Des Ok 2018

DAFTAR PENERIMAAN BELANJA OPERASIONAL PETUGAS LAPANGAN TANGGAL 01 DESEMBER 2018
KEGIATAN BANTUAN OPERASIONAL KESEHATAN PADA UPTD PUSKESMAS NGUNUT
JUMLAH
TGL
NO NAMA NIP JABATAN GOL. TUJUAN PPh 21 (Rp)
KEGIATAN
UANG (Rp)
1 1-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Gilang 75,000 3,750
2 1-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId SMPN 1 Ngunut 75,000 3,750
3 1-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId SMPN 1 Ngunut 75,000 -
4 1-Dec-18 Endah Ristiwahyuni, AMK 196401191983122001 Perawat IIId Ds. Ngunut 75,000 3,750
5 1-Dec-18 Ivan Febri Artanto, Amd.Kep 198702162010011004 Perawat IId Ds. Ngunut 75,000 -
6 1-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds .Gilang 75,000 3,750
7 1-Dec-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Ds .Gilang 75,000 3,750
8 1-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Ngunut 75,000 3,750
9 1-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc Ds. Ngunut 75,000 -
10 1-Dec-18 Restuning Diana, Amd. Keb 198505012009012007 Bidan IIIa Ds. Ngunut 75,000 3,750
11 1-Dec-18 dr. Pasha Candra R Dokter PKM Ngunut Ds. Ngunut 75,000 4,500
12 1-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Ngunut 75,000 3,750
TOTAL 900,000 34,500
TULUNGAGUNG,
KUASA PENGGUNA ANGGARAN BENDAHARA PENGELUARAN PEMBANTU
Hanik Mudayati, S.ST.M.Kes Hery Nur Faishol

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
BER 2018
JUMLAH
TANDA TANGAN
DITERIMA (Rp)
71,250 1
71,250 2
75,000 3
71,250 4
75,000 5
71,250 6
71,250 7
71,250 8
75,000 9
71,250 10
70,500 11
71,250 12
865,500
TULUNGAGUNG,
ENDAHARA PENGELUARAN PEMBANTU
Hery Nur Faishol

NIP. 19840608 201001 1 002
DAFTAR PENERIMAAN BELANJA OPERASIONAL PETUGAS LAPANGAN TANGGAL 03-08 DESEMBER 2018
JUMLAH
TGL
KEGIATAN
UANG (Rp)
1 3-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds.Kromasan 75,000 3,750
2 3-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds.Kromasan 75,000 3,750
3 3-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds.Kromasan 75,000 3,750
IId TK dan PAUD Aisyiyah

4 3-Dec-18 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi 75,000 -
Ngunut
IIc TK dan PAUD Aisyiyah

5 3-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan 75,000 -
Ngunut
6 3-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId SMPN 3 Ngunut 75,000 3,750
7 3-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId SMPN 3 Ngunut 75,000 -
11 3-Dec-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Ds .Gilang 75,000 3,750
14 3-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Gilang 75,000 3,750
15 4-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Sumberejo Kulon 75,000 3,750
16 4-Dec-18 Erlin Nur W, Amd.Kep Perawat Ds. Sumberejo Kulon 75,000 4,500
17 4-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Pulotondo 75,000 3,750
18 4-Dec-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Puskesmas Ngunut 75,000 3,750
19 4-Dec-18 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc Puskesmas Ngunut 75,000 -
20 4-Dec-18 Suhartatik, SST 197312191993022002 Bidan IIIc Puskesmas Ngunut 75,000 3,750
21 4-Dec-18 Christina Wisnu W, S.ST 197210091993022007 Bidan IIId Puskesmas Ngunut 75,000 3,750
22 4-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Puskesmas Ngunut 75,000 3,750
23 4-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc Puskesmas Ngunut 75,000 -
24 4-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Puskesmas Ngunut 75,000 -
25 4-Dec-18 Tumini, S.Tr. Keb. 196808251990012002 Bidan IIId Ds. Kaliwungu 75,000 3,750
26 4-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId Ds. Kaliwungu 75,000 -
29 4-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds. Sumberejo Kulon 75,000 3,750
31 4-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Kromasan 75,000 3,750
32 4-Dec-18 Tri Kurnia, Amd.Kep Perawat Ds. Kromasan 75,000 4,500
33 4-Dec-18 Binti Qomariyah, AMK 197108121995032002 Perawat IIIc TK Dharma Wanita Pulosari 75,000 3,750
36 4-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Gilang 75,000 3,750
37 5-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Pulotondo 75,000 3,750
38 5-Dec-18 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc Ds. Pulotondo 75,000 -
39 5-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Pulosari 75,000 3,750
40 5-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId MTsN 5 Tulungagung 75,000 3,750
41 5-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId MTsN 5 Tulungagung 75,000 -
42 5-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc Puskesmas Ngunut 75,000 -
45 5-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds. Sumberejo Kulon 75,000 3,750
47 5-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Pulotondo 75,000 3,750
48 5-Dec-18 Mahpuzah, AMK 196608091993122000 Perawat IIId Ds.Pulotondo 75,000 3,750
49 5-Dec-18 Restuning Diana, Amd. Keb 198505012009012007 Bidan IIIa Ds. Kromasan 75,000 3,750
50 5-Dec-18 dr. Pasha Candra R Dokter PKM Ngunut Ds. Kromasan 75,000 4,500
51 5-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Kromasan 75,000 3,750
52 5-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Pulosari 75,000 3,750
53 5-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Pulosari 75,000 3,750
54 6-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Pulosari 75,000 3,750
56 6-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Pulosari 75,000 3,750
57 6-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds. Pulosari 75,000 -
58 6-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Sumberejo Kulon 75,000 3,750
59 6-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId SMPI Sunan Giri 75,000 3,750
60 6-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId SMPI Sunan Giri 75,000 -
63 6-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds.Pulotondo 75,000 3,750
65 6-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Gilang 75,000 3,750
66 6-Dec-18 Ariningsih, AMK 197507232006042022 Perawat IIIb Ds.Gilang 75,000 3,750
67 6-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. ngunut 75,000 4,500

