TANDA TERIMA PERSALINAN Lengkap

TANDA TERIMA KLAIM DANA PERSALINAN ( JKN )
PUSKESMAS RAWAT INAP TANJUNGBINTANG
BULAN : MARET 2018

JENIS PELAYANAN JUMLAH YANG DITERIMA (Rp)
PENANGANAN PENANGANAN
PERDARAHAN PELAYANAN
PERDARAHAN PELAYANAN PRA PASKA PRA
PASKA TOTAL YANG
NO PERSALINAN KEGUGURAN, TINDAKAN RUJUKAN PD PNC PNC PNC PERSALINAN KEGUGURAN, TINDAKAN RUJUKAN PD JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
ANC 1 ANC 2 ANC 3 ANC 4 NORMAL PAERSALINAN PASKA KOMPLIKASI 1 2 3 ANC 1 ANC 2 ANC 3 ANC 4 NORMAL PAERSALINAN PASKA KOMPLIKASI PNC 1 PNC 2 PNC 3 (Rp)
PERVAGINAM DG PERSALINAN KEBIDANAN DAN PERVAGINAM DG PERSALINAN KEBIDANAN
NEONATAL TIND. DAN
TIND. EMERGENSI EMERGENSI NEONATAL
DASAR
DASAR
1 RAHAYU 2 2 2 2 3 0 0 0 2 5 7 100,000 100,000 100,000 100,000 2,100,000 0 0 0 50,000 125,000 175,000 2,850,000 142,500 2,707,500 1
2 MUTIA PKM 1 1 1 1 1 0 0 0 1 0 0 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 0 0 555,000 27,750 527,250 2
3 JILLY PUNICA 3 3 3 3 4 0 0 0 4 5 4 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 125,000 100,000 3,725,000 186,250 3,538,750 3
4 HESTI RESTU 1 1 1 1 2 0 0 0 2 1 0 50,000 50,000 50,000 50,000 1,400,000 0 0 0 50,000 25,000 0 1,675,000 83,750 1,591,250 4
5 HALIDESNA 1 1 1 1 3 0 0 0 3 0 3 50,000 50,000 50,000 50,000 2,100,000 0 0 0 75,000 0 75,000 2,450,000 122,500 2,327,500 5
6 PUJI AIRAWATI 2 2 2 2 3 0 0 0 3 3 6 100,000 100,000 100,000 100,000 2,100,000 0 0 0 75,000 75,000 150,000 2,800,000 140,000 2,660,000 6
7 YULINAWATI 3 3 3 3 5 0 0 0 5 2 3 150,000 150,000 150,000 150,000 3,500,000 0 0 0 125,000 50,000 75,000 4,350,000 217,500 4,132,500 7
8 RISTIANA 6 6 6 6 8 0 0 0 8 4 2 300,000 300,000 300,000 300,000 5,600,000 0 0 0 200,000 100,000 50,000 7,150,000 357,500 6,792,500 8
9 RUBIYATI 2 2 2 2 2 0 0 0 2 1 2 100,000 100,000 100,000 100,000 0 0 0 50,000 25,000 50,000 525,000 26,250 498,750 9
10 WAWAT MIKE 3 3 3 3 3 0 0 0 2 3 2 150,000 150,000 150,000 150,000 2,100,000 0 0 0 50,000 75,000 50,000 2,875,000 143,750 2,731,250 10
11 REVI DWITA 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 11
TOTAL 24 24 24 24 34 0 0 0 32 25 30 1,200,000 1,200,000 1,200,000 1,200,000 22,400,000 0 0 0 800,000 625,000 750,000 29,005,000 1,450,250 27,554,750
MENGETAHUI :
KA. UPT PUSKESMAS RI TANJUNG BINTANG
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
Pajak
maret 2018 1538750

Sep-18 1560000
November 1605000
Oktober 18 422500
Total 5,126,250 102525000 97,398,750
TERIMA KLEM TOTAL TERIMA

NAMA BIDAN MARET 2018 Sep-18 Nov-18 OKTOBER ANC PNC 2018
RAHAYU Rp 2,707,500 Rp 7,386,250 Rp 4,417,500 Rp 2,208,750 Rp 16,720,000 Rp 1,300,000
MUTIA PKM Rp 527,250 Rp 1,097,250 Rp - Rp 28,500 Rp 1,653,000
JILLY PUNICA Rp 3,538,750 Rp 3,728,750 Rp 2,707,500 Rp 237,500 Rp 10,212,500 Rp 600,000
HESTI RESTU Rp 1,591,250 Rp 47,500 Rp 1,828,750 Rp 1,306,250 Rp 4,773,750 Rp 200,000
HALIDESNA Rp 2,327,500 Rp 1,805,000 Rp 1,781,250 Rp 308,750 Rp 6,222,500 Rp 250,000
PUJI AIRAWATI Rp 2,660,000 Rp 3,776,250 Rp 2,778,750 Rp 783,750 Rp 9,998,750 Rp 350,000
YULINAWATI Rp 4,132,500 Rp 950,000 Rp 2,541,250 Rp 831,250 Rp 8,455,000 Rp 300,000
RISTIANA Rp 6,792,500 Rp 1,781,250 Rp 4,393,750 Rp 617,500 Rp 13,585,000 Rp 500,000
RUBIYATI Rp 1,828,750 Rp 1,995,000 Rp 2,778,750 Rp 831,250 Rp 7,433,750 Rp 200,000
WAWAT MIKE Rp 2,731,250 Rp 2,731,250 Rp 3,633,750 Rp 380,000 Rp 9,476,250 Rp 300,000
REVI DWITA Rp 47,500 Rp 23,750 Rp 902,500 Rp 475,000 Rp 1,448,750
MEKA Rp - Rp - Rp 878,750 Rp 878,750 Rp 50,000
IRIN S DEWI Rp 3,586,250 Rp 1,852,500 Rp 5,438,750 Rp 300,000
TOTAL Rp 28,884,750 Rp 28,908,500 Rp 30,495,000 Rp 8,008,500 Rp 96,296,750
Rp 29,236,250 Rp 29,640,000 Rp 30,495,000 Rp 8,027,500 Rp 97,398,750
BULAN : OKTOBER 2018

PENANGANAN
PENANGANAN
PERDARAHAN PERDARAHAN PELAYANAN
PASKA PELAYANAN PRA PASKA PRA TOTAL YANG
NO NAMA BIDAN TINDAKAN RUJUKAN PD KEGUGURAN, TINDAKAN RUJUKAN PD JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
ANC 1 ANC 2 ANC 3 ANC 4 PERSALINAN KEGUGURAN, PASKA KOMPLIKASI PNC PNC PNC ANC 1 ANC 2 ANC 3 ANC 4 PERSALINAN PAERSALINAN PASKA KOMPLIKASI PNC 1 PNC 2 PNC 3
NORMAL PAERSALINAN 1 2 3 NORMAL (Rp)
TIND. EMERGENSI NEONATAL TIND. DAN
EMERGENSI NEONATAL
DASAR DASAR
1 RAHAYU 8 8 8 8 0 0 0 9 11 9 400,000 400,000 400,000 400,000 0 0 0 0 225,000 275,000 225,000 2,325,000 116,250 2,208,750 1
2 YULINAWATI 3 3 3 3 0 0 0 4 5 2 150,000 150,000 150,000 150,000 0 0 0 0 100,000 125,000 50,000 875,000 43,750 831,250 2
3 REVI DWITA 2 2 2 2 0 0 0 2 2 0 100,000 100,000 100,000 100,000 0 0 0 0 50,000 50,000 0 500,000 25,000 475,000 3
4 JILLY PUNICA 1 1 1 1 0 0 0 1 1 0 50,000 50,000 50,000 50,000 0 0 0 0 25,000 25,000 0 250,000 12,500 237,500 4
5 HALIDESNA 1 1 1 1 0 0 0 1 1 3 50,000 50,000 50,000 50,000 0 0 0 0 25,000 25,000 75,000 325,000 16,250 308,750 5
6 PUJI AIRAWATI 3 3 3 3 0 0 0 2 2 5 150,000 150,000 150,000 150,000 0 0 0 0 50,000 50,000 125,000 825,000 41,250 783,750 6
7 RUBIYATI 3 3 3 3 0 0 0 3 3 5 150,000 150,000 150,000 150,000 0 0 0 0 75,000 75,000 125,000 875,000 43,750 831,250 7
8 RISTIANA 2 2 2 2 0 0 0 4 5 1 100,000 100,000 100,000 100,000 0 0 0 0 100,000 125,000 25,000 650,000 32,500 617,500 8
9 WAWAT MIKE 1 1 1 1 0 0 0 1 1 6 50,000 50,000 50,000 50,000 0 0 0 0 25,000 25,000 150,000 400,000 20,000 380,000 9
10 HESTI RESTU 6 6 6 6 0 0 0 7 0 0 300,000 300,000 300,000 300,000 0 0 0 0 175,000 0 0 1,375,000 68,750 1,306,250 10
11 MUTIA PKM 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 30,000 1,500 28,500 11
TOTAL 30 30 30 30 0 0 0 34 32 32 1,500,000 1,500,000 1,500,000 1,500,000 0 0 0 0 850,000 800,000 800,000 8,430,000 421,500 8,008,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : NOVEMBER 2018

