Data pasien dengan diagnosa PRB

DATA PASIEN DENGAN DIAGNOSA PRB YANG MENDAPATKAN OBAT DARI FKTP
BPJS KESEHATAN DIVISI REGIONAL IV

KANTOR CABANG BEKASI
NAMA FKTP : PUSKESMAS SETU I

KODE FKTP: 10140601
Bulan : 4 Januari 2016
DATA PESERTA
No No. Kartu BPJS DIAGNOSA
Nama Pasien
Kesehatan
1 GILANG R 1659371152 TB PARU
2 ANAH 490633479 TB PARU
3 MARSONO 1447336146 FARINGITIS ACUTE
4 ENTAY 490293966 ASMA BRONCHIALE
5 SULISTIYATI 1477897481 MYALGIA
6 MIMIN 489915663 CHF
7 ESIN 1462366045 LYPOMA
8 ABD MANAF 1646795215 DERMATITIS
9 SUHAENI 1011209332 PRESBYOPIA
10 SANEM 1472802366 CEPHALGIA
11 SUMARNINGSIH 1440347319 GASTRITIS
12 RICKY 1862918188 GONORE
13 ANOH 1886785108 GASTRITIS
14 UDIK P 1281036813 CALCULUS OF KIDNEY
15 TIANUR 1284835498 SCHIZOFRENIA
16 ARIF 1650563853 MYALGIA
17 DICKY 1814240597 GE
18 M WAJIB 1906654612 TB PARU
19 CICIH 1461689188 ISPSA
20 DEDE S 1717451807 MYALGIA
21 LILIS M 1793627717 DERMATITIS

22 ABDULN KODIR 47763922 FARINGITIS ACUTE
23 BUDI S 1476746212 PRESBIOPIA
24 WIDARWATI 1840348304 DM
25 ST HINDUN 47769208 GASTRITIS
26 RAHMAT SOLEH 1621685452 KONSULTASI
27 NURHAYATI 725545501 COLISITITIS
28 H ABDURAHMAN 1271160268 ABSES
29 OMAH 1261765157 BP
30 UMAY 1645858078 ASSMA BRONCHIALE
31 SIMAH 1011189903 DM
32 YOYOH 47576171 MYALGIA
33 DEA AULIA 1788900535 DEMAM
34 SUNARTI 1888949529 CEPHALGIA
35 TUMPUN 1906652878 FARINGITIS ACUTE
36 YOAMA 1716803886 GASTRITIS

KODE FKTP: 10140601
BULAN 5 Januari 2016
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 GEMOY 1463614773 LYMPHADENOPHATY
2 WINDI AYUM 1455816475 TB PARU
3 SUMISIH 44095623 DM
4 NIAN 1516470085 GASTERITIS , FARINGITIS
5 ENING 1260294827 CEPALGIA
6 TB DEDEN A 1336733 LYMPHADENOPHATY
7 AIMAN SUKARTA 490753359 GASTERITIS ,CRONIS
8 AMIN FAUZI 1643504545 HAARDEOLUM
9 BUNYAMIN 72436094 CHF
10 NURFITRI 1648008595 DERMATITIS INFECTSI
11 PAHIRA DP 1641976121 FARINGITIS
12 RICKY DWI 1255914191 TALASAMIA
13 KARSIH 489313258 MYALGIA
14 HARNILA 1158111494 GASTERITIS
15 AMA WASMA 72984835 MYALGIA
16 YOYOH MARDIAH 47576171 MYALGIA
17 KARMIN 1462369623 FARINGITIS ,HIPERYENSI
18 SRIMULYATI 1429980131 MYALGIA
19 JERICO 1475960624 DERMATITIS
20 ARIPAH 1876949548 DERMATITIS
21 ASANAH 1876951012 BATUK
22 NARSIH 489796716 GASTERITIS
23 LINDAWATI 1454504297 CRF
24 HENDRIYETI 1278893856 CHF
25 AQILHA FATHA 1380955329 TB PARU
26 H RUJITO 1263835888 HEMIPLEGI
27 UJANG 1965792221 DISLIPEDEMIA
28 SRI YUNINGSIH 72377109 GASTERITIS
29 ELA MARYANI 1630549866 PRESBIOPIA
30 ATIN FIRMANSYAH 1893128499 FRAKTUR

KODE FKTP: 10140601
Bulan : 2 JANUARI 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 NURYANI 72703348 CHF
2 MARJUKI 490138571 ASMA BRONCHIALE
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
32
33
34
35

KODE FKTP: 10140601
Bulan 5 januari 2016
DATA PESERTA
No DIAGNOSA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36
37
38
39
40
41
42
43
44
45

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36
KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36
37

KODE FKTP: 10140601
10-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36
37
38
KODE FKTP: 10140601
12-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34

KODE FKTP: 10140601
13-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1
2
3
4
5
6
7
8
9
10
11
12
13
14

KODE FKTP: 10140601
14-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36

KODE FKTP: 10140601
BULAN 16 NOPEMBER 2015
DATA PESERTA
No No. Kartu BPJS
DIAGNOSA
Nama Pasien
Kesehatan
11/16/2015
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
32
33
34

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36

KODE FKTP: 10140601
BULAN 18NOPEMBER 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
35
36
37
38
39
40

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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

KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
Kesehatan
1
2
3
4
5
6
7
8
9

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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

KODE FKTP: 10140601
Bulan 24-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

KODE FKTP: 10140601
Bulan 125-Jan-16
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

KODE FKTP: 10140601
Bulan 126-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
KODE FKTP: 10140601
Bulan januari 2016
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
11/27/2015
1
2
3
4
5
6
7
8
9
10
11
12
13
14

KODE FKTP: 10140601
28-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1
2
3
4
5
6
7
8
9
10
11
12
13
14
KODE FKTP: 10140601
30 N0P 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
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
32
33
34
Petugas Penanggungjawab Program BPJS
dr. Suhaimi
Nip.1965090620003005
NGAN DIAGNOSA PRB YANG MENDAPATKAN OBAT DARI FKTP
RUJUKAN
OBAT RS TUJUAN
Spesialis Non Spesialis
KONSUL
P PARU RS MITRA MEDIKA

OBH 3X1,AMOX 3X1,PCT 3X1,BC 3X1
OBH 3X1,SALBUTAMOL 3X1,ASMEF 3X1
ASMEF 3X1,BC 3X1,SIMVASTATIN 1X1
P JANTUNG RSUD KAB BEKASI

P BEDAH RSUD KAB BEKASI
P KULIT RS H GW
P MATA RSUD KAB BEKASI
P SYARAF RS H GW
P DALAM RS H GW
P KULIT RS H GW
PCT 3X1,ANTASID 3X1,RANITIDIN 2X1,BC 3X1
P URO RSUD KAB BEKASI

P JIWA RSUD KAB BEKASI
ASMET 3X1 BC 3X1 VIT B1 3X1 PRED 3X1
COTRI D 2X2 ,SPASMINAL 3X1 CTM 3X1 BC 3X1
P ANAK RS MITRA MEDIKA

PCTT EX1 CTM 3X1 AMBROXOL 3X1
B1 3X1 ALUPURINOL 3X1 KSLIUM D 2X1
AMOX 3X1 CTM SK BACITRACIN 1
AMOX 3X1 PCT 3X1 BC 3X1 OBH SY
P MATA RS MITRA MEDIKA

BC 3X1 RANITIDIN 2X1 METPORMIN 3X1 SIMPASTATIN 1X1
PCT 3X1 RANITIDIN 2X1 ANTASID 3X1 BC 3X1
P DALAM RS H GW
PCT 3X1 BC 3X1 DEX 3X1
P PARU RSUD KAB BKS

KONSULTASI
ASMET 3X1 METFORMIN 3X1 BC 3X1
KALIUM D 2X1 RANITIDIN 2X1 BVC 3X1
P ANAK MITRA MEDIKA

PCT 3X1 BC 3X1 RANITIDIN 2X1
ASMET 3X1 C 3X1
ANTASID 3X1 PCT 3X1 RANITIDIN 2X1 BC 3X1 OBH SY

RUJUKAN
OBAT RS TUJUAN
P PARU RS H GW
P DLM RSUD KAB BKS
PCT 3X1 ANTASID 3X1 RANITIDIN 2X1 OBH SY
ASMET 3X1 PRITAGESIK 3X2 BC 3X1 OBH SY
P PARU RSUD KAB BKS

P DLM RS MEDIROSA
SM MATA DEX 3X1 AMOX 3X1
RUSUD KAB BKS

P KULIT RS H GW
PCT 3X1 AMOX 3X1 OBH SY
P ANSK RS CENTRA MEDIKA

BC 3X1 RANITIDIN 2X1 KALIUM D 2X1
PCT 3X1 BC 3X1 ANTASID 3X1 RANITIDIN 2X2
KALIUD 2X1 B C 3X1
KALIUD 2X1 ASMET 3X1 BC 3X1
TM CLOROMPENICOL
ASMET 3X1 BC 3X1
CTM 3X1 SK BACITRACIN 1
CETIRIZIN 1X1 DEX 3X1 SALICIL TALK
PCT 3X1 CTM 3X1 GG 3X1
PCT 3X1 ANTASID 3X1 RANITIDIN 2X1
PDLM RS ANNA
P JNTNG RSUD KOTA BKS
P ANAK RSUD KOTA BKS
P SYARAF RS KARYA MEDIKA
SIMPASTATIN 1X1 ASMET 3X1 B1 E3X1
P DLM RS RAWA LUMBU

P MATA RS H GW
P ORT RS HGW
RUJUKAN
OBAT RS TUJUAN

RUJUKAN
OBAT RS TUJUAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
OBAT RUJUKAN
RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
RUJUKAN
OBAT RS TUJUAN
Kepala Puskesmas Setu I
H. Agus Sarin, S.AP

Nip. 196507041987031010
DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALIS
Bulan : OKTOBER 2015
Diagnosa
No Nama Pasien Nomor BPJS
No Spesialis No
TOTAL
*Note : Alasan dirujuk diisi dengan :
kontrol ulang
Tindakan Medis
Keterbatasan Obat
Lanjutan ke RS Khusus / tingkat III ( contoh: pasien jiwa yg harus ke rs jiwa

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
9/5/2015
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat
Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis ICD X No
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

No Nama Pasien Nomor BPJS Diagnosa

TOTAL
kontrol ulang

TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat


TOTAL


TOTAL


TOTAL


TOTAL


TOTAL 5
kontrol ulang
Tindakan Medis
Keterbatasan Obat
N NON SPESIALIS
RS Tujuan Alasan Dirujuk*

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS
Non Spesialis
N NON SPESIALIS
RS Tujuan
Non Spesialis
N NON SPESIALIS
RS Tujuan
Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis
N NON SPESIALIS

Non Spesialis ICD X
AN NON SPESIALIS

Non Spesialis ICD X
N NON SPESIALIS

Non Spesialis ICD X
N NON SPESIALIS

Non Spesialis ICD X
N NON SPESIALIS

Non Spesialis ICD X
N NON SPESIALIS

Non Spesialis ICD X
N NON SPESIALIS

Non Spesialis ICD X
N NON SPESIALIS

Non Spesialis ICD X
Bulan : SEPTEMBER 2015
Diagnosa
No Spesialis No
1 adang zaenal 72613585 1 non insulin dependent dm w/unsp
2 engkos 1801385482 2 allergic contact dermatitis,unsp
3 indra gunawan 1634995427 3 cystitis,unsp
4 sri hadi 1862213422 4 myalgia
5 samson sri 1451483638 5 bacterial intestinal infection
6 ely eryanti 1444404936 6 conduct hear loss unilat unresring contralat side
7 maman nurochman 72570857 7 1
8 ati misati 72570868 8 myalgia
9 hartati 1169397742 9 epilepsy,unsp
10 m rizal 1516214678 10 dislocatiom,sprain and strain of unsp body region
11 rindon rusmana 1869970735 11 mastoiditis,unsp
12 damara rida 72431649 12 thyrotoxicosis,unsp
13 omah 1261765157 13 spinal stenosis
14 sumisih 44095623 14 non insulin dependent dm without complication
TOTAL 13 1
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
2 9 2015
1 rasmi 1257674433 1 insulin dependent dm w/ comp
2 najma kamilah 1290166773 2 benign lipomatous neopl skin
3 St maryam 18615944828 3 presbyopia 3
4 sumariyah 72563545 4 TB of lung bacteriologically
TOTAL 3 1
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
3 9 2015
1 NURHAYATI 1327041033 1 CHF
2 NURHAYATI OOOOO72554501 2 ULCERATIVE COLITIS,UNSPECIFED
3 POVI 72320229 3 EPILEPSY
4 RONI PELIK RONAL 72282317 4 1
5 ANING 1452158728 5 CRONIIC NEAL FAILURE UNSPECIFED
9/4/2015 6
1 RATU ADE HERDIANI 1320673549 7 ACUTE SYNDROME,UNSPECIFED
2 Alkamah komalasari 157272851 8 ATHEROSCLEROSIS OF OTHER ARTERIES
3 ANNI NS 1169828662 9 CHRONIC GASTRITIS,UNSPECIFIED
4 AKIRA KORI 46476213 10 CHF
5 NANI WARYANI 1637937292 11 CHRONIC NEPHRITIC SYNDROME,UNSPECIFIED
6 CICI UTAMI 1861624326 12 MALIGNANT NEOPLASM,STOMACH,UNSPECIFIED
7 ST MARYAM 1465484196 13 ACUTE NEPHRITIC SYNDROME,UNSPECIFIED
8 SHINTA SUSILAWATI 1301758143 14 CHRONIC SINUSITIS,UNSPECIFIED
9 FAKHRI MUHAMMAD 1631092331 15 ORCHITIS EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS WITHOUT ABCESS
TOTAL 14 1
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
9/5/2015
1 rosmawati 1379331459 1 other chronic thryroiditis EO6.5
TOTAL 1
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
7 9 2015
1 TRI ANGGORO 1862317348 1 DISLOCATION OF ELBOW UNSPECIFED
2 ST MARYAM 1465484196 2 ACUTE NEPROTIC,SYNDROME,UNSPECIFED
3 ENAN JUANA 72722092 3 ,HEARING LOSS,UNSPECIFED H91
4 ASMUNIH 1433322966 4 CATARACT,BILATERAL H25.2
5 M RAMDANI 1289574821 5 INTRACRANIAL INJURI,UNPECIFED
6 ENJU SUHERMAN 4903322013 6 HEARTDISEASE,UNSPECIFED
7 ST HALIMAH 1434571222 7 INSULIN DEPENDENT DM WITHOUT COMPLICATION
TOTAL 7
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
8 9 2015
1 ELITA MALIDA 1457172696 3 FOLLICULAR CYST OF OVARY
2 SUKEMI 1849285866 1 UNSTABLE ANGINA
3 UTAR DJUANDA 72432753 1 CONGESTIVE HEART FAILURE
4 IPAH 490189364 3 unspecified chronic bronchitis
5 tumiar samosir 13527909 3 myalgia
6 daulat pasaribu 13527898 1 non insulin depend dm w/comp
7 mochamad ibrohim 1422805162 1 tb of lung bacteriologocally
8 sanin 55604272 1 mylgia.other site
9 eti hartati 490293505 3 alergic contact dermatitis,unsp
10 armaen 489997236 1 CONGESTIVE HEART FAILURE
11 sopian 1149293495 1
12 FATHIR RAHMA 1193657433 4 ACUTE TONSILITIS,UNSP
13 ILHAM MAYA 1634479683 1 tb of lung bacteriologocally
14 ABDURAHMAN HAILI 1816432885 1 THYROTOXICOSIS,UNSP
TOTAL

