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PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )

BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015

PUSKESMAS : PUTRI AYU


JUMLAH PESERTA 30.072
: 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI 69 ORANG 136,553,250
:
BULAN : Januari 2016

VARIABEL
POIN PER PERHITUNGAN JASA PPH Pas 21
NO NAMA GOL JABATAN JENIS KEHADIRAN ORG PER POINT PER ORG PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAGA EFEKTIF TIDAK JABATAN HARI DITERIMA
AN 15% 5%
1 BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 5,584,387 5,584,400 837,660 14.357.939.9.331.001 4,746,740 1
2 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,906,864 1,906,900 95,345 14.595.781.7.331.000 1,811,555
3 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 3,405,114 3,405,100 510,765 06.705.913.9.331.001 2,894,335 3
4 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 0 0 6.00 175.00 4,767,160 4,767,200 715,080 14.628.009.4.331.000 4,052,120
5 drg.Galuh Puteri Maulida IV Dokter gigi Puskesmas 150 25 4 0 6.00 147.00 4,004,414 4,004,400 600,660 69.834.144.3.331.000 3,403,740 5
6 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 4,767,160 4,767,200 715,080 08.520.228.1.331.001 4,052,120
7 dr.Raja Nilawati IV Dokter 150 25 3 0 6.00 154.00 4,195,101 4,195,100 629,265 14.595.199.2.331.000 3,565,835 7
8 Juden III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.566.794.5.331.000 1,682,070
9 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.595.801.3.331.000 1,682,070 9
10 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.584.108.6.331.000 1,682,070
11 Pudjiati, SKM III Staf Puskesmas 40 25 4 0 1.60 54.60 1,487,354 1,487,300 74,365 09.629.891.4.331.001 1,412,935 11
12 Hj. Fatmawati, S.ST III Staf Puskesmas 60 25 0 0 2.40 85.00 2,315,478 2,315,500 115,775 14.595.800.5.331.000 2,199,725
13 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.595.803.9.331.000 1,682,070 13
14 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,315,478 2,315,500 115,775 14.628.177.9.331.000 2,199,725
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 1 30 1.60 92.40 2,517,060 2,517,100 125,855 14.583.707.6.331.001 2,391,245 15
16 Diana Novita, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,315,478 2,315,500 115,775 14.519.602.8.331.000 2,199,725
17 Hj. Sri Haryanti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 69.834.138.5.331.000 1,682,070 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.595.796.5.331.000 1,682,070
19 dr.Nining Indah Sari III Dokter 150 25 0 0 6.00 175.00 4,767,160 4,767,200 238,360 14.786.073.8.331.000 4,528,840 19
20 Hidayati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.628.180.3.331.000 1,682,070
21 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.595.783.3.331.000 1,682,070 21
22 Jumiarsih III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.595.780.9.331.000 1,682,070
23 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,315,478 2,315,500 115,775 14.628.176.1.331.000 2,199,725 23
24 Yuliana Pariati, Am.Kep III Staf Puskesmas 40 25 3 0 1.60 57.20 1,558,180 1,558,200 77,910 05.928.992.6.331.001 1,480,290
25 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 1,089,637 1,089,600 54,480 14.595.783.3.331.000 1,035,120 25
26 Suaibatul Aslamiyah,SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 15.746.478.5.331.000 1,682,070
27 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 2,315,478 2,315,500 115,775 16.270.140.3.331.000 2,199,725 27
28 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 25 0 2.40 - - - - 16.270.144.5.331.000 -
29 Lidyawati, Am.Far III Staf Puskesmas 40 25 1 0 1.60 62.40 1,699,833 1,699,800 84,990 09.601.948.4.331.001 1,614,810 29
30 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 8 0 1.60 44.20 1,204,048 1,204,000 60,200 14.584.042.7.331.000 1,143,800
31 Yuniarti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 15.770.613.6.331.000 1,682,070 31
32 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
33 Ariesti Andani H II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700 33
34 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
35 Netti Herawati II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700 35
36 Nani Hidayati II Staf Puskesmas 25 25 0 0 1.00 50.00 1,362,046 1,362,000 1,362,000
37 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 1,089,637 1,089,600 1,089,600 37
38 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 1,089,637 1,089,600 1,089,600
39 Lindawati,Am.Kep II Staf Puskesmas 40 25 5 0 1.60 52.00 1,416,527 1,416,500 1,416,500 39
40 Mita susanti,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
41 Erni MasrianaBr.Batubara II Staf Puskesmas 40 25 1 0 1.60 62.40 1,699,833 1,699,800 1,699,800 41
42 Yenni Liyestana,AMAK II Staf Puskesmas 40 25 2 0 1.60 59.80 1,629,007 1,629,000 1,629,000
43 Rts.Leli Fitriani,AmTG II Staf Puskesmas 40 25 1 0 1.60 62.40 1,699,833 1,699,800 1,699,800 43
44 Erwis Hartaty II Staf Puskesmas 25 25 1 0 1.00 48.00 1,307,564 1,307,600 1,307,600
45 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 49.108.871.2.331.001 1,682,165 45
46 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
47 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700 47
48 Hj.Metty Rosita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 49.768.731.9.331.001 1,682,165
49 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 14.680.064.4.331.000 1,682,165 49
50 Komariah, Am. Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 49.630.002.5.331.001 1,682,165
51 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 14.388.312.2.331.001 1,682,165 51
52 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 14.595.781.7.331.000 1,682,165
53 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700 53
54 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 16.270.142.9.331.000 1,682,165
55 Leny Marlina II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700 55
56 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
Staf Puskesmas 40 25 9 0 1.60 41.60 57
57 Sumiati, Am.Keb III 1,133,222 1,133,200 56,660 14.520.497.0.331.000 1,076,540
58 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 14.584.043.5.331.000 1,682,165
59 Liti Puspita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 88,535 14.895.791.3.331.000 1,682,165 59
60 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 16.202.931.8.331.000 1,682,070
61 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,650 88,533 14.644.277.7.331.000 1,682,117 61
62 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,600 88,530 14.584.045.0.331.000 1,682,070
63 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 2 0 1.60 59.80 1,629,007 1,629,000 1,629,000 63
64 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
65 Deasy Andriani II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700 65
66 Zuraida.S II Staf Puskesmas 25 25 0 0 1.00 50.00 1,362,046 1,362,000 1,362,000
II Staf Puskesmas 15 25 0 0 0.60 40.00 67
67 Satirah 1,089,637 1,089,600 1,089,600
68 Nurhayati,Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,770,659 1,770,700 1,770,700
II Staf Puskesmas 40 25 0 0 1.60 65.00 69
69 Trisna Oktaviani,Am.Keb 1,770,659 1,770,700 1,770,700
5,012.80 136,553,250 136,553,250 4,008,510 3,483,278 129,061,462

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
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PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015

PUSKESMAS : PUTRI AYU


JUMLAH PESERTA 30.086
: 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI 69 ORANG 135,306,750
:
BULAN : FEBRUARI 2016

VARIABEL
POIN PER PERHITUNG JASA PPH Pas 21
NO NAMA GOL JABATAN JENIS KEHADIRAN ORG PER AN POINT PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAGA EFEKTIF TIDAK JABATAN HARI DITERIMA
AN PER ORG 15% 5%
1 BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 24 0 30 6.25 204.00 5,509,863 5,509,900 826,485 14.357.939.9.331.001 4,683,415 1
2 Marbawi III Kepala Tata Usaha 15 24 0 30 0.63 69.00 1,863,630 1,863,600 93,180 14.595.781.7.331.000 1,770,420
3 dra.Dharmashanti.G IV Apoteker 100 24 0 0 4.17 124.00 3,349,132 3,349,100 502,365 06.705.913.9.331.001 2,846,735 3
4 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 24 4 0 6.25 145.00 3,916,324 3,916,300 587,445 14.628.009.4.331.000 3,328,855
5 drg.Galuh Puteri Maulida IV Dokter gigi Puskesmas 150 24 9 0 6.25 108.75 2,937,243 2,937,200 440,580 69.834.144.3.331.000 2,496,620 5
6 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 24 0 0 6.25 174.00 4,699,589 4,699,600 704,940 08.520.228.1.331.001 3,994,660
7 dr.Raja Nilawati IV Dokter 150 24 0 0 6.25 174.00 4,699,589 4,699,600 704,940 14.595.199.2.331.000 3,994,660 7
8 Juden III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.566.794.5.331.000 1,642,170
9 Hj.Tartilah, Am.KG III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.595.801.3.331.000 1,642,170 9
10 Hj.Erni trisnawati III Staf Puskesmas 40 24 2 0 1.67 58.67 1,584,536 1,584,500 79,225 14.584.108.6.331.000 1,505,275
11 Pudjiati, SKM III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 09.629.891.4.331.001 1,642,170 11
12 Hj. Fatmawati, S.ST III Staf Puskesmas 60 24 0 0 2.50 84.00 2,268,767 2,268,800 113,440 14.595.800.5.331.000 2,155,360
13 Elis Fatmah III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.595.803.9.331.000 1,642,170 13
14 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 24 0 0 2.50 84.00 2,268,767 2,268,800 113,440 14.628.177.9.331.000 2,155,360
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 24 0 30 1.67 94.00 2,538,858 2,538,850 126,943 14.583.707.6.331.001 2,411,907 15
16 Diana Novita, S.Kep III Staf Puskesmas 60 24 0 0 2.50 84.00 2,268,767 2,268,800 113,440 14.519.602.8.331.000 2,155,360
17 Hj. Sri Haryanti III Staf Puskesmas 40 24 3 0 1.67 56.00 1,512,511 1,512,500 75,625 69.834.138.5.331.000 1,436,875 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.595.796.5.331.000 1,642,170
19 dr.Nining Indah Sari III Dokter 150 24 1 0 6.25 166.75 4,503,773 4,503,800 225,190 14.786.073.8.331.000 4,278,610 19
20 Hidayati III Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,600 82,830 14.628.180.3.331.000 1,573,770
21 Hartini III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.595.783.3.331.000 1,642,170 21
22 Jumiarsih III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.595.780.9.331.000 1,642,170
23 Ns.Ana, S.Kep III Staf Puskesmas 60 24 0 0 2.50 84.00 2,268,767 2,268,800 113,440 14.628.176.1.331.000 2,155,360 23
24 Yuliana Pariati, Am.Kep III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 05.928.992.6.331.001 1,642,170
25 Yuliarti III Staf Puskesmas 15 24 0 0 0.63 39.00 1,053,356 1,053,300 52,665 14.595.783.3.331.000 1,000,635 25
26 Suaibatul Aslamiyah,SKM III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 15.746.478.5.331.000 1,642,170
27 Zulkartoni, SKM III Staf Puskesmas 60 24 0 0 2.50 84.00 2,268,767 2,268,800 113,440 16.270.140.3.331.000 2,155,360 27
28 Risa Dona Emalia, SKM III Staf Puskesmas 60 24 1 0 2.50 80.50 2,174,235 2,174,200 108,710 16.270.144.5.331.000 2,065,490
29 Lidyawati, Am.Far III Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,600 82,830 09.601.948.4.331.001 1,573,770 29
30 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 24 2 0 1.67 58.67 1,584,536 1,584,500 79,225 14.584.042.7.331.000 1,505,275
31 Yuniarti III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 15.770.613.6.331.000 1,642,170 31
32 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600
33 Ariesti Andani H II Staf Puskesmas 40 24 2 0 1.67 58.67 1,584,536 1,584,500 1,584,500 33
34 Novianti, Am.Keb II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600
35 Netti Herawati II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600 35
36 Nani Hidayati II Staf Puskesmas 25 24 0 0 1.04 49.00 1,323,447 1,323,400 1,323,400
37 Rohaina II Staf Puskesmas 15 24 0 0 0.63 39.00 1,053,356 1,053,300 1,053,300 37
38 M. Saleh II Staf Puskesmas 15 24 0 0 0.63 39.00 1,053,356 1,053,300 1,053,300
39 Lindawati,Am.Kep II Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,500 1,656,500 39
40 Mita susanti,Am.Kep II Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,500 1,656,500
41 Erni MasrianaBr.Batubara II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600 41
42 Yenni Liyestana,AMAK II Staf Puskesmas 40 24 5 0 1.67 50.67 1,368,463 1,368,500 1,368,500
43 Rts.Leli Fitriani,AmTG II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600 43
44 Erwis Hartaty II Staf Puskesmas 25 24 0 0 1.04 49.00 1,323,447 1,323,400 1,323,400
45 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 49.108.871.2.331.001 1,642,170 45
46 Lismayanti II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600
47 Anggraini II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600 47
48 Hj.Metty Rosita III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 49.768.731.9.331.001 1,642,170
49 Surya Nirwana III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.680.064.4.331.000 1,642,170 49
50 Komariah, Am. Kep III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 49.630.002.5.331.001 1,642,170
51 Hartati, Am.Keb III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.388.312.2.331.001 1,642,170 51
52 Mildarianto III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.595.781.7.331.000 1,642,170
53 Murni II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600 53
54 Chamidah, Am.Keb III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 16.270.142.9.331.000 1,642,170
55 Leny Marlina II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600 55
56 Elfi Maulinda II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600
Staf Puskesmas 40 24 0 0 1.67 64.00 57
57 Sumiati, Am.Keb III 1,728,584 1,728,600 86,430 14.520.497.0.331.000 1,642,170
58 Tin Marlina, Am.Keb III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.584.043.5.331.000 1,642,170
59 Liti Puspita III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.895.791.3.331.000 1,642,170 59
60 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,600 82,830 16.202.931.8.331.000 1,573,770
61 Saflina, Am.Keb III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.644.277.7.331.000 1,642,170 61
62 Novita Putriani, Am.Keb III Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 86,430 14.584.045.0.331.000 1,642,170
63 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,500 1,656,500 63
64 Paraswati, Am.Keb II Staf Puskesmas 40 24 0 0 1.67 64.00 1,728,584 1,728,600 1,728,600
65 Deasy Andriani II Staf Puskesmas 40 24 2 0 1.67 58.67 1,584,536 1,584,500 1,584,500 65
66 Zuraida.S II Staf Puskesmas 25 24 0 0 1.04 49.00 1,323,447 1,323,400 1,323,400
II Staf Puskesmas 15 24 0 0 0.63 39.00 67
67 Satirah 1,053,356 1,053,300 1,053,300
68 Nurhayati,Am.Keb II Staf Puskesmas 40 24 1 0 1.67 61.33 1,656,560 1,656,500 1,656,500
II Staf Puskesmas 40 24 0 0 1.67 64.00 69
69 Trisna Oktaviani,Am.Keb 1,728,584 1,728,600 1,728,600
5,009.67 135,306,750 135,306,750 3,766,755 3,557,913 127,982,082

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
TANDA TANGAN

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PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015

PUSKESMAS : PUTRI AYU


JUMLAH PESERTA : 30.020
6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 69 ORANG 135,087,000

