PEMERINTAH KOTA PALEMBA

DINAS KESEHATAN KOTA PALEM

PUSKESMAS MULTIWAHAN
SURAT TANDA SETOR

STS NO
KODE REKENING :
HARAP DITERIMA UANG SEBESAR
BULAN : FEBRUARI 2022
Dengan rincian penerimaan sebagai berikut :

Jumlah
2-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 294,978-294,996 19 Rp 4,000 Rp 76,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003,627-003.628 2 Rp 15,000 Rp 30,000
b.HB 011.858 1 Rp 10,000 Rp 10,000
c.Glukosa 193.521 1 Rp 5,000 Rp 5,000
d.Protein 193.522 1 Rp 5,000 Rp 5,000
e.cholestrol 019.352-019.353 2 Rp 25,000 Rp 50,000
f.Asam Urat 011.860-011,861 2 Rp 10,000 Rp 20,000
g.KB Depo 011.859 1 Rp 10,000 Rp 10,000
h.Keur 193.523 1 Rp 5,000 Rp 5,000
i.Praktek siswa 6 Rp 26,500 Rp 159,000

Jumlah
3-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 294.997-295.021 25 Rp 4,000 Rp 100,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003.629-003.630 2 Rp 15,000 Rp 30,000
b.HB 011.863-011.865 4 Rp 10,000 Rp 40,000
c.Hematokrit 015.680-015.684 3 Rp 7,500 Rp 22,500
d.Lekosit 193.524-193.530 3 Rp 5,000 Rp 15,000
e.Eritrosit 193.525-193.531 3 Rp 5,000 Rp 15,000
f.Trombosit 015.681-015.685 3 Rp 7,500 Rp 22,500
g.Hitungan Jenis 193.526-193.529 2 Rp 5,000 Rp 10,000
 h.Glukosa 193.536 1 Rp 5,000 Rp 5,000
i..Protein 193.537 1 Rp 5,000 Rp 5,000
j.golda 011.867 1 Rp 10,000 Rp 10,000
k.rhesus 193.539 1 Rp 5,000 Rp 5,000
i.urine lengkap 192.532-192.535 4 Rp 5,000 Rp 20,000
m.Keur 193.539-193,540 2 Rp 5,000 Rp 10,000
n.asam urat 011.867 1 Rp 10,000 Rp 10,000
Jumlah

Jumlah
4-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,022-295,040 19 Rp 4,000 Rp 76,000

2 Pemeriksaan penunjang diagnostic

a.gds 003,631-003,632 2 Rp 15,000 Rp 30,000
b.AU 011,867 1 Rp 10,000 Rp 10,000
c.HB 011,868 1 Rp 10,000 Rp 10,000
d.protein 193,541 1 Rp 5,000 Rp 5,000
e.Glukosa 193.542 1 Rp 5,000 Rp 5,000
f.keur 193,543-193.546 4 Rp 5,000 Rp 20,000
Jumlah

Jumlah
5-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295.041-295.049 9 Rp 4,000 Rp 36,000

2 Pemeriksaan penunjang diagnostic

a.cholestrol 019.354 1 Rp 25,000 Rp 25,000
b.hb 011.870 1 Rp 10,000 Rp 10,000
c.glukosa 193,547 1 Rp 5,000 Rp 5,000
d.protein 193.548 1 Rp 5,000 Rp 5,000
e.gds 003,633 1 Rp 15,000 Rp 15,000
Jumlah

Jumlah
7-Feb-22 Karcis Unit Cost Jumlah Uang

1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295.050-295.080 31 Rp 4,000 Rp 124,000

2 Pemeriksaan penunjang diagnostic

 a.GDS 003.634 1 Rp 15,000 Rp 15,000
b.AU 011.871 1 Rp 10,000 Rp 10,000
Jumlah

Jumlah
8-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,081-295,106 26 Rp 4,000 Rp 104,000

2 Pemeriksaan penunjang diagnostic

a.HB 011,872 1 Rp 10,000 Rp 10,000
b.Gluk 193,549 1 Rp 5,000 Rp 5,000
c.Protein 193.550 1 Rp 5,000 Rp 5,000
d.Golda 011,873 1 Rp 10,000 Rp 10,000
e.Rhesus 193,551 1 Rp 5,000 Rp 5,000
f.HB 011,874 1 Rp 10,000 Rp 10,000
g.HB 011.875 1 Rp 10,000 Rp 10,000
h.HB 011876 1 Rp 10,000 Rp 10,000
i.Gluk 193,552 1 Rp 5,000 Rp 5,000
j.Protein 193,553 1 Rp 5,000 Rp 5,000
Jumlah

Jumlah
9-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,107-295,123 17 Rp 4,000 Rp 68,000

2 Pemeriksaan penunjang diagnostic

a.Choles 019,355 1 Rp 25,000 Rp 25,000
b.AU 011.877 1 Rp 10,000 Rp 10,000
c.Keur 193.554 1 Rp 5,000 Rp 5,000
Jumlah

Jumlah
10-Feb-22 Karcis Unit Cost Jumlah Uang

1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,124-295,152 29 Rp 4,000 Rp 116,000

Jumlah
11-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
 1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,153-295,167 15 Rp 4,000 Rp 60,000

Jumlah
12-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 294,168-295,196 29 Rp 4,000 Rp 116,000

2 Pemeriksaan penunjang diagnostic

a.Choles 019,356 1 Rp 25,000 Rp 25,000
b.GDS 003,635 1 Rp 15,000 Rp 15,000
c.AU 011,878 1 Rp 10,000 Rp 10,000
d.KEUR 193,555-193,557 3 Rp 5,000 Rp 15,000
Jumlah

Jumlah
14-Feb-22 Karcis Unit Cost Jumlah Uang

1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,197-295,227 31 Rp 4,000 Rp 124,000

2 Pemeriksaan penunjang diagnostic

a.Choles 019,357-019,358 2 Rp 25,000 Rp 50,000
b.KEUR 193,558-193,559 2 Rp 5,000 Rp 10,000
Jumlah

Jumlah
15-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,228-295,253 26 Rp 4,000 Rp 104,000

2 Pemeriksaan penunjang diagnostic

a.GDP 003,636 1 Rp 15,000 Rp 15,000
b.AU 011,879-011,880 2 Rp 10,000 Rp 20,000
c.PT 003,637 1 Rp 15,000 Rp 15,000
d.KEUR 193,560-193,562 3 Rp 5,000 Rp 15,000
Jumlah

Jumlah
16-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
 PUSKESMAS MULTIWAHANA 295,254-295,267 14 Rp 4,000 Rp 56,000

2 Pemeriksaan penunjang diagnostic

a.Golda 011,881-011,882 2 Rp 10,000 Rp 20,000
b.Rhesus 193,563-193,564 2 Rp 5,000 Rp 10,000
c.Gds 003,638 1 Rp 15,000 Rp 15,000
d.KEUR 193,565-193,566 2 Rp 5,000 Rp 10,000
Jumlah

Jumlah
17-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,268-295,300 33 Rp 4,000 Rp 132,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003,639-003,640 2 Rp 15,000 Rp 30,000
b.AU 011.883 1 Rp 10,000 Rp 10,000
c.Cholestrol 019,359-019,360 2 Rp 25,000 Rp 50,000
d.ganti perban 193.567 1 Rp 5,000 Rp 5,000
e.KEUR 193.568-193.569 2 Rp 5,000 Rp 10,000
Jumlah

Jumlah
18-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,301-295,324 24 Rp 4,000 Rp 96,000

2 Pemeriksaan penunjang diagnostic

a.HB 011,884 1 Rp 10,000 Rp 10,000
b.Gluk 193,570 1 Rp 5,000 Rp 5,000
c.Protein 193.571 1 Rp 5,000 Rp 5,000
d.KEUR 193.572-193,573 2 Rp 5,000 Rp 10,000
Jumlah

Jumlah
19-Feb-22 Karcis Unit Cost Jumlah Uang

1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,325-295,339 15 Rp 4,000 Rp 60,000

2 Pemeriksaan penunjang diagnostic

a.KEUR 193,574 1 Rp 5,000 Rp 5,000
Jumlah
 Jumlah
21-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,340-295,355 16 Rp 4,000 Rp 64,000

2 Pemeriksaan penunjang diagnostic

a.GDP 003,641-003,642 2 Rp 15,000 Rp 30,000
b.Cholesterol 019,361 1 Rp 25,000 Rp 25,000
c.AU 011,885 1 Rp 10,000 Rp 10,000
d.Buka jahitan 193,575-193-579 5 Rp 5,000 Rp 25,000
e.Golda 011,886 1 Rp 10,000 Rp 10,000
f.Rhesus 193,580 1 Rp 5,000 Rp 5,000
g.KB Depo 011.887 1 Rp 10,000 Rp 10,000
Jumlah

Jumlah
22-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,356-295,375 20 Rp 4,000 Rp 80,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003,643 1 Rp 15,000 Rp 15,000
b.Cholesterol 019,362 1 Rp 25,000 Rp 25,000
c.AU 011,888 1 Rp 10,000 Rp 10,000
d.Golda 011,889 1 Rp 10,000 Rp 10,000
e.Rhesus 193,581 1 Rp 5,000 Rp 5,000
Jumlah

Jumlah
23-Feb-22 Karcis Unit Cost Jumlah Uang

1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,376-295,386 11 Rp 4,000 Rp 44,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003,644 1 Rp 15,000 Rp 15,000
b.Cholesterol 019,363 1 Rp 25,000 Rp 25,000
c.AU 011,890 1 Rp 10,000 Rp 10,000
Jumlah
 Jumlah
24-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,387-295,414 28 Rp 4,000 Rp 112,000

2 Pemeriksaan penunjang diagnostic

a.GDP 003,645 1 Rp 15,000 Rp 15,000
b.HB 011.891 1 Rp 10,000 Rp 10,000
c.Golda 011,892 1 Rp 10,000 Rp 10,000
d.Rhesus 193.582 1 Rp 5,000 Rp 5,000
e.cholestrol 019,364 1 Rp 25,000 Rp 25,000
f.Asam Urat 011,893 1 Rp 10,000 Rp 10,000
Jumlah