72 7-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Gilang 75,000 3,750
73 7-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Gilang 75,000 3,750
74 7-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Gilang 75,000 3,750
75 7-Dec-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Ds. Gilang 75,000 3,750
76 7-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Gilang 75,000 3,750
77 7-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Gilang 75,000 3,750
80 7-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Ngunut 75,000 3,750
81 7-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId SMAI Sunan Giri 75,000 3,750
82 7-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId SMAI Sunan Giri 75,000 -
85 7-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds.Pulotondo 75,000 3,750
87 7-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Kaliwungu 75,000 3,750
88 7-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Kaliwungu 75,000 4,500
89 7-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Pulotondo 75,000 3,750
90 7-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Pulotondo 75,000 3,750
91 7-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Pulotondo 75,000 3,750
93 8-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Sumberejo Kulon 75,000 3,750
94 8-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Sumberejo Kulon 75,000 3,750
95 8-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Sumberejo Kulon 75,000 3,750
96 8-Dec-18 Suhartatik, SST 197312191993022002 Bidan IIIc Ds. Sumberejo Kulon 75,000 3,750
97 8-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Ngunut 75,000 3,750
98 8-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Ngunut 75,000 3,750
101 8-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Kaliwungu 75,000 3,750
102 8-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId MA Aswaja 75,000 3,750
103 8-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId MA Aswaja 75,000 -
104 8-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds .Kromasan 75,000 3,750
105 8-Dec-18 Tri Kurniasari, Amd.Kep Perawat Ds .Kromasan 75,000 4,500
106 8-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Pulosari 75,000 3,750
108 8-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Pulotondo 75,000 3,750
109 8-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Pulotondo 75,000 3,750
111 8-Dec-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Ds. Sumberejo Kulon 75,000 3,750
TOTAL 8,325,000 334,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
MBER 2018
JUMLAH
TANDA TANGAN
DITERIMA (Rp)
71,250 1
71,250 2
71,250 3
75,000 4
75,000 5
71,250 6
75,000 7
71,250 8
75,000 9
71,250 10
71,250 11
71,250 12
70,500 13
71,250 14
71,250 15
70,500 16
71,250 17
71,250 18
75,000 19
71,250 20
71,250 21
71,250 22
75,000 23
75,000 24
71,250 25
75,000 26
71,250 27
75,000 28
71,250 29
70,500 30
71,250 31
70,500 32
71,250 33
71,250 34
70,500 35
71,250 36
71,250 37
75,000 38
71,250 39
71,250 40
75,000 41
75,000 42
71,250 43
75,000 44
71,250 45
70,500 46
71,250 47
71,250 48
71,250 49
70,500 50
71,250 51
71,250 52
71,250 53
71,250 54
71,250 55
71,250 56
75,000 57
71,250 58
71,250 59
75,000 60
71,250 61
75,000 62
71,250 63
71,250 64
71,250 65
71,250 66
70,500 67
75,000 68
71,250 69
70,500 70
71,250 71
71,250 72
71,250 73
71,250 74
71,250 75
71,250 76
71,250 77
75,000 78
71,250 79
71,250 80
71,250 81
75,000 82
71,250 83
75,000 84
71,250 85
71,250 86
71,250 87
70,500 88
71,250 89
71,250 90
71,250 91
75,000 92
71,250 93
71,250 94
71,250 95
71,250 96
71,250 97
71,250 98
75,000 99
71,250 100
71,250 101
71,250 102
75,000 103
71,250 104
70,500 105
71,250 106
75,000 107
71,250 108
71,250 109
71,250 110
8325000
71,250 111
3,180,000
TULUNGAGUNG, 750000
Hery Nur Faishol

NIP. 19840608 201001 1 002
JUMLAH
TGL
KEGIATAN
UANG (Rp)
1 10-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Kaliwungu 75,000 3,750
3 10-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Pulosari 75,000 3,750
5 10-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId SMK Ngunut 75,000 3,750
6 10-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId SMK Ngunut 75,000 -
7 10-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Sumberejo Kulon 75,000 3,750
11 10-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds. Kromasan 75,000 3,750
12 10-Dec-18 Tri Kurnia, Amd.Kep Perawat Ds. Kromasan 75,000 4,500
13 10-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Sumberejo Kulon 75,000 3,750
IId TK dan PAUD Aisyiyah

15 10-Dec-18 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi 75,000 -
Ngunut
IIc TK dan PAUD Aisyiyah

16 10-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan 75,000 -
Ngunut
20 11-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Pulotondo 75,000 3,750
21 11-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Pulotondo 75,000 3,750
26 11-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Ngunut 75,000 3,750
32 11-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId SMK Kalijaga 75,000 3,750
33 11-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId SMK Kalijaga 75,000 -
36 11-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds .Pulosari 75,000 3,750
37 11-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds .Pulosari 75,000 -
38 11-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Sumberejo Kulon 75,000 3,750
40 11-Dec-18 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi IId SDN 4 Ngunut 75,000 -
41 11-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc SDN 4 Ngunut 75,000 -
IIIc PAUD Tunas Ceria

42 11-Dec-18 Binti Qomariyah, AMK 197108121995032002 Perawat 75,000 3,750
Pulotondo
43 12-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Ngunut 75,000 3,750
45 12-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Ngunut 75,000 4,500
47 12-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Ngunut 75,000 3,750
48 12-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Ngunut 75,000 3,750
50 12-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Gilang 75,000 3,750
53 12-Dec-18 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc Ds. Pulosari 75,000 -
54 12-Dec-18 Tumini, S.Tr. Keb. 196808251990012002 Bidan IIId Ds. Pulosari 75,000 3,750
55 12-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId Ds. Pulosari 75,000 -
58 12-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds .Pulosari 75,000 3,750

60 12-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds .Pulosari 75,000 3,750
62 12-Dec-18 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi IId SDN Kaliwungu 75,000 -
63 12-Dec-18 Christina Wisnu W, S.ST 197210091993022007 Bidan IIId SDN Kaliwungu 75,000 3,750
64 13-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Kaliwungu 75,000 3,750
65 13-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Kaliwungu 75,000 3,750
66 13-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Kaliwungu 75,000 3,750
67 13-Dec-18 Christina Wisnu W, S.ST 197210091993022007 Bidan IIId Ds. Kaliwungu 75,000 3,750
68 13-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Ngunut 75,000 3,750
70 13-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Sumberejo Kulon 75,000 3,750
72 13-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Pulotondo 75,000 3,750
73 13-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Pulotondo 75,000 3,750

78 13-Dec-18 Tumini, S.Tr. Keb. 196808251990012002 Bidan IIId Ds. Pulosari 75,000 3,750
79 13-Dec-18 Abdul Majid 197901072006041015 Pranata Lab. IId Ds. Pulosari 75,000 -
82 13-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds. Ngunut 75,000 3,750
86 13-Dec-18 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi IId MI Mutiara Iman Ngunut 75,000 -
87 13-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa MI Mutiara Iman Ngunut 75,000 3,750
88 13-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Ngunut 75,000 3,750
89 13-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Ngunut 75,000 3,750
90 13-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds. Ngunut 75,000 3,750
92 13-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId Ds. Ngunut 75,000 3,750
93 14-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds. Ngunut 75,000 3,750
97 14-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Sumberejo Kulon 75,000 3,750
100 14-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Sumberejo Kulon 75,000 3,750
101 14-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds .Pulosari 75,000 3,750
109 14-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds. Kaliwungu 75,000 3,750
111 14-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds. Gilang 75,000 3,750
112 14-Dec-18 Ariningsih, AMK 197507232006042022 Perawat IIIb Ds. Gilang 75,000 3,750
113 14-Dec-18 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi IId SDN 4 Pulosari 75,000 -
114 14-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc SDN 4 Pulosari 75,000 -
115 14-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId Ds. Kromasan 75,000 3,750
116 15-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Pulosari 75,000 3,750
118 15-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Kaliwungu 75,000 3,750
124 15-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Gilang 75,000 4,500
126 15-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds. Kaliwungu 75,000 3,750
128 15-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Pulotondo 75,000 3,750
130 15-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId Ds. Sumberejo Kulon 75,000 3,750
TOTAL 9,750,000 360,750
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
MBER 2018
JUMLAH
TANDA TANGAN
DITERIMA (Rp)
71,250 1
70,500 2
71,250 3
75,000 4
71,250 5
75,000 6
71,250 7
71,250 8
71,250 9
75,000 10
71,250 11
70,500 12
71,250 13
70,500 14
75,000 15
75,000 16
71,250 17
70,500 18
71,250 19
71,250 20
71,250 21
71,250 22
75,000 23
71,250 24
70,500 25
71,250 26
75,000 27
70,500 28
71,250 29
71,250 30
71,250 31
71,250 32
75,000 33
71,250 34
75,000 35
71,250 36
75,000 37
71,250 38
70,500 39
75,000 40
75,000 41
71,250 42
71,250 43
75,000 44
70,500 45
75,000 46
71,250 47
71,250 48
75,000 49
71,250 50
71,250 51
71,250 52
75,000 53
71,250 54
75,000 55
71,250 56
75,000 57
71,250 58
75,000 59
71,250 60
75,000 61
75,000 62
71,250 63
71,250 64
71,250 65
71,250 66
71,250 67
71,250 68
75,000 69
71,250 70
71,250 71
71,250 72
71,250 73
75,000 74
71,250 75
71,250 76
71,250 77
71,250 78
75,000 79
71,250 80
75,000 81
71,250 82
75,000 83
71,250 84
70,500 85
75,000 86
71,250 87
71,250 88
71,250 89
71,250 90
75,000 91
71,250 92
71,250 93
71,250 94
71,250 95
75,000 96
71,250 97
71,250 98
71,250 99
71,250 100
71,250 101
75,000 102
71,250 103
71,250 104
75,000 105
70,500 106
71,250 107
75,000 108
71,250 109
71,250 110
71,250 111
71,250 112
75,000 113
75,000 114
71,250 115
71,250 116
75,000 117
71,250 118
71,250 119
71,250 120
71,250 121
71,250 122
75,000 123
70,500 124
71,250 125
71,250 126
71,250 127
71,250 128
71,250 129
71,250 130
9,389,250
TULUNGAGUNG,
Hery Nur Faishol

