Dinas Kesehatan PKM

Halaman : 1
PEMERINTAH KABUPATEN CIANJUR

DAFTAR PEMBAYARAN GAJI INDUK PNS/CPNS
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIANJUR
(019) D30100301900003 BULAN : AGUSTUS 2023
NAMA PEGAWAI PENGHASILAN POTONGAN

TANGGAL LAHIR STS GAJI POKOK TUNJ. ESELON TUNJ. TERPENCIL TUNJ BPJSKES 4% POT. PAJAK TAPERA PK
NIP KAWIN TUNJ. ISTRI/SMI TUNJ. FUNG UMUM TKD TUNJ. JKK POT. BPJS KES TAPERA PEG
STATUS PEGAWAI / GOLONGAN ANAK TUNJ. ANAK TUNJ. FUNGSIONAL TUNJ. BERAS TUNJ. JKM POT IWP 1% HUTANG/LAIN2 TANDA TANGAN
NO
NPWP JML JUMLAH TUNJ. KHUSUS TUNJ. PAJAK TAPERA PK POT IWP 8% BULOG NO REKENING
JIWA PEMBULATAN POT. TAPERUM SEWA RUMAH
JML. KOTOR POT. JKK JML. POTONGAN
POT. JKM JUMLAH BERSIH
drg.DIAN NUSWANTARI,M.Kes. K-0 4,898,100 0 0 445,835 79,875 0

0 0 0 0 11,755 445,835 0
02-06-1969
0 1,200,000 72,420 35,266 111,459 0
1 196906021998032005 0 391,848 0 ..................
4,898,100 0 79,875
( PNS - 4B ) MKG: 28 1 87 0 0
6,743,338 11,755 1,076,038
-
35,266 5,667,300
dr.LINDA YULIYANTI YUSA TK - 0 4,326,700 0 0 408,357 52,054 0
0 0 0 0 10,384 408,357 0
28-09-1974
0 1,200,000 72,420 31,152 102,089 0
2 197409282006042011 0 346,136 0 ..................
4,326,700 0 52,054
( PNS - 4B ) MKG: 20 1 5 0 0
6,101,072 10,384 950,172
-
31,152 5,150,900
YULIA YUSTIANI, S.Farm,Apt K-1 3,666,900 0 0 353,802 0 0
2 366,690 0 0 8,801 353,802 0
26-07-1983
146,676 1,200,000 289,680 26,402 88,450 0
3 198307262011012001 0 334,421 0 ..................
4,180,266 0 0
( PNS - 4A ) MKG: 12 4 25 0 0
6,058,976 8,801 811,876
-
26,402 5,247,100
SUB TOTAL PERGOLONGAN : IV 12,891,700 0 0 1,207,994 131,929 0
366,690 0 0 30,940 1,207,994 0
146,676 3,600,000 434,520 92,820 301,998 0
PEG : 3 13,405,066 0 131,929 0 1,072,405 0
IST : 1 JIWA = 6 117 0 0
ANK : 2 18,903,386 30,940 2,838,086
92,820 16,065,300
dr.GUSNADI RAMA ANGGITA K-1 3,628,900 0 0 480,000 0 0
2 362,890 0 0 8,709 480,000 0
17-08-1980
145,156 750,000 289,680 26,128 120,000 0
4 198008172009021009 0 330,956 0 ..................
4,136,946 0 0
( PNS - 3D ) MKG: 14 4 30 0 0
5,691,493 8,709 965,793
-
26,128 4,725,700
ASEP SUTISNA, AM.Kp K-1 4,797,000 0 0 343,149 21,517 0
2 479,700 0 0 11,513 343,149 0
20-02-1966
191,880 500,000 289,680 34,538 85,787 0
5 196602201986031005 0 437,486 0 ..................
5,468,580 0 21,517
( PNS - 3D ) MKG: 32 4 13 0 0
6,668,990 11,513 933,990
-
34,538 5,735,000
Halaman : 2
(019) D30100301900003 BULAN : AGUSTUS 2023

NO
RENI HAYATI GANTINI, AM.Keb. K-1 4,650,600 0 0 327,937 35,421 0

0 465,060 0 0 11,161 327,937 0
27-02-1968
0 500,000 144,840 33,484 81,984 0
6 196802271988032001 0 409,253 0 ..................
5,115,660 0 35,421
( PNS - 3D ) MKG: 30 2 37 0 0
6,168,540 11,161 899,240
-
33,484 5,269,300
JAZID SETIAWAN, A.Mk K-1 4,508,600 0 0 346,805 29,204 0
0 450,860 0 0 10,821 346,805 0
29-02-1968
0 500,000 144,840 32,462 86,701 0
7 196802291989011001 0 396,757 0 ..................
4,959,460 0 29,204
( PNS - 3D ) MKG: 28 2 58 0 0
6,023,650 10,821 902,750
-
32,462 5,120,900
DADANG WAHYU HERMAWAN,AMK K-1 4,508,600 0 0 324,931 16,925 0
1 450,860 0 0 10,821 324,931 0
18-12-1968
90,172 500,000 217,260 32,462 81,233 0
8 196812181989011001 0 403,971 0 ..................
5,049,632 0 16,925
( PNS - 3D ) MKG: 28 3 12 0 0
6,152,043 10,821 870,343
-
32,462 5,281,700
HELY CHAFSJACHAJATY, AM.Keb K-0 4,370,900 0 0 291,211 15,250 0
0 0 0 0 10,490 291,211 0
12-05-1971
0 500,000 72,420 31,470 72,803 0
9 197105121992032009 0 349,672 0 ..................
4,370,900 0 15,250
( PNS - 3D ) MKG: 26 1 55 0 0
5,291,796 10,490 770,896
-
31,470 4,520,900
YANI NURYANI, A.Md.Keb K-0 4,237,500 0 0 286,240 8,938 0
0 0 0 0 10,170 286,240 0
24-11-1968
0 500,000 72,420 30,510 71,560 0
10 196811241991032004 0 339,000 0 ..................
4,237,500 0 8,938
( PNS - 3D ) MKG: 24 1 40 0 0
5,145,818 10,170 746,418
-
30,510 4,399,400
SUSILAWATI, AM.Kep TK - 0 3,861,000 0 0 273,370 0 0
0 0 0 0 9,266 273,370 0
09-01-1976
0 500,000 72,420 27,799 68,343 0
11 197601092002122003 0 308,880 0 ..................
3,861,000 0 0
( PNS - 3D ) MKG: 18 1 3 0 0
4,743,858 9,266 687,658
-
27,799 4,056,200
Halaman : 3
(019) D30100301900003 BULAN : AGUSTUS 2023

NO
NUR RENI WATI, AM.Keb TK - 0 3,743,100 0 0 331,714 0 0

0 0 0 0 8,983 331,714 0
31-12-1981
0 500,000 72,420 26,950 82,928 0
12 198112312003122004 0 299,448 0 ..................
3,743,100 0 0
( PNS - 3D ) MKG: 16 1 56 0 0
4,683,223 8,983 750,023
-
26,950 3,933,200
AI NURAISAH, AMG K-1 3,481,600 0 0 357,257 0 0
2 348,160 0 0 8,356 357,257 0
21-06-1979
139,264 600,000 289,680 25,068 89,314 0
13 197906212006042018 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 32 0 0
5,249,417 8,356 797,517
-
25,068 4,451,900
HERMAN SUJANA.AM.KL K-1 4,065,500 0 0 226,507 0 0
2 406,550 0 0 9,757 226,507 0
12-10-1968
162,620 500,000 289,680 29,272 56,627 0
14 196810121997021009 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 51 0 0
5,689,937 9,757 692,937
-
29,272 4,997,000
ELIS KARWATI, AM.Kep K-1 3,591,200 0 0 278,210 0 0
2 359,120 0 0 8,619 278,210 0
10-07-1980
143,648 500,000 289,680 25,857 69,553 0
15 198007102008012009 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 22 0 0
5,196,356 8,619 709,756
-
25,857 4,486,600
AI RUSMIATI, AM.Keb. K-1 3,481,600 0 0 282,072 0 0
2 348,160 0 0 8,356 282,072 0
17-07-1975
139,264 500,000 289,680 25,068 70,518 0
16 197507172002122006 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 36 0 0
5,074,236 8,356 703,536
-
25,068 4,370,700
NURLENA, SE K-0 4,325,600 0 0 306,368 0 0
0 0 185,000 0 10,381 306,368 0
12-01-1967
0 0 72,420 31,144 76,592 0
17 196701121985032001 0 346,048 0 ..................
4,325,600 0 0
( PNS - 3C ) MKG: 28 1 20 0 0
4,930,933 10,381 770,533
-
31,144 4,160,400
Halaman : 4
(019) D30100301900003 BULAN : AGUSTUS 2023

NO
DEDE SURYANI, SKM K-1 3,554,000 0 0 317,164 0 0

2 355,400 0 0 8,530 317,164 0
14-02-1979
142,160 300,000 289,680 25,589 79,291 0
18 197902142014092001 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 76 0 0
4,992,599 8,530 754,699
-
25,589 4,237,900
NENENG SADIAH K-1 3,238,300 0 0 251,234 0 0
2 323,830 0 0 7,772 251,234 0
13-05-1977
129,532 265,000 289,680 23,316 62,808 0
19 197705132006042017 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 99 0 0
4,528,763 7,772 640,463
-
23,316 3,888,300
RIKA DWI PRAJANI, A.Md.Keb K-1 3,238,300 0 0 249,753 0 0
2 323,830 0 0 7,772 249,753 0
07-09-1987
129,532 265,000 289,680 23,316 62,438 0
20 198709072009022005 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 29 0 0
4,527,212 7,772 638,612
-
23,316 3,888,600
DEWI RAHAYU PERMASIH, A.M.Keb. K-0 3,139,400 0 0 225,937 0 0
0 0 0 0 7,535 225,937 0
20-06-1986
0 265,000 72,420 22,604 56,484 0
21 198606202010012016 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 16 0 0
3,732,912 7,535 563,712
-
22,604 3,169,200
IIS HARTATI, A.Md.Keb. TK - 0 3,139,400 0 0 232,551 0 0
0 0 0 0 7,535 232,551 0
07-08-1987
0 265,000 72,420 22,604 58,138 0
22 198708072010012011 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 70 0 0
3,739,580 7,535 571,980
-
22,604 3,167,600
LEILI RAKHMIATI JD - 0 3,627,900 0 0 255,602 0 0
2 0 0 0 8,707 255,602 0
11-07-1975
145,116 265,000 217,260 26,121 63,901 0
23 197507112006042032 0 301,841 0 ..................
3,773,016 0 0
( PNS - 3A ) MKG: 22 3 66 0 0
4,545,772 8,707 656,172
-
26,121 3,889,600
Halaman : 5
(019) D30100301900003 BULAN : AGUSTUS 2023

NO
HETI YUSTIRA K-0 3,517,200 0 0 244,172 0 0

0 0 0 0 8,441 244,172 0
06-08-1976
0 265,000 72,420 25,324 61,043 0
24 197608062006042019 0 281,376 0 ..................
3,517,200 0 0
( PNS - 3A ) MKG: 20 1 99 0 0
4,132,656 8,441 620,356
-
25,324 3,512,300
ANI HENDRIYANI K-1 3,305,700 0 0 313,156 0 0
2 330,570 0 0 7,934 313,156 0
21-11-1977
132,228 265,000 289,680 23,801 78,289 0
25 197711212008012004 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 91 0 0
4,668,160 7,934 724,660
-
23,801 3,943,500
IMAS KURNIAWATY, Amd.Kep K-0 3,305,700 0 0 250,837 0 0
0 0 0 0 7,934 250,837 0
23-04-1981
0 265,000 72,420 23,801 62,709 0
26 198104232012122002 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 45 0 0
3,925,737 7,934 609,737
-
23,801 3,316,000
ADE NURKAYA, Amd,Kep K-1 3,012,000 0 0 278,229 0 0
2 301,200 0 0 7,229 278,229 0
01-03-1979
120,480 265,000 289,680 21,686 69,557 0
27 197903012011011001 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 91 0 0
4,295,595 7,229 651,395
-
21,686 3,644,200
RINA ANDRIANI, Amd.Kep K-1 3,305,700 0 0 332,769 0 0
2 330,570 0 0 7,934 332,769 0
01-06-1975
132,228 240,000 289,680 23,801 83,192 0
28 197506012012122001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 94 0 0
4,662,776 7,934 749,176
-
23,801 3,913,600
MAMAT RAHMATULLAH K-1 3,742,200 0 0 231,196 0 0
0 374,220 185,000 0 8,981 231,196 0
02-04-1966
0 0 144,840 26,944 57,799 0
29 196604021992031005 0 329,314 0 ..................
4,116,420 0 0
( PNS - 3A ) MKG: 24 2 53 0 0
4,713,434 8,981 654,234
26,944 4,059,200
Halaman : 6
(019) D30100301900003 BULAN : AGUSTUS 2023

NO
SUB TOTAL PERGOLONGAN : III 97,377,500 0 0 7,638,371 127,255 0
6,010,980 370,000 0 233,707 7,638,371 0
1,943,280 9,775,000 4,996,980 701,119 1,909,592 0
PEG : 26 105,331,760 0 127,255 0 8,426,542 0
IST : 16 JIWA = 69 1,294 0 0
ANK : 27 129,175,486 233,707 19,036,586
701,119 110,138,900
YUSTI SRI MARGAYATI, A.Md.Keb K-1 2,889,800 0 0 239,232 0 0
2 288,980 180,000 0 6,936 239,232 0
16-02-1989
115,592 0 289,680 20,807 59,808 0
30 198902162017042006 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 6 0 0
4,031,033 6,936 590,333
0
20,807 3,440,700
AMILIA ADISTI TK - 0 2,687,800 0 0 169,704 0 0
0 0 180,000 0 6,451 169,704 0
10-12-1987
0 0 72,420 19,352 42,426 0
31 198712102009022002 0 215,024 0 ..................
2,687,800 0 0
( PNS - 2C ) MKG: 14 1 30 0 0
3,135,757 6,451 452,957
-
19,352 2,682,800
SUB TOTAL PERGOLONGAN : II 5,577,600 0 0 408,936 0 0
288,980 360,000 0 13,387 408,936 0
115,592 0 362,100 40,159 102,234 0
PEG : 2 5,982,172 0 0 0 478,574 0
IST : 1 JIWA = 5 36 0 0
ANK : 2 7,166,790 13,387 1,043,290
40,159 6,123,500
TOTAL PER SATKER 115,846,800 0 0 9,255,301 259,184 0
6,666,650 730,000 0 278,034 9,255,301 0
2,205,548 13,375,000 5,793,600 834,098 2,313,824 0
PEG : 31 124,718,998 0 259,184 0 9,977,521 0
IST : 18 JIWA = 80 1,447 0 0
ANK : 31 155,245,662 278,034 22,917,962
834,098 132,327,700
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 7
(019) D30100301900003 BULAN : AGUSTUS 2023

NO
Halaman : 8
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS MUKA
(019) D30100301900004 BULAN : AGUSTUS 2023

NO
dr.USI YUSNITASWARI TK - 0 3,666,900 0 0 347,883 0 0

0 0 0 0 8,801 347,883 0
25-06-1983
0 750,000 72,420 26,402 86,971 0
1 198306252011012001 0 293,352 0 ..................
3,666,900 0 0
( PNS - 4A ) MKG: 12 1 3 0 0
4,872,409 8,801 763,409
-
26,402 4,109,000
SUB TOTAL PERGOLONGAN : IV 3,666,900 0 0 347,883 0 0
0 0 0 8,801 347,883 0
0 750,000 72,420 26,402 86,971 0
PEG : 1 3,666,900 0 0 0 293,352 0
IST : 0 JIWA = 1 3 0 0
ANK : 0 4,872,409 8,801 763,409
26,402 4,109,000
LENA PURNAMA, SKM. K-1 3,518,100 0 0 300,039 0 0
2 351,810 0 0 8,443 300,039 0
03-05-1982
140,724 600,000 289,680 25,330 75,010 0
2 198205032010012012 0 320,851 0 ..................
4,010,634 0 0
( PNS - 3D ) MKG: 12 4 47 0 0
5,234,173 8,443 729,673
-
25,330 4,504,500
HERTI KRISNAWATI K-0 4,650,600 0 0 364,678 31,492 0
0 0 0 0 11,161 364,678 0
01-01-1968
0 500,000 72,420 33,484 91,170 0
3 196801011990032011 0 372,048 0 ..................
4,650,600 0 31,492
( PNS - 3D ) MKG: 30 1 98 0 0
5,663,933 11,161 904,033
-
33,484 4,759,900
TATI HARTATI K-1 4,237,500 0 0 281,304 1,029 0
1 423,750 0 0 10,170 281,304 0
28-02-1967
84,750 500,000 217,260 30,510 70,326 0
4 196702281994032003 0 379,680 0 ..................
4,746,000 0 1,029
( PNS - 3D ) MKG: 24 3 46 0 0
5,786,319 10,170 773,019
-
30,510 5,013,300
SUPIYATI K-0 4,237,500 0 0 273,351 8,325 0
0 0 0 0 10,170 273,351 0
17-08-1969
0 500,000 72,420 30,510 68,338 0
5 196908171997032004 0 339,000 0 ..................
4,237,500 0 8,325
( PNS - 3D ) MKG: 24 1 18 0 0
5,132,294 10,170 729,694
-
30,510 4,402,600
Halaman : 9
(019) D30100301900004 BULAN : AGUSTUS 2023

NO
JAVED SUMAWE MATA PULUNG K-1 4,237,500 0 0 400,617 6,696 0

1 423,750 0 0 10,170 400,617 0
13-09-1972
84,750 500,000 217,260 30,510 100,154 0
6 197209131994031002 0 379,680 0 ..................
4,746,000 0 6,696
( PNS - 3D ) MKG: 24 3 74 0 0
5,911,327 10,170 927,827
-
30,510 4,983,500
TIARMAULI SAMOSIR K-0 4,108,100 0 0 260,995 1,838 0
0 0 0 0 9,859 260,995 0
16-09-1975
0 500,000 72,420 29,578 65,249 0
7 197509161996032001 0 328,648 0 ..................
4,108,100 0 1,838
( PNS - 3D ) MKG: 22 1 77 0 0
4,982,867 9,859 696,167
-
29,578 4,286,700
ATIN SUKWATIN K-1 4,797,000 0 0 311,110 16,013 0
1 479,700 185,000 0 11,513 311,110 0
28-10-1965
95,940 0 217,260 34,538 77,777 0
8 196510281986032008 0 429,811 0 ..................
5,372,640 0 16,013
( PNS - 3D ) MKG: 32 3 88 0 0
6,148,162 11,513 880,762
-
34,538 5,267,400
ENENG ELIS MUTHMAINNAH K-0 3,821,000 0 0 279,485 0 0
0 0 0 0 9,170 279,485 0
02-11-1979
0 600,000 72,420 27,511 69,871 0
9 197911022006042007 0 305,680 0 ..................
3,821,000 0 0
( PNS - 3C ) MKG: 21 1 31 0 0
4,809,617 9,170 691,717
-
27,511 4,117,900
HERI MULYANA, S.Kep.Ners. K-1 3,821,000 0 0 289,386 0 0
2 382,100 0 0 9,170 289,386 0
29-07-1979
152,840 600,000 289,680 27,511 72,346 0
10 197907292007011005 0 348,475 0 ..................
4,355,940 0 0
( PNS - 3C ) MKG: 20 4 1 0 0
5,571,688 9,170 746,888
0
27,511 4,824,800
DINA HARIYANTI, AM.Keb. TK - 0 4,065,500 0 0 263,350 8 0
0 0 0 0 9,757 263,350 0
31-10-1973
0 500,000 72,420 29,272 65,837 0
11 197310311993012003 0 325,240 0 ..................
4,065,500 0 8
( PNS - 3C ) MKG: 24 1 57 0 0
4,940,364 9,757 693,464
-
29,272 4,246,900
Halaman : 10
(019) D30100301900004 BULAN : AGUSTUS 2023

NO
ANGGRAENI WULANDARI, S.Farm., Apt. K-1 2,773,200 0 0 182,723 0 0

2 277,320 0 0 6,656 182,723 0
14-04-1988
110,928 325,000 289,680 19,967 45,681 0
12 198804142020122005 0 252,916 0 ..................
3,161,448 0 0
( PNS - 3B ) MKG: 2 4 69 0 0
3,985,543 6,656 507,943
-
19,967 3,477,600
dr. SITI CHOLIFAH K-0 2,773,200 0 0 268,627 0 0
0 0 0 0 6,656 268,627 0
09-06-1991
0 325,000 72,420 19,967 67,157 0
13 199106092020122009 0 221,856 0 ..................
2,773,200 0 0
( PNS - 3B ) MKG: 2 1 93 0 0
3,465,963 6,656 584,263
-
19,967 2,881,700
ROYANI, Am.Keb TK - 0 3,781,400 0 0 273,433 0 0
0 0 0 0 9,075 273,433 0
25-08-1973
0 265,000 72,420 27,226 68,358 0
14 197308252006042011 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 50 0 0
4,428,604 9,075 680,604
-
27,226 3,748,000
ANI RINAWATI TK - 0 3,554,000 0 0 231,430 0 0
0 0 0 0 8,530 231,430 0
15-08-1976
0 265,000 72,420 25,589 57,858 0
15 197608152002122006 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 58 0 0
4,157,027 8,530 607,727
-
25,589 3,549,300
CECEP SUPANGKAT, A.Md.Kep K-1 3,554,000 0 0 279,518 0 0
2 355,400 0 0 8,530 279,518 0
03-01-1979
142,160 265,000 289,680 25,589 69,879 0
16 197901032007011006 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 64 0 0
4,919,941 8,530 707,641
-
25,589 4,212,300
CICA ERAYANI JATNIKA K-1 3,238,300 0 0 262,356 0 0
1 323,830 0 0 7,772 262,356 0
25-01-1975
64,766 265,000 217,260 23,316 65,589 0
17 197501252005012015 0 290,152 0 ..................
3,626,896 0 0
( PNS - 3B ) MKG: 12 3 85 0 0
4,402,685 7,772 649,185
-
23,316 3,753,500
Halaman : 11
(019) D30100301900004 BULAN : AGUSTUS 2023

NO
INEU SITI ANISAH, Amd,Keb TK - 0 3,139,400 0 0 204,880 0 0

0 0 0 0 7,535 204,880 0
15-05-1987
0 265,000 72,420 22,604 51,220 0
18 198705152011012003 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 52 0 0
3,711,891 7,535 537,391
-
22,604 3,174,500
RIKA DWI SERTIAWATI, AMd,Keb K-1 3,139,400 0 0 277,907 0 0
2 313,940 0 0 7,535 277,907 0
02-09-1987
125,576 265,000 289,680 22,604 69,477 0
19 198709022011012001 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 94 0 0
4,441,736 7,535 663,836
-
22,604 3,777,900
TATI SURYATI K-1 4,280,800 0 0 243,168 0 0
0 428,080 185,000 0 10,274 243,168 0
23-09-1965
0 0 144,840 30,822 60,792 0
20 196509231988032007 0 376,710 0 ..................
4,708,880 0 0
( PNS - 3B ) MKG: 30 2 82 0 0
5,323,066 10,274 721,766
-
30,822 4,601,300
WATI RAHMAWATY, Amd.Kep K-1 3,305,700 0 0 265,493 0 0
2 330,570 0 0 7,934 265,493 0
18-08-1982
132,228 300,000 289,680 23,801 66,373 0
21 198208182012122002 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 75 0 0
4,655,481 7,934 665,081
-
23,801 3,990,400
ATIKAH YULIANA K-0 3,517,200 0 0 256,253 0 0
0 0 0 0 8,441 256,253 0
14-07-1977
0 265,000 72,420 25,324 64,063 0
22 197707142006042013 0 281,376 0 ..................
3,517,200 0 0
( PNS - 3A ) MKG: 20 1 19 0 0
4,144,657 8,441 635,457
-
25,324 3,509,200
DEASI SRI WAHYUNI K-1 3,204,700 0 0 230,854 0 0
1 320,470 0 0 7,691 230,854 0
24-04-1980
64,094 265,000 217,260 23,074 57,713 0
23 198004242007012010 0 287,141 0 ..................
3,589,264 0 0
( PNS - 3A ) MKG: 14 3 30 0 0
4,333,173 7,691 606,473
-
23,074 3,726,700
Halaman : 12
(019) D30100301900004 BULAN : AGUSTUS 2023

NO
IRMA LESTARI, S.Gz K-1 2,830,900 0 0 131,960 0 0

0 283,090 185,000 0 6,794 131,960 0
13-02-1991
0 0 144,840 20,382 32,990 0
24 199102132015032009 0 249,119 0 ..................
3,113,990 0 0
( PNS - 3A ) MKG: 6 2 79 0 0
3,603,045 6,794 441,245
0
20,382 3,161,800
4,693,810 555,000 0 203,006 6,132,917 0
1,198,756 7,870,000 3,838,260 609,019 1,533,228 0
PEG : 23 90,478,566 0 65,401 0 7,238,285 0
IST : 13 JIWA = 53 1,387 0 0
ANK : 17 109,753,556 203,006 15,781,856
609,019 93,971,700
DESI HELVINA, A.Md.Keb K-1 2,980,800 0 0 223,978 0 0
2 298,080 0 0 7,154 223,978 0
10-09-1984
119,232 240,000 289,680 21,462 55,994 0
25 198409102017052002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 51 0 0
4,180,437 7,154 580,437
-
21,462 3,600,000
NURWILAN GENARY HARAHAP, A.Md.Keb K-0 2,801,500 0 0 198,585 0 0
0 0 0 0 6,724 198,585 0
04-09-1988
0 240,000 72,420 20,171 49,646 0
26 198809042017052004 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 13 1 46 0 0
3,339,446 6,724 499,246
-
20,171 2,840,200
MUTIAH MAULAN, A.Md.Keb TK - 0 2,801,500 0 0 121,660 0 0
0 0 0 0 6,724 121,660 0
04-11-1988
0 240,000 72,420 20,171 30,415 0
27 198811042017042001 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 13 1 15 0 0
3,262,490 6,724 403,090
0002
20,171 2,859,400
298,080 0 0 20,602 544,223 0
119,232 720,000 434,520 61,804 136,055 0
PEG : 3 9,001,112 0 0 0 720,089 0
IST : 1 JIWA = 6 112 0 0
ANK : 2 10,782,373 20,602 1,482,773
61,804 9,299,600
Halaman : 13
(019) D30100301900004 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 96,836,700 0 0 7,025,023 65,401 0
4,991,890 555,000 0 232,409 7,025,023 0
1,317,988 9,340,000 4,345,200 697,225 1,756,254 0
PEG : 27 103,146,578 0 65,401 0 8,251,726 0
IST : 14 JIWA = 60 1,502 0 0
ANK : 19 125,408,338 232,409 18,028,038
697,225 107,380,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 14
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS NAGRAK
(019) D30100301900005 BULAN : AGUSTUS 2023

NO
drg.SRI SUNDARI JD - 0 4,024,400 0 0 359,124 24,254 0

1 0 0 0 9,659 359,124 0
26-09-1968
80,488 1,200,000 144,840 28,976 89,781 0
1 196809262006042002 0 328,391 0 ..................
4,104,888 0 24,254
( PNS - 4A ) MKG: 18 2 44 0 0
5,871,785 9,659 840,185
-
28,976 5,031,600
SUB TOTAL PERGOLONGAN : IV 4,024,400 0 0 359,124 24,254 0
0 0 0 9,659 359,124 0
80,488 1,200,000 144,840 28,976 89,781 0
PEG : 1 4,104,888 0 24,254 0 328,391 0
IST : 0 JIWA = 2 44 0 0
ANK : 1 5,871,785 9,659 840,185
28,976 5,031,600
ROHAYAH, AM.Keb. K-1 4,508,600 0 0 296,505 43,438 0
0 450,860 0 0 10,821 296,505 0
16-11-1968
0 850,000 144,840 32,462 74,126 0
2 196811161989032003 0 396,757 0 ..................
4,959,460 0 43,438
( PNS - 3D ) MKG: 28 2 83 0 0
6,337,609 10,821 854,109
-
32,462 5,483,500
dr.DIKDIK WAHYUDI K-1 3,743,100 0 0 396,669 0 0
2 374,310 0 0 8,983 396,669 0
07-02-1977
149,724 750,000 289,680 26,950 99,167 0
3 197702072010011011 0 341,371 0 ..................
4,267,134 0 0
( PNS - 3D ) MKG: 16 4 24 0 0
5,739,440 8,983 873,140
-
26,950 4,866,300
dr.DEWI RUSLINDA K-1 3,628,900 0 0 299,374 0 0
1 362,890 0 0 8,709 299,374 0
27-04-1970
72,578 750,000 217,260 26,128 74,844 0
4 197004272010012003 0 325,149 0 ..................
4,064,368 0 0
( PNS - 3D ) MKG: 14 3 65 0 0
5,365,904 8,709 734,204
-
26,128 4,631,700
HESTY HERLIANI K-0 4,508,600 0 0 268,212 20,438 0
0 0 0 0 10,821 268,212 0
16-04-1967
0 500,000 72,420 32,462 67,053 0
5 196704161989032006 0 360,688 0 ..................
4,508,600 0 20,438
( PNS - 3D ) MKG: 28 1 21 0 0
5,412,974 10,821 759,674
-
32,462 4,653,300
Halaman : 15
(019) D30100301900005 BULAN : AGUSTUS 2023

NO
DEDEN JUANDA, A.Md.Kep K-1 4,370,900 0 0 318,139 0 0

2 437,090 0 0 10,490 318,139 0
10-10-1969
174,836 500,000 289,680 31,470 79,535 0
6 196910101995031003 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 55 0 0
6,132,660 10,490 838,260
-
31,470 5,294,400
N. YELI YULIANI, AM.Keb K-1 4,370,900 0 0 300,479 8,742 0
1 437,090 0 0 10,490 300,479 0
14-02-1970
87,418 500,000 217,260 31,470 75,120 0
7 197002141991032004 0 391,633 0 ..................
4,895,408 0 8,742
( PNS - 3D ) MKG: 26 3 85 0 0
5,963,934 10,490 817,934
-
31,470 5,146,000
SRI WAHYUNINGSIH K-1 4,237,500 0 0 293,978 1,629 0
1 423,750 0 0 10,170 293,978 0
11-06-1971
84,750 500,000 217,260 30,510 73,494 0
8 197106111994032005 0 379,680 0 ..................
4,746,000 0 1,629
( PNS - 3D ) MKG: 24 3 14 0 0
5,799,561 10,170 789,461
-
30,510 5,010,100
IMAS FARIDAH K-1 4,237,500 0 0 279,529 0 0
2 423,750 0 0 10,170 279,529 0
17-12-1972
169,500 500,000 289,680 30,510 69,882 0
9 197212171993012001 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 12 0 0
5,940,651 10,170 776,551
-
30,510 5,164,100
ONOH RODIAH K-1 4,650,600 0 0 276,323 18,008 0
0 465,060 185,000 0 11,161 276,323 0
06-06-1966
0 0 144,840 33,484 69,081 0
10 196606061988032024 0 409,253 0 ..................
5,115,660 0 18,008
( PNS - 3D ) MKG: 30 2 34 0 0
5,784,510 11,161 817,310
-
33,484 4,967,200
N.IDA FARIDA JD - 0 4,370,900 0 0 242,617 0 0
1 0 185,000 0 10,490 242,617 0
06-11-1968
87,418 0 144,840 31,470 60,654 0
11 196811061991032007 0 356,665 0 ..................
4,458,318 0 0
( PNS - 3D ) MKG: 26 2 61 0 0
5,072,796 10,490 701,896
-
31,470 4,370,900
Halaman : 16
(019) D30100301900005 BULAN : AGUSTUS 2023

NO
dr. WINA SELVIA K-0 3,172,300 0 0 290,442 0 0

0 0 0 0 7,614 290,442 0
17-09-1981
0 750,000 72,420 22,841 72,611 0
12 198109172014122001 0 253,784 0 ..................
3,172,300 0 0
( PNS - 3C ) MKG: 8 1 75 0 0
4,315,692 7,614 647,292
-
22,841 3,668,400
ENDANG SRI MULYATI K-1 4,325,600 0 0 281,655 5,538 0
1 432,560 0 0 10,381 281,655 0
07-12-1967
86,512 500,000 217,260 31,144 70,414 0
13 196712071989012002 0 387,574 0 ..................
4,844,672 0 5,538
( PNS - 3C ) MKG: 28 3 56 0 0
5,890,706 10,381 786,706
-
31,144 5,104,000
HANI SUSANTI, AM.Keb JD - 0 3,591,200 0 0 221,622 0 0
2 0 0 0 8,619 221,622 0
20-04-1979
143,648 500,000 217,260 25,857 55,405 0
14 197904202006042020 0 298,788 0 ..................
3,734,848 0 0
( PNS - 3C ) MKG: 16 3 85 0 0
4,708,291 8,619 610,291
-
25,857 4,098,000
NURULHADI, AM.Kep K-1 3,591,200 0 0 240,875 0 0
2 359,120 0 0 8,619 240,875 0
16-11-1979
143,648 500,000 289,680 25,857 60,219 0
15 197911162008011002 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 88 0 0
5,159,087 8,619 663,087
-
25,857 4,496,000
ENJANG KOMARA, AM.Kep K-1 3,481,600 0 0 271,150 0 0
2 348,160 0 0 8,356 271,150 0
26-07-1977
139,264 265,000 289,680 25,068 67,788 0
16 197707262006041007 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 6 0 0
4,828,284 8,356 689,884
-
25,068 4,138,400
SYAPUR YUSUP, AM.Kep. K-1 3,554,000 0 0 231,470 0 0
2 355,400 0 0 8,530 231,470 0
25-12-1971
142,160 265,000 289,680 25,589 57,868 0
17 197112252006041010 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 53 0 0
4,871,882 8,530 647,582
-
25,589 4,224,300
Halaman : 17
(019) D30100301900005 BULAN : AGUSTUS 2023

NO
SITI MAKHARROMAH, A.Md,Farm K-1 3,139,400 0 0 204,254 0 0

2 313,940 0 0 7,535 204,254 0
07-09-1986
125,576 265,000 289,680 22,604 51,063 0
18 198609072011012002 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 80 0 0
4,368,069 7,535 571,769
-
22,604 3,796,300
SUSY MULYATY K-1 3,305,700 0 0 256,326 0 0
2 330,570 0 0 7,934 256,326 0
16-01-1978
132,228 300,000 289,680 23,801 64,082 0
19 197801162007012006 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 84 0 0
4,646,323 7,934 653,623
-
Kenaikan Gaji Berkala 23,801 3,992,700
CHAIRIYYAH RAHMA SYIFA,Amd.Kep K-1 3,305,700 0 0 201,533 0 0
2 330,570 0 0 7,934 201,533 0
02-10-1981
132,228 265,000 289,680 23,801 50,383 0
20 198110022012122001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 85 0 0
4,556,531 7,934 585,131
-
23,801 3,971,400
USTI SRI NURHAYATI K-0 2,920,100 0 0 182,800 0 0
0 0 0 0 7,008 182,800 0
12-07-1989
0 265,000 72,420 21,025 45,700 0
21 198907122012122001 0 233,608 0 ..................
2,920,100 0 0
( PNS - 3A ) MKG: 8 1 88 0 0
3,468,441 7,008 490,141
-
21,025 2,978,300
HELFRIDA JELANI EDOR, A.Md.Keb K-1 2,830,900 0 0 134,224 0 0
1 283,090 185,000 0 6,794 134,224 0
08-02-1990
56,618 0 217,260 20,382 33,556 0
22 199002082017042003 0 253,649 0 ..................
3,170,608 0 0
( PNS - 3A ) MKG: 6 3 37 0 0
3,734,305 6,794 448,605
0
20,382 3,285,700
6,128,210 555,000 0 191,629 5,488,176 0
1,928,106 8,725,000 4,562,460 574,885 1,372,045 0
PEG : 21 87,901,516 0 97,793 0 7,032,122 0
IST : 16 JIWA = 63 1,191 0 0
ANK : 26 108,097,650 191,629 14,756,650
574,885 93,341,000
Halaman : 18
(019) D30100301900005 BULAN : AGUSTUS 2023

NO
REDI ACHMAD SYOFARUDIN,Amd,Kep K-1 3,171,500 0 0 216,932 0 0

1 317,150 0 0 7,612 216,932 0
14-12-1982
63,430 240,000 217,260 22,835 54,233 0
23 198212142012121002 0 284,166 0 ..................
3,552,080 0 0
( PNS - 2D ) MKG: 21 3 59 0 0
4,256,778 7,612 585,778
-
22,835 3,671,000
LENINA NURANI K-1 3,074,700 0 0 244,826 0 0
2 307,470 0 0 7,379 244,826 0
07-06-1982
122,988 240,000 289,680 22,138 61,206 0
24 198206072012122001 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 81 0 0
4,309,262 7,379 615,962
-
22,138 3,693,300
TELI ANDA VITRI YANI, A.Md.Keb K-1 2,980,800 0 0 202,958 0 0
1 298,080 0 0 7,154 202,958 0
27-06-1985
59,616 240,000 217,260 21,462 50,739 0
25 198506272017052002 0 267,080 0 ..................
3,338,496 0 0
( PNS - 2D ) MKG: 17 3 63 0 0
4,027,393 7,154 549,393
-
21,462 3,478,000
FITRI S JUNIAWATI, A.Md.Keb K-0 2,889,800 0 0 184,403 0 0
0 0 0 0 6,936 184,403 0
04-06-1987
0 240,000 72,420 20,807 46,101 0
26 198706042017052004 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 65 0 0
3,414,431 6,936 489,431
-
20,807 2,925,000
ANDRIYANI, A.Md.Keb K-1 2,801,500 0 0 197,358 0 0
2 280,150 0 0 6,724 197,358 0
15-03-1989
112,060 240,000 289,680 20,171 49,340 0
27 198903152017052003 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 47 0 0
3,947,690 6,724 529,090
-
20,171 3,418,600
DERA PRIROSA K-1 3,074,700 0 0 205,035 0 0
2 307,470 180,000 0 7,379 205,035 0
04-07-1980
122,988 0 289,680 22,138 51,259 0
28 198007042008012010 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 34 0 0
4,209,424 7,379 566,224
-
22,138 3,643,200
Halaman : 19
(019) D30100301900005 BULAN : AGUSTUS 2023

NO
ANI MULYANTI, A.Md.Kep TK - 0 2,301,800 0 0 147,300 0 0

0 0 0 0 5,524 147,300 0
17-07-1997
0 240,000 72,420 16,573 36,825 0
29 199707172020122015 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 49 0 0
2,783,666 5,524 390,366
-
16,573 2,393,300
SUB TOTAL PERGOLONGAN : II 20,294,800 0 0 1,398,812 0 0
1,510,320 180,000 0 48,708 1,398,812 0
481,082 1,440,000 1,448,400 146,124 349,703 0
PEG : 7 22,286,202 0 0 0 1,782,897 0
IST : 5 JIWA = 20 398 0 0
ANK : 8 26,948,644 48,708 3,726,244
146,124 23,222,400
TOTAL PER SATKER 104,164,400 0 0 7,246,112 122,047 0
7,638,530 735,000 0 249,996 7,246,112 0
2,489,676 11,365,000 6,155,700 749,985 1,811,529 0
PEG : 29 114,292,606 0 122,047 0 9,143,410 0
IST : 21 JIWA = 85 1,633 0 0
ANK : 35 140,918,079 249,996 19,323,079
749,985 121,595,000
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 20
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SUKASARI
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
Hj. DIDA AISAH, S.ST K-0 5,052,300 0 0 374,975 66,913 0

0 0 0 0 12,126 374,975 0
03-09-1966
0 850,000 72,420 36,377 93,744 0
1 196609031988032003 0 404,184 0 ..................
5,052,300 0 66,913
( PNS - 4B ) MKG: 30 1 8 0 0
6,465,119 12,126 988,319
36,377 5,476,800
TUTI SUPENTI, S.ST K-0 4,898,100 0 0 344,006 58,417 0
0 0 0 0 11,755 344,006 0
06-07-1970
0 850,000 72,420 35,266 86,002 0
2 197007061990032004 0 391,848 0 ..................
4,898,100 0 58,417
( PNS - 4B ) MKG: 28 1 30 0 0
6,269,994 11,755 927,294
-
35,266 5,342,700
RAHMATIAH, ST K-1 4,555,800 0 0 347,222 37,017 0
1 455,580 0 0 10,934 347,222 0
04-07-1970
91,116 850,000 217,260 32,802 86,805 0
3 197007041992032004 0 408,200 0 ..................
5,102,496 0 37,017
( PNS - 4A ) MKG: 26 3 49 0 0
6,597,780 10,934 922,980
0
32,802 5,674,800
dr.ANGGIA NURAFRILLA K-0 3,666,900 0 0 379,048 0 0
0 0 0 0 8,801 379,048 0
15-04-1984
0 750,000 72,420 26,402 94,762 0
4 198404152010012018 0 293,352 0 ..................
3,666,900 0 0
( PNS - 4A ) MKG: 12 1 94 0 0
4,903,665 8,801 802,365
-
26,402 4,101,300
455,580 0 0 43,616 1,445,251 0
91,116 3,300,000 434,520 130,847 361,313 0
PEG : 4 18,719,796 0 162,347 0 1,497,584 0
IST : 1 JIWA = 6 181 0 0
ANK : 1 24,236,558 43,616 3,640,958
130,847 20,595,600
AYI NANI HARYANI, AMd.Keb K-0 4,237,500 0 0 292,451 25,854 0
0 0 0 0 10,170 292,451 0
13-06-1973
0 850,000 72,420 30,510 73,113 0
5 197306131993012001 0 339,000 0 ..................
4,237,500 0 25,854
( PNS - 3D ) MKG: 24 1 93 0 0
5,518,998 10,170 771,098
-
30,510 4,747,900
Halaman : 21
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
SLAMET NOVERIANTO, S.Farm.Apt. K-1 3,628,900 0 0 328,739 0 0

2 362,890 0 0 8,709 328,739 0
18-11-1980
145,156 750,000 289,680 26,128 82,185 0
6 198011182009021001 0 330,956 0 ..................
4,136,946 0 0
( PNS - 3D ) MKG: 14 4 15 0 0
5,540,217 8,709 776,717
-
26,128 4,763,500
ICEU HINDAROH, AM.Keb. JD - 0 4,650,600 0 0 308,978 22,483 0
1 0 0 0 11,161 308,978 0
13-12-1966
93,012 600,000 144,840 33,484 77,245 0
7 196612131987032003 0 379,489 0 ..................
4,743,612 0 22,483
( PNS - 3D ) MKG: 30 2 82 0 0
5,864,640 11,161 832,840
33,484 5,031,800
ARIPIN K-1 4,797,000 0 0 325,310 42,633 0
0 479,700 0 0 11,513 325,310 0
30-10-1965
0 500,000 144,840 34,538 81,327 0
8 196510301986031006 0 422,136 0 ..................
5,276,700 0 42,633
( PNS - 3D ) MKG: 32 2 23 0 0
6,335,557 11,513 917,457
-
34,538 5,418,100
EDI SUMITRA,AMK K-1 4,650,600 0 0 318,868 34,992 0
0 465,060 0 0 11,161 318,868 0
12-10-1967
0 500,000 144,840 33,484 79,717 0
9 196710121988031004 0 409,253 0 ..................
5,115,660 0 34,992
( PNS - 3D ) MKG: 30 2 70 0 0
6,159,075 11,161 887,475
-
33,484 5,271,600
NUNUNG NURJANAH, AM.Keb. TK - 0 4,508,600 0 0 294,586 21,688 0
0 0 0 0 10,821 294,586 0
20-10-1968
0 500,000 72,420 32,462 73,646 0
10 196810201989012001 0 360,688 0 ..................
4,508,600 0 21,688
( PNS - 3D ) MKG: 28 1 14 0 0
5,440,591 10,821 793,891
-
32,462 4,646,700
JAYADI K-1 4,237,500 0 0 308,380 2,317 0
1 423,750 0 0 10,170 308,380 0
08-06-1970
84,750 500,000 217,260 30,510 77,095 0
11 197006081994031005 0 379,680 0 ..................
4,746,000 0 2,317
( PNS - 3D ) MKG: 24 3 15 0 0
5,814,652 10,170 808,152
-
30,510 5,006,500
Halaman : 22
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
ROSDIANI K-1 4,237,500 0 0 298,791 1,858 0

1 423,750 0 0 10,170 298,791 0
17-12-1970
84,750 500,000 217,260 30,510 74,698 0
12 197012171993022001 0 379,680 0 ..................
4,746,000 0 1,858
( PNS - 3D ) MKG: 24 3 18 0 0
5,804,607 10,170 795,707
-
30,510 5,008,900
NURHAYATI TK - 0 4,108,100 0 0 322,215 4,746 0
0 0 0 0 9,859 322,215 0
03-09-1973
0 500,000 72,420 29,578 80,554 0
13 197309031995032001 0 328,648 0 ..................
4,108,100 0 4,746
( PNS - 3D ) MKG: 22 1 82 0 0
5,047,000 9,859 775,600
-
29,578 4,271,400
dr. SUSILAWATI JD - 0 3,272,200 0 0 367,173 0 0
2 0 0 0 7,853 367,173 0
27-10-1983
130,888 750,000 217,260 23,560 91,793 0
14 198310272014122001 0 272,247 0 ..................
3,403,088 0 0
( PNS - 3C ) MKG: 10 3 92 0 0
4,769,026 7,853 762,626
-
23,560 4,006,400
drg. ANISA NURAIDA K-1 3,172,300 0 0 351,580 0 0
2 317,230 0 0 7,614 351,580 0
10-07-1989
126,892 750,000 289,680 22,841 87,895 0
15 198907102014122001 0 289,314 0 ..................
3,616,422 0 0
( PNS - 3C ) MKG: 8 4 7 0 0
5,038,144 7,614 759,244
-
22,841 4,278,900
ROKAYAH, ST K-1 3,821,000 0 0 307,360 0 0
2 382,100 0 0 9,170 307,360 0
25-09-1977
152,840 600,000 289,680 27,511 76,840 0
16 197709252007012003 0 348,475 0 ..................
4,355,940 0 0
( PNS - 3C ) MKG: 20 4 95 0 0
5,589,756 9,170 769,356
27,511 4,820,400
dr. SITI RAHMAWATI K-1 2,773,200 0 0 331,420 0 0
2 277,320 0 0 6,656 331,420 0
01-06-1988
110,928 325,000 289,680 19,967 82,855 0
17 198806012020122007 0 252,916 0 ..................
3,161,448 0 0
( PNS - 3B ) MKG: 2 4 43 0 0
4,134,214 6,656 693,814
-
19,967 3,440,400
Halaman : 23
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
dr. YACLIN NATALIA DAMAYANTI TK - 0 2,773,200 0 0 295,666 0 0

0 0 0 0 6,656 295,666 0
20-01-1991
0 325,000 72,420 19,967 73,917 0
18 199101202020122014 0 221,856 0 ..................
2,773,200 0 0
( PNS - 3B ) MKG: 2 1 53 0 0
3,492,962 6,656 618,062
-
19,967 2,874,900
SITI FARIDA K-1 3,781,400 0 0 297,445 0 0
2 378,140 0 0 9,075 297,445 0
03-08-1977
151,256 265,000 289,680 27,226 74,361 0
19 197708032006042015 0 344,864 0 ..................
4,310,796 0 0
( PNS - 3B ) MKG: 22 4 49 0 0
5,199,271 9,075 752,971
-
RUSI RUSMIATI, A.Md.Kep. K-0 3,139,400 0 0 244,742 0 0
0 0 0 0 7,535 244,742 0
15-09-1983
0 265,000 72,420 22,604 61,186 0
20 198309152010012011 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 18 0 0
3,751,719 7,535 587,219
-
22,604 3,164,500
IIS SARIPAH, Amd,Kep K-1 3,139,400 0 0 262,006 0 0
2 313,940 0 0 7,535 262,006 0
27-08-1987
125,576 265,000 289,680 22,604 65,501 0
21 198708272011012003 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 18 0 0
4,425,759 7,535 643,959
-
22,604 3,781,800
AYIK SUKARNAH, SKM DD - 0 3,781,400 0 0 302,943 0 0
0 0 0 0 9,075 302,943 0
21-06-1971
0 240,000 72,420 27,226 75,736 0
22 197106211995031003 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 28 0 0
4,433,092 9,075 717,492
0
27,226 3,715,600
NENI YUNINGSIH, AM.Kep K-1 3,554,000 0 0 260,613 0 0
2 355,400 0 0 8,530 260,613 0
01-04-1981
142,160 240,000 289,680 25,589 65,153 0
23 198104012008012007 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 38 0 0
4,876,010 8,530 684,010
-
25,589 4,192,000
Halaman : 24
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
HENDI ROHENDI K-1 4,023,300 0 0 245,423 0 0

2 402,330 185,000 0 9,656 245,423 0
17-01-1968
160,932 0 289,680 28,968 61,356 0
24 196801171991031003 0 366,925 0 ..................
4,586,562 0 0
( PNS - 3B ) MKG: 26 4 39 0 0
5,345,328 9,656 712,328
-
28,968 4,633,000
EKA SUSILAWATI K-1 3,627,900 540,000 0 358,118 0 0
2 362,790 0 0 8,707 358,118 0
28-01-1976
145,116 0 289,680 26,121 89,529 0
25 197601282006042011 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 7 0 0
5,358,439 8,707 813,339
-
26,121 4,545,100
SITI ZAENAB TK - 0 3,204,700 0 0 222,779 0 0
0 0 0 0 7,691 222,779 0
29-09-1980
0 265,000 72,420 23,074 55,695 0
26 198009292008012008 0 256,376 0 ..................
3,204,700 0 0
( PNS - 3A ) MKG: 14 1 51 0 0
3,795,715 7,691 565,615
-
23,074 3,230,100
ELIS LISMAWATI, AMd.Gz K-1 3,012,000 0 0 260,707 0 0
2 301,200 0 0 7,229 260,707 0
15-01-1981
120,480 265,000 289,680 21,686 65,177 0
27 198101152011012001 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 11 0 0
4,277,993 7,229 629,493
-
21,686 3,648,500
SUB TOTAL PERGOLONGAN : III 86,131,700 540,000 0 6,906,293 156,571 0
5,245,600 185,000 0 206,716 6,906,293 0
1,774,736 9,755,000 4,490,040 620,148 1,726,574 0
PEG : 23 93,152,036 0 156,571 0 7,452,163 0
IST : 14 JIWA = 62 961 0 0
ANK : 25 116,012,765 206,716 17,068,465
620,148 98,944,300
R.ROSE ROSIDAH JD - 0 3,171,500 0 0 222,483 0 0
2 0 0 0 7,612 222,483 0
18-02-1971
126,860 240,000 217,260 22,835 55,621 0
28 197102182007012005 0 263,869 0 ..................
3,298,360 0 0
( PNS - 2D ) MKG: 21 3 70 0 0
4,008,620 7,612 572,420
-
Halaman : 25
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
RENI ARYANI, A.Md.Kep K-1 3,171,500 0 0 246,147 0 0

2 317,150 0 0 7,612 246,147 0
09-11-1978
126,860 240,000 289,680 22,835 61,537 0
29 197811092014092001 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 88 0 0
4,421,872 7,612 627,372
-
22,835 3,794,500
RIKA NURMILA, A.Md.Keb K-0 2,889,800 0 0 211,167 0 0
0 0 0 0 6,936 211,167 0
18-04-1983
0 240,000 72,420 20,807 52,792 0
30 198304182017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 56 0 0
3,441,186 6,936 522,886
-
20,807 2,918,300
RESGIAWATI, A.Md.Keb K-1 2,889,800 0 0 252,150 0 0
2 288,980 0 0 6,936 252,150 0
08-08-1985
115,592 240,000 289,680 20,807 63,038 0
31 198508082017052004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 36 0 0
4,103,981 6,936 606,481
-
20,807 3,497,500
ANITA KAMELIA, A.Md.Keb K-1 2,889,800 0 0 252,150 0 0
2 288,980 0 0 6,936 252,150 0
02-07-1987
115,592 240,000 289,680 20,807 63,038 0
32 198707022017052004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 36 0 0
4,103,981 6,936 606,481
-
20,807 3,497,500
ERNA HELMINA, A.Md.Keb K-1 2,889,800 0 0 223,911 0 0
2 288,980 0 0 6,936 223,911 0
02-03-1989
115,592 240,000 289,680 20,807 55,978 0
33 198903022017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 76 0 0
4,075,782 6,936 571,182
-
20,807 3,504,600
HELMI NURMALA, Amd K-1 2,801,500 0 0 218,363 0 0
2 280,150 0 0 6,724 218,363 0
16-09-1989
112,060 240,000 289,680 20,171 54,591 0
34 198909162017052001 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 98 0 0
3,968,746 6,724 555,346
-
20,171 3,413,400
Halaman : 26
(019) D30100301900006 BULAN : AGUSTUS 2023

NO
1,464,240 0 0 49,692 1,626,371 0
712,556 1,680,000 1,738,080 149,069 406,595 0
PEG : 7 22,880,496 0 0 0 1,830,441 0
IST : 5 JIWA = 24 460 0 0
ANK : 12 28,124,168 49,692 4,062,168
149,069 24,062,000
TOTAL PER SATKER 125,008,500 540,000 0 9,977,915 318,918 0
7,165,420 185,000 0 300,024 9,977,915 0
2,578,408 14,735,000 6,662,640 900,064 2,494,482 0
PEG : 34 134,752,328 0 318,918 0 10,780,188 0
IST : 20 JIWA = 92 1,602 0 0
ANK : 38 168,373,491 300,024 24,771,591
900,064 143,601,900
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 27
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIBEBER
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
drg.RATNA JUARIYAH K-1 4,651,800 0 0 480,000 53,729 0

