PERHITUNGAN JASA LAYANAN MEDIS

BULAN JANUARI 2022

Nama Puskesmas SUKOREJO Jumlah Kapitasi : 143,858,250
Jumlah Peserta JKN 30,647 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 86,314,950
Jumlah Besaran Kapitasi 4,950 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 57,543,300
BULAN Januari 2022

KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG ( JANUARI 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr. Ella Sandra Iswari 19770429 201001 2 003 III Dokter / Kep FKTP S1 150 16 15 25 25 100 265 100% 265 4,466,601 223,330 4,243,271 44,666 4,198,605 1

2 Jalal, SE 196508111985121001 III Kepala Subbag TU S1 100 30 25 25 25 30 155 100% 155 2,612,540 130,627 2,481,913 26,125 2,455,788 2

3 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 25 25 160 100% 160 2,696,815 134,841 2,561,975 26,968 2,535,007 3

4 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 25 25 151 100% 151 2,545,120 127,256 2,417,864 25,451 2,392,412 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 25 25 80 100% 80 1,348,408 67,420 1,280,987 13,484 1,267,503 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 12 10 25 25 70 100% 70 1,179,857 58,993 1,120,864 11,799 1,109,065 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 25 25 110 100% 110 1,854,061 92,703 1,761,358 18,541 1,742,817 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 25 25 70 100% 70 1,179,857 58,993 1,120,864 11,799 1,109,065 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 25 25 75 100% 75 1,264,132 63,207 1,200,926 12,641 1,188,284 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 25 25 75 100% 75 1,264,132 63,207 1,200,926 12,641 1,188,284 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 25 25 70 100% 70 1,179,857 58,993 1,120,864 11,799 1,109,065 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 25 25 65 100% 65 1,095,581 0 1,095,581 10,956 1,084,625 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 25 25 101 100% 101 1,702,365 85,118 1,617,247 17,024 1,600,223 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 25 25 61 100% 61 1,028,161 0 1,028,161 10,282 1,017,879 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 25 25 61 100% 61 1,028,161 0 1,028,161 10,282 1,017,879 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 25 25 105 100% 105 1,769,785 88,489 1,681,296 17,698 1,663,598 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 25 25 70 100% 70 1,179,857 58,993 1,120,864 11,799 1,109,065 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 25 25 80 100% 80 1,348,408 67,420 1,280,987 13,484 1,267,503 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 80 20 15 25 25 95 100% 95 1,601,234 80,062 1,521,172 16,012 1,505,160 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 II Bidan Terampil D3 60 25 20 25 25 5 85 100% 85 1,432,683 0 1,432,683 14,327 1,418,356 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 25 25 80 100% 80 1,348,408 0 1,348,408 13,484 1,334,924 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 II Bidan Terampil D3 60 23 20 25 25 80 100% 80 1,348,408 0 1,348,408 13,484 1,334,924 22

23 Raupa, AMd. Keb 19750601 200701 2 013 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,348,408 0 1,348,408 13,484 1,334,924 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 25 25 90 100% 90 1,516,959 75,848 1,441,111 15,170 1,425,941 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,348,408 67,420 1,280,987 13,484 1,267,503 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,348,408 67,420 1,280,987 13,484 1,267,503 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 25 25 80 100% 80 1,348,408 0 1,348,408 13,484 1,334,924 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,348,408 0 1,348,408 13,484 1,334,924 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 II Bidan Terampil D3 60 23 15 25 25 75 100% 75 1,264,132 0 1,264,132 12,641 1,251,491 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 25 25 50 115 100% 115 1,938,336 96,917 1,841,419 19,383 1,822,036 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,348,408 0 1,348,408 13,484 1,334,924 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 25 25 100 100% 100 1,685,510 84,275 1,601,234 16,855 1,584,379 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 25 25 70 100% 70 1,179,857 0 1,179,857 11,799 1,168,058 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,264,132 0 1,264,132 12,641 1,251,491 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 60 15 10 25 25 70 100% 70 1,179,857 0 1,179,857 11,799 1,168,058 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,264,132 0 1,264,132 12,641 1,251,491 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,264,132 0 1,264,132 12,641 1,251,491 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 25 25 70 100% 70 1,179,857 0 1,179,857 11,799 1,168,058 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 25 25 70 100% 70 1,179,857 0 1,179,857 11,799 1,168,058 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 25 25 61 100% 61 1,028,161 0 1,028,161 10,282 1,017,879 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 25 25 101 100% 101 1,702,365 85,118 1,617,247 17,024 1,600,223 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 25 25 85 100% 85 1,432,683 71,634 1,361,049 14,327 1,346,722 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 25 25 80 100% 80 1,348,408 67,420 1,280,987 13,484 1,267,503 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 25 25 65 100% 65 1,095,581 54,779 1,040,802 10,956 1,029,846 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 25 25 70 100% 70 1,179,857 58,993 1,120,864 11,799 1,109,065 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 25 25 61 100% 61 1,028,161 0 1,028,161 10,282 1,017,879 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 25 25 2 47 100% 47 792,190 39,609 752,580 7,922 744,658 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 25 25 50 100% 50 842,755 42,138 800,617 8,428 792,190 48

49 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 5 45 100% 45 758,479 37,924 720,555 720,555 49

50 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 40 100% 40 674,204 33,710 640,494 640,494 50

51 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 25 25 10 60 100% 60 1,011,306 50,565 960,741 960,741 51

52 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 52

53 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 53

54 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 54

55 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 55

56 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 56

57 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 57

58 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 58

59 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 59

60 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 60

61 Fatimatuz Zahro, S.KM - PROMKES S1 50 25 25 50 100% 50 842,755 42,138 800,617 800,617 61

62 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 25 25 40 100% 40 674,204 33,710 640,494 640,494 62

63 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 25 25 50 100% 50 842,755 42,138 800,617 800,617 63

64 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 25 25 35 100% 35 589,928 29,496 560,432 560,432 64

65 Doni Fuad - ADMINISTRASI SMK 35 25 25 2 37 100% 37 623,639 31,182 592,457 592,457 65

66 Agus Cahyono - ADMINISTRASI SMA 35 25 25 35 100% 35 589,928 29,496 560,432 560,432 66

67 Muhammad Nur Efendi - ADMINISTRASI SMK 35 25 25 35 100% 35 589,928 29,496 560,432 560,432 67
 KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG ( JANUARI 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

68 Yunita - ADMINISTRASI SMK 35 25 25 35 100% 35 589,928 29,496 560,432 560,432 68

69 Riyanto - DRIVER SMA 30 25 25 30 100% 30 505,653 25,283 480,370 480,370 69

70 Sunoto - DRIVER SMP 30 25 25 30 100% 30 505,653 25,283 480,370 480,370 70

71 Saiin - CLEANING SERVICE SMA 30 25 25 30 100% 30 505,653 25,283 480,370 480,370 71

72 Sunyoto - CLEANING SERVICE SMA 30 25 25 30 100% 30 505,653 25,283 480,370 480,370 72

73 Heru Gunawan - SCURITY SMA 30 25 25 30 100% 30 505,653 25,283 480,370 480,370 73

85 4,295 763 622 180 24 5,121 73 5,121 86,314,950 3,090,382 83,224,568 699,318 82,525,250

Terbilang : DELAPAN PULUH ENAM JUTA TIGA RATUS EMPAT BELAS RIBU SEMBILAN RATUS LIMA PULUH RUPIAH

Pasuruan, 31 Januari 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN FEBRUARI 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 145,515,425
Jumlah Peserta JKN 31,119 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 87,309,255
Jumlah Besaran Kapitasi 4,675 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 58,206,170
BULAN Februari 2022

KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN BPJS 1% JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA ( FEBRUARI PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH 2022) YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 16 15 22 22 100 265 100% 265 4,659,072 232,954 4,426,119 46,591 4,379,528 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 22 22 160 100% 160 2,813,025 140,651 2,672,373 28,130 2,644,243 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 22 22 151 100% 151 2,654,792 132,740 2,522,052 26,548 2,495,505 3

4 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 22 22 80 100% 80 1,406,512 70,326 1,336,187 14,065 1,322,122 4

5 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 12 10 22 22 70 100% 70 1,230,698 61,535 1,169,163 12,307 1,156,856 5

6 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 22 22 110 100% 110 1,933,955 96,698 1,837,257 19,340 1,817,917 6

7 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 22 22 70 100% 70 1,230,698 61,535 1,169,163 12,307 1,156,856 7

8 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 22 22 75 100% 75 1,318,605 65,930 1,252,675 13,186 1,239,489 8

9 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 22 22 75 100% 75 1,318,605 65,930 1,252,675 13,186 1,239,489 9

10 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 22 22 70 100% 70 1,230,698 61,535 1,169,163 12,307 1,156,856 10

11 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 22 22 65 100% 65 1,142,791 0 1,142,791 11,428 1,131,363 11

12 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 22 22 101 100% 101 1,775,722 88,786 1,686,936 17,757 1,669,179 12

13 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 22 22 61 100% 61 1,072,466 0 1,072,466 10,725 1,061,741 13

14 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 22 22 61 100% 61 1,072,466 0 1,072,466 10,725 1,061,741 14

15 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 22 22 105 100% 105 1,846,047 92,302 1,753,745 18,460 1,735,285 15

16 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 22 22 70 100% 70 1,230,698 61,535 1,169,163 12,307 1,156,856 16

17 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 22 22 80 100% 80 1,406,512 70,326 1,336,187 14,065 1,322,122 17

18 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 80 20 15 22 22 95 100% 95 1,670,233 83,512 1,586,722 16,702 1,570,019 18

19 Nanin Suharti, AMd. Keb 19760225 200701 2 009 II Bidan Terampil D3 60 25 20 22 22 5 85 100% 85 1,494,419 0 1,494,419 14,944 1,479,475 19

20 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 22 22 80 100% 80 1,406,512 0 1,406,512 14,065 1,392,447 20

21 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 II Bidan Terampil D3 60 23 20 22 22 80 100% 80 1,406,512 0 1,406,512 14,065 1,392,447 21

22 Raupa, AMd. Keb 19750601 200701 2 013 II Bidan Terampil D3 60 25 20 22 22 80 100% 80 1,406,512 0 1,406,512 14,065 1,392,447 22

23 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 22 22 90 100% 90 1,582,326 79,116 1,503,210 15,823 1,487,387 23

24 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 22 22 80 100% 80 1,406,512 70,326 1,336,187 14,065 1,322,122 24

25 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 22 22 80 100% 80 1,406,512 70,326 1,336,187 14,065 1,322,122 25

