RemunerasiPuskesmas

DASAR : PERATURAN BUPATI NO.36 TAHUN 2017 TGL.
27 NOVEMBER 2017
Tentang : Sistem Remunerasi Pada Puskesmas BLUD Di Lingkungan Dinas Kesehatan Kab.Madiun
1. Alokasi Remunerasi maksimal sebesar 60% dari pendapatan fungsional puskesmas

2. Jenis penerima remunerasi :
a. Pimpinan Puskesmas BLUD
b. Dewan Pengawas Puskesmas BLUD
c. Pejabat Teknis Puskesmas BLUD
d. Karyawan Pemberi Pelayanan Langsung dan Pemberi Pelayanan Tidak Langsung
e. Pejabat Dinas Kesehatan dan Tim Pembina
3. Pola Remunerasi :
3.1 2% Untuk Pos Pembinaan Pengelolaan Puskesmas BLUD
3.2 98% Untuk Pola Umum Remunerasi
3.2.1 10% untuk Pimpinan, Tim Pengelola Keuangan dan Pejabat Teknis BLUD
3.2.2 90% untuk Pemberi Pelayanan
3.2.2.1 35% untuk Pemberi Pelayanan Langsung
3.2.2.2 65% untuk Seluruh Karyawan (indexing)
4. Pola Remunerasi Pimpinan Puskesmas BLUD dg Formula (Rumus) :
Gaji = GD + Nba = Nbi
Ket.
GD = Gaji Dasar (Maksimal 5x gaji PNS tertinggi di Puskesmas
Nba = Nilai Bobot Aset (40% dari FPa x GD)
Nbi = Nilai Bobot Income (60% dari FPi x GD)
Fpa = Faktor Penyesuaian aset (Skala Fpa dari total aset dlm neraca puskesmas)
Fpi = Faktor Penyesuaian income (Skala Pendapatan Puskesmas tahun terakhir)
5. Pola Remunerasi Dewan Pengawas
Remunerasi dalam bentuk honorarium dengan pola sbb:
5.1 Ketua 1 org = Max 40% dari Remunerasi Pemimpin Puskesmas
5.2 Anggota 2 org = Max 35% dari Remunerasi Pemimpin Puskesmas
5.3 Sekretaris 1 org = Max 15% dari Remunerasi Pemimpin Puskesmas
6. Pola Remunerasi Pejabat Teknis
6.1 Pejabat Teknis Pelayanan (insentif ditetapkan KaDinkes atas usul Kapus)
6.2 Pejabat Teknis Pengelolaan Keuangan (insentif ditetapkan KaDinkes atas usul Kapus)
masing-masing jg berhak Remunerasi Pola Umum
7. Pola Remunerasi Dinas Kesehatan & Tim Pembina
Merupakan bagian dari proporsi Pemberi Pelayanan Tidak Langsung …?
Maksimal 2% = dari pos Pembinaan
KETETAPAN PUSKESMAS KARE UNTUK POLA REMUNERASI PEJABAT TEKNIS:

1 Remunerasi Pimpinan 35% #REF!
2 Remunerasi Pejabat Teknis
2.1 Pejabat Teknis Pelayanan 20% #REF!
Admen ( Ka Tu ) 20.0% #REF!
PJ UKP 25.0% #REF!
PJ UKM Essensial 25.0% #REF!
PJ UKM Pengembangan 20.0% #REF!
PJ Jejaring 10.0% #REF!
2.2 Pejabat Teknis Keuangan 45% #REF!

KPA (KAPUS) 25.0% #REF!
PPK (KTU) 15.0% #REF!
PPTK 15.0% #REF!
Bendahara Penerimaan 15.0% #REF!
Bendahara Pengeluaran 20.0% #REF!
Bendahara Pembantu 10.0% #REF!
SKALA
1. SKALA FAKTOR PENYESUAIAN ASET (FPA) Fpa

1.1 Total Aset S.D. Rp. 50 Milyar 0.10
1.2 Total Aset Rp. 50 - Rp. 100 Milyar 0.20
1.6 Total Aset Rp. 800 - Rp. 1.600 Milyar 0.60
1.7 Total Aset Rp. 1.600 - Rp. 2.400 Milyar 0.70
1.10 Total Aset > Rp. 4.000 Milyar 1.00
2. SKALA FAKTOR PENYESUAIAN INCOME (FPI) Fpi

2.1 Total Income/Omset S.D. Rp. 5 Milyar 0.10
2.2 Total Income/Omset S.D. Rp. 5 - Rp. 10 Milyar 0.20
2.11 Total Income/Omset > Rp. 1000 Milyar 1.50
INDEKS PEMBAGIAN POS REMUNERASI TIDAK LANGSUNG
1. INDEKS DASAR (Basic Index)
1.1 Setiap gaji pokok pegawai sebesar Rp. 100.000,- dinilai = 1
1.2 Setiap kelebihan Rp. 10.000,- dipersamakan = 0,1
Catatan: - Gaji pokok berdasarkan SK Gaji Berkala Terakhir
- Gaji Pegawai BLUD Non PNS Menyesuaikan
2. INDEKS KEMAMPUAN (Competency Index)
2.1 Jenjang Pendidikan Formal (Linear dg pekerjaan)
2.1.1 SD atau sederajat Nilai Indeks = 1
2.1.2 SLTP atau sederajat Nilai Indeks = 2
2.1.3 SLTA atau sederajat Nilai Indeks = 3
2.1.4 Diploma 1 (D1) Nilai Indeks = 4
2.1.5 Diploma 3 (D3) Nilai Indeks = 5
2.1.6 Diploma 4 (D4)/ Strata 1 Nilai Indeks = 6
2.1.7 Apoteker, S.Kep.Ners (S1-Apt-Ns) Nilai Indeks = 7
2.1.8 Dokter Umum/ Dokter Gigi (S1-dr-drg) Nilai Indeks = 8
2.1.9 Strata 2/ Dokter Spesialis/ Dokter Gigi Spesialis (S2) Nilai Indeks = 9
2.1.10 Strata 3/ Doktoral (S3) Nilai Indeks = 10
2.2 Jenjang Pelatihan Teknis / Fungsi
2.2.1 2 hari - 7 hari Nilai Indeks = 0,2
2.2.6 Lebih dari 180 hari Nilai Indeks = 1
3. INDEKS RESIKO
3.1 Resiko Tertular Penyakit
3.1.1 Tingkat Resiko Rendah (Nilai Indeks = 1)
RTP1 Admin Perkantoran
RTP2 Admin Instalasi Pelayanan Langsung (Pasien) yang ada shift
RTP3 Staf Admin Keuangan
RTP4 KPA, Bendahara, PPKn, PPTK, Pejabat Pengadaan
3.1.2 Tingkat Resiko Sedang (Nilai Indeks = 2)
RTP5 Rekam Medik, Sanitarian, Dapur/Gizi, Farmasi, Fisioterapist
3.1.3 Tingkat Resiko Tinggi (Nilai Indeks = 3)
RTP6 Pelaksana Pely Rawat Inap, Rawat Jalan
3.1.4 Tingkat Resiko Sangat Tinggih (Nilai Indeks = 4)
RTP7 UGD, Kamar Bersalin, Radiologi, Poli Gigi, Laborat, Loundry & Sterilisasi
3.2 Resiko Hukum dan Keuangan
3.2.1 Tingkat Resiko Rendah (Nilai Indeks = 1)
RHK1 Admin Perkantoran
RHK2 Admin Instalasi Pelayanan Langsung (Pasien) yang ada shift
RHK3 Rekam Medik, Sanitarian, Dapur, Loundry & Sterilisasi
3.2.2 Tingkat Resiko Sedang (Nilai Indeks = 2)
RHK4 Staf Admin Keuangan
3.2.3 Tingkat Resiko Tinggi (Nilai Indeks = 3)
RHK5 Pelaksana Pely Rawat Inap, Rawat Jalan, Gizi, Farmasi, Fisioterapis
RHK6 UGD, Kamar Bersalin, Radiologi, Laborat
3.2.4 Tingkat Resiko Sangat Tinggih (Nilai Indeks = 4)
RHK7 KPA, Bendahara, PPKn, PPTK, Pejabat Pengadaan
4. INDEKS KEGAWATDARURATAN
4.1 Emergency Grade 1 (Nilai Indeks = 1)
GD1 Admin, Sanitasi, Sopir Mobdin Kantor
GD2 Petugas Keamanan & Ketertiban, Parkir
GD3 Staf Admin & Keuangan, Pelak Pely. Rawat Inap, Rawat Jalan, Pendaftaran,Rekam Medik
GD4 Staf Gizi, Staf Keuangan
GD5 Tenaga Profesi di Rawat Inap, Rawat Jalan, Sterilisasi & Binatu
GD6 Pemberi Pelayanan Obat (Depo Farmasi), Sopir Ambulance/Jenazah
GD7 Tenaga UGD
GD8 Pelayanan Radiologi dan Laboratorium
5. INDEKS JABATAN (POSITION INDEX)
5.1 Kepala Puskesmas Nilai Indeks = 5
5.2 Kepala Tata Usaha Nilai Indeks = 3
5.3 Pejabat Pengelola Keuangan, PPTK, Penanggungjawab Nilai Indeks = 2
5.4 Penanggungjawab Program, Koordinator Pustu Nilai Indeks = 1
6. INDEKS KINERJA
6.1 Grade 1 : Capaian SKP < 40% Nilai Indeks = 1
6.2 Grade 1 : Capaian SKP < 40% - 59% Nilai Indeks = 2
6.3 Grade 1 : Capaian SKP < 60% - 79% Nilai Indeks = 3
6.4 Grade 1 : Capaian SKP ≥ 80% Nilai Indeks = 4
7. INDEKS PENGURANGAN
6.1 Ketidakhadiran Minlok (Nilai -5%) Nilai Indeks = 5 25%
6.2 Ketidakhadiran Hari Kerja (nilai -1% utk setiap hari tidak hadir) Nilai Indeks = 3 75%
PEMBAGIAN POS PIMPINAN, PEJABAT TEKNIS & KEUANGAN (KARE)

1. PIMPINAN 35% 2,930,359
2. PEJABAT TEKNIS 20% 1,674,491

PJ UKM ESENSIAL 25% 418,623
PJ UKM PENGEMBANGAN 20% 334,898
PJ UKP 25% 418,623
PJ ADMEN 20% 334,898 167,449
PJ JEJARING 10% 167,449
100%
3. TIM PENGELOLA KEUANGAN 45% 3,767,605
KPA 25% 941,901
PPK (KTU) 15% 565,141 282,570
PPTK 15% 565,141
Bendahara Penerimaan 10% 376,761
Bendahara Pengeluaran 20% 753,521
pptk dan bendahara bok 15% 565,141 282,570
100% 100%
3,767,605
8,372,456
FORMULA REMUNERASI BAGI PEMBERI LAYANAN LANGSUNG
UNIT LAYANAN
NO. HASIL UNIT PELY BOBOT UNIT NILAI UNIT BOBOT SKOR PROPORSI JASPEL 35% Penerimaan Jasa
PEMBERI LAYANAN PELY PELY Pelayanan Langsung
1 2 3 4 5 6 7=3X4 8 9 10 = 6 X 7
Pemberi Pelayanan Langsung 26,373,235.01
A.UNIT PENGHASIL (77% dari Alokasi Jasa Pelayanan Langsung) 20,307,391
1. POLI UMUM 6,101,000 1 6,101,000
1.1 ISMI PALUPI, A.Md Kep 5 0.030 614,333
1.2 JIAT PUJANG TRI SAKADEWA, A.Md Kep 4.67 0.028 573,787
1.3 RINA OKTA FUJIANI, A.Md Kep 5 0.030 614,333
1.4 dr. AMALIA 6.00 0.036 737,200
2. POLI GIGI 6,101,000 1 6,101,000

2.1 drg.AGUS BUDI PRASETYO 12.00 0.073 1,474,399
2.2 IMAM WAHYUDI 4.33 0.026 532,012
3. POLI KIA 6,101,000 1 6,101,000

3.1 SULASMIATI,SST 3.67 0.022 450,920
4 POLI KB 6,101,000 1 6,101,000

4.1 ENDAH TRININGSIH, S ST (morang) 3.67 0.022 450,920
5 PONED 6,101,000 1 6,101,000

5.1 TITIN HARIYANTI, A.Md Keb 3.00 0.018 368,600
5.2 NOVI PRAMITASARI, A.Md>Keb 2.33 0.014 286,279
5.3 ANTIKA LUPI M,A.Md Keb 2.33 0.014 286,279
5.4 WULIDA ABIRUL FAIZAH,A.Md Keb 2.33 0.014 286,279
5.5 IIS AKTIVA (PONED) 2.33 0.014 286,279

