LAPORAN B

PUSKESMAS K
BULAN : OKTOBER 2017

NERACA AWAL PENERIMAAN BULAN

NO NAMA BARANG JUMLAH HARGA JUMLAH
NILAI (Rp)
BARANG SATUAN BARANG
1 Blangko DP3 DF muka 11 1400 15400 0
2 Amplop putih kop surat BLUD 0 250 - 0
3 Buku kartu kendali surat keluar 3 7,000 21,000 0
4 Buku kartu kendali surat masuk 1 7,000 7,000 0
5 Buku register pelayanan gigi 400 280 112,000 0
6 Buku register rawat jalan 400 280 112,000 0
7 Family folder rawat jalan 0 3,000 - 100
8 Karcis resep berobat Umum 9084 70 635,880 0
9 Karcis resep berobat BPJS 9785 70 684,950 0
10 Kartu Ibu (isi 100 lembar) 0 50,000 - 0
11 Kartu Bayi (isi 100 lembar) 0 50,000 - 0
12 Kartu rawat jalan 0 1,400 - 0
13 Kartu tanda berobat 1000 250 250,000 0
14 Lembar disposisi 3 13,500 40,500 0
15 Surat keterangan dokter capeng 784 270 211,680 250
16 Surat keterangan dokter umum 308 270 83,160 100
17 Buku Tindakan umum 395 270 106,650 0
18 Buku Tindakan gigi 334 270 90,180 0
19 Buku Tindakan laboratorium 0 270 - 0
20 Buku KIA + Stiker 0 21,500 - 0
21 Kwitansi Rawat Inap/Poned 347 270 93,690 0
22 Etiket obat 0 10 - 0
23 Blangko Pemriks. Kes. Jamaah Haji 35 270 9,450 0
24 Blangko Rujukan Pasien Umum 0 135 - 0
25 Blangko Rujukan Pasien BPJS 0 135 - 0
26 Formulir MTBS 4 50,000 200,000 0
27 Stiker Inventaris 24 500 12,000 0
28 Family folder rawat inap 1000 3,000 3,000,000 0
29 Buku Bon Barang 0 13,500 - 0
30 KMS Faktor Resiko PTM 165 2,000 330,000 0
31 Kohort Ibu 5 50,000 250,000 0
32 Kohort Bayi 5 50,000 250,000 0
33 Kohort Balita 5 50,000 250,000 0
34 Buku Surat Masuk 0 50,000 - 0
35 Buku Surat Keluar 0 50,000 - 0
36 Formulir MTBM 4 50,000 200,000 0
37 Kartu Rawat jalan 2 0 1,400 - 0
38 Sertifikat Imunisasi 0 2,600 - 0
39 Kartu TT 0 600 - 0
40 Register Balita 4 50,000 200,000 0
41 Bukti Tindakan Pelayanan 593 140 83,020 500
42 Kwitansi Rawat Jalan 383 270 103,410 0
43 CM Pasien Partus 0 50,000 - 0
44 Partograf Persalinan 0 50,000 - 0
45 Register Rajal Balita Sakit umu 2 s/d 5 t 0 50,000 - 0
46 Catatan Medik dan Keperawatan 0 300 - 0
47 Blanko Laporan Poned 0 300 - 0
48 Lembar Kerja Rujukan Maternal 0 300 - 0
49 Lembar Kerja Rujukan Neonatal 0 300 - 0
50 Surat Bukti Pelayanan Tindakan Pra Ruj 0 300 - 0
51 Kartu Pasien TB 01 0 2,500 - 0
52 Blanko register TB 02 0 400 - 0
53 Blanko register TB 03 0 50,000 - 0
54 Blanko register TB 04 0 50,000 - 0
55 Blanko register TB 05 0 400 - 0
56 Blanko register TB 06 0 50,000 - 0
57 Blanko register TB 09 0 200 - 0
58 Famly Folder Rawat jalan Besar 0 5,000 - 0
59 Buku Kegiatan 0 15,000 - 0
7,351,970

