No Tgl Nama No BJPS No Reg No Indeks

1 2 3 4 5 6
1 3 HAFIT 1131855579 2229
2 3 MUH EDO FAHREZI 13106
3 3 HOLIL 15466
4 3 AMIN 689848266 17553
5 3 HUSNUL HOTIMAH 2804
6 3 NAFISAH 17552
7 3 ROFIQOTUL DINIAH 17554
8 3 MIMIN FERAWATI 17550
9 3 REHAN RIJATUL 11064
10 3 SURIYE B WASIL 17507
11 3 JUHADIO 1240
12 3 WITRIYAH 0000690720276 15592
13 4 NINING RODIYAH 17576
14 4 ABDUL GANI 07199
15 4 AMIR FAISOL 17578
16 4 MOH HELMI 17531
17 4 NADILA FERA DWIYANTI 13194
18 4 MUH HAIKAL 16735
19 4 BILQIS 15856
20 4 NAFISAH 01324
21 4 LAILA 03033
22 4 ASMAUL VADILAH 17582
23 4 KHOIRIYAH 17580
24 4 MUSRIFA 06616
25 4 DEWI PUTRI 03572
26 4 SITI KOILATUL 12774
27 4 SUMINA 0000113901164 17052
28 4 MARIA ULFA 17579
29 5 AMELIA NAFISA 17608
30 5 M SOFIANTO 729
31 5 AFIAH HOIRUN 17596
32 5 RISKITA AULYA 9860
33 5 SAIHONA 17607
34 5 SULISTIYAWATI 0000691083235 14682
35 5 SINTA AYU A 0000690620523 17322
36 5 DETY URMILA 16017
37 5 SAMI 17598
38 5 NANIK CANDRA 11847
39 5 SISKA AYU 10733
40 5 HOSNIA 02984
41 5 SRI HARTATIK 17603
42 6 M ARDAN 894
43 6 M FANGKI 3871
44 6 FARINA 13584
45 6 RISALATUL INAYAH 1759
46 6 AHMADI 17628
47 6 MELGA M.
48 6 M. NABIL
49 6 M. REVAN
50 6 M. TEGAR
51 6 JOVITA
52 6 SALSABILA
53 6 M. REGA
54 6 NOVAIL
55 6 M. SYARIF
56 6 M. REFAN
57 6 KHEISA
58 6 FIRA A.
59 6 MIRZA S.
60 6 SOFIATUL
61 6 RAMADANI
62 6 M. FADIL
63 6 GILANG K.
64 6 DEBY C.
65 6 SULTON A.
66 6 SOFIATUL
67 6 LARASASTI
68 6 M. SABILILLAH
69 6 M. RIEZKY
70 6 M. FIRDAUS
71 6 LUQMAN H.
72 6 KEMAL A.
73 6 ALIYAH S.
74 6 NADISYA M.
75 6 HOFIFAH
76 6 TATIK 17626
77 6 ADELIA 09384
78 6 AYU DWI 17616
79 6 FAISEH 11812
80 6 SUMIATI 0000690951778 17614
81 7 SAIHONA 17607
82 7 MIMIN FERAWATI 17550
83 7 ABDUL GANI 7199
84 7 KANZA MEIDINA 17634
85 7 MUZANI 1452
86 7 AMELIA 1620
87 7 HUSNUL HOTIMAH 2804
88 7 JUNAIDA 7012
89 7 SUDARWATI 16452
90 7 SILVATUL KISLIA 16454
91 9 M SAFDAN 15044
92 9 WANGI 3648
 93 9 ELOK HARDIANA 17642
94 9 ULFIYAH 16492
95 9 DEDI KURNIAWAN 17660
96 9 NUR HASANAH 17647
97 9 AHMAD WASILATUS 17638
98 9 ROFIQUL D 17554
99 9 PUTRI DWI 3899
100 9 FARHAN FARA
101 9 REGINA AULFA 17230
102 9 AURA ZHAFA 17661
103 9 M RIZKY 17726
104 9 M FATAN 17728
105 9 AMAS ASKIYA 17729
106 9 M REZA 9282
107 9 AMELIA PUTRI 17731
108 9 INESYA AZKA 17732
109 9 ALIA RISKY 17733
110 9 NAULAILA 13734
111 9 ANISA ZASKIA 17735
112 9 NIKEN AYU 17736
113 9 FAROHATUL 17737
114 9 INA YULIANTO 17738
115 9 NABILA 17723
116 9 DANISA 1147
117 9 FELY 17724
118 9 LAILA F 17725
119 9 ARDIAN 17727
120 9 M FIFI RAHMAWATI 7012
121 9 LIDIA FITRIA 17663
122 9 SAMIATUN 0001039513588 04322
123 9 MUHIBAH 17648
124 9 LIATUL HASANAH 16472
125 9 KATIMAH 17649
126 9 NIA WAHYU KUSUMA 17655
127 9 ALIYAH 17656
128 9 HOLISOH 16403
129 9 EKA SULISTIAWATI 0002201527618 17662
130 9 RATIH BUDI UTARI 17664
131 9 MILA NURDIANA 17665
132 10 NAFSI RINI 17684
133 10 NURUL 689980601 17692
134 10 ASMAWATI 690352121 17678
135 10 ELISA MAULIDA 6401
136 10 JANUAR BIMA 692100263 17682
137 10 WASILUDIN 17693
138 10 NIKO FEBRIANSYAH 17694
139 10 DIAH ERININGSIH 17695
140 10 RANIATUS SOLEHA 13385
141 10 SUHAENING 1424078471 189
142 10 SUCIATI 6003
143 10 AHMADI 17628
144 10 EKA RIZKI 0001543656071 17700
145 10 INTAN 17697
146 10 BUSANI 0000690524494 17321
147 10 SUMINA ARIYANI 0000113901164 17052
148 10 LIATUL HASANAH 14672
149 10 AMALIATUS SOLEHA 17680
150 10 RAVIS B. 17664
151 10 EKA SULISTIANI 17662
152 11 M BIMA SAKTI 03555
153 11 SURIPAH 17708
154 11 KHORIYAH 17580
155 11 RIKO PURWANTO 17711
156 11 ERVAN 17718
157 11 MUH AFIN MUSAFI 000154371612 17040
158 11 YULIS 0001543711228 17719
159 11 HOLILAH 09486
160 11 BILQIS 03893
161 12 HJ HASANAH 1049
162 12 B NISAH 1081
163 12 M DIDIK 689757221 17746
164 12 FAHRI 17750
165 12 ALMIRA 17748
166 12 ADE AYU W 689403723 10984
167 12 DESI HARUM 17753
168 12 MOH MAULANA 17754
169 12 MELDA RINJANI 3885
170 12 MUH AKBAR 17752
171 12 FERLIANA CINTIYA 17379
172 12 ARIFATUR ROHMAN 691401677 1493
173 12 NANDA SAFIRA 16188
174 13 FIRDAUSIL MAHMUDAH 12303
175 13 SITTI MA'RIFAH F 17761
176 13 MUSRIFA 690994607 6616
177 13 ABDUL QADIR 690891355 12506
178 13 TAUFIK 17765
179 13 YOYOK 1039528506 5194
180 14 RIZAL UMAR 17773
181 14 AHMADI 17628
182 16 AHMAD WASILATUS SHOLEH 17638
183 16 M RIHO 17317
184 16 FIRTRI WIDIASTIANA 0000690873974 00470
185 16 WASILATUL M 0002078993351
186 16 FEKTIAN AINUL 17793
187 16 SITI HALIMA 17794
188 16 SUKIRMAN 0000114587021 00541
189 16 LILIK FARIDA 17070
190 16 DWI RISKI 15678
191 16 ADITIA 17790
192 17 IDRIS 0001040051575 17811
193 17 HASANAH B HALIMATUS 01049
194 17 DEWI KARIMAH 17816
195 17 ZAHLUL MIQDAT 06214
196 17 HALISA RAMADAN 17817
197 17 FITRATUL HASANAH
198 17 M SULTON AZIS 07672
199 17 NABILA PUTRI 13176
200 17 SANTIKA ANDRIANI 17825
201 17 WINDASARI D 17827
202 17 ABDUL WAFI 17832
203 17 FATHOR ROSI 17833
204 17 AUREL 00723
205 17 NINDI PUTRI 17836
206 17 MUH NUFAL 17477
207 17 HAIKAL SYAHRUL 10977
208 17 MILA 691344202 2869
209 17 FALENTINA 1784
210 17 SUSI A 17822
211 17 DEVI 17826
212 17 ANI SAFITRI 14980
213 18 RIZAL UMAR 17773
214 18 AGIL SAPUTRA 17848
215 18 HILDA NUR HOIRIYAH 17850
216 19 SITI NURIL HIFADAH 17860
217 19 SITTINA 0001997701716 10341
218 19 TASYA NURUL H 09148
219 19 MULYADI 0001894733763 03845
220 19 FAHRI 15128
221 19 SITI FADILAH 15641
222 20 MOH KEFIN 0001541722498 08661
223 20 MH SULHAN FAIZI 17868
224 20 A. KHOIRIL 17869
225 21 BASTIYAN 17882
226 21 AHMADI 17628
227 21 FAREN APRILIA PUTRI 17884
228 21 FEBIANSYAH 0000690615483 00330
229 21 ARYA MISI 09585
230 23 Farah Dhita 0000689377026 14508
231 23 AHMAD MISNAWR 0000689930019 17889
232 23 MUFTI ALI 0001903639511 11246
233 23 SRINATUN
234 23 NAHRIL ILHAM 12512
235 23 HOSNIAH 0000690706124 11464
236 23 M FANGKI 03871
237 23 SENIWATI 17896
238 23 FARIDA 13584
239 23 ERI SUMANDINATA 13764
240 23 NUR LAILI 000114728488 06829
241 23 IRFAN MAULANA 0000689786684 01392
242 23 ANDINI 16404
243 23 ABDULLAH P DILA 17902
244 23 RODIYAH 17906
245 23 CIKA SALSABILA 0000690812109 16903
246 24 SOLEHA 0001541821678 15571
247 24 MUH SULHAN 0001039518022 17868
248 24 BASTIYAN 17822
249 24 AULIA NURAINI 12957
250 24 ANNISA FIRYAL
251 24 AHMAD DANIEL 02321
252 24 ATIM
253 24 SITTINA 0001997701716
254 24 VIVIN 01631
255 25 SITI FATIMAH 17926
256 25 KAMILA 17929
257 25 REHANA 0000690862904 11479
258 25 CINTA DWI CANTIKA 17931
259 25 JUALA 02749
260 25 ANNISA FIRYAL
261 25 ADIT NUROSID 08262
262 25 MOH ARIK 0000689889429 17925
263 25 YELSA 17927
264 25 HENDRA 0000690861904 17993
265 26 SELA PUTRI 16783
266 26 HANDARINI 17939
267 26 SRINATUN 17891
268 26 SA I P NABIL 16845
269 26 HABIBI 0000690103506 03106
270 26 APRILIANA PUTRI
271 26 JUMAIYA 12582
272 26 PUTRI PURNAMA SARI 17419
273 26 INA YULIATIN
274 26 ZUBAIDA
275 26 SENIWATI 17896
276 27 MUH SULHAN 0001039518022 17868
277 27 IKA ROBIATUL 0000690561268 01587
278 27 FATUR 0000691401677 1493
279 27 HASANAH B HALIMATUS 0000690601015
280 30 ANISWATI
281 30 EDIYANTO
282 30 HABIBAH 0000690001931
283 30 INDAH
284 30 HINAYATUL 01264
285 30 BASTIYAN 17822
286 30 HAZIN HAMID 15475
287 30 AHMAD MALIK SUGIARTO
288 30 MAURA AYU NIRFANA 12077
289 30 ISRAL RADIT F 17946
290 30 AULIA NURAINI 12957
291 30 ALIFIA APRIKATUL 0002092597503 17943
292 31 AHMAD SOBRI 17963
293 31 MUSTAJIB 17964
294 31 ADITIA SAPUTRA 17790
295 31 RISALATUL INAYAH 01759
296 31 TUTIK SUHAIMI 17973
297 31 ADITIA 17974
298 31 KANIA KASNA ADILA 0000694485516 16185
299 31 ZUBAIDA 17978
300
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301
302
303
304
305 1 MARSINI 13147
306 1 ALIEF SANTOSO 02653
307 1 DANIL 17994
308 1 FAHRI 15128
309 1 ARIFATUR 000069140167 01493
310 2 SENIWATI 17896
311 2 ZAHIRATUL JANNAH 18011
312 2 HAZIM HAMID 14475
313 2 M JASULI 06501
314 2 SALSABILA SALIHAH 17367
315 2 KEVIN SYAHPUTRA 18019
316 2 ARIKATUL M 0000695236386 16222
317 2 SRI AYU NINGSIH 04516
318 2 LIA YULISTARI 0000691206052 18014
319 3 WAHYU NAFISAH 01412
320 3 MARSINI 0000691279086 13147
321 3 HOLIDATUS SAFINAH 18041
322 4 HONIF 08322
323 4 FATIMAH RAHMATUS 0000690939955 06610
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#REF!
 Tempat Kerja
Umur

