No. Bukti = mr/as/e@ [t(20.0 [orf 2020 Tanggel No. Rekening KWITANSI Sudah Terima Dari: BENDAHARA PUSKESMAS CEMPA KABUPATEN PINRANG Jumiah Uang § a Paluh Delapan Juta Lima Ratus Tujuh Puluh Tiga Ribu Lis tus Enam Puluh Rupiah Untuk Pembayaran —_: Bayar Jasa Pelayanan Kesehatan BPJS Kapitasl Bulan Januar! 2020 Puskesmas Cempa An. H, Fatiha, SKM dkk, sesual daftar terlampir Compa, 21 Januar 2070 Lunas bayarTgl: 4/2/2000 Bendahara Pengeluaran / DY Zulfianti, Nip. 19830706 200903 2 002 IP. 19660310 198703 1 008 Scanned with CamScannerComer DAFTAR PENERIMAAN JASA DPIS KAPITASI ‘ UNIT ORGANISASI: PUSKESMAS CEMPA, BULAN JANUAR! TAHUN 2020 DANA Kaprtast Rr. 47,622.60 PELAVANAN (60%). RP. 20.573.560 é NAMA wapatan— |yumean(np)|"2N'ia9 — TANDA TANGAN z i z = @ tf ra a. Puskesmas | 9255002 | anazes| 276seze HH Fath Sm kT 735.566 | 110335 625.231 L | Ame bain Pergola KN s3476s| e02as] 454550] |Ranmawat, SKM, SST. Bikor | 612972] 9ae46] 521026 Mab, Abas Reps Ka. Pustu eo7sz0| 104628] 592892 | ~— | Domterumum | 1.293670] sates] 1.124406 ——]eravaicigs | 507207] 76008] 128308 z DokterGigi | 989210| t4aser| —_e08z8 is Hy. Sunre, Skep Ners. part | —_697.520| toas2e| 592.092 (0 |syahricaltbrcawk |UD wsse| 73779) asuaoz| Or IH). Nurhment, SKM Pengelola Kesling| 486.150] 24.308 401283 | Fy 2 |Murniats BidanDesa | 520424| 26421 502003 | sian ie ssei| arava] sz0es| @ 24 [ronyudains sr Ka, Pustu sisi | a7a7e| 322083 15 |raneats, SKepers Pengelola Usila | 378774| — 18939| 359836 | 26 [earnizuiionsskepers. | end.Pengeiuaran| 1.680.043 | e442 | 1.608401 27 |soplah SkepNers P.Barang 6s5246| 32.762| 22.483 ia faerie sa FimaniaaiTe | __seeaes | _a900s | seaeea| Surya, SST. PKA | _s49sex| _27478| 522083 asda Ss. Bidan Desa swsei| 27a78| 522083 sarwat. P,Gudang Obat ae04es| 19023] 362.442 ssteman. ANAK Pengelolaox | 359328| 17966| aeiagpt un. Kasim Alimaddin,Skenis | Petwgasucp | 570.098| 2asa5| saza6a ir Kasaw, AMA. 443.976 = 443876 avshana - 295.17 | =| 29ssi7 Sudarel, AMA.Keb, 443.876 - 443876 27 |eskiamaliyah SS, ape | 338.191 : 338.191 | 2 [mina Ame 443.876 -| 443876 4 al 267882 =f era | | 30 [surivac see 351.550 | =| 351550 [31 friorpastia anvgrowad, AMAxeD. | 3076 =| 443876 [32 [ror alam, ska Bend. Penerima | 186428 186428 Fa [ats sc F Pengelota Kesker | 206973 | + 20630 | fyoscisna }_Petugas Obat 228.279 ~| 228279 se Haan, AMA Bidan Desa 43.876 =| 443876 | 2.430.170 Sendahara Pengeluaran Puskesmgs Cempa “Seat : ‘ZARTINLZULEIANTL.S Kep.NS ‘iip.18961231 201001 1 043 \Nip. 19830706 200903 2 002 Scanned with CamScannerPAJAKPPH| DITERIMA | ganpAaTANGAN 21 (Rp), NAMA JABATAN — |juMLAH (Rp) z ——_2__ Hertann, AMK Perawat 20.931 20.931 Sei Anra Stella, SKM aM = = 