Per Salin An

REKAPITULASI PENGAJUAN KLAIM PERSALINAN
PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN FEBRUARI TAHUN 2014
Nomor Iden titas Nomor Telepon Bidan Jenis

No Nama Penderita Alamat Diagnosa GPA Biaya
/ NIK Pasien/ Keluarga Penolong Tindakan
1 Nina Rahmadani 1103106607830001 Alue Udep 081376762332 Persalinan Normal G III. P II .A0 Yuli Melasari - Rp 600,000
2 Wardani 1103105303840002 Alue Udep - Persalinan Normal G III. P II .A0 Yuli Melasari - Rp 600,000
3 Nurbaiti 1103105205910002 Pertamina 082361482698 Persalinan Normal G III. P II .A0 Mahzahera - Rp 600,000
4 Fidiah Fitriyani 1103105903930001 Alue Genteng 081376030622 Persalinan Normal G I P0. A0 Erna AMKeb - Rp 600,000
5 Nurainah 1103104712830002 Paya Palas - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
6 Fitriani 110310550880001 Matang Kuli - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
7 Tina 1103104408900005 Punti Payong - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
8 Suliana 1103106503800002 Seumali - Persalinan Normal G IV.PIII A0 Levriani Dewi - Rp 600,000
9 Rohana 1103104607870001 Alue Dua 85360081852 Persalinan Penyulit G I .P0 A0 Nurbaiti Letak Sungsang Rp 750,000
10 Jasmani 1103194205930001 Tampak - Persalinan Normal G I .P0 A0 Nurbaiti Rp 600,000
Total
Ranto Peureulak, 28 Februari 2014

Mengetahui, Kepala Puskesmas Ranto Peureulak
Dinas Kesehatan Kab.Aceh Timur
Kabid Jaminan & Sarana Kesehatan
( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006
PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN MARET TAHUN 2014

1 Nur Ainon 000021477235 Pulo Blang - Persalinan Normal G VI. P V .A0 Elyati - Rp 600,000
2 Novita Elvira 1103104210850001 Alue Batee - Persalinan Normal G VI. P III .AII Samsinar - Rp 600,000
3 Asmaniar 1103105606810002 Alue Batee - Persalinan Normal G III. P II .A0 Samsinar - Rp 600,000
4 Hariyani 1103106706930001 Alue Batee - Persalinan Normal G II PI. A0 Samsinar - Rp 600,000
5 Wagiatik 1103105501860001 Paya Palas - Persalinan Normal G III PII. A0 Siti Fujana - Rp 600,000
6 Tria Novi Yanti 1103106811930002 Paya Palas - Persalinan Normal G II PI. A0 Siti Fujana - Rp 600,000
7 Sulastri 1103104103830002 Paya Palas - Persalinan Normal G II PI. A0 Siti Fujana - Rp 600,000
8 Halimatun Sakdiah 1103106210860001 Paya Palas - Persalinan Normal G II PI. A0 Siti Fujana - Rp 600,000
9 Suparni 1103105504720001 Alue Genting - Persalinan Normal GV.PIV. A0 Erna - Rp 600,000
10 Tihadanah 1103104511810002 Alue Genting - Persalinan Normal G II PI. A0 Erna - Rp 600,000
11 Aprilia Sari 1116025504880004 Alue Genting - Persalinan Normal GI. P0. A0 Erna - Rp 600,000
12 Novi Irwani 1103106011810001 Alue Genting - Persalinan Normal G II PI. A0 Erna - Rp 600,000
13 Nurfida Hanum 1103104212830004 Bhom Lama 085372878875 Persalinan Normal G IV. P III .A0 Sri Rahayu - Rp 600,000
14 Saudah 0000215736521 Pasi Puteh 082272871373 Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
15 Fitria 1103104507850004 Pulo Blang - Persalinan Normal G II. P I .A0 Levriani Dewi - Rp 600,000
16 Triana Shafira 1103104108890003 Pertamina - Persalinan Normal G III. P II.A0 Levriani Dewi - Rp 600,000
17 Mariyani 0000215846943 Alue Dua - Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
18 Sumiati 1103105703800001 Pasi Puteh - Persalinan Normal G IV.PIII A0 Levriani Dewi - Rp 600,000
19 Pujiati 1103106512840002 Pasi Puteh - Persalinan Normal G IV .PIII A0 Linda - Rp 600,000
20 Eni Dwita 0000214163436 Mata Iee - Persalinan Normal G IV .PIII A0 Nova Arianda - Rp 600,000
Total

NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN APRIL TAHUN 2014

1 Mariati 0000978907847 Snb Johan - Persalinan Normal G I. P 0 .A0 Fenti Mavika - Rp 600,000
2 Jauharul Sag 1103184504760002 Beusa Seberang - Persalinan Normal G IV. P III .A0 Elyati - Rp 600,000
3 Kasmah 0000214731977 Pulo Blang - Persalinan Normal G IV. P III .A0 Elyati - Rp 600,000
4 Mariani 1174054207800001 Kliet - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
5 Ida Sriani S 1103106012820002 Pertamina - Persalinan Normal G I. P 0 .A0 Levriani Dewi - Rp 600,000
6 Hanifah 1103104107820156 Bhom Lama - Persalinan Normal GV P.IV. A0 Levriani Dewi - Rp 600,000
7 Nursiah 1103104406710001 Alue Dua - Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
8 Darma Yanti 1174034901900001 Gampong Teungoh - Persalinan Normal GI . P0 .A0 Levriani Dewi - Rp 600,000
9 Halimatun Sakdiah 1103104508860004 Alue Batee - Persalinan Normal GI . P0 .A0 Levriani Dewi - Rp 600,000
10 Silvia Hariyana 1103105808890003 Buket Pala - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
11 Siti Hajar 1103074112890006 Lubuk Pempeng - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
12 Ramidayani 1103104205850001 Paya Palas - Persalinan Normal G II PI. A0 Levriani Dewi - Rp 600,000
13 Fitri Lusiawati 1103105212860005 Alue geunteng - Persalinan Normal G II PI. A0 Erna - Rp 600,000
14 Safrina 0000215469191 Bhom Lama - Persalinan Normal G I. P 0 .A0 Sri Rahayu - Rp 600,000
15 Halimatussakdiah 1103106004790001 Alue Dua - Persalinan Normal G III. P II .A0 Sri Rahayu - Rp 600,000
16 Rohamah 1103104505790005 Seumali - Persalinan Normal GV P.IV. A0 Yuli Melasari - Rp 600,000
17 Salminawati 1103104107740094 Alue Batee - Persalinan Normal G X. P VII .AII Samsinar - Rp 600,000
Total


NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN JULI TAHUN 2014

1 Agustina 0000214259062 Seumanah Jaya 082361830568 Persalinan Normal G III. P II .A0 Fetri Washila - Rp 600,000
2 Dewi Imaniar 0000978913484 Seumanah Jaya 085373069789 Persalinan Normal G II. P I .A0 Fetri Washila - Rp 600,000
3 Yuyun Paimin 0000978915598 Seumanah Jaya 082304506637 Persalinan Normal G IV. P III .A0 Fetri Washila - Rp 600,000
4 Ani 0000213101987 Seumanah Jaya 085353736129 Persalinan Normal G III PII. A0 Fetri Washila - Rp 600,000
5 Hasni 1103106208840001 Seumanah Jaya 085277953569 Persalinan Normal G IV P.III. A0 Fetri Washila - Rp 600,000
6 Cut Yunita 1103105905880001 Seumanah Jaya 085370303632 Persalinan Normal G III. P II .A0 Fetri Washila - Rp 600,000
7 Harma Yunita 1205064302910003 Seumanah Jaya 085260609710 Persalinan Normal G I . P0 .A0 Fetri Washila - Rp 600,000
8 Mariani 1103106304830001 Seumanah Jaya 085275227546 Persalinan Normal G IV P III. A0 Fetri Washila - Rp 600,000
9 Desi Amelia 1103106612870001 Seumanah Jaya 085358171489 Persalinan Normal G I. P0. A0 Fetri Washila - Rp 600,000
10 Ismayuni 0000978894606 Beurandang - Persalinan Normal G II. PI. A0 Sri Hartati K - Rp 600,000
11 Siti Hajar 0000214317358 Lubuk Pempeng 085261939071 Persalinan Normal G I. P 0 .A0 Sri Hartati K - Rp 600,000
12 Masnah 1103104707880002 Alue Genteng 082364117511 Persalinan Normal G II. P I .A0 Sri Hartati K - Rp 600,000
13 Ruwaida 1103074107850458 Lubuk Pempeng 082363812831 Persalinan Normal G III. P II .A0 Sri Hartati K - Rp 600,000
14 Yenni Riska 1103104411920001 Kliet 085206095501 Persalinan Normal G I. P 0 .A0 Sri Hartati K - Rp 600,000
15 Nurhayati 1103104102960002 Kliet - Persalinan Normal G I. P 0 .A0 Sri Hartati K - Rp 600,000
16 Nurlaila 1103105110790001 Kliet 085260996875 Persalinan Normal G III. P II .A0 Sri Hartati K - Rp 600,000
17 Rini Jumiati 1103105002900002 Paya Palas 082363265066 Persalinan Normal G I. P 0 .A0 Siti Fujana AMKeb - Rp 600,000
18 Risma Dewi 1103106807880002 Paya Palas 082162334226 Persalinan Normal G II. P I .A0 Siti Fujana AMKeb - Rp 600,000
19 Suminah 1103107012850001 Paya Palas 085277762475 Persalinan Normal G III. P II .A0 Siti Fujana AMKeb - Rp 600,000
20 Ngatemi 1103104110800002 Alue Genteng - Persalinan Normal G III. P.II .A0 Erna AMKeb - Rp 600,000
21 Fitriani Masitah 1103105507870005 Alue Genteng - Persalinan Normal G II. P I .A0 Erna AMKeb - Rp 600,000
22 Reni Datun Dwi Mulyati 1103105409860001 Alue Genteng - Persalinan Normal G II. P I .A0 Erna AMKeb - Rp 600,000
23 Nurjannah 1103106402860002 Alue Udep - Persalinan Normal G II. P I .A0 Yuli Melasari AMKeb - Rp 600,000
24 Riana 1108095002930003 Matang Jeulikat - Persalinan Normal G II. P I .A0 Yuli Melasari AMKeb - Rp 600,000
25 Nur Asiah 1103104504900001 Alue Udep - Persalinan Normal G II. P I .A0 Nurlaili AMKeb - Rp 600,000
26 Riana 1103104204820001 Alue Udep - Persalinan Normal G IV. P III . A0 Nurlaili AMKeb - Rp 600,000
27 Siti Sapura 1103106612930001 Seumali - Persalinan Normal G I. P 0 .A0 Nurlaili AMKeb - Rp 600,000
28 Ratna Dewi 1103106804890001 Mata Iee - Persalinan Normal G III. P II . A0 Leli Yusnita - Rp 600,000
29 Raziah 0000978895348 Beurandang 82363582112 Persalinan Normal G I. P 0 .A0 Yuni Fitriani - Rp 600,000
30 Samsiah 1103104708740002 Seumanah Jaya 085373750117 Persalinan Normal G VI. P V . A0 Lisa Dianti - Rp 600,000
31 Misni 1103105104770001 Seumanah Jaya 085262634510 Persalinan Normal G V. P IV . A0 Lisa Dianti - Rp 600,000
32 Dewi 1103105202820002 Seumanah Jaya 085358205292 Persalinan Normal G IV. P III .A0 Lisa Dianti - Rp 600,000
33 Eka Maranda 1103104803970002 Seumanah Jaya 082312208059 Persalinan Normal G I. P 0 .A0 Lisa Dianti - Rp 600,000
34 Samsida Latip 1103104107730114 Seumanah Jaya 082277026288 Persalinan Normal G III. P II .A0 Lisa Dianti - Rp 600,000
35 Ernawati 1103106108860002 Seumanah Jaya 085207488818 Persalinan Normal G IV. P III . A0 Lisa Dianti - Rp 600,000
36 Maimunah 1103104203880002 Seuneubok Baro - Persalinan Normal G III. P II .A0 Fenti Mavika AMKeb - Rp 600,000
37 Siti Amaliah 0000214254606 Seuneubok Baro - Persalinan Normal G II. P I .A0 Fenti Mavika AMKeb - Rp 600,000
38 Suryani 0000214732934 Paya Unoe 82369952613 Persalinan Normal G VIII. P VII. A0Fenti Mavika AMKeb - Rp 600,000
39 Layuda 1103106006940001 Seuneubok Dalam 082364832520 Persalinan Normal G I. P 0 .A0 Elvi Dawantia AMKeb - Rp 600,000
40 Nurbaiti 1103105707870003 Seuleumak Muda 085261168648 Persalinan Normal G III. P II . A0 Elvi Dawantia AMKeb - Rp 600,000
41 Nazla Khairani 0000002598748 Paya Bujuk Tunong 085270334084 Persalinan Normal G V. P II . A II Levriani Dewi AMKeb - Rp 600,000
42 Nur Aisyah Sofyan 1103184501800002 Kabu 085261196609 Persalinan Normal G IV. P III .A0 Levriani Dewi AMKeb - Rp 600,000
43 Armiati 1103104305800002 Paya Unou - Persalinan Normal G VIII. P VII. A0Levriani Dewi AMKeb - Rp 600,000
44 Mariani 0000978907757 Seuneubok Johan - Persalinan Normal G II. P I .A0 Levriani Dewi AMKeb - Rp 600,000
45 Iryani 1103104301770001 Punti Payong - Persalinan Normal G VI. P V .A0 Levriani Dewi AMKeb - Rp 600,000
46 Nurjannah 1103194204840002 Paya Ketapang - Persalinan Normal G III. P II . A0 Levriani Dewi AMKeb - Rp 600,000
47 Dewi Yunita 1103104910850005 Bhom Lama - Persalinan Normal G II. P I .A0 Levriani Dewi AMKeb - Rp 600,000
48 Ramlah 1103045304900003 Buket Pala - Persalinan Normal G II .PI . A0 Levriani Dewi AMKeb - Rp 600,000
49 Rita Sahara 1103104802840001 Buket Pala - Persalinan Normal G II . PI . A0 - Rp 600,000
50 Suryani 0000214417989 Beurandang - Persalinan Normal GI. P0. A0 Maya Sari . AmKeb - Rp 600,000
51 Barizah 0000172611178 Pasi Puteh - Persalinan Normal G II . PI . A0 Cut Maya Eka Rahayu - Rp 600,000
Total
Ranto Peureulak, 31 Juli 2014


NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006
PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN AGUSTUS TAHUN 2014

1 Isniati 1103185112940001 Seumanah Jaya 82368064508 Persalinan Normal G I. P 0 .A0 Lisa Dianti - Rp 600,000
2 Fitriani 1103104409890003 Seumanah Jaya 85362712842 Persalinan Normal G II . PI . A0 Lisa Dianti - Rp 600,000
3 Nurlita 1103104101750002 Seumanah Jaya 85207488818 Persalinan Normal G V. P IV . A0 Lisa Dianti - Rp 600,000
4 Susilawati 1103104502840001 Seumanah Jaya 85262634510 Persalinan Normal G III. P II . A0 Lisa Dianti - Rp 600,000
5 Marlina Razali 1103104606790002 Seumanah Jaya 82363683308 Persalinan Normal G VIII. P IV . A1ILisa Dianti - Rp 600,000
6 Ima Husna 1103105802930002 Seumanah Jaya 82312205290 Persalinan Normal G II . PI . A0 Lisa Dianti - Rp 600,000
7 Nuraini 1103105204840001 Seumanah Jaya 81362660549 Persalinan Normal G II . PI . A0 Lisa Dianti - Rp 600,000
8 Kamaliah 1103106109830001 Seumanah Jaya 85373940746 Persalinan Normal G III. P II . A0 Lisa Dianti - Rp 600,000
9 Aminah 0000214275273 Seumanah Jaya 85360083199 Persalinan Normal G I. P 0 .A0 Lisa Dianti - Rp 600,000
10 Nurhazimah 1103105404970001 Seumanah Jaya 85371176278 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
11 Kusmiati 1103105707860004 Seumanah Jaya 85373139157 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
12 Minah 1103104107770109 Seumanah Jaya 81377123247 Persalinan Normal G V. P IV . A0 Fetri Washila - Rp 600,000
13 Sanimah 1103104503730004 Seumanah Jaya - Persalinan Normal G VI. P V . A Fetri Washila - Rp 600,000
14 Sri Ulina 1103104510920005 Seumanah Jaya 52360083936 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
15 Nurlailawati 1103084203870001 Seumanah Jaya 85266123249 Persalinan Normal G II . PI . A0 Fetri Washila - Rp 600,000
16 Samipianti 1103104103880003 Seumanah Jaya 85362515188 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
17 Arfiah 0000213976967 Bhom Lama 85359729392 Persalinan Normal GV. PIV. A0 Sri Rahayu AMKeb - Rp 600,000
18 Jamawati 0000213448217 Kliet 85260996875 Persalinan Normal G VIII . PVII . A Sri Hartati - Rp 600,000
19 Intas Yusni 0000214932521 Beurandang - Persalinan Normal G III. PII. A0 Nuraini AMKeb - Rp 600,000
20 Yanti 0000214330853 Beurandang - Persalinan Normal G IV. P III . A0 Nuraini AMKeb - Rp 600,000
21 Nurhayati 0000214763534 Pulo Blang - Persalinan Normal G III. P II . A0 Elyati - Rp 600,000
22 Maryani 0000214512963 Seuleumak Muda - Persalinan Normal G X. P IX A1 Elvi Dawantiya AMKeb - Rp 600,000
23 Juarni 1103105106890001 Seuleumak Muda - Persalinan Normal G I. P 0 .A2 Elvi Dawantiya AMKeb - Rp 600,000
24 Sri Rahayu H 0000203485847 Buket Pala 82160161337 Persalinan Normal G I. P 0 . A1 Masyitah AMKeb - Rp 600,000
25 Khairul Nisa 1103104906940003 Alue Batee 82362087189 Persalinan Normal G I. P 0 .A3 Masyitah AMKeb - Rp 600,000
26 Juminem 1103105004770001 Punti Payong 85373134849 Persalinan Normal GV. PIV. A0 Masyitah AMKeb - Rp 600,000
27 Nurul Khamsiah 1103185001910001 Blang Betra 85272322071 Persalinan Normal GI. P0. A0 Levriani Dewi - Rp 600,000
28 Diana 1103104107960130 Paya Unoe 82368734155 Persalinan Normal G I. P 0 .A0 Levriani Dewi - Rp 600,000
29 Idawati 1103104611800001 Alue Dua 81260771728 Persalinan Normal GII. PI. A0 Levriani Dewi - Rp 600,000
30 Irmalasari 1103105212900006 Bhom Lama 85261974599 Persalinan Normal GI P0 A0 Levriani Dewi - Rp 600,000
31 Rosnita 1103105505810002 Tampak - Persalinan Normal GIV PIII. A0 Levriani Dewi - Rp 600,000
32 Dewi Sartika 1103104707940027 Paya Palas 82165667716 Persalinan Normal GI P0 A0 Levriani Dewi - Rp 600,000
33 Ainul Mardiah 1103104507870002 Alue Dua - Persalinan Normal G I. P 0 .A1 Levriani Dewi - Rp 600,000
34 Nurhajinah 1103104803900002 Paya Unue - Persalinan Normal G II. P I . A1 Yusmiliani - Rp 600,000
35 Husna Wati 1103105010760003 Paya Unue - Persalinan Normal G V. PIV . A0 Yusmiliani - Rp 600,000
36 Safrida 1103174110880001 Paya Unue - Persalinan Normal GII. PI. A0 Fenti Mavika AMKeb - Rp 600,000
Total
Mengetahui, Ranto Peureulak, 31 Agustus 2014

Dinas Kesehatan Kab.Aceh Timur Kepala Puskesmas Ranto Peureulak

NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN SEPTEMBER TAHUN 2014
Nomor Iden titas Nomor Telepon Tanggal Bidan Jenis

