LAPORAN PTM BULAN AGUSTUS 2022

USIA
NO NAMA PENYAKIT KODE ICD X L/B 15-19 20-44
L P L P
L
1 HT I10
B
L
2 DM E119
B
L
3 JANTUNG KORONER I 25
B
L
4 GAGAL JANTUNG I 50
B
L
5 OBESITAS E 66
B
L
6 TIROID E03 / E07
B
L
7 STROKE I 63
B
L
8 ASMA B J45.9
B
L
9 SLE M329
B
L
10 THALASEMIA D56.9
B
L
11 PPOK J44.9
B
L
12 OSTEOPOROSIS M81
B
L
13 GAGAL GINJAL N18
B
L
14 TU. MAMAE D24.9
B
L
15 RETINO BLASTOMA C69.21
B
L
16 LEUKIMIA C95.9
B
L
17 CA. CERVIC C53
B
L
18 CEDERA AKIBAT LAIN S-T
B
USIA PRODUKTIF L
19
15-59 P
 LAPORAN PTM
NO NAMA PASIEN DIAGNOSA L/B TTL UMUR ALAMAT L/P 1 2 3 4 5 6 7 8 9 10 11 12

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
1. ANDRIYANI I10 SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
2. SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
3. SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
4. SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:

TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL: TGL:
TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD: TD:
SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC: SC:
RUANGAN :
BULAN:
NO KARTU
NO TANGGAL NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA
BPJS/KTP

1 00019300662551 M. FIKRI SAIFA 12/09/1998 L I10

2 000192584443 NURLINDA 25/06/1981 P I10
3 0001481243932 M. IMAM SAFI'I 24/05/1997 L I10
4 0001925282867 SUARNI 10/02/1987 P I10
5 647202020880005 DARMANSYAH 02/08/1980 L E11.6 + I10
6 0000902934472 SITI HAMIDAH 29/04/1977 P I10
7 0001066417266 YANA GUCI 31/11/1984 P E11
8 0000902493279 SRI HARTATI 8/28/1978 P I10
9 0003019661403 HENNY ABDUL 14/08/1978 P I10
10 0000902475055 SUNIAH 15/08/1977 P I10
11 0002001392098 HELEN FINARIS 12/05/1982 P I10
12 0000901121409 SUROSO 01/06/1984 L I10
13 0000903244173 SUSANTI 01/07/1992 P E11.9
14 0001925252594 JUMAINAH 28/08/1983 P I10
15 0000903243521 SUWARTI 7/2/1983 P I10
16 0002930045229 NUR HIJRAH 12/02/1982 P I10 + E11.9
17 0002446434977 HERMAN 03/03/1983 L I10
18 0001768840795 YUSUF 08/12/1989 L I10
 PEMERIKSAAN
NO HP ALAMAT PEKERJAAN SADANIS HASIL IVA
TD TB BB LP
JL. BIOLA 168/101 161 84 -
JL.. KEMAKMURAN 180/85 153 70 IRT
JL. OTISTA RT.15 172/119 182 132 MAHASISWA
JL. ELANG RT.06 171/116 151 64 IRT
JL. BIAWAN RT.9 148/95 160 135 -
JL. OTISTA RT.24 159/89 158 54 JUALAN
JL. DAMAI RT.28 116/78 155 64 SATPAM
JL. KAKAP 144/86 146 56 IRT
JL. GURAMI 164/115 146 61 IRT
JL. MASALATI 171/102 150 72 BURUH CUCI
JL. S. ALIMUDDIN 149/99 148 69 IRT
JL. BIAWAN 152/92 179 92 -
JL. BIAWAN RT.8 141/91 154 50 -
JL. JELAWAT RT.04 164/109 149 64 IRT
JL. DAMAI 135/99 159 66 IRT
JL. LUMBA-LUMBA 178/106 147 61 IRT
JL. OTISTA RT.02 156/90 172 84 -
JL. OTISTA 156/101 169 78 -
RUANGAN :
BULAN:
NO KARTU
NO TANGGAL NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA
BPJS/KTP

