REKAPITULASI PENERIMAAN HONOR PETUGAS PENUNJANG PELAYANAN KESEHATAN

BULAN MARET 2020

JUMLAH
NO NAMA JABATAN TANDA TANGAN
DITERIMA

1 Bagus Wahya P Petugas Sanitarian Rp 1,152,000 1

2 Ratih Widyawati Bidan Rp 1,400,000 2

3 Dewi Lestari Administrasi Rp 900,000 3

4 Rivan Administrasi Rp 448,000 4

5 Dwi Agung S Perawat Rp 1,078,000 5

6 Cipto Administrasi Rp 1,100,000 6

7 Novandra Perawat Rp 955,500 7

8 Tutik Salasah Bidan Rp 1,056,000 8

9 Zaimah Bidan Rp 1,056,000 9

10 Listiyani Bidan Rp 1,100,000 10

11 Sugiman Administrasi Rp 476,000 11

12 Ngadimin Penjaga Malam Rp 450,000 12

13 dr. Lauza Dokter umum Rp 2,820,000 13

14 dr. Lita Dokter umum Rp 3,000,000 14

15 Karunia Nurul Petugas Gizi Rp 672,000 15

16 Zeni Petugas Laborat Rp 768,000 16

17 Wahyu Larasati Bidan Rp 900,000 17

18 Dewi ratna Widyawati Bidan Rp 900,000 18

19 Wijayanti P Bidan Rp 1,000,000 19

20 Hana Kartika Muhari Bidan Rp 720,000 20

21 Taufiqurrahman Sopir Rp 900,000 21

22 Cicik Nurul Bidan Rp 470,000 22

23 Jumariono Sopir Rp 900,000 23

24 Ninik Bidan Rp 900,000 24

25 Nurul Bidan Rp 900,000 25

26 Nita Ristiyana Bidan Rp 588,000 26

27 Evi Novita Sari Bidan Rp 600,000 27

28 Mardliyah Bidan Rp 750,000 28

29 Nur Chamidah Bidan Rp 700,000 29

30 Puna Ifa Perawat Rp 500,000 30

31 Siti Yulaikah Bidan Rp 900,000 31

32 Mustika Perawat Rp 500,000 32

33 Rini Perawat Rp 588,000 33

34 Parjono Promotor Kesehatan Rp 300,000 34

35 Moh Ali Nurul Alam Sopir Rp 688,000 35

36 Retno Apoteker Rp 900,000 36

JUMLAH Rp 33,035,500

Mengetahui

Kepala Puskesmas Kayen Bendahara Pengeluaran BLUD

dr. Indri Kurnia Sari Wardani

NIP. 19780428 200801 2 015 NIP. 19731029 199301 2 001

 No : 5
Telah terima dari : Bendahara JKN
Banyaknya uang : #NAME?
Guna membayar : Jasa Pelayanan bulan Desember 2018

NIP. 19780428 200801 2 015

Kepala Puskesmas Kayen

dr. Indri Kurnia Sari

Mengetahui

Remunerasi : Rp5,166,550
PPH 21 : Rp258,328
Diterima : Rp4,908,223

No : 6
Telah terima dari : Bendahara JKN
Banyaknya uang : #NAME?
Guna membayar : Jasa Pelayanan bulan Desember 2018
NIP. 19780428 200801 2 015
Kepala Puskesmas Kayen

dr. Indri Kurnia Sari

Mengetahui

Remunerasi : Rp4,217,921
PPH 21 : Rp210,896

Diterima : Rp4,007,025
Pati, 28 Desember 2018
Yang Menerima

dr.M.wahyudin
NIP.19740418 201506 1 001

Pati, 28 Desember 2018

Yang Menerima

Candra Rosanti, SKM

NIP.19880501 201101 2 014
BLUD UPT PUSKESMAS KAYEN
BULAN MARET 2020

a JML PENDAPATAN KAPITASI 273,333,700 RUPIAH

b JML PENDAPATAN NON KAPIT 46,475,500 RUPIAH YANG DIISI HANYA KOLOM
c HARI KERJA 25 HARI YANG DIWARNA KUNING
d JML GAJI NON PNS 33,035,500 RUPIAH
e JML HONOR DEWAS RUPIAH
f JML TUNJANGAN PEJAB NON PNS RUPIAH