Mengetahui
Kepala Puskesmas

dr. WAKHIDI
NIP. 19600117 199503 1 001
 LAPORAN BARANG CETAK
PUSKESMAS KETANGGUNGAN

PENERIMAAN BULAN INI PENGELUARAN BULAN INI SISA S/D BULAN INI
HARGA NILAI (Rp) JUMLAH HARGA NILAI (Rp) JUMLAH
SATUAN BARANG SATUAN BARANG
1400 1400 11
250 - 250 0 0
7,000 - 7,000 0 3
7,000 - 7,000 0 1
280 - 280 0 400
280 - 100 280 28000 300
3,000 300,000 3,000 0 100
70 - 6075 70 425250 3009
70 - 3191 70 223370 6594
50,000 - 50,000 0 0
50,000 - 50,000 0 0
1,400 - 1,400 0 0
250 - 250 0 1000
13,500 - 1 13,500 13500 2
270 67,500 102 270 27540 932
270 27,000 358 270 96660 50
270 - 10 270 2700 385
270 - 92 270 24840 242
270 - 270 0 0
21,500 - 21,500 0 0
270 - 134 270 36180 213
10 - 10 0 0
270 - 270 0 35
135 - 135 0 0
135 - 135 0 0
50,000 - 50,000 0 4
500 - 500 0 24
3,000 - 200 3,000 600000 800
13,500 - 13,500 0 0
2,000 - 2,000 0 165
50,000 - 50,000 0 5
50,000 - 50,000 0 5
50,000 - 50,000 0 5
50,000 - 50,000 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 4
 1,400 - 1,400 0 0
2,600 - 2,600 0 0
600 - 600 0 0
50,000 - 50,000 0 4
140 70,000 240 140 33600 853
270 - 240 270 64800 143
50,000 - 50,000 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
2,500 - 2,500 0 0
400 - 400 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 0
400 - 400 0 0
50,000 - 50,000 0 0
200 - 200 0 0
5,000 - 5,000 0 0
15,000 15,000 0 0
464,500 1,576,440

Mengetahui
BLUD UPTD Puskesmas Banjarharjo

dr. EDI JUNAEDI

NIP. 19750207 200701 1 009
SISA S/D BULAN INI
HARGA KET
NILAI (Rp)
SATUAN
1400 15400
250 0
7,000 21000
7,000 7000
280 112000
280 84000
3,000 300000
70 210630
70 461580
50,000 0
50,000 0
1,400 0
250 250000
13,500 27000
270 251640
270 13500
270 103950
270 65340
270 0
21,500 0
270 57510
10 0
270 9450
135 0
135 0
50,000 200000
500 12000
3,000 2400000
13,500 0
2,000 330000
50,000 250000
50,000 250000
50,000 250000
50,000 0
50,000 0
50,000 200000
 1,400 0
2,600 0
600 0
50,000 200000
140 119420
270 38610
50,000 0
50,000 0
50,000 0
300 0
300 0
300 0
300 0
300 0
2,500 0
400 0
50,000 0
50,000 0
400 0
50,000 0
200 0
5,000 0
15,000 0
6,240,030

