DAFTAR NAMA PASIEN YANG MEMBAYAR RET

PUSKESMAS : JATIBENING
TAHUN : 2018
JENIS
KEPALA KELAMIN ALAMAT RETRIBUSI
TANGGAL NO NAMA PASIEN UMUR NO KARCIS
KELUARGA
L P KEL RT RW 5,000 10,000

1/3/2018 1 Linda 28 x JB
2 Hartini 49 x JB
3 dwi santoso 37 x JB 6 1
4 Rahayu 60 x JB 13 13
5 Cucu 33 x JB 11 13
6 Yanah 58 x JB 3 2
7 Piere 8 x JB 4 1
8 Haikal 2 x JB 6 3
9 Nayaka 1 x JB
10 Azizah 2 x JB 3 1
11 Warija 40 x JB
12 Maryani 75 x JB 3 1
13 Nur C 30 x JB 2 2
14 Virgi 2 x JB 4 2
15 Faqih 3 x JB 4 2
16 Charisma 4
17 Cahaya 1
18 Sri 32
19 M. Indra 12
20 M. Rasan 4
2/3/2018 1 Agus Suryono 34 x JB 2 4
2 Zikri Aditra 20 x JB 1 2
3 Sri Andayani 21 x JB 7 12
4 Taufik Almuhidin 46 x JB 7 8
5 Sri Hasyanti 5 x JB 6 2
6 Warsiah 56 x JB 6 1
7 Sukamto 61 x JB 6 1
8 Suprapti 65 x JB 8 2
9 Suharti 40 x JB 3 2
10 Aam Amin 45 x JB 1 8
11 Jimmy 26 x JB 6 14
12 Gazzy 2 x JB 4 4
13 Syafira 1 x JB 8 2
14 Aditya Rifai 1,8 x JB 6 3
15 Daffita 9 x JB 1 3
16 Anggun 4,5 x JB 3 1
17 Muntira 51 x JB
3/3/2018 1 Misti 42 x JB 2 15
2 Rizka Novianti 26 x JKM 1 1
3 Thifalvana 16 x JB 3 14
 4 Fatia 1,5 x JB 6 3
5 Stefanie 15 x JB
6 Surara 9 x JB
7 Gerado 27 x JB
8 M. Dikky 15 x JK 7 15
9 Haura 6 x JB
10 feila 9 x JB
11 Renandr 3 x JB
12 Rifai 2 x JB 5 2
13 Yulianti 37 x JB
14 Dhiza 1,8 x JB 4 3
15 Affan 8 x JB
16 Karisa 4 x JB
5/3/2018 1 Lucky 5 x JB 6 3
2 Sariyah 40 x x JBB 4 4
3 Syahreun x JBB 4 4
4 Alfans 46 x JKM 2 4
5 Amirudin 6,3 x JB 6 1
6 Clara 53 x JB 2 3
7 Yoga 2bln x JB
8 Khanza 21 x JB
9 Hardiana 22 x JB 2 3
10 Dyah 25 x JB 2 2
11 Dana Pasarit 22 x JB 2 6
12 Rifqi 30 x JB 6 2
13 Arif 2 x JB 6 2
14 Elfira 27 x JB 1 2
15 Hasan 21 x JB 4 4
16 Edy 74 x JB 1 2
17 Kim Qireina 45 x JB 4 4
18 Mutiara Nadifa 5 x JB 4 2
19 Kefas 9bln x JB 7 2
20 Siskawati 13 x JB 6 2
21 Mayang 27 x JB
22 Reza Anis 19 x JB
23 Sarniti 40 x JKM
24 Aldrian 4 x JB 1 1
25 Agrainer 4bln x JB 1 12
26 Nafasya 2 x JB 11 2
27 Gisella 2 x JB 7 3
28 Ginas 31 x JB 7 3
29 Siti R 18 x JB 12 12
30 Damai Alfuin 2 x JB 6 12
31 rendi 23 x JB 1 1
6/3/2018 1 Lynete Asdienar 46 x JB
 2 Juminah 55 x JB 1 3
3 Annisa 10bln x JB 5 2
4 Ayu Melani 26 x JB 2 4
5 Ida Yani 38 x JB 1 1
6 Juriah Febriani 20 x JBB 3 4
7 Aneri 2,5 x JBB 6 2
8 Rfan 23 x JB 1 3
9 Aneri 62 x JB 1 1
10 Sri W 35 x JB 13 13
11 Juliana 19 x JB 5 12
12 Topik 29 x JB
13 Nur R 21 x JTK 10 2
14 Karunia P 5,5 x JB 7 3
15 Rosyanti 36 x JB 6 3
12/3/2018 1 Naila 4bln x JB 5 2
2 Rini Stiani 43 x JB 2 6
3 Rohiidir 43 x JB
4 Raisyah 3 x JB
5 Zain 1,3 x JB 5 3
6 Dyah Rat 24 x JB 3 12
7 Nadila 34 x JB 4 1
8 Aina Sanih 5 x JB 4 1
9 Rosyanti 36 x JB 3 6
10 Tatik 16 x JB 1 5
11 Eva 22 x JB 1 11
12 Endang 34 x JK 8 1
13 Suminah 40 x JB 2 14
13/3/2018 1 Anindira 2 x JB 1 1
2 Selvia 22 x JB 1 1
3 Munyati 40 x JB 2 1
4 Aratha 3 x JB 1 2
5 Putri Arsyila 4 x JB 3 6
6 Tarti 34 x JB 6 2
7 Ahmad 6 x JB 8 11
8 Riska 26 x JB
9 Ahmad Panji 23 x JB
10 Nuri 24 x JB 6 13
11 M. Luky 23 x JB
12 M. Yulistio 18 x JB
13 Adi 58 x JB 13 12
14 Suprianto 18 x JB 3 3
15 Deppy Anggraini 16 x JB 1 4
16 Rosima 29 x JB 3 4
17 Cici 28 x JB 3 4
18 Munela 45 x JB 4 2
 19 ibnu 10bln x JB 1 2
20 Hana 26 x JB 3 11
21 Siti J 24 x JB 7 3
9/3/2018 1 Mayang 20 x JB 7 12
2 Marsi 45 x JB
3 Lestari 38 x JB
4 Martinoi 35 x JB
5 M. Farhan 4 x JKM 6 2
6 Warimah 50 x JB
7 Argi 16 x JB 4 3
8 Krisna M 19bln x JB
9 Suryani 30 x JB 3 4
10 Hanifiah 3 x JB 8 4
11 M. A. Alfatih 2 x JB 8 4
12 Rukniah 45 x JB 3 5
13 Wartiah 39 x JB
14 Irnandi 26 x JB 3 12
10/3/2018 1 Syamsul 21 x JB 5 2
2 Asyifah 4bln x JB
3 Ziban 4 x JB 3 3
4 M. Aditya 9 x JB 8 3
5 Omi 18 x JB 1 3
6 Sylvia 30 x JB
7 Oktavina 16 x JK 2 15
8 Sadiyem 60 x JB 1 1
9 Salananda 13 x JB
10 Nicholas 5 x JB
11 Toha 60 x JB 2 2
12/3/2018 1 Haifan Sinaga JB
2 JB
3 JB
4 JB
5 JB
6 JB
7 JB
8 JB
9 JB
10
11
12
13
14
15
16
17
18
TAR NAMA PASIEN YANG MEMBAYAR RETRIBUSI DAN TINDAKAN
BULAN : maret NO.SSRD
MINGGU : 1-5

