Data pemasukan Retribusi Puskesmas suralaga ta

NO Tanggal No RM Nama Alamat Pembayaran Re

Penda SKS Labora Haji
ftaran torium

1/1/2020
1 2/1/2020 Barhain 5,000
Esa Anjani 5,000
H Fauzi 5,000
Jubaedah 5,000
m Ramzi 5,000
Bq Alisa Yumna 5,000
Sulhan 5,000 10,000
Samsul hadi 5,000
Nasila Nasifa 5,000
Raden Abizar 5,000
M Azmi Akbar 5,000
Iq Lindawati 5,000
Ibnu Hakim 5,000
naena atiqoh 5,000
Muh. Bayu suminah -
Hujzatul Husnah 5,000
Lindawati 5,000
Nadia Azzahra 5,000
JUMLAH 85,000 10,000
3/1/2020 M nasrullah 5,000
Maun - 10,000
Pandi Albani 5,000
Iq Romla 5,000
Papuk Bisin 5,000
Nuraeni 5,000
Aisah Farhan 5,000
JUMLAH 30,000 10,000
4/1/2020 St komalasari 5,000
Fadila 5,000
Aoulia sukarni 5,000
AisahAurel 5,000
Miskam 5,000
Arfan Habibi 5,000
Musipuddin 5,000
Febriana Maulina 5,000
Alsa Agustina 5,000
Nuril Muharti 5,000
Salma Laeli 5,000
 Algifari 5,000
Alpan sori 5,000
JUMLAH 65,000
5/1/2020
6/1/2020 Ahi tholid Attani 5,000
zaepah 5,000
L Kurnia 5,000 10000
Mu Awalli 5,000
Bq Aisah 5,000 40000
Bq Muliani 5,000
L. arkino 5,000
Murzilani 5,000
Azka fafizun 5,000
Suhaeli 5,000
Mahnun 5,000 40000
Raudatul imami 5,000 10000
Zuradika 5,000 10000
Bq Sri wahyuni 5,000
M Alqak Akbar 5,000
Jumlah 75,000 30000 40000
7/1/2020 Nurul Huda 5000
Yuyun 5000
Azal Sami 5000
Yumna KholifaH 5000
m Azmi 5000
Iq Wardani 5000
Fajar 5000
Ahmad Ridwan 5000 10000
Iq Huswatun 5000
Iq Zaetun 5000
Hasan Basri 5000 10000 10000
Bq nilawati 0
Naora Salsa 5000
Jumlah 60,000 20000 10000
8/1/2020 01004400 M. Fatir Habait 5000 50000
Naura Salsa 5000
Iq. Alimuddin 0 10000 10000
Muzammil 5000 10000
Bq. Diva 5000 30000
Teguh Pribumi 5000 60000
M. Fauz 5000
Hj. Mislahun 5000 25000
hanun qonita 5000
Pidiyatul 5000
Dilan Karunia 5000 40000
 Safa Marwah 5000
Nahdatain 5000
marnah 5000
inaq hidayati 5000
zama nawawi 5000
rangga hadi 5000
JUMLAH 80000 20000 215000
9/1/2020 Mariati 5000 40000
L. Abdul Aziz 5000 60000
M. Anwar 5000 15000
I. Roha 5000
Diawati 5000 40000
Muhlisin 5000
H. halid 5000
Khaerul Atqira 5000
JUMLAH 40000 155000
10/1/2020 Adiba syakila 5000
Rina Zahrani 5000 10000
Arsila Husni 5000
Aq. Suharni 5000
Sumariah 0 40000
Bq. Anisa Ihwani 5000
Nurhasanah 5000 40000
sasharadia 5000 60000
Supriadi 5000
Iq. Qabul 0
Arsyia Syavina 5000
Arsyila Husni 5000
Rahmatul Karomah 5000
Bq. Saharpiah 5000
Zaid Hanan 5000
L. Ahmad Zaen 5000
Usdayanti 5000
JUMLAH 75000 10000 140000
11/1/2020 Bq. Hazira 5000
Safa Marwah 0
L. Herniawan 5000
Nurrohmadani 5000
Bq. Aulia Soraya 5000
