PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.

CHALIK MASULILI PAGIMANA

BULAN JUNI 2022
Jumlah Kapitasi non kapitasi Rp 11,194,848.50

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 17 23 0 0 60 74% 44 11,194,848.50 365,972 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 14 14 0 0 60 100% 60 11,194,848.50 495,139 2

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 14 15 0 0 60 93% 56 11,194,848.50 462,129 3
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 15 15 0 0 60 100% 60 11,194,848.50 495,139 4

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 14 14 0 0 60 100% 60 11,194,848.50 495,139 5
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 15 15 0 0 60 100% 60 11,194,848.50 495,139 6
/198608042017052004

Na'ama
7 Mone,A.Md.Kep/19890 Perawat D3 II/d 60 0 14 15 0 0 60 93% 56 11,194,848.50 462,129 7
526 201403 1 001

Sakina Ahmad,
8 A.Md.Kep/19880526 Perawat D3 II/d 60 0 15 15 0 0 60 100% 60 11,194,848.50 495,139 8
201403 2 001

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 14 14 0 0 60 100% 60 11,194,848.50 495,139 9

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 11 14 0 0 60 79% 47 11,194,848.50 389,037 10

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 14 15 0 0 60 93% 56 11,194,848.50 462,129 11

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 14 14 0 0 60 100% 60 11,194,848.50 495,139 12

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 10 14 0 0 60 71% 43 11,194,848.50 353,670 13

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 12 14 0 0 60 86% 51 11,194,848.50 424,405 14

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 11 14 0 0 60 79% 47 11,194,848.50 389,037 15
 Helly Heldawati Darise,
16 A.Md.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 11,194,848.50 495,139 16

Igha Nurul Apriyanti

17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 14 15 0 0 60 93% 56 11,194,848.50 462,129 17

18 Sukartini, A.Md.Kep Perawat D3 PTTD 60 0 13 13 0 0 60 100% 60 11,194,848.50 495,139 18

Nurhayati Hamkah,
19 A.Md,Kep Perawat D3 PHL 60 0 14 23 0 0 60 61% 37 11,194,848.50 301,389 19

20 Imelda, A.Md.Kep Perawat D3 PHL 60 0 15 15 0 0 60 100% 60 11,194,848.50 495,139 20

21 Inayah, A.Md.Keb Bidan D3 PHL 60 0 13 15 0 0 60 87% 52 11,194,848.50 429,120 21

22 Isnania, A.Md.Keb Bidan D3 PNS 60 0 14 15 0 0 60 93% 56 11,194,848.50 462,129 22

23 Nini Karlina, S.Kep..,Ns Perawat D3 PHL 60 0 15 15 0 0 60 100% 60 11,194,848.50 495,139 23

Fitri Salapang,
24 A.Md.Keb Bidan D3 PHL 60 0 14 15 0 0 60 93% 56 11,194,848.50 462,129 24

Lilisri Sulisdiawati,
25 S.Kep.,Ns Perawat D3 PHL 60 0 11 23 0 0 60 48% 29 11,194,848.50 236,805 25

26 Kamelia, A.Md.Keb Bidan D3 PHL 60 0 4 23 0 0 60 17% 10 11,194,848.50 86,111 26

TOTAL 1357 11,194,848.50

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN JULI 2022
Jumlah Kapitasi non kapitasi Rp 17,374,029.75

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 0 17 0 0 60 0% 0 17,374,029.75 - 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 15 15 0 0 60 100% 60 17,374,029.75 762,497 2

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 9 13 0 0 60 69% 42 17,374,029.75 527,882 3
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 14 14 0 0 60 100% 60 17,374,029.75 762,497 4

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 5 13 0 0 60 38% 23 17,374,029.75 293,268 5
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 15 15 0 0 60 100% 60 17,374,029.75 762,497 6
/198608042017052004

Na'ama
7 Mone,A.Md.Kep/19890 Perawat D3 II/d 60 0 11 14 0 0 60 79% 47 17,374,029.75 599,104 7
526 201403 1 001

Sakina Ahmad,
8 A.Md.Kep/19880526 Perawat D3 II/d 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 8
201403 2 001

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 9

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 12 13 0 0 60 92% 55 17,374,029.75 703,843 10

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 11

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 13 14 0 0 60 93% 56 17,374,029.75 708,033 12

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 13

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 12 14 0 0 60 86% 51 17,374,029.75 653,569 14

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 11 14 0 0 60 79% 47 17,374,029.75 599,104 15
 Helly Heldawati Darise,
16 A.Md.Keb Bidan D3 PHL 60 0 14 14 0 0 60 100% 60 17,374,029.75 762,497 16

Igha Nurul Apriyanti

17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 17

18 Sukartini, A.Md.Kep Perawat D3 PTTD 60 0 14 14 0 0 60 100% 60 17,374,029.75 762,497 18

Nurhayati Hamkah,
19 A.Md,Kep Perawat D3 PHL 60 0 11 22 0 0 60 50% 30 17,374,029.75 381,248 19

