DAFTAR PENERIMAAN JASA PELAYANAN KAPITASI

PROGRAM JAMINAN KESEHATAN NASIONAL

PUSKESMAS LIMBOTO BARAT
BULAN JANUARI 2022
JUMLAH PESERTA :
JUMLAH PEGAWAI :
BESARAN KAPITASI :
TOTAL KAPITASI : Rp 99,146,500
TOTAL JASPEL SESUAI SK KADIS 60 % = Rp 59,487,900

Jumlah

Rangkap Tugas Administrasi

Jasa

Tanggung Jawab Program

Point
Presentasi Jumlah Total Penerimaan Kapitasi dengan Pelayanan
Kehadiran Variabel
Kehadiran seluruh point Jumlah Peserta 17,480 jiwa yang diterima

Jenis Ketenagaan
Ketenaga
an dengan
STR peserta 17,480
Pendidikan
Masa jiwa PAJAK JUMLAH DI
& TTD
No Nama Pegawai Jabatan Kerja (PPh 21) TERIMA

Jumlah Hari Kerja

SIP

Masuk Kerja
Jumlah Hari
(%
(=Kolom (Perkalian Jasa Biaya (Kolom 11
Pembagian
1+2+3+5+ Kolom Pelayanan Operasional dikali Kolom
Klm 4 dibagi
6) 9xKolom 10) (60%) (40%) 12 dibagi
Klm 5)
jumlah Kolom
11)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 Fatmawati A. Palilati, SKM Kepala Puskesmas S1 80 20 25 25 100 200 100 200 59,487,900 39,658,600 2,246,013 112,301 2,133,712 1

2 dr. Novita Kaluku Dokter Umum S1 150 10 25 25 160 100 160 59,487,900 39,658,600 1,796,810 269,522 1,527,289 2

3 drg. Lianty Kemala Dewi Dokter Umum S1 150 0 25 25 150 100 150 59,487,900 39,658,600 1,684,510 84,225 1,600,284 3

4 dr. Ida Ayu Arina Risa Dokter Umum S1 150 0 25 25 150 100 150 59,487,900 23,795,160 1,684,510 0 1,684,510 4

5 Hermuni Abubakar KTU SPK 40 25 25 25 30 95 100 95 59,487,900 39,658,600 1,066,856 53,343 1,013,513 5

6 Verawaty Ayuba, SKM Bendahara S1 80 10 25 25 50 140 100 140 59,487,900 39,658,600 1,572,209 235,831 1,336,378 6

7 Sri Novia Sudjarno, A.Md.Kep Staf D3 60 10 24 25 70 96 67.2 59,487,900 39,658,600 754,660 37,733 716,927 7

8 Sri Haryati Pratiwi, SKM Staf S1 80 10 24 25 90 96 86.4 59,487,900 39,658,600 970,278 145,542 824,736 8

9 Erke F. Masengi, A.Md. Keb Staf D3 60 25 0 25 85 0 0 59,487,900 39,658,600 - 0 0 9

10 Merry H. Bauka, S.Tr.Keb Staf D4 80 10 25 25 90 100 90 59,487,900 39,658,600 1,010,706 50,535 960,171 10
11 Mayorin Hasan, A.Md Keb Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 11