26 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 22 22 80 100% 80 1,406,512 0 1,406,512 14,065 1,392,447 26

27 Sri Handini, AMd. Keb 19740715 200701 2 016 II Bidan Terampil D3 60 25 20 22 22 80 100% 80 1,406,512 0 1,406,512 14,065 1,392,447 27

28 Vera Faridah, AMd.Keb. 19780822 200701 2 007 II Bidan Terampil D3 60 23 15 22 22 75 100% 75 1,318,605 0 1,318,605 13,186 1,305,419 28

29 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 22 22 50 115 100% 115 2,021,862 101,093 1,920,768 20,219 1,900,550 29

30 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 II Bidan Terampil D3 60 25 20 22 22 80 100% 80 1,406,512 0 1,406,512 14,065 1,392,447 30

31 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 22 22 100 100% 100 1,758,140 87,907 1,670,233 17,581 1,652,652 31

32 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 22 22 70 100% 70 1,230,698 0 1,230,698 12,307 1,218,391 32

33 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 22 22 75 100% 75 1,318,605 0 1,318,605 13,186 1,305,419 33

34 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 60 15 10 22 22 70 100% 70 1,230,698 0 1,230,698 12,307 1,218,391 34

35 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 22 22 75 100% 75 1,318,605 0 1,318,605 13,186 1,305,419 35

36 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 22 22 75 100% 75 1,318,605 0 1,318,605 13,186 1,305,419 36

37 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 22 22 70 100% 70 1,230,698 0 1,230,698 12,307 1,218,391 37

38 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 22 22 70 100% 70 1,230,698 0 1,230,698 12,307 1,218,391 38

39 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 22 22 61 100% 61 1,072,466 0 1,072,466 10,725 1,061,741 39

40 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 22 22 101 100% 101 1,775,722 88,786 1,686,936 17,757 1,669,179 40

41 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 22 22 85 100% 85 1,494,419 74,721 1,419,698 14,944 1,404,754 41

42 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 22 22 80 100% 80 1,406,512 70,326 1,336,187 14,065 1,322,122 42

43 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 22 22 65 100% 65 1,142,791 57,140 1,085,652 11,428 1,074,224 43

44 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 22 22 70 100% 70 1,230,698 61,535 1,169,163 12,307 1,156,856 44

45 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 22 22 61 100% 61 1,072,466 0 1,072,466 10,725 1,061,741 45

46 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 22 22 2 47 100% 47 826,326 41,316 785,010 8,263 776,746 46

47 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 22 22 50 100% 50 879,070 43,954 835,117 8,791 826,326 47

48 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 22 22 5 45 100% 45 791,163 39,558 751,605 751,605 48

49 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 22 22 40 100% 40 703,256 35,163 668,093 668,093 49

50 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 22 22 10 60 100% 60 1,054,884 52,744 1,002,140 1,002,140 50

51 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 51

52 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 52

53 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 53

54 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 54

55 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 55

56 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 56

57 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 57

58 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 58

59 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 59

60 Fatimatuz Zahro, S.KM - PROMKES S1 50 22 22 50 100% 50 879,070 43,954 835,117 835,117 60

61 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 22 22 40 100% 40 703,256 35,163 668,093 668,093 61

62 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 22 22 50 100% 50 879,070 43,954 835,117 835,117 62

63 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 22 22 35 100% 35 615,349 30,767 584,582 584,582 63

64 Doni Fuad - ADMINISTRASI SMK 35 22 22 2 37 100% 37 650,512 32,526 617,986 617,986 64

65 Agus Cahyono - ADMINISTRASI SMA 35 22 22 35 100% 35 615,349 30,767 584,582 584,582 65

66 Muhammad Nur Efendi - ADMINISTRASI SMK 35 22 22 35 100% 35 615,349 30,767 584,582 584,582 66

67 Yunita - ADMINISTRASI SMK 35 22 22 35 100% 35 615,349 30,767 584,582 584,582 67

 KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN BPJS 1% JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA ( FEBRUARI PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH 2022) YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

68 Riyanto - DRIVER SMA 30 22 22 30 100% 30 527,442 26,372 501,070 501,070 68

69 Sunoto - DRIVER SMP 30 22 22 30 100% 30 527,442 26,372 501,070 501,070 69

70 Saiin - CLEANING SERVICE SMA 30 22 22 30 100% 30 527,442 26,372 501,070 501,070 70

71 Sunyoto - CLEANING SERVICE SMA 30 22 22 30 100% 30 527,442 26,372 501,070 501,070 71

72 Heru Gunawan - SCURITY SMA 30 22 22 30 100% 30 527,442 26,372 501,070 501,070 72

4,195 733 597 150 24 4,966 72 4,966 87,309,255 3,087,295 84,221,960 702,201 83,519,759

Terbilang : DELAPAN PULUH TUJUH JUTA TIGA RATUS SEMBILAN RIBU DUA RATUS LIMA PULUH LIMA RUPIAH

Pasuruan, 28 Februari 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN MARET 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 154,205,975
Jumlah Peserta JKN 31,158 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 92,523,585
Jumlah Besaran Kapitasi 4,950 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 61,682,390
BULAN Maret 2022

KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA BPJS 1%
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% KURANG BAYAR TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG ( MARET 2022) BULAN TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA FEBRUARI 2022
KERJA AM DIRAN POTONG PPH
AAN POIN

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 26 26 100 255 100% 255 4,761,409 238,070 4,523,339 47,614 1,925 4,473,799 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 26 26 160 100% 160 2,987,551 149,378 2,838,173 29,876 1,162 2,807,136 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 26 26 5 156 100% 156 2,912,862 145,643 2,767,219 29,129 1,097 2,736,993 3

4 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 26 26 80 100% 80 1,493,775 74,689 1,419,087 14,938 581 1,403,568 4

5 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 12 10 26 26 6 76 100% 76 1,419,087 70,954 1,348,132 14,191 508 1,333,433 5

6 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 26 26 4 114 100% 114 2,128,630 106,431 2,022,198 21,286 799 2,000,113 6

7 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 26 26 2 72 100% 72 1,344,398 67,220 1,277,178 13,444 508 1,263,226 7

8 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 26 26 4 79 100% 79 1,475,103 73,755 1,401,348 14,751 545 1,386,052 8

9 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 26 26 2 77 100% 77 1,437,759 71,888 1,365,871 14,378 545 1,350,948 9

10 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 26 26 4 74 100% 74 1,381,742 69,087 1,312,655 13,817 508 1,298,330 10

11 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 26 26 4 69 100% 69 1,288,381 0 1,288,381 12,884 472 1,275,025 11

12 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 26 26 2 103 100% 103 1,923,236 96,162 1,827,074 19,232 734 1,807,108 12

13 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 24 26 2 63 92% 58 1,085,860 0 1,085,860 10,859 443 1,074,558 13

14 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 26 26 4 65 100% 65 1,213,692 0 1,213,692 12,137 443 1,201,113 14

15 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 26 26 105 100% 105 1,960,580 98,029 1,862,551 19,606 763 1,842,182 15

16 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 26 26 2 72 100% 72 1,344,398 67,220 1,277,178 13,444 508 1,263,226 16

17 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 26 26 80 100% 80 1,493,775 74,689 1,419,087 14,938 581 1,403,568 17

18 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 80 20 15 26 26 95 100% 95 1,773,858 88,693 1,685,165 17,739 690 1,666,737 18

19 Nanin Suharti, AMd. Keb 19760225 200701 2 009 II Bidan Terampil D3 25 25 20 26 26 5 50 100% 50 933,610 0 933,610 9,336 617 923,657 19

20 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 26 26 80 100% 80 1,493,775 0 1,493,775 14,938 581 1,478,257 20

21 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 II Bidan Terampil D3 60 23 20 26 26 7 87 100% 87 1,624,481 0 1,624,481 16,245 581 1,607,655 21

22 Raupa, AMd. Keb 19750601 200701 2 013 II Bidan Terampil D3 60 25 20 26 26 80 100% 80 1,493,775 0 1,493,775 14,938 581 1,478,257 22

23 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 26 26 90 100% 90 1,680,497 84,025 1,596,472 16,805 654 1,579,013 23

24 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 26 26 80 100% 80 1,493,775 74,689 1,419,087 14,938 581 1,403,568 24

25 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 26 26 80 100% 80 1,493,775 74,689 1,419,087 14,938 581 1,403,568 25

26 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 26 26 2 82 100% 82 1,531,120 0 1,531,120 15,311 581 1,515,228 26

27 Sri Handini, AMd. Keb 19740715 200701 2 016 II Bidan Terampil D3 60 25 20 26 26 80 100% 80 1,493,775 0 1,493,775 14,938 581 1,478,257 27

28 Vera Faridah, AMd.Keb. 19780822 200701 2 007 II Bidan Terampil D3 60 23 15 26 26 75 100% 75 1,400,414 0 1,400,414 14,004 545 1,385,865 28

29 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 26 26 50 5 120 100% 120 2,240,663 112,033 2,128,630 22,407 832 2,105,391 29

30 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 II Bidan Terampil D3 60 25 20 26 26 80 100% 80 1,493,775 0 1,493,775 14,938 581 1,478,257 30

31 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 26 26 4 104 100% 104 1,941,908 97,095 1,844,813 19,419 726 1,824,668 31

32 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 26 26 70 100% 70 1,307,053 0 1,307,053 13,071 508 1,293,475 32

33 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 26 26 75 100% 75 1,400,414 0 1,400,414 14,004 545 1,385,865 33

34 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 25 15 10 26 26 35 100% 35 653,527 0 653,527 6,535 508 646,483 34

35 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 26 26 75 100% 75 1,400,414 0 1,400,414 14,004 545 1,385,865 35

36 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 26 26 2 77 100% 77 1,437,759 0 1,437,759 14,378 545 1,422,836 36

37 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 26 26 70 100% 70 1,307,053 0 1,307,053 13,071 508 1,293,475 37

38 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 26 26 70 100% 70 1,307,053 0 1,307,053 13,071 508 1,293,475 38

39 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 26 26 61 100% 61 1,139,004 0 1,139,004 11,390 443 1,127,171 39

40 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 26 26 101 100% 101 1,885,891 94,295 1,791,597 18,859 734 1,772,004 40

41 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 26 26 2 87 100% 87 1,624,481 81,224 1,543,257 16,245 617 1,526,395 41

42 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 26 26 80 100% 80 1,493,775 74,689 1,419,087 14,938 581 1,403,568 42

43 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 26 26 65 100% 65 1,213,692 60,685 1,153,008 12,137 472 1,140,399 43