20 Imelda, A.Md.Kep Perawat D3 PHL 60 0 14 14 0 0 60 100% 60 17,374,029.75 762,497 20

21 Inayah, A.Md.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 21

22 Isnania, A.Md.Keb Bidan D3 PNS 60 0 13 13 0 0 60 100% 60 17,374,029.75 762,497 22

23 Nini Karlina, S.Kep..,Ns Perawat D3 PHL 60 0 17 17 0 0 60 100% 60 17,374,029.75 762,497 23

Fitri Salapang,
24 A.Md.Keb Bidan D3 PHL 60 0 14 14 0 0 60 100% 60 17,374,029.75 762,497 24

Lilisri Sulisdiawati,
25 S.Kep.,Ns Perawat D3 PHL 60 0 14 14 0 0 60 100% 60 17,374,029.75 762,497 25

26 Kamelia, A.Md.Keb Bidan D3 PHL 60 0 13 14 0 0 60 93% 56 17,374,029.75 708,033 26

TOTAL 1367 17,374,029.75

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN MEI 2022
Jumlah Kapitasi non kapitasi Rp 7,883,125.25

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 12 17 0 0 60 71% 42 7,883,125.25 284,383 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 19 20 0 0 60 95% 57 7,883,125.25 382,732 2

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 12 13 0 0 60 92% 55 7,883,125.25 371,885 3
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 16 17 0 0 60 94% 56 7,883,125.25 379,177 4

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 20 20 0 0 60 100% 60 7,883,125.25 402,876 5
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 12 15 0 0 60 80% 48 7,883,125.25 322,301 6
/198608042017052004

Na'ama
7 Mone,A.Md.Kep/19890 Perawat D3 II/d 60 0 10 17 0 0 60 59% 35 7,883,125.25 236,986 7
526 201403 1 001

Sakina Ahmad,
8 A.Md.Kep/19880526 Perawat D3 II/d 60 0 15 15 0 0 60 100% 60 7,883,125.25 402,876 8
201403 2 001

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 16 17 0 0 60 94% 56 7,883,125.25 379,177 9

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 16 16 0 0 60 100% 60 7,883,125.25 402,876 10

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 8 16 0 0 60 50% 30 7,883,125.25 201,438 11

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 16 16 0 0 60 100% 60 7,883,125.25 402,876 12

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 15 16 0 0 60 94% 56 7,883,125.25 377,696 13

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 17 17 0 0 60 100% 60 7,883,125.25 402,876 14

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 16 17 0 0 60 94% 56 7,883,125.25 379,177 15
 Helly Heldawati Darise,
16 A.Md.Keb Bidan D3 PHL 60 0 16 16 0 0 60 100% 60 7,883,125.25 402,876 16

Igha Nurul Apriyanti

17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 16 17 0 0 60 94% 56 7,883,125.25 379,177 17

18 Sukartini, A.Md.Kep Perawat D3 PTTD 60 0 17 17 0 0 60 100% 60 7,883,125.25 402,876 18

Nurhayati Hamkah,
19 A.Md,Kep Perawat D3 PHL 60 0 0 18 0 0 60 0% 0 7,883,125.25 - 19

20 Imelda, A.Md.Kep Perawat D3 PHL 60 0 18 18 0 0 60 100% 60 7,883,125.25 402,876 20

21 Inayah, A.Md.Keb Bidan D3 PHL 60 0 14 16 0 0 60 88% 53 7,883,125.25 352,516 21

22 Isnania, A.Md.Keb Bidan D3 PNS 60 0 12 16 0 0 60 75% 45 7,883,125.25 302,157 22

23 Nini Karlina, S.Kep..,Ns Perawat D3 PHL 60 0 11 22 0 0 60 50% 30 7,883,125.25 201,438

Fitri Salapang,
24 A.Md.Keb Bidan D3 PHL 60 0 6 22 0 0 60 27% 16 7,883,125.25 109,875 23

TOTAL 1174 7,883,125.25

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN JANUARI 2022
Jumlah Kapitasi non kapitasi Rp 7,730,512.00

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 15 21 0 0 60 71% 43 7,730,512.00 295,134 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 14 15 0 0 60 93% 56 7,730,512.00 385,642 2

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 9 15 0 0 60 60% 36 7,730,512.00 247,913 3
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 4

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 14 18 0 0 60 78% 47 7,730,512.00 321,368 5
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 6
/198608042017052004

Isnaniah,Amd.Keb Bidan
7 /198811142017052003 Pelaksana
D3 II/d 60 0 14 14 0 0 60 100% 60 7,730,512.00 413,188 7

Jusiana, Amd.Keb Bidan

8 /199006082017052005 Pelaksana
D3 II/d 60 0 0 21 0 0 60 0% 0 7,730,512.00 - 8

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 13 14 0 0 60 93% 56 7,730,512.00 383,675 9

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 7,730,512.00 413,188 10

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 16 17 0 0 60 94% 56 7,730,512.00 388,883 11

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 12

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 10 14 0 0 60 71% 43 7,730,512.00 295,134 13

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 15 18 0 0 60 83% 50 7,730,512.00 344,323 14

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 16 18 0 0 60 89% 53 7,730,512.00 367,278 15

Helly Heldawati Darise,

16 A.Md.Keb Bidan D3 PHL 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 16
 Igha Nurul Apriyanti
17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 14 15 0 0 60 93% 56 7,730,512.00 385,642 17

18 Sukartini, A.Md.Kep Perawat D3 PTTD 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 18

Na'ama
19 Mone,A.Md.Kep/19890 Perawat D3 II/d 60 0 12 18 0 0 60 67% 40 7,730,512.00 275,459 19
526 201403 1 001

