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1 INDRAWATI 000 1852825228 BPJS PASARAN 085 255745440 GIII PII A0 3/3/2017 KF2 2/24/2017
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6 AGUSTINA 000 1071930723 KIS KASAMBI 085 240463779 GIII PII A0 3/5/2017 KF1 3/4/2017
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7 ULFA MUSTAFA 000 0148872644 KIS MAMPU 082 293947421 GI PO AO 3/7/2017 KF1 3/6/2017
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8 YASNI 000 0939681011 KIS CENDANA 081 355767789 GII PI AO 3/8/2017 KF1 3/7/2017
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15 NUR AINI 000 1071937045 KIS CENDANA GII PI AO 3/17/2017 KF3 2/16/2017 25000 25000
16 ZULFRIDA 000 1554783041 BPJS MAKASSAR 085 242900569 GII PI AO 3/20/2017 KF1 3/18/2017
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3/25/2017 KF2
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17 FERAWATI 000 2081221224 KIS CAKKE 081 342274940 GII PI AO 3/20/2017 KF3 2/16/2017 25000 25000
18 JUSWITA 000 0939708022 KIS SOSSOK 082 257341603 GII PI AO 3/24/2017 KF1 3/7/2017
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19 JASMIA 000 1937668397 KIS SUMULLUK 082 345431723 GIII PII AO 3/26/2017 KF1 3/23/2017
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3/26/2017 KN2
20 IMA 000 2065995977 BPJS MARENA 081 355701102 GIV PIII AO 3/29/2017 KF1 3/29/2017 25000 25000
3/29/2017 KN1
21 SURIANI 000 0940152396 KIS MANGGUGU 085 217849442 GV PIV AO 3/31/2017 KF1 3/30/2017
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3/31/2017 KN1
22 HASNA 000 2218023843 KIS DENGEN 081 343375473 GII PI AO 3/14/2017 KF1 3/13/2017
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3/14/2017 KN1
3/20/2017 KF2
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22 NUR MUQARAHMA 000 1936757046 KIS BUNU 085 256314113 GI PO AO 3/19/2017 KF2 3/13/2017
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3/19/2017 KN2
23 JUSRIA TABBA 000 1544997161 BPJS LEMPANGAN 085 255308886 GII PI AO 3/9/2017 KF2 3/3/2017
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3/9/2017 KN2
24 LILIS HANDAYANI 000 1072266669 KIS BUNU 085 298498052 GI PO AO 3/12/2017 KF2 3/6/2017
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25 MUTMAINNAH 000 0193913561 ASKES LEMPANGAN 085 255127232 GIII PII AO 3/25/2017 KF2 3/20/2017
25000 25000
3/25/2017 KN2
3/29/2017 KN3 25000 25000
26 FITRI BACO 000 0130359881 ASKES BUNGGAWAI 081 342946338 GIII PII AO 3/26/2017 KF2 3/20/2017
25000 25000
3/26/2017 KN2
3/29/2017 KF3 25000 25000
JUMLAH 1150000 1150000
1 SURI 000 1561073444 KIS SUMULLUK 085 323310552 GIV PII AI 05/09/2016 K1 10 MG 4 HR 50000 50000
20/10/2016 K2 17 MG 5 HR 50000 50000
22/02/2017 K3 34 MG 6 HR 50000 50000
13/03/2017 K4 37 MG 3 HR 50000 50000
