138
Template Data Analisa Biaya MN.1 Halaman : 1 GAMBAR STRUKTUR ORGANISASI Direktur Utama Biro PURS Kom. Keperawatan Komite Etik RS Komite Medik Biro SISFO Sekretaris RS Audit Internal Biro K3RS Quality Assurance Unit Direktur Medis Direktur Perawatan Direktur SDM & Umum Direktur Keuangan Bid. Pelayanan Medis Bid. Penunjang Medis Bid. Rawat Inap 1 Bid. Rawat Inap 2 Biro SDM Biro Umum Biro Keuangan UGD Laboratorium Anggrek Soka Pengemb & Pemb. SDM Pemeliharaan Sarana Administrasi Keu. Poliklinik Radiologi Mawar ICU Administrasi SDM Laundry Akuntansi Klinik Kesehatan Ibu Farmasi Melati NICU/PICU Pelayanan Pendidikan Kebersihan & Limbah Verifikasi ODS/ODC Rehab. Medik Seruni (KM. Bayi) Intermediate RT & Keamanan Kamar Operasi Fisio Klinik Seruni (VK) RRI Med. Check Up Gizi (Dapur) Home Care Hemodialisis Rekam Medik Pel. Kes. Mas Poliklinik : Klinik Kebid. & Kandungan Klinik Anak Klinik Penyakit Dalam Klinik Saluran Cerna Klinik Gigi & Mulut Klinik Bedah Klinik Jantung Klinik Bedah Thorax Klinik Neurologi Klinik Mata Klinik Saluran Kencing Klinik Psikologi Klinik Kulit & Kelamin Klinik Bedah Anak Klinik Psikiatri Klinik THT Klinik Bedah Tulang Klinik Hematologi&Onkolog Klinik Gizi Klinik Rheumatologi

Template MN contoh.xls

Embed Size (px)

DESCRIPTION

Template MN contoh.xls

Citation preview

Page 1: Template MN contoh.xls

Template Data Analisa Biaya

MN.1 Halaman : 1

GAMBAR STRUKTUR ORGANISASI

Direktur Utama

Biro PURS

Kom. Keperawatan Komite Etik RS Komite Medik Biro SISFO

Sekretaris RS

Audit Internal Biro K3RS

Quality Assurance Unit

Direktur Medis Direktur Perawatan Direktur SDM & Umum Direktur Keuangan

Bid. Pelayanan Medis Bid. Penunjang Medis Bid. Rawat Inap 1 Bid. Rawat Inap 2 Biro SDM Biro Umum Biro Keuangan

UGD Laboratorium Anggrek Soka Pengemb & Pemb. SDM Pemeliharaan Sarana Administrasi Keu.

Poliklinik Radiologi Mawar ICU Administrasi SDM Laundry Akuntansi

Klinik Kesehatan Ibu Farmasi Melati NICU/PICU Pelayanan Pendidikan Kebersihan & Limbah Verifikasi

ODS/ODC Rehab. Medik Seruni (KM. Bayi) Intermediate RT & Keamanan

Kamar Operasi Fisio Klinik Seruni (VK) RRI

Med. Check Up Gizi (Dapur) Home Care

Hemodialisis Rekam Medik

Pel. Kes. Mas

Poliklinik :

Klinik Kebid. & Kandunga Klinik Anak Klinik Penyakit Dalam Klinik Saluran Cerna

Klinik Gigi & Mulut Klinik Bedah Klinik Jantung Klinik Bedah Thorax

Klinik Neurologi Klinik Mata Klinik Saluran Kencing

Klinik Psikologi Klinik Kulit & Kelamin Klinik Bedah Anak

Klinik Psikiatri Klinik THT Klinik Bedah Tulang

Klinik Hematologi&OnkoloKlinik Gizi Klinik Rheumatologi

Page 2: Template MN contoh.xls

Template Data Analisa Biaya

MN.2 Halaman : 1

PEMETAAN, LOKASI, DAN LUAS MASING-MASING UNIT KERJA

No Nama Unit KerjaLokasi

Nama Gedung Lantai ke Luas Ruangan (m2)1 Direktur Utama Gedung Utama 3 40

2 Kom. Keperawatan Gedung Utama 2 9

3 Komite Etik RS Gedung Utama 2 9

4 Komite Medik Gedung Utama 2 16

5 Audit Internal Gedung Utama 2 25

6 Biro PURS Gedung Utama 1 20

7 Biro SISFO Gedung Utama 1 30

8 Sekretaris RS Gedung Utama 1 30

9 Biro K3RS Gedung Utama 1 20

10 Quality Assurance Unit Gedung Utama 1 25

11 Direktur Medis Gedung Utama 3 30

12 Bid. Pelayanan Medis Gedung Utama 2 9

13 Bid. Penunjang Medis Gedung Utama 2 9

14 Direktur Perawatan Gedung Utama 3 30

15 Bid. Rawat Inap 1 Gedung IRNA A 2 9

16 Bid. Rawat Inap 2 Gedung IRNA B 2 9

17 Direktur SDM & Umum Gedung Utama 3 30

18 Biro SDM Gedung Utama 2 9

19 Pengemb & Pemb. SDM Gedung Utama 2 20

20 Administrasi SDM Gedung Utama 2 20

21 Biro Umum Gedung Facility 1 9

22 Pemeliharaan Sarana Gedung Facility 1 30

23 Laundry Gedung Laundry 1 120

24 Kebersihan & Limbah Gedung Facility 1 20

25 RT & Keamanan Gedung Facility 1 20

26 Direktur Keuangan Gedung Utama 3 30

27 Biro Keuangan Gedung Utama 2 9

28 Administrasi Keu. Gedung Utama 2 30

29 Akuntansi Gedung Utama 2 30

30 Verifikasi Gedung Utama 1 20

3132333435363738394041424344454647484950

Unit-unit Kerja Manajemen / General Support

Page 3: Template MN contoh.xls

Template Data Analisa Biaya

MN.2 Halaman : 2

PEMETAAN, LOKASI, DAN LUAS MASING-MASING UNIT KERJAUnit-unit Kerja di Rumah Sakit (selain manajemen)

No Nama Unit KerjaLokasi

Nama Gedung Lantai ke Luas Ruangan (m2)51 UGD Gedung IGD 1 & 2 400

52 Klinik Kebid. & Kandungan Gedung IRJ 2 30

53 Klinik Gigi & Mulut Gedung IRJ 1 45

54 Klinik Neurologi Gedung IRJ 2 15

55 Klinik Psikologi Gedung IRJ 2 15

56 Klinik Psikiatri Gedung IRJ 2 15

57 Klinik Hematologi&Onkologi Gedung IRJ 2 15

58 Klinik Anak Gedung IRJ 2 45

59 Klinik Bedah Gedung IRJ 1 30

60 Klinik Mata Gedung IRJ 1 30

61 Klinik Kulit & Kelamin Gedung IRJ 1 15

62 Klinik THT Gedung IRJ 1 15

63 Klinik Gizi Gedung IRJ 2 15

64 Klinik Penyakit Dalam Gedung IRJ 1 30

65 Klinik Jantung Gedung IRJ 2 15

66 Klinik Saluran Kencing Gedung IRJ 2 15

67 Klinik Bedah Anak Gedung IRJ 2 15

68 Klinik Bedah Tulang Gedung IRJ 1 15

69 Klinik Rheumatologi Gedung IRJ 1 15

70 Klinik Saluran Cerna Gedung IRJ 2 15

71 Klinik Bedah Thorax Gedung IRJ 1 15

72 Klinik Kesehatan Ibu Gedung IRJ 2 15

73 ODS/ODC Gedung IGD 1 120

74 Kamar Operasi Gedung Kamar Operasi 1 200

75 Med. Check Up Gedung IRJ 2 15

76 Hemodialisis Gedung Kamar Operasi 2 200

77 Pel. Kes. Mas Gedung IRJ 1 15

78 Laboratorium Gedung Lab & Rad 2 120

79 Radiologi Gedung Lab & Rad 1 120

80 Farmasi Gedung Farmasi 1 120

81 Rehab. Medik Gedung IRJ 1 30

82 Fisio Klinik Gedung IRJ 1 30

83 Gizi (Dapur) Gedung Dapur 1 200

84 Rekam Medik Gedung IRJ 2 90

85 Anggrek Gedung IRNA A 1 750

86 Mawar Gedung IRNA A 2 750

87 Melati Gedung IRNA A 2 800

88 Seruni (KM. Bayi) Gedung IRNA A 1 100

89 Seruni (VK) Gedung IRNA A 1 400

90 Soka Gedung IRNA B 2 800

91 ICU Gedung IRNA B 1 400

92 NICU/PICU Gedung IRNA B 1 200

93 Intermediate Gedung IRNA B 1 300

94 RRI Gedung IRNA B 1 200

95 Home Care Gedung IRNA B 1 40

96 Pelayanan Pendidikan Gedung Diklat 1 300

979899

100

Page 4: Template MN contoh.xls

Template Data Analisa Biaya

MN.3 Halaman : 1JUMLAH SDM, LISTRIK, AIR, TELEPON, KOMPUTER, DAN TEMPAT TIDUR MASING-MASING UNIT KERJAUnit-unit Kerja Manajemen

No Nama Unit KerjaSDM Listrik Air Telepon Tempat Tidur

Shift (8 jam)

jml orang

Total Kwh titik jml. User

jml. TT per kelas perawatan

dr Prwt Non SVIP VIP Utama I II III Khusus

1 Direktur Utama 1 1 1 202.7 8.1 1 1

2 Kom. Keperawatan 1 5 5 24.0 40.5 1

3 Komite Etik RS 1 5 5 24.0 40.5 1

4 Komite Medik 1 5 5 42.7 40.5 1

5 Audit Internal 1 5 5 258.7 40.5 1 2

6 Biro PURS 1 3 3 149.3 24.3 1 1

7 Biro SISFO 1 6 6 656.0 48.6 1 6

8 Sekretaris RS 1 5 5 368.0 40.5 1 3

9 Biro K3RS 1 3 3 149.3 24.3 1 1

10 Quality Assurance Unit 1 3 3 162.7 24.3 1 1

11 Direktur Medis 1 1 1 176.0 8.1 1 1

12 Bid. Pelayanan Medis 1 1 1 120.0 8.1 1 1

13 Bid. Penunjang Medis 1 1 1 120.0 8.1 1 1

14 Direktur Perawatan 1 1 1 176.0 8.1 1 1

15 Bid. Rawat Inap 1 1 1 1 120.0 8.1 1 1

16 Bid. Rawat Inap 2 1 1 1 120.0 8.1 1 1

17 Direktur SDM & Umum 1 1 1 176.0 8.1 1 1

18 Biro SDM 1 1 1 120.0 8.1 1 1

19 Pengemb & Pemb. SDM 1 3 3 245.3 24.3 1 2

20 Administrasi SDM 1 3 3 245.3 24.3 1 2

21 Biro Umum 1 1 1 120.0 8.1 1 1

22 Pemeliharaan Sarana 2 7 7 80.0 56.7 1

23 Laundry 2 15 15 320.0 655.8 1

24 Kebersihan & Limbah 2 50 50 53.3 1060.0 1

25 RT & Keamanan 1 40 40 53.3 324 1

26 Direktur Keuangan 1 1 1 176.0 8.1 1 1

27 Biro Keuangan 1 1 1 120.0 8.1 1 1

28 Administrasi Keu. 1 15 15 1520.0 121.5 1 15

29 Akuntansi 1 10 10 1040.0 81 1 10

30 Verifikasi 1 5 5 245.3 40.5 1 2

3132333435363738394041424344454647484950

Template Data Analisa Biaya

MN.3 Halaman : 2JUMLAH SDM, LISTRIK, AIR, TELEPON, KOMPUTER, DAN TEMPAT TIDUR MASING-MASING UNIT KERJAUnit-unit Kerja di Rumah Sakit (selain manajemen)

No Nama Unit KerjaSDM Listrik Air Telepon Tempat Tidur

Shift (8 jam)

jml orang

Total Kwh titik jml. User

jml. TT per kelas perawatan

dr Prwt Non SVIP VIP Utama I II III Khusus

51 UGD 3 3 9 3 15 3776.0 121.50 2 2

52 Klinik Kebid. & Kandungan 2 5 4 9 352.0 72.90 1 1

53 Klinik Gigi & Mulut 2 3 6 9 432.0 72.90 1 1

54 Klinik Neurologi 2 2 2 4 272.0 32.40 1 1

55 Klinik Psikologi 1 2 1 3 136.0 24.30 1 1

56 Klinik Psikiatri 1 1 1 2 136.0 16.20 1 1

57 Klinik Hematologi&Onkologi 1 1 1 2 136.0 16.20 1 1

58 Klinik Anak 2 4 6 10 432.0 81.00 1 1

59 Klinik Bedah 2 3 4 7 352.0 56.70 1 1

60 Klinik Mata 2 2 4 6 352.0 48.60 1 1

61 Klinik Kulit & Kelamin 2 2 2 4 272.0 32.40 1 1

62 Klinik THT 2 3 2 5 272.0 40.50 1 1

63 Klinik Gizi 1 1 1 2 136.0 16.20 1 1

64 Klinik Penyakit Dalam 2 4 4 8 352.0 64.80 1 1

65 Klinik Jantung 2 2 2 4 272.0 32.40 1 1

66 Klinik Saluran Kencing 1 1 1 2 136.0 16.20 1 1

67 Klinik Bedah Anak 2 2 2 4 272.0 32.40 1 1

68 Klinik Bedah Tulang 2 2 2 4 272.0 32.40 1 1

69 Klinik Rheumatologi 1 1 1 2 136.0 16.20 1 1

70 Klinik Saluran Cerna 1 1 1 2 136.0 16.20 1 1

71 Klinik Bedah Thorax 1 1 1 2 136.0 16.20 1 1

72 Klinik Kesehatan Ibu 2 2 2 4 272.0 32.40 1 1

73 ODS/ODC 3 2 3 1 6 1248.0 48.60 1 1

74 Kamar Operasi 3 2 6 2 10 2176.0 81.00 1 2

75 Med. Check Up 3 1 1 1 3 408.0 24.30 1 1

76 Hemodialisis 3 1 6 7 1888.0 56.70 1 1

Jml jam Praktek /hari

Komputer (SIMRS)

m3

Jml jam Praktek /hari

Komputer (SIMRS)

m3

Page 5: Template MN contoh.xls

77 Pel. Kes. Mas 1 1 1 1 3 136.0 24.30 1 1

78 Laboratorium 3 1 3 3 7 9984.0 56.70 1 1

79 Radiologi 3 1 3 3 7 11856.0 56.70 1 1

80 Farmasi 3 1 6 3 10 1824.0 81.00 1 3

81 Rehab. Medik 1 1 1 1 3 176.0 24.30 1 1

82 Fisio Klinik 1 3 1 4 176.0 32.40 1 1

83 Gizi (Dapur) 2 2 12 14 1258.7 475.47 1 1

84 Rekam Medik 3 15 15 4176.0 121.50 2 12

85 Anggrek 3 15 2 17 6288.0 450.09 1 1 1 2 4 8 16 24

86 Mawar 3 15 2 17 6288.0 472.50 1 1 5 8 16 30

87 Melati 3 15 2 17 6688.0 562.41 1 1 20 60

88 Seruni (KM. Bayi) 3 12 2 14 1196.8 425.79 1 1 55

89 Seruni (VK) 3 15 2 17 4185.6 223.16 1 1 1 2 4 8

90 Soka 3 15 2 17 6688.0 457.76 1 1 1 2 4 8 16 24

91 ICU 3 1 12 2 15 4534.4 213.44 1 1 16

92 NICU/PICU 3 1 12 2 15 2454.4 202.15 1 1 10

93 Intermediate 3 12 2 14 3225.6 209.03 1 1 16

94 RRI 3 12 2 14 2265.6 179.04 1 1 10

95 Home Care 1 4 2 6 298.7 48.60 2 2

96 Pelayanan Pendidikan 2 4 4 1792.0 32.40 2 1

979899

100

Page 6: Template MN contoh.xls

Template Data Analisa Biaya

MN.4 Halaman : 1 ###JUMLAH KEGIATAN UNIT KERJAUnit-unit Kerja Manajemen

No Nama Unit KerjaKunjungan Resep Cucian Hari Rawat Pelayanan Pendidikan

jml pasien

kg. Cucian jml. Porsi jml. Porsi

jml. Hari Rawat per kelas perawatan

Total

jml. Siswa

Lama Baru Total SVIP VIP Utama I II III Khusus Baru Lama

1 Direktur Utama 37.8 195

2 Kom. Keperawatan 18 975

3 Komite Etik RS 18 975

4 Komite Medik 24 975

5 Audit Internal 30 975

6 Biro PURS 26.4 585

7 Biro SISFO 32.4 1170

8 Sekretaris RS 32.4 975

9 Biro K3RS 26.4 585

10 Quality Assurance Unit 30 585

11 Direktur Medis 32.4 195

12 Bid. Pelayanan Medis 18 195

13 Bid. Penunjang Medis 18 195

14 Direktur Perawatan 32.4 195

15 Bid. Rawat Inap 1 18 195

16 Bid. Rawat Inap 2 18 195

17 Direktur SDM & Umum 32.4 195

18 Biro SDM 18 195

19 Pengemb & Pemb. SDM 26.4 585

20 Administrasi SDM 26.4 585

21 Biro Umum 18 195

22 Pemeliharaan Sarana 32.4 1365

23 Laundry 65.4 2925

24 Kebersihan & Limbah 26.4 9750

25 RT & Keamanan 26.4 7800

26 Direktur Keuangan 32.4 195

27 Biro Keuangan 18 195

28 Administrasi Keu. 32.4 2925

29 Akuntansi 32.4 1950

30 Verifikasi 26.4 975

3132333435363738394041424344454647484950

Template Data Analisa Biaya

MN.4 Halaman : 2JUMLAH KEGIATAN UNIT KERJAUnit-unit Kerja di Rumah Sakit (selain manajemen)