Sakina Ahmad,
20 A.Md.Kep/19880526 Perawat D3 II/d 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 20
201403 2 001

Nurhayati Hamkah,
21 A.Md,Kep Perawat D3 60 0 0 21 0 0 60 0% 0 7,730,512.00 - 21

22 Imelda, A.Md.Kep Perawat D4 60 0 18 18 0 0 60 100% 60 7,730,512.00 413,188 22

23 Inayah, A.Md.Keb Bidan D5 60 0 14 18 0 0 60 78% 47 7,730,512.00 321,368 23

TOTAL 1123 7,730,512.00

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN JANUARI 2022
Jumlah Kapitasi non kapitasi Rp 10,067,808.00

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 14 18 0 0 60 78% 47 10,067,808.00 394,151 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 18 18 0 0 60 100% 60 10,067,808.00 506,766 2

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 8 18 0 0 60 44% 27 10,067,808.00 225,229 3
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 12 13 0 0 60 92% 55 10,067,808.00 467,784 4

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 18 18 0 0 60 100% 60 10,067,808.00 506,766 5
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 13 13 0 0 60 100% 60 10,067,808.00 506,766 6
/198608042017052004

Isnaniah,Amd.Keb Bidan
7 /198811142017052003 Pelaksana
D3 II/d 60 0 16 18 0 0 60 89% 53 10,067,808.00 450,459 7

Jusiana, Amd.Keb Bidan

8 /199006082017052005 Pelaksana
D3 II/d 60 0 8 13 0 0 60 62% 37 10,067,808.00 311,856 8

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 17 18 0 0 60 94% 57 10,067,808.00 478,612 9

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 10,067,808.00 506,766 10

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 16 18 0 0 60 89% 53 10,067,808.00 450,459 11

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 18 18 0 0 60 100% 60 10,067,808.00 506,766 12

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 18 18 0 0 60 100% 60 10,067,808.00 506,766 13

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 11 13 0 0 60 85% 51 10,067,808.00 428,802 14

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 11 13 0 0 60 85% 51 10,067,808.00 428,802 15

Helly Heldawati Darise,

16 A.Md.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 10,067,808.00 506,766 16
 Igha Nurul Apriyanti
17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 18 18 0 0 60 100% 60 10,067,808.00 506,766 17

18 Sukartini, A.Md.Kep Farmasi S1 PHL 60 0 8 13 0 0 60 62% 37 10,067,808.00 311,856 18

Na'ama
19 Mone,A.Md.Kep/19890 Perawat D3 II/d 60 0 13 14 0 0 60 93% 56 10,067,808.00 470,569 19
526 201403 1 001

Sakina Ahmad,
20 A.Md.Kep/19880526 Perawat D3 II/d 60 0 12 13 0 0 60 92% 55 10,067,808.00 467,784 20
201403 2 001

Nurhayati Hamkah,
21 A.Md,Kep Perawat D3 60 0 10 23 0 0 60 43% 26 10,067,808.00 220,333 21

22 Imelda, A.Md.Kep Perawat D4 60 0 13 15 0 0 60 87% 52 10,067,808.00 439,197 22

23 Inayah, A.Md.Keb Bidan D5 60 0 12 13 0 0 60 92% 55 10,067,808.00 467,784 23

TOTAL 1192 10,067,808.00

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN JANUARI 2022
Jumlah Kapitasi non kapitasi Rp 8,644,908.00

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 9 12 0 0 60 75% 45 8,644,908.00 363,306 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 12 12 0 0 60 100% 60 8,644,908.00 484,407 2

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 1 12 0 0 60 8% 5 8,644,908.00 40,367 3
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 16 17 0 0 60 94% 56 8,644,908.00 455,913 4

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 12 12 0 0 60 100% 60 8,644,908.00 484,407 5
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 12 17 0 0 60 71% 42 8,644,908.00 341,935 6
/198608042017052004

Isnaniah,Amd.Keb Bidan
7 /198811142017052003 Pelaksana
D3 II/d 60 0 12 12 0 0 60 100% 60 8,644,908.00 484,407 7

Jusiana, Amd.Keb Bidan

8 /199006082017052005 Pelaksana
D3 II/d 60 0 13 17 0 0 60 76% 46 8,644,908.00 370,429 8

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 12 12 0 0 60 100% 60 8,644,908.00 484,407 9

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 14 17 0 0 60 82% 49 8,644,908.00 398,924 10

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 12 12 0 0 60 100% 60 8,644,908.00 484,407 11

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 9 12 0 0 60 75% 45 8,644,908.00 363,306 12

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 16 17 0 0 60 94% 56 8,644,908.00 455,913 13

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 14 17 0 0 60 82% 49 8,644,908.00 398,924 14

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 14 17 0 0 60 82% 49 8,644,908.00 398,924 15

Helly Heldawati Darise,

16 A.Md.Keb Bidan D3 PHL 60 0 16 17 0 0 60 94% 56 8,644,908.00 455,913 16
 Igha Nurul Apriyanti
17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 12 12 0 0 60 100% 60 8,644,908.00 484,407 17