44 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 26 26 70 100% 70 1,307,053 65,353 1,241,701 13,071 508 1,228,122 44

45 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 26 26 2 63 100% 63 1,176,348 0 1,176,348 11,763 443 1,164,142 45

46 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 26 26 4 49 100% 49 914,937 45,747 869,191 9,149 341 859,700 46

47 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 26 26 50 100% 50 933,610 46,680 886,929 9,336 363 877,230 47

48 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 26 26 7 47 100% 47 877,593 43,880 833,713 833,713 48

49 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 26 26 4 44 100% 44 821,576 41,079 780,498 780,498 49

50 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 26 26 2 52 100% 52 970,954 48,548 922,406 922,406 50

51 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 2 42 100% 42 784,232 39,212 745,020 745,020 51

52 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 52

53 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 53

54 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 54

55 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 55

56 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 56

57 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 57

58 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 58

59 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 26 26 40 100% 40 746,888 37,344 709,543 709,543 59

60 Fatimatuz Zahro, S.KM - PROMKES S1 50 26 26 5 55 100% 55 1,026,971 51,349 975,622 975,622 60

61 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 26 26 2 42 100% 42 784,232 39,212 745,020 745,020 61

62 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 26 26 50 100% 50 933,610 46,680 886,929 886,929 62

63 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 26 26 35 100% 35 653,527 32,676 620,850 620,850 63

64 Doni Fuad - ADMINISTRASI SMK 35 26 26 2 37 100% 37 690,871 34,544 656,328 656,328 64

65 Agus Cahyono - ADMINISTRASI SMA 35 26 26 35 100% 35 653,527 32,676 620,850 620,850 65

66 Muhammad Nur Efendi - ADMINISTRASI SMK 35 26 26 35 100% 35 653,527 32,676 620,850 620,850 66

67 Yunita - ADMINISTRASI SMK 35 26 26 35 100% 35 653,527 32,676 620,850 620,850 67

68 Riyanto - DRIVER SMA 30 26 26 30 100% 30 560,166 28,008 532,157 532,157 68

69 Sunoto - DRIVER SMP 30 26 26 30 100% 30 560,166 28,008 532,157 532,157 69

70 Saiin - CLEANING SERVICE SMA 30 26 26 30 100% 30 560,166 28,008 532,157 532,157 70

71 Sunyoto - CLEANING SERVICE SMA 30 26 26 30 100% 30 560,166 28,008 532,157 532,157 71

72 Heru Gunawan - SCURITY SMA 30 26 26 30 100% 30 560,166 28,008 532,157 532,157 72

4,125 727 587 150 98 4,960 72 4,955 92,523,585 3,317,115 89,206,470 742,435 29,003 88,435,032
 KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA BPJS 1%
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% KURANG BAYAR TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG ( MARET 2022) BULAN TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA FEBRUARI 2022
KERJA AM DIRAN POTONG PPH
AAN POIN

Terbilang : Sembilan Puluh Dua Juta Lima Ratus Dua Puluh Tiga Ribu Lima Ratus Delapan Puluh Lima Rupiah

Pasuruan, 31 Maret 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN APRIL 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 154,034,100
Jumlah Peserta JKN 31,214 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 92,420,460
Jumlah Besaran Kapitasi 4,950 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 61,613,640
BULAN Apr-22

KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% ( April TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 25 25 100 255 100% 255 4,656,522 232,826 4,423,696 46,565 4,377,131 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 21 25 160 84% 134 2,454,261 122,713 2,331,548 24,543 2,307,005 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 22 25 5 156 88% 137 2,506,852 125,343 2,381,510 25,069 2,356,441 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 25 25 151 100% 151 2,757,392 137,870 2,619,522 27,574 2,591,948 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 25 25 80 100% 80 1,460,870 73,043 1,387,826 14,609 1,373,218 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 12 10 25 25 6 76 100% 76 1,387,826 69,391 1,318,435 13,878 1,304,557 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 25 25 4 114 100% 114 2,081,739 104,087 1,977,652 20,817 1,956,835 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 25 25 2 72 100% 72 1,314,783 65,739 1,249,044 13,148 1,235,896 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 25 25 4 79 100% 79 1,442,609 72,130 1,370,478 14,426 1,356,052 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 23 25 2 77 92% 71 1,293,600 64,680 1,228,920 12,936 1,215,984 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 25 25 4 74 100% 74 1,351,304 67,565 1,283,739 13,513 1,270,226 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 25 25 4 69 100% 69 1,260,000 0 1,260,000 12,600 1,247,400 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 24 25 2 103 96% 99 1,805,635 90,282 1,715,353 18,056 1,697,297 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 11 25 2 63 44% 28 506,191 0 506,191 5,062 501,129 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 18 25 4 65 72% 47 854,609 0 854,609 8,546 846,063 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 25 25 105 100% 105 1,917,391 95,870 1,821,522 19,174 1,802,348 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 25 25 2 72 100% 72 1,314,783 65,739 1,249,044 13,148 1,235,896 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 25 25 80 100% 80 1,460,870 73,043 1,387,826 14,609 1,373,218 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 80 20 15 25 25 95 100% 95 1,734,783 86,739 1,648,044 17,348 1,630,696 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 II Bidan Terampil D3 25 25 20 25 25 5 50 100% 50 913,044 0 913,044 9,130 903,913 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 25 25 80 100% 80 1,460,870 0 1,460,870 14,609 1,446,261 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 II Bidan Terampil D3 60 23 20 25 25 7 87 100% 87 1,588,696 0 1,588,696 15,887 1,572,809 22

23 Raupa, AMd. Keb 19750601 200701 2 013 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,460,870 0 1,460,870 14,609 1,446,261 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 25 25 90 100% 90 1,643,478 82,174 1,561,304 16,435 1,544,870 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,460,870 73,043 1,387,826 14,609 1,373,218 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,460,870 73,043 1,387,826 14,609 1,373,218 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 25 25 2 82 100% 82 1,497,391 0 1,497,391 14,974 1,482,418 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,460,870 0 1,460,870 14,609 1,446,261 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 II Bidan Terampil D3 60 23 15 25 25 75 100% 75 1,369,565 0 1,369,565 13,696 1,355,870 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 25 25 50 5 120 100% 120 2,191,305 109,565 2,081,739 21,913 2,059,826 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,460,870 0 1,460,870 14,609 1,446,261 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 25 25 4 104 100% 104 1,899,131 94,957 1,804,174 18,991 1,785,183 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 25 25 70 100% 70 1,278,261 0 1,278,261 12,783 1,265,478 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,369,565 0 1,369,565 13,696 1,355,870 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 25 15 10 25 25 35 100% 35 639,130 0 639,130 6,391 632,739 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,369,565 0 1,369,565 13,696 1,355,870 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 25 25 2 77 100% 77 1,406,087 0 1,406,087 14,061 1,392,026 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 24 25 70 96% 67 1,227,131 0 1,227,131 12,271 1,214,859 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 25 25 70 100% 70 1,278,261 0 1,278,261 12,783 1,265,478 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 25 25 61 100% 61 1,113,913 0 1,113,913 11,139 1,102,774 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 25 25 101 100% 101 1,844,348 92,217 1,752,131 18,443 1,733,687 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 25 25 2 87 100% 87 1,588,696 79,435 1,509,261 15,887 1,493,374 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 25 25 80 100% 80 1,460,870 73,043 1,387,826 14,609 1,373,218 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 25 25 65 100% 65 1,186,957 59,348 1,127,609 11,870 1,115,739 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 25 25 70 100% 70 1,278,261 63,913 1,214,348 12,783 1,201,565 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 25 25 2 63 100% 63 1,150,435 0 1,150,435 11,504 1,138,931 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 25 25 4 49 100% 49 894,783 44,739 850,044 8,948 841,096 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 25 25 50 100% 50 913,044 45,652 867,391 9,130 858,261 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 25 25 61 100% 61 1,113,913 0 1,113,913 11,139 1,102,774 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 7 47 100% 47 858,261 42,913 815,348 815,348 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 4 44 100% 44 803,478 40,174 763,304 763,304 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 25 25 2 52 100% 52 949,565 47,478 902,087 902,087 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 2 42 100% 42 766,957 38,348 728,609 728,609 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 25 25 40 100% 40 730,435 36,522 693,913 693,913 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 25 25 5 55 100% 55 1,004,348 50,217 954,131 954,131 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 25 25 2 42 100% 42 766,957 38,348 728,609 728,609 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 25 25 50 100% 50 913,044 45,652 867,391 867,391 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 25 25 35 100% 35 639,130 31,957 607,174 607,174 65

66 Doni Fuad - ADMINISTRASI SMK 35 25 25 2 37 100% 37 675,652 33,783 641,870 641,870 66

67 Agus Cahyono - ADMINISTRASI SMA 35 25 25 35 100% 35 639,130 31,957 607,174 607,174 67

 KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% ( April TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 25 25 35 100% 35 639,130 31,957 607,174 607,174 68

69 Yunita - ADMINISTRASI SMK 35 25 25 35 100% 35 639,130 31,957 607,174 607,174 69

70 Riyanto - DRIVER SMA 30 25 25 30 100% 30 547,826 27,391 520,435 520,435 70

71 Sunoto - DRIVER SMP 30 25 25 30 100% 30 547,826 27,391 520,435 520,435 71

72 Saiin - CLEANING SERVICE SMA 30 25 25 30 100% 30 547,826 27,391 520,435 520,435 72

73 Sunyoto - CLEANING SERVICE SMA 30 25 25 30 100% 30 547,826 27,391 520,435 520,435 73

74 Heru Gunawan - SCURITY SMA 30 25 25 30 100% 30 547,826 27,391 520,435 520,435 74

4,335 727 589 150 98 5,172 73 5,061 92,420,460 3,332,061 89,088,399 745,431 88,342,968

Terbilang : Sembilan Puluh Dua Juta Empat Ratus Dua Puluh Ribu Empat Ratus Enam Puluh Rupiah

Pasuruan, 30 April 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN MEI 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 167,197,225
Jumlah Peserta JKN 31,038 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 100,318,335
Jumlah Besaran Kapitasi 5,400 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 66,878,890
BULAN MEI 22

KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% ( MEI TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 18 18 100 255 100% 255 5,000,393 250,020 4,750,373 50,004 4,700,369 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 18 18 160 100% 160 3,137,501 156,875 2,980,626 31,375 2,949,251 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 18 18 5 156 100% 156 3,059,064 152,953 2,906,111 30,591 2,875,520 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 18 18 151 100% 151 2,961,017 148,051 2,812,966 29,610 2,783,356 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 18 18 80 100% 80 1,568,751 78,438 1,490,313 15,688 1,474,626 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 12 10 18 18 6 76 100% 76 1,490,313 74,516 1,415,797 14,903 1,400,894 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 18 18 4 114 100% 114 2,235,470 111,773 2,123,696 22,355 2,101,341 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 18 18 2 72 100% 72 1,411,876 70,594 1,341,282 14,119 1,327,163 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 18 18 4 79 100% 79 1,549,141 77,457 1,471,684 15,491 1,456,193 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 18 18 2 77 100% 77 1,509,922 75,496 1,434,426 15,099 1,419,327 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 18 18 4 74 100% 74 1,451,094 72,555 1,378,540 14,511 1,364,029 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 18 18 4 69 100% 69 1,353,047 0 1,353,047 13,530 1,339,517 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 18 18 2 103 100% 103 2,019,766 100,988 1,918,778 20,198 1,898,580 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 18 18 2 63 100% 63 1,235,391 0 1,235,391 12,354 1,223,037 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 3 18 4 65 17% 11 212,435 0 212,435 2,124 210,311 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 18 18 105 100% 105 2,058,985 102,949 1,956,036 20,590 1,935,446 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 18 18 70 100% 70 1,372,657 68,633 1,304,024 13,727 1,290,297 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 18 18 80 100% 80 1,568,751 78,438 1,490,313 15,688 1,474,626 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 80 20 15 18 18 95 100% 95 1,862,891 93,145 1,769,747 18,629 1,751,118 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 II Bidan Terampil D3 25 25 20 18 18 5 50 100% 50 980,469 0 980,469 9,805 970,664 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 18 18 80 100% 80 1,568,751 0 1,568,751 15,688 1,553,063 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 II Bidan Terampil D3 60 23 20 18 18 7 87 100% 87 1,706,016 0 1,706,016 17,060 1,688,956 22

23 Raupa, AMd. Keb 19750601 200701 2 013 II Bidan Terampil D3 60 25 20 18 18 80 100% 80 1,568,751 0 1,568,751 15,688 1,553,063 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 18 18 90 100% 90 1,764,844 88,242 1,676,602 17,648 1,658,954 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 18 18 80 100% 80 1,568,751 78,438 1,490,313 15,688 1,474,626 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 18 18 80 100% 80 1,568,751 78,438 1,490,313 15,688 1,474,626 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 18 18 2 82 100% 82 1,607,969 0 1,607,969 16,080 1,591,890 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 II Bidan Terampil D3 60 25 20 18 18 80 100% 80 1,568,751 0 1,568,751 15,688 1,553,063 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 II Bidan Terampil D3 60 23 15 18 18 75 100% 75 1,470,704 0 1,470,704 14,707 1,455,997 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 18 18 50 5 120 100% 120 2,353,126 117,656 2,235,470 23,531 2,211,938 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 II Bidan Terampil D3 60 25 20 18 18 80 100% 80 1,568,751 0 1,568,751 15,688 1,553,063 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 18 18 4 104 100% 104 2,039,376 101,969 1,937,407 20,394 1,917,013 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 18 18 70 100% 70 1,372,657 0 1,372,657 13,727 1,358,930 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 18 18 75 100% 75 1,470,704 0 1,470,704 14,707 1,455,997 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 25 15 10 18 18 35 100% 35 686,328 0 686,328 6,863 679,465 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 18 18 75 100% 75 1,470,704 0 1,470,704 14,707 1,455,997 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 18 18 2 77 100% 77 1,509,922 0 1,509,922 15,099 1,494,823 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 18 18 70 100% 70 1,372,657 0 1,372,657 13,727 1,358,930 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 18 18 70 100% 70 1,372,657 0 1,372,657 13,727 1,358,930 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 18 18 61 100% 61 1,196,172 0 1,196,172 11,962 1,184,211 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 18 18 101 100% 101 1,980,548 99,027 1,881,520 19,805 1,861,715 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 18 18 2 87 100% 87 1,706,016 85,301 1,620,716 17,060 1,603,655 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 18 18 80 100% 80 1,568,751 78,438 1,490,313 15,688 1,474,626 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 18 18 65 100% 65 1,274,610 63,730 1,210,879 12,746 1,198,133 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 18 18 70 100% 70 1,372,657 68,633 1,304,024 13,727 1,290,297 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 18 18 2 63 100% 63 1,235,391 0 1,235,391 12,354 1,223,037 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 18 18 4 49 100% 49 960,860 48,043 912,817 9,609 903,208 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 18 18 50 100% 50 980,469 49,023 931,446 9,805 921,641 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 18 18 61 100% 61 1,196,172 0 1,196,172 11,962 1,184,211 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 18 18 7 47 100% 47 921,641 46,082 875,559 875,559 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 18 18 4 44 100% 44 862,813 43,141 819,672 819,672 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 18 18 2 52 100% 52 1,019,688 50,984 968,704 968,704 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 18 18 2 42 100% 42 823,594 41,180 782,414 782,414 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 18 18 40 100% 40 784,375 39,219 745,157 745,157 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 18 18 5 55 100% 55 1,078,516 53,926 1,024,590 1,024,590 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 18 18 2 42 100% 42 823,594 41,180 782,414 782,414 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 18 18 50 100% 50 980,469 49,023 931,446 931,446 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 18 18 35 100% 35 686,328 34,316 652,012 652,012 65

66 Doni Fuad - ADMINISTRASI SMK 35 18 18 2 37 100% 37 725,547 36,277 689,270 689,270 66

67 Agus Cahyono - ADMINISTRASI SMA 35 18 18 35 100% 35 686,328 34,316 652,012 652,012 67

 KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% ( MEI TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 18 18 35 100% 35 686,328 34,316 652,012 652,012 68

69 Yunita - ADMINISTRASI SMK 35 18 18 35 100% 35 686,328 34,316 652,012 652,012 69

70 Riyanto - DRIVER SMA 30 18 18 30 100% 30 588,281 29,414 558,867 558,867 70

71 Sunoto - DRIVER SMP 30 18 18 30 100% 30 588,281 29,414 558,867 558,867 71

72 Saiin - CLEANING SERVICE SMA 30 18 18 30 100% 30 588,281 29,414 558,867 558,867 72

73 Sunyoto - CLEANING SERVICE SMA 30 18 18 30 100% 30 588,281 29,414 558,867 558,867 73

74 Heru Gunawan - SCURITY SMA 30 18 18 30 100% 30 588,281 29,414 558,867 558,867 74

4,335 727 589 150 96 5,170 73 5,116 100,318,335 3,629,697 96,688,638 811,207 95,877,431

Terbilang : SERATUS JUTA TIGA RATUS DELAPAN BELAS RIBU TIGA RATUS TIGA PULUH LIMA RIBU RUPIAH

Pasuruan, 31 Mei 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN JUNI 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 166,033,800
Jumlah Peserta JKN 30,747 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 99,620,280
Jumlah Besaran Kapitasi 5,400 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 66,413,520
BULAN JUNI 2022

KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% ( JUNI TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 25 25 100 255 100% 255 5,177,052 258,853 4,918,199 51,771 4,866,429 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 25 25 160 100% 160 3,248,346 162,417 3,085,929 32,483 3,053,445 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 25 25 5 156 100% 156 3,167,138 158,357 3,008,781 31,671 2,977,109 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 5 25 151 20% 30 613,125 30,656 582,469 6,131 576,338 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 25 25 80 100% 80 1,624,173 81,209 1,542,964 16,242 1,526,723 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 12 10 25 25 6 76 100% 76 1,542,964 77,148 1,465,816 15,430 1,450,387 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 25 25 4 114 100% 114 2,314,447 115,722 2,198,724 23,144 2,175,580 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 25 25 2 72 100% 72 1,461,756 73,088 1,388,668 14,618 1,374,050 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 25 25 4 79 100% 79 1,603,871 80,194 1,523,677 16,039 1,507,639 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 25 25 2 77 100% 77 1,563,267 78,163 1,485,103 15,633 1,469,471 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 25 25 4 74 100% 74 1,502,360 75,118 1,427,242 15,024 1,412,218 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 25 25 4 69 100% 69 1,400,849 0 1,400,849 14,008 1,386,841 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 25 25 2 103 100% 103 2,091,123 104,556 1,986,567 20,911 1,965,655 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 19 25 2 63 76% 48 972,068 0 972,068 9,721 962,347 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 3 25 4 65 12% 8 158,357 0 158,357 1,584 156,773 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 25 25 105 100% 105 2,131,727 106,586 2,025,141 21,317 2,003,824 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 25 25 70 100% 70 1,421,151 71,058 1,350,094 14,212 1,335,882 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 25 24 20 25 25 45 100% 45 913,597 45,680 867,917 9,136 858,782 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 80 20 15 25 25 95 100% 95 1,928,706 96,435 1,832,270 19,287 1,812,983 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 II Bidan Terampil D3 25 25 20 25 25 5 50 100% 50 1,015,108 0 1,015,108 10,151 1,004,957 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 25 25 80 100% 80 1,624,173 0 1,624,173 16,242 1,607,931 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 II Bidan Terampil D3 60 23 20 25 25 7 87 100% 87 1,766,288 0 1,766,288 17,663 1,748,625 22