Diagnosa
No Spesialis No
9 9 2015
1 NEWIN 115960505 1 TB OF LUNG. CONFIRMED BY UNSP MEANS
2 DEWI SRIJAYANTI 173553671 2 APLASTIC ANAEMIA,UNSP
3 ZAINUDIN 73044325 3 CALCULUS OF LOWER URINARY TRACT,UNSP
4 MULYADI ANAS 1336762462 4 TB OF LUNG. CONFIRMED BY UNSP MEANS
5 YUSUF HIDAYAT 14614495564 5 KELOID SCAR
6 ROSITA 1428069778 6 NON INSULIN DEPEND DM W/ COMP
7 LILIS BT KARMIN 1865473975 7 NON INSULIN DEPEND DM W/ COMP
8 YUYUNANINGSIH 72389259 8 HYPERTENSION,STAGE
9 FEBRI RAHMAWATI 72303502 9 FEVER UNSP
TOTAL 9
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
10 9 2015
1 Ratu ade 1329678549 1 myalgia
2 kemikem 101907281 2 myalgia, lower leg
3 sri yugiarti 1806756636 3
4 omasih 1390398783 3 external haemorroids w/ comp
5 povi amelia fajar 72320229 5 primary oligomenorhoea
6 aqilha 1380955329 6 TB lung bact and histological examin not done
TOTAL 6 1
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
11 9 2015
1 yudi 1126854764 1 cataract
2 hendriyeti 1278893856 2 congestive heart failure
3 tuti setia 1464787719 3 headache
TOTAL 3
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
12 9 15
1 siti muflikha 1264135094 1 gastric ucler, acute haemorhage or perforation
2 yani nurhayati 1314579543 2 epilepsi
TOTAL 3
kontrol ulang
Tindakan Medis
Keterbatasan Obat
Diagnosa
No Spesialis No
14 9 2015
1 sabin 1463143353 1 thyrotoxicosis,unsp
2 gede surya 1456998298 1 tb of lung bacteriologically & histolog'y neg
3 ilman hafidz 1837551543 4 depressive episode,unp
4 cahyadi 1440961942 1 acute cytitis
5 udur novi 1799929405 3 tb of lung bacteriologically & histolog'y neg
6 rujito 1263835888 1 stroke, not specified as haemorrhage or infartion
7 yuyum bt muhi 1465612209 3 tb of bones and joins
8 marsudiono 2339947369 1 unsp renal colic
9 lilis alawiyah 72451157 3 tb of bones and joins
10 enur 1469799527 1 hyperplasia of prostate
11 bambang 38874161 1 myalgia.lower leg
12 siti nuraliah 1264137805 3 external haemorrhoid w/ comp
13 partiyah 1340101113 1 thyrotoxicosis,unsp
14 gerry 55401513 4 other injuries of unsp body region
15 marlon 1306035033 4 schizophrenia,unsp
TOTAL
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
15 9 15
1 zainudin 73044325 1 bronchophenemonia,unspeciefied
2 KARTINAH 1422985454 2 MYALGIA
3 FIRMAN SYAEFULLOH 1660175367 3 Tubercolosis of lung bacteriologicalldan histology neg
4 SURIAH 1791649383 4 CHF
5 UNTUNG ANDIKA 1830167032 5 CHRONIC GASTRITIS,UNSPECIFIED
6 H MUHADI PADTMO ATMODJO 1832582529 6 CHF
7 HJ SURYATI MUHADI 1832582542 7 CHF
8 GERRY ANGKARA 55401513 8 OTHER INJURIES OF UNSPECIEFIED BODY REGION
9 GEDE SURYA ATMAJA 1456998296 9 Tubercolosis of lung bacteriologicalldan histology neg
TOTAL 9

Diagnosa
No Spesialis No
16-Sep-15
1 JUMIN 1880864526 1 BILATERAL FEMORAL HERNIA,WHIT OBTRUCTION,WHTHOUT GANGRENE
2 M LUTFI TANJUNG 1290605444 2 DEVELOPMENTAL DISORDER OF SPEECH AND LANGUANGE,UNSPECIFIED
3 ENEN SERTIKA NENGSIH 72562904 3 CHF
4 HENDRIK 480025586 4 TUBERCULOSIS OF LUNG,BACTERIOLOGICALLY &
5 DARMO 1379487238 5 STROKE,NOT SPECIEFIED AS HAEMORRHAGE OF INFARCTION
6 NURSIA 44559279 6 ACUTE MYOCARDITIS,UNSPECIFIED
7 BUDI SANTOSO 1476746212 7 CHF
8 SYAFRUDDIN 1301553314 8 OTHER SPECIEFIED ARTHRITIS, PELVIC/THIGH
9 M NASIR NURRAHMAN 1461315712 9 SCHIZOPHRENIA,UNSPECIFIED
TOTAL 9
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
9/17/2015
1 hj komariah 1434568803 1 non insulin depend dm without complication
2 anyi 1462484834 2 non insulin depend dm without complication
3 ranah herawati 1804054026 3 myalgia ,upper am
4 sulistiowati 47769388 4 3
5 siti muflikha 1254136094 5 CHF
6 anton hl tobing 1854546287 6 chronic gasteritis unspecifed
7 bunawan 73159773 7 myalgia lower
8 akira kori 46476213 8 CHF
TOTAL 8
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
9/18/2015
1 kristian adi 1379997472 1 frakture of lower end of femur
2 nursia 44559279 2 non hodgkir,s lymphoma ,unspecifed type
3 R RRETNO HAYATI 1258454248 3 myalgia lower leg
4 ALIFA KHANSA 1642124507 4 epilepsy unspecifed
5 DEWI SARTIKA 1439324008 5 benign neoplasm of breast
6 wahyu rintan 1641900576 6 chronic sinusitis,unsp
7 mimin 1192267585 7 cataract,letf
8 saan sanjaya 1624302797 8 acute hep b without delta agent
9 arifin 1472717608 9 congestive heart failure
TOTAL 9
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
No Spesialis No
9/19/2015
1 ahmad muslih 72451282 1 schizophenia unspecifed F20
2 JUWANTO 1624309762 2 paratyphoid fever ,unspecifed A01
3 HAMIDIN 1478142461 3 CHF I50
TOTAL 4
kontrol ulang
Tindakan Medis
Keterbatasan Obat

Diagnosa
9/21/2015
1 AHMAD MUSLIH 72451282 1 SCHIZOPHRENIA F 20
2JUWANTO 1624309762 2 FEVER UNSPECIFED A01
3 OOM ZAENAL MUKAROM 1472750087 3 BENIGN NEOPLASMA OF UNSPECIFED D 36.9
4 H IDRIS SYAPEI 47766709 4 PRIMRY ARTHROSIS OF OTHER JOIRITS UNSPECI
5 SUMIYATI ALAWIYAH 143080122 5 SEBORH0EIC DERMATITIS UNSPECIFED L21.9
6 LINNIATI 1263836373 6 CATARACT BILATERAL H25
7 SUSILANTO 1273218704 7 CATARACT,LET H25
8 SUDARSIH 1670882301 8 CHF I50
9 SUPAD 43960432 9 CHF I50
TOTAL 10
kontrol ulang
Tindakan Medis
Keterbatasan Obat
DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALI


9/22/2015
1 LIMHANA 1454477556 1 UNSPECIFED DM WITHOUT COMPLICATIONS E11.9
2 WAHIDIN 0-001454537215 1 CHF I50
3SUHAENI 1192661379 3 tubercolosis lung bed and histological examin not done A 15
4 BASYARIA 1257225513 1
5 SURYADI 00-01460839072 1 CHF I50
6 ZUBAEDAH 000-14366031184 3 ACUTE APPENDICITIS UNSPECIFED K35.9
7 asiah 1808829821 3 CHF I50
8 maria as sidabutar 1406683618 1 MALIGNANT MELANOMA OF TRUNK
TOTAL
kontrol ulang

23 9 2015
1 wili ade 1011196236 1 conussion,withoutopen wound
2 MUHIDA MUCTHAR 72330838 2 BENIGN NEOPLASMA,BOES OF SKULL AND FACE
TOTAL 2
kontrol ulang
Tindakan Medis
Keterbatasan Obat


9/25/2015
1 DWIIPURWATI 1868851157 1 DEPOMITY OF FINGER M20
2 RICKY 1862918188 2 MENTAL DESONDER ,NOS G40
3 SHELA SALSABILAS 1640067873 3 DISONDER OF EXTERNAL EAR,UNSPECIFED
4 BONAH NURAENI 1663265585 4 ACUTE AND SUBCUTE HEPATIC FAILURE K.72.0
5 LUTFI ADHY LASMANA 173029083 5 CHF I 50
TOTAL 5


9/26/2015
1 NANI 18017256924 1 UNSPECIGFED DM WITHOUT COMPLICATIONS E11.9
2 SITI AISAH 1341360707 2 HEADACHE
3 ahmad chirudin 1622679412 3 disonder of skin and subcutaneous fissue unspecifed
4 SUTIN SUSY 1308716673 4C H F I 50
5 AISYAH 1294559717 5C H F I50
6 MUHAMAD ALWAN Y 1294582364 1
TOTAL 5 1


9/28/2015
1 IPAH 000-0490189364 1 CHRONIC RENAL FAILURE ,UNSPECIFED N 18
2 ILMAN HAFIDZ 1837551543 2 MENTAL DISONDER F99
3 DEDY SOYANDI 1793663636 3 FRACTURE OF CLAVIDE CLOSED S .42
4 BUDI SANTOSO 1476746212 4 OTHER ENDOPHTHALMITIS
5 ROSNELLY 1810949139 5 RHEUMATISM,UNSPECIFED M79
6 ABAS 1290244318 6 SNILE INCIPIENT CATARACT H25
7 SOLICHUN 1461887572 7 HYPERTENSION,STAGE I10
8 AHMAD MUSLIH 72451 8 SCHIZOPHRENIA UNSPECIFED F20
9 TIANUR PAKPAHAN 1284835498 9 PARANOID SCHIZPHRENIA F 20
10 MARYATI 1260632585 10 CRONIC SINUSITIS UNSPECIFED J 32
11 PITHER SAMOSIR 1339900975 11 GASTRODUODENITIS ,UNSPECIFED K29
12 SARI NURYATI 72431638 12 ACUTE APPENDICITIS,UNSPECIFED K 35.9
13 NELI SUPRIYENTI 1795186157 13 TUBERCOLOSIS PERPHERAL LYMPHADENOPATHY A16
TOTAL 13


9/29/2015
1 KASMUD JUNAEDI 72614788 1 TBC OF LUNG l bacteriologically dan histology neg a 16
2 NASMAINI MANIK 1848822221 1 CARDIAC,ARHYHMIA ,UNSPECIFED
3 CAHYA FEBRIAN 1646947697 4 CARDIAC,ARHYTHMIA,UNSPECIFED
4 SITI AISAH 1456623494 1 Tubercolous peripheral lymhadenopathy
5 RATNA WATI TAMPUBOLON 1854547637 3 HYPERTENSION,STAGE 1 I 10
6 KUSWANTI 1304762321 3 Malignat neoplasm,central pontion of breast
7 liniati 1263836373 3 unspecifed cronic bronchitis j 42
8 berlin arthur ps 1308386799 4 dislocation of toe s 93.9
9 ROHANI 1473254684 1 INSULIN DEPENDENT DM WITHOUT COMPLICATION E 10
10 SAIP 46480623 1 UNSPECIFED CRONIC BRONCHITITIS J42
11 REFIA 1451219872 4 CH F I50

12 SITI ARIFAH 1311945662 1 BENIGN NEOPLASM,ADRENAL GLAND
TOTAL


9/30/2015
1 ruri nurapiyanti 1631969616 1 disonder of external ear,unspecifed h 61
2 SARAH ALIYAH ANUGRAH 1848898473 2 VITILIGO l 80
3 MAYA HS 976022897 3 NON INSU;LIN DEPENDET DM WITHOUT coplication E11
4 SAKOEN 82203366 4 NON INSU;LIN DEPENDET DM WITHOUT coplication E11
5 SUMIYATI ALAWIYAH 14331080122 5 OEDEMA UNSPECIFED R 60.9
TOTAL 5
kontrol ulang
Tindakan Medis
Keterbatasan Obat
UKAN SPESIALIS DAN NON SPESIALIS
Diagnosa
Non Spesialis
rs bhakti kartini/P dalam kontrol ulang
rs rw lumbu/P kulit kontrol ulang
rs hermina gw/P kulit kontrol ulang
rs hermina gw/P dalam kontrol ulang
rs rw lumbu/P anak kontrol ulang
rs hermina gw/P THT kontrol ulang
presbyopia rsud kota bekasi/P mata kontrol ulang
rsud kota bekasi/P Dalam kontrol ulang
rsud kota bekasi/P syaraf kontrol ulang
rsud kab bekasi/P ORT kontrol ulang
rsud kab bekasi/P THT kontrol ulang
rsud kab bekasi/P dalam kontrol ulang
rsud kab bekasi/Bedah syakontrol ulang
rsud kab bekasi/P dalam kontrol ulang

Diagnosa
Non Spesialis
RSUD KOTA BEKASI

RSUD KAB BEKASI
presbyopia RSUD KAB BEKASI
RS MITRA MEDIKA
1

Diagnosa
Non Spesialis
P JANTUNG RSUD KOTA BKS

P DALAM RS H G W
P PSIKIATER RS H G W
PRESBIOPIA P MATA RS HG W
URO RSUD KAB BKS
URO RS H G W
P JANTUNG RS H G W
P DALAM RSUD KOTA BKS
P JANTUNG RSUD KAB BKS
P URO RSUD KAB BKS
P BEDAH RS H G W
P URO RS H G W
P THT RS BHAKTI HUSADA
P URO RS KARYA MEDIKA
1