18 Sukartini, A.Md.Kep Farmasi S1 PHL 60 0 16 17 0 0 60 94% 56 8,644,908.00 455,913 18

Na'ama
19 Mone,A.Md.Kep/19890 Perawat D3 II/d 60 0 13 14 0 0 60 93% 56 9,002,715.50 468,424 19
526 201403 1 001

Sakina Ahmad,
20 A.Md.Kep/19880526 Perawat D3 II/d 60 0 13 14 0 0 60 93% 56 9,002,715.50 468,424 20
201403 2 001

Nurhayati Hamkah,
21 A.Md,Kep Perawat D3 II/d 60 0 14 20 0 0 60 70% 42 9,002,715.50 353,120 21

22 - 22

TOTAL 1071 8,696,177.00

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN JANUARI 2022
Jumlah Kapitasi non kapitasi Rp 4,945,368.00

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 15 18 0 0 60 83% 50 4,945,368.00 248,671 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 18 18 0 0 60 100% 60 4,945,368.00 298,405 3

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 7 18 0 0 60 39% 23 4,945,368.00 116,047 4
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 11 13 0 0 60 85% 51 4,945,368.00 252,497 5

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 18 18 0 0 60 100% 60 4,945,368.00 298,405 7
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 12 13 0 0 60 92% 55 4,945,368.00 275,451 8
/198608042017052004

Isnaniah,Amd.Keb Bidan
7 /198811142017052003 Pelaksana
D3 II/d 60 0 18 18 0 0 60 100% 60 4,945,368.00 298,405 9

Jusiana, Amd.Keb Bidan

8 /199006082017052005 Pelaksana
D3 II/d 60 0 13 13 0 0 60 100% 60 4,945,368.00 298,405 10

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 18 18 0 0 60 100% 60 4,945,368.00 298,405 11

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 13 13 0 0 60 100% 60 4,945,368.00 298,405 12

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 18 18 0 0 60 100% 60 4,945,368.00 298,405 13

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 17 18 0 0 60 94% 57 4,945,368.00 281,827 14

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 11 13 0 0 60 85% 51 4,945,368.00 252,497 15

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 12 13 0 0 60 92% 55 4,945,368.00 275,451 16

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 13 13 0 0 60 100% 60 4,945,368.00 298,405 17

Helly Heldawati Darise,

16 A.Md.Keb Bidan D3 PHL 60 0 12 13 0 0 60 92% 55 4,945,368.00 275,451 18
 Igha Nurul Apriyanti
17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 17 18 0 0 60 94% 57 4,945,368.00 281,827 19

18 Sukartini, A.Md.Kep Farmasi S1 PHL 60 0 13 13 0 0 60 100% 60 4,945,368.00 298,405 20

21 21

22 - 22

TOTAL 994 4,945,368.00

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN AGUSTUS 2021
Jumlah Kapitasi non kapitasi Rp 1,035,559.25

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 22 22 0 0 60 100% 60 1,035,559.25 85,270 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 5 22 0 0 60 23% 14 1,035,559.25 19,380 3

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 6 19 0 0 60 32% 19 1,035,559.25 26,927 4
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 17 19 0 0 60 89% 54 1,035,559.25 76,294 5

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 13 22 0 0 60 59% 35 1,035,559.25 50,387 7
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 18 18 0 0 60 100% 60 1,035,559.25 85,270 8
/198608042017052004

Isnaniah,Amd.Keb Bidan
7 /198811142017052003 Pelaksana
D3 II/d 60 0 2 19 0 0 60 11% 6 1,035,559.25 8,976 9

Jusiana, Amd.Keb Bidan

8 /199006082017052005 Pelaksana
D3 II/d 60 0 16 21 0 0 60 76% 46 1,035,559.25 64,967 10

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 5 19 0 0 60 26% 16 1,035,559.25 22,439 11

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 7 19 0 0 60 37% 22 1,035,559.25 31,415 12

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 18 18 0 0 60 100% 60 1,035,559.25 85,270 13

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 19 21 0 0 60 90% 54 1,035,559.25 77,149 14

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 1 19 0 0 60 5% 3 1,035,559.25 4,488 15

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 12 13 0 0 60 92% 55 1,035,559.25 78,711 16

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 14 18 0 0 60 78% 47 1,035,559.25 66,321 17
 Helly Heldawati Darise,
16 A.Md.Keb Bidan D3 PHL 60 0 17 18 0 0 60 94% 57 1,035,559.25 80,533 18

Igha Nurul Apriyanti

17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 5 19 0 0 60 26% 16 1,035,559.25 22,439 19

18 Sukartini, A.Md.Kep Farmasi D3 PHL 60 0 5 19 0 0 60 26% 16 1,035,559.25 22,439 20

19 Abd. Kadir Perawat D3 PNS 60 0 4 22 0 0 60 18% 11 1,035,559.25 15,504 21

20 Noviqa Supri S Bidan D3 PHL 60 0 8 19 0 0 60 42% 25 1,035,559.25 35,903

21 Aprilina Bidan D3 PHL 60 0 8 22 0 0 60 36% 22 1,035,559.25 31,007

22 Haeria Perawat S! PHL 60 0 3 19 0 0 60 16% 9 1,035,559.25 13,464

23 Sara Partika Bidan D3 PHL 60 0 8 22 0 0 60 36% 22 1,035,559.25 31,007 22

TOTAL 729 1,035,559.25

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN JULI 2021
Jumlah Kapitasi non kapitasi Rp 5,316,877.50