12 Nurmasita Hasan, ST Keb Staf D4 80 10 25 25 90 100 90 59,487,900 39,658,600 1,010,706 50,535 960,171 12

13 Yudawati Hasan, ST Keb Staf D4 80 10 21 25 90 84 75.6 59,487,900 39,658,600 848,993 42,450 806,543 13

14 Sintje Ali Babuta, A.Md.Keb Staf D3 60 25 25 25 85 100 85 59,487,900 39,658,600 954,556 47,728 906,828 14

15 Ade Reiko Badu, A.Md Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 15

16 Nurliyan Eksan, A.Md Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 16

17 Winarti Otaya, A.Md Kep Staf D3 60 15 25 25 75 100 75 59,487,900 39,658,600 842,255 42,113 800,142 17

18 Sri Larasaty Lahay, A.Md Kep Staf D3 60 10 24 25 70 96 67.2 59,487,900 39,658,600 754,660 37,733 716,927 18

19 Arlin Pulukadang, A.Md Kep Staf D3 60 25 25 25 85 100 85 59,487,900 39,658,600 954,556 47,728 906,828 19

20 Rustam Ma'aruf, A.Md Kep Staf D3 60 25 25 25 85 100 85 59,487,900 39,658,600 954,556 47,728 906,828 20

21 Olysmawati G. Kadir, S.Kep Staf S1 80 20 19 25 100 76 76 59,487,900 39,658,600 853,485 42,674 810,811 21

22 Sumarni S, AMKL Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 22

23 Elvin Y. Saleh, AMG Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 23

24 Mimin Suhira Staf D1 40 25 25 25 65 100 65 59,487,900 39,658,600 729,954 36,498 693,457 24

25 Hermin N. Uri, S.Si Staf S1 80 10 24 25 90 96 86.4 59,487,900 39,658,600 970,278 48,514 921,764 25

26 Darfin S. Laiya, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 1,010,706 50,535 960,171 26

27 Husain Pakaya Staf D1 40 25 25 25 65 100 65 59,487,900 39,658,600 729,954 36,498 693,457 27

28 Jaiz Botutihe Staf SMA 25 25 25 25 50 100 50 59,487,900 39,658,600 561,503 0 561,503 28

29 Susanti Amuntu, A.Md.KG Staf D3 60 15 25 25 75 100 75 59,487,900 39,658,600 842,255 42,113 800,142 29

30 Yolanda Heri L. Pasi, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 1,010,706 50,535 960,171 30

31 Erfinta Niati, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 1,010,706 50,535 960,171 31
32 Sri Wilin B. Suleman, A.Md Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 32

33 Meilanti Ui, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 1,010,706 50,535 960,171 33

34 Mega Musalam, A.Md Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 34

35 Siska Ahaya, A.Md Keb Staf D3 60 0 17 25 60 68 40.8 59,487,900 39,658,600 458,187 0 458,187 35

36 Titi S. Hulopango, A.Md Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 36

37 Hadjara Ntoma Staf D1 40 25 24 25 65 96 62.4 59,487,900 39,658,600 700,756 35,038 665,718 37

38 Sri Nandri Pakaya, A.Md. Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 38

39 Maryam Hasan, A.Md. Kes Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 39

40 Irfhan, A.Md.Kep Staf D3 60 10 13 25 70 52 36.4 59,487,900 39,658,600 408,774 20,439 388,336 40

41 Dedyanto Mokodompis Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 41

42 Sunarti Gusasi, A.Md.Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 786,105 39,305 746,799 42

43 Nurlaila Pulukadang, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 43

44 Hartati Umar Staf SMA 25 0 0 25 25 0 0 59,487,900 39,658,600 - 0 0 44

45 Yuliana Radjak Staf SMA 25 0 0 25 25 0 0 59,487,900 39,658,600 - 0 0 45

46 Winarto Naway Staf SMA 25 10 25 25 35 100 35 59,487,900 39,658,600 393,052 0 393,052 46

47 Dwi Utari Loleh, S.Kep,Ns Staf S1 100 0 23 25 100 92 92 59,487,900 39,658,600 1,033,166 0 1,033,166 47

48 Anita Yusuf, AMG Staf D3 60 0 0 25 60 0 0 59,487,900 39,658,600 - 0 0 48

49 Iin Polapa, SKM Staf S1 80 0 21 25 80 84 67.2 59,487,900 39,658,600 754,660 0 754,660 49

50 Lin Otaya, S.Kep Staf S1 80 0 22 25 80 88 70.4 59,487,900 39,658,600 790,597 0 790,597 50

51 Fitri Yanti Intili, SKM Staf S1 80 0 0 25 80 0 0 59,487,900 39,658,600 - 0 0 51

52 Mutiara Aprilani Tahir, SKM Staf S1 80 0 0 25 80 0 0 59,487,900 39,658,600 - 0 0 52

53 Ilham Dangkua, SKM Staf S1 80 0 0 25 80 0 0 59,487,900 39,658,600 - 0 0 53

54 Fitriyanti Zees, S. Farm Staf S1 80 0 22 25 80 88 70.4 59,487,900 39,658,600 790,597 0 790,597 54

55 Rabia Alingo, S.Kep Ns Staf S1 100 0 23 25 100 92 92 59,487,900 39,658,600 1,033,166 0 1,033,166 55

56 Venny Cristanti Hamzah, A.Md, Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 56

57 Meylan R.Palilati, S.T. Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 57

58 Inda Dewi Pratiwi Jamale, S.Tr. Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 58

59 Sri Yulistia Niati, A.Md.Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 59

60 Khusnul Khotimah, SKM Staf S1 80 0 21 25 80 84 67.2 59,487,900 39,658,600 754,660 0 754,660 60

61 Rini Pakaya, SKM Staf S1 80 0 18 25 80 72 57.6 59,487,900 39,658,600 646,852 0 646,852 61

62 Sri Oktaviani Nani, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 62

63 Saripudin Moha, A. Md. Kep Staf D3 60 0 23 25 60 92 55.2 59,487,900 39,658,600 619,900 0 619,900 63

64 Qatra Idrus, S.Tr. Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 64

65 Irfan Noho Staf SMA 25 0 25 25 25 100 25 59,487,900 39,658,600 280,752 0 280,752 65

66 Dwi Andrian Gusasi, S.Gz Staf S1 80 0 0 25 80 0 0 59,487,900 39,658,600 - 0 0 66

67 Windi Adiyati Angge, S.Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 67

68 Sri Handayani Saputri Noor, S.Tr Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 68

69 Fatma Gani, SKM Staf S1 80 0 24 25 80 96 76.8 59,487,900 39,658,600 862,469 0 862,469 69

70 Istiqoma Duke,S.Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 70

71 Erisca R.Dude, S,Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 71

72 Sri Vidyanti Moha, A.Md.Kep Staf D3 60 0 20 25 60 80 48 59,487,900 39,658,600 539,043 0 539,043 72

73 Ayu R.Bengkal, S.Kep.Ns Staf S1 100 0 18 25 100 72 72 59,487,900 39,658,600 808,565 0 808,565 73
74 Fransiska P.Lihawa, A.Md.Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 74