316.713, 60.864 S01 Wahyuniogsl SST. idan 316.713. abana, AMAL Ke Bidan 60864 230.236 si = 211.142 thaayanl AMA, idan | 230236 r 211.142 Ravwl, SS. Bian 156.979 | 73.287 “5141 Subet, st. Bidan [sina AM Ke Bidan St rahunabanma, AMA, acta AMAR svar, AMK ssimawat AMAKED. idan Rusna Ad. Keb. Bidan Nasiniah, AMdLKeb Bidan 125.308 125.308 Syahrir Kaslm, SKM. SKM 196.637 196.637 192.782 111538 34701 | 5.233 111630 25.337 Salah, Sep. Ns [Aha atl, Skep.ners Lame ies SKep, Nes Perawat [Sunnaeni, AMd.Keb, idan [sri Wahyuni, AMAKeb. idan 111.630 ttacrtanl, §Kep.ners Perawat 25337 arma, AM. Keb idan “21971 219.771 181.031 edub, zutkiny, SKepNers Perawat 191.031 327.178 254472 173.504 118.607 | 174472 57.264 | 158.632 ueman, SkspNers Perswat 327178 surtan,SKepNers Perawat 254472 na, AMAK Lab 173508 ania, AMK Ferawat 118607 ards, sk SKM 174azz im Handayant, MK Perawat 5728+ Nur Alams.Kep NS Perawat 251.167 | rasta, aM Peramat asian Hariya, AMK Perawat 465.701 “165.701 [Dana Aree Base, AMd.Keb. Bidan 30556 | 38.556 fsrani Ame Bidan 57.559 57.559 bagira SKM SKM 28.091 |Wiwiek Triono, SKep. ‘Perawat a 142 211442 Jandi Frnawat, AMA. Keb Bidan 130816] 130816 | [Salawatl, AMA.Keb idan 193,143 163.143 saris sk ‘kM 149.258 148.258 Sumit Amir. Ama Keb Bidan | 2307] 2207| | pusdalifah, Amd Keb Bidan 4774 | 4774 ' a2 |satrian, SKep.tis | Perawat | 312306 | 312.306 - 13 |Worhidayah, SKepMs Perawat ___ 168546 168.546 14 [uta anita | an 165701 | 165701 [ Scanned with CamScanner= othe Payax pri] DITERIMA | +aypa TANGAN NAMA JABATAN —[JUMLAH (RP.] "24 (Rp) (Rp) z z a = z Sarit, ame Bidan 240.702 : 240,702 | atiana Bidan 76378 76378 asia STR KES Bidan 5 : i 48 |winda,m, Shep Perawat 327.178 327.178 | usd) ST | ~ t HHumacrah, NK Perawat 240702 240,702 | St [Arafat Subunana Bian 174A22 422 2 [Ramiah, Sept Perawat 327.178 32778] See 53 |Marhani, AMK Pecawat 281.167 251.167 ie JUMLAR 7.143.390 =] 7.443.390 Bendshara Pengeluaran Compa, 3) Sarna 2820 Puskesmas Compa Yan ima oF a) TARTINIZULEIANTL SKep.NS ! ‘Nip. 19830706 200903 2 002 Nip. 19660310 198703 1008 Scanned with CamScanneri" Burti 212 Ap) Jann 290 Tanggal 02/07/9090 No. Rakening : KWITANSI Sudah Terima Dari =; BENDAHARA PUSKESMAS CEMPA KABUPATEN PINRANG Jumiah Uang Puluh Enam Juta Seratus Tiga Puluh Ribu Enam Ratus Ruy Untuk Pembayaran —; Bayar Jasa Pelayanan Kesehatan BPJS Kapitasi Bulan Juni 2020 Puskesmas Cempa An. H. Fatiha, SKM dkk, sesual daftar terlampir Compa, zo duit eo. Lunas bayar Tal: 7/) /2a20 Bendahara Pengeluaran Yang Menerima ON fini Nip. 19830706 2009032002 © NIP,49660310 18703 1 008 Scanned with CamScanneree DAFTAR PENERIMAAN JASA BP]S KAPITASI UNIT ORGANISASI : PUSKESMAS CEMPA BULAN JUNI TAHUN 