06 Sentol Laok Jun 2023

DAFTAR TAGIHAN KLAIM RAWAT JALAN BPJS PONKESDES / POLINDES SE
PUSKESMAS PRAGAAN
BULAN : JUNI 2023
UMUR Lingkar
NO TANGGAL NAMA PASIEN NO. BPJS TB / BB T/N/R
L P Perut
1 03/06//2023 Maina 0000778194538 49 150/45 71 140/70/80/20
2 Sumar 0000777611621 54 150/45 72 140/80/80/20
3 Moh Noril Hakiki 0000778196709 19 158/55 70 110/80/80/20
4 Minasun 0000777665237 48 152/45 69 130/80/80/20
5 Nordin Fardian Shah 0001048790597 16 158/55 77 110/70/80/20
6 05/06//2023 Basirotul Uyni 0000778256199 15 155/48 68 110/70/80/20
7 Suhaniyah 0001048790586 36 155/49 73 120/80/80/20
8 Misnawi 0000778258146 50 155/48 68 140/70/80/20
9 Suhaina 0000778256739 46 155/48 69 130/80/80/20
10 Yuliati 0000778208308 54 154/48 74 140/80/80/20
11 M Sahrih 0000778212461 52 152/45 68 140/70/80/20
12 Surati 0000778210187 42 154/48 74 130/80/80/20
13 06/06//2023 Hasan 0000777566261 56 155/48 69 140/80/80/20
14 Sukarti 0000778249596 54 157/46 70 140/80/80/20
15 Ghafiroh 0000777655427 20 155/48 70 110/80/80/20
16 Edi Suryanto 0000778250193 41 158/55 66 130/70/80/20
17 Naemah 0000778250902 37 154/48 70 130/70/80/20
18 Sujo 0000778248538 61 155/49 70 150/70/80/20
19 Abd Ghafur 0000777562029 21 150/45 79 110/80/80/20
20 Sahtiyah 0000777568555 46 157/46 74 130/80/80/20
21 07/06//2023 Abd Mukti 0000777562964 63 158/55 76 180/90/80/20
22 Moh Ansori 0000777600843 25 158/55 71 120/70/80/20
23 Isriatin 0000777629788 50 152/45 81 140/70/80/20
24 Juhena 0000778192042 43 155/48 79 130/80/80/20
25 Matheri 0000778190602 47 155/48 76 130/80/80/20
26 Maryati 0000777587433 60 160/48 69 150/70/80/20
27 Mas Odi 0000777577961 28 152/45 71 120/70/80/20
28 Jubri 0000777606737 27 158/55 70 120/70/80/20
29 Suyinah 0000778195113 19 152/45 71 110/80/80/20
30 Kamilatus Zahrah 0000777630655 21 150/45 73 110/80/80/20
31 Jumali 0000777632387 62 152/45 69 180/90/80/20
32 Mosrifah 0000777604386 44 155/48 72 130/80/80/20
33 08/06//2023 Miskaji 0000777664067 59 154/48 73 150/70/80/20
34 Zulfa Fannani 0000778253422 19 150/45 69 110/80/80/20
35 Bustomi 0000777664686 56 158/55 72 140/80/80/20
36 Moh Tubri 0000777665384 28 158/55 70 120/70/80/20
37 Suharti 0000778184706 58 160/50 69 150/70/80/20
38 Hanik 0000777654009 14 152/45 74 110/70/80/20
39 Supandi 0000778023549 44 154/47 72 130/80/80/20
40 Sumati 0000778023584 36 154/48 71 120/80/80/20
41 09/06//2023 Lina Fitria 0000777630003 27 154/48 72 120/70/80/20
42 Misnadi 0000777599043 49 152/45 74 140/70/80/20
43 Hatiyah 0000777559138 48 150/45 71 130/80/80/20
44 Najiyah 0000778229728 15 152/45 72 110/70/80/20
45 Asmadi 0000777603857 49 152/45 74 140/70/80/20
46 Suhami 0000777573876 49 152/45 69 140/70/80/20
47 Suhra 0001048790171 63 152/45 77 180/90/80/20
48 Junasah 0000778215407 45 154/48 72 130/80/80/20