Pengelola Barang

NINIK NURHAMIDAH
NIP.19751028 201409 2 001
 LAPORAN BA
PUSKESMAS KE
BULAN : NOVEMBER 2017

NERACA AWAL PENERIMAAN BULAN

NO NAMA BARANG JUMLAH HARGA JUMLAH
NILAI (Rp)
BARANG SATUAN BARANG
11 1400 15400
1 Amplop putih kop surat BLUD 0 250 - 0
2 Buku kartu kendali surat keluar 3 7,000 21,000 0
3 Buku kartu kendali surat masuk 1 7,000 7,000 0
4 Buku register pelayanan gigi 400 280 112,000 0
5 Buku register rawat jalan 300 280 84,000 0
6 Family folder rawat jalan 100 3,000 300,000 0
7 Karcis resep berobat Umum 3009 70 210,630 2000
8 Karcis resep berobat BPJS 6594 70 461,580 1000
9 Kartu Ibu (isi 100 lembar) 0 50,000 - 0
10 Kartu Bayi (isi 100 lembar) 0 50,000 - 0
11 Kartu rawat jalan 0 1,400 - 0
12 Kartu tanda berobat 1000 250 250,000 0
13 Lembar disposisi 2 13,500 27,000 0
14 Surat keterangan dokter capeng 932 270 251,640 100
15 Surat keterangan dokter umum 50 270 13,500 450
16 Buku Tindakan umum 385 270 103,950 0
17 Buku Tindakan gigi 242 270 65,340 250
18 Buku Tindakan laboratorium 0 270 - 0
19 Buku KIA + Stiker 0 21,500 - 0
20 Kwitansi Rawat Inap/Poned 213 270 57,510 250
21 Etiket obat 0 10 - 0
22 Blangko Pemriks. Kes. Jamaah Haji 35 270 9,450 0
23 Blangko Rujukan Pasien Umum 0 135 - 0
24 Blangko Rujukan Pasien BPJS 0 135 - 0
25 Formulir MTBS 4 50,000 200,000 0
26 Stiker Inventaris 24 500 12,000 0
27 Family folder rawat inap 800 3,000 2,400,000 0
28 Buku Bon Barang 0 13,500 - 0
29 KMS Faktor Resiko PTM 165 2,000 330,000 0
30 Kohort Ibu 5 50,000 250,000 0
31 Kohort Bayi 5 50,000 250,000 0
32 Kohort Balita 5 50,000 250,000 0
33 Buku Surat Masuk 0 50,000 - 0
34 Buku Surat Keluar 0 50,000 - 0
35 Formulir MTBM 4 50,000 200,000 0
36 Kartu Rawat jalan 2 0 1,400 - 0
37 Sertifikat Imunisasi 0 2,600 - 0
38 Kartu TT 0 600 - 0
39 Register Balita 4 50,000 200,000 5
40 Bukti Tindakan Pelayanan 853 140 119,420 0
41 Kwitansi Rawat Jalan 143 270 38,610 500
42 CM Pasien Partus 0 50,000 - 0
43 Partograf Persalinan 0 50,000 - 0
44 Register Rajal Balita Sakit umu 2 s/d 5 t 0 50,000 - 0
45 Catatan Medik dan Keperawatan 0 300 - 0
46 Blanko Laporan Poned 0 300 - 0
47 Lembar Kerja Rujukan Maternal 0 300 - 0
48 Lembar Kerja Rujukan Neonatal 0 300 - 0
49 Surat Bukti Pelayanan Tindakan Pra Ruj 0 300 - 0
50 Kartu Pasien TB 01 0 2,500 - 0
51 Blanko register TB 02 0 400 - 0
52 Blanko register TB 03 0 50,000 - 0
53 Blanko register TB 04 0 50,000 - 0
54 Blanko register TB 05 0 400 - 0
55 Blanko register TB 06 0 50,000 - 0
56 Blanko register TB 09 0 200 - 0
57 Famly Folder Rawat jalan Besar 0 5,000 - 0
58 Buku Kegiatan 0 15,000 - 0
6,240,030

Mengetahui
Kepala Puskesmas

dr. WAKHIDI
NIP. 19600117 199503 1 001
 LAPORAN BARANG CETAK
PUSKESMAS KETANGGUNGAN

PENERIMAAN BULAN INI PENGELUARAN BULAN INI SISA S/D BULAN INI
HARGA NILAI (Rp) JUMLAH HARGA NILAI (Rp) JUMLAH
SATUAN BARANG SATUAN BARANG
1400 1400 11
250 - 250 0 0
7,000 - 1 7,000 7000 2
7,000 - 1 7,000 7000 0
280 - 100 280 28000 300
280 - 200 280 56000 100
3,000 - 3,000 0 100
70 140,000 3849 70 269430 1160
70 70,000 1782 70 124740 5812
50,000 - 50,000 0 0
50,000 - 50,000 0 0
1,400 - 1,400 0 0
250 - 250 0 1000
13,500 - 1 13,500 13500 1
270 27,000 112 270 30240 920
270 121,500 249 270 67230 251
270 - 11 270 2970 374
270 67,500 75 270 20250 417
270 - 270 0 0
21,500 - 21,500 0 0
270 67,500 155 270 41850 308
10 - 10 0 0
270 - 270 0 35
135 - 135 0 0
135 - 135 0 0
50,000 - 50,000 0 4
500 - 500 0 24
3,000 - 200 3,000 600000 600
13,500 - 13,500 0 0
2,000 - 2,000 0 165
50,000 - 1 50,000 50000 4
50,000 - 1 50,000 50000 4
50,000 - 1 50,000 50000 4
50,000 - 50,000 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 4
1,400 - 1,400 0 0
2,600 - 2,600 0 0
600 - 600 0 0
50,000 250,000 50,000 0 9
140 - 166 140 23240 687
270 135,000 167 270 45090 476
50,000 - 50,000 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
2,500 - 2,500 0 0
400 - 400 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 0
400 - 400 0 0
50,000 - 50,000 0 0
200 - 200 0 0
5,000 - 5,000 0 0
15,000 15,000 0 0
878,500 1,486,540