BULAN : MARET 2016

VARIABEL
PPH Pas 21
KEHADIRAN POIN PER PERHITUNGA JASA
NO NAMA GOL JABATAN JENIS ORG PER N POINT PER PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAGA EFEKTIF TIDAK JABATAN HARI DITERIMA
AN ORG 15% 5%
1 BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 5,514,158 5,514,100 827,115 14.357.939.9.331.001 4,686,985 1
2 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,882,883 1,882,900 94,145 14.595.781.7.331.000 1,788,755
3 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 3,362,291 3,362,300 504,345 06.705.913.9.331.001 2,857,955 3
4 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 1 0 6.00 168.00 4,518,919 4,518,900 677,835 14.628.009.4.331.000 3,841,065
5 drg.Galuh Puteri Maulida IV Dokter gigi Puskesmas 150 25 6 0 6.00 133.00 3,577,478 3,577,500 536,625 69.834.144.3.331.000 3,040,875 5
6 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 4,707,208 4,707,200 706,080 08.520.228.1.331.001 4,001,120
7 dr.Raja Nilawati IV Dokter 150 25 1 0 6.00 168.00 4,518,919 4,518,900 677,835 14.595.199.2.331.000 3,841,065 7
8 Juden III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 14.566.794.5.331.000 1,594,575
9 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 14.595.801.3.331.000 1,594,575 9
10 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.584.108.6.331.000 1,660,980
11 Pudjiati, SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 09.629.891.4.331.001 1,660,980 11
12 Hj. Fatmawati, S.ST III Staf Puskesmas 60 25 0 0 2.40 85.00 2,286,358 2,286,300 114,315 14.595.800.5.331.000 2,171,985
13 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.595.803.9.331.000 1,660,980 13
14 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 10 0 2.40 51.00 1,371,815 1,371,800 68,590 14.628.177.9.331.000 1,303,210
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,555,341 2,555,300 127,765 14.583.707.6.331.001 2,427,535 15
16 Diana Novita, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,286,358 2,286,300 114,315 14.519.602.8.331.000 2,171,985
17 Hj. Sri Haryanti III Staf Puskesmas 40 25 6 0 1.60 49.40 1,328,778 1,328,800 66,440 69.834.138.5.331.000 1,262,360 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.595.796.5.331.000 1,660,980
19 dr.Nining Indah Sari III Dokter 150 25 1 0 6.00 168.00 4,518,919 4,518,900 225,945 14.786.073.8.331.000 4,292,955 19
20 Hidayati III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 14.628.180.3.331.000 1,594,575
21 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.595.783.3.331.000 1,660,980 21
22 Jumiarsih III Staf Puskesmas 40 25 9 0 1.60 41.60 1,118,971 1,119,000 55,950 14.595.780.9.331.000 1,063,050
23 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,286,358 2,286,300 114,315 14.628.176.1.331.000 2,171,985 23
24 Yuliana Pariati, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 05.928.992.6.331.001 1,660,980
25 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 1,075,933 1,075,900 53,795 14.595.783.3.331.000 1,022,105 25
26 Suaibatul Aslamiyah,SKM III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 15.746.478.5.331.000 1,594,575
27 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 2,286,358 2,286,300 114,315 16.270.140.3.331.000 2,171,985 27
28 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 2 0 2.40 78.20 2,103,449 2,103,400 105,170 16.270.144.5.331.000 1,998,230
29 Lidyawati, Am.Far III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 09.601.948.4.331.001 1,594,575 29
30 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 14.584.042.7.331.000 1,594,575
31 Yuniarti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 15.770.613.6.331.000 1,660,980 31
32 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400
33 Ariesti Andani H II Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 1,678,500 33
34 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400
35 Netti Herawati II Staf Puskesmas 40 25 8 0 1.60 44.20 1,188,906 1,188,900 1,188,900 35
36 Nani Hidayati II Staf Puskesmas 25 25 0 0 1.00 50.00 1,344,917 1,344,900 1,344,900
37 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 1,075,933 1,075,900 1,075,900 37
38 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 1,075,933 1,075,900 1,075,900
39 Lindawati,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 39
40 Mita susanti,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400
41 Erni MasrianaBr.Batubara II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 41
42 Yenni Liyestana,AMAK II Staf Puskesmas 40 25 2 0 1.60 59.80 1,608,520 1,608,500 1,608,500
43 Rts.Leli Fitriani,AmTG II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 43
44 Erwis Hartaty II Staf Puskesmas 25 25 0 0 1.00 50.00 1,344,917 1,344,900 1,344,900
45 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 49.108.871.2.331.001 1,660,980 45
46 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400
47 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 47
48 Hj.Metty Rosita III Staf Puskesmas 40 25 4 0 1.60 54.60 1,468,649 1,468,600 73,430 49.768.731.9.331.001 1,395,170
49 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.680.064.4.331.000 1,660,980 49
50 Komariah, Am. Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 49.630.002.5.331.001 1,660,980
51 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.388.312.2.331.001 1,660,980 51
52 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.595.781.7.331.000 1,660,980
53 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 53
54 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 16.270.142.9.331.000 1,660,980
55 Leny Marlina II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 55
56 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400
III Staf Puskesmas 40 25 0 0 1.60 65.00 57
57 Sumiati, Am.Keb 1,748,391 1,748,400 87,420 14.520.497.0.331.000 1,660,980
58 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.584.043.5.331.000 1,660,980
59 Liti Puspita III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 14.895.791.3.331.000 1,594,575 59
60 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,500 83,925 16.202.931.8.331.000 1,594,575
61 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 87,420 14.644.277.7.331.000 1,660,980 61
62 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 1 0 1.60 62.40 1,678,456 1,678,400 83,920 14.584.045.0.331.000 1,594,480
63 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400 63
64 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,748,391 1,748,400 1,748,400
65 Deasy Andriani II Staf Puskesmas 40 25 5 0 1.60 52.00 1,398,713 1,398,700 1,398,700 65
66 Zuraida.S II Staf Puskesmas 25 25 0 0 1.00 50.00 1,344,917 1,344,900 1,344,900
II Staf Puskesmas 15 25 0 0 0.60 40.00 67
67 Satirah 1,075,933 1,075,900 1,075,900
68 Nurhayati,Am.Keb II Staf Puskesmas 40 24 0 0 1.67 64.00 1,721,493 1,721,500 1,721,500
II Staf Puskesmas 40 24 1 0 1.67 61.33 69
69 Trisna Oktaviani,Am.Keb 1,649,764 1,649,800 1,649,800
5,022.13 135,087,000 135,087,000 3,929,835 3,482,530 127,674,635

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
TANDA TANGAN

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PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.481 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 67 ORANG 132,642,000
BULAN : APRIL 2015

VARIABEL
POIN JASA PPH Pas 21
KEHADIRAN
NO NAMA GOL JABATAN JENIS PER ORG PERHITUNG PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENA EFEKTIF 1 TIDAK JABATAN PER HARI AN POINT DITERIMA
GAAN PER ORG 15% 5%
BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 13 30 6.00 114.00 3,191,336 3,191,400 478,710 14.357.939.9.331.001 2,712,690 1
2 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 1 0 6.00 168.00 4,703,021 4,703,100 705,465 14.628.009.4.331.000 3,997,635 2
3 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 25 5 0 6.00 140.00 3,919,185 3,919,200 587,880 69.834.144.3.331.000 3,331,320 3
4 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 4,898,981 4,899,000 734,850 08.520.228.1.331.001 4,164,150 4
5 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 3,499,272 3,499,300 524,895 06.705.913.9.331.001 2,974,405 5
6 dr.Nining Indah Sari III Dokter 150 25 0 0 6.00 175.00 4,898,981 4,899,000 244,950 14.786.073.8.331.000 4,654,050 6
7 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,379,505 2,379,500 118,975 14.628.176.1.331.000 2,260,525 7
8 Diana Novita, S.Kep III Staf Puskesmas 60 25 4 0 2.40 71.40 1,998,784 1,998,800 99,940 14.519.602.8.331.000 1,898,860 8
9 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,379,505 2,379,500 118,975 14.628.177.9.331.000 2,260,525 9
10 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 2,379,505 2,379,500 118,975 16.270.140.3.331.000 2,260,525 10
11 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 1 0 2.40 81.60 2,284,325 2,284,400 114,220 16.270.144.5.331.000 2,170,180 11
12 Sumiati, Am.Keb III Staf Puskesmas 40 25 1 0 1.60 62.40 1,746,837 1,746,900 87,345 14.520.497.0.331.000 1,659,555 12
13 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,659,447 2,659,500 132,975 14.583.707.6.331.001 2,526,525 13
14 Pudjiati, SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 09.629.891.4.331.001 1,728,620 14
15 Hj. Fatmawati, S.ST III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.800.5.331.000 1,728,620 15
16 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.584.043.5.331.000 1,728,620 16
17 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.796.5.331.000 1,728,620 17
18 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 49.108.871.2.331.001 1,728,620 18
19 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.388.312.2.331.001 1,728,620 19
20 Yuliana Pariati, AMK III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 05.928.992.6.331.001 1,728,620 20
21 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 16.270.142.9.331.000 1,728,620 21
22 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 16.202.931.8.331.000 1,728,620 22
23 Komariah, Am. Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 49.630.002.5.331.001 1,728,620 23
24 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.801.3.331.000 1,728,620 24
25 Lidyawati, Am.Far III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 09.601.948.4.331.001 1,728,620 25
26 Hj.Metty Rosita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 49.768.731.9.331.001 1,728,620 26
27 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.680.064.4.331.000 1,728,620 27
28 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.584.108.6.331.000 1,728,620 28
29 Liti Puspita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.895.791.3.331.000 1,728,620 29
30 Jumiarsih III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.780.9.331.000 1,728,620 30
31 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.783.3.331.000 1,728,620 31
32 Juden III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.566.794.5.331.000 1,728,620 32
33 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.803.9.331.000 1,728,620 33
34 Suaibatul Aslamiyah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 15.746.478.5.331.000 1,728,620 34
35 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.595.781.7.331.000 1,728,620 35
36 Hidayati III Staf Puskesmas 40 25 2 0 1.60 59.80 1,674,052 1,674,100 83,705 14.628.180.3.331.000 1,590,395 36
37 Hj. Sri Haryanti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 69.834.138.5.331.000 1,728,620 37
38 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,959,592 1,959,600 97,980 14.595.781.7.331.000 1,861,620 38
39 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 1,119,767 1,119,800 55,990 14.595.783.3.331.000 1,063,810 39
40 Novita Putriani, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.584.045.0.331.000 1,728,620 40
41 Saflina, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.644.277.7.331.000 1,728,620 41
42 Yetti Herlinda, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 90,980 14.584.042.7.331.000 1,728,620 42
43 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 43
44 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 44
45 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 45
46 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 46
47 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 47
48 Deasy Andriani II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 48
49 Leny Marlina II Staf Puskesmas 40 25 2 0 1.60 59.80 1,674,052 1,674,100 1,674,100 49
50 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 50
51 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 51
52 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 52
53 Netti Herawati II Staf Puskesmas 40 25 1 0 1.60 62.40 1,746,837 1,746,900 1,746,900 53
54 Zuraida II Staf Puskesmas 25 25 0 0 1.00 50.00 1,399,709 1,399,700 1,399,700 54
55 Nani Hidayati II Staf Puskesmas 25 25 25 0 1.00 - - - - 55
56 Yuniarti II Staf Puskesmas 40 25 10 0 1.60 39.00 1,091,773 1,091,800 1,091,800 56
57 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 1,119,767 1,119,800 1,119,800 57
58 Satirah II Staf Puskesmas 15 25 0 0 0.60 40.00 1,119,767 1,119,800 1,119,800 58
59 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 1,119,767 1,119,800 1,119,800 59
60 Nurhayati,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 60
61 Trisna Oktaviani,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 61
62 Lindawati,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 62
63 Meta susanti,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 63
63 Rts.Leli Fitriani,AmTG II CPNS 40 25 2 0 1.60 59.80 1,674,052 1,674,100 1,674,100 64
65 Erni MasrianaBr.Batubara II CPNS 40 25 0 0 1.60 65.00 1,819,621 1,819,600 1,819,600 65
66 Yenni Liyestana,AMAK II CPNS 40 25 0 0 1.60 65.00 1,819,621 1,819,700 1,819,700 66
67 Erwis Hartaty II CPNS 25 25 0 0 1.00 50.00 1,399,709 1,399,700 1,399,700 67
4,738.20 132,642,000 132,642,000 3,031,800 3,639,510 125,970,690

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.574 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 67 ORANG 133,049,250
BULAN : MEI 2015

VARIABEL
PPH Pas 21
KEHADIRAN POIN PER PERHITUNG JASA
JENIS JUMLAH
NO NAMA GOL JABATAN ORG PER AN POINT PELAYANAN PEMBULATAN NPWP TANDA TANGAN
KETENAGA EFEKTIF TIDAK JABATA HARI DITERIMA BERSIH
N PER ORG 15% 5%
AN 1 BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 23 0 30 6.52 203.00 5,756,340 5,756,300 863,445 14.357.939.9.331.001 4,892,855 1
2 Marbawi III Kepala Tata Usaha 15 23 2 30 0.65 64.70 1,834,533 1,834,500 91,725 14.595.781.7.331.000 1,742,775 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 23 0 0 6.52 173.00 4,905,649 4,905,600 735,840 14.628.009.4.331.000 4,169,760 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 23 2 0 6.52 157.96 4,479,071 4,479,100 671,865 69.834.144.3.331.000 3,807,235 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 23 0 0 6.52 173.00 4,905,649 4,905,600 735,840 08.520.228.1.331.001 4,169,760 5
6 dra.Dharmashanti.G IV Apoteker 100 23 0 0 4.35 123.00 3,487,832 3,487,800 523,170 06.705.913.9.331.001 2,964,630 6
7 dr.Nining Indah Sari III Dokter 150 23 2 0 6.52 157.96 4,479,071 4,479,100 223,955 14.786.073.8.331.000 4,255,145 7
8 Ns.Ana, S.Kep III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 14.628.176.1.331.000 2,235,920 8
9 Diana Novita, S.Kep III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 14.519.602.8.331.000 2,235,920 9
10 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 23 6 0 2.61 61.35 1,739,601 1,739,600 86,980 14.628.177.9.331.000 1,652,620 10
11 Zulkartoni, SKM III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 16.270.140.3.331.000 2,235,920 11
12 Risa Dona Emalia, SKM III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 16.270.144.5.331.000 2,235,920 12
13 Sumiati, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.520.497.0.331.000 1,697,128 13
14 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 23 1 30 1.74 90.26 2,559,469 2,559,500 127,975 14.583.707.6.331.001 2,431,525 14
15 Pudjiati, SKM III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 09.629.891.4.331.001 1,697,128 15
16 Hj. Fatmawati, S.ST III Staf Puskesmas 40 23 2 0 1.74 57.52 1,631,107 1,631,100 81,555 14.595.800.5.331.000 1,549,545 16
17 Tin Marlina, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.584.043.5.331.000 1,697,128 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.796.5.331.000 1,697,128 18
19 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 49.108.871.2.331.001 1,697,128 19
20 Hartati, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.388.312.2.331.001 1,697,128 20
21 Yuliana Pariati, AMK III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 05.928.992.6.331.001 1,697,128 21
22 Chamidah, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 16.270.142.9.331.000 1,697,128 22
23 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 16.202.931.8.331.000 1,697,128 23
24 Komariah, Am. Kep III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 49.630.002.5.331.001 1,697,128 24
25 Hj.Tartilah, Am.KG III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.801.3.331.000 1,697,128 25
26 Lidyawati, Am.Far III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 09.601.948.4.331.001 1,697,128 26
27 Hj.Metty Rosita III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 49.768.731.9.331.001 1,697,128 27
28 Surya Nirwana III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.680.064.4.331.000 1,697,128 28
29 Hj.Erni trisnawati III Staf Puskesmas 40 23 1 0 1.74 60.26 1,708,779 1,708,800 85,440 14.584.108.6.331.000 1,623,360 29
30 Liti Puspita III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.895.791.3.331.000 1,697,128 30
31 Jumiarsih III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.780.9.331.000 1,697,128 31
32 Hartini III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.783.3.331.000 1,697,128 32
33 Juden III Staf Puskesmas 40 23 1 0 1.74 60.26 1,708,779 1,708,800 85,440 14.566.794.5.331.000 1,623,360 33
34 Elis Fatmah III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.803.9.331.000 1,697,128 34
35 Suaibatul Aslamiyah III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 15.746.478.5.331.000 1,697,128 35
36 Mildarianto III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.781.7.331.000 1,697,128 36
37 Hidayati III Staf Puskesmas 40 23 1 0 1.74 60.26 1,708,779 1,708,800 85,440 14.628.180.3.331.000 1,623,360 37
38 Hj. Sri Haryanti III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 69.834.138.5.331.000 1,697,128 38
39 Yuliarti III Staf Puskesmas 15 23 13 0 0.65 16.52 468,496 468,500 23,425 14.595.783.3.331.000 445,075 39
40 Novita Putriani, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.584.045.0.331.000 1,697,128 40
41 Saflina, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.644.277.7.331.000 1,697,127 41
42 Yetti Herlinda, Am.Keb II Staf Puskesmas 40 23 10 0 1.74 35.61 1,009,733 1,009,800 50,490 14.584.042.7.331.000 959,310 42
43 Novianti, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 43
44 Paraswati, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 44
45 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 45
46 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 46
47 Lismayanti II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 47
48 Deasy Andriani II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 48
49 Leny Marlina II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 49
50 Anggraini II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 50
51 Murni II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 51
52 Elfi Maulinda II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 52
53 Netti Herawati II Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 53
54 Zuraida II Staf Puskesmas 25 23 0 0 1.09 48.00 1,361,105 1,361,100 1,361,100 54
55 Nani Hidayati II Staf Puskesmas 25 23 8 0 1.09 31.30 887,677 887,700 887,700 55
56 Yuniarti II Staf Puskesmas 40 23 8 0 1.74 41.09 1,165,076 1,165,100 1,165,100 56
57 Rohaina II Staf Puskesmas 15 23 0 0 0.65 38.00 1,077,541 1,077,500 1,077,500 57
58 Satirah II Staf Puskesmas 15 23 0 0 0.65 38.00 1,077,541 1,077,500 1,077,500 58
59 M. Saleh II Staf Puskesmas 15 23 0 0 0.65 38.00 1,077,541 1,077,500 1,077,500 59
60 Nurhayati,Am.Keb II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 60
61 Trisna Oktaviani,Am.Keb II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 61
62 Lindawati,Am.Kep II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 62
63 Meta susanti,Am.Kep II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 63
63 Rts.Leli Fitriani,AmTG II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 64
65 Erni MasrianaBr.Batubara II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 65
66 Yenni Liyestana,AMAK II CPNS 40 23 0 0 1.74 63.00 1,786,450 1,786,450 1,786,450 66
67 Erwis Hartaty II CPNS 25 23 0 0 1.09 48.00 1,361,105 1,361,100 1,361,100 67
4,692.04 133,049,250 133,049,250 3,530,160 3,467,563 126,051,527

