Daftar Penerima

PEMERINTAH KABUPATEN LOMBOK UTARA
DINAS KESEHATAN
UPT BLUD PUSKESMAS BAYAN
Jl. Raya Tanjung – Bayan KM. 38 Kode Pos : 83354, Email. Puskesmasbayan@gmail.com
DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKESMAS BAYAN
TAHUN 2020
POTONGAN JUMLAH TANDA TANGAN

NO BULAN NAMA KEGIATAN JUMLAH
-20% DITERIMA
1 Januari Fitri Handayani Pelayanan Antenatal 450,000 90,000 360,000 1
2 Sofiaturohmi F.A Pelayanan Antenatal 300,000 60,000 240,000 2
3 Ina Handawati Pelayanan Antenatal 300,000 60,000 240,000 3
4 Ana Risnayanti Pelayanan Antenatal 350,000 70,000 280,000 4
5 Sahniwati Pelayanan Antenatal 300,000 60,000 240,000 5
6 Agusni Pelayanan Antenatal 300,000 60,000 240,000 6
7 Hariani Pelayanan Imunisasi 450,000 90,000 360,000 7
8 Kadek Satria Pelayanan Imunisasi 600,000 120,000 480,000 8
9 Novan J.S Pelayanan Imunisasi 650,000 130,000 520,000 9
10 Sri Sulanti Pelayanan Imunisasi 500,000 100,000 400,000 10
11 Rabiatun Pelayanan Balita 900,000 180,000 720,000 11
12 Puasniwati Pelayanan Balita 1,200,000 240,000 960,000 12
13 Linda Martin Pelayanan Balita 1,300,000 260,000 1,040,000 13
14 Nova Mariani Pelayanan Balita 1,000,000 200,000 800,000 14
15 Ade Irmayani Posyandu Lansia 1,400,000 280,000 1,120,000 15
16 Nova Mariani Pemantauan Bumil Resti 500,000 100,000 400,000 16
17 Ahmad Yono Penemuan BTA(+) 400,000 80,000 320,000 17
18 Muliawati Sikat Gigi Masal Disekolah 200,000 40,000 160,000 18
19 Februari Fitri Handayani Pelayanan Antenatal 450,000 90,000 360,000 19
20 Sofiaturohmi F.A Pelayanan Antenatal 300,000 60,000 240,000 20
22 Ana Risnayanti Pelayanan Antenatal 350,000 70,000 280,000 22
29 Supiani Pelayanan SDIDTK 700,000 140,000 560,000 29
30 Susianto E. Skrining Umur 15-59 thn 500,000 100,000 400,000 30
31 Dedy S. Pemantauan Dehidrasi RT 500,000 100,000 400,000 31
32 Dedy S. Follow UP Kasus Ispa 500,000 100,000 400,000 32
33 Nuryati Penyuluhan Masal UKM 500,000 100,000 400,000 33
34 Nurul Isnaeni Penjaringan kasus PTM 1,050,000 210,000 840,000 34
35 Nova Mariani Pelayanan Neonatal Resti 500,000 100,000 400,000 35
36 Eko Supriadi Pelacakan Penderita Keswa 200,000 40,000 160,000 36
37 Eko Supriadi kunjungan Jiwa mankir Obat 100,000 20,000 80,000 37
38 Susianto E. Pelaksanaan Posbindu 3,750,000 750,000 3,000,000 38
39 Emi Purniawati Kelas Ibu Hamil 450,000 90,000 360,000 39
40 Ade Irmayani Posyandu Lansia 1,400,000 280,000 1,120,000 40
41 Ahmad Yono Pelacakan Kontak Serumah 500,000 100,000 400,000 41
42 Januari Eko Supriadi kunjungan Jiwa mankir Obat 100,000 20,000 80,000 42
Total 26,250,000 5,250,000 21,000,000
Mengetahui
Kepala UPT BLUD Puskesmas Bayan Bendahara BOK
Hj. Rusniatun, Amd. Keb Baiq Ayu Nahdiatul Afni,S.Tr.Keb
NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020
TANDA TANGAN
NO BULAN NAMA KEGIATAN JUMLAH JUMLAH DITERIMA
1 Januari Fitri Handayani Pelayanan Antenatal 450,000 450,000 1

2 Sofiaturohmi F.A Pelayanan Antenatal 300,000 300,000 2
3 Ina Handawati Pelayanan Antenatal 300,000 300,000 3
4 Ana Risnayanti Pelayanan Antenatal 350,000 350,000 4
5 Sahniwati Pelayanan Antenatal 300,000 300,000 5
6 Agusni Pelayanan Antenatal 300,000 300,000 6
7 Hariani Pelayanan Imunisasi 450,000 450,000 7
8 Kadek Satria Pelayanan Imunisasi 600,000 600,000 8
9 Novan J.S Pelayanan Imunisasi 650,000 650,000 9
10 Sri Sulanti Pelayanan Imunisasi 500,000 500,000 10
11 Rabiatun Pelayanan Balita 900,000 900,000 11
12 Puasniwati Pelayanan Balita 1,200,000 1,200,000 12
13 Linda Martin Pelayanan Balita 1,300,000 1,300,000 13
14 Nova Mariani Pelayanan Balita 1,000,000 1,000,000 14
15 Ade Irmayani Posyandu Lansia 1,400,000 1,400,000 15
16 Nova Mariani Pemantauan Bumil Resti 500,000 500,000 16
17 Ahmad Yono Penemuan BTA(+) 400,000 400,000 17
18 Muliawati Sikat Gigi Masal Disekolah 200,000 200,000 18
19 Februari Fitri Handayani Pelayanan Antenatal 450,000 450,000 19
20 Sofiaturohmi F.A Pelayanan Antenatal 300,000 300,000 20
22 Ana Risnayanti Pelayanan Antenatal 350,000 350,000 22
29 Supiani Pelayanan SDIDTK 700,000 700,000 29
30 Susianto E. Skrining Umur 15-59 thn 500,000 500,000 30
31 Dedy S. Pemantauan Dehidrasi RT 500,000 500,000 31
32 Dedy S. Follow UP Kasus Ispa 500,000 500,000 32
33 Nuryati Penyuluhan Masal UKM 500,000 500,000 33
34 Nurul Isnaeni Penjaringan kasus PTM 1,050,000 1,050,000 34
35 Nova Mariani Pelayanan Neonatal Resti 500,000 500,000 35
36 Eko Supriadi Pelacakan Penderita Keswa 200,000 200,000 36
37 Eko Supriadi kunjungan Jiwa mankir Obat 100,000 100,000 37
38 Susianto E. Pelaksanaan Posbindu 3,750,000 3,750,000 38
39 Emi Purniawati Kelas Ibu Hamil 450,000 450,000 39
40 Ade Irmayani Posyandu Lansia 1,400,000 1,400,000 40
41 Ahmad Yono Pelacakan Kontak Serumah 500,000 500,000 41
42 Januari Eko Supriadi kunjungan Jiwa mankir Obat 100,000 100,000 42
Total 26,250,000 26,250,000
Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
b
DINAS KESEHATAN
TAHUN 2020

