Daftar Tagihan Klaim Pelayanan Anc/Pnc Peserta JKN Di Pelayanan Dasar

DAFTAR TAGIHAN KLAIM PELAYANAN ANC/PNC PESERTA JKN DI PELAYANAN DASAR
PROPINSI : GORONTALO BULAN : MARET

KABUPATEN : BONE BOLANGO TAHUN : 2016
ANC PNC
NO NAMA PASIEN UMUR ALAMAT NO.KARTU K1 K2 K3 K4 TOTAL KF- 1 KF-2 KN-3
ANC & &
KN- 1 KN-2
1. ASMIYA TAWABA 37 Thn POOWO 000 1237339899 08/10/2015 17/12/2015 31/01/2016 12/03/2016 Rp 200,000 - - -
2. Suriyati Yusuf 36 Thn Poowo Barat 0000 959708676 24/09/2015 08/12/2015 02/02/2016 01/03/2016 Rp 200,000
3. Inaya Limbe 32 Thn Lamu 0000 956915019 05/10/2015 05/01/2016 20/02/2016 15/03/2016 Rp 200,000
4. Siskawati Hamid 36 Thn Poowo Barat 0000 959743888 20/10/2015 13/12/2015 20/01/2016 25/03/2016 Rp 200,000
5. Jainun Daulima 25 Thn Talango 0000 959643314 01/11/2015 05/01/2016 25/02/2016 20/03/2016 Rp 200,000
6. Rahmawati Ismail 21 Thn Poowo Barat 000 1237344985 30/11/2015 15/01/2016 13/02/2016 02/03/2016 Rp 200,000
7. Nurhasni Pakaya 24 Thn Poowo Barat 000 1235097134 25/11/2015 05/01/2016 10/02/2016 08/03/2016 Rp 200,000
8. Rusmin Yusuf 36 Thn Poowo 000 1234500377 10/11/2015 28/12/2015 31/01/2016 01/03/2016 Rp 200,000
9. Rahmawati Umar 23 Thn Poowo Barat 000 1237290412 20/09/2015 15/12/2015 02/02/2016 14/03/2016 Rp 200,000
10. Sari Abjul 36 Thn Dutohe Barat 0000 959477949 10/10/2015 02/01/2016 15/02/2016 20/03/2016 Rp 200,000
11. Nurmila Hasan 23 Thn Dutohe Barat 0000 959478219 05/10/2015 10/01/2016 20/02/2016 17/03/2016 Rp 200,000
12. Darmayanti Saleh 32 Thn Molosifat 0000 961071322 06/09/2015 02/01/2016 13/02/2016 02/03/2016 Rp 200,000
13. Apriyana Yusuf 31 Thn Tanggilingo 0000 959446912 11/11/2015 08/12/2015 12/01/2016 13/03/2016 Rp 200,000
14. Yonarti Bouti 29 Thn Tanggilingo 000 1324414664 08/11/2015 22/12/2015 10/02/2016 02/03/2016 Rp 200,000
15. Nirmawati Limehu 21 Thn Poowo Barat 000 1234690266 20/10/2015 15/12/2015 17/01/2016 06/03/2016 Rp 200,000
16. Sulastri Abdullah 24 Thn Poowo Barat 000 1237324667 27/11/2015 05/12/2015 10/01/2016 10/03/2016 Rp 200,000
PUSKESMAS : KABILA
KF-3 TOTAL JUMLAH