Jumlah
25-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,415-295,429 15 Rp 4,000 Rp 60,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003,646-003,647 2 Rp 15,000 Rp 30,000
b.Cholestrol 019,365-019,366 2 Rp 50,000 Rp 50,000
c.AU 011,894-011,895 2 Rp 10,000 Rp 20,000
d.KEUR 193.583 1 Rp 5,000 Rp 5,000
Jumlah

Jumlah
26-Feb-22 Unit Cost Jumlah Uang
Karcis
1 2 3 4 5 6=4*5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,430-295,438 9 Rp 4,000 Rp 36,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,367-019,368 2 Rp 25,000 Rp 50,000
b.AU 011.896 1 Rp 10,000 Rp 10,000
Jumlah

Tersebut Diterima Pada Bulan Februari 2022 Uang Sebesar Rp. 3.334.000,-
Mengetahui,
Pimpinan Puskesmas Multiwahana Bendahara PKM Multiwahana Petugas Karcis Multiwahana
dr, HJ. Dian Hayati Neti Ariani,SKM Euis Darliah,SKM
NIP.197910012006042017 NIP.197210211994032002 NIP.198206072005012008
AH KOTA PALEMBANG
ATAN KOTA PALEMBANG
MAS MULTIWAHANA
T TANDA SETOR

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Rp10,000
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Rp5,000
Rp50,000
Rp20,000
Rp10,000
Rp5,000
Rp159,000
Rp370,000

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Rp40,000
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Rp181,000

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 7

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Rp10,000
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Rp179,000

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Rp25,000
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Rp145,000

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Rp10,000
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 7

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Rp10,000
Rp10,000
Rp5,000
Rp25,000
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Rp187,000

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Rp50,000
Rp20,000
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Multiwahana
 PEMERINTAH KOTA PALEMB
DINAS KESEHATAN KOTA PALE
PUSKESMAS MULTIWAHA
SURAT TANDA SETOR

STS NO
KODE REKENING :
HARAP DITERIMA UANG SEBESAR
BULAN : MARET2022
Dengan rincian penerimaan sebagai berikut :

Jumlah
1-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,439-295453 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,369-019,370 2 Rp 25,000
b.AU 011,897-011,898 2 Rp 10,000
c.KB Depo 011,899 1 Rp 10,000
d.Keur 193,584-193,588 5 Rp 5,000
10 Jumlah

Jumlah
2-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,454-295,477 24 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Keur 193,589-193,590 2 Rp 5,000
Jumlah

Jumlah
4-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
 PUSKESMAS MULTIWAHANA 295,478-295,486 9 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 011,900 1 Rp 10,000
b.Gluk 193,591 1 Rp 5,000
c.Protein 193,592 1 Rp 5,000
3 Jumlah

Jumlah
5-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,487-295,494 8 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,648-003,649 2 Rp 15,000
b.Cholesterol 019,371-019,372 2 Rp 25,000
c.Asam urat 011,901-011,902 2 Rp 10,000
6 Jumlah

Jumlah
7-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,495-295,508 14 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,650 1 Rp 15,000
b.Cholesterol 019,373 1 Rp 25,000
c.Asam urat 011,903 1 Rp 10,000
3 Jumlah

Jumlah
8-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,509-295,535 27 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.KB Depo 011,904 1 Rp 10,000
b.Gds 003,651 1 Rp 15,000
c.Cholesterol 019,374-019,376 3 Rp 25,000
 d.HB 011,905-011,907-908 3 Rp 10,000
e.Gluk 193,593-193,595,597 3 Rp 5,000
f.Protein 193,594-193,596-598 3 Rp 5,000
g.Gdp 003,652 1 Rp 15,000
h.Asam urat 011,906 1 Rp 10,000
i.Golda 011,909 1 Rp 10,000
j.Rhesus 193,599 1 Rp 5,000
18 Jumlah

Jumlah
9-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,536-295,542 7 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,377 1 Rp 25,000
b.Asam urat 011,910 1 Rp 10,000
2 Jumlah

Jumlah
10-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,543-295,568 26 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,653 1 Rp 15,000
b.asam urat 011,911 1 Rp 10,000
2 Jumlah

Jumlah
11-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,569-295,584 16 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.buka jahitan 193,600-193,602 3 Rp 5,000
b.ganti perban 193,603 1 Rp 5,000
c.Keur 193,604-193,605 2 Rp 5,000
6 Jumlah
 12-Mar-22 Jumlah Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,585-295,590 6 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,378 1 Rp 25,000
b.Gds 003,654 1 Rp 15,000
c.Keur 193,606 1 Rp 5,000
d.praktik siswa D.3 047,074-047,079 6 Rp 22,500
9 Jumlah

Jumlah
14-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295.591-295.614 24 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 011.917-011.913 2 Rp 10,000
b.Glukosa 193.607-193.609 2 Rp 5,000
c.protein 193.608 2 Rp 5,000
d.cholestrol 019.379-019.381 3 Rp 25,000
e.GDS 003.655-003.657 3 Rp 15,000
f.Asam Urat 011.914-011.915 2 Rp 10,000
g.Keur 193.611 1 Rp 5,000
15 Jumlah

Jumlah
15-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,615-295,633 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,658 1 Rp 15,000
b.HB 011,916 1 Rp 10,000
c.Gluk 193,612 1 Rp 5,000
d.Protein 019,613 1 Rp 5,000
e.Lepas implant 003,659 1 Rp 15,000
f.Keur 193,614-193,615 2 Rp 5,000
g.BW 011,917 1 Rp 10,000
 8 Jumlah

16-Mar-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,634-295,645 12 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 011,918 1 Rp 10,000
b.Gluk 193,616 1 Rp 5,000
c.Protein 193,617 1 Rp 5,000
d.Asam urat 011,919-011,920 2 Rp 10,000
e.Cholesterol 019,382 1 Rp 25,000
f.Keur 193,618-193,621 4 Rp 5,000
10 Jumlah

Jumlah
17-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,646-295,656 11 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Keur 193,622 1 Rp 5,000
Jumlah

Jumlah
18-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,657-295,669 13 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Golda 011,921 1 Rp 10,000
b.Rhesus 193,623 1 Rp 5,000
c.Keur 193,624-193,626 3 Rp 5,000
5 Jumlah

Jumlah
19-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,670-295,677 8 Rp 4,000
 2 Pemeriksaan penunjang diagnostic
a.Gds 003,660 1 Rp 15,000
b.Cholesterol 019,383 1 Rp 25,000
c.asam urat 011,922 1 Rp 10,000
3 Jumlah

Jumlah
21-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,678-295,690 13 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,661 1 Rp 15,000
b.Cholesterol 019,384 1 Rp 25,000
c.Asam urat 011,923 1 Rp 10,000
d.Keur 193,627 1 Rp 5,000
4 Jumlah

Jumlah
22-Mar-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,691-295,704 14 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.tindik telinga 011,924 1 Rp 10,000
Jumlah

23-Mar-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,705-295,723 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,662-003,663 2 Rp 15,000
b.Cholesterol 019,385-019,387 3 Rp 25,000
c.asam urat 011,925-011,926 2 Rp 10,000
d.jahitan 193,628-193,652 25 Rp 5,000
e.keur 193,653-193,659 7 Rp 5,000
f.Bw 011,927-011,928 2 Rp 10,000

41 Jumlah
 Jumlah
24-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,724-295,745 22 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Kb depo 011,929 1 Rp 10,000
b.HB 011,930 1 Rp 10,000
2 Jumlah

Jumlah
25-Mar-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,746-295,764 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.bersih luka asing 013,021 1 Rp 30,000
b.keur 193,660 1 Rp 5,000
2 Jumlah

Jumlah
26-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,765-295,771 7 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.asam urat 011,931 1 Rp 10,000
b.keur 193,661 1 Rp 5,000
2 Jumlah

Jumlah
28-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,772-295,790 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,664 1 Rp 15,000
b.Cholesterol 019,388-019,389 2 Rp 25,000
c.asam urat 011,932-019,934 2 Rp 10,000
d.kb depo 019,933 1 Rp 10,000
6 Jumlah
 29-Mar-22 Jumlah Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,791-295,818 28 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.buka jahitan 193,662-193,665 4 Rp 5,000
b.cabut gigi susu 193,666-193,676 11 Rp 5,000
c.cabut gigi permanen 011,935 1 Rp 10,000
d.cabut gigi tetap 011,936-011,938 3 Rp 10,000
e.keur 193,677-193,678 2 Rp 5,000
21 Jumlah

Jumlah
30-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,819-295,830 12 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.cholesterol 019,390 1 Rp 25,000
b.asam urat 011,939 1 Rp 10,000
c.keur 193,679-193,680 2 Rp 5,000
4 Jumlah

Jumlah
31-Mar-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,831-295,864 34 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.hb 011,940 1 Rp 10,000
b.gluk 193,681 1 Rp 5,000
c.protein 193,682 1 Rp 5,000
d.golda 011,941 1 Rp 10,000
e.rhesus 193,683 1 Rp 5,000
f.keur 193,684-193,685 2 Rp 5,000
g.bw 011,942 1 Rp 10,000
8 Jumlah
MERINTAH KOTA PALEMBANG
KESEHATAN KOTA PALEMBANG
USKESMAS MULTIWAHANA
SURAT TANDA SETOR

Jumlah Uang

6=4*5 7

Rp 60,000 Rp60,000

Rp 50,000 Rp50,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 25,000 Rp25,000
Jumlah Rp165,000

Jumlah Uang

6=4*5 7

Rp 96,000 Rp96,000

Rp 10,000 Rp10,000
Jumlah Rp106,000

Jumlah Uang

6=4*5 7
 Rp 36,000 Rp36,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Jumlah Rp56,000

Jumlah Uang

6=4*5 7

Rp 32,000 Rp32,000

Rp 30,000 Rp30,000
Rp 50,000 Rp50,000
Rp 20,000 Rp20,000
Jumlah Rp132,000

Jumlah Uang

6=4*5 7

Rp 56,000 Rp56,000

Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Jumlah Rp106,000

Jumlah Uang

6=4*5 7

Rp 108,000 Rp108,000

Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 75,000 Rp75,000
 Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Jumlah Rp308,000

