BUKU RETRIBUSI HARIAN

Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
192020 1 An. Prishilla. Al.S P PU P
2 Tn. Kurniadi L PU
3 Ny. Y. Amon P PU
4 Tn. Johri L PU
5 Ny. Rupina P PU
6 Ny. Maslah P PU
7 An. Paulus Alianto L PU P
8 An. Stevania Aurel P PU P
9 Ny. Dy. Maimon P PU
10 Ny. Dy. Astita Ulfah P PU
11 Ny. Asteria P PU
12 Ny. Pangurai P PU
13 Ny. Nika P DEPO
14 Ny. Lusia Sonya P PU
15 Ny. Cunuraini P PU
16 Ny. Jamaliah P PU
17 An. Aldo L PU Rp 5,000 P
18 Ny. Sumi P DEPO Rp 10,000
19 Ny. B. Lianti P DEPO Rp 10,000
20 Ny. Marlisa P DEPO Rp 10,000
21 Tn. Aban L PU Rp 5,000
22 Nn. Amanda P PU Rp 5,000 P
23 Ny. Sarah P PU
24 Tn. Thamrin P PU
25 Ny. Matia P PU
26 Tn. Lorensius Ligak L PU
27 An. Sulastri P PU P
28 Ny. Yuyun P KB Pil

JUMLAH Rp 45,000 0 0 0 0 0 0 1 0 1 3 0 0 0 1
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P
P P
P P
P P
P P
P P
P
P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P
P
P P
P P
P P
P P
P
P P

2 6 1 7 0 2 2 2 0 0 2 4 4 16 0 0 1 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
292020 1 Tn. Niko Marius L PU Rp 5,000
2 Ny. Siti Alfah P DEPO Rp 10,000
3 Ny. Arianti P DEPO Rp 10,000
4 Ny. Epi Kartika P DEPO Rp 10,000
5 Ny. Noni P DEPO Rp 10,000
6 Ny. Santi P DEPO Rp 10,000
7 Tn. Edi Surahman L S.K.K Rp 15,000
8 Ny. Anastasia P PU
9 Ny. Santi P PU
10 An. Faisal AN L PU P
11 Ny. Yuliana P Jiwa P
12 Ny. Monika Wani P Jiwa
13 Ny. Ng. Anyau P PU
14 An. Syahira Nur Rahma P PU P
15 An. Ab. Arjun. A L PU P
16 Ny. Kartina Tina P DEPO
17 Nn. Rupina Seni P PU P
18 Ny. Keeng P PU
19 Ny. Mamik P ANC P
20 Tn. Abong L PU
21 Ny. Ani Neng P PU
22 Tn. Tagah Anthony L PU

JUMLAH Rp 70,000 0 0 0 0 0 0 1 0 0 0 1 1 0 3
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P
P
P P
P
P
P
P P
P
P P
P
P P
P P
P P

2 8 0 0 0 1 1 2 1 0 2 5 4 8 0 0 0 3
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
392020 1 Tn. Zapet L PU
2 Ny. Not P PU
3 An. Citra Dewi Renanda P PU P
4 An. Gresia Novani P PU P
5 Ny. Samsiar P PU
6 Ny. Stepani. M P PU
7 An. Jonathan L PU Rp 5,000 P
8 Ny. Yuyun P KB Pil Rp 5,000
9 Ny. Beti Lusiana P ANC Rp 5,000
10 Tn. Ignasius Rizki. M L PU
11 Ny. Anong P PU
12 An. Yulia Ratia P PU P

JUMLAH Rp 15,000 0 0 0 0 1 0 0 1 0 1 0 1 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P
P
P P
P P
P
P P
P P
P P
P P
P