Lama kerja
Jen
Nama KK is Alamat Pekerjaan
Kel
Hr Bln Thn

7 8 9 10 11 12 13 14 15

HAFIT L 44 LEDOK-SIDOMUKTI WIRASWASTA 2

SUHED L 7 S AGUNG-LAPENG PELAJAR 1
M RAFLI FIRDAUS L 5 PRINGTALI-MRAWAN PELAJAR 1
AMIN L 50 NGANGKANG-KEDAWUNG TANI 2
RAHMATULLAH P 26 KLAYU-TEGAL WARU IRT 2
SUYITNO P 7 DAMSODA-T.REJO PELAJAR 1
YUDIANTO L 7 S JEDING-S PUTIH PELAJAR 1
HOLEK P 42 LAMPARAN-KERTOSARI IRT 2
SUHRI L 8 KRAJAN PELAJAR 1
SAMURI L 39 KERANGDAM IRT 2
JUHADIO L 35 PAKUSARI WIRASWASTA 2
WASIL P 34 LEDOK-SIDOMUKTI IRT 2
SLAMET P HERI P 18 GAMBIRAN-KALISAT PELAJAR 1
ABDUL GENI L 59 KLAYU-T WARU PERDAGANGAN 2
AMIR FAISOL L 44 ROWO-MRAWAN PETANI 2
MOH HILMI L 36 T GUSI-MAYANG BURUH TANI 2
ERFAN SAHAR P 15 KRAJAN-MAYANG PELAJAR 1
ALI MAKI L 6 S JEDING-SEPUTIH PELAJAR 1
SAMPURNO P 7 S JEDING-SEPUTIH PELAJAR 1
ANAM P 7 KRAJAN-MAYANG PELAJAR 1
ABDUL HALIM P 3 PANDIAN-SEPUTIH PELAJAR 1
VERI P 25 KRAJAN-MAYANG IRT 2
RIKO PURWANTO P 24 KRAJAN-MAYANG IRT 2
MAYANG P 31 KRAJAN-MAYANG IRT 2
HIDAYATULLAH P 23 PLALANGAN-T WARU IRT 2
MOH FAQIH P 24 KLAYU-MAYANG IRT 2
ZURNI P 40 KRAJAN-MAYANG IRT 2
BUDI SISWANTO P 20 KRAJAN-MAYANG IRT 2
AHMAM P 7 JATIAN PELAJAR 1
M SOFIANTO P 25 KRAJAN SWASTA 2
SUBAIDI P 5 MRAPEN PELAJAR 1
DEFI KRISBIANTO P 6 KRAJAN PELAJAR 1
NURI P 48 KRAJAN IRT 2
AMIR P 21 KLAYU-T WARU IRT 2
AGUS P 25 S PINANG-T WARU IRT 2
SAHRONO P 20 KRAJAN-SEMPOLAN IRT
USMAN P 34 S PINANG-T WARU IRT
MASRURI P 36 KRAJAN-SEPUTIH IRT 2
DENI ISLAMI P 23 KRAJAN-T REJO IRT 2
JUHARDI P 24 K GUNUNG-T REJO IRT 2
HUSEN P 23 KLAYU-MAYANG IRT 2
M FAISAL L 7 S JEDING PELAJAR 1
ABD HAMID L 7 S KRAJAN PELAJAR 1
ABD HAMID P 44 S KRAJAN IRT 2
SULIHAN P 9 S PINANG PELAJAR 1
AHMADI L 53 S KRAJAN SWASTA 2
P 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 5 MAYANG PELAJAR 1
L 5 MAYANG PELAJAR 1
P 5 MAYANG PELAJAR 1
P 5 MAYANG PELAJAR 1
L 5 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
 P 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
L 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
P 6 MAYANG PELAJAR 1
ERVAN P 28 PRASIAN-JATIAN IRT 2
SETYA DIRGANTARA P 21 KRAJAN-T REJO IRT 2
HAFID P 19 KRAJAN-SIDOMUKTI IRT 2
MUNAWIR P 21 JAMBUAN-PLALANGAN IRT 2
BURIANTO P 15 KRAJAN-SIDOMUKTI IRI 2
NURI P 39 KRAJAN IRT 2
HOLEK P 43 LAMPARAN-KERTOSARI IRT 2
ABDUL GANI L 58 T WARU SWASTA 2
KANZA MEIDINA P 5 PAKUSARI PELAJAR 1
MUZANI L 39 SEMPOLAN SWASTA 2
UUS KATIJO P 7 TEGAL REJO PELAJAR 1
RAHMATULLAH P 26 KLAYU - TEGAL WARU IRT 2
P 22 KRAJAN PELAJAR 1
RIFAI P 28 DAMSAOLA-T REJO IRT 2
SAMHADI P 19 DAMSAOLA-T REJO IRT 2
M FAISAL P 8 ROWO-MRAWAN PELAJAR 1
ANDRIK P 8 TEGALAN IRT 2
HIDAYAT P 26 LAMPARAN-KERTOSARI IRT 2
IMAM L 57 BADELAN SWASTA 2
DEDI KURNIAWAN P 35 K GUNUNG IRT 2
NUR HASANAH L 26 ROWO-MRAWAN SWASTA 2
AHMAD MURSIDI P 20 JEDING PELAJAR 1
YUDIANTO P 8 KLAYU PELAJAR 1
SUKARDI L 8 KLAYU PELAJAR 1
MUSTOFA P 10 KLAYU PELAJAR 1
PURWADI P 6 KRAJAN PELAJAR 1
WARSITO L 10 SIDOMUKTI SWASTA 2
TOYADI L 5 SIDOMUKTI SWASTA 2
SUGIONO P 5 SIDOMUKTI SWASTA 2
ABDUL L 5 SIDOMUKTI SWASTA 2
MUZANI P 5 SIDOMUKTI SWASTA 2
M AZKA P 5 SIDOMUKTI SWASTA 2
IFAN P 5 SIDOMUKTI SWASTA 2
MIFTAHUL P 5 SIDOMUKTI SWASTA 2
MASTHORI P 5 SIDOMUKTI SWASTA 2
MUHDIN P 5 SIDOMUKTI SWASTA 2
SISWANTO P 5 SIDOMUKTI SWASTA 2
SUCIPTO P 5 SIDOMUKTI SWASTA 2
ADNAN P 5 SIDOMUKTI SWASTA 2
ROSI P 6 SIDOMUKTI SWASTA 2
DAHLAN P 5 SIDOMUKTI SWASTA 2
IMAM P 6 SIDOMUKTI SWASTA 2
M TAUFIK P 5 SIDOMUKTI SWASTA 2
ABDUL P 5 SEMPOLAN SWASTA 2
YUDIANTO P 9 TEGALAN IRT 2
HABIBI L 9 KLAYU PELAJAR 1
ABD BASIR P 32 KRAJAN-SEPUTIH IRT 2
MULYADI P 26 KLAYU-MAYANG IRT 2
EKKI P 17 KLAYU-MAYANG IRT 2
HERYANTO P 29 KLAYU-MAYANG IRT 2
WAHYU HIDAYAT P 26 KRAJAN-MAYANG IRT 2
DEDI KURNIAWAN P 38 TETELAN-SEPUTIH IRT 2
AGUS TAUFIK P 24 ROWO-PAKUSARI IRT 2
ZAIMNUDIN P 32 KRAJAN-MUMBULSARI IRT 2
FAISOL ABRORI P 25 KRAJAN-MUMBULSARI IRT 2
MULYADI P 20 S WADUNG-HARJOMULYO IRT 2
FADLI P 28 KRAJAN IRT 2
HASAN L 18 KRAJAN TANI 2
JUNAR P 29 KRAJAN IRT 2
HADI P 23 S KJAYAN IRT 2
JANUAR L 5 MRAWAN PELAJAR 2
WASILUDIN L 35 PAKUSARI TANI 2
YUDI L 8 KRAJAN PELAJAR 2
TOTOK P 33 KALISAT WIRASWASTA 2
ABDUL MUKID P 8 GAMBIRAN-KALISAT PELAJAR 2
SUNARDI P 46 SEPUTIH-MAYANG IRT 2
RIDWAN P 59 TJ REJO IRT 2
AHMADI L 53 MAYANG WIRASWASTA 2
IMAM BUHORI P 24 TAMAN SARI-MUMBULSARIIRT 2
BUDI P 24 KLAYU-MAYANG IRT 2
YUDI RAHMAN P 23 CURAH LAOS-LAMPEJI IRT 2
ZURNI P 41 MULYOREJO IRT 2
EKKI P 19 KLAYU-MAYANG IRT 2
NURUL HIDAYAT P 21 PRINGTALI-MRAWAN IRT 2
P 25 MUMBUL IRT 2
P 32 MUMBUL IRT 2
DANDI L 8 KRAJAN SEPUTIH
EDI H. P 30 KARANG HARJO SWASTA
RIKO P. P 25 SUMBERKEJAYAN IRT
RIKO P. L 29 SUMBERKEJAYAN SWASTA
ERVAN L 33 KRAJAN-SIDOMUKTI TANI 2
FATHUR SUHDI L 18 JAMBUAN-PLALANGAN PELAJAR
FATHUR SUHDI P 25 JAMBUAN-PLALANGAN IRT 2
ALI P 7 KRAJAN-SEPUTIH PELAJAR
FARUQ P 7 TEGALAN S KJYAN 2
H SUWARDI P 50 S KEJAYAN IRT
B NISA P 74 KRAJAN SEPUTIH IRT
M DIDIK L 39 PLALANGAN SWASTA
AGUS JUNAIDI L 9 TETELAN PELAJAR
HENDRA P 4 KRAJAN SEPUTIH PELAJAR
ANDRIK P 20 KRAJAN SEPUTIH IRT
ASMUNI P 13 KRAJAN SEPUTIH PELAJAR
ISMAIL L 9 KLAYU PELAJAR
MUHAMMAD P 22 KRAJAN SEPUTIH PELAJAR
SUGIK L 6 JEDING PELAJAR
FIRMAN P 5 KRAJAN SEPUTIH PELAJAR
ABDUL ROHMAN L 7 KRAJAN SEPUTIH PELAJAR
AGUS JUNAIDI P 7 TETELAN PELAJAR
TOTOK SURYONO P 18 SEPUTIH-MAYANG PELAJAR 2
SITI ARIFAH P 23 KLAYU-MAYANG MAHASISWA 2
HERMANTO P 34 MAYANG IRT 2
ABDUL GANI L 9 SEPUTIH-MAYANG PELAJAR 2
FANI L 31 KRAJAN WIRASWASTA 2
YOYOK L 42 MAYANG WIRASWASTA 2
UMAR HIDAYATULLAH L 21 PEJI TALANG-K KEDAWUNGPELAJAR
AHMADI L 53 KRAJAN-MAYANG WIRASWASTA 2
AHMAD MURSIDI P 20 ROWO-PAKUSARI WIRASWASTA 2
M RIDHO L 26 JATIAN-PAKUSARI WIRASWASTA 2
SALIM P 34 KRAJAN-MAYANG IRT 2
SAIFUL P 7 ROWO-PAKUSARI PELAJAR
ASNAWI P 10 KRAJAN-S KEJAYAN PELAJAR
SAMSUL ARIFIN P 10 KRAJAN-S KEJAYAN PELAJAR
SUKIRMAN L 68 KRAJAN-S KEJAYAN PENSIUNAN 1
ABDUL KOHAR P 47 G SUDA-MRAWAN IRT 2
HERI P 7 KRAJAN-K KEDAWUNG
L 6 SEPUTIH-MAYANG 2
HOLILUR ROHMAN L 39 PRASIAN-JATIAN 2
ABDUS SALAM P 54 TEGALAN-S KEJAYAN 2
M SALIM P 7 KRAJAN-S KEJAYAN
JEKI L 7 KRAJAN-S KEJAYAN
ALUL P 8 KRAJAN-S KEJAYAN
AHAN KURNIAWAN P 9 KRAJAN-S KEJAYAN
FATHOR L 9 KRAJAN-S KEJAYAN
ALI HUSNI P 9 KRAJAN-T REJO
DONI P 8 KRAJAN-S KEJAYAN
SALEH P 9 KRAJAN-S KEJAYAN
SELAMET L 40 KRAJAN-PAKUSARI 2
SETYA DIRGANTARA L 10 KRAJAN-S KEJAYAN
BUYAMIN P 6 KLAYU-MAYANG
MOH HARIYANTO P 6 DAMSAOLA T REJO
DEDI SURYA L 7 KRAJAN T REJO 2
MUH AFDAN L 6 S JEDING-SEPUTIH 2
P 12 KRAJAN-S KEJAYAN
P 8 KRAJAN-S KEJAYAN
P 10 KRAJAN-S KEJAYAN
P 10 KRAJAN-S KEJAYAN
P 9 KRAJAN-S KEJAYAN
SLAMET L 21 PEJI TALANG-K KEDAWUNGMAHASISWA
JOTO L 7 BUNDER-PAKUSARI PELAJAR
SUGIANTO L 7 ROWO MRAWAN PELAJAR 2
AHMAD FARIS P 6 L TOKO-MRAWAN
SAKUR P 37 KRAJAN-T REJO IRT 2
AHMAD HANAN P 9 PLALANGAN-T WARU PELAJAR
MULYADI L 44 KRAJAN-MAYANG PNS 1
LUDIYANTO L 7 KRAJAN-SEPUTIH PELAJAR
P 7 MAYANG
MOH HODRI L 7 S JEDING-SEPUTIH PELAJAR
ABDUL ADIM L 15 LEDOK-SIDOMUKTI PELAJAR
L 4 KLAYU - TEGAL WARU
RIBUT L # 20 KLAYU-MAYANG PELAJAR
AHMADI L 53 KRAJAN-MAYANG TANI
SUYANTO P 6 KRAJAN-MAYANG PELAJAR
JUNI L 8 KRAJAN-T REJO PELAJAR
IMAM HIDAYT L 8 KLAYU-MAYANG PELAJAR
Fathor rosi P 6 SUMBERKEJAYAN PELAJAR
AHMAD MISNAWAR L 19 S JEDING-SEPUTIH TAMBANG PASIR
MUFTI ALI L 40 KRAJAN-MAYANG KEPALA SEKOLAH 1
SRINATUN P 67 ROWO-PAKUSARI IRT
SUGIYANTO P 7 DAMSAOLA T REJO PELAJAR
SUMARWI P 35 S JEDING-SEPUTIH IRT 2
ABD HAMID L 7 KRAJAN-S KEJAYAN PELAJAR
SUDARJI N P 51 AJUNG-KALISAT GURU 1
ABD HAMID P 44 KRAJAN-S KEJAYAN IRT 2
NAIM L 6 S PAKEM-SEPUTIH PELAJAR
MUH JUNAIDI P 46 KLAYU-T WARU GURU 1
TOHARI L 9 KLAYU PELAJAR
ABDUS SOMAD P 7 KRAJAN-S KEJAYAN PELAJAR
ABDULLAH P DILA L 48 S PINANG-T REJO WIRASWASTA 2
SENIMAN P 55 MRAPEN-S KEJAYAN IRT 2
JUKIANTO P 6 KRAJAN-S KEJAYAN PELAJAR
KODRI P 25 KRAJAN-SEPUTIH IRT 2
ABDUL ADIM L 15 LEDOK-SIDOMUKTI PELAJAR
RIBUT L 20 KLAYU-MAYANG PELAJAR
SULI P 7 KLAYU-T WARU PELAJAR
LUTFI P 9 KLAYU MAYANG PELAJAR 2
DANDI L 7 TEGALAN-S KEJAYAN PELAJAR 2
ATIM L 40 KRAJAN-T REJO WIRASWASTA 2
SAKUR P 37 KRAJAN-T REJO IRT 2
P 23 KLAYU MAYANG WIRASWASTA 2
FAUZAN P 25 KRAJAN-SEPUTIH IRT 2
HARTONO P 15 T GUSI-MAYANG PELAJAR
KISNALI P 39 IRT IRT 2
ABDUL HALIM P 7 KRAJAN-GAMBIRN PELAJAR
JUALA L 60 T GUSI-MAYANG TANI 2
LUTFI P 9 KLAYU MAYANG PELAJAR 2
SAIFUL L 9 TEGALAN-S KEJAYAN PELAJAR 2
MOH ARIK AGUSTIN L 7 S JEDING-SEPUTIH PELAJAR 1
KUSNADI P 6 T GUSI-MAYANG PELAJAR
HENDRA L 24 PLALANGAN-T WARU TANI 2
ZAENAL P 10 GAMBURAN KALISAT PELAJAR 2
TARYADI P 47 ROWO PAKUSARI IRT 2
P 67 ROWO PAKUSARI IRT 2
SAI L 60 KLAYU MAYANG TANI 2
HABIBI L 28 PANDIAN SEPUTIH TANI 2
P 8 S JEDING-SEPUTIH PELAJAR 2
P 36 KLAYU TEGALWARU IRT
HARIYANTO P 13 KRAJAN SEPUTIH PELAJAR
ATNAN P 9 SIDOMUKTI PELAJAR
SUTRISNO P 20 ROWO-MERAWAN MAHASISWA 2
SUDARJI N P 51 AJUNG-KALISAT IRT
ABDUL ADIM L 15 LEDOK-SIDOMUKTI PELAJAR 1
SUBAIRI P 30 TEGALAN-S KEJAYAN IRT 2
HOJI P 7 KRAJAN-T REJO PELAJAR 1
P 26 PELAJAR 1
ARIF CANDRA P 35 MRAPEN-S KEJAYAN IRT 1
EDIYANTO L 44 PLALANGAN-T WARU WIRASWASTA 2
MUH ASIS P 24 PANDIAN-SEPUTIH IRT 2
IMAM SAFII P 35 LAMPEJI-MUMBULSARI BURUH GUDANG 2
ALI WAFA P 6 ROWO-GAMBIRAN PELAJAR 1
RIBUT L 20 KLAYU-MAYANG PELAJAR
HAZIN HAMID L 44 S JEDING-SEPUTIH WIRASWASTA 2
ARJONO RIDWAN L 12 KRAJAN-GAMBIRN PELAJAR 1
MARYANTO P 6 KRAJAN-SEPUTIH
ANDI L 8 S JEDING-SEPUTIH PELAJAR 1
SULI P 7 KLAYU-T WARU PELAJAR 1
ALIWAFA P 6 PLALANGAN-T WARU PELAJAR 1
MUSTAJIB L 7 MRAPEN-S KEJAYAN PELAJAR 1
MUSTAJIB L 50 MRAPEN-S KEJAYAN TANI 2
ZAINUDIN L 6 KRAJAN-SIDOMUKTI
SULHAN P 10 S PINANG-T REJO PELAJAR 1
SAERI P 35 ROWO-MRAWAN IRT 2
MOH RIDWAN L 4 ROWO PAKUSARI PELAJAR 1
P 7 ROWO-PAKUSARI PELAJAR 1
SUTRISNO P 20 ROWO-MRAWAN PELAJAR 2

