REKAPITULASI TAGIHAN KLAIM RITP PESERTA JKN (JAMINAN KESEHATAN NASIONAL)

PUSKESMAS COT SEUMEUREUNG KEC. SAMATIGA BULAN PELAYANAN JANUARI 2018

NO. KARTU TGL MASUK TGL KELUAR JUMLAH HARI TARIF BIAYA TOTAL BIAYA
NO NAMA PENDERITA ALAMAT NO. TELP DIAGNOSA PENYAKIT KETERANGAN

BPJS KESEHATAN PERAWATAN PERAWATAN RAWATAN RAWATAN/HARI RAWATAN

1 Asmanidar 0000004236816 Ds. Krueng Tinggai Tipoid Fever 29 12 2017 01 01 2018 3 180,000 540,000

2 Ajaran 0001305737526 Ds. Pinem DM 30 12 2017 02 01 2018 3 180,000 540,000

3 Syahrul Muharam 0001114012326 Ds. Cot Darat Obs. Febris ec. Tifoid Fever 30 12 2017 03 01 2018 4 180,000 720,000

4 Lindayani 0000215903709 Ds. Cot Darat DM + Obs. Febris 31 12 2017 02 01 2018 2 180,000 360,000

5 Nafkarul Faras 0001305492074 Ds. Paya Lumpat Urtikaria + Abdominal Pain 31 12 2017 01 01 2018 1 180,000 180,000

6 Yuswardi 0001118196303 Ds. Paya Lumpat Tipoid Fever 01 01 2018 04 01 2018 3 180,000 540,000

7 Rusniati 0002045020072 Ds. Cot Darat Obs. Febris 02 05 2018 05 01 2018 3 180,000 540,000

8 Maisarah 0001310081692 Ds. Lhok Bubon Obs. Febris dd. Tipoid Fever 02 01 2018 05 01 2018 3 180,000 540,000

9 Asnawiyah 0000216535779 Ds. Reusak Obs. Vomitus 02 01 2018 05 01 2018 3 180,000 540,000

10 Rismayana 0000979285882 Ds. Ujong Nga Tonsilo Faringitis 03 01 2018 06 01 2018 3 180,000 540,000

11 Malahayati 0001314015052 Ds. Cot Darat HT Emergency + Vertigo 03 01 2018 05 01 2018 2 180,000 360,000

12 Saiful 0002220031798 Ds. Gampong Cot Asma Bronchial 03 01 2018 05 01 2018 2 180,000 360,000

13 Rafiq Kamal 0001814934644 Ds.Cot seumeureng Obs. Febris 04 01 2018 06 01 2018 2 180,000 360,000

14 Lidya Safitri 0001421254078 Ds. Cot Darat Obs. Febris 04 01 2018 06 01 2018 2 180,000 360,000

15 M. Sakhi Zaidan 0001814935566 Ds.Cot seumeureng Obs. Febris 04 01 2018 06 01 2018 2 180,000 360,000

16 Abdullah 0000216899381 Ds.Cot Pluh Abdomonal Pain 05 01 2018 08 01 2018 3 180,000 540,000

17 Aliya Calista 0001384271087 Ds. Pange Obs. Febris 05 01 2018 08 01 2018 3 180,000 540,000

18 Khamsata Ramadhan 0000215395446 Ds. Pange Obs. Febris ec. Tipoid Fever 05 01 2018 07 01 2018 2 180,000 360,000

19 Suryanita 0002072830814 Ds. Cot Lampise GEA 05 01 2018 07 01 2018 2 180,000 360,000
20 M. Khalil Al-Qaiz 0002325119231 Ds. Cot Pluh Obs. Febris ec. Deman Dengue, Tipoid 05 01 2018 06 01 2018 1 180,000 180,000

