BULADU DM+HT
40 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT
41 NY. RATNA NIODE 0000139773003 LIBUO DM+HT
42 TN. RIKO PILILI 0000139683508 LIBUO DM+HT
43 NY. RASUNA LATJENGKE 0000961148474 MOLOSIFAT W DM
44 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM
45 NY. SERPIN MUSA 0000961024059 BULADU 085343615306 DM
46 TN. SAMSUDIN IBRAHIM 0001249699465 BULADU 085256914119 DM
47 TN. THAMRIN TULEN 0000139762697 DM+HT
JUMLAH
TOTAL
APITULASI PELAYANAN
PLEMENTASI PROLANIS
SKESMAS KOTA BARAT
LAN APRIL TAHUN 2018

JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

KET.
GDS GDP GDPP GDS GDP GDPP GDS DGP GDPP
√ 360 Rp 10,000
√ 111 Rp 10,000
√ 256 Rp 10,000
√ 114 Rp 10,000
√ 223 Rp 10,000
√ 233 Rp 10,000
√ 202 Rp 10,000
√ 315 Rp 10,000
√ 201 Rp 10,000
√ 173 Rp 10,000
√ 95 Rp 10,000
√ 114 Rp 10,000
√ 393 Rp 10,000
√ 167 Rp 10,000
√ 115 Rp 10,000
√ 136 Rp 10,000
√ 203 Rp 10,000
√ 230 Rp 10,000
√ 214 Rp 10,000
√ 349 Rp 10,000
√ 138 Rp 10,000
√ 154 Rp 10,000
√ 209 Rp 10,000
√ 231 Rp 10,000
√ 225 Rp 10,000
√ 185 Rp 10,000
√ 310 Rp 10,000
√ 159 Rp 10,000
√ 187 Rp 10,000
√ 159 Rp 10,000
√ 207 Rp 10,000
√ 135 Rp 10,000
√ 168 Rp 10,000
√ 138 Rp 10,000
√ 257 Rp 10,000
√ 171 Rp 10,000
√ 177 Rp 10,000
√ 180 Rp 10,000
 √ 170 Rp 10,000
√ 196 Rp 10,000
√ 161 Rp 10,000
√ 152 Rp 10,000
√ 134 Rp 10,000
√ 207 Rp 10,000
√ 179 Rp 10,000
√ 148 Rp 10,000
√ 102 Rp 10,000
Rp 10,000 Rp 460,000
Rp 470,000
 REKAPITULASI PELAYANAN
IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN MEI TAHUN 2018