Diagnosa
Non Spesialis

Diagnosa
RS Tujuan
Non Spesialis
P ORT RS H GW
P DALAM RS H G W
P THT RSUD KAB BKS
P MATA RS RAWA LUMBU
P SYARAF RS H G W
P DALAM RS CIBITUNG MEDIKA

Diagnosa
RS Tujuan
Non Spesialis
RS HERMINA GW
RSUD KOTA BEKASI
RSUD KAB BEKASI
RSUD KOTA BEKASI
RSUD KOTA BEKASI
RSUD KOTA BEKASI
RSUD KAB BEKASI
rs bakti kartini
rs rawa lumbu
RSUD KAB BEKASI
myopia RS HERMINA GW
RS HERMINA GW
RS HERMINA GW
RS HERMINA GW

Diagnosa
Non Spesialis
RS MITRA MEDIKA KONTROL ULANG

RSUD KAB BEKASI KONTROL ULANG
RSUD KOTA BEKASI
RS HERMINA GW
RS BHAKTI KARTINI
RS HERMINA GW
RS HERMINA GW

Diagnosa
Non Spesialis
rs hermina gw
rs hermina gw
asthma rsud kab bekasi keterbatasan obat
rs hermina gw
rs hermina gw
rsud kota bekasi
1

Diagnosa
Non Spesialis
rs karya medika
rsud kab bekasi
rs rawa lumbu

Diagnosa
Non Spesialis
rs hermin gw
rs sentra medika kontrol ulang
Diagnosa
Non Spesialis
rs hermina gw
rs rawa lumbu
rsud kab bekasi
rs hermina gw
rs rawa lumbu
rs karya medika
rs hermina gw kontrol ulang
rsud kab bekasi kontrol ulang
rsud kota bekasi kontrol ulang

Diagnosa
Non Spesialis
RSUD KOTA BKS P PARU KONTROL ULANG
RS H GW PSYARAF KETERBATASAN OBAT
RS KARTIKA HUSADA P DLM KONTROL ULANG
RSUDKABBEKASI POLI JAN KONTROL ULANG
RS MITRA MEDIKA KONTROL ULANG
RS HGW POLI JANTUNG KONTROL ULANG
RS HGW POLI JANTUNG KONTROL ULANG
RS HGW POLI ORT
RS RAWA LUMBU POLI DA KONTROL ULANG

Diagnosa
Non Spesialis
RS HGW POLI BEDAH KETERBATASAN ALAT

RS HGW POLI ANAK
RS MEDIROSA P JANTUNG KONTROL ULANG
RS MITRA MEDIKA P PARU KONTROL ULANG
RS CENTRA MEDIKA P SARKONTROL ULANG
RSUD KOTA BEKASI KONTROL ULANG
RSUD KOTA BEKASI POLI KONTROL ULANG
RS HGW, P SARAF

Diagnosa
Non Spesialis
RS aprilia P DLM kontrrol ulang

RS rawa lumbu P DLM kontrol ulang
RS mitra medika P SYARAF keterbatasan obat
presbyopia RS aprilia mata keterbatasan alat
RS ud kab bks Pjantung kontrol ulang
RS karya medika PDLM keterbatasaan obat
RS UD KAB BKS P SYARAF kontrol ulang
RS BH KARTINI PJANTUNG kontroll ulang

Diagnosa
Non Spesialis
RSUD KOTA BKS ORT

RSUD KOTA BKS p DLM kontrol ulang
RS RAWA lumbu P SYARAF kontrol ulang
RS H G W P ANAK
rs karya medika kontrol ulang
rs karya medika
rsud kab bekasi
rs aprilia kontrol ulang
rsud kab bekasi
Diagnosa
Non Spesialis
RSUD KAB BKS RUJUK LANJUT

rs hgw p dalam keterbatasan alat
RS H G W P JANTUNG KONTROL ULANG
Diagnosa
Non Spesialis ICD X
RSUD KAB BKS PJIWA KONTROL ULANG

RS H G W P DLM KETERBATASAN ALAT
RSUD KAB BKS P SYARAF KONTROL ULANG
RSUD KOTA BKS P SYF KONT ROL ULANG
RS H G W P DLM
RS KARYA M P MATA
RS H G W P MATA
RS H G W
RSUD KOTA BEKASI
KAN SPESIALIS DAN NON SPESIALIS
Diagnosa RS Tujuan Alasan Dirujuk*

Non Spesialis ICD X
RS H G W P.DLM
RS KARYA MDK
RS APRILIA P PARU
MY0PIA H 52 RSUD KAB BKS P MATA KETERBATASAN ALAT
RSUD KOTA BKS
RS MEDIROSA BKS
RS H G W P. JANTUNG
RS H G W P BEDAH

Non Spesialis ICD X
RSUD KAB BKS

RSUD KOTA BKS

Non Spesialis ICD X
Rrs H G W P BEDAH
RSUD KAB BKS P JIWA
RS H G W P.THT
RS H G W P DLM
RS UD KOTA BKS P JTNG

Non Spesialis ICD X
RSUD KAB BKS PDLM

RS H G W P SYRF
RS APRILIA M PBEDAH
RS H G W P JNTNG
RSUD KAB BKS PJNTNG
MYOPIA H52 RSUD KAB BKS P MATA
1

Non Spesialis ICD X
RSUD KOTA P HEMODIALISSA

RSUD KAB BKS P SYRF
RS H G W ORT
RSUD KAB BKS PMATA
RS KARYA MEDIKA P DLM
RS RW LM B P MATA
RS APRILIA P DLM
RSUD KAB BKS P JIWA
RSUD KAB BKS P JIWA
RSUD KAB BKS P TH T
RS HOSANA MEDICAL LIPO PDALAM
RS RW LMB P BEDAH
RSUD KAB BKS P PARU

Non Spesialis ICD X
RS MITRA MEDIKA P PARU

RS H G W P JNTNG
RS H G W P JNTNG
RSUD KAB BKS P PARU
RS MITRA MEDIKA PDLM
rs ud kab bks
RS KARYA MEDIKA PDLM
RS H G W ORT
RS H G W P DLM
RS MITRA MEDIKA P PARU
RS UD KAB BKS P ANAK

RS H G W P BEDAH

Non Spesialis ICD X
RS H G W P THT
RS H G W P KULIT
RS H G W P DLM
RS APRILIA P DLM
RS H G W P SYARAF
POLI UMUM
KODE FKTP: 10140601
Bulan : 1 OKTOBER 2015
No DATA PESERTA
No. Kartu BPJS DIAGNOSA OBAT
Nama Pasien
Kesehatan
1 yuyum binti muhi 1466612209 TB TULANG
2 ASEP RUSDI 72290384 CHF
3 Engkah 489455019 TB of lung bacteriolgicallyaand histologiccal
4 AMUNG stroke ,not specifed as haemorhage or infection
147894367
5 SUMARNINGSIH 1443347319 MYALGIA
6 GDE EKA ANANTA WIJAYA orchitis ,epiicymitis and epididymo orchitis without abscess
1338889353
7 sanusi 72752837 CHF
8 MARLON PUTRULAN mental and behavioural disorder due to use of hallucnogens
1306035033 ,acute intoxication
9 WIDI ASTUTI 1483170063 CHRONIC MAXILLARY SINUSITIS
10 MUHAMAD RAFLY SYABAN 1514783913 MYOPIA
11 YAKINO 72558551 OLD MYOCARDIAL INFARCTION
12 SRI BUDIARTI
72538683
13 SUKAENAH Kaliumdiklopena 2x1, bc3x1,pct 3x1
1471896378 MYALGIA
14 M GILANG Pct 3x1,Amox 3x1 ,VIT BC3X1
1616596468 FARINGITIS ACUT
15 WALUYO 1463113754 TB PARU
KONTROL
16 RAYHAN Sanadryl syr 3x1,amox 3x1,pct 3x1,antasid 3x1

1293885808 FARINGITIS ACUT
17 SURIAH Cetirizin 2x1,pct 3x1,bc 3x1
1791649383 DERMATITIS
18 SUMIYATI KONSULTASI
1431080122 SUSP.OEDEM
19 DIAN SUKMAWATI ZALP HIDRO 3X1
20 SUPAR SALP KETOKONAZOL 3X1,CTM 3X1,BC 3X1,AMOX 3X1
21 NASRUL SAGITA 182614597 BATUK CEK BTA
22 JAANIH ANTASID 3X1,AMOX 3X1,OBH 3X1,BC 3X1

1625054916 GASTRITIS KRONIS
23 RAFLY SYABAN SANADRYL SYR 3X1,AMOX 3X1/2,PCT 3X1/2
1514763913 DEMAM
23 MUMUN AMOX5003X1,PCT 3X1 ,VIT BC3X1
489815897 TONSILITIS
24 HARYANTO AMOX 5003X1VIT BC3X1 ASAMFENAMAT 3X1

POLI UMUM

KODE FKTP: 10140601
No DATA PESERTA
Nama Pasien
Kesehatan
1 ASEP RUSDI 72290384 C H F
2 Siti Marwiya 1839396655 myalgia kaliumdiklopena 2x1 ,vit bc 3x1
3 MIRAH 210486789 GASTERITIS Antasi 3x1,pct 3x1 vitb6 3x1
4 RIZKY DWI HARTANTO 1255914191 Faringitis acute WINASAL SYR ,AMOX 3X1,PCT 3X1
5 Neneng 1819216113 MYALGIA aasampenamat 3x1 bcomc 1x1 ,piroxicam 2x1
6 KUSNADI AMLODIPIN 1X1 KALIUMDIKLOPENA 2X1,SIMPASTATIN 3X1,

1819215066 Hipertensi DEX 3X1
7 OMAH METPORMIN 3X1 CTM 3X1 BC 3X1,ANTASID 3X1
1261765157 DM
8 Erna zelita 1789328812 BRONCHITIS
9 yayan m 72732958 UNSPECIFED chronic bronchitis
10 MERIYANTI 1387797862 BELL,S PALSY
11 POVI AMALIA FAJAR 72320229 EPILEFSI ,UNSPECIFED
12 EROM 1831727158 C H F
13 BUNYAMIN 72436094 C H F
14 WAHIIDIN 1454537215 C H F
15 SUHAENI 1192661379 UNSPECIFED CHRONIC BRONCHITIS
16 SITI LES TARI 142811715 CRONIC GASTERITIS ,UNSPECIFED
17 EMAD BUFAKRIS SYR ,3X1,ASAMFENAMAT 3X1 DEX 3X1 PCT 3X1
1148112641 ASMA BROCHIALE
18 Drdindjari sarasih 73333552 dermatitis sk gentamicin selcomc 1x1 ,cloratadin 1x1
19 YUKILAH ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,VIT BC 3X1
1632519264 GASTERITIS ACUTE
20 FADLAN SANADRIL SYR AMOX 250 3X1 ,PCT 3X1/2 SALBUTAMOL 3X1/2
1192661381 FARINGITIS ACUTE
21 SUHAEMI 1192661379 ASMA BROCHIALE SANAD RIL SYR 3X1PCT 3X1 BC 3X1
22 EVA.S 1635423998 myalgia ASMEF 3X1,DEXA 3X1,RANITIDIN 2X1
23 RAHMI DARNIYAH 1444214463 myalgia ASMEF 3X1,BECOM C 1X1,RANITIDIN 2X1
POLI UMUM

KODE FKTP: 10140601
No DATA PESERTA
Nama Pasien
Kesehatan
2 OMAN DM GLIMEPIRID 1X1,ASMEF 3X1,BECOM C 1X1
3 FERY MYALGIA ASMEF 3X1,BECOM C 1X1
4 ELIS KLL ASMEF 3X1,BECOM C 1X1
5 SALAMAH ANTASID 3X1 RANITIDIN 2X1 ,PCT 3X1 BOOM C 1X1

GASTERITIS
6 DEDEH SAKIT KEPALA ASAMFENAMAT 3X1,BCOMC 1X1
7 M RIPQI FARINGITIS ACUTE GG 3X1,CTM 3X1 PCT 3X1
8 DESI ,ISPA ,GASTRO ENTERITIS ACUTE TUNZALOS 2X1 /2,,ZINK SY ORALIT
9 AMELIA GASTROENTERITIS ACUTE ZINK SY,ORALIT
10 SUBAGIO ASAMPENAMAT 3X1,OMEPRAZOL 1X1,GG 3X1