-20% DITERIMA
1 Januari As'af Fyzee Hidayat Distribusi Fe Remaja Putri 1,200,000 240,000 960,000 1
2 munawar PE kasus 200,000 40,000 160,000 2
3 Februari munawar PE kasus 300,000 60,000 240,000 3
4 munawar PSN 800,000 160,000 640,000 4
5 ulfa ismayanti Distribusi Fe Remaja Putri 1,200,000 240,000 960,000 5
6 Jitrali Distribusi Vit.A 650,000 0 650,000 6
7 Ny.Sentani Distribusi Vit.A 500,000 0 500,000 7
8 sudiarta IKL TTU 400,000 80,000 320,000 8
9 abdul kholik IKL TPM 200,000 40,000 160,000 9
10 sudiarta Inspeksi Rumah 800,000 160,000 640,000 10
11 sudiarta Pemberian Kaporit 200,000 40,000 160,000 11
12 nova mariani Bulan penimbangan 1,500,000 300,000 1,200,000 12
13 denda irabayan Distribusi Vit.A 450,000 0 450,000 13
14 mutaharoh Distribusi Vit.A 600,000 0 600,000 14
15 munawar Pelacakan Kasus KIPI 300,000 60,000 240,000 15
16 ahmad yono Community Bassed Approach (CBA) 100,000 20,000 80,000 16
17 muliawati Demo Sikat Gigi 200,000 40,000 160,000 17
18 emi purniawati Kelas Ibu Balita 450,000 90,000 360,000 18
19 Maret muliawati Penyuluhan dan Pemeriksaan Gigi 400,000 80,000 320,000 19
20 susianto effendy Posbindu PTM 2,500,000 0 2,500,000 20
21 saptahandi PE kasus 400,000 80,000 320,000 21

22 Fitri Handayani Pelayanan Antenatal 400,000 80,000 320,000 22
23 Sofiaturrohmi Pelayanan Antenatal 300,000 60,000 240,000 23
31 Rabiatun Pelayanan&Pemantauan Balita 800,000 160,000 640,000 31
32 Puasniwati Pelayanan&Pemantauan Balita 800,000 160,000 640,000 32
33 Linda Martin Pelayanan&Pemantauan Balita 800,000 160,000 640,000 33
34 Nova Mariani Pelayanan&Pemantauan Balita 700,000 140,000 560,000 34
35 Arina Ernawati Kesehatan Bumil Resti 500,000 100,000 400,000 35
36 Dedy S Dehidrasi Rumah Tangga 500,000 100,000 400,000 36
37 Dedy S Follow Up Kasus ISPA 500,000 100,000 400,000 37
38 haerani Distribusi Fe Remaja Putri 1,200,000 240,000 960,000 38
39 abdul kholik IKL SAB 800,000 160,000 640,000 39
40 sudiarta IKL SAB 350,000 70,000 280,000 40
41 sudiarta IKL TTU 400,000 80,000 320,000 41
42 nuryati Penyuluhan Masal tentang UKM 500,000 100,000 400,000 42
43 Indra Marsinta Pembinaan Posyandu Keluarga 800,000 160,000 640,000 43
44 Muliawati pembinaan kesehatan gigi 600,000 120,000 480,000 44
45 ahmad yono penemuan BTA (+) 400,000 80,000 320,000 45
46 Indra Marsinta Pembinaan desa siaga 400,000 80,000 320,000 46
Total 26,450,000 4,350,000 22,100,000

Mengetahui
NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020
JUMLAH TANDA TANGAN

DITERIMA
1 Januari As'af Fyzee Hidayat Distribusi Fe Remaja Putri 1,200,000 1,200,000 1
2 munawar PE kasus 200,000 200,000 2
3 Februari munawar PE kasus 300,000 300,000 3
4 munawar PSN 800,000 800,000 4
5 ulfa ismayanti Distribusi Fe Remaja Putri 1,200,000 1,200,000 5
6 Jitrali Distribusi Vit.A 650,000 650,000 6
7 Ny.Sentani Distribusi Vit.A 500,000 500,000 7
8 sudiarta IKL TTU 400,000 400,000 8
9 abdul kholik IKL TPM 200,000 200,000 9
10 sudiarta Inspeksi Rumah 800,000 800,000 10
11 sudiarta Pemberian Kaporit 200,000 200,000 11
12 nova mariani Bulan penimbangan 1,500,000 1,500,000 12
13 denda irabayan Distribusi Vit.A 450,000 450,000 13
14 mutaharoh Distribusi Vit.A 600,000 600,000 14
15 munawar Pelacakan Kasus KIPI 300,000 300,000 15
16 ahmad yono Community Bassed Approach (CBA) 100,000 100,000 16
17 muliawati Demo Sikat Gigi 200,000 200,000 17
18 emi purniawati Kelas Ibu Balita 450,000 450,000 18
19 Maret muliawati Penyuluhan dan Pemeriksaan Gigi 400,000 400,000 19
20 susianto effendy Posbindu PTM 2,500,000 2,500,000 20
21 saptahandi PE kasus 400,000 400,000 21

22 Fitri Handayani Pelayanan Antenatal 400,000 400,000 22
23 Sofiaturrohmi Pelayanan Antenatal 300,000 300,000 23




31 Rabiatun Pelayanan&Pemantauan Balita 800,000 800,000 31

32 Puasniwati Pelayanan&Pemantauan Balita 800,000 800,000 32
33 Linda Martin Pelayanan&Pemantauan Balita 800,000 800,000 33

34 Nova Mariani Pelayanan&Pemantauan Balita 700,000 700,000 34
35 Arina Ernawati Kesehatan Bumil Resti 500,000 500,000 35

36 Dedy S Dehidrasi Rumah Tangga 500,000 500,000 36
37 Dedy S Follow Up Kasus ISPA 500,000 500,000 37

38 haerani Distribusi Fe Remaja Putri 1,200,000 1,200,000 38
39 abdul kholik IKL SAB 800,000 800,000 39