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu
dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb
NIP.196905032000122001 NIP.19731110 199303 2 006

VARIABEL
PPH Pas 21
KEHADIRAN POIN PER PERHITUNG JASA
JENIS JUMLAH
NO NAMA GOL JABATAN JABATA ORG PER PELAYANAN PEMBULATAN NPWP TANDA TANGAN
KETENAGA EFEKTIF TIDAK AN POINT BERSIH
N HARI DITERIMA
AN PER ORG 15% 5%
1 BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 23 0 30 6.52 203.00 5,756,340 5,756,300 863,445 14.357.939.9.331.001 4,892,855 1
2 Marbawi III Kepala Tata Usaha 15 23 2 30 0.65 64.70 1,834,533 1,834,500 91,725 14.595.781.7.331.000 1,742,775
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 23 0 0 6.52 173.00 4,905,649 4,905,600 735,840 14.628.009.4.331.000 4,169,760
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 23 2 0 6.52 157.96 4,479,071 4,479,100 671,865 69.834.144.3.331.000 3,807,235
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 23 0 0 6.52 173.00 4,905,649 4,905,600 735,840 08.520.228.1.331.001 4,169,760
6 dra.Dharmashanti.G IV Apoteker 100 23 0 0 4.35 123.00 3,487,832 3,487,800 523,170 06.705.913.9.331.001 2,964,630
7 dr.Nining Indah Sari III Dokter 150 23 2 0 6.52 157.96 4,479,071 4,479,100 223,955 14.786.073.8.331.000 4,255,145
8 Ns.Ana, S.Kep III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 14.628.176.1.331.000 2,235,920
9 Diana Novita, S.Kep III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 14.519.602.8.331.000 2,235,920
10 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 23 6 0 2.61 61.35 1,739,601 1,739,600 86,980 14.628.177.9.331.000 1,652,620
11 Zulkartoni, SKM III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 16.270.140.3.331.000 2,235,920
12 Risa Dona Emalia, SKM III Staf Puskesmas 60 23 0 0 2.61 83.00 2,353,577 2,353,600 117,680 16.270.144.5.331.000 2,235,920
13 Sumiati, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.520.497.0.331.000 1,697,128
14 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 23 1 30 1.74 90.26 2,559,469 2,559,500 127,975 14.583.707.6.331.001 2,431,525
15 Pudjiati, SKM III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 09.629.891.4.331.001 1,697,128
16 Hj. Fatmawati, S.ST III Staf Puskesmas 40 23 2 0 1.74 57.52 1,631,107 1,631,100 81,555 14.595.800.5.331.000 1,549,545
17 Tin Marlina, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.584.043.5.331.000 1,697,128
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.796.5.331.000 1,697,128
19 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 49.108.871.2.331.001 1,697,128
20 Hartati, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.388.312.2.331.001 1,697,128
21 Yuliana Pariati, AMK III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 05.928.992.6.331.001 1,697,128
22 Chamidah, Am.Keb III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 16.270.142.9.331.000 1,697,128
23 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 16.202.931.8.331.000 1,697,128
24 Komariah, Am. Kep III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 49.630.002.5.331.001 1,697,128
25 Hj.Tartilah, Am.KG III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.801.3.331.000 1,697,128
26 Lidyawati, Am.Far III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 09.601.948.4.331.001 1,697,128
27 Hj.Metty Rosita III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 49.768.731.9.331.001 1,697,128
28 Surya Nirwana III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.680.064.4.331.000 1,697,128
29 Hj.Erni trisnawati III Staf Puskesmas 40 23 1 0 1.74 60.26 1,708,779 1,708,800 85,440 14.584.108.6.331.000 1,623,360
30 Liti Puspita III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.895.791.3.331.000 1,697,128
31 Jumiarsih III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.780.9.331.000 1,697,128
32 Hartini III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.783.3.331.000 1,697,128
33 Juden III Staf Puskesmas 40 23 1 0 1.74 60.26 1,708,779 1,708,800 85,440 14.566.794.5.331.000 1,623,360
34 Elis Fatmah III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.803.9.331.000 1,697,128
35 Suaibatul Aslamiyah III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 15.746.478.5.331.000 1,697,128
36 Mildarianto III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 14.595.781.7.331.000 1,697,128
37 Hidayati III Staf Puskesmas 40 23 1 0 1.74 60.26 1,708,779 1,708,800 85,440 14.628.180.3.331.000 1,623,360
38 Hj. Sri Haryanti III Staf Puskesmas 40 23 0 0 1.74 63.00 1,786,450 1,786,450 89,323 69.834.138.5.331.000 1,697,128
39 Yuliarti III Staf Puskesmas 15 23 13 0 0.65 ### 468,496 468,500 23,425 14.595.783.3.331.000 445,075
40 Novita Putriani, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 89,323 14.584.045.0.331.000 1,697,128
41 Saflina, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 89,323 14.644.277.7.331.000 1,697,128
42 Yetti Herlinda, Am.Keb II Staf Puskesmas 40 23 10 0 1.74 ### 1,009,733 1,009,800 50,490 14.584.042.7.331.000 959,310
43 Novianti, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
44 Paraswati, Am.Keb II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
45 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
46 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
47 Lismayanti II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
48 Deasy Andriani II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
49 Leny Marlina II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
50 Anggraini II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
51 Murni II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
52 Elfi Maulinda II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
53 Netti Herawati II Staf Puskesmas 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
54 Zuraida II Staf Puskesmas 25 23 0 0 1.09 ### 1,361,105 1,361,100 1,361,100
55 Nani Hidayati II Staf Puskesmas 25 23 8 0 1.09 ### 887,677 887,700 887,700
56 Yuniarti II Staf Puskesmas 40 23 8 0 1.74 ### 1,165,076 1,165,100 1,165,100
57 Rohaina II Staf Puskesmas 15 23 0 0 0.65 ### 1,077,541 1,077,500 1,077,500
58 Satirah II Staf Puskesmas 15 23 0 0 0.65 ### 1,077,541 1,077,500 1,077,500
59 M. Saleh II Staf Puskesmas 15 23 0 0 0.65 ### 1,077,541 1,077,500 1,077,500
60 Nurhayati,Am.Keb II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
61 Trisna Oktaviani,Am.Keb II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
62 Lindawati,Am.Kep II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
63 Meta susanti,Am.Kep II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
63 Rts.Leli Fitriani,AmTG II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
65 Erni MasrianaBr.Batubara II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
66 Yenni Liyestana,AMAK II CPNS 40 23 0 0 1.74 ### 1,786,450 1,786,450 1,786,450
67 Erwis Hartaty II CPNS 25 23 0 0 1.09 48.00 1,361,105 1,361,100 1,361,100

### 133,049,250 133,049,250


JUMLAH YANG DITERIMA TOTAL PPH Pasal 21 TOTAL JUMLAH YANG DITERIMA TOTAL
NO NAMA
JANUARI FEBRUARI MARET APRIL JANUARI FEBRUARI MARET APRIL JANUARI FEBRUARI MARET APRIL
1 dr.Hj.Rini K 6,201,500 5,560,600 5,661,500 3,191,400 20,615,000 930,225 834,090 849,225 478,710 3,092,250 5,271,275 4,726,510 4,812,275 2,712,690 17,522,750
2 Marbawi 2,117,600 1,862,700 1,889,000 1,959,600 7,828,900 105,880 93,135 94,450 97,980 391,445 2,011,720 1,769,565 1,794,550 1,861,620 7,437,455
3 drg.Yohana M 5,294,000 4,738,800 4,833,000 4,703,100 19,568,900 794,100 710,820 724,950 705,465 2,935,335 4,499,900 4,027,980 4,108,050 3,997,635 16,633,565
4 drg.Galuh P 5,082,200 4,738,800 4,059,800 3,919,200 17,800,000 762,330 710,820 608,970 587,880 2,670,000 4,319,870 4,027,980 3,450,830 3,331,320 15,130,000
5 dr.Hj.Imat R 5,294,000 4,738,800 4,833,000 4,899,000 19,764,800 794,100 710,820 724,950 734,850 2,964,720 4,499,900 4,027,980 4,108,050 4,164,150 16,800,080
6 dra.Dharma.S 3,781,400 3,369,200 3,452,200 3,499,300 14,102,100 567,210 505,380 517,830 524,895 2,115,315 3,214,190 2,863,820 2,934,370 2,974,405 11,986,785
7 dr.Nining I.S 1,739,900 4,899,000 6,638,900 86,995 244,950 331,945 - - 1,652,905 4,654,050 6,306,955
8 Ns.Ana, S.Kep 2,571,400 2,075,800 2,347,500 2,379,500 9,374,200 128,570 103,790 117,375 118,975 468,710 2,442,830 1,972,010 2,230,125 2,260,525 8,905,490
9 Diana Novita 2,365,600 2,273,600 751,200 1,998,800 7,389,200 118,280 113,680 37,560 99,940 369,460 2,247,320 2,159,920 713,640 1,898,860 7,019,740
10 Eva Febrina Y 2,571,400 2,273,600 2,347,500 2,379,500 9,572,000 128,570 113,680 117,375 118,975 478,600 2,442,830 2,159,920 2,230,125 2,260,525 9,093,400
11 Zulkartoni 2,571,400 2,273,600 2,347,500 2,379,500 9,572,000 128,570 113,680 117,375 118,975 478,600 2,442,830 2,159,920 2,230,125 2,260,525 9,093,400
12 Risa Dona E 925,700 2,273,600 2,347,500 2,284,400 7,831,200 46,285 113,680 117,375 114,220 391,560 879,415 2,159,920 2,230,125 2,170,180 7,439,640
13 Sumiati 1,809,000 1,725,700 1,723,300 1,746,900 7,004,900 90,450 86,285 86,165 87,345 350,245 1,718,550 1,639,415 1,637,135 1,659,555 6,654,655
14 Yuslindawati 2,873,900 2,547,500 2,623,700 2,659,500 10,704,600 143,695 127,375 131,185 132,975 535,230 2,730,205 2,420,125 2,492,515 2,526,525 10,169,370
15 Pudjiati 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
16 Hj. Fatmawati 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
17 Tin Marlina 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
18 Widya Trisianti 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
19 Gusniar H 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
20 Hartati 1,730,400 1,725,700 1,795,100 1,819,600 7,070,800 86,520 86,285 89,755 90,980 353,540 1,643,880 1,639,415 1,705,345 1,728,620 6,717,260
21 Yuliana P 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
22 Chamidah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
23 Nurjanah L 1,651,700 1,425,600 1,723,300 1,819,600 6,620,200 82,585 71,280 86,165 90,980 331,010 1,569,115 1,354,320 1,637,135 1,728,620 6,289,190
24 Komariah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
25 Hj.Tartilah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
26 Lidyawati 1,966,300 1,650,700 1,795,100 1,819,600 7,231,700 98,315 82,535 89,755 90,980 361,585 1,867,985 1,568,165 1,705,345 1,728,620 6,870,115
27 Hj.Metty R 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
28 Surya N 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
29 Hj.Erni T 1,966,300 1,650,700 1,795,100 1,819,600 7,231,700 98,315 82,535 89,755 90,980 361,585 1,867,985 1,568,165 1,705,345 1,728,620 6,870,115
30 Liti Puspita 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
31 Jumiarsih 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
32 Hartini 1,966,300 1,725,700 1,723,300 1,819,600 7,234,900 98,315 86,285 86,165 90,980 361,745 1,867,985 1,639,415 1,637,135 1,728,620 6,873,155
33 Juden 1,337,100 1,575,600 1,795,100 1,819,600 6,527,400 66,855 78,780 89,755 90,980 326,370 1,270,245 1,496,820 1,705,345 1,728,620 6,201,030
34 Elis Fatmah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
35 Suaibatul A 1,887,700 1,725,700 1,795,100 1,819,600 7,228,100 94,385 86,285 89,755 90,980 361,405 1,793,315 1,639,415 1,705,345 1,728,620 6,866,695
36 Mildarianto 1,966,300 1,725,700 861,700 1,819,600 6,373,300 98,315 86,285 43,085 90,980 318,665 1,867,985 1,639,415 818,615 1,728,620 6,054,635
37 Hidayati 1,966,300 1,650,700 1,651,500 1,674,100 6,942,600 98,315 82,535 82,575 83,705 347,130 1,867,985 1,568,165 1,568,925 1,590,395 6,595,470
38 Hj. Sri H 1,887,700 1,725,700 1,795,100 1,819,600 7,228,100 94,385 86,285 89,755 90,980 361,405 1,793,315 1,639,415 1,705,345 1,728,620 6,866,695
39 Yuliarti 1,210,100 1,040,900 1,104,700 1,119,800 4,475,500 60,505 52,045 55,235 55,990 223,775 1,149,595 988,855 1,049,465 1,063,810 4,251,725
40 Novita P 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
41 Saflina 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
42 Yetti H 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
43 Novianti 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700
44 Paraswati 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700
45 Maria H. S 1,651,700 1,725,700 1,795,100 1,819,600 6,992,100 1,651,700 1,725,700 1,795,100 1,819,600 6,992,100
46 Ardiany D 1,966,300 1,725,700 1,651,500 1,819,600 7,163,100 1,966,300 1,725,700 1,651,500 1,819,600 7,163,100
47 Lismayanti 1,179,800 1,725,700 1,795,100 1,819,600 6,520,200 1,179,800 1,725,700 1,795,100 1,819,600 6,520,200
48 Deasy A 1,730,400 1,650,700 1,795,100 1,819,600 6,995,800 1,730,400 1,650,700 1,795,100 1,819,600 6,995,800
49 Leny M 1,966,300 1,725,700 1,795,100 1,674,100 7,161,200 1,966,300 1,725,700 1,795,100 1,674,100 7,161,200
50 Anggraini 1,966,300 1,650,700 1,795,100 1,819,600 7,231,700 1,966,300 1,650,700 1,795,100 1,819,600 7,231,700
51 Murni 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700
52 Elfi Maulinda 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700
53 Netti H 1,966,300 1,650,700 1,651,500 1,746,900 7,015,400 1,966,300 1,650,700 1,651,500 1,746,900 7,015,400
54 Zuraida 1,512,600 1,314,800 1,380,900 1,399,700 5,608,000 1,512,600 1,314,800 1,380,900 1,399,700 5,608,000
55 Nani H 1,512,600 400,100 - - 1,912,700 1,512,600 400,100 - - 1,912,700
56 Yuniarti 1,966,300 1,575,600 1,795,100 1,091,800 6,428,800 1,966,300 1,575,600 1,795,100 1,091,800 6,428,800
57 Rohaina 968,000 1,040,900 1,104,700 1,119,800 4,233,400 968,000 1,040,900 1,104,700 1,119,800 4,233,400
58 Satirah 1,161,700 1,040,900 1,104,700 1,119,800 4,427,100 1,161,700 1,040,900 1,104,700 1,119,800 4,427,100
59 M. Saleh 1,210,100 1,040,900 1,104,700 1,119,800 4,475,500 1,210,100 1,040,900 1,104,700 1,119,800 4,475,500
60 Nurhayati 1,725,700 1,795,100 1,819,600 5,340,400 - 1,725,700 1,795,100 1,819,600 5,340,400
61 Trisna O 1,725,700 1,795,100 1,819,600 5,340,400 - 1,725,700 1,795,100 1,819,600 5,340,400
62 Lindawati 1,725,700 1,795,100 1,819,600 5340400 - 1,725,700 1,795,100 1,819,600 5,340,400
63 Meta s 1,725,700 1,795,100 1,819,600 5340400 - 1,725,700 1,795,100 1,819,600 5,340,400
63 Rts.Leli F 1,725,700 1,795,100 1,674,100 5194900 - 1,725,700 1,795,100 1,674,100 5,194,900
65 Erni Masriana 1,725,700 1,795,100 1,819,600 5340400 - 1,725,700 1,795,100 1,819,600 5,340,400
66 Yenni L 1,725,700 1,795,100 1,819,700 5340500 - 1,725,700 1,795,100 1,819,700 5,340,500
67 Erwis Hartaty 1,314,800 1,380,900 1,399,700 4095400 - 1,314,800 1,380,900 1,399,700 4,095,400
125,046,000 125,977,500 129,204,000 132,642,000 512,869,500 7,386,430 6,685,215 6,749,370 6,671,310 27,492,325 117,659,570 119,292,285 122,454,630 125,970,690 485,377,175