Jumlah Uang

6=4*5 7

Rp 28,000 Rp28,000

Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Jumlah Rp63,000

Jumlah Uang

6=4*5 7

Rp 104,000 Rp104,000

Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Jumlah Rp129,000

Jumlah Uang

6=4*5 7

Rp 64,000 Rp64,000

Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Jumlah Rp94,000
Jumlah Uang

6=4*5 7

Rp 24,000 Rp24,000

Rp 25,000 Rp25,000
Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Rp 135,000 Rp135,000
Jumlah Rp204,000

Jumlah Uang

6=4*5 7

Rp 96,000 Rp96,000

Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 75,000 Rp75,000
Rp 45,000 Rp45,000
Rp 20,000 Rp20,000
Rp 5,000 Rp5,000
Jumlah Rp281,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp76,000

Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp146,000

Jumlah Uang

6=4*5 7

Rp 48,000 Rp48,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 20,000 Rp20,000
Rp 25,000 Rp25,000
Rp 20,000 Rp20,000
Jumlah Rp133,000

Jumlah Uang

6=4*5 7

Rp 44,000 Rp44,000

Rp 5,000 Rp5,000
Jumlah Rp49,000

Jumlah Uang

6=4*5 7

Rp 52,000 Rp52,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Jumlah Rp82,000

Jumlah Uang

6=4*5 7

Rp 32,000 Rp32,000
 Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Jumlah Rp82,000

Jumlah Uang

6=4*5 7

Rp 52,000 Rp52,000

Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Jumlah Rp107,000

Jumlah Uang

6=4*5 7

Rp 56,000 Rp56,000

Rp 10,000 Rp10,000
Jumlah Rp66,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp76,000

Rp 30,000 Rp30,000
Rp 75,000 Rp75,000
Rp 20,000 Rp20,000
Rp 125,000 Rp125,000
Rp 35,000 Rp35,000
Rp 20,000 Rp20,000

Jumlah Rp381,000
Jumlah Uang

6=4*5 7

Rp 88,000 Rp88,000

Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp108,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp76,000

Rp 30,000 Rp30,000
Rp 5,000 Rp5,000
Jumlah Rp111,000

Jumlah Uang

6=4*5 7

Rp 28,000 Rp28,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Jumlah Rp43,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp76,000

Rp 15,000 Rp15,000
Rp 50,000 Rp50,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Jumlah Rp171,000
Jumlah Uang

6=4*5 7

Rp 112,000 Rp112,000

Rp 20,000 Rp20,000
Rp 55,000 Rp55,000
Rp 10,000 Rp10,000
Rp 30,000 Rp30,000
Rp 10,000 Rp10,000
Jumlah Rp237,000

Jumlah Uang

6=4*5 7

Rp 48,000 Rp48,000

Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp93,000

Jumlah Uang

6=4*5 7

Rp 136,000 Rp136,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp191,000
 PEMERINTAH KOTA PAL
DINAS KESEHATAN KOTA P
PUSKESMAS MULTIW
SURAT TANDA SET

STS NO
KODE REKENING :
HARAP DITERIMA UANG SEBESAR
BULAN : APRIL 2022
Dengan rincian penerimaan sebagai berikut :

Jumlah
1-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,865-295,877 13 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,391 1 Rp 25,000
b.Keur 193,686-193,689 4 Rp 5,000
5 Jumlah

2-Apr-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,878-295,885 8 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,665 1 Rp 15,000
b.Keur 193,690 1 Rp 5,000
2 Jumlah

Jumlah
4-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,886-295,899 14 Rp 4,000

2 Pemeriksaan penunjang diagnostic

 a.Golda 011,943 1 Rp 10,000
b.Rhesus 193,691 1 Rp 5,000
c.Keur 193,692-193,695 4 Rp 5,000
d.BW 011,944 1 Rp 10,000
7 Jumlah

Jumlah
5-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,900-295,910 11 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Hb 011,945 1 Rp 10,000
b.Gluk 193,696 1 Rp 5,000
c.Protein 193,697 1 Rp 5,000
d.keur 193,698-193,700 3 Rp 5,000
6 Jumlah

Jumlah
6-Apr-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,911-295,928 18 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Choleterol 019,392-019,393 2 Rp 25,000
b.Gds 003,666 1 Rp 15,000
c.Asam urat 011,946 1 Rp 10,000
d.Keur 193,701-193,705 5 Rp 5,000
9 Jumlah

Jumlah
7-Apr-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,929-295,946 18 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Choleterol 019,394-019,395 2 Rp 25,000
b.Asam urat 011,947 1 Rp 10,000
c.Keur 193,706 1 Rp 5,000
4 Jumlah
 Jumlah
8-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,947-295,961 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Pemeriksaan IVA 019,396 1 Rp 25,000
b.Golda 011,948 1 Rp 10,000
c.Rhesus 193,707 1 Rp 5,000
d.Kb depo 011,949 1 Rp 10,000
e.Keur 193,708-193,711 4 Rp 5,000
8 Jumlah

Jumlah
9-Apr-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,962-295,976 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Jahitan 193,712-193,718 7 Rp 5,000
b.Ganti perban 193,719 1 Rp 5,000
c.Asam urat 011,950 1 Rp 10,000
d.HB 011,951 1 Rp 10,000
e.Hematokrit 015,686 1 Rp 7,500
f.Jumlah lekosit 193,720 1 Rp 5,000
g.Jumlah eritrosit 193,721 1 Rp 5,000
h.Jumlah trombosit 015,687 1 Rp 7,500
i.Hitung jenis 193,722 1 Rp 5,000
j.Widal 003,667 1 Rp 15,000
k.Keur 193,723-193,724 2 Rp 5,000
18 Jumlah

Jumlah
11-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,977-295,993 17 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,668 1 Rp 15,000
b.Keur 193,725-193,726 2 Rp 10,000
3 Jumlah
 Jumlah
12-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 295,994-296,000 7 Rp 4,000
PUSKESMAS MULTIWAHANA 311,001-311,018 18 Rp 4,000
25
2 Pemeriksaan penunjang diagnostic
a.Asam urat 011,952 1 Rp 10,000
b.Golda 011,953 1 Rp 10,000
c.Rhesus 193,727 1 Rp 5,000
d.Ganti perban 193,728 1 Rp 5,000
e.Keur 193,729-193,731 3 Rp 5,000
7 Jumlah

Jumlah
13-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,019-311,033 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Pt 003,669 1 Rp 15,000
b.Keur 193,732-193,735 4 Rp 5,000
5 Jumlah

Jumlah
14-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,034-311,065 32 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Hb 011,954-011,955 2 Rp 10,000
b.Gluk 193,736-193,737 2 Rp 5,000
c.Protein 193,738-193,739 2 Rp 5,000
d.PH 193,740-193,741 2 Rp 5,000
e.Kb depo 011,956 1 Rp 10,000
f.Golda 011,957 1 Rp 10,000
g.Rhesus 193,742 1 Rp 5,000
h.Keur 193,743-193,745 3 Rp 5,000
14 Jumlah

Jumlah
16-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,066-311,077 12 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Golda 011,958 1 Rp 10,000
b.Rhesus 193,746 1 Rp 5,000
c.Tindik telinga 011,959 1 Rp 10,000
d.Keur 193,747 1 Rp 5,000
4 Jumlah

Jumlah
18-Apr-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,078-311,095 18 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Tcm 193,748-193,749 2 Rp 5,000
b.Bersih telinga 013,023 1 Rp 30,000
c.Gdp 003,670 1 Rp 15,000
d.Bw 011,960 1 Rp 10,000
5 Jumlah

19-Apr-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,096-311,109 14 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Kb depo 011,961 1 Rp 10,000
b.Hb 011,962 1 Rp 10,000
c.PH 193,750 1 Rp 5,000
d.Gluk 193,751 1 Rp 5,000
e.Protein 193,752 1 Rp 5,000
f.Golda 011,963 1 Rp 10,000
g.Rhesus 193,753 1 Rp 5,000
h.Gds 003,671 1 Rp 15,000
8 Jumlah

Jumlah
20-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
 PUSKESMAS MULTIWAHANA 311,110-311,115 6 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,672 1 Rp 15,000
b.Cholesterol 019,397-019,398 2 Rp 25,000
c.Asam urat 011,964 1 Rp 10,000
d.Keur 193,754-193,755 2 Rp 5,000
6 Jumlah

Jumlah
21-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,116-311,139 24 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,673-003,674 2 Rp 15,000
b.Cholesterol 019,399 1 Rp 25,000
c.Asam urat 011,965 1 Rp 10,000
4 Jumlah

Jumlah
22-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,140-311,152 13 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Widal 003,675 1 Rp 15,000
b.Hb 011,966-011,967 2 Rp 10,000
c.Hematokrit 015,688 1 Rp 7,500
d.Jumlah lekosit 193,756 1 Rp 5,000
e.Jumlah eritrosit 193,757 1 Rp 5,000
f.jumlah trombosit 015,689 1 Rp 7,500
g.Gds 003,676 1 Rp 15,000
h.Cholesterol 019,400 1 Rp 25,000
i.Asam urat 011,968 1 Rp 10,000
j.Lepas implant 003,677 1 Rp 15,000
k.Gluk 193,758 1 Rp 5,000
l.Protein 193,759 1 Rp 5,000
m.Golda 011,969 1 Rp 10,000
n.Rhesus 193,760 1 Rp 5,000
o.Keur 193,761 1 Rp 15,000
16 Jumlah
 Jumlah
23-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,153-311,162 10 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Keur 193,762 1 Rp 5,000
Jumlah

Jumlah
25-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,163-311,173 11 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Asam urat 011,970 1 Rp 10,000
b.Kb depo 011,971 1 Rp 10,000
c.Keur 193,763-193,764 2 Rp 5,000
d.Bw 011,972 1 Rp 10,000
5 Jumlah

26-Apr-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,174-311,192 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,678 1 Rp 15,000
b.Cholesterol 019,401 1 Rp 25,000
c.Bersih telinga 013,024 1 Rp 30,000
d.HB 011,973 1 Rp 10,000
e.Gluk 193,765 1 Rp 5,000
f.Protein 193,766 1 Rp 5,000
g.PH 193,767 1 Rp 5,000
h.Golda 011,974 1 Rp 10,000
i.Rhesus 193,768 1 Rp 5,000
j.Keur 193,769 1 Rp 5,000
k.Bw 011,975 1 Rp 10,000
11 Jumlah

