Inventaris

PT. AN-NISAA Putri

Laporan Daftar Penyusutan dan Amortisasi Fiskal
FEBRUARI 2021
(dalam satuan rupiah)

1 Harta
Partus setBerwujud Kelompok 1
ALAT Bak instrumen 23 xRUANG
KESEHATAN 13x15 cm BERSALIN
Kom kecil
Gunting tallipusat
Gunting episiotomi Tahun Harga Nilai Sisa Buku Fiskal Metode Penyusutan Penyusutan/Amortisasi Penyusutan/Amortisasi
Klem talipusat
No NAMA BARANG
Gunting benang JUMLAH
1/2 koher Perolehan Perolehan Awal Tahun Komersial Fiskal Tahun Ini Bulan Ini
Pinset anatomis
Pinset cirurgis
1 2020 2 set 1,300,000.00 1,300,000.00 Garis lurus Garis Lurus 325,000.00 27,083.33
Nal puder
2 Doppler 2020 2 1,400,000.00 1,400,000.00 Garis lurus Garis Lurus 350,000.00 29,166.67

3 Metlin 2020 2 50,000.00 50,000.00 Garis lurus Garis Lurus 12,500.00 1,041.67

4 2020 14,200,000.00 14,200,000.00 Garis lurus Garis Lurus 3,550,000.00 295,833.33

CTG (Cardiotopography)
5 Suction Aparatus 2020 3,800,000.00 3,800,000.00 Garis lurus Garis Lurus 950,000.00 79,166.67

6 Tensimeter Mobile 2020 1 2,700,000.00 2,700,000.00 Garis lurus Garis Lurus 675,000.00 56,250.00

7 Timbangan Bayi 2020 1 300,000.00 300,000.00 Garis lurus Garis Lurus 75,000.00 6,250.00

8 Lampu Periksa 2020 1 1,200,000.00 1,200,000.00 Garis lurus Garis Lurus 300,000.00 25,000.00

9 Standar Infus Mobile 2020 2 800,000.00 800,000.00 Garis lurus Garis Lurus 200,000.00 16,666.67

10 Oksigen Mobile 2020 850,000.00 850,000.00 Garis lurus Garis Lurus 212,500.00 17,708.33

11 Regulator Oksigen 2020 1 270,000.00 270,000.00 Garis lurus Garis Lurus 67,500.00 5,625.00

12 Trolly Tindakan 2020 1 3,200,000.00 3,200,000.00 Garis lurus Garis Lurus 800,000.00 66,666.67

13 Meja Mayo 2020 10 13,500,000.00 13,500,000.00 Garis lurus Garis Lurus 3,375,000.00 281,250.00

14 Vacum Ekstraktor 2020 1 3,400,000.00 3,400,000.00 Garis lurus Garis Lurus 850,000.00 70,833.33

15 Pispot 2020 20 7,600,000.00 7,600,000.00 Garis lurus Garis Lurus 1,900,000.00 158,333.33

16 Celemek 2020 3 450,000.00 450,000.00 Garis lurus Garis Lurus 112,500.00 9,375.00

17 Sepatu Boots 2020 1 50,000.00 50,000.00 Garis lurus Garis Lurus 12,500.00 1,041.67

18 Washlap 2020 2 Garis lurus Garis Lurus

Page 1
 Inventaris

19 Waskom Besar 2020 Garis lurus Garis Lurus

20 Waskom kecil 2020 3 Garis lurus Garis Lurus

21 Bengkok besar 2020 1 40,000.00 40,000.00 Garis lurus Garis Lurus 10,000.00 833.33

22 Bengkok Kecil 2020 2 52,000.00 52,000.00 Garis lurus Garis Lurus 13,000.00 1,083.33

23 Dressing jar 2020 5 500,000.00 500,000.00 Garis lurus Garis Lurus 125,000.00 10,416.67

24 Trombol Besar 2020 200,000.00 200,000.00 Garis lurus Garis Lurus 50,000.00 4,166.67

25 Kom Kecil tertutup 2020 1 60,000.00 60,000.00 Garis lurus Garis Lurus 15,000.00 1,250.00

26 Korentang 2020 1 100,000.00 100,000.00 Garis lurus Garis Lurus 25,000.00 2,083.33

27 Bengkok Sedang 2020 1 30,000.00 30,000.00 Garis lurus Garis Lurus 7,500.00 625.00

28 Tourniquet 2020 10 150,000.00 150,000.00 Garis lurus Garis Lurus 37,500.00 3,125.00

29 Infant Warmer 2020 2 47,600,000.00 47,600,000.00 Garis lurus Garis Lurus 11,900,000.00 991,666.67

30 Bed bayi paramounr + Bantal 2020 6 30,000,000.00 30,000,000.00 Garis lurus Garis Lurus 7,500,000.00 625,000.00

31 Meja Gynekologi + Bantal 2020 2 7,000,000.00 7,000,000.00 Garis lurus Garis Lurus 1,750,000.00 145,833.33

32 Bed pasien + Bantal 2020 2 31,500,000.00 31,500,000.00 Garis lurus Garis Lurus 7,875,000.00 656,250.00

33 Forcef 2020 Garis lurus Garis Lurus 0.00 0.00

34 Set Curretage 2020 1 9,700,000.00 9,700,000.00 Garis lurus Garis Lurus 2,425,000.00 202,083.33

Bak Instrumen 32x17x10 cm 2020

Vensterlklem 2020 -

Kogeltang 2020 -

Sonde uterus lentur 2020 1

Abortus tang 2020 1

Sendok curretage no 1 2020 1

Sendok curretage no 2 2020 1

Sendok curretage no 3 2020 1

Sendok curretage no 5 2020 1

Page 2
 Inventaris

Sendok curretage no 6 2020 1

Sendok curretage no 10 2020 1

Tampon tang 2020 1

Kom kecil 2020

Spekulum SIM sedang 2020

Spekulum SIM Kecil 2020

HPP Set
Spekulum SIM Besar 2020
Set Hecting
Bak instrumen 32x17x10 cm
Bak instrumen
Nald poeder 23x13x15 cm
Busi no 1 - 17 2020
Gunting benang
Vensterlklem
operator
Gunting benang
Tenakulum 2020
Pinset anatomis
Tampon tang
Pinsetkecil
Kom cirurgis
Bak instrumen besar 2020
Nald poeder
Pinset anatomis
Kom
Pinsetkecil
cirurgis
35 2020 2 set 900,000.00 900,000.00 Garis lurus Garis Lurus 225,000.00 18,750.00
Klem peanSIM
Spekulum lurusSedang
14cm
Spekulum
Minor SIM set
Surgery Kecil
36 2020 9,500,000.00 9,500,000.00 Garis lurus Garis Lurus 2,375,000.00 197,916.67
Kristerel
Pinset vagina
anatomis
Pinset cirurgis
l. Klem Ven Lurus 2020
Gunting benang
Kom kecil
37 2020 1 set 375,000.00 375,000.00 Garis lurus Garis Lurus 93,750.00 7,812.50
Bisturi
38 Ambu Bag Dewasa 2020 1 475,000.00 475,000.00 Garis lurus Garis Lurus 118,750.00 9,895.83

39 Thermometer digital 2020 1 150,000.00 150,000.00 Garis lurus Garis Lurus 37,500.00 3,125.00

40 Penlight 2020 35,000.00 35,000.00 Garis lurus Garis Lurus 8,750.00 729.17

41 Refleks hummer 2020 1 27,000.00 27,000.00 Garis lurus Garis Lurus 6,750.00 562.50

42 Trombol kecil 2020 50,000.00 50,000.00 Garis lurus Garis Lurus 12,500.00 1,041.67

43 Monoaural 2020 50,000.00 50,000.00 Garis lurus Garis Lurus 12,500.00 1,041.67

44 Suction Molahidatidosa 2020 2,600,000.00 2,600,000.00 Garis lurus Garis Lurus 650,000.00 54,166.67

45 usg 4d 2022 250,000,000.00 250,000,000.00 Garis lurus Garis Lurus 62,500,000.00 5,208,333.33