1 3 0 0 0 1 0 2 1 0 1 2 2 6 0 0 0 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
492020 1 An. Nursifa P PU Rp 5,000 P
2 Ny. Natallia Desi P PU
3 Ny. Teresia Endang P DEPO
4 Ny. Teresia Endang P PU
5 Ny. Saimah P PU
6 Ny. Yustina Ibint P PU
7 Tn. Lito L Jiwa
8 Ny. L Linda P PU
9 An. Rimsha Naureen P PU P
10 Tn. Yohanes Rongki L PU
11 An. Karissa. P P PU P
12 Ny. Mila. S P DEPO
13 Ny. Dy. Nita P DEPO
14 Ny. Dy. Suarni P PU
15 Tn. Darius L PU
16 Ny. Ana P KB Pil Rp 5,000
17 An. Verdi L PU Rp 5,000 P
18 Ny. Santori P DEPO Rp 10,000
19 Ny. Margareta Ayu Lendari P PU Rp 5,000
20 Ny. Yulita Wati P DEPO Rp 10,000
21 Ny. Linda P DEPO

JUMLAH Rp 40,000 0 0 0 0 1 0 0 2 0 1 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P
P P
P P
P P
P P
P P
P P
P P
P
P P
P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P

2 9 0 2 0 2 1 1 0 0 1 5 1 11 0 0 2 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
792020 1 Ny. Yuni Susanti P DEPO Rp 10,000
2 Ny. Salabiah P ANC Rp 5,000 P
3 Ny. Esi P DEPO Rp 10,000
4 Ny. Marni P DEPO Rp 10,000
5 Ny. Sabina P PU Rp 5,000
6 Ny. Nana P DEPO Rp 10,000
7 An. Erlina P PU Rp 5,000 P
8 Ny. Samsil P PU
9 Ny. Soliah P Konsul gigi
10 Tn. Ucok L Jiwa
11 An. Elbert. R.M L PU P
12 Tn. Adrianus olk L PU
13 Ny. Ida P DEPO
14 Tn. Adrianus Ace L PU
15 Ny. Merry P ANC
16 Ny. Albina P ANC
17 An. Florensiana. V P PU P
18 Ny. Dion P DEPO
19 Ny. Dy. Endang P PU
20 Tn. Jainal L PU
21 Ny. Tapsiah P PU
22 Ny. Seravina Oni P PU
23 Tn. Baiit L PU
24 Ny. Kristina M P ANC
25 An. Adrianus R L PU P
26 An. Elsa P PU P
27 Ny. Pina Wati P DEPO

JUMLAH Rp 55,000 0 0 0 0 0 0 0 2 1 1 1 0 0 1
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P
P P
P P
P P
P P
P
P P
P P
P P
P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P
P P
P P
P P
P
P
P P

1 11 3 3 1 1 0 1 0 0 0 7 6 13 0 0 1 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
892020 1 Ny. Ayang Sam P DEPO Rp 10,000
2 Ny. Selawah P DEPO Rp 10,000
3 Ny. Samsiah P DEPO Rp 10,000
4 Ny. Nilam. M P DEPO Rp 10,000
5 Ny. Ina Wati P PU Rp 5,000
6 Ny. Dy. Syalbbi. Y P PU Rp 5,000
7 Ny. Suli P DEPO
8 Nyy. Yanti P DEPO
9 Ny. Anastasia. W P DEPO
10 Tn. Jailin. J L PU
11 Ny. Kartini P .P. Implant
12 Tn. Kornelius. H L PU
13 Ny. Asteria Aman P PU
14 Ny. Suli P PU
15 Tn. Akim L PU
16 Ny. Dominika P PU
17 Ny. Sunarti P PU
18 Ny. Dominika Ana P KB Pil
19 Tn. Simon L PU
20 Ny. Anyuk P PU
21 Ny. Lemi P PU

JUMLAH Rp 50,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P

1 12 0 3 0 0 2 2 1 0 0 6 4 11 0 0 0 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
992020 1 Tn. Cadek L Jiwa
2 Tn. Linus L Jiwa
3 Tn. Heri Riyanto L PU
4 Tn. Ab. Tarmiji L PU
5 Ny. Pileh P PU
6 Tn. Aka L Jiwa
7 Tn. Karoteng L PU
8 Ny. Wardiyati P PU
9 Ny. Siti Nurhayati P PU
10 Ny. Agata Ita P TT P
11 Ny. Eti Kurniati P DEPO Rp 10,000
12 Ny. Nurhayati P DEPO Rp 10,000
13 Ny. Marta P KB Pil Rp 5,000
14 Nn. Jesica P PU Rp 5,000 P
15 An. Martius. D.A L PU Rp 5,000 P
16 An. Markus S L PU Rp 5,000 P
17 Ny. Ana P PU Rp 5,000
18 Tn. Andro Andreas L PU Rp 5,000
19 Ny. Isak P PU
20 Ny. Dionisia Saripah P PU
21 Tn. Herkulanus M. A L PU

