JM ASKES

DESKTOK\JP PELAYANAN\ASKES WAJIB 2008

ASKES RAWAT INAP BULAN MARET 2011

NO Pelayanan Klaim JP 40 % Kasus Nilai JP Dr Nilai Dr.Umum Nilai Kembali Rgn Nilai Perawat Nilai Labor Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.Spesialis Umum Prwt Umum sederhana Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 42.50% 5% 8.50% 11.25% 4% 28.25% 0.50% 1 Kelas I 190,000 76,000 910 69,160,000 32,300 29,393,000 3,800 3,458,000 6,460 5,878,600 8,550 7,780,500 3,040 2,766,400 21,470 19,537,700 380 345,800 2 Kelas II 140,000 56,000 398 22,288,000 23,800 9,472,400 2,800 1,114,400 4,760 1,894,480 6,300 2,507,400 2,240 891,520 15,820 6,296,360 280 111,440

Jumlah 1,308 91,448,000 38,865,400 4,572,400 7,773,080 10,287,900 3,657,920 25,834,060 457,240 91,448,000

RAWAT INAP LUAR PAKET BULAN FEBRUARI 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dr Nilai Dr.Umum Nilai Kembali Rgn Nilai Perawat Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.Pelayanan Spesialis kembali Umum Prwt Umum Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 45.00% Dr. Spesialis 10% Dr. Umum 5.00% ke Rgn 11.25% 28.25% 0.50% 1 Paket II A 28,000 11,200 - - 5,040 - 1,120 - 560 - 1,260 - 3,164 - 56 - 2 Paket II B 50,000 20,000 51 1,020,000 9,000 459,000 2,000 102,000 1,000 51,000 2,250 114,750 5,650 288,150 100 5,100 3 Paket II C 45,000 18,000 137 2,466,000 8,100 1,109,700 1,800 246,600 900 123,300 2,025 277,425 5,085 696,645 90 12,330 4 Labor Luar Paket 15,875,500 6,350,200 1 6,350,200 2,857,590 2,857,590 635,020 635,020 317,510 317,510 714,398 714,398 1,793,931 1,793,931 31,751 31,751 5 Cairan Pleura 78,000 31,200 - - 14,040 - 3,120 - 1,560 - 3,510 - 8,814 - 156 - 5 J. Besar 78,000 31,200 13 405,600 14,040 182,520 3,120 40,560 1,560 20,280 3,510 45,630 8,814 114,582 156 2,028 6 J. Sedang 65,000 26,000 17 442,000 11,700 198,900 2,600 44,200 1,300 22,100 2,925 49,725 7,345 124,865 130 2,210 7 J. Kecil 54,000 21,600 2 43,200 9,720 19,440 2,160 4,320 1,080 2,160 2,430 4,860 6,102 12,204 108 216 8 P. Beku 155,000 62,000 - - 27,900 - 6,200 - 3,100 - 6,975 - 17,515 - 310 - 9 FNAB 168,000 67,200 2 134,400 30,240 60,480 6,720 13,440 3,360 6,720 7,560 15,120 18,984 37,968 336 672 10 Sitologi 3 serial 70,000 28,000 - - 12,600 - 2,800 - 1,400 - 3,150 - 7,910 - 140 - 11 Sitologi Cairan 72,000 28,800 1 28,800 12,960 12,960 2,880 2,880 1,440 1,440 3,240 3,240 8,136 8,136 144 144 12 Laringoscope 105,000 42,000 3 126,000 18,900 56,700 4,200 12,600 2,100 6,300 4,725 14,175 11,865 35,595 210 630 13 Endoscopy 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 - 14 Apendicogram 50,000 20,000 - - 9,000 - 2,000 - 1,000 - 2,250 - 5,650 - 100 - 15 Colonoscopy 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 - 16 Gastrocopy 150,000 60,000 - - 27,000 - 6,000 - 3,000 - 6,750 - 16,950 - 300 - 17 Gastrduodenoscpy 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 - 18 Esophagusduodenos 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 - 18 Fistulagrafi 70,000 28,000 - - 12,600 - 2,800 - 1,400 - 3,150 - 7,910 - 140 - 19 Cholesistografi 150,000 60,000 - - 27,000 - 6,000 - 3,000 - 6,750 - 16,950 - 300 - 20 Uretrografi 85,000 34,000 - - 15,300 - 3,400 - 1,700 - 3,825 - 9,605 - 170 - 21 USG 60,000 24,000 22 528,000 10,800 237,600 2,400 52,800 1,200 26,400 2,700 59,400 6,780 149,160 120 2,640 22 Barium Enema 62,500 25,000 3 75,000 11,250 33,750 2,500 7,500 1,250 3,750 2,813 8,438 7,062 21,187 125 375 23 IVP + BNO 180,000 72,000 - - 32,400 - 7,200 - 3,600 - 8,100 - 20,340 - 360 - 24 Abdomen 3 Posisi 55,000 22,000 1 22,000 9,900 9,900 2,200 2,200 1,100 1,100 2,475 2,475 6,215 6,215 110 110 25 Colon In Loop 62,500 25,000 - - 11,250 - 2,500 - 1,250 - 2,813 - 7,062 - 125 -

JUMLAH - 11,641,200 5,238,540 1,164,120 582,060 1,309,635 3,288,639 58,206 11,641,200

OPERASI BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dr. Nilai Dokter Nilai Kembali ke Nilai Kembali ke Nilai Prwt Umum Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.Pelayanan Operator Anesthesi Prwt OK Kembali Prwt Anesthe Kembali Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 48.75% Dr.Operator 16.25% Dr. Anesthesi 3.00% Prwt OK 2.00% Prwt Anesth 7.50% Prwt Umum 22.00% 0.50% 1 Kelompok I 1,500,000 600,000 23 13,800,000 292,500 6,727,500 97,500 2,242,500 18,000 414,000 12,000 276,000 45,000 1,035,000 132,000 3,036,000 3,000 69,000

Kelompok I ( 60 %) 900,000 360,000 2 720,000 175,500 351,000 58,500 117,000 10,800 21,600 7,200 14,400 27,000 54,000 79,200 158,400 1,800 3,600 2 Kelompok II 2,000,000 800,000 11 8,800,000 390,000 4,290,000 130,000 1,430,000 24,000 264,000 16,000 176,000 60,000 660,000 176,000 1,936,000 4,000 44,000

Kelompok II ( 60 % ) 1,200,000 480,000 - - 234,000 - 78,000 - 14,400 - 9,600 - 36,000 - 105,600 - 2,400 - 3 Kelompok III 3,000,000 1,200,000 14 16,800,000 585,000 8,190,000 195,000 2,730,000 36,000 504,000 24,000 336,000 90,000 1,260,000 264,000 3,696,000 6,000 84,000 3 Kelompok III ( 60 % ) 1,800,000 720,000 - - 351,000 - 117,000 - 21,600 - 14,400 - 54,000 - 158,400 - 3,600 - 4 Kel. Khusus 2 4,000,000 1,600,000 - - 780,000 - 260,000 - 48,000 - 32,000 - 120,000 - 352,000 - 8,000 - 5 Kel. Khusus 1 5,000,000 2,000,000 5 10,000,000 975,000 4,875,000 325,000 1,625,000 60,000 300,000 40,000 200,000 150,000 750,000 440,000 2,200,000 10,000 50,000

JUMLAH 55 50,120,000 24,433,500 8,144,500 1,503,600 1,002,400 3,759,000 11,026,400 250,600 50,120,000

DESKTOK\JP PELAYANAN\ASKES WAJIB 2008

ASKES ICU/ICCU BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dokter Nilai Kembali ke Nilai Perawat Nilai Labor Nilai Lab JP Non Nilai JP Non Kompensasi Nilai Komp.Pelayanan Dokter Ruangan Kembali Umum Prwt Sederhana Sederhana Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 47.50% 8.50% ke Rgn 11.25% Umum 4.00% 28.25% 0.50%1 ICU / NICU 450,000 180,000 11 1,980,000 85,500 940,500 15,300 168,300 20,250 222,750 7,200 79,200 50,850 559,350 900 9,900 2 ICCU 500,000 200,000 3 600,000 95,000 285,000 17,000 51,000 22,500 67,500 8,000 24,000 56,500 169,500 1,000 3,000 3 H C U 210,000 84,000 10 840,000 39,900 399,000 7,140 71,400 9,450 94,500 3,360 33,600 23,730 237,300 420 4,200

- 3,420,000 1,624,500 290,700 384,750 136,800 966,150 17,100 3,420,000

RAWAT INAP/TINDAKAN FEBRUARI 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dokter Nilai Kembali ke Nilai Perawat Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.Pelayanan Dokter Rgn/ Pl Kembali Umum Prwt Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 60.00% 5.00% ke Rgn / Pl 11.25% Umum 23.25% 0.50% 1 PAKET III A 37,500 15,000 98 1,470,000 9,000 882,000 750 73,500 1,688 165,375 3,488 341,775 75 7,350 2 PAKET III B 90,000 36,000 70 2,520,000 21,600 1,512,000 1,800 126,000 4,050 283,500 8,370 585,900 180 12,600 3 PAKET III C 300,000 120,000 13 1,560,000 72,000 936,000 6,000 78,000 13,500 175,500 27,900 362,700 600 7,800

PAKET III C 60 % 180,000 72,000 - - 43,200 - 3,600 - 8,100 - 16,740 - 360 - 4 Partus Normal 450,000 180,000 4 720,000 108,000 432,000 9,000 36,000 20,250 81,000 41,850 167,400 900 3,600 5 Pervaginam 850,000 340,000 - - 204,000 - 17,000 - 38,250 - 79,050 - 1,700 -

6,270,000 3,762,000 313,500 705,375 1,457,775 31,350 6,270,000

162,899,200

HAEMODIALISA BULAN MARET 2011

NO Jenis Klaim Nilai Jumlah Tindakan JP 40 % Nilai JP Nilai HD Perawat Nilai JP Non FgsPelayanan Klaim Pasien 80% Umum ( 10%) Non Prwt ( 10%)

1 BULAN FEBR 2011 150,000 150,000 1 1 60,000 60,000 48,000 6,000 6,000

2 BULAN MARET 2011 160,000 25,760,000 20 161 64,000 10,304,000 8,243,200 1,030,400 1,030,400

JUMLAH 25,910,000 21 124,000 10,364,000 8,291,200 1,036,400 1,036,400 10,364,000

ASKES RAWAT JALAN BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dokter Nilai Dokter Nilai Kembali Nilai Perawat Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.Pelayanan Spesialis Dokter Umum Dr. Umum ke Poli kembali Umum Prwt Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 45.00% Spesialis 10.00% 5.00% ke Poli 11.25% Umum 28.25% 0.50%1 Paket I Biasa 13,000 5,200 3,878 20,165,600 2,340 9,074,520 520 2,016,560 260 1,008,280 585 2,268,630 1,469 5,696,782 26 100,828 2 Paket I UGD 22,000 8,800 207 1,821,600 3,960 819,720 880 182,160 440 91,080 990 204,930 2,486 514,602 44 9,108 3 Paket II A 30,000 12,000 471 5,652,000 5,400 2,543,400 1,200 565,200 600 282,600 1,350 635,850 3,390 1,596,690 60 28,260 4 Paket II B 50,000 20,000 142 2,840,000 9,000 1,278,000 2,000 284,000 1,000 142,000 2,250 319,500 5,650 802,300 100 14,200 5 Paket II C 45,000 18,000 1,311 23,598,000 8,100 10,619,100 1,800 2,359,800 900 1,179,900 2,025 2,654,775 5,085 6,666,435 90 117,990 6 Labor Luar Paket 22,523,500 9,009,400 1 9,009,400 4,054,230 4,054,230 900,940 900,940 450,470 450,470 1,013,558 1,013,558 2,545,155 2,545,155 45,047 45,047 7 Cairan Pleural 78,000 31,200 - - 14,040 - 3,120 - 1,560 - 3,510 - 8,814 - 156 - 8 FNAB 168,000 67,200 20 1,344,000 30,240 604,800 6,720 134,400 3,360 67,200 7,560 151,200 18,984 379,680 336 6,720 9 Biopsi J Besar 78,000 31,200 4 124,800 14,040 56,160 3,120 12,480 1,560 6,240 3,510 14,040 8,814 35,256 156 624

10 Biopsi J Sedang 65,000 26,000 15 390,000 11,700 175,500 2,600 39,000 1,300 19,500 2,925 43,875 7,345 110,175 130 1,950 11 Biopsi J Kecil 54,000 21,600 - - 9,720 - 2,160 - 1,080 - 2,430 - 6,102 - 108 - 12 Sitologi Cairan 72,000 28,800 2 57,600 12,960 25,920 2,880 5,760 1,440 2,880 3,240 6,480 8,136 16,272 144 288 13 Pap Smear 50,000 20,000 4 80,000 9,000 36,000 2,000 8,000 1,000 4,000 2,250 9,000 5,650 22,600 100 400 14 Potong Beku 155,000 62,000 - - 27,900 - 6,200 - 3,100 - 6,975 - 17,515 - 310 - 14 Sistografi 80,000 32,000 1 32,000 14,400 14,400 3,200 3,200 1,600 1,600 3,600 3,600 9,040 9,040 160 160 14 Apendikogram 50,000 20,000 2 40,000 9,000 18,000 2,000 4,000 1,000 2,000 2,250 4,500 5,650 11,300 100 200 15 USG 60,000 24,000 31 744,000 10,800 334,800 2,400 74,400 1,200 37,200 2,700 83,700 6,780 210,180 120 3,720 16 Barium Enema 62,500 25,000 1 25,000 11,250 11,250 2,500 2,500 1,250 1,250 2,813 2,813 7,062 7,062 125 125 17 Esophagusduodenosco 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 - 18 Colesistografi 165,000 66,000 - - 29,700 - 6,600 - 3,300 - 7,425 - 18,645 - 330 - 18 Fistulalografi 55,000 22,000 - - 9,900 - 2,200 - 1,100 - 2,475 - 6,215 - 110 - 19 Colon Inloop 60,000 24,000 - - 10,800 - 2,400 - 1,200 - 2,700 - 6,780 - 120 - 20 IVP + BNO 180,000 72,000 - - 32,400 - 7,200 - 3,600 - 8,100 - 20,340 - 360 - 21 Endoscopi 150,000 60,000 - - 27,000 - 6,000 - 3,000 - 6,750 - 16,950 - 300 - 22 ECHO 185,000 74,000 - - 33,300 - 7,400 - 3,700 - 8,325 - 20,905 - 370 - 23 ONE DAY CARE 100,000 40,000 - - 18,000 - 4,000 - 2,000 - 4,500 - 11,300 - 200 - 24 Uretrografi 75,000 30,000 - - 13,500 - 3,000 - 1,500 - 3,375 - 8,475 - 150 - 25 Gadtrocopy 80,000 32,000 - - 14,400 - 3,200 - 1,600 - 3,600 - 9,040 - 160 - 26 Laringoscopy 105,000 42,000 10 420,000 18,900 189,000 4,200 42,000 2,100 21,000 4,725 47,250 11,865 118,650 210 2,100

Jumlah 6,100 66,344,000 29,854,800 6,634,400 3,317,200 7,463,700 18,742,180 331,720 66,344,000

TINDAKAN RAWAT JALAN BULAN MARET 2011 2010

NO Jenis Klaim JP 40 % Kasus Nilai JP Dokter Nilai Kembali nilai kembali Perawat Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.Pelayanan Dokter ke rgn/pol ke rgn / pol Umum Perawat Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 60.00% 5.00% 11.25% Umum 23.25% 0.50%1 PAKET III A 37,500 15,000 479 7,185,000 9,000 4,311,000 750 359,250 1,688 808,313 3,488 1,670,513 75 35,925 2 PAKET III B 90,000 36,000 490 17,640,000 21,600 10,584,000 1,800 882,000 4,050 1,984,500 8,370 4,101,300 180 88,200 3 PAKET III C 300,000 120,000 10 1,200,000 72,000 720,000 6,000 60,000 13,500 135,000 27,900 279,000 600 6,000

Jumlah 26,025,000 15,615,000 1,301,250 2,927,813 6,050,813 130,125 26,025,000

ASKES RAWAT INAP BULAN MARET 2011

NO Pelayanan Klaim JP 40 % Kasus Nilai JP Dr Nilai Dr.Umum Nilai Kembali Rgn Nilai Perawat Nilai Labor Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.