5.6 - -
5.7 WINARNI (LANSIA) 1.67 0.010 205,187
6 UGD & RAWAT INAP 6,101,000 1 6,101,000
6.1 dr. SAIFUDIN 5.00 0.030 614,333
6.2 SUPRIYONO,A.Md Kep 4.33 0.026 532,012
6.3 MARYAM, S. Kep Ns 4.33 0.026 532,012
6.4 HERI BUDWIAJI, A.Md Kep 4.33 0.026 532,012
6.5 MAULIDA FITRIANI, A.Md Kep 3.33 0.020 409,146
6.6 ANISA RATNAWATI, A.Md Kep 4.33 0.026 532,012
6.7 ARIE WIDYA ASTUTI, A.Md Kep 4.33 0.026 532,012
6.8 FATKUL JANAH, A.Md.Kep 4.33 0.026 532,012
6.9 SUJONO 4.33 0.026 532,012
6.10 - -
6.11 TITIK WAHYU SUSANTI,S.Kep Ners 4.33 0.026 532,012
6.12 SUPARNO, A.Md.Kep 4.00 0.024 491,466
6.13 - -
7 LABORAT 6,101,000 1 6,101,000

7.1 WURI HANDAYANI, AM AK 5.00 0.030 614,333
8 IMUNISASI 6,101,000 1 6,101,000

8.1 - -
8.2 MAT SANUSI 3.67 0.022 450,920
8.3 PUJI HARIYANTI, A.Md Keb 3.33 0.020 409,146
9 FISIO TERAPI 6,101,000 1 6,101,000
9.1 TRI SUNDARI A.Ad. Fis 2.33 0.014 286,279
10 PUSTU CERMO 6,101,000 1 6,101,000

10.1 SUHARNI,A.Md Keb 4.33 0.026 532,012
10.2 TONY YUSTANTO, A.Md Kep 4.00 0.024 491,466
11 PUSTU RANDUALAS 6,101,000 1 6,101,000

11.1 SIDIK MURNI AKBAR,A.Md Kep 4.33 0.026 532,012
11.2 NIAN LUK LUK 4.33 0.026 532,012
12 PUSTU BOLO 6,101,000 1 6,101,000

12.1 SITI RODIYAH, A.Md Keb 3.33 0.020 409,146
12.2 DONI HERES DWI A, A.Md Kep 3.33 0.020 409,146
13 POLINDES BODAG 6,101,000 1 6,101,000

13.1 SIRATUR ROFIQOH,A.Md Keb 3.33 0.020 409,146
13.1 OKTAVIA MENTARI PUTRI,A.Md Kep 3.33 0.020 409,146
14 POLINDES KEPEL 6,101,000 1 6,101,000

14.1 SUTINI ENDARWATI,A.Md Keb 3.67 0.022 450,920
14.2 DHIAH ANDARITA,A.Md Kep 3.67 0.022 450,920
15 POLINDES KUWIRAN 6,101,000 1 6,101,000

15.1 PARTINI SRI WINARSIH,A.Md Keb 3.00 0.018 368,600
16 POLINDES MORANG 6,101,000 1 6,101,000

16.1 DESI NOVITA SARI,A.md Keb (KB) 5.00 0.030 614,333
JUMLAH 165.28 1.000 20,307,391
B.UNIT PENDUKUNG (20% dari Alokasi Jasa Pelayanan Langsung) 5,274,647

1 LOKET
1.1 HARIYANTI 5.00 0.058 305,493
1.2 ATIK 5.00 0.058 305,493
1.3 IKA 5.00 0.058 305,493
2 GIZI / DAPUR
2.1 FITRI HARWIYANTI NURHIDAYAH, A.Md Gz 5.00 0.058 305,493
2.2 0.000 -
2.3 MARSINI 5.00 0.058 305,493
3 TATA USAHA
3.1 DAWI, S.Sos 5.00 0.058 305,493
3.2 ISNANI WIJIASIH,Amd.Kl 5.00 0.058 305,493
3.3 NOVI INDRIA K .D, A.Md Kep 5.00 0.058 305,493
3.4 BINTI NURJANAH,SE 4.00 0.046 244,395
3.5 YUYUK SRI MULYANI, SE 5.00 0.058 305,493
3.6 DWI NINGSIH, A.Md Kep 4.00 0.046 244,395
3.7 PITRIA ARIYANI, A.Md Kep 4.33 0.050 264,557
4 PENUNJANG (Policy)
4.1 MULYONO, ST 4.00 0.046 244,395
4.2 ROVI SRI HARTATIK,A.M.d. Kep 5.00 0.058 305,493
4.3 AWANG 5.00 0.058 305,493
4.4 YULI BRASTA ADITYA 5.00 0.058 305,493
5 APOTIK
5.1 SOFYAN 5.00 0.058 305,493
5.2 RINDANG 5.00 0.058 305,493
JUMLAH 86.33 1.000 5,274,647
C. PIMPINAN BLUD (3% dari Alokasi Jasa Pelayanan Langsung) 791,197

DR.SAIFUDIN 791,197
D. JASA PERSALINAN Jml.Persalin Jaspel Total -
1 SUHARNI, A.Md.Keb 0 400,000 - -
2 SULASMIATI, SST 0 400,000 - -
3 PUJI HARIYANTI,A.Md Keb 0 400,000 - -
TOTAL JUMLAH 26,373,235
ENTRY POLA REMUNERASI BLUD PUSKESM
pendapatan Tanggal :
1.1. Pos Pembinaan (2%)

1. Alokasi Remunerasi
(60% Pendapatan Rp 1,708,664.40
Fungsional PKM)
√ Rp 85,433,220.00 1.2. Pola Umum Remunerasi (98%)
Rp 83,724,555.60
Kontrol
BENAR
Kontrol
Tanda √ harap DIISI...! BENAR
A REMUNERASI BLUD PUSKESMAS KARE
Friday, April 30, 2021 √
1.2.1. Pimpinan, Tim Pengelola Keuangan dan

Pejabat Teknis BLUD (10%)
Rp 8,372,455.56
1.2.2. Pemberi Pelayanan (90%) 1.2.2.1. Pemberi Pelayanan Langsung (35%)

Rp 75,352,100.04 Rp 26,373,235.01
1.2.2.2. Seluruh Karyawan (indexing) (65%)