PNC TOTAL
- Rp - Rp 200,000
PROPINSI : GORONTALO BULAN : MARET
ANC PNC
ANC & &
KN- 1 KN-2
17. Nurlan Yahya 24 Thn Oluhuta 000 1235444681 15/09/2015 20/12/2015 25/02/2016 05/03/2016 Rp 200,000 - - -
18. Sofya Kasim 35 Thn Pauwo 000 1235433071 02/12/2015 07/01/2016 10/02/2016 01/03/2016 Rp 200,000
19. Erni Kalila 35 Thn Pauwo 000 1892018204 26/10/2015 02/12/2015 11/02/2016 15/03/2016 Rp 200,000
20. Risna Djibu 37 Thn Pauwo 000 12352529244 11/11/2015 02/12/2015 23/02/2016 02/03/2016 Rp 200,000
21. Yanti Isa 44 Thn Pauwo 000 1235379611 02/12/2015 07/01/2016 02/02/2016 02/03/2016 Rp 200,000
22. Lindawaty Umar 20 Thn Pauwo 000 1970976295 05/10/2015 04/11/2015 16/02/2016 01/03/2016 Rp 200,000
23. Kasmi Karim 31 Thn Pauwo 000 1237169126 - - - - Rp - 2/10/2016 2/13/2015 2/25/2016
24. Sinta Musilu 28 Thn Pauwo 000 1235460892 - - - - Rp - 2/14/2016 2/17/2016 2/26/2016
25. Candra Laila Kadir 37 Thn Oluhuta Utara 000 1236543849 - - - - Rp - 2/6/2016 2/10/2016 3/1/2016
26. Suhartin Ishak 28 Thn Poowo Barat 0000 959748974 - - - - Rp - 2/29/2016 3/3/2016 3/14/2016
27. Noviyanti Daud 28 Thn Poowo Barat 0000 959703783 - - - - Rp - 2/19/2016 2/23/2016 3/13/2016
28. Wiwin Yunus 34 Thn Poowo Barat 000 1235096932 - - - - Rp - 2/12/2016 2/18/2016 3/5/2016
29. Rahma Delanti Karim 23 Thn Poowo Barat 000 1235096695 - - - - Rp - 2/7/2016 2/10/2016 3/1/2016
30.
MENGETAHUI KABILA, 2016

KEPALA PUSKESMAS KABILA PENGAJU KLAIM
MERI SILVANA ADAM, S.KM

NIP. 19830310 201001 2 037
PUSKESMAS : KABILA
KF-3 TOTAL JUMLAH

PNC TOTAL
- Rp - Rp 200,000
3/15/2016 Rp 100,000
3/19/2016 Rp 100,000
3/5/2016 Rp 100,000
3/27/2016 Rp 100,000
3/20/2016 Rp 100,000
3/12/2016 Rp 100,000
3/8/2016 Rp 100,000
KABILA, 2016
PENGAJU KLAIM

NIP. 19830310 201001 2 037
DAFTAR TAGIHAN KLAIM PELAYANAN ANC/PNC PESE
PROPINSI : GORONTALO
KABUPATEN : BONE BOLANGO
ANC
NO NAMA PASIEN UMUR ALAMAT NO.KARTU K1 K2
1. Misra Gani 32 Thn Padengo 000 1235378722 10/12/2015 10/02/2016

2. Yuyun Radjak 22 Thn Poowo Barat 000 1236474415 25/11/2015 05/02/2016
3. Nurlayla Laingo 35 Thn Dutohe 000 1235261024 05/12/2015 05/02/2016
4. Salmin Anwar 35 Thn Tanggilingo 0000 959541478 22/12/2015 15/02/2016
5. Siti Harmia Bakari 28 Thn Poowo Barat 0000 959719116 23/12/2015 15/03/2016
6. Salma Abdullah 22 Thn Toto Selatan 000 1237082073 12/12/2015 03/03/2016
7. Vina S Umar 21 Thn Toto Selatan 0000 956946879 10/11/2015 20/02/2016
8. Salma Kiayi 33 Thn Poowo 000 1234500502 10/11/2015 10/01/2016
9. Yolanda Harun 25 Thn Huyula 000 1149026736 11/12/2015 15/02/2016
10. Sandra Ahmad 19 Thn Poowo Barat 0000 959747308 15/12/2015 18/02/2016
11. Nurjayanti Ali 25 Thn Pauwo 000 1237148897 01/11/2015 18/02/2016
12. Susanti Iki 19 Thn Pauwo 000 1125205391 02/02/2016 21/03/2016
13. Waty Usman 23 Thn Pauwo 0000 139934823 15/01/2016 15/03/2016
14. Apin Abdul Kahar 31 Thn Pauwo 000 2033545678 02/02/2016 02/03/2016
15. Yuniarti Karim 33 Thn Dutohe Barat 000 1237499482 20/10/2015 18/12/2015
16. Sulastri Daud 21 Thn Dutohe Barat 0000 959125072 26/11/2015 17/02/2016
MENGETAHUI
KEPALA PUSKESMAS KABILA
ANAN ANC/PNC PESERTA JKN DI PELAYANAN DASAR
BULAN : MEI PUSKESMAS : KABILA
TAHUN : 2016
ANC PNC
K3 K4 TOTAL KF- 1 KF-2 KN-3 KF-3 TOTAL
ANC & & PNC
KN- 1 KN-2
25/03/2016 11/05/2016 Rp 200,000 - - - - Rp -
15/04/2016 10/05/2016 Rp 200,000 Rp -
15/04/2016 10/05/2016 Rp 200,000 Rp -
27/03/2016 19/05/2016 Rp 200,000 Rp -
24/04/2016 22/05/2016 Rp 200,000 Rp -
10/04/2016 02/05/2016 Rp 200,000 Rp -
15/04/2016 05/05/2016 Rp 200,000 - - - - Rp -
15/03/2016 01/05/2016 Rp 200,000 - - - - Rp -
11/04/2016 20/05/2016 Rp 200,000 - - - - Rp -
23/03/2016 30/05/2016 Rp 200,000 - - - - Rp -
23/03/2016 03/05/2016 Rp 200,000 - - - - Rp -
04/04/2016 03/05/2016 Rp 200,000 - - - - Rp -
04/04/2016 03/05/2016 Rp 200,000 - - - - Rp -
04/04/2016 16/05/2016 Rp 200,000 - - - - Rp -
17/03/2016 02/05/2016 Rp 200,000 - - - - Rp -
16/04/2016 25/05/2016 Rp 200,000 - - - - Rp -
KABILA, 2016
PENGAJU KLAIM