19 000575597193 MUJIONO 10/20/1979 L E11.9

20 0001772581509 TOTOK SUYANTO 6/19/1979 L I10
21 0000903633344 SUPRIATI 3/26/1979 P I10 + E11.9
22 0000903632736 SURIJO 12/8/1977 L I10
23 0003002237515 JUMNANI 1/8/1979 L I10
24 0000903633344 SUMIATI 4/26/1977 P I10 + E11
25 6402045804861001 UMINATUS SARAH 18/04/1986 P I10
26 0002294440964 WIJI LESTARI 4/19/1984 P E11
27 647204206850003 AULIA RAHMAN 6/12/1985 L E11 + I10
28 0001066434524 SISKA FITRIA 3/30/1993 P E11 + I10
29 0002216755282 YAYUK ASTUTI 5/23/1979 P I10
30 0001442590176 ROSDIANA 7/14/1981 P I10
31 0000901691047 RAHMADI 5/28/1977 L I10
32 0003002237515 JUMRIANI 1/8/1979 P I10
33 0002524068494 DEDI DARMADI 5/15/1985 L I10 + E11.9
34 000192533932 INAWATI 3/3/1977 P I10
35 0002292309652 AHMAD SYAFI'I 11/15/1991 L I10
36 0002241236541 M. NIZAR 8/5/1978 L E11.9

37 0001942196051 YASMINING 12/19/1979 P I10 + E119

38 0001730173454 NGATNI 5/21/1982 P I10

39 0002175805135 ARBAINAH 8/23/1977 P I10

40 000115638103 FATIMAH 1/16/1978 P E11.5

41 0000903218332 SUNARTI 7/7/1977 P I10

42 0001925305547 KHALID 11/11/1994 L E11.9 + I10

43 0000902087818 YULI ASTUTI 8/15/1979 P E11 + I10

44 0002294441368 WIJI LESTARI 4/19/1984 P E11

45 6472045605810012 RAMADANIAH 5/16/1981 P E11.9

46 0000907472794 RINA ASTUTI 21/05/1978 P I10

47 0001791883349 PAUZIAH 10/16/1978 P I10
48 0002234077503 HILDAWATI 5/15/1980 P I10
49 0000902465673 TIARA SUCI R 10/30/2003 P I10
50 0002068728895 ELI FUJIATI 5/7/1977 P I10
51 647204500980 AISYAH 9/10/1980 P I10
52 0001441567437 HENDRA ASRANI 1/10/1991 L I10 + E11
53 0002078677247 ARDIANSYAH 8/1/1983 L I10
54 0002081945924 MURNI 10/1/1981 P I10
55 0002294040868 MARSINTEN 8/27/1978 P I10
56 0001925244966 TRI INDAH H 10/5/1983 P I10
57 0000902133685 JULIANTI 7/25/1987 P I10
58 0001621747963 ANDRYANTO 10/9/1988 L I10

59 6472082807870002 ISMIATI 10/08/1978 P v I10

60 0002872038695 M. ARJUN 14/09/2002 L v I10

61 0002229991097 HENDRA 12/11/1986 L v I10

62 0001153081899 MUNGIN 12/09/1978 L v E11.9
0001066412103 LA TONI R 4/20/1984 L v I10
0002524651626 SUCI SRI SUGIANTI 28/10/92 P v E11.6
0001792364714 RAHMAWATI 04/09/1995 P v I10
0001925249196 SUBADIAH 29/08/1985 P v I10
0000901121409 SUROSO 01/06/1984 L I10
0001925282867 SUARNI 10/02/1987 P I10
0002498272244 SUNARSIH 05/03/1979 P v I10
0000902531171 MARITA 09/10/77 P v E11
0000903021186 NOPIANSYAH 07/09/98 L v E11.9
000200259944 HESTY HANDAYANI 18/09/83 P v I10
0000902751243 RINDA ANTIKA 01/09/88 P v I10
0001925249883 FITRI HARTATY 09/07/1975 P v I10
0001922961341 HERRY YUDHISTIRA 10/3/81 L v E11.6
6408016408770002 DEVI SILVIANTI 24/08/77 P v I10
0000902884566 MUSTIAH 27/3/92 P v E11
0001545848278 ARBAINAH (2) 01/01/85 P v I10
0001447990334 SITI NUR H 24/12/79 P v I10
0000902120949 BAHTIAR DAMRI 26/07/87 L I10
0002210473359 NURBAYAH 14/12/1985 P I10
000237274738 WIDIAWATI 08/11/1985 P v I10
0000902353149 DEDE SUMARNI 08/08/1983 P v I10
0001446726137 HENI MULYAWATI 08/03/78 P v I10
0002081245004 RUSMIATI 12/11/77 P v I10
0001925267681 WIRDAN 31/01/1987 L v i10
0000902913208 HERI NURCAHYO 04/08/1979 L v I10
0002001395103 ALFIANUR 12/04/1990 L v E11.5
0001066411495 PURWANTO 30/07/1982 L v I10
0002094251297 HALIMAH 07/07/1977 P v I10
 PEMERIKSAAN
NO HP ALAMAT PEKERJAAN SADANIS HASIL IVA
TD TB BB LP
JL. JELAWAT RT.05 111/80 167 58 -
JL. M.A SALEH 130/80 169 87 SATPAM
JL. S. SALAM 195/95 155 70 IRT
JL. S. SALAM 148/105 163 70 BURUH
JL. OTISTA 148/109 156 47 -
JL. S. SALAM 168/92 152 72 JUALAN MAKANAN