jml
SCORE INDIVIDU KINERJA JML SCORE INDIV score TOTAL JML
NAMA / NIP/
NO
JABATAN
KUA KUA KTP INO kehadi % jml
PK JT K AHLI RK TKGD TJ N L T HI V ran Hadir score kenerja SCORE REMUN PPH PENERIMAAN TANDA TANGAN Pot Dana X riil di terima
1 2 3 4 5 6 7 8 9 10 11 12 ### 13 14 15 16 17 18 19 20 21 22
1 dr. Indri.K 26 150 14 25 15 150 230 5 5 5 0 23 0.92 349.6 245 594.6 5,983,187 299,159 5,684,028 1 227,361 5,456,667
2 Salis Diah Rahmawati 26 80 4 25 8 100 150 5 5 5 0 25 1 243 165 408 4,105,517 205,276 3,900,241 2 156,010 3,744,231
3 Drg Sri surtini 35 150 20 20 15 70 225 3 3 4 0 25 1 310 235 545 5,484,085 822,613 4,661,472 3 186,459 4,475,013
4 dr.M.wahyudin 12 150 14 20 15 80 63 3 4 3 0 7 0.28 81.48 73 154.48 1,554,461 77,723 1,476,738 4 59,070 1,417,669
5 Sulistiono budi 45 60 12 16 8 40 175 3 3 3 0 25 1 181 184 365 3,672,828 183,641 3,489,186 5 139,567 3,349,619
6 Tri istiani 18 60 8 16 8 70 164.5 3 3 3 0 23.5 0.94 169.2 173.5 342.7 3,448,433 3,448,433 6 137,937 3,310,496
7 Warsini 45 80 12 16 7 25 138 3 3 3 0 23 0.92 170.2 147 317.2 3,191,838 159,592 3,032,246 7 121,290 2,910,956
8 Slamet Khawadis 45 60 8 4 8 25 62.5 2 2 2 0 12.5 0.5 75 68.5 143.5 1,443,975 72,199 1,371,776 8 54,871 1,316,905
9 Zuwariyah 35 80 10 16 8 50 168 3 3 3 0 24 0.96 191.04 177 368.04 3,703,418 185,171 3,518,247 9 140,730 3,377,517
10 Kaelah 26 80 10 16 8 50 161 3 3 3 0 23 0.92 174.8 170 344.8 3,469,564 173,478 3,296,086 10 131,843 3,164,243
11 Tri Rohmad 45 25 4 8 8 25 87.5 2 2 2 0 17.5 0.7 80.5 93.5 174 1,750,882 1,750,882 11 70,035 1,680,847
12 Junaidi 45 60 10 16 8 25 129 2 2 2 0 21.5 0.86 141.04 135 276.04 2,777,664 138,883 2,638,781 12 105,551 2,533,229
13 RPE.Wulansari 45 60 12 8 8 50 175 3 3 3 0 25 1 183 184 367 3,692,953 184,648 3,508,305 13 140,332 3,367,973
14 Hardi Widiarjoso 45 50 10 16 8 50 171.5 3 2 3 0 24.5 0.98 175.42 179.5 354.92 3,571,397 178,570 3,392,827 14 135,713 3,257,114
15 Dewi karolina 26 60 10 16 8 40 168 3 3 3 0 24 0.96 153.6 177 330.6 3,326,676 166,334 3,160,342 15 126,414 3,033,929
16 Siti Khalimah 35 60 10 16 8 60 171.5 3 3 3 0 24.5 0.98 185.22 180.5 365.72 3,680,073 184,004 3,496,069 16 139,843 3,356,226
17 Sukari 35 60 10 16 8 50 171.5 3 3 3 0 24.5 0.98 175.42 180.5 355.92 3,581,460 179,073 3,402,387 17 136,095 3,266,291
18 Wardani 45 60 12 8 8 70 171.5 3 3 3 0 24.5 0.98 198.94 180.5 379.44 3,818,131 190,907 3,627,224 18 145,089 3,482,135
19 Sumarni 45 60 12 16 8 25 171.5 3 3 3 0 24.5 0.98 162.68 180.5 343.18 3,453,263 172,663 3,280,600 19 131,224 3,149,376
20 Budi Setyowati 45 60 10 16 8 25 175 3 3 3 0 25 1 164 184 348 3,501,764 175,088 3,326,676 20 133,067 3,193,609
21 Enny Anggraeni 35 60 10 16 8 70 171.5 3 3 3 0 24.5 0.98 195.02 180.5 375.52 3,778,685 188,934 3,589,751 21 143,590 3,446,161
