SELISIH TELAAHAN PENGAJUAN KLAIM PERSALINAN RITP PUSKESMAS JEUNIEB

NAMA PKM : PUSKESMAS JEUNIEB

BUPEL : APRIL 2019

Pasien Diajukan
No Nama BPS Tanggal Persalinan INC
Noka Nama KASUS BIAYA
1 0000980133131 RIZA SAFRINA 1 Rp 700,000 4/20/2019

2 0001121747815 DESI SUSANTI 1 Rp 700,000 4/4/2019

3 0002040629163 ERNAWATI 1 Rp 700,000 4/4/2019

4 0002741624504 MAISYURA 1 Rp 700,000 4/18/2019

5 0000220240427 NURYANTI AHAMID 1 Rp 700,000 4/15/2019

6 0002309697235 SAFRIANI 1 Rp 700,000 4/10/2019

7 0001421812596 NURMASYITHAH 1 Rp 700,000 3/31/2019

8 0001422180088 NURMASYITAH 1 Rp 700,000 4/19/2019

9 0001893477868 NURLAINA 1 Rp 700,000 3/23/2019

HJ. ROSDIANA, S. SiT
10 0000980140983 ELY YANTI 1 Rp 700,000 3/24/2019

11 0002198375144 ROSDIANA 1 Rp 700,000 3/27/2019

12 0000219854621 MARDHIAH 1 Rp 700,000 3/28/2019

13 0002737467123 DINI SABILA 1 Rp 700,000 4/17/2019

14 0002081794239 SAFRIDA 1 Rp 700,000 4/13/2019

15 0000221711141 FATIMAH 1 Rp 700,000 4/6/2019

16 0002066088148 HALIMATUSSAKDIAH 1 Rp 700,000 4/4/2019

17 0001122440152 LINDA AFRA 1 Rp 700,000 4/3/2019

18 0000219141257 SRI WAHYUNI 1 Rp 700,000 3/31/2019

19 0000218922142 RAHMATI ATALEB 1 Rp 700,000 4/20/2019

20 0000220231642 IKHWANI M SALEH 1 Rp 700,000 4/17/2019

21 0000980144302 HALIMAH TUNSAKDIAH 1 Rp 700,000 4/12/2019

22 0002295156172 JANNATUN NAIM 1 Rp 700,000 4/12/2019

23 NURSIAH,S.SiT 0001121767839 ZUHRA 1 Rp 700,000 4/8/2019

24 0002094257826 MURNIATI 1 Rp 700,000 4/7/2019

25 0000221069136 ELVIANI 1 Rp 700,000 3/31/2019

26 0002307924955 RISKA MAULIDA 1 Rp 700,000 4/8/2019

27 0000980127371 MIMI SUSANTI 1 Rp 700,000 4/7/2019

28 0002240455498 NURHAFNI 1 Rp 700,000 4/2/2019

NURLINA ,Amd.Keb
29 0000219808462 RAHMAYATI 1 Rp 700,000 4/1/2019

Total 29 Rp 20,300,000
NGAJUAN KLAIM PERSALINAN RJTP PUSKESMAS JEUNIEB

NAMA PKM : PUSKESMAS JEUNIEB

BUPEL : APRIL 2019

Pasien Diajukan
No Nama BPS KET
Noka Nama KASUS BIAYA
1 0000980133131 RIZA SAFRINA 1 Rp 75,000 4/20/2019