Jumlah
27-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,193-311,203 11 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,402-019,404 3 Rp 25,000
b.Gds 003,679 1 Rp 15,000
c.Asam urat 011,976 1 Rp 10,000
5 Jumlah

Jumlah
28-Apr-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,204-311,234 31 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Bersih luka 013,025 1 Rp 30,000
b.Jahitan 193,770-193,772 3 Rp 5,000
c.HB 011,977 1 Rp 10,000
d.Hematokrit 015,690 1 Rp 7,500
e.Jumlah lekosit 193,773 1 Rp 5,000
f.Jumlah eritrosit 193,774 1 Rp 5,000
g.Jumlah trombosit 015,691 1 Rp 7,500
h.Hitung jenis 193,775 1 Rp 5,000
i.Golda 011,978 1 Rp 10,000
j.Rhesus 193,776 1 Rp 5,000
k.Keur 193,777-193,778 2 Rp 5,000
14 Jumlah
EMERINTAH KOTA PALEMBANG
AS KESEHATAN KOTA PALEMBANG
PUSKESMAS MULTIWAHANA
SURAT TANDA SETOR

Jumlah Uang

6=4*5 7

Rp 52,000 Rp52,000

Rp 25,000 Rp25,000
Rp 20,000 Rp20,000
Jumlah Rp97,000

Jumlah Uang

6=4*5 7

Rp 32,000 Rp32,000

Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Jumlah Rp52,000

Jumlah Uang

6=4*5 7

Rp 56,000 Rp56,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Jumlah Rp101,000

Jumlah Uang

6=4*5 7

Rp 44,000 Rp44,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Jumlah Rp79,000

Jumlah Uang

6=4*5 7

Rp 72,000 Rp72,000

Rp 50,000 Rp50,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 25,000 Rp25,000
Jumlah Rp172,000

Jumlah Uang

6=4*5 7

Rp 72,000 Rp72,000

Rp 50,000 Rp50,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Jumlah Rp137,000
Jumlah Uang

6=4*5 7

Rp 60,000 Rp60,000

Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 20,000 Rp20,000
Jumlah Rp130,000

Jumlah Uang

6=4*5 7

Rp 60,000 Rp60,000

Rp 35,000 Rp35,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Jumlah Rp175,000

Jumlah Uang

6=4*5 7

Rp 68,000 Rp68,000

Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Jumlah Rp93,000
Jumlah Uang

6=4*5 7

Rp 28,000 Rp28,000
Rp 72,000 Rp72,000

Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Jumlah Rp145,000

Jumlah Uang

6=4*5 7

Rp 60,000 Rp60,000

Rp 15,000 Rp15,000
Rp 20,000 Rp20,000
Jumlah Rp95,000

Jumlah Uang

6=4*5 7

Rp 128,000 Rp128,000

Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Jumlah Rp218,000

Jumlah Uang
 6=4*5 7

Rp 48,000 Rp48,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Jumlah Rp78,000

Jumlah Uang

6=4*5 7

Rp 72,000 Rp72,000

Rp 10,000 Rp10,000
Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Jumlah Rp137,000

Jumlah Uang

6=4*5 7

Rp 56,000 Rp56,000

Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Jumlah Rp121,000

Jumlah Uang

6=4*5 7
Rp 24,000 Rp24,000

Rp 15,000 Rp15,000
Rp 50,000 Rp50,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp109,000

Jumlah Uang

6=4*5 7

Rp 96,000 Rp96,000

Rp 30,000 Rp30,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Jumlah Rp161,000

Jumlah Uang

6=4*5 7

Rp 52,000 Rp52,000

Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 7,500 Rp7,500
Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Jumlah Rp207,000
Jumlah Uang

6=4*5 7

Rp 40,000 Rp40,000

Rp 5,000 Rp5,000
Jumlah Rp45,000

Jumlah Uang

6=4*5 7

Rp 44,000 Rp44,000

Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp84,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp76,000

Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 30,000 Rp30,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Jumlah Rp201,000

Jumlah Uang
 6=4*5 7

Rp 44,000 Rp44,000

Rp 75,000 Rp75,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Jumlah Rp144,000

Jumlah Uang

6=4*5 7

Rp 124,000 Rp124,000

Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Jumlah Rp234,000
 PEMERINTAH KOTA P
DINAS KESEHATAN KOT
PUSKESMAS MULT
SURAT TANDA

STS NO
KODE REKENING :
HARAP DITERIMA UANG SEBESAR
BULAN : MEI 2022
Dengan rincian penerimaan sebagai berikut :

Jumlah
9-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,235-311,283 49 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Asam urat 011,979-011,981 3 Rp 10,000
b.Cholesterol 019,405-019,407 3 Rp 25,000
c.Gds 003,680-003,683 4 Rp 15,000
d.Golda 011,982-011,985 4 Rp 10,000
e.Rhesus 193,779-193,782 4 Rp 5,000
f.HB 011,986-011,987 2 Rp 10,000
g.PH 193,783-193,784 2 Rp 5,000
h.Gluk 193,785-193,786 2 Rp 5,000
i.Protein 193,787-193,788 2 Rp 5,000
j.Keur 193,789-193,795 7 Rp 5,000
k.BW 011,988 1 Rp 10,000
34 Jumlah

Jumlah
10-May-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,284-311,314 31 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 011,989-011,992 4 Rp 10,000
b.PH 193,796-193,798 3 Rp 5,000
 c.Gluk 193,799-193,801 3 Rp 5,000
d.Protein 193,802-193,804 3 Rp 5,000
e.Jahitan 193,805,193,807 3 Rp 5,000
f.Gds 003,684-003,685 2 Rp 15,000
g.Cholesterol 019,408-019,409 2 Rp 25,000
h.Asam urat 011,993,011,994 2 Rp 10,000
i.Golda 011,995 1 Rp 10,000
j.Rhesus 193,808 1 Rp 5,000
k.Keur 193,809-193,816 8 Rp 5,000
k.BW 011,996-011,997 2 Rp 10,000
34 Jumlah

Jumlah
11-May-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,315-311,333 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,410-019,414 5 Rp 25,000
b.Gds 003,686-003,687 2 Rp 15,000
c.Asam urat 011,998 1 Rp 10,000
d.HB 011,999-012,001 3 Rp 10,000
e.Gluk 193,817-193,819 3 Rp 5,000
f.PH 193,820-193,822 3 Rp 5,000
g.Protein 193,823-193,825 3 Rp 5,000
h.KB Depo 012,002 1 Rp 10,000
i.Trombosit 015,692 1 Rp 7,500
j.Golda 012,003-012,004 2 Rp 10,000
k.Rhesus 193,826-193,827 2 Rp 5,000
k.Keur 193,828-193,829 2 Rp 5,000
28 Jumlah

Jumlah
12-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,334-311,361 28 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,688 1 Rp 15,000
b.Cholesterol 019,415 1 Rp 25,000
c.Asam urat 012,005 1 Rp 10,000
d.Keur 193,830-193,834 5 Rp 5,000
e.Bw 012,006-012,007 2 Rp 10,000
 10 Jumlah

13-May-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,362-311,381 20 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,008-012,010 3 Rp 10,000
b.Hematokrit 015,693-015,694 2 Rp 7,500
c.Jumlah lekosit 193,835-193,836 2 Rp 5,000
d.Jumlah eritrosit 193,837-193,838 2 Rp 5,000
e.jumlah trombosit 015,695-015,696 2 Rp 7,500
f.Hitung jenis 193,839-193,840 2 Rp 5,000
g.PH 193,841-193,843 3 Rp 5,000
h.Gluk 193,844-193,846 3 Rp 5,000
i.Protein 193,847-193,849 3 Rp 5,000
j.Urine lengkap 193,850-193,857 8 Rp 5,000
k.Gds 003,689-003,691 3 Rp 15,000
l.Asam urat 012,011-012,012 2 Rp 10,000
m.Cholesterol 019,416 1 Rp 25,000
n.Keur 193,858-193,861 4 Rp 5,000
o.BW 012,013 1 Rp 10,000
41 Jumlah

Jumlah
14-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,382-311,407 26 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,417-019,419 3 Rp 25,000
b.Gdp 003,692 1 Rp 15,000
c.Ganti perban 193,862 1 Rp 5,000
d.Gds 003,693-003,694 2 Rp 15,000
e.HB 012,014 1 Rp 10,000
f.PH 193,863 1 Rp 5,000
g.Gluk 193,864 1 Rp 5,000
h.Protein 193,865 1 Rp 5,000
i.Asam urat 012,015 1 Rp 10,000
j.Keur 193,866-193,867 2 Rp 5,000
k.BW 012,016 1 Rp 10,000
15 Jumlah
 17-May-22 Jumlah Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,408-311,435 28 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,695-003,697 3 Rp 15,000
b.Cholesterol 019,420-019,422 3 Rp 25,000
c.Asam urat 012,017-012,019 3 Rp 10,000
d.HB 012,020-012,021 2 Rp 10,000
e.PH 193,868-193,869 2 Rp 5,000
f.Gluk 193,870-193,871 2 Rp 5,000
g.Protein 193,872-193,873 2 Rp 5,000
h.Golda 012,022 1 Rp 10,000
i.Rhesus 193,874 1 Rp 5,000
j.Keur 193,875-193,881 7 Rp 5,000
k.BW 012,023 1 Rp 10,000
27 Jumlah