46 Stetoskop Dewasa 2020 3 2,800,000.00 2,800,000.00 Garis lurus Garis Lurus 700,000.00 58,333.33

Grand Total
448,964,000.00 198,964,000.00 112,241,000.00 9,353,416.67

Page 3
 Inventaris

Inventaris Kantor

Tahun Harga Nilai Sisa Buku Fiskal Metode Penyusutan Penyusutan/Amortisasi Penyusutan/Amortisasi
No NAMA BARANG JUMLAH
Perolehan Perolehan Awal Tahun Komersial Fiskal Tahun Ini Bulan Ini

13 13,000,000.00 13,000,000.00 Garis lurus Garis Lurus 3,250,000.00 270,833.33

1 Meja 2020

5 22,000,000.00 22,000,000.00 Garis lurus Garis Lurus 5,500,000.00 458,333.33

2 Komputer 2020

3 TV 2020 10 26,000,000.00 26,000,000.00 Garis lurus Garis Lurus 6,500,000.00 541,666.67

4 Printer 2020 5 5,000,000.00 5,000,000.00 Garis lurus Garis Lurus 1,250,000.00 104,166.67

5 Kipas angin 10 6,500,000.00 6,500,000.00 Garis lurus Garis Lurus 1,625,000.00 135,416.67

Grand Total 72,500,000.00 72,500,000.00 18,125,000.00 1,510,416.67

2 Harta Berwujud Kelompok 2

Inventaris Kantor

Tahun Harga Nilai Sisa Buku Fiskal Metode Penyusutan Penyusutan/Amortisasi Penyusutan/Amortisasi
No NAMA BARANG JUMLAH
Perolehan Perolehan Awal Tahun Komersial Fiskal Tahun Ini Bulan Ini
1 Kursi tunggu pasien 2020 9 13,000,000.00 13,000,000.00 Garis lurus Garis Lurus 1,625,000.00 135,416.67
2 AC 2020 21 68,250,000.00 68,250,000.00 Garis lurus Garis Lurus 8,531,250.00 710,937.50
3 Ranjang /Kasur Periksa 2020 5 12,500,000.00 12,500,000.00 Garis lurus Garis Lurus 1,562,500.00 130,208.33
4 Ranjang /Kasur Pasien Rawat Inap 2020 10 73,000,000.00 73,000,000.00 Garis lurus Garis Lurus 9,125,000.00 760,416.67
5 Ranjang /Kasur Pasien IGD 2020 2 9,000,000.00 9,000,000.00 1,125,000.00
6 Kursi Roda 2020 1 1,000,000.00 1,000,000.00 125,000.00
5 Kipas angin 2020 10 6,500,000.00 6,500,000.00 Garis lurus Garis Lurus 812,500.00 67,708.33
Grand Total 173,250,000.00 173,250,000.00 21,656,250.00 1,804,687.50

TOTAL PENYUSUTAN FISKAL 444,714,000.00 152,022,250.00 12,668,520.83

Page 4
 Laba

PT AN-NISAA PUTRI KALIGAYAM

LAPORAN LABA RUGI
FEBRUARI 2022
(dalam satuan rupiah)

Pendapatan
1. Rawat Jalan Umum
Obat Obatan 21,094,750
Konsultasi Dokter 12,730,000
Penunjang Medis 9,825,000
Administrasi 3,060,100

Total Pendapatan Rawat Jalan Umum 46,709,850

2. Rawat Inap Umum
Obat Obatan 17,943,000
Konsultasi Dokter 1,910,000
Penunjang Medis 2,576,000
Persalinan
Kamar 7,200,000
Total Pendapatan Rawat Inap Umum 29,629,000
3. Rawat Jalan BPJS
Obat Obatan 832,300
Konsultasi Dokter 1,066,300
Penunjang Medis 0
Administrasi 150,000
Potongan perawatan 131,600
Total Pendapatan Rawat Jalan BPJS 1,917,000
4. Rawat Inap BPJS
Obat Obatan 29,475,600
Konsultasi Dokter 34,718,600
Penunjang Medis 10,169,000
Administrasi 950,000
Kamar 24,375,000
Potongan perawatan 4,690,300
Total Pendapatan Rawat Inap BPJS 94,997,900

Grand Total pendapatan 173,253,750

Persediaan
1 Obat Obatan

persediaan awal 6,079,056.00

pembelian TUNAI 10,341,100.00
pembelian TEMPO
Total Persediaan Obat Akhir -18,252,669.00
2 Penunjang Medis
persediaan awal 3,200,885.00
pembelian 2,500,000.00
Total Persediaan Penunjang Medis Akhir 882,295.00
Total Persediaan Akhir Obat+P Medis -17,370,374.00

Harga Pokok Persediaan

Hpp Obat 34,672,825.00
Hpp Penunjang Medis 4,818,590.00
Total HPP Persediaan 39,491,415.00

Laba Kotor Penjualan 133,762,335.00

Beban Operasional
Beban sewa 2,000,000.00
Beban listrik, telp 6,037,500.00
Beban internet 50% 286,506.00
Beban ATK 5,106,250.00
Beban transportasi dan perawatan kendaraan 50% 1,345,500.00
Beban gaji karyawan 49,500,000.00
Beban perawatan gedung 2,408,250.00
Beban APD 800,000.00
Beban dapur klinik 7,612,200.00
Beban penyusutan 12,668,520.00
Total Beban Operasional 87,764,726.00

LABA Bersih Usaha 45,997,609.00

PAJAK YG DIBAYARKAN 11% 5,059,736.99

Page 5
 PT AN-NISAA PUTRI
LAPORAN NERACA
31 JULI 2020
(dalam satuan rupiah)

KEWAJIBAN DAN MODAL

NO AKTIVA JUMLAH NO JUMLAH
KEWAJIBAN
1 Kas 333,904,048.00 1 Hutang persediaan 15,780,500.00
2 Piutang usaha BPJS 229,295,248.00
3 Persediaan 86,943,001.00
4 Beban sewa dibayar dimuka 25,000,000.00 MODAL
5 Aktiva tetap 414,873,251.00 1 Modal awal 1,278,846,500.00
6 Akumulasi Penyusutan 52,221,309.00 2 Rugi bulan berjalan -141,509,529.00
3 Rugi Usaha JULI 2020 -10,880,614.00

TOTAL AKTIVA 1,142,236,857.00 TOTAL KEWAJIBAN DAN MODAL 1,142,236,857.00

 PT AN-NISAA PUTRI KALIGAYAM
LAPORAN PEMBAYARAN PAJAK PENGHASILAN BADAN
PPH FINAL 0.5%
DESEMBER 2021
(dalam satuan rupiah)

KODE AKUN PAJAK (KAP) 4111.28

PPH FINAL: KODE JENIS SETORAN (KJS) 420
Pendapatan
1. Rawat Jalan Umum
Obat Obatan 13,059,300
Konsultasi Dokter 10,670,000
Penunjang Medis 8,630,000
Administrasi 2,856,900

Total Pendapatan Rawat Jalan Umum 35,216,200

2. Rawat Inap Umum
Obat Obatan 19,065,000
Konsultasi Dokter 2,410,000
Penunjang Medis 2,890,000
Persalinan 3,500,000
Kamar 7,525,000
Total Pendapatan Rawat Inap Umum 35,390,000
3. Rawat Jalan BPJS
Obat Obatan 1,587,900
Konsultasi Dokter 1,080,000
Penunjang Medis 0
Administrasi 240,000
Potongan perawatan 0
Total Pendapatan Rawat Jalan BPJS 2,907,900
4. Rawat Inap BPJS
Obat Obatan 37,452,340
Konsultasi Dokter 16,575,000
Penunjang Medis 14,910,000
Administrasi 1,275,000
Kamar 30,925,000
Potongan perawatan 0
Total Pendapatan Rawat Inap BPJS 101,137,340
Grand Total pendapatan 174,651,440
PAJAK OKTOBER YANG DIBAYARKAN 873,257
 PT AN-NISAA PUTRI
LAPORAN LABA RUGI
MEI 2021
(dalam satuan rupiah)