muh.irzani 5000
bq.suci dewi 5000
Bq. Aulia 5000
M. Anwi 5000
L. Arka Aditia 5000
Huswatun Hasanah 5000 10000
 zulfatun muhammad 5000
Mahasan Siddik 5000
JUMLAH 60000 10000
13/1/2019 Riki Junanda S 5000 10000
H. Zaenal Arifin 5000 15000
Wi'am Abdul Karim 5000 10000
H. Husni 5000
Muh. Sarapuddin 5000
Adiatul Aulia 5000
Muh. Sayuti Malik 5000
H. Ghazali 5000 10000
Hasbiah BT Rohani 5000
Iq. Pahruddin 5000
Hidayatussyafina 5000
Moh. Kailani Anwar 5000
M. yazid Alfariz 0 10000
Amira Husna 5000
Lina Tamara 5000
Supriadi 5000
L. Heri Ismayadi 5000
M. yusril Mayadi 5000
Siti Hidayati 0 5000
Jaril mas'ud 5000
Maika Syarif P 5000
Alfansori 5000
Mina Afrayani 5000
Adi Wijaya 5000 60000
Vina Tamara 0 10000
Bq. Sarhapiah 0 40000
Yanti 5000 40000
Ardiana 5000 30000
JUMLAH 120000 20000 220000
14/1/2020 M. Aulia R 5000
Suparman 5000
Bq. Rosita 5000
Ubidillah 5000
Ahmad Basri 5000
M. fauzi 5000
Nazril Askari 5000
Zaeni Mustafa 5000
Mukarramah 5000
Rauhil Jannah 5000
Hj. Madlah 5000
Fajar Bahran 5000
Aq. Yuliana 5000 25000
 Husnul Khotimah 5000 15000
Nuta Ningsih 5000
Iq. Hani 5000 5000
Abdurrahman 5000
M. abdurrahman 5000
Zaehun 5000
JUMLAH 95000 45000
15/1/2020 Ernawati 5000
Aq. M. Alparobi 5000 10000
M. sadli 5000 10000
M. Syahat 5000
Agus Harianto 5000 10000
Barhan 5000
Naura Sasa 5000
Rozianto 5000
Putriani 5000
Siti Nuraebah 5000
Tasyhur 5000
JUMLAH 55000 30000
Nurma Wanida 5000 10000 10000
16/1/2020 Khaerul Asrari 5000 10000
M. Amir Amirullah 5000
Fikriawati 5000
M. Fariz 5000
Aulia Ulfa 5000
H. Muh. Nur A 5000
Syarifa S 5000
Kurnia 5000
Omal Makali 5000
Fitriah 5000
Hafiz Kamil 5000
JUMLAH 60000 20000 10000
17/1/2020 Sopian zakir 5000 10000 10000
Ismail Miza 5000
Ita Madatul Has 5000
Abdullah Abad 5000
Halil Almalid 5000
Zahratul Aini 5000
Derin Ulul Azmi 5000
Dumhuru 5000
Iq. Sriwahyuni 5000 15000
L. Ahmad Adam 5000
H. Sahirman 5000 25000
Adinda Ayu s 5000
Uswatun Hasanah 5000
 JUMLAH 65000 10000 50000
18/1/2020 Ubadillah 5000
Sinta Dewi 5000
Bq. Aufa Elfina 5000
Asmaul Laeli 5000
M. Nur ali akbar 5000
Salmiah 5000
JUMLAH 30000
19/1/2020
20/1/2020 Aquila Zafira B 5000
Aqnia Ilma 5000
Jamilatul Laeli 5000 10000
Isna Dinda Putri 5000
M. Azhari 5000
Mustajab ali R 5000
M. Nauval Azzahidi 5000
Johana 5000
Hj. Mursiah 5000
Ahmad Mustafa Z 5000
Naira Jaoza Safa 5000
Novi Indriani 5000
Inaq asror 5000
M. Azka Alfaruh 5000
JUMLAH 70000 10000
21/1/2020 Asip 5000
Muh. Ramdani S 5000
Asri Hidayah 5000
Bq. Yuli Aprona 5000
Iwan 5000