TANGGAL
NO NAMA PESERTA NOMOR IDENTITAS BPJS ALAMAT PESERTA NO TELEPON/ HP DOAGNOSA PELAYANAN

1 TN.ABD. RAUF THALIB 0000201090396 BULADU 081356761555 DM

2 NY.ADRIAN LAJOMPO 0001236808618 TENILO DM
3 TN.AHMAD GULA 0000139775591 TENILO DM
4 NY.AISARI KASIM 0001236808631 TENILO DM
5 NY. DJAMI HARIS 0000960938019
6 NY.FATMA UMAR 0001237989385 TENILO DM
7 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM
8 TN. FARIS TAHA 0001838836822 BULADU DM
9 TN. ISWAN LATJENGKE 0001236779998 DM
10 TN.IBRAHIM PAATO 0000139667433 TENILO DM
11 TN.ISHAK KONILI 0001237543547 BULADU DM
12 NY.KARDINA ADIKO 0000959459398 BUIIDE 081342994481 DM
13 NY.MASTIN DAMA 0000960788709 TENILO 085240290119 DM
14 NY RITA HASAN 0000163525511 BULADU 085298414222 DM
15 NY.RISNA LATJENGKE 0001237946793 MOLOSIFAT W 085256122615 DM
16 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM
17 NY.SURIYATI DJAFAR 0000960525134 BULIIDE DM
18 TN.SALIM MOHAMAD 0001249532605 BULIIDE 085240011675 DM
19 TN. SYARIF ILIMULLAH 0000136769196 BULADU 082394686789 DM
20 NY. SAURIN LATJENGKE 00001315120645 DM
21 NY.VIBRIYANTI D.TUI 0000139685095 DM
22 NY. WIRNA TANIYO 0001236267832 DM
23 NY.AISA MUSTAFA 0001249523087 BULADU DM+HT
24 TN.ARDIN JAHJA 0001797584332 BULADU 085256539645 DM+HT
25 NY.ERVINA NING DJAFAR 0001249515606 BULADU DM
26 NY. FARIDA NANI 0001249526338 HT
27 NY. HADIJAH DATAU 0001249548208 MOLOSIFAT W DM
28 TN. ISA IBRAHIM 0000139649499 BULIIDE DM
29 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT
30 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM
31 NY KULSUM TANGAHU 0001267509115 MOLOSIFAT W 08534177211 DM
32 TN. KARIM BAHTIAR 0000139844698 BULADU DM
33 NY. LATIPA PADU 0000139651626 BULIIDE DM
34 NY. LENA MOHAMAD 0000137951032 DM
35 NY LUNCE TAIB 0001236814637 BULADU 081527504855 DM
36 TN. MUCHTAR PANTU 0002220283484 TOMULABUTAO 085240324918 DM
37 NY.NURSEHA MAKRUN 0000139796335 TULADENGGI DM + HT
38 NY.RAHIMA SALILO 0001249518857 BULIIDE DM+HT
39 NY.ROSITA UMAR 0001235081182 BULADU DM+HT
40 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT
41 NY. RATNA NIODE 0000139773003 LIBUO DM+HT
42 TN. RIKO PILILI 0000139683508 LIBUO DM+HT
43 NY. RASUNA LATJENGKE 0000961148474 MOLOSIFAT W DM
44 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM
45 NY. SERPIN MUSA 0000961024059 BULADU 085343615306 DM
46 TN. SAMSUDIN IBRAHIM 0001249699465 BULADU 085256914119 DM
47 TN. THAMRIN TULEN 0000139762697 DM+HT
JUMLAH
TOTAL
APITULASI PELAYANAN
PLEMENTASI PROLANIS
SKESMAS KOTA BARAT
ULAN MEI TAHUN 2018

JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

KET.
GDS GDP GDPP GDS GDP GDPP GDS DGP GDPP
√ 238 Rp 10,000
√ 106 Rp 10,000
√ 409 Rp 10,000
√ 119 Rp 10,000
√ 231 Rp 10,000
√ 175 Rp 10,000
√ 198 Rp 10,000
√ 217 Rp 10,000
√ 382 Rp 10,000
√ 150 Rp 10,000
√ 122 Rp 10,000
√ 120 Rp 10,000
√ 471 Rp 10,000
√ 282 Rp 10,000
√ 126 Rp 10,000
√ 125 Rp 10,000
√ 220 Rp 10,000
√ 337 Rp 10,000
√ 298 Rp 10,000
√ 95 Rp 10,000
√ 126 Rp 10,000
√ 147 Rp 10,000
√ 201 Rp 10,000
√ 272 Rp 10,000
√ 225 Rp 10,000
√ 190 Rp 10,000
√ 138 Rp 10,000
√ 144 Rp 10,000
√ 184 Rp 10,000
√ 178 Rp 10,000
√ 199 Rp 10,000
√ 144 Rp 10,000
√ 151 Rp 10,000
√ 170 Rp 10,000
√ 218 Rp 10,000
√ 169 Rp 10,000
√ 162 Rp 10,000
√ 150 Rp 10,000
√ 142 Rp 10,000
√ 187 Rp 10,000
√ 159 Rp 10,000
√ 147 Rp 10,000
√ 129 Rp 10,000
√ 198 Rp 10,000
√ 234 Rp 10,000
√ 146 Rp 10,000
√ 127 Rp 10,000
Rp 20,000 Rp 450,000
Rp 470,000
 REKAPITULASI PELAYANAN
IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN JUNI TAHUN 2018