75 Nandita A.Koni, S.Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 898,405 0 898,405 75

76 Vanny R. Haris,A,Md.Kes Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 673,804 0 673,804 76

JUMLAH TOTAL 5297.2 59,487,900 39,658,600 59,487,900 2,122,707 57,365,193

Limboto Barat, Februari 2022

MENGETAHUI
KEPALA FKTP LIMBOTO BARAT BENDAHARA

FATMAWATI A. PALILATI, SKM VERAWATY AYUBA, SKM

NIP. 19750505 199603 2 007 NIP. 19831016 200802 2 001
25

10 20

10 20

5 15

15 25

10 20

7 17

5 15

5 15
 DAFTAR PENERIMAAN JASA PELAYANAN KAPITASI
PROGRAM JAMINAN KESEHATAN NASIONAL
PUSKESMAS LIMBOTO BARAT
BULAN JANUARI 2022
JUMLAH PESERTA :
JUMLAH PEGAWAI :
BESARAN KAPITASI :
TOTAL KAPITASI : Rp 99,146,500
TOTAL JASPEL SESUAI SK KADIS 60 % = Rp 59,487,900

Jumlah

Rangkap Tugas Administrasi

Jasa

Tanggung Jawab Program

Point
Presentasi Jumlah Total Penerimaan Kapitasi dengan Pelayanan
Kehadiran Variabel
Kehadiran seluruh point Jumlah Peserta 17,480 jiwa yang diterima

Jenis Ketenagaan
Ketenaga
an dengan
STR peserta 17,480
Pendidikan
Masa jiwa PAJAK JUMLAH DI
& TTD
No Nama Pegawai Jabatan Kerja (PPh 21) TERIMA

Jumlah Hari Kerja

SIP

Masuk Kerja
Jumlah Hari
(%
(=Kolom (Perkalian Jasa Biaya (Kolom 11
Pembagian
1+2+3+5+ Kolom Pelayanan Operasional dikali Kolom
Klm 4 dibagi
6) 9xKolom 10) (60%) (40%) 12 dibagi
Klm 5)
jumlah Kolom
11)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 Fatmawati A. Palilati, SKM Kepala Puskesmas S1 80 20 25 25 100 200 100 200 59,487,900 39,658,600 2,030,858 101,543 1,929,315 1

2 dr. Novita Kaluku Dokter Umum S1 150 10 25 25 160 100 160 59,487,900 39,658,600 1,624,687 243,703 1,380,984 2

3 drg. Lianty Kemala Dewi Dokter Umum S1 150 0 25 25 150 100 150 59,487,900 39,658,600 1,523,144 76,157 1,446,987 3

4 dr. Ida Ayu Arina Risa Dokter Umum S1 150 0 25 25 150 100 150 59,487,900 23,795,160 1,523,144 0 1,523,144 4

5 Hermuni Abubakar KTU SPK 40 25 25 25 30 95 100 95 59,487,900 39,658,600 964,658 48,233 916,425 5

6 Verawaty Ayuba, SKM Bendahara S1 80 10 25 25 50 140 100 140 59,487,900 39,658,600 1,421,601 213,240 1,208,361 6

7 Sri Novia Sudjarno, A.Md.Kep Staf D3 60 10 24 25 70 96 67.2 59,487,900 39,658,600 682,368 34,118 648,250 7

8 Sri Haryati Pratiwi, SKM Staf S1 80 10 24 25 90 96 86.4 59,487,900 39,658,600 877,331 131,600 745,731 8

9 Erke F. Masengi, A.Md. Keb Staf D3 60 25 0 25 85 0 0 59,487,900 39,658,600 - 0 0 9

10 Merry H. Bauka, S.Tr.Keb Staf D4 80 10 25 25 90 100 90 59,487,900 39,658,600 913,886 45,694 868,192 10
11 Mayorin Hasan, A.Md Keb Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 11

