Tanda Terima Non Kapitasi 2015

NO.
NAMA JUMLAH UANG

1. dr. H. HENDARTO, M.SI Rp 3,440,192
2. MOH. BURA Rp 481,336
3. dr. DWI WIJONO Rp 3,058,856
4. drg. R. SRI ROCHANI Rp 1,068,569
5. dr. TRI PUSPITA N. Rp 3,058,856
6. TITIK PRASETYAWATI MR, S.Kep.Ns Rp 980,871
7. RINA PURWANTARI, SST Rp 432,288
8. SUHARMIASIH, SST Rp 235,728
9. A.P. NURHAYATI Rp 100,000
10. KUSNO RIADI Rp 149,178
11. TUFFAH SALEH Rp 100,000
12. DJUFFRI Rp 530,514
13. ABU MUTFARI, S.Kep.Ns Rp 333,735
14. YAYUK SRI RAHAYU Rp 100,000
15. SUFIANSAH, S.Kep.Ns Rp 333,735
16. DINA AINUN, A.Md.Kep Rp 382,913
17. ENNY NURHAYATI, SKM Rp 100,000
18. AMINULLAH Rp 100,000
19. SOCHIBATUL I, A.Md.Kep Rp 764,249
20. NURUR RAHMAH, A.Md.Kep Rp 382,913
21. INDRI WIDIASTUTI, A.Md Rp 414,496
22. BUSTAMI Rp 100,000
23. AMRI NUR AINI Rp 382,913
24. MOH.SAHE Rp 149,178
25. SRI SUSANTIN CH Rp 149,178
26. HEPIE SEPTIANI, A.Md.Kep Rp 319,831
27. AYNUL LUTHFIY, A.Md.Kep Rp 382,913
28. ARISKA YULIANTO, S.Kep.Ns Rp 505,514
29. SITI HATIJAH, A.Md.Kep Rp 505,514
30. SILFANA YULANDIA A, A.Md Rp 347,160
31. MOHAMMAD HAIRURROZY, A.Md Rp 592,579
32. MAHDALI Rp 75,000
33. MOHAMMAD SLAMET RIYADI Rp 75,000
34. YOGI SEPTIAN Rp 75,000
35. ENNI Rp 294,831
36. FIFIN Rp 294,831
37. FIQA Rp 294,831
38. FENDI Rp 294,831
39. SUBAI Rp 294,831
40. LINI Rp 294,831
41. IFA Rp 294,831
42. WIWIN Rp 294,831
43. ARUM Rp 250,728
44. LINA Rp 250,728
45. SUKO Rp 250,728
46 Nurhasanah Rp 100,000 Plus
47 Dewi Cahya Rp 100,000 Plus
48 Hj.Noerul Rp 100,000
49 Khairus Sami'ul Ulum Rp 100,000 Plus
50 Halimaturrahmah Rp 100,000 Plus
51 Yeni P Rp 100,000 Plus
52 Dewi Kurnia Putri Rp 100,000 Plus
53 Ferika Rp 100,000 Plus
54 Dewi Wardani Rp 100,000 Plus
55 Mariyatul hamida Rp 100,000 Plus
56 Nurul Kamariah Rp 100,000 Plus
57 Yulia Rofik Rp 100,000
58 Nur Hafifah Rp 100,000
59 Nurul Fadjriyah Rp 100,000
60 Yuni Tri Mardiana Rp 100,000
61 Farida Rp 100,000
62 Ani Rp 75,000
63 Beny Rp 75,000
64 Saktiyani Rp 75,000
65 Febri Rp 75,000
Poskestren Panempan Plus
Rp 25,219,041
Rp 151,200
Rp 37,800
Rp 89,200
Rp 243,600
Rp 198,000
Rp 177,800
Rp 67,200
Rp 87,200
Rp 138,600
Rp 84,000
Rp 168,000
Rp 1,442,600 Rp 26,661,641
PEMBERI PELAYANAN LANGSUNG
60%
NO. URAIAN JENIS PELAYANAN
DOKTER
Pemeriksaan Rawat Jalan BP Rp 2,804,820

KIA Rp 1,014,588
Gigi Rp 292,409
Rp 4,111,817
70%
DOKTER
Pemeriksaan Kesehatan Rp 2,163,840

60%
DOKTER
Tindakan Medik Gigi Rp 776,160

60%
DOKTER
Pemeriksaan Lab. Sederhana Rp 136,080

60%
DOKTER
Praktek Klinik/Manajemen PKM D3 Rp 131,040

Praktek Klinik/Manajemen PKM S1 Rp 272,160
Praktek Klinik/Manajemen PKM SLTA Rp 28,224
60%
DOKTER
Pemeriksaan Umum Rawat Jalan UGD (khitan) 0

80%
DOKTER
Pemeriksaan Rawat Inap Rp 2,627,520

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK
60% LANGSUNG 40%
POS
KEPERAWATAN/PRO PIMPINAN
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 1,869,880 Rp 3,427,200 Rp 1,142,400
Rp 676,392
Rp 194,939
Rp 2,741,212
70% LANGSUNG 30%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 540,960 Rp 869,400 Rp 289,800 Rp 3,864,000

60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 332,640 Rp 554,400 Rp 184,800 Rp 1,848,000

60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 544,320 Rp 340,200 Rp 113,400 Rp 1,134,000

60% LANGSUNG 40%
POS
PIMPINAN
PEMBIMBING REMUNERASI
PUSKESMAS
PUSKESMAS
Rp 196,560 Rp 163,800 Rp 54,600 Rp 546,000
Rp 408,240 Rp 340,200 Rp 113,400 Rp 1,134,000
Rp 42,336 Rp 35,280 Rp 11,760 Rp 117,600
Rp 238,896 Rp 199,080 Rp 66,360 Rp 663,600
60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
226800 113400 37800 378000

80% LANGSUNG 20%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 1,751,680 Rp 821,100 Rp 273,700 Rp 5,474,000
Rp 6,864,060
516,000 344,000
60%
DOKTER
Pemeriksaan Rawat Jalan BP Rp 1,869,880

KIA Rp 1,014,588
Gigi Rp 292,409
Rp 3,176,877
70%
DOKTER
Pemeriksaan Kesehatan Rp 2,163,840

60%
DOKTER
Tindakan Medik Gigi Rp 776,160

60%
DOKTER
Pemeriksaan Lab. Sederhana Rp 136,080

60%
DOKTER
Praktek Klinik/Manajemen PKM D3 Rp 131,040

Praktek Klinik/Manajemen PKM S1 Rp 272,160
60%
DOKTER
Pemeriksaan Umum Rawat Jalan UGD (khitan) 0

80%
DOKTER
Pemeriksaan Rawat Inap Rp 2,627,520

60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 2,804,820 Rp 3,427,200 Rp 1,142,400
Rp 676,392
Rp 194,939
Rp 3,676,151
70% LANGSUNG 30%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 540,960 Rp 869,400 Rp 289,800 Rp 3,864,000

60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 332,640 Rp 554,400 Rp 184,800 Rp 1,848,000

60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 544,320 Rp 340,200 Rp 113,400 Rp 1,134,000

60% LANGSUNG 40%
POS
PIMPINAN
PEMBIMBING REMUNERASI
PUSKESMAS
PUSKESMAS
Rp 196,560 Rp 163,800 Rp 54,600 Rp 546,000
Rp 408,240 Rp 340,200 Rp 113,400 Rp 1,134,000
Rp 42,336 Rp 35,280 Rp 11,760 Rp 117,600
Rp 238,896 Rp 199,080 Rp 66,360 Rp 663,600
60% LANGSUNG 40%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
226800 113400 37800 378000

80% LANGSUNG 20%
POS
REMUNERASI
FESI LAIN PUSKESMAS
PUSKESMAS
Rp 1,751,680 Rp 821,100 Rp 273,700 Rp 5,474,000
Rp 6,864,060
dr. H. HENDARTO, M.SI
dr. DWI WIJONO
25%
drg. R. SRI ROCHANI
dr. TRI PUSPITA N.
MOH. BURA
TITIK PRASETYAWATI MR, S.Kep.Ns
RINA PURWANTARI, SST 20%
YAYUK SRI RAHAYU
DJUFFRI
ABU MUTFARI, S.Kep.Ns
SUFIANSAH, S.Kep.Ns
DINA AINUN, A.Md.Kep
SOCHIBATUL I, A.Md.Kep
NURUR RAHMAH, A.Md.Kep 25%
AMRI NUR AINI
HEPIE SEPTIANI, A.Md.Kep
AYNUL LUTHFIY, A.Md.Kep
SUHARMIASIH, SST
A.P. NURHAYATI
KUSNO RIADI
TUFFAH SALEH
ENNY NURHAYATI, SKM
AMINULLAH
INDRI WIDIASTUTI, A.Md 20%
BUSTAMI
MOH.SAHE
SRI SUSANTIN CH
ARISKA YULIANTO, S.Kep.Ns
SITI HATIJAH, A.Md.Kep
SILFANA YULANDIA A, A.Md
MOHAMMAD HAIRURROZY, A.Md
YOGI SEPTIAN
ENNI
FIFIN
FIQA
FENDI
8%
SUBAI
LINI
IFA
WIWIN
ARUM
LINA
SUKO
MAHDALI
2%
MOHAMMAD SLAMET RIYADI
100%
JASA TAK LANGSUNG (40%) TOTAL