Pendapatan
1. Rawat Jalan Umum
Obat Obatan 58,277,500
Konsultasi Dokter
Bidan Ika
Konsultasi 31,680,000
USG 2,970,000
Jasa Nebu 1,195,000
Jasa Suntik 2,060,000
Jasa EKG 600,000
Oksigen 390,000
Buku 390,000
Ambulance 150,000
Total Bidan Ika 39,435,000

dr Yudha 3,045,000
dr. Agung 990,000
dr. Novidasari 1,260,000
5,295,000
Total Konsultasi 44,730,000

Laboratorium 65,838,000
HV 7,491,800
Administrasi 10,481,300 83,811,100

Total Pendapatan Rawat Jalan Umum 186,818,600

2. Rawat Inap Umum
Obat Obatan 61,809,000
Konsultasi Dokter 8,410,000
Penunjang Medis
Oksigen 380,000
EKG 260,000
Jasa nebu 0
Jasa USG 140,000
Belanja garam ,kendil 70,000
Paket Persalinan 17,450,000
CAESAR 24,501,000
Kamar 25,425,000
Tindakan 725,000
Ambulance 100,000
kuretase 0
Grand Total pendapatan 139,270,000
Naik kelas BPJS 11,050,000 (uang di bu Ika)
Total Pendapatan Rawat Inap Umum dan naik kelas bpjs 150,320,000
tanpa naik kelas bpjs 326,088,600
3. Rawat Jalan BPJS
Obat Obatan 830,000
Konsultasi Dokter 4,608,100
Penunjang Medis 945,000
Administrasi 310,000
Potongan perawatan 173,200
Total Pendapatan Rawat Jalan BPJS 6,519,900
4. Rawat Inap BPJS
Obat Obatan 38,757,300
Konsultasi Dokter 57,034,600
Penunjang Medis 17,677,000
Administrasi 1,675,000
Kamar 34,475,000
Potongan perawatan 7,620,300
Total Pendapatan Rawat Inap BPJS 141,998,600

Page 8
 Total Pendapatan BPJS 148,518,500.00
Grand Total pendapatan 474,607,100.00

Page 9
Persediaan
1 Obat Obatan

persediaan awal -
pembelian inkaso 84,996,796
pembelian tunai 6,796,433
Total Persediaan Obat Akhir 91,793,229.00
2 Penunjang Medis
pembelian inkaso 6,625,000
pembelian tunai 249,500
Total Persediaan Penunjang Medis Akhir 6,874,500.00
Total Persediaan Akhir Obat+P Medis 98,667,729.00

Harga Pokok Persediaan

Hpp Obat 78,456,700.00
Hpp Penunjang Medis 10,230,000.00
Total HPP Persediaan 88,686,700.00

Penggunaan Bahan Habis Pakai 11,325,000.00

Laba Kotor Penjualan 374,595,400.00

Beban Operasional

Beban listrik, telp, internet 8,031,253.00

Beban fee dokter dan bidan
Beban ATK 2,376,700.00
Beban transportasi dan perawatan kendaraan 1,346,000.00
Beban gaji karyawan 65,000,000.00
Beban perawatan gedung 1,815,100.00
Beban DAPUR 8,436,500.00
Beban Fee resep apotik 1,600,000.00
Beban Fee laborat 300,000.00
Bebam tunjangan transportasi karyawan 3,030,000.00
Beban pembelian o/ kel. P Djalal 4,540,800.00
Beban APD 1,855,000.00
Beban sumbangan 150,000.00
Beban BPJS 3,735,166.00
Beban Penyusutan 7,480,187.00
RUJUK MITRA SIAGA
Total Beban Operasional 109,696,706.00

Laba Bersih Usaha 264,898,694.00

Page 10
 PT AN-NISAA PUTRI
LAPORAN LABA RUGI – BPJS
MEI 2021
(dalam satuan rupiah)

Pendapatan
1. Rawat Jalan Umum
Obat Obatan 58,277,500
Konsultasi Dokter
Bidan Ika
Konsultasi 31,680,000
USG 2,970,000
Jasa Nebu 1,195,000
Jasa Suntik 2,060,000
Jasa EKG 600,000
Oksigen 390,000
Buku 390,000
Ambulance 150,000
Total Bidan Ika 39,435,000

dr Yudha 3,045,000
dr. Agung 990,000
dr. Novidasari 1,260,000
5,295,000
Total Konsultasi 44,730,000

Laboratorium 65,838,000
HV 7,491,800
Administrasi 10,481,300 83,811,100

Total Pendapatan Rawat Jalan Umum 186,818,600

2. Rawat Inap Umum
Obat Obatan 61,809,000
Konsultasi Dokter 8,410,000
Penunjang Medis
Oksigen 380,000
EKG 260,000
Jasa nebu 0
Jasa USG 140,000
Belanja garam ,kendil 70,000
Paket Persalinan 17,450,000
CAESAR 24,501,000
Kamar 25,425,000
Tindakan 725,000
Ambulance 100,000
kuretase 0
Grand Total pendapatan 139,270,000
Naik kelas BPJS 11,050,000 (uang di bu Ika)
Total Pendapatan Rawat Inap Umum dan naik kelas bpjs 150,320,000
tanpa naik kelas bpjs 326,088,600
3. Rawat Jalan BPJS
Obat Obatan 830,000
Konsultasi Dokter 4,608,100
Penunjang Medis 945,000
Administrasi 310,000
Potongan perawatan 173,200
Total Pendapatan Rawat Jalan BPJS 6,519,900
4. Rawat Inap BPJS
Obat Obatan 38,757,300
Konsultasi Dokter 57,034,600
Penunjang Medis 17,677,000
Administrasi 1,675,000

Page 11
 Kamar 34,475,000
Potongan perawatan 7,620,300
Total Pendapatan Rawat Inap BPJS 141,998,600

Total Pendapatan BPJS 148,518,500.00

Grand Total pendapatan 474,607,100.00

Persediaan
1 Obat Obatan

persediaan awal -
pembelian inkaso 84,996,796
pembelian tunai 6,796,433
Total Persediaan Obat Akhir 91,793,229.00
2 Penunjang Medis
pembelian inkaso 6,625,000
pembelian tunai 249,500
Total Persediaan Penunjang Medis Akhir 6,874,500.00
Total Persediaan Akhir Obat+P Medis 98,667,729.00

Harga Pokok Persediaan

Hpp Obat 78,456,700.00
Hpp Penunjang Medis 10,230,000.00
Total HPP Persediaan 88,686,700.00

Penggunaan Bahan Habis Pakai 11,325,000.00

Laba Kotor Penjualan 374,595,400.00

Beban Operasional

Beban listrik, telp, internet 8,031,253.00

Beban fee dokter dan bidan
Beban ATK 2,376,700.00
Beban transportasi dan perawatan kendaraan 1,346,000.00
Beban gaji karyawan 65,000,000.00
Beban perawatan gedung 1,815,100.00
Beban DAPUR 8,436,500.00
Beban Fee resep apotik 1,600,000.00
Beban Fee laborat 300,000.00
Bebam tunjangan transportasi karyawan 3,030,000.00
Beban pembelian o/ kel. P Djalal 4,540,800.00
Beban APD 1,855,000.00
Beban sumbangan 150,000.00
Beban BPJS 3,735,166.00
Beban Penyusutan 7,480,187.00
RUJUK MITRA SIAGA
Total Beban Operasional 109,696,706.00

KLAIM bpjs TDK CAIR 67,699,260.00

Laba Bersih Usaha 197,199,434.00

Page 12
 KLINIK AN-NISAA
PT AN-NISAA PUTRI KALIGAYAM
LAPORAN BUKTI KAS MASUK RAWAT JALAN UMUM
APRIL 2022
(dalam satuan rupiah)