21 Cut Azalea Dayana 0001327449317 Ds. Reusak Obs. Febris ec. Tipoid 06 01 2018 09 01 2018 3 180,000 540,000

22 Rika Rosdian Putri 0001118216182 Ds. Cot Mesjid Obs. Febris 06 01 2018 08 01 2018 2 180,000 360,000

23 Juandra 0002202729792 Ds. Alue Raya GEA 08 01 2018 10 01 2018 2 180,000 360,000

24 Resti Meza 0002077119909 Ds. Alue Raya Post. Op a/i Fibroma + Vertigo 08 01 2018 10 01 2018 2 180,000 360,000

25 Imam Zuhdi 0001849207893 Ds. Paya Lumpat Obs. Febris 08 01 2018 11 01 2018 3 180,000 540,000

26 Jamison 0000215558908 Ds. Leubok Hipertensi 08 01 2018 10 01 2018 2 180,000 360,000

27 Lola Alfira 0000004277103 Ds. Seuneubok Obs. Febris 09 01 2018 11 01 2018 2 180,000 360,000

28 Fitriadi 0000214635971 Ds. Cot Lampise GEA 09 01 2018 11 01 2018 2 180,000 360,000

29 Aqil Lulbawi 0002294789535 Ds. Cot Darat Obs. Febris 09 01 2018 10 01 2018 1 180,000 180,000

30 Jalimah Yulisa 0000215626285 Ds. Leuken Hyperemesis Gravidarum 10 01 2018 13 01 2018 3 180,000 540,000

31 Martina 0001484229655 Ds. Leubok GEA 10 01 2018 11 01 2018 1 180,000 180,000

32 Wahi 0000208410849 Ds. Cot Pluh GEA 10 01 2018 13 01 2018 3 180,000 540,000

33 Suryadi 0000215313377 Ds. Cot Pluh Obs. Febris 10 01 2018 11 01 2018 1 180,000 180,000

34 Salsabila 0000214938088 Ds. Cot Seumeureng obs. Febris 10 01 2018 11 01 2018 1 180,000 180,000

35 Supaiyah 0000004307185 Ds. Paya Lumpat Hipertensi 11 01 2018 13 01 2018 2 180,000 360,000

36 Fajri 0000216346173 Ds. Keureuseng Obs. Febris 10 01 2018 11 01 2018 1 180,000 180,000

37 M.Riyan Maulana 0001114036492 Ds.Cot Seumeureung Obs.Febris 11 01 2018 14 01 2018 3 180,000 540,000

38 Khairil Anwar 0000215238881 Ds. Cot Seumeureng Obs.Febris 11 01 2018 14 01 2018 3 180,000 540,000

39 Marzuki Y. 0000004353759 Ds. Cot Pluh Obs. Febris dd. Tipoid Fever 12 01 2018 15 01 2018 3 180,000 540,000

40 M. Yunus 0002002541499 Ds. Cot Seumeureng Dyspepsia 12 01 2018 14 01 2018 2 180,000 360,000

41 Hasniati 0001276948236 Ds. Cot Pluh Tipoid Fever 12 01 2018 14 01 2018 2 180,000 360,000

42 Cut Jamisah 0000215238341 Ds. Cot Seumeureng Vertigo 12 01 2018 14 01 2018 2 180,000 360,000

43 Usman Ali 0000215620187 Ds. Mesjid Baroe Hipertensi 12 01 2018 15 01 2018 3 180,000 540,000
44 Imam Ramadhan 0001305934637 Ds. Pinem Obs. Febris 13 01 2018 16 01 2018 3 180,000 540,000

45 M. Sultan Nazhirul 0002053357817 Ds. Pinem Obs. Febris 13 01 2018 16 01 2018 3 180,000 540,000

46 Mariani Is 0000979286275 Ds. Gampong Ladang Hipertensi + Obs. Febris 13 01 2018 14 01 2018 1 180,000 180,000

47 Hasbi 0000216841724 Ds. Woyla Timur Obs. Febris 14 01 2018 15 01 2018 1 180,000 180,000

48 Neta Purnama Sari 0001478442137 Ds. Cot Seulamat GEA + Obs. Febris 14 01 2018 17 01 2018 3 180,000 540,000

49 Rusdi B. 0000214951162 Ds. Ujong Nga Obs. Febris 14 01 2018 17 01 2018 3 180,000 540,000

50 Amirullah 0002070200856 Ds. Paya Lumpat Insomnia + Chepalgia 15 01 2018 17 01 2018 2 180,000 360,000

51 Marjuni Hanif 0002321060354 Ds. Reusak Obs. Febris dd. Tipoid Fever 15 01 2018 17 01 2018 2 180,000 360,000

52 Maisuri 0002320385409 Ds. Suak Pante Breuh Obs. Febris 15 01 2018 17 01 2018 2 180,000 360,000

53 Eri Yusmaizi 0001118178281 Ds. Paya Lumpat Obs. Febris + Candidiasis 15 01 2018 17 01 2018 2 180,000 360,000

54 Jihan Talita Fauza 0000232374536 Ds. Keureuseng Obs. Febris 16 01 2018 19 01 2018 3 180,000 540,000

55 Chaca Molina 0002216090248 Ds. Cot Seumeureng Obs. Febris 16 01 2018 19 01 2018 3 180,000 540,000

56 Erna 0001118224495 Ds. Suak Geudebang GEA 16 01 2018 17 01 2018 1 180,000 180,000

57 Asep Satria 0001423139027 Ds. Cot Darat Obs. Febris 16 01 2018 19 01 2018 3 180,000 540,000

58 Sri Afriana 0001284956649 Ds. Lhok Bubon Obs. Febris 16 01 2018 19 01 2018 3 180,000 540,000

59 Teuku Jumaitha Alrya Ta. 0000201751694 Ds. Alue Raya Obs. Febris 16 01 2018 18 01 2018 2 180,000 360,000

60 Cut Jamisah 0000215238341 Ds. Cot Seumeureng Obs. Febris + Post Trauma Capitis 17 01 2018 20 01 2018 3 180,000 540,000

61 Yusmanidar 0001114013518 Ds. Cot Darat Obs. Febris Susp. Typoid Fever 17 01 2018 20 01 2018 3 180,000 540,000

62 Sadita Meriyani 0000215631894 Ds. Suak Timah Dyspepsia 17 01 2018 19 01 2018 2 180,000 360,000

63 Yura Liska Arifa 0000004277283 Ds. Paya Lumpat Tipoid Fever 18 01 2018 21 01 2018 3 180,000 540,000

64 Imam Zuhdi 0001849207893 Ds. Paya Lumpat Tipoid Fever 18 01 2018 21 01 2018 3 180,000 540,000

65 M. Junaidi 0001112138649 Ds. Pinem Susp. Tipoid Fever 18 01 2018 21 01 2018 3 180,000 540,000

66 Muslimah 0000979284723 Ds. Cot Seumeureng Amoebiasis 18 01 2018 21 01 2018 3 180,000 540,000

67 Musliadi 0001305857687 Ds. Pinem Obs. Febris 19 01 2018 22 01 2018 3 180,000 540,000
68 Dewi Yana 0001118179363 Ds. Suak Pante Breuh Abdomen Discomform 19 01 2018 22 01 2018 3 180,000 540,000