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
Arianto H M soni,SIP/ Perawat
1 196811251990031012 Penyelia
D1 III/d 60 0 21 24 0 0 60 88% 53 5,316,877.50 287,265 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 23 24 0 0 60 96% 58 5,316,877.50 314,624 3

Simson Steven Perawat

3 Dapimundi, Amd.An /
Anastesi
D3 II/c 60 0 3 22 0 0 60 14% 8 5,316,877.50 44,769 4
197809222009031004

Yudi Ndeba, Amd.Kep/ Perawat

4 198811262014031001 Anastesi
D3 II/c 60 0 15 18 0 0 60 83% 50 5,316,877.50 273,586 5

Norpiance Tiak, Perawat

5 Amd.Kep/
Pelaksana
D3 II/d 60 0 21 24 0 0 60 88% 53 5,316,877.50 287,265 7
198411222014122001

Rahmi Bidan
6 Trisnawati,Amd.Keb
Pelaksana
D3 II/d 60 0 15 15 0 0 60 100% 60 5,316,877.50 328,303 8
/198608042017052004

Isnaniah,Amd.Keb Bidan
7 /198811142017052003 Pelaksana
D3 II/d 60 0 16 23 0 0 60 70% 42 5,316,877.50 228,385 9

Jusiana, Amd.Keb Bidan

8 /199006082017052005 Pelaksana
D3 II/d 60 0 16 16 0 0 60 100% 60 5,316,877.50 328,303 10

Ismawati
9 Hamzah,Amd.Keb Bidan D3 PHL 60 0 20 23 0 0 60 87% 52 5,316,877.50 285,481 11

Ernik Trirahayu,
10 Amd.Keb Bidan D3 PHL 60 0 13 16 0 0 60 81% 49 5,316,877.50 266,746 12

11 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 14 15 0 0 60 93% 56 5,316,877.50 306,416 13

Inda Triyana Lasimpala,

12 Amd.Keb Bidan D3 PHL 60 0 16 20 0 0 60 80% 48 5,316,877.50 262,642 14

Yunita A Maurana,
13 S.Kep.Ns Perawat S1 PHL 60 0 13 16 0 0 60 81% 49 5,316,877.50 266,746 15

Hartono Jamaludin,
14 Amd.Kep Perawat D3 PHL 60 0 13 15 0 0 60 87% 52 5,316,877.50 284,529 16

Wanda Ndeba,
15 Amd.Kep Perawat D3 PHL 60 0 10 15 0 0 60 67% 40 5,316,877.50 218,869 17
 Helly Heldawati Darise,
16 A.Md.Keb Bidan D3 PHL 60 0 12 14 0 0 60 86% 51 5,316,877.50 281,403 18

Igha Nurul Apriyanti

17 Abdullah, Str.Keb Bidan S1 PTTD 60 0 13 15 0 0 60 87% 52 5,316,877.50 284,529 19

18 Sukartini, A.Md.Kep Farmasi D3 PHL 60 0 0 14 0 0 60 0% 0 5,316,877.50 - 20

19 Abd. Kadir Perawat D3 PNS 60 0 13 24 0 0 60 54% 33 5,316,877.50 177,831 21

20 Noviqa Supri S Bidan D3 PHL 60 0 15 16 0 0 60 94% 56 5,316,877.50 307,784

21 Aprilina Bidan D3 PHL 60 0 0 22 0 0 60 0% 0 5,316,877.50 -

22 Haeria Perawat S! PHL 60 0 12 14 0 0 60 86% 51 5,316,877.50 281,403

23 Sara Partika Bidan D3 PHL 60 0 0 22 0 0 60 0% 0 5,316,877.50 - 22

TOTAL 972 5,316,877.50

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI (RAWAT INAP) RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER S/D DESEMBER 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

Norpiance Tiak, Amd.Kep/

1 198411222014122001 Karu D3 337,802 1

Yudi Ndeba, Amd.Kep/

2 198811262014031001 Karu D3 337,802 2

3 Inda Triyana Lasimpala, Amd.Keb P Care D3 225,201 3

4 Muhardi, Amd.Ak/ Analis D3 225,201 4

198010302008011005

5
Herlina Saguni,Ssi, Apt/ Apotik S1 225,201 5
198110112006042006
6 Purnama Sopir Ambulance 90,080 6

7 Haris Satpam 90,080 7

8 Awat Satpam 90,080 8

9 Imran Nuhu CS 90,080 9

10 Fitri CS 90,080 10

11 Wirna CS 90,080 11

12 Sunarti Tahili CS 90,080 12

13 Zulkifli Liaga CS 90,080 13

14 Fahria Bahsoan CS 90,080 14

15 Febriyanto Kobaa CS 90,080 15

TOTAL 2,252,007.6

Kepala Rumah Sakit Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER S/D DESEMBER 2021
Jumlah Kapitasi non kapitasi : 688.500

Kehadiran Jumlah
Rangkap Persenta Jumlah
Jenis Jumlah Tanggung Poin
Pendidika Masa Jumlah Tugas se Total Jasa Pelayanan Tanda
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel Jumlah
n Kerja Hari Administr Program Ketenaga kehadira Seluruh 60% Tangan
an Masuk
Dinas atif n Poin
Kerja an
1 dr.Ester Dokter Umum S1 60 0 2 60 0 0 60 3% 2 688,500.00 275,400 1