KREDIT
TGL DEBIT KET PENUNJANG MEDIS
NO OBAT KONSULTASI ADMINISTRASI TOTAL
KAS EKG NEBU LABORATORIUM USG OKSIGEN
BKM 001 1 11,800 APOTEK 11,800 11,800
1 285,000 LABORATORIUM 285,000 285,000
1 45,000 POLI GIGI 35,000 10,000 45,000
BKM 002 1 965,100 POLI UMUM 496,800 235,000 50,000 100,000 83,300 965,100
BKM 003 2 55,000 APOTEK 55,000 55,000
2 415,000 LABORATORIUM 415,000 415,000
BKM 004 2 638,000 POLI UMUM 338,000 170,000 100,000 30,000 638,000
BKM 005 3 84,800 APOTEK 84,800 84,800
3 185,000 LABORATORIUM 185,000 185,000
BKM 006 3 734,000 POLI UMUM 301,400 175,000 50,000 25,000 100,000 82,600 734,000
BKM 007 4 977,600 POLI UMUM 519,000 350,000 108,600 977,600
BKM 008 4 140,000 POLI ANAK 17,000 110,000 13,000 140,000
4 390,000 LABORATORIUM 390,000 390,000
BKM 009 5 429,000 POLI KANDUNGAN 179,000 230,000 20,000 429,000
5 560,000 LABORATORIUM 560,000 560,000
5 117,000 POLI GIGI 7,000 100,000 10,000 117,000
BKM 010 5 350,000 POLI UMUM 160,300 165,000 24,700 350,000
BKM 011 6 45,200 APOTEK 45,200 45,200
6 200,000 LABORATORIUM 200,000 200,000
6 125,000 POLI KANDUNGAN 115,000 10,000 125,000
BKM 012 6 696,500 POLI UMUM 306,800 300,000 89,700 696,500
BKM 013 7 492,000 POLI UMUM 196,800 200,000 50,000 45,200 492,000
BKM 014 7 430,000 LABORATORIUM 430,000 430,000
7 10,000 APOTEK 10,000 10,000
7 345,000 POLI GIGI 325,000 20,000 345,000
BKM 015 8 814,500 POLI UMUM 403,000 280,000 30,000 101,500 814,500
BKM 016 8 255,000 LABORATORIUM 255,000 255,000
8 193,500 POLI GIGI 8,500 175,000 10,000 193,500
BKM 017 9 220,000 LABORATORIUM 220,000 220,000
9 7,000 APOTEK 7,000 7,000
BKM 018 9 468,000 POLI UMUM 239,700 180,000 48,300 468,000
BKM 019 10 523,000 POLI UMUM 228,500 230,000 64,500 523,000
BKM 020 10 25,000 APOTEK 25,000 25,000
10 300,000 LABORATORIUM 300,000 300,000
BKM 021 11 625,600 POLI UMUM 261,200 285,000 79,400 625,600
BKM 022 11 345,000 LABORATORIUM 345,000 345,000
11 49,100 APOTEK 49,100 49,100
11 85,000 POLI GIGI 75,000 10,000 85,000
11 110,000 POLI AESTETIK 110,000 110,000
BKM 023 12 22,200 APOTEK 22,200 22,200
12 375,000 LABORATORIUM 375,000 375,000
BKM 024 12 570,600 POLI UMUM 178,300 300,000 92,300 570,600
BKM 025 13 709,000 POLI UMUM 273,000 365,000 71,000 709,000
BKM 026 13 25,500 APOTEK 25,500 25,500
13 275,000 LABORATORIUM 275,000 275,000
13 275,000 POLI GIGI 275,000 275,000
BKM 027 14 631,300 POLI UMUM 259,700 280,000 91,600 631,300
BKM 028 14 97,000 APOTEK 97,000 97,000
14 200,000 LABORATORIUM 200,000 200,000
BKM029 15 39,000 APOTEK 39,000 39,000
15 80,000 LABORATORIUM 80,000 80,000
BKM 030 15 617,000 POLI UMUM 222,900 220,000 100,000 74,100 617,000
BKM 031 16 761,000 POLI UMUM 400,200 285,000 75,800 761,000
BKM032 16 235,000 LABORATORIUM 235,000 235,000
BKM 033 17 543,000 POLI UMUM 151,100 230,000 100,000 61,900 543,000
BKM 034 17 11,500 APOTEK 11,500 11,500
17 160,000 LABORATORIUM 160,000 160,000
BKM 035 18 690,200 POLI UMUM 341,800 255,000 30,000 63,400 690,200
BKM 036 18 17,000 APOTEK 17,000 17,000
18 275,000 LABORATORIUM 275,000 275,000
BKM 037 19 125,000 POLI KANDUNGAN 115,000 10,000 125,000
19 215,000 POLI AESTETIK 215,000 215,000
BKM 038 19 25,000 APOTEK 25,000 25,000
19 140,000 LABORATORIUM 140,000 140,000
BKM 039 19 735,600 POLI UMUM 332,700 175,000 50,000 100,000 77,900 735,600
BKM 040 20 175,000 POLI GIGI 175,000 175,000

Page 13
 20 245,000 LABORATORIUM 245,000 245,000
20 16,700 APOTEK 16,700 16,700
20 125,000 POLI KANDUNGAN 115,000 10,000 125,000
BKM 041 20 655,600 POLI UMUM 267,600 300,000 88,000 655,600
BKM 042 21 540,000 POLI UMUM 250,800 200,000 25,000 64,200 540,000
21 140,000 POLI DALAM 40,000 90,000 10,000 140,000
BKM 043 21 330,000 LABORATORIUM 330,000 330,000
21 27,000 APOTEK 27,000 27,000
BKM 044 22 785,200 POLI UMUM 401,300 305,000 78,900 785,200
BKM 045 22 300,000 LABORATORIUM 300,000 300,000
22 23,500 APOTEK 23,500 23,500
BKM 046 23 622,400 POLI UMUM 330,300 240,000 52,100 622,400
BKM 047 23 115,000 LABORATORIUM 115,000 115,000
23 10,000 APOTEK 10,000 10,000
BKM 048 24 645,600 POLI UMUM 301,600 265,000 79,000 645,600
BKM 049 24 190,000 LABORATORIUM 190,000 190,000
24 54,500 APOTEK 54,500 54,500
24 110,000 POLI AESTETIK 110,000 110,000
BKM 050 25 844,500 POLI UMUM 434,200 325,000 85,300 844,500
BKM 051 25 160,000 LABORATORIUM 160,000 160,000
25 23,800 APOTEK 23,800 23,800
25 131,000 POLI GIGI 21,000 100,000 10,000 131,000
BKM 052 26 250,000 POLI KANDUNGAN 230,000 20,000 250,000
26 30,000 LABORATORIUM 30,000 30,000
26 185,000 POLI AESTETIK 185,000 185,000
26 26,700 APOTEK 26,700 26,700
BKM 053 26 260,000 POLI UMUM 97,900 140,000 22,100 260,000
BKM 054 27 150,000 LABORATORIUM 150,000 150,000
27 24,000 APOTEK 24,000 24,000
27 119,000 POLI GIGI 9,000 100,000 10,000 119,000
27 250,000 POLI AESTETIK 250,000 250,000
BKM 055 27 400,000 POLI UMUM 204,000 165,000 31,000 400,000
BKM 056 28 718,600 POLI UMUM 276,000 270,000 100,000 72,600 718,600
BKM 057 28 295,000 LABORATORIUM 295,000 295,000
28 10,000 APOTEK 10,000 10,000
28 185,000 POLI GIGI 175,000 10,000 185,000
28 485,000 POLI DALAM 285,000 180,000 20,000 485,000
BKM 058 29 35,000 LABORATORIUM 35,000 35,000
29 55,300 APOTEK 55,300 55,300
BKM 059 29 713,300 POLI UMUM 364,700 295,000 53,600 713,300
BKM 060 30 530,000 POLI UMUM 188,100 180,000 100,000 61,900 530,000
BKM 061 30 30,000 LABORATORIUM 30,000 30,000
30 43,600 APOTEK 43,600 43,600
30 500,000 POLI AESTETIK 500,000 500,000
0