23 Raupa, AMd. Keb 19750601 200701 2 013 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,624,173 0 1,624,173 16,242 1,607,931 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 25 25 90 100% 90 1,827,195 91,360 1,735,835 18,272 1,717,563 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 25 22 20 25 25 45 100% 45 913,597 45,680 867,917 9,136 858,782 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,624,173 81,209 1,542,964 16,242 1,526,723 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 25 25 2 82 100% 82 1,664,777 0 1,664,777 16,648 1,648,130 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,624,173 0 1,624,173 16,242 1,607,931 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 II Bidan Terampil D3 60 23 15 25 25 75 100% 75 1,522,662 0 1,522,662 15,227 1,507,436 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 25 25 50 5 120 100% 120 2,436,260 121,813 2,314,447 24,363 2,290,084 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 II Bidan Terampil D3 60 25 20 25 25 80 100% 80 1,624,173 0 1,624,173 16,242 1,607,931 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 25 25 4 104 100% 104 2,111,425 105,571 2,005,854 21,114 1,984,740 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 25 25 70 100% 70 1,421,151 0 1,421,151 14,212 1,406,940 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,522,662 0 1,522,662 15,227 1,507,436 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 25 15 10 25 25 35 100% 35 710,576 0 710,576 7,106 703,470 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,522,662 0 1,522,662 15,227 1,507,436 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 25 25 2 77 100% 77 1,563,267 0 1,563,267 15,633 1,547,634 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 25 25 70 100% 70 1,421,151 0 1,421,151 14,212 1,406,940 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 25 25 70 100% 70 1,421,151 0 1,421,151 14,212 1,406,940 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 25 25 61 100% 61 1,238,432 0 1,238,432 12,384 1,226,048 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 25 25 101 100% 101 2,050,519 102,526 1,947,993 20,505 1,927,487 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 25 25 2 87 100% 87 1,766,288 88,314 1,677,974 17,663 1,660,311 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 25 25 80 100% 80 1,624,173 81,209 1,542,964 16,242 1,526,723 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 25 25 65 100% 65 1,319,641 65,982 1,253,659 13,196 1,240,462 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 25 25 70 100% 70 1,421,151 71,058 1,350,094 14,212 1,335,882 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 25 25 2 63 100% 63 1,279,036 0 1,279,036 12,790 1,266,246 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 25 25 4 49 100% 49 994,806 49,740 945,066 9,948 935,118 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 25 25 50 100% 50 1,015,108 50,755 964,353 10,151 954,202 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 25 25 61 100% 61 1,238,432 0 1,238,432 12,384 1,226,048 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 7 47 100% 47 954,202 47,710 906,492 906,492 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 4 44 100% 44 893,295 44,665 848,630 848,630 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 25 25 2 52 100% 52 1,055,713 52,786 1,002,927 1,002,927 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 2 42 100% 42 852,691 42,635 810,056 810,056 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 25 25 40 100% 40 812,087 40,604 771,482 771,482 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 25 25 5 55 100% 55 1,116,619 55,831 1,060,788 1,060,788 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 25 25 2 42 100% 42 852,691 42,635 810,056 810,056 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 25 25 50 100% 50 1,015,108 50,755 964,353 964,353 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 25 25 35 100% 35 710,576 35,529 675,047 675,047 65

66 Doni Fuad - ADMINISTRASI SMK 35 25 25 2 37 100% 37 751,180 37,559 713,621 713,621 66

67 Agus Cahyono - ADMINISTRASI SMA 35 25 25 35 100% 35 710,576 35,529 675,047 675,047 67

 KEHADIRAN

JUMLAH JUMLA
TANGG PERSE JASA
MASA RANGKAP POIN H JASA
JENIS POIN JML UNG N- PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS VARIABE TOTAL PELAYANAN BPJS 1% ( JUNI TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI JAWAB TASE PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- L SELUR YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF KETENAG UH DITERIMA
KERJA AM DIRAN POTONG PPH
AAN POIN

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 25 25 35 100% 35 710,576 35,529 675,047 675,047 68

69 Yunita - ADMINISTRASI SMK 35 25 25 35 100% 35 710,576 35,529 675,047 675,047 69

70 Riyanto - DRIVER SMA 30 25 25 30 100% 30 609,065 30,453 578,612 578,612 70

71 Sunoto - DRIVER SMP 30 25 25 30 100% 30 609,065 30,453 578,612 578,612 71

72 Saiin - CLEANING SERVICE SMA 30 25 25 30 100% 30 609,065 30,453 578,612 578,612 72

73 Sunyoto - CLEANING SERVICE SMA 30 25 25 30 100% 30 609,065 30,453 578,612 578,612 73

74 Heru Gunawan - SCURITY SMA 30 25 25 30 100% 30 609,065 30,453 578,612 578,612 74

4,265 727 589 150 96 5,100 72 4,907 99,620,280 3,564,248 96,056,032 797,445 95,258,588

Terbilang : SEMBILAN PULUH SEMBILAN JUTA ENAM RATUS DUA PULUH RIBU DUA RATUS DELAPAN PULUH RUPIAH

Pasuruan, 30 Juni 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN JULI 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 168,069,600
Jumlah Peserta JKN 31,124 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 100,841,760
Jumlah Besaran Kapitasi 5,400 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 67,227,840
BULAN JULI 2022

KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN BPJS 1% ( JULI TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 24 24 100 255 100% 255 5,040,852 252,043 4,788,810 50,212 4,738,598 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 24 24 7 167 100% 167 3,301,264 165,063 3,136,201 32,884 3,103,317 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 24 24 7 158 100% 158 3,123,352 156,168 2,967,184 31,112 2,936,073 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 24 24 5 156 100% 156 3,083,816 154,191 2,929,625 30,718 2,898,907 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 24 24 80 100% 80 1,581,444 79,072 1,502,372 15,753 1,486,619 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 15 10 24 24 6 76 100% 76 1,502,372 75,119 1,427,253 14,965 1,412,288 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 21 24 9 119 88% 104 2,058,348 102,917 1,955,431 20,503 1,934,928 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 24 24 2 72 100% 72 1,423,300 71,165 1,352,135 14,177 1,337,957 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 24 24 4 79 100% 79 1,561,676 78,084 1,483,592 15,556 1,468,036 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 24 24 4 79 100% 79 1,561,676 78,084 1,483,592 15,556 1,468,036 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 24 24 2 72 100% 72 1,423,300 71,165 1,352,135 14,177 1,337,957 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 24 24 2 67 100% 67 1,324,459 0 1,324,459 13,193 1,311,266 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 24 24 4 105 100% 105 2,075,645 103,782 1,971,863 20,675 1,951,187 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 24 24 2 63 100% 63 1,245,387 0 1,245,387 12,405 1,232,982 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 11 24 2 63 46% 29 570,802 0 570,802 5,686 565,117 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 24 24 105 100% 105 2,075,645 103,782 1,971,863 20,675 1,951,187 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 24 24 2 72 100% 72 1,423,300 71,165 1,352,135 14,177 1,337,957 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 21 24 80 88% 70 1,383,763 69,188 1,314,575 13,784 1,300,792 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 60 20 15 24 24 75 100% 75 1,482,604 74,130 1,408,473 18,706 1,389,767 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 III Bidan Terampil D3 25 21 20 24 24 5 50 100% 50 988,402 49,420 938,982 9,845 929,137 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 24 24 2 82 100% 82 1,620,980 0 1,620,980 16,146 1,604,834 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 III Bidan Terampil D3 60 19 15 24 24 7 82 100% 82 1,620,980 81,049 1,539,931 16,146 1,523,785 22

23 Raupa, AMd. Keb 19750601 200701 2 013 III Bidan Terampil D3 60 21 20 24 24 80 100% 80 1,581,444 79,072 1,502,372 15,753 1,486,619 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 23 24 90 96% 86 1,704,994 85,250 1,619,745 16,983 1,602,761 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 24 24 80 100% 80 1,581,444 79,072 1,502,372 15,753 1,486,619 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 24 24 80 100% 80 1,581,444 79,072 1,502,372 15,753 1,486,619 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 24 24 2 82 100% 82 1,620,980 0 1,620,980 16,146 1,604,834 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 III Bidan Terampil D3 60 20 15 24 24 75 100% 75 1,482,604 74,130 1,408,473 14,768 1,393,705 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 III Bidan Terampil D3 60 19 15 24 24 2 77 100% 77 1,522,140 76,107 1,446,033 15,162 1,430,871 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 24 24 50 5 120 100% 120 2,372,166 118,608 2,253,558 23,629 2,229,929 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 III Bidan Terampil D3 60 21 20 24 24 80 100% 80 1,581,444 79,072 1,502,372 15,753 1,486,619 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 24 24 2 102 100% 102 2,016,341 100,817 1,915,524 20,085 1,895,439 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 24 24 70 100% 70 1,383,763 0 1,383,763 13,784 1,369,980 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 24 24 75 100% 75 1,482,604 0 1,482,604 14,768 1,467,836 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 25 15 10 24 24 35 100% 35 691,882 0 691,882 6,892 684,990 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 24 24 75 100% 75 1,482,604 0 1,482,604 14,768 1,467,836 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 24 24 2 77 100% 77 1,522,140 0 1,522,140 15,162 1,506,978 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 24 24 70 100% 70 1,383,763 0 1,383,763 13,784 1,369,980 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 24 24 70 100% 70 1,383,763 0 1,383,763 13,784 1,369,980 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 24 24 61 100% 61 1,205,851 0 1,205,851 12,011 1,193,840 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 24 24 2 103 100% 103 2,036,109 101,805 1,934,304 20,282 1,914,022 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 24 24 4 89 100% 89 1,759,356 87,968 1,671,389 17,525 1,653,864 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 60 24 20 24 24 2 82 100% 82 1,620,980 81,049 1,539,931 16,146 1,523,785 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 24 24 2 67 100% 67 1,324,459 66,223 1,258,236 13,193 1,245,043 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 24 24 70 100% 70 1,383,763 69,188 1,314,575 13,784 1,300,792 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 24 24 61 100% 61 1,205,851 0 1,205,851 12,011 1,193,840 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 24 24 4 49 100% 49 968,634 48,432 920,203 9,649 910,554 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 24 24 50 100% 50 988,402 49,420 938,982 9,845 929,137 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 24 24 61 100% 61 1,205,851 0 1,205,851 12,011 1,193,840 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 24 24 2 42 100% 42 830,258 41,513 788,745 788,745 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 24 24 4 44 100% 44 869,794 43,490 826,304 826,304 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 24 24 5 55 100% 55 1,087,243 54,362 1,032,881 1,032,881 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 24 24 2 42 100% 42 830,258 41,513 788,745 788,745 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 24 24 40 100% 40 790,722 39,536 751,186 751,186 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 24 24 2 42 100% 42 830,258 41,513 788,745 788,745 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 24 24 2 52 100% 52 1,027,939 51,397 976,542 976,542 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 24 24 2 42 100% 42 830,258 41,513 788,745 788,745 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 24 24 50 100% 50 988,402 49,420 938,982 938,982 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 24 24 35 100% 35 691,882 34,594 657,288 657,288 65

66 Doni Fuad - ADMINISTRASI SMK 35 24 24 2 37 100% 37 731,418 36,571 694,847 694,847 66

67 Agus Cahyono - ADMINISTRASI SMA 35 24 24 35 100% 35 691,882 34,594 657,288 657,288 67

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 24 24 35 100% 35 691,882 34,594 657,288 657,288 68

69 Yunita - ADMINISTRASI SMK 35 24 24 35 100% 35 691,882 34,594 657,288 657,288 69

 KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN BPJS 1% ( JULI TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG 2022) TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

