JAMINAN KESEHATAN SUMSEL SEMESTA

KAB. EMPAT LAWANG

DAFTAR REGISTRASI KUNJUNGAN PESERTA JAMSOSKES SUMATERA SELATAN
(KEABSAHAN PESERTA)
NAMA PPK P0SKESDES AIR KELINSAR
BULAN JANUARI
NO TANGGAL NAMA PASIEN TGL LAHIR/ L/P DIAGNOSA TINDAKAN MEDIS
BIAYA (Rp) (SESUAI PERDA)
UMUR
JASA MEDIS TINDAKAN JUMLAH
1 01/01/2017 RENI 34TH P CEK GDS CEK GDS 5000 10,000 15,000
2 01/01/2017 MADI 37TH L JTH R POHON PSG O2,INF RL,INJ DEXA 5000 52,000 57,000
3 02/01/2017 SRI HARTATI 36TH P SUSP.MALARIA INJ.DONDRIL, SULDOX, AMOX, PCT 5000 4,000 9,000
4 03/01/2017 BOBY HARIANTO 37TH L DIARE INJ DON,KOTRI ,PCT,ORALIT 5000 2,000 7,000
5 05/01/2017 NOPIAN 43TH L INFEKSI TELINGA DEBRIDEMEN,AMOX,PCT,TETES TELINGA 5000 7,500 12,500
6 05/01/2017 YURPANSI 34TH L GE INJ.DONDRIL, ANTASIDA, PCT, B.COM 5000 9,000
7 06/01/2017 WENI ROSITA 35TH P BONGKAR PASANG IMPLANT INJ LIDO,AMOX ASMET 5000 125,000 130,000
8 07/01/2017 SUSILAWATI 34TH P DIPEPSIA INJ.DONDRIL, IBUFROFEN, AMOX 5000 4,000 9,000
9 07/01/2017 ASARWAN 50TH L DIARE INJ DON,KOTRI ,PCT,ORALIT 5000 2,000 7,000
10 07/01/2017 YESI MAHARETA 30TH P MIGRAN INJ.DONDRIL, PCT, AMOX, CTM, B.COM 5000 4,000 9,000
11 08/01/2017 SELVI JUNIARTI 28TH P ALERGI INJ.DEXA, DEXA TAB, AMOX, CTM 5000 2,000 7,000
12 08/01/2017 SARI PUDIN 43TH L ISPA INJ DON,GG,AMOX,PCT 5000 2,000 7,000
13 09/01/2017 TARZAN 49TH L SUSP TYPOID INF RL,KLORAM,IN JRANI.RANI,PCT 5000 32,000 37,000
14 10/01/2017 REPALDI BENI.S 16TH L FEBRIS INJ DON,AMOX SYP,PCT SYP 5000 2,000 7,000
15 10/01/2017 ROZER JEHRICON 5TH L FEBRIS AMOX SYP,PCT SYP 5000 2,000 7,000
16 13/01/2017 ENDANG.SP 41TH L KONTROL LUKA DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
17 13/01/2017 DENI KUSENDANG 37TH L KEMASUKAN BENDA ASING PENGELUARAN BENDA ASING,AMOX,PCT 5000 70,000 7,000
18 14/01/2017 MUHAMMAD.JA 11TH L FEBRIS AMOX SYP,PCT SYP 5000 5,000
19 14/01/2017 TUNAIYA 42TH P CEK GDS CEK GDS 5000 10,000 15,000
20 15/01/2017 FAHRI MAULID.K 4 TH L DIARE KOTRI SYP,PCT SYP,ORALIT 5000 5,000
21 15/01/2017 AGUS ARIADI 36TH L KONTROL LUKA OP DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
22 16/01/2017 CAH 38TH L SUAP MALARIA INJ.DONDRIL, PCT, AMOX, CTM, B.COM 5000 4,000 9,000
23 17/01/2017 SUHARDI 47TH L ISPA GG,AMOX,PCT 5000 5,000
24 17/01/2017 APRANI MASARI 32TH P GASTRITIS INF RL,INJ RANI,ANTASID,PCT,B.COM 5000 32,000 37,000