No Nama Unit KerjaKunjungan Resep Cucian Hari Rawat Pelayanan Pendidikanjml pasien

kg. Cucian jml. Porsi jml. Porsi

jml. Hari Rawat per kelas perawatan

Total

jml. Siswa

Lama Baru Total SVIP VIP Utama I II III Khusus Baru Lama

51 UGD 1,413 9,598 11,011 14,314 12,112 120 2925

52 Klinik Kebid. & Kandungan 10,326 2,065 12,391 22,491 11,276 32.4 1755

53 Klinik Gigi & Mulut 9,461 1,892 11,353 13,056 10,331 40.2 1755

54 Klinik Neurologi 6,448 1,290 7,738 8,899 7,042 22.8 780

55 Klinik Psikologi 5,281 1,056 6,337 7,288 5,767 22.8 585

56 Klinik Psikiatri 4,937 987 5,924 6,813 5,391 22.8 390

57 Klinik Hematologi&Onkologi 3,582 716 4,298 4,943 3,911 22.8 390

58 Klinik Anak 10,566 2,113 12,679 14,581 11,538 40.2 1950

59 Klinik Bedah 9,206 1,841 11,047 12,704 10,053 32.4 1365

60 Klinik Mata 5,312 1,062 6,374 7,330 5,800 32.4 1170

61 Klinik Kulit & Kelamin 5,763 1,153 6,916 7,953 6,294 22.8 780

62 Klinik THT 7,126 1,425 8,551 9,834 7,781 22.8 975

63 Klinik Gizi 3,128 626 3,754 4,317 3,416 22.8 390

64 Klinik Penyakit Dalam 11,356 2,271 13,627 15,671 12,401 32.4 1560

65 Klinik Jantung 6,765 1,353 8,118 9,336 7,387 22.8 780

66 Klinik Saluran Kencing 3,607 721 4,328 4,977 3,938 22.8 390

67 Klinik Bedah Anak 7,108 1,422 8,530 9,810 7,762 22.8 780

68 Klinik Bedah Tulang 7,451 1,490 8,941 10,282 8,136 22.8 780

69 Klinik Rheumatologi 3,600 720 4,320 4,968 3,931 22.8 390

70 Klinik Saluran Cerna 3,591 718 4,309 4,955 3,921 22.8 390

71 Klinik Bedah Thorax 3,161 632 3,793 4,362 3,452 22.8 390

72 Klinik Kesehatan Ibu 7,166 1,433 8,599 9,889 7,825 22.8 780

73 ODS/ODC 7,614 1,523 9,137 11,878 9,228 65.4 1170

74 Kamar Operasi 26,927 5,385 32,312 37,159 32,635 84.6 1950

75 Med. Check Up 3,496 699 4,195 4,656 2,139 22.8 585

76 Hemodialisis 3,556 711 4,267 5,547 4,310 84.6 1365

77 Pel. Kes. Mas 2,118 424 2,542 2,822 22.8 585

78 Laboratorium 93,607 18,721 112,328 143,421 65.4 1365

79 Radiologi 59,211 11,842 71,053 71,053 65.4 1365

80 Farmasi - 6,379 65.4 1950

81 Rehab. Medik 3,734 747 4,481 4,974 32.4 585

82 Fisio Klinik 9,893 1,979 11,872 13,178 32.4 780

83 Gizi (Dapur) - 84.6 2730 16,517

84 Rekam Medik 217,982 53,056 271,038 56.4 2925

85 Anggrek 4,163 833 4,996 26,611 15,538 17,519 3315 34,710 220 421 842 1,684 3,363 5,040 11,570

86 Mawar 4,063 813 4,876 28,520 15,164 18,764 3315 37,200 1,052 1,681 3,365 6,302 12,400

87 Melati 4,333 867 5,200 36,179 16,172 23,764 3315 47,190 4,131 11,599 15,730

88 Seruni (KM. Bayi) 2,205 441 2,646 26,611 8,229 17,415 2730 34,710 11,570 11,570

89 Seruni (VK) 2,167 433 2,600 7,280 8,086 4,868 3315 9,495 211 425 841 1,688 3,165

90 Soka 4,301 860 5,161 27,264 16,051 17,950 3315 35,562 210 422 845 1,682 3,460 5,235 11,854

91 ICU 2,167 433 2,600 7,832 8,086 5,228 2925 10,215 3,405 3,405

92 NICU/PICU 1,083 217 1,300 6,870 4,043 4,565 2925 8,961 2,987 2,987

93 Intermediate 1,625 325 1,950 8,147 6,065 5,417 2730 10,626 3,542 3,542

94 RRI 1,030 206 1,236 5,591 3,844 3,731 2730 7,293 2,431 2,431

95 Home Care 5,424 1,085 6,509 6,509 37.8 1170

96 Pelayanan Pendidikan 80 240 11520

97

Tindakan/ Pemeriksaan

Makanan Karyawan

Makanan Pasien

Jml. Tind. / Pemeriksaan

Lembar Resep

jml. SKS (tot. siswa)

Tindakan/ Pemeriksaan

Makanan Karyawan

Makanan Pasien

Jml. Tind. / Pemeriksaan

Lembar Resep

jml. SKS (tot. siswa)

H95
Widiyas: Pasien Luar
K98
Widiyas: Keluarga Pasien
Page 7: Template MN contoh.xls

9899

100

Page 8: Template MN contoh.xls

Template Data Analisa Biaya

MN.5 Halaman : 1 ###JUMLAH PENDAPATAN MASING-MASING UNIT KERJAUnit-unit Kerja Manajemen

No Nama Unit KerjaAdministrasi Obat / Alkes Cucian Makanan Akomodasi Pelayanan Pendidikan

Total PendapatanKarcis

Obat / Alkes Keluarga Pasien

Sewa Kamar

SKSLama Baru SVIP VIP Utama I II III Khusus

1 Direktur Utama

2 Kom. Keperawatan

3 Komite Etik RS

4 Komite Medik

5 Audit Internal

6 Biro PURS

7 Biro SISFO

8 Sekretaris RS

9 Biro K3RS

10 Quality Assurance Unit

11 Direktur Medis

12 Bid. Pelayanan Medis

13 Bid. Penunjang Medis

14 Direktur Perawatan

15 Bid. Rawat Inap 1

16 Bid. Rawat Inap 2

17 Direktur SDM & Umum

18 Biro SDM

19 Pengemb & Pemb. SDM

20 Administrasi SDM

21 Biro Umum

22 Pemeliharaan Sarana

23 Laundry

24 Kebersihan & Limbah

25 RT & Keamanan

26 Direktur Keuangan

27 Biro Keuangan

28 Administrasi Keu.

29 Akuntansi

30 Verifikasi

3132333435363738394041424344454647484950

Template Data Analisa Biaya

MN.5 Halaman : 2JUMLAH PENDAPATAN MASING-MASING UNIT KERJAUnit-unit Kerja di Rumah Sakit (selain manajemen)

No Nama Unit KerjaAdministrasi Obat / Alkes Cucian Makanan Akomodasi Pelayanan Pendidikan

Total PendapatanKarcis

Obat / Alkes Keluarga Pasien

Sewa Kamar

SKSLama Baru SVIP VIP Utama I II III Khusus

51 UGD 1,178,400,050 1,178,400,050

52 Klinik Kebid. & Kandungan 1,221,823,575 1,221,823,575

53 Klinik Gigi & Mulut 317,587,200 317,587,200

54 Klinik Neurologi 216,468,175 216,468,175

55 Klinik Psikologi 111,688,600 111,688,600

56 Klinik Psikiatri 104,409,225 104,409,225

57 Klinik Hematologi&Onkologi 120,238,475 120,238,475

58 Klinik Anak 792,112,825 792,112,825

59 Klinik Bedah 791,776,800 791,776,800

60 Klinik Mata 456,842,250 456,842,250

61 Klinik Kulit & Kelamin 193,456,725 193,456,725

62 Klinik THT 239,212,050 239,212,050

63 Klinik Gizi 66,158,025 66,158,025

64 Klinik Penyakit Dalam 381,197,075 381,197,075

65 Klinik Jantung 227,098,200 227,098,200

66 Klinik Saluran Kencing 121,065,525 121,065,525

67 Klinik Bedah Anak 611,408,250 611,408,250

68 Klinik Bedah Tulang 640,825,650 640,825,650

69 Klinik Rheumatologi 120,846,600 120,846,600

70 Klinik Saluran Cerna 120,530,375 120,530,375

71 Klinik Bedah Thorax 271,861,650 271,861,650

72 Klinik Kesehatan Ibu 151,548,925 151,548,925

73 ODS/ODC 4,149,282,350 4,149,282,350

74 Kamar Operasi 10,045,006,675 10,045,006,675

75 Med. Check Up 71,353,200 71,353,200

76 Hemodialisis 833,852,775 833,852,775

77 Pel. Kes. Mas 43,247,150 43,247,150

78 Laboratorium 12,667,659,825 12,667,659,825

79 Radiologi 7,128,392,225 7,128,392,225

80 Farmasi 12,761,348,975 12,761,348,975

81 Rehab. Medik 101,096,550 101,096,550

82 Fisio Klinik 267,842,850 267,842,850

83 Gizi (Dapur) 173,428,500 173,428,500

84 Rekam Medik 1,089,910,000 530,560,000 1,620,470,000

85 Anggrek 407,813,575 165,000,000 252,600,000 378,900,000 589,400,000 840,750,000 756,000,000 - 3,390,463,575

86 Mawar 437,069,000 789,000,000 1,008,600,000 1,514,250,000 2,205,700,000 - - - 5,954,619,000

87 Melati 554,443,175 - - - - 1,032,750,000 1,739,850,000 - 3,327,043,175

88 Seruni (KM. Bayi) 274,758,575 - - - - - - 867,750,000 1,142,508,575

89 Seruni (VK) 5,098,366,000 - 126,600,000 191,250,000 294,350,000 422,000,000 - - 6,132,566,000

90 Soka 417,820,800 157,500,000 253,200,000 380,250,000 588,700,000 865,000,000 785,250,000 - 3,447,720,800

91 ICU 1,177,345,400 - - - - - - 255,375,000 1,432,720,400

92 NICU/PICU 689,232,750 - - - - - - 224,025,000 913,257,750

93 Intermediate 572,937,775 - - - - - - 265,650,000 838,587,775

94 RRI 141,592,075 - - - - - - 182,325,000 323,917,075

95 Home Care 360,110,425 360,110,425

96 Pelayanan Pendidikan 240,000,000 320,000,000 6,336,000,000 6,896,000,000

97 -

98 -

99 -

100 -

Total 92,479,051,850

Tindakan/ Pemeriksaan

Tindakan / Pemeriksaan Pihak Luar

Iuran Pemb. Siswa Baru

Iuran Semesteran

Tindakan/ Pemeriksaan

Tindakan / Pemeriksaan Pihak Luar

Iuran Pemb. Siswa Baru

Iuran Semesteran

Page 9: Template MN contoh.xls

Template Data Analisa Biaya

MN.6 Halaman 2

BIAYA UNIT KERJAUnit-unit Kerja Manajemen

No Nama Unit Kerja

Biaya-biaya

Biaya Listrik Biaya Air Biaya TeleponTotal BiayaBottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Mix Top Down Top Down Top Down Bottom-Up

1 Direktur Utama 494,520,000 2,172,000 4,670,025 777,000 2,652,000 - 7,770,000 6,397,941 2,636,763 735,671 12,502,511 25,239,551 560,073,462

2 Kom. Keperawatan 309,075,000 488,700 3,972,500 305,700 596,700 - 3,057,000 1,436,718 312,197 3,678,356 12,502,511 3,144,386 338,569,767

3 Komite Etik RS 309,075,000 488,700 3,600,725 305,700 596,700 - 3,057,000 1,436,718 312,197 3,678,356 12,502,511 3,140,668 338,194,274

4 Komite Medik 309,075,000 868,800 2,370,500 391,800 1,060,800 - 3,918,000 2,534,576 555,450 3,678,356 12,502,511 3,137,669 340,093,462

5 Audit Internal 309,075,000 1,357,500 6,700,250 994,500 1,657,500 - 9,945,000 4,166,160 3,365,222 3,678,356 12,502,511 3,197,848 356,639,846

6 Biro PURS 185,445,000 1,086,000 7,760,250 609,000 1,326,000 - 6,090,000 3,266,575 1,942,125 2,207,013 12,502,511 1,962,263 224,196,736

7 Biro SISFO 370,890,000 1,629,000 4,572,550 2,079,000 1,989,000 - 20,790,000 5,393,133 8,533,381 4,414,027 12,502,511 3,811,596 436,604,198

8 Sekretaris RS 309,075,000 1,629,000 10,670,625 1,302,000 1,989,000 - 13,020,000 5,060,367 4,787,019 3,678,356 12,502,511 3,246,656 366,960,534

9 Biro K3RS 185,445,000 1,086,000 4,870,250 609,000 1,326,000 - 6,090,000 3,266,575 1,942,125 2,207,013 12,502,511 1,933,363 221,277,836

10 Quality Assurance Unit 185,445,000 1,357,500 3,765,350 670,500 1,657,500 - 6,705,000 4,050,762 2,116,435 2,207,013 12,502,511 1,928,959 222,406,529

11 Direktur Medis 370,890,000 1,629,000 4,570,250 654,000 1,989,000 - 6,540,000 4,829,572 2,289,444 735,671 12,502,511 18,986,613 425,616,060

12 Bid. Pelayanan Medis 61,815,000 488,700 4,870,250 395,700 596,700 - 3,957,000 1,536,003 1,560,984 735,671 12,502,511 681,664 89,140,183

13 Bid. Penunjang Medis 61,815,000 488,700 4,750,500 395,700 596,700 - 3,957,000 1,536,003 1,560,984 735,671 12,502,511 680,466 89,019,235

14 Direktur Perawatan 370,890,000 1,629,000 4,670,250 654,000 1,989,000 - 6,540,000 4,829,572 2,289,444 735,671 12,502,511 18,991,613 425,721,060

15 Bid. Rawat Inap 1 61,815,000 488,700 5,170,025 395,700 596,700 - 3,957,000 1,605,385 1,560,984 735,671 12,502,511 684,661 89,512,338

16 Bid. Rawat Inap 2 61,815,000 488,700 5,710,250 395,700 596,700 - 3,957,000 1,655,857 1,560,984 735,671 12,502,511 690,064 90,108,436

17 Direktur SDM & Umum 370,890,000 1,629,000 4,570,525 654,000 1,989,000 - 6,540,000 4,829,572 2,289,444 735,671 12,502,511 18,986,626 425,616,349

18 Biro SDM 61,815,000 488,700 3,370,025 395,700 596,700 - 3,957,000 1,536,003 1,560,984 735,671 12,502,511 666,661 87,624,955

19 Pengemb & Pemb. SDM 148,356,000 1,086,000 8,670,250 855,000 1,326,000 - 8,550,000 3,376,601 3,190,912 2,207,013 12,502,511 1,602,933 191,723,220

20 Administrasi SDM 148,356,000 1,086,000 9,670,500 855,000 1,326,000 - 8,550,000 3,376,601 3,190,912 2,207,013 12,502,511 1,612,935 192,733,473

21 Biro Umum 61,815,000 488,700 3,765,500 395,700 596,700 - 3,957,000 1,166,319 1,560,984 735,671 12,502,511 670,616 87,654,702

22 Pemeliharaan Sarana 302,893,500 81,629,000 3,678,025 6,420,000 1,989,000 - 64,200,000 3,503,379 1,040,656 5,149,698 12,502,511 3,966,095 486,971,864

23 Laundry ### 556,335,000 6,516,000 12,670,025 2,061,000 7,956,000 - 20,610,000 16,949,562 4,162,625 59,559,250 12,502,511 5,855,380 ###

24 Kebersihan & Limbah 1,854,450,000 90,598,800 1,670,025 2,196,000 1,326,000 - 21,960,000 2,678,397 693,337 96,274,831 12,502,511 1,950,241 ###

25 RT & Keamanan 1,483,560,000 1,086,000 970,025 1,806,000 1,326,000 - 18,060,000 2,434,387 693,337 29,426,846 12,502,511 1,488,748 ###

26 Direktur Keuangan 370,890,000 1,629,000 7,478,025 654,000 1,989,000 - 6,540,000 4,829,572 2,289,444 735,671 12,502,511 19,132,001 428,669,224

27 Biro Keuangan 61,815,000 488,700 5,750,625 395,700 596,700 - 3,957,000 1,536,003 1,560,984 735,671 12,502,511 690,467 90,029,361

28 Administrasi Keu. 741,780,000 1,629,000 15,670,050 4,644,000 1,989,000 - 46,440,000 6,407,543 19,772,469 11,035,067 12,502,511 7,657,121 869,526,760

29 Akuntansi 494,520,000 1,629,000 13,725,650 3,219,000 1,989,000 - 32,190,000 5,843,982 13,528,531 7,356,712 12,502,511 5,150,827 591,655,212

30 Verifikasi 247,260,000 1,086,000 6,660,250 933,000 1,326,000 - 9,330,000 3,381,972 3,190,912 3,678,356 12,502,511 2,572,653 291,921,653

31 -

32 -

33 -

34 -

35 -

36 -

37 -

38 -

39 -

40 -

41 -

42 -

43 -

44 -

45 -

46 -

47 -

48 -

49 -

50 -

- - ### - - ### ### ### - 36,419,100 47,537,100 - 364,191,000 ### 96,051,272 255,149,687 375,075,319 ### ###

Template Data Analisa Biaya

Biaya Medis Habis Pakai (Obat & Alkes)

Biaya Bahan Makanan (Dapur Gizi)

Biaya Bahan Cucian (Laundry)

Biaya Materi Pendidikan /Praktikum

Biaya SDM (jasa langsung)

Biaya SDM (diluar jasa langsung)

Biaya Alat Rumah Tangga & Bengkel

Biaya Alat Tulis Kantor

Biaya Pemeliharaan Alat Medis

Biaya Pemeliharaan Alat Non Medis

Biaya Pemeliharaan Gedung & Bangunan

Biaya Penyusutan Alat Medis

Biaya Penyusutan Alat Non Medis

Biaya Penyusutan Gedung & Bangunan

Biaya Lain-lain

TOTAL (1 s/d 50)

Q7
Sumber : MN. 6.1.2
R7
Sumber : MN.6.2
S7
Sumber : MN.6.2
T7
Sumber : MN.6.2
Page 10: Template MN contoh.xls

MN.6 Halaman 2

BIAYA UNIT KERJAUnit-unit Kerja Selain Manajemen

No Nama Unit Kerja

Biaya-biaya

Biaya Listrik Biaya Air Biaya TeleponTotal BiayaBottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Bottom-Up Mix Top Down Top Down Top Down Bottom-Up

51 UGD 443,667,619 707,040,030 51,300,000 21,720,000 8,258,250 14,494,325 5,529,000 26,520,000 144,943,250 55,290,000 70,412,036 49,118,975 11,035,067 25,005,021 1,133,273 ###

52 Klinik Kebid. & Kandungan 126,582,865 733,094,145 29,450,000 1,629,000 9,293,250 15,028,425 615,000 1,989,000 150,284,250 6,150,000 5,283,166 4,578,888 6,621,040 12,502,511 429,763 ###

53 Klinik Gigi & Mulut 119,571,581 190,552,320 31,350,000 2,443,500 8,514,750 3,906,325 799,500 2,983,500 39,063,250 7,995,000 7,848,668 5,619,544 6,621,040 12,502,511 460,913 440,232,401

54 Klinik Neurologi 81,500,268 129,880,905 13,300,000 814,500 5,803,500 2,662,550 430,500 994,500 26,625,500 4,305,000 2,704,238 3,538,231 2,942,685 12,502,511 213,430 288,218,317

55 Klinik Psikologi 42,050,758 67,013,160 9,500,000 814,500 4,752,750 430,500 994,500 - 4,305,000 2,692,759 1,769,116 2,207,013 12,502,511 164,923 149,197,489

56 Klinik Psikiatri 39,310,073 62,645,535 6,650,000 814,500 4,443,000 430,500 994,500 - 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 133,325 138,159,476

57 Klinik Hematologi&Onkologi 45,269,786 72,143,085 6,650,000 814,500 3,223,500 1,478,925 430,500 994,500 14,789,250 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 121,130 168,653,218