Rp 48,978,865.03
Kontrol
BENAR
BADAN LAY
D
Bulan: April 2021
NAMA, JENIS & KODE INDEKS
DATA MASTER
NO. Indeks Dasar Indeks Kemampuan
Urut STATUS TMT CPNS/ TRANSFER PENDIDIKAN DIKLAT
NAMA NIP Gol. KEPEG KONTRAK GAJI BERKALA
BANK NO.REKENING JURUSAN TH Jenjang Nama Lama
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 dr.SAIFUDIN 19730102 200312 1 000 IV-b PNS 01/12/2003 BRI 6351-01-010534-53-7 4,194,600 S1 Kedokteran 1999 S1-dr-drg
2 MARYAM, S. Kep Ns 19660422 198803 2 011 IV-b PNS 01/03/1988 BRI 6351-01-000430-53-1 4,748,500 S1 Keperawatan 2007 S1-Apt-Ns
3 drg. AGUS BUDI PRASETYO 19820804 200604 1 012 IV-a PNS 4/1/2006 BRI 0045-01-076534-50-6 3,782,400 S1 Kedokteran Gigi 2005 S1-dr-drg
4 MULYONO, ST 19661015 198710 1 001 III-d PNS 10/1/1987 BRI 6351-01-000631-53-5 4,370,900 S1 Teknik Lingk 2003 S1
5 DAWI, S.Sos 19631019 198801 1 002 III-d PNS 1/1/1988 BRI 6351-01-001280-53-1 4,370,900 S1 Sosial 2003 S1
6 SUPRIYONO,A.Md Kep 19651224 199003 1 011 III-d PNS 3/1/1993 BRI 6351-01-000243-53-6 4,237,500 DIII Keperawatan 2006 D3
7 TITIN HARIYANTI, A.Md Keb 19711117 199102 2 001 III-d PNS 2/1/1991 BRI 6351-01-000074-53-9 4,237,500 DIII Kebidanan 2006 D3
8 ENDAH TRININGSIH, S ST 19650909 199302 2 003 III-d PNS 1/1/1995 BRI 6351-01-005538-53-8 4,108,100 D IV Kebidanan 2011 D4
9 SUJONO,A.Md Kep 19710628 199303 1 009 III-d PNS 3/1/1993 BRI 6351-01-008804-53-0 4,108,100 DIII Keperawatan 2003 D3
10 WINARNI,A.Md Kep 19700215 199303 2 005 III-d PNS 3/1/1993 BRI 3508-01-032768-53-4 4,108,100 DIII Keperawatan 2003 D3
11 IMAM WAHYUDI 19751218 199503 1 002 III-c PNS 1/1/1997 BRI 6351-01-007704-53-3 3,821,000 Perawat Gigi 2018 D3
12 ISMI PALUPI, A.Md Kep 19770912 200501 2 006 III-c PNS 12/1/2006 BRI 0045-01-024738-50-2 3,375,300 DIII Keperawatan 2009 D3
13 SULASMIATI,Amd Keb 19730628 199302 2 003 III-b PNS 2/1/1993 BRI 6351-01-005820-53-7 3,781,400 DIV Kebidanan 1999 D3
14 SUHARNI, S.Tr Keb 19740207 200604 2 011 III-a PNS 4/1/2006 BRI 6351-01-004060-53-2 3,106,900 D IV Kebidanan 2017 D4
15 SIDIK MURNI AKBAR,A.Md Kep 19851109 200902 1 004 III-b PNS 2/1/2009 BRI 3884-01-001166-50-9 3,043,600 DIII Keperawatan 2007 D3
16 DWI NINGSIH, A.Md Kep 19820302 201001 2 026 III-b PNS 1/1/2012 BRI 6351-01-006560-53-8 3,043,600 DIII Keperawatan 2003 D3
17 PITRIA ARIYANI, A.Md Kep 19850121 201001 2 023 III-b PNS 1/1/2010 BRI 3876-01-017997-53-7 3,043,600 DIII Keperawatan 2008 D3
18 WURI HANDAYANI, AM AK 19820912 201001 2 035 III-b PNS 1/1/2010 BRI 3508-01-032767-53-8 3,043,600 DIII Analis 2003 D3
19 HERI BUDWIAJI, A.Md Kep 19851111 201101 1 015 III-a PNS 1/1/2011 BRI 3880-01-019866-53-7 2,830,900 DIII Keperawatan 2008 D3
20 SOFYAN,A.Md Farm 19770301 200604 1 004 III-a PNS 4/1/2006 BRI 6351-01-006614-53-1 2,920,100 DIII Farmasi 2013 D3
21 TRI SUNDARI, A.Md, Fis 197802072009022002 II-d PNS 1/1/2011 BRI 6351-01-000090-50-1 2,801,500 DIIIFisioterapi 1999 D3
22 FITRI HARWIYANTI, A.Md Gz 19880221 201001 2 014 II-d PNS 1/1/2010 BRI 6351-01-007555-53-6 2,801,500 DIII Gizi 2009 D3
23 JIAT PUJANG TRI S, A.Md Kep 19820608 201001 1 022 III-a PNS 1/1/2010 BRI 6351-01-008844-53-0 2,830,900 DIII Keperawatan 2004 D3
24 ISNANI WIJIASIH,Amd.Kl 19870623 201001 2 023 III-a PNS 1/1/2012 BRI 6351-01-0004058-53-5 2,920,100 D III Kesling 2008 D3
25 MAT SANUSI 19780414 200701 1 012 II-d PNS 1/1/2009 BRI 6351-01-003350-53-6 3,074,700 SPK 1998 SLTA
26 PUJI HARIYANTI, S.Tr. Keb 19830420 201406 2 004 II-d PNS 6/1/2014 BRI 6351-01-003713-53-0 2,980,800 D III Kebidanan 2004 D3
27 DESI NOVITA SARI,A.md Keb 19891216 201704 2 002 II-c PNS 4/1/2017 BRI 3884-01-021019-53-8 2,605,800 D III Kebidanan 2011 D3
28 NIAN LUK LUK ATUL F,A.Md Keb 19890411 201704 2001 II-c PNS 4/1/2017 BRI 6351-01-001245-50-7 2,605,800 D III Kebidanan 2010 D3
29 SITI RODIYAH, A.Md Keb 19820625 201704 2 004 II-c PNS 4/1/2017 BRI 0045-01-044001-50-3 2,772,500 D III Kebidanan '2004 D3
30 PARTINI SRI W,A.Md Keb 19820306 201704 2 002 II-c PNS 4/1/2017 BRI 6341-01-010869-53-1 2,687,800 D III Kebidanan 2002 D3
31 SUTINI ENDARWATI,A.Md Keb 19780227 201905 2 001 II-c PNS 4/1/2017 BRI 0045-01-044013-50-0 2,772,500 D III Kebidanan D3
32 SUPARNO,A.Md.Kep 19850226 201903 1 003 II-c PNS 3/1/2019 BRI 3887-01-014986-53-4 2,301,800 DIII Keperawatan 2006 D3
33 NOVI INDRIA K.D, A.Md.Kep 19881116 201903 2 003 II-c PNS 3/1/2019 BRI 0045-01-024562-53-7 2,301,800 DIII Keperawatan 2011 D3
34 ROVI SRI HARTATIK,A.M.d. Kep 19891010 201903 2 010 II-c PNS 3/1/2019 BRI 6351-01-010011-53-9 2,301,800 DIII Keperawatan 2011 D3
35 HARIYANTI 19840328 200501 2 002 II-b PNS 12/1/2006 BRI 6341-01-011114-53-1 2,500,000 SMA 2003 SLTA
36 DONI HERES DWI A, A.Md Kep - - HONORER 03/07/2007 BRI 6340-01-021338-53-7 1,250,000 DIII Keperawatan 2005 D3
37 FATKUL JANAH, A.Md Kep - - HONORER 03/07/2007 BRI 6341-01-006465-53-1 1,250,000 DIII Keperawatan 2005 D3
38 RINA OKTA FUJIANI, A.Md Kep - - HONORER 03/07/2007 BRI 6351-01-001909-53-3 1,250,000 DIII Keperawatan 2006 D3
39 MAULIDA FITRIANI, A.Md Kep - - HONORER 03/07/2007 BRI 3508-01-002031-53-5 1,250,000 DIII Keperawatan 2006 D3
40 ANISA RATNAWATI, A.Md Kep - - HONORER 03/07/2007 BRI 6351-01-003674-53-2 1,250,000 DIII Keperawatan 2006 D3
41 TONY YUSTANTO, A.Md Kep - - HONORER 03/07/2007 BRI 6340-01-018639-53-8 1,250,000 DIII Keperawatan 2005 D3
42 ARIE WIDYA ASTUTI, A.Md Kep - - HONORER 03/07/2007 BRI 6351-01-008800-53-6 1,250,000 DIII Keperawatan 2006 D3
43 BINTI NURJANAH,SE - - HONORER 03/07/2007 BRI 6351-01-004712-53-7 1,250,000 S1 Ekonomi 2015 S1
44 YUYUK SRI MULYANI,SE - - SUKWAN 02/01/2008 BRI 6351-01-007113-53-8 750,000 S1 Ekonomi 2012 S1
45 NOVI PRAMITA SARI,A.Md Keb - - SUKWAN 01/02/2012 BRI 6351-01-005001-53-1 750,000 D III Kebidanan 2011 D3
46 ATIK EKA SRI M - - SUKWAN 02/01/ 2008 BRI 6351-01-000377-53-9 750,000 SMA 1995 SLTA
47 DHIMAS AWANG Y - - SUKWAN 02/01/2008 BRI 6341-01-000665-50-7 750,000 SMA SLTA
48 DHIAH ANDARITA,A.Md Kep - - HONORER BRI 6354-01-008016-53-7 1,885,000 DIII Keperawatan D3
49 OKTAVIA MENTARI PUTRI,A.Md Kep - - HONORER BRI 6351-01-007878-53-6 1,885,000 DIII Keperawatan 2015 D3
50 YULI BRASTA ADITYA - - HONORER BRI 6351-01-005999-53-0 750,000 SMA SLTA
51 SIRATUR ROFIQOH,A.Md Keb - - HONORER BRI 6341-01-010872-53-4 - D III Kebidanan D3
52 TITIK WAHYU SUSANTI,S.Kep Ners - - HONORER BRI 6351-01-0088-05-53-6 - S1 Keperawatan S1
53 ANTIKA LUPI M,A.Md Keb - - HONORER BRI 6351-01-006119-53-1 - D III Kebidanan D3
54 IIS AKTIVASARI,A.Md Keb - - HONORER BRI 6351-01-007955-53-2 - D III Kebidanan D3
55 WULIDA ABIRUL FAIZAH,A.Md Keb - - HONORER BRI 6351-01-005851-83-8 - D III Kebidanan D3
56 IKA TRISNI FAJARWATI - - SUKWAN BRI - D III Rekam medis 2018 D3
57 MARSINI - - SUKWAN BRI 750,000 SMP SLTP
60 dr AMALIA FACHRIYAN - - KONTRAK 11/2/2020 BRI 6351-01-011821-53-9 2,500,000 S1 Kedokteran S1-dr-drg
61 RINDANG DIAH OKTARANI, S.Farm,A 19871013 202012 2 004 III-b PNS 12/1/2020 BRI 2167-01-003879-53-3 2,150,800 S1 Farmasi Apt 2012 S1-Apt-Ns
JUMLAH
REMUNERASI TIDAK LANGSUNG
BADAN LAYANAN UMUM DAERAH (BLUD) PUSKESMAS KARE
DINAS KESEHATAN KABUPATEN MADIUN
Jml Minlo 1 Hr.Kerja 25 √
MA, JENIS & KODE INDEKS NILAI INDEKS
Indeks Resiko Indeks Indeks Pengurang Indeks Dasar Indeks Kemampuan Indeks Resiko Indeks Kegawatan Indeks Jabatan
Indeks Indeks Tidak Hadir Pendd Diklat Tertular Hukum
RESIKO RESIKO HUKUM Kegawat Jabatan Kinerja TOTAL
TERTULAR & KEUANGAN Daruratan % Nilai Bobot Skor Bobot Skor Bobot Skor Nilai Bobot Skor Nilai Bobot
Minlok % Hr Kerja % Nilai Nilai Nilai Nilai
16 17 18 19 20 21 22 23 24 25 26 27 28 29
RTP6 RHK7 GD5 5.1 6.4 0% 0% 0% 41.9 1 41.95 8 - 5 40.00 3 4 4 28.00 3 4 12.00 5 4
RTP6 RHK5 GD5 5.3 6.4 0% 0% 0% 47.5 1 47.49 7 - 3 21.00 3 3 3 18.00 3 3 9.00 2 3
RTP7 RHK5 GD5 5.3 6.4 0% 0% 0% 37.8 2 75.65 8 - 5 40.00 4 3 4 28.00 3 4 12.00 2 4
RTP5 RHK3 GD1 5.4 6.4 0% 0% 0% 43.7 1 43.71 6 - 3 18.00 2 1 3 9.00 1 3 3.00 1 3
RTP4 RHK7 GD4 5.2 6.4 0% 0% 0% 43.7 1 43.71 6 - 3 18.00 1 4 3 15.00 2 3 6.00 3 3
RTP7 RHK6 GD7 5.3 6.4 0% 0% 0% 42.4 1 42.38 5 - 3 15.00 4 3 3 21.00 4 3 12.00 2 3
RTP7 RHK6 GD5 5.3 6.4 0% 0% 0% 42.4 1 42.38 5 - 3 15.00 4 3 3 21.00 3 3 9.00 2 3
RTP6 RHK5 GD5 5.3 6.4 0% 0% 0% 41.1 1 41.08 6 - 3 18.00 3 3 3 18.00 3 3 9.00 2 3
RTP4 RHK7 GD7 5.2 6.4 0% 0% 0% 41.1 1 41.08 5 - 3 15.00 1 4 3 15.00 4 3 12.00 3 3
RTP5 RHK5 GD6 5.4 6.4 0% 0% 0% 41.1 1 41.08 5 - 3 15.00 2 3 3 15.00 3 3 9.00 1 3
RTP7 RHK5 GD5 5.4 6.4 0% 0% 0% 38.2 1 38.21 5 - 3 15.00 4 3 3 21.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 33.8 1 33.75 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.3 6.4 0% 0% 0% 37.8 1 37.81 5 - 3 15.00 3 3 3 18.00 3 3 9.00 2 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 31.1 1 31.07 6 - 3 18.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 30.4 1 30.44 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP4 RHK7 GD4 5.3 6.4 0% 0% 0% 30.4 1 30.44 5 - 3 15.00 1 4 3 15.00 2 3 6.00 2 3
RTP4 RHK7 GD4 5.3 6.4 0% 0% 0% 30.4 1 30.44 5 - 3 15.00 1 4 3 15.00 2 3 6.00 2 3
RTP7 RHK6 GD8 5.3 6.4 0% 0% 0% 30.4 1 30.44 5 - 4 20.00 4 3 4 28.00 4 3 12.00 2 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 28.3 1 28.31 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP5 RHK5 GD6 5.3 6.4 0% 0% 0% 29.2 1 29.20 5 - 3 15.00 2 3 3 15.00 3 3 9.00 2 3
RTP5 RHK5 GD5 5.4 6.4 0% 0% 0% 28.0 1 28.02 5 - 3 15.00 2 3 3 15.00 3 3 9.00 1 3
RTP5 RHK5 GD4 5.4 6.4 0% 0% 0% 28.0 1 28.02 5 - 3 15.00 2 3 3 15.00 2 3 6.00 1 3
RTP6 RHK5 GD5 5.3 6.4 0% 0% 0% 28.3 1 28.31 5 - 3 15.00 3 3 3 18.00 3 3 9.00 2 3
RTP4 RHK7 GD4 5.3 6.4 0% 0% 0% 29.2 1 29.20 5 - 3 15.00 1 4 3 15.00 2 3 6.00 2 3
RTP6 RHK5 GD3 5.4 6.4 0% 0% 0% 30.7 1 30.75 3 - 3 9.00 3 3 3 18.00 2 3 6.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 29.8 1 29.81 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 6.4 0% 0% 0% 26.1 1 26.06 5 - 3 15.00 3 3 3 18.00 3 3 9.00 - 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 26.1 1 26.06 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 27.7 1 27.73 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 26.9 1 26.88 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 27.7 1 27.73 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 6.4 0% 0% 0% 23.0 1 23.02 5 - 3 15.00 3 3 3 18.00 3 3 9.00 - 3
RTP4 RHK7 GD4 5.3 6.4 0% 0% 0% 23.0 1 23.02 5 - 3 15.00 1 4 3 15.00 2 3 6.00 2 3
RTP4 RHK7 GD4 5.3 6.4 0% 0% 0% 23.0 1 23.02 5 - 3 15.00 1 4 3 15.00 2 3 6.00 2 3
RTP5 RHK3 GD3 5.3 6.4 0% 0% 0% 25.0 1 25.00 3 - 3 9.00 2 1 3 9.00 2 3 6.00 2 3
RTP6 RHK5 GD5 5.3 6.4 0% 0% 0% 12.5 1 12.50 5 - 4 20.00 3 3 3 18.00 3 4 12.00 2 3
RTP7 RHK6 GD7 6.4 0% 0% 0% 12.5 1 12.50 5 - 3 15.00 4 3 3 21.00 4 3 12.00 - 3
RTP6 RHK5 GD5 6.4 0% 0% 0% 12.5 1 12.50 5 - 3 15.00 3 3 3 18.00 3 3 9.00 - 3
RTP7 RHK6 GD7 5.4 6.4 0% 0% 0% 12.5 1 12.50 5 - 4 20.00 4 3 3 21.00 4 4 16.00 1 3
RTP7 RHK6 GD7 5.4 6.4 0% 0% 0% 12.5 1 12.50 5 - 3 15.00 4 3 3 21.00 4 3 12.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 12.5 1 12.50 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP7 RHK6 GD7 5.4 6.4 0% 0% 0% 12.5 1 12.50 5 - 3 15.00 4 3 3 21.00 4 3 12.00 1 3
RTP3 RHK4 GD4 6.4 0% 0% 0% 12.5 1 12.50 6 - 3 18.00 1 2 3 9.00 2 3 6.00 - 3
RTP3 RHK4 GD4 6.4 0% 0% 0% 7.5 1 7.50 6 - 3 18.00 1 2 3 9.00 2 3 6.00 - 3
RTP7 RHK6 GD5 6.4 0% 0% 0% 7.5 1 7.50 5 - 3 15.00 4 3 3 21.00 3 3 9.00 - 3
RTP7 RHK3 GD5 6.4 0% 0% 0% 7.5 1 7.50 3 - 3 9.00 4 1 3 15.00 3 3 9.00 - 3
RTP7 RHK6 GD6 6.4 0% 0% 0% 7.5 1 7.50 3 - 3 9.00 4 3 3 21.00 3 3 9.00 - 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 18.9 1 18.85 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% 18.9 1 18.85 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP7 RHK6 GD6 6.4 0% 0% 0% 7.5 1 7.50 3 - 3 9.00 4 3 3 21.00 3 3 9.00 - 3
RTP6 RHK5 GD5 5.4 6.4 0% 0% 0% - 1 - 5 - 3 15.00 3 3 3 18.00 3 3 9.00 1 3
RTP7 RHK6 GD7 6.4 0% 0% 0% - 1 - 6 - 3 18.00 4 3 3 21.00 4 3 12.00 - 3
RTP7 RHK6 GD5 6.4 0% 0% 0% - 1 - 5 - 3 15.00 4 3 3 21.00 3 3 9.00 - 3
RTP7 RHK6 GD5 6.4 0% 0% 0% - 1 - 5 - 3 15.00 4 3 3 21.00 3 3 9.00 - 3
RTP7 RHK6 GD5 6.4 0% 0% 0% - 1 - 5 - 3 15.00 4 3 3 21.00 3 3 9.00 - 3
RTP5 RHK3 GD3 6.4 0% 0% 0% - 1 - 5 - 3 15.00 2 1 3 9.00 2 3 6.00 - 3
RTP5 RHK3 GD4 6.4 0% 0% 0% 7.5 1 7.50 2 - 3 6.00 2 1 3 9.00 2 3 6.00 - 3
RTP7 RHK6 GD7 5.3 6.4 0% 0% 0% 25.0 1 25.00 8 - 4 32.00 4 3 4 28.00 4 4 16.00 2 3
RTP5 RHK5 GD6 5.3 6.4 0% 0% 0% 21.5 1 21.51 7 - 3 21.00 2 3 4 20.00 3 3 9.00 2 3
1,375 295 - 166 170 168 67
BOBOT 5 3
Indeks Jabatan Indeks Kinerja Indeks Pengurang REMUN TIDAK RUMUS

