REKAPITULASI BIAYA RETRIBUSI PASIEN JAMKESDA MASKIN DAN NON MASKIN

PUSKESMAS : SUKOSARI
TGL / BULAN : 01 - 31 April
TAHUN : 2016

JENIS KUNJUNGAN
BPJS JAMKESDA SURAT TOTAL JUMLAH KLAIM
NO TEMPAT PELAYANAN LUAR KUNJUNGAN Px. JAMKESDA
JUMLAH UANG
NON CPW SEHAT /
DLM LUAR MASKIN KAB.
MASKIN SAKIT

1 2 3 4 5 6 7 8 9 10 11 = 5+6 12 = 6 X 6000

1 PKM INDUK 201 642 41 27 21 932 642 3,852,000

2 PUSTU NGUNUT 75 304 0 379 304 1,824,000

3 POLINDES SUKOSARI 5 116 0 121 116 696,000

4 POLINDES TRISONO 18 264 0 282 264 1,584,000

5 POLINDES NGUNUT 22 119 0 141 119 714,000

6 POLINDES BARENG 25 304 0 329 304 1,824,000

7 POLINDES POLOREJO 16 280 0 296 280 1,680,000

8 POLINDES GUPOLO 32 283 0 315 283 1,698,000

9 POLINDES CEKOK 15 367 0 382 367 2,202,000

10 POLI UGD 12 20 0 32 -

JUMLAH 421 0 0 2699 41 27 21 3209 2679 16,074,000

Mengetahui,
Kepala Puskesmas Sukosari Pengelola Program JAMKESDA

LILIK LINAWATI, S,Sos. SUGIANTO, Amd Farm

NIP, 19641122 199103 2 004 NIP.19820406 201101 1 008
 REKAPITULASI BIAYA RETRIBUSI PASIEN JAMKESDA MASKIN DAN NON MASKIN

PUSKESMAS / PUSTU / POSKESDES / POLINDES : PKM INDUK

JENIS KUNJUNGAN

BPJS JAMKESDA SURAT TOTAL JUMLAH KLAIM

No. TANGGAL JUMLAH UANG
CPW SEHAT / LUAR KAB. KUNJUNGAN Px. JAMKESDA
NON
MASKIN SAKIT
DLM LUAR MASKIN
10 = 12 =
1 2 3 4 5 6 7 8 9 11 = 5+6
3+4+5+6+7+8+9 11xRp.6000,-
1 1 Apr 2016 22 1 3 26 22 132,000
2 2 Apr 2016 10 2 3 15 10 60,000
3 3 Apr 2016 0 0 0 0 -
4 4 Apr 2016 34 5 1 0 40 34 204,000
5 5 Apr 2016 41 2 9 1 53 41 246,000
6 6 Apr 2016 20 1 1 0 22 20 120,000
7 7 Apr 2016 37 3 1 41 37 222,000
8 8 Apr 2016 33 3 0 36 33 198,000
9 9 Apr 2016 4 0 4 4 24,000
10 10 Apr 2016 0 0 0 0 -
11 11 Apr 2016 27 3 1 31 27 162,000
12 12 Apr 2016 27 1 2 1 31 27 162,000
13 13 Apr 2016 19 4 2 1 26 19 114,000
14 14 Apr 2016 14 3 17 14 84,000
15 15 Apr 2016 15 5 3 0 23 15 90,000
16 16 Apr 2016 17 0 17 17 102,000
17 17 Apr 2016 0 0 0 0 -
18 18 Apr 2016 29 5 0 34 29 174,000
19 19 Apr 2016 19 1 1 1 22 19 114,000
20 20 Apr 2016 16 0 16 16 96,000
21 21 Apr 2016 15 1 3 1 20 15 90,000
22 22 Apr 2016 23 0 23 23 138,000
23 23 Apr 2016 18 2 4 1 25 18 108,000
24 24 Apr 2016 0 0 0 0 -
25 25 Apr 2016 36 0 36 36 216,000
26 26 Apr 2016 35 1 1 37 35 210,000
27 27 Apr 2016 45 1 1 47 45 270,000
28 28 Apr 2016 51 1 1 53 51 306,000
29 29 Apr 2016 18 1 19 18 108,000
30 30 Apr 2016 17 0 17 17 102,000
31 31 Apr 2016 0 0 0 0 -

J U M LAH 0 0 0 642 41 27 21 731 642 3,852,000

Mengetahui,
Kepala Puskesmas Sukosari Pengelola Program JAMKESDA

LILIK LINAWATI, S,Sos. SUGIANTO, Amd Farm

NIP, 19641122 199103 2 004 NIP.19820406 201101 1 008