/ NIK Pasien/ Keluarga Persalinan Penolong Tindakan
1 Fitriani 1103106909860001 Paya Palas - Persalinan Normal G I. P 0 .A0 Siti Fujana AMKeb - Rp 600,000
2 Alpiah 1103106912830002 Paya Palas 085276634052 Persalinan Normal G III . PII . A0 Siti Fujana AMKeb - Rp 600,000
3 Nur Aini 1103104306850001 Paya Palas - Persalinan Normal G V. P III . AI Siti Fujana AMKeb - Rp 600,000
4 Roslinawati 0000214548884 Paya Palas - Persalinan Normal G II. P I . A0 Siti Fujana AMKeb - Rp 600,000
5 Siti Rahmah 0000978904113 Punti Payong 085373145814 Persalinan Normal G III . PII . A0 Siti Fujana AMKeb - Rp 600,000
6 Yanti 1108064101890005 Alue Batee - Persalinan Normal G I. P 0 .A0 Samsinar AMKeb - Rp 600,000
7 Sri Arna Yanti 1103106804840002 Paya Palas - Persalinan Normal G II . PI . A0 Samsinar AMKeb - Rp 600,000
8 Nuralila 0000214748234 Pulo Blang - Persalinan Normal G VI. P V. A0 Elyati - Rp 600,000
9 Suparti 1103106508910001 Alue Genteng - Persalinan Normal G I. P 0 .A0 Erna AMKeb - Rp 600,000
10 Karnila 1103104396930002 Paya Palas - Persalinan Normal G I. P 0 .A0 Erna AMKeb - Rp 600,000
11 Fatimah 0000215355897 Punti Payong 085270573475 Persalinan Normal G II. P I .A0 Masyitah AMKeb - Rp 600,000
12 Supinah 0000978912112 Alue Udep - Persalinan Normal G I. P 0 .A0 Yuli Melasari AMKeb - Rp 600,000
13 Nazariah 0000213482576 Kliet 085288307885 Persalinan Normal G V. P IV . A0 Yuni Fitriani AMKeb - Rp 600,000
14 Suryana 1103104107840148 Pertamina - Persalinan Normal G III. P II . A Nurlaili AMKeb - Rp 600,000
15 Ernawati 1103105103920001 Seuneubok Dalam - Persalinan Normal G I. P 0 .A0 Nurlaili AMKeb - Rp 600,000
16 Wanti 1103106912780001 Alue Genteng - Persalinan Normal G I. P 0 .A0 Nurbaiti - Rp 600,000
17 Diyana 1103105510880003 Seumanah Jaya 085275939321 Persalinan Normal G II. P I .A0 Fetri Washila - Rp 600,000
18 Nur Aini SPd 1103106103840001 Seumanah Jaya - Persalinan Normal G II. P I .A0 Fetri Washila - Rp 600,000
19 Kiki Handayani 1103104708930004 Seumanah Jaya 085207282063 Persalinan Normal G II. P I .A0 Fetri Washila - Rp 600,000
20 Sy Raini 1103104901960001 Seumanah Jaya - Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
21 Neni Dwi Lestari 1103105604940003 Seumanah Jaya 081377123247 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
22 Fitriani 1103105504960003 Seumanah Jaya - Persalinan Normal G II. P I .A0 Fetri Washila - Rp 600,000
23 Megawati 0000214286951 Seumanah Jaya 082165674954 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
24 Fatimah Wati 1103105004940001 Seumanah Jaya - Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
25 Irmawati 0000213817296 Seumanah Jaya - Persalinan Normal G III. P II . A Lisa Dianti - Rp 600,000
26 Sri Sundari 1103106312830003 Seumanah Jaya - Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
27 Nilawati 1103104305830001 Seumanah Jaya - Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
28 Siti Mariyam 1103104107860179 Seumanah Jaya - Persalinan Normal GI. P0. A0 Lisa Dianti - Rp 600,000
29 Marlinda 1103106703870002 Seumanah Jaya - Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
30 Maryana 1103105002950003 Seumanah Jaya - Persalinan Normal G I. P 0 .A0 Lisa Dianti - Rp 600,000
31 Cut Zahara 1103105103810001 Seumanah Jaya 085359093121 Persalinan Normal G.IV PIII A0 Lisa Dianti - Rp 600,000
32 Ti Hasanah Husen 1103105110700002 Seumanah Jaya - Persalinan Normal G.IV PIII. A0 Lisa Dianti - Rp 600,000
33 Nurmi 1103184401890001 Seumanah Jaya - Persalinan Normal G II PI A0 Lisa Dianti - Rp 600,000
34 Hajiah AD 1103106208910001 Seumanah Jaya - Persalinan Normal G II PI A0 Lisa Dianti - Rp 600,000
35 Habibah Jafar 1103106312800001 Seumanah Jaya - Persalinan Normal G III. P II . A Lisa Dianti - Rp 600,000
36 Halimatussakdiah 1103104503800002 Seumanah Jaya - Persalinan Normal G III. P II . A Lisa Dianti - Rp 600,000
37 Nurlela 1103105501950002 Mata Iee - Persalinan Normal G I. P 0 .A0 Leli Yusnita - Rp 600,000
38 Putri Febriani 1103104702990002 Buket Pala - Persalinan Normal G I. P 0 .A0 Levriani Dewi AMKeb - Rp 600,000
39 Ramadani Yunita 1103106708840001 Paya Palas 085277899788 Persalinan Normal G II . PI A0 Levriani Dewi AMKeb - Rp 600,000
40 Ainul Mardhiah 1103105108870001 Tampak 082160161337 Persalinan Normal G III. P II . A Levriani Dewi AMKeb - Rp 600,000
41 Safriani 1103105306850006 Alue Dua 082312204205 Persalinan Normal G III. P II . A Levriani Dewi AMKeb - Rp 600,000
42 Murizawati 1103105009900003 Buket Tualang 085372879400 Persalinan Normal G II. PI .A0 Yusmiliani - Rp 600,000
43 Mursidah 1103074707780003 Leuge Cot 085372879400 Persalinan Normal G III. P II . A Yusmiliani - Rp 600,000
44 Masni Wati 0000241691725 Seuneubok Johan - Persalinan Normal G.IV P.III. A0 Yusmiliani - Rp 600,000
45 Mahyani
46 Siti Aisyah
47 Ariani
48 Winda Purnama Sari 1103104208870001 Paya Unue - Persalinan Normal G I. P 0 . A0 Yusmiliani - Rp 600,000
Total
Mengetahui, Ranto Peureulak, 31 September 2014


NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006
PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN OKTOBER TAHUN 2014