69 Sayuti 000130354763 Ds. Lhok Bubon Obs. Febris 20 01 2018 23 01 2018 3 180,000 540,000

70 Rosmiati 0001310354785 Ds. Lhok Bubon Obs. Febris + DM 20 01 2018 23 01 2018 3 180,000 540,000

71 Raju Lianda 0000215628726 Ds. Gampong Teungoh Obs. Febris ec. Tipoid 20 01 2018 21 01 2018 1 180,000 180,000

72 Aisyah 0000215237463 Ds. Cot Seulamat Obs. Febris + Dyspepsia 21 01 2018 24 01 2018 3 180,000 540,000

73 Rosnani 0000004214665 Ds. Cot Seumeureng Obs. Febris + DM 23 01 2018 26 01 2018 3 180,000 540,000

74 M. Yunus 0002002541499 Ds. Cot Seumeureng Obs. Febris 23 01 2018 25 01 2018 2 180,000 360,000

75 Zukian 0001972162023 Ds. Cot Seumeureng GEA 24 01 2018 27 01 2018 3 180,000 540,000

76 Ernita 0002423423687 Ds.Cot Amun HT+Obs.Febris 24 01 2018 27 01 2018 3 180,000 540,000

77 Rahmatun Maqfirah 0001118177381 Ds. Paya Lumpat Dyspepsia 24 01 2018 26 01 2018 2 180,000 360,000

78 Agus Maidi 0000215235573 Ds. Cot Seulamat Disentri 24 01 2018 27 01 2018 3 180,000 540,000

79 Marjuni Hanif 0002321060354 Ds. Reusak GEA 25 01 2018 27 01 2018 2 180,000 360,000

80 Yasfadillah 0000979282991 Ds. Cot Darat Obs. Febris 25 01 2018 27 01 2018 2 180,000 360,000

81 Ali Fikri 0001114025297 Ds. Pucok Lueng PPOK + Dyspepsia 25 01 2018 28 01 2018 3 180,000 540,000

82 Deviana 0000215949993 Ds. Pange Disentri 25 01 2018 27 01 2018 2 180,000 360,000

83 Mukhtar 0000216535948 Ds. Reusak DM 26 01 2018 27 01 2018 1 180,000 180,000

84 Malawati 0000004270639 Ds. Cot Seumeureng Obs. Febris 26 01 2018 29 01 2018 3 180,000 540,000

85 Nurizani 0000004338483 Ds. Reusak Dyspepsia 26 01 2018 27 01 2018 1 180,000 180,000

86 Asnidar 0000979286409 Ds. Gampong Ladang GEA 26 01 2018 29 01 2018 3 180,000 540,000

87 Elli Maulida Yani 0000979284047 Ds. Cot Pluh Vertigo + Asma Bronchial 27 01 2018 29 01 2018 2 180,000 360,000

88 Hasan 0000216166691 Ds. Cot Amun Obs. Febris 27 01 2018 30 01 2018 3 180,000 540,000

89 Nyakti 0001897033318 Ds. Cot Lampise HT 27 01 2018 29 01 2018 2 180,000 360,000

90 Danang Satria 0000004242554 Ds. Cot Seumeureng DM 27 01 2018 29 01 2018 2 180,000 360,000

91 Nyak Umar 0002424510415 Ds.Leukeun Dyspepsia 28 01 2018 30 01 2018 2 180,000 360,000

92 Mustawa 0000216152414 Ds. Cot Amun Obs. Febris 28 01 2018 31 01 2018 3 180,000 540,000

93 Rohabi 0000979291168 Ds. Pange HT 28 01 2018 30 01 2018 2 180,000 360,000

94 Nasrawati 0000215630998 Ds. Suak Timah Obs. Febris 29 01 2018 31 01 2018 2 180,000 360,000

95 Julian 0000979298256 Ds. Reusak Obs. Febris 29 01 2018 31 01 2018 2 180,000 360,000

96 Muhammad Nazar 0000215313412 Ds. Cot Pluh Obs. Febris 29 01 2018 30 01 2018 1 180,000 180,000

97 Nuraida 0000216572106 Ds. Deuah Dyspepsia 29 01 2018 31 01 2018 2 180,000 360,000

TOTAL 227 40.860.000

Mengetahui : Cot Seumeureung, 2018

Kepala Dinas Kesehatan Kepala UPTD Puskesmas Cot Seumeureung
Kabupaten Aceh Barat Kecamatan Samatiga

dr.H.Zafril Luthfi. RA, M.Kes dr. Susanti

Pembina Utama Muda/Nip. 19630605 199703 1 003 NIP. 19681021 200012 2 001
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 REKAPITULASI TAGIHAN KLAIM RITP PESERTA JKN (JAMINAN KESEHATAN NASIONAL)
PUSKESMAS COT SEUMEUREUNG KEC. SAMATIGA BULAN PELAYANAN FEBRUARI 2018

NO. KARTU TGL MASUK TGL KELUAR JUMLAH HARI TARIF BIAYA TOTAL BIAYA
NO NAMA PENDERITA ALAMAT NO. TELP DIAGNOSA PENYAKIT KETERANGAN