JML TOTAL LANGSUNG (Rp.) BANTU
Skor Nilai Bobot Skor Minlok Hr Kerja
30 31 32 33
20.00 1 5 5.00 146.95 0% 0% 146.95 1,660,692.80 IV
6.00 1 4 4.00 105.49 0% 0% 105.49 1,192,126.22 IV
8.00 1 5 5.00 168.65 0% 0% 168.65 1,905,955.38 IV
3.00 1 4 4.00 80.71 0% 0% 80.71 912,123.20 III
9.00 1 4 4.00 95.71 0% 0% 95.71 1,081,643.92 III
6.00 1 4 4.00 100.38 0% 0% 100.38 1,134,376.16 III
6.00 1 4 4.00 97.38 0% 0% 97.38 1,100,472.02 III
6.00 1 4 4.00 96.08 0% 0% 96.08 1,085,848.03 III
9.00 1 4 4.00 96.08 0% 0% 96.08 1,085,848.03 III
3.00 1 4 4.00 87.08 0% 0% 87.08 984,135.60 III
3.00 1 4 4.00 90.21 0% 0% 90.21 1,019,497.62 III
3.00 1 4 4.00 82.75 0% 0% 82.75 935,223.22 III
6.00 1 4 4.00 89.81 0% 0% 89.81 1,015,022.28 III
3.00 1 4 4.00 83.07 0% 0% 83.07 938,794.46 III
3.00 1 4 4.00 79.44 0% 0% 79.44 897,736.54 III
6.00 1 4 4.00 76.44 0% 0% 76.44 863,832.39 III
6.00 1 4 4.00 76.44 0% 0% 76.44 863,832.39 III
6.00 1 4 4.00 100.44 0% 0% 100.44 1,135,065.55 III
3.00 1 4 4.00 77.31 0% 0% 77.31 873,698.50 III
6.00 1 5 5.00 79.20 0% 0% 79.20 895,080.71 III
3.00 1 4 4.00 74.02 0% 0% 74.02 836,471.75 II
3.00 1 4 4.00 71.02 0% 0% 71.02 802,567.61 II
6.00 1 4 4.00 80.31 0% 0% 80.31 907,602.64 III
6.00 1 4 4.00 75.20 0% 0% 75.20 849,875.19 III
3.00 1 4 4.00 70.75 0% 0% 70.75 799,538.83 II
3.00 1 4 4.00 78.81 0% 0% 78.81 890,639.27 II
- 1 4 4.00 72.06 0% 0% 72.06 814,354.95 II
3.00 1 4 4.00 75.06 0% 0% 75.06 848,259.09 II
3.00 1 4 4.00 76.73 0% 0% 76.73 867,098.49 II
3.00 1 4 4.00 75.88 0% 0% 75.88 857,526.22 II
3.00 1 4 4.00 76.73 0% 0% 76.73 867,098.49 II
- 1 4 4.00 69.02 0% 0% 69.02 779,998.75 II
6.00 1 4 4.00 69.02 0% 0% 69.02 779,998.75 II
6.00 1 4 4.00 69.02 0% 0% 69.02 779,998.75 II
6.00 1 4 4.00 59.00 0% 0% 59.00 666,781.51 II
6.00 1 5 5.00 73.50 0% 0% 73.50 830,651.54
- 1 4 4.00 64.50 0% 0% 64.50 728,939.10
- 1 4 4.00 58.50 0% 0% 58.50 661,130.82
3.00 1 5 5.00 77.50 0% 0% 77.50 875,857.06
3.00 1 4 4.00 67.50 0% 0% 67.50 762,843.25
3.00 1 4 4.00 61.50 0% 0% 61.50 695,034.96
3.00 1 4 4.00 67.50 0% 0% 67.50 762,843.25
- 1 4 4.00 49.50 0% 0% 49.50 559,418.38
- 1 4 4.00 44.50 0% 0% 44.50 502,911.48
- 1 4 4.00 56.50 0% 0% 56.50 638,528.05
- 1 4 4.00 44.50 0% 0% 44.50 502,911.48
- 1 4 4.00 50.50 0% 0% 50.50 570,719.76
3.00 1 4 4.00 67.85 0% 0% 67.85 766,798.73
3.00 1 4 4.00 67.85 0% 0% 67.85 766,798.73
- 1 4 4.00 50.50 0% 0% 50.50 570,719.76
3.00 1 4 4.00 49.00 0% 0% 49.00 553,767.69
- 1 4 4.00 55.00 0% 0% 55.00 621,575.98
- 1 4 4.00 49.00 0% 0% 49.00 553,767.69
- 1 4 4.00 49.00 0% 0% 49.00 553,767.69
- 1 4 4.00 49.00 0% 0% 49.00 553,767.69
- 1 4 4.00 34.00 0% 0% 34.00 384,246.97
- 1 4 4.00 32.50 0% 0% 32.50 367,294.90
6.00 1 5 5.00 112.00 0% 0% 112.00 1,265,754.72
6.00 1 4 4.00 81.51 0% 0% 81.51 921,153.00 III
58 - - 4,334 48,978,865.03
REKAPITULASI SKOR INDEXING DAN PEMBAGIAN REMUNERASI JASA PELAYANAN LANGSUNG DAN TIDAK LANGSUNG
BADAN LAYANAN UMUM DAERAH (BLUD) PUSKESMAS KARE
BULAN NOVEMBER 2020 Bulan : April 2021
FORMULA REMUNERASI BAGI SELURUH KARYAWAN
INDEK
NO NAMA KOMPENTENSI INDEK
INDEKS DASAR INDEK RISIKO (Risk INDEK KEGAWATAN INDEK JABATAN INDEK KINERJA PENGURAN
(Performnce Index) Nilai jaspel dari
(Competenscy Index) (Emergency Index) (Position Index) G Total skor Proporsi pos remunerasi
Index) index karyawan
nilai bobot skor nilai bobot skor nilai bobot skor nilai bobot skor nilai bobot skor nilai bobot skor %
22=(5+8+11
11=(9X1 14=(12X 17=(15X 20=(18X
1 2 3 4 5=(3X4) 6 7 8=(6X7) 9 10 12 13 15 16 18 19 21 +14+17+20) 23 24
0) 13) 16) 19)
-21
1 dr.SAIFUDIN 42 1 41.946 8 3 24 7 4 28 3 4 12 5 4 20 1 5 5 0% 130.946 0.0303 48,978,865

2 MARYAM, S. Kep Ns 47 1 47.485 7 3 21 6 3 18 3 3 9 2 3 6 1 4 4 0% 105.485 0.0244 48,978,865
3 drg. AGUS BUDI PRASETYO 38 1 37.824 8 3 24 7 4 28 3 4 12 2 4 8 1 5 5 0% 114.824 0.0266 48,978,865
4 MULYONO, ST 44 1 43.709 6 3 18 3 3 9 1 3 3 1 3 3 1 4 4 0% 80.709 0.0187 48,978,865
5 DAWI, S.Sos 44 1 43.709 6 3 18 5 3 15 2 3 6 3 3 9 1 4 4 0% 95.709 0.0221 48,978,865
6 SUPRIYONO,A.Md Kep 42 1 42.375 5 3 15 7 3 21 4 3 12 2 3 6 1 4 4 0% 100.375 0.0232 48,978,865
7 TITIN HARIYANTI, A.Md Keb 42 1 42.375 5 3 15 7 3 21 3 3 9 2 3 6 1 4 4 0% 97.375 0.0225 48,978,865
8 ENDAH TRININGSIH, S ST 41 1 41.081 6 3 18 6 3 18 3 3 9 2 3 6 1 4 4 0% 96.081 0.0222 48,978,865
9 SUJONO,A.Md Kep 41 1 41.081 5 3 15 5 3 15 4 3 12 3 3 9 1 4 4 0% 96.081 0.0222 48,978,865
10 WINARNI,A.Md Kep 41 1 41.081 5 3 15 5 3 15 3 3 9 1 3 3 1 4 4 0% 87.081 0.0201 48,978,865
11 IMAM WAHYUDI 38 1 38.21 5 3 15 7 3 21 3 3 9 1 3 3 1 4 4 0% 90.21 0.0209 48,978,865
12 ISMI PALUPI, A.Md Kep 34 1 33.753 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 82.753 0.0191 48,978,865
13 SULASMIATI,SST 38 1 37.814 5 3 15 6 3 18 3 3 9 2 3 6 1 4 4 0% 89.814 0.0208 48,978,865
14 SUHARNI, S.Tr. Keb 31 1 31.069 6 3 18 6 3 18 3 3 9 1 3 3 1 4 4 0% 83.069 0.0192 48,978,865
15 SIDIK MURNI AKBAR,A.Md Kep 30 1 30.436 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 79.436 0.0184 48,978,865
16 DWI NINGSIH, A.Md Kep 30 1 30.436 5 3 15 5 3 15 2 3 6 2 3 6 1 4 4 0% 76.436 0.0177 48,978,865
17 PITRIA ARIYANI, A.Md Kep 30 1 30.436 5 3 15 5 3 15 2 3 6 2 3 6 1 4 4 0% 76.436 0.0177 48,978,865
18 WURI HANDAYANI, AM AK 30 1 30.436 5 3 15 7 4 28 4 3 12 2 3 6 1 4 4 0% 95.436 0.0221 48,978,865
19 HERI BUDWIAJI, A.Md Kep 28 1 28.309 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 77.309 0.0179 48,978,865
20 SOFYAN,A.Md Farm 29 1 29.201 5 3 15 5 3 15 3 3 9 2 3 6 1 5 5 0% 79.201 0.0183 48,978,865
21 TRI SUNDARI, A.Md, Fis 28 1 28.015 5 3 15 5 3 15 3 3 9 1 3 3 1 4 4 0% 74.015 0.0171 48,978,865
22 FITRI HARWIYANTI, A.Md Gz 28 1 28.015 5 3 15 5 3 15 2 3 6 1 3 3 1 4 4 0% 71.015 0.0164 48,978,865
23 JIAT PUJANG TRI S, A.Md Kep 28 1 28.309 5 3 15 6 3 18 3 3 9 2 3 6 1 4 4 0% 80.309 0.0186 48,978,865
24 ISNANI WIJIASIH,Amd.Kl 29 1 29.201 5 3 15 5 3 15 2 3 6 2 3 6 1 4 4 0% 75.201 0.0174 48,978,865
25 MAT SANUSI 31 1 30.747 3 39 6 3 18 2 3 6 1 3 3 1 4 4 0% 70.747 0.0164 48,978,865
26 PUJI HARIYANTI, S.Tr. Keb 30 1 29.808 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 78.808 0.0182 48,978,865
27 DESI NOVITA SARI,A.md Keb 26 1 26.058 5 3 15 6 3 18 3 3 9 - 3 0 1 4 4 0% 72.058 0.0167 48,978,865
28 NIAN LUK LUK ATUL F,A.Md Keb 26 1 26.058 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 75.058 0.0174 48,978,865
29 SITI RODIYAH, A.Md Keb 28 1 27.725 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 76.725 0.0177 48,978,865
30 PARTINI SRI W,A.Md Keb 27 1 26.878 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 75.878 0.0176 48,978,865
31 SUTINI ENDARWATI,A.Md Keb 28 1 27.725 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 76.725 0.0177 48,978,865
32 SUPARNO,A.Md.Kep 23 1 23.018 5 3 15 6 3 18 3 3 9 - 3 0 1 4 4 0% 69.018 0.0160 48,978,865
33 NOVI INDRIA K.D, A.Md.Kep 23 1 23.018 5 3 15 5 3 15 2 3 6 2 3 6 1 4 4 0% 69.018 0.0160 48,978,865
34 ROVI SRI HARTATIK,A.M.d. Kep 23 1 23.018 5 3 15 5 3 15 2 3 6 2 3 6 1 4 4 0% 69.018 0.0160 48,978,865
35 HARIYANTI 25 1 25 3 39 3 3 9 2 3 6 2 3 6 1 4 4 0% 59 0.0136 48,978,865
36 DONI HERES DWI A, A.Md Kep 13 1 12.5 5 3 15 6 3 18 3 4 12 2 3 6 1 5 5 0% 68.5 0.0158 48,978,865
37 FATKUL JANAH, A.Md Kep 13 1 12.5 5 3 15 7 3 21 4 3 12 - 3 0 1 4 4 0% 64.5 0.0149 48,978,865
38 RINA OKTA FUJIANI, A.Md Kep 13 1 12.5 5 3 15 6 3 18 3 3 9 - 3 0 1 4 4 0% 58.5 0.0135 48,978,865
39 MAULIDA FITRIANI, A.Md Kep 13 1 12.5 5 3 15 7 3 21 4 4 16 1 3 3 1 5 5 0% 72.5 0.0168 48,978,865
40 ANISA RATNAWATI, A.Md Kep 13 1 12.5 5 3 15 7 3 21 4 3 12 1 3 3 1 4 4 0% 67.5 0.0156 48,978,865
41 TONY YUSTANTO, A.Md Kep 13 1 12.5 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 61.5 0.0142 48,978,865
42 ARIE WIDYA ASTUTI, A.Md Kep 13 1 12.5 5 3 15 7 3 21 4 3 12 1 3 3 1 4 4 0% 67.5 0.0156 48,978,865
43 BINTI NURJANAH,SE 13 1 12.5 6 3 18 3 3 9 2 3 6 - 3 0 1 4 4 0% 49.5 0.0115 48,978,865
44 YUYUK SRI MULYANI,SE 8 1 7.5 6 3 18 3 3 9 2 3 6 - 3 0 1 4 4 0% 44.5 0.0103 48,978,865
45 NOVI PRAMITA SARI,A.Md Keb 8 1 7.5 5 3 15 7 3 21 3 3 9 - 3 0 1 4 4 0% 56.5 0.0131 48,978,865
46 ATIK EKA SRI M 8 1 7.5 3 39 5 3 15 3 3 9 - 3 0 1 4 4 0% 44.5 0.0103 48,978,865
47 DHIMAS AWANG Y 8 1 7.5 3 39 7 3 21 3 3 9 - 3 0 1 4 4 0% 50.5 0.0117 48,978,865
48 DHIAH ANDARITA,A.Md Kep 19 1 18.85 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 67.85 0.0157 48,978,865
49 OKTAVIA MENTARI PUTRI,A.Md Kep 19 1 18.85 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 67.85 0.0157 48,978,865
50 YULI BRASTA ADITYA 8 1 7.5 3 39 7 3 21 3 3 9 - 3 0 1 4 4 0% 50.5 0.0117 48,978,865
51 SIRATUR ROFIQOH,A.Md Keb - 10 5 3 15 6 3 18 3 3 9 1 3 3 1 4 4 0% 49 0.0113 48,978,865
53 TITIK WAHYU SUSANTI,S.Kep Ners - 10 6 3 18 7 3 21 4 3 12 - 3 0 1 4 4 0% 55 0.0127 48,978,865
54 ANTIKA LUPI M,A.Md Keb - 10 5 3 15 7 3 21 3 3 9 - 3 0 1 4 4 0% 49 0.0113 48,978,865
56 IIS AKTIVASARI,A.Md Keb - 10 5 3 15 7 3 21 3 3 9 - 3 0 1 4 4 0% 49 0.0113 48,978,865
57 WULIDA ABIRUL FAIZAH,A.Md Keb - 10 5 3 15 7 3 21 3 3 9 - 3 0 1 4 4 0% 49 0.0113 48,978,865
58 IKA TRISNI FAJARWATI - 10 5 3 15 3 3 9 2 3 6 - 3 0 1 4 4 0% 34 0.0079 48,978,865
59 MARSINI 8 1 7.5 2 36 3 3 9 2 3 6 - 3 0 1 4 4 0% 32.5 0.0075 48,978,865
60 dr AMALIA FACHRIYAN 25 1 25 8 3 24 7 4 28 4 4 16 2 3 6 1 5 5 0% 104 0.0241 48,978,865
61 RINDANG 22 1 21.508 7 3 21 5 4 20 3 3 9 2 3 6 1 4 4 0% 81.508 0.0189 48,978,865
TOTAL 4322.567 0.9811
Mengetahui
Kuasa Pengguna Anggaran Pejabat Penatausahaan Keuangan
dr. AMAM SANTOSA,M.M Kes DAWI