JUMLAH YANG DITERIMA TOTAL PPH Pasal 21 TOTAL JUMLAH YANG DITERIMA TOTAL
NO NAMA
JANUARI FEBRUARI MARET APRIL JANUARI FEBRUARI MARET APRIL JANUARI FEBRUARI MARET APRIL
1 dr.Hj.Rini K 6,201,500 5,560,600 5,661,500 3,191,400 20,615,000 930,225 834,090 849,225 478,710 3,092,250 5,271,275 4,726,510 4,812,275 2,712,690 17,522,750
2 Marbawi 2,117,600 1,862,700 1,889,000 1,959,600 7,828,900 105,880 93,135 94,450 97,980 391,445 2,011,720 1,769,565 1,794,550 1,861,620 7,437,455
3 drg.Yohana M 5,294,000 4,738,800 4,833,000 4,703,100 19,568,900 794,100 710,820 724,950 705,465 2,935,335 4,499,900 4,027,980 4,108,050 3,997,635 16,633,565
4 drg.Galuh P 5,082,200 4,738,800 4,059,800 3,919,200 17,800,000 762,330 710,820 608,970 587,880 2,670,000 4,319,870 4,027,980 3,450,830 3,331,320 15,130,000
5 dr.Hj.Imat R 5,294,000 4,738,800 4,833,000 4,899,000 19,764,800 794,100 710,820 724,950 734,850 2,964,720 4,499,900 4,027,980 4,108,050 4,164,150 16,800,080
6 dra.Dharma.S 3,781,400 3,369,200 3,452,200 3,499,300 14,102,100 567,210 505,380 517,830 524,895 2,115,315 3,214,190 2,863,820 2,934,370 2,974,405 11,986,785
7 dr.Nining I.S 1,739,900 4,899,000 6,638,900 86,995 244,950 331,945 - - 1,652,905 4,654,050 6,306,955
8 Ns.Ana, S.Kep 2,571,400 2,075,800 2,347,500 2,379,500 9,374,200 128,570 103,790 117,375 118,975 468,710 2,442,830 1,972,010 2,230,125 2,260,525 8,905,490
9 Diana Novita 2,365,600 2,273,600 751,200 1,998,800 7,389,200 118,280 113,680 37,560 99,940 369,460 2,247,320 2,159,920 713,640 1,898,860 7,019,740
10 Eva Febrina Y 2,571,400 2,273,600 2,347,500 2,379,500 9,572,000 128,570 113,680 117,375 118,975 478,600 2,442,830 2,159,920 2,230,125 2,260,525 9,093,400
11 Zulkartoni 2,571,400 2,273,600 2,347,500 2,379,500 9,572,000 128,570 113,680 117,375 118,975 478,600 2,442,830 2,159,920 2,230,125 2,260,525 9,093,400
12 Risa Dona E 925,700 2,273,600 2,347,500 2,284,400 7,831,200 46,285 113,680 117,375 114,220 391,560 879,415 2,159,920 2,230,125 2,170,180 7,439,640
13 Sumiati 1,809,000 1,725,700 1,723,300 1,746,900 7,004,900 90,450 86,285 86,165 87,345 350,245 1,718,550 1,639,415 1,637,135 1,659,555 6,654,655
14 Yuslindawati 2,873,900 2,547,500 2,623,700 2,659,500 10,704,600 143,695 127,375 131,185 132,975 535,230 2,730,205 2,420,125 2,492,515 2,526,525 10,169,370
15 Pudjiati 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
16 Hj. Fatmawati 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
17 Tin Marlina 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
18 Widya Trisianti 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
19 Gusniar H 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
20 Hartati 1,730,400 1,725,700 1,795,100 1,819,600 7,070,800 86,520 86,285 89,755 90,980 353,540 1,643,880 1,639,415 1,705,345 1,728,620 6,717,260
21 Yuliana P 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
22 Chamidah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
23 Nurjanah L 1,651,700 1,425,600 1,723,300 1,819,600 6,620,200 82,585 71,280 86,165 90,980 331,010 1,569,115 1,354,320 1,637,135 1,728,620 6,289,190
24 Komariah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
25 Hj.Tartilah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
26 Lidyawati 1,966,300 1,650,700 1,795,100 1,819,600 7,231,700 98,315 82,535 89,755 90,980 361,585 1,867,985 1,568,165 1,705,345 1,728,620 6,870,115
27 Hj.Metty R 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
28 Surya N 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
29 Hj.Erni T 1,966,300 1,650,700 1,795,100 1,819,600 7,231,700 98,315 82,535 89,755 90,980 361,585 1,867,985 1,568,165 1,705,345 1,728,620 6,870,115
30 Liti Puspita 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
31 Jumiarsih 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
32 Hartini 1,966,300 1,725,700 1,723,300 1,819,600 7,234,900 98,315 86,285 86,165 90,980 361,745 1,867,985 1,639,415 1,637,135 1,728,620 6,873,155
33 Juden 1,337,100 1,575,600 1,795,100 1,819,600 6,527,400 66,855 78,780 89,755 90,980 326,370 1,270,245 1,496,820 1,705,345 1,728,620 6,201,030
34 Elis Fatmah 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
35 Suaibatul A 1,887,700 1,725,700 1,795,100 1,819,600 7,228,100 94,385 86,285 89,755 90,980 361,405 1,793,315 1,639,415 1,705,345 1,728,620 6,866,695
36 Mildarianto 1,966,300 1,725,700 861,700 1,819,600 6,373,300 98,315 86,285 43,085 90,980 318,665 1,867,985 1,639,415 818,615 1,728,620 6,054,635
37 Hidayati 1,966,300 1,650,700 1,651,500 1,674,100 6,942,600 98,315 82,535 82,575 83,705 347,130 1,867,985 1,568,165 1,568,925 1,590,395 6,595,470
38 Hj. Sri H 1,887,700 1,725,700 1,795,100 1,819,600 7,228,100 94,385 86,285 89,755 90,980 361,405 1,793,315 1,639,415 1,705,345 1,728,620 6,866,695
39 Yuliarti 1,210,100 1,040,900 1,104,700 1,119,800 4,475,500 60,505 52,045 55,235 55,990 223,775 1,149,595 988,855 1,049,465 1,063,810 4,251,725
40 Novita P 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
41 Saflina 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
42 Yetti H 1,966,300 1,725,700 1,795,100 1,819,600 7,306,700 98,315 86,285 89,755 90,980 365,335 1,867,985 1,639,415 1,705,345 1,728,620 6,941,365
43 Novianti
44 Paraswati
45 Maria H. S
46 Ardiany D
47 Lismayanti
48 Deasy A
49 Leny M
50 Anggraini
51 Murni
52 Elfi Maulinda
53 Netti H
54 Zuraida
55 Nani H
56 Yuniarti
57 Rohaina
58 Satirah
59 M. Saleh
60 Nurhayati
61 Trisna O
62 Lindawati
63 Meta s
63 Rts.Leli F
65 Erni Masriana
66 Yenni L
67 Erwis Hartaty
96,422,400 87,411,900 89,308,400 93,002,200 366,144,900 7,386,430 6,685,215 6,749,370 6,671,310 27,492,325 89,035,970 80,726,685 82,559,030 86,330,890 338,652,575
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.247 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 67 ORANG 131,611,500

BULAN : JUNI 2015

VARIABEL
POIN PER PERHITUNGA JASA PPH Pas 21
NO NAMA GOL JABATAN JENIS KEHADIRAN ORG PER N POINT PER PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENA EFEKTIF TIDAK JABATAN HARI DITERIMA
GAAN ORG 15% 5%
1 BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 5,691,818 5,691,800 853,770 14.357.939.9.331.001 4,838,030 1
2 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,943,548 1,943,600 97,180 14.595.781.7.331.000 1,846,420 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 7 0 6.00 126.00 3,498,386 3,498,400 524,760 14.628.009.4.331.000 2,973,640 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 25 1 0 6.00 168.00 4,664,515 4,664,500 699,675 69.834.144.3.331.000 3,964,825 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 4,858,869 4,858,900 728,835 08.520.228.1.331.001 4,130,065 5
6 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 3,470,621 3,470,600 520,590 06.705.913.9.331.001 2,950,010 6
7 dr.Nining Indah Sari III Dokter 150 25 1 0 6.00 168.00 4,664,515 4,664,500 233,225 14.786.073.8.331.000 4,431,275 7
8 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,360,022 2,360,000 118,000 14.628.176.1.331.000 2,242,000 8
9 Diana Novita, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,360,022 2,360,000 118,000 14.519.602.8.331.000 2,242,000 9
10 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,360,022 2,360,000 118,000 14.628.177.9.331.000 2,242,000 10
11 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 2,360,022 2,360,000 118,000 16.270.140.3.331.000 2,242,000 11
12 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 1 0 2.40 81.60 2,265,621 2,265,600 113,280 16.270.144.5.331.000 2,152,320 12
13 Sumiati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.520.497.0.331.000 1,714,465 13
14 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,637,672 2,637,700 131,885 14.583.707.6.331.001 2,505,815 14
15 Pudjiati, SKM III Staf Puskesmas 40 25 9 0 1.60 41.60 1,155,023 1,155,000 57,750 09.629.891.4.331.001 1,097,250 15
16 Hj. Fatmawati, S.ST III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.595.800.5.331.000 1,714,465 16
17 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.584.043.5.331.000 1,714,465 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 13 0 1.60 31.20 866,267 866,300 43,315 14.595.796.5.331.000 822,985 18
19 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 49.108.871.2.331.001 1,714,465 19
20 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.388.312.2.331.001 1,714,465 20
21 Yuliana Pariati, AMK III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 05.928.992.6.331.001 1,714,465 21
22 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 16.270.142.9.331.000 1,714,465 22
23 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 1 0 1.60 62.40 1,732,534 1,732,600 86,630 16.202.931.8.331.000 1,645,970 23
24 Komariah, Am. Kep III Staf Puskesmas 40 25 7 0 1.60 46.80 1,299,400 1,299,400 64,970 49.630.002.5.331.001 1,234,430 24
25 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 1 0 1.60 62.40 1,732,534 1,732,600 86,630 14.595.801.3.331.000 1,645,970 25
26 Lidyawati, Am.Far III Staf Puskesmas 40 25 1 0 1.60 62.40 1,732,534 1,732,600 86,630 09.601.948.4.331.001 1,645,970 26
27 Hj.Metty Rosita III Staf Puskesmas 40 25 12 0 1.60 33.80 938,456 938,500 46,925 49.768.731.9.331.001 891,575 27
28 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.680.064.4.331.000 1,714,465 28
29 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.584.108.6.331.000 1,714,465 29
30 Liti Puspita III Staf Puskesmas 40 25 1 0 1.60 62.40 1,732,534 1,732,600 86,630 14.895.791.3.331.000 1,645,970 30
31 Jumiarsih III Staf Puskesmas 40 25 1 0 1.60 62.40 1,732,534 1,732,600 86,630 14.595.780.9.331.000 1,645,970 31
32 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.595.783.3.331.000 1,714,465 32
33 Juden III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.566.794.5.331.000 1,714,465 33
34 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.595.803.9.331.000 1,714,465 34
35 Suaibatul Aslamiyah III Staf Puskesmas 40 25 3 0 1.60 57.20 1,588,156 1,588,200 79,410 15.746.478.5.331.000 1,508,790 35
36 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.595.781.7.331.000 1,714,465 36
37 Hidayati III Staf Puskesmas 40 25 1 0 1.60 62.40 1,732,534 1,732,600 86,630 14.628.180.3.331.000 1,645,970 37
38 Hj. Sri Haryanti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 69.834.138.5.331.000 1,714,465 38
39 Yuliarti III Staf Puskesmas 15 25 1 0 0.60 38.40 1,066,175 1,066,200 53,310 14.595.783.3.331.000 1,012,890 39
40 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.584.045.0.331.000 1,714,465 40
41 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.644.277.7.331.000 1,714,465 41
42 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 90,235 14.584.042.7.331.000 1,714,465 42
43 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 43
44 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 44
45 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 8 0 1.60 44.20 1,227,212 1,227,200 1,227,200 45
46 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 3 0 1.60 57.20 1,588,156 1,588,200 1,588,200 46
47 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 47
48 Deasy Andriani II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 48
49 Leny Marlina II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 49
50 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 50
51 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 51
52 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 52
53 Netti Herawati II Staf Puskesmas 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 53
54 Zuraida II Staf Puskesmas 25 25 0 0 1.00 50.00 1,388,248 1,388,300 1,388,300 54
55 Nani Hidayati II Staf Puskesmas 25 25 0 0 1.00 50.00 1,388,248 1,388,300 1,388,300 55
56 Yuniarti II Staf Puskesmas 40 25 2 0 1.60 59.80 1,660,345 1,660,300 1,660,300 56
II Staf Puskesmas 15 25 0 0 0.60 40.00 57
57 Rohaina 1,110,599 1,110,600 1,110,600
58 Satirah II Staf Puskesmas 15 25 0 0 0.60 40.00 1,110,599 1,110,600 1,110,600 58
59 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 1,110,599 1,110,600 1,110,600 59
60 Nurhayati,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 60
61 Trisna Oktaviani,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 61
62 Lindawati,Am.Kep II CPNS 40 25 4 0 1.60 54.60 1,515,967 1,516,000 1,516,000 62
63 Meta susanti,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 63
63 Rts.Leli Fitriani,AmTG II CPNS 40 25 1 0 1.60 62.40 1,732,534 1,732,600 1,732,600 64
65 Erni MasrianaBr.Batubara II CPNS 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 65
66 Yenni Liyestana,AMAK II CPNS 40 25 0 0 1.60 65.00 1,804,723 1,804,700 1,804,700 66
II CPNS 25 25 0 0 1.00 50.00 67
67 Erwis Hartaty 1,388,248 1,388,300 1,388,300
4,740.20 131,611,500 131,611,500 3,327,630 3,447,025 124,836,845