12 Nurmasita Hasan, ST Keb Staf D4 80 10 25 25 90 100 90 59,487,900 39,658,600 913,886 45,694 868,192 12

13 Yudawati Hasan, ST Keb Staf D4 80 10 21 25 90 84 75.6 59,487,900 39,658,600 767,664 38,383 729,281 13

14 Sintje Ali Babuta, A.Md.Keb Staf D3 60 25 25 25 85 100 85 59,487,900 39,658,600 863,115 43,156 819,959 14

15 Ade Reiko Badu, A.Md Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 15

16 Nurliyan Eksan, A.Md Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 16

17 Winarti Otaya, A.Md Kep Staf D3 60 15 25 25 75 100 75 59,487,900 39,658,600 761,572 38,079 723,493 17

18 Sri Larasaty Lahay, A.Md Kep Staf D3 60 10 24 25 70 96 67.2 59,487,900 39,658,600 682,368 34,118 648,250 18

19 Arlin Pulukadang, A.Md Kep Staf D3 60 25 25 25 85 100 85 59,487,900 39,658,600 863,115 43,156 819,959 19

20 Rustam Ma'aruf, A.Md Kep Staf D3 60 25 25 25 85 100 85 59,487,900 39,658,600 863,115 43,156 819,959 20

21 Olysmawati G. Kadir, S.Kep Staf S1 80 20 19 25 100 76 76 59,487,900 39,658,600 771,726 38,586 733,140 21

22 Sumarni S, AMKL Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 22

23 Elvin Y. Saleh, AMG Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 23

24 Mimin Suhira Staf D1 40 25 25 25 65 100 65 59,487,900 39,658,600 660,029 33,001 627,027 24

25 Hermin N. Uri, S.Si Staf S1 80 10 24 25 90 96 86.4 59,487,900 39,658,600 877,331 43,867 833,464 25

26 Darfin S. Laiya, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 913,886 45,694 868,192 26

27 Husain Pakaya Staf D1 40 25 25 25 65 100 65 59,487,900 39,658,600 660,029 33,001 627,027 27

28 Jaiz Botutihe Staf SMA 25 25 25 25 50 100 50 59,487,900 39,658,600 507,715 0 507,715 28

29 Susanti Amuntu, A.Md.KG Staf D3 60 15 25 25 75 100 75 59,487,900 39,658,600 761,572 38,079 723,493 29

30 Yolanda Heri L. Pasi, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 913,886 45,694 868,192 30

31 Erfinta Niati, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 913,886 45,694 868,192 31
32 Sri Wilin B. Suleman, A.Md Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 32

33 Meilanti Ui, SKM Staf S1 80 10 25 25 90 100 90 59,487,900 39,658,600 913,886 45,694 868,192 33

34 Mega Musalam, A.Md Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 34

35 Siska Ahaya, A.Md Keb Staf D3 60 0 17 25 60 68 40.8 59,487,900 39,658,600 414,295 0 414,295 35

36 Titi S. Hulopango, A.Md Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 36

37 Hadjara Ntoma Staf D1 40 25 24 25 65 96 62.4 59,487,900 39,658,600 633,628 31,681 601,946 37

38 Sri Nandri Pakaya, A.Md. Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 38

39 Maryam Hasan, A.Md. Kes Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 39

40 Irfhan, A.Md.Kep Staf D3 60 10 13 25 70 52 36.4 59,487,900 39,658,600 369,616 18,481 351,135 40

41 Dedyanto Mokodompis Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 41

42 Sunarti Gusasi, A.Md.Kep Staf D3 60 10 25 25 70 100 70 59,487,900 39,658,600 710,800 35,540 675,260 42

43 Nurlaila Pulukadang, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 43

44 Hartati Umar Staf SMA 25 0 25 25 25 100 25 59,487,900 39,658,600 253,857 0 253,857 44

45 Yuliana Radjak Staf SMA 25 0 25 25 25 100 25 59,487,900 39,658,600 253,857 0 253,857 45

46 Winarto Naway Staf SMA 25 10 25 25 35 100 35 59,487,900 39,658,600 355,400 0 355,400 46

47 Dwi Utari Loleh, S.Kep,Ns Staf S1 100 0 25 25 100 100 100 59,487,900 39,658,600 1,015,429 0 1,015,429 47

48 Anita Yusuf, AMG Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 48

49 Iin Polapa, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 49

50 Lin Otaya, S.Kep Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 50

51 Fitri Yanti Intili, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 51

52 Mutiara Aprilani Tahir, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 52
53 Ilham Dangkua, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 53

54 Fitriyanti Zees, S. Farm Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 54

55 Rabia Alingo, S.Kep Ns Staf S1 100 0 25 25 100 100 100 59,487,900 39,658,600 1,015,429 0 1,015,429 55

56 Venny Cristanti Hamzah, A.Md, Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 56

57 Meylan R.Palilati, S.T. Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 57

58 Inda Dewi Pratiwi Jamale, S.Tr. Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 58

59 Sri Yulistia Niati, A.Md.Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 59

60 Khusnul Khotimah, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 60

61 Rini Pakaya, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 61

62 Sri Oktaviani Nani, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 62

63 Saripudin Moha, A. Md. Kep Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 63

64 Qatra Idrus, S.Tr. Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 64

65 Irfan Noho Staf SMA 25 0 25 25 25 100 25 59,487,900 39,658,600 253,857 0 253,857 65

66 Dwi Andrian Gusasi, S.Gz Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 66

67 Windi Adiyati Angge, S.Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 67

68 Sri Handayani Saputri Noor, S.Tr Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 68

69 Fatma Gani, SKM Staf S1 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 69

70 Istiqoma Duke,S.Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 70

71 Erisca R.Dude, S,Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 71

72 Sri Vidyanti Moha, A.Md.Kep Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 72

73 Ayu R.Bengkal, S.Kep.Ns Staf S1 100 0 25 25 100 100 100 59,487,900 39,658,600 1,015,429 0 1,015,429 73
74 Fransiska P.Lihawa, A.Md.Keb Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 74