HIPER TENSI,ISPA
11 ONYIN SAKIT KEPALA ASAMPENAMAT 3X1 BECOMC 1X1
12 HASIYATII AMOX 3X1,CTM 3X1 OBH SYR ASAMPENAMAT 3X1

ISPA
13 RINDJAN ASAMPENAMAT 3X1,DE 3X1 CTM 3X1 SK GENTAMICIN
PENYAKIT KULIT
14 LUKMAN HERVES ACICLOVIR 1X4 CTM 3X1 DEX 3X1
POLI UMUM
KODE FKTP: 10140601
No DATA PESERTA
Nama Pasien
Kesehatan
1 FIRMAN 1653569381 ASAMFENAMAT 3X1, SELCOC1X1 GG3X1
MYALGIA
2 FIRLY AMOX 3X1/2 ,PCT 3X1/2 CTM 3X1/2 SELCOC 1X1/2 SANADRIL
1653569414 TONSILITIS SYR
3 ADITYA AMOX 3X1/2 PCT 3X1/2 ,ANTASID 3X1/2 SANADRIL SY
1653569403 FARNGITIS ACUTE
4 NURLAILA 1653569392 THYROTOXICOSIS
5 nurhayati antasid 3x1 ,ranitidin2x1 ,pct 3x1 bc 3x1
46476224 gasteritis acute
6 ENING AMOX 5003X1,PCT 3X1 .,BC 3X1 OBH SY 3X1SDM
7 H RUSLAN RANITIDIN 2X1 PCT 3X1 SELCOM C1X1
8 AMA ASAMPENAMAT 3X1 PIROXICAM 2X1 KALIUMDKLOPENA 2X1
72984835 MYALGIA
9 ST LESTARI 142811715 EPILEPSI
10 HELDA N 1318335276 MYOPIA
11 NURLAILAH 1653569392 THYROTOXISIS,UNSPECIFED
12 ENDANG KOSIM 1607527293 MYALGIA,LOWER LEG
13 EMAD SANADRI SYR 3X1SDM SALBUTAMOL 2MG 2X1 ,DEX 3X1 GG
1148112641 ASMA BROCHIALE 3X1
14 ALI M METFORMIN 3X1 BC 3X1
1824192094 DM TANPA INSULIN
15 BELLA PUTRI CITIZIN 1X1 BCOMC 1X1 SK SCABINI
16 NANDANG SANADRILSYR 3X1SDM,AMOX 5003X1,PCT 3X1 BC 3X1
17 IMAY AFIANTI SK GENTAMICIN AMAOX 3X1/2 CTM 3X1/2
18 SAADAH AMLODIFIN5MG 1X1,PCT 3X1 ,BC 3X1
726148822 HIPERTENSI
19 SUSILANTO ANTASID 3X1,RANITIDIN 2X1 ,ASMET 3X1
1273218704 GASTERITIS ACUTE1
20 LILIS SETIAWATI AMLODIPIN 1X1 ASMET 3X1 BECOM C 1X1
72377144 HIPERTENSI
21 EBY SANADRILSYRPCT 3X1/2 BC 3X1/2 CLATRITOMICIN 2X1/2
13355767185 TONSILITIS CRONIS
22 RATIIH 1810838040 PENYAKIT KULIT LAIN
23 IMAM BUCHORI ASMET 3X1 ,DEX 3X1 ,SELCOMC1 X1
1283025521 MYALGIA
24 ENGKOS OBH SY ,DEX 3X1 PCT 3X1 CLORITROMICIN 2X1
25 SUKARNI RANITIDIN2X1 PCT 3X1 ,SELCOM C1X1 OBH
1432131164 GASTERIOTIS ACUTE
26 MARDJK LORATADIN 2X1,DEX 3X1 ,PCT 3X1 BCOMC 1X1
47767083 PENYAKIT KULIT LAIN
27 SUMARNA ANTASID 3X1, RANITIDIN2X1 ,PCT 3X1 BC 3X1
28 FATIMAH AMOX 3X1 ,PCT 3X1 CTM 3X1 SANADRIL SY 3X1SDM
29 LILING ANTASID 3X1 RANITIDIN2X1,TUNZALOS
1835869522 GASTERITIS 2X1,KALIMDIKLOPENA 2X1
POLI UMUM
KODE FKTP: 10140601
No DATA PESERTA
Nama Pasien
Kesehatan
10/6/2015
1 TOSIMN 47577148 FARINGITIS AMOX3X1,PCT 3X1 BC 3X1 OBH SY3X1SDM
2 TUSIH ANTASID 3X1 ,CTM 3X1 COTRI 2X2 LOPAMID 3X1

1011211255 GASTRO ENTERITIS ACUTE
3 CH SUPARTINAH 72678464 DM TANPA INSULIN
4 NATIH SURYANA 72554499 FARINGITIS ACUTE OBH AMOX 3X1 ,PCT 3X1 ,BC 3X1
5 LAUREN T F 1638520705 GASTRO ENTERITIS ACUTE COTRI 2X1 CTM 3X1 ANTASID 3X1 PCT 3X1
NEU DIATAB 3X1
6 AYU PCT 3X1 AMLOPDIPIN1X1 SIMPASTATIN 3X1 CTM 3X1

39127792 HIPERTENSI
7 SUTINI 1308716673 GASTERITIS CRONIS
8 SUKENDAR PCT 3X1,BCOM C1X1 AMOX 3X1 OBH 3X1 SDM
9 SYAKIFA SANADRIL SY 3X1, AMOX 3X1/2 ,PCT 3X1/2 VIT KUR SY
1169493333 FARINGITIS ACUTE 1X1SDK
10 FERI ADI 13119114169 MYALGIA
11 SRI 46119532 MYALGIA
12 RISMANTA CLATROMICIN,SANADRIL SYR 3X1SDM,DEX 3X1 PVCT 3X1
POLI UMUM
KODE FKTP: 10140601
No DATA PESERTA
DIAGNOSA OBAT
No
Nama Pasien No. Kartu BPJS Kesehatan DIAGNOSA OBAT
10/7/2015
1 ELA MARYANI 1630549866 DM TANPA INSULIN METFORMIN 3X1 ,BC 3X1
2 SUSILANTO 1273218704 DM DGN INSULIN METFORMIN 3X1 ,
3 CHEVITA 1630549877 COMM ON COLD WINASAL 3X1SDM SK HIDRO
4 ENJU 490322013 CHF

5 H NAWAWI 1328527473 MYALGIA ASMET 3X1 ,BCOMC 1X1 ,MOLAKRIM
6 RUDY 1465661799 GASTRITIS KRONIS ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,BC 1X1
7 M.ZAINI 490634065 GASTRITIS KRONIS ANTASID 3X1,RANITIDIN 2X1,SPASMAL 2X1
8 YUYUN 200012771 TB PARU

9 DAHLIA 1465661812 CHF
10 SRI RAHADI 1862213422 MYALGIA ALLOPURINOL 1X1
11 NARMI 490873522 GASTRITIS KRONIS ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,BC 1X1
12 M.SOLEH 1650565181 GASTRITIS KRONIS ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,BC 1X1
13 FITRIANI PCT 3X1,RANITIDIN 2X1,BC 3X1,SIMVASTATIN 1X1

1326726461 DISLIPIDEMIA
14 AL RIZQ 1870248892 KWASIORKOR
POLI UMUM
KODE FKTP: 10140601
No DATA PESERTA
Nama Pasien No. Kartu BPJS Kesehatan DIAGNOSA OBAT
1 SUMARDI 1645195702 GASTRITIS ACUTE ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,BC 1X1
2 ENING KLARITROMICIN 3X1,SANADRYL 3X1,AMBROXOL 3X1,BC 1X1

3 ST SUTIAH 46138702 CHF
4 ASANAH 1876951012 MYALGIA ASMEF 3X1,BECOM C 1X1,KALIUM D 3X1
5 KEISYA AMOX 3X1/2,VIT C 1X1,CTM 3X1/2,SALISYL TALK

1388926631 HERVES
6 DEWI SRIJAYANTI 173553671 ANEMIA APLASIA
7 SASTRA 1638520874 GASTRITIS ACUTE ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,BC 1X1
8 LIYANI 1874202434 TB.PARU

9 ONYIN 1469115191 HIPERTENSI AMLODIPIN 1X1,PCT 3X1,BC 1X1
10 DARMO 1379487238 STROKE

11 NURHAYATI 72554501 COLISISTITIS
12 ENUY ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,CAPTOPRIL 1X1
1461098452 GASTRITIS ACUTE
13 H.TAMPUBOLON 1864572332 FARINGITIS ACUTE BECOM C 1X1,TUZALOS 3X1
14 RENTA 1864573165 ISPA AMOX 3X1,DEXA 3X1,TUZALOS 3X1

POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
No No. Kartu BPJS Kesehatan DIAGNOSA OBAT
Nama Pasien
1 SOLICHUN 1461887572 HIPERTENSI CAPTOPRIL 1X1,ASMEF 3X1
2 HANAFI 1475914476 ISPA PCT 3X1,CTM 3X1,AMOX 3X1,OBH 3X1
3 RIZALULLAH 1457176375 ISPA AMBROXOL 3X1,PCT 3X1
4 DESSY.P 1644196588 DIARE NEW DIATAB 3X1,PCT 3X1,ANTASID 3X1
5 ST MARYAM 1465484196 ACUTE NEPRYTIC SYNDROME

6 M.SOLEH KOTRI 2X2,ANTASID 3X1,SPASMAL 2X1,NEW DIATAB
1650565181 DIARE 3X1,ORALIT
7 IDA RAHMAWATI 1642124485 TB PARU
8 HASNIATI 1261050917 CHF
9 SUMIYATI 1431080122 OEDEMA UNSPECIFIED
10 ST MUFLIKHA 1264135094 MIGRAINE,UNSPECIFIED
11 H.RUSLAN 1461115956 CHF
12 RATNAWATI T 1854547637 CHRONIC SINUSITIS
13 ST HAIMAH 1434571222 DM
14 RATU ADE 1320678549 MYALGIA
15 JOHAN AMOX 3X1,PCT 3X1,LITACUR 1X1,SANADRYL 3X1
16 DJARIMAN 72490094 FARINGITIS ACUTE SANADRYL 3X1,AMOX 3X11,PCT 3X1,BC 1X1
17 SURIAH 1791649383 DERMATITIS CETIRIZIN 1X1,BC 1X1,PCT 3X1
18 KINTAN 1311915756 GASTRITIS ACUTE ANTASID 3X1,PCT 3X1
19 SANUJI AMOX 3X1,PCT 3X1,BECOM C 1X1,SANADRYL 3X1

20 ALIYA SANADRYL 3X1,,AMOX 3X1,PCT 3X1,VITCUR 1X1
21 DAFFA 1798342863 KONSULTASI
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 JOYS AK 1183464641 PAROTITIS AMOX 3X1 PCT 3X1 OBH SY 3X1 SDM
2 ANDI ARDIANA 1649399534 GASTIRITIS ACUTE RANITIDIN 2X1 BC 3X1 ,PCT 3X1
3 AHMADIYO 1443211716 GASTERITIS ACUTE ANTASID 3X1 ,RANITIDIN2X1 ,BC 3X1
4 SINTA 1448199009 CRONIC SUPERFICIALGASTRITI/DBD
5 SANTISETIANTIA MA 1290165996 MYALGIA ,LOWER LEG ASMEF 3X1,BC 1X1
6 ZUBAEDAH 1436503184 OTHER CHOLELIHIASIS
7 SUMIYATI 1386260662 CRONIC MAXILLARY SINUSITIS
8 IKIN 1489023155 CRONIC RENAL FAILURE,UNSPECIFED
9 M RAMDHANI 1289674821 EPILEPSY
10 ELDIANAR SIMBOLON 1129415343 TB PARU
11 IRFAN ARDIANSYAH 1456819221 TB PARU
12 KINTAN 1311915758 ULCERATIVE COLITIS,UNSPECIFED
13 M SOLEH 60810153 MYALGIA ,
14 SRIROHATI PCT 3X1,RANITIDIN 2X1,BECOM C 1X1,ALLOPURINOL
1862213422 ARTRITIS 1X1
15 M.RAFI HERMAN SANADRYL 3X1,AMOX 3X1/2,PCT 3X1/2,VITACUR 1X1
16 SUHERMAN 1633739499 ARTRITIS KALIUM D 3X1,DEXA 3X1,
17 M.ALMA SANADRYL 3X1,LITACUR 1X1,SK KETOKONAZOL
18 GIATI 1861623865 ARTRITIS ASMEF 3X1,BECOM C 1X1
19 SULASTIN ASMEF 3X1,BECOM C 1X1,RANITIDIN 2X1
1861252075 ARTRITIS
20 M.AZIS RAHMAN AMOX 3X1/2, PCT 3X1/2SANADRYL SY 3X1 SDM
21 AISYAH 1294559717 KONTROL HIPERTENSI
22 FARIS HIBBAN SANADRYL 3X1,AMOX 3X1/2,PCT 3X1/2,VITACUR 1X1
23 SATEM 1299634367 FARINGITIS ACUTE AMOX 3X1,PCT 3X1,TK KLORO 3X1
24 ARFAN CIPRO 2X1,PCT 3X1,OBH 3X1,ANTASID 3X1
1641894412 GASTRITIS KRONIS
25 NENENG HASANAH AMOX 3X1,PCT 3X1,BC 1X1,SANADRYL 3X1
26 ZULKIFLI 168354666 GASTRITIS KRONIS PCT 3X1,RANITIDIN 2X1,BECOM C 1X1
27 RIZKI 489842526 FARINGITIS ACUTE SANADRYL 3X1,AMOX 3X1/2,PCT 3X1/2
28 AMANI SK GENTAMICIN 3X1,SK KETOKONAZOL 3X1
29 BUNAWAN KALIUM D 3X1, BC3X1,SK GENTAMICIN 3X1,OBH 3X1
73159773 MYALGIA
30 AVANTIE 1460687885 DEMAM PCT 3X1/2,AMOX 3X1/2,LITACUR 1X1
31 ST ROHAMAH 72732666 ABSES AMOX 3X1,PCT 3X1,SK BACITRACIN 3X1
32 LAMAH 11011206496 BRONKHITIS AMOX 3X1,PCT 3X1,OBH 3X1
33 ENCIH SK MIKONAZOL 3X1,CTM 3X1,PCT 3X1,AMOX 3X1
34 M.FADHILAH 1386260998 FARINGITIS ACUTE SANADRYL 3X1,AMOX 3X1/2,PCT 3X1/2
POLI UMUM
KODE FKTP: 10140601
No DATA PESERTA OBAT
Nama Pasien No. Kartu BPJS Kesehatan DIAGNOSA
10/12/2015
1 HJ.MUHIDA 72330838 POLIP ENDOMETRIUM

2 BLUKUNG 1859309098 PRESBYOPIA
3 SRI MARYANTI 46119532 ACUTE MYOCARDITIS UNSPECIFIED
4 MANIK INDRAMAJA 1129462402 TARSAL TUNNEL SYNDROME
5 ADITYA WISNU WARDANA 1437101054 OTHER CONJUNCTIVITIS
6 YASMINDA PRIYANDARI 1626584681 HEPERMETROPIA
7 M FADILLAH 1386260998 BATUK CIPRO 2X1 PCT 3X1/2
8 SUMIYATI 1386266662 MYALGIA PCT 3X1 BC 3X1 OPBH SY
9 ENUR 1469799527 BATKTUK AMOX 3X1,PCT 3X1,BC3X1 OBH SY
10 ABDULILI 1816432885 HIPERTIROD

11 ERPINA 727 PENYAKIT KULIT LAIN SCABINI SK ,CETIRIZIN 1X1
12 DECI 1300306735 GASTERITIS ACUTE ANTASID SY RANITIDIN 2X1 BC 3X1 ,PCT 3X1
13 ANGGITA R 1300311494 FARINGGITIS ACUTE SANADRIL SY 3X1,AMOX 3X1 PCT 3X1
14 MARINAH 47769017 MYALGIA BC 3X1 KALIUMDIKLOPENA 2X1 OBH SY
15 MUZOTI 39825235 DM TANPA INSULIN METFORMIN 3X1 GG 3X1 BC 3X1
16 HASANUDIN 1626442154 FARINGGITIS ACUTE AMOX 3X1,PCT 3X1 OBH SY
17 HARTINI 1626442165 MYOPIA