2 465,180 0 0 11,164 480,000 0
10-08-1970
186,072 1,200,000 289,680 33,493 120,000 0
1 197008102002122003 0 424,244 0 ..................
5,303,052 0 53,729
( PNS - 4C ) MKG: 22 4 12 0 0
7,371,130 11,164 1,122,630
-
33,493 6,248,500
dr.HERU BIMA SUSILA K-1 4,326,700 0 0 455,336 35,688 0
2 432,670 0 0 10,384 455,336 0
01-08-1969
173,068 1,200,000 289,680 31,152 113,834 0
2 196908012002121006 0 394,595 0 ..................
4,932,438 0 35,688
( PNS - 4B ) MKG: 20 4 11 0 0
6,954,689 10,384 1,040,989
-
31,152 5,913,700
DASEP SUMAWIHARJA,AMK K-1 4,281,800 540,000 0 381,452 0 0
2 428,180 0 0 10,276 381,452 0
29-07-1972
171,272 0 289,680 30,829 95,363 0
3 197207291995031001 0 390,500 0 ..................
4,881,252 0 0
( PNS - 4A ) MKG: 22 4 31 0 0
6,133,520 10,276 908,420
-
30,829 5,225,100
DEDAH JUNAEDAH K-0 5,000,000 0 0 396,308 65,546 0
0 0 0 0 12,000 396,308 0
09-11-1963
0 850,000 72,420 36,000 99,077 0
4 196311091984092001 0 400,000 0 ..................
5,000,000 0 65,546
( PNS - 4A ) MKG: 32 1 57 0 0
6,432,331 12,000 1,008,931
-
36,000 5,423,400
SUB TOTAL PERGOLONGAN : IV 18,260,300 540,000 0 1,713,096 154,963 0
1,326,030 0 0 43,824 1,713,096 0
530,412 3,250,000 941,460 131,474 428,274 0
PEG : 4 20,116,742 0 154,963 0 1,609,339 0
IST : 3 JIWA = 13 111 0 0
ANK : 6 26,891,670 43,824 4,080,970
131,474 22,810,700
dr.NINA WINARTI TK - 0 3,518,100 0 0 405,449 0 0
0 0 0 0 8,443 405,449 0
09-06-1980
0 750,000 72,420 25,330 101,362 0
5 198006092010012010 0 281,448 0 ..................
3,518,100 0 0
( PNS - 3D ) MKG: 12 1 90 0 0
4,779,832 8,443 822,032
-
25,330 3,957,800
Halaman : 28
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
EFFRELIYA, AM.Keb. TK - 0 4,370,900 0 0 331,389 21,908 0

0 0 0 0 10,490 331,389 0
17-08-1969
0 600,000 72,420 31,470 82,847 0
6 196908171991032010 0 349,672 0 ..................
4,370,900 0 21,908
( PNS - 3D ) MKG: 26 1 99 0 0
5,438,676 10,490 827,776
-
31,470 4,610,900
DEWI ANGGRAENI,AM.Keb K-1 4,237,500 0 0 343,004 8,708 0
1 423,750 0 0 10,170 343,004 0
22-11-1972
84,750 600,000 217,260 30,510 85,751 0
7 197211221993012001 0 379,680 0 ..................
4,746,000 0 8,708
( PNS - 3D ) MKG: 25 3 71 0 0
5,955,723 10,170 857,823
-
30,510 5,097,900
ASEP ROSIHULHAQ,AMK K-1 4,237,500 0 0 480,000 3,733 0
2 423,750 0 0 10,170 480,000 0
05-06-1973
169,500 600,000 289,680 30,510 120,000 0
8 197306051994031004 0 386,460 0 ..................
4,830,750 0 3,733
( PNS - 3D ) MKG: 24 4 30 0 0
6,244,873 10,170 1,030,873
-
30,510 5,214,000
DWI SUSANTI, SKM. K-0 3,518,100 0 0 344,092 0 0
0 0 0 0 8,443 344,092 0
16-06-1979
0 600,000 72,420 25,330 86,023 0
9 197906162010012010 0 281,448 0 ..................
3,518,100 0 0
( PNS - 3D ) MKG: 12 1 51 0 0
4,568,436 8,443 745,336
-
25,330 3,823,100
LILIS MARLINA K-1 4,508,600 0 0 327,966 17,071 0
1 450,860 0 0 10,821 327,966 0
15-09-1967
90,172 500,000 217,260 32,462 81,991 0
10 196709151989032009 0 403,971 0 ..................
5,049,632 0 17,071
( PNS - 3D ) MKG: 28 3 70 0 0
6,155,282 10,821 874,282
-
32,462 5,281,000
ELI K-1 4,370,900 0 0 345,955 10,900 0
1 437,090 0 0 10,490 345,955 0
17-07-1969
87,418 500,000 217,260 31,470 86,489 0
11 196907171991032008 0 391,633 0 ..................
4,895,408 0 10,900
( PNS - 3D ) MKG: 26 3 54 0 0
6,011,537 10,490 876,937
-
31,470 5,134,600
Halaman : 29
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
ANAH TK - 0 4,370,900 0 0 331,311 17,154 0

0 0 0 0 10,490 331,311 0
02-04-1971
0 500,000 72,420 31,470 82,828 0
12 197104021992032009 0 349,672 0 ..................
4,370,900 0 17,154
( PNS - 3D ) MKG: 26 1 80 0 0
5,333,825 10,490 822,925
-
31,470 4,510,900
APIP MUHTAROM K-1 4,237,500 0 0 343,902 0 0
2 423,750 0 0 10,170 343,902 0
14-01-1972
169,500 500,000 289,680 30,510 85,976 0
13 197201141994031004 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 6 0 0
6,005,018 10,170 857,018
-
30,510 5,148,000
EMALIA SUSILAWATI K-1 4,237,500 0 0 341,907 0 0
2 423,750 0 0 10,170 341,907 0
10-08-1972
169,500 500,000 289,680 30,510 85,477 0
14 197208101994032004 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 7 0 0
6,003,024 10,170 854,524
-
30,510 5,148,500
YETI SUMIYATI TK - 0 4,108,100 0 0 270,587 2,296 0
0 0 0 0 9,859 270,587 0
12-01-1968
0 500,000 72,420 29,578 67,647 0
15 196801121995032001 0 328,648 0 ..................
4,108,100 0 2,296
( PNS - 3D ) MKG: 22 1 75 0 0
4,992,915 9,859 708,615
-
29,578 4,284,300
LITA YULIANTI, AM.Kep TK - 0 3,481,600 0 0 369,476 0 0
0 0 0 0 8,356 369,476 0
06-07-1981
0 600,000 72,420 25,068 92,369 0
16 198107062006042027 0 278,528 0 ..................
3,481,600 0 0
( PNS - 3C ) MKG: 14 1 77 0 0
4,556,997 8,356 773,797
-
25,068 3,783,200
HETI HERAWATI, AMG K-1 4,065,500 0 0 333,576 0 0
2 406,550 0 0 9,757 333,576 0
18-02-1972
162,620 500,000 289,680 29,272 83,394 0
17 197202181994022001 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 18 0 0
5,796,973 9,757 826,773
-
29,272 4,970,200
Halaman : 30
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
SRI HARTATI NURLAELA, AM.Kep K-1 3,591,200 0 0 315,360 0 0

2 359,120 0 0 8,619 315,360 0
29-12-1981
143,648 500,000 289,680 25,857 78,840 0
18 198112292008012003 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 9 0 0
5,233,493 8,619 756,193
-
25,857 4,477,300
RINA HERLIANY, AM.Kep. K-1 3,375,300 0 0 376,850 0 0
2 337,530 0 0 8,101 376,850 0
27-02-1981
135,012 500,000 289,680 24,302 94,213 0
19 198102272005011006 0 307,827 0 ..................
3,847,842 0 0
( PNS - 3C ) MKG: 12 4 18 0 0
5,046,793 8,101 811,293
-
24,302 4,235,500
FENTI KUSMAWATI HADI, A.Md.Kep K-1 3,139,400 0 0 283,346 0 0
2 313,940 0 0 7,535 283,346 0
21-02-1985
125,576 300,000 289,680 22,604 70,836 0
20 198502212010012007 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 53 0 0
4,482,134 7,535 670,634
-
22,604 3,811,500
SITI AISAH K-0 3,781,400 0 0 290,045 0 0
0 0 0 0 9,075 290,045 0
05-05-1971
0 265,000 72,420 27,226 72,511 0
21 197105052006042025 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 23 1 3 0 0
4,445,169 9,075 701,369
-
27,226 3,743,800
UDIN WAHYUDIN K-1 3,665,900 0 0 302,055 0 0
2 366,590 0 0 8,798 302,055 0
05-05-1978
146,636 265,000 289,680 26,394 75,514 0
22 197805052006041016 0 334,330 0 ..................
4,179,126 0 0
( PNS - 3B ) MKG: 20 4 38 0 0
5,071,091 8,798 747,091
-
26,394 4,324,000
DADAN TATING SAMSUAR, A.Md.Kep K-1 3,554,000 0 0 323,354 0 0
1 355,400 0 0 8,530 323,354 0
14-07-1976
71,080 265,000 217,260 25,589 80,838 0
23 197607142000031001 0 318,438 0 ..................
3,980,480 0 0
( PNS - 3B ) MKG: 18 3 36 0 0
4,820,249 8,530 756,749
25,589 4,063,500
Halaman : 31
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
CECEP HENDRA YUAN P, AM.Kep TK - 0 3,554,000 0 0 304,893 0 0

0 0 0 0 8,530 304,893 0
09-09-1977
0 265,000 72,420 25,589 76,223 0
24 197709092008011002 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 23 0 0
4,230,455 8,530 699,555
25,589 3,530,900
LUSI GINANJAR RAHAYU, A.Md.Keb K-1 3,340,300 0 0 329,494 0 0
2 334,030 0 0 8,017 329,494 0
03-01-1978
133,612 265,000 289,680 24,050 82,373 0
25 197801032002122002 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 14 4 86 0 0
4,724,269 8,017 748,569
24,050 3,975,700
IDA ADAWIAH, A.Md.Keb. K-1 3,627,900 0 0 310,308 0 0
2 362,790 0 0 8,707 310,308 0
09-10-1976
145,116 300,000 289,680 26,121 77,577 0
26 197610092006042017 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 55 0 0
5,070,677 8,707 753,577
-
26,121 4,317,100
IMAS SULASTRI K-0 3,627,900 0 0 279,658 0 0
0 0 0 0 8,707 279,658 0
14-11-1968
0 265,000 72,420 26,121 69,914 0
27 196811142006042002 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 26 0 0
4,279,832 8,707 674,632
-
26,121 3,605,200
ANE LISDAYANI K-0 3,627,900 0 0 327,772 0 0
0 0 0 0 8,707 327,772 0
15-06-1976
0 265,000 72,420 26,121 81,943 0
28 197606152006042033 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 55 0 0
4,327,975 8,707 734,775
-
26,121 3,593,200
ANI MASLIAH K-1 3,517,200 0 0 271,832 0 0
2 351,720 0 0 8,441 271,832 0
02-06-1975
140,688 265,000 289,680 25,324 67,958 0
29 197506022006042015 0 320,769 0 ..................
4,009,608 0 0
( PNS - 3A ) MKG: 20 4 39 0 0
4,869,924 8,441 694,324
-
25,324 4,175,600
Halaman : 32
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
5,770,620 0 0 229,596 8,283,581 0
1,974,828 10,970,000 4,779,720 688,788 2,070,894 0
PEG : 25 103,410,548 0 81,770 0 8,272,843 0
IST : 15 JIWA = 66 1,169 0 0
ANK : 26 128,445,172 229,596 19,627,472
688,788 108,817,700
IYAH SULASIYAH K-1 3,171,500 0 0 272,036 0 0
2 317,150 0 0 7,612 272,036 0
01-10-1976
126,860 240,000 289,680 22,835 68,009 0
30 197610012012122002 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 22 4 60 0 0
4,447,733 7,612 659,733
-
22,835 3,788,000
RIAH RODIAH, A.Md.Kep TK - 0 3,171,500 0 0 288,669 0 0
0 0 0 0 7,612 288,669 0
08-04-1980
0 240,000 72,420 22,835 72,167 0
31 198004082014092001 0 253,720 0 ..................
3,171,500 0 0
( PNS - 2D ) MKG: 21 1 67 0 0
3,803,103 7,612 645,003
-
22,835 3,158,100
BETI BADRIAH. A.Md.Keb K-1 3,074,700 0 0 279,945 0 0
2 307,470 0 0 7,379 279,945 0
20-06-1980
122,988 240,000 289,680 22,138 69,986 0
32 198006202019052001 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 61 0 0
4,344,361 7,379 659,861
0
22,138 3,684,500
RINRIN MULYAWATI, A.Md.Keb K-1 2,889,800 0 0 265,499 0 0
2 288,980 0 0 6,936 265,499 0
30-06-1988
115,592 240,000 289,680 20,807 66,375 0
33 198806302017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 73 0 0
4,117,367 6,936 623,167
-
20,807 3,494,200
MIA MASITOH, A.Md.Keb JD - 0 2,889,800 0 0 245,812 0 0
1 0 0 0 6,936 245,812 0
15-05-1989
57,796 240,000 144,840 20,807 61,453 0
34 198905152017042011 0 235,808 0 ..................
2,947,596 0 0
( PNS - 2D ) MKG: 15 2 25 0 0
3,606,016 6,936 570,816
0
20,807 3,035,200
Halaman : 33
(019) D30100301900007 BULAN : AGUSTUS 2023

NO
913,600 0 0 36,475 1,351,961 0
423,236 1,200,000 1,086,300 109,422 337,990 0
PEG : 5 16,534,136 0 0 0 1,322,732 0
IST : 3 JIWA = 15 286 0 0
ANK : 7 20,318,580 36,475 3,158,580
109,422 17,160,000
TOTAL PER SATKER 129,122,700 540,000 0 11,348,638 236,733 0
8,010,250 0 0 309,895 11,348,638 0
2,928,476 15,420,000 6,807,480 929,684 2,837,158 0
PEG : 34 140,061,426 0 236,733 0 11,204,914 0
IST : 21 JIWA = 94 1,566 0 0
ANK : 39 175,655,422 309,895 26,867,022
929,684 148,788,400
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 34
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIBAREGBEG
(019) D30100301900008 BULAN : AGUSTUS 2023

NO
AGUS KUSWARA SURYADI,SKM,M.Kes K-1 4,847,300 0 0 480,000 30,629 0

2 484,730 0 0 11,634 480,000 0
08-11-1966
193,892 500,000 289,680 34,901 120,000 0
1 196611081988031001 0 442,074 0 ..................
5,525,922 0 30,629
( PNS - 4A ) MKG: 30 4 72 0 0
6,872,838 11,634 1,119,238
-
34,901 5,753,600
484,730 0 0 11,634 480,000 0
193,892 500,000 289,680 34,901 120,000 0
PEG : 1 5,525,922 0 30,629 0 442,074 0
IST : 1 JIWA = 4 72 0 0
ANK : 2 6,872,838 11,634 1,119,238
34,901 5,753,600
dr. SRI DANIASARI K-0 3,306,500 0 0 407,527 0 0
0 0 0 0 7,936 407,527 0
24-02-1984
0 750,000 72,420 23,807 101,882 0
2 198402242014122001 0 264,520 0 ..................
3,306,500 0 0
( PNS - 3D ) MKG: 8 1 82 0 0
4,568,272 7,936 805,672
-
23,807 3,762,600
NONENG,AMK TK - 0 4,508,600 0 0 280,870 25,788 0
0 0 0 0 10,821 280,870 0
19-03-1968
0 600,000 72,420 32,462 70,217 0
3 196803191990032005 0 360,688 0 ..................
4,508,600 0 25,788
( PNS - 3D ) MKG: 28 1 85 0 0
5,531,046 10,821 780,846
-
32,462 4,750,200
RAHMATIYAH MULYANI, SKM K-1 4,650,600 0 0 339,872 24,875 0
1 465,060 0 0 11,161 339,872 0
15-04-1966
93,012 500,000 217,260 33,484 84,968 0
4 196604151988032008 0 416,694 0 ..................
5,208,672 0 24,875
( PNS - 3D ) MKG: 30 3 30 0 0
6,335,354 11,161 911,054
-
33,484 5,424,300
ENGKOS SUDRAJAT K-1 3,481,600 0 0 366,280 0 0
1 348,160 0 0 8,356 366,280 0
20-11-1973
69,632 600,000 217,260 25,068 91,570 0
5 197311202006041007 0 311,951 0 ..................
3,899,392 0 0
( PNS - 3C ) MKG: 14 3 69 0 0
5,116,425 8,356 803,225
-
25,068 4,313,200
Halaman : 35
(019) D30100301900008 BULAN : AGUSTUS 2023

NO
SRI MULYANI FEBDIARI W. K-1 3,591,200 0 0 337,800 0 0

2 359,120 0 0 8,619 337,800 0
13-02-1982
143,648 500,000 289,680 25,857 84,450 0
6 198202132008012007 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 19 0 0
5,255,943 8,619 784,243
25,857 4,471,700
RISKI ZAKIAH HAETAMI K-1 3,781,400 0 0 279,646 0 0
2 378,140 0 0 9,075 279,646 0
19-09-1975
151,256 265,000 289,680 27,226 69,911 0
7 197509192006042015 0 344,864 0 ..................
4,310,796 0 0
( PNS - 3B ) MKG: 22 4 99 0 0
5,181,522 9,075 730,722
-
27,226 4,450,800
FAUZI MUHAMAD HAMDAN, AM.Kep K-1 3,204,700 0 0 156,734 0 0
2 320,470 0 0 7,691 156,734 0
02-05-1979
128,188 265,000 289,680 23,074 39,184 0
8 197905022007011003 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 15 0 0
4,395,552 7,691 518,952
-
23,074 3,876,600
1,870,950 0 0 63,659 2,168,729 0
585,736 3,480,000 1,448,400 190,978 542,182 0
PEG : 7 28,981,286 0 50,663 0 2,318,503 0
IST : 5 JIWA = 20 399 0 0
ANK : 8 36,384,114 63,659 5,334,714
190,978 31,049,400
KRISNI WIDANINGSIH, A.Md.Keb K-1 2,980,800 0 0 267,347 0 0
2 298,080 0 0 7,154 267,347 0
08-03-1986
119,232 240,000 289,680 21,462 66,837 0
9 198603082017052003 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 94 0 0
4,223,849 7,154 634,649
-
21,462 3,589,200
ELI NURHAYATI, A.Md.Keb K-1 2,889,800 0 0 141,375 0 0
2 288,980 0 0 6,936 141,375 0
03-02-1985
115,592 240,000 289,680 20,807 35,344 0
10 198502032017042004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 42 0 0
3,993,212 6,936 468,012
0
20,807 3,525,200
Halaman : 36
(019) D30100301900008 BULAN : AGUSTUS 2023

NO
AYI RAHMAT K-1 3,304,800 0 0 246,890 0 0

2 330,480 180,000 0 7,932 246,890 0
30-07-1972
132,192 0 289,680 23,795 61,722 0
11 197207302014091001 0 301,398 0 ..................
3,767,472 0 0
( PNS - 2B ) MKG: 29 4 68 0 0
4,515,837 7,932 641,737
-
23,795 3,874,100
917,540 180,000 0 22,022 655,612 0
367,016 480,000 869,040 66,064 163,903 0
PEG : 3 10,459,956 0 0 0 836,797 0
IST : 3 JIWA = 12 204 0 0
ANK : 6 12,732,898 22,022 1,744,398
66,064 10,988,500
TOTAL PER SATKER 40,547,300 0 0 3,304,341 81,292 0
3,273,220 180,000 0 97,315 3,304,341 0
1,146,644 4,460,000 2,607,120 291,943 826,085 0
PEG : 11 44,967,164 0 81,292 0 3,597,374 0
IST : 9 JIWA = 36 675 0 0
ANK : 16 55,989,850 97,315 8,198,350
291,943 47,791,500
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 37
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS WARUNGKONDANG
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
TINTIN KURAESIN, AM.Keb TK - 0 4,555,800 0 0 340,978 42,671 0

0 0 0 0 10,934 340,978 0
16-07-1970
0 850,000 72,420 32,802 85,245 0
1 197007161991012002 0 364,464 0 ..................
4,555,800 0 42,671
( PNS - 4A ) MKG: 26 1 89 0 0
5,905,694 10,934 877,094
-
32,802 5,028,600
0 0 0 10,934 340,978 0
0 850,000 72,420 32,802 85,245 0
PEG : 1 4,555,800 0 42,671 0 364,464 0
IST : 0 JIWA = 1 89 0 0
ANK : 0 5,905,694 10,934 877,094
32,802 5,028,600
TETI NURHAYATI, S.Kep.Ners. JD - 0 4,237,500 0 0 278,829 13,333 0
0 0 0 0 10,170 278,829 0
09-09-1971
0 600,000 72,420 30,510 69,707 0
2 197109091994032002 0 339,000 0 ..................
4,237,500 0 13,333
( PNS - 3D ) MKG: 24 1 87 0 0
5,242,849 10,170 741,549
12345
30,510 4,501,300
CUCU SRI LESTARI JD - 0 4,508,600 0 0 274,283 0 0
2 0 0 0 10,821 274,283 0
17-03-1968
180,344 500,000 217,260 32,462 68,571 0
3 196803171989112001 0 375,116 0 ..................
4,688,944 0 0
( PNS - 3D ) MKG: 28 3 83 0 0
5,723,853 10,821 761,253
-
32,462 4,962,600
AI ROCHAYATI K-0 4,370,900 0 0 297,893 15,571 0
0 0 0 0 10,490 297,893 0
16-11-1966
0 500,000 72,420 31,470 74,473 0
4 196611161991032007 0 349,672 0 ..................
4,370,900 0 15,571
( PNS - 3D ) MKG: 26 1 25 0 0
5,298,769 10,490 779,569
-
31,470 4,519,200
IKE HAYATI K-1 4,237,500 0 0 300,859 1,954 0
1 423,750 0 0 10,170 300,859 0
12-06-1970
84,750 500,000 217,260 30,510 75,215 0
5 197006121994032005 0 379,680 0 ..................
4,746,000 0 1,954
( PNS - 3D ) MKG: 24 3 35 0 0
5,806,788 10,170 798,388
-
30,510 5,008,400
Halaman : 38
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
NANANG SURYANA, SKM. K-1 4,237,500 0 0 323,684 0 0

2 423,750 0 0 10,170 323,684 0
11-11-1971
169,500 500,000 289,680 30,510 80,921 0
6 197111111994031004 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 51 0 0
5,984,845 10,170 831,745
30,510 5,153,100
TATI NURHAYATI JD - 0 4,237,500 0 0 268,309 0 0
2 0 0 0 10,170 268,309 0
02-12-1972
169,500 500,000 217,260 30,510 67,077 0
7 197212021992032003 0 352,560 0 ..................
4,407,000 0 0
( PNS - 3D ) MKG: 24 3 77 0 0
5,433,326 10,170 728,626
-
30,510 4,704,700
EKA KUSMANA K-1 4,237,500 0 0 323,684 0 0
2 423,750 0 0 10,170 323,684 0
21-12-1972
169,500 500,000 289,680 30,510 80,921 0
8 197212211994031003 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 51 0 0
5,984,845 10,170 831,745
-
30,510 5,153,100
NENENG SUPARTINI K-1 4,650,600 0 0 377,263 4,375 0
2 465,060 0 0 11,161 377,263 0
17-08-1967
186,024 265,000 289,680 33,484 94,316 0
9 196708171987032002 0 424,135 0 ..................
5,301,684 0 4,375
( PNS - 3D ) MKG: 30 4 87 0 0
6,282,734 11,161 944,734
33,484 5,338,000
YUDIANSYAH SUTAWIJAYA, SKM K-1 3,821,000 540,000 0 421,356 0 0
2 382,100 0 0 9,170 421,356 0
16-02-1971
152,840 0 289,680 27,511 105,339 0
10 197102162000031004 0 348,475 0 ..................
4,355,940 0 0
( PNS - 3C ) MKG: 20 4 94 0 0
5,643,751 9,170 911,851
-
27,511 4,731,900
EUIS MASNONEH K-0 3,591,200 0 0 247,253 0 0
0 0 0 0 8,619 247,253 0
11-03-1981
0 600,000 72,420 25,857 61,813 0
11 198103112008012006 0 287,296 0 ..................
3,591,200 0 0
( PNS - 3C ) MKG: 16 1 89 0 0
4,545,438 8,619 630,838
-
25,857 3,914,600
Halaman : 39
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
DEWI ROSTIKA K-1 4,065,500 0 0 274,043 0 0

1 406,550 0 0 9,757 274,043 0
28-08-1973
81,310 500,000 217,260 29,272 68,511 0
12 197308281993012003 0 364,269 0 ..................
4,553,360 0 0
( PNS - 3C ) MKG: 24 3 60 0 0
5,583,752 9,757 745,852
-
29,272 4,837,900
DIAN DAMAYANTI, Am.KG K-1 3,481,600 0 0 237,191 0 0
2 348,160 0 0 8,356 237,191 0
15-06-1981
139,264 500,000 289,680 25,068 59,298 0
13 198106152006042028 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 16 0 0
5,029,335 8,356 647,435
-
25,068 4,381,900
dr. SETYA ROFIQ K-1 2,773,200 0 0 308,410 0 0
0 277,320 0 0 6,656 308,410 0
07-04-1992
0 325,000 144,840 19,967 77,103 0
14 199204072020121003 0 244,042 0 ..................
3,050,520 0 0
( PNS - 3B ) MKG: 2 2 85 0 0
3,855,478 6,656 656,178
-
19,967 3,199,300
ANI LINDAYANI K-1 3,445,500 0 0 296,736 0 0
2 344,550 0 0 8,269 296,736 0
20-05-1981
137,820 300,000 289,680 24,808 74,184 0
15 198105202007012007 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 64 0 0
4,847,427 8,269 718,227
-
24,808 4,129,200
WANDI SUNARYA DD - 0 3,900,500 0 0 220,284 0 0
2 0 0 0 9,361 220,284 0
13-06-1972
156,020 265,000 217,260 28,084 55,071 0
16 197206131994031002 0 324,522 0 ..................
4,056,520 0 0
( PNS - 3B ) MKG: 24 3 13 0 0
4,796,522 9,361 637,322
-
28,084 4,159,200
IIS LISNAWATI K-0 3,781,400 0 0 266,044 0 0
0 0 0 0 9,075 266,044 0
02-02-1974
0 265,000 72,420 27,226 66,511 0
17 197402022006042022 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 3 0 0
4,421,168 9,075 671,368
-
27,226 3,749,800
Halaman : 40
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
YANI PARMAN K-1 4,280,800 0 0 251,920 0 0

2 428,080 185,000 0 10,274 251,920 0
10-10-1966
171,232 0 289,680 30,822 62,980 0
18 196610101987031007 0 390,409 0 ..................
4,880,112 0 0
( PNS - 3B ) MKG: 30 4 97 0 0
5,647,905 10,274 746,405
30,822 4,901,500
YEYET HERYATI, A.Md.Kep K-1 4,023,300 0 0 237,871 0 0
0 402,330 185,000 0 9,656 237,871 0
03-11-1965
0 0 144,840 28,968 59,468 0
19 196511031991082001 0 354,050 0 ..................
4,425,630 0 0
( PNS - 3B ) MKG: 26 2 48 0 0
5,032,013 9,656 690,013
28,968 4,342,000
YANTI KHAERAYANTI ASMARA K-0 3,627,900 0 0 243,175 0 0
0 0 0 0 8,707 243,175 0
30-03-1975
0 300,000 72,420 26,121 60,794 0
20 197503302006042014 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 6 0 0
4,278,329 8,707 629,029
-
26,121 3,649,300
AHMAD BUHORI K-1 3,742,200 0 0 310,265 0 0
1 374,220 0 0 8,981 310,265 0
14-08-1975
74,844 265,000 217,260 26,944 77,566 0
21 197508142006041014 0 335,301 0 ..................
4,191,264 0 0
( PNS - 3A ) MKG: 24 3 43 0 0
5,019,757 8,981 759,057
-
26,944 4,260,700
DADANG ZAENAL ABIDIN K-1 3,627,900 0 0 215,690 0 0
2 362,790 0 0 8,707 215,690 0
19-10-1970
145,116 265,000 289,680 26,121 53,923 0
22 197010191995031001 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 1 0 0
4,941,005 8,707 635,305
-
26,121 4,305,700
EEN NURAENI K-0 3,517,200 0 0 235,415 0 0
0 0 0 0 8,441 235,415 0
16-04-1977
0 265,000 72,420 25,324 58,854 0
23 197704162007012006 0 281,376 0 ..................
3,517,200 0 0
( PNS - 3A ) MKG: 20 1 10 0 0
4,123,810 8,441 609,410
-
25,324 3,514,400
Halaman : 41
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
JEJEN ZAENAL ARIPIN, Amd.Kep K-1 3,305,700 0 0 232,682 0 0

2 330,570 0 0 7,934 232,682 0
07-01-1978
132,228 265,000 289,680 23,801 58,170 0
24 197801072012121001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 72 0 0
4,587,667 7,934 624,067
-
23,801 3,963,600
LUKMANUL HAKIM, Amd.Kep K-1 3,305,700 0 0 243,070 0 0
2 330,570 0 0 7,934 243,070 0
21-07-1981
132,228 265,000 289,680 23,801 60,767 0
25 198107212012121001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 69 0 0
4,598,052 7,934 637,052
-
23,801 3,961,000
YANE INDRIANI IRAWAN K-1 3,106,900 0 0 259,701 0 0
0 310,690 0 0 7,457 259,701 0
05-01-1975
0 265,000 144,840 22,370 64,925 0
26 197501052008012002 0 273,407 0 ..................
3,417,590 0 0
( PNS - 3A ) MKG: 12 2 2 0 0
4,116,960 7,457 627,860
22,370 3,489,100
YANTI KUSNIANTI, A.Md. K-1 3,012,000 0 0 210,726 0 0
2 301,200 0 0 7,229 210,726 0
09-06-1988
120,480 265,000 289,680 21,686 52,681 0
27 198806092010012007 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 15 0 0
4,228,016 7,229 567,016
-
21,686 3,661,000
ELA NURLAELA K-1 3,742,200 0 0 235,524 0 0
2 374,220 185,000 0 8,981 235,524 0
05-06-1973
149,688 0 289,680 26,944 58,881 0
28 197306051993012002 0 341,289 0 ..................
4,266,108 0 0
( PNS - 3A ) MKG: 24 4 82 0 0
5,012,319 8,981 671,619
-
26,944 4,340,700
6,709,660 555,000 0 246,886 7,392,160 0
2,552,688 8,775,000 5,648,760 740,661 1,848,040 0
PEG : 27 112,131,648 0 35,233 0 8,970,533 0
IST : 18 JIWA = 78 1,365 0 0
ANK : 33 136,066,713 246,886 19,233,513
740,661 116,833,200
Halaman : 42
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
TUTI WIDIYANINGSIH JD - 0 3,171,500 0 0 218,621 0 0

1 0 0 0 7,612 218,621 0
09-06-1978
63,430 240,000 144,840 22,835 54,655 0
29 197806092008012004 0 258,794 0 ..................
3,234,930 0 0
( PNS - 2D ) MKG: 21 2 79 0 0
3,868,917 7,612 562,517
-
MAS SUTIARA APRILIANI, A.Md.Keb K-1 2,889,800 0 0 252,801 0 0
2 288,980 0 0 6,936 252,801 0
15-04-1982
115,592 240,000 289,680 20,807 63,200 0
30 198204152017052004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 98 0 0
4,104,694 6,936 607,294
-
20,807 3,497,400
YULI RUSLIANI, A.Md.Keb K-0 2,889,800 0 0 206,818 0 0
0 0 0 0 6,936 206,818 0
22-07-1989
0 240,000 72,420 20,807 51,704 0
31 198907222017052004 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 68 0 0
3,436,849 6,936 517,449
-
20,807 2,919,400
TENTI SUPRIYANTI, A.Md.Keb K-1 2,801,500 0 0 219,298 0 0
2 280,150 0 0 6,724 219,298 0
25-10-1989
112,060 240,000 289,680 20,171 54,825 0
32 198910252017052002 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 32 0 0
3,969,615 6,724 556,515
-
20,171 3,413,100
569,130 0 0 28,208 897,538 0
291,082 960,000 796,620 84,620 224,384 0
PEG : 4 12,612,812 0 0 0 1,009,025 0
IST : 2 JIWA = 11 277 0 0
ANK : 5 15,380,075 28,208 2,243,775
84,620 13,136,300
TOTAL PER SATKER 119,177,700 540,000 0 8,630,676 77,904 0
7,278,790 555,000 0 286,028 8,630,676 0
2,843,770 10,585,000 6,517,800 858,083 2,157,669 0
PEG : 32 129,300,260 0 77,904 0 10,344,022 0
IST : 20 JIWA = 90 1,731 0 0
ANK : 38 157,352,482 286,028 22,354,382
858,083 134,998,100
Halaman : 43
(019) D30100301900009 BULAN : AGUSTUS 2023

NO
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 44
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS GEKBRONG
(019) D30100301900010 BULAN : AGUSTUS 2023

NO
dr.DIANA FITRIA JUANDA K-1 3,782,400 0 0 361,589 2,988 0

2 378,240 0 0 9,078 361,589 0
15-11-1980
151,296 1,200,000 289,680 27,233 90,397 0
1 198011152009012004 0 344,955 0 ..................
4,311,936 0 2,988
( PNS - 4A ) MKG: 14 4 36 0 0
6,202,540 9,078 836,240
-
27,233 5,366,300
IDEN SOLEHUDIN, AM.Kep K-1 4,555,800 0 0 358,237 26,342 0
2 455,580 0 0 10,934 358,237 0
28-08-1970
182,232 850,000 289,680 32,802 89,559 0
2 197008281991031006 0 415,489 0 ..................
5,193,612 0 26,342
( PNS - 4A ) MKG: 26 4 56 0 0
6,761,663 10,934 933,363
-
32,802 5,828,300
RATNA WINARSIH, SKM, M.Kes K-0 4,699,300 0 0 362,139 38,338 0
0 0 0 0 11,278 362,139 0
20-03-1969
0 600,000 72,420 33,835 90,535 0
3 196903201989012001 0 375,944 0 ..................
4,699,300 0 38,338
( PNS - 4A ) MKG: 28 1 59 0 0
5,817,369 11,278 912,069
-
33,835 4,905,300
833,820 0 0 31,290 1,081,965 0
333,528 2,650,000 651,780 93,870 270,491 0
PEG : 3 14,204,848 0 67,668 0 1,136,388 0
IST : 2 JIWA = 9 151 0 0
ANK : 4 18,781,572 31,290 2,681,672
93,870 16,099,900
NENENG HERMAYATI, Am.Keb TK - 0 4,370,900 0 0 303,978 20,608 0
0 0 0 0 10,490 303,978 0
12-10-1970
0 600,000 72,420 31,470 75,995 0
4 197010121991032006 0 349,672 0 ..................
4,370,900 0 20,608
( PNS - 3D ) MKG: 26 1 47 0 0
5,409,913 10,490 792,213
-
31,470 4,617,700
SITI MARDIAH K-1 4,508,600 0 0 314,608 5,192 0
2 450,860 0 0 10,821 314,608 0
06-08-1967
180,344 500,000 289,680 32,462 78,652 0
5 196708061989032008 0 411,184 0 ..................
5,139,804 0 5,192
( PNS - 3D ) MKG: 28 4 52 0 0
6,292,619 10,821 852,919
-
32,462 5,439,700
Halaman : 45
(019) D30100301900010 BULAN : AGUSTUS 2023

NO
UCI SANUSI K-1 4,237,500 0 0 292,663 0 0

2 423,750 0 0 10,170 292,663 0
30-12-1971
169,500 500,000 289,680 30,510 73,166 0
6 197112301994031007 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 96 0 0
5,953,869 10,170 792,969
-
30,510 5,160,900
CINCIN NURYANTI K-1 4,237,500 0 0 294,494 13,138 0
0 423,750 0 0 10,170 294,494 0
24-01-1973
0 500,000 144,840 30,510 73,624 0
7 197301241993022002 0 372,900 0 ..................
4,661,250 0 13,138
( PNS - 3D ) MKG: 24 2 34 0 0
5,654,436 10,170 794,836
-
30,510 4,859,600
RAHMAT SUTARDI K-1 4,237,500 0 0 321,618 0 0
2 423,750 0 0 10,170 321,618 0
09-03-1973
169,500 500,000 289,680 30,510 80,405 0
8 197303091994031006 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 35 0 0
5,982,763 10,170 829,163
-
30,510 5,153,600
ANI RAHMIATI K-1 4,237,500 0 0 300,187 0 0
2 423,750 0 0 10,170 300,187 0
22-08-1974
169,500 500,000 289,680 30,510 75,047 0
9 197408221993022005 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 77 0 0
5,961,374 10,170 802,374
-
30,510 5,159,000
IYUS YUSUF TK - 0 4,108,100 0 0 272,526 2,383 0
0 0 0 0 9,859 272,526 0
29-01-1972
0 500,000 72,420 29,578 68,132 0
10 197201291995031002 0 328,648 0 ..................
4,108,100 0 2,383
( PNS - 3D ) MKG: 22 1 60 0 0
4,994,926 9,859 711,126
-
29,578 4,283,800
SISWANTO K-1 4,370,900 0 0 331,948 0 0
2 437,090 185,000 0 10,490 331,948 0
10-04-1968
174,836 0 289,680 31,470 82,987 0
11 196804101992031008 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 7 0 0
5,831,421 10,490 855,521
-
31,470 4,975,900
Halaman : 46
(019) D30100301900010 BULAN : AGUSTUS 2023

NO
PURWANTO SELAMET, AM.Kep K-1 3,704,300 0 0 273,158 0 0

2 370,430 0 0 8,890 273,158 0
06-10-1979
148,172 500,000 289,680 26,671 68,289 0
12 197910062008011006 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 39 0 0
5,321,340 8,890 714,840
-
26,671 4,606,500
LIA RUSLIANA, SKM TK - 0 3,375,300 0 0 269,061 0 0
0 0 0 0 8,101 269,061 0
04-08-1983
0 500,000 72,420 24,302 67,265 0
13 198308042009022004 0 270,024 0 ..................
3,375,300 0 0
( PNS - 3C ) MKG: 12 1 69 0 0
4,249,253 8,101 638,753
0
24,302 3,610,500
dr. ARDI NUGRAHA PRANASETIA TK - 0 2,773,200 0 0 283,746 0 0
0 0 0 0 6,656 283,746 0
24-04-1986
0 325,000 72,420 19,967 70,936 0
14 198604242020121005 0 221,856 0 ..................
2,773,200 0 0
( PNS - 3B ) MKG: 2 1 72 0 0
3,481,061 6,656 603,161
-
19,967 2,877,900
TATI MULYATI, S.T. K-0 3,554,000 0 0 250,500 0 0
0 0 0 0 8,530 250,500 0
12-02-1976
0 300,000 72,420 25,589 62,625 0
15 197602122007012007 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 25 0 0
4,211,064 8,530 631,564
0
25,589 3,579,500
ARTI YULISTIANI K-0 3,781,400 0 0 243,816 0 0
0 0 0 0 9,075 243,816 0
19-02-1976
0 265,000 72,420 27,226 60,954 0
16 197602192006042012 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 46 0 0
4,398,983 9,075 643,583
-
27,226 3,755,400
SUSILAWATI MUFLIHAT K-0 3,665,900 0 0 228,340 0 0
0 0 0 0 8,798 228,340 0
20-01-1976
0 265,000 72,420 26,394 57,085 0
17 197601202006042014 0 293,272 0 ..................
3,665,900 0 0
( PNS - 3B ) MKG: 21 1 37 0 0
4,266,889 8,798 613,889
-
26,394 3,653,000
Halaman : 47
(019) D30100301900010 BULAN : AGUSTUS 2023

NO
ASTI SULISTIAWATI TK - 0 3,340,300 0 0 247,921 0 0

0 0 0 0 8,017 247,921 0
04-02-1983
0 265,000 72,420 24,050 61,980 0
18 198302042006042013 0 267,224 0 ..................
3,340,300 0 0
( PNS - 3B ) MKG: 15 1 84 0 0
3,957,792 8,017 609,192
-
24,050 3,348,600
PENTI SUVENTINA ROSIDAH K-1 3,238,300 0 0 241,673 0 0
2 323,830 0 0 7,772 241,673 0
25-04-1978
129,532 265,000 289,680 23,316 60,418 0
19 197804252006042022 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 9 0 0
4,519,112 7,772 628,512
-
23,316 3,890,600
YANI HERAYANI K-1 3,409,800 0 0 249,378 0 0
2 340,980 0 0 8,184 249,378 0
10-03-1979
136,392 265,000 289,680 24,551 62,344 0
20 197903102007012010 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 66 0 0
4,724,031 8,184 655,431
-
24,551 4,068,600
NANI NURHAYATI JD - 0 3,204,700 0 0 236,248 0 0
2 0 0 0 7,691 236,248 0
25-03-1973
128,188 265,000 217,260 23,074 59,062 0
21 197303252007012007 0 266,631 0 ..................
3,332,888 0 0
( PNS - 3A ) MKG: 14 3 45 0 0
4,082,206 7,691 592,706
-
23,074 3,489,500
WIDA WIDIYANINGSIH, A.Md.Keb. K-0 3,012,000 0 0 221,466 0 0
0 0 0 0 7,229 221,466 0
10-10-1986
0 265,000 72,420 21,686 55,367 0
22 198610102010012018 0 240,960 0 ..................
3,012,000 0 0
( PNS - 3A ) MKG: 10 1 7 0 0
3,599,808 7,229 546,708
-
21,686 3,053,100
3,618,190 185,000 0 171,283 5,177,329 0
1,405,964 7,080,000 3,331,320 513,846 1,294,333 0
PEG : 19 76,391,854 0 41,321 0 6,111,348 0
IST : 9 JIWA = 46 907 0 0
ANK : 18 92,892,860 171,283 13,309,460
513,846 79,583,400
Halaman : 48
(019) D30100301900010 BULAN : AGUSTUS 2023

NO
HERI DJATNIKA K-1 3,171,500 0 0 279,507 0 0

1 317,150 0 0 7,612 279,507 0
30-05-1980
63,430 240,000 217,260 22,835 69,877 0
23 198005302008011010 0 284,166 0 ..................
3,552,080 0 0
( PNS - 2D ) MKG: 21 3 3 0 0
4,319,297 7,612 663,997
-
22,835 3,655,300
IRMA YULIYANTI HIDAYAT, A.Md.Keb K-0 3,074,700 0 0 215,025 0 0
0 0 0 0 7,379 215,025 0
09-05-1984
0 240,000 72,420 22,138 53,756 0
24 198405092017052003 0 245,976 0 ..................
3,074,700 0 0
( PNS - 2D ) MKG: 19 1 12 0 0
3,631,674 7,379 544,274
-
22,138 3,087,400
LENI FATMAWATI, A.Md.Keb K-1 2,980,800 0 0 145,524 0 0
2 298,080 0 0 7,154 145,524 0
04-02-1984
119,232 240,000 289,680 21,462 36,381 0
25 198402042017042003 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 38 0 0
4,101,970 7,154 482,370
0
21,462 3,619,600
YANTI SUPRIATIN, A.Md.Keb K-1 2,889,800 0 0 222,711 0 0
2 288,980 0 0 6,936 222,711 0
28-04-1980
115,592 240,000 289,680 20,807 55,678 0
26 198004282019052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 76 0 0
4,074,582 6,936 569,682
0
20,807 3,504,900
YUNI NURMALASARI, A.Md.Keb K-0 2,889,800 0 0 125,192 0 0
0 0 0 0 6,936 125,192 0
01-04-1989
0 240,000 72,420 20,807 31,298 0
27 198904012017042003 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 62 0 0
3,355,217 6,936 415,417
0
20,807 2,939,800
ASRI NIRMALASARI, A.Md.Keb K-0 2,889,800 0 0 178,057 0 0
0 0 0 0 6,936 178,057 0
29-08-1989
0 240,000 72,420 20,807 44,514 0
28 198908292017052004 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 78 0 0
3,408,098 6,936 481,498
-
20,807 2,926,600
Halaman : 49
(019) D30100301900010 BULAN : AGUSTUS 2023

NO
904,210 0 0 42,953 1,166,016 0
298,254 1,440,000 1,013,880 128,856 291,504 0
PEG : 6 19,098,864 0 0 0 1,527,909 0
IST : 3 JIWA = 14 269 0 0
ANK : 5 22,890,838 42,953 3,157,238
128,856 19,733,600
TOTAL PER SATKER 102,301,600 0 0 7,425,310 108,989 0
5,356,220 185,000 0 245,526 7,425,310 0
2,037,746 11,170,000 4,996,980 736,572 1,856,328 0
PEG : 28 109,695,566 0 108,989 0 8,775,645 0
IST : 14 JIWA = 69 1,327 0 0
ANK : 27 134,565,270 245,526 19,148,370
736,572 115,416,900
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 50
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIRANJANG
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
dr.ELFIRA FIRDAUS K-1 4,281,800 0 0 480,000 45,975 0

1 428,180 0 0 10,276 480,000 0
10-12-1968
85,636 1,200,000 217,260 30,829 120,000 0
1 196812102002122003 0 383,649 0 ..................
4,795,616 0 45,975
( PNS - 4A ) MKG: 22 3 73 0 0
6,780,029 10,276 1,070,729
-
30,829 5,709,300
dr.LENA ROHSETIANI K-1 3,666,900 0 0 465,995 1,950 0
2 366,690 0 0 8,801 465,995 0
18-07-1980
146,676 1,200,000 289,680 26,402 116,499 0
2 198007182010012010 0 334,421 0 ..................
4,180,266 0 1,950
( PNS - 4A ) MKG: 12 4 74 0 0
6,173,168 8,801 954,068
-
26,402 5,219,100
PENI ANDINI, Apt. K-1 3,666,900 0 0 352,368 8,554 0
1 366,690 0 0 8,801 352,368 0
02-02-1984
73,338 1,200,000 217,260 26,402 88,092 0
3 198402022010012022 0 328,554 0 ..................
4,106,928 0 8,554
( PNS - 4A ) MKG: 12 3 58 0 0
5,920,371 8,801 812,771
-
26,402 5,107,600
SRI LESTARI, S.Kep. K-1 4,699,300 0 0 351,812 33,483 0
2 469,930 0 0 11,278 351,812 0
20-08-1968
187,972 850,000 289,680 33,835 87,953 0
4 196808201988122001 0 428,576 0 ..................
5,357,202 0 33,483
( PNS - 4A ) MKG: 28 4 47 0 0
6,927,337 11,278 946,937
-
33,835 5,980,400
drg.FIFI SETIAWARDANI K-0 3,666,900 0 0 364,097 0 0
0 0 0 0 8,801 364,097 0
01-03-1981
0 750,000 72,420 26,402 91,024 0
5 198103012011012001 0 293,352 0 ..................
3,666,900 0 0
( PNS - 4A ) MKG: 12 1 56 0 0
4,888,676 8,801 783,676
-
26,402 4,105,000
YULMARISVA, S.Kep.Ners K-0 4,699,300 0 0 383,683 39,367 0
0 0 0 0 11,278 383,683 0
24-07-1969
0 600,000 72,420 33,835 95,921 0
6 196907241989032002 0 375,944 0 ..................
4,699,300 0 39,367
( PNS - 4A ) MKG: 28 1 45 0 0
5,839,928 11,278 940,028
33,835 4,899,900
Halaman : 51
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
1,631,490 0 0 59,235 2,397,955 0
493,622 5,800,000 1,158,720 177,705 599,489 0
PEG : 6 26,806,212 0 129,329 0 2,144,496 0
IST : 4 JIWA = 16 353 0 0
ANK : 6 36,529,509 59,235 5,508,209
177,705 31,021,300
ERNA HERNAYATI, AM.Keb.S.IP K-1 4,370,900 0 0 327,620 3,413 0
2 437,090 0 0 10,490 327,620 0
20-12-1971
174,836 600,000 289,680 31,470 81,905 0
7 197112201992032004 0 398,626 0 ..................
4,982,826 0 3,413
( PNS - 3D ) MKG: 26 4 25 0 0
6,245,524 10,490 853,524
-
31,470 5,392,000
ELIS YENI TK - 0 4,508,600 0 0 298,952 21,896 0
0 0 0 0 10,821 298,952 0
12-03-1966
0 500,000 72,420 32,462 74,738 0
8 196603121989032009 0 360,688 0 ..................
4,508,600 0 21,896
( PNS - 3D ) MKG: 28 1 6 0 0
5,445,157 10,821 799,557
-
32,462 4,645,600
KOHARUDIN, AM.Kep K-1 4,508,600 0 0 339,675 17,625 0
1 450,860 0 0 10,821 339,675 0
13-09-1966
90,172 500,000 217,260 32,462 84,919 0
9 196609131990031004 0 403,971 0 ..................
5,049,632 0 17,625
( PNS - 3D ) MKG: 28 3 98 0 0
6,167,573 10,821 889,473
-
32,462 5,278,100
N.ROHANI K-0 4,508,600 0 0 298,952 21,896 0
0 0 0 0 10,821 298,952 0
06-04-1967
0 500,000 72,420 32,462 74,738 0
10 196704061990032008 0 360,688 0 ..................
4,508,600 0 21,896
( PNS - 3D ) MKG: 28 1 6 0 0
5,445,157 10,821 799,557
-
32,462 4,645,600
GINA FARIDA HIDAYAT K-1 3,591,200 0 0 300,013 0 0
2 359,120 0 0 8,619 300,013 0
17-12-1983
143,648 600,000 289,680 25,857 75,003 0
11 198312172005012001 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 72 0 0
5,318,209 8,619 737,009
-
25,857 4,581,200
Halaman : 52
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
AJAT SUDARAJAT, S.Kep, Ners K-1 3,375,300 0 0 397,416 0 0

2 337,530 0 0 8,101 397,416 0
23-05-1978
135,012 600,000 289,680 24,302 99,354 0
12 197805232010011007 0 307,827 0 ..................
3,847,842 0 0
( PNS - 3C ) MKG: 12 4 59 0 0
5,167,400 8,101 837,000
-
24,302 4,330,400
KHUNTARI ZAMMAMI TK - 0 3,941,400 0 0 325,681 0 0
0 0 0 0 9,459 325,681 0
24-01-1973
0 500,000 72,420 28,378 81,420 0
13 197301241996032002 0 315,312 0 ..................
3,941,400 0 0
( PNS - 3C ) MKG: 22 1 12 0 0
4,877,350 9,459 760,250
-
28,378 4,117,100
ARIEF RAHMAN HAKIM, S.Kep.Ners. K-1 3,554,000 0 0 361,254 0 0
2 355,400 0 0 8,530 361,254 0
10-06-1980
142,160 300,000 289,680 25,589 90,313 0
14 198006102007011004 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 98 0 0
5,036,711 8,530 809,811
0
25,589 4,226,900
KARTIWA K-1 4,023,300 0 0 288,690 0 0
1 402,330 0 0 9,656 288,690 0
25-05-1972
80,466 265,000 217,260 28,968 72,173 0
15 197205251992031007 0 360,488 0 ..................
4,506,096 0 0
( PNS - 3B ) MKG: 26 3 5 0 0
5,315,675 9,656 759,975
-
28,968 4,555,700
DEDAH JUBAEDAH K-1 3,781,400 0 0 254,703 0 0
1 378,140 0 0 9,075 254,703 0
07-11-1974
75,628 265,000 217,260 27,226 63,676 0
16 197411072006042012 0 338,813 0 ..................
4,235,168 0 0
( PNS - 3B ) MKG: 23 3 61 0 0
5,008,493 9,075 693,493
-
27,226 4,315,000
RANA, A.Md.Farm JD - 0 3,554,000 0 0 255,180 0 0
2 0 0 0 8,530 255,180 0
05-05-1978
142,160 265,000 217,260 25,589 63,795 0
17 197805052000031004 0 295,693 0 ..................
3,696,160 0 0
( PNS - 3B ) MKG: 18 3 68 0 0
4,467,787 8,530 648,787
0
25,589 3,819,000
Halaman : 53
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
NYAI NAJIAH, AM.Kep K-1 3,139,400 0 0 246,238 0 0

0 313,940 0 0 7,535 246,238 0
11-07-1977
0 265,000 144,840 22,604 61,560 0
18 197707112011012001 0 276,267 0 ..................
3,453,340 0 0
( PNS - 3B ) MKG: 10 2 47 0 0
4,139,604 7,535 614,204
-
22,604 3,525,400
EULIS KOMALASARI K-1 4,023,300 0 0 254,404 0 0
2 402,330 185,000 0 9,656 254,404 0
30-09-1970
160,932 0 289,680 28,968 63,601 0
19 197009301992032003 0 366,925 0 ..................
4,586,562 0 0
( PNS - 3B ) MKG: 26 4 84 0 0
5,354,354 9,656 723,554
-
28,968 4,630,800
ATIN SUPRIATIN K-1 3,627,900 0 0 356,891 0 0
2 362,790 0 0 8,707 356,891 0
19-12-1975
145,116 300,000 289,680 26,121 89,223 0
20 197512192006042008 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 1 0 0
5,117,206 8,707 811,806
-
26,121 4,305,400
DEWI HANDAYANI, A.Md K-1 3,012,000 0 0 270,825 0 0
0 301,200 0 0 7,229 270,825 0
06-07-1983
0 300,000 144,840 21,686 67,706 0
21 198307062011012001 0 265,056 0 ..................
3,313,200 0 0
( PNS - 3A ) MKG: 10 2 22 0 0
4,057,802 7,229 632,502
-
21,686 3,425,300
NIRA PURNA SARI, A.Md.Keb. K-0 3,012,000 0 0 235,602 0 0
0 0 0 0 7,229 235,602 0
13-10-1986
0 300,000 72,420 21,686 58,900 0
22 198610132010012010 0 240,960 0 ..................
3,012,000 0 0
( PNS - 3A ) MKG: 10 1 40 0 0
3,648,977 7,229 564,377
-
21,686 3,084,600
YAYAN HERYANI JD - 0 3,627,900 0 0 265,319 0 0
2 0 0 0 8,707 265,319 0
12-09-1973
145,116 265,000 217,260 26,121 66,330 0
23 197309122006042016 0 301,841 0 ..................
3,773,016 0 0
( PNS - 3A ) MKG: 22 3 95 0 0
4,555,518 8,707 668,318
-
26,121 3,887,200
Halaman : 54
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
EUIS SRI RAHAYU, A.Md.Kep K-0 3,305,700 0 0 247,888 0 0

0 0 0 0 7,934 247,888 0
24-06-1982
0 265,000 72,420 23,801 61,972 0
24 198206242012122002 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 8 0 0
3,922,751 7,934 606,051
-
23,801 3,316,700
SURYA KENCANA S, Amd.Kep K-1 3,305,700 0 0 270,742 0 0
2 330,570 0 0 7,934 270,742 0
09-09-1982
132,228 265,000 289,680 23,801 67,686 0
25 198209092012121001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 88 0 0
4,625,743 7,934 671,643
-
23,801 3,954,100
NOVI HARMI AI TIKAH,Amd.Kep K-1 3,305,700 0 0 258,407 0 0
1 330,570 0 0 7,934 258,407 0
10-11-1982
66,114 265,000 217,260 23,801 64,602 0
26 198211102012122001 0 296,191 0 ..................
3,702,384 0 0
( PNS - 3A ) MKG: 16 3 49 0 0
4,474,835 7,934 650,935
-
23,801 3,823,900
4,761,870 185,000 0 177,788 5,854,452 0
1,633,588 7,120,000 3,983,100 533,354 1,463,614 0
PEG : 20 80,472,358 0 64,830 0 6,437,788 0
IST : 13 JIWA = 55 944 0 0
ANK : 22 98,391,826 177,788 14,531,826
533,354 83,860,000
TIA ROSTIANTI K-0 3,374,400 0 0 236,928 0 0
0 0 0 0 8,099 236,928 0
22-11-1978
0 240,000 72,420 24,296 59,232 0
27 197811222007012007 0 269,952 0 ..................
3,374,400 0 0
( PNS - 2D ) MKG: 25 1 64 0 0
3,956,207 8,099 598,507
-
24,296 3,357,700
EVA FATIMAH, A.Md.Keb K-0 2,980,800 0 0 219,381 0 0
0 0 0 0 7,154 219,381 0
22-02-1985
0 240,000 72,420 21,462 54,845 0
28 198502222017052001 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 89 0 0
3,541,306 7,154 541,306
-
21,462 3,000,000
Halaman : 55
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
SANTI SULASTRI, A.Md.Keb K-0 2,980,800 0 0 216,232 0 0