75 Nandita A.Koni, S.Tr.Keb Staf D4 80 0 25 25 80 100 80 59,487,900 39,658,600 812,343 0 812,343 75

76 Vanny R. Haris,A,Md.Kes Staf D3 60 0 25 25 60 100 60 59,487,900 39,658,600 609,257 0 609,257 76

JUMLAH TOTAL 5858.4 59,487,900 39,658,600 59,487,900 1,919,364 57,568,536

Limboto Barat, Februari 2022

MENGETAHUI
KEPALA FKTP LIMBOTO BARAT BENDAHARA

FATMAWATI A. PALILATI, SKM VERAWATY AYUBA, SKM

NIP. 19750505 199603 2 007 NIP. 19831016 200802 2 001
25

10 20

10 20

5 15

15 25

10 20

7 17

5 15

5 15
 DAFTAR PENERIMAAN JASA PELAYANAN BLUD
BPJS, PAD, NON KAPITASI
PUSKESMAS LIMBOTO BARAT
BULAN AGUSTUS 2023
JUMLAH PESERTA :
JUMLAH PEGAWAI :
BESARAN KAPITASI :
TOTAL KAPITASI : Rp 111,647,126 5079.20 10990.62
TOTAL JASPEL SESUAI SK KADIS 50 % = Rp 55,823,563

Jumlah

Rangkap Tugas Administrasi

Tanggung Jawab Program

Point
Presentasi Jumlah Total Penerimaan Kapitasi dengan
Kehadiran Variabel
Kehadiran seluruh point Jumlah Peserta 17,480 jiwa Jasa Pelayanan

Jenis Ketenagaan
Ketenaga
an yang diterima
STR dengan peserta PAJAK

Pendidikan
Masa 17,480 jiwa IURAN 1 % JUMLAH DI
& (PPh TTD
No Nama Pegawai Jabatan Kerja BPJS TERIMA

Jumlah Hari Kerja

SIP 21)

Masuk Kerja
Jumlah Hari
(%
(=Kolom (Perkalian Jasa Biaya
Pembagian
1+2+3+6+ Kolom Pelayanan Operasional (Kolom 11
Klm 4 dibagi
7) 9xKolom 10) (50%) (50%) dikali Kolom 12
Klm 5)
dibagi jumlah
Kolom 11)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

1 Fatmawati A.Palilati,SKM,M.Si Kepala Puskesmas S1 80 25 23 25 100 205 92 188.60 55,823,563 55,823,563 1,998,087.75 99,904 19,981 1,878,202 1

2 dr. Novita Kaluku Dokter Umum S1 150 15 25 25 165 100 165.00 55,823,563 55,823,563 1,748,061.92 262,209 17,481 1,468,372 2

3 drg. Lianty Kemala Dewi Dokter Gigi S1 150 5 19 25 155 76 117.80 55,823,563 55,823,563 1,248,010.27 62,401 12,480 1,173,130 3

4 dr. Shindy Galuh Narantika Dokter Umum S1 150 0 25 25 150 100 150.00 55,823,563 55,823,563 1,589,147.20 0 0 1,589,147 4

5 Hermuni Abubakar Staf SPK 25 25 22 25 50 88 44.00 55,823,563 55,823,563 466,149.85 23,307 4,661 438,181 5

6 Verawaty Ayuba, SKM SP2TP S1 80 10 25 25 90 100 90.00 55,823,563 55,823,563 953,488.32 143,023 9,535 800,930 6

7 Sri Novia Sudjarno, A.Md.Kep Staf D3 60 10 19 25 70 76 53.20 55,823,563 55,823,563 563,617.54 28,181 5,636 529,800 7

8 Sri Haryati Pratiwi, SKM Staf S1 80 10 25 25 90 100 90.00 55,823,563 55,823,563 953,488.32 143,023 9,535 800,930 8

9 Erke F. Masengi, A.Md. Keb Staf D3 60 25 18 25 85 72 61.20 55,823,563 55,823,563 648,372.06 32,419 6,484 609,470 9

10 Merry H. Bauka, S.Tr.Keb Staf D4 80 10 25 25 90 100 90.00 55,823,563 55,823,563 953,488.32 47,674 9,535 896,279 10

11 Mayorin Hasan, A.Md Keb Staf D3 60 10 25 25 70 100 70.00 55,823,563 55,823,563 741,602.03 37,080 7,416 697,106 11

12 Nurmasita Hasan, ST Keb Staf D4 80 15 25 25 95 100 95.00 55,823,563 55,823,563 1,006,459.90 50,323 10,065 946,072 12
13 Yudawati Hasan, ST Keb Staf D4 80 15 25 25 95 100 95.00 55,823,563 55,823,563 1,006,459.90 50,323 10,065 946,072 13