18 SUMIYATI 1431080122 OEDEMA ,UNSPECIFED
19 MUMUN MAEMUNAH 1828965339 PARANID SCHIZOPRENIA
20 ASMUNIH 1433322966 SENILEN CATARAC UNSPECIFED
21 MAMAN FIRMANSAH 491131765 OTHER ACUTE OSTEOMYELITIS FOREAM
22 ARFAN 1641894412 ACUTE TONSILITIS UNSPECIPED
23 ABDURAHMAN HALILI 1816432985 THYROTOXICOSIS,UNSPECIFED
24 ONYIN 1469115191
GE
MOLAGIT 3X1,PCT 3X1,CATOPPRIL 2X1 VIT BC 3X1
25 SHERTIZ 1627820919 FARINGITIS ACUTE AMOX 3X1 BC 3X1 DEX 3X1
26 SATRYO 1625049325 FARINGITIS ACUTE OBH 3X1SDM ,AMOX 3X1 ,PCT 3X1 BC 3X1
27 WINDI A SANADRIL 3X1 SDM AMOX 3X1 ,PCT 3X1 BC 3X1

28 LAMAH OBH 3X1SDM , AMOX ,3X1 PCT 3X1 BCOMC 1X1
1011206496 BROCHITITIS CRONIS
29 ENING 1260294827 FARINGITIS ACUTE CLARITROMICIN 3X1 ,CETIRIZIN 2X1 BC 3X1
30 GIFARI 45100877 FANHITIS ACUTE

OBH 3X1SDM AMOX 3X1 ,PCT 3X1 ,CTM 3X1
31 MIRANDA
73333585 NGITIS ACUTE
SANADRIL 3X1SDM ,AMOX 3X1 DEX 3X1 PCT 3X1
32 IZAH
SANADRIL 3X1SDM AMOX 3X1 PCT 3X1 BC 3X1
33 NURI FIZ 1299633142 FARINGITIS ACUTE SANDRIL 3X1ST ,AMOX 3X1/2 ,PCT 3X1/2
34 YUYUM 1465612209 TB TULANG KONSUL
35 FAJAR
AMOX 3X1/2 PCT 3X1/2 ,SANADRIL 3X1,ANTASID 3X1
37 SUKARTI
37008314 MYALGIA
ALUPURINOL 2X1 , KALIUDIKLOPENA 2X1 ,SIMFASTATIN 1X1
38 GITA 1437103181 DERMATITIS CETIRIZIN 1X1 DEX 3X1 ,BC 3X1
39 HENDRI 1375757403 GE COTRI 2X2 ,CT,M 3X1 ,PCT 3X1 BC 3X1
40 ARIF 1635284687 FARINGITIS ACUTE , AMOX 3X1/2 PCT 3X1/2 ,SANADRIL 3X1ST
41 TOPIA DIANA 1635284676 DERMATITIS VITC 3X1/2 DEX 3X1/2 SK HIDROCOPRTISON
42 KODAM 1641974815 GASTERITIS ACUTE ANTASID 3X1 ,RANITIDIN 2X1 ,PCT 3X1
43 SURIAH 1791649383 DERMATITIS ALERGI CETIRIZIN 1X1 PCT 3X1 BC 3X1
POLI UMUM
KODE FKTP: 10140601
1 M NURSAM 1281866993 TB PARU

2 ETI HARTARI 490293505 DERMATITIS ALERGI
3 PARTIMAN 1128865353 FARINGITIS ACUTE OBH SY 3X1 ,AMOX 3X1 PCT 3X1 BC 3X1
4 RAHMI 1635582137 TB PARU

5 A SANI 490608268 FANGITIS ACUTE SANADRIL SY 3X1,AMOX 3X1 ,PCT 3X1
6 YULIARTI SANADRIL 3X1,AMOX 3X1 ,AMBROL 3X1 BC 3X1

7 SINAH 1011189903 DM TANPA INSULIN METFORMIN 3X1 ,BC 3X1 AMOX 3X1
8 ROHMATULLAH 1629686327 GASTERITIS ACUTE ANTASID 3X1 RANITIDIN BC 3X1 PCT 3X1
9 MUHADA AMOX 3X1 ,TUZALOS 2X1 SANADRIL 3X1 SELCOM C1X1

10 H EROM 47575967 BATUK AMROXOSOL 3X1,OBH 3X1 BC 3X1
11 HEDI SAEFUL 1404307045 GASTERITIS ACUTE PCT 3X1 ANTASID 3X1 RANITIDIN2X1 2X1
12 CIKAL B 1648008606 DERMATITIS ALERGI AMOX 3X1/2 CETIRIN 1X1 DEX 3X1
13 NYARNO BCOM C1X1 CETIRIZIN1X1 DEX 3X1 SK SCABINI

1648008584 DERMATITIS ALERGI
14 HUSDNUL YAKIN METRO 3X1ANTASID 3X1 RANITIDIN 2X1 MOLAGIT 3X1
1134144999 GE
15 ALI RIDWAN 1635539736 SAKIT KEPALA ASMET 3X1 BOMC 1X1
16 NURAINI 1328879384 DSISLIFIDEMIA SIMFASTATIN 1X1 ,ASMET 3X1 BC 3X1
17 HASAN PATONI 72394356 DEMAM

18 EVA SRI GENANA 1635423298 CISTITIS ANTASID 3X1 PCT 3X1 BC 3XC1
19 LILIS 1865473975 DM TANPA INSULIN

20 FIRMANSYAH AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY 3X1
21 SUHENI AMLODIPIN 1X1 METFORMIN 3X1 BCOM C 1X1 PCT 3X1
22 ASANAH 1876951012 TB PATRU OAT
23 FAUZIAH 1835872378 FANGITIS ACUTE WISANAL SY,PCT 3X1 BC 3X1
24 SAPRUDIN 1301553314 C H F
25 ATMAJA AMOX 3X1 PCT 3X1 ANTASID 3X1 SANADRIL SY LITAUR
26 MARWARNI 72356231 MYALGIA
27 RAY FIDEL 1079617645 ORCHITIS
POLI UMUM
KODE FKTP: 10140601
1 ADE PUTRA 1870882942 CONJUNGTIVITIS AMOX 3X1,PCT 3X1 TM KLORO 3X13TTS
2 IMAS R 72563657 CERUMEN PROP

3 HATA AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY 3X1
4 SUMARNI 1271159763 CH F
5 DEDEH 1832581787 MALIGNANTNEOPLASM OF COLON UNSPECIFED
6 MARYATI 489827845 TB PARU
7 ERNA 490014404 MYOPIA
8 ERVINA VIRGANTINI 72746561 DERMATITI S
9 RAFA AZIOZAH 162329591 BRONCHITIS CRONIC
10 SUTINI 1308716673 GANGGUAN CEMAS
11 FITRIANI 1326726461 DISLIPIDEMIA SIMPASTATIN 1X1 ASMET 3X1 SELCOM 1X1
12 WARSIH 1459666563 DM GLIBEKLAMID 1X1 GENTIAN VIOLETY BC 3X1
13 MUARIFAH CATROPRIL 2X1 PCT 3X1 AMOX 3X1 SANADRI SY 3X1 BCOMC
1159403692 HIPERTENSI 1X1
14 SAJIANTO 1373358835 DISLIPIDEMIA SIMFASTATIN 1X1 ASMET 3X1 BC 3X1
15 NINING MARNINGSIH 1819216113 MYALGIA KALIUM D 2X1,SELCOMC 1X1 MOLAKRIM
16 ALFIRA 1283118603 CEPALGIA PCT 3X1 BI 3X1 DEX 3X1
17 M IKWAN AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY 3X1

18 SARTIYEM 1517849188 KONSULTASI
19 H NAWAWI ASMET 3X1 RANITIDIN 2X1 DEX 3X1 SELCOMC 1X1
1328527473 MYALGIA
20 KUSNADI 1819215066 HIPERTENSI AMLODIPIN 1X1,BECOMC 1X1 ASMET 3X1
21 ELI 490037207 GE KOTRI 2X1PCT 3X1 CTM 3X1 BC 3X1
22 LILIS SETIAWATI 72377144 MYALGIA BC 3X1 ,KALIUM D 2X1 AMLODIPIN 1X1
23 H ST AMAH 47766969 MYALGIA ASMET 3X1 BC 3X1
24 DEDEH S 1832581787 KONSULTASI

25 MUHAMAD 1317700811 MYALGIA ASMET 3X1 DEX 3X1 BC 3X1
26 H DARUS SALAM ASMET 3X1 ,AMOX 3X1 ,TM AILIN GLIBEKLAMID 1X1
1272363906 DM NON INSULIN
27 M ZAZULI ANTASID 3X1 CTM 3X1 MOLAGIT 3X1 SPASMINAL 3X1
1426801329 GE
28 ENING 12602948 GASTERITIA ACUTE PCT 3X1 ANTASID 3X1 RANITIDIN 2X1
29 MUHADA 1147714907 FARINGITIS ACUTE TUNZALOS 2X1,GG 3X1
30 DAFFA 1798342863 ,FARINGITIOS ACUTE 16
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 AGUS HIDAYAT 1146581818 CISTITIS AMOX 3X1 ,ASMET 3X1 ,DEX 3X1
2 SARMAN 72997727 MYALGIA SELCOM C 1X1
3 ARMAIN 489997236 CHF

4 MARSIH AMOX 3X1 ,KALIUM D 2X1 DEX 3X1 SK BETAMETASON
5 YULIARTI 1643504657 TB PARU
6 ENUR AMOX 3X1 ,PCT 3X1 ,SALBUTAMOL 2X1 SANADRIL SY
1469799527 BATUK
7 ANZALLA 1375758729 DERMATITIS SK HIDROTISON CTM BC 3X1
8 ENI SAMSIATI 1375758404 FARINGITIS PCT 3X1 ,AMOX 3X1 .SANADRIL 3X1SDM
9 AMA WASMA 72984835 MYALGIA FARINGITIS OBH SY KALIUMDIKLOPENA BCOMC
10 MIRANDA 73333585 FARINGITIS AMOX 3X1 ,PCT 3X1 DEX 3X1
11 DIAN AMOX 3X1 TUNZALOS 2X1 ,AMBROXOL SELCOMC 1X1

14762210-84 FARINGITIS ACUTE
12 ST MAEMUNAH 1889578062 SUSP FILARIASIS ASMET 3X1 BC 3X1
13 HASANUDIN 203387049 UNSPECIFED CRONIC BROCHITITIS

POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 SATEM 1299634367 MASTOIDENITIS ASM,ET 3X1 ,DEX 3X1 TK KLORO
2 EEN 1225105626 DM NON INSULIN METFORMIN 3X1 ASMET 3X1 BCOMC 1X1
3 SUKASIH 1861252075 ISPA TUNZALOS 2X1 BECOMC 1X1
4 ARYA 1626584692 FARINGITIS ACUTE AMOX 3X1 OBH 3X1 CTM 3X1 VIT C 3X1
5 RISKINA 1716621489 DERMATITIS CTM 3X1 DEX 3X1 SK BETAMETASON
6 RIZKI PAREL 489842526 ISPA PCT 3X1/2 GG 3X1/2 CTM 3X1/2
7 EDI SUBAGYO 1335767185 MYALGIA ASMET3X1 BCOM C1X1
8 ST ARIFAH 1311945862 MYALGIA ASMET3X1 BCOM C1X1
9 ZAENUDIN 73044325 ISPA OBH ST 3X1 CTM 3X1 ASMET 3X1
10 TRI MUJI 490717078 ISPA PCT 3X1 GG 3X1 DEX 3X1/2 PROCURMA SY
11 MAROH 490716101 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 OBH 3X1 ANTASID 3X1
12 ANDI 16085892336 ISPA PCT 3X1 OBH SY CTM 3X1
13 M RIZKI 1393100177 HEPATITIS

14 WALUYO 1463113754 KONSULTASI
15 BUNAWAN 73159773 ISPA TUZALOS 2X1 BC 3X1
16 SUTINI 1308716673 MYOPIA

17 OMAN 18721372 DM NON INSULIN GLIBEN 1X1, PIROXICAM 2X1 BCOM C 1X1
18 YANI 1314579543 EPILEPSI

19 DEWI 1308387431 HERVES PCT 3X1 CTM 3X1 ACICLOVIR 4X1
20 MASUT 146710492 KONSULTASI

21 DWI ATINURWATI 1335898697 MYALGIA PIROXICAM 2X1,ASMET 3X1 BC 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 ROHATI 1889161435 HEMOROID

2 ENUR 1469799527 SUSP TB
3 FLORA 18524078966 FARINGITIS AMOX 3X1 PCT 3X1 OBH SY
4 SARWONO 146580385 PRAKTUR

5 WAHYUDI 1625379309 HYPERMETROPIA
6 YUDI S 1126854764 MYOPOIA
7 NEKO 1263089777 EPILEPSI
8 NURAENI HASANAH CETIRIZIN 1X1 BC 3X1 PCT 3X1 SK HIODROCORTISON
9 IDA ROYASNI 1423567596 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 CTM 3X1 SANADRIL 3X1
10 M HOESNI THAMRIN 73374557 DM NON INSULIN

11 MAYA HS 976022897 LOW BACK PAIN
12 H SOBARI AMOX 3X1 TUZALOS 2X1 OBH 3X1 KALIM 2X1
13 UUN UNASIH 1639487 MYALGIA ASMET 3X1 B1 3X1 KALIUM 2X1
14 SUKARSIH 1861252075 MYALGIA ASMET 3X1 SELCOM C1X1
15 SAIMAN 16318285 MYALGIA KALIUM 2X1 SELCOMC1X1
16 ENING 1260294837 FARINGITIS ACUTE SANADRIL 3X1 BC 3X1
17 NINING RUSTINI 173028969 MYALGIA KAL;IUM 2X1 BC 3X1 ALUPURINOL 3X1
18 AYU KALIUM 2X1 ANTASID 3X1 RANITIDIN 2X1 AMLODIPIN 1X1

39107792 MYALGIA
19 SAJIANTO 1373358835 MYALGIA ASMET 3X1 SIMFASTATIN1X1 ,BCOMC 1X1
20 KASIH 490201839 OSTEMA PRONTALIS

21 M SAEIPUDIN 1156055771 MYALGIA ASMET3X1 BCOMC1X1
22 DALILAH 1464073413 DM NON INSULIN

23 WAWAT WATI 16563900554 MYALGIA KA;LIUM 2X1 ,ASMET 3X1 BC 3X1
24 KRISTANTO 1837051176 ISK

25 ONYA 1309515017 GASTERITIS
26 ILMAN 1837551543 DEPRESI
27 AZAM 164407717 GANGGUAN PENDENGARAN
28 PRIOYATI 45911452 HEMOROID
29 ASAM 1716871342 HEMIPLEGI
30 NYARNO 1648008584 DERMATITUIS INFECSI
31 CIKAL 1648008606 DERMATITIS
32 BUNAWAN 73159773 MYALGIA
33 MAYA ALFIANTI 1169497293 R51,K29 VIT B6 3X1 ANTASID 3X1 PCT 3X1
34 ANJANI 1300311088 KONSULTASI

