Kode Rekening : 1.02.1.02.01.16.18.5.2.2.29.

01 DAFTAR :

Tahun : 2016

Variabel Ketenagaan Kehadiran Presentas

Jlh Total
Jlh Point i Jasa Pelayanan Yang
No Nama / Nip / Nrptt Gol Pendidikan Jabatan Keseluru
Jenis Variabel Kehadira Diterima
Masa Beban Jlh Hari Jlh Hari han Point
Ketenagaa n
Kerja Kerja Masuk Kerja
n

dr.Heppy Maulizar A / Kepala

1
197903092014091001
III/b S1 Kedokteran Puskesmas
150 0 100 20 22 250 91 227 Rp 3,450,229

Irwansyah / K.a Tata

2
196003031986031005
III/b SMA 25 25 30 22 22 80 100 80 Rp 1,214,481
Usaha
dr.Indrieani /
3
198408222014092001
III/b S1 Kedokteran K.a Poli 150 0 10 20 22 160 91 145 Rp 2,208,147

Zulkifli.SKM / Petugas
4
196409081988031004
III/d S1 Kes Masy 80 25 10 22 22 115 100 115 Rp 1,745,816
Promkes
Bendahara
5 Samuil / 196607121989111001 III/d SPK 50 25 0 21 22 75 95 72 Rp 1,086,822
Rutin
Abdul Manan.AMK /
6
197103251923031002
III/d D-III Kesehatan K.a Pustu 60 20 10 22 22 90 100 90 Rp 1,366,291

7 Sarinem / 197409211993032002 III/c SPK K.a Pustu 50 20 10 22 22 80 100 80 Rp 1,214,481

Muslem.SKM /
8
197812302007011002
III/b S1 Kes Masy Survelen 80 15 10 22 22 105 100 105 Rp 1,594,006

Maizaharina.S.Kep /
9
198008142001122001
III/b S1 Kep K.a Apotik 80 10 10 22 22 100 100 100 Rp 1,518,101

Nurlaila.SKM /
10
197704052014062003
III/a S1 Kes Masy K.a Gizi 80 10 10 21 22 100 95 95 Rp 1,449,096
 Muhajir.S.Kep /
11
198703132010031002
III/a S1 Kep UKS 80 5 10 21 22 95 95 91 Rp 1,376,641

Merida.Am.Keb /
12
197706202007012002
III/a D-III Kebidanan Koor Bides 60 15 10 21 22 85 95 81 Rp 1,231,732

Dahliana.Am.Keb / Pengelola
13
198803122010032001
III/a D-III Kebidanan 60 5 0 22 22 65 100 65 Rp 986,766
BOK
Ratnawati.Am.Keb /
14
197702202008012002
II/d D-III Kebidanan Pengelola JKN 60 15 50 22 22 125 100 125 Rp 1,897,626

Salmiati.Am.Keb /
15
197812312008012006
II/d D-III Kebidanan Pengelola KB 60 15 10 21 22 85 95 81 Rp 1,231,732

Saifullah.Amd.Kl / Petugas
16 II/d D-III Kesling 60 5 10 21 22 75 95 72 Rp 1,086,822
197908072010031001 Kesling
Idaryanti.Am.Keb / Koor
17 II/d D-III Kebidanan 60 15 10 22 22 85 100 85 Rp 1,290,386
197701012008012003 Posyandu
Yuliana.Am.Keb /
18
197707262007012001
II/d D-III Kebidanan K.a Poli KIA 60 15 10 22 22 85 100 85 Rp 1,290,386

M.Zia Ulhaq,AMd.Kep / Petugas

19 II/c D-III Kesehatan 60 5 10 20 22 75 91 68 Rp 1,035,069
198808262009041001 Keswa
Herlia Esofa.AMK / Petugas
20
198302012014062002
II/c D-III Kesehatan 60 10 10 18 22 80 82 65 Rp 993,666
SP2TP
Faisal.A.Md.FARMA /
21
197908052014061003
II/c D-III Farmasi Staf Apotik 60 10 0 22 22 70 100 70 Rp 1,062,671

Nurhayati.A.Md.AK /
22
198012012014062008
II/c D-III Analis K.a Poli LAB 60 10 10 22 22 80 100 80 Rp 1,214,481

Boihaki.Am.Kg /
23
197805032014061004
II/c D-III Kes Gigi K.a Poli Gigi 60 10 10 20 22 80 91 73 Rp 1,104,073

Martunis.AMK /
24
197908082014061002
II/c D-III Kesehatan K.a UGD 60 10 10 22 22 80 100 80 Rp 1,214,481

Fauziani.AMK /
25
197811152014062003
II/c D-III Kesehatan Petugas Diare 60 10 10 21 22 80 95 76 Rp 1,159,277
 Suryani Idris /
26
197504052007012002
II/b SPK Staf Pustu 50 15 0 22 22 65 100 65 Rp 986,766

Amiruddin / Pengelola
27
197302102008011001
II/b SMA 25 15 10 22 22 50 100 50 Rp 759,050
Barang

28 Junida / 198505062014062002 II/a SPK K.a Imunisasi 50 5 10 3 22 65 14 9 Rp 134,559

Salahuddin / Petugas
29
198402232014061001
II/a SPK 50 10 10 21 22 70 95 67 Rp 1,014,367
Malaria
M.Ali Usman /
30
195812311979011018
I/c SMP K.a Kartu 25 25 10 9 22 60 41 25 Rp 372,625

Sachara.Am.Keb /
31 D-III Kebidanan Bides 60 0 0 8 22 60 36 22 Rp 331,222
01.4.04892001
Nuraini.Am.Kb /
32
01.4.350240011
D-III Kebidanan Bides 60 0 0 0 22 60 0 0 Rp -

Sri Dahniar.Am.Keb /
33 D-III Kebidanan Bides 60 0 0 7 22 60 32 19 Rp 289,819
01.4.3502318
Nurul Aflah.Amd.Keb /
34
01.4.3502420
D-III Kebidanan Bides 60 0 0 8 22 60 36 22 Rp 331,222

Mastura.Am.Keb /
35 D-III Kebidanan Bides 60 0 0 8 22 60 36 22 Rp 331,222
01.4.3502386

36 Elisah.Am.Keb / 01.4.3502211 D-III Kebidanan Bides 60 0 0 7 22 60 32 19 Rp 289,819

Mawarni.Amd.Keb /
37 D-III Kebidanan Bides 60 0 0 0 22 60 0 0 Rp -
01.4.024787

38 Dewi Susana.AMK D-III Kesehatan Bakti Murni 60 0 0 10 22 60 45 27 Rp 414,028

39 Eva Yuliana.AMK D-III Kesehatan Bakti Murni 60 0 0 13 22 60 59 35 Rp 538,236

40 Marliah SPK Bakti Murni 50 0 0 13 22 50 59 30 Rp 448,530

41 Nurwahidah.AMK D-III Kesehatan Bakti Murni 60 0 0 13 22 60 59 35 Rp 538,236

42 Saifullah.AMK D-III Kesehatan Bakti Murni 60 0 0 11 22 60 50 30 Rp 455,430

43 Sri Wahyuni SMA Honorer 25 0 0 13 22 25 59 15 Rp 224,265

44 Suryani.Amd.Keb D-III Kebidanan Honorer 60 0 0 10 22 60 45 27 Rp 414,028

JUMLAH 2826 Rp 42,896,700

Mengetahui :
Kepala Puskesmas Langkahan

dr.Heppy Maulizar Andrean

Nip. 19790309 201409 1 001
PEMBAYARAN JASA PELAYANAN KAPITASI JKN TENAGA MEDIS,PARAMEDIS DAN NON PARAMEDIS PUSKESMAS LANGKAHAN UNTUK BULAN
NOVEMBER TAHUN 2016