0 0 0 0 7,154 216,232 0
26-03-1986
0 240,000 72,420 21,462 54,058 0
29 198603262017052001 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 2 0 0
3,538,070 7,154 537,370
-
21,462 3,000,700
ERNI ROHAENI, A.Md.Keb K-1 2,980,800 0 0 231,598 0 0
2 298,080 0 0 7,154 231,598 0
07-05-1987
119,232 240,000 289,680 21,462 57,899 0
30 198705072017052002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 56 0 0
4,188,062 7,154 589,962
-
21,462 3,598,100
MALIS YUNIARTI, A.Md.Keb K-1 2,980,800 0 0 231,230 0 0
1 298,080 0 0 7,154 231,230 0
23-06-1987
59,616 240,000 217,260 21,462 57,807 0
31 198706232017052004 0 267,080 0 ..................
3,338,496 0 0
( PNS - 2D ) MKG: 17 3 31 0 0
4,055,633 7,154 584,733
-
21,462 3,470,900
ELANG HERDIANA, AM.Kep. DD - 0 3,374,400 0 0 147,575 0 0
2 0 180,000 0 8,099 147,575 0
04-05-1979
134,976 0 217,260 24,296 36,894 0
32 197905042006041020 0 280,750 0 ..................
3,509,376 0 0
( PNS - 2D ) MKG: 25 3 8 0 0
4,086,614 8,099 497,614
24,296 3,589,000
ISNA MULYAWATI, A.Md.Kep K-1 2,374,300 0 0 202,993 0 0
1 237,430 0 0 5,698 202,993 0
21-10-1992
47,486 240,000 217,260 17,095 50,748 0
33 199210212020122011 0 212,737 0 ..................
2,659,216 0 0
( PNS - 2C ) MKG: 5 3 9 0 0
3,342,271 5,698 489,271
-
17,095 2,853,000
NUNUY RISNAWATI K-1 2,830,200 0 0 256,089 0 0
1 283,020 0 0 6,792 256,089 0
19-08-1979
56,604 240,000 217,260 20,377 64,022 0
34 197908192008012007 0 253,586 0 ..................
3,169,824 0 0
( PNS - 2B ) MKG: 19 3 24 0 0
3,910,366 6,792 600,866
-
20,377 3,309,500
Halaman : 56
(019) D30100301900011 BULAN : AGUSTUS 2023

NO
1,116,610 180,000 0 57,304 1,742,026 0
417,914 1,680,000 1,375,980 171,912 435,505 0
PEG : 8 25,411,024 0 0 0 2,032,882 0
IST : 4 JIWA = 19 283 0 0
ANK : 7 30,618,529 57,304 4,439,629
171,912 26,178,900
TOTAL PER SATKER 122,634,500 0 0 9,994,433 194,159 0
7,509,970 365,000 0 294,327 9,994,433 0
2,545,124 14,600,000 6,517,800 882,971 2,498,608 0
PEG : 34 132,689,594 0 194,159 0 10,615,166 0
IST : 21 JIWA = 90 1,580 0 0
ANK : 35 165,539,864 294,327 24,479,664
882,971 141,060,200
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 57
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIPEUYEUM
(019) D30100301900012 BULAN : AGUSTUS 2023

NO
dr.KRISTIYANTO BERUTU K-1 3,901,500 0 0 390,365 10,538 0

2 390,150 0 0 9,364 390,365 0
29-11-1976
156,060 1,200,000 289,680 28,091 97,591 0
1 197611292006041007 0 355,817 0 ..................
4,447,710 0 10,538
( PNS - 4A ) MKG: 16 4 18 0 0
6,375,766 9,364 891,766
-
28,091 5,484,000
drg.MILA KARMILA K-1 3,666,900 0 0 440,204 725 0
2 366,690 0 0 8,801 440,204 0
25-05-1978
146,676 1,200,000 289,680 26,402 110,051 0
2 197805252010012005 0 334,421 0 ..................
4,180,266 0 725
( PNS - 4A ) MKG: 12 4 26 0 0
6,146,104 8,801 920,604
-
26,402 5,225,500
756,840 0 0 18,165 830,569 0
302,736 2,400,000 579,360 54,493 207,642 0
PEG : 2 8,627,976 0 11,263 0 690,238 0
IST : 2 JIWA = 8 44 0 0
ANK : 4 12,521,870 18,165 1,812,370
54,493 10,709,500
ANING WIDANINGSIH, AM.Keb. K-0 4,508,600 0 0 336,463 28,429 0
0 0 0 0 10,821 336,463 0
01-06-1967
0 600,000 72,420 32,462 84,116 0
3 196706011989032005 0 360,688 0 ..................
4,508,600 0 28,429
( PNS - 3D ) MKG: 28 1 84 0 0
5,589,279 10,821 852,979
-
32,462 4,736,300
TITIN PATIMAH, AM.Keb K-1 4,370,900 0 0 384,154 6,100 0
2 437,090 0 0 10,490 384,154 0
05-01-1969
174,836 600,000 289,680 31,470 96,039 0
4 196901051992032006 0 398,626 0 ..................
4,982,826 0 6,100
( PNS - 3D ) MKG: 26 4 59 0 0
6,304,779 10,490 926,879
-
31,470 5,377,900
HENI SETIAWATI D. K-1 4,237,500 0 0 348,966 0 0
2 423,750 0 0 10,170 348,966 0
24-09-1973
169,500 600,000 289,680 30,510 87,242 0
5 197309241993012002 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 72 0 0
6,110,148 10,170 863,348
-
30,510 5,246,800
Halaman : 58
(019) D30100301900012 BULAN : AGUSTUS 2023

NO
SRI RAHAYU, S.Kep.Ners. TK - 0 3,982,600 0 0 388,185 6,913 0

0 0 0 0 9,558 388,185 0
19-08-1970
0 600,000 72,420 28,675 97,046 0
6 197008191997032007 0 318,608 0 ..................
3,982,600 0 6,913
( PNS - 3D ) MKG: 20 1 34 0 0
5,088,385 9,558 848,985
0
28,675 4,239,400
TUTIAH, AM.Keb TK - 0 4,797,000 0 0 316,656 35,883 0
0 0 0 0 11,513 316,656 0
06-04-1966
0 500,000 72,420 34,538 79,164 0
7 196604061985032002 0 383,760 0 ..................
4,797,000 0 35,883
( PNS - 3D ) MKG: 32 1 4 0 0
5,768,014 11,513 861,514
-
34,538 4,906,500
YANI ROYANI TK - 0 4,650,600 0 0 315,166 29,142 0
0 0 0 0 11,161 315,166 0
07-11-1966
0 500,000 72,420 33,484 78,792 0
8 196611071987012001 0 372,048 0 ..................
4,650,600 0 29,142
( PNS - 3D ) MKG: 30 1 20 0 0
5,611,993 11,161 839,793
-
33,484 4,772,200
FRANSISKA RINI TANDI SAPAN K-1 4,370,900 0 0 324,958 9,904 0
1 437,090 0 0 10,490 324,958 0
23-12-1969
87,418 500,000 217,260 31,470 81,240 0
9 196912231992032011 0 391,633 0 ..................
4,895,408 0 9,904
( PNS - 3D ) MKG: 26 3 5 0 0
5,989,495 10,490 849,695
-
31,470 5,139,800
NENENG KARTIKA K-1 4,370,900 0 0 320,960 9,713 0
1 437,090 0 0 10,490 320,960 0
17-09-1970
87,418 500,000 217,260 31,470 80,240 0
10 197009171991012001 0 391,633 0 ..................
4,895,408 0 9,713
( PNS - 3D ) MKG: 26 3 5 0 0
5,985,306 10,490 844,506
-
31,470 5,140,800
KANKAN SUMPENA, AM.Kep,SKM K-1 4,370,900 0 0 480,000 5,904 0
2 437,090 0 0 10,490 480,000 0
29-03-1971
174,836 500,000 289,680 31,470 120,000 0
11 197103291991031004 0 398,626 0 ..................
4,982,826 0 5,904
( PNS - 3D ) MKG: 26 4 20 0 0
6,300,390 10,490 1,046,490
-
31,470 5,253,900
Halaman : 59
(019) D30100301900012 BULAN : AGUSTUS 2023

NO
MIRA NOVANTIKA SY K-0 4,237,500 0 0 325,449 10,800 0

0 0 0 0 10,170 325,449 0
10-11-1974
0 500,000 72,420 30,510 81,362 0
12 197411101997032004 0 339,000 0 ..................
4,237,500 0 10,800
( PNS - 3D ) MKG: 24 1 42 0 0
5,186,891 10,170 797,291
-
30,510 4,389,600
DWI SARTIKA K-0 3,481,600 0 0 319,893 0 0
0 0 0 0 8,356 319,893 0
14-10-1969
0 600,000 72,420 25,068 79,973 0
13 196910142002122002 0 278,528 0 ..................
3,481,600 0 0
( PNS - 3C ) MKG: 15 1 81 0 0
4,507,418 8,356 711,818
-
25,068 3,795,600
DEDE NANI HERLIANI, AM.Kep. K-1 3,704,300 0 0 292,314 0 0
2 370,430 0 0 8,890 292,314 0
12-01-1980
148,172 500,000 289,680 26,671 73,078 0
14 198001122007012003 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 28 0 0
5,340,485 8,890 738,785
-
26,671 4,601,700
ROSIDAH, AMK K-0 3,481,600 0 0 263,045 0 0
0 0 0 0 8,356 263,045 0
30-04-1982
0 500,000 72,420 25,068 65,761 0
15 198204302006042012 0 278,528 0 ..................
3,481,600 0 0
( PNS - 3C ) MKG: 14 1 69 0 0
4,350,558 8,356 640,758
-
25,068 3,709,800
SUSI SRI RAHMAWATI, A.Md.Keb TK - 0 3,781,400 0 0 259,892 0 0
0 0 0 0 9,075 259,892 0
25-04-1973
0 265,000 72,420 27,226 64,973 0
16 197304252006042010 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 23 1 65 0 0
4,415,078 9,075 663,678
-
27,226 3,751,400
MUJI ERNAWATI K-0 3,627,900 0 0 255,152 0 0
0 0 0 0 8,707 255,152 0
11-06-1975
0 300,000 72,420 26,121 63,788 0
17 197506112006042014 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 0 0 0
4,290,300 8,707 644,000
-
26,121 3,646,300
Halaman : 60
(019) D30100301900012 BULAN : AGUSTUS 2023

NO
HENDY RAMADHAN M, AMd,Kep K-1 3,012,000 0 0 291,423 0 0

2 301,200 0 0 7,229 291,423 0
11-05-1988
120,480 300,000 289,680 21,686 72,856 0
18 198805112011011002 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 90 0 0
4,343,788 7,229 667,888
-
21,686 3,675,900
TITI SETIAWATI K-1 3,204,700 0 0 285,907 0 0
1 320,470 0 0 7,691 285,907 0
18-09-1980
64,094 265,000 217,260 23,074 71,477 0
19 198009182008012009 0 287,141 0 ..................
3,589,264 0 0
( PNS - 3A ) MKG: 14 3 94 0 0
4,388,290 7,691 675,290
-
23,074 3,713,000
NURITA HASTININGRUM, A.MG. K-1 3,012,000 0 0 247,787 0 0
1 301,200 0 0 7,229 247,787 0
26-09-1983
60,240 265,000 217,260 21,686 61,947 0
20 198309262010012008 0 269,875 0 ..................
3,373,440 0 0
( PNS - 3A ) MKG: 10 3 22 0 0
4,132,424 7,229 608,524
-
21,686 3,523,900
YUNARDI DANTJI K-1 3,742,200 0 0 274,932 0 0
2 374,220 185,000 0 8,981 274,932 0
06-06-1968
149,688 0 289,680 26,944 68,733 0
21 196806061994031011 0 341,289 0 ..................
4,266,108 0 0
( PNS - 3A ) MKG: 24 4 34 0 0
5,051,679 8,981 720,879
-
26,944 4,330,800
3,839,630 185,000 0 179,867 6,031,302 0
1,236,682 8,395,000 3,258,900 539,603 1,507,827 0
PEG : 19 80,021,412 0 142,788 0 6,401,713 0
IST : 10 JIWA = 45 828 0 0
ANK : 16 98,754,700 179,867 14,803,100
539,603 83,951,600
MIRA MARYATI K-0 2,980,800 0 0 260,951 0 0
0 0 0 0 7,154 260,951 0
07-12-1979
0 240,000 72,420 21,462 65,238 0
22 197912072007012002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 82 0 0
3,582,869 7,154 593,269
-
21,462 2,989,600
Halaman : 61
(019) D30100301900012 BULAN : AGUSTUS 2023

NO
YULIANTI, A.Md.Keb K-1 2,980,800 0 0 236,964 0 0

1 298,080 0 0 7,154 236,964 0
12-01-1985
59,616 240,000 217,260 21,462 59,241 0
23 198501122017052002 0 267,080 0 ..................
3,338,496 0 0
( PNS - 2D ) MKG: 17 3 65 0 0
4,061,401 7,154 591,901
-
21,462 3,469,500
RUNI NURLITASARI, A.Md.Keb K-1 2,889,800 0 0 265,041 0 0
0 288,980 0 0 6,936 265,041 0
22-06-1988
0 240,000 144,840 20,807 66,260 0
24 198806222017052003 0 254,302 0 ..................
3,178,780 0 0
( PNS - 2D ) MKG: 15 2 42 0 0
3,856,446 6,936 613,346
-
20,807 3,243,100
ETI NURHASANAH, A.Md.Keb K-1 2,889,800 0 0 267,353 0 0
1 288,980 0 0 6,936 267,353 0
13-09-1988
57,796 240,000 217,260 20,807 66,838 0
25 198809132017052002 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 28 0 0
3,988,960 6,936 620,860
-
20,807 3,368,100
876,040 0 0 28,180 1,030,309 0
117,412 960,000 651,780 84,538 257,577 0
PEG : 4 12,734,652 0 0 0 1,018,772 0
IST : 3 JIWA = 9 217 0 0
ANK : 2 15,489,676 28,180 2,419,376
84,538 13,070,300
TOTAL PER SATKER 94,254,700 0 0 7,892,180 154,051 0
5,472,510 185,000 0 226,212 7,892,180 0
1,656,830 11,755,000 4,490,040 678,634 1,973,046 0
PEG : 25 101,384,040 0 154,051 0 8,110,723 0
IST : 15 JIWA = 62 1,089 0 0
ANK : 22 126,766,246 226,212 19,034,846
678,634 107,731,400
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 62
(019) D30100301900012 BULAN : AGUSTUS 2023

NO
Halaman : 63
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SUKALUYU
(019) D30100301900013 BULAN : AGUSTUS 2023

NO
AJIH AJIJAH,AMK K-1 4,555,800 0 0 374,026 27,092 0

2 455,580 0 0 10,934 374,026 0
10-11-1968
182,232 850,000 289,680 32,802 93,506 0
1 196811101991012003 0 415,489 0 ..................
5,193,612 0 27,092
( PNS - 4A ) MKG: 26 4 3 0 0
6,778,149 10,934 953,849
-
32,802 5,824,300
455,580 0 0 10,934 374,026 0
182,232 850,000 289,680 32,802 93,506 0
PEG : 1 5,193,612 0 27,092 0 415,489 0
IST : 1 JIWA = 4 3 0 0
ANK : 2 6,778,149 10,934 953,849
32,802 5,824,300
dr.RONI PASLAH K-1 3,628,900 0 0 457,479 0 0
2 362,890 0 0 8,709 457,479 0
01-01-1979
145,156 750,000 289,680 26,128 114,370 0
2 197901012010011024 0 330,956 0 ..................
4,136,946 0 0
( PNS - 3D ) MKG: 14 4 0 0 0
5,668,942 8,709 937,642
-
26,128 4,731,300
dr.NURUL HADIE K-1 3,628,900 0 0 480,000 0 0
2 362,890 0 0 8,709 480,000 0
18-09-1980
145,156 750,000 289,680 26,128 120,000 0
3 198009182010011016 0 330,956 0 ..................
4,136,946 0 0
( PNS - 3D ) MKG: 14 4 30 0 0
5,691,493 8,709 965,793
-
26,128 4,725,700
NILUH KETUT SRIWIDANI, AM.Keb. K-1 4,650,600 0 0 362,779 19,600 0
2 465,060 0 0 11,161 362,779 0
11-11-1965
186,024 600,000 289,680 33,484 90,695 0
4 196511111988032006 0 424,135 0 ..................
5,301,684 0 19,600
( PNS - 3D ) MKG: 30 4 66 0 0
6,618,454 11,161 941,854
-
33,484 5,676,600
R.ASEP SUMARJO, Am.Kep K-1 4,650,600 0 0 358,765 36,888 0
0 465,060 0 0 11,161 358,765 0
08-12-1966
0 500,000 144,840 33,484 89,691 0
5 196612081987031005 0 409,253 0 ..................
5,115,660 0 36,888
( PNS - 3D ) MKG: 30 2 44 0 0
6,200,842 11,161 939,242
-
33,484 5,261,600
Halaman : 64
(019) D30100301900013 BULAN : AGUSTUS 2023

NO
LINLIN SUSIANTI K-1 4,193,500 0 0 335,614 0 0

2 419,350 0 0 10,064 335,614 0
08-12-1968
167,740 500,000 289,680 30,193 83,904 0
6 196812081990122002 0 382,447 0 ..................
4,780,590 0 0
( PNS - 3C ) MKG: 26 4 81 0 0
5,946,222 10,064 842,222
-
30,193 5,104,000
ELAH NURLAELAH TK - 0 4,193,500 0 0 316,132 8,354 0
0 0 0 0 10,064 316,132 0
22-07-1970
0 500,000 72,420 30,193 79,033 0
7 197007221991032005 0 335,480 0 ..................
4,193,500 0 8,354
( PNS - 3C ) MKG: 26 1 93 0 0
5,130,756 10,064 779,256
-
30,193 4,351,500
SITI JULAEHA K-0 3,481,600 0 0 277,213 0 0
0 0 0 0 8,356 277,213 0
12-02-1981
0 500,000 72,420 25,068 69,303 0
8 198102122006042023 0 278,528 0 ..................
3,481,600 0 0
( PNS - 3C ) MKG: 14 1 11 0 0
4,364,668 8,356 658,468
-
25,068 3,706,200
dr. DENNY TAKBIR FIKRIANDANI K-1 2,773,200 0 0 346,625 0 0
0 277,320 0 0 6,656 346,625 0
02-03-1995
0 325,000 144,840 19,967 86,656 0
9 199503022020121005 0 244,042 0 ..................
3,050,520 0 0
( PNS - 3B ) MKG: 2 2 38 0 0
3,893,646 6,656 703,946
-
19,967 3,189,700
ASAH SUDARSAH, AM.Kep. K-1 3,445,500 0 0 249,394 0 0
2 344,550 0 0 8,269 249,394 0
18-12-1980
137,820 300,000 289,680 24,808 62,349 0
10 198012182008011004 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 29 0 0
4,800,050 8,269 659,050
-
24,808 4,141,000
DARUL ANAM K-1 3,445,500 0 0 395,283 0 0
2 344,550 0 0 8,269 395,283 0
12-12-1980
137,820 265,000 289,680 24,808 98,821 0
11 198012122008011002 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 1 0 0
4,910,911 8,269 841,411
-
24,808 4,069,500
Halaman : 65
(019) D30100301900013 BULAN : AGUSTUS 2023

NO
EUIS RATNA SUMINAR TK - 0 3,445,500 0 0 328,687 0 0

0 0 0 0 8,269 328,687 0
12-06-1983
0 265,000 72,420 24,808 82,172 0
12 198306122008012004 0 275,640 0 ..................
3,445,500 0 0
( PNS - 3B ) MKG: 16 1 92 0 0
4,144,776 8,269 719,576
-
24,808 3,425,200
ICEU JUITA JD - 0 3,517,200 0 0 323,624 0 0
2 0 0 0 8,441 323,624 0
16-11-1977
140,688 265,000 217,260 25,324 80,906 0
13 197711162007012004 0 292,631 0 ..................
3,657,888 0 0
( PNS - 3A ) MKG: 20 3 89 0 0
4,497,626 8,441 730,926
-
25,324 3,766,700
3,041,670 0 0 108,128 4,231,595 0
1,060,404 5,520,000 2,462,280 324,393 1,057,900 0
PEG : 12 49,156,574 0 64,842 0 3,932,528 0
IST : 8 JIWA = 34 574 0 0
ANK : 14 61,868,386 108,128 9,719,386
324,393 52,149,000
OKEU PERMATA K-0 3,374,400 0 0 359,601 0 0
1 0 0 0 8,099 359,601 0
28-10-1977
67,488 240,000 144,840 24,296 89,900 0
14 197710282007012007 0 275,351 0 ..................
3,441,888 0 0
( PNS - 2D ) MKG: 25 2 23 0 0
4,218,747 8,099 757,247
-
24,296 3,461,500
AI RATIH, A.Md.Keb K-1 2,801,500 0 0 289,764 0 0
2 280,150 0 0 6,724 289,764 0
25-06-1989
112,060 240,000 289,680 20,171 72,441 0
15 198906252017052003 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 48 0 0
4,040,097 6,724 644,597
-
20,171 3,395,500
MARJANAH TK - 0 3,820,000 0 0 255,211 0 0
0 0 180,000 0 9,168 255,211 0
05-05-1968
0 0 72,420 27,504 63,803 0
16 196805051990022002 0 305,600 0 ..................
3,820,000 0 0
( PNS - 2D ) MKG: 33 1 83 0 0
4,364,386 9,168 661,286
-
27,504 3,703,100
Halaman : 66
(019) D30100301900013 BULAN : AGUSTUS 2023

NO
LIA HERLINA, A.Md.Keb JD - 0 2,859,800 0 0 226,713 0 0

2 0 0 0 6,864 226,713 0
17-07-1986
114,392 240,000 217,260 20,591 56,678 0
17 198607172017052005 0 237,935 0 ..................
2,974,192 0 0
( PNS - 2C ) MKG: 17 3 61 0 0
3,685,681 6,864 548,781
-
20,591 3,136,900
DEDI K-0 2,859,800 0 0 265,524 0 0
0 0 180,000 0 6,864 265,524 0
22-12-1972
0 0 72,420 20,591 66,381 0
18 197212222010011001 0 228,784 0 ..................
2,859,800 0 0
( PNS - 2C ) MKG: 17 1 45 0 0
3,405,244 6,864 588,144
-
20,591 2,817,100
280,150 360,000 0 37,719 1,396,813 0
293,940 720,000 796,620 113,153 349,203 0
PEG : 5 16,289,590 0 0 0 1,303,167 0
IST : 1 JIWA = 11 260 0 0
ANK : 5 19,714,155 37,719 3,200,055
113,153 16,514,100
TOTAL PER SATKER 65,325,800 0 0 6,002,434 91,934 0
3,777,400 360,000 0 156,781 6,002,434 0
1,536,576 7,090,000 3,548,580 470,348 1,500,609 0
PEG : 18 70,639,776 0 91,934 0 5,651,184 0
IST : 10 JIWA = 49 837 0 0
ANK : 21 88,360,690 156,781 13,873,290
470,348 74,487,400
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 67
(019) D30100301900013 BULAN : AGUSTUS 2023

NO
Halaman : 68
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS BOJONGPICUNG
(019) D30100301900014 BULAN : AGUSTUS 2023

NO
dr.RUKUN SUTRISNO K-1 4,281,800 0 0 426,116 31,971 0

2 428,180 0 0 10,276 426,116 0
03-01-1968
171,272 1,200,000 289,680 30,829 106,529 0
1 196801032002121002 0 390,500 0 ..................
4,881,252 0 31,971
( PNS - 4A ) MKG: 22 4 97 0 0
6,870,221 10,276 996,221
-
30,829 5,874,000
428,180 0 0 10,276 426,116 0
171,272 1,200,000 289,680 30,829 106,529 0
PEG : 1 4,881,252 0 31,971 0 390,500 0
IST : 1 JIWA = 4 97 0 0
ANK : 2 6,870,221 10,276 996,221
30,829 5,874,000
ENOK HERNAWATI, SKM K-0 4,650,600 0 0 315,182 33,892 0
0 0 0 0 11,161 315,182 0
13-09-1966
0 600,000 72,420 33,484 78,796 0
2 196609131987032004 0 372,048 0 ..................
4,650,600 0 33,892
( PNS - 3D ) MKG: 30 1 24 0 0
5,716,763 11,161 844,563
-
33,484 4,872,200
EKA SUMARTIKA, A.Md.Keb JD - 0 4,508,600 0 0 308,636 27,108 0
0 0 0 0 10,821 308,636 0
01-09-1967
0 600,000 72,420 32,462 77,159 0
3 196709011990032005 0 360,688 0 ..................
4,508,600 0 27,108
( PNS - 3D ) MKG: 28 1 27 0 0
5,560,074 10,821 816,874
-
32,462 4,743,200
EUIS WIDANINGSIH K-1 4,650,600 0 0 311,344 23,521 0
1 465,060 0 0 11,161 311,344 0
20-07-1967
93,012 500,000 217,260 33,484 77,836 0
4 196707201989022002 0 416,694 0 ..................
5,208,672 0 23,521
( PNS - 3D ) MKG: 30 3 98 0 0
6,305,540 11,161 874,040
-
33,484 5,431,500
TITIN KURAESIN JD - 0 4,650,600 0 0 268,394 15,804 0
1 0 0 0 11,161 268,394 0
09-12-1967
93,012 500,000 144,840 33,484 67,098 0
5 196712091988032005 0 379,489 0 ..................
4,743,612 0 15,804
( PNS - 3D ) MKG: 30 2 35 0 0
5,717,330 11,161 775,430
-
33,484 4,941,900
Halaman : 69
(019) D30100301900014 BULAN : AGUSTUS 2023

NO
LILIS PATMAWATI K-1 4,508,600 0 0 334,492 6,138 0

2 450,860 0 0 10,821 334,492 0
17-05-1967
180,344 500,000 289,680 32,462 83,623 0
6 196705171989122001 0 411,184 0 ..................
5,139,804 0 6,138
( PNS - 3D ) MKG: 28 4 23 0 0
6,313,420 10,821 878,720
-
32,462 5,434,700
NINA YULIANA, A.Md.Keb K-1 4,508,600 0 0 312,619 5,096 0
2 450,860 0 0 10,821 312,619 0
09-12-1970
180,344 500,000 289,680 32,462 78,155 0
7 197012091990032001 0 411,184 0 ..................
5,139,804 0 5,096
( PNS - 3D ) MKG: 28 4 55 0 0
6,290,537 10,821 850,337
-
32,462 5,440,200
NENENG NURHAYATI K-1 4,237,500 0 0 295,076 0 0
2 423,750 0 0 10,170 295,076 0
04-03-1973
169,500 500,000 289,680 30,510 73,769 0
8 197303041993012002 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 99 0 0
5,956,285 10,170 795,985
30,510 5,160,300
HENI SUPENTI K-1 4,508,600 0 0 385,244 0 0
2 450,860 0 0 10,821 385,244 0
02-03-1968
180,344 265,000 289,680 32,462 96,311 0
9 196803021990032004 0 411,184 0 ..................
5,139,804 0 0
( PNS - 3D ) MKG: 28 4 11 0 0
6,123,022 10,821 936,022
-
32,462 5,187,000
ASEP SUHAYAT K-1 4,108,100 0 0 275,712 0 0
2 410,810 185,000 0 9,859 275,712 0
02-02-1966
164,324 0 289,680 29,578 68,928 0
10 196602021996011001 0 374,659 0 ..................
4,683,234 0 0
( PNS - 3D ) MKG: 22 4 73 0 0
5,473,136 9,859 758,736
-
29,578 4,714,400
AANG AHMAD, AM.Kep K-1 3,704,300 0 0 268,813 0 0
2 370,430 0 0 8,890 268,813 0
21-05-1977
148,172 500,000 289,680 26,671 67,203 0
11 197705212007011004 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 53 0 0
5,317,009 8,890 709,409
-
26,671 4,607,600
Halaman : 70
(019) D30100301900014 BULAN : AGUSTUS 2023

NO
RINA MARLINA, AM.Kep. JD - 0 3,591,200 0 0 251,240 0 0

2 0 0 0 8,619 251,240 0
25-05-1981
143,648 500,000 217,260 25,857 62,810 0
12 198105252008012008 0 298,788 0 ..................
3,734,848 0 0
( PNS - 3C ) MKG: 16 3 90 0 0
4,737,914 8,619 647,314
-
25,857 4,090,600
EULIS SRI NURWANINGSIH K-1 3,665,900 0 0 314,776 0 0
1 366,590 0 0 8,798 314,776 0
24-01-1973
73,318 300,000 217,260 26,394 78,694 0
13 197301242006042012 0 328,465 0 ..................
4,105,808 0 0
( PNS - 3B ) MKG: 20 3 91 0 0
4,973,127 8,798 757,127
-
26,394 4,216,000
ERNIE RUSMAYANTI TK - 0 3,340,300 0 0 225,548 0 0
0 0 0 0 8,017 225,548 0
24-04-1975
0 265,000 72,420 24,050 56,387 0
14 197504242002122005 0 267,224 0 ..................
3,340,300 0 0
( PNS - 3B ) MKG: 14 1 91 0 0
3,935,426 8,017 581,226
-
24,050 3,354,200
SITI KOMARIAH K-1 3,238,300 0 0 240,688 0 0
2 323,830 0 0 7,772 240,688 0
11-08-1974
129,532 265,000 289,680 23,316 60,172 0
15 197408112006042013 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 63 0 0
4,518,181 7,772 627,281
-
23,316 3,890,900
drg. TOMMY FRAHDIAN K-1 2,688,500 0 0 266,646 0 0
2 268,850 185,000 0 6,452 266,646 0
14-02-1991
107,540 0 289,680 19,357 66,662 0
16 199102142022031001 0 245,191 0 ..................
3,064,890 0 0
( PNS - 3B ) MKG: 1 4 83 0 0
3,832,108 6,452 604,308
-
19,357 3,227,800
JUJUN NURHAKIM K-1 3,305,700 0 0 253,162 0 0
2 330,570 0 0 7,934 253,162 0
08-06-1974
132,228 500,000 289,680 23,801 63,290 0
17 197406082006041012 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 92 0 0
4,843,167 7,934 649,667
-
23,801 4,193,500
Halaman : 71
(019) D30100301900014 BULAN : AGUSTUS 2023

NO
TETI KARTIAGARA, Amd.Kep K-1 3,305,700 0 0 265,020 0 0

2 330,570 0 0 7,934 265,020 0
27-03-1983
132,228 300,000 289,680 23,801 66,255 0
18 198303272012122001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 57 0 0
4,654,990 7,934 664,490
-
23,801 3,990,500
YUSTI PASARI, A.Md. Kep K-1 3,305,700 0 0 260,400 0 0
1 330,570 0 0 7,934 260,400 0
18-08-1981
66,114 265,000 217,260 23,801 65,100 0
19 198108182014092001 0 296,191 0 ..................
3,702,384 0 0
( PNS - 3A ) MKG: 16 3 47 0 0
4,476,826 7,934 653,426
-
23,801 3,823,400
4,973,610 370,000 0 169,146 5,152,992 0
1,993,660 6,860,000 4,127,940 507,436 1,288,248 0
PEG : 18 77,444,670 0 111,559 0 6,195,574 0
IST : 13 JIWA = 57 1,112 0 0
ANK : 26 94,744,855 169,146 13,424,955
507,436 81,319,900
ERIES SUMIATI, A.Md.Keb K-0 2,889,800 0 0 205,887 0 0
0 0 0 0 6,936 205,887 0
27-05-1984
0 240,000 72,420 20,807 51,472 0
20 198405272017052002 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 36 0 0
3,435,886 6,936 516,286
-
20,807 2,919,600
AYUNG RUSTINAH TK - 0 3,703,400 0 0 208,218 0 0
0 0 0 0 8,888 208,218 0
03-03-1970
0 197,000 72,420 26,664 52,054 0
21 197003031991022002 0 296,272 0 ..................
3,703,400 0 0
( PNS - 2D ) MKG: 31 1 6 0 0
4,216,596 8,888 592,096
-
26,664 3,624,500
0 0 0 15,824 414,105 0
0 437,000 144,840 47,471 103,526 0
PEG : 2 6,593,200 0 0 0 527,456 0
IST : 0 JIWA = 2 42 0 0
ANK : 0 7,652,482 15,824 1,108,382
47,471 6,544,100
Halaman : 72
(019) D30100301900014 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 81,352,400 0 0 5,993,213 143,530 0
5,401,790 370,000 0 195,246 5,993,213 0
2,164,932 8,497,000 4,562,460 585,736 1,498,303 0
PEG : 21 88,919,122 0 143,530 0 7,113,530 0
IST : 14 JIWA = 63 1,251 0 0
ANK : 28 109,267,558 195,246 15,529,558
585,736 93,738,000
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 73
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIKONDANG
(019) D30100301900015 BULAN : AGUSTUS 2023

NO
TETI HERAWATI TK - 0 4,370,900 0 0 280,028 31,350 0

0 0 0 0 10,490 280,028 0
20-11-1970
0 850,000 72,420 31,470 70,007 0
1 197011201991032005 0 349,672 0 ..................
4,370,900 0 31,350
( PNS - 3D ) MKG: 26 1 59 0 0
5,646,717 10,490 773,017
31,470 4,873,700
NONOK KUSTIAH, A.Md.Kep K-1 4,650,600 0 0 297,798 22,875 0
1 465,060 0 0 11,161 297,798 0
01-10-1968
93,012 500,000 217,260 33,484 74,450 0
2 196810011991032007 0 416,694 0 ..................
5,208,672 0 22,875
( PNS - 3D ) MKG: 30 3 12 0 0
6,291,262 11,161 856,462
0
33,484 5,434,800
ASEP SONJAYA, S.IP,SKM K-1 4,650,600 0 0 318,225 14,350 0
1 465,060 0 0 11,161 318,225 0
20-10-1965
93,012 300,000 217,260 33,484 79,556 0
3 196510201987031004 0 416,694 0 ..................
5,208,672 0 14,350
( PNS - 3D ) MKG: 30 3 18 0 0
6,103,170 11,161 873,470
-
33,484 5,229,700
YENI GUSTIANI TK - 0 3,481,600 540,000 0 363,447 0 0
0 0 0 0 8,356 363,447 0
18-08-1980
0 0 72,420 25,068 90,862 0
4 198008182002122006 0 278,528 0 ..................
3,481,600 0 0
( PNS - 3C ) MKG: 14 1 70 0 0
4,490,961 8,356 766,261
-
25,068 3,724,700
HETTI SULASTRI TK - 0 4,193,500 0 0 263,229 10,592 0
0 0 0 0 10,064 263,229 0
08-12-1972
0 600,000 72,420 30,193 65,807 0
5 197212081992032002 0 335,480 0 ..................
4,193,500 0 10,592
( PNS - 3C ) MKG: 26 1 67 0 0
5,180,065 10,064 715,365
-
30,193 4,464,700
dr. RITA JUNIAR TK - 0 2,773,200 0 0 257,425 0 0
0 0 0 0 6,656 257,425 0
26-06-1993
0 325,000 72,420 19,967 64,356 0
6 199306262020122012 0 221,856 0 ..................
2,773,200 0 0
( PNS - 3B ) MKG: 3 1 92 0 0
3,454,760 6,656 570,260
-
19,967 2,884,500
Halaman : 74
(019) D30100301900015 BULAN : AGUSTUS 2023

NO
ILIS UUS LUSMIATI K-1 3,900,500 0 0 273,529 0 0

2 390,050 185,000 0 9,361 273,529 0
04-04-1970
156,020 0 289,680 28,084 68,382 0
7 197004041994012001 0 355,726 0 ..................
4,446,570 0 0
( PNS - 3B ) MKG: 24 4 58 0 0
5,232,282 9,361 735,082
-
28,084 4,497,200
NURJANAH, A.Md.Keb K-1 3,627,900 0 0 267,137 0 0
2 362,790 0 0 8,707 267,137 0
18-02-1974
145,116 265,000 289,680 26,121 66,784 0
8 197402182006042010 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 62 0 0
4,992,513 8,707 699,613
-
26,121 4,292,900
LENI RIDHAWAHYUNI, A.Md.Kep K-1 3,409,800 0 0 253,173 0 0
1 340,980 0 0 8,184 253,173 0
20-05-1978
68,196 265,000 217,260 24,551 63,293 0
9 197805202014102001 0 305,518 0 ..................
3,818,976 0 0
( PNS - 3A ) MKG: 18 3 75 0 0
4,587,219 8,184 654,719
-
24,551 3,932,500
DINI NURMAN RESMIATI, A.Md.Keb JD - 0 3,409,800 0 0 219,612 0 0
1 0 0 0 8,184 219,612 0
02-09-1979
68,196 265,000 144,840 24,551 54,903 0
10 197909022007012005 0 278,240 0 ..................
3,477,996 0 0
( PNS - 3A ) MKG: 18 2 7 0 0
4,140,190 8,184 585,490
-
24,551 3,554,700
DANI RADIANA, A.Md.Kep K-0 3,305,700 0 0 246,340 0 0
0 0 0 0 7,934 246,340 0
27-06-1981
0 265,000 72,420 23,801 61,585 0
11 198106272014091001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 21 0 0
3,921,216 7,934 604,116
-
23,801 3,317,100
UJANG ABDUL PATAH, AM.Kep K-1 3,204,700 0 0 225,491 0 0
2 320,470 0 0 7,691 225,491 0
17-06-1981
128,188 265,000 289,680 23,074 56,373 0
12 198106172008011004 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 4 0 0
4,464,298 7,691 604,898
-
23,074 3,859,400
Halaman : 75
(019) D30100301900015 BULAN : AGUSTUS 2023

NO
DINDIN WAHYUDIN K-1 3,106,900 0 0 220,726 0 0

2 310,690 0 0 7,457 220,726 0
04-06-1977
124,276 265,000 289,680 22,370 55,181 0
13 197706042005011011 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 84 0 0
4,347,183 7,457 589,083
-
22,370 3,758,100
2,655,100 185,000 0 115,406 3,486,160 0
876,016 4,165,000 2,317,440 346,218 871,539 0
PEG : 13 51,616,816 0 79,167 0 4,129,346 0
IST : 7 JIWA = 32 629 0 0
ANK : 12 62,851,836 115,406 9,027,836
346,218 53,824,000
RUDI SARIPUDIN RUDIANTO K-1 3,374,400 0 0 244,471 0 0
2 337,440 0 0 8,099 244,471 0
17-01-1978
134,976 240,000 289,680 24,296 61,118 0
14 197801172008011003 0 307,745 0 ..................
3,846,816 0 0
( PNS - 2D ) MKG: 25 4 67 0 0
4,653,429 8,099 645,729
-
24,296 4,007,700
TITIN SUPRIATIN JD - 0 3,480,700 0 0 170,918 0 0
2 0 180,000 0 8,354 170,918 0
29-03-1970
139,228 0 217,260 25,061 42,729 0
15 197003291996032003 0 289,594 0 ..................
3,619,928 0 0
( PNS - 2D ) MKG: 27 3 35 0 0
4,221,556 8,354 536,656
-
25,061 3,684,900
337,440 180,000 0 16,453 415,389 0
274,204 240,000 506,940 49,357 103,847 0
PEG : 2 7,466,744 0 0 0 597,339 0
IST : 1 JIWA = 7 102 0 0
ANK : 4 8,874,985 16,453 1,182,385
49,357 7,692,600
TOTAL PER SATKER 54,940,800 540,000 0 3,901,549 79,167 0
2,992,540 365,000 0 131,859 3,901,549 0
1,150,220 4,405,000 2,824,380 395,575 975,386 0
PEG : 15 59,083,560 0 79,167 0 4,726,685 0
IST : 8 JIWA = 39 731 0 0
ANK : 16 71,726,821 131,859 10,210,221
395,575 61,516,600
Halaman : 76
(019) D30100301900015 BULAN : AGUSTUS 2023

NO
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 77
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS KARANGTENGAH
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
drg.ENUR NURHAYATI K-0 5,266,100 0 0 480,000 98,275 0

0 0 0 0 12,639 480,000 0
24-11-1965
0 1,200,000 72,420 37,916 120,000 0
1 196511241992032006 0 421,288 0 ..................
5,266,100 0 98,275
( PNS - 4C ) MKG: 30 1 68 0 0
7,167,418 12,639 1,170,118
-
37,916 5,997,300
dr.NENDEN EVI WULANDARI TK - 0 3,666,900 0 0 480,000 25,383 0
0 0 0 0 8,801 480,000 0
22-05-1979
0 1,200,000 72,420 26,402 120,000 0
2 197905222010012005 0 293,352 0 ..................
3,666,900 0 25,383
( PNS - 4A ) MKG: 12 1 32 0 0
5,479,938 8,801 953,938
-
26,402 4,526,000
RANI GULTOM,Amd.Keb TK - 0 4,555,800 0 0 367,614 43,933 0
0 0 0 0 10,934 367,614 0
29-11-1970
0 850,000 72,420 32,802 91,904 0
3 197011291992022001 0 364,464 0 ..................
4,555,800 0 43,933
( PNS - 4A ) MKG: 26 1 48 0 0
5,933,551 10,934 911,651
-
32,802 5,021,900
0 0 0 32,374 1,327,614 0
0 3,250,000 217,260 97,120 331,904 0
PEG : 3 13,488,800 0 167,591 0 1,079,104 0
IST : 0 JIWA = 3 148 0 0
ANK : 0 18,580,907 32,374 3,035,707
97,120 15,545,200
DINCE ELIANA, SKM K-1 3,518,100 0 0 392,988 0 0
2 351,810 0 0 8,443 392,988 0
28-09-1979
140,724 600,000 289,680 25,330 98,247 0
4 197909282011012001 0 320,851 0 ..................
4,010,634 0 0
( PNS - 3D ) MKG: 12 4 84 0 0
5,327,159 8,443 845,859
-
25,330 4,481,300
SRI SEJATI K-1 4,508,600 0 0 328,239 5,842 0
2 450,860 0 0 10,821 328,239 0
01-01-1967
180,344 500,000 289,680 32,462 82,060 0
5 196701011989032014 0 411,184 0 ..................
5,139,804 0 5,842
( PNS - 3D ) MKG: 28 4 60 0 0
6,306,908 10,821 870,608
-
32,462 5,436,300
Halaman : 78
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
ATI RAHMAWATI, AM.Keb. K-1 4,508,600 0 0 350,170 18,125 0

1 450,860 0 0 10,821 350,170 0
20-10-1968
90,172 500,000 217,260 32,462 87,542 0
6 196810201990032004 0 403,971 0 ..................
5,049,632 0 18,125
( PNS - 3D ) MKG: 28 3 21 0 0
6,178,491 10,821 903,091
-
32,462 5,275,400
AI KUSMIATI JD - 0 4,370,900 0 0 321,881 5,342 0
1 0 0 0 10,490 321,881 0
20-04-1969
87,418 500,000 144,840 31,470 80,470 0
7 196904201991032006 0 356,665 0 ..................
4,458,318 0 5,342
( PNS - 3D ) MKG: 26 2 77 0 0
5,472,418 10,490 806,318
-
31,470 4,666,100
TINA NURLINA EKAWATI TK - 0 4,370,900 0 0 358,513 18,446 0
0 0 0 0 10,490 358,513 0
16-02-1972
0 500,000 72,420 31,470 89,628 0
8 197202161992032005 0 349,672 0 ..................
4,370,900 0 18,446
( PNS - 3D ) MKG: 26 1 80 0 0
5,362,319 10,490 858,219
-
31,470 4,504,100
NENENG LIA AMALIA TK - 0 4,237,500 0 0 361,144 12,496 0
0 0 0 0 10,170 361,144 0
30-10-1971
0 500,000 72,420 30,510 90,286 0
9 197110301993032006 0 339,000 0 ..................
4,237,500 0 12,496
( PNS - 3D ) MKG: 24 1 66 0 0
5,224,306 10,170 843,606
-
30,510 4,380,700
MULYADI K-1 3,941,400 0 0 330,205 0 0
2 394,140 0 0 9,459 330,205 0
17-08-1974
157,656 500,000 289,680 28,378 82,551 0
10 197408171994031006 0 359,456 0 ..................
4,493,196 0 0
( PNS - 3C ) MKG: 23 4 31 0 0
5,650,949 9,459 810,049
-
28,378 4,840,900
ARIEF HERMAWAN, AMKL K-1 3,941,400 0 0 318,926 0 0
2 394,140 0 0 9,459 318,926 0
23-05-1975
157,656 500,000 289,680 28,378 79,731 0
11 197505232003121002 0 359,456 0 ..................
4,493,196 0 0
( PNS - 3C ) MKG: 22 4 11 0 0
5,639,650 9,459 795,950
-
28,378 4,843,700
Halaman : 79
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
NANI ROHAENI TK - 0 4,461,800 0 0 396,192 13,221 0

0 0 0 0 10,708 396,192 0
23-06-1967
0 265,000 72,420 32,125 99,048 0
12 196706231988032002 0 356,944 0 ..................
4,461,800 0 13,221
( PNS - 3C ) MKG: 30 1 72 0 0
5,251,538 10,708 908,238
-
32,125 4,343,300
dr. MAYA ROGAYANTI K-1 3,139,400 0 0 393,395 0 0
1 313,940 0 0 7,535 393,395 0
09-01-1973
62,788 325,000 217,260 22,604 98,349 0
13 197301092014122002 0 281,290 0 ..................
3,516,128 0 0
( PNS - 3B ) MKG: 10 3 51 0 0
4,481,973 7,535 803,173
-
22,604 3,678,800
EVI SUSILAWATI, AM.Keb. K-1 3,340,300 0 0 270,794 0 0
1 334,030 0 0 8,017 270,794 0
18-08-1981
66,806 300,000 217,260 24,050 67,699 0
14 198108182006042017 0 299,291 0 ..................
3,741,136 0 0
( PNS - 3B ) MKG: 14 3 94 0 0
4,561,351 8,017 669,851
-
24,050 3,891,500
LILIS SANTIKASARI TK - 0 3,665,900 0 0 287,733 0 0
0 0 0 0 8,798 287,733 0
04-03-1972
0 265,000 72,420 26,394 71,933 0
15 197203041993012003 0 293,272 0 ..................
3,665,900 0 0
( PNS - 3B ) MKG: 20 1 85 0 0
4,326,330 8,798 688,130
-
26,394 3,638,200
FITRIA PURWANTI, AM.Kep K-1 3,445,500 0 0 361,965 0 0
2 344,550 0 0 8,269 361,965 0
14-08-1979
137,820 265,000 289,680 24,808 90,491 0
16 197908142008012006 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 71 0 0
4,877,663 8,269 799,763
-
24,808 4,077,900
ENING SUARSIH, AMd.Keb K-0 3,627,900 0 0 283,364 0 0
0 0 0 0 8,707 283,364 0
27-07-1968
0 265,000 72,420 26,121 70,841 0
17 196807272006042004 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 53 0 0
4,283,565 8,707 679,265
-
26,121 3,604,300
Halaman : 80
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
NENDEN HERNAWATI K-1 3,627,900 0 0 294,688 0 0

1 362,790 0 0 8,707 294,688 0
10-02-1969
72,558 265,000 217,260 26,121 73,672 0
18 196902102006042008 0 325,060 0 ..................
4,063,248 0 0
( PNS - 3A ) MKG: 22 3 24 0 0
4,875,048 8,707 728,248
-
26,121 4,146,800
AAS AISAH, A.Md.Keb JD - 0 3,627,900 0 0 289,601 0 0
2 0 0 0 8,707 289,601 0
13-05-1972
145,116 265,000 217,260 26,121 72,400 0
19 197205132006042009 0 301,841 0 ..................
3,773,016 0 0
( PNS - 3A ) MKG: 22 3 65 0 0
4,579,770 8,707 698,670
-
26,121 3,881,100
RADEN DINNY ISMAYATI, Amd.Kep K-1 3,305,700 0 0 285,195 0 0
2 330,570 0 0 7,934 285,195 0
23-05-1983
132,228 265,000 289,680 23,801 71,299 0
20 198305232012122001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 1 0 0
4,640,109 7,934 689,709
-
23,801 3,950,400
R.YOGI GINANJAR, A.MD.AK K-1 3,106,900 0 0 334,843 0 0
1 310,690 0 0 7,457 334,843 0
16-06-1985
62,138 265,000 217,260 22,370 83,711 0
21 198506162009021001 0 278,378 0 ..................
3,479,728 0 0
( PNS - 3A ) MKG: 12 3 1 0 0
4,326,659 7,457 726,759
-
22,370 3,599,900
LIA ISKANI, Amd, Kep K-1 3,012,000 0 0 317,683 0 0
2 301,200 0 0 7,229 317,683 0
30-07-1986
120,480 265,000 289,680 21,686 79,421 0
22 198607302011012001 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 55 0 0
4,335,013 7,229 700,713
-
21,686 3,634,300
ERNA SRIWULANDARI, AMd,Keb TK - 0 2,830,900 0 0 250,908 0 0
0 0 0 0 6,794 250,908 0
16-11-1987
0 265,000 72,420 20,382 62,727 0
23 198711162011012001 0 226,472 0 ..................
2,830,900 0 0
( PNS - 3A ) MKG: 6 1 79 0 0
3,446,483 6,794 567,283
-
20,382 2,879,200
Halaman : 81
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
ASEP SUMPENA K-1 3,860,100 0 0 275,425 0 0

2 386,010 0 0 9,264 275,425 0
13-04-1967
154,404 240,000 289,680 27,793 68,856 0
24 196704131990031003 0 352,041 0 ..................
4,400,514 0 0
( PNS - 3A ) MKG: 26 4 3 0 0
5,242,679 9,264 733,379
-
27,793 4,509,300
ARIEF SETIA K-1 3,305,700 0 0 323,467 0 0
1 330,570 0 0 7,934 323,467 0
08-01-1971
66,114 240,000 217,260 23,801 80,867 0
25 197101082000121002 0 296,191 0 ..................
3,702,384 0 0
( PNS - 3A ) MKG: 16 3 14 0 0
4,514,860 7,934 732,260
-
23,801 3,782,600
5,056,160 0 0 196,213 7,127,319 0
1,834,422 7,855,000 4,417,620 588,637 1,781,829 0
PEG : 22 88,645,882 0 73,472 0 7,091,671 0
IST : 14 JIWA = 61 1,098 0 0
ANK : 25 108,905,241 196,213 16,859,141
588,637 92,046,100
DINI NURHANDINI JUNAEDI, A.Md.Keb K-1 2,980,800 0 0 273,095 0 0
1 298,080 0 0 7,154 273,095 0
16-09-1986
59,616 240,000 217,260 21,462 68,274 0
26 198609162017052002 0 267,080 0 ..................
3,338,496 0 0
( PNS - 2D ) MKG: 17 3 98 0 0
4,097,565 7,154 637,065
-
21,462 3,460,500
ENENG RANI ARYANTI, A.Md.Keb K-0 2,889,800 0 0 249,715 0 0
0 0 0 0 6,936 249,715 0
06-02-1989
0 240,000 72,420 20,807 62,429 0
27 198902062017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 93 0 0
3,479,771 6,936 571,071
-
RENA AGUSTINA, A.Md.Keb K-1 2,801,500 0 0 252,795 0 0
1 280,150 0 0 6,724 252,795 0
09-08-1989
56,030 240,000 217,260 20,171 63,199 0
28 198908092017052001 0 251,014 0 ..................
3,137,680 0 0
( PNS - 2D ) MKG: 13 3 73 0 0
3,874,703 6,724 593,903
-
20,171 3,280,800
Halaman : 82
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
LIA MARLIANA, A.Md.Kep K-1 2,374,300 0 0 188,069 0 0

0 237,430 0 0 5,698 188,069 0
05-03-1989
0 240,000 144,840 17,095 47,017 0
29 198903052020122004 0 208,938 0 ..................
2,611,730 0 0
( PNS - 2C ) MKG: 5 2 85 0 0
3,207,517 5,698 466,817
-
17,095 2,740,700
YAYAT SETIASIH K-0 3,106,100 0 0 215,661 0 0
0 0 0 0 7,455 215,661 0
07-04-1979
0 240,000 72,420 22,364 53,915 0
30 197904072007012009 0 248,488 0 ..................
3,106,100 0 0
( PNS - 2B ) MKG: 25 1 83 0 0
3,664,083 7,455 547,883
-
815,660 0 0 33,967 1,179,335 0
115,646 1,200,000 724,200 101,899 294,834 0
PEG : 5 15,083,806 0 0 0 1,206,704 0
IST : 3 JIWA = 10 432 0 0
ANK : 2 18,323,639 33,967 2,816,739
101,899 15,506,900
TOTAL PER SATKER 109,396,600 0 0 9,634,268 241,063 0
5,871,820 0 0 262,554 9,634,268 0
1,950,068 12,305,000 5,359,080 787,656 2,408,567 0
PEG : 30 117,218,488 0 241,063 0 9,377,479 0
IST : 17 JIWA = 74 1,678 0 0
ANK : 27 145,809,787 262,554 22,711,587
787,656 123,098,200
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 83
(019) D30100301900016 BULAN : AGUSTUS 2023

NO
Halaman : 84
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIHERANG
(019) D30100301900017 BULAN : AGUSTUS 2023