SUNARTO p 46 KLAYU-MAYANG irt 2

HARTONO L 7 KLAYU-T WARU PELAJAR 1
ALEX KURNIAWAN L 4 ROWO-PAKUSARI 2
LUDIANTO L 6 KRAJAN-SEPUTIH PELAJAR
HOJI L 7 KRAJAN-T REJO PELAJAR
SUDARJI NUGROHO P 51 AJUNG-KALISAT GURU 1
SAMSUL MAARIF P 6 S PINANG-T REJO PELAJAR 1
HAZIM HAMID L 44 S JEDING-SEPUTIH WIRASWASTA 2
M JASULI L 39 GAMBIRAN-KALISAT TANI 2
KUSNADI P 7 TEGALAN-S KEJAYAN PELAJAR
PURYADI L 7 KLAYU-T WARU PELAJAR
HASIN P 8 ROWO-GAMBIRAN PELAJAR
RANDI P 21 KRAJAN-MAYANG IRT 2
ASAN P 6 TETELAN-SEPUTIH PELAJAR 1
HOFIT P 5 ROWO-PAKUSARI PELAJAR 1
SUNARTO 46 P KLAYU-MAYANG IRT 2
EKO P 24 KRAJAN-SIDOMUKTI IRT 2
SYAIFUR P 40 KLAYU-MAYANG IRT 2
SUTRISNO P 10 KLAYU-MAYANG PELAJAR
 Kelompok Kerja
Status

Yan Med Das

Jen Kunj B,L

Peserta

Jenis Kasus
Rujukan
Kode
Keluhan Diagnosa ICD-X Terapi
Peny

Kasus

Umum
Resep

Dari

Bpjs
Ke
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
PERIKSA GIGI PERIODONTITIS K04 20.05 MEDIKASI 3 1 8 2 0 L 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K04 20.05 MEDIKASI 3 1 8 1 0 B 0 0 1A 0
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI 1 0 8 3 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05 20.06 MEDIKASI 1 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3b 2 0 B 0 0 0 1
PERIKSA GIGI HIPEREMI PULPA K02 20.03 TUMPAT ART 0 1 2B 2 0 B 0 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 3 0 L 0 0 0 1
PERIKSA GIGI ABSES MANDIBULA K12.2 20.13 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 1 3b 2 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN ART 0 1 2b 3 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3b 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING 0 0 6 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 1 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05.2 20.06 KONTROL 0 0 8 3 0 L 0 0 1B 1
PUSING,MUAL GINGIVITIS K05 20.06 SCALING 0 0 6 2 0 L 0 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA HAMIL GANGREN RADIKS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN 1 0 1b 3 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 0 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 KONSULTASI 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05.2 20.06 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PERIODONTITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL GANGREN PULPA K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 L 0 0 0 1
CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN 1 0 1b 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL [USG] GANGREN RADIKS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 1B 0
PERIKSA GIGI GINGIVITIS K05 20.06 MEDIKASI 1 0 8 2 0 L 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05.2 20.06 MEDIKASI 1 0 8 2 0 L 0 0 0 1
CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN 1 1 1B 3 0 L 0 0 0 1
CABUT GIGI ULKUS DECUBITUS K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 1 3B 3 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 1B 0
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI 1 0 8 3 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 1 0 B 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 TUMPAT ART 0 0 2A 1 0 L 0 0 0 1
PERIKSA GIGI HIPEREMI PULPA K02 20.03 TUMPAT ART 0 0 2A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
CABUT GIGI HIPEREMI PULPA K02 20.03 TUMPAT ART 0 0 2B 1 0 B 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.05 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI HIPEREMI PULPA K02 20.03 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 1B 0
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 1B 0
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 1B 0
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING 0 0 6 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 1 0 B 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 1 0 B 0 0 1B 0
PERIKSA GIGI PULPITIS K05 20.05 MEDIKASI 1 0 8 3 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 B 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI ABSES K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 L 0 0 0 1
PERIKSA GIGI HIPEREMI PULPA K02.1 20.03 TUMPATAN ART 0 0 2B 1 0 L 0 0 1B 0
PERIKSA GIGI HIPEREMI PULPA K02 20.01 MEDIKASI 1 0 8 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 2 0 L 0 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 1B 0
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 2 1 L 2 0 1B 0
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 2 1 L 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL 0 0 8 1 1 B 2 0 0 1
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL 0 0 8 1 1 B 2 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1a 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPAT ART 0 0 2B 2 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING 0 0 6 2 0 L 0 0 1B 0
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING 0 0 6 1 0 B 0 0 1B 0
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 1 0 L 0 0 0 1
PERIKSA GIGI GANGREN RADIKS K04 20.05 MEDIKASI 3 0 8 1 0 L 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 1 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 1 0 B 0 0 0 1
PERIKSA GIGI HIPEREMI PULPA K02.1 20.03 TUMPATAN SEMENTARA 0 0 3B 1 0 L 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 3 0 L 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 3 0 3B 2 0 L 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05.2 20.06 MEDIKASI 1 0 8 3 0 L 0 0 0 1
PERIKSA GIGI GINGIVITIS K05.2 20.06 SCALING 0 0 6 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 3 0 L 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 1B 0
PERIKSA GIGI GANGREN PULPA K04 20.05 EKSTRAKSI LIDOKAIN 0 0 1B 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN ART 0 0 2B 3 0 L 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 0 0 3B 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN SEMENTARA 1 1 3B 2 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 2 0 L 0 0 0 1
CABUT GIGI GANGREN RADIKS K04 20.05 EKSTRAKSI LIDOKAIN 3 0 1B 1 0 L 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 1 0 B 0 0 1B 0
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 2 0 L 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 EKSTRAKSI CE 1 0 1B 2 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI 3 0 8 1 0 B 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN ART 0 0 2B 3 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K00 20.01 EKSTRAKSI CE 1 0 1A 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 L 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 1A 1 0 B 0 0 0 1
CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN 1 0 1B 2 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 KONTROL 0 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 KONTROL 0 0 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 3 0 L 0 0 1B 0
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 8 1 0 B 0 0 0 1
SAKIT GIGI PULPITIS K04 20.05 MEDIKASI 3 0 8 1 0 B 0 0 1A 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 8 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL 0 0 8 1 0 L 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 0 B 1 0 L 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 KONSULTASI 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 KONSULTASI 0 0 8 1 0 B 0 0 0 1
PERIKSA GIGI ABSES K04 20.05 Medikasi 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONSULTASI 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 B 0 0 1B 0
SAKIT GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 1 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 L 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara 0 1 3B 1 0 B 0 0 3 0
SAKIT GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 2 0 L 0 0 1B 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 1 0 B 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 KONSULTASI 0 1 8 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 1 0 B 0 0 1B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05 20.06 EKSTRAKSI CE 0 1 1B 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
CABUT GIGI PERIODONTITIS K05 20.06 EKSTRAKSI LIDOKAIN 1 1 1B 2 0 L 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 2 0 L 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara 0 1 3B 2 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 1A 0
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
SAKIT GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 0 1
SAKIT GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 1A 0
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05 20.06 EKSTRAKSI LIDOKAIN 1 1 1B 2 0 L 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05 20.06 KONTROL 0 1 8 2 0 B 0 0 0 1
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI 3 1 8 2 0 B 0 0 1B 0
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 Tumpat sementara 0 1 3B 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 Tumpat sementara 1 1 3B 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 Tumpat sementara 1 1 3B 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.01 Medikasi 1 1 8 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 2 0 L 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 2 0 B 0 0 1A 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 Medikasi 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 Medikasi 1 1 8 2 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI 1 1 8 2 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 Medikasi 1 1 8 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara 0 1 3B 2 0 L 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONTROL 0 1 8 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 2B 0
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 KONSULTASI 1 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 KONSULTASI 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING 0 0 6 2 0 L 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 2A 0
PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara 0 1 3B 2 0 L 0 0 0 1

PERIKSA GIGI Pulpitis k04 20.05 tumpatan ART 0 1 2b 2 0 B 0 0 1A 0

CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
PERIKSA GIGI PULPITIS K04 20.05 Medikasi 1 1 8 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.01 Medikasi 1 1 8 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERIODONTITIS K05 20.06 KONTROL 0 1 8 2 0 B 0 0 0 1
TAMBAL GIGI Pulpitis k04 20.05 tumpatan ART 0 1 2b 2 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 B 0 0 0 1
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 0 1
TAMBAL GIGI Pulpitis k04 20.05 tumpatan ART 0 1 2b 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL 0 1 8 1 0 B 0 0 0 1
PERIKSA GIGI Pulpitis k04 20.05 tumpatan ART 0 1 2b 2 0 B 0 0 1A 0
PERIKSA GIGI PULPITIS K04 20.05 Medikasi 1 1 8 2 0 B 0 0 0 1
PERIKSA GIGI Pulpitis k04 20.05 tumpatan ART 0 1 2b 1 0 B 0 0 0 1
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE 0 1 1A 2 0 B 0 0 1A 0
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3 Jelas 2 1 2
4 Jelas 2 1 6
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6 Jelas 2 1 2
7 Jelas 2 1 2
8 L : Laki-laki 2 1 5
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9 Jelas 2 1 5
10 Jelas 2 1 5
11 Jelas 2 1 5
12 Jelas 2 1 4
13 Jelas 2 1 7
14 1: Formal 2 1 5
2: Non formal 2 1 5
15 Jelas 2 1 4
16 Jelas 2 1 2
17 Jelas 2 1 2
18 Jelas 2 1 2
19 Jelas 2 1 1
20 Jelas 2 1 5
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25 1: Maternal 2 1 2
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27 1: BP 2 1 2
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2 1 1
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2 1 1
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2 1 1
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 2 1 1
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29 59 2 1 1
84 146 2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
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2 1 1
2 1 1
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2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
2 1 1
No Tgl Nama No BJPS No Reg No Indeks

1 2 3 4 5 6
1 3 HAFIT 1131855579 0 2229
2 3 MUH EDO FAHREZI 0 0 13106
3 3 HOLIL 0 0 15466
4 3 AMIN 689848266 0 17553
5 3 HUSNUL HOTIMAH 0 0 2804
6 3 NAFISAH 0 0 17552
7 3 ROFIQOTUL DINIAH 0 0 17554
8 3 MIMIN FERAWATI 0 0 17550
9 3 REHAN RIJATUL 0 0 11064

10 3 SURIYE B WASIL 0 0 17507

11 3 JUHADIO 0 0 1240
12 3 WITRIYAH 0000690720276 0 15592
13 4 NINING RODIYAH 0 0 17576
14 4 ABDUL GANI 0 0 07199
15 4 AMIR FAISOL 0 0 17578
16 4 MOH HELMI 0 0 17531
17 4 NADILA FERA DWIYANTI 0 0 13194
18 4 MUH HAIKAL 0 0 16735
19 4 BILQIS 0 0 15856
20 4 NAFISAH 0 0 01324

21 4 LAILA 0 0 03033
22 4 ASMAUL VADILAH 0 0 17582
23 4 KHOIRIYAH 0 0 17580
24 4 MUSRIFA 0 0 06616
25 4 DEWI PUTRI 0 0 03572
26 4 SITI KOILATUL 0 0 12774
27 4 SUMINA 0000113901164 0 17052
28 4 MARIA ULFA 0 0 17579
29 5 AMELIA NAFISA 0 0 17608

30 5 M SOFIANTO 0 0 729
31 5 AFIAH HOIRUN 0 0 17596
32 5 RISKITA AULYA 0 0 9860
33 5 SAIHONA 0 0 17607
34 5 SULISTIYAWATI 0000691083235 0 14682
35 5 SINTA AYU A 0000690620523 0 17322
36 5 DETY URMILA 0 0 16017
37 5 SAMI 0 0 17598
38 5 NANIK CANDRA 0 0 11847
39 5 SISKA AYU 0 10733
40 5 HOSNIA 0 0 02984
41 5 SRI HARTATIK 0 17603
42 6 M ARDAN 0 0 894
43 6 M FANGKI 0 0 3871

44 6 FARINA 0 0 13584
45 6 RISALATUL INAYAH 0 0 1759
46 6 AHMADI 0 0 17628
47 6 MELGA M. 0 0 0
 48 6 M. NABIL 0 0 0
49 6 M. REVAN 0 0 0
50 6 M. TEGAR 0 0 0
51 6 JOVITA 0 0 0
52 6 SALSABILA 0 0 0
53 6 M. REGA 0 0 0
54 6 NOVAIL 0 0 0
55 6 M. SYARIF 0 0 0
56 6 M. REFAN 0 0 0
57 6 KHEISA 0 0 0
58 6 FIRA A. 0 0 0
59 6 MIRZA S. 0 0 0
60 6 SOFIATUL 0 0 0
61 6 RAMADANI 0 0 0
62 6 M. FADIL 0 0 0
63 6 GILANG K. 0 0 0
64 6 DEBY C. 0 0 0
65 6 SULTON A. 0 0 0
66 6 SOFIATUL 0 0 0
67 6 LARASASTI 0 0 0
68 6 M. SABILILLAH 0 0 0
69 6 M. RIEZKY 0 0 0
70 6 M. FIRDAUS 0 0 0
71 6 LUQMAN H. 0 0 0
72 6 KEMAL A. 0 0 0
73 6 ALIYAH S. 0 0 0
74 6 NADISYA M. 0 0 0
75 6 HOFIFAH 0 0 0
76 6 TATIK 0 0 17626
77 6 ADELIA 0 0 09384
78 6 AYU DWI 0 0 17616
79 6 FAISEH 0 0 11812
80 6 SUMIATI 0000690951778 0 17614
81 7 SAIHONA 0 0 17607
82 7 MIMIN FERAWATI 0 0 17550