PENANGANAN
PENANGANAN PERDARAHAN PELAYANAN
PASKA TOTAL YANG
NO NAMA BIDAN PERSALINAN KEGUGURAN, TINDAKAN RUJUKAN PD PNC PNC PNC PERSALINAN KEGUGURAN, TINDAKAN RUJUKAN PD JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
PERSALINAN KEBIDANAN DAN PERVAGINAM DG PERSALINAN KEBIDANAN
PERVAGINAM DG NEONATAL TIND. DAN
DASAR
DASAR
1 RAHAYU 3 3 3 3 5 0 0 0 7 6 9 150,000 150,000 150,000 150,000 3,500,000 0 0 0 175,000 150,000 225,000 4,650,000 232,500 4,417,500 1
2 HESTI RESTU 2 2 2 2 2 0 0 0 2 1 2 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 50,000 1,925,000 96,250 1,828,750 2
3 JILLY PUNICA 2 2 2 2 3 0 0 0 7 7 0 100,000 100,000 100,000 100,000 2,100,000 0 0 0 175,000 175,000 0 2,850,000 142,500 2,707,500 3
4 YULINAWATI 2 2 2 2 3 0 0 0 4 3 0 100,000 100,000 100,000 100,000 2,100,000 0 0 0 100,000 75,000 0 2,675,000 133,750 2,541,250 4
5 IRINE S DEWI 2 2 2 2 2 0 0 0 2 2 2 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 50,000 50,000 1,950,000 97,500 1,852,500 5
6 PUJI AIRAWATI 3 3 3 3 3 0 0 0 3 3 3 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 75,000 75,000 2,925,000 146,250 2,778,750 6
7 RISTIANA 4 4 4 4 5 0 0 0 5 4 4 200,000 200,000 200,000 200,000 3,500,000 0 0 0 125,000 100,000 100,000 4,625,000 231,250 4,393,750 7
8 HALIDESNA 2 2 2 2 2 0 0 0 2 1 0 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 0 1,875,000 93,750 1,781,250 8
10 MEKA 1 1 1 1 1 0 0 0 1 0 0 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 0 0 925,000 46,250 878,750 9
10 RUBIYATI 3 3 3 3 3 0 0 0 3 3 3 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 75,000 75,000 2,925,000 146,250 2,778,750 10
11 WAWAT MIKE 4 4 4 4 4 0 0 0 4 4 1 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 100,000 25,000 3,825,000 191,250 3,633,750 11
12 REVI DWITA 1 1 1 1 1 0 0 0 1 0 1 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 0 25,000 950,000 47,500 902,500 12
TOTAL 29 29 29 29 34 0 0 0 41 34 25 1,450,000 1,450,000 1,450,000 1,450,000 23,800,000 0 0 0 1,025,000 850,000 625,000 32,100,000 1,605,000 30,495,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : SEPTEMBER 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 5 5 5 5 9 0 0 0 8 6 5 250,000 250,000 250,000 250,000 6,300,000 0 0 0 200,000 150,000 125,000 7,775,000 388,750 7,386,250 1
2 MUTIA PKM 2 2 2 2 2 0 0 0 2 1 2 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 50,000 1,155,000 57,750 1,097,250 2
3 HALIDESNA 2 2 2 2 2 0 0 0 2 2 0 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 50,000 0 1,900,000 95,000 1,805,000 3
4 RISTIANA 1 1 1 1 2 0 0 0 3 2 6 50,000 50,000 50,000 50,000 1,400,000 0 0 0 75,000 50,000 150,000 1,875,000 93,750 1,781,250 4
5 JILLY PUNICA 3 3 3 3 4 0 0 0 5 6 10 150,000 150,000 150,000 150,000 2,800,000 0 0 0 125,000 150,000 250,000 3,925,000 196,250 3,728,750 5
6 PUJI AIRAWATI 4 4 4 4 4 0 0 0 4 6 5 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 150,000 125,000 3,975,000 198,750 3,776,250 6
7 YULINAWATI 1 1 1 1 1 0 0 0 1 0 3 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 0 75,000 1,000,000 50,000 950,000 7
8 IRINE S DEWI 4 4 4 4 4 0 0 0 4 3 0 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 75,000 0 3,775,000 188,750 3,586,250 8
9 RUBIYATI 2 2 2 2 2 0 0 0 2 3 7 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 75,000 175,000 2,100,000 105,000 1,995,000 9
10 WAWAT MIKE 3 3 3 3 3 0 0 0 3 3 1 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 75,000 25,000 2,875,000 143,750 2,731,250 10
11 REVI DWITA 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 11
11 HESTI RESTU 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 12
TOTAL 27 27 27 27 33 0 0 0 34 33 41 1,350,000 1,350,000 1,350,000 1,350,000 23,100,000 0 0 0 850,000 825,000 1,025,000 30,430,000 1,521,500 28,908,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : MARET 2018

PASKA TOTAL YANG
NO PERSALINAN KEGUGURAN, TINDAKAN RUJUKAN PD PNC PNC PNC PERSALINAN KEGUGURAN, TINDAKAN RUJUKAN PD JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
NEONATAL TIND. DAN
DASAR
DASAR
1 RAHAYU 2 2 2 2 3 0 0 0 2 5 7 100,000 100,000 100,000 100,000 2,100,000 0 0 0 50,000 125,000 175,000 2,850,000 142,500 2,707,500 1
2 MUTIA PKM 1 1 1 1 1 0 0 0 1 0 0 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 0 0 555,000 27,750 527,250 2
3 JILLY PUNICA 3 3 3 3 4 0 0 0 4 5 4 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 125,000 100,000 3,725,000 186,250 3,538,750 3
4 HESTI RESTU 1 1 1 1 2 0 0 0 2 1 0 50,000 50,000 50,000 50,000 1,400,000 0 0 0 50,000 25,000 0 1,675,000 83,750 1,591,250 4
5 HALIDESNA 1 1 1 1 3 0 0 0 3 0 3 50,000 50,000 50,000 50,000 2,100,000 0 0 0 75,000 0 75,000 2,450,000 122,500 2,327,500 5
6 PUJI AIRAWATI 2 2 2 2 3 0 0 0 3 3 6 100,000 100,000 100,000 100,000 2,100,000 0 0 0 75,000 75,000 150,000 2,800,000 140,000 2,660,000 6
7 YULINAWATI 3 3 3 3 5 0 0 0 5 2 3 150,000 150,000 150,000 150,000 3,500,000 0 0 0 125,000 50,000 75,000 4,350,000 217,500 4,132,500 7
8 RISTIANA 6 6 6 6 8 0 0 0 8 4 2 300,000 300,000 300,000 300,000 5,600,000 0 0 0 200,000 100,000 50,000 7,150,000 357,500 6,792,500 8
9 RUBIYATI 2 2 2 2 2 0 0 0 2 1 2 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 50,000 1,925,000 96,250 1,828,750 9
10 WAWAT MIKE 3 3 3 3 3 0 0 0 2 3 2 150,000 150,000 150,000 150,000 2,100,000 0 0 0 50,000 75,000 50,000 2,875,000 143,750 2,731,250 10
11 REVI DWITA 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 11
TOTAL 24 24 24 24 34 0 0 0 32 25 30 1,200,000 1,200,000 1,200,000 1,200,000 23,800,000 0 0 0 800,000 625,000 750,000 30,405,000 1,520,250 28,884,750
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001