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.311 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 67 ORANG 131,877,000

BULAN : JULI 2015

VARIABEL
POIN PER PERHITUNGA JASA PPH Pas 21
NO NAMA GOL JABATAN JENIS KEHADIRAN ORG PER N POINT PER PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
JABATA
KETENAGA EFEKTIF 1 TIDAK HARI DITERIMA
N ORG 15% 5%
AN BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 22 0 30 6.82 202.00 5,856,514 5,856,500 878,475 14.357.939.9.331.001 4,978,025 1
2 Marbawi III Kepala Tata Usaha 15 22 0 30 0.68 67.00 1,942,507 1,942,500 97,125 14.595.781.7.331.000 1,845,375 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 22 0 0 6.82 172.00 4,986,735 4,986,700 748,005 14.628.009.4.331.000 4,238,695 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 22 5 0 6.82 132.91 3,853,386 3,853,400 578,010 69.834.144.3.331.000 3,275,390 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 22 0 0 6.82 172.00 4,986,735 4,986,700 748,005 08.520.228.1.331.001 4,238,695 5
6 dra.Dharmashanti.G IV Apoteker 100 22 0 0 4.55 122.00 3,537,103 3,537,100 530,565 06.705.913.9.331.001 3,006,535 6
7 dr.Nining Indah Sari III Dokter 150 22 0 0 6.82 172.00 4,986,735 4,986,700 249,335 14.786.073.8.331.000 4,737,365 7
8 Ns.Ana, S.Kep III Staf Puskesmas 60 22 2 0 2.73 74.55 2,161,270 2,161,300 108,065 14.628.176.1.331.000 2,053,235 8
9 Diana Novita, S.Kep III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 14.519.602.8.331.000 2,258,530 9
10 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 14.628.177.9.331.000 2,258,530 10
11 Zulkartoni, SKM III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 16.270.140.3.331.000 2,258,530 11
12 Risa Dona Emalia, SKM III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 16.270.144.5.331.000 2,258,530 12
13 Sumiati, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.520.497.0.331.000 1,707,720 13
14 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 22 0 30 1.82 92.00 2,667,323 2,667,300 133,365 14.583.707.6.331.001 2,533,935 14
15 Pudjiati, SKM III Staf Puskesmas 40 22 7 0 1.82 42.27 1,225,598 1,225,600 61,280 09.629.891.4.331.001 1,164,320 15
16 Hj. Fatmawati, S.ST III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.800.5.331.000 1,707,720 16
17 Tin Marlina, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.584.043.5.331.000 1,707,720 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.796.5.331.000 1,707,720 18
19 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 49.108.871.2.331.001 1,707,720 19
20 Hartati, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.388.312.2.331.001 1,707,720 20
21 Yuliana Pariati, AMK III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 05.928.992.6.331.001 1,707,720 21
22 Chamidah, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 16.270.142.9.331.000 1,707,720 22
23 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 16.202.931.8.331.000 1,630,010 23
24 Komariah, Am. Kep III Staf Puskesmas 40 22 5 0 1.82 47.91 1,389,011 1,389,000 69,450 49.630.002.5.331.001 1,319,550 24
25 Hj.Tartilah, Am.KG III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.801.3.331.000 1,707,720 25
26 Lidyawati, Am.Far III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 09.601.948.4.331.001 1,707,720 26
27 Hj.Metty Rosita III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 49.768.731.9.331.001 1,707,720 27
28 Surya Nirwana III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.680.064.4.331.000 1,707,720 28
29 Hj.Erni trisnawati III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.584.108.6.331.000 1,707,720 29
30 Liti Puspita III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.895.791.3.331.000 1,630,010 30
31 Jumiarsih III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.595.780.9.331.000 1,630,010 31
32 Hartini III Staf Puskesmas 40 22 3 0 1.82 53.55 1,552,424 1,552,400 77,620 14.595.783.3.331.000 1,474,780 32
33 Juden III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.566.794.5.331.000 1,630,010 33
34 Elis Fatmah III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.803.9.331.000 1,707,720 34
35 Suaibatul Aslamiyah III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 15.746.478.5.331.000 1,707,720 35
36 Mildarianto III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.781.7.331.000 1,707,720 36
37 Hidayati III Staf Puskesmas 40 22 11 0 1.82 31.00 898,772 898,800 44,940 14.628.180.3.331.000 853,860 37
38 Hj. Sri Haryanti III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 69.834.138.5.331.000 1,707,720 38
39 Yuliarti III Staf Puskesmas 15 22 0 0 0.68 37.00 1,072,728 1,072,700 53,635 14.595.783.3.331.000 1,019,065 39
40 Novita Putriani, Am.Keb III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.584.045.0.331.000 1,630,010 40
41 Saflina, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.644.277.7.331.000 1,707,720 41
42 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.584.042.7.331.000 1,707,720 42
43 Novianti, Am.Keb II Staf Puskesmas 40 22 9 0 1.82 36.64 1,062,185 1,062,200 1,062,200 43
44 Paraswati, Am.Keb II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 44
45 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 22 4 0 1.82 50.73 1,470,718 1,470,700 1,470,700 45
46 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 22 2 0 1.82 56.36 1,634,131 1,634,100 1,634,100 46
47 Lismayanti II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 47
48 Deasy Andriani II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 48
49 Leny Marlina II Staf Puskesmas 40 22 9 0 1.82 36.64 1,062,185 1,062,200 1,062,200 49
50 Anggraini II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 50
51 Murni II Staf Puskesmas 40 22 9 0 1.82 36.64 1,062,185 1,062,200 1,062,200 51
52 Elfi Maulinda II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 52
53 Netti Herawati II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 53
54 Zuraida II Staf Puskesmas 25 22 0 0 1.14 47.00 1,362,654 1,362,600 1,362,600 54
55 Nani Hidayati II Staf Puskesmas 25 22 0 0 1.14 47.00 1,362,654 1,362,600 1,362,600 55
56 Yuniarti II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 56
II Staf Puskesmas 15 22 0 0 0.68 37.00 57
57 Rohaina 1,072,728 1,072,700 1,072,700
58 Satirah II Staf Puskesmas 15 22 0 0 0.68 37.00 1,072,728 1,072,700 1,072,700 58
59 M. Saleh II Staf Puskesmas 15 22 0 0 0.68 37.00 1,072,728 1,072,700 1,072,700 59
60 Nurhayati,Am.Keb II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 60
61 Trisna Oktaviani,Am.Keb II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 61
62 Lindawati,Am.Kep II CPNS 40 22 1 0 1.82 59.18 1,715,837 1,715,800 1,715,800 62
63 Meta susanti,Am.Kep II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 63
63 Rts.Leli Fitriani,AmTG II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 64
65 Erni MasrianaBr.Batubara II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,500 1,797,500 65
66 Yenni Liyestana,AMAK II CPNS 40 22 2 0 1.82 56.36 1,634,131 1,634,100 1,634,100 66
II CPNS 25 22 0 0 1.14 47.00 67
67 Erwis Hartaty 1,362,654 1,362,700 1,362,700
4,548.64 131,877,000 131,877,000 3,483,060 3,506,965 124,886,975

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006

VARIABEL
POIN PER PERHITUNGA JASA PPH Pas 21
NO NAMA GOL JABATAN JENIS KEHADIRAN ORG PER N POINT PER PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAGA EFEKTIF 1 TIDAK JABATA HARI DITERIMA
AN N ORG 15% 5%
BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 22 0 30 6.82 202.00 5,856,514 5,856,500 878,475 14.357.939.9.331.001 4,978,025 1
2 Marbawi III Kepala Tata Usaha 15 22 0 30 0.68 67.00 1,942,507 1,942,500 97,125 14.595.781.7.331.000 1,845,375 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 22 0 0 6.82 172.00 4,986,735 4,986,700 748,005 14.628.009.4.331.000 4,238,695 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 22 5 0 6.82 132.91 3,853,386 3,853,400 578,010 69.834.144.3.331.000 3,275,390 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 22 0 0 6.82 172.00 4,986,735 4,986,700 748,005 08.520.228.1.331.001 4,238,695 5
6 dra.Dharmashanti.G IV Apoteker 100 22 0 0 4.55 122.00 3,537,103 3,537,100 530,565 06.705.913.9.331.001 3,006,535 6
7 dr.Nining Indah Sari III Dokter 150 22 0 0 6.82 172.00 4,986,735 4,986,700 249,335 14.786.073.8.331.000 4,737,365 7
8 Ns.Ana, S.Kep III Staf Puskesmas 60 22 2 0 2.73 74.55 2,161,270 2,161,300 108,065 14.628.176.1.331.000 2,242,000 8
9 Diana Novita, S.Kep III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 14.519.602.8.331.000 2,258,530 9
10 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 14.628.177.9.331.000 2,258,530 10
11 Zulkartoni, SKM III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 16.270.140.3.331.000 2,242,000 11
12 Risa Dona Emalia, SKM III Staf Puskesmas 60 22 0 0 2.73 82.00 2,377,397 2,377,400 118,870 16.270.144.5.331.000 2,258,530 12
13 Sumiati, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.520.497.0.331.000 1,707,720 13
14 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 22 0 30 1.82 92.00 2,667,323 2,667,300 133,365 14.583.707.6.331.001 2,533,935 14
15 Pudjiati, SKM III Staf Puskesmas 40 22 7 0 1.82 42.27 1,225,598 1,225,600 61,280 09.629.891.4.331.001 1,164,320 15
16 Hj. Fatmawati, S.ST III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.800.5.331.000 1,707,720 16
17 Tin Marlina, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.584.043.5.331.000 1,707,720 17
18 Widya Trisianti, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.796.5.331.000 1,707,720 18
19 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 49.108.871.2.331.001 1,707,720 19
20 Hartati, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.388.312.2.331.001 1,707,720 20
21 Yuliana Pariati, AMK III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 05.928.992.6.331.001 1,707,720 21
22 Chamidah, Am.Keb III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 16.270.142.9.331.000 1,707,720 22
23 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 16.202.931.8.331.000 1,630,010 23
24 Komariah, Am. Kep III Staf Puskesmas 40 22 5 0 1.82 47.91 1,389,011 1,389,000 69,450 49.630.002.5.331.001 1,319,550 24
25 Hj.Tartilah, Am.KG III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.801.3.331.000 1,707,720 25
26 Lidyawati, Am.Far III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 09.601.948.4.331.001 1,707,720 26
27 Hj.Metty Rosita III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 49.768.731.9.331.001 1,707,720 27
28 Surya Nirwana III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.680.064.4.331.000 1,707,720 28
29 Hj.Erni trisnawati III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.584.108.6.331.000 1,707,720 29
30 Liti Puspita III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.895.791.3.331.000 1,630,010 30
31 Jumiarsih III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.595.780.9.331.000 1,630,010 31
32 Hartini III Staf Puskesmas 40 22 3 0 1.82 53.55 1,552,424 1,552,400 77,620 14.595.783.3.331.000 1,474,780 32
33 Juden III Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.566.794.5.331.000 1,630,010 33
34 Elis Fatmah III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.803.9.331.000 1,707,720 34
35 Suaibatul Aslamiyah III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 15.746.478.5.331.000 1,707,720 35
36 Mildarianto III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.595.781.7.331.000 1,707,720 36
37 Hidayati III Staf Puskesmas 40 22 11 0 1.82 31.00 898,772 898,800 44,940 14.628.180.3.331.000 853,860 37
38 Hj. Sri Haryanti III Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 69.834.138.5.331.000 1,707,720 38
39 Yuliarti III Staf Puskesmas 15 22 0 0 0.68 37.00 1,072,728 1,072,700 53,635 14.595.783.3.331.000 1,019,065 39
40 Novita Putriani, Am.Keb II Staf Puskesmas 40 22 1 0 1.82 59.18 1,715,837 1,715,800 85,790 14.584.045.0.331.000 1,630,010 40
41 Saflina, Am.Keb II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.644.277.7.331.000 1,714,465 41
42 Yetti Herlinda, Am.Keb II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 89,880 14.584.042.7.331.000 1,707,720 42
43 Novianti, Am.Keb II Staf Puskesmas 40 22 9 0 1.82 36.64 1,062,185 1,062,200 1,062,200 43
44 Paraswati, Am.Keb II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 44
45 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 22 4 0 1.82 50.73 1,470,718 1,470,700 1,470,700 45
46 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 22 2 0 1.82 56.36 1,634,131 1,634,100 1,634,100 46
47 Lismayanti II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 47
48 Deasy Andriani II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 48
49 Leny Marlina II Staf Puskesmas 40 22 9 0 1.82 36.64 1,062,185 1,062,200 1,062,200 49
50 Anggraini II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 50
51 Murni II Staf Puskesmas 40 22 9 0 1.82 36.64 1,062,185 1,062,200 1,062,200 51
52 Elfi Maulinda II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 52
53 Netti Herawati II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 53
54 Zuraida II Staf Puskesmas 25 22 0 0 1.14 47.00 1,362,654 1,362,600 1,362,600 54
55 Nani Hidayati II Staf Puskesmas 25 22 0 0 1.14 47.00 1,362,654 1,362,600 1,362,600 55
56 Yuniarti II Staf Puskesmas 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 56
II Staf Puskesmas 15 22 0 0 0.68 37.00 57
57 Rohaina 1,072,728 1,072,700 1,072,700
58 Satirah II Staf Puskesmas 15 22 0 0 0.68 37.00 1,072,728 1,072,700 1,072,700 58
59 M. Saleh II Staf Puskesmas 15 22 0 0 0.68 37.00 1,072,728 1,072,700 1,072,700 59
60 Nurhayati,Am.Keb II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 60
61 Trisna Oktaviani,Am.Keb II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 61
62 Lindawati,Am.Kep II CPNS 40 22 1 0 1.82 59.18 1,715,837 1,715,800 1,715,800 62
63 Meta susanti,Am.Kep II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 63
63 Rts.Leli Fitriani,AmTG II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 64
65 Erni MasrianaBr.Batubara II CPNS 40 22 0 0 1.82 62.00 1,797,544 1,797,600 1,797,600 65
66 Yenni Liyestana,AMAK II CPNS 40 22 2 0 1.82 56.36 1,634,131 1,634,100 1,634,100 66
II CPNS 25 22 0 0 1.14 47.00 67
67 Erwis Hartaty 1,362,654 1,362,700 1,362,700
4,548.64 131,877,000 131,878,200 3,483,060 3,506,965 125,067,155
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.453 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 68 ORANG 110,426,250