14 Sintje Ali Babuta, A.Md.Keb Staf D3 60 25 25 25 85 100 85.00 55,823,563 55,823,563 900,516.75 45,026 9,005 846,486 14

15 Ade Reiko Badu, A.Md Kep Staf D3 60 10 18 25 70 72 50.40 55,823,563 55,823,563 533,953.46 26,698 5,340 501,916 15

16 Nurliyan Eksan, A.Md Kep Staf D3 60 10 25 25 70 100 70.00 55,823,563 55,823,563 741,602.03 37,080 7,416 697,106 16

17 Winarti Otaya, A.Md Kep Staf D3 60 15 25 25 75 100 75.00 55,823,563 55,823,563 794,573.60 39,729 7,946 746,899 17

18 Sri Larasaty Lahay, A.Md Kep Staf D3 60 15 25 25 75 100 75.00 55,823,563 55,823,563 794,573.60 39,729 7,946 746,899 18

19 Arlin Pulukadang, A.Md Kep Staf D3 60 25 25 25 85 100 85.00 55,823,563 55,823,563 900,516.75 45,026 9,005 846,486 19

20 Rustam Ma'aruf, A.Md Kep Staf D3 60 25 23 25 85 92 78.20 55,823,563 55,823,563 828,475.41 41,424 8,285 778,767 20

21 Olysmawati G. Kadir, S.Kep Staf S1 80 25 16 25 105 64 67.20 55,823,563 55,823,563 711,937.95 35,597 7,119 669,222 21

22 Sumarni S, AMKL Staf D3 60 10 25 25 70 100 70.00 55,823,563 55,823,563 741,602.03 37,080 7,416 697,106 22

23 Elvin Y. Saleh, AMG Staf D3 60 10 25 25 70 100 70.00 55,823,563 55,823,563 741,602.03 37,080 7,416 697,106 23

24 Mimin Suhira Staf D1 25 25 24 25 50 96 48.00 55,823,563 55,823,563 508,527.11 25,426 5,085 478,015 24

25 Hermin N. Uri, S.Si Staf S1 80 15 25 25 95 100 95.00 55,823,563 55,823,563 1,006,459.90 50,323 10,065 946,072 25

26 Darfin S. Laiya, SKM Staf S1 80 10 23 25 90 92 82.80 55,823,563 55,823,563 877,209.26 43,860 8,772 824,577 26

27 Husain Pakaya Staf D1 25 25 22 25 50 88 44.00 55,823,563 55,823,563 466,149.85 23,307 4,661 438,181 27

28 Susanti Amuntu, A.Md.KG Staf D3 60 15 25 25 75 100 75.00 55,823,563 55,823,563 794,573.60 39,729 7,946 746,899 28

29 Yolanda Heri L. Pasi, SKM Staf S1 80 10 25 25 10 100 100 100.00 55,823,563 55,823,563 1,059,431.47 52,972 10,594 995,866 29

30 Erfinta Niati, SKM Pengurus Barang S1 80 10 25 25 90 100 90.00 55,823,563 55,823,563 953,488.32 47,674 9,535 896,279 30

31 Sri Wilin B. Suleman, A.Md Kep Staf D3 60 10 25 25 70 100 70.00 55,823,563 55,823,563 741,602.03 37,080 7,416 697,106 31

32 Meilanti Ui, SKM Perencanaan S1 80 10 23 25 10 100 92 92.00 55,823,563 55,823,563 974,676.95 48,734 9,747 916,196 32

33 Mega Musalam, A.Md Keb Staf D3 60 5 25 25 65 100 65.00 55,823,563 55,823,563 688,630.46 0 6,886 681,744 33

34 Siska Ahaya, A.Md Keb Staf D3 60 5 25 25 65 100 65.00 55,823,563 55,823,563 688,630.46 0 6,886 681,744 34

35 Titi S. Hulopango, A.Md Keb Staf D3 60 5 25 25 65 100 65.00 55,823,563 55,823,563 688,630.46 0 6,886 681,744 35
 Bendahara
36 Hadjara Ntoma D1 25 25 25 25 25 75 100 75.00 55,823,563 55,823,563 794,573.60 39,729 7,946 746,899 36
Penerimaan

37 Sri Nandri Pakaya, A.Md. Keb Staf D3 40 5 18 25 45 72 32.40 55,823,563 55,823,563 343,255.80 0 3,433 339,823 37

38 Maryam Hasan, A.Md. Kes Staf D3 60 10 25 25 10 80 100 80.00 55,823,563 55,823,563 847,545.18 42,377 8,475 796,692 38

39 Irfhan, A.Md.Kep Staf D3 60 10 19 25 70 76 53.20 55,823,563 55,823,563 563,617.54 28,181 5,636 529,800 39

40 Dediarto Mokodompis KTU / PPTK D3 60 15 16 25 40 115 64 73.60 55,823,563 55,823,563 779,741.56 38,987 7,797 732,957 40

Bendahara
41 Sunarti Gusasi, A.Md.Kep D3 60 10 23 25 50 120 92 110.40 55,823,563 55,823,563 1,169,612.34 58,481 11,696 1,099,436 41
Pengeluaran

