PEMERINTAH KABUPATEN CIANJUR

BUKU KAS UMUM

periode 1 Januari 2021 s/d 31 Desember 2021

Urusan Pemerintahan : 1 Urusan Wajib Pelayanan Dasar

Bidang Pemerintahan : 1 . 02 Kesehatan
Unit Organisasi : 1 . 02 . 01 DINAS KESEHATAN
Sub Unit Organisasi : 1 . 02 . 01 . 32 PUSKESMAS TAKOKAK (BLUD)
Pengguna Anggaran/Kuasa Pengguna Anggaran : HODIDJAH S Tr.Keb
Bendahara Penerimaan : ENANG SUHERMAN
NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
1 02/01/21 01-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 145.000,00
k/2021
2 04/01/21 01-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 210.000,00
k/2021
3 05/01/21 01-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 275.000,00
k/2021
4 06/01/21 01-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 330.000,00
k/2021
5 07/01/21 01-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 215.000,00
k/2021
6 08/01/21 01-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 195.000,00
k/2021
7 09/01/21 01-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
8 11/01/21 01-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 235.000,00
k/2021
9 12/01/21 01-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 275.000,00
k/2021
10 13/01/21 01-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 365.000,00
k/2021
11 14/01/21 01-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
12 15/01/21 01-001/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 7.060.000,00
k/2021
13 01-002/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 158.100.100,00
k/2021 FKTP
14 01-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.470.000,00
k/2021
15 01-013/bp/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 158.100.100,00
k/2021 FKTP
16 16/01/21 01-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 80.000,00
k/2021
17 18/01/21 01-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 175.000,00
k/2021
18 01-016/bp/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 7.747.100,00
k/2021 FKTP
19 19/01/21 01-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 175.000,00
k/2021
20 20/01/21 01-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 320.000,00
k/2021
21 21/01/21 01-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 110.000,00
k/2021
22 22/01/21 01-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 150.000,00
k/2021
23 23/01/21 01-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 30.000,00
k/2021
24 25/01/21 01-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 165.000,00
k/2021
25 26/01/21 01-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 245.000,00
k/2021
26 27/01/21 01-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 60.000,00
k/2021
27 28/01/21 01-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 50.000,00
k/2021
28 29/01/21 01-003/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 7.560.000,00
k/2021
29 01-004/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 7.747.100,00
k/2021 FKTP
30 01-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.000.000,00
k/2021
31 01-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
32 01-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
33 01-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
34 01-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
35 01-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
36 01-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
37 01-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
38 01-034/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
39 30/01/21 01-005/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 213.860,00
k/2021
40 01-035/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 213.860,00
k/2021
41 02-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 240.000,00
k/2021

BUKU KAS UMUM Halaman 1 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
42 01/02/21 02-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
43 02/02/21 02-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 215.000,00
k/2021
44 03/02/21 02-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 350.000,00
k/2021
45 04/02/21 02-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 320.000,00
k/2021
46 05/02/21 02-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
47 06/02/21 02-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 60.000,00
k/2021
48 08/02/21 02-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 110.000,00
k/2021
49 09/02/21 02-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
50 10/02/21 02-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 360.000,00
k/2021
51 11/02/21 02-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 320.000,00
k/2021
52 13/02/21 02-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.140.000,00
k/2021
53 15/02/21 02-006/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 6.800.000,00
k/2021
54 02-006a/sts/pkm- 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 156.412.200,00
tkk/2021 FKTP
55 02-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 260.000,00
k/2021
56 02-013a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 7.247.100,00
kk/2021 FKTP
57 02-013b/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 149.165.100,00
kk/2021 FKTP
58 16/02/21 02-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 155.000,00
k/2021
59 17/02/21 02-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 260.000,00
k/2021
60 18/02/21 02-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 270.000,00
k/2021
61 19/02/21 02-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 125.000,00
k/2021
62 20/02/21 02-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 85.000,00
k/2021
63 22/02/21 02-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 235.000,00
k/2021
64 23/02/21 02-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
65 24/02/21 02-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 170.000,00
k/2021
66 25/02/21 02-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 235.000,00
k/2021
67 26/02/21 02-007/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 8.755.000,00
k/2021
68 02-008/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 269.979,00
k/2021
69 02-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 5.060.000,00
k/2021
70 02-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
71 02-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
72 02-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
73 02-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
74 02-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
75 02-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
76 02-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
77 02-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
78 02-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 269.979,00
k/2021
79 27/02/21 03-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 30.000,00
k/2021
80 01/03/21 03-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 85.000,00
k/2021
81 02/03/21 03-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 90.000,00
k/2021
82 03/03/21 03-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 195.000,00
k/2021
83 04/03/21 03-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 110.000,00
k/2021
84 05/03/21 03-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 90.000,00
k/2021
85 06/03/21 03-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 90.000,00
k/2021
86 08/03/21 03-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
87 03-009/bp/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 8.806.100,00
k/2021 FKTP
88 03-009/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 8.806.100,00
k/2021 FKTP
89 09/03/21 03-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 95.000,00
k/2021
90 10/03/21 03-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 200.000,00
k/2021