NIP. 19830310 201001 2 037
JUMLAH
TOTAL
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
ANC
17. Nurlinda Yusuf 25 Thn Dutohe Barat 0000 960701163 17/12/2015 17/02/2016
18. Sukriya Usman 25 Thn Dutohe Barat 000 1237065737 20/11/2015 22/02/2016
19. Indriani Hasan 35 Thn Dutohe 000 1235261024 05/12/2015 05/02/2016
20. Anita Makuta 34 Thn Dutohe Barat 000 2033847854 18/12/2015 17/02/2016
21. Sulastri Abdullah 23 Thn Poowo Barat 000 1237324667 - -
22. Ririn Sagita puloli 21 Thn Poowo Barat 000 1237290625 - -
23. Fityawati Rahman 31 Thn Poowo Barat 0000 209835077 - -
24. Ramla Toonaw 22 Thn Toto Selatan 0000 959939177 - -
25. Ismawati Kadir 23 Thn Molowahu 0000 957327783 - -
26. Isra Baku 36 Thn Oluhuta Utara 0000 959490988 - -
27. Nirmawati Limehu 23 Thn Poowo Barat 000 1234690266 - -
28. Erni Kalila 35 Thn Pauwo 000 1892018204 - -
29. Sofya Kasim 34 Thn Pauwo 000 1235433071 - -
30. Asri Ali 34 Thn Pauwo 000 1816625957 - -
31. Lindawaty Umar 21 Thn Pauwo 000 1970976295 - -
32. Risna Djibu 36 Thn Pauwo 000 1235252924 - -
MENGETAHUI
TAHUN : 2016
ANC PNC
ANC & & PNC
KN- 1 KN-2
16/04/2016 20/05/2016 Rp 200,000 - - - - Rp -
16/04/2016 20/05/2016 Rp 200,000 Rp -
15/04/2016 10/05/2016 Rp 200,000 Rp -
10/04/2016 28/05/2016 Rp 200,000 Rp -
- - Rp - 4/17/2016 4/23/2016 5/2/2016 5/19/2016 Rp 100,000
- - Rp - 4/9/2016 4/15/2016 5/1/2016 5/12/2016 Rp 100,000
- - Rp - 4/25/2016 4/30/2016 5/12/2016 5/23/2016 Rp 100,000
- - Rp - 4/12/2016 4/18/2016 5/2/2016 5/15/2016 Rp 100,000
- - Rp - 4/21/2016 4/27/2016 5/10/2016 5/21/2016 Rp 100,000
- - Rp - 4/14/2016 4/20/2016 5/10/2016 5/18/2016 Rp 100,000
- - Rp - 4/21/2016 4/26/2016 5/16/2016 5/23/2016 Rp 100,000
- - Rp - 4/12/2016 4/14/2016 4/23/2016 5/20/2016 Rp 100,000
- - Rp - 4/20/2016 4/25/2016 5/4/2016 5/28/2016 Rp 100,000
- - Rp - 4/26/2016 4/28/2016 5/17/2016 5/31/2016 Rp 100,000
- - Rp - 3/31/2016 4/4/2016 4/11/2016 5/3/2016 Rp 100,000
- - Rp - 3/26/2016 3/29/2016 4/8/2016 5/2/2016 Rp 100,000
KABILA, 2016
PENGAJU KLAIM