Jlh Dana Yang

PPH Zakat Infaq Jlh Dana Yang Diterima Tanda Tangan
Dipotong

Rp 172,511 Rp - Rp 34,502 Rp 207,014 Rp 3,243,215 1

Rp 60,724 Rp 30,362 Rp - Rp 91,086 Rp 1,123,395 2

Rp 110,407 Rp - Rp 22,081 Rp 132,489 Rp 2,075,658 3

Rp 87,291 Rp 43,645 Rp - Rp 130,936 Rp 1,614,880 4

Rp 54,341 Rp 27,171 Rp - Rp 81,512 Rp 1,005,311 5

Rp 68,315 Rp 34,157 Rp - Rp 102,472 Rp 1,263,819 6

Rp 60,724 Rp 30,362 Rp - Rp 91,086 Rp 1,123,395 7

Rp 79,700 Rp - Rp 15,940 Rp 95,640 Rp 1,498,366 8

Rp 75,905 Rp - Rp 15,181 Rp 91,086 Rp 1,427,015 9

Rp 72,455 Rp - Rp 14,491 Rp 86,946 Rp 1,362,150 10

Rp 68,832 Rp - Rp 13,766 Rp 82,598 Rp 1,294,043 11

Rp 61,587 Rp - Rp 12,317 Rp 73,904 Rp 1,157,828 12

Rp 49,338 Rp - Rp 9,868 Rp 59,206 Rp 927,560 13

Rp - ### Rp 18,976 Rp 18,976 Rp 1,878,650 14

Rp - ### Rp 12,317 Rp 12,317 Rp 1,219,415 15

Rp - ### Rp 10,868 Rp 10,868 Rp 1,075,954 16

Rp - ### Rp 12,904 Rp 12,904 Rp 1,277,482 17

Rp - ### Rp 12,904 Rp 12,904 Rp 1,277,482 18

Rp - ### Rp 10,351 Rp 10,351 Rp 1,024,718 19

Rp - ### Rp 9,937 Rp 9,937 Rp 983,729 20

Rp - ### Rp 10,627 Rp 10,627 Rp 1,052,044 21

Rp - ### Rp 12,145 Rp 12,145 Rp 1,202,336 22

Rp - ### Rp 11,041 Rp 11,041 Rp 1,093,033 23

Rp - ### Rp 12,145 Rp 12,145 Rp 1,202,336 24

Rp - ### Rp 11,593 Rp 11,593 Rp 1,147,684 25

Rp - ### Rp 9,868 Rp 9,868 Rp 976,898 26

Rp - ### Rp 7,591 Rp 7,591 Rp 751,460 27

Rp - ### Rp 1,346 Rp 1,346 Rp 133,213 28

Rp - ### Rp 10,144 Rp 10,144 Rp 1,004,224 29

Rp - ### Rp 3,726 Rp 3,726 Rp 368,899 30

Rp - ### Rp - Rp - Rp 331,222 31

Rp - ### Rp - Rp - Rp - 32'----------------------------

Rp - ### Rp - Rp - Rp 289,819 33

Rp - ### Rp - Rp - Rp 331,222 34

Rp - ### Rp - Rp - Rp 331,222 35

Rp - ### Rp - Rp - Rp 289,819 36

Rp - ### Rp - Rp - Rp - 37.----------------------------

Rp - ### Rp - Rp - Rp 414,028 38

Rp - ### Rp - Rp - Rp 538,236 39

Rp - ### Rp - Rp - Rp 448,530 40
Rp - ### Rp - Rp - Rp 538,236 41

Rp - ### Rp - Rp - Rp 455,430 42

Rp - ### Rp - Rp - Rp 224,265 43

Rp - ### Rp - Rp - Rp 414,028 44

Rp 1,022,130 Rp 165,697 Rp 316,628 Rp 1,504,455 Rp 41,392,245

Langkahan, 09 Desember 2016

Bendahara JKN

Ratnawati.Amd.Keb
Nip . 19770220 200801 2 002
 TOTAL TOTAL 35,896,000
Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826
Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826
Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826
Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826

Rp 42,896,700 2826
 Kode Rekening : 1.02.1.02.01.16.18.5.2.2.29.01 DAFTAR :

Tahun : 2016

Variabel Ketenagaan Kehadiran

Jlh Total
Jlh Point Presentasi
No Nama Gol Pendidikan Jabatan Keseluruh
Variabel Kehadiran
Jenis Beban Jlh Hari Jlh Hari an Point
Masa Kerja
Ketenagaan Kerja Masuk Kerja

D-III
1 Nasrul Yani.AMK - Staf T.U 60 0 5 22 22 65 100 65
Keperawatan
D-III Staf Poli
2 Farlina.AMK - 60 0 0 8 22 60 36 22
Keperawatan Umum
D-III
3 Azhariadi.AMK - Staf T.U 60 0 50 22 22 110 100 110
Keperawatan
D-III Staf Poli
4 Iskandar.AMK - 60 0 0 12 22 60 55 33
Keperawatan Umum
D-III Staf Poli
5 Ratna Fauzi.AMK - 60 0 0 11 22 60 50 30
Keperawatan Umum

6 Zulfadli.SKM - S1 Kes Masy Staf R.Kartu 60 0 0 1 22 60 5 3

D-III Staf Poli

7 Maria Ulfa.AMK - 60 0 0 8 22 60 36 22
Keperawatan Umum

8 Helmiati.Amd.Keb - D-III Kebidanan Staf Pustu 60 0 0 21 22 60 95 57

9 Suryani.Amd.Keb - D-III Kebidanan Staf Imunisasi 60 0 0 11 22 60 50 30

10 Juliani.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 11 22 60 50 30

11 Nurhayati.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 5 22 60 23 14

Staf Poli
12 Rosmawar.Amd.Keb - D-III Kebidanan 60 0 0 12 22 60 55 33
Umum

13 Riska Yasinta.Am.Keb - D-III Kebidanan Staf T.U 60 0 5 22 22 65 100 65

14 Siti Hadijah.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 11 22 60 50 30

15 Masyitah.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 12 22 60 55 33

16 Aini Yatinur.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 11 22 60 50 30

17 Irnawati.S.Kep - S1 Keperawatan Staf R.Kartu 60 0 0 10 22 60 45 27

18 Dina Sumariana.Am.Keb - D-III Kebidanan Staf R.Kartu 60 0 0 11 22 60 50 30

19 - D-III Kebidanan Staf R.Kartu 60 0 0 10 22 60 45 27

Anita Susanti.Amd.Keb
D-III
20 Nurlaila.AMK - Staf Apotik 60 0 0 10 22 60 45 27
Keperawatan

21 Elli Safrinawati.Amd.Keb - D-III Kebidanan Staf R.Keswa 60 0 0 13 22 60 59 35

D-III Staf
22 Rusli.AMK - 60 0 0 22 22 60 100 60
Keperawatan Ambulance

23 Iklima.Am.Keb - D-III Kebidanan Staf R.Kartu 60 0 0 12 22 60 55 33

24 Efendi - SMA Staf T.U 60 0 0 22 22 60 100 60

25 Bukhari - SMA Staf Cs 60 0 0 22 22 60 100 60

26 Mega Mustika.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 11 22 60 50 30

D-III
27 Sofyan.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan
D-III
28 Muhammad Nasir.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan
D-III
29 Muhammad Yani.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan
D-III
30 Amrizal.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan
D-III
31 Muhammad Ikhsan.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan
D-III
32 Yunita Tya Ningsih.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan
D-III
33 Nazaruddin.AMK - Staf UGD 60 0 0 12 22 60 55 33
Keperawatan

34 Erni Purwitasari.Am.Keb - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

35 Siti Nurchasanah.Amd.Keb - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

36 Elia Juwita.Am.Keb - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

37 Muhammad Ilyas.S.Kep - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

38 Lukman Hakim.AMK - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

39 Wahyuni.Amd.Keb - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

40 Zurrahmawati.Amd.Kg - D-III Kebidanan Staf UGD 60 0 0 10 22 60 45 27

41 Safrina, Str.Keb - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

42 Rabial Mawarni, Amd.Keb - D-III Kebidanan Staf UGD 60 0 0 12 22 60 55 33

JUMLAH 1514

Mengetahui :
Kepala Puskesmas Langkahan

dr.Heppy Maulizar Andrean

Nip. 19790309 201409 1 001

5898394.8834281
 PEMBAYARAN JASA PELAYANAN KAPITASI JKN TENAGA MEDIS,PARAMEDIS DAN NON PARAMEDIS PUSKESMAS
LANGKAHAN UNTUK BULAN NOVEMBER TAHUN 2016

Jasa Pelayanan Yang Jlh Dana Yang

PPH Zakat Infaq Jlh Dana Yang Diterima Tanda Tangan
Diterima Dipotong

Rp 253,294 Rp - Rp - Rp - Rp - Rp 253,294 1

Rp 85,022 Rp - Rp - Rp - Rp - Rp 85,022 2

Rp 428,652 Rp - Rp - Rp - Rp - Rp 428,652 3

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 4

Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 5

Rp 10,628 Rp - Rp - Rp - Rp - Rp 10,628 6

Rp 85,022 Rp - Rp - Rp - Rp - Rp 85,022 7

Rp 223,183 Rp - Rp - Rp - Rp - Rp 223,183 8

Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 9

Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 10
Rp 53,139 Rp - Rp - Rp - Rp - Rp 53,139 11

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 12

Rp 253,294 Rp - Rp - Rp - Rp - Rp 253,294 13

Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 14

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 15

Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 16

Rp 106,277 Rp - Rp - Rp - Rp - Rp 106,277 17

Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 18

Rp 106,277 Rp - Rp - Rp - Rp - Rp 106,277 19

Rp 106,277 Rp - Rp - Rp - Rp - Rp 106,277 20

Rp 138,161 Rp - Rp - Rp - Rp - Rp 138,161 21

Rp 233,810 Rp - Rp - Rp - Rp - Rp 233,810 22

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 23

Rp 233,810 Rp - Rp - Rp - Rp - Rp 233,810 24

Rp 233,810 Rp - Rp - Rp - Rp - Rp 233,810 25
Rp 116,905 Rp - Rp - Rp - Rp - Rp 116,905 26

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 27

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 28

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 29

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 30

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 31

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 32

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 33

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 34

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 35

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 36

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 37

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 38

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 39

Rp 106,277 Rp - Rp - Rp - Rp - Rp 106,277 40
Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 41

Rp 127,533 Rp - Rp - Rp - Rp - Rp 127,533 42

Rp 5,898,395 Rp - Rp - Rp - Rp - Rp 5,898,395

Langkahan, 09 Desember 2016

Bendahara JKN

Rp -
Ratnawati.Amd.Keb
Nip . 19770220 200801 2 002
 TOTAL TOTAL 35,896,000
Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514
Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514
Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514

Rp 5,898,395 1514
Rp 5,898,395 1514

Rp 5,898,395 1514

5898394.88342807
 JLH DANA KESELURUHAN JLH DANA PON 5% DARI JLH DANA KURANG DARI JLH DANA PON 15% DARI
No Nama / Nip / Nrptt Gol Pendidikan
BULAN NOVEMBER (kolom 6 * 5%) (kolom 5 - kolom 6) (kolom 7 * 15%)