BULAN : AGUSTUS 2015

VARIABEL
POIN PER PERHITUNG JASA PPH Pas 21
NO NAMA GOL JABATAN JENIS KEHADIRAN ORG PER AN POINT PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAG EFEKTIF TIDAK JABATA HARI DITERIMA
N PER ORG 15% 5%
AAN 1 BLN HADIR
1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 4,640,139 4,640,100 696,015 14.357.939.9.331.001 3,944,085 1
2 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,584,438 1,584,400 79,220 14.595.781.7.331.000 1,505,180 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 1 0 6.00 168.00 3,802,650 3,802,600 570,390 14.628.009.4.331.000 3,232,210 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 25 4 0 6.00 147.00 3,327,319 3,327,300 499,095 69.834.144.3.331.000 2,828,205 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 3,961,094 3,961,100 594,165 08.520.228.1.331.001 3,366,935 5
6 dra.Dharmashanti.G IV Apoteker 100 25 4 0 4.00 105.00 2,376,656 2,376,600 356,490 06.705.913.9.331.001 2,020,110 6
7 dr.Raja Nilawati IV Dokter 150 25 7 0 6.00 126.00 2,851,988 2,852,000 427,800 14.595.199.2.331.000 2,424,200 7
8 dr.Nining Indah Sari III Dokter 150 25 1 0 6.00 168.00 3,802,650 3,802,600 190,130 14.786.073.8.331.000 3,612,470 8
9 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 1,923,960 1,924,000 96,200 14.628.176.1.331.000 1,827,800 9
10 Diana Novita, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 1,923,960 1,924,000 96,200 14.519.602.8.331.000 1,827,800 10
11 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 8 0 2.40 57.80 1,308,293 1,308,300 65,415 14.628.177.9.331.000 1,242,885 11
12 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 1,923,960 1,924,000 96,200 16.270.140.3.331.000 1,827,800 12
13 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 1,923,960 1,924,000 96,200 16.270.144.5.331.000 1,827,800 13
14 Sumiati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.520.497.0.331.000 1,397,735 14
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,150,308 2,150,300 107,515 14.583.707.6.331.001 2,042,785 15
16 Pudjiati, SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 09.629.891.4.331.001 1,397,735 16
17 Hj. Fatmawati, S.ST III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.800.5.331.000 1,397,735 17
18 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 1 0 1.60 62.40 1,412,413 1,412,400 70,620 14.584.043.5.331.000 1,341,780 18
19 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.796.5.331.000 1,397,735 19
20 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 49.108.871.2.331.001 1,397,735 20
21 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.388.312.2.331.001 1,397,735 21
22 Yuliana Pariati, AMK III Staf Puskesmas 40 25 12 0 1.60 33.80 765,057 765,000 38,250 05.928.992.6.331.001 726,750 22
23 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 16.270.142.9.331.000 1,397,735 23
24 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 1 0 1.60 62.40 1,412,413 1,412,400 70,620 16.202.931.8.331.000 1,341,780 24
25 Komariah, Am. Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 49.630.002.5.331.001 1,397,735 25
26 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.801.3.331.000 1,397,735 26
27 Lidyawati, Am.Far III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 09.601.948.4.331.001 1,397,735 27
28 Hj.Metty Rosita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 49.768.731.9.331.001 1,397,735 28
29 Surya Nirwana III Staf Puskesmas 40 25 9 0 1.60 41.60 941,609 941,600 47,080 14.680.064.4.331.000 894,520 29
30 Hj.Erni trisnawati III Staf Puskesmas 40 25 12 0 1.60 33.80 765,057 765,000 38,250 14.584.108.6.331.000 726,750 30
31 Liti Puspita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.895.791.3.331.000 1,397,735 31
32 Jumiarsih III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.780.9.331.000 1,397,735 32
33 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.783.3.331.000 1,397,735 33
34 Juden III Staf Puskesmas 40 25 1 0 1.60 62.40 1,412,413 1,412,400 70,620 14.566.794.5.331.000 1,341,780 34
35 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.803.9.331.000 1,397,735 35
36 Suaibatul Aslamiyah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 15.746.478.5.331.000 1,397,735 36
37 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.595.781.7.331.000 1,397,735 37
38 Hidayati III Staf Puskesmas 40 25 1 0 1.60 62.40 1,412,413 1,412,400 70,620 14.628.180.3.331.000 1,341,780 38
39 Hj. Sri Haryanti III Staf Puskesmas 40 25 1 0 1.60 62.40 1,412,413 1,412,400 70,620 69.834.138.5.331.000 1,341,780 39
40 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 905,393 905,400 45,270 14.595.783.3.331.000 860,130 40
41 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.584.045.0.331.000 1,397,735 41
42 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.644.277.7.331.000 1,397,735 42
43 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,300 73,565 14.584.042.7.331.000 1,397,735 43
44 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 44
45 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 45
46 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 46
47 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 47
48 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 48
49 Deasy Andriani II Staf Puskesmas 40 25 1 0 1.60 62.40 1,412,413 1,412,400 1,412,400 49
50 Leny Marlina II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 50
51 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 51
52 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 52
53 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,471,264 1,471,200 1,471,200 53
54 Netti Herawati II Staf Puskesmas 40 25 2 0 1.60 59.80 1,353,562 1,353,600 1,353,600 54
55 Zuraida II Staf Puskesmas 25 25 0 0 1.00 50.00 1,131,741 1,131,700 1,131,700 55
56 Nani Hidayati II Staf Puskesmas 25 25 2 0 1.00 46.00 1,041,202 1,041,200 1,041,200 56
II Staf Puskesmas 40 25 4 0 1.60 54.60 57
57 Yuniarti 1,235,861 1,235,800 1,235,800
58 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 905,393 905,400 905,400 58
59 Satirah II Staf Puskesmas 15 25 0 0 0.60 40.00 905,393 905,400 905,400 59
60 M. Saleh II Staf Puskesmas 15 25 9 0 0.60 25.60 579,451 579,450 579,450 60
61 Nurhayati,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,471,264 1,471,300 1,471,300 61
62 Trisna Oktaviani,Am.Keb II CPNS 40 25 3 0 1.60 57.20 1,294,712 1,294,700 1,294,700 62
63 Lindawati,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,471,264 1,471,300 1,471,300 63
63 Meta susanti,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,471,264 1,471,300 1,471,300 64
65 Rts.Leli Fitriani,AmTG II CPNS 40 25 0 0 1.60 65.00 1,471,264 1,471,300 1,471,300 65
66 Erni MasrianaBr.Batubara II CPNS 40 25 0 0 1.60 65.00 1,471,264 1,471,300 1,471,300 66
II CPNS 40 25 0 0 1.60 65.00 67
67 Yenni Liyestana,AMAK 1,471,264 1,471,300 1,471,300
68 Erwis Hartaty II CPNS 25 25 0 0 1.00 50.00 1,131,741 1,131,700 1,131,700 68
4,878.60 110,426,250 110,426,250 3,143,955 2,820,330 104,461,965

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.723 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 69 ORANG 110,628,750

BULAN : SEPTEMBER 2015

VARIABEL
PPH Pas 21
KEHADIRAN POIN PER PERHITUNGAN JASA PELAYANAN
NO NAMA GOL JABATAN JENIS ORG PER POINT PER ORG PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
JABATA DITERIMA
KETENAGAA EFEKTIF 1 TIDAK HARI
N 15% 5%
N BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 4,499,066 4,499,100 674,865 14.357.939.9.331.001 3,824,235 1
2 Marbawi III Kepala Tata Usaha 15 25 1 30 0.60 68.40 1,501,152 1,501,200 75,060 14.595.781.7.331.000 1,426,140 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 0 0 6.00 175.00 3,840,666 3,840,700 576,105 14.628.009.4.331.000 3,264,595 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 25 2 0 6.00 161.00 3,533,413 3,533,400 530,010 69.834.144.3.331.000 3,003,390 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 3,840,666 3,840,700 576,105 08.520.228.1.331.001 3,264,595 5
6 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 2,743,333 2,743,300 411,495 06.705.913.9.331.001 2,331,805 6
7 dr.Raja Nilawati IV Dokter 150 25 1 0 6.00 168.00 3,687,040 3,687,100 553,065 14.595.199.2.331.000 3,134,035 7
8 dr.Nining Indah Sari III Dokter 150 25 2 0 6.00 161.00 3,533,413 3,533,400 176,670 14.786.073.8.331.000 3,356,730 8
9 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 1,865,467 1,865,500 93,275 14.628.176.1.331.000 1,772,225 9
10 Diana Novita, S.Kep III Staf Puskesmas 60 25 2 0 2.40 78.20 1,716,229 1,716,200 85,810 14.519.602.8.331.000 1,630,390 10
11 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 1 0 2.40 81.60 1,790,848 1,790,900 89,545 14.628.177.9.331.000 1,701,355 11
12 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 1,865,467 1,865,500 93,275 16.270.140.3.331.000 1,772,225 12
13 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 4 0 2.40 71.40 1,566,992 1,567,000 78,350 16.270.144.5.331.000 1,488,650 13
14 Sumiati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.520.497.0.331.000 1,355,175 14
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,084,933 2,084,900 104,245 14.583.707.6.331.001 1,980,655 15
16 Pudjiati, SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 09.629.891.4.331.001 1,355,175 16
17 Hj. Fatmawati, S.ST III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.595.800.5.331.000 1,355,175 17
18 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.584.043.5.331.000 1,355,175 18
19 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.595.796.5.331.000 1,355,175 19
20 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 49.108.871.2.331.001 1,355,175 20
21 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.388.312.2.331.001 1,355,175 21
22 Yuliana Pariati, AMK III Staf Puskesmas 40 25 1 0 1.60 62.40 1,369,472 1,369,500 68,475 05.928.992.6.331.001 1,301,025 22
23 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 16.270.142.9.331.000 1,355,175 23
24 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 2 0 1.60 59.80 1,312,411 1,312,400 65,620 16.202.931.8.331.000 1,246,780 24
25 Komariah, Am. Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 49.630.002.5.331.001 1,355,175 25
26 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.595.801.3.331.000 1,355,175 26
27 Lidyawati, Am.Far III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 09.601.948.4.331.001 1,355,175 27
28 Hj.Metty Rosita III Staf Puskesmas 40 25 7 0 1.60 46.80 1,027,104 1,027,100 51,355 49.768.731.9.331.001 975,745 28
29 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.680.064.4.331.000 1,355,175 29
30 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.584.108.6.331.000 1,355,175 30
31 Liti Puspita III Staf Puskesmas 40 25 1 0 1.60 62.40 1,369,472 1,369,500 68,475 14.895.791.3.331.000 1,301,025 31
32 Jumiarsih III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.595.780.9.331.000 1,355,175 32
33 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.595.783.3.331.000 1,355,175 33
34 Juden III Staf Puskesmas 40 25 7 0 1.60 46.80 1,027,104 1,027,100 51,355 14.566.794.5.331.000 975,745 34
35 Elis Fatmah III Staf Puskesmas 40 25 1 0 1.60 62.40 1,369,472 1,369,500 68,475 14.595.803.9.331.000 1,301,025 35
36 Suaibatul Aslamiyah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 15.746.478.5.331.000 1,355,175 36
37 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.595.781.7.331.000 1,355,175 37
38 Hidayati III Staf Puskesmas 40 25 4 0 1.60 54.60 1,198,288 1,198,300 59,915 14.628.180.3.331.000 1,138,385 38
39 Hj. Sri Haryanti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 69.834.138.5.331.000 1,355,175 39
40 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 877,867 877,900 43,895 14.595.783.3.331.000 834,005 40
41 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 1 0 1.60 62.40 1,369,472 1,369,500 68,475 14.584.045.0.331.000 1,301,025 41
42 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.644.277.7.331.000 1,355,175 42
43 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 71,325 14.584.042.7.331.000 1,355,175 43
44 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 44
45 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 45
46 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 1 0 1.60 62.40 1,369,472 1,369,500 1,369,500 46
47 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 47
48 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 48
49 Deasy Andriani II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 49
50 Leny Marlina II Staf Puskesmas 40 25 3 0 1.60 57.20 1,255,349 1,255,400 1,255,400 50
51 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 51
52 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 52
53 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 53
54 Netti Herawati II Staf Puskesmas 40 25 1 0 1.60 62.40 1,369,472 1,369,500 1,369,500 54
55 Ariesti Andani H II Staf Puskesmas 40 25 8 0 1.60 44.20 970,043 970,050 970,050 55
56 Zuraida II Staf Puskesmas 25 25 5 0 1.00 40.00 877,867 877,900 877,900 56
II Staf Puskesmas 25 25 1 0 1.00 48.00 57
57 Nani Hidayati 1,053,440 1,053,500 1,053,500
58 Yuniarti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,426,533 1,426,500 1,426,500 58
59 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 877,867 877,900 877,900 59
60 Satirah II Staf Puskesmas 15 25 0 0 0.60 40.00 877,867 877,900 877,900 60
61 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 877,867 877,900 877,900 61
62 Nurhayati,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,426,533 1,426,600 1,426,600 62
63 Trisna Oktaviani,Am.Keb II CPNS 40 25 2 0 1.60 59.80 1,312,411 1,312,400 1,312,400 63
63 Lindawati,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,426,533 1,426,600 1,426,600 64
65 Meta susanti,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,426,533 1,426,600 1,426,600 65
66 Rts.Leli Fitriani,AmTG II CPNS 40 25 1 0 1.60 62.40 1,369,472 1,369,500 1,369,500 66
II CPNS 40 25 3 0 1.60 57.20 67
67 Erni MasrianaBr.Batubara 1,255,349 1,255,400 1,255,400
68 Yenni Liyestana,AMAK II CPNS 40 25 0 0 1.60 65.00 1,426,533 1,426,600 1,426,600 68
II CPNS 25 25 0 0 1.00 50.00 69
69 Erwis Hartaty 1,097,333 1,097,300 1,097,300
5,040.80 110,628,750 110,628,750 3,321,645 2,768,770 104,538,335

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.530 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 69 ORANG 184,311,750