40 sudiarta IKL SAB 350,000 350,000 40
41 sudiarta IKL TTU 400,000 400,000 41

42 nuryati Penyuluhan Masal tentang UKM 500,000 500,000 42
43 Indra Marsinta Pembinaan Posyandu Keluarga 800,000 800,000 43

44 Muliawati pembinaan kesehatan gigi 600,000 600,000 44
45 ahmad yono penemuan BTA (+) 400,000 400,000 45

46 Indra Marsinta Pembinaan desa siaga 400,000 400,000 46
Total 26,450,000 26,450,000

Mengetahui
NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
PAJAK TOTAL Terima Dinas PKM TOTAL Terima

No Nama Kegiatan PAGU/DITERIMA Penerima Tanda Tangan
PPN PPH21 PPH23 PD PAJAK stl pajak 5% 5% Ptg lain Bersih
1 Makmin POS UKK 750,000
2 Transport Tribulanan 1,500,000
3 Makmin Tribulanan 1,050,000
4 Makmin Sekolah Sehat 750,000
5 Honor Tenaga Akuntan 4,000,000
6 Honor Tenaga Promkes&Gizi 1,350,000
7 Makmin Minilok Maret 8,000,000
8 Makmin Kelas Balita 1,350,000
9 Transport Pos UKK 1,250,000
10 Makmin Refreshing kader 900,000
11 Makmin Kelas Ibu hamil 900,000
12 Belanja Spanduk 2,970,000
13 Makmin CBA 750,000
14 Makmin Peserta minilok 450,000
16 Makmin sosialisasi Psy 1,320,000
Jumlah
DINAS KESEHATAN
TAHUN 2020

-20% DITERIMA
1 Februari Rabiatun Bulan penimbangan 900,000 180,000 720,000 1
Kader 450,000 450,000
2 Puasniwati Bulan penimbangan 1,200,000 240,000 960,000 2
kader 600,000 600,000
3 linda martin Bulan penimbangan 1,300,000 260,000 1,040,000 3
kader 650,000 650,000
4 hj rusniatun advokasi/sosialisasi Covid19 600,000 120,000 480,000 4
5 april achmad yonono (m) skreening/pelacakan covid19 1,200,000 240,000 960,000 5
6 hariani pelayanan imunisasi 450,000 90,000 360,000 6
7 sigit kurniawan (m) pemeriksaan laboratorium covid19 1,500,000 300,000 1,200,000 7
8 novan Juweni pelayanan imunisasi 650,000 130,000 520,000 8
9 achmad yono(m) kontak tracking 300,000 60,000 240,000 9
10 achmad yono(m) skreening/pelacakan covid19 900,000 180,000 720,000 10
11 mei novan Juweni pelayanan imunisasi 650,000 130,000 520,000 11
13 sigit kurniawan (m) pemeriksaan laboratorium covid19 2,250,000 450,000 1,800,000 13
14 achmad yono(m) kontak tracking 900,000 180,000 720,000 14
15 juni sigit kurniawan (m) pemeriksaan laboratorium covid19 750,000 150,000 600,000 15
16 Kadek Satria pelayanan imunisasi 600,000 120,000 480,000 16
17 Nova Mariani pelayanan kesehatan balita 1,000,000 200,000 800,000 17
18 nova juwendi pelayanan imunisasi 650,000 130,000 520,000 18

20 Puasniwati pelayanan kesehatan balita 1,200,000 240,000 960,000 20
21 juli Puasniwati pelayanan kesehatan balita 1,200,000 240,000 960,000 21
22 Sri Sulanti pelayanan imunisasi 500,000 100,000 400,000 22
23 Nova Mariani pelayanan kesehatan balita 1,000,000 200,000 800,000 23
Total 22,800,000 4,220,000 18,580,000

Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020
JUMLAH TANDA TANGAN

DITERIMA
1 Januari Rabiatun Bulan penimbangan 1,350,000 1,350,000 1
2 Puasniwati Bulan penimbangan 1,800,000 1,800,000 2
3 Februari linda martin Bulan penimbangan 1,950,000 1,950,000 3
4 hj rusniatun advokasi/sosialisasi Covid19 600,000 600,000 4
5 achmad yonono (m) skreening/pelacakan covid19 1,200,000 1,200,000 5
6 hariani pelayanan imunisasi 450,000 450,000 6
7 sigit kurniawan (m) pemeriksaan laboratorium covid19 1,500,000 1,500,000 7
8 novan Juweni pelayanan imunisasi 650,000 650,000 8
9 achmad yono(m) kontak tracking 300,000 300,000 9
10 achmad yono(m) skreening/pelacakan covid19 900,000 900,000 10
11 novan Juweni pelayanan imunisasi 650,000 650,000 11
13 sigit kurniawan (m) pemeriksaan laboratorium covid19 2,250,000 2,250,000 13
14 achmad yono(m) kontak tracking 900,000 900,000 14
15 sigit kurniawan (m) pemeriksaan laboratorium covid19 750,000 750,000 15
16 Kadek Satria pelayanan imunisasi 600,000 600,000 16
17 Nova Mariani pelayanan kesehatan balita 1,000,000 1,000,000 17
18 nova juwendi pelayanan imunisasi 650,000 650,000 18
19 Maret Agusni Pelayanan Antenatal 500,000 500,000 19
20 Puasniwati pelayanan kesehatan balita 1,200,000 1,200,000 20
21 Puasniwati pelayanan kesehatan balita 1,200,000 1,200,000 21