35 ST MAEMUNAH 1889978062 APP CRONIC
36 SUINAH CETIRIZIN 1X1 SELCOMC 1X1,SK HIDROCORTISON
37 BAMBANG 1404187108 FARINGITIS ACUTE SANADRIL 3X1 AMOX 3X1 PCT 3X1
38 MARSANDA 1631828597 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 SANADRIL SY

POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA OBAT
Nama Pasien
1 EVA SRIGEMANA 163542298 SAKIT KEPALA ASMET 3X1 BC 3X1
2 TINAH 1854575662 MYALGIA SELCOM C1 1CTM 3X1
3 WALUYO 1463113754 TB PARU KONSULTASI
4 MARINAH 47769017 MYALGIA ASMET 3X1 SELCOM C 1X1
5 ALI M 1824 192494 DM NON INSULIN METFORMIN 3X1,SELCOM C 1X1
6 MARLIAH 1880637939 KONTROL POST CATARAC

7 YAMINDA
1626584681
AMOX 3X1PCT 3X1ANTASID 3X1 CTM 3X1 DMOP 3X1
FARINGITIS ACUTE
8 HANIPAN 1854223626 TB PARU,CEK BTA OBH SY CTM3X1
9 TASIH
1195788688
KOTRI 2X1,PCT 3X1/2 ANTASID 3X1/2 SANMADRIL SY
FARINGITIS ACUTE
10 TRI ANGGORO 1862317348 DISLOCATION OF RIBAU
11 ZAENUDIN 73044325 CALCULUS OF LOWE URINARY TRACT,UNSPECIFIED
12 ASIAH 1311503139 STROKE
13 KUSMAYATI 1453540713 PRESBIPIA
14 ST MAEMUNAH 1889978062 PFILARIASIS UNSPECIFEID
15 HARNILA 1273038783 ALERGIC CONTACT DERMATITOS ,UNSPECIFED
16 MURTI 49040328 KUSTA MDT PREDNISON 1X4
17 LUSTA 1850214508 DM GLIBEN, SIMVASTATIN, ASMEF
18 NURLENI 1787072433 MYALGIA PIROX, AS MEF, BECOM C
19 CLARA 1451724827 ISK ASMEF, BI, CIPRO
20 SANEM 1472802366 ASMEF, BECOM C

CEPALGIA
21 M. MALIK 1475907096 ISPA AMOX, DEXA, PCT, SANADRYL SYP
22 SITI NURHAJIJAH 1657705061 FEBRIS BECOM C

23 M. EFFENDI 1379330526 DERMATITIS CETIRIZIN, DEXA, MICONAZOL SK
24 TANTRA 194471122 AMOX, CTM, PCT, RANITIDIN

FARINGITIS ACUTE
25 RASIH 1649402278 FARINGITIS ACUTE AMOX 3X1 TUZALOS 2X1 GG 3X1
26 AMANI 167014838
AMOX 3X1 DEX 3X1 AMBROXOL 3X1 SANADRIL SY 3X1
DEMAM
27 YAYAN 1465612209 DERMATITIS CTM 3X1 DEX 3X1 SALICIL TALK
28 DINDA SEPTIA 1409647116 AMOX 3X1 TUZALOS 2X1 GG 3X1

BATUK
29 ST ROHANAH 72732666 ABSES DEX 3X1 SELCOM C1X1
30 KUSMIYSATI 1453540713 MYOPIA

31 NIKLO HADI 1631312065 ABSES CIPRO 2X1 ASMET 3X1 VIT C3X1
32 RACHMAHJULLOH 1629686327 SAKIT KEPALA PCT 3X1 SELCOM C 1X1
33 MARWANTO 1303021361 GASTERITIS ACUTE AMOX 3X1 PCT 3X1 RANITIDIN 2X1
34 JUDIN 1649399499 GASTERITIS ACUTE PCT 3X1 ANTASID 3X1 RANITIDIN 2X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 EZRA TATI KOTRI 2X2,PCT 3X1,MOLAGIT 3X1,ANTASID 3X1

1241128484 DIARE
2 MIRAH ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,KALIUM D 3X1
210486789 GASTRITIS
3 MAS'UT 1467610492 TB PARU
4 ERSIH 490293764 DERMATITIS DEXA 3X1,CTM 3X1,SELKOM C 1X1
5 NINA MARLINA 1479712184 LIMFADENITIS TB

6 WALUYO 1463113754 TB PARU KONTROL
7 SUNARTI 1634295396 FARINGITIS AKUT AMOX 3X1,TUZALOS 3X1
8 ROATIN 1196794067 SUSPEC LIMFADENITIS TB AMOX 3X1,ASMEF 3X1,SELKOM C 1X1
9 OHIM 1532509828 DISLIPIDEMIA SIMVASTATIN 1X1,ANTALGIN 3X1,BC 1X1

10 KASNING 45970356 MYALGIA CTM 3X1,DEXA 3X1,KALIUM D 3X1,SELCOM C 1X1
11 MAHARDIKA 162802761 CEPHALGIA ASMEF 3X1,KALIUM D 3X1
12 HARTINI 1626442165 FARINGITISAKUT AMOX 3X1,DEXA 3X1,PCT 3X1,SANADRYL
13 NAPILAH CAHYA 1626442176 DERMATITIS CTM 3X1/2,DEXA 3X1/2,SALICYL 3X1
14 SURADJI 1217985647 GGK
15 TITI SUDARMI 72561159 MYOPIA
16 ILYAS ADZZAKIR 1187013453 BATUK AMOX 3X1,PCT 3X1,SANADRYL 3X1
17 IDRIS 1426812906 KATARAK
18 WINDA 1258044028 CYSTITIS CIPRO 2X1,ASMEF 3X1
19 KRISTANTO 1837051176 MYALGIA
20 ERNA 490014404 KATARAK
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 YANI NURYATI
FARINGITIS ACUT
AMOX 3X1,PCT 3X1,CTM 3X1,SELCOM C 1X1,SANADRYL 3X1
1630310005
2 IMAM TARMUDZI 1649288173 LYMPOMA
3 SUKARNI 1432131164 SUSP.TB CEK BTA
4 H.DARUSSALAM 1272363906
5 ONYIN 1469115191
6 TRI WAHYUNI 1429087926 FARINGITIS ACUT AMOX 3X1,TUZALOS 3X1,,SELCOM C 1X1
7 ENUR 1469799527 TB PARU

8 ENENNG RAHMA 1459666664 DBD/FEVER WITH CHILLS
9 H.LILI AMOX 3X1,CTM,SELCOM C 1X1,SANADRYL 3X1
47765722 BATUK
10 SRI L AMOX 3X1,TUZALOS 3X1,,SELCOM C 1X1,SANADRYL 3X1
144045316 ISPA
11 SUKASIH 1861252075 SAKIT KEPALA DEMAM PCT 3X1 GG 3X1
12 KARTINI SIROIT 1862918728 GASTERITIS ACUTE ANTASID 3X1 RANITIDIN2X1 PCT 3X1
13 SUKAMTO 1308526986 MYALGIA ASMET 3X1,B1 3X1,FIROXICAM 2X
14 OJAH HOJANAH 1337024226 HIPERMETROPIA

15 SUHAENI 1011209332 HIPERTENSI AMLODIPIN 1X1,PCT 3X1 BCOMC1X1
16 ARIF 1645878532 LUKA BAKAR CIPRO 2X1 ,ASMET 3X1 SELCOM C1X1
17 MAYADIKA 1862218348 FARINGITIS ACUT AMOX 3X1,TUZALOS 2X1,,SELCOM C1X1
18 WACHYATI 1338252614 MYALGIA ASMET 3X1 FIROXICAM 2X1 DEX 3X1
19 EZRA TARIHOTAN 1241128488 ,ISPA SANADRIL 3X1 CTM 3X1 ,SALICIL TALK
20 M SOLEH 60810153 GASTERITIS ACUTE ASMET 3X1 ,ANTASID 3X1 RANITIDIN 2X1
21 MUMUN 489815897 GASTERITIS ACUTE PCT 3X1 PRENAMIA 2X1 ,ANTASID 3X1
22 WAWATWATI 1656390554 MYALGIA KALIUM D 2X1 ,ASMET 3X1
23 ONYIN 1469115191 HIPERTENSI AMLODIPIN1X1, FIROXICAM 2X1 ,BCOMC 1X1
24 LAILA HADIJAH 1630310049 DEMAM A,MOX 3X1 ,PCT 3X1 DEX 3X1 ,SALILTALK
25 NEKO 1263089777 EPILEPSI
26 OHIM ROHIMIN 1532509828
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 EVA SRI G 1635423298 CEPALGIA ASMET 3X1 BC 3X1
2 TINAH 1854575662 MYALGIA CTM 3X1 SELCOM C1X1
3 WALUYO 1463113754 KONSULTASI

4 MARINAH 47769017 MYALGIA ASMET 3X1 ,SELCOM C1X1
5 ALI M 1824192494 DM METFORMIN 1X1 ,SELCOM 1X
6 MARLIAH 1880637939 CATARAC

7 YASMINDA AMOX 3X1 PCT 3X1 ANTASID 3X1 CTM 3X1 DMP 3X1
1626584681 GASTERITIS
8 HANIFAH 1854223626 TB PARU CEK BTA CTM 3X1 OBH 3X1SDM
9 TASIH COTRI 2X1 PCT 3X1 ANTASID 3X1 SANADRIL SY

10 TRI ANGGORO 1862317348 DISLOCATION OF ELBOW
11 ZAENUDIN 73044325 GGK
12 MURTI 490403283 KUSTA ASMET 3X1 ANTASID 3X1 ,PREDNISON 3X1
13 LUSTA GLIBENKLAMID 1X1 ,SIMPASTATIN 1X1 ASMMET 3X1

1850214508 DM
14 MARLENI 1787072433 MYALGIA PIROXICAM2X1 ASMET 3X1 BCOMC 1X1
15 CLARA DONA 1451724827 SISCITIS ASMET 3X1 CIPRO 2XQ ,B13X1
16 SANEM 1472802366 CEPALGIA ASMET 3X1 BCOM C1X1
17 M MANIK 1475907096 FAREINGITIS ACUTE AMOX 3X1 DEX 3X1 SANADRIL 3X1 SDM
18 SITI NURHAJIJAH 1657705061 DEMAM BCOMC 1X1
19 M EFENDI 1379330526 DERMATITIS CETIRIZIN1X1 ,DEX3X1 SK MICONAZOLE
20 TANTRA DAREL AMOX 3X1/2 ,PCT 3X1/2 CTM 3X1/2 RANITIDIN 2X1/2
21 RASIH 1649402278 FARINGITIS ACUTE AMOX 3X1 TUZALOS 2X1 GG 3X1
22 AMANI AMOX 3X1 CTM 3X1 DEX 3X1 PCT 3X1 SANADRIL 3X1SADM
167014838 DEMAM
23 YAYAN 1465612209 DERMATITIS ACUTE CTM 3X1 DEX 3X1 SALICILTALK
24 DINDA SEFTIA 1409647116 BATUK AMOX 3X1 TUZALOS 2X1 GG 3XQ
25 ST ROHANAH 72732666 ABSES DEX 3X1 SELCOMC 1X1
26 KUSMIYAH 14535408713 MYOMA

27 HARNILA 1273038783 DERMATITIS INFECTION
28 ASIAH 1311503139 HIPERTENSI
29 NIKO HADI 1631312065 ABSES CIPRO 2X1 ASMET 3X1 ,SK HIDRO
31 RAHMACTULLOH 1629686327 CEPALGIA PCT 3X1 SELCOMC 1X1
32 MARWANTO 1303021361 MASTOID AMOX 3X1/2 PCT 3X1/2 RANITIDI 2X1/2
33 JUDIN 1649399499 GASTERITIS ACUTE PCT 3XQ1 RANITIDIN 2X1 ANTASID 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 TETTY LAURA SANADRIL 3X1 ,AMOX 3X1 PCT 3X1 ,AMLODIPIN 1X1
2 AI RINA 1456276623 MYALGIA ,KOLESTEROL TINGGI SIMFASTATIN1X1 BCOMC 1X1
3 KLARA AGUSTINA AMOX 3X1 DEX 3X1 SELCOM C1X1SANADRILSY 3X1

4 MUHADI 1832582529 CHF
5 WARSIH 1793653727 MYALGIA
6 MELDA 1621982204 DEMAM AMOX 3X1 PCT 3X1 BC 3X1
7 MARIYATI 1621982182 FANGITIS SANADRIL 3X1 AMOX 3X1 PCT 3X1 BC 3X1
8 SUYATI 1832582542 CHF

9 NUYANI 72703348 CHF
10 ABDUL KODIR 1624295924 MYALGIA
11 ADI PUTRA 1629059837 G E PCT 3D1 COTRI 2X2 CTM 3XC1 BC 3X1
12 NENENG MARNINGSIH 1819216113 MYALGIA ASMET 3X1 BC 3X1 MOLACRIM
13 VERDIAN 1339467063 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 DEX 3X1 BC 3X1
14 KUSNADI 1819215066 HEMOROID

15 RASINO 72697814 MYALGIA KALIUM 2X1 ASMET 3X1 BC 3X1
16 GAGAH SURYADI 1835675109 G E ANTASID 3X1 PCT 3X1 COTRI2X2 CTM 3X1
17 ABAY 490721815 DM ONN INSULIN GLIBENKLAMID 1X1,SELCOPM 1X1
18 YAYA MULYANA 72484659

AMLODIPIN 1X1 PCT 3X1 BC 3X1 RANITIDIN 2X1
HIPERTENSI
19 ZUBAEDAH 1436503184 CISTITIS AMOX 3X1 ASMET 3X1 BC 3X1
20 IPO MARPAUNG 1138365652 BATU GINJAL

21 H DARUSALAM 1272363906 LYPOMA
22 NIKO HADI 1631312065 LYPOMA
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 FATHIHATUZKRULLAH FIRDAUS 1644236133 ACUTE APP ,UNSPECIFED

2 ABAS 1290244318 UNSPECIFED,ABNORMAL HERNIA WITHOUT OBSTUCTIO OR GANGRAENE
3 RAFA AZIZAH 162329691 BRNCHOPNEMONIA,UNSPECIFED
4 TUSIH 1011211255 THYROTOXISIS WITH TOXIC MULTINODULLAR
5 rizqi karim 1385722001 EDRMATITIS INFETION VIT C3X1 ,AMOX 3X1 SK GENTAMICIN
6 AATHNAH 1275294497 FSARINGITIS ACUTE SANADRIL SY ,AMOX 3X1
7 JUPIANTO 1256012357 FARINGITIS ACUTE AMOX 3X1 PCT 3X1,BC3X1
8 FATHIHAZIKRULLAH 1644236133 POST OP APP