NIP. 19830310 201001 2 037
JUMLAH
TOTAL
Rp 200,000
Rp 200,000
Rp 200,000
Rp 200,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
Rp 100,000
ANC
33. Zeni Kono 33 Thn Dutohe Barat 0000 9632242987 - -

34. Suriyati 27 Thn Dutohe Barat 000 9203351985 - -
MENGETAHUI
TAHUN : 2016
ANC PNC
ANC & & PNC
KN- 1 KN-2
- - Rp - 4/16/2016 4/21/2016 4/30/2016 5/17/2016 Rp 100,000
- - Rp - 4/20/2016 4/24/2016 5/2/2016 5/21/2016 Rp 100,000
KABILA, 2016
PENGAJU KLAIM

NIP. 19830310 201001 2 037
JUMLAH
TOTAL
Rp 100,000
Rp 100,000
PROPINSI : GORONTALO BULAN : JUNI
ANC PNC
ANC & &
KN- 1 KN-2
1. Rahayu Amara 23 Thn Timbuolo 0000 960501431 10/11/2015 03/01/2016 23/04/2016 01/06/2016 Rp 200,000 - - -
2. Rusmina Harun 31 Thn Toto Selatan 0000 959976134 02/11/2015 10/02/2016 10/05/2016 20/06/2016 Rp 200,000
3. Asriani Wahda 32 Thn Tumbihe 0000 165074106 20/10/2015 02/02/2016 05/03/2016 05/06/2016 Rp 200,000
4. Saryam Tamola 29 Thn Oluhuta Utara 000 1236766206 20/10/2015 10/01/2016 24/04/2016 02/06/2016 Rp 200,000
5. Wisna Saleh 45 Thn Sidomukti 000 1075583891 30/09/2015 15/02/2016 10/05/2016 10/06/2016 Rp 200,000
6. Rukmin Karim 30 Thn Dutohe Barat 000 1237064747 05/01/2016 18/03/2016 19/05/2016 20/06/2016 Rp 200,000
7. Yuliyanti Padja 28 Thn Dutohe Barat 0000 960760596 01/01/2016 17/03/2016 19/05/2016 20/06/2016 Rp 200,000 - - -
8. Eva Rosdiana 28 Thn Dutohe Barat 0000 209946352 05/01/2016 18/03/2016 19/05/2016 20/06/2016 Rp 200,000 - - -
9. Lindawati Hendrik 35 Thn Pauwo 000 1236144666 - - - - Rp - 5/17/2016 5/19/2016 6/22/2016
10. Nurjayanti Ali 25 Thn Pauwo 000 1237148897 - - - - Rp - 5/16/2016 5/21/2016 6/22/2016
11. Irma Ahmad 33 Thn Pauwo 000 1236144161 - - - - Rp - 5/15/2016 5/18/2016 6/20/2016
12. Susanti Iki 19 Thn Pauwo 000 1125205391 - - - - Rp - 5/17/2016 5/19/2016 6/21/2016
13. Apriyani 26 Thn Dutohe Barat 000 1237513623 - - - - Rp - 5/15/2016 5/19/2016 6/2/2016
14. Indriani Husain 25 Thn Dutohe Barat 000 1959617384 - - - - Rp - 5/14/2016 5/17/2016 6/1/2016
15. Yuniarti Karim 33 Thn Dutohe Barat 000 1237499482 - - - - Rp - 5/6/2016 5/10/2016 5/24/2016
16. Salma Abdulah 22 Thn Toto Selatan 000 1237082073 - - - - Rp - 5/12/2016 5/17/2016 6/8/2016
MENGETAHUI
PUSKESMAS : KABILA
KF-3 TOTAL JUMLAH