224000 224000
520000 520000
48000 48000
300000 300000
TANDA TERIMA JASA PELAYANAN YANKESDAS JANUARI 2015
NO. NAMA FEBRUARI

1 Dr. H. NANANG SUYANTO, M.Si 43,072
2 MOH. BURA 35,000
3 dr. DWI WIJONO 31,000
4 drg. R. SRI ROCHANI 31,000
5 dr. TRI PUSPITA NIRMALA 31,000
6 NURUL KAMARIYAH, A.Md.Kep 22,000
7 RADEN SRI NOEROEL HIDAJATI 20,000
8 TITIK PRASETYAWATI MAIRAH RUBY, S.Kep.Ns 22,000
9 RINA PURWANTARI, SST 20,000
10 AMOR PATRIYA NURHAYATI 15,000
11 KUSNO RIADI 15,000
12 TUFFAH SHALEH 15,000
13 SUHARMIASIH, A.Md.Keb 20,000
14 SUFIANSAH, S.Kep, Ns 22,000
15 NURHASANAH 20,000
16 ABU MUTFARI, S.Kep. Ns 22,000
17 YAYUK SRI RAHAYU 20,000
18 ENNY NURHAYATI, SKM 20,000
19 YULIA ROFIT SUTRISNO, A.Md.Kep 22,000
20 AMINULLAH 15,000
21 DINA AINUN, A.Md.Kep. 22,000
22 MARIYATUL HAMIDA, A.Md.Keb 20,000
23 SOCHIBATUL ISLAMIYAH, A.Md.Kep 22,000
24 NURUR RAHMAH, A.Md.Kep 22,000
25 INDRI WIDYASTUTI, A.Md 20,000
26 DJUFFRI 15,000
27 MOH. BUSTAMI 15,000
28 HEPIE SEPTIANI, A.Md.Kep 22,000
29 MOH. SAHE 15,000
30 RR. DEWI CHAHYA NINGURIPI 20,000
31 SRI SUSANTIN CHARIJAH 15,000
32 AMRI NUR AINI, A.Md.Kep 22,000
33 DEWI WARDANI 20,000
34 HALIMATURRAHMAH, A.Md. Keb 20,000
35 AYNUL LUTHFIY, A.Md.Kep 22,000
36 NUR FITRIAH HIDAYAH, SST 20,000
37 KHAIRUS SAMI'UL ULUM, A.Md.Keb 20,000
38 YENI PURWATI, A.Md.Keb 20,000
39 DWI KURNIA PUTRI, A.Md.Keb 20,000
40 FERIKA HARDIANA, A.Md.Keb 20,000
41 NURUL FADJRIYAH, A.Md.Kep 22,000
42 NUR HAFIFAH, A.Md.Kep 22,000
43 FARIDATUL ROCHMAH, A.Md.Keb 20,000
44 TRI YUNI MARDIANA, A.Md.Keb 20,000
45 NANIK FAJRIYAH, A.Md.Kep 22,000
46 SETIYO SUGIONO, A.Md.Kep 22,000
JUMLAH 981,072
Mengetahui
Kepala Puskesmas Teja
dr. H. Nanang Suyanto, M.Si

NIP. 19691105 200212 1 002
TIM JAPEL:
1. MOH. BURA
2. SOCHIBATUL ISLAMIYAH
3. dr. TRI PUSPITA N.
4. drg. R. SRI ROCHANI
5. Hj.TITIK PRASETYAWATI, S.Kep.Ns
6. Hj.RINA PURWANTARI, SST
7. DJUFFRI
8. Hj. R. SRI NOEROEL H.
9. ABU MUTFARI, S.Kep.Ns
10. SUFIANSAH, S.Kep.Ns
SDAS JANUARI 2015
JAN
JUMLAH
TANDA TANGAN 60 40
PENERIMAAN
1 981,072 654,048
2 21,328 1,635,120
3
4
5 -
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
75 25
490,536 163,512
122,634
6,606,640
3,963,984
TANDA TERIMA JASA PELAYANAN YANKESDAS FEBRUARI 2015
NO. NAMA FEBRUARI

2 MOH. BURA 35,000
20 AMINULLAH 15,000
26 DJUFFRI 15,000
29 MOH. SAHE 15,000
JUMLAH 993,288
Mengetahui

NIP. 19691105 200212 1 002
TIM JAPEL:
1. MOH. BURA
7. DJUFFRI
DAS FEBRUARI 2015
FEB
JUMLAH
TANDA TANGAN 60 40
PENERIMAAN
1 993,288 662,192
2 21,593 1,655,480
3
4
5 -
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
75 25
496,644 165,548
124,161
6,606,640
3,963,984
TANDA TERIMA JASA PELAYANAN YANKESDAS MARET 2015
NO. NAMA MARET

2 MOH. BURA 68,000
20 AMINULLAH 32,000
26 DJUFFRI 32,000
29 MOH. SAHE 32,000
JUMLAH 1,989,624
Mengetahui

NIP. 19691105 200212 1 002
TIM JAPEL:
1. MOH. BURA
7. DJUFFRI
SDAS MARET 2015
MAR
JUMLAH
TANDA TANGAN 60 40
PENERIMAAN
1 1,989,624 1,326,416
2 43,253 3,316,040
3
4
5 -
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
75 25
994,812 331,604
248,703
6,606,640
3,963,984
TANDA TERIMA JASA PELAYANAN RAWAT JALAN JANUARI s/d MARET 2015
NO. NAMA RAWAT JALAN PEL. KESEHATAN PEL. GIGI PRAKTIKUM PEL. LABORAT
1 Dr. H. NANANG SUYANTO, M.Si 120,000 51,000 60,000
2 MOH. BURA 45,000
3 dr. DWI WIJONO 90,000 40,000 70,000 15,000
4 drg. R. SRI ROCHANI 90,000 50,000
5 dr. TRI PUSPITA N. 90,000 40,000 70,000 15,000
6 TITIK PRASETYAWATI MR, S.Kep.Ns 70,000 30,000 132,200 13,000
7 RINA PURWANTARI, SST 70,000 13,000
8 YAYUK SRI RAHAYU 70,000 35,000
9 INDRI WIDIASTUTI, A.Md 80,384
10 DJUFFRI 74,000 30,000 40,000
12 ABU MUTFARI, S.Kep.Ns 70,000 30,000 65,000 13,000
13 SUFIANSAH, S.Kep.Ns 70,000 30,000 13,000
14 DINA AINUN, A.Md.Kep 70,000 30,000 65,000 13,000
15 SOCHIBATUL I, A.Md.Kep 70,000 30,000 65,000 13,000
16 NURUR RAHMAH, A.Md.Kep 70,000 30,000 65,000 13,000
17 AMRI NUR AINI 70,000 30,000 65,000 13,000
18 AYNUL LUTHFIY, A.Md.Kep 70,000 30,000 65,000 13,000
20 SUHARMIASIH, SST 70,000 13,000
21 HALIMATURRAHMAH, A.Md.Keb. 65,000
22 A.P. NURHAYATI 21,000
24 TUFFAH SALEH 55,000 21,000
25 AMINULLAH 55,000 34,000 50,000
26 MOH.SAHE 55,000 21,000 34,000
27 SRI SUSANTIN CH 55,000 21,000 34,000 11,000
28 ARISKA YULIANTO, S.Kep.Ns 40,000 14,000
29 SITI HATIJAH, A.Md.Kep 40,000 14,000
30 ENNI
31 FIFIN
32 FIQA
33 FENDI
34 SUBAI
35 LINI
36 IFA
37 WIWIN
38 YOGI SEPTIAN 40,000 20,000
39 MOH. HAIRURROZY 40,000 25,400
40 SILFANA YULANDIA A, A.Md 40,000
41 ARUM 40,000
42 LINA 40,000
43 SUKO 40,000
JUMLAH 1,734,000 579,000 272,400 907,200 351,384
Mengetahui Pamekasan,
Kepala Puskesmas Teja Bendahara
Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMIYAH

NIP. 19711030 200212 1 003 NIP. 19761024 200903 2 001
TIM JAPEL:
1. MOH. BURA
7. DJUFFRI
TIND. KHITAN TOTAL TANDA TANGAN
231,000 1
45,000 2
215,000 3
140,000 4
215,000 5
245,200 6
83,000 7
105,000 8
80,384 9
144,000 10
65,000 11
16,000 194,000 12
113,000 13
178,000 14
178,000 15
178,000 16
178,000 17
178,000 18
65,000 19
83,000 20
21
22
23
76,000 24
139,000 25
110,000 26
121,000 27
54,000 28
54,000 29
13,000 30
13,000 31
13,000 32
13,000 33
13,000 34
13,000 35
13,000 36
13,000 37
60,000 38
65,400 39
40
40,000 41
40,000 42
40,000 43
120,000 3,712,984
60
1,734,000
64,222
-
TANDA TERIMA JASA PELAYANAN RAWAT JALAN DESEMBER 2014
NO. NAMA JUMLAH PENERIMAAN
1 dr. NANANG SUYANTO, M.SI Rp44,900