BPJS KESEHATAN PERAWATAN PERAWATAN RAWATAN RAWATAN/HARI RAWATAN

1 Diva Ziatul Jannah 0001122890872 Ds. Gampong Teungoh Obs. Febris 29 01 2018 01 02 2018 3 180,000 540,000
2 Sapria Ida 0000214944693 Ds. Paya Lumpat Sy. Dgn Hemodinamic tidak stabil 30 01 2018 02 02 2018 3 180,000 540,000
3 M. Yunus 0001292741673 Ds. Suak Pante Breuh Obs. Febris dd. Tifoid Fever 31 12 2018 03 02 2018 3 180,000 540,000
4 M. Nur 0000004351162 Ds. Suak Seuke DM 01 02 2018 04 02 2018 3 180,000 540,000
5 Syaura Al Zakiya 0001966690383 Ds. Cot Pluh Obs. Febris 01 02 2018 04 02 2018 3 180,000 540,000
6 M. Yasir 0002423408477 Ds. Suak Pante Breuh Obs. Febris 01 02 2018 04 02 2018 3 180,000 540,000
7 M. Iqbal Maulana 0000215981583 Ds. Gampong Teungoh Obs. Febris 03 02 2018 05 02 2018 2 180,000 360,000
8 Suratul Muttaqin 0001315527759 Ds. Suak Seuke Obs. Febris 04 02 2018 07 02 2018 3 180,000 540,000
9 Dimas Faturrahman 0000979290641 Ds. Krueng Tinggai Obs. Febris 03 02 2018 06 02 2018 3 180,000 540,000
10 Harmaini 0001443564167 Ds. Gampong Ladang Hipotensi 04 02 2018 05 02 2018 1 180,000 180,000
11 T. Bahari 0001112127895 Ds. Keureuseng GEA 04 02 2018 05 02 2018 1 180,000 180,000
12 Wirda 0002115635416 Ds. Keureuseng GEA 04 02 2018 06 02 2018 2 180,000 360,000
13 Lisa 0000215943153 Ds. Pucok Lueng Obs. Febris + Dyspepsia 05 02 2018 08 02 2018 3 180,000 540,000
14 Aisyah Farhana 0002212204061 Ds. Paya Lumpat Obs. Febris 05 02 2018 09 02 2018 4 180,000 720,000
15 Della Febi Ayu 0001309012626 Ds. Kuala Bubon Dyspepsia + ISPA 05 02 2018 07 02 2018 2 180,000 360,000
16 Adnan Sulaiman 0001308953136 Ds. Kuala Bubon Dyspepsia 05 02 2018 07 02 2018 2 180,000 360,000
17 Yuslina 0000215942229 Ds. Pucok Lueng Obs. Febris + DM 06 02 2018 08 02 2018 2 180,000 360,000
18 Sri Ica Yanti 0001118512247 Ds. Suak Pante Breuh Dyspepsia 06 02 2018 08 02 2018 2 180,000 360,000
19 Reva Nanda 0002091610326 Ds. Cot Seulamat GEA 06 02 2018 07 02 2018 1 180,000 180,000
20 Maisarah 0002268147161 Ds. Gampong Ladang HT Gravidarum 06 02 2018 07 02 2018 1 180,000 180,000
21 Furqan 0001422490048 Ds. Suak Pante Breuh Obs. Febris 06 02 2018 10 02 2018 4 180,000 720,000
22 Nur Jumati 0000215775753 Ds. Alue Raya Obs. Febris 07 02 2018 10 02 2018 3 180,000 540,000
23 Khalis 0002055119714 Ds. Ulee Blang Gastritis 07 02 2018 09 02 2018 2 180,000 360,000
24 Kamaruzzaman 0001114100728 Ds. Suak Trieng GEA 07 02 2018 09 02 2018 2 180,000 360,000
25 Elmi 0001122685964 Ds. Pucok Lueng GEA 07 02 2018 11 02 2018 4 180,000 720,000
26 Muhazir Al Siddiqi 0001114010831 Ds. Cot Darat Obs. Febris 08 02 2018 10 02 2018 2 180,000 360,000
27 Halimah 0000214947865 Ds. Paya Lumpat Obs. Febris 09 02 2018 11 02 2018 2 180,000 360,000
28 Nurma 0000216345532 Ds. Keureuseng Artritis 09 02 2018 11 02 2018 2 180,000 360,000
29 Sulaiman 0000979291517 Ds. Keureuseng Gastritis 09 02 2018 11 02 2018 2 180,000 360,000
30 Zulkifli 0001150795416 Ds. Suak Pante Breuh Obs. Febris EC. Typoid Fever 09 02 2018 12 02 2018 3 180,000 540,000
31 Cut Hirlita 0001311817048 Ds. Suak Timah Hiperemesis Gravidarum 10 02 2018 12 02 2018 2 180,000 360,000
32 M. Juned B. 0000215236585 Ds. Cot Seulamat PPOK 10 02 2018 11 02 2018 1 180,000 180,000
33 Nabila Ridwan 0001840877785 Ds. Cot Darat Obs. Febris ec. Tonsilo Faringitis 11 02 2018 14 02 2018 3 180,000 540,000
34 Maulana 0000215631955 Ds. Suak Timah Obs. Febris 11 02 2018 14 02 2018 3 180,000 540,000
35 Rukayah 0000004195798 Ds. Keureuseng Dyspepsia 11 02 2018 12 02 2018 1 180,000 180,000