Jumlah
18-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,436-311,467 32 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,698 1 Rp 15,000
b.Golda 012,024-012,026 3 Rp 10,000
c.Rhesus 193,882-193,884 3 Rp 5,000
d.Asam urat 012,027-012,028 2 Rp 10,000
e.HB 012,029 1 Rp 10,000
f.PH 193,885 1 Rp 5,000
g.Gluk 193,886 1 Rp 5,000
h.Protein 193,887 1 Rp 5,000
i.Bersih luka asing 013,026 1 Rp 30,000
j.Gds 003,699-003,700 2 Rp 15,000
k.Cholesterol 019,423-019,424 2 Rp 25,000
l.Kb depo 012,030 1 Rp 10,000
m.Keur 193,888-193,893 6 Rp 5,000
n.BW 012,031 1 Rp 10,000
26 Jumlah
 Jumlah
19-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,468-311,503 36 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,032-012,034 3 Rp 10,000
b.Hematokrit 015,697-015,698 2 Rp 7,500
c.Jumlah lekosit 193,894-193,895 2 Rp 5,000
d.Jumlah eritrosit 193,896-193,897 2 Rp 5,000
e.jumlah trombosit 015,699-015,700 2 Rp 7,500
f.Hitung jenis 193,898-193,899 2 Rp 5,000
g.Gdp 003,701 1 Rp 15,000
h.PH 193,900-193,901 2 Rp 5,000
i.Gluk 193,902-193,903 2 Rp 5,000
j.Protein 193,904-193,905 2 Rp 5,000
k.Golda 012,035-012,036 2 Rp 10,000
l.Rhesus 193,906-193,907 2 Rp 5,000
m.Bersih luka asing 013,027 1 Rp 30,000
n.Tampal sementara 015,701-015,721 21 Rp 7,500
o.Cabut susu 193,908-193,926 19 Rp 5,000
p.Cabut tetap 012,037-012,045 9 Rp 10,000
q.Keur 193,927-193,928 2 Rp 5,000
76 Jumlah

Jumlah
20-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,504-311,521 18 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Choleterol 019,425 1 Rp 25,000
b.Kb depo 012,046 1 Rp 10,000
c.Keur 193,929-193,930 2 Rp 5,000
4 Jumlah

Jumlah
21-May-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,522-311,537 16 Rp 4,000

2 Pemeriksaan penunjang diagnostic

 a.Hb 012,047 1 Rp 10,000
b.PH 193,931 1 Rp 5,000
c.Gluk 193,932 1 Rp 5,000
d.Protein 193,933 1 Rp 5,000
e.Gds 003,702 1 Rp 15,000
f.Keur 193,934 1 Rp 5,000
6 Jumlah

23-May-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,538-311,564 27 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,426 1 Rp 25,000
b.Asam urat 012,048-012,049 2 Rp 10,000
c.PT ( tes kekehamilan ) 003,703 1 Rp 15,000
d.Gds 003,704 1 Rp 15,000
e.Keur 193,935 1 Rp 5,000
6 Jumlah

Jumlah
24-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,565-311,585 21 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,050 1 Rp 10,000
b.Hematokrit 015,722 1 Rp 7,500
c.Jumlah lekosit 193,936 1 Rp 5,000
d.Jumlah eritrosit 193,937 1 Rp 5,000
e.Jumlah trombosit 015,723 1 Rp 7,500
f.Hitung jenis 193,938 1 Rp 5,000
g.GDS 003,705-003,706 2 Rp 15,000
h.Cholesterol 019,427 1 Rp 25,000
i.Asam urat 012,051 1 Rp 10,000
j.Urine lengkap 193,939-193,942 4 Rp 5,000
k.Golda 012,052 1 Rp 10,000
l.Rhesus 193,943 1 Rp 5,000
m.Keur 193,944-193,947 4 Rp 5,000
20 Jumlah
 Jumlah
25-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,586-311,619 34 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,053-012.056 2 Rp 10,000
b.Hematokrit 015,724 1 Rp 7,500
c.Jumlah lekosit 193,948 1 Rp 5,000
d.Jumlah eritrosit 193,949 1 Rp 5,000
e.Jumlah trombosit 015,725 1 Rp 7,500
f.Hitung jenis 193,950 1 Rp 5,000
g.GDS 003,707 1 Rp 15,000
h.Cholesterol 019,428 1 Rp 25,000
i.Asam urat 012,054-012.055 2 Rp 10,000
j.Urine 193,952-193.954 3 Rp 5,000
k.Golda 012,057 1 Rp 10,000
l.Rhesus 193,951 1 Rp 5,000
m.Keur 193,955 1 Rp 5,000
51 Jumlah

Jumlah
27-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,620-311,640 21 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,429-019,430 2 Rp 25,000
b.Asam urat 012,058 1 Rp 10,000
c.GDS 003,708 1 Rp 15,000
d.HB 012,059 1 Rp 10,000
e.Keur 193,956-193,958 3 Rp 5,000
f.Cabut tetap 012,060-012,068 9 Rp 10,000
g.Tampal sementara 015,726-015,738 13 Rp 7,500
h.Cabut susu 193,959-193,961 3 Rp 5,000
i.Tampal tetap 004,850-004,852 3 Rp 100,000
36 Jumlah

Jumlah
28-May-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,641-311,657 17 Rp 4,000
 2 Pemeriksaan penunjang diagnostic
a.GDS 003,709 1 Rp 15,000
b.Kb depo 012,069 1 Rp 10,000
c.Keur 193,962-193,963 2 Rp 5,000
4 Jumlah

30-May-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,658-311,674 17 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,070 1 Rp 10,000
b.GDS 003,710-003,711 2 Rp 15,000
c.Cholesterol 019,431 1 Rp 25,000
d.Asam urat 012,071 1 Rp 10,000
e.Sunat bayi 012,072 1 Rp 10,000
f.Keur 193,964-193,966 3 Rp 5,000
g.Cabut premanen 012,073-012,074 2 Rp 10,000
h.Cabut susu 193,967-193,970 4 Rp 5,000
i.Tampal sementara 015,739-015,744 6 Rp 7,500
j.Tampal tetap GIC/ART 003,712-003,714 3 Rp 15,000
41 Jumlah

Jumlah
31-May-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,675-311,689 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.GDS 003,715 1 Rp 15,000
b.Cholesterol 019,432 1 Rp 25,000
c.Asam urat 012,075 1 Rp 10,000
d.TCM 193,971 1 Rp 5,000
4 Jumlah
EMERINTAH KOTA PALEMBANG
AS KESEHATAN KOTA PALEMBANG
PUSKESMAS MULTIWAHANA
SURAT TANDA SETOR

Jumlah Uang

6=4*5 7

Rp 196,000 Rp196,000

Rp 30,000 Rp30,000
Rp 75,000 Rp75,000
Rp 60,000 Rp60,000
Rp 40,000 Rp40,000
Rp 20,000 Rp20,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 35,000 Rp35,000
Rp 10,000 Rp10,000
Jumlah Rp320,000

Jumlah Uang

6=4*5 7

Rp 124,000 Rp124,000

Rp 40,000 Rp40,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 30,000 Rp30,000
Rp 50,000 Rp50,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 40,000 Rp40,000
Rp 20,000 Rp20,000
Jumlah Rp275,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp76,000

Rp 125,000 Rp125,000
Rp 30,000 Rp30,000
Rp 10,000 Rp10,000
Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 7,500 Rp7,500
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp297,500

Jumlah Uang

6=4*5 7

Rp 112,000 Rp112,000

Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 25,000 Rp25,000
Rp 20,000 Rp20,000
Jumlah Rp95,000

Jumlah Uang

6=4*5 7

Rp 80,000 Rp80,000

Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 40,000 Rp40,000
Rp 45,000 Rp45,000
Rp 20,000 Rp20,000
Rp 25,000 Rp25,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Jumlah Rp295,000

Jumlah Uang

6=4*5 7

Rp 104,000 Rp104,000

Rp 75,000 Rp75,000
Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Rp 30,000 Rp30,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp180,000
Jumlah Uang

6=4*5 7

Rp 112,000 Rp112,000

Rp 45,000 Rp45,000
Rp 75,000 Rp75,000
Rp 30,000 Rp30,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 35,000 Rp35,000
Rp 10,000 Rp10,000
Jumlah Rp260,000

Jumlah Uang

6=4*5 7

Rp 128,000 Rp128,000

Rp 15,000 Rp15,000
Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 30,000 Rp30,000
Rp 30,000 Rp30,000
Rp 50,000 Rp50,000
Rp 10,000 Rp10,000
Rp 30,000 Rp30,000
Rp 10,000 Rp10,000
Jumlah Rp265,000
Jumlah Uang

6=4*5 7

Rp 144,000 Rp144,000

Rp 30,000 Rp30,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 30,000 Rp30,000
Rp 157,500 Rp157,500
Rp 95,000 Rp95,000
Rp 90,000 Rp90,000
Rp 10,000 Rp10,000
Jumlah Rp547,500

Jumlah Uang

6=4*5 7

Rp 72,000 Rp72,000

Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp45,000

Jumlah Uang

6=4*5 7

Rp 64,000 Rp64,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Jumlah Rp45,000

Jumlah Uang

6=4*5 7

Rp 108,000 Rp108,000

Rp 25,000 Rp25,000
Rp 20,000 Rp20,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Jumlah Rp80,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp84,000

Rp 10,000 Rp10,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 7,500 Rp7,500
Rp 5,000 Rp5,000
Rp 30,000 Rp30,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 20,000 Rp20,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 20,000 Rp20,000
Jumlah Rp160,000
Jumlah Uang

6=4*5 7

Rp 136,000 Rp 136,000

Rp 20,000 Rp 20,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 20,000 Rp 20,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Jumlah Rp145,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp84,000

Rp 50,000 Rp50,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 15,000 Rp15,000
Rp 90,000 Rp90,000
Rp 97,500 Rp97,500
Rp 15,000 Rp15,000
Rp 300,000 Rp300,000
Jumlah Rp602,500

Jumlah Uang

6=4*5 7

Rp 68,000 Rp68,000
Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Jumlah Rp35,000

Jumlah Uang

6=4*5 7

Rp 68,000 Rp 68,000

Rp 10,000 Rp 10,000
Rp 30,000 Rp 30,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 15,000 Rp 15,000
Rp 20,000 Rp 20,000
Rp 20,000 Rp 20,000
Rp 45,000 Rp 45,000
Rp 45,000 Rp 45,000
Jumlah Rp230,000

Jumlah Uang

6=4*5 7

Rp 60,000 Rp60,000

Rp 15,000 Rp15,000
Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Jumlah Rp55,000
 DINAS KESEHATAN KOTA P
PUSKESMAS MULTIW
SURAT TANDA SET

STS NO
KODE REKENING :
HARAP DITERIMA UANG SEBESAR
BULAN : JUNI 2022
Dengan rincian penerimaan sebagai berikut :