Nadia 5000
Nurhaliza 5000
L. Muh Ibrahim 5000
H. Munawir 5000
Muh. Aropan M 5000
Muh. Fanji 5000
Fawazatun N 5000
Ayudia S. A 5000
JUMLAH 65000
22/1/2020 Anati Fatin 5000
Wasiah 5000
Muh. Afdan Dzaki 5000
Maulida Azzahra 5000
Aliya Noviana 5000
Izzatun M 5000
Rumaesa 5000
 Senep 5000
JUMLAH 40000
23/1/2020 Usman Bin 5000
Rosikah 5000
Rehanah 5000
Iq. Zaini 5000
Hj. Wardiah 5000
Febrian saputra 5000
Mustariah 5000 5000
Furqan Ahmad 5000
Mahesun 5000
Bq. Siti Halimah 5000 30000
Taufik Ulfas Al 5000
Hartini 5000
Wardatul J 5000
Musipudin 5000
Bpk Mustairah 5000
Bpk Maulida 5000
Ibhalul Hakim 0 70000
Siti gina Septiana 5000
Hj. Wardiah 5000
Mahesun 5000
Inges Adelia Kama 5000
M. Tegu Zapra 5000
Asnawati 5000
JUMLAH 110000 105000
24/1/2020 M. Fariz 5000
Iwan 5000
Raden Abizar 5000
Arsyila Humi B 5000
Aquila Z. B 5000
L. Firmansyah 5000
Salmiah 5000
Widiya 5000
M. Rizdi M 5000
JUMLAH 45000
25/1/2020
26/1/2020
27/1/2020 Yuliana 0
Yulirahmawati 0
Siti Rauhun 0
Hamdi 5000
Asqina Sania 5000
Syarifa AL 5000
H. sarapuddin 5000
 Hastini 5000
Turmuzi 5000 15000
Nurlina 5000 5000
Bq. Zahriah 5000
Mafana 5000
Inaq Ajis 5000
Hj. Hmidah 5000
Liza Umami P U 5000
Yuliana 5000 15000
Parida Nova 5000 10000
H. Irwandi 5000
H. Edi Hidayat 5000
Wahyu 5000 10000 10000
Imratun 5000 10000
Aufa Hasa 5000
Kadusiah 5000
JUMLAH 100000 30000 45000
28/1/2020 Sariapiatun H 5000 10000
Salpiatun Jannah 5000 10000
Inayatussolihah 5000 10000
M. Kadri 5000
Payyad Rizky M 5000
M. aza Najwani 5000
Ahmad Ramdani S 5000
Kusmiati 5000 10000
Mursidin K 5000
L. suparman 5000 10000
Muh. Taufik Ismail 5000
M. zafri 5000
Mandela Fitriani 5000
Yuliawati 5000
Adina durratus 5000
JUMLAH 75000 50000
29/1/2020 Aida Rahsetia 5000
Alisa Hasna Aqila 5000
M. yusro Azzahri 0 10000
Bpk Muliadi 5000 10000
Bpk Mustiarab 5000
Mujahidin 5000
Hanan Qonita 5000
Kamsatul Asror 5000
Musipuddin 5000
Mutla'ah 5000
zuhaidah 5000
Nurhadijah 0 10000
 azilatul fitri 5000
m hasan alwi 5000 10000
JUMLAH 60000 40000
30/1/2010 Musa 5000
Lukman 5000
Rayab Ramdhani 5000
Hj kusniah 5000
Lalu anang 5000
Nurul Fitri 5000
Andia Abdullah 5000
JUMLAH 35000
31/1/2020 m.FAIZ 5000
Raza Aramuddin 5000
Sania Rahmani 5000
M.Rafa Azka 5000
Adiba Atma Purnama 5000
Nadi Ningsih 5000
M Alam Sidik 5000
M. Sapiq 5000
Rahana 5000
M.Muhibuddin 5000 10000
JUMLAH 50000 10000
1,600,000 320,000 1045000 0
kesmas suralaga tahun 2020
Pembayaran Retribusi
Catin poly UGD JUMLAH Ket
Gigi umum ANC tindakan Ambulan
KB kecil perawat Bidan