2 FATIMAH 000 2073893321 KIS KOTU 085 299634607 GI PO AO 02/08/2016 KI 8 MG 50000 50000
09/11/2016 K2 22 MG 2 HR 50000 50000
09/01/2017 K3 31 MG 50000 50000
07/03/2017 K4 39 MG 1 HR 50000 50000
3 FURWANTI 000 2205276118 KIS MARENA 085 399166283 GI PO AO 28/08/2016 K1 11 MG 2 HR 50000 50000
31/10/2016 K2 20 MG 3 HR 50000 50000
28/12/2016 K3 28 MG 2 HR 50000 50000
01/03/2017 K4 37 MG 3 HR 50000 50000
4 RISMAYANTI 000 1937668634 KIS KASAMBI 085 145369198 GII PI AO 17/09/2016 K1 12 MG 3 HR 50000 50000
20/10/2016 K2 17 MG 1 HR 50000 50000
23/01/2017 K3 30 MG 5 HR 50000 50000
14/03/2017 K4 37 MG 6 HR 50000 50000
5 JASMIA 000 1937668397 KIS SUMULLUK 082 345431723 GIII PII A0 13/08/2016 KI 8 MG 5 HR 50000 50000
24/11/2016 K2 21 MG 5 HR 50000 50000
23/01/2017 K3 30 MG 4 HR 50000 50000
22/03/2017 K4 38 MG 6 HR 50000 50000
6 NOVIKAWATI 000 1938423622 KIS CENDANA 082 348015798 GII PI AO 26/07/2016 KI 9 MG 2 HR 50000 50000
26/09/2016 K2 17 MG 50000 50000
16/02/2017 K3 39 MG 5 HR 50000 50000
14/03/2017 K4 41 MG 1 HR 50000 50000
7 IMA 000 2065995977 BPJS MARENA 081 355 701102 GIV PIII AO 18/08/2016 K1 8 MG 2 HR 50000 50000
05/12/2016 K2 18 MG 5 HR 50000 50000
10/02/2017 K3 33 MG 1 HR 50000 50000
14/03/2017 K4 37 MG 2 HR 50000 50000
8 SURIANI 000 0940152396 KIS MANGGUGU 085 217849442 GV PIV AO 29/08/2016 K1 6 MG 6 HR 50000 50000
04/11/2016 K2 18 MG 50000 50000
04/02/2017 K3 29 MG 6 HR 50000 50000
28/03/2017 K4 37 MG 50000 50000
9 FITRI BACO 000 0130359881 ASKES BUNGGAWAI 081 342946338 GIV PIII AO 10/09/2016 K1 11 MG 50000 50000
01/12/2016 K2 22 MG 5 HR 50000 50000
21/01/2017 K3 29 MG 6 HR 50000 50000
18/03/2017 K4 37 MG 6 HR 50000 50000
10 MUTMAINNAH 000 0193913561 ASKES LEMPANGAN 085 255127232 GIII PII A0 31/08/2016 K1 10 MG 3 HR 50000 50000
28/10/2016 K2 20 MG 2 HR 50000 50000
01/02/2017 K3 32 MG 2 HR 50000 50000
16/03/2017 K4 38 MG 3 HR 50000 50000
11 JUSRIA TABBA 000 1544997161 BPJS LEMPANGAN 085 255308886 GII PI AO 11/08/2016 K1 8 MG 1 HR 50000 50000
11/10/2016 K2 16 MG 6 HR 50000 50000
09/02/2017 K3 34 MG 1 HR 50000 50000
02/03/2017 K4 37 MG 1 HR 50000 50000
JUMLAH 2200000 2200000
1 NASRA 000 2214248422 KIS SINGKI 3/4/2017 GII PII A0 SPONTAN/PBK 700000 700000
2 SANTI 000 1302433389 BPJS DULANG 085 397770866 3/5/2017 GII PI A0 SPONTAN/PBK 700000 700000
3 ULFA MUSTAFA 000 0148872644 KIS MAMPU 082 293947420 3/5/2017 GI P0 A0 SPONTAN/PBK 700000 700000
4 AGUSTINA 000 1071930723 KIS KASAMBI 085 240463779 3/4/2017 GIII PII A0 SPONTAN/PBK 700000 700000
5 YASNI 000 0939681011 KIS SINGKI 3/7/2017 GII PI AO SPONTAN/PBK 700000 700000
6 WAHYUNI KARYA 000 2209686783 KIS PANA 085 256321619 2/12/2017 GI P0 A0 SPONTAN/PBK 700000 700000
7 FATIMAH 000 2073893321 BPJS KOTU 085 299634607 3/12/2017 GI PO AO SPONTAN/PBK 700000 700000
