DAFTAR : PASIEN UMUM RAWAT INAP DAN RAWAT JALAN PUSKESMAS

BULAN : …………………………..

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
 DAFTAR : PASIEN UMUM RAWAT JALAN PUSKESMAS GEBANG
BULAN : DESEMBER 2014
Kategori Pasien Umum
Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
1 SYAMSIDAR 04 – 12 – 2014 8000
2 ARI ANANDA 04 – 12 – 2014 8000
3 ANDIKA PUTRA 04 – 12 – 2014 8000
4 SITI AMINAH 04 – 12 – 2014 8000
5 AQILA 05 – 12 – 2014 8000
6 WILSON 05 – 12 – 2014 8000
7 NAZLA SELVIA 05 – 12 – 2014 8000
8 KUMALA SINAGA 05 – 12 – 2014 8000
9 LUTFI 06 – 12 – 2014 8000
10 NURAINUN 06 – 12 – 2014 8000
11 ELY 06 – 12 – 2014 8000
12 L. BR REGAR 06 – 12 – 2014 8000
13 MARIO 08 – 12 – 2014 8000
14 M. SAFARUDDIN 08 – 12 – 2014 8000
15 SURIONO 08 – 12 – 2014 8000
16 ROSMAWATI 09 – 12 – 2014 8000
17 M. SYAHRUL 09 – 12 – 2014 8000
18 LILIS 09 – 12 – 2014 8000
19 ROSMAH 10 – 12 – 2014 8000
20 HAFIZA 10 – 12 – 2014 8000
21 NOVRI ANGGIE 10 – 12 – 2014 8000
22 MANDA APRILIA 11 – 12 – 2014 8000
23 BUDI MUTAROM 11 – 12 – 2014 8000
24 PUTRI 11 – 12 – 2014 8000
25 WIDYA AULIA 12 – 12 – 2014 8000
26 MIKAEL 12 – 12 – 2014 8000
27 VIVI SUSANTI 12 – 12 – 2014 8000
28 EVA UTAMI 13 – 12 – 2014 8000
29 ZURAIDA 13 – 12 – 2014 8000
30 ASIFA ZAHARA 13 – 12 – 2014 8000
31 ILHAM 15 – 12 – 2014 8000
32 GINA MUHFIDA 15 – 12 – 2014 8000
33 TIARA 15 – 12 – 2014 8000
34 ABDUL HAKIM 15 – 12 – 2014 8000
35 SUTARMI 15 – 12 – 2014 8000
36 AMRI 16 – 12 – 2014 8000
37 AGUNG SIREGAR 17 – 12 – 2014 8000
38 YENI 17 – 12 – 2014 8000
39 SUSI INDARIANI 17 – 12 – 2014 8000
40 DIMAS 18 – 12 – 2014 8000
41 MUSLIMIN 18 – 12 – 2014 8000
42 SUMIN SUSANTO 19 – 12 – 2014 8000
43 SYAMSIDAR 19 – 12 – 2014 8000
44 ADITYA 19 – 12 – 2014 8000
45 NURAINI 20 – 12 – 2014 8000
46 RENO 22 – 12 – 2014 8000
47 SALSABILA 22 – 12 – 2014 8000
48 NGATIMIN 23 – 12 – 2014 8000
49 HENDRI 24 – 12 – 2014 8000
50 SARNI 24 – 12 – 2014 8000
51 HALIMAH 24 – 12 – 2014 8000
52 AMIS 24 – 12 – 2014 8000
53 FAISAL REZA 26 – 12 – 2014 8000
54 NURIADI 26 – 12 – 2014 8000
55 ABDULAH HAKIM 26 – 12 – 2014 8000
56 E. GULTOM 27 – 12 – 2014 8000
57 VIVALDI 29 – 12 – 2014 8000
58 ADI SYAHPUTRA 29 – 12 – 2014 8000
59 PUTRI 29 – 12 – 2014 8000
60 NURDIAR DINI 29 – 12 – 2014 8000
61 SYAIFUL HARAHAP 29 – 12 – 2014 8000
62 EDI SYAHRIAL 29 – 12 – 2014 8000
63 MASIAH 29 – 12 – 2014 8000
64 JUMINI 29 – 12 – 2014 8000
65 EVA UTAMI 29 – 12 – 2014 8000
66 ZURAIDA 29 – 12 – 2014 8000
JUMLAH PASIEN PUSK.GEBANG ( 66 PASIEN ) 528.000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
63 ULI NUA 01 – 12 – 2014 8000
64 JUMINI 01 – 12 – 2014 8000
65 MASIAH 01 – 12 – 2014 8000
66 ANTO 05 – 12 – 2014 8000
67 PONIMAN 05 – 12 – 2014 8000
68 SELA RAHMAH 05 – 12 – 2014 8000
69 MAHYUDAN 08 – 12 – 2014 8000
70 PUTRI 08 – 12 – 2014 8000
71 WIDYA 08 – 12 – 2014 8000
72 MUSAMELIA 08 – 12 – 2014 8000
73 R. SITUMORANG 10 – 12 – 2014 8000
74 ABDI HASIN 10 – 12 – 2014 8000
75 NUR MAISYARAH 13 – 12 – 2014 8000
76 PURNAMA 13 – 12 – 2014 8000
77 RIMA MAULINA 13 – 12 – 2014 8000
78 INTAN SASKIA 15 – 12 – 2014 8000
79 M. SIHOMBING 15 – 12 – 2014 8000
80 ABDI HAKIM 15 – 12 – 2014 8000
81 NGATEMI 18 – 12 – 2014 8000
82 SENANG 18 – 12 – 2014 8000
83 JUMILA 18 – 12 – 2014 8000
84 DARLINA 22 – 12 – 2014 8000
85 JINGGA 22 – 12 – 2014 8000
86 NURAINI 27 – 12 – 2014 8000
87 SRI 27 – 12 – 2014 8000
88 SIREN SAHARA 27 – 12 – 2014 8000
89 SAHRUDDIN 27 – 12 – 2014 8000
90 ELZA FAHRI 29 – 12 – 2014 8000
91 MERI HANDAYANI 29 – 12 – 2014 8000
92 ROSDAH 29 – 12 – 2014 8000
93 RATIH NURFADILAH 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU PEKAN GEBANG ( 31 PASIEN ) 248.000
94 SUSI 03 – 12 – 2014 8000
95 SARTINAH 03 – 12 – 2014 8000
96 TURINI 05 – 12 – 2014 8000
97 ERNA 05 – 12 – 2014 8000
98 NARSI 05 – 12 – 2014 8000
99 PARMAN 09 – 12 – 2014 8000
100 ARI SYAHPUTRA 09 – 12 – 2014 8000
101 MARULI S 17 – 12 – 2014 8000
102 MISKA 17 – 12 – 2014 8000
103 LUKTI 17 – 12 – 2014 8000
104 AKMAD TEGAR LUBIS 20 – 12 – 2014 8000
105 VERA WATI 20 – 12 – 2014 8000
106 HAFIZA 29 – 12 – 2014 8000
107 BASARIAH 29 – 12 – 2014 8000
108 OSCAR 29 – 12 – 2014 8000
109 AWALUDDIN 29 – 12 – 2014 8000
110 IRFAN FAUZAN 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU PASAR RAWA ( 17 PASIEN ) 136.000
111 ALFATHAR 04 – 12 – 2014 8000
112 WAHYUDI 04 – 12 – 2014 8000
113 HENIARNITA 06 – 12 – 2014 8000