PNC TOTAL
- Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
- Rp - Rp 200,000
- Rp - Rp 200,000
6/27/2016 Rp 100,000 Rp 100,000
6/25/2016 Rp 100,000 Rp 100,000
6/24/2016 Rp 100,000 Rp 100,000
6/27/2016 Rp 100,000 Rp 100,000
6/15/2016 Rp 100,000 Rp 100,000
6/14/2016 Rp 100,000 Rp 100,000
6/6/2016 Rp 100,000 Rp 100,000
6/20/2016 Rp 100,000 Rp 100,000
PROPINSI : GORONTALO BULAN : JUNI
ANC PNC
ANC & &
KN- 1 KN-2
17. Siti Harmia Bakari 28 Thn Poowo Barat 0000 959719116 - - - - Rp - 6/1/2016 6/10/2016 6/24/2016
18. Fina S Umar 21 Thn Toto Selatan 0000 956946879 - - - - Rp - 5/9/2016 5/15/2016 6/5/2016
19. Salma Kiayi 33 Thn Poowo 000 1234500502 - - - - Rp - 5/7/2016 5/14/2016 6/5/2016
20. Yuyun Radjak 22 Thn Poowo Barat 000 1236474415 - - - - Rp - 5/23/2016 5/30/2016 6/15/2016
21. Fitriyani Daud 29 Thn Poowo Barat 000 1237197014 - - - - Rp - 5/13/2016 5/18/2016 6/5/2016
22. Misra Gani 32 Thn Padengo 000 1235378722 - - - - Rp - 5/21/2016 5/26/2016 6/15/2016
MENGETAHUI
PUSKESMAS : KABILA
KF-3 TOTAL JUMLAH