Yefan Adji, STr.Keb/ Bidan Ahli

2 197701152007012001 Pertama
D4 III/a 60 0 0 60 0 0 60 0% 0 688,500.00 - 2

Aprilina,Amd.Keb/
3 198904032017052003 Bidan Pelaksana D3 II/d 60 0 1 60 0 0 60 2% 1 688,500.00 137,700 3

Rahmi Trisnawati,Amd.Keb
4 /198608042017052004 Bidan Pelaksana D3 II/d 60 0 1 60 0 0 60 2% 1 688,500.00 137,700 4

Isnaniah,Amd.Keb
5 /198811142017052003 Bidan Pelaksana D3 II/d 60 0 0 60 0 0 60 0% 0 688,500.00 - 5

Jusiana, Amd.Keb
6 /199006082017052005 Bidan Pelaksana D3 II/d 60 0 1 60 0 0 60 2% 1 688,500.00 137,700 6

7 Ismawati Hamzah,Amd.Keb Bidan D3 PHL 60 0 0 60 0 0 60 0% 0 688,500.00 - 7

8 Ernik Trirahayu, Amd.Keb Bidan D3 PHL 60 0 0 60 0 0 60 0% 0 688,500.00 - 8

9 Adelia Sari, A.Md.Keb Bidan D3 PHL 60 0 0 60 0 0 60 0% 0 688,500.00 - 9

10 Inda Triyana Lasimpala, Amd.Keb Bidan D3 PHL 60 0 1 60 0 0 60 2% 1 688,500.00 137,700 10

11 Helly Heldawati Darise, A.Md.Keb Bidan D3 PHL 60 0 1 60 0 0 60 2% 1 688,500.00 137,700 11

Igha Nurul Apriyanti Abdullah,

12 Str.Keb Bidan S1 PTTD 60 0 0 60 0 0 60 0% 0 688,500.00 - 12

TOTAL 5 688,500.00

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
PEMBAGIAN JASA NON KAPITASI (PERSALINAN) RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER S/D DESEMBER 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

1 dr.Ester Dokter Umum S1 172,125 1

TOTAL 172,125

Kepala RS Pratama Pagimana Bendahara

dr. Anita Anggraeny Sunarni Kamaru, AMG

NIP. 19860111 201412 2 001 NIP. 19840306 200604 2 010
 PEMBAGIAN JASA NON KAPITASI (PERSALINAN) PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER 2020 - JUNI 2021
Nama Faskes RS PRATAMA PAGIMANA
Jumlah Besaran Kapitasi
Jumlah Kapitasi 6,212,160

Kehadiran Jumlah
Rangkap Jumlah
Jenis Jumlah Tanggung Poin Persentas
Pendidika Masa Jumlah Tugas Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Hari Jawab Variabel e Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Masuk
Dinas atif Poin
Kerja an
dr.Ester
1 Dokter S1 PTTD 100 0 12 300 0 0 100 4% 4 6,212,160 2,070,720 1
Mbatono

Yefan Adji,
STr.Keb/ Bidan Ahli
2 19770115200 Pertama
D4 III/a 60 0 3 300 0 0 60 1% 1 6,212,160 310,608 2
7012001

Aprilina,Amd.
Keb/ Bidan
3 19890403201 Pelaksana D3 II/d 60 0 3 300 0 0 60 1% 1 6,212,160 310,608 3
7052003

Rahmi
Trisnawati,A Bidan
4 md.Keb
Pelaksana D3 II/d 60 0 2 300 0 0 60 1% 0 6,212,160 207,072 4
/1986080420
17052004

Isnaniah,Amd
.Keb Bidan
5 /1988111420 Pelaksana D3 II/d 60 0 9 300 0 0 60 3% 2 6,212,160 931,824 5
17052003

Jusiana,
Amd.Keb Bidan
6 /1990060820 Pelaksana D3 II/d 60 0 2 300 0 0 60 1% 0 6,212,160 207,072 6
17052005

Ismawati
7 Hamzah,Amd. Bidan D3 PHL 60 0 3 300 0 0 60 1% 1 6,212,160 310,608 7
Keb
Ernik
8 Trirahayu, Bidan D3 PHL 60 0 4 300 0 0 60 1% 1 6,212,160 414,144 8
Amd.Keb
Inda Triyana
9 Lasimpala, Bidan D3 PHL 60 0 6 300 0 0 60 2% 1 6,212,160 621,216 9
Amd.Keb
TOTAL RRI DAN KEBIDANAN

98,999,214
88,849,214
10,150,000

Jadi RRI = 88,849,214

15% = 88849214 * 15 % = 13,327,382.1

13,327,382.1 = 1% = 888,492.14

DIREKTUR 5%

5 * 88.492,14 = 4,442,460.7
KASUBAG 2%
2 * 888,492,14 = 1,776,984.28

KASIE (WARDAH , SKM)

2 * 88.492,14 = 1,776,984.28 / 10 BLN = 1,776,984.28
8 * 1.776.678,428 = 1,421,427.424
2* 1.776.678,428 = 355,356,856

BENDAHARA
2 * 888.492,14 = 1,776,984.28

DANA TAKTIS 4%
4 * 888.492,14 = 3,553,968.56 3,909,325.416 SISA KASI 2 BLN
355,356.856
 88,849,214
75,521,831.9
13,327,382.1