PASKA TOTAL YANG
NEONATAL TIND. DAN
DASAR
DASAR
1 RAHAYU 9 0 0 0 0 0 0 0 6,300,000 0 0 0 0 0 0 6,300,000 315,000 5,985,000 1
2 YULINAWATI 4 0 0 0 0 0 0 0 2,800,000 0 0 0 0 0 0 2,800,000 140,000 2,660,000 2
3 REVI DWITA 2 0 0 0 0 0 0 0 1,400,000 0 0 0 0 0 0 1,400,000 70,000 1,330,000 3
4 JILLY PUNICA 1 0 0 0 0 0 0 0 700,000 0 0 0 0 0 0 700,000 35,000 665,000 4
5 HALIDESNA 1 0 0 0 0 0 0 0 700,000 0 0 0 0 0 0 700,000 35,000 665,000 5
6 PUJI AIRAWATI 3 0 0 0 0 0 0 0 2,100,000 0 0 0 0 0 0 2,100,000 105,000 1,995,000 6
7 RUBIYATI 3 0 0 0 0 0 0 0 2,100,000 0 0 0 0 0 0 2,100,000 105,000 1,995,000 7
8 RISTIANA 4 0 0 0 0 0 0 0 2,800,000 0 0 0 0 0 0 2,800,000 140,000 2,660,000 8
9 WAWAT MIKE 1 0 0 0 0 0 0 0 700,000 0 0 0 0 0 0 700,000 35,000 665,000 9
10 HESTI RESTU 7 0 0 0 0 0 0 0 4,900,000 0 0 0 0 0 0 4,900,000 245,000 4,655,000 10
11 PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11
TOTAL 35 0 0 0 0 0 0 0 24,500,000 0 0 0 0 0 0 24,500,000 1,225,000 23,275,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : FEBRUARI 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 6 6 6 6 7 0 0 0 7 4 3 300,000 300,000 300,000 300,000 4,900,000 0 0 0 175,000 100,000 75,000 6,450,000 322,500 6,127,500 1
2 YULINAWATI 2 2 2 2 3 0 0 0 3 4 5 100,000 100,000 100,000 100,000 2,100,000 0 0 0 75,000 100,000 125,000 2,800,000 140,000 2,660,000 2
3 REVI DWITA 0 0 0 0 1 0 0 0 1 0 3 0 0 0 0 700,000 0 0 0 25,000 0 75,000 800,000 40,000 760,000 3
4 JILLY PUNICA 3 3 3 3 4 0 0 0 4 4 3 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 100,000 75,000 3,675,000 183,750 3,491,250 4
5 HALIDESNA 3 3 3 3 3 0 0 0 3 4 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 100,000 100,000 2,975,000 148,750 2,826,250 5
6 PUJI AIRAWATI 4 4 4 4 7 0 0 0 7 6 5 200,000 200,000 200,000 200,000 4,900,000 0 0 0 175,000 150,000 125,000 6,150,000 307,500 5,842,500 6
7 RUBIYATI 2 2 2 2 2 0 0 0 2 3 5 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 75,000 125,000 2,050,000 102,500 1,947,500 7
8 RISTIANA 2 2 2 2 2 0 0 0 2 2 1 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 50,000 25,000 1,925,000 96,250 1,828,750 8
9 WAWAT MIKE 1 1 1 1 1 0 0 0 1 2 6 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 50,000 150,000 1,125,000 56,250 1,068,750 9
10 HESTI RESTU 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 700,000 0 0 0 25,000 25,000 0 750,000 37,500 712,500 10
11 PUSKESMAS 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 11
TOTAL 23 23 23 23 31 0 0 0 31 31 36 1,150,000 1,150,000 1,150,000 1,150,000 21,700,000 0 0 0 775,000 775,000 900,000 28,750,000 1,437,500 27,312,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
BULAN : AGUSTUS 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 3 3 3 3 5 0 0 0 5 6 5 150,000 150,000 150,000 150,000 3,500,000 0 0 0 125,000 150,000 125,000 4,500,000 225,000 4,275,000 1
2 MUTIA PKM 2 2 2 2 3 0 0 1 2 2 100,000 100,000 100,000 100,000 2,100,000 0 #VALUE! 0 25,000 50,000 50,000 #VALUE! #VALUE! #VALUE! 2
3 RISTIANA 5 5 5 5 6 0 0 0 5 7 4 250,000 250,000 250,000 250,000 4,200,000 0 0 0 125,000 175,000 100,000 5,600,000 280,000 5,320,000 3
4 RUBIYATI 5 5 5 5 7 0 0 0 7 6 6 250,000 250,000 250,000 250,000 4,900,000 0 0 0 175,000 150,000 150,000 6,375,000 318,750 6,056,250 4
5 YULINAWATI 3 3 3 3 4 0 0 0 4 5 5 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 125,000 125,000 3,750,000 187,500 3,562,500 5
6 PUJI AIRAWATI 4 4 4 4 5 0 0 0 4 4 6 200,000 200,000 200,000 200,000 3,500,000 0 0 0 100,000 100,000 150,000 4,650,000 232,500 4,417,500 6
7 REVI DWITA 0 0 0 0 1 0 0 0 1 2 3 0 0 0 0 700,000 0 0 0 25,000 50,000 75,000 850,000 42,500 807,500 7
8 HESTI RESTU 1 1 1 1 1 0 0 0 1 0 3 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 0 75,000 1,000,000 50,000 950,000 8
9 JILLY PUNICA 7 7 7 7 10 0 0 0 8 12 10 350,000 350,000 350,000 350,000 7,000,000 0 0 0 200,000 300,000 250,000 9,150,000 457,500 8,692,500 9
10 WAWAT MIKE 1 1 1 1 1 0 0 0 1 4 4 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 100,000 100,000 1,125,000 56,250 1,068,750 10
11 MEKA FITRIANA 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 11
TOTAL 31 31 31 31 43 0 0 0 37 48 49 1,550,000 1,550,000 1,550,000 1,550,000 30,100,000 0 0 0 925,000 1,200,000 1,225,000 #VALUE! #VALUE! #VALUE!
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : JULI 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 4 4 4 4 6 0 0 0 6 4 7 200,000 200,000 200,000 200,000 4,200,000 0 0 0 150,000 100,000 175,000 5,425,000 271,250 5,153,750 1
2 MUTIA PKM 0 0 0 0 2 0 0 0 2 4 2 0 0 0 0 1,400,000 0 0 0 50,000 100,000 50,000 960,000 48,000 912,000 2
3 YULINAWATI 5 5 5 5 5 0 0 0 5 2 5 250,000 250,000 250,000 250,000 3,500,000 0 0 0 125,000 50,000 125,000 4,800,000 240,000 4,560,000 3
4 MEKA FITRIANI 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 700,000 0 0 0 25,000 25,000 25,000 775,000 38,750 736,250 4
5 HESTI RESTU 3 3 3 3 3 0 0 0 3 2 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 50,000 100,000 2,925,000 146,250 2,778,750 5
6 REVI DWITA 3 3 3 3 3 0 0 0 3 2 0 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 50,000 0 2,825,000 141,250 2,683,750 6
7 RISTIANA 3 3 3 3 4 0 0 0 3 3 1 150,000 150,000 150,000 150,000 2,800,000 0 0 0 75,000 75,000 25,000 3,575,000 178,750 3,396,250 7
8 JILLY PUNICA 7 7 7 7 9 0 0 0 8 7 6 350,000 350,000 350,000 350,000 6,300,000 0 0 0 200,000 175,000 150,000 8,225,000 411,250 7,813,750 8
9 RUBIYATI 6 6 6 6 7 0 0 0 7 4 3 300,000 300,000 300,000 300,000 4,900,000 0 0 0 175,000 100,000 75,000 6,450,000 322,500 6,127,500 9
10 PUJI AIRAWATI 5 5 5 5 7 0 0 0 7 7 7 250,000 250,000 250,000 250,000 4,900,000 0 0 0 175,000 175,000 175,000 6,425,000 321,250 6,103,750 10
11 WAWAT MIKE 3 3 3 3 4 0 0 0 3 1 1 150,000 150,000 150,000 150,000 2,800,000 0 0 0 75,000 25,000 25,000 3,525,000 176,250 3,348,750 11
12 HALIDESNA 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 100,000 100,000 200,000 10,000 190,000 12
TOTAL 39 39 39 39 51 0 0 0 48 41 41 1,950,000 1,950,000 1,950,000 1,950,000 35,700,000 0 0 0 1,200,000 1,025,000 1,025,000 46,110,000 2,305,500 43,804,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : JULI 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 4 4 4 4 6 0 0 0 6 5 7 200,000 200,000 200,000 200,000 4,200,000 0 0 0 150,000 125,000 175,000 5,450,000 272,500 5,177,500 1
2 MUTIA PKM 0 0 0 0 2 0 0 0 2 4 2 0 0 0 0 1,400,000 0 0 0 50,000 100,000 50,000 1,600,000 80,000 1,520,000 2
3 YULINAWATI 5 5 5 5 5 0 0 0 5 4 5 250,000 250,000 250,000 250,000 3,500,000 0 0 0 125,000 100,000 125,000 4,850,000 242,500 4,607,500 3
4 MEKA FITRIANI 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 700,000 0 0 0 25,000 25,000 25,000 775,000 38,750 736,250 4
5 HESTI RESTU 3 3 3 3 3 0 0 0 3 4 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 100,000 100,000 2,975,000 148,750 2,826,250 5
6 REVI DWITA 3 3 3 3 3 0 0 0 3 2 0 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 50,000 0 2,825,000 141,250 2,683,750 6
7 RISTIANA 3 3 3 3 4 0 0 0 4 3 1 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 75,000 25,000 3,600,000 180,000 3,420,000 7
8 JILLY PUNICA 7 7 7 7 9 0 0 0 8 7 6 350,000 350,000 350,000 350,000 6,300,000 0 0 0 200,000 175,000 150,000 8,225,000 411,250 7,813,750 8
9 RUBIYATI 6 6 6 6 7 0 0 0 7 7 3 300,000 300,000 300,000 300,000 4,900,000 0 0 0 175,000 175,000 75,000 6,525,000 326,250 6,198,750 9
10 PUJI AIRAWATI 5 5 5 5 7 0 0 0 7 8 7 250,000 250,000 250,000 250,000 4,900,000 0 0 0 175,000 200,000 175,000 6,450,000 322,500 6,127,500 10
11 WAWAT MIKE 3 3 3 3 4 0 0 0 4 2 1 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 50,000 25,000 3,575,000 178,750 3,396,250 11
12 HALIDESNA 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 100,000 100,000 200,000 10,000 190,000 12
TOTAL 39 39 39 39 51 0 0 0 50 51 41 1,950,000 1,950,000 1,950,000 1,950,000 35,700,000 0 0 0 1,250,000 1,275,000 1,025,000 47,050,000 2,352,500 44,697,500
83,550,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
BULAN : JUNI 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 3 3 3 3 7 0 0 0 7 8 7 150,000 150,000 150,000 150,000 4,900,000 0 0 0 175,000 200,000 175,000 6,050,000 302,500 5,747,500 1
2 RISTIANA 0 0 0 0 1 0 0 0 2 2 5 0 0 0 0 700,000 0 0 0 50,000 50,000 125,000 925,000 46,250 878,750 2
3 YULINAWATI 2 2 2 2 5 0 0 0 3 5 5 100,000 100,000 100,000 100,000 3,500,000 0 0 0 75,000 125,000 125,000 4,225,000 211,250 4,013,750 3
4 JILLY PUNICA 4 4 4 4 5 0 0 0 6 5 4 200,000 200,000 200,000 200,000 3,500,000 0 0 0 150,000 125,000 100,000 4,675,000 233,750 4,441,250 4
5 HALLDESNA 2 2 2 2 4 0 0 0 4 1 2 100,000 100,000 100,000 100,000 2,800,000 0 0 0 100,000 25,000 50,000 3,375,000 168,750 3,206,250 5
6 HESTI RESTU 3 3 3 3 4 0 0 0 3 3 4 150,000 150,000 150,000 150,000 2,800,000 0 0 0 75,000 75,000 100,000 3,650,000 182,500 3,467,500 6
7 RUBIYATI 3 3 3 3 3 0 0 0 3 2 5 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 50,000 125,000 2,950,000 147,500 2,802,500 7
8 MEKA FITRIANI 1 1 1 1 1 0 0 0 1 1 2 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 50,000 1,000,000 50,000 950,000 8
9 PUJI AIRAWATI 7 7 7 7 8 0 0 0 6 6 0 350,000 350,000 350,000 350,000 5,600,000 0 0 0 150,000 150,000 0 7,300,000 365,000 6,935,000 9
10 WAWAT MIKE 1 1 1 1 1 0 0 0 1 1 1 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 25,000 975,000 48,750 926,250 10
11 MUTIA PKM 1 1 1 1 2 0 0 0 2 0 3 50,000 50,000 50,000 50,000 1,400,000 0 0 0 50,000 0 75,000 1,725,000 86,250 1,638,750 11
TOTAL 27 27 27 27 41 0 0 0 38 34 38 1,350,000 1,350,000 1,350,000 1,350,000 28,700,000 0 0 0 950,000 850,000 950,000 36,850,000 1,842,500 35,007,500
73,350,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
BULAN : MEI 2018

PASKA TOTAL YANG
NEONATAL TIND. DAN
DASAR
DASAR
1 RAHAYU 4 4 4 4 7 0 0 0 7 6 10 200,000 200,000 200,000 200,000 4,900,000 0 0 0 175,000 150,000 250,000 6,275,000 313,750 5,961,250 1
2 RISTIANA 4 4 4 4 5 0 0 0 5 4 4 200,000 200,000 200,000 200,000 3,500,000 0 0 0 125,000 100,000 100,000 4,625,000 231,250 4,393,750 2
3 YULINAWATI 4 4 4 4 5 0 0 0 5 5 4 200,000 200,000 200,000 200,000 3,500,000 0 0 0 125,000 125,000 100,000 4,650,000 232,500 4,417,500 3
4 JILLY PUNICA 3 3 3 3 4 0 0 0 3 3 6 150,000 150,000 150,000 150,000 2,800,000 0 0 0 75,000 75,000 150,000 3,700,000 185,000 3,515,000 4
5 HALLDESNA 2 2 2 2 2 0 0 0 2 1 1 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 25,000 1,900,000 95,000 1,805,000 5
6 HESTI RESTU 3 3 3 3 6 0 0 0 5 5 7 150,000 150,000 150,000 150,000 4,200,000 0 0 0 125,000 125,000 175,000 5,225,000 261,250 4,963,750 6
7 RUBIYATI 3 3 3 3 5 0 0 0 5 5 5 150,000 150,000 150,000 150,000 3,500,000 0 0 0 125,000 125,000 125,000 4,475,000 223,750 4,251,250 7
8 MEKA FITRIANI 2 2 2 2 2 0 0 0 2 2 2 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 50,000 50,000 1,950,000 97,500 1,852,500 8
9 IRIN S DEWI 1 1 1 1 1 0 0 0 1 1 1 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 25,000 975,000 48,750 926,250 9
10 MUTIA PKM 2 2 2 2 3 0 0 0 3 3 3 100,000 100,000 100,000 100,000 2,100,000 0 0 0 75,000 75,000 75,000 2,725,000 136,250 2,588,750 10
TOTAL 28 28 28 28 40 0 0 0 38 35 43 1,400,000 1,400,000 1,400,000 1,400,000 28,000,000 0 0 0 950,000 875,000 1,075,000 36,500,000 1,825,000 34,675,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : APRIL 2018