114 ZAKARIA 10 – 12 – 2014 8000
115 FITRI YNITA 10 – 12 – 2014 8000
116 DEA RANTIZA 16 – 12 – 2014 8000
117 DEWI 16 – 12 – 2014 8000
118 ALFRIDA 16 – 12 – 2014 8000
119 ANGELIA 20 – 12 – 2014 8000
120 DINDA ELZA 24 – 12 – 2014 8000
121 M SYAHDI 24 – 12 – 2014 8000
122 YOHANA 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU PAYA BENGKUANG ( 12 PASIEN ) 96.000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
123 HALIMAH 01 – 12 – 2014 8000
124 ERNAWATI 01 – 12 – 2014 8000
125 AISYAH 04 – 12 – 2014 8000
126 FARIDA HANUM 04 – 12 – 2014 8000
127 MAIMUNAH 04 – 12 – 2014 8000
128 ZIHAN 08 – 12 – 2014 8000
129 ARI 08 – 12 – 2014 8000
130 FIRMANSYAH 11 – 12 – 2014 8000
131 SUGIANTO 11 – 12 – 2014 8000
132 FITRI 13 – 12 – 2014 8000
133 PUTRI 15 – 12 – 2014 8000
134 MARIKI 15 – 12 – 2014 8000
135 ALFRIDA 15 – 12 – 2014 8000
136 ANGELINA 19 – 12 – 2014 8000
137 EDINAR 22 – 12 – 2014 8000
138 NORMAN 22 – 12 – 2014 8000
139 NORMANSYAH 29 – 12 – 2014 8000
140 SITI MARDINA 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU DOGANG ( 18 PASIEN ) 144.000
141 AZWAR 01 – 12 – 2014 8000
138 MISA 05 – 12 – 2014 8000
139 WIJAYA KESUMA 05 – 12 – 2014 8000
140 SIREN SAHARA 08 – 12 – 2014 8000
141 NAZLAH 20 – 12 – 2014 8000
142 R SIANTURI 20 – 12 – 2014 8000
143 AS GULTOM 24 – 12 – 2014 8000
144 LILIS 29 – 12 – 2014 8000
145 YOGA 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU AIR HITAM ( 9 PASIEN ) 72.000
146 TIKA 01 – 12 – 2014 8000
147 ZURAIDA 01 – 12 – 2014 8000
148 MADI 11 – 12 – 2014 8000
149 SUHARNI 11 – 12 – 2014 8000
150 M HAZIB 11 – 12 – 2014 8000
151 DONI 15 – 12 – 2014 8000
152 KALIS SIAHAAN 15 – 12 – 2014 8000
153 BAMBANG 22 – 12 – 2014 8000
154 FARIDA 22 – 12 – 2014 8000
155 EDI SYAHRIAL 29 – 12 – 2014 8000
156 M SYAHRUL R 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU SANGGALIMA ( 11 PASIEN ) 88.000
159 SITI AFRIDA 01 – 12 – 2014 8000
160 WIBOWO 09 – 12 – 2014 8000
161 INTAN RAJAGUKGUK 09 – 12 – 2014 8000
162 K ANGELI 15 – 12 – 2014 8000
163 M RIZKI 22 – 12 – 2014 8000
164 KALIS SIAHAAN 29 – 12 – 2014 8000
165 BAMBANG 29 – 12 – 2014 8000
JUMLAH PASIEN PUSTU KWALA GEBANG ( 7 PASIEN ) 56.000
 Kategori Pasien Umum
Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
166 TIKA 04 – 12 – 2014 8000
167 ZURAIDA 04 – 12 – 2014 8000
168 MADI 04 – 12 – 2014 8000
169 SUHARNI 04 – 12 – 2014 8000
170 AQILA 05 – 12 – 2014 8000
171 WILSON 05 – 12 – 2014 8000
172 NAZLA SELVIA 05 – 12 – 2014 8000
173 KUMALA SINAGA 05 – 12 – 2014 8000
174 LUTFI 06 – 12 – 2014 8000
175 NURAINUN 06 – 12 – 2014 8000
176 ELY 06 – 12 – 2014 8000
177 L. BR REGAR 06 – 12 – 2014 8000
178 MARIO 08 – 12 – 2014 8000
179 M. SAFARUDDIN 08 – 12 – 2014 8000
180 EDINAR 08 – 12 – 2014 8000
181 NORMAN 09 – 12 – 2014 8000
182 NORMANSYAH 09 – 12 – 2014 8000
183 SITI MARDINA 09 – 12 – 2014 8000
184 ROSMAH 10 – 12 – 2014 8000
185 HAFIZA 10 – 12 – 2014 8000
186 NOVRI ANGGIE 10 – 12 – 2014 8000
187 MANDA APRILIA 11 – 12 – 2014 8000
188 BUDI MUTAROM 11 – 12 – 2014 8000
189 PUTRI 11 – 12 – 2014 8000
190 WIDYA AULIA 12 – 12 – 2014 8000
191 MIKAEL 12 – 12 – 2014 8000
192 VIVI SUSANTI 12 – 12 – 2014 8000
193 EVA UTAMI 13 – 12 – 2014 8000
194 ZURAIDA 13 – 12 – 2014 8000
195 ASIFA ZAHARA 13 – 12 – 2014 8000
196 ILHAM 15 – 12 – 2014 8000
197 GINA MUHFIDA 15 – 12 – 2014 8000
198 TIARA 15 – 12 – 2014 8000
199 ABDUL HAKIM 15 – 12 – 2014 8000
200 SUTARMI 15 – 12 – 2014 8000
201 AMRI 16 – 12 – 2014 8000
202 AGUNG SIREGAR 17 – 12 – 2014 8000
203 YENI 17 – 12 – 2014 8000
204 SUSI INDARIANI 17 – 12 – 2014 8000
205 DIMAS 18 – 12 – 2014 8000
206 MUSLIMIN 18 – 12 – 2014 8000
207 SUMIN SUSANTO 19 – 12 – 2014 8000
208 SYAMSIDAR 19 – 12 – 2014 8000
209 ADITYA 19 – 12 – 2014 8000
210 NURAINI 20 – 12 – 2014 8000
211 RENO 22 – 12 – 2014 8000
212 SALSABILA 22 – 12 – 2014 8000
213 NGATIMIN 23 – 12 – 2014 8000
214 HENDRI 24 – 12 – 2014 8000
215 SARNI 24 – 12 – 2014 8000
216 HALIMAH 24 – 12 – 2014 8000
217 AMIS 24 – 12 – 2014 8000
 218 FAISAL REZA 26 – 12 – 2014 8000
219 NURIADI 26 – 12 – 2014 8000
220 ABDULAH HAKIM 26 – 12 – 2014 8000
221 E. GULTOM 27 – 12 – 2014 8000
222 VIVALDI 29 – 12 – 2014 8000
223 INTAN RAJAGUKGUK 29 – 12 – 2014 8000
224 K ANGELI 29 – 12 – 2014 8000
225 M RIZKI 29 – 12 – 2014 8000
JUMLAH PASIEN BIDAN DESA 483.000
JUMLAH PASIEN KESELURUHAN 1.851.000
JUMLAH PAJAK RUMAH DINAS 3 UNIT 1.050.000
TOTAL 2.901.000

