Form A1- Individu - Data Keadaan SDM Kesehatan di Fasyankes

Pekerjaan Pendidikan
Kode Unit Jenis Status
NIK (Nomor Induk
No Kerja ID/NIP/NRP Nama ( Nama Lengkap) Kela Kepegawaia Kode Kode Program Tahun
Kependudukan) Mulai Berakhir
(Fasyankes) min n SDMK Studi Lulus

1106125404870004 19820927 201412 2002 dr. DEVI EFRINA P PNS dokter U

1106125404870004 01.1.0055833 dr. FAJRIYA WAHYUNI P PTT dokter U
01.3.001.3404 drg. CUT REINILDA RISCHA P PTT dokter G
1105040201840001 19840102 200212 1 001 MISWAR L PNS Perawat
1105045001790001 19790110 200704 2 014 SURIANI Z P PNS Perawat
1105055501820002 19820105 201412 2 003 WAHYU NIAR P PNS Perawat
1105010102790003 19790201 200604 1 005 FAISAL FUADI L PNS Perawat
1105044605820001 19820506 201412 2 002 AIDAR P PNS Perawat
1107166506770001 19761231 200604 2 008 CUT HERLINDA P PNS Bidan
1105046304770002 19770423 200604 2 007 JEVI WAHYUNI P PNS Bidan
1105045203780003 19780312 200604 2 001 ERNIYANTI P PNS Bidan
1105044501840001 19840105 200801 2 001 MASYITAH P PNS Perawat
1105044508780003 19710614 200701 2 006 ROSMANIDAR P PNS Bidan
1105046410830001 19831024 201103 2 001 RENI ASNIDAR P PNS SKM
1105045307770002 19770913 200701 2 004 LILIS SURIANI P PNS Bidan
1105040505750002 19750505 200604 1 010 M.NASIR L PNS Perawat
1105025008740001 19740810 200604 2 008 DARMIATI P PNS Bidan
1105045011740002 19751110 200604 2 012 NURSIAH YAHYA P PNS Bidan
1105042905830003 19830529 201001 1 011 SEJAHTERA L PNS TU
1105046601820002 19820126 200504 2 001 SYARIFAH KASMARAZMUATY P PNS Bidan
1105040310830003 19801102 200604 1 004 T.DENNI OCTA FIRDIANSYAH L PNS Perawat
1105010508740004 19740805 200604 1 001 WASPADA SEMBIRING L PNS Kesling
1105016607780004 19780726 200604 2 005 NINA SISKA ARDINI P PNS Asisten aptker
1105045504750001 19750415 200604 2 012 KHAIRUL WARAH P PNS Bidan
1105044706780005 19780607 200701 2 004 CUT AJA LINDAWATI P PNS Bidan
11050454 810002 19810114 200904 2 006 MISRIANI P PNS Fisioterpis
1105044205770003 19770502 200604 2 016 ERLINAWATI P PNS Bidan
 1106096007850003 19850710 201003 2 001 TETI MELLYANA PARDEDE P PNS Bidan
9 PTT
10 1105046304870002 01.4.030758 ORIZA SURIANI P BIDAN PTT Bidan
11 1105016008880003 01.4.026419 ZULIA AGUSTI P BIDAN PTT Bidan
12 1105016008880003 01.4.35057 DARNIWATI P BIDAN PTT Bidan
13 1105016008880003 01.4.026416 RAUZAH P BIDAN PTT Bidan
14 1105016008880003 01.4.026409 HERNI EFRIDA P BIDAN PTT Bidan
15 1105016008880003 01.4.026420 YANTI P BIDAN PTT Bidan
16 1105016008880003 01.4.030761 AZIZAH HR P BIDAN PTT Bidan
17 1105016008880003 01.4.3403556 MAFLUZAH YUSWA P BIDAN PTT Bidan
18 1105016008880003 01.4.026410 SITI HAJAR P BIDAN PTT Bidan
19 1105016008880003 01.4.026475 NAULI P BIDAN PTT Bidan
20 1105016008880003 01.4.3502065 MARWIJAH P BIDAN PTT Bidan
21 1105016008880003 01.4.3502072 DEVI YULIANI P BIDAN PTT Bidan
1105096005870001 01.4.048.19406 SITI RAMADHANI HASIBUAN P BIDAN PTT Bidan
1105014605900002 01.4.3502077 SUSANTI P BIDAN PTT Bidan
1105014303860004 01.4.048.12963 MIRA YANTI P BIDAN PTT Bidan
1105044506880004 01.4.030751 ROSLINA P BIDAN PTT Bidan
BAKTI
1105044405900002 NURITA P Perawat Perawat 2011
1105045002880002 WIRDA NOVITA P Perawat Perawat 2010
1105044807870006 NAILUS SAKDAH P Perawat Perawat
1105040411900002 BENIS NOPAN JAYA L Perawat Perawat 2012
1105044405900002 ELI SUSANTI P Perawat Perawat 2012
1105044405900002 FADLISA P Perawat
1105044405900002 MIRA RAHAYU P Bidan Bidan 2011
1105045706920001 RUSLADAH P Bidan Bidan 2012
1105044405900002 SAIFULLAH L Perawat
1105044405900002 RUSLAINI P Perawat Perawat 2012
1105044405900002 ASRIANTI P Perawat
 1105044405900002 ROHANI P Perawat
1105044405900002 NAILIS RISNAYANTI P Perawat
1105040209870003 SYARIFUL KAMAL L Perawat IPA 2007
1105044405900002 EKA SURIYANI P Perawat
1105044403880001 ROHANI P Bidan
1105044405900002 AINAL MARDIAH P Bidan
1105044201940003 WIRDA RAHMI P Bidan Bidan 2015
1105046408920001 WIRLIA AGUS SUSANTI P Bidan
1105045505880005 LINDA WATI P Bidan
1105044405900002 YUSMAIDAR P Bidan
1105045108890001 RUSNA P Bidan
22 1105044201910001 CUT NASRITA P Perawat Bidan 2012
Pendidikan

