Data Pasien Pemasukan Dan Pengeluaran 2019

Pemasukan dan Pengeluaran Uang Retribusi,Laboratorium ,KIA, UGD .
Puskesmas Suralaga Bulan juni 2019

URAIAN KET
JENIS PELAYANAN PEMASUKAN PENGELUARAN
No TANGGAL NAMA JUMLAH
PENGELUARAN
Ret Lab UGD KIA LOKET LAB UGD KIA LOKET LAB POLY KIA UGD SISA
Tanggal 1 s/d 9 /Juni /2019 Libur Bersama
1 10/6/2019 Hadiyatussalihah V 5,000 5,000 PC STATUS 40,000 (35,000)
2 Inaq Jiadah v 5,000 5,000 5,000
3 ayra riysa naira V 5,000 5,000 Kertas HPS 28,000 (23,000)
4 faris naofal V 5,000 5,000 bensin ambul 100,000 (95,000)
5 usman V V 5,000 25000 30,000 30,000
6 sumiati V V 5,000 40000 45,000 45,000
7 huswatun hasanah V 5,000 5,000 5,000
8 raya ramadani V 5,000 5,000 5,000
9 turkiyanti V V 5,000 30000 35,000 35,000
10 aq sapuri V 5,000 5,000 5,000
11 saopiah V 5,000 5,000 5,000
12 miskam V 5,000 5,000 5,000
13 suhanti V 5,000 10000 15,000 15,000
65,000 105,000 - - 170,000 - 168,000 - - - 2,000
1 11/6/2019 iq husnawati V 5,000 15000 20,000 20,000
2 aq zar V 5,000 5,000 5,000
3 khairul lutfi V 5,000 5,000 5,000
4 siti khadijah V 5,000 5,000 5,000
5 edi satria watoni V 10,000 10,000 10,000
6 rizwan halid V 5,000 5,000 5,000
7 suri sahara V 5,000 5,000 5,000
8 kholida V V 5,000 5000 10,000 10,000
9 ll ahmad fatih V 5,000 5,000 5,000
10 siti nurul ridayanti V 5,000 5,000 5,000
11 muhamad rifa'i V 5,000 5,000 5,000
12 iq zarkasi V V 5,000 15000 20,000 20,000
13 komariah V 5,000 10000 15,000 15,000
14 hj haeriah V 5,000 5,000 5,000
15 suburiah V 5,000 5,000 5,000
16 piza utami V 5,000 5,000 5,000
17 zulkifli V 5,000 5,000 5,000
18 bq zaenab V 5,000 5,000 5,000
19 iq suriana V 5,000 5,000 5,000
20 siti hadijah V 5,000 5,000 5,000
21 mariani V 5,000 5,000 5,000
22 m zahid syarip V 5,000 5,000 5,000
23 iq ramlan V 5,000 5,000 5,000
120,000 45,000 - - 165,000 - - - - - 165,000
1 12/6/2019 bq zohrah V 5,000 20000 25,000 poto copi sta 40,000 (15,000)
2 abd hafiz pratama V V 5,000 25000 30,000 Kantong Plast 20,000 10,000
3 m sultan fahril.m V 5,000 5,000 5,000
4 mariah V 5,000 5,000 5,000
5 bq nurul hani fitriya V V 5,000 25000 30,000 30,000
6 l zaiyyan ata V 5,000 5,000 5,000
7 iq nurhasanah V 5,000 5,000 5,000
8 L M LATHIP WIRYAHADI V 15,000 15,000 15,000
9 abib al ansor V 5,000 5,000 5,000
10 ubaidillaj al haris V 5,000 5,000 5,000
11 muzil aslan V 5,000 5,000 5,000
12 aq mahram V 5,000 5,000 5,000
13 virga dwi yana V 10,000 10,000 10,000
14 m yusril rasyid V 5,000 5,000 5,000
85,000 25,000 45,000 0 155,000 0 60,000 0 0 0 95,000
1 13/6/2019 raya ramadani V 5,000 5,000 5,000
2 iq mislah V 5,000 5,000 5,000
3 rosina asma V 5,000 5,000 5,000
4 munawarah V 5,000 5,000 5,000
5 siti atika rahmatin V 5,000 5,000 5,000
6 muhammad asranudin V 15,000 15,000 15,000
7 hilliyah V 5,000 5,000 5,000
8 asyifa jannatul husna V 5,000 5,000 5,000
9 asila mufiza V 5,000 5,000 5,000
10 hj murniah V 5,000 5,000 5,000
11 ahda sabila V 5,000 5,000 5,000
12 najma V 5,000 5,000 5,000
13 nika mustika sari V 5,000 5,000 5,000
14 musannif V 15,000 10000 25,000 25,000
90,000 10,000 0 0 100,000 0 0 0 0 0 100,000
1 14/6/2019 Maeni V 5,000 5,000 pc status 40,000 (35,000)
2 iq hartini V 5,000 5,000 AIR UNTUK T 20,000 (15,000)
3 Dapa K.B V 5,000 5,000 5,000
4 Bq Rohadiah V 5,000 5,000 5,000
5 hamidah V 5,000 30000 35,000 35,000
6 aggus V 5,000 5,000 5,000
7 l jidni haer V 5,000 5,000 5,000
8 bq rahmatun s V 5,000 5,000 5,000
9 siti hadijah V 5,000 5,000 5,000
10 sumiyati V 5,000 5,000 5,000
11 m byvan V 5,000 5,000 5,000
12 abdul kadir V 15,000 15,000 15,000
13 rifai V 5,000 5,000 5,000
75,000 30,000 0 0 105,000 0 60,000 0 0 0 45,000
1 15/6/2019 siti khodijah V 5,000 5,000 5,000
2 m ridho V 5,000 5,000 5,000
3 risma anisa V v 5,000 50000 55,000 55,000
4 ijat abdulloh V 5,000 5,000 5,000
5 bq amira V 5,000 5,000 5,000
6 hamidah V 5,000 5,000 5,000
7 h.m.hilmi V 5,000 5,000 5,000
8 nurhayati v 0 40000 40,000 40,000
35,000 90,000 0 0 125,000 0 0 0 0 0 125,000
1 17/6/2019 muh raehan azkiyah V 5,000 5,000 5,000
2 zohrah V V 5,000 10000 15,000 Alat Waifi + 60,000 (45,000)
3 iq paridah V 5,000 5,000 5,000
4 saufian as sauri V 5,000 5,000 5,000
5 maudatul laeli V 5,000 5,000 5,000
6 sukarna wadi V 5,000 5,000 5,000
7 asrul sani V 5,000 5,000 5,000
8 muh ilham jayadi V 5,000 5,000 5,000
9 siti khodijah V 5,000 5,000 5,000
10 suaediyah V 5,000 5,000 5,000
11 h makbul V 5,000 5,000 5,000
12 muh yazid V 5,000 5,000 5,000
13 paoziah V 5,000 5,000 5,000
14 muliani V 5,000 5,000 5,000
15 muh malik a V 5,000 5,000 5,000
16 handa a V 5,000 5,000 5,000
17 iq ekayanti V 5,000 5,000 5,000
18 mustariah V V 5,000 40000 45,000 45,000
19 h saepuddin V 5,000 5,000 5,000
20 muh hazril a V 5,000 5,000 5,000
21 naila salsabila V 5,000 5,000 5,000
22 aska rafa adril V 5,000 5,000 5,000
23 malika rafa k V 5,000 5,000 5,000
24 iq huzrin V 5,000 5,000 5,000
25 Nurjanah v 5,000 5,000 5,000
26 iq hamidi V 5,000 5,000 5,000
130,000 50,000 0 0 180,000 0 60,000 0 0 0 120,000
1 18/6/2019 arjuna berkah r V 5,000 5,000 pc status dan 77,500 (72,500)
2 nadia azzahra V 5,000 5,000 bensin 20,000 (15,000)
3 muh ilwan V 5,000 5,000 beli alat wifi 28,000 (23,000)
4 bq lingkahasi V 15,000 15,000 Pc Status Ruj 20,000 (5,000)
5 h harun V 5,000 5,000 5,000
6 deo bagus p V 5,000 5,000 5,000
7 vanisa azhari V 5,000 5,000 5,000
8 iq hidaytul l V 5,000 5,000 5,000
9 nurhasanah V V 5,000 15000 20,000 20,000
10 sukarna wadi V 5,000 5,000 5,000
11 aq munahar V 5,000 5,000 5,000
12 hijjatul hasanah V V 5,000 15000 20,000 20,000
13 hj siti aminah V 5,000 5,000 5,000
14 murdaini V V 5,000 85000 90,000 90,000
15 ade irma suryani V 5,000 5,000 5,000
16 sim V V 5,000 25000 30,000 30,000
17 muh faisal h V 5,000 5,000 5,000
18 al fadil m V 5,000 5,000 5,000
19 bq zohriah V 5,000 5,000 5,000
20 iq sororiyah V 5,000 5,000 5,000
21 ema fitrianti V 0 40000 40,000 40,000
110,000 180,000 0 0 290,000 0 145,500 0 0 0 144,500
1 19/6/2019 apiatussolihah V 5,000 5,000 5,000
2 zar'artul intiana V V 5,000 30000 35,000 35,000
3 aliya sahira V 5,000 5,000 5,000
4 muh alif z V 5,000 5,000 5,000
5 m zaenul a V 15,000 15,000 15,000
6 murniati V V 5,000 30000 35,000 35,000
7 aq zohrah V 5,000 5,000 5,000
8 zahiriah V V 5,000 40000 45,000 45,000
9 aq busaeri V V 5,000 25000 30,000 30,000
10 marhani V V 5,000 40000 45,000 45,000
11 Aulia Maharani V 5,000 5,000 5,000
12 Fuji Astuti V 5,000 5,000 5,000
70,000 165,000 0 0 235,000 0 0 0 0 0 235,000
1 20/6/2019 endang estarina h V V 15,000 10000 25,000 25,000
2 muh zohri V V 15,000 10000 25,000 25,000
3 m abd aziz V V 15,000 10000 25,000 25,000
4 m ikhwan majidi V 15,000 15,000 15,000
5 nurhikmah V 5,000 5,000 5,000
6 bq lesiana putri V V 5,000 40000 45,000 45,000
7 yuliani V V 5,000 40000 45,000 45,000
8 novia sinta a V 5,000 5,000 5,000
9 arkan hadi l s V 5,000 5,000 5,000
10 jodi marta p V 5,000 5,000 5,000
11 naila putri s V 5,000 5,000 5,000
12 irfa y V 5,000 5,000 5,000
13 siti aisyah V 5,000 5,000 5,000
14 witri wulandari V V 5,000 40000 45,000 45,000
110,000 150,000 0 0 260,000 0 0 0 0 0 260,000
1 21/6/2019 syamsul islam V v 15,000 10000 25,000 Pc Status RM 40,000 (15,000)
2 maryatun V 15,000 15,000 Transpot ida 15,000 -
3 bq pahima isani V 5,000 5,000 Pak Faozan 200,000 (195,000)
4 selfiana V 5,000 5,000 5,000
5 aq hamzani V 5,000 5,000 5,000
6 salim al paruq V 5,000 5,000 5,000
7 musallamah V 5,000 5,000 5,000
8 yumna khalifa V 5,000 5,000 5,000
9 muzakarussalim V v 5,000 10000 15,000 15,000
10 haeriah V v 5,000 15000 20,000 20,000
11 bq maharani V 5,000 5,000 5,000
12 maudatul laeli V 5,000 5,000 5,000
13 hj siti aisyah V 5,000 5,000 5,000
14 haemi patihin V 5,000 5,000 5,000
15 abdul hafiz p V 5,000 5,000 5,000
16 jannatul aini V v 15,000 10000 25,000 25,000
17 aukia r V 5,000 5,000 5,000
18 zaenal arifin V 5,000 5,000 5,000
19 novayanti V 5,000 5,000 5,000
20 zayyan ariqin s V 5,000 5,000 5,000
130,000 45,000 0 0 175,000 0 255,000 0 0 0 -80,000
1 22/6/2019 M Zubaer V 5,000 5,000 5,000
2 Bq maida Rohmi A V 5,000 5,000 5,000
3 Saepul zahri V 5,000 5,000 5,000
4 Heriawati V 15,000 15,000 15,000
5 Handa Al Bustani V 5000 5,000 5,000
6 Azizan Arfan V 5000 5,000 5,000
7 Bq Linda Wati V 5000 5,000 5,000
45,000 0 0 0 45,000 0 0 0 0 0 45,000
1 24/6/2019 Dina Nabila V 5000 5,000 PC Status 40,000 (35,000)
2 Alisa Indiwahyun V 5000 5,000 5,000
3 Selvia Apriani V 5000 5,000 5,000
4 Aq Khamsatul Arsan V 5000 5,000 5,000
5 Nurul Asman V 5000 5,000 5,000
6 Raffa Syarifa V 5000 5,000 5,000
7 Zafran V 5000 5,000 5,000
8 M Yasir jami V 5000 5,000 5,000
9 yumna khalifa V 5000 5,000 5,000
10 H Makbul V 5000 5,000 5,000
11 Aq Miftahul aini V 5000 5,000 5,000
12 H saprudin V 5000 5,000 5,000
13 Marlin Andari V v 5000 10000 15,000 15,000
14 Hikmah V 5000 5,000 5,000
15 Sosia V 5000 5,000 5,000
16 Anisa Andi wahyuni V 5000 5,000 5,000
17 Aska Al Korni V 5000 5,000 5,000
18 M Raditsa H V 5000 5,000 5,000
19 Sumiati V 5000 5,000 5,000
20 Maulidatul nurul a V 5000 5,000 5,000
21 Algifar V 5000 5,000 5,000
22 Anati V 5000 5,000 5,000
23 Hamdia Gunawan V 15000 15,000 15,000
24 Iwan Santari V 15000 15,000 15,000
140,000 10,000 0 0 150,000 0 40,000 0 0 0 110,000
1 25/6/2019 Laelatul Rahman V 5000 5,000 5,000
2 H Edi Hidayat V V 5000 25000 30,000 30,000
3 Iq Saenal V 5000 5,000 5,000
4 Salman Alfarisi V 5000 5,000 5,000
5 Wafdah Solihah V 5000 5,000 5,000
6 Giyan Khaeri S V 5000 5,000 5,000
7 H l Hursaha V 5000 5,000 5,000
8 Danu ShatirAfgani V 5000 5,000 5,000
9 Dolah/iq Zahra V 5000 5,000 5,000
10 Wahyu Kurniawan V 5000 5,000 5,000
11 Nizam Fikri V 15000 15,000 15,000
12 Abdul Aziz V V 15000 10000 25,000 25,000
13 Jakna Sultan F V 10000 10,000 10,000
14 Abdul Hayyi V 15000 15,000 15,000
15 St Mariam V V 15,000 10000 25,000 25,000
120,000 45,000 0 0 165,000 0 0 0 0 0 165,000
1 26/6/2019 M afkar rafizi V 5,000 5,000 5,000
2 mulyani V 15,000 15,000 15,000
3 iq wahidah V 5,000 5,000 5,000
4 hermawan efendi V 10,000 10,000 10,000
5 wafa ilmira V 5,000 5,000 5,000
6 m.sayuti mailik V 5,000 5,000 5,000
7 fiqotun hajiah V 5,000 5,000 5,000
8 aq khaer V 5,000 5,000 5,000
9 m.azril maulana V 5,000 5,000 5,000
10 M. Rifai V 5,000 5,000 5,000
11 h muksin V V 5,000 50000 55,000 55,000
70,000 50,000 0 0 120,000 0 0 0 0 0 120,000
1 27/6/2019 muh arif qudsi V 5,000 5,000 pc status 40,000 (35,000)
2 iq hairani V 5,000 5,000 Pc Status 25,000 (20,000)
3 muliadi s.kom V 5,000 5,000 5,000
4 hj khusnul k V 5,000 5,000 5,000
5 alika naila p V 5,000 5,000 5,000
6 kurnaen,s.kom V 5,000 5,000 5,000
7 hj halimatussa'diah V 5,000 5,000 5,000
8 aufa hasan V 5,000 5,000 5,000
9 Nur Islamia V 5,000 5,000 5,000
10 Iq Masruni V 5,000 5,000 5,000
11 Lisa Asta Candra V 15,000 15,000 15,000
12 Muh Adi SKM V 5,000 5,000 5,000
70,000 0 0 0 70,000 0 65,000 0 0 0 5,000
1 28/6/2019 St Aminah V 5,000 5,000 5,000
2 Muhammad Joni V 5,000 5,000 5,000
3 Subaedah S V 5000 5,000 5,000
15,000 0 0 0 15,000 0 0 0 0 0 15,000
1 29/6/2019 Gifran Hambali V 5000 5,000 wardah 75,000 (70,000)
2 Hikmaturahman V 5000 5,000 bayar kasur 1000000 -995000
3 M Razin Jafair V 5000 5,000 5000
4 Iq Husnah V 5000 5,000 5000
5 H. Harun V 5000 5,000 5,000
6 St Aisah V 5000 5,000 5,000
30,000 0 0 0 30,000 0 1,075,000 0 0 0 -1,045,000
1,510,000 1,000,000 45,000 0 2,555,000 0 1,928,500 0 0 0 626,500
Mengetahui, Suralaga, 1 Juli 2019