JL.JELAWAT 153/94 150 48 IRT

JL. OTISTA 150/83 159 57 BURUH
JL. LAMBUNG M 137/81 161 69 PEDAGANG
JL. PM NOOR 164/100 155 102 IRT
JL. BIAWAN 176/100 154 73 -
JL. S.SALAM 172/90 158 65 IRT
JL.JELAWAT 168/90 159 57 -
JL. OTISTA 165/103 156 47 IRT
JL. BIAWAN 130/84 144 43 SATPAM
JL. MUSO SALIM 127/92 154 77 JUAL AYAM
JL. BIAWAN 163/121 167 91 SUPIR
JL. JELAWAT 136/98 157 85 -

JL. BIAWAN RT 8 169/94 154 76 TUKANG MASAK

JL.JELAWAT 124/83 152 65 PEMULUNG

JL. JELAWAT 182/95 151 63 IRT
JL. DAMAI RT26 152/91 58 IRT
JL. ABD. MUTHALIB 162/98 154 57 IRT
JL. KEMAKMURAN 169/103 172 103 -
JL.M. A SALEH 128/85 150 85 PENJUAL KUE
JL. OTISTA 144/87 154 37 IRT
JL. JELAWAT 108/75 140 65 IRT

JL. PERJUANGAN 106/82 161 89 IRT

JL.JELAWAT 131/92 150 56 JUALAN ES
JL. OTISTA 171/102 140 51 IRT
JL. S. SALIM 180/110 146 55 -
 JL. SAMBUTAN 156/96 155 73 IRT
JL. JELAWAT 189/111 150 56 IRT
JL. JELAWAT 208/141 150 60 -
JL. OTISTA 147/90 160 90 -
JL. S. SALAM 152/96 156 68 IRT
JL. SEI KAPUAS 130/90 146 55 KARY R.MAKAN
JL.DAMAI 216/119 160 79 IRT
JL. A.R HAKIM 175/87 160 69 IRT
JL.OTISTA 144/85 166 96 KEPALA GUDANG

JL. LAMBUNG M 152/98 155 86 IRT

082158215590 JL. S. ALIMUDDIN 152/90 168 63 -

JL. LUMBA-LUMBA 126/89 158 58 KULI

JL. OTISTA 146/88 168 67.5 -
JL.OTISTA 140/81 163 79.9 GURU
85392027389 JL.JELAWAT 169/95 156 64 MAHASISWA
JL. BIAWAN 171/116 153 42 IRT
JL.S.ALIMUDDIN 130/90 154 71 STAFF ADMIN
JL. BIAWAN 152/92 179 92 -
JL. ELANG RT.06 171/116 151 64 IRT
JL. OTISTA 137/112 50 IRT
JL.OTISTA 124/97 159 57.3 IRT
JL. OTISTA RT24 114/78 148 73.6 JAGA STAND
JL.JELAWAT 176/100 158 58 IRT
JL. JELAWAT 148/92 150 54 IRT
JL. OTISTA RT 21 110/80 152 63
JL. L. MANGKURAT 146/98 175 90
JL. JELAWAT 152/110 151 54 KARY R.MKN
JL.KAKAP 118/91 155 90
JL.JELAWAT 160/94 158 65 SATPAM
JL.OTISTA 152/103 149 53 JUALAN
JL.. U.BRAHIM 168/99 156 68 DRIVER
JL.S.ALIMUDDIN 150/101 150 58 IRT
JL. OTISTA 157/116 149 69 -
JL.P.SAMOSIR 167/108 156 60 -
JL.S.ALIMUDDIN 152/105 155 67 IRT
JL.KH.A SAUM 204/119 158 61 IRT
JL.M.A SALEH 177/127 166 89
JL. RUMBIA 139/100 175 71 -
JL.DAMAI 136/92 164 65 SATPAM
JL. PESUT 151/101 175 66 JUALAN
JL. JELAWAT 196/101 155 71 TOKO ROTI
249
98
148
RUANGAN : UMUM
BULAN: FEBRUARI 2022
NO KARTU
NO TANGGAL NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA NO HP
BPJS/KTP