PENANGANAN
PASKA TOTAL YANG
DASAR
DASAR
1 RAHAYU 8 8 8 8 10 0 0 0 9 11 5 400,000 400,000 400,000 400,000 7,000,000 0 0 0 225,000 275,000 125,000 9,225,000 461,250 8,763,750 1
2 RISTIANA 4 4 4 4 4 0 0 0 4 6 8 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 150,000 200,000 4,050,000 202,500 3,847,500 2
3 YULINAWATI 4 4 4 4 5 0 0 0 5 4 5 200,000 200,000 200,000 200,000 3,500,000 0 0 0 125,000 100,000 125,000 4,650,000 232,500 4,417,500 3
4 JILLY PUNICA 4 4 4 4 6 0 0 0 6 5 4 200,000 200,000 200,000 200,000 4,200,000 0 0 0 150,000 125,000 100,000 5,375,000 268,750 5,106,250 4
5 HALLDESNA 2 2 2 2 3 0 0 0 2 5 3 100,000 100,000 100,000 100,000 2,100,000 0 0 0 50,000 125,000 75,000 2,750,000 137,500 2,612,500 5
6 PUJI AIRAWAT] 4 4 4 4 4 0 0 0 4 5 2 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 125,000 50,000 3,875,000 193,750 3,681,250 6
7 HESTI RESTU 3 3 3 3 4 0 0 0 4 3 2 150,000 150,000 150,000 150,000 2,800,000 0 0 0 100,000 75,000 50,000 3,625,000 181,250 3,443,750 7
8 RUBIYATI 1 1 1 1 3 0 0 0 3 3 2 50,000 50,000 50,000 50,000 2,100,000 0 0 0 75,000 75,000 50,000 2,500,000 125,000 2,375,000 8
9 WAWAT MIKE 2 2 2 2 2 0 0 0 3 3 3 100,000 100,000 100,000 100,000 1,400,000 0 0 0 75,000 75,000 75,000 2,025,000 101,250 1,923,750 9
10 MUTIA PKM 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 10
TOTAL 32 32 32 32 41 0 0 0 40 46 35 1,600,000 1,600,000 1,600,000 1,600,000 28,700,000 0 0 0 1,000,000 1,150,000 875,000 38,125,000 1,906,250 36,218,750
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
PENERIMAAN KLEM PERSALINAN
Jan-18
TOTAL POTONGAN
NAMA BIDAN TOTAL PNC PNC yang diterima pot pers normal POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA TOTAL POT TANDA TANGAN
PERSALINAN
RAHAYU 6 150,000 40,000 120,000 52500 2,345,000 8 60000 2,285,000 232,500 1
YULINAWATI 11 275,000 40,000 200,000 96250 4,050,000 16 120000 3,930,000 416,250 2
RISTIANA 6 150,000 40,000 40,000 52500 905,000 4 30000 875,000 122,500 3
WAWAT MIKE 13 325,000 40,000 240,000 113750 5,085,000 24 180000 4,905,000 533,750 4
RUBIYATI 12 300,000 40,000 200,000 105000 4,255,000 20 150000 4,105,000 455,000 5
HALIDESNA 11 275,000 40,000 160,000 96250 3,425,000 16 120000 3,305,000 376,250 6
PUJI AIRAWATI 12 300,000 40,000 200,000 105000 3,875,000 12 90000 3,785,000 395,000 7
REVI DWITA 9 225,000 40,000 120,000 78750 2,580,000 12 90000 2,490,000 288,750 8
JILLI PUNICA 10 250,000 40,000 120,000 87500 2,595,000 12 90000 2,505,000 297,500 9
MUTIA PKM 6 150,000 40,000 40,000 52500 905,000 4 30000 875,000 122,500 10
IRIN S DEWI 4 100,000 40,000 0 35000 60,000 0 0 60,000 35,000 11
EKA WIJAYANTI 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750 12
PUSKESMAS 101 2,525,000 40,000 1,440,000 883750 30,095,000 128 960000 29,135,000 3,283,750
PERSALINAN 36 KASUS 25200000

ANC 128 640,000 6400000
PNC 101 505,000 2525000
1,145,000 34125000
255,000
555,000
795,000
4,900,000
BULAN : JULI 2017

PASKA PELAYANAN PRA PASKA PRA TOTAL YANG
NO NAMA BIDAN TINDAKAN RUJUKAN PD KEGUGURAN, TINDAKAN RUJUKAN PD JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
ANC 1 ANC 2 ANC 3 ANC 4 PERSALINAN KEGUGURAN, PASKA KOMPLIKASI PNC PNC PNC ANC 1 ANC 2 ANC 3 ANC 4 PERSALINAN PAERSALINAN PASKA KOMPLIKASI PNC 1 PNC 2 PNC 3
NORMAL PAERSALINAN 1 2 3 NORMAL (Rp)
EMERGENSI NEONATAL
DASAR DASAR
1 RAHAYU 8 8 8 8 8 0 0 0 8 4 4 400,000 400,000 400,000 400,000 5,600,000 0 0 0 200,000 100,000 100,000 7,600,000 380,000 7,220,000 1
2 JILLI PUNICA 3 3 3 3 3 0 0 0 3 5 3 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 125,000 75,000 2,975,000 148,750 2,826,250 2
3 RUBIYATI 6 6 6 6 6 0 0 0 6 7 4 300,000 300,000 300,000 300,000 4,200,000 0 0 0 150,000 175,000 100,000 5,825,000 291,250 5,533,750 3
4 YULINAWATI 2 2 2 2 2 0 0 0 2 1 4 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 100,000 1,975,000 98,750 1,876,250 4
5 RISTIANA 2 2 2 2 3 0 0 0 2 2 6 100,000 100,000 100,000 100,000 2,100,000 0 0 0 50,000 50,000 150,000 2,750,000 137,500 2,612,500 5
6 REVI DWITA 2 2 2 2 2 0 0 0 2 1 0 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 25,000 0 1,875,000 93,750 1,781,250 6
7 EKA WIJAYANTI 1 1 1 1 1 0 0 0 1 1 1 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 25,000 975,000 48,750 926,250 7
8 PUJI AIRAWATI 4 4 4 4 4 0 0 0 4 5 3 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 125,000 75,000 3,900,000 195,000 3,705,000 8
9 HALIDESNA 5 5 5 5 6 0 0 0 6 5 6 250,000 250,000 250,000 250,000 4,200,000 0 0 0 150,000 125,000 150,000 5,625,000 281,250 5,343,750 9
10 WAWAT MIKE 3 3 3 3 3 0 0 0 3 3 3 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 75,000 75,000 2,925,000 146,250 2,778,750 10
11 IRIN S DEWI 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 11
12 HESTI RESTU 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 12
TOTAL 36 36 36 36 38 0 0 0 37 34 36 1,800,000 1,800,000 1,800,000 1,800,000 26,600,000 0 0 0 925,000 850,000 900,000 36,475,000 1,823,750 34,651,250
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : NOVEMBER, DESEMBER 2016 DAN JANUARI, FEBRUARI, MARET 2017
TOTAL PNC PNC yang diterima pot pers normal TOTAL POTONGAN POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA
PERSALINAN
RAHAYU 0 0 140,000 2,520,000 0 0 0 0
HALIDESNA 0 0 60,000 1,080,000 0 0 0 0
PUJI AIRAWATI 0 0 45,000 810,000 0 0 0 0
RISTIANA 0 0 85,000 1,530,000 0 0 0 0
YULINAWATI 0 0 70,000 1,260,000 0 0 0 0
MEKA FITRIANI 0 0 15,000 270,000 0 0 0 0
JILLY PUNICA 0 0 80,000 1,440,000 0 0 0 0
REVI DWITA 0 0 10,000 180,000 0 0 0 0
RUBIYATI 0 0 45,000 810,000 0 0 0 0
WAWAT MIKE 0 0 40,000 720,000 0 0 0 0
DAYU SONETHA 0 0 35,000 630,000 0 0 0 0
MUTIA PKM 0 0 15,000 270,000 0 0 0 0
IRINE S DEWI 0 0 30,000 540,000 0 0 0 0
HESTI RESTU 0 0 15,000 270,000 0 0 0 0
EKA WIJAYANTI 0 0 5,000 90,000 0 0 0 0
PUSKESMAS 0 0 690,000 12,420,000 0 0 0 0

BULAN : NOVEMBER, DESEMBER 2016 DAN JAN URI, FEBRUARI, MARET 2017
TOTAL PNC PNC yang diterima pot pers normal TOTAL POTONGAN POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA TOTAL POT
PERSALINAN
SITI RUSMIATI 0 0 70,000 1,260,000 0 0 0
RINA ZULIDA 0 0 80,000 1,440,000 0 0 0
MASLIDAWATI 0 0 60,000 1,080,000 0 0 0
SRI RAHAYU 0 0 45,000 810,000 0 0 0
SUGIYATI 0 0 40,000 720,000 0 0 0
NIKMAH 0 0 60,000 1,080,000 0 0 0
SUMIASIH 0 0 5,000 90,000 0 0 0
REFRI YANTI DEVI 0 0 15,000 270,000 0 0 0
PUSKESMAS 0 0 375,000 6,750,000 0 0 0
720,000
760,000
0
0
40,000
40,000
TANDA TERIMA KLAIM DANA PERSALINAN (JKN)
PUSKESMAS TANJUNGBINTANG

PELAYANAN PRA PASKA PRA TOTAL YANG
PASKA TINDAKAN RUJUKAN PD KEGUGURAN, TINDAKAN RUJUKAN PD
NO NAMA BIDAN PERSALINAN KEGUGURAN, PNC PNC PNC PERSALINAN JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 7 7 7 7 7 0 0 0 7 8 6 350,000 350,000 350,000 350,000 4,900,000 0 0 0 175,000 200,000 150,000 6,825,000 341,250 6,483,750 1
2 RINA ZULIDA 4 4 4 4 4 0 0 0 4 3 2 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 75,000 50,000 3,825,000 191,250 3,633,750 2
3 SRI RAHAYU 0 0 0 0 3 0 0 0 3 3 2 0 0 0 0 2,100,000 0 0 0 75,000 75,000 50,000 2,300,000 115,000 2,185,000 3
4 MASLIDAWATI 3 3 3 3 3 0 0 0 3 3 2 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 75,000 50,000 2,900,000 145,000 2,755,000 4
5 SUGIYATI 1 1 1 1 1 0 0 0 1 1 1 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 25,000 975,000 48,750 926,250 5
6 NIKMAH 1 1 1 1 1 0 0 0 1 1 1 50,000 50,000 50,000 50,000 700,000 0 0 25,000 25,000 25,000 975,000 48,750 926,250 6
TOTAL 16 16 16 16 19 0 0 0 19 19 14 800,000 800,000 800,000 800,000 13,300,000 0 0 0 475,000 475,000 350,000 17,800,000 890,000 16,910,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
Dec-17
TOTAL PNC PNC yang diterima pot pers normal TOTAL POTONGAN POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA
PERSALINAN
RAHAYU 4 100,000 40,000 40,000 35000 685,000 0 0 685,000
IRIN S DEWI 16 400,000 40,000 200,000 140000 3,745,000 8 60000 3,685,000
YULINAWATI 9 225,000 40,000 80,000 78750 1,765,000 8 60000 1,705,000
EKA WIJAYANTI 2 50,000 40,000 40,000 17500 655,000 0 0 655,000
RISTIANA 14 350,000 40,000 160,000 122500 3,280,000 12 90000 3,190,000
WAWAT MIKE 7 175,000 40,000 80,000 61250 1,735,000 8 60000 1,675,000
RUBIYATI 9 225,000 40,000 120,000 78750 2,580,000 12 90000 2,490,000
HALIDESNA 9 225,000 40,000 120,000 78750 2,200,000 4 30000 2,170,000
PUJI AIRAWATI 9 225,000 40,000 120,000 78750 2,390,000 8 60000 2,330,000
JILLI PUNICA 12 300,000 40,000 160,000 105000 2,870,000 4 30000 2,840,000
MUTIA PKM 6 150,000 40,000 80,000 52500 1,720,000 8 60000 1,660,000
REVI DWITA 6 150,000 40,000 0 52500 90,000 0 0 90,000
PUSKESMAS 103 2,575,000 40,000 1,200,000 901250 23,715,000 72 540000 23,175,000
anc 72
pnc 101 372,500
173 865000 3,750,000
total 1441250
saldo 576250