42 Mus Pautina, A.Md,Kep Staf D3 60 25 25 25 85 100 85.00 55,823,563 55,823,563 900,516.75 45,026 9,005 846,486 42

43 Nurelan Lumbato,S.Kep,Ns Staf S1 100 0 22 25 100 88 88.00 55,823,563 55,823,563 932,299.69 42,622 9,323 880,355 43

44 Anita Yusuf, AMG Staf D3 60 0 23 25 60 92 55.20 55,823,563 55,823,563 584,806.17 42,622 5,848 536,336 44

45 Fitriyanti Zees, S.Farm Staf S1 80 0 20 25 80 80 64.00 55,823,563 55,823,563 678,036.14 42,622 6,780 628,634 45

46 Andri Nusi, A.Md.Kep Staf D3 60 0 22 25 60 88 52.80 55,823,563 55,823,563 559,379.82 42,622 5,594 511,164 46

47 Moh. Zulkarnain Patamani, Amd Staf D3 60 0 23 25 60 92 55.20 55,823,563 55,823,563 584,806.17 42,622 5,848 536,336 47

48 Nurlaila Pulukadang, SKM Staf S1 40 10 25 25 50 100 50.00 55,823,563 55,823,563 529,715.73 0 0 529,716 48

49 Hartati Umar Staf SMA 15 10 25 25 25 100 25.00 55,823,563 55,823,563 264,857.87 0 0 264,858 49

50 Yuliana Radjak Staf SMA 15 10 25 25 25 100 25.00 55,823,563 55,823,563 264,857.87 0 0 264,858 50

51 Winarto Naway Staf SMA 15 5 25 25 20 100 20.00 55,823,563 55,823,563 211,886.29 0 0 211,886 51

52 Iin Polapa, SKM Staf S1 40 5 23 25 45 92 41.40 55,823,563 55,823,563 438,604.63 0 0 438,605 52

53 Lin Otaya, S.Kep Staf S1 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 53

54 Reyni Ali, SKM Staf S1 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 54

55 Ilham Dangkua, SKM Staf S1 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 55

56 Rabia Alingo, S.Kep Ns Staf S1 50 5 25 25 55 100 55.00 55,823,563 55,823,563 582,687.31 0 0 582,687 56

57 Venny Cristanti Hamzah, A.Md, Staf D3 30 5 25 25 35 100 35.00 55,823,563 55,823,563 370,801.01 0 0 370,801 57

58 Meylan R.Palilati, S.T. Keb Staf D4 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 58
59 Inda Dewi Pratiwi Jamale, S.Tr. Staf D4 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 59

60 Sri Yulistia Niati, A.Md.Keb Staf D3 30 5 25 25 35 100 35.00 55,823,563 55,823,563 370,801.01 0 0 370,801 60

61 Khusnul Khotimah, SKM Staf S1 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 61

62 Sri Oktaviani Nani, SKM Staf S1 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 62

63 Saripudin Moha, A. Md. Kep Staf D3 30 5 25 25 35 100 35.00 55,823,563 55,823,563 370,801.01 0 0 370,801 63

64 Qatra Idrus, S.Tr. Keb Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 64

65 Moh Apriliyanto Matani Staf SMA 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 65

66 Dwi Andrian Gusasi, S.Gz Staf S1 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 66

67 Sri Handayani Saputri Noor, S.Tr Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 67

68 Istiqoma Duke,S.Tr.Keb Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 68

69 Erisca R.Dude, S,Tr.Keb Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 69

70 Sri Vidyanti Moha, A.Md.Kep Staf D3 30 0 25 25 30 100 30.00 55,823,563 55,823,563 317,829.44 0 0 317,829 70

71 Ayu R.Bengkal, S.Kep.Ns Staf S1 50 0 25 25 50 100 50.00 55,823,563 55,823,563 529,715.73 0 0 529,716 71

72 Fransiska P.Lihawa, A.Md.Keb Staf D3 30 0 23 25 30 92 27.60 55,823,563 55,823,563 292,403.09 0 0 292,403 72

73 Nandita A.Koni, S.Tr.Keb Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 73

74 Hadijah Hulamahe,SKM Staf SI 40 5 25 25 45 100 45.00 55,823,563 55,823,563 476,744.16 0 0 476,744 74

75 Verawati Radji, S.Kep.Ns Staf SI 50 0 24 25 50 96 48.00 55,823,563 55,823,563 508,527.11 0 0 508,527 75

76 Moh Tyas V. Laya,A.Md Kes Staf D3 30 0 25 25 30 100 30.00 55,823,563 55,823,563 317,829.44 0 0 317,829 76

77 Lilian Towapa. S.Tr.Keb Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 77

78 Fahmila U.Pilomonu,S.Kep Ns Staf SI 50 0 25 25 50 100 50.00 55,823,563 55,823,563 529,715.73 0 0 529,716 78

79 Mayanti Mahmud, S.Kep.Ns Staf SI 50 0 25 25 50 100 50.00 55,823,563 55,823,563 529,715.73 0 0 529,716 79

80 Sri Wilin Mangopa, S.Tr.Keb Staf D4 40 0 25 25 40 100 40.00 55,823,563 55,823,563 423,772.59 0 0 423,773 80

81 Febriani S.Bagu. A.Md.Keb Staf D3 30 0 25 25 30 100 30.00 55,823,563 55,823,563 317,829.44 0 0 317,829 81
82 Novawati Adimula, SE Staf S1 25 0 25 25 25 100 25.00 55,823,563 55,823,563 264,857.87 0 0 264,858 82