22 Sri Sulanti pelayanan imunisasi 500,000 500,000 22
23 Nova Mariani pelayanan kesehatan balita 1,000,000 1,000,000 23

Total 22,800,000 22,800,000

Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020

-20% DITERIMA
1 mei SRI Sulanti posuandu imunisasi 300,000 60,000 240,000 1
3 juni rabiatun riani posyandu balita 900,000 180,000 720,000 3
4 munawar pemberantasan larva 800,000 160,000 640,000 4
5 juli rabiatun riani posyandu balita 900,000 180,000 720,000 5
6 munawar MBS 1,000,000 200,000 800,000 6
7 MULIAWATI kesehatan gigi di sekolah 400,000 80,000 320,000 7
8 Linda Martin posyandu balita 1,300,000 260,000 1,040,000 8
9 sudiarta IKL TTU 400,000 80,000 320,000 9
10 agustus SRI Sulanti posyandu imunisasi 500,000 100,000 400,000 10
11 linda martin posyandu balita 1,300,000 260,000 1,040,000 11

kader 650,000 0 650,000
12 emi purniawati kelas ibu hamil 450,000 90,000 360,000 12
14 susianto effendy screening kasus 15-59 thn 500,000 100,000 400,000 14
15 munawar PSN 800,000 160,000 640,000 15
16 sudiarta IKL TPM 200,000 40,000 160,000 16
17 sudiarta pembagian kaporit 200,000 40,000 160,000 17
18 nova mariani kunjungan neo resti 500,000 100,000 400,000 18
19 Puasniwati posyandu balita 1,200,000 240,000 960,000 19
20 september rabiatun riani posyandu balita 900,000 180,000 720,000 20
21 nurul isnaeni pembinaan poskestren 400,000 80,000 320,000 21

23 munawar pemberantasan larva 800,000 160,000 640,000 23
24 fitri handayani Pelayanan Antenatal 500,000 100,000 400,000 24
25 Arina Ernawati kunjungan neo resti 500,000 100,000 400,000 25
26 supiani SDIDTK 700,000 140,000 560,000 26
27 SRI Sulanti Pelayanan Imunisasi 500,000 100,000 400,000 27
28 emi purniawati kelas ibu hamil 450,000 90,000 360,000 28
29 nova mariani kelas balita 1,000,000 200,000 800,000 29
30 munawar PSN 800,000 160,000 640,000 30
31 Puasniwati Pelayanan&Pemantauan Balita 1,200,000 240,000 960,000 31
32 Linda Martin Pelayanan&Pemantauan Balita 1,300,000 260,000 1,040,000 32
33 yusup ari p kesehatan gigi di sekolah 400,000 80,000 320,000 33
34 Linda Martin kelompok remaja 400,000 80,000 320,000 34
35 SRI Sulanti posyandu imunisasi 500,000 100,000 400,000 35
Total 23,450,000 4,560,000 18,890,000

Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020
JUMLAH TANDA TANGAN

DITERIMA
1 mei SRI Sulanti posuandu imunisasi 300,000 300,000 1
3 juni rabiatun riani posyandu balita 900,000 900,000 3
4 munawar pemberantasan larva 800,000 800,000 4
5 juli rabiatun riani posyandu balita 900,000 900,000 5
6 munawar MBS 1,000,000 1,000,000 6
7 MULIAWATI kesehatan gigi di sekolah 400,000 400,000 7
8 Linda Martin posyandu balita 1,300,000 1,300,000 8
9 sudiarta IKL TTU 400,000 400,000 9
10 agustus SRI Sulanti posyandu imunisasi 500,000 500,000 10
11 linda martin posyandu balita 1,300,000 1,300,000 11

kader 650,000 650,000
12 emi purniawati kelas ibu hamil 450,000 450,000 12
14 susianto effendy screening kasus 15-59 thn 500,000 500,000 14
15 munawar PSN 800,000 800,000 15
16 sudiarta IKL TPM 200,000 200,000 16
17 sudiarta pembagian kaporit 200,000 200,000 17
18 nova mariani kunjungan neo resti 500,000 500,000 18
19 Puasniwati posyandu balita 1,200,000 1,200,000 19
20 september rabiatun riani posyandu balita 900,000 900,000 20
21 nurul isnaeni pembinaan poskestren 400,000 400,000 21

23 munawar pemberantasan larva 800,000 800,000 23

24 fitri handayani Pelayanan Antenatal 500,000 500,000 24
25 Arina Ernawati kunjungan neo resti 500,000 500,000 25

26 supiani SDIDTK 700,000 700,000 26
27 SRI Sulanti Pelayanan Imunisasi 500,000 500,000 27

28 emi purniawati kelas ibu hamil 450,000 450,000 28
29 nova mariani kelas balita 1,000,000 1,000,000 29

30 munawar PSN 800,000 800,000 30
31 Puasniwati Pelayanan&Pemantauan Balita 1,200,000 1,200,000 31

32 Linda Martin Pelayanan&Pemantauan Balita 1,300,000 1,300,000 32
33 yusup ari p kesehatan gigi di sekolah 400,000 400,000 33

34 Linda Martin kelompok remaja 400,000 400,000 34
35 SRI Sulanti posyandu imunisasi 500,000 500,000 35

Total 23,450,000 23,450,000
Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020

-20% DITERIMA
1 maret dr. wilia pelacakan/skrining 1,350,000 270,000 1,080,000 1
3 april dr. wilia pelacakan/skrining 600,000 120,000 480,000 3
4 dende ayu rujukan covid-19 150,000 30,000 120,000 4
5 dr. ida ayu rujukan covid-19 150,000 30,000 120,000 5
6 adenia rujukan covid-19 150,000 30,000 120,000 6
7 baiq lilis endriyani rujukan covid-19 150,000 30,000 120,000 7
8 ria apriani rujukan covid-19 150,000 30,000 120,000 8
9 etik sukmawati rujukan covid-19 150,000 30,000 120,000 9

sri sulanti rujukan covid-19 150,000 30,000 120,000
10 putu gede sudiarta rujukan covid-19 150,000 30,000 120,000 10
11 saptahandi rujukan covid-19 150,000 30,000 120,000 11
mei kadek satria posyandu imunisasi 600,000 120,000 480,000

12 nurhasanah rujukan covid-19 150,000 30,000 120,000 12
13 lia widianingsih rujukan covid-19 150,000 30,000 120,000 13
14 dedy setiawan rujukan covid-19 150,000 30,000 120,000 14
15 edi hermanto rujukan covid-19 150,000 30,000 120,000 15
16 baiq ayu rujukan covid-19 150,000 30,000 120,000 16
17 juni hariani poyandu imunisasi 450,000 90,000 360,000 17
18 fitri handayani posyandu antenatal 450,000 90,000 360,000 18
19 juli muliawati demo sikat gigi 200,000 40,000 160,000 19
20 emi purniawati kunjungan bumil bufas resti 500,000 100,000 400,000 20