TANGGAL JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

NOMOR IDENTITAS ALAMAT DOAGNOS
NO NAMA PESERTA NO TELEPON/ HP PELAYANA KET.
BPJS PESERTA A GDS GDP GDPP GDS GDP GDPP GDS DGP GDPP
N
1 TN.ABD. RAUF THALIB 0000201090396 BULADU 081356761555 DM √ 588 Rp 10,000
2 NY.ADRIAN LAJOMPO 0001236808618 TENILO DM √ 202 Rp 10,000
3 TN.AHMAD GULA 0000139775591 TENILO DM √ 220 Rp 10,000
4 NY.AISARI KASIM 0001236808631 TENILO DM √ 120 Rp 10,000
5 NY. DJAMI HARIS 0000960938019 BULIIDE DM √ 182 Rp 10,000
6 NY.FATMA UMAR 0001237989385 TENILO DM √ 166 Rp 10,000
7 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM √ 200 Rp 10,000
8 TN. FARIS TAHA 0001838836822 BULADU DM √ 177 Rp 10,000
9 TN. ISWAN LATJENGKE 0001236779998 BULADU DM √ 311 Rp 10,000
10 TN.IBRAHIM PAATO 0000139667433 TENILO DM √ 129 Rp 10,000
11 TN.ISHAK KONILI 0001237543547 BULADU DM √ 125 Rp 10,000
12 NY.KARDINA ADIKO 0000959459398 BUIIDE 081342994481 DM √ 177 Rp 10,000
13 NY.MASTIN DAMA 0000960788709 TENILO 085240290119 DM √ 396 Rp 10,000
14 NY RITA HASAN 0000163525511 BULADU 085298414222 DM √ 277 Rp 10,000
15 NY.RISNA LATJENGKE 0001237946793 MOLOSIFAT W 085256122615 DM √ 101 Rp 10,000
16 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM √ 166 Rp 10,000
17 NY.SURIYATI DJAFAR 0000960525134 BULIIDE DM √ 282 Rp 10,000
18 TN.SALIM MOHAMAD 0001249532605 BULIIDE 085240011675 DM √ 184 Rp 10,000
19 TN. SYARIF ILIMULLAH 0000136769196 BULADU 082394686789 DM √ 414 Rp 10,000
20 NY. SAURIN LATJENGKE 00001315120645 MOLOSIFAT W DM √ 241 Rp 10,000
21 NY.VIBRIYANTI D.TUI 0000139685095 LIBUO DM √ 101 Rp 10,000
22 NY. WIRNA TANIYO 0001236267832 BULADU DM √ 111 Rp 10,000
23 NY.AISA MUSTAFA 0001249523087 BULADU DM+HT √ 252 Rp 10,000
24 TN.ARDIN JAHJA 0001797584332 BULADU 085256539645 DM+HT √ 316 Rp 10,000
25 NY.ERVINA NING DJAFAR 0001249515606 BULADU DM √ 377 Rp 10,000
26 NY. FARIDA NANI 0001249526338 BULIIDE HT √ 189 Rp 10,000
27 NY. HADIJAH DATAU 0001249548208 MOLOSIFAT W DM √ 285 Rp 10,000
28 TN. ISA IBRAHIM 0000139649499 BULIIDE DM √ 256 Rp 10,000
29 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT √ 172 Rp 10,000
30 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM √ 296 Rp 10,000
31 NY KULSUM TANGAHU 0001267509115 MOLOSIFAT W 08534177211 DM √ 202 Rp 10,000
32 TN. KARIM BAHTIAR 0000139844698 BULADU DM √ 144 Rp 10,000
33 NY. LATIPA PADU 0000139651626 BULIIDE DM √ 183 Rp 10,000
34 NY. LENA MOHAMAD 0000137951032 BULIIDE DM √ 201 Rp 10,000
35 NY LUNCE TAIB 0001236814637 BULADU 081527504855 DM √ 237 Rp 10,000
36 TN. MUCHTAR PANTU 0002220283484 TOMULABUTAO 085240324918 DM √ 147 Rp 10,000
37 NY.NURSEHA MAKRUN 0000139796335 TULADENGGI DM + HT √ 152 Rp 10,000
38 NY.RAHIMA SALILO 0001249518857 BULIIDE DM+HT √ 143 Rp 10,000
3 NY.ROSITA UMAR 0001235081182 BULADU DM+HT √ 225 Rp 10,000
40 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT √ 152 Rp 10,000
41 NY. RASUNA LATJENGKE 0000961148474 MOLOSIFAT W DM √ 145 Rp 10,000
42 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM √ 160 Rp 10,000
43 NY. SERPIN MUSA 0000961024059 BULADU 085343615306 DM √ 182 Rp 10,000
44 TN. SAMSUDIN IBRAHIM 0001249699465 BULADU 085256914119 DM √ 160 Rp 10,000
45 TN. THAMRIN TULEN 0000139762697 HUNAGOBOTU DM+HT √ 127 Rp 10,000
JUMLAH Rp 120,000 Rp 330,000
TOTAL Rp 450,000
 REKAPITULASI PELAYANAN
IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN JULI TAHUN 2018

