3. Lap. JKN Bln Maret 14

7/25/2019 3. Lap. JKN Bln Maret 14

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No. Nama UPT Puskesmas Alamat Kecamatan Klasifkasi

1 UPT PUSKESMAS WINONG DESA WINONG KEMIRI Pusk. Rajal.


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SDM

A"oteker anitarianPromkes Pera#at

La$orat %isiotera"&iUmum Gigi


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REKAPITULASI

LAPORAN PELAYANA

RAWAT JALAN TINGKAT PERT

UPT PUSKESMAS WINO

TAHUN 2014

BULAN : MARET 20

Kepala Kepaa Y!" :

#$% Kepala &'a Kee"a!a Ka*+ P,-./-e/' Tepa!

Be-aa '' Ka' a,3a !a'"a Kla' Pea!'a B'a5a Pela5aa Ra.a! Jala Pee-!a JKN

No Nama Pasien Umur Kode No Card. Jamkesmas Alamat

Ket

diisi Tujuan

Kode

J A JKN TP JT

! & ' ) $

1 AGUNG RUDI+ANTO ,- Askes ,*--&1/ 1 U$u$ 0an"u Uri

& RI2KI SAPUTRO 3 #PS 4,,&&-5, 1 Gi!i Win'n! 3 #UMINI ,3 #PS 4,4&5/15& 1 U$u$ Giri$ul"'

, PONI+AH , #PS 4,5&4,*3/ 1 U$u$ Sut'ra!an

5 +U6I HARTATI & #PS 4,,,&-/-1 1 U$u$ Kedun!l'

5 SUPIRAH ,* #PS 4,5*15-,& 1 U$u$ Win'n!

7 MUNIROH ,, #PS 1-1/&,,,5 1 K0 6'nin!

SUKINI 3& #PS 4,,&,/-1& 1 U$u$ 6'nin!

9 PAI#AH 4 #PS 4,5**,,,5 1 U$u$ Win'n!

1- ISROWATI &, #PS 4,,/*343 1 Gi!i Win'n!

11 0AINGAH 5 #PS 4,51*,* 1 U$u$ Turus

1& PAI#AH 4 #PS 4,5**,,,5 1 Gi!i #atian!san


50/99

13 7(usnul 7('ti$a( 5/ #PS 1&3&3114/ 1 U$u$ Mlaran

1, KISMI+ATI &- #PS 4,415,4,3 1 K0 Win'n!

15 NUR A8I8AH &3 #PS 4,4413*,3 1 U$u$ Win'n!

15 PARI+EM 41 #PS 4,,/3,* 1 U$u$ Tursin'

17 RO9HIMAH */ #PS 4,,,/435 1 U$u$ Tursin'

1 0ADRI+ATUN *- #PS 4,,4*&&5 1 U$u$ Girij'"'

19 7(usnul 7('ti$a( 5/ #PS 1&3&3114/ 1 U$u$ Turus

&- WA6RO8INGAH ,& #PS 4,44&1,3 1 K0 Turus

21 ANDIKA PUTRA P , #PS 4,54/1-31 1 K I A Sut'ra!an

&& SITI AMINAH 4& #PS 4,51&-3 1 U$u$ #atian!san

23 TRI ASIH &/ #PS 4,,515-3 1 K0 6'nin!

&, SURIP SUPRI+ANTO 41 #PS 4,,/&&4* 1 U$u$ 6'nin!

25 HA0I0 * #PS 4,,/&135& 1 K I A Win'n!

&5 ENI PU#I ASTUTI ,, #PS 4,,/&-,1& 1 U$u$ Win'n!

27 I68I RO#A0 1& #PS 4,5&-/,4 1 U$u$ Tursin'

& SITI MUDRIKAH &- #PS 4,5*5-*&& 1 K I A Win'n!

29 SU6ASTRI ** #PS 4,,/-&, 1 U$u$ Tursin'

*- PAINAH ,/ #PS 4,444&1 1 K0 Girij'"'

31 +AH+A DWI PRASETI+ANTO * #PS 4,4-331,5 1 K I A Win'n! 6'r

*& 6ASMI ,1 #PS 4,5*,13/* 1 K0 Win'n!

33 SUTARMI ,4 #PS 4,4-5&5/ 1 K0 Turus

*, TUKIRAN 4* #PS 4,515//* 1

U$u$ Girij'"'35 ASMINAH , #PS 1-1/&5*411 1 U$u$ Win'n!

*5 NUR KHO6ISAH ,1 #PS 4,5&/-5-4 1 U$u$ Re%u!

37 +OGA A6AMS+AH 4 #PS 4,,&111 1 U$u$ Win'n!

* TU8UDHA & #PS 1-1/&,4,35 1 Gi!i Mlaran

39 AMAT SO6IHIN 1, #PS 4,4,5*54 1 U$u$ Sut'ra!an

,- SI6:IANA 8ADHI6A 4 #PS 4,41/5/*5 1 K I A Karan! Duur

41 MUHAMAD NUR 0A++IN / #PS 4,5*&331 1 U$u$ Win'n!

,& MUD6IKAH *& #PS 4,,&45/&1 1 K I A Win'n!

43 SARMINI *4 #PS 4,,/4// 1 K0 6'nin!

,, NUR HIDA+AH ** #PS 4,,&1/& 1 K0 6'nin!

45 SUDIRO 3* Askes 15&154&-4 1 U$u$ Win'n!


51/99

,5 MOEHADI 3& Askes 33-**/5 1 U$u$ Win'n!

47 TE#O SUNARKO 3 #PS 4,,3,5/& 1 U$u$ Win'n!

, SUHARTI ,- #PS 4,51*&5// 1 U$u$ Sut'ra!an

49 SATINAH 45 #PS 4,,/,&34, 1 U$u$ Turus

4- UMMI KU6SUM 11 #PS 4,5-4/-1 1 Gi!i Win'n!

51 DARWI+AH ** #PS 4,5-4/53 1 K0 Turus

4& SITI NGAISAH */ #PS 1-1/&3,15 1 U$u$ Turus

53 NA8IS HAIKA6 5 #PS 1-1/&3,,/ 1 U$u$ Win'n! Kidul

4, NURI6 ANWAR 1* #PS 4,,3-3- 1 U$u$ Win'n! Kidul

55 HUSNAH A8I8AH 13 Askes /354*,/4* 1 U$u$ Sut'ra!an

45 HENDI RASTIAWAN * Askes ,,-,15/ 1 U$u$ 6'nin!

57 +ATIMAH 41 Askes ,54-43 1 U$u$ Pa!er'n

4 PARTI 45 #PS 4,,4/31- 1 U$u$ Pa!er'n

59 KHOIRI+AH *, #PS 4,4,5,*, 1 U$u$ Sut'ra!an

5- M SODA MAU6ANA 3 #PS 4,,/1&,1 1 U$u$ Win'n!