TOTAL 32,161,900 11,504,400 10,085,000 200,000 110,000 7,205,000 800,000 0 2,257,500 32,161,900

8,315,000

Page 14
 PT AN-NISAA PUTRI KALIGAYAM
LAPORAN BUKTI KAS MASUK RAWAT INAP UMUM
MARET 2022
(dalam satuan rupiah)

KREDIT
TGL DEBIT KET PENUNJANG MEDIS
NO OBAT PERSALINAN KONSULTASI AMBULANCE KAMAR TOTAL
KAS EKG KURET LABORATORIUM USG OKSIGEN
BKM 072 2 2,166,000 AHMAD NISRON 1,461,000 180,000 525,000 2,166,000
BKM 073 5 2,554,000 REFANDI 1,614,000 240,000 700,000 2,554,000
BKM 074 9 2,247,000 AYU TIA 1,542,000 180,000 525,000 2,247,000
BKM 075 17 2,661,000 AHMAD KOFI 1,851,000 210,000 600,000 2,661,000
BKM 076 19 2,684,000 MUKTI 1,874,000 210,000 600,000 2,684,000
BKM 077 18 2,561,000 VANIA 1,621,000 240,000 700,000 2,561,000
BKM 078 19 2,679,000 JULELI 1,671,000 210,000 198,000 600,000 2,679,000
BKM 079 22 2,533,000 NABILA 1,593,000 240,000 700,000 2,533,000
BKM 080 23 2,481,000 GHONIMAH 1,621,000 210,000 50,000 600,000 2,481,000
BKM 081 29 1,731,000 ADE 1,241,000 140,000 350,000 1,731,000
BKM 082 28 2,574,000 KHASANAH 1,674,000 180,000 50,000 145,000 525,000 2,574,000
BKM 083 0
BKM 084 0
TOTAL 26,871,000 17,763,000 0 2,240,000 100,000 0 0 0 343,000 0 6,425,000 26,871,000
443,000

Page 15
 BAHAN HABIS PAKAI
KLINIK AN-NISAA
LAPORAN PENGGUNAAN BAHAN HABIS PAKAI
april 2021
(dalam satuan rupiah)

JENIS SATUAN HARGA TOTAL

KEPERAWATAN
Infus set makro 84 5,000 420,000
Infus set mikro 2 25,000 50,000
Abocat 20 39 8,000 312,000
Abocat 24 23 8,000 184,000
Abocat 26 20 8,000 160,000
Abocat 18 3
Selang transfusi 01 2 6,000 12,000
Selang transfusi 02 7 6,000 42,000
Infus RL 421 11,000 4,631,000
Infus D5 23 8,000 184,000
Infus D10 5 18,000 90,000
infus NaCl 7 12,000 84,000
Pamol 6 20,000 120,000
Kasa 10 14,000 140,000
Handscoon 264 1,500 396,000
Spuit 1cc 8 1,000 8,000
Spuit 3cc 104 2,000 208,000
Spuit 5cc 73 2,000 146,000
Spuit 10cc 36 2,000 72,000

LABORATORIUM
Spuit 3cc 258 2,000 516,000
Needle 3 1,500 4,500
Tabung Edta 241 2,500 602,500
kapas 290 2,000 580,000
plaster 256 500 128,000
Testpack kehamilan 23 2,000 46,000
GDS stick 51 2,000 102,000
Aquabides 5 6,500 32,500
Handscoon 83 1,500 124,500
NaCL mikron 1500 2000/100ml 25,000

GRAND TOTAL 9,420,000

rapid antibodi 129 25000 3,225,000

rapid antigen 19 35000 665,000
3890000

Page 16
 grafik laba rugi real

KLINIK AN-NISAA
GRAFIK LABA REAL
s/d MEI 2021

BULAN LABA
JANUARI 223,683,816
FEBRUARI 168,608,932
MARET 243,179,791
APRIL 265,923,246
MEI 264,898,694

GRAFIL LABA BERJALAN

12

10

8
LABA

0
BULAN

Page 17
 KLINIK AN-NISAA
LAPORAN BUKTI KAS MASUK RAWAT INAP BPJS
MARET 2022
(dalam satuan rupiah)

KREDIT
TGL DEBIT KET KAMAR PENUNJANG MEDIS
NO OBAT KONSULTASI JASA ADM DISC TOTAL
PIUTANG PERAWATAN EKG LABORATORIUM USG/rontgen OKS/DARAH
BPJS 001 2 2,155,300 HANA NATALIA 525,000 610,200 285,000 394,100 120,000 196,000 25,000 2,155,300
BPJS 002 2 2,603,800 SAIDAH 350,000 688,800 190,000 1,085,000 50,000 215,000 25,000 2,603,800
BPJS 003 3 2,155,300 LIA ELISA 700,000 967,400 380,000 17,900 65,000 25,000 2,155,300
BPJS 004 3 3,910,800 ACHMAD FAIZ MAULA 600,000 723,300 330,000 2,112,500 120,000 25,000 3,910,800
BPJS 005 3 2,155,300 WIJI SETYANINGRUM 525,000 648,900 285,000 551,400 120,000 25,000 2,155,300
BPJS 006 4 2,155,300 WARID 525,000 846,500 285,000 72,800 205,000 196,000 25,000 2,155,300
BPJS 007 5 2,155,300 KORIMUN 700,000 1,189,600 380,000 50,000 175,000 196,000 25,000 560,300 2,155,300
BPJS 008 9 3,260,900 TAMINAH 525,000 809,800 285,000 1,195,100 50,000 175,000 196,000 25,000 3,260,900
BPJS 009 9 2,155,300 RAFA AWI IRZANI 700,000 767,900 380,000 162,400 120,000 25,000 2,155,300
BPJS 010 10 2,155,300 BELVA ALFATHUNISSA 700,000 626,600 380,000 168,700 255,000 25,000 2,155,300
BPJS 011 13 3,017,400 ALIFA SYAHIFAH 1,375,000 907,200 625,000 140,000 25,000 54,800 3,017,400
BPJS 012 14 2,155,300 ROHMAENI 525,000 725,300 285,000 455,000 140,000 25,000 2,155,300
BPJS 013 15 2,586,400 ZENIT YUMNA Q 600,000 521,000 330,000 990,400 120,000 25,000 2,586,400
BPJS 014 16 2,155,300 FARADILA 525,000 999,900 285,000 185,000 196,000 25,000 60,600 2,155,300
BPJS 015 16 2,471,000 YAZID MUBAROK 525,000 684,500 285,000 831,500 120,000 25,000 2,471,000
BPJS 016 19 2,586,400 ATIKA TRIYANA 600,000 787,300 330,000 528,100 120,000 196,000 25,000 2,586,400
BPJS 017 20 2,155,300 NAUVIA TSAMANIYATUNNUSSA 700,000 902,800 380,000 27,500 120,000 25,000 2,155,300
BPJS 018 22 1,112,000 ARUMI SHIDQIA 875,000 629,000 475,000 120,000 25,000 1,012,000 1,112,000
BPJS 019 23 1,334,400 AQILA PUTRI S 800,000 471,400 440,000 140,000 25,000 542,000 1,334,400
BPJS 020 23 1,787,100 AISYAH SHANUM A 1,050,000 662,900 570,000 65,000 25,000 585,800 1,787,100
BPJS 021 24 1,993,100 MUFLIKHANAH 525,000 935,500 285,000 50,000 335,000 196,000 720,000 25,000 1,078,400 1,993,100
BPJS 022 25 3,260,900 SRIYANA 525,000 846,700 285,000 1,263,200 120,000 196,000 25,000 3,260,900
BPJS 023 25 2,155,300 TRI ANJANI 525,000 989,000 285,000 15,300 120,000 196,000 25,000 2,155,300
BPJS 025 28 2,155,300 TARPIAH 525,000 783,600 285,000 80,700 50,000 210,000 196,000 25,000 2,155,300
BPJS 026 30 1,334,400 AIRLANGGA PRATAMA 1,000,000 952,500 550,000 185,000 25,000 1,378,100 1,334,400
BPJS 027 31 3,124,500 MUTIARA EKA C 600,000 1,444,000 330,000 409,500 120,000 196,000 25,000 3,124,500
BPJS 028 31 3,260,900 KHOLIDAH 525,000 986,800 285,000 1,123,100 120,000 196,000 25,000 3,260,900
BPJS 029 31 3,913,100 MIPROKHA 800,000 1,309,800 440,000 827,300 50,000 265,000 196,000 25,000 3,913,100
BPJS 030 0
BPJS 031 0
BPJS 032 0
BPJS 033 0
BPJS 034 0
BPJS 035 0
BPJS 036 0
BPJS 037 0
BPJS 038 0
BPJS 039 0
0