22 Mukhayanah 26 60 10 16 8 60 171.5 3 3 3 0 24.5 0.98 176.4 180.5 356.9 3,591,321 179,566 3,411,755 22 136,470 3,275,285
23 Dwi Susilowati 26 60 10 16 8 40 175 3 3 3 0 25 1 160 184 344 3,461,514 173,076 3,288,438 23 131,538 3,156,901
24 Risning K 26 60 10 16 8 25 175 3 3 3 0 25 1 145 184 329 3,310,576 165,529 3,145,047 24 125,802 3,019,245
25 Noorhidayati 18 60 8 16 8 60 171.5 3 3 3 0 24.5 0.98 166.6 180.5 347.1 3,492,708 3,492,708 25 139,708 3,353,000
26 Ika Meilani 26 60 4 16 8 70 150 3 3 3 0 25 1 184 159 343 3,451,452 172,573 3,278,879 26 131,155 3,147,724
27 Pitri 45 25 4 8 8 25 100 3 3 3 0 25 1 115 109 224 2,254,009 2,254,009 27 90,160 2,163,849
28 Ratih Widowati 12 60 8 16 8 40 175 3 3 3 0 25 1 144 184 328 3,300,513 3,300,513 28 132,021 3,168,493
29 Sri Lestari 12 80 10 16 8 40 168 3 3 3 0 24 0.96 159.36 177 336.36 3,384,636 169,232 3,215,405 29 128,616 3,086,788
30 Supriyanto 12 80 12 12 8 80 168 3 3 3 0 24 0.96 195.84 177 372.84 3,751,718 187,586 3,564,132 30 142,565 3,421,567
31 Mustari 12 50 10 8 6 25 154 2 2 2 0 22 0.88 97.68 160 257.68 2,592,916 129,646 2,463,270 31 98,531 2,364,739
32 Ainun Naimah 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 32 122,763 2,946,312
33 Titik ismawati 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 33 122,763 2,946,312
34 Dian Ayu Pangastuti 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 34 122,763 2,946,312
35 Erni Nugrohoningsih 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 35 122,763 2,946,312
36 Ayu Jauhar M 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 36 122,763 2,946,312
37 Murniwati 6 60 6 16 8 25 168 3 3 3 0 24 0.96 116.16 177 293.16 2,949,935 2,949,935 37 117,997 2,831,937
38 Abida Afiyani 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 38 122,763 2,946,312
39 Diah ayu Setyowati 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 39 122,763 2,946,312
40 Ery Diah Lestari 6 60 6 16 8 25 168 3 2 3 0 24 0.96 116.16 176 292.16 2,939,872 2,939,872 40 117,595 2,822,277
41 Feety Sari Fatmawati 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 41 122,763 2,946,312
42 Elvita Sitra Fuadah 6 60 6 16 8 25 175 3 2 3 0 25 1 121 183 304 3,059,013 3,059,013 42 122,361 2,936,652
43 Istiqomah 6 60 6 16 8 25 175 3 3 3 0 25 1 121 184 305 3,069,075 3,069,075 43 122,763 2,946,312
44 Arif Sukristiana 12 80 10 16 8 25 168 3 3 3 0 24 0.96 144.96 177 321.96 3,239,736 161,987 3,077,749 44 123,110 2,954,639
45 Malihah 6 60 8 16 8 25 164.5 3 3 3 0 23.5 0.94 115.62 173.5 289.12 2,909,282 145,464 2,763,818 45 110,553 2,653,265
46 Didik Wijarnoko 6 80 10 16 8 25 66.5 1 1 1 0 9.5 0.38 55.1 69.5 124.6 1,253,793 62,690 1,191,103 46 47,644 1,143,459