NIP. 19840608 201001 1 002
JUMLAH
TGL
KEGIATAN
UANG (Rp)
1 17-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Kaliwungu 75,000 3,750
3 17-Dec-18 Nur Muftin, S.ST 196802181993022002 Bidan IIIb Ds. Kromasan 75,000 3,750
4 17-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Kromasan 75,000 3,750
5 17-Dec-18 Indah Setyorini, STP 197509282000122002 Nutrisionis IIIb Ds. Ngunut 75,000 3,750
7 17-Dec-18 Ivan Febri Artanto, Amd.Kep 198702162010011004 Perawat IId Ds. Pulosari 75,000 -
8 17-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Pulosari 75,000 4,500
9 17-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Kromasan 75,000 3,750
10 17-Dec-18 Tri Kurnisari, Amd.Kep Perawat Ds.Kromasan 75,000 4,500
11 17-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds.Kromasan 75,000 3,750

12 17-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds.Kromasan 75,000 3,750
13 17-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds.Kromasan 75,000 3,750
15 17-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId Ds.Kromasan 75,000 3,750
16 18-Dec-18 Tri Endah W, SST,M.Kes 197405132006042022 Bidan IIIc Ds.Kromasan 75,000 3,750
17 18-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds.Kromasan 75,000 3,750
18 18-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds.Kromasan 75,000 3,750
22 18-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Kromasan 75,000 3,750
23 18-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds. Kromasan 75,000 3,750
26 18-Dec-18 Ivan Febri Artanto, Amd.Kep 198702162010011004 Perawat IId Ds. Pulotondo 75,000 -
27 18-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Pulotondo 75,000 4,500

IIIc TK dan PAUD Aisyiyah

Pulosari
33 18-Dec-18 Agus Eko Sapto 196304041983101001 Perawat IIId Ds.Pulosari 75,000 3,750
34 19-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Gilang 75,000 3,750
44 19-Dec-18 Yusi Rahmawati, Amd.Kep 197601182009012002 Perawat IIIa Ds.Gilang 75,000 3,750
45 19-Dec-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc Ds.Gilang 75,000 -
46 19-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Gilang 75,000 4,500
47 19-Dec-18 Ariningsih, AMK 197507232006042022 Perawat IIIb Ds. Gilang 75,000 3,750
48 20-Dec-18 Dominika Martina, Amd.Keb 196911052006042004 Bidan IId Ds. Sumberejo Kulon 75,000 -
50 20-Dec-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Pulotondo 75,000 3,750
58 20-Dec-18 Satriya Andri, Amd.Kep Perawat Ds.Pulotondo 75,000 4,500
60 20-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds.Pulosari 75,000 3,750
61 20-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds.Pulosari 75,000 3,750
62 20-Dec-18 dr. Nurma Indah Pratiwi 198212102010012002 Dokter PKM Ngunut IIIc Ds.Pulosari 75,000 3,750
63 20-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds.Pulosari 75,000 -
64 21-Dec-18 Dominika Martina, Amd.Keb 196911052006042004 Bidan IId Ds. Pulotondo 75,000 -
66 21-Dec-18 Hanik Mudayati, SST Mkes 197204161992032000 Kepala Puskesmas IIId Ds. Ngunut 75,000 3,750
67 21-Dec-18 Tumini, S.Tr. Keb. 196808251990012002 Bidan IIId Ds. Ngunut 75,000 3,750
70 21-Dec-18 Ivan Febri Artanto, Amd.Kep 198702162010011004 Perawat IId Ds. Sumberejo Kulon 75,000 -
71 21-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Sumberejo Kulon 75,000 4,500
72 21-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Kaliwungu 75,000 3,750

73 21-Dec-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc Ds. Kaliwungu 75,000 3,750
77 22-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds. Pulosari 75,000 3,750
78 22-Dec-18 Ivan Febri Artanto, Amd.Kep 198702162010011004 Perawat IId Ds. Kaliwungu 75,000 -
IIIc PAUD Rousdhotul Jannah

Gilang
TOTAL 6,000,000 237,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
MBER 2018
JUMLAH
TANDA TANGAN
DITERIMA (Rp)
71,250 1
71,250 2
71,250 3
71,250 4
71,250 5
75,000 6
75,000 7
70,500 8
71,250 9
70,500 10
71,250 11
71,250 12
71,250 13
71,250 14
71,250 15
71,250 16
71,250 17
71,250 18
71,250 19
71,250 20
75,000 21
71,250 22
71,250 23
71,250 24
75,000 25
75,000 26
70,500 27
71,250 28
75,000 29
71,250 30
75,000 31
71,250 32
71,250 33
71,250 34
71,250 35
71,250 36
71,250 37
71,250 38
71,250 39
75,000 40
70,500 41
75,000 42
70,500 43
71,250 44
75,000 45
70,500 46
71,250 47
75,000 48
70,500 49
71,250 50
75,000 51
71,250 52
71,250 53
75,000 54
70,500 55
71,250 56
75,000 57
70,500 58
71,250 59
71,250 60
71,250 61
71,250 62
75,000 63
75,000 64
75,000 65
71,250 66
71,250 67
71,250 68
71,250 69
75,000 70
70,500 71
71,250 72
71,250 73
71,250 74
71,250 75
71,250 76
71,250 77
75,000 78
70,500 79
71,250 80
5,763,000
TULUNGAGUNG,
Hery Nur Faishol