1 0000907472794 RINA ASTUTI 21/05/1978 P I10

2 0001925282867 SUARNI 10/02/1987 P I10
3 0001791883349 PAUZIAH 10/16/1978 P I10
4 000192584443 NURLINDA 25/06/1981 P I10
5 647202020880005 DARMANSYAH 02/08/1980 L E11.6 + I10
6 0002234077503 HILDAWATI 5/15/1980 P I10
7 0000902934472 SITI HAMIDAH 29/04/1977 P I10
8 0000902465673 TIARA SUCI R 10/30/2003 P I10
9 0002068728895 ELI FUJIATI 5/7/1977 P I10
10 647204500980 AISYAH 9/10/1980 P I10
11 0001942196051 YASMINING 12/19/1979 P I10 + E119

12 0001441567437 HENDRA ASRANI 1/10/1991 L I10 + E11

13 0002078677247 ARDIANSYAH 8/1/1983 L I10
14 0002081945924 MURNI 10/1/1981 P I10
15 0002294040868 MARSINTEN 8/27/1978 P I10
16 0001925244966 TRI INDAH H 10/5/1983 P I10
17 0000902133685 JULIANTI 7/25/1987 P I10
18 000575597193 MUJIONO 10/20/1979 L E11.9
19 0001442590176 ROSDIANA 7/14/1981 P I10
20 6402045804861001 UMINATUS SARAH 18/04/1986 P I10
21 000192533932 INAWATI 3/3/1977 P I10
22 0000901691047 RAHMADI 5/28/1977 L I10
23 0002241236541 M. NIZAR 8/5/1978 L E11.9
24 0000903633344 SUPRIATI 3/26/1979 P I10 + E11.9
25 0001621747963 ANDRYANTO 10/9/1988 L I10
 PEMERIKSAAN
ALAMAT PEKERJAAN SADANIS HASIL IVA
TD TB BB LP
JL. PERJUANGAN 106/82 161 89 IRT
JL. ELANG RT.06 171/116 151 64 IRT
JL.JELAWAT 131/92 150 56 JUALAN ES
JL.. KEMAKMURAN 132/82 153 69 IRT
JL. BIAWAN RT.9 130/90 160 134 SWASTA
JL. OTISTA 171/102 140 51 IRT
JL. OTISTA RT.24 168/94 151 56 IRT
JL. S. SALIM 180/110 146 55 -
JL. SAMBUTAN 156/96 155 73 IRT
JL. JELAWAT 189/111 150 56 IRT
JL. BIAWAN RT 8 171/96 154 75 TUKANG MASAK

JL. JELAWAT 208/141 150 60 -

JL. OTISTA 147/90 160 90 -
JL. S. SALAM 152/96 156 68 IRT
JL. SEI KAPUAS 130/90 146 55 KARY R.MAKAN
JL.DAMAI 216/119 160 79 IRT
JL. A.R HAKIM 175/87 160 69 IRT
JL. JELAWAT RT.05 107/77 167 59 -
JL. S.SALAM 173/105 158 66 IRT
JL.JELAWAT 161/94 150 47 IRT
JL. MUSO SALIM 170/103 154 74 JUAL AYAM
JL.JELAWAT 158/96 159 57 -
JL. JELAWAT 117/77 157 52 -
JL. S. SALAM 199/107 155 71 IRT
JL.OTISTA 144/85 166 96 KEPALA GUDANG
RUANGAN : UMUM
BULAN: MARET 2022
NO TANGGAL NO KARTU NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA NO HP ALAMAT
BPJS/KTP