Mengetahui
BLUD UPTD Puskesmas Banjarharjo

dr. EDI JUNAEDI

NIP. 19750207 200701 1 009
SISA S/D BULAN INI TANGGAL B0N
HARGA KET
NILAI (Rp)
SATUAN 6/11 11/11
1400 15400
250 0
7,000 14000
7,000 0
280 84000
280 28000
3,000 300000
70 81200
70 406840
50,000 0
50,000 0
1,400 0
250 250000
13,500 13500
270 248400
270 67770 200 250
270 100980
270 112590
270 0
21,500 0
270 83160
10 0
270 9450
135 0
135 0
50,000 200000
500 12000
3,000 1800000
13,500 0
2,000 330000
50,000 200000
50,000 200000
50,000 200000
50,000 0
50,000 0
50,000 200000
1,400 0
2,600 0
600 0
50,000 450000
140 96180
270 128520 500
50,000 0
50,000 0
50,000 0
300 0
300 0
300 0
300 0
300 0
2,500 0
400 0
50,000 0
50,000 0
400 0
50,000 0
200 0
5,000 0
15,000 0
5,631,990

Pengelola Barang

NINIK NURHAMIDAH
NIP.19751028 201409 2 001
TANGGAL B0N
18/11
24/11

1000 1000
1000

100

250

250
5
 LAPORA
PUSKESMA
BULAN : DESEMBER 2017

NERACA AWAL PENERIMAAN BU

NO NAMA BARANG JUMLAH HARGA JUMLAH
NILAI (Rp)
BARANG SATUAN BARANG
Blangko DP3 DF muka 11 1400 15400 0
1 Amplop putih kop surat BLUD 0 250 - 0
2 Buku kartu kendali surat keluar 2 7,000 14,000 0
3 Buku kartu kendali surat masuk 0 7,000 - 0
4 Buku register pelayanan gigi 300 280 84,000 0
5 Buku register rawat jalan 100 280 28,000 0
6 Family folder rawat jalan 100 3,000 300,000 0
7 Karcis resep berobat Umum 1160 70 81,200 0
8 Karcis resep berobat BPJS 5812 70 406,840 0
9 Kartu Ibu (isi 100 lembar) 0 50,000 - 0
10 Kartu Bayi (isi 100 lembar) 0 50,000 - 0
11 Kartu rawat jalan 0 1,400 - 0
12 Kartu tanda berobat 1000 250 250,000 0
13 Lembar disposisi 1 13,500 13,500 0
14 Surat keterangan dokter capeng 920 270 248,400 0
15 Surat keterangan dokter umum 251 270 67,770 0
16 Buku Tindakan umum 374 270 100,980 0
17 Buku Tindakan gigi 417 270 112,590 0
18 Buku Tindakan laboratorium 0 270 - 0
19 Buku KIA + Stiker 0 21,500 - 0
20 Kwitansi Rawat Inap/Poned 308 270 83,160 0
21 Etiket obat 0 10 - 0
22 Blangko Pemriks. Kes. Jamaah Haji 35 270 9,450 0
23 Blangko Rujukan Pasien Umum 0 135 - 0
24 Blangko Rujukan Pasien BPJS 0 135 - 0
25 Formulir MTBS 4 50,000 200,000 0
26 Stiker Inventaris 24 500 12,000 0
27 Family folder rawat inap 600 3,000 1,800,000 0
28 Buku Bon Barang 0 13,500 - 0
29 KMS Faktor Resiko PTM 165 2,000 330,000 0
30 Kohort Ibu 4 50,000 200,000 0
31 Kohort Bayi 4 50,000 200,000 0
32 Kohort Balita 4 50,000 200,000 0
33 Buku Surat Masuk 0 50,000 - 0
34 Buku Surat Keluar 0 50,000 - 0
35 Formulir MTBM 4 50,000 200,000 0
36 Kartu Rawat jalan 2 0 1,400 - 0
37 Sertifikat Imunisasi 0 2,600 - 0
38 Kartu TT 0 600 - 0
39 Register Balita 9 50,000 450,000 0
40 Bukti Tindakan Pelayanan 687 140 96,180 0
41 Kwitansi Rawat Jalan 476 270 128,520 0
42 CM Pasien Partus 0 50,000 - 0
43 Partograf Persalinan 0 50,000 - 0
44 Register Rajal Balita Sakit umu 2 s/d 5 t 0 50,000 - 0
45 Catatan Medik dan Keperawatan 0 300 - 0
46 Blanko Laporan Poned 0 300 - 0
47 Lembar Kerja Rujukan Maternal 0 300 - 0
48 Lembar Kerja Rujukan Neonatal 0 300 - 0
49 Surat Bukti Pelayanan Tindakan Pra Ruj 0 300 - 0
50 Kartu Pasien TB 01 0 2,500 - 0
51 Blanko register TB 02 0 400 - 0
52 Blanko register TB 03 0 50,000 - 0
53 Blanko register TB 04 0 50,000 - 0
54 Blanko register TB 05 0 400 - 0
55 Blanko register TB 06 0 50,000 - 0
56 Blanko register TB 09 0 200 - 0
57 Famly Folder Rawat jalan Besar 0 5,000 - 0
58 Buku Kegiatan 0 15,000 - 0
5,631,990