58 Klinik Anak 298,230,479 475,267,695 34,200,000 2,443,500 9,509,250 9,743,000 799,500 2,983,500 97,430,000 7,995,000 7,851,353 5,619,544 7,356,712 12,502,511 499,358 972,431,400

59 Klinik Bedah 298,103,965 475,066,080 23,750,000 1,629,000 8,285,250 9,738,850 615,000 1,989,000 97,388,500 6,150,000 5,277,795 4,578,888 5,149,698 12,502,511 362,683 950,587,219

60 Klinik Mata 172,001,107 274,105,350 20,900,000 1,629,000 4,780,500 5,619,150 615,000 1,989,000 56,191,500 6,150,000 5,275,110 4,578,888 4,414,027 12,502,511 299,135 571,050,277

61 Klinik Kulit & Kelamin 72,836,457 116,074,035 13,300,000 814,500 5,187,000 2,379,525 430,500 994,500 23,795,250 4,305,000 2,704,238 3,538,231 2,942,685 12,502,511 207,265 262,011,696

62 Klinik THT 90,063,337 143,527,230 16,150,000 814,500 6,413,250 2,942,300 430,500 994,500 29,423,000 4,305,000 2,706,923 3,538,231 3,678,356 12,502,511 248,028 317,737,665

63 Klinik Gizi 24,908,496 39,694,815 6,650,000 814,500 2,815,500 430,500 994,500 - 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 117,050 99,163,404

64 Klinik Penyakit Dalam 143,520,699 228,718,245 26,600,000 1,629,000 10,220,250 468,875 615,000 1,989,000 4,688,750 6,150,000 5,280,481 4,578,888 5,885,369 12,502,511 410,533 453,257,599

65 Klinik Jantung 85,502,472 136,258,920 13,300,000 814,500 6,088,500 2,793,300 430,500 994,500 27,933,000 4,305,000 2,704,238 3,538,231 2,942,685 12,502,511 216,280 300,324,636

66 Klinik Saluran Kencing 45,581,170 72,639,315 6,650,000 814,500 3,246,000 148,900 430,500 994,500 1,489,000 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 121,355 154,853,283

67 Klinik Bedah Anak 230,195,206 366,844,950 13,300,000 814,500 6,397,500 1,406,250 430,500 994,500 14,062,500 4,305,000 2,704,238 3,538,231 2,942,685 12,502,511 219,370 660,657,940

68 Klinik Bedah Tulang 241,270,857 384,495,390 13,300,000 814,500 6,705,750 1,473,900 430,500 994,500 14,739,000 4,305,000 2,704,238 3,538,231 2,942,685 12,502,511 222,453 690,439,514

69 Klinik Rheumatologi 45,498,745 72,507,960 6,650,000 814,500 3,240,000 277,950 430,500 994,500 2,779,500 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 121,295 156,052,992

70 Klinik Saluran Cerna 45,379,686 72,318,225 6,650,000 814,500 3,231,750 277,225 430,500 994,500 2,772,250 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 121,213 155,727,891

71 Klinik Bedah Thorax 102,355,911 163,116,990 6,650,000 814,500 2,844,750 625,275 430,500 994,500 6,252,750 4,305,000 2,690,074 1,769,116 1,471,342 12,502,511 117,343 306,940,561

72 Klinik Kesehatan Ibu 57,058,170 90,929,355 13,300,000 814,500 6,449,250 430,500 994,500 - 4,305,000 2,704,238 3,538,231 2,942,685 12,502,511 219,888 196,188,827

73 ODS/ODC ### ### 19,950,000 6,516,000 6,852,750 5,103,625 1,761,000 7,956,000 51,036,250 17,610,000 21,181,319 16,234,238 4,414,027 12,502,511 430,358 ###

74 Kamar Operasi ### ### 34,200,000 10,860,000 24,234,000 12,355,350 3,030,000 13,260,000 123,553,500 30,300,000 35,219,787 28,305,850 7,356,712 12,502,511 855,840 ###

75 Med. Check Up 26,864,480 42,811,920 9,500,000 814,500 3,146,250 87,775 469,500 994,500 877,750 4,695,000 2,710,345 5,307,347 2,207,013 12,502,511 149,248 113,138,139

76 Hemodialisis 313,945,570 500,311,665 25,650,000 10,860,000 3,200,250 10,256,400 2,706,000 13,260,000 102,564,000 27,060,000 35,089,290 24,559,488 5,149,698 12,502,511 556,763 ###

77 Pel. Kes. Mas 16,282,552 25,948,290 9,500,000 814,500 1,906,500 469,500 994,500 - 4,695,000 2,692,759 1,769,116 2,207,013 12,502,511 136,850 79,919,091

78 Laboratorium ### ### 22,800,000 6,516,000 84,246,000 15,581,225 1,839,000 7,956,000 155,812,250 18,390,000 21,979,591 129,873,901 5,149,698 12,502,511 1,233,570 ###

79 Radiologi ### ### 22,800,000 6,516,000 53,289,750 16,395,300 1,839,000 7,956,000 163,953,000 18,390,000 22,100,623 154,225,257 5,149,698 12,502,511 924,008 ###

80 Farmasi ### ### 34,200,000 6,516,000 2,331,000 7,956,000 - 23,310,000 19,417,711 23,726,963 7,356,712 12,502,511 510,030 ###

81 Rehab. Medik 38,062,851 60,657,930 9,500,000 1,629,000 3,360,750 124,350 654,000 1,989,000 1,243,500 6,540,000 5,255,675 2,289,444 2,207,013 12,502,511 171,328 146,187,351

82 Fisio Klinik 100,842,833 160,705,710 14,250,000 1,629,000 8,904,000 329,450 654,000 1,989,000 3,294,500 6,540,000 5,258,360 2,289,444 2,942,685 12,502,511 274,260 322,405,752

83 Gizi (Dapur) - ### - 41,800,000 10,860,000 3,174,000 13,260,000 - 31,740,000 23,787,437 16,373,425 43,183,806 12,502,511 690,940 ###

84 Rekam Medik - - 42,750,000 4,887,000 ### 4,644,000 5,967,000 - 46,440,000 16,941,613 54,322,257 11,035,067 25,005,021 4,392,024 597,338,383

85 Anggrek 178,509,955 841,218,145 62,700,000 40,725,000 3,747,000 41,702,700 30,702,000 49,725,000 417,027,000 307,020,000 ### 81,795,582 40,878,794 12,502,511 1,875,990 ###

86 Mawar 164,556,479 ### 62,700,000 40,725,000 3,657,000 73,241,825 32,240,400 49,725,000 732,418,250 322,404,000 ### 81,795,582 42,914,150 12,502,511 1,890,474 ###

87 Melati 208,747,855 887,185,905 62,700,000 43,440,000 3,900,000 40,922,625 40,932,000 53,040,000 409,226,250 409,320,000 ### 86,998,863 51,080,100 12,502,511 2,040,120 ###

88 Seruni (KM. Bayi) 103,446,603 338,405,145 51,300,000 5,430,000 1,984,500 14,052,850 22,707,000 6,630,000 140,528,500 227,070,000 16,771,457 15,568,218 38,671,780 12,502,511 880,515 995,949,079

89 Seruni (VK) ### ### 62,700,000 21,720,000 1,950,000 75,430,550 11,013,000 26,520,000 754,305,500 110,130,000 66,209,528 54,447,135 20,267,740 12,502,511 1,239,030 ###

90 Soka 157,309,531 856,672,480 62,700,000 43,440,000 3,870,750 42,406,975 31,317,000 53,040,000 424,069,750 313,170,000 ### 86,998,863 41,575,229 12,502,511 1,943,678 ###

91 ICU 443,270,543 757,482,240 54,150,000 21,720,000 1,950,000 32,952,575 11,397,600 26,520,000 329,525,750 113,976,000 68,472,032 58,984,397 19,384,935 12,502,511 1,157,376 ###

92 NICU/PICU 259,496,130 458,344,650 54,150,000 10,860,000 975,000 21,004,925 6,630,000 13,260,000 210,049,250 66,300,000 34,337,548 31,927,334 18,359,900 12,502,511 858,750 ###

93 Intermediate 215,711,072 396,892,665 51,300,000 16,290,000 1,462,500 10,314,625 10,167,600 19,890,000 103,146,250 101,676,000 51,387,823 41,959,260 18,985,220 12,502,511 991,101 ###

94 RRI 53,309,416 121,420,245 51,300,000 10,860,000 927,000 3,984,175 6,630,000 13,260,000 39,841,750 66,300,000 34,317,679 29,471,385 16,260,785 12,502,511 829,770 461,214,716

95 Home Care 135,581,575 216,066,255 20,900,000 2,172,000 4,881,750 1,062,000 2,652,000 - 10,620,000 7,065,839 3,885,550 4,414,027 25,005,021 316,678 434,622,695

96 Pelayanan Pendidikan 72,000,000 11,400,000 16,290,000 4,092,000 19,890,000 - 40,920,000 31,753,211 23,310,700 2,942,685 25,005,021 516,720 248,120,337

97

98

99

100### ### ### - ### ### ### ### ### 284,926,200 520,587,600 ### ### ### ### 750,168,000 ### ### ###

Biaya Medis Habis Pakai (Obat & Alkes)

Biaya Bahan Makanan (Dapur Gizi)

Biaya Bahan Cucian (Laundry)

Biaya Materi Pendidikan /Praktikum

Biaya SDM (jasa langsung)

Biaya SDM (diluar jasa langsung)

Biaya Alat Rumah Tangga

Biaya Alat Tulis Kantor

Biaya Pemeliharaan Alat Medis

Biaya Pemeliharaan Alat Non Medis

Biaya Pemeliharaan Gedung & Bangunan

Biaya Penyusutan Alat Medis

Biaya Penyusutan Alat Non Medis

Biaya Penyusutan Gedung & Bangunan

Biaya Lain-lain

TOTAL (1 s/d 100)

Q65
Sumber : MN. 6.1.2
R65
Sumber : MN.6.2
S65
Sumber : MN.6.2
T65
Sumber : MN.6.2
Page 11: Template MN contoh.xls

Template Data Analisa Biaya

MN.6.1.1 Perhitungan Penyusutan Gedung & Bangunan

Metode Penyusutan

2009 Garis Lurus, Tanpa Nilai Residu

No Nama Gedung Lantai Ruang/Unit Kerja Luas Dibangun Nilai Perolehan UE Biaya Penyusutan

ke …. Ruangan Tahun (Rp) (tahun) per tahun

KANTOR & PERAWATAN

A Gedung Utama 620 1999 1,550,000,000 20 77,500,000

A.1 Gedung Utama Selasar 120

Luas setelah dikurangi selasar 500 100%

A.2 Gedung Utama 1 Biro PURS 20 4% 3,100,000

A.3 Gedung Utama 1 Biro SISFO 30 6% 4,650,000

A.4 Gedung Utama 1 Sekretaris RS 30 6% 4,650,000

A.5 Gedung Utama 1 Biro K3RS 20 4% 3,100,000

A.6 Gedung Utama 1 Quality Assurance Unit 25 5% 3,875,000

A.7 Gedung Utama 1 Verifikasi 20 4% 3,100,000

A.8 Gedung Utama 2 Kom. Keperawatan 9 2% 1,395,000

A.9 Gedung Utama 2 Komite Etik RS 9 2% 1,395,000

A.10 Gedung Utama 2 Komite Medik 16 3% 2,480,000

A.11 Gedung Utama 2 Audit Internal 25 5% 3,875,000

A.12 Gedung Utama 2 Bid. Pelayanan Medis 9 2% 1,395,000

A.13 Gedung Utama 2 Bid. Penunjang Medis 9 2% 1,395,000

A.14 Gedung Utama 2 Biro SDM 9 2% 1,395,000

A.15 Gedung Utama 2 Pengemb & Pemb. SDM 20 4% 3,100,000

A.16 Gedung Utama 2 Administrasi SDM 20 4% 3,100,000

A.17 Gedung Utama 2 Biro Keuangan 9 2% 1,395,000

A.18 Gedung Utama 2 Administrasi Keu. 30 6% 4,650,000

A.19 Gedung Utama 2 Akuntansi 30 6% 4,650,000

A.20 Gedung Utama 3 Direktur Utama 40 8% 6,200,000

A.21 Gedung Utama 3 Direktur Medis 30 6% 4,650,000

A.22 Gedung Utama 3 Direktur Perawatan 30 6% 4,650,000

Tahun Buku (31 Des….)

Page 12: Template MN contoh.xls

Template Data Analisa Biaya

MN.6.1.2 Perhitungan Penyusutan Gedung & Bangunan

Alokasi Biaya Penyusutan Gedung/Bangunan Fasilitas Umum

No Unit Kerja Kelistrikan Telepon

Kantor & Perawatan Kwh % Titik %1 Direktur Utama 6,200,000 202.7 0.21% 13,105 1 1.25%

Alokasi Biaya Penyusutan Gedung

Biaya Peny. Teralokasi

Page 13: Template MN contoh.xls

Template Data Analisa Biaya

MN.6.2Perhitungan Alokasi Biaya Listrik, Air, dan Telepon

Biaya Listrik Biaya Air Biaya Telepon

No Unit Kerja Tot. Biaya = 1,270,065,025 Tot. Biaya = 750,168,000 Tot. Biaya =

Kwh % Biaya Teralokasi M3 % Biaya Teralokasi Titik %1 Direktur Utama 202.7 0.21% 2,636,763 8.1 0.10% 735,671 1 1.25%

Page 14: Template MN contoh.xls

TEKNIK ALOKASI BIAYA TIDAK LANGSUNG

DATA

Sumber Data : Template MNBiaya Tahunan -->

Unit Kerja Penunjang Biaya Tahunan Dasar Alokasi KeteranganDirektur Utama 560,073,462 Jml. PegawaiKom. Keperawatan 338,569,767 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananKomite Etik RS 338,194,274 Jml. PegawaiKomite Medik 340,093,462 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananAudit Internal 356,639,846 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiBiro PURS 224,196,736 Jml. PegawaiBiro SISFO 436,604,198 Jml. Komputer eq. jml. UserSekretaris RS 366,960,534 Jml. PegawaiBiro K3RS 221,277,836 Jml. PegawaiQuality Assurance Unit 222,406,529 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananDirektur Medis 425,616,060 Jml. PegawaiBid. Pelayanan Medis 89,140,183 Jml. PegawaiBid. Penunjang Medis 89,019,235 Jml. PegawaiDirektur Perawatan 425,721,060 Jml. PegawaiBid. Rawat Inap 1 89,512,338 Jml. PegawaiBid. Rawat Inap 2 90,108,436 Jml. PegawaiDirektur SDM & Umum 425,616,349 Jml. PegawaiBiro SDM 87,624,955 Jml. PegawaiPengemb & Pemb. SDM 191,723,220 Jml. PegawaiAdministrasi SDM 192,733,473 Jml. PegawaiBiro Umum 87,654,702 Jml. PegawaiPemeliharaan Sarana 486,971,864 Jml. PegawaiLaundry 1,312,370,353 Kg CucianKebersihan & Limbah 2,086,300,142 Luas LantaiRT & Keamanan 1,553,353,854 Luas LantaiDirektur Keuangan 428,669,224 Jml. PegawaiBiro Keuangan 90,029,361 Jml. PegawaiAdministrasi Keu. 869,526,760 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiAkuntansi 591,655,212 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiVerifikasi 291,921,653 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiTotal 13,310,285,078

Perhitungan Alokasi Biaya Tidak LangsungBiaya Tahunan -->

Unit Kerja Penunjang Biaya Tahunan Dasar Alokasi Keterangan Direktur Utama Jml. Pegawai Kom. Keperawatan Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan

1 2

Page 15: Template MN contoh.xls

Komite Etik RS Jml. Pegawai Komite Medik Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Audit Internal Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Biro PURS Jml. Pegawai Biro SISFO Jml. Komputer eq. jml. User Sekretaris RS Jml. Pegawai Biro K3RS Jml. Pegawai Quality Assurance Unit Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Direktur Medis Jml. Pegawai Bid. Pelayanan Medis Jml. Pegawai Bid. Penunjang Medis Jml. Pegawai Direktur Perawatan Jml. Pegawai Bid. Rawat Inap 1 Jml. Pegawai Bid. Rawat Inap 2 Jml. Pegawai Direktur SDM & Umum Jml. Pegawai Biro SDM Jml. Pegawai Pengemb & Pemb. SDM Jml. Pegawai Administrasi SDM Jml. Pegawai Biro Umum Jml. Pegawai Pemeliharaan Sarana Jml. Pegawai Laundry Kg Cucian Kebersihan & Limbah Luas Lantai RT & Keamanan Luas Lantai Direktur Keuangan Jml. Pegawai Biro Keuangan Jml. Pegawai Administrasi Keu. Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Akuntansi Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Verifikasi Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Total Alokasi I Direktur Utama Jml. Pegawai Kom. Keperawatan Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Komite Etik RS Jml. Pegawai Komite Medik Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Audit Internal Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Biro PURS Jml. Pegawai Biro SISFO Jml. Komputer eq. jml. User Sekretaris RS Jml. Pegawai Biro K3RS Jml. Pegawai Quality Assurance Unit Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Direktur Medis Jml. Pegawai Bid. Pelayanan Medis Jml. Pegawai Bid. Penunjang Medis Jml. Pegawai Direktur Perawatan Jml. Pegawai Bid. Rawat Inap 1 Jml. Pegawai Bid. Rawat Inap 2 Jml. Pegawai Direktur SDM & Umum Jml. Pegawai Biro SDM Jml. Pegawai Pengemb & Pemb. SDM Jml. Pegawai

3

44

Page 16: Template MN contoh.xls

Administrasi SDM Jml. Pegawai Biro Umum Jml. Pegawai Pemeliharaan Sarana Jml. Pegawai Laundry Kg Cucian Kebersihan & Limbah Luas Lantai RT & Keamanan Luas Lantai Direktur Keuangan Jml. Pegawai Biro Keuangan Jml. Pegawai Administrasi Keu. Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Akuntansi Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Verifikasi Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Total Alokasi IITotal Biaya Tidak Langsung TeralokasiTotal Biaya

6

Page 17: Template MN contoh.xls

### ### ### ### ### ### ### ### ###

Biro PURS Biro SISFO Biro K3RS5 5 5 5 3 6 5 3

1 5 5 5 3 6 5 3

1 5 5 5 3 6 5 31 5 5 5 5 6 5 3

1 - - - 2 1 3 1 1 5 5 5 5 3 6 31 5 5 5 5 3 6 5

1 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 3

37.8 18.0 18.0 24.0 30.0 26.4 32.4 32.4 26.4 40 9 9 16 25 20 30 30 2040 9 9 16 25 20 30 30 20

1 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 3

### ### ### ### ### ### ### ### ###

Biro PURS Biro SISFO Biro K3RS

Direktur Utama

Kom. Keperawatan

Komite Etik RS

Komite Medik

Audit Internal

Sekretaris RS

Direktur Utama

Kom. Keperawatan

Komite Etik RS

Komite Medik

Audit Internal

Sekretaris RS

Page 18: Template MN contoh.xls
Page 19: Template MN contoh.xls
Page 20: Template MN contoh.xls