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 2 2 2 2 2 0 0 0 2 2 5 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 50,000 125,000 2,025,000 101,250 1,923,750 1
2 RINA ZULIDA 6 6 6 6 7 0 0 0 7 8 8 300,000 300,000 300,000 300,000 4,900,000 0 0 0 175,000 200,000 200,000 6,675,000 333,750 6,341,250 2
3 SRI RAHAYU 0 0 0 0 1 0 0 0 1 2 2 0 0 0 0 700,000 0 0 0 25,000 50,000 50,000 825,000 41,250 783,750 3
4 MASLIDAWATI 5 5 5 5 5 0 0 0 5 3 2 250,000 250,000 250,000 250,000 3,500,000 0 0 0 125,000 75,000 50,000 4,750,000 237,500 4,512,500 4
5 SUGIYATI 0 0 0 0 0 0 0 0 0 6 5 0 0 0 0 0 0 0 0 0 150,000 125,000 275,000 13,750 261,250 5
6 NIKMAH 3 3 3 3 3 0 0 0 3 3 3 150,000 150,000 150,000 150,000 2,100,000 0 0 75,000 75,000 75,000 2,925,000 146,250 2,778,750 6
TOTAL 16 16 16 16 18 0 0 0 18 24 25 800,000 800,000 800,000 800,000 12,600,000 0 0 0 450,000 600,000 625,000 17,475,000 873,750 16,601,250
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 5 0 0 0 4 3 4 150,000 150,000 150,000 150,000 3,500,000 0 0 0 100,000 75,000 100,000 4,375,000 218,750 4,156,250 1
2 RINA ZULIDA 4 4 4 4 8 0 0 0 4 6 4 200,000 200,000 200,000 200,000 5,600,000 0 0 0 100,000 150,000 100,000 6,750,000 337,500 6,412,500 2
3 SRI RAHAYU 2 2 2 2 3 0 0 0 5 3 4 100,000 100,000 100,000 100,000 2,100,000 0 0 0 125,000 75,000 100,000 2,800,000 140,000 2,660,000 3
4 MASLIDAWATI 2 2 2 2 3 0 0 0 1 1 2 100,000 100,000 100,000 100,000 2,100,000 0 0 0 25,000 25,000 50,000 2,600,000 130,000 2,470,000 4
5 SUGIYATI 1 1 1 1 1 0 0 0 0 0 0 50,000 50,000 50,000 50,000 700,000 0 0 0 0 0 0 900,000 45,000 855,000 5
6 REFRI YANTI DEVI 2 2 2 2 2 0 0 0 3 3 3 100,000 100,000 100,000 100,000 1,400,000 0 0 75,000 75,000 75,000 2,025,000 101,250 1,923,750 6
0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 14 14 14 14 22 0 0 17 16 17 700,000 700,000 700,000 700,000 15,400,000 #VALUE! 0 0 400,000 425,000 #VALUE! #VALUE! #VALUE!
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
KLEM NOVEMBER 2017
TOTAL POTONGAN
TOTAL PNC PNC yang diterima pot pers normal POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA TOTAL POT
PERSALINAN
JILLI PUNICA 4 100,000 40,000 40,000 35000 875,000 4 30000 845,000 105,000
MUTIA PKM 4 100,000 40,000 80,000 35000 1,690,000 8 60000 1,630,000 175,000
YULINAWATI 14 350,000 40,000 160,000 122500 3,470,000 16 120000 3,350,000 402,500
HALI DESNA 10 250,000 40,000 120,000 87500 2,025,000 0 0 2,025,000 207,500
RAHAYU 3 75,000 40,000 40,000 26250 860,000 4 30000 830,000 96,250
REVI DWITA 7 175,000 40,000 80,000 61250 1,735,000 8 60000 1,675,000 201,250
RUBIYATI 3 75,000 40,000 80,000 26250 1,485,000 4 30000 1,455,000 136,250
RISTIANA 5 125,000 40,000 120,000 43750 2,140,000 4 30000 2,110,000 193,750
IRIN S DEWI 5 125,000 40,000 120,000 43750 2,140,000 4 30000 2,110,000 193,750
WAWAT MIKE 11 275,000 40,000 120,000 96250 2,610,000 12 90000 2,520,000 306,250
PUJI AIRAWATI 8 200,000 40,000 120,000 70000 2,375,000 8 60000 2,315,000 250,000
PUSKESMAS 74 1,850,000 40,000 1,080,000 647500 21,405,000 72 540000 20,865,000 2,267,500

KLEM OKTOBER 2017
TOTAL POTONGAN
TOTAL PNC PNC yang diterima pot pers normal PERSALINAN POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA TOTAL POT
JILLY PUNICA 14 350,000 40,000 80,000 122500 1,460,000 0 0 1,460,000 202,500
YULINAWATI 12 300,000 40,000 160,000 105000 3,250,000 12 90000 3,160,000 355,000
HALIDESNA 12 300,000 40,000 160,000 105000 #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!
RAHAYU 7 175,000 40,000 80,000 61250 1,735,000 8 60000 1,675,000 201,250
WAWAT MIKE 10 250,000 40,000 160,000 87500 3,220,000 12 90000 3,130,000 337,500
MUTIA PKM 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500
RISTIANA 11 275,000 40,000 160,000 96250 3,235,000 12 90000 3,145,000 346,250
RUBIYATI 6 150,000 40,000 80,000 52500 1,720,000 8 60000 1,660,000 192,500
REVI DWITA 4 100,000 40,000 80,000 35000 1,690,000 8 60000 1,630,000 175,000
PUJI AIRAWATI 14 350,000 40,000 200,000 122500 4,285,000 20 150000 4,135,000 472,500
EKA WIJAYANTI 2 50,000 40,000 0 17500 30,000 0 0 30,000 17,500
HESTI RESTU 2 50,000 40,000 0 17500 30,000 0 0 30,000 17,500
MEKA FITRIANA 4 100,000 40,000 0 35000 60,000 0 0 60,000 35,000
IRIN S DEWI 2 50,000 40,000 0 17500 30,000 0 0 30,000 17,500
REFRI YANTI DEVI 4 100,000 40,000 80,000 35000 1,310,000 0 0 1,310,000 115,000
PUSKESMAS 106 2,650,000 40,000 1,280,000 927500 #VALUE! 90 675000 #VALUE! #VALUE!
KLEM SEPTEMBER 2017
TOTAL PNC PNC yang diterima pot pers normal TOTAL POTONGAN POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA TOTAL POT
PERSALINAN
RUBIYATI 8 200,000 40,000 80,000 70000 1,750,000 8 60000 1,690,000 210,000
RAHAYU 9 225,000 40,000 120,000 78750 2,580,000 12 90000 2,490,000 288,750
HALIDESNA 5 125,000 40,000 120,000 43750 2,140,000 4 30000 2,110,000 193,750
RISTIANA 9 225,000 40,000 120,000 78750 2,580,000 12 90000 2,490,000 288,750
MEKA FITRIANI 3 75,000 40,000 80,000 26250 1,675,000 8 60000 1,615,000 166,250
EKA WIJAYANTI 1 25,000 40,000 40,000 8750 830,000 4 30000 800,000 78,750
JILLI PUNICA 9 225,000 40,000 200,000 78750 3,830,000 12 90000 3,740,000 368,750
YULINAWATI 8 200,000 40,000 120,000 70000 2,565,000 12 90000 2,475,000 280,000
WAWAT MIKE 8 200,000 40,000 40,000 70000 935,000 4 30000 905,000 140,000
PUJI AIRAWATI 3 75,000 40,000 80,000 26250 1,675,000 8 60000 1,615,000 166,250
HESTI RESTU 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500
SUGIYATI 9 225,000 40,000 80,000 78750 2,145,000 16 120000 2,025,000 278,750
IRIN S DEWI 4 100,000 40,000 40,000 35000 875,000 4 30000 845,000 105,000
MUTIA PKM 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750
PUSKESMAS 78 1,950,000 40,000 1,160,000 682500 24,425,000 108 810000 23,615,000 2,652,500
BULAN : SEPTEMBER 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 7 0 0 0 4 3 4 150,000 150,000 150,000 150,000 4,900,000 0 0 0 100,000 75,000 100,000 5,775,000 288,750 5,486,250 1
2 RINA ZULIDA 4 2 2 2 4 0 0 0 4 6 4 200,000 100,000 100,000 100,000 2,800,000 0 0 0 100,000 150,000 100,000 3,650,000 182,500 3,467,500 2
3 SRI RAHAYU 1 2 2 2 5 0 0 0 5 3 4 50,000 100,000 100,000 100,000 3,500,000 0 0 0 125,000 75,000 100,000 4,150,000 207,500 3,942,500 3
4 MASLIDAWATI 1 2 2 2 1 0 0 0 1 1 2 50,000 100,000 100,000 100,000 700,000 0 0 0 25,000 25,000 50,000 1,150,000 57,500 1,092,500 4
5 SUGIYATI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5
6 NIKMAH 3 1 1 1 3 0 0 0 3 3 3 150,000 50,000 50,000 50,000 2,100,000 0 0 75,000 75,000 75,000 2,625,000 131,250 2,493,750 6
0 0 0 0 0 0 0 0 0 0 0
TOTAL 12 10 10 10 20 0 0 0 17 16 17 600,000 500,000 500,000 500,000 14,000,000 0 0 0 400,000 425,000 16,925,000 846,250 16,078,750
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
KLEM AGUSTUS 2017
TOTAL POTONGAN
TOTAL PNC PNC yang diterima pot pers normal PERSALINAN POTONGAN PNC YANG DITERIMA TOTAL ANC potongan ANC TOTAL DITERIMA TOTAL POT
YULINAWATI 6 150,000 40,000 80,000 52500 1,530,000 4 30000 1,500,000 162,500
MUTIA PKM 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500
IRIN S DEWI 6 150,000 40,000 120,000 52500 2,155,000 4 30000 2,125,000 202,500
RISTIANA 8 200,000 40,000 120,000 70000 2,375,000 8 60000 2,315,000 250,000
RAHAYU 18 450,000 40,000 120,000 157500 2,715,000 12 90000 2,625,000 367,500
RUBIYATI 12 300,000 40,000 200,000 105000 3,685,000 8 60000 3,625,000 365,000
JILLY PUNICA 6 150,000 40,000 80,000 52500 1,530,000 4 30000 1,500,000 162,500
HALLDESNA 7 175,000 40,000 40,000 61250 920,000 4 30000 890,000 131,250
PUJI AIRAWAT] 6 150,000 40,000 80,000 52500 1,720,000 8 60000 1,660,000 192,500
HESTI RESTU 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500
WAWAT MIKE 4 100,000 40,000 0 35000 60,000 0 0 60,000 35,000
REVI DWITA 3 75,000 40,000 0 26250 45,000 0 0 45,000 26,250
PUSKESMAS 80 2,000,000 40,000 920,000 700000 18,425,000 60 450000 17,975,000 2,070,000