Diketahui oleh : Pembantu Kasir Penerima

KEPALA PUSKESMAS GEBANG Puskesmas Gebang

Hj. ERLINA , SKM TRESIA , AS

Nip. 19690824 199903 2 004 Nip. 19650604 198603 2 004

DAFTAR : PASIEN UMUM RAWAT JALAN PUSKESMAS GEBANG

BULAN : JANUARI 2015

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
1 ZUL ZALI RAO 30 – 12 – 2014 3000
2 AWALUDDIN 30 – 12 – 2014 3000
3 WASDI 30 – 12 – 2014 3000
4 EMI LAILI 30 – 12 – 2014 3000
5 SYAMSUL BAHRI 30 – 12 – 2014 3000
6 YANDA 30 – 12 – 2014 3000
7 R. BR GULTOM 30 – 12 – 2014 3000
8 REZA AFRITA 30 – 12 – 2014 3000
9 YUSNIAR 30 – 12 – 2014 3000
10 NASRI BELA 30 – 12 – 2014 3000
11 SRI WAHYUNI 30 – 12 – 2014 3000
12 HENRI 30 – 12 – 2014 3000
13 INGGIT K 30 – 12 – 2014 3000
14 BUNGA 30 – 12 – 2014 3000
15 ROHANI 30 – 12 – 2014 3000
16 HAMIDAH 30 – 12 – 2014 3000
17 RONI 30 – 12 – 2014 3000
18 WENTI SITORUS 30 – 12 – 2014 3000
19 MARUDUT 31 – 12 – 2014 3000
20 TEJA 31 – 12 – 2014 3000
21 NURUL 31 – 12 – 2014 3000
22 ZUHRIADI 31 – 12 – 2014 3000
23 NURUL 31 – 12 – 2014 3000
24 THOMAS 31 – 12 – 2014 3000
25 AZI MAULANA 31 – 12 – 2014 3000
26 SRI WAHYUNI 31 – 12 – 2014 3000
27 TASYA 31 – 12 – 2014 3000
28 M. AZHAR 31 – 12 – 2014 3000
29 DIAN ANGGUR 31 – 12 – 2014 3000
30 MARTA 31 – 12 – 2014 3000
31 ARIF RAHMAN 31 – 12 – 2014 3000
32 FATIMAH 31 – 12 – 2014 3000
33 M. PUTRA 02 – 01 – 2015 3000
34 LASTIUR 02 – 01 – 2015 3000
35 CINDY AFRIANA 02 – 01 – 2015 3000
36 RISKA AMELIA 02 – 01 – 2015 3000
37 SILVIA A PASARIBU 02 – 01 – 2015 3000
38 PUTRI SALSABILA R 02 – 01 – 2015 3000
39 ZURAIDA 02 – 01 – 2015 3000
40 PUTRI PRADANA 02 – 01 – 2015 3000
41 MARIANI HARAHAP 03 – 01 – 2015 3000
42 SRI GUSTINA 03 – 01 – 2015 3000
43 MINATI SITOHANG 03 – 01 – 2015 3000
44 KASMIATI 03 – 01 – 2015 3000
45 NADIA AFRIZA 03 – 01 – 2015 3000
46 M. LUMBAN GAOL 05 – 01 – 2015 3000
47 SETIA SURBAKTI 05 – 01 – 2015 3000
48 WILLIEM SILALAHI 05 – 01 – 2015 3000
50 M. RIDHO 05 – 01 – 2015 3000
51 NGATIMIN 05 – 01 – 2015 3000
52 SUARTI 05 – 01 – 2015 3000
53 FAHRIZAL 05 – 01 – 2015 3000
54 BAGUS 05 – 01 – 2015 3000
55 MALADI NASUTION 05 – 01 – 2015 3000
56 MARIATI 05 – 01 – 2015 3000
57 HENDRA SYAHPUTRA 05 – 01 – 2015 3000
58 FIRMANSYAH 05 – 01 – 2015 3000
59 IRWAN ARITONANG 05 – 01 – 2015 3000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
60 ALFRIDA 05 – 01 – 2015 3000
61 ANGELINA 05 – 01 – 2015 3000
62 NANDA SYAHPUTRI 06 – 01 – 2015 3000
63 WINDY 06 – 01 – 2015 3000
64 ROSMAWATI 06 – 01 – 2015 3000
65 RIAN 06 – 01 – 2015 3000
66 TAMBA TUA SIMBOLON 06 – 01 – 2015 3000
67 SELAMAT 06 – 01 – 2015 3000
68 PIUS 07 – 01 – 2015 3000
69 VERONICA A 07 – 01 – 2015 3000
70 JUMINTA BR. M 07 – 01 – 2015 3000
71 EVI FARULLAH H 07 – 01 – 2015 3000
72 SITI RADIAH 07 – 01 – 2015 3000
73 ASNANI 07 – 01 – 2015 3000
74 JULI INDRAWAN 07 – 01 – 2015 3000
75 SAKINA V 07 – 01 – 2015 3000
76 YOHANA S 08 – 01 – 2015 3000
77 INDAH KHAIRANI 08 – 01 – 2015 3000
78 M. FAUZAN 08 – 01 – 2015 3000
79 BUTET BANGUN 08 – 01 – 2015 3000
80 A MAPAUNG 08 – 01 – 2015 3000
81 MISCA 08 – 01 – 2015 3000
82 SUMARDI 08 – 01 – 2015 3000
83 FITRIADI 08 – 01 – 2015 3000
84 VIVI SUMANTI 08 – 01 – 2015 3000
85 SILVIA 08 – 01 – 2015 3000
86 AISYAH 08 – 01 – 2015 3000
87 SRI LESTARI 08 – 01 – 2015 3000
88 D SIMANJUNTAK 09 – 01 – 2015 3000
89 CHOKY 09 – 01 – 2015 3000
90 M. ZIDAN P 09 – 01 – 2015 3000
91 MUBARAQ 09 – 01 – 2015 3000
92 RUDI IRAWAN SIREGAR 09 – 01 – 2015 3000
93 VIVALDI 09 – 01 – 2015 3000
94 SABAR SIMBOLON 09 – 01 – 2015 3000
95 ALI USMAN 09 – 01 – 2015 3000
96 AMEL FEBIANTI 09 – 01 – 2015 3000
97 MISNAH 10 – 01 – 2015 3000
98 ABDI LESMANA 10 – 01 – 2015 3000
99 HAMDANI 10 – 01 – 2015 3000
100 FARAH 10 – 01 – 2015 3000
101 NOVAL 10 – 01 – 2015 3000
102 ANGELINA 10 – 01 – 2015 3000
103 ALFRIDA 10 – 01 – 2015 3000
104 NANDA SYAHPUTRI 10 – 01 – 2015 3000
105 INDAH NOVITA 10 – 01 – 2015 3000
106 TEGAR PANGARIBUAN 11 – 01 – 2015 3000
107 FARIDA HANUM 11 – 01 – 2015 3000
108 INTAN 11 – 01 – 2015 3000
109 ZIA ULFA 11 – 01 – 2015 3000
110 FAREL 11 – 01 – 2015 3000
111 ASNIAR D’JAFAR 11 – 01 – 2015 3000
112 JALILAH 11 – 01 – 2015 3000
113 GLORIA 11 – 01 – 2015 3000
114 KRISTI 11 – 01 – 2015 3000
115 LILIS 11 – 01 – 2015 3000
116 SAKIN 11 – 01 – 2015 3000