1 0002524068494 DEDI DARMADI 5/15/1985 L I10 + E11.9 JL. BIAWAN

2 0000901121409 SUROSO 01/06/1984 L I10 JL. BIAWAN
3 0001925282867 SUARNI 10/02/1987 P I10 JL. ELANG RT.06
4 0001942196051 YASMINING 12/19/1979 P I10 + E119 JL. BIAWAN RT 8

5 0000902493279 SRI HARTATI 8/28/1978 P I10 JL. KAKAP

6 6402045804861001 UMINATUS SARAH 18/04/1986 P I10 JL.JELAWAT
7 0000901691047 RAHMADI 5/28/1977 L I10 JL.JELAWAT
8 0002216755282 YAYUK ASTUTI 5/23/1979 P I10 JL. BIAWAN
9 0001925305547 KHALID 11/11/1994 L E11.9 + I10 JL. KEMAKMURAN

10 0000903633344 SUPRIATI 3/26/1979 P I10 + E11.9 JL. S. SALAM

11 0000902087818 YULI ASTUTI 8/15/1979 P E11 + I10 JL.M. A SALEH

12 0001730173454 NGATNI 5/21/1982 P I10 JL.JELAWAT

13 0002175805135 ARBAINAH 8/23/1977 P I10 JL. JELAWAT

14 000115638103 FATIMAH 1/16/1978 P E11.5 JL. DAMAI RT26

15 0000903218332 SUNARTI 7/7/1977 P I10 JL. ABD. MUTHALIB

16 0002294441368 WIJI LESTARI 4/19/1984 P E11 JL. OTISTA

17 6472045605810012 RAMADANIAH 5/16/1981 P E11.9 JL. JELAWAT

18
 PEMERIKSAAN
PEKERJAAN SADANIS HASIL IVA
TD TB BB LP
130/84 144 43 SATPAM
152/92 179 92 -
171/116 151 64 IRT
169/94 154 76 TUKANG MASAK

144/86 146 56 IRT

153/94 150 48 IRT
168/90 159 57 -
160/89 154 71.3 IRT
169/103 172 103 -

172/93 155 71 IRT

128/85 150 85 PENJUAL KUE
124/83 152 65 PEMULUNG
182/95 151 63 IRT
152/91 58 IRT
162/98 154 57 IRT
144/87 154 37 IRT
108/75 140 65 IRT
RUANGAN : UMUM
BULAN: APRIL 2022
NO KARTU PEMERIKSAAN
NO TANGGAL NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA NO HP ALAMAT PEKERJAAN SADANIS HASIL IVA
BPJS/KTP TD TB BB LP
1 01/04/22 000192533932 INAWATI 3/3/1977 P v I10 JL. MUSO SALIM 154/94 154 70 JUAL AYAM
2 04/4/22 0001925282867 SUARNI 10/02/1987 P v I10 JL. ELANG RT.06 144/70 151 63 IRT
3 04/4/23 6472082807870002 ISMIATI 10/08/1978 P v I10 JL. LAMBUNG M 152/98 155 86 IRT
4 05/4/22 0002872038695 M. ARJUN 14/09/2002 L v I10 082158215590 JL. S. ALIMUDDIN 152/90 168 63 -

5 07/04/22 0002229991097 HENDRA 12/11/1986 L v I10 JL. LUMBA-LUMBA 126/89 158 58 KULI
6 13/04/22 0001942196051 YASMINING 12/19/1979 P I10 + E119 JL. BIAWAN RT 8 166/93 154 78 TUKANG MASAK

7 13/04/22 0001153081899 MUNGIN 12/09/1978 L v E11.9 JL. OTISTA 146/88 168 67.5 -
8 16/04/22 000575597193 MUJIONO 10/20/1979 L E11.9 JL. JELAWAT RT.05 104/67 167 57 BURUH
9 18/04/22 0001066412103 LA TONI R 4/20/1984 L v I10 JL.OTISTA 140/81 163 79.9 GURU
10 18/04/23 0002524651626 SUCI SRI SUGIANTI 28/10/92 P v E11.6 85392027389 JL.JELAWAT 169/95 156 64 MAHASISWA
11 19/04/24 0002294040868 MARSINTEN 8/27/1978 P I10 JL. SEI KAPUAS 167/98 146 55 KARY R.MAKAN
12 20/04/22 0001442590176 ROSDIANA 7/14/1981 P I10 JL. S.SALAM 157/105 158 65 IRT
13 21/04/23 0001792364714 RAHMAWATI 04/09/1995 P v I10 JL. BIAWAN 171/116 153 42 IRT
14 23/04/24 6402045804861001 UMINATUS SARAH 18/04/1986 P I10 JL.JELAWAT 148/84 150 46 IRT
15 25/04/25 0000901691047 RAHMADI 5/28/1977 L I10 JL.JELAWAT 164/91 159 55 -
16 25/04/26 0001925249196 SUBADIAH 29/08/1985 P v I10 JL.S.ALIMUDDIN 130/90 154 71 STAFF ADMIN
17 26/04/27 0000903633344 SUPRIATI 3/26/1979 P I10 + E11.9 JL. S. SALAM 198/105 155 70 IRT
RUANGAN : UMUM
BULAN: MEI 2022
NO KARTU
NO TANGGAL NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA
BPJS/KTP