BULAN : AGUSTUS 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 3 0 0 0 3 1 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 25,000 100,000 2,900,000 145,000 2,755,000 1
2 SUGIYATI 2 2 2 2 2 0 0 0 1 1 5 100,000 100,000 100,000 100,000 1,400,000 0 0 0 25,000 25,000 125,000 1,975,000 98,750 1,876,250 2
3 MASLIDAWATI 2 2 2 2 2 0 0 0 3 3 3 100,000 100,000 100,000 100,000 1,400,000 0 0 0 75,000 75,000 75,000 2,025,000 101,250 1,923,750 3
4 SRI RAHAYU 2 2 2 2 2 0 0 0 2 3 1 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 75,000 25,000 1,950,000 97,500 1,852,500 4
5 RINA ZULIDA 7 7 7 7 8 0 0 0 4 5 0 350,000 350,000 350,000 350,000 5,600,000 0 0 0 100,000 125,000 0 7,225,000 361,250 6,863,750 5
6 REFRI YANTI DERVI 1 1 1 1 2 0 0 0 2 1 0 50,000 50,000 50,000 50,000 1,400,000 0 0 50,000 25,000 0 1,675,000 83,750 1,591,250 6
6 NIKMAH 1 1 1 1 5 0 0 0 2 1 0 50,000 50,000 50,000 50,000 3,500,000 0 0 50,000 25,000 0 3,775,000 188,750 3,586,250 6
TOTAL 17 17 17 17 19 0 0 0 15 14 13 850,000 850,000 850,000 850,000 13,300,000 0 0 0 375,000 350,000 325,000 17,750,000 887,500 16,862,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
KLEM JUNI 2017
TOTAL POTONGAN
PERSALINAN
YULINAWATI 12 300,000 40,000 120,000 105000 2,625,000 12 90000 2,535,000 315,000
HALIDESNA 9 225,000 40,000 120,000 78750 2,580,000 12 90000 2,490,000 288,750
PUJI AIRAWATI 6 150,000 40,000 120,000 52500 2,535,000 12 90000 2,445,000 262,500
HESTI RESTU 3 75,000 40,000 40,000 26250 860,000 4 30000 830,000 96,250
RUBIYATI 9 225,000 40,000 160,000 78750 3,205,000 12 90000 3,115,000 328,750
IRIN S DEWI 6 150,000 40,000 120,000 52500 2,535,000 12 90000 2,445,000 262,500
WAWAT MIKE 8 200,000 40,000 160,000 70000 3,000,000 8 60000 2,940,000 290,000
RAHAYU 10 250,000 40,000 80,000 87500 1,780,000 8 60000 1,720,000 227,500
RISTIANA 12 300,000 40,000 240,000 105000 5,070,000 24 180000 4,890,000 525,000
JILLY PUNICA 10 250,000 40,000 80,000 87500 1,780,000 8 60000 1,720,000 227,500
MUTIA PKM 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500
PUSKESMAS 87 2,175,000 40,000 1,280,000 761250 26,815,000 116 870000 25,945,000 2,911,250
KLEM JUNI 2017
TOTAL POTONGAN
PERSALINAN
YULINAWATI 12 300,000 40,000 120,000 105000 2,625,000 12 90000 2,535,000 315,000
HALIDESNA 9 225,000 40,000 120,000 78750 2,580,000 12 90000 2,490,000 288,750
PUJI AIRAWATI 6 150,000 40,000 120,000 52500 2,535,000 12 90000 2,445,000 262,500
HESTI RESTU 3 75,000 40,000 40,000 26250 860,000 4 30000 830,000 96,250
RUBIYATI 9 225,000 40,000 160,000 78750 3,205,000 12 90000 3,115,000 328,750
IRIN S DEWI 6 150,000 40,000 120,000 52500 2,535,000 12 90000 2,445,000 262,500
WAWAT MIKE 8 200,000 40,000 160,000 70000 3,000,000 8 60000 2,940,000 290,000
RAHAYU 10 250,000 40,000 80,000 87500 1,780,000 8 60000 1,720,000 227,500
RISTIANA 12 300,000 40,000 240,000 105000 5,070,000 24 180000 4,890,000 525,000
JILLY PUNICA 10 250,000 40,000 80,000 87500 1,780,000 8 60000 1,720,000 227,500
MUTIA PKM 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500
PUSKESMAS 87 2,175,000 40,000 1,280,000 761250 26,815,000 116 870000 25,945,000 2,911,250
BULAN : JUNI 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 3 0 0 0 3 1 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 25,000 100,000 2,900,000 145,000 2,755,000 1
2 SUGIYATI 2 2 2 2 2 0 0 0 1 1 5 100,000 100,000 100,000 100,000 1,400,000 0 0 0 25,000 25,000 125,000 1,975,000 98,750 1,876,250 2
3 MASLIDAWATI 2 2 2 2 2 0 0 0 3 3 3 100,000 100,000 100,000 100,000 1,400,000 0 0 0 75,000 75,000 75,000 2,025,000 101,250 1,923,750 3
4 SRI RAHAYU 2 2 2 2 2 0 0 0 2 3 1 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 75,000 25,000 1,950,000 97,500 1,852,500 4
5 RINA ZULIDA 7 7 7 7 8 0 0 0 4 5 0 350,000 350,000 350,000 350,000 5,600,000 0 0 0 100,000 125,000 0 7,225,000 361,250 6,863,750 5
6 NIKMAH 1 1 1 1 5 0 0 0 2 1 0 50,000 50,000 50,000 50,000 3,500,000 0 0 50,000 25,000 0 3,775,000 188,750 3,586,250 6
TOTAL 17 17 17 17 19 0 0 0 15 14 13 850,000 850,000 850,000 850,000 13,300,000 0 0 0 375,000 350,000 325,000 17,750,000 887,500 16,862,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : MEI 2017

NEONATAL TIND. DAN
DASAR DASAR
1 YULINAWATI 6 6 6 6 6 0 0 0 6 6 6 300,000 300,000 300,000 300,000 4,200,000 0 0 0 150,000 150,000 150,000 5,850,000 292,500 5,557,500 1
2 JILLI PUNIOCA 5 5 5 5 5 0 0 0 5 5 5 250,000 250,000 250,000 250,000 3,500,000 0 0 0 125,000 125,000 125,000 4,875,000 243,750 4,631,250 2
3 HESTI RESTU 1 1 1 1 1 0 0 0 2 2 2 50,000 50,000 50,000 50,000 700,000 0 0 0 50,000 50,000 50,000 1,050,000 52,500 997,500 3
4 IRIN S DEWI 1 1 1 1 1 0 0 0 1 1 2 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 50,000 1,000,000 50,000 950,000 4
5 WAWAT MIKE 1 1 1 1 1 0 0 0 1 1 3 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 75,000 1,025,000 51,250 973,750 5
6 RUBIYATI 1 1 1 1 1 0 0 0 1 1 4 50,000 50,000 50,000 50,000 700,000 0 0 0 25,000 25,000 100,000 1,050,000 52,500 997,500 6
7 HALIDESNA 3 3 3 3 3 0 0 0 3 3 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 75,000 100,000 2,950,000 147,500 2,802,500 7
8 PUJI AIRAWATI 1 1 1 1 2 0 0 0 2 2 5 50,000 50,000 50,000 50,000 1,400,000 0 0 0 50,000 50,000 125,000 1,825,000 91,250 1,733,750 8
9 RAHAYU 6 6 6 6 6 0 0 0 6 3 5 300,000 300,000 300,000 300,000 4,200,000 0 0 0 150,000 75,000 125,000 5,750,000 287,500 5,462,500 9
10 REVI DWITA 2 2 2 2 2 0 0 0 1 1 1 100,000 100,000 100,000 100,000 1,400,000 0 0 0 25,000 25,000 25,000 1,875,000 93,750 1,781,250 10
11 RISTIANA 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 125,000 125,000 6,250 118,750 11
12 MUTIA PKM 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 125,000 125,000 6,250 118,750 12
TOTAL 27 27 27 27 28 0 0 0 28 25 47 1,350,000 1,350,000 1,350,000 1,350,000 19,600,000 0 0 0 700,000 625,000 1,175,000 27,500,000 1,375,000 26,125,000
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
BULAN : MEI 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 3 0 0 0 3 1 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 25,000 100,000 2,900,000 145,000 2,755,000 1
2 SUGIYATI 2 2 2 2 2 0 0 0 1 1 5 100,000 100,000 100,000 100,000 1,400,000 0 0 0 25,000 25,000 125,000 1,975,000 98,750 1,876,250 2
3 MASLIDAWATI 2 2 2 2 2 0 0 0 3 3 3 100,000 100,000 100,000 100,000 1,400,000 0 0 0 75,000 75,000 75,000 2,025,000 101,250 1,923,750 3
4 SRI RAHAYU 1 1 1 1 2 0 0 0 2 3 1 50,000 50,000 50,000 50,000 1,400,000 0 0 0 50,000 75,000 25,000 1,750,000 87,500 1,662,500 4
5 RINA ZULIDA 4 4 4 4 4 0 0 0 4 5 0 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 125,000 0 3,825,000 191,250 3,633,750 5
TOTAL 13 13 13 13 15 0 0 0 15 14 13 650,000 650,000 650,000 650,000 10,500,000 0 0 0 375,000 350,000 325,000 14,150,000 707,500 13,442,500
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
KLEM APRIL 2017
TOTAL
PNC yang pot pers POTONGAN YANG TOTAL
TOTAL PNC diterima normal POTONGAN PNC DITERIMA TOTAL ANC potongan ANC DITERIMA TOTAL POT
PERSALINAN
MUTIA PKM 13 325,000 40,000 200,000 113750 4,270,000 20 150000 4,120,000 463,750 66,250
RAHAYU 17 425,000 40,000 200,000 148750 4,330,000 20 150000 4,180,000 498,750 71,250
HALIDESNA 11 275,000 40,000 160,000 96250 3,425,000 16 120000 3,305,000 376,250 53,750
YULINAWATI 2 50,000 40,000 40,000 17500 845,000 4 30000 815,000 87,500 12,500
RUBIYATI 7 175,000 40,000 80,000 61250 1,545,000 4 30000 1,515,000 171,250 24,464
RISTIANA 13 325,000 40,000 200,000 113750 4,270,000 20 150000 4,120,000 463,750 66,250
PUJI AIRAWATI 14 350,000 40,000 200,000 122500 4,285,000 20 150000 4,135,000 472,500 67,500
JILLI PUNIOCA 5 125,000 40,000 80,000 43750 1,705,000 8 60000 1,645,000 183,750 26,250
HESTI RESTU 4 100,000 40,000 80,000 35000 1,500,000 4 30000 1,470,000 145,000 20,714
WAWAT MIKE 11 275,000 40,000 120,000 96250 2,610,000 12 90000 2,520,000 306,250 43,750
MEKA FITRIANI 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750 1,250
DAYU SONETA 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750 1,250
PUSKESMAS 99 2,475,000 40,000 1,360,000 866250 28,815,000 128 960000 27,855,000 3,186,250 455,179
anc 128 171,250