JUMLAH 14863 149,554,920 5,485,302 144,069,618 5,762,785 138,306,833

182,590,420

Kayen,
Kepala Puskesmas Kayen

dr.Indri Kurnia Sari

NIP. 19780428 200801 2 015
 DAFTAR PENERIMAAN JASA REMUNERASI KARYAWAN PUSKESMAS KAYEN
BULAN FEBRUARI 2020

NOMOR POTONGAN JUMLAH JUMLAH

NO NAMA UANG YANG
REKENING DITERIMAKAN PPH 21 BPJS BPR Dana Sosial POTONGAN BERSIH Tanda - Tangan
1 dr. Indri.K 3-006-11126-1 5,983,187 299,159 227,361 526,520 5,456,667 1
2 Salis Diah Rahmawati 3-006-11156-3 4,105,517 205,276 156,010 361,285 3,744,231 2
3 Drg Sri surtini 3-006-11161-0 5,484,085 822,613 186,459 1,009,072 4,475,013 3
4 dr.M.wahyudin 3-006-27251-6 1,554,461 77,723 59,070 136,793 1,417,669 4
5 Sulistiono budi 3-006-11153-9 3,672,828 183,641 139,567 323,209 3,349,619 5
6 Tri istiani 3-006-11154-7 3,448,433 0 137,937 137,937 3,310,496 6
7 Warsini 3-006-11162-8 3,191,838 159,592 121,290 280,882 2,910,956 7
8 Slamet Khawadis 3-006-11158-0 1,443,975 72,199 827,000 54,871 954,070 489,905 8
9 Zuwariyah 3-006-11181-4 3,703,418 185,171 140,730 325,901 3,377,517 9
10 Kaelah 3-006-11159-8 3,469,564 173,478 131,843 305,322 3,164,243 10
11 Tri Rohmad 3-006-11157-1 1,750,882 0 70,035 70,035 1,680,847 11
12 Junaidi 3-006-11197-1 2,777,664 138,883 470,000 105,551 714,434 2,063,229 12
13 RPE.Wulansari 3-006-11160-1 3,692,953 184,648 140,332 324,980 3,367,973 13
14 Hardi Widiarjoso 2-006-17175-6 3,571,397 178,570 552,000 135,713 866,283 2,705,114 14
15 Dewi karolina 3-006-11169-5 3,326,676 166,334 126,414 292,747 3,033,929 15
16 Siti Kalimah 3-006-11190-3 3,680,073 184,004 139,843 323,846 3,356,226 16
17 Sukari 3-006-11192-0 3,581,460 179,073 136,095 315,168 3,266,291 17
18 Wardani 3-006-11191-1 3,818,131 190,907 145,089 335,995 3,482,135 18
19 Sumarni 3-006-11182-2 3,453,263 172,663 131,224 303,887 3,149,376 19
20 Budi Setyowati 3-006-11185-7 3,501,764 175,088 133,067 308,155 3,193,609 20
21 Enny Anggraeni 3-006-11188-1 3,778,685 188,934 143,590 332,524 3,446,161 21
22 Mukhayanah 3-006-11187-3 3,591,321 179,566 136,470 316,036 3,275,285 22
23 Dwi Susilowati 3-006-11163-6 3,461,514 173,076 1,980,000 131,538 2,284,613 1,176,901 23
24 Risning K 3-006-11165-2 3,310,576 165,529 125,802 291,331 3,019,245 24
25 Noorhidayati 3-006-11167-9 3,492,708 0 139,708 139,708 3,353,000 25
26 Ika Meilani 3-006-11171-7 3,451,452 172,573 131,155 303,728 3,147,724 26
27 Pitri 3-006-11193-8 2,254,009 0 90,160 90,160 2,163,849 27
28 Ratih Widowati 3-006-27230-3 3,300,513 0 132,021 132,021 3,168,493 29
29 Sri Lestari 3-006-16833-6 3,384,636 169,232 128,616 297,848 3,086,788 30
30 Supriyanto 3-006-10686-1 3,751,718 187,586 142,565 330,151 3,421,567 31
31 Mustari 3-006-27219-2 2,592,916 129,646 98,531 228,177 2,364,739 32
32 Ainun Naimah 3-006-27224-9 3,069,075 0 122,763 122,763 2,946,312 33
33 Titik ismawati 3-006-27222-2 3,069,075 0 122,763 122,763 2,946,312 34
34 Dian Ayu Pangastuti 3-006-27226-5 3,069,075 0 122,763 122,763 2,946,312 35