117 RINA JULIANA 11 – 01 – 2015 3000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
118 DAHLIA PUTRI 13 – 01 – 2015 3000
119 DEDEK SULAIMAN 13 – 01 – 2015 3000
120 ROHANI 13 – 01 – 2015 3000
121 MUKHLIS 13 – 01 – 2015 3000
122 M. ISYA 13 – 01 – 2015 3000
123 ARIF BUDIMAN 13 – 01 – 2015 3000
124 DEA LESTARI 13 – 01 – 2015 3000
125 CUT JURIANA 13 – 01 – 2015 3000
126 HASNI 13 – 01 – 2015 3000
127 KAMALIA 13 – 01 – 2015 3000
128 SULTAN 13 – 01 – 2015 3000
129 LUTFI P 13 – 01 – 2015 3000
130 SURIAWATI 13 – 01 – 2015 3000
131 REZA SAFRIANSYAH 14 – 01 – 2015 3000
132 RIDHO CALVIANO 14 – 01 – 2015 3000
133 ANDIKA 14 – 01 – 2015 3000
134 MUSDIANTO 14 – 01 – 2015 3000
135 RIMA BR. SIMBOLON 14 – 01 – 2015 3000
136 RIZKI RAHMADANI 15 – 01 – 2015 3000
137 SILVIA HANDAYANI 15 – 01 – 2015 3000
138 HUSAINI SYAHPUTRA 15 – 01 – 2015 3000
139 KITA SEMBIRING 15 – 01 – 2015 3000
140 ARIANSYAH 15 – 01 – 2015 3000
141 AYU NAZRIAH 15 – 01 – 2015 3000
142 KHAIRUL AMRI 15 – 01 – 2015 3000
143 RAJA HANAN 15 – 01 – 2015 3000
144 TONI AGITA 16 – 01 – 2015 3000
145 INAL PASARIBU 16 – 01 – 2015 3000
146 H OP SUNGGUL 16 – 01 – 2015 3000
147 RAMADANI 16 – 01 – 2015 3000
148 DAFA R 16 – 01 – 2015 3000
149 SATRIA 16 – 01 – 2015 3000
150 OLIVIA 16 – 01 – 2015 3000
151 RIDA PRATAMA 16 – 01 – 2015 3000
152 JELITA RAJA GUGUK 16 – 01 – 2015 3000
153 MARIATI 16 – 01 – 2015 3000
154 SITI ZF 17 – 01 – 2015 3000
155 PONI WIJAYA 17 – 01 – 2015 3000
156 SUHARSOYO 17 – 01 – 2015 3000
157 HALIMAH 17 – 01 – 2015 3000
158 GITA 17 – 01 – 2015 3000
159 RIKA ELINA 17 – 01 – 2015 3000
160 FADIL 19 – 01 – 2015 3000
161 BENI 19 – 01 – 2015 3000
162 M. RAMADHAN FANI 19 – 01 – 2015 3000
163 AGNES MAULANA 19 – 01 – 2015 3000
164 GITA 19 – 01 – 2015 3000
165 RIKA ELINA 19 – 01 – 2015 3000
166 SIFA 19 – 01 – 2015 3000
167 TINA 19 – 01 – 2015 3000
168 SUPRIANTI 19 – 01 – 2015 3000
169 BONITA 19 – 01 – 2015 3000
170 ARYA 19 – 01 – 2015 3000
171 MIRAWATI 19 – 01 – 2015 3000
172 PIPIN 19 – 01 – 2015 3000
173 NURLIAH 19 – 01 – 2015 3000
174 CHLESEA 19 – 01 – 2015 3000
175 IQBAL MAULANA 19 – 01 – 2015 3000
176 RAMADHAN 19 – 01 – 2015 3000
177 NURAINI 19 – 01 – 2015 3000
178 MISA NURIZA 19 – 01 – 2015 3000
179 RENO ANGGARA 19 – 01 – 2015 3000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
180 ILHAM SYAHPUTRA 19 – 01 – 2015 3000
181 SAFA 19 – 01 – 2015 3000
182 ANI 20 – 01 – 2015 3000
183 BEBI SINTA 20 – 01 – 2015 3000
184 MASITA 20 – 01 – 2015 3000
185 YOGASAH 20 – 01 – 2015 3000
186 LENI LESTARI 20 – 01 – 2015 3000
187 IRMAYANTI 20 – 01 – 2015 3000
188 ANDRIYANTO 21 – 01 – 2015 3000
189 M. RIDHO 21 – 01 – 2015 3000
190 RASMI 21 – 01 – 2015 3000
191 NAHDA 21 – 01 – 2015 3000
192 AFRIZAHARA 21 – 01 – 2015 3000
193 ADE MUNTI 21 – 01 – 2015 3000
194 ARYA 21 – 01 – 2015 3000
195 ASNI 21 – 01 – 2015 3000
196 ANZOLA 21 – 01 – 2015 3000
197 NURHAYATI 21 – 01 – 2015 3000
198 KEISHA 21 – 01 – 2015 3000
199 IBNU 21 – 01 – 2015 3000
200 WARA 21 – 01 – 2015 3000
201 AFRA AKASAH 21 – 01 – 2015 3000
202 LIANA 22 – 01 – 2015 3000
203 SRI WAHYUNI 22 – 01 – 2015 3000
204 M. TAMBUNAN 22 – 01 – 2015 3000
205 KARSI 22 – 01 – 2015 3000
206 ASRI 22 – 01 – 2015 3000
207 ASRI 22 – 01 – 2015 3000
208 ASRI 22 – 01 – 2015 3000
209 BOIMEN 22 – 01 – 2015 3000
210 MUSLIMAH 22 – 01 – 2015 3000
211 M. FIKRI 23 – 01 – 2015 3000
212 A OP SUNGGUL 23 – 01 – 2015 3000
213 RAMLI 23 – 01 – 2015 3000
214 EVAN 23 – 01 – 2015 3000
215 ANI 23 – 01 – 2015 3000
216 RATIH 23 – 01 – 2015 3000
217 KHAIRUNISA 24 – 01 – 2015 3000
218 LILIS 24 – 01 – 2015 3000
219 YOGA 24 – 01 – 2015 3000
220 FIKA 24 – 01 – 2015 3000
221 ZURAIDA 24 – 01 – 2015 3000
222 MADI 24 – 01 – 2015 3000
223 SUMARNI 26 – 01 – 2015 3000
224 DONI 26 – 01 – 2015 3000
225 JAMILAH 26 – 01 – 2015 3000
226 NELFI SAHANATIVA 26 – 01 – 2015 3000
227 BOIMEN 26 – 01 – 2015 3000
228 EVI VANIUS 26 – 01 – 2015 3000
229 YULI INDRAWATI 26 – 01 – 2015 3000
230 BUNGA 26 – 01 – 2015 3000
231 ROHANI 26 – 01 – 2015 3000
232 HAMIDAH 27 – 01 – 2015 3000
233 RONI 27 – 01 – 2015 3000
234 WENTI SITUORUS 27 – 01 – 2015 3000
235 MARUDUT 27 – 01 – 2015 3000
236 NURUL 27 – 01 – 2015 3000
237 NONI 27 – 01 – 2015 3000
238 NOVA 27 – 01 – 2015 3000
239 IKA NOVI 27 – 01 – 2015 3000
240 DION NABILA 27 – 01 – 2015 3000