NIP. 19840608 201001 1 002
DAFTAR PENERIMAAN BELANJA OPERASIONAL PETUGAS LAPANGAN TANGGAL 23-24 SEPTEMBER 2018
JUMLAH
TGL
KEGIATAN
UANG (Rp)
1 22-Oct-18 Binti Qomariyah, AMK 197108121995032002 Perawat IIIc TK Al Khodijah Kromasan 75,000 3,750
2 22-Oct-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Ds. Ngunut 75,000 3,750
3 22-Oct-18 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc Ds. Ngunut 75,000 -
4 22-Oct-18 Suhartatik, SST 197312191993022002 Bidan IIIc Ds. Ngunut 75,000 3,750
5 22-Oct-18 Christina Wisnu W, S.ST 197210091993022007 Bidan IIId Ds. Ngunut 75,000 3,750
6 22-Oct-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds. Ngunut 75,000 3,750
7 22-Oct-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc Ds. Ngunut 75,000 -
8 22-Oct-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds. Ngunut 75,000 -
9 22-Oct-18 Tri Kurnisari, Amd.Kep Perawat Ds. Ngunut 75,000 4,500
10 22-Oct-18 Erlin Nur W, Amd.Kep Perawat Ds. Ngunut 75,000 4,500
11 22-Oct-18 Satriya Andri, Amd.Kep Perawat Ds. Ngunut 75,000 4,500

12 22-Oct-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Ngunut 75,000 3,750
13 22-Oct-18 Yuda Wastu R, Amd.Kep 197407152006041009 Perawat IIIa Ds. Ngunut 75,000 3,750
14 22-Oct-18 Tri Endah Wahyuni. S.ST,M.Kes 197405132006042022 Bidan IIIb Ds. Ngunut 75,000 3,750
15 22-Oct-18 Rika Rustika, AMK 196901251991032006 Perawat IIId Ds. Ngunut 75,000 3,750
16 22-Oct-18 Tumini, S.Tr. Keb. 196808251990012002 Bidan IIId Ds. Ngunut 75,000 3,750
17 22-Oct-18 Abdul Majid 197901072006041015 Pranata Lab. IId Ds. Ngunut 75,000 -
18 22-Oct-18 Sujarwadi 198406122009011010 Staf PKM Ngunut IIa Ds. Ngunut 75,000 3,750
19 22-Oct-18 Hery Nur Faishol 198406082010011002 Staf PKM Ngunut IIIa Ds. Ngunut 75,000 3,750
20 22-Oct-18 Nika Asnamuna, S.Kep.Ners 198201152005012002 Perawat IIIa Ds. Ngunut 75,000 3,750
21 22-Oct-18 Ivan Febri Artanto, Amd.Kep 198702162020011004 Perawat IId Ds. Ngunut 75,000 -
22 22-Oct-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc SDN 1 Sumberejo Kulon 75,000 3,750
23 23-Oct-18 Binti Maslikah, Amd.AK 197212111994032002 Analis IIIc SDN 2 Sumberejo Kulon 75,000 3,750
24 23-Oct-18 Yuli Herawati, SST 198007102005012022 Bidan IIIb Ds. Ngunut 75,000 3,750
25 23-Oct-18 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc Ds. Ngunut 75,000 -
26 23-Oct-18 Suhartatik, SST 197312191993022002 Bidan IIIc Ds. Ngunut 75,000 3,750
27 23-Oct-18 Christina Wisnu W, S.ST 197210091993022007 Bidan IIId Ds. Ngunut 75,000 3,750
28 23-Oct-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds. Ngunut 75,000 3,750
29 23-Oct-18 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc Ds. Ngunut 75,000 -
30 23-Oct-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds. Ngunut 75,000 -
31 23-Oct-18 Tri Kurnisari, Amd.Kep Perawat Ds. Ngunut 75,000 4,500
32 23-Oct-18 Erlin Nur W, Amd.Kep Perawat Ds. Ngunut 75,000 4,500
33 23-Oct-18 Satriya Andri, Amd.Kep Perawat Ds. Ngunut 75,000 4,500
34 23-Oct-18 Muhari, AKL 197106121994031006 Sanitarian IIIc Ds. Gilang 75,000 3,750
35 23-Oct-18 Yuda Wastu R, Amd.Kep 197407152006041009 Perawat IIIa Ds. Gilang 75,000 3,750
36 23-Oct-18 Tri Endah Wahyuni. S.ST,M.Kes 197405132006042022 Bidan IIIb Ds. Gilang 75,000 3,750
37 23-Oct-18 Rika Rustika, AMK 196901251991032006 Perawat IIId Ds. Gilang 75,000 3,750
38 23-Oct-18 Tumini, S.Tr. Keb. 196808251990012002 Bidan IIId Ds. Gilang 75,000 3,750
39 23-Oct-18 Abdul Majid 197901072006041015 Pranata Lab. IId Ds. Gilang 75,000 -
40 23-Oct-18 Sujarwadi 198406122009011010 Staf PKM Ngunut IIa Ds. Gilang 75,000 3,750
41 23-Oct-18 Hery Nur Faishol 198406082010011002 Staf PKM Ngunut IIIa Ds. Gilang 75,000 3,750
42 23-Oct-18 Nika Asnamuna, S.Kep.Ners 198201152005012002 Perawat IIIa Ds. Gilang 75,000 3,750
43 23-Oct-18 Ivan Febri Artanto, Amd.Kep 198702162020011004 Perawat IId Ds. Gilang 75,000 -
TOTAL 3,225,000 128,250
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
MBER 2018
JUMLAH
TANDA TANGAN
DITERIMA (Rp)
71,250 1
71,250 2
75,000 3
71,250 4
71,250 5
71,250 6
75,000 7
75,000 8
70,500 9
70,500 10
70,500 11
71,250 12
71,250 13
71,250 14
71,250 15
71,250 16
75,000 17
71,250 18
71,250 19
71,250 20
75,000 21
71,250 22
71,250 23
71,250 24
75,000 25
71,250 26
71,250 27
71,250 28
75,000 29
75,000 30
70,500 31
70,500 32
70,500 33
71,250 34
71,250 35
71,250 36
71,250 37
71,250 38
75,000 39
71,250 40
71,250 41
71,250 42
75,000 43
3,096,750
TULUNGAGUNG,
Hery Nur Faishol

NIP. 19840608 201001 1 002
DAFTAR PENERIMAAN BELANJA PERJALANAN DINAS DALAM DAERAH
DISTRIBUSI SARANA DAN PRASARANA KE DINAS KESEHATAN
BANTUAN OPERASIONAL KESEHATAN UPTD PUSKESMAS NGUNUT
JUMLAH PPh 21 JUMLAH

NO NAMA JABATAN GOL TANDA TANGAN
UANG (Rp) DITERIMA
1 Merawati, Amd Keb Bidan IIId Rp 150,000 Rp 150,000
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,
KUASA PENGGUNA ANGGARAN BENDAHARA PENGELUARAN PEMBA

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PENGIRIMAN SAMPEL AIR BAKTERIOLOGIS

UANG (Rp) DITERIMA
1 Muhari, AKL Sanitarian IIId Rp 150,000 Rp 150,000
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002

UANG (Rp) DITERIMA
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002

UANG (Rp) DITERIMA
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002


UANG (Rp) DITERIMA
UANG (Rp) DITERIMA
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
KONSULTASI ATAU MENGHADIRI UNDANGAN DAN KEPERLUAN LAIN KE KABUPATEN/KOTA

UANG (Rp) DITERIMA
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002

UANG (Rp) DITERIMA
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002

UANG (Rp) DITERIMA
JUMLAH Rp 150,000 Rp - Rp 150,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PENGIRIMAN LAPORAN

UANG (Rp) DITERIMA
BPP Puskesmas
1 Hery Nur Faishol Ngunut IIb Rp 100,000 Rp - Rp 100,000
JUMLAH Rp 100,000 Rp - Rp 100,000

TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
M DAERAH
HATAN
NGUNUT
TANDA TANGAN
GAGUNG,
ARA PENGELUARAN PEMBANTU
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
NGUNUT
TANDA TANGAN
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
KE KABUPATEN/KOTA
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
KE KABUPATEN/KOTA
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
KE KABUPATEN/KOTA
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
M DAERAH
NGUNUT
TANDA TANGAN
GAGUNG,
Hery Nur Faishol

P. 19840608 201001 1 002
DAFTAR PENERIMAAN BELANJA JASA KERJA
LAPORAN BAGAS TANGGAL 25 SEPTEMBER 2018
JUMLAH
NO NAMA JABATAN GOL PPh 21 (Rp)
UANG
1 Dina Setyawati Bagas Kaliwungu Rp 50,000 Rp 3,000
2 Linda S Bagas Ngunut Rp 50,000 Rp 3,000
3 Hartutik Bagas Gilang Rp 50,000 Rp 3,000
4 Srini Bagas Pulosari Rp 50,000 Rp 3,000
5 Suyono Bagas Pulotondo Rp 50,000 Rp 3,000
6 Siti Amanah Bagas Kromasan Rp 50,000 Rp 3,000
7 Mimik Hartatik Bagas Sumberjo Kulon Rp 50,000 Rp 3,000
JUMLAH Rp 350,000 Rp 21,000
TULUNGAGUNG,
KUASA PENGGUNA ANGGARAN BENDAHARA PENGELUARAN PEMBAN

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
ASA KERJA
EMBER 2018
USKESMAS NGUNUT
JUMLAH TANDA TANGAN

DITERIMA
Rp 47,000 1
Rp 47,000 2
Rp 47,000 3
Rp 47,000 4
Rp 47,000 5
Rp 47,000 6
Rp 47,000 7
Rp 329,000
TULUNGAGUNG,
BENDAHARA PENGELUARAN PEMBANTU
Hery Nur Faishol

NIP. 19840608 201001 1 002
PEMANTAUAN IBU HAMIL RESTI /PENDAMPINGAN BUMIL RESTI DS. NGUNUT TANGGAL 26 JULI 2018
JUMLAH JUMLAH
NO NAMA JABATAN GOL PPh 21 (Rp) TANDA TANGAN
UANG DITERIMA
1 Sri Kanthi Kader Ds. Ngunut Rp 50,000 Rp 3,000 Rp 47,000 1.
2 Siti Rodiyah Kader Ds. Ngunut Rp 50,000 Rp 3,000 Rp 50,000 2.
3 Ria Tri Ningsih Kader Ds. Ngunut Rp 50,000 Rp 3,000 Rp 50,000 3.
4 Isni Nuryati Kader Ds. Ngunut Rp 50,000 Rp 3,000 Rp 50,000 4.
5 Indriasih Kader Ds. Ngunut Rp 50,000 Rp 3,000 Rp 50,000 5.
JUMLAH Rp 250,000 Rp 15,000 Rp 247,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMANTAUAN IBU HAMIL RESTI/ PENDAMPINGAN BUMIL RESTI DS. PULOSARI TANGGAL 26 JULI 2018
JUMLAH JUMLAH
UANG DITERIMA
1 Srini Kader Ds. Pulosari Rp 50,000 Rp 3,000 Rp 47,000 1.
2 Rohmiati Kader Ds. Pulosari Rp 50,000 Rp 3,000 Rp 47,000 2.
JUMLAH Rp 100,000 Rp 6,000 Rp 94,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMANTAUAN IBU HAMIL RESTI/ PENDAMPINGAN BUMIL RESTI DS. SUMBEREJO KULONTANGGAL 26 JULI 2018
JUMLAH JUMLAH
UANG DITERIMA
Kader Ds.
1 Maysaroh Sumberejo Kulon Rp 50,000 Rp 3,000 Rp 47,000 1.
JUMLAH Rp 50,000 Rp 3,000 Rp 47,000
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMANTAUAN IBU HAMIL RESTI/ PENDAMPINGAN BUMIL RESTI DS.KROMASAN TANGGAL 26 JULI 2018
JUMLAH JUMLAH
UANG DITERIMA
Wahyu Dwi
1 Kader Ds. Kromasan Rp 50,000 Rp 3,000 Rp 47,000 1.
Kartini
2 Luluk Farida Kader Ds. Kromasan Rp 50,000 Rp 3,000 Rp 47,000 2.
3 Wasilatul Rofiah Kader Ds. Kromasan Rp 50,000 Rp 3,000 Rp 47,000 3.
4 Muslimah Kader Ds. Kromasan Rp 50,000 Rp 3,000 Rp 47,000 4.
JUMLAH Rp 150,000 Rp 9,000 Rp 141,000
TULUNGAGUNG,
NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
26 JULI 2018
TANDA TANGAN
1.
2.
3.
5.
AN PEMBANTU
26 JULI 2018
TANDA TANGAN
1.
2.
AN PEMBANTU
GAL 26 JULI 2018
TANDA TANGAN
1.
AN PEMBANTU
26 JULI 2018
TANDA TANGAN
1.
2.
3.
4.
AN PEMBANTU
PEMERIKSAAN JENTIK BERKALA DESA NGUNUT TANGGAL 23 OKTOBER 2017
JUMLAH JUMLAH
UANG DITERIMA
1 Isni Nuryati Kader Ds. Ngunut Rp 75,000 Rp 4,500 Rp 70,500 1.
2 Erna Kader Ds. Ngunut Rp 75,000 Rp 4,500 Rp 70,500 2.
3 Yemima Kader Ds. Ngunut Rp 75,000 Rp 4,500 Rp 70,500 3.
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMERIKSAAN JENTIK BERKALA DESA PULOSARI TANGGAL 23 OKTOBER 2017
JUMLAH JUMLAH
UANG DITERIMA
1 Mudjiati Kader Ds. Pulosari Rp 75,000 Rp 4,500 Rp 70,500 1.
2 Srini Kader Ds. Pulosari Rp 75,000 Rp 4,500 Rp 70,500 2.
3 Tutik Kader Ds. Pulosari Rp 75,000 Rp 4,500 Rp 70,500 3.
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMERIKSAAN JENTIK BERKALA DESA PULOTONDO TANGGAL 23 OKTOBER 2017
JUMLAH JUMLAH
UANG DITERIMA
1 Kusnul Kader Ds. Pulotondo Rp 75,000 Rp 4,500 Rp 70,500 1.
2 Muslimatin Kader Ds. Pulotondo Rp 75,000 Rp 4,500 Rp 70,500 2.
3 Sri Wahyuni Kader Ds. Pulotondo Rp 75,000 Rp 4,500 Rp 70,500 3.
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMERIKSAAN JENTIK BERKALA DESA KROMASAN TANGGAL 23 OKTOBER 2017
JUMLAH JUMLAH
UANG DITERIMA
1 Indah Yuliani Kader Ds. Kromasan Rp 75,000 Rp 4,500 Rp 70,500 1.
2 Siti Amaroh Kader Ds. Kromasan Rp 75,000 Rp 4,500 Rp 70,500 2.
3 Sunarmi Kader Ds. Kromasan Rp 75,000 Rp 4,500 Rp 70,500 3.
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,
NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMERIKSAAN JENTIK BERKALA DESA SUMBERJO KULON TANGGAL 23 OKTOBER 2017
JUMLAH JUMLAH
UANG DITERIMA
Kader Ds. Sumberjo