36 Khairan 0001118161732 Ds. Cot Seumeureng Hiperglikemia dd. DM Type II 12 02 2018 14 02 2018 2 180,000 360,000
37 Yusri Desi Welly 0000162732058 Ds. Cot Darat GEA 13 02 2018 16 02 2018 3 180,000 540,000
38 Sadita Meriyani 0000215631898 Ds. Suak Timah Obs. Febris EC. Typoid Fever 13 02 2018 16 02 2018 3 180,000 540,000
39 Novita Sari 0001421258624 Ds. Cot Darat Dyspepsia 13 02 2018 16 02 2018 3 180,000 540,000
40 Junaidi, Ama 0000156772565 Ds. Cot Darat GEA 14 02 2018 17 02 2018 3 180,000 540,000
41 Nofal Hibatullah 0000215548053 Ds. Leubok Obs. Febris dd. ISPA 15 02 2018 18 02 2018 3 180,000 540,000
42 Puteh Us 0000215797691 Ds. Leubok Obs. Vomitus + Konstipasi 15 02 2018 18 02 2018 3 180,000 540,000
43 Janwar Usra 0002205951737 Ds. Cot Seumeureng Ghout Artritis dd. Rhema Artritis 15 02 2018 17 02 2018 2 180,000 360,000
44 Ti Aja 0000979291495 Ds. Keureuseng Hipertensi 15 02 2018 18 02 2018 3 180,000 540,000
45 Munalisa 0001484243493 Ds. Leubok Dyspepsia 16 02 2018 19 02 2018 3 180,000 540,000
46 Hendra 0000214635508 Ds. Cot Lampise Susp. Tifoid Fever 17 02 2018 20 02 2018 3 180,000 540,000
47 Adian Saputra 0000215343123 Ds. Kuala Bubon Susp. Tifoid Fever 17 02 2018 20 02 2018 3 180,000 540,000
48 Neta Purnama Sari 0001478442137 Ds. Cot Seulamat Dyspepsia 17 02 2018 18 02 2018 1 180,000 180,000
49 Siska Maulida Herika 0000979281562 Ds. Lhok Bubon Obs. Febris + Dyspepsia 18 02 2018 20 02 2018 2 180,000 360,000
50 Mul Musyeni 0000215606417 Ds. Cot Darat Obs. Febris 19 02 2018 21 02 2018 2 180,000 360,000
51 Maisuki 0002002540228 Ds. Kuala Bubon Obs. Febris 19 02 2018 22 02 2018 3 180,000 540,000
52 Ratna Agoestina 0002222174373 Ds. Reusak GEA 19 02 2018 21 02 2018 2 180,000 360,000
53 Rusnawati 0000215606441 Ds. Cot Darat Hiperemesis Gravidarum 19 02 2018 22 02 2018 3 180,000 540,000
54 Asmaran Murni 0001306634411 Ds. Cot Mesjid Obs. Febris + HT 19 02 2018 20 02 2018 1 180,000 180,000
55 M. Yasir Aditia 0002201748107 Ds. Alue Raya Obs. Febris ec. Tifoid Fever 19 02 2018 22 02 2018 3 180,000 540,000
56 Rahmatul Jannah 0000215634688 Ds. Suak Timah Asma Bronchial 20 02 2018 22 02 2018 2 180,000 360,000
57 Lisma Diana Putri 0000214577302 Ds. Suak Seuke Obs. Febris 20 02 2018 23 02 2018 3 180,000 540,000
58 Desi Syatifa 0002236041538 Ds. Gampong Teungoh Obs. Febris ec. Tifoid Fever 20 02 2018 23 02 2018 3 180,000 540,000
59 Cut Reta 000138734357 Ds. Cot Seumeureng Obs. Febris 20 02 2018 24 02 2018 4 180,000 720,000
60 Zulkarnaini 0000216193972 Ds. Keureuseng GEA 21 02 2018 23 02 2018 2 180,000 360,000
61 Cut Intan 0000215237507 Cot Seulamat Morbili 21 02 2018 24 02 2018 3 180,000 540,000
62 Rasanah 0001114015533 Ds. Cot Darat GEA 22 02 2018 24 02 2018 2 180,000 360,000
63 Nuryani 0001309054498 Ds. Kuala Bubon Obs. Febris 22 02 2018 25 02 2018 3 180,000 540,000
64 Nurlina 0002044069187 Ds. Cot Seumeureng Hiperemesis Gravidarum 22 02 2018 25 02 2018 3 180,000 540,000
65 M. Rafi Aly 0001293494106 Ds. Suak Seuke Obs. Febris 25 02 2018 28 02 2018 3 180,000 540,000
66 Icha Natasya 0000004277676 Ds. Cot Seumeureng Obs. Febris dd. Tifoid 25 02 2018 27 02 2018 2 180,000 360,000
67 Yulizam 0002246518361 Ds. Suak Pante Breuh Obs. Febris ec. Dd. Tifoid Fever 09 02 2018 10 02 2018 1 180,000 180,000
68 Izza Adela 0001831161115 Ds Suak Timah Bronchitis 24 02 2018 27 02 2018 3 180,000 540,000
69 Yulia Tursina 0002081852662 Ds. Pinem Obs. Febris ec. DHF 10 02 2018 11 02 2018 1 180,000 180,000
TOTAL 169 30,420,000