61 S6AMET ;OSHIRI ,- #PS 4,4*4&&54 1 U$u$ Win'n! Kidul

5& MUSTO;I+AH 4 #PS 1-1/&,4,&1 1 U$u$ Win'n!

63 IRMA WAH+U 8E0RIANINGSIH 5 #PS 4,5*,/,*& 1 U$u$ Win'n!

5, GUNARTI ,1 #PS 4,413/,3 1 U$u$ #atian!san

65 PARINGAH , #PS 4,4*,1& 1 U$u$ Turus

55 IMAN HASANUDIN &4 #PS 4,5*5,15 1 U$u$ Win'n!

67

ASRO8I+AH *3 #PS 4,4&5/4&& 1

U$u$ Sut'ra!an5 MUHAMMAD S+A8I N / #PS 4,,/3&13* 1 U$u$ #atian!san

69 SITI RU0AEAH *3 #PS 4,,/3-535 1 U$u$ #atian!san

3- SATI+AH */ #PS 4,,/&&-/ 1 U$u$ #atian!san

71 RO00IATUS SO6IKHAH 14 #PS 4,515*/5 1 U$u$ Turus

3& 0AH#ATU6 HIDA+ATI 5 #PS 4,513--41 1 K I A Turus

73 MARI+ATU6 KI0TI+AH #PS 4,,&5/4- 1 U$u$ 6'nin!

3, ADE6IA ASTUTIK #PS 4,411-,5 1 U$u$ #atian!san

75 SITI MUNAWAROH ,5 #PS 4,4&14& 1 U$u$ #atian!san

35 DIAH ARISA +UNIARSIH *3 Askes ,*--1*1 1 U$u$ Pa!er'n

77 AMAD MANSUR 44 #PS 4,454//5 1 U$u$ 6'nin!

3 SUGI+ATI ,/ #PS 4,51&3-/3 1 U$u$ Turus


52/99

79 9AHA+A DWI WI#A+ANTI 4 #PS 1-1/&4&/*4 1 K I A Kedun!l'

- A68+ RAHMAWATI 4 #PS 4,,/5-&,3 1 K I A Kedun!l'

81 SETI+AWAN ARRI+ADH 4 Askes 1//1&/-&5 1 K I A 6'nin!

& #ARI+AH EKA +U6IANTI &3 #PS 1-1/&4&/1* 1 U$u$ #atian!san

83 MIS+ATI 54 #PS 4,,&/,/1& 1 U$u$ Sut'ra!an

, KHA8ID 4 #PS 4,,51///& 1 U$u$ Win'n!

85 IMAN HASANUDIN &4 #PS 4,5*5,15 1 U$u$ Win'n!

5 AU6I+A 2AHROTUNNISA / #PS 4,5&4&&&1 1 U$u$ Turus

87 A0DU6 ROHMAN & #PS 1-1/&,5* 1 U$u$ #atian!san

MUHAMMAD KAUTSAR 1/ #PS 4,4&&/54 1 U$u$ #atian!san

89 TUKI+AH ,1 #PS 4,,/11/*/ 1 U$u$ Turus

/- NUR 8AU2IAH #PS 4,,/1,4, 1 U$u$ Turus

91 SUDIRO 3* Askes 15&154&-4 1 U$u$ Win'n!

/& SURO#I ,3 #PS 4,4&31, 1 U$u$ Sut'ra!an

93 MUHAMAD A6I8 , #PS 4,4*5/5*4 1 U$u$ W'n'suk'

/, ROSIDAH 4 #PS ,34,/-5 1 U$u$ Win'n!

95 HARIS SETIAWAN 1& #PS 4,411&&1* 1 U$u$ W'n'suk'

/5 SO6I9HUN 1* #PS 4,44-*&4 1 U$u$ Sut'ra!an

97 SUSANTI *1 #PS 4,4*&31,, 1 U$u$ Sut'ra!an

/ SUMINTRI 41 #PS 4,,535*1/ 1 U$u$ Pus'

99 HARINI 41 Askes ,3*,*1* 1 U$u$ Sid'rej'

1-- SITI NUROHIMAH ,* #PS 4,415/3-1 1

K I A #atian!san101ISTINGANAH & #PS 4,,*&5, 1 U$u$ Sut'ra!an

1-& SRI NUR+ANTI */ Askes 1--35/& 1 U$u$ Win'n! 6'r

103SENAP 5* #PS 4,5**,1&1 1 U$u$ Win'n!

1-, WI#I ASTUTI 15 #PS 4,41-,*, 1 U$u$ Win'n! Kidul

105SRI SODERIKAH 45 Askes ,3**/*1 1 U$u$ Seren

1-5 8IKRI+ANA 2AKARIA &- Askes ,3&*33& 1 U$u$ Win'n!

107ANANG KHO6I6UR 4 #PS 1-1/&,*3 1 U$u$ 6'nin!

1- 8ATKHUROHMAN 1* #PS 4,,*-&5*/ 1 U$u$ Win'n!

109UMI INDA+ANI &1 #PS 4,5&&/11 1 U$u$ Win'n!

11- RODI+AH INDA A+U ,5 #PS 4,5&&/31/ 1 U$u$ Win'n!

111A0U DARDAK 3, Askes ,35&4, 1 U$u$ Sut'ra!an


53/99

11& ISTI+ANA *5 #PS 4,4,4*-54 1 K I A Pus'

113SITI MARKHAMAH 4, #PS 4,5&&-,/4 1 U$u$ Win'n!