JUMLAH Rp 50,000 0 0 0 0 0 0 0 0 1 0 1 0 0 2
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P
P
P
P P
P P
P P
P P
P P

3 6 3 1 1 1 0 1 1 0 3 5 4 6 0 0 3 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1092020 1 An. Andreas Marsil L PU P
2 Ny. Wenny P DEPO Rp 10,000
3 Ny. Siti Uswatun Hasanah P PU
4 Tn. Yusuf Isa L PU
5 Ny. Petronela Mon P PU
6 Ny. Ira Fitri P PU
7 Tn. Anto L PU
8 Rival L PU P
9 Ny. Susi P ANC
10 Ny. Syamsiah P Konsul Gigi
11 Ny. Yun Yuliana P PU
12 Nn. Neli Yuliana P PU P

JUMLAH Rp 10,000 0 0 0 0 0 0 1 0 0 0 0 0 1 1
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P

1 5 0 2 0 0 1 0 0 0 0 1 4 6 0 1 0 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1192020 1 Tn. Tagah A L PU
2 Tn. Hasan Basri L PU
3 Ny. Natalia Beta P PU
4 Ny. Malek P PU
5 Tn. Abu L PU
6 Tn. Hermas L PU
7 Ny. Juliana P PU
8 Ny. Son P PU
9 Ny. Norma P DEPO
10 Ny. F. Anyu P PU
11 Tn. Sudin L PU
12 Ny. Adriani. R P PU Rp 5,000
13 Tn. Sugeng L PU
14 Ny. Makatia. N P DEPO
15 Ny. Suprihatini P DEPO
16 Ny. L. Maria P DEPO
17 Ny. Temi P DEPO
18 Ny. Linda P ANC
19 Ny. Sera P DEPO

JUMLAH Rp 5,000 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P

1 11 1 1 0 0 3 2 0 0 0 1 6 12 0 0 0 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1492020 1 AN. Gwen Aqila Alkansa P PU Rp 5,000 P
2 Ny. Ami P PU Rp 5,000
3 Ny. Ana P PU Rp 5,000
4 Ny. Anita P ANC Rp 5,000
5 Ny. Katarina P S.K.K Rp 15,000 P
6 Ny. Yulia Jini P PU Rp 5,000
7 Ny. Ida P DEPO Rp 10,000
8 Tn. Alam L PU
9 Ny. Uwent P PU
10 Ny. Lusia Yulita P PU
11 Tn. Suroto L PU
12 Ny. Niarti P S.K.K
13 Ny. Mayon P PU
14 Tn. Sukardi L PU
15 Ny. Lusia Lusia P PU
16 Tn. Mahriansyah L PU
17 Ny. Dy. Norhelly P PU
18 An. Haneva P PU P
19 Tn. Yulianus Eni L OAT
20 Ny. Dominika Merdeka P Jiwa
21 An. Maria Yelsi P PU P
22 Tn. Sadam L Jiwa
23 Ny. Sesilia P PU
24 Tn. Ayan Risdiyanto L PU
25 Ny. Sulastri P PU
26 Tn. Antonio Paskalis L PU
27 Tn. Isot L Jiwa
28 Tn. Otaik L PU
29 Tn. Septio L S.K.K

JUMLAH Rp 50,000 0 0 0 0 0 1 0 1 0 1 0 0 0 1
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P
P P
P P
P P
P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P
P P
P P
P P
P P
P P
P P
P P
P P