5,000
5,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
120000 120,000
5,000
5,000
5,000
120000 215,000
5,000
10,000
5,000
5,000
5,000
5,000
5,000
40,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
 5,000
10000 15,000
10000 75,000
-
5,000
5,000
15,000
5,000
45,000
5,000
5,000
5,000
5,000
5,000
45,000
15,000
15,000
5,000
5,000
145,000
5,000
5,000
5,000
25000 30,000
5,000
5,000
5,000
15,000
5,000
5,000
25,000
25000 25,000
5,000
25000 25000 140,000
60000 115,000
5,000
20,000
15,000
35,000
65,000
5,000
30,000
5,000
5,000
45,000
 5,000
5,000
5,000
5,000
5,000
5,000
60000 375,000
45,000
65,000
20,000
5,000
45,000
5,000
5,000
5,000
195,000
5,000
15,000
5,000
5,000
40,000
5,000
45,000
180000 245,000
5,000
-
5,000
5,000
5,000
5,000
5,000
5,000
10000 15,000
10000 180000 415,000
5,000
180000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
 5,000
5,000
180000 250,000
15,000
60000 80,000
15,000
5,000
5,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
10,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
65,000
10,000
40,000
45,000
35,000
60000 420,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
30,000
 20,000
5,000
10,000
5,000
5,000
5,000
140,000
5,000
15,000
15,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
85,000
25,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
90,000
25,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
20,000
5,000
30,000
25000 30,000
5,000
 25000 150,000
5,000
5,000
5,000
5,000
5,000
5,000
30,000
-
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
20000 25,000
5,000
20000 100,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
65,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
 5,000
40,000
5,000
5,000
5,000
5,000
5,000
5,000
10,000
5,000
5,000
35,000
5,000
5,000
5,000
5,000
5,000
5,000
70,000
5,000
5,000
5,000
5,000
5,000
5,000
215,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15000 20,000
15000 60,000
-
-
85000 85,000
85000 85,000
85000 85,000
5,000
5,000
5,000
5,000
 5,000
20,000
10,000
5,000
5,000
5,000
5,000
5,000
20,000
15,000
5,000
5,000
25,000
15,000
5,000
5,000
0 255000 430,000
15,000
15,000
15,000
5,000
5,000
5,000
5,000
15,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
125,000
5,000
5,000
10,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
10,000
 5,000
15,000
100,000
10000 15,000
5,000
5,000
5,000
5,000
5,000
5,000
10000 45,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
15,000
60,000
0 40000 25000 25000 50000 600,000 255000 3,960,000
1,690,000
2,270,000
46000
2,224,000
 Data pemasukan Retribusi Puskesmas suralaga
NO Tanggal No RM Nama Alamat Pembaya
Penda SKS Labora Haji
ftaran torium