Kepala Puskesmas suralaga Bendahara Puskesmas
MEIDINAAM INSYA, S.Kep Hj. Kusmiyati S.ST
NIP : 19730531 199205 1 002 NIP : 19680605 198903 2 014
Puskesmas Suralaga
URAIAN KET
No TANGGAL NAMA JUMLAH JUMLAH
PENGELUARAN
Ret Lab UGD KIA LOKET LAB UGD KIA UMUM LOKET LAB POLY KIA UGD SISA
1 2/5/2019 AQ Reza V V 5,000 25,000 30,000 fc Status 40,000 40,000 (10,000)
2 Marhaeni V V 5,000 5,000 - 5,000
3 LALU Ridwan A V 15,000 30,000 45,000 - 45,000
4 mardian A V 5,000 5,000 - 5,000
5 nurhidayati V 5,000 5,000 - 5,000
6 Alesa Ayudia P V 5,000 5,000 - 5,000
7 habib tamrin V 5,000 5,000 - 5,000
8 Halid Azhar V 5,000 5,000 - 5,000
9 M Arsal Hakim V 5,000 5,000 - 5,000
10 Kartini V 5,000 5,000 - 5,000
11 Asila Mupida V 5,000 5,000 - 5,000
12 Aq Masui V 5,000 5,000 - 5,000
13 H.L Nursaha V 5,000 5,000 - 5,000
14 Iq Nurmiyati V 5,000 5,000 - 5,000
15 Aq hariani V 5,000 5,000 - 5,000
16 3/5/2019 h. sahrudin V 5,000 5,000 - 5,000
17 IQ rosiah V 5,000 5,000 - 5,000
18 Masitah V 5,000 5,000 - 5,000
19 IQ Ziadah V 5,000 15000 20,000 - 20,000
20 huswatun hasanah V 5,000 25000 30,000 - 30,000
21 H. SYAKRAWI V 5,000 5,000 - 5,000
22 Sima Nihayatul U V 5,000 5,000 - 5,000
23 m rian alfarisi V 5,000 5,000 - 5,000
24 Julia Supani V 5,000 5,000 - 5,000
25 4/5/2019 Marzoan V 5,000 5,000 PC STATUS 40,000 40,000 (35,000)
26 aq kudusiah V 10,000 10,000 - 10,000
27 Iq Husniati zikro V 5,000 5,000 - 5,000
28 aq Mahmul V 5,000 5,000 - 5,000
29 Iq Rohlah V 5,000 5,000 - 5,000
30 iq Takiudin V 5,000 5,000 - 5,000
31 M.Sayuti Mailik V 5,000 5,000 - 5,000
32 NAZRIL V 5,000 5,000 - 5,000
33 M. Asral Hakim V 5,000 5,000 - 5,000
34 Adiatul aulia V 5,000 5,000 - 5,000
35 Yuliani V 10,000 10,000 - 10,000
36 Jalaludin V 5,000 5,000 - 5,000
37 6/5/2019 Iq Saleh V 5,000 5,000 - 5,000
38 Rustan Hadi V 5,000 5,000 - 5,000
39 Syahra Aulia V 5,000 5,000 - 5,000
40 Haifa nazila V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
41 Aulia Maharani V 5,000 5,000 - 5,000
42 Nadia Azzahra V 5,000 5,000 - 5,000
43 Khaerunisa V 5,000 5,000 - 5,000
44 Yuhna Sarifah V 5,000 5,000 - 5,000
45 Anati fatin V 5,000 5,000 - 5,000
46 firkatun Najiah V 5,000 5,000 - 5,000
47 Hapipi V 5,000 5,000 - 5,000
48 Alwi Arsagaf V 5,000 5,000 - 5,000
49 Mami Misni V 5,000 5,000 - 5,000
50 7/5/2019 M.Dahrani V v 15,000 10000 25,000 fc Status 40,000 40,000 (15,000)
51 M Azam V 5,000 5,000 - 5,000
52 Feri Ardiansah V 5,000 5,000 - 5,000
53 Ahmad Ridwan V 5,000 5,000 - 5,000
54 Rian aluni V 5,000 5,000 - 5,000
55 fatimatuzzahroh V 15000 15,000 - 15,000
56 Miskan V 5,000 5,000 - 5,000
57 Nasihan V 5,000 5,000 - 5,000
58 Hapsah V 5,000 5,000 - 5,000
59 M.Azka V 5,000 5,000 - 5,000
60 8/5/2019 Riwa Asnawi V 5,000 5,000 - 5,000
61 Aris Akbar V 10,000 10,000 - 10,000
62 Irsalina V 5,000 5,000 - 5,000
63 Hj.st Aminah V 5,000 5,000 - 5,000
64 Iq Salamah V 5,000 5,000 - 5,000
65 Iq Lindawati V 5,000 5,000 - 5,000
66 Risaul Auliah V 5,000 5,000 - 5,000
67 Arista Adinda V 5,000 5,000 - 5,000
68 Indriani V 5,000 5,000 - 5,000
69 M.Makbul v 25000 25,000 - 25,000
70 9/5/2019 aziza Arkan V 5,000 5,000 - 5,000
71 H Makbul V 5,000 5,000 - 5,000
72 St Zuliantih V 5,000 5,000 - 5,000
73 Bq Ezlin Elmi V 5,000 5,000 - 5,000
74 Zahira Rahmayanti V 5,000 5,000 - 5,000
75 St Nurul Ridayanti V 5,000 5,000 - 5,000
76 Gepita Agustina V 5,000 5,000 - 5,000
77 Hj. Haeriah V 5,000 5,000 - 5,000
78 Bq Suhastini V 5,000 5,000 - 5,000
79 Dimas Agustian s V 5,000 5,000 - 5,000
80 Hizbul Izzi V 5,000 5,000 - 5,000
81 Hendrayani 40000 40,000 - 40,000
82 gairi alfarizi V 5,000 5,000 - 5,000
83 L M Malagusagit V 15,000 15,000 - 15,000
URAIAN KET
PENGELUARAN
84 Sakiratul Laeni V 5,000 5,000 - 5,000
85 Kariah V 5,000 5,000 - 5,000
86 10/5/2019 Azzizah Asitani V 5,000 5,000 PC STATUS 40,000 40,000 (35,000)
87 Zulhadah V 5,000 5,000 kantong kresek 20,000 20,000 (15,000)
88 M Fawwaz V 5,000 5,000 Klip Obat 50,000 50,000 (45,000)
89 Huriani V 5,000 40000 45,000 pulsa internet 60,000 60,000 (15,000)
90 Aisyah Syira V 5,000 5,000 Bender MTBS 45,000 45,000 (40,000)
91 M Raka azka V 5,000 5,000 - 5,000
92 Nazma Nira A V 5,000 5,000 - 5,000
93 Abdul Wahyi V 5,000 5,000 - 5,000
94 Hartini A .Pd i V 5,000 5,000 - 5,000
95 Azzijah V 5,000 5,000 - 5,000
96 Srikuardani V 5,000 5,000 - 5,000
97 11/5/2019 Bq AidaLutfilatin N V 5,000 5,000 - 5,000
98 Asyila Mufida V 5,000 5,000 - 5,000
99 Izad Abdullah V 5,000 5,000 - 5,000
100 L M Adam V 5,000 5,000 - 5,000
101 Aq Suriani V 5,000 5,000 - 5,000
102 L Abid Mufadda V 5,000 5,000 - 5,000
103 Zaenal V 5,000 5,000 - 5,000
104 Wafa Murmita V 5,000 5,000 - 5,000
105 Yusup Abdullah V 5,000 5,000 - 5,000
106 iq Takiudin V 5,000 5,000 - 5,000
107 13/5/2019 Hudni V V 5,000 40000 45,000 ATK 87,000 87,000 (42,000)
108 Masitah V 5,000 5,000 - 5,000
109 M Rizki Abbas V 5,000 5,000 - 5,000
110 Elda Sulistira V 5,000 5,000 - 5,000
111 Jamatul Aeni V 5,000 5,000 - 5,000
112 Safni V 5,000 5,000 - 5,000
113 Quratul Aini V V 5,000 10000 15,000 - 15,000
114 liana Yustiana K V V 15,000 30000 45,000 - 45,000
115 Muawiyah V 5,000 5,000 - 5,000
116 M Iqbal V 5,000 5,000 - 5,000
117 Hasiah V 5,000 5,000 - 5,000
118 Wika Humaro V 5,000 5,000 - 5,000
119 Iq Rahla V 5,000 5,000 - 5,000
120 h lalu nursaat V 5,000 5,000 - 5,000
121 14/5/2019 muh wahyu ramdan V 5,000 5,000 - 5,000
122 geri alfarizi V 5,000 5,000 poto copy status 40,000 40,000 (35,000)
123 sukasih rahmawati V 5,000 40000 45,000 - 45,000
124 inaq helmawati V 5,000 5,000 - 5,000
125 aisya shifa V 5,000 5,000 - 5,000
126 m barok sulaiman V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
127 abdurahman al paya V 5,000 5,000 - 5,000
128 akila hafisa azalia V 5,000 5,000 - 5,000
129 bila al hafiz V 5,000 5,000 - 5,000
130 zohrani zakirudin V 5,000 5,000 - 5,000
131 zusha V 20000 20,000 - 20,000
132 15/5/2019 risma nurmala V 5,000 5,000 poto copy mtbs 10,000 10,000 (5,000)
133 amira azzahra V 5,000 5,000 - 5,000
134 bq kartini V 5,000 5,000 - 5,000
135 mumparizah V 5,000 5,000 - 5,000
136 l abid munpadal V 5,000 60000 65,000 - 65,000
137 inayatussulihah V 5,000 5,000 - 5,000
138 sahrudin V 5,000 5,000 - 5,000
139 iq samsul lutfi V 5,000 5,000 - 5,000
140 m yakub V 5,000 5,000 - 5,000
141 laelatul husmi V 5,000 5,000 - 5,000
142 ismaini V 5,000 30000 35,000 - 35,000
143 iq zubaedah V 5,000 5,000 - 5,000
144 kholid akbar V 5,000 5,000 - 5,000
145 malika al husna V 5,000 5,000 - 5,000
146 mikayla al kanza V 5,000 5,000 - 5,000
147 tasya nur aisa V 5,000 5,000 - 5,000
148 latifa V 5,000 5,000 - 5,000
149 al aira nova V 5,000 5,000 - 5,000
150 16/5/2019 l.iskandar zulkarnae V 15,000 15,000 - 15,000
151 saida ayudi V 5,000 5,000 - 5,000
152 aq zaenudin V 5,000 5,000 - 5,000
153 multini V V 5,000 15000 20,000 - 20,000
154 al aira nova V 5,000 5,000 - 5,000
155 susilawati V V 5,000 40000 45,000 - 45,000
156 h burhanudin V 5,000 5,000 - 5,000
157 iq mahmuludin V 5,000 5,000 - 5,000
158 iq jaeni V 5,000 5,000 - 5,000
159 malina V 10000 10,000 - 10,000
160 wardatul uyun V V 5,000 10000 15,000 - 15,000
161 m faiz V 5,000 5,000 - 5,000
162 Dina Jahira V 5,000 5,000 - 5,000
163 Aq Rukaiyah V 5,000 5,000 - 5,000
164 M Azmi Akbar V 5,000 5,000 - 5,000
165 17/5/2019 h abib alhakim V 5,000 5,000 bensin ambulan 30,000 30,000 (25,000)
166 laelatul karimah V 5,000 5,000 - 5,000
167 nurhidayatullah V 5,000 30000 35,000 - 35,000
168 sumiati V 5,000 5,000 - 5,000
169 surya jayadi V 5,000 65000 70,000 - 70,000
URAIAN KET
PENGELUARAN
170 haeriah V 5,000 40000 45,000 - 45,000
171 m rifai V 5,000 5,000 - 5,000
172 muh haeron V 5,000 5,000 - 5,000
173 bq masitah V V 5,000 20000 25,000 - 25,000
174 18/5/2019 qais nabani V 5,000 5,000 - 5,000
175 amaq saprudin V 5,000 5,000 - 5,000
176 anabi patin V 5,000 5,000 - 5,000
177 hj halimah V 5,000 5,000 - 5,000
178 ahmad mujamin V 5,000 5,000 - 5,000
179 parida V V 5,000 40000 45,000 - 45,000
180 H.L. patmawe V 5,000 5,000 - 5,000
181 l arka aditia pra V 5,000 5,000 - 5,000
182 bq zahriah V 5,000 5,000 - 5,000
183 hj.hidayah V 5,000 5,000 - 5,000
184 hamzatul musari V 5,000 5,000 - 5,000
185 guffa utama V 5,000 5,000 - 5,000
186 iq ziadah V 5,000 5,000 - 5,000
187 st latifa aeni V 5,000 5,000 - 5,000
188 eli agussuranti V 5,000 5,000 - 5,000
189 h.l fatmawa V 5,000 5,000 - 5,000
190 bq rohaeni V 5,000 5,000 - 5,000
191 bq aida lutfiayun n V 5,000 5,000 - 5,000
192 20/5/2019 Irsalina V 5,000 5,000 - 5,000
193 abdurahman al paya V V 5,000 10000 15,000 - 15,000
194 Al Masyirah V 5,000 5,000 - 5,000
195 Bq cahya Anindia p V 5,000 5,000 - 5,000
196 m zahid syarip V 5,000 5,000 - 5,000
197 m azka ajrofi V 5,000 5,000 - 5,000
198 munawaroh V 5,000 5,000 - 5,000
199 nieta pasti V 5,000 5,000 - 5,000
200 nurhidayah V 5,000 5,000 - 5,000
201 fahira V 5,000 5,000 - 5,000
202 iq husniat zikro V 5,000 5,000 - 5,000
203 naela nuryakila V 5,000 5,000 - 5,000
204 h makbul V 5,000 5,000 - 5,000
205 raodatul faizah V 5,000 30000 35,000 - 35,000
206 siti raehanun V 5,000 30000 35,000 - 35,000
207 Rujukan 5,000 80000 85,000 - 85,000
208 siti hajar V 5,000 50000 55,000 - 55,000
209 21/5/2019 aufa hasan V 5,000 5,000 PC STATUS 40,000 40,000 (35,000)
210 iq zaenal V 5,000 5,000 - 5,000
211 siti atika rahmatin V 5,000 5,000 - 5,000
212 aq athrudin V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
213 jumaiyah V V 5,000 40000 45,000 - 45,000
214 hafizatul ramadani V 5,000 5,000 - 5,000
215 rosita dinirosa V 5,000 5,000 - 5,000
216 hawafis magfirah V 5,000 5,000 - 5,000
217 masitah V V 5,000 15000 20,000 - 20,000
218 suhat V V 5,000 40000 45,000 - 45,000
220 22/5/2019 iq linda wati V 5,000 5,000 TRASPOT 15,000 15,000 (10,000)
221 muh irwani V 5,000 5,000 LAP KE DIKES - 5,000
222 marzoan V 5,000 5,000 - 5,000
223 abdurrahaman al-pa V 5,000 5,000 - 5,000
224 m irwan V V 5,000 40000 45,000 - 45,000
225 Hidayat Mustopa V 5,000 5,000 - 5,000
226 Fikri Raqhman V 5,000 5,000 - 5,000
227 Iq Husnaeni V 5,000 5,000 - 5,000
228 M.Irwana V 5,000 5,000 - 5,000
229 Holid Azhzr V 5,000 5,000 - 5,000
230 23/5/2019 h.harun V 5,000 5,000 - 5,000
231 IQ asror V 5,000 5,000 - 5,000
232 muh fazil V 5,000 5,000 - 5,000
233 toharah V 5,000 5,000 - 5,000
234 ahsan V 5,000 5,000 - 5,000
235 mamiq saprudin V 5,000 5,000 - 5,000
236 fadila handayani V 5,000 5,000 - 5,000
237 fatimah wiwin ns V V 5,000 40000 45,000 - 45,000
238 azizatur rohmah V 5,000 5,000 - 5,000
239 Ahmad rozokin V 5,000 5,000 - 5,000
240 alamatun nisa V 5,000 5,000 - 5,000
241 sahilatun V 5,000 5,000 - 5,000
242 St Hawa V 5,000 5,000 - 5,000
243 M Arsal Hakim V 5,000 10000 15,000 - 15,000
244 Leni Nurdiantari V V 5,000 5,000 - 5,000
245 Aa Ma al V 5,000 5,000 - 5,000
246 Eva Huhna V V 5,000 40000 45,000 - 45,000
247 24/5/2019 Rozikin V 5,000 5,000 - 5,000
248 H Ahmad zaki V V 5,000 15000 20,000 - 20,000
249 Hj Halimah V 5,000 5,000 - 5,000
250 Iq salamah V 5,000 5,000 - 5,000
251 Aufa Hasan V 5,000 5,000 - 5,000
252 bq Mariana V 40000 40,000 - 40,000
253 L Muh Addi Hulhaki V 5,000 5,000 - 5,000
254 Ainun B V 5,000 5,000 - 5,000
255 Mulkam V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
256 M Rizki Maulana V 5,000 5,000 - 5,000
257 Fitriah V 5,000 5,000 - 5,000
258 25/5/2019 Fitri Rahman V 5,000 5,000 - 5,000
259 Gustina Alia V 5,000 5,000 - 5,000
260 L Aqsha Sarfaraz V 5,000 5,000 - 5,000
261 Rumaesa Atura V 5,000 5,000 - 5,000
262 Hanik Rifai V 5,000 5,000 - 5,000
263 Iq Rosahia V 5,000 5,000 - 5,000
265 Hatim V 5,000 5,000 - 5,000
266 27/5/2019 Aq Atharudin V 5,000 5,000 Pc Status 40,000 40,000 (35,000)
267 L Aksyar Sarparaz V 5,000 5,000 Kantong Plastik 13,000 13,000 (8,000)
268 L Zidni Khaer V 5,000 5,000 obat - 5,000
269 M Rifai V 5,000 5,000 Pc Mtbs 15,000 15,000 (10,000)
270 Raya Rahmadani V 5,000 5,000 - 5,000
271 Yumna Khalifa V 5,000 5,000 - 5,000
272 Ainun Dania V 5,000 5,000 - 5,000
273 L Hery Saopan T V 5,000 5,000 - 5,000
274 Yaumul Zaijah V 5,000 5,000 - 5,000
275 M Daud V 5,000 5,000 - 5,000
276 Iq Romlah V 5,000 5,000 - 5,000
277 Aira Nafisa V 5,000 5,000 - 5,000
278 Iq Wahyuni V 5,000 5,000 - 5,000
279 Raska Arga nabil V 5,000 5,000 - 5,000
280 arsul sani V 5,000 5,000 - 5,000
281 bq intihan V 5,000 5,000 - 5,000
282 bq nafizatun V 5,000 5,000 - 5,000
283 bq siti nurul kahni V 5,000 5,000 - 5,000
284 ahmad mujamil V 5,000 5,000 - 5,000
285 28/5/2019 Asna wati V V 5,000 50000 55,000 - 55,000
286 gina sonia V V 5,000 40000 45,000 THR 1,500,000 1,500,000 (1,455,000)
287 muh arif qudsi V 5,000 5,000 Bayar Regen Lab 450,000 450,000 (445,000)
288 afka hadi l.sadik V 5,000 5,000 Kekurangan Regen 260,000 260,000 (255,000)
289 zahiratul husna V 5,000 5,000 ngantar lap ke Dikes 15,000 15,000 (10,000)
290 nurlaili sulhiati V 5,000 5,000 - 5,000
291 handa albustani V 5,000 5,000 - 5,000
292 kasiati V 5,000 5,000 - 5,000
293 muh khaerul watoni V 5,000 5,000 - 5,000
294 haekal raditya azka V 5,000 5,000 - 5,000
295 afifah V 5,000 5,000 - 5,000
296 muhammad artan V 5,000 5,000 - 5,000
297 iq hidayatul laili V 5,000 5,000 - 5,000
298 siddiq hidayat V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
299 29/5/2019 l arka aditya V 5,000 5,000 - 5,000
230 hj patimah V 5,000 5,000 - 5,000
231 m yezan V 5,000 5,000 - 5,000
232 iq hendriyani V 5,000 5,000 - 5,000
233 mariam alesa V 5,000 5,000 - 5,000
234 dilan karunia V 5,000 5,000 - 5,000
235 hasna aila V 5,000 5,000 - 5,000
236 31/5/2019 husnawati V 5,000 5,000 - 5,000
237 nilawati V 5,000 5,000 - 5,000
238 rohida komala sari V 5,000 5,000 - 5,000
239 bq asifa naela r V 5,000 5,000 - 5,000
240 aq khamsatul askar V 5,000 5,000 - 5,000
JUMLAH 1,585,000 1,160,000 10,000 125,000 2,880,000 2,850,000 2,850,000 30,000
241 10/6/2019 IQ ZIADAH V 5,000 5,000 pc status 40,000 40,000 (35,000)