5 6 2 4 0 3 4 1 0 0 0 7 7 10 0 0 4 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1592020 1 Ny. Neti P DEPO
2 Ny. Sameon P DEPO
3 Ny. Maria. F P PU
4 Tn. Ambang L PU
5 Ny. Suryati P DEPO
6 Ny. Meri.A P DEPO
7 Ny. Apriani P PU P
8 Ny. Pinsensia P PU
9 Tn. Usman L PU
10 Tn. Ayan L Jiwa
11 An. Vransiskus Alien L PU P
12 Tn. Suwandi L PU
13 Tn. Ahmad Nasir L PU
14 Ny. Albina Ayu P PU
15 Tn. Jamli L PU
16 Tn. Tagan. A L PU
17 Nn. Suci Indah Sari P PU P
18 Tn. Ab. Safarudin L PU
19 An. Rivan. S L PU Rp 5,000 P
20 An. Andrea. C P PU Rp 5,000 P
21 An. Heru L PU Rp 5,000 P
22 Ny. Sabina P PU Rp 5,000
23 Ny. Eni P DEPO Rp 10,000
24 An. Riko A L PU Rp 5,000 P
25 Ny. Ema P DEPO Rp 10,000
26 Tn. Marsianus Keteng L PU Rp 5,000
27 Ny. Eni Haryati P PU Rp 5,000

JUMLAH Rp 55,000 0 0 0 0 0 0 3 1 1 0 0 0 0 2
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P
P P
P P
P P
P P
P P
P
P P
P
P
P
P P
P P
P
P P
P P
P P

2 9 3 1 2 0 2 0 0 1 4 5 8 9 0 0 1 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1692020 1 Ny, Noni P PU
2 Ny. Sumiyati. U P ANC
3 Ny. Sesilia Herrmina P DEPO
4 Ny. Alem Bato P PU
5 An. Alfriza. A.T L PU P
6 Ny. Angelina Aneng P PU
7 Tn. Kedabang L PU
8 Ny. Paulina Jamiah P PU
9 Ny. Maria Ana P PU
10 Tn. Abun Hendra L PU
11 Ny. Sumian P PU
12 Ny. Lusia ana P PU
13 Tn. Syahri L PU
14 Ny. F. Anyu P PU
15 Tn. Samsun L Jiwa
16 Tn. Suwondo L Jiwa
17 Ny. Iche Trisnawati P PU
18 Ny. Rika P PU Rp 5,000
19 Tn. Mili L PU
20 Ny. Yustina Digna P DEPO Rp 10,000

JUMLAH Rp 15,000 0 0 0 0 0 0 0 0 1 0 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P

1 8 2 2 1 0 1 2 1 1 0 2 4 11 0 0 3 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1792020 1 Tn. Anep L PU
2 Ny. Hepni P Konsul Gigi
3 Ny. Surianti P DEPO
4 Ny. Ling Ling P DEPO
5 Tn. Ono L PU
6 Tn. Soroto L PU
7 Tn. Abong L PU
8 Ny. Juni Sumarni P DEPO
9 Tn. A. Karubin L PU
10 Ny. Lemi P PU
11 Ny. Yuyun P DEPO
12 Ny. Teni P OAT
13 Tn. Stefanus Telih L OAT
14 Tn. Akim L OAT
15 Ny. Keramai Klara P KB Pil Rp 5,000
16 Ny. Eton P DEPO Rp 10,000
17 Ny. Wani P DEPO Rp 10,000
18 An. Dirza Juanda L PU Rp 5,000 P
19 Ny. Mari Yati P PU Rp 5,000
20 Ny. Jihon P PU Rp 5,000
21 An. Ab. Fabian L PU Rp 5,000 P

JUMLAH Rp 45,000 0 0 0 0 1 0 1 0 0 0 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P

1 10 3 1 0 0 1 1 2 0 2 5 5 7 0 0 2 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
1892020 1 Tn. Ebeltus D L PU Rp 5,000
2 Ny. Sarah P PU
3 Ny. Semi P DEPO
4 Ny. Dy. Syamsuri P PU
5 Ny. Sentorot P PU
6 Ny. Siti Hajijah P PU
7 An. Haneva G. E P PU P
8 An. Kristianus. M.J L PU P
9 Ny. Sopia Ningsih P Jiwa
10 Tn. Yosep. K L PU

JUMLAH Rp 5,000 0 0 0 0 0 0 0 1 0 0 1 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P
P
P P
P P