83 7 ABDUL GANI 0 0 7199

84 7 KANZA MEIDINA 0 0 17634

85 7 MUZANI 0 0 1452
86 7 AMELIA 0 0 1620
87 7 HUSNUL HOTIMAH 0 0 2804
88 7 JUNAIDA 0 0 7012
89 7 SUDARWATI 0 0 16452
90 7 SILVATUL KISLIA 0 0 16454
91 9 M SAFDAN 0 0 15044
92 9 WANGI 0 0 3648
93 9 ELOK HARDIANA 0 0 17642
94 9 ULFIYAH 0 0
95 9 DEDI KURNIAWAN 0 0 17660
96 9 NUR HASANAH 0 0 17647
97 9 AHMAD WASILATUS 0 0 17638
98 9 ROFIQUL D 0 0 17554
99 9 PUTRI DWI 0 0 3899
100 9 FARHAN FARA 0 0 0
101 9 REGINA AULFA 0 0 17230
102 9 AURA ZHAFA 0 0 17661
103 9 M RIZKY 0 0 17726
104 9 M FATAN 0 0 17728
105 9 AMAS ASKIYA 0 0 17729
106 9 M REZA 0 0 9282
107 9 AMELIA PUTRI 0 0 17731
108 9 INESYA AZKA 0 0 17732
109 9 ALIA RISKY 0 0 17733
110 9 NAULAILA 0 0 13734
111 9 ANISA ZASKIA 0 0 17735
112 9 NIKEN AYU 0 0 17736
113 9 FAROHATUL 0 0 17737
114 9 INA YULIANTO 0 0 17738
115 9 NABILA 0 0 17723
116 9 DANISA 0 0 1147
117 9 FELY 0 0 17724
118 9 LAILA F 0 0 17725
119 9 ARDIAN 0 0 17727
120 9 M FIFI RAHMAWATI 0 0 7012
121 9 LIDIA FITRIA 0 0 17663
122 9 SAMIATUN 0001039513588 0 04322
123 9 MUHIBAH 0 0 17648
124 9 LIATUL HASANAH 0 0 16472
125 9 KATIMAH 0 0 17649
126 9 NIA WAHYU KUSUMA 0 0 17655
127 9 ALIYAH 0 0 17656
128 9 HOLISOH 0 0 16403
129 9 EKA SULISTIAWATI 0002201527618 0 17662
130 9 RATIH BUDI UTARI 0 17664
131 9 MILA NURDIANA 0 0 17665
132 10 NAFSI RINI 0 0 17684
133 10 NURUL 689980601 0 17692
134 10 ASMAWATI 690352121 0 17678
135 10 ELISA MAULIDA 0 0 6401
136 10 JANUAR BIMA 692100263 0 17682
137 10 WASILUDIN 0 0 17693
138 10 NIKO FEBRIANSYAH 0 0 17694
139 10 DIAH ERININGSIH 0 0 17695
140 10 RANIATUS SOLEHA 0 0 13385
141 10 SUHAENING 1424078471 0 189
142 10 SUCIATI 0 0 6003

143 10 AHMADI 0 0 17628

144 10 EKA RIZKI 0001543656071 0 17700
145 10 INTAN 0 0 17697
146 10 BUSANI 0000690524494 0 17321
147 10 SUMINA ARIYANI 0000113901164 0 17052
148 10 LIATUL HASANAH 0 14672
149 10 AMALIATUS SOLEHA 0 0 17680
150 10 RAVIS B. 0 0 17664
151 10 EKA SULISTIANI 0 0 17662
152 11 M BIMA SAKTI 0 0 03555
153 11 SURIPAH 0 0 17708

154 11 KHORIYAH 0 0 17580

155 11 KHORIYAH 0 0 17580

156 11 RIKO PURWANTO 0 0 17711

157 11 ERVAN 0 0 17718
158 11 MUH AFIN MUSAFI 000154371612 0 17040
159 11 YULIS 0001543711228 0 17719
160 11 HOLILAH 0 0 09486
161 11 BILQIS 0 0 03893

162 12 HJ HASANAH 0 0 1049

163 12 B NISAH 0 0 1081
164 12 M DIDIK 689757221 0 17746
165 12 FAHRI 0 0 17750
166 12 ALMIRA 0 0 17748

167 12 ADE AYU W 689403723 0 10984

168 12 DESI HARUM 0 0 17753

169 12 MOH MAULANA 0 0 17754
170 12 MELDA RINJANI 0 0 3885
171 12 MUH AKBAR 0 0 17752
172 12 FERLIANA CINTIYA 0 0 17379

173 12 ARIFATUR ROHMAN 691401677 0 1493

174 12 NANDA SAFIRA 0 0 16188
175 13 FIRDAUSIL MAHMUDAH 0 0 12303
176 13 SITTI MA'RIFAH F 0 0 17761
177 13 MUSRIFA 690994607 0 6616
178 13 ABDUL QADIR 690891355 0 12506

179 13 TAUFIK 0 0 17765

180 13 YOYOK 1039528506 0 5194
181 14 RIZAL UMAR 0 17773

182 14 AHMADI 0 17628

183 16 AHMAD WASILATUS SHOLEH 0 17638

184 16 M RIHO 0 17317

185 16 FIRTRI WIDIASTIANA 0000690873974 0 00470

186 16 WASILATUL M 0002078993351 0
187 16 FEKTIAN AINUL 0 17793
188 16 SITI HALIMA 0 17794
189 16 SUKIRMAN 0000114587021 0 00541
190 16 LILIK FARIDA 0 17070
191 16 DWI RISKI 0 15678
192 16 ADITIA 0 0 17790
193 17 IDRIS 0001040051575 0 17811
194 17 HASANAH B HALIMATUS 0 0 01049
195 17 DEWI KARIMAH 0 17816
196 17 ZAHLUL MIQDAT 0 06214
197 17 HALISA RAMADAN 0 17817
198 17 FITRATUL HASANAH 0
199 17 M SULTON AZIS 0 07672
200 17 NABILA PUTRI 0 13176
201 17 SANTIKA ANDRIANI 0 17825
202 17 WINDASARI D 0 17827
203 17 ABDUL WAFI 0 17832
204 17 FATHOR ROSI 0 17833
205 17 AUREL 0 00723
206 17 NINDI PUTRI 0 17836
207 17 MUH NUFAL 0 0 17477
208 17 HAIKAL SYAHRUL 0 0 10977
209 17 MILA 691344202 0 2869
210 17 FALENTINA 0 0 1784
211 17 SUSI A 0 0 17822
212 17 DEVI 0 0 17826
213 17 ANI SAFITRI 0 0 14980

214 18 RIZAL UMAR 0 17773

215 18 AGIL SAPUTRA 0 17848
216 18 HILDA NUR HOIRIYAH 0 17850
217 19 SITI NURIL HIFADAH 0 17860
218 19 SITTINA 0001997701716 0 10341
219 19 TASYA NURUL H 0 09148
220 19 MULYADI 0001894733763 0 03845
221 19 FAHRI 0 15128
222 19 SITI FADILAH 0 0 15641
223 20 MOH KEFIN 0001541722498 0 08661
224 20 MH SULHAN FAIZI 0 17868
225 20 A. KHOIRIL 0 0 17869
226 21 BASTIYAN 0 17882
227 21 AHMADI 0 17628
228 21 FAREN APRILIA PUTRI 0 0 17884
229 21 FEBIANSYAH 0000690615483 0 00330
230 21 ARYA MISI 0 0 09585
231 23 Farah Dhita 0000689377026 0 14508

232 23 AHMAD MISNAWR 0000689930019 0 17889

233 23 MUFTI ALI 0001903639511 0 11246
234 23 SRINATUN 0
235 23 NAHRIL ILHAM 0 12512
236 23 HOSNIAH 0000690706124 0 11464
237 23 M FANGKI 0 03871
238 23 SENIWATI 0 0 17896
239 23 FARIDA 0 13584
240 23 ERI SUMANDINATA 0 13764
241 23 NUR LAILI 000114728488 0 06829
242 23 IRFAN MAULANA 0000689786684 0 01392
243 23 ANDINI 0 0 16404
244 23 ABDULLAH P DILA 0 17902
245 23 RODIYAH 0 17906
246 23 CIKA SALSABILA 0000690812109 0 16903

247 24 SOLEHA 0001541821678 0 15571

248 24 MUH SULHAN 0001039518022 0 17868

249 24 BASTIYAN 0 17822

250 24 AULIA NURAINI 0 0 12957
251 24 ANNISA FIRYAL 0 0
252 24 AHMAD DANIEL 0 0 02321
253 24 ATIM 0 0
254 24 SITTINA 0001997701716 0
255 24 VIVIN 0 0 01631
256 25 SITI FATIMAH 0 0 17926
257 25 KAMILA 0 17929
258 25 REHANA 0000690862904 0 11479
259 25 CINTA DWI CANTIKA 0 17931
260 25 JUALA 0 0 02749
261 25 ANNISA FIRYAL 0 0
262 25 ADIT NUROSID 0 0 08262
263 25 MOH ARIK 0000689889429 0 17925
264 25 YELSA 0 0 17927
265 25 HENDRA 0000690861904 0 17993
266 26 SELA PUTRI 0 16783
267 26 HANDARINI 0 0 17939

268 26 SRINATUN 0 17891

269 26 SA I P NABIL 0 16845
270 26 HABIBI 0000690103506 0 HABIBI
271 26 APRILIANA PUTRI

272 26 JUMAIYA 0 0 12582

273 26 PUTRI PURNAMA SARI 0 0 17419

274 26 INA YULIATIN ATNAN

275 26 ZUBAIDA 0
276 26 SENIWATI 0 0 17896
277 27 MUH SULHAN 0001039518022 0 17868
278 27 IKA ROBIATUL 0000690561268 01587 Err:509
279 27 FATUR 0000691401677 0 1493
280 27 HASANAH B HALIMATUS 0000690601015 0 0
281 30 ANISWATI 0
282 30 EDIYANTO 0 0
283 30 HABIBAH 0000690001931 MUH ASIS
284 30 INDAH 0
285 30 HINAYATUL 0 01264

286 30 BASTIYAN 0 17822

287 30 HAZIN HAMID 0 15475
288 30 AHMAD MALIK SUGIARTO ARJONO RIDWAN
289 30 MAURA AYU NIRFANA 0 12077
290 30 ISRAL RADIT F 0 17946
291 30 AULIA NURAINI 0 12957
292 30 ALIFIA APRIKATUL 0002092597503 17943 Err:509
293 31 AHMAD SOBRI 0 MUSTAJIB
294 31 MUSTAJIB 0 MUSTAJIB
295 31 ADITIA SAPUTRA 0 17790 ZAINUDIN
296 31 RISALATUL INAYAH 0 01759
297 31 TUTIK SUHAIMI 0 0 17973
298 31 ADITIA 0 0 17974
299 31 KANIA KASNA ADILA 0000694485516 0 16185

300 31 ZUBAIDA 0 17978

301 0 0 0 0 0
302 0 0 0 0 0
303 0 0 0 0 0
304 0 0 0 0 0
305 0 0 0 0 0
306 0 0 0 0 0
307 1 MARSINI 0 13147
308 1 Err:509 ALIEF SANTOSO 02653 HARTONO
309 1 Err:509 DANIL 17994 ALEX KURNIAWAN
310 1 Err:509 FAHRI 15128 LUDIANTO
311 1 Err:509 ARIFATUR 01493 HOJI
312 2 Err:509 SENIWATI 17896 SUDARJI NUGROHO
313 2 Err:509 ZAHIRATUL JANNAH 18011 SAMSUL MAARIF
314 2 Err:509 HAZIM HAMID 14475 HAZIM HAMID
315 2 Err:509 M JASULI 06501 M JASULI
316 2 Err:509 SALSABILA SALIHAH 17367 KUSNADI
317 2 Err:509 KEVIN SYAHPUTRA 18019 PURYADI
318 2 Err:509 ARIKATUL M 16222 HASIN
319 2 Err:509 SRI AYU NINGSIH 04516 RANDI
320 2 Err:509 LIA YULISTARI 18014 ASAN
321 3 Err:509 WAHYU NAFISAH 01412 HOFIT
322 3 Err:509 MARSINI 13147 SUNARTO
323 3 Err:509 HOLIDATUS SAFINAH 18041 EKO
324 4 Err:509 HONIF 08322 SYAIFUR
325 4 Err:509 FATIMAH RAHMATUS06610 SUTRISNO
326 0 0 0 0 0
327 0 0 0 0 0
328 0 0 0 0 0
329 0 0 0 0 0
330 0 0 0 0 0
331 0 0 0 0 0
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482 0 0 0 0 0
483 0 0 0 0 0
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485 0 0 0 0 0
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499 0 0 0 0 0
500 499
501
502
503
504
505
506
507
508
509
510
511
512
513
#REF!
 Tempat Kerja
Umur

Lama kerja
Jen
Nama KK is Alamat Pekerjaan
Kel
Hr Bln Thn

7 8 9 10 11 12 13 14 15

HAFIT L 0 0 44 LEDOK-SIDOMUKTI WIRASWASTA 2 0

SUHED L 0 0 7 S AGUNG-LAPENG PELAJAR 1 0
M RAFLI FIRDAUS L 0 0 5 PRINGTALI-MRAWAN PELAJAR 1 0
AMIN L 0 0 50NGANGKANG-KEDAWUNGTANI 2 0
RAHMATULLAH P 0 0 26 KLAYU-TEGAL WARU IRT 2 0
SUYITNO P 0 0 7 DAMSODA-T.REJO PELAJAR 1 0
YUDIANTO L 0 0 7 S JEDING-S PUTIH PELAJAR 1 0
HOLEK P 0 0 42 LAMPARAN-KERTOSARI IRT 2 0
SUHRI L 0 0 8 KRAJAN PELAJAR 1 0

SAMURI L 0 0 39 KERANGDAM IRT 2 0

JUHADIO L 0 0 35 PAKUSARI WIRASWASTA 2 0
WASIL P 0 0 34 LEDOK-SIDOMUKTI IRT 2 0
SLAMET P HERI P 0 0 18 GAMBIRAN-KALISAT PELAJAR 1 0
ABDUL GENI L 0 0 59 KLAYU-T WARU PERDAGANGAN 2 0
AMIR FAISOL L 0 0 44 ROWO-MRAWAN PETANI 2 0
MOH HILMI L 0 0 36 T GUSI-MAYANG BURUH TANI 2 0
ERFAN SAHAR P 0 0 15 KRAJAN-MAYANG PELAJAR 1 0
ALI MAKI L 0 0 6 S JEDING-SEPUTIH PELAJAR 1 0
SAMPURNO P 0 0 7 S JEDING-SEPUTIH PELAJAR 1 0
ANAM P 0 0 7 KRAJAN-MAYANG PELAJAR 1 0

ABDUL HALIM P 0 0 3 PANDIAN-SEPUTIH PELAJAR 1 0

VERI P 0 0 25 KRAJAN-MAYANG IRT 2 0
RIKO PURWANTO P 0 0 24 KRAJAN-MAYANG IRT 2 0
MAYANG P 0 0 31 KRAJAN-MAYANG IRT 2 0
HIDAYATULLAH P 0 0 23 PLALANGAN-T WARU IRT 2 0
MOH FAQIH P 0 0 24 KLAYU-MAYANG IRT 2 0
ZURNI P 0 0 40 KRAJAN-MAYANG IRT 2 0
BUDI SISWANTO P 0 0 20 KRAJAN-MAYANG IRT 2 0
AHMAM P 0 0 7 JATIAN PELAJAR 1 0

M SOFIANTO P 0 0 25 KRAJAN SWASTA 2 0

SUBAIDI P 0 0 5 MRAPEN PELAJAR 1 0
DEFI KRISBIANTO P 0 0 6 KRAJAN PELAJAR 1 0
NURI P 0 0 48 KRAJAN IRT 2 0
AMIR P 0 0 21 KLAYU-T WARU IRT 2 0
AGUS P 0 0 25 S PINANG-T WARU IRT 2 0
SAHRONO P 0 0 20 KRAJAN-SEMPOLAN IRT 0 0
USMAN P 0 0 34 S PINANG-T WARU IRT 0 0
MASRURI P 0 0 36 KRAJAN-SEPUTIH IRT 2 0
DENI ISLAMI P 0 0 23 KRAJAN-T REJO IRT 2 0
JUHARDI P 0 0 24 K GUNUNG-T REJO IRT 2 0
HUSEN P 0 0 23 KLAYU-MAYANG IRT 2 0
M FAISAL L 0 0 7 S JEDING PELAJAR 1 0
ABD HAMID L 0 0 7 S KRAJAN PELAJAR 1 0