1 Susiyani Rp 75,000 Rp 4,500 Rp 70,500 1.
Kulon
Kader Ds. Sumberjo

2 Novita Rp 75,000 Rp 4,500 Rp 70,500 2.
Kulon
Kader Ds. Sumberjo

3 Endah Mar'atus Rp 75,000 Rp 4,500 Rp 70,500 3.
Kulon
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMERIKSAAN JENTIK BERKALA DESA KALIWUNGU TANGGAL 23 OKTOBER 2017
JUMLAH JUMLAH
UANG DITERIMA
1 Kurnia Susilowati Kader Ds. Kaliwungu Rp 75,000 Rp 4,500 Rp 70,500 1.
2 Sulistyorini Kader Ds. Kaliwungu Rp 75,000 Rp 4,500 Rp 70,500 2.
3 Sringatin Kader Ds. Kaliwungu Rp 75,000 Rp 4,500 Rp 70,500 3.
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
PEMERIKSAAN JENTIK BERKALA DESA GILANG TANGGAL 23 OKTOBER 2017

JUMLAH JUMLAH
UANG DITERIMA
1 Enik Ervina Kader Ds. Gilang Rp 75,000 Rp 4,500 Rp 70,500 1.
2 Rina Darmiati Kader Ds. Gilang Rp 75,000 Rp 4,500 Rp 70,500 2.
3 Retno Kader Ds. Gilang Rp 75,000 Rp 4,500 Rp 70,500 3.
JUMLAH Rp 225,000 Rp 13,500 Rp 211,500
TULUNGAGUNG,

NIP 19720416 199203 2 007 NIP. 19840608 201001 1 002
R 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
ER 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
BER 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
BER 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
TOBER 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
BER 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
R 2017
UT
TANDA TANGAN
1.
2.
3.
AN PEMBANTU
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
MENGETAHUI, TULUNGAGUNG, 23 DESEMBER 201

KEPALA UPTD PKM NGUNUT
Hanik Mudayati, S.ST.M.Kes ……………………………………….

NIP 19720416 199203 2 007 NIP ………………………………
HADIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
TULUNGAGUNG, 23 DESEMBER 2017

PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT
5
6
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30


NIP 19720416 199203 2 007 NIP ………………………………
HADIR
TANDA TANGAN
5
6
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR HADIR
KEGIATAN BANTUAN OPERASIONAL KESEHATAN (BOK)
UPTD PUSKESMAS NGUNUT
JL Raya Ngunut No.1, Telp. (0355) 395337 Email : pkmngunut@gmail.com
TULUNGAGUNG Kode Pos (66292)
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT / JABATAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
……………………………………….
NIP ………………………………
HADIR
ASIONAL KESEHATAN (BOK)
MAS NGUNUT
5) 395337 Email : pkmngunut@gmail.com
UNG Kode Pos (66292)
HADIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

PELAKSANA
……………………………………….
NIP ………………………………
PEMERINTAH KABUPATEN TULUNGAGUNG
DINAS KESEHATAN
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
……………………………………….
NIP ………………………………
BUPATEN TULUNGAGUNG
S KESEHATAN
ESMAS NGUNUT
UNG Kode Pos (66292)
HADIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

PELAKSANA
……………………………………….
NIP ………………………………
DINAS KESEHATAN
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
……………………………………….
NIP ………………………………
BUPATEN TULUNGAGUNG
S KESEHATAN
KESMAS NGUNUT
NG Kode Pos (66292)
HADIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

PELAKSANA
……………………………………….
NIP ………………………………
DINAS KESEHATAN
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA JABATAN
1 Hanik Mudayati, SST,M.Kes Kepala Puskesmas

2 dr. Nurma Indah Pratiwi Dokter Umum
3 dr. Pasha Chandra Dokter Umum
4 Endah Ristiwahyuni, AMK Perawat
5 Agus Eko Sapto Perawat
6 Sarengah,AMK Perawat
7 Mahpuzah,AMK Perawat
8 Merawati,Amd.Keb Bidan
9 Tumini, S.Tr.Keb, M.kes Bidan
10 Rika Rustika, AMK Perawat
11 Sundari, SE Staf
12 Mamik Prihatin Perawat
13 Christina Wisnu W, SST Bidan
14 Nur Muftin, S.ST Bidan
15 Suhartatik, SST Bidan
16 Binti Maslikah, Amd. AK Analis
17 Abdul Majid Analis
18 Muhari, SKM Sanitasi
19 Hery Nur Faishol Staf
20 Tri Endah Wahyuni. S.ST,M.Kes Bidan
21 Aprilia Kurniasari, SKM. Adminkes
22 Indah Setyorini, STP Nutrisionist Lanjutan
23 Tintin Yuliati, Amd.Rad Radiologi
24 Yuli Herawati, SST Bidan
25 Mahfud, S.ST.Ars Staf
26 Ariningsih, AMK Perawat
27 Nursofi Umamah, S.ST,M.Kes Bidan
28 Nika Asnamuna, S.Kep.Ners Perawat
29 Tanwirul Huda, Amd.Kep Perawat
30 Restuning Diana N,Amd.Keb Bidan
31 Widaningsih, Amd.Keb Bidan
32 Yuda Wastu R, Amd.Kep Perawat
33 Ivan Febri A, Amd.Kep Perawat
34 Dominika M, Amd.Keb Bidan
35 Sujarwadi Sujarwadi
………………………………………
NIP ………………………………
ATEN TULUNGAGUNG
ESEHATAN
MAS NGUNUT
95337 Email : pkmngunut@gmail.com
Kode Pos (66292)
DIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR HADIR PERTEMUAN
Nama Kegiatan : Sosialisasi Penggerakan Pelaksanaan (P2) Melalui Lokakarya Mini

Tanggal : 20 Nopember 2017
Tempat : Ruang Pertemuan Puskesmas Ngunut
NO NAMA NIP JABATAN GOL TANDA TANGAN
1 Hanik Mudayati, SST,M.Kes 197204161992032007 Kepala Puskesmas IIId 1