1 1/2/2020 Aira Napisa 5,000

Zulkurnain 5,000
Lisa Asta Candra 5,000 10,000
Bq. Zaenap 5,000
M. Zulaidafi 5,000
L. Ahmad Hairil 5,000
Bq. Arin cantika 5,000
JUMLAH 35,000 10,000
2/2/2020
3/2/2020 Risma Nurmala 5,000
Desi Ratna Sari 5,000
I. Muhijozi 5,000
Susmawati 5,000
Fawas 5,000
Bq.Intan Purn 5,000
Rauhil Jihan 5,000
I. M. Rifqi I 5,000
Maya Kardina 5,000
Iq. Zaeni 5,000
Bq. Ihza Sasih 5,000
Iq. Romlah 5,000
60,000
4/2/2020 Abdurrahman 5,000
Muh. Abizar 5,000
Arsila Nafa 5,000
Tiara 5,000
Raedani 5,000
Zaenur Aini 5,000
Abdullah 5,000
I. Nasuhan 5,000
Amruziadi Maf 5,000
Zidan Alfarizi 5,000
Nafita Nafit 5,000
Abdul Hakim 5,000
Arsila Nafa 5,000
JUMLAH 65,000
5/2/2020 01004796 Inara 5,000
Ardiana Pradil 5,000
01004749 Najlatifa 5,000
 Bayi Siti 5,000
Habibi 5,000
Taufik U 5,000
Hartini 5,000
Amira Husna 5,000
01004793 Kaerunnida 5,000
0100 Febriana Maulana 5,000
01004806 Bq. Ratna 5,000
01003722 Salihun 5,000
01004468 Mahsun Sidik 5,000
01000395 Guta Utama 5,000
JUMLAH 70,000
6/2/2020 01001849 Siti Rohani 10,000
01004807 Edi Juniardi 5,000 10,000
01003156 Afifa fatya 5,000
01004809 Lia Nurmalika 5,000
01004810 L. Sirlan 5,000 10,000
01004812 L. Muh.Firman 5,000
01004532 Tasyanur Aisah 5,000
01004815 M. Zayyan 5,000
01004617 Muh. Arfan Muktar 5,000
01001165 Iq. Samsul Lutfi 5,000
01000482 M. Rafa Aska 5,000
01004823 Marhamah 5,000
01002821 Fitri Suci Ramdani 5,000
01003976 teguh pribumi 5,000
JUMLAH 65,000 30,000
7/2/2020 Muh. Zuriati 5,000
Yumna Khalifa 5,000
Haliyana rosmiya 5,000
Hj. Nurhayati 5,000
Fitriah 5,000
Muh. Azid M 5,000
Zayyan Arikin 5,000
Bagus Maulidata 5,000
Irnawati 5,000
Reni Ismayani 5,000
Juan Firza A.F 5,000
Gadis Maulida A 5,000
Yahya Sadir 5,000
Hasnah 5,000
JUMLAH 70,000
8/2/2020 Muh. Ramdhani 5,000
Ahmad Muba 5,000
Dewi Muliati 5,000 10,000
 L. Zidni Khair 5,000
Nayla Ulfa 5,000
Azizatul Khusna 5,000
I. Supriadi 5,000
JUMLAH 35,000 10,000
9/2/2020
10/2/2020 1000079 Nadia Azzahra 5,000
1004848 Muh. Kahaolid A 5,000
1003534 Zaetun 5,000
1004854 muhsin ibrahim 5,000 10,000
1004850 hafizaturrohmi 5,000
jumlah 25,000 10,000
11/2/2020 1000092 H.fauzi 5,000
1000586 muhammad 5,000
1004857 H.sadarudin 5,000
01004860 jahnur aeni 5,000
01004707 mursidul khaer 5,000
01004861 hasna kamila 5,000
01000722 raya ramadani 5,000
01003047 lalu rancani 5,000
01004865 saepudin 5,000
01001212 h. saepuddin 5,000
JUMLAH 50,000
12/2/2020 Muhammad 5,000
Mahira Hasna 5,000
Siti Aminah
Susiati
Malika 10,000
Piti Oca Hasman 5,000
M. Taufik Ismail 5,000
Sinta Wati 5,000
JUMLAH 25,000 10,000
13/2/2020 01000627 Iq. Romlah 5,000
01002185 Mafaza Junia A 5,000
01002706 Nurussyafa 5,000
01002055 Hazana 5,000
01002891 Alya Adriana 5,000
01004847 Zurrahmah 5,000
01004004 Sumarni 5,000
01004847 Hj. Sur'aen 5,000
JUMLAH 40000
14/2/2020 Dhefin Aufabian 5,000
M. Gafar Maulana 5,000
H. Zaena Arifin 5,000
Poziah 5,000
 Abdul Hafiz P 5,000
Bq. Aseka Pajina S 5,000
Muh. Abyan R 5,000
Nuraima Rizkia 5,000
Zahira Hasna H 5,000
lalu hanif satriadi 5,000
JUMLAH 50,000
15/2/2020 01001219 Muh raehan aziansyah gbk puntik 5,000
01004896 Muh muzammil alkhaer telaga tampat 5,000
01003529 Halid almadani gelumpang 5,000
01000699 Hj nurhasanah telaga tampat 5,000
01004899 lalu ismail bantek 5,000
1000631 Iq. Asror Gegurun 5,000
1002578 M. Khaerul Muttaqin R gbk puntik 5,000
1004906 Alpan Shreza Lauk Kul Kul 5,000
JUMLAH 40,000
16/2/2020
17/2/2020 Siti Nuraeba 5,000
Ahmad Faqih 5,000
Paoziah 5,000
Muhammad Fawaz 5,000
Elmayani 5,000
Iq. Hirman 5,000
Nurazizah 5,000 10000
Bq. Kerdi 5,000
Lalu Raka Sura 5,000
Danis Zaenul A 5,000
Sarpiyah 5,000
H. Multazam 5,000
Bintang Samudra 5,000
smas suralaga tahun 2020
Pembayaran Retribusi
Catin poly UGD Persa KET jumlah
Gigi umum ANC tindakan Ambulan linan
kecil perawat Bidan Normal
5,000
5,000
15,000
5,000
5,000
5,000
5,000
45,000
-
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
60,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
65,000
5,000
5,000
10,000 15,000
 5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
70,000
10,000
15,000
5,000
5,000
15,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
95,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
70,000
5,000
5,000
15,000
 5,000
5,000
5,000
5,000
45,000