70 Riyanto - DRIVER SMA 30 24 24 30 100% 30 593,041 29,652 563,389 563,389 70

71 Sunoto - DRIVER SMP 30 24 24 30 100% 30 593,041 29,652 563,389 563,389 71

72 Saiin - CLEANING SERVICE SMA 30 24 24 30 100% 30 593,041 29,652 563,389 563,389 72

73 Sunyoto - CLEANING SERVICE SMA 30 24 24 30 100% 30 593,041 29,652 563,389 563,389 73

74 Heru Gunawan - SCURITY SMA 30 24 24 30 100% 30 593,041 29,652 563,389 563,389 74

4,315 705 579 150 120 5,164 73 5,101 100,841,760 4,075,554 96,766,206 816,235 95,949,971

Terbilang : SERATUS JUTA DELAPAN RATUS EMPAT PULUH SATU RIBU TUJUH RATUS ENAM PULUH RUPIAH

Pasuruan, 31 Juli 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN AGUSTUS 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 167,772,600
Jumlah Peserta JKN 31,069 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 100,663,560
Jumlah Besaran Kapitasi 5,400 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 67,109,040
BULAN AGUSTUS 2022

KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN BPJS 1% TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG ( AGUSTUS 2022) TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 26 26 100 255 100% 255 5,004,720 250,236 4,754,484 50,047 4,704,437 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 26 26 7 167 100% 167 3,277,601 163,880 3,113,721 32,776 3,080,945 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 26 26 7 158 100% 158 3,100,964 155,048 2,945,915 31,010 2,914,906 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 26 26 5 156 100% 156 3,061,711 153,086 2,908,625 30,617 2,878,008 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 26 26 80 100% 80 1,570,108 78,505 1,491,603 15,701 1,475,902 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 15 10 26 26 6 76 100% 76 1,491,603 74,580 1,417,023 14,916 1,402,107 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 26 26 9 119 100% 119 2,335,536 116,777 2,218,759 23,355 2,195,404 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 26 26 2 72 100% 72 1,413,097 70,655 1,342,442 14,131 1,328,312 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 26 26 4 79 100% 79 1,550,482 77,524 1,472,958 15,505 1,457,453 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 26 26 4 79 100% 79 1,550,482 77,524 1,472,958 15,505 1,457,453 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 26 26 2 72 100% 72 1,413,097 70,655 1,342,442 14,131 1,328,312 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 26 26 2 67 100% 67 1,314,966 0 1,314,966 13,150 1,301,816 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 26 26 4 105 100% 105 2,060,767 103,038 1,957,729 20,608 1,937,121 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 26 26 2 63 100% 63 1,236,460 0 1,236,460 12,365 1,224,096 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 26 26 2 63 100% 63 1,236,460 0 1,236,460 12,365 1,224,096 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 26 26 105 100% 105 2,060,767 103,038 1,957,729 20,608 1,937,121 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 26 26 2 72 100% 72 1,413,097 70,655 1,342,442 14,131 1,328,312 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 26 26 80 100% 80 1,570,108 78,505 1,491,603 15,701 1,475,902 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 25 20 15 26 26 40 100% 40 785,054 39,253 745,801 7,851 737,951 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 III Bidan Terampil D3 25 21 20 26 26 5 50 100% 50 981,318 49,066 932,252 9,813 922,439 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 26 26 2 82 100% 82 1,609,361 0 1,609,361 16,094 1,593,267 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 III Bidan Terampil D3 60 19 15 26 26 7 82 100% 82 1,609,361 80,468 1,528,893 16,094 1,512,799 22

23 Raupa, AMd. Keb 19750601 200701 2 013 III Bidan Terampil D3 60 21 20 26 26 80 100% 80 1,570,108 78,505 1,491,603 15,701 1,475,902 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 26 26 90 100% 90 1,766,372 88,319 1,678,053 17,664 1,660,389 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 26 26 80 100% 80 1,570,108 78,505 1,491,603 15,701 1,475,902 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 26 26 80 100% 80 1,570,108 78,505 1,491,603 15,701 1,475,902 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 26 26 2 82 100% 82 1,609,361 0 1,609,361 16,094 1,593,267 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 III Bidan Terampil D3 60 20 15 26 26 75 100% 75 1,471,976 73,599 1,398,378 14,720 1,383,658 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 III Bidan Terampil D3 60 19 15 26 26 2 77 100% 77 1,511,229 75,561 1,435,668 15,112 1,420,555 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 26 26 50 5 120 100% 120 2,355,162 117,758 2,237,404 23,552 2,213,853 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 III Bidan Terampil D3 60 21 20 26 26 80 100% 80 1,570,108 78,505 1,491,603 15,701 1,475,902 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 26 26 2 102 100% 102 2,001,888 100,094 1,901,794 20,019 1,881,775 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 26 26 70 100% 70 1,373,845 0 1,373,845 13,738 1,360,106 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 26 26 75 100% 75 1,471,976 0 1,471,976 14,720 1,457,257 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 60 15 10 26 26 70 100% 70 1,373,845 0 1,373,845 13,738 1,360,106 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 26 26 75 100% 75 1,471,976 0 1,471,976 14,720 1,457,257 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 26 26 2 77 100% 77 1,511,229 0 1,511,229 15,112 1,496,117 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 26 26 70 100% 70 1,373,845 0 1,373,845 13,738 1,360,106 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 26 26 70 100% 70 1,373,845 0 1,373,845 13,738 1,360,106 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 26 26 61 100% 61 1,197,207 0 1,197,207 11,972 1,185,235 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 26 26 2 103 100% 103 2,021,514 101,076 1,920,439 20,215 1,900,223 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 26 26 4 89 100% 89 1,746,745 87,337 1,659,408 17,467 1,641,941 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 25 24 20 26 26 2 47 100% 47 922,439 46,122 876,317 9,224 867,092 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 26 26 2 67 100% 67 1,314,966 65,748 1,249,217 13,150 1,236,068 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 26 26 70 100% 70 1,373,845 68,692 1,305,152 13,738 1,291,414 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 26 26 61 100% 61 1,197,207 0 1,197,207 11,972 1,185,235 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 26 26 4 49 100% 49 961,691 48,085 913,607 9,617 903,990 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 26 26 50 100% 50 981,318 49,066 932,252 9,813 922,439 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 26 26 61 100% 61 1,197,207 0 1,197,207 11,972 1,185,235 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 26 26 2 42 100% 42 824,307 41,215 783,091 783,091 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 26 26 4 44 100% 44 863,559 43,178 820,382 820,382 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 26 26 5 55 100% 55 1,079,449 53,972 1,025,477 1,025,477 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 2 42 100% 42 824,307 41,215 783,091 783,091 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 26 26 40 100% 40 785,054 39,253 745,801 745,801 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 26 26 2 42 100% 42 824,307 41,215 783,091 783,091 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 26 26 2 52 100% 52 1,020,570 51,029 969,542 969,542 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 26 26 2 42 100% 42 824,307 41,215 783,091 783,091 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 26 26 50 100% 50 981,318 49,066 932,252 932,252 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 26 26 35 100% 35 686,922 34,346 652,576 652,576 65

66 Doni Fuad - ADMINISTRASI SMK 35 26 26 2 37 100% 37 726,175 36,309 689,866 689,866 66

67 Agus Cahyono - ADMINISTRASI SMA 35 26 26 35 100% 35 686,922 34,346 652,576 652,576 67

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 26 26 35 100% 35 686,922 34,346 652,576 652,576 68

69 Yunita - ADMINISTRASI SMK 35 26 26 35 100% 35 686,922 34,346 652,576 652,576 69

 KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN BPJS 1% TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG ( AGUSTUS 2022) TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

70 Riyanto - DRIVER SMA 30 26 26 30 100% 30 588,791 29,440 559,351 559,351 70

71 Sunoto - DRIVER SMP 30 26 26 30 100% 30 588,791 29,440 559,351 559,351 71

72 Saiin - CLEANING SERVICE SMA 30 26 26 30 100% 30 588,791 29,440 559,351 559,351 72

73 Sunyoto - CLEANING SERVICE SMA 30 26 26 30 100% 30 588,791 29,440 559,351 559,351 73

74 Heru Gunawan - SCURITY SMA 30 26 26 30 100% 30 588,791 29,440 559,351 559,351 74

4,280 705 579 150 120 5,129 74 5,129 100,663,560 4,005,738 96,657,822 815,082 95,842,739

Terbilang : SERATUS ENAM PULUH ENAM JUTA TIGA RIBU LIMA RATUS ENAM PULUH RUPIAH

Pasuruan, 31 Agustus 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN SEPTEMBER 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 168,490,800
Jumlah Peserta JKN 31,202 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 101,094,480
Jumlah Besaran Kapitasi 5,400 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 67,396,320
BULAN Sep-22

KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN BPJS 1% JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA ( SEPTEMBER PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH 2022) YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 26 26 100 255 100% 255 5,045,440 252,272 4,793,168 50,454 4,742,713 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 24 26 7 167 92% 154 3,050,094 152,505 2,897,589 30,501 2,867,088 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 26 26 2 153 100% 153 3,027,264 151,363 2,875,901 30,273 2,845,628 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 26 26 6 157 100% 157 3,106,408 155,320 2,951,088 31,064 2,920,024 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 26 26 80 100% 80 1,582,883 79,144 1,503,739 15,829 1,487,910 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 15 10 26 26 6 76 100% 76 1,503,739 75,187 1,428,552 15,037 1,413,515 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 26 26 8 118 100% 118 2,334,753 116,738 2,218,015 23,348 2,194,667 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 26 26 2 72 100% 72 1,424,595 71,230 1,353,365 14,246 1,339,119 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 26 26 4 79 100% 79 1,563,097 78,155 1,484,942 15,631 1,469,311 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 26 26 6 81 100% 81 1,602,669 80,133 1,522,536 16,027 1,506,509 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 26 26 4 74 100% 74 1,464,167 73,208 1,390,958 14,642 1,376,317 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 26 26 2 67 100% 67 1,325,665 0 1,325,665 13,257 1,312,408 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 26 26 4 105 100% 105 2,077,534 103,877 1,973,657 20,775 1,952,882 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 26 26 2 63 100% 63 1,246,520 0 1,246,520 12,465 1,234,055 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 26 26 2 63 100% 63 1,246,520 0 1,246,520 12,465 1,234,055 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 26 26 105 100% 105 2,077,534 103,877 1,973,657 20,775 1,952,882 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 26 26 2 72 100% 72 1,424,595 71,230 1,353,365 14,246 1,339,119 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 26 26 80 100% 80 1,582,883 79,144 1,503,739 15,829 1,487,910 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 25 20 15 26 26 40 100% 40 791,442 39,572 751,869 7,914 743,955 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 III Bidan Terampil D3 60 21 20 26 26 5 85 100% 85 1,681,813 84,091 1,597,723 16,818 1,580,904 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 26 26 2 82 100% 82 1,622,455 0 1,622,455 16,225 1,606,231 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 III Bidan Terampil D3 60 19 15 26 26 7 82 100% 82 1,622,455 81,123 1,541,332 16,225 1,525,108 22