2 dr. DWI WIJONO Rp32,900
3 drg. R. SRI ROCHANI Rp22,900
4 dr. TRI PUSPITA N. Rp32,900
5 TITIK PRASETYAWATI MR, S.Kep.Ns Rp25,900
6 RINA PURWANTARI, SST Rp25,900
7 YAYUK SRI RAHAYU Rp25,900
8 DJUFFRI Rp25,900
9 ABU MUTFARI, S.Kep.Ns Rp25,900
10 SUFIANSAH, S.Kep.Ns Rp25,900
11 DINA AINUN, A.Md.Kep Rp25,900
12 SOCHIBATUL I, A.Md.Kep Rp25,900
13 NURUR RAHMAH, A.Md.Kep Rp25,900
14 AMRI NUR AINI Rp25,900
15 AYNUL LUTHFIY, A.Md.Kep Rp25,900
16 SUHARMIASIH, SST Rp25,900
17 TUFFAH SALEH Rp17,900
18 AMINULLAH Rp17,900
19 MOH.SAHE Rp17,900
20 SRI SUSANTIN CH Rp17,900
21
22
23
24
25
26
27
JUMLAH Rp516,000
dr. NANANG SUYANTO, M.SI SOCHIBATUL ISLAMIYAH

NIP. 19691105 200212 1 002 NIP. 19761024 200903 2 001
TIM JAPEL:
1. MOH. BURA
7. DJUFFRI
TANDA TERIMA JASA PELAYANAN RAWAT JALAN JANUARI s/d MARET 2015
JUMLAH
NO. NAMA
PENERIMAAN
1 Dr. H. NANANG SUYANTO, M.Si
2 dr. DWI WIJONO
3 drg. R. SRI ROCHANI
4 dr. TRI PUSPITA N.
5 TITIK PRASETYAWATI MR, S.Kep.Ns
6 RINA PURWANTARI, SST
7 YAYUK SRI RAHAYU
8 DJUFFRI
9 ABU MUTFARI, S.Kep.Ns
10 SUFIANSAH, S.Kep.Ns
11 DINA AINUN, A.Md.Kep
12 SOCHIBATUL I, A.Md.Kep
13 NURUR RAHMAH, A.Md.Kep
14 AMRI NUR AINI
15 AYNUL LUTHFIY, A.Md.Kep
16 SUHARMIASIH, SST
17 TUFFAH SALEH
18 AMINULLAH
19 MOH.SAHE
20 SRI SUSANTIN CH
21 ARISKA YULIANTO, S.Kep.Ns
22 SITI HATIJAH, A.Md.Kep
23 YOGI SEPTIAN
24 MOH. HAIRURROZY
25 ARUM
26 LINA
27 SUKO
JUMLAH
dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLAMIYAH

NIP. 19691105 200212 1 002 NIP. 19761024 200903 2 001
TIM JAPEL:
1. MOH. BURA
7. DJUFFRI
EMBER 2014
60 40 75
TANDA TANGAN 516,000 344,000 258,000
1 19,111 860,000 64,500

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
an,
Bendahara
1,630,000
1,649,960
SOCHIBATUL ISLAMIYAH 1,191,960
NIP. 19761024 200903 2 001
s/d MARET 2015
TANDA TANGAN 60 40 75
1 1,734,000 1,156,000 867,000
2 64,222 2,890,000 216,750
3
4 -
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
an,
Bendahara
SOCHIBATUL ISLAMIYAH
NIP. 19761024 200903 2 001
25
86,000
344,000
21500
25
289,000
1,156,000
TANDA TERIMA JASA PELAYANAN KIR DESEMBER 2014

1 dr. H. HENDARTO, M.SI 30% Rp14,500
4 MOH. BURA 66% Rp8,000
6 DJUFFRI Rp7,000
14 A.P. NURHAYATI Rp5,700
15 KUSNO RIADI Rp5,700
17 MOH.SAHE Rp5,700
19 4%
20
JUMLAH 3990000 Rp132,000
Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMI

NIP. 19711030 200212 1 003 NIP. 19761024 200903
TIM JAPEL:
1. MOH. BURA 1.
2. SOCHIBATUL ISLAMIYAH 2.
3. dr. TRI PUSPITA N. 3.
4. drg. R. SRI ROCHANI 4.
5. Hj.TITIK PRASETYAWATI, S.Kep.Ns 5.
6. Hj.RINA PURWANTARI, SST 6.
7. DJUFFRI 7.
8. Hj. R. SRI NOEROEL H. 8.
9. ABU MUTFARI, S.Kep.Ns 9.
10. SUFIANSAH, S.Kep.Ns 10.
TANDA TERIMA JASA PELAYANAN KIR JANUARI s/d MARET 2015

1 dr. H. NANANG SUYANTO, M.SI 30% 51,000
2 MOH. BURA 45,000
4 dr. TRI PUSPITA N. 66% 40,000
5 TITIK PRASETYAWATI MR, S.Kep.Ns 30,000
6 DJUFFRI 30,000
7 ABU MUTFARI, S.Kep.Ns 30,000
8 SUFIANSAH, S.Kep.Ns 30,000
9 DINA AINUN, A.Md.Kep 30,000
10 SOCHIBATUL I, A.Md.Kep 30,000
12 AMRI NUR AINI 30,000
14 A.P. NURHAYATI 21,000
16 TUFFAH SALEH 21,000
17 MOH.SAHE 21,000
18 SRI SUSANTIN CH 21,000
19 ARISKA YULIANTO, S.Kep.Ns 4% 14,000
20 SITI HATIJAH, A.Md.Kep 14,000
JUMLAH 3990000 Rp579,000
dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLAMI

NIP. 19691105 200212 1 002 NIP. 19761024 200903
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
014
TANDA TANGAN 60 40 75 25
1 132,000 88,000 66,000 22,000
2 4,889 220,000 16,500 88,000
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Bendahara
IP. 19761024 200903 2 001
ET 2015
1 579,000 386,000 289,500 96,500
2 28,950 965,000 72,375 386,000
3
4 -
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Bendahara
IP. 19761024 200903 2 001
TANDA TERIMA JASA PELAYANAN TINDAKAN MEDIK GIGI DESEMBER 2014

1 drg. R. SRI ROCHANI 50% Rp32,200
2 YAYUK SRI RAHAYU 45% Rp25,000
3 DJUFFRI Rp22,000
5 MOH.SAHE Rp22,000
7
8 2%
JUMLAH Rp145,200
Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMIY

NIP. 19711030 200212 1 003 NIP. 19761024 200903 2
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
TANDA TERIMA JASA PELAYANAN TINDAKAN MEDIK GIGI JAN s/d MAR 2015

1 drg. R. SRI ROCHANI 50% 50,000
2 YAYUK SRI RAHAYU 45% 35,000
3 DJUFFRI 40,000
4 AMINULLAH 34,000
5 MOH.SAHE 34,000
7 MOHAMMAD HAIRURROZY, A.Md 25,400
8 YOGI SEPTIAN 2% 20,000
JUMLAH 272,400
dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLAMIY

NIP. 19691105 200212 1 002 NIP. 19761024 200903 2
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
EMBER 2014
1 145,200 96,800 72,600 24,200
2 5,378 242,000 18,150 96,800
3
4 18,150
5
6
7
8
Bendahara
IP. 19761024 200903 2 001
s/d MAR 2015
TANDA TANGAN 60 40 75
1 272,400 181,600 136,200
2 34,050 454,000 34,050
3
4 -
5 60 40 75 25
6 272,400 181,600 136,200 45,400
7 10,089 454,000 34,050 181,600
8
Bendahara
IP. 19761024 200903 2 001
TANDA TERIMA BIMBINGAN SISWA SLTA, D3 & S1 DESEMBER 2014
NO. NAMA SLTA S1

1 dr. DWI WIJONO
8 AMRI NUR AINI, A.Md.Kep
10 AMINULLAH
11 HEPIE SEPTIANI, A.Md.Kep
12 HALIMATURRAHMAH, A.Md.Keb.
13 NURUL KAMARIYAH, A.Md.Kep
JUMLAH 0 36,000
Pamekasan,
Mengetahui
Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLA

NIP. 19711030 200212 1 003 NIP. 19761024 2009
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
TANDA TERIMA BIMBINGAN SISWA SLTA, D3 & S1 JAN s/d MAR 2015
NO. NAMA SLTA S1