1 05/05/22 0001791883349 PAUZIAH 16/10/1978 P v I10

2 07/05/22 0001621747963 ANDRYANTO 09/10/1988 L v I10
3 09/05/22 0000901121409 SUROSO 01/06/1984 L v I10
4 09/05/22 0001925282867 SUARNI 10/02/1987 P v I10
5 11/05/22 0002294440964 WIJI LESTARI 19/04/1984 P v E11
6 12/05/2022 0001942196051 YASMINING 19/12/1979 P v I10 + E119

7 13/05/22 0002498272244 SUNARSIH 05/03/1979 P v I10

8 14/05/22 0002216755282 YAYUK ASTUTI 23/05/1979 P v I10
9 14/05/22 0000902087818 YULI ASTUTI 15/08/1979 P v E11 + I10

10 14/05/22 0000902531171 MARITA 09/10/77 P v E11

11 14/05/22 0000903021186 NOPIANSYAH 07/09/98 L v E11.9
12 17/05/22 000200259944 HESTY HANDAYANI 18/09/83 P v I10
13 17/05/22 0000902751243 RINDA ANTIKA 01/09/88 P v I10
14 18/05/22 000575597193 MUJIONO 20/10/1979 L v E11.9
15 20/05/22 0001925249883 FITRI HARTATY 09/07/1975 P v I10
16 20/05/22 0001922961341 HERRY YUDHISTIRA 10/3/81 L v E11.6
17 20/05/22 6408016408770002 DEVI SILVIANTI 24/08/77 P v I10
18 21/05/22 0001442590176 ROSDIANA 14/07/1981 P v I10
19 21/05/22 0001925244966 TRI INDAH H 05/10/1983 P v I10
20 23/05/22 6402045804861001 UMINATUS SARAH 18/04/1986 P v I10
21 25/05/22 0000901691047 RAHMADI 28/05/1977 L v I10
22 25/05/22 0000902884566 MUSTIAH 27/3/92 P v E11
23 27/05/22 0000903633344 SUPRIATI 26/03/1979 P v I10 + E11.9
24 30/05/85 0001545848278 ARBAINAH 01/01/85 P v I10
25 31/05/22 0001925305547 KHALID 11/11/1994 L v E11.9 + I10

26 31/05/22 0001447990334 SITI NUR H 24/12/79 P v I10

 PEMERIKSAAN
NO HP ALAMAT PEKERJAAN SADANIS HASIL IVA
TD TB BB LP
JL.JELAWAT 131/92 150 56 JUALAN ES
JL.OTISTA 152/90 166 96 KEPALA GUDANG
JL. BIAWAN 148/88 179 92 -
JL. ELANG RT.06 128/97 151 64 IRT
JL. OTISTA 150/83 159 57 BURUH
JL. BIAWAN RT 8 169/103 154 78 TUKANG MASAK

JL. OTISTA 137/112 50 IRT

JL. BIAWAN 150/86 154 70 -
JL.M. A SALEH 140/85 150 87 PENJUAL KUE

JL.OTISTA 124/97 159 57.3 IRT

JL. OTISTA RT24 114/78 148 73.6 JAGA STAND
JL.JELAWAT 176/100 158 58 IRT
JL. JELAWAT 148/92 150 54 IRT
JL. JELAWAT RT.05 107/66 167 58 -
JL. OTISTA RT 21 110/80 152 63
JL. L. MANGKURAT 146/98 175 90
JL. JELAWAT 152/110 151 54 KARY R.MKN
JL. S.SALAM 149/84 158 64 IRT
JL.DAMAI 177/100 160 76 IRT
JL.JELAWAT 154/108 150 45 IRT
JL.JELAWAT 161/81 159 55 -
JL.KAKAP 118/91 155 90
JL. S. SALAM 160/93 155 73 IRT
JL.JELAWAT 160/94 158 65 SATPAM
JL. KEMAKMURAN 169/103 172 103 -