8 HASNA 000 2218023843 KIS DENGEN 081 342325473 3/13/2017 GII PI A0 SPONTAN/PBK 700000 700000
9 NOVIKAWATI 000 1938423622 KIS CENDANA 082 348015798 3/15/2017 GII PI A0 SPONTAN/PBK 700000 700000
10 FURWANTI 000 2205276118 KIS MARENA 085 399166283 3/15/2017 GI PO AO SPONTAN/PBK 700000 700000
11 SURI 000 1561073444 KIS TINDALUN 085 325310552 3/14/2017 GIII PII A0 SPONTAN/PBK 700000 700000
12 ZULFRIDA 000 1554783041 BPJS MAKASSAR 085 242900569 3/18/2017 GII PI AO SPONTAN/PBK 700000 700000
13 MUSLIANA 000 2211995856 KIS TAMPO 081 253999550 3/19/2017 GI PO AO SPONTAN/PBK 700000 700000
14 JASMIA 000 1937668397 KIS SUMULLUK 082 345431723 3/23/2017 GIII PII A0 SPONTAN/PBK 700000 700000
15 IMA 000 2065995977 BPJS MARENA 081 355701102 3/29/2017 GIV PIII A0 SPONTAN/PBK 700000 700000
16 SURIANI 000 0940152396 KIS MANGGUGU 085 217849442 3/30/2017 GV PIV A0 SPONTAN/PBK 700000 700000
JUMLAH 11200000 11200000
RS. TEMPAT
NO NAMA PASIEN NO KARTU JKN TANGGAL MASUK TANGGAL DIRUJUK TINDAKAN TARIF
RUJUKAN
1 DEWI SARTIKA S.PD 000 1936768959 1/1/2017 1/1/2017 RS. LAKIPADADA INFUS RL 125 000
2 KASMAYAWATI 000 1563954502 14/07/2017 14/07/2017 RS. LAKIPADADA INFUS RL 125 000
3 NURWIDA SUDIRMAN 000 1870278941 24/01/2017 24/01/2017 RS. MASPUL INFUS RL 125 000
4 NURUL FAHRINA 000 2033675515 30/01/2017 30/01/2017 RS. LAKIPADADA INFUS RL 125 000
5 HAPIPA 000 0939328424 15/01/2017 15/01/2017 RS. LAKIPADADA INFUS RL 125 000
JUMLAH 625 000
KEPESERTAAN(PNS/T JENIS
TANGGAL GPA(GRAVID,PAR PELAYANA BESARAN TOTAL
NO NAMA PASIEN NO KARTU JKN NI/POLRI/BU/JAMKE ALAMAT N0.TELPON PELAYANAN TUS,ABORTUS) TARIF KLAIM
SMAS) N
1 SUMARNI 000 0939570682 KIS CENDANA 1/1/2017 SUNTIK 15000 15000
2 SARTINI 000 0939430607 KIS CENDANA 4/1/2017 SUNTIK 15000 15000
3 SALMI WAHID 000 0939377068 KIS CENDANA 082 393854214 9/1/2017 IMPLANT 100000 100000
4 UHRA BUREN 000 1936703542 KIS CENDANA 081 354843313 11/1/2017 SUNTIK 15000 15000
5 HASMIATI 000 0939557193 KIS CENDANA 16/01/2017 SUNTIK 15000 15000
6 RUKIA 000 0939404834 KIS BT. GALUNG 24/01/2017 SUNTIK 15000 15000
7 RASMA 000 1936757103 KIS LURA 19/01/2017 SUNTIK 15000 15000
8 ARNAWATI 000 0938565551 KIS MAMPU 082 293486168 15/01/2017 IMPLANT 100000 100000
9 MARISA 000 0939340631 KIS MARENA 085 146404953 25/01/2017 IMPLANT 100000 100000
10 FITRIANI 000 0938800124 KIS CAKKE 082 395143447 10/2/2017 SUNTIK 15000 15000
11 RISMAWATI Amd.keb 000 1936756822 KIS KARENGKE 082 337826661 20/01/2017 IUD 100000 100000
12 SITI KHADIJA 000 1967759346 BPJS PASARAN 26/01/2017 SUNTIK 15000 15000
13 RAMLAH 000 1892928014 KIS SOSSOK 5/1/2017 IMPLANT 100000 100000
14 SULPRIANTI 000 0130327119 ASKES PASARAN 085 242364777 8/1/2017 IMPLANT 100000 100000
15 JUMAWATI 000 1563958642 KIS PASARAN 5/1/2017 SUNTIK 15000 15000
JUMLAH 735000 735000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