BUKU KAS UMUM Halaman 2 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
91 12/03/21 03-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 80.000,00
k/2021
92 13/03/21 03-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.780.000,00
k/2021
93 15/03/21 03-010/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 6.125.000,00
k/2021
94 03-011/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 178.404.450,00
k/2021 FKTP
95 03-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
96 03-015/bp/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 178.404.450,00
k/2021 FKTP
97 16/03/21 03-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 185.000,00
k/2021
98 17/03/21 03-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 330.000,00
k/2021
99 18/03/21 03-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 220.000,00
k/2021
100 19/03/21 03-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 155.000,00
k/2021
101 20/03/21 03-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
102 22/03/21 03-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 105.000,00
k/2021
103 23/03/21 03-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
104 24/03/21 03-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
105 25/03/21 03-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 55.000,00
k/2021
106 26/03/21 03-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 60.000,00
k/2021
107 27/03/21 03-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 45.000,00
k/2021
108 29/03/21 03-012/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 8.574.100,00
k/2021 FKTP
109 03-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
110 03-028/bp/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 8.574.100,00
k/2021 FKTP
111 30/03/21 03-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 190.000,00
k/2021
112 31/03/21 03-013/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 8.413.465,00
k/2021
113 03-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.135.000,00
k/2021
114 03-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
115 03-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
116 03-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
117 03-034/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
118 03-035/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
119 03-036/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
120 03-037/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
121 03-038/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
122 03-039/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 288.465,00
k/2021
123 01/04/21 04-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 305.000,00
k/2021
124 03/04/21 04-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
125 05/04/21 04-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
126 06/04/21 04-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 185.000,00
k/2021
127 07/04/21 04-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 335.000,00
k/2021
128 08/04/21 04-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 125.000,00
k/2021
129 09/04/21 04-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 50.000,00
k/2021
130 10/04/21 04-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.240.000,00
k/2021
131 12/04/21 04-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 85.000,00
k/2021
132 13/04/21 04-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
133 14/04/21 04-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 180.000,00
k/2021
134 15/04/21 04-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 80.000,00
k/2021
135 04-014/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 6.080.000,00
k/2021
136 16/04/21 04-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 90.000,00
k/2021
137 04-013a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 149.202.700,00
kk/2021 FKTP
138 04-015/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 149.202.700,00
k/2021 FKTP
139 17/04/21 04-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 25.000,00
k/2021

BUKU KAS UMUM Halaman 3 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
140 19/04/21 04-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 345.000,00
k/2021
141 20/04/21 04-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 310.000,00
k/2021
142 21/04/21 04-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 410.000,00
k/2021
143 22/04/21 04-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 150.000,00
k/2021
144 23/04/21 04-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 255.000,00
k/2021
145 24/04/21 04-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
146 26/04/21 04-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 435.000,00
k/2021
147 27/04/21 04-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 65.000,00
k/2021
148 28/04/21 04-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 245.000,00
k/2021
149 29/04/21 04-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
150 30/04/21 04-016/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 10.496.206,00
k/2021
151 04-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 5.520.000,00
k/2021
152 04-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
153 04-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
154 04-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
155 04-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
156 04-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
157 04-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
158 04-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
159 04-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
160 04-033a/bp/pkm-t 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 376.206,00
kk/2021
161 03/05/21 05-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 245.000,00
k/2021
162 04/05/21 05-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 70.000,00
k/2021
163 05/05/21 05-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 300.000,00
k/2021
164 06/05/21 05-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
165 07/05/21 05-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 110.000,00
k/2021
166 08/05/21 05-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 185.000,00
k/2021
167 10/05/21 06-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.535.000,00
k/2021
168 11/05/21 05-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 30.000,00
k/2021
169 12/05/21 05-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
170 15/05/21 05-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.780.000,00
k/2021
171 17/05/21 05-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 235.000,00
k/2021
172 05-011a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 158.281.850,00
kk/2021 FKTP
173 05-011b/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 5.112.100,00
kk/2021 FKTP
174 05-017/sts/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 163.393.950,00
k/2021 FKTP
175 18/05/21 05-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 380.000,00
k/2021
176 19/05/21 05-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 735.000,00
k/2021
177 20/05/21 05-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 470.000,00
k/2021
178 21/05/21 05-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.310.000,00
k/2021
179 05-018/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 9.210.000,00
k/2021
180 22/05/21 05-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 265.000,00
k/2021
181 24/05/21 05-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 425.000,00
k/2021
182 25/05/21 05-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 345.000,00
k/2021
183 27/05/21 05-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 305.000,00
k/2021
184 28/05/21 05-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 325.000,00
k/2021
185 29/05/21 05-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 245.000,00
k/2021
186 31/05/21 05-019/sts/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 8.805.837,00
k/2021
187 05-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.485.000,00
k/2021
188 05-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021