242 Hadiyatussalihah V 5,000 5,000 Kantong Plastik 20,000 20,000 (15,000)
243 ayra riysa naira V 5,000 5,000 bensin ambulan 100,000 100,000 (95,000)
244 faris naofal V 5,000 5,000 - 5,000
245 usman V V 5,000 25000 30,000 - 30,000
246 sumiati V V 5,000 40000 45,000 - 45,000
247 huswatun hasanah V 5,000 5,000 - 5,000
248 raya ramadani V 5,000 5,000 - 5,000
249 turkiyanti V V 5,000 30000 35,000 - 35,000
250 aq sapuri V 5,000 5,000 - 5,000
251 saopiah V 5,000 5,000 - 5,000
252 miskam V 5,000 5,000 - 5,000
253 suhanti V 5,000 10000 15,000 - 15,000
254 11/6/2019 iq husnawati V 5,000 15000 20,000 - 20,000
255 aq zar V 5,000 5,000 - 5,000
256 khairul lutfi V 5,000 5,000 - 5,000
257 siti khadijah V 5,000 5,000 - 5,000
258 edi satria watoni V 10,000 10,000 - 10,000
259 rizwan halid V 5,000 5,000 - 5,000
260 suri sahara V 5,000 5,000 - 5,000
261 kholida V V 5,000 5000 10,000 - 10,000
262 ll ahmad fatih V 5,000 5,000 - 5,000
263 siti nurul ridayanti V 5,000 5,000 - 5,000
264 muhamad rifa'i V 5,000 5,000 - 5,000
265 iq zarkasi V V 5,000 15000 20,000 - 20,000
266 komariah V 5,000 10000 15,000 - 15,000
267 hj haeriah V 5,000 5,000 - 5,000
268 suburiah V 5,000 5,000 - 5,000
269 piza utami V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
270 zulkifli V 5,000 5,000 - 5,000
271 bq zaenab V 5,000 5,000 - 5,000
272 iq suriana V 5,000 5,000 - 5,000
273 siti hadijah V 5,000 5,000 - 5,000
274 mariani V 5,000 5,000 - 5,000
275 m zahid syarip V 5,000 5,000 - 5,000
276 iq ramlan V 5,000 5,000 - 5,000
277 12/6/2019 bq zohrah V 5,000 20000 25,000 poto copi status 40,000 40,000 (15,000)
278 abd hafiz pratama V V 5,000 25000 30,000 - 30,000
279 m sultan fahril.m V 5,000 5,000 - 5,000
280 mariah V 5,000 5,000 - 5,000
281 bq nurul hani fitriya V V 5,000 25000 30,000 - 30,000
282 l zaiyyan ata V 5,000 5,000 - 5,000
283 iq nurhasanah V 5,000 5,000 - 5,000
284 L M LATHIP WIRYAH V 15,000 15,000 - 15,000
285 abib al ansor V 5,000 5,000 - 5,000
286 ubaidillaj al haris V 5,000 5,000 - 5,000
287 muzil aslan V 5,000 5,000 - 5,000
288 aq mahram V 5,000 5,000 - 5,000
289 virga dwi yana V 10,000 10,000 - 10,000
290 m yusril rasyid V 5,000 5,000 - 5,000
291 13/6/2019 raya ramadani V 5,000 5,000 - 5,000
292 iq mislah V 5,000 5,000 - 5,000
293 rosina asma V 5,000 5,000 - 5,000
294 munawarah V 5,000 5,000 - 5,000
296 muhammad asranud V 15,000 15,000 - 15,000
297 hilliyah V 5,000 5,000 - 5,000
298 asyifa jannatul husn V 5,000 5,000 - 5,000
299 asila mufiza V 5,000 5,000 - 5,000
300 hj murniah V 5,000 5,000 - 5,000
301 ahda sabila V 5,000 5,000 - 5,000
302 najma V 5,000 5,000 - 5,000
303 nika mustika sari V 5,000 5,000 - 5,000
304 musannif V 15,000 10000 25,000 - 25,000
305 14/6/2019 Maeni V 5,000 5,000 pc status 40,000 40,000 (35,000)
306 iq hartini V 5,000 5,000 - 5,000
307 Dapa K.B V 5,000 5,000 - 5,000
308 Bq Rohadiah V 5,000 5,000 - 5,000
309 hamidah V 5,000 30000 35,000 - 35,000
310 aggus V 5,000 5,000 - 5,000
311 l jidni haer V 5,000 5,000 - 5,000
312 bq rahmatun s V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
313 siti hadijah V 5,000 5,000 - 5,000
314 sumiyati V 5,000 5,000 - 5,000
315 m byvan V 5,000 5,000 - 5,000
316 abdul kadir V 5,000 5,000 - 5,000
317 rifai V 5,000 5,000 - 5,000
318 15/6/2019 siti khodijah V 5,000 5,000 pak faozan 200,000 200,000 (195,000)
319 m ridho V 5,000 5,000 - 5,000
320 risma anisa V 5,000 5,000 - 5,000
321 ijat abdulloh V 5,000 5,000 - 5,000
322 bq amira V 5,000 5,000 - 5,000
323 hamidah V 5,000 5,000 - 5,000
324 h.m.hilmi V 5,000 5,000 - 5,000
325 nurhayati V 5,000 5,000 kopi tamu pak kapus 20,000 20,000 (15,000)
326 17/6/2019 muh raehan azkiyah V 5,000 5,000 pulsa listrik 205,000 205,000 (200,000)
327 zohrah V V 5,000 10000 15,000 - 15,000
328 iq paridah V 5,000 5,000 - 5,000
329 saufian as sauri V 5,000 5,000 - 5,000
330 maudatul laeli V 5,000 5,000 - 5,000
331 sukarna wadi V 5,000 5,000 - 5,000
332 asrul sani V 5,000 5,000 - 5,000
333 muh ilham jayadi V 5,000 5,000 - 5,000
334 siti khodijah V 5,000 5,000 - 5,000
335 suaediyah V 5,000 5,000 - 5,000
336 h makbul V 5,000 5,000 - 5,000
337 muh yazid V 5,000 5,000 - 5,000
338 paoziah V 5,000 5,000 - 5,000
339 muliani V 5,000 5,000 - 5,000
340 muh malik a V 5,000 5,000 - 5,000
341 handa a V 5,000 5,000 - 5,000
342 iq ekayanti V 5,000 5,000 - 5,000
343 mustariah V V 5,000 40000 45,000 - 45,000
344 h saepuddin V 5,000 5,000 - 5,000
345 muh hazril a V 5,000 5,000 - 5,000
346 naila salsabila V 5,000 5,000 - 5,000
347 aska rafa adril V 5,000 5,000 - 5,000
348 malika rafa k V 5,000 5,000 - 5,000
349 iq huzrin V 5,000 5,000 - 5,000
350 iq hamidi V 5,000 5,000 - 5,000
351 18/6/2019 arjuna berkah r V 5,000 5,000 pc status dan 77,500 77,500 (72,500)
352 nadia azzahra V 5,000 5,000 bensin 20,000 20,000 (15,000)
353 muh ilwan V 5,000 5,000 beli alat wifi 28,000 28,000 (23,000)
354 bq lingkahasi V 5,000 5,000 kopi tamu 10,000 10,000 (5,000)
355 h harun V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
356 deo bagus p V 5,000 5,000 - 5,000
357 vanisa azhari V 5,000 5,000 - 5,000
358 iq hidaytul l V 5,000 5,000 - 5,000
359 nurhasanah V V 5,000 15000 20,000 - 20,000
360 sukarna wadi V 5,000 5,000 - 5,000
361 aq munahar V 5,000 5,000 - 5,000
362 hijjatul hasanah V V 5,000 15000 20,000 - 20,000
363 hj siti aminah V 5,000 5,000 - 5,000
364 murdaini V V 5,000 85000 90,000 - 90,000
365 ade irma suryani V 15,000 15,000 - 15,000
366 sim V V 5,000 25000 30,000 - 30,000
367 muh faisal h V 5,000 5,000 - 5,000
368 al fadil m V 5,000 5,000 - 5,000
369 bq zohriah V 5,000 5,000 - 5,000
370 iq sororiyah V 5,000 5,000 - 5,000
371 ema fitrianti V V 5,000 40000 45,000 - 45,000
372 19/6/2019 apiatussolihah V 5,000 5,000 pc status rujukan 20,000 20,000 (15,000)
373 zar'artul intiana V V 5,000 30000 35,000 - 35,000
374 aliya sahira V 5,000 5,000 - 5,000
375 muh alif z V 5,000 5,000 - 5,000
376 m zaenul a V 5,000 5,000 - 5,000
377 murniati V V 5,000 30000 35,000 - 35,000
378 aq zohrah V 5,000 5,000 - 5,000
379 zahiriah V V 5,000 40000 45,000 - 45,000
380 aq busaeri V V 5,000 25000 30,000 - 30,000
381 marhani V V 5,000 40000 45,000 - 45,000
382 20/6/2019 endang estarina h V V 5,000 10000 15,000 - 15,000
383 muh zohri V V 5,000 10000 15,000 - 15,000
384 m abd aziz V V 5,000 10000 15,000 - 15,000
385 m ikhwan majidi V 5,000 5,000 - 5,000
386 nurhikmah V 5,000 5,000 - 5,000
387 bq lesiana putri V V 5,000 40000 45,000 - 45,000
388 yuliani V V 5,000 40000 45,000 - 45,000
389 novia sinta a V 5,000 5,000 - 5,000
390 arkan hadi l s V 5,000 5,000 - 5,000
391 jodi marta p V 5,000 5,000 - 5,000
392 naila putri s V 5,000 5,000 - 5,000
393 irfa y V 5,000 5,000 - 5,000
394 siti aisyah V 5,000 5,000 - 5,000
395 witri wulandari V V 5,000 40000 45,000 - 45,000
396 21/6/2019 syamsul islam 15,000 10000 25,000 Pc Status RM 40,000 40,000 (15,000)
397 maryatun 15,000 15,000 Transpot ida ke Dikes 15,000 15,000 -
398 bq pahima isani 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
399 selfiana 5,000 5,000 - 5,000
400 aq hamzani 5,000 5,000 - 5,000
401 salim al paruq 5,000 5,000 - 5,000
402 musallamah 5,000 5,000 - 5,000
403 yumna khalifa 5,000 5,000 - 5,000
404 muzakarussalim 5,000 10000 15,000 - 15,000
405 haeriah 5,000 15000 20,000 - 20,000
406 bq maharani 5,000 5,000 - 5,000
407 maudatul laeli 5,000 5,000 - 5,000
408 hj siti aisyah 5,000 5,000 - 5,000
409 haemi patihin 5,000 5,000 - 5,000
410 abdul hafiz p 5,000 5,000 - 5,000
411 jannatul aini 15,000 10000 25,000 - 25,000
412 aukia r 5,000 5,000 - 5,000
413 zaenal arifin 5,000 5,000 - 5,000
414 novayanti 5,000 5,000 - 5,000
415 zayyan ariqin s 5,000 5,000 - 5,000
416 22/6/2019 M Zubaer 5,000 5,000 - 5,000
417 Bq maida Rohmi A 5,000 5,000 - 5,000
418 Saepul zahri 5,000 5,000 - 5,000
419 Heriawati 15,000 15,000 - 15,000
420 Handa Al Bustani 5000 5000 - 5,000
421 Azizan Arfan 5000 5000 - 5,000
995,000 805000 45000 1,845,000 875,500 875,500 969,500
Bendahara Puskesmas
Mengetahui,
Kepala Puskesmas suralaga
Hj. Kusmiyati S.ST