Spesialis Umum Prwt Umum sederhana Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 42.50% 5% 8.50% 11.25% 4% 28.25% 0.50%

1 Kelas I 190,000 76,000 910 69,160,000 32,300 29,393,000 3,800 3,458,000 6,460 5,878,600 8,550 7,780,500 3,040 2,766,400 21,470 19,537,700 380 345,800

2 Kelas II 140,000 56,000 398 22,288,000 23,800 9,472,400 2,800 1,114,400 4,760 1,894,480 6,300 2,507,400 2,240 891,520 15,820 6,296,360 280 111,440

Jumlah 1,308 91,448,000 38,865,400 4,572,400 7,773,080 10,287,900 3,657,920 25,834,060 457,240

91,448,000

RAWAT INAP LUAR PAKET BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dr Nilai Dr.Umum Nilai Kembali Rgn Nilai Perawat Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.

Pelayanan Spesialis kembali Umum Prwt UmumFgs + Non PrwtFgs + Non Prwt PKS PKS

40% 45% Dr. Spesialis 10% Dr. Umum 5% ke Rgn 11.25% 28.25% 0.50%

1 Paket II A 28,000 11,200 - - 5,040 - 1,120 - 560 - 1,260 - 3,164 - 56 -

2 Paket II B 50,000 20,000 51 1,020,000 9,000 459,000 2,000 102,000 1,000 51,000 2,250 114,750 5,650 288,150 100 5,100

3 Paket II C 45,000 18,000 137 2,466,000 8,100 1,109,700 1,800 246,600 900 ### 2,025 277,425 5,085 696,645 90 12,330

4 Labor Luar Paket ### ### 1 6,350,200 ### 2,857,590 ### 635,020 317,510 ### ### 714,398 1,793,932 1,793,932 31,751 31,751

5 Cairan Pleura 78,000 31,200 - - 14,040 - 3,120 - 1,560 - 3,510 - 8,814 - 156 -

5 J. Besar 78,000 31,200 13 405,600 14,040 182,520 3,120 40,560 1,560 20,280 3,510 45,630 8,814 114,582 156 2,028

6 J. Sedang 65,000 26,000 17 442,000 11,700 198,900 2,600 44,200 1,300 22,100 2,925 49,725 7,345 124,865 130 2,210

7 J. Kecil 54,000 21,600 2 43,200 9,720 19,440 2,160 4,320 1,080 2,160 2,430 4,860 6,102 12,204 108 216

8 P. Beku 155,000 62,000 - - 27,900 - 6,200 - 3,100 - 6,975 - 17,515 - 310 -

9 FNAB 168,000 67,200 2 134,400 30,240 60,480 6,720 13,440 3,360 6,720 7,560 15,120 18,984 37,968 336 672

### Sitologi 3 serial 70,000 28,000 - - 12,600 - 2,800 - 1,400 - 3,150 - 7,910 - 140 -

### Sitologi Cairan 72,000 28,800 1 28,800 12,960 12,960 2,880 2,880 1,440 1,440 3,240 3,240 8,136 8,136 144 144

### Laringoscope 105,000 42,000 3 126,000 18,900 56,700 4,200 12,600 2,100 6,300 4,725 14,175 11,865 35,595 210 630

### Endoscopy 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 -

### Apendicogram 50,000 20,000 - - 9,000 - 2,000 - 1,000 - 2,250 - 5,650 - 100 -

### Colonoscopy 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 -

### Gastrocopy 150,000 60,000 - - 27,000 - 6,000 - 3,000 - 6,750 - 16,950 - 300 -

### Gastrduodenoscpy 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 -

### Esophagusduodenos 350,000 140,000 - - 63,000 - 14,000 - 7,000 - 15,750 - 39,550 - 700 -

### Fistulagrafi 70,000 28,000 - - 12,600 - 2,800 - 1,400 - 3,150 - 7,910 - 140 -

### Cholesistografi 150,000 60,000 - - 27,000 - 6,000 - 3,000 - 6,750 - 16,950 - 300 -

### Uretrografi 85,000 34,000 - - 15,300 - 3,400 - 1,700 - 3,825 - 9,605 - 170 -

### USG 60,000 24,000 22 528,000 10,800 237,600 2,400 52,800 1,200 26,400 2,700 59,400 6,780 149,160 120 2,640

### Barium Enema 62,500 25,000 3 75,000 11,250 33,750 2,500 7,500 1,250 3,750 2,813 8,438 7,063 21,188 125 375

### IVP + BNO 180,000 72,000 - - 32,400 - 7,200 - 3,600 - 8,100 - 20,340 - 360 -

### Abdomen 3 Posisi 55,000 22,000 1 22,000 9,900 9,900 2,200 2,200 1,100 1,100 2,475 2,475 6,215 6,215 110 110

### Colon In Loop 62,500 25,000 - - 11,250 - 2,500 - 1,250 - 2,813 - 7,063 - 125 -

JUMLAH - 11,641,200 5,238,540 1,164,120 582,060 1,309,635 3,288,639 58,206

11,641,200

OPERASI BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dr. Nilai Dokter Nilai Kembali ke Nilai Kembali ke Nilai Prwt Umum Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.

Pelayanan Operator Anesthesi Prwt OK Kembali Prwt Anesthe Kembali Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 48.75% Dr.Operator 16.25% Dr. Anesthesi 3.00% Prwt OK 2% Prwt Anesth 7.50% Prwt Umum 22.00% 0.50%

1 Kelompok I 1,500,000 600,000 23 13,800,000 292,500 6,727,500 97,500 2,242,500 18,000 414,000 12,000 276,000 45,000 1,035,000 132,000 3,036,000 3,000 69,000

Kelompok I ( 60 %) 900,000 360,000 2 720,000 175,500 351,000 58,500 117,000 10,800 21,600 7,200 14,400 27,000 54,000 79,200 158,400 1,800 3,600

2 Kelompok II 2,000,000 800,000 11 8,800,000 390,000 4,290,000 130,000 1,430,000 24,000 264,000 16,000 176,000 60,000 660,000 176,000 1,936,000 4,000 44,000

Kelompok II ( 60 % ) 1,200,000 480,000 - - 234,000 - 78,000 - 14,400 - 9,600 - 36,000 - 105,600 - 2,400 -

3 Kelompok III 3,000,000 1,200,000 14 16,800,000 585,000 8,190,000 195,000 2,730,000 36,000 504,000 24,000 336,000 90,000 1,260,000 264,000 3,696,000 6,000 84,000

3 Kelompok III ( 60 % 1,800,000 720,000 - - 351,000 - 117,000 - 21,600 - 14,400 - 54,000 - 158,400 - 3,600 -

4 Kel. Khusus 2 4,000,000 1,600,000 - - 780,000 - 260,000 - 48,000 - 32,000 - 120,000 - 352,000 - 8,000 -

5 Kel. Khusus 1 5,000,000 2,000,000 5 10,000,000 975,000 4,875,000 325,000 1,625,000 60,000 300,000 40,000 200,000 150,000 750,000 440,000 2,200,000 10,000 50,000

JUMLAH 55 50,120,000 24,433,500 8,144,500 1,503,600 1,002,400 3,759,000 11,026,400 250,600

50,120,000

ASKES ICU/ICCU BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dokter Nilai Kembali ke Nilai Perawat Nilai Labor Nilai Lab JP Non Nilai JP Non Kompensasi Nilai Komp.

Pelayanan Dokter Ruangan Kembali Umum Prwt Sederhana Sederhana Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 47.50% 8.50% ke Rgn 11.25% Umum 4.00% 28.25% 0.50%

1 ICU / NICU 450,000 180,000 11 1,980,000 85,500 940,500 15,300 168,300 20,250 222,750 7,200 79,200 50,850 559,350 900 9,900

2 ICCU 500,000 200,000 3 600,000 95,000 285,000 17,000 51,000 22,500 67,500 8,000 24,000 56,500 169,500 1,000 3,000

3 H C U 210,000 84,000 10 840,000 39,900 399,000 7,140 71,400 9,450 94,500 3,360 33,600 23,730 237,300 420 4,200

- 3,420,000 1,624,500 290,700 384,750 136,800 966,150 17,100

3,420,000 3,420,000

TINDAKAN RAWAT INAP ASKES BULAN MARET 2011

NO Jenis Klaim JP 40 % Kasus Nilai JP Dokter Nilai Kembali ke Nilai Perawat Nilai JP Non Nilai JP Non Kompensasi Nilai Komp.

Pelayanan Dokter Rgn/ Pl Kembali Umum Prwt Fgs + Non Prwt Fgs + Non Prwt PKS PKS

40% 60% 5% ke Rgn / Pl 11.25% Umum 23.25% 0.50%

1 PAKET III A 37,500 15,000 98 1,470,000 9,000 882,000 750 73,500 1,688 165,375 3,488 341,775 75 7,350

2 PAKET III B 90,000 36,000 70 2,520,000 21,600 1,512,000 1,800 126,000 4,050 283,500 8,370 585,900 180 12,600

3 PAKET III C 300,000 120,000 13 1,560,000 72,000 936,000 6,000 78,000 13,500 175,500 27,900 362,700 600 7,800

PAKET III C 60 % 180,000 72,000 - - 43,200 - 3,600 - 8,100 - 16,740 - 360 -

4 Partus Normal 450,000 180,000 4 720,000 108,000 432,000 9,000 36,000 20,250 81,000 41,850 167,400 900 3,600

5 Pervaginam 850,000 340,000 - - 204,000 - 17,000 - 38,250 - 79,050 - 1,700 -

6,270,000 3,762,000 313,500 705,375 1,457,775 31,350 6,270,000

HAEMODIALISA

NO Jenis Klaim Nilai Jumlah Tindakan JP 40 % Nilai JP Nilai HD Perawat Nilai JP Non fgs +

Pelayanan Klaim Pasien 80% Umum ( 10%) Non Prwt ( 10%)

1 BULAN FEBR 2011 150,000 150,000 1 1 60,000 60,000 48,000 6,000 6,000

2 BULAN MARET 2011 160,000 25,760,000 20 161 64,000 10,304,000 8,243,200 1,030,400 1,030,400

JUMLAH 25,910,000 21 124,000 10,364,000 8,291,200 1,036,400 1,036,400

10,364,000

DAFTAR PENERIMAAN DAN PEMBAYARAN JASA ASKES SOSIAL BULAN JANUARI 2011

NO BULAN PENERIMAAN JASA PELAYANAN URUT PELAYANANAN (100 %)

1 ASKES SOSIAL FEBRUARI 2011 Rp 638,170,500 Rp 255,268,200

2 HAEMODIALISA BULAN FEBRUARI 2011 Rp 150,000 Rp 60,000

TOTAL Rp 638,320,500 Rp 255,328,200 PAJAK Rp 26,835,406

JUMLAH JASA PELAYANAN Rp 228,492,794

Terbilang : Dua ratus dua puluh sembilan juta empat ratus dua puluh satu ribu lima ratus empat puluh satu rupiah

Bukittinggi, 1 JUNI 2011

A.n. Direktur Menyetujui : Mengetahui : Bendahara

Wadir Umum dan Keuangan Kabag Akuntansi dan Atasan Langsung Bendaharawan Manajemen

Dr. YUN EFIANTINA, MM R O S I T A . M MARDIYETTY. Z E F R I A N I

NIP. 140 255 270 NIP.19551107 198009 2 001 NIP. 140 156 443 NIP. 410 036 407

REKAPITULASI DISTRIBUSI PEMBAGIAN JASA ASKES BULAN MARET 2011

NO KELOMPOK RAWAT INAP RAWAT TINDAKAN OPERASI ICU HAEMODIALISA JUMAH

RAWATAN LUAR PAKET JALAN RAWAT JALAN RAWAT INAP

1 Dr. Dpesialis 38,865,400 5,238,540 29,854,800 15,615,000 3,762,000 24,433,500 1,624,500 - 119,393,740

2 Dr.Umum dan Apt 4,572,400 1,164,120 6,634,400 - - - - - 12,370,920

3 Kembali ke ruangan 7,773,080 582,060 3,317,200 1,301,250 313,500 - 290,700 - 13,577,790

4 Perawat Umum 10,287,900 1,309,635 7,463,700 2,927,813 705,375 3,759,000 384,750 1,036,400 27,874,573

5 Labor Sederhana 3,657,920 - - - - - 136,800 - 3,794,720

6 Dr. Operator - - - - - - - - -

7 Dr. Anesthesi - - - - - 8,144,500 - - 8,144,500

8 Perawat OK - - - - - 1,503,600 - - 1,503,600

9 Perawat Anesthesi - - - - - 1,002,400 - - 1,002,400

10 JP Non Fungsional 25,834,060 3,288,639 18,742,180 6,050,813 1,457,775 11,026,400 966,150 1,036,400 68,402,416

11 Kompensasi PKS 457,240 58,206 331,720 130,125 31,350 250,600 17,100 - 1,276,341

12 Haemodialisa - - - - - - - 8,291,200 8,291,200

JUMLAH 91,448,000 11,641,200 66,344,000 26,025,000 6,270,000 50,120,000 3,420,000 10,364,000 265,632,200


Ket: Nilai Klaim ke PT ASKES 638,170,500 Wadir Umum dan Setuju Kabag Akuntansi Bendahara Nilai Klaim HD 150,000 Keuangan dan Manajemen Jumlah 638,320,500

Jp 40 % 255,328,200 Nilai yang dibagikan 265,632,200 Selisih (10,304,000)

Dr. Yun Efiantina, MM R O S I T A . M Efriani Nip. 140 255 270 NIP.19551107 198009 2 001 NIP. 410 036 407