TANGGAL JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

NOMOR IDENTITAS ALAMAT NO TELEPON/ DOAGNOS
NO NAMA PESERTA PELAYANA KET.
BPJS PESERTA HP A
N GDS GDP GDPP GDS GDP GDPP GDS GDP GDPP

1 TN.ABD. RAUF THALIB 0000201090396 BULADU 081356761555 DM √ 243 Rp 10,000

2 NY.ADRIAN LAJOMPO 0001236808618 TENILO DM √ 144 Rp 10,000
3 TN.AHMAD GULA 0000139775591 TENILO DM √ 405 Rp 10,000
4 NY.AISARI KASIM 0001236808631 TENILO DM √ 107 Rp 10,000
5 NY. DJAMI HARIS 0000960938019 BULIIDE DM √ 255 Rp 10,000
6 NY.FATMA UMAR 0001237989385 TENILO DM √ 105 Rp 10,000
7 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM √ 121 Rp 10,000
8 TN. FARIS TAHA 0001838836822 BULADU DM √ 245 Rp 10,000
9 TN.IBRAHIM PAATO 0000139667433 TENILO DM √ 145 Rp 10,000
10 TN.ISHAK KONILI 0001237543547 BULADU DM √ 106 Rp 10,000
11 NY.KARDINA ADIKO 0000959459398 BUIIDE 081342994481 DM √ 126 Rp 10,000
12 NY.MASTIN DAMA 0000960788709 TENILO 085240290119 DM √ 201 Rp 10,000
13 NY RITA HASAN 0000163525511 BULADU 085298414222 DM √ 105 Rp 10,000
14 NY.RISNA LATJENGKE 0001237946793 MOLOSIFAT W 085256122615 DM √ 167 Rp 10,000
15 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM √ 196 Rp 10,000
16 NY.SURIYATI DJAFAR 0000960525134 BULIIDE DM √ 173 Rp 10,000
17 TN.SALIM MOHAMAD 0001249532605 BULIIDE 085240011675 DM √ 299 Rp 10,000
18 TN. SYARIF ILIMULLAH 0000136769196 BULADU 082394686789 DM √ 140 Rp 10,000
19 NY. SAURIN LATJENGKE 00001315120645 MOLOSIFAT W DM √ 299 Rp 10,000
20 NY.VIBRIYANTI D.TUI 0000139685095 LIBUO DM √ 132 Rp 10,000
21 NY. WIRNA TANIYO 0001236267832 BULADU DM √ 210 Rp 10,000
22 NY.AISA MUSTAFA 0001249523087 BULADU DM+HT √ 204 Rp 10,000
23 .NY.ASTIN RAJAK 0000960511937 BULIIDE DM √ 258 Rp 10,000
24 NY.ERVINA NING DJAFAR 0001249515606 BULADU DM √ 258 Rp 10,000
25 FARIDA NANI 0001249526338 BULIIDE DM √ 182 Rp 10,000
26 NY. HADIJAH DATAU 0001249548208 MOLOSIFAT W DM √ 116 Rp 10,000
27 TN. ISA IBRAHIM 0000139649499 BULIIDE DM √ 186 Rp 10,000
28 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT √ 178 Rp 10,000
29 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM √ 168 Rp 10,000
30 NY KULSUM TANGAHU 0001267509115 MOLOSIFAT W 08534177211 DM √ 147 Rp 10,000
31 TN. KARIM BAHTIAR 0000139844698 BULADU DM √ 119 Rp 10,000