49 Suhatun 0000778215712 29 152/45 70 120/70/80/20
50 Moh Asum 0001048790182 38 157/46 69 130/70/80/20
51 Mozanni 0000778254636 52 158/55 71 140/70/80/20
52 Khalifah 0000777615131 16 154/48 67 110/70/80/20
53 10/06//2023 Muhatib 0000778197431 42 150/45 65 130/80/80/20
54 Moh Raji 0000778201784 44 152/45 70 130/80/80/20
55 Surriyah 0000777647463 55 154/48 69 140/80/80/20
56 Komariyah 0000778203483 16 155/49 68 110/70/80/20
57 Musdari 0000778215216 51 158/55 69 140/70/80/20
58 Sulaihah 0000778235681 44 158/55 67 130/80/80/20
59 Nasuha 0000777597388 61 150/45 70 180/90/80/20
60 Jahri 0000778235646 47 150/45 74 130/80/80/20
61 Romlah 0000778232261 42 155/49 70 130/80/80/20
62 Abd Salam 0000778232057 50 158/55 79 140/70/80/20
63 Kholisah 0000777653583 30 155/48 66 120/80/80/20
64 12/06//2023 Sunarpun 0001048790373 44 152/45 80 130/80/80/20
65 Abd Waris 0000778204361 26 155/49 71 120/70/80/20
66 Jumu 0000777601506 61 150/45 72 150/70/80/20
67 Misbahul Anm 0000777665575 22 155/49 65 110/80/80/20
68 Sunah 0000777577724 54 155/49 73 140/80/80/20
69 Moh Hamdani Shaleh 0000778023674 17 155/49 70 110/70/80/20
70 Busiri 0000777664642 22 150/45 74 110/80/80/20
71 13/06//2023 Suwanah 0000778198083 52 152/45 70 140/70/80/20
72 Sulaihah 0000778198116 25 155/48 75 120/70/80/20
73 Ismail 0000778197622 56 150/45 77 140/80/80/20
74 Muslimah 0000778197475 30 158/55 80 120/80/80/20
75 Sitti Subayyah 0000778197554 14 155/49 79 110/70/80/20
76 Haji Umam 0000777612745 21 155/49 72 110/80/80/20
77 Junaidi 0000777656046 53 152/45 74 140/80/80/20
78 Endawati 0000777603183 24 154/48 70 120/70/80/20
79 Ilham As Ari 0000778185922 16 152/45 81 110/70/80/20
80 Dinarso 0000778186067 59 158/55 79 150/70/80/20
81 14/06//2023 Kiswatun Hasanah 0000777566305 53 158/55 71 140/80/80/20
82 Hasan 0000777566485 42 150/45 66 130/80/80/20
83 Sapiya 0000777562391 36 152/45 75 120/80/80/20
84 Asri 0001048790294 41 158/55 72 130/70/80/20
85 Sulia 0000777562209 57 154/48 70 140/80/80/20
86 Ach Mulan 0001048790496 22 155/48 71 110/80/80/20
87 Hadirah 0000777610833 51 150/45 68 140/70/80/20
88 Satrawi 0000778230281 61 155/48 60 150/70/80/20
89 Baina 0001048790351 42 158/55 70 130/80/80/20
90 Moh Abbas 0000778226815 28 158/55 70 120/70/80/20
91 Sa'Edah 0000777557981 79 158/55 70 150/80/80/20
92 15/06//2023 Aan Sri Astutik 0000777571187 25 155/48 70 120/70/80/20
93 Apd Wahab 0000777558339 49 154/48 72 140/70/80/20
94 Ifa Anita 0000778206532 39 150/45 73 130/70/80/20
95 Kholilah 0000778217883 24 160/50 69 120/70/80/20
96 Safi'Udin 0000778193616 40 158/55 77 130/70/80/20
97 Fitriyah 0000778218761 32 158/55 71 120/80/80/20
98 Fadil 0000778227939 61 158/55 76 180/90/80/20
99 Farhatin 0001048790261 39 155/48 74 130/70/80/20
100 Hayati 0000777632409 57 155/48 60 140/80/80/20
101 16/06//2023 Hasib 0001048790507 37 154/48 72 130/70/80/20