URAIAN PENERIMAAN ASKES RAWAT INAP KELOMPOK TINDAKAN RUANGAN BULAN : MARET 2011

NO RUANGAN JUMLAH JASA JUMLAH PAJAK TERIMA TANDA

KASUS 15% BERSIH TANGAN

1 R. NEORO 2 9,000 18,000 2,700 15,300

2 R. KLAS INTERNE 29 9,000 261,000 39,150 221,850

3 R. JANTUNG 1 9,000 9,000 1,350 7,650

4 R. BEDAH PRIA - 9,000 - - -

5 R. KEBIDANAN - 9,000 - - -

6 R. MATA - 9,000 - - -

7 R. BAYI 3 9,000 27,000 4,050 22,950

8 R. THT 1 9,000 9,000 1,350 7,650

9 R. BEDAH WANITA - 9,000 - - -

10 R. ANAK - 9,000 - - -

11 R. PARU 32 9,000 288,000 43,200 244,800

12 R. AMBUN SURI - 9,000 - - -

13 R. VIP KHUSUS 29 9,000 261,000 39,150 221,850

14 R. I C U 1 9,000 9,000 1,350 7,650

15 U G D - 9,000 - - -

16 R. INTERNE PRIA - 9,000 - - -

17 R. INTERNE WANITA - 9,000 - - -

18 PRE OP - 9,000 - - -

98 882,000 132,300 749,700

Ketua Pelaksana Harian Atasan Langsung Bukittinggi, 1 JUNI 2011PPATRS Bendaharawan Bendahara

Dra. Triza Yenni, Apt.MSc. MARDIYETTY.Z E F R I A N I Nip. Nip. 140 156 443 Nip. 410 036 407

PENERIMAAN JM ASKES RAWAT INAP DOKTER PENUNJANG MEDIS

BULAN : MARET 2011

NO URAIAN KASUS JASA JUMLAH PAJAK TERIMA BERSIH TTD

15%

I Rontgen Canggih

1 USG 13 10,800 140,400 21,060 119,340

2 Barium Enema 3 11,250 33,750 5,063 28,688

3 Cholesistographi - 27,000 - - -

4 Abd 3 Posisi 1 9,900 9,900 1,485 8,415

5 IVP - 32,400 - - -

6 Colon In Lop - 11,250 - - -

7 Rontgen Sederhana 51 9,000 459,000 68,850 390,150

JUMLAH 68 643,050 96,458 546,593

II Labor PA -

1 Sitologi cairan 1 12,960 12,960 1,944 11,016

2 J. Sedang 17 11,700 198,900 29,835 169,065

3 J. Besar 13 14,040 182,520 27,378 155,142

4 J. Kecil 2 9,720 19,440 2,916 16,524

5 FNAB 2 30,240 60,480 9,072 51,408

6 Cairan Pleura - 14,040 - - -

JUMLAH 35 474,300 71,145 403,155

III Lab. Klinik Luar Paket - 1 2,857,590 428,639 2,428,952

JUMLAH - 1 2,857,590 428,639 2,428,952

IV FISIOTHERAPI 57 21,600 1,231,200 184,680 1,046,520

JUMLAH 57 1,231,200 184,680 1,046,520

-

V U S G RUANGAN K I 9 10,800 97,200 14,580 82,620

JUMLAH 9 97,200 14,580 82,620

VI LARINGOSCOPY

3 18,900 56,700 8,505 48,195

JUMLAH 3 - 56,700 8,505 48,195

VI ECG/PII C

R. NEORO 7 8,100 56,700 8,505 48,195

R. KLAS INTERNE 25 8,100 202,500 30,375 172,125

R. JANTUNG 17 8,100 137,700 20,655 117,045

R. BEDAH WANITA 1 8,100 8,100 1,215 6,885

R. AMBUN SURI 8 8,100 64,800 9,720 55,080

R. ANAK - 8,100 - - -

R. VIP KHUSUS 33 8,100 267,300 40,095 227,205

R. Pre Op (IGD) 3 8,100 24,300 3,645 20,655

R. MATA ( P II C ) - 8,100 - - -

SLIT LAMP 27 8,100 218,700 32,805 185,895

BIO METRI 7 8,100 56,700 8,505 48,195

TONOMETRI - 8,100 - - -

R. THT - 8,100 - - -

R. INTERNE PRIA - 8,100 - - -

R. I C U - 8,100 - - -

R. KEBIDANAN - 8,100 - - -

R. PARU 7 8,100 56,700 8,505 48,195

R. INTERNE WANITA 2 8,100 16,200 2,430 13,770

JUMLAH 137 1,109,700 166,455 943,245

VI ESOPAGUSDUODENOSCOPI - 63,000 - - -

GASTROCOPY - 63,000 - - -

ENDOSCOPI - 63,000 - - -

JUMLAH - - - -

COLONSCOPY - 63,000 - - -

JUMLAH - - -

TOTAL LUAR PAKET R. INAP 309 6,469,740 970,461 5,499,279

Ketua Pelaksana Harian Atasan Langsung Bukittinggi, 1 JUNI 2011

PPATRS Bendarawan Bendahara Jasa

Dra. Triza Yenni, Apt.MSc. Mardiyetty.Z E f r I a n i

Nip. Nip. 140 156 443 Nip. 410036 407

URAIAN PENERIMAAN ASKES RAWAT INAP

KELOMPOK TINDAKAN HAEMODIALISA

BULAN : MARET 2011

NO Jenis Klaim Nilai Jumlah Tindakan JP 40 % Nilai JP Nilai HD PAJAK Pajak TANDA

Pelayanan Klaim Pasien 80% TANGAN

1 HD Bulan Februari 2011 150,000 150,000 1 1 60,000 60,000 48,000 7,200 Rp 40,800

1 HD Bulan Maret 2011 160,000 25760000 20 161 64,000 10,304,000 8,243,200 1,236,480 5,181,600

JUMLAH 25,910,000 21 162 10,364,000 8,291,200 1,243,680 5,222,400

Bukittinggi, 1 JUNI 2011 Atasan Langsung

Bendarawan BENDAHARA JASA

Mardiyetty.Z EFRIANI Nip. 140 156 443 NIP. 410 036 407

SETORAN PAJAK JASA PELAYANAN ASKES BULAN MARET 2011

NO KELOMPOK TERIMA SEBELUM JML PAJAK TERIMA BERSIH

PAJAK

1 - Dr. Spesialis rawat jalan 45,469,800 6,820,470 38,649,330

2 - Dr. Spesialis rawat inap + operator + anestesi 74,764,300 11,214,645 63,549,655

3 - Dr. spesialis penunjang medis rawat inap 6,469,740 970,461 5,499,279

4 - Tindakan ruangan rawat inap 882,000 132,300 749,700

5 Dr. Umum 12,370,920 1,266,320 11,104,600

6 Kembali ke Ruangan Perawat + Labor Sederhana 17,372,510 392,756 16,979,754

7 - Perawat Anestesi 1,002,400 51,169 951,231

8 - Perawat OK 1,503,600 57,099 1,446,501

9 Perawat Umum 27,874,573 833,477 27,041,096

10 Jasa Pelayanan Non Fungsional 68,402,416 3,661,577 64,740,839

11 Konpensasi PKS 1,276,341 191,451 1,084,890

12 Haemodialisa 8,291,200 1,243,680 7,047,520

Total 265,679,800 26,835,406 238,844,394

Ket : Nilai Klaim ke PT ASKES 638,170,500 Nilai Klaim HD 150,000 Jumlah 638,320,500

Jp 40 % 255,328,200 Nilai yang dibagikan 265,679,800 Selisih (10,351,600)

Bukittinggi, 1 JUNI 2011Ketua Pelaksana Harian ATASAN LANGSUNG BENDAHARA JASA

PPATRS

Dra.Triza yeni,APT,Msc MARDIYETTY, Z EFRIANINip. 140 319 015 NIP. 140 156 443 NIP. 410 036 407

PENERIMAAN JASA MEDIS Dr SPESIALIS RAWAT INAP ASKES BULAN MARET 2011

NO DOKTER JUMLAH PAJAK TERIMA BERSIH TTD TERIMA 15%

1 RUANG VIP KHUSUS1 Dr. Khairullah, Sp.PD 2,843,300 426,495 2,416,805 2 Dr. Syafrudin Tamar, Sp.PDKV 904,400 135,660 768,740 3 Dr. Delsi hidayat Sp ORT - - - 4 Dr. Arsil Hamzah, Sp B 357,100 53,565 303,535 5 Dr. Erinaldi, Sp B Ort - - - 6 Dr. Zeno F ,Sp Keb 519,200 77,880 441,320 `7 Dr. Husdal Badri,Sp 258,400 38,760 219,640 8 Dr. Sabrina,Sp P 395,000 59,250 335,750 9 Dr. Azwir Dahlan, Sp.PD 1,356,800 203,520 1,153,280

10 Dr. Firman Abd ,Sp Keb 215,400 32,310 183,090 11 Dr. Hj. Yunita, Sp.PD 484,500 72,675 411,825 12 Dr. Metrizal , Sp A 64,600 9,690 54,910 13 Dr. Amilus Ismail, Sp.S 661,300 99,195 562,105 14 Dr. Linda Evanita, Sp PDd 489,600 73,440 416,160 15 Dr. Anbiar Manjas, Sp.B - - - 16 Dr. Hardy AR ,SP S 868,700 130,305 738,395 17 Dr. Khairul Said,Sp M - - -

JUMLAH 9,418,300 1,412,745 8,005,555

2 RUANG AMBUN SURI1 Dr. Erinaldi, Sp Ort 766,400 114,960 651,440 2 Dr.Husdal Badri , Sp B.sy 572,900 85,935 486,965 3 Dr. Amilus Ismail, Sp S - - - 4 Dr. Anbiar Manjas, Sp.B 10,009,400 1,501,410 8,507,990 5 Dr. Pelsi S,Sp OG Onk - - - 6 Dr. Delsi Hidayat, Sp Ort 2,313,500 347,025 1,966,475 7 Dr. Arsil Hamzah.Sp B 3,736,900 560,535 3,176,365 8 Dr. Taufik Hidayat, Sp.P 129,200 19,380 109,820 9 Dr. Hj. Yunita 323,000 48,450 274,550

10 Dr. Sabrina Sp P 166,600 24,990 141,610 11 Dr. Khairullah Sp Pd 200,600 30,090 170,510 12 Dr. Syafrudin Tamar. Sp PDKV - - - 13 Dr.Firman Abdullah, Sp OG 1,868,800 280,320 1,588,480 14 Dr. Supriadi ,Sp U 4,898,100 734,715 4,163,385 15 Dr. Rahmiyetti,Sp A 285,600 42,840 242,760

JUMLAH 25,271,000 3,790,650 21,480,350

3 R. KLAS INTERNE 1 Dr. Khairullah, Sp.PD 2,075,700 311,355 1,764,345 2 Dr. Azwir Dahlan. Sp.Pd 919,700 137,955 781,745 3 Dr. Yunita, Sp.PD 2,137,700 320,655 1,817,045 4 Dr. Linda Evanita, Sp Pd 3,851,700 577,755 3,273,945

JUMLAH 8,984,800 1,347,720 7,637,080

4 RUANG SYARAFDr. Amilus , Sp.S 2,274,600 341,190 1,933,410

JUMLAH 2,274,600 341,190 1,933,410

5 RUANG BEDAH WANITA1 Dr. Arsil Hamzah, Sp.B 1,252,900 187,935 1,064,965

JUMLAH 1,252,900 187,935 1,064,965

6 RUANG BEDAH PRIA1 Dr. Arsil Hamzah, Sp.B 2,224,100 333,615 1,890,485

JUMLAH 2,224,100 333,615 1,890,485

7 RUANG THT1 Dr. Mhd. Yunus, SP.THT 96,900 14,535 82,365

2 Dr. Puti Alia, Sp.THT 562,700 84,405 478,295 JUMLAH 659,600 98,940 560,660

8 RUANG BAYI1 Dr. Rahmiyetti, Sp.A 954,900 143,235 811,665

JUMLAH 954,900 143,235 811,665

9 RUANG ANAK1 Dr. Metrizal, Sp.A 1,310,700 196,605 1,114,095 1 Dr. Nazdi, Sp.A - - -

JUMLAH 1,310,700 196,605 1,114,095

10 RUANG MATA1 Dr. Heksan, Sp.M 4,247,300 637,095 3,610,205 2 Dr. Khairul Said, Sp.M - - - 3 Dr. Romi Yusardi,Sp M 935,800 140,370 795,430

JUMLAH 5,183,100 777,465 4,405,635

11 RUANG PARU1 Dr. Sabrina, Sp P 699,900 104,985 594,915 2 Dr.Taufiq H, Sp P 323,000 48,450 274,550 3 Dr. Dedi Herman, Sp P 872,100 130,815 741,285

JUMLAH 1,895,000 284,250 1,610,750

12 RUANG JANTUNG1 Dr. Syafrudin Tamar, Sp.KV 651,100 97,665 553,435

JUMLAH 651,100 97,665 553,435

13 RUANG INTERNE WANITADr Khairullah 248,200 37,230 210,970

JUMLAH 248,200 37,230 210,970

17 RUANG INTERNE PRIA1 Dr.Khairullah - - -

JUMLAH - - -

15 RUANG KEBIDANAN1 Dr. Pelsi Sulaini, Sp.OG.Onk 714,200 107,130 607,070

Dr. Pelsi Sulaini, Sp.OG.Onk 4,254,900 638,235 3,616,665 JUMLAH 4,969,100 745,365 4,223,735

16 RUANG Pre OP1 Dr. Pre OP 96,900 14,535 82,365

JUMLAH 96,900 14,535 82,365

17 RUANG ICU/ICCU1 Dr. ICCU 285,000 42,750 242,250 2 Dr. ICU 940,500 141,075 799,425

JUMLAH 1,225,500 183,825 1,041,675 18 Dr. Anestesi

1 Dr. Anestesi 8,144,500 1,221,675 6,922,825 JUMLAH 8,144,500 1,221,675 6,922,825

TOTAL 74,764,300 11,214,645 63,549,655

Ketua Pelaksana Harian Atasan Langsung Bukittinggi, 1 JUNI 2011 PPTRS Bendarawan Bendahara

Dra.Triza yeni,APT,Msc Mardiyetty.Z E f r i a n i Nip. 140 319 015 Nip. 410036407