BUKU KAS UMUM Halaman 4 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
189 31/05/21 05-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
190 05-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
191 05-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
192 05-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
193 05-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
194 05-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
195 05-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
196 05-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 410.837,00
k/2021
197 02/06/21 06-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 860.000,00
k/2021
198 03/06/21 06-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
199 04/06/21 06-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
200 05/06/21 06-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
201 07/06/21 06-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 545.000,00
k/2021
202 08/06/21 06-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 365.000,00
k/2021
203 09/06/21 06-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.535.000,00
k/2021
204 10/06/21 06-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 235.000,00
k/2021
205 11/06/21 06-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
206 12/06/21 06-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
207 14/06/21 06-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 300.000,00
k/2021
208 15/06/21 06-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 255.000,00
k/2021
209 06-014a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 158.383.600,00
kk/2021 FKTP
210 16/06/21 06-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 440.000,00
k/2021
211 17/06/21 06-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 320.000,00
k/2021
212 18/06/21 06-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
213 19/06/21 06-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 135.000,00
k/2021
214 21/06/21 06-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 115.000,00
k/2021
215 22/06/21 06-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
216 23/06/21 06-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.470.000,00
k/2021
217 24/06/21 06-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 275.000,00
k/2021
218 25/06/21 06-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
219 26/06/21 06-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 50.000,00
k/2021
220 28/06/21 06-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 245.000,00
k/2021
221 29/06/21 06-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 260.000,00
k/2021
222 30/06/21 06-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.990.000,00
k/2021
223 06-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
224 06-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
225 06-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
226 06-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
227 06-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
228 06-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
229 06-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
230 06-034/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
231 06-034a/bp/pkm-t 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 476.986,00
kk/2021
232 01/07/21 07-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
233 02/07/21 07-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 175.000,00
k/2021
234 03/07/21 07-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 55.000,00
k/2021
235 05/07/21 07-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 180.000,00
k/2021
236 07-004a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 11.065.100,00
kk/2021 FKTP
237 06/07/21 07-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 165.000,00
k/2021

BUKU KAS UMUM Halaman 5 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
238 07/07/21 07-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 855.000,00
k/2021
239 08/07/21 07-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
240 09/07/21 07-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
241 10/07/21 07-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
242 12/07/21 07-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 270.000,00
k/2021
243 07-010a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 10.006.100,00
kk/2021 FKTP
244 13/07/21 07-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 175.000,00
k/2021
245 14/07/21 07-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 3.090.000,00
k/2021
246 15/07/21 07-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
247 07-013a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 158.316.100,00
kk/2021 FKTP
248 16/07/21 07-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 190.000,00
k/2021
249 17/07/21 07-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
250 19/07/21 07-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 255.000,00
k/2021
251 21/07/21 07-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 3.255.000,00
k/2021
252 22/07/21 07-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 150.000,00
k/2021
253 23/07/21 07-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
254 24/07/21 07-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 135.000,00
k/2021
255 26/07/21 07-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 305.000,00
k/2021
256 27/07/21 07-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 85.000,00
k/2021
257 28/07/21 07-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 4.130.000,00
k/2021
258 29/07/21 07-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 55.000,00
k/2021
259 30/07/21 07-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.590.000,00
k/2021
260 07-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 555.954,00
k/2021
261 31/07/21 08-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 290.000,00
k/2021
262 02/08/21 08-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 115.000,00
k/2021
263 03/08/21 08-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 205.000,00
k/2021
264 04/08/21 08-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 930.000,00
k/2021
265 05/08/21 08-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
266 06/08/21 08-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 85.000,00
k/2021
267 07/08/21 08-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
268 09/08/21 08-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 95.000,00
k/2021
269 10/08/21 08-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 750.000,00
k/2021
270 12/08/21 08-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 710.000,00
k/2021
271 13/08/21 08-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
272 14/08/21 08-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 95.000,00
k/2021
273 16/08/21 08-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.395.000,00
k/2021
274 08-013a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 149.416.600,00
kk/2021 FKTP
275 18/08/21 08-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 230.000,00
k/2021
276 19/08/21 08-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 325.000,00
k/2021
277 20/08/21 08-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 205.000,00
k/2021
278 21/08/21 08-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 45.000,00
k/2021
279 23/08/21 08-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 460.000,00
k/2021
280 24/08/21 08-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 285.000,00
k/2021
281 25/08/21 08-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.430.000,00
k/2021
282 26/08/21 08-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 325.000,00
k/2021
283 27/08/21 08-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 105.000,00
k/2021
284 28/08/21 08-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 60.000,00
k/2021
285 30/08/21 08-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 95.000,00
k/2021
286 31/08/21 08-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.540.000,00
k/2021