NIP : 19680605 198903 2 014
MEIDINAAM INSYA, S.Kep
NIP : 19730531 199205 1 002
Puskesmas Suralaga Bulan Mei 2019
URAIAN KET
PENGELUARAN
Ret Lab UGD KIA LOKET LAB UGD KIA LOKET LAB KIA UGD SISA
1 2/5/2019 AQ Reza V V 5,000 25,000 30,000 fc Status 40,000 40,000 (10,000)
2 Marhaeni V V 5,000 5,000 - 5,000
3 LALU Ridwan A V 15,000 30,000 45,000 - 45,000
4 mardian A V 5,000 5,000 - 5,000
5 nurhidayati V 5,000 5,000 - 5,000
6 Alesa Ayudia P V 5,000 5,000 - 5,000
7 habib tamrin V 5,000 5,000 - 5,000
8 Halid Azhar V 5,000 5,000 - 5,000
9 M Arsal Hakim V 5,000 5,000 - 5,000
10 Kartini V 5,000 5,000 - 5,000
11 Asila Mupida V 5,000 5,000 - 5,000
12 Aq Masui V 5,000 5,000 - 5,000
13 H.L Nursaha V 5,000 5,000 - 5,000
14 Iq Nurmiyati V 5,000 5,000 - 5,000
15 Aq hariani V 5,000 5,000 - 5,000
16 3/5/2019 h. sahrudin V 5,000 5,000 - 5,000
17 IQ rosiah V 5,000 5,000 - 5,000
18 Masitah V 5,000 5,000 - 5,000
19 IQ Ziadah V 5,000 15000 20,000 - 20,000
20 huswatun hasanah V 5,000 25000 30,000 - 30,000
21 H. SYAKRAWI V 5,000 5,000 - 5,000
22 Sima Nihayatul U V 5,000 5,000 - 5,000
23 m rian alfarisi V 5,000 5,000 - 5,000
24 Julia Supani V 5,000 5,000 - 5,000
25 4/5/2019 Marzoan V 5,000 5,000 - 5,000
26 aq kudusiah V 10,000 10,000 - 10,000
27 Iq Husniati zikro V 5,000 5,000 - 5,000
28 aq Mahmul V 5,000 5,000 - 5,000
29 Iq Rohlah V 5,000 5,000 - 5,000
30 iq Takiudin V 5,000 5,000 - 5,000
31 M.Sayuti Mailik V 5,000 5,000 - 5,000
32 NAZRIL V 5,000 5,000 - 5,000
33 M. Asral Hakim V 5,000 5,000 - 5,000
34 Adiatul aulia V 5,000 5,000 - 5,000
35 Yuliani V 10,000 10,000 - 10,000
36 Jalaludin V 5,000 5,000 - 5,000
37 6/5/2019 Iq Saleh V 5,000 5,000 - 5,000
38 Rustan Hadi V 5,000 5,000 - 5,000
39 Syahra Aulia V 5,000 5,000 - 5,000
40 Haifa nazila V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
41 Aulia Maharani V 5,000 5,000 - 5,000
42 Nadia Azzahra V 5,000 5,000 - 5,000
43 Khaerunisa V 5,000 5,000 - 5,000
44 Yuhna Sarifah V 5,000 5,000 - 5,000
45 Anati fatin V 5,000 5,000 - 5,000
46 firkatun Najiah V 5,000 5,000 - 5,000
47 Hapipi V 5,000 5,000 - 5,000
48 Alwi Arsagaf V 5,000 5,000 - 5,000
49 Mami Misni V 5,000 5,000 - 5,000
50 7/5/2019 M.Dahrani V v 15,000 10000 25,000 fc Status 40,000 40,000 (15,000)
51 M Azam V 5,000 5,000 plastik obat 17000 17,000 (12,000)
52 Feri Ardiansah V 5,000 5,000 Klip Obat 70000 70,000 (65,000)
53 Ahmad Ridwan V 5,000 5,000 Kertas Puyer 32000 32,000 (27,000)
54 Rian aluni V 5,000 5,000 - 5,000
55 fatimatuzzahroh V 15000 15,000 - 15,000
56 Miskan V 5,000 5,000 - 5,000
57 Nasihan V 5,000 5,000 - 5,000
58 Hapsah V 5,000 5,000 - 5,000
59 M.Azka V 5,000 5,000 - 5,000
60 8/5/2019 Riwa Asnawi V 5,000 5,000 Cetak Bender 45,000 45,000 (40,000)
61 Aris Akbar V 10,000 10,000 - 10,000
62 Irsalina V 5,000 5,000 - 5,000
63 Hj.st Aminah V 5,000 5,000 - 5,000
64 Iq Salamah V 5,000 5,000 - 5,000
65 Iq Lindawati V 5,000 5,000 - 5,000
66 Risaul Auliah V 5,000 5,000 - 5,000
67 Arista Adinda V 5,000 5,000 - 5,000
68 Indriani V 5,000 5,000 - 5,000
69 M.Makbul v 25000 25,000 - 25,000
70 9/5/2019 aziza Arkan V 5,000 5,000 - 5,000
71 H Makbul V 5,000 5,000 - 5,000
72 St Zuliantih V 5,000 5,000 - 5,000
73 Bq Ezlin Elmi V 5,000 5,000 - 5,000
74 Zahira Rahmayanti V 5,000 5,000 - 5,000
75 St Nurul Ridayanti V 5,000 5,000 - 5,000
76 Gepita Agustina V 5,000 5,000 - 5,000
77 Hj. Haeriah V 5,000 5,000 - 5,000
78 Bq Suhastini V 5,000 5,000 - 5,000
79 Dimas Agustian s V 5,000 5,000 - 5,000
80 Hizbul Izzi V 5,000 5,000 - 5,000
81 Hendrayani 40000 40,000 - 40,000
82 gairi alfarizi V 5,000 5,000 - 5,000
83 L M Malagusagit V 15,000 15,000 - 15,000
URAIAN KET
PENGELUARAN
84 Sakiratul Laeni V 5,000 5,000 - 5,000
85 Kariah V 5,000 5,000 - 5,000
86 10/5/2019 Azzizah Asitani V 5,000 5,000 PC STATUS MTBS 40,000 40,000 (35,000)
87 Zulhadah V 5,000 5,000 - 5,000
88 M Fawwaz V 5,000 5,000 - 5,000
89 Huriani V 5,000 40000 45,000 - 45,000
90 Aisyah Syira V 5,000 5,000 - 5,000
91 M Raka azka V 5,000 5,000 - 5,000
92 Nazma Nira A V 5,000 5,000 - 5,000
93 Abdul Wahyi V 5,000 5,000 - 5,000
94 Hartini A .Pd i V 5,000 5,000 - 5,000
95 Azzijah V 5,000 5,000 - 5,000
96 Srikuardani V 5,000 5,000 - 5,000
97 11/5/2019 Bq AidaLutfilatin N V 5,000 5,000 - 5,000
98 Asyila Mufida V 5,000 5,000 - 5,000
99 Izad Abdullah V 5,000 5,000 - 5,000
100 L M Adam V 5,000 5,000 - 5,000
101 Aq Suriani V 5,000 5,000 - 5,000
102 L Abid Mufadda V 5,000 5,000 - 5,000
103 Zaenal V 5,000 5,000 - 5,000
104 Wafa Murmita V 5,000 5,000 - 5,000
105 Yusup Abdullah V 5,000 5,000 - 5,000
106 iq Takiudin V 5,000 5,000 - 5,000
107 13/5/2019 Hudni V V 5,000 40000 45,000 ATK 87,000 87,000 (42,000)
108 Masitah V 5,000 5,000 - 5,000
109 M Rizki Abbas V 5,000 5,000 - 5,000
110 Elda Sulistira V 5,000 5,000 - 5,000
111 Jamatul Aeni V 5,000 5,000 - 5,000
112 Safni V 5,000 5,000 - 5,000
113 Quratul Aini V V 5,000 10000 15,000 - 15,000
114 liana Yustiana K V V 15,000 30000 45,000 - 45,000
115 Muawiyah V 5,000 5,000 - 5,000
116 M Iqbal V 5,000 5,000 - 5,000
117 Hasiah V 5,000 5,000 - 5,000
118 Wika Humaro V 5,000 5,000 - 5,000
119 Iq Rahla V 5,000 5,000 - 5,000
120 h lalu nursaat V 5,000 5,000 - 5,000
121 14/5/2019 muh wahyu ramdan V 5,000 5,000 - 5,000
122 geri alfarizi V 5,000 5,000 poto copy status 40,000 40,000 (35,000)
123 sukasih rahmawati V 5,000 40000 45,000 - 45,000
124 inaq helmawati V 5,000 5,000 - 5,000
125 aisya shifa V 5,000 5,000 - 5,000
126 m barok sulaiman V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
128 akila hafisa azalia V 5,000 5,000 - 5,000
129 bila al hafiz V 5,000 5,000 - 5,000
130 zohrani zakirudin V 5,000 5,000 - 5,000
131 zusha V 20000 20,000 - 20,000
132 15/5/2019 risma nurmala V 5,000 5,000 poto copy mtbs 10,000 10,000 (5,000)
133 amira azzahra V 5,000 5,000 - 5,000
134 bq kartini V 5,000 5,000 - 5,000
135 mumparizah V 5,000 5,000 - 5,000
136 l abid munpadal V 5,000 60000 65,000 - 65,000
137 inayatussulihah V 5,000 5,000 - 5,000
138 sahrudin V 5,000 5,000 - 5,000
139 iq samsul lutfi V 5,000 5,000 - 5,000
140 m yakub V 5,000 5,000 - 5,000
141 laelatul husmi V 5,000 5,000 - 5,000
142 ismaini V 5,000 30000 35,000 - 35,000
143 iq zubaedah V 5,000 5,000 - 5,000
144 kholid akbar V 5,000 5,000 - 5,000
145 malika al husna V 5,000 5,000 - 5,000
147 tasya nur aisa V 5,000 5,000 - 5,000
148 latifa V 5,000 5,000 - 5,000
149 al aira nova V 5,000 5,000 - 5,000
150 16/5/2019 l.iskandar zulkarnae V 15,000 15,000 - 15,000
151 saida ayudi V 5,000 5,000 - 5,000
152 aq zaenudin V 5,000 5,000 - 5,000
153 multini V V 5,000 15000 20,000 - 20,000
154 al aira nova V 5,000 5,000 - 5,000
155 susilawati V V 5,000 40000 45,000 - 45,000
156 h burhanudin V 5,000 5,000 - 5,000
157 iq mahmuludin V 5,000 5,000 - 5,000
158 iq jaeni V 5,000 5,000 - 5,000
159 malina V 10000 10,000 - 10,000
160 wardatul uyun V V 5,000 10000 15,000 - 15,000
161 m faiz V 5,000 5,000 - 5,000
162 Dina Jahira V 5,000 5,000 - 5,000
163 Aq Rukaiyah V 5,000 5,000 - 5,000
164 M Azmi Akbar V 5,000 5,000 - 5,000
165 17/5/2019 h abib alhakim V 5,000 5,000 bensin ambulan 50,000 50,000 (45,000)
166 laelatul karimah V 5,000 5,000 PC Status 40,000 40,000 (35,000)
167 nurhidayatullah V 5,000 30000 35,000 - 35,000
168 sumiati V 5,000 5,000 - 5,000
169 surya jayadi V 5,000 65000 70,000 - 70,000
URAIAN KET
PENGELUARAN
170 haeriah V 5,000 40000 45,000 - 45,000
171 m rifai V 5,000 5,000 - 5,000
172 muh haeron V 5,000 5,000 - 5,000
173 bq masitah V V 5,000 20000 25,000 - 25,000
174 18/5/2019 qais nabani V 5,000 5,000 - 5,000
175 amaq saprudin V 5,000 5,000 - 5,000
176 anabi patin V 5,000 5,000 - 5,000
177 hj halimah V 5,000 5,000 - 5,000
178 ahmad mujamin V 5,000 5,000 - 5,000
179 parida V V 5,000 40000 45,000 - 45,000
180 H.L. patmawe V 5,000 5,000 - 5,000
181 l arka aditia pra V 5,000 5,000 - 5,000
182 bq zahriah V 5,000 5,000 - 5,000
183 hj.hidayah V 5,000 5,000 - 5,000
184 hamzatul musari V 5,000 5,000 - 5,000
185 guffa utama V 5,000 5,000 - 5,000
186 iq ziadah V 5,000 5,000 - 5,000
187 st latifa aeni V 5,000 5,000 - 5,000
188 eli agussuranti V 5,000 5,000 - 5,000
189 h.l fatmawa V 5,000 5,000 - 5,000
190 bq rohaeni V 5,000 5,000 - 5,000
191 bq aida lutfiayun n V 5,000 5,000 - 5,000
192 20/5/2019 Irsalina V 5,000 5,000 - 5,000
193 abdurahman al paya V V 5,000 10000 15,000 - 15,000
194 Al Masyirah V 5,000 5,000 - 5,000
195 Bq cahya Anindia p V 5,000 5,000 - 5,000
196 m zahid syarip V 5,000 5,000 - 5,000
197 m azka ajrofi V 5,000 5,000 - 5,000
198 munawaroh V 5,000 5,000 - 5,000
199 nieta pasti V 5,000 5,000 - 5,000
200 nurhidayah V 5,000 5,000 - 5,000
201 fahira V 5,000 5,000 - 5,000
202 iq husniat zikro V 5,000 5,000 - 5,000
203 naela nuryakila V 5,000 5,000 - 5,000
204 h makbul V 5,000 5,000 - 5,000
205 raodatul faizah V 5,000 30000 35,000 - 35,000
206 siti raehanun V 5,000 30000 35,000 - 35,000
207 Rujukan 5,000 80000 85,000 - 85,000
208 siti hajar V 5,000 50000 55,000 - 55,000
209 21/5/2019 aufa hasan V 5,000 5,000 PC STATUS 40,000 40,000 (35,000)
210 iq zaenal V 5,000 5,000 - 5,000
212 aq athrudin V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
213 jumaiyah V V 5,000 40000 45,000 - 45,000
214 hafizatul ramadani V 5,000 5,000 - 5,000
215 rosita dinirosa V 5,000 5,000 - 5,000
216 hawafis magfirah V 5,000 5,000 - 5,000
217 masitah V V 5,000 15000 20,000 - 20,000
218 suhat V V 5,000 40000 45,000 - 45,000
220 22/5/2019 iq linda wati V 5,000 5,000 TRASPOT 15,000 15,000 (10,000)
221 muh irwani V 5,000 5,000 LAP KE DIKES - 5,000
222 marzoan V 5,000 5,000 - 5,000
223 abdurrahaman al-pa V 5,000 5,000 - 5,000
224 m irwan V V 5,000 40000 45,000 - 45,000
225 Hidayat Mustopa V 5,000 5,000 - 5,000
226 Fikri Raqhman V 5,000 5,000 - 5,000
227 Iq Husnaeni V 5,000 5,000 - 5,000
228 M.Irwana V 5,000 5,000 - 5,000
229 Holid Azhzr V 5,000 5,000 - 5,000
230 24/5/2019 h.harun V 5,000 5,000 - 5,000
231 IQ asror V 5,000 5,000 - 5,000
232 muh fazil V 5,000 5,000 - 5,000
233 toharah V 5,000 5,000 - 5,000
234 ahsan V 5,000 5,000 - 5,000
235 mamiq saprudin V 5,000 5,000 - 5,000
236 fadila handayani V 5,000 5,000 - 5,000
237 fatimah wiwin ns V V 5,000 40000 45,000 - 45,000
238 azizatur rohmah V 5,000 5,000 - 5,000
239 Ahmad rozokin V 5,000 5,000 - 5,000
240 alamatun nisa V 5,000 5,000 - 5,000
241 sahilatun V 5,000 5,000 - 5,000
242 St Hawa V 5,000 5,000 - 5,000
243 M Arsal Hakim V 5,000 10000 15,000 - 15,000
244 Leni Nurdiantari V V 5,000 5,000 - 5,000
245 Aa Ma al V 5,000 5,000 - 5,000
246 Eva Huhna V V 5,000 40000 45,000 - 45,000
247 25/5/2019 Rozikin V 5,000 5,000 - 5,000
248 H Ahmad zaki V V 5,000 15000 20,000 - 20,000
249 Hj Halimah V 5,000 5,000 - 5,000
250 Iq salamah V 5,000 5,000 - 5,000
251 Aufa Hasan V 5,000 5,000 - 5,000
252 bq Mariana V 40000 40,000 - 40,000
253 L Muh Addi Hulhaki V 5,000 5,000 - 5,000
254 Ainun B V 5,000 5,000 - 5,000
255 Mulkam V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
256 M Rizki Maulana V 5,000 5,000 - 5,000
257 Fitriah V 5,000 5,000 - 5,000
258 26/5/2019 Fitri Rahman V 5,000 5,000 - 5,000
259 Gustina Alia V 5,000 5,000 - 5,000
260 L Aqsha Sarfaraz V 5,000 5,000 - 5,000
261 Rumaesa Atura V 5,000 5,000 - 5,000
262 Hanik Rifai V 5,000 5,000 - 5,000
263 Iq Rosahia V 5,000 5,000 - 5,000
265 Hatim V 5,000 5,000 - 5,000
266 27/5/2019 Aq Atharudin V 5,000 5,000 Pc Status 40,000 40,000 (35,000)
267 L Aksyar Sarparaz V 5,000 5,000 Kantong Plastik 13,000 13,000 (8,000)
268 L Zidni Khaer V 5,000 5,000 obat - 5,000
269 M Rifai V 5,000 5,000 Pc Mtbs 15,000 15,000 (10,000)
270 Raya Rahmadani V 5,000 5,000 bensin 30,000 30,000 (25,000)
271 Yumna Khalifa V 5,000 5,000 THR 1,500,000 1,500,000 (1,495,000)
272 Ainun Dania V 5,000 5,000 Regen 450,000 450,000 (445,000)
273 L Hery Saopan T V 5,000 5,000 Bayar Kekurangan 260,000 260,000 (255,000)
274 Yaumul Zaijah V 5,000 5,000 Beli Regen - 5,000
275 M Daud V 5,000 5,000 Pulsa Modem 60,000 60,000 (55,000)
276 Iq Romlah V 5,000 5,000 - 5,000
277 Aira Nafisa V 5,000 5,000 - 5,000
278 Iq Wahyuni V 5,000 5,000 - 5,000
279 Raska Arga nabil V 5,000 5,000 - 5,000
280 arsul sani V 5,000 5,000 - 5,000
281 bq intihan V 5,000 5,000 - 5,000
282 bq nafizatun V 5,000 5,000 - 5,000
283 bq siti nurul kahni V 5,000 5,000 - 5,000
284 ahmad mujamil V 5,000 5,000 - 5,000
285 28/5/2019 Asna wati V V 5,000 50000 55,000 ngantar lap ke Dikes 15,000 15,000 40,000
286 gina sonia V V 5,000 40000 45,000 - 45,000
287 muh arif qudsi V 5,000 5,000 - 5,000
288 afka hadi l.sadik V 5,000 5,000 - 5,000
289 zahiratul husna V 5,000 5,000 - 5,000
290 nurlaili sulhiati V 15,000 15,000 - 15,000
291 handa albustani V 5,000 5,000 - 5,000
292 kasiati V 5,000 5,000 - 5,000
293 muh khaerul watoni V 5,000 5,000 - 5,000
294 haekal raditya azka V 5,000 5,000 - 5,000
295 afifah V 5,000 5,000 - 5,000
296 muhammad artan V 5,000 5,000 - 5,000
297 iq hidayatul laili V 5,000 5,000 - 5,000
298 siddiq hidayat V 5,000 5,000 - 5,000
URAIAN KET
PENGELUARAN
299 29/5/2019 l arka aditya V 5,000 5,000 - 5,000
230 hj patimah V 5,000 5,000 - 5,000
231 m yezan V 5,000 5,000 - 5,000
232 iq hendriyani V 5,000 5,000 - 5,000
233 mariam alesa V 5,000 5,000 - 5,000
234 dilan karunia V 5,000 5,000 - 5,000
235 hasna aila V 5,000 5,000 - 5,000
236 31/5/2019 husnawati V 5,000 5,000 - 5,000
237 nilawati V 5,000 5,000 - 5,000
238 rohida komala sari V 5,000 5,000 - 5,000
239 bq asifa naela r V 5,000 5,000 - 5,000
240 aq khamsatul askar V 5,000 5,000 - 5,000
JUMLAH 1,595,000 1,160,000 10,000 125,000 2,890,000 2,949,000 2,949,000 (59,000)
Mengetahui, Puskesmas Suralaga 01 Juni 2019