11, ANNA IRAWATI && #PS 4,,3&14&* 1 K0 Sut'ra!an

115SITI AMINAH 45 #PS 4,,-4&53 1 U$u$ Sut'ra!an

115 NUR+ATI ,4 #PS 1-1/&,*3 1 U$u$ #atian!san

117A+U NO:ITA SARI &- #PS 1-1/&,*/ 1 U$u$ #atian!san

11 HAR+ANTI *1 #PS 4,4-35- 1 U$u$ W'n'suk'

119SUGINING RAHA+U 4 Askes ,3*15/& 1 U$u$ Sid'rej'

1&- SAUDAH 42 #PS 546189344 1 K I A Karang Duwur121 FAIS ABDUL AZIS 3 #PS 1279724679 1 K I A Wonosuko

1&& A!AS"A #UIKA AFAI 5 #PS 545$92266 1 K I A Wonosuko

123 %KA U&DI"A!' 11 #PS 545$77$89 1 U(u( W)nong Lor

1&, *U!ASI&'H 59 #PS 544915798 1 U(u( W)nong

125 DA*A& 58 #PS 5462$7827 1 U(u( W)nong

1&5 SUDI"A!I 6$ #PS 5457991$4 1 U(u( Lon)ng

127 SI!I *AH*UDAH 42 #PS 5458$1758 1 U(u( Lon)ng

1& WASI+A!U 49 #PS 544641276 1 U(u( W)nong

129 &'H*ADI 8$ #PS 544824584 1 U(u( W)nong

1*- FAA 31 #PS 544812322 1 U(u( Su,oragan

131 AL &IZK" ZAH &'!UL HIDA"AH 2 #PS 545339981 1 K I A Lon)ng

1*& ALFI!' &A*ADHA 5 #PS 545339665 1 K I A Lon)ng

133 SAFA&UDI 36 #PS 544821491 1 U(u( Su,oragan

1*, #UI!A -U!&I &AHA"U 3 #PS 544886919 1 K I A Lon)ng

135 SA!I"AH 39 #PS 544922$98 1 U(u( #a,)wangsan

1*5 SA*U&I 49 #PS 544921288 1 U(u( #a,)wangsan

137 SUDI&' 73 Askes 1621652$5 1 U(u( W)nong

1* I*A*A!UL KH'I&I"AH 23 Askes 84245$51 1 U(u( W)nong

139 DIA DWI 'K!A.IAI 7 #PS 544689426 1 U(u( Su,oragan

1,- I&*A WAH"U F%B&IAI+SIH 6 #PS 546349432 1 +)g) W)nong

141 *AKI"AH 29 #PS 544998$69 1 KB #a,)wangsan

1,& *A&ZUKI 83 #PS 544819263 1 U(u( W)nong

143 SUWA&!I 69 #PS 544439441 1 U(u( K/0ungo

1,, BAI+AH 68 #PS 546183483 1 U(u( W)nong


54/99

145 !ULUS #AU&ISWA!' 21 #PS 545157292 1 U(u( Brunor/o

1,5 I*A!UL +AII ZAI*AH 3 #PS 546658121 1 K I A !urus

147 HAWA S"AKILA 9 #PS 545$73232 1 U(u( W)nong Lor

1, ADA* S"A&UL HABIBI 7 #PS 545$73636 1 U(u( W)nong Lor

149 A&IF "'+A -A*U+KAS 6 #PS 545$73$96 1 U(u( W)nong Lor

14- HIDA"A! 18 #PS 1$19244$69 1 U(u( Lon)ng

151 *UHA**AD AUFAL 3 #PS 545715674 1 K I A *aran

14& %K' WIDI"A!I 31 Askes 198393243 1 U(u( K/0ungo

153 BA+US BI*'K' WIU++'#A!I 12 Askes 14879$248 1 +)g) #a,)wangsan14, USWA!U KHASAAH 45 Askes 84411281 1 U(u( W)nong

155 DA&WA!IK 34 #PS 545$14$56 1 KB -uang Agung

145 &'-I"A!U 49 #PS 544834$12 1 U(u( Lon)ng

157 KAS*IAH 5$ #PS 5454$7413 1 U(u( W)nong K)0u

14 SU-&I"A!I 26 #PS 546635981 1 K I A !urus

159 SU+II+ &AHA"U 58 Askes 84731692 1 U(u( S)0or/o

15- S'.IA WA&DAI 4 #PS 54462$431 1 K I A &/ug

161 S&I &'KHI*AH 39 #PS 544675836 1 U(u( Su,oragan

15& SU-IAH 6$ Askes 173573684 1 U(u( W)nong K)0u

163 !UKIAH 41 #PS 545234769 1 KB Su,oragan

15, AS*ULK'DA& 39 #PS 544619226 1 KB &/ug

165WA+I"%*

4$#PS 5456$8269

1 U(u(

+)r)(uo

155 SU*A&I 58 Askes 84733841 1 U(u( W)nong

167 S'LIDAH 4$ #PS 544651852 1 U(u( &/ug

15 !U!I WA&SIH 33 #PS 545771136 1 KB +)r)oo

169 SU+II+ &AHA"U 58 Askes 84731692 1 LAB S)0or/o

13- *A&WI"AH 5$ #kn 1261649259 1 U(u( -ag/ron

171 AULI"A ZAH&'!UISA 9 #PS 546252221 1 U(u( Su,oragan

13& S&I DA"A!I 39 #PS 545141564 1 U(u( W)nong K)0u

173 A*AD SA&IFUDI 27 #PS 1$19246229 1 U(u( W)nong

13, SA%-U&A 37 #PS 5446211$5 1 U(u( W)nong

175SRI SODERIKAH 45 Askes ,3**/*1 1 U$u$ Seren

135 MUSTO;I+AH 4 #PS 1-1/&,4,&1 1 U$u$ W)nong

177ENI PU#I ASTUTI ,, #PS 4,,/&-,1& 1 U$u$ Lon)ng


55/99

13 MUH ARI8IN && #PS 4,4,/,,/ 1 U$u$ Su,oragan

179SU9I NUR#ANAH 5 #PS 4,,/&1315 1 U$u$ Lon)ng

1- SU6ASIH *, #PS 1-1/&4-&,5 1 U$u$ K/0ungo

181SUKARMAN 5- #PS 1-1/&,5&4* 1 U$u$ W)nong

1& AHMAD 0AKIR 34 #PS 4,,3--** 1 U$u$ Su,oragan

1839HA6IMATUS SA


56/99

211HASAN 8AU2I */ #PS 4,5*&445/ 1 K I A Lon)ng

&1& NGAISAH *& #PS 4,4,/53* 1 6A0 #a,)wangsan

213USWATUN KHASANAH ,4 Askes ,,11&1 1 U$u$ W)nong

&1, MINI * #PS 4,4-/5-5 1 K I A -uang Agung

215SUPONO 53 #PS 4,4&4/ 1 U$u$ -uso

&15 SUMI+ATI , Askes &-441&&*& 1 U$u$ Lon)ng

217AHMAD 8AU2AN 13 #PS 4,,/&13, 1 U$u$ Lon)ng

&1 KHA8ID 4 #PS 4,,51///& 1 U$u$ W)nong

219SURATMI &/ #PS 11*,,&5/-* 1 K I A W)nong Lor&&- TAMRO , #PS 4,43,-4-* 1 U$u$ +)r)oo