pnc 99 1,775,000
227 1,135,000
91,250
total 866250 266,250
960000 355,000
1826250 1,870,000
BULAN : APRIL 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 4 4 4 4 4 0 0 0 4 4 1 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 100,000 25,000 3,825,000 191,250 3,633,750 1
2 MASLIDAWATI 3 3 3 3 3 0 0 0 2 2 2 150,000 150,000 150,000 150,000 2,100,000 0 0 0 50,000 50,000 50,000 2,850,000 142,500 2,707,500 2
3 SUGIYATI 2 2 2 2 2 0 0 0 1 3 3 100,000 100,000 100,000 100,000 1,400,000 0 0 0 25,000 75,000 75,000 1,975,000 98,750 1,876,250 3
4 RINA ZULIDA 4 4 4 4 4 0 0 0 4 4 3 200,000 200,000 200,000 200,000 2,800,000 0 0 0 100,000 100,000 75,000 3,875,000 193,750 3,681,250 4
5 SRI RAHAYU 2 2 2 2 2 0 0 0 2 3 2 100,000 100,000 100,000 100,000 1,400,000 0 0 0 50,000 75,000 50,000 1,975,000 98,750 1,876,250 5
6 NIKMAH 3 3 3 3 3 0 0 0 3 2 4 150,000 150,000 150,000 150,000 2,100,000 0 0 0 75,000 50,000 100,000 2,925,000 146,250 2,778,750 6
TOTAL 18 18 18 18 18 0 0 0 16 18 15 900,000 900,000 900,000 900,000 12,600,000 0 0 0 400,000 450,000 375,000 17,425,000 871,250 16,553,750
MENGETAHUI :
DARMAWAN, SKM.M.Kes
NIP. 19720603 199302 1 001
KLEM MARET 2017
TOTAL
TOTAL PNC POTONGAN TOTAL ANC potongan ANC TOTAL POT
diterima normal PNC DITERIMA DITERIMA
PERSALINAN
RAHAYU 8 200,000 40,000 320,000 70000 5,690,000 28 210000 5,480,000 600,000
HALIDESNA 3 75,000 40,000 40,000 26250 765,000 4 30000 735,000 96,250
PUJI AIRAWATI 5 125,000 40,000 80,000 43750 1,325,000 4 30000 1,295,000 153,750
RISTIANA 8 200,000 40,000 120,000 70000 2,090,000 8 60000 2,030,000 250,000
YULINAWATI 11 275,000 40,000 40,000 96250 885,000 4 30000 855,000 166,250
MEKA FITRIANI 10 250,000 40,000 80,000 87500 1,590,000 8 60000 1,530,000 227,500
JILLY PUNICA 2 50,000 40,000 120,000 17500 2,190,000 12 90000 2,100,000 227,500
REVI DWITA 4 100,000 40,000 80,000 35000 1,500,000 8 60000 1,440,000 175,000
RUBIYATI 4 100,000 40,000 80,000 35000 1,500,000 8 60000 1,440,000 175,000
WAWAT MIKE 7 175,000 40,000 80,000 61250 1,545,000 8 60000 1,485,000 201,250
DAYU SONETHA 6 150,000 40,000 120,000 52500 2,060,000 8 60000 2,000,000 232,500
MUTIA PKM 2 50,000 40,000 40,000 17500 750,000 4 30000 720,000 87,500
Total 68 1,700,000 440,000 1,160,000 595,000 21,140,000 100 750,000 20,390,000 2,505,000
BULAN : MARET 2017
NO NAMA BIDAN PASKA TINDAKAN RUJUKAN PD KEGUGURAN, TINDAKAN RUJUKAN PD JUMLAH (Rp) PPh 21 5% DITERIMA TANDA TANGAN
PERSALINAN KEGUGURAN, PNC PNC PNC PERSALINAN
NEONATAL TIND. DAN
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 3 0 0 0 1 1 1 150,000 150,000 150,000 150,000 1,800,000 0 0 0 25,000 25,000 25,000 2,475,000 123,750 2,351,250 1
2 RINA ZULIDA 3 3 3 3 3 0 0 0 2 1 2 150,000 150,000 150,000 150,000 1,800,000 0 0 0 50,000 25,000 50,000 2,525,000 126,250 2,398,750 2
3 MASLIDAWATI 1 1 1 1 1 0 0 0 2 3 2 50,000 50,000 50,000 50,000 600,000 0 0 0 50,000 75,000 50,000 975,000 48,750 926,250 3
4 SRI RAHAYU 1 1 1 1 1 0 0 0 1 3 2 50,000 50,000 50,000 50,000 600,000 0 0 0 25,000 75,000 50,000 950,000 47,500 902,500 4
5 SUGIYATI 2 2 2 2 2 0 0 0 4 3 3 100,000 100,000 100,000 100,000 1,200,000 0 0 0 100,000 75,000 75,000 1,850,000 92,500 1,757,500 5
6 NIKMAH 4 4 4 4 4 0 0 0 2 2 3 200,000 200,000 200,000 200,000 2,400,000 0 0 0 50,000 50,000 75,000 3,375,000 168,750 3,206,250 6
TOTAL 14 14 14 14 14 0 0 0 12 13 13 700,000 700,000 700,000 700,000 8,400,000 0 0 0 300,000 325,000 325,000 12,150,000 607,500 11,542,500
MENGETAHUI :
Feb-17
TOTAL
PERSALINAN
IRINE S DEWI 4 100,000 40,000 80,000 35000 1,500,000 8 60000 1,440,000 175,000
SUMIASIH 2 50,000 40,000 40,000 17500 750,000 4 30000 720,000 87,500
RUBIYATI 6 150,000 40,000 40,000 52500 810,000 4 30000 780,000 122,500
JILLY PUNICA 8 200,000 40,000 40,000 70000 840,000 4 30000 810,000 140,000
RAHAYU 15 375,000 40,000 160,000 131250 3,105,000 16 120000 2,985,000 411,250
YULINAWATI 9 225,000 40,000 80,000 78750 1,575,000 8 60000 1,515,000 218,750
HALIDESNA 10 250,000 40,000 120,000 87500 2,310,000 12 90000 2,220,000 297,500
RISTIANA 10 250,000 40,000 120,000 87500 2,310,000 12 90000 2,220,000 297,500
PUJI AIRAWATI 4 100,000 40,000 40,000 35000 590,000 0 0 590,000 75,000
WAWAT MIKE 4 100,000 40,000 40,000 35000 780,000 4 30000 750,000 105,000
DAYU SONETA 6 150,000 40,000 80,000 52500 1,340,000 4 30000 1,310,000 162,500
Total 78 1,950,000 440,000 840,000 682,500 15,910,000 76 570,000 15,340,000 2,092,500

BULAN : FEBRUARI 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 1 1 1 1 1 0 0 0 1 1 3 50,000 50,000 50,000 50,000 600,000 0 0 0 25,000 25,000 75,000 925,000 46,250 878,750 1
2 MASLIDAWATI 2 2 2 2 2 0 0 0 2 1 2 100,000 100,000 100,000 100,000 1,200,000 0 0 0 50,000 25,000 50,000 1,725,000 86,250 1,638,750 2
3 SRI RAHAYU 2 2 2 2 2 0 0 0 2 3 2 100,000 100,000 100,000 100,000 1,200,000 0 0 0 50,000 75,000 50,000 1,775,000 88,750 1,686,250 3
4 RINA ZULIDA 2 2 2 2 2 0 0 0 1 3 5 100,000 100,000 100,000 100,000 1,200,000 0 0 0 25,000 75,000 125,000 1,825,000 91,250 1,733,750 4
5 SUGIYATI 1 1 1 1 1 0 0 0 1 0 0 50,000 50,000 50,000 50,000 600,000 0 0 0 25,000 0 0 825,000 41,250 783,750 5
6 NIKMAH 2 2 2 2 2 0 0 0 2 2 3 100,000 100,000 100,000 100,000 1,200,000 0 0 0 50,000 50,000 75,000 1,775,000 88,750 1,686,250 6
7 REFRI YANTI DEVI 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 7
TOTAL 10 10 10 10 10 0 0 0 9 11 16 500,000 500,000 500,000 500,000 6,000,000 0 0 0 225,000 275,000 400,000 8,900,000 445,000 8,455,000 8
MENGETAHUI :
BULAN : JANUARI 2017