23 Raupa, AMd. Keb 19750601 200701 2 013 III Bidan Terampil D3 60 21 20 26 26 80 100% 80 1,582,883 79,144 1,503,739 15,829 1,487,910 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 26 26 90 100% 90 1,780,743 89,037 1,691,706 17,807 1,673,899 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 26 26 80 100% 80 1,582,883 79,144 1,503,739 15,829 1,487,910 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 26 26 80 100% 80 1,582,883 79,144 1,503,739 15,829 1,487,910 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 26 26 2 82 100% 82 1,622,455 0 1,622,455 16,225 1,606,231 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 III Bidan Terampil D3 60 20 15 26 26 75 100% 75 1,483,953 74,198 1,409,755 14,840 1,394,916 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 III Bidan Terampil D3 60 19 15 26 26 2 77 100% 77 1,523,525 76,176 1,447,349 15,235 1,432,113 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 26 26 50 7 122 100% 122 2,413,897 120,695 2,293,202 24,139 2,269,063 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 III Bidan Terampil D3 60 21 20 26 26 80 100% 80 1,582,883 79,144 1,503,739 15,829 1,487,910 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 26 26 4 104 100% 104 2,057,748 102,887 1,954,861 20,577 1,934,283 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 26 26 70 100% 70 1,385,023 0 1,385,023 13,850 1,371,172 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 26 26 75 100% 75 1,483,953 0 1,483,953 14,840 1,469,113 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 60 15 10 26 26 70 100% 70 1,385,023 0 1,385,023 13,850 1,371,172 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 26 26 75 100% 75 1,483,953 0 1,483,953 14,840 1,469,113 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 26 26 2 77 100% 77 1,523,525 0 1,523,525 15,235 1,508,290 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 26 26 70 100% 70 1,385,023 0 1,385,023 13,850 1,371,172 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 26 26 70 100% 70 1,385,023 0 1,385,023 13,850 1,371,172 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 26 26 61 100% 61 1,206,948 0 1,206,948 12,069 1,194,879 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 26 26 2 103 100% 103 2,037,962 101,898 1,936,064 20,380 1,915,684 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 26 26 4 89 100% 89 1,760,957 88,048 1,672,910 17,610 1,655,300 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 25 24 20 26 26 2 47 100% 47 929,944 46,497 883,447 9,299 874,147 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 26 26 2 67 100% 67 1,325,665 66,283 1,259,381 13,257 1,246,125 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 26 26 70 100% 70 1,385,023 69,251 1,315,772 13,850 1,301,921 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 23 26 61 88% 54 1,067,685 0 1,067,685 10,677 1,057,008 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 26 26 4 49 100% 49 969,516 48,476 921,040 9,695 911,345 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 23 26 50 88% 44 875,152 43,758 831,394 8,752 822,643 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 26 26 61 100% 61 1,206,948 0 1,206,948 12,069 1,194,879 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 26 26 2 42 100% 42 831,014 41,551 789,463 789,463 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 26 26 4 44 100% 44 870,586 43,529 827,056 827,056 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 26 26 4 54 100% 54 1,068,446 53,422 1,015,024 1,015,024 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 2 42 100% 42 831,014 41,551 789,463 789,463 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 26 26 40 100% 40 791,442 39,572 751,869 751,869 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 26 26 2 42 100% 42 831,014 41,551 789,463 789,463 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 26 26 2 52 100% 52 1,028,874 51,444 977,430 977,430 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 26 26 2 42 100% 42 831,014 41,551 789,463 789,463 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 26 26 50 100% 50 989,302 49,465 939,837 939,837 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 3 26 35 12% 4 79,905 3,995 75,910 75,910 65

66 Doni Fuad - ADMINISTRASI SMK 35 26 26 2 37 100% 37 732,083 36,604 695,479 695,479 66

67 Agus Cahyono - ADMINISTRASI SMA 35 26 26 35 100% 35 692,511 34,626 657,886 657,886 67

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 26 26 35 100% 35 692,511 34,626 657,886 657,886 68

69 Yunita - ADMINISTRASI SMK 35 26 26 35 100% 35 692,511 34,626 657,886 657,886 69

 KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN BPJS 1% JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA ( SEPTEMBER PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH 2022) YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

70 Riyanto - DRIVER SMA 30 26 26 30 100% 30 593,581 29,679 563,902 563,902 70

71 Sunoto - DRIVER SMP 30 26 26 30 100% 30 593,581 29,679 563,902 563,902 71

72 Saiin - CLEANING SERVICE SMA 30 26 26 30 100% 30 593,581 29,679 563,902 563,902 72

73 Sunyoto - CLEANING SERVICE SMA 30 26 26 30 100% 30 593,581 29,679 563,902 563,902 73

74 Heru Gunawan - SCURITY SMA 30 26 26 30 100% 30 593,581 29,679 563,902 563,902 74

4,315 705 579 150 122 5,166 73 5,109 101,094,480 4,025,888 97,068,592 824,157 96,244,435

Terbilang : SERATUS SATU JUTA SEMBILAN PULUH EMPAT RIBU EMPAT RATUS DELAPAN PULUH RUPIAH

Pasuruan, 30 September 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009
 PERHITUNGAN JASA LAYANAN MEDIS
BULAN OKTOBER 2022
Nama Puskesmas SUKOREJO Jumlah Kapitasi : 168,490,800
Jumlah Peserta JKN 31,202 Penerimaan Kapitasi untuk Jasa Pelayanan (60%) : 101,094,480
Jumlah Besaran Kapitasi 5,400 Penerimaan Kapitasi untuk Biaya Operasional (40%) : 67,396,320
BULAN Oct-22

KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN BPJS 1% JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA ( SEPTEMBER PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH 2022) YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

1 2 4 5 6 7 8 9 10 11 12 13=7+8+11+12 14=9/10 15=13x14 16 17 18 19 20 19

1 dr.Agus Tri Cahyono 19800826 201001 1 009 III Dokter / Kep FKTP S1 150 10 5 25 25 100 255 100% 255 5,044,121 252,206 4,791,915 50,454 4,741,461 1

2 dr. Hanif Wanadri Kautsar 19830217 201001 1 014 III Dokter Umum S1 150 12 10 25 25 7 167 100% 167 3,303,405 165,170 3,138,235 30,501 3,107,734 2

3 dr. Kerisfi Megah Purnama 198802072019032001 III Dokter Umum S1 150 2 1 21 25 2 153 84% 129 2,542,237 127,112 2,415,125 30,273 2,384,853 3

4 drg.Muhammad Iqbal, S.KG 198905102022031003 III Dokter Gigi S1 150 0 1 25 25 6 157 100% 157 3,105,596 155,280 2,950,317 31,064 2,919,252 4

5 Nur Aini ,A,Md Kep 19690805 199303 2 008 III Perawat Penyelia D3 60 22 20 25 25 80 100% 80 1,582,469 79,123 1,503,346 15,829 1,487,517 5

6 Siti Ulfa Damayanti A,Md.Kep 19781205 200604 2 021 III Perawat Mahir D3 60 15 10 25 25 6 76 100% 76 1,503,346 75,167 1,428,179 15,037 1,413,141 6

7 Dian Eko Prasetyo, S.Kep.Ns 19820320 200501 1 003 III Perawat Penyelia S1 100 13 10 25 25 8 118 100% 118 2,334,142 116,707 2,217,435 23,348 2,194,088 7

8 Qurotul Aini A.Md.Kep 19760710 200604 2 013 III Perawat Penyelia D3 60 12 10 25 25 2 72 100% 72 1,424,223 71,211 1,353,011 14,246 1,338,765 8

9 Erna Suswaningsri A,Md,Kep 19760314 200504 2 013 III Perawat Penyelia D3 60 18 15 25 25 4 79 100% 79 1,562,689 78,134 1,484,554 15,631 1,468,923 9

10 Tatik Mufidah A,Md,Kep 19721013 199803 2 007 III Perawat Penyelia D3 60 18 15 25 25 6 81 100% 81 1,602,250 80,113 1,522,138 16,027 1,506,111 10

11 Sugeng Mariyono, AMd.Kep 19730907 200604 1 014 III Perawat Mahir D3 60 12 10 25 25 4 74 100% 74 1,463,784 73,189 1,390,595 14,642 1,375,953 11

12 Syafitri Miftakhul Jannah, A.Md. Kep 199606072019032004 II Perawat Terampil D3 60 5 5 25 25 2 67 100% 67 1,325,318 0 1,325,318 13,257 1,312,062 12

13 Ayunda Karna Dwi Putra, S.Kep.,Ns 199005032020122017 III Perawat Mahir S1 100 1 1 25 25 4 105 100% 105 2,076,991 103,850 1,973,142 20,775 1,952,366 13

14 Faridatul Ainia, A.Md 199503122020122018 II Perawat Terampil D3 60 1 1 25 25 2 63 100% 63 1,246,195 0 1,246,195 12,465 1,233,730 14

15 Asyifa Felayati Nur Azani, A.Md. Kep 199409262020122018 II Perawat Terampil D3 60 1 1 25 25 2 63 100% 63 1,246,195 0 1,246,195 12,465 1,233,730 15

16 Nuriyati, SST 19660502 198802 2 005 III Bidan Penyelia D4 80 26 25 25 25 105 100% 105 2,076,991 103,850 1,973,142 20,775 1,952,366 16

17 Fransiska Noviana ,A.Md.Keb 19830603 200501 2 007 III Bidan Penyelia D3 60 14 10 25 25 2 72 100% 72 1,424,223 71,211 1,353,011 14,246 1,338,765 17

18 Rahayu Susminarti, AMd.Keb 19730418 199302 2 001 III Bidan Penyelia D3 60 24 20 25 25 80 100% 80 1,582,469 79,123 1,503,346 15,829 1,487,517 18

19 Rini Dwi Utami, SST 19700803 199301 2 001 III Bidan Penyelia D4 25 20 15 25 25 40 100% 40 791,235 39,562 751,673 7,914 743,759 19

20 Nanin Suharti, AMd. Keb 19760225 200701 2 009 III Bidan Terampil D3 60 21 20 25 25 5 85 100% 85 1,681,374 84,069 1,597,305 16,818 1,580,487 20

21 Sari Nurhayati, Amd.Keb 19781115 200801 2 012 II Bidan Terampil D3 60 23 20 25 25 2 82 100% 82 1,622,031 0 1,622,031 16,225 1,605,807 21