32 NY. LATIPA PADU 0000139651626 BULIIDE DM √ 213 Rp 10,000
33 NY. LENA MOHAMAD 0000137951032 LEKOBALO DM √ 154 Rp 10,000
34 NY LUNCE TAIB 0001236814637 BULADU 081527504855 DM √ 170 Rp 10,000
35 NY.NURSEHA MAKRUN 0000139796335 TULADENGGI DM + HT √ 167 Rp 10,000
36 NY.RAHIMA SALILO 0001249518857 BULIIDE DM+HT √ 108 Rp 10,000
37 NY.ROSITA UMAR 0001235081182 BULADU DM+HT √ 181 Rp 10,000
38 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT √ 224 Rp 10,000
39 NY. RASUNA LATJENGKE 0000961148474 MOLOSIFAT W DM √ 215 Rp 10,000
40 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM √ 159 Rp 10,000
41 NY. SERPIN MUSA 0000961024059 BULADU 085343615306 DM √ 252 Rp 10,000
42 TN. THAMRIN TULEN 0000139762697 H. BOTU DM+HT √ 116 Rp 10,000
JUMLAH Rp 10,000 Rp 410,000
TOTAL Rp 420,000
 REKAPITULASI PELAYANAN
IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN AGUSTUS TAHUN 2018

TANGGAL
NO NAMA PESERTA NOMOR IDENTITAS BPJS ALAMAT PESERTA NO TELEPON/ HP DOAGNOSA PELAYANAN

1 TN.AHMAD GULA 0000139775591 TENILO DM

2 NY.AISARI KASIM 0001236808631 TENILO DM
3 NY.FATMA UMAR 0001237989385 TENILO DM
4 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM
5 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM
6 NY. SAURIN LATJENGKE 00001315120645 DM
7 NY.VIBRIYANTI D.TUI 0000139685095 DM
8 NY. WIRNA TANIYO 0001236267832 DM
9 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT
10 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM
11 NY. MARYAM HULINGGI 0001234854055 DM
12 NY.NURSEHA MAKRUN 0000139796335 TULADENGGI DM + HT
13 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT
14 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM
15 TN. THAMRIN TULEN 0000139762697 H. BOTU DM+HT
JUMLAH
TOTAL
PITULASI PELAYANAN
EMENTASI PROLANIS
KESMAS KOTA BARAT
AGUSTUS TAHUN 2018

JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

KET.
GDS GDP GDPP GDS GDP GDPP GDS GDP GDPP
√ 212 Rp 10,000
√ 124 Rp 10,000
√ 164 Rp 10,000
√ 142 Rp 10,000
√ 179 Rp 10,000
√ 143 Rp 10,000
√ 125 Rp 10,000
√ 215 Rp 10,000
√ 178 Rp 10,000
√ 168 Rp 10,000
√ 133 Rp 10,000
√ 156 Rp 10,000
√ 224 Rp 10,000
√ 159 Rp 10,000
√ 129 Rp 10,000
Rp 150,000
Rp 150,000
 REKAPITULASI PELAYANAN
IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN SEPTEMBER TAHUN 2018