JASA PELAYANAN ASKES Distribusi JP Non Fungsional Bulan : MARET 2011

No Uraian Persentase Nilai Yg dibagi Jumlah Pembagi Pajak 15% Terima Bersih

1 Biaya Umum ( Setor ke Bend. RS ) 15.0% 68,402,416 10,260,362 - 10,260,362

2 Pengelola PPATRS 25.0% 68,402,416 17,100,604 2,071,738 15,028,866

3 Bag. Keu , Verifikasi & klaim terkait 3.5% 68,402,416 2,394,085 215,468 2,178,617

4 Ka. Instalasi 3.0% 68,402,416 2,052,072 230,975 1,821,097

5 Komite Medis dan Perawatan 1.0% 68,402,416 684,024 102,604 581,421

6 Kabid/Kabag 3.5% 68,402,416 2,394,085 6 322,774 2,071,311

7 Kasie 7.5% 68,402,416 5,130,181 21 256,509 4,873,672

8 Farmasi 7.5% 68,402,416 5,130,181 52 91,793 5,038,389

9 Loket Pembayaran 3.5% 68,402,416 2,394,085 15 24,938 2,369,146

10 Gizi 7.0% 68,402,416 4,788,169 49 50,884 4,737,285

11 Adm PPATRS 1.0% 68,402,416 684,024 1 - 684,024

12 Insentiv Peg. Askes di RSAM 0.5% 68,402,416 342,012 3 51,302 290,710

13 Lain-lain 22.0% 68,402,416 15,048,532 195 242,593 14,805,938

100.0% 68,402,416 3,661,577 64,740,839


Ketua Pelaksana Harian ATASAN LANGSUNG BENDAHARA JASAPPATRS

Dra.Triza yeni,APT,Msc MARDIYETTY, Z EFRIANI

Nip. 140 319 015 NIP. 140 156 443 NIP. 410 036 407

ASKES BULAN MARET 2011

HONOR PENGELOLA & PELAKSANA PPATRS

NO NAMA URAIAN PROSENTASE NILAI YANG DIBAGI JUMLAH/org PAJAK TERIMA BERSIH TANDA TANGAN

1 Dr. H.SY.HASMI HPS,MM Ketua PPATRS 28.60% 17,100,604 4,890,773 733,616 4,157,157

2 Dr. Khairul Said, Sp.M Wakil Ketua I 14.30% 17,100,604 2,445,386 366,808 2,078,578

3 Dr. Nazdi, Sp.A Wakil Ketua III 14.30% 17,100,604 2,445,386 366,808 2,078,578

4 Dr. Yun Efiantina, MM Wakil Ketua III 14.30% 17,100,604 2,445,386 366,808 2,078,578

5 Dra. TrizaYeni, Apt Ketua Pelaksana Harian 8.20% 17,100,604 1,402,250 210,337 1,191,912

6 Mardiyetty Atasan langsung 3.20% 17,100,604 547,219 27,361 519,858

7 Efriani Bendaharawan JP 3.50% 17,100,604 598,521 - 598,521

7 Isnawati Pembantu Bendahara Jasa 3.10% 17,100,604 530,119 - 530,119

9 Ernitawati Pel. Adm 1 3.50% 17,100,604 598,521 - 598,521

10 Elmiza Fitri, SE Pel. Adm 2 3.50% 17,100,604 598,521 - 598,521

11 Rahmiwati Pel. Adm 3 3.50% 17,100,604 598,521 - 598,521

JUMLAH 100.0% 17,100,604 2,071,738 15,028,866


ATASAN LANGSUNG BENDAHARA JASA

MARDIYETTY, Z EFRIANI

NIP. 140 156 443 NIP. 410 036 407

ASKES BULAN MARET 2011 BAGIAN KEUANGAN, VERIFIKASI DAN KLAIM TERKAIT

No Uraian Persentase Jml yg di bagi Jumlah PAJAK Terima Bersih Tanda Tangan

1 KABID. AKUNTANSI DAN MANAJEMEN 22.5% 2,394,085 538,669 80,800 457,869

2 ELFA YENTI, SE.M.Si KABAG KEUANGAN 22.5% 2,394,085 538,669 80,800 457,869

3 ROSITA.M KASUBAG. VERIFIKASI 19.0% 2,394,085 454,876 22,744 432,132

4 KASUBAG. MOBILISASI DANA 16.0% 2,394,085 383,054 19,153 363,901

5 LINDA EMILIA BENDAHARA LOKET PENERIMA 10.0% 2,394,085 239,408 11,970 227,438

6 YUSDAINAR BENDAHARA PENGELUARAN SWADANA 10.0% 2,394,085 239,408 - 239,408

JUMLAH 100.0% 2,394,085 215,468 2,178,617

JASA MEDIS ASKES SOSIALBULAN : MARET 2011 RUANGAN : KA. INSTALASI

NO N A M A GOL JABATAN PENERIMAAN PAJAK TERIMA

KOTOR 15% & 5 % BERSIH TANDA TANGAN

1 Dr. EUGINA ALIA, Sp.PK IV/A KA.INS. LABOR KLINIK 107,959 16,194 91,765

2 Drg. NUR ICHWAN, SP.ORT IV/C KA.INS. RAWAT JALAN 107,959 16,194 91,765

3 Dr. ARSIL HAMZAH, Sp.B IV/B KA.INS. OK 107,959 16,194 91,765

4 Dr. MHD. YUNUS, SP.THT IV/B KA.INS. BEDAH 107,959 16,194 91,765

5 Dr. KHAIRULLAH, Sp.PD IV/B KA.INS. VIP 107,959 16,194 91,765

6 Dr. YANUEL AZIZ, Sp.RAD IV/B KA.INS. RADIOLOGI 107,959 16,194 91,765

7 Dr. SITI MARYANI, Sp.RM IV/B KA.INS. URM 107,959 16,194 91,765

8 Dr. YAN PITER, Sp.AN IV/A KA.INS. ANESTESI 107,959 16,194 91,765

9 Dr. SALMIAH AGUS, Sp.PA IV KA.INS. LABOR PA 107,959 16,194 91,765

10 Dr. DELSI HIDAYAT, Sp.BO III/D KA.INS. IGD 96,595 4,830 91,765

11 Dr. YUNITA, Sp.PD III/D KA.INS. NON BEDAH 96,595 4,830 91,765

12 TRIZA YENI ,Apt IV/A KA.INS. FARMASI 107,959 16,194 91,765

13 Ns.YUGI YASTININGSIH Sk IV/A KA.INS. IBU DAN ANA 107,959 16,194 91,765

14 ERNAWATI,SKM IV/A KA.INS. IPL 107,959 16,194 91,765

15 Dr. BUDI PATRIA III/B KA.INS. KAMAR JENA 107,959 5,398 91,765

16 RISWEMBI III/C KA.INS. PUSTAKA 107,959 5,398 91,765

17 NOVITA MUTIA III/B KA.INS. GIZI 107,959 5,398 91,765

18 TAUFIK HIDAYAT,S.Si III/B KA.INS. IPS 107,959 5,398 91,765

19 ZULNAYLY III/B KA.INS. WASRAY 107,959 5,398 91,765

20 FIRMAN SYAFEI II/D KA.INS. CCSD 91,765 - 91,765

JUMLAH 2,120,257 230,975 1,835,302

DAFTAR JASA PELAYANAN ASKES

BULAN : MARET 20II

RUANGAN : KABID/KABAG

NO N A M A PENERIMAAN PAJAK PENERIMAAN

KOTOR 15% & 5 % BERSIH TANDA TANGAN

1 Hj.ADRIANI.SKP.M.Kes 406,139 60,921 345,218

2 Hj.Dra.RIDA ERNOLA 406,139 60,921 345,218

3 YASMI,SKP 406,139 60,921 345,218

4 M.SYARIL.SKM 406,139 60,921 345,218

5 LILI HENRAWATI,SKM. 363,388 18,169 345,218

6 Dr. ANBIAR MANJAS, S 406,139 60,921 345,218

JUMLAH 2,394,085 322,774 2,071,311

DAFTAR JASA PELAYANAN ASKES BULAN : MARET 20IIRUANGAN : KASIE/KASUBAG

NO N A M APENERIMAAN PAJAK PENERIMAAN

TANDA TANGANKOTOR 5% BERSIH

1 NIRLIATI, SE 244,294 12,215 232,080

2 HERMON. J .SE 244,294 12,215 232,080

3 MARIATI, SE 244,294 12,215 232,080

4 SASMAWATI, SKM 244,294 12,215 232,080

5 M. THIBRANI, SE 244,294 12,215 232,080

6 ERNIF 244,294 12,215 232,080

7 DESRIZAL,SE 244,294 12,215 232,080

8 WENI ROZALINI,SKM 244,294 12,215 232,080

9 Ns.GUSBET,Skep 244,294 12,215 232,080

10 MURSALMAN,SH.MM 244,294 12,215 232,080

11 FEBRIENTI,SKP 244,294 12,215 232,080

12 Dr. DAVID 244,294 12,215 232,080

13 FERINALDI 244,294 12,215 232,080

14 KRISNA BETI.SH 244,294 12,215 232,080

15 INONG LELI R 244,294 12,215 232,080

16 JAHIDIN 244,294 12,215 232,080

17 Drg. MERRY 244,294 12,215 232,080

18 KASIE KET LOGISTIK 244,294 12,215 232,080

19 KASIE KET.JANGMED 244,294 12,215 232,080

20 KASUBAG RM DAN HUK 244,294 12,215 232,080

21 KASUBID PENG. YAN ME 244,294 12,215 232,080

JUMLAH 5,130,181 256,509 4,873,672

JASA MEDIS ASKES WAJIB BULAN : MARET 20II RUANG : INSTALASI FARMASI

NO NAMA GOL JASA PPH15% JUMLAH YG TANDA

MEDIS TERIMA TANGAN

1 DESNAWATI.R III/D 101,992 5,100 96,892 1

2 ASYULIANTI.A III/A 101,992 5,100 96,892 2

3 DELVIRA III/A 101,992 5,100 96,892 3

4 DESTI HERTAWATI III/a 101,992 5,100 96,892 4

5 GUSIARNI III/C 101,992 5,100 96,892 5

6 HARNEL NAZIR III/B 101,992 5,100 96,892 6

7 HASNI III/D 101,992 5,100 96,892 7

8 ISNEDA H III/D 101,992 5,100 96,892 8

9 KHAIRITA III/A 101,992 5,100 96,892 9

10 LENI SILVIA III/B 101,992 5,100 96,892 10

11 NETI ILYAS III/D 101,992 5,100 96,892 11

12 NOVIYANTI III/A 101,992 5,100 96,892 12

13 RITA YUNIARTI III/D 101,992 5,100 96,892 13

14 ROSWITA III/D 101,992 5,100 96,892 14

15 SUAIDA III/D 101,992 5,100 96,892 15

16 WARDANI III/A 101,992 5,100 96,892 16

17 YURNELY III/D 101,992 5,100 96,892 17

18 FEBRIANTI III/B 101,992 5,100 96,892 18

19 AFRIA SANDAY L II/B 96,892 - 96,892 19

20 AFRIDA II/A 96,892 - 96,892 20

21 AKMAL EMLI II/A 96,892 - 96,892 21

22 DESVA ADRIANI II/B 96,892 - 96,892 22

23 FATMAWATI II/A 96,892 - 96,892 23

24 FAUZIAH II/A 96,892 - 96,892 24

25 IDRA OKTA SAFIRA II/D 96,892 - 96,892 25

26 MARDIA HAYATI II/B 96,892 - 96,892 26

27 MERI SUSANTI II/B 96,892 - 96,892 27

28 NELVIANTI II/B 96,892 - 96,892 28

29 NELY AZMI II/A 96,892 - 96,892 29

30 NENGSI R.Z II/B 96,892 - 96,892 30

31 NILA NILAM SARI II/C 96,892 - 96,892 31

32 NURASMAH II/B 96,892 - 96,892 32

33 RAHMI SURYANI II/B 96,892 - 96,892 33

34 RENI FEBRIANTI II/B 96,892 - 96,892 34

35 SANTI VIVIANI II/D 96,892 - 96,892 35

36 SRI FRIOLA DEWI II/C 96,892 - 96,892 36

37 WENI SULASTRI II/B 96,892 - 96,892 37

38 YANITA II/A 96,892 - 96,892 38

39 YULIA DONA II/D 96,892 - 96,892 39

40 YULIAR II/C 96,892 - 96,892 40

41 YURIZA AMIR II/B 96,892 - 96,892 41

42 ZUNIARTI 96,892 - 96,892 42

43 ALDO RIKO K 96,892 - 96,892 43

44 MEGA PURNAMA S 96,892 - 96,892 44

45 MUTRI NINGSIH 96,892 - 96,892 45

46 NELLY OKTAVIANI 96,892 - 96,892 46

47 NILA KARMILA 96,892 - 96,892 47

48 SUCI SUKMA PUTRI 96,892 - 96,892 48

49 SYUKRINA S, Apt 96,892 - 96,892 49

50 SOVIA 96,892 - 96,892 50

51 SUSILAWATI 96,892 - 96,892 51

52 AMIZAR 96,892 - 96,892 52

5,130,181 91,793 5,038,389


Ka Instalasi Farmasi

Drs. SAFITRI, APT.M.Si

JASA MEDIS ASKES WAJIB

BULAN : MARET 20II

BAGIAN : LOKET PEMBAYARAN

NO N A M A PENERIMAA PAJAK PENERIMAAN

KOTOR JM 5% JM BERSIH TANDA TANGAN

1 SANIUS 166,256 8,313 157,943

2 RENI SUKMAWATI 166,256 8,313 157,943

3 ELVIRA CANDRA 166,256 8,313 157,943

4 ERITAWARNI 157,943 157,943

5 YOSSI ELVIA 157,943 157,943

6 LINDA SRI W 157,943 157,943

7 HERLINA UMAR 157,943 157,943

8 NURUL IMARNI 157,943 157,943

9 NURAFNI 157,943 157,943

10 ELVI PRIMUS 157,943 157,943

11 MAWARNI 157,943 157,943

12 TRI SUCI 157,943 157,943

13 ASMIDAR 157,943 157,943

14 MARIA SIREGAR 157,943 157,943

15 MERI KURNIA SAR 157,943 157,943

JUMLAH 2,394,085 24,938 2,369,146

TANDA TANGAN

JASA MEDIS ASKES WAJIB

BULAN : MARET 20II

RUANGAN : INSTALASI GIZI

NO NAMA GOL JASA PPH 5% JUMLAH YG TANDA

MEDIS TERIMA TANGAN

1 NOVITA MUTIA III/B 101,768 5,088 96,679

2 KHAIRUNNAS III/D 101,768 5,088 96,679

3 WAZIRATUL ISRAL III/B 101,768 5,088 96,679

4 DELIZARTI III/B 101,768 5,088 96,679

5 EFIZAL III/A 101,768 5,088 96,679

6 ROIDA.S III/A 101,768 5,088 96,679

7 PAGAR.T III/A 101,768 5,088 96,679