35 Erni Nugrohoningsih 3-006-27225-7 3,069,075 0 122,763 122,763 2,946,312 36
36 Ayu Jauhar M 3-006-27559-1 3,069,075 0 122,763 122,763 2,946,312 37
37 Murniwati 3-006-27220-6 2,949,935 0 117,997 117,997 2,831,937 38
38 Abida Afiyani 3-006-27227-3 3,069,075 0 122,763 122,763 2,946,312 39
39 Diah ayu Setyowati 3-006-27252-4 3,069,075 0 122,763 122,763 2,946,312 40
40 Ery Diah Lestari 3-006-27228-1 2,939,872 0 117,595 117,595 2,822,277 41
41 Feety Sari Fatmawati 3-006-27229-0 3,069,075 0 122,763 122,763 2,946,312 42
42 Elvita Sitra Fuadah 3-006-27223-1 3,059,013 0 1,153,000 122,361 1,275,361 1,783,652 43
43 Istikhomah 3-006-27221-4 3,069,075 0 122,763 122,763 2,946,312 44
44 Arif Sukristiana 3-006-07309-2 3,239,736 161,987 123,110 285,097 2,954,639 45
45 Malihah 3-006-27767-4 2,909,282 145,464 110,553 256,017 2,653,265 46
46 Didik Wijarnoko 2-006-08034-3 1,253,793 62,690 47,644 110,334 1,143,459
47 Bagus Wahya P 2-153-03087-4 1,152,000 0 1,152,000 47
48 Ratih Widyawati 2-153-03082-3 1,400,000 0 1,400,000 48
49 Dewi Lestari 2-153-03083-1 900,000 0 900,000 49
50 Rivan 2-153-03092-1 448,000 448,000 448,000 0 50
51 Dwi Agung S 2-153-03086-6 1,078,000 0 1,078,000 51
52 Cipto 2-153-03090-4 1,100,000 0 1,100,000 52
53 Novandra 2-153-03089-1 955,500 0 955,500 53
54 Tutik Salasah 2-153-01349-0 1,056,000 0 1,056,000 54
55 Zaimah 2-153-03084-0 1,056,000 0 1,056,000 55
56 Listiyani 2-153-03085-8 1,100,000 0 1,100,000 56
57 Sugiman 3-153-01164-7 476,000 441,000 441,000 35,000 57
58 Ngadimin 2-153-03363-6 450,000 0 450,000 58
59 dr. Lauyazinatul Usriyah 2-153-03201-0 2,820,000 150,000 150,000 2,670,000 59
60 dr. Lita 2-153-03093-9 3,000,000 150,000 150,000 2,850,000 60
61 Karunia Agustin Nurul 2-153-03095-5 672,000 0 672,000 61
62 Zeni Nurhidayati 2-153-03197-8 768,000 0 768,000 62
63 Wahyu Larasati 2-017-23231-5 900,000 0 900,000 63
64 Dewi ratna Widyawati 2-153-03237-1 900,000 0 900,000 64
65 Wijayanti P 2-153-03098-0 1,000,000 0 1,000,000 65
66 Hana Kartika Muhari 2-153-03105-6 720,000 0 720,000 66
67 Taufiqurrahman 2-153-03099-8 900,000 0 900,000 67
68 Cicik Nurul 3-006-30624-1 470,000 0 470,000 68
69 Jumariono 2-153-03097-1 900,000 0 900,000 69
70 Ninik Srihartatik 2-153-03094-7 900,000 0 900,000 70
71 Nurul Kholisah 2-153-03282-6 900,000 0 900,000 71
72 Nita Ristiyana 2-153-03203-6 588,000 0 588,000 72
73 Evi Novita Sari 2-153-03202-8 600,000 0 600,000 73
74 Mardliyah 2-153-03106-4 750,000 0 750,000 74
75 Siti Nur Chamidah 2-153-03100-5 700,000 0 700,000 75
76 Puna Ifa 2-153-03222-2 500,000 0 500,000 76
77 Siti Yulaikah 2-153-03351-2 900,000 0 900,000 77
78 Mustika 2-153-03218-4 500,000 0 500,000 78
79 Riningsih Yulianti 2-153-03096-3 588,000 0 588,000 79
80 Parjono 2-153-02894-2 300,000 0 300,000 80
81 Moh Ali Nurul Alam 2-153-03348-2 688,000 0 688,000 81
82 Retno Damayanti 2-153-02039-9 900,000 0 900,000 82
182,590,420 5,485,302 300,000 5,871,000 5,762,785 17,419,087 165,171,333