102 Moh Ediyanto 0000778192795 22 152/45 70 110/80/80/20
103 Hamimah 0000777576824 55 157/46 69 140/80/80/20
104 Baidawi 0000778188644 44 155/49 69 130/80/80/20
105 Susmawati 0001048790384 40 158/55 79 130/70/80/20
106 Samsul Arifin 0000777632095 21 158/55 74 110/80/80/20
107 Sa Niyah 0000777633939 56 155/49 70 140/80/80/20
108 17/06//2023 Muhammad 0000778247403 51 154/48 69 140/70/80/20
109 Misnatun 0001048790452 39 152/45 72 130/70/80/20
110 Atsura 0001048790474 61 154/48 72 180/90/80/20
111 Wulqn Aulia Rahman 0000778243544 17 150/45 72 110/70/80/20
112 Maisaroh 0000778249416 29 158/55 68 120/70/80/20
113 Suparmuni 0001048790575 42 158/55 69 130/80/80/20
114 Selvi Sonia 0000778203156 21 154/48 71 110/80/80/20
115 Arsuni 0000777591077 53 158/55 70 140/80/80/20
116 Bukhari 0000777665744 54 150/45 67 140/80/80/20
117 Rofiqah 0000777666756 49 155/49 69 140/70/80/20
118 19/06//2023 Iszal Fanasani 0000777667127 20 154/48 66 110/80/80/20
119 Asmawi 0000777667162 56 150/45 72 140/80/80/20
120 Saningram 0000777635976 58 158/55 70 150/70/80/20
121 Mardiyah 0000777636854 56 155/49 72 140/80/80/20
122 Seftian Hendra 0000777623163 23 160/50 70 120/70/80/20
123 Ali 0000778238302 60 158/55 72 180/90/80/20
124 Siti Maisaroh 0000778212988 18 150/45 69 110/70/80/20
125 20/06//2023 Masduki 0000777613779 41 155/49 69 130/70/80/20
126 Sujiati 0000777614422 39 160/50 68 130/70/80/20
127 Mathari 0000777570377 48 154/48 69 130/80/80/20
128 Shaherah 0000777570671 44 152/45 66 130/80/80/20
129 Mohammad 0000777591876 26 158/55 69 120/70/80/20
130 Marsuto 0001048790553 65 157/46 69 150/80/80/20
131 Amna 0000777604959 36 158/55 76 120/80/80/20
132 Sanusih 0000778256706 53 152/45 70 140/80/80/20
133 Rofiani 0000777581201 17 160/50 68 110/70/80/20
134 21/06//2023 Hasan 0000777576789 54 154/48 70 140/80/80/20
135 Juri 0001048790248 63 158/55 70 150/80/80/20
136 Salimah 0000777663911 27 154/47 70 120/70/80/20
137 Sappa 0000777590526 57 158/55 66 140/80/80/20
138 Puzai 0000777579186 62 158/55 69 180/90/80/20
139 Monirah 0000778258214 39 158/55 76 130/70/80/20
140 Khairi 0000778258833 21 157/46 74 110/80/80/20
141 Matsihra 0000778259103 56 160/48 69 140/80/80/20
142 Hayati 0000778259474 49 152/45 77 140/70/80/20
143 Suhri 0000778260982 51 155/48 69 140/70/80/20
144 22/06//2023 Taqiah 0000778261059 42 154/48 66 130/80/80/20
145 Tahir 0000777574877 57 150/45 65 140/80/80/20
146 Liha 0000777575801 55 158/55 70 140/80/80/20
147 Rukmiati 0000777576442 30 155/49 74 120/80/80/20
148 Fais Riyad 0000778020524 36 150/45 72 120/80/80/20
149 Sariyah 0000777649814 52 152/45 70 140/70/80/20
150 Wulan Aprilia 0000777650523 17 155/48 72 110/70/80/20
151 Tolari 0000777630723 42 154/48 71 130/80/80/20
152 Saniyah 0000777606445 43 152/45 69 130/80/80/20