2-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,690-311,731 42 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Kb depo 012,076 1 Rp 10,000
b.Cholesterol 019,433-019,434 2 Rp 25,000
c.HB 012,077 1 Rp 10,000
d.PH 193,972 1 Rp 5,000
e.Gluk 193,973 1 Rp 5,000
f.Protein 193,974 1 Rp 5,000
g.Asam urat 012,078-012,079 2 Rp 10,000
9 Jumlah

3-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,732-311,738 7 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.GDP 003,716 1 Rp 15,000
b.Cholesterol 019,435 1 Rp 25,000
c.Asam urat 012,080 1 Rp 10,000
d.HB 012,081-012,082 2 Rp 10,000
e.PH 193,975 1 Rp 5,000
 f.Gluk 193,976-193,977 2 Rp 5,000
g.Protein 193,978-193,979 2 Rp 5,000
h.Jahitan 193,980-193,984 5 Rp 5,000
i.Urine lengkap 193,985-193,988 4 Rp 5,000
j.Golda 012,083 1 Rp 10,000
k.Rhesus 193,989 1 Rp 5,000
l.Keur 193,990 1 Rp 5,000
22 Jumlah

4-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,739-311,748 10 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,436-019,437 2 Rp 25,000
b.Asam urat 012,084-012,085 2 Rp 10,000
c.GDS 003,717 1 Rp 15,000
d.Jahitan 193,991-193,993 3 Rp 5,000
e.Keur 193,994 1 Rp 5,000
9 Jumlah

6-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,749-311,769 21 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Widal 003,718 1 Rp 15,000
b.Gdp 003,719 1 Rp 15,000
c.Asam urat 012,086 1 Rp 10,000
d.Gds 003,720-003,721 2 Rp 15,000
e.Cholesterol 019,438 1 Rp 25,000
f.Tampal sementara 015,745-015,776 32 Rp 7,500
g.Cabut tetap 012,087-012,090 4 Rp 10,000
h.Tampal tetap gic 003,722-003,725 4 Rp 15,000
46 Jumlah

7-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,770-311,778 9 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,726 1 Rp 15,000
b.Golda 012,091 1 Rp 10,000
c.Rhesus 193,995 1 Rp 5,000
d.Gds 003,727-003,728 2 Rp 15,000
e.PT(tes kehamilan) 003,729 1 Rp 15,000
f.Cholesterol 019,439 1 Rp 25,000
g.Asam urat 012,092 1 Rp 10,000
h.Keur 193,996-193,997 2 Rp 5,000
10 Jumlah

8-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,779-311,795 17 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.PT 003,730 1 Rp 15,000
b.HB 012,093 1 Rp 10,000
c.Keur 193,998-194,002 5 Rp 5,000
7 Jumlah

9-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,796-311,835 40 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,440-019,441 2 Rp 25,000
b.Asam urat 012,094-012,095 2 Rp 10,000
c.Gds 003,731 1 Rp 15,000
d.HB 012,096 1 Rp 10,000
e.PH 194,003 1 Rp 5,000
f.Gluk 194,004 1 Rp 5,000
g.Protein 194,005 1 Rp 5,000
h.Golda 012,097 1 Rp 10,000
 i.Rhesus 194,006 1 Rp 5,000
j.PT(tes kehamilan) 003,732 1 Rp 15,000
k.Keur 194,007-194,008 2 Rp 5,000
14 Jumlah

10-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,836-311,900 65 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,442 1 Rp 25,000
b.Golda 012,098 1 Rp 10,000
c.Rhesus 194,009 1 Rp 5,000
d.Praktek siswa @5 minggu 047,080-047,129 50 Rp 22,500
53 Jumlah

11-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,901-311,911 11 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,733 1 Rp 15,000
b.BTA 194,010 1 Rp 5,000
c.TCM 194,011 1 Rp 5,000
d.HB 012,099 1 Rp 10,000
e.PH 194,012 1 Rp 5,000
f.Gluk 194,013 1 Rp 5,000
g.Protein 194,014 1 Rp 5,000
h.Keur 194,015 1 Rp 5,000
8 Jumlah

13-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,912-311,932 21 Rp 4,000
 2 Pemeriksaan penunjang diagnostic
a.Cholesterol 019,443-019,444 2 Rp 25,000
b.Golda 012,100 1 Rp 10,000
c.Rhesus 194,016 1 Rp 5,000
d.Gds 003,734 1 Rp 15,000
e.BW 012,101 1 Rp 10,000
f.Keur 194,017-194,019 3 Rp 5,000
g.Tampal gic 003,735-003,744 10 Rp 15,000
h.Tampal sementara 015,777-015,783 7 Rp 7,500
i.Tampal komposite 004,853 1 Rp 100,000
j.Cabut tetap 012,102-012,103 2 Rp 10,000
k.Cabut susu 194,020-194,021 2 Rp 5,000
31 Jumlah

14-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,933-311,975 43 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Asam urat 012,104-012,105 2 Rp 10,000
b.PT(tes kehamilan) 003,745 1 Rp 15,000
c.Keur 194,022-194,027 6 Rp 5,000
d.BW 012,106-012,108 3 Rp 10,000
e.Tampal komposive 004,854 1 Rp 100,000
f.Tampal gic 003,746-003,751 6 Rp 15,000
g.Tampal sementara 015,784-015,791 8 Rp 7,500
h.Cabut susu 194,028-194,029 2 Rp 5,000
i.Cabut tetap 012,109-012,113 5 Rp 10,000
34 Jumlah

15-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 311,976-312,000 25 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.BTA 194,030 1 Rp 5,000
b.HB 012,114 1 Rp 10,000
c.Hematokrit 015,792 1 Rp 7,500
 d.Jumlah lekosit 194,031 1 Rp 5,000
e.Jumlah eritrosit 194,032 1 Rp 5,000
f.Jumlah trombosit 015,793 1 Rp 7,500
g.Hitung jenis 194,033 1 Rp 5,000
h.Gdp 003,752-003,753 2 Rp 15,000
i.Gula darah 2 jam pp 003,754 1 Rp 15,000
j.Widal 003,755 1 Rp 15,000
k.Cholesterol 019,445 1 Rp 25,000
l.Asam urat 012,115 1 Rp 10,000
m.Tampal sementara 015,794-015,807 14 Rp 7,500
n.Tampal komposive 004,855 1 Rp 100,000
o.Tampal gic 003,756-003,763 8 Rp 15,000
p.Cabut susu 194,034-194,036 3 Rp 5,000
39 Jumlah

16-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,000-315,034 34 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,764-003,765 2 Rp 15,000
b.Gds 003,766-003,768 3 Rp 15,000
c.Cholesterol 019,446-019,448 3 Rp 25,000
d.Asam urat 012,116 1 Rp 10,000
e.Praktek siswa 047,130-047,141 12 Rp 22,500
f.Keur 194,037 1 Rp 5,000
22 Jumlah

17-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,035-315,044 10 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Keur 194,038 1 Rp 5,000
1 Jumlah
 18-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,045-315,055 11 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Asam urat 012,117 1 Rp 10,000
b.HB 012,118 1 Rp 10,000
c.Golda 012,119 1 Rp 10,000
d.Rhesus 194,039 1 Rp 5,000
e.Urine lengkap 194,040-194,043 4 Rp 5,000
f.Keur 194,044 1 Rp 5,000
9 Jumlah

20-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,056-315,076 21 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,769 1 Rp 15,000
b.Cholesterol 019,449-019,451 3 Rp 25,000
c.Asam urat 012,120 1 Rp 10,000
d.Jahitan luar 194,045-194,046 2 Rp 5,000
e.Bersih luka asing 013,028 1 Rp 30,000
f.Gdp 003,770 1 Rp 15,000
g.Tcm 194,047-194,050 4 Rp 5,000
h.Keur 194,051-194,055 5 Rp 5,000
18 Jumlah

21-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,077-315,104 28 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Golda 012,121-012,127 7 Rp 10,000
b.Rhesus 194,056-194,062 7 Rp 5,000
 c.Gds 003,771 1 Rp 15,000
d.Cholesterol 019,452 1 Rp 25,000
e.Asam urat 012,128 1 Rp 10,000
f.Tampal sementara 015,808-015,815 8 Rp 7,500
g.Tampal gic 003,772-003,782 11 Rp 15,000
h.Tampal komposite 004,856 1 Rp 100,000
i.Cabut tetap 012,129-012,130 2 Rp 10,000
j.Keur 194,063-194,069 7 Rp 5,000
46 Jumlah

22-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,105-315,127 23 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,783 1 Rp 15,000
b.Cholesterol 019,453-019,454 2 Rp 25,000
c.Asam urat 012,131 1 Rp 10,000
d.Golda 012,132 1 Rp 10,000
e.Rhesus 194,070 1 Rp 5,000
f.Gds 003,784 1 Rp 15,000
h.Keur 194,071-194,078 8 Rp 5,000
15 Jumlah

23-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,128-315,170 43 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,785-003,786 2 Rp 15,000
b.Cholesterol 019,455-019,456 2 Rp 25,000
c.Asam urat 012,133-012,134 2 Rp 10,000
d.Golda 012,135 1 Rp 10,000
e.Rhesus 194,079 1 Rp 5,000
f.HB 012,136 1 Rp 10,000
h.Keur 194,080-194,081 2 Rp 5,000
11 Jumlah
 24-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,171-315,184 14 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Golda 012,137-012,140 4 Rp 10,000
b.Rhesus 194,082-194,085 4 Rp 5,000
c.PT 003,787 1 Rp 15,000
d.HB 012,141 1 Rp 10,000
e.PH 194,086 1 Rp 5,000
f.Gluk 194,087 1 Rp 5,000
h.Protein 194,088 1 Rp 5,000
13 Jumlah

25-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,185-315,197 13 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Bersih telinga (skulling) 013,029 1 Rp 30,000
1 Jumlah