75,521,831.9 * 10% 7,552,183.19

7,552,183.19 = 1% = 755,218.319

KARU 3%
755,218.319 *3 = 2,265,654.957 /2
= 1,132,827.4785
1,132,827.4785 /10 113,282.74785

AISYAH 3 * 113.282,74785 339,848.24355

NOR 7 * 113.282,74785 792,979.23495

1,132,827.4785 /10 113,282.74785

EPEN 8 * 113.282,74785 906,261.9828
YUDI 2 * 113.282,74785 226,565.4957

P CARE 1% 755,218.319
LAB 0,63% 475,787.54097
BEND 0,5%
0,5 * 755.218,319 = 377,609.1595

CS + SATPAM 4%
4* 775.218,319 = 3,020,873.276 /9
335,652.586222

0,87 * 755,218,319 = 657,039.93753

 75,521,831.9
67,969,648.71
7,552,183.19

67,969,648.71 * 20% DOKTER JAGA

13,593,929.742 /2
6,796,964.871 / 10 679,696.4871

dr.Ester 10 Bln 6,796,964.871

dr.Andry 5,5 Bln 3,738,330.67905
dr.Andrew 4,5 Bln 3,058,634.19195

SISA TOTAL UNTUK KEPERAWATAN

67,969,648.71
54,375,718.968
13,593,929.742
 KEBIDANAN

10,150,000
8,628,000
1,522,000

8,628,000 /10
862,800 1% 86,280

KARU 3% 86,280 *3 258,840

P CARE 1% 86,280
LAB 1% 86,280
BENDAHARA 1% 86,280
CS 4% 345,100

8,628,000
7,765,200
862,800

7,765,200 *20% 1,553,040 /2

dr.ester 776,520 /10 77,652
dr.Andry 5,5 Bln * 77.652 427,086
dr. andrew 4,5 Bln * 77.652 349,434

7,765,200
6,212,160
1,553,040
 PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER S/D JUNI 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

dr. ASTUTI H.TOBAN, DIPL, CIBTAC/

1 19690120 200012 2 002 Direktur S2 4,442,460.7 1

2 WARDAH, SKM/ 197005271993032000 Kesmas S1 1,776,984.28 2

3 Isnaniah,Amd.Keb /198811142017052003 Perawat Penyedia D3 1,776,984.28 3

ENDANG SRI HARTINI
4 M,SIP/197408222010012001 Kasubag S1 1,776,984.28 4

5 DANA TAKTIS 3,553,968.56 5

TOTAL 13,327,382.1

PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA

BULAN SEPTEMBER S/D JUNI 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

1 Norpiance Tiak, Amd.Kep/ Karu D3 792,979.23495 1

198411222014122001
Aisyah Usman,
2 Amd.Kep/196407121987032016 Karu D3 339,848.24355 2

Simson Steven Dapimundi,

3 Amd.An / 197809222009031004 Perawat Anastesi D3 906,261.9828 3

4 Yudi Ndeba, Amd.Kep/ Perawat Pelaksana D3 226,565.4957 4

198811262014031001

5 Inda Triyana Lasimpala, Amd.Keb P Care D3 755,218.319 5

6 Muhardi, Analis D3 475,787.54097 6

Amd.Ak/198010302008011005

7 Yunita A Maurana, S.Kep.Ns Perawat S1 377,609.1595 7

8 Fitri CS 335,652.586222 8

9 Nating CS 335,652.586222 9

10 Atu CS 335,652.586222 10

11 ZULKIFLI CS 335,652.586222 11

12 Wirna CS 335,652.586222 12

13 CS 335,652.586222 13
FAHRIA BAHSOAN
14 CS 335,652.586222 14
Ebi
15 Haris Satpam 335,652.586222 15

16 Awat Satpam 335,652.586222 16

17 Pur Supir Ambulance 335,652.586222 17

18 Taktis 321,387.35131 18

TOTAL 7,552,183.19
LUWUK DESEMBER 2021
 DIREKTUR RSP.Dr.Abd.Chalik
masulili pagimana BENDAHARA DANA KAPITASI JKN

dr.Astuti H.Toban,Dipl.cibtac,MH ISNANIAH Amd.keb

NIP.19690120 200012 2 002 NIP: 19881114 201705 2003
PEMBAGIAN JASA NON KAPITASI PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER S/D JUNI 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

1 dr.Ester Dokter Umum S1 6,796,964.871 1

2 dr. Andry Dokter Umum S1 3,738,330.67905 2

3 dr. Andrew Dokter Umum S1 3,058,634.19195 3

TOTAL 13,593,929.742
- 14,265.234914
 PEMBAGIAN JASA NON KAPITASI (PERSALINAN) PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER 2020 - JUNI 2021
Nama Faskes RS PRATAMA PAGIMANA
Jumlah Besaran Kapitasi
Jumlah Kapitasi 6,651,843.2

Kehadiran Jumlah
Rangkap Jumlah
Jenis Tanggung Poin
Pendidika Masa Jumlah Tugas Persentase Total Jasa Pelayanan
No. Nama Jabatan Gol Ketenaga Jumlah Jawab Variabel Jumlah Tanda Tangan
n Kerja Hari Administr Program Ketenaga kehadiran Seluruh 60%
an Pasien
Dinas atif Poin
an
dr.Ester
1 Dokter S1 PTTD 70 0 7 300 0 0 70 2% 2 6,651,843 1,127,821.2 1
Mbatono