Mengetahui
Tim Verivikasi Jamsoskes Pimpinan PPK/Puskes Kab. Empat Lawang
Dinas kesehatan Kabupaten Nanjungan PAK Bendahara Puskesmas Nanjungan
........................................... SITI HODIJAH S.Kep FARMA SUSANTI
Nip. Nip. 198505112009042001 Nip.198402142011012004
JAMINAN KESEHATAN SUMSEL SEMESTA
KAB. EMPAT LAWANG
DAFTAR REGISTRASI KUNJUNGAN PESERTA JAMSOSKES SUMATERA SELATAN
(KEABSAHAN PESERTA)
NAMA PPK POSKESDES AIR KELINSAR
BULAN JANUARI
NO TANGGAL NAMA PASIEN TGL LAHIR/ L/P DIAGNOSA TINDAKAN MEDIS BIAYA (Rp) (SESUAI PERDA)
UMUR JASA MEDIS TINDAKAN JUMLAH
25 19/01/2017 TURIA 50TH P KONTROL LUKA DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
26 20-Jan-17 LUCIA FT 11TH P LUKA BAKAR DEBRIDEMEN,AMOX SYP,PCT SYP 5000 7,500 12,500
27 20-Jan-17 SOPYAN 31TH L FEBRIS INJ DON,AMOX,PCT 5000 2,000 7,000
28 21-Jan-17 ERNI ZANI HARTATI 41TH P BOMGKAR PASANG IMPLANT INJ LIDO,AMOX,ASMET 5000 125,000 130,000
29 21-Jan-17 ILMAN 37TH L SESAK NAPAS PSG O2,SALBU,GG,PCT 5000 20,000 25,000
30 22-Jan-17 LENI PS 25TH P KONTROL LUKA DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
31 22-Jan-17 WIDIA PILTASARI 9TH P ISPA GG,AMOX SYP,PCT SYP,INJ DON 5000 2,000 7,000
32 23-Jan-17 ZENI AGUSTIAN 10TH L FEBRIS AMOX SYP.PCT SYP 5000 5,000
33 #NAME? ZUKRIADI 35TH L ALERGI INJ DEXA,DEXA,CTM 5000 2,000 7,000
34 24-Jan-17 ADI ZUZANDRA 30TH L BISULAN DEBRIDEMEN,AMOX,ASMET 5000 7,500 12,500
35 24-Jan-17 HERLIN SULAISI 35TH P UP IMPLANT INJ LIDO,AMOX,ASMET 5000 75,000 80,000
36 26-Jan-17 SARNIDI 39TH L KONTROL LUKA DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
37 26-Jan-17 SISMAINI 36TH P SAKIT GIGI INJ.DONDRIL, ASMET,CTM, AMOX 5000 4,000 9,000
38 27-Jan-17 HELDA 25TH P GASTRITIS INJ RANI,RANI,PCT,B.COM 5000 2,000 7,000
39 27-Jan-17 NURIN PRATAMI 7TH L DIARE INJ DO,KOTRI SYP,PCT SYP,ORALIT 5000 2,000 7,000
40 27-Jan-17 HARMILIANA 30TH P KONTROL LUKA DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
41 28-Jan-17 SUHARDI 47TH L GASTRITIS INF RL,INJ RANI,RANI,PCT,B.COM 5000 32,000 37,000
42 28-Jan-17 OCI PUSPITA 33TH P FEBRIS INJ DON,AMOX,PCT 5000 2,000 7,000
43 28-Jan-17 HAJIBA 48TH P ANEMIA INF RL,INJ B12,PCT,NOVABION,ANTASID 5000 32,000 37,000
44 29-Jan-17 AGUS ARIADI 36TH L KONTROL LUKA DEBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
45 29-Jan-17 M.ANDIKA 15TH P KONTROL LUKA DERBRIDEMEN,GV,AMOX,ASMET 5000 12,500 17,500
46 30-Jan-17 NURIL AINI 34TH P DYSENTRI INJ DON,DRIL,KOTRI,METRO,PCT,ORALIT 5000 4,000 9,000
47 30-Jan-17 ZAILIN ASTUTI 40TH P ABSES DEBRIDEMEN,AMOX,ASMET 5000 7,500 12,500
Mengetahui
Tim Verivikasi Jamsoskes Pimpinan PPK/Puskes Kab. Empat Lawang
Dinas kesehatan Kabupaten Nanjungan PAK Bendahara Puskesmas Nanjungan