50.000
2800.000
1 ENDANG LESTARI 000 204987187 KIS MAMPU 081 342042822 1/1/2017 GIII PII A0 KURETASE 750000 750000
2 RIA 000 093942532 KIS BUNGGAWAI 1/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
3 MASNAWATI 000 0939297971 KIS KOTU 082 344439812 4/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
4 MUHLISA 000 1563995452 KIS PASUI 082 194311246 4/1/2017 GI P0 A0 SPONTAN/PBK 600000 600000
5 HERNAWATI 000 0939256108 KIS MENDATTE 085 340689808 8/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
6 SATIFITRIANI 000 0130481403 ASKES BT.NONI 082 395622055 7/1/2017 GIII PII A0 KURETASE 750000 750000
7 MASNAH 000 1071935583 KIS CAKKE 082 336065010 14/1/2017 GV PIV A0 SPONTAN/PBK 600000 600000
8 NURWINDA 000 0938890844 KIS MANGGUGU 085 298758104 15/1/2017 GV PIV A0 SPONTAN/PBK 600000 600000
9 JAHARIA 000 1380347436 BPJS LEMBONG 081 355396056 15/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
10 RISDA 000 0939673495 KIS SOSSOK 082 336822825 16/1/2017 GIII PII A0 SPONTAN/PBK 600000 600000
11 NURHAYATI 000 1632353411 BPJS MENDATTE 081 355767789 17/1/2017 GIII PII A0 SPONTAN/PBK/REST PLASENTA 600000 600000
12 WARNI 000 1936757575 KIS MENDATTE 085 242964436 19/1/2017 GIII PII A0 SPONTAN/PBK/DISTOSIA BAHU 600000 600000
13 SOFYAWATI 000 2197206955 KIS KOTA 085 347868684 19/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
14 NURWINDA 000 1870278941 BPJS CAKKE 081 342111600 24/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
15 ISMAYANTI 000 093936322 KIS MARENA 085 255895052 26/1/2017 GII PI A0 SPONTAN/PBK 600000 600000
16 RUSNI 000 0939557046 KIS LEMPAN 085 242558896 5/1/2017 GI P0 A0 SPONTAN/PBK 600000 600000
JUMLAH 9900000 9900000
1 HERLINA 000 0939404226 KIS CENDANA 085 340974733 GII PI AO 2/2/2017 KN1
25000 25000
2/2/2017 KF1
2/6/2017 KN2
25000 25000
6/6/2017 KF2
28-20-17 KN3 25000 25000
2 NUR NAPRATILOVA 000 1902647867 KIS PADUKKU 085 240555040 GII PI AO 2/8/2017 KN1
25000 25000
2/8/2017 KF1
2/12/2017 KN2
25000 25000
2/12/2017 KF2
3 RISMAWATI 000 1429782761 BPJS CAKKE 085 299926926 GII PI A0 2/9/2017 KN1
25000 25000
12/9/2017 KF1
2/12/2017 KN2
25000 25000
2/12/2017 KF2
4 NURRAHMI 000 0939501145 KIS BT.AMPANG 085 394472535 GII PII A0 2/11/2017 KN1
25000 25000
2/11/2017 KF1
2/16/2017 KN2
25000 25000
2/16/2017 KF2
5 HASNANI 000 1936769567 KIS BT.NONI 082 190670898 GII PI A0 2/14/2017 KN1
25000 25000
2/14/2017 KF1
6 SULFI 000 1253411605 BPJS BT.NONI 082 343386870 GI P0A0 2/13/2017 KN1
25000 25000
2/13/2017 KF1
2/16/2017 KN2
25000 25000
2/16/2017 KF2
2/24/2017 KN3 25000 25000
7 LISWENI 000 1811575271 KIS BELALANG 085 298731176 GII PI A0 2/17/2017 KN1
25000 25000
2/17/2017 KF1
2/20/2017 KN2
25000 25000
2/20/2017 KF2
8 HASNI 000 2209506039 KIS MAKASSAR 081 355278855 GII PI A0 2/16/2017 KN1