21 agusni posyandu antenatal 500,000 100,000 400,000 21
22 sudiarta inspeksi rumah 800,000 160,000 640,000 22
23 agustus nova mariani bulan penimbangan 1,000,000 200,000 800,000 23

kader 500,000 0 500,000
24 Puasniwati bulan penimbangan 1,200,000 240,000 960,000 24
kader 600,000 0 600,000
26 sudiarta IKL TTU 400,000 80,000 320,000 26
27 september nova mariani posyandu balita 1,000,000 200,000 800,000 27
30 Linda Martin posyandu balita 1,300,000 260,000 1,040,000 30
31 nurul isnaeni sosialisasi HIV/AIDS 600,000 120,000 480,000 31
32 Susianto effendi skrining kasus 15-59 thn 500,000 100,000 400,000 32
33 Linda Martin kelompok remaja 400,000 80,000 320,000 33
34 nurul isnaeni sosialisasi UKM 500,000 100,000 400,000 34
oktober agusni posyandu antenatal 500,000 100,000 400,000

35 Susianto effendi skrining kasus 15-59 thn 1,000,000 200,000 800,000 35
Total 18,050,000 3,390,000 14,660,000

Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020
JUMLAH TANDA TANGAN

DITERIMA
1 maret dr. wilia pelacakan/skrining 1,350,000 1,350,000 1
3 april dr. wilia pelacakan/skrining 600,000 600,000 3
4 dende ayu rujukan covid-19 150,000 150,000 4
5 dr. ida ayu rujukan covid-19 150,000 150,000 5
6 adenia rujukan covid-19 150,000 150,000 6
7 baiq lilis endriyani rujukan covid-19 150,000 150,000 7
8 ria apriani rujukan covid-19 150,000 150,000 8
9 etik sukmawati rujukan covid-19 150,000 150,000 9

sri sulanti rujukan covid-19 150,000 150,000
10 putu gede sudiarta rujukan covid-19 150,000 150,000 10
11 saptahandi rujukan covid-19 150,000 150,000 11
mei kadek satria posyandu imunisasi 600,000 600,000
12 nurhasanah rujukan covid-19 150,000 150,000 12
13 lia widianingsih rujukan covid-19 150,000 150,000 13
14 dedy setiawan rujukan covid-19 150,000 150,000 14
15 edi hermanto rujukan covid-19 150,000 150,000 15
16 baiq ayu rujukan covid-19 150,000 150,000 16
17 juni hariani poyandu imunisasi 450,000 450,000 17
18 fitri handayani posyandu antenatal 450,000 450,000 18
19 juli muliawati demo sikat gigi 200,000 200,000 19
20 emi purniawati kunjungan bumil bufas resti 500,000 500,000 20

21 agusni posyandu antenatal 500,000 500,000 21
22 sudiarta inspeksi rumah 800,000 800,000 22
23 agustus nova mariani bulan penimbangan 1,000,000 1,000,000 23

kader 500,000 500,000
24 Puasniwati bulan penimbangan 1,200,000 1,200,000 24
kader 600,000 600,000
26 sudiarta IKL TTU 400,000 400,000 26
27 september nova mariani posyandu balita 1,000,000 1,000,000 27

30 Linda Martin posyandu balita 1,300,000 1,300,000 30
31 nurul isnaeni sosialisasi HIV/AIDS 600,000 600,000 31

32 Susianto effendi skrining kasus 15-59 thn 500,000 500,000 32
33 Linda Martin kelompok remaja 400,000 400,000 33

34 nurul isnaeni sosialisasi UKM 500,000 500,000 34
oktober agusni posyandu antenatal 500,000 500,000

35 Susianto effendi skrining kasus 15-59 thn 1,000,000 1,000,000 35
Total 18,050,000 18,050,000
Mengetahui
Hj. Rusniatun, Amd. Keb

NIP. 19681231 198803 2 085
DINAS KESEHATAN
TAHUN 2020

-20% DITERIMA
1 april ana risnayanti posyandu antenatal 350,000 70,000 280,000 1
3 mei ana risnayanti posyandu antenatal 350,000 70,000 280,000 3
4 juni sri sulanti posyandu imunisasi 500,000 100,000 400,000 4
5 ana risnayanti posyandu antenatal 350,000 70,000 280,000 5

linda martin posyandu balita 1,300,000 260,000 1,040,000
6 juli susianto effendy skrining kasus 15-19 500,000 100,000 400,000 6
Total 3,350,000 670,000 2,680,000

Mengetahui

NIP. 19681231 198803 2 085 NIP. 19950616 201902 2 008
DINAS KESEHATAN
TAHUN 2020
JUMLAH TANDA TANGAN

DITERIMA
1 april ana risnayanti posyandu antenatal 350,000 350,000 1
3 mei ana risnayanti posyandu antenatal 350,000 350,000 3
4 juni sri sulanti posyandu imunisasi 500,000 500,000 4
5 ana risnayanti posyandu antenatal 350,000 350,000 5

linda martin posyandu balita 1,300,000 1,300,000
6 juli susianto effendy skrining kasus 15-19 500,000 500,000 6
Total 3,350,000 3,350,000

Mengetahui
Hj. Rusniatun, Amd. Keb

NIP. 19681231 198803 2 085

PPN PPH21 PPH23 PD PAJAK stl pajak 5% 5% Ptg lain Bersih
1 Makmin POS UKK 750,000
2 Transport Tribulanan 1,500,000
3 Makmin Tribulanan 1,050,000
4 Makmin Sekolah Sehat 750,000
5 Honor Tenaga Akuntan 4,000,000
6 Honor Tenaga Promkes&Gizi 1,350,000
7 Makmin Minilok Maret 8,000,000
8 Makmin Kelas Balita 1,350,000
9 Transport Pos UKK 1,250,000
10 Makmin Refreshing kader 900,000
11 Makmin Kelas Ibu hamil 900,000
12 Belanja Spanduk 2,970,000
13 Makmin CBA 750,000
16 Makmin sosialisasi Psy 1,320,000
Jumlah
DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKESM
PAJAK TOTAL Terima

No Nama Kegiatan PAGU/DITERIMA PPN PPH21 PPH22 PPH23 PD PAJAK stl pajak
10% 5% 1.50% 2% 9%
1 Transport posbindu 1,500,000 0 1,500,000
2 makmin minilok jan 1,350,000 27000 121,500 148,500 1,201,500
3 makmin minilok feb 1,350,000 27000 121,500 148,500 1,201,500
4 transport posy. Keluarga 2,200,000 0 2,200,000
5 ATK rutin jan 986,000 98600 14790 113,390 872,610
6 belanja materai januar 435,000 0 435,000
7 penggandaan SPJ JAN 960,000 96000 14400 110,400 849,600
8 bahan praktik sikat gigi 200,000 20000 3000 23,000 177,000
Jumlah 8,981,000 214600 32190 54000 243000 543,790 8,437,210