1 Nilawati AD 1103104107800154 Seumanah Jaya - 10/2/2014 Persalinan Normal G III. P II .A0 Lisa Dianti - Rp 600,000
2 Maryana 1103105705920003 Seumanah Jaya - 10/11/2014 Persalinan Normal G I . P0 . A0 Lisa Dianti - Rp 600,000
3 Nuraida 1103105003970004 Seumanah Jaya - 10/17/2014 Persalinan Normal G I . P0 . A0 Lisa Dianti - Rp 600,000
4 Hasanah Hs 0001116459898 Seumanah Jaya - 10/9/2014 Persalinan Normal G IV. P III . A0 Lisa Dianti - Rp 600,000
5 Nurlela 0000213096881 Seumanah Jaya 10/21/2014 Persalinan Normal G III . PII . A0 Lisa Dianti - Rp 600,000
6 Erni 0000214016501 Seumanah Jaya - 10/15/2014 Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
7 Maya Sari 0000978914935 Seumanah Jaya - 10/1/2014 Persalinan Normal G II . PI . A0 Lisa Dianti - Rp 600,000
8 Susanti 0000214419194 Seumanah Jaya - 10/26/2014 Persalinan Normal G III. P II. A0 Fetri Washila - Rp 600,000
9 Nurafni 0000214441841 Seumanah Jaya 85315281462 10/26/2014 Persalinan Normal G III. P II. A0 Fetri Washila - Rp 600,000
10 Sumilawati 1103105506910002 Seumanah Jaya - 10/24/2014 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
11 Rosmawardani 1103105002880006 Seumanah Jaya 82369985881 10/25/2014 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
12 Fatmawati 1103105905960002 Alue Genteng 82363374563 10/2/2014 Persalinan Normal G I. P 0 .A0 Fetri Washila - Rp 600,000
13 Abidah 1103105105700001 Seumanah Jaya 82364054307 10/1/2014 Persalinan Normal G III. P II . A Fetri Washila - Rp 600,000
14 Delima 1103104312910001 Babah Krueng 85372445111 10/4/2014 Persalinan Normal G II. P I . A Fetri Washila - Rp 600,000
15 Misnawati 1103104110910004 Seumanah Jaya 85358782856 10/13/2014 Persalinan Normal G II. P I . A Fetri Washila - Rp 600,000
16 Erni 1103104107770106 Seumanah Jaya 85295475669 10/23/2014 Persalinan Normal G VI. P V .A0 Fetri Washila - Rp 600,000
17 Sanimah 1103104211860001 Seumanah Jaya 85373145883 10/3/2014 Persalinan Normal G III. P II .A0 Fetri Washila - Rp 600,000
18 Aminah 1103104805790002 Alue Genteng - 10/1/2014 Persalinan Normal G II. P I .A0 Erna AMKeb - Rp 600,000
19 Siti Nurimah 1103105803960005 Seumali 085277240455 10/2/2014 Persalinan Normal G I. P 0 .A0 Sri Hartati - Rp 600,000
20 Sarimah 1103105305860002 Seumali - 9/29/2014 Persalinan Normal G III. P II .A0 Sri Hartati - Rp 600,000
21 Rosmawati 0000214738942 Pulo Blang - 10/2/2014 Persalinan Normal G VI. P V .A0 Elyati - Rp 600,000
22 Masnah 1103106707880002 Pulo Blang - 10/9/2014 Persalinan Normal G I. P 0 .A0 Elyati - Rp 600,000
23 Khairun Nisak 1103075708840002 Lubok Pempeng 085275773507 10/26/2014 Persalinan Normal G III. P II .A0 Sri Hartati K - Rp 600,000
24 Rusdiana 0000156900014 Kliet 082363812831 10/11/2014 Persalinan Normal G II. PI .A0 Sri Hartati K - Rp 600,000
25 Nurasnah 1103074710940001 Kliet 085359738056 10/12/2014 Persalinan Normal G I. P 0 . A Sri Hartati K - Rp 600,000
26 Mariani 0000216608073 Kliet 08236088580 10/18/2014 Persalinan Normal G II. P I .A0 Sri Hartati K - Rp 600,000
27 Zubaidah 1103105908780001 Seumanah Jaya - 10/14/2014 Persalinan Normal G VII. P VI .A0 Nurbaiti - Rp 600,000
28 Faridah Anum 0000213933936 Alue Genteng - 10/12/2014 Persalinan Normal G III. PII. A0 Nurbaiti - Rp 600,000
29 Masniwati 1103104111800003 Seuneubok Johan - 9/9/2014 Persalinan Normal G IV. P III .A0 Erlina - Rp 600,000
30 Ruwaidah 0000213423309 Teumpeun - 10/25/2014 Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
31 Verawati BR Situmorang 0000214433256 Seuneubok Baro - 10/4/2014 Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
32 Nurhayati 0000212217063 Kebun Teumpeun - 10/9/2014 Persalinan Normal G III. PII. A0 Erlina - Rp 600,000
33 Halimatussakdiah 0000214744252 Pulo Blang - 10/14/2014 Persalinan Normal G II. P I .A0 Levriani Dewi - Rp 600,000
34 Sumaniar 0000978909693 Seuneubok Baro - 10/20/2014 Persalinan Normal G II. P I .A0 Erlina - Rp 600,000
35 Nurfina 0000978909175 Seuneubok Baro - 10/20/2014 Persalinan Normal G I. P 0 . A Levriani Dewi - Rp 600,000
36 Mariana 0000214762432 Pulo Blang - 10/25/2014 Persalinan Normal G IV. P III .A0 Erlina - Rp 600,000
37 Husna Wati 1103037108850003 Seuneubok Baro - 10/4/2014 Persalinan Normal G II. P I .A0 Levriani Dewi - Rp 600,000
38 Yusrawati 1103104506840002 Seuleumak Muda 085277751202 10/3/2014 Persalinan Normal G III. PII. A0 Levriani Dewi - Rp 600,000
39 Nurmala 1103104307930003 Seumali 085297928292 10/2/2014 Persalinan Normal G I. P 0 . A0 Levriani Dewi - Rp 600,000
40 Yenni Kusuma 1103105004790001 Punti Payong 0821668073 10/9/2013 Persalinan Normal G IX P V AIII Levriani Dewi - Rp 600,000
41 Widia Astuti 1103074608880002 Buket Pala 082370586024 10/6/2014 Persalinan Normal G III. PII. A0 Levriani Dewi - Rp 600,000
42 Sri Wahyuni 1271065808780002 Pertamina 085297375228 10/8/2014 Persalinan Normal G II. P I .A0 Levriani Dewi - Rp 600,000
43 Gusita Mahdalena 1103104105800001 Tampak - 10/17/2014 Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
44 Misiatik 0000214853422 Alue Dua 085270445150 10/8/2014 Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
45 Yusliana 1103104508850003 Bhom Lama - 10/28/2014 Persalinan Normal G VI P II A III Sri Rahayu AMKeb - Rp 600,000
46 Nur Ainun 1103105811760001 Punti Payong - 10/24/2014 Persalinan Normal G III. PII. A0 Masyithah AMKeb - Rp 600,000
47 Maimunah 0000214005666 Alue Bu Jalan - 10/6/2014 Prarujukan G V P IV A0 Levriani Dewi Rp 125,000 -
48 Neti Rosmawati 1103104711750002 Alue Batee - 10/23/2014 Prarujukan G III. PII. A0 Levriani Dewi Rp 125,000 -
49 Yusni 0000978906879 Blang Barom - 10/3/2014 Prarujukan G III. PII. A0 Levriani Dewi Rp 125,000 -
50 Siti Hajar 1103105707850002 Penaron Baru 081360296611 10/24/2014 Prarujukan G II. P I .A0 Nurbaiti Rp 125,000 -
Total
Mengetahui, Ranto Peureulak, 31 Oktober 2014


NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN NOVEMBER TAHUN 2014

1 Juneti Ningsih 1103104506820006 Paya Palas - 11/1/2014 Persalinan Normal G III. P II. A0 Siti Fujana AMKeb - Rp 600,000
2 Sri Wahyuni 1103104902910001 Paya Palas - 11/2/2014 Persalinan Normal G II. PI .A0 Siti Fujana AMKeb - Rp 600,000
3 Katijah 1103057012960001 Kliet 081277022972 11/2/2014 Persalinan Normal G I. P 0 .A0 Yuni Fitriani AMKeb - Rp 600,000
4 Rosmawati 0000214738942 Pulo Blang - 10/2/2014 Persalinan Normal G VI. P V .A0 Elyati - Rp 600,000
5 Aminah 000021275273 Seumanah Jaya 085360083199 8/3/2014 Persalinan Normal G I. P 0. A0 Lisa Dianti - Rp 600,000
6 Nurhayati 1103104101840002 Seuneubok Baro - 11/4/2014 Persalinan Normal G II. P I. A0 Levriani Dewi - Rp 600,000
7 Suratmi 1103105202860001 Paya Palas - 11/4/2014 Persalinan Normal G III. P II .A0 Siti Fujana AMKeb - Rp 600,000
8 Siti Maryanti '1103106505940003 Seumanah Jaya - 11/6/2014 Persalinan Normal G I. P 0 .A0 Lisa Dianti - Rp 600,000
9 Faridah 1103104606860001 Seumanah Jaya - 11/6/2014 Persalinan Normal G II. P I. A0 Fetri Washila - Rp 600,000
10 Rohani '1103104108880006 Seumanah Jaya - 11/6/2014 Persalinan Normal G II. P I. A0 Lisa Dianti - Rp 600,000
11 Yunika Rahmi 0000978908826 Seuneubok Baro - 11/7/2014 Persalinan Normal G I. P 0 .A0 Levriani Dewi - Rp 600,000
12 Misiatik 0000214853422 Alue Dua 085270445150 10/8/2014 Persalinan Normal G II. P I .A0 Levriani Dewi - Rp 600,000
13 Hasanah Hs 0001116459898 Seumanah Jaya - 10/9/2014 Persalinan Normal G I. P 0 .A0 Lisa Dianti - Rp 600,000
14 Rusliana '0000214537893 Seumanah Jaya - 11/9/2014 Persalinan Normal G III. P II. A0 Lisa Dianti - Rp 600,000
15 Wahyuni. M. Amin 1103106211910002 Seumanah Jaya - 11/10/2014 Persalinan Normal G II. P I. A0 Lisa Dianti - Rp 600,000
16 Mariam Idris 0000214218437 Seuneubok Baro - 11/10/2014 Persalinan Normal G IV. P III .A0 Levriani Dewi - Rp 600,000
17 Rusdiana 0000156900014 Kliet 082363812831 10/11/2014 Persalinan Normal G II. P I .A0 Sri Hartati K - Rp 600,000
18 Tursiani 1103106005860002 Alue Genteng - 11/13/2014 Persalinan Normal G III. P II .A0 Nurbaiti Manual Placenta Rp 750,000
19 Muliyana 1103105404920001 Kliet 085207428770 11/14/2014 Persalinan Normal G I. P0 .A0 Yuni Fitriani AMKeb - Rp 600,000
20 Fitriana 1103104606820003 Beurandang - 11/15/2014 Persalinan Normal G III. P II .A0 Fetri Washila Rp 600,000
21 Erni 0000214016501 Seumanah Jaya - 10/15/2014 Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
22 Suriati 1103104705860002 Seumanah Jaya - 11/15/2014 Persalinan Normal G V. P IV .A0 Lisa Dianti - Rp 600,000
23 Ayuni Andriani 1103105412890001 Seumanah Jaya - 11/16/2014 Persalinan Normal G I. P 0 . A Fetri Washila - Rp 600,000
24 Faridah 1103104107830159 Seumali - Persalinan Normal G IV. P III .A0 Nurlaili AMKeb - Rp 600,000
25 Anisah 0000214726375 Paya Unou - 11/18/2014 Persalinan Normal G XIII.P XII .A0 Lisa Dianti - Rp 600,000
26 Maryani 1103184201900002 Seumanah Jaya - 11/19/2014 Persalinan Normal G II. PI. A0 Lisa Dianti - Rp 600,000
28 Siti Hajar 1103105107870005 Alue Batee 085284424834 11/21/2014 Persalinan Normal G II. P I . A Samsinar AMKeb - Rp 600,000
29 Ade Irma 1103106903900002 Seumanah Jaya - 11/23/2014 Persalinan Normal G II. P I . A Lisa Dianti - Rp 600,000
30 Hasanah 0000978914215 Seumanah Jaya - 11/25/2014 Persalinan Normal G VI P V A0 Fetri Washila - Rp 600,000
31 Rohana Yusuf 000213428531 Paya Biek - 11/25/2014 Persalinan Normal G V P IV A0 Levriani Dewi Rp 600,000
32 Rosyanti 1103105602910001 Seuneubok Baro 085372041470 11/26/2014 Persalinan Normal G I. P 0 . A Levriani Dewi Rp 600,000
33 Nurafni 0000214441841 Seumanah Jaya 085315281462 10/26/2014 Persalinan Normal G IV. P III .A0 Fetri Washila - Rp 600,000
34 Susanti 0000214419194 Seumanah Jaya - 10/26/2014 Persalinan Normal G IV. P III .A0 Fetri Washila - Rp 600,000
Total
Mengetahui, Ranto Peureulak, 30 November 2014

NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN DESEMBER TAHUN 2014

Tanggal
Persalinan
1 Cut Patimah 1103105211880002 Seumanah Jaya - 12/1/2014 Persalinan Normal G II. P I. A0 Lisa Dianti - Rp 600,000
2 Suhari 1174024607770004 Gampong Lhee - 12/1/2014 Persalinan Normal GVI. P IV .A0 Fetri Washila - Rp 600,000
3 Wardatul Jannah 1103105508940001 Tampak - 12/1/2014 Persalinan Normal G II. P I. A0 Levriani Dewi - Rp 600,000
4 Siti Hawa Seumanah Jaya - 12/2/2014 Persalinan Normal G II. P I. A0 Lisa Dianti - Rp 600,000
11030336302810003
5 Rosmina Buket Pala - 12/2/2014 Persalinan Normal G III. P II .A0 Levriani Dewi - Rp 600,000
1103104202870006
6 Muliana 1103104504920005 Seumanah Jaya - 12/7/2014 Persalinan Normal G I. P0. A0 Lisa Dianti - Rp 600,000
7 Suryani 1108074107850241 Alue Udep - 12/7/2014 Persalinan Normal G V. P IV .A0 Yuli Melasari AMKeb - Rp 600,000
8 Yusnidar 1103106601900001 Seumanah Jaya - 12/8/2014 Persalinan Normal G I. P0. A0 Fetri Washila - Rp 600,000
9 Rifka Elisa Sianturi 1103104611940002 Paya Palas - 12/9/2014 Persalinan Normal G I. P 0. A0 Nurbaiti - Rp 600,000
10 Asminah 1103106301790001 Paya Palas - 12/9/2014 Persalinan Normal G V. P III .AI Siti Fujana AMKeb - Rp 600,000
11 Ilmiyati 1103105210940005 Alue Udep - 12/10/2014 Persalinan Normal GI . P 0 .A0 Yuli Melasari AMKeb - Rp 600,000
12 Ika Widia Ningsih 1103104408910002 Paya Palas - 12/12/2014 Persalinan Normal G II. P I. A0 Siti Fujana AMKeb - Rp 600,000
13 Fitriana 1103104202920001 Alue Udep - 12/13/2014 Persalinan Normal GI. P 0. A0 Yuli Melasari AMKeb - Rp 600,000
14 Susanti 1103104201860001 Seumanah Jaya - 12/14/2014 Persalinan Normal G III. P II .A0 Lisa Dianti - Rp 600,000
15 Raudhatul Jannah 1103075509900001 Pasi Puteh - 12/15/2014 Persalinan Normal G I. P0 .A0 Cut Maya Eka Rahayu - Rp 600,000
16 Tika Rahayu 1103104907920002 Paya Palas - 12/15/2014 Persalinan Normal G II. PI .A0 Siti Fujana AMKeb - Rp 600,000
17 Jannati 1103104107950133 Alue Udep - 12/15/2014 Persalinan Normal G I. 0I .A0 Levriani Dewi - Rp 600,000
18 Siti Roya 1103106508800002 Seuneubok Johan - 12/15/2014 Persalinan Normal G IV. PIII .A0 Levriani Dewi - Rp 600,000
19 Sri Wahyuni 1207026509890003 Seumanah Jaya - 12/15/2014 Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
20 Suriana 1103105803950001 Seumali - 12/19/2014 Persalinan Normal G I. P 0 .A0 Sri Hartati S - Rp 600,000
21 Emi Gustiana 1103134608880001 Seumali - 12/20/2014 Persalinan Normal G III. PII . A0 Sri Hartati S - Rp 600,000
22 Ubudiah 1103107112830006 Beurandang - 12/20/2014 Persalinan Normal G III. P II .A0 Fetri Washila - Rp 600,000
23 Fitriani 1103105307830001 Alue Genteng - 12/20/2014 Persalinan Normal G I. P 0 .A0 Levriani Dewi - Rp 600,000
Total
Mengetahui, Ranto Peureulak, 31 Desember 2014