TANGGAL
NO NAMA PESERTA NOMOR IDENTITAS BPJS ALAMAT PESERTA NO TELEPON/ HP DOAGNOSA PELAYANAN

1 TN.ABD. RAUF THALIB 0000201090396 BULADU 081356761555 DM

2 NY.ADRIAN LAJOMPO 0001236808618 TENILO DM
3 TN.AHMAD GULA 0000139775591 TENILO DM
4 NY.AISARI KASIM 0001236808631 TENILO DM
5 NY. DJAMI HARIS 0000960938019 DM
6 TN. DADANG MUSTAFA 0000506541442 BULADU
7 NY.FATMA UMAR 0001237989385 TENILO DM
8 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM
9 TN. FARIS TAHA 0001838836822 BULADU DM
10 TN.IBRAHIM PAATO 0000139667433 TENILO DM
11 TN.ISHAK KONILI 0001237543547 BULADU DM
12 NY.KARDINA ADIKO 0000959459398 BUIIDE 081342994481 DM
13 NY. MILA AL AMRI 0001236430293 DM
14 NY.MASTIN DAMA 0000960788709 TENILO 085240290119 DM
15 NY RITA HASAN 0000163525511 BULADU 085298414222 DM
16 NY.RISNA LATJENGKE 0001237946793 MOLOSIFAT W 085256122615 DM
17 TN. RUSTAM LAPARAGA 0001235964644 BULADU 085398388992 DM
18 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM
19 NY.SURIYATI DJAFAR 0000960525134 BULIIDE DM
20 TN.SALIM MOHAMAD 0001249532605 BULIIDE 085240011675 DM
21 TN. SYARIF ILIMULLAH 0000136769196 BULADU 082394686789 DM
22 NY. SAURIN LATJENGKE 00001315120645 DM
23 NY.VIBRIYANTI D.TUI 0000139685095 DM
24 NY. WIRNA TANIYO 0001236267832 DM
25 TN.YUSUF IBRAHIM 0001235273073 BULADU 085341394068 DM
26 NY.AISA MUSTAFA 0001249523087 BULADU DM+HT
27 TN.ARDIN JAHJA 0001797584332 BULADU 085256539645 DM+HT
28 NY.ERVINA NING DJAFAR 0001249515606 BULADU DM
29 NY. FARIDA NANI 0001249526338 DM
30 NY. HADIJAH DATAU 0001249548208 MOLOSIFAT W DM
31 TN. ISA IBRAHIM 0000139649499 BULIIDE DM
32 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT
33 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM
34 NY KULSUM TANGAHU 0001267509115 MOLOSIFAT W 08534177211 DM
35 TN. KARIM BAHTIAR 0000139844698 BULADU DM
36 NY. LATIPA PADU 0000139651626 BULIIDE DM
37 NY. LENA MOHAMAD 0000137951032 DM
38 NY LUNCE TAIB 0001236814637 BULADU 081527504855 DM
39 NY. MARYAM HULINGGI 0001234854055 DM
40 NY.RAHIMA SALILO 0001249518857 BULIIDE DM+HT
41 NY.ROSITA UMAR 0001235081182 BULADU DM+HT
42 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT
43 NY. RASUNA LATJENGKE 0000961148474 MOLOSIFAT W DM
44 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM
45 NY. SERPIN MUSA 0000961024059 BULADU 085343615306 DM
46 TN. THAMRIN TULEN 0000139762697 H. BOTU DM+HT
47 TN. SAMSUDIN IBRAHIM 0001249699465 BULADU 085256914119 DM