BULAN : OKTOBER 2015

VARIABEL
PPH Pas 21
KEHADIRAN POIN PER PERHITUNG JASA
NO NAMA GOL JABATAN JENIS ORG PER AN POINT PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
JABATA
KETENA EFEKTIF TIDAK HARI DITERIMA
N PER ORG 15% 5%
GAAN 1 BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 26 0 30 5.77 206.00 7,319,392 7,319,400 1,097,910 14.357.939.9.331.001 6,221,490 1
2 Marbawi III Kepala Tata Usaha 15 26 0 30 0.58 71.00 2,522,703 2,522,700 126,135 14.595.781.7.331.000 2,396,565 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 26 2 0 5.77 162.46 5,772,426 5,772,400 865,860 14.628.009.4.331.000 4,906,540 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 26 2 0 5.77 162.46 5,772,426 5,772,400 865,860 69.834.144.3.331.000 4,906,540 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 26 0 0 5.77 176.00 6,253,461 6,253,500 938,025 08.520.228.1.331.001 5,315,475 5
6 dra.Dharmashanti.G IV Apoteker 100 26 0 0 3.85 126.00 4,476,910 4,476,900 671,535 06.705.913.9.331.001 3,805,365 6
7 dr.Raja Nilawati IV Dokter 150 26 0 0 5.77 176.00 6,253,461 6,253,500 938,025 14.595.199.2.331.000 5,315,475 7
8 dr.Nining Indah Sari III Dokter 150 26 0 0 5.77 176.00 6,253,461 6,253,500 312,675 14.786.073.8.331.000 5,940,825 8
9 Ns.Ana, S.Kep III Staf Puskesmas 60 26 0 0 2.31 86.00 3,055,669 3,055,700 152,785 14.628.176.1.331.000 2,902,915 9
10 Diana Novita, S.Kep III Staf Puskesmas 60 26 1 0 2.31 82.69 2,938,143 2,938,100 146,905 14.519.602.8.331.000 2,791,195 10
11 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 26 0 0 2.31 86.00 3,055,669 3,055,700 152,785 14.628.177.9.331.000 2,902,915 11
12 Zulkartoni, SKM III Staf Puskesmas 60 26 0 0 2.31 86.00 3,055,669 3,055,700 152,785 16.270.140.3.331.000 2,902,915 12
13 Risa Dona Emalia, SKM III Staf Puskesmas 60 26 0 0 2.31 86.00 3,055,669 3,055,700 152,785 16.270.144.5.331.000 2,902,915 13
14 Sumiati, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.520.497.0.331.000 2,227,750 14
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 26 0 30 1.54 96.00 3,410,979 3,411,000 170,550 14.583.707.6.331.001 3,240,450 15
16 Pudjiati, SKM III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 09.629.891.4.331.001 2,227,750 16
17 Hj. Fatmawati, S.ST III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.800.5.331.000 2,227,750 17
18 Tin Marlina, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.584.043.5.331.000 2,227,750 18
19 Widya Trisianti, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.796.5.331.000 2,227,750 19
20 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 49.108.871.2.331.001 2,227,750 20
21 Hartati, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.388.312.2.331.001 2,227,750 21
22 Yuliana Pariati, AMK III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 05.928.992.6.331.001 2,227,750 22
23 Chamidah, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 16.270.142.9.331.000 2,227,750 23
24 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 26 2 0 1.54 60.92 2,164,660 2,164,700 108,235 16.202.931.8.331.000 2,056,465 24
25 Komariah, Am. Kep III Staf Puskesmas 40 26 2 0 1.54 60.92 2,164,660 2,164,700 108,235 49.630.002.5.331.001 2,056,465 25
26 Hj.Tartilah, Am.KG III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.801.3.331.000 2,227,750 26
27 Lidyawati, Am.Far III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 09.601.948.4.331.001 2,227,750 27
28 Hj.Metty Rosita III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 49.768.731.9.331.001 2,227,750 28
29 Surya Nirwana III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.680.064.4.331.000 2,227,750 29
30 Hj.Erni trisnawati III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.584.108.6.331.000 2,227,750 30
31 Liti Puspita III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.895.791.3.331.000 2,227,750 31
32 Jumiarsih III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.780.9.331.000 2,227,750 32
33 Hartini III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.783.3.331.000 2,227,750 33
34 Juden III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.566.794.5.331.000 2,227,750 34
35 Elis Fatmah III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.803.9.331.000 2,227,750 35
36 Suaibatul Aslamiyah III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 15.746.478.5.331.000 2,227,750 36
37 Mildarianto III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.595.781.7.331.000 2,227,750 37
38 Hidayati III Staf Puskesmas 40 26 1 0 1.54 63.46 2,254,854 2,254,900 112,745 14.628.180.3.331.000 2,142,155 38
39 Hj. Sri Haryanti III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 69.834.138.5.331.000 2,227,750 39
40 Yuliarti III Staf Puskesmas 15 26 0 0 0.58 41.00 1,456,772 1,456,800 72,840 14.595.783.3.331.000 1,383,960 40
41 Novita Putriani, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.584.045.0.331.000 2,227,750 41
42 Saflina, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.644.277.7.331.000 2,227,750 42
43 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 14.584.042.7.331.000 2,227,750 43
44 Yuniarti II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,000 117,250 15.770.613.6.331.000 2,227,750 44
45 Novianti, Am.Keb II Staf Puskesmas 40 26 1 0 1.54 63.46 2,254,854 2,254,900 2,254,900 45
46 Paraswati, Am.Keb II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 46
47 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 47
48 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 48
49 Lismayanti II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 49
50 Deasy Andriani II Staf Puskesmas 40 26 1 0 1.54 63.46 2,254,854 2,254,900 2,254,900 50
51 Leny Marlina II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 51
52 Anggraini II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 52
53 Murni II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 53
54 Elfi Maulinda II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 54
55 Netti Herawati II Staf Puskesmas 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 55
56 Ariesti Andani H II Staf Puskesmas 40 26 1 0 1.54 63.46 2,254,854 2,254,900 2,254,900 56
II Staf Puskesmas 25 26 12 0 0.96 27.46 57
57 Zuraida 975,737 975,750 975,750
58 Nani Hidayati II Staf Puskesmas 25 26 1 0 0.96 49.04 1,742,387 1,742,400 1,742,400 58
59 Rohaina II Staf Puskesmas 15 26 0 0 0.58 41.00 1,456,772 1,456,800 1,456,800 59
60 Satirah II Staf Puskesmas 15 26 0 0 0.58 41.00 1,456,772 1,456,800 1,456,800 60
61 M. Saleh II Staf Puskesmas 15 26 0 0 0.58 41.00 1,456,772 1,456,800 1,456,800 61
62 Nurhayati,Am.Keb II CPNS 40 26 0 0 1.54 66.00 2,345,048 2,345,000 2,345,000 62
63 Trisna Oktaviani,Am.Keb II CPNS 40 26 12 0 1.54 35.54 1,262,718 1,262,700 1,262,700 63
63 Lindawati,Am.Kep II CPNS 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 64
65 Meta susanti,Am.Kep II CPNS 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 65
66 Rts.Leli Fitriani,AmTG II CPNS 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 66
II CPNS 40 26 0 0 1.54 66.00 67
67 Erni MasrianaBr.Batubara 2,345,048 2,345,100 2,345,100
68 Yenni Liyestana,AMAK II CPNS 40 26 0 0 1.54 66.00 2,345,048 2,345,100 2,345,100 68
II CPNS 25 26 0 0 0.96 51.00 69
69 Erwis Hartaty 1,812,083 1,812,100 1,812,100
5,187.35 184,311,750 184,311,750 5,377,215 4,817,960 174,116,575

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.561 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 69 ORANG 133,987,500

BULAN : NOVEMBER 2015

VARIABEL
PPH Pas 21
KEHADIRAN POIN PER JASA
JENIS PERHITUNG
NO NAMA GOL JABATAN ORG PER PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAGA EFEKTIF TIDAK JABATA HARI AN POINT DITERIMA
N PER ORG 15% 5%
AN 1 BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 5,482,304 5,482,300 822,345 14.357.939.9.331.001 4,659,955 1
2 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,872,006 1,872,000 93,600 14.595.781.7.331.000 1,778,400 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 0 0 6.00 175.00 4,680,015 4,680,000 702,000 14.628.009.4.331.000 3,978,000 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 25 4 0 6.00 147.00 3,931,213 3,931,200 589,680 69.834.144.3.331.000 3,341,520 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 1 0 6.00 168.00 4,492,815 4,492,800 673,920 08.520.228.1.331.001 3,818,880 5
6 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 3,342,868 3,342,900 501,435 06.705.913.9.331.001 2,841,465 6
7 dr.Raja Nilawati IV Dokter 150 25 2 0 6.00 161.00 4,305,614 4,305,600 645,840 14.595.199.2.331.000 3,659,760 7
8 dr.Nining Indah Sari III Dokter 150 25 3 0 6.00 154.00 4,118,413 4,118,400 205,920 14.786.073.8.331.000 3,912,480 8
9 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,273,150 2,273,100 113,655 14.628.176.1.331.000 2,159,445 9
10 Diana Novita, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,273,150 2,273,100 113,655 14.519.602.8.331.000 2,159,445 10
11 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,273,150 2,273,100 113,655 14.628.177.9.331.000 2,159,445 11
12 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 2,273,150 2,273,100 113,655 16.270.140.3.331.000 2,159,445 12
13 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 25 0 2.40 - - - - 16.270.144.5.331.000 - 13
14 Sumiati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.520.497.0.331.000 1,651,385 14
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,540,580 2,540,600 127,030 14.583.707.6.331.001 2,413,570 15
16 Pudjiati, SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 09.629.891.4.331.001 1,651,385 16
17 Hj. Fatmawati, S.ST III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.800.5.331.000 1,651,385 17
18 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.584.043.5.331.000 1,651,385 18
19 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.796.5.331.000 1,651,385 19
20 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 49.108.871.2.331.001 1,651,385 20
21 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.388.312.2.331.001 1,651,385 21
22 Yuliana Pariati, AMK III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 05.928.992.6.331.001 1,651,385 22
23 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 16.270.142.9.331.000 1,651,385 23
24 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 16.202.931.8.331.000 1,651,385 24
25 Komariah, Am. Kep III Staf Puskesmas 40 25 2 0 1.60 59.80 1,599,228 1,599,200 79,960 49.630.002.5.331.001 1,519,240 25
26 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.801.3.331.000 1,651,385 26
27 Lidyawati, Am.Far III Staf Puskesmas 40 25 13 0 1.60 31.20 834,380 834,400 41,720 09.601.948.4.331.001 792,680 27
28 Hj.Metty Rosita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 49.768.731.9.331.001 1,651,385 28
29 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.680.064.4.331.000 1,651,385 29
30 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.584.108.6.331.000 1,651,385 30
31 Liti Puspita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.895.791.3.331.000 1,651,385 31
32 Jumiarsih III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.780.9.331.000 1,651,385 32
33 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.783.3.331.000 1,651,385 33
34 Juden III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.566.794.5.331.000 1,651,385 34
35 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.803.9.331.000 1,651,385 35
36 Suaibatul Aslamiyah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 15.746.478.5.331.000 1,651,385 36
37 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.595.781.7.331.000 1,651,385 37
38 Hidayati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.628.180.3.331.000 1,651,385 38
39 Hj. Sri Haryanti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 69.834.138.5.331.000 1,651,385 39
40 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 1,069,718 1,069,700 53,485 14.595.783.3.331.000 1,016,215 40
41 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.584.045.0.331.000 1,651,385 41
42 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.644.277.7.331.000 1,651,385 42
43 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 14.584.042.7.331.000 1,651,385 43
44 Yuniarti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 86,915 15.770.613.6.331.000 1,651,385 44
45 Novianti, Am.Keb II Staf Puskesmas 40 25 4 0 1.60 54.60 1,460,165 1,460,200 1,460,200 45
46 Paraswati, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 46
47 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 47
48 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 48
49 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 49
50 Deasy Andriani II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 50
51 Leny Marlina II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 51
52 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 52
53 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 53
54 Elfi Maulinda II Staf Puskesmas 40 25 2 0 1.60 59.80 1,599,228 1,599,200 1,599,200 54
55 Netti Herawati II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 55
56 Ariesti Andani H II Staf Puskesmas 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 56
II Staf Puskesmas 25 25 0 0 1.00 50.00 57
57 Zuraida 1,337,147 1,337,100 1,337,100
58 Nani Hidayati II Staf Puskesmas 25 25 0 0 1.00 50.00 1,337,147 1,337,100 1,337,100 58
59 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 1,069,718 1,069,700 1,069,700 59
60 Satirah II Staf Puskesmas 15 25 0 0 0.60 40.00 1,069,718 1,069,700 1,069,700 60
61 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 1,069,718 1,069,700 1,069,700 61
62 Nurhayati,Am.Keb II CPNS 40 25 1 0 1.60 62.40 1,668,760 1,668,800 1,668,800 62
63 Trisna Oktaviani,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 63
63 Lindawati,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 64
65 Meta susanti,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 65
66 Rts.Leli Fitriani,AmTG II CPNS 40 25 0 0 1.60 65.00 1,738,291 1,738,300 1,738,300 66
II CPNS 40 25 0 0 1.60 65.00 67
67 Erni MasrianaBr.Batubara 1,738,291 1,738,300 1,738,300
68 Yenni Liyestana,AMAK II CPNS 40 25 1 0 1.60 62.40 1,668,760 1,668,800 1,668,800 68
II CPNS 25 25 0 0 1.00 50.00 69
69 Erwis Hartaty 1,337,147 1,337,100 1,337,100
5,010.20 133,987,500 133,987,500 3,935,220 3,403,040 126,649,240

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015

PUSKESMAS : PUTRI AYU


JUMLAH PESERTA : 29.868 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 69 ORANG 134,394,750