### ### 89,140,183 89,019,235 ### 89,512,338 90,108,436 ### 87,624,955

Biro SDM3 1 1 1 1 1 1 1 1

3 1 1 1 1 1 1 1 1

3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

1 1

1 1

3 1 1 1 1 1 1 13 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

30.0 32.4 18.0 18.0 32.4 18.0 18.0 32.4 18.0 25 30 9 9 30 9 9 30 925 30 9 9 30 9 9 30 9

3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

### ### 89,140,183 89,019,235 ### 89,512,338 90,108,436 ### 87,624,955

Biro SDM

Quality Assurance Unit

Direktur Medis

Bid. Pelayanan Medis

Bid. Penunjang Medis

Direktur Perawatan

Bid. Rawat Inap 1

Bid. Rawat Inap 2

Direktur SDM & Umum

Quality Assurance Unit

Direktur Medis

Bid. Pelayanan Medis

Bid. Penunjang Medis

Direktur Perawatan

Bid. Rawat Inap 1

Bid. Rawat Inap 2

Direktur SDM & Umum

Page 21: Template MN contoh.xls
Page 22: Template MN contoh.xls
Page 23: Template MN contoh.xls

### ### 87,654,702 ### 1,312,370,353 ### ### ### 90,029,361

Biro Umum Laundry3 3 1 7 15 50 40 1 1

3 3 1 7 15 50 40 1 1

3 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

2 2 1 - - - - 1 1 3 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

3 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

3 1 7 15 50 40 1 13 1 7 15 50 40 1 13 3 7 15 50 40 1 13 3 1 15 50 40 1 1

26.4 26.4 18.0 32.4 26.4 26.4 32.4 18.0 20 20 9 30 120 20 30 920 20 9 30 120 20 30 9

3 3 1 7 15 50 40 13 3 1 7 15 50 40 13 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

### ### 87,654,702 ### 1,312,370,353 ### ### ### 90,029,361

Biro Umum Laundry

Pengemb & Pemb. SDM

Administrasi SDM

Pemeliharaan Sarana

Kebersihan & Limbah

RT & Keamanan

Direktur Keuangan

Biro Keuangan

Pengemb & Pemb. SDM

Administrasi SDM

Pemeliharaan Sarana

Kebersihan & Limbah

RT & Keamanan

Direktur Keuangan

Biro Keuangan

Page 24: Template MN contoh.xls
Page 25: Template MN contoh.xls
Page 26: Template MN contoh.xls

### ### ### 1,635,466,846 1,103,531,302 440,232,401 288,218,317 149,197,489

Akuntansi Verifikasi UGD Klinik Psikologi15 10 5 15 9 9 4 3

11,011 12,391 11,353 7,738 6,337 15 10 5 15 9 9 4 3

11,011 12,391 11,353 7,738 6,337 15 10 5 11026 12400 11362 7742 634015 10 5 15 9 9 4 3

15 10 2 2 1 1 1 1 15 10 5 15 9 9 4 315 10 5 15 9 9 4 3

11011 12391 11353 7738 633715 9 9 4 315 9 9 4 3

15 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 3

32.4 32.4 26.4 120.0 32.4 40.2 22.8 22.8 30 30 20 400 30 45 15 1530 30 20 400 30 45 15 1515 10 5 15 9 9 4 315 10 5 15 9 9 4 3

10 5 11026 12400 11362 7742 634015 5 11026 12400 11362 7742 634015 10 11026 12400 11362 7742 6340

### ### ### 1,635,466,846 1,103,531,302 440,232,401 288,218,317 149,197,489

Akuntansi Verifikasi UGD Klinik Psikologi

Administrasi Keu.

Klinik Kebid. & Kandungan

Klinik Gigi & Mulut

Klinik Neurologi

Administrasi Keu.

Klinik Kebid. & Kandungan

Klinik Gigi & Mulut

Klinik Neurologi

Page 27: Template MN contoh.xls

5

Page 28: Template MN contoh.xls

78

Page 29: Template MN contoh.xls

138,159,476 168,653,218 972,431,400 950,587,219 571,050,277 262,011,696 317,737,665

Klinik Psikiatri Klinik Anak Klinik Bedah Klinik Mata Klinik THT2 2 10 7 6 4 5

5,924 4,298 12,679 11,047 6,374 6,916 8,551 2 2 10 7 6 4 5

5,924 4,298 12,679 11,047 6,374 6,916 8,551 5926 4300 12689 11054 6380 6920 8556

2 2 10 7 6 4 5 1 1 1 1 1 1 1

2 2 10 7 6 4 52 2 10 7 6 4 5

5924 4298 12679 11047 6374 6916 85512 2 10 7 6 4 52 2 10 7 6 4 5

2 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 5

22.8 22.8 40.2 32.4 32.4 22.8 22.8 15 15 45 30 30 15 1515 15 45 30 30 15 15

2 2 10 7 6 4 52 2 10 7 6 4 5

5926 4300 12689 11054 6380 6920 85565926 4300 12689 11054 6380 6920 85565926 4300 12689 11054 6380 6920 8556

138,159,476 168,653,218 972,431,400 950,587,219 571,050,277 262,011,696 317,737,665

Klinik Psikiatri Klinik Anak Klinik Bedah Klinik Mata Klinik THT

Klinik Hematologi&Onkologi

Klinik Kulit & Kelamin

Klinik Hematologi&Onkologi

Klinik Kulit & Kelamin

Page 30: Template MN contoh.xls
Page 31: Template MN contoh.xls
Page 32: Template MN contoh.xls

99,163,404 453,257,599 300,324,636 154,853,283 660,657,940 690,439,514 156,052,992

Klinik Gizi Klinik Jantung2 8 4 2 4 4 2

3,754 13,627 8,118 4,328 8,530 8,941 4,320 2 8 4 2 4 4 2

3,754 13,627 8,118 4,328 8,530 8,941 4,320 3756 13635 8122 4330 8534 8945 4322

2 8 4 2 4 4 2 1 1 1 1 1 1 1

2 8 4 2 4 4 22 8 4 2 4 4 2

3754 13627 8118 4328 8530 8941 43202 8 4 2 4 4 22 8 4 2 4 4 2

2 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 2

22.8 32.4 22.8 22.8 22.8 22.8 22.8 15 30 15 15 15 15 1515 30 15 15 15 15 15

2 8 4 2 4 4 22 8 4 2 4 4 2

3756 13635 8122 4330 8534 8945 43223756 13635 8122 4330 8534 8945 43223756 13635 8122 4330 8534 8945 4322

99,163,404 453,257,599 300,324,636 154,853,283 660,657,940 690,439,514 156,052,992

Klinik Gizi Klinik Jantung

Klinik Penyakit Dalam

Klinik Saluran Kencing

Klinik Bedah Anak

Klinik Bedah Tulang

Klinik Rheumatologi

Klinik Penyakit Dalam

Klinik Saluran Kencing

Klinik Bedah Anak

Klinik Bedah Tulang

Klinik Rheumatologi

Page 33: Template MN contoh.xls
Page 34: Template MN contoh.xls
Page 35: Template MN contoh.xls

155,727,891 306,940,561 196,188,827 4,223,322,292 10,144,982,567 113,138,139 1,087,671,634

ODS/ODC Kamar Operasi Med. Check Up Hemodialisis2 2 4 6 10 3 7

4,309 3,793 8,599 9,137 32,312 4,195 4,267 2 2 4 6 10 3 7

4,309 3,793 8,599 9,137 32,312 4,195 4,267 4311 3795 8603 9143 32322 4198 4274

2 2 4 6 10 3 7 1 1 1 1 2 1 1

2 2 4 6 10 3 72 2 4 6 10 3 7

4309 3793 8599 9137 32312 4195 42672 2 4 6 10 3 72 2 4 6 10 3 7

2 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 7

22.8 22.8 22.8 65.4 84.6 22.8 84.6 15 15 15 120 200 15 20015 15 15 120 200 15 200

2 2 4 6 10 3 72 2 4 6 10 3 7

4311 3795 8603 9143 32322 4198 42744311 3795 8603 9143 32322 4198 42744311 3795 8603 9143 32322 4198 4274

155,727,891 306,940,561 196,188,827 4,223,322,292 10,144,982,567 113,138,139 1,087,671,634

ODS/ODC Kamar Operasi Med. Check Up Hemodialisis

Klinik Saluran Cerna

Klinik Bedah Thorax

Klinik Kesehatan Ibu

Klinik Saluran Cerna

Klinik Bedah Thorax

Klinik Kesehatan Ibu

Page 36: Template MN contoh.xls
Page 37: Template MN contoh.xls
Page 38: Template MN contoh.xls

79,919,091 5,652,468,643 3,768,965,338 10,047,014,405 146,187,351 322,405,752 2,700,013,408

Pel. Kes. Mas Laboratorium Radiologi Farmasi Rehab. Medik Fisio Klinik Gizi (Dapur)3 7 7 10 3 4 14

2,542 112,328 71,053 6,379 4,481 11,872 - 3 7 7 10 3 4 14

2,542 112,328 71,053 6,379 4,481 11,872 - 2545 112335 71060 6389 4484 11876 14

3 7 7 10 3 4 14 1 1 1 3 1 1 1

3 7 7 10 3 4 143 7 7 10 3 4 14

2542 112328 71053 6379 4481 11872 03 7 7 10 3 4 143

7 7 10 3 4 14

3 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 14

22.8 65.4 65.4 65.4 32.4 32.4 84.6 15 120 120 120 30 30 20015 120 120 120 30 30 200

3 7 7 10 3 4 143 7 7 10 3 4 14

2545 112335 71060 6389 4484 11876 142545 112335 71060 6389 4484 11876 142545 112335 71060 6389 4484 11876 14

79,919,091 5,652,468,643 3,768,965,338 10,047,014,405 146,187,351 322,405,752 2,700,013,408

Pel. Kes. Mas Laboratorium Radiologi Farmasi Rehab. Medik Fisio Klinik Gizi (Dapur)

Page 39: Template MN contoh.xls
Page 40: Template MN contoh.xls
Page 41: Template MN contoh.xls

597,338,383 2,234,081,049 3,110,480,873 2,444,269,370 995,949,079 6,403,829,394 2,267,701,561

Rekam Medik Anggrek Mawar Melati Seruni (VK) Soka15 17 17 17 14 17 17

271,038 11,570 12,400 15,730 11,570 3,165 11,854 15 17 17 17 14 17 17

271,038 11,570 12,400 15,730 11,570 3,165 11,854 271053 5013 4893 5217 2660 2617 5178

15 17 17 17 14 17 17 12 1 1 1 1 1 1

15 17 17 17 14 17 1715 17 17 17 14 17 17

271038 16566 17276 20930 14216 5765 1701515

1517 17 17 14 17 1717 17 17 14 17

1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 17

56.4 17,519.0 18,764.0 23,764.0 17,415.0 4,868.0 17,950.0 90 750 750 800 100 400 80090 750 750 800 100 400 80015 17 17 17 14 17 1715 17 17 17 14 17 17

271053 5013 4893 5217 2660 2617 5178271053 5013 4893 5217 2660 2617 5178271053 5013 4893 5217 2660 2617 5178

597,338,383 2,234,081,049 3,110,480,873 2,444,269,370 995,949,079 6,403,829,394 2,267,701,561

Rekam Medik Anggrek Mawar Melati Seruni (VK) Soka

Seruni (KM. Bayi)

Seruni (KM. Bayi)

Page 42: Template MN contoh.xls
Page 43: Template MN contoh.xls
Page 44: Template MN contoh.xls

1,953,445,958 1,199,055,997 1,052,676,627 461,214,716 434,622,695 248,120,337 85,170,043,692

ICU NICU/PICU Intermediate RRI Home Care Total Dasar Alokasi 15 15 14 14 6 4 565

3,405 2,987 3,542 2,431 6,509 - 787,705 15 15 14 14 6 4 561

3,405 2,987 3,542 2,431 6,509 - 787,705 2615 1315 1964 1250 6515 4 742,177

15 15 14 14 6 4 563 1 1 1 1 2 1 113

15 15 14 14 6 4 561 15 15 14 14 6 4 563

6005 4287 5492 3667 6509 820,270 201 139 60

15 15 14 14 6 165 82

15 15 14 14 6 81 15 15 14 14 6 4 565 15 15 14 14 6 4 565 15 15 14 14 6 4 563 15 15 14 14 6 4 563 15 15 14 14 6 4 565 15 15 14 14 6 4 559

5,228.0 4,565.0 5,417.0 3,731.0 37.8 - 121,373 400 200 300 200 40 300 7,832 400 200 300 200 40 300 7,832

15 15 14 14 6 4 565 15 15 14 14 6 4 565

2615 1315 1964 1250 6515 4 742,167 2615 1315 1964 1250 6515 4 742,172 2615 1315 1964 1250 6515 4 742,177

1,953,445,958 1,199,055,997 1,052,676,627 461,214,716 434,622,695 248,120,337 85,170,043,692

ICU NICU/PICU Intermediate RRI Home Care Total

Pelayanan Pendidikan

Pelayanan Pendidikan

Page 45: Template MN contoh.xls
Page 46: Template MN contoh.xls
Page 47: Template MN contoh.xls

9

Page 48: Template MN contoh.xls

TEKNIK ALOKASI BIAYA TIDAK LANGSUNG

DATA

Sumber Data : Template MNBiaya Tahunan -->

Unit Kerja Penunjang Biaya Tahunan Dasar Alokasi KeteranganDirektur Utama 560,073,462 Jml. PegawaiKom. Keperawatan 338,569,767 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananKomite Etik RS 338,194,274 Jml. PegawaiKomite Medik 340,093,462 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananAudit Internal 356,639,846 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiBiro PURS 224,196,736 Jml. PegawaiBiro SISFO 436,604,198 Jml. Komputer eq. jml. UserSekretaris RS 366,960,534 Jml. PegawaiBiro K3RS 221,277,836 Jml. PegawaiQuality Assurance Unit 222,406,529 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananDirektur Medis 425,616,060 Jml. PegawaiBid. Pelayanan Medis 89,140,183 Jml. PegawaiBid. Penunjang Medis 89,019,235 Jml. PegawaiDirektur Perawatan 425,721,060 Jml. PegawaiBid. Rawat Inap 1 89,512,338 Jml. PegawaiBid. Rawat Inap 2 90,108,436 Jml. PegawaiDirektur SDM & Umum 425,616,349 Jml. PegawaiBiro SDM 87,624,955 Jml. PegawaiPengemb & Pemb. SDM 191,723,220 Jml. PegawaiAdministrasi SDM 192,733,473 Jml. PegawaiBiro Umum 87,654,702 Jml. PegawaiPemeliharaan Sarana 486,971,864 Jml. PegawaiLaundry 1,312,370,353 Kg CucianKebersihan & Limbah 2,086,300,142 Luas LantaiRT & Keamanan 1,553,353,854 Luas LantaiDirektur Keuangan 428,669,224 Jml. PegawaiBiro Keuangan 90,029,361 Jml. PegawaiAdministrasi Keu. 869,526,760 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiAkuntansi 591,655,212 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiVerifikasi 291,921,653 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiTotal 13,310,285,078

Perhitungan Alokasi Biaya Tidak LangsungBiaya Tahunan -->

Unit Kerja Penunjang Biaya Tahunan Dasar Alokasi Keterangan Direktur Utama =B8 Jml. Pegawai Kom. Keperawatan Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan 1 2

Page 49: Template MN contoh.xls

Komite Etik RS Jml. Pegawai Komite Medik Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Audit Internal Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Biro PURS Jml. Pegawai Biro SISFO Jml. Komputer eq. jml. User Sekretaris RS Jml. Pegawai Biro K3RS Jml. Pegawai Quality Assurance Unit Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Direktur Medis Jml. Pegawai Bid. Pelayanan Medis Jml. Pegawai Bid. Penunjang Medis Jml. Pegawai Direktur Perawatan Jml. Pegawai Bid. Rawat Inap 1 Jml. Pegawai Bid. Rawat Inap 2 Jml. Pegawai Direktur SDM & Umum Jml. Pegawai Biro SDM Jml. Pegawai Pengemb & Pemb. SDM Jml. Pegawai Administrasi SDM Jml. Pegawai Biro Umum Jml. Pegawai Pemeliharaan Sarana Jml. Pegawai Laundry Kg Cucian Kebersihan & Limbah Luas Lantai RT & Keamanan Luas Lantai Direktur Keuangan Jml. Pegawai Biro Keuangan Jml. Pegawai Administrasi Keu. Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Akuntansi Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Verifikasi Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Total Alokasi I =SUM(B44:B73) Direktur Utama =$E$74 Jml. Pegawai Kom. Keperawatan =$F$74 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Komite Etik RS =$G$74 Jml. Pegawai Komite Medik =$H$74 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Audit Internal =$I$74 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Biro PURS =$J$74 Jml. Pegawai Biro SISFO =$K$74 Jml. Komputer eq. jml. User Sekretaris RS =$L$74 Jml. Pegawai Biro K3RS =$M$74 Jml. Pegawai Quality Assurance Unit =$N$74 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Direktur Medis =$O$74 Jml. Pegawai Bid. Pelayanan Medis =$P$74 Jml. Pegawai Bid. Penunjang Medis =$Q$74 Jml. Pegawai Direktur Perawatan =$R$74 Jml. Pegawai Bid. Rawat Inap 1 =$S$74 Jml. Pegawai Bid. Rawat Inap 2 =$T$74 Jml. Pegawai Direktur SDM & Umum =$U$74 Jml. Pegawai Biro SDM =$V$74 Jml. Pegawai Pengemb & Pemb. SDM =$W$74 Jml. Pegawai

3

44

Page 50: Template MN contoh.xls

Administrasi SDM =$X$74 Jml. Pegawai Biro Umum =$Y$74 Jml. Pegawai Pemeliharaan Sarana =$Z$74 Jml. Pegawai Laundry =$AA$74 Kg Cucian Kebersihan & Limbah =$AB$74 Luas Lantai RT & Keamanan =$AC$74 Luas Lantai Direktur Keuangan =$AD$74 Jml. Pegawai Biro Keuangan =$AE$74 Jml. Pegawai Administrasi Keu. =$AF$74 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Akuntansi =$AG$74 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Verifikasi =$AH$74 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Total Alokasi II =SUM(B75:B104) Total Biaya Tidak Langsung TeralokasiTotal Biaya

6

Page 51: Template MN contoh.xls

### ### ### ### ### ### ### ### ###

Biro PURS Biro SISFO Biro K3RS5 5 5 5 3 6 5 3

1 5 5 5 3 6 5 3

1 5 5 5 3 6 5 31 5 5 5 5 6 5 3

1 - - - 2 1 3 1 1 5 5 5 5 3 6 31 5 5 5 5 3 6 5

1 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 3

37.8 18.0 18.0 24.0 30.0 26.4 32.4 32.4 26.4 40 9 9 16 25 20 30 30 2040 9 9 16 25 20 30 30 20

1 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 3

### ### ### ### ### ### ### ### ###

Biro PURS Biro SISFO Biro K3RS =$B8*E8/$CC8

Direktur Utama

Kom. Keperawatan

Komite Etik RS

Komite Medik

Audit Internal

Sekretaris RS

Direktur Utama

Kom. Keperawatan

Komite Etik RS

Komite Medik

Audit Internal

Sekretaris RS

Page 52: Template MN contoh.xls
Page 53: Template MN contoh.xls
Page 54: Template MN contoh.xls

