REKAPITULASI KLAIM PERSALINAN BIDAN JEJARING FKTP

NO NAMA FKTP NAMA BIDAN JEJARING NO. REKENING NO.NPWP TANGGAL PERSALINAN

1 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 28/07/2018

2 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 07/08/2018

3 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 09/08/2018

4 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 09/08/2018

5 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 09/08/2018

6 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 14/08/2018

7 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 25/08/2018

8 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 07/09/2018

9 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 08/09/2018

10 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 09/09/2018

11 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 11/09/2018

12 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 04/10/2018

13 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 05/10/2018

14 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 07/10/2018

15 Puskesmas Berutung Raya Mini Rahmiati, Am.Keb 0010328150379 159945252733000 08/10/2018

16 Puskesmas Berutung Raya Mini Rahmiati, Am.Keb 0010328150379 159945252733000 08/10/2018

17 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 13/10/2018

18 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 19/10/2018

19 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 21/10/2018

20 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 25/10/2018

21 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 26/10/2018

22 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 27/10/2018

23 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 28/10/2018

24 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 29/10/2018

25 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 01/11/2018

26 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 06/11/2018

27 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 08/11/2018

28 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 09/11/2018

29 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 11/11/2018

30 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 12/11/2018

31 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 13/11/2018

32 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 17/11/2018

33 Puskesmas Berutung Raya Mini Rahmiati, Am.Keb 0010328150379 159945252733000 27/11/2018

34 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 27/11/2018

35 Puskesmas Berutung Raya Mini Rahmiati, Am.Keb 0010328150379 159945252733000 29/11/2018

36 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 08/12/2018

37 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 16/12/2018

38 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 17/12/2018

39 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 18/12/2018

40 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 19/12/2018

41 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 24/12/2018

42 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 27/12/2018

43 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 29/12/2018

44 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 30/12/2018

45 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 30/12/2018

TOTAL

Banjarmasin,

Pengaju Klaim

dr. Hj. Santi Indriyani Achmadiyah

NIP. 19821117 201101 2 005
FKTP

NAMA PESERTA NO. JKN-KIS TARIF PAKET

Islamiyah 0000895598818 700,000

Yunita Hastuti 0000894674327 700,000

Krisna Wati 0000894785703 700,000

Milda 0001177847662 700,000

Jum'ah 0000891602561 700,000

Sri Widati 0002446111574 700,000

Elka Arytianti 0002429017391 700,000

Siti Maisarah 0002369657114 700,000

Raudah 0002458372397 700,000

Halimah 0002256087881 700,000

Wahdyatifah 0001616149809 700,000

Nurjannah 0002299729195 700,000

Lasriati 0002465925333 700,000

Annisa Kahfi 0000895444885 700,000

Mutia Dewi 0002453875604 700,000

Fitriani 0002434466788 700,000

Rabiah 0000895945961 700,000

Khairun Nisa 0001195463722 700,000

Pina 00008888720333 700,000

Juriati 0002448070143 700,000

Nisa 0000895012108 700,000

Kania Munjila Sakinah 0001312881693 700,000

Gusti Nor Aida 0002464224232 700,000

Ismida 0002047753743 700,000

Bariah 0000894791788 700,000

Hartini 0000895865117 700,000

Mariani 0000895045443 700,000

Faridah 0002467230265 700,000

Hadijah 0002480293708 700,000

Marshella 0002490506594 700,000

Usih 0002461959077 700,000

Rabiatul 0000895903514 700,000

Nur Hikmah 0002448332728 700,000

Noorhikmah 0001880440086 700,000

Desy Lisnayanti 0000200514789 700,000

Sri Yanti 0000895451916 700,000

Mariati 0000894894838 700,000

Sri Hairani 0000895959977 700,000

Noor Latifah 0002495784791 700,000

Winda Hayati 0001923871386 700,000

Asmah 0001065808675 700,000

 Harfiah Wulandari 0000895485475 700,000

Jumiati 0000895636135 700,000

Dina Indah Saputri 0000895164118 700,000

Noor Ainah 00008951101873 700,000

31,500,000

2019

chmadiyah
 REKAPITULASI KLAIM PERSALINAN BIDAN JEJARING FKTP

NO NAMA FKTP NAMA BIDAN JEJARING NO. REKENING NO.NPWP TANGGAL PERSALINAN

1 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 06/07/2018

2 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 12/07/2018

3 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 13/07/2018

4 Puskesmas Berutung Raya Rusna, Am.keb 0010328150189 14776554731000 13/07/2018

5 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 18/07/2018

6 Puskesmas Berutung Raya Hj. Jumilah, S.Si.T 0010328151203 083798926731000 22/07/2018

7 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 28/07/2018

8 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 31/07/2018

9 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 30/11/2018

10 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 01/12/2018