1 dr. DWI WIJONO
10 AMINULLAH
12 HALIMATURRAHMAH, A.Md.Keb.
13 NURUL KAMARIYAH, A.Md.Kep
JUMLAH 0 0
Pamekasan,
Mengetahui
dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLA

NIP. 19691105 200212 1 002 NIP. 19761024 2009
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
S1 DESEMBER 2014
JUMLAH TANDA TANGAN 60 40

01 36,000 24,000
0 2 1,333 60,000
36,000 3
0 4 4,500
05
0 6
07
0 8
09
0 10
0 11
0 12
0 13
36,000
n,
Bendahara
NIP. 19761024 200903 2 001
S1 JAN s/d MAR 2015
JUMLAH TANDA TANGAN 60 40

70,000 1 907,200 604,800
70,000 2 69,785 1,512,000
132,200 3
65,000 4 -
65,000 5
65,000 6
65,000 7
65,000 8
65,000 9
50,000 10
65,000 11
65,000 12
65,000 13
907,200
n,
Bendahara
NIP. 19761024 200903 2 001
75 25
18,000 6,000
4,500 24,000
75 25
453,600 151,200
113,400 604,800
TANDA TERIMA JASA PELAYANAN LABORATORIUM DESEMBER 2014

1 dr. H. HENDARTO, M.SI Rp8,000
14 INDRI WIDIASTUTI, A.Md Rp15,000
16
JUMLAH Rp70,776
Kepala Puskesmas Teja Bendaha
Dr. H. HENDARTO, M.Si. SOCHIBATUL IS

NIP. 19711030 200212 1 003 NIP. 19761024 20
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
TANDA TERIMA JASA PELAYANAN LABORATORIUM JAN s/d MAR 2015

1 dr. H. NANANG SUYANTO, M.SI 60,000
3 dr. TRI PUSPITA N. 15,000
6 ABU MUTFARI, S.Kep.Ns 13,000
7 SUFIANSAH, S.Kep.Ns 13,000
8 DINA AINUN, A.Md.Kep 13,000
9 SOCHIBATUL I, A.Md.Kep 13,000
11 AMRI NUR AINI 13,000
13 SUHARMIASIH, SST 13,000
14 INDRI WIDIASTUTI, A.Md 80,384
16 SILFANA YULANDIA A, A.Md 40,000
JUMLAH 351,384
Kepala Puskesmas Teja Bendaha
dr. H. NANANG SUYANTO, M.Si SOCHIBATUL IS

NIP. 19691105 200212 1 002 NIP. 19761024 20
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
BER 2014
1 70,776 47,184 35,388 11,796
2 2,621 117,960 8,847 47,184
3
4 -
5
6
7
8
9
10
11
12
13
14
15
16
Bendahara
IP. 19761024 200903 2 001
MAR 2015
1 351,384 234,256 175,692 58,564
2 21,962 585,640 43,923 234,256
3
4 -
5
6
7
8
9
10
11
12
13
14
15
16
Bendahara
IP. 19761024 200903 2 001
TANDA TERIMA JASA PELAYANAN KHITAN DESEMBER 2014

2
3
4
5
6
7
8
9
JUMLAH Rp90,000
Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLA

NIP. 19711030 200212 1 003 NIP. 19761024 20090
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
TANDA TERIMA JASA PELAYANAN KHITAN JAN s/d MAR 2015

2 ENNI Rp13,000
3 FIFIN Rp13,000
4 FIQA Rp13,000
5 FENDI Rp13,000
6 SUBAI Rp13,000
7 LINI Rp13,000
8 IFA Rp13,000
9 WIWIN Rp13,000
JUMLAH Rp120,000
dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLA

NIP. 19691105 200212 1 002 NIP. 19761024 20090
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
2014
1 90,000 60,000 45,000 15,000
2 10,000 150,000 11,250 60,000
3
4 -
5
6
7
8
9
Bendahara
IP. 19761024 200903 2 001
2015
1 120,000 80,000 60,000 20,000
2 13,333 200,000 15,000 80,000
3
4 -
5
6
7
8
9
Bendahara
IP. 19761024 200903 2 001
TANDA TERIMA JASA PELAYANAN RAWAT INAP UGD 2014 (JAN-NOP)

5 HEPIE SEPTIANI, A.Md.Kep Rp300,000
6 ARISKA YULIANTO, S.Kep.Ns Rp88,000
7 ENNI Rp200,000
8 FIFIN Rp200,000
9 FIQA Rp200,000
10 FENDI Rp200,000
11 SUBAI Rp200,000
12 LINI Rp200,000
13 IFA Rp200,000
14 WIWIN Rp200,000
16 Hj. RINA PURWANTARI, S.ST Rp50,000
17 NOR HAFIFAH Rp60,000
18 MAHDALI Rp61,200
19 MOHAMMAD SLAMET RIYADI Rp30,000
JUMLAH Rp4,059,200
Mengetahui
Dr. H. HENDARTO, M.Si.

NIP. 19711030 200212 1 003
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
11. HEPIE SEPTIANI 11.
UGD 2014 (JAN-NOP)
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Pamekasan,
Bendahara
NIP. 19761024 200903 2 001
TANDA TERIMA JASA PELAYANAN RAWAT INAP KIA 2014 (JAN-NOP)
NO. NAMA JUMLAH PENERIMAAN TANDA TANGAN
JUMLAH 150,000
Dr. H. HENDARTO, M.Si. Sochibatul Islamiyah

NIP. 19711030 200212 1 003 NIP. 19761024 200903 2 001
n,
Bendahara
ibatul Islamiyah
61024 200903 2 001
TANDA TERIMA JASA TAK LANGSUNG POS REMUNERASI PUSKESMAS 2014 (JAN-NOP)
NO. NAMA JUMLAH

3 drg. R. SRI ROCHANI Rp135,000
5 MOH. BURA Rp135,000
9 DJUFFRI Rp135,000
15 AMRI NUR AINI, A.Md.Kep Rp135,000
16 HEPIE SEPTIANI, A.Md.Kep Rp135,000
22 ENNY NURHAYATI, SKM Rp135,000
25 BUSTAMI Rp135,000
26 MOH.SAHE Rp135,000
28 ARISKA YULIANTO, S.Kep.Ns Rp98,000
29 SITI HATIJAH, A.Md.Kep Rp98,000
30 SILFANA YULANDIA A, A.Md Rp98,000
31 MOHAMMAD HAIRURROZY, A.Md Rp98,000
32 YOGI SEPTIAN Rp98,000
33 ENNI Rp98,000
34 FIFIN Rp98,000
35 FIQA Rp98,000
36 FENDI Rp98,000
37 SUBAI Rp98,000
38 LINI Rp98,000
39 IFA Rp98,000
40 WIWIN Rp98,000
41 ARUM Rp98,000
42 LINA Rp98,000
43 SUKO Rp98,000
44 MAHDALI Rp98,000
45 MOHAMMAD SLAMET RIYADI Rp98,000
46 NURHASANAH Rp135,000
47 Rr. DEWI CAHYA Rp135,000
48 Hj. NOERUL H. Rp135,000
49 KHAIRUS SAMI'UL ULUM Rp135,000
50 HALIMATURRAHMAH Rp135,000
51 YENI P. Rp135,000
52 DEWI KURNIA PUTRI Rp135,000
53 FERIKA Rp135,000
54 DEWI WARDANI Rp135,000
55 MARIYATUL HAMIDA Rp135,000
56 NURUL KAMARIYAH Rp135,000
57 YULIA ROFIT Rp135,000
58 NOR HAFIFAH Rp135,000
59 NURUL FADJRIYAH Rp135,000
60 YUNI TRI MARDIANA Rp135,000
61 FARIDA Rp135,000
62 NANIK FITRIYAH Rp135,000
63 SETYO Rp135,000
64 ANI Rp98,000
65 BENY Rp98,000
66 SAKTIYANI Rp98,000
67 FEBRI Rp98,000
68 POSKESTREN PANEMPAN (4 org) Rp219,063
JUMLAH Rp8,450,063
Mengetahui

NIP. 19711030 200212 1 003
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
NERASI PUSKESMAS 2014 (JAN-NOP)
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
Pamekasan,
Bendahara
NIP. 19761024 200903 2 001
TANDA TERIMA JASA BIMBINGAN SISWA 2014 (JAN-NOP)
NO. PENERIMA JASA LANGSUNG (60%)

1 PEMBIMBING D3 Rp336,000
2 PEMBIMBING S1 Rp780,000
3 PEMBIMBING SLTA/LAB. Rp72,000
4 PEMBIMBING SLTA/SMK KESH. Rp450,000
Mengetahui

NIP. 19711030 200212 1 003
TIM JAPEL:
1. MOH. BURA 1.
5. Hj.TITIK PRASETYAWATI, S.Kep.Ns5.
7. DJUFFRI 7.
SWA 2014 (JAN-NOP)
TANDA TANGAN
1
2
3
4
Pamekasan,
Bendahara
NIP. 19761024 200903 2 001
TANDA TERIMA JASA TAK LANGSUNG PIMPINAN PUSKESMAS 2014 (JAN-NOP)
NO. NAMA JUMLAH TANDA TANGAN