ON FISIK UPT BLUD PUSKESMAS BAYAN
Dinas PKM TOTAL Terima

Penerima Tanda Tangan
5% 5% Ptg lain Bersih
0 1,500,000
67,500 67,500 135,000 1,066,500
67,500 67,500 135,000 1,066,500
0 2,200,000
49,300 49,300 98,600 774,010
21,750 21,750 43,500 391,500
48,000 48,000 96,000 753,600
10,000 10,000 20,000 157,000
264,050 264,050 528,100 7,909,110 8,120,523 211,413 sisa

DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKESMAS
PAJAK TOTAL Terima Dinas

No Nama Kegiatan PAGU/DITERIMA
PPN PPH21 PPH22 PPH23 PD PAJAK stl pajak 5%
10% 5% 1.50% 2% 9%
1 Penggandaan feb 907,500 90,750 13,613 104,363 803,138 45,375
2 penggandaan mar 867,000 86,700 13,005 99,705 767,295 43,350
3 penggandaan april 919,500 91,950 13,793 105,743 813,758 45,975
4 honor gizi & prom 8,000,000 400,000 400,000 7,600,000
5 Honor Tenaga Akuntan 4,000,000 200,000 200,000 3,800,000
Jumlah 14,694,000 269,400 600,000 40,410 0 0 909,810 13,784,190 134,700

N FISIK UPT BLUD PUSKESMAS BAYAN
PKM TOTAL Terima

5% Ptg lain Bersih
45,375 90,750 712,388
43,350 86,700 680,595
45,975 91,950 721,808
400,000 400,000 7,200,000
200,000 200,000 3,600,000
734,700 869,400 12,914,790 13,055,154 140,364 sisa

DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSK
PAJAK TOTAL Terima

PPN PPH21 PPH22 PPH23 PD PAJAK stl pajak
10% 5% 1.50% 2% 9%
1 Makmin POS UKK 750,000 15,000 67,500 82,500 667,500
2 Transport Tribulanan 1,500,000 0 1,500,000
3 Makmin Tribulanan 1,050,000 21,000 94,500 115,500 934,500
4 Makmin Sekolah Sehat 750,000 15,000 67,500 82,500 667,500
5 Honor Tenaga Akuntan 4,000,000 200,000 200,000 3,800,000
6 Honor Tenaga Promkes&Gizi 8,000,000 400,000 400,000 7,600,000
7 Makmin Minilok Maret 1,350,000 27,000 121,500 148,500 1,201,500
8 Makmin Kelas Balita 1,350,000 27,000 121,500 148,500 1,201,500
9 Transport Pos UKK 1,250,000 0 1,250,000
10 Makmin Refreshing kader 900,000 18,000 81,000 99,000 801,000
11 Makmin Kelas Ibu hamil 900,000 18,000 81,000 99,000 801,000
12 Belanja Spanduk 2,970,000 297,000 44,550 341,550 2,628,450
13 Makmin CBA 750,000 15,000 67,500 82,500 667,500
14 Makmin Peserta minilok 450,000 9,000 40,500 49,500 400,500
15 Makmin Peserta minilok 450,000 9,000 40,500 49,500 400,500
16 Makmin sosialisasi Psy 1,320,000 26,400 118,800 145,200 1,174,800
Jumlah 27,740,000 297,000 600,000 44,550 200,400 901,800 2,043,750 25,696,250

ON FISIK UPT BLUD PUSKESMAS BAYAN

37,500 37,500 75,000 592,500
0 1,500,000
52,500 52,500 105,000 829,500
37,500 37,500 75,000 592,500
200,000 200,000 3,600,000
400,000 400,000 7,200,000
67,500 67,500 135,000 1,066,500
67,500 67,500 135,000 1,066,500
0 1,250,000
45,000 45,000 90,000 711,000
45,000 45,000 90,000 711,000
148,500 148,500 297,000 2,331,450
37,500 37,500 75,000 592,500
22,500 22,500 45,000 355,500
22,500 22,500 45,000 355,500
66,000 66,000 132,000 1,042,800
649,500 1,249,500 1,899,000 23,797,250 54,190,000

26,450,000
27,740,000 3,942,750 Sisa
DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD
PAJAK TOTAL
PPN PPH21 PPH22 PPH23 PD PAJAK
10% 5% 1.50% 2% 9%
1 catridge juni 3,925,000 392,500 58,875 451,375
2 leflet maret 2,500,000 250,000 37,500 287,500
3 materai april 465,000 0
4 materai juli 480,000 0
5 ATK Rutin juli 1,466,000 146,600 21,990 168,590
Jumlah 8,836,000 789,100 118,365 907,465

DAK NON FISIK UPT BLUD PUSKESMAS BAYAN
Terima Dinas PKM TOTAL Terima

stl pajak 5% 5% Ptg lain Bersih
3,473,625 196,250 196,250 392,500 3,081,125
2,212,500 125,000 125,000 250,000 1,962,500
465,000 23,250 23,250 46,500 418,500
480,000 24,000 24,000 48,000 432,000
1,297,410 73,300 73,300 146,600 1,150,810
7,928,535 441,800 441,800 883,600 7,044,935 7,571,981 527,046 Sisa

DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKESMAS
PAJAK TOTAL Terima Dinas

PPN PPH21 PPH22 PPH23 PD PAJAK stl pajak 5%
10% 5% 1.50% 2% 9%
1 Makmin Satgas Covid-19 900,000 18,000 81,000 99,000 801,000 45,000
2 BBM rujukan Covid-19 april 700,000 0 700,000
3 BBM rujukan Covid-19 mei 700,000 0 700,000
4 bahan praktek sikat gigi 200,000 0 200,000 10,000
5 makmin tribulanan juli 1,050,000 21,000 94,500 115,500 934,500 52,500
6 Transport minilok agus 450,000 0 450,000
7 Makmin Minilok agustus 1,350,000 27,000 121,500 148,500 1,201,500 67,500
8 Makmin Kelas Bumil agus 900,000 18,000 81,000 99,000 801,000 45,000
9 makmin minilok sept 1,350,000 27,000 121,500 148,500 1,201,500 67,500
10 transport minilok sept 450,000 0 450,000
11 ATK BIAS OKTO 150,000 0 150,000 7,500
12 SPANDUK BIAS OKTO 225,000 0 225,000 11,250
13 transport Bias okto 1,750,000 0 1,750,000
14 makmin kemitraan dkun okto 750,000 15,000 67,500 82,500 667,500 37,500
15 makmin Bias okto 1,140,000 22,800 102,600 125,400 1,014,600 57,000
16 honor narasumber BIAS 175,000 8,750 8,750 166,250
17 transport kemmitraan dkun 1,250,000 0 1,250,000
18 Makmin sosialisasi covi19 900,000 18,000 81,000 99,000 801,000 45,000
Jumlah 14,390,000 0 8,750 0 166,800 750,600 926,150 13,463,850 445,750