11 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 04/12/2018

12 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 20/12/2018

13 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 05/01/2019

14 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 07/01/2019

15 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 09/01/2018

16 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 16/01/2019

17 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 17/01/2019

18 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 17/01/2019

19 Puskesmas Berutung Raya Yuni Indriati, Am.Keb 0010328150403 159720499731000 18/01/2019

20 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 21/01/2019

21 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 21/01/2019

22 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 22/01/2019

23 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 25/01/2019

24 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 27/01/2019

25 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 29/01/2019

26 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 29/01/2019

27 Puskesmas Berutung Raya Rusna, Am.keb 0010328150189 14776554731000 04/02/2019

28 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 06/02/2019

29 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 07/02/2019

30 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 12/02/2019

31 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 12/02/2019

32 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 15/02/2019

33 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 18/02/2019

34 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 19/02/2019

35 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 19/02/2019

36 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 20/02/2019

37 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 21/02/2019

38 Puskesmas Berutung Raya Mini Rahmiati, Am.Keb 0010328150379 159945252733000 26/02/2019

39 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 27/02/2019

40 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 06/03/2019

41 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 08/03/2019

42 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 09/03/2019

43 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 16/03/2019

44 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 17/03/2019

45 Puskesmas Berutung Raya Nurul Inayah, Am.Keb 0010328180587 161638093734000 30/03/2019

TOTAL

Banjarmasin,

Pengaju Klaim

dr. Hj. Santi Indriyani Achmadiyah

NIP. 19821117 201101 2 005
FKTP

NAMA PESERTA NO. JKN-KIS TARIF PAKET

Halifah 0000896110503 700,000

Halimatussa'diyah 0002452351689 700,000

Kadariah 0002122994891 700,000

Nana Rusiana 0001065799506 700,000

Khairiah 0002242469518 700,000

Fatimah 0002465959072 700,000

Mahmudah 0002445233545 700,000

Yunita 0002463463449 700,000

Nor Madina 0002328225197 700,000

Nurul Hidayah 0001925430862 700,000

Salasiah 0001817978848 700,000

Khairunnimah 0001546539906 700,000

Mita Afsari 0002623521746 700,000

Emilia Agustina 0000894157288 700,000

Hamsiah 0002307786783 700,000

Nursinah 000895448259 700,000

Riani 0001450635535 700,000

Ramadana 0001193046772 700,000

Rohana 0001446060846 700,000

Miranda Sari 0001971775348 700,000

Nila Sari 0001317320526 700,000

Nor Ahadiyah 0002303830012 700,000

Sariah 0001065791777 700,000

Nor Hidayah 0001409609744 700,000

Mia Apriani 0002502340773 700,000

Fitriyati 0000895398309 700,000

Rusdiana Efendy 0000896090736 700,000

Arbayah 000894677499 700,000

Halimah 0001932414671 700,000

Norlaila 0002250035223 700,000

Minda Yolanda 0002618354507 700,000

Bainah 0002438998176 700,000

Halidah 0001883980078 700,000

Rusmini 0001305449032 700,000

Nurul Alfiah 0001195135672 700,000

Amariah 0002053674268 700,000

Rahmi 0002134148714 700,000

Saniyah 0001925435169 700,000

Sarmila 0001479412181 700,000

Linda Wati 0002370539092 700,000

 Noraina Yanti 0000895280455 700,000

Mulianti 0000895836791 700,000

Anna Farlina 0002499636598 700,000

Munawarah 0002748785163 700,000

Norfah 0002034099099 700,000

31,500,000

2019

chmadiyah
 REKAPITULASI KLAIM PERSALINAN BIDAN JEJARING FKTP

NO NAMA FKTP NAMA BIDAN JEJARING NO. REKENING NO.NPWP TANGGAL PERSALINAN

1 Puskesmas Berutung Raya Satumi, Am.Keb 0010328150205 553623810731000 09/03/2019

2 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 01/04/2019

3 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 04/04/2019

4 Puskesmas Berutung Raya Ais Santi, Am.Keb 0010301001203 661485466735000 04/04/2019

5 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 05/04/2019

6 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 13/04/2019

7 Puskesmas Berutung Raya Sekar S.W.A, Am.Keb 0010328150258 160470308731000 17/04/2019

8 Puskesmas Berutung Raya Kumala N.A, Am.Keb 0010328150261 155933914731000 18/04/2019

9 Puskesmas Berutung Raya Lydia Noviana, Amd.Keb 0010301008941 811558568731000 26/04/2019

10 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 28/04/2019

11 Puskesmas Berutung Raya Mini Rahmiati, Am.Keb 0010328150379 159945252733000 28/04/2019

12 Puskesmas Berutung Raya Hj. Norhayati, Am.Keb 0010328150229 559837604731000 28/04/2019

TOTAL
 Banjarmasin,

Pengaju Klaim

dr. Hj. Santi Indriyani Achmadiyah

NIP. 19821117 201101 2 005
FKTP

NAMA PESERTA NO. JKN-KIS TARIF PAKET

Khadijah 0001722658432 700,000

Rabiatul Adawiyah 0000895107159 700,000

Rusmalina 0002446167892 700,000

Aulia 0000896043892 700,000

Yulia 0002749513239 700,000

Barlian 0002625995619 700,000

Samiyah 000895866445 700,000

Gusti Suhartini 0002492232535 700,000

D'yantie Hamsatun 0000123159363 700,000

Muna Ashari Ariani 0002622214923 700,000

Norhasanah 0002621339728 700,000

Nurul Hikmah 0002207455929 700,000

8,400,000
 2019

chmadiyah