JL.OTISTA 152/103 149 53 JUALAN

GDP /GDS

GDS :105
GDP:155
GDS:376
GDP :86

GDS : 103

GDS:89

GDS:88
RUANGAN : UMUM
BULAN: JUNI 2022
NO TANGGAL NO KARTU NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA NO HP ALAMAT
BPJS/KTP

1 02/06/22 0001791883349 PAUZIAH 16/10/1978 P v I10 JL.JELAWAT

2 06/06/22 0001925282867 SUARNI 10/02/1987 P v I10 JL. ELANG RT.06
3 06/06/22 0000902120949 BAHTIAR DAMRI 26/07/87 L v I10 JL.. U.BRAHIM
4 06/06/22 0000902493279 SRI HARTATI 8/28/1978 P v I10 JL. KAKAP
5 09/06/22 0002210473359 NURBAYAH 14/12/1985 P v I10 JL.S.ALIMUDDIN
6 10/06/22 0000901121409 SUROSO 01/06/1984 L v I10 JL. BIAWAN
7 11/06/22 000237274738 WIDIAWATI 08/11/1985 P v I10 JL. OTISTA
8 13/06/22 0000903218332 SUNARTI 7/7/1977 P v I10 JL. ABD. MUTHALIB

9 13/06/22 0001730173454 NGATNI 5/21/1982 P v I10 JL.JELAWAT

10 18/06/22 0001442590176 ROSDIANA 14/07/1981 P v I10 JL. S.SALAM

11 20/06/22 0000902353149 DEDE SUMARNI 08/08/1983 P v I10 JL.P.SAMOSIR
12 21/06/22 0001446726137 HENI MULYAWATI 08/03/78 P v I10 JL.S.ALIMUDDIN
13 22/06/22 0002081245004 RUSMIATI 12/11/77 P v I10 JL.KH.A SAUM
14 22/06/22 0002446434977 HERMAN 03/03/1983 L v I10 JL. OTISTA RT.02
15 23/06/22 6402045804861001 UMINATUS SARAH 18/04/1986 P v I10 JL.JELAWAT
16 23/06/22 0001925267681 WIRDAN 31/01/1987 L v i10 JL.M.A SALEH
17 27/06/22 0000903633344 SUPRIATI 26/03/1979 P v I10 + E11.9 JL. S. SALAM
18 29/06/22 0000902913208 HERI NURCAHYO 04/08/1979 L v I10 JL. RUMBIA
19 30/06/22 0002001395103 ALFIANUR 12/04/1990 L v E11.5 JL.DAMAI
20 30/06/22 0001066411495 PURWANTO 30/07/1982 L v I10 JL. PESUT
21 30/06/22 0002094251297 HALIMAH 07/07/1977 P v I10 JL. JELAWAT
 PEMERIKSAAN
PEKERJAAN SADANIS HASIL IVA
TD TB BB LP GDP /GDS
128/84 150 69 JUALAN ES 98
144/95 151 63 IRT
168/99 156 68 DRIVER 90
150/95 146 57 IRT
150/101 150 58 IRT
126/75 179 85 -
157/116 149 69 -
148/90 154 57 IRT
127/83 152 62 PEMULUNG

134/82 158 65 IRT

167/108 156 60 -
152/105 155 67 IRT
204/119 158 61 IRT
134/88 172 78 PEDAGANG
160/87 150 45 IRT
177/127 166 89
189/97 155 70 IRT 182
139/100 175 71 -
136/92 164 65 SATPAM 249
151/101 175 66 JUALAN 98
196/101 155 71 TOKO ROTI 148
RUANGAN : UMUM
BULAN: JULI 2022
NO TANGGAL NO KARTU NAMA PASIEN TGL LAHIR L/P BARU LAMA DIAGNOSA
BPJS/KTP

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3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
 PEMERIKSAAN
NO HP ALAMAT PEKERJAAN SADANIS HASIL IVA
TD TB BB LP
GDP /GDS