27-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,198-315,226 29 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,788 1 Rp 15,000
b.Cholesterol 019,457-019,458 2 Rp 25,000
c.Asam urat 012,142-012,143 2 Rp 10,000
d.HB 012,144 1 Rp 10,000
e.PH 194,089 1 Rp 5,000
f.Gluk 194,090 1 Rp 5,000
g.Protein 094,091 1 Rp 5,000
 h.Golda 012,145 1 Rp 10,000
i.Rhesus 194,092 1 Rp 5,000
j.Gds 003,789-003,790 2 Rp 15,000
k.Bersih luka asing 013,030 1 Rp 30,000
l.Ganti perban 194,93 1 Rp 5,000
m.Keur 194,094-194,097 4 Rp 5,000
19 Jumlah

28-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,227-315,243 17 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Golda 012,146 1 Rp 10,000
b.Rhesus 194,098 1 Rp 5,000
c.Keur 194,099-194,103 5 Rp 5,000
7 Jumlah

29-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,244-315,263 20 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Keur 194,104-194,105 2 Rp 5,000
b.Tampal sementara 015,816-015,832 17 Rp 7,500
c.Tampal gic 003,791-003,801 11 Rp 15,000
d.Cabut susu 194,106-194,112 7 Rp 5,000
e.Cabut tetap 012,147 1 Rp 10,000
38 Jumlah

30-Jun-22 Jumlah Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,264-315,284 21 Rp 4,000
2 Pemeriksaan penunjang diagnostic
a.HB 012,148 1 Rp 10,000
b.PH 194,113 1 Rp 5,000
c.Gluk 194,114 1 Rp 5,000
d.Protein 194,115 1 Rp 5,000
e.Golda 012,149 1 Rp 10,000
f.Rhesus 194,116 1 Rp 5,000
g.Keur 194,117 1 Rp 5,000
7 Jumlah
S KESEHATAN KOTA PALEMBANG
PUSKESMAS MULTIWAHANA
SURAT TANDA SETOR

Jumlah Uang

6=4*5 7

Rp 168,000 Rp168,000

Rp 10,000 Rp10,000
Rp 50,000 Rp50,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 5,000 Rp5,000
Rp 20,000 Rp20,000
Jumlah Rp105,000

Jumlah Uang

6=4*5 7

Rp 28,000 Rp 28,000

Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 20,000 Rp 20,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 25,000 Rp 25,000
Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Jumlah Rp160,000

Jumlah Uang

6=4*5 7

Rp 40,000 Rp40,000

Rp 50,000 Rp50,000
Rp 20,000 Rp20,000
Rp 15,000 Rp15,000
Rp 15,000 Rp15,000
Rp 5,000 Rp5,000
Jumlah Rp105,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp 84,000

Rp 15,000 Rp 15,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 30,000 Rp 30,000
Rp 25,000 Rp 25,000
Rp 240,000 Rp 240,000
Rp 40,000 Rp 40,000
Rp 60,000 Rp 60,000
Jumlah Rp435,000

Jumlah Uang
 6=4*5 7

Rp 36,000 Rp 36,000

Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 30,000 Rp 30,000
Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Jumlah Rp120,000

Jumlah Uang

6=4*5 7

Rp 68,000 Rp68,000

Rp 15,000 Rp15,000
Rp 10,000 Rp10,000
Rp 25,000 Rp25,000
Jumlah Rp50,000

Jumlah Uang

6=4*5 7

Rp 160,000 Rp 160,000

Rp 50,000 Rp 50,000
Rp 20,000 Rp 20,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Jumlah Rp150,000

Jumlah Uang

6=4*5 7

Rp 260,000 Rp260,000

Rp 25,000 Rp25,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 1,125,000 Rp1,125,000
Jumlah Rp1,165,000

Jumlah Uang

6=4*5 7

Rp 44,000 Rp 44,000

Rp 15,000 Rp 15,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Jumlah Rp55,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp 84,000
Rp 50,000 Rp 50,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 15,000 Rp 15,000
Rp 150,000 Rp 150,000
Rp 52,500 Rp 52,500
Rp 100,000 Rp 100,000
Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Jumlah Rp437,500

Jumlah Uang

6=4*5 7

Rp 172,000 Rp 172,000

Rp 20,000 Rp 20,000
Rp 15,000 Rp 15,000
Rp 30,000 Rp 30,000
Rp 30,000 Rp 30,000
Rp 100,000 Rp 100,000
Rp 90,000 Rp 90,000
Rp 60,000 Rp 60,000
Rp 10,000 Rp 10,000
Rp 50,000 Rp 50,000
Jumlah Rp405,000

Jumlah Uang

6=4*5 7

Rp 100,000 Rp 100,000

Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 30,000 Rp 30,000
Rp 15,000 Rp 15,000
Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 105,000 Rp 105,000
Rp 100,000 Rp 100,000
Rp 120,000 Rp 120,000
Rp 15,000 Rp 15,000
Jumlah Rp480,000

Jumlah Uang

6=4*5 7

Rp 136,000 Rp 136,000

Rp 30,000 Rp 30,000
Rp 45,000 Rp 45,000
Rp 75,000 Rp 75,000
Rp 10,000 Rp 10,000
Rp 270,000 Rp 270,000
Rp 5,000 Rp 5,000
Jumlah Rp435,000

Jumlah Uang

6=4*5 7

Rp 40,000 Rp40,000

Rp 5,000 Rp5,000
Jumlah Rp5,000
Jumlah Uang

6=4*5 7

Rp 44,000 Rp44,000

Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 20,000 Rp20,000
Rp 5,000 Rp5,000
Jumlah Rp60,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp 84,000

Rp 15,000 Rp 15,000
Rp 75,000 Rp 75,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 30,000 Rp 30,000
Rp 15,000 Rp 15,000
Rp 20,000 Rp 20,000
Rp 25,000 Rp 25,000
Jumlah Rp200,000

Jumlah Uang

6=4*5 7

Rp 112,000 Rp 112,000

Rp 70,000 Rp 70,000
Rp 35,000 Rp 35,000
Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 60,000 Rp 60,000
Rp 165,000 Rp 165,000
Rp 100,000 Rp 100,000
Rp 20,000 Rp 20,000
Rp 35,000 Rp 35,000
Jumlah Rp535,000

Jumlah Uang

6=4*5 7

Rp 92,000 Rp 92,000

Rp 15,000 Rp 15,000
Rp 50,000 Rp 50,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 15,000 Rp 15,000
Rp 40,000 Rp 40,000
Jumlah Rp145,000

Jumlah Uang

6=4*5 7

Rp 172,000 Rp 172,000

Rp 30,000 Rp 30,000
Rp 50,000 Rp 50,000
Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Jumlah Rp135,000
Jumlah Uang

6=4*5 7

Rp 56,000 Rp 56,000

Rp 40,000 Rp 40,000
Rp 20,000 Rp 20,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Jumlah Rp100,000

Jumlah Uang

6=4*5 7

Rp 52,000 Rp52,000

Rp 30,000 Rp30,000
Jumlah Rp30,000

Jumlah Uang

6=4*5 7

Rp 116,000 Rp 116,000

Rp 15,000 Rp 15,000
Rp 50,000 Rp 50,000
Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 30,000 Rp 30,000
Rp 30,000 Rp 30,000
Rp 5,000 Rp 5,000
Rp 20,000 Rp 20,000
Jumlah Rp210,000

Jumlah Uang

6=4*5 7

Rp 68,000 Rp68,000

Rp 10,000 Rp10,000
Rp 5,000 Rp5,000
Rp 25,000 Rp25,000
Jumlah Rp40,000

Jumlah Uang

6=4*5 7

Rp 80,000 Rp 80,000

Rp 10,000 Rp 10,000
Rp 127,500 Rp 127,500
Rp 165,000 Rp 165,000
Rp 35,000 Rp 35,000
Rp 10,000 Rp 10,000
Jumlah Rp347,500

Jumlah Uang

6=4*5 7

Rp 84,000 Rp 84,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Jumlah Rp45,000
 DINAS KESEHATAN KOTA
PUSKESMAS MULTIW
SURAT TANDA SE

STS NO
KODE REKENING :
HARAP DITERIMA UANG SEBESAR
BULAN : JULI 2022
Dengan rincian penerimaan sebagai berikut :

Jumlah
1-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,285-315,301 17 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Keur 194,118-194,119 2 Rp 5,000
2 Jumlah

Jumlah
2-Jul-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,302-315,316 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Asam urat 012,150-012,151 2 Rp 10,000
b.Tindik telinga 012,152-012,153 2 Rp 10,000
c.Cholesterol 019,459-019,460 2 Rp 25,000
d.Gdp 003,802 1 Rp 15,000
e.Keur 194,120 1 Rp 5,000
8 Jumlah

4-Jul-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,317-315,331 15 Rp 4,000
 2 Pemeriksaan penunjang diagnostic
a.Gds 003,803 1 Rp 15,000
b.Cholesterol 019,461 1 Rp 25,000
c.Asam urat 012,154 1 Rp 10,000
d.Keur 194,121-194,123 3 Rp 5,000
6 Jumlah

5-Jul-22 Jumlah Unit Cost

Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,332-315,343 12 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.GDP 003,804 1 Rp 15,000
b.Cholesterol 019,462-019,465 4 Rp 25,000
c.TCM 194,124 1 Rp 5,000
d.Gds 003,805-003,807 3 Rp 15,000
e.Asam urat 012,155-012,157 3 Rp 10,000
f.HB 012,158 1 Rp 10,000
g.PH 194,125 1 Rp 5,000
h.Gluk 194,126 1 Rp 5,000
i.Protein 194,127 1 Rp 5,000
j.Golda 012,159 1 Rp 10,000
k.Rhesus 194,128 1 Rp 5,000
18 Jumlah

Jumlah
6-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,344-315,359 16 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,466-019,468 3 Rp 25,000
b.Asam urat 012,160-012,163 4 Rp 10,000
c.Gds 003,808 1 Rp 15,000
d.Golda 012,164 1 Rp 10,000
e.Rhesus 194,129 1 Rp 5,000
f.Keur 194,130 1 Rp 5,000
11 Jumlah
 Jumlah
7-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,360-315,391 32 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,165-012,167 3 Rp 10,000
b.Hematokrit 015,833 1 Rp 7,500
c.Jumlah lekosit 194,131 1 Rp 5,000
d.Jumlah eritrosit 194,132 1 Rp 5,000
e.Jumlah trombosit 015,834 1 Rp 7,500
f.Hitung jenis 194,133 1 Rp 5,000
h.PH 194,134-194,135 2 Rp 5,000
i.Gluk 194,136-194,137 2 Rp 5,000
j.Protein 194,138-194,139 2 Rp 5,000
k.Golda 012,168 1 Rp 10,000
l.Rhesus 194,140 1 Rp 5,000
m.Keur 194,141-194,143 3 Rp 5,000
19 Jumlah