241 ANI 27 – 01 – 2015 3000

242 PAING 27 – 01 – 2015 3000
243 IKHTIAR LUBIS 27 – 01 – 2015 3000
244 KRISTIAN 27 – 01 – 2015 3000
245 SUSI PRATIWI 27 – 01 – 2015 3000
246 M. FAHRIZAL 27 – 01 – 2015 3000
247 KOMARI 27 – 01 – 2015 3000
248 GABI AULIA 27 – 01 – 2015 3000
249 SURYA EFFENDY 27 – 01 – 2015 3000
250 ADE INDRA IRAWAN 28 – 01 – 2015 3000
251 KIKI ANGGRAINI 28 – 01 – 2015 3000
252 BAHARUDDIN 28 – 01 – 2015 3000
253 BAHTIAR EFFENDI 28 – 01 – 2015 3000
254 ADITYA 28 – 01 – 2015 3000
255 PAIDI 28 – 01 – 2015 3000
256 ISAH 29 – 01 – 2015 3000
257 ELVI SAHARTIAN 29 – 01 – 2015 3000
258 JULIANA 29 – 01 – 2015 3000
259 SELVI 29 – 01 – 2015 3000
260 ASNI 29 – 01 – 2015 3000
261 FANI 29 – 01 – 2015 3000
262 EVI 30 – 01 – 2015 3000
263 NONI 30 – 01 – 2015 3000
264 WISNALDY 30 – 01 – 2015 3000
265 RIZKI 30 – 01 – 2015 3000
266 SUGIANI 31 – 01 – 2015 3000
267 EDI 31 – 01 – 2015 3000
268 ESTER S 31 – 01 – 2015 3000
269 MUBARAQ 31 – 01 – 2015 3000
270 KHAIDIR 02 – 02 – 2015 3000
271 M. ADITYA 02 – 02 – 2015 3000
272 DIAN NABILA 02 – 02 – 2015 3000
273 RAMLAH 02 – 02 – 2015 3000
274 NURHAYATI 02 – 02 – 2015 3000
275 ANGELINA 02 – 02 – 2015 3000
276 ALFRIDA 02 – 02 – 2015 3000
277 RIZKY 02 – 02 – 2015 3000
278 DIAH IRWANA SARI 02 – 02 – 2015 3000
279 VERONICA 02 – 02 – 2015 3000
JUMLAH 837.000
Diketahui oleh : Pembantu Kasir Penerima
KEPALA PUSKESMAS GEBANG Puskesmas Gebang