ABD HAMID P 0 0 44 S KRAJAN IRT 2 0

SULIHAN P 0 0 9 S PINANG PELAJAR 1 0
AHMADI L 0 0 53 S KRAJAN SWASTA 2 0
0P 0 0 6 MAYANG PELAJAR 1 0
 0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 5 MAYANG PELAJAR 1 0
0L 0 0 5 MAYANG PELAJAR 1 0
0P 0 0 5 MAYANG PELAJAR 1 0
0P 0 0 5 MAYANG PELAJAR 1 0
0L 0 0 5 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0L 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
0P 0 0 6 MAYANG PELAJAR 1 0
ERVAN P 0 0 28 PRASIAN-JATIAN IRT 2 0
SETYA DIRGANTARA P 0 0 21 KRAJAN-T REJO IRT 2 0
HAFID P 0 0 19 KRAJAN-SIDOMUKTI IRT 2 0
MUNAWIR P 0 0 21 JAMBUAN-PLALANGAN IRT 2 0
BURIANTO P 0 0 15 KRAJAN-SIDOMUKTI IRI 2 0
NURI P 0 0 39 KRAJAN IRT 2 0
HOLEK P 0 0 43 LAMPARAN-KERTOSARI IRT 2 0

ABDUL GANI L 0 0 58 T WARU SWASTA 2 0

KANZA MEIDINA P 0 0 5 PAKUSARI PELAJAR 1 0

MUZANI L 0 0 39 SEMPOLAN SWASTA 2 0

UUS KATIJO P 0 0 7 TEGAL REJO PELAJAR 1 0
RAHMATULLAH P 0 0 26 KLAYU - TEGAL WARU IRT 2 0
0P 0 0 22 KRAJAN PELAJAR 1 0
RIFAI P 0 0 28 DAMSAOLA-T REJO IRT 2 0
SAMHADI P 0 0 19 DAMSAOLA-T REJO IRT 2 0
M FAISAL P 0 0 8 ROWO-MRAWAN PELAJAR 1 0
ANDRIK P 0 0 8 TEGALAN IRT 2 0
HIDAYAT P 0 0 26 LAMPARAN-KERTOSARI IRT 2 0
IMAM L 0 0 57 BADELAN SWASTA 2 0
DEDI KURNIAWAN P 0 0 35 K GUNUNG IRT 2 0
NUR HASANAH L 0 0 26 ROWO-MRAWAN SWASTA 2 0
AHMAD MURSIDI P 0 0 20 JEDING PELAJAR 1 0
YUDIANTO P 0 0 8 KLAYU PELAJAR 1 0
SUKARDI L 0 0 8 KLAYU PELAJAR 1 0
MUSTOFA P 0 0 10 KLAYU PELAJAR 1 0
PURWADI P 0 0 6 KRAJAN PELAJAR 1 0
WARSITO L 0 0 10 SIDOMUKTI SWASTA 2 0
TOYADI L 0 0 5 SIDOMUKTI SWASTA 2 0
SUGIONO P 0 0 5 SIDOMUKTI SWASTA 2 0
ABDUL L 0 0 5 SIDOMUKTI SWASTA 2 0
MUZANI P 0 0 5 SIDOMUKTI SWASTA 2 0
M AZKA P 0 0 5 SIDOMUKTI SWASTA 2 0
IFAN P 0 0 5 SIDOMUKTI SWASTA 2 0
MIFTAHUL P 0 0 5 SIDOMUKTI SWASTA 2 0
MASTHORI P 0 0 5 SIDOMUKTI SWASTA 2 0
MUHDIN P 0 0 5 SIDOMUKTI SWASTA 2 0
SISWANTO P 0 0 5 SIDOMUKTI SWASTA 2 0
SUCIPTO P 0 0 5 SIDOMUKTI SWASTA 2 0
ADNAN P 0 0 5 SIDOMUKTI SWASTA 2 0
ROSI P 0 0 6 SIDOMUKTI SWASTA 2 0
DAHLAN P 0 0 5 SIDOMUKTI SWASTA 2 0
IMAM P 0 0 6 SIDOMUKTI SWASTA 2 0
M TAUFIK P 0 0 5 SIDOMUKTI SWASTA 2 0
ABDUL P 0 0 5 SEMPOLAN SWASTA 2 0
YUDIANTO P 0 0 9 TEGALAN IRT 2 0
HABIBI L 0 0 9 KLAYU PELAJAR 1 0
ABD BASIR P 0 0 32 KRAJAN-SEPUTIH IRT 2 0
MULYADI P 0 0 26 KLAYU-MAYANG IRT 2 0
EKKI P 0 0 17 KLAYU-MAYANG IRT 2 0
HERYANTO P 0 0 29 KLAYU-MAYANG IRT 2 0
WAHYU HIDAYAT P 0 0 26 KRAJAN-MAYANG IRT 2 0
DEDI KURNIAWAN P 0 0 38 TETELAN-SEPUTIH IRT 2 0
AGUS TAUFIK P 0 0 24 ROWO-PAKUSARI IRT 2 0
ZAIMNUDIN P 0 0 32 KRAJAN-MUMBULSARI IRT 2 0
FAISOL ABRORI P 0 0 25 KRAJAN-MUMBULSARI IRT 2 0
MULYADI P 0 0 20 S WADUNG-HARJOMULYO IRT 2 0
FADLI P 0 0 28 KRAJAN IRT 2 0
HASAN L 0 0 18 KRAJAN KRAJAN 2 0
JUNAR P 0 0 29 KRAJAN IRT 2 0
HADI P 0 0 23 S KJAYAN IRT 2 0
JANUAR L 0 0 5 MRAWAN PELAJAR 2 0
WASILUDIN L 0 0 35 PAKUSARI TANI 2 0
YUDI L 0 0 8 KRAJAN PELAJAR 2 0
TOTOK P 0 0 33 KALISAT WIRASWASTA 2 0
ABDUL MUKID P 0 0 8 GAMBIRAN-KALISAT PELAJAR 2 0
SUNARDI P 0 0 46 SEPUTIH-MAYANG IRT 2 0
RIDWAN P 0 0 59 TJ REJO IRT 2 0

AHMADI L 0 0 53 MAYANG WIRASWASTA 2 0

IMAM BUHORI P 0 0 24 TAMAN SARI-MUMBULSARI IRT 2 0
BUDI P 0 0 24 KLAYU-MAYANG IRT 2 0
YUDI RAHMAN P 0 0 23 CURAH LAOS-LAMPEJI IRT 2 0
ZURNI P 0 0 41 MULYOREJO IRT 2 0
EKKI P 0 0 19 KLAYU-MAYANG IRT 2 0
NURUL HIDAYAT P 0 0 21 PRINGTALI-MRAWAN IRT 2 0
0P 0 0 25 MUMBUL IRT 2 0
0P 0 0 32 MUMBUL 2 2 0
DANDI L 0 0 8 KRAJAN SEPUTIH 0
EDI H. P 0 0 30 KARANG HARJO SWASTA 0 0

RIKO P. P 0 0 25 SUMBERKEJAYAN IRT 0 0

RIKO P. P 0 0 25 SUMBERKEJAYAN IRT 0 0

RIKO P. L 0 0 29 SUMBERKEJAYAN SWASTA 0 0

ERVAN L 0 0 33 KRAJAN-SIDOMUKTI TANI 2 0
FATHUR SUHDI L 0 0 18 JAMBUAN-PLALANGAN PELAJAR 0
FATHUR SUHDI P 0 0 25 JAMBUAN-PLALANGAN IRT 2 0
ALI P 0 0 7 KRAJAN-SEPUTIH PELAJAR 0
FARUQ P 0 0 7 TEGALAN S KJYAN 2 0

H SUWARDI P 0 0 50 S KEJAYAN IRT 0 0

B NISA P 0 0 74 KRAJAN SEPUTIH IRT 0 0
M DIDIK L 0 0 39 PLALANGAN SWASTA 0 0
AGUS JUNAIDI L 0 0 9 TETELAN PELAJAR 0 0
HENDRA P 0 0 4 KRAJAN SEPUTIH PELAJAR 0 0

ANDRIK P 0 0 20 KRAJAN SEPUTIH IRT 0 0

ASMUNI P 0 0 13 KRAJAN SEPUTIH PELAJAR 0 0

ISMAIL L 0 0 9 KLAYU PELAJAR 0 0
MUHAMMAD P 0 0 22 KRAJAN SEPUTIH PELAJAR 0 0
SUGIK L 0 0 6 JEDING PELAJAR 0 0
FIRMAN P 0 0 5 KRAJAN SEPUTIH PELAJAR 0 0

ABDUL ROHMAN L 0 0 7 KRAJAN SEPUTIH PELAJAR 0 0

AGUS JUNAIDI P 0 0 7 TETELAN PELAJAR 0 0
TOTOK SURYONO P 0 0 18 SEPUTIH-MAYANG PELAJAR 2 0
SITI ARIFAH P 0 0 23 KLAYU-MAYANG MAHASISWA 2 0
HERMANTO P 0 0 34 MAYANG IRT 2 0
ABDUL GANI L 0 0 9 SEPUTIH-MAYANG PELAJAR 2 0

FANI L 0 0 31 KRAJAN WIRASWASTA 2 0

YOYOK L 0 0 42 MAYANG WIRASWASTA 2 0
UMAR HIDAYATULLAL 0 0 21 PEJI TALANG-K KEDAWUNG PELAJAR 0 0

AHMADI L 0 0 53 KRAJAN-MAYANG WIRASWASTA 2 0

AHMAD MURSIDI P 0 0 20 ROWO-PAKUSARI WIRASWASTA 2 0

M RIDHO L 0 0 26 JATIAN-PAKUSARI WIRASWASTA 2 0

SALIM P 0 0 34 KRAJAN-MAYANG IRT 2 0

SAIFUL P 0 0 7 ROWO-PAKUSARI PELAJAR 0
ASNAWI P 0 0 10 KRAJAN-S KEJAYAN PELAJAR 0
SAMSUL ARIFIN P 0 0 10 KRAJAN-S KEJAYAN PELAJAR 0
SUKIRMAN L 0 0 68 KRAJAN-S KEJAYAN PENSIUNAN 1 0
ABDUL KOHAR P 0 0 47 G SUDA-MRAWAN IRT 2 0
HERI P 0 0 7 KRAJAN-K KEDAWUNG 0 0
0L 0 0 6 SEPUTIH-MAYANG 0 2 0
HOLILUR ROHMAN L 0 0 39 PRASIAN-JATIAN 0 2 0
ABDUS SALAM P 0 0 54 TEGALAN-S KEJAYAN 0 2 0
M SALIM P 0 0 7 KRAJAN-S KEJAYAN 0 0 0
JEKI L 0 0 7 KRAJAN-S KEJAYAN 0 0 0
ALUL P 0 0 8 KRAJAN-S KEJAYAN 0 0
AHAN KURNIAWAN P 0 0 9 KRAJAN-S KEJAYAN 0 0 0
FATHOR L 0 0 9 KRAJAN-S KEJAYAN 0 0 0
ALI HUSNI P 0 0 9 KRAJAN-T REJO 0 0
DONI P 0 0 8 KRAJAN-S KEJAYAN 0 0
SALEH P 0 0 9 KRAJAN-S KEJAYAN 0 0
SELAMET L 0 0 40 KRAJAN-PAKUSARI 0 2 0
SETYA DIRGANTARA L 0 0 10 KRAJAN-S KEJAYAN 0 0
BUYAMIN P 0 0 6 KLAYU-MAYANG 0 0
MOH HARIYANTO P 0 0 6 DAMSAOLA T REJO 0 0
DEDI SURYA L 0 0 7 KRAJAN T REJO 0 2 0
MUH AFDAN L 0 0 6 S JEDING-SEPUTIH 0 2 0
0P 0 0 12 KRAJAN-S KEJAYAN 0 0 0
0P 0 0 8 KRAJAN-S KEJAYAN 0 0 0
0P 0 0 10 KRAJAN-S KEJAYAN 0 0 0
0P 0 0 10 KRAJAN-S KEJAYAN 0 0 0
0P 0 0 9 KRAJAN-S KEJAYAN 0 0 0

SLAMET L 0 0 21 PEJI TALANG-K KEDAWUNG MAHASISWA 0 0

JOTO L 0 0 7 BUNDER-PAKUSARI PELAJAR 0 0
SUGIANTO L 0 0 7 ROWO MRAWAN PELAJAR 2 0
AHMAD FARIS P 0 0 6 L TOKO-MRAWAN 0 0 0
SAKUR P 0 0 37 KRAJAN-T REJO IRT 2 0
AHMAD HANAN P 0 0 9 PLALANGAN-T WARU PELAJAR 0
MULYADI L 0 0 44 KRAJAN-MAYANG PNS 1 0
LUDIYANTO L 0 0 7 KRAJAN-SEPUTIH PELAJAR 0 0
0P 0 0 7 MAYANG 0 0 0
MOH HODRI L 0 0 7 S JEDING-SEPUTIH PELAJAR 0 0
ABDUL ADIM L 0 0 15 LEDOK-SIDOMUKTI PELAJAR 0 0
0L 0 0 4 KLAYU - TEGAL WARU 0 0 0
RIBUT L # 0 20 KLAYU-MAYANG PELAJAR 0 0
AHMADI L 0 0 53 KRAJAN-MAYANG TANI 0 0
SUYANTO P 0 0 6 KRAJAN-MAYANG PELAJAR 0 0
JUNI L 0 0 8 KRAJAN-T REJO PELAJAR 0 0
IMAM HIDAYT L 0 0 8 KLAYU-MAYANG PELAJAR 0
Fathor rosi P 0 0 6 SUMBERKEJAYAN PELAJAR 0 0

AHMAD MISNAWAR L 0 0 19 S JEDING-SEPUTIH TAMBANG PASIR 0 0

MUFTI ALI L 0 0 40 KRAJAN-MAYANG KEPALA SEKOLAH 1 0
SRINATUN P 0 0 67 ROWO-PAKUSARI IRT 0 0
SUGIYANTO P 0 0 7 DAMSAOLA T REJO PELAJAR 0 0
SUMARWI P 0 0 35 S JEDING-SEPUTIH IRT 2 0
ABD HAMID L 0 0 7 KRAJAN-S KEJAYAN PELAJAR 0 0
SUDARJI N P 0 0 51 AJUNG-KALISAT GURU 1 0
ABD HAMID P 0 0 44 KRAJAN-S KEJAYAN IRT 2 0
NAIM L 0 0 6 S PAKEM-SEPUTIH PELAJAR 0 0
MUH JUNAIDI P 0 0 46 KLAYU-T WARU GURU 1 0
TOHARI L 0 0 9 KLAYU PELAJAR 0 0
ABDUS SOMAD P 0 0 7 KRAJAN-S KEJAYAN PELAJAR 0 0
ABDULLAH P DILA L 0 0 48 S PINANG-T REJO WIRASWASTA 2 0
SENIMAN P 0 0 55 MRAPEN-S KEJAYAN IRT 2 0
JUKIANTO P 0 0 6 KRAJAN-S KEJAYAN PELAJAR 0 0