NIP. 19651019 200212 1 003 NIP. 19631019 198801 1 002
TIM REMUNERASI PUSKESMAS BALEREJO

1 SODIKIN, S.Kep.Ners. Ketua 1 ……………..
2 WILDANA FAHMI, SKM Sekretaris 2 ……………..
3 RUSMAT, MKes Anggota 3 ……………..
4 SRIATI, S.ST Anggota 4 ……………..
5 ATUT WINARSIH, A.Md KL Anggota 5 ……………..
6 SRIANI, AMd Keb Anggota 6 ……………..
7 SUPARDIONO, AMdKep, Anggota 7 ……………..
8 RULI RATNANINGSIH Anggota 8 ……………..
9 YULIAMIN RATNAWATI Anggota 9 ……………..
10 MARTINI Anggota 10 ……………..
11 SURYANI, AMd KL Anggota 11 ……………..
12 PUJI ASTUTIK Anggota 12 ……………..
13 UFIK ZUNAIDAH Anggota 13 ……………..
14 DENNY WIYANTI Anggota 14 ……………..
SUNG
FORMULA REMUNERASI BAGI PIMPINAN DAN

PEJABAT TEKNIS BLUD
REMUNERASI
Jumlah Jaspel BAGI PEMBERI TOTAL PENERIMAAN
Pemimpin Pejabat Pejabat Teknis PELAYANAN JASA PELAYANAN
dari pos BLUD 35% Keuangan 45% Keg. 20%
remunerasi LANGSUNG (Rp.)
seluruh
karyawan (Rp.)
2,930,359 3,767,605 1,674,491
30=(25+26+29) atau
25=(22X23) 26 27 28 29 (25+27+29) atau
(25+28+29)
1,483,745 2,930,359 941,901 1,405,530 6,761,536

1,195,247 532,012 1,727,259
1,301,067 418,623 1,474,399 3,194,089
914,511 244,395 1,158,906
1,084,476 282,570 167,449 305,493 1,839,988
1,137,346 532,012 1,669,358
1,103,353 368,600 1,471,953
1,088,691 450,920 1,539,611
1,088,691 282,570 167,449 532,012 2,070,723
986,712 205,187 1,191,899
1,022,167 532,012 1,554,179
937,672 614,333 1,552,005
1,017,679 450,920 1,468,600
941,252 532,012 1,473,264
900,087 532,012 1,432,099
866,094 753,521 244,395 1,864,009
866,094 282,570 264,557 1,413,221
1,081,382 614,333 1,695,715
875,986 532,012 1,407,998
897,424 305,493 1,202,917
838,662 286,279 1,124,941
804,669 305,493 1,110,162
909,979 418,623 573,787 1,902,388
852,100 376,761 305,493 1,534,354
801,632 450,920 1,252,552
892,971 409,146 1,302,117
816,487 614,333 1,430,820
850,480 532,012 1,382,492
869,368 409,146 1,278,514
859,771 368,600 1,228,371
869,368 450,920 1,320,289
782,041 491,466 1,273,507
782,041 565,141 305,493 1,652,675
782,041 282,570 305,493 1,370,104
668,527 305,493 974,020
776,171 167,449 409,146 1,352,766
730,847 532,012 1,262,860
662,862 614,333 1,277,195
821,495 409,146 1,230,641
764,840 532,012 1,296,853
696,854 334,898 491,466 1,523,219
764,840 532,012 1,296,853
560,883 244,395 805,278
504,228 305,493 809,721
640,200 286,279 926,479
504,228 305,493 809,721
572,214 305,493 877,707
768,806 450,920 1,219,727
768,806 409,146 1,177,952
572,214 305,493 877,707
555,217 409,146 964,363
623,203 532,012 1,155,216
555,217 286,279 841,497
555,217 286,279 841,497
555,217 286,279 841,497
385,253 305,493 690,746
368,256 305,493 673,750
1,178,421 737,200 1,915,620
923,564 305,493 1,229,058
48,978,865 2,930,359 3,767,605 1,674,491 26,373,235 83,724,556
Madiun, Friday, April 30, 2021

Pejabat Pelaksana Teknis Kegiatan,
WURI HANDAYANI
NIP. 19820912 201001 2 035
PENERIMAAN JASA PELAYANAN PUSKESMAS
FKTP PUSKESMAS KARE TAHUN 2021
BULAN April
KODE REKENING 1.02.1.02.01.10.43.09.5.2.2.37.01
JUMLAH JASA PELAYANAN Rp 83,724,556
JUMLAH
NO NAMA NIP GOL PAJAK PPH PASAL 21 JUMLAH DITERIMA TANDA TANGAN RUMUS
PENERIMAAN
BANTU
1 2 3 4 5 6 7 8
1 dr.SAIFUDIN 19730102 200312 1 000 IV-b 6,761,536 1,014,230 5,747,305 1 IV

2 MARYAM, S. Kep Ns 19660422 198803 2 011 IV-b 1,727,259 259,089 1,468,171 2 IV
3 drg. AGUS BUDI PRASETYO 19820804 200604 1 012 IV-a 3,194,089 479,113 2,714,976 3 IV
4 MULYONO, ST 19661015 198710 1 001 III-d 1,158,906 57,945 1,100,960 4 III
5 DAWI, S.Sos 19631019 198801 1 002 III-d 1,839,988 91,999 1,747,989 5 III
6 SUPRIYONO,A.Md Kep 19651224 199003 1 011 III-d 1,669,358 83,468 1,585,890 6 III
7 TITIN HARIYANTI, A.Md Keb 19711117 199102 2 001 III-d 1,471,953 73,598 1,398,355 7 III
8 ENDAH TRININGSIH, S ST 19650909 199302 2 003 III-d 1,539,611 76,981 1,462,631 8 III
9 SUJONO,A.Md Kep 19710628 199303 1 009 III-d 2,070,723 103,536 1,967,186 9 III
10 WINARNI,A.Md Kep 19700215 199303 2 005 III-d 1,191,899 59,595 1,132,304 10 III
11 IMAM WAHYUDI 19751218 199503 1 002 III-c 1,554,179 77,709 1,476,470 11 III
12 ISMI PALUPI, A.Md Kep 19770912 200501 2 006 III-c 1,552,005 77,600 1,474,404 12 III
13 SULASMIATI,SST 19730628 199302 2 003 III-b 1,468,600 73,430 1,395,170 13 III
14 SUHARNI, S.Tr. Keb 19740207 200604 2 011 III-a 1,473,264 73,663 1,399,601 14 III
15 SIDIK MURNI AKBAR,A.Md Kep 19851109 200902 1 004 III-b 1,432,099 71,605 1,360,494 15 III
16 DWI NINGSIH, A.Md Kep 19820302 201001 2 026 III-b 1,864,009 93,200 1,770,809 16 III
17 PITRIA ARIYANI, A.Md Kep 19850121 201001 2 023 III-b 1,413,221 70,661 1,342,560 17 III
18 WURI HANDAYANI, AM AK 19820912 201001 2 035 III-b 1,695,715 84,786 1,610,929 18 III
19 HERI BUDWIAJI, A.Md Kep 19851111 201101 1 015 III-a 1,407,998 70,400 1,337,598 19 III
20 SOFYAN,A.Md Farm 19770301 200604 1 004 III-a 1,202,917 60,146 1,142,771 20 III
21 TRI SUNDARI, A.Md, Fis 197802072009022002 II-d 1,124,941 - 1,124,941 21 II
22 FITRI HARWIYANTI, A.Md Gz 19880221 201001 2 014 II-d 1,110,162 - 1,110,162 22 II
23 JIAT PUJANG TRI S, A.Md Kep 19820608 201001 1 022 III-a 1,902,388 95,119 1,807,269 23 III
24 ISNANI WIJIASIH,Amd.Kl 19870623 201001 2 023 III-a 1,534,354 76,718 1,457,636 24 III
25 MAT SANUSI 19780414 200701 1 012 II-d 1,252,552 - 1,252,552 25 II
26 PUJI HARIYANTI, S.Tr. Keb 19830420 201406 2 004 II-d 1,302,117 - 1,302,117 26 II
27 DESI NOVITA SARI,A.md Keb 19891216 201704 2 002 II-c 1,430,820 - 1,430,820 27 II
28 NIAN LUK LUK ATUL F,A.Md Keb 19890411 201704 2001 II-c 1,382,492 - 1,382,492 28 II
29 SITI RODIYAH, A.Md Keb 19820625 201704 2 004 II-c 1,278,514 - 1,278,514 29 II
30 PARTINI SRI W,A.Md Keb 19820306 201704 2 002 II-c 1,228,371 - 1,228,371 30 II
31 SUTINI ENDARWATI,A.Md Keb 19780227 201905 2 001 II-c 1,320,289 - 1,320,289 31
32 SUPARNO,A.Md.Kep 19850226 201903 1 003 II-c 1,273,507 - 1,273,507 32
33 NOVI INDRIA K.D, A.Md.Kep 19881116 201903 2 003 II-c 1,652,675 - 1,652,675 33
34 ROVI SRI HARTATIK,A.M.d. Kep 19891010 201903 2 010 II-c 1,370,104 - 1,370,104 34
35 HARIYANTI 19840328 200501 2 002 II-b 974,020 - 974,020 35 II