9 ADELIA 1647422864 FARNGITIS ACUTE AMOX 3X1 PCT 3X1 SANADRIL SY
10 WIYANI 1647422842 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 OBH SY
11 ROHAYA IBUPROPEN3X1,ALUPURINOL 3X1,SIMPASTATIN1X1

1011205607 MYALGIA
12 ROHMAN HASAN 1653923081 FARINGITIS ACUTE AMOX 3X1,PCTV 3X1 BC 3X1 SANADRIL SY
13 MUHAMAD A 1192672945 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 DEX 3X1
14 ABAS 1290244818 POST OP HERNIA INGUINALIS SINISTRA

15 SHAFRI 1157498987 GASTRO ENTERITIS CTM PCT 3X1 COTRI 2X1 SK GENTAMICIN
16 NURCHADI SANADRIL 3X1 AMOX 3X1 RANITIDIN 2X1 PCT 3X1

17 CHOLIHUDIN 167361671 MASTOD TK AMOX 3X1 PCT 3X1
18 MAY 145559862 GASTERITIS CRONIS ANTASID 3X1 RANITIDIN 2X1 PCT 3X1 BC 3X1
19 SATRIYO 1625049325 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 OBH 3X1SDM
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 LILIS SOLIHAT 1031072417 GASTERITIS CRONIS

2 MUARIPAH 1159403692 HIPERTENSI PCT 3XZ1 AMLODIPIN 1X1 BC 3X1
3 RIZQY 1176094428 IS\PA AMOX 3X1 DEX 3X1 CTM 3X1 SANADRIL 3X1
4 ELIDA 1456423997 DERMATITIS CETIRIZIN1XQ1 BC 3X1 SK HIDRO
5 WIDI ASTUTI 1483170063 MYALGIA ASMET 3X1 BC 3X1
6 NELI 1795186157 TB PARU

7 ENUR 1469799527 HIPERPLASIA OF PROSTATE
8 BOSIH 72391656 MYOPIA
9 YULIANTI 1643504652 KONSULTASI
10 NOOR SARINAH 1888788598 ANTASID 3X1 RANITIDIN2X1 PCT 3X1
GASTERITIS ACUTE
11 ANISA EKA AOMX 3X1 PCT 3X1 BC 3X1 SANADRIL

12 ETI HARTATI 490293505 GASTERITIS CRONIS RANITIDIN3X1 PCT 3X1 BC 3X1
13 FAISAL 1888789915 CERUMEN

14 BLUKUNG 1859309098 PRESBIOPIA
15 TITI SUNDARI 72561159 HIPERTENSI CATROLPIL 25 2X1/2 ASMET 3X1
17 ZUBAEDAH 1436503184 MYALGIA ANTASID 3X1 ASMET 3X1 BC 3X1
18 NUR FITRI 1648008595 DERMATITIS INFECTION

19 H ROSID SANADRI SY SALBUTAMOL 2X1 PCT 3X1 BC 3X1
1458546243 ASMA BRONCHIALE
20 ILHAM SANADRI SY SALBUTAMOL 2X1 PCT 3X1 BC 3X1
21 WAWAT WATI 1656390554 MYALGIA KALIU D 2X1 SELCOM C 1X1 SANADRIL SY
22 TATANG 72339557 MYALGIA ,GASTERITIS ACUTE RANITIDIN 2X1 PCT 3X1 BC 3X1
23 IDA ROYANI 1423567596 BRONCHOPNEMONIA

24 DITA SARI 1607527304 MYOPIA
25 ABDUL MANAF 72554861 72554861 FARINGITIS ACUTE PCT 3X1 SELCOM C1X1
26 M SHAFRI 1157498987 GASROENTERITIS

27 INTAN AMALIA 1631371858 FARINGITIS ACUTE SANADRIL 3X1 AMOX 3X1 PCT 3X1 /2
28 TIANUR 1284835498 PARANOID SCHIZOFRENIA

29 H IDRIS 47765709 GANGGUAN DAYA DENGAR
30 EMEN 1890663704 PRAKTUR HAND DEXTRA
31 BAMBANG ARJONO 38874161 MYALGIA
32 NENGSIH 1865782405 BATUK GG3X1
33 H BUNAWAN 73159773 DERMATITIS INFECTION CETIRIZIN 1X1,BCOMC 1X1 OBH SY
34 RIFA LATIPAH 1638975903 G E SANADRIL 3X1 COTRI 2X1 PCT 3X1
35 SUKARNI SANADRILB3X1 CIPRO2X1 ASMET 3X1 BCOM C 1X1

1432131164 BRONCHOPNEMONIA
36 ZUBAEDAH 1436503184 MYALGIA ANTASID 3X1 ASMET 3X1 BC 3X1
37 SUKAMTO 1308526986 PRESBIOPIA

38 AYU 977431961 DERMATITIS INFECTION
39 IWAN SETIAWAN 1406381398 DERMATITIS KETOKONAZOLE SK GENTAMICI
40 AISAH 1849828465 DERMATITIS CERIRIZIN 1X1 BC 3X1
41 RANDIKA 72340255 FARINGITIS ACUTE WINASAL AMOX 3X1 PCT 3X1 BC 3X1
42 ENCIK K 1877535101 DM
43 SUNARTI 1888949529 MYALGIA KALIM D 2X1 ,ASMET 3X1 BC 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 YUYUNINGSIH AMOX 3X1 ,TUZALOS 2X1 SELCOMC 1X1 CATOPRIL 2X1

72389259 HIPERTENSI
2 FIANNA N 1838524632 TONSILITIS AMOX 3X1 SELCOM C 1X1 PCT 3X1 CTM 3X1
3 SUNARYA MOLAGIT 3X1 ,CTM 3X1 PCT 3X1 ANTASID 3X1

1643377408 GE
4 AGNES OKTARIANI 1192672956 DEMAM AMOX 3X1 ,PCT 3X1
5 SALSABILA 167259835 SUS HEPATITIS

6 AMIEN 1404002182 MYALGIA KALIUM D 2X1 SELCOMC 1X1
7 NURJANAH
61376365869
ASMET 3X1 CTM 3X1 A,MOX 3X1 ,FIROXCAM2X1
MYALGIA
8 ATI MISAH 22570868 MYALGIA KALIM D2X1 ASMET 3X1
9 ISMAIL FAHMI 1837694351 GASTERITIS ACUTE OMZ 1X1,RANITIDIN 2X1,PCT 3X1
10 JIMAN 1135983082 MYALGIA KALIUM 2X1 ASMET 3X1 FIROXICAM 2X1
11 SUKARSIH 1650322776 DM GLIBENKLAMID,SELCOM 1X1 ,PCT 3X1
12 ONYA 1309515017 GASTERITIS CRONIS

13 LUNA ALMIRA 1543138097 DERMATITIS AMOX 3X1 CTM 3X1 DEX V3X1
14 OJAH HOJANAH
1337024226
CSATOPRIL 2X1/2 SELCOM 1X1 SIMPASTATIN 1X1
HIPERTENSI ,COLESTEROL TINGGI
15 ENENG SINTIA 1649411244 GASTERITIS CRONIS
16 JANET ENITA 1464266725 CEPALGIA
17 SUJIARTI
1157400922
A,MOX 3X1,PCT 3X1 AMBROXOL 3X1 CTM 3X1
ISPA
18 NASIH 1299632679 MYALGIA ASMET 3X1 FIROXICAM 2X1
19 ROHAYA 1011205607 MYALGIA ASMET3X1 B1 3X1
20 ALICA INTAN 1617876369 GASTERITIS CRONIS ANTASID 3X1 B6 3X1 RANITIDIN 2X1
21 ASANAH 1876951012 ISPA PCT 3X1 ,CTM 3X1 GG 3X1
22 ARIPAH 1876949548 DERMATITIS CRONIS KALIUM D 2X1 CTM 3X1 SALICILTALK
23 ENGKOS 1801385482 FARINGITIS ACUTE

24 DIAS ADI 1648559979 CEPALGIA
25 ELIS WATI SOLEHA 1453913313 PREDMINANTY ALLERGIC ,ASTHMA
26 ANAN 1489659937 PRESBIOPIA
27 ANAH 147764369 CHF
28 RIZQY MAULANA 1176094438 FEVER WITH CHILLS
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 ST NURJANAH 490295079 ISPA TUZALOS SELCOMC 1X1
2 EDI KUSNADI 1385815285 CHF

3 WACHYATI 1338252614 OSTEOMELITIS
4 NOOR SARINAH 1888788598 GASRITIS ACUTE
5 DUMARIS PCT 3X1 SELCOMC 1X1 CTM 3X1 AMBROXOL 3X1
1854529209 BATUK
6 OHIM ROHIMIN 15325090828 HEMOROID
7 ST RODIAH 72484661 MYALGIA ASMET 3X1 RANITIDIN2X1
8 UMMU K 1635606573 FARINGITIS ACUTE AMOX 3X1 TUZALOS 2X1 SELCOMC 1X1
9 IWAN SETIAWAN 1406381398 SAKIT KEPALA TUZLOS 2X1
10 SRI YUNINGSIH AMOX 3X1 CTM 3X1 AMBROXOL 3X1 SELCOM C 1X1
72377109 BATUK
11 SURCHMAN 1436502802 KONTROL STRUK
12 WANDIN DWI 1656390565 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 RANITIDIN 2X1
13 ONYIN 1469115101 KCEPALGIA SELCOMC 1X1 PCT 3X1
14 OJAH HOJANAH 1337024226 PRESBIOPIA

15 IPAH 4901893674 GGK
16 ENING 1260294827 GASTRERITIS ACUTE PCT 3X1 ANTASID 3X1 RANITIDIN 2X1
17 AMBAR AYU AMOX 3X1 PCT 3X1 CTM 3X1 ANTASID 3X1 AMBROXOL 3X1
18 STASIAH 4909994289 OPOSTOP TUMOR
20 DAFFA CTM 3X1/2 DEX 3X1/2 ANTASID 3X1/2 TUZALOS 2X1/2
1798342863 DERMAYITIS
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 JANET ENITA 1464266725 GASTERITIS CRONIS

2 NAZRIL AMOX 3X1/2 PCT 3X1/2 SELCOMC 1X1/1 AMBROXOL 3X1/2
3 SUMIASIH 1426801858 BATUK AMOX 3X1 SELCOM C 1X1 DEX 3X1
4 WERMIS AMOX 3X1 TUZALOS 2X1 FIROXICAM 2X1 CTM 3X1 OBH SY
1439304006 ,ISPA
5 TRI ANGGORO 1862317348 DISLOCATION OF ELLOW ,UNSPECIFIED
6 ANDI ARDIANNA 1649399534 GASTERITIS CRONIS ANTASID 3X1 RANITIDIN 2X1 MOLAGIT 3X1
7 SUCIPTO AM 1787848514 BATUK SELCOM C 1X1 AMBROXOL 3X1 CTM 3X1
8 AMMA WASMA SELCOM C 1X1 KALIUM D 2X1 TUZALOS 2X1 FIROXICAM 2Z1
72984835 MYALGIA
9 ANING 14552158728 GGK
10 EDI KUSNADI AMOX 3X1 TUZALOS 2X1 SELCOM C1X1 AMBROXOL 3X1
1385815285 faringitis acute
11 SAANDI AMOX 3X1 ASMET 3X1 CTM 3X1 SELCOMC 1X1
12101969203 ABSES
12 AGUNG 1626381088 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 CTM 3X1 SELCOM C 1X1
13 SULTHAN PCT 3X1/2 ,CTM 3X1/2 COTRI 2X1 AMBROXOL 3X1

1822975075 ISPA
14 RUDY 1465661799 CISTITIS CIPRO 2X1 ASMET 3X1 KALIU D 2X1
15 SUCIPTO AM 1787848514 BATUK CTM 3X1 AMBROXOL 3X1 SELCOM C1X1
16 DIANA SARI AMOX 3X1 ASMET 3X1 CTM 3X1 AMBROXOL 3X1
1825602625 ISPA
17 IIS ISTIQOMAH 1663642309 TONSILITIS CRONIS
18 HAERU ANTSID SY 3X1 PCT 3X1 RANITIDIN2X1 CTM 3X1
1460428694 GASTERITIS CRONIS
19 NINA AMOX 3X1 KALIUM D 2X1 TUZALOS 2X1 SELCOMC1X1
20 FIKRI 1631312098 CERUMEN
21 MATHEN 12730209096 PARANOID ,SHIZOPRENIA
22 DITASARI 1607527304 MYOPIA
23 ELITA 1457172696 PRESBIOPIA MATA
24 ARWINSHAH 1457173743 JATUH DARI LANTAI
25 IDA CAHAYA AMOX 3X1 PCT 3X1 AMNTASID 3X1 RANITIDIN 2X1
26 GUSTIAWAN 1632792431 HAEMOROID AMOX 3X1 ANTASID 3X1 SELCOM C1X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
1 HASAN MUHASAN 72561161 CATARAK

2 SUMISIH 44095623 MYALGIA KALIUM D 2X1 SELCOMC 1X1
3 NRSAN 210747036 CEPALGIA ANTAL 3X1 B1 3X1
4 PENDI BAYU 16746810368 GASTERITIS CRONIS PCXT 3X1 ANTASID 3X1 ,RANITIDIN2X1
5 AGUS HARTPONO 1456171389 DM

6 MARGO 1079678733 HEMIPLEGI
7 IMAS YULIE 1813690315 PRESBIOPIOA
8 CICIH SUNARSIH 1480059909 HIPERTIROID
9 OHOM ROHIMIN 15322509828 ISPA TUZALOS 2X1
10 YUYUM 489988449 TYPOID FIVER

11 AISAH 1294559717 CHF
12 YOGI A PCT 3X1/2 ,CTM 3X1/2 ANTASI 3X1/2 NEOKOMINAL SY
1202059631 G E
13 EEN 1882729315 GASTERITIS ACUTE ANTASID 3X1 TUZALOS 2X1
14 INDAH 1716803897 FARINGITIS ACITE AMOX 3X1 PCT 3X1 GG 3X1
15 YOAMA TUZALOS 2X1 AMOX 3X1 ANTASID 3X1 AMBROXOL 3X1

16 SUINAH 1272364097 MYALGIA AMOX3X1 ,PCT 3X1 KALIM 2X1 OBH SY 3X1
17 LAS MARIA ,AMOX 3X1 PCT 3X1 GG 3X1 ANTSID 3X1 CTM 3X1
18 H DARUSALAM 1272363906 LYPOMA
19 NURHAYATI 72554501 COLISITITIS
20 BASYARIA 1257225513 MYOPIA
21 ST ZUBAEDAH 455396009 PRESBIOPIA
22 SRI I 1629045707 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 CTM AMBROXOL 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA OBAT
Nama Pasien
1 CASTA 1473895016 POST OP CATARAK