KODRI P 0 0 25 KRAJAN-SEPUTIH IRT 2 0

ABDUL ADIM L 0 0 15 LEDOK-SIDOMUKTI PELAJAR 0 0

RIBUT L 0 0 20 KLAYU-MAYANG PELAJAR 0 0

SULI P 0 0 7 KLAYU-T WARU PELAJAR 0 0
LUTFI P 0 0 9 KLAYU MAYANG PELAJAR 2 0
DANDI L 0 0 7 TEGALAN-S KEJAYAN PELAJAR 2 0
ATIM L 0 0 40 KRAJAN-T REJO WIRASWASTA 2 0
SAKUR P 0 0 37 KRAJAN-T REJO IRT 2 0
0P 0 0 23 KLAYU MAYANG WIRASWASTA 2 0
FAUZAN P 0 0 25 KRAJAN-SEPUTIH IRT 2 0
HARTONO P 0 0 15 T GUSI-MAYANG PELAJAR 0 0
KISNALI P 0 0 39 IRT IRT 2 0
ABDUL HALIM P 0 0 7 KRAJAN-GAMBIRN PELAJAR 0 0
JUALA L 0 0 60 T GUSI-MAYANG TANI 2 0
LUTFI P 0 0 9 KLAYU MAYANG PELAJAR 2 0
SAIFUL L 0 0 9 TEGALAN-S KEJAYAN PELAJAR 2 0
MOH ARIK AGUSTIN L 0 0 7 S JEDING-SEPUTIH PELAJAR 1 0
KUSNADI P 0 0 6 T GUSI-MAYANG PELAJAR 0 0
HENDRA L 0 0 24 PLALANGAN-T WARU TANI 2 0
ZAENAL P 0 0 10 GAMBURAN KALISAT PELAJAR 2 0
TARYADI P 0 0 47 ROWO PAKUSARI IRT 2 0

0P 0 0 67 ROWO PAKUSARI IRT 2 0

SAI L 0 0 60 KLAYU MAYANG TANI 2 0
Err:509 L 0 0 28 PANDIAN SEPUTIH TANI 2 0
0P 0 0 8 S JEDING-SEPUTIH PELAJAR 2 0

0P 0 0 36 KLAYU TEGALWARU IRT 0 0

HARIYANTO P 0 0 13 KRAJAN SEPUTIH PELAJAR 0 0

Err:509 P 0 0 SIDOM
Err:509 PELAJAR 0 0

SUTRISNO P 0 0 20 ROWO-MERAWAN MAHASISWA 2 PERI

SUDARJI N P 0 0 51 AJUNG-KALISAT IRT 0 Err:
ABDUL ADIM L 0 0 15 LEDOK-SIDOMUKTI PELAJAR 1 0
SUBAIRI P 0 0 30 TEGALAN-S KEJAYAN IRT 2 PERI
HOJI P 0 0 7 KRAJAN-T REJO PELAJAR 1 CABU
0P 0 0 26 0 PELAJAR 1 0
ARIF CANDRA P 0 0 35 MRAPEN-S KEJAYAN IRT 1 0
EDIYANTO L 0 0 44 PLALANGAN-T WARU WIRASWASTA 2 0
Err:509 P 0 0 24 PANDIAN-SEPUTIH IRT 2 0
IMAM SAFII P 0 0 35 BURUH GUDANG Err:509 2 0
ALI WAFA P 0 0 6 ROWO-GAMBIRAN PELAJAR 1 0

RIBUT L 0 0 20 KLAYU-MAYANG PELAJAR 0 0

HAZIN HAMID L 0 0 44 S JEDING-SEPUTIH WIRASWASTA 2 0
Err:509 L 0 0 12 KRAJAN-GAMBIRN PELAJAR 1 0
MARYANTO P 0 0 KRAJAErr:509 0 0 0
ANDI L 0 0 8 S JEDING-SEPUTIH PELAJAR 1 CABU
SULI P 0 0 KLAYUErr:509 PELAJAR 1 0
ALIWAFA P 0 0 6 PLALANGAN-T WARU PELAJAR 1 0
Err:509 L 0 0 7 MRAPEN-S KEJAYAN PELAJAR 1 CABU
Err:509 L 0 0 50 MRAPEN-S KEJAYAN TANI 2 PERI
Err:509 L 0 0 6 KRAJAN-SIDOMUKTI 0 PERI
SULHAN P 0 0 10 S PINANG-T REJO PELAJAR 1 0
SAERI P 0 0 35 ROWO-MRAWAN IRT 2 PERI
MOH RIDWAN L 0 0 4 ROWO PAKUSARI PELAJAR 1 0
0P 0 0 7 ROWO-PAKUSARI PELAJAR 1 CABU

SUTRISNO P 0 0 20 ROWO-MRAWAN PELAJAR 2 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
SUNARTO p 0 0 KLAY Err:509 irt 2 PERI
HARTONO L 0 7 KLAYU-T WARU PELAJAR 1 0
ALEX KURNIAWAN L 0 0 4 ROWO-PAKUSARI 2 0
LUDIANTO L 0 0 6 KRAJAN-SEPUTIH PELAJAR 0
HOJI L 0 0 7 KRAJAN-T REJO PELAJAR 0
SUDARJI NUGROHO P 0 0 51 AJUNG-KALISAT GURU 1 0
SAMSUL MAARIF P 0 0 6 S PINANG-T REJO PELAJAR 1 0
HAZIM HAMID L 0 0 44 S JEDING-SEPUTIH WIRASWASTA 2 0
M JASULI L 0 0 39 GAMBIRAN-KALISAT TANI 2 0
KUSNADI P 0 0 7 TEGALAN-S KEJAYAN PELAJAR 0 0
PURYADI L 0 0 7 KLAYU-T WARU PELAJAR 0 0
HASIN P 0 0 8 ROWO-GAMBIRAN PELAJAR 0
RANDI P 0 0 21 KRAJAN-MAYANG IRT 2 0
ASAN P 0 0 6 TETELAN-SEPUTIH PELAJAR 1 0
HOFIT P 0 0 5 ROWO-PAKUSARI PELAJAR 1 0
SUNARTO 0 0 46 P KLAYU-MAYANG IRT 2 0
EKO P 0 0 24 KRAJAN-SIDOMUKTI IRT 2 0
SYAIFUR P 0 0 40 KLAYU-MAYANG IRT 2 0
SUTRISNO P 0 0 10 KLAYU-MAYANG PELAJAR 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
 Kode
Keluhan Diagnosa ICD-X Terapi
Peny

Tanggal
masuk
16 17 18 19 20 21
PERIKSA GIGI PERIODONTITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERIODONTITIS K04 20.05 MEDIKASI
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERIODONTITIS K05 20.06 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI HIPEREMI PULPA K02 20.03 TUMPAT ART
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI ABSES MANDIBULA K12.2 20.13 MEDIKASI
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN ART
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI PERIODONTITIS K05.2 20.06 KONTROL
PUSING,MUAL GINGIVITIS K05 20.06 SCALING
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL GANGREN RADIKS K04 20.05 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN

PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 KONSULTASI
PERIKSA GIGI PERIODONTITIS K05.2 20.06 MEDIKASI
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PERIODONTITIS K05 20.06 KONTROL
PERIKSA HAMIL GANGREN PULPA K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN

CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL [USG] GANGREN RADIKS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 MEDIKASI
PERIKSA GIGI PERIODONTITIS K05.2 20.06 MEDIKASI

CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN

CABUT GIGI ULKUS DECUBITUS K00 20.01 EKSTRAKSI CE
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 TUMPAT ART
PERIKSA GIGI HIPEREMI PULPA K02 20.03 TUMPAT ART
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K02 20.01 EKSTRAKSI CE
CABUT GIGI HIPEREMI PULPA K00 20.03 TUMPAT ART
CABUT GIGI PERSISTENSI K00 20.05 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI HIPEREMI PULPA K02 20.03 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K05 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI ABSES K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI HIPEREMI PULPA K02.1 20.03 TUMPATAN ART
PERIKSA GIGI HIPEREMI PULPA K02 20.01 MEDIKASI
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL PULPITIS K04 20.05 KONTROL
PERIKSA HAMIL GINGIVITIS K05 20.06 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI

PERIKSA GIGI PULPITIS K04 20.05 BASIS+TUMPAT ART

PERIKSA GIGI PULPITIS K04 20.05 TUMPAT ART
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING
PERIKSA GIGI GINGIVITIS K05 20.06 SCALING
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI GANGREN RADIKS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
TUMPATAN
PERIKSA GIGI HIPEREMI PULPA K02.1 20.03 SEMENTARA
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI
PERIKSA GIGI PERIODONTITIS K05.2 20.06 MEDIKASI
PERIKSA GIGI GINGIVITIS K05.2 20.06 SCALING
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

PERIKSA GIGI GANGREN PULPA K04 20.05 EKSTRAKSI LIDOKAIN

PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN ART
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
TUMPATAN
PERIKSA GIGI PULPITIS K04 20.05 SEMENTARA
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI

CABUT GIGI GANGREN RADIKS K04 20.05 EKSTRAKSI LIDOKAIN

PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 TUMPATAN ART
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

CABUT GIGI PULPITIS K04 20.05 EKSTRAKSI LIDOKAIN

CABUT GIGI PERSISTENSI K00 20.01 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
SAKIT GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 KONSULTASI
PERIKSA GIGI PERSISTENSI K00 20.01 KONSULTASI
PERIKSA GIGI ABSES K04 20.05 Medikasi
PERIKSA GIGI PULPITIS K04 20.05 KONSULTASI
PERIKSA GIGI PULPITIS K04 20.05 KONTROL
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
SAKIT GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara

SAKIT GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI GINGIVITIS K05 20.06 KONSULTASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERIODONTITIS K05 20.06 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

CABUT GIGI PERIODONTITIS K05 20.06 EKSTRAKSI LIDOKAIN

PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI

PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara

CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
SAKIT GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI
SAKIT GIGI PULPITIS K04 20.01 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.01 MEDIKASI

PERIKSA GIGI PERIODONTITIS K05 20.06 EKSTRAKSI LIDOKAIN

PERIKSA GIGI PERIODONTITIS K05 20.06 KONTROL
PERIKSA GIGI IMPAKSI K01.1 20.02 MEDIKASI
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL

PERIKSA GIGI PULPITIS K04 20.01 Tumpat sementara

PERIKSA GIGI PULPITIS K04 20.01 Tumpat sementara

PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL

Err:509 PULPITIS K04 20.01 Tumpat sementara

Err:509 PULPITIS K04 20.01 Medikasi
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
Err:509 PULPITIS K04 20.05 MEDIKASI
Err:509 PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 Medikasi
PERIKSA GIGI PULPITIS K04 20.05 Medikasi
PERIKSA GIGI PULPITIS K04 20.05 MEDIKASI
PERIKSA GIGI PULPITIS K04 20.05 Medikasi
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE

PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara

PERIKSA GIGI PULPITIS K04 20.05 KONTROL
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
Err:509 PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
Err:509 PERSISTENSI K00 20.01 EKSTRAKSI CE
Err:509 PULPITIS K04 20.05 KONSULTASI
Err:509 PERSISTENSI K00 20.01 KONSULTASI
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
Err:509 GINGIVITIS K05 20.06 SCALING
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
Err:509 PERSISTENSI K00 20.01 EKSTRAKSI CE

PERIKSA GIGI PULPITIS K04 20.05 Tumpat sementara

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
Err:509 Pulpitis k04 20.05 tumpatan ART
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.05 Medikasi
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PULPITIS K04 20.01 Medikasi
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERIODONTITIS K05 20.06 KONTROL
TAMBAL GIGI Pulpitis k04 20.05 tumpatan ART
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
TAMBAL GIGI Pulpitis k04 20.05 tumpatan ART
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
PERIKSA GIGI PERSISTENSI K00 20.01 KONTROL
PERIKSA GIGI Pulpitis k04 20.05 tumpatan ART
PERIKSA GIGI PULPITIS K04 20.05 Medikasi
PERIKSA GIGI Pulpitis k04 20.05 tumpatan ART
CABUT GIGI PERSISTENSI K00 20.01 EKSTRAKSI CE
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Hari Perawatan
Rujukan Status

Jen Kunj B,L

Peserta

Jenis Kasus
dari

Jenis kunj
Keterangan

Unit kes lain

Kader

Kategor
Keluar

Umum

kasus
(HP)

Bpjs
Tanggal

KLB

i
keluar
22 23 24 25 26 27 28 29 30 31 32 32 Keterangan
2 2 1 Jelas
1 2 Jelas
1 3 Jelas
1 4 Jelas
3 5 Jelas
1 6 Jelas
1 7 Jelas
1 8 L : Laki-laki
1 P : Perempuan

2 9 Jelas
2 10 Jelas
2 11 Jelas
1 12 Jelas
3 13 Jelas
1 14 1: Formal
2 2: Non formal
3 15 Jelas
1 16 Jelas
1 17 Jelas
1 18 Jelas

1 19 Jelas
1 20 Jelas
1 21 Jelas
3 22 Jelas
2 23 Jelas
2 24 1: Sembuh
2 2: Pulang paksa/APS
1 3: Dirujuk
1 4: Meninggal dunia <48 Jam

3 5: Meninggal dunia > 48 Ja

1 25 1 : Maternal
1 2: Neonatal
1 3: Balita
2 4: KLL
2 26 B : Baru
2 L : Lama
1 27 Jelas
1 28 1 : Dalam Wilayah
1 2: Luar Wilayah
2 29 1 : Dalam Wilayah
1 2: Luar Wilayah
1 3: SKM
1 30 1 : Dalam Wilayah

1 2: Luar Wilayah
1 31 Jenis kunjungan kasus
1 1: Baru
1 2: Lama
1 3: KKL
1 32 KLB
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
2
2

3
1

3
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
1
1
3
1
1
1
1
1
1
1

2
1
1
2
2
2
1
1
1
1
1

1
2

1
1
2
1
1
1

1
1
1
1
1

1
1
3
1
1

2
1
3
1
3
1

1
3
1

2
2

1
1
1
1
2
2
1
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
1
1
1
3
1
1
1
1
1
1
1
1
1
1
1
1
1

1
2
1
1
1
2
1
2
2
1
2
2
1
1
2

2
2

2
2
2
2
1
1
1
1
1
1
2
2
2
2
2
1
1
2
1

2
2
2
1

2
1

1
2
2
2
2
2
1
2
2
2
2

2
2
1
2
2
2
2
2
1
1
2
2
2
2

2
0
0
0
0
0
0
2
2
1
2
2
2
1
2
2
1
1
2
1
2
1
2
2
1
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 0
 Kategori HP

thn
bln

hr
BPJS SKM UMUM B

L P L P L P L
0 2 1 5 k00 1
0 2 1 11 k00.6 0
0 2 1 2 k01 0
0 2 1 6 k02 0
0 2 1 5 k03 0
0 2 1 11 k04 1
0 2 1 11 k04.1 0
0 2 1 5 k04.2 0
0 2 1 11 k04.3 0

0 2 1 5 k04.4 0
0 2 1 5 k04.5 0
0 2 1 5 k04.6 0
0 2 1 4 k04.7 0
0 2 1 7 k05 0
0 2 1 5 k05.1 0
0 2 1 5 k05.2 0
0 2 1 4 k05.3 0
0 2 1 2 k05.4 0
0 2 1 11 k06 0
0 2 1 11 k06.1 0

0 2 1 1 k07 0
0 2 1 5 k07.2 0
0 2 1 5 k08 0
0 2 1 5 k09 0
0 2 1 5 k10 0
0 2 1 5 k11 0
0 2 1 5 k12 0
0 2 1 5 k13 0
8 Jam 0 2 1 11 k14 0