MEIDINAAM INSYA, S.Kep Hj Kusmiyati S.ST

NIP : 19730531 199205 1 002 NIP : 19680605 198903 2 014
Puskesmas Suralaga Bulan juni 2019
URAIAN KET
PENGELUARAN
Tanggal 1 s/d 9 /Juni /2019 Libur Bersama
242 10/6/2019 Hadiyatussalihah V 5,000 5,000 PC STATUS 40,000 - (23,000)
243 ayra riysa naira V 5,000 5,000 Kertas HPS 28,000 28,000 (95,000)
244 faris naofal V 5,000 5,000 bensin ambulan 100,000 100,000 (35,000)
245 usman V V 5,000 25000 30,000 - 2,000
246 sumiati V V 5,000 40000 45,000 - 45,000
247 huswatun hasanah V 5,000 5,000 - 5,000
248 raya ramadani V 5,000 5,000 - 5,000
249 turkiyanti V V 5,000 30000 35,000 - 35,000
250 aq sapuri V 5,000 5,000 - 5,000
251 saopiah V 5,000 5,000 - 5,000
252 miskam V 5,000 5,000 - 5,000
253 suhanti V 5,000 10000 15,000 - 15,000
254 11/6/2019 iq husnawati V 5,000 15000 20,000 - 20,000
255 aq zar V 5,000 5,000 - 5,000
256 khairul lutfi V 5,000 5,000 - 5,000
257 siti khadijah V 5,000 5,000 - 5,000
258 edi satria watoni V 10,000 10,000 - 10,000
259 rizwan halid V 5,000 5,000 - 5,000
260 suri sahara V 5,000 5,000 - 5,000
261 kholida V V 5,000 5000 10,000 - 10,000
262 ll ahmad fatih V 5,000 5,000 - 5,000
263 siti nurul ridayanti V 5,000 5,000 - 5,000
264 muhamad rifa'i V 5,000 5,000 - 5,000
265 iq zarkasi V V 5,000 15000 20,000 - 20,000
266 komariah V 5,000 10000 15,000 - 15,000
267 hj haeriah V 5,000 5,000 - 5,000
268 suburiah V 5,000 5,000 - 5,000
269 piza utami V 5,000 5,000 - 5,000
270 zulkifli V 5,000 5,000 - 5,000
271 bq zaenab V 5,000 5,000 - 5,000
272 iq suriana V 5,000 5,000 - 5,000
273 siti hadijah V 5,000 5,000 - 5,000
274 mariani V 5,000 5,000 - 5,000
275 m zahid syarip V 5,000 5,000 - 5,000
276 iq ramlan V 5,000 5,000 - 5,000
277 12/6/2019 bq zohrah V 5,000 20000 25,000 poto copi status 40,000 40,000 (15,000)
278 abd hafiz pratama V V 5,000 25000 30,000 Kantong Plastik 20,000 20,000 10,000
279 m sultan fahril.m V 5,000 5,000 - 5,000
280 mariah V 5,000 5,000 - 5,000
281 bq nurul hani fitriya V V 5,000 25000 30,000 - 30,000
282 l zaiyyan ata V 5,000 5,000 - 5,000
283 iq nurhasanah V 5,000 5,000 - 5,000
284 L M LATHIP WIRYAHADI V 15,000 15,000 - 15,000
285 abib al ansor V 5,000 5,000 - 5,000
286 ubaidillaj al haris V 5,000 5,000 - 5,000
287 muzil aslan V 5,000 5,000 - 5,000
288 aq mahram V 5,000 5,000 - 5,000
289 virga dwi yana V 10,000 10,000 - 10,000
290 m yusril rasyid V 5,000 5,000 - 5,000
291 13/6/2019 raya ramadani V 5,000 5,000 - 5,000
292 iq mislah V 5,000 5,000 - 5,000
293 rosina asma V 5,000 5,000 - 5,000
294 munawarah V 5,000 5,000 - 5,000
296 muhammad asranudin V 15,000 15,000 - 15,000
297 hilliyah V 5,000 5,000 - 5,000
298 asyifa jannatul husna V 5,000 5,000 - 5,000
299 asila mufiza V 5,000 5,000 - 5,000
300 hj murniah V 5,000 5,000 - 5,000
301 ahda sabila V 5,000 5,000 - 5,000
302 najma V 5,000 5,000 - 5,000
303 nika mustika sari V 5,000 5,000 - 5,000
304 musannif V 15,000 10000 25,000 - 25,000
305 14/6/2019 Maeni V 5,000 5,000 pc status 40,000 40,000 (35,000)
306 iq hartini V 5,000 5,000 AIR UNTUK TAMU 20,000 20,000 (15,000)
307 Dapa K.B V 5,000 5,000 - 5,000
308 Bq Rohadiah V 5,000 5,000 - 5,000
309 hamidah V 5,000 30000 35,000 - 35,000
310 aggus V 5,000 5,000 - 5,000
311 l jidni haer V 5,000 5,000 - 5,000
312 bq rahmatun s V 5,000 5,000 - 5,000
313 siti hadijah V 5,000 5,000 - 5,000
314 sumiyati V 5,000 5,000 - 5,000
315 m byvan V 5,000 5,000 - 5,000
316 abdul kadir V 5,000 5,000 - 5,000
317 rifai V 5,000 5,000 - 5,000
318 15/6/2019 siti khodijah V 5,000 5,000 - 5,000
319 m ridho V 5,000 5,000 - 5,000
320 risma anisa V 5,000 5,000 - 5,000
321 ijat abdulloh V 5,000 5,000 - 5,000
322 bq amira V 5,000 5,000 - 5,000
323 hamidah V 5,000 5,000 - 5,000
324 h.m.hilmi V 5,000 5,000 - 5,000
325 nurhayati V 5,000 5,000 - 5,000
326 17/6/2019 muh raehan azkiyah V 5,000 5,000 - 5,000
327 zohrah V V 5,000 10000 15,000 Alat Waifi + Kopinya 60,000 60,000 (45,000)
328 iq paridah V 5,000 5,000 - 5,000
329 saufian as sauri V 5,000 5,000 - 5,000
330 maudatul laeli V 5,000 5,000 - 5,000
331 sukarna wadi V 5,000 5,000 - 5,000
332 asrul sani V 5,000 5,000 - 5,000
333 muh ilham jayadi V 5,000 5,000 - 5,000
334 siti khodijah V 5,000 5,000 - 5,000
335 suaediyah V 5,000 5,000 - 5,000
336 h makbul V 5,000 5,000 - 5,000
337 muh yazid V 5,000 5,000 - 5,000
338 paoziah V 5,000 5,000 - 5,000
339 muliani V 5,000 5,000 - 5,000
340 muh malik a V 5,000 5,000 - 5,000
341 handa a V 5,000 5,000 - 5,000
342 iq ekayanti V 5,000 5,000 - 5,000
343 mustariah V V 5,000 40000 45,000 - 45,000
344 h saepuddin V 5,000 5,000 - 5,000
345 muh hazril a V 5,000 5,000 - 5,000
346 naila salsabila V 5,000 5,000 - 5,000
347 aska rafa adril V 5,000 5,000 - 5,000
348 malika rafa k V 5,000 5,000 - 5,000
349 iq huzrin V 5,000 5,000 - 5,000
350 iq hamidi V 5,000 5,000 - 5,000
351 18/6/2019 arjuna berkah r V 5,000 5,000 pc status dan 77,500 77,500 (72,500)
352 nadia azzahra V 5,000 5,000 bensin 20,000 20,000 (15,000)
353 muh ilwan V 5,000 5,000 beli alat wifi 28,000 28,000 (23,000)
354 bq lingkahasi V 5,000 5,000 Pc Status Rujukan 20,000 20,000 (15,000)
355 h harun V 5,000 5,000 - 5,000
356 deo bagus p V 5,000 5,000 - 5,000
357 vanisa azhari V 5,000 5,000 - 5,000
358 iq hidaytul l V 5,000 5,000 - 5,000
359 nurhasanah V V 5,000 15000 20,000 - 20,000
360 sukarna wadi V 5,000 5,000 - 5,000
361 aq munahar V 5,000 5,000 - 5,000
362 hijjatul hasanah V V 5,000 15000 20,000 - 20,000
363 hj siti aminah V 5,000 5,000 - 5,000
364 murdaini V V 5,000 85000 90,000 - 90,000
365 ade irma suryani V 15,000 15,000 - 15,000
366 sim V V 5,000 25000 30,000 - 30,000
367 muh faisal h V 5,000 5,000 - 5,000
368 al fadil m V 5,000 5,000 - 5,000
369 bq zohriah V 5,000 5,000 - 5,000
370 iq sororiyah V 5,000 5,000 - 5,000
371 ema fitrianti V V 5,000 40000 45,000 - 45,000
372 19/6/2019 apiatussolihah V 5,000 5,000 - 5,000
373 zar'artul intiana V V 5,000 30000 35,000 - 35,000
374 aliya sahira V 5,000 5,000 - 5,000
375 muh alif z V 5,000 5,000 - 5,000
376 m zaenul a V 15,000 15,000 - 15,000
377 murniati V V 5,000 30000 35,000 - 35,000
378 aq zohrah V 5,000 5,000 - 5,000
379 zahiriah V V 5,000 40000 45,000 - 45,000
380 aq busaeri V V 5,000 25000 30,000 - 30,000
381 marhani V V 5,000 40000 45,000 - 45,000
Aulia Maharani V 5,000 5,000 - 5,000
Fuji Astuti V 5,000 5,000 - 5,000
382 20/6/2019 endang estarina h V V 15,000 10000 25,000 - 25,000
383 muh zohri V V 15,000 10000 25,000 - 25,000
384 m abd aziz V V 15,000 10000 25,000 - 25,000
385 m ikhwan majidi V 15,000 15,000 - 15,000
386 nurhikmah V 5,000 5,000 - 5,000
387 bq lesiana putri V V 5,000 40000 45,000 - 45,000
388 yuliani V V 5,000 40000 45,000 - 45,000
389 novia sinta a V 5,000 5,000 - 5,000
390 arkan hadi l s V 5,000 5,000 - 5,000
391 jodi marta p V 5,000 5,000 - 5,000
392 naila putri s V 5,000 5,000 - 5,000
393 irfa y V 5,000 5,000 - 5,000
394 siti aisyah V 5,000 5,000 - 5,000
395 witri wulandari V V 5,000 40000 45,000 - 45,000
396 21/6/2019 syamsul islam V v 15,000 10000 25,000 Pc Status RM 40,000 40,000 (15,000)
397 maryatun V 15,000 15,000 Transpot ida ke Dikes 15,000 15,000 -
398 bq pahima isani V 5,000 5,000 Pak Faozan 200,000 200,000 (195,000)
399 selfiana V 5,000 5,000 - 5,000
400 aq hamzani V 5,000 5,000 - 5,000
401 salim al paruq V 5,000 5,000 - 5,000
402 musallamah V 5,000 5,000 - 5,000
403 yumna khalifa V 5,000 5,000 - 5,000
404 muzakarussalim V v 5,000 10000 15,000 - 15,000
405 haeriah V v 5,000 15000 20,000 - 20,000
406 bq maharani V 5,000 5,000 - 5,000
407 maudatul laeli V 5,000 5,000 - 5,000
408 hj siti aisyah V 5,000 5,000 - 5,000
409 haemi patihin V 5,000 5,000 - 5,000
410 abdul hafiz p V 5,000 5,000 - 5,000
411 jannatul aini V v 15,000 10000 25,000 - 25,000
412 aukia r V 5,000 5,000 - 5,000
413 zaenal arifin V 5,000 5,000 - 5,000
414 novayanti V 5,000 5,000 - 5,000
415 zayyan ariqin s V 5,000 5,000 - 5,000
416 22/6/2019 M Zubaer V 5,000 5,000 - 5,000
417 Bq maida Rohmi A V 5,000 5,000 - 5,000
418 Saepul zahri V 5,000 5,000 - 5,000
419 Heriawati V 15,000 15,000 - 15,000
420 Handa Al Bustani V 5000 5000 - 5,000
421 Azizan Arfan V 5000 5000 - 5,000
422 Bq Linda Wati V 5000 5000 - 5,000
424 24/6/2019 Dina Nabila V 5000 5000 PC Status 40,000 40,000 (35,000)
425 Alisa Indiwahyun V 5000 5000 - 5,000
426 Selvia Apriani V 5000 5000 - 5,000
427 Aq Khamsatul Arsan V 5000 5000 - 5,000
428 Nurul Asman V 5000 5000 - 5,000
429 Raffa Syarifa V 5000 5000 - 5,000
430 Zafran V 5000 5000 - 5,000
431 M Yasir jami V 5000 5000 - 5,000
432 yumna khalifa V 5000 5000 - 5,000
433 H Makbul V 5000 5000 - 5,000
434 Aq Miftahul aini V 5000 5000 - 5,000
435 H saprudin V 5000 5000 - 5,000
436 Marlin Andari V v 5000 10000 15000 - 15,000
437 Hikmah V 5000 5000 - 5,000
438 Sosia V 5000 5000 - 5,000
439 Anisa Andi wahyuni V 5000 5000 - 5,000
440 Aska Al Korni V 5000 5000 - 5,000
441 M Raditsa H V 5000 5000 - 5,000
442 Sumiati V 5000 5000 - 5,000
443 Maulidatul nurul a V 5000 5000 - 5,000
444 Algifar V 5000 5000 - 5,000
445 Anati V 5000 5000 - 5,000
Hamdia Gunawan V 15000 15000 - 15,000
Iwan Santari V 15000 15000 - 15,000
446 25/6/2019 Laelatul Rahman V 5000 5000 - 5,000
447 H Edi Hidayat V V 5000 25000 30000 - 30,000
448 Iq Saenal V 5000 5000 - 5,000
449 Salman Alfarisi V 5000 5000 - 5,000
450 Wafdah Solihah V 5000 5000 - 5,000
451 Giyan Khaeri S V 5000 5000 - 5,000
452 H l Hursaha V 5000 5000 - 5,000
453 Danu ShatirAfgani V 5000 5000 - 5,000
454 Dolah/iq Zahra V 5000 5000 - 5,000
455 Wahyu Kurniawan V 5000 5000 - 5,000
456 Nizam Fikri V 5000 5000 - 5,000
457 Abdul Aziz V V 15000 10000 25000 - 25,000
458 Jakna Sultan F V 10000 10000 - 10,000
459 Abdul Hayyi V 15000 15000 - 15,000
460 St Mariam V V 15,000 10000 25,000 - 25,000
461 26/6/2019 M afkar rafizi V 5,000 5,000 - 5,000
462 mulyani V 15,000 15,000 - 15,000
463 iq wahidah V 5,000 5,000 - 5,000
464 hermawan efendi V 10,000 10,000 - 10,000
465 wafa ilmira V 5,000 5,000 - 5,000
466 m.sayuti mailik V 5,000 5,000 - 5,000
467 fiqotun hajiah V 5,000 5,000 - 5,000
468 aq khaer V 5,000 5,000 - 5,000
469 m.azril maulana V 5,000 5,000 - 5,000
470 h muksin V V 5,000 50000 55,000 - 55,000
471 27/6/2019 muh arif qudsi V 5,000 5,000 Pc Status RM 40,000 40,000 (35,000)
472 iq hairani V 5,000 5,000 Pc Status RM 25,000 25,000 (20,000)
473 muliadi s.kom V 5,000 5,000 - 5,000
474 hj khusnul k V 5,000 5,000 - 5,000
475 alika naila p V 5,000 5,000 - 5,000
476 kurnaen,s.kom V 5,000 5,000 - 5,000
477 hj halimatussa'diah V 5,000 5,000 - 5,000
478 aufa hasan V 5,000 5,000 - 5,000
479 Nur Islamia V 5,000 5,000 - 5,000
480 Iq Masruni V 5,000 5,000 - 5,000
481 Lisa Asta Candra V 15,000 15,000 - 15,000
482 Muh Adi SKM V 5,000 5,000 - 5,000
483 28/6/2019 St Aminah V 5,000 5,000 - 5,000
484 Muhammad Joni V 5,000 5,000 - 5,000
485 Subaedah S V 5000 5000 - 5,000
486 29/6/2019 Gifran Hambali V 5000 5000 mba wardah 75,000 75,000 (70,000)
487 Hikmaturahman V 5000 5000 Bayar U/M Kasur 1,000,000 -995000
488 M Razin Jafair V 5000 5000 5000
489 Iq Husnah V 5000 5000 5000
490 H. Harun V 5000 5000 - 5,000
491 St Aisah V 5000 5000 - 5,000
1,485,000 910000 45000 2,440,000 1,888,500 1,888,500 551,500
Mengetahui, Puskesmas Suralaga 1 juli 2019