25000 25000
2/16/2017 KF1
2/20/2017 KF2
25000 25000
2/20/2017 KN2
9 FERAWATI 000 2081221244 KIS CAKKKE 081 342274940 GII PI A0 2/18/2017 KN1
25000 25000
2/18/2017 KF2
2/20/2017 KN2
25000 25000
2/20/2017 KF2
10 SURIANI 000 0200397396 ASKES BELAJEN 085 255598577 GIII PII A0 15-021-7 KN 1
25000 25000
2/15/2017 KF1
11 SULFI 000 1286795698 BPJS PASARAN 085 299713474 GII PI A0 2/25/2017 KN1
25000 25000
2/25/2017 KF1
12 INDRAWATI 000 1852825228 BPJS PASARAN 085 255745440 GIV PII AI 2/25/2017 KN1
25000 25000
2/25/2017 KF1
13 NASRIATI 000 2062847406 BPJS TAMPO 085 342803829 GII PI A0 2/28/2017 KN1
25000 25000
2/28/2017 KF1
14 RISNAWATI 000 2209547114 KIS SIAMBO 085 340182645 GI P0A0 2/7/2017 KN1
25000 25000
2/7/2017 KF1
2/15/2017 KN2 25000 25000
15 NURAINI 000 1071937045 KIS CENDANA GII PI A0 2/23/2017 KN2
25000 25000
2/23/2017 KF2
16 JASNA 000 0939909082 KIS LEMPANGAN GIV PII A0 2/7/2017 KN2
25000 25000
2/7/2017 KF2
2/28/2017 KN3 25000 25000
2/14/2017 KF3 25000 25000
17 MURNI 000 093993156 KIS BUNGGAWAI 081 340202913 GI P0A0 2/26/2017 KN1
25000 25000
2/26/2017 KF1
18 HERNAWATI 000 0938920926 KIS BT.NONI 085 398214692 GII PI A0 2/26/2017 KN1
25000 25000
2/26/2017 KF1
19 MASNA 000 1071935583 KIS CAKKE 082 336065010 GV PIV A0 2/17/2017 KF3 25000 25000
20 JAHARIA 000 1380347436 BPJS LEMBONG GII PI A0 2/18/2017 KF3 25000 25000
21 RISDA 000 0939673495 KIS SOSSOK GIII PII A0 2/20/2017 KF3 25000 25000
22 SOFIAWATI 000 2197206955 KIS KOTA 085 347 868 684 GII PI A0 2/22/2017 KF3 25000 25000
23 ISMAYANTI 000 0939363322 KIS BT.RAMPUN 085 255 845 052 GII PI A0 2/26/2017 KF3 25000 25000
JUMLAH 900000 900000
1 HERLINA 000 0939404226 KIS TONTONAN 082 348029943 GIII PII AO 6/15/2016 K1 50000 50000
10/19/2016 K2 50000 50000
12/20/2016 K3 50000 50000
1/31/2017 K4 50000 50000
2 RISMAWATI 000 1429782761 BPJS CAKKE 085 299 926 926 GII PI A0 6/27/2016 K1 50000 50000
10/17/2016 K2 50000 50000
12/7/2016 K3 50000 50000
2/4/2017 K4 50000 50000
3 NUR RAHMI 000 0939301145 KIS BT.AMPANG 082 394472535 GIII PII AO 8/19/2016 K1 50000 50000
11/7/2016 K2 50000 50000
1/5/2017 K3 50000 50000
2/5/2017 K4 50000 50000
4 SULFI 000 1253411605 BPJS BT.NONI 082 343386870 GI P0A0 8/26/2016 K1 50000 50000
10/16/2016 K2 50000 50000
11/18/2016 K3 50000 50000
1/20/2017 K4 50000 50000
5 LISWENI 000 1811575271 KIS BELALANG 085 298 731176 GII PI A0 8/5/2016 K1 50000 50000
9/29/2016 K2 50000 50000
12/14/2016 K3 50000 50000
2/10/2017 K4 50000 50000
6 FERAWATI 000 2081221244 KIS CAKKE 081 342274940 GII PI A0 8/8/2016 KI 50000 50000
9/29/2016 K2 50000 50000
11/30/2016 K3 50000 50000
2/9/2017 K4 50000 50000
7 SULFI 000 1286795698 BPJS PASARAN 085 299713474 GII PI A0 7/23/2016 K1 50000 50000
9/1/2016 K2 50000 50000
10/3/2016 K3 50000 50000
2/17/2017 K4 50000 50000