2020 DANA KAPITAST RP, 43,551.00 JASA PELAVANAN (60% ) RP. 26.130,600 No pata: JABATAN — | JUMLAH (Rp) ee a ‘TANDA en i 7 7 z = = TV |e. Hath be Puskesmas 2.394623 | 359.193 | __ 2.035.430 = 2 |i roti, sew KTU aezoea| 129312| 732.774 8 |i amatah | Pengotoiayxn | 031127 | 94669 | 536.450 4 fhhmawany SKM, ST. Bikor s49.000| 82362| 466.718 5 |. Muh. Abbas, SKep.s. a. Pasta 754.608, 641.417 | [6 fér.ttuhanmadtuty | Dokter Umum 1.280.547 1216520 | 7 _ Perawat Gigi 484401 86.250 | 8 DokterGigi | _069.309| 130396] 738.912 P.RRI emaie| 93722 | 531.093 P.ueD ain604] 20500] 391.024 113 fi. nurhaens ska Pengelols Kesting| 48368] 72580] 411.204 12 |otornian | Bidan Desa | _571673| zese+| 543.009 33 ih ssbtdah. sr. P.MTBS a7oe7s| 23sa4] 447.332 | Bs hasan ce oe 15 |Rahmatis, SkepNers P. Barang ‘2idea| 21074| 400.409 16 [2artin ian Skepiers. | Rend.Pengetuaran| —1827.066| 91353] 1.735.713, 47 |Sapiansicensiers | __—PaThypoid 377853] 18893 358,960 | 26 |i. asian, sks Tmunisasi/TB 378676| 18934 389.742 19 |surya.ssr. Pekin | asz279| zane | 467.665 20 |otasdalia, SST. Bidan s26nst| 26343] 500511 21 |Marwah ¢ P.Gudang Obat zasee1| 16300] 309.691 22 | aleman, AMA | Pengelota Box 3zus7s| 16094] 305.781 23 |Muh. Kasim Alimuddin,SitepNs | PetugasUCD 262585| 14818 281.537 4 [rer Kasan, AMULKeD, Bend. Penerima 525939 =| 528999 25 |ruram Administrasi | sz0aa7|__——=s-|~——ssao.ts7 26 |sadarni. AMA.eb ‘idan Resa 441709 ~| 4709 27 |Reaki Amaliyah RSS, A. 87.167 =| svae7 iaaralamaieh 400205 =| 480205 30 [suivant sk a 380.322 =| se0322 31 [Norpata Amoprawan asked, | Bidan Desa 480205 =| 480.205 | = 232 [Nur Alam Ske Pengelola Gi | 186594 =| 186596 | 33 fru, suo | rengetotakesker | 307,860 =| 307880 | F 34 [Yusrana Petugas Obat 219522 =| 219522 35 [se Hatiah, AMA Keb Bidan Desa 276598 =| 276598 = JUMLAH 19597.950| 1850472| 19039478 Bendahara Pengeluaran co i Cempa Pushesmas Cempa oo 19761234 201001 1 043, ‘Nip. 19830706 200903 2 002 ip. 19660314 198703 1 008 Scanned with CamScannerPitriana,s Kep Herta, AME Beh Anra Seti, si 4 |set Wahyuningsl 557 Mablanundssa, AIA. Heb, si Seihandayani, AMA Ket, Ravws, 5ST, Zale, AM Ke St rahmia ann, A Md.Keh, Syamnslar, AMK as |e Ald Kel 12 |Itasinia, AMaKeb 13 |Syahrie Kasten, So Samah, Step Ws. star Kate, As eb. 16 [ava ja Skepners 17 [ames tris, SKep. Mere. 16 | asian, SKepners 19 [oun toteiny SKepners 20 |Pusman, sepNers 21 |suriant, Skep er 22 |Eerna, amaK 23 {atta AK, JABATAN Perawa Persea eM idan idan idan dan Perawat * Perawat JUMLAH (Rp) 1921 109.934 18200 16a. 109637 199637 110.965 110965 wos} 100.155 2208 “Maze 172322 | ae32e nan] tan #2451 | BRAS ~aees | 244.879 244.879 148.412 148412 130.547 130547 PAJAK PPA 24 (Rp) 