1 2 3 4 5 6 7 8
dr.Heppy Maulizar A /
1 III/b S1 Kedokteran Rp 3,243,215 Rp 162,161 Rp 3,081,055 Rp 462,158
197903092014091001

Irwansyah /
2 III/b SMA Rp 1,123,395 Rp 56,170 Rp 1,067,225 Rp 160,084
196003031986031005

dr.Indrieani /
3 III/b S1 Kedokteran Rp 2,075,658 Rp 103,783 Rp 1,971,875 Rp 295,781
198408222014092001

Zulkifli.SKM /
4 III/d S1 Kes Masy Rp 1,614,880 Rp 80,744 Rp 1,534,136 Rp 230,120
196409081988031004

5 Samuil / 196607121989111001 III/d SPK Rp 1,005,311 Rp 50,266 Rp 955,045 Rp 143,256.75

Abdul Manan.AMK /
6 III/d D-III Kesehatan Rp 1,263,819 Rp 63,191 Rp 1,200,628 Rp 180,094
197103251923031002

7 Sarinem / 197409211993032002 III/c SPK Rp 1,123,395 Rp 56,170 Rp 1,067,225 Rp 160,084

Muslem.SKM /
8 III/b S1 Kes Masy Rp 1,498,366 Rp 74,918 Rp 1,423,447 Rp 213,517
197812302007011002

Maizaharina.S.Kep /
9 III/b S1 Kep Rp 1,427,015 Rp 71,351 Rp 1,355,664 Rp 203,350
198008142001122001

Nurlaila.SKM /
10 III/a S1 Kes Masy Rp 1,362,150 Rp 68,108 Rp 1,294,043 Rp 194,106
197704052014062003

Muhajir.S.Kep /
11 III/a S1 Kep Rp 1,294,043 Rp 64,702 Rp 1,229,341 Rp 184,401
198703132010031002

Merida.Am.Keb /
12 III/a D-III Kebidanan Rp 1,157,828 Rp 57,891 Rp 1,099,937 Rp 164,990
197706202007012002

Dahliana.Am.Keb /
13 III/a D-III Kebidanan Rp 927,560 Rp 46,378 Rp 881,182 Rp 132,177
198803122010032001

Ratnawati.Am.Keb /
14 II/d D-III Kebidanan Rp 1,878,650 Rp 93,932 Rp 1,784,717 Rp 267,708
197702202008012002
 Salmiati.Am.Keb /
15 II/d D-III Kebidanan Rp 1,219,415 Rp 60,971 Rp 1,158,444 Rp 173,767
197812312008012006

Saifullah.Amd.Kl /
16 II/d D-III Kesling Rp 1,075,954 Rp 53,798 Rp 1,022,156 Rp 153,323
197908072010031001

Idaryanti.Am.Keb /
17 II/d D-III Kebidanan Rp 1,277,482 Rp 63,874 Rp 1,213,608 Rp 182,041
197701012008012003

Yuliana.Am.Keb /
18 II/d D-III Kebidanan Rp 1,277,482 Rp 63,874 Rp 1,213,608 Rp 182,041
197707262007012001

19 M.Zia Ulhaq,AMd.Kep / II/c D-III Kesehatan Rp 1,024,718 Rp 51,236 Rp 973,482 Rp 146,022

198808262009041001
Herlia Esofa.AMK /
20 II/c D-III Kesehatan Rp 983,729 Rp 49,186 Rp 934,543 Rp 140,181
198302012014062002

Faisal.A.Md.FARMA /
21 II/c D-III Farmasi Rp 1,052,044 Rp 52,602 Rp 999,442 Rp 149,916
197908052014061003

Nurhayati.A.Md.AK /
22 II/c D-III Analis Rp 1,202,336 Rp 60,117 Rp 1,142,219 Rp 171,333
198012012014062008

Boihaki.Am.Kg /
23 II/c D-III Kes Gigi Rp 1,093,033 Rp 54,652 Rp 1,038,381 Rp 155,757
197805032014061004

Martunis.AMK /
24 II/c D-III Kesehatan Rp 1,202,336 Rp 60,117 Rp 1,142,219 Rp 171,333
197908082014061002

Fauziani.AMK /
25 II/c D-III Kesehatan Rp 1,147,684 Rp 57,384 Rp 1,090,300 Rp 163,545
197811152014062003

Suryani Idris /
26 II/b SPK Rp 976,898 Rp 48,845 Rp 928,053 Rp 139,208
197504052007012002

Amiruddin /
27 II/b SMA Rp 751,460 Rp 37,573 Rp 713,887 Rp 107,083
197302102008011001

28 Junida / 198505062014062002 II/a SPK Rp 133,213 Rp 6,661 Rp 126,553 Rp 18,983

Salahuddin /
29 II/a SPK Rp 1,004,224 Rp 50,211 Rp 954,013 Rp 143,102
198402232014061001

M.Ali Usman /
30 I/c SMP Rp 368,899 Rp 18,445 Rp 350,454 Rp 52,568
195812311979011018
 Sachara.Am.Keb /
31 D-III Kebidanan Rp 331,222 Rp 16,561 Rp 314,661 Rp 47,199
01.4.04892001

Nuraini.Am.Kb /
32 D-III Kebidanan Rp - Rp - Rp - Rp -
01.4.350240011

Sri Dahniar.Am.Keb /
33 D-III Kebidanan Rp 289,819 Rp 14,491 Rp 275,328 Rp 41,299
01.4.3502318

Nurul Aflah.Amd.Keb /
34 D-III Kebidanan Rp 331,222 Rp 16,561 Rp 314,661 Rp 47,199
01.4.3502420

35 Mastura.Am.Keb / 01.4.3502386 D-III Kebidanan Rp 331,222 Rp 16,561 Rp 314,661 Rp 47,199

36 Elisah.Am.Keb / 01.4.3502211 D-III Kebidanan Rp 289,819 Rp 14,491 Rp 275,328 Rp 41,299

Mawarni.Amd.Keb /
37 D-III Kebidanan Rp - Rp - Rp - Rp -
01.4.024787

38 Dewi Susana.AMK D-III Kesehatan Rp 414,028 Rp 20,701 Rp 393,326 Rp 58,999

39 Eva Yuliana.AMK D-III Kesehatan Rp 538,236 Rp 26,912 Rp 511,324 Rp 76,699

40 Marliah SPK Rp 448,530 Rp 22,426 Rp 426,103 Rp 63,915

41 Nurwahidah.AMK D-III Kesehatan Rp 538,236 Rp 26,912 Rp 511,324 Rp 76,699

42 Saifullah.AMK D-III Kesehatan Rp 455,430 Rp 22,772 Rp 432,659 Rp 64,899

43 Sri Wahyuni SMA Rp 224,265 Rp 11,213 Rp 213,052 Rp 31,958

44 Suryani.Amd.Keb D-III Kebidanan Rp 414,028 Rp 20,701 Rp 393,326 Rp 58,999

JUMLAH Rp 41,392,245 Rp 2,069,612 Rp 39,322,633 Rp 5,898,395

Nb
Ratnawati.Amd.Keb
Idaryanti.Amd.Keb
SISA
 JLH TOTAL DANA YANG JLH TOTAL DANA PON 5%
DITERIMA DARI (kolom 7- DITAMBAH 15% (kolom 6 + Kolom
kolom 8) 8)