........................................... SITI HODIJAH S.Kep FARMA SUSANTI

Nip. Nip. 198505112009042001 Nip.198402142011012004
 NAMA PPK POSKESDES AIR KELINSAR
BULAN JANUARI

JUMLAH RAWAT JALAN JUMLAH KLAIM PESERTA

NO JUMLAH KUNJUNGAN NO KTP/KK JUMLAH RUJUKAN RJTP RJTL TOTAL RETRIBUSI TOTAL TINDAKAN TOTAL BIAYA (Rp)
1 47 235,000 797,000 1,032,500

Mengetahui
Tim Verivikasi Jamsoskes Pimpinan PPK/Puskes Kab. Empat Lawang
Dinas kesehatan Kabupaten Nanjungan PAK Bendahara Puskesmas Nanjungan

........................................... SITI HODIJAH S.Kep FARMA SUSANTI

Nip. Nip. 198505112009042001 Nip.198402142011012004
JAMINAN KESEHATAN SUMSEL SEMESTA
KAB. EMPAT LAWANG

DAFTAR REGISTRASI KUNJUNGAN PESERTA JAMSOSKES SUMATERA SELATAN

(KEABSAHAN PESERTA)

NAMA PPK : PUSKESMAS ( POLY REMAJA )

BULAN : JULI 2016
NO TANGGAL KUNJUNGAN NO KTP/KK NAMA PASIEN NAMA KEP. KELUARGA TGL LAHIR/UMUR ALAMAT
50 28/07/2016 1611071103083428 NIKEN AYU ANGELIA UNSI 23/03/2000 AIR MAYAN
51 28/07/2016 1611070610090011 ARGO SA'BAN KUNIL SON 17/12/1997 NANJUNGAN
52 28/07/2016 1611070810880001 RIZAL EFENDI 8/10/1988 MUARA SINDANG
53 29/07/2016 1571071108100006 DEDI PRABOWO SALIYO 9/2/1996 NANJUNGAN
54 29/07/2016 1611072804100001 PARI YANSI MARKONI 13/03/2000 MUARA RUNGGA
55 29/07/2016 1611072804100001 ANGGA MARKONI 13/03/2004 MUARA RUNGGA
56 30/07/2016 1611070306090010 VIRA LUKMAN 6/8/2003 MUARA AMAN
57 30/07/2016 1611070312090009 BUNGA OKTAVIA PARDI 8/10/2004 TALANG RANDAI
58 30/07/2016 1611071103082330 ANDIKA MUKTAR ALI SUHARTO 25/02/1998 NANJUNGAN
59 30/07/2016 1611070902100006 VISI YUNIARTI ARLAN 7/6/2001 PADANG GELAI

Mengetahui
Tim Verifikasi Jamsoskes Pimpinan PPK/Puskes Kab. Empat Lawang
Dinas Kesehatan Kab/Kota Nanjungan PAK Bendahara Puskesmas Nanjungan

-------------------------------- SITI HODIJAH S.Kep FARMA SUSANTI

Nip. Nip. 198505112009042001 Nip.198402142011012004