2 0001121747815 DESI SUSANTI 1 Rp 75,000 4/4/2019

3 0002040629163 ERNAWATI 1 Rp 75,000 4/4/2019

4 0002741624504 MAISYURA 1 Rp 75,000 4/18/2019

5 0000220240427 NURYANTI AHAMID 1 Rp 75,000 4/15/2019

6 0002309697235 SAFRIANI 1 Rp 75,000 4/10/2019

7 0001421812596 NURMASYITHAH 1 Rp 75,000 3/31/2019

8 0001422180088 NURMASYITAH 1 Rp 75,000 4/19/2019

9 0001893477868 NURLAINA 1 Rp 75,000 3/23/2019

HJ. ROSDIANA, S. SiT
10 0000980140983 ELY YANTI 1 Rp 75,000 3/24/2019

11 0002198375144 ROSDIANA 1 Rp 75,000 3/27/2019

12 0000219854621 MARDHIAH 1 Rp 75,000 3/28/2019

13 0002737467123 DINI SABILA 1 Rp 75,000 4/17/2019

14 0002081794239 SAFRIDA 1 Rp 50,000 4/13/2019

15 0000221711141 FATIMAH 1 Rp 75,000 4/6/2019

16 0002066088148 HALIMATUSSAKDIAH 1 Rp 75,000 4/4/2019

17 0001122440152 LINDA AFRA 1 Rp 75,000 4/3/2019

18 0000219141257 SRI WAHYUNI 1 Rp 75,000 3/31/2019

19 0000218922142 RAHMATI ATALEB 1 Rp 75,000 4/20/2019

20 0000220231642 IKHWANI M SALEH 1 Rp 75,000 4/17/2019

21 0000980144302 HALIMAH TUNSAKDIAH 1 Rp 75,000 4/12/2019

22 0002295156172 JANNATUN NAIM 1 Rp 75,000 4/12/2019

23 NURSIAH,S.SiT 0001121767839 ZUHRA 1 Rp 75,000 4/8/2019

24 0002094257826 MURNIATI 1 Rp 75,000 4/7/2019

25 0000221069136 ELVIANI 1 Rp 75,000 3/31/2019

26 0002307924955 RISKA MAULIDA 1 Rp 75,000 4/8/2019

27 0000980127371 MIMI SUSANTI 1 Rp 75,000 4/7/2019

28 0002240455498 NURHAFNI 1 Rp 75,000 4/2/2019

NURLINA, A.Md.Keb
29 0000219808462 RAHMAYATI 1 Rp 75,000 4/1/2019

Total 29 Rp 2,150,000
KLAIM PERSALINAN PUSKESMAS JEUNIEB PER BIDAN

NAMA PKM : PUSKESMAS JEUNIEB

BUPEL : APRIL 2019

Pasien Diajukan
No Nama BPS KET
Noka Nama KASUS BIAYA
1 0000980133131 RIZA SAFRINA 1 Rp 775,000 4/20/2019

2 0001121747815 DESI SUSANTI 1 Rp 775,000 4/4/2019

3 0002040629163 ERNAWATI 1 Rp 775,000 4/4/2019

4 0002741624504 MAISYURA 1 Rp 775,000 4/18/2019

5 0000220240427 NURYANTI AHAMID 1 Rp 775,000 4/15/2019

6 0002309697235 SAFRIANI 1 Rp 775,000 4/10/2019

7 0001421812596 NURMASYITHAH 1 Rp 775,000 3/31/2019

8 0001422180088 NURMASYITAH 1 Rp 775,000 4/19/2019

9 0001893477868 NURLAINA 1 Rp 775,000 3/23/2019

HJ. ROSDIANA, S. SiT
10 0000980140983 ELY YANTI 1 Rp 775,000 3/24/2019

11 0002198375144 ROSDIANA 1 Rp 775,000 3/27/2019

12 0000219854621 MARDHIAH 1 Rp 775,000 3/28/2019

13 0002737467123 DINI SABILA 1 Rp 775,000 4/17/2019

14 0002081794239 SAFRIDA 1 Rp 750,000 4/13/2019

15 0000221711141 FATIMAH 1 Rp 775,000 4/6/2019

16 0002066088148 HALIMATUSSAKDIAH 1 Rp 775,000 4/4/2019

17 0001122440152 LINDA AFRA 1 Rp 775,000 4/3/2019

18 0000219141257 SRI WAHYUNI 1 Rp 775,000 3/31/2019

TOTAL 18 Rp 13,925,000
19 0000218922142 RAHMATI ATALEB 1 Rp 775,000 4/20/2019

20 0000220231642 IKHWANI M SALEH 1 Rp 775,000 4/17/2019

21 0000980144302 HALIMAH TUNSAKDIAH 1 Rp 775,000 4/12/2019

22 0002295156172 JANNATUN NAIM 1 Rp 775,000 4/12/2019

23 NURSIAH,S.SiT 0001121767839 ZUHRA 1 Rp 775,000 4/8/2019

24 0002094257826 MURNIATI 1 Rp 775,000 4/7/2019

25 0000221069136 ELVIANI 1 Rp 775,000 3/31/2019

26 0002307924955 RISKA MAULIDA 1 Rp 775,000 4/8/2019

27 0000980127371 MIMI SUSANTI 1 Rp 775,000 4/7/2019

TOTAL 9 Rp 6,975,000
28 0002240455498 NURHAFNI 1 Rp 775,000 4/2/2019
NURLINA ,Amd.Keb
29 0000219808462 RAHMAYATI 1 Rp 775,000 4/1/2019

TOTAL 2 Rp 1,550,000
TOTAL Rp 22,450,000

Mengetahui, Jeunieb, 30 April 2019

Kepala UPT.Dinas Kesehatan Puskesmas Jeunieb Bendahara Dana Kapitasi JKN Puskesmas Jeunieb
Ners. Kafrawi, S. Kep, M. Kes Sri Wahyuni
Pembina Nip. 19820603 200701 2 012
Nip. 19651017 198803 1 001