Mengetahui
UPT PUSKESMAS KAYEN Bendahara Pengeluaran

dr. Indri Kurnia Sari Wardani

NIP. 19780428 200801 2 015 NIP. 19731029 199301 2 001
Februari

DANA X 5,762,785
FORKOM 1,440,696
DANA X setelah forkom 4,322,089
WIYATA #REF!
 REKAPITULASI PENERIMAAN HONOR PETUGAS PENUNJANG PELAYANAN KESEHATAN

GAJI UTUH

JUMLAH
NO NAMA JABATAN TANDA TANGAN
DITERIMA

1 Bagus Wahya P Petugas Sanitarian Rp 1,200,000 1

2 Ratih Widyawati Bidan Rp 1,300,000 2

3 Dewi Lestari Administrasi Rp 900,000 3

4 Rivan Administrasi Rp 800,000 4

5 Dwi Agung S Perawat Rp 1,100,000 5

6 Cipto Administrasi Rp 1,100,000 6

7 Novandra Perawat Rp 900,000 7

8 Tutik Salasah Bidan Rp 1,100,000 8

9 Zaimah Bidan Rp 1,100,000 9

10 Listiyani Bidan Rp 1,100,000 10

11 Sugiman Administrasi Rp 700,000 11

12 Ngadimin Penjaga Malam Rp 450,000 12

13 dr. Lauza Dokter umum Rp 3,000,000 13

14 dr. Lita Dokter umum Rp 3,000,000 14

15 Karunia Nurul Petugas Gizi Rp 800,000 15

16 Zeni Petugas Laborat Rp 800,000 16

17 Wahyu Larasati Bidan Rp 800,000 17

18 Dewi ratna Widyawati Bidan Rp 800,000 18

19 Wijayanti P Bidan Rp 900,000 19

20 Hana Kartika Muhari Bidan Rp 700,000 20

21 Taufiqurrahman Sopir Rp 800,000 21

22 Cicik Nurul Bidan Rp 500,000 22

23 Jumariono Sopir Rp 800,000 23

24 Ninik Bidan Rp 800,000 24

25 Nurul Bidan Rp 800,000 25

26 Nita Ristiyana Bidan Rp 600,000 26

27 Evi Novita Sari Bidan Rp 600,000 27

28 Mardliyah Bidan Rp 700,000

29 Nur Chamidah Bidan Rp 600,000

30 Puna Ifa Perawat Rp 500,000

31 Siti Yulaikah Bidan Rp 800,000

32 Mustika Perawat Rp 500,000

33 Rini Perawat Rp 600,000

34 Parjono Promotor Kesehatan Rp 300,000

35 Moh Ali Nurul Alam Sopir Rp 700,000

36 Retno Apoteker Rp 900,000

JUMLAH Rp 33,050,000