221S6AMET ;OSHIRI ,- #PS 4,4*4&&54 1 U$u$ W)nong K)0u

&&& MUSTO;I+AH 4 #PS 1-1/&,4,&1 1 U$u$ W)nong

223WAHID RAMDANI 14 #PS 4,45/,/3, 1 U$u$ #a,)wangsan

&&, NUR KHA0I0AH 4* #PS 4,44--4*/ 1 U$u$ Su,oragan

225DASIMAH ,* #PS 4,4&4*&- 1 Gi!i Su,oragan

&&5 SUMARSIH 5, Askes ,,&// 1 U$u$ -ag/ron

227MISKI+AH 51 #PS 4,4&-3453 1 U$u$ Su,oragan

&& MAR+ANAH */ #PS 4,411* 1 Gi!i Lon)ng

229GUNARTI ,1 #PS 4,413/,3 1 U$u$ #a,)wangsan

&*- SOERONO ADIPUTRO ,1 #PS 1-1/&3,, 1 U$u$ W)nong

231NGAMI6ATUN 4, Askes ,31-1,3 1 U$u$ +)r)(uo

&*& ARI SUWARGI+ANTO &- #PS 4,4,/-1/1 1 U$u$ K/0ungo

233SUGINING RAHA+U 4 Askes ,3*15/& 1 U$u$ S)0or/o

&*, KURNIA ADI #A2U6I R 3 #PS 4,,3,31, 1 U$u$ Su,oragan

235NGAISAH *& #PS 4,4,/53* 1 U$u$ #a,)wangsan

&*5 DA88A ANANT+O 1- Askes ,*--&&1 1 U$u$ D/(angan

237USWATUN 0ARIROH & #PS 4,543,5/ 1 K I A !urus

&* 0ARODIN 4- #PS 1&&4*-&5& 1 U$u$ D)/(

239SA8RUDIN 4/ Askes ,55&// 1 U$u$ W)nong K)0u

&,- MUSTAKIM *4 #PS 4,,//,*3/ 1 U$u$ !urus

241TRIANA NUR 9AH+ANI 4 #PS 4,43,//5 1 K I A &/ug

&,& AMAD 2AIDIN 4 #PS 4,,/*-/1 1 U$u$ #a,)wangsan

243SATINAH 45 #PS 4,,/,&34, 1 U$u$ W)nong


57/99

&,, K. 0UDI SUHARNI 45 Askes ,3,-&/3 1 U$u$ #a,)wangsan

245HERU SUPRAPTO 5& Askes ,3,-&5 1 U$u$ Su,oragan

&,5 MISTI+AH ,, #PS 1&&5,/-3* 1 U$u$ #a,)wangsan

247SUKARTIM - #PS 4,,4/5*// 1 U$u$ &/ug

&, SITI NGASAH 5& #PS 1-1/&,,&15 1 U$u$ W)nong

249MUTIMAH ,5 #PS 4,,14&,*1 1 U$u$ Kroo

&4- RO#I+AH 5/ Askes ,,&&554 1 U$u$ W)nong

251AMAD 0ASORI 41 #PS 4,4-*,533 1 U$u$ #a,)wangsan

&4& MISTINAH 41 #PS 4,4-*,/& 1 U$u$ #a,)wangsan253MARDAH ,& #PS 4,,54&5* 1 U$u$ W)nong

&4, NUR A8I8AH 1- #PS 4,41333// 1 U$u$ #a,)wangsan

255KOMSI+AH 45 #PS 4,,&443, 1 U$u$ Lon)ng

&45 DWI 6IST+ARINI ,- Askes ,*--&- 1 U$u$ D/(angan

257AGUNG RUDI+ANTO */ Askes ,*--&1/ 1 U$u$ D/(angan

&4 EKO WIDI+ATI *1 Askes 1/*/*&,* 1 U$u$ K/0ungo

259SUKARNI &3 #PS 1&1331&1 1 U$u$ Pa!er'n

&5- KHA8ID 4 #PS 4,,51///& 1 U$u$ W)nong

261PUTRI ENDANG SETIOWATI 11 #PS 4,4&&1534 1 U$u$ +)r)(uo

&5& SITI SARI+AH *3 #PS 4,4554-3& 1 K0 Lon)ng

263SUMARNO ,- #PS 4,455,31& 1 U$u$ Lon)ng

&5, SU6ASTRI ,- #PS 4,,/53*1 1 K0 Lon)ng

265TUTI ASIH ,* Askes ,3&*5&4 1 U$u$ Su,oragan

&55 S(ENA AMRINA ROSADA #PS 1&5*511/ 1 U$u$ Su,oragan

267SUKARNI &3 #PS 1&1331&1 1 U$u$ -ag/ron

&5 KHA8ID 4 #PS 4,,51///& 1 U$u$ W)nong

269PUTRI ENDANG SETIOWATI 11 #PS 4,4&&1534 1 U$u$ +)r)(uo

&3- SITI SARI+AH *3 #PS 4,4554-3& 1 K0 Lon)ng

271SUMARNO ,- #PS 4,455,31& 1 U$u$ Lon)ng

&3& SU6ASTRI ,- #PS 4,,/53*1 1 K0 Lon)ng

273S(ENA AMRINA ROSADA #PS 1&5*511/ 1 U$u$ Su,oragan

&3, RATINEM *- #PS 4,45&/,1/ 1 K0 +)r)(uo

275SITI PAINGAH *, #PS 4,,&*-4, 1 K0 #a,)wangsan

&35 SURTINAH ,/ #PS 4,,-&, 1 K0 Su,oragan


58/99

277SITI #AMI6AH ,- #PS 4,,45453 1 K0 W)nong

&3 SUKARMI *5 #PS 4,41/*4, 1 K0 Su,oragan

279SADAR+ANTI &/ #PS 4,4341-55 1 K0 +)r)oo

&- WAGISAH * #PS 4,,&*&-3/ 1 K0 Lon)ng

281WASIDAH ,5 #PS 4,,**,-, 1 U$u$ Su,oragan

&& SUPI+ATI 55 #PS 4,5&14--4 1 U$u$ W)nong

283REWOT 33 #PS 4,,/1*&,4 1 U$u$ -uso

&, MUH KHANA8I / #PS 4,,54*35 1 U$u$ W)nong

285SUMINTRI 41 #PS 4,,535*1/ 1 U$u$ -uso&5 GUNARTI ,1 #PS 4,413/,3 1 U$u$ #a,)wangsan