153 23/06//2023 Jamaluddin 0000777561772 28 154/48 80 120/70/80/20
154 Yuliana 0000778202559 40 155/48 69 130/70/80/20
155 Dhalilah Sintia Sari 0000778251363 14 150/45 72 110/70/80/20
156 Samokri 0000778212909 31 154/48 70 120/80/80/20
157 Sulhan 0000778214968 55 150/45 69 140/80/80/20
158 Suyyima 0000778238886 27 154/48 79 120/70/80/20
159 Rukaiyah 0000777557338 51 150/45 72 140/70/80/20
160 Munarsat 0000777602351 39 158/55 72 130/70/80/20
161 24/06//2023 Rifqi Firniaton 0000777598053 26 150/45 70 120/70/80/20
162 Rosidah 0000778194707 28 155/49 65 120/70/80/26
163 Rusmini 0000777667342 51 160/50 69 140/70/80/20
164 Arjeto 0000777604926 49 150/45 69 140/70/80/20
165 Jamilah 0000777617111 19 155/49 70 110/80/80/20
166 Sukarsih 0000778243195 45 158/55 71 130/80/80/20
167 Salehoddin 0000777597761 47 158/55 71 130/80/80/20
168 Subaidah 0000777637721 56 158/55 65 140/80/80/20
169 26/06//2023 Moh Rosul 0000777638237 32 154/47 77 120/80/80/20
170 Muslimah 0000777586713 52 158/55 72 140/70/80/20
171 Fahri Qirom 0000778187158 17 155/49 77 110/70/80/20
172 Atmi 0000778187632 64 150/45 70 150/80/80/20
173 Norhana 0000778199005 49 152/45 66 140/70/80/20
174 Abul Fait 0000778199815 26 155/48 77 120/70/80/20
175 Abd Kadir 0000778239584 41 155/49 71 130/70/80/20
176 Sajurah 0000778186541 40 154/48 74 130/70/80/20
177 Sudarman 0000778242745 45 150/45 70 130/80/80/20
178 Monainah 0000777607593 51 155/48 77 140/70/80/20
179 Nasuha 0000778239718 39 155/49 72 130/70/80/20
180 27/06//2023 Ashari 0000778252162 42 155/49 80 130/80/80/20
181 Musahwi 0000777649263 58 154/48 65 150/70/80/20
182 Maryam 0000778196496 40 152/45 71 130/70/80/20
183 Suya 0000777612723 53 154/48 72 140/80/80/20
184 Zendi Rohmani 0000777598367 17 152/45 69 110/70/80/20
185 Dewi Rahwiya 0000777616896 52 154/48 72 140/70/80/20
186 Fadli 0000777624579 54 154/47 71 140/80/80/20
187 Pindah Wati 0000777597816 44 155/49 68 130/80/80/20
188 Musamma 0000777646089 63 154/48 66 150/80/80/20
189 Sandi Maulana 0000777605027 16 155/49 74 110/70/80/20
190 Andri 0000777663573 36 158/55 69 120/80/80/20
191 Yusriyah 0000777571277 18 154/48 68 110/70/80/20
192 28/06//2023 Mistarum 0001048790169 67 155/48 71 150/80/80/20
193 Fathor Rahman 0000778025531 52 155/49 71 140/70/80/20
194 Mohlas Adi Noval 0000778207803 18 150/45 81 110/70/80/20
195 Sahemah 0000777654729 41 150/45 70 130/70/80/20
196 Sahom 0000777596343 67 152/45 75 150/80/80/20
197 Bubrianto 0000778231304 50 155/48 69 140/70/80/20
198 Hosniyah 0000777631318 41 154/48 72 130/70/80/20
199 Abd Hamid 0000777628473 27 155/49 80 120/70/80/20
200 30/06//2023 Jamilia 0000778244073 36 150/45 70 120/80/80/20
201 Mohammad Halil 0000777653537 43 152/45 71 130/80/80/20
202 Ansari 0000777650556 56 158/55 71 140/80/80/20