TOTAL 67,420,700 18,450,000 23,418,200 9,930,000 12,311,500 300,000 4,315,000 2,548,000 720,000 700,000 5,272,000 67,420,700

7,883,000

Page 18
 KLINIK AN-NISAA
LAPORAN BUKTI KAS MASUK RAWAT JALAN UMUM BPJS
MARET 2022
(dalam satuan rupiah)

KREDIT
TGL DEBIT KET KONSULTASI USG/
NO OBAT ADMINISTRASI JASA DISCOUNT TOTAL
PIUTANG DOKTER EKG
BPJSU 001 4 127,800 DZAKIRA ARAFAH 45,000 14,400 10,000 58,400 127,800
BPJSU 002 4 127,800 MUH. ARJUNAJA G 45,000 17,300 10,000 55,500 127,800
BPJSU 003 4 127,800 FITRI RAHMA A 45,000 14,400 10,000 58,400 127,800
BPJSU 004 7 182,100 FIRZA S 45,000 24,400 10,000 102,700 182,100
BPJSU 005 7 127,800 LUTFI KHOERUNISA 45,000 5,000 10,000 67,800 127,800
BPJSU 006 15 127,800 SHINTA A 45,000 43,000 10,000 29,800 127,800
BPJSU 007 17 127,800 TAMINAH 45,000 68,200 10,000 4,600 127,800
BPJSU 008 18 127,800 RAFA AWI IRZANI 45,000 11,000 10,000 61,800 127,800
BPJSU 009 21 127,800 ALIFA SYAHIFAH 45,000 28,400 10,000 44,400 127,800
BPJSU 010 24 127,800 FARADILA 45,000 52,000 10,000 20,800 127,800
BPJSU 011 31 127,800 MUFLIKHANAH 45,000 46,000 10,000 26,800 127,800
BPJSU 012 15 127,800 KHORIMUN 45,000 39,800 10,000 33,000 127,800
BPJSU 013 0
BPJSU 030 0
BPJSU 031 0
0

TOTAL 1,587,900 540000 363,900 120,000 0 564,000 0 1,587,900

Page 19
 HPP

PT AN-NISAA PUTRI KALIGAYAM

LAPORAN HPP OBAT
28 FEB 2022
(dalam satuan rupiah)

NO KETERANGAN HPP/debit Persediaan/kredit

1 Rawat jalan umum 10,547,375.00 10,547,375.00
2 Rawat inap umum 8,971,500.00 8,971,500.00
3 Rawat jalan bpjs 416,150.00 416,150.00
4 Rawat inap bpjs 14,737,800.00 14,737,800.00

34,672,825.00 34,672,825.00

PT AN-NISAA PUTRI KALIGAYAM

LAPORAN HPP OBAT
28 FEB 2022
(dalam satuan rupiah)

NO KETERANGAN HPP/debit Persediaan/kredit

1 Rawat jalan umum 982,500.00 982,500.00
2 Rawat inap umum 257,600.00 257,600.00
3 Rawat jalan bpjs 106,630.00 106,630.00
4 Rawat inap bpjs 3,471,860.00 3,471,860.00

4,818,590.00 4,818,590.00

Page 20
 PT AN-NISAA PUTRI
LAPORAN PIUTANG
31 agustus 2020
(dalam satuan rupiah)

NO KETERANGAN PIUTANG/debit
1 Rawat jalan bpjs 2,801,300.00
2 Rawat inap bpjs 63,653,866.00

66,455,166.00
Grand Total 0.00

PT AN-NISAA PUTRI
LAPORAN KAS
31 agustus 2020
(dalam satuan rupiah)

NO KETERANGAN KAS/debit
1 Rawat jalan umum 25,649,800.00
2 Rawat inap umum 5,029,000.00

30,678,800.00

PT AN-NISAA PUTRI
LAPORAN ARUS KAS
31 agustus 2020
(dalam satuan rupiah)
KAS
NO KETERANGAN DEBIT
saldo awal 333,904,048.00
1 Rawat jalan umum 25,649,800.00
2 Rawat inap umum 5,029,000.00
3 Biaya operasional
4 Pembelian apotik
5 Pembelian laboratorium
364,582,848.00
saldo akhir
ANG
20
piah)

PENDAPATAN/kredit
2,801,300.00
63,653,866.00

66,455,166.00

S
20
piah)

PENDAPATAN/kredit
25,649,800.00
5,029,000.00

30,678,800.00

KAS
20
piah)
KREDIT

86,338,291.00
6,528,394.00
6,560,000.00
99,426,685.00
265,156,163
 KLINIK AN-NISAA
LAPORAN BUKTI KAS KELUAR
JURNAL PENGELUARAN KAS apotik
JANUARI 2022
(dalam satuan rupiah)

NO TGL KAS/KREDIT
ATK APD P.GEDUNG LISTRIK/TELP/INTERNET TRANSPORTASI DAPUR P.APOTIK P.LABORAT TOTAL
1 1 385,000 92,000 470,000 947,000 947,000
2 2 1,196,900 1,196,900 1,196,900
3 3 280,000 502,500 1,881,000 138,000 2,801,500 2,801,500
4 4 1,855,000 30,000 375,500 2,260,500 2,260,500
5 5 173,000 35,000 502,500 30,000 120,000 419,996 1,280,496 1,280,496
6 6 860,000 183,000 243,500 1,286,500 1,286,500
7 7 414,500 25,000 502,000 10,000 951,500 951,500
8 8 10,000 300,000 401,500 711,500 711,500
9 9 210,000 20,000 1,026,000 1,256,000 1,256,000
10 10 7,000 205,000 502,000 10,000 182,500 906,500 906,500
11 11 169,450 200,000 72,500 441,950 441,950
12 12 254,500 502,000 10,000 42,000 87,000 895,500 895,500
13 13 22,000 70,000 10,000 62,500 164,500 164,500
14 14 56,100 502,500 20,000 578,600 578,600
15 15 31,900 800,000 244,000 218,800 1,294,700 1,294,700
16 16 30,000 225,000 22,000 168,000 445,000 445,000
17 17 150,000 573,012 180,000 203,500 1,106,512 1,106,512
18 18 354,000 25,000 1,015,000 1,394,000 1,394,000
19 19 502,500 20,000 127,300 285,198 934,998 934,998
20 20 90,000 277,000 367,000 367,000
21 21 297,700 7,500 512,500 10,000 40,000 867,700 867,700
22 22 30,000 30,000 30,000
23 23 53,500 46,000 99,500 99,500
24 24 138,700 502,000 10,000 1,408,000 94,500 2,153,200 2,153,200
25 25 22,000 128,500 10,000 35,000 48,900 244,400 244,400
26 26 25,000 502,000 210,000 56,000 71,000 864,000 864,000
27 27 87,900 172,250 10,000 20,000 152,400 442,550 442,550
28 28 197,500 502,500 10,000 20,000 173,000 903,000 903,000
29 29 60,000 10,000 192,000 1,189,000 1,451,000 1,451,000
30 30 450,000 10,000 541,000 1,001,000 1,001,000
31 31 502,500 10,000 203,000 500,000 500,000 1,715,500 1,715,500
0
TOTAL 5,106,250 800,000 2,408,250 6,610,512 2,691,000 7,612,200 5,264,794 500,000 30,993,006 30,993,006
 absensi