2870AINGAH 5 #PS 4,51*,* 1 U$u$ W)nong

& SITI TRIANA 8A#ARWATI 3 #PS 4,45/5/- 1 U$u$ *aran

289SITI NGANANI+AH */ #PS 4,5&-//54 1 U$u$ W)nong

&/- RUMI+ATI *, #PS 4,41-31, 1 U$u$ #a,)wangsan

291RIRIN DWI ARI+ANTI 5 #PS 4,,33&,4 1 U$u$ #a,)wangsan

&/& SITI MUNAWAROH ,5 #PS 4,4&14& 1 U$u$ #a,)wangsan

293MUSTAKIM 4* #PS 4,4-&1,& 1 U$u$ #a,)wangsan

&/, #UMINURHADI #PS 4,,/1-*3 1 U$u$ Lon)ng

295SU6ASI+AH 4, Askes ,54//, 1 U$u$ #a,)wangsan

&/5 SI+ONO 44 Askes ,3*3*/4 1 U$u$ W)nong

297SUGI+ANTO * #PS 4,,51-554 1 U$u$ Karang Duwur

&/ SARINDI 3, #PS 4,451-1 1 U$u$ +)r)oo

299KESUT SU0ANDI ,3 #PS 4,4**5,& 1 U$u$ +)r)oo

*-- MISTI+AH ,, #PS 1&&5,/-3* 1 U$u$ &/ug

301SU+ATI ,- #PS 4,,53/3/5 1 K0 Su,oragan

*-& NUR+ATI ,4 #PS 1-1/&,*3 1 U$u$ #a,)wangsan

303ARI8 DWI 9AH+O 1 #PS 4,,,-*/1 1 U$u$ Lw

*-, MARATUR RO8IAH / #PS 4,5*14&35 1 U$u$ W)nong

305ASTRO , #PS 1-1/&3/44* 1 U$u$ Lw

*-5 ROUPI+AH 45 #PS 4,,5515 1 U$u$ Lon)ng

307SET+O UTOMO *- #PS 4,4*15,/ 1 Gi!i W)nong K)0u

*- SUHAR+ANTO ** #PS 4,4&1*&-, 1 Gi!i Su,oragan

309MUHAMAD SID;UN M 5 #PS 4,4&-,5- 1 U$u$ Su,oragan


59/99

*1- MUH ARI8IN && #PS 4,4,/,,/ 1 U$u$ Su,oragan

311DASIMAH ,* #PS 4,4&4*&- 1 Gi!i Su,oragan

*1& 2AINUDIN 3, #PS 1-1/&*/,1 1 U$u$ -ag/ron

313RUKUN PRA+ITNO */ #PS 4,,33*13& 1 U$u$ -uso

*1, WAHID RAMDANI 14 #PS 4,45/,/3, 1 U$u$ *aran

315SANDI 3, Askes ,35,--& 1 U$u$ Su,oragan

*15 H# MUNDAR+ATI SANDI 5/ Askes ,35*--1 1 U$u$ Su,oragan

317PARTI */ #PS 4,4-&&1-1 1 U$u$ Wonosuko

*1 SETI+AWAN ARRI+ADH 4 Askes 1//1&/-&5 1 K I A Su,oragan319SITI RO9HIMAH * #PS 4,5*1*5/ 1 K I A W)nong

*&- I6HAM MAU6ANA 4 #PS 4,,5311/ 1 K I A Su,oragan

321SU6IMAN ,/ #PS 4,5&/1&1 1 U$u$ *aran

*&& KHO8I8AH 6AI6ATU6 MUNA #PS 4,41/,,5& 1 U$u$ Su,oragan

323KAROMATUNISA 1, #PS 4,,3-1*,1 1 U$u$ Su,oragan

*&, PONISAH 3- #PS 4,4,3/4& 1 U$u$ W)nong

325TRISNANI 4* #PS 4,5,*&/4& 1 U$u$ W)nong

*&5 SUPINATUN ,1 #PS 4,,/-/31 1 U$u$ W)nong

327A6=8ANI ADI KURNIAWAN 5 #PS 4,,3&45-5 1 K I A Su,oragan

*& A68IN KURNIAWAN * #PS 4,43,/-5 1 K I A &/ug

329#UINAH *, #PS 4,54,15* 1 U$u$ !urus

**- KUSMIRAWATI &5 #PS 1-1/&5,-41 1 K0 +)r)(uo

331NASRU6 11 #PS 4,4&&4* 1 U$u$ +)r)(uo

**& KA6IMAH 4- #PS 4,411,3&& 1 U$u$ Wonosuko

333S+ARI8 IMAM SANTOSO *5 Askes ,,-&/,, 1 U$u$ W)nong

**, MUHAMAD HANI8 S 4 #PS 4,4*,35&/ 1 K I A Lon)ng

335SRI+ANI ,3 #PS 1&5--&/3 1 U$u$ Lon)ng

**5 TUR+ANTO *1 #PS 4,44-3-3 1 U$u$ +)r)(uo

337SUKARMI *5 #PS 4,41/*4, 1 Gi!i Su,oragan

** WENI APRI6OWATI 15 #PS 4**-*&13 1 K I A Lon)ng

339SANGADAH 4/ Askes ,*,,,11 1 U$u$ W)nong Lor

*,- SITI 9HOTIMAH *1 #PS 4,,/5441 1 K I A !urus

341 2AHRITUSS+I8A , #PS 4,5&&11& 1 U$u$ W)nong

*,& IKMA6UDIN 1- #PS 4,,-&1,1 1 U$u$ Su,oragan


60/99

343MISKI+AH 51 #PS 4,4&-3453 1 U$u$ Su,oragan

*,, ROHMADI - #PS 4,,&,4, 1 U$u$ !urus

345A0DU6 HA8I2D AS SAI8I &- #PS 4,45414*3 1 U$u$ *aran

*,5 SUR+ATI *4 #PS 4,,555-* 1 U$u$ Lon)ng

347AMAD 2AIDIN 4 #PS 4,,/*-/1 1 U$u$ #a,)wangsan

*, KHATAMI A6I 8A9HRI+AN 5 #PS 4,,511&, 1 U$u$ Karang Duwur

349A68IAH ,, Askes ,&,4-,/ 1 U$u$ W)nong

*4- SET+O UTOMO *- #PS 4,4*15,/ 1 Gi!i W)nong K)0u

3510ADRI+ATUN *- #PS 4,,4*&&5 1 U$u$ Karang Duwur*4& SUPARMI ,/ Askes ,3*4*4 1 U$u$ W)nong