Mengetahui : Cot Seumeureung, 2018

Kepala Dinas Kesehatan Kepala UPTD Puskesmas Cot Seumeureung
Kabupaten Aceh Barat Kecamatan Samatiga

dr.H.Zafril Luthfi. RA, M.Kes dr. Susanti

Pembina Utama Muda/Nip. 19630605 199703 1 003 NIP. 19681021 200012 2 001
 dr.H.Zafril Luthfi. RA, M.Kes dr. Susanti
Pembina Utama Muda/Nip. 19630605 199703 1 003 NIP. 19681021 200012 2 001
 REKAPITULASI TAGIHAN KLAIM RITP PESERTA JKN (JAMINAN KESEHATAN NASIONAL)
PUSKESMAS COT SEUMEUREUNG KEC. SAMATIGA BULAN PELAYANAN MARET 2018

NO. KARTU TGL MASUK TGL KELUAR JUMLAH HARI TARIF BIAYA TOTAL BIAYA
NO NAMA PENDERITA ALAMAT NO. TELP DIAGNOSA PENYAKIT KETERANGAN

BPJS KESEHATAN PERAWATAN PERAWATAN RAWATAN RAWATAN/HARI RAWATAN

1 Aula Miranda Adella 0002054028701 Ds. Suak Pante Breuh Obs. Febris 26 02 2018 01 03 2018 3 180,000 540,000
2 Devian Ayulian 0000216174442 Ds. Keureuseng Obs. Febris 26 02 2018 01 03 2018 3 180,000 540,000
3 Fahrul 0001112048572 Ds. Paya Lumpat Obs. Febris dd. ISPA 27 02 2018 02 03 2018 3 180,000 540,000
4 Nahyatul Ula 0002198389645 Ds. Ujong Nga Obs. Febris dd. ISPA 27 02 2018 02 03 2018 3 180,000 540,000
5 Fatimah 0000227042842 Ds. Panga Dyspepsia 27 02 2018 02 03 2018 3 180,000 540,000
6 Ardi 0001309969967 Ds. Suak Timah Obs. Febris dd. Tifoid Fever, ISPA 27 02 2018 03 02 2018 3 180,000 540,000
7 Fitriani 0000214914554 Ds. Suak Pante Breuh Obs. Febris dd. Tifoid Fever 28 02 2018 03 02 2018 3 180,000 540,000
8 Fajar Rizki 0002219430723 Ds. Alue Raya ISPA 01 03 2018 04 03 2018 3 180,000 540,000
9 Siti Zahura 0001112149506 Ds. Cot Darat Obs. Febris dd. Tifoid Fever 01 03 2018 03 03 2018 2 180,000 360,000
10 Debiyani 0000004236568 Ds. Deuah GEA + Febris 01 03 2018 04 03 2018 3 180,000 540,000
11 Supaiyah 0000004307185 Ds. Paya Lumpat Hipertensi 01 03 2018 04 03 2018 3 180,000 540,000
12 Nurhayati 0001313514044 Ds. Suak Seuke Tifoid Fever 02 03 2018 06 03 2018 4 180,000 720,000
13 Nuraini 0001804509077 Ds. Cot Seumeureng Hipertensi 02 03 2018 05 03 2018 3 180,000 540,000
14 Abdul Rauf 0000216849789 Ds. Suak Pandan Dyspepsia 02 03 2018 04 03 2018 2 180,000 360,000
15 Hanifah 0000004233093 Ds. Cot Seumeureng Hipertensi 03 03 2018 06 03 2018 3 180,000 540,000
16 Safiyah 0001112223508 Ds. Ujong Nga GEA 04 03 2018 07 03 2018 3 180,000 540,000
17 Abidah 0001801614644 Ds. Deuah Dyspepsia + HT + Candidiasis 04 03 2018 07 03 2018 3 180,000 540,000
18 Cut Ida Laila 0001308412888 Ds. Suak Pante Breuh Dyspepsia 01 03 2018 04 03 2018 2 180,000 360,000
19 Riswandi 0001308672202 Ds. Kuala Bubon Urtikaria 05 03 2018 07 03 2018 2 180,000 360,000
20 Muslimatus Sakdiyah 0000216088299 Ds. Pucok Lueng Obs. Febris 05 03 2018 08 03 2018 3 180,000 540,000
21 Marwati 0000214640572 Ds. Pinem Gastritis 05 03 2018 08 03 2018 3 180,000 540,000
22 Rini Aprilia Z. 0001081871537 Ds. Cot Darat Dyspepsia + Epilepsi 06 03 2018 07 03 2018 1 180,000 180,000
23 Ridha Armadi 0001118224462 Ds. Reusak Obs. Febris 06 03 2018 09 03 2018 3 180,000 540,000
24 Vinny Tri Dwinove 0001819183331 Ds. Cot Seumeureng Morbili 06 03 2018 09 03 2018 3 180,000 540,000
25 Erfriansyah 0000004178261 Ds. Cot Darat Obs. Febris EC. Typoid 07 03 2018 10 03 2018 3 180,000 540,000
26 Rita Wani 0000214944298 Ds. Paya Lumpat Obs. Febris EC. Typoid 07 03 2018 11 03 2018 4 180,000 720,000
27 Nurhayati 0002198117215 Ds. Reusak Hipertensi 07 03 2018 10 03 2018 3 180,000 540,000
28 Reka Hanim 0000216114434 Ds. Krueng Tinggai Hipertensi + Alergi Obat 01 03 2018 02 03 2018 1 180,000 180,000
29 Siti Arma 0001309442501 Ds. Cot Amun Obs.Febris + HT 08 03 2018 10 03 2018 2 180,000 360,000