TINDAKAN RETRIBUSI HAJI

NO KARCIS
2,000 2,500 3,000 5,000 7,500 10,000 15,000 18,000 20,000 25,000 30,000 50,000 55,000 165,000 NO KARCIS

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 : 3

RETRIBUSI HAJI KET

15,000
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 LAPORAN MINGGUAN DI BLN FE
PuSKESMAS JATIBEN

TINDAKA
NO TANGGAL JUMLAH UANG
2000 total 3000 total 5000 total 7500 total 10000
1 1/3/2018 20 100000 0 0 0 0 1
2 2/3/2018 18 90000 0 0 0 0
3 3/3/2018 16 80000 0 0 0 0 1
4 5/3/2013 31 155000 2 4000 0 0 0
5 6/3/2018 15 75000 1 2000 0 0 0 1
6 7/3/2018 13 65000 0 0 1 5000 0
7 8/3/2018 21 105000 4 8000 0 0 0
8 9/3/2018 14 70000 1 2000 0 0 0 1
9 11/3/2018 11 55000 0 0 0 0
10 12/3/2018 18 90000 0 0 0 0
11 13/3/2018 22 110000 1 2000 0 4 20000 0 2
12 14/3/2018 20 100000 0 0 4 20000 0
13 16/3/2018 8 40000 0 0 0 0
14 19/3/2018 18 90000 0 0 1 5000 0
15 20/3/2018 26 130000 2 4000 0 1 5000 0 1
16 21/3/2018 9 45000 0 0 0 0
17 22/3/2018 19 95000 1 2000 0 1 5000 0 1
18 23/3/2018 11 55000 0 0 0 0
19 24/3/2018 20 100000 2 4000 0 1 5000 0 1
20 26/3/2018 26 130000 0 0 0 0
21 27/3/2018 19 95000 0 0 0 0 1
22 28/3/2018 0 0 0 0 0
23 29/3/2018 0 0 0 0 0
375 1875000 14 28000 0 0 13 65000 0 0 10
Total
RAN MINGGUAN DI BLN FEBRUARI 2018
PuSKESMAS JATIBENING