121.924 109.938 360722 | 0799 AGATZ 157.687 74206 239,107 81.626 24 [Paria sk iw Handayanl, AMK Kasma, MK asmiah Mariyat, AMK 29 |Aaseiant Armd kets 30 |Mapfira. SKM 31 |rwiek Tone, SKep, 32 [solawats, AMAKe 32 [Marini sen 34 [Masala Amd Keb 135 [Satrisnl, Sepa ‘a6 [Murbidayah, siep.ns 37 [Mutians, Amakeb 30 [sartah, Amd xed, ‘39 |Yutiana 40 | tastinda STR. KEB a1 [Winds M, Sep 42 | Numaeran, ak idan Perawat Perawat 56.067 101.140 173.147 120.155, 52219 156.657 101.140 173.147 742755 | 107.166 | p244879 108.217 156.657, | 372.322 Scanned with CamScannerJABATAN Perawat 45 JRartah, Skep x Martan, AMK JUMLAH (Rp. a a 222617 DITERIMA (Rp.) TANDA TANGAN 222.617 Peravat 392.22 172.322 Mariana, AMK Perawat 156657 156.657 utr Lown Klayawat AmdKes | Perawat Gig 158.306 158.306 JUMLAN 6.532.650 =| 6.532.650 Bendahara Pengetuaran Cempa, 40 dun 200 ahem Puskesmas Cempa NIP.19761231 201001 1 043 Nip. 19830706 200903 2 0 Nip. 19660310 198703 1 008 Scanned with CamScannerNo. Bukti_ : 001 /su Jemp /3 200 Tanggal : \s /1/ zou KWITANSI Sudah Terima Dari : BENDAHARA PUSKESMAS GEMPA KABUPATEN PINRANG sJumiah Usng ‘Untuk Pembayaran : Bayar Jasa Pelayanan Kesehatan BPJS Kapitasi Bulan Desember 2020 Puskesmas Cempa An. H. Fatiha, SKM dkk, sesuai daftar terlampir Cempa, 5 Santen) 9924 Lunas bayar Tal : Bendahara Pengc'yag-~ Yang Menerima ) Zartini Zulfianti, S.Kep, Ns Nip. 19761231 201001 1043 Nip. 19830706 200803 2 002 patina, SKM ti M NIP. 19660310 198703 1 008 Scanned with CamScannerDANA KAPITAS LASA PELAYANAN (609% a. Wabi 2 |i ratina, sim Hamratiah Muir, SKM Rahmawat, SKM, SST, H. Muh. Abbas, SKep.Ne DAFTAR PENERIMAAN JASA BP}S KAPITASL UNIT ORGANISASI : PUSKESMAS CEMPA BULAN DESEMBER TANUN 2020 43,497,000 26.098.200 2.013.942 635.078 855.146 Dokter Cig hi, Nurbaent, SKM Murniet i Sanaa, sr Mabyuddin SST. |Rahmatis, SKepNers PRR P.uGD | Pengelola Kesling Bidan Desa MTBS Ka, Pustu “475.001 P.Barang 409.301 an ae fo 602,908 456.009 | DITERIMA tp) ‘TANDA TANGAN 2.391.851 s 540.496 __ 357.225 205.262 512.540 972.069 372.756 726.874 512.540 390.572 357225 433.960 451.327 451.327 300,036 422.091 Bend.Pengeluaran| 1.459.961 1.396.963 P.Thypoid | 444.016 ~— 41.017 i). Nasrtan, SKM P.imunisasi/T8 | 263.122 249.966 rye SST. PS ewia | 475.001 "451327 a, SST. an 451327 Marwah.C —__|P.Gudang obat 257.777 Suleman, AMAK | Pengelola BOK __ 295.099 Petugas UCD __374.949 24 [tri Kasau, AMALKeD. | Bend. Penerima 359.326 ADI 25 |rormons Administrast 285013 26 | sudacml, AMALeb. dan Besa | 303.719 /27 |Reckiamaliyan RSL Amt | _Apoteke “ainiz0 | 20 [minarnt Ame xen | Bian Desa [29 | Nirwana Hasan, AMK _ | Pengetotabap | 444.010 +| aasor8 te 30 [surat sum P.surveians | 