Kode Sekolah/
Perguruan Tinggi
depkes
depkes
depkes
Depkes
Depkes

StiKes
StiKes

Depkes
SMAN 1 WOYLA

Stikes Seramoe Barat

Depkes
Form A4- Individu - Data Registrasi dan Perjanjian Tenaga Kesehatan

Registrasi
Jenis
Kode Status
ID/NIP Nama Kelam Kepegawaian Tanggal Penerbitan
Unit No. Surat. Tanda Registrasi Jenis Profesi
in STR
NIK
PNS
1 1105045006670001 19670610 198812 2 001 CUT ELI YUSRA P PNS Perawat
2 1105016709820004 19820927 2014 2 002 dr. DEVI EFRINA P PNS 11 21 100214098338 26-Sep-19 Dokter Umum
3 1106125404870004 01.1.0055833 dr. FAJRIYA WAHYUNI P PTT 11 21 100112130283 24-Apr-17 Dokter Umum
4 1105014405880004 01.3.3404 drg. CUT REINILDA RISCHA P PTT 12 21 100115163495 25-Apr-17 Dokter Gigi
5 19840102 200212 1 001 MISWAR L PNS 01 01 21116-1143618 31-Mar-16 Perawat
6 1105045001790001 19790110 200701 2 014 SURIANI Z P PNS 01 01 52116-1093878 15-Jan-16 Perawat
7 1105055501820002 19820105 201412 2 003 WAHYUNIAR P PNS 01 01 22112-0461951 29-Sep-12 Perawat
8 19790605 200312 1 006 YANDI SOFYAN L PNS 01 03 51112-0029937 1-May-12 Fisioterapis
9 1105010102790003 19790201 200604 1 005 FAISAL FUADI L PNS 01 01 51112-0460095 29-Sep-12 Perawat
10 1105044605820001 19820506 201412 2 002 AIDAR P PNS 01 01 52112-0460393 29-Sep-12 Perawat
11 1107166506770001 19761231 200604 2 008 CUT HERLINDA P PNS Bidan
12 1105046304770002 19770423 200604 2 007 JEVI WAHYUNI P PNS Bidan
13 1105045203780003 19780312 200604 2 001 ERNIYANTI P PNS 01 02 52115-1082313 23-Dec-15 Bidan
14 1105044501840001 19840105 200801 2 001 MASYITAH P PNS 01 01 52112-0459930 29-Sep-12 Perawat
15 1105044508780003 19710614 200701 2 006 ROSMANIDAR P PNS Bidan
16 1105046410830001 19831024 201103 2 001 RENI ASNIDAR P PNS SKM
17 1105045307770002 19770913 200701 2 004 LILIS SURIANI P PNS 01 02 32115-0938096 31-Mar-15 Bidan
18 1105040505750002 19750505 200604 1 010 M.NASIR L PNS 01 01 21112-0461948 29-Sep-12 Perawat
19 1105025008740001 19740810 200604 2 008 DARMIATI P PNS 01 02 52115-1082299 23-Dec-15 Bidan
20 1105045011740002 19751110 200604 2 012 NURSIAH YAHYA P PNS Bidan
21 1105042905830003 19830529 201001 1 011 SEJAHTERA L PNS TU
22 1105046601820002 19820126 200504 2 001 SYARIFAH KASMARAZMUATY P PNS 01 02 52114-0789277 1-Sep-14 Bidan
23 1105040310830003 19801102 200604 1 004 T.DENNI OCTA FIRDIANSYAH L PNS Perawat
24 1105010508740004 19740805 200604 1 001 WASPADA SEMBIRING L PNS SKM
19780726/STRTTK_11/1996/0
25 1105016607780004 19780726 200604 2 005 NINA SISKA ARDINI P PNS 27-Feb-14 Asisten Apoteker
7.0042
26 1105045504750001 19750415 200604 2 012 KHAIRUL WARAH P PNS Bidan
27 1105044706780005 19780607 200701 2 004 CUT AJA LINDAWATI P PNS Bidan
28 11050454 810002 19810114 200904 2 006 MISRIANI P PNS 01 0352112-0029917 1-May-12 Fisioterafis
29 1105044205770003 19770502 200604 2 016 ERLINAWATI P PNS 01 02 32114-0789278 1-Sep-14 Bidan
30 1106096007850003 19850710 201003 2 001 TETI MELLYANA PARDEDE P PNS Bidan
31
32
33
PTT
1105046304870002 01.4.030758 ORIZA SURIANI P BIDAN PTT 01 02 52114-0789293 1-Sep-14 Bidan
1105016008880003 01.4.026419 ZULIA AGUSTI P BIDAN PTT 01 02 52112-0431581 5-Oct-12 Bidan
1105025010880001 01.4.35057 DARNIWATI P BIDAN PTT 01 02 52115-0938090 31-Mar-15 Bidan
1105044106870006 01.4.026416 RAUZAH P BIDAN PTT 01 02 52112-0434409 5-Oct-12 Bidan