203 Norhayati 0000777650872 51 157/46 70 140/70/80/20
204 Maliyah 0000777611079 47 158/55 77 130/80/80/20
205 Sapi Uddin 0000777611351 23 154/47 70 120/70/80/20
206 Molyadi 0000778209996 44 158/55 70 130/80/80/20
207 Lailatun Naumi 0000778253883 34 152/45 70 120/80/80/20
DES SENTOL LAOK DAFTAR 10 BESAR PENYAKIT BPJS
PONKESDES / POLINDES SENTOL LAOK
PUSKESMAS PRAGAAN
BULAN : JUNI 2023
KODE DIAGNOSE TERAPI KET

NO NAMA PENYAKIT JUMLAH
M7919 Mialgia Inj3. B-12, Kalium Diklofenac 1 Sehat 107
Z008 Sehat - 2 Mialgia 31
R509 Febris Pamol tab, Amox500 3 Chepalgia 11
Z008 Sehat - 4 Febris 10
K121 Stomatitis Inj3. Diph, Vit C 5 Gastritis 9
K297 Gastritis Antasida Tab, Zink 6 Hipertensi 8
Z008 Sehat - 7 Sakit Gigi 7
Z008 Sehat - 8 Dermatitis 6
K038 Sakit Gigi Asmet, Dexa tab 9 Stomatitis 5
M7919 Mialgia Ibuprofen400, Prednison 10 Disminorhe 3
Z008 Sehat - 11 Anemis 3
Z008 Sehat - 12 Diare 2
M7919 Mialgia Inj3. B-12, Kalium Diklofenac 13 OMA 2
Z008 Sehat - 14 Asma 1
Z008 Sehat - 15 ISPA 1
Z008 Sehat - 16 Konjungtivitis 1
K297 Gastritis Antasida Tab, Zink JUMLAH 207
Z008 Sehat -
L23 Dermatitis CTM, Keto tab
Z008 Sehat -
I10 Hipertensi Amlodipin
Z008 Sehat -
M7919 Mialgia Ibuprofen400, Prednison
Z008 Sehat -
Z008 Sehat -
R51 Chepalgia Asmet, F.E
Z008 Sehat -
Z008 Sehat -
N946 Disminorhe Ibuprofen400, F.E
K121 Stomatitis Inj3. Diph, Vit C
M7919 Mialgia Inj3. B-12, Kalium Diklofenac
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
K297 Gastritis Antasida Tab, Zink
Z008 Sehat -
D649 Anemis Inj3. B-12, F.E
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
R509 Febris Pamol tab, Amox500
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
K038 Sakit Gigi Asmet, Dexa tab
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
M7919 Mialgia Ibuprofen400, B.com
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
H10 Konjungtivitis Inj3. Diph, Asmet, Kloram 250
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
A09 Diare Atapulgit, Metro 500, Oralit
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
H93 OMA CTM, Kotri Tab
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
A09 Diare Atapulgit, Metro 500, Oralit
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
J069 ISPA Pamol tab, Cefadroxil 500, Acetylcysteine
Z008 Sehat -
H93 OMA CTM, Kotri Tab
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
J459 Asma Inj3. Diph, Salbutamol, B.com
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Z008 Sehat -
Pragaan,
PELAPOR
RUZANA
NITK. 3529.219811.2020.004

06 Sentol Laok Jun 2023

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06 Sentol Laok Jun 2023

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DAFTAR TAGIHAN KLAIM RAWAT JALAN BPJS PONKESDES / POLINDES SE

KODE DIAGNOSE TERAPI KET

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