30 Rinda Wati 0000215632866 Ds. Suak Timah GEA 08 03 2018 09 03 2018 1 180,000 180,000
31 M. Ali 0000214913924 Ds. Suak Pante Breuh Obs. Febris EC. Typoid 08 03 2018 10 03 2018 2 180,000 360,000
32 T. Akmal Putra 0000207524698 Ds. Suak Timah Obs. Febris EC. Typoid 08 03 2018 11 03 2018 3 180,000 540,000
33 Suraiya 0000004375179 Ds. Suak Timah Obs. Febris EC. Typoid 08 03 2018 11 03 2018 3 180,000 540,000
34 Tarzani Usman 0000214944243 Ds. Paya Lumpat Obs. Febris EC. Typoid 08 03 2018 11 03 2018 3 180,000 540,000
35 Rosnidar 0000215751429 Ds. Pucok Lueng GEA 10 03 2018 13 03 2018 3 180,000 540,000
36 Erlina Wati 0001384598259 Ds. Pange Hiperemesis Gravidarum 11 03 2018 14 03 2018 3 180,000 540,000
37 Cut Ramlan 0001122867066 Ds. Leuken HT Emergency + Pneumonia 12 03 2018 14 03 2018 2 180,000 360,000
38 Nur Azizah 0000215602154 Ds. Woyla GEA 13 03 2018 16 03 2018 3 180,000 540,000
39 Saiful 0002220031798 Ds. Gampong Cot Febris + Rhematoid 13 03 2018 16 03 2018 3 180,000 540,000
40 Mutiani 0001436445977 Ds. Pinem GEA + Vomitus 13 03 2018 16 03 2018 3 180,000 540,000
41 Rukaiyah 0002307948118 Ds. Reusak Hiperemesis Gravidarum 15 03 2018 17 03 2018 2 180,000 360,000
42 Darwis Nur 0002439466018 Ds. Suak Pante Breuh Susp. TB Paru 14 03 2018 17 03 2018 3 180,000 540,000
43 Rahmatul Maqfirah 0000214949092 Ds. Paya Lumpat Obs.Febris 14 03 2018 17 03 2018 3 180,000 540,000
44 Mariana 0000215920899 Ds. Cot Darat PPOK + Asma Bronchial 14 03 2018 17 03 2018 3 180,000 540,000
45 M. Yunus 0001118196527 Ds. Gampong Teungoh Gastritis 17 03 2018 20 03 2018 3 180,000 540,000
46 M. Iskandar 0001858168034 Ds. Suak Timah GEA 17 03 2018 19 03 2018 2 180,000 360,000
47 Ansari Hasan 0000216339603 Ds. Keureuseng Disfagia + HT 17 03 2018 19 03 2018 2 180,000 360,000
48 Bahtiar 0002282654136 Ds. Kuta Padang Gastritis 19 03 2018 22 03 2018 3 180,000 540,000
49 Alfatun Zuhra 0001114009086 Ds. Cot Darat Asma Bronchial 20 03 2018 22 03 2018 2 180,000 360,000
50 Ahmad Al-Fata 0002285196928 Ds. Pinem GEA 20 03 2018 23 03 2018 3 180,000 540,000
51 Sri Wahyuni 0000215631865 Ds. Suak Timah Mastitis 20 03 2018 22 03 2018 2 180,000 360,000
52 Tiara Fadhillah 0002441257029 Ds. Leuken Morbili 21 03 2018 24 03 2018 3 180,000 540,000
53 Fadyatul Jannah 0002082744944 Ds. Kuala Bubon GEA 22 03 2018 25 03 2018 3 180,000 540,000
54 T. Ikhsanuddin 0001118185424 Ds. Leuken Obs. Febris ec.Tifoid 22 03 2018 24 03 2018 2 180,000 360,000
55 Rasyidah 0001308846633 Ds. Mesjid Baroe Asma Bronchial 22 03 2018 23 03 2018 1 180,000 180,000
56 Aisyah 0000214620704 Ds. Cot Amun Bronchitis 22 03 2018 24 03 2018 2 180,000 360,000
57 Nyak Bulen 0000038393335 Ds. Cot Amun CKR 22 03 2018 25 03 2018 3 180,000 540,000
58 Ati Yuliana 0000004340215 Ds. Reusak Gastritis 23 03 2018 25 03 2018 2 180,000 360,000
59 Hanif Ikram 0002211229168 Ds. Ujong Nga Tifoid Fever 23 03 2018 26 03 2018 3 180,000 540,000
60 Agustina 0001483191832 Ds. Alue Raya Dyspepsia 24 03 2018 27 03 2018 3 180,000 540,000
61 Khairol Fadlan 0001122847964 Ds. Cot Pluh Obs. Febris ec.Tifoid 24 03 2018 27 03 2018 3 180,000 540,000
62 Aidarus 0000216347826 Ds. Keureuseng Dyspepsia 26 03 2018 28 03 2018 2 180,000 360,000
63 Siti Amalan 0001310091276 Ds. Suak Timah SOPT 27 03 2018 28 03 2018 1 180,000 180,000
64 Rusli Sulaiman 0000216335575 Ds. Keureuseng Dyspepsia 27 03 2018 30 03 2018 3 180,000 540,000
65 Abd. Rahman 0001118177291 Ds. Paya Lumpat Susp. Tifoid Fever 28 03 2018 31 03 2018 3 180,000 540,000
66 Nurhayati 0001310795223 Ds. Pucok Lueng Dyspepsia + HT 03 03 2018 06 03 2018 3 180,000 540,000
TOTAL 174 31,320,000