### ### 89,140,183 89,019,235 ### 89,512,338 90,108,436 ### 87,624,955

Biro SDM3 1 1 1 1 1 1 1 1

3 1 1 1 1 1 1 1 1

3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

1 1

1 1

3 1 1 1 1 1 1 13 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

30.0 32.4 18.0 18.0 32.4 18.0 18.0 32.4 18.0 25 30 9 9 30 9 9 30 925 30 9 9 30 9 9 30 9

3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

### ### 89,140,183 89,019,235 ### 89,512,338 90,108,436 ### 87,624,955

Biro SDM

Quality Assurance Unit

Direktur Medis

Bid. Pelayanan Medis

Bid. Penunjang Medis

Direktur Perawatan

Bid. Rawat Inap 1

Bid. Rawat Inap 2

Direktur SDM & Umum

Quality Assurance Unit

Direktur Medis

Bid. Pelayanan Medis

Bid. Penunjang Medis

Direktur Perawatan

Bid. Rawat Inap 1

Bid. Rawat Inap 2

Direktur SDM & Umum

Page 55: Template MN contoh.xls
Page 56: Template MN contoh.xls
Page 57: Template MN contoh.xls

### ### 87,654,702 ### 1,312,370,353 ### ### ### 90,029,361

Biro Umum Laundry3 3 1 7 15 50 40 1 1

3 3 1 7 15 50 40 1 1

3 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

2 2 1 - - - - 1 1 3 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

3 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

3 1 7 15 50 40 1 13 1 7 15 50 40 1 13 3 7 15 50 40 1 13 3 1 15 50 40 1 1

26.4 26.4 18.0 32.4 26.4 26.4 32.4 18.0 20 20 9 30 120 20 30 920 20 9 30 120 20 30 9

3 3 1 7 15 50 40 13 3 1 7 15 50 40 13 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 13 3 1 7 15 50 40 1 1

### ### 87,654,702 ### 1,312,370,353 ### ### ### 90,029,361

Biro Umum Laundry

Pengemb & Pemb. SDM

Administrasi SDM

Pemeliharaan Sarana

Kebersihan & Limbah

RT & Keamanan

Direktur Keuangan

Biro Keuangan

Pengemb & Pemb. SDM

Administrasi SDM

Pemeliharaan Sarana

Kebersihan & Limbah

RT & Keamanan

Direktur Keuangan

Biro Keuangan

Page 58: Template MN contoh.xls
Page 59: Template MN contoh.xls
Page 60: Template MN contoh.xls

### ### ### 1,635,466,846 1,103,531,302 440,232,401 288,218,317 149,197,489

Akuntansi Verifikasi UGD Klinik Psikologi15 10 5 15 9 9 4 3

11,011 12,391 11,353 7,738 6,337 15 10 5 15 9 9 4 3

11,011 12,391 11,353 7,738 6,337 15 10 5 11026 12400 11362 7742 634015 10 5 15 9 9 4 3

15 10 2 2 1 1 1 1 15 10 5 15 9 9 4 315 10 5 15 9 9 4 3

11011 12391 11353 7738 633715 9 9 4 315 9 9 4 3

15 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 315 10 5 15 9 9 4 3

32.4 32.4 26.4 120.0 32.4 40.2 22.8 22.8 30 30 20 400 30 45 15 1530 30 20 400 30 45 15 1515 10 5 15 9 9 4 315 10 5 15 9 9 4 3

10 5 11026 12400 11362 7742 634015 5 11026 12400 11362 7742 634015 10 11026 12400 11362 7742 6340

### ### ### 1,635,466,846 1,103,531,302 440,232,401 288,218,317 149,197,489

Akuntansi Verifikasi UGD Klinik Psikologi

Administrasi Keu.

Klinik Kebid. & Kandungan

Klinik Gigi & Mulut

Klinik Neurologi

Administrasi Keu.

Klinik Kebid. & Kandungan

Klinik Gigi & Mulut

Klinik Neurologi

Page 61: Template MN contoh.xls

=$B75*AI8/SUM($AI8:$CB8) 5

Page 62: Template MN contoh.xls

=SUM(AI105,AI74) =SUM(AI106,AI42)

7

8

Page 63: Template MN contoh.xls

138,159,476 168,653,218 972,431,400 950,587,219 571,050,277 262,011,696 317,737,665

Klinik Psikiatri Klinik Anak Klinik Bedah Klinik Mata Klinik THT2 2 10 7 6 4 5

5,924 4,298 12,679 11,047 6,374 6,916 8,551 2 2 10 7 6 4 5

5,924 4,298 12,679 11,047 6,374 6,916 8,551 5926 4300 12689 11054 6380 6920 8556

2 2 10 7 6 4 5 1 1 1 1 1 1 1

2 2 10 7 6 4 52 2 10 7 6 4 5

5924 4298 12679 11047 6374 6916 85512 2 10 7 6 4 52 2 10 7 6 4 5

2 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 52 2 10 7 6 4 5

22.8 22.8 40.2 32.4 32.4 22.8 22.8 15 15 45 30 30 15 1515 15 45 30 30 15 15

2 2 10 7 6 4 52 2 10 7 6 4 5

5926 4300 12689 11054 6380 6920 85565926 4300 12689 11054 6380 6920 85565926 4300 12689 11054 6380 6920 8556

138,159,476 168,653,218 972,431,400 950,587,219 571,050,277 262,011,696 317,737,665

Klinik Psikiatri Klinik Anak Klinik Bedah Klinik Mata Klinik THT

Klinik Hematologi&Onkologi

Klinik Kulit & Kelamin

Klinik Hematologi&Onkologi

Klinik Kulit & Kelamin

Page 64: Template MN contoh.xls
Page 65: Template MN contoh.xls
Page 66: Template MN contoh.xls

99,163,404 453,257,599 300,324,636 154,853,283 660,657,940 690,439,514 156,052,992

Klinik Gizi Klinik Jantung2 8 4 2 4 4 2

3,754 13,627 8,118 4,328 8,530 8,941 4,320 2 8 4 2 4 4 2

3,754 13,627 8,118 4,328 8,530 8,941 4,320 3756 13635 8122 4330 8534 8945 4322

2 8 4 2 4 4 2 1 1 1 1 1 1 1

2 8 4 2 4 4 22 8 4 2 4 4 2

3754 13627 8118 4328 8530 8941 43202 8 4 2 4 4 22 8 4 2 4 4 2

2 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 22 8 4 2 4 4 2

22.8 32.4 22.8 22.8 22.8 22.8 22.8 15 30 15 15 15 15 1515 30 15 15 15 15 15

2 8 4 2 4 4 22 8 4 2 4 4 2

3756 13635 8122 4330 8534 8945 43223756 13635 8122 4330 8534 8945 43223756 13635 8122 4330 8534 8945 4322

99,163,404 453,257,599 300,324,636 154,853,283 660,657,940 690,439,514 156,052,992

Klinik Gizi Klinik Jantung

Klinik Penyakit Dalam

Klinik Saluran Kencing

Klinik Bedah Anak

Klinik Bedah Tulang

Klinik Rheumatologi

Klinik Penyakit Dalam

Klinik Saluran Kencing

Klinik Bedah Anak

Klinik Bedah Tulang

Klinik Rheumatologi

Page 67: Template MN contoh.xls
Page 68: Template MN contoh.xls
Page 69: Template MN contoh.xls

155,727,891 306,940,561 196,188,827 4,223,322,292 10,144,982,567 113,138,139 1,087,671,634

ODS/ODC Kamar Operasi Med. Check Up Hemodialisis2 2 4 6 10 3 7

4,309 3,793 8,599 9,137 32,312 4,195 4,267 2 2 4 6 10 3 7

4,309 3,793 8,599 9,137 32,312 4,195 4,267 4311 3795 8603 9143 32322 4198 4274

2 2 4 6 10 3 7 1 1 1 1 2 1 1

2 2 4 6 10 3 72 2 4 6 10 3 7

4309 3793 8599 9137 32312 4195 42672 2 4 6 10 3 72 2 4 6 10 3 7

2 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 72 2 4 6 10 3 7

22.8 22.8 22.8 65.4 84.6 22.8 84.6 15 15 15 120 200 15 20015 15 15 120 200 15 200

2 2 4 6 10 3 72 2 4 6 10 3 7

4311 3795 8603 9143 32322 4198 42744311 3795 8603 9143 32322 4198 42744311 3795 8603 9143 32322 4198 4274

155,727,891 306,940,561 196,188,827 4,223,322,292 10,144,982,567 113,138,139 1,087,671,634

ODS/ODC Kamar Operasi Med. Check Up Hemodialisis

Klinik Saluran Cerna

Klinik Bedah Thorax

Klinik Kesehatan Ibu

Klinik Saluran Cerna

Klinik Bedah Thorax

Klinik Kesehatan Ibu

Page 70: Template MN contoh.xls
Page 71: Template MN contoh.xls
Page 72: Template MN contoh.xls

79,919,091 5,652,468,643 3,768,965,338 10,047,014,405 146,187,351 322,405,752 2,700,013,408

Pel. Kes. Mas Laboratorium Radiologi Farmasi Rehab. Medik Fisio Klinik Gizi (Dapur)3 7 7 10 3 4 14

2,542 112,328 71,053 6,379 4,481 11,872 - 3 7 7 10 3 4 14

2,542 112,328 71,053 6,379 4,481 11,872 - 2545 112335 71060 6389 4484 11876 14

3 7 7 10 3 4 14 1 1 1 3 1 1 1

3 7 7 10 3 4 143 7 7 10 3 4 14

2542 112328 71053 6379 4481 11872 03 7 7 10 3 4 143

7 7 10 3 4 14

3 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 143 7 7 10 3 4 14

22.8 65.4 65.4 65.4 32.4 32.4 84.6 15 120 120 120 30 30 20015 120 120 120 30 30 200

3 7 7 10 3 4 143 7 7 10 3 4 14

2545 112335 71060 6389 4484 11876 142545 112335 71060 6389 4484 11876 142545 112335 71060 6389 4484 11876 14

79,919,091 5,652,468,643 3,768,965,338 10,047,014,405 146,187,351 322,405,752 2,700,013,408

Pel. Kes. Mas Laboratorium Radiologi Farmasi Rehab. Medik Fisio Klinik Gizi (Dapur)

Page 73: Template MN contoh.xls
Page 74: Template MN contoh.xls
Page 75: Template MN contoh.xls

597,338,383 2,234,081,049 3,110,480,873 2,444,269,370 995,949,079 6,403,829,394 2,267,701,561

Rekam Medik Anggrek Mawar Melati Seruni (VK) Soka15 17 17 17 14 17 17

271,038 11,570 12,400 15,730 11,570 3,165 11,854 15 17 17 17 14 17 17

271,038 11,570 12,400 15,730 11,570 3,165 11,854 271053 5013 4893 5217 2660 2617 5178

15 17 17 17 14 17 17 12 1 1 1 1 1 1

15 17 17 17 14 17 1715 17 17 17 14 17 17

271038 16566 17276 20930 14216 5765 1701515

1517 17 17 14 17 1717 17 17 14 17

1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 1715 17 17 17 14 17 17

56.4 17,519.0 18,764.0 23,764.0 17,415.0 4,868.0 17,950.0 90 750 750 800 100 400 80090 750 750 800 100 400 80015 17 17 17 14 17 1715 17 17 17 14 17 17

271053 5013 4893 5217 2660 2617 5178271053 5013 4893 5217 2660 2617 5178271053 5013 4893 5217 2660 2617 5178

597,338,383 2,234,081,049 3,110,480,873 2,444,269,370 995,949,079 6,403,829,394 2,267,701,561

Rekam Medik Anggrek Mawar Melati Seruni (VK) Soka

Seruni (KM. Bayi)

Seruni (KM. Bayi)

Page 76: Template MN contoh.xls
Page 77: Template MN contoh.xls
Page 78: Template MN contoh.xls

1,953,445,958 1,199,055,997 1,052,676,627 461,214,716 434,622,695 248,120,337 85,170,043,692

ICU NICU/PICU Intermediate RRI Home Care Total Dasar Alokasi 15 15 14 14 6 4 565

3,405 2,987 3,542 2,431 6,509 - 787,705 15 15 14 14 6 4 561

3,405 2,987 3,542 2,431 6,509 - 787,705 2615 1315 1964 1250 6515 4 742,177

15 15 14 14 6 4 563 1 1 1 1 2 1 113

15 15 14 14 6 4 561 15 15 14 14 6 4 563

6005 4287 5492 3667 6509 820,270 201 139 60

15 15 14 14 6 165 82

15 15 14 14 6 81 15 15 14 14 6 4 565 15 15 14 14 6 4 565 15 15 14 14 6 4 563 15 15 14 14 6 4 563 15 15 14 14 6 4 565 15 15 14 14 6 4 559

5,228.0 4,565.0 5,417.0 3,731.0 37.8 - 121,373 400 200 300 200 40 300 7,832 400 200 300 200 40 300 7,832

15 15 14 14 6 4 565 15 15 14 14 6 4 565

2615 1315 1964 1250 6515 4 742,167 2615 1315 1964 1250 6515 4 742,172 2615 1315 1964 1250 6515 4 742,177

1,953,445,958 1,199,055,997 1,052,676,627 461,214,716 434,622,695 248,120,337 85,170,043,692

ICU NICU/PICU Intermediate RRI Home Care Total =SUM(E44:CB44)

Pelayanan Pendidikan

Pelayanan Pendidikan

Page 79: Template MN contoh.xls
Page 80: Template MN contoh.xls
Page 81: Template MN contoh.xls

9

Page 82: Template MN contoh.xls

TEKNIK ALOKASI BIAYA TIDAK LANGSUNG

DATA

Sumber Data : Template MNBiaya Tahunan -->

Unit Kerja Penunjang Biaya Tahunan Dasar Alokasi KeteranganDirektur Utama 560,073,462 Jml. PegawaiKom. Keperawatan 338,569,767 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananKomite Etik RS 338,194,274 Jml. PegawaiKomite Medik 340,093,462 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananAudit Internal 356,639,846 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiBiro PURS 224,196,736 Jml. PegawaiBiro SISFO 436,604,198 Jml. Komputer eq. jml. UserSekretaris RS 366,960,534 Jml. PegawaiBiro K3RS 221,277,836 Jml. PegawaiQuality Assurance Unit 222,406,529 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Res eq. jml. PelayananDirektur Medis 425,616,060 Jml. PegawaiBid. Pelayanan Medis 89,140,183 Jml. PegawaiBid. Penunjang Medis 89,019,235 Jml. PegawaiDirektur Perawatan 425,721,060 Jml. PegawaiBid. Rawat Inap 1 89,512,338 Jml. PegawaiBid. Rawat Inap 2 90,108,436 Jml. PegawaiDirektur SDM & Umum 425,616,349 Jml. PegawaiBiro SDM 87,624,955 Jml. PegawaiPengemb & Pemb. SDM 191,723,220 Jml. PegawaiAdministrasi SDM 192,733,473 Jml. PegawaiBiro Umum 87,654,702 Jml. PegawaiPemeliharaan Sarana 486,971,864 Jml. PegawaiLaundry 1,312,370,353 Kg CucianKebersihan & Limbah 2,086,300,142 Luas LantaiRT & Keamanan 1,553,353,854 Luas LantaiDirektur Keuangan 428,669,224 Jml. PegawaiBiro Keuangan 90,029,361 Jml. PegawaiAdministrasi Keu. 869,526,760 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiAkuntansi 591,655,212 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiVerifikasi 291,921,653 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. TransaksiTotal 13,310,285,078

Perhitungan Alokasi Biaya Tidak LangsungBiaya Tahunan -->

Unit Kerja Penunjang Biaya Tahunan Dasar Alokasi Keterangan Direktur Utama 560,073,462 Jml. Pegawai Kom. Keperawatan 338,569,767 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Komite Etik RS 338,194,274 Jml. Pegawai Komite Medik 340,093,462 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Audit Internal 356,639,846 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi

Page 83: Template MN contoh.xls

Biro PURS 224,196,736 Jml. Pegawai Biro SISFO 436,604,198 Jml. Komputer eq. jml. User Sekretaris RS 366,960,534 Jml. Pegawai Biro K3RS 221,277,836 Jml. Pegawai Quality Assurance Unit 222,406,529 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Direktur Medis 425,616,060 Jml. Pegawai Bid. Pelayanan Medis 89,140,183 Jml. Pegawai Bid. Penunjang Medis 89,019,235 Jml. Pegawai Direktur Perawatan 425,721,060 Jml. Pegawai Bid. Rawat Inap 1 89,512,338 Jml. Pegawai Bid. Rawat Inap 2 90,108,436 Jml. Pegawai Direktur SDM & Umum 425,616,349 Jml. Pegawai Biro SDM 87,624,955 Jml. Pegawai Pengemb & Pemb. SDM 191,723,220 Jml. Pegawai Administrasi SDM 192,733,473 Jml. Pegawai Biro Umum 87,654,702 Jml. Pegawai Pemeliharaan Sarana 486,971,864 Jml. Pegawai Laundry 1,312,370,353 Kg Cucian Kebersihan & Limbah 2,086,300,142 Luas Lantai RT & Keamanan 1,553,353,854 Luas Lantai Direktur Keuangan 428,669,224 Jml. Pegawai Biro Keuangan 90,029,361 Jml. Pegawai Administrasi Keu. 869,526,760 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Akuntansi 591,655,212 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Verifikasi 291,921,653 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Total Alokasi I 13,310,285,078 Direktur Utama 28,447,762 Jml. Pegawai Kom. Keperawatan 37,266,761 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Komite Etik RS 34,252,552 Jml. Pegawai Komite Medik 40,584,648 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Audit Internal 52,557,071 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Biro PURS 31,982,685 Jml. Pegawai Biro SISFO 53,759,434 Jml. Komputer eq. jml. User Sekretaris RS 55,502,164 Jml. Pegawai Biro K3RS 31,998,239 Jml. Pegawai Quality Assurance Unit 35,539,844 Jml. Pasien (RJ) /Hari Rawat (RI) /Lbr. Re eq. jml. Pelayanan Direktur Medis 24,733,497 Jml. Pegawai Bid. Pelayanan Medis 16,936,255 Jml. Pegawai Bid. Penunjang Medis 16,936,255 Jml. Pegawai Direktur Perawatan 24,733,497 Jml. Pegawai Bid. Rawat Inap 1 17,398,890 Jml. Pegawai Bid. Rawat Inap 2 17,398,890 Jml. Pegawai Direktur SDM & Umum 23,980,193 Jml. Pegawai Biro SDM 14,663,674 Jml. Pegawai Pengemb & Pemb. SDM 36,019,477 Jml. Pegawai Administrasi SDM 36,014,094 Jml. Pegawai Biro Umum 14,663,621 Jml. Pegawai Pemeliharaan Sarana 54,239,334 Jml. Pegawai Laundry 154,434,966 Kg Cucian Kebersihan & Limbah 333,149,049 Luas Lantai RT & Keamanan 268,730,613 Luas Lantai