8 SAFITRI RAMADANI III/A 101,768 5,088 96,679

9 DEWI M. SARI III/A 101,768 5,088 96,679

10 JUMRINI III/A 101,768 5,088 96,679

11 FITRI ANIDA II/D 96,679 - 96,679

12 YUSMANIZAR II/A 96,679 - 96,679

13 DESRIATI II/D 96,679 - 96,679

14 GUSTINA II/D 96,679 - 96,679

15 NELWATI II/A 96,679 - 96,679

16 DELFI ARIANI II/C 96,679 - 96,679

17 JONI ANDRI I/C 96,679 - 96,679

18 MEIZENTI II/A 96,679 - 96,679

19 AIDA FITRI I/A 96,679 - 96,679

20 NURHAYATI I/A 96,679 - 96,679

21 JURETNO 96,679 - 96,679

22 ZALINA 96,679 - 96,679

23 NURSYAMSI I/A 96,679 - 96,679

24 ROSMANETI I/C 96,679 - 96,679

25 ELFIRA II/A 96,679 - 96,679

26 NOVRI HELMI II/A 96,679 - 96,679

27 YENITA II/A 96,679 - 96,679

28 HARNI.SISWANTI II/A 96,679 - 96,679

29 SARIFAH II/A 96,679 - 96,679

30 BETI II/A 96,679 - 96,679

31 HARNI YUSNETI II/A 96,679 - 96,679

32 RISNAWATI II/A 96,679 - 96,679

33 ZULFIA II/A 96,679 - 96,679

34 ANEM KOMARIA II/A 96,679 - 96,679

35 NELY ISNAINI II/A 96,679 - 96,679

36 YUSRIZA I/A 96,679 - 96,679

37 ZAHARA 96,679 - 96,679

38 BETRIA I/C 96,679 - 96,679

39 ANLISA II/A 96,679 - 96,679

40 YELNITA II/A 96,679 - 96,679

41 ZULAINI II/A 96,679 - 96,679

42 WISDAYANTI II/A 96,679 - 96,679

43 DESI ERLINDA II/A 96,679 - 96,679

44 GUSNAINI II/A 96,679 - 96,679

45 KEMALA SARI II/ 96,679 - 96,679

46 NELA RAHMAWATI 96,679 - 96,679

47 ELVIRA SAFRINA 96,679 - 96,679

48 NOVI SURYATI 96,679 - 96,679

49 DESI MUSTIKA SARI 96,679 - 96,679

4,788,169 50,884 4,737,285


Ka.INSTALASI GIZI

DAFTAR JASA PELAYANAN ASKES DOKTER UMUM DAN APOTEKERBULAN MARET 2011

NO N A M A PENERIMAAN PAJAK 15 % JUMLAH TANDA TANGAN

1 Dr.HERMAN SETIAWAN IV/D 635,669 95,350 540,319

2 Dr.EMMIYATI ASWARIE IV/C 635,669 95,350 540,319

3 Dr.ZARNI IV/C 635,669 95,350 540,319

4 Dr.ERIDA DARWIS IV/A 635,669 95,350 540,319

5 Drg.HERLINA IV/C 635,669 95,350 540,319

6 Drg.DIANA T.Z IV/A 635,669 95,350 540,319

7 Drg IRA FEMINA III/D 568,757 28,438 540,319

8 Dr.BUDI PATRIA III/B 568,757 28,438 540,319

9 Dr. DAVID III/C 568,757 28,438 540,319

10 Dr. ORIANA HESTI D. III/B 568,757 28,438 540,319

11 ZERA MENDOZA III/B 568,757 28,438 540,319

12 Dr.FAJRIANSYAH III/B 568,757 28,438 540,319

13 Dr. FERDI FAISAL III/B 568,757 28,438 540,319

14 Dr. JARMILA ELMACO III/B 568,757 28,438 540,319

15 Dr. VERA YULIA III/B 568,757 28,438 540,319

16 Dr. MUHAMMAD ADAM P III/B 568,757 28,438 540,319

17 Dr. ANDRI BOY III/B 568,757 28,438 540,319

18 Dra. Triza Yenni, Apt.M. IV 635,669 95,350 540,319

19 Drs. Zamril, Apt IV 635,669 95,350 540,319

20 Drs Safitri, Apt.M.Si IV 635,669 95,350 540,319

21 Dra. Elly Zein, Apt IV 635,669 95,350 540,319

Jumlah 12,613,020 1,266,320 11,346,700

PENERIMAAN JASA ASKES Dr. POLIKLINIK RAWAT JALAN BULAN MARET 2011

NO POLI TINDAKAN KASUS 45% JUMLAH PAJAK TERIMA BERSIH TTD

TERIMA 15%

1 POLI SYARAF P I 184 2,340 430,560 64,584 365,976

JUMLAH 184 - 430,560 64,584 365,976

2 POLI INTERNE P I 895 2,340 2,094,300 314,145 1,780,155

II C 48 8,100 388,800 58,320 330,480

JUMLAH 943 - 2,483,100 372,465 2,110,635

3 POLI JANTUNG P I 720 2,340 1,684,800 252,720 1,432,080

II C 720 8,100 5,832,000 874,800 4,957,200

JUMLAH 1,440 - 7,516,800 ### 6,389,280

4 I G D P I UGD 207 3,960 819,720 122,958 696,762

P I Biasa 43 2,340 100,620 15,093 85,527

II C 114 8,100 923,400 138,510 784,890

III A 79 9,000 711,000 106,650 604,350

III B 2 ### 43,200 6,480 36,720

III C 9 ### 648,000 97,200 550,800

One Day Care - ### - - -

JUMLAH 454 - 3,245,940 486,891 2,759,049

5 POLI MATA

0 P I 428 2,340 1,001,520 150,228 851,292

II C 428 8,100 3,466,800 520,020 2,946,780

0 P I - 2,340 - - -

II C - 8,100 - - -

JUMLAH 856 - 4,468,320 670,248 3,798,072

6 POLI KEBIDANAN P I 95 2,340 222,300 33,345 188,955

III A 29 9,000 261,000 39,150 221,850

JUMLAH 124 483,300 72,495 410,805

7 POLI THT - - -

P I 227 2,340 531,180 79,677 451,503

II C 1 8,100 8,100 1,215 6,885

III A 122 9,000 1,098,000 164,700 933,300

JUMLAH 350 1,637,280 245,592 1,391,688

8 POLI ANAK P I 37 2,340 86,580 12,987 73,593

III A 3 9,000 27,000 4,050 22,950

-

JUMLAH 40 113,580 17,037 96,543

9 POLI KULIT P I 133 2,340 311,220 46,683 264,537

JUMLAH 133 311,220 46,683 264,537

10 POLI BEDAH P I 565 2,340 1,322,100 198,315 1,123,785

III A 67 9,000 603,000 90,450 512,550

III B 4 ### 86,400 12,960 73,440

III C - ### - - -

JUMLAH 636 2,011,500 301,725 1,709,775

11 POLI PARU P I 146 2,340 341,640 51,246 290,394

II C - 8,100 - - -

III A - 9,000 - - -

JUMLAH 146 341,640 51,246 290,394

12 POLI JIWA P I 127 2,340 297,180 44,577 252,603

III A 127 9,000 1,143,000 171,450 971,550

JUMLAH 254 1,440,180 216,027 1,224,153

13 POLI GIGI P I 96 2,340 224,640 33,696 190,944

III A 52 9,000 468,000 70,200 397,800

III B 7 ### 151,200 22,680 128,520

III C 1 ### 72,000 10,800 61,200

-

JUMLAH 156 915,840 137,376 778,464

14 LABOR II A 471 5,400 2,543,400 381,510 2,161,890

C EA - ### - - -

Luar Paket RJ - 4,054,230 608,135 3,446,096

JUMLAH 471 6,597,630 989,645 5,607,986

15 FISIOTERAPI P I 174 2,340 407,160 61,074 346,086

III B 477 ### ### ### 8,757,720

JUMLAH 651 ### ### 9,103,806

16 RADIOLOGI II B 142 9,000 1,278,000 191,700 1,086,300

USG 31 ### 334,800 50,220 284,580

APPENDIGRAM 2 9,000 18,000 2,700 15,300

BA ANEMA 1 ### 11,250 1,688 9,563

I V P + B N O - ### - - -

CYSROGRAM 1 ### 14,400 2,160 12,240

JUMLAH 175 1,656,450 248,468 1,407,983

17 GIZI P I 8 2,340 18,720 2,808 15,912

-

JUMLAH 8 18,720 2,808 15,912

18 LABOR PA - -

FNAB 20 ### 604,800 90,720 514,080

BIOPSI J. BESAR 4 ### 56,160 8,424 47,736

BIOPSI J SEDANG 15 ### 175,500 26,325 149,175

BIOPSI J KECIL - 9,720 - - -

SITOLOGI CAIRAN 2 ### 25,920 3,888 22,032

CAIRAN PLEURAL - ### - - -

SISTOGRAFI - ### - - -

PAP SMEAR 4 9,000 36,000 5,400 30,600

POTONG BEKU - ### - - -

JUMLAH 45 898,380 134,757 763,623

19 U S G

Poli kebidanan - ### - - -

### - - -

JUMLAH ### - - -

20 - Esophagusduodenoscopy

- Dr Azwir Dahlan,SpPD - ### - - -

- Dr Yunita,SpPD - ### - - -

JUMLAH - - - -

21 U S G K I

- ### - - -

JUMLAH - - - -

LARINGOSCOPY 10 ### 189,000 28,350 160,650

JUMLAH 189,000 28,350 160,650

TOTAL 7,066 ### ### 38,649,330

Ketua Pelaksana Harian ATASAN LANGSUNG BENDAHARA JASAPPATRS

SDra. Trizayeni, APT.MSc MARDIYETTY, Z EFRIANI

Nip. 140 319 015 NIP. 140 156 443 NIP. 410 036 407

DAFTAR PENGEMBALIAN KE RUANGAN

JASA ASKES BULAN MARET 2011

NO RUANGAN KEMBALI JUMLAH JML PEG JML PAJA JML PEG JML PAJA TOTAL TERIMA TANDA

KE RUANGAN PEMBAGI GOL III GOL 3 GOL IV GOL 4 PAJAK BERSIH TANGAN

1 POLI BEDAH 204,350 3 3 10,218 - - 10,218 194,133

2 POLI INTERNE 275,900 5 4 11,147 - - 11,147 264,753

3 POLI KEBIDANAN 46,450 3 3 2,323 - - 2,323 44,128

4 POLI ANAK & BAYI 11,870 3 2 381 1 638 1,019 10,851

5 POLI KULIT & KEL 34,580 2 2 1,729 - - 1,729 32,851

6 POLI SYARAF 47,840 3 3 2,392 - - 2,392 45,448

7 POLI MATA 496,480 4 3 18,854 - - 18,854 477,626

8 POLI JANTUNG 835,200 3 3 41,760 - - 41,760 793,440

9 POLI T H T 151,420 3 1 2,611 - - 2,611 148,809

10 POLI PARU 37,960 4 3 1,442 - - 1,442 36,518

11 POLI JIWA 128,270 3 3 6,414 - - 6,414 121,857

12 U G D 321,710 24 11 7,578 - - 7,578 314,132

13 POLI GIGI 82,560 5 5 4,128 - - 4,128 78,432

14 POLI GIZI 2,080 1 1 104 - - 104 1,976

15 FISIOTERAFI 903,840 8 4 23,175 - - 23,175 880,665

16 RADIOLOGI 255,500 10 5 6,551 - - 6,551 248,949

17 LABOR PA 152,520 5 3 4,669 - - 4,669 147,851

18 RUANG T H T 159,970 6 3 4,102 - - 4,102 155,868

19 RUANG I C C U 220,050 12 9 8,356 - - 8,356 211,694

20 RUANG C W 55,640 12 4 959 - - 959 54,681

21 RUANG C P 155,380 12 3 2,018 - - 2,018 153,362

22 RUANG KEBIDANAN 498,460 25 16 16,243 - - 16,243 482,217

23 RUANG BAYI 176,430 13 6 4,184 - - 4,184 172,246

24 RUANG I P - 8 4 - - - - -

25 KLAS INTERNE 1,849,370 16 3 18,072 - - 18,072 1,831,298

26 RUANG NEORO 502,320 13 6 11,913 - - 11,913 490,407

27 RUANG PARU 406,780 11 8 14,996 - - 14,996 391,784

28 RUANG ANAK 262,140 10 4 5,405 - - 5,405 256,735

29 RUANG MATA 270,600 6 4 9,173 - - 9,173 261,427

30 RUANG JANTUNG 146,270 7 4 4,271 - - 4,271 141,999

31 RUANG VIP C. MATO 1,508,770 19 4 16,384 1 13,734 30,118 1,478,652

32 RUANG AMBUN SURI 2,252,980 22 8 42,309 - - 42,309 2,210,671

33 RUANG I W 51,440 8 5 1,638 - - 1,638 49,802

34 PRE OP 22,080 1 1 1,104 - - 1,104 20,976

35 LABOR 4,845,300 21 6 71,782 - - 71,782 4,773,518

JUMLAH 17,372,510 311 157 378,384 2 14,372 392,756 ### -

37 RUANGAN ANASTHES 1,002,400 16 13 40,678 1 10,492 51,169 951,231

38 OK SENTRAL 1,503,600 24 18 57,099 - - 57,099 1,446,501

Jumlah 2,506,000 40 31 97,776 1 10,492 108,268 2,397,732

JASA MEDIS ASKES WAJIB BULAN FEBRUARI 2011

PETUGAS ASKES

NO NAMA GOL JASA MEDIS TANDA

PENERIMAAN PAJAK BERSIH TANGAN

1 Drg. Ayu metriza 114,004 17,101 96,903

2 Reni 114,004 17,101 96,903

3 Rani Fitillah Apt 114,004 17,101 96,903

JUMLAH 342,012 51,302 290,710

-

Yang Menerima

………………

PENERIMAAN JASA ASKES BULAN FEBRUARI 2011 KOMPENSASIRUANG POLI MATA

NO NAMA DOKTER TERIMA PAJAK 15 % TERIMA BERSIH TANDA TANGAN

1 Dr. Khairul Said, Sp.M

Streak Retinoscopy 663,697 99,555 564,143

2 Dr. Heksan

Streak Retinoscopy 612,644 91,897 520,747

1,276,341 191,451 1,084,890

Ketua Pelaksana Harian Atasan Langsung 0PPATRS Bendahawaran Bendahara

Dra. Trizayeni, APT.MSc MARDIYETTY.Z EFRIANINip. 140 319 015 Nip. 140 156 443 Nip.410 036 407