MEIDINAAM INSYA, S.Kep Hj. Kusmiyati S.ST

NIP : 19730531 199205 1 002 NIP : 19680605 198903 2 014
Puskesmas Suralaga Bulan juli 2019
URAIAN KET
PENGELUARAN
1 1/7/2019 Hasyatin V V 5000 10000 15,000 - 15,000
2 H Hafisudin V 5000 5,000 Plastik Obat 10,000 -5000
3 St Aminah V V 5000 50000 55,000 - 55,000
4 Nurusyafa V 5000 5,000 - 5,000
5 H Yahya V 5000 5,000 - 5,000
6 Risma Nurmala V 5000 5,000 - 5,000
7 Kartini V 5000 5,000 - 5,000
8 Hijatul Hasanah V V 5000 15000 20,000 - 20,000
9 Shakiera V 5000 5,000 - 5,000
10 Bq Zakriah V 5000 5,000 - 5,000
11 Bq Imzarosian V 5000 5,000 - 5,000
12 Zidan Alfarisi V 5000 5,000 - 5,000
13 St Suhasdah V 5000 5,000 - 5,000
14 Yuza m.m.H V 5000 5,000 - 5,000
15 Akila Nadila V 5000 5000 - 5,000
16 H Saepudin V 5000 5000 - 5,000
17 Sulhiyah V 5000 5000 5000
18 Solihah V 40000 40000 40000
19 Taufik Uwais V 5000 5000 5000
20 2/7/2019 L Kurnia/sks V 15000 15000 - 15,000
21 h. sakirin V 5000 5,000 PC Status 40,000 -35000
22 selfiana V 5000 5000 5,000
23 mahmiah V 5000 5000 Bensin Ambulan 100,000 (95,000)
24 sakia putri V 5000 5000 5,000
25 muh suhaedi V 5000 5000 5,000
26 m. zaopan shakil V 5000 5000 5,000
27 fadil maulan al V 5000 5000 5,000
28 m.fakih al lutfi V 5000 5000 5,000
29 arfan habibi V 5000 5000 5,000
30 hj aisah V 5000 5000 5,000
31 eni wahyuni V 5000 5000 5,000
32 kariawati V 5000 5000 5,000
33 iq rayahin V 5000 5000 5,000
34 airya shifa V 5000 5000 5,000
35 3/7/2019 Hj halimah V 5000 5000 5,000
36 rini sulastri V 5000 5000 5,000
37 anisatun nisa V 5000 5000 5,000
38 hj halimah V 5000 5000 5,000
39 syakira aulia V 5000 5000 5,000
40 jalaluddin V 5000 5000 5,000
41 raehan mubarok V 5000 5000 5,000
42 h musippudin V 5000 5000 5,000
43 abdullah abbad V 5000 5000 5,000
44 bq solatiah/sks V 15000 15000 15,000
45 mardiana V V 5000 40000 45000 45,000
46 aulia maharani V 5000 5000 5,000
47 naura salsa olivia V 5000 5000 5,000
48 sima nihayatul u V 5000 5000 5,000
49 rini sulistina V 5000 5000 5,000
50 4/7/2019 m.reza muharam/sks V 15000 15000 15,000
51 nurul hidayah V 5000 5000 5,000
52 m.gibran al-kahfi V 5000 5000 5,000
53 iq jauzi V 5000 5000 5,000
54 siti qomariah V 5000 5000 5,000
55 sandi putra V 5000 5000 5,000
56 iq husniati zikro V 5000 5000 5,000
57 abdussalam V 5000 5000 5,000
58 dhefin arfabian V 5000 5000 5,000
59 fiktoriati V 5000 5000 5,000
60 nabila hasna a V 5000 5000 5,000
61 5/7/2019 L. jupriadi/sks V 15000 15000 15,000
62 bq aisyah V V 15000 10000 25000 25,000
63 musanif V 15000 15000 15,000
64 bq heni marlina/sks V 15000 10000 25000 25,000
65 haeriah V 5000 5000 5,000
66 ahmad maulana V 5000 5000 5,000
67 wafda V 5000 5000 5,000
68 zoya askairi V 5000 5000 5,000
69 dafi malik ibrahim V 5000 5000 5,000
70 suprianti V 5000 5000 5,000
71 musuf wandi V 5000 5000 5,000
72 azalia halika V 5000 5000 5,000
73 6/7/2019 rahni V 5000 5000 5,000
74 sahibul kahfi V 5000 5000 5,000
75 bq fitri ramadani V 5000 5000 5,000
76 l abd rahman V 5000 5000 5,000
77 muh.husain V 5000 5000 5,000
78 jaiya supani V 5000 5000 5,000
79 8/7/2109 nur azizah V 5000 5000 Kertas puyer + 40,000 (35,000)
80 siti alya wahidah V 5000 5000 Kantong Obat 5,000
81 asma aqilatunnisa V 5000 5000 5,000
82 zidan rizkona V 5000 5000 5,000
83 sahibul kahfi V 5000 5000 5,000
84 indatul fitri V 5000 5000 5,000
85 aq miftahul a V 5000 5000 5,000
86 iq rohmah V 5000 5000 5,000
87 iq raehun V 5000 5000 5,000
88 husanti V 5000 5000 5,000
89 johariah V 5000 5000 5,000
90 iq sahmini V 5000 5000 5,000
91 rahimah V 5000 5000 5,000
92 rogi damantara V 5000 5000 5,000
93 munawarah V 5000 5000 5,000
94 halifah novi f V 5000 5000 5,000
95 9/7/2019 Alesa V 5000 5000 Bensin Ambulan 1 100,000 (95,000)
96 Hidayattullah V 5000 5000 PC Status 40,000 (35,000)
97 Roni yunita V 5000 5000 ATK 10,000 (5,000)
98 Saidah hafizah S V 5000 5000 5,000
99 M Raehan Aziansyah V 5000 5000 5,000
100 M Gibran Al Kahfi V 5000 5000 5,000
101 Ubaidilah Al haris V 5000 5000 5,000
102 Lutfitun Solehah V 5000 5000 5,000
103 Miwansih V 5000 5000 5,000
104 10/7/2019 IQ Zaenal Arifin V 5000 5000 Ambulan 2 100,000 (95,000)
105 Iq Sainur V 5000 5000 5,000
106 Hj. Haeriyah V 5000 5000 5,000
107 Sim V 5000 5000 5,000
108 Kaila Lamia V 5000 5000 5,000
109 Rail Husni V 5000 5000 5,000
110 Raehan Musina V 5000 5000 5,000
111 Iq Hamsani V 5000 5000 5,000
112 Giyan Khaeri Sabani V 5000 5000 5,000
113 Hazanah V 5000 5000 5,000
114 Zakwan V 5000 5000 5,000
115 Suburiah V 5000 5000 5,000
116 Junakiyah V 5000 5000 5,000
117 Anti V 5000 5000 5,000
118 11/7/2019 riza umami V 5000 5000 5,000
119 nasiva indah/sks V 15000 15000 Nita Bon u/PC 70,000 (55,000)
120 rohni V 5000 5000 5,000
121 septia hafifa/sks V 10000 10000 10,000
122 ainun dania V 5000 5000 5,000
123 ahmad muzakir/sks V 10000 10000 10,000
124 hakim rabbani V 5000 5000 5,000
125 paoziah V 5000 5000 5,000
126 mamiq saprudin V 5000 5000 5,000
127 m.yusuf V 5000 5000 5,000
128 salsabila ayu h V 5000 5000 5,000
129 nia azka V 5000 5000 5,000
130 rohanah V 5000 5000 5,000
Sumaiyah V 5000 5000 5,000
131 12/7/2019 abdul ra'uf V 5000 5000 5,000
132 amruziadi afanza V 5000 5000 rini bon u/ Listrik 405,000 (400,000)
133 ahmad ridho V 5000 5000 5,000
134 muthoharoh/sks V 10000 10000 10,000
135 musu f wandy V 5000 5000 5,000
136 bq khadijah h V 5000 5000 5,000
137 rabiatul adawiyah V 5000 5000 5,000
138 muh badrudin V 5000 5000 5,000
139 nazeril adrasafar V 5000 5000 5,000
140 l.muh rosidi V 5000 5000 5,000
141 haerani bt suhaeli V 5000 5000 5,000
142 ibnu hakim V 5000 5000 5,000
143 l.muh haerun V 5000 5000 5,000
144 sri handayani V 5000 5000 5,000
L M Haeron V 5000 5000 5,000
145 sahril ramadan V 5000 5000 5,000
146 13/7/2019 arsilia azahra V 5000 5000 Sepidol 2 10,000 (5,000)
147 h.edi hidayat V 5000 5000 5,000
148 iq sainur V 5000 5000 5,000
149 jagat ali akbar V 5000 5000 5,000
150 m.yusuf V 5000 5000 5,000
151 jumratul hasanah V 15000 5000 5,000
152 h.abdusalam V 5000 5000 5,000
153 afitassauhah V 5000 5000 5,000
154 komariah V 5000 5000 5,000
155 15/7/2019 h.ghazali V 5000 5000 PC Status 40,000 (35,000)
156 qoni'ah V 5000 5000 5,000
157 khaerudin V 10000 10000 10,000
158 m.sultan fahril V 5000 5000 5,000
159 m.aska pranaja V 5000 5000 5,000
160 hj halimah V 5000 5000 5,000
161 h.muh nur adnan V 5000 5000 5,000
162 dolah V 5000 5000 5,000
163 rina apriana V 5000 5000 5,000
164 arsyla safina V 5000 5000 5,000
165 l.muh azam al-akbar V 5000 5000 5,000
166 Azizati Aeni V 5000 5000 5,000
167 Sobian V 5000 5000 5,000
168 Hana Naswa V 5000 5000 5,000
169 16/7/2019 Musipudin V 5000 5000 Bayar pak Kapus 500,000 (495,000)
170 Nurhasanah V 5000 5000 Bekas Gordeng 5,000
171 Aisha Syifa Khasanah V 5000 5000 Sisa 500,000 5,000
172 Sabrin V 5000 5000 5,000
173 Guta Utama V 5000 5000 Pager Bambu 100,000 (95,000)
Muh Viranda V 5000 5000 5,000
174 M Sayuti Malik V 5000 5000 5,000
175 Al Zaidan Farqi V 5000 5000 5,000
176 Hamidah V 5000 5000 5,000
177 Bq Nur Asifa V 5000 5000 5,000
178 m Makrif Ali V 5000 5000 5,000
179 Iq Sariana V 5000 5000 5,000
180 St Hidayati F V 10000 10000 10,000
181 Iq Zauti V 5000 5000 5,000
182 17/7/2019 Zakwan V 5000 5000 5,000
183 Sopiana V 5000 5000 5,000
184 Dina Nabila V 5000 5000 5,000
185 Martina Azzahra V 5000 5000 5,000
186 Rika Indi Sartika V 5000 5000 5,000
187 Shakira V 5000 5000 5,000
188 m Ilham Jayadi V 5000 5000 5,000
189 Ade Irma Suryani V 10000 10000 10,000
190 Iq Anan V 5000 5000 5,000
191 Bq Nur Asyika V 5000 5000 5,000
M Yayid V 5000 5000 5,000
192 Fawwas Supardan V 15000 15000 15,000
193 18/7/2019 Iq Husnaeni V 5000 5000 5,000
194 Yulianti V 5000 5000 5,000
195 Yahya satia V 5000 5000 5,000
196 Aqila Arifin V 5000 5000 5,000
197 Muh Azharullah V 5000 5000 5,000
198 Muh Yazid V 5000 5000 5,000
199 Sabarudin V 5000 5000 5,000
200 19/7/2019 Mdanu Gibran S V 5000 5000 Bensin Ambulan 100,000 (95,000)
201 Hj Sumar V 5000 5000 5,000
202 M Rozikul Khaer V 15000 15000 15,000
203 Dania Marlina V 5000 5000 5,000
204 Aldo Firmansah V 5000 5000 5,000
205 Kurnaen SKM V 5000 5000 5,000
206 Nadine Nadia Afifah V 5000 5000 5,000
207 Sahudin Rosyidi V 5000 5000 5,000
208 20/7/2019 Risma Nurmata V 5000 5000 5,000
209 Iq Seni V 5000 5000 5,000
210 Nadia Azhari V 5000 5000 5,000
211 Hj. Halimah V 5000 5000 5,000
212 Sabriati Sabani V 5000 5000 5,000
213 Mofaza junia azhra V 5000 5000 5,000
214 Muhid V 5000 5000 5,000
215 Nurul Aeni V 5000 5000 5,000
216 Suci Ramdani V 5000 5000 5,000
217 Hida Suraisa V 5000 5000 5,000
218 Kholisa Sajida V 5000 5000 5,000
219 Mulaini V 5000 5000 5,000
220 Nurhidayatullah V 5000 5000 5,000
221 22/7/2019 Sifaiah V 5000 5000 Ambulan 2 100,000 (95,000)
222 Sabarudin V 5000 5000 5,000
223 Izat Abdullah V 5000 5000 5,000
224 Muh Yakub V 5000 5000 5,000
225 Yuyun V 5000 5000 5,000
226 Iq Yanti V 5000 5000 5,000
227 Nasila Mupida V 5000 5000 5,000
228 Mamiq saprudin V 5000 5000 5,000
229 M Rizki Akbar V 5000 5000 5,000
230 Yuliana Wastika V 5000 5000 5,000
231 Bq Najira Janatul Aeni V 5000 5000 5,000
232 23/7/2019 nadia azzahra V 5000 5000 batre jam dan 20,000 (15,000)
233 pina andriana V 5000 5000 timbangan 5,000
234 muliani V 5000 5000 pulpen 10,000 (5,000)
235 saad al gomidi V 5000 5000 5,000
236 fatimah V 5000 5000 5,000
237 nasrudin V 5000 5000 5,000
238 arka hadi s V 5000 5000 5,000
239 afifa alia V 5000 5000 5,000
240 lia zafira V 5000 5000 5,000
241 M .muazamul V 5000 5000 5,000
242 Iq Indrawati V 5000 5000 5,000
Bq Zihan V 5000 5000 5,000
243 Bq Yuliana V 5000 5000 5,000
244 24/7/2019 Mariam Alisa V 5000 5000 5,000
245 Hj. Mutaharoh V 5000 5000 5,000
246 Intan Johratul Aeni V 5000 5000 5,000
247 L M Rizki adrian V 5000 5000 5,000
248 M Badarudin V 5000 5000 5,000
249 Paozan V 5000 5000 5,000
250 m Rizki Maulana V 5000 5000 5,000
251 25/7/2019 Aq Munahar V 5000 5000 5,000
252 Giyan Khaeri Sabani V 5000 5000 5,000
253 Zahratul Aeni V 15000 15000 15,000
254 Rohimah V 5000 5000 5,000
255 M Taupiq Wira Alhakim V 15000 15000 15,000
256 Arka Hadi Sidik V 5000 5000 5,000
257 Muhammad Irwan V 5000 5000 5,000
Nurul Hidayati V 5000 5000 5,000
Ismurniati V 5000 5000 5,000
Alia Anggraeni V 5000 5000 5,000
Raya Ramdani V 5000 5000 5,000
Ahmad Alwi V 5000 5000 5,000
258 26/7/2019 Iq Suriana V 5000 5000 5,000
259 Isah V 5000 5000 5,000
260 Najwa Oktalia V 5000 5000 5,000
261 Zaskia Putri V 5000 5000 5,000
262 Janatul Aeni V 10000 10000 10,000
263 Mariam Alisa V 5000 5000 5,000
264 Muh Sapii V 5000 5000 5,000
265 Suhat V 5000 5000 5,000
266 27/7./2019 Nila wati V 5000 5000 5,000
267 Fajar Rizki Maulana V 5000 5000 5,000
268 St Nuraeba V 5000 5000 5,000
269 L Rubai V 15000 15000 15,000
270 Alika Zikro Aulia V 5000 5000 5,000
271 Reni Fitriani V 5000 5000 5,000
272 Bq Risiana V 5000 5000 5,000
273 Andrian Hakim V 5000 5000 5,000
274 M Yazil Alfarisi V 10000 10000 10,000
275 Johan Arikin Chazani V 5000 5000 5,000
276 bq aisyah V 15000 15000 15,000
277 Nurul Hidayati V 5000 5000 5,000
278 Sabarudin V 5000 5000 5,000
279 Zaenul Majdi V 5000 5000 5,000
280 Diky Zulkarna V 5000 5000 5,000
281 29/7/2019 Sri Handayani V 15000 15000 15,000
282 Nassil Qur ani V 15000 15000 Bender 10 250,000 (235,000)
283 Ade Irma Suryani V 10000 10000 PC Status /rawat 81,000 (71,000)
284 Numi Fitri Mardianti V 15000 15000 jalan 15,000
285 Rah V 5000 5000 5,000
286 Iq wardah V 5000 5000 5,000
287 Zaskia putri V 5000 5000 5,000
288 Suriati V 5000 5000 5,000
289 M Aminullah Adami V 5000 5000 5,000
290 L Firman Ahmadi V 5000 5000 5,000
291 M Aska Praja V 5000 5000 5,000
292 Bq Radiati V 5000 5000 5,000
293 Arsila Safina V 5000 5000 5,000
294 Rumaisa Rasidi V 5000 5000 5,000
295 Bq Ezlina Azmi V 5000 5000 5,000
296 Iza Ramdani V 5000 5000 5,000
297 30/7/2019 Aq Rifai V 5000 5000 5,000
298 Bq Zohriah V 5000 5000 5,000
299 l tidui Khaer V 5000 5000 5,000
300 M Fathul mubin V 5000 5000 5,000
301 Ozi Rizki V 5000 5000 5,000
302 St Rauhun V 5000 5000 5,000
303 Liana V 5000 5000 5,000
304 31/7/2019 Kasiati V 5000 5000 5,000
305 Iq Nurul Laili V 5000 5000 5,000
306 Herlina Astuti V 15000 15000 15,000
307 Iq Suriani V 5000 5000 5,000
308 Sakinatun V 5000 5000 5,000
309 nabila V 5000 5000 5,000
310 Asro Robi V 15000 15000 15,000
311 hakim rabbani V 5000 5000 5,000
1,845,000 175000 2,020,000 2,126,000 - (116,000)
Pemasukan Retribusi Pasien Umum Rawat Jalan Dan Rawat Inap
Puskesmas Suralaga Bulan Agustus 2019
Pelayanan Retribusi Rawat Jalan Pelayanan Retribusi Rawat In
Tindakan Persalinan Ranap
Jenis Pembayaran Retribusi di Poly Rujukan Ambulan
No TANGGAL No RM Nama Alamat JUMLAH VK Pasien
Kecil
Pendaf SKS Lab Gigi KIA Umum Haji Catin IGD VK Umum
1 1/8/2019 rizka rizkiani t 5,000 5,000
2 sinarah 5,000 5,000
3 iq sutuhiah 5,000 5,000
4 hajiah zahraena 5,000 5,000
5 mulsani 5,000 5,000
6 misahatul f 5,000 5,000
7 madinatussyariah 5,000 5,000
8 sriati 5,000 5,000
9 m.rafa azka 5,000 5,000
10 haefa ramdayani 5,000 5,000
11 2/8/2019 saebah sulastri 5,000 5,000
12 febrian saputra 5,000 5,000
13 bq khadijah 5,000 5,000
14 muh adrian y 5,000 5,000
15 suhat 5,000 5,000
16 ismail 5,000 5,000
17 asyifatul jannah 5,000 5,000
18 nasiva indah 15,000 15,000
19 bq aida lutfiatun 5,000 5,000
20 mikayla alkanta 5,000 5,000
21 rohalidin 15,000 15,000
22 sri handayani 15,000 15,000
23 3/8/2019 m haedar 5,000 5,000
24 sabarudin 5,000 5,000
25 urnayati 5,000 5,000
26 h munawar said 5,000 5,000
27 m raehan a 5,000 5,000
28 wadatul jannah 5,000 5,000
29 sakinatul l 5,000 5,000
30 masniati 5,000 5,000
31 ziadah 5,000 5,000
32 bq zaskia h 5,000 5,000
33 fitriani 5,000 5,000
34 bq adita a 5,000 5,000
35 5/8/2019 heryana putri 5,000 5,000
36 izza ramdani 5,000 5,000
37 ll surya darma 5,000 5,000
38 rosikah 5,000 5,000
Kecil
39 ahmad abyan 5,000 5,000
40 rauhil jinan 5,000 5,000
41 iq riska 5,000 5,000
42 rahmad firdaus 5,000 5,000
43 abdul gani 5,000 5,000
44 sumiati 5,000 5,000
46 rida wardani 5,000 5,000
47 nadira kirana 5,000 5,000
48 azam maliki 5,000 5,000
49 sukma 5,000 5,000
50 muh syadzali 15,000 15,000
51 hermawati 5,000 5,000
52 muh ramdani 5,000 5,000
53 hj mutharoh 5,000 5,000
54 faiha nada zalfa 5,000 5,000
55 zidan alfarizi 5,000 5,000
56 iq jauzi 5,000 5,000
57 6/8/2019 bq lina nuriyani 15,000 15,000
58 ahmad maulana 5,000 5,000
59 iq zaenuddin 5,000 5,000
60 hustadiah 15,000 15,000
61 nuri marsida 5,000 5,000
62 m aditia nova 5,000 5,000
63 ozy rizkira'il h 5,000 5,000
64 paner ardian 5,000 5,000
65 bq murahani 5,000 5,000
66 7/8/2019 aq ahyar 5,000 5,000
67 hasan halimi 5,000 5,000
68 farhana 5,000 5,000
69 rizka daffa a 5,000 5,000
70 harisuni 5,000 5,000
71 siti raodatul j 5,000 5,000
72 hj bq nurhayati 5,000 5,000
73 muhammad rifki 5,000 5,000
74 tosimi 5,000 5,000
75 hj halimah 5,000 5,000
76 naora salsa o 5,000 5,000
77 husnayani 5,000 5,000
78 suciati 5,000 5,000
79 jumratul aeni 5,000 5,000
80 8/8/2019 yogi ramdani 10,000 10,000
81 najma 5,000 5,000
Kecil
82 juhaeri 5,000 5,000
83 anindita kaisha 5,000 5,000
84 iq suhar 5,000 5,000
85 aqila arifin 5,000 5,000
86 samian 15,000 15,000
87 robiatul hasana 5,000 5,000
89 9/8/2019 hj sumar 5,000 5,000
90 arkan hadi l 5,000 5,000
91 najiha aulia 5,000 5,000
92 sabarudin 5,000 5,000
93 rima indrawati 5,000 5,000
94 ll ruba'i 15,000 15,000
95 ll umamin syakur 15,000 15,000
96 bq nazla 5,000 5,000
97 bq najwa 5,000 5,000
98 riana 5,000 5,000
99 m yezan 5,000 5,000
100 davi malik i 5,000 5,000
101 suprianti 5,000 5,000
102 10/8/2019 bq adibe a 5,000 5,000