TINDAKAN HAJI 15000

total 15000 total 20,000 total 30000 total 55000 total 50,000 total 15000 total
10000 1 15000 0 0 0 0 0
0 0 0 0 0 0 0
10000 1 15000 0 0 0 1 50000 0
0 3 45000 0 0 0 0 2 30000
10000 1 15000 0 2 60000 0 0 0
0 0 1 20000 1 30000 0 0 0
0 0 1 20000 0 0 0 0
10000 1 15000 1 20000 1 30000 0 0 0
0 1 15000 0 0 0 0 0
0 0 2 40000 1 30000 0 0 0
20000 0 0 0 0 0 0
0 0 0 0 0 0 1 15000
0 0 0 0 0 0 0
0 1 15000 0 0 0 0 0
10000 1 15000 1 20000 0 1 55000 0 0
0 0 0 0 0 0 0
10000 1 15000 0 0 0 0 0
0 0 0 0 0 0 0
10000 0 0 0 0 0 0
0 1 15000 0 0 0 0 0
10000 1 15000 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
100000 13 195000 6 120000 5 150000 1 55000 1 50000 3 45000
TOTAL

125000
90000
155000
234000
162000
120000
133000
147000
70000
160000
152000
135000
40000
110000
239000
45000
127000
55000
119000
145000
120000
0
0
2683000
2683000
 DAFTAR NAMA PASIEN YANG MEMBAYAR RETR
PUSKESMAS : JATIBENING
TAHUN : 2018