REKAP PEMBAGIAN JASA PELAYANAN PERAWAT UMUM ASKES BLN: MARET 2011

NO RUANGAN JUMLAH JUMLAHTERIMA PAJAK JUMLAHTERIMA JUMLAHPAJAK / JUMLAH TERIMA/ JUMLAH TANDA

YG DIBAGI PEMBAGI GOL III GOL III GOL III GOL IV GOL IV ORG PAJAK ORANG TERIMA TANGAN

1 R. AMBUN SURI 1,918,639 22 90,077 4,504 8 - - - 36,031 85,573 1,882,608

2 R. C P 1,040,389 12 90,077 4,504 3 - - - 13,512 85,573 1,026,877

3 R. T H T 526,950 6 90,077 4,504 3 - - - 13,512 85,573 513,439

4 R. VIP KHUSUS 1,659,005 19 90,077 4,504 4 ### 1 15,101 33,117 85,573 1,625,889

5 R. ANASTESI 1,442,821 16 90,077 4,504 13 ### 1 15,101 73,651 85,573 1,369,169

6 R. ANAK 873,746 10 90,077 4,504 4 - - - 18,015 85,573 855,731

7 R. BAYI 1,139,473 13 90,077 4,504 6 - - - 27,023 85,573 1,112,450

8 R. I P 702,600 8 90,077 4,504 4 - - - 18,015 85,573 684,585

9 R. KLAS INTERN 1,382,681 16 90,077 4,504 3 - - - 13,512 85,573 1,369,169

10 R. MATA 531,454 6 90,077 4,504 4 - - - 18,015 85,573 513,439

11 R. PARU 977,335 11 90,077 4,504 8 - - - 36,031 85,573 941,304

12 R. I W 707,104 8 90,077 4,504 5 - - - 22,519 85,573 684,585

13 R. JANTUNG 617,027 7 90,077 4,504 4 - - - 18,015 85,573 599,012

14 R. NEOROLOGI 1,139,473 13 90,077 4,504 6 - - - 27,023 85,573 1,112,450

15 R. KEBIDANAN 2,211,389 25 90,077 4,504 16 - - - 72,062 85,573 2,139,327

16 R. ICCU 1,067,412 12 90,077 4,504 9 - - - 40,535 85,573 1,026,877

17 R. C W 1,044,892 12 90,077 4,504 4 - - - 18,015 85,573 1,026,877

18 R. OK SENTRAL 2,134,823 24 90,077 4,504 18 - - - 81,069 85,573 2,053,754

19 U G D 2,103,296 24 90,077 4,504 11 - - - 49,542 85,573 2,053,754

20 POLI BEDAH 270,231 3 90,077 4,504 3 - - - 13,512 85,573 256,719

21 P. KULIT 180,154 2 90,077 4,504 2 - - - 9,008 85,573 171,146

22 POLI JIWA 270,231 3 90,077 4,504 3 - - - 13,512 85,573 256,719

23 POLI SYARAF 270,231 3 90,077 4,504 3 - - - 13,512 85,573 256,719

24 POLI ANAK 280,828 3 90,077 4,504 2 ### 1 15,101 24,109 85,573 256,719

25 POLI GIGI 450,385 5 90,077 4,504 5 - - - 22,519 85,573 427,865

26 POLI MATA 355,804 4 90,077 4,504 3 - - - 13,512 85,573 342,292

27 POLI INTERNE 445,881 5 90,077 4,504 4 - - - 18,015 85,573 427,865

28 POLI JANTUNG 270,231 3 90,077 4,504 3 - - - 13,512 85,573 256,719

29 POLI PARU 355,804 4 90,077 4,504 3 - - - 13,512 85,573 342,292

30 POLI KEBIDANAN 270,231 3 90,077 4,504 3 - - - 13,512 85,573 256,719

31 POLI THT 261,223 3 90,077 4,504 1 - - - 4,504 85,573 256,719

32 POLI KARYAWAN 180,154 2 90,077 4,504 2 - - - 9,008 85,573 171,146

33 MPK 261,223 3 90,077 4,504 1 - - - 4,504 85,573 256,719

34 HEAMODIALISA 360,308 4 90,077 4,504 4 - - - 18,015 85,573 342,292

35 PSIKOLOGI 85,573 1 90,077 4,504 0 - - - - 85,573 85,573

36 P. JENAZAH 85,573 1 90,077 4,504 0 - - - - 85,573 85,573

Jumlah 27,874,573 316 - 175 ### 3 833,477 27,041,096

316

s

JASA MEDIS ASKES WAJIB BULAN MARET 2011

RUANGAN AMBUN SURI



1 Ns. ARFIDA, S.Kep III/D 90,077 4,504 85,573

2 Ns. ZULFA. S.Kep IIIC 90,077 4,504 85,573

3 MAIYUNIZAR III/B 90,077 4,504 85,573

4 HASTUTI RATNASARI III/B 90,077 4,504 85,573

5 ZUARNI III/B 90,077 4,504 85,573

6 ERMANELI U III/B 90,077 4,504 85,573

7 NENI KRISNAWATI III/C 90,077 4,504 85,573

8 YENI ZIARITA III/A 90,077 4,504 85,573

9 RISKA DEWI II/C 85,573 - 85,573

10 YULIANA RAHMADENI 85,573 - 85,573

11 FEBRIA NOVITA II/C 85,573 - 85,573

12 RIZKA IPRIYULIA II/C 85,573 - 85,573

13 ARIE SYAHRINI II/C 85,573 - 85,573

14 HERLINA II/C 85,573 - 85,573

15 RINI FAUZI YETTY II/C 85,573 - 85,573

16 WATI MULIA 85,573 - 85,573

17 GEFRI LIDIYA 85,573 - 85,573

18 GUSTI MUTIA 85,573 - 85,573

19 RESTI YULINAS PUTRI 85,573 - 85,573

20 RITA HENITA 85,573 - 85,573

21 MARISA 85,573 - 85,573

22 YOKTRISIA WELZI 85,573 - 85,573

JUMLAH 1,918,639 36,031 1,882,608

Bukittinggi, 1 JUNI 2011 Yang Menerima

…………………………….