353A0DURROHMAN WA9HID 3 #PS 4,41/&-1/ 1 U$u$ W)nong K)0u

*4, 6IS NURHA+ATI *1 #PS 4,,*4&14 1 K0 Lon)ng

355MANISAH 4 #PS 4,41/&/3 1 U$u$ Su,oragan

*45 SANI+AH *3 #PS 4,4*1/54& 1 K I A W)nong K)0u

357SITI MASU6AH U68AH &- #PS 4,4*,5/ 1 K0 Wonosuko

*4 SU6ANINGSIH *1 #PS 4,411&/55 1 K I A Wonosuko

359KURNIASIH *1 #PS 4,43&4--1 1 K0 -ag/ron

*5- DWI HER+ANTI ** #PS 4,4&4535 1 K I A D)/(

3618E0RI A0DU66AH & #PS 4,,43-4 1 K I A W)nong

*5& 6ESTARI ,& #PS 4,,5&-14/ 1 K0 W)nong

363WI#I+ATI *, #PS 4,441/-/& 1 K0 K/0ungo

*5, WAH+UNINGSIH 4 #PS 4,,5&*/4 1 K I A W)nong

365SI6:IANA 8ADHI6A 4 #PS 4,41/5/*5 1 K I A Su,oragan

*55 KHAMIDAH ,- #PS 4,,*-&,14 1 K0 Lon)ng

367SITI KAU6AH * #PS 4,4**4,1 1 K0 Lon)ng

*5 TU6US 54 Askes ,354-/* 1 U$u$ Wonosuko

369USNADI PONIRAN 5- #PS 4,4&1514 1 U$u$ -ag/ron

*3- NGADIRUN 33 #PS 4,,35/&/ 1 U$u$ K/0ungo

371HARIS SETIAWAN 1& #PS 4,411&&1* 1 U$u$ Wonosuko

*3& INGGIT SIWIS RE#EKI 1, #PS 4,441/&*3 1 U$u$ K/0ungo

373SOIM 8AHRURO2I 15 #PS 4,4-,&,4 1 Gi!i #a,)wangsan

*3, IRHAMUDIN &- #PS 4,,&33/43 1 U$u$ Lon)ng

375RO#I+AH 5/ Askes ,,&&554 1 U$u$ W)nong


61/99

*35 USWATUN KHASANAH ,4 Askes ,,11&1 1 U$u$ W)nong

377PATIMAN 5& #PS 4,,&-3-* 1 U$u$ Lon)ng

*3 SRI+ATUN 4- #PS 4,4,1--,4 1 U$u$ W)nong Lor

379PAR#AN 4/ #PS 4,4**,/*/ 1 U$u$ Lon)ng

*- 0AINGAH 5 #PS 4,51*,* 1 U$u$ W)nong

381 #UMINURHADI #PS 4,,/1-*3 1 U$u$ Lon)ng

*& AMAT TOI8UR */ #PS 1&41-&/45 1 U$u$ W)nong

383SUPINAH *1 #PS 4,,5,& 1 U$u$ W)nong K)0u

*, #UINAH *, #PS 4,54,15* 1

U$u$ !urus

385NASRUDIN 43 Askes ,31,-4 1 U$u$ W)nong

*5 IRMA WAH+U 8E0RIANINGSIH 5 #PS 4,5*,/,*& 1 U$u$ W)nong

387TUKIRIN 53 #PS 4,4**34* 1 U$u$ Lon)ng

* +U68A 8ITRI SAKINAH 3 #PS 4,4&-*&-* 1 U$u$ +)r)(uo

389KRIS MARSANI , #PS 4,,&4,5& 1 U$u$ Lon)ng

*/- SUPRI+ATI 4, #PS 1-1/&3335 1 U$u$ W)nong K)0u

391MUSTO;I+AH 4 #PS 1-1/&,4,&1 1 U$u$ W)nong

*/& MUHAMMAD KAUTSAR 1/ #PS 4,4&&/54 1 U$u$ #a,)wangsan

393SUGINING RAHA+U 4 Askes ,3*15/& 1 U$u$ Su,oragan

*/, WARSITO 4- #PS 4,45-4,1 1 U$u$ Wonosuko

395MARSI+AH 1 #PS 4,413/1, 1 U$u$ Su,oragan

*/5 AKHMAD 4, Askes ,3**4& 1 U$u$ Kroo

397SUGENG RAHAR#O 44 #PS 1-1/&33334 1 U$u$ W)nong K)0u

*/ KOTIMAH , #PS 4,4-/4*, 1 U$u$ Wonosuko

399MUGI ARISWANTI *- #PS 4,51*3/,* 1 K0 Karan! Duur

,-- 2U0AIDAH ,1 #PS 1-1/&,,5&& 1 K0 6'nin!

401WASI+AH 4 #PS 4,,/3*13, 1 U$u$ Turus

,-& DAMAR 4 #PS 4,5&-3&3 1 U$u$ Win'n!

4038AHRU ADI PAMUNGKAS #PS 4,4551- 1 U$u$ 6'nin!

,-, 2AROMI ,4 Askes ,55//*/ 1 U$u$ Krande!an

4050ONI+AH 4- #PS 4,,/*&,4/ 1 U$u$ Win'n!

,-5 A0DURROHMAN , #PS 4,,3-,5& 1 U$u$ Sut'ra!an

407WASI6ATUN 43 Askes ,3**5/, 1 U$u$ 6'nin!

,- M KHARIS MUHAIMIN 1* #PS 4,5*1,,44 1 Gi!i Win'n!


62/99

409AS6AMI+ATI ,* #PS 4,,3-41- 1 K I A Sut'ra!an

,1- A+UP 3, #PS 4,4,,&,/1 1 U$u$ Sut'ra!an

411RO9HANI 5 #PS 1-1/&,4,1/ 1 U$u$ Win'n!