8 Jam 0 2 1 5 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 6 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 11 0 0
0 2 1 11 0 0

0 2 1 5 0 0
0 2 1 11 0 0
0 2 1 6 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 4 0 0
0 2 1 5 0 0
0 2 1 4 0 0
0 2 1 5 0 0
0 2 1 5 0 0

0 2 1 7 0 0
0 2 1 2 0 0

0 2 1 5 0 0
0 2 1 11 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 4 0 0
0 2 1 11 0 0
0 2 1 11 0 0
0 2 1 5 0 0
0 2 1 0 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 11 0 0
0 2 1 11 0 0
0 2 1 3 0 0
0 2 1 2 0 0
0 2 1 3 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 2 0 0
0 2 1 11 0 0
0 2 1 11 0 0
0 2 1 5 0 0
0 2 1 0 0 0
0 2 1 4 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 0 0 0
0 2 1 5 0 0
0 2 1 4 0 0
0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 0 0 0
0 2 1 5 0 0
0 2 1 11 0 0
0 0 0 5 0 0
0 0 2 11 0 0
0 0 0 6 0 0
0 0 0 7 0 0

0 0 0 0 0 0
0 0 2 5 0 0
0 0 2 5 0 0
0 0 2 5 0 0
0 0 0 5 0 0
0 0 2 4 0 0
0 0 2 5 0 0
0 0 2 5 0 0
0 0 0 5 0 0
0 2 1 11 0 0
0 2 1 5 0 0

0 2 1 5 0 0
0 2 1 5 0 0

0 2 1 5 0 0
0 2 1 5 0 0
0 2 1 4 0 0
0 2 1 5 0 0
0 2 1 11 0 0
0 2 1 11 0 0

0 2 1 6 0 0
0 2 1 10 0 0
0 2 1 5 0 0
0 0 2 11 0 0
0 0 1 1 0 0

0 0 2 5 0 0

0 0 2 3 0 0
0 0 2 11 0 0
0 0 2 5 0 0
0 0 1 2 0 0
0 0 1 2 0 0

0 0 1 11 0 0
0 0 1 11 0 0
0 0 2 4 0 0
0 0 2 5 0 0
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2 1 1
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 1th - 4th 5th - 6th 10th -14th 15th - 19th

B L KL B L KL B L KL B L KL

P L P L P L P L P L P L P L P L P L P L P L P
0 1 0 0 0 6 10 2 4 0 0 2 6 0 3 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 15 25 0 0 0 0 0 1 0 1 0 0 3 4 2 1 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 2 5 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
 NO URUT ICD X Jenis Penyakit

01 I PENYAKIT INFEKSI PADA USUS

01.01 A 00 Kolera

01.02 A 01 Demam tifoid dan paratifoid

01.03 A 03 Shigellosis

01.04 A 06 Amoebiasis

01.05 A 08 Infeksi usus lain

01.06 A 09 Diare dan gastroenteritis (Colitis)

02 II PENYAKIT TUBERKULOSA

02.01 A 15 TB paru BTA +

02.02 A 16 TB paru klinis (rontgen +)

02.03 A 18 TB selain Paru (Extra Pulmonner)

02.04 TB ANAK (PK TB)

02.05 Tersangka TB Paru

03 III PENYAKIT BAKTERI

03.01 A 30 Kusta

03.02 A 33 Tetanus Neonatorum

03.03 A 35 Tetanus

03.04 A 36 Difteria

03.05 A 37 Batuk Rejan

03.06 A 48 Penyakit bakteri lain

04 IV INFEKSI AKIBAT HUBUNGAN SEKSUAL

04.01 A 53 Siphilis

04.02 A 54 Infeksi Gonokok

04.03 A 59 Trichomoniasis

04.04 A 60 Infeksi Anogenital Herpes Viral

04.05 A 63 Penyakit akibat hubungan seksual lainnya

05 V PENYAKIT VIRUS

05.01 A 80 Poliomielitis akut

05.02 A 90 DF (Demam Dengue)

05.03 A 91 DHF (Demam Berdarah Dengue)

05.04 B 00 Herpes Simplex

05.05 B 01 Cacar air

05.06 B 02 Herpes Zoster

05.07 B 05 Campak

05.08 B 19 Hepatitis virus

05.09 B 15 Hepatitis A

05.10 B 16 Hepatitis B

05.11 B 17.1 Hepatitis C

05.12 B 18 Hepatitis Viral Cronik

05.13 B 23 HIV

05.14 B 24 AIDS

05.15 A 90.2 Cikungunya

05.16 B 26 Parotitis

05.17 B 33 Penyakit virus lainnya

06 VI PENYAKIT JAMUR

06.01 B 35 Dermatofitosis

06.02 B 37 Kandidiasis

06.03 B 37.2 Candidiasis Kulit dan kuku

06.04 B 37.3 Candidiasis Vulva dan Vagina

06.05 B 49 Mikosis lainnya

07 VII PENYAKIT PROTOZOA

07.01 B 50 Malaria Tropika/mixed (P.Falciparum)

07.02 B 51 Malaria Tertiana (P.Vivax)

07.03 B 53 Malaria tanpa pemeriksaan Lab. (Malaria klinis)

07.04 B 58 Toxoplasmosis

08 VIII PENYAKIT KECACINGAN

08.01 B 74 Filariasis

08.02 B 77 Ascariasis

08.03 B 79 Trichuriasis

08.04 B 80 Enterobiasis

08.05 B 83 Penyakit Cacing lain

09 IX PEDIKULOSIS

09.01 B 85 Pedikulosis

09.02 B 86 Scabies

10 X NEOPLASMA MALIGNA

10. 01 C 07 Ca Kelenjar Parotis

10. 02 C 10 Ca Orofaring
10. 03 C 11 Ca Nasopharink

10. 04 C 18 Ca Colon

10. 05 C 20 Ca Rectum

10. 06 C 22 Ca Hepar

10. 07 C 34 Ca Paru

10. 08 C 41 Ca Tulang

10. 09 C 43 Ca Kulit

10. 10 C 50 Ca Payudara

10. 11 C 53 Ca Cerviks Uteri

10. 12 C 54 Ca Uteri

10. 13 C 61 Ca Prostat

10. 14 C 71 Ca Otak

10. 15 C 73 Ca Kelenjar Tiroid

11 XI NEOPLASMA BENIGNA

11.01 D 17 Lipoma

11.02 D 18 Hemangioma and Lymphangioma

11.03 D 22 Nevus pigmentosus

11.04 D 24 Fibro adenoma mammae

11.05 D 26 Myoma Uteri (Leher Rahim dan Rahim)

11.06 D 34 Pembesaran kelenjar Tiroid

11.07 D 36 Neoplasma benigna lain

12 XII ANEMIA

12.01 D 50 Anemia Defisiensi Besi

12.02 D 56 Thalassemia

12.03 D 59 Anemia Hemolitic di dapat

12.04 D 61 Anemia Aplastik Lainnya

12.05 D 62 Anemia Posthaemorrhagic akut

12.06 D 64 Anemia Lainnya

12.07 D 69 Purpura dan exanthema

13 XIII GANGGUAN ENDOKRIN, NUTRISI DAN METABOLIK

E 00 Gangguan Kekurangan Iodium Kongenital

E 01 Gangguan Kekurangan Iodium Non Kongenital (GondokGoiter)

13.01 E 10 Diabetes Mellitus (IDDM)

13.02 E 11 Diabetes Mellitus (NIDDM)

13.03 E 16. 2 Hipoglikemi

13.04 E 34 Gangguan endokrin lain

13.05 E 40 Kwashiorkor

13.06 E 41 Marasmus

13.07 E 42 Marasmus Kwashiorkor

13.08 E 56 Defisiensi Vitamin

13.09 E 66 Obesitas

13.10 E 73 Intoleransi Lakstosa

13.11 E 88 Gangguan Metabolik Lain

14 XIV GANGGUAN MENTAL DAN PERILAKU

14.01 F 03 Demensia

14.02 F 05 Delirium
Gangguan mental dan perilaku akibat penggunaan zat psikoaktif
14.03 F 19

14.04 F 20 Schizophrenia

14.05 F 23 Gangguan Psikotik Akut

14.06 F 29 Gangguan Psikotik nonorganik lain

14.07 F 41 Gangguan Kecemasan

14.08 F 44 Reaksi Konversi

14.09 F 45 Psikosomatis

14.10 F 48 Gangguan Neurotik Lain

14.11 F 51 Gangguan tidur nonorganik

14.12 F 60 Gangguan Kepribadian

14.13 F 79 Retardasi Mental

14.14 F 90 Hiperaktivitas pada anak

14.15 F 93 Gangguan Emosi pada anak

14.16 F 94 Gangguan fungsi sosial bermula pada anak

14.17 F 99 Gangguan jiwa lainnya

15 XV PENYAKIT SUSUNAN SYARAF

15.01 G 03 Meningitis

15.02 G 29 Sindroma Parkinson

15.03 G 41 Status Epilepticus

15.04 G 40 Epilepsi

15.05 G 43 Migraine

15.06 G 44 Sindroma nyeri kepala

15.07 G 47 Gangguan tidur

15.08 G 51 Gangguan Nervus Facial

15.09 G 62 Polyneuropathy

15.10 G 80 Cerebral Palsy

15.11 G81 Hemiplegi

15.12 G82 Paraplegi, tetraplegi

15.13 G 91 Hydrocephalus

15.14 G 95 Penyakit lain pada susunan tulang belakang

16 XVI PENYAKIT MATA DAN ADNEKSA

16.01 H 00 Hordeolum dan Chalazion

16.02 H 10 Konjuntivitis

16.03 H 11 Pterigium

16.04 H 16 Keratitis

16.05 H 18 Gangguan lain pada Kornea

16.06 H 25 Katarak

16.07 H 40 Glaukoma

16.08 H 50 Strabismus

16.09 H 52 Gangguan refraksi dan akomodasi

16.10 H 54 Kebutaan dan penurunan visus

16.11 H 57 Penyakit mata dan adneksa lain

17 XVII PENYAKIT PADA TELINGA DAN MASTOID

17.01 H 60 Otitis Eksterna

17.02 H 61 Cerumen

17.03 H 67 Otitis Media

17.04 H 70 Infeksi Mastoid (Mastoiditis)

17.05 H 72 Perforasi membran Tympani

17.06 H 90 Ketulian dan pendengaran menurun

17.07 H 92 Otalgia

17.08 H 93 Gangguan Lain pada Telinga

18 XVIII PENYAKIT PEMBULUH DARAH

18.01 I 10 Hipertensi primer

18.02 I 15 Hipertensi Sekunder

18.03 I 20 Angina Pektoris

18.04 I 21 Infark Miokard akut

18.05 I 49.9 Aritmia

18.06 I 50 Gagal jantung

18.07 I 64 Stroke

18.08 I 67 Penyakit Cerebrovasculer lain

18.09 I 80 Phlebitis dan thrombophlebitis

18.10 I 84 Hemoroid

18.11 I 87 Varises

18.12 I 95 Hipotensi

18.13 I 99 Gangguan Pembuluh darah lain

19 XIX PENYAKIT SISTEM PERNAFASAN

19.01 J 00 Common Cold/Nasopharyngitis Akut

19.02 J 01 Sinusitis

19.03 J 02 Faringitis akut

19.04 J 03 Tonsilitis Akut

Infeksi Akut lain pada saluran Pernafasan bagian atas
19.05 J 06

19.06 J 18 Pneumonia

19.07 J 20 Bronkhitis akut

Infeksi Akut lain pada saluran Pernafasan bagian bawah
19.08 J 22

19.09 J 30 Rhinitis alergi

19.10 J 32 Sinusitis

19.11 J 33 Nasal polip

J 35 Tonsilitis Kronis

19.12 J 36 Peritonsiler abses

J 39 Penyebab lain pada saluran pernapasan atas

19.13 J 44 COPD (Chronic Obstructive Pulmonary Disease)

19.14 J 45 Asma
19.15
J 46 Status asmatikus
J 98 Gangguan lain dari sistem pernafasan
19.16
PENYAKIT PADA RONGGA MULUT, GLANDULA SALIVARIUS DAN
XX RAHANG
20
20.01 K 00 Gangguan Perkembangan dan Erupsi Gigi