Page 84: Template MN contoh.xls

Direktur Keuangan 23,974,790 Jml. Pegawai Biro Keuangan 14,659,419 Jml. Pegawai Administrasi Keu. 170,899,613 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Akuntansi 118,700,754 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Verifikasi 50,195,003 Jml. Pegawai & Pasien & Lbr Resep (Farm) eq. jml. Transaksi Total Alokasi II 1,834,353,045 Total Biaya Tidak Langsung TeralokasiTotal Biaya

Page 85: Template MN contoh.xls

### ### ### ### ### ### ### ### ###

Biro PURS Biro SISFO Biro K3RS5 5 5 5 3 6 5 3

1 5 5 5 3 6 5 3

1 5 5 5 3 6 5 31 5 5 5 5 6 5 3

1 - - - 2 1 3 1 1 5 5 5 5 3 6 31 5 5 5 5 3 6 5

1 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 3

37.8 18.0 18.0 24.0 30.0 26.4 32.4 32.4 26.4 40 9 9 16 25 20 30 30 2040 9 9 16 25 20 30 30 20

1 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 31 5 5 5 5 3 6 5 3

### ### ### ### ### ### ### ### ###

Biro PURS Biro SISFO Biro K3RS 4,956,402 4,956,402 4,956,402 4,956,402 2,973,841 5,947,683 4,956,402 2,973,841

- - - - - - - - 602,842 3,014,209 3,014,209 3,014,209 1,808,526 3,617,051 3,014,209 1,808,526 - - - - - - - - 481 2,403 2,403 2,403 1,442 2,883 2,403 1,442

Direktur Utama

Kom. Keperawatan

Komite Etik RS

Komite Medik

Audit Internal

Sekretaris RS

Direktur Utama

Kom. Keperawatan

Komite Etik RS

Komite Medik

Audit Internal

Sekretaris RS

Page 86: Template MN contoh.xls

398,218 1,991,090 1,991,090 1,991,090 1,991,090 2,389,308 1,991,090 1,194,654 3,863,754 - - - 7,727,508 3,863,754 11,591,262 3,863,754 654,119 3,270,593 3,270,593 3,270,593 3,270,593 1,962,356 3,924,712 1,962,356 393,033 1,965,167 1,965,167 1,965,167 1,965,167 1,179,100 2,358,201 1,965,167 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 753,303 3,766,516 3,766,516 3,766,516 3,766,516 2,259,910 4,519,820 3,766,516 2,259,910 155,088 775,442 775,442 775,442 775,442 465,265 930,530 775,442 465,265 340,539 1,702,693 1,702,693 1,702,693 1,702,693 1,021,616 2,043,231 1,702,693 1,021,616 342,333 1,711,665 1,711,665 1,711,665 1,711,665 1,026,999 2,053,998 1,711,665 1,026,999 155,141 775,705 775,705 775,705 775,705 465,423 930,846 775,705 465,423 871,148 4,355,741 4,355,741 4,355,741 4,355,741 2,613,445 5,226,889 4,355,741 2,613,445 408,720 194,628 194,628 259,504 324,381 285,455 350,331 350,331 285,455 10,655,261 2,397,434 2,397,434 4,262,104 6,659,538 5,327,631 7,991,446 7,991,446 5,327,631 7,933,370 1,785,008 1,785,008 3,173,348 4,958,356 3,966,685 5,950,028 5,950,028 3,966,685 758,707 3,793,533 3,793,533 3,793,533 3,793,533 2,276,120 4,552,240 3,793,533 2,276,120 159,344 796,720 796,720 796,720 796,720 478,032 956,064 796,720 478,032 1,172 5,858 5,858 5,858 5,858 3,515 7,030 5,858 3,515 797 3,986 3,986 3,986 3,986 2,392 4,783 3,986 2,392 393 1,967 1,967 1,967 1,967 1,180 2,360 1,967 1,180 28,447,762 37,266,761 34,252,552 40,584,648 52,557,071 31,982,685 53,759,434 55,502,164 31,998,239

Page 87: Template MN contoh.xls
Page 88: Template MN contoh.xls

### ### 89,140,183 89,019,235 ### 89,512,338 90,108,436 ### 87,624,955

Biro SDM3 1 1 1 1 1 1 1 1

3 1 1 1 1 1 1 1 1

3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1 1 3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

1 1

1 1

3 1 1 1 1 1 1 13 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

30.0 32.4 18.0 18.0 32.4 18.0 18.0 32.4 18.0 25 30 9 9 30 9 9 30 925 30 9 9 30 9 9 30 9

3 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 13 1 1 1 1 1 1 1 1

### ### 89,140,183 89,019,235 ### 89,512,338 90,108,436 ### 87,624,955

Biro SDM 2,973,841 991,280 991,280 991,280 991,280 991,280 991,280 991,280 991,280 - - - - - - - - - 1,808,526 602,842 602,842 602,842 602,842 602,842 602,842 602,842 602,842 - - - - - - - - - 1,442 481 481 481 481 481 481 481 481

Quality Assurance Unit

Direktur Medis

Bid. Pelayanan Medis

Bid. Penunjang Medis

Direktur Perawatan

Bid. Rawat Inap 1

Bid. Rawat Inap 2

Direktur SDM & Umum

Quality Assurance Unit

Direktur Medis

Bid. Pelayanan Medis

Bid. Penunjang Medis

Direktur Perawatan

Bid. Rawat Inap 1

Bid. Rawat Inap 2

Direktur SDM & Umum

Page 89: Template MN contoh.xls

1,194,654 398,218 398,218 398,218 398,218 398,218 398,218 398,218 398,218 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 1,962,356 654,119 654,119 654,119 654,119 654,119 654,119 654,119 654,119 1,179,100 393,033 393,033 393,033 393,033 393,033 393,033 393,033 393,033

- - - - - - - - - 2,117,493 2,117,493 - - - - - - - - - - - - - - - - - - - - - - - - - 2,580,128 2,580,128 - - - - - - - - - - - - - - - - - - 2,259,910 753,303 753,303 753,303 753,303 753,303 753,303 753,303 465,265 155,088 155,088 155,088 155,088 155,088 155,088 155,088 1,021,616 340,539 340,539 340,539 340,539 340,539 340,539 340,539 340,539 1,026,999 342,333 342,333 342,333 342,333 342,333 342,333 342,333 342,333 465,423 155,141 155,141 155,141 155,141 155,141 155,141 155,141 155,141 2,613,445 871,148 871,148 871,148 871,148 871,148 871,148 871,148 871,148 324,381 350,331 194,628 194,628 350,331 194,628 194,628 350,331 194,628 6,659,538 7,991,446 2,397,434 2,397,434 7,991,446 2,397,434 2,397,434 7,991,446 2,397,434 4,958,356 5,950,028 1,785,008 1,785,008 5,950,028 1,785,008 1,785,008 5,950,028 1,785,008 2,276,120 758,707 758,707 758,707 758,707 758,707 758,707 758,707 758,707 478,032 159,344 159,344 159,344 159,344 159,344 159,344 159,344 159,344 3,515 1,172 1,172 1,172 1,172 1,172 1,172 1,172 1,172 2,392 797 797 797 797 797 797 797 797 1,180 393 393 393 393 393 393 393 393 35,539,844 24,733,497 16,936,255 16,936,255 24,733,497 17,398,890 17,398,890 23,980,193 14,663,674

Page 90: Template MN contoh.xls
Page 91: Template MN contoh.xls

### ### 87,654,702 ### 1,312,370,353 ### ### ###

Biro Umum Laundry3 3 1 7 15 50 40 1

3 3 1 7 15 50 40 1

3 3 1 7 15 50 40 13 3 1 7 15 50 40 1

2 2 1 - - - - 1 3 3 1 7 15 50 40 13 3 1 7 15 50 40 1

3 3 1 7 15 50 40 13 3 1 7 15 50 40 1

3 1 7 15 50 40 13 1 7 15 50 40 13 3 7 15 50 40 13 3 1 15 50 40 1

26.4 26.4 18.0 32.4 26.4 26.4 32.4 20 20 9 30 120 20 3020 20 9 30 120 20 30

3 3 1 7 15 50 403 3 1 7 15 50 40 13 3 1 7 15 50 40 13 3 1 7 15 50 40 13 3 1 7 15 50 40 1

### ### 87,654,702 ### 1,312,370,353 ### ### ###

Biro Umum Laundry 2,973,841 2,973,841 991,280 6,938,963 14,869,207 49,564,023 39,651,219 991,280 - - - - - - - - 1,808,526 1,808,526 602,842 4,219,893 9,042,628 30,142,092 24,113,674 602,842 - - - - - - - - 1,442 1,442 481 3,364 7,208 24,027 19,221 481

Pengemb & Pemb. SDM

Administrasi SDM

Pemeliharaan Sarana

Kebersihan & Limbah

RT & Keamanan

Direktur Keuangan

Pengemb & Pemb. SDM

Administrasi SDM

Pemeliharaan Sarana

Kebersihan & Limbah

RT & Keamanan

Direktur Keuangan

Page 92: Template MN contoh.xls

1,194,654 1,194,654 398,218 2,787,526 5,973,270 19,910,900 15,928,720 398,218 7,727,508 7,727,508 3,863,754 - - - - 3,863,754 1,962,356 1,962,356 654,119 4,578,830 9,811,779 32,705,930 26,164,744 654,119 1,179,100 1,179,100 393,033 2,751,234 5,895,502 19,651,673 15,721,338 393,033 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2,259,910 2,259,910 753,303 5,273,123 11,299,549 37,665,164 30,132,131 753,303 465,265 465,265 155,088 1,085,619 2,326,326 7,754,421 6,203,537 155,088

1,021,616 340,539 2,383,770 5,108,079 17,026,929 13,621,543 340,539 1,026,999 342,333 2,396,331 5,134,995 17,116,649 13,693,320 342,333 465,423 465,423 1,085,987 2,327,116 7,757,053 6,205,643 155,141 2,613,445 2,613,445 871,148 13,067,224 43,557,412 34,845,929 871,148 285,455 285,455 194,628 350,331 285,455 285,455 350,331 5,327,631 5,327,631 2,397,434 7,991,446 31,965,784 5,327,631 7,991,446 3,966,685 3,966,685 1,785,008 5,950,028 23,800,110 3,966,685 5,950,028 2,276,120 2,276,120 758,707 5,310,946 11,380,599 37,935,330 30,348,264 478,032 478,032 159,344 1,115,408 2,390,160 7,967,200 6,373,760 159,344 3,515 3,515 1,172 8,201 17,574 58,580 46,864 1,172 2,392 2,392 797 5,580 11,958 39,860 31,888 797 1,180 1,180 393 2,753 5,900 19,667 15,733 393 36,019,477 36,014,094 14,663,621 54,239,334 154,434,966 333,149,049 268,730,613 23,974,790

Page 93: Template MN contoh.xls
Page 94: Template MN contoh.xls

90,029,361 ### ### ### 1,635,466,846 1,103,531,302 440,232,401 288,218,317

Akuntansi Verifikasi UGD1 15 10 5 15 9 9 4

11,011 12,391 11,353 7,738 1 15 10 5 15 9 9 4

11,011 12,391 11,353 7,738 1 15 10 5 11026 12400 11362 77421 15 10 5 15 9 9 4

1 15 10 2 2 1 1 1 1 15 10 5 15 9 9 41 15 10 5 15 9 9 4

11011 12391 11353 773815 9 9 415 9 9 4

1 15 10 5 15 9 9 41 15 10 5 15 9 9 41 15 10 5 15 9 9 41 15 10 5 15 9 9 41 15 10 5 15 9 9 41 15 10 5 15 9 9 4

18.0 32.4 32.4 26.4 120.0 32.4 40.2 22.8 9 30 30 20 400 30 45 159 30 30 20 400 30 45 151 15 10 5 15 9 9 4

15 10 5 15 9 9 41 10 5 11026 12400 11362 77421 15 5 11026 12400 11362 77421 15 10 11026 12400 11362 7742

90,029,361 ### ### ### 1,635,466,846 1,103,531,302 440,232,401 288,218,317

Akuntansi Verifikasi UGD 991,280 14,869,207 9,912,805 4,956,402 14,869,207 8,921,524 8,921,524 3,965,122 - - - - 4,732,726 5,325,875 4,879,723 3,325,931 602,842 9,042,628 6,028,418 3,014,209 9,042,628 5,425,577 5,425,577 2,411,367 - - - - 4,754,025 5,349,843 4,901,684 3,340,899 481 7,208 4,805 2,403 5,298,347 5,958,598 5,459,805 3,720,279

Biro Keuangan

Administrasi Keu.

Klinik Kebid. & Kandungan

Klinik Gigi & Mulut

Klinik Neurologi

Biro Keuangan

Administrasi Keu.

Klinik Kebid. & Kandungan

Klinik Gigi & Mulut

Klinik Neurologi

Page 95: Template MN contoh.xls

398,218 5,973,270 3,982,180 1,991,090 5,973,270 3,583,962 3,583,962 1,592,872 3,863,754 57,956,309 38,637,540 7,727,508 7,727,508 3,863,754 3,863,754 3,863,754 654,119 9,811,779 6,541,186 3,270,593 9,811,779 5,887,067 5,887,067 2,616,474 393,033 5,895,502 3,930,335 1,965,167 5,895,502 3,537,301 3,537,301 1,572,134 - - - - 2,985,503 3,359,673 3,078,232 2,098,067 - - - - 31,762,393 19,057,436 19,057,436 8,469,971 - - - - 9,619,444 5,771,667 5,771,667 2,565,185 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 753,303 11,299,549 7,533,033 3,766,516 11,299,549 6,779,729 6,779,729 3,013,213 155,088 2,326,326 1,550,884 775,442 2,326,326 1,395,796 1,395,796 620,354 340,539 5,108,079 3,405,386 1,702,693 5,108,079 3,064,847 3,064,847 1,362,154 342,333 5,134,995 3,423,330 1,711,665 5,134,995 3,080,997 3,080,997 1,369,332 155,141 2,327,116 1,551,411 775,705 2,327,116 1,396,270 1,396,270 620,564 871,148 13,067,224 8,711,482 4,355,741 13,067,224 7,840,334 7,840,334 3,484,593 194,628 350,331 350,331 285,455 1,297,522 350,331 434,670 246,529 2,397,434 7,991,446 7,991,446 5,327,631 106,552,612 7,991,446 11,987,169 3,995,723 1,785,008 5,950,028 5,950,028 3,966,685 79,333,700 5,950,028 8,925,041 2,975,014 758,707 11,380,599 7,587,066 3,793,533 11,380,599 6,828,359 6,828,359 3,034,826

2,390,160 1,593,440 796,720 2,390,160 1,434,096 1,434,096 637,376 1,172 11,716 5,858 12,918,120 14,527,905 13,311,779 9,070,568 797 11,958 3,986 8,789,863 9,885,208 9,057,720 6,171,877 393 5,900 3,933 4,336,874 4,877,312 4,469,033 3,045,173 14,659,419 ### ### 50,195,003 378,735,069 151,444,934 154,373,573 79,189,355

1,165,892 699,535 699,535 310,905 520,937 586,225 537,117 366,089 1,403,793 842,276 842,276 374,345 567,316 638,417 584,937 398,682 781,009 878,334 804,809 548,392 1,310,766 786,459 786,459 349,538 1,734,175 867,088 867,088 867,088 2,274,679 1,364,807 1,364,807 606,581 1,311,403 786,842 786,842 349,708 477,074 536,865 491,892 335,264 1,864,334 1,118,600 1,118,600 497,156 1,827,653 1,096,592 1,096,592 487,374 - - - - - - - - - - - - - - - - 982,795 589,677 589,677 262,079 600,970 360,582 360,582 160,259 1,476,208 885,725 885,725 393,655 1,475,987 885,592 885,592 393,597 600,968 360,581 360,581 160,258 2,222,924 1,333,754 1,333,754 592,780 153,650 41,486 51,473 29,194 18,676,891 1,400,767 2,101,150 700,383 15,065,486 1,129,911 1,694,867 564,956

Page 96: Template MN contoh.xls

982,573 589,544 589,544 262,020 600,796 360,478 360,478 160,212 2,539,602 2,856,074 2,616,993 1,783,203 1,763,917 1,983,726 1,817,669 1,238,549 745,908 838,859 768,638 523,745 63,127,706 23,818,796 24,397,676 12,716,010 441,862,775 175,263,729 178,771,250 91,905,365 2,077,329,620 1,278,795,032 619,003,651 380,123,682

Page 97: Template MN contoh.xls

149,197,489 138,159,476 168,653,218 972,431,400 950,587,219 571,050,277 262,011,696

Klinik Psikologi Klinik Psikiatri Klinik Anak Klinik Bedah Klinik Mata3 2 2 10 7 6 4

6,337 5,924 4,298 12,679 11,047 6,374 6,916 3 2 2 10 7 6 4

6,337 5,924 4,298 12,679 11,047 6,374 6,916 6340 5926 4300 12689 11054 6380 6920

3 2 2 10 7 6 4 1 1 1 1 1 1 1

3 2 2 10 7 6 43 2 2 10 7 6 4

6337 5924 4298 12679 11047 6374 69163 2 2 10 7 6 43 2 2 10 7 6 4

3 2 2 10 7 6 43 2 2 10 7 6 43 2 2 10 7 6 43 2 2 10 7 6 43 2 2 10 7 6 43 2 2 10 7 6 4

22.8 22.8 22.8 40.2 32.4 32.4 22.8 15 15 15 45 30 30 1515 15 15 45 30 30 15

3 2 2 10 7 6 43 2 2 10 7 6 4

6340 5926 4300 12689 11054 6380 69206340 5926 4300 12689 11054 6380 69206340 5926 4300 12689 11054 6380 6920

149,197,489 138,159,476 168,653,218 972,431,400 950,587,219 571,050,277 262,011,696

Klinik Psikologi Klinik Psikiatri Klinik Anak Klinik Bedah Klinik Mata 2,973,841 1,982,561 1,982,561 9,912,805 6,938,963 5,947,683 3,965,122 2,723,756 2,546,242 1,847,358 5,449,662 4,748,199 2,739,660 2,972,621 1,808,526 1,205,684 1,205,684 6,028,418 4,219,893 3,617,051 2,411,367 2,736,014 2,557,701 1,855,671 5,474,188 4,769,568 2,751,989 2,985,999 3,046,573 2,847,633 2,066,288 6,097,471 5,311,801 3,065,795 3,325,282

