INSTRUMEN MONEV PELAKSANAAN JAMINAN KESEHATAN NASIONAL (JKN)

FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP)

TAHUN 2022

PROVINSI : SULAWESI UTARA KAB/KOTA : MINAHASA UTARA

I. DATA UMUM

1. Nama FKTP

2. Nama Contact Person ............................................... No. HP ..........................................

3. No. telp dan atau faks ........................................................................................................

4. Email ........................................................................................................

5. Jenis Puskesmas Perawatan / Non Perawatan / PONED

II. DATA KUNJUNGAN PELAYANAN JKN

Bulan Pelayanan
No Jenis Pelayanan
JAN FEB MAR APR MEI JUN JUL AGUST SEPT
1 Rawat Jalan
2 Rawat Inap
3 Persalinan
4 Rujukan
5 Rujuk Balik

III. PEMANFAATAN DANA KAPITASI

Besaran Dana Kapitasi Yang diterima (Rp)

Jenis Bulan Pelayanan

Pembayaran JAN FEB MAR APR MEI JUN JUL AGUST SEPT
Kapitasi
Non Kapitasi
IV. IMPLEMENTASI PERPRES 32 TAHUN 2014

(Sebutkan untuk pemanfatan apa saja dana kapitasi tersebut)

V. SISTEM INFORMASI DAN PELAPORAN

1. Apakah FKTP Saudara telah menggunakan system P-Care ?

 Sudah  Belum
jika belum, apa masalahnya : ..............................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
jika sudah, apakah ada Petugas Khusus yang melakukan input data di system P-care?

 Ada  Tidak
Apakah ada pelatihan bagi Petugas Penginput data di system P-Care?

 Ada, Siapa yang melatihkannya ………………………………………….  Tidak

Ada kah kendala dalam mengoperasionalkan system P-Care? jelaskan ............................................
..............................................................................................................................................................
..............................................................................................................................................................
Apakah Instansi Anda menggunakan Sistem Aplikasi (input data pelayanan) selain P-Care?

 iya  Tidak
jika iya, sebutkan nama aplikasi yang digunakan? apakah ada kendala dalam mengoperasikannya?
..............................................................................................................................................................
..............................................................................................................................................................

2. Apakah ada kewajiban pelaporan program JKN ke :

a. BPJS ? jika ada apakah FKTP anda melaksanakan secara rutin (setiap bulannya)?
.........................................................................................................................................................
b. Dinas Kesehatan ? jika ada apakah FKTP anda melaksanakan secara rutin (setiap bulannya)?
.........................................................................................................................................................
3. Permasalahan dalam system pelaporan yang ada?
..............................................................................................................................................................
..............................................................................................................................................................
VI. PERMASALAHAN

Mohon di isi mengenai masalah yang di alami/temukan dalam pelaksanaan JKN terkait pada :

1. Aspek Kepesertaan :
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
2. Aspek Pelayanan :
..............................................................................................................................................................
..............................................................................................................................................................
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3. Aspek pembiayaan :
..............................................................................................................................................................
..............................................................................................................................................................
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4. Aspek organisasi dan manajemen , hubungan kerja dengan BPJS Kesehatan:
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................

, ……………………………………

Mengetahui,
Kepala Puskesmas

( )
NIP.