,1& SISKA NO:ITASARI 5 #PS 4,45-4& 1 U$u$ Giri$ul"'

413MU#I6AH *, #PS 4,45-4,-& 1 U$u$ Giri$ul"'

,1, ANGGA 0UDI PRATAMA 3 #PS 4,44133/3 1 U$u$ Mlaran

415WAKIDI 4- Askes ,3*,44/ 1 U$u$ Seren

,15 A0DUS SAKIR 14 #PS 4,4-&14* 1 Gi!i Girij'"'

417AS6AMI+ATI ,* #PS 4,,3-41- 1 K0 Sut'ra!an

,1 SOPI+AH 4- #PS 4,45333* 1 K0 Girij'"'

419MAR+ATI *4 #PS 4,4*&13 1 K0 Giri$ul"'

,&- MISKI+AH ,* #PS 4,4414*/ 1 K0 Win'n!

421WAIS A6=;ORNIA &* #PS 4,,3&4,51 1 K I A Win'n!

,&& SRI ROKHIMAH */ #PS 4,,534*5 1 K0 Sut'ra!an

423#ARODAH , #PS 1-1/&,5445 1 U$u$ Win'n!

,&, AMAT SO6IHIN */ #PS 4,4143,, 1 U$u$ #atian!san

425TITI U68AH &, #PS 4,43-435* 1 U$u$ Girij'"'

,&5 NI


63/99

,,& SRI+ATI 41 #PS 4,,/*314 1 U$u$ Turus

443SITI RO9HIMAH *4 #PS 4,,313// 1 K0 6'nin!

,,, #UMINURHADI #PS 4,,/1-*3 1 U$u$ 6'nin!

445MUAWANAH ,, #PS 4,4-&11 1 K0 Win'n!

,,5 M NASRU6 MU#AHID , #PS 4,,13,4 1 K I A Win'n!

4470ARODIN 4- #PS 1&&4*-&5& 1 U$u$ Dile$

,, SITI AMINAH &5 #PS 4,434&44 1 U$u$ Girij'"'

449SAMSU6 MA


64/99

475DWI 6IST+ARINI ,- Askes ,*--&- 1 U$u$ De$an!an

,35 SUDIRO 3* Askes 15&154&-4 1 U$u$ 6'nin!

477WAGI+EM 5 Askes &-1--&,-/ 1 U$u$ Win'n!

,3 MU6+ANI ,5 #PS 4,41533- 1 K0 #atian!san

479TUPARI+AH */ #PS 4,,51/*,/ 1 U$u$ Pus'

,- RISKI +U6IANINGSIH #PS 4,4&,43-4 1 U$u$ Giri$ul"'

481PAINEM 4& #PS 4,4&,441, 1 U$u$ Giri$ul"'

,& HENI SUR+ANI *3 #PS 4,4&,--1 1 K0 Giri$ul"'

4838AIRU2 MAU6ANA A 3 Askes 13,5333-* 1 U$u$ Giri$ul"'

,, 8ADHI6 INSANI 11 Askes 13,45411 1 U$u$ Giri$ul"'

485MUNTO NGA6IMAN 14 #PS 4,4&,5,1, 1 U$u$ Giri$ul"'

,5 +U6I+ATI ,1 #PS 4,4&,4/-3 1 U$u$ Giri$ul"'

487HENI SUR+ANI *3 #PS 4,4&,--1 1 U$u$ Giri$ul"'

, 0AINGAH 5 #PS 4,51*,* 1 U$u$ Win'n!

489AR8A RAIHANA A 5 Askes /35415135 1 U$u$ Sut'ra!an

,/- 2AHROTU6 8ITRI+AH 1* #PS 4,,,&4, 1 U$u$ Win'n!

491S6AMET SUWARNO ,- #PS 4,44-,543 1 U$u$ Mlaran

,/& SU0OWO * Askes ,,-/5*3 1 U$u$ Krande!an

493A0DU6 8ARI2A6 5 #PS 4,4&,5,5/ 1 Gi!i Giri$ul"'

,/, ROWI+AH ,3 #PS 1-1/&,4553 1 U$u$ Win'n!

4958AIRU2 MAU6ANA A 3 Askes 13,5333-* 1 Gi!i Giri$ul"'

,/5 RAHMAWATU6 MUNA 5 #PS 4,5*,533 1

U$u$ Giri$ul"' 497SITI #ARI+AH 4 Askes ,,*43* 1 U$u$ Win'n! Kidul

,/ S+AMSU 0AHRI 3 #PS 4,,3,15*3 1 U$u$ Giri$ul"'

499WAGIMAN 3* #PS 4,,/-3311 1 U$u$ Win'n!

4-- SARMINI *4 #PS 4,,/4// 1 Gi!i 6'nin!

501HA6IMAH *1 #PS 1-1/&4&355 1 K I A Kedun!l'

4-& PUTRA ARDI+ANSAH , #PS 4,,5-35 1 K I A 6'nin!

503KRIS MARSANI , #PS 4,,&4,5& 1 K0 6'nin!

4-, SU6ANINGSIH *1 #PS 4,411&/55 1 K0 Win'n!

505DWI HER+ANTI ** #PS 4,4&4535 1 K0 Dile$

4-5 DWISINTA KHOIRONI 4 #PS 4,4,5,5*1 1 K I A Sut'ra!an

507WI#I+ATI *, #PS 4,441/-/& 1 K I A Sut'ra!an


65/99

4- +ASIR &4 #PS 4,,,,*41 1 U$u$ Kedun!l'

509KOMAMI , #PS 4,,,,1& 1 U$u$ Kedun!l'

41- SAR+ONO ** #PS 4,,,1&5&1 1 K I A Kedun!l'

511TU+ONO ,1 #PS 4,,,1,411 1 U$u$ Kedun!l'

41& TU+EM 4/ #PS 4,,,33& 1 U$u$ Kedun!l'

513RUM6AH *& #PS 4,,,4445& 1 U$u$ Kedun!l'

41, ARTIKA PERMATASARI #PS 4,,,&145, 1 U$u$ Kedun!l'

515SHO8I NAI6A HANIE8AH / Askes 1&,41//& 1 U$u$ Win'n!

415 MUHAMMAD HAKAM ARROU8 1 Askes ,,-11 1 U$u$ Win'n!

517RETNO SUKENGSIH ,1 Askes ,,-1-3 1 U$u$ Win'n!