NO
dr.I MADE SETIAWAN K-1 4,416,700 0 0 440,087 39,638 0

2 441,670 0 0 10,600 440,087 0
22-08-1972
176,668 1,200,000 289,680 31,800 110,022 0
1 197208222002121005 0 402,803 0 ..................
5,035,038 0 39,638
( PNS - 4A ) MKG: 24 4 7 0 0
7,046,850 10,600 1,034,950
-
MINI JD - 0 4,416,700 0 0 293,989 22,771 0
1 0 0 0 10,600 293,989 0
06-08-1971
88,334 850,000 144,840 31,800 73,497 0
2 197108061991032003 0 360,403 0 ..................
4,505,034 0 22,771
( PNS - 4A ) MKG: 25 2 26 0 0
5,859,060 10,600 793,060
-
Kenaikan Pangkat 31,800 5,066,000
441,670 0 0 21,200 734,076 0
265,002 2,050,000 434,520 63,600 183,519 0
PEG : 2 9,540,072 0 62,409 0 763,206 0
IST : 1 JIWA = 6 33 0 0
ANK : 3 12,905,910 21,200 1,828,010
63,600 11,077,900
dr.MIRRA PERMATASARI JD - 0 3,743,100 0 0 348,614 0 0
1 0 0 0 8,983 348,614 0
02-01-1979
74,862 750,000 144,840 26,950 87,154 0
3 197901022010012014 0 305,437 0 ..................
3,817,962 0 0
( PNS - 3D ) MKG: 16 2 89 0 0
5,097,438 8,983 777,138
-
26,950 4,320,300
drg.INDRIANI ULFAH K-1 3,518,100 0 0 324,912 0 0
2 351,810 0 0 8,443 324,912 0
27-08-1978
140,724 750,000 289,680 25,330 81,228 0
4 197808272010012007 0 320,851 0 ..................
4,010,634 0 0
( PNS - 3D ) MKG: 12 4 65 0 0
5,409,064 8,443 760,764
-
25,330 4,648,300
NANAN SUPRIATNA K-1 4,508,600 0 0 300,191 4,508 0
2 450,860 0 0 10,821 300,191 0
09-08-1965
180,344 500,000 289,680 32,462 75,048 0
5 196508091991031009 0 411,184 0 ..................
5,139,804 0 4,508
( PNS - 3D ) MKG: 28 4 48 0 0
6,277,514 10,821 834,214
-
32,462 5,443,300
Halaman : 85
(019) D30100301900017 BULAN : AGUSTUS 2023

NO
DEDEH KARYAWATI JD - 0 4,508,600 0 0 274,895 0 0

2 0 0 0 10,821 274,895 0
16-10-1969
180,344 500,000 217,260 32,462 68,724 0
6 196910161990032003 0 375,116 0 ..................
4,688,944 0 0
( PNS - 3D ) MKG: 28 3 36 0 0
5,724,418 10,821 762,018
-
32,462 4,962,400
SITI RAHMAWATI, A.Md.Keb TK - 0 4,508,600 0 0 271,218 20,579 0
0 0 0 0 10,821 271,218 0
29-04-1970
0 500,000 72,420 32,462 67,804 0
7 197004291990032009 0 360,688 0 ..................
4,508,600 0 20,579
( PNS - 3D ) MKG: 28 1 72 0 0
5,416,172 10,821 763,572
-
32,462 4,652,600
ROYATI K-1 4,237,500 0 0 306,502 0 0
2 423,750 0 0 10,170 306,502 0
25-11-1974
169,500 500,000 289,680 30,510 76,626 0
8 197411251994032001 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 56 0 0
5,967,668 10,170 810,268
-
30,510 5,157,400
LAILA LESNASARI, AM.Kep K-1 3,743,100 0 0 264,905 0 0
2 374,310 0 0 8,983 264,905 0
26-04-1983
149,724 500,000 289,680 26,950 66,226 0
9 198304262005012006 0 341,371 0 ..................
4,267,134 0 0
( PNS - 3D ) MKG: 16 4 83 0 0
5,357,735 8,983 708,435
-
26,950 4,649,300
YANTI NURHATI, Am,Farm K-1 3,272,200 0 0 277,699 0 0
2 327,220 0 0 7,853 277,699 0
08-07-1977
130,888 750,000 289,680 23,560 69,425 0
10 197707082011012002 0 298,425 0 ..................
3,730,308 0 0
( PNS - 3C ) MKG: 10 4 62 0 0
5,079,162 7,853 676,962
-
23,560 4,402,200
BUDI SUKMAWAN, AM.Kep. TK - 0 3,941,400 0 0 298,083 754 0
0 0 0 0 9,459 298,083 0
04-10-1976
0 600,000 72,420 28,378 74,521 0
11 197610042001121004 0 315,312 0 ..................
3,941,400 0 754
( PNS - 3C ) MKG: 22 1 13 0 0
4,950,507 9,459 726,507
-
28,378 4,224,000
Halaman : 86
(019) D30100301900017 BULAN : AGUSTUS 2023

NO
BAMBANG SANTOSO K-1 4,065,500 0 0 279,914 0 0

2 406,550 0 0 9,757 279,914 0
21-12-1970
162,620 500,000 289,680 29,272 69,979 0
12 197012211994031007 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 3 0 0
5,743,296 9,757 759,696
-
29,272 4,983,600
DIAH FITRYA, AM.Kep K-1 3,704,300 0 0 291,162 0 0
2 370,430 0 0 8,890 291,162 0
27-09-1977
148,172 500,000 289,680 26,671 72,790 0
13 197709272007012005 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 40 0 0
5,339,345 8,890 737,345
-
26,671 4,602,000
TITA RATNA JUWITA, AM.K K-1 3,704,300 0 0 277,874 0 0
2 370,430 0 0 8,890 277,874 0
08-04-1980
148,172 500,000 289,680 26,671 69,468 0
14 198004082008012004 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 18 0 0
5,326,035 8,890 720,735
12345
26,671 4,605,300
NIA HERNIATI, A.MK K-1 3,704,300 0 0 269,747 0 0
2 370,430 0 0 8,890 269,747 0
05-10-1981
148,172 500,000 289,680 26,671 67,437 0
15 198110052007012012 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 87 0 0
5,317,977 8,890 710,577
-
RINA ANDRIANA WIDIANTI, AM.Kep TK - 0 3,591,200 0 0 275,052 0 0
0 0 0 0 8,619 275,052 0
07-09-1981
0 500,000 72,420 25,857 68,763 0
16 198109072008012006 0 287,296 0 ..................
3,591,200 0 0
( PNS - 3C ) MKG: 16 1 39 0 0
4,473,187 8,619 665,587
25,857 3,807,600
RETNIA UTAMI, AMG K-1 3,481,600 0 0 271,701 0 0
2 348,160 0 0 8,356 271,701 0
04-10-1983
139,264 500,000 289,680 25,068 67,925 0
17 198310042006042018 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 43 0 0
5,063,872 8,356 690,572
-
25,068 4,373,300
Halaman : 87
(019) D30100301900017 BULAN : AGUSTUS 2023

NO
DEWI SUSILAWATI, S.Kep.Ners K-0 3,445,500 0 0 248,449 0 0

0 0 0 0 8,269 248,449 0
06-03-1980
0 300,000 72,420 24,808 62,112 0
18 198003062012122002 0 275,640 0 ..................
3,445,500 0 0
( PNS - 3B ) MKG: 16 1 32 0 0
4,099,478 8,269 619,278
0
24,808 3,480,200
DESY SUSANTI KARTIWA, A.Md.Keb K-1 3,238,300 0 0 243,780 0 0
2 323,830 0 0 7,772 243,780 0
03-09-1976
129,532 300,000 289,680 23,316 60,945 0
19 197609032005012008 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 36 0 0
4,556,246 7,772 631,146
12345
23,316 3,925,100
ICE MARYANI K-0 3,781,400 0 0 232,635 0 0
0 0 0 0 9,075 232,635 0
26-03-1974
0 265,000 72,420 27,226 58,159 0
20 197403262006042011 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 51 0 0
4,387,807 9,075 629,607
-
YENI YULIANTI K-1 3,445,500 0 0 260,797 0 0
2 344,550 0 0 8,269 260,797 0
07-05-1976
137,820 265,000 289,680 24,808 65,199 0
21 197605072007012007 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 79 0 0
4,776,503 8,269 673,303
-
TINEU SURTINA JD - 0 3,445,500 0 0 228,271 0 0
2 0 0 0 8,269 228,271 0
01-11-1978
137,820 265,000 217,260 24,808 57,068 0
22 197811012007012006 0 286,666 0 ..................
3,583,320 0 0
( PNS - 3B ) MKG: 16 3 54 0 0
4,326,982 8,269 605,082
-
JUBAEDAH K-1 3,305,700 0 0 235,701 0 0
2 330,570 0 0 7,934 235,701 0
03-02-1979
132,228 265,000 289,680 23,801 58,925 0
23 197902032007012006 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 27 0 0
4,590,641 7,934 627,841
-
23,801 3,962,800
Halaman : 88
(019) D30100301900017 BULAN : AGUSTUS 2023

NO
YENI SULASTRI K-1 3,106,900 0 0 222,499 0 0

2 310,690 0 0 7,457 222,499 0
26-06-1976
124,276 265,000 289,680 22,370 55,625 0
24 197606262005012012 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 28 0 0
4,348,900 7,457 591,300
-
22,370 3,757,600
RETNO ARI SAVITRI, Am.Keb K-0 3,106,900 0 0 210,498 0 0
0 0 0 0 7,457 210,498 0
25-06-1985
0 265,000 72,420 22,370 52,624 0
25 198506252009022004 0 248,552 0 ..................
3,106,900 0 0
( PNS - 3A ) MKG: 12 1 56 0 0
3,684,701 7,457 541,501
-
22,370 3,143,200
5,103,590 0 0 204,258 6,215,099 0
2,434,462 10,540,000 5,069,400 612,781 1,553,775 0
PEG : 23 92,646,152 0 25,841 0 7,411,694 0
IST : 14 JIWA = 70 1,117 0 0
ANK : 33 115,314,648 204,258 16,023,448
612,781 99,291,200
OKTOBIYANTI NUR ELANG, AM.Keb K-0 2,980,800 0 0 203,061 0 0
0 0 0 0 7,154 203,061 0
17-10-1985
0 240,000 72,420 21,462 50,765 0
26 198510172017052002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 9 0 0
3,524,906 7,154 520,906
-
21,462 3,004,000
RIMA NURHAKIM, A.Md.Keb JD - 0 2,980,800 0 0 198,971 0 0
0 0 0 0 7,154 198,971 0
28-02-1986
0 240,000 72,420 21,462 49,743 0
27 198602282017052003 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 87 0 0
3,520,894 7,154 515,794
-
21,462 3,005,100
LILIS SUMARYANI, A.Md.Keb TK - 0 2,889,800 0 0 198,512 0 0
0 0 0 0 6,936 198,512 0
19-05-1987
0 240,000 72,420 20,807 49,628 0
28 198705192017052005 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 92 0 0
3,428,567 6,936 507,067
-
20,807 2,921,500
Halaman : 89
(019) D30100301900017 BULAN : AGUSTUS 2023

NO
0 0 0 21,244 600,544 0
0 720,000 217,260 63,731 150,136 0
PEG : 3 8,851,400 0 0 0 708,112 0
IST : 0 JIWA = 3 188 0 0
ANK : 0 10,474,367 21,244 1,543,767
63,731 8,930,600
TOTAL PER SATKER 102,792,900 0 0 7,549,719 88,250 0
5,545,260 0 0 246,702 7,549,719 0
2,699,464 13,310,000 5,721,180 740,112 1,887,430 0
PEG : 28 111,037,624 0 88,250 0 8,883,012 0
IST : 15 JIWA = 79 1,338 0 0
ANK : 36 138,694,925 246,702 19,395,225
740,112 119,299,700
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 90
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS MANDE
(019) D30100301900018 BULAN : AGUSTUS 2023

NO
dr.CAHYO PRIAMBODO K-1 4,066,500 0 0 358,843 17,600 0

2 406,650 0 0 9,760 358,843 0
31-03-1975
162,660 1,200,000 289,680 29,279 89,711 0
1 197503312005011009 0 370,865 0 ..................
4,635,810 0 17,600
( PNS - 4B ) MKG: 16 4 86 0 0
6,541,058 9,760 876,058
-
29,279 5,665,000
H.MUHAMMAD SOEKARNO K-1 4,898,100 0 0 349,314 43,683 0
2 489,810 0 0 11,755 349,314 0
04-08-1968
195,924 850,000 289,680 35,266 87,328 0
2 196808041989031008 0 446,707 0 ..................
5,583,834 0 43,683
( PNS - 4B ) MKG: 28 4 21 0 0
7,163,553 11,755 974,053
-
35,266 6,189,500
drg.TUTIK SUPRIHATIN K-1 4,699,300 0 0 348,565 61,021 0
1 469,930 0 0 11,278 348,565 0
08-04-1965
93,986 1,200,000 217,260 33,835 87,141 0
3 196504081994032002 0 421,057 0 ..................
5,263,216 0 61,021
( PNS - 4A ) MKG: 28 3 22 0 0
7,135,197 11,278 962,897
-
33,835 6,172,300
dr.SANDRAWATI K-1 4,151,100 0 0 373,596 22,692 0
2 415,110 0 0 9,963 373,596 0
16-05-1974
166,044 1,200,000 289,680 29,888 93,399 0
4 197405162006042006 0 378,580 0 ..................
4,732,254 0 22,692
( PNS - 4A ) MKG: 20 4 45 0 0
6,658,118 9,963 908,118
-
29,888 5,750,000
1,781,500 0 0 42,756 1,430,318 0
618,614 4,450,000 1,086,300 128,268 357,579 0
PEG : 4 20,215,114 0 144,996 0 1,617,209 0
IST : 4 JIWA = 15 174 0 0
ANK : 7 27,497,926 42,756 3,721,126
128,268 23,776,800
LIA RACHMAWATI, SST TK - 0 4,237,500 0 0 273,958 13,104 0
0 0 0 0 10,170 273,958 0
11-12-1972
0 600,000 72,420 30,510 68,489 0
5 197212111993032004 0 339,000 0 ..................
4,237,500 0 13,104
( PNS - 3D ) MKG: 24 1 69 0 0
5,237,731 10,170 735,231
-
30,510 4,502,500
Halaman : 91
(019) D30100301900018 BULAN : AGUSTUS 2023

NO
EUIS RATNA JUITA K-1 4,370,900 0 0 377,745 12,408 0

1 437,090 0 0 10,490 377,745 0
11-08-1969
87,418 500,000 217,260 31,470 94,436 0
6 196908111991032004 0 391,633 0 ..................
4,895,408 0 12,408
( PNS - 3D ) MKG: 26 3 1 0 0
6,044,782 10,490 918,182
-
31,470 5,126,600
YAYAN HERYANI TK - 0 4,370,900 0 0 267,121 14,113 0
0 0 0 0 10,490 267,121 0
13-10-1971
0 500,000 72,420 31,470 66,780 0
7 197110131992032005 0 349,672 0 ..................
4,370,900 0 14,113
( PNS - 3D ) MKG: 26 1 32 0 0
5,266,546 10,490 739,646
-
31,470 4,526,900
JULIAH K-1 4,237,500 0 0 278,476 12,379 0
0 423,750 0 0 10,170 278,476 0
06-08-1968
0 500,000 144,840 30,510 69,619 0
8 196808061993032004 0 372,900 0 ..................
4,661,250 0 12,379
( PNS - 3D ) MKG: 24 2 29 0 0
5,637,654 10,170 774,054
-
30,510 4,863,600
ROKAYAH TK - 0 4,237,500 0 0 279,541 8,617 0
0 0 0 0 10,170 279,541 0
06-06-1972
0 500,000 72,420 30,510 69,885 0
9 197206061994032006 0 339,000 0 ..................
4,237,500 0 8,617
( PNS - 3D ) MKG: 24 1 65 0 0
5,138,823 10,170 737,723
-
30,510 4,401,100
ELIS HARTATI TK - 0 4,237,500 0 0 280,957 8,683 0
0 0 0 0 10,170 280,957 0
06-07-1972
0 500,000 72,420 30,510 70,239 0
10 197207061993012003 0 339,000 0 ..................
4,237,500 0 8,683
( PNS - 3D ) MKG: 24 1 19 0 0
5,140,259 10,170 739,559
-
30,510 4,400,700
SERI SUNARSI NENGSIH TK - 0 3,941,400 0 0 249,423 0 0
0 0 0 0 9,459 249,423 0
29-01-1975
0 500,000 72,420 28,378 62,356 0
11 197501292000122002 0 315,312 0 ..................
3,941,400 0 0
( PNS - 3C ) MKG: 22 1 48 0 0
4,801,128 9,459 664,928
-
28,378 4,136,200
Halaman : 92
(019) D30100301900018 BULAN : AGUSTUS 2023

NO
SITI ASIAH, AM.Kep K-0 3,704,300 0 0 237,459 0 0

0 0 0 0 8,890 237,459 0
23-12-1979
0 500,000 72,420 26,671 59,365 0
12 197912232007012010 0 296,344 0 ..................
3,704,300 0 0
( PNS - 3C ) MKG: 18 1 89 0 0
4,549,829 8,890 628,729
-
26,671 3,921,100
DINDIN KURNIADIN K-1 3,481,600 0 0 283,172 0 0
2 348,160 0 0 8,356 283,172 0
28-05-1972
139,264 500,000 289,680 25,068 70,793 0
13 197205282006041010 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 11 0 0
5,075,311 8,356 704,911
-
25,068 4,370,400
dr. DEA DWIRANI K-1 2,773,200 0 0 271,846 0 0
1 277,320 0 0 6,656 271,846 0
24-04-1993
55,464 325,000 217,260 19,967 67,961 0
14 199304242020122013 0 248,479 0 ..................
3,105,984 0 0
( PNS - 3B ) MKG: 2 3 96 0 0
3,946,809 6,656 614,909
-
19,967 3,331,900
NENI SURTINAH K-1 3,781,400 0 0 254,539 0 0
2 378,140 0 0 9,075 254,539 0
30-12-1973
151,256 265,000 289,680 27,226 63,635 0
15 197312302006042012 0 344,864 0 ..................
4,310,796 0 0
( PNS - 3B ) MKG: 23 4 23 0 0
5,156,339 9,075 699,339
-
27,226 4,457,000
SRI BUDIARTI K-1 3,781,400 0 0 254,539 0 0
2 378,140 0 0 9,075 254,539 0
27-08-1974
151,256 265,000 289,680 27,226 63,635 0
16 197408272006042019 0 344,864 0 ..................
4,310,796 0 0
( PNS - 3B ) MKG: 23 4 23 0 0
5,156,339 9,075 699,339
-
27,226 4,457,000
ASEP MULYA PERMANA K-1 3,445,500 0 0 235,893 0 0
2 344,550 0 0 8,269 235,893 0
26-07-1982
137,820 265,000 289,680 24,808 58,973 0
17 198207262008011004 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 53 0 0
4,751,573 8,269 642,173
-
24,808 4,109,400
Halaman : 93
(019) D30100301900018 BULAN : AGUSTUS 2023

NO
ENDAH SITI SAADAH, AM.KG K-1 3,238,300 0 0 246,355 0 0

2 323,830 0 0 7,772 246,355 0
26-03-1980
129,532 265,000 289,680 23,316 61,589 0
18 198003262009022002 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 80 0 0
4,523,865 7,772 634,365
-
23,316 3,889,500
LATIFAH, AM.Kep K-1 3,139,400 0 0 232,106 0 0
1 313,940 0 0 7,535 232,106 0
10-11-1986
62,788 265,000 217,260 22,604 58,027 0
19 198611102011012002 0 281,290 0 ..................
3,516,128 0 0
( PNS - 3B ) MKG: 10 3 29 0 0
4,260,662 7,535 601,562
-
22,604 3,659,100
JEJEN ISKANDAR, A.Md.Kep K-1 3,305,700 0 0 234,627 0 0
2 330,570 0 0 7,934 234,627 0
09-11-1981
132,228 265,000 289,680 23,801 58,657 0
20 198111092014101001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 59 0 0
4,589,599 7,934 626,499
-
23,801 3,963,100
VIKA YUSTIKASARI, A.Md.Farm K-1 2,920,100 0 0 206,710 0 0
1 292,010 0 0 7,008 206,710 0
09-12-1988
58,402 265,000 217,260 21,025 51,677 0
21 198812092009022001 0 261,641 0 ..................
3,270,512 0 0
( PNS - 3A ) MKG: 8 3 46 0 0
3,987,561 7,008 548,061
000
21,025 3,439,500
3,847,500 0 0 151,689 4,464,467 0
1,105,428 6,780,000 3,186,480 455,070 1,116,116 0
PEG : 17 68,157,028 0 69,304 0 5,452,564 0
IST : 11 JIWA = 44 772 0 0
ANK : 16 83,264,810 151,689 11,709,210
455,070 71,555,600
SRI DESI WIDIANTI K-0 3,374,400 0 0 220,393 0 0
0 0 0 0 8,099 220,393 0
01-12-1976
0 240,000 72,420 24,296 55,098 0
22 197612012012122001 0 269,952 0 ..................
3,374,400 0 0
( PNS - 2D ) MKG: 25 1 30 0 0
3,939,638 8,099 577,838
-
24,296 3,361,800
Halaman : 94
(019) D30100301900018 BULAN : AGUSTUS 2023

NO
AI RINA RACHMAWATY, A.Md.Keb K-0 3,074,700 0 0 206,495 0 0

0 0 0 0 7,379 206,495 0
07-09-1983
0 240,000 72,420 22,138 51,624 0
23 198309072017052001 0 245,976 0 ..................
3,074,700 0 0
( PNS - 2D ) MKG: 19 1 80 0 0
3,623,212 7,379 533,612
-
22,138 3,089,600
ERNA NURHAYATI, A.Md.Keb K-1 2,980,800 0 0 177,265 0 0
2 298,080 0 0 7,154 177,265 0
09-01-1986
119,232 240,000 289,680 21,462 44,316 0
24 198601092017052002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 73 0 0
4,133,746 7,154 522,046
-
21,462 3,611,700
HERTI OKTAPIAWATI, A.Md.Kep K-1 2,374,300 0 0 160,218 0 0
2 237,430 0 0 5,698 160,218 0
28-10-1985
94,972 240,000 289,680 17,095 40,054 0
25 198510282020122006 0 216,536 0 ..................
2,706,702 0 0
( PNS - 2C ) MKG: 5 4 8 0 0
3,419,401 5,698 439,601
-
17,095 2,979,800
535,510 0 0 28,330 764,371 0
214,204 960,000 724,200 84,991 191,092 0
PEG : 4 12,553,914 0 0 0 1,004,313 0
IST : 2 JIWA = 10 191 0 0
ANK : 4 15,115,997 28,330 2,073,097
84,991 13,042,900
TOTAL PER SATKER 92,823,300 0 0 6,659,156 214,300 0
6,164,510 0 0 222,775 6,659,156 0
1,938,246 12,190,000 4,996,980 668,329 1,664,787 0
PEG : 25 100,926,056 0 214,300 0 8,074,086 0
IST : 17 JIWA = 69 1,137 0 0
ANK : 27 125,878,733 222,775 17,503,433
668,329 108,375,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 95
(019) D30100301900018 BULAN : AGUSTUS 2023

NO
Halaman : 96
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS KADEMANGAN
(019) D30100301900019 BULAN : AGUSTUS 2023

NO
dr.RD.YADI YULIADI K-1 4,898,100 0 0 372,762 61,417 0

2 489,810 0 0 11,755 372,762 0
21-07-1964
195,924 1,200,000 289,680 35,266 93,191 0
1 196407211994031006 0 446,707 0 ..................
5,583,834 0 61,417
( PNS - 4B ) MKG: 28 4 84 0 0
7,554,798 11,755 1,021,098
-
35,266 6,533,700
dr.NETTY HARNETTY K-1 4,463,000 0 0 325,100 36,575 0
2 446,300 0 0 10,711 325,100 0
20-07-1966
178,520 1,200,000 289,680 32,134 81,275 0
2 196607202002122001 0 407,026 0 ..................
5,087,820 0 36,575
( PNS - 4B ) MKG: 23 4 1 0 0
6,982,021 10,711 892,821
-
32,134 6,089,200
DEDEH ROHAYATI, AM.Keb TK - 0 4,847,300 0 0 322,694 55,088 0
0 0 0 0 11,634 322,694 0
01-02-1968
0 850,000 72,420 34,901 80,673 0
3 196802011987032001 0 387,784 0 ..................
4,847,300 0 55,088
( PNS - 4A ) MKG: 30 1 37 0 0
6,194,074 11,634 892,774
-
34,901 5,301,300
936,110 0 0 34,100 1,020,556 0
374,444 3,250,000 651,780 102,301 255,139 0
PEG : 3 15,518,954 0 153,080 0 1,241,517 0
IST : 2 JIWA = 9 122 0 0
ANK : 4 20,730,893 34,100 2,806,693
102,301 17,924,200
E.HANNY WINDYALARAS, S.Kep. K-0 3,743,100 0 0 336,042 0 0
0 0 0 0 8,983 336,042 0
24-12-1978
0 600,000 72,420 26,950 84,010 0
4 197812242005012011 0 299,448 0 ..................
3,743,100 0 0
( PNS - 3D ) MKG: 16 1 38 0 0
4,787,533 8,983 755,433
-
26,950 4,032,100
YAYAN, AM.Keb K-1 4,370,900 0 0 276,408 0 0
2 437,090 0 0 10,490 276,408 0
26-02-1970
174,836 500,000 289,680 31,470 69,102 0
5 197002261991022001 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 22 0 0
6,090,896 10,490 786,096
31,470 5,304,800
Halaman : 97
(019) D30100301900019 BULAN : AGUSTUS 2023

NO
UCU ROHANAH, AM.Keb K-1 3,591,200 0 0 237,647 0 0

2 359,120 0 0 8,619 237,647 0
01-02-1980
143,648 240,000 289,680 25,857 59,412 0
6 198002012005012009 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 81 0 0
4,895,852 8,619 659,052
-
25,857 4,236,800
WHENI ANDRIANI, ST K-1 3,781,400 0 0 257,740 0 0
2 378,140 0 0 9,075 257,740 0
17-11-1973
151,256 300,000 289,680 27,226 64,435 0
7 197311172006042007 0 344,864 0 ..................
4,310,796 0 0
( PNS - 3B ) MKG: 22 4 23 0 0
5,194,540 9,075 703,340
0
27,226 4,491,200
RINA INSYAFRIATINI K-0 3,554,000 0 0 251,642 0 0
0 0 0 0 8,530 251,642 0
10-03-1978
0 300,000 72,420 25,589 62,911 0
8 197803102007012008 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 11 0 0
4,212,192 8,530 632,992
-
25,589 3,579,200
ELLY ASTUTI, Amd.Kep TK - 0 3,139,400 0 0 221,759 0 0
0 0 0 0 7,535 221,759 0
07-10-1980
0 300,000 72,420 22,604 55,440 0
9 198010072010012003 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 72 0 0
3,763,790 7,535 558,490
-
22,604 3,205,300
SHANTY NOVIANTY K-1 3,665,900 0 0 266,711 0 0
1 366,590 0 0 8,798 266,711 0
08-11-1976
73,318 265,000 217,260 26,394 66,678 0
10 197611082006042011 0 328,465 0 ..................
4,105,808 0 0
( PNS - 3B ) MKG: 20 3 75 0 0
4,890,046 8,798 697,046
-
26,394 4,193,000
AYI NURHAYATI K-1 3,554,000 0 0 240,989 0 0
2 355,400 0 0 8,530 240,989 0
11-06-1979
142,160 265,000 289,680 25,589 60,247 0
11 197906112007012022 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 32 0 0
4,881,380 8,530 659,480
-
25,589 4,221,900
Halaman : 98
(019) D30100301900019 BULAN : AGUSTUS 2023

NO
IIN KASWATI TK - 0 3,238,300 0 0 231,105 0 0

0 0 0 0 7,772 231,105 0
15-06-1975
0 265,000 72,420 23,316 57,776 0
12 197506152006042018 0 259,064 0 ..................
3,238,300 0 0
( PNS - 3B ) MKG: 12 1 20 0 0
3,837,933 7,772 579,033
-
23,316 3,258,900
NINA FARIDAWATI TK - 0 4,023,300 0 0 226,746 0 0
0 0 185,000 0 9,656 226,746 0
12-05-1972
0 0 72,420 28,968 56,687 0
13 197205121992032004 0 321,864 0 ..................
4,023,300 0 0
( PNS - 3B ) MKG: 26 1 31 0 0
4,546,121 9,656 643,921
-
28,968 3,902,200
DELLY WIDIA ASTUTI K-1 3,409,800 0 0 256,224 0 0
2 340,980 0 0 8,184 256,224 0
29-11-1978
136,392 265,000 289,680 24,551 64,056 0
14 197811292007012002 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 78 0 0
4,730,889 8,184 663,989
-
24,551 4,066,900
KANIYANTI, A.Md K-1 3,409,800 0 0 251,561 0 0
2 340,980 185,000 0 8,184 251,561 0
14-09-1974
136,392 0 289,680 24,551 62,890 0
15 197409142014092001 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 19 4 12 0 0
4,646,160 8,184 658,160
-
24,551 3,988,000
SUB TOTAL PERGOLONGAN : III 43,481,100 0 0 3,054,574 0 0
2,578,300 370,000 0 104,356 3,054,574 0
958,002 3,300,000 2,317,440 313,065 763,644 0
PEG : 12 47,017,402 0 0 0 3,761,393 0
IST : 7 JIWA = 32 495 0 0
ANK : 13 56,477,332 104,356 7,997,032
313,065 48,480,300
EUIS LAELASARI, A.Md.Keb K-1 3,074,700 0 0 220,002 0 0
2 307,470 0 0 7,379 220,002 0
03-10-1984
122,988 240,000 289,680 22,138 55,000 0
16 198410032017052002 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 75 0 0
4,284,432 7,379 584,932
-
22,138 3,699,500
Halaman : 99
(019) D30100301900019 BULAN : AGUSTUS 2023

NO
HENI HENDRIYANI K-1 2,980,800 0 0 253,918 0 0

1 298,080 0 0 7,154 253,918 0
13-03-1978
59,616 240,000 217,260 21,462 63,479 0
17 197803132012122001 0 267,080 0 ..................
3,338,496 0 0
( PNS - 2D ) MKG: 17 3 3 0 0
4,078,293 7,154 613,093
-
21,462 3,465,200
NAIH YUWIANTI K-1 2,980,800 0 0 195,346 0 0
2 298,080 0 0 7,154 195,346 0
19-03-1980
119,232 240,000 289,680 21,462 48,837 0
18 198003192012122001 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 94 0 0
4,151,848 7,154 544,648
-
21,462 3,607,200
YATI KUSMIATI, A.Md.Keb K-0 2,980,800 0 0 206,236 0 0
0 0 0 0 7,154 206,236 0
15-08-1986
0 240,000 72,420 21,462 51,559 0
19 198608152017052001 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 3 0 0
3,528,075 7,154 524,875
00
21,462 3,003,200
SESTI DESIYANTI, A.Md.Keb K-0 2,980,800 0 0 201,003 0 0
0 0 0 0 7,154 201,003 0
18-12-1986
0 240,000 72,420 21,462 50,251 0
20 198612182017052001 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 95 0 0
3,522,934 7,154 518,334
-
21,462 3,004,600
FUZI ARIA MANDALA SARI, A.Md.Keb K-1 2,980,800 0 0 228,042 0 0
2 298,080 0 0 7,154 228,042 0
20-12-1987
119,232 240,000 289,680 21,462 57,010 0
21 198712202017052003 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 67 0 0
4,184,517 7,154 585,517
-
21,462 3,599,000
IDA WIDIA MEILINA, A.Md.Keb K-0 2,889,800 0 0 219,278 0 0
0 0 0 0 6,936 219,278 0
24-05-1986
0 240,000 72,420 20,807 54,820 0
22 198605242017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 84 0 0
3,449,325 6,936 533,025
-
20,807 2,916,300
Halaman : 100
(019) D30100301900019 BULAN : AGUSTUS 2023

NO
1,201,710 0 0 50,085 1,523,825 0
421,068 1,680,000 1,303,560 150,255 380,956 0
PEG : 7 22,491,278 0 0 0 1,799,303 0
IST : 4 JIWA = 18 421 0 0
ANK : 7 27,199,424 50,085 3,904,424
150,255 23,295,000
TOTAL PER SATKER 78,558,000 0 0 5,598,955 153,080 0
4,716,120 370,000 0 188,541 5,598,955 0
1,753,514 8,230,000 4,272,780 565,621 1,399,739 0
PEG : 22 85,027,634 0 153,080 0 6,802,213 0
IST : 13 JIWA = 59 1,038 0 0
ANK : 24 104,407,649 188,541 14,708,149
565,621 89,699,500
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 101
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS PACET
(019) D30100301900020 BULAN : AGUSTUS 2023

NO
AGUS SUHENDAR K-1 4,237,500 0 0 480,000 0 0

2 423,750 0 0 10,170 480,000 0
18-08-1974
169,500 500,000 289,680 30,510 120,000 0
1 197408181994031002 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 30 0 0
6,141,140 10,170 1,027,140
-
30,510 5,114,000
SUB TOTAL PERGOLONGAN : III 4,237,500 0 0 480,000 0 0
423,750 0 0 10,170 480,000 0
169,500 500,000 289,680 30,510 120,000 0
PEG : 1 4,830,750 0 0 0 386,460 0
IST : 1 JIWA = 4 30 0 0
ANK : 2 6,141,140 10,170 1,027,140
30,510 5,114,000
TOTAL PER SATKER 4,237,500 0 0 480,000 0 0
423,750 0 0 10,170 480,000 0
169,500 500,000 289,680 30,510 120,000 0
PEG : 1 4,830,750 0 0 0 386,460 0
IST : 1 JIWA = 4 30 0 0
ANK : 2 6,141,140 10,170 1,027,140
30,510 5,114,000
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 102
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SUKARESMI
(019) D30100301900021 BULAN : AGUSTUS 2023

NO
dr.HEPY TRI OCTAVIA K-1 3,518,100 0 0 362,070 0 0

2 351,810 0 0 8,443 362,070 0
26-10-1979
140,724 750,000 289,680 25,330 90,518 0
1 197910262010012004 0 320,851 0 ..................
4,010,634 0 0
( PNS - 3D ) MKG: 12 4 55 0 0
5,446,212 8,443 807,212
-
25,330 4,639,000
LILI MULYATI K-1 4,237,500 0 0 404,809 158 0
2 423,750 0 0 10,170 404,809 0
31-08-1970
169,500 600,000 289,680 30,510 101,202 0
2 197008311992032005 0 386,460 0 ..................
4,830,750 0 158
( PNS - 3D ) MKG: 25 4 32 0 0
6,166,109 10,170 933,309
-
30,510 5,232,800
NINING WIDANINGSIH, ST TK - 0 4,237,500 0 0 308,070 14,721 0
0 0 0 0 10,170 308,070 0
25-12-1968
0 600,000 72,420 30,510 77,017 0
3 196812251992032006 0 339,000 0 ..................
4,237,500 0 14,721
( PNS - 3D ) MKG: 24 1 97 0 0
5,273,488 10,170 779,488
12345
30,510 4,494,000
MAD SUPRIATNA, A.Md.Kep. K-1 4,508,600 0 0 382,025 8,396 0
2 450,860 0 0 10,821 382,025 0
12-07-1968
180,344 500,000 289,680 32,462 95,506 0
4 196807121989031012 0 411,184 0 ..................
5,139,804 0 8,396
( PNS - 3D ) MKG: 28 4 6 0 0
6,363,194 10,821 940,394
-
32,462 5,422,800
ANAH ROHANAH, Am.Keb K-0 4,237,500 0 0 281,003 8,692 0
0 0 0 0 10,170 281,003 0
01-12-1972
0 500,000 72,420 30,510 70,251 0
5 197212011993012001 0 339,000 0 ..................
4,237,500 0 8,692
( PNS - 3D ) MKG: 24 1 31 0 0
5,140,326 10,170 739,626
0
30,510 4,400,700
dr. ZAMZAMI AHMAD BAIDOWI TK - 0 2,688,500 0 0 303,544 0 0
0 0 0 0 6,452 303,544 0
23-06-1993
0 325,000 72,420 19,357 75,886 0
6 199306232020121009 0 215,080 0 ..................
2,688,500 0 0
( PNS - 3B ) MKG: 1 1 46 0 0
3,415,319 6,452 620,319
-
19,357 2,795,000
Halaman : 103
(019) D30100301900021 BULAN : AGUSTUS 2023

NO
WINDY KUSUMAWATI RAHAYU,AM.Keb K-0 3,554,000 0 0 251,171 0 0

0 0 0 0 8,530 251,171 0
02-09-1979
0 300,000 72,420 25,589 62,793 0
7 197909022007012006 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 93 0 0
4,211,803 8,530 632,403
-
25,589 3,579,400
LISNAWATI, Am.Keb TK - 0 3,106,900 0 0 229,075 0 0
0 0 0 0 7,457 229,075 0
15-02-1984
0 265,000 72,420 22,370 57,269 0
8 198402152009022004 0 248,552 0 ..................
3,106,900 0 0
( PNS - 3A ) MKG: 12 1 1 0 0
3,703,223 7,457 564,723
-
22,370 3,138,500
DIAN SAFITRI, A.Md.Keb K-1 3,012,000 0 0 252,862 0 0
1 301,200 0 0 7,229 252,862 0
27-06-1985
60,240 265,000 217,260 21,686 63,215 0
9 198506272009022006 0 269,875 0 ..................
3,373,440 0 0
( PNS - 3A ) MKG: 10 3 90 0 0
4,137,567 7,229 614,867
-
21,686 3,522,700
1,527,620 0 0 79,442 2,774,629 0
550,808 4,105,000 1,448,400 238,324 693,657 0
PEG : 9 35,179,028 0 31,967 0 2,814,322 0
IST : 4 JIWA = 20 451 0 0
ANK : 7 43,857,241 79,442 6,632,341
238,324 37,224,900
ANILFA K-1 3,374,400 0 0 256,297 0 0
2 337,440 0 0 8,099 256,297 0
14-06-1971
134,976 240,000 289,680 24,296 64,074 0
10 197106142006042017 0 307,745 0 ..................
3,846,816 0 0
( PNS - 2D ) MKG: 25 4 23 0 0
4,665,211 8,099 660,511
-
24,296 4,004,700
LINA MARLINA, A.Md.Keb K-0 3,374,400 0 0 233,698 0 0
0 0 0 0 8,099 233,698 0
10-01-1978
0 240,000 72,420 24,296 58,424 0
11 197801102007012003 0 269,952 0 ..................
3,374,400 0 0
( PNS - 2D ) MKG: 25 1 56 0 0
3,952,969 8,099 594,469
24,296 3,358,500
Halaman : 104
(019) D30100301900021 BULAN : AGUSTUS 2023

NO
DANAH HAMDANAH K-1 3,271,400 0 0 255,832 0 0

2 327,140 0 0 7,851 255,832 0
16-08-1979
130,856 240,000 289,680 23,554 63,958 0
12 197908162007012011 0 298,352 0 ..................
3,729,396 0 0
( PNS - 2D ) MKG: 23 4 34 0 0
4,546,347 7,851 649,547
-
23,554 3,896,800
YUDI BUDIMAN, A.Md.Kep. K-1 3,171,500 0 0 270,725 0 0
2 317,150 0 0 7,612 270,725 0
30-10-1978
126,860 240,000 289,680 22,835 67,681 0
13 197810302014091001 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 32 0 0
4,446,394 7,612 658,094
-
22,835 3,788,300
HENNY KURNIAWATI, A.Md.Keb K-0 2,980,800 0 0 225,898 0 0
0 0 0 0 7,154 225,898 0
27-06-1984
0 240,000 72,420 21,462 56,474 0
14 198406272017052004 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 18 0 0
3,547,752 7,154 549,452
-
21,462 2,998,300
NURUL DWI PUTRI OCTAVIANI, A.Md.Keb K-1 2,980,800 0 0 245,115 0 0
2 298,080 0 0 7,154 245,115 0
05-10-1985
119,232 240,000 289,680 21,462 61,279 0
15 198510052017042018 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 36 0 0
4,201,559 7,154 606,859
0
21,462 3,594,700
SUPIANTI YULIANI, A.Md.Keb K-0 2,889,800 0 0 218,363 0 0
0 0 0 0 6,936 218,363 0
10-07-1986
0 240,000 72,420 20,807 54,591 0
16 198607102017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 55 0 0
3,448,381 6,936 531,881
-
20,807 2,916,500
ENENG NURHASANAH, A.Md.Keb K-1 2,889,800 0 0 225,194 0 0
1 288,980 0 0 6,936 225,194 0
11-01-1989
57,796 240,000 217,260 20,807 56,298 0
17 198901112017052003 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 88 0 0
3,946,861 6,936 568,161
-
20,807 3,378,700
Halaman : 105
(019) D30100301900021 BULAN : AGUSTUS 2023

NO
RANTI APRILIANTI, A.Md.Kes TK - 0 2,301,800 0 0 99,272 0 0

0 0 180,000 0 5,524 99,272 0
21-04-1998
0 0 72,420 16,573 24,818 0
18 199804212022032007 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 42 0 0
2,675,631 5,524 330,331
-
16,573 2,345,300
NENENG AISAH K-1 3,106,100 0 0 256,762 0 0
0 310,610 0 0 7,455 256,762 0
08-05-1976
0 240,000 144,840 22,364 64,190 0
19 197605082012122001 0 273,337 0 ..................
3,416,710 0 0
( PNS - 2B ) MKG: 25 2 77 0 0
4,088,208 7,455 624,108
-
22,364 3,464,100
1,879,400 180,000 0 72,820 2,287,156 0
569,720 2,160,000 1,810,500 218,456 571,787 0
PEG : 10 32,789,920 0 0 0 2,623,194 0
IST : 6 JIWA = 25 461 0 0
ANK : 9 39,519,313 72,820 5,773,413
218,456 33,745,900
TOTAL PER SATKER 63,441,400 0 0 5,061,785 31,967 0
3,407,020 180,000 0 152,262 5,061,785 0
1,120,528 6,265,000 3,258,900 456,780 1,265,444 0
PEG : 19 67,968,948 0 31,967 0 5,437,516 0
IST : 10 JIWA = 45 912 0 0
ANK : 16 83,376,554 152,262 12,405,754
456,780 70,970,800
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 106
(019) D30100301900021 BULAN : AGUSTUS 2023

NO
Halaman : 107
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIPENDAWA
(019) D30100301900022 BULAN : AGUSTUS 2023

NO
dr.INTAN ROSEDIANA T. TK - 0 3,901,500 0 0 446,190 34,467 0

0 0 0 0 9,364 446,190 0
07-05-1979
0 1,200,000 72,420 28,091 111,548 0
1 197905072010012016 0 312,120 0 ..................
3,901,500 0 34,467
( PNS - 4A ) MKG: 16 1 48 0 0
5,692,080 9,364 941,780
-
28,091 4,750,300
dr.SITI MAHDANIAR TK - 0 3,666,900 0 0 439,948 23,479 0
0 0 0 0 8,801 439,948 0
05-03-1983
0 1,200,000 72,420 26,402 109,987 0
2 198303052011012002 0 293,352 0 ..................
3,666,900 0 23,479
( PNS - 4A ) MKG: 12 1 19 0 0
5,437,969 8,801 901,969
-
26,402 4,536,000
TETI SURAIDAH, AM.Keb K-0 4,847,300 0 0 358,914 56,808 0
0 0 0 0 11,634 358,914 0
24-11-1966
0 850,000 72,420 34,901 89,729 0
3 196611241987032006 0 387,784 0 ..................
4,847,300 0 56,808
( PNS - 4A ) MKG: 30 1 93 0 0
6,232,070 11,634 939,770
-
34,901 5,292,300
0 0 0 29,799 1,245,052 0
0 3,250,000 217,260 89,394 311,264 0
PEG : 3 12,415,700 0 114,754 0 993,256 0
IST : 0 JIWA = 3 160 0 0
ANK : 0 17,362,119 29,799 2,783,519
89,394 14,578,600
SRI YUNIASWATI, A.Md.Kes K-1 4,508,600 0 0 328,742 17,108 0
1 450,860 0 0 10,821 328,742 0
28-06-1967
90,172 500,000 217,260 32,462 82,185 0
4 196706281989032001 0 403,971 0 ..................
5,049,632 0 17,108
( PNS - 3D ) MKG: 28 3 64 0 0
6,156,089 10,821 875,289
0000
32,462 5,280,800
SUSANTO K-1 4,508,600 0 0 355,272 18,367 0
1 450,860 0 0 10,821 355,272 0
13-07-1967
90,172 500,000 217,260 32,462 88,818 0
5 196707131989031007 0 403,971 0 ..................
5,049,632 0 18,367
( PNS - 3D ) MKG: 28 3 97 0 0
6,183,911 10,821 909,711
32,462 5,274,200
Halaman : 108
(019) D30100301900022 BULAN : AGUSTUS 2023

NO
ANI ROHANI, A.Md.KG K-1 4,508,600 0 0 364,931 18,825 0

1 450,860 0 0 10,821 364,931 0
10-06-1968
90,172 500,000 217,260 32,462 91,233 0
6 196806101989032006 0 403,971 0 ..................
5,049,632 0 18,825
( PNS - 3D ) MKG: 28 3 12 0 0
6,193,943 10,821 922,243
0
32,462 5,271,700
EUIS SUMARNI, AM.Keb. JD - 0 4,370,900 0 0 308,462 0 0
2 0 0 0 10,490 308,462 0
05-01-1967
174,836 500,000 217,260 31,470 77,116 0
7 196701051988032001 0 363,659 0 ..................
4,545,736 0 0
( PNS - 3D ) MKG: 26 3 79 0 0
5,613,497 10,490 791,197
-
31,470 4,822,300
ADE SUHERLIS M, AM.Keb K-1 4,370,900 0 0 358,706 11,508 0
1 437,090 0 0 10,490 358,706 0
19-05-1971
87,418 500,000 217,260 31,470 89,676 0
8 197105191991032002 0 391,633 0 ..................
4,895,408 0 11,508
( PNS - 3D ) MKG: 26 3 41 0 0
6,024,883 10,490 893,483
-
31,470 5,131,400
TINTIN FATIMAH, AMd.Kep K-0 4,237,500 0 0 362,612 12,567 0
0 0 0 0 10,170 362,612 0
24-04-1972
0 500,000 72,420 30,510 90,653 0
9 197204241993032006 0 339,000 0 ..................
4,237,500 0 12,567
( PNS - 3D ) MKG: 24 1 33 0 0
5,225,812 10,170 845,512
-
30,510 4,380,300
dr. PRISKILA MADELYN PRIMAULI TK - 0 2,773,200 0 0 321,627 0 0
0 0 0 0 6,656 321,627 0
06-04-1993
0 325,000 72,420 19,967 80,407 0
10 199304062020122006 0 221,856 0 ..................
2,773,200 0 0
( PNS - 3B ) MKG: 3 1 43 0 0
3,518,913 6,656 650,513
-
19,967 2,868,400
MARWIYAH, A.Md.Kep JD - 0 3,238,300 0 0 249,605 0 0
1 0 0 0 7,772 249,605 0
07-10-1986
64,766 265,000 144,840 23,316 62,401 0
11 198610072009022002 0 264,245 0 ..................
3,303,066 0 0
( PNS - 3B ) MKG: 12 2 40 0 0
3,993,639 7,772 607,339
-
23,316 3,386,300
Halaman : 109
(019) D30100301900022 BULAN : AGUSTUS 2023

NO
MIA NAZMIAWATI K-1 3,627,900 0 0 287,207 0 0

2 362,790 0 0 8,707 287,207 0
13-09-1974
145,116 300,000 289,680 26,121 71,802 0
12 197409132006042010 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 80 0 0
5,047,601 8,707 724,701
-
26,121 4,322,900
WIWI HANDAYANI JD - 0 3,517,200 0 0 256,021 0 0
1 0 0 0 8,441 256,021 0
06-12-1974
70,344 300,000 144,840 25,324 64,005 0
13 197412062006042010 0 287,004 0 ..................
3,587,544 0 0
( PNS - 3A ) MKG: 20 2 25 0 0
4,322,195 8,441 640,795
-
25,324 3,681,400
NENENG ROHIMAH K-1 3,204,700 0 0 266,701 0 0
2 320,470 0 0 7,691 266,701 0
29-05-1978
128,188 300,000 289,680 23,074 66,675 0
14 197805292002122002 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 6 0 0
4,540,510 7,691 656,410
-
23,074 3,884,100
NOVA ZIRMAWATI K-1 3,106,900 0 0 276,015 0 0
1 310,690 185,000 0 7,457 276,015 0
29-08-1977
62,138 0 217,260 22,370 69,004 0
15 197708292005012005 0 278,378 0 ..................
3,479,728 0 0
( PNS - 3A ) MKG: 12 3 94 0 0
4,187,924 7,457 653,224
-
22,370 3,534,700
2,783,620 185,000 0 110,337 3,735,901 0
1,003,322 4,490,000 2,317,440 331,008 933,975 0
PEG : 12 49,760,242 0 78,375 0 3,980,821 0
IST : 7 JIWA = 32 614 0 0
ANK : 13 61,008,917 110,337 9,170,417
331,008 51,838,500
YOYOK LATIFAH, A.Md. Kep K-1 3,171,500 0 0 262,430 0 0
2 317,150 0 0 7,612 262,430 0
08-08-1982
126,860 240,000 289,680 22,835 65,607 0
16 198208082014092001 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 58 0 0
4,438,125 7,612 647,725
-
22,835 3,790,400
Halaman : 110
(019) D30100301900022 BULAN : AGUSTUS 2023

NO
317,150 0 0 7,612 262,430 0
126,860 240,000 289,680 22,835 65,607 0
PEG : 1 3,615,510 0 0 0 289,241 0
IST : 1 JIWA = 4 58 0 0
ANK : 2 4,438,125 7,612 647,725
22,835 3,790,400
TAUFIK RUSLAN K-1 2,117,700 0 0 232,029 0 0
1 211,770 175,000 0 5,082 232,029 0
04-03-1978
42,354 0 217,260 15,247 58,007 0
17 197803042014061002 0 189,746 0 ..................
2,371,824 0 0
( PNS - 1B ) MKG: 17 3 69 0 0
3,016,511 5,082 500,111
-
15,247 2,516,400
SUB TOTAL PERGOLONGAN : I 2,117,700 0 0 232,029 0 0
211,770 175,000 0 5,082 232,029 0
42,354 0 217,260 15,247 58,007 0
PEG : 1 2,371,824 0 0 0 189,746 0
IST : 1 JIWA = 3 69 0 0
ANK : 1 3,016,511 5,082 500,111
15,247 2,516,400
TOTAL PER SATKER 63,678,200 0 0 5,475,412 193,129 0
3,312,540 360,000 0 152,830 5,475,412 0
1,172,536 7,980,000 3,041,640 458,484 1,368,853 0
PEG : 17 68,163,276 0 193,129 0 5,453,064 0
IST : 9 JIWA = 42 901 0 0
ANK : 16 85,825,672 152,830 13,101,772
458,484 72,723,900
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 111
(019) D30100301900022 BULAN : AGUSTUS 2023

NO
Halaman : 112
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIPANAS
(019) D30100301900023 BULAN : AGUSTUS 2023

NO
drg.RITA TRESNA DEWI JD - 0 3,901,500 0 0 425,567 9,913 0

2 0 0 0 9,364 425,567 0
08-04-1977
156,060 1,200,000 217,260 28,091 106,392 0
1 197704082006042016 0 324,605 0 ..................
4,057,560 0 9,913
( PNS - 4A ) MKG: 16 3 77 0 0
5,947,832 9,364 903,932
-
28,091 5,043,900
0 0 0 9,364 425,567 0
156,060 1,200,000 217,260 28,091 106,392 0
PEG : 1 4,057,560 0 9,913 0 324,605 0
IST : 0 JIWA = 3 77 0 0
ANK : 2 5,947,832 9,364 903,932
28,091 5,043,900
ISTIQOMAH TK - 0 4,370,900 0 0 386,350 36,396 0
0 0 0 0 10,490 386,350 0
26-06-1971
0 850,000 72,420 31,470 96,587 0
2 197106261992032005 0 349,672 0 ..................
4,370,900 0 36,396
( PNS - 3D ) MKG: 26 1 39 0 0
5,758,065 10,490 910,965
-
31,470 4,847,100
dr. NGESTI ISWANDA JD - 0 3,410,600 0 0 470,633 0 0
0 0 0 0 8,185 470,633 0
17-06-1985
0 750,000 72,420 24,556 117,658 0
3 198506172014122001 0 272,848 0 ..................
3,410,600 0 0
( PNS - 3D ) MKG: 10 1 86 0 0
4,736,480 8,185 893,880
-
24,556 3,842,600
ADE SURYANI TK - 0 4,508,600 0 0 349,475 24,296 0
0 0 0 0 10,821 349,475 0
14-04-1968
0 500,000 72,420 32,462 87,369 0
4 196804141987032002 0 360,688 0 ..................
4,508,600 0 24,296
( PNS - 3D ) MKG: 29 1 37 0 0
5,498,111 10,821 865,111
-
32,462 4,633,000
N.NURJANAH K-1 4,508,600 0 0 378,228 19,458 0
1 450,860 0 0 10,821 378,228 0
23-03-1966
90,172 500,000 217,260 32,462 94,557 0
5 196603231989032012 0 403,971 0 ..................
5,049,632 0 19,458
( PNS - 3D ) MKG: 28 3 36 0 0
6,207,897 10,821 939,497
-
32,462 5,268,400
Halaman : 113
(019) D30100301900023 BULAN : AGUSTUS 2023

NO
SULISNAWATI K-0 4,508,600 0 0 342,654 23,971 0

0 0 0 0 10,821 342,654 0
05-02-1967
0 500,000 72,420 32,462 85,663 0
6 196702051989031006 0 360,688 0 ..................
4,508,600 0 23,971
( PNS - 3D ) MKG: 28 1 31 0 0
5,490,959 10,821 856,259
-
32,462 4,634,700
CUCU ROHMIATI TK - 0 4,508,600 0 0 427,054 27,983 0
0 0 0 0 10,821 427,054 0
23-08-1967
0 500,000 72,420 32,462 106,763 0
7 196708231989032002 0 360,688 0 ..................
4,508,600 0 27,983
( PNS - 3D ) MKG: 28 1 31 0 0
5,579,371 10,821 965,771
-
32,462 4,613,600
DEWI RATIH KUSMIATI,Am.Keb TK - 0 4,508,600 0 0 480,000 30,500 0
0 0 0 0 10,821 480,000 0
19-12-1967
0 500,000 72,420 32,462 120,000 0
8 196712191990032002 0 360,688 0 ..................
4,508,600 0 30,500
( PNS - 3D ) MKG: 28 1 68 0 0
5,634,871 10,821 1,034,471
-
32,462 4,600,400
INUN AENUNA K-0 4,370,900 0 0 347,946 17,950 0
0 0 0 0 10,490 347,946 0
16-05-1971
0 500,000 72,420 31,470 86,986 0
9 197105161991032003 0 349,672 0 ..................
4,370,900 0 17,950
( PNS - 3D ) MKG: 27 1 38 0 0
5,351,214 10,490 844,514
-
31,470 4,506,700
HANDINI, Am.Keb K-1 4,065,500 0 0 359,393 0 0
2 406,550 0 0 9,757 359,393 0
30-03-1968
162,620 600,000 289,680 29,272 89,848 0
10 196803301993032003 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 72 0 0
5,922,844 9,757 859,044
-
29,272 5,063,800
YANI SURYANI K-1 4,065,500 0 0 359,452 0 0
2 406,550 0 0 9,757 359,452 0
25-12-1971
162,620 500,000 289,680 29,272 89,863 0
11 197112251993012001 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 87 0 0
5,822,918 9,757 859,118
-
29,272 4,963,800
Halaman : 114
(019) D30100301900023 BULAN : AGUSTUS 2023