5,000
5,000
5,000
15,000
5,000
35,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
50,000
5,000
5,000
60,000 60,000
60,000 60,000
10,000
5,000
5,000
5,000
120,000 155,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
40,000
5,000
5,000
5,000
5,000
 5,000
5,000
5,000
5,000
5,000
5,000
50,000
5,000
5,000
5,000
5,000
5,000
5,000
5000
5000
40000
 Pemasukan dan Pengeluaran Bulan januari 2020
No tanggal URAIAN Pemasukan pengeluaran JUMLAH ket
pemasukan
1 2/1/2020 Retribusi 85,000 85,000
sks 10,000 10,000
ranap 120,000 120,000
2 3/1/2020 pemasukan retribusi 30,000 30,000
sks 10,000 10,000
pak kapus 150,000 (150,000)
3 beli paku paayung 30,000 (30,000)
4/1/2020 pemasukan retribusi 65,000 65,000
4 pemasukan perawatan gigi 10,000 10,000
5/1/2020 -
6/1/2020 pemasukan retribusi 75,000 75,000
sks 30,000 30,000
lab 80,000 80,000
beli sok(sambungan pipa) 27,000 (27,000)
fc model DK 25,000 (25,000)
7/1/2020 pemasukan retribusi 60,000 60,000
sks 10,000 10,000
lab 20,000 20,000
tindakan kecil 25,000 25,000
implan 25,000 25,000
fc Dk + matrai 53,000 (53,000)
5 8/1/2020 pemasukan retribusi 80,000 80,000
sks 20,000 20,000
lab 215,000 215,000
UGD(perawatan) 60,000 60,000
6 9/9/2020 pemasukan retribusi 40,000 40,000
lab 155,000 155,000
bensin + solar 150,000 (150,000)
beli lis bener 100,000 (100,000)
7 beli paku 12,000 (12,000)
10/1/2020 pemasukan retribusi 75,000 75,000
sks 10,000 10,000
lab 140,000 140,000
UGD(perawatan) - -
pemasukan gigi 10,000 10,000
 fc status 40,000 (40,000)
8 11/1/2020 pemasukan retribusi 60,000 60,000
lab 10,000 10,000
UGD(perawatan) 180,000 180,000
buat tamu 29,000 (29,000)
9 12/1/2020 -
13/1/2020 pemasukan retribusi 120,000 120,000
sks 20,000 20,000
lab 220,000 220,000
UGD(perawatan) 60,000 60,000
oksigen mba rini - sudah di ganti
fc matrai 28,000 (28,000)
10 14/1/2020 pemasukan retribusi 95,000 95,000
lab 45,000 45,000
11 15/1/2020 pemasukan retribusi 55,000 55,000
sks 30,000 30,000
fc status 40,000 (40,000)
12 16/1/2020 pemasukan retribusi 60,000 60,000
sks 20,000 20,000
lab 10,000 10,000
amplas sona 15,000 (15,000)
beli ATK ( kunci inggris) 100,000 (100,000)
13 17/1/2020 pemasukan retribusi 65,000 65,000 -
sks 10000 10,000 -
lab 50000 50,000 -
implan( ANC) 25000 -
by fc + jilid 25,000 -
14 18/1/2020 pemasukan retribusi 30,000 30,000
15 19/1/2020 -
16 20/1/2020 pemasukan retribusi 70,000 70,000
sks 10,000 10,000
pemasukan perawatan gigi 20,000 20,000
foto copy -
17 21/1/2020 pemasukan retribusi 65,000 65,000
persiapan visitasi (pak kapus) -
18 22/1/2020 pemasukan retribusi 40,000 40,000
sampah PKM -
19 23/1/2020 pemasukan retribusi 110,000 110,000
lab 105,000 105,000
 20 24/1/2020 pemasukan retribusi 45,000 45,000
pemasukan perawatan gigi 15,000 15,000
21 25/1/2020 -
22 26/1/2020 -
23 27/1/2020 pemsuksn retribusi 100,000 100,000
sks 45,000 45,000
lab 30,000 30,000
puskel 255,000 255,000
bensin + solar 150,000 (150,000)
batrai 6,000 (6,000)
24 28/1/2020 pemasukan retribusi 75,000 75,000
sks 50,000 50,000
air minum untuk dikes dan krongkong 100,000 (100,000)
25 29/1/2020 pemasukan retribusi 60,000 60,000
sks 40,000 40,000
beli plastik 20,000 (20,000)
26 30/1/2020 pemasukan retribusi 35,000 35,000
pemasukan perawatan gigi 10,000 10,000
beli batrai 6,000 (6,000)
27 31/1/2020 pemasukan retribusi 50000 50,000
sks 10000 10,000
batrai 12,000 (12,000)
Retribusi Pendaftaran 1,646,000 (1,646,000)
Retribusi Gigi 65,000 (65,000)
Retribusi SKS 320,000 (320,000)
Jumlah 3,865,000 3,274,000 591,000