Jumlah
8-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,392-315,404 13 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,809-0003,810 2 Rp 15,000
b.Keur 194,144-194,147 4 Rp 5,000
6 Jumlah

Jumlah
11-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,405-315,419 15 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,469-019,473 5 Rp 25,000
b.Gds 003,811 1 Rp 15,000
c.Asam urat 012,169 1 Rp 10,000
d.Widal 003,812 1 Rp 15,000
 e.Jumlah lekosit 194,148 1 Rp 5,000
f.Keur 194,149-194,154 6 Rp 5,000
g.BW 012,170 1 Rp 10,000
16 Jumlah

Jumlah
12-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,420-315,440 21 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,813-003,815 3 Rp 15,000
b.Cholesterol 019,474-019,476 3 Rp 25,000
c.Asam urat 012,171-012,172 2 Rp 10,000
d.HB 012,173 1 Rp 10,000
e.Jahitan luar 194,155-194,158 4 Rp 5,000
f.BW 012,174-012,176 3 Rp 10,000
g.Keur 194,159-194,163 5 Rp 5,000
21 Jumlah

Jumlah
13-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,441-315,456 16 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gdp 003,816 1 Rp 15,000
b.Cholesterol 019,477-019,478 2 Rp 25,000
c.Asam urat 012,177 1 Rp 10,000
d.Bw 012,178-012,179 2 Rp 10,000
e.Keur 194,164-194,167 4 Rp 5,000
10 Jumlah

Jumlah
14-Jul-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,457-315,509 53 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,180 1 Rp 10,000
 b.PH 194,168 1 Rp 5,000
c.Gluk 194,169 1 Rp 5,000
d.Protein 194,170 1 Rp 5,000
e.Golda 012,181-012,182 2 Rp 10,000
f.Rhesus 194,171-194,172 2 Rp 5,000
h.Asam urat 012,183-012,186 4 Rp 10,000
i.Urine lengkap 194,173-194,176 4 Rp 5,000
j.Gds 003,817-003,818 2 Rp 15,000
k.Cholesterol 019,479-019,481 3 Rp 25,000
l.Gdp 003,819 1 Rp 15,000
22 Jumlah

Jumlah
15-Jul-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,510-315,530 21 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,820 1 Rp 15,000
b.Asam urat 012,187 1 Rp 10,000
c.HB 012,188 1 Rp 10,000
d.Ph 194,177 1 Rp 5,000
e.Gluk 194,178 1 Rp 5,000
f.Protein 194,179 1 Rp 5,000
h.Kb depo 012,189 1 Rp 10,000
i.Keur 194,180-194,183 4 Rp 5,000
11 Jumlah

Jumlah
16-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,531-315,536 6 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,190-012,191 2 Rp 10,000
b.PH 194,184 1 Rp 5,000
c.Gluk 194,185 1 Rp 5,000
d.Protein 194,186 1 Rp 5,000
e.Hematokrit 015,835 1 Rp 7,500
f.Jumlah lekosit 194,187 1 Rp 5,000
g.Jumlah eritrosit 194,188 1 Rp 5,000
 h.Jumlah trombosit 015,836 1 Rp 7,500
i.Hitung jenis 194,189 1 Rp 5,000
j.BW 012,192 1 Rp 10,000
K.Keur 194,190-194,191 2 Rp 5,000
13 Jumlah

Jumlah
18-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,537-315,564 28 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,821 1 Rp 15,000
b.Cholesterol 019,482 1 Rp 25,000
c.Asam urat 012,193 1 Rp 10,000
d.HB 012,194 1 Rp 10,000
e.PH 194,192 1 Rp 5,000
f.Gluk 194,193 1 Rp 5,000
h.Protein 194,194 1 Rp 5,000
i.Keur 194,195-194,198 4 Rp 5,000
11 Jumlah

Jumlah
19-Jul-22 Karcis Unit Cost

1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,565-315,583 19 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.HB 012,195-012,196 2 Rp 10,000
b.PH 194,199-194,200 2 Rp 5,000
c.Gluk 194,201-194,202 2 Rp 5,000
d.Protein 194,203-194,204 2 Rp 5,000
e.Golda 012,197 1 Rp 10,000
f.Rhesus 194,205 1 Rp 5,000
h.Keur 194,206-194,207 2 Rp 5,000
12 Jumlah

Jumlah
20-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
 PUSKESMAS MULTIWAHANA 315,584-315,593 10 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Cholesterol 019,483-019,484 2 Rp 25,000
b.Gds 003,822-003,823 2 Rp 15,000
c.Asam urat 012,198 1 Rp 10,000
d.Bw 012,199 1 Rp 10,000
e.Keur 194,208-194,209 2 Rp 5,000
8 Jumlah

Jumlah
21-Jul-22 Unit Cost
Karcis
1 2 3 4 5
1 Rawat Jalan
PUSKESMAS MULTIWAHANA 315,594-315,623 30 Rp 4,000

2 Pemeriksaan penunjang diagnostic

a.Gds 003,824-003,826 3 Rp 15,000
b.Cholesterol 019,485-019,486 2 Rp 25,000
c.Asam urat 012,200-012,201 2 Rp 10,000
d.Tampal sementara 015,837-015,844 8 Rp 7,500
e.Tampal gic 003,827-003,832 6 Rp 15,000
f.Cabut susu 194,210-194,219 10 Rp 5,000
g.Cabut tetap 012,202-012,203 2 Rp 10,000
h.Tampal tetap 003,833-003,838 6 Rp 15,000
i.Keur 194,220-194,221 2 Rp 5,000
41 Jumlah
AS KESEHATAN KOTA PALEMBANG
PUSKESMAS MULTIWAHANA
SURAT TANDA SETOR

Jumlah Uang

6=4*5 7

Rp 68,000 Rp68,000

Rp 10,000 Rp10,000
Jumlah Rp10,000

Jumlah Uang

6=4*5 7

Rp 60,000 Rp 60,000

Rp 20,000 Rp 20,000
Rp 20,000 Rp 20,000
Rp 50,000 Rp 50,000
Rp 15,000 Rp 15,000
Rp 5,000 Rp 5,000
Jumlah Rp110,000

Jumlah Uang

6=4*5 7

Rp 60,000 Rp 60,000
Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 15,000 Rp 15,000
Jumlah Rp65,000

Jumlah Uang

6=4*5 7

Rp 48,000 Rp 48,000

Rp 15,000 Rp 15,000
Rp 100,000 Rp 100,000
Rp 5,000 Rp 5,000
Rp 45,000 Rp 45,000
Rp 30,000 Rp 30,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Jumlah Rp235,000

Jumlah Uang

6=4*5 7

Rp 64,000 Rp 64,000

Rp 75,000 Rp 75,000
Rp 40,000 Rp 40,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Jumlah Rp150,000
 Jumlah Uang

6=4*5 7

Rp 128,000 Rp 128,000

Rp 30,000 Rp 30,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 15,000 Rp 15,000
Jumlah Rp120,000

Jumlah Uang

6=4*5 7

Rp 52,000 Rp 52,000

Rp 30,000 Rp 30,000
Rp 20,000 Rp 20,000
Jumlah Rp50,000

Jumlah Uang

6=4*5 7

Rp 60,000 Rp 60,000

Rp 125,000 Rp 125,000
Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 15,000 Rp 15,000
 Rp 5,000 Rp 5,000
Rp 30,000 Rp 30,000
Rp 10,000 Rp 10,000
Jumlah Rp210,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp 84,000

Rp 45,000 Rp 45,000
Rp 75,000 Rp 75,000
Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Rp 20,000 Rp 20,000
Rp 30,000 Rp 30,000
Rp 25,000 Rp 25,000
Jumlah Rp225,000

Jumlah Uang

6=4*5 7

Rp 64,000 Rp 64,000

Rp 15,000 Rp 15,000
Rp 50,000 Rp 50,000
Rp 10,000 Rp 10,000
Rp 20,000 Rp 20,000
Rp 20,000 Rp 20,000
Jumlah Rp115,000

Jumlah Uang

6=4*5 7

Rp 212,000 Rp 212,000

Rp 10,000 Rp 10,000
 Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Rp 40,000 Rp 40,000
Rp 20,000 Rp 20,000
Rp 30,000 Rp 30,000
Rp 75,000 Rp 75,000
Rp 15,000 Rp 15,000
Jumlah Rp235,000

Jumlah Uang

6=4*5 7

Rp 84,000 Rp 84,000

Rp 15,000 Rp 15,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 20,000 Rp 20,000
Jumlah Rp80,000

Jumlah Uang

6=4*5 7

Rp 24,000 Rp 24,000

Rp 20,000 Rp 20,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
 Rp 7,500 Rp 7,500
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Jumlah Rp85,000

Jumlah Uang

6=4*5 7

Rp 112,000 Rp 112,000

Rp 15,000 Rp 15,000
Rp 25,000 Rp 25,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 5,000 Rp 5,000
Rp 20,000 Rp 20,000
Jumlah Rp95,000

Jumlah Uang

6=4*5 7

Rp 76,000 Rp 76,000

Rp 20,000 Rp 20,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 5,000 Rp 5,000
Rp 10,000 Rp 10,000
Jumlah Rp75,000

Jumlah Uang

6=4*5 7
 Rp 40,000 Rp 40,000

Rp 50,000 Rp 50,000
Rp 30,000 Rp 30,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Rp 10,000 Rp 10,000
Jumlah Rp110,000

Jumlah Uang

6=4*5 7

Rp 120,000 Rp 120,000

Rp 45,000 Rp 45,000
Rp 50,000 Rp 50,000
Rp 20,000 Rp 20,000
Rp 60,000 Rp 60,000
Rp 90,000 Rp 90,000
Rp 50,000 Rp 50,000
Rp 20,000 Rp 20,000
Rp 90,000 Rp 90,000
Rp 10,000 Rp 10,000
Jumlah Rp435,000