Yefan Adji,
STr.Keb/ Bidan Ahli
2 19770115200 Pertama
D4 III/a 60 0 3 300 0 0 60 1% 1 6,651,843 414,302 2
7012001

Aprilina,Amd.
Keb/ Bidan
3 19890403201 Pelaksana D3 II/d 60 0 3 300 0 0 60 1% 1 6,651,843 414,302 3
7052003

Rahmi
Trisnawati,A Bidan
4 md.Keb
Pelaksana D3 II/d 60 0 2 300 0 0 60 1% 0 6,651,843 276,201 4
/1986080420
17052004

Isnaniah,Amd
.Keb Bidan
5 /1988111420 Pelaksana D3 II/d 60 0 9 300 0 0 60 3% 2 6,651,843 1,242,905 5
17052003

Jusiana,
Amd.Keb Bidan
6 /1990060820 Pelaksana D3 II/d 60 0 2 300 0 0 60 1% 0 6,651,843 276,201 6
17052005

Ismawati
7 Hamzah,Amd. Bidan D3 PHL 60 0 3 300 0 0 60 1% 1 6,651,843 414,302 7
Keb
Ernik
8 Trirahayu, Bidan D3 PHL 60 0 4 300 0 0 60 1% 1 6,651,843 552,402 8
Amd.Keb
Inda Triyana
9 Lasimpala, Bidan D3 PHL 60 0 6 300 0 0 60 2% 1 6,651,843 828,603 9
Amd.Keb
 PEMBAGIAN JASA NON KAPITASI (PERSALINAN) RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN SEPTEMBER S/D JUNI 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

dr. ASTUTI H.TOBAN, DIPL, CIBTAC/

1 19690120 200012 2 002 Direktur S2 507,500 1

2 WARDAH, SKM/ 197005271993032000 Kesmas S1 142,100 2

3 Isnaniah,Amd.Keb /198811142017052003 Perawat Penyedia D3 203,000 3

ENDANG SRI HARTINI
4 M,SIP/197408222010012001 Kasubag S1 203,000 4

5 DANA TAKTIS 467,000 5

TOTAL 1,522,600

Direktur RS Pratama Pagimana Bendahara

dr. Astuti H Toban, Dipl, CIBTAC, MH Isnaniah, Amd.Keb

NIP. 19690120 200012 2 002 NIP. 19881114 201705 2 003
 Jusiana,
Amd.Keb Bidan
10 /1990060820 Pelaksana D3 II/d 60 0 98 211 0 0 60 46% 28 1,625,692.32 84,340 10
17052005

Ismawati
11 Hamzah,Amd. Bidan D3 PHL 60 0 83 211 0 0 60 39% 24 1,625,692.32 71,431 11
Keb
Ernik
12 Trirahayu, Bidan D3 PHL 60 0 67 211 0 0 60 32% 19 1,625,692.32 57,661 12
Amd.Keb
Inda Triyana
13 Lasimpala, Bidan D3 PHL 60 0 124 211 0 0 60 59% 35 1,625,692.32 106,716 13
Amd.Keb
Yunita A
14 Maurana, Perawat S1 PHL 60 0 73 211 0 0 60 35% 21 1,625,692.32 62,825 14
S.Kep.Ns
Hartono
15 Jamaludin, Perawat D3 PHL 60 0 90 211 0 0 60 43% 26 1,625,692.32 77,455 15
Amd.Kep
Wanda
16 Ndeba, Perawat D3 PHL 60 0 79 211 0 0 60 37% 22 1,625,692.32 67,988 16
Amd.Kep

Helly
Heldawati
17 Darise, Bidan D3 PHL 60 0 112 211 0 0 60 53% 32 1,625,692.32 96,388 17
A.Md.Keb

Igha Nurul
Apriyanti
18 Abdullah, Bidan S1 PTTD 60 0 74 211 0 0 60 35% 21 1,625,692.32 63,685 18
Str.Keb

Haeria
19 Lawero, Farmasi S1 PHL 60 0 58 211 0 0 60 27% 16 1,625,692.32 49,915 19
S.Kep.Ns
Noviqa
20 Supri,Amd.Ke Bidan D3 PHL 60 0 24 211 0 0 60 11% 7 1,625,692.32 20,655 20
b

Nela
21 Kurniawati,S. Farmasi S1 PHL 60 0 24 211 0 0 60 11% 7 1,625,692.32 20,655 21
Farm
 PEMBAGIAN JASA PASIEN UMUM PADA RS PRATAMA DR ADB.CHALIK MASULILI PAGIMANA
BULAN FEBRUARI S/D SEPTEMBER 2021

No. Nama Jabatan Pendidikan Jumlah Tanda Tangan

1 dr.Ester Dokter Umum S1 203,211.54 1

2 dr. Andry Dokter Umum S1 203,211.54 2

TOTAL 406,423.08

Direktur RS Pratama Pagimana Bendahara

dr. Astuti H Toban, Dipl, CIBTAC, MH Dewi Marlinda Masulili,SKM

NIP. 19690120 200012 2 002