PT AN-NISAA PUTRI KALIGAYAM

LAPORAN ABSENSI
15 Agustus s/d September 2022
(dalam satuan rupiah)

HADIR TIDAK TERLAMBAT UANG

NO NAMA PAGI/SIANG MALAM HADIR TGL/MENIT TRANSPORT
1 HANU 27 135,000
2 WILDAN 27 135,000
3 ALFIAH 10 11 TERLAMBAT TGL29/8 160,000
4 RAHAYU 21 3 135,000
5 ANNISA 16 6 CUTI 2 HARI 140,000
6 NELLI 27 135,000
7 NISA 27 135,000
8 LITA 27 135,000
9 INKA 27 135,000
10 NURFATIKHA 15 9 165,000
11 SITI 11 11 TERLAMBAT TGL18/8 165,000
12 HERSA 48 240,000
13 FEBI 17 6 145,000
14 AHID 50,000
15 DESI 13 65,000
16 KHOLIS 75,000
17 NOVA 50,000
18 KHARISMA 18 6 150,000
19 ELOK 4 80,000
20 SONI 50,000
21 DEVA 25 125,000
22 WINDA 19 8 175,000
23 INDRIYANI 27 135,000
24 NADIA 27 135,000
25 UNTUNG 27 135,000
TOTAL 3,185,000

FEE LABORATORIUM NELLI 200,000

DESI 50,000

GRAND TOTAL 3,435,000

Page 26
 absensi

PT AN-NISAA PUTRI KALIGAYAM

LAPORAN ABSENSI
15 Agustus s/d September 2022
(dalam satuan rupiah)

NO NAMA TANDA TANGAN

1 HANU 1 2

2 WILDAN
3 ALFIAH 3 4

4 RAHAYU
5 ANNISA 5 6

6 NELLI
7 NISA 7 8

8 LITA
9 INKA 9 10

10 NURFATIKHA
11 SITI 11 12

12 HERSA
13 FEBI 13 14

14 AHID
15 DESI 15 16

16 KHOLIS
17 NOVA 17 18

18 KHARISMA
19 ELOK 19 20

20 SONI
21 DEVA 21 22

22 WINDA
23 INDRIYANI
24 NADIA 25 26

25 UNTUNG

Page 27
 PIUTANG BPJS

PT AN-NISAA PUTRI
LAPORAN PIUTANG BPJS
MEI 2021
(dalam satuan rupiah)

PELUNASAN PELUNASAN KLAIM TDK CAIR

1 Rawat Jalan BPJS OKTOBER NOVEMBER JANUARI OKTOBER
Obat Obatan 1,792,300
Konsultasi Dokter 2,120,000
Penunjang Medis 735,000
Administrasi 560,000
Total Pendapatan Rawat Jalan BPJS 5,207,300 4,320,800 1,195,000 -308,500
2. Rawat Inap BPJS LEBIH BAYAR
Obat Obatan 62,736,200
Konsultasi Dokter 35,675,000
Penunjang Medis 24,750,000
Administrasi 2,340,000
Kamar 45,175,000
Total Pendapatan Rawat Inap BPJS 170,676,200 91,156,380 18,419,940 61,099,880
TOTAL 175,883,500 95,477,180 19,614,940 60,791,380

PELUNASAN PELUNASAN KLAIM TDK CAIR

1. Rawat Jalan BPJS NOVEMBER DESEMBER FEBRUARI NOVEMBER
Obat Obatan 2,700,400
Konsultasi Dokter 2,365,000
Penunjang Medis 840,000
Administrasi 420,000
Total Pendapatan Rawat Jalan BPJS 6,325,400 4,596,600 2,149,500 -420,700
2. Rawat Inap BPJS
Obat Obatan 91,202,200
Konsultasi Dokter 52,475,000
Penunjang Medis 35,828,000
Administrasi 4,600,000
Kamar 65,950,000
Total Pendapatan Rawat Inap BPJS 250,055,200 53,834,760 54,645,710 141,574,730
TOTAL 256,380,600 58,431,360 56,795,210 141,154,030

PELUNASAN PELUNASAN KLAIM TDK CAIR

1. Rawat Jalan BPJS DESEMBER JANUARI MARET
Obat Obatan 610,500
Konsultasi Dokter 1,540,000
Penunjang Medis 630,000
Administrasi 160,000
Total Pendapatan Rawat Jalan BPJS 2,940,500 2,940,500 0
4. Rawat Inap BPJS
Obat Obatan 36,074,800
Konsultasi Dokter 16,965,000
Penunjang Medis 20,730,000
Administrasi 1,485,000
Kamar 34,600,000
Total Pendapatan Rawat Inap BPJS 109,854,800 36,407,560 26,064,010 47,383,230
TOTAL 112,795,300 39,348,060 26,064,010 47,383,230

Page 28
 PIUTANG BPJS

PELUNASAN PELUNASAN KLAIM TDK CAIR

1. Rawat Jalan BPJS JANUARI FEBRUARI APRIL
Obat Obatan 610,400.00
Konsultasi Dokter 720,000.00
Penunjang Medis 630,000.00
jasa 2,023,200.00
Administrasi 160,000.00
Total Pendapatan Rawat Jalan BPJS 4,143,600 3,133,600 438,200 571,800
2. Rawat Inap BPJS
Obat Obatan 35,599,400.00
Konsultasi Dokter 15,120,000.00
Penunjang Medis 61,934,900.00
Administrasi 1,260,000.00
Kamar 30,275,000.00
Potongan perawatan 13,325,200.00
Total Pendapatan Rawat Inap BPJS 130,864,100 56,426,580 16,998,030 57,439,490
TOTAL 135,007,700 59,560,180 17,436,230 58,011,290

PELUNASAN PELUNASAN KLAIM TDK CAIR

1. Rawat Jalan BPJS FEBRUARI MARET MEI
Obat Obatan 584,600
Konsultasi Dokter 2,684,000
Penunjang Medis 735,000
Administrasi 220,000
Total Pendapatan Rawat Jalan BPJS 4,223,600 3,928,100 84,400 211,100
2. Rawat Inap BPJS
Obat Obatan 30,097,820
Konsultasi Dokter 47,016,080
Penunjang Medis 13,991,000
Administrasi 1,020,000
Kamar 28,650,000
Potongan perawatan 10,387,700
Total Pendapatan Rawat Inap BPJS 110,387,200 56,049,630 10,439,450 43,898,120
TOTAL 114,610,800 59,977,730 10,523,850 44,109,220

PELUNASAN PELUNASAN KLAIM TDK CAIR

1. Rawat Jalan BPJS MARET APRIL
Obat Obatan 1,504,900
Konsultasi Dokter 2,288,500
Penunjang Medis 210,000
Administrasi 280,000
Potongan perawatan 295,600
Total Pendapatan Rawat Jalan BPJS 3,987,800 3,987,800 0 0
2. Rawat Inap BPJS
Obat Obatan 38,296,200
Konsultasi Dokter 58,581,300
Penunjang Medis 22,827,000
Administrasi 1,120,000
Kamar 30,275,000
Potongan perawatan 9,060,800
Total Pendapatan Rawat Inap BPJS 142,038,700 42,093,170 32,246,270 67699260
TOTAL 146,026,500 46,080,970 32,246,270 67,699,260