JUMLAH
TOTAL
PITULASI PELAYANAN
EMENTASI PROLANIS
KESMAS KOTA BARAT
EPTEMBER TAHUN 2018

JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

KET.
GDS GDP GDPP GDS GDP GDPP GDS GDP GDPP
√ 110 Rp 10,000
√ 143 Rp 10,000
√ 245 Rp 10,000
√ 101 Rp 10,000
√ 232 Rp 10,000
√ 176 Rp 10,000
√ 128 Rp 10,000
√ 221 Rp 10,000
√ 327 Rp 10,000
√ 103 Rp 10,000
√ 188 Rp 10,000
√ 135 Rp 10,000
√ 154 Rp 10,000
√ 219 Rp 10,000
√ 230 Rp 10,000
√ 195 Rp 10,000
√ 183 Rp 10,000
√ 206 Rp 10,000
√ 160 Rp 10,000
√ 315 Rp 10,000
√ 189 Rp 10,000
√ 143 Rp 10,000
√ 125 Rp 10,000
√ 215 Rp 10,000
√ 211 Rp 10,000
√ 204 Rp 10,000
√ 231 Rp 10,000
√ 258 Rp 10,000
√ 109 Rp 10,000
√ 116 Rp 10,000
√ 186 Rp 10,000
√ 178 Rp 10,000
√ 168 Rp 10,000
√ 147 Rp 10,000
√ 119 Rp 10,000
√ 213 Rp 10,000
√ 154 Rp 10,000
√ 170 Rp 10,000
√ 175 Rp 10,000
√ 108 Rp 10,000
√ 181 Rp 10,000
√ 224 Rp 10,000
√ 215 Rp 10,000
√ 159 Rp 10,000
√ 252 Rp 10,000
√ 116 Rp 10,000
√ 154 Rp 10,000
Rp 470,000
Rp 470,000
 REKAPITULASI PELAYANAN
IMPLEMENTASI PROLANIS
PUSKESMAS KOTA BARAT
BULAN OKTOBER TAHUN 2018

NO TELEPON/ TANGGAL
NO NAMA PESERTA NOMOR IDENTITAS BPJS ALAMAT PESERTA HP DOAGNOSA PELAYANAN

1 TN.ABD. RAUF THALIB 0000201090396 BULADU 081356761555 DM

2 NY.ADRIAN LAJOMPO 0001236808618 TENILO DM
3 TN.AHMAD GULA 0000139775591 TENILO DM
4 NY.AISARI KASIM 0001236808631 TENILO DM
5 TN.ABUBAKAR MOHAMAD 0001249553755 DM
6 NY. DJAMI HARIS 0000960938019 DM
7 TN. DADANG MUSTAFA 0000506541442 BULADU
8 NY.FATMA UMAR 0001237989385 TENILO DM
9 NY.FITRI DADI 0001235668713 BULADU 085298488838 DM
10 TN. FARIS TAHA 0001838836822 BULADU DM
11 TN.IBRAHIM PAATO 0000139667433 TENILO DM
12 TN.ISHAK KONILI 0001237543547 BULADU DM
13 TN . ISWAN LATJENGKE 0001236779998 DM
14 NY.KARDINA ADIKO 0000959459398 BUIIDE 081342994481 DM
15 NY.MASTIN DAMA 0000960788709 TENILO 085240290119 DM
16 NY RITA HASAN 0000163525511 BULADU 085298414222 DM
17 NY.RISNA LATJENGKE 0001237946793 MOLOSIFAT W 085256122615 DM
18 TN.SAIFUL OTOLUWA 0000139841548 WUMIYALO 082188966727 DM
19 NY.SURIYATI DJAFAR 0000960525134 BULIIDE DM
20 TN.SALIM MOHAMAD 0001249532605 BULIIDE 085240011675 DM
21 TN. SYARIF ILIMULLAH 0000136769196 BULADU 082394686789 DM
22 NY. SAURIN LATJENGKE 00001315120645 DM
23 NY.VIBRIYANTI D.TUI 0000139685095 DM
24 NY. WIRNA TANIYO 0001236267832 DM
25 NY.AISA MUSTAFA 0001249523087 BULADU DM+HT
26 TN.ARDIN JAHJA 0001797584332 BULADU 085256539645 DM+HT
27 NY.ERVINA NING DJAFAR 0001249515606 BULADU DM
28 TN.ERVAN BIKI 0000959512149 BULIIDE 085340198628 DM
2 NY. FARIDA NANI 0001249526338 DM
30 NY. HADIJAH DATAU 0001249548208 MOLOSIFAT W DM
31 TN. ISA IBRAHIM 0000139649499 BULIIDE DM
32 NY. ISWARI MAHMUD 0000139815909 BULADU 081340027196 DM+HT
33 NY. INO PALOWA 0001249546691 MOLOSIFAT W DM
34 NY KULSUM TANGAHU 0001267509115 MOLOSIFAT W 08534177211 DM
35 TN. KARIM BAHTIAR 0000139844698 BULADU DM
36 NY. LATIPA PADU 0000139651626 BULIIDE DM
37 NY. LENA MOHAMAD 0000137951032 DM
38 NY LUNCE TAIB 0001236814637 BULADU 081527504855 DM
39 NY. MARYAM HULINGGI 0001234854055 DM
40 NY.NURSEHA MAKRUN 0000139796335 TULADENGGI DM + HT