PNC TOTAL
6/28/2016 Rp 100,000 Rp 100,000

6/16/2016 Rp 100,000 Rp 100,000
6/10/2016 Rp 100,000 Rp 100,000
6/20/2016 Rp 100,000 Rp 100,000
6/11/2016 Rp 100,000 Rp 100,000
6/22/2016 Rp 100,000 Rp 100,000
PROPINSI : GORONTALO BULAN : JULI PUSKESMAS : KABILA
ANC PNC
NO NAMA PASIEN UMUR ALAMAT NO.KARTU K1 K2 K3 K4 TOTAL KF- 1 KF-2 KN-3 KF-3
ANC & &
KN- 1 KN-2
1. Amna Dama 37 Thn Pauwo 000 1288148319 19/01/2016 04/04/2016 02/06/2016 19/07/2016 Rp 200,000 - - - -
2. Asni Nanue 32 Thn Pauwo 000 2048073388 02/03/2016 04/04/2016 03/05/2016 19/07/2016 Rp 200,000
3. Mey Sako 34 Thn Pauwo 000 1075838894 23/03/2016 08/04/2016 02/06/2016 15/07/2016 Rp 200,000
4. Yanti Lukum 36 Thn Pauwo 000 1128236253 02/03/2016 04/04/2016 03/05/2016 11/07/2016 Rp 200,000
5. Nurhayati Hamzah 25 Thn Pauwo 000 1075838984 15/03/2016 14/04/2016 03/05/2016 16/07/2016 Rp 200,000
6. Delista Zakria 23 Thn Dutohe Barat 000 1237492798 10/01/2016 18/03/2016 21/06/2016 12/07/2016 Rp 200,000
7. Maratul Jannah Hunow 28 Thn Poowo Barat 000 1237325455 17/01/2016 22/03/2016 10/06/2016 15/07/2016 Rp 200,000 - - - -
8. Sendi Akib 26 Thn Oluhuta Utara 000 1234507162 10/01/2016 15/03/2016 12/06/2016 05/07/2016 Rp 200,000 - - - -
9. Nurlayla Mohamad 32 Thn Poowo Barat 000 1237290107 05/01/2016 10/04/2016 08/06/2016 03/07/2016 Rp 200,000 - - - -
10. Ervina Lumbato 37 Thn Liluwo 000 1288192858 21/01/2016 20/03/2016 20/06/2016 10/07/2016 Rp 200,000 - - - -
11. Narti Tahir 37 Thn Dutohe Barat 0000 960746975 15/01/2016 25/03/2016 28/05/2016 02/07/2016 Rp 200,000 - - - -
12. Nurten Ismail 25 Thn Oluhuta Utara 000 1805621995 05/03/2016 15/05/2016 25/06/2016 24/07/2016 Rp 200,000 - - - -
13. Sukriya Usman 25 Thn Dutohe Barat 000 1237065737 - - - - Rp - 4/6/2016 8/6/2016 22/06/2016 5/7/2016
14. Anita Makunta 34 Thn Dutohe Barat 000 2033847854 - - - - Rp - 16/06/2016 19/06/2016 29/06/2016 17/07/2016
15. Nurlinda Yusuf 22 Thn Dutohe Barat 0000 960701163 - - - - Rp - 7/6/2016 11/6/2016 24/06/2016 8/7/2016
16. Sulastri Daud 21 Thn Dutohe Barat 0000 959125072 - - - - Rp - 11/6/2016 15/06/2016 27/06/2016 12/7/2016
MENGETAHUI
USKESMAS : KABILA
TOTAL JUMLAH
PNC TOTAL
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp - Rp 200,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
PROPINSI : GORONTALO BULAN : JULI PUSKESMAS : KABILA
ANC PNC
NO NAMA PASIEN UMUR ALAMAT NO.KARTU K1 K2 K3 K4 TOTAL KF- 1 KF-2 KN-3 KF-3
ANC & &
KN- 1 KN-2
17. Waty Usman 24 Thn Pauwo 0000 139934823 - - - - Rp - 30/05/2016 2/6/2016 10/6/2016 12/7/2016
18. Rusnina Harun 31 Thn Toto Selatan 0000 939976134 - - - - Rp - 30/06/2016 3/7/2016 17/07/2016 29/07/2016
19. Rahayu Amara 23 Thn Timbuolo 0000 960501431 - - - - Rp - 5/6/2016 10/6/2016 28/06/2016 5/7/2016
20. Sandra Ahmad 19 Thn Poowo Barat 0000 959747308 - - - - Rp - 18/06/2016 22/06/2016 10/7/2016 19/07/2016
21. Maryam Kumai 33 Thn Dulohupa 000 2055430282 - - - - Rp - 3/7/2016 8/7/2016 20/07/2016 28/07/2016
22. Saryam Tamola 29 Thn Oluhuta Utara 000 1236766206 - - - - Rp - 13/06/2016 17/06/2016 2/7/2016 15/07/2016
23 Wisna Saleh 35 Thn Sidomukti 000 1075583891 - - - - Rp - 23/06/2016 27/06/2016 16/07/2016 21/07/2016
24 Asriani Wahda 32 Thn Tumbihe 0000 165074106 - - - - Rp - 25/06/2016 2/7/2016 17/07/2016 27/07/2016
MENGETAHUI
USKESMAS : KABILA
TOTAL JUMLAH
PNC TOTAL
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000
Rp 100,000 Rp 100,000

Daftar Tagihan Klaim Pelayanan Anc/Pnc Peserta JKN Di Pelayanan Dasar

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Daftar Tagihan Klaim Pelayanan Anc/Pnc Peserta JKN Di Pelayanan Dasar

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DAFTAR TAGIHAN KLAIM PELAYANAN ANC/PNC PESERTA JKN DI PELAYANAN DASAR

PROPINSI : GORONTALO BULAN : MARET

KF-3 TOTAL JUMLAH

MENGETAHUI KABILA, 2016

MERI SILVANA ADAM, S.KM

KF-3 TOTAL JUMLAH

MERI SILVANA ADAM, S.KM

1. Misra Gani 32 Thn Padengo 000 1235378722 10/12/2015 10/02/2016

MERI SILVANA ADAM, S.KM

MERI SILVANA ADAM, S.KM

33. Zeni Kono 33 Thn Dutohe Barat 0000 9632242987 - -

MERI SILVANA ADAM, S.KM

KF-3 TOTAL JUMLAH

KF-3 TOTAL JUMLAH

6/28/2016 Rp 100,000 Rp 100,000

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