9 10

Rp 2,618,896 Rp 624,319

Rp 907,141 Rp 216,253

Rp 1,676,094 Rp 399,564

Rp 1,304,015 Rp 310,864

Rp 811,788 Rp 193,522

Rp 1,020,534 Rp 243,285

Rp 907,141 Rp 216,253

Rp 1,209,930 Rp 288,435

Rp 1,152,314 Rp 274,700

Rp 1,099,937 Rp 262,214

Rp 1,044,940 Rp 249,103

Rp 934,946 Rp 222,882

Rp 749,004 Rp 178,555

Rp 1,517,010 Rp 361,640
Rp 984,677 Rp 234,737

Rp 868,833 Rp 207,121

Rp 1,031,567 Rp 245,915

Rp 1,031,567 Rp 245,915

Rp 827,460 Rp 197,258

Rp 794,361 Rp 189,368

Rp 849,525 Rp 202,518

Rp 970,886 Rp 231,450

Rp 882,624 Rp 210,409

Rp 970,886 Rp 231,450

Rp 926,755 Rp 220,929

Rp 788,845 Rp 188,053

Rp 606,804 Rp 144,656

Rp 107,570 Rp 25,644

Rp 810,911 Rp 193,313

Rp 297,886 Rp 71,013
Rp 267,462 Rp 63,760

Rp - Rp -

Rp 234,029 Rp 55,790

Rp 267,462 Rp 63,760

Rp 267,462 Rp 63,760

Rp 234,029 Rp 55,790

Rp - Rp -

Rp 334,327 Rp 79,700

Rp 434,625 Rp 103,610

Rp 362,188 Rp 86,342

Rp 434,625 Rp 103,610

Rp 367,760 Rp 87,670

Rp 181,094 Rp 43,171

Rp 334,327 Rp 79,700

Rp 33,424,238 Rp 7,968,007
 PERTANGUNG JAWABAN 15%

JLH DANA KESELURUHAN

No Nama Gol Pendidikan Jabatan BULAN NOVEMBER

1 Nasrul Yani.AMK - D-III Keperawatan Staf T.U Rp 253,294

2 Farlina.AMK - D-III Keperawatan Staf Poli Umum Rp 85,022

3 Azhariadi.AMK - D-III Keperawatan Staf T.U Rp 428,652

4 Iskandar.AMK - D-III Keperawatan Staf Poli Umum Rp 127,533

5 Ratna Fauzi.AMK - D-III Keperawatan Staf Poli Umum Rp 116,905

6 Zulfadli.SKM - S1 Kes Masy Staf R.Kartu Rp 10,628

7 Maria Ulfa.AMK - D-III Keperawatan Staf Poli Umum Rp 85,022

8 Helmiati.Amd.Keb - D-III Kebidanan Staf Pustu Rp 223,183

9 Suryani.Amd.Keb - D-III Kebidanan Staf Imunisasi Rp 116,905

10 Juliani.Amd.Keb - D-III Kebidanan Staf Apotik Rp 116,905

11 Nurhayati.Amd.Keb - D-III Kebidanan Staf Apotik Rp 53,139

12 Rosmawar.Amd.Keb - D-III Kebidanan Staf Poli Umum Rp 127,533

13 Riska Yasinta.Am.Keb - D-III Kebidanan Staf T.U Rp 253,294

14 Siti Hadijah.Amd.Keb - D-III Kebidanan Staf Apotik Rp 116,905

15 Masyitah.Amd.Keb - D-III Kebidanan Staf Apotik Rp 127,533

16 Aini Yatinur.Amd.Keb - D-III Kebidanan Staf Apotik Rp 116,905

17 Irnawati.S.Kep - S1 Keperawatan Staf R.Kartu Rp 106,277

18 Dina Sumariana.Am.Keb - D-III Kebidanan Staf R.Kartu Rp 116,905

19 - D-III Kebidanan Staf R.Kartu Rp 106,277

Anita Susanti.Amd.Keb

20 Nurlaila.AMK - D-III Keperawatan Staf Apotik Rp 106,277

21 Elli Safrinawati.Amd.Keb - D-III Kebidanan Staf R.Keswa Rp 138,161

22 Rusli.AMK - D-III Keperawatan Staf Ambulance Rp 233,810

23 Iklima.Am.Keb - D-III Kebidanan Staf R.Kartu Rp 127,533

24 Efendi - SMA Staf T.U Rp 233,810

25 Bukhari - SMA Staf Cs Rp 233,810

26 Mega Mustika.Amd.Keb - D-III Kebidanan Staf Apotik Rp 116,905

27 Sofyan.AMK - D-III Keperawatan Staf UGD Rp 127,533

28 Muhammad Nasir.AMK - D-III Keperawatan Staf UGD Rp 127,533

29 Muhammad Yani.AMK - D-III Keperawatan Staf UGD Rp 127,533

30 Amrizal.AMK - D-III Keperawatan Staf UGD Rp 127,533

31 Muhammad Ikhsan.AMK - D-III Keperawatan Staf UGD Rp 127,533

32 Yunita Tya Ningsih.AMK - D-III Keperawatan Staf UGD Rp 127,533

33 Nazaruddin.AMK - D-III Keperawatan Staf UGD Rp 127,533

34 Erni Purwitasari.Am.Keb - D-III Kebidanan Staf UGD Rp 127,533

35 Siti Nurchasanah.Amd.Keb - D-III Kebidanan Staf UGD Rp 127,533

36 Elia Juwita.Am.Keb - D-III Kebidanan Staf UGD Rp 127,533

37 Muhammad Ilyas.S.Kep - D-III Kebidanan Staf UGD Rp 127,533

38 Lukman Hakim.AMK - D-III Kebidanan Staf UGD Rp 127,533

39 Wahyuni.Amd.Keb - D-III Kebidanan Staf UGD Rp 127,533

40 Zurrahmawati.Amd.Kg - D-III Kebidanan Staf UGD Rp 106,277

41 Safrina, Str.Keb - D-III Kebidanan Staf UGD Rp 127,533

42 Rabial Mawarni, Amd.Keb - D-III Kebidanan Staf UGD Rp 127,533

JUMLAH Rp 5,898,395
AN 15%

Tanda Tangan

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
 Kode Rekening : 1.02.1.02.01.16.18.5.2.2.29.01 DAFTAR :

Tahun : 2016

Variabel Ketenagaan Kehadiran Presentas

Jlh Total
Jlh Point i Jasa Pelayanan Yang
No Nama / Nip / Nrptt Gol Pendidikan Jabatan Keseluru
Jenis Variabel Kehadira Diterima
Masa Beban Jlh Hari Jlh Hari han Point
Ketenagaa n
Kerja Kerja Masuk Kerja
n

dr.Heppy Maulizar A / Kepala

1
197903092014091001
III/b S1 Kedokteran Puskesmas
150 0 100 20 22 250 91 227 Rp 3,389,168

Irwansyah / K.a Tata

2
196003031986031005
III/b SMA 25 25 30 22 22 80 100 80 Rp 1,192,987
Usaha
dr.Indrieani /
3
198408222014092001
III/b S1 Kedokteran K.a Poli 150 0 10 20 22 160 91 145 Rp 2,169,068

Zulkifli.SKM / Petugas
4
196409081988031004
III/d S1 Kes Masy 80 25 10 22 22 115 100 115 Rp 1,714,919
Promkes
Bendahara
5 Samuil / 196607121989111001 III/d SPK 50 25 0 21 22 75 95 72 Rp 1,067,588
Rutin
Abdul Manan.AMK /
6
197103251923031002
III/d D-III Kesehatan K.a Pustu 60 20 10 22 22 90 100 90 Rp 1,342,111

7 Sarinem / 197409211993032002 III/c SPK K.a Pustu 50 20 10 22 22 80 100 80 Rp 1,192,987

Muslem.SKM /
8
197812302007011002
III/b S1 Kes Masy Survelen 80 15 10 22 22 105 100 105 Rp 1,565,796

Maizaharina.S.Kep /
9
198008142001122001
III/b S1 Kep K.a Apotik 80 10 10 22 22 100 100 100 Rp 1,491,234

Nurlaila.SKM /
10
197704052014062003
III/a S1 Kes Masy K.a Gizi 80 10 10 21 22 100 95 95 Rp 1,423,451
 Muhajir.S.Kep /
11
198703132010031002
III/a S1 Kep UKS 80 5 10 21 22 95 95 91 Rp 1,352,278

Merida.Am.Keb /
12
197706202007012002
III/a D-III Kebidanan Koor Bides 60 15 10 21 22 85 95 81 Rp 1,209,933

Dahliana.Am.Keb / Pengelola
13
198803122010032001
III/a D-III Kebidanan 60 5 0 22 22 65 100 65 Rp 969,302
BOK
Ratnawati.Am.Keb /
14
197702202008012002
II/d D-III Kebidanan Pengelola JKN 60 15 50 22 22 125 100 125 Rp 1,864,042

Salmiati.Am.Keb /
15
197812312008012006
II/d D-III Kebidanan Pengelola KB 60 15 10 21 22 85 95 81 Rp 1,209,933

Saifullah.Amd.Kl / Petugas
16 II/d D-III Kesling 60 5 10 21 22 75 95 72 Rp 1,067,588
197908072010031001 Kesling
Idaryanti.Am.Keb / Koor
17 II/d D-III Kebidanan 60 15 10 22 22 85 100 85 Rp 1,267,549
197701012008012003 Posyandu
Yuliana.Am.Keb /
18
197707262007012001
II/d D-III Kebidanan K.a Poli KIA 60 15 10 22 22 85 100 85 Rp 1,267,549

M.Zia Ulhaq,AMd.Kep / Petugas

19 II/c D-III Kesehatan 60 5 10 20 22 75 91 68 Rp 1,016,750
198808262009041001 Keswa
Herlia Esofa.AMK / Petugas
20
198302012014062002
II/c D-III Kesehatan 60 10 10 20 22 80 91 73 Rp 1,084,534
SP2TP
Faisal.A.Md.FARMA /
21
197908052014061003
II/c D-III Farmasi Staf Apotik 60 10 0 22 22 70 100 70 Rp 1,043,864

Nurhayati.A.Md.AK /
22
198012012014062008
II/c D-III Analis K.a Poli LAB 60 10 10 22 22 80 100 80 Rp 1,192,987

Boihaki.Am.Kg /
23
197805032014061004
II/c D-III Kes Gigi K.a Poli Gigi 60 10 10 20 22 80 91 73 Rp 1,084,534

Martunis.AMK /
24
197908082014061002
II/c D-III Kesehatan K.a UGD 60 10 10 22 22 80 100 80 Rp 1,192,987

Fauziani.AMK /
25
197811152014062003
II/c D-III Kesehatan Petugas Diare 60 10 10 21 22 80 95 76 Rp 1,138,760
 Suryani Idris /
26
197504052007012002
II/b SPK Staf Pustu 50 15 0 22 22 65 100 65 Rp 969,302

Amiruddin / Pengelola
27
197302102008011001
II/b SMA 25 15 10 22 22 50 100 50 Rp 745,617
Barang

28 Junida / 198505062014062002 II/a SPK K.a Imunisasi 50 5 10 3 22 65 14 9 Rp 132,178

Salahuddin / Petugas
29
198402232014061001
II/a SPK 50 10 10 21 22 70 95 67 Rp 996,415
Malaria
M.Ali Usman /
30
195812311979011018
I/c SMP K.a Kartu 25 25 10 19 22 60 86 52 Rp 772,730

Sachara.Am.Keb /
31 D-III Kebidanan Bides 60 0 0 8 22 60 36 22 Rp 325,360
01.4.04892001
Nuraini.Am.Kb /
32
01.4.350240011
D-III Kebidanan Bides 60 0 0 0 22 60 0 0 Rp -