Klinik Hematologi&Onkologi

Klinik Kulit & Kelamin

Klinik Hematologi&Onkologi

Klinik Kulit & Kelamin

Page 98: Template MN contoh.xls

1,194,654 796,436 796,436 3,982,180 2,787,526 2,389,308 1,592,872 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 1,962,356 1,308,237 1,308,237 6,541,186 4,578,830 3,924,712 2,616,474 1,179,100 786,067 786,067 3,930,335 2,751,234 2,358,201 1,572,134 1,718,203 1,606,223 1,165,352 3,437,761 2,995,264 1,728,235 1,875,192 6,352,479 4,234,986 4,234,986 21,174,928 14,822,450 12,704,957 8,469,971 1,923,889 1,282,593 1,282,593 6,412,963 4,489,074 3,847,778 2,565,185 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2,259,910 1,506,607 1,506,607 7,533,033 5,273,123 4,519,820 3,013,213 465,265 310,177 310,177 1,550,884 1,085,619 930,530 620,354 1,021,616 681,077 681,077 3,405,386 2,383,770 2,043,231 1,362,154 1,026,999 684,666 684,666 3,423,330 2,396,331 2,053,998 1,369,332 465,423 310,282 310,282 1,551,411 1,085,987 930,846 620,564 2,613,445 1,742,296 1,742,296 8,711,482 6,098,038 5,226,889 3,484,593 246,529 246,529 246,529 434,670 350,331 350,331 246,529 3,995,723 3,995,723 3,995,723 11,987,169 7,991,446 7,991,446 3,995,723 2,975,014 2,975,014 2,975,014 8,925,041 5,950,028 5,950,028 2,975,014 2,276,120 1,517,413 1,517,413 7,587,066 5,310,946 4,552,240 3,034,826 478,032 318,688 318,688 1,593,440 1,115,408 956,064 637,376 7,427,977 6,942,933 5,037,903 14,866,499 12,950,925 7,474,842 8,107,508 5,054,211 4,724,173 3,427,935 10,115,597 8,812,185 5,086,099 5,516,584 2,493,722 2,330,883 1,691,326 4,990,984 4,347,887 2,509,455 2,721,855 64,283,132 53,304,576 46,840,622 168,981,644 127,428,580 99,514,941 75,921,599 233,178 155,452 155,452 777,261 544,083 466,357 310,905 299,807 280,268 203,341 599,851 522,640 301,557 327,200 280,759 187,172 187,172 935,862 655,103 561,517 374,345 326,499 305,220 221,444 653,256 569,171 328,405 356,331 449,083 419,758 304,583 898,804 782,992 451,917 490,167 262,153 174,769 174,769 873,844 611,691 524,306 349,538 867,088 867,088 867,088 867,088 867,088 867,088 867,088 454,936 303,291 303,291 1,516,453 1,061,517 909,872 606,581 262,281 174,854 174,854 874,269 611,988 524,561 349,708 274,563 256,669 186,219 549,343 478,633 276,166 299,650 372,867 248,578 248,578 1,242,889 870,022 745,734 497,156 365,531 243,687 243,687 1,218,436 852,905 731,061 487,374 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 196,559 131,039 131,039 655,197 458,638 393,118 262,079 120,194 80,129 80,129 400,647 280,453 240,388 160,259 295,242 196,828 196,828 984,139 688,897 590,483 393,655 295,197 196,798 196,798 983,992 688,794 590,395 393,597 120,194 80,129 80,129 400,645 280,452 240,387 160,258 444,585 296,390 296,390 1,481,949 1,037,364 889,169 592,780 29,194 29,194 29,194 51,473 41,486 41,486 29,194 700,383 700,383 700,383 2,101,150 1,400,767 1,400,767 700,383 564,956 564,956 564,956 1,694,867 1,129,911 1,129,911 564,956

Page 99: Template MN contoh.xls

196,515 131,010 131,010 655,049 458,534 393,029 262,020 120,159 80,106 80,106 400,531 280,371 240,318 160,212 1,460,283 1,364,927 990,413 2,922,639 2,546,051 1,469,496 1,593,873 1,014,260 948,029 687,905 2,029,960 1,768,396 1,020,659 1,107,047 428,900 400,893 290,895 858,409 747,802 431,606 468,137 10,435,365 8,817,617 7,726,653 26,628,001 20,235,749 15,759,756 12,164,490 74,718,496 62,122,193 54,567,274 195,609,644 147,664,329 115,274,696 88,086,089 223,915,986 200,281,669 223,220,493 1,168,041,044 1,098,251,548 686,324,974 350,097,785

Page 100: Template MN contoh.xls

317,737,665 99,163,404 453,257,599 300,324,636 154,853,283 660,657,940 690,439,514

Klinik THT Klinik Gizi Klinik Jantung5 2 8 4 2 4 4

8,551 3,754 13,627 8,118 4,328 8,530 8,941 5 2 8 4 2 4 4

8,551 3,754 13,627 8,118 4,328 8,530 8,941 8556 3756 13635 8122 4330 8534 8945

5 2 8 4 2 4 4 1 1 1 1 1 1 1

5 2 8 4 2 4 45 2 8 4 2 4 4

8551 3754 13627 8118 4328 8530 89415 2 8 4 2 4 45 2 8 4 2 4 4

5 2 8 4 2 4 45 2 8 4 2 4 45 2 8 4 2 4 45 2 8 4 2 4 45 2 8 4 2 4 45 2 8 4 2 4 4

22.8 22.8 32.4 22.8 22.8 22.8 22.8 15 15 30 15 15 15 1515 15 30 15 15 15 15

5 2 8 4 2 4 45 2 8 4 2 4 4

8556 3756 13635 8122 4330 8534 89458556 3756 13635 8122 4330 8534 89458556 3756 13635 8122 4330 8534 8945

317,737,665 99,163,404 453,257,599 300,324,636 154,853,283 660,657,940 690,439,514

Klinik THT Klinik Gizi Klinik Jantung 4,956,402 1,982,561 7,930,244 3,965,122 1,982,561 3,965,122 3,965,122 3,675,373 1,613,537 5,857,130 3,489,262 1,860,252 3,666,347 3,843,003 3,014,209 1,205,684 4,822,735 2,411,367 1,205,684 2,411,367 2,411,367 3,691,914 1,620,798 5,883,489 3,504,965 1,868,624 3,682,847 3,860,298 4,111,432 1,804,878 6,552,055 3,902,881 2,080,704 4,100,861 4,298,359

Klinik Penyakit Dalam

Klinik Saluran Kencing

Klinik Bedah Anak

Klinik Bedah Tulang

Klinik Penyakit Dalam

Klinik Saluran Kencing

Klinik Bedah Anak

Klinik Bedah Tulang

Page 101: Template MN contoh.xls

1,991,090 796,436 3,185,744 1,592,872 796,436 1,592,872 1,592,872 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 3,270,593 1,308,237 5,232,949 2,616,474 1,308,237 2,616,474 2,616,474 1,965,167 786,067 3,144,268 1,572,134 786,067 1,572,134 1,572,134 2,318,503 1,017,853 3,694,800 2,201,100 1,173,486 2,312,809 2,424,247 10,587,464 4,234,986 16,939,943 8,469,971 4,234,986 8,469,971 8,469,971 3,206,481 1,282,593 5,130,370 2,565,185 1,282,593 2,565,185 2,565,185 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3,766,516 1,506,607 6,026,426 3,013,213 1,506,607 3,013,213 3,013,213 775,442 310,177 1,240,707 620,354 310,177 620,354 620,354 1,702,693 681,077 2,724,309 1,362,154 681,077 1,362,154 1,362,154 1,711,665 684,666 2,738,664 1,369,332 684,666 1,369,332 1,369,332 775,705 310,282 1,241,129 620,564 310,282 620,564 620,564 4,355,741 1,742,296 6,969,186 3,484,593 1,742,296 3,484,593 3,484,593 246,529 246,529 350,331 246,529 246,529 246,529 246,529 3,995,723 3,995,723 7,991,446 3,995,723 3,995,723 3,995,723 3,995,723 2,975,014 2,975,014 5,950,028 2,975,014 2,975,014 2,975,014 2,975,014 3,793,533 1,517,413 6,069,653 3,034,826 1,517,413 3,034,826 3,034,826 796,720 318,688 1,274,752 637,376 318,688 637,376 637,376 10,024,255 4,400,549 15,974,838 9,515,778 5,073,051 9,998,479 10,480,009 6,820,794 2,994,261 10,869,743 6,474,811 3,451,851 6,803,255 7,130,902 3,365,345 1,477,353 5,363,076 3,194,639 1,703,126 3,356,692 3,518,351 91,758,059 44,678,019 147,021,766 80,699,996 46,959,883 82,337,849 83,971,727 388,631 155,452 621,809 310,905 155,452 310,905 310,905 404,553 177,604 644,701 384,067 204,760 403,559 423,004 467,931 187,172 748,690 374,345 187,172 374,345 374,345 440,570 193,416 702,099 418,261 222,990 439,488 460,664 606,050 266,050 965,813 575,308 306,708 604,492 633,604 436,922 174,769 699,075 349,538 174,769 349,538 349,538 867,088 867,088 867,088 867,088 867,088 867,088 867,088 758,226 303,291 1,213,162 606,581 303,291 606,581 606,581 437,134 174,854 699,415 349,708 174,854 349,708 349,708 370,489 162,650 590,417 351,729 187,519 369,579 387,387 621,445 248,578 994,311 497,156 248,578 497,156 497,156 609,218 243,687 974,749 487,374 243,687 487,374 487,374 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 327,598 131,039 524,157 262,079 131,039 262,079 262,079 200,323 80,129 320,517 160,259 80,129 160,259 160,259 492,069 196,828 787,311 393,655 196,828 393,655 393,655 491,996 196,798 787,193 393,597 196,798 393,597 393,597 200,323 80,129 320,516 160,258 80,129 160,258 160,258 740,975 296,390 1,185,559 592,780 296,390 592,780 592,780 29,194 29,194 41,486 29,194 29,194 29,194 29,194 700,383 700,383 1,400,767 700,383 700,383 700,383 700,383 564,956 564,956 1,129,911 564,956 564,956 564,956 564,956

Page 102: Template MN contoh.xls

327,524 131,010 524,039 262,020 131,010 262,020 262,020 200,265 80,106 320,424 160,212 80,106 160,212 160,212 1,970,691 865,114 3,140,529 1,870,728 997,322 1,965,624 2,060,289 1,368,771 600,877 2,181,299 1,299,341 692,704 1,365,252 1,431,003 578,812 254,093 922,406 549,452 292,924 577,324 605,128 14,602,138 7,361,656 23,307,445 12,970,971 7,746,781 13,247,403 13,523,163 106,360,196 52,039,676 170,329,211 93,670,967 54,706,664 95,585,251 97,494,890 424,097,861 151,203,080 623,586,810 393,995,603 209,559,947 756,243,192 787,934,404

Page 103: Template MN contoh.xls

156,052,992 155,727,891 306,940,561 196,188,827 4,223,322,292 10,144,982,567 113,138,139

ODS/ODC Kamar Operasi Med. Check Up2 2 2 4 6 10 3

4,320 4,309 3,793 8,599 9,137 32,312 4,195 2 2 2 4 6 10 3

4,320 4,309 3,793 8,599 9,137 32,312 4,195 4322 4311 3795 8603 9143 32322 4198

2 2 2 4 6 10 3 1 1 1 1 1 2 1

2 2 2 4 6 10 32 2 2 4 6 10 3

4320 4309 3793 8599 9137 32312 41952 2 2 4 6 10 32 2 2 4 6 10 3

2 2 2 4 6 10 32 2 2 4 6 10 32 2 2 4 6 10 32 2 2 4 6 10 32 2 2 4 6 10 32 2 2 4 6 10 3

22.8 22.8 22.8 22.8 65.4 84.6 22.8 15 15 15 15 120 200 1515 15 15 15 120 200 15

2 2 2 4 6 10 32 2 2 4 6 10 3

4322 4311 3795 8603 9143 32322 41984322 4311 3795 8603 9143 32322 41984322 4311 3795 8603 9143 32322 4198

156,052,992 155,727,891 306,940,561 196,188,827 4,223,322,292 10,144,982,567 113,138,139

ODS/ODC Kamar Operasi Med. Check Up 1,982,561 1,982,561 1,982,561 3,965,122 5,947,683 9,912,805 2,973,841 1,856,814 1,852,086 1,630,300 3,696,005 3,927,247 13,888,278 1,803,086 1,205,684 1,205,684 1,205,684 2,411,367 3,617,051 6,028,418 1,808,526 1,865,170 1,860,421 1,637,637 3,712,638 3,944,921 13,950,781 1,811,201 2,076,860 2,071,574 1,823,619 4,134,017 4,393,505 15,531,757 2,017,274

Klinik Rheumatologi

Klinik Saluran Cerna

Klinik Bedah Thorax

Klinik Kesehatan Ibu

Klinik Rheumatologi

Klinik Saluran Cerna

Klinik Bedah Thorax

Klinik Kesehatan Ibu

Page 104: Template MN contoh.xls

796,436 796,436 796,436 1,592,872 2,389,308 3,982,180 1,194,654 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 7,727,508 3,863,754 1,308,237 1,308,237 1,308,237 2,616,474 3,924,712 6,541,186 1,962,356 786,067 786,067 786,067 1,572,134 2,358,201 3,930,335 1,179,100 1,171,317 1,168,334 1,028,427 2,331,517 2,477,390 8,761,017 1,137,425 4,234,986 4,234,986 4,234,986 8,469,971 12,704,957 21,174,928 6,352,479 1,282,593 1,282,593 1,282,593 2,565,185 3,847,778 6,412,963 1,923,889 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1,506,607 1,506,607 1,506,607 3,013,213 4,519,820 7,533,033 2,259,910 310,177 310,177 310,177 620,354 930,530 1,550,884 465,265 681,077 681,077 681,077 1,362,154 2,043,231 3,405,386 1,021,616 684,666 684,666 684,666 1,369,332 2,053,998 3,423,330 1,026,999 310,282 310,282 310,282 620,564 930,846 1,551,411 465,423 1,742,296 1,742,296 1,742,296 3,484,593 5,226,889 8,711,482 2,613,445 246,529 246,529 246,529 246,529 707,150 914,753 246,529 3,995,723 3,995,723 3,995,723 3,995,723 31,965,784 53,276,306 3,995,723 2,975,014 2,975,014 2,975,014 2,975,014 23,800,110 39,666,850 2,975,014 1,517,413 1,517,413 1,517,413 3,034,826 4,552,240 7,587,066 2,276,120 318,688 318,688 318,688 637,376 956,064 1,593,440 478,032 5,063,678 5,050,790 4,446,242 10,079,320 10,711,987 37,868,625 4,918,399 3,445,473 3,436,704 3,025,352 6,858,262 7,288,747 25,766,911 3,346,621 1,699,979 1,695,652 1,492,693 3,383,832 3,596,231 12,713,263 1,651,206 46,928,080 46,884,351 44,833,059 82,612,149 152,680,131 323,404,897 55,767,886 155,452 155,452 155,452 310,905 466,357 777,261 233,178 204,382 203,861 179,449 406,823 432,277 1,528,699 198,468 187,172 187,172 187,172 374,345 561,517 935,862 280,759 222,578 222,011 195,425 443,043 470,762 1,664,800 216,138 306,142 305,363 268,813 609,379 647,629 2,289,476 297,358 174,769 174,769 174,769 349,538 524,306 873,844 262,153 867,088 867,088 867,088 867,088 867,088 1,734,175 867,088 303,291 303,291 303,291 606,581 909,872 1,516,453 454,936 174,854 174,854 174,854 349,708 524,561 874,269 262,281 187,173 186,696 164,339 372,569 395,879 1,399,982 181,757 248,578 248,578 248,578 497,156 745,734 1,242,889 372,867 243,687 243,687 243,687 487,374 731,061 1,218,436 365,531 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 131,039 131,039 131,039 262,079 393,118 655,197 196,559 80,129 80,129 80,129 160,259 240,388 400,647 120,194 196,828 196,828 196,828 393,655 590,483 984,139 295,242 196,798 196,798 196,798 393,597 590,395 983,992 295,197 80,129 80,129 80,129 160,258 240,387 400,645 120,194 296,390 296,390 296,390 592,780 889,169 1,481,949 444,585 29,194 29,194 29,194 29,194 83,739 108,323 29,194 700,383 700,383 700,383 700,383 5,603,067 9,338,446 700,383 564,956 564,956 564,956 564,956 4,519,646 7,532,743 564,956

Page 105: Template MN contoh.xls

131,010 131,010 131,010 262,020 393,029 655,049 196,515 80,106 80,106 80,106 160,212 240,318 400,531 120,159 995,480 992,946 874,097 1,981,516 2,105,894 7,444,678 966,919 691,425 689,665 607,116 1,376,290 1,462,678 5,170,807 671,587 292,383 291,639 256,731 581,992 618,523 2,186,580 283,994 7,741,414 7,734,033 7,387,823 13,293,698 25,247,879 53,799,870 8,998,190 54,669,494 54,618,384 52,220,882 95,905,848 177,928,010 377,204,767 64,766,076 210,722,486 210,346,275 359,161,443 292,094,675 4,401,250,302 10,522,187,335 177,904,214

Page 106: Template MN contoh.xls

1,087,671,634 79,919,091 5,652,468,643 3,768,965,338 10,047,014,405 146,187,351 322,405,752

Hemodialisis Pel. Kes. Mas Laboratorium Radiologi Farmasi Rehab. Medik Fisio Klinik7 3 7 7 10 3 4

4,267 2,542 112,328 71,053 6,379 4,481 11,872 7 3 7 7 10 3 4

4,267 2,542 112,328 71,053 6,379 4,481 11,872 4274 2545 112335 71060 6389 4484 11876

7 3 7 7 10 3 4 1 1 1 1 3 1 1

7 3 7 7 10 3 47 3 7 7 10 3 4

4267 2542 112328 71053 6379 4481 118727 3 7 7 10 3 47 3

7 7 10 3 4

7 3 7 7 10 3 47 3 7 7 10 3 47 3 7 7 10 3 47 3 7 7 10 3 47 3 7 7 10 3 47 3 7 7 10 3 4

84.6 22.8 65.4 65.4 65.4 32.4 32.4 200 15 120 120 120 30 30200 15 120 120 120 30 30

7 3 7 7 10 3 47 3 7 7 10 3 4

4274 2545 112335 71060 6389 4484 118764274 2545 112335 71060 6389 4484 118764274 2545 112335 71060 6389 4484 11876

1,087,671,634 79,919,091 5,652,468,643 3,768,965,338 10,047,014,405 146,187,351 322,405,752

Hemodialisis Pel. Kes. Mas Laboratorium Radiologi Farmasi Rehab. Medik Fisio Klinik 6,938,963 2,973,841 6,938,963 6,938,963 9,912,805 2,973,841 3,965,122 1,834,033 1,092,597 48,280,593 30,539,856 2,741,809 1,926,014 5,102,799 4,219,893 1,808,526 4,219,893 4,219,893 6,028,418 1,808,526 2,411,367 1,842,287 1,097,514 48,497,875 30,677,298 2,754,148 1,934,682 5,125,764 2,053,794 1,222,954 53,980,569 34,146,608 3,070,119 2,154,706 5,706,799