67699260

Page 29
 PIUTANG BPJS

PELUNASAN PELUNASAN KLAIM TDK CAIR

1. Rawat Jalan BPJS APRIL MEI
Obat Obatan 1,362,800
Konsultasi Dokter 2,019,000
Penunjang Medis 420,000
Administrasi 280,000
Potongan perawatan 394,900
Total Pendapatan Rawat Jalan BPJS 3,686,900 3,391,400
4. Rawat Inap BPJS
Obat Obatan 47,361,900
Konsultasi Dokter 56,558,400
Penunjang Medis 25,747,000
Administrasi 1,340,000
Kamar 32,025,000
Potongan perawatan 13,195,000
Total Pendapatan Rawat Inap BPJS 149,837,300 63,806,400
TOTAL 153,524,200 67,197,800

PELUNASAN PELUNASAN KLAIM TDK CAIR

3. Rawat Jalan BPJS MEI JUNI
Obat Obatan 830,000
Konsultasi Dokter 4,608,100
Penunjang Medis 945,000
Administrasi 310,000
Potongan perawatan 173,200
Total Pendapatan Rawat Jalan BPJS 6,519,900 3,724,100
4. Rawat Inap BPJS
Obat Obatan 38,757,300
Konsultasi Dokter 57,034,600
Penunjang Medis 17,677,000
Administrasi 1,675,000
Kamar 34,475,000
Potongan perawatan 7,620,300
Total Pendapatan Rawat Inap BPJS 141,998,600 75,403,300
TOTAL 148,518,500 79,127,400

Page 30
 jurnal

PT AN-NISAA PUTRI KALIGAYAM

JURNAL
'DESEMBER 2020
(dalam satuan rupiah)

REFF 1.0 JURNAL KAS DEBIT

SALDO AWAL KAS 69,792,687
SALDO AWAL KAS DI BANK 116,993,530

1.1 Kas 31,938,700

Pendapatan rawat jalan umum
Pendapatan rawat inap umum
(pendapatan rawat umum)

1.2 Kas di bank 16,768,890

Piutang Rawat Jalan BPJS
Piutang Rawat Inap BPJS
(pembayaran klaim SEP ke 2)

1.3 Kas di bank 58,431,360

Piutang Rawat Jalan BPJS
Piutang Rawat Inap BPJS
(pembayaran klaim NOV ke 1)

1.4 Pembelian persediaan obat 8,212,950

kas
(pemnelian persediaan obat)

1.5 Pembelian persediaan labolatorium 780,000

Kas
(pemnelian persediaan penunjang medis)

1.6 Hutang obat 15,527,966

kas di bank
(pelunasan pembelian obat nov)

1.7 Hutang penunjang Medis 6,085,000

kas di bank
(pelunasan pembelian penunjang medis nov)

Page 31
 jurnal
1.8 Biaya operasional 102,865,273
sewa dibayar dimuka
kas
akumulasi penyusutan
(biaya operasional september)

19 kas 100,000,000
kas di bank
(setoran kas )

340,610,139

SALDO KAS 99,333,351

SALDO KAS di bank -22,824,272

REFF 2.0 JURNAL PERSEDIAAN DEBIT

SALDO AWAL PERSEDIAAN OBAT 6,447,295.00
SALDO AWAL PERSEDIAAN PENUNJANG MEDIS 8,775,085.00

2.1 HPP obat 18,258,105

HPP Penunjang Medis 2,326,050
Persediaan Obat
Persediaan Penunjang Medis

1.6 Pembelian persediaan obat 8,212,950

kas
(pemnelian persediaan obat)

1.7 Pembelian persediaan labolatorium 780,000

Kas
(pemnelian persediaan penunjang medis)

2.2 Pembelian persediaan labolatorium 5,235,000

hutang Laboratorium
(pembelian penunjang medis tempo)

2.3 Pembelian persediaan obat 10,331,472

Hutang obat
(pembelian persediaan obat tempo)

45,143,577

Page 32
 jurnal

Saldo persediaan obat 6,733,612

Saldo persediaan penunjang medis 12,464,035

REFF 3.0 JURNAL PIUTANG BPJS DEBIT

SALDO AWAL PIUTANG BPJS
Piutang Rawat Jalan BPJS 5,555,800
Piutang Rawat Inap BPJS 385,595,060

3.1 Piutang Rawat Jalan BPJS 2,940,500

Piutang Rawat Inap BPJS 109,854,800
Pendapatan rawat jalan BPJS
Pendapatan rawat inap BPJS
(pendapatan bpjs des)
1.2 Kas di bank 16,768,890
Piutang Rawat Jalan BPJS
Piutang Rawat Inap BPJS
(pembayaran klaim SEP ke 2)

1.3 Kas di bank 58,431,360

Piutang Rawat Jalan BPJS
Piutang Rawat Inap BPJS
(pembayaran klaim NOV ke 1)

3.2 Biaya klaim BPJS tidak cair juli 42,793,740

Piutang Rawat Jalan BPJS
Piutang Rawat Inap BPJS
(biaya klaim bpjs tidak cair sept)

230,789,290

Saldo Piutang BPJS 385,952,170

Saldo Piutang BPJS rajal 3,265,000
Saldo Piutang BPJS ranap 382,687,170

REFF 4.0 JURNAL MODAL DEBIT

SALDO AWAL MODAL

Page 33
 jurnal

Saldo Modal

REFF 5.0 JURNAL HUTANG OBAT DEBIT

SALDO AWAL HUTANG OBAT 10,331,472

2.3 Hutang obat 15,527,966

kas di bank
(pelunasan pembelian obat nov)

5.1 Pembelian persediaan obat 10,331,472

Hutang obat
(pembelian persediaan obat des tempo)

25,859,438
SALDO HUTANG OBAT

REFF 6.0 JURNAL HUTANG SEWA TEMPAT DEBIT

SALDO AWAL HUTANG SEWA TEMPAT USAHA

SALDO HUTANG SEWA TEMPAT USAHA

REFF 7.0 JURNAL HUTANG PENUNJANG MEDIS DEBIT

SALDO AWAL HUTANG PENUNJANG MEDIS 5,235,000

2.2 Hutang laboratorium 6,085,000

kas di bank

Page 34
 jurnal
(pelunasan penunjang medis nov)

7.1 Pembelian persediaan labolatorium 5,235,000

hutang Laboratorium
(pembelian penunjang medis tempo)

11,320,000
SALDO HUTANG OBAT

Page 35
 jurnal

KREDIT

17,660,700
14,278,000

465,400
16,303,490

4,596,600
53,834,760

8,212,950

780,000

15,527,966

6,085,000

Page 36
 jurnal

2,000,000
93,405,086
7,460,187

100,000,000

340,610,139

KREDIT

18,258,105
2,326,050

8,212,950

780,000

5,235,000

10,331,472

45,143,577

Page 37
 jurnal

KREDIT

2,940,500
109,854,800

465,400
16,303,490

4,596,600
53,834,760

169,300
42,624,440

230,789,290

KREDIT
932,814,741

Page 38
 jurnal

932,814,741

KREDIT
-

15,527,966

10,331,472

25,859,438
10,331,472

KREDIT
-

KREDIT
-

6,085,000

Page 39
 jurnal

5,235,000

11,320,000
5,235,000

Page 40
 hutang

KLINIK AN-NISAA
LAPORAN BUKTI KAS KELUAR
JURNAL PENGELUARAN KAS pelunasan hutang
JANUARI 2021
(dalam satuan rupiah)

bkk/32/jan

NO TGL KET
P.APOTIK
1 9 Bergas Saporette
2 14 Bergas Saporette
3 16 Bergas Saporette
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31

TOTAL 0

Page 41
 hutang

N-NISAA
TI KAS KELUAR
N KAS pelunasan hutang
RI 2021
uan rupiah)

KAS/KREDIT
P.LABORAT TOTAL
1,075,000 1,075,000 1,075,000
2,900,000 2,900,000 2,900,000
1,260,000 1,260,000 1,260,000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

5,235,000 5,235,000 5,235,000

Page 42