Mengetahui
Kepala Puskesmas

dr. WAKHIDI
NIP. 19600117 199503 1 001
 LAPORAN BARANG CETAK
PUSKESMAS KETANGGUNGAN

PENERIMAAN BULAN INI PENGELUARAN BULAN INI SISA S/D BULAN INI
HARGA NILAI (Rp) JUMLAH HARGA NILAI (Rp) JUMLAH
SATUAN BARANG SATUAN BARANG
1400 1400 11
250 - 250 0 0
7,000 - 1 7,000 7000 1
7,000 - 7,000 0 0
280 - 100 280 28000 200
280 - 100 280 28000 0
3,000 - 3,000 0 100
70 - 1160 70 81200 0
70 - 1641 70 114870 4171
50,000 - 50,000 0 0
50,000 - 50,000 0 0
1,400 - 1,400 0 0
250 - 250 0 1000
13,500 - 1 13,500 13500 0
270 - 110 270 29700 810
270 - 182 270 49140 69
270 - 11 270 2970 363
270 - 87 270 23490 330
270 - 270 0 0
21,500 - 21,500 0 0
270 - 144 270 38880 164
10 - 10 0 0
270 - 270 0 35
135 - 135 0 0
135 - 135 0 0
50,000 - 50,000 0 4
500 - 500 0 24
3,000 - 100 3,000 300000 500
13,500 - 13,500 0 0
2,000 - 2,000 0 165
50,000 - 50,000 0 4
50,000 - 50,000 0 4
50,000 - 50,000 0 4
50,000 - 50,000 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 4
1,400 - 1,400 0 0
2,600 - 2,600 0 0
600 - 600 0 0
50,000 - 50,000 0 9
140 - 149 140 20860 538
270 - 152 270 41040 324
50,000 - 50,000 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
300 - 300 0 0
2,500 - 2,500 0 0
400 - 400 0 0
50,000 - 50,000 0 0
50,000 - 50,000 0 0
400 - 400 0 0
50,000 - 50,000 0 0
200 - 200 0 0
5,000 - 5,000 0 0
15,000 15,000 0 0
- 778,650

Mengetahui
BLUD UPTD Puskesmas Banjarharjo

dr. EDI JUNAEDI

NIP. 19750207 200701 1 009
SISA S/D BULAN INI
HARGA KET
NILAI (Rp)
SATUAN
1400 15400
250 0
7,000 7000
7,000 0
280 56000
280 0
3,000 300000
70 0
70 291970
50,000 0
50,000 0
1,400 0
250 250000
13,500 0
270 218700
270 18630
270 98010
270 89100
270 0
21,500 0
270 44280
10 0
270 9450
135 0
135 0
50,000 200000
500 12000
3,000 1500000
13,500 0
2,000 330000
50,000 200000
50,000 200000
50,000 200000
50,000 0
50,000 0
50,000 200000
1,400 0
2,600 0
600 0
50,000 450000
140 75320
270 87480
50,000 0
50,000 0
50,000 0
300 0
300 0
300 0
300 0
300 0
2,500 0
400 0
50,000 0
50,000 0
400 0
50,000 0
200 0
5,000 0
15,000 0
4,853,340

Pengelola Barang

NINIK NURHAMIDAH
NIP.19751028 201409 2 001