NO
ASEP SYA'BAN K-1 4,065,500 0 0 391,572 0 0

2 406,550 0 0 9,757 391,572 0
24-09-1973
162,620 500,000 289,680 29,272 97,893 0
12 197309241994031002 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 17 0 0
5,854,968 9,757 899,268
-
29,272 4,955,700
MELVA SINAGA, Am.Keb K-1 3,941,400 0 0 336,722 0 0
2 394,140 0 0 9,459 336,722 0
05-02-1975
157,656 500,000 289,680 28,378 84,180 0
13 197502052006042014 0 359,456 0 ..................
4,493,196 0 0
( PNS - 3C ) MKG: 22 4 60 0 0
5,657,495 9,459 818,195
-
28,378 4,839,300
RUBI GILANG PURNAMA, AMKL K-1 3,139,400 0 0 365,905 0 0
2 313,940 0 0 7,535 365,905 0
05-11-1989
125,576 265,000 289,680 22,604 91,476 0
14 198911052011011001 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 93 0 0
4,529,733 7,535 773,833
-
22,604 3,755,900
YATI NURHAYATI K-1 3,981,600 0 0 370,861 0 0
2 398,160 0 0 9,556 370,861 0
09-11-1970
159,264 265,000 289,680 28,668 92,715 0
15 197011091990032002 0 363,122 0 ..................
4,539,024 0 0
( PNS - 3A ) MKG: 28 4 33 0 0
5,502,822 9,556 864,922
-
28,668 4,637,900
MARLINDA K-1 3,409,800 0 0 310,602 0 0
2 340,980 0 0 8,184 310,602 0
03-03-1977
136,392 265,000 289,680 24,551 77,650 0
16 197703032007012015 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 72 0 0
4,785,261 8,184 731,961
-
24,551 4,053,300
YANTI SUSANTI TK - 0 3,106,900 0 0 272,406 0 0
0 0 0 0 7,457 272,406 0
22-12-1978
0 265,000 72,420 22,370 68,102 0
17 197812222005012010 0 248,552 0 ..................
3,106,900 0 0
( PNS - 3A ) MKG: 12 1 34 0 0
3,746,587 7,457 618,887
-
22,370 3,127,700
Halaman : 115
(019) D30100301900023 BULAN : AGUSTUS 2023

NO
ANGGI JUANITA HADIANA, AMG K-1 3,012,000 0 0 326,251 0 0

2 301,200 0 0 7,229 326,251 0
27-06-1985
120,480 265,000 289,680 21,686 81,563 0
18 198506272010012008 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 97 0 0
4,343,623 7,229 711,423
-
21,686 3,632,200
3,418,930 0 0 161,961 6,275,504 0
1,277,400 8,025,000 3,114,060 485,879 1,568,873 0
PEG : 17 72,179,330 0 180,554 0 5,774,348 0
IST : 9 JIWA = 43 931 0 0
ANK : 17 90,423,219 161,961 14,447,119
485,879 75,976,100
LASMARIA SIDABALOK, A.Md.Keb K-1 2,980,800 0 0 280,628 0 0
2 298,080 0 0 7,154 280,628 0
01-03-1978
119,232 240,000 289,680 21,462 70,157 0
19 197803012019052003 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 14 0 0
4,237,050 7,154 651,250
0
21,462 3,585,800
RISTIANI, A.Md.Keb K-0 2,980,800 0 0 275,298 0 0
0 0 0 0 7,154 275,298 0
07-07-1984
0 240,000 72,420 21,462 68,825 0
20 198407072017052002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 69 0 0
3,597,203 7,154 611,203
-
21,462 2,986,000
NI MADE JUITHA MANDA SARI, A.Md.Keb K-1 2,889,800 0 0 279,358 0 0
2 288,980 0 0 6,936 279,358 0
08-04-1989
115,592 240,000 289,680 20,807 69,840 0
21 198904082017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 38 0 0
4,131,191 6,936 640,491
-
20,807 3,490,700
IDA FITRIA K-0 3,042,800 0 0 281,271 0 0
0 0 0 0 7,303 281,271 0
12-08-1981
0 240,000 72,420 21,908 70,318 0
22 198108122014092001 0 243,424 0 ..................
3,042,800 0 0
( PNS - 2C ) MKG: 21 1 22 0 0
3,665,724 7,303 624,224
-
21,908 3,041,500
Halaman : 116
(019) D30100301900023 BULAN : AGUSTUS 2023

NO
AGUNG ISKANDAR K-1 2,859,800 0 0 227,396 0 0

2 285,980 180,000 0 6,864 227,396 0
14-12-1975
114,392 0 289,680 20,591 56,849 0
23 197512142014091001 0 260,814 0 ..................
3,260,172 0 0
( PNS - 2C ) MKG: 17 4 11 0 0
3,984,714 6,864 572,514
-
20,591 3,412,200
873,040 180,000 0 35,411 1,343,951 0
349,216 960,000 1,013,880 106,230 335,989 0
PEG : 5 15,976,256 0 0 0 1,278,101 0
IST : 3 JIWA = 14 154 0 0
ANK : 6 19,615,882 35,411 3,099,682
106,230 16,516,200
TOTAL PER SATKER 86,138,500 0 0 8,045,022 190,467 0
4,291,970 180,000 0 206,736 8,045,022 0
1,782,676 10,185,000 4,345,200 620,200 2,011,254 0
PEG : 23 92,213,146 0 190,467 0 7,377,054 0
IST : 12 JIWA = 60 1,162 0 0
ANK : 25 115,986,933 206,736 18,450,733
620,200 97,536,200
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 117
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SUKAMAHI
(019) D30100301900024 BULAN : AGUSTUS 2023

NO
CUCU ERNAWATI K-1 4,370,900 0 0 263,732 0 0

2 437,090 0 0 10,490 263,732 0
17-03-1971
174,836 500,000 289,680 31,470 65,933 0
1 197103171991012001 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 53 0 0
6,078,251 10,490 770,251
-
31,470 5,308,000
ASEP SUBHAN TK - 0 3,982,600 0 0 219,451 0 0
0 0 0 0 9,558 219,451 0
14-06-1970
0 500,000 72,420 28,675 54,863 0
2 197006141997021003 0 318,608 0 ..................
3,982,600 0 0
( PNS - 3D ) MKG: 20 1 51 0 0
4,812,755 9,558 631,155
-
28,675 4,181,600
UJANG RUHIYAT KUSMANA, AM.Keb K-0 3,704,300 0 0 322,394 0 0
0 0 0 0 8,890 322,394 0
01-05-1978
0 600,000 72,420 26,671 80,598 0
3 197805012006041022 0 296,344 0 ..................
3,704,300 0 0
( PNS - 3C ) MKG: 18 1 22 0 0
4,734,697 8,890 734,897
-
26,671 3,999,800
DODI APRIANA K-1 3,340,300 540,000 0 291,582 0 0
2 334,030 0 0 8,017 291,582 0
20-04-1978
133,612 0 289,680 24,050 72,895 0
4 197804202002121006 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 14 4 8 0 0
4,961,279 8,017 701,179
-
24,050 4,260,100
DEDE SITI HODIJAH, A.Md.Kep. K-0 3,139,400 0 0 233,955 0 0
2 0 0 0 7,535 233,955 0
05-10-1977
125,576 265,000 217,260 22,604 58,489 0
5 197710052010012004 0 261,198 0 ..................
3,264,976 0 0
( PNS - 3B ) MKG: 11 3 51 0 0
4,011,381 7,535 583,781
-
22,604 3,427,600
ROSINI, Amd.Kep K-1 3,204,700 0 0 262,095 0 0
2 320,470 0 0 7,691 262,095 0
08-01-1980
128,188 265,000 289,680 23,074 65,524 0
6 198001082012122002 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 15 4 55 0 0
4,500,953 7,691 650,653
-
23,074 3,850,300
Halaman : 118
(019) D30100301900024 BULAN : AGUSTUS 2023

NO
IKHSAN RIDHA K-1 3,204,700 0 0 197,566 0 0

2 320,470 0 0 7,691 197,566 0
08-09-1975
128,188 265,000 289,680 23,074 49,391 0
7 197509082002121002 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 22 0 0
4,436,391 7,691 569,991
-
23,074 3,866,400
SUB TOTAL PERGOLONGAN : III 24,946,900 540,000 0 1,790,775 0 0
1,412,060 0 0 59,872 1,790,775 0
690,400 2,395,000 1,520,820 179,618 447,693 0
PEG : 7 27,049,360 0 0 0 2,163,949 0
IST : 4 JIWA = 21 262 0 0
ANK : 10 33,535,707 59,872 4,641,907
179,618 28,893,800
NANI NURHAYATI K-0 3,271,400 0 0 183,803 0 0
0 0 0 0 7,851 183,803 0
01-08-1978
0 265,000 72,420 23,554 45,951 0
8 197808012007012007 0 261,712 0 ..................
3,271,400 0 0
( PNS - 2D ) MKG: 23 1 43 0 0
3,824,071 7,851 522,871
-
23,554 3,301,200
IA SITI NURUL FITRI, A.Md.Keb K-0 2,889,800 0 0 216,502 0 0
0 0 0 0 6,936 216,502 0
30-04-1989
0 240,000 72,420 20,807 54,126 0
9 198904302017052003 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 90 0 0
3,446,555 6,936 529,555
-
20,807 2,917,000
RANI SAFTIANI FAJRIN, A.Md.Keb K-1 2,801,500 0 0 223,477 0 0
2 280,150 0 0 6,724 223,477 0
10-10-1987
112,060 240,000 289,680 20,171 55,869 0
10 198710102017052002 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 76 0 0
3,973,838 6,724 561,738
-
280,150 0 0 21,511 623,782 0
112,060 745,000 434,520 64,532 155,946 0
PEG : 3 9,354,910 0 0 0 748,393 0
IST : 1 JIWA = 6 209 0 0
ANK : 2 11,244,464 21,511 1,614,164
64,532 9,630,300
Halaman : 119
(019) D30100301900024 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 33,909,600 540,000 0 2,414,557 0 0
1,692,210 0 0 81,383 2,414,557 0
802,460 3,140,000 1,955,340 244,150 603,639 0
PEG : 10 36,404,270 0 0 0 2,912,342 0
IST : 5 JIWA = 27 471 0 0
ANK : 12 44,780,171 81,383 6,256,071
244,150 38,524,100
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 120
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CUGENANG
(019) D30100301900025 BULAN : AGUSTUS 2023

NO
dr.YULI YATIN K-1 4,194,600 0 0 470,165 29,538 0

2 419,460 0 0 10,067 470,165 0
26-07-1974
167,784 1,200,000 289,680 30,201 117,541 0
1 197407262005012008 0 382,548 0 ..................
4,781,844 0 29,538
( PNS - 4B ) MKG: 18 4 65 0 0
6,811,560 10,067 1,040,060
-
30,201 5,771,500
IDAH SARIDAH,Am.Keb TK - 0 4,847,300 0 0 357,348 56,738 0
0 0 0 0 11,634 357,348 0
02-03-1967
0 850,000 72,420 34,901 89,337 0
2 196703021988032004 0 387,784 0 ..................
4,847,300 0 56,738
( PNS - 4A ) MKG: 30 1 1 0 0
6,230,342 11,634 937,742
-
34,901 5,292,600
N.MARIAM, ST JD - 0 4,555,800 0 0 353,916 20,888 0
2 0 0 0 10,934 353,916 0
29-06-1968
182,232 850,000 217,260 32,802 88,479 0
3 196806291991032003 0 379,043 0 ..................
4,738,032 0 20,888
( PNS - 4A ) MKG: 26 3 30 0 0
6,223,862 10,934 886,062
12345
32,802 5,337,800
NYI IDA, Am.Keb TK - 0 4,416,700 0 0 341,063 36,333 0
0 0 0 0 10,600 341,063 0
20-03-1969
0 850,000 72,420 31,800 85,266 0
4 196903201991012001 0 353,336 0 ..................
4,416,700 0 36,333
( PNS - 4A ) MKG: 24 1 82 0 0
5,758,998 10,600 858,398
-
31,800 4,900,600
419,460 0 0 43,235 1,522,492 0
350,016 3,750,000 651,780 129,704 380,623 0
PEG : 4 18,783,876 0 143,497 0 1,502,711 0
IST : 1 JIWA = 9 178 0 0
ANK : 4 25,024,762 43,235 3,722,262
129,704 21,302,500
dr. YUDI DUDUN ZULKURNAIN K-1 3,410,600 0 0 480,000 0 0
1 341,060 0 0 8,185 480,000 0
13-12-1984
68,212 750,000 217,260 24,556 120,000 0
5 198412132014121001 0 305,590 0 ..................
3,819,872 0 0
( PNS - 3D ) MKG: 10 3 58 0 0
5,299,931 8,185 938,331
-
24,556 4,361,600
Halaman : 121
(019) D30100301900025 BULAN : AGUSTUS 2023

NO
dr. RETNO DWI JUANITA K-1 3,306,500 0 0 395,159 0 0

0 330,650 0 0 7,936 395,159 0
28-11-1988
0 750,000 144,840 23,807 98,790 0
6 198811282014122001 0 290,972 0 ..................
3,637,150 0 0
( PNS - 3D ) MKG: 9 2 72 0 0
4,958,964 7,936 816,664
-
23,807 4,142,300
ALIT SULASTRI,Am.Kep TK - 0 4,370,900 0 0 358,841 18,467 0
0 0 0 0 10,490 358,841 0
06-01-1972
0 500,000 72,420 31,470 89,710 0
7 197201061992032003 0 349,672 0 ..................
4,370,900 0 18,467
( PNS - 3D ) MKG: 26 1 62 0 0
5,362,650 10,490 858,650
-
31,470 4,504,000
NENENG KARTIKA DEWI, AM.Kep. JD - 0 3,704,300 0 0 286,409 0 0
1 0 0 0 8,890 286,409 0
21-06-1978
74,086 500,000 144,840 26,671 71,602 0
8 197806212007012008 0 302,271 0 ..................
3,778,386 0 0
( PNS - 3C ) MKG: 18 2 47 0 0
4,745,243 8,890 695,843
-
26,671 4,049,400
II URIPAH K-1 3,665,900 0 0 322,106 0 0
2 366,590 0 0 8,798 322,106 0
10-04-1973
146,636 300,000 289,680 26,394 80,527 0
9 197304102006042020 0 334,330 0 ..................
4,179,126 0 0
( PNS - 3B ) MKG: 20 4 51 0 0
5,126,155 8,798 772,155
-
26,394 4,354,000
LASTI MULYATI TK - 0 3,445,500 0 0 264,474 0 0
0 0 0 0 8,269 264,474 0
25-12-1981
0 300,000 72,420 24,808 66,119 0
10 198112252008012002 0 275,640 0 ..................
3,445,500 0 0
( PNS - 3B ) MKG: 16 1 39 0 0
4,115,510 8,269 639,310
-
24,808 3,476,200
YANA BUDIAWAN K-1 4,023,300 0 0 285,954 0 0
1 402,330 0 0 9,656 285,954 0
22-08-1968
80,466 265,000 217,260 28,968 71,489 0
11 196808221991031004 0 360,488 0 ..................
4,506,096 0 0
( PNS - 3B ) MKG: 26 3 21 0 0
5,312,955 9,656 756,555
-
28,968 4,556,400
Halaman : 122
(019) D30100301900025 BULAN : AGUSTUS 2023

NO
FAIZAL AZIZ, Amd.Kep K-1 3,139,400 0 0 362,460 0 0

2 313,940 0 0 7,535 362,460 0
30-12-1983
125,576 265,000 289,680 22,604 90,615 0
12 198312302011011001 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 32 0 0
4,526,227 7,535 769,527
-
22,604 3,756,700
IDA MUSLIMAH K-1 3,517,200 0 0 308,203 0 0
2 351,720 0 0 8,441 308,203 0
19-05-1978
140,688 300,000 289,680 25,324 77,051 0
13 197805192007012004 0 320,769 0 ..................
4,009,608 0 0
( PNS - 3A ) MKG: 20 4 32 0 0
4,941,288 8,441 739,788
-
25,324 4,201,500
RESTY SARI HILYANTI, A.Md,Keb K-1 3,012,000 0 0 294,292 0 0
2 301,200 0 0 7,229 294,292 0
26-02-1987
120,480 300,000 289,680 21,686 73,573 0
14 198702262011012001 0 274,694 0 ..................
3,433,680 0 0
( PNS - 3A ) MKG: 10 4 7 0 0
4,346,574 7,229 671,474
-
21,686 3,675,100
NANI JD - 0 3,627,900 0 0 277,901 0 0
0 0 0 0 8,707 277,901 0
08-09-1974
0 265,000 72,420 26,121 69,475 0
15 197409082006042010 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 87 0 0
4,278,136 8,707 672,436
-
26,121 3,605,700
MILY RACHMILIA FITRIANI,AM.KG K-1 3,106,900 0 0 295,267 0 0
1 310,690 0 0 7,457 295,267 0
17-03-1984
62,138 265,000 217,260 22,370 73,817 0
16 198403172009022005 0 278,378 0 ..................
3,479,728 0 0
( PNS - 3A ) MKG: 12 3 7 0 0
4,287,089 7,457 677,289
-
22,370 3,609,800
2,718,180 0 0 101,593 3,931,066 0
818,282 4,760,000 2,317,440 304,779 982,768 0
PEG : 12 45,866,862 0 18,467 0 3,669,349 0
IST : 8 JIWA = 32 515 0 0
ANK : 12 57,300,722 101,593 9,008,022
304,779 48,292,700
Halaman : 123
(019) D30100301900025 BULAN : AGUSTUS 2023

NO
ERNI AQUARISTIN, A.Md.Keb K-1 2,980,800 0 0 265,440 0 0

2 298,080 0 0 7,154 265,440 0
13-02-1986
119,232 240,000 289,680 21,462 66,360 0
17 198602132017052002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 17 0 0
4,221,865 7,154 632,265
-
21,462 3,589,600
SHINTA KANDAYANI RUKENDAR, A.Md.Keb K-0 2,980,800 0 0 282,122 0 0
0 0 0 0 7,154 282,122 0
13-10-1986
0 240,000 72,420 21,462 70,530 0
18 198610132017052002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 74 0 0
3,604,032 7,154 619,732
-
21,462 2,984,300
RENI NURAZIZAH, A.Md.Keb K-0 2,980,800 0 0 309,189 0 0
0 0 0 0 7,154 309,189 0
12-12-1986
0 240,000 72,420 21,462 77,297 0
19 198612122017052002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 41 0 0
3,631,066 7,154 653,566
-
21,462 2,977,500
LINLIN HINDAYATI, A.Md.Keb K-0 2,980,800 0 0 246,885 0 0
0 0 0 0 7,154 246,885 0
31-12-1986
0 240,000 72,420 21,462 61,721 0
20 198612312017052002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 65 0 0
3,568,786 7,154 575,686
-
21,462 2,993,100
ETRI USMAYANTI, A.Md.Keb K-0 2,889,800 0 0 237,330 0 0
0 0 0 0 6,936 237,330 0
19-03-1989
0 240,000 72,420 20,807 59,333 0
21 198903192017052002 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 97 0 0
3,467,390 6,936 555,590
00
20,807 2,911,800
EMA SRI MULYATI K-1 3,074,700 0 0 236,385 0 0
2 307,470 180,000 0 7,379 236,385 0
05-03-1981
122,988 0 289,680 22,138 59,096 0
22 198103052008012009 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 20 4 71 0 0
4,240,811 7,379 605,411
-
22,138 3,635,400
Halaman : 124
(019) D30100301900025 BULAN : AGUSTUS 2023

NO
ATI RUSMIATI K-1 3,138,600 0 0 217,889 0 0

1 313,860 0 0 7,533 217,889 0
09-06-1978
62,772 240,000 217,260 22,598 54,472 0
23 197806092007012005 0 281,219 0 ..................
3,515,232 0 0
( PNS - 2C ) MKG: 23 3 99 0 0
4,220,611 7,533 583,711
-
22,598 3,636,900
919,410 180,000 0 50,464 1,795,240 0
304,992 1,440,000 1,086,300 151,391 448,809 0
PEG : 7 22,250,702 0 0 0 1,780,057 0
IST : 3 JIWA = 15 464 0 0
ANK : 5 26,954,561 50,464 4,225,961
151,391 22,728,600
TOTAL PER SATKER 81,371,100 0 0 7,248,798 161,964 0
4,057,050 180,000 0 195,292 7,248,798 0
1,473,290 9,950,000 4,055,520 585,874 1,812,200 0
PEG : 23 86,901,440 0 161,964 0 6,952,117 0
IST : 12 JIWA = 56 1,157 0 0
ANK : 21 109,280,045 195,292 16,956,245
585,874 92,323,800
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 125
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIJEDIL
(019) D30100301900026 BULAN : AGUSTUS 2023

NO
drg.RAHMA DINANTI K-1 4,024,400 0 0 395,878 28,854 0

1 402,440 0 0 9,659 395,878 0
06-07-1975
80,488 1,200,000 217,260 28,976 98,969 0
1 197507062007012008 0 360,586 0 ..................
4,507,328 0 28,854
( PNS - 4A ) MKG: 18 3 67 0 0
6,388,022 9,659 922,922
-
28,976 5,465,100
402,440 0 0 9,659 395,878 0
80,488 1,200,000 217,260 28,976 98,969 0
PEG : 1 4,507,328 0 28,854 0 360,586 0
IST : 1 JIWA = 3 67 0 0
ANK : 1 6,388,022 9,659 922,922
28,976 5,465,100
dr. NIA NURSETYO PERTIWI K-0 3,410,600 0 0 393,886 0 0
0 0 0 0 8,185 393,886 0
04-12-1986
0 750,000 72,420 24,556 98,472 0
2 198612042014122001 0 272,848 0 ..................
3,410,600 0 0
( PNS - 3D ) MKG: 10 1 0 0 0
4,659,647 8,185 797,947
-
24,556 3,861,700
RINA HASANAH TK - 0 4,370,900 0 0 333,490 22,008 0
0 0 0 0 10,490 333,490 0
12-10-1972
0 600,000 72,420 31,470 83,373 0
3 197210121992032005 0 349,672 0 ..................
4,370,900 0 22,008
( PNS - 3D ) MKG: 26 1 25 0 0
5,440,803 10,490 830,503
-
31,470 4,610,300
AHMAD SAEPUDIN, AM.Kep K-1 4,797,000 0 0 411,149 35,725 0
1 479,700 0 0 11,513 411,149 0
11-09-1966
95,940 500,000 217,260 34,538 102,787 0
4 196609111986031004 0 429,811 0 ..................
5,372,640 0 35,725
( PNS - 3D ) MKG: 32 3 98 0 0
6,582,923 11,513 1,025,523
-
34,538 5,557,400
YUNIDAR, AM.Keb. TK - 0 4,508,600 0 0 338,754 23,788 0
0 0 0 0 10,821 338,754 0
10-06-1969
0 500,000 72,420 32,462 84,689 0
5 196906101990032007 0 360,688 0 ..................
4,508,600 0 23,788
( PNS - 3D ) MKG: 28 1 57 0 0
5,486,902 10,821 851,202
-
32,462 4,635,700
Halaman : 126
(019) D30100301900026 BULAN : AGUSTUS 2023

NO
SRI YUNINGSIH TK - 0 4,370,900 0 0 330,771 17,133 0

0 0 0 0 10,490 330,771 0
17-05-1968
0 500,000 72,420 31,470 82,693 0
6 196805171991032004 0 349,672 0 ..................
4,370,900 0 17,133
( PNS - 3D ) MKG: 26 1 45 0 0
5,333,229 10,490 822,229
-
31,470 4,511,000
NURLIANTI TK - 0 4,108,100 0 0 289,648 3,200 0
0 0 0 0 9,859 289,648 0
05-04-1975
0 500,000 72,420 29,578 72,412 0
7 197504051996032002 0 328,648 0 ..................
4,108,100 0 3,200
( PNS - 3D ) MKG: 22 1 40 0 0
5,012,845 9,859 733,345
-
29,578 4,279,500
MELI JAMILAH FITRIANI JD - 0 4,650,600 0 0 439,958 0 0
2 0 185,000 0 11,161 439,958 0
03-11-1967
186,024 0 217,260 33,484 109,990 0
8 196711031987032002 0 386,930 0 ..................
4,836,624 0 0
( PNS - 3D ) MKG: 30 3 36 0 0
5,723,523 11,161 981,523
-
33,484 4,742,000
ADE JAMILUDIN K-1 4,508,600 0 0 251,280 0 0
2 450,860 185,000 0 10,821 251,280 0
01-03-1967
180,344 0 289,680 32,462 62,820 0
9 196703011990031009 0 411,184 0 ..................
5,139,804 0 0
( PNS - 3D ) MKG: 28 4 20 0 0
5,909,067 10,821 768,567
-
32,462 5,140,500
drg. ANNISA PRISTIANI K-0 3,172,300 0 0 438,473 0 0
0 0 0 0 7,614 438,473 0
05-08-1989
0 750,000 72,420 22,841 109,618 0
10 198908052014122001 0 253,784 0 ..................
3,172,300 0 0
( PNS - 3C ) MKG: 8 1 82 0 0
4,463,730 7,614 832,330
-
22,841 3,631,400
DEVY KIRANA SOBANDI, Amd.Kep K-1 3,043,600 0 0 272,715 0 0
2 304,360 0 0 7,305 272,715 0
23-08-1987
121,744 300,000 289,680 21,914 68,179 0
11 198708232011011001 0 277,576 0 ..................
3,469,704 0 0
( PNS - 3B ) MKG: 8 4 71 0 0
4,361,389 7,305 647,689
-
21,914 3,713,700
Halaman : 127
(019) D30100301900026 BULAN : AGUSTUS 2023

NO
ELIS SUSILAWATI JD - 0 3,900,500 0 0 284,220 0 0

2 0 0 0 9,361 284,220 0
26-11-1972
156,020 265,000 217,260 28,084 71,055 0
12 197211261993012001 0 324,522 0 ..................
4,056,520 0 0
( PNS - 3B ) MKG: 24 3 97 0 0
4,860,542 9,361 717,242
-
28,084 4,143,300
IDAN NURHAMDAN K-1 3,445,500 0 0 283,686 0 0
2 344,550 0 0 8,269 283,686 0
29-09-1979
137,820 265,000 289,680 24,808 70,922 0
13 197909292008011002 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 17 4 2 0 0
4,799,315 8,269 701,915
-
24,808 4,097,400
TINA MU'MINAH RASYID, SST JD - 0 3,445,500 0 0 311,103 0 0
2 0 185,000 0 8,269 311,103 0
05-08-1980
137,820 0 217,260 24,808 77,776 0
14 198008052005012011 0 286,666 0 ..................
3,583,320 0 0
( PNS - 3B ) MKG: 16 3 62 0 0
4,329,822 8,269 708,622
12345
24,808 3,621,200
ELIS SETIANI K-0 3,517,200 0 0 289,833 0 0
0 0 0 0 8,441 289,833 0
24-09-1976
0 265,000 72,420 25,324 72,458 0
15 197609242006042014 0 281,376 0 ..................
3,517,200 0 0
( PNS - 3A ) MKG: 21 1 14 0 0
4,178,232 8,441 677,432
-
25,324 3,500,800
NENENG HIKMAT HIJRIYAH K-0 3,517,200 0 0 247,025 0 0
0 0 0 0 8,441 247,025 0
03-06-1976
0 265,000 72,420 25,324 61,756 0
16 197606032006042034 0 281,376 0 ..................
3,517,200 0 0
( PNS - 3A ) MKG: 20 1 12 0 0
4,135,422 8,441 623,922
-
25,324 3,511,500
IIS RISWANTI TK - 0 3,106,900 0 0 237,172 0 0
0 0 0 0 7,457 237,172 0
14-04-1974
0 265,000 72,420 22,370 59,293 0
17 197404142005012010 0 248,552 0 ..................
3,106,900 0 0
( PNS - 3A ) MKG: 12 1 25 0 0
3,711,344 7,457 574,844
-
22,370 3,136,500
Halaman : 128
(019) D30100301900026 BULAN : AGUSTUS 2023

NO
1,579,470 555,000 0 148,497 5,153,163 0
1,015,712 5,725,000 2,389,860 445,493 1,288,293 0
PEG : 16 64,469,182 0 101,854 0 5,157,535 0
IST : 4 JIWA = 33 686 0 0
ANK : 13 78,988,735 148,497 12,294,835
445,493 66,693,900
RUSLAN ABDUL GANI, A.Md.Kep K-0 3,171,500 0 0 230,564 0 0
0 0 0 0 7,612 230,564 0
22-01-1981
0 240,000 72,420 22,835 57,641 0
18 198101222014091002 0 253,720 0 ..................
3,171,500 0 0
( PNS - 2D ) MKG: 21 1 41 0 0
3,744,972 7,612 572,372
-
22,835 3,172,600
ASRI WIDI RAHAYU, A.Md.Keb K-1 2,889,800 0 0 227,076 0 0
1 288,980 0 0 6,936 227,076 0
29-11-1989
57,796 240,000 217,260 20,807 56,769 0
19 198911292017052002 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 59 0 0
3,948,714 6,936 570,514
-
20,807 3,378,200
WINWIN MAULANI, A.Md.Keb TK - 0 2,801,500 0 0 179,350 0 0
0 0 0 0 6,724 179,350 0
16-10-1980
0 240,000 72,420 20,171 44,837 0
20 198010162019052004 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 13 1 37 0 0
3,320,202 6,724 475,202
0
20,171 2,845,000
288,980 0 0 21,272 636,990 0
57,796 720,000 362,100 63,813 159,247 0
PEG : 3 9,209,576 0 0 0 736,766 0
IST : 1 JIWA = 5 137 0 0
ANK : 1 11,013,888 21,272 1,618,088
63,813 9,395,800
TOTAL PER SATKER 74,761,200 0 0 6,186,031 130,708 0
2,270,890 555,000 0 179,428 6,186,031 0
1,153,996 7,645,000 2,969,220 538,282 1,546,509 0
PEG : 20 78,186,086 0 130,708 0 6,254,887 0
IST : 6 JIWA = 41 890 0 0
ANK : 15 96,390,645 179,428 14,835,845
538,282 81,554,800
Halaman : 129
(019) D30100301900026 BULAN : AGUSTUS 2023

NO
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 130
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIKALONGKULON
(019) D30100301900027 BULAN : AGUSTUS 2023

NO
DEDEN HARYANTO K-1 4,416,700 0 0 354,052 18,921 0

2 441,670 0 0 10,600 354,052 0
05-06-1972
176,668 850,000 289,680 31,800 88,513 0
1 197206051994031003 0 402,803 0 ..................
5,035,038 0 18,921
( PNS - 4A ) MKG: 24 4 98 0 0
6,590,189 10,600 906,689
-
31,800 5,683,500
441,670 0 0 10,600 354,052 0
176,668 850,000 289,680 31,800 88,513 0
PEG : 1 5,035,038 0 18,921 0 402,803 0
IST : 1 JIWA = 4 98 0 0
ANK : 2 6,590,189 10,600 906,689
31,800 5,683,500
dr.BUDI BAKHTIAR K-1 3,518,100 0 0 413,655 0 0
2 351,810 0 0 8,443 413,655 0
23-02-1979
140,724 750,000 289,680 25,330 103,414 0
2 197902232010011006 0 320,851 0 ..................
4,010,634 0 0
( PNS - 3D ) MKG: 12 4 51 0 0
5,497,793 8,443 871,693
-
25,330 4,626,100
SAYONO, S.KM K-0 3,628,900 0 0 265,108 0 0
0 0 0 0 8,709 265,108 0
14-03-1977
0 600,000 72,420 26,128 66,277 0
3 197703142006041009 0 290,312 0 ..................
3,628,900 0 0
( PNS - 3D ) MKG: 14 1 69 0 0
4,601,334 8,709 656,534
12345
26,128 3,944,800
HENDI ROHENDI, SKM K-1 4,508,600 0 0 309,119 4,929 0
2 450,860 0 0 10,821 309,119 0
07-07-1967
180,344 500,000 289,680 32,462 77,280 0
4 196707071989121003 0 411,184 0 ..................
5,139,804 0 4,929
( PNS - 3D ) MKG: 28 4 80 0 0
6,286,895 10,821 845,795
-
32,462 5,441,100
WIWIN TARYANI K-0 4,508,600 0 0 327,710 23,267 0
0 0 0 0 10,821 327,710 0
11-12-1968
0 500,000 72,420 32,462 81,927 0
5 196812111989012002 0 360,688 0 ..................
4,508,600 0 23,267
( PNS - 3D ) MKG: 28 1 95 0 0
5,475,375 10,821 836,875
-
32,462 4,638,500
Halaman : 131
(019) D30100301900027 BULAN : AGUSTUS 2023

NO
ELAWATI. AM.Keb TK - 0 4,370,900 0 0 284,852 14,950 0

0 0 0 0 10,490 284,852 0
06-03-1968
0 500,000 72,420 31,470 71,213 0
6 196803061991032012 0 349,672 0 ..................
4,370,900 0 14,950
( PNS - 3D ) MKG: 26 1 65 0 0
5,285,147 10,490 762,647
-
31,470 4,522,500
IMAS M RUSMIAWATI TK - 0 4,370,900 0 0 280,619 14,746 0
0 0 0 0 10,490 280,619 0
13-02-1970
0 500,000 72,420 31,470 70,155 0
7 197002131991032006 0 349,672 0 ..................
4,370,900 0 14,746
( PNS - 3D ) MKG: 26 1 7 0 0
5,280,652 10,490 757,152
-
31,470 4,523,500
CUCU YAYAN ROYANI K-1 4,370,900 0 0 247,266 6,213 0
1 437,090 0 0 10,490 247,266 0
20-06-1972
87,418 500,000 217,260 31,470 61,817 0
8 197206201992032003 0 391,633 0 ..................
4,895,408 0 6,213
( PNS - 3D ) MKG: 26 3 82 0 0
5,908,189 10,490 748,889
-
31,470 5,159,300
SRI YUDHA WIYANTI, S.Kep.Ners JD - 0 3,272,200 0 0 291,096 0 0
1 0 0 0 7,853 291,096 0
15-12-1986
65,444 600,000 144,840 23,560 72,774 0
9 198612152010012004 0 267,012 0 ..................
3,337,644 0 0
( PNS - 3C ) MKG: 10 2 2 0 0
4,404,995 7,853 662,295
0
23,560 3,742,700
DEDE IAH JUARIAH, A.Md.Keb. K-0 3,781,400 0 0 250,378 0 0
0 0 0 0 9,075 250,378 0
07-09-1972
0 265,000 72,420 27,226 62,594 0
10 197209072006042011 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 86 0 0
4,405,585 9,075 651,785
-
27,226 3,753,800
RIKA KARMILA K-0 3,781,400 0 0 251,623 0 0
0 0 0 0 9,075 251,623 0
06-10-1976
0 265,000 72,420 27,226 62,906 0
11 197610062006042015 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 98 0 0
4,406,842 9,075 653,342
-
27,226 3,753,500
Halaman : 132
(019) D30100301900027 BULAN : AGUSTUS 2023

NO
WIDI WIDURI, AMd.Keb K-1 3,554,000 0 0 260,188 0 0

2 355,400 0 0 8,530 260,188 0
20-06-1978
142,160 265,000 289,680 25,589 65,047 0
12 197806202007012005 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 32 0 0
4,900,579 8,530 683,479
25,589 4,217,100
AI SAMSIAH K-1 3,340,300 0 0 257,980 0 0
1 334,030 0 0 8,017 257,980 0
15-02-1977
66,806 265,000 217,260 24,050 64,495 0
13 197702152002122006 0 299,291 0 ..................
3,741,136 0 0
( PNS - 3B ) MKG: 14 3 90 0 0
4,513,533 8,017 653,833
-
24,050 3,859,700
SUMARTINI, A.Md.AK TK - 0 3,139,400 0 0 221,710 0 0
0 0 0 0 7,535 221,710 0
19-01-1975
0 265,000 72,420 22,604 55,427 0
14 197501192010012007 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 59 0 0
3,728,728 7,535 558,428
-
22,604 3,170,300
ENJANG SUHERMAN K-0 3,900,500 0 0 259,387 0 0
2 0 0 0 9,361 259,387 0
15-05-1970
156,020 240,000 217,260 28,084 64,847 0
15 197005151994031006 0 324,522 0 ..................
4,056,520 0 0
( PNS - 3B ) MKG: 24 3 89 0 0
4,810,701 9,361 686,201
-
28,084 4,124,500
drg. RAMDAN TRESNA NUGRAHA K-1 2,688,500 0 0 295,862 0 0
1 268,850 185,000 0 6,452 295,862 0
18-03-1992
53,770 0 217,260 19,357 73,965 0
16 199203182022031001 0 240,890 0 ..................
3,011,120 0 0
( PNS - 3B ) MKG: 1 3 75 0 0
3,735,126 6,452 636,526
-
19,357 3,098,600
NURMALITA JD - 0 3,627,900 0 0 249,544 0 0
2 0 0 0 8,707 249,544 0
08-08-1978
145,116 265,000 217,260 26,121 62,386 0
17 197808082006042035 0 301,841 0 ..................
3,773,016 0 0
( PNS - 3A ) MKG: 22 3 51 0 0
4,539,699 8,707 648,599
-
26,121 3,891,100
Halaman : 133
(019) D30100301900027 BULAN : AGUSTUS 2023

NO
SRI KLANA K-0 3,409,800 0 0 239,124 0 0

0 0 0 0 8,184 239,124 0
04-04-1979
0 265,000 72,420 24,551 59,781 0
18 197904042007012010 0 272,784 0 ..................
3,409,800 0 0
( PNS - 3A ) MKG: 18 1 45 0 0
4,019,124 8,184 604,424
-
24,551 3,414,700
RENI NURSILAWATI, AM.Keb. JD - 0 3,305,700 0 0 225,265 0 0
1 0 0 0 7,934 225,265 0
17-04-1978
66,114 265,000 144,840 23,801 56,316 0
19 197804172007012008 0 269,745 0 ..................
3,371,814 0 0
( PNS - 3A ) MKG: 16 2 7 0 0
4,038,661 7,934 583,061
-
23,801 3,455,600
ASEP YANDI SUPRIADI, AM.Kep K-1 3,204,700 0 0 280,900 0 0
1 320,470 0 0 7,691 280,900 0
03-01-1978
64,094 265,000 217,260 23,074 70,225 0
20 197801032007011006 0 287,141 0 ..................
3,589,264 0 0
( PNS - 3A ) MKG: 14 3 42 0 0
4,383,231 7,691 669,031
-
23,074 3,714,200
ANI SUSANTI K-0 3,409,800 0 0 233,518 0 0
0 0 0 0 8,184 233,518 0
12-09-1977
0 240,000 72,420 24,551 58,379 0
21 197709122007012011 0 272,784 0 ..................
3,409,800 0 0
( PNS - 3A ) MKG: 18 1 43 0 0
3,988,516 8,184 597,416
-
24,551 3,391,100
2,518,510 185,000 0 176,862 5,444,904 0
1,168,010 7,315,000 3,114,060 530,586 1,361,225 0
PEG : 20 77,379,020 0 64,105 0 6,190,323 0
IST : 7 JIWA = 43 1,168 0 0
ANK : 16 94,210,705 176,862 13,768,005
530,586 80,442,700
IDA HERAWATI K-1 3,171,500 0 0 245,566 0 0
2 317,150 0 0 7,612 245,566 0
03-06-1981
126,860 240,000 289,680 22,835 61,392 0
22 198106032008012003 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 43 0 0
4,421,246 7,612 626,646
-
Halaman : 134
(019) D30100301900027 BULAN : AGUSTUS 2023

NO
PERATRISNA M, A.Md.Keb TK - 0 2,980,800 0 0 218,867 0 0

0 0 0 0 7,154 218,867 0
19-10-1986
0 240,000 72,420 21,462 54,717 0
23 198610192017052001 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 61 0 0
3,540,764 7,154 540,664
-
21,462 3,000,100
ETI LIANTI, A.Md.Keb K-1 2,889,800 0 0 254,213 0 0
2 288,980 0 0 6,936 254,213 0
23-05-1987
115,592 240,000 289,680 20,807 63,553 0
24 198705232017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 51 0 0
4,106,059 6,936 609,059
-
20,807 3,497,000
DEWI ANGGRAENI, A.Md.Keb K-0 2,889,800 0 0 234,099 0 0
0 0 0 0 6,936 234,099 0
22-08-1989
0 240,000 72,420 20,807 58,525 0
25 198908222017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 89 0 0
3,464,151 6,936 551,551
-
20,807 2,912,600
IRMA YUNIAR, A.Md.Keb K-0 2,801,500 0 0 210,647 0 0
0 0 0 0 6,724 210,647 0
27-06-1990
0 240,000 72,420 20,171 52,662 0
26 199006272017052002 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 13 1 62 0 0
3,351,524 6,724 514,324
-
20,171 2,837,200
ERMA ERVINA JD - 0 2,889,800 0 0 152,467 0 0
1 0 180,000 0 6,936 152,467 0
11-01-1976
57,796 0 144,840 20,807 38,117 0
27 197601112005012010 0 235,808 0 ..................
2,947,596 0 0
( PNS - 2D ) MKG: 15 2 89 0 0
3,452,735 6,936 454,135
-
20,807 2,998,600
606,130 180,000 0 42,298 1,315,859 0
300,248 1,200,000 941,460 126,889 328,966 0
PEG : 6 18,529,578 0 0 0 1,482,367 0
IST : 2 JIWA = 13 395 0 0
ANK : 5 22,336,479 42,298 3,296,379
126,889 19,040,100
Halaman : 135
(019) D30100301900027 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 95,732,400 0 0 7,114,815 83,026 0
3,566,310 365,000 0 229,760 7,114,815 0
1,644,926 9,365,000 4,345,200 689,275 1,778,704 0
PEG : 27 100,943,636 0 83,026 0 8,075,493 0
IST : 10 JIWA = 60 1,661 0 0
ANK : 23 123,137,373 229,760 17,971,073
689,275 105,166,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 136
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIJAGANG
(019) D30100301900028 BULAN : AGUSTUS 2023

NO
MARPUAH JD - 0 4,555,800 0 0 311,005 41,246 0

0 0 0 0 10,934 311,005 0
02-06-1967
0 850,000 72,420 32,802 77,751 0
1 196706021991032004 0 364,464 0 ..................
4,555,800 0 41,246
( PNS - 4A ) MKG: 26 1 95 0 0
5,874,302 10,934 838,202
-
32,802 5,036,100
YETI NURHAYATI, Am.Keb K-1 4,847,300 0 0 316,893 38,567 0
1 484,730 0 0 11,634 316,893 0
18-05-1967
96,946 600,000 217,260 34,901 79,223 0
2 196705181988032003 0 434,318 0 ..................
5,428,976 0 38,567
( PNS - 4A ) MKG: 30 3 5 0 0
6,648,236 11,634 915,536
-
34,901 5,732,700
484,730 0 0 22,568 627,898 0
96,946 1,450,000 289,680 67,703 156,974 0
PEG : 2 9,984,776 0 79,813 0 798,782 0
IST : 1 JIWA = 4 100 0 0
ANK : 1 12,522,538 22,568 1,753,738
67,703 10,768,800
dr. YANOVA TRIMUJASMARA K-1 3,410,600 540,000 0 338,462 0 0
2 341,060 0 0 8,185 338,462 0
19-11-1981
136,424 0 289,680 24,556 84,616 0
3 198111192014121001 0 311,047 0 ..................
3,888,084 0 0
( PNS - 3D ) MKG: 10 4 99 0 0
5,089,066 8,185 766,866
-
24,556 4,322,200
TETI RAHMAWATI TK - 0 4,508,600 0 0 301,361 22,013 0
0 0 0 0 10,821 301,361 0
05-10-1970
0 500,000 72,420 32,462 75,340 0
4 197010051990032004 0 360,688 0 ..................
4,508,600 0 22,013
( PNS - 3D ) MKG: 28 1 8 0 0
5,447,685 10,821 802,685
-
32,462 4,645,000
YUNI MARIA K-0 4,108,100 0 0 250,854 1,358 0
0 0 0 0 9,859 250,854 0
03-06-1972
0 500,000 72,420 29,578 62,714 0
5 197206031995032004 0 328,648 0 ..................
4,108,100 0 1,358
( PNS - 3D ) MKG: 23 1 42 0 0
4,972,211 9,859 683,011
-
29,578 4,289,200
Halaman : 137
(019) D30100301900028 BULAN : AGUSTUS 2023

NO
YOYO WALUYO K-1 3,982,600 0 0 307,902 0 0

2 398,260 0 0 9,558 307,902 0
28-01-1971
159,304 500,000 289,680 28,675 76,976 0
6 197101281998031005 0 363,213 0 ..................
4,540,164 0 0
( PNS - 3D ) MKG: 20 4 45 0 0
5,676,024 9,558 786,324
-
28,675 4,889,700
TUTI ROHAYATI K-1 4,461,800 0 0 276,902 1,096 0
1 446,180 0 0 10,708 276,902 0
15-06-1966
89,236 265,000 217,260 32,125 69,226 0
7 196606151988032007 0 399,777 0 ..................
4,997,216 0 1,096
( PNS - 3C ) MKG: 30 3 27 0 0
5,800,334 10,708 789,834
-
32,125 5,010,500
RETNA DAYANINGSIH,AMKL K-1 3,238,300 0 0 239,328 0 0
2 323,830 0 0 7,772 239,328 0
13-10-1978
129,532 240,000 289,680 23,316 59,832 0
8 197810132009022001 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 23 0 0
4,491,781 7,772 625,581
-
23,316 3,866,200
CUCUM, AM.Keb. K-0 3,627,900 0 0 223,193 0 0
0 0 0 0 8,707 223,193 0
01-02-1974
0 265,000 72,420 26,121 55,798 0
9 197402012007012010 0 290,232 0 ..................
3,627,900 0 0
( PNS - 3A ) MKG: 22 1 10 0 0
4,223,351 8,707 604,051
-
26,121 3,619,300
DEWI SULASTRI, A.Md.Keb. K-1 3,409,800 0 0 227,430 0 0
2 340,980 0 0 8,184 227,430 0
30-05-1974
136,392 265,000 289,680 24,551 56,858 0
10 197405302006042008 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 80 0 0
4,702,097 8,184 627,997
-
24,551 4,074,100
YUSITA ANDINI, AM.Kep K-1 3,409,800 0 0 207,700 0 0
2 340,980 0 0 8,184 207,700 0
05-03-1981
136,392 265,000 289,680 24,551 51,925 0
11 198103052008012008 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 47 0 0
4,682,334 8,184 603,334
-
24,551 4,079,000
Halaman : 138
(019) D30100301900028 BULAN : AGUSTUS 2023

NO
DEWI RESMIATI, Amd.Kep TK - 0 3,305,700 0 0 224,169 0 0

0 0 0 0 7,934 224,169 0
29-05-1980
0 265,000 72,420 23,801 56,042 0
12 198005292012122001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 78 0 0
3,899,102 7,934 576,402
-
23,801 3,322,700
SUSILAWATI, Amd.Kep K-0 3,305,700 0 0 223,163 0 0
0 0 0 0 7,934 223,163 0
15-09-1981
0 265,000 72,420 23,801 55,791 0
13 198109152012122001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 27 0 0
3,898,045 7,934 575,145
-
23,801 3,322,900
2,191,290 0 0 97,846 2,820,464 0
787,280 3,330,000 2,027,760 293,537 705,118 0
PEG : 11 43,747,470 0 24,467 0 3,499,798 0
IST : 6 JIWA = 28 486 0 0
ANK : 11 52,882,030 97,846 7,441,230
293,537 45,440,800
SITI NURJANAH K-1 3,480,700 0 0 251,518 0 0
1 348,070 0 0 8,354 251,518 0
07-02-1974
69,614 240,000 217,260 25,061 62,879 0
14 197402072006042008 0 311,871 0 ..................
3,898,384 0 0
( PNS - 2D ) MKG: 27 3 6 0 0
4,640,583 8,354 659,683
-
25,061 3,980,900
NENENG ALFIAH, A.Md.Keb K-1 2,889,800 0 0 198,835 0 0
2 288,980 0 0 6,936 198,835 0
10-03-1983
115,592 240,000 289,680 20,807 49,709 0
15 198303102017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 7 0 0
4,050,637 6,936 539,837
-
20,807 3,510,800
637,050 0 0 15,290 450,353 0
185,206 480,000 506,940 45,868 112,588 0
PEG : 2 7,192,756 0 0 0 575,421 0
IST : 2 JIWA = 7 13 0 0
ANK : 3 8,691,220 15,290 1,199,520
45,868 7,491,700
Halaman : 139
(019) D30100301900028 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 56,542,500 540,000 0 3,898,715 104,280 0
3,313,070 0 0 135,704 3,898,715 0
1,069,432 5,260,000 2,824,380 407,108 974,680 0
PEG : 15 60,925,002 0 104,280 0 4,874,001 0
IST : 9 JIWA = 39 599 0 0
ANK : 15 74,095,788 135,704 10,394,488
407,108 63,701,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 140
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SUKANAGARA
(019) D30100301900029 BULAN : AGUSTUS 2023

NO
KUSNADI B, SKM, M.Kes K-1 4,555,800 0 0 406,463 842 0

2 455,580 0 0 10,934 406,463 0
08-10-1970
182,232 265,000 289,680 32,802 101,616 0
1 197010081991011002 0 415,489 0 ..................
5,193,612 0 842
( PNS - 4A ) MKG: 26 4 13 0 0
6,199,346 10,934 968,146
12345
32,802 5,231,200
SUB TOTAL PERGOLONGAN : IV 4,555,800 0 0 406,463 842 0
455,580 0 0 10,934 406,463 0
182,232 265,000 289,680 32,802 101,616 0
PEG : 1 5,193,612 0 842 0 415,489 0
IST : 1 JIWA = 4 13 0 0
ANK : 2 6,199,346 10,934 968,146
32,802 5,231,200
H. ACEP, SKM K-1 4,650,600 0 0 327,629 24,296 0
1 465,060 0 0 11,161 327,629 0
29-06-1966
93,012 500,000 217,260 33,484 81,907 0
2 196606291987031006 0 416,694 0 ..................
5,208,672 0 24,296
( PNS - 3D ) MKG: 30 3 69 0 0
6,322,571 11,161 895,171
33,484 5,427,400
ANAK AGUNG ISTRI ALIT, AM.Keb. TK - 0 4,508,600 0 0 295,799 21,750 0
0 0 0 0 10,821 295,799 0
30-12-1966
0 500,000 72,420 32,462 73,950 0
3 196612301990032006 0 360,688 0 ..................
4,508,600 0 21,750
( PNS - 3D ) MKG: 28 1 18 0 0
5,441,870 10,821 795,470
-
32,462 4,646,400
LELA SULASIH K-1 4,370,900 0 0 288,930 8,192 0
1 437,090 0 0 10,490 288,930 0
11-08-1970
87,418 500,000 217,260 31,470 72,232 0
4 197008111991032002 0 391,633 0 ..................
4,895,408 0 8,192
( PNS - 3D ) MKG: 26 3 97 0 0
5,951,847 10,490 802,947
-
31,470 5,148,900
HAMBALI LEBAR, SKM K-1 4,237,500 0 0 309,086 0 0
2 423,750 0 0 10,170 309,086 0
17-10-1969
169,500 500,000 289,680 30,510 77,272 0
5 196910171994031005 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 2 0 0
5,970,198 10,170 813,498
-
30,510 5,156,700
Halaman : 141
(019) D30100301900029 BULAN : AGUSTUS 2023

NO
HEN HEN RESMIATI K-1 4,193,500 0 0 297,372 0 0

2 419,350 0 0 10,064 297,372 0
16-10-1971
167,740 600,000 289,680 30,193 74,343 0
6 197110161992032005 0 382,447 0 ..................
4,780,590 0 0
( PNS - 3C ) MKG: 26 4 20 0 0
6,007,919 10,064 794,419
-
30,193 5,213,500
SRI PRIYATINI K-1 4,193,500 0 0 307,478 0 0
2 419,350 0 0 10,064 307,478 0
15-08-1969
167,740 500,000 289,680 30,193 76,869 0
7 196908151991022002 0 382,447 0 ..................
4,780,590 0 0
( PNS - 3C ) MKG: 26 4 46 0 0
5,918,051 10,064 807,051
-
30,193 5,111,000
dr. MOCHAMMAD RIDWAN NUR HAKIM TK - 0 2,773,200 0 0 300,058 0 0
0 0 0 0 6,656 300,058 0
28-05-1992
0 325,000 72,420 19,967 75,014 0
8 199205282020121011 0 221,856 0 ..................
2,773,200 0 0
( PNS - 3B ) MKG: 2 1 50 0 0
3,497,351 6,656 623,551
-
19,967 2,873,800
SOFIE SOFIATY, AM.Kep K-1 3,445,500 0 0 282,025 0 0
2 344,550 0 0 8,269 282,025 0
17-06-1982
137,820 265,000 289,680 24,808 70,506 0
9 198206172005012006 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 86 0 0
4,797,738 8,269 699,838
24,808 4,097,900
VERA HAZIZAH, S. Farm.,Apt K-1 2,688,500 0 0 187,622 0 0
2 268,850 185,000 0 6,452 187,622 0
07-07-1990
107,540 0 289,680 19,357 46,905 0
10 199007072022032004 0 245,191 0 ..................
3,064,890 0 0
( PNS - 3B ) MKG: 1 4 26 0 0
3,753,027 6,452 505,527
-
19,357 3,247,500
EMI ANJARWATI K-1 3,742,200 0 0 266,594 0 0
2 374,220 0 0 8,981 266,594 0
27-05-1970
149,688 265,000 289,680 26,944 66,648 0
11 197005271994032002 0 341,289 0 ..................
4,266,108 0 0
( PNS - 3A ) MKG: 24 4 49 0 0
5,123,356 8,981 710,456
-
26,944 4,412,900
Halaman : 142
(019) D30100301900029 BULAN : AGUSTUS 2023