JASA MEDIS ASKES WAJIB BULAN MARET 2011 RUANGAN BEDAH PRIA



1 Ns.WETRIATI,S Ke III/D 90,077 4,504 85,573

2 HATMIYANTI III/B 90,077 4,504 85,573

3 ZURYENTI III/B 90,077 4,504 85,573

4 ANDRA HAYU 85,573 - 85,573

5 HILDA YANTI II/C 85,573 - 85,573

6 YETNIWATI II/C 85,573 - 85,573

7 NELVIA 85,573 - 85,573

8 ELSYA MARIA,AM II/C 85,573 - 85,573

9 LILI SURYALNI ,A II/C 85,573 - 85,573

10 STEVANI AYUTRI II/C 85,573 - 85,573

11 YOVI SYAFNOVEL 85,573 - 85,573

12 YANTI 85,573 - 85,573

JUMLAH 1,040,389 13,512 1,026,877


Yang Menerima

------------------------------


RUANGAN T H T



1 DODI ZARTINI III/D 90,077 4,504 85,573

2 YENI TRIPUTRI III/D 90,077 4,504 85,573

3 KARTINI SARI III/D 90,077 4,504 85,573

4 ALMI RAHMIWATI II/D 85,573 - 85,573

5 REFLI JUNAIDI II/C 85,573 - 85,573

6 RAHMIWATI 85,573 - 85,573

TOTAL 526,950 13,512 513,439


Yang Menerima

------------------------------


RUANGAN V I P KHUSUS



1 Ns.ROSMAIZAR,Skep IV 100,674 15,101 85,573

2 YENITA ROZA, S.Kep III/D 90,077 4,504 85,573

3 RAHMI YULIS, S.Kep III/C 90,077 4,504 85,573

4 LAILA AZMI III/B 90,077 4,504 85,573

5 YETTI SRINOVA III/B 90,077 4,504 85,573

6 RISE ANDRIANI II/C 85,573 - 85,573

7 YENI MARLINA II/C 85,573 - 85,573

8 PIPIT RAHMAWATI 85,573 - 85,573

9 FITRINA 85,573 - 85,573

10 ADE ISRAYUNI 85,573 - 85,573

11 IRMALENI 85,573 - 85,573

12 NURAFIANA II C 85,573 - 85,573

13 LUSI FEBRIANTI II C 85,573 - 85,573

14 FADILAH RISKA U II C 85,573 - 85,573

15 DEVI YUSMA II C 85,573 - 85,573

16 FITRA II C 85,573 - 85,573

17 EKA LUSIANA II C 85,573 - 85,573

18 SAMSUL HUDA 85,573 - 85,573

19 YENTI 85,573 - 85,573

JUMLAH 1,659,005 33,117 1,625,889


------------------------------

JASA MEDIS ASKES WAJIB BULAN MARET 2011 RUANGAN ANESTHESI



1 Ns.YASNI, S. Kep IV/a 100,674 15,101 85,573

2 JUNAIDI III/D 90,077 4,504 85,573

3 FARIDA SOFNI III/D 90,077 4,504 85,573

4 DESWITA AZHAR III/D 90,077 4,504 85,573

5 OPRIADI III/C 90,077 4,504 85,573

6 YOSI SARFINA III/D 90,077 4,504 85,573

7 INDRA SONI III/C 90,077 4,504 85,573

8 ZAHARI III/D 90,077 4,504 85,573

9 EKA SRIWAHYUNI III/A 90,077 4,504 85,573

10 HENDRI EKA PUTR III/B 90,077 4,504 85,573

11 KHAIRUL IKHWAN III/B 90,077 4,504 85,573

12 MULHENDRA III/A 90,077 4,504 85,573

13 JONI SUHERI III/B 90,077 4,504 85,573

14 TETI MUNIR III/C 90,077 4,504 85,573

15 MISNAR II/A 85,573 85,573

16 MILA VESRA 85,573 85,573

- -

JUMLAH 1,442,821 73,651 1,369,169


------------------------------


RUANGAN ANAK



1 NS. ADRIANI, SKEP III/D 90,077 4,504

85,573

2 RESWARNI, AMD. KEP III/c 90,077 4,504

85,573

3 SRIWAHYUNI III/B 90,077 4,504

85,573

4 SUSI DEWI YANTI, S. KEP III/B 90,077 4,504

85,573

5 RITA.TRIWARNI, AMD. KEP 85,573 85,573

6 YENNI SUSILAWATI. AMK II/C 85,573 85,573

7 ENNIYUSNITA, AMK II/C 85,573 85,573

8 HAMNITES, AMD.Kep 85,573 85,573

9 YULIA NINGSIH, AMK II/C 85,573 85,573

10 MARVITA ZULVIANIS, AMD.KEP 85,573 85,573

JUMLAH 873,746 18,015 855,731


------------------------------


RUANGAN BAYI



1 ELFIDA III/D 90,077 4,504 85,573

2 BULKIS III/B 90,077 4,504 85,573

3 LINA MARWITA III/D 90,077 4,504 85,573

4 MENTI SINAGA III/D 90,077 4,504 85,573

5 SOFNI SYAFRIL III/D 90,077 4,504 85,573

6 BETRI YULIS III/C 90,077 4,504 85,573

7 ADABIYAH II/C 85,573 - 85,573

8 YEALNI LIFNINUR II/C 85,573 85,573

9 NELWITA 85,573 85,573

10 WELMIRA YANTI 85,573 85,573

11 EFRIANI 85,573 85,573

12 NIDYA DIRAMAYANA IIC 85,573 85,573

13 MAIMA DARMAYANTI IIC 85,573 85,573

JUMLAH 1,139,473 27,023 1,112,450


------------------------------


RUANGAN INTERNE PRIA



1 Ns. ANDRIYANI, S.Kep III/d 90,077

4,504 85,573

2 YASNI III/C 90,077

4,504 85,573

3 SUSANA SUSILAWATI III/B 90,077

4,504 85,573

4 HESI YOSFITA III/B 90,077

4,504 85,573

5 RISMAYENI 85,573 - 85,573

6 INDRA FIRMAN II/C 85,573 - 85,573

7 RAHMAYANTI AZMI II/C 85,573 - 85,573

8 RIKA SAFITRI II/C 85,573 - 85,573

JUMLAH 702,600 18,015 684,585


------------------------------


RUANGAN KLAS INTERNE



1 Ns. SUSI SUSANTI,Skep III/B 90,077 4,504 85,573

2 EMIDAR III/C 90,077 4,504 85,573

3 RENI SUSANTI, SKp III/B 90,077 4,504 85,573

4 DIANA NOVRITA II/D 85,573 - 85,573

5 SITI ZAHARNI II/C 85,573 - 85,573

6 DORSIS FORDIATI II/C 85,573 - 85,573

7 WELI KOMALA SARI 85,573 - 85,573

8 ASNETI 85,573 - 85,573

9 MIRA FEBRIANTI 85,573 - 85,573

10 DELMI ZEBUA II/C 85,573 - 85,573

11 RINA SANDRA SEWI 85,573 - 85,573

12 SUSI AFRIANI II/A 85,573 - 85,573

13 WETNI RULIZA II/D 85,573 - 85,573

14 ENDANG LESTARI II/C 85,573 - 85,573

15 DIAN TUTUPIKA 85,573 - 85,573

16 MELLISOLINA II/C 85,573 - 85,573

JUMLAH 1,382,681 13,512 1,369,169


------------------------------


RUANGAN MATA



1 ELI USMAN III/D 90,077 4,504

85,573

2 DESWITA III/C 90,077 4,504

85,573

3 HERAWATI ZALMA III/C 90,077 4,504

85,573

4 ELISTRI NELHUDA III/B 90,077 4,504

85,573

5 EVA YULIARTI II/C 85,573 -

85,573

6 RINI NOVITASARI 85,573 -

85,573

JUMLAH 531,454 18,015 513,439


------------------------------


RUANGAN PARU



1 Ns. YON ANWAR Ske III/D 90,077

4,504 85,573

2 SADIMA III/D 90,077

4,504 85,573

3 ENNI FEBRIANTI III/C 90,077

4,504 85,573

4 SYAFNI HARTINI III/C 90,077

4,504 85,573

5 ROSMAITI III/B 90,077

4,504 85,573

6 YENDRINETA III/A 90,077

4,504 85,573

7 SAFDELINUR III/A 90,077

4,504 85,573

8 SUNIAR III/C 90,077

4,504 85,573

9 EKA VERAWATI,AMK II/C 85,573 - 85,573

10 POPI SULASTRI II/C 85,573 - 85,573

11 GUSTINA DEWI 85,573 - 85,573

JUMLAH 977,335 36,031 941,304


------------------------------


RUANGAN INTERNE WANITA



1 DA.ANNIWITRANURSANTI III/D 90,077

4,504 85,573

2 FETMAWATI III/C 90,077

4,504 85,573

3 HASNIDAR III/D 90,077

4,504 85,573

4 ENNI GUSNITA III/B 90,077

4,504 85,573

5 DESYONA III/B 90,077

4,504 85,573

6 YULIANTI II/C 85,573 - 85,573

7 DANTI 85,573 - 85,573

8 YOSI YOLANDA 85,573 85,573

JUMLAH 707,104 22,519 684,585


------------------------------

JASA MEDIS ASKES WAJIB BULAN MARET 2011 RUANGAN JANTUNG



1 ROSDIANA. L III/D 90,077 4,504 85,573

2 YURBAINI III/D 90,077 4,504 85,573

3 SAFNIDAR III/D 90,077 4,504 85,573

4 ASMURNI III/C 90,077 4,504 85,573

5 YOSWITA EDWINA 85,573 - 85,573

6 AFRIA SARI DEWI 85,573 - 85,573

7 LENI NOVIARTI 85,573 - 85,573

JUMLAH 617,027 18,015 599,012


------------------------------

JASA MEDIS ASKES WAJIB BULAN MARET 2011 RUANGAN NEOROLOGI



1 Ns.NEFI ELFIKA,Skep III/D 90,077 4,504 85,573

2 ELIAFRIDA SAFYANTI III/C 90,077 4,504 85,573

3 ELMALIA III/B 90,077 4,504 85,573

4 Ns.YOSEFINA, S.Kep III/C 90,077 4,504 85,573

5 LILI ISWARI II/D 85,573 - 85,573

6 LENI MARLINA 85,573 - 85,573

7 WIDIA YUWITRI II/c 85,573 - 85,573

8 RITA DAMAI YANTI 85,573 - 85,573

9 YEYI ERDAWATI 85,573 - 85,573

10 YUNIZAR HERAWATI II/C 85,573 - 85,573

11 ELVIA DEWITA II/C 85,573 - 85,573

12 TISMAWATI (BLN JAN 20 III/D 90,077 4,504 85,573

13 TISMAWATI(BLN Febr 20 III/D 90,077 4,504 85,573

JUMLAH 1,139,473 27,023 ###


------------------------------

JASA MEDIS ASKES WAJIB BULAN MARET 2011 RUANGAN KEBIDANAN



1 AFIFAH III/D 90,077 4,504 85,573

2 DIAN SAFITRI III/B 90,077 4,504 85,573

3 ZURAIDA, S III/C 90,077 4,504 85,573

4 LAGINAM III/D 90,077 4,504 85,573

5 ELIZARTI III/C 90,077 4,504 85,573

6 YARMANIARTI III/D 90,077 4,504 85,573

7 ASMIWARTI III/D 90,077 4,504 85,573

8 YUSNELI III/D 90,077 4,504 85,573

9 AFDALELI III/D 90,077 4,504 85,573

10 NELHAYATI III/C 90,077 4,504 85,573

11 HENDRI WATI III/B 90,077 4,504 85,573

12 ARYATI III/C 90,077 4,504 85,573

13 JASMIAH III/A 90,077 4,504 85,573

14 MURNIATI III/D 90,077 4,504 85,573

15 SUGIARTI III/B 90,077 4,504 85,573

16 FIFIFACHRI III/A 90,077 4,504 85,573

17 NOVRIANTI II/D 85,573 - 85,573

18 OKTAVIANA M S II/A 85,573 - 85,573

19 ELVA MUTIA II/C 85,573 - 85,573

20 MERIZA.S II/C 85,573 - 85,573

21 LUSI AMRAWATI II/A 85,573 - 85,573

22 DIAN TRA METTA II/C 85,573 - 85,573

23 NOVI ARMA II/C 85,573 - 85,573

24 WIDYA EKA PETRI II/C 85,573 - 85,573

25 LIDYA WIZASARI II/C 85,573 - 85,573

JUMLAH 2,211,389 72,062 2,139,327


------------------------------

JASA MEDIS ASKES WAJIB BULAN MARET 2011 RUANGAN ICU / ICCU



1 Ns.MISFATRIA,N SKep III/C 90,077 4,504 85,573

2 GUSFIA NORITA III/B 90,077 4,504 85,573

3 ERLINDA III/B 90,077 4,504 85,573

4 TESSY MEGAWATI III/B 90,077 4,504 85,573

5 ANITAWILIS III/C 90,077 4,504 85,573

6 ZULKIFLI III/B 90,077 4,504 85,573

7 YENNI FITRINA III/D 90,077 4,504 85,573

8 NORA SUNARSIH III/B 90,077 4,504 85,573

9 MASNITA III/B 90,077 4,504 85,573

10 DESWITRI, Amd.Kep II/C 85,573 - 85,573

11 YUSI YUSMAN II/C 85,573 - 85,573

12 MULHARDI II/C 85,573 - 85,573

JUMLAH 1,067,412 40,535 1,026,877


------------------------------


RUANGAN BEDAH WANITA



1 Ns.DESNAWATI, S Kep III/D 90,077 4,504 85,573

2 MEIRIDA III/D 90,077 4,504 85,573

3 DARNA III/D 90,077 4,504 85,573

4 ROSMAITA III/D 90,077 4,504 85,573

5 JUNIARTI 85,573 - 85,573

6 ZURYATI 85,573 85,573

7 VERAWATI 85,573 85,573

8 SEFTRINA DEWITA 85,573 85,573

9 WELVY MARTHANIUS II/C 85,573 85,573

10 ABDUL HAFIZ II/C 85,573 85,573

11 IRA TRISNAWATI II/C 85,573 85,573

12 ERNAWATI, AMD.Kep II/C 85,573 85,573

JUMLAH 1,044,892 18,015 1,026,877


------------------------------


RUANGAN OK CENTRAL



1 DARMIATY III/D 90,077 4,504 85,573

2 YUHARTINI III/D 90,077 4,504 85,573

3 RIRI SUSANTI III/D 90,077 4,504 85,573

4 ELLI SOLFIDA III/D 90,077 4,504 85,573

5 YUTISMA III/C 90,077 4,504 85,573

6 ROSNAINI III/C 90,077 4,504 85,573

7 JONI RAHMAT III/D 90,077 4,504 85,573

8 SUSMITA III/C 90,077 4,504 85,573

9 SRI RAHAYU III/C 90,077 4,504 85,573

10 INDRA YENI III/C 90,077 4,504 85,573

11 HERMAN GUSNADI III/B 90,077 4,504 85,573

12 DEWI DESWITA III/C 90,077 4,504 85,573

13 ALFAJRI III/A 90,077 4,504 85,573

14 JONI KURNIAWAN III/A 90,077 4,504 85,573

15 AFRIYENI III/C 90,077 4,504 85,573

16 MAINIL GUSTI III/D 90,077 4,504 85,573

17 TILVIWATI III/B 90,077 4,504 85,573

18 NOVA ANGGRAINI III/A 90,077 4,504 85,573

19 RAHMAN JUNAIDI II/C 85,573 - 85,573

20 NURLIANTI 85,573 - 85,573

21 ADI WANDRA II/A 85,573 - 85,573

22 HENDRI DARMAYANT II/C 85,573 85,573

23 DASNIMAR 85,573 85,573

24 FITRIA SUSANTI 85,573 85,573

JUMLAH 2,134,823 81,069 2,053,754


…………………….


RUANGAN U G D



1 Ns.RENI MULYANTI, S.Kep III/D 90,077 4,504

85,573

2 ISMAIZAR RAMLI, AMK III/D 90,077 4,504

85,573

3 ELVI ISMAIL III/D 90,077 4,504

85,573

4 USWATUL HUSNI, AMK III/B 90,077 4,504

85,573

5 RIYANTI III/C 90,077 4,504

85,573

6 DARMILIS III/B 90,077 4,504

85,573

7 ERLIWATI III/D 90,077 4,504

85,573

8 ALMIATI III/D 90,077 4,504

85,573

9 EVI MARLENI III/B 90,077 4,504

85,573

10 Ns. EVAWANI ELISA, S.Kep III/A 90,077 4,504

85,573

11 DARNIL YANTI III/A 90,077 4,504

85,573

12 DESI KASRINETA II/C 85,573 - 85,573

13 SYAFRIEDI II/C 85,573 - 85,573

14 SILFIANDRI I/C 85,573 - 85,573

15 AMRIZAL I/A 85,573 - 85,573

16 DASRIL I/A 85,573 - 85,573

17 DINA, AMD.KEP II/A 85,573 - 85,573

18 NURLELI, AMD.KEP II/C 85,573 - 85,573

19 NOVA ANGRAINI, AMD.KEP 85,573 - 85,573

20 YUHELMI, AMD.KEP 85,573 - 85,573

21 HERI ISMANTO 85,573 - 85,573

22 ADE SURYANI II/C 85,573 - 85,573

23 YOGI SUWITO 85,573 - 85,573

24 RIKO SAPUTRA 85,573 - 85,573

JUMLAH 2,103,296 49,542 2,053,754


………………


POLIKLINIK BEDAH



1 YUNIZAR EDWAR III/D 90,077 4,504 85,573

2 MULFEN EFNALETI III/D 90,077 4,504 85,573

3 RINI INDRIANI III/D 90,077 4,504 85,573

JUMLAH 270,231 13,512 256,719


------------------------------


POLIKLINIK KULIT & KELAMIN



1 WINDAYULFANITA III/D 90,077 4,504 85,573

2 ELFIZON III/B 90,077 4,504 85,573

JUMLAH 180,154 9,008 171,146


------------------------------


POLIKLINIK J I W A



1 NS IFIDRIANSAH S.Kep III/D 90,077 4,504 85,573

2 ROSMIWATI III/D 90,077 4,504 85,573

3 ROSITA RUSLI III/D 90,077 4,504 85,573

JUMLAH 270,231 13,512 256,719


------------------------------


POLIKLINIK SYARAF



1 MURNIYETTI III/D 90,077 4,504 85,573

2 MAIZULFA, S.Kep III/D 90,077 4,504 85,573

3 SUKANDAR III/C 90,077 4,504 85,573

JUMLAH 270,231 13,512 256,719


------------------------------


POLIKLINIK ANAK



1 FATMAWARNI III/D 90,077 4,504 85,573

2 RINTA III/C 90,077 4,504 85,573

3 NIBRAS IV/A 100,674 15,101 85,573

JUMLAH 280,828 24,109 256,719


------------------------------


POLIKLINIK G I G I



1 NURHASANAH III/D 90,077 4,504 85,573

2 NELISABET III/C 90,077 4,504 85,573

3 DESRITA III/C 90,077 4,504 85,573

4 ELFIRA DEVIAN III/a 90,077 4,504 85,573

5 JONNI III/A 90,077 4,504 85,573

JUMLAH 450,385 22,519 427,865


------------------------------


POLIKLINIK M A T A



1 ASNELI DAHLAN III/D 90,077 4,504 85,573

2 RITA SAFITRI III/C 90,077 4,504 85,573

3 NEVI NOVITA III/B 90,077 4,504 85,573

4 RIKA OKTAVIANI II/D 85,573 - 85,573

JUMLAH 355,804 13,512 342,292


------------------------------


POLIKLINIK INTERNE



1 NELLI HERWATI III/D 90,077 4,504 85,573

2 EMMI Z III/D 90,077 4,504 85,573

3 HARLINDA III/C 90,077 4,504 85,573

4 YURLINIS III/C 90,077 4,504 85,573

5 DARWISMAN II/D 85,573 85,573

JUMLAH 445,881 18,015 427,865


------------------------------

JASA MEDIS ASKES WAJIB BULAN MARET 2011 POLIKLINIK JANTUNG



1 RUKSALMI III/D 90,077 4,504 85,573

2 ENNI III/D 90,077 4,504 85,573

3 REFNI YULAIDA III/D 90,077 4,504 85,573

JUMLAH 270,231 13,512 256,719


------------------------------


POLIKLINIK PARU



1 FIRDA ELITA III/D 90,077 4,504 85,573

2 DAHRIL SYAH III/D 90,077 4,504 85,573

3 WIRZAWATI III/D 90,077 4,504 85,573

4 HELMIWATI II/A 85,573 - 85,573

JUMLAH 355,804 13,512 342,292


------------------------------


POLIKLINIK KEBIDANAN



1 INDRESWATI III/D 90,077 4,504 85,573

2 ELIDAR III/D 90,077 4,504 85,573

3 NURDINI III/D 90,077 4,504 85,573

JUMLAH 270,231 13,512 256,719


------------------------------


POLIKLINIK T H T



1 SASTRI NANI III/D 90,077 4,504 85,573

2 DEDI ARIANTO II/D 85,573 - 85,573

3 NOPRITA 85,573 - 85,573

JUMLAH 261,223 4,504 256,719


------------------------------


POLIKLINIK KARYAWAN



1 YUSBAIBAR III/D 90,077 4,504 85,573

2 SAMSUHAWALIS III/B 90,077 4,504 85,573

JUMLAH 180,154 9,008 171,146


------------------------------


POLI MPK



1 SULASTRI III/D 90,077 4,504 85,573

2 DESI SUSANTI II/A 85,573 - 85,573

3 MAIYAR II/B 85,573 - 85,573

JUMLAH 261,223 4,504 256,719


------------------------------


RUANGAN HAEMODALISA



1 SAFLIMAILIZA III/D 90,077 4,504 85,573

2 EKA GUSTI III/C 90,077 4,504 85,573

3 DESRIWANTI III/C 90,077 4,504 85,573

4 LILIA FEBRITA III/A 90,077 4,504 85,573

JUMLAH 360,308 18,015 342,292


………………………………..


RUANGAN ; PERAWATAN JENAZAH



1 IDHAM II/A 85,573 - 85,573

JUMLAH 85,573 - 85,573


………………………………..


POLIKLINIK PSIKOLOGI



1 RINALDI II/C 85,573 - 85,573

JUMLAH 85,573 - 85,573


………………………………..

PERAWAT KANTOR DOKTER KABAG KA.INS

JML KENA PJK GOL 4 3 2 10 5 11 JML KENA PJK GOL 3 175 54 11 1 8 TIDAK KENA PAJAK 138 139 - - 1 JUMLAH 316 195 21 6 20

JML KENA PJK GOL 4 4 2 12 6 13 JML KENA PJK GOL 3 184 57 12 1 8 TIDAK KENA PAJAK 138 139 - - 1

326 198 23 7 22

UANG DIBAGI 27,874,573 15,048,532 12,613,020 2,394,085 2,052,072 JML KENA PJK GOL 4 100,674 89,327 635,669 406,139 107,959 JML KENA PJK GOL 3 90,077 79,924 568,757 363,388 96,595 TIDAK KENA PAJAK 85,573 75,928 540,319 345,218 91,765

FARMASI GIZI LOKET LABOR KLINIK

- - - 1 18 10 3 5 34 39 12 15 52 49 15 21

- - - 1 19 11 3 5 34 39 12 15 53 50 15 21

5,130,181 4,788,169 2,394,085 1,726,614 113,991 113,740 185,815 94,746 101,992 101,768 166,256 84,772 96,892 96,679 157,943 80,534