0 3 0 1 0 2 1 0 1 0 1 0 2 5 0 0 0 2
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2192020 1 Ny. Yustina W P DEPO Rp 10,000
2 Tn. Manding L OAT
3 Tn. Dimatius Jantan L PU
4 Ny. Dionisia Saripah P PU
5 Nn. Apriani P PU P
6 Ny. Fransiska. C P PU
7 Tn. Rudianto. A L PU
8 Ny. Dy. Epi P ANC
9 Ny. Anita P PU
10 Ny. Leni. L P PU
11 Ny. Asiyah P PU
12 Ny. Lasi P PU
13 Nn. Neli Yuliana P PU P
14 An. Vivi. P P PU P
15 Ny. Nurdiance. S P PU
16 An. Sahir. K L PU P
17 Tn. Kalana L PU
18 Tn. Lorensius. S L PU
19 Ny. M. Yuliana P PU
20 Ny. Rupina P Jiwa
21 Ny. Rosdiana P PU
22 An. Nurul Hakiki P PU P
23 Tn. Amir L PU
24 Ny. Galuh P DEPO
25 Ny. Cimes P DEPO
26 Ny. Roliah P Konsul Gigi
27 Ny. Siti Hajijah P PU

JUMLAH Rp 10,000 0 0 0 0 1 0 0 2 0 0 0 0 0 2
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P
P P
P P
P P
P P
P P
P P
P P
P
P
P P
P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P
P P

2 12 2 3 2 0 0 1 0 0 0 1 6 17 0 1 1 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2292020 1 Tn. Ab. Iswandi L PU Rp 5,000
2 Tn. Prapto Susilo L PU
3 Ny. Suli P PU
4 Ny. Nuraini P Konsul Gigi
5 Ny. Paulina. A P PU
6 Ny. Atus P PU
7 Ny. Atik P PU
8 Tn. Ucok L Jiwa
9 Ny. Misoik P PU Rp 5,000
10 Ny. Tinah P Konsul Gigi Rp 5,000
11 Tn. Bambang Eko. S.M L PU Rp 5,000
12 Ny. Lusia P PU Rp 5,000
13 AN. Radinka L PU Rp 5,000 P
14 Ny. Ana P PU Rp 5,000

JUMLAH Rp 35,000 0 0 0 0 0 0 1 0 0 0 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P

3 7 1 2 0 0 0 0 0 0 3 4 1 5 0 0 1 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2392020 1 An. Hardianto L PU Rp 5,000 P
2 Ny. Nia Daniati P DEPO
3 Tn. Nazarius L Jiwa P
4 Tn. Adrianus Olk L PU
5 Tn. Adrianus Jabudet L PU
6 An. Maria Keisa P PU P
7 Tn. Darius Culak L PU
8 Ny. Albina Susi P ANC
9 Ny. Siri P DEPO Rp 10,000
10 Ny. Juntah P DEPO Rp 10,000
11 Ny. Yohana Lena P DEPO Rp 10,000
12 Ny. Yanti P DEPO Rp 10,000
13 An. Lola P PU Rp 5,000 P

JUMLAH Rp 50,000 0 0 0 0 0 0 0 1 1 1 0 0 1 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P
P P
P
P P
P P
P
P P
P P
P P
P P
P P
P P
P

0 5 2 1 1 0 0 0 0 0 1 5 3 3 0 0 1 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2492020 1 Tn. Johan L PU
2 Ny. Dy. Damoi P PU
3 Tn. Adrianus. J L GDS&Chol
4 Ny. Tini P PU
5 Tn. Untung L Jiwa
6 Ny. Abon P Jiwa
7 Ny. Maspah P PU
8 Tn. Ab Nazarudin L PU
9 Ny. Martina Anita P PU
10 Ny. Siti P PU
11 NY. Theresia Apong P PU Rp 5,000
12 Tn. Sarbia L PU Rp 5,000
13 An. Nabila. S P PU Rp 5,000 P

JUMLAH Rp 15,000 0 0 0 0 0 0 0 0 0 0 0 1 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P