NO
NILA ESTI YULIANTI K-1 3,627,900 0 0 307,544 0 0

2 362,790 0 0 8,707 307,544 0
18-07-1972
145,116 265,000 289,680 26,121 76,886 0
12 197207182006042009 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 64 0 0
5,032,922 8,707 750,122
-
26,121 4,282,800
TITA MARLINA K-1 3,517,200 0 0 322,582 0 0
2 351,720 0 0 8,441 322,582 0
06-04-1977
140,688 265,000 289,680 25,324 80,645 0
13 197704062006042036 0 320,769 0 ..................
4,009,608 0 0
( PNS - 3A ) MKG: 20 4 26 0 0
4,920,661 8,441 757,761
-
25,324 4,162,900
NANA SUTIANA, Amd.Kep K-1 3,305,700 0 0 259,156 0 0
2 330,570 0 0 7,934 259,156 0
07-12-1972
132,228 265,000 289,680 23,801 64,789 0
14 197212072012121001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 91 0 0
4,614,160 7,934 657,160
-
23,801 3,957,000
ASRIANI RUSTIAN,Am.Keb K-1 3,106,900 0 0 290,304 0 0
2 310,690 0 0 7,457 290,304 0
28-03-1987
124,276 265,000 289,680 22,370 72,576 0
15 198703282009022003 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 79 0 0
4,416,756 7,457 676,056
-
22,370 3,740,700
RINA ROSDIANA K-1 2,920,100 0 0 156,391 0 0
2 292,010 0 0 7,008 156,391 0
27-02-1985
116,804 240,000 289,680 21,025 39,098 0
16 198502272009022002 0 266,313 0 ..................
3,328,914 0 0
( PNS - 3A ) MKG: 8 4 17 0 0
4,043,035 7,008 489,835
-
21,025 3,553,200
4,800,000 185,000 0 132,675 4,198,570 0
1,739,570 5,255,000 3,765,840 398,029 1,049,640 0
PEG : 15 61,821,370 0 54,238 0 4,945,710 0
IST : 13 JIWA = 52 740 0 0
ANK : 24 75,811,462 132,675 10,778,862
398,029 65,032,600
Halaman : 143
(019) D30100301900029 BULAN : AGUSTUS 2023

NO
IMAS KARYATI K-0 3,374,400 0 0 229,261 0 0

0 0 0 0 8,099 229,261 0
22-03-1977
0 240,000 72,420 24,296 57,315 0
17 197703222007012005 0 269,952 0 ..................
3,374,400 0 0
( PNS - 2D ) MKG: 25 1 47 0 0
3,948,523 8,099 588,923
-
24,296 3,359,600
AI NURHAYATI, A.Md.Kep K-1 3,171,500 0 0 277,190 0 0
2 317,150 0 0 7,612 277,190 0
09-02-1982
126,860 240,000 289,680 22,835 69,298 0
18 198202092014092002 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 49 0 0
4,452,876 7,612 666,176
-
22,835 3,786,700
ASRI EKA MUTIARA K-0 3,074,700 0 0 215,140 0 0
2 0 0 0 7,379 215,140 0
01-04-1976
122,988 240,000 217,260 22,138 53,785 0
19 197604012002122008 0 255,815 0 ..................
3,197,688 0 0
( PNS - 2D ) MKG: 19 3 52 0 0
3,899,657 7,379 554,257
-
22,138 3,345,400
BETY NURHIDAYATI, A.Md.Keb K-1 2,889,800 0 0 211,809 0 0
2 288,980 0 0 6,936 211,809 0
01-12-1986
115,592 240,000 289,680 20,807 52,952 0
20 198612012017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 50 0 0
4,063,654 6,936 556,054
-
20,807 3,507,600
TESI SANDY TRIPENA, A.Md.Keb K-1 2,889,800 0 0 243,006 0 0
2 288,980 0 0 6,936 243,006 0
01-12-1987
115,592 240,000 289,680 20,807 60,752 0
21 198712012017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 50 0 0
4,094,851 6,936 595,051
-
20,807 3,499,800
ERWIN SUHERMAN K-1 2,949,900 0 0 293,878 0 0
2 294,990 0 0 7,080 293,878 0
11-12-1979
117,996 240,000 289,680 21,239 73,469 0
22 197912112007011004 0 269,031 0 ..................
3,362,886 0 0
( PNS - 2C ) MKG: 20 4 34 0 0
4,214,797 7,080 664,697
-
21,239 3,550,100
Halaman : 144
(019) D30100301900029 BULAN : AGUSTUS 2023

NO
DENI A.FAISAL, A.Md.Kep K-1 2,949,900 0 0 190,030 0 0

2 294,990 0 0 7,080 190,030 0
07-06-1980
117,996 240,000 289,680 21,239 47,508 0
23 198006072008011030 0 269,031 0 ..................
3,362,886 0 0
( PNS - 2C ) MKG: 19 4 73 0 0
4,110,988 7,080 534,888
0
21,239 3,576,100
ALI IRAWAN, A.Md.Kep K-1 2,374,300 0 0 189,741 0 0
2 237,430 0 0 5,698 189,741 0
25-09-1990
94,972 240,000 289,680 17,095 47,435 0
24 199009252020121006 0 216,536 0 ..................
2,706,702 0 0
( PNS - 2C ) MKG: 5 4 89 0 0
3,449,005 5,698 476,505
-
17,095 2,972,500
ANDHINIE TYANA POETRI YUDITHEA, K-1 2,374,300 0 0 193,052 0 0
1 237,430 0 0 5,698 193,052 0
11-07-1991 47,486 240,000 217,260 17,095 48,263 0
25 199107112020122012 2,659,216 0 0 0 212,737 0 ..................
3 24 0 0
( PNS - 2C ) MKG: 5
3,332,345 5,698 476,845
- 17,095 2,855,500

1,959,950 0 0 62,518 2,043,107 0
859,482 2,160,000 2,245,020 187,551 510,777 0
PEG : 9 28,868,032 0 0 0 2,309,443 0
IST : 7 JIWA = 31 468 0 0
ANK : 15 35,566,696 62,518 5,113,396
187,551 30,453,300
TOTAL PER SATKER 85,886,200 0 0 6,648,140 55,080 0
7,215,530 185,000 0 206,127 6,648,140 0
2,781,284 7,680,000 6,300,540 618,382 1,662,033 0
PEG : 25 95,883,014 0 55,080 0 7,670,642 0
IST : 21 JIWA = 87 1,221 0 0
ANK : 41 117,577,504 206,127 16,860,404
618,382 100,717,100
Halaman : 145
(019) D30100301900029 BULAN : AGUSTUS 2023

NO
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 146
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CAMPAKA
(019) D30100301900030 BULAN : AGUSTUS 2023

NO
DEDEH KURNIASIH,Am.Keb. TK - 0 4,555,800 0 0 364,816 43,800 0

0 0 0 0 10,934 364,816 0
23-02-1968
0 850,000 72,420 32,802 91,204 0
1 196802231991032004 0 364,464 0 ..................
4,555,800 0 43,800
( PNS - 4A ) MKG: 27 1 48 0 0
5,930,620 10,934 908,020
-
32,802 5,022,600
0 0 0 10,934 364,816 0
0 850,000 72,420 32,802 91,204 0
PEG : 1 4,555,800 0 43,800 0 364,464 0
IST : 0 JIWA = 1 48 0 0
ANK : 0 5,930,620 10,934 908,020
32,802 5,022,600
dr. TITO NURTANSAH K-1 3,410,600 0 0 480,000 0 0
1 341,060 0 0 8,185 480,000 0
15-08-1984
68,212 750,000 217,260 24,556 120,000 0
2 198408152014121001 0 305,590 0 ..................
3,819,872 0 0
( PNS - 3D ) MKG: 10 3 58 0 0
5,299,931 8,185 938,331
-
24,556 4,361,600
ENCIH SUNARSIH K-1 4,370,900 0 0 343,221 4,154 0
2 437,090 0 0 10,490 343,221 0
04-08-1969
174,836 600,000 289,680 31,470 85,805 0
3 196908041991032014 0 398,626 0 ..................
4,982,826 0 4,154
( PNS - 3D ) MKG: 26 4 25 0 0
6,261,866 10,490 873,766
-
31,470 5,388,100
DIAN TAUFIK HIDAYAT, S.Kep.Ners. K-1 3,743,100 0 0 437,012 0 0
2 374,310 0 0 8,983 437,012 0
28-12-1976
149,724 600,000 289,680 26,950 109,253 0
4 197612282005011005 0 341,371 0 ..................
4,267,134 0 0
( PNS - 3D ) MKG: 16 4 10 0 0
5,629,769 8,983 923,569
0
26,950 4,706,200
EDI ARIANTO, S.Kep.,Ners K-1 3,410,600 0 0 396,960 0 0
2 341,060 0 0 8,185 396,960 0
21-08-1981
136,424 600,000 289,680 24,556 99,240 0
5 198108212011011002 0 311,047 0 ..................
3,888,084 0 0
( PNS - 3D ) MKG: 10 4 23 0 0
5,207,488 8,185 839,988
-
24,556 4,367,500
Halaman : 147
(019) D30100301900030 BULAN : AGUSTUS 2023

NO
SRI AMPELI, AM.Keb. K-0 4,508,600 0 0 321,804 22,983 0

0 0 0 0 10,821 321,804 0
10-08-1969
0 500,000 72,420 32,462 80,451 0
6 196908101989032006 0 360,688 0 ..................
4,508,600 0 22,983
( PNS - 3D ) MKG: 28 1 19 0 0
5,469,109 10,821 829,209
-
32,462 4,639,900
TUTUN ROHMATUN K-1 4,370,900 0 0 348,674 0 0
2 437,090 0 0 10,490 348,674 0
11-09-1972
174,836 500,000 289,680 31,470 87,168 0
7 197209111992032004 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 88 0 0
6,163,228 10,490 876,428
-
31,470 5,286,800
ELAH ROHILAH HAYATI, AM.Kep. K-1 3,743,100 0 0 354,287 0 0
2 374,310 0 0 8,983 354,287 0
12-03-1980
149,724 500,000 289,680 26,950 88,572 0
8 198003122005012014 0 341,371 0 ..................
4,267,134 0 0
( PNS - 3D ) MKG: 16 4 29 0 0
5,447,063 8,983 820,163
-
26,950 4,626,900
EDO MUHAMMAD ZEIN, AMKL TK - 0 3,591,200 0 0 341,047 0 0
0 0 0 0 8,619 341,047 0
23-03-1981
0 600,000 72,420 25,857 85,262 0
9 198103232005011006 0 287,296 0 ..................
3,591,200 0 0
( PNS - 3C ) MKG: 16 1 38 0 0
4,639,181 8,619 748,081
-
25,857 3,891,100
EKA, AM.Kep K-0 3,591,200 0 0 328,790 0 0
0 0 0 0 8,619 328,790 0
14-12-1981
0 500,000 72,420 25,857 82,197 0
10 198112142007012003 0 287,296 0 ..................
3,591,200 0 0
( PNS - 3C ) MKG: 16 1 73 0 0
4,526,959 8,619 732,759
-
25,857 3,794,200
CECEP KOMARUDIN, AM.Kep K-1 3,554,000 0 0 358,447 0 0
2 355,400 0 0 8,530 358,447 0
10-01-1976
142,160 265,000 289,680 25,589 89,612 0
11 197601102008011008 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 97 0 0
4,998,903 8,530 806,303
-
25,589 4,192,600
Halaman : 148
(019) D30100301900030 BULAN : AGUSTUS 2023

NO
REZA ISMAIL FAHMI K-1 3,238,300 0 0 344,051 0 0

2 323,830 0 0 7,772 344,051 0
07-04-1984
129,532 265,000 289,680 23,316 86,013 0
12 198404072005011003 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 13 4 4 0 0
4,621,485 7,772 756,485
-
23,316 3,865,000
RISKA SUAIDA FAHRIA, AM.Kep K-1 3,106,900 0 0 344,940 0 0
2 310,690 0 0 7,457 344,940 0
11-08-1985
124,276 265,000 289,680 22,370 86,235 0
13 198508112009022003 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 38 0 0
4,471,351 7,457 744,351
12345
22,370 3,727,000
NIRA IKA APRILIA, S.K.M TK - 0 2,579,400 0 0 177,283 0 0
0 0 185,000 0 6,191 177,283 0
23-04-1996
0 0 72,420 18,572 44,321 0
14 199604232022032005 0 206,352 0 ..................
2,579,400 0 0
( PNS - 3A ) MKG: 1 1 53 0 0
3,038,919 6,191 452,719
-
18,572 2,586,200
3,294,840 185,000 0 113,325 4,576,516 0
1,249,724 5,945,000 2,824,380 339,975 1,144,129 0
PEG : 13 51,763,364 0 27,137 0 4,141,070 0
IST : 9 JIWA = 39 555 0 0
ANK : 17 65,775,252 113,325 10,342,152
339,975 55,433,100
MIRA MARDIANA K-1 3,171,500 0 0 319,362 0 0
2 317,150 0 0 7,612 319,362 0
04-05-1980
126,860 240,000 289,680 22,835 79,840 0
15 198005042008012008 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 91 0 0
4,495,090 7,612 718,890
-
RESTRI RAHSETIA PUTRI, AM.Keb K-1 3,074,700 0 0 270,041 0 0
2 307,470 0 0 7,379 270,041 0
19-02-1985
122,988 240,000 289,680 22,138 67,510 0
16 198502192017052003 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 85 0 0
4,334,481 7,379 647,481
-
22,138 3,687,000
Halaman : 149
(019) D30100301900030 BULAN : AGUSTUS 2023

NO
EKO ARIADI K-1 2,980,800 0 0 268,261 0 0

2 298,080 0 0 7,154 268,261 0
04-05-1979
119,232 240,000 289,680 21,462 67,065 0
17 197905042009021003 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 22 0 0
4,224,691 7,154 635,791
-
21,462 3,588,900
RESTI NURSARI, A.Md.Keb K-1 2,980,800 0 0 272,159 0 0
2 298,080 0 0 7,154 272,159 0
14-07-1985
119,232 240,000 289,680 21,462 68,040 0
18 198507142017052002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 97 0 0
4,228,664 7,154 640,664
-
21,462 3,588,000
LILI PAKPAHAN, A.Md.Keb K-0 2,889,800 0 0 231,816 0 0
0 0 0 0 6,936 231,816 0
14-01-1984
0 240,000 72,420 20,807 57,954 0
19 198401142017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 18 0 0
3,461,797 6,936 548,697
-
20,807 2,913,100
TOPAH, A.Md.Keb K-1 2,889,800 0 0 266,998 0 0
2 288,980 0 0 6,936 266,998 0
24-10-1989
115,592 240,000 289,680 20,807 66,749 0
20 198910242017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 47 0 0
4,118,840 6,936 625,040
-
20,807 3,493,800
EUIS KUSMAWATI K-1 3,042,800 0 0 275,829 0 0
2 304,280 0 0 7,303 275,829 0
05-01-1976
121,712 240,000 289,680 21,908 68,957 0
21 197601052014092001 0 277,503 0 ..................
3,468,792 0 0
( PNS - 2C ) MKG: 21 4 88 0 0
4,303,600 7,303 651,500
-
21,908 3,652,100
1,814,040 0 0 50,474 1,904,466 0
725,616 1,680,000 1,810,500 151,419 476,115 0
PEG : 7 23,569,856 0 0 0 1,885,589 0
IST : 6 JIWA = 25 448 0 0
ANK : 12 29,167,163 50,474 4,468,063
151,419 24,699,100
Halaman : 150
(019) D30100301900030 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 72,804,800 0 0 6,845,798 70,937 0
5,108,880 185,000 0 174,733 6,845,798 0
1,975,340 8,475,000 4,707,300 524,196 1,711,448 0
PEG : 21 79,889,020 0 70,937 0 6,391,123 0
IST : 15 JIWA = 65 1,051 0 0
ANK : 29 100,873,035 174,733 15,718,235
524,196 85,154,800
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 151
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CAMPAKAMULYA
(019) D30100301900031 BULAN : AGUSTUS 2023

NO
SESEP SOLIHIN, Am.Kep. K-1 4,237,500 0 0 308,904 2,338 0

1 423,750 0 0 10,170 308,904 0
04-07-1972
84,750 500,000 217,260 30,510 77,226 0
1 197207041994031007 0 379,680 0 ..................
4,746,000 0 2,338
( PNS - 3D ) MKG: 24 3 46 0 0
5,815,228 10,170 808,828
-
30,510 5,006,400
TUTI LATIFAH, AM.Keb. TK - 0 4,237,500 0 0 274,328 8,371 0
0 0 0 0 10,170 274,328 0
03-09-1972
0 500,000 72,420 30,510 68,582 0
2 197209031993022001 0 339,000 0 ..................
4,237,500 0 8,371
( PNS - 3D ) MKG: 24 1 62 0 0
5,133,361 10,170 730,961
-
30,510 4,402,400
ETY KURNIAWATI TK - 0 4,237,500 0 0 219,897 5,783 0
0 0 0 0 10,170 219,897 0
19-09-1973
0 500,000 72,420 30,510 54,974 0
3 197309191993012001 0 339,000 0 ..................
4,237,500 0 5,783
( PNS - 3D ) MKG: 24 1 54 0 0
5,076,334 10,170 660,334
-
30,510 4,416,000
TB.WAHYU RAHAYU, AM.Kep. K-1 4,370,900 0 0 333,661 0 0
2 437,090 0 0 10,490 333,661 0
04-05-1970
174,836 265,000 289,680 31,470 83,415 0
4 197005041990031003 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 35 0 0
5,913,162 10,490 857,662
-
31,470 5,055,500
ANDRI ARIFIANTO, AM.Kep. K-1 3,238,300 0 0 244,373 0 0
2 323,830 0 0 7,772 244,373 0
16-05-1977
129,532 300,000 289,680 23,316 61,093 0
5 197705162005011007 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 84 0 0
4,556,887 7,772 631,887
23,316 3,925,000
NENENG ROHIMAH SUTISNA TK - 0 3,238,300 0 0 215,295 0 0
0 0 0 0 7,772 215,295 0
20-03-1978
0 300,000 72,420 23,316 53,824 0
6 197803202005012012 0 259,064 0 ..................
3,238,300 0 0
( PNS - 3B ) MKG: 12 1 68 0 0
3,857,171 7,772 559,271
23,316 3,297,900
Halaman : 152
(019) D30100301900031 BULAN : AGUSTUS 2023

NO
NINA RUKINAH JD - 0 4,280,800 0 0 212,453 0 0

1 0 185,000 0 10,274 212,453 0
09-11-1965
85,616 0 144,840 30,822 53,113 0
7 196511091987032006 0 349,313 0 ..................
4,366,416 0 0
( PNS - 3B ) MKG: 30 2 70 0 0
4,949,875 10,274 655,975
-
30,822 4,293,900
1,184,670 185,000 0 66,818 1,808,911 0
474,734 2,365,000 1,158,720 200,454 452,227 0
PEG : 7 29,500,204 0 16,492 0 2,360,016 0
IST : 3 JIWA = 16 419 0 0
ANK : 6 35,302,018 66,818 4,904,918
200,454 30,397,100
AYI SUPRIATNA, Amd.Kep K-1 3,171,500 0 0 215,885 0 0
0 317,150 0 0 7,612 215,885 0
17-03-1975
0 240,000 144,840 22,835 53,971 0
8 197503172012121001 0 279,092 0 ..................
3,488,650 0 0
( PNS - 2D ) MKG: 21 2 73 0 0
4,119,895 7,612 579,395
-
22,835 3,540,500
RISA PUSPITA MARTIN, AM.Keb K-1 2,889,800 0 0 306,910 0 0
2 288,980 0 0 6,936 306,910 0
08-07-1983
115,592 240,000 289,680 20,807 76,727 0
9 198307082017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 25 0 0
4,158,730 6,936 674,930
-
20,807 3,483,800
RINDA SUPRIATINI, A.Md.Keb K-1 2,889,800 0 0 216,785 0 0
2 288,980 0 0 6,936 216,785 0
06-08-1987
115,592 240,000 289,680 20,807 54,196 0
10 198708062017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 94 0 0
4,068,674 6,936 562,274
-
20,807 3,506,400
AI MARIYAM NURHASANAH, A.Md.Keb K-1 2,889,800 0 0 205,683 0 0
1 288,980 0 0 6,936 205,683 0
08-08-1989
57,796 240,000 217,260 20,807 51,421 0
11 198908082017052002 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 11 0 0
3,927,273 6,936 543,773
-
20,807 3,383,500
Halaman : 153
(019) D30100301900031 BULAN : AGUSTUS 2023

NO
1,184,090 0 0 28,420 945,263 0
288,980 960,000 941,460 85,256 236,315 0
PEG : 4 13,313,970 0 0 0 1,065,118 0
IST : 4 JIWA = 13 203 0 0
ANK : 5 16,274,572 28,420 2,360,372
85,256 13,914,200
TOTAL PER SATKER 39,681,700 0 0 2,754,174 16,492 0
2,368,760 185,000 0 95,238 2,754,174 0
763,714 3,325,000 2,100,180 285,710 688,542 0
PEG : 11 42,814,174 0 16,492 0 3,425,134 0
IST : 7 JIWA = 29 622 0 0
ANK : 11 51,576,590 95,238 7,265,290
285,710 44,311,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 154
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS KADUPANDAK
(019) D30100301900032 BULAN : AGUSTUS 2023

NO
INEU DINIAH, S.KM K-1 3,628,900 0 0 265,216 0 0

2 362,890 0 0 8,709 265,216 0
16-12-1984
145,156 600,000 289,680 26,128 66,304 0
1 198412162009022002 0 330,956 0 ..................
4,136,946 0 0
( PNS - 3D ) MKG: 14 4 34 0 0
5,326,713 8,709 697,313
-
26,128 4,629,400
NUNUNG NURJANAH, AM.Keb JD - 0 4,650,600 0 0 266,998 4,625 0
2 0 0 0 11,161 266,998 0
05-11-1968
186,024 500,000 217,260 33,484 66,750 0
2 196811051988032002 0 386,930 0 ..................
4,836,624 0 4,625
( PNS - 3D ) MKG: 30 3 96 0 0
5,870,248 11,161 769,948
-
33,484 5,100,300
KOKON SUNARYO K-1 4,508,600 0 0 288,958 3,975 0
2 450,860 0 0 10,821 288,958 0
14-08-1966
180,344 500,000 289,680 32,462 72,239 0
3 196608141990011001 0 411,184 0 ..................
5,139,804 0 3,975
( PNS - 3D ) MKG: 28 4 39 0 0
6,265,739 10,821 819,639
-
32,462 5,446,100
ENOK RUSTIATI ATUN M, AM.Keb. TK - 0 4,370,900 0 0 248,993 13,246 0
0 0 0 0 10,490 248,993 0
05-07-1967
0 500,000 72,420 31,470 62,248 0
4 196707051990032008 0 349,672 0 ..................
4,370,900 0 13,246
( PNS - 3D ) MKG: 26 1 0 0 0
5,247,519 10,490 716,119
-
31,470 4,531,400
SURYANA K-1 4,237,500 0 0 302,274 0 0
2 423,750 0 0 10,170 302,274 0
02-04-1974
169,500 500,000 289,680 30,510 75,569 0
5 197404021994031003 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 99 0 0
5,963,483 10,170 804,983
-
30,510 5,158,500
NUNUNG SUMARYANI, AM.Keb K-1 3,554,000 0 0 229,160 0 0
2 355,400 0 0 8,530 229,160 0
24-11-1973
142,160 265,000 289,680 25,589 57,290 0
6 197311241993012001 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 75 0 0
4,869,594 8,530 644,694
-
25,589 4,224,900
Halaman : 155
(019) D30100301900032 BULAN : AGUSTUS 2023

NO
CUCU SURYANI K-1 3,627,900 0 0 232,426 0 0

2 362,790 0 0 8,707 232,426 0
23-09-1973
145,116 265,000 289,680 26,121 58,106 0
7 197309232006042012 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 84 0 0
4,957,824 8,707 656,224
-
26,121 4,301,600
DJADJANG SUPRIATNA, Amd.Kep K-1 3,305,700 0 0 234,535 0 0
2 330,570 0 0 7,934 234,535 0
26-12-1980
132,228 265,000 289,680 23,801 58,634 0
8 198012262012121002 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 36 0 0
4,589,484 7,934 626,384
-
23,801 3,963,100
E.ARISWANDI SUGIANTO,Amd.Kep K-1 3,305,700 0 0 224,776 0 0
2 330,570 0 0 7,934 224,776 0
13-10-1981
132,228 265,000 289,680 23,801 56,194 0
9 198110132012121001 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 96 0 0
4,579,785 7,934 614,185
-
23,801 3,965,600
LENI HERLINAWATI, Am.Keb. K-0 3,012,000 0 0 204,479 0 0
0 0 0 0 7,229 204,479 0
30-09-1983
0 265,000 72,420 21,686 51,120 0
10 198309302010012012 0 240,960 0 ..................
3,012,000 0 0
( PNS - 3A ) MKG: 10 1 60 0 0
3,582,874 7,229 525,474
-
21,686 3,057,400
RATIH SUKMA PUJAWATI, S.Tr.Kes TK - 0 2,579,400 0 0 166,704 0 0
0 0 185,000 0 6,191 166,704 0
22-06-1997
0 0 72,420 18,572 41,676 0
11 199706222022032008 0 206,352 0 ..................
2,579,400 0 0
( PNS - 3A ) MKG: 1 1 8 0 0
3,028,295 6,191 439,495
-
18,572 2,588,800
2,616,830 185,000 0 97,876 2,664,519 0
1,232,756 3,925,000 2,462,280 293,624 666,130 0
PEG : 11 44,630,786 0 21,846 0 3,570,463 0
IST : 7 JIWA = 34 627 0 0
ANK : 16 54,281,558 97,876 7,314,458
293,624 46,967,100
Halaman : 156
(019) D30100301900032 BULAN : AGUSTUS 2023

NO
IDA NURLAELA K-1 3,480,700 0 0 232,061 0 0

2 348,070 0 0 8,354 232,061 0
13-01-1975
139,228 240,000 289,680 25,061 58,015 0
12 197501132006042017 0 317,440 0 ..................
3,967,998 0 0
( PNS - 2D ) MKG: 27 4 77 0 0
4,763,231 8,354 640,931
-
25,061 4,122,300
NANI YURESNA JD - 0 3,480,700 0 0 211,214 0 0
2 0 0 0 8,354 211,214 0
08-03-1975
139,228 240,000 217,260 25,061 52,803 0
13 197503082006042019 0 289,594 0 ..................
3,619,928 0 0
( PNS - 2D ) MKG: 27 3 9 0 0
4,321,826 8,354 587,026
-
25,061 3,734,800
TITIN AGUSTINA K-0 3,271,400 0 0 196,948 0 0
0 0 0 0 7,851 196,948 0
17-08-1977
0 240,000 72,420 23,554 49,237 0
14 197708172007012009 0 261,712 0 ..................
3,271,400 0 0
( PNS - 2D ) MKG: 23 1 29 0 0
3,812,202 7,851 539,302
-
23,554 3,272,900
DEWI PUSPAYUNA K-1 3,074,700 0 0 214,759 0 0
2 307,470 0 0 7,379 214,759 0
14-05-1979
122,988 240,000 289,680 22,138 53,690 0
15 197905142008012007 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 65 0 0
4,279,179 7,379 578,379
-
22,138 3,700,800
MIRA YUSTIKA, A.Md.Keb K-1 2,889,800 0 0 198,090 0 0
2 288,980 0 0 6,936 198,090 0
23-05-1987
115,592 240,000 289,680 20,807 49,522 0
16 198705232017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 20 0 0
4,049,905 6,936 538,905
-
20,807 3,511,000
KUSMIATI K-1 2,859,800 0 0 204,753 0 0
2 285,980 0 0 6,864 204,753 0
04-01-1979
114,392 240,000 289,680 20,591 51,188 0
17 197901042012122002 0 260,814 0 ..................
3,260,172 0 0
( PNS - 2C ) MKG: 17 4 50 0 0
4,022,110 6,864 544,210
-
20,591 3,477,900
Halaman : 157
(019) D30100301900032 BULAN : AGUSTUS 2023

NO
1,230,500 0 0 45,738 1,257,825 0
631,428 1,440,000 1,448,400 137,212 314,455 0
PEG : 6 20,919,028 0 0 0 1,673,523 0
IST : 4 JIWA = 20 250 0 0
ANK : 10 25,248,453 45,738 3,428,753
137,212 21,819,700
TOTAL PER SATKER 59,838,300 0 0 3,922,344 21,846 0
3,847,330 185,000 0 143,614 3,922,344 0
1,864,184 5,365,000 3,910,680 430,836 980,585 0
PEG : 17 65,549,814 0 21,846 0 5,243,986 0
IST : 11 JIWA = 54 877 0 0
ANK : 26 79,530,011 143,614 10,743,211
430,836 68,786,800
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 158
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS BOJONGLARANG
(019) D30100301900033 BULAN : AGUSTUS 2023

NO
BENI SUSANTO, SKM, M.Kes K-1 4,237,500 0 0 347,942 0 0

2 423,750 0 0 10,170 347,942 0
11-08-1972
169,500 500,000 289,680 30,510 86,985 0
1 197208111993031008 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 15 0 0
6,009,067 10,170 862,067
30,510 5,147,000
EKO SUTARKA TK - 0 3,941,400 0 0 248,627 0 0
0 0 0 0 9,459 248,627 0
07-05-1974
0 500,000 72,420 28,378 62,157 0
2 197405071995031002 0 315,312 0 ..................
3,941,400 0 0
( PNS - 3C ) MKG: 22 1 49 0 0
4,800,333 9,459 663,933
-
28,378 4,136,400
BAMBANG HERMAWAN K-1 4,065,500 0 0 292,087 0 0
2 406,550 0 0 9,757 292,087 0
06-09-1972
162,620 265,000 289,680 29,272 73,022 0
3 197209061993031009 0 370,774 0 ..................
4,634,670 0 0
( PNS - 3C ) MKG: 24 4 46 0 0
5,520,512 9,757 774,912
-
29,272 4,745,600
FERRY FERDIAN TK - 0 3,900,500 0 0 259,288 0 0
0 0 0 0 9,361 259,288 0
16-02-1973
0 265,000 72,420 28,084 64,822 0
4 197302161994031002 0 312,040 0 ..................
3,900,500 0 0
( PNS - 3B ) MKG: 24 1 42 0 0
4,534,695 9,361 673,595
-
28,084 3,861,100
ERLI SUHAETI JD - 0 3,781,400 0 0 229,950 0 0
1 0 0 0 9,075 229,950 0
01-12-1971
75,628 240,000 144,840 27,226 57,487 0
5 197112012001122002 0 308,562 0 ..................
3,857,028 0 0
( PNS - 3B ) MKG: 22 2 81 0 0
4,508,200 9,075 632,300
-
27,226 3,875,900
DWI SUNARTO, S.KM TK - 0 2,579,400 0 0 147,016 0 0
0 0 185,000 0 6,191 147,016 0
13-12-1996
0 0 72,420 18,572 36,754 0
6 199612132022031002 0 206,352 0 ..................
2,579,400 0 0
( PNS - 3A ) MKG: 1 1 86 0 0
3,008,685 6,191 414,885
-
18,572 2,593,800
Halaman : 159
(019) D30100301900033 BULAN : AGUSTUS 2023

NO
830,300 185,000 0 54,013 1,524,910 0
407,748 1,770,000 941,460 162,042 381,227 0
PEG : 6 23,743,748 0 0 0 1,899,500 0
IST : 2 JIWA = 13 319 0 0
ANK : 5 28,381,492 54,013 4,021,692
162,042 24,359,800
PERI PRIATNA PIRMANSYAH, A.Md.Kep K-1 3,171,500 0 0 207,885 0 0
1 317,150 0 0 7,612 207,885 0
17-06-1981
63,430 240,000 217,260 22,835 51,971 0
7 198106172014091001 0 284,166 0 ..................
3,552,080 0 0
( PNS - 2D ) MKG: 21 3 97 0 0
4,247,769 7,612 574,469
-
22,835 3,673,300
ARISMAN, A.Md.Kep K-1 3,074,700 0 0 229,976 0 0
2 307,470 0 0 7,379 229,976 0
10-04-1980
122,988 240,000 289,680 22,138 57,494 0
8 198004102014101003 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 69 0 0
4,294,400 7,379 597,400
-
22,138 3,697,000
ANI SUMIATI, A.Md.Keb K-1 3,074,700 0 0 210,923 0 0
1 307,470 0 0 7,379 210,923 0
24-09-1985
61,494 240,000 217,260 22,138 52,731 0
9 198509242017052005 0 275,493 0 ..................
3,443,664 0 0
( PNS - 2D ) MKG: 19 3 0 0 0
4,141,364 7,379 568,664
-
22,138 3,572,700
LENI ARIANTI, A.Md.Keb K-1 2,889,800 0 0 212,211 0 0
1 288,980 0 0 6,936 212,211 0
09-08-1987
57,796 240,000 217,260 20,807 53,053 0
10 198708092017052002 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 16 3 43 0 0
3,933,833 6,936 551,933
-
20,807 3,381,900
HERI SUDIAR K-1 3,480,700 0 0 223,067 0 0
2 348,070 180,000 0 8,354 223,067 0
07-07-1974
139,228 0 289,680 25,061 55,767 0
11 197407072006041015 0 317,440 0 ..................
3,967,998 0 0
( PNS - 2D ) MKG: 28 4 29 0 0
4,694,189 8,354 629,689
-
25,061 4,064,500
Halaman : 160
(019) D30100301900033 BULAN : AGUSTUS 2023

NO
1,569,140 180,000 0 37,660 1,084,062 0
444,936 960,000 1,231,140 112,979 271,016 0
PEG : 5 17,705,476 0 0 0 1,416,438 0
IST : 5 JIWA = 17 238 0 0
ANK : 7 21,311,555 37,660 2,922,155
112,979 18,389,400
TOTAL PER SATKER 38,197,100 0 0 2,608,972 0 0
2,399,440 365,000 0 91,673 2,608,972 0
852,684 2,730,000 2,172,600 275,021 652,243 0
PEG : 11 41,449,224 0 0 0 3,315,938 0
IST : 7 JIWA = 30 557 0 0
ANK : 12 49,693,047 91,673 6,943,847
275,021 42,749,200
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 161
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS PAGELARAN
(019) D30100301900034 BULAN : AGUSTUS 2023

NO
ZENI BAGJA NUGRAHA, Amd.Kep K-1 3,204,700 0 0 320,158 0 0

2 320,470 0 0 7,691 320,158 0
03-06-1981
128,188 265,000 289,680 23,074 80,039 0
1 198106032012121001 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 70 0 0
4,559,031 7,691 723,231
-
23,074 3,835,800
IRMA AFRIADIANI, Amd.Kep K-0 3,204,700 0 0 226,348 0 0
0 0 0 0 7,691 226,348 0
03-06-1981
0 265,000 72,420 23,074 56,587 0
2 198106032012122001 0 256,376 0 ..................
3,204,700 0 0
( PNS - 3A ) MKG: 14 1 43 0 0
3,799,276 7,691 570,076
-
23,074 3,229,200
LATIFAH NURKOMARIAH TK - 0 3,106,900 0 0 196,615 0 0
0 0 0 0 7,457 196,615 0
01-08-1985
0 265,000 72,420 22,370 49,154 0
3 198508012005012003 0 248,552 0 ..................
3,106,900 0 0
( PNS - 3A ) MKG: 12 1 86 0 0
3,670,848 7,457 524,148
-
22,370 3,146,700
320,470 0 0 22,839 743,121 0
128,188 795,000 434,520 68,518 185,780 0
PEG : 3 9,964,958 0 0 0 797,197 0
IST : 1 JIWA = 6 199 0 0
ANK : 2 12,029,155 22,839 1,817,455
68,518 10,211,700
NENENG SUKAENI, A.Md.Keb. K-1 3,271,400 0 0 276,419 0 0
2 327,140 0 0 7,851 276,419 0
18-06-1974
130,856 240,000 289,680 23,554 69,105 0
4 197406182006042009 0 298,352 0 ..................
3,729,396 0 0
( PNS - 2D ) MKG: 23 4 81 0 0
4,566,981 7,851 675,281
23,554 3,891,700
RIYANI, A.Md.Keb K-0 2,889,800 0 0 184,399 0 0
0 0 0 0 6,936 184,399 0
04-06-1987
0 240,000 72,420 20,807 46,100 0
5 198706042017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 16 1 64 0 0
3,414,426 6,936 489,426
-
20,807 2,925,000
Halaman : 162
(019) D30100301900034 BULAN : AGUSTUS 2023

NO
NURLAELA, A.Md.Keb K-1 2,889,800 0 0 186,375 0 0

2 288,980 0 0 6,936 186,375 0
02-01-1989
115,592 240,000 289,680 20,807 46,594 0
6 198901022017052004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 92 0 0
4,038,262 6,936 524,262
-
20,807 3,514,000
MARIA ULFA, A.Md.Keb K-1 2,889,800 0 0 197,206 0 0
1 288,980 0 0 6,936 197,206 0
27-01-1989
57,796 240,000 217,260 20,807 49,301 0
7 198901272017052003 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 91 0 0
3,918,876 6,936 533,176
-
20,807 3,385,700
FITRI FAOZ MUSTOPA, A.Md.Keb K-1 2,801,500 0 0 238,482 0 0
2 280,150 0 0 6,724 238,482 0
12-04-1981
112,060 240,000 289,680 20,171 59,621 0
8 198104122019052001 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 28 0 0
3,988,795 6,724 580,495
0
20,171 3,408,300
ROSLAH, A.Md.KL TK - 0 2,374,300 0 0 147,258 0 0
0 0 0 0 5,698 147,258 0
25-09-1996
0 240,000 72,420 17,095 36,814 0
9 199609252020122010 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 5 1 38 0 0
2,856,809 5,698 396,809
-
17,095 2,460,000
FUJI SETIAWATI, A.Md.Gz K-1 2,301,800 0 0 155,406 0 0
1 230,180 0 0 5,524 155,406 0
07-08-1998
46,036 240,000 217,260 16,573 38,852 0
10 199808072020122003 0 206,241 0 ..................
2,578,016 0 0
( PNS - 2C ) MKG: 4 3 17 0 0
3,212,796 5,524 422,596
-
16,573 2,790,200
1,415,430 0 0 46,605 1,385,545 0
462,340 1,680,000 1,448,400 139,814 346,387 0
PEG : 7 21,296,170 0 0 0 1,703,694 0
IST : 5 JIWA = 20 411 0 0
ANK : 8 25,996,945 46,605 3,622,045
139,814 22,374,900
Halaman : 163
(019) D30100301900034 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 28,934,700 0 0 2,128,666 0 0
1,735,900 0 0 69,444 2,128,666 0
590,528 2,475,000 1,882,920 208,332 532,167 0
PEG : 10 31,261,128 0 0 0 2,500,891 0
IST : 6 JIWA = 26 610 0 0
ANK : 10 38,026,100 69,444 5,439,500
208,332 32,586,600
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 164
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SINDANGKERTA
(019) D30100301900035 BULAN : AGUSTUS 2023

NO
TUTI AMALIA, AM.Keb.SKM K-1 4,370,900 0 0 360,282 11,583 0

1 437,090 0 0 10,490 360,282 0
17-09-1968
87,418 500,000 217,260 31,470 90,071 0
1 196809171991012002 0 391,633 0 ..................
4,895,408 0 11,583
( PNS - 3D ) MKG: 26 3 36 0 0
6,026,529 10,490 895,529
-
31,470 5,131,000
ENJANG SUNENDI K-1 3,821,000 0 0 273,487 0 0
2 382,100 0 0 9,170 273,487 0
17-01-1977
152,840 500,000 289,680 27,511 68,372 0
2 197701172006041007 0 348,475 0 ..................
4,355,940 0 0
( PNS - 3C ) MKG: 20 4 27 0 0
5,455,815 9,170 727,015
-
27,511 4,728,800
NENENG PUJAWATI, AM.Keb K-1 3,704,300 0 0 250,968 0 0
2 370,430 0 0 8,890 250,968 0
29-09-1979
148,172 500,000 289,680 26,671 62,742 0
3 197909292006042024 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 92 0 0
5,299,203 8,890 687,103
-
26,671 4,612,100
SUPARJO RUSTAM, S.Kep.Ners K-1 3,445,500 0 0 273,956 0 0
2 344,550 0 0 8,269 273,956 0
15-04-1981
137,820 300,000 289,680 24,808 68,489 0
4 198104152014091001 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 69 0 0
4,824,652 8,269 689,752
0
24,808 4,134,900
RANI SUHARTINI, AM.Keb TK - 0 3,554,000 0 0 245,769 0 0
0 0 0 0 8,530 245,769 0
14-02-1979
0 265,000 72,420 25,589 61,442 0
5 197902142006042017 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 42 0 0
4,171,350 8,530 625,650
-
25,589 3,545,700
EUIS SUMARTINI, Amd.Kep K-0 3,409,800 0 0 224,728 0 0
0 0 0 0 8,184 224,728 0
05-08-1977
0 265,000 72,420 24,551 56,182 0
6 197708052012122001 0 272,784 0 ..................
3,409,800 0 0
( PNS - 3A ) MKG: 18 1 46 0 0
4,004,729 8,184 586,429
-
24,551 3,418,300
Halaman : 165
(019) D30100301900035 BULAN : AGUSTUS 2023

NO
ELAN SUHERLAN, Amd.Kep K-1 3,305,700 0 0 221,878 0 0

2 330,570 0 0 7,934 221,878 0
10-08-1982
132,228 265,000 289,680 23,801 55,470 0
7 198208102012121002 0 301,480 0 ..................
3,768,498 0 0
( PNS - 3A ) MKG: 16 4 72 0 0
4,576,863 7,934 610,563
-
23,801 3,966,300
1,864,740 0 0 61,467 1,851,068 0
658,478 2,595,000 1,520,820 184,401 462,768 0
PEG : 7 28,134,418 0 11,583 0 2,250,754 0
IST : 5 JIWA = 21 384 0 0
ANK : 9 34,359,141 61,467 4,822,041
184,401 29,537,100
DEWI DAMAYANTI K-1 3,590,300 0 0 214,699 0 0
2 359,030 0 0 8,617 214,699 0
04-11-1972
143,612 265,000 289,680 25,850 53,675 0
8 197211041993012001 0 327,435 0 ..................
4,092,942 0 0
( PNS - 2D ) MKG: 29 4 88 0 0
4,896,876 8,617 630,276
-
25,850 4,266,600
MILA KARMILAH, A.Md.Keb K-0 3,074,700 0 0 192,094 0 0
0 0 0 0 7,379 192,094 0
17-04-1984
0 240,000 72,420 22,138 48,024 0
9 198404172017052001 0 245,976 0 ..................
3,074,700 0 0
( PNS - 2D ) MKG: 19 1 80 0 0
3,608,811 7,379 515,611
-
22,138 3,093,200
LUSIANA WULANDARI, A.Md.Keb K-1 3,074,700 0 0 202,769 0 0
2 307,470 0 0 7,379 202,769 0
10-08-1984
122,988 240,000 289,680 22,138 50,692 0
10 198408102017052002 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 67 0 0
4,267,191 7,379 563,391
-
22,138 3,703,800
DEWI SURYATI, A.Md.Keb K-1 3,074,700 0 0 209,313 0 0
2 307,470 0 0 7,379 209,313 0
10-12-1985
122,988 240,000 289,680 22,138 52,328 0
11 198512102017052005 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 3 0 0
4,273,671 7,379 571,571
-
22,138 3,702,100
Halaman : 166
(019) D30100301900035 BULAN : AGUSTUS 2023

NO
AI RENI, A.Md.Keb K-1 2,980,800 0 0 217,460 0 0

0 298,080 0 0 7,154 217,460 0
01-02-1987
0 240,000 144,840 21,462 54,365 0
12 198702012017052003 0 262,310 0 ..................
3,278,880 0 0
( PNS - 2D ) MKG: 17 2 55 0 0
3,909,851 7,154 562,751
-
21,462 3,347,100
IIS KUSTINI, A.Md.Keb K-1 2,889,800 0 0 200,881 0 0
2 288,980 0 0 6,936 200,881 0
05-10-1986
115,592 240,000 289,680 20,807 50,220 0
13 198610052017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 18 0 0
4,052,694 6,936 542,394
-
20,807 3,510,300
IKA YULIANTI, A.Md.Keb K-0 2,889,800 0 0 184,698 0 0
0 0 0 0 6,936 184,698 0
02-07-1987
0 240,000 72,420 20,807 46,175 0
14 198707022017052003 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 39 0 0
3,414,700 6,936 489,800
-
20,807 2,924,900
RINA APRIANI FAUZIE, A.Md.Keb K-1 2,889,800 0 0 200,881 0 0
2 288,980 0 0 6,936 200,881 0
06-09-1988
115,592 240,000 289,680 20,807 50,220 0
15 198809062017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 18 0 0
4,052,694 6,936 542,394
-
20,807 3,510,300
YULIANTI, A.Md.Keb K-1 2,801,500 0 0 227,812 0 0
2 280,150 0 0 6,724 227,812 0
26-03-1988
112,060 240,000 289,680 20,171 56,953 0
16 198803262017052002 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 60 0 0
3,978,157 6,724 567,157
-
20,171 3,411,000
ANDAN SISWANTARI, A.Md.KL TK - 0 2,301,800 0 0 143,826 0 0
0 0 180,000 0 5,524 143,826 0
30-05-1995
0 0 72,420 16,573 35,956 0
17 199505302022032001 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 80 0 0
2,720,223 5,524 386,023
-
16,573 2,334,200
Halaman : 167
(019) D30100301900035 BULAN : AGUSTUS 2023

NO
2,130,160 180,000 0 70,964 1,994,433 0
732,832 2,185,000 2,100,180 212,891 498,608 0
PEG : 10 32,430,892 0 0 0 2,594,472 0
IST : 7 JIWA = 29 508 0 0
ANK : 12 39,174,868 70,964 5,371,368
212,891 33,803,500
TOTAL PER SATKER 55,179,100 0 0 3,845,501 11,583 0
3,994,900 180,000 0 132,431 3,845,501 0
1,391,310 4,780,000 3,621,000 397,292 961,376 0
PEG : 17 60,565,310 0 11,583 0 4,845,226 0
IST : 12 JIWA = 50 892 0 0
ANK : 21 73,534,009 132,431 10,193,409
397,292 63,340,600
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 168
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SINDANGBARANG
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
CUCU SUKAESIH JD - 0 4,370,900 0 0 245,878 17,850 0

0 0 0 0 10,490 245,878 0
18-05-1971
0 600,000 72,420 31,470 61,470 0
1 197105181991032004 0 349,672 0 ..................
4,370,900 0 17,850
( PNS - 3D ) MKG: 26 1 22 0 0
5,349,030 10,490 716,830
-
31,470 4,632,200
OMAN SUDIRMAN K-1 4,508,600 0 0 277,072 14,650 0
1 450,860 0 0 10,821 277,072 0
15-12-1969
90,172 500,000 217,260 32,462 69,268 0
2 196912151990031007 0 403,971 0 ..................
5,049,632 0 14,650
( PNS - 3D ) MKG: 28 3 47 0 0
6,101,944 10,821 808,244
-
32,462 5,293,700
HIDMAN RAMDANI K-1 4,370,900 0 0 273,458 0 0
2 437,090 0 0 10,490 273,458 0
28-10-1971
174,836 500,000 289,680 31,470 68,365 0
3 197110281992031006 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 85 0 0
6,088,009 10,490 782,409
-
31,470 5,305,600
AGUS BAJURI K-1 4,237,500 0 0 256,998 11,358 0
0 423,750 0 0 10,170 256,998 0
17-08-1968
0 500,000 144,840 30,510 64,249 0
4 196808171994031010 0 372,900 0 ..................
4,661,250 0 11,358
( PNS - 3D ) MKG: 24 2 59 0 0
5,615,185 10,170 746,185
-
30,510 4,869,000
IWA SUPRIATNA K-1 4,237,500 0 0 255,256 0 0
1 423,750 0 0 10,170 255,256 0
06-09-1970
84,750 500,000 217,260 30,510 63,814 0
5 197009061997031008 0 379,680 0 ..................
4,746,000 0 0
( PNS - 3D ) MKG: 24 3 34 0 0
5,759,230 10,170 739,430
-
30,510 5,019,800
TIK TIK MARTIKA K-1 3,481,600 0 0 239,285 0 0
2 348,160 0 0 8,356 239,285 0
31-03-1975
139,264 600,000 289,680 25,068 59,821 0
6 197503312002122004 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 39 0 0
5,131,452 8,356 650,052
-
25,068 4,481,400
Halaman : 169
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
NASOHUDIN K-1 4,193,500 0 0 258,421 0 0

2 419,350 0 0 10,064 258,421 0
08-08-1969
167,740 500,000 289,680 30,193 64,605 0
7 196908081990031010 0 382,447 0 ..................
4,780,590 0 0
( PNS - 3C ) MKG: 26 4 82 0 0
5,869,030 10,064 745,730
-
30,193 5,123,300
HADI SUANDA, AM.Kep. K-1 3,704,300 0 0 268,240 0 0
2 370,430 0 0 8,890 268,240 0
22-01-1978
148,172 500,000 289,680 26,671 67,060 0
8 197801222007011004 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 10 0 0
5,316,393 8,890 708,693
-
26,671 4,607,700
RONI SETIAWAN, AM.Kep. TK - 0 3,591,200 0 0 292,906 0 0
2 0 0 0 8,619 292,906 0
02-06-1978
143,648 500,000 217,260 25,857 73,227 0
9 197806022007011004 0 298,788 0 ..................
3,734,848 0 0
( PNS - 3C ) MKG: 17 3 7 0 0
4,779,497 8,619 699,397
-
25,857 4,080,100
NANANG PRIATNA, S.Kep.Ners K-1 3,445,500 540,000 0 332,402 0 0
2 344,550 0 0 8,269 332,402 0
01-10-1982
137,820 0 289,680 24,808 83,101 0
10 198210012014091001 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 81 0 0
5,123,110 8,269 762,810
0
24,808 4,360,300
IMRON SULAEMAN A,AM.Kep K-1 3,554,000 0 0 232,358 0 0
2 355,400 0 0 8,530 232,358 0
24-05-1979
142,160 300,000 289,680 25,589 58,090 0
11 197905242007011002 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 75 0 0
4,907,792 8,530 648,692
-
25,589 4,259,100
EVI AGUSTINI K-1 3,238,300 0 0 220,222 0 0
2 323,830 0 0 7,772 220,222 0
19-08-1979
129,532 300,000 289,680 23,316 55,055 0
12 197908192005012015 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 13 4 46 0 0
4,532,698 7,772 601,698
-
23,316 3,931,000
Halaman : 170
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
HERMAN K-0 3,665,900 0 0 212,776 0 0

0 0 0 0 8,798 212,776 0
02-06-1978
0 265,000 72,420 26,394 53,194 0
13 197806022007011003 0 293,272 0 ..................
3,665,900 0 0
( PNS - 3B ) MKG: 20 1 46 0 0
4,251,334 8,798 594,434
-
26,394 3,656,900
GUNAWAN, AM.Kep. K-0 3,554,000 0 0 189,793 0 0
0 0 0 0 8,530 189,793 0
05-01-1974
0 265,000 72,420 25,589 47,448 0
14 197401052007011014 0 284,320 0 ..................
3,554,000 0 0
( PNS - 3B ) MKG: 18 1 48 0 0
4,115,380 8,530 555,680
-
25,589 3,559,700
SUTIANINGSIH AM.Kep. TK - 0 3,139,400 0 0 179,593 0 0
0 0 0 0 7,535 179,593 0
01-01-1982
0 265,000 72,420 22,604 44,898 0
15 198201012010012015 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 11 1 30 0 0
3,686,582 7,535 505,782
-
22,604 3,180,800
HENDAR SOLEH, A.Md.Kep. K-1 3,139,400 0 0 198,232 0 0
2 313,940 0 0 7,535 198,232 0
30-11-1982
125,576 265,000 289,680 22,604 49,558 0
16 198211302010011011 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 11 4 75 0 0
4,362,042 7,535 564,242
-
22,604 3,797,800
RIDWAN RISNAWIADI, A.Md.Kep. K-1 3,139,400 0 0 195,294 0 0
2 313,940 0 0 7,535 195,294 0
06-02-1982
125,576 265,000 289,680 22,604 48,824 0
17 198202062010011010 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 41 0 0
4,359,070 7,535 560,570
-
22,604 3,798,500
HABIB, AMd.Kep K-1 3,139,400 0 0 224,310 0 0
2 313,940 0 0 7,535 224,310 0
26-07-1984
125,576 265,000 289,680 22,604 56,077 0
18 198407262011011002 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 94 0 0
4,388,139 7,535 596,839
-
22,604 3,791,300
Halaman : 171
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
dr. KUSNADI K-1 2,688,500 0 0 189,807 0 0

1 268,850 185,000 0 6,452 189,807 0
03-11-1989
53,770 0 217,260 19,357 47,452 0
19 198911032022031001 0 240,890 0 ..................
3,011,120 0 0
( PNS - 3B ) MKG: 1 3 62 0 0
3,629,058 6,452 503,958
-
19,357 3,125,100
dr. HENDRO GUNAWAN TK - 0 2,688,500 0 0 189,036 0 0
0 0 185,000 0 6,452 189,036 0
11-03-1992
0 0 72,420 19,357 47,259 0
20 199203112022031004 0 215,080 0 ..................
2,688,500 0 0
( PNS - 3B ) MKG: 1 1 19 0 0
3,160,784 6,452 477,184
-
19,357 2,683,600
DEA NURDIANTI PUTRI PRAMESWARI, K-1 2,688,500 0 0 161,183 0 0
1 268,850 185,000 0 6,452 161,183 0
27-10-1996 53,770 0 217,260 19,357 40,296 0
21 199610272022032007 3,011,120 0 0 0 240,890 0 ..................
3 6 0 0
( PNS - 3B ) MKG: 1
3,600,378 6,452 468,178
- 19,357 3,132,200
YANI NURBAYANI K-0 3,517,200 0 0 199,418 0 0

0 0 0 0 8,441 199,418 0
09-04-1977
0 300,000 72,420 25,324 49,854 0
22 197704092006042009 0 281,376 0 ..................
3,517,200 0 0
( PNS - 3A ) MKG: 20 1 10 0 0
4,122,813 8,441 564,413
-
25,324 3,558,400
SAMSIJAR ALAMSAH K-1 3,860,100 0 0 233,369 0 0
2 386,010 0 0 9,264 233,369 0
04-12-1969
154,404 265,000 289,680 27,793 58,342 0
23 196912042006041007 0 352,041 0 ..................
4,400,514 0 0
( PNS - 3A ) MKG: 26 4 89 0 0
5,225,709 9,264 680,809
-
27,793 4,544,900
Halaman : 172
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
DANI HANDAYANI K-1 3,742,200 0 0 226,774 0 0