1 dr. H.HENDARTO, M.Si Rp625,000 1
2 MOH. BURA Rp475,000 2
3 SOCHIBATUL ISLAMIYAH Rp465,000 3
4 DJUFFRI Rp475,000 4
5 ARISKA YULIANTO Rp175,000 5
6 SITI HATIJAH Rp340,000 6
JUMLAH Rp2,555,000
Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMIYAH

NIP. 19711030 200212 1 003 NIP. 19761024 200903 2 001
TIM JAPEL:
1. MOH. BURA 1.
5. Hj.TITIK PRASETYAWATI, S 5.
6. Hj.RINA PURWANTARI, SST6.
7. DJUFFRI 7.
Pamekasan,
Bendahara
NIP. 19761024 200903 2 001
RAWAT JALAN 5,021,744 3,766,308 1,255,436
KIR 1,710,000 1,282,500 427,500
LAB 480,000 360,000 120,000
GIGI 800,000 600,000 200,000
BIMBINGAN D3 224,000 168,000 56,000
BIMBINGAN S1 520,000 390,000 130,000
BIMBINGAN SLTA 480,000 360,000 120,000
BIMBINGAN SLTA AKPER 300,000 225,000 75,000
KHITAN 160,000 120,000 40,000
RWT INAP/UGD 1,014,800 761,100 253700
DESA 122,400
10,710,544 8,155,308 2,555,236
jasa tak lsg pos remun pimpinan pkm
425,873
JASA L
NO. NAMA
RAWAT JALAN KIR TINDAKAN MEDIK GIGI LABORATORIUM
1 dr. H. HENDARTO, M.SI Rp762,104 Rp399,000 Rp15,500
2 dr. DWI WIJONO Rp762,104 Rp399,000 Rp15,500
3 drg. R. SRI ROCHANI Rp350,000 Rp700,000
4 dr. TRI PUSPITA N. Rp762,104 Rp399,000 Rp15,500
5 MOH. BURA Rp202,569
6 TITIK PRASETYAWATI MR, S.Kep.Ns Rp324,519 Rp202,569 Rp15,500
7 RINA PURWANTARI, SST Rp313,859 Rp15,500
8 YAYUK SRI RAHAYU Rp313,859 Rp66,000
9 DJUFFRI Rp313,859 Rp202,569 Rp66,000
10 ABU MUTFARI, S.Kep.Ns Rp313,859 Rp45,000 Rp15,500
11 SUFIANSAH, S.Kep.Ns Rp313,859 Rp45,000 Rp15,500
12 DINA AINUN, A.Md.Kep Rp324,519 Rp202,569 Rp15,500
13 SOCHIBATUL I, A.Md.Kep Rp324,519 Rp202,569 Rp15,500
14 NURUR RAHMAH, A.Md.Kep Rp324,519 Rp202,569 Rp15,500
15 AMRI NUR AINI, A.Md.Kep Rp324,519 Rp202,569 Rp15,500
17 AYNUL LUTHFIY, A.Md.Kep Rp324,519 Rp202,569 Rp15,500
18 SUHARMIASIH, SST Rp250,000 Rp15,500
21 TUFFAH SALEH Rp125,544 Rp180,000
22 ENNY NURHAYATI, SKM
23 AMINULLAH Rp125,544 Rp66,000
25 BUSTAMI
26 MOH.SAHE Rp125,544 Rp180,000 Rp66,000
27 SRI SUSANTIN CH Rp125,544 Rp180,000 Rp66,000 Rp18,500
28 ARISKA YULIANTO, S.Kep.Ns Rp100,000 Rp80,000
29 SITI HATIJAH, A.Md.Kep Rp151,089 Rp80,000
30 SILFANA YULANDIA A, A.Md Rp100,000
31 MOHAMMAD HAIRURROZY, A.Md Rp75,326 Rp150,000
32 YOGI SEPTIAN Rp75,326 Rp20,000
33 ENNI
34 FIFIN
35 FIQA
36 FENDI
37 SUBAI
38 LINI
39 IFA
40 WIWIN
41 ARUM Rp75,326
42 LINA Rp75,326
43 SUKO Rp75,326
44 MAHDALI
45 MOHAMMAD SLAMET RIYADI
46 NURHASANAH
47 Rr. DEWI CAHYA
48 Hj. NOERUL H.
49 KHAIRUS SAMI'UL ULUM
50 HALIMATURRAHMAH
51 YENI P.
52 DEWI KURNIA PUTRI
53 FERIKA
54 DEWI WARDANI
55 MARIYATUL HAMIDA
56 NURUL KAMARIYAH
57 YULIA ROFIT
58 NOR HAFIFAH
59 NURUL FADJRIYAH
60 YUNI TRI MARDIANA
61 FARIDA
62 NANIK FITRIYAH
63 SETYO
64 ANI
65 BENY
66 SAKTIYANI
67 FEBRI
68 POSKESTREN PANEMPAN (4 org)
SETORAN PUSTU/POLINDES
Rp7,532,616 Rp3,990,121 Rp1,200,000 Rp720,000
JUMLAH
R
Mengetahui

NIP. 19711030 200212 1 003
TIM JAPEL:
1. MOH. BURA 1.
7. DJUFFRI 7.
TANDA TERIMA JASA PELAYANAN PUSKESMAS 2014 (JAN-NOP)
JASA LANGSUNG (60%)

BIMBINGAN D3 BIMBINGAN S1 BIMBINGAN SLTA/LAB. BIMBINGAN SLTA/SMK RAWAT INAP UGD KHITAN
Rp550,000
Rp800,000
Rp400,000
Rp780,000 Rp450,000
Rp336,000 Rp50,000
Rp70,000
Rp300,000 Rp30,000
Rp50,000
Rp72,000
Rp88,000
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp200,000 Rp26,250
Rp61,200
Rp30,000
Rp60,000
Rp336,000 Rp780,000 Rp72,000 Rp450,000 Rp4,059,200 Rp240,000
Rp19,379,937
JASA TAK LANGSUNG (40%)
JUMLAH KESELURUHAN TANDA TANGAN
POS REMUNERASI POS PIMPINAN PKM
Rp135,000 Rp625,000 Rp2,486,604 1
Rp135,000 Rp2,111,604 2
Rp135,000 Rp1,185,000 3
Rp135,000 Rp1,711,604 4
Rp135,000 Rp475,000 Rp812,569 5
Rp135,000 Rp1,907,588 6
Rp135,000 Rp850,359 7
Rp135,000 Rp584,859 8
Rp135,000 Rp475,000 Rp1,192,428 9
Rp135,000 Rp509,359 10
Rp135,000 Rp509,359 11
Rp135,000 Rp677,588 12
Rp135,000 Rp465,000 Rp1,142,588 13
Rp135,000 Rp677,588 14
Rp135,000 Rp677,588 15
Rp135,000 Rp465,000 16
Rp135,000 Rp677,588 17
Rp135,000 Rp400,500 18
Rp135,000 Rp315,000 19
Rp135,000 Rp337,569 20
Rp135,000 Rp440,544 21
Rp135,000 Rp135,000 22
Rp135,000 Rp376,544 23
Rp135,000 Rp607,000 24
Rp135,000 Rp135,000 25
Rp135,000 Rp506,544 26
Rp135,000 Rp525,044 27
Rp98,000 Rp175,000 Rp541,000 28
Rp98,000 Rp340,000 Rp669,089 29
Rp98,000 Rp198,000 30
Rp98,000 Rp323,326 31
Rp98,000 Rp193,326 32
Rp98,000 Rp324,250 33
Rp98,000 Rp324,250 34
Rp98,000 Rp324,250 35
Rp98,000 Rp324,250 36
Rp98,000 Rp324,250 37
Rp98,000 Rp324,250 38
Rp98,000 Rp324,250 39
Rp98,000 Rp324,250 40
Rp98,000 Rp173,326 41
Rp98,000 Rp173,326 42
Rp98,000 Rp173,326 43
Rp98,000 Rp159,200 44
Rp98,000 Rp128,000 45
Rp135,000 Rp135,000 46
Rp135,000 Rp135,000 47
Rp135,000 Rp135,000 48
Rp135,000 Rp135,000 49
Rp135,000 Rp135,000 50
Rp135,000 Rp135,000 51
Rp135,000 Rp135,000 52
Rp135,000 Rp135,000 53
Rp135,000 Rp135,000 54
Rp135,000 Rp135,000 55
Rp135,000 Rp135,000 56
Rp135,000 Rp135,000 57
Rp135,000 Rp195,000 58
Rp135,000 Rp135,000 59
Rp135,000 Rp135,000 60
Rp135,000 Rp135,000 61
Rp135,000 Rp135,000 62
Rp135,000 Rp135,000 63
Rp98,000 Rp98,000 64
Rp98,000 Rp98,000 65
Rp98,000 Rp98,000 66
Rp98,000 Rp98,000 67
Rp219,063 Rp219,063 68
Rp1,509,000
Rp8,450,063 Rp2,555,000 Rp31,894,000
Rp11,005,063
Pamekasan,
Bendahara
NIP. 19761024 200903 2 001
JAN-OKT NOP.
KONSUL/RAWAT JALAN 15,455,000 211,040
BP 13,600,000
POLINDES/PUSTU 1,855,000
KIR 4,600,000 1,100,000
GIGI 2,200,000 142,000
LAB. 1,350,000 131,960
D3 650,000
S1 1,350,000
SLTA/LAB. 140,000
SMK KESH. 790,000
KHITAN 450,000
26,985,000 1,585,000
(-) 1,600,000
(=) 25,385,000
26,970,000
RWT INAP(UGD+KIA) 5,074,000
TOTAL 32,044,000
TANDA TERIMA JASA PELAYANAN NON MASKIN (J