BUKU KAS UMUM Halaman 6 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
287 31/08/21 08-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
288 08-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
289 08-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
290 08-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
291 08-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
292 08-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
293 08-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
294 08-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
295 08-034/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 544.301,00
k/2021
296 01/09/21 09-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 205.000,00
k/2021
297 09-001a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 19.095.100,00
kk/2021 FKTP
298 02/09/21 09-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 285.000,00
k/2021
299 03/09/21 09-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
300 04/09/21 09-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 50.000,00
k/2021
301 06/09/21 09-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
302 07/09/21 09-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 190.000,00
k/2021
303 08/09/21 09-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.545.000,00
k/2021
304 09/09/21 09-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 240.000,00
k/2021
305 10/09/21 09-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 145.000,00
k/2021
306 11/09/21 09-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 35.000,00
k/2021
307 13/09/21 09-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 145.000,00
k/2021
308 14/09/21 09-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
309 15/09/21 09-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.620.000,00
k/2021
310 09-014/bp/pkm-tk 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 143.330.000,00
k/2021 FKTP
311 16/09/21 09-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 335.000,00
k/2021
312 17/09/21 09-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
313 18/09/21 09-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
314 20/09/21 09-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 220.000,00
k/2021
315 21/09/21 09-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 180.000,00
k/2021
316 22/09/21 09-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.730.000,00
k/2021
317 23/09/21 09-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 190.000,00
k/2021
318 24/09/21 09-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 990.000,00
k/2021
319 25/09/21 09-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
320 27/09/21 09-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
321 28/09/21 09-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
322 29/09/21 09-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 380.000,00
k/2021
323 30/09/21 09-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.670.000,00
k/2021
324 09-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
325 09-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
326 09-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
327 09-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
328 09-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
329 09-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
330 09-034/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
331 09-035/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
332 09-036/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 553.122,00
k/2021
333 01/10/21 10-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 265.000,00
k/2021
334 02/10/21 10-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 35.000,00
k/2021
335 04/10/21 10-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 265.000,00
k/2021

BUKU KAS UMUM Halaman 7 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
336 04/10/21 10-003a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 13.245.100,00
kk/2021 FKTP
337 05/10/21 10-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 180.000,00
k/2021
338 06/10/21 10-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 695.000,00
k/2021
339 07/10/21 10-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
340 08/10/21 10-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 105.000,00
k/2021
341 09/10/21 10-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 45.000,00
k/2021
342 11/10/21 10-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
343 12/10/21 10-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 185.000,00
k/2021
344 13/10/21 10-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.420.000,00
k/2021
345 14/10/21 10-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 175.000,00
k/2021
346 15/10/21 10-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 735.000,00
k/2021
347 10-013a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 116.641.150,00
kk/2021 FKTP
348 16/10/21 10-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 90.000,00
k/2021
349 18/10/21 10-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 195.000,00
k/2021
350 20/10/21 10-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 145.000,00
k/2021
351 21/10/21 10-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.385.000,00
k/2021
352 22/10/21 10-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 160.000,00
k/2021
353 23/10/21 10-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 20.000,00
k/2021
354 25/10/21 10-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 315.000,00
k/2021
355 26/10/21 10-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 165.000,00
k/2021
356 27/10/21 10-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.155.000,00
k/2021
357 28/10/21 10-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 170.000,00
k/2021
358 29/10/21 10-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 875.000,00
k/2021
359 10-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
360 10-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
361 10-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
362 10-028/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
363 10-029/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
364 10-030/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
365 10-031/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
366 10-032/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
367 30/10/21 10-033/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 541.920,00
k/2021
368 11-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 155.000,00
k/2021
369 01/11/21 11-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 195.000,00
k/2021
370 11-002a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 4.790.100,00
kk/2021 FKTP
371 02/11/21 11-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 255.000,00
k/2021
372 03/11/21 11-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.170.000,00
k/2021
373 04/11/21 11-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 150.000,00
k/2021
374 05/11/21 11-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
375 06/11/21 11-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
376 08/11/21 11-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 240.000,00
k/2021
377 09/11/21 11-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
378 10/11/21 11-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.545.000,00
k/2021
379 11/11/21 11-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 225.000,00
k/2021
380 12/11/21 11-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 105.000,00
k/2021
381 13/11/21 11-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 85.000,00
k/2021
382 15/11/21 11-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 670.000,00
k/2021
383 11-014a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 118.419.100,00
kk/2021 FKTP
384 16/11/21 11-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 220.000,00
k/2021