2 374,220 0 0 8,981 226,774 0
07-08-1975
149,688 265,000 289,680 26,944 56,694 0
24 197508072006041011 0 341,289 0 ..................
4,266,108 0 0
( PNS - 3A ) MKG: 24 4 95 0 0
5,083,582 8,981 660,682
-
26,944 4,422,900
FAJAR RISWANTO K-1 3,409,800 0 0 212,482 0 0
2 340,980 0 0 8,184 212,482 0
01-12-1979
136,392 265,000 289,680 24,551 53,121 0
25 197912012000031002 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 43 0 0
4,687,112 8,184 609,312
-
24,551 4,077,800
SUSSY IRAWATY, Amd.Kep K-0 3,305,700 0 0 193,859 0 0
0 0 0 0 7,934 193,859 0
12-01-1982
0 265,000 72,420 23,801 48,465 0
26 198201122012122001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 1 0 0
3,868,715 7,934 538,515
-
23,801 3,330,200
NASTITI PINASTI, S.K.M K-1 2,579,400 0 0 154,275 0 0
1 257,940 185,000 0 6,191 154,275 0
29-07-1990
51,588 0 217,260 18,572 38,569 0
27 199007292022032002 0 231,114 0 ..................
2,888,928 0 0
( PNS - 3A ) MKG: 1 3 95 0 0
3,470,321 6,191 448,721
-
18,572 3,021,600
6,735,840 740,000 0 228,460 6,112,697 0
2,334,434 8,250,000 5,721,180 685,379 1,528,176 0
PEG : 27 104,261,474 0 43,858 0 8,340,919 0
IST : 19 JIWA = 79 1,341 0 0
ANK : 33 126,584,389 228,460 16,939,489
685,379 109,644,900
PARMI RAHMAYANTI, A.Md.Keb K-1 2,980,800 0 0 192,592 0 0
2 298,080 0 0 7,154 192,592 0
01-06-1986
119,232 240,000 289,680 21,462 48,148 0
28 198606012017052002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 5 0 0
4,149,005 7,154 541,205
-
21,462 3,607,800
Halaman : 173
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
DESTI CITRA LESTARI, A.Md.Keb K-1 2,980,800 0 0 191,813 0 0

2 298,080 0 0 7,154 191,813 0
14-12-1987
119,232 240,000 289,680 21,462 47,953 0
29 198712142017052004 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 10 0 0
4,148,231 7,154 540,231
-
21,462 3,608,000
ELIS MINTARSIH, A.Md.Keb K-1 2,889,800 0 0 216,903 0 0
2 288,980 0 0 6,936 216,903 0
10-06-1985
115,592 240,000 289,680 20,807 54,226 0
30 198506102017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 24 0 0
4,068,722 6,936 562,422
-
20,807 3,506,300
RIAN SUCI LESTARI, A.Md.Keb K-0 2,889,800 0 0 171,481 0 0
0 0 0 0 6,936 171,481 0
02-08-1989
0 240,000 72,420 20,807 42,870 0
31 198908022017052005 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 34 0 0
3,401,478 6,936 473,278
-
20,807 2,928,200
RENI AGUSTIN, A.Md.Keb K-0 2,889,800 0 0 186,727 0 0
0 0 0 0 6,936 186,727 0
23-08-1989
0 240,000 72,420 20,807 46,682 0
32 198908232017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 46 0 0
3,416,736 6,936 492,336
-
20,807 2,924,400
RESTI MELIAWATI, A.Md.Keb K-1 2,801,500 0 0 183,637 0 0
2 280,150 0 0 6,724 183,637 0
10-05-1989
112,060 240,000 289,680 20,171 45,909 0
33 198905102017052003 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 16 0 0
3,933,938 6,724 511,938
-
20,171 3,422,000
WINA SINTA DEWI, A.Md.Kep K-1 2,374,300 0 0 156,869 0 0
2 237,430 0 0 5,698 156,869 0
11-06-1987
94,972 240,000 289,680 17,095 39,217 0
34 198706112020122005 0 216,536 0 ..................
2,706,702 0 0
( PNS - 2C ) MKG: 5 4 71 0 0
3,416,115 5,698 435,415
-
17,095 2,980,700
Halaman : 174
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
ABDUL KOSIM, A.Md.Kep K-1 2,374,300 0 0 174,010 0 0

2 237,430 0 0 5,698 174,010 0
12-06-1990
94,972 240,000 289,680 17,095 43,502 0
35 199006122020121007 0 216,536 0 ..................
2,706,702 0 0
( PNS - 2C ) MKG: 5 4 56 0 0
3,433,241 5,698 456,841
-
17,095 2,976,400
NITA WINATI, A.Md.Kep TK - 0 2,374,300 0 0 145,274 0 0
0 0 0 0 5,698 145,274 0
26-12-1996
0 240,000 72,420 17,095 36,318 0
36 199612262020122015 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 5 1 42 0 0
2,854,829 5,698 394,329
-
17,095 2,460,500
DISA NUR MAULIDA, A.Md.Kes TK - 0 2,301,800 0 0 120,487 0 0
0 0 180,000 0 5,524 120,487 0
27-06-1998
0 0 72,420 16,573 30,122 0
37 199806272022032005 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 46 0 0
2,696,850 5,524 356,850
-
16,573 2,340,000
1,640,150 180,000 0 64,458 1,739,793 0
656,060 2,160,000 2,027,760 193,374 434,947 0
PEG : 10 29,153,410 0 0 0 2,332,273 0
IST : 6 JIWA = 28 350 0 0
ANK : 12 35,519,145 64,458 4,764,845
193,374 30,754,300
TOTAL PER SATKER 122,048,400 540,000 0 7,852,490 43,858 0
8,375,990 920,000 0 292,918 7,852,490 0
2,990,494 10,410,000 7,748,940 878,753 1,963,123 0
PEG : 37 133,414,884 0 43,858 0 10,673,192 0
IST : 25 JIWA = 107 1,691 0 0
ANK : 45 162,103,534 292,918 21,704,334
878,753 140,399,200
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 175
(019) D30100301900036 BULAN : AGUSTUS 2023

NO
Halaman : 176
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIBINONG
(019) D30100301900037 BULAN : AGUSTUS 2023

NO
IMAS ROHIMAH, S.ST, M.Kes TK - 0 4,555,800 0 0 389,475 44,975 0

0 0 0 0 10,934 389,475 0
19-11-1971
0 850,000 72,420 32,802 97,369 0
1 197111191991032005 0 364,464 0 ..................
4,555,800 0 44,975
( PNS - 4A ) MKG: 27 1 13 0 0
5,956,419 10,934 940,019
12345
32,802 5,016,400
0 0 0 10,934 389,475 0
0 850,000 72,420 32,802 97,369 0
PEG : 1 4,555,800 0 44,975 0 364,464 0
IST : 0 JIWA = 1 13 0 0
ANK : 0 5,956,419 10,934 940,019
32,802 5,016,400
RUSTIKA K-1 4,508,600 0 0 292,753 4,158 0
2 450,860 0 0 10,821 292,753 0
05-10-1967
180,344 500,000 289,680 32,462 73,188 0
2 196710051990032012 0 411,184 0 ..................
5,139,804 0 4,158
( PNS - 3D ) MKG: 28 4 88 0 0
6,269,766 10,821 824,566
-
32,462 5,445,200
AGUN ERNAWAN K-1 4,508,600 0 0 286,226 15,088 0
1 450,860 0 0 10,821 286,226 0
28-01-1968
90,172 500,000 217,260 32,462 71,556 0
3 196801281990071002 0 403,971 0 ..................
5,049,632 0 15,088
( PNS - 3D ) MKG: 28 3 35 0 0
6,111,524 10,821 820,124
-
32,462 5,291,400
ATIN SUPRIATIN, A.Md.Keb K-1 4,370,900 0 0 289,906 8,242 0
1 437,090 0 0 10,490 289,906 0
29-12-1970
87,418 500,000 217,260 31,470 72,476 0
4 197012291992032007 0 391,633 0 ..................
4,895,408 0 8,242
( PNS - 3D ) MKG: 26 3 41 0 0
5,952,817 10,490 804,217
0
31,470 5,148,600
DANG RUSLI, AM.Kep K-1 4,108,100 0 0 280,593 0 0
2 410,810 0 0 9,859 280,593 0
19-02-1972
164,324 500,000 289,680 29,578 70,148 0
5 197202191994031007 0 374,659 0 ..................
4,683,234 0 0
( PNS - 3D ) MKG: 23 4 93 0 0
5,793,037 9,859 764,837
-
29,578 5,028,200
Halaman : 177
(019) D30100301900037 BULAN : AGUSTUS 2023

NO
YULI SRI MEIYAWATI, AM.Kep K-1 3,591,200 0 0 290,972 0 0

2 359,120 0 0 8,619 290,972 0
31-05-1981
143,648 600,000 289,680 25,857 72,743 0
6 198105312008012006 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 12 0 0
5,309,108 8,619 725,708
-
25,857 4,583,400
ROSIDAH, AM.Keb TK - 0 3,445,500 0 0 217,807 0 0
0 0 0 0 8,269 217,807 0
02-05-1975
0 300,000 72,420 24,808 54,452 0
7 197505022005012014 0 275,640 0 ..................
3,445,500 0 0
( PNS - 3B ) MKG: 16 1 72 0 0
4,068,876 8,269 580,976
-
24,808 3,487,900
HENI, A.Md.Keb K-0 3,781,400 0 0 187,295 0 0
0 0 0 0 9,075 187,295 0
05-02-1975
0 265,000 72,420 27,226 46,824 0
8 197502052006042029 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 16 0 0
4,342,432 9,075 572,932
-
27,226 3,769,500
IMAS ROKAYAH K-1 3,665,900 0 0 268,115 0 0
2 366,590 0 0 8,798 268,115 0
02-09-1977
146,636 265,000 289,680 26,394 67,029 0
9 197709022007012007 0 334,330 0 ..................
4,179,126 0 0
( PNS - 3B ) MKG: 20 4 53 0 0
5,037,166 8,798 704,666
-
26,394 4,332,500
ABDUL SUPARDI K-1 3,340,300 0 0 205,731 0 0
2 334,030 0 0 8,017 205,731 0
15-10-1974
133,612 265,000 289,680 24,050 51,433 0
10 197410152002121007 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 14 4 46 0 0
4,600,466 8,017 593,866
-
24,050 4,006,600
ZAKSE AHMAD IBNU SOFWAN, S. Farm.,Apt K-1 2,688,500 0 0 211,583 0 0
0 268,850 185,000 0 6,452 211,583 0
05-08-1993
0 0 144,840 19,357 52,896 0
11 199308052022031003 0 236,588 0 ..................
2,957,350 0 0
( PNS - 3B ) MKG: 1 2 94 0 0
3,524,676 6,452 526,876
-
19,357 2,997,800
Halaman : 178
(019) D30100301900037 BULAN : AGUSTUS 2023

NO
3,078,210 185,000 0 91,221 2,530,981 0
946,154 3,695,000 2,172,600 273,664 632,745 0
PEG : 10 42,033,364 0 27,488 0 3,362,669 0
IST : 8 JIWA = 30 550 0 0
ANK : 12 51,009,868 91,221 6,918,768
273,664 44,091,100
YUNI OKTAPIANI, A.Md.Kep TK - 0 3,171,500 0 0 249,837 0 0
0 0 0 0 7,612 249,837 0
29-10-1982
0 240,000 72,420 22,835 62,459 0
12 198210292014092002 0 253,720 0 ..................
3,171,500 0 0
( PNS - 2D ) MKG: 21 1 59 0 0
3,764,263 7,612 596,463
-
22,835 3,167,800
DETI HADYATI, A.Md.Kep K-1 3,074,700 0 0 250,699 0 0
2 307,470 0 0 7,379 250,699 0
06-04-1982
122,988 240,000 289,680 22,138 62,675 0
13 198204062014092001 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 50 0 0
4,315,104 7,379 623,304
-
22,138 3,691,800
NENI SUGIHERMIANI, A.Md.Keb K-1 2,889,800 0 0 213,270 0 0
2 288,980 0 0 6,936 213,270 0
06-03-1981
115,592 240,000 289,680 20,807 53,318 0
14 198103062019052004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 16 0 0
4,065,081 6,936 557,881
0
20,807 3,507,200
MIMI MARYAMI, A.Md.Keb JD - 0 2,889,800 0 0 242,154 0 0
1 0 0 0 6,936 242,154 0
11-05-1981
57,796 240,000 144,840 20,807 60,538 0
15 198105112019052002 0 235,808 0 ..................
2,947,596 0 0
( PNS - 2D ) MKG: 15 2 10 0 0
3,602,343 6,936 566,243
0
20,807 3,036,100
SITI NENAH SUGIAR, A.Md.Keb K-1 2,801,500 0 0 234,603 0 0
2 280,150 0 0 6,724 234,603 0
26-12-1990
112,060 240,000 289,680 20,171 58,651 0
16 199012262017052002 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 58 0 0
3,984,946 6,724 575,646
-
20,171 3,409,300
Halaman : 179
(019) D30100301900037 BULAN : AGUSTUS 2023

NO
AI SUMINAR K-1 3,171,500 0 0 246,195 0 0

2 317,150 0 0 7,612 246,195 0
25-10-1981
126,860 220,000 289,680 22,835 61,549 0
17 198110252008012003 0 289,241 0 ..................
3,615,510 0 0
( PNS - 2D ) MKG: 21 4 0 0 0
4,401,832 7,612 627,432
-
22,835 3,774,400
YOKI KURNIAWAN, A.Md.Kep K-1 3,237,500 0 0 230,805 0 0
2 323,750 0 0 7,770 230,805 0
22-06-1976
129,500 240,000 289,680 23,310 57,701 0
18 197606222006041011 0 295,260 0 ..................
3,690,750 0 0
( PNS - 2C ) MKG: 25 4 31 0 0
4,482,346 7,770 614,846
0
23,310 3,867,500
YURA AISYIATURROHMAH, A.Md.Keb K-1 2,374,300 0 0 177,169 0 0
2 237,430 0 0 5,698 177,169 0
29-04-1991
94,972 240,000 289,680 17,095 44,292 0
19 199104292020122003 0 216,536 0 ..................
2,706,702 0 0
( PNS - 2C ) MKG: 5 4 46 0 0
3,436,390 5,698 460,790
0
17,095 2,975,600
FAUZYAH ULHAQ, A.Md.Keb TK - 0 2,374,300 0 0 171,733 0 0
0 0 0 0 5,698 171,733 0
31-08-1996
0 240,000 72,420 17,095 42,933 0
20 199608312020122010 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 5 1 57 0 0
2,881,303 5,698 427,403
-
17,095 2,453,900
RUSDIMAN K-1 2,552,000 0 0 165,532 0 0
2 255,200 180,000 0 6,125 165,532 0
06-03-1974
102,080 0 289,680 18,374 41,383 0
21 197403062014101001 0 232,742 0 ..................
2,909,280 0 0
( PNS - 2A ) MKG: 15 4 65 0 0
3,569,056 6,125 464,156
-
18,374 3,104,900
2,010,130 180,000 0 68,490 2,181,997 0
861,848 2,140,000 2,317,440 205,467 545,499 0
PEG : 10 31,408,878 0 0 0 2,512,711 0
IST : 7 JIWA = 32 392 0 0
ANK : 15 38,502,664 68,490 5,514,164
205,467 32,988,500
Halaman : 180
(019) D30100301900037 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 71,101,700 0 0 5,102,453 72,463 0
5,088,340 365,000 0 170,645 5,102,453 0
1,808,002 6,685,000 4,562,460 511,933 1,275,613 0
PEG : 21 77,998,042 0 72,463 0 6,239,844 0
IST : 15 JIWA = 63 955 0 0
ANK : 27 95,468,951 170,645 13,372,951
511,933 82,096,000
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 181
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS GUNUNGBITUNG
(019) D30100301900038 BULAN : AGUSTUS 2023

NO
RUSLAN RUSPIANDI. AM.Kep. K-0 3,704,300 0 0 215,331 0 0

0 0 0 0 8,890 215,331 0
16-08-1978
0 500,000 72,420 26,671 53,833 0
1 197808162007011006 0 296,344 0 ..................
3,704,300 0 0
( PNS - 3C ) MKG: 18 1 57 0 0
4,527,669 8,890 601,069
-
26,671 3,926,600
IMAS CANTIKAWATI, AM.Keb. K-1 3,481,600 0 0 231,159 0 0
2 348,160 0 0 8,356 231,159 0
07-02-1983
139,264 500,000 289,680 25,068 57,790 0
2 198302072005012004 0 317,522 0 ..................
3,969,024 0 0
( PNS - 3C ) MKG: 14 4 8 0 0
5,023,295 8,356 639,895
-
25,068 4,383,400
348,160 0 0 17,246 446,490 0
139,264 1,000,000 362,100 51,739 111,623 0
PEG : 2 7,673,324 0 0 0 613,866 0
IST : 1 JIWA = 5 65 0 0
ANK : 2 9,550,964 17,246 1,240,964
51,739 8,310,000
MARYANI, A.Md.Keb K-1 2,889,800 0 0 218,594 0 0
2 288,980 0 0 6,936 218,594 0
16-07-1987
115,592 240,000 289,680 20,807 54,648 0
3 198707162017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 46 0 0
4,070,435 6,936 564,535
-
20,807 3,505,900
RISKA SRI MULYANTI, A.Md.Keb K-1 2,889,800 0 0 216,282 0 0
1 288,980 0 0 6,936 216,282 0
23-10-1987
57,796 240,000 217,260 20,807 54,070 0
4 198710232017052002 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 60 0 0
3,937,921 6,936 557,021
-
20,807 3,380,900
RINI RAMADHANTI Z.M, A.Md.Keb K-1 2,889,800 0 0 207,562 0 0
2 288,980 0 0 6,936 207,562 0
27-04-1988
115,592 240,000 289,680 20,807 51,891 0
5 198804272017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 89 0 0
4,059,446 6,936 550,746
-
20,807 3,508,700
Halaman : 182
(019) D30100301900038 BULAN : AGUSTUS 2023

NO
SONO WIHARJO K-1 3,703,400 0 0 248,458 0 0

2 370,340 0 0 8,888 248,458 0
21-02-1972
148,136 197,000 289,680 26,664 62,115 0
6 197202211991031002 0 337,750 0 ..................
4,221,876 0 0
( PNS - 2D ) MKG: 31 4 9 0 0
4,992,575 8,888 683,875
-
26,664 4,308,700
LINLIN NURDINI, A.Md.Kep K-1 2,889,800 0 0 173,696 0 0
2 288,980 180,000 0 6,936 173,696 0
19-12-1986
115,592 0 289,680 20,807 43,424 0
7 198612192009022004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 22 0 0
3,965,513 6,936 508,413
-
20,807 3,457,100
1,526,260 180,000 0 36,632 1,064,592 0
552,708 917,000 1,375,980 109,892 266,148 0
PEG : 5 17,341,568 0 0 0 1,387,326 0
IST : 5 JIWA = 19 226 0 0
ANK : 9 21,025,890 36,632 2,864,590
109,892 18,161,300
TOTAL PER SATKER 22,448,500 0 0 1,511,082 0 0
1,874,420 180,000 0 53,878 1,511,082 0
691,972 1,917,000 1,738,080 161,631 377,771 0
PEG : 7 25,014,892 0 0 0 2,001,192 0
IST : 6 JIWA = 24 291 0 0
ANK : 11 30,576,854 53,878 4,105,554
161,631 26,471,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 183
(019) D30100301900038 BULAN : AGUSTUS 2023

NO
Halaman : 184
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIKADU
(019) D30100301900039 BULAN : AGUSTUS 2023

NO
MOH IKHSAN JAKARIA, AM.Kep K-1 3,704,300 0 0 208,535 0 0

2 370,430 0 0 8,890 208,535 0
20-04-1976
148,172 500,000 289,680 26,671 52,134 0
1 197604202007011007 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 84 0 0
5,256,762 8,890 634,062
-
26,671 4,622,700
GUNAWAN K-1 4,193,500 0 0 219,767 0 0
2 419,350 185,000 0 10,064 219,767 0
17-12-1967
167,740 0 289,680 30,193 54,942 0
2 196712171990031006 0 382,447 0 ..................
4,780,590 0 0
( PNS - 3C ) MKG: 26 4 19 0 0
5,515,313 10,064 697,413
-
30,193 4,817,900
IDA WIDIAWATI, AM.Keb K-1 3,139,400 0 0 172,490 0 0
2 313,940 0 0 7,535 172,490 0
11-12-1984
125,576 265,000 289,680 22,604 43,122 0
3 198412112009022005 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 11 4 39 0 0
4,336,264 7,535 532,064
-
22,604 3,804,200
ANDRI JUMAEDI, A.Md.Kep. K-1 3,139,400 0 0 172,218 0 0
2 313,940 0 0 7,535 172,218 0
11-10-1985
125,576 265,000 289,680 22,604 43,054 0
4 198510112010011008 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 71 0 0
4,336,024 7,535 531,724
-
22,604 3,804,300
LILIS MULYANI K-0 3,409,800 0 0 153,062 0 0
0 0 0 0 8,184 153,062 0
25-11-1979
0 300,000 72,420 24,551 38,265 0
5 197911252007012007 0 272,784 0 ..................
3,409,800 0 0
( PNS - 3A ) MKG: 18 1 29 0 0
3,968,046 8,184 496,846
-
24,551 3,471,200
1,417,660 185,000 0 42,208 926,072 0
567,064 1,330,000 1,231,140 126,623 231,517 0
PEG : 5 19,571,124 0 0 0 1,565,689 0
IST : 4 JIWA = 17 242 0 0
ANK : 8 23,412,409 42,208 2,892,109
126,623 20,520,300
Halaman : 185
(019) D30100301900039 BULAN : AGUSTUS 2023

NO
IRMAYANTI, AMK K-0 3,171,500 0 0 145,841 0 0

0 0 0 0 7,612 145,841 0
27-01-1980
0 240,000 72,420 22,835 36,460 0
6 198001272014092001 0 253,720 0 ..................
3,171,500 0 0
( PNS - 2D ) MKG: 21 1 60 0 0
3,660,268 7,612 466,468
-
22,835 3,193,800
IA NURLIANI, A.Md.Keb K-0 2,889,800 0 0 134,209 0 0
0 0 0 0 6,936 134,209 0
09-02-1984
0 240,000 72,420 20,807 33,552 0
7 198402092017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 16 1 16 0 0
3,364,188 6,936 426,688
-
20,807 2,937,500
LENI HERLINA, A.Md.Keb K-1 2,801,500 0 0 155,507 0 0
2 280,150 0 0 6,724 155,507 0
05-06-1985
112,060 240,000 289,680 20,171 38,877 0
8 198506052017052001 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 14 4 84 0 0
3,905,876 6,724 476,776
-
20,171 3,429,100
ELVI RUSTIAWATI K-1 3,138,600 0 0 165,640 0 0
1 313,860 0 0 7,533 165,640 0
16-08-1976
62,772 240,000 217,260 22,598 41,410 0
9 197608162014092001 0 281,219 0 ..................
3,515,232 0 0
( PNS - 2C ) MKG: 23 3 37 0 0
4,168,300 7,533 518,400
-
22,598 3,649,900
SRI WAHYUNI, A.Md.Keb K-1 2,374,300 0 0 128,956 0 0
1 237,430 0 0 5,698 128,956 0
01-12-1992
47,486 240,000 217,260 17,095 32,239 0
10 199212012020122012 0 212,737 0 ..................
2,659,216 0 0
( PNS - 2C ) MKG: 5 3 0 0 0
3,268,225 5,698 396,725
-
17,095 2,871,500
LARAS DWI YOENNANDA, A.Md.Keb TK - 0 2,301,800 0 0 108,513 0 0
0 0 0 0 5,524 108,513 0
14-02-1991
0 240,000 72,420 16,573 27,128 0
11 199102142020122005 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 52 0 0
2,744,882 5,524 341,882
-
16,573 2,403,000
Halaman : 186
(019) D30100301900039 BULAN : AGUSTUS 2023

NO
MUTINI K-1 2,743,800 0 0 152,747 0 0

2 274,380 0 0 6,585 152,747 0
16-04-1975
109,752 240,000 289,680 19,755 38,187 0
12 197504162008012006 0 250,235 0 ..................
3,127,932 0 0
( PNS - 2B ) MKG: 17 4 10 0 0
3,836,709 6,585 467,509
-
19,755 3,369,200
1,105,820 0 0 46,612 991,413 0
332,070 1,680,000 1,231,140 139,834 247,853 0
PEG : 7 20,859,190 0 0 0 1,668,736 0
IST : 4 JIWA = 17 259 0 0
ANK : 6 24,948,448 46,612 3,094,448
139,834 21,854,000
TOTAL PER SATKER 37,007,700 0 0 1,917,485 0 0
2,523,480 185,000 0 88,820 1,917,485 0
899,134 3,010,000 2,462,280 266,457 479,370 0
PEG : 12 40,430,314 0 0 0 3,234,425 0
IST : 8 JIWA = 34 501 0 0
ANK : 14 48,360,857 88,820 5,986,557
266,457 42,374,300
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 187
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIDAUN
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
dr.VIVI WIJAYANTI K-1 3,743,100 0 0 317,992 0 0

1 374,310 0 0 8,983 317,992 0
28-08-1980
74,862 750,000 217,260 26,950 79,498 0
1 198008282006042027 0 335,382 0 ..................
4,192,272 0 0
( PNS - 3D ) MKG: 16 3 48 0 0
5,513,505 8,983 768,805
-
26,950 4,744,700
EMAN SULAEMAN, AM.Kep K-1 4,370,900 0 0 329,371 21,479 0
0 437,090 0 0 10,490 329,371 0
14-04-1972
0 500,000 144,840 31,470 82,343 0
2 197204141992031003 0 384,639 0 ..................
4,807,990 0 21,479
( PNS - 3D ) MKG: 26 2 52 0 0
5,845,692 10,490 859,792
-
31,470 4,985,900
NANI SUTIANA, AM.Keb K-1 4,237,500 0 0 271,465 0 0
2 423,750 0 0 10,170 271,465 0
02-02-1971
169,500 500,000 289,680 30,510 67,866 0
3 197102021993032005 0 386,460 0 ..................
4,830,750 0 0
( PNS - 3D ) MKG: 24 4 96 0 0
5,932,671 10,170 766,471
-
30,510 5,166,200
SAKRI, AM.Kep K-1 4,108,100 0 0 295,594 0 0
1 410,810 0 0 9,859 295,594 0
06-04-1973
82,162 500,000 217,260 29,578 73,898 0
4 197304061996031002 0 368,086 0 ..................
4,601,072 0 0
( PNS - 3D ) MKG: 22 3 52 0 0
5,653,415 9,859 777,015
-
29,578 4,876,400
SATINO, Apt. K-0 3,238,300 0 0 261,358 0 0
2 0 0 0 7,772 261,358 0
15-06-1980
129,532 325,000 217,260 23,316 65,339 0
5 198006152006041017 0 269,427 0 ..................
3,367,832 0 0
( PNS - 3B ) MKG: 12 3 74 0 0
4,202,612 7,772 627,212
0
23,316 3,575,400
dr. BENI SETYAWAN K-1 2,773,200 0 0 235,978 0 0
1 277,320 0 0 6,656 235,978 0
13-08-1991
55,464 325,000 217,260 19,967 58,995 0
6 199108132020121006 0 248,479 0 ..................
3,105,984 0 0
( PNS - 3B ) MKG: 2 3 30 0 0
3,910,875 6,656 570,075
-
19,967 3,340,800
Halaman : 188
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
YADI BURHANUDIN, S.Kep K-1 3,665,900 0 0 248,896 0 0

2 366,590 0 0 8,798 248,896 0
02-06-1977
146,636 300,000 289,680 26,394 62,224 0
7 197706022007011010 0 334,330 0 ..................
4,179,126 0 0
( PNS - 3B ) MKG: 20 4 48 0 0
5,052,942 8,798 680,642
26,394 4,372,300
SITI FITRIATI, AM.KG K-1 3,238,300 0 0 237,831 0 0
0 323,830 0 0 7,772 237,831 0
14-05-1985
0 300,000 144,840 23,316 59,458 0
8 198505142009022007 0 284,970 0 ..................
3,562,130 0 0
( PNS - 3B ) MKG: 12 2 58 0 0
4,275,947 7,772 613,347
-
23,316 3,662,600
OOY SARTIKA SARI, AMd.Keb K-1 3,554,000 0 0 229,726 0 0
2 355,400 0 0 8,530 229,726 0
06-05-1977
142,160 265,000 289,680 25,589 57,431 0
9 197705062007012006 0 324,125 0 ..................
4,051,560 0 0
( PNS - 3B ) MKG: 18 4 16 0 0
4,870,101 8,530 645,401
-
25,589 4,224,700
MELIAWATI K-0 3,445,500 0 0 205,319 0 0
0 0 0 0 8,269 205,319 0
15-05-1977
0 265,000 72,420 24,808 51,330 0
10 197705152002122005 0 275,640 0 ..................
3,445,500 0 0
( PNS - 3B ) MKG: 16 1 50 0 0
4,021,366 8,269 565,366
-
24,808 3,456,000
MELI RIA ARIANITA, A.Md.Keb K-0 3,445,500 0 0 204,578 0 0
0 0 0 0 8,269 204,578 0
22-04-1979
0 265,000 72,420 24,808 51,145 0
11 197904222007012004 0 275,640 0 ..................
3,445,500 0 0
( PNS - 3B ) MKG: 16 1 65 0 0
4,020,640 8,269 564,440
-
24,808 3,456,200
ATEP DAHRIANA, AM.Kep K-1 3,340,300 0 0 219,796 0 0
2 334,030 0 0 8,017 219,796 0
02-07-1980
133,612 265,000 289,680 24,050 54,949 0
12 198007022008011004 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 15 4 62 0 0
4,614,547 8,017 611,447
-
24,050 4,003,100
Halaman : 189
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
ERPAN HERPANSYAH K-1 3,340,300 0 0 247,579 0 0

2 334,030 0 0 8,017 247,579 0
21-07-1980
133,612 265,000 289,680 24,050 61,895 0
13 198007212008011005 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 15 4 8 0 0
4,642,276 8,017 646,176
-
24,050 3,996,100
ASEP HERMAWAN NH, AM.Kep K-1 3,238,300 0 0 213,849 0 0
2 323,830 0 0 7,772 213,849 0
16-07-1984
129,532 265,000 289,680 23,316 53,462 0
14 198407162009021006 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 53 0 0
4,491,332 7,772 593,732
-
23,316 3,897,600
SRI HARYANI, A.M.Keb. K-1 3,139,400 0 0 224,578 0 0
2 313,940 0 0 7,535 224,578 0
16-10-1984
125,576 265,000 289,680 22,604 56,144 0
15 198410162010012018 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 11 4 61 0 0
4,388,374 7,535 597,174
-
WIHARYANTI PURNAMA D,A.Md,Kep TK - 0 3,139,400 0 0 206,792 0 0
0 0 0 0 7,535 206,792 0
28-12-1982
0 265,000 72,420 22,604 51,698 0
16 198212282011012001 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 30 0 0
3,713,781 7,535 539,781
-
22,604 3,174,000
HERI SEPTI RUSDIANSAH,A.Md.Kep K-1 3,139,400 0 0 206,437 0 0
1 313,940 0 0 7,535 206,437 0
25-11-1986
62,788 265,000 217,260 22,604 51,609 0
17 198611252011011001 0 281,290 0 ..................
3,516,128 0 0
( PNS - 3B ) MKG: 10 3 11 0 0
4,234,975 7,535 569,475
-
22,604 3,665,500
AHMAD RIVAI, Amd.Kep K-0 3,305,700 0 0 225,374 0 0
0 0 0 0 7,934 225,374 0
01-09-1979
0 300,000 72,420 23,801 56,344 0
18 197909012012121001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 80 0 0
3,935,309 7,934 577,909
-
23,801 3,357,400
Halaman : 190
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
ETI YULIANTI K-1 3,517,200 0 0 231,267 0 0

2 351,720 0 0 8,441 231,267 0
14-02-1975
140,688 265,000 289,680 25,324 57,817 0
19 197502142006042007 0 320,769 0 ..................
4,009,608 0 0
( PNS - 3A ) MKG: 20 4 98 0 0
4,829,418 8,441 643,618
-
25,324 4,185,800
EVA AGUSTINA, A.Md.Keb. JD - 0 3,305,700 0 0 233,355 0 0
2 0 0 0 7,934 233,355 0
17-08-1975
132,228 265,000 217,260 23,801 58,339 0
20 197508172007012016 0 275,034 0 ..................
3,437,928 0 0
( PNS - 3A ) MKG: 16 3 85 0 0
4,185,363 7,934 598,463
-
23,801 3,586,900
NOVI SULISTYOWATI, Amd.Kep JD - 0 3,305,700 0 0 207,556 0 0
2 0 0 0 7,934 207,556 0
12-11-1979
132,228 265,000 217,260 23,801 51,889 0
21 197911122012122002 0 275,034 0 ..................
3,437,928 0 0
( PNS - 3A ) MKG: 16 3 35 0 0
4,159,514 7,934 566,214
-
23,801 3,593,300
SULAIMAN K-1 3,106,900 0 0 204,526 0 0
2 310,690 0 0 7,457 204,526 0
18-08-1980
124,276 265,000 289,680 22,370 51,132 0
22 198008182005011011 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 35 0 0
4,330,934 7,457 568,834
-
22,370 3,762,100
5,251,280 0 0 181,679 5,259,217 0
1,914,856 7,245,000 4,707,300 545,031 1,314,805 0
PEG : 22 82,864,736 0 21,479 0 6,629,178 0
IST : 15 JIWA = 65 1,147 0 0
ANK : 28 100,825,589 181,679 13,951,389
545,031 86,874,200
DESWY MUSTIKAWATI, A.Md.Keb K-0 3,074,700 0 0 188,173 0 0
0 0 0 0 7,379 188,173 0
19-12-1982
0 240,000 72,420 22,138 47,043 0
23 198212192017052001 0 245,976 0 ..................
3,074,700 0 0
( PNS - 2D ) MKG: 19 1 99 0 0
3,604,909 7,379 510,709
-
22,138 3,094,200
Halaman : 191
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
VIANI NURLELA, A.Md.Keb K-1 3,074,700 0 0 205,587 0 0

2 307,470 0 0 7,379 205,587 0
04-06-1984
122,988 240,000 289,680 22,138 51,397 0
24 198406042017052001 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 72 0 0
4,270,014 7,379 566,914
-
22,138 3,703,100
NUNUNG NURYANTI, A.Md.Keb K-1 2,980,800 0 0 202,807 0 0
2 298,080 0 0 7,154 202,807 0
15-03-1985
119,232 240,000 289,680 21,462 50,702 0
25 198503152017052001 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 59 0 0
4,159,274 7,154 553,974
-
21,462 3,605,300
EMA FITRIYAH, A.Md.Keb K-1 2,889,800 0 0 194,740 0 0
0 288,980 0 0 6,936 194,740 0
23-09-1983
0 240,000 144,840 20,807 48,685 0
26 198309232017052002 0 254,302 0 ..................
3,178,780 0 0
( PNS - 2D ) MKG: 15 2 67 0 0
3,786,170 6,936 525,470
-
20,807 3,260,700
SANTI SAPARINA, A.Md.Keb K-1 2,889,800 0 0 199,580 0 0
2 288,980 0 0 6,936 199,580 0
28-09-1987
115,592 240,000 289,680 20,807 49,895 0
27 198709282017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 93 0 0
4,051,468 6,936 540,768
-
20,807 3,510,700
LINGGA LUGINA, AMKG K-1 2,889,800 0 0 209,191 0 0
2 288,980 0 0 6,936 209,191 0
29-01-1988
115,592 240,000 289,680 20,807 52,298 0
28 198801292011011001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 96 0 0
4,061,082 6,936 552,782
-
20,807 3,508,300
YUYUN YUNINGSIH, A.Md.Keb K-1 2,889,800 0 0 193,804 0 0
1 288,980 0 0 6,936 193,804 0
13-08-1988
57,796 240,000 217,260 20,807 48,451 0
29 198808132017052005 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 41 0 0
3,915,424 6,936 528,924
-
20,807 3,386,500
Halaman : 192
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
ERLIN PUSPITASARI, A.Md.Keb K-1 2,801,500 0 0 191,635 0 0

2 280,150 0 0 6,724 191,635 0
01-08-1990
112,060 240,000 289,680 20,171 47,909 0
30 199008012017052006 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 16 0 0
3,941,936 6,724 521,936
-
20,171 3,420,000
DARWATI, A.Md.Kep TK - 0 2,374,300 0 0 150,200 0 0
0 0 0 0 5,698 150,200 0
01-06-1985
0 240,000 72,420 17,095 37,550 0
31 198506012020122005 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 5 1 74 0 0
2,859,787 5,698 400,487
-
17,095 2,459,300
RESTU ISWARA, A.Md.Kep K-1 2,374,300 0 0 159,697 0 0
0 237,430 0 0 5,698 159,697 0
08-10-1993
0 240,000 144,840 17,095 39,924 0
32 199310082020121014 0 208,938 0 ..................
2,611,730 0 0
( PNS - 2C ) MKG: 5 2 92 0 0
3,179,152 5,698 431,352
-
17,095 2,747,800
2,279,050 0 0 67,776 1,895,414 0
643,260 2,400,000 2,100,180 203,327 473,854 0
PEG : 10 31,161,810 0 0 0 2,492,945 0
IST : 8 JIWA = 29 709 0 0
ANK : 11 37,829,216 67,776 5,133,316
203,327 32,695,900
TOTAL PER SATKER 103,938,100 0 0 7,154,631 21,479 0
7,530,330 0 0 249,455 7,154,631 0
2,558,116 9,645,000 6,807,480 748,358 1,788,659 0
PEG : 32 114,026,546 0 21,479 0 9,122,123 0
IST : 23 JIWA = 94 1,856 0 0
ANK : 39 138,654,805 249,455 19,084,705
748,358 119,570,100
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 193
(019) D30100301900040 BULAN : AGUSTUS 2023

NO
Halaman : 194
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS TAKOKAK
(019) D30100301900041 BULAN : AGUSTUS 2023

NO
SITI AISAH, S.Kep.Ners. K-1 4,370,900 0 0 321,804 14,504 0

1 437,090 0 0 10,490 321,804 0
14-10-1971
87,418 600,000 217,260 31,470 80,451 0
1 197110141992032005 0 391,633 0 ..................
4,895,408 0 14,504
( PNS - 3D ) MKG: 26 3 16 0 0
6,090,952 10,490 850,352
12345
31,470 5,240,600
ABAD BADRUJAMAN K-1 4,370,900 0 0 303,320 0 0
2 437,090 0 0 10,490 303,320 0
13-06-1967
174,836 500,000 289,680 31,470 75,830 0
2 196706131991031003 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 50 0 0
6,117,836 10,490 819,736
-
31,470 5,298,100
ENANG SUHERMAN DD - 0 4,508,600 0 0 249,292 4,575 0
0 0 185,000 0 10,821 249,292 0
10-10-1967
0 0 72,420 32,462 62,323 0
3 196710101989011004 0 360,688 0 ..................
4,508,600 0 4,575
( PNS - 3D ) MKG: 28 1 91 0 0
5,063,261 10,821 720,161
32,462 4,343,100
HODIDJAH, AM.Keb TK - 0 4,193,500 0 0 275,515 11,171 0
0 0 0 0 10,064 275,515 0
12-09-1970
0 600,000 72,420 30,193 68,879 0
4 197009121991012003 0 335,480 0 ..................
4,193,500 0 11,171
( PNS - 3C ) MKG: 26 1 39 0 0
5,192,902 10,064 731,302
-
30,193 4,461,600
PARSIKIN K-1 4,325,600 0 0 346,058 0 0
2 432,560 0 0 10,381 346,058 0
21-07-1970
173,024 500,000 289,680 31,144 86,515 0
5 197007211989121001 0 394,495 0 ..................
4,931,184 0 0
( PNS - 3C ) MKG: 28 4 46 0 0
6,108,493 10,381 868,593
-
31,144 5,239,900
dr. AGI REZA SURANTA PANDIA K-1 2,773,200 0 0 241,135 0 0
0 277,320 0 0 6,656 241,135 0
02-05-1993
0 325,000 144,840 19,967 60,284 0
6 199305022020121008 0 244,042 0 ..................
3,050,520 0 0
( PNS - 3B ) MKG: 2 2 66 0 0
3,788,184 6,656 572,084
-
19,967 3,216,100
Halaman : 195
(019) D30100301900041 BULAN : AGUSTUS 2023

NO
DERI SUBADRI, AM.Kep K-0 3,665,900 0 0 286,728 0 0

0 0 0 0 8,798 286,728 0
02-01-1980
0 265,000 72,420 26,394 71,682 0
7 198001022008011002 0 293,272 0 ..................
3,665,900 0 0
( PNS - 3B ) MKG: 20 1 34 0 0
4,325,274 8,798 686,874
-
26,394 3,638,400
MAHYULIANI K-1 3,204,700 0 0 342,435 0 0
2 320,470 0 0 7,691 342,435 0
27-07-1983
128,188 265,000 289,680 23,074 85,609 0
8 198307272008012005 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 40 0 0
4,581,278 7,691 751,078
-
23,074 3,830,200
DANYIH YUWASTARI K-1 3,106,900 0 0 235,118 0 0
2 310,690 0 0 7,457 235,118 0
15-07-1977
124,276 265,000 289,680 22,370 58,780 0
9 197707152005012017 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 83 0 0
4,361,574 7,457 607,074
-
22,370 3,754,500
SITI NURJANAH K-1 3,106,900 0 0 253,425 0 0
2 310,690 0 0 7,457 253,425 0
27-04-1981
124,276 265,000 289,680 22,370 63,356 0
10 198104272005012011 0 283,349 0 ..................
3,541,866 0 0
( PNS - 3A ) MKG: 12 4 59 0 0
4,379,857 7,457 629,957
-
22,370 3,749,900
NURKHASANAH, AM.Keb. K-1 3,012,000 0 0 224,321 0 0
0 301,200 0 0 7,229 224,321 0
19-05-1978
0 265,000 144,840 21,686 56,080 0
11 197805192006042006 0 265,056 0 ..................
3,313,200 0 0
( PNS - 3A ) MKG: 11 2 96 0 0
3,976,372 7,229 574,372
21,686 3,402,000
HENI HENDRAWATI, AM.Kep JD - 0 3,204,700 0 0 219,825 0 0
1 0 0 0 7,691 219,825 0
06-05-1977
64,094 240,000 144,840 23,074 54,956 0
12 197705062008012006 0 261,504 0 ..................
3,268,794 0 0
( PNS - 3A ) MKG: 14 2 26 0 0
3,904,250 7,691 567,050
-
23,074 3,337,200
Halaman : 196
(019) D30100301900041 BULAN : AGUSTUS 2023

NO
CUCU SETIAWATI JD - 0 3,106,900 0 0 197,910 0 0

1 0 0 0 7,457 197,910 0
19-05-1977
62,138 240,000 144,840 22,370 49,478 0
13 197705192006042018 0 253,523 0 ..................
3,169,038 0 0
( PNS - 3A ) MKG: 12 2 23 0 0
3,781,638 7,457 530,738
-
22,370 3,250,900
ADE RISMANA, S.K.M K-1 2,579,400 0 0 199,930 0 0
0 257,940 185,000 0 6,191 199,930 0
16-04-1996
0 0 144,840 18,572 49,982 0
14 199604162022031007 0 226,987 0 ..................
2,837,340 0 0
( PNS - 3A ) MKG: 1 2 89 0 0
3,391,962 6,191 501,662
-
18,572 2,890,300
3,085,050 370,000 0 118,873 3,696,816 0
938,250 4,330,000 2,607,120 356,616 924,205 0
PEG : 14 53,553,400 0 30,250 0 4,284,273 0
IST : 9 JIWA = 36 758 0 0
ANK : 13 65,063,833 118,873 9,411,033
356,616 55,652,800
TUTUT ANDRIYANI, A.Md.Keb K-0 2,980,800 0 0 254,804 0 0
0 0 0 0 7,154 254,804 0
20-05-1984
0 240,000 72,420 21,462 63,701 0
15 198405202017052004 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 45 0 0
3,576,685 7,154 585,585
-
21,462 2,991,100
EVI NOVITA, A.Md.Keb K-1 2,889,800 0 0 240,914 0 0
1 288,980 0 0 6,936 240,914 0
24-01-1983
57,796 240,000 217,260 20,807 60,229 0
16 198301242017052001 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 19 0 0
3,962,512 6,936 587,812
-
20,807 3,374,700
TITA LATIFAH, A.Md.Keb K-1 2,889,800 0 0 220,611 0 0
2 288,980 0 0 6,936 220,611 0
29-09-1986
115,592 240,000 289,680 20,807 55,153 0
17 198609292017052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 51 0 0
4,072,457 6,936 567,057
-
20,807 3,505,400
Halaman : 197
(019) D30100301900041 BULAN : AGUSTUS 2023

NO
MAYASARI, A.Md.Keb K-0 2,889,800 0 0 236,169 0 0

0 0 0 0 6,936 236,169 0
12-04-1989
0 240,000 72,420 20,807 59,042 0
18 198904122017052005 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 6 0 0
3,466,138 6,936 554,138
-
20,807 2,912,000
CENDY MIRWANTI, A.Md.Keb TK - 0 2,374,300 0 0 187,047 0 0
0 0 0 0 5,698 187,047 0
05-03-1996
0 240,000 72,420 17,095 46,762 0
19 199603052020122008 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 6 1 86 0 0
2,896,646 5,698 446,546
-
17,095 2,450,100
577,960 0 0 33,660 1,139,545 0
173,388 1,200,000 724,200 100,978 284,887 0
PEG : 5 14,775,848 0 0 0 1,182,068 0
IST : 2 JIWA = 10 207 0 0
ANK : 3 17,974,438 33,660 2,741,138
100,978 15,233,300
TOTAL PER SATKER 63,554,600 0 0 4,836,361 30,250 0
3,663,010 370,000 0 152,533 4,836,361 0
1,111,638 5,530,000 3,331,320 457,594 1,209,092 0
PEG : 19 68,329,248 0 30,250 0 5,466,341 0
IST : 11 JIWA = 46 965 0 0
ANK : 16 83,038,271 152,533 12,152,171
457,594 70,886,100
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 198
(019) D30100301900041 BULAN : AGUSTUS 2023

NO
Halaman : 199
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS TANGGEUNG
(019) D30100301900042 BULAN : AGUSTUS 2023

NO
HASANAH, AM.Keb TK - 0 4,370,900 0 0 317,184 21,238 0

0 0 0 0 10,490 317,184 0
24-08-1970
0 600,000 72,420 31,470 79,296 0
1 197008241991032006 0 349,672 0 ..................
4,370,900 0 21,238
( PNS - 3D ) MKG: 26 1 48 0 0
5,423,750 10,490 809,350
-
31,470 4,614,400
TUTANG HERYANA K-1 4,508,600 0 0 437,314 11,021 0
2 450,860 0 0 10,821 437,314 0
27-08-1968
180,344 500,000 289,680 32,462 109,329 0
2 196808271990011001 0 411,184 0 ..................
5,139,804 0 11,021
( PNS - 3D ) MKG: 28 4 29 0 0
6,421,131 10,821 1,012,131
-
32,462 5,409,000
UCU SUTISNA, Ners K-1 4,508,600 0 0 358,339 7,271 0
2 450,860 0 0 10,821 358,339 0
11-02-1969
180,344 500,000 289,680 32,462 89,585 0
3 196902111989121003 0 411,184 0 ..................
5,139,804 0 7,271
( PNS - 3D ) MKG: 28 4 85 0 0
6,338,462 10,821 909,662
0012
32,462 5,428,800
AYI YULIATI, A.Md.Kep K-1 4,108,100 0 0 324,251 0 0
2 410,810 0 0 9,859 324,251 0
02-03-1975
164,324 500,000 289,680 29,578 81,063 0
4 197503021995032002 0 374,659 0 ..................
4,683,234 0 0
( PNS - 3D ) MKG: 22 4 8 0 0
5,836,610 9,859 819,410
-
29,578 5,017,200
AI SUSI JD - 0 3,941,400 0 0 307,925 0 0
2 0 0 0 9,459 307,925 0
12-04-1974
157,656 600,000 217,260 28,378 76,981 0
5 197404121993012002 0 327,924 0 ..................
4,099,056 0 0
( PNS - 3C ) MKG: 22 3 89 0 0
5,262,167 9,459 750,667
-
28,378 4,511,500
MISBAH K-1 4,325,600 0 0 302,914 17,954 0
0 432,560 0 0 10,381 302,914 0
14-04-1968
0 500,000 144,840 31,144 75,729 0
6 196804141989031004 0 380,653 0 ..................
4,758,160 0 17,954
( PNS - 3C ) MKG: 28 2 82 0 0
5,765,475 10,381 818,775
31,144 4,946,700
Halaman : 200
(019) D30100301900042 BULAN : AGUSTUS 2023

NO
TRESNA PURNAMA K, AM.Kep. K-1 3,704,300 0 0 336,511 0 0

2 370,430 0 0 8,890 336,511 0
05-12-1979
148,172 500,000 289,680 26,671 84,128 0
7 197912052007011005 0 337,832 0 ..................
4,222,902 0 0
( PNS - 3C ) MKG: 18 4 78 0 0
5,384,732 8,890 794,032
-
26,671 4,590,700
IKA KARTIKA K-0 3,340,300 0 0 264,730 0 0
0 0 0 0 8,017 264,730 0
09-08-1979
0 265,000 72,420 24,050 66,182 0
8 197908092002122004 0 267,224 0 ..................
3,340,300 0 0
( PNS - 3B ) MKG: 14 1 86 0 0
3,974,603 8,017 630,203
-
24,050 3,344,400
HENI RACHMAH JD - 0 3,627,900 0 0 253,525 0 0
2 0 0 0 8,707 253,525 0
13-11-1973
145,116 265,000 217,260 26,121 63,381 0
9 197311132007012003 0 301,841 0 ..................
3,773,016 0 0
( PNS - 3A ) MKG: 22 3 46 0 0
4,543,675 8,707 653,575
-
26,121 3,890,100
ENI RUHAENI K-1 3,627,900 0 0 243,431 0 0
2 362,790 0 0 8,707 243,431 0
26-09-1974
145,116 265,000 289,680 26,121 60,858 0
10 197409262007012003 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 36 0 0
4,968,781 8,707 669,981
-
26,121 4,298,800
TURAYAH K-1 3,517,200 0 0 279,181 0 0
2 351,720 0 0 8,441 279,181 0
05-05-1978
140,688 265,000 289,680 25,324 69,795 0
11 197805052007012011 0 320,769 0 ..................
4,009,608 0 0
( PNS - 3A ) MKG: 20 4 76 0 0
4,877,310 8,441 703,510
-
25,324 4,173,800
ENTEP JAMALUDIN K-1 3,409,800 0 0 269,573 0 0
2 340,980 0 0 8,184 269,573 0
05-06-1979
136,392 265,000 289,680 24,551 67,393 0
12 197906052007011007 0 310,974 0 ..................
3,887,172 0 0
( PNS - 3A ) MKG: 18 4 15 0 0
4,744,175 8,184 680,675
-
24,551 4,063,500
Halaman : 201
(019) D30100301900042 BULAN : AGUSTUS 2023

NO
ELAH HAYATI, A.Md.Kep. K-0 3,012,000 0 0 237,553 0 0

0 0 0 0 7,229 237,553 0
17-12-1981
0 265,000 72,420 21,686 59,388 0
13 198112172011012005 0 240,960 0 ..................
3,012,000 0 0
( PNS - 3A ) MKG: 10 1 28 0 0
3,615,916 7,229 566,816
-
21,686 3,049,100
3,171,010 0 0 120,006 3,932,431 0
1,398,152 5,290,000 2,824,380 360,018 983,108 0
PEG : 13 54,571,762 0 57,484 0 4,365,740 0
IST : 8 JIWA = 39 706 0 0
ANK : 18 67,156,787 120,006 9,818,787
360,018 57,338,000
DINI LESMANA SUKMAWATI, A.Md.Keb K-0 3,074,700 0 0 186,652 0 0
0 0 0 0 7,379 186,652 0
07-10-1984
0 240,000 72,420 22,138 46,663 0
14 198410072017052002 0 245,976 0 ..................
3,074,700 0 0
( PNS - 2D ) MKG: 19 1 19 0 0
3,603,308 7,379 508,808
-
22,138 3,094,500
AI SRI RAHAYU, A.Md.Keb K-0 2,980,800 0 0 252,540 0 0
0 0 0 0 7,154 252,540 0
25-11-1986
0 240,000 72,420 21,462 63,135 0
15 198611252017052003 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 79 0 0
3,574,455 7,154 582,755
-
21,462 2,991,700
ELI HETI SAINORA, A.Md.Keb K-0 2,889,800 0 0 235,070 0 0
0 0 0 0 6,936 235,070 0
02-07-1981
0 240,000 72,420 20,807 58,767 0
16 198107022017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 31 0 0
3,465,064 6,936 552,764
-
20,807 2,912,300
MASITOH K-0 3,374,400 0 0 247,262 0 0
0 0 0 0 8,099 247,262 0
11-02-1974
0 220,000 72,420 24,296 61,816 0
17 197402112012122001 0 269,952 0 ..................
3,374,400 0 0
( PNS - 2D ) MKG: 25 1 48 0 0
3,946,525 8,099 611,425
-
24,296 3,335,100
Halaman : 202
(019) D30100301900042 BULAN : AGUSTUS 2023

NO
0 0 0 29,568 921,524 0
0 940,000 289,680 88,703 230,381 0
PEG : 4 12,319,700 0 0 0 985,576 0
IST : 0 JIWA = 4 177 0 0
ANK : 0 14,589,352 29,568 2,255,752
88,703 12,333,600
TOTAL PER SATKER 62,322,300 0 0 4,853,955 57,484 0
3,171,010 0 0 149,574 4,853,955 0
1,398,152 6,230,000 3,114,060 448,721 1,213,489 0
PEG : 17 66,891,462 0 57,484 0 5,351,316 0
IST : 8 JIWA = 43 883 0 0
ANK : 18 81,746,139 149,574 12,074,539
448,721 69,671,600
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 203
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS AGRABINTA
(019) D30100301900043 BULAN : AGUSTUS 2023