Sri Dahniar.Am.Keb /
33 D-III Kebidanan Bides 60 0 0 9 22 60 41 25 Rp 366,030
01.4.3502318
Nurul Aflah.Amd.Keb /
34
01.4.3502420
D-III Kebidanan Bides 60 0 0 9 22 60 41 25 Rp 366,030

Mastura.Am.Keb /
35 D-III Kebidanan Bides 60 0 0 9 22 60 41 25 Rp 366,030
01.4.3502386

36 Elisah.Am.Keb / 01.4.3502211 D-III Kebidanan Bides 60 0 0 7 22 60 32 19 Rp 284,690

Mawarni.Amd.Keb /
37 D-III Kebidanan Bides 60 0 0 0 22 60 0 0 Rp -
01.4.024787

38 Dewi Susana.AMK D-III Kesehatan Bakti Murni 60 0 0 10 22 60 45 27 Rp 406,700

39 Eva Yuliana.AMK D-III Kesehatan Bakti Murni 60 0 0 13 22 60 59 35 Rp 528,710

40 Marliah SPK Bakti Murni 50 0 0 13 22 50 59 30 Rp 440,592

41 Nurwahidah.AMK D-III Kesehatan Bakti Murni 60 0 0 13 22 60 59 35 Rp 528,710

42 Saifullah.AMK D-III Kesehatan Bakti Murni 60 0 0 11 22 60 50 30 Rp 447,370

43 Sri Wahyuni SMA Honorer 25 0 0 13 22 25 59 15 Rp 220,296

44 Suryani.Amd.Keb D-III Kebidanan Honorer 60 0 0 12 22 60 55 33 Rp 488,040

JUMLAH 2877 Rp 42,896,700

Mengetahui :
Kepala Puskesmas Langkahan

dr.Heppy Maulizar Andrean

Nip. 19790309 201409 1 001
PEMBAYARAN JASA PELAYANAN KAPITASI JKN TENAGA MEDIS,PARAMEDIS DAN NON PARAMEDIS PUSKESMAS LANGKAHAN UNTUK BULAN
NOVEMBER TAHUN 2016

Jlh Dana Yang

PPH Zakat Infaq Jlh Dana Yang Diterima Tanda Tangan
Dipotong

Rp 169,458 Rp - Rp 33,892 Rp 203,350 Rp 3,185,818 1

Rp 59,649 Rp 29,825 Rp - Rp 89,474 Rp 1,103,513 2

Rp 108,453 Rp - Rp 21,691 Rp 130,144 Rp 2,038,923 3

Rp 85,746 Rp 42,873 Rp - Rp 128,619 Rp 1,586,300 4

Rp 53,379 Rp 26,690 Rp - Rp 80,069 Rp 987,519 5

Rp 67,106 Rp 33,553 Rp - Rp 100,658 Rp 1,241,452 6

Rp 59,649 Rp 29,825 Rp - Rp 89,474 Rp 1,103,513 7

Rp 78,290 Rp - Rp 15,658 Rp 93,948 Rp 1,471,848 8

Rp 74,562 Rp - Rp 14,912 Rp 89,474 Rp 1,401,760 9

Rp 71,173 Rp - Rp 14,235 Rp 85,407 Rp 1,338,044 10

Rp 67,614 Rp - Rp 13,523 Rp 81,137 Rp 1,271,141 11

Rp 60,497 Rp - Rp 12,099 Rp 72,596 Rp 1,137,337 12

Rp 48,465 Rp - Rp 9,693 Rp 58,158 Rp 911,144 13

Rp - ### Rp 18,640 Rp 18,640 Rp 1,845,402 14

Rp - ### Rp 12,099 Rp 12,099 Rp 1,197,834 15

Rp - ### Rp 10,676 Rp 10,676 Rp 1,056,912 16

Rp - ### Rp 12,675 Rp 12,675 Rp 1,254,873 17

Rp - ### Rp 12,675 Rp 12,675 Rp 1,254,873 18

Rp - ### Rp 10,168 Rp 10,168 Rp 1,006,583 19

Rp - ### Rp 10,845 Rp 10,845 Rp 1,073,688 20

Rp - ### Rp 10,439 Rp 10,439 Rp 1,033,425 21

Rp - ### Rp 11,930 Rp 11,930 Rp 1,181,057 22

Rp - ### Rp 10,845 Rp 10,845 Rp 1,073,688 23

Rp - ### Rp 11,930 Rp 11,930 Rp 1,181,057 24

Rp - ### Rp 11,388 Rp 11,388 Rp 1,127,373 25

Rp - ### Rp 9,693 Rp 9,693 Rp 959,609 26

Rp - ### Rp 7,456 Rp 7,456 Rp 738,161 27

Rp - ### Rp 1,322 Rp 1,322 Rp 130,856 28

Rp - ### Rp 9,964 Rp 9,964 Rp 986,451 29

Rp - ### Rp 7,727 Rp 7,727 Rp 765,003 30

Rp - ### Rp - Rp - Rp 325,360 31

Rp - ### Rp - Rp - Rp - 32.,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Rp - ### Rp - Rp - Rp 366,030 33

Rp - ### Rp - Rp - Rp 366,030 34

Rp - ### Rp - Rp - Rp 366,030 35

Rp - ### Rp - Rp - Rp 284,690 36

Rp - ### Rp - Rp - Rp - 37.----------------------------

Rp - ### Rp - Rp - Rp 406,700 38

Rp - ### Rp - Rp - Rp 528,710 39

Rp - ### Rp - Rp - Rp 440,592 40
Rp - ### Rp - Rp - Rp 528,710 41

Rp - ### Rp - Rp - Rp 447,370 42

Rp - ### Rp - Rp - Rp 220,296 43

Rp - ### Rp - Rp - Rp 488,040 44

Rp 1,004,041 Rp 162,765 Rp 316,175 Rp 1,482,981 Rp 41,413,719

Langkahan, 09 Desember 2016

Bendahara JKN

Ratnawati.Amd.Keb
Nip . 19770220 200801 2 002
 TOTAL TOTAL 35,896,000
Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877
Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877
Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877
Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877

Rp 42,896,700 2877
 Kode Rekening : 1.02.1.02.01.16.18.5.2.2.29.01 DAFTAR :

Tahun : 2016

Variabel Ketenagaan Kehadiran Presentas

Jlh Total
Jlh Point i Jasa Pelayanan Yang
No Nama / Nip / Nrptt Gol Pendidikan Jabatan Keseluru
Jenis Variabel Kehadira Diterima
Masa Beban Jlh Hari Jlh Hari han Point
Ketenagaa n
Kerja Kerja Masuk Kerja
n

dr.Heppy Maulizar A / Kepala

1
197903092014091001
III/b S1 Kedokteran Puskesmas
150 0 100 20 20 250 100 250 Rp 3,784,321

Irwansyah / K.a Tata

2
196003031986031005
III/b SMA 25 25 30 20 20 80 100 80 Rp 1,210,983
Usaha
dr.Indrieani /
3
198408222014092001
III/b S1 Kedokteran K.a Poli 150 0 10 19 20 160 95 152 Rp 2,300,867

Zulkifli.SKM / Petugas
4
196409081988031004
III/d S1 Kes Masy 80 25 10 19 20 115 95 109 Rp 1,653,748
Promkes
Bendahara
5 Samuil / 196607121989111001 III/d SPK 50 25 0 18 20 75 90 68 Rp 1,021,767
Rutin
Abdul Manan.AMK /
6
197103251923031002
III/d D-III Kesehatan K.a Pustu 60 20 10 19 20 90 95 86 Rp 1,294,238

7 Sarinem / 197409211993032002 III/c SPK K.a Pustu 50 20 10 20 20 80 100 80 Rp 1,210,983

Muslem.SKM /
8
197812302007011002
III/b S1 Kes Masy Survelen 80 15 10 20 20 105 100 105 Rp 1,589,415

Maizaharina.S.Kep /
9
198008142001122001
III/b S1 Kep K.a Apotik 80 10 10 19 20 100 95 95 Rp 1,438,042

Nurlaila.SKM /
10
197704052014062003
III/a S1 Kes Masy K.a Gizi 80 10 10 18 20 100 90 90 Rp 1,362,356
 Muhajir.S.Kep /
11
198703132010031002
III/a S1 Kep UKS 80 5 10 19 20 95 95 90 Rp 1,366,140

Merida.Am.Keb /
12
197706202007012002
III/a D-III Kebidanan Koor Bides 60 15 10 18 20 85 90 77 Rp 1,158,002

Dahliana.Am.Keb / Pengelola
13
198803122010032001
III/a D-III Kebidanan 60 5 0 20 20 65 100 65 Rp 983,923
BOK
Ratnawati.Am.Keb /
14
197702202008012002
II/d D-III Kebidanan Pengelola JKN 60 15 50 20 20 125 100 125 Rp 1,892,161

Salmiati.Am.Keb /
15
197812312008012006
II/d D-III Kebidanan Pengelola KB 60 15 10 18 20 85 90 77 Rp 1,158,002

Saifullah.Amd.Kl / Petugas
16 II/d D-III Kesling 60 5 10 19 20 75 95 71 Rp 1,078,532
197908072010031001 Kesling
Idaryanti.Am.Keb / Koor
17 II/d D-III Kebidanan 60 15 10 20 20 85 100 85 Rp 1,286,669
197701012008012003 Posyandu
Yuliana.Am.Keb /
18
197707262007012001
II/d D-III Kebidanan K.a Poli KIA 60 15 10 19 20 85 95 81 Rp 1,222,336