K NON FISIK UPT BLUD PUSKESMAS BAYAN
PKM TOTAL Terima

5% Ptg lain Bersih
45,000 90,000 711,000
0 700,000
0 700,000
10,000 20,000 180,000
52,500 105,000 829,500
0 450,000
67,500 135,000 1,066,500
45,000 90,000 711,000
67,500 135,000 1,066,500
0 450,000
7,500 15,000 135,000
11,250 22,500 202,500
0 1,750,000
37,500 75,000 592,500
57,000 114,000 900,600
0 166,250
0 1,250,000
45,000 90,000 711,000
445,750 891,500 12,572,350 12,602,057 29,707


PPN PPH21 PPH22 PPH23 PD PAJAK stl pajak 5% 5% Ptg lain Bersih
10% 5% 1.50% 2% 9%
1 HANDSINITIZER juli 9,860,000
986,000 493,000 1,479,000 8,381,000 0 8,381,000
HANDSINITIZER agust
2 9,520,000 952,000 476,000 1,428,000 8,092,000 0 8,092,000
Jumlah 19,380,000 1,938,000 969,000 0 0 0 2,907,000 16,473,000 0 0 0 16,473,000

16,509,908 36,908
DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKES
PAJAK TOTAL Terima

10% 5% 1.50% 2% 9%
1 Makmin juli 2020 1,350,000 27,000 121,500 148,500 1,201,500
2 honor gizi&promkes 8,000,000 400,000 400,000 7,600,000
Jumlah 9,350,000 0 400,000 0 27,000 121,500 597,536 8,752,464

AN DAK NON FISIK UPT BLUD PUSKESMAS BAYAN

67,500 67,500 135,000 1,066,500
400,000 400,000 7,200,000
67,500 467,500 535,000 8,217,464 8,684,964 467,500

DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKES
PAJAK TOTAL Terima

10% 5% 1.50% 2% 9%
1 HONOR AKUNTAN 4,000,000

200,000 200,000 3,800,000
2 TRANSPORT minilok des 450,000

0 450,000
makmin Minilok Desember

3 1,350,000 27,000 121,500 148,500 1,201,500
Jumlah 5,350,000 0 200,000 0 27,000 121,500 348,500 5,001,500

AN DAK NON FISIK UPT BLUD PUSKESMAS BAYAN

200,000 200,000 3,600,000
22,500 22,500 427,500
67,500 67,500 135,000 1,066,500
67,500 267,500 335,000 4,666,500 5,232,964 566,464

DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKESM
PAJAK TOTAL Terima

10% 5% 1.50% 2% 9%
1 BELANJA Gaun APD 8,250,000 825,000 12,788 837,788 7,412,213
2 HONOR NARASUMBER tribun 350,000 17,500 17,500 332,500
3 makmin evaluasi prog 750,000 15,000 67,500 82,500 667,500
4 tranpost tribulanan min 1,500,000 0 1,500,000
5 makmin penyusunan RUK 900,000 18,000 81,000 99,000 801,000
7 ATK Rutin sept 1,445,000 144,500 144,500 1,300,500
8 ATK rutin okto 1,643,000 164,300 164,300 1,478,700
9 ATK orientasi PMBA 150,000 0 150,000
10 HONOR narasumber PMBA 1,575,000 78,750 78,750 1,496,250
12 TRANSPORT MINILOK OKT 450,000 0 450,000
13 makmin minilok okto 1,350,000 27,000 121,500 148,500 1,201,500
14 transport PMBA 1,500,000 0 1,500,000
15 MAKMIN PMBA 1,170,000 23,400 105,300 128,700 1,041,300
16 TRANSPRTTRIBULANAN NOV 1,500,000 0 1,500,000

17 MAKMIN TRIBULANAN NOV 1,050,000 21,000 94,500 115,500 934,500
18 TRAnsport minilok nov 450,000 0 450,000
19 makmin minilok nov 1,350,000 27,000 121,500 148,500 1,201,500
20 makmin prtemuan mnajamen 900,000 18,000 81,000 99,000 801,000
Jumlah 26,283,000 1,133,800 96,250 12,788 149,400 672,300 2,064,538 24,218,463

ISIK UPT BLUD PUSKESMAS BAYAN

412,500 412,500 6,999,713

17,500 17,500 315,000
37,500 37,500 75,000 592,500
0 1,500,000
45,000 45,000 90,000 711,000
72,250 72,250 144,500 1,156,000
82,150 82,150 164,300 1,314,400
7,500 7,500 15,000 135,000
78,750 78,750 1,417,500
0 450,000
67,500 67,500 135,000 1,066,500
0 1,500,000
58,500 58,500 117,000 924,300
0 1,500,000
52,500 52,500 105,000 829,500
0 450,000
67,500 67,500 135,000 1,066,500
45,000 45,000 90,000 711,000
535,400 1,044,150 1,579,550 22,638,913 23,621,468 982,556

DAFTAR PENERIMA BELANJA PERJALANAN DINAS ANGGARAN DAK NON FISIK UPT BLUD PUSKESMAS BAY
PAGU/DITERI PAJAK TOTAL Terima

No Nama Kegiatan
MA PPN PPH21 PPH22 PPH23 PD PAJAK stl pajak
10% 5% 1.50% 2% 9%
1 MAKMIN MBS 600,000 12,000 54,000 66,000 534,000
2 Penggandaan juli 987,000 98,700 14,805 113,505 873,495
3 hnor nrasumber imunisasi 175,000 8,750 8,750 166,250
4 makmin imunisasi 900,000 18,000 81,000 99,000 801,000
5 transport imunisasi 450,000 0 450,000
6 pengandaan agst 954,000 95,400 14,310 109,710 844,290
7 pngandaan sept 922,500 92,250 13,838 106,088 816,413
8 pengandaan PIS-PK 3,480,000 348,000 52,200 400,200 3,079,800
9 MAKMIN MBS SEPT 600,000 12,000 54,000 66,000 534,000
10 makmin intensifikasi k1k9 720,000 14,400 64,800 79,200 640,800
11 makmin klas bumil 900,000 18,000 81,000 99,000 801,000
12 pngadaan okto 990,000 99,000 14,850 113,850 876,150
13 pngandaan nov 993,000 99,300 14,895 114,195 878,805
Jumlah 12,671,500 832,650 8,750 124,898 74,400 334,800 1,375,498 11,296,003