2 dr. Nurma Indah Pratiwi 198212102010012002 Dokter Umum IIIc
3 Endah Ristiwahyuni, AMK 196401191983122001 Perawat IIId 3
4 Agus Eko Sapto 196304041983101001 Perawat IIId
5 Sarengah,AMK 196511151993032003 Perawat IIId 5
6 Mahpuzah,AMK 196608091993122002 Perawat IIId
7 Merawati,Amd.Keb 196904241990012002 Bidan IIId 7
8 Tumini, S.Tr.Keb, M.kes 196808251990012002 Bidan IIId
9 Rika Rustika, AMK 196901251991032006 Perawat IIId 9
10 Sundari, SE 196510071988122001 Staf IIId
11 Mamik Prihatin 196804041993022003 Perawat IIIc 11
12 Christina Wisnu W, SST 197210091993022007 Bidan IIId
13 Nur Muftin, S.ST 196802181993022002 Bidan IIIc 13
14 Suhartatik, SST 197312191993022002 Bidan IIIc
15 Binti Maslikah, Amd. AK 197212111994032002 Analis IIIc 15
16 Binti Qomariyah, AMK 197108121995032002 Perawat IIIb
17 Muhari, SKM 197106121994031006 Sanitasi IIIb 17
18 Yustiani, S.Kep, Ners 198306242009012003 Perawat IIIc
19 Tri Endah Wahyuni. S.ST,M.Kes 197405132006042022 Bidan IIIb 19
20 Aprilia Kurniasari, SKM. 198504022010012029 Adminkes IIIb
21 Indah Setyorini, STP 197509282000122002 Nutrisionist Lanjutan IIIb 21
22 Tintin Yuliati, Amd.Rad 197407302005012010 Radiologi IIIb
23 Yuli Herawati, SST 198007102005012022 Bidan IIIb 23
24 Mahfud, S.ST.Ars 196908111991021002 Staf IIIb
25 Ariningsih, AMK 197507232006042022 Perawat IIIb 25
26 Nursofi Umamah, S.ST,M.Kes 197704212006042015 Bidan IIIb
27 Nika Asnamuna, S.Kep.Ners 198201152005012002 Perawat IIIa 27
28 Suparti 196902071987112002 Staf IId
29 Restuning Diana N,Amd.Keb 198505012009012007 Bidan IId 29
30 Widaningsih, Amd.Keb 197105202006042017 Bidan IId
31 Yuda Wastu R, Amd.Kep 197407152006041009 Perawat IId 31
32 Ivan Febri A, Amd.Kep 198702162010011004 Perawat IId
33 Dominika M, Amd.Keb 196911052006042004 Bidan IId 33
34 Ahmad Saifu H, Amd.Kep 197604102006041020 Perawat IIc
35 Abdul Majid 197901072006041015 Analis IIc 35
36 Tanwirul Huda, Amd.Kep 197804252014061001 Perawat IIc
37 Musriati 196404152006042005 Staf IIc 37
38 Susi Mei Prisida, Amd. AFM 198105082005012000 Asisten Apoteker IId
39 Sri Wariningsih 197701042007012008 Bidan IIb 39
40 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc
41 Tony Yuswantoro 197209242009011001 Staf (Driver) IIb 41
42 Hery Nur Faishol 198406082010011002 Staf IIb
43 Sujarwadi 198406122009011010 Staf IIa 43
44 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi IId
45 Atik Yuliana, Amd.Keb 198407262017042005 Bidan IIc 45
46 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc
47 dr. Pasha Chandra - Dokter PTT - 47
48 Satriya A, Amd.Kep - Perawat PTT -
49 Tri Kurnia, Amd.Kep - Perawat PTT - 49
50 Erlin Nur W, Amd.Kep - Perawat PTT -
TULUNGAGUNG, 27 SEPTEMBER 2017

KUASA PENGGUNA ANGGARAN
Hanik Mudayati, SST,M.Kes

NIP 19720416 199203 2 007
kakarya Mini
TANDA TANGAN
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
G, 27 SEPTEMBER 2017
NGGUNA ANGGARAN
dayati, SST,M.Kes
416 199203 2 007
DAFTAR HADIR PERTEMUAN
Nama Kegiatan : Sosialisasi Pengawasan Pengendalian Penilaian (P3)

Tanggal : 28 September 2017
Tempat : Ruang Pertemuan Puskesmas Ngunut

18 Yustiani, S.Kep, Ners 198306242009012003 Perawat IIIb
28 Suparti 196902071987112002 Staf IId
35 Abdul Majid 197901072006041015 Analis IId 35
TULUNGAGUNG, 28 SEPTEMBER 2017
KUASA PENGGUNA ANGGARAN
Hanik Mudayati, SST,M.Kes

NIP 19720416 199203 2 007
TANDA TANGAN
10
12
14
16
18
20
22
24
26
28
30
32
34
G, 28 SEPTEMBER 2017
NGGUNA ANGGARAN
dayati, SST,M.Kes
416 199203 2 007
DAFTAR KARYAWAN

18 Yustiani, S.Kep, Ners 198306242009012003 Perawat IIIb
28 Suparti 196902071987112002 Staf IId
34 Ahmad Saifu H, Amd.Kep 197604102006041020 Perawat IIc
35 Abdul Majid 197901072006041015 Analis IIc 35
36 Tanwirul Huda, Amd.Kep 197804252014061001 Perawat IIc
37 Musriati 196404152006042005 Staf IIc 37
38 Susi Mei Prisida, Amd. AFM 198105082005012000 Asisten Apoteker IId
39 Sri Wariningsih 197701042007012008 Bidan IIb 39
40 Choirul Masruroch, Amd.Keb 197603042008012011 Bidan IIc
41 Tony Yuswantoro 197209242009011001 Staf (Driver) IIb 41
43 Sujarwadi 198406122009011010 Staf IIa 43
44 Lusy Mayasari, Amd.KG 198502192010012000 Perawat Gigi IId
45 Atik Yuliana, Amd.Keb 198407262017042005 Bidan IIc 45
46 Ratna Artha C, Amd. Keb. 198906162017042003 Bidan IIc
47 dr. Pasha Chandra - Dokter PTT - 47
48 Satriya A, Amd.Kep - Perawat PTT -
49 Tri Kurnia, Amd.Kep - Perawat PTT - 49
50 Erlin Nur W, Amd.Kep - Perawat PTT -
I a : Juru Muda III a : Penata Muda IV a : Pembina

I b : Juru Muda Tk 1 III b : Pengatur Muda Tk 1 IV b : Pembina Tk 1
I c : Juru III c : Pengatur IV c : Pembina Utama Muda
I d : Juru Tk 1 III d : Pengatur Tk 1 IV d : Pembina Utama Madya
IV e : Pembina Utama
II a : Pengatur Muda
II b : Pengatur Muda Tk 1
II c : Pengatur
II d : Pengatur Tk 1
TANDA TANGAN
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
bina Utama Muda
bina Utama Madya
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25


NIP 19720416 199203 2 007 NIP ………………………………
HADIR
TANDA TANGAN
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45


NIP 19720416 199203 2 007 NIP ………………………………
HADIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45

PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR PENERIMA TRANSPORT
Nama Kegiatan :
Tanggal :
Tempat :
JUMLAH
NO NAMA ALAMAT GOL PPh 21 (Rp)
UANG
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
TOTAL Rp 2,000,000 Rp 2,000,000
KUASA PENGGUNA ANGGARAN BENDAHARA PENGELU
Hanik Mudayati, S.ST.M.Kes

NIP 19720416 199203 2 007
ANSPORT
JUMLAH
TANDA TANGAN
DITERIMA
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
Rp 2,000,000
TULUNGAGUNG, 29 NOPEMBER 2017

Hery Nur Faishol

NIP. 19840608 201001 1 002
DAFTAR HADIR
Nama Kegiatan : Loka Karya Mini Lintas Sektor

Tanggal : 14 Pebruari 2018
Tempat : Kantor Kecamatan Ngunut
NO NAMA JABATAN / ALAMAT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
MENGETAHUI, TULUNGAGUNG, 14 PEBRUARI 2017

Hanik Mudayati, S.ST.M.Kes Hanik Mudayati, S.ST.M.Kes

NIP 19720416 199203 2 007 NIP 19720416 199203 2 007
HADIR
TANDA TANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
TULUNGAGUNG, 14 PEBRUARI 2017

PELAKSANA

NIP 19720416 199203 2 007
DAFTAR PENERIMA TRANSPORT
Nama Kegiatan :
Tanggal :
Tempat :
JUMLAH
NO NAMA JABATAN GOL PPh 21 (Rp)
UANG
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
TOTAL Rp2,000,000 Rp2,000,000
TULUNGAGUNG, 29 N
KUASA PENGGUNA ANGGARAN BENDAHARA PENGELU

NIP 19720416 199203 2 007
RANSPORT
JUMLAH
TANDA TANGAN
DITERIMA
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Rp2,000,000
TULUNGAGUNG, 29 NOPEMBER 2017