Suralaga 5 Fabruari 2020

Mengetahui
Kepala Puskesmas Suralaga Penanggung Jawab Retribusi

Meidinaam Insya S.Kep Hj. Kusmiyati S.ST

 Pemasukan dan Pengeluaran Retribusi Tahun 2020
No tanggal URAIAN Pemasukan pengeluaran SISA SALDO ket
pemasukan
1 1/2/2020 Pendapatan retribusi 35,000 35,000
sks 10,000 45,000
by beli snac u/ MTBS 45,000
FC STATUS 45,000
2 2/2/2020 45,000
3 3/2/2020 Pendapatan retribusi 60,000 105,000
FC STATUS 50,000 55,000
4 4/2/2020 pendapastan retribusi 65,000 120,000
5 5/2/2020 Pendapatan retribusi 70,000 190,000
pendapatan gigi 10,000 200,000
by beli map transparan 200,000
fc status 200,000
kertas puyer 200,000
bensin ambulan 200,000
6 6/2/2020 Pendapatan retribusi 65,000 265,000
sks 30,000 295,000
copy + jilid 295,000
7 7/2/2020 Pendapatan retribusi 70,000 365,000
copy f4 365,000
8 8/2/2020 Pendapatan retribusi 35,000 400,000
sks 10,000 410,000
copy + jilid 410,000
9 9/2/2020 410,000
10 10/2/2020 Pendapatan retribusi 25,000 435,000
sks 10,000 445,000
beli 2 ikat plastik apotik 445,000
11 11/2/2020 pendpapatan retribusi 50,000 495,000
12 12/2/2020 pendapatan retribusi 25,000 520,000
sks 10,000 530,000
persalinan 120,000 650,000
Komsumsi Buat tamu 650,000
13 13/2/2020 pendapatan retribusi 40,000 690,000
14 14/2/2020 pendapatan retribusi 50,000 740,000
Ambulan 170,000 910,000
15 15/2/2020 pendapatan retribusi 40,000 950,000
16 16/2/2020 minggu 950,000
17 17/2/2020 pendapatan retribusi 70,000 1,020,000
sks 10,000 1,030,000
18/2/2020 pendapatan retribusi 70,000 1,100,000
sks 20,000 1,120,000
19/2/2020 pendapatan retribusi 45,000 1,165,000
20/2/2020 pendapatan retribusi 20,000 1,185,000
Zip Solar 100,000 1,085,000
21/2/2020 pendapatan retribusi 45,000 1,130,000
22/2/2020 pendapatan retribusi 75,000 1,205,000
sks 10,000 1,215,000
FC STATUS 1,215,000
1,215,000
map pembolong 1,215,000
23/2/2020 minggu 1,215,000
24/2/2020 pendapatan retribusi 60,000 1,275,000
Ambulan 85,000 1,360,000
batre ABC MIX 1,360,000
1,360,000
25/2/2020 pendapatan retribusi 50,000 1,410,000
laboratorium 65,000 1,475,000
26/2/2020 pendapatan retribusi 75,000 1,550,000
poly gigi 25,000 1,575,000
27/2/2020 pendapatan retribusi 60,000 1,635,000
laboratorium 15,000 1,650,000
Bensin Ambulan 100,000 1,550,000
28/2/2020 pendapatan retribusi 30,000 1,580,000
sks 20,000 1,600,000
29/2/2020 pendapatan retribusi 45,000 1,645,000
poly gigi 5,000 1,650,000
poto copi Laporan Sapras 11,000 1,639,000
Retribusi 1,445,000 194,000
1,900,000 1,706,000 194,000