8 INDRAWATI 000 1852825228 BPJS PASARAN 085 255745440 GIV PII AI 8/1/2016 K1 50000 50000
11/5/2016 K2 50000 50000
1/23/2017 K3 50000 50000
2/24/2017 K4 50000 50000
9 HERMAWATI 000 0938920926 KIS BT.NONI 085 398214692 GII PI A0 6/17/2016 KI 50000 50000
10/28/2016 K2 50000 50000
11/19/2016 K3 50000 50000
1/25/2017 K4 50000 50000
10 MURNI 000 0939931569 KIS BUNGGAWAI 085 299560705 GI P0A0 6/30/2016 KI 50000 50000
9/24/2016 K2 50000 50000
12/23/2016 K3 50000 50000
2/25/2017 K4 50000 50000
11 NASRIATI 000 2062847406 BPJS TAMPO 085 342803829 GII PI AO 8/18/2016 K1 50000 50000
9/7/2016 K2 50000 50000
1/19/2017 K3 50000 50000
2/17/2017 K4 50000 50000
12 RISMAWATI 000 220 9547114 KIS CENDANA 085 340182645 GI P0 A0 7/12/2016 K1 50000 50000
9/22/2016 K2 50000 50000
12/20/2016 K3 50000 50000
1/22/2017 K4 50000 50000
13 NURAINI 000 1071937045 KIS CENDANA GII PI A0 7/5/2016 K1 50000 50000
9/11/2016 K2 50000 50000
10/12/2016 K3 50000 50000
2/14/2017 K4 50000 50000
14 JASNA TABBA 000 0939908092 KIS BUBUN LAMBA 082 293 501708 GVI PIV AI 6/23/2016 K1 50000 50000
10/27/2016 K2 50000 50000
1/14/2017 K3 50000 50000
1/29/2017 K4 50000 50000
JUMLAH 2800000 2800000
1 HERLINA 000 O939404226 KIS TONTONAN 082 348029943 2/1/2017 GIII PII A0 SPONTAN/PBK/Perdarahan Post Partum 875000
2 NUR NAPRATILOVA 000 1902647867 KIS PADUKKU 085 240555040 2/6/2017 GII PI A0 SPONTAN/PBK 700000
3 RISMAWATI 000 1429782761 BPJS CAKKE 085 299926926 2/8/2017 GII PI A0 SPONTAN/PBK 700000
4 NUR RAHMI 000 0939501145 KIS BT.AMPANG 082 394472535 2/10/2017 GIII PII A0 SPONTAN/PBK 700000
5 JURANA 000 0939463154 JASKESMAS BT.AMPANG 081 241416749 2/12/2017 GIV PIII A0 KURETASE 950000
6 SULFI 000 1253411605 BPJS BT.NONI 082 343386870 2/12/2017 GI P0 A0 SPONTAN/PBK 700000
7 HASNANI 000 1936769567 KIS BT.NONI 082 190670898 2/13/2017 GII PI A0 SPONTAN/PBK 700000
8 LISWENI 000 1811575271 KIS BELALANG 085 298731176 2/13/2017 GII PI A0 SPONTAN/PBK 700000
9 HASNI 000 2209506039 KIS MAKASSAR 2/14/2017 GII PI A0 SPONTAN/PBK 700000
10 FERAWATI 000 2081221244 KIS CAKKE 081 342274940 2/16/2017 GII PI A0 SPONTAN/PBK 700000
11 SURIANI MADA ALI 000 0200397396 ASKES BELAJEN 085 255598577 2/17/2017 GIII PII A0 SPONTAN/PBK/KPD 900000
12 SULFI 000 1286795698 BPJS PASARAN 085 299713474 2/24/2017 GII PI A0 SPONTAN/PBK 700000
13 INDRAWATI 000 1852825228 BPJS PASARAN 085 255745440 2/24/2017 GIV PII AI SPONTAN/PBK 700000
14 HERMAWATI 000 0938920926 KIS BT.NONI 082 190252781 2/25/2017 GII PI A0 SPONTAN/PBK 700000
15 MURNI 000 0939931569 KIS BUNGGAWAI 081 340202913 2/25/2017 GI PI A0 SPONTAN/PBK 700000
16 NASRIATI 000 2062847406 BPJS TAMPO 085 342803829 2/27/2017 GII PI A0 SPONTAN/PBK 700000
JUMLAH 11825000
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11825000
Asriany S.ST
NIP.197607302005022005