Kepala Puskesmas Ranto Peureulak
NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN DESEMBER TAHUN 2014

Tanggal
1 Juliana 0000214768078 Pulo Blang - 12/1/2014 Persalinan Normal G IV. PII .AI Elyati - Rp 600,000
2 Lina
1103104108750003
Seumanah Jaya - 12/2/2014 Persalinan Normal G III. P II .A0 Fetri Washila - Rp 600,000
3 Cut Mutia 0000214753105 Ule Blang Mane - 12/3/2014 Persalinan Normal G I. P 0 .A0 Levriani Dewi - Rp 600,000
4 Fitriani 0001790916827 Paya Palas - 12/7/2014 Persalinan Normal G I. P 0 .A0 Siti Fujana AMKeb - Rp 600,000
5 Rohana 1103104202820004 Paya Palas - 12/11/2014 Persalinan Normal G II. PI .A0 Siti Fujana AMKeb - Rp 600,000
6 Dewi Andriani 0000214251399 Seumanah Jaya - 12/14/2014 Persalinan Normal G II. P I .A0 Lisa Dianti - Rp 600,000
7 Nursiah 0000213976844 Bhom Lama - 12/15/2014 Persalinan Normal G V. PIV .A0 Levriani Dewi - Rp 600,000
8 Nurhalimah 0000214408267 Mata Iee - 12/18/2014 Persalinan Normal G I. P 0 .A0 Nova Arianda AMKeb - Rp 600,000
9 Nurazizah 0000213560291 Seuneubok Johan - 12/20/2014 Persalinan Normal G III. P II .A0 Levriani Dewi - Rp 600,000
11 Poniati 0000214020639 Tampak - 12/25/2014 Persalinan Normal G VIII. PVII. A0 Levriani Dewi - Rp 600,000
12 Irnawati 0000978909456 Seuneubok Baro - 12/27/2014 Persalinan Normal G I. P 0 . A0 Levriani Dewi - Rp 600,000
Total
Mengetahui, Ranto Peureulak, 31 Desember 2014


NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN JANUARI TAHUN 2015

1 Cut Boinati 0000214234615 Seumanah Jaya - 1/1/2015 Persalinan Normal G III. P II. A0 Lisa Dianti - Rp 600,000
2 Kusniati 0000214017026 Seumanah Jaya - 1/1/2015 Persalinan Normal GI. P 0 .A0 Lisa Dianti - Rp 600,000
3 Lisa Alawiyah 1103125001870004 Seuneubok Johan - 1/2/2015 Persalinan Normal G II. P I. A0 Levriani Dewi - Rp 600,000
4 Kamariah 0001443800531 Simpang Lhee - 1/4/2015 Persalinan Normal GI.P0.A0 Levriani Dewi - Rp 600,000
5 Suriana 1103104107850160 Seumanah Jaya - 1/5/2015 Persalinan Normal GV.P0.A0 Fetri Washila - Rp 600,000
6 Maimunah 1103104508720001 Alue Udep - 1/8/2015 Persalinan Normal GIV.P0.A0 Rosita - Rp 600,000
7 Fatmawati 1103104505920004 Beurandang - 1/9/2015 Persalinan Normal GI.P0.A0 Fetri Washila - Rp 600,000
8 Aminah 1103105608760002 Alue Genteng - 1/11/2015 Persalinan Normal G I. P0. A0 Erna - Rp 600,000
9 Siti Khatijah 0000214272336 Seumanah Jaya - 1/11/2015 Persalinan Normal G II. P I. A0 Fetri Washila - Rp 600,000
10 Asri Diana Pohan 0001116456208 Seumanah Jaya - 1/12/2015 Persalinan Normal G IV. PII .A0 Fetri Washila - Rp 600,000
11 Hamidah 0000214537487 Seumanah Jaya - 1/13/2015 Persalinan Normal GVI . P V .A0 Lisa Dianti - Rp 600,000
12 Siti Mariyani 0001119850492 Seumanah Jaya - 1/14/2015 Persalinan Normal G III. PI I. A0 Lisa Dianti - Rp 600,000
13 Putri Susilawati 0000978915273 Seumanah Jaya - 1/14/2015 Persalinan Normal GII. P I. A0 Fetri Washila - Rp 600,000
14 Rosmiati 0000214499733 Alue Udep - 1/14/2015 Persalinan Normal G IV. P III .A0 Yuli melasari - Rp 600,000
15 Nurma 0000214499891 Alue Udep - 1/15/2015 Persalinan Normal GIV.PII.A0 Yuli melasari - Rp 600,000
16 Timariah 0000213557084 Seuneubok Johan - 1/17/2015 Persalinan Normal G IV. PIII .A0 Levriani Dewi - Rp 600,000
17 Halimah 0000214714056 Paya Gajah - 1/18/2015 Persalinan Normal G I. P0 .A0 Levriani Dewi - Rp 600,000
18 Turiyati 1103107112740003 Beurandang - 1/19/2015 Persalinan Normal G IV. PIII .A0 Fetri Washila - Rp 600,000
19 Sri Dewi 1103072809850001 Punti Payong - 1/20/2015 Persalinan Normal G I. P 0 .A0 Masyitah - Rp 600,000
20 Ainsyah 1103105203890001 Mata Iee - 1/21/2015 Persalinan Normal GIII.PII.A0 Yuli melasari - Rp 600,000
21 Suriani 0000214561563 Alue Udep - 1/21/2015 Persalinan Normal GIV.PIII.A0 Yuli melasari - Rp 600,000
22 Mariyani 1103104605960004 Seumanah Jaya - 1/22/2015 Persalinan Normal GI.P0.A0 Fetri Washila - Rp 600,000
23 Halimah Hasan Basri 0000214442651 Seumanah Jaya - 1/24/2015 Persalinan Normal GIII.PII.A0 Fetri Washila - Rp 600,000
24 Rini Istiani 0000214174629 Blang Barom - 1/26/2015 Persalinan Normal GII.PI.A0 Akmalia - Rp 600,000
Total
Mengetahui, Ranto Peureulak, 31 januari 2015


NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 750,000
Rp 600,000
Rp 6,150,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 12,000,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 10,200,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 30,600,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 ami
Rp 600,000 ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 ami
Rp 21,600,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 27,000,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami Susulan
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 125,000
Rp 125,000
Rp 125,000
Rp 125,000
Rp 28,100,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami
Rp 600,000
Rp 750,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 Ami
Rp 600,000 Ami
Rp 600,000
Rp 600,000
Rp 20,550,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 13,800,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000 ami
Rp 600,000
Rp 600,000 Ami
Rp 7,200,000
Total
Biaya
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 600,000
Rp 14,400,000
PENGAJUAN TAGIHAN TINDAKAN PRA RUJUKAN
UPT.PELAYANAN KESEHATAN MASYARAKAT RANTO PEUREULAK
KABUPATEN ACEH TIMUR
BULAN PELAYANAN : Maret 2014
Status No.Jamkesmas / Persalinan Tgl.Tindakan

No Nama Ibu Tgl Lahir/Umur Alamat Nama Bidan yg Menolong Ket Jumlah Biaya
PNS/PTT Kepala Keluarga Anak Ke Persalinan
1 Zuraidah 27 Thn Seumali Sri Hartati PNS 1103105607860000 III 3/23/2014 Rujuk Rp125,000
2 Nurpita Sari 19 Thn Punti Payong Maya Sari, Amd.Keb PNS 1103104101950003 I 3/10/2014 Rujuk Rp125,000
3 Nursitah 24 Thn Alue Dua Levriani Dewi PNS 110310490890003 I 3/15/2014 Rujuk Rp125,000
4 Alfianti,S.Pd 29 Thn Paya Palas Maya Sari, Amd.Keb PNS 1103105804840001 I 3/16/2014 Rujuk Rp125,000
5 Kasmiati 30 Thn Seuneubok Johan Salamiah PNS 1103105508830002 III 3/21/2014 Rujuk Rp125,000
Total Biaya Pra Rujukan
Total Kasus 2 Kasus Rp625,000
Terbilang Enam Ratus Dua Puluh Lima Ribu Rupiah
Mengetahui, Ranto Peureulak, 31 Maret 2014


NIP. 19780226 200012 1 002 NIP. 19720807 199403 1 006
PENGAJUAN TAGIHAN TINDAKAN PRA RUJUKAN
UPT.PELAYANAN KESEHATAN MASYARAKAT RANTO PEUREULAK
KABUPATEN ACEH TIMUR
BULAN PELAYANAN : FEBRUARI 2014
Status No.Jamkesmas / Persalinan Tgl.Tindakan

No Nama Ibu Tgl Lahir/Umur Alamat Nama Bidan yg Menolong Ket Jumlah Biaya
PNS/PTT Kepala Keluarga Anak Ke Persalinan
1 Nur Azizah 40 Tahun Seumanah Jaya Nurbaiti PNS 1103104306740000 III 2/20/2014 Rujuk Rp125,000
2 Ana Dewi 23 Tahun Seuleumak Muda Elvy Dawantia, AM.Keb PTT 1103104703900000 I 2/25/2014 Rujuk Rp125,000
Rp250,000
Total Biaya Pra Rujukan
Total Kasus 2 Kasus
Terbilang Dua Ratus Lima Puluh Ribu Rupiah
Mengetahui, Ranto Peureulak, 28 Februari 2014


NIP. 19780226 200012 1 002 NIP. 19720807 199403 1 006
DATA PESERTA PBI YANG NON AKTIF BPJS KC LANGSA
No Kartu
No Nama Nik No KK
Jamkesmas
1 Halimah 0000214013542 1103105507910002 1103102404070035
TIF BPJS KC LANGSA
Jenis
Tanggal Lahir Alamat
Kelamin
7/15/1991 Pr Tampak
Ranto Peureulak 30 Oktober 2014

Mengetahui
Ka. UPT Pelayanan Kesehatan Masyarakat
Ranto Peureulak
U S M A N , SKM
NIP.19720807 199403 1 006

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REKAPITULASI PENGAJUAN KLAIM PERSALINAN

PUSKESMAS RANTO PEUREULAK BULAN PELAYANAN FEBRUARI TAHUN 2014

Nomor Iden titas Nomor Telepon Bidan Jenis

Ranto Peureulak, 28 Februari 2014

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

Nomor Iden titas Nomor Telepon Bidan Jenis

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

REKAPITULASI PENGAJUAN KLAIM PERSALINAN

Nomor Iden titas Nomor Telepon Bidan Jenis

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( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

REKAPITULASI PENGAJUAN KLAIM PERSALINAN

Nomor Iden titas Nomor Telepon Bidan Jenis

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( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

Nomor Iden titas Nomor Telepon Bidan Jenis

21 Nurhayati 0000214763534 Pulo Blang - Persalinan Normal G III. P II . A0 Elyati - Rp 600,000

34 Nurhajinah 1103104803900002 Paya Unue - Persalinan Normal G II. P I . A1 Yusmiliani - Rp 600,000

Mengetahui, Ranto Peureulak, 31 Agustus 2014

Kabid Jaminan & Sarana Kesehatan

REKAPITULASI PENGAJUAN KLAIM PERSALINAN

Nomor Iden titas Nomor Telepon Tanggal Bidan Jenis

14 Suryana 1103104107840148 Pertamina - Persalinan Normal G III. P II . A Nurlaili AMKeb - Rp 600,000

16 Wanti 1103106912780001 Alue Genteng - Persalinan Normal G I. P 0 .A0 Nurbaiti - Rp 600,000

34 Hajiah AD 1103106208910001 Seumanah Jaya - Persalinan Normal G II PI A0 Lisa Dianti - Rp 600,000

Mengetahui, Ranto Peureulak, 31 September 2014

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

Nomor Iden titas Nomor Telepon Tanggal Bidan Jenis

Mengetahui, Ranto Peureulak, 31 Oktober 2014

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

REKAPITULASI PENGAJUAN KLAIM PERSALINAN

Nomor Iden titas Nomor Telepon Tanggal Bidan Jenis

Kabid Jaminan & Sarana Kesehatan

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

REKAPITULASI PENGAJUAN KLAIM PERSALINAN

Nomor Iden titas Nomor Telepon Bidan Jenis

Mengetahui, Ranto Peureulak, 31 Desember 2014

Kabid Jaminan & Sarana Kesehatan

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

NIP. 19780226 200012 1 002 Nip. 19720807 199403 1 006

Nomor Iden titas Nomor Telepon Bidan Jenis

Mengetahui, Ranto Peureulak, 31 Desember 2014

Kabid Jaminan & Sarana Kesehatan

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

REKAPITULASI PENGAJUAN KLAIM PERSALINAN

Nomor Iden titas Nomor Telepon Tanggal Bidan Jenis

Mengetahui, Ranto Peureulak, 31 januari 2015

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

Status No.Jamkesmas / Persalinan Tgl.Tindakan

Mengetahui, Ranto Peureulak, 31 Maret 2014

( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

Status No.Jamkesmas / Persalinan Tgl.Tindakan

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( Zainal Abidin, SKM, M.Kes ) ( USMAN,SKM )

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