KEPALA JENIS KELAMIN ALAMAT RETRIBUSI NO

TANGGAL NO NAMA PASIEN UMUR NO KARCIS
KELUARGA L P KEL RT RW 5,000 10,000 KARCIS

10/4/2018 1 Prihartono
2 Faryadi
3 Maiva Ben
4 Teguh N
5 Asnawati
6 Sumuyati
7 Mila
8 Ezra
9 Fitriani
10 Nurhalimah
11 Iwan S
12 Seli
13 Rahmat H
14 Sartinem
15 Gibran
16 Selli
11/4/2018 1 Suminah 40 x JB 2 14
2 Kimora 2 x LW
3 Dayanti 32 x JB 2 8
4 Zulfa 19 x LW
5 Sopia 13 x JB 6 1
6 Tiara 16 x lw
12/4/2018 1 Aisyah 51 x JB 12 7
2 Aslichah 13 x JB 5 1
3 Riska Sari 38 x JB 1 10
4 Idham 25 x JBB 2 7
5 Fenilia 32 x LW
6 Slamat 28 x JB 2 2
7 Tarwati 26 x JB
8 Nurfatimah 7 x LW
9 Yuni Mintarsih 29 x LW
10 Habibi 9 x LW
11 Sugiyo 70 x JB
12 M. Solihin 33 x JB
13 Agus 25 x JB
13/4/2018 1 Dede K 34 x LW
2 Pancar E 40 x JB 5 1
3 Soleh N 23 x LW
4 Kharisma 10 x LW
5 Ikhsan M 3 x LW
 6 Nurfahiro 31 x JBB 2 9
7 Nurmawati 40 x JB
8 Karisma 4 x JB
9 Zedia 9 x JK
10 Yane 32 x JB
11 Sapra 18 x JBB 7 2
12 Sri 18 x JBB 7 2
16/4/2018 1 Iyna 20 x LW
2 Ananda 17 x JB 7 9
3 Sukimin 31 x LW
4 Sendy 11 x JBB 2 1
5 Razi 7 x LW
6 Suryani 22 x JB 5 2
7 Naufal 2 x JB 8 3
17/4/2018 1 M. Zidan 9 x JB 5 2
2 Wasini 29 x JB 4 1
3 Christan L 9 x JB 4 1
4 Kurniati 42 x JB 2 2
5 M. Dian 25 x JB
6 Joko 32 x JB
7 Avita 7 x JB 8 1
8 Sahrul 2 x JB 8 1
9 Ketti 21 x lw
10 Ahmad Anshari 23 x JB
11 M. Umar 3 x JB 3 3
12 Farikhin 37 x JB 4 1
13 Adah Fatimah 47 x JB 2 3
14 Nazril 2bln x JB 3 12
15 Putri 4bln x LW
16 Musminatun 20 x JB 6 14
17 Nurhalimah 28 x JB 3 2
18 Srin w 50 x JB 1 11
19 Fauzan 1bln x JB 5 12
20 Mega 29 x JB 5 2
21 Gibran K 20bln x JB
18/4/2018 1 Syamsul Qomar 39 x JB 4 3
2 Imelda K 33 x JB 5 4
3 Vivi Okta 21 x JB 1 1
4 Ikhya 8 x JB 4 3
5 Salsabila 6 x JB 4 3
6 Desi R 10 x LW
7 Endro 5 x LW
8 Maryani 38 x JBB 2 3
9 Fathoni 75 x LW
10 Nababan 2 x LW
 11 Gracia 11 x JBB
12 Nuris 26 x LW
19/4/2018 1 Tati 17 x LW
2 Iswanto 49 x LW
3 Iffa Astira 5 x LW
4 Dariyanto 47 x LW
5 Asa Yulika 2,5 x JB 7 4
6 Kimora 21 x JB 7 3
7 Yuliana 37 x JB 5 12
8 Suada 2 x JB 8 1
9 Ismu 30 x JB
10 Siti 55 x LW
11 Zulkifly 17 x JB 2 13
12 Lulu 28 x JB 11 5
13 Darwanto 4 x JB 1 11
14 Repan 3,5 x JB 4 2
15 Satria 20 x JB 2 4
16 Reni 20 x JB 2 4
20/4/2018 1 Teguh 20 x JB
2 Erik Efendi 30 x JB
3 Zidan 9 x JB 5 2
4 Nabila 27 x LW
5 Saudah 37 x JB 8 1
6 Rena A 17 x LW
7 Karsiti 50 x LW
8 Nur L 34 x LW
9 Miftahul 28 x LW
10 Peti 23 x LW
21/4/2018 1 Jupri S 25 x JKM 4 2
2 alkalifi 1 x JB 1 2
3 Nanda Catur 26 x LW
4 Pera 18 x JB 1 8
5 Diva 1 x LW
6 Aryuni 32 x JB 5 12
7 Fatimah 1 x JB 3 14
8 Sulaiman 29 x JB 7 14
9 Achazia 18 x JB 3 3
10 M. Dian 24 x JB 4 7
11 M. Sauqi 4 x JB 5 2
12 Eldha 16 x JBB 2 9
13 Ahmad Nur 27 x JB 3 2
23/4/2018 1 Yusnaini 32 x LW
2 Abdul S 28 x JB 1 1
3 Aidan 10 x JB 3 1
4 Azahra 4 x LW
 5 Nur K 53 x JB 5 13
6 Darianto 47 x LW
7 Arsyad 1 x LW
8 Al Hasbi 23 x LW
9 Fitri N 18 x LW
10 Aisyah 35 x LW
11 Dimiri 2 x LW
12 Ibrahim 19 x JBB 3 4
13 Donny 22 x JBB 3 4
14 Faryal 4bln x LW
24/4/2018 1 Rizka Noor 17 x JB 2 14
2 Vinaya 17 x JB 2 2
3 Hafidza 8 x LW
4 Humaira 6 x LW
5 Stevano 27 x JB 12
6 Siti K 2 x JKM
7 Nurhalimah 47 x LW
8 Shely 14 x JB 1 2
9 Mega S 51 x LW
10 Dinar 18 x LW
11 Ida 22 x LW
12 M. Agung 27 x LW
13 Achazia 18bln x JB 7 3
14 Nana 35 x LW
25/4/2018 1 Arfan Nur Jaya 5 x LW
2 Endang 33 x LW
3 Karsiti 50 x LW
4 Rita 21 x JB 3 2
5 Asri 14 x LW
6 Marsya `12 x LW
7 Fauzan 19 x LW
8 Nur aisya 30 x LW
9 Supriatin 31 x JB 7 2
10 Ipit 45 x LW
11 Yuniar 51 x LW
26/4/2018 1 Siti L 20 x LW
2 Fatia 17bln x LW
3 Hawa 9 x LW
4 Faqih Choiri 3 x JB 4 2
5 Thyeri Atta 4 x JTK 3 1
6 Elvita Loka 18 x JB 6 3
7 Syahmi 18 x JBB 4 4
8 Atiah 53 x LW
9 Rahmat 63 x LW
10 Nirma L 61 x LW
A PASIEN YANG MEMBAYAR RETRIBUSI DAN TINDAKAN
BULAN : NO.SSRD :
MINGGU : 1-5
TINDAKAN RETRIBUSI HAJI
2,000 2,500 3,000 5,000 7,500 10,000 15,000 18,000 20,000 25,000 30,000 50,000 55,000 165,000 NO KARCIS 15,000

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