36 DONI HERES DWI A, A.Md Kep - - 1,352,766 - 1,352,766 36
37 FATKUL JANAH, A.Md Kep - - 1,262,860 - 1,262,860 37
38 RINA OKTA FUJIANI, A.Md Kep - - 1,277,195 - 1,277,195 38
39 MAULIDA FITRIANI, A.Md Kep - - 1,230,641 - 1,230,641 39
40 ANISA RATNAWATI, A.Md Kep - - 1,296,853 - 1,296,853 40
41 TONY YUSTANTO, A.Md Kep - - 1,523,219 - 1,523,219 41
42 ARIE WIDYA ASTUTI, A.Md Kep - - 1,296,853 - 1,296,853 42
43 BINTI NURJANAH,SE - - 805,278 - 805,278 43
44 YUYUK SRI MULYANI,SE - - 809,721 - 809,721 44
45 NOVI PRAMITA SARI,A.Md Keb - - 926,479 - 926,479 45
46 ATIK EKA SRI M - - 809,721 - 809,721 46
47 DHIMAS AWANG Y - - 877,707 - 877,707 47
48 DHIAH ANDARITA,A.Md Kep - - 1,219,727 - 1,219,727 48
49 OKTAVIA MENTARI PUTRI,A.Md Kep - - 1,177,952 - 1,177,952 49

50 YULI BRASTA ADITYA - - 877,707 - 877,707 50
51 SIRATUR ROFIQOH,A.Md Keb - - 964,363 - 964,363 51
52 TITIK WAHYU SUSANTI,S.Kep Ners - - 1,155,216 - 1,155,216 52
53 ANTIKA LUPI M,A.Md Keb - - 841,497 - 841,497 53
54 IIS AKTIVASARI,A.Md Keb - - 841,497 - 841,497 54
55 WULIDA ABIRUL FAIZAH,A.Md Keb - - 841,497 - 841,497 55
56 IKA TRISNI FAJARWATI - - 690,746 - 690,746 56
57 MARSINI - - 673,750 - 673,750 57
58 dr.AMALIA FACHRIYAN MAHFUDHAH - - 1,915,620 - 1,915,620 58
59 RINDANG DIAH OKTARANI,S.Farm,Apt 19871013 202012 2 004 III-b 1,229,058 61,453 1,167,605 59 III
JUMLAH 83,724,556 3,286,045 80,438,511
Mengetahui Madiun, Friday, April 30, 2021

Kuasa Pengguna Anggaran Pejabat Penatausahaan Keuangan Pejabat Pelaksana Teknis Kegiatan Bendahara Pengeluaran
dr.SAIFUDIN SUJONO NOVI INDRIA KUSUMA DEWI DWI NINGSIH

NIP.19730102 200312 1 006 NIP. 19710628 199303 1 009 NIP. 19881116 201903 2 003 NIP. 19820302 201001 2 026
BULAN April
KODE REKENING 1.02.1.02.01.10.43.09.5.2.2.37.01
JUMLAH
NO NAMA NIP GOL PAJAK PPH PASAL 21 JUMLAH DITERIMA TANDA TANGAN RUMUS
PENERIMAAN
BANTU
1 2 3 4 5 6 7 8
1 dr.SAIFUDIN 19730102 200312 1 000 IV-b 6,761,536 1,014,230 5,747,306 1 IV

2 MARYAM, S. Kep Ns 19660422 198803 2 011 IV-b 1,727,259 259,089 1,468,170 2 IV
3 drg. AGUS BUDI PRASETYO 19820804 200604 1 012 IV-a 3,194,089 479,113 2,714,976 3 IV
4 MULYONO, ST 19661015 198710 1 001 III-d 1,161,770 58,089 1,103,682 4 III
5 DAWI, S.Sos 19631019 198801 1 002 III-d 1,843,568 92,178 1,751,390 5 III
6 SUPRIYONO,A.Md Kep 19651224 199003 1 011 III-d 1,669,358 83,468 1,585,890 6 III
7 TITIN HARIYANTI, A.Md Keb 19711117 199102 2 001 III-d 1,471,953 73,598 1,398,355 7 III
8 ENDAH TRININGSIH, S ST 19650909 199302 2 003 III-d 1,539,611 76,981 1,462,630 8 III
9 SUJONO,A.Md Kep 19710628 199303 1 009 III-d 2,070,723 103,536 1,967,187 9 III
10 WINARNI,A.Md Kep 19700215 199303 2 005 III-d 1,191,899 59,595 1,132,304 10 III
11 IMAM WAHYUDI 19751218 199503 1 002 III-c 1,554,179 77,709 1,476,470 11 III
12 ISMI PALUPI, A.Md Kep 19770912 200501 2 006 III-c 1,552,005 77,600 1,474,405 12 III
13 SULASMIATI,SST 19730628 199302 2 003 III-b 1,468,600 73,430 1,395,170 13 III
14 SUHARNI, S.Tr. Keb 19740207 200604 2 011 III-a 1,473,264 73,663 1,399,601 14 III
15 SIDIK MURNI AKBAR,A.Md Kep 19851109 200902 1 004 III-b 1,432,099 71,605 1,360,494 15 III
16 DWI NINGSIH, A.Md Kep 19820302 201001 2 026 III-b 1,866,874 93,344 1,773,530 16 III
17 PITRIA ARIYANI, A.Md Kep 19850121 201001 2 023 III-b 1,416,322 70,816 1,345,506 17 III
18 WURI HANDAYANI, AM AK 19820912 201001 2 035 III-b 1,695,715 84,786 1,610,929 18 III
19 HERI BUDWIAJI, A.Md Kep 19851111 201101 1 015 III-a 1,407,998 70,400 1,337,598 19 III
20 SOFYAN,A.Md Farm 19770301 200604 1 004 III-a 1,206,497 60,325 1,146,172 20 III
21 TRI SUNDARI, A.Md, Fis 197802072009022002 II-d 1,124,941 - 1,124,941 21 II
22 FITRI HARWIYANTI, A.Md Gz 19880221 201001 2 014 II-d 1,113,742 - 1,113,742 22 II
23 JIAT PUJANG TRI S, A.Md Kep 19820608 201001 1 022 III-a 1,902,388 95,119 1,807,269 23 III
24 ISNANI WIJIASIH,Amd.Kl 19870623 201001 2 023 III-a 1,537,934 76,897 1,461,037 24 III
25 MAT SANUSI 19780414 200701 1 012 II-d 1,252,552 - 1,252,552 25 II
26 PUJI HARIYANTI, S.Tr. Keb 19830420 201406 2 004 II-d 1,302,117 - 1,302,117 26 II
27 DESI NOVITA SARI,A.md Keb 19891216 201704 2 002 II-c 1,430,820 - 1,430,820 27 II
28 NIAN LUK LUK ATUL F,A.Md Keb 19890411 201704 2001 II-c 1,382,492 - 1,382,492 28 II
29 SITI RODIYAH, A.Md Keb 19820625 201704 2 004 II-c 1,278,514 - 1,278,514 29 II
30 PARTINI SRI W,A.Md Keb 19820306 201704 2 002 II-c 1,228,371 - 1,228,371 30 II
35 HARIYANTI 19840328 200501 2 002 II-b 977,600 - 977,600 35 II

40 ANISA RATNAWATI, A.Md Kep - - 1,296,853 - 1,296,853 40
46 ATIK EKA SRI M - - 813,301 - 813,301 46
47 DHIMAS AWANG Y - - 881,287 - 881,287 47

50 YULI BRASTA ADITYA - - 881,287 - 881,287 50
57 MARSINI - - 677,330 - 677,330 57
59 RINDANG DIAH OKTARANI,S.Farm,Apt 19871013 202012 2 004 III-b 1,232,638 61,632 1,171,006 59 III
JUMLAH 83,724,556 3,287,202 80,437,354
Mengetahui Madiun, Friday, April 30, 2021


NIP.19730102 200312 1 006 NIP. 19710628 199303 1 009 NIP. 19881116 201903 2 003 NIP. 19820302 201001 2 026
BULAN MARET
KODE REKENING 1.02.1.02.01.10.43.09.5.2.2.37.01
JUMLAH
NO NAMA NIP GOL PAJAK PPH PASAL 21 JUMLAH DITERIMA RUMUS
PENERIMAAN
BANTU
1 2 3 4 5 6 7
1 dr.SAIFUDIN 19730102 200312 1 000 IV-b 6,761,536 994,457 5,767,079 IV 6629715

2 MARYAM, S. Kep Ns 19660422 198803 2 011 IV-b 1,727,259 252,979 1,474,280 IV 1686524
3 drg. AGUS BUDI PRASETYO 19820804 200604 1 012 IV-a 3,194,089 466,428 2,727,661 IV 3109523
4 MULYONO, ST 19661015 198710 1 001 III-d 1,158,906 59,465 1,099,441 III 1189305
5 DAWI, S.Sos 19631019 198801 1 002 III-d 1,839,988 89,313 1,750,675 III 1798262
6 SUPRIYONO,A.Md Kep 19651224 199003 1 011 III-d 1,669,358 81,483 1,587,875 III 1629652
7 TITIN HARIYANTI, A.Md Keb 19711117 199102 2 001 III-d 1,471,953 71,942 1,400,011 III 1438834
8 ENDAH TRININGSIH, S ST 19650909 199302 2 003 III-d 1,539,611 81,105 1,458,506 III 1622108
9 SUJONO,A.Md Kep 19710628 199303 1 009 III-d 2,070,723 101,194 1,969,529 III 2023878
10 WINARNI,A.Md Kep 19700215 199303 2 005 III-d 1,191,899 62,248 1,129,651 20,364,708 III 1244961
11 IMAM WAHYUDI 19751218 199503 1 002 III-c 1,554,179 71,920 1,482,259 III 1438398
12 ISMI PALUPI, A.Md Kep 19770912 200501 2 006 III-c 1,552,005 75,642 1,476,363 III 1512836
13 SULASMIATI,SST 19730628 199302 2 003 III-b 1,468,600 73,653 1,394,947 III 1473053
14 SUHARNI, S.Tr. Keb 19740207 200604 2 011 III-a 1,473,264 69,899 1,403,365 III 1397985
15 SIDIK MURNI AKBAR,A.Md Kep 19851109 200902 1 004 III-b 1,432,099 65,925 1,366,174 III 1318490
16 DWI NINGSIH, A.Md Kep 19820302 201001 2 026 III-b 1,864,009 94,093 1,769,916 III 1881868
17 PITRIA ARIYANI, A.Md Kep 19850121 201001 2 023 III-b 1,413,221 70,965 1,342,256 III 1419293
18 WURI HANDAYANI, AM AK 19820912 201001 2 035 III-b 1,695,715 82,700 1,613,015 III 1653991
19 HERI BUDWIAJI, A.Md Kep 19851111 201101 1 015 III-a 1,407,998 68,647 1,339,351 III 1372940
20 SOFYAN,A.Md Farm 19770301 200604 1 004 III-a 1,202,917 58,626 1,144,291 14,331,937 III 1172521
21 TRI SUNDARI, A.Md, Fis 197802072009022002 II-d 1,124,941 - 1,124,941 II 1099544
22 FITRI HARWIYANTI, A.Md Gz 19880221 201001 2 014 II-d 1,110,162 - 1,110,162 II 1081416
23 JIAT PUJANG TRI S, A.Md Kep 19820608 201001 1 022 III-a 1,902,388 94,481 1,807,907 III 1896813
24 ISNANI WIJIASIH,Amd.Kl 19870623 201001 2 023 III-a 1,534,354 74,903 1,459,451 III 1498063
25 MAT SANUSI 19780414 200701 1 012 II-d 1,252,552 - 1,252,552 II 1221786
26 PUJI HARIYANTI, S.Tr. Keb 19830420 201406 2 004 II-d 1,302,117 - 1,302,117 II 1311500
27 DESI NOVITA SARI,A.md Keb 19891216 201704 2 002 II-c 1,430,820 - 1,430,820 II 1236377
28 NIAN LUK LUK ATUL F,A.Md Keb 19890411 201704 2001 II-c 1,382,492 - 1,382,492 II 1269765
29 SITI RODIYAH, A.Md Keb 19820625 201704 2 004 II-c 1,278,514 - 1,278,514 II 1248073
30 PARTINI SRI W,A.Md Keb 19820306 201704 2 002 II-c 1,228,371 - 1,228,371 13,377,327 II 1238646
35 HARIYANTI 19840328 200501 2 002 II-b 974,020 - 974,020 II 947695
40 ANISA RATNAWATI, A.Md Kep - - 1,296,853 - 1,296,853 13,010,910 1263772
46 ATIK EKA SRI M - - 809,721 - 809,721 786319
47 DHIMAS AWANG Y - - 877,707 - 877,707 853095
50 YULI BRASTA ADITYA - - 877,707 - 877,707 10,324,364 853095
57 MARSINI - - 673,750 - 673,750 652765
59 RINDANG DIAH OKTARANI,S.Farm,Apt 19871013 202012 2 004 III-b 1,229,058 59,910 1,169,148 9,093,334 III 1198197
JUMLAH 83,724,558 3,221,978 80,502,580 80,502,580 82,235,505
Mengetahui Madiun,
Friday, April 30, 2021

NIP.19730102 200312 1 006 NIP. 19710628 199303 1 009 NIP. 19881116 201903 2 003 NIP. 19820302 201001 2 026
REKAPITULASI PENERIMAAN JASA PELAYANAN PUSKESMAS KARE
BULAN APRIL TAHUN 2021
NO NAMA NO REK JUMLAH PAJAK JUMLAH YANG

