19 Cici/ Abad 446096542 27 G3P2A0 grav 37 mgg 16/06/2023 1

Cipedes

20 Yesi/ Juju 1006343076 26 G2P1A0 grav 22 mgg 9/6/2023 1

Cipedes

21 Nia/ Oca 66551567 34 G4P2A1 grav 32 mgg 24/06/2023 1

Cipedes

22 Rina/ Gilang 2420393207 26 G2P1A0 grav 19 mgg 21/6/2023 1

Cipedes

23 Rosa/ Adit 2942424628 25 G2P1A0 grav 19 mgg 9/6/2023 1

Cipedes

24 Serli/ Ali 2430436836 20 G1P0A0 grav 14 mgg 6/6/2023 1

Cipedes

25 Joheti/ Darmawan 2964866332 35 G3P2A0 grav 27 mgg 22/06/2023 1

Cipedes

26 Ita/ Uci 1729542576 28 G2P1A0 grav 27 mgg 22/06/2023 1

Cipedes

27 Rosita/ Juju 2964866308 27 G2P1A0 grav 32 mgg 27/06/2023 1

Cipedes

28 Ita/ Fahrul 441768857 21 G1P0A0 grav 33 mgg 8/6/2023 1

Cipedes

29 Vina/ Asnad 3502144697 37 G3P2A0 grav 34 mgg 12/6/2023 1

Cipedes

30 Evi/ Diding 2061346904 38 G3P2A0 grav 36 mgg 7/6/2023 1

Cipedes
31 Ririn/ Agus 2061361541 29 G2P1A0 grav 37 mgg 6/6/2023 1
Cipedes

32 Ani 3298552165 29 G1P0A0 grav 10 mgg 6/17/2023 1

G. Manik

33 Nurul 2707483871 23 G1P0A0 grav 32 mgg 6/17/2023 1

G. Manik

34 Dewi 442117765 27 G2P1A0 grav 22 mgg 6/17/2023 1

G. Manik

35 Ratih 3209848615 35 G2P1A0 grav 32 mgg 6/17/2023 1

G. Manik

36 Reni 16692660958 26 G2P1A0 grav 35 mgg 6/17/2023 1

G. Manik

37 Kiki 442593347 23 G1P0A0 grav 34 mgg 6/17/2023 1

G. Manik

38 Rustini 443904851 28 G2P1A0 grav 39 mgg 6/17/2023 1

G. Manik

JUMLAH 8 5 23 2 38

Ciniru, 03 Juni 2023

Mengetahui, Pengelola Klaim BPJS Kesehatan
Kepala UPTD Puskesmas Ciniru UPTD Puskesmas Ciniru
 INA LISTIANA, S. Farm, Apt ROSITA SUSAN DAMAYANTI A.Md.Keb
NIP. 19810828 200902 2 008 NITNP : 6114 19870113 1 001
Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000
 Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

Rp 60,000

2,280,000

ni 2023
JS Kesehatan
as Ciniru
YANTI A.Md.Keb
70113 1 001
 REKAPITULASI PENGAJUAN KLAIM KUNJUNGAN PEMERIKSAAN PNC

Bulan : JUNI 2023

Puskesmas : PUSKESMAS CINIRU

KUNJUNGAN PNC
NO NAMA PASIEN NO.KARTU PESERTA UMUR DIAGNOSA
PNC 1 PNC 2
1 Eha/ Jahdi 2698937111 41 P4A0 PP 3 hari 13/6/2023
Longkewang P4A0 PP 6 hari 17/6/2023

2 Endah 3306290782 29 P2A0 PP 37 hari

Rambatan

3 Indriyani/ Yadi 2395944729 20 P4A0 PP 3 hari 13/6/2023

Longkewang P4A0 PP 7 hari 17/6/2023

4 Puja/ Egi 2520845605 22 P1A0 PP 39 hari

Cipedes

5 Septiani/ Dading 442472207 22 P1A0 PP 39 hari

Cipedes

6 Rika/ Asep 441435295 23 P2A0 PP 39 hari

Cipedes

7 Ayu/ Suherman 2900792463 28 P2A0 PP 39 hari

Cipedes

8 Evi/ Diding 2061346904 38 P3A0 PP 3 hari 15/6/2023

Cipedes P3A0 PP 5 hari 17/6/2023

9 Ririn/ Agus 2061361541 29 P1A0 PP 3 hari 22/06/2023

Cipedes P1A0 PP 5 hari 24/06/2023

10 Winti/ Akbar 444760299 19 P1A0 PP 5 hari 3/6/2023

Cipedes

11 Nova/ Rona 2232518264 24 P1A0 PP 39 hari

Cipedes

12 Icih/ Sanhari 2603395258 42 P4A0 PP 39 hari

Cipedes

13 Yuyun/ Jemi 3320226494 29 P2A0 PP 39 hari

Cipedes

14 Siska/ Robi 3285182586 21 P1A0 PP 6 hari 12/6/2023

 Cipedes

15 Yuyun 1006341489 35 P2A0 PP 39 hari

G. Manik

16 Neni 3209848582 32 P4A0 PP 38 hari

G.Manik

17 Inah Marlinah 1776272051 40 P3A0 PP 5 hari 6/24/2023

Rambatan

18 Rustini 3235322902 28 P2A0 PP 5 hari 6/26/2023

G.manik

JUMLAH 4 8

Mengetahui,
Kepala UPTD Puskesmas Ciniru

INA LISTIANA, S. Farm, Apt

NIP. 19810828 200902 2 008
NGAN PEMERIKSAAN PNC

KUNJUNGAN PNC JMLH

TARIF ANC (Rp)
PNC 3 PNC 4 KUNJUNGAN
1 40,000
1 40,000

24/06/2023 1 40,000

1 40,000
1 40,000

13/06/2023 1 40,000

19/06/2023 1 40,000

22/06/2023 1 40,000

23/06/2023 1 40,000

1 40,000
1 40,000

1 40,000
1 40,000

1 40,000

6/6/2023 1 40,000

7/6/2023 1 40,000

26/6/2023 1 40,000

1 40,000
6/9/2023 1 40,000

6/14/2023 1 40,000

1 40,000

1 40,000

10 22 880,000

Ciniru, 03 Juni 2023

Pengelola Klaim BPJS Kesehatan
UPTD Puskesmas Ciniru

ROSITA SUSAN DAMAYANTI A.Md.Keb

NITNP : 6114 19870113 1 001