Suralaga 5 Maret 2020

Mengetahui
Kepala Puskesmas Suralaga Penanggung Jawab Retribusi
Meidinaam Insya S.Kep Hj. Kusmiyati S.ST
 pemasukan dan pengeluaran Maret 2020
No tanggal URAIAN Pemasukan pengeluaran SISA SALDO
pemasukan
1 1/3/2020 P
2/3/2020 Retribusi 55,000 55,000
Lab 70,000 125,000
Gigi 25,000 150,000
3/3/2020 Retribusi 55,000 205,000
4/3/2020 Retribusi 40,000 245,000
5/3/2020 retribusi 105,000 350,000
SKS 10,000 360,000
Lab 25,000 385,000
Gigi 15,000 400,000
Fc + Jilid (TU) 20,000 380,000
6/3/2020 Retribusi 75,000 455,000
Bensin Ambulan 100,000 355,000
Bayar Sampah 15,000 340,000
Bensin Pak Kapus 50,000 290,000
Konsumsi 2 Orang Nasi 20,000 270,000
7/3/2020 Retribusi 60,000 330,000
8/3/2020 -
9/3/2020 Retribusi 130,000 460,000
Gigi 5,000 465,000
Leb 205,000 670,000
SKS 40,000 710,000
Fc + Resef Dokter 50,000 660,000
10/3/2020 Retribusi 60,000 720,000
Lab 60,000 780,000
SKS 30,000 810,000
11/3/2020 Retribusi 45,000 855,000
SKS 20,000 875,000
Fc surat MOU 50,000 825,000
Beli Plastk Klip Obat 20,000 805,000
12/3/2020 Retribusi 80,000 885,000
Leb 110,000 995,000
SKS 30,000 1,025,000
Solar Ambulan 100,000 925,000
13/3/2020 Retribusi 30,000 955,000
Lab 65,000 1,020,000
SKS 10,000 1,030,000
Beli Deker Bak Sampah 165,000 865,000
14/3/2020 Retribusi 50,000 915,000
Gigi 15,000 930,000
SKS 25,000 955,000
15/3/2020 -
16/3/2020 Retribusi 110,000 1,065,000
Lab 15,000 1,080,000
SKS 10,000 1,090,000
17/3/2020 Retribusi 70,000 1,160,000
Lab 80,000 1,240,000
Fc LPLPO 5,000 1,235,000
18/3/2020 Retribusi 80,000 1,315,000
SKS 10,000 1,325,000
ANC 25,000 1,350,000
Pak Kapus U / Bener 150,000 1,200,000
19/3/2020 Retribusi 70,000 1,270,000
Gigi 10,000 1,280,000
Lab 45,000 1,325,000
Fc + Jilid ( TU ) 50,000 1,275,000
Jas Hujan U/ APD 95,000 1,180,000

2,070,000 890,000 1,180,000

ket