22 Lilis Andrini, AMd.Keb. 19770609 200701 2 010 III Bidan Terampil D3 60 19 15 25 25 7 82 100% 82 1,622,031 81,102 1,540,930 16,225 1,524,705 22

23 Raupa, AMd. Keb 19750601 200701 2 013 III Bidan Terampil D3 60 21 20 25 25 80 100% 80 1,582,469 79,123 1,503,346 15,829 1,487,517 23

24 Kamilah ,SST 19791029 200801 2 023 III Bidan Mahir D4 80 14 10 25 25 90 100% 90 1,780,278 89,014 1,691,264 17,807 1,673,457 24

25 Wiwik Asiyah, AMd. Keb 19710503 200504 2 023 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,582,469 79,123 1,503,346 15,829 1,487,517 25

26 Diyah Winarni, AMd.Keb 19690705 200604 2 008 III Bidan Mahir D3 60 22 20 25 25 80 100% 80 1,582,469 79,123 1,503,346 15,829 1,487,517 26

27 Suciati, AMd.Keb 19780908 200801 2 015 II Bidan Terampil D3 60 23 20 25 25 2 82 100% 82 1,622,031 0 1,622,031 16,225 1,605,807 27

28 Sri Handini, AMd. Keb 19740715 200701 2 016 III Bidan Terampil D3 60 20 15 25 25 75 100% 75 1,483,565 74,178 1,409,387 14,840 1,394,547 28

29 Vera Faridah, AMd.Keb. 19780822 200701 2 007 III Bidan Terampil D3 60 19 15 25 25 2 77 100% 77 1,523,127 76,156 1,446,971 15,235 1,431,735 29

30 Mega Fitria Isabella Aditya, AMd. Keb 19890503 201101 2 010 III Bidan Mahir D3 60 8 5 25 25 50 7 122 100% 122 2,413,266 120,663 2,292,603 24,139 2,268,464 30

31 Lilik Yunarsih, AMd. Keb 19750510 200701 2 015 III Bidan Terampil D3 60 21 20 25 25 80 100% 80 1,582,469 79,123 1,503,346 15,829 1,487,517 31

32 Raudlatul Jannah, SST 19721106 200604 2 010 III Bidan Mahir D4 80 22 20 25 25 4 104 100% 104 2,057,210 102,861 1,954,350 20,577 1,933,772 32

33 Fitriah Nur Chamidah AMd.Keb. 19880505 201704 2 005 II Bidan Terampil D3 60 13 10 25 25 70 100% 70 1,384,661 0 1,384,661 13,850 1,370,811 33

34 Inoki Fatmadiyanti, A.Md.Keb 19810807 201704 2 001 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,483,565 0 1,483,565 14,840 1,468,726 34

35 Anita Hidayati, AMd.Keb. 19850116 201704 2 005 II Bidan Terampil D3 60 15 10 25 25 70 100% 70 1,384,661 0 1,384,661 13,850 1,370,811 35

36 Sulistina Rahayu, AMd.Keb. 19820409 201704 2 004 II Bidan Terampil D3 60 17 15 25 25 75 100% 75 1,483,565 0 1,483,565 14,840 1,468,726 36

37 Ulfatul Qomariyah, Amd. Keb 197905142019052001 II Bidan Terampil D3 60 17 15 25 25 2 77 100% 77 1,523,127 0 1,523,127 15,235 1,507,892 37

38 Rahmawati Ayu Purnamasari, Amd. Keb 198101062019052004 II Bidan Terampil D3 60 15 10 25 25 70 100% 70 1,384,661 0 1,384,661 13,850 1,370,811 38

39 Eva Agustina, Amd. Keb 198008012019052001 II Bidan Terampil D3 60 14 10 25 25 70 100% 70 1,384,661 0 1,384,661 13,850 1,370,811 39

40 Istiqomah, A.Md.Keb 198808182020122009 II Bidan Terampil D3 60 4 1 25 25 61 100% 61 1,206,633 0 1,206,633 12,069 1,194,563 40

41 Yanish Aditya Mahendra, S.Farm., Apt 199604282019031001 III Apoteker Ahli Pertama S1 100 2 1 25 25 2 103 100% 103 2,037,429 101,871 1,935,558 20,380 1,915,178 41

42 Windha Titis Prisdhiyan, Amd. AK 19880110 201001 2 013 III Penata Lab. Kes Mahir D4 80 10 5 25 25 4 89 100% 89 1,760,497 88,025 1,672,472 17,610 1,654,863 42

43 Sri Rejeki, A.Md.Gz 19690805 199003 2 006 III Nutrisionist Penyelia D3 25 24 20 25 25 2 47 100% 47 929,701 46,485 883,216 9,299 873,916 43

44 Ery Damayani, A.Md. Kes 19841103 201101 2 011 III Sanitarian Terampil D3 60 8 5 25 25 2 67 100% 67 1,325,318 66,266 1,259,052 13,257 1,245,796 44

45 Ida Zuraidah, A.Md. Farm 19810112 200902 2 004 III Asisten Apoteker Mahir D3 60 13 10 25 25 70 100% 70 1,384,661 69,233 1,315,428 13,850 1,301,578 45

46 Sulistyo Rini, A.Md. RMIK. 198901212020122008 II REKAM MEDIS D3 60 4 1 25 25 61 100% 61 1,206,633 0 1,206,633 10,677 1,195,956 46

47 Mahmud Al Askhar 19660704 199403 1 009 III PEMEGANG PROGRAM P2 SMA 25 21 20 25 25 4 49 100% 49 969,263 48,463 920,799 9,695 911,104 47

48 Subinasri 19650702 198711 2 002 III PETUGAS KASIR SMA 25 28 25 25 25 50 100% 50 989,043 49,452 939,591 8,752 930,840 48

49 Sri Kuswatun Ana, A.Md.Kep 198103252022212001 II Perawat Terampil D3 60 0 1 25 25 61 100% 61 1,206,633 0 1,206,633 12,069 1,194,563 49

50 Sigit Kurniawan, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 2 42 100% 42 830,796 41,540 789,257 789,257 50

51 Reni Indah Setya Purnamasari, Amd.Kep. - PERAWAT PONKESDES D3 40 1 25 25 4 44 100% 44 870,358 43,518 826,840 826,840 51

52 Ina Puspita, S.Kep.Ners. - PELAKSANA KEPERAWATAN S1 50 25 25 4 54 100% 54 1,068,167 53,408 1,014,759 1,014,759 52

53 Yogeswara Probo Pandu Putro, A.Md.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 2 42 100% 42 830,796 41,540 789,257 789,257 53

54 Riky Bagus Prayogo, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 54

55 Siti Zulaikhah, Amd. Kep - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 55

56 Sri Ranista, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 56

57 Heru Setyono, Amd. Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 57

58 Risna Disnanda P P, Amd.Kep. - PELAKSANA KEPERAWATAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 58

59 Devi Nurdiana, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 59

60 Etyk Rofika, A.Md.Keb. - PELAKSANA KEBIDANAN D3 40 25 25 40 100% 40 791,235 39,562 751,673 751,673 60

61 Geva Ajeng Ardianty, Amd. Gz - NUTRISIONIST D3 40 25 25 2 42 100% 42 830,796 41,540 789,257 789,257 61

62 Fatimatuz Zahro, S.KM - PROMKES S1 50 25 25 2 52 100% 52 1,028,605 51,430 977,175 977,175 62

63 Lilia Ayu Nanda, A.Md. Kes - PELAKSANA KESLING D3 40 25 25 2 42 100% 42 830,796 41,540 789,257 789,257 63

64 Fadhillah Aria Digdaya S.Kom - ADMINISTRASI S1 50 25 25 50 100% 50 989,043 49,452 939,591 939,591 64

65 Syilvia Rosyita Dewi - PELAKSANA ANALIS SMK 35 3 25 35 12% 4 83,080 4,154 78,926 78,926 65

66 Doni Fuad - ADMINISTRASI SMK 35 25 25 2 37 100% 37 731,892 36,595 695,298 695,298 66

67 Agus Cahyono - ADMINISTRASI SMA 35 25 25 35 100% 35 692,330 34,617 657,714 657,714 67

68 Muhammad Nur Efendi - ADMINISTRASI SMK 35 25 25 35 100% 35 692,330 34,617 657,714 657,714 68

69 Yunita - ADMINISTRASI SMK 35 25 25 35 100% 35 692,330 34,617 657,714 657,714 69

 KEHADIRAN

TANGG JUMLAH PERSEN JASA

MASA RANGKAP JUMLAH JASA
JENIS POIN JML UNG POIN - PELAYANAN BPJS 1% JASA
PENDIDI KERJA JUMLAH TUGAS JAWAB VARIABEL TASE TOTAL PELAYANAN TANDA
No NAMA PEGAWAI NIP GOLONGAN JABATAN KETENA MASA HARI PPH 21 YANG DITERIMA ( SEPTEMBER PELAYANAN
KAN GOLONG HARI ADMINIS- SELURUH YANG TANGAN
GAAN KERJA MASUK PROGR KETENAG KEHA- SETELAH 2022) YANG DITERIMA
AN KERJA TRATIF POIN DITERIMA
KERJA AM AAN DIRAN POTONG PPH

70 Riyanto - DRIVER SMA 30 25 25 30 100% 30 593,426 29,671 563,755 563,755 70

71 Sunoto - DRIVER SMP 30 25 25 30 100% 30 593,426 29,671 563,755 563,755 71

72 Saiin - CLEANING SERVICE SMA 30 25 25 30 100% 30 593,426 29,671 563,755 563,755 72

73 Sunyoto - CLEANING SERVICE SMA 30 25 25 30 100% 30 593,426 29,671 563,755 563,755 73

74 Heru Gunawan - SCURITY SMA 30 25 25 30 100% 30 593,426 29,671 563,755 563,755 74

4,315 705 579 150 122 5,166 73 5,111 101,094,480 4,019,196 97,075,284 824,157 96,251,127

Terbilang : SERATUS SATU JUTA SEMBILAN PULUH EMPAT RIBU EMPAT RATUS DELAPAN PULUH RUPIAH

Pasuruan, 31 Oktober 2022

Setuju dibayar Lunas dibayar tanggal,
PPTK Puskesmas Sukorejo Bendahara JKN Kepala UOBF Puskesmas Sukorejo

dr.Agus Tri Cahyono Mega Fitria Isabella Aditya, A.Md.Keb dr.Agus Tri Cahyono
NIP.198008262010011009 NIP. 19890503 201101 2 010 NIP.198008262010011009