60%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
Pemeriksaan Rawat Jalan Pertama Rp 9,584,100 Rp 6,389,400
1 dr. H. HENDARTO, M.SI Rp 2,396,025
2 dr. DWI WIJONO Rp 2,396,025
3 drg. R. SRI ROCHANI Rp 2,396,025
4 dr. TRI PUSPITA N. Rp 2,396,025
5 MOH. BURA
6 TITIK PRASETYAWATI MR, S.Kep.Ns Rp 220,324
7 RINA PURWANTARI, SST Rp 220,324
8 YAYUK SRI RAHAYU
9 DJUFFRI
10 ABU MUTFARI, S.Kep.Ns Rp 220,324
11 SUFIANSAH, S.Kep.Ns Rp 220,324
12 DINA AINUN, A.Md.Kep Rp 220,324
13 SOCHIBATUL I, A.Md.Kep Rp 220,324
14 NURUR RAHMAH, A.Md.Kep Rp 220,324
15 AMRI NUR AINI, A.Md.Kep Rp 220,324
16 HEPIE SEPTIANI, A.Md.Kep Rp 220,324
17 AYNUL LUTHFIY, A.Md.Kep Rp 220,324
18 SUHARMIASIH, SST Rp 220,324
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
24 INDRI WIDIASTUTI, A.Md
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH Rp 220,324
29 Rr. DEWI CAHYA Rp 220,324
30 Hj. NOERUL H. Rp 220,324
31 KHAIRUS SAMI'UL ULUM Rp 220,324
32 HALIMATURRAHMAH Rp 220,324
33 YENI P. Rp 220,324
34 DEWI KURNIA PUTRI Rp 220,324
35 FERIKA Rp 220,324
36 DEWI WARDANI Rp 220,324
37 MARIYATUL HAMIDA Rp 220,324
38 NURUL KAMARIYAH Rp 220,324
39 YULIA ROFIT Rp 220,324
40 NOR HAFIFAH Rp 220,324
41 NURUL FADJRIYAH Rp 220,324
42 YUNI TRI MARDIANA Rp 220,324
43 FARIDA Rp 220,324
44 NANIK FITRIYAH Rp 220,324
45 SETYO Rp 220,324
JUMLAH Rp 9,584,100 Rp 6,389,396
KEPALA PUSKESMAS TEJA

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003
YANAN NON MASKIN (JAMKESDA BULAN SEPTEMBER s/d DESEMBER 2014)
PEMBERI PELAYANAN TAK LANGSUNG 40%

JUMLAH PAJAK
POS REMUNERASI PIMPINAN
PUSKESMAS PUSKESMAS
Rp 7,986,750 Rp 2,662,250
Rp 177,502 Rp 1,996,688 Rp 4,570,215 Rp 228,511
Rp 177,483 Rp 2,573,508 Rp 386,026
Rp 177,483 Rp 2,573,508 Rp 386,026
Rp 177,483 Rp 2,573,508 Rp 128,675
Rp 177,483 Rp 665,563 Rp 843,046 Rp 42,152
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 177,483 Rp 8,874
Rp 177,483 Rp 177,483
Rp 177,483 Rp 177,483
Rp 177,483 Rp 177,483
Rp 177,483 Rp 177,483
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807 Rp 19,890
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 177,483 Rp 397,807
Rp 7,986,754 Rp 2,662,250 Rp 26,622,500 Rp 1,412,523
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
14)
JUMLAH TOTAL TTD
Rp 4,341,704 1
Rp 2,187,482 2
Rp 2,187,482 3
Rp 2,444,833 4
Rp 800,893 5
Rp 377,917 6
Rp 377,917 7
Rp 168,609 8
Rp 168,609 9
Rp 377,917 10
Rp 377,917 11
Rp 397,807 12
Rp 397,807 13
Rp 397,807 14
Rp 397,807 15
Rp 397,807 16
Rp 397,807 17
Rp 377,917 18
Rp 168,609 19
Rp 168,609 20
Rp 168,609 21
Rp 168,609 22
Rp 168,609 23
Rp 177,483 24
Rp 177,483 25
Rp 177,483 26
Rp 177,483 27
Rp 377,917 28
Rp 397,807 29
Rp 377,917 30
Rp 397,807 31
Rp 397,807 32
Rp 397,807 33
Rp 397,807 34
Rp 397,807 35
Rp 397,807 36
Rp 397,807 37
Rp 377,917 38
Rp 377,917 39
Rp 397,807 40
Rp 397,807 41
Rp 397,807 42
Rp 397,807 43
Rp 397,807 44
Rp 397,807 45
Rp 25,209,977
TANDA TERIMA JASA PELAYANAN NON MASKIN (JAM

60%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
Pemeriksaan Rawat Jalan Ketiga Rp 3,545,100 Rp 2,363,400
1 dr. H. HENDARTO, M.SI Rp 886,262
2 dr. DWI WIJONO Rp 886,275
3 drg. R. SRI ROCHANI Rp 886,275
4 dr. TRI PUSPITA N. Rp 886,275
5 MOH. BURA
6 TITIK PRASETYAWATI MR, S.Kep.Ns Rp 81,497
7 RINA PURWANTARI, SST Rp 81,497
8 YAYUK SRI RAHAYU
9 DJUFFRI
10 ABU MUTFARI, S.Kep.Ns Rp 81,497
11 SUFIANSAH, S.Kep.Ns Rp 81,497
12 DINA AINUN, A.Md.Kep Rp 81,497
13 SOCHIBATUL I, A.Md.Kep Rp 81,497
14 NURUR RAHMAH, A.Md.Kep Rp 81,497
15 AMRI NUR AINI, A.Md.Kep Rp 81,497
17 AYNUL LUTHFIY, A.Md.Kep Rp 81,497
18 SUHARMIASIH, SST Rp 81,497
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH Rp 81,497
30 Hj. NOERUL H. Rp 81,497
33 YENI P. Rp 81,497
35 FERIKA Rp 81,497
36 DEWI WARDANI Rp 81,497
38 NURUL KAMARIYAH Rp 81,497
39 YULIA ROFIT Rp 81,497
40 NOR HAFIFAH Rp 81,497
41 NURUL FADJRIYAH Rp 81,497
42 YUNI TRI MARDIANA Rp 81,497
43 FARIDA Rp 81,497
44 NANIK FITRIYAH Rp 81,497
45 SETYO Rp 81,497
JUMLAH Rp 3,545,087 Rp 2,363,413

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003
NAN NON MASKIN (JAMKESDA BULAN SEPTEMBER s/d DESEMBER 2014)
PEMBERI PELAYANAN TAK LANGSUNG

40%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 2,954,250 Rp 984,750
Rp 65,650 Rp 738,563 Rp 1,690,475 Rp 84,524
Rp 65,650 Rp 951,925 Rp 142,789
Rp 65,650 Rp 951,925 Rp 142,789
Rp 65,650 Rp 951,925 Rp 47,596
Rp 65,650 Rp 246,188 Rp 311,838 Rp 15,592
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 65,650 Rp 3,283
Rp 65,650 Rp 65,650
Rp 65,650 Rp 65,650
Rp 65,650 Rp 65,650
Rp 65,650 Rp 65,650
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147 Rp 7,357
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 65,650 Rp 147,147
Rp 2,954,250 Rp 984,750 Rp 9,847,500 Rp 522,483
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 1,605,951 1
Rp 809,136 2
Rp 809,136 3
Rp 904,329 4
Rp 296,246 5
Rp 139,789 6
Rp 139,790 7
Rp 62,368 8
Rp 62,368 9
Rp 139,790 10
Rp 139,790 11
Rp 147,147 12
Rp 147,147 13
Rp 147,147 14
Rp 147,147 15
Rp 147,147 16
Rp 147,147 17
Rp 139,790 18
Rp 62,368 19
Rp 62,368 20
Rp 62,368 21
Rp 62,368 22
Rp 62,368 23
Rp 65,650 24
Rp 65,650 25
Rp 65,650 26
Rp 65,650 27
Rp 139,790 28
Rp 147,147 29
Rp 139,790 30
Rp 147,147 31
Rp 147,147 32
Rp 147,147 33
Rp 147,147 34
Rp 147,147 35
Rp 147,147 36
Rp 147,147 37
Rp 139,790 38
Rp 139,790 39
Rp 147,147 40
Rp 147,147 41
Rp 147,147 42
Rp 147,147 43
Rp 147,147 44
Rp 147,147 45
Rp 9,325,017