Hj. ERLINA , SKM TRESIA , AS

Nip. 19690824 199903 2 004 Nip. 19650604 198603 2 004

DAFTAR : PASIEN UMUM RAWAT JALAN PUSKESMAS GEBANG

BULAN : FEBRUARI 2015

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
1 GLORIA 03 – 02 – 2015 3000
2 HERI SISWANTO 03 – 02 – 2015 3000
3 TIO SITUMORANG 03 – 02 – 2015 3000
4 RAYAMAN SITUMORANG 03 – 02 – 2015 3000
5 ULINUHA 03 – 02 – 2015 3000
6 BINSAR SIAHAAN 03 – 02 – 2015 3000
7 SYARIFUDDIN 03 – 02 – 2015 3000
8 ALFRIDA 03 – 02 – 2015 3000
9 ANGELINA 03 – 02 – 2015 3000
10 ZULFAHMI 03 – 02 – 2015 3000
11 M. ABID AZNAI 03 – 02 – 2015 3000
12 AFIKA 04 – 02 – 2015 3000
13 MIRA 04 – 02 – 2015 3000
14 AZNI 04 – 02 – 2015 3000
15 NURAIDA 04 – 02 – 2015 3000
16 JESIKA 04 – 02 – 2015 3000
17 IRFAN 04 – 02 – 2015 3000
18 BUDI IRAWAN 05 – 02 – 2015 3000
19 NURNAILA 05 – 02 – 2015 3000
20 WAHIDAS 05 – 02 – 2015 3000
21 RAJID HANAN 05 – 02 – 2015 3000
22 LEGIMIN 05 – 02 – 2015 3000
23 LENI 05 – 02 – 2015 3000
24 ANDI SYAHPUTRA 06 – 02 – 2015 3000
25 SILVIA HANDAYANI 06 – 02 – 2015 3000
26 SUPRIATI 06 – 02 – 2015 3000
27 SUMARNI 06 – 02 – 2015 3000
28 NOVIA FEBRIA 06 – 02 – 2015 3000
29 ITA 06 – 02 – 2015 3000
30 TEPAN 06 – 02 – 2015 3000
31 RINALDI 07 – 02 – 2015 3000
32 RIZKI ANANDA 07 – 02 – 2015 3000
33 LINA 07 – 02 – 2015 3000
34 DIMAS 07 – 02 – 2015 3000
35 WAGIMAN 07 – 02 – 2015 3000
36 NASIFAH 09 – 02 – 2015 3000
37 JAMAIYAH 09 – 02 – 2015 3000
38 MISNAN 09 – 02 – 2015 3000
39 NIEM 09 – 02 – 2015 3000
40 DARMINTA 09 – 02 – 2015 3000
41 MARFUAH 09 – 02 – 2015 3000
42 FITRI 09 – 02 – 2015 3000
43 ASARAH 09 – 02 – 2015 3000
44 RAHAYU 09 – 02 – 2015 3000
45 MASLIAH 09 – 02 – 2015 3000
46 KARSIMAH 09 – 02 – 2015 3000
47 RAMADHAN 09 – 02 – 2015 3000
48 IRFAN 09 – 02 – 2015 3000
50 S SIMATUPANG 09 – 02 – 2015 3000
51 NURLIA ASNI 10 – 02 – 2015 3000
52 PUTRI 10 – 02 – 2015 3000
53 ANI 10 – 02 – 2015 3000
54 GLORIA NOVA MALAU 10 – 02 – 2015 3000
55 BUDI UTOMO 10 – 02 – 2015 3000
56 PUTRI ADELIA 10 – 02 – 2015 3000
57 HARMOKO 10 – 02 – 2015 3000
58 AHMAD TEGAR LUBIS 10 – 02 – 2015 3000
59 NURMA 10 – 02 – 2015 3000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
60 ADLAN 11 – 02 – 2015 3000
61 NURMALIAH 11 – 02 – 2015 3000
62 M. FANITAN 11 – 02 – 2015 3000
63 HERWIN 11 – 02 – 2015 3000
64 NUR ISMI 11 – 02 – 2015 3000
65 RAMLI 11 – 02 – 2015 3000
66 MUHTAR ARIFIN 11 – 02 – 2015 3000
67 LILI DAMAYANI 11 – 02 – 2015 3000
68 ABIAN 11 – 02 – 2015 3000
69 DARIUS 11 – 02 – 2015 3000
70 SILVIA 11 – 02 – 2015 3000
71 LATIFAH 11 – 02 – 2015 3000
72 JAMRI 11 – 02 – 2015 3000
73 ALFA 11 – 02 – 2015 3000
74 REIHAN 11 – 02 – 2015 3000
75 SANTI 11 – 02 – 2015 3000
76 BENGBENG 12 – 02 – 2015 3000
77 JAMAIYAH 12 – 02 – 2015 3000
78 MEISYA AYU 12 – 02 – 2015 3000
79 JALILA 12 – 02 – 2015 3000
80 NURHAYATI 12 – 02 – 2015 3000
81 KRISTIAN 12 – 02 – 2015 3000
82 RISKIANA 13 – 02 – 2015 3000
83 MURNI BR. S 13 – 02 – 2015 3000
84 ALIYAH 13 – 02 – 2015 3000
85 MARFUAH 14 – 02 – 2015 3000
86 HARMOKO 14 – 02 – 2015 3000
87 RAMLI 14 – 02 – 2015 3000
88 RAMIYEM 14 – 02 – 2015 3000
89 MUKHTAR ARIFIN 14 – 02 – 2015 3000
90 NURUL FAUZI 14 – 02 – 2015 3000
91 M. RAMADHAN 14 – 02 – 2015 3000
92 AMI 14 – 02 – 2015 3000
93 RAGIL RAFIKI 14 – 02 – 2015 3000
94 NOVAL 14 – 02 – 2015 3000
95 NONI 14 – 02 – 2015 3000
96 FITRI RAMDAHANI 16 – 02 – 2015 3000
97 V BR. GINTING 16 – 02 – 2015 3000
98 MEISYA AYU 16 – 02 – 2015 3000
99 JUSTIN PASARIBU 16 – 02 – 2015 3000
100 M. RAFLI 16 – 02 – 2015 3000
101 AURA NAZWA D 16 – 02 – 2015 3000
102 SAQILAH 16 – 02 – 2015 3000
103 JUMANTI 16 – 02 – 2015 3000
104 M. AGIL GUNAWAN 16 – 02 – 2015 3000
105 M. ADITYA 16 – 02 – 2015 3000
106 MAIMUNAH 17 – 02 – 2015 3000
107 M. NUR J 17 – 02 – 2015 3000
108 WILLY 17 – 02 – 2015 3000
109 RAMADHAN 17 – 02 – 2015 3000
110 MELANI 17 – 02 – 2015 3000
111 NURHAIDA 17 – 02 – 2015 3000
112 JUNAIDI 17 – 02 – 2015 3000
113 MINARIA 17 – 02 – 2015 3000
114 MIRA 17 – 02 – 2015 3000
115 INDAH 17 – 02 – 2015 3000
116 ROSMAWATI 17 – 02 – 2015 3000
117 SURIANI 17 – 02 – 2015 3000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
118 ABIZAR 17 – 02 – 2015 3000
119 SURATMAN 18 – 02 – 2015 3000
120 ERNI 18 – 02 – 2015 3000
121 SITI RAHMAH 18 – 02 – 2015 3000
122 SUSILAWATI 18 – 02 – 2015 3000
123 AKBAR 18 – 02 – 2015 3000
124 SINTA 18 – 02 – 2015 3000
125 IKHSAN SURYA 18 – 02 – 2015 3000
126 RASYID 18 – 02 – 2015 3000
127 GINO 18 – 02 – 2015 3000
128 ARI S 20 – 02 – 2015 3000
129 SANTI 20 – 02 – 2015 3000
130 RUSTAM EFFENDI 20 – 02 – 2015 3000
131 M. TAUFIK 20 – 02 – 2015 3000
132 MARFUAH 20 – 02 – 2015 3000
133 REZA 20 – 02 – 2015 3000
134 DIMAS 20 – 02 – 2015 3000
135 ASIFA TA’QIA 20 – 02 – 2015 3000
136 HALIMAH 21 – 02 – 2015 3000
137 SALBIAH 21 – 02 – 2015 3000
138 AMIRA 21 – 02 – 2015 3000
139 NATASHA 21 – 02 – 2015 3000
140 NORA YOSEVIN 21 – 02 – 2015 3000
141 SORAYA 21 – 02 – 2015 3000
142 AMIAH 21 – 02 – 2015 3000
143 TRISAWATI 21 – 02 – 2015 3000
144 SAMINI 21 – 02 – 2015 3000
145 JELITA FITRI 21 – 02 – 2015 3000
146 ALIYAH 23 – 02 – 2015 3000
147 M. BENING 23 – 02 – 2015 3000
148 SERSIA GINTING 23 – 02 – 2015 3000
149 AYU PURNAMA SARI 23 – 02 – 2015 3000
150 ELVINE 23 – 02 – 2015 3000
151 SUPRIANTI 23 – 02 – 2015 3000
152 NURCHOLIS 23 – 02 – 2015 3000
153 M. DEVI AFRITA 23 – 02 – 2015 3000
154 NESA 23 – 02 – 2015 3000
155 GENI 23 – 02 – 2015 3000
156 JELITA 23 – 02 – 2015 3000
157 DEVA 23 – 02 – 2015 3000
158 ANGELINA 23 – 02 – 2015 3000
159 ARI A SIANTURI 23 – 02 – 2015 3000
160 RUKIATI 24 – 02 – 2015 3000
 161 IRWANSYAH 24 – 02 – 2015 3000
162 EKO 24 – 02 – 2015 3000
163 RIVALDI 24 – 02 – 2015 3000
164 M. TAMBUNAN 24 – 02 – 2015 3000
165 ROSMAWATI 24 – 02 – 2015 3000
166 DEWI ASTUTI 24 – 02 – 2015 3000
167 FITASARI 24 – 02 – 2015 3000
168 HAICAL 24 – 02 – 2015 3000
169 M. DAFA 24 – 02 – 2015 3000
170 HARRIS 24 – 02 – 2015 3000
171 RIZKI 24 – 02 – 2015 3000
172 JAYANTI S 24 – 02 – 2015 3000
173 DAHLIA 24 – 02 – 2015 3000
174 M. RIDWAN 24 – 02 – 2015 3000
175 ROSLIANA 24 – 02 – 2015 3000
176 RICHARD 25 – 02 – 2015 3000
177 SANIAH 25 – 02 – 2015 3000
178 RASYID 25 – 02 – 2015 3000
179 ANAYA 25 – 02 – 2015 3000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
180 M. RAMADHAN 25 – 02 – 2015 3000
181 KURIADI 25 – 02 – 2015 3000
182 SUYEM 26 – 02 – 2015 3000
183 RAJA 26 – 02 – 2015 3000
184 SALSABILA 26 – 02 – 2015 3000
185 FARIDAH 26 – 02 – 2015 3000
186 ABDI GUNAWAN 26 – 02 – 2015 3000
187 ADE 27 – 02 – 2015 3000
188 RIZKI A SINAGA 27 – 02 – 2015 3000
189 BALQIS 27 – 02 – 2015 3000
190 HAFIZA 27 – 02 – 2015 3000
191 UDAN 27 – 02 – 2015 3000
192 HAFISAH RAMADHANI 28 – 02 – 2015 3000
193 M. SYAHRUL 28 – 02 – 2015 3000
194 ROY MANULANG 28 – 02 – 2015 3000
195 ARMAYANI 28 – 02 – 2015 3000
196 WAN TRIONO 28 – 02 – 2015 3000
197 ALIYA SAFIRA 28 – 02 – 2015 3000
198 AZIZAH 28 – 02 – 2015 3000
199 GLORIA 28 – 02 – 2015 3000
200 TIO SITUMORANG 28 – 02 – 2015 3000
JUMLAH 600.000