306976; - | a0e.976 — 31 |Norpasa Anugrawati amaxct | BidanDesa | 303719; | gaara _— 32 | ur alam, SKM PengelolaGii | 249.504 «| 2sasoe 4 33 | munis, si | Pengelolanester | 279867| | ~—av9sq 34 | Yusriana | Petugasopat | 2466 346677 [35 [se Haman, aMaxeds | Bidan Desa asa Fae femur ‘idan 370230 ~ 359326 _ [dr Nadrah Zuhriah Amr Doktertnirebsip | 657.905 | _ __ 657.005 | JUMLAH | 19.573.650 | 1.473.094 | in.000.756 Bendahara Pengeluaran FE ME 2004 \Cempa Puskesmas Cempa ai) A 19761231 201001 1.043 Nip. 19930706 200903 2.002 Nip, 19660310 198703 1 008 Scanned with CamScannerPAIAKPPH| DITERIMA | pany a tANGAN yanaran frummanicneg ei | tga a 4 a é 7 Pernwat 160716 roo | Pehriyse Perawat 159.060 159.060 Je Asra Satta, SKM. SKM BAG abe 4 [Set Wohyunt st, Hela 1928647 192.547 5 JRobnundata, AM Ke Han y03.409 103.09 © | Si Seitvanelayanl, A.M. Ke Blebon 151.107 151,107 7 Jia r Weta 30.138 30.138 8 feainsn, abn, fan 95.456 95436 9 [St rahmla bonny, AME Keb, ‘Weton 119.295 119.295 10 }Syamstar, AMK Perawat 89.297 89.297 11 [iowa AMR tan 351.607 951.607 SKM kM 163.605 163.665 Sikep. Perawot anno an2a0 14 [uate ate, Ato idan 39.067 39.007 epinera Pecan ariza0 ania 16 [Art ets, Kop Ners Veaat 113.017 113.017 17 [Sri Wahyunl, AMdReb, ‘Hiden 97.669 97.669 18 |Karmita, A.Md. Keb, ‘Didi, 87,902 87.902 19 [Mub, Zulle fly, S.kep ers: Pernwit 22777 242.777 20 |rusman s.kepNers erawnt 240.637 240.637 “| Peranen 169.525 | 169,525 22 [lena AMAK sats 130131 136.131 23 Janna, ami | tenwa | 27.240 “27240 24 |arda, sk sk 143.154 143.154 25 [wnt andyantank | Perawat ara rs 18 Janet 21 |Surtant, Sep.Ners 26 |Kasma, AM Peravwat 119.295 235 |Sutetani,kep.n Perawat 240.637 136 | Nurhidayaby septs Poraveat 193.304 137 [Mutlona, Amd Keb 190.873 | 190.873 ___ 190878 143.54 193.154 114.342 Scanned with CamScanner 27 rasa arya, AM Peru 3576 28 Dana Asta trl, AMG Keb, “idan | tan 29 [astiant Amately ‘idan 11.720 30 |Wiwiek Triona, SKep. Persw =| «134.783 334703 | sa [satawau, Ama wan | ans.s94 a 232 [Maran son sea | angst] | arost | ag 338 [anu via tahaye, AMisKeb, ‘dan 9.55 eons | 24 [Manali Ar. idan wa] | ar aa an [sarah amastet 174.967 174.967 a9 [Yutiana ‘wan | agaor| tastinda sreketh MAI AIT 226033 | 226.033 | aNAMA JABATAN —|JUMLAH (Rp) ro aa TANDA TANGAN = z 3 7 z 7 Ramah, SkepNs Perawat 37672 37.672 MarhaniAMK Perawat a7ase7| a7ane7 |" Wye Mardian AME “Perawat 103389 | 103.309 ahsKM skM 330458 130458 | 14d 49 [Rosita H. Mula, AmaKeb Bidan 135.201 135201 | 2 50 fins Ahmad, Ande Bian 135201 assz0| 2+ 6.524.550 =| 6.524.550 es creer Bendahara Pengeluaran PuskesmasCempa Nip. 19830706 200903 2,002 Compa, 21/1. (tr) Yang Menerima Nip. 19660310 198703 1008 Scanned with CamScanner