1105045009870003 01.4.026409 HERNI EFRIDA P BIDAN PTT 01 02 52114-0789289 1-Sep-14 Bidan
1105044301870002 01.4.026420 YANTI P BIDAN PTT 01 02 52114-0789290 1-Sep-14 Bidan
1105045206880007 01.4.030761 AZIZAH HR P BIDAN PTT 01 02 52112-0431573 5-Oct-12 Bidan
1105046006890003 01.4.3403556 MAFLUZAH YUSWA P BIDAN PTT 01 02 52112-0434413 5-Oct-12 Bidan
1105044701870001 01.4.026410 SITI HAJAR P BIDAN PTT 01 02 52112-0434411 5-Oct-12 Bidan
1105045506880002 01.4.026475 NAULI P BIDAN PTT 01 02 52112-0431319 5-Oct-12 Bidan
1105045610880001 01.4.3502065 MARWIJAH P BIDAN PTT 01 02 52112-0433726 5-Oct-12 Bidan
1105026007880003 01.4.3502072 DEVI YULIANI P BIDAN PTT 01 02 52114-0789269 1-Sep-14 Bidan
1105096005870001 01.4.048.19406 SITI RAMADHANI HASIBUAN P BIDAN PTT 01 02 52112-0431597 5-Oct-12 Bidan
1105014605900002 01.4.3502077 SUSANTI P BIDAN PTT 01 02 52115-0966459 6-May-15 Bidan
1105014303860004 01.4.048.12963 MIRA YANTI P BIDAN PTT 01 02 52112-0431608 5-Oct-12 Bidan
1105044506880004 01.4.030751 ROSLINA P BIDAN PTT 01 02 52114-0789294 1-Sep-14 Bidan
THR
1105040209870003 SYARIFUL KAMAL L THR 01 01 51115-1082176 23-Dec-15 CS
ZULFIKAR L THR SOPIR
KAUSAR YUSMIDA L THR Jaga Malam
BAKTI
4 1105044405900002 NURITA P Bakti 01 01 52112-0460317 29-Sep-12 Perawat
5 1105045002880002 WIRDA NOVITA P Bakti 01 01 52115-1082175 4-Jun-20 Perawat
6 1105044807870006 NAILUS SAKDAH P Bakti 01 01 52112-0460388 29-Sep-12 Perawat
7 1105040411900002 BENIS NOPAN JAYA L Bakti 01 01 51112-0544450 21-May-13 Perawat
8 ELI SUSANTI P Bakti 01 01 52112-0544387 21-May-13 Perawat
9 1105044909890004 FADLISA P Bakti 01 02 52112-0434416 5-Oct-12 Perawat
10 1114014607890001 MIRA RAHAYU P Bakti 01 02 52112-0541392 17-May-13 Bidan
11 1105045706920001 RUSLADAH P Bakti 01 02 52114-0771354 14-Aug-14 Bidan
12 SAIFULLAH P Bakti 01 01 51112-0460390 29-Sep-12 Perawat
13 RUSLAINI P Bakti 01 01 52112-0544448 21-May-13 Perawat
14 1105044604890004 ASRIANTI P Bakti 01 02 52112-0416427 5-Oct-12 Perawat
15 1105044810890002 ROHANI P Bakti 01 01 52112-0460318 29-Sep-12 Perawat
16 1105045101860001 NAILIS RISNAYANTI P Bakti 01 01 52115-1082173 23-Dec-15 Perawat
18 EKA SURIYANI P Bakti 01 01 52112-0460394 29-Dec-15 Perawat
19 1105044403880001 ROHANI P Bakti 01 02 52115-0418465 29-Dec-15 Bidan
20 1105045802900001 AINAL MARDIAH P Bakti 01 02 52112-0541377 17-May-13 Bidan
21 1105044201940003 WIRDA RAHMI P Bakti 01 02 52115-1082296 23-Dec-13 Bidan
22 1105046408920001 WIRLIA AGUS SUSANTI P Bakti 01 02 52114-0771367 12-Aug-14 Bidan
23 1105045505880005 LINDA WATI P Bakti 01 02 52114-0771368 12-Aug-14 Bidan
24 1105055111890005 YUSMAIDAR P Bakti 01 21 62115-1049435 13-Oct-15 Bidan
25 1105045108890001 RUSNA P Bakti 01 02 52112-0416405 14-Aug-14 Bidan
26 1105044201910001 CUT NASRITA P Bakti 15-Aug-14 Perawat
1105044307880002 SITI ZALIKHA P Bakti 01 01 52112-0544449 21-May-13 Perawat
1105044407920003 NASRI YANTI P Bakti Perawat
1105045304910001 RAUZIAH P Bakti Bidan
1105044906930003 RAHMAUL HAYANI P Bakti Bidan
1105045308920001 ERMA AGUSDIANA P Bakti Bidan
1111176811930001 FAIZAH P Bakti Bidan
1105045111930001 RIZKA NURITA P Bakti Psikologi
1105046306940001 CUT LIS MALINDA P Bakti Bidan
1105044207900001 MARWAN P Bakti Perawat
1105045010930001 ROSLILI P Bakti Bidan
1112056607910002 CUT SRI YULIANA P Bakti Bidan
 Perijinan