41 0ARODIN 4- #PS 1&&4*-&5& 1 U$u$ Dile$

519HENI SUR+ANI *3 #PS 4,4&,--1 1 U$u$ Giri$ul"'

4&- RU0I+ATI ,- #PS 4,,/4/-33 1 U$u$ #atian!san

521RODI+AH 1/ #PS 4,,51,* 1 U$u$ Girij'"'

4&& KA+6A 8E0+ NE6I2AR * #PS 4,441*/41 1 K I A Pa!er'n

523SUWARNI 31 #PS 4,,14*-* 1 U$u$ Kedun!l'

4&, SISNIANTI *3 #PS 4,,5/5315 1 K I A Sut'ra!an

525SARMINI *4 #PS 4,,/4// 1 Gi!i 6'nin!

4&5 RONDHI+AH ,- #PS 4,4335/,& 1 U$u$ Girij'"'

527RO#I+AH 5/ Askes ,,&&554 1 U$u$ Win'n!

4& AU6IA HIDA+ATI #PS 4,4&/41* 1 U$u$ 6'nin!

529

SUDARNO 3- Askes ,413,3/ 1

U$u$ Win'n!4*- TU6US 54 Askes ,354-/* 1 U$u$ W'n'suk'

531RO0IATU6 NGADAWI+AH ,& #PS 4,4*--,5/ 1 U$u$ Win'n! 6'r

4*& MU9H NURWAHIDIN HIDA 14 #PS 4,4*--3/5 1 U$u$ Win'n! 6'r

533A+U NO:ITA SARI &- #PS 1-1/&,*/ 1 Gi!i #atian!san

4*, PONI+AH 33 #PS 4,45*5&* 1 U$u$ Pa!er'n

535AMIR RE#O 3 #PS 4,45***1 1 U$u$ Pa!er'n

4*5 SAR+ONO 5- Askes ,3**/-3 1 Gi!i Seren

5378ARDAN 8A2A 8AU2AN / Askes ,,-&/55 1 U$u$ Win'n!

4* SUGINING RAHA+U 4 Askes ,3*15/& 1 U$u$ Sid'rej'

539U6:I 9HASANAH 15 #PS 4,4-&15&3 1 U$u$ #atian!san

4,- ENDAH RI+AH 44 #PS 4,4-&1&&* 1 U$u$ #atian!san


66/99

541TE#O SUNARKO 3 #PS 4,,3,5/& 1 U$u$ Sut'ra!an

4,& SITI MUHANAH ,3 #PS 4,,3,4554 1 U$u$ Re%u!

543ANDRI WI#A+ANTO &1 #PS 4,,&3-5/ 1 Gi!i 6'nin!

4,, SARWI+AH * #PS 4,,/-5** 1 U$u$ 6'nin!

545 #UMINURHADI #PS 4,,/1-*3 1 U$u$ 6'nin!

4,5 SAR+ONO ** #PS 4,,,1&5&1 1 U$u$ Seren

547PAI#AH 4 #PS 4,5**,,,5 1 U$u$ Pus'

4, SITI 9HAMIDAH 4* #PS 1-1/&,,-4 1 U$u$ 6'nin!

549MUH KHANA8I / #PS 4,,54*35 1 U$u$ Win'n!

44- MUSTANGIN 5 #PS 4,5*5&541 1 U$u$ Win'n!

551RE0I+EM 5* #PS 4,,14,4/ 1 U$u$ Sut'ra!an

44& E:E6IN 9INTA MIRA0I6A , #PS 4,44&/1 1 K I A Pus'

553KARTINI ,& #PS 4,4*45 1 K0 Pus'

44, RATNO ,, #PS 4,4&541*, 1 U$u$ Dile$

555SITRISNO ,3 #PS 4,4&51&*1 1 U$u$ Dile$

445 SITI NUR#ANAH 1& #PS 4,4**&,3 1 U$u$ Girij'"'

557MUHAMMAD HARIS 8AISA6 , #PS 4,4,,,5 1 U$u$ Girij'"'

44 8ATIMAH 1 #PS 4,45,5511 1 U$u$ Girij'"'

559PARTI 45 #PS 4,,4/31- 1 U$u$ Pa!er'n

45- EN+ PU#I SET+AWATI &3 #PS 4,4*&&1 1 K I A Pa!er'n

561EN+ PU#I SET+AWATI &3 #PS 4,4*&&1 1 U$u$ Pa!er'n

45& 0ONISIH *- #PS 4,5&,*1,& 1

K I A Pa!er'n563NASRI:ATUN ,& #PS 4,4/15*4& 1 K I A Pa!er'n

45, SAUDAH ,& #PS 4,51/*,, 1 K I A Pa!er'n

565SAUDAH ,& #PS 4,51/*,, 1 U$u$ Pa!er'n

455 SUHARTI ,- #PS 4,51*&5// 1 K0 Mlaran

567TANGGUN U#I 6UT RIAWAN & #PS 4,4&-,&3& 1 Gi!i Pus'

45 PAISAH ,3 #PS 4,415&*1/ 1 U$u$ Pus'

569MAR2UKI * #PS 4,,1/&5* 1 U$u$ Win'n!

43- I6HAM WU6AN RAMADHAN 5 #PS 4,,53-4* 1 K I A 6'nin!

571SRI ASTIATUN ,& #PS 4,51/34/ 1 K0 Win'n!

43& RI2KI SAPUTRO 3 #PS 4,,&&-5, 1 U$u$ Win'n!

573MUKMINAH *3 #PS 4,,5&&3&4 1 U$u$ Win'n!


67/99

43, U68AH MUSAROH &, #PS 4,4*4&45 1 K0 Giri$ul"'

575PRI+ANTI &3 #PS 4,,1-,35 1 U$u$ 6'nin!

435 PRI+ANTI &3 #PS 4,,1-,35 1 K I A 6'nin!

577SAR+ONO 5- Askes ,3**/-3 1 Gi!i Seren

43 MUH ARIP ANWAR 4 #PS 4,54,*-** 1 U$u$ Turus

# u $ l a ( ,5 & 1- - - 1

578


68/99


69/99


70/99

Kunj. Askes

Kunj) #KN

Kunj. #t

Kunj. TNI>P'l

TUJUAN PELAYANAN 2AN 3ESARAN TARI4 SESUAI PER2A

KES

3PU 5i1i KIA I1d La6. T"n !+#%) T"n %$ 7 T"n

P L P L P !( !+ &, &! &&

!' !) !$ !% !*

'

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88/99

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Documents

3. Lap. JKN Bln Maret 14