80%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
RAWAT INAP I Rp 1,900,800 Rp 1,267,200
5 MOH. BURA
8 YAYUK SRI RAHAYU
9 DJUFFRI
16 HEPIE SEPTIANI, A.Md.Kep Rp 1,267,200
18 SUHARMIASIH, SST
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH
29 Rr. DEWI CAHYA
30 Hj. NOERUL H.
32 HALIMATURRAHMAH
33 YENI P.
35 FERIKA
36 DEWI WARDANI
37 MARIYATUL HAMIDA
38 NURUL KAMARIYAH
39 YULIA ROFIT
40 NOR HAFIFAH
41 NURUL FADJRIYAH
43 FARIDA
44 NANIK FITRIYAH
45 SETYO
JUMLAH Rp 1,900,800 Rp 1,267,200

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003

20%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 594,000 Rp 198,000
Rp 13,200 Rp 148,500 Rp 795,300 Rp 39,765
Rp 13,200 Rp 646,800 Rp 97,020
Rp 13,200 Rp 13,200 Rp 1,980
Rp 13,200 Rp 646,800 Rp 32,340
Rp 13,200 Rp 49,500 Rp 62,700 Rp 3,135
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 1,280,400
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200 Rp 660
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 13,200 Rp 13,200
Rp 594,000 Rp 198,000 Rp 3,960,000 Rp 184,800
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 755,535 1
Rp 549,780 2
Rp 11,220 3
Rp 614,460 4
Rp 59,565 5
Rp 12,540 6
Rp 12,540 7
Rp 12,540 8
Rp 12,540 9
Rp 12,540 10
Rp 12,540 11
Rp 13,200 12
Rp 13,200 13
Rp 13,200 14
Rp 13,200 15
Rp 1,280,400 16
Rp 13,200 17
Rp 12,540 18
Rp 12,540 19
Rp 12,540 20
Rp 12,540 21
Rp 12,540 22
Rp 12,540 23
Rp 13,200 24
Rp 13,200 25
Rp 13,200 26
Rp 13,200 27
Rp 12,540 28
Rp 13,200 29
Rp 12,540 30
Rp 13,200 31
Rp 13,200 32
Rp 13,200 33
Rp 13,200 34
Rp 13,200 35
Rp 13,200 36
Rp 13,200 37
Rp 12,540 38
Rp 12,540 39
Rp 13,200 40
Rp 13,200 41
Rp 13,200 42
Rp 13,200 43
Rp 13,200 44
Rp 13,200 45
Rp 3,775,200

80%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
RAWAT INAP II Rp 537,600 Rp 358,400
5 MOH. BURA
8 YAYUK SRI RAHAYU
9 DJUFFRI
18 SUHARMIASIH, SST
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH
29 Rr. DEWI CAHYA
30 Hj. NOERUL H.
32 HALIMATURRAHMAH
33 YENI P.
35 FERIKA
36 DEWI WARDANI
37 MARIYATUL HAMIDA
38 NURUL KAMARIYAH
39 YULIA ROFIT
40 NOR HAFIFAH
41 NURUL FADJRIYAH
43 FARIDA
44 NANIK FITRIYAH
45 SETYO
JUMLAH Rp 537,600 Rp 358,400

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003

20%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 168,000 Rp 56,000
Rp 3,748 Rp 42,000 Rp 224,948 Rp 11,247
Rp 3,733 Rp 182,933 Rp 27,440
Rp 3,733 Rp 3,733 Rp 560
Rp 3,733 Rp 182,933 Rp 9,147
Rp 3,733 Rp 14,000 Rp 17,733 Rp 887
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 362,133
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733 Rp 187
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 3,733 Rp 3,733
Rp 168,000 Rp 56,000 Rp 1,120,000 Rp 52,267
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 213,701 1
Rp 155,493 2
Rp 3,173 3
Rp 173,786 4
Rp 16,846 5
Rp 3,546 6
Rp 3,546 7
Rp 3,546 8
Rp 3,546 9
Rp 3,546 10
Rp 3,546 11
Rp 3,733 12
Rp 3,733 13
Rp 3,733 14
Rp 3,733 15
Rp 362,133 16
Rp 3,733 17
Rp 3,546 18
Rp 3,546 19
Rp 3,546 20
Rp 3,546 21
Rp 3,546 22
Rp 3,546 23
Rp 3,733 24
Rp 3,733 25
Rp 3,733 26
Rp 3,733 27
Rp 3,546 28
Rp 3,733 29
Rp 3,546 30
Rp 3,733 31
Rp 3,733 32
Rp 3,733 33
Rp 3,733 34
Rp 3,733 35
Rp 3,733 36
Rp 3,733 37
Rp 3,546 38
Rp 3,546 39
Rp 3,733 40
Rp 3,733 41
Rp 3,733 42
Rp 3,733 43
Rp 3,733 44
Rp 3,733 45
Rp 1,067,733

80%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
RAWAT INAP III Rp 307,200 Rp 204,800
5 MOH. BURA
8 YAYUK SRI RAHAYU
9 DJUFFRI
18 SUHARMIASIH, SST
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH
29 Rr. DEWI CAHYA
30 Hj. NOERUL H.
32 HALIMATURRAHMAH
33 YENI P.
35 FERIKA
36 DEWI WARDANI
37 MARIYATUL HAMIDA
38 NURUL KAMARIYAH
39 YULIA ROFIT
40 NOR HAFIFAH
41 NURUL FADJRIYAH
43 FARIDA
44 NANIK FITRIYAH
45 SETYO
JUMLAH Rp 307,200 Rp 204,800

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003

20%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 96,000 Rp 32,000
Rp 2,148 Rp 24,000 Rp 128,548 Rp 6,427
Rp 2,133 Rp 104,533 Rp 15,680
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 104,533 Rp 5,227
Rp 2,133 Rp 8,000 Rp 10,133 Rp 507
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 206,933
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 96,000 Rp 32,000 Rp 640,000 Rp 29,867
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 122,121 1
Rp 88,853 2
Rp 1,813 3
Rp 99,306 4
Rp 9,626 5
Rp 2,026 6
Rp 2,026 7
Rp 2,026 8
Rp 2,026 9
Rp 2,026 10
Rp 2,026 11
Rp 2,133 12
Rp 2,133 13
Rp 2,133 14
Rp 2,133 15
Rp 206,933 16
Rp 2,133 17
Rp 2,026 18
Rp 2,026 19
Rp 2,026 20
Rp 2,026 21
Rp 2,026 22
Rp 2,026 23
Rp 2,133 24
Rp 2,133 25
Rp 2,133 26
Rp 2,133 27
Rp 2,026 28
Rp 2,133 29
Rp 2,026 30
Rp 2,133 31
Rp 2,133 32
Rp 2,133 33
Rp 2,133 34
Rp 2,133 35
Rp 2,133 36
Rp 2,133 37
Rp 2,026 38
Rp 2,026 39
Rp 2,133 40
Rp 2,133 41
Rp 2,133 42
Rp 2,133 43
Rp 2,133 44
Rp 2,133 45
Rp 610,133

85%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
PERSALINAN I Rp - Rp 11,666,250
1 dr. H. HENDARTO, M.SI
2 dr. DWI WIJONO
5 MOH. BURA
8 YAYUK SRI RAHAYU
9 DJUFFRI
18 SUHARMIASIH, SST
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH
29 Rr. DEWI CAHYA Rp 1,220,750
30 Hj. NOERUL H.
31 KHAIRUS SAMI'UL ULUM Rp 2,020,750
32 HALIMATURRAHMAH Rp 5,283,250
33 YENI P.
34 DEWI KURNIA PUTRI Rp 2,470,750
35 FERIKA
36 DEWI WARDANI
37 MARIYATUL HAMIDA
38 NURUL KAMARIYAH
39 YULIA ROFIT
40 NOR HAFIFAH
41 NURUL FADJRIYAH
44 NANIK FITRIYAH
45 SETYO
JUMLAH Rp - Rp 11,666,250