Page 107: Template MN contoh.xls

2,787,526 1,194,654 2,787,526 2,787,526 3,982,180 1,194,654 1,592,872 3,863,754 3,863,754 3,863,754 3,863,754 11,591,262 3,863,754 3,863,754 4,578,830 1,962,356 4,578,830 4,578,830 6,541,186 1,962,356 2,616,474 2,751,234 1,179,100 2,751,234 2,751,234 3,930,335 1,179,100 1,572,134 1,156,947 689,233 30,456,411 19,265,182 1,729,591 1,214,970 3,218,953 14,822,450 6,352,479 14,822,450 14,822,450 21,174,928 6,352,479 8,469,971 4,489,074 1,923,889 - - - - - - - 10,385,577 10,385,577 14,836,539 4,450,962 5,934,616 - - - - - - - - - - - - - - - - - - - - - 5,273,123 2,259,910 5,273,123 5,273,123 7,533,033 2,259,910 3,013,213 1,085,619 465,265 1,085,619 1,085,619 1,550,884 465,265 620,354 2,383,770 1,021,616 2,383,770 2,383,770 3,405,386 1,021,616 1,362,154 2,396,331 1,026,999 2,396,331 2,396,331 3,423,330 1,026,999 1,369,332 1,085,987 465,423 1,085,987 1,085,987 1,551,411 465,423 620,564 6,098,038 2,613,445 6,098,038 6,098,038 8,711,482 2,613,445 3,484,593 914,753 246,529 707,150 707,150 707,150 350,331 350,331 53,276,306 3,995,723 31,965,784 31,965,784 31,965,784 7,991,446 7,991,446 39,666,850 2,975,014 23,800,110 23,800,110 23,800,110 5,950,028 5,950,028 5,310,946 2,276,120 5,310,946 5,310,946 7,587,066 2,276,120 3,034,826 1,115,408 478,032 1,115,408 1,115,408 1,593,440 478,032 637,376 5,007,441 2,981,735 131,612,277 83,254,270 7,485,386 5,253,478 13,913,984 3,407,208 2,028,859 89,552,810 56,648,620 5,093,274 3,574,619 9,467,478 1,681,099 1,001,029 44,184,903 27,950,142 2,512,995 1,763,699 4,671,206 180,041,665 49,196,596 578,135,932 414,052,470 195,214,050 66,506,453 106,067,510 544,083 233,178 544,083 544,083 777,261 233,178 310,905 201,874 120,263 5,314,300 3,361,557 301,794 211,999 561,671 655,103 280,759 655,103 655,103 935,862 280,759 374,345 219,847 130,971 5,787,436 3,660,839 328,663 230,873 611,677 302,742 180,271 7,957,064 5,033,418 452,554 317,617 841,217 611,691 262,153 611,691 611,691 873,844 262,153 349,538 867,088 867,088 867,088 867,088 2,601,263 867,088 867,088 1,061,517 454,936 1,061,517 1,061,517 1,516,453 454,936 606,581 611,988 262,281 611,988 611,988 874,269 262,281 349,708 184,876 110,137 4,866,836 3,078,514 276,383 194,148 514,378 870,022 372,867 870,022 870,022 1,242,889 372,867 497,156 852,905 365,531 - - - - - - - 1,975,896 1,975,896 2,822,709 846,813 1,129,084 - - - - - - - - - - - - - - - - - - - - - 458,638 196,559 458,638 458,638 655,197 196,559 262,079 280,453 120,194 280,453 280,453 400,647 120,194 160,259 688,897 295,242 688,897 688,897 984,139 295,242 393,655 688,794 295,197 688,794 688,794 983,992 295,197 393,597 280,452 120,194 280,452 280,452 400,645 120,194 160,258 1,037,364 444,585 1,037,364 1,037,364 1,481,949 444,585 592,780 108,323 29,194 83,739 83,739 83,739 41,486 41,486 9,338,446 700,383 5,603,067 5,603,067 5,603,067 1,400,767 1,400,767 7,532,743 564,956 4,519,646 4,519,646 4,519,646 1,129,911 1,129,911

Page 108: Template MN contoh.xls

458,534 196,515 458,534 458,534 655,049 196,515 262,020 280,371 120,159 280,371 280,371 400,531 120,159 160,212 984,424 586,186 25,873,954 16,367,144 1,471,569 1,032,793 2,735,381 683,746 407,144 17,971,122 11,368,033 1,022,099 717,341 1,899,898 289,136 172,169 7,599,451 4,807,201 432,215 303,342 803,410 30,094,057 7,889,110 96,947,508 69,254,050 32,098,428 10,948,995 17,409,058 210,135,722 57,085,706 675,083,440 483,306,520 227,312,478 77,455,448 123,476,568 1,297,807,357 137,004,797 6,327,552,083 4,252,271,858 10,274,326,882 223,642,799 445,882,320

Page 109: Template MN contoh.xls

2,700,013,408 597,338,383 2,234,081,049 3,110,480,873 2,444,269,370 995,949,079 6,403,829,394

Gizi (Dapur) Rekam Medik Anggrek Mawar Melati Seruni (VK)14 15 17 17 17 14 17

- 271,038 11,570 12,400 15,730 11,570 3,165 14 15 17 17 17 14 17

- 271,038 11,570 12,400 15,730 11,570 3,165 14 271053 5013 4893 5217 2660 261714 15 17 17 17 14 17

1 12 1 1 1 1 1 14 15 17 17 17 14 1714 15 17 17 17 14 17

0 271038 16566 17276 20930 14216 576514 15

14 1517 17 17 14 1717 17 17 14 17

14 15 17 17 17 14 1714 15 17 17 17 14 1714 15 17 17 17 14 1714 15 17 17 17 14 1714 15 17 17 17 14 1714 15 17 17 17 14 17

84.6 56.4 17,519.0 18,764.0 23,764.0 17,415.0 4,868.0 200 90 750 750 800 100 400200 90 750 750 800 100 400

14 15 17 17 17 14 1714 15 17 17 17 14 1714 271053 5013 4893 5217 2660 261714 271053 5013 4893 5217 2660 261714 271053 5013 4893 5217 2660 2617

2,700,013,408 597,338,383 2,234,081,049 3,110,480,873 2,444,269,370 995,949,079 6,403,829,394

Gizi (Dapur) Rekam Medik Anggrek Mawar Melati Seruni (VK) 13,877,926 14,869,207 16,851,768 16,851,768 16,851,768 13,877,926 16,851,768 - 116,497,004 4,972,994 5,329,743 6,761,037 4,972,994 1,360,374 8,439,786 9,042,628 10,248,311 10,248,311 10,248,311 8,439,786 10,248,311 - 117,021,286 4,995,374 5,353,729 6,791,464 4,995,374 1,366,496 6,727 130,249,658 2,408,907 2,351,243 2,506,936 1,278,215 1,257,552

Seruni (KM. Bayi)

Seruni (KM. Bayi)

Page 110: Template MN contoh.xls

5,575,052 5,973,270 6,769,706 6,769,706 6,769,706 5,575,052 6,769,706 3,863,754 46,365,048 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 9,157,660 9,811,779 11,120,016 11,120,016 11,120,016 9,157,660 11,120,016 5,502,468 5,895,502 6,681,569 6,681,569 6,681,569 5,502,468 6,681,569 - 73,488,755 4,491,675 4,684,184 5,674,922 3,854,501 1,563,112 29,644,900 31,762,393 - - - - - - - - - - - - 20,771,155 22,254,809 - - - - - - - 43,862,170 43,862,170 43,862,170 36,121,787 43,862,170 - - 18,557,436 18,557,436 18,557,436 15,282,594 18,557,436 - - - - - - - 10,546,246 11,299,549 12,806,156 12,806,156 12,806,156 10,546,246 12,806,156 2,171,238 2,326,326 2,636,503 2,636,503 2,636,503 2,171,238 2,636,503 4,767,540 5,108,079 5,789,156 5,789,156 5,789,156 4,767,540 5,789,156 4,792,662 5,134,995 5,819,661 5,819,661 5,819,661 4,792,662 5,819,661 2,171,975 2,327,116 2,637,398 2,637,398 2,637,398 2,171,975 2,637,398 12,196,075 13,067,224 14,809,520 14,809,520 14,809,520 12,196,075 14,809,520 914,753 609,836 189,427,454 202,889,248 256,952,680 188,302,934 52,636,158 53,276,306 23,974,338 199,786,147 199,786,147 213,105,224 26,638,153 106,552,612 39,666,850 17,850,083 148,750,688 148,750,688 158,667,401 19,833,425 79,333,700 10,621,892 11,380,599 12,898,012 12,898,012 12,898,012 10,621,892 12,898,012 2,230,816 2,390,160 2,708,848 2,708,848 2,708,848 2,230,816 2,708,848 16,402 317,567,120 5,873,257 5,732,665 6,112,265 3,116,470 3,066,091 11,161 216,081,879 3,996,335 3,900,671 4,158,962 2,120,537 2,086,257 5,507 106,613,705 1,971,771 1,924,571 2,052,011 1,046,262 1,029,349 240,228,853 1,318,962,343 744,734,587 758,762,873 840,842,885 403,478,337 428,311,684 1,088,166 1,165,892 1,321,344 1,321,344 1,321,344 1,088,166 1,321,344 - 12,822,958 547,383 586,651 744,195 547,383 149,738 1,310,207 1,403,793 1,590,966 1,590,966 1,590,966 1,310,207 1,590,966 - 13,964,596 596,117 638,881 810,451 596,117 163,069 992 19,199,592 355,088 346,588 369,538 188,417 185,371 1,223,381 1,310,766 1,485,535 1,485,535 1,485,535 1,223,381 1,485,535 867,088 10,405,052 867,088 867,088 867,088 867,088 867,088 2,123,034 2,274,679 2,577,969 2,577,969 2,577,969 2,123,034 2,577,969 1,223,976 1,311,403 1,486,257 1,486,257 1,486,257 1,223,976 1,486,257 - 11,743,265 717,755 748,517 906,834 615,937 249,780 1,740,045 1,864,334 - - - - - - - - - - - - 3,951,793 4,234,064 - - - - - - - 2,579,567 2,579,567 2,579,567 2,124,349 2,579,567 - - 3,607,087 3,607,087 3,607,087 2,970,542 3,607,087 - - - - - - - 917,275 982,795 1,113,834 1,113,834 1,113,834 917,275 1,113,834 560,906 600,970 681,100 681,100 681,100 560,906 681,100 1,377,794 1,476,208 1,673,036 1,673,036 1,673,036 1,377,794 1,673,036 1,377,588 1,475,987 1,672,786 1,672,786 1,672,786 1,377,588 1,672,786 560,904 600,968 681,097 681,097 681,097 560,904 681,097 2,074,729 2,222,924 2,519,313 2,519,313 2,519,313 2,074,729 2,519,313 108,323 72,216 22,431,630 24,025,749 30,427,836 22,298,467 6,233,071 9,338,446 4,202,301 35,019,171 35,019,171 37,353,783 4,669,223 18,676,891 7,532,743 3,389,734 28,247,787 28,247,787 30,130,973 3,766,372 15,065,486

Page 111: Template MN contoh.xls

917,068 982,573 1,113,583 1,113,583 1,113,583 917,068 1,113,583 560,743 600,796 680,902 680,902 680,902 560,743 680,902 3,225 62,431,235 1,154,637 1,126,997 1,201,624 612,674 602,770 2,240 43,362,501 801,969 782,772 834,605 425,541 418,662 947 18,336,706 339,129 331,011 352,929 179,949 177,040 38,861,611 222,438,308 115,862,129 117,505,588 128,784,231 55,177,828 67,573,342 279,090,464 1,541,400,652 860,596,716 876,268,461 969,627,116 458,656,166 495,885,027 2,979,103,872 2,138,739,034 3,094,677,766 3,986,749,334 3,413,896,486 1,454,605,245 6,899,714,420

Page 112: Template MN contoh.xls

2,267,701,561 1,953,445,958 1,199,055,997 1,052,676,627 461,214,716 434,622,695 248,120,337

Soka ICU NICU/PICU Intermediate RRI Home Care17 15 15 14 14 6 4

11,854 3,405 2,987 3,542 2,431 6,509 - 17 15 15 14 14 6 4

11,854 3,405 2,987 3,542 2,431 6,509 - 5178 2615 1315 1964 1250 6515 4

17 15 15 14 14 6 4 1 1 1 1 1 2 1

17 15 15 14 14 6 417 15 15 14 14 6 4

17015 6005 4287 5492 3667 6509

17 15 15 14 14 6

17 15 15 14 14 617 15 15 14 14 6 417 15 15 14 14 6 417 15 15 14 14 6 417 15 15 14 14 6 417 15 15 14 14 6 417 15 15 14 14 6 4

17,950.0 5,228.0 4,565.0 5,417.0 3,731.0 37.8 - 800 400 200 300 200 40 300800 400 200 300 200 40 300

17 15 15 14 14 6 417 15 15 14 14 6 4

5178 2615 1315 1964 1250 6515 45178 2615 1315 1964 1250 6515 45178 2615 1315 1964 1250 6515 4

2,267,701,561 1,953,445,958 1,199,055,997 1,052,676,627 461,214,716 434,622,695 248,120,337

Soka ICU NICU/PICU Intermediate RRI Home Care 16,851,768 14,869,207 14,869,207 13,877,926 13,877,926 5,947,683 3,965,122 5,095,062 1,463,530 1,283,866 1,522,415 1,044,887 2,797,685 - 10,248,311 9,042,628 9,042,628 8,439,786 8,439,786 3,617,051 2,411,367 5,117,992 1,470,117 1,289,644 1,529,267 1,049,590 2,810,276 - 2,488,195 1,256,591 631,900 943,765 600,665 3,130,666 1,922

Pelayanan Pendidikan

Pelayanan Pendidikan

Page 113: Template MN contoh.xls

6,769,706 5,973,270 5,973,270 5,575,052 5,575,052 2,389,308 1,592,872 3,863,754 3,863,754 3,863,754 3,863,754 3,863,754 7,727,508 3,863,754 11,120,016 9,811,779 9,811,779 9,157,660 9,157,660 3,924,712 2,616,474 6,681,569 5,895,502 5,895,502 5,502,468 5,502,468 2,358,201 1,572,134 4,613,416 1,628,185 1,162,369 1,489,091 994,264 1,764,839 - - - - - - - - - - - - - - - - - - - - - - 43,862,170 38,701,915 38,701,915 36,121,787 36,121,787 15,480,766 - - - - - - - - 18,911,647 16,686,747 16,686,747 15,574,298 15,574,298 6,674,699 - 12,806,156 11,299,549 11,299,549 10,546,246 10,546,246 4,519,820 3,013,213 2,636,503 2,326,326 2,326,326 2,171,238 2,171,238 930,530 620,354 5,789,156 5,108,079 5,108,079 4,767,540 4,767,540 2,043,231 1,362,154 5,819,661 5,134,995 5,134,995 4,792,662 4,792,662 2,053,998 1,369,332 2,637,398 2,327,116 2,327,116 2,171,975 2,171,975 930,846 620,564 14,809,520 13,067,224 13,067,224 12,196,075 12,196,075 5,226,889 3,484,593 194,087,721 56,528,725 49,359,914 58,572,322 40,342,133 408,720 - 213,105,224 106,552,612 53,276,306 79,914,459 53,276,306 10,655,261 79,914,459 158,667,401 79,333,700 39,666,850 59,500,275 39,666,850 7,933,370 59,500,275 12,898,012 11,380,599 11,380,599 10,621,892 10,621,892 4,552,240 3,034,826 2,708,848 2,390,160 2,390,160 2,230,816 2,230,816 956,064 637,376 6,066,572 3,063,748 1,540,661 2,301,033 1,464,507 7,633,008 4,686 4,127,872 2,084,663 1,048,310 1,565,689 996,493 5,193,720 3,189 2,036,671 1,028,562 517,231 772,503 491,664 2,562,555 1,573 773,820,321 412,289,282 307,655,900 355,721,996 287,538,535 114,223,646 169,590,241 1,321,344 1,165,892 1,165,892 1,088,166 1,088,166 466,357 310,905 560,819 161,092 141,317 167,574 115,012 307,944 - 1,590,966 1,403,793 1,403,793 1,310,207 1,310,207 561,517 374,345 610,749 175,435 153,898 182,493 125,252 335,361 - 366,775 185,229 93,146 139,117 88,542 461,479 283 1,485,535 1,310,766 1,310,766 1,223,381 1,223,381 524,306 349,538 867,088 867,088 867,088 867,088 867,088 1,734,175 867,088 2,577,969 2,274,679 2,274,679 2,123,034 2,123,034 909,872 606,581 1,486,257 1,311,403 1,311,403 1,223,976 1,223,976 524,561 349,708 737,209 260,179 185,743 237,952 158,880 282,015 - - - - - - - - - - - - - - - - - - - - - - 2,579,567 2,276,089 2,276,089 2,124,349 2,124,349 910,435 - - - - - - - - 3,651,619 3,222,017 3,222,017 3,007,216 3,007,216 1,288,807 - 1,113,834 982,795 982,795 917,275 917,275 393,118 262,079 681,100 600,970 600,970 560,906 560,906 240,388 160,259 1,673,036 1,476,208 1,476,208 1,377,794 1,377,794 590,483 393,655 1,672,786 1,475,987 1,475,987 1,377,588 1,377,588 590,395 393,597 681,097 600,968 600,968 560,904 560,904 240,387 160,258 2,519,313 2,222,924 2,222,924 2,074,729 2,074,729 889,169 592,780 22,983,490 6,694,021 5,845,105 6,936,020 4,777,237 48,400 - 37,353,783 18,676,891 9,338,446 14,007,668 9,338,446 1,867,689 14,007,668 30,130,973 15,065,486 7,532,743 11,299,115 7,532,743 1,506,549 11,299,115

Page 114: Template MN contoh.xls

1,113,583 982,573 982,573 917,068 917,068 393,029 262,020 680,902 600,796 600,796 560,743 560,743 240,318 160,212 1,192,641 602,309 302,882 452,365 287,911 1,500,590 921 828,366 418,342 210,371 314,197 199,972 1,042,256 640 350,291 176,904 88,960 132,864 84,562 440,739 271 120,811,091 65,190,837 46,667,557 55,183,789 44,022,980 18,290,342 30,551,921 894,631,412 477,480,119 354,323,457 410,905,785 331,561,515 132,513,989 200,142,162 3,162,332,973 2,430,926,077 1,553,379,455 1,463,582,412 792,776,230 567,136,684 448,262,499

Page 115: Template MN contoh.xls

85,170,043,692

565 787,705 561 787,705 742,177 563 113 561 563 820,270 201 139 60 165 82 81 565 565 563 563 565 559 121,373 7,832 7,832 565 565 742,167 742,172 742,177

85,170,043,692

Total 560,073,462 338,569,767 338,194,274 340,093,462 356,639,846

Total Dasar Alokasi

Page 116: Template MN contoh.xls

224,196,736 436,604,198 366,960,534 221,277,836 222,406,529 425,616,060 89,140,183 89,019,235 425,721,060 89,512,338 90,108,436 425,616,349 87,624,955 191,723,220 192,733,473 87,654,702 486,971,864 1,312,370,353 2,086,300,142 1,553,353,854 428,669,224 90,029,361 869,526,760 591,655,212 291,921,653 13,310,285,078 28,447,762 37,266,761 34,252,552 40,584,648 52,557,071 31,982,685 53,759,434 55,502,164 31,998,239 35,539,844 24,733,497 16,936,255 16,936,255 24,733,497 17,398,890 17,398,890 23,980,193 14,663,674 36,019,477 36,014,094 14,663,621 54,239,334 154,434,966 333,149,049 268,730,613

Page 117: Template MN contoh.xls

23,974,790 14,659,419 170,899,613 118,700,754 50,195,003 1,834,353,045 13,310,285,078 85,170,043,692