Diketahui oleh : Pembantu Kasir Penerima

KEPALA PUSKESMAS GEBANG Puskesmas Gebang

Hj. ERLINA , SKM TRESIA , AS

Nip. 19690824 199903 Nip. 19650604 198603 2 004
 DAFTAR : PASIEN UMUM RAWAT JALAN PUSKESMAS GEBANG
BULAN : JANUARI 2015
Kategori Pasien Umum
Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
1 ZUL ZALI RAO 30 – 12 – 2014 8000
2 AWALUDDIN 30 – 12 – 2014 8000
3 WASDI 30 – 12 – 2014 8000
4 EMI LAILI 30 – 12 – 2014 8000
5 SYAMSUL BAHRI 30 – 12 – 2014 8000
6 YANDA 30 – 12 – 2014 8000
7 R. BR GULTOM 31 – 12 – 2014 8000
8 REZA AFRITA 31 – 12 – 2014 8000
9 YUSNIAR 31 – 12 – 2014 8000
10 NASRI BELA 31 – 12 – 2014 8000
11 SRI WAHYUNI 31 – 12 – 2014 8000
12 HENRI 02 – 01 – 2015 8000
13 INGGIT K 02 – 01 – 2015 8000
14 BUNGA 02 – 01 – 2015 8000
15 ROHANI 03 – 01 – 2015 8000
16 HAMIDAH 03 – 01 – 2015 8000
17 RONI 03 – 01 – 2015 8000
18 WENTI SITORUS 05 – 01 – 2015 8000
19 MARUDUT 05 – 01 – 2015 8000
20 TEJA 05 – 01 – 2015 8000
21 NURUL 05 – 01 – 2015 8000
22 ZUHRIADI 05 – 01 – 2015 8000
23 NURUL 05 – 01 – 2015 8000
24 THOMAS 06 – 01 – 2015 8000
25 AZI MAULANA 06 – 01 – 2015 8000
26 SRI WAHYUNI 07 – 01 – 2015 8000
27 TASYA 07 – 01 – 2015 8000
28 M. AZHAR 07 – 01 – 2015 8000
29 DIAN ANGGUR 08 – 01 – 2015 8000
30 MARTA 08 – 01 – 2015 8000
31 ARIF RAHMAN 08 – 01 – 2015 8000
32 FATIMAH 08 – 01 – 2015 8000
33 M. PUTRA 08 – 01 – 2015 8000
34 LASTIUR 09 – 01 – 2015 8000
35 CINDY AFRIANA 09 – 01 – 2015 8000
36 RISKA AMELIA 09 – 01 – 2015 8000
37 SILVIA A PASARIBU 10 – 01 – 2015 8000
38 PUTRI SALSABILA R 10 – 01 – 2015 8000
39 ZURAIDA 10 – 01 – 2015 8000
40 PUTRI PRADANA 12 – 01 – 2015 8000
41 MARIANI HARAHAP 12 – 01 – 2015 8000
42 SRI GUSTINA 12 – 01 – 2015 8000
43 MINATI SITOHANG 12 – 01 – 2015 8000
44 KASMIATI 12 – 01 – 2015 8000
45 NADIA AFRIZA 13 – 01 – 2015 8000
46 M. LUMBAN GAOL 13 – 01 – 2015 8000
47 SETIA SURBAKTI 13 – 01 – 2015 8000
48 WILLIEM SILALAHI 13 – 01 – 2015 8000
49 M. RIDHO 14 – 01 – 2015 8000
50 NGATIMIN 15 – 01 – 2015 8000
51 SUARTI 15 – 01 – 2015 8000
52 FAHRIZAL 15 – 01 – 2015 8000
53 BAGUS 16 – 01 – 2015 8000
54 MALADI NASUTION 16 – 01 – 2015 8000
55 MARIATI 16 – 01 – 2015 8000
56 HENDRA SYAHPUTRA 16 – 01 – 2015 8000
57 FIRMANSYAH 17 – 01 – 2015 8000
58 IRWAN ARITONANG 17 – 01 – 2015 8000
59 ZUL ZALI RAO 19 – 01 – 2015 8000
60 NURDIAR DINI 19 – 01 – 2015 8000
61 SYAIFUL HARAHAP 19 – 01 – 2015 8000
62 EDI SYAHRIAL 19 – 01 – 2015 8000
63 MASIAH 19 – 01 – 2015 8000
64 JUMINI 19 – 01 – 2015 8000
65 EVA UTAMI 19 – 01 – 2015 8000
66 ZURAIDA 19 – 01 – 2015 8000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
67 ALFRIDA 20 – 01 – 2015 8000
68 ANGELINA 20 – 01 – 2015 8000
69 NANDA SYAHPUTRI 21 – 01 – 2015 8000
70 WINDY 21 – 01 – 2015 8000
71 ROSMAWATI 21 – 01 – 2015 8000
72 RIAN 21 – 01 – 2015 8000
73 TAMBA TUA SIMBOLON 21 – 01 – 2015 8000
74 SELAMAT 22 – 01 – 2015 8000
75 PIUS 22 – 01 – 2015 8000
76 VERONICA A 22 – 01 – 2015 8000
77 JUMINTA BR. M 22 – 01 – 2015 8000
78 EVI FARULLAH H 23 – 01 – 2015 8000
79 SITI RADIAH 23 – 01 – 2015 8000
80 ASNANI 24 – 01 – 2015 8000
81 JULI INDRAWAN 24 – 01 – 2015 8000
82 SAKINA V 26 – 01 – 2015 8000
83 YOHANA S 26 – 01 – 2015 8000
84 INDAH KHAIRANI 26 – 01 – 2015 8000
85 M. FAUZAN 27 – 01 – 2015 8000
86 BUTET BANGUN 27 – 01 – 2015 8000
87 A MAPAUNG 27 – 01 – 2015 8000
88 MISCA 27 – 01 – 2015 8000
89 SUMARDI 27 – 01 – 2015 8000
90 FITRIADI 27 – 01 – 2015 8000
91 VIVI SUMANTI 28 – 01 – 2015 8000
92 SILVIA 28 – 01 – 2015 8000
93 AISYAH 30 – 01 – 2015 8000
94 SRI LESTARI 30 – 01 – 2015 8000
95 D SIMANJUNTAK 31 – 01 – 2015 8000
96 CHOKY 31 – 01 – 2015 8000
97 YUSNIAR 31 – 01 – 2015 8000
98 NASRI BELA 31 – 01 – 2015 8000
99 SRI WAHYUNI 31 – 01 – 2015 8000
100 HENRI 31 – 01 – 2015 8000
101 INGGIT K 31 – 01 – 2015 8000
102 MISCA 31 – 01 – 2015 8000
103 SUMARDI 31 – 01 – 2015 8000
104 FITRIADI 31 – 01 – 2015 8000
106 MINATI SITOHANG 31 – 01 – 2015 8000
JUMLAH PASIEN PUSKESMAS 854.000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
107 ULI NUA 02 – 01 – 2015 8000
108 JUMINI 02 – 01 – 2015 8000
109 MASIAH 02 – 01 – 2015 8000
110 ANTO 05 – 01 – 2015 8000
111 PONIMAN 05 – 01 – 2015 8000
112 SELA RAHMAH 05 – 01 – 2015 8000
113 MAHYUDAN 05 – 01 – 2015 8000
114 PUTRI 05 – 01 – 2015 8000
115 WIDYA 23 – 01 – 2015 8000
116 MUSAMELIA 23 – 01 – 2015 8000
117 R. SITUMORANG 23 – 01 – 2015 8000
118 ABDI HASIN 23 – 01 – 2015 8000
119 NUR MAISYARAH 27 – 01 – 2015 8000
120 PURNAMA 28 – 01 – 2015 8000
121 RIMA MAULINA 28 – 01 – 2015 8000
122 INTAN SASKIA 28 – 01 – 2015 8000
123 M. SIHOMBING 28 – 01 – 2015 8000
124 ABDI HAKIM 28 – 01 – 2015 8000
125 NGATEMI 29 – 01 – 2015 8000
126 SENANG 29 – 01 – 2015 8000
127 JUMILA 29 – 01 – 2015 8000
128 DARLINA 29 – 01 – 2015 8000
129 JINGGA 29 – 01 – 2015 8000
130 NURAINI 29 – 01 – 2015 8000
131 SRI 30 – 01 – 2015 8000
132 SIREN SAHARA 30 – 01 – 2015 8000
133 SAHRUDDIN 30 – 01 – 2015 8000
134 ELZA FAHRI 30 – 01 – 2015 8000
135 MERI HANDAYANI 30 – 01 – 2015 8000
136 ROSDAH 31 – 01 – 2015 8000
137 RATIH NURFADILAH 31 – 01 – 2015 8000
JUMLAH PASIEN PUSTU PEKAN GEBANG ( 31 PASIEN ) 248.000
138 SUSI 05 – 01 – 2015 8000
139 SARTINAH 05 – 01 – 2015 8000
140 TURINI 05 – 01 – 2015 8000
141 ERNA 05 – 01 – 2015 8000
142 NARSI 05 – 01 – 2015 8000
143 PARMAN 23 – 01 – 2015 8000
144 ARI SYAHPUTRA 23 – 01 – 2015 8000
145 MARULI S 23 – 01 – 2015 8000
146 MISKA 23 – 01 – 2015 8000
147 LUKTI 27 – 01 – 2015 8000
148 AKMAD TEGAR LUBIS 28 – 01 – 2015 8000
149 VERA WATI 28 – 01 – 2015 8000
150 HAFIZA 28 – 01 – 2015 8000
151 BASARIAH 29 – 01 – 2015 8000
152 OSCAR 30 – 01 – 2015 8000
153 AWALUDDIN 30 – 01 – 2015 8000
154 IRFAN FAUZAN 31 – 01 – 2015 8000
JUMLAH PASIEN PUSTU PASAR RAWA ( 17 PASIEN ) 136.000
155 ALFATHAR 02 – 01 – 2015 8000
156 WAHYUDI 02 – 01 – 2015 8000
157 HENIARNITA 02 – 01 – 2015 8000
158 ZAKARIA 22 – 01 – 2015 8000
159 FITRI YNITA 22 – 01 – 2015 8000
160 DEA RANTIZA 27 – 01 – 2015 8000
161 DEWI 27 – 01 – 2015 8000
162 ALFRIDA 29 – 01 – 2015 8000
163 ANGELIA 29 – 01 – 2015 8000
164 DINDA ELZA 30 – 01 – 2015 8000
165 M SYAHDI 31 – 01 – 2015 8000
166 YOHANA 31 – 01 – 2015 8000
JUMLAH PASIEN PUSTU PAYA BENGKUANG ( 12 PASIEN ) 96.000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
167 HALIMAH 05 – 01 – 2015 8000
168 ERNAWATI 05 – 01 – 2015 8000
169 AISYAH 05 – 01 – 2015 8000
170 FARIDA HANUM 06 – 01 – 2015 8000
171 MAIMUNAH 08 – 01 – 2015 8000
172 ZIHAN 08 – 01 – 2015 8000
173 ARI 08 – 01 – 2015 8000
174 FIRMANSYAH 08 – 01 – 2015 8000
175 SUGIANTO 10 – 01 – 2015 8000
176 FITRI 10 – 01 – 2015 8000
177 PUTRI 10 – 01 – 2015 8000
178 MARIKI 23 – 01 – 2015 8000
179 ALFRIDA 27 – 01 – 2015 8000
180 ANGELINA 28 – 01 – 2015 8000
181 EDINAR 30 – 01 – 2015 8000
182 NORMAN 30 – 01 – 2015 8000
183 NORMANSYAH 31 – 01 – 2015 8000
184 SITI MARDINA 31 – 01 – 2015 8000
JUMLAH PASIEN PUSTU DOGANG ( 18 PASIEN ) 144.000
185 AZWAR 02 – 01 – 2015 8000
186 MISA 05 – 01 – 2015 8000
187 WIJAYA KESUMA 05 – 01 – 2015 8000
188 SIREN SAHARA 05 – 01 – 2015 8000
189 NAZLAH 27 – 01 – 2015 8000
190 R SIANTURI 29 – 01 – 2015 8000
191 AS GULTOM 29 – 01 – 2015 8000
192 LILIS 29 – 01 – 2015 8000
193 YOGA 31 – 01 – 20145 8000
JUMLAH PASIEN PUSTU AIR HITAM ( 9 PASIEN ) 72.000
 146 TIKA 07 – 01 – 2015 8000
147 ZURAIDA 07 – 01 – 2015 8000
148 MADI 07 – 01 – 2015 8000
149 SUHARNI 23 – 01 – 2015 8000
150 M HAZIB 26 – 01 – 2015 8000
151 DONI 27 – 01 – 2015 8000
152 KALIS SIAHAAN 29 – 01 – 2015 8000
153 BAMBANG 30 – 01 – 2015 8000
154 FARIDA 30 – 01 – 2015 8000
155 EDI SYAHRIAL 30 – 01 – 2015 8000
156 M SYAHRUL R 31 – 01 – 2015 8000
JUMLAH PASIEN PUSTU SANGGALIMA ( 11 PASIEN ) 88.000
159 SITI AFRIDA 23 – 01 – 2015 8000
160 WIBOWO 26 – 01 – 2015 8000
161 INTAN RAJAGUKGUK 27 – 01 – 2015 8000
162 K ANGELI 30 – 01 – 2015 8000
163 M RIZKI 30 – 01 – 2015 8000
164 KALIS SIAHAAN 30 – 01 – 2015 8000
165 BAMBANG 31 – 01 – 2015 8000
JUMLAH PASIEN PUSTU KWALA GEBANG ( 7 PASIEN ) 56.000
JUMLAH PASIEN KESELURUHAN 1.702.000