BULAN : DESEMBER 2015

VARIABEL
PPH Pas 21
KEHADIRAN
POIN JASA
NO NAMA GOL JABATAN JENIS PER ORG PERHITUNGA PELAYANAN PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN
KETENAGA EFEKTIF 1 TIDAK JABATAN PER HARI N POINT PER DITERIMA
AN ORG 15% 5%
BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskesmas 150 25 0 30 6.00 205.00 5,427,256 5,427,300 814,095 14.357.939.9.331.001 4,613,205 1
2 Marbawi III Kepala Tata Usaha 15 25 0 30 0.60 70.00 1,853,209 1,853,200 92,660 14.595.781.7.331.000 1,760,540 2
3 drg.Yohana Meilina.S IV Dokter gigi Puskesmas 150 25 1 0 6.00 168.00 4,447,703 4,447,700 667,155 14.628.009.4.331.000 3,780,545 3
4 drg.Galuh Puteri IV Dokter gigi Puskesmas 150 25 2 0 6.00 161.00 4,262,382 4,262,400 639,360 69.834.144.3.331.000 3,623,040 4
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 25 0 0 6.00 175.00 4,633,024 4,633,000 694,950 08.520.228.1.331.001 3,938,050 5
6 dra.Dharmashanti.G IV Apoteker 100 25 0 0 4.00 125.00 3,309,303 3,309,300 496,395 06.705.913.9.331.001 2,812,905 6
7 dr.Raja Nilawati IV Dokter 150 25 2 0 6.00 161.00 4,262,382 4,262,400 639,360 14.595.199.2.331.000 3,623,040 7
8 dr.Nining Indah Sari III Dokter 150 25 0 0 6.00 175.00 4,633,024 4,633,000 231,650 14.786.073.8.331.000 4,401,350 8
9 Ns.Ana, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,250,326 2,250,300 112,515 14.628.176.1.331.000 2,137,785 9
10 Diana Novita, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,250,326 2,250,300 112,515 14.519.602.8.331.000 2,137,785 10
11 Eva Febrina Yanti, S.Kep III Staf Puskesmas 60 25 0 0 2.40 85.00 2,250,326 2,250,300 112,515 14.628.177.9.331.000 2,137,785 11
12 Zulkartoni, SKM III Staf Puskesmas 60 25 0 0 2.40 85.00 2,250,326 2,250,300 112,515 16.270.140.3.331.000 2,137,785 12
13 Risa Dona Emalia, SKM III Staf Puskesmas 60 25 25 0 2.40 - - - - 16.270.144.5.331.000 - 13
14 Sumiati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.520.497.0.331.000 1,634,760 14
15 Yuslindawati, Am.Keb III Bend.Dana Kapitasi JKN 40 25 0 30 1.60 95.00 2,515,070 2,515,100 125,755 14.583.707.6.331.001 2,389,345 15
16 Pudjiati, SKM III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 09.629.891.4.331.001 1,634,760 16
17 Hj. Fatmawati, S.ST III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.800.5.331.000 1,634,760 17
18 Tin Marlina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.584.043.5.331.000 1,634,760 18
19 Widya Trisianti, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.796.5.331.000 1,634,760 19
20 Gusniar Harahap, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 49.108.871.2.331.001 1,634,760 20
21 Hartati, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.388.312.2.331.001 1,634,760 21
22 Yuliana Pariati, AMK III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 05.928.992.6.331.001 1,634,760 22
23 Chamidah, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 16.270.142.9.331.000 1,634,760 23
24 Nurjanah Lubis, Am.Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 16.202.931.8.331.000 1,634,760 24
25 Komariah, Am. Kep III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 49.630.002.5.331.001 1,634,760 25
26 Hj.Tartilah, Am.KG III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.801.3.331.000 1,634,760 26
27 Lidyawati, Am.Far III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 09.601.948.4.331.001 1,634,760 27
28 Hj.Metty Rosita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 49.768.731.9.331.001 1,634,760 28
29 Surya Nirwana III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.680.064.4.331.000 1,634,760 29
30 Hj.Erni trisnawati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.584.108.6.331.000 1,634,760 30
31 Liti Puspita III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.895.791.3.331.000 1,634,760 31
32 Jumiarsih III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.780.9.331.000 1,634,760 32
33 Hartini III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.783.3.331.000 1,634,760 33
34 Juden III Staf Puskesmas 40 25 1 0 1.60 62.40 1,652,004 1,652,000 82,600 14.566.794.5.331.000 1,569,400 34
35 Elis Fatmah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.803.9.331.000 1,634,760 35
36 Suaibatul Aslamiyah III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 15.746.478.5.331.000 1,634,760 36
37 Mildarianto III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.595.781.7.331.000 1,634,760 37
38 Hidayati III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.628.180.3.331.000 1,634,760 38
39 Hj. Sri Haryanti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 69.834.138.5.331.000 1,634,760 39
40 Yuliarti III Staf Puskesmas 15 25 0 0 0.60 40.00 1,058,977 1,059,000 52,950 14.595.783.3.331.000 1,006,050 40
41 Novita Putriani, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.584.045.0.331.000 1,634,760 41
42 Saflina, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.644.277.7.331.000 1,634,760 42
43 Yetti Herlinda, Am.Keb III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 14.584.042.7.331.000 1,634,760 43
44 Yuniarti III Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,800 86,040 15.770.613.6.331.000 1,634,760 44
45 Novianti, Am.Keb II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 45
46 Paraswati, Am.Keb II Staf Puskesmas 40 25 8 0 1.60 44.20 1,170,169 1,170,200 1,170,200 46
47 Maria H. Sinaga, Am.Kep II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 47
48 Ardiany dinanty ,Am.Kep II Staf Puskesmas 40 25 1 0 1.60 62.40 1,652,004 1,652,000 1,652,000 48
49 Lismayanti II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 49
50 Deasy Andriani II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 50
51 Leny Marlina II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 51
52 Anggraini II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 52
53 Murni II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 53
54 Elfi Maulinda II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 54
55 Netti Herawati II Staf Puskesmas 40 25 1 0 1.60 62.40 1,652,004 1,652,000 1,652,000 55
56 Ariesti Andani H II Staf Puskesmas 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 56
II Staf Puskesmas 25 25 0 0 1.00 50.00 57
57 Zuraida 1,323,721 1,323,700 1,323,700
58 Nani Hidayati II Staf Puskesmas 25 25 0 0 1.00 50.00 1,323,721 1,323,700 1,323,700 58
59 Rohaina II Staf Puskesmas 15 25 0 0 0.60 40.00 1,058,977 1,059,000 1,059,000 59
60 Satirah II Staf Puskesmas 15 25 0 0 0.60 40.00 1,058,977 1,059,000 1,059,000 60
61 M. Saleh II Staf Puskesmas 15 25 0 0 0.60 40.00 1,058,977 1,059,000 1,059,000 61
62 Nurhayati,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 62
63 Trisna Oktaviani,Am.Keb II CPNS 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 63
63 Lindawati,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 64
65 Meta susanti,Am.Kep II CPNS 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 65
66 Rts.Leli Fitriani,AmTG II CPNS 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 66
II CPNS 40 25 0 0 1.60 65.00 67
67 Erni MasrianaBr.Batubara 1,720,837 1,720,900 1,720,900
68 Yenni Liyestana,AMAK II CPNS 40 25 0 0 1.60 65.00 1,720,837 1,720,900 1,720,900 68
II CPNS 25 25 0 0 1.00 50.00 69
69 Erwis Hartaty 1,323,721 1,323,750 1,323,750
5,076.40 134,394,750 134,394,750 3,951,315 3,444,795 126,998,640

Jambi,
Mengetahui Yang membayar Bendahara Dana Kapitasi JKN
Kepala FKTP Puskesmas Putri Ayu Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes Yuslindawati,Am.Keb


NIP.196905032000122001 NIP.19731110 199303 2 006
PROPORSI PEMBAGIAN JASA PELAYANAN TENAGA KESEHATAN DI FASILITAS KESEHATAN T
BERDASARKAN PERMENKES NO.19 TAHUN 2014,PERMENKES NO.28 TAHUN 2014 DAN PERWAL JAMBI N0
PUSKESMAS : PUTRI AYU
JUMLAH PESERTA : 29.980 6,000 PERBULAN PERJIWA
JUMLAH PEGAWAI : 69 ORANG 134,910,000

BULAN : DESEMBER 2015

VARIABEL
KEHADIRAN POIN PER JASA
NO NAMA GOL JABATAN JENIS ORG PER PERHITUNGAN PELAYANAN
JABATA POINT PER ORG
KETENAGA EFEKTIF TIDAK HARI DITERIMA
N
AN 1 BLN HADIR

1 dr.Hj.Rini Kartika H,M.Kes IV Kepala Puskes 150 24 0 30 6.25 204.00 5,482,216


2 Marbawi III Kepala Tata Us 15 24 0 30 0.63 69.00 1,854,279
3 drg.Yohana Meilina.S IV Dokter gigi Pu 150 24 1 0 6.25 166.75 4,481,174
4 drg.Galuh Puteri IV Dokter gigi Pu 150 24 0 0 6.25 174.00 4,676,008
5 dr.Hj.Imat Rahmatilah IV Dokter kedua 150 24 0 0 6.25 174.00 4,676,008
6 dra.Dharmashanti.G IV Apoteker 100 24 0 0 4.17 124.00 3,332,328
7 dr.Raja Nilawati IV Dokter 150 24 1 0 6.25 166.75 4,481,174
8 dr.Nining Indah Sari III Dokter 150 24 0 0 6.25 174.00 4,676,008
9 Ns.Ana, S.Kep III Staf Puskesma 60 24 0 0 2.50 84.00 2,257,383
10 Diana Novita, S.Kep III Staf Puskesma 60 24 0 0 2.50 84.00 2,257,383
11 Eva Febrina Yanti, S.Kep III Staf Puskesma 60 24 0 0 2.50 84.00 2,257,383
12 Zulkartoni, SKM III Staf Puskesma 60 24 0 0 2.50 84.00 2,257,383
13 Risa Dona Emalia, SKM III Staf Puskesma 60 24 24 0 2.50 - -
14 Sumiati, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
15 Yuslindawati, Am.Keb III Bend.Dana Kapi 40 24 0 30 1.67 94.00 2,526,119
16 Pudjiati, SKM III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
17 Hj. Fatmawati, S.ST III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
18 Tin Marlina, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
19 Widya Trisianti, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
20 Gusniar Harahap, Am.Kep III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
21 Hartati, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
22 Yuliana Pariati, AMK III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
23 Chamidah, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
24 Nurjanah Lubis, Am.Kep III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
25 Komariah, Am. Kep III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
26 Hj.Tartilah, Am.KG III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
27 Lidyawati, Am.Far III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
28 Hj.Metty Rosita III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
29 Surya Nirwana III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
30 Hj.Erni trisnawati III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
31 Liti Puspita III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
32 Jumiarsih III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
33 Hartini III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
34 Juden III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
35 Elis Fatmah III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
36 Suaibatul Aslamiyah III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
37 Mildarianto III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
38 Hidayati III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
39 Hj. Sri Haryanti III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
40 Yuliarti III Staf Puskesma 15 24 0 0 0.63 39.00 1,048,071
41 Novita Putriani, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
42 Saflina, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
43 Yetti Herlinda, Am.Keb III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
44 Yuniarti III Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
45 Novianti, Am.Keb II Staf Puskesma 40 24 4 0 1.67 53.33 1,433,259
46 Paraswati, Am.Keb II Staf Puskesma 40 24 8 0 1.67 42.67 1,146,607
47 Maria H. Sinaga, Am.Kep II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
48 Ardiany dinanty ,Am.Kep II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
49 Lismayanti II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
50 Deasy Andriani II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
51 Leny Marlina II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
52 Anggraini II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
53 Murni II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
54 Elfi Maulinda II Staf Puskesma 40 24 2 0 1.67 58.67 1,576,585
55 Netti Herawati II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
56 Ariesti Andani H II Staf Puskesma 40 24 0 0 1.67 64.00 1,719,911
57 Zuraida II Staf Puskesma 25 24 0 0 1.04 49.00 1,316,807
58 Nani Hidayati II Staf Puskesma 25 24 0 0 1.04 49.00 1,316,807
59 Rohaina II Staf Puskesma 15 24 0 0 0.63 39.00 1,048,071
60 Satirah II Staf Puskesma 15 24 0 0 0.63 39.00 1,048,071
61 M. Saleh II Staf Puskesma 15 24 0 0 0.63 39.00 1,048,071
62 Nurhayati,Am.Keb II CPNS 40 24 0 0 1.67 64.00 1,719,911
63 Trisna Oktaviani,Am.Keb II CPNS 40 24 0 0 1.67 64.00 1,719,911
63 Lindawati,Am.Kep II CPNS 40 24 0 0 1.67 64.00 1,719,911
65 Meta susanti,Am.Kep II CPNS 40 24 0 0 1.67 64.00 1,719,911
66 Rts.Leli Fitriani,AmTG II CPNS 40 24 0 0 1.67 64.00 1,719,911
67 Erni MasrianaBr.Batubara II CPNS 40 24 0 0 1.67 64.00 1,719,911
68 Yenni Liyestana,AMAK II CPNS 40 24 0 0 1.67 64.00 1,719,911
69 Erwis Hartaty II CPNS 25 24 0 0 1.04 49.00 1,316,807
5,020.17 134,910,000

Mengetahui
Kepala FKTP Puskesmas Putri Ayu

dr. Hj. Rini Kartika Handayani, M.Kes


NIP.196905032000122001
EHATAN DI FASILITAS KESEHATAN TINGKAT PERTAMA ( FKTP )
HUN 2014 DAN PERWAL JAMBI N0.2 TAHUN 2015 TANGGAL 2 JANUARI 2015

PPH Pas 21

PEMBULATAN NPWP JUMLAH BERSIH TANDA TANGAN


15% 5%

5,482,200 822,330 14.357.939.9.331.001 4,659,870 1


1,854,300 92,715 14.595.781.7.331.000 1,761,585 2
4,481,200 672,180 14.628.009.4.331.000 3,809,020 3
4,676,000 701,400 69.834.144.3.331.000 3,974,600 4
4,676,000 701,400 08.520.228.1.331.001 3,974,600 5
3,332,300 499,845 06.705.913.9.331.001 2,832,455 6
4,481,200 672,180 14.595.199.2.331.000 3,809,020 7
4,676,000 233,800 14.786.073.8.331.000 4,442,200 8
2,257,400 112,870 14.628.176.1.331.000 2,144,530 9
2,257,400 112,870 14.519.602.8.331.000 2,144,530 10
2,257,400 112,870 14.628.177.9.331.000 2,144,530 11
2,257,400 112,870 16.270.140.3.331.000 2,144,530 12
- - 16.270.144.5.331.000 - 13
1,719,900 85,995 14.520.497.0.331.000 1,633,905 14
2,526,100 126,305 14.583.707.6.331.001 2,399,795 15
1,719,900 85,995 09.629.891.4.331.001 1,633,905 16
1,719,900 85,995 14.595.800.5.331.000 1,633,905 17
1,719,900 85,995 14.584.043.5.331.000 1,633,905 18
1,719,900 85,995 14.595.796.5.331.000 1,633,905 19
1,719,900 85,995 49.108.871.2.331.001 1,633,905 20
1,719,900 85,995 14.388.312.2.331.001 1,633,905 21
1,719,900 85,995 05.928.992.6.331.001 1,633,905 22
1,719,900 85,995 16.270.142.9.331.000 1,633,905 23
1,719,900 85,995 16.202.931.8.331.000 1,633,905 24
1,719,900 85,995 49.630.002.5.331.001 1,633,905 25
1,719,900 85,995 14.595.801.3.331.000 1,633,905 26
1,719,900 85,995 09.601.948.4.331.001 1,633,905 27
1,719,900 85,995 49.768.731.9.331.001 1,633,905 28
1,719,900 85,995 14.680.064.4.331.000 1,633,905 29
1,719,900 85,995 14.584.108.6.331.000 1,633,905 30
1,719,900 85,995 14.895.791.3.331.000 1,633,905 31
1,719,900 85,995 14.595.780.9.331.000 1,633,905 32
1,719,900 85,995 14.595.783.3.331.000 1,633,905 33
1,719,900 85,995 14.566.794.5.331.000 1,633,905 34
1,719,900 85,995 14.595.803.9.331.000 1,633,905 35
1,719,900 85,995 15.746.478.5.331.000 1,633,905 36
1,719,900 85,995 14.595.781.7.331.000 1,633,905 37
1,719,900 85,995 14.628.180.3.331.000 1,633,905 38
1,719,900 85,995 69.834.138.5.331.000 1,633,905 39
1,048,100 52,405 14.595.783.3.331.000 995,695 40
1,719,900 85,995 14.584.045.0.331.000 1,633,905 41
1,719,900 85,995 14.644.277.7.331.000 1,633,905 42
1,719,900 85,995 14.584.042.7.331.000 1,633,905 43
1,719,900 85,995 15.770.613.6.331.000 1,633,905 44
1,433,300 1,433,300 45
1,146,600 1,146,600 46
1,719,900 1,719,900 47
1,719,900 1,719,900 48
1,719,900 1,719,900 49
1,719,900 1,719,900 50
1,719,900 1,719,900 51
1,719,900 1,719,900 52
1,719,900 1,719,900 53
1,576,600 1,576,600 54
1,719,900 1,719,900 55
1,719,900 1,719,900 56
57
1,316,900 1,316,900
1,316,900 1,316,900 58
1,048,100 1,048,100 59
1,048,100 1,048,100 60
1,048,100 1,048,100 61
1,719,900 1,719,900 62
1,719,900 1,719,900 63
1,719,900 1,719,900 64
1,719,900 1,719,900 65
1,719,900 1,719,900 66
67
1,719,900 1,719,900
1,719,900 1,719,900 68
69
1,316,900 1,316,900
134,910,000 4,069,335 3,450,560 127,390,105

Jambi,
Yang membayar Bendahara Dana Kapitasi JKN
Puskesmas Putri Ayu

Yuslindawati,Am.Keb
NIP.19731110 199303 2 006