Hery Nur Faishol

NIP. 19840608 201001 1 002
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40


NIP 19720416 199203 2 007 NIP ………………………………
HADIR
TANDA TANGAN
1
2
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PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR HADIR
Nama Kegiatan :
Tanggal :
Tempat :
NO NAMA ALAMAT
10
11
12
13
14
15
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NIP 19720416 199203 2 007 NIP ………………………………
HADIR
TANDA TANGAN
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PELAKSANA
……………………………………….
NIP ………………………………
DAFTAR PETUGAS PELAKSANAAN ORI DIFTERI TAHAP II
UPTD PUSKESMAS NGUNUT TAHUN 2018
BULAN JULI 2018

NO NAMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 MERAWATI
2 TUMINI
3 TRI ENDAH
4 MUHARI
5 BINTI MASLIKAH
6 INDAH SETYORINI
7 LUSY MAYASARI
8 NIKA ASNAMUNA
9 ABDUL MAJID
10 WIDANINGSIH
11 RATNA ARTHA
12 MAHPUZAH
13 MAHFUD
14 DWI RATNASARI
15 NUR MUFTIN
16 SARENGAH
17 YULI HERAWATI
18 ERLIN NUR
19 SATRIYA
20 SUPARTI
21 NURSOFI UMAMAH
22 DINA ALFI
23 SUHARTATIK
24 ARININGSIH
25 SUJARWADI
26 DERISTA A.K
27 CHRISTINA WISNU
28 CHOIRUL MASRUROH
29 TRI KURNIA
30 YUSI RAHMAWATI
31 ATIK YULIANA
DAFTAR PETUGAS PELAKSANAAN ORI DIFTERI TAHAP II
UPTD PUSKESMAS NGUNUT TAHUN 2018
BULAN AGUSTUS 2018

NO NAMA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 MERAWATI
2 TUMINI
3 TRI ENDAH
4 MUHARI
5 BINTI MASLIKAH
6 INDAH SETYORINI
7 LUSY MAYASARI
8 NIKA ASNAMUNA
9 ABDUL MAJID
10 WIDANINGSIH
11 RATNA ARTHA
12 MAHPUZAH
13 MAHFUD
14 DWI RATNASARI
15 NUR MUFTIN
16 SARENGAH
17 YULI HERAWATI
18 ERLIN NUR
19 SATRIYA
20 SUPARTI
21 NURSOFI UMAMAH
22 DINA ALFI
23 SUHARTATIK
24 ARININGSIH
25 SUJARWADI
26 DERISTA A.K
27 CHRISTINA WISNU
28 CHOIRUL MASRUROH
29 TRI KURNIA
30 YUSI RAHMAWATI
31 ATIK YULIANA

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DAFTAR PENERIMAAN BELANJA OPERASIONAL PETUGAS LAPANGAN TANGGAL 01 DESEMBER 2018

KEGIATAN BANTUAN OPERASIONAL KESEHATAN PADA UPTD PUSKESMAS NGUNUT

TOTAL 900,000 34,500

Hanik Mudayati, S.ST.M.Kes Hery Nur Faishol

Hery Nur Faishol

KEGIATAN BANTUAN OPERASIONAL KESEHATAN PADA UPTD PUSKESMAS NGUNUT

2 3-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds.Kromasan 75,000 3,750

IId TK dan PAUD Aisyiyah

IIc TK dan PAUD Aisyiyah

32 4-Dec-18 Tri Kurnia, Amd.Kep Perawat Ds. Kromasan 75,000 4,500

47 5-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Pulotondo 75,000 3,750

48 5-Dec-18 Mahpuzah, AMK 196608091993122000 Perawat IIId Ds.Pulotondo 75,000 3,750

64 6-Dec-18 Mahpuzah, AMK 196608091993122000 Perawat IIId Ds.Pulotondo 75,000 3,750

65 6-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Gilang 75,000 3,750

66 6-Dec-18 Ariningsih, AMK 197507232006042022 Perawat IIIb Ds.Gilang 75,000 3,750

67 6-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. ngunut 75,000 4,500

86 7-Dec-18 Mahpuzah, AMK 196608091993122000 Perawat IIId Ds.Pulotondo 75,000 3,750

88 7-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Kaliwungu 75,000 4,500

89 7-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Pulotondo 75,000 3,750

105 8-Dec-18 Tri Kurniasari, Amd.Kep Perawat Ds .Kromasan 75,000 4,500

TOTAL 8,325,000 334,500

Hanik Mudayati, S.ST.M.Kes Hery Nur Faishol

Hery Nur Faishol

KEGIATAN BANTUAN OPERASIONAL KESEHATAN PADA UPTD PUSKESMAS NGUNUT

2 10-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Kaliwungu 75,000 4,500

IId TK dan PAUD Aisyiyah

IIc TK dan PAUD Aisyiyah

37 11-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds .Pulosari 75,000 -

IIIc PAUD Tunas Ceria

45 12-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Ngunut 75,000 4,500

59 12-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds .Pulosari 75,000 -

61 12-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds .Pulosari 75,000 -

68 13-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Ngunut 75,000 3,750

75 13-Dec-18 Mahpuzah, AMK 196608091993122000 Perawat IIId Ds.Pulotondo 75,000 3,750

77 13-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds.Kromasan 75,000 3,750

83 13-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds .Pulosari 75,000 -

85 13-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Kaliwungu 75,000 4,500

88 13-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Ngunut 75,000 3,750

TOTAL 9,750,000 360,750

Hanik Mudayati, S.ST.M.Kes Hery Nur Faishol

Hery Nur Faishol

KEGIATAN BANTUAN OPERASIONAL KESEHATAN PADA UPTD PUSKESMAS NGUNUT

8 17-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Pulosari 75,000 4,500

9 17-Dec-18 Merawati, Amd.Keb 196904241990012002 Bidan IIId Ds.Kromasan 75,000 3,750

10 17-Dec-18 Tri Kurnisari, Amd.Kep Perawat Ds.Kromasan 75,000 4,500

11 17-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds.Kromasan 75,000 3,750

14 17-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds.Kromasan 75,000 3,750

19 18-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds.Kromasan 75,000 3,750

27 18-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Pulotondo 75,000 4,500

IIIc TK dan PAUD Aisyiyah

37 19-Dec-18 Widaningsih, S.ST 197105202006042017 Bidan IIIa Ds.Kromasan 75,000 3,750

41 19-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Kaliwungu 75,000 4,500

46 19-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Gilang 75,000 4,500

55 20-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Ngunut 75,000 4,500

59 20-Dec-18 Mahpuzah, AMK 196608091993122000 Perawat IIId Ds.Pulotondo 75,000 3,750

60 20-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds.Pulosari 75,000 3,750

63 20-Dec-18 Atik Yuliana, AMd.Keb 198407262017042005 Bidan IIc Ds.Pulosari 75,000 -

72 21-Dec-18 Sarengah,AMK 196511151993032003 Perawat IIId Ds. Kaliwungu 75,000 3,750

79 22-Dec-18 Satriya Andri, Amd.Kep Perawat Ds. Kaliwungu 75,000 4,500

IIIc PAUD Rousdhotul Jannah

Hanik Mudayati, S.ST.M.Kes Hery Nur Faishol

Hery Nur Faishol

KEGIATAN BANTUAN OPERASIONAL KESEHATAN PADA UPTD PUSKESMAS NGUNUT