Diketahui oleh : Pembantu Kasir Penerima

KEPALA PUSKESMAS GEBANG Puskesmas Gebang

Hj. ERLINA , SKM TRESIA , AS

Nip. 19690824 199903 2 004 Nip. 19650604 198603 2 004

DAFTAR : PASIEN UMUM RAWAT JALAN PUSKESMAS GEBANG

BULAN : FEBRUARI 2015
Kategori Pasien Umum
Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
1 R. SITUMORANG 03 – 02 – 2015 8000
2 ABDI HASIN 03 – 02 – 2015 8000
3 NUR MAISYARAH 03 – 02 – 2015 8000
4 PURNAMA 03 – 02 – 2015 8000
5 RIMA MAULINA 04 – 02 – 2015 8000
6 INTAN SASKIA 04 – 02 – 2015 8000
7 M. SIHOMBING 05 – 02 – 2015 8000
8 KARSI 05 – 02 – 2015 8000
9 M. TAMBUNAN 06 – 02 – 2015 8000
10 M. FIKRI 06 – 02 – 2015 8000
11 A. OP SUNGGUL 06 – 02 – 2015 8000
12 RATIH 06 – 02 – 2015 8000
13 INGGIT K 07 – 02 – 2015 8000
14 BUNGA 09 – 02 – 2015 8000
15 ROHANI 09 – 02 – 2015 8000
16 HAMIDAH 09 – 02 – 2015 8000
17 RONI 09 – 02 – 2015 8000
18 WENTI SITORUS 09 – 02 – 2015 8000
19 MARUDUT 10 – 02 – 2015 8000
20 TEJA 10 – 02 – 2015 8000
21 NURUL 10 – 02 – 2015 8000
22 MELVI SAHANATIVA 11 – 02 – 2015 8000
23 BOIMEN 11 – 02 – 2015 8000
24 WENTI SITORUS 11 – 02 – 2015 8000
25 IKA NOVI 11 – 02 – 2015 8000
26 DIAN NABILA 11 – 02 – 2015 8000
27 AFRI ZAHARA 11 – 02 – 2015 8000
28 M. AZHAR 12 – 02 – 2015 8000
29 DIAN ANGGUR 12 – 02 – 2015 8000
30 MARTA 13 – 02 – 2015 8000
31 ARIF RAHMAN 14 – 02 – 2015 8000
32 FATIMAH 14 – 02 – 2015 8000
33 M. PUTRA 14 – 02 – 2015 8000
34 LASTIUR 14 – 02 – 2015 8000
35 CINDY AFRIANA 14 – 02 – 2015 8000
36 RISKA AMELIA 14 – 02 – 2015 8000
37 SILVIA A PASARIBU 16 – 02 – 2015 8000
38 PUTRI SALSABILA R 16 – 02 – 2015 8000
39 ZURAIDA 16 – 02 – 2015 8000
40 SURYA EFENDI 17 – 02 – 2015 8000
41 ADE INDRA IRAWAN 17 – 02 – 2015 8000
42 KIKI ANGGRAINI 17 – 02 – 2015 8000
43 BAHTAR EFENDI 17 – 02 – 2015 8000
44 PAIDI 18 – 02 – 2015 8000
45 NADIA AFRIZA 18 – 02 – 2015 8000
46 M. LUMBAN GAOL 18 – 02 – 2015 8000
47 SETIA SURBAKTI 20 – 02 – 2015 8000
48 WILLIEM SILALAHI 20 – 02 – 2015 8000
49 M. RIDHO 20 – 02 – 2015 8000
50 NGATIMIN 21 – 02 – 2015 8000
51 SUARTI 21 – 02 – 2015 8000
52 FAHRIZAL 21 – 02 – 2015 8000
53 BAGUS 21 – 02 – 2015 8000
54 MALADI NASUTION 23 – 02 – 2015 8000
55 MARIATI 23 – 02 – 2015 8000
56 HENDRA SYAHPUTRA 23 – 02 – 2015 8000
57 FIRMANSYAH 23 – 02 – 2015 8000
58 IRWAN ARITONANG 23 – 02 – 2015 8000
59 WISNELDI 24 – 02 – 2015 8000
60 NONI 24 – 02 – 2015 8000
61 SYAIFUL HARAHAP 24 – 02 – 2015 8000
62 EDI SYAHRIAL 24 – 02 – 2015 8000
63 MASIAH 24 – 02 – 2015 8000
64 JUMINI 24 – 02 – 2015 8000
65 EVA UTAMI 25 – 02 – 2015 8000
66 ZURAIDA 25 – 02 – 2015 8000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
67 ALFRIDA 26 – 02 – 2015 8000
68 ANGELINA 27 – 02 – 2015 8000
69 NANDA SYAHPUTRI 27 – 02 – 2015 8000
70 WINDY 28 – 02 – 2015 8000
71 ROSMAWATI 28 – 02 – 2015 8000
72 RIAN 28 – 02 – 2015 8000
73 TAMBA TUA SIMBOLON 28 – 02 – 2015 8000
74 SELAMAT 28 – 02 – 2015 8000
75 PIUS 28 – 02 – 2015 8000
76 VERONICA A 28 – 02 – 2015 8000
77 JUMINTA BR. M 28 – 01 – 2015 8000
JUMLAH PASIEN PUSKESMAS 616.000
 Kategori Pasien Umum
Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
78 ALFRIDA 03 – 02 – 2015 8000
79 ANGELINA 03 – 02 – 2015 8000
80 NANDA SYAHPUTRI 03 – 02 – 2015 8000
81 WINDY 03 – 02 – 2015 8000
82 ROSMAWATI 03 – 02 – 2015 8000
83 RIAN 03 – 02 – 2015 8000
84 TAMBA TUA SIMBOLON 03 – 02 – 2015 8000
85 SELAMAT 16 – 02 – 2015 8000
86 WIDYA 17 – 02 – 2015 8000
87 MUSAMELIA 23 – 02 – 2015 8000
88 R. SITUMORANG 23 – 02 – 2015 8000
89 ABDI HASIN 23 – 02 – 2015 8000
90 NUR MAISYARAH 25 – 02 – 2015 8000
91 PURNAMA 25 – 02 – 2015 8000
92 RIMA MAULINA 25 – 02 – 2015 8000
93 INTAN SASKIA 25 – 02 – 2015 8000
94 M. SIHOMBING 25 – 02 – 2015 8000
95 ABDI HAKIM 27 – 02 – 2015 8000
96 NGATEMI 27 – 02 – 2015 8000
97 SENANG 27 – 02 – 2015 8000
 98 JUMILA 27 – 02 – 2015 8000
99 DARLINA 27 – 02 – 2015 8000
100 JINGGA 28 – 02 – 2015 8000
101 NURAINI 28 – 02 – 2015 8000
102 SRI 28 – 02 – 2015 8000
103 SIREN SAHARA 28 – 02 – 2015 8000
104 SAHRUDDIN 28 – 02 – 2015 8000
105 ELZA FAHRI 28 – 02 – 2015 8000
106 MERI HANDAYANI 28 – 02 – 2015 8000
107 ROSDAH 28 – 02 – 2015 8000
108 RATIH NURFADILAH 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU PEKAN GEBANG ( 31 PASIEN ) 248.000
138 MARUDUT 05 – 02 – 2015 8000
139 TEJA 05 – 02 – 2015 8000
140 NURUL 05 – 02 – 2015 8000
141 MELVI SAHANATIVA 05 – 02 – 2015 8000
142 BOIMEN 05 – 02 – 2015 8000
143 PARMAN 05 – 02 – 2015 8000
144 ARI SYAHPUTRA 20 – 02 – 2015 8000
145 MARULI S 23 – 02 – 2015 8000
146 MISKA 23 – 02 – 2015 8000
147 LUKTI 27 – 02 – 2015 8000
148 AKMAD TEGAR LUBIS 28 – 02 – 2015 8000
149 VERA WATI 28 – 02 – 2015 8000
150 HAFIZA 28 – 02 – 2015 8000
151 BASARIAH 28 – 02 – 2015 8000
152 OSCAR 28 – 02 – 2015 8000
153 AWALUDDIN 28 – 02 – 2015 8000
154 IRFAN FAUZAN 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU PASAR RAWA ( 17 PASIEN ) 136.000
155 ALFATHAR 04 – 02 – 2015 8000
156 WAHYUDI 04 – 02 – 2015 8000
157 HENIARNITA 04 – 02 – 2015 8000
158 ZAKARIA 04 – 02 – 2015 8000
159 FITRI YNITA 04 – 02 – 2015 8000
160 DEA RANTIZA 27 – 02 – 2015 8000
161 DEWI 27 – 02 – 2015 8000
162 ALFRIDA 27 – 02 – 2015 8000
163 ANGELIA 28 – 02 – 2015 8000
164 DINDA ELZA 28 – 02 – 2015 8000
165 M SYAHDI 28 – 02 – 2015 8000
166 YOHANA 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU PAYA BENGKUANG ( 12 PASIEN ) 96.000

Kategori Pasien Umum

Jumlah Setoran
No Nama Pasien Tgl.Rawat
Tgl. Rawat Jalan ( Rp )
Inap
167 HALIMAH 07 – 02 – 2015 8000
168 ERNAWATI 07 – 02 – 2015 8000
169 AISYAH 07 – 02 – 2015 8000
170 FARIDA HANUM 07 – 02 – 2015 8000
171 MAIMUNAH 07 – 02 – 2015 8000
172 ZIHAN 21 – 02 – 2015 8000
173 ARI 23 – 02 – 2015 8000
174 FIRMANSYAH 23 – 02 – 2015 8000
175 SUGIANTO 23 – 02 – 2015 8000
176 FITRI 23 – 02 – 2015 8000
177 PUTRI 23 – 02 – 2015 8000
178 MARIKI 26 – 02 – 2015 8000
179 ALFRIDA 26 – 02 – 2015 8000
180 ANGELINA 26 – 02 – 2015 8000
 181 EDINAR 26 – 02 – 2015 8000
182 NORMAN 28 – 02 – 2015 8000
183 NORMANSYAH 28 – 02 – 2015 8000
184 SITI MARDINA 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU DOGANG ( 18 PASIEN ) 144.000
185 AZWAR 02 – 02 – 2015 8000
186 MISA 05 – 02 – 2015 8000
187 WIJAYA KESUMA 05 – 02 – 2015 8000
188 SIREN SAHARA 05 – 02 – 2015 8000
189 NAZLAH 27 – 02 – 2015 8000
190 R SIANTURI 28 – 02 – 2015 8000
191 AS GULTOM 28 – 02 – 2015 8000
192 LILIS 28 – 02 – 2015 8000
193 YOGA 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU AIR HITAM ( 9 PASIEN ) 72.000
146 TIKA 14 – 02 – 2015 8000
147 ZURAIDA 14 – 02 – 2015 8000
148 MADI 14 – 02 – 2015 8000
149 SUHARNI 14 – 02 – 2015 8000
150 M HAZIB 26 – 02 – 2015 8000
151 DONI 27 – 02 – 2015 8000
152 KALIS SIAHAAN 27 – 02 – 2015 8000
153 BAMBANG 27 – 02 – 2015 8000
154 FARIDA 27 – 02 – 2015 8000
155 EDI SYAHRIAL 28 – 02 – 2015 8000
156 M SYAHRUL R 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU SANGGALIMA ( 11 PASIEN ) 88.000
159 SITI AFRIDA 23 – 02 – 2015 8000
160 WIBOWO 26 – 02 – 2015 8000
161 INTAN RAJAGUKGUK 27 – 02 – 2015 8000
162 K ANGELI 27 – 02 – 2015 8000
163 M RIZKI 27 – 02 – 2015 8000
164 KALIS SIAHAAN 28 – 02 – 2015 8000
165 BAMBANG 28 – 02 – 2015 8000
JUMLAH PASIEN PUSTU KWALA GEBANG ( 7 PASIEN ) 56.000
JUMLAH PASIEN KESELURUHAN 1.464.000

Diketahui oleh : Pembantu Kasir Penerima

KEPALA PUSKESMAS GEBANG Puskesmas Gebang

Hj. ERLINA , SKM TRESIA , AS

Nip. 19690824 199903 2 004 Nip. 19650604 198603 2 004