Tanggal
No. Surta Ijin Praktik (SIP) Penerbitan
SIP

446/004/SIP DU/2016 18-Jan-16

446/005/SIP DU/2016 18-Jan-16
446/006/SIP DG/2017 18-Jan-16

446/275/SIK P/2016 11-Apr-16

446/274/SIK P/2016 11-Apr-16

446/276/SIK P/2016 11-Apr-16

446/306/SIK B/2016 26-Apr-16

446/109/SIK B/2016 9-Feb-16

446/311/SIK B/2016 11-May-16

441/294/SIPB/2012 21-Feb-12
446/104/SIK B/2016 9-Feb-16

446/1005/SIK B/2015 10-Sep-15

446/744/SIK B/2015 19-Jun-15
446/919/SIK B/2015 13-Aug-15
446/1008/SIK B/2015 15-Oct-15
446/745/SIK B/2015 19-Jun-15
446/746/SIK B/2015 19-Jun-15
446/1004/SIK B/2015 10-Sep-15
446/1002/SIK B/2015 10-Sep-15
446/1010/SIK B/2015 11-Sep-15
446/1007/SIK B/2015 11-Sep-15
446/1006/SIK B/2015 10-Sep-15
446/1003/SIK B/2015 10-Sep-15
446/113/SIK B/2016 9-Feb-16

446/108/SIK B/2016 9-Feb-16

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