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LAPORAN AKHIR TAHUN PELAKSANAAN JAMKESMAS DAN JAMPERSAL | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16
[NAME] DASAR
TAHUN 2012
[NAME] terhormat, |  |  |  |  |  |  |  |  |  |  |  |  | …………………. Januari 2013
Kepala Pusat Pembiayaan dan [NAME]
di   Jakarta
 | Bersama ini Kami kirimkan Laporan akhir tahun (Januari s/d Desember ) pelaksanaan [NAME] ([NAME])
 | Tahun 2012 yang meliputi; Pemanfaatan [NAME] Pelayanan Kesehatan sebagai berikut:
PROPINSI |  |  |  | : |  |  |  | [NAME]  …………………………………………………….
 | I. | PEMANFAATAN DANA |  |  |  |  |  |  |  |  |  | [NAME] (Rp)
 |  | 1. | Total [NAME] Yankes Dasar diterima ([NAME]) |  |  |  |  |  |  |  |  | : | ……………………………….
 |  | 2. | Total [NAME] [NAME]: (A + B) |  |  |  |  |  |  |  |  | : | ……………………………….
 |  |  | [NAME] Peserta Jamkesmas
 |  |  | Bulan   Pelayanan |  |  | Pemanfaatan [NAME] ([NAME])
 |  |  |  |  |  | Rawat Jalan |  |  | Rawat Inap |  |  | Transport Rujukan Jamkesmas
 |  |  | Januari
 |  |  | Pebruari
 |  |  | Maret
 |  |  | April
 |  |  | [NAME]
 |  |  | Juni
 |  |  | [NAME]
 |  |  | Agustus
 |  |  | September
 |  |  | Oktober
 |  |  | Nopember
 |  |  | [NAME]
 |  |  | JUMLAH TOTAL
 |  |  | [NAME] [NAME]
 |  |  | Bulan   Pelayanan |  |  | Pemanfaatan [NAME] ([NAME])
 |  |  |  |  |  | ANC | PNC | Persalinan Normal | [NAME] | [NAME] di Poned | [NAME] (Manual Placenta) | [NAME] |  | [NAME] ([NAME])
 |  |  |  |  |  |  |  |  |  |  |  |  |  | IUD + IMPLAN | Suntik | Penanganan Komplikasi KB Pasca Salin
 |  |  | Januari
 |  |  | Pebruari
 |  |  | Maret
 |  |  | April
 |  |  | [NAME]
 |  |  | Juni
 |  |  | [NAME]
 |  |  | Agustus
 |  |  | September
 |  |  | Oktober
 |  |  | Nopember
 |  |  | [NAME]
 |  |  | JUMLAH TOTAL
 |  | 3. | Total [NAME] ke Kas Negara  (SSBP [NAME]) = [NAME] (1 - 2) |  |  |  |  |  |  |  |  | : | ……………………………….
 |  | 4. | Total Jasa/ [NAME] [NAME] ke Kas Negara  (SSBP [NAME]) |  |  |  |  |  |  |  |  | : | ……………………………….
 |  | 5. | Total Klaim 2012 [NAME] terbayarkan |  |  |  |  |  |  |  |  | : | ……………………………….
 |  |  | ( [NAME] ……………………….. s/d Bln. ………………………………)
 | II. | PEMANFAATAN PELAYANAN KESEHATAN (DATA DALAM SETIAP TABEL HARAP DIISI SEMUA)
 |  | 1. | [NAME] Peserta Jamkesmas
 |  |  | Bulan   Pelayanan |  |  | PELAYANAN DASAR PESERTA JAMKESMAS
 |  |  |  |  |  | Rawat Jalan (Kunjungan) |  |  | [NAME]) |  |  | Peserta Jamkesmas dirujuk
 |  |  | Januari
 |  |  | Pebruari
 |  |  | Maret
 |  |  | April
 |  |  | [NAME]
 |  |  | Juni
 |  |  | [NAME]
 |  |  | Agustus
 |  |  | September
 |  |  | Oktober
 |  |  | Nopember
 |  |  | [NAME]
 |  |  | JUMLAH TOTAL
 |  | 2. | [NAME]
 |  |  | Bulan   Pelayanan |  |  | PELAYANAN PERSALINAN
 |  |  |  |  |  | ANC | PNC | Persalinan Normal | [NAME] | [NAME] di Poned | [NAME] (Manual Placenta) | [NAME] dirujuk |  | [NAME] ([NAME])
 |  |  |  |  |  |  |  |  |  |  |  |  |  | IUD + IMPLAN | Suntik | Penanganan Komplikasi KB Pasca Salin
 |  |  | Januari
 |  |  | Pebruari
 |  |  | Maret
 |  |  | April
 |  |  | [NAME]
 |  |  | Juni
 |  |  | [NAME]
 |  |  | Agustus
 |  |  | September
 |  |  | Oktober
 |  |  | Nopember
 |  |  | [NAME]
 |  |  | JUMLAH TOTAL
 |  | [NAME], atas perhatian [NAME] terima kasih
 |  |  |  |  |  |  |  |  |  |  | …………………………………………………..
 |  | Contact Person TP Jamkesmas [NAME] |  |  |  |  |  |  |  |  | [NAME]
 |  |  |  |  |  |  |  |  |  |  | Kab/Kota ……………………………………….
 |  | Nama |  |  | :
 |  | No. Tlp/ HP |  |  | :
 |  |  |  |  |  |  |  |  |  |  | (…………………………………………………………………….)