103 bq nur asifa 5,000 5,000
104 fahira 5,000 5,000
105 hidayah h 5,000 5,000
106 12/8/2019 Fiktoriah 5,000 5,000
107 h kamaluddin 5,000 5,000
108 iq huldiani 5,000 5,000
109 parhana 5,000 5,000
110 dipawan 5,000 5,000
111 muh patir a 5,000 5,000
112 ll aku sanjaya 5,000 5,000
113 muzzaki 5,000 5,000
114 miza kurnia m 5,000 5,000
115 dania pareza 5,000 5,000
116 h irwadi 5,000 5,000
117 azma almera 5,000 5,000
118 13/8/2019 bq aulia soraya 5,000 5,000
119 bq hannah 5,000 5,000
120 haris azima 5,000 5,000
121 hana fatimatul a 5,000 5,000
122 ahmad lukman 15,000 15,000
123 inaq lukman 5,000 5,000
124 siti aisah 5,000 5,000
Kecil
125 maharatul aedi 5,000 5,000
126 wasila 5,000 5,000
127 rosikah 5,000 5,000
128 inaq riska 5,000 5,000
129 masitah 5,000 5,000
130 lia numi malika 5,000 5,000
131 azam maliki 5,000 5,000
132 afan maliki 5,000 5,000
133 hafifudin 5,000 5,000
134 hanif zaen 5,000 5,000
135 ismar 5,000 5,000
136 dalila fadila 5,000 5,000
137 14/8/2019 dafa khairul b 5,000 5,000
138 inaq amanah 15,000 15,000
139 itta agustina 5,000 5,000
140 bq dian yuliana 5,000 5,000
141 ziyad alfatan 5,000 5,000
142 tosimi 5,000 5,000
143 bq kamila 5,000 5,000
144 alika naela 5,000 5,000
145 m.ulul azmi 5,000 5,000
147 15/8/2019 m.rafa azka 5,000 5,000
148 siti nurul r 5,000 5,000
149 rizatul wardah 5,000 5,000
150 adiatul aulia 5,000 5,000
151 gutta utama 5,000 5,000
152 nova yanti 5,000 5,000
153 nazril a 5,000 5,000
154 16/8/2019 siti suhadak 5,000 5,000
155 zidan alfarizi 5,000 5,000
156 zidena lima 5,000 5,000
157 ferhana 5,000 5,000
158 nurzaen 5,000 5,000
159 hj husnul k 5,000 5,000
160 bq zaskia 5,000 5,000
161 bq ezlina a 5,000 5,000
162 muh badaruddin 5,000 5,000
163 siti mariam 5,000 5,000
164 19/8/2019 wahyu k 5,000 5,000
165 m.azka alfana 5,000 5,000
166 masiah 5,000 5,000
167 siti hajar 5,000 5,000
Kecil
168 bq aida lutfiatun 5,000 5,000
169 musipuddin 5,000 5,000
170 akifa naela 5,000 5,000
171 mariam 5,000 5,000
172 rosikah 5,000 5,000
173 iq riska 5,000 5,000
174 paoziah 5,000 5,000
175 abd hayyi 5,000 5,000
176 hasna aqila 5,000 5,000
177 ll abdani 5,000 5,000
178 rohalidin 5,000 5,000
179 20/8/2019r riskiyah 15,000 15,000
180 rahimah 5,000 5,000
181 salsabila 5,000 5,000
182 dania ainun 5,000 5,000
183 sri handayani 15,000 15,000
184 iq winda 5,000 5,000
185 dewi juliana 5,000 5,000
186 riski yuliana 5,000 5,000
187 yunus 5,000 5,000
188 zurriatun solihah 5,000 5,000
189 bq adira 5,000 5,000
190 sohroni 5,000 5,000
191 bq zohriah 5,000 5,000
192 muziroh 5,000 5,000
193 megawati 5,000 5,000
194 muh ilham hadi 5,000 5,000
195 aldo firmansyah 5,000 5,000
196 Iq saenal 5,000 5,000
197 mawardi 5,000 5,000
198 iq husniati zikro 5,000 5,000
199 raefandi 5,000 5,000
200 h syakrami 5,000 5,000
201 21/8/2019 siti hafizatun 5,000 5,000
202 rail husni 5,000 5,000
203 hj siti aisyah 5,000 5,000
204 muh arfani 5,000 5,000
205 santari 5,000 5,000
206 muh muzakir 5,000 5,000
207 linda susmati 5,000 5,000
208 iq mahnur 5,000 5,000
209 iq sanah 5,000 5,000
210 bq imtihan 5,000 5,000
Kecil
211 gebril mutia 5,000 5,000
212 bq siti aisah 5,000 5,000
213 22/8/2019 aisya 5,000 5,000
214 23/8/2019 muh syahar 5,000 5,000
215 masitah 5,000 5,000
216 raffa syarifa 5,000 5,000
217 selvia apriani 5,000 5,000
218 raisa arini 5,000 5,000
219 muh fawaz 5,000 5,000
220 hayani 5,000 5,000
221 hj mardiah 5,000 5,000
222 isniati 5,000 5,000
223 hasan huluki 5,000 5,000
224 24/8/2019 muh rizky 15,000 15,000
225 m.zikrullah 5,000 5,000
226 taufik uwais 5,000 5,000
227 siti hafsah 5,000 5,000
228 m.rizal h 5,000 5,000
229 anisa atusoleha 5,000 5,000
230 26/8/2019 aq usnaini 5,000 5,000
231 zayyan ariq 5,000 5,000
232 hj bq muliana 5,000 5,000
233 m.khaekal m 5,000 5,000
234 bq darmawati 5,000 5,000
235 mas'ud 5,000 5,000
236 m sayuti m 5,000 5,000
237 hustariatun 5,000 5,000
238 27/8/2019 wulan mauli 15,000 15,000
239 misa ayu n 15,000 15,000
240 bq hajira j 5,000 5,000
241 husnan 5,000 5,000
242 iq riska 5,000 5,000
243 rosikah 5,000 5,000
244 hamidah 5,000 5,000
245 aq musipudin 5,000 5,000
246 muh abdul 5,000 5,000
247 abdul wahyi 5,000 5,000
248 aisah ayudia 5,000 5,000
249 hj zakiah 5,000 5,000
250 bq zuhrah 5,000 5,000
251 28/8/2019 siti zahratul l 5,000 5,000
252 LL muhammad a 5,000 5,000
253 Aq fathur 5,000 5,000
Kecil
254 Mafaza junia 5,000 5,000
255 H.l patmawa 5,000 5,000
256 Megawati 5,000 5,000
257 Bq juliani 5,000 5,000
258 Abd hafis r 5,000 5,000
259 Heri adianta 15,000 15,000
260 Muliana 15,000 15,000
261 Kusmiati 15,000 15,000
262 29/8/2019 Zhahiratul h 5,000 5,000
263 Eli agustin 5,000 5,000
264 bq nur asifa 5,000 5,000
265 muh anwar 5,000 5,000
266 sri handayani 15,000 15,000
267 Hilliatun n 15,000 15,000
268 Essudin m 5,000 5,000
269 ayyas m 5,000 5,000
270 parisa u 5,000 5,000
271 amq hasbian 5,000 5,000
272 tolin 5,000 5,000
273 muh azam 5,000 5,000
274 zahiratil husna 5,000 5,000
275 30/8/2019 muh syhat 5,000 5,000
276 haziah z 5,000 5,000
277 bq nova m 5,000 5,000
278 supriati 5,000 5,000
279 parida nopa a 15,000 15,000
280 amq ulpayani 15,000 15,000
281 m faqih m 5,000 5,000
282 hartini 5,000 5,000
283 ayu fani d 5,000 5,000
284 febian t 5,000 5,000
285 dina nabila 5,000 5,000
286 ahmad m 5,000 5,000
287 hj sumar 5,000 5,000
288 asma a 5,000 5,000
289 31/8/2019 maulana hadi 5,000 5,000
290 ayu arsita 5,000 5,000
291 muh faqih 5,000 5,000
292 m ariya p 5,000 5,000
293 nizar gapran 5,000 5,000
294 LL iwan p a 5,000 5,000
295 LL riski parhan 5,000 5,000
296 Murnah 5,000 5,000
Kecil
297 Iq linda wati 5,000 5,000
JUMLAH 1,730,000 1,730,000
Rawat Inap
Total Uraian Sisa
JUMLAH Saldo Pengeluaran Jumlah Saldo
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
Total Uraian Sisa
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
15,000
5,000
5,000
5,000 paku,atap 65,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 bensin ambulan 100,000
5,000
5,000
10,000
5,000
Total Uraian Sisa
5,000
5,000
5,000
5,000
15,000 p.c status 40,000
5,000 bendel 190,000
15,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000 map plastik 30,000
5,000
5,000
5,000
5,000 spidol 3 biji 21,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
Total Uraian Sisa
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 p.c status 40,000
5,000 kertas puyer 20,000
5,000 plastik obat 17,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000 pc status 40,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
Total Uraian Sisa
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 buat meja obat 500,000
5,000 bensin ambulan 100,000
5,000 modem 25,000
15,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 pc status 40,000
5,000 konsumsi p3k 60,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 pc,kunsumsi p3k 72,000
Total Uraian Sisa
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 pc status 40,000
5,000 lakban 15,000
5,000
15,000
5,000
5,000
5,000 kabel wifi 90,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
Total Uraian Sisa
5,000
5,000
5,000
5,000
5,000
15,000 pc status 40,000
15,000 selang air 28,000
15,000 bayar kasur 185,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000 buku besar 25,000
5,000 keresek obat 19,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
Total Uraian Sisa
5,000
1,730,000 Jumlah 1,802,000 (72,000)
Puskesmas
Pelayanan Retribusi Rawa
No TANGGAL No RM
Jenis Pem
NAMA Alamat
Pendaf SKS
1 2/9/2019 muh yazid 10,000
2 firda rojak 5,000
3 iq hidayatul l 5,000
4 liana 5,000
5 amaq hasbiah 5,000
6 dinda nilasuri 5,000
7 rahimah 5,000
8 m paris algani 5,000
9 nirwana fadil 5,000
10 muh ansori y 5,000
11 iq saprudin 5,000
12 bq hilya 5,000
13 nopidatul parizy 5,000
14 tolen sawi 5,000
15 ozy rizki 5,000
16 suhaeni 5,000
17 masitah 5,000
18 amq khamsatul 5,000
19 paoziah 5,000
20 amilia rahmani 5,000
21 sar'iyah 5,000
22 ibnu hakim 5,000
23 3/9/2019 fitriani 5,000
24 vania vanesa 5,000
25 arika fathina 5,000
26 hj johariah 5,000
27 m alamul huda 5,000
28 bq inzasasih 5,000
29 bq rosita hardianti 5,000
30 adel 5,000
31 ina fitriana 5,000
32 eko guniawan 5,000
33 iq hani 5,000
34 irfayani 5,000
35 5/9/2019 Rohida 5,000
36 aulia maharani 5,000
37 puji astuti 5,000
38 aqila arifin 5,000
39 muhammad suhalli 5,000
40 khairul athoq 15,000
41 hj mursiah 5,000
42 mulani 5,000
43 Ll nizar 5,000
44 zianul karim zunet 5,000
45 wafa hilmira 5,000
46 muh azam 5,000
47 Ll adi hidayat 5,000
48 ll zidni khair 5,000
49 6/9/2019 raihana 5,000
50 nur sapah 5,000
51 herma nurasyah 5,000
52 musannip 15,000
53 naura artafaza 5,000
54 zayyan ariqih shazani 5,000
55 h harun 5,000
56 bq intan p 5,000
57 zidan alfarisi 5,000
58 siti suhadak 5,000
59 harini 5,000
60 abi bagus r 5,000
61 m zapwan zaki 5,000
62 muh rizki 5,000
63 muh ramzi 5,000
64 7/9/2019 zriviatul fahira 5,000
65 zidan alfarizi 5,000
66 amaq hayani 5,000
67 azizah 5,000
68 fahira 5,000
69 aq bahrul aen 5,000
70 m aziz mahendra 5,000
71 inaq asrol 5,000
72 zian hafizurrahman 5,000
73 hj nikmatul w 5,000
74 9/9/2019 saeba sulastri 5,000
75 iq haeran 5,000
76 muhammad 5,000
77 5,000
78 5,000
79 5,000
80 10,000
81 5,000
82 5,000
83 5,000
84 5,000
85 5,000
86 15,000
87 5,000
88 15,000
89 9/8/2019 5,000
90 5,000
91 5,000
92 5,000
93 5,000
94 15,000
95 15,000
96 5,000
97 5,000
98 5,000
99 5,000
100 5,000
101 5,000
102 10/8/2019 5,000
103 5,000
104 5,000
105 5,000
106 12/8/2019 5,000
107 5,000
108 5,000
109 5,000
110 5,000
111 5,000
112 5,000
113 5,000
114 5,000
115 5,000
116 5,000
117 5,000
118 13/8/2019 5,000
119 5,000
120 5,000
121 5,000
122 15,000
123 5,000
124 5,000
125 5,000
126 5,000
127 5,000
128 5,000
129 5,000
130 5,000
131 5,000
132 5,000
133 5,000
134 5,000
135 5,000
136 5,000
137 14/8/2019 5,000
138 15,000
139 5,000
140 5,000
141 5,000
142 5,000
143 5,000
144 5,000
145 5,000
146 5,000
147 15/8/2019 5,000
148 5,000
149 5,000
150 5,000
151 5,000
152 5,000
153 5,000
154 16/8/2019 5,000
155 5,000
156 5,000
157 5,000
158 5,000
159 5,000
160 5,000
161 5,000
162 5,000
163 5,000
164 19/8/2019 5,000
165 5,000
166 5,000
167 5,000
168 5,000
169 5,000
170 5,000
171 5,000
172 5,000
173 5,000
174 5,000
175 5,000
176 5,000
177 5,000
178 5,000
179 20/8/2019r 15,000
180 5,000
181 5,000
182 5,000
183 15,000
184 5,000
185 5,000
186 5,000
187 5,000
188 5,000
189 5,000
190 5,000
191 5,000
192 5,000
193 5,000
194 5,000
195 5,000
196 5,000
197 5,000
198 5,000
199 raefandi 5,000
200 h syakrami 5,000
201 21/8/2019 siti hafizatun 5,000
202 rail husni 5,000
203 hj siti aisyah 5,000
204 muh arfani 5,000
205 santari 5,000
206 muh muzakir 5,000
207 linda susmati 5,000
208 iq mahnur 5,000
209 iq sanah 5,000
210 bq imtihan 5,000
211 gebril mutia 5,000
212 bq siti aisah 5,000
213 22/8/2019 aisya 5,000
214 23/8/2019 muh syahar 5,000
215 masitah 5,000
216 raffa syarifa 5,000
217 selvia apriani 5,000
218 raisa arini 5,000
219 muh fawaz 5,000
220 hayani 5,000
221 hj mardiah 5,000
222 isniati 5,000
223 hasan huluki 5,000
224 24/8/2019 muh rizky 15,000
225 m.zikrullah 5,000
226 taufik uwais 5,000
227 siti hafsah 5,000
228 m.rizal h 5,000
229 anisa atusoleha 5,000
230 26/8/2019 aq usnaini 5,000
231 zayyan ariq 5,000
232 hj bq muliana 5,000
233 m.khaekal m 5,000
234 bq darmawati 5,000
235 mas'ud 5,000
236 m sayuti m 5,000
237 hustariatun 5,000
238 27/8/2019 wulan mauli 15,000
239 misa ayu n 15,000
240 bq hajira j 5,000
241 husnan 5,000
242 iq riska 5,000
243 rosikah 5,000
244 hamidah 5,000
245 aq musipudin 5,000
246 muh abdul 5,000
247 abdul wahyi 5,000
248 aisah ayudia 5,000
249 hj zakiah 5,000
250 bq zuhrah 5,000
251 28/8/2019 siti zahratul l 5,000
252 LL muhammad a 5,000
253 Aq fathur 5,000
254 Mafaza junia 5,000
255 H.l patmawa 5,000
256 Megawati 5,000
257 Bq juliani 5,000
258 Abd hafis r 5,000
259 Heri adianta 15,000
260 Muliana 15,000
261 Kusmiati 15,000
262 29/8/2019 Zhahiratul h 5,000
263 Eli agustin 5,000
264 bq nur asifa 5,000
265 muh anwar 5,000
266 sri handayani 15,000
267 Hilliatun n 15,000
268 Essudin m 5,000
269 ayyas m 5,000
270 parisa u 5,000
271 amq hasbian 5,000
272 tolin 5,000
273 muh azam 5,000
274 zahiratil husna 5,000
275 30/8/2019 muh syhat 5,000
276 haziah z 5,000
277 bq nova m 5,000
278 supriati 5,000
279 parida nopa a 15,000
280 amq ulpayani 15,000
281 m faqih m 5,000
282 hartini 5,000
283 ayu fani d 5,000
284 febian t 5,000
285 dina nabila 5,000
286 ahmad m 5,000
287 hj sumar 5,000
288 asma a 5,000
289 31/8/2019 maulana hadi 5,000
290 ayu arsita 5,000
291 muh faqih 5,000
292 m ariya p 5,000
293 nizar gapran 5,000
294 LL iwan p a 5,000
295 LL riski parhan 5,000
296 Murnah 5,000
297 Iq linda wati 5,000
1,695,000
Puskesmas Suralaga Bulan September 2019
Pelayanan Retribusi Rawat Jalan Pelayanan Retrib
Tindakan
Jenis Pembayaran Retribusi di Poly
JUMLAH
Kecil
Lab Gigi KIA Umum Haji Catin
10,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
10,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
15,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
1,695,000
Pelayanan Retribusi Rawat Inap dan IGD
Persalinan Ranap Total URAIAN
Rujukan Ambulan
VK Pasien JUMLAH Saldo
PENGELUARAN
IGD VK Umum
10,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
10,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 p.c status
15,000 kertas puyer
5,000 plastik obat
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 pc status
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000 buat meja obat
5,000 bensin ambulan
5,000 modem
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 pc status
5,000 konsumsi p3k
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 pc,kunsumsi p3k
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000 pc status
5,000 lakban
5,000
5,000
5,000
5,000
5,000 kabel wifi
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
15,000
5,000 pc status
5,000 selang air
5,000 bayar kasur
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000 buku besar
5,000 keresek obat
5,000
5,000
5,000
5,000
5,000
5,000
5,000
1,695,000 JUMLAH
Jumlah Sisa
Saldo
40,000
20,000
17,000
40,000
500,000
100,000
25,000
40,000
60,000
72,000
40,000
15,000
90,000
40,000
28,000
185,000
25,000
19,000
1,356,000 339,000
Pemasukan dan Pengeluaran
Puskesmas Su
Pelayanan Retribusi Rawat ja
No TANGGAL No RM
Jenis Pem
NAMA Alamat
Pendaf UKS
dan Pengeluaran Uang Retribusi,Laboratorium ,KIA, UGD .
Puskesmas Suralaga Bulan Oktober 2019
Pelayanan Retribusi Rawat jalan Jenis Pelayanan Rawat
Tindakan
JUMLAH Rujukan Ambulan
Kecil
Lab Gigi KIA Umum Haji Catin Lain-Lain IGD
Jenis Pelayanan Rawat Inap dan IGD Total
Persalinan Ranap Saldo
Rujukan Ambulan VK Pasien JUMLAH
VK Umum
Pemasukan dan Pengeluaran Uang Retr
Puskesmas Suralaga Bulan
Pelayanan Retribusi Rawat jalan
No TANGGAL No RM
NAMA Alamat
Pendaf UKS Lab Gigi KIA
uaran Uang Retribusi,Laboratorium ,KIA, UGD .
as Suralaga Bulan November 2019
ibusi Rawat jalan Jenis Pelayanan Rawat Inap dan IGD
ayaran Retribusi di Poly
JUMLAH Rujukan Ambulan VK Pasien
Kecil
Umum Haji Catin Lain-Lain IGD VK Umum
dan IGD Total
Saldo
JUMLAH
Puskesmas Suralaga Bulan
Pelayanan Retribusi Rawat jalan
No TANGGAL No RM
NAMA Alamat
Pendaf UKS Lab Gigi KIA
as Suralaga Bulan Desember 2019
ibusi Rawat jalan Jenis Pelayanan Rawat Inap dan IGD
ayaran Retribusi di Poly
JUMLAH Rujukan Ambulan VK Pasien
Kecil
Umum Haji Catin Lain-Lain IGD VK Umum
dan IGD Total
Saldo
JUMLAH
Rekapitulasi Pemasukan Retribusi Pa
Puskesmas Suralaga Tahun 2
No Bulan
Pendaf UKS Lab Gigi KIA Umum Haji Catin