PENERIMAAN DITERIMA
1 dr. SAIFUDIN 6351-01-010534-53-7 6,761,536 1,014,230 5,747,306
2 MARYAM, S. Kep Ns 6351-01-000430-53-1 1,727,259 259,089 1,468,170
3 drg. AGUS BUDI PRASETYO 0045-01-076534-50-6 3,194,089 479,113 2,714,976
4 MULYONO, ST 6351-01-000631-53-5 1,161,770 58,089 1,103,682
5 DAWI, S.Sos 6351-01-001280-53-1 1,843,568 92,178 1,751,390
6 SUPRIYONO,A.Md Kep 6351-01-000243-53-6 1,669,358 83,468 1,585,890
7 TITIN HARIYANTI, A.Md Keb 6351-01-000074-53-9 1,471,953 73,598 1,398,355
8 ENDAH TRININGSIH, S ST 6351-01-005538-53-8 1,539,611 76,981 1,462,630
9 SUJONO,A.Md Kep 6351-01-008804-53-0 2,070,723 103,536 1,967,187
10 WINARNI,A.Md Kep 3508-01-032768-53-4 1,191,899 59,595 1,132,304

20,331,889
11 IMAM WAHYUDI 6351-01-007704-53-3 1,554,179 77,709 1,476,470
12 ISMI PALUPI, A.Md Kep 6351-01-003903-53-3 1,552,005 77,600 1,474,405
13 SULASMIATI,SST 6351-01-005820-53-7 1,468,600 73,430 1,395,170
14 SUHARNI, A.Md Keb 6351-01-004060-53-2 1,473,264 73,663 1,399,601
15 SIDIK MURNI AKBAR,A.Md Kep 3884-01-001166-50-9 1,432,099 71,605 1,360,494
16 DWI NINGSIH, A.Md Kep 6351-01-006560-53-8 1,866,874 93,344 1,773,530
17 PITRIA ARIYANI, A.Md Kep 3876-01-017997-53-7 1,416,322 70,816 1,345,506
18 WURI HANDAYANI, AM AK 3508-01-032767-53-8 1,695,715 84,786 1,610,929
19 HERI BUDWIAJI, A.Md Kep 3880-01-019866-53-7 1,407,998 70,400 1,337,598
20 SOFYAN,A.Md Farm 6351-01-006614-53-1 1,206,497 60,325 1,146,172

14,319,875
21 TRI SUNDARI, A.Md, Fis 3504-01-024239-53-7 1,124,941 0 1,124,941
22 FITRI HARWIYANTI N, A.Md Gz 6351-01-007555-53-6 1,113,742 0 1,113,742
23 JIAT PUJANG TRI S, A.Md Kep 6351-01-008844-53-0 1,902,388 95,119 1,807,269
24 ISNANI WIJIASIH,Amd.Kl 6351-01-004058-53-5 1,537,934 76,897 1,461,037
25 MAT SANUSI 6351-01-003350-53-6 1,252,552 0 1,252,552
26 PUJI HARIYANTI, A.Md Keb 6351-01-003713-53-0 1,302,117 0 1,302,117
27 DESI NOVITA SARI,A.Md Keb 3884-01-021019-53-8 1,430,820 0 1,430,820
28 NIAN LUK LUK ATUL F,A.Md Keb 6351-01-001245-50-7 1,382,492 0 1,382,492
29 SITI RODIYAH, A.Md Keb 0045-01-044001-50-3 1,278,514 0 1,278,514
30 PARTINI SRI WINARSIH,A.Md Keb 6341-01-010869-53-1 1,228,371 0 1,228,371

13,381,855
31 SUTINI ENDARWATI, A.Md Keb 6341-01-003818-53-1 1,320,289 0 1,320,289
32 SUPARNO, A.Md.KeP 3887-01-014986-53-4 1,273,507 0 1,273,507
33 NOVI INDRIA K.D, A.Md.Kep 0045-01-024562-53-7 1,656,253 0 1,656,253
34 ROVI SRI HARTATIK, A.Md.Kep 6351-01-010011-53-9 1,373,684 0 1,373,684
35 HARIYANTI 3508-01-035152-53-8 977,600 0 977,600
36 DONI HERES DWI A, A.Md Kep 6340-01-021338-53-7 1,352,766 0 1,352,766
37 FATKUL JANAH, A.Md Kep 6341-01-006465-53-1 1,262,860 0 1,262,860
38 RINA OKTA FUJIANI, A.Md Kep 6351-01-001909-53-3 1,277,195 0 1,277,195
39 MAULIDA FITRIANI, A.Md Kep 3508-01-002031-53-5 1,230,641 0 1,230,641
40 ANISA RATNAWATI, A.Md Kep 6351-01-003674-53-2 1,296,853 0 1,296,853

13,021,648
41 TONY YUSTANTO, A.Md Kep 6340-01-018639-53-8 1,523,219 0 1,523,219
42 ARIE WIDYA ASTUTI, A.Md Kep 6351-01-008800-53-6 1,296,853 0 1,296,853
43 BINTI NURJANAH,SE 6351-01-004712-53-7 808,142 0 808,142
44 YUYUK SRI MULYANI,SE 6351-01-007113-53-8 751,487 0 751,487
45 NOVI PRAMITA SARI,A.Md Keb 6351-01-005001-53-1 926,479 0 926,479
10,279,734
46 ATIK EKA SRI M 6351-01-000377-53-9 813,301 0 813,301
47 DHIMAS AWANG Y 6341-01-000665-50-7 881,287 0 881,287
48 DHIAH ANDARITA, A.Md Kep 6354-01-008016-53-7 1,219,727 0 1,219,727
49 OKTAVIA MENTARI PUTRI,A.Md Kep 6351-01-007878-53-6 1,177,952 0 1,177,952
50 YULI BRASTA ADITYA 6351-01-005999-53-0 881,287 0 881,287

10,279,734
51 SIRATUR ROFIQOH, A.Md Keb 6342-01-019178-53-3 964,363 0 964,363
52 TITIK WAHYU SUSANTI, S.Kep Ners 6351-01-008805-53-6 1,155,216 0 1,155,216
53 ANTIKA LUPI M, A.Md Keb 6351-01-006119-53-1 841,497 0 841,497
54 IIS AKTIVASARI,A.Md Keb 6351-01-007955-53-2 841,497 841,497

0
55 WULIDA ABIRUL FAIZAH, A.Md Keb 6351-01-005851-53-8 841,497 0 841,497
56 IKA TRISNI FAJARWATI 6341-01-008798-53-2 694,326 0 694,326
57 MARSINI 6351-01-008967-53-2 677,330 0 677,330
58 dr. AMALIA 6351-01-011821-53-9 1,915,620 0 1,915,620
59 RINDANG DIAH OKTARANI,S.Farm,Apt 2167-01-003879-53-3 1,232,638 61,632 1,171,006

9,102,352
TOTAL 83,724,556 3,287,202 80,437,354

80,437,354
Mengetahui Madiun, 06 April 2021

KEPALA PUSKESMAS KARE BENDAHARA PENGELUARAN
dr. SAIFUDIN DWI NINGSIH, A.Md Kep

NIP. 19730102 200312 1 006 NIP. 19820302 201001 2 026
pajak
6,761,536 1,014,230 6,761,536 7015295.9125 1052294.4 5963001.5
1,727,259 259,089 1,727,259 1828332.6449 274249.9 1554082.7
3,194,089 479,113 3,194,089 3559244.0035 533886.6 3025357.4
1,161,770 58,089 1,161,770 1269901.2083 63495.06 1206406.1
1,843,568 92,178 1,843,568 1923594.5861 96179.729 1827414.9
1,669,358 83,468 1,669,358 1766880.7851 88344.039 1678536.7
1,471,953 73,598 1,471,953 1610933.8474 80546.692 1530387.2
1,539,611 76,981 1,539,611 1595372.4566 79768.623 1515603.8
2,070,723 103,536 2,070,723 2116393.4696 105819.67 2010573.8
1,191,899 59,595 1,191,899 1406827.6365 70341.382 1336486.3
1,554,179 77,709 1,554,179 1484013.3213 74200.666 1409812.7
1,552,005 77,600 1,552,005 1474649.4805 73732.474 1400917
1,468,600 73,430 1,468,600 1639876.2661 81993.813 1557882.5
1,473,264 73,663 1,473,264 2238892.6914 111944.63 2126948.1
1,432,099 71,605 1,432,099 1395202.9445 69760.147 1325442.8
1,866,874 93,344 1,866,874 2011027.844 100551.39 1910476.5
1,416,322 70,816 1,416,322 1515707.2831 75785.364 1439921.9
1,416,322 70,816 1,695,715 1662861.6511 83143.083 1579718.6
1,695,715 84,786 1,407,998 1489493.5837 74474.679 1415018.9
1,407,998 70,400 1,206,497 1251766.2954 62588.315 1189178
1,206,497 60,325 1,124,941 1169385.8962 0 1169385.9
0 1,113,742 1153323.0616 0 1153323.1
0 1,902,388 1885543.3578 94277.168 1791266.2
1,902,388 95,119 1,537,934 1599919.527 79995.976 1519923.6
1,537,934 76,897 1,252,552 1290710.7312 0 1290710.7
1,232,638 61,632 1,171,006 1387650.7394 0 1387650.7
43,794,601 3,358,018 45,807,882 1306476.5606 0 1306476.6
1342553.9734 0 1342554
1362600.9891 0 1362601
1311659.4944 0 1311659.5
1362600.9891 0 1362601
1389787.6405 0 1389787.6
1723692.2036 0 1723692.2
1426499.867 0 1426499.9
1008833.0233 0 1008833
1391699.5091 0 1391699.5
1335455.0568 0 1335455.1
1182987.6495 0 1182987.6
1371532.4696 0 1371532.5
1371532.4696 0 1371532.5
1531736.0735 0 1531736.1
1371532.4696 0 1371532.5
894587.88271 0 894587.88
834458.86135 0 834458.86
1039066.516 0 1039066.5
834458.86135 0 834458.86
906613.68698 0 906613.69
1255871.9762 0 1255872
1175559.3945 0 1175559.4
906613.68698 0 906613.69
316,687 948872.984 0 948872.98
1221209.9162 0 1221209.9
948872.984 0 948872.98
948872.984 0 948872.98
948872.984 0 948872.98
#REF! 708187.91648 0 708187.92
690149.21007 0 690149.21
83,724,556 2041356.2871 0 2041356.3
82,378,854 1219380.8045 60969.04 1158411.8
80,437,354
80,437,354 80,437,354 -1,345,702 #REF!
-5,106,173 #REF!
80,437,354
#REF!
#REF!
#REF!
75740133 2500485
-7,984,423 -786,717
PEMERINTAH KABUPATEN MADIUN
Bukti Kas No.
KWITANSI DINAS
Terima Dari : Kepala Puskesmas Kare
Uang sejumlah : # Delapan Puluh Juta Lima Ratus Empat Puluh Tiga Juta Tujuh Ratus Delapan Puluh Sembilan
Rupiah #
Untuk Pembayaran : Jasa Pelayanan Puskesmas Bulan April 2021 dari Dana Belanja Langsung
Kegiatan Peningkatan Penyelenggaraan BLUD Puskesmas Kare Tahun Anggaran 2020, dengan
Daftar Penerimaan terlampir
Kode rekening : 1.02.1.02.01.10.43.09.5.2.2.37.01
Terbilang : Rp 83,724,555.60
Lunas dibayar tgl. Madiun,

Pejabat Pelaksana Teknis Kegiatan, Bendahara Pengeluaran Yang menerima
WURI HANDAYANI ISNANI WIJIASIH ISNANI WIJIASIH

NIP. 19820912 201001 2 035 NIP. 19870623 201001 2 023 NIP. 19870623 201001 2 023
Mengetahui
Kuasa Pengguna Anggaran Pejabat Penatausahaan Keuangan
dr. AMAM SANTOSA M.Mkes DAWI

