FORMAT PENCATATAN PELAPORAN HASIL

PEMERIKSAAN KESEHATAN CALON JAMAAH HAJI 2016

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REKAPITULASI HASIL PEMERIKSAAN KESEHATAN CALON JAMAAH HAJI TAHAP PERTAMA
Puskesmas : BANTARSARI
Kabupaten : CILACAP

UMUR KESIMPULAN
TGL HASIL PEMERIKSAAN KATEGORI KETERANGAN
No NAMA CALON HAJI PEKERJAAN ALAMAT DOMISILI

OBSERVASI

TUNDA
MANDIRI

PENGAWASAN
L P PERIKSA (No PORSI)
DIAGNOSA KLINIS KODE ICD-X

1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 WARNO MUKHLASIN BIN HADI MULYO 64 Petani Jakatawa 01/10 Blk Bts 24/02/2016 Senility R54 P
2 NGATIJEM BIN DULAH WARDI 65 Petani Jakatawa 01/10 Blk Bts 24/02/2016 Senility hypercholesterolaemia R54 E78.0 P
3 YULIARTI BINTI ZARKASIH AHMAD DIRSAD 54 Swasta Petenangan 02/03 Bts Bt 24/02/2016 Obesity hypercholesterolaemia E66 E78.0 P
4 SUTRISNO BIN SARJU'I SURAJIWA 56 PNS Petenangan 02/03 Bts Bt 24/02/2016 HT HHD I10 I51.9 P
5 ANIS BAROROH BINTI SAMSURI 45 Pedagang Rawakeling 02/01 Rwj Bt 24/02/2016 Obesity E66 P
6 SUPARMAN HOZALI BIN MOHAMAD HOZAL 50 Pedagang Rawakeling 02/01 Rwj Bt 24/02/2016 HT Obesity hyperglyceridemia I10 E66 E78.1 P
7 NGADISAH BINTI WIRYO MAMAD 64 Pensiunan Karangreja 05/03 Blk Bts 24/02/2016 Senility HT R54 P
8 WALUYO ADI SISWOYO BIN MARMO WIYOT 65 Pensiunan Karangreja 05/03 Blk Bts 24/02/2016 Senility HT hyperglyceridemia R54 I10 E78.1 P
9 MAD SYAEFI MADRAWI BIN MADRAWI 76 Petani Cimeneng 01/08 Kml Bts 24/02/2016 Senility HT R54 I10 P
10 AKHMAD KHUSEN BIN SABIHIS 80 Petani Sidadadi 02/06 Blk Bts 24/02/2016 Senility HT R54 I10 P
11 TITI BINTI ABDUL SANGID 65 Petani Sidadadi 02/06 Blk Bts 24/02/2016 Senility HT Anemia R54 I10 D64.9 P
12 SLAMET RIYADI BIN SANMARDI 52 Pedagang Agraria 01/05 Bts Bts 24/02/2016 KP A16.0 P
13 SITI ZAENAB BINTI KHOLIFAH 63 Petani Kebogoran 02/10 Kml Bt 24/02/2016 Senility HT Obesity R54 I10 E66 P
14 MUNIRUDIN BIN WASBIR SOBARI 65 Petani Sitinggil 05/03 Rwj Bts 24/02/2016 Senility R54 P
15 SUMINAH BINTI SAHROMI DULATIP 51 Petani Sitinggil 05/03 Rwj Bts 24/02/2016 KP A16.0 P
16 JARIYEM BINTI SARAJI WIRAWIJAYA 53 Petani Sitinggil 10/04 Rwj Bts 24/02/2016 Obesity hyperglyceridemia E66 E78.1 P
17 SANIYAH BINTI MADKANAN KRAMAWIRANA 75 Petani Cimeneng 01/08 Kml Bts 24/02/2016 Senility HT Anemia LVH HHD R54 I10 D64.9 I51.7 I51.9 P
18 ACHMAD CHUZIN BIN MUCHLASIN 30 Swasta Rawakeling 03/02 Rwj Bt 24/02/2016 Z00 Z00 P
19 TUKIYEM BINTI SANAWI WIRAMENAWI 57 Petani Rawakeling 03/02 Rwj Bt 24/02/2016 HT Obesity hyperglyceridemia I10 E66 E78.1 P
20 KAMISAH BINTI NURYADI KRSUDI 41 Pedagang Tambakreja 03/06 Bin Bt 24/02/2016 Obesity hyperglyceridemia E66 E78.1 P
21 TUJIMAN PUJIANTORO BIN MADSUWARDI 46 Pedagang Tambakreja 03/06 Bin Bt 24/02/2016 hyperglyceridemia E78.1 P
22 SAMSUL ANWAR WARIDIN BASRI BIN MA 44 Petani Cimeneng 06/07 Kml Bts 24/02/2016 Obesity hyperglyceridemia E66 E78.1 P
23 JARIYAH BINTI AMIN ANWARI 55 Pedagang Mulyadadi 04/04 Kml Bts 24/02/2016 hyperglyceridemia E78.1 P
24 SYAYID MA'RUF AL SAYIDI BIN MUHAMAD 60 Pedagang Mulyadadi 04/04 Kml Bts 24/02/2016 Senility hyperglyceridemia R54 E78.1 P
25 SYAFAAT JAZULI BIN MUHAMAD SUHEDI 57 Petani Agraria RT 02 RW 05 Bant 24/02/2016 hypercholesterolaemia E78.0 P
26 WARSINAH BINTI DULAH MUHAMAD 75 Petani Agraria RT 02 RW 05 Bant 24/02/2016 Senility HT HHD hypercholesterolaemi R54 I10 I51.9 E78.0 P

Mengetahui, Cilacap, 18/05/2016

Kepala UPT Puskesmas Bantarsari

H. Tulus Aji Yuwono, SKM, MKes dr. Muhammad Hasan Budi S

NIP : 19610620 198207 1 001 NIP : 19710303 200906 1 005