83 Ririen Agustina Isa, AMd.Kep Staf D3 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 83

84 Meylan Hulopi, Amd.Kep Staf D3 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 84

85 Asturi Alawiyah Z.Otaya,Amd.Ke Staf D3 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 85

86 Mariyani Umar, Amd.Farm Staf D3 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 86

87 Rahmatia S.Harun,S.Gz Staf S1 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 87

88 Fatmah Khairunisa Kadir Staf SMA 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 88

89 Ririyanti D.J Lahabu,Amd.Keb Staf D3 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 89

90 Fia Sisilia Ntobuo,Amd.Keb Staf D3 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 90

91 Nurain Ali,S.Tr.Keb Staf S1 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 91

92 Rival Hilimi Staf SMA 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 92

93 Santi Staf SMA 15 0 25 25 15 100 15.00 55,823,563 55,823,563 158,914.72 0 0 158,915 93

JUMLAH TOTAL 5269.20 55,823,563 55,823,563 55,823,563 2,199,332 381,628 53,242,602

Limboto Barat, Agustus 2023

MENGETAHUI
KEPALA FKTP LIMBOTO BARAT BENDAHARA JKN

FATMAWATI A. PALILATI, SKM,M.Si SUNARTY GUSASI, Amd.Kep

NIP. 19750505 199603 2 007 NIP. 19840706 201001 2 003
-
25

10 20

10 20

5 15

7 17

5 15
55,823,563
0
Bulan : JULI 2021
Tanggal Nama Alasan Tidak Hadir
1 juli Mei Ui TL - Pertemuan IRTP (Aston)
2 Juli Lin Otaya Sakit (wa)
dr Anti ijin Jaga Ortu (WA)
3 Juli Marni & Maryam TL - Ikut Muscab Hakli (WA)
Muti Duka (Wa)
Fitri Zees Sakit (wa)
5 Juli Mayorin Sakit (wa)
6 Juli Wilin Sakit (wa)
Novia TL - Pertemuan Evaluasi HIV (WA)
7 Juli Hermin ijin Acara Keluarga (WA PNS)
Wilin Sakit (wa)
Lian Ijin Aqiqah Ponakan (WA PNS)
8 Juli Ardi TL - Pertemuan Rabies (wa)
9 Juli Tiwi Moito Ijin anak sakit (wa)
Inday Sakit (wa)
Winarti TL- Monev Ispa (wa)
Andri Gusasi Sakit (wa)
10 Juli windi Sakit (wa)
Lian Sakit (wa)
dr Anti Ijin Acara Keluarga Aqiqah dan Sunat (WA)
12 juli Laras Sakit (wa)
Venny Sakit (wa)
maryam Sakit (WA PNS)
Lian Sakit (WA PNS)
Hermin TL Bimtek - Aston tgl 12 s/d 13 (wa)
Tiwi Moito Sakit (WA PNS)
14 JULI Mimin ijin Acara Keluarga (WA PNS)
maryam sakit (wa) tgl 14 s/d 16
15 JULI Yayan Ijin Jaga adik sakit (wa)
dr Anti Sakit (WA PNS)
mastin Ijin anak sakit (wa)
16 juli Fitri Zees Sakit (WA)
17 JULI ERKE Berduka (suami meninggal)
ILHAM jaga ortu sakit (wa)
19 juli narti sakit (WA)
Laras ijin urusar keluarga (wa)
yuli sakit (WA)
Winarti sakit (WA)
21 JULI SINTJE IJIN ACARA KELUARGA (WA)
22 JULI Hj.Muni sakit (WA)
Popi sakit (WA)
 Novia sakit (WA pns)
23 juii ILHAM Ijin Ortu Sakit (wa)
Mayorin sakit (WA)
Reyni sakit (WA)
24 juli irphan Ijin ujian UNG (wa)
vera Ijin (wa)
olan Ijin (wa)
fitri zees Ijin (wa)
dedy & debby Ijin (wa)
26 juli Fitri Zees Sakit (wa)
Mei Ui Ijin Urus Ponakan Operasi (wa)
27 juli Cici Nur sakit (wa)
Olan kedukaan
tia sakit (wa)
28 juli Laras Ijin Mertua Meninggal
inka sakit (WA)
Mayorin sakit (WA)
inday sakit (WA)
29 juli ILHAM kedukaan
Hj.Muni sakit (WA)
Wilin sakit (WA)
30 juli ILHAM ijin
iin polapa sakit (WA)
popi Duka (Wa)