41 NY.RAHIMA SALILO 0001249518857 BULIIDE DM+HT

42 NY.ROSITA UMAR 0001235081182 BULADU DM+HT

43 NY.RABIAH J SALEH 0000961374161 TENILO 082343240624 DM+HT
44 NY. RASUNA LATJENGKE 0000961148474 MOLOSIFAT W DM
45 NY.SAWIA ISHAK 0001235037701 MOLOSIFAT W 085240831363 DM
46 NY. SERPIN MUSA 0000961024059 BULADU 085343615306 DM
47 TN. THAMRIN TULEN 0000139762697 H. BOTU DM+HT
JUMLAH
TOTAL
PITULASI PELAYANAN
EMENTASI PROLANIS
KESMAS KOTA BARAT
OKTOBER TAHUN 2018

JENIS PEMERIKSAAN HASIL PEMERRIKSAAN JUMLAH TAGIHAN

KET.
GDS GDP GDPP GDS GDP GDPP GDS GDP GDPP
√ 137 Rp 10,000
√ 144 Rp 10,000
√ 405 Rp 10,000
√ 107 Rp 10,000
√ 111 Rp 10,000
√ 255 Rp 10,000
√
√ 105 Rp 10,000
√ 121 Rp 10,000
√ 245 Rp 10,000
√ 145 Rp 10,000
√ 106 Rp 10,000
√ 192 Rp 10,000
√ 135 Rp 10,000
√ 201 Rp 10,000
√ 230 Rp 10,000
√ 195 Rp 10,000
√ 196 Rp 10,000
√ 173 Rp 10,000
√ 299 Rp 10,000
√ 140 Rp 10,000
√ 299 Rp 10,000
√ 132 Rp 10,000
√ 210 Rp 10,000
√ 147 Rp 10,000
√ 198 Rp 10,000
√ 304 Rp 10,000
√ 156 Rp 10,000
√ 186 Rp 10,000
√ 299 Rp 10,000
√ 185 Rp 10,000
√ 143 Rp 10,000
√ 164 Rp 10,000
√ 202 Rp 10,000
√ 120 Rp 10,000
√ 134 Rp 10,000
√ 120 Rp 10,000
√ 88 Rp 10,000
√ 231 Rp 10,000
√ 185 Rp 10,000
√ 106 Rp 10,000
√ 209 Rp 10,000
√ 182 Rp 10,000
√ 308 Rp 10,000
√ 144 Rp 10,000
√ 111 Rp 10,000
√ 98 Rp 10,000
Rp 20,000 Rp 440,000
Rp 460,000