1 Januari
2 Februari
3 Maret
4 April
5 Mei
6 Juni
7 Juli
8 Agustus
9 September
10 Oktober
11 November
12 Desember
JUMLAH
ukan Retribusi Pasien Umum
Suralaga Tahun 2019
Jenis Pelayanan Rawat Inap dan IGD Total
Tindakan Persalinan Ranap Saldo
JUMLAH Rujukan Ambulan VK Pasien JUMLAH
Kecil
Lain-Lain IGD VK Umum

Data Pasien Pemasukan Dan Pengeluaran 2019

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Data Pasien Pemasukan Dan Pengeluaran 2019

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Pemasukan dan Pengeluaran Uang Retribusi,Laboratorium ,KIA, UGD .

Puskesmas Suralaga Bulan juni 2019

Mengetahui, Suralaga, 1 Juli 2019

241 10/6/2019 IQ ZIADAH V 5,000 5,000 pc status 40,000 40,000 (35,000)

Hj. Kusmiyati S.ST

Mengetahui, Puskesmas Suralaga 01 Juni 2019

MEIDINAAM INSYA, S.Kep Hj Kusmiyati S.ST

1,485,000 910000 45000 2,440,000 1,888,500 1,888,500 551,500

Mengetahui, Puskesmas Suralaga 1 juli 2019

MEIDINAAM INSYA, S.Kep Hj. Kusmiyati S.ST

Pendaf UKS Lab Gigi KIA Umum Haji Catin

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