Mengetahui : Cot Seumeureung, 2018

Kepala Dinas Kesehatan Kepala UPTD Puskesmas Cot Seumeureung
Kabupaten Aceh Barat Kecamatan Samatiga

dr.H.Zafril Luthfi. RA, M.Kes dr. Susanti

Pembina Utama Muda/Nip. 19630605 199703 1 003 NIP. 19681021 200012 2 001
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 REKAPITULASI TAGIHAN KLAIM RITP PESERTA JKN (JAMINAN KESEHATAN NASIONAL)
PUSKESMAS COT SEUMEUREUNG KEC. SAMATIGA BULAN PELAYANAN APRIL 2018

NO. KARTU NO. TGL MASUK TGL KELUAR JUMLAH HARI TARIF BIAYA TOTAL BIAYA
NO NAMA PENDERITA ALAMAT DIAGNOSA PENYAKIT KETERANGAN
BPJS KESEHATAN TELP PERAWATAN PERAWATAN RAWATAN RAWATAN/HARI RAWATAN
1 Abidah 0001801614644 Ds. Deuah GEA 01 04 2018 04 04 2018 3 180,000 540,000
2 Ismalita 0001114025488 Ds. Pucok Lueng Gastritis + Obs.Febris 04 04 2018 07 04 2018 3 180,000 540,000
3 Iskandar 0000215021098 Ds. Mesjid Baroe Vertigo 05 04 2018 08 04 2018 3 180,000 540,000
4 Rifal Maulana 0001388209656 Ds. Suak Timah GEA 05 04 2018 08 04 2018 3 180,000 540,000
5 Siti Rufaidah 0001884726562 Ds. Cot Seulamat Gastritis 06 04 2018 09 04 2018 3 180,000 540,000
6 Rismayana 0000979285882 Ds. Ujong Nga Susp. Tifoid Fever 01 04 2018 04 04 2018 3 180,000 540,000
7 Rohani 0001382922944 Ds. Reusak HT + Vertigo 06 04 2018 09 04 2018 3 180,000 540,000
8 Ratnawati 0001276946627 Ds. Cot Pluh Vertigo 06 04 2018 09 04 2018 3 180,000 540,000
9 Malawati 0000004270634 Ds. Cot Seumeureng Gephalgia 07 04 2018 10 04 2018 3 180,000 540,000
10 Juni Mukran 0000215937674 Ds. Cot Darat Obs. Febris EC. Typoid 08 04 2018 11 04 2018 3 180,000 540,000
11 T. Roesman 0000004564091 Ds. Cot Darat Gastritis 08 04 2018 11 04 2018 3 180,000 540,000
12 Juanda 0002447921171 Ds. Cot Seulamat Tifoid Fever 09 04 2018 12 04 2018 3 180,000 540,000
13 Merni 0000979282631 Ds. Suak Timah Obs. Febris + Dyspepsia 09 04 2018 12 04 2018 3 180,000 540,000
14 Rusli AR. 0000215632337 Ds. Suak Timah GEA 11 04 2018 14 04 2018 3 180,000 540,000
15 Erni Yanti 0001276270378 Ds. Suak Pandan DM Type II 11 04 2018 14 04 2018 3 180,000 540,000
16 Mariani 0001270824197 Ds. Cot Darat Tifoid Fever 12 04 2018 15 04 2018 3 180,000 540,000
17 Rita Rolinda 0000004232687 Ds. Cot Seumeureng GEA 12 04 2018 15 04 2018 3 180,000 540,000
18 Anwar 0001309322845 Ds. Cot Amun Susp. Tifoid Fever 13 04 2018 16 04 2018 3 180,000 540,000
19 Nursamsidar 0000214946728 Ds. Paya Lumpat GEA +Ca. Kelenjar 13 04 2018 16 04 2018 3 180,000 540,000
20 Khairil Anwar 0000215238881 Ds. Cot Seumeureng Tifoid Fever 13 04 2018 16 04 2018 3 180,000 540,000
21 Rusmiati 0002443273593 Ds. Reusak Dyspepsia + Chepalgia 14 04 2018 17 04 2018 3 180,000 540,000
22 Khatijah Ahmad 0002229969273 Ds. Sigli Obs. Febris 15 04 2018 18 04 2018 3 180,000 540,000
23 Halimah 0000215234447 Ds. Cot Seulamat Pneumonia 15 04 2018 16 04 2018 1 180,000 180,000
24 Munir Pakeh 0002083884028 Ds. Gampong Teungoh Hipertensi + Dimentia 16 04 2018 19 04 2018 3 180,000 540,000
25 Aris Munandar 0000004374808 Ds. Cot Seumeureng Vertigo + CKR 16 04 2018 18 04 2018 2 180,000 360,000
26 Shinta Maulida 0000979281573 Ds. Lhok Bubon Gastritis 16 04 2018 19 04 2018 3 180,000 540,000
27 Herwandi 0001299256626 Ds. Cot Seumeureng Gastritis 17 04 2018 19 04 2018 2 180,000 360,000
28 Jesmir Hanisa 0001118179473 Ds. Suak Pante Breuh Tifoid Fever 17 04 2018 20 04 2018 3 180,000 540,000
29 Safiyah 0001112223508 Ds. Ujong Nga Hipertensi 17 04 2018 19 04 2018 2 180,000 360,000
30 T. Nizal Kurniawan 0001387342427 Ds. Cot Seumeureng Gastritis 18 04 2018 21 04 2018 3 180,000 540,000
31 Syawal 0002450463748 Ds. Pinem Obs. Febris 18 04 2018 21 04 2018 3 180,000 540,000
32 Wahyuni 0002450848623 Ds. Gampong Ladang Tifoid Fever 19 04 2018 22 04 2018 3 180,000 540,000
33 Fitri Wahyuni 0000214944941 Ds. Paya Lumpat Obs. Febris 19 04 2018 22 04 2018 3 180,000 540,000
34 Nurul Hasikin 0000226941113 Ds. Beutong Dyspepsia 20 04 2018 22 04 2018 2 180,000 360,000
35 Yeni Kurniawati 0000226651926 Ds. Suak Pante Breuh Obs. Febris 20 04 2018 21 04 2018 1 180,000 180,000
36 Neiliati 0000215236146 Ds. Gampong Cot GEA 21 04 2018 25 04 2018 4 180,000 720,000
37 Muhaimin 0001308736405 Ds. Kuala Bubon Dyspepsia 22 04 2018 26 04 2018 4 180,000 720,000
38 Khayla Azzahra 0002308683543 Ds. Cot Darat GEA 24 04 2018 27 04 2018 3 180,000 540,000
39 Nazir M. 0001273007171 Ds. Paya Lumpat Obs. Febris + Tifoid Fever 24 04 2018 27 04 2018 3 180,000 540,000
40 Julia Putri 0001112106969 Ds. Suak Timah Dyspepsia 24 04 2018 27 04 2018 3 180,000 540,000
41 Nuraida 0000979284789 Ds. Cot Seumeureng Dyspepsia 24 04 2018 27 04 2018 3 180,000 540,000
42 Ayu Fadilla 0001305302286 Ds. Paya Lumpat Obs. Febris dd. Tifoid Fever 25 04 2018 28 04 2018 3 180,000 540,000
43 Rusnawati 0000215628041 Ds. Gampong Teungoh Electrika Burn Injury 25 04 2018 28 04 2018 3 180,000 540,000
44 Juriyati 0002002540781 Ds. Alue Raya Gastritis 26 04 2018 29 04 2018 3 180,000 540,000
45 Roziatul Fazillah 0001200745539 Ds. Suak Pante Breuh Hiperemesis Gravidarum 26 04 2018 29 04 2018 3 180,000 540,000
46 Usman Muhammad 0002427413477 Ds. Paya Lumpat Dyspepsia 26 04 2018 29 04 2018 3 180,000 540,000
47 Siti Rufaidah 0001884726562 Ds. Cot Seulamat Obs. Vomitus 26 04 2018 29 04 2018 3 180,000 540,000
48 Kamil 0001272388476 Ds. Kuala Bubon Asma Bronchial + Dyspepsia 27 04 2018 30 04 2018 3 180,000 540,000
49 Zainab 0002201165763 Ds. Paya Lumpat Dyspepsia Psikosomatik 27 04 2018 30 04 2018 3 180,000 540,000
50 Masdiana 0000214945198 Ds. Paya Lumpat Dyspepsia 27 04 2018 30 04 2018 3 180,000 540,000
TOTAL 144 25,920,000

Mengetahui : Cot Seumeureung, 2018

Kepala Dinas Kesehatan Kepala UPTD Puskesmas Cot
Kabupaten Aceh Barat Seumeureung
Kecamatan Samatiga
dr.H.Zafril Luthfi. RA, M.Kes
Pembina Utama Muda/Nip. 19630605 199703 1 003 Ilham Kamaruzzaman, SKM
NIP. 19760501 200212 1 007
Ilham Kamaruzzaman, SKM
NIP. 19760501 200212 1 007
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