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : SOPIR


KOTOR 5% BERSIH TANDA TANGAN

1 RIFLEN 75,928 75,928

2 ERIZAL 75,928 75,928

3 ZULKIFLI 75,928 75,928

4 DEDI SUKANTO 75,928 75,928

5 ANTON BACTIAR 75,928 75,928

6 ZUHERMAN 75,928 75,928

JUMLAH 455,567 - 455,567

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN M R



1 MAFRIYET 79,924 3,996 75,928

2 NURHASANAH 79,924 3,996 75,928

3 ERNAWATI 79,924 3,996 75,928

4 DANIL RINALDI 75,928 75,928

5 TRIONO 79,924 3,996 75,928

6 RISA MAFRIYENTI 75,928 75,928

7 DEDI IKLAS 75,928 75,928

8 RAHMAWITA 75,928 75,928

9 YULINAR 75,928 75,928

10 WISNETI 75,928 75,928

11 DESMA ZULFIA 75,928 75,928

12 YUSRIFA 75,928 75,928

13 YULIAR 75,928 75,928

14 KASMIATI 75,928 75,928

15 SUFRIYANTI 75,928 75,928

16 APRIANTO 75,928 75,928

17 DIANI 75,928 75,928

18 SITI ZUBAIDAH 75,928 75,928

19 DODI LESMANA 75,928 75,928

20 DONA AMELIA 75,928 75,928

21 SRI IDAYATI 75,928 75,928

22 MILA NOVIA ANGRAI 75,928 75,928

JUMLAH 1,686,398 15,985 1,670,414

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : CCSD



1 ELFIRMAN SYAFEI 75,928 75,928

2 YANUARIDAS 79,924 3,996 75,928

3 MUKHLIS 79,924 3,996 75,928

4 MARDIANIS 79,924 3,996 75,928

5 SYARIDA 75,928 75,928

6 NAFRIL 75,928 75,928

7 NURWAHYUNI 75,928 75,928

8 ELFAHMI 75,928 75,928

JUMLAH 619,412 11,989 607,423

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : WASRAY

NO N A M A PENERIMAAN PAJAK TERIMA TANDA TANGAN

KOTOR 5% BERSIH

1 ZULNAILY 79,924 3,996 75,928

2 JUMARNI 75,928 75,928

3 NELWATI 75,928 75,928

4 ASNI BUSNITA 75,928 75,928

5 SUARMI 75,928 75,928

6 ERNITA 75,928 75,928

7 ASNIDEWITA 75,928 75,928

8 ERMATATI 75,928 75,928

9 YUSNELI 75,928 75,928

10 MARDIASNI 75,928 75,928

11 NURMI 75,928 75,928

12 USNORA SAFITRI 75,928 75,928

JUMLAH 915,131 3,996 911,135

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : OPERATOR



1 RIKA YAMASITA 75,928 - 75,928

2 JUWARNI 75,928 75,928

3 LILI SURIANI 75,928 75,928

4 MAIGUS JENEDI 75,928 75,928

JUMLAH 303,712 - 303,712

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : I P S



1 TAUFIK HIDAYAT, ST 79,924 3,996 75,928

2 RIGANTA, ST 79,924 3,996 75,928

3 ASMADI 79,924 3,996 75,928

4 ALISIUS PB 79,924 3,996 75,928

5 AGAM TRI W 79,924 3,996 75,928

6 ZAINIR 79,924 3,996 75,928

7 AZHAR 79,924 3,996 75,928

8 BIHOLTER 79,924 3,996 75,928

9 FERNANDES 75,928 75,928

10 SYAFRIYANDI 75,928 75,928

11 MOWALDI 75,928 75,928

12 ISMAIL MARZUKI 75,928 75,928

13 WELDI ARIF 75,928 75,928

14 ELA ANJASMARA 75,928 75,928

15 CANDRA SYAHPUTR 75,928 75,928

16 UNDRIZAL 75,928 75,928

17 DEDI SAPUTRA 75,928 75,928

JUMLAH 1,322,744 31,970 1,290,774

REKAP PEMBAGIAN PARAMEDIS NON PERAWAT JASA MEDIS ASKES WAJIB BULAN JANUARI 2011

NO RUANGAN JML YG JML TERIMA JML GOL PAJAK TERIMA JML GOL PAJAK JML JUMLAH JUMLAH DI BAGI PEMBAGI GOL III III GOL IV IV IV PAJAK TERIMA/ORG TERIMA

1 Bag. Pelayanan 155,852 2 79,924 1 3,996 - - - 3,996 75,928 151,856 2 Perpustakaan 159,848 2 79,924 2 3,996 - - - 7,992 75,928 151,856 3 Diklat 151,856 2 79,924 - 3,996 - - - - 75,928 151,856 4 Bid.Perawatan 235,776 3 79,924 2 3,996 - - - 7,992 75,928 227,784 5 Keuangan 455,567 6 79,924 3,996 - - - - 75,928 455,567 6 Bag, Kepegawaian 627,404 8 79,924 5 3,996 - - - 19,981 75,928 607,423 7 Ban Jang Med - - - - - - - - - - - 8 Bag. Umum 547,480 7 79,924 4 3,996 - - - 15,985 75,928 531,495 9 Perencanaan 387,632 5 79,924 2 3,996 - - - 7,992 75,928 379,639 10 Ustad 303,712 4 - - - - - - 75,928 303,712 11 Akuntansi 307,708 4 79,924 1 3,996 - - - 3,996 75,928 303,712 12 IPAL 472,963 6 79,924 1 3,996 89,327 1 13,399 17,395 75,928 455,567 13 Rumah Tangga 851,192 11 79,924 4 3,996 - - - 15,985 75,928 835,207 14 Sopir 455,567 6 - - - - - - 75,928 455,567 15 Radiologi 779,260 10 79,924 5 3,996 - - - 19,981 75,928 759,279 16 MR 1,686,398 22 79,924 4 3,996 - - - 15,985 75,928 1,670,414 17 Wasray 915,131 12 79,924 1 3,996 - - - 3,996 75,928 911,135 18 Operator 303,712 4 - - - - - - 75,928 303,712 19 Satpam 1,442,630 19 - - - - - 75,928 1,442,630 20 Lab. Klinik 1,623,870 21 79,924 4 3,996 89,327 1 13,399 29,384 75,928 1,594,486 21 TPA 227,784 3 - - - - - - 75,928 227,784 22 CCSD 619,412 8 79,924 3 3,996 - - - 11,989 75,928 607,423 23 URM 623,408 8 79,924 4 3,996 - - - 15,985 75,928 607,423 24 IPS 1,322,744 17 79,924 8 3,996 - - - 31,970 75,928 1,290,774 25 Labor PA 391,628 5 79,924 3 3,996 - - - 11,989 75,928 379,639

TOTAL 15,048,532 195 54 2 242,593 14,805,938

15,048,532 Ketua Pelaksana Harian Atasan Langsung Atasan Langsung Bukittinggi, 1 JUNI 2011

PPTRS Bendarawan Bendarawan Bendahara

Dra.Triza yeni,APT,Msc Mardiyetty.Z Mardiyetty.Z E f r I a n i Nip. 140 319 015 Nip. 140 156 443 Nip. 140 156 443 Nip. 410036 407

JASA MEDIS ASKES WAJIB BULAN : MARET 20II RUANGAN : KANTOR



YAN MED

1 YUSNITA 79,924 3,996 75,928

2 LOLI OKTALESVIA 75,928 75,928

JUMLAH 155,852 3,996 151,856

PUSTAKA

3 RISWEMBI 79,924 3,996 75,928

4 BENI PRISDON,SKM 79,924 3,996 75,928

JUMLAH 159,848 7,992 151,856

DIKLAT

5 HUSNITA 75,928 75,928

6 SUARNA 75,928 75,928

JUMLAH 151,856 151,856

PERAWATAN

7 ARMAIZON 75,928 75,928

8 Ns.NETTI JUSEFA.S ke 79,924 3,996 75,928

9 RIZANETI 159,848 7,992 151,856

JUMLAH 315,700 11,989 303,712

KEUANGAN

9 SULASTRI 79,924 3,996 75,928

10 MERIDAWATI 79,924 3,996 75,928

11 GUSNI ELIZA 79,924 3,996 75,928

12 MELA TANIA 79,924 3,996 75,928

13 DESI MULYA SARI 79,924 3,996 75,928

14 VINA 75,928 - 75,928

JUMLAH 475,548 19,981 455,567

U P

15 NORA CAIRANI 79,924 3,996 75,928

16 EFRIZA,SKM 79,924 3,996 75,928

17 ELFA SUSANTI 79,924 3,996 75,928

18 ABDULLAH GANI,SKM 79,924 3,996 75,928

19 BONI ZULKIFLI 79,924 3,996 75,928

20 DARLINDA EKA PUTRI 75,928 75,928

21 EDIZAL 75,928 75,928

22 WENI HARDINETI 75,928 75,928

JUMLAH 627,404 19,981 607,423

UMUM

23 YUFRIZAL 79,924 3,996 75,928

24 MARLINA, AMK 79,924 3,996 75,928

25 WARSINI 79,924 3,996 75,928

26 ZULMAR, S SOS 79,924 3,996 75,928

27 SUPER SAURI 75,928 75,928

28 RAHMAN SAFRIL 75,928 75,928

29 RAYU ARIFON 75,928 75,928

JUMLAH 547,480 15,985 531,495

PERENCANAAN

30 ERIANTO.SH 79,924 3,996 75,928

31 Ns. YULNOFALDI, S.Kep 79,924 3,996 75,928

32 MELI ROZA 75,928 75,928

33 ARDI 75,928 75,928

34 RIKI SATRIA 75,928 75,928

JUMLAH 387,632 7,992 379,639

USTAD

35 SUHARDI 75,928 75,928

36 RAFIKA HASAN 75,928 75,928

37 HJ.NURMIATI 75,928 75,928

38 ZULKIFLI 75,928 75,928

JUMLAH 303,712 - 303,712

AKUNTANSI

39 SATYA HANIFA, SE 79,924 3,996 75,928

40 ELVA SUSANTI, SE 75,928 75,928

41 IRA NIKMATU ZAKIAH 75,928 75,928

42 SILVIA ANITA 75,928 75,928

JUMLAH 307,708 3,996 303,712

IPAL

43 ERNAWATI 89,327 13,399 75,928

44 LAHARKO, ST 79,924 3,996 75,928

45 ERIZAL 75,928 75,928

46 SALMI YENTI 75,928 75,928

47 SYAMSULBAHRI 75,928 75,928

48 YASRIL MULYADI 75,928 75,928

JUMLAH 472,963 17,395 455,567

RT

49 MUZAHAR 79,924 3,996 75,928

50 IBRAHIM,SH 79,924 3,996 75,928

51 ZALBY,SOS 79,924 3,996 75,928

52 ALI WARINALDI 79,924 3,996 75,928

53 RAMSINI 75,928 75,928

54 TEMI ISMELDI 75,928 75,928

55 BENI AGUSTA S 75,928 75,928

56 RAMADANI AMD 75,928 75,928

57 RIO PUTRA 75,928 75,928

58 WISBERY YOFIST 75,928 75,928

59 YANDRA ZULWENDI 75,928 75,928

JUMLAH 851,192 15,985 835,207

TPA

60 MISNAWATI 75,928 75,928

61 SALMA 75,928 75,928

62 YULIANI 75,928 75,928

JUMLAH 227,784 227,784

TOTAL KANTOR 4,984,678 125,293 4,859,385

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : SATPAM



1 AZWIR 75,928 75,928

2 NAZWIR NOPEN 75,928 75,928

3 MARLAINIS 75,928 75,928

4 YUSRIZAL HENDRIK 75,928 75,928

5 IRSAL 75,928 75,928

6 M.NOOR 75,928 75,928

7 MARJAN DENI 75,928 75,928

8 ARDIPAL 75,928 75,928

9 IDWAN 75,928 75,928

10 SUPRIANATA 75,928 75,928

11 JONIMAR 75,928 75,928

12 YEFRIZAL 75,928 75,928

13 YONHENDRI 75,928 75,928

14 ZULKIFLI 75,928 75,928

15 ZULHELMI 75,928 75,928

16 RAHMAT 75,928 75,928

17 ANDRES FEBRIAN 75,928 75,928

18 DAFRIZAL 75,928 75,928

19 ANDRE PESOLIMA 75,928 75,928

JUMLAH 1,442,630 - 1,442,630

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : LABOR KLINIK

NO NAMA GOL JASA MEDIS PPH15% JUMLAH YG TANDA

& 5% TERIMA TANGAN

1 Dra.ENIKE IV 89,327 13,399 75,928

2 IMELDA ILIAS III 79,924 3,996 75,928

3 DESMAWATI III 79,924 3,996 75,928

4 YULI HERNI III 79,924 3,996 75,928

5 SUHERNI NELIA II 79,924 3,996 75,928

6 YENI SUSIANTI II 75,928 - 75,928

7 MARNI 75,928 - 75,928

8 JAMIARTI II 75,928 - 75,928

9 ZULKIFLI II 75,928 - 75,928

10 ELVIA RIDA II 75,928 - 75,928

11 ARDISMAN II 75,928 - 75,928

12 IDA SRI WAHYUNI II 75,928 - 75,928

13 HUTRIWATI II 75,928 - 75,928

14 RIKA ANGGRAINI II 75,928 - 75,928

15 NELVI YUNITA SARI II 75,928 - 75,928

16 RIKA JUWITA II 75,928 - 75,928

17 HENDRI YADI II 75,928 - 75,928

18 JASMIDA ST 75,928 - 75,928

19 MIRA LOVIKA. 75,928 - 75,928

20 ROZA DELVITA 75,928 - 75,928

21 ROZA DEWITA 75,928 - 75,928

JUMLAH 1,623,870 29,384 1,594,486


KA.INSTALASI

Dra.ENIKE

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : U R M

NO NAMA GOL JASA MEDIS PPH 5% JUMLAH YG TANDA

TERIMA TANGAN

1 SUSESWOYO III/A 79,924 3,996 75,928

2 ERISWANDI III/A 79,924 3,996 75,928

3 ASMAHAYATI III/A 79,924 3,996 75,928

4 ANDAR BASA III/A 79,924 3,996 75,928

5 MULYANTI AZMAR II/C 75,928 - 75,928

6 DESI II/C 75,928 - 75,928

7 ELDA II/A 75,928 - 75,928

8 FITRI II/C 75,928 - 75,928

JUMLAH 623,408 15,985 607,423

Bukittinggi, 1 JUNI 2011yang Menerima

S U S E S W O Y O

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : RADIOLOGI

NO NAMA GOL JASA MEDISPPH 5%JUMLAH YG TANDA

TERIMA TANGAN

1 ALIMARZA III/C 79,924 3,996 75,928

2 TITIK ISMAINI III/B 79,924 3,996 75,928

3 ERLINA BAKTI III/BA 79,924 3,996 75,928

4 ULYA MAKSUM III/A 79,924 3,996 75,928

5 AFDAL III/A 79,924 3,996 75,928

6 KATRIN AFRIADI II/C 75,928 - 75,928

7 RONI SELMA FELSA 75,928 - 75,928

8 AMI RAHMAWATI II/D 75,928 - 75,928

9 HENDRA II/D 75,928 - 75,928

10 MUSLIMATUL HUSNAII/D 75,928 - 75,928

JUMLAH 779,260 19,981 759,279


KARU RADIOLOGI

TASLIM TAURUS

JASA MEDIS ASKES WAJIB BULAN : MARET 20IIRUANGAN : LABOR PA

NO NAMA GOL JASA MEDIS PPH 5% JUMLAH YG TANDA

TERIMA TANGAN

1 MITRAWATI III/A 79,924 3,996 75,928

2 ERNI GINTING III/A 79,924 3,996 75,928

3 DEWI KARTIKA III/A 79,924 3,996 75,928

4 DESI FEBRIYENTI 75,928 - 75,928

5 SURIANA II/A 75,928 - 75,928

JUMLAH 391,628 11,989 379,639


Ka.INSTALASI

MITRAWATI

JM ASKES

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