M.Zia Ulhaq,AMd.Kep / Petugas

19 II/c D-III Kesehatan 60 5 10 20 20 75 100 75 Rp 1,135,296
198808262009041001 Keswa
Herlia Esofa.AMK / Petugas
20
198302012014062002
II/c D-III Kesehatan 60 10 10 17 20 80 85 68 Rp 1,029,335
SP2TP
Faisal.A.Md.FARMA /
21
197908052014061003
II/c D-III Farmasi Staf Apotik 60 10 0 20 20 70 100 70 Rp 1,059,610

Nurhayati.A.Md.AK /
22
198012012014062008
II/c D-III Analis K.a Poli LAB 60 10 10 20 20 80 100 80 Rp 1,210,983

Boihaki.Am.Kg /
23
197805032014061004
II/c D-III Kes Gigi K.a Poli Gigi 60 10 10 20 20 80 100 80 Rp 1,210,983

Martunis.AMK /
24
197908082014061002
II/c D-III Kesehatan K.a UGD 60 10 10 20 20 80 100 80 Rp 1,210,983

Fauziani.AMK /
25
197811152014062003
II/c D-III Kesehatan Petugas Diare 60 10 10 19 20 80 95 76 Rp 1,150,434
 Suryani Idris /
26
197504052007012002
II/b SPK Staf Pustu 50 15 0 20 20 65 100 65 Rp 983,923

Amiruddin / Pengelola
27
197302102008011001
II/b SMA 25 15 10 20 20 50 100 50 Rp 756,864
Barang

28 Junida / 198505062014062002 II/a SPK K.a Imunisasi 50 5 10 18 20 65 90 59 Rp 885,531

Salahuddin / Petugas
29
198402232014061001
II/a SPK 50 10 10 20 20 70 100 70 Rp 1,059,610
Malaria
M.Ali Usman /
30
195812311979011018
I/c SMP K.a Kartu 25 25 10 9 20 60 45 27 Rp 408,707

Sachara.Am.Keb /
31 D-III Kebidanan Bides 60 0 0 7 20 60 35 21 Rp 317,883
01.4.04892001
Nuraini.Am.Kb /
32
01.4.350240011
D-III Kebidanan Bides 60 0 0 0 20 60 0 0 Rp -

Sri Dahniar.Am.Keb /
33 D-III Kebidanan Bides 60 0 0 3 20 60 15 9 Rp 136,236
01.4.3502318
Nurul Aflah.Amd.Keb /
34
01.4.3502420
D-III Kebidanan Bides 60 0 0 5 20 60 25 15 Rp 227,059

Mastura.Am.Keb /
35 D-III Kebidanan Bides 60 0 0 4 20 60 20 12 Rp 181,647
01.4.3502386

36 Elisah.Am.Keb / 01.4.3502211 D-III Kebidanan Bides 60 0 0 1 20 60 5 3 Rp 45,412

Mawarni.Amd.Keb /
37 D-III Kebidanan Bides 60 0 0 0 20 60 0 0 Rp -
01.4.024787

38 Dewi Susana.AMK D-III Kesehatan Bakti Murni 60 0 0 10 20 60 50 30 Rp 454,119

39 Eva Yuliana.AMK D-III Kesehatan Bakti Murni 60 0 0 11 20 60 55 33 Rp 499,530

40 Marliah SPK Bakti Murni 50 0 0 11 20 50 55 28 Rp 416,275

41 Nurwahidah.AMK D-III Kesehatan Bakti Murni 60 0 0 11 20 60 55 33 Rp 499,530

42 Saifullah.AMK D-III Kesehatan Bakti Murni 60 0 0 12 20 60 60 36 Rp 544,942

43 Sri Wahyuni SMA Honorer 25 0 0 10 20 25 50 13 Rp 189,216

44 Suryani.Amd.Keb D-III Kebidanan Honorer 60 0 0 9 20 60 45 27 Rp 408,707

JUMLAH 2843 Rp 43,035,300

Mengetahui :
Kepala Puskesmas Langkahan

dr.Heppy Maulizar Andrean

Nip. 19790309 201409 1 001
a

Jlh Dana Yang

PPH Zakat Infaq Jlh Dana Yang Diterima Tanda Tangan
Dipotong

Rp 189,216 Rp - Rp 37,843 Rp 227,059 Rp 3,557,262 1

Rp 60,549 Rp 30,275 Rp - Rp 90,824 Rp 1,120,159 2

Rp 115,043 Rp - Rp 23,009 Rp 138,052 Rp 2,162,815 3

Rp 82,687 Rp 41,344 Rp - Rp 124,031 Rp 1,529,717 4

Rp 51,088 Rp 25,544 Rp - Rp 76,633 Rp 945,134 5

Rp 64,712 Rp 32,356 Rp - Rp 97,068 Rp 1,197,170 6

Rp 60,549 Rp 30,275 Rp - Rp 90,824 Rp 1,120,159 7

Rp 79,471 Rp - Rp 15,894 Rp 95,365 Rp 1,494,050 8

Rp 71,902 Rp - Rp 14,380 Rp 86,283 Rp 1,351,760 9

Rp 68,118 Rp - Rp 13,624 Rp 81,741 Rp 1,280,614 10

Rp 68,307 Rp - Rp 13,661 Rp 81,968 Rp 1,284,172 11

Rp 57,900 Rp - Rp 11,580 Rp 69,480 Rp 1,088,522 12

Rp 49,196 Rp - Rp 9,839 Rp 59,035 Rp 924,888 13

Rp - ### Rp 18,922 Rp 18,922 Rp 1,873,239 14

Rp - ### Rp 11,580 Rp 11,580 Rp 1,146,422 15

Rp - ### Rp 10,785 Rp 10,785 Rp 1,067,746 16

Rp - ### Rp 12,867 Rp 12,867 Rp 1,273,802 17

Rp - ### Rp 12,223 Rp 12,223 Rp 1,210,112 18

Rp - ### Rp 11,353 Rp 11,353 Rp 1,123,943 19

Rp - ### Rp 10,293 Rp 10,293 Rp 1,019,042 20

Rp - ### Rp 10,596 Rp 10,596 Rp 1,049,014 21

Rp - ### Rp 12,110 Rp 12,110 Rp 1,198,873 22

Rp - ### Rp 12,110 Rp 12,110 Rp 1,198,873 23

Rp - ### Rp 12,110 Rp 12,110 Rp 1,198,873 24

Rp - ### Rp 11,504 Rp 11,504 Rp 1,138,929 25

Rp - ### Rp 9,839 Rp 9,839 Rp 974,084 26

Rp - ### Rp 7,569 Rp 7,569 Rp 749,296 27

Rp - ### Rp 8,855 Rp 8,855 Rp 876,676 28

Rp - ### Rp 10,596 Rp 10,596 Rp 1,049,014 29

Rp - ### Rp 4,087 Rp 4,087 Rp 404,620 30

Rp - ### Rp - Rp - Rp 317,883 31

Rp - ### Rp - Rp - Rp - 32'----------------------------

Rp - ### Rp - Rp - Rp 136,236 33

Rp - ### Rp - Rp - Rp 227,059 34

Rp - ### Rp - Rp - Rp 181,647 35

Rp - ### Rp - Rp - Rp 45,412 36

Rp - ### Rp - Rp - Rp - 37.----------------------------

Rp - ### Rp - Rp - Rp 454,119 38

Rp - ### Rp - Rp - Rp 499,530 39

Rp - ### Rp - Rp - Rp 416,275 40
Rp - ### Rp - Rp - Rp 499,530 41

Rp - ### Rp - Rp - Rp 544,942 42

Rp - ### Rp - Rp - Rp 189,216 43

Rp - ### Rp - Rp - Rp 408,707 44

Rp 1,018,739 Rp 159,793 Rp 327,230 Rp 1,505,762 Rp 41,529,538

Langkahan, 23 Desember 2016

Bendahara JKN

Ratnawati.Amd.Keb
Nip . 19770220 200801 2 002
 TOTAL TOTAL 35,896,000
Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843
Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843
Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843
Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843

Rp 43,035,300 2843
 JLH DANA KESELURUHAN JLH DANA PON 5% DARI JLH DANA KURANG DARI JLH DANA PON 15% DARI
No Nama / Nip / Nrptt Gol Pendidikan
BULAN NOVEMBER (kolom 6 * 5%) (kolom 5 - kolom 6) (kolom 7 * 15%)

1 2 3 4 5 6 7 8
dr.Heppy Maulizar A /
1 III/b S1 Kedokteran Rp 3,557,262 Rp 177,863 Rp 3,379,399 Rp 506,910
197903092014091001

Irwansyah /
2 III/b SMA Rp 1,120,159 Rp 56,008 Rp 1,064,151 Rp 159,623
196003031986031005

dr.Indrieani /
3 III/b S1 Kedokteran Rp 2,162,815 Rp 108,141 Rp 2,054,674 Rp 308,201
198408222014092001

Zulkifli.SKM /
4 III/d S1 Kes Masy Rp 1,529,717 Rp 76,486 Rp 1,453,231 Rp 217,985
196409081988031004

5 Samuil / 196607121989111001 III/d SPK Rp 945,134 Rp 47,257 Rp 897,877 Rp 134,681.62

Abdul Manan.AMK /
6 III/d D-III Kesehatan Rp 1,197,170 Rp 59,858 Rp 1,137,311 Rp 170,597
197103251923031002

7 Sarinem / 197409211993032002 III/c SPK Rp 1,120,159 Rp 56,008 Rp 1,064,151 Rp 159,623

Muslem.SKM /
8 III/b S1 Kes Masy Rp 1,494,050 Rp 74,702 Rp 1,419,347 Rp 212,902
197812302007011002