20.02 K 01 Gigi Terbenam dan Impaksi

20.03 K 02 Karies Gigi

20.04 K 03 Penyakit jaringan keras gigi lain

20.05 K 04 Penyakit Pulpa dan jaringan periapikal

20.06 K 05 Gingivitis dan Penyakit Periodontal

20.07 K 06 Gangguan Gusi dan Hubungan Alveolar tak bergigi lainnya

20.08 K 07 Anomali dentofasial (termasuk maloklusi )

20.09 K 08 Gangguan gigi dan jaringan penyangga lainnya

20.10 K 09 Kista di rongga mulut

20.11 K 10 Penyakit rahang lainnya

20.12 K 11 Penyakit Kelenjar Liur

20.13 K 12 Stomatitis dan Lesi-lesi yang berhubungan

20.14 K 13 Penyakit Bibir dan Mukosa Mulut Lainnya

20.15 K 14 Penyakit Lidah

21 XXI PENYAKIT SISTEM PENCERNAAN

21.01 K 27 Ulkus Peptikum

21.02 K 29 Gastritis

21.03 K 30 Dispepsia

21.04 K 35 Appendicitis

K 36 appendicitis Kronis rekuren

21.05 K 40 Hernia Inguinal / Scrotalis

K 42 Hernia Umbilikalis

k 56 Illeus Paralitik dan Obstruksi tanpa diikuti hernia

21.06 K 45 Hernia Abdominal yg lain

21.07 K 62 Penyakit pada Anus dan Rectum

21.08 K 65 Peritonitis

21.09 K 73 Hepatitis Kronik

K 74 Sirosis

21.10 K 76 Penyakit hati lainnya

21.11 K 80 Cholelithiasis

21.12 K 81 Cholecystitis

21.13 K 90 Malabsorbsi

21.14 K 92 Penyakit Sistem Pencernaan lain

22 XXII PENYAKIT KULIT

22.01 L 01 Impetigo

22.02 L 02 Abses, Furunkel dan Karbunkel

22.03 L 03 Cellulitis
 L 04 Acute Limpadenitis

22.04 L 08 Infeksi kulit dan jaringan sub kutan yang lain

22.05 L 20 Dermatitits atopik

22.06 L 21 Dermatitits Seboroik

L 22 Dermatitis Supervisial

22.07 L 23 Dermatitis kontak alergi

22.08 L 24 Dermatitis kontak iritan

L 25 Dermatitis Kontak Yang Tidak spesifik

22.09 L 29 Pruritus

22.10 L 30 Dermatitis lainnya

22.11 L 40 Psoriasis

22.12 L 42 Ptiriasis Rosea

22.13 L 43 Lichen Planus

22.14 L 50 Urtikaria

22.15 L 53 Eritema

22.16 L 60 Nail Disorders

22.17 L 63 Alopesia areata

22.18 L 70 Acne

22.19 L 80 Vitiligo

L 84 Klavus / Caplak

22.20 L 88 Pyoderma

L 89 Ulkus Dekubitus

22.21 L 93 Lupus Eritematosus

22.22 L 98 Penyakit kulit lainnya

Gigitan serangga

23 XXIII PENYAKIT OTOT DAN JARINGAN IKAT

23.01 M 06 Rheumatoid Arthritis

23.02 M10 Gout

23.03 M 13 Arthritis lain

23.04 M 15 Polyarthrosis

M 22 Gangguan Pada lutut

23.05 M 25 Gangguan sendi

23.06 M 30 Polyarteritis nodosa

23.07 M 33 Dermatopolymyositis
23.08 M 47 Spondylosis

23.09 M 62 Gangguan lain pada jaringan otot

M 79 Gangguan jaringan yang lain yang tidak spesifik

23.10 M 86 Osteomyelitis

23.11 M 89 Gangguan lain pada tulang

24 XXIV PENYAKIT SISTEM UROGENITAL

24.01 N 02 Hematuri

24.02 N 04 Sindroma Nefrotik

24.03 N 17 Gagal Ginjal Akut

24.04 N 18 Gagal Ginjal Kronis

24.05 N 20 Urolithiasis

24.06 N 23 Kolik Renal yang lain

24.07 N 28 Gangguan lain pada Ginjal dan Ureter

24.08 N 30 Cystitis

24.09 N 34 Urethritis

24.10 N 39 Penyakit Saluran Kencing lainnya

25 XXV PENYAKIT ORGAN GENITAL LAKI-LAKI

25.01 N 40 BPH (Benigna Prostate Hyperthrophy)

25.02 N 43 Hydrocele dan spermatocele

25.03 N 44 Torsi Testis

25.04 N 45 Orchitis dan epididymitis

25.05 N 48 Gangguan lain pada penis

26 XXVI PENYAKIT ORGAN WANITA

26.01 N 60 Dysplasia Mammae

26.02 N 61 Gangguan inflamasi pada mammae

26.03 N 64 Gangguan lain pada mammae

26.04 N 73 PID (Pelvic Inflamatory Diseases)

26.05 N 80 Endometreosis

26.06 N 81 Prolaps

26.07 N 84 Polip traktus genital

26.08 N 86 Erosi

26.09 N 91 Amenorea

26.10 N 92 Menometrorrhagi

26.11 N 94 Nyeri organ genital dan menstruasi

26.12 N 95 Gangguan pada masa Menopause

26.13 N 97 Infertilitas

26.14 N 99 Gangguan Sistem Genitourinaria lain

27 XXVII SEBAB KELAINAN KEBIDANAN LANGSUNG

27.01 O 00 Kehamilan Ektopik

O 01 Kehamilan Anggur

27.02 O 04 Abortus

27.03 O 14 Preeklamsia

27.04 O 15 Eklamsia

27.05 O 20 Pendarahan pada kehamilan

27.06 O 21 Hiperemesis Gravidarum

27.07 O 30 Kehamilan kembar

27.08 O 40 Polihidramnion

27.09 O 42 Ketuban Pecah Dini

27.10 O 44 Placenta Previa

27.11 O 48 Kehamilan serotinus

27.12 O 60 Partus Prematurus

27.13 O 63 Partus Lama

27.14 O 70 Laserasi perineum

27.15 O 71 Trauma Obstetric Lain

27.16 O 72 Perdarahan post partum

27.17 0 80 Persalinan tunggal spontan

27.18 0 83 Persalinan dengan kesulitan

27.19 0 84 Persalinan Kembar

27.20 O 92 Mastitis

O 72.0 Retensio Plasenta

Solutio Plasenta

27.21 O 97 Kematian Ibu akibat obstetrik langsung

28 XXVIII KEADAAN TERTENTU PADA MASA PERINATAL
28.01
P 07 BBLR

28.02 P 15 Trauma lahir

28.03 P 21 Asfiksia

28.04 P 57 Kuning Pada bayi Baru lahir (Kernicterus)

28.05 P 95 Lahir mati

28.06 P 96 Kondisi lain pada masa perinatal

29 XXIX KELAINAN KONGENITAL

29.01 Q 37 Bibir Sumbing

29.02 Q 69 Polydactily

29.03 Q 89 Kelainan Kongenital lain

SIMTOMATOLOGI DAN TANDA PADA SISTEM SIRKULASI DAN
30 XXX
RESPIRATORIUS
30.01
R 00 Suara jantung abnormal

30.02 R 04 Perdarahan dari saluran respirasi

30.03 R 05 Batuk

30.04 R 06 Pernafasan abnormal

30.05 R 07 Nyeri Dada

Simtom dan tanda lain pada sistem sirkulasi dan respirasi
30.06 R 09
SIMTOMATOLOGI DAN TANDA PADA SISTEM PENCERNAAN DAN
31 XXXI
ABDOMEN

31.01 R 10 Nyeri Abdomen

31.02 R 11 Nausea dan Vomitus

31.03 R 12 Nyeri Epigastrium

31.04 R 13 Disfagi

31.05 R 14 Meteorismus

31.06 R 15 Faecal incontinence

31.07 R 16 Hepatomegali dan splenomegali

31.08 R 18 Asites
Simtom dan tanda lain pada sistem pencernaan dan abdomen
31.09 R 19
32 XXXII SIMTOMATOLOGI DAN TANDA PADA SISTEM URINARIUS

32.01
R 30 Nyeri yang berhubungan dengan miksi
32.02
R 32 Inkontinensia Urine

32.03 R 33 Retensi urine

32.04 R 34 Anuria dan Oliguria

32.05 R 35 Poliuria

32.06 R 36 Urethral Discharge

32.07 R 39 Gejala lain pada sistem urinarius

32.08 R 50 Demam yang tdk diketahui sebabnya

33 XXXIII GEJALA DAN TANDA UMUM

33.01 R 50 Demam yang tdk diketahui sebabnya

33.02 R 51 Nyeri kepala

33.03 R 53 Malaise dan Fatigue

33.04 R 55 Syncope

33.05 R 56 Kejang

33.06 R 57 Shock

33.07 R 60 Oedem

33.08 R 61 Hiperhidrosis

33.09 R 64 Cachexia

34 XXXIV TRAUMA

34.01 S 09 Trauma Kepala

34.02 S 19 Trauma Leher

34.03 S 29 Trauma Dada

34.04 S 39 Trauma Perut, punggung bawah dan pelvis

34.05 S 49 Trauma Anggota Gerak Atas

34.06 S 89 Trauma Anggota Gerak Bawah

34.07 T 00 Luka Lecet

34.08 T 01 Luka Terbuka

34.09 T 03 Fraktur

34.10 T 04 Dislokasi

34.11 T 07 Trauma multiple

35 XXXV BENDA ASING

35.01 T 15 Benda asing di mata

35.02 T 16 Benda asing di telinga

35.03 T 17 Benda asing di saluran pernafasan

35.04 T 18 Benda asing di saluran makanan

36 XXXVI LUKA BAKAR DAN KOROSIF

36.01 T 20 Luka bakar dan korosi di kepala dan leher

36.02 T 22 Luka bakar di anggota badan atas

36.03 T 23 Luka bakar di pergelangan tangan dan tangan

36.04 T 24 Luka bakar di anggota badan bawah

36.05 T 25 Luka bakar di pergelangan kaki dan kaki

36.06 T 27 Luka bakar dan korosi di saluran pernafasan

36.07 T 28 Luka Bakar dan korosi di Organ Internal

36.08 T 31 Luka bakar dan korosi lainnya

37 XXXVII KERACUNAN
37.01 T 50 Keracunan Obat

37.02 T 60 Keracunan Pestisida

37.03 T 62 Keracunan Makanan

37.04 T 65 Keracunan substansi lain

Z 04.1 Pemeriksaan Kehamilan

LAPORAN BULANAN KEGIATAN PUSKESMAS
USAHA KESEHATAN GIGI DAN MULUT PUSKESMAS

Bulan : OKTOBER
Tahun : 2016

I JUMLAH KUNJUNGAN PUSKESMAS (DALAM GEDUNG)

1 Kunjungan baru rawat jalan bumil
2 Kunjungan lama rawat jalan bumil
3 Kunjungan baru rawat jalan Apras (5-6th)
4 Kunjungan lama rawat jalan Apras (5-6th)
5 Kunjungan baru rawat jalan balita (1-5th)
6 Kunjungan lama rawat jalan balita (1-5th)
7 Kunjungan baru rawat jalan Masyarakat umum
8 Kunjungan lama rawat jalan Masyarakat umum
9 Kunjungan baru rawat jalan dalam gedung
10 Kunjungan lama rawat jalan dalam gedung
11 Kunjungan gratis dengan rincian
a. BPJS
b. SPM
c. Anak sekolah
d. Lain-lain
II KESEHATAN SEKOLAH
1 Jumlah murid SD UKGS Tahap I yang telah dapat paket promotif
2 Jumlah murid SD UKGS Tahap II yang telah dapat paket preventif
3 Jumlah SD UKGS Tahap I yang dibina
4 Jumlah SD UKGS Tahap II yang dibina
5 Jumlah kunjungan petugas ke TK
6 Jumlah kunjungan petugas ke SD UKGS
7 Jumlah murid SD yang diperiksa
8 Jumlah murid SD yang perlu perawatan
9 Jumlah murid SD yang diobati
III PELAYANAN MEDIS DASAR KESEHATAN GIGI
1 Tumpatan tetap (amalgam) pada gigi permanen
2 Tumpatan tetap (ART) pada gigi permanen
3 Tumpatan tetap (ART/amalgam) pada gigi sulung
4 Pencabutan Gigi permanen :
a. Karena kerusakan
b. Karena sebab lain
5 Pencabutan Gigi sulung
6 Pengobatan pulpa (perawatan syaraf gigi)
7 Scalling
8 Lain-lain perawatan gigi dan mulut/tanpa tindakan
9 Kasus gigi yng dirujuk ke RSUD
 10 Tumpatan sementara
11 Operasi kecil/Incisi abses
IV UPAYA KESEHATAN GIGI MASYARAKAT DESA (UKGMD)
1 Jumlah desa yang dibina
2 Jumlah kunjungan ke desa (posyandu)
3 Jumlah masyarakat umum yang mendapat pelayanan gigi
4 Jumlah ibu hamil yang dilayani di posyandu
5 Jumlah balita yang dilayani di posyandu
V Kegiatan pelayanan ASKES
1 Jumlah Pemegang KTP yang berobat
2 Jumlah Anggota yang berobat
3 Jumlah KTP pensiunan yang berobat
4 Jumlah anggota keluarga pensiunan yang berobat
5 Jumlah penderita askes yang dirujuk ke Rumah sakit
VI PENDAPATAN KEUANGAN
Jumlah pendataan tindakan medis terdiri dari :
1 Pencabutan Gigi dengan komplikasi
2 Tumpatan ART
3 Operasi kecil/Incisi abses
L P jumlah
0 25 25
0 12 12
24 42 66
1 3 4
3 2 5
0 0 0
57 77 134
28 44 72
84 146 230
29 59 88

22 44 66
0 0 0
36 49 85
53 114 167

3 9 12
1 1 2

4 6 10
0 0 0
36 54 90
0 0 0
1 6 7
57 118 175
0 0 0
10 11 21
0 0 0

2 2 4
LB DATA KESAKITAN GIGI

BULAN : OKTOBER

1-4th 5-9th 10-14th 15-19th 20-44th

No KODE B L KKL B L KKL B L KKL B L KKL B L
L P L P L P L P L P L P L P L P L P L P L P L P L P L
1 k00 1 0 1 0 0 0 25 37 11 0 0 0 2 6 0 3 0 0 0 0 0 0 0 0 0 0 0
2 k00.6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 k01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 k02 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
5 k03 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 k04 1 2 0 0 0 0 17 27 1 0 0 0 0 1 0 1 0 0 3 4 2 1 0 1 11 28 11
7 k04.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 k04.2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 k04.3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 k04.4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 k04.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 k04.6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 k04.7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 k05 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 14 1
15 k05.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 k05.2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
17 k05.3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 k05.4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 k06 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 k06.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 k07 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 k07.2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 k08 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 k09 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 k10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 k11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 k12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 k13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 k14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20-44th 45-54th 55-59th 60-64th 65-69th >70th
L KKL B L KKL B L KKL B L KKL B L KKL B L KKL
P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 2 4 5 4 0 3 0 0 0 1 0 0 2 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70th
KKL
P
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
LAPORAN BULANAN KEGIATAN PUSKESMAS
USAHA KESEHATAN GIGI DAN MULUT PUSKESMAS

Bulan :
Tahun :

I JUMLAH KUNJUNGAN PUSKESMAS (DALAM GEDUNG)

1 Kunjungan baru rawat jalan bumil
2 Kunjungan lama rawat jalan bumil
3 Kunjungan baru rawat jalan Apras (5-6th)
4 Kunjungan lama rawat jalan Apras (5-6th)
5 Kunjungan baru rawat jalan balita (1-5th)
6 Kunjungan lama rawat jalan balita (1-5th)
7 Kunjungan baru rawat jalan Masyarakat umum
8 Kunjungan lama rawat jalan Masyarakat umum
9 Kunjungan baru rawat jalan dalam gedung
10 Kunjungan lama rawat jalan dalam gedung
11 Kunjungan gratis dengan rincian
a. BPJS
b. SPM
c. Anak sekolah
d. Lain-lain
II KESEHATAN SEKOLAH
1 Jumlah murid SD UKGS Tahap I yang telah dapat paket promotif
2 Jumlah murid SD UKGS Tahap II yang telah dapat paket preventif
3 Jumlah SD UKGS Tahap I yang dibina
4 Jumlah SD UKGS Tahap II yang dibina
5 Jumlah kunjungan petugas ke TK
6 Jumlah kunjungan petugas ke SD UKGS
7 Jumlah murid SD yang diperiksa
8 Jumlah murid SD yang perlu perawatan
9 Jumlah murid SD yang diobati
III PELAYANAN MEDIS DASAR KESEHATAN GIGI
1 Tumpatan tetap (amalgam) pada gigi permanen
2 Tumpatan tetap (ART) pada gigi permanen
3 Tumpatan tetap (ART/amalgam) pada gigi sulung
4 Pencabutan Gigi permanen :
a. Karena kerusakan
b. Karena sebab lain
5 Pencabutan Gigi sulung
6 Pengobatan pulpa (perawatan syaraf gigi)
7 Scalling
8 Lain-lain perawatan gigi dan mulut/tanpa tindakan
9 Kasus gigi yng dirujuk ke RSUD
 10 Tumpatan sementara
11 Operasi kecil/Incisi abses
IV UPAYA KESEHATAN GIGI MASYARAKAT DESA (UKGMD)
1 Jumlah desa yang dibina
2 Jumlah kunjungan ke desa (posyandu)
3 Jumlah masyarakat umum yang mendapat pelayanan gigi
4 Jumlah ibu hamil yang dilayani di posyandu
5 Jumlah balita yang dilayani di posyandu
V Kegiatan pelayanan ASKES
1 Jumlah Pemegang KTP yang berobat
2 Jumlah Anggota yang berobat
3 Jumlah KTP pensiunan yang berobat
4 Jumlah anggota keluarga pensiunan yang berobat
5 Jumlah penderita askes yang dirujuk ke Rumah sakit
VI PENDAPATAN KEUANGAN
Jumlah pendataan tindakan medis terdiri dari :
1 Pencabutan Gigi dengan komplikasi
2 Tumpatan ART
3 Operasi kecil/Incisi abses
L P jumlah
BULAN : April 2016

1-4th 5-9th 10-14th

No KODE B L KKL B L KKL B L KKL

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
 LB DATA KESAKITAN GIGI

15-19th 20-44th 45-54th 55-59th

B L KKL B L KKL B L KKL B L
55-59th 60-64th 65-69th >70th
KKL B L KKL B L KKL B L KKL