NO
HIKMAT SUSILA K-1 3,821,000 0 0 262,088 0 0

2 382,100 0 0 9,170 262,088 0
25-06-1973
152,840 500,000 289,680 27,511 65,522 0
1 197306251996031001 0 348,475 0 ..................
4,355,940 0 0
( PNS - 3C ) MKG: 20 4 77 0 0
5,444,466 9,170 712,766
-
27,511 4,731,700
SUDIN GUSLANDI K-1 4,023,300 0 0 269,993 0 0
2 402,330 0 0 9,656 269,993 0
05-04-1966
160,932 265,000 289,680 28,968 67,498 0
2 196604051989121002 0 366,925 0 ..................
4,586,562 0 0
( PNS - 3B ) MKG: 26 4 81 0 0
5,449,940 9,656 743,040
-
28,968 4,706,900
ADE IRLAN MAKHMURONI, AM.Kep K-1 4,023,300 0 0 257,922 0 0
0 402,330 0 0 9,656 257,922 0
12-08-1968
0 240,000 144,840 28,968 64,481 0
3 196808121992031010 0 354,050 0 ..................
4,425,630 0 0
( PNS - 3B ) MKG: 26 2 61 0 0
5,107,077 9,656 715,077
-
28,968 4,392,000
drg. DIAH APRILLIASARI TK - 0 2,688,500 0 0 167,621 0 0
0 0 185,000 0 6,452 167,621 0
24-04-1992
0 0 72,420 19,357 41,905 0
4 199204242022032002 0 215,080 0 ..................
2,688,500 0 0
( PNS - 3B ) MKG: 1 1 65 0 0
3,139,415 6,452 450,415
-
19,357 2,689,000
dr. YAYAN ARI KURNIAWAN K-1 2,688,500 0 0 180,526 0 0
1 268,850 185,000 0 6,452 180,526 0
10-10-1992
53,770 0 217,260 19,357 45,131 0
5 199210102022031005 0 240,890 0 ..................
3,011,120 0 0
( PNS - 3B ) MKG: 1 3 41 0 0
3,619,756 6,452 492,356
-
19,357 3,127,400
H. MARWATUL ZAMIL, S.Farm.,Apt K-1 2,688,500 0 0 166,336 0 0
1 268,850 185,000 0 6,452 166,336 0
08-11-1997
53,770 0 217,260 19,357 41,584 0
6 199711082022032005 0 240,890 0 ..................
3,011,120 0 0
( PNS - 3B ) MKG: 1 3 94 0 0
3,605,619 6,452 474,619
-
19,357 3,131,000
Halaman : 204
(019) D30100301900043 BULAN : AGUSTUS 2023

NO
SITI SOLIKHA, A.Md Keb. JD - 0 3,012,000 0 0 182,137 0 0

1 0 0 0 7,229 182,137 0
06-05-1980
60,240 300,000 144,840 21,686 45,534 0
7 198005062010012012 0 245,779 0 ..................
3,072,240 0 0
( PNS - 3A ) MKG: 10 2 33 0 0
3,728,165 7,229 502,365
-
21,686 3,225,800
AGUNG SHIHABUDIN PEBRIANA, S.KM K-1 2,579,400 0 0 157,835 0 0
2 257,940 185,000 0 6,191 157,835 0
14-02-1992
103,176 0 289,680 18,572 39,459 0
8 199202142022031001 0 235,241 0 ..................
2,940,516 0 0
( PNS - 3A ) MKG: 1 4 4 0 0
3,597,798 6,191 457,298
-
18,572 3,140,500
1,982,400 740,000 0 61,258 1,644,458 0
584,728 1,305,000 1,665,660 183,776 411,114 0
PEG : 8 28,091,628 0 0 0 2,247,330 0
IST : 6 JIWA = 23 456 0 0
ANK : 9 33,692,236 61,258 4,547,936
183,776 29,144,300
ANDI APANDI K-1 2,980,800 0 0 199,467 0 0
2 298,080 0 0 7,154 199,467 0
16-08-1981
119,232 240,000 289,680 21,462 49,867 0
9 198108162008011002 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 24 0 0
4,155,899 7,154 549,799
-
21,462 3,606,100
MARTINA SOEMARJANTI, A.Md.Keb K-1 2,889,800 0 0 194,597 0 0
2 288,980 0 0 6,936 194,597 0
11-03-1970
115,592 240,000 289,680 20,807 48,649 0
10 197003112019052001 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 47 0 0
4,046,439 6,936 534,539
0
20,807 3,511,900
SUSI HERLINA, A.Md.Keb K-1 2,889,800 0 0 195,363 0 0
2 288,980 0 0 6,936 195,363 0
18-05-1985
115,592 240,000 289,680 20,807 48,841 0
11 198505182017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 39 0 0
4,047,197 6,936 535,497
-
20,807 3,511,700
Halaman : 205
(019) D30100301900043 BULAN : AGUSTUS 2023

NO
ENI NURAENI, A.Md.Keb K-1 2,889,800 0 0 183,874 0 0

2 288,980 0 0 6,936 183,874 0
02-01-1988
115,592 240,000 289,680 20,807 45,969 0
12 198801022017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 67 0 0
4,035,736 6,936 521,136
-
20,807 3,514,600
EVA SANIA, A.Md.Keb TK - 0 2,801,500 0 0 182,081 0 0
0 0 0 0 6,724 182,081 0
17-08-1977
0 240,000 72,420 20,171 45,520 0
13 197708172019052006 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 14 1 20 0 0
3,322,916 6,724 478,616
0
20,171 2,844,300
ENENG LISTIANA, A.Md.Kes K-1 2,301,800 0 0 137,459 0 0
1 230,180 180,000 0 5,524 137,459 0
01-09-1997
46,036 0 217,260 16,573 34,365 0
14 199709012022032006 0 206,241 0 ..................
2,578,016 0 0
( PNS - 2C ) MKG: 4 3 30 0 0
3,134,862 5,524 400,162
-
16,573 2,734,700
1,395,200 180,000 0 40,210 1,092,841 0
512,044 1,200,000 1,448,400 120,627 273,211 0
PEG : 6 18,660,744 0 0 0 1,492,860 0
IST : 5 JIWA = 20 227 0 0
ANK : 9 22,743,049 40,210 3,019,749
120,627 19,723,300
TOTAL PER SATKER 42,278,000 0 0 2,737,299 0 0
3,377,600 920,000 0 101,468 2,737,299 0
1,096,772 2,505,000 3,114,060 304,403 684,325 0
PEG : 14 46,752,372 0 0 0 3,740,190 0
IST : 11 JIWA = 43 683 0 0
ANK : 18 56,435,285 101,468 7,567,685
304,403 48,867,600
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 206
(019) D30100301900043 BULAN : AGUSTUS 2023

NO
Halaman : 207
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS PUSAKASARI
(019) D30100301900044 BULAN : AGUSTUS 2023

NO
MUKAROM, S.Kep. K-1 3,821,000 0 0 298,678 0 0

2 382,100 0 0 9,170 298,678 0
06-03-1974
152,840 500,000 289,680 27,511 74,670 0
1 197403061998031003 0 348,475 0 ..................
4,355,940 0 0
( PNS - 3C ) MKG: 20 4 25 0 0
5,481,004 9,170 758,504
27,511 4,722,500
CEP MUHIDIN, S.Kep Ners K-1 3,445,500 0 0 292,251 0 0
2 344,550 0 0 8,269 292,251 0
04-05-1982
137,820 300,000 289,680 24,808 73,063 0
2 198205042014091002 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 43 0 0
4,842,921 8,269 712,621
12345
24,808 4,130,300
SANI SRI NOVIANTI, A.M.Keb. K-1 3,139,400 0 0 195,908 0 0
2 313,940 0 0 7,535 195,908 0
09-11-1987
125,576 265,000 289,680 22,604 48,977 0
3 198711092010012007 0 286,313 0 ..................
3,578,916 0 0
( PNS - 3B ) MKG: 10 4 94 0 0
4,359,737 7,535 561,337
-
22,604 3,798,400
TEDI NUGRAHA, A.Md.Kep K-0 3,305,700 0 0 241,336 0 0
0 0 0 0 7,934 241,336 0
02-01-1982
0 300,000 72,420 23,801 60,334 0
4 198201022014091001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 70 0 0
3,951,261 7,934 597,861
-
23,801 3,353,400
HENDARSO K-0 3,409,800 0 0 188,301 0 0
0 0 0 0 8,184 188,301 0
16-06-1979
0 265,000 72,420 24,551 47,075 0
5 197906162007011009 0 272,784 0 ..................
3,409,800 0 0
( PNS - 3A ) MKG: 18 1 39 0 0
3,968,295 8,184 540,895
24,551 3,427,400
WAHYUDIN, Amd.Kep K-1 3,204,700 0 0 231,209 0 0
2 320,470 0 0 7,691 231,209 0
05-07-1980
128,188 265,000 289,680 23,074 57,802 0
6 198007052012121002 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 14 4 33 0 0
4,470,045 7,691 612,045
-
23,074 3,858,000
Halaman : 208
(019) D30100301900044 BULAN : AGUSTUS 2023

NO
AI HARTATI, Amd.Kep K-1 3,012,000 0 0 192,671 0 0

1 301,200 0 0 7,229 192,671 0
29-12-1985
60,240 265,000 217,260 21,686 48,168 0
7 198512292011012002 0 269,875 0 ..................
3,373,440 0 0
( PNS - 3A ) MKG: 10 3 43 0 0
4,077,329 7,229 539,629
-
21,686 3,537,700
1,662,260 0 0 56,012 1,640,354 0
604,664 2,160,000 1,520,820 168,035 410,089 0
PEG : 7 25,605,024 0 0 0 2,048,402 0
IST : 5 JIWA = 21 347 0 0
ANK : 9 31,150,592 56,012 4,322,892
168,035 26,827,700
RATNA OCTAVIANA, A.Md.Keb K-0 3,074,700 0 0 175,583 0 0
0 0 0 0 7,379 175,583 0
21-10-1985
0 240,000 72,420 22,138 43,896 0
8 198510212017052001 0 245,976 0 ..................
3,074,700 0 0
( PNS - 2D ) MKG: 19 1 52 0 0
3,592,272 7,379 494,972
-
22,138 3,097,300
AYI ERNI NURLIYANI, A.Md.Keb K-1 2,889,800 0 0 200,291 0 0
2 288,980 0 0 6,936 200,291 0
15-06-1987
115,592 240,000 289,680 20,807 50,073 0
9 198706152017052002 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 71 0 0
4,052,157 6,936 541,657
-
20,807 3,510,500
DEWI PUSPITA, A.Md.Keb K-1 2,889,800 0 0 168,773 0 0
2 288,980 0 0 6,936 168,773 0
16-08-1988
115,592 240,000 289,680 20,807 42,193 0
10 198808162017052003 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 91 0 0
4,020,659 6,936 502,259
-
20,807 3,518,400
SITI SUPIATI, A.Md.Keb K-1 2,801,500 0 0 195,461 0 0
1 280,150 0 0 6,724 195,461 0
09-03-1991
56,030 240,000 217,260 20,171 48,865 0
11 199103092017052001 0 251,014 0 ..................
3,137,680 0 0
( PNS - 2D ) MKG: 13 3 39 0 0
3,817,335 6,724 522,235
-
20,171 3,295,100
Halaman : 209
(019) D30100301900044 BULAN : AGUSTUS 2023

NO
YESI MAYA PUSPAWATI K-1 3,374,400 0 0 202,211 0 0

1 337,440 180,000 0 8,099 202,211 0
04-04-1977
67,488 0 217,260 24,296 50,553 0
12 197704042006042022 0 302,346 0 ..................
3,779,328 0 0
( PNS - 2D ) MKG: 25 3 11 0 0
4,411,205 8,099 587,505
-
24,296 3,823,700
NURHIKMAH DALILAH, A.Md.Keb TK - 0 2,301,800 0 0 142,138 0 0
0 0 0 0 5,524 142,138 0
21-04-1995
0 240,000 72,420 16,573 35,534 0
13 199504212020122006 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 58 0 0
2,778,513 5,524 383,913
-
16,573 2,394,600
FITRI FIDAYANI, A.Md.Keb K-1 2,301,800 0 0 167,401 0 0
0 230,180 0 0 5,524 167,401 0
14-03-1997
0 240,000 144,840 16,573 41,850 0
14 199703142020122008 0 202,558 0 ..................
2,531,980 0 0
( PNS - 2C ) MKG: 4 2 88 0 0
3,106,406 5,524 433,906
-
16,573 2,672,500
ENDRI IRMAWAN K-1 2,687,800 0 0 125,463 0 0
0 268,780 180,000 0 6,451 125,463 0
26-09-1983
0 0 144,840 19,352 31,366 0
15 198309262006041009 0 236,526 0 ..................
2,956,580 0 0
( PNS - 2C ) MKG: 13 2 72 0 0
3,432,758 6,451 419,158
-
19,352 3,013,600
EDWIN SALEH, A.Md.,KL K-1 2,301,800 0 0 136,378 0 0
1 230,180 180,000 0 5,524 136,378 0
18-11-1987
46,036 0 217,260 16,573 34,095 0
16 198711182022031002 0 206,241 0 ..................
2,578,016 0 0
( PNS - 2C ) MKG: 4 3 60 0 0
3,133,811 5,524 398,811
-
16,573 2,735,000
1,924,690 540,000 0 59,097 1,513,699 0
400,738 1,440,000 1,665,660 177,290 378,425 0
PEG : 9 26,948,828 0 0 0 2,155,905 0
IST : 7 JIWA = 23 542 0 0
ANK : 7 32,345,116 59,097 4,284,416
177,290 28,060,700
Halaman : 210
(019) D30100301900044 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 47,961,500 0 0 3,154,053 0 0
3,586,950 540,000 0 115,109 3,154,053 0
1,005,402 3,600,000 3,186,480 345,325 788,514 0
PEG : 16 52,553,852 0 0 0 4,204,307 0
IST : 12 JIWA = 44 889 0 0
ANK : 16 63,495,708 115,109 8,607,308
345,325 54,888,400
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 211
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS NARINGGUL
(019) D30100301900045 BULAN : AGUSTUS 2023

NO
IMAS SUMIATI, A.Md.Keb K-1 4,370,900 0 0 313,204 20,708 0

0 437,090 0 0 10,490 313,204 0
01-06-1969
0 500,000 144,840 31,470 78,301 0
1 196906011990032009 0 384,639 0 ..................
4,807,990 0 20,708
( PNS - 3D ) MKG: 26 2 10 0 0
5,828,712 10,490 838,812
-
31,470 4,989,900
AAN HERLINA, A.Md.Keb. K-0 3,781,400 0 0 281,435 0 0
0 0 0 0 9,075 281,435 0
09-01-1975
0 300,000 72,420 27,226 70,359 0
2 197501092006042018 0 302,512 0 ..................
3,781,400 0 0
( PNS - 3B ) MKG: 22 1 51 0 0
4,471,607 9,075 690,607
-
27,226 3,781,000
ARIP SOPIAN, A.Md.Kep K-1 3,340,300 0 0 287,391 0 0
2 334,030 0 0 8,017 287,391 0
06-03-1982
133,612 300,000 289,680 24,050 71,848 0
3 198203062014091002 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 15 4 61 0 0
4,717,141 8,017 695,941
-
24,050 4,021,200
ANTON THOMAS GINANJAR, AM.Kep K-1 3,445,500 0 0 275,467 0 0
2 344,550 0 0 8,269 275,467 0
10-04-1980
137,820 265,000 289,680 24,808 68,867 0
4 198004102008011006 0 314,230 0 ..................
3,927,870 0 0
( PNS - 3B ) MKG: 16 4 47 0 0
4,791,141 8,269 691,641
-
24,808 4,099,500
ATIN SUPRIATIN JD - 0 3,340,300 0 0 269,338 0 0
1 0 0 0 8,017 269,338 0
29-03-1971
66,806 265,000 144,840 24,050 67,334 0
5 197103292002122004 0 272,568 0 ..................
3,407,106 0 0
( PNS - 3B ) MKG: 14 2 56 0 0
4,118,407 8,017 641,307
-
24,050 3,477,100
drg. YUNIE YUSTRI RESPATININGTYAS TK - 0 2,688,500 0 0 224,460 0 0
0 0 185,000 0 6,452 224,460 0
22-06-1989
0 0 72,420 19,357 56,115 0
6 198906222022032002 0 215,080 0 ..................
2,688,500 0 0
( PNS - 3B ) MKG: 1 1 75 0 0
3,196,264 6,452 521,464
-
19,357 2,674,800
Halaman : 212
(019) D30100301900045 BULAN : AGUSTUS 2023

NO
FAJAR GILANG RINALDI, S.Farm.,Apt TK - 0 2,688,500 0 0 190,235 0 0

0 0 185,000 0 6,452 190,235 0
07-10-1993
0 0 72,420 19,357 47,559 0
7 199310072022031001 0 215,080 0 ..................
2,688,500 0 0
( PNS - 3B ) MKG: 1 1 19 0 0
3,161,983 6,452 478,683
-
19,357 2,683,300
NENENG SUMIATI K-1 3,517,200 0 0 278,702 0 0
2 351,720 0 0 8,441 278,702 0
04-03-1976
140,688 265,000 289,680 25,324 69,676 0
8 197603042006042013 0 320,769 0 ..................
4,009,608 0 0
( PNS - 3A ) MKG: 20 4 57 0 0
4,876,812 8,441 702,912
-
25,324 4,173,900
RINRIN IMA HERWANSAH H, Am.KG K-1 3,204,700 0 0 313,109 0 0
2 320,470 0 0 7,691 313,109 0
23-06-1980
128,188 265,000 289,680 23,074 78,277 0
9 198006232006041015 0 292,269 0 ..................
3,653,358 0 0
( PNS - 3A ) MKG: 15 4 8 0 0
4,551,920 7,691 714,420
-
23,074 3,837,500
FAUZAN, S.K.M TK - 0 2,579,400 0 0 172,181 0 0
0 0 185,000 0 6,191 172,181 0
10-08-1993
0 0 72,420 18,572 43,045 0
10 199308102022031002 0 206,352 0 ..................
2,579,400 0 0
( PNS - 3A ) MKG: 1 1 77 0 0
3,033,841 6,191 446,341
-
18,572 2,587,500
1,787,860 555,000 0 79,095 2,605,522 0
607,114 2,160,000 1,738,080 237,288 651,381 0
PEG : 10 35,351,674 0 20,708 0 2,828,134 0
IST : 5 JIWA = 24 461 0 0
ANK : 9 42,747,828 79,095 6,422,128
237,288 36,325,700
LUCIANA LISETYA NINGRUM, AM.Keb K-1 2,980,800 0 0 247,977 0 0
2 298,080 0 0 7,154 247,977 0
23-09-1986
119,232 240,000 289,680 21,462 61,994 0
11 198609232017052001 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 51 0 0
4,204,436 7,154 610,436
-
21,462 3,594,000
Halaman : 213
(019) D30100301900045 BULAN : AGUSTUS 2023

NO
WIDANINGSIH, A.Md.Keb TK - 0 2,889,800 0 0 280,124 0 0

0 0 0 0 6,936 280,124 0
21-02-1981
0 240,000 72,420 20,807 70,031 0
12 198102212019052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 95 0 0
3,510,182 6,936 609,082
0
20,807 2,901,100
RINDA TRISNAWATI, A.Md.Keb K-1 2,889,800 0 0 184,354 0 0
2 288,980 0 0 6,936 184,354 0
17-08-1985
115,592 240,000 289,680 20,807 46,089 0
13 198508172017052004 0 263,550 0 ..................
3,294,372 0 0
( PNS - 2D ) MKG: 15 4 87 0 0
4,036,236 6,936 521,736
-
20,807 3,514,500
WIN WIN MULYANI, A.Md.Keb K-0 2,889,800 0 0 259,504 0 0
0 0 0 0 6,936 259,504 0
07-02-1987
0 240,000 72,420 20,807 64,876 0
14 198702072017052003 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 40 0 0
3,489,507 6,936 583,307
-
20,807 2,906,200
SITI ROHIMAH, A.Md.Keb K-1 2,889,800 0 0 269,894 0 0
1 288,980 0 0 6,936 269,894 0
09-03-1989
57,796 240,000 217,260 20,807 67,474 0
15 198903092017052004 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 64 0 0
3,991,537 6,936 624,037
-
20,807 3,367,500
TUTI NURHAYATI, A.Md.Keb K-1 2,801,500 0 0 225,373 0 0
2 280,150 0 0 6,724 225,373 0
04-05-1987
112,060 240,000 289,680 20,171 56,343 0
16 198705042017052003 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 50 0 0
3,975,708 6,724 564,108
-
20,171 3,411,600
YANI NURDAYATI K-1 3,237,500 0 0 271,419 0 0
2 323,750 0 0 7,770 271,419 0
04-06-1977
129,500 240,000 289,680 23,310 67,855 0
17 197706042006042019 0 295,260 0 ..................
3,690,750 0 0
( PNS - 2C ) MKG: 25 4 85 0 0
4,523,014 7,770 665,614
-
23,310 3,857,400
Halaman : 214
(019) D30100301900045 BULAN : AGUSTUS 2023

NO
DESI LESTARI PANJAITAN, A.Md.Keb TK - 0 2,374,300 0 0 186,198 0 0

0 0 0 0 5,698 186,198 0
26-11-1995
0 240,000 72,420 17,095 46,549 0
18 199511262020122012 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 5 1 73 0 0
2,895,784 5,698 445,484
-
17,095 2,450,300
NISSA AULIA FARMA SOMARLI, A.Md.Keb TK - 0 2,374,300 0 0 188,204 0 0
0 0 0 0 5,698 188,204 0
10-11-1997
0 240,000 72,420 17,095 47,051 0
19 199711102020122005 0 189,944 0 ..................
2,374,300 0 0
( PNS - 2C ) MKG: 5 1 75 0 0
2,897,792 5,698 447,992
-
17,095 2,449,800
1,479,940 0 0 60,788 2,113,047 0
534,180 2,160,000 1,665,660 182,361 528,262 0
PEG : 9 27,341,720 0 0 0 2,187,338 0
IST : 5 JIWA = 23 620 0 0
ANK : 9 33,524,196 60,788 5,071,796
182,361 28,452,400
TOTAL PER SATKER 58,284,300 0 0 4,718,569 20,708 0
3,267,800 555,000 0 139,883 4,718,569 0
1,141,294 4,320,000 3,403,740 419,649 1,179,643 0
PEG : 19 62,693,394 0 20,708 0 5,015,472 0
IST : 10 JIWA = 47 1,081 0 0
ANK : 18 76,272,024 139,883 11,493,924
419,649 64,778,100
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 215
(019) D30100301900045 BULAN : AGUSTUS 2023

NO
Halaman : 216
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS SUKANAGALIH
(019) D30100301900046 BULAN : AGUSTUS 2023

NO
WAWAN EFENDI, S.AP, MM K-1 4,699,300 0 0 402,834 24,033 0

2 469,930 0 0 11,278 402,834 0
05-04-1968
187,972 600,000 289,680 33,835 100,708 0
1 196804051989031007 0 428,576 0 ..................
5,357,202 0 24,033
( PNS - 4A ) MKG: 28 4 2 0 0
6,718,864 11,278 1,001,264
-
33,835 5,717,600
469,930 0 0 11,278 402,834 0
187,972 600,000 289,680 33,835 100,708 0
PEG : 1 5,357,202 0 24,033 0 428,576 0
IST : 1 JIWA = 4 2 0 0
ANK : 2 6,718,864 11,278 1,001,264
33,835 5,717,600
HENDRA, AM.Kep. K-1 3,628,900 0 0 433,155 0 0
2 362,890 0 0 8,709 433,155 0
12-04-1979
145,156 600,000 289,680 26,128 108,289 0
2 197904122006041018 0 330,956 0 ..................
4,136,946 0 0
( PNS - 3D ) MKG: 15 4 19 0 0
5,494,637 8,709 907,237
-
26,128 4,587,400
IIN KUSMAWATI TK - 0 4,650,600 0 0 368,647 31,683 0
0 0 0 0 11,161 368,647 0
27-01-1966
0 500,000 72,420 33,484 92,162 0
3 196601271987032003 0 372,048 0 ..................
4,650,600 0 31,683
( PNS - 3D ) MKG: 30 1 90 0 0
5,668,085 11,161 909,185
-
33,484 4,758,900
ENOK SUMINAR K-1 4,650,600 0 0 460,250 30,596 0
1 465,060 0 0 11,161 460,250 0
01-08-1967
93,012 500,000 217,260 33,484 115,063 0
4 196708011988032006 0 416,694 0 ..................
5,208,672 0 30,596
( PNS - 3D ) MKG: 30 3 25 0 0
6,461,448 11,161 1,067,248
-
33,484 5,394,200
NANI RUSNANI, AM.Keb. K-1 4,508,600 0 0 397,492 9,129 0
2 450,860 0 0 10,821 397,492 0
14-05-1968
180,344 500,000 289,680 32,462 99,373 0
5 196805141988032004 0 411,184 0 ..................
5,139,804 0 9,129
( PNS - 3D ) MKG: 28 4 73 0 0
6,379,461 10,821 960,461
-
32,462 5,419,000
Halaman : 217
(019) D30100301900046 BULAN : AGUSTUS 2023

NO
DEDE SUHARMINI, AM.Keb. TK - 0 4,508,600 0 0 370,950 25,317 0

0 0 0 0 10,821 370,950 0
01-10-1968
0 500,000 72,420 32,462 92,738 0
6 196810011990032005 0 360,688 0 ..................
4,508,600 0 25,317
( PNS - 3D ) MKG: 28 1 6 0 0
5,520,576 10,821 892,976
-
32,462 4,627,600
UTARI DORIOMAS. AM.Keb. JD - 0 3,591,200 0 0 431,559 0 0
1 0 0 0 8,619 431,559 0
24-03-1983
71,824 500,000 144,840 25,857 107,890 0
7 198303242005012011 0 293,042 0 ..................
3,663,024 0 0
( PNS - 3C ) MKG: 16 2 68 0 0
4,773,967 8,619 866,967
-
dr. MANDA PISILIA TK - 0 2,688,500 0 0 431,038 0 0
0 0 0 0 6,452 431,038 0
19-03-1992
0 325,000 72,420 19,357 107,760 0
8 199203192020122008 0 215,080 0 ..................
2,688,500 0 0
( PNS - 3B ) MKG: 1 1 20 0 0
3,542,787 6,452 779,687
-
19,357 2,763,100
NIA SRI JUNIAWATI K-0 3,665,900 0 0 322,705 0 0
0 0 0 0 8,798 322,705 0
04-06-1976
0 265,000 72,420 26,394 80,676 0
9 197606042006042016 0 293,272 0 ..................
3,665,900 0 0
( PNS - 3B ) MKG: 20 1 28 0 0
4,361,245 8,798 731,845
-
26,394 3,629,400
RENI RESMALASARI DEWI, AM.Kep. K-1 3,238,300 0 0 320,357 0 0
1 323,830 0 0 7,772 320,357 0
07-07-1982
64,766 265,000 217,260 23,316 80,089 0
10 198207072005012009 0 290,152 0 ..................
3,626,896 0 0
( PNS - 3B ) MKG: 13 3 85 0 0
4,460,686 7,772 721,686
-
23,316 3,739,000
RINI APRIANI, A.Md.Keb K-1 3,238,300 0 0 310,288 0 0
2 323,830 0 0 7,772 310,288 0
02-04-1987
129,532 265,000 289,680 23,316 77,572 0
11 198704022009022003 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 63 0 0
4,587,781 7,772 714,281
-
23,316 3,873,500
Halaman : 218
(019) D30100301900046 BULAN : AGUSTUS 2023

NO
YUSUP SUPANDI K-1 4,280,800 0 0 416,669 0 0

2 428,080 185,000 0 10,274 416,669 0
17-12-1965
171,232 0 289,680 30,822 104,167 0
12 196512171987031007 0 390,409 0 ..................
4,880,112 0 0
( PNS - 3B ) MKG: 30 4 84 0 0
5,812,641 10,274 952,341
-
30,822 4,860,300
2,354,550 185,000 0 102,360 4,263,110 0
855,866 4,220,000 2,027,760 307,082 1,065,779 0
PEG : 11 45,860,716 0 96,725 0 3,668,858 0
IST : 6 JIWA = 28 561 0 0
ANK : 11 57,063,314 102,360 9,503,914
307,082 47,559,400
TESI KARTIKA EKA SARI, A.Md.Keb K-0 2,801,500 0 0 335,724 0 0
0 0 0 0 6,724 335,724 0
11-06-1988
0 240,000 72,420 20,171 83,931 0
13 198806112017052003 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 13 1 31 0 0
3,476,570 6,724 670,670
-
20,171 2,805,900
ANI RISTIANINGSIH JD - 0 3,374,400 0 0 290,368 0 0
2 0 0 0 8,099 290,368 0
03-11-1978
134,976 220,000 217,260 24,296 72,592 0
14 197811032006042015 0 280,750 0 ..................
3,509,376 0 0
( PNS - 2D ) MKG: 25 3 6 0 0
4,269,405 8,099 676,105
-
24,296 3,593,300
PUTRI SEPTIANI BULDAN, A.Md.Keb. TK - 0 2,301,800 0 0 207,786 0 0
0 0 0 0 5,524 207,786 0
05-09-1995
0 240,000 72,420 16,573 51,947 0
15 199509052020122011 0 184,144 0 ..................
2,301,800 0 0
( PNS - 2C ) MKG: 4 1 71 0 0
2,844,174 5,524 465,974
-
16,573 2,378,200
TUTI LENASARI K-1 3,138,600 0 0 282,075 0 0
0 313,860 180,000 0 7,533 282,075 0
05-10-1969
0 0 144,840 22,598 70,519 0
16 196910052014072003 0 276,197 0 ..................
3,452,460 0 0
( PNS - 2C ) MKG: 23 2 16 0 0
4,089,522 7,533 658,922
-
22,598 3,430,600
Halaman : 219
(019) D30100301900046 BULAN : AGUSTUS 2023

NO
DAVID EFENDHI K-1 3,042,800 0 0 319,877 0 0

2 304,280 180,000 0 7,303 319,877 0
19-04-1977
121,712 0 289,680 21,908 79,969 0
17 197704192014091001 0 277,503 0 ..................
3,468,792 0 0
( PNS - 2C ) MKG: 21 4 0 0 0
4,287,560 7,303 706,560
-
21,908 3,581,000
618,140 360,000 0 35,183 1,435,830 0
256,688 700,000 796,620 105,546 358,958 0
PEG : 5 15,533,928 0 0 0 1,242,714 0
IST : 2 JIWA = 11 124 0 0
ANK : 4 18,967,231 35,183 3,178,231
105,546 15,789,000
TOTAL PER SATKER 62,008,700 0 0 6,101,774 120,758 0
3,442,620 545,000 0 148,821 6,101,774 0
1,300,526 5,520,000 3,114,060 446,463 1,525,445 0
PEG : 17 66,751,846 0 120,758 0 5,340,148 0
IST : 9 JIWA = 43 687 0 0
ANK : 17 82,749,409 148,821 13,683,409
446,463 69,066,000
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 220
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS GIRIJAYA
(019) D30100301900047 BULAN : AGUSTUS 2023

NO
IMAM SUJATI, A.Md.Kep K-1 4,508,600 0 0 333,626 6,096 0

2 450,860 0 0 10,821 333,626 0
07-10-1969
180,344 500,000 289,680 32,462 83,407 0
1 196910071990031003 0 411,184 0 ..................
5,139,804 0 6,096
( PNS - 3D ) MKG: 28 4 7 0 0
6,312,496 10,821 877,596
-
32,462 5,434,900
AIDIN FIRMANSYAH K-1 4,370,900 0 0 304,666 0 0
2 437,090 0 0 10,490 304,666 0
10-09-1968
174,836 500,000 289,680 31,470 76,166 0
2 196809101991031004 0 398,626 0 ..................
4,982,826 0 0
( PNS - 3D ) MKG: 26 4 86 0 0
6,119,218 10,490 821,418
-
31,470 5,297,800
ASEP RUSWANDI K-1 4,508,600 0 0 421,517 0 0
2 450,860 0 0 10,821 421,517 0
04-02-1970
180,344 265,000 289,680 32,462 105,379 0
3 197002041991031008 0 411,184 0 ..................
5,139,804 0 0
( PNS - 3D ) MKG: 28 4 79 0 0
6,159,363 10,821 981,363
-
32,462 5,178,000
ERWIN RIZALINUR RAMDHAN, S.Kep.Ners. K-1 3,591,200 0 0 360,367 0 0
1 359,120 0 0 8,619 360,367 0
22-10-1977
71,824 600,000 217,260 25,857 90,092 0
4 197710222005011005 0 321,772 0 ..................
4,022,144 0 0
( PNS - 3C ) MKG: 16 3 60 0 0
5,234,307 8,619 806,707
0
25,857 4,427,600
POPI LUPIA MAHARANI, AM.Keb. K-1 3,591,200 0 0 264,635 0 0
2 359,120 0 0 8,619 264,635 0
25-09-1981
143,648 500,000 289,680 25,857 66,159 0
5 198109252005012008 0 327,517 0 ..................
4,093,968 0 0
( PNS - 3C ) MKG: 16 4 28 0 0
5,182,787 8,619 692,787
-
25,857 4,490,000
dr. AYU PERMATASARI K-1 2,773,200 0 0 271,219 0 0
1 277,320 0 0 6,656 271,219 0
28-02-1992
55,464 325,000 217,260 19,967 67,805 0
6 199202282020122006 0 248,479 0 ..................
3,105,984 0 0
( PNS - 3B ) MKG: 2 3 40 0 0
3,946,126 6,656 614,126
-
19,967 3,332,000
Halaman : 221
(019) D30100301900047 BULAN : AGUSTUS 2023

NO
TATA KUSMANA, AM.Kep K-0 3,340,300 0 0 225,088 0 0

0 0 0 0 8,017 225,088 0
28-02-1978
0 265,000 72,420 24,050 56,272 0
7 197802282006041014 0 267,224 0 ..................
3,340,300 0 0
( PNS - 3B ) MKG: 15 1 76 0 0
3,934,951 8,017 580,651
-
24,050 3,354,300
YEDI ROYBAFIE, AM.Kep K-1 3,340,300 0 0 283,486 0 0
2 334,030 0 0 8,017 283,486 0
29-09-1980
133,612 265,000 289,680 24,050 70,872 0
8 198009292008011008 0 304,635 0 ..................
3,807,942 0 0
( PNS - 3B ) MKG: 15 4 85 0 0
4,678,260 8,017 691,060
-
24,050 3,987,200
2,668,400 0 0 72,060 2,464,604 0
940,072 3,220,000 1,955,340 216,175 616,152 0
PEG : 8 33,632,772 0 6,096 0 2,690,621 0
IST : 7 JIWA = 27 461 0 0
ANK : 12 41,567,508 72,060 6,065,708
216,175 35,501,800
CAHYADI K-1 3,074,700 0 0 230,086 0 0
2 307,470 0 0 7,379 230,086 0
10-02-1978
122,988 240,000 289,680 22,138 57,521 0
9 197802102008011005 0 280,413 0 ..................
3,505,158 0 0
( PNS - 2D ) MKG: 19 4 96 0 0
4,294,537 7,379 597,537
-
22,138 3,697,000
SRI SANTI RAHAYU, A.Md.Keb K-1 2,980,800 0 0 245,501 0 0
2 298,080 0 0 7,154 245,501 0
27-10-1984
119,232 240,000 289,680 21,462 61,375 0
10 198410272017052001 0 271,849 0 ..................
3,398,112 0 0
( PNS - 2D ) MKG: 17 4 32 0 0
4,201,941 7,154 607,341
-
21,462 3,594,600
IIS HAMIDAH, A.Md.Keb K-0 2,889,800 0 0 202,786 0 0
0 0 0 0 6,936 202,786 0
13-02-1985
0 240,000 72,420 20,807 50,696 0
11 198502132017052002 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 60 0 0
3,432,809 6,936 512,409
-
20,807 2,920,400
Halaman : 222
(019) D30100301900047 BULAN : AGUSTUS 2023

NO
DIAN MEIRA, A.Md.Keb K-0 2,889,800 0 0 225,168 0 0

0 0 0 0 6,936 225,168 0
05-05-1986
0 240,000 72,420 20,807 56,292 0
12 198605052017052004 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 56 0 0
3,455,187 6,936 540,387
-
20,807 2,914,800
WENI SALWENI, A.Md.Keb K-1 2,889,800 0 0 241,128 0 0
1 288,980 0 0 6,936 241,128 0
02-06-1987
57,796 240,000 217,260 20,807 60,282 0
13 198706022010012008 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 72 0 0
3,962,779 6,936 588,079
20,807 3,374,700
ANDRI HERDIAN, A.Md.Kep K-1 2,605,800 0 0 130,340 0 0
1 260,580 0 0 6,254 130,340 0
27-08-1986
52,116 240,000 217,260 18,762 32,585 0
14 198608272011011003 0 233,480 0 ..................
2,918,496 0 0
( PNS - 2C ) MKG: 11 3 9 0 0
3,531,121 6,254 421,421
-
18,762 3,109,700
MOHAMAD SAPEI PUTRA DD - 0 3,042,800 0 0 203,316 0 0
2 0 180,000 0 7,303 203,316 0
09-03-1970
121,712 0 217,260 21,908 50,829 0
15 197003092014091001 0 253,161 0 ..................
3,164,512 0 0
( PNS - 2C ) MKG: 21 3 18 0 0
3,794,317 7,303 536,517
-
21,908 3,257,800
1,155,110 180,000 0 48,898 1,478,325 0
473,844 1,440,000 1,375,980 146,691 369,580 0
PEG : 7 22,002,454 0 0 0 1,760,197 0
IST : 4 JIWA = 19 343 0 0
ANK : 8 26,672,691 48,898 3,803,691
146,691 22,869,000
TOTAL PER SATKER 50,397,800 0 0 3,942,929 6,096 0
3,823,510 180,000 0 120,958 3,942,929 0
1,413,916 4,660,000 3,331,320 362,866 985,732 0
PEG : 15 55,635,226 0 6,096 0 4,450,818 0
IST : 11 JIWA = 46 804 0 0
ANK : 20 68,240,199 120,958 9,869,399
362,866 58,370,800
Halaman : 223
(019) D30100301900047 BULAN : AGUSTUS 2023

NO
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 224
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIJATI
(019) D30100301900048 BULAN : AGUSTUS 2023

NO
dr.LINDA LINDIAWATI TK - 0 3,628,900 0 0 390,295 0 0

0 0 0 0 8,709 390,295 0
17-03-1978
0 750,000 72,420 26,128 97,574 0
1 197803172009022003 0 290,312 0 ..................
3,628,900 0 0
( PNS - 3D ) MKG: 14 1 66 0 0
4,876,518 8,709 813,018
-
26,128 4,063,500
MASDIDOH, A.Md.Kep. K-0 3,139,400 0 0 173,196 0 0
0 0 0 0 7,535 173,196 0
27-08-1976
0 265,000 72,420 22,604 43,299 0
2 197608272010012004 0 251,152 0 ..................
3,139,400 0 0
( PNS - 3B ) MKG: 10 1 31 0 0
3,680,186 7,535 497,786
-
22,604 3,182,400
SEPTI ANGGI LESTARI, S.Farm.,Apt K-1 2,688,500 0 0 190,642 0 0
0 268,850 185,000 0 6,452 190,642 0
06-09-1997
0 0 144,840 19,357 47,660 0
3 199709062022032005 0 236,588 0 ..................
2,957,350 0 0
( PNS - 3B ) MKG: 1 2 58 0 0
3,503,699 6,452 500,699
-
19,357 3,003,000
268,850 185,000 0 22,696 754,133 0
0 1,015,000 289,680 68,089 188,533 0
PEG : 3 9,725,650 0 0 0 778,052 0
IST : 1 JIWA = 4 155 0 0
ANK : 0 12,060,403 22,696 1,811,503
68,089 10,248,900
HERRA WINY PERMANA, A.Md.Kep K-1 3,171,500 0 0 272,107 0 0
1 317,150 0 0 7,612 272,107 0
25-08-1981
63,430 240,000 217,260 22,835 68,027 0
4 198108252014092001 0 284,166 0 ..................
3,552,080 0 0
( PNS - 2D ) MKG: 21 3 53 0 0
4,311,947 7,612 654,747
-
SARI MULYANI K-0 3,374,400 0 0 213,889 0 0
0 0 180,000 0 8,099 213,889 0
05-01-1971
0 0 72,420 24,296 53,472 0
5 197101052007012008 0 269,952 0 ..................
3,374,400 0 0
( PNS - 2D ) MKG: 25 1 4 0 0
3,873,108 8,099 569,708
-
24,296 3,303,400
Halaman : 225
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIJATI
(019) D30100301900048 BULAN : AGUSTUS 2023

NO
317,150 180,000 0 15,711 485,996 0
63,430 240,000 289,680 47,131 121,499 0
PEG : 2 6,926,480 0 0 0 554,118 0
IST : 1 JIWA = 4 57 0 0
ANK : 1 8,185,055 15,711 1,224,455
47,131 6,960,600
TOTAL PER SATKER 16,002,700 0 0 1,240,129 0 0
586,000 365,000 0 38,407 1,240,129 0
63,430 1,255,000 579,360 115,220 310,032 0
PEG : 5 16,652,130 0 0 0 1,332,170 0
IST : 2 JIWA = 8 212 0 0
ANK : 1 20,245,458 38,407 3,035,958
115,220 17,209,500
........., 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 226
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS HAURWANGI
(019) D30100301900049 BULAN : AGUSTUS 2023

NO
RINNY FITRIA DEWI, A.Md.Keb TK - 0 2,920,100 0 0 245,605 0 0

0 0 0 0 7,008 245,605 0
25-01-1988
0 300,000 72,420 21,025 61,401 0
1 198801252017042007 0 233,608 0 ..................
2,920,100 0 0
( PNS - 3A ) MKG: 8 1 89 0 0
3,566,247 7,008 568,647
0
21,025 2,997,600
0 0 0 7,008 245,605 0
0 300,000 72,420 21,025 61,401 0
PEG : 1 2,920,100 0 0 0 233,608 0
IST : 0 JIWA = 1 89 0 0
ANK : 0 3,566,247 7,008 568,647
21,025 2,997,600
TOTAL PER SATKER 2,920,100 0 0 245,605 0 0
0 0 0 7,008 245,605 0
0 300,000 72,420 21,025 61,401 0
PEG : 1 2,920,100 0 0 0 233,608 0
IST : 0 JIWA = 1 89 0 0
ANK : 0 3,566,247 7,008 568,647
21,025 2,997,600
, 24 JULI 2023
...... ...... ......

NIP ......... NIP ......... NIP .........
Halaman : 227
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS KALAPANUNGGAL
(019) D30100301900050 BULAN : AGUSTUS 2023

NO
HIKMAT K-1 4,108,100 0 0 222,202 0 0

1 410,810 0 0 9,859 222,202 0
10-12-1970
82,162 500,000 217,260 29,578 55,551 0
1 197012101995031004 0 368,086 0 ..................
4,601,072 0 0
( PNS - 3D ) MKG: 22 3 5 0 0
5,579,976 9,859 685,276
-
29,578 4,894,700
SANTI KARTIKA K-1 3,627,900 0 0 195,810 0 0
2 362,790 0 0 8,707 195,810 0
20-01-1973
145,116 265,000 289,680 26,121 48,953 0
2 197301202006042011 0 330,864 0 ..................
4,135,806 0 0
( PNS - 3A ) MKG: 22 4 31 0 0
4,921,155 8,707 610,455
-
26,121 4,310,700
773,600 0 0 18,566 418,012 0
227,278 765,000 506,940 55,699 104,504 0
PEG : 2 8,736,878 0 0 0 698,950 0
IST : 2 JIWA = 7 36 0 0
ANK : 3 10,501,131 18,566 1,295,731
55,699 9,205,400
WENY ISMAWATI, A.Md.Keb K-1 2,716,000 0 0 146,265 0 0
1 271,600 0 0 6,518 146,265 0
14-03-1989
54,320 240,000 217,260 19,555 36,566 0
3 198903142017052002 0 243,354 0 ..................
3,041,920 0 0
( PNS - 2D ) MKG: 11 3 40 0 0
3,671,558 6,518 452,258
-
19,555 3,219,300
RINA KRISTINA K-1 3,339,400 0 0 181,222 0 0
2 333,940 0 0 8,015 181,222 0
01-01-1970
133,576 240,000 289,680 24,044 45,306 0
4 197001011994032011 0 304,553 0 ..................
3,806,916 0 0
( PNS - 2C ) MKG: 27 4 63 0 0
4,549,940 8,015 563,140
-
24,044 3,986,800
DASEP MIPTAH K-1 3,444,600 0 0 183,227 0 0
2 344,460 180,000 0 8,267 183,227 0
17-05-1975
137,784 0 289,680 24,801 45,807 0
5 197505172014091003 0 314,148 0 ..................
3,926,844 0 0
( PNS - 2C ) MKG: 29 4 31 0 0
4,612,850 8,267 576,250
-
24,801 4,036,600
Halaman : 228
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS KALAPANUNGGAL
(019) D30100301900050 BULAN : AGUSTUS 2023

NO
950,000 180,000 0 22,800 510,714 0
325,680 480,000 796,620 68,400 127,679 0
PEG : 3 10,775,680 0 0 0 862,055 0
IST : 3 JIWA = 11 134 0 0
ANK : 5 12,834,348 22,800 1,591,648
68,400 11,242,700
TOTAL PER SATKER 17,236,000 0 0 928,726 0 0
1,723,600 180,000 0 41,366 928,726 0
552,958 1,245,000 1,303,560 124,099 232,183 0
PEG : 5 19,512,558 0 0 0 1,561,005 0
IST : 5 JIWA = 18 170 0 0
ANK : 8 23,335,479 41,366 2,887,379
124,099 20,448,100
null, 24 JULI 2023
null null null
null null null

NIP null NIP null NIP null
Halaman : 229
[ DINAS KESEHATAN (PUSKESMAS) ] PUSKESMAS CIBULUH
(019) D30100301900051 BULAN : AGUSTUS 2023

NO
ADE WAHYUDIN S, AM.Kep K-1 4,508,600 0 0 290,683 4,058 0

2 450,860 0 0 10,821 290,683 0
03-10-1968
180,344 500,000 289,680 32,462 72,671 0
1 196810031990031005 0 411,184 0 ..................
5,139,804 0 4,058
( PNS - 3D ) MKG: 28 4 71 0 0
6,267,579 10,821 821,879
-
32,462 5,445,700
SUMINAR SRIHARYANI, Am.Kep K-1 3,238,300 0 0 210,849 0 0
2 323,830 0 0 7,772 210,849 0
19-04-1981
129,532 265,000 289,680 23,316 52,712 0
2 198104192009022005 0 295,333 0 ..................
3,691,662 0 0
( PNS - 3B ) MKG: 12 4 3 0 0
4,488,282 7,772 589,982
-
23,316 3,898,300
WAWAN AHMAD NURHIDAYA,A.Md.Kep K-0 3,305,700 0 0 197,750 0 0
0 0 0 0 7,934 197,750 0
12-03-1979
0 265,000 72,420 23,801 49,438 0
3 197903122012121001 0 264,456 0 ..................
3,305,700 0 0
( PNS - 3A ) MKG: 16 1 74 0 0
3,872,679 7,934 543,379
-
23,801 3,329,300
SUB TOTAL PERGOLONGAN : III 11,052,600 0 0 699,282 4,058 0
774,690 0 0 26,527 699,282 0
309,876 1,030,000 651,780 79,579 174,821 0
PEG : 3 12,137,166 0 4,058 0 970,973 0
IST : 2 JIWA = 9 148 0 0
ANK : 4 14,628,540 26,527 1,955,240
79,579 12,673,300
NURLAELA HAYATI JD - 0 3,374,400 0 0 205,738 0 0
2 0 0 0 8,099 205,738 0
09-11-1975
134,976 240,000 217,260 24,296 51,434 0
4 197511092007012004 0 280,750 0 ..................
3,509,376 0 0
( PNS - 2D ) MKG: 25 3 48 0 0
4,204,817 8,099 570,317
-
24,296 3,634,500
DEWI NOVIA, A.Md.Keb K-0 2,980,800 0 0 183,190 0 0
0 0 0 0 7,154 183,190 0
19-02-1986
0 240,000 72,420 21,462 45,797 0
5 198602192017052002 0 238,464 0 ..................
2,980,800 0 0
( PNS - 2D ) MKG: 17 1 41 0 0
3,505,067 7,154 496,067
-
21,462 3,009,000
Halaman : 230
(019) D30100301900051 BULAN : AGUSTUS 2023

NO
AIH MASROPAH, A.Md.Keb K-0 2,889,800 0 0 179,376 0 0

0 0 0 0 6,936 179,376 0
03-11-1982
0 240,000 72,420 20,807 44,844 0
6 198211032017052001 0 231,184 0 ..................
2,889,800 0 0
( PNS - 2D ) MKG: 15 1 8 0 0
3,409,347 6,936 483,147
-
20,807 2,926,200
RUSMILAWATI, A.Md.Keb K-1 2,889,800 0 0 193,145 0 0
1 288,980 0 0 6,936 193,145 0
05-06-1986
57,796 240,000 217,260 20,807 48,286 0
7 198606052017052003 0 258,926 0 ..................
3,236,576 0 0
( PNS - 2D ) MKG: 15 3 76 0 0
3,914,800 6,936 528,100
-
20,807 3,386,700
EKA KARTIKA, A.Md.Keb K-1 2,801,500 0 0 191,127 0 0
2 280,150 0 0 6,724 191,127 0
06-02-1987
112,060 240,000 289,680 20,171 47,782 0
8 198702062017052001 0 255,497 0 ..................
3,193,710 0 0
( PNS - 2D ) MKG: 13 4 89 0 0
3,941,501 6,724 521,301
-
20,171 3,420,200
NENDEN SINTAWATI, A.Md.Keb K-0 2,801,500 0 0 175,554 0 0
0 0 0 0 6,724 175,554 0
14-02-1989
0 240,000 72,420 20,171 43,889 0
9 198902142017052003 0 224,120 0 ..................
2,801,500 0 0
( PNS - 2D ) MKG: 13 1 89 0 0
3,316,458 6,724 470,458
-
20,171 2,846,000
MASITOH K-0 3,480,700 0 0 201,939 0 0
0 0 180,000 0 8,354 201,939 0
05-03-1971
0 0 72,420 25,061 50,485 0
10 197103052006042019 0 278,456 0 ..................
3,480,700 0 0
( PNS - 2D ) MKG: 27 1 21 0 0
3,968,495 8,354 564,295
-
25,061 3,404,200
569,130 180,000 0 50,927 1,330,069 0
304,832 1,440,000 1,013,880 152,775 332,517 0
PEG : 7 22,092,462 0 0 0 1,767,397 0
IST : 2 JIWA = 14 372 0 0
ANK : 5 26,260,485 50,927 3,633,685
152,775 22,626,800
Halaman : 231
(019) D30100301900051 BULAN : AGUSTUS 2023

NO
TOTAL PER SATKER 32,271,100 0 0 2,029,351 4,058 0
1,343,820 180,000 0 77,454 2,029,351 0
614,708 2,470,000 1,665,660 232,354 507,338 0
PEG : 10 34,229,628 0 4,058 0 2,738,370 0
IST : 4 JIWA = 23 520 0 0
ANK : 9 40,889,025 77,454 5,588,925
232,354 35,300,100
null, 24 JULI 2023
null null null
null null null

NIP null NIP null NIP null

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PEMERINTAH KABUPATEN CIANJUR

NAMA PEGAWAI PENGHASILAN POTONGAN

drg.DIAN NUSWANTARI,M.Kes. K-0 4,898,100 0 0 445,835 79,875 0

NAMA PEGAWAI PENGHASILAN POTONGAN

RENI HAYATI GANTINI, AM.Keb. K-1 4,650,600 0 0 327,937 35,421 0

NAMA PEGAWAI PENGHASILAN POTONGAN

NUR RENI WATI, AM.Keb TK - 0 3,743,100 0 0 331,714 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

DEDE SURYANI, SKM K-1 3,554,000 0 0 317,164 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

HETI YUSTIRA K-0 3,517,200 0 0 244,172 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

...... ...... ......

NAMA PEGAWAI PENGHASILAN POTONGAN

NAMA PEGAWAI PENGHASILAN POTONGAN

dr.USI YUSNITASWARI TK - 0 3,666,900 0 0 347,883 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

JAVED SUMAWE MATA PULUNG K-1 4,237,500 0 0 400,617 6,696 0

NAMA PEGAWAI PENGHASILAN POTONGAN

ANGGRAENI WULANDARI, S.Farm., Apt. K-1 2,773,200 0 0 182,723 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

INEU SITI ANISAH, Amd,Keb TK - 0 3,139,400 0 0 204,880 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

IRMA LESTARI, S.Gz K-1 2,830,900 0 0 131,960 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

...... ...... ......

NAMA PEGAWAI PENGHASILAN POTONGAN

drg.SRI SUNDARI JD - 0 4,024,400 0 0 359,124 24,254 0

NAMA PEGAWAI PENGHASILAN POTONGAN

DEDEN JUANDA, A.Md.Kep K-1 4,370,900 0 0 318,139 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

dr. WINA SELVIA K-0 3,172,300 0 0 290,442 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

SITI MAKHARROMAH, A.Md,Farm K-1 3,139,400 0 0 204,254 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

REDI ACHMAD SYOFARUDIN,Amd,Kep K-1 3,171,500 0 0 216,932 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

ANI MULYANTI, A.Md.Kep TK - 0 2,301,800 0 0 147,300 0 0

...... ...... ......

NAMA PEGAWAI PENGHASILAN POTONGAN

Hj. DIDA AISAH, S.ST K-0 5,052,300 0 0 374,975 66,913 0

NAMA PEGAWAI PENGHASILAN POTONGAN

SLAMET NOVERIANTO, S.Farm.Apt. K-1 3,628,900 0 0 328,739 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

ROSDIANI K-1 4,237,500 0 0 298,791 1,858 0

NAMA PEGAWAI PENGHASILAN POTONGAN

dr. YACLIN NATALIA DAMAYANTI TK - 0 2,773,200 0 0 295,666 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

HENDI ROHENDI K-1 4,023,300 0 0 245,423 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

RENI ARYANI, A.Md.Kep K-1 3,171,500 0 0 246,147 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN

...... ...... ......

NAMA PEGAWAI PENGHASILAN POTONGAN

drg.RATNA JUARIYAH K-1 4,651,800 0 0 480,000 53,729 0

NAMA PEGAWAI PENGHASILAN POTONGAN

EFFRELIYA, AM.Keb. TK - 0 4,370,900 0 0 331,389 21,908 0

NAMA PEGAWAI PENGHASILAN POTONGAN

ANAH TK - 0 4,370,900 0 0 331,311 17,154 0

NAMA PEGAWAI PENGHASILAN POTONGAN

SRI HARTATI NURLAELA, AM.Kep K-1 3,591,200 0 0 315,360 0 0

NAMA PEGAWAI PENGHASILAN POTONGAN