Maizaharina.S.Kep /
9 III/b S1 Kep Rp 1,351,760 Rp 67,588 Rp 1,284,172 Rp 192,626
198008142001122001

Nurlaila.SKM /
10 III/a S1 Kes Masy Rp 1,280,614 Rp 64,031 Rp 1,216,584 Rp 182,488
197704052014062003

Muhajir.S.Kep /
11 III/a S1 Kep Rp 1,284,172 Rp 64,209 Rp 1,219,963 Rp 182,994
198703132010031002

Merida.Am.Keb /
12 III/a D-III Kebidanan Rp 1,088,522 Rp 54,426 Rp 1,034,096 Rp 155,114
197706202007012002

Dahliana.Am.Keb /
13 III/a D-III Kebidanan Rp 924,888 Rp 46,244 Rp 878,644 Rp 131,797
198803122010032001

Ratnawati.Am.Keb /
14 II/d D-III Kebidanan Rp 1,873,239 Rp 93,662 Rp 1,779,577 Rp -
197702202008012002
 Salmiati.Am.Keb /
15 II/d D-III Kebidanan Rp 1,146,422 Rp 57,321 Rp 1,089,101 Rp 163,365
197812312008012006

Saifullah.Amd.Kl /
16 II/d D-III Kesling Rp 1,067,746 Rp 53,387 Rp 1,014,359 Rp 152,154
197908072010031001

Idaryanti.Am.Keb /
17 II/d D-III Kebidanan Rp 1,273,802 Rp 63,690 Rp 1,210,112 Rp 181,517
197701012008012003

Yuliana.Am.Keb /
18 II/d D-III Kebidanan Rp 1,210,112 Rp 60,506 Rp 1,149,607 Rp 172,441
197707262007012001

19 M.Zia Ulhaq,AMd.Kep / II/c D-III Kesehatan Rp 1,123,943 Rp 56,197 Rp 1,067,746 Rp 160,162

198808262009041001
Herlia Esofa.AMK /
20 II/c D-III Kesehatan Rp 1,019,042 Rp 50,952 Rp 968,090 Rp 145,213
198302012014062002

Faisal.A.Md.FARMA /
21 II/c D-III Farmasi Rp 1,049,014 Rp 52,451 Rp 996,563 Rp 149,484
197908052014061003

Nurhayati.A.Md.AK /
22 II/c D-III Analis Rp 1,198,873 Rp 59,944 Rp 1,138,929 Rp 170,839
198012012014062008

Boihaki.Am.Kg /
23 II/c D-III Kes Gigi Rp 1,198,873 Rp 59,944 Rp 1,138,929 Rp 170,839
197805032014061004

Martunis.AMK /
24 II/c D-III Kesehatan Rp 1,198,873 Rp 59,944 Rp 1,138,929 Rp 170,839
197908082014061002

Fauziani.AMK /
25 II/c D-III Kesehatan Rp 1,138,929 Rp 56,946 Rp 1,081,983 Rp 162,297
197811152014062003

Suryani Idris /
26 II/b SPK Rp 974,084 Rp 48,704 Rp 925,380 Rp 138,807
197504052007012002

Amiruddin /
27 II/b SMA Rp 749,296 Rp 37,465 Rp 711,831 Rp 106,775
197302102008011001

28 Junida / 198505062014062002 II/a SPK Rp 876,676 Rp 43,834 Rp 832,842 Rp 124,926

Salahuddin /
29 II/a SPK Rp 1,049,014 Rp 52,451 Rp 996,563 Rp 149,484
198402232014061001

M.Ali Usman /
30 I/c SMP Rp 404,620 Rp 20,231 Rp 384,389 Rp 57,658
195812311979011018
 Sachara.Am.Keb /
31 D-III Kebidanan Rp 317,883 Rp 15,894 Rp 301,989 Rp 45,298
01.4.04892001

Nuraini.Am.Kb /
32 D-III Kebidanan Rp - Rp - Rp - Rp -
01.4.350240011

Sri Dahniar.Am.Keb /
33 D-III Kebidanan Rp 136,236 Rp 6,812 Rp 129,424 Rp 19,414
01.4.3502318

Nurul Aflah.Amd.Keb /
34 D-III Kebidanan Rp 227,059 Rp 11,353 Rp 215,706 Rp 32,356
01.4.3502420

35 Mastura.Am.Keb / 01.4.3502386 D-III Kebidanan Rp 181,647 Rp 9,082 Rp 172,565 Rp 25,885

36 Elisah.Am.Keb / 01.4.3502211 D-III Kebidanan Rp 45,412 Rp 2,271 Rp 43,141 Rp 6,471

Mawarni.Amd.Keb /
37 D-III Kebidanan Rp - Rp - Rp - Rp -
01.4.024787

38 Dewi Susana.AMK D-III Kesehatan Rp 454,119 Rp 22,706 Rp 431,413 Rp 64,712

39 Eva Yuliana.AMK D-III Kesehatan Rp 499,530 Rp 24,977 Rp 474,554 Rp 71,183

40 Marliah SPK Rp 416,275 Rp 20,814 Rp 395,462 Rp 59,319

41 Nurwahidah.AMK D-III Kesehatan Rp 499,530 Rp 24,977 Rp 474,554 Rp 71,183

42 Saifullah.AMK D-III Kesehatan Rp 544,942 Rp 27,247 Rp 517,695 Rp 77,654

43 Sri Wahyuni SMA Rp 189,216 Rp 9,461 Rp 179,755 Rp 26,963

44 Suryani.Amd.Keb D-III Kebidanan Rp 408,707 Rp 20,435 Rp 388,271 Rp 58,241

JUMLAH Rp 41,529,538 Rp 2,076,477 Rp 39,453,061 Rp 5,651,023

Nb
Ratnawati.Amd.Keb
Idaryanti.Amd.Keb
SISA
 JLH TOTAL DANA YANG JLH TOTAL DANA PON 5%
DITERIMA DARI (kolom 7- DITAMBAH 15% (kolom 6 + Kolom
kolom 8) 8)

9 10

Rp 2,872,489 Rp 684,773

Rp 904,528 Rp 215,631

Rp 1,746,473 Rp 416,342

Rp 1,235,247 Rp 294,471

Rp 763,196 Rp 181,938

Rp 966,715 Rp 230,455

Rp 904,528 Rp 215,631

Rp 1,206,445 Rp 287,605

Rp 1,091,546 Rp 260,214

Rp 1,034,096 Rp 246,518

Rp 1,036,969 Rp 247,203

Rp 878,982 Rp 209,541

Rp 746,847 Rp 178,041

Rp 1,779,577 Rp 93,662
Rp 925,736 Rp 220,686

Rp 862,205 Rp 205,541

Rp 1,028,596 Rp 245,207

Rp 977,166 Rp 232,947

Rp 907,584 Rp 216,359

Rp 822,876 Rp 196,166

Rp 847,079 Rp 201,935

Rp 968,090 Rp 230,783

Rp 968,090 Rp 230,783

Rp 968,090 Rp 230,783

Rp 919,685 Rp 219,244

Rp 786,573 Rp 187,511

Rp 605,056 Rp 144,239

Rp 707,916 Rp 168,760

Rp 847,079 Rp 201,935

Rp 326,730 Rp 77,889
Rp 256,691 Rp 61,192

Rp - Rp -

Rp 110,010 Rp 26,225

Rp 183,350 Rp 43,709

Rp 146,680 Rp 34,967

Rp 36,670 Rp 8,742

Rp - Rp -

Rp 366,701 Rp 87,418

Rp 403,371 Rp 96,160

Rp 336,142 Rp 80,133

Rp 403,371 Rp 96,160

Rp 440,041 Rp 104,901

Rp 152,792 Rp 36,424

Rp 330,031 Rp 78,676 Rp 5,384,023

Rp 33,802,038 Rp 7,727,499
 Kode Rekening : 1.02.1.02.01.16.18.5.2.2.29.01 DAFTAR :

Tahun : 2016

Variabel Ketenagaan Kehadiran

Jlh Total
Jlh Point Presentasi
No Nama Gol Pendidikan Jabatan Keseluruh
Variabel Kehadiran
Jenis Beban Jlh Hari Jlh Hari an Point
Masa Kerja
Ketenagaan Kerja Masuk Kerja

D-III
1 Nasrul Yani.AMK - Staf T.U 60 0 5 20 20 65 100 65
Keperawatan
D-III Staf Poli
2 Farlina.AMK - 60 0 0 0 20 60 0 0
Keperawatan Umum
D-III
3 Azhariadi.AMK - Staf T.U 60 0 50 20 20 110 100 110
Keperawatan
D-III Staf Poli
4 Iskandar.AMK - 60 0 0 11 20 60 55 33
Keperawatan Umum
D-III Staf Poli
5 Ratna Fauzi.AMK - 60 0 0 10 20 60 50 30
Keperawatan Umum