EMERGENSI NEONATAL
DASAR DASAR
1 SITI RUSMIATI 3 3 3 3 4 0 0 0 4 5 3 150,000 150,000 150,000 150,000 2,400,000 0 0 0 100,000 125,000 75,000 3,300,000 165,000 3,135,000 1
2 RINA ZULIDA 5 5 5 5 6 0 0 0 6 4 4 250,000 250,000 250,000 250,000 3,600,000 0 0 0 150,000 100,000 100,000 4,950,000 247,500 4,702,500 2
3 MASLIDAWATI 2 2 2 2 2 0 0 0 2 3 3 100,000 100,000 100,000 100,000 1,200,000 0 0 0 50,000 75,000 75,000 1,800,000 90,000 1,710,000 3
4 SRI RAHAYU 2 2 2 2 2 0 0 0 2 1 0 100,000 100,000 100,000 100,000 1,200,000 0 0 0 50,000 25,000 0 1,675,000 83,750 1,591,250 4
5 REFRI YANTI DEVI 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 600,000 0 0 0 25,000 0 0 625,000 31,250 593,750 5
6 NIKMAH 3 3 3 3 3 0 0 0 3 2 0 150,000 150,000 150,000 150,000 1,800,000 0 0 0 75,000 50,000 0 2,525,000 126,250 2,398,750 6
TOTAL 15 15 15 15 18 0 0 0 18 15 10 750,000 750,000 750,000 750,000 10,800,000 0 0 0 450,000 375,000 250,000 14,875,000 743,750 14,131,250
MENGETAHUI :
DARMAWAN SKM, M.Kes

NIP. 19700710 199703 1 004
Jan-17
TOTAL
PERSALINAN
IRIN.S.DEWI 8 200,000 40,000 40,000 70000 840,000 4 30000 810,000 140,000
RUBIYATI 9 225,000 40,000 120,000 78750 2,295,000 12 90000 2,205,000 288,750
RAHAYU 24 600,000 40,000 360,000 210000 6,650,000 32 240000 6,410,000 810,000
DAYU SONETA 4 100,000 40,000 80,000 35000 1,500,000 8 60000 1,440,000 175,000
RISTIANA 10 250,000 40,000 120,000 87500 2,310,000 12 90000 2,220,000 297,500
WAWAT MIKE 7 175,000 40,000 80,000 61250 1,545,000 8 60000 1,485,000 201,250
YULINAWATI 11 275,000 40,000 120,000 96250 2,325,000 12 90000 2,235,000 306,250
HALIDESNA 7 175,000 40,000 120,000 61250 2,075,000 8 60000 2,015,000 241,250
PUJI AIRAWATI 6 150,000 40,000 80,000 52500 1,530,000 8 60000 1,470,000 192,500
JILLY PUNICA 13 325,000 40,000 200,000 113750 3,795,000 20 150000 3,645,000 463,750
PUSKESMAS 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750
HESTI RESTU 4 100,000 40,000 0 35000 60,000 0 0 60,000 35,000
Total 99 2,475,000 400,000 1,320,000 866,250 24,865,000 124 930,000 23,935,000 3,116,250
KLEM NOVEMBER 2016
TOTAL
TOTAL PNC diterima normal POTONGAN PNC DITERIMA TOTAL ANC potongan ANC DITERIMA TOTAL POT
PERSALINAN
SITI RUSMIATI 8 200,000 40,000 80,000 70000 1,560,000 8 60000 1,500,000 210,000 30,000
SUGIYATI 8 200,000 40,000 120,000 70000 1,900,000 4 30000 1,870,000 220,000 31,429
MASLIDAWATI 9 225,000 40,000 120,000 78750 2,105,000 8 60000 2,045,000 258,750 36,964
RINA ZULIDA 10 250,000 40,000 120,000 87500 2,120,000 8 60000 2,060,000 267,500 38,214
RUBIYATI 6 150,000 40,000 120,000 52500 2,060,000 8 60000 2,000,000 232,500 33,214
RAHAYU 11 275,000 40,000 120,000 96250 2,325,000 12 90000 2,235,000 306,250 43,750
MUTIA PKM 2 50,000 40,000 0 17500 742,500 0 0 742,500 17,500 2,500
HALIDESNA 8 200,000 40,000 120,000 70000 2,280,000 12 90000 2,190,000 280,000 40,000
PUJI AIRAWATI 6 150,000 40,000 80,000 52500 1,530,000 8 60000 1,470,000 192,500 27,500
JILLY PUNICA 13 325,000 40,000 160,000 113750 2,885,000 12 90000 2,795,000 363,750 51,964
RISTIANA 12 300,000 40,000 240,000 105000 4,310,000 20 150000 4,160,000 495,000 70,714
REFRI YANTI DEVI 2 50,000 40,000 40,000 17500 560,000 0 0 560,000 57,500 8,214
WAWAT MIKE 5 125,000 40,000 80,000 43750 1,515,000 8 60000 1,455,000 183,750 26,250
YULINA 13 325,000 40,000 240,000 113750 4,135,000 16 120000 4,015,000 473,750 67,679
HESTI RESTU 5 125,000 40,000 120,000 43750 2,235,000 12 90000 2,145,000 253,750 36,250
IRIN.S.DEWI 4 100,000 40,000 120,000 35000 2,220,000 12 90000 2,130,000 245,000 35,000
SRI RAHAYU 7 175,000 40,000 0 61250 105,000 0 0 105,000 61,250 8,750
NIKMAH 4 100,000 40,000 0 35000 60,000 0 0 60,000 35,000 5,000
MEKA FITRIANI 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750 1,250
Total 129 3,225,000 680,000 1,880,000 1,128,750 34,587,500 148 1,110,000 33,477,500 4,118,750
4,118,750
39,581,250
2,238,750
5,463,750
7,448,750
40,926,250

TANDA TERIMA PERSALINAN Lengkap

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TANDA TERIMA PERSALINAN Lengkap

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TANDA TERIMA KLAIM DANA PERSALINAN ( JKN )

PUSKESMAS RAWAT INAP TANJUNGBINTANG

BULAN : MARET 2018

11 REVI DWITA 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 11

maret 2018 1538750

Total 5,126,250 102525000 97,398,750

TERIMA KLEM TOTAL TERIMA

BULAN : OKTOBER 2018

11 MUTIA PKM 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 30,000 1,500 28,500 11

BULAN : NOVEMBER 2018

BULAN : SEPTEMBER 2018

11 REVI DWITA 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 11

11 HESTI RESTU 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 12

BULAN : MARET 2018

11 REVI DWITA 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 11

BULAN : OKTOBER 2018

1 RAHAYU 9 0 0 0 0 0 0 0 6,300,000 0 0 0 0 0 0 6,300,000 315,000 5,985,000 1

2 YULINAWATI 4 0 0 0 0 0 0 0 2,800,000 0 0 0 0 0 0 2,800,000 140,000 2,660,000 2

3 REVI DWITA 2 0 0 0 0 0 0 0 1,400,000 0 0 0 0 0 0 1,400,000 70,000 1,330,000 3

4 JILLY PUNICA 1 0 0 0 0 0 0 0 700,000 0 0 0 0 0 0 700,000 35,000 665,000 4

5 HALIDESNA 1 0 0 0 0 0 0 0 700,000 0 0 0 0 0 0 700,000 35,000 665,000 5

6 PUJI AIRAWATI 3 0 0 0 0 0 0 0 2,100,000 0 0 0 0 0 0 2,100,000 105,000 1,995,000 6

7 RUBIYATI 3 0 0 0 0 0 0 0 2,100,000 0 0 0 0 0 0 2,100,000 105,000 1,995,000 7

8 RISTIANA 4 0 0 0 0 0 0 0 2,800,000 0 0 0 0 0 0 2,800,000 140,000 2,660,000 8

9 WAWAT MIKE 1 0 0 0 0 0 0 0 700,000 0 0 0 0 0 0 700,000 35,000 665,000 9

10 HESTI RESTU 7 0 0 0 0 0 0 0 4,900,000 0 0 0 0 0 0 4,900,000 245,000 4,655,000 10

TOTAL 35 0 0 0 0 0 0 0 24,500,000 0 0 0 0 0 0 24,500,000 1,225,000 23,275,000

BULAN : FEBRUARI 2018

3 REVI DWITA 0 0 0 0 1 0 0 0 1 0 3 0 0 0 0 700,000 0 0 0 25,000 0 75,000 800,000 40,000 760,000 3

10 HESTI RESTU 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 700,000 0 0 0 25,000 25,000 0 750,000 37,500 712,500 10

11 PUSKESMAS 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 11

BULAN : AGUSTUS 2018

7 REVI DWITA 0 0 0 0 1 0 0 0 1 2 3 0 0 0 0 700,000 0 0 0 25,000 50,000 75,000 850,000 42,500 807,500 7

11 MEKA FITRIANA 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 11

BULAN : JULI 2018

2 MUTIA PKM 0 0 0 0 2 0 0 0 2 4 2 0 0 0 0 1,400,000 0 0 0 50,000 100,000 50,000 960,000 48,000 912,000 2

4 MEKA FITRIANI 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 700,000 0 0 0 25,000 25,000 25,000 775,000 38,750 736,250 4

12 HALIDESNA 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 100,000 100,000 200,000 10,000 190,000 12

BULAN : JULI 2018

2 MUTIA PKM 0 0 0 0 2 0 0 0 2 4 2 0 0 0 0 1,400,000 0 0 0 50,000 100,000 50,000 1,600,000 80,000 1,520,000 2

4 MEKA FITRIANI 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 700,000 0 0 0 25,000 25,000 25,000 775,000 38,750 736,250 4

12 HALIDESNA 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 100,000 100,000 200,000 10,000 190,000 12

BULAN : JUNI 2018

2 RISTIANA 0 0 0 0 1 0 0 0 2 2 5 0 0 0 0 700,000 0 0 0 50,000 50,000 125,000 925,000 46,250 878,750 2

BULAN : MEI 2018

BULAN : APRIL 2018

10 MUTIA PKM 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 25,000 25,000 50,000 2,500 47,500 10

RAHAYU 6 150,000 40,000 120,000 52500 2,345,000 8 60000 2,285,000 232,500 1

YULINAWATI 11 275,000 40,000 200,000 96250 4,050,000 16 120000 3,930,000 416,250 2

RISTIANA 6 150,000 40,000 40,000 52500 905,000 4 30000 875,000 122,500 3

RUBIYATI 12 300,000 40,000 200,000 105000 4,255,000 20 150000 4,105,000 455,000 5

HALIDESNA 11 275,000 40,000 160,000 96250 3,425,000 16 120000 3,305,000 376,250 6

IRIN S DEWI 4 100,000 40,000 0 35000 60,000 0 0 60,000 35,000 11

EKA WIJAYANTI 1 25,000 40,000 0 8750 15,000 0 0 15,000 8,750 12

PERSALINAN 36 KASUS 25200000

BULAN : JULI 2017

11 IRIN S DEWI 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 11

12 HESTI RESTU 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 25,000 25,000 1,250 23,750 12

RAHAYU 0 0 140,000 2,520,000 0 0 0 0

HALIDESNA 0 0 60,000 1,080,000 0 0 0 0

PUJI AIRAWATI 0 0 45,000 810,000 0 0 0 0

RISTIANA 0 0 85,000 1,530,000 0 0 0 0

YULINAWATI 0 0 70,000 1,260,000 0 0 0 0