DINAS KESEHATAN

LAPORAN RETRIBUSI PENGAJUAN JASA PELAYANAN PUSKESMAS JONGGOL

BULAN JANUARI 2019

PASIEN
JENIS PELAYANAN JASA SARANA JASPEL JUMLAH %
JONG

1 2 3 4 5 2
1 Rawat Jalan/Poli Umum 2,000 3,000 5,000 60.00 3545
4 Pemasangan Oksigen 7,500 7,500 15,000 50.00 6
5 Pemasangan Inpus 7,500 7,500 15,000 50.00 15
6 Injeksi 7,500 7,500 15,000 50.00 21
7 Rawat Inap Kelas II 12,500 15,000 27,500 54.55 0
8 Rawat Inap Kelas III 10,000 12,500 22,500 55.56 0
9 Rawat Inap Bayi Baru 7,500 7,500 15,000 50.00 0
10 Rawat Inap Bayi Baru Perlu Perawatan 12,500 15,000 27,500 54.55 0
11 Perawatan luka dengan jahitan 1 s/d 5 7,500 7,500 15,000 50.00 15
12 Perawatan luka dg jahitan 6 s/d 10 15,000 15,000 30,000 50.00 6
13 Perawatan luka tanpa jahitan 3,000 3,000 6,000 50.00 22
14 Khitanan 25,000 25,000 50,000 50.00 0
15 Katerisasi Kandung Kemih 7,500 7,500 15,000 50.00 0
16 Incisi 7,500 7,500 15,000 50.00 11
17 Vena seksi 17,500 20,000 37,500 53.33 0
18 Ganti Balutan 2,500 7,500 10,000 75.00 26
19 Ekstraksi Benda Asing 10,000 10,000 20,000 50.00 3
20 Tindik 5,000 5,000 10,000 50.00 0
21 Buka Jahitan 3,500 3,500 7,000 50.00 6
22 Epistaksis Packing Anterior 3,500 3,500 7,000 50.00 0
23 Ekstraksi Kuku 7,500 7,500 15,000 50.00 2
36 Nebulizer 10,000 10,000 20,000 50.00 12
37 Pencabutan gigi sulung topikal 4,000 6,000 10,000 60.00 65
38 Pencabutan gigi sulung suntik 6,000 9,000 15,000 60.00 6
39 Pencabutan Gigi tetap 6,000 9,000 15,000 60.00 10
40 Pencabutan Gigi tetap dng komplikasi 10,000 20,000 30,000 66.67 9
41 Tambalan sementara 4,000 6,000 10,000 60.00 18
42 Tambahan sementara endo 4,000 6,000 10,000 60.00 15
43 Folp Coping 6,000 9,000 15,000 60.00 7
44 Pengisian perawatan Endo 5,000 5,000 10,000 50.00 0
47 Tambalan silikat 7,500 7,500 15,000 50.00 12
48 Tambalan sinar 70,000 20,000 90,000 22.22 5
49 Scaling Manual 5,000 10,000 15,000 66.67 0
50 Scaling dg Alat 10,000 15,000 25,000 60.00 3
87 Hemaglobin 2,500 1,000 3,500 28.57 20
88 Leukosit 2,500 1,000 3,500 28.57 0
89 Laju Endap Darah 2,500 1,000 3,500 28.57 19
90 Hitung Jenis Hematologi 2,500 1,000 3,500 28.57 0
96 Trombosit 3,400 1,600 5,000 32.00 0
101 Golongan Darah 4,000 2,000 6,000 33.33 0
104 Hematologi Automatik 15,000 10,000 25,000 40.00 39
109 GD Puasa 6,000 2,500 8,500 29.41 0
110 GD 2 Jam PP 6,000 2,500 8,500 29.41 0
111 GD Sewaktu 6,000 2,500 8,500 29.41 32
112 Cholesterol 7,500 5,000 12,500 40.00 18
113 Trigliserida 9,000 7,000 16,000 43.75 0
114 HDL 7,500 5,000 12,500 40.00 0
115 LDL 7,500 5,000 12,500 40.00 0
119 Albumin 6,250 3,750 10,000 37.50 0
120 SGOT 10,200 4,800 15,000 32.00 20
121 SGPT 10,200 4,800 15,000 32.00 20
130 Asam Urat 8,750 6,250 15,000 41.67 30
148 Urin Rutin 6,250 3,750 10,000 37.50 20
149 Urin Test Kehamilan 10,000 5,000 15,000 33.33 11
152 Widal 10,000 7,000 17,000 41.18 39
171 USG 25,000 25,000 50,000 50.00 0
172 Dopler 3,000 3,000 6,000 50.00 60
173 Foto ukuran besar 20,000 20,000 40,000 50.00 77
174 Foto ukuran kecil 15,000 15,000 30,000 50.00 20
177 Pemeriksaan dalam pd persalinan 7,500 7,500 15,000 50.00 0
178 Persalinan Normal 200,000 150,000 350,000 42.86 0
179 Persalinan dg tindakan ringan 315,000 300,000 615,000 48.78 0
181 kuretase 150,000 500,000 650,000 76.92 0
182 Plasenta manual 150,000 200,000 350,000 57.14 0
183 Pemasangan IUD 55,000 50,000 105,000 47.62 0
184 Pencabutan IUD tanpa penyulit 25,000 15,000 40,000 37.50 0
185 Pemasangan Implan 150,000 50,000 200,000 25.00 0
186 Pencabutan Implan 30,000 30,000 60,000 50.00 0
192 Konseling Kesehatan Reproduksi - 30,000 30,000 100.0 0
193 Pemeriksaan kesehatan umum 2,000 3,000 5,000 60.00 30
194 Pemeriksaan calon pengantin dan Imunisasi 5,000 5,000 10,000 50.00 2
195 Pemeriksaan calon jama'ah haji tahap I 10,000 10,000 20,000 50.00 57
JUMLAH TOTAL 4,354

Jonggol, 31 Januari 2018

Kepala Puskesmas Jonggol

dr.H.Suparno
NIP: 19760216 200801 1006
GGOL

TARIF JASPEL

JONGGOL

2
17,725,000 10,635,000
90,000 45,000
225,000 112,500
315,000 157,500
- -
- -
- -
- -
225,000 112,500
180,000 90,000
132,000 66,000
- -
- -
165,000 82,500
- -
260,000 195,000
60,000 30,000
- -
42,000 21,000
- -
30,000 15,000
240,000 120,000
650,000 390,000
90,000 54,000
150,000 90,000
270,000 180,000
180,000 108,000
150,000 90,000
105,000 63,000
- -
180,000 90,000
450,000 100,000
- -
75,000 45,000
70,000 20,000
- -
67,000 19,000
- -
- -
- -
975,000 390,000
- -
 - -
272,000 80,000
225,000 90,000
- -
- -
- -
- -
300,000 96,000
300,000 96,000
450,000 187,500
200,000 75,000
165,000 55,000
663,000 273,000
- -
360,000 180,000
3,080,000 1,540,000
600,000 300,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
150,000 90,000
20,000 10,000
1,140,000 570,000
31,026,000 16,963,500
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