6 Zulfadli.SKM - S1 Kes Masy Staf R.Kartu 60 0 0 9 20 60 45 27

D-III Staf Poli

7 Maria Ulfa.AMK - 60 0 0 7 20 60 35 21
Keperawatan Umum

8 Helmiati.Amd.Keb - D-III Kebidanan Staf Pustu 60 0 0 20 20 60 100 60

9 Suryani.Amd.Keb - D-III Kebidanan Staf Imunisasi 60 0 0 10 20 60 50 30

10 Juliani.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 10 20 60 50 30

11 Nurhayati.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 0 20 60 0 0

Staf Poli
12 Rosmawar.Amd.Keb - D-III Kebidanan 60 0 0 8 20 60 40 24
Umum

13 Riska Yasinta.Am.Keb - D-III Kebidanan Staf T.U 60 0 5 20 20 65 100 65

14 Siti Hadijah.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 11 20 60 55 33

15 Masyitah.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 10 20 60 50 30

16 Aini Yatinur.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 10 20 60 50 30

17 Irnawati.S.Kep - S1 Keperawatan Staf R.Kartu 60 0 0 10 20 60 50 30

18 Dina Sumariana.Am.Keb - D-III Kebidanan Staf R.Kartu 60 0 0 10 20 60 50 30

19 - D-III Kebidanan Staf R.Kartu 60 0 0 10 20 60 50 30

Anita Susanti.Amd.Keb
D-III
20 Nurlaila.AMK - Staf Apotik 60 0 0 12 20 60 60 36
Keperawatan

21 Elli Safrinawati.Amd.Keb - D-III Kebidanan Staf R.Keswa 60 0 0 11 20 60 55 33

D-III Staf
22 Rusli.AMK - 60 0 0 20 20 60 100 60
Keperawatan Ambulance

23 Iklima.Am.Keb - D-III Kebidanan Staf R.Kartu 60 0 0 10 20 60 50 30

24 Efendi - SMA Staf T.U 60 0 0 20 20 60 100 60

25 Bukhari - SMA Staf Cs 60 0 0 20 20 60 100 60

26 Mega Mustika.Amd.Keb - D-III Kebidanan Staf Apotik 60 0 0 10 20 60 50 30

D-III
27 Sofyan.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan
D-III
28 Muhammad Nasir.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan
D-III
29 Muhammad Yani.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan
D-III
30 Amrizal.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan
D-III
31 Muhammad Ikhsan.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan
D-III
32 Yunita Tya Ningsih.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan
D-III
33 Nazaruddin.AMK - Staf UGD 60 0 0 12 20 60 60 36
Keperawatan

34 Erni Purwitasari.Am.Keb - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

35 Siti Nurchasanah.Amd.Keb - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

36 Elia Juwita.Am.Keb - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

37 Muhammad Ilyas.S.Kep - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

38 Lukman Hakim.AMK - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

39 Wahyuni.Amd.Keb - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

40 Zurrahmawati.Amd.Kg - D-III Kebidanan Staf UGD 60 0 0 10 20 60 50 30

41 Safrina, Str.Keb - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

42 Rabial Mawarni, Amd.Keb - D-III Kebidanan Staf UGD 60 0 0 12 20 60 60 36

JUMLAH 1557

Mengetahui :
Kepala Puskesmas Langkahan

dr.Heppy Maulizar Andrean

Nip. 19790309 201409 1 001
 PEMBAYARAN JASA PELAYANAN KAPITASI JKN TENAGA MEDIS,PARAMEDIS DAN NON PARAMEDIS PUSKESMAS
LANGKAHAN UNTUK BULAN DESEMBER TAHUN 2016

Jasa Pelayanan Yang Jlh Dana Yang

PPH Zakat Infaq Jlh Dana Yang Diterima Tanda Tangan
Diterima Dipotong

Rp 224,767 Rp - Rp - Rp - Rp - Rp 224,767 1

Rp - Rp - Rp - Rp - Rp - Rp - 2

Rp 380,374 Rp - Rp - Rp - Rp - Rp 380,374 3

Rp 114,112 Rp - Rp - Rp - Rp - Rp 114,112 4

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 5

Rp 93,365 Rp - Rp - Rp - Rp - Rp 93,365 6

Rp 72,617 Rp - Rp - Rp - Rp - Rp 72,617 7

Rp 207,477 Rp - Rp - Rp - Rp - Rp 207,477 8

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 9

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 10
Rp - Rp - Rp - Rp - Rp - Rp - 11

Rp 82,991 Rp - Rp - Rp - Rp - Rp 82,991 12

Rp 224,767 Rp - Rp - Rp - Rp - Rp 224,767 13

Rp 114,112 Rp - Rp - Rp - Rp - Rp 114,112 14

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 15

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 16

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 17

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 18

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 19

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 20

Rp 114,112 Rp - Rp - Rp - Rp - Rp 114,112 21

Rp 207,477 Rp - Rp - Rp - Rp - Rp 207,477 22

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 23

Rp 207,477 Rp - Rp - Rp - Rp - Rp 207,477 24

Rp 207,477 Rp - Rp - Rp - Rp - Rp 207,477 25
Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 26

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 27

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 28

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 29

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 30

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 31

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 32

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 33

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 34

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 35

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 36

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 37

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 38

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 39

Rp 103,738 Rp - Rp - Rp - Rp - Rp 103,738 40
Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 41

Rp 124,486 Rp - Rp - Rp - Rp - Rp 124,486 42

Rp 5,384,023 Rp - Rp - Rp - Rp - Rp 5,384,023

Langkahan, 09 Desember 2016

Bendahara JKN

Ratnawati.Amd.Keb
Nip . 19770220 200801 2 002
 TOTAL TOTAL 35,896,000
Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557
Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557
Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557

Rp 5,384,023 1557
Rp 5,384,023 1557

Rp 5,384,023 1557

5384022.54708286
 PERTANGUNG JAWABAN 15%

JLH DANA KESELURUHAN

No Nama Gol Pendidikan Jabatan BULAN NOVEMBER

1 Nasrul Yani.AMK - D-III Keperawatan Staf T.U Rp 224,767

2 Farlina.AMK - D-III Keperawatan Staf Poli Umum Rp -

3 Azhariadi.AMK - D-III Keperawatan Staf T.U Rp 380,374

4 Iskandar.AMK - D-III Keperawatan Staf Poli Umum Rp 114,112

5 Ratna Fauzi.AMK - D-III Keperawatan Staf Poli Umum Rp 103,738

6 Zulfadli.SKM - S1 Kes Masy Staf R.Kartu Rp 93,365

7 Maria Ulfa.AMK - D-III Keperawatan Staf Poli Umum Rp 72,617

8 Helmiati.Amd.Keb - D-III Kebidanan Staf Pustu Rp 207,477

9 Suryani.Amd.Keb - D-III Kebidanan Staf Imunisasi Rp 103,738

10 Juliani.Amd.Keb - D-III Kebidanan Staf Apotik Rp 103,738

11 Nurhayati.Amd.Keb - D-III Kebidanan Staf Apotik Rp -

12 Rosmawar.Amd.Keb - D-III Kebidanan Staf Poli Umum Rp 82,991

13 Riska Yasinta.Am.Keb - D-III Kebidanan Staf T.U Rp 224,767

14 Siti Hadijah.Amd.Keb - D-III Kebidanan Staf Apotik Rp 114,112

15 Masyitah.Amd.Keb - D-III Kebidanan Staf Apotik Rp 103,738

16 Aini Yatinur.Amd.Keb - D-III Kebidanan Staf Apotik Rp 103,738

17 Irnawati.S.Kep - S1 Keperawatan Staf R.Kartu Rp 103,738

18 Dina Sumariana.Am.Keb - D-III Kebidanan Staf R.Kartu Rp 103,738

19 - D-III Kebidanan Staf R.Kartu Rp 103,738

Anita Susanti.Amd.Keb

20 Nurlaila.AMK - D-III Keperawatan Staf Apotik Rp 124,486

21 Elli Safrinawati.Amd.Keb - D-III Kebidanan Staf R.Keswa Rp 114,112

22 Rusli.AMK - D-III Keperawatan Staf Ambulance Rp 207,477

23 Iklima.Am.Keb - D-III Kebidanan Staf R.Kartu Rp 103,738

24 Efendi - SMA Staf T.U Rp 207,477

25 Bukhari - SMA Staf Cs Rp 207,477

26 Mega Mustika.Amd.Keb - D-III Kebidanan Staf Apotik Rp 103,738

27 Sofyan.AMK - D-III Keperawatan Staf UGD Rp 124,486

28 Muhammad Nasir.AMK - D-III Keperawatan Staf UGD Rp 124,486

29 Muhammad Yani.AMK - D-III Keperawatan Staf UGD Rp 124,486

30 Amrizal.AMK - D-III Keperawatan Staf UGD Rp 124,486

31 Muhammad Ikhsan.AMK - D-III Keperawatan Staf UGD Rp 124,486

32 Yunita Tya Ningsih.AMK - D-III Keperawatan Staf UGD Rp 124,486

33 Nazaruddin.AMK - D-III Keperawatan Staf UGD Rp 124,486

34 Erni Purwitasari.Am.Keb - D-III Kebidanan Staf UGD Rp 124,486

35 Siti Nurchasanah.Amd.Keb - D-III Kebidanan Staf UGD Rp 124,486

36 Elia Juwita.Am.Keb - D-III Kebidanan Staf UGD Rp 124,486

37 Muhammad Ilyas.S.Kep - D-III Kebidanan Staf UGD Rp 124,486

38 Lukman Hakim.AMK - D-III Kebidanan Staf UGD Rp 124,486

39 Wahyuni.Amd.Keb - D-III Kebidanan Staf UGD Rp 124,486

40 Zurrahmawati.Amd.Kg - D-III Kebidanan Staf UGD Rp 103,738

41 Safrina, Str.Keb - D-III Kebidanan Staf UGD Rp 124,486

42 Rabial Mawarni, Amd.Keb - D-III Kebidanan Staf UGD Rp 124,486

JUMLAH Rp 5,384,023
AN 15%

Tanda Tangan

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