BUKU KAS UMUM Halaman 8 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
385 17/11/21 11-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 230.000,00
k/2021
386 18/11/21 11-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 70.000,00
k/2021
387 19/11/21 11-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 100.000,00
k/2021
388 20/11/21 11-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 150.000,00
k/2021
389 22/11/21 11-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 135.000,00
k/2021
390 11-020a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 7.356.100,00
kk/2021 FKTP
391 23/11/21 11-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
392 24/11/21 11-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 3.915.000,00
k/2021
393 25/11/21 11-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 165.000,00
k/2021
394 26/11/21 11-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 145.000,00
k/2021
395 27/11/21 11-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 40.000,00
k/2021
396 29/11/21 11-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 140.000,00
k/2021
397 30/11/21 11-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.945.000,00
k/2021
398 11-027a/bp/pkm-t 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 540.742,00
kk/2021
399 01/12/21 12-001/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 460.000,00
k/2021
400 02/12/21 12-002/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 255.000,00
k/2021
401 03/12/21 12-003/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 105.000,00
k/2021
402 04/12/21 12-004/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 75.000,00
k/2021
403 06/12/21 12-005/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 310.000,00
k/2021
404 07/12/21 12-006/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 300.000,00
k/2021
405 08/12/21 12-007/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 1.270.000,00
k/2021
406 09/12/21 12-008/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 230.000,00
k/2021
407 10/12/21 12-009/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 115.000,00
k/2021
408 11/12/21 12-010/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 70.000,00
k/2021
409 13/12/21 12-011/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 250.000,00
k/2021
410 14/12/21 12-012/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 220.000,00
k/2021
411 15/12/21 12-013/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.095.000,00
k/2021
412 12-013a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 133.722.700,00
kk/2021 FKTP
413 16/12/21 12-014/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 210.000,00
k/2021
414 17/12/21 12-015/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 120.000,00
k/2021
415 18/12/21 12-016/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 195.000,00
k/2021
416 20/12/21 12-017/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 300.000,00
k/2021
417 12-017a/bp/pkm-t 4 . 1 . 4 . 61 . 01 Pendapatan Dana Kapitasi JKN pada 8.612.100,00
kk/2021 FKTP
418 21/12/21 12-018/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 245.000,00
k/2021
419 22/12/21 12-019/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 2.820.000,00
k/2021
420 23/12/21 12-020/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 355.000,00
k/2021
421 24/12/21 12-021/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 70.000,00
k/2021
422 27/12/21 12-022/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 130.000,00
k/2021
423 28/12/21 12-023/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 200.000,00
k/2021
424 29/12/21 12-024/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 300.000,00
k/2021
425 30/12/21 12-025/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 180.000,00
k/2021
426 31/12/21 12-026/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 3.200.000,00
k/2021
427 12-027/bp/pkm-tk 4 . 1 . 4 . 58 . 01 Pendapatan BLUD 6.993,00
k/2021

BUKU KAS UMUM Halaman 9 dari 10

 NO. TGL NO. BUKTI KODE REK. URAIAN PENERIMAAN PENGELUARAN
Jumlah periode ini 2.067.914.015,00 910.430.047,00

Jumlah sampai periode lalu 0,00 0,00

Jumlah semua sampai periode ini 2.067.914.015,00 910.430.047,00

Sisa Kas 1.157.483.968,00

Pada hari ini tanggal 31 Desember 2021

oleh kami didapat dalam kas Rp. 1.157.483.968,00
Satu milyar seratus lima puluh tujuh juta empat ratus delapan puluh tiga ribu sembilan ratus enam puluh delapan rupiah

Mengetahui, Cianjur, 31 Desember 2021

KEPALA PUSKESMAS TAKOKAK BENDAHARA PENERIMAAN

HODIDJAH S Tr.Keb ENANG SUHERMAN

NIP. 19700912 199101 2 003 NIP. 19671010 198901 1 004

BUKU KAS UMUM Halaman 10 dari 10