4 3 0 2 1 2 0 0 0 0 1 2 3 5 0 0 1 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2592020 1 Ny. Sarah P PU
2 Ny. Norhi P DEPO
3 Tn. Rebin L PU
4 Ny. Anisah P DEPO
5 Tn. Ruben Kaha L PU
6 Ny. Yuliana E.K P ANC
7 Tn. Aker Rinto L PU
8 Ny. Yuyun P PU
9 An. Azriel. N L PU P
10 Ny. Yulsari P DEPO
11 Ny. Nika P PU
12 Ny. Seriyani P PU
13 Tn. Kris L PU
14 An. Kristina Erin P PU Rp 5,000 P
15 Tn. Jagum L PU Rp 5,000
16 Ny. Sumiyati P DEPO Rp 10,000

JUMLAH Rp 20,000 0 0 0 0 0 0 1 0 0 1 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P
P
P P
P P

3 8 0 1 0 0 2 0 0 0 1 2 4 7 0 0 1 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2892020 1 Ny. Mardalena P DEPO Rp 10,000
2 Tn. Linus L Jiwa
3 Tn. Isot L Jiwa
4 An. Agustinus Pinosio L PU P
5 Ny. Beliper. W P PU
6 Ny. Asdot P ANC
7 Nn. Anastasia. N P PU P
8 Ny. Anyuk P PU
9 Tn. Kedabang L PU
10 TN. Adrianus Ace L PU
11 Ny. Ciang P PU
12 Ny. Kristina. L P PU
13 Ny. Dy. Supijati P PU
14 Tn. Basri L PU
15 An. Paulus. A L PU P
16 Ny. Jaminah P PU
17 Ny. Pius Kosak P Jiwa
18 Tn. Vinsensius Noliman L PU
19 Tn. Jabui L OAT
20 An. Ropin L PU Rp 5,000 P
21 Tn. Ebeltus. D L PU
22 An. Aying Kristina P PU Rp 5,000 P
23 Tn. F. Maridin L PU Rp 5,000

JUMLAH Rp 25,000 0 0 0 0 0 0 2 0 0 1 1 0 0 1
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P
P P
P P
P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P
P
P P
P
P P

3 5 3 2 0 1 3 1 0 0 2 2 6 8 0 0 4 1
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
2992020 1 Ny. Ana P PU Rp 5,000
2 TN. Zek L PU
3 Tn. Ahmad Nasir L PU
4 Ny. Susima Wati P PU
5 Ny. Yustina D P PU
6 Tn. Martinus. R L PU
7 Tn. Aliang L Konsul Gigi
8 Ny. Maspah P PU
9 An. Yuliana M P PU P
10 Ny. Ramnah P Konsul Gigi
11 Tn. Ab. Mohtar L PU
12 Tn. Abong L PU
13 Ny. Salbiah P PU
14 Tn. Jeki L Jiwa
15 Ny. Lita Kristina P DEPO

JUMLAH Rp 5,000 0 0 0 0 0 0 0 1 0 0 0 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P P
P P
P P
P P
P P
P P
P P
P P
P
P P
P P
P P
P P
P P
P P

3 3 2 4 0 0 1 0 1 0 0 1 6 7 0 0 1 0
 BUKU RETRIBUSI HARIAN
Umur

Tgl No Nama Pasien JK Tindakan Jumlah Uang 1-<1 10 - 14 15 - 19

0-7 Hr 8-28 Hr 1 - 4 Thn 5 - 9 Thn
Thn Thn Thn
L P L P L P L P L P L P L P
3092020 1 An. Fran L PU P
2 An. Petrus Nathan L PU Rp 5,000 P
3 Tn. Bertus. E L PU Rp 5,000
4 Ny. Damiana Herrika P PU Rp 5,000
5 Tn. Martinus Adi L PU
6 Tn. Bernadus Dasi L PU
7 Tn. Lindong L PU
8 Tn. Leso L PU
9 Ny. Oni Jayanti P ANC
10 Tn. Donatus L PU
11 Tn. Ab. Yuslan L PU
12 Ny. Mariati P PU
13 Ny. Lusia Ana P PU

JUMLAH Rp 15,000 0 0 0 0 0 0 1 0 0 0 1 0 0 0
 STATUS

20 - 44 45 - 54 55 - 59 60 -69 ≥ 70 Thn UMUM BPJS UKS LAIN 2

Thn Thn Thn Thn
L P L P L P L P L P L P L P L P L P
P
P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P
P P

2 2 2 2 2 0 1 0 0 0 2 1 7 3 0 0 0 0