N FISIK UPT BLUD PUSKESMAS BAYAN
Dinas PKM TOTAL Terima SPU Sisa nanti dibagi untuk tim dan dinas
26,700 30,000 56,700 477,300
43,675 49,350 93,025 780,470
8,750 8,750 157,500
40,050 45,000 85,050 715,950
0 450,000
42,215 47,700 89,915 754,376
40,821 46,125 86,946 729,467
153,990 174,000 327,990 2,751,810
26,700 30,000 56,700 477,300
32,040 36,000 68,040 572,760
40,050 45,000 85,050 715,950
43,808 49,500 93,308 782,843
43,940 49,650 93,590 785,215
533,988 611,075 1,145,063 10,150,940 10,704,164 553,224

ti dibagi untuk tim dan dinas
GU 1 264,050
GU 2 734,700
GU 3 1,249,500
GU 4 441,800
GU 5 445,750
GU 6 0
GU 7 467,500
GU 8 267,500
GU 9 1,044,150
GU 10 611,075
5,526,025

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PEMERINTAH KABUPATEN LOMBOK UTARA

POTONGAN JUMLAH TANDA TANGAN

1 Januari Fitri Handayani Pelayanan Antenatal 450,000 450,000 1

Hj. Rusniatun, Amd. Keb Baiq Ayu Nahdiatul Afni,S.Tr.Keb

POTONGAN JUMLAH TANDA TANGAN

2 munawar PE kasus 200,000 40,000 160,000 2

3 Februari munawar PE kasus 300,000 60,000 240,000 3

4 munawar PSN 800,000 160,000 640,000 4

5 ulfa ismayanti Distribusi Fe Remaja Putri 1,200,000 240,000 960,000 5

6 Jitrali Distribusi Vit.A 650,000 0 650,000 6

7 Ny.Sentani Distribusi Vit.A 500,000 0 500,000 7

8 sudiarta IKL TTU 400,000 80,000 320,000 8

9 abdul kholik IKL TPM 200,000 40,000 160,000 9

10 sudiarta Inspeksi Rumah 800,000 160,000 640,000 10

11 sudiarta Pemberian Kaporit 200,000 40,000 160,000 11

12 nova mariani Bulan penimbangan 1,500,000 300,000 1,200,000 12

13 denda irabayan Distribusi Vit.A 450,000 0 450,000 13

14 mutaharoh Distribusi Vit.A 600,000 0 600,000 14

15 munawar Pelacakan Kasus KIPI 300,000 60,000 240,000 15

16 ahmad yono Community Bassed Approach (CBA) 100,000 20,000 80,000 16

17 muliawati Demo Sikat Gigi 200,000 40,000 160,000 17

18 emi purniawati Kelas Ibu Balita 450,000 90,000 360,000 18

19 Maret muliawati Penyuluhan dan Pemeriksaan Gigi 400,000 80,000 320,000 19

20 susianto effendy Posbindu PTM 2,500,000 0 2,500,000 20

21 saptahandi PE kasus 400,000 80,000 320,000 21

23 Sofiaturrohmi Pelayanan Antenatal 300,000 60,000 240,000 23

24 Ina Handawati Pelayanan Antenatal 100,000 20,000 80,000 24

25 Sahniwati Pelayanan Antenatal 300,000 60,000 240,000 25

26 Agusni Pelayanan Antenatal 350,000 70,000 280,000 26

27 Hariani Pelayanan Imunisasi 450,000 90,000 360,000 27

28 Kadek Satria Pelayanan Imunisasi 400,000 80,000 320,000 28

29 Novan J.S Pelayanan Imunisasi 400,000 80,000 320,000 29

30 Sri Sulanti Pelayanan Imunisasi 350,000 70,000 280,000 30

31 Rabiatun Pelayanan&Pemantauan Balita 800,000 160,000 640,000 31

32 Puasniwati Pelayanan&Pemantauan Balita 800,000 160,000 640,000 32

33 Linda Martin Pelayanan&Pemantauan Balita 800,000 160,000 640,000 33

34 Nova Mariani Pelayanan&Pemantauan Balita 700,000 140,000 560,000 34

35 Arina Ernawati Kesehatan Bumil Resti 500,000 100,000 400,000 35

36 Dedy S Dehidrasi Rumah Tangga 500,000 100,000 400,000 36

37 Dedy S Follow Up Kasus ISPA 500,000 100,000 400,000 37

38 haerani Distribusi Fe Remaja Putri 1,200,000 240,000 960,000 38

39 abdul kholik IKL SAB 800,000 160,000 640,000 39

40 sudiarta IKL SAB 350,000 70,000 280,000 40

41 sudiarta IKL TTU 400,000 80,000 320,000 41

42 nuryati Penyuluhan Masal tentang UKM 500,000 100,000 400,000 42

43 Indra Marsinta Pembinaan Posyandu Keluarga 800,000 160,000 640,000 43

44 Muliawati pembinaan kesehatan gigi 600,000 120,000 480,000 44

45 ahmad yono penemuan BTA (+) 400,000 80,000 320,000 45

46 Indra Marsinta Pembinaan desa siaga 400,000 80,000 320,000 46

Total 26,450,000 4,350,000 22,100,000

JUMLAH TANDA TANGAN

2 munawar PE kasus 200,000 200,000 2

3 Februari munawar PE kasus 300,000 300,000 3

4 munawar PSN 800,000 800,000 4

5 ulfa ismayanti Distribusi Fe Remaja Putri 1,200,000 1,200,000 5

6 Jitrali Distribusi Vit.A 650,000 650,000 6

7 Ny.Sentani Distribusi Vit.A 500,000 500,000 7

8 sudiarta IKL TTU 400,000 400,000 8

9 abdul kholik IKL TPM 200,000 200,000 9

10 sudiarta Inspeksi Rumah 800,000 800,000 10

11 sudiarta Pemberian Kaporit 200,000 200,000 11

12 nova mariani Bulan penimbangan 1,500,000 1,500,000 12

13 denda irabayan Distribusi Vit.A 450,000 450,000 13