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003

15%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 1,544,063 Rp 514,688
Rp 2,148 Rp 386,016 Rp 388,164 Rp 19,408
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 128,672 Rp 130,805 Rp 6,540
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 1,222,883
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,022,883
Rp 2,133 Rp 5,285,383
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,472,883
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 672,883
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 96,000 Rp 514,688 Rp 12,276,938 Rp 28,401
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 368,755 1
Rp 1,813 2
Rp 1,813 3
Rp 2,026 4
Rp 124,265 5
Rp 2,026 6
Rp 2,026 7
Rp 2,026 8
Rp 2,026 9
Rp 2,026 10
Rp 2,026 11
Rp 2,133 12
Rp 2,133 13
Rp 2,133 14
Rp 2,133 15
Rp 2,133 16
Rp 2,133 17
Rp 2,026 18
Rp 2,026 19
Rp 2,026 20
Rp 2,026 21
Rp 2,026 22
Rp 2,026 23
Rp 2,133 24
Rp 2,133 25
Rp 2,133 26
Rp 2,133 27
Rp 2,026 28
Rp 1,222,883 29
Rp 2,026 30
Rp 2,022,883 31
Rp 5,285,383 32
Rp 2,133 33
Rp 2,472,883 34
Rp 2,133 35
Rp 2,133 36
Rp 2,133 37
Rp 2,026 38
Rp 2,026 39
Rp 2,133 40
Rp 2,133 41
Rp 2,133 42
Rp 672,883 43
Rp 2,133 44
Rp 2,133 45
Rp 12,248,536

85%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
PERSALINAN III Rp - Rp 2,677,500
2 dr. DWI WIJONO
5 MOH. BURA
8 YAYUK SRI RAHAYU
9 DJUFFRI
18 SUHARMIASIH, SST
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH
30 Hj. NOERUL H.
33 YENI P. Rp 382,500
35 FERIKA
36 DEWI WARDANI
38 NURUL KAMARIYAH
39 YULIA ROFIT
40 NOR HAFIFAH
41 NURUL FADJRIYAH
44 NANIK FITRIYAH
45 SETYO

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003

15%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 354,375 Rp 118,125
Rp 2,148 Rp 88,594 Rp 90,742 Rp 4,537
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 29,531 Rp 31,664 Rp 1,583
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 384,633
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 384,633
Rp 2,133 Rp 384,633
Rp 2,133 Rp 384,633
Rp 2,133 Rp 384,633
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 384,633
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 384,633
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 96,000 Rp 118,125 Rp 2,891,625 Rp 8,573
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 86,205 1
Rp 1,813 2
Rp 1,813 3
Rp 2,026 4
Rp 30,081 5
Rp 2,026 6
Rp 2,026 7
Rp 2,026 8
Rp 2,026 9
Rp 2,026 10
Rp 2,026 11
Rp 2,133 12
Rp 2,133 13
Rp 2,133 14
Rp 2,133 15
Rp 2,133 16
Rp 2,133 17
Rp 2,026 18
Rp 2,026 19
Rp 2,026 20
Rp 2,026 21
Rp 2,026 22
Rp 2,026 23
Rp 2,133 24
Rp 2,133 25
Rp 2,133 26
Rp 2,133 27
Rp 2,026 28
Rp 384,633 29
Rp 2,026 30
Rp 384,633 31
Rp 384,633 32
Rp 384,633 33
Rp 384,633 34
Rp 2,133 35
Rp 2,133 36
Rp 384,633 37
Rp 2,026 38
Rp 2,026 39
Rp 2,133 40
Rp 2,133 41
Rp 2,133 42
Rp 384,633 43
Rp 2,133 44
Rp 2,133 45
Rp 2,883,052

85%
KEPERAWATAN/PR
DOKTER
OFESI LAIN
PERSALINAN II Rp - Rp 2,295,000
2 dr. DWI WIJONO
5 MOH. BURA
8 YAYUK SRI RAHAYU
9 DJUFFRI
18 SUHARMIASIH, SST Rp 1,147,500
19 A.P. NURHAYATI
20 KUSNO RIADI
21 TUFFAH SALEH
23 AMINULLAH
25 BUSTAMI
26 MOH.SAHE
27 SRI SUSANTIN CH
28 NURHASANAH
29 Rr. DEWI CAHYA
30 Hj. NOERUL H.
32 HALIMATURRAHMAH Rp 1,147,500
33 YENI P.
35 FERIKA
36 DEWI WARDANI
37 MARIYATUL HAMIDA
38 NURUL KAMARIYAH
39 YULIA ROFIT
40 NOR HAFIFAH
41 NURUL FADJRIYAH
43 FARIDA
44 NANIK FITRIYAH
45 SETYO

KABUPATEN PAMEKASAN
Dr.H.HENDARTO,M.Si
NIP.19711030 200212 1 003

15%
JUMLAH PAJAK
PUSKESMAS PUSKESMAS
Rp 303,750 Rp 101,250
Rp 2,148 Rp 75,938 Rp 78,086 Rp 3,904
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 2,133 Rp 320
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 25,313 Rp 27,446 Rp 1,372
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 1,149,633 Rp 57,482
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 1,149,633
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133 Rp 107
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 2,133 Rp 2,133
Rp 96,000 Rp 101,250 Rp 2,492,250 Rp 65,105
Pamekasan,
BENDAHARA JKN
NIP. 19761024 200903 2 001
2014)
JUMLAH TOTAL TTD
Rp 74,181 1
Rp 1,813 2
Rp 1,813 3
Rp 2,026 4
Rp 26,073 5
Rp 2,026 6
Rp 2,026 7
Rp 2,026 8
Rp 2,026 9
Rp 2,026 10
Rp 2,026 11
Rp 2,133 12
Rp 2,133 13
Rp 2,133 14
Rp 2,133 15
Rp 2,133 16
Rp 2,133 17
Rp 1,092,151 18
Rp 2,026 19
Rp 2,026 20
Rp 2,026 21
Rp 2,026 22
Rp 2,026 23
Rp 2,133 24
Rp 2,133 25
Rp 2,133 26
Rp 2,133 27
Rp 2,026 28
Rp 2,133 29
Rp 2,026 30
Rp 2,133 31
Rp 1,149,633 32
Rp 2,133 33
Rp 2,133 34
Rp 2,133 35
Rp 2,133 36
Rp 2,133 37
Rp 2,026 38
Rp 2,026 39
Rp 2,133 40
Rp 2,133 41
Rp 2,133 42
Rp 2,133 43
Rp 2,133 44
Rp 2,133 45
Rp 2,427,146

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NO.

NAMA JUMLAH UANG

Pemeriksaan Rawat Jalan BP Rp 2,804,820

Pemeriksaan Kesehatan Rp 2,163,840

PEMBERI PELAYANAN LANGSUNG

Tindakan Medik Gigi Rp 776,160

PEMBERI PELAYANAN LANGSUNG

Pemeriksaan Lab. Sederhana Rp 136,080

PEMBERI PELAYANAN LANGSUNG

Praktek Klinik/Manajemen PKM D3 Rp 131,040

Pemeriksaan Umum Rawat Jalan UGD (khitan) 0

PEMBERI PELAYANAN LANGSUNG

Pemeriksaan Rawat Inap Rp 2,627,520

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

Pemeriksaan Rawat Jalan BP Rp 1,869,880

Pemeriksaan Kesehatan Rp 2,163,840

PEMBERI PELAYANAN LANGSUNG

Tindakan Medik Gigi Rp 776,160

PEMBERI PELAYANAN LANGSUNG

Pemeriksaan Lab. Sederhana Rp 136,080

PEMBERI PELAYANAN LANGSUNG

Praktek Klinik/Manajemen PKM D3 Rp 131,040

Pemeriksaan Umum Rawat Jalan UGD (khitan) 0

PEMBERI PELAYANAN LANGSUNG

Pemeriksaan Rawat Inap Rp 2,627,520

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

ERI PELAYANAN LANGSUNG PEMBERI PELAYANAN TAK

JASA TAK LANGSUNG (40%) TOTAL

NO. NAMA FEBRUARI

dr. H. Nanang Suyanto, M.Si

NO. NAMA FEBRUARI

dr. H. Nanang Suyanto, M.Si

NO. NAMA MARET

dr. H. Nanang Suyanto, M.Si

Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMIYAH

NO. NAMA JUMLAH PENERIMAAN

1 dr. NANANG SUYANTO, M.SI Rp44,900

dr. NANANG SUYANTO, M.SI SOCHIBATUL ISLAMIYAH

dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLAMIYAH

1 19,111 860,000 64,500

NO. NAMA JUMLAH PENERIMAAN

Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMI

NO. NAMA JUMLAH PENERIMAAN

dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLAMI

NO. NAMA JUMLAH PENERIMAAN

Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLAMIY

NO. NAMA JUMLAH PENERIMAAN

dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLAMIY

NO. NAMA SLTA S1

Dr. H. HENDARTO, M.Si. SOCHIBATUL ISLA

NO. NAMA SLTA S1

dr. H. NANANG SUYANTO, M.Si SOCHIBATUL ISLA

JUMLAH TANDA TANGAN 60 40

JUMLAH TANDA TANGAN 60 40

NO. NAMA JUMLAH PENERIMAAN

Dr. H. HENDARTO, M.Si. SOCHIBATUL IS

NO. NAMA JUMLAH PENERIMAAN

dr. H. NANANG SUYANTO, M.Si SOCHIBATUL IS

NO. NAMA JUMLAH PENERIMAAN