NIP. 19651019 200212 1 003 NIP. 19631019 199801 1 002
NO NAMA nopember
1 dr. SAIFUDIN 5,747,305 574,731
2 MARYAM, S. Kep Ns 1,468,171 146,817
3 drg. AGUS BUDI PRASETYO 2,714,976 271,498
4 MULYONO, ST 1,100,960 110,096
5 DAWI, S.Sos 1,747,989 174,799
6 SUPRIYONO,A.Md Kep 1,585,890 158,589
7 TITIN HARIYANTI, A.Md Keb 1,398,355 139,836
8 ENDAH TRININGSIH, S ST 1,462,631 146,263
9 SUJONO,A.Md Kep 1,967,186 196,719
10 WINARNI,A.Md Kep 1,132,304 113,230
11 IMAM WAHYUDI 1,476,470 147,647
12 ISMI PALUPI, A.Md Kep 1,474,404 147,440
13 SULASMIATI,Amd Keb 1,395,170 139,517
14 SUHARNI, S.Tr Keb 1,399,601 139,960
15 SIDIK MURNI AKBAR,A.Md Kep 1,360,494 136,049
16 BAGUS DWI ARTANTO, A.Md Kep Err:509 #ERROR!
17 DWI NINGSIH, A.Md Kep 1,770,809 177,081
18 PITRIA ARIYANI, A.Md Kep 1,342,560 134,256
19 WURI HANDAYANI, AM AK 1,610,929 161,093
20 HERI BUDWIAJI, A.Md Kep 1,337,598 133,760
21 SOFYAN,A.Md Farm 1,142,771 114,277
22 TRI SUNDARI, A.Md, Fis 1,124,941 112,494
23 FITRI HARWIYANTI, A.Md Gz 1,110,162 111,016
24 JIAT PUJANG TRI S, A.Md Kep 1,807,269 180,727
25 ISNANI WIJIASIH,Amd.Kl 1,457,636 145,764
26 MAT SANUSI 1,252,552 125,255
27 PUJI HARIYANTI, S.Tr. Keb 1,302,117 130,212
28 DESI NOVITA SARI,A.md Keb 1,430,820 143,082
29 NIAN LUK LUK ATUL F,A.Md Keb 1,382,492 138,249
30 SITI RODIYAH, A.Md Keb 1,278,514 127,851
31 PARTINI SRI W,A.Md Keb 1,228,371 122,837
32 SUTINI ENDARWATI,A.Md Keb 1,320,289 132,029
33 SUPARNO,A.Md.Kep 1,273,507 127,351
34 NOVI INDRIA K.D, A.Md.Kep 1,652,675 165,267
35 ROVI SRI HARTATIK,A.M.d. Kep 1,370,104 137,010
36 HARIYANTI 974,020 97,402
37 DONI HERES DWI A, A.Md Kep 1,352,766 135,277
38 FATKUL JANAH, A.Md Kep 1,262,860 126,286
39 RINA OKTA FUJIANI, A.Md Kep 1,277,195 127,719
40 MAULIDA FITRIANI, A.Md Kep 1,230,641 123,064
41 ANISA RATNAWATI, A.Md Kep 1,296,853 129,685
42 TONY YUSTANTO, A.Md Kep 1,523,219 152,322
43 ARIE WIDYA ASTUTI, A.Md Kep 1,296,853 129,685
44 BINTI NURJANAH,SE 805,278 80,528
45 YUYUK SRI MULYANI,SE 809,721 80,972
46 NOVI PRAMITA SARI,A.Md Keb 926,479 92,648
47 ATIK EKA SRI M 809,721 80,972
48 DHIMAS AWANG Y 877,707 87,771
49 DHIAH ANDARITA,A.Md Kep 1,219,727 121,973
50 ERVAN PRASETYO,A.Md Kep 1,177,952 117,795
51 YULI BRASTA ADITYA 877,707 87,771
52 SIRATUR ROFIQOH,A.Md Keb 964,363 96,436
53 OKTAVIA MENTARI PUTRI,A.Md Kep Err:509 #ERROR!
54 TITIK WAHYU SUSANTI,S.Kep Ners 1,155,216 115,522
55 ANTIKA LUPI M,A.Md Keb 841,497 84,150
56 LUTFIANA DEWI K,S.Gz Err:509 #ERROR!
57 IIS AKTIVASARI,A.Md Keb 841,497 84,150
58 WULIDA ABIRUL FAIZAH,A.Md Keb 841,497 84,150
59 IKA TRISNI FAJARWATI 690,746 69,075
60 MARSINI 673,750 67,375
#ERROR! #ERROR!
LANTAI 2
NO NAMA TOTAL KESEPAKATAN
1 dr.SAIFUDIN #REF! #REF!
2 DAWI, S.Sos 1,747,989 104,879
3 ISNANI WIJIASIH,Amd.Kl 1,457,636 87,458
4 PITRIA ARIYANI, A.Md Kep 1,342,560 80,554
5 NIAN LUK LUK ATUL F,A.Md Keb 1,382,492 82,950
6 BINTI NURJANAH,SE 805,278 48,317
7 YUYUK SRI MULYANI,SE 809,721 48,583
8 DHIMAS AWANG Y 877,707 52,662
9 YULI BRASTA ADITYA 877,707 52,662
10 MARSINI 673,750 40,425
11 NOVI INDRIA K.D, A.Md.Kep 1,652,675 99,160
12 FITRI HARWIYANTI, A.Md Gz 1,110,162 66,610
13 DWI NINGSIH, A.Md Kep 1,770,809 106,249
RAWAT JALAN
1 drg. AGUS BUDI PRASETYO 2,714,976 162,899
2 MULYONO, ST 1,100,960 66,058
3 SUPRIYONO,A.Md Kep 1,585,890 95,153

4 WINARNI,A.Md Kep 1,132,304 67,938
5 IMAM WAHYUDI 1,476,470 88,588
6 ISMI PALUPI, A.Md Kep 1,474,404 88,464
7 WURI HANDAYANI, AM AK 1,610,929 96,656
8 SOFYAN,A.Md Farm 1,142,771 68,566
9 TRI SUNDARI, A.Md, Fis 1,124,941 67,496
10 JIAT PUJANG TRI S, A.Md Kep 1,807,269 108,436
11 SUJONO,A.Md Kep 1,967,186 118,031
12 HARIYANTI 974,020 58,441
13 RINA OKTA FUJIANI, A.Md Kep 1,277,195 76,632
14 ATIK EKA SRI M 809,721 48,583
15 TITIK WAHYU SUSANTI,S.Kep Ners 1,155,216 69,313
16 LUTFIANA DEWI K,S.Gz #ERROR! #ERROR!
17 IKA TRISNI FAJARWATI 690,746 41,445
18 BAGUS DWI ARTANTO, A.Md Kep #ERROR! #ERROR!
RAWAT INAP
1 MARYAM, S. Kep Ns 1,468,171 88,090
2 ROVI SRI HARTATIK,A.M.d. Kep 1,370,104 82,206
3 HERI BUDWIAJI, A.Md Kep 1,337,598 80,256
4 SUPARNO,A.Md.Kep 1,273,507 76,410
5 FATKUL JANAH, A.Md Kep 1,262,860 75,772
6 MAULIDA FITRIANI, A.Md Kep 1,230,641 73,838
7 ANISA RATNAWATI, A.Md Kep 1,296,853 77,811
8 OKTAVIA MENTARI PUTRI,A.Md Kep #ERROR! #ERROR!

9 ARIE WIDYA ASTUTI, A.Md Kep 1,296,853 77,811
RUANG PONED
1 TITIN HARIYANTI, A.Md Keb 1,398,355 83,901
2 ENDAH TRININGSIH, S ST 1,462,631 87,758
3 SULASMIATI,Amd Keb 1,395,170 83,710
4 MAT SANUSI 1,252,552 75,153
5 NOVI PRAMITA SARI,A.Md Keb 926,479 55,589
6 ANTIKA LUPI M,A.Md Keb 841,497 50,490
7 WULIDA ABIRUL FAIZAH,A.Md Keb 841,497 50,490
8 PUJI HARIYANTI, S.Tr. Keb 1,302,117 78,127

PUSTU/POLINDES
1 SUHARNI, S.Tr Keb 1,399,601 83,976
2 SIDIK MURNI AKBAR,A.Md Kep 1,360,494 81,630
3 DESI NOVITA SARI,A.md Keb 1,430,820 85,849
4 SITI RODIYAH, A.Md Keb 1,278,514 76,711
5 PARTINI SRI W,A.Md Keb 1,228,371 73,702
6 SUTINI ENDARWATI,A.Md Keb 1,320,289 79,217
7 DONI HERES DWI A, A.Md Kep 1,352,766 81,166
8 TONY YUSTANTO, A.Md Kep 1,523,219 91,393
9 DHIAH ANDARITA,A.Md Kep 1,219,727 73,184
10 ERVAN PRASETYO,A.Md Kep 1,177,952 70,677
11 SIRATUR ROFIQOH,A.Md Keb 964,363 57,862
12 IIS AKTIVASARI,A.Md Keb 841,497 50,490

Aug-20
DIBULATKAN
#REF!
Aug-20
DIBULATKAN
#ERROR!
Aug-20
DIBULATKAN
#ERROR!
Aug-20
DIBULATKAN
565,218
Aug-20
DIBULATKAN
905,857
#REF!

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DASAR : PERATURAN BUPATI NO.36 TAHUN 2017 TGL.

1. Alokasi Remunerasi maksimal sebesar 60% dari pendapatan fungsional puskesmas

KETETAPAN PUSKESMAS KARE UNTUK POLA REMUNERASI PEJABAT TEKNIS:

2.2 Pejabat Teknis Keuangan 45% #REF!

1. SKALA FAKTOR PENYESUAIAN ASET (FPA) Fpa

2. SKALA FAKTOR PENYESUAIAN INCOME (FPI) Fpi

PEMBAGIAN POS PIMPINAN, PEJABAT TEKNIS & KEUANGAN (KARE)

2. PEJABAT TEKNIS 20% 1,674,491

2. POLI GIGI 6,101,000 1 6,101,000

3. POLI KIA 6,101,000 1 6,101,000

4 POLI KB 6,101,000 1 6,101,000

5 PONED 6,101,000 1 6,101,000

5.5 IIS AKTIVA (PONED) 2.33 0.014 286,279

7 LABORAT 6,101,000 1 6,101,000

8 IMUNISASI 6,101,000 1 6,101,000

10 PUSTU CERMO 6,101,000 1 6,101,000

11 PUSTU RANDUALAS 6,101,000 1 6,101,000

12 PUSTU BOLO 6,101,000 1 6,101,000

13 POLINDES BODAG 6,101,000 1 6,101,000

14 POLINDES KEPEL 6,101,000 1 6,101,000

15 POLINDES KUWIRAN 6,101,000 1 6,101,000

16 POLINDES MORANG 6,101,000 1 6,101,000

JUMLAH 165.28 1.000 20,307,391

B.UNIT PENDUKUNG (20% dari Alokasi Jasa Pelayanan Langsung) 5,274,647

JUMLAH 86.33 1.000 5,274,647

C. PIMPINAN BLUD (3% dari Alokasi Jasa Pelayanan Langsung) 791,197

1.1. Pos Pembinaan (2%)

1.2.1. Pimpinan, Tim Pengelola Keuangan dan

1.2.2. Pemberi Pelayanan (90%) 1.2.2.1. Pemberi Pelayanan Langsung (35%)

1.2.2.2. Seluruh Karyawan (indexing) (65%)

Indeks Jabatan Indeks Kinerja Indeks Pengurang REMUN TIDAK RUMUS

FORMULA REMUNERASI BAGI SELURUH KARYAWAN

1 dr.SAIFUDIN 42 1 41.946 8 3 24 7 4 28 3 4 12 5 4 20 1 5 5 0% 130.946 0.0303 48,978,865

dr. AMAM SANTOSA,M.M Kes DAWI

TIM REMUNERASI PUSKESMAS BALEREJO

FORMULA REMUNERASI BAGI PIMPINAN DAN

1,483,745 2,930,359 941,901 1,405,530 6,761,536

Madiun, Friday, April 30, 2021

1 dr.SAIFUDIN 19730102 200312 1 000 IV-b 6,761,536 1,014,230 5,747,305 1 IV

32 SUPARNO,A.Md.Kep 19850226 201903 1 003 II-c 1,273,507 - 1,273,507 32

35 HARIYANTI 19840328 200501 2 002 II-b 974,020 - 974,020 35 II

37 FATKUL JANAH, A.Md Kep - - 1,262,860 - 1,262,860 37

38 RINA OKTA FUJIANI, A.Md Kep - - 1,277,195 - 1,277,195 38

39 MAULIDA FITRIANI, A.Md Kep - - 1,230,641 - 1,230,641 39

40 ANISA RATNAWATI, A.Md Kep - - 1,296,853 - 1,296,853 40

41 TONY YUSTANTO, A.Md Kep - - 1,523,219 - 1,523,219 41

42 ARIE WIDYA ASTUTI, A.Md Kep - - 1,296,853 - 1,296,853 42

43 BINTI NURJANAH,SE - - 805,278 - 805,278 43

44 YUYUK SRI MULYANI,SE - - 809,721 - 809,721 44

45 NOVI PRAMITA SARI,A.Md Keb - - 926,479 - 926,479 45

46 ATIK EKA SRI M - - 809,721 - 809,721 46

47 DHIMAS AWANG Y - - 877,707 - 877,707 47

48 DHIAH ANDARITA,A.Md Kep - - 1,219,727 - 1,219,727 48

49 OKTAVIA MENTARI PUTRI,A.Md Kep - - 1,177,952 - 1,177,952 49

51 SIRATUR ROFIQOH,A.Md Keb - - 964,363 - 964,363 51

52 TITIK WAHYU SUSANTI,S.Kep Ners - - 1,155,216 - 1,155,216 52

53 ANTIKA LUPI M,A.Md Keb - - 841,497 - 841,497 53

54 IIS AKTIVASARI,A.Md Keb - - 841,497 - 841,497 54

55 WULIDA ABIRUL FAIZAH,A.Md Keb - - 841,497 - 841,497 55

56 IKA TRISNI FAJARWATI - - 690,746 - 690,746 56

57 MARSINI - - 673,750 - 673,750 57

58 dr.AMALIA FACHRIYAN MAHFUDHAH - - 1,915,620 - 1,915,620 58