2 RAHMI 1653582137 ISPA PCT 3X1 VIT C3X1 GG 3X1
3 ENDANG 1607527293 MYAGIA

4 AMINOPHILIN 3X1 PCT 3X1 GG 3 1 CATOPRIL 25 2X1/2
MARIPAH 1159403692 HIPERTENSI
5 RASMI 1257574433 DM
6 ENI 1849000658 GASTERITIS ACUTE PCT 3X1 RANITIDIN 2X1 ANTASID 3X1
7 SIMPASTATIN 1X1 ,ASMET 3X1 SELCOMC 1X1

FITRIANI 1326726461 MYALGIA
8 ST HINDUIN 47769208 GASTERITIS ACUTE ANTASID 3X1 ,PCT 3X1 SELCOM C1X1
9 ENDANG 1079678905 PRESBIOPIA

10 BUDI 1476746212 DM ASMET 3X1 SELCOMC 1X1
11 DESI 1647352067 MYOMA UTERI

12 MALIK 16317181 MYALGIA ASMET 3X1 BCOMC 1X1
13 ST AISAH 134136077 CERVIK MUSCLE SPASMA

14 ISMAN 48200433 PRESBIOPIA
15 MARGO 1079678733 PRESBIPIA
16 ASMET 3X1,SELCOMC1X1 CTM 1X1 SK BETAMETASON
KASNING 45970356 DERMATITIS
17 ENDANG 1079678902 PRESBOIPIA
18 ROATIN 1196794067 LYMPHADENOPHATY ASMET 3X1 ,SELCOM C1X1
19 ELDRAJAT 1129415343 BRONCHITIS COTRI 2X1 ,AMBROXOL DEX 3X1
dr. Suhaimi
Nip.1965090620003005
RUJUKAN
RS TUJUAN
PARU RS H G W
PARU RS SENTRA MEDIKA
PARU RS MITRA MEDIKA
SYARAF RS H G W
DALAM RS H G W
KULIT RS H G W
JIWA RSUD KAB BKS

THT RSUD KAB BKS
MATA RS H G W
JANTUNG RSUD KB BKS
RUJUKAN
RS TUJUAN
P jantung RS CENTRA MEDIKA
P PARU RSUD KAB BKS

p paru RSUD KAB BKS
P SYARAF RS H G W
P SYARAF RS H G W
P JANTUNG RS KARYA MEDIKA
P PARU RS H G W
P DALAM RS H G W
RUJUKAN
RS TUJUAN
RUJUKAN
RS TUJUAN
P DLM RSUD KOTA BKS

P SYARAF RS H G W
P MATA RS H G W
P DLM RS UD KOTA BKS
P KULIT RS H G W
RUJUKAN
RS TUJUAN
P DLM RSUD KAB BKS

P DLM RS H G W
P DLM RS CIBITUNG MEDIKA

P.DLM RSUD KAB BKS
RUJUKAN
RS TUJUAN
RS TUJUAN
P JNTG RSUD KAB BKS
P.PARU RS RAWA LUMBU

P.JANTUNG RSUD KAB BKS
P.ANAK RS.CIBITUNG MEDIKA

RUJUKAN
RS TUJUAN
P.JANTUNG RSUD KAB BKSI
P.DALAM RSUD KAB BKSI
P.PARU RSUD KAB BKSI
P.SYARAF RS SENTRA MEDIKA

P.DALAM RS.H.GW
RUJUKAN
RS TUJUAN
P.DALAM RS H.GW
P.DALAM RS.KARYA MEDIKA

P.JANTUNG RS H.GW
P.SYARAF RS H.GW
P.SYARAF RSUD KAB BKSI
P.JANTUNG RS H.GW
P.THT RS H.GW
P.DALAM RS CIBITUNG MEDIKA
P.DALAM RS H.GW
RUJUKAN
RS TUJUAN
P DLM RS H G W
P SYARAF RS H G W
P DLM RS MEDIROSASA 2
P THT RS CIBITUNG MEDIKA
URO RSUD KOTA BKS
P SYARAF RS H G W
P PARU RS H G W
PANAK RS H G W
P SYARAF RS RAWA LUMBU
RUJUKAN
RS TUJUAN
P.OBGYN RS.KOTA BEKASI

P.MATA RS.MEDIROSSA BEKASI
P.JANTUNG RS.H. GW
P.ORT RS KARYA MEDIKA
P.MATA RS H .GW
P MATA RS H G W
P DLM RS H G W
P MATA RS H G W
P MATA RS H G W
P BEDAH RS H G W
P JIWA RSUD KAB BKS
ORT RS HG W
P THT RS H G W
P DLM RS H G W
RUJUKAN
RS TUJUAN
P PARU RS CIBITUNG MEDIKA

P KULIT RS RAWA LUMBU
P PARU RS H G W
P DLM RS H G W
P DLM RS BHAKTI HUSADFA
P JTNG RS H G W
P DLM RS KARYA MEDIKA

P BEDAH RSUD KAB BKS
RUJUKAN
RS TUJUAN
P THT RSUD KAB BKS
P JNTNG RSUD KOTA BKS

P MATA RS MEIDROSA
P MATA RS B KARTINI
P ANAK RS RAWA LUMBU
P JIWA RS UD KAB BKS
RUJUKAN
RS TUJUAN
P JNTNG RSUD KAB BKS
P PARU RS H G W
P PARU RS B H KARTINI
RUJUKAN
RS TUJUAN
P DLM RS H G W
P MATA RS H G W
P SYARAF RS SENTRA MEDIKA
RUJUKAN
RS TUJUAN
P BEDAH RS H G W
,CEK BTA
P ORT RS UD KOTA BKS

P MATA RSH G W
P MATA RS KARYA MEDIKA
PSYARAF RS MEDIROSA
P DLM RS BH KARTINI
P SYARAF RS H G W
P SYARAF RSUD KAB BKS
P DLM RSUD KOTA BKS
P URO RS H G W
P DLM RS HOSANA MEDIKA
P JIWA RSUD KAB BKS
P ANAK RS H G W
P DLM RS RAWA LUMBU
P SYARAF RS H G W
P KULIT RS H G W
P KULIT RS H G W
PBEDAH RS H G W
RUJUKAN
RS TUJUAN
RS TUJUAN
;P MATA RS H G W
P ORT RS H G W
P URO RSUD KOTA BKS
P SYARAF RS H G W
P MATA RS H GW
P DLM RS H G W
P KULIT RS H G W
P MATA RS H G W
RUJUKAN
RS TUJUAN
P.PARU RS.RAWA LUMBU
P.PARU RS.MEDIROSA BEKASI

P.PARU RS.RAWA LUMBU
SELCOM C 1X1 TOTAL

kontrol ulang
Tindakan Medis
P.HEMODIALISA RS H GW Keterbatasan Obat
P.MATA RS H GW Lanjutan ke RS Khusus / tingkat III ( contoh: pasien jiwa yg harus ke rs jiwa
P.MATA RS.RAWA LUMBU
P.DALAM RS H GW
P.MATA DAFTAR
RS MEDIROSA BEKASI RUJUKAN SPESIALIS DAN NON SPESIALIS
DATA PESERTA
No No. Kartu OBAT
Nama Pasien BPJS RUJUKAN
DIAGNOSA RS TUJUAN
Kesehatan
RUJUKAN
RS TUJUAN
P.BEDAH RS H GW
P.PARU RSUD KAB.BEKASI

P.DALAM RS.MITRA MEDIKA
1
P MATA RSUD KAB BKS
P SYARAF RS MEDIROSA
P DLM RS H G W
RUJUKAN
RS TUJUAN
P MATA RS H G W
ORT RS H G W
URO RSUD KOTA BKS
P KANDUNGAN RS H G W
P KULIT RS H G W
P SYARAF RS H G W
RUJUKAN
RS TUJUAN
P JNTNG RS H G W
P SYARAF RS H G W
P JNTNG RS H G W
PSYARAF RS H G W
P BEDAH RS H G W
P URO RS H BG W
P BEDAH RS H BG W
P BEDAH RS H BG W
RUJUKAN
RS TUJUAN
P BEDAH RS H G W
P BEDAH RS RAWA LUMBU
PANAK RS RAWA LUMBU
P DALAM RSUD KAB BKS
P BEDAH RS H G W

RUJUKAN
RS TUJUAN
P DLM RSUD KAB BKS
P PARU RSUD KAB BKS

P URO RSUD KAB BKS
P MATA RS H G W
P THT RS H G W
P MATA RS G H G W
P KULIT RS H G W
P PARU RSUD KAB BKS
P ANAK RS H G W
P JIWA RSUD KAB BKS

P THT RSUD KOTA BKS
P BEDAH ORT RS SILOAM
P MATA RS H G W
P KULIT RSUD KAB BKS
P DALAM RS H G W
RUJUKAN
RS TUJUAN
P DLM RS H G W
P DLM RS HOSANA MEDIKA
P DLM RS MITRA MEDIKA

P SYARAF RS G H W
P THT RS RAWA LUMBU

P ANAK RS HG W
P PARU RS ANISA
P MATA RS MEDIROSA BKS
P ANAK RS H G W
RUJUKAN
RS TUJUAN

P JNTG RS H G W
P ORT RS H G W
P BEDAH RS H G W
P SYARAF SERTRA MEDIKA
P MATA RSUD KAB BKS

HAEMOLISA RSUD KAB BKS

RUJUKAN
RS TUJUAN
P DLM RS H G W
P ORT RS UDS KAB BKS
P HEMODELISA RSUD KAB BKS
P THT RS H G W
P THT RS H G W
P JIWA RSUD KOTA BKS
P MATA RS H G W
MATA RS H G W
P ANAK RS H G W
RUJUKAN
RS TUJUAN
P MATA RS H G W
P DLM RSUD KABBKS

P SYARAF RS H G W
P MATA RS H G W
PDLM RSUD KABBKS
P BEDAH RS H GW
P DLM RS H GW
P MATA RSUD KAB BKS
P MATA RS H G W
RUJUKAN
RS TUJUAN
RS TUJUAN
P MATA RS MITRA MEDIKA
P SYARAF RS H G W
P DLM RSUD KOTA BKS
P MATA RS H G W
P OBZYN RS H GW
P OBZYN RS H G W
P MATA RS H GW
P MATA RS H G W
P MATA RS H G W
Bekasi, 4 Oktober 2015
H. Agus Sarin, S.AP

Nip. 196507041987031010

KODE FKTP: 10140601
Bulan : 3 November 2015
DATA PESERTA
Nama Pasien
Kesehatan
1 RIRIN 1306034807 BATUK
2 JIKI JULIANTO 1641896684 FARINGITIS ACUTE
3 LASIDAH 1837694439 FARINGITIS ACUTE
4 ISMAIL 1837694351 GASTERITIS ACUTE
5 ROMIN 1637979502 GASTERITIS ACUTE
6 SUJOTO 1341422684 FARINGITIS ACUTE
7 DAYU EKO 1622679276 CONJUNGTIVITIS
8 SRI BUDIARTI 72558683 SINUSITIS CRONIC
9 BUNYAMIN 72436094 MYALGIA
10 BOLLY AMALIA 1137555371 HYPERTYROID
11 MARLON P 1306035033 SHIZOPRENIA
12 RICKKY 1862918188 PARANOID
13 AMIH 1011189848 GASTERITIS ACUTE
14 AINUN 173029239 FARINGITIS ACUTE
15 BEKTI HANDAYANI 1627354899 DERMATITIS
16 ZUBAEDAH 1436503184 GASTERITIS ACUTE
17 TINA H 1462518303 MYALGIA

18 ATIN FIRMANSYAH 1893128499 FRAKTUR OF SHAFT OF HUMERUS OPEN
19 ILHAM 1634479683 TB PARU
20 MASIH 490188262 CATARAC
21 TITO S 1656422054 GASTERITIS ACUTE

22 SUMARNI 1271159763 CHF
23 MURBAINI 1881300374 DERMATITIS
24 SRI KUSMIATI 72613765 LYPOMA

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 NAVILAH 1626442176 FARINGITIS ACUTE
2 KARTINI 1626442165 FARINGITIS ACUTE
3 TASYA 167506931 FARINGITIS ACUTE
4 DUMARIS 18545292098 PRESBIOPA
5 MAYA 976022897 DM INSULIN
6 HADI SUMANTRA 1637220688 FARINGITIS ACUTE
7 RIZAL PRIATNA 1631072441 VARICELA
8 ONYIN 1469115191 MYALGIA
9 EDI 133576785 MYALGIA
10 DWI APNUR WATI 1335898697 ATRITIS
11 ABAY 490421815 DM
12 ROHATI 1454923282 CHF
13 DEDI S 1793653536 FR.OF CLAVICULE
14 NOVRIZA 1440470935 DERMATITIS
15 DEVI 1443212943 ABSES
16 SAMAD 489610495 BRONKHITIS
17 EMAD 1148112641 BATUK
18 ENCUM 1455287499 ISPA
19 ENING 1260294827 GASTRITIS
20 NASORI 1819492378 BATUK
21 H.ONO 1716113867 CHF
22 HJ.ASTI 1716113878 DISLOCATION OF ELBOW
23 YOHANES 1889959882 ISPA
24 KODAM 1641974815 DERMATITIS
TOTAL

KODE FKTP: 10140601
Bulan : 4NOPEMBER 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 ENUR 1469799527 TB PARU
2 SUIMARNO 1622848959
3 SANTI 1655440885 FARINGITIS ACUTE
4 ST NURALIA 490173726 ISPA
5 MARWATI 489017068 GASTERITIS ACUTE
6 ENENG RATNA 1459666664 ,GASTERITIS ACUTE MYALGIA
7 EVIANTI 1634588662 CLAVUS L84
8 ANGGUN 490136139 VARICELLA
9 INANG 1477943098 MYALGIA
10 NURINUN 1622848972 FARINGITIS ACUTE
11 MAEMUNAH 1716725002 KONSULTASI
12 NIMANSYAH 1656367615 CARDIAC ARTHYTHMIA
13 SURYADI 16428553722 FARINGITIS ACUTE
14 ADIRA NAFAL 1610532077 HORDEOLUM
15 TITING AFIAH 72298822 MYALGIA
16 AYU 39127792 HIPERTENSI MYALGIA
17 RATIH 490588391 DERMATITIS
18 KIRANA 1623671177 FARINGITIS ACUTE
19 DAMAN 72298811 MYALGIA
KODE FKTP: 10140601
Bulan 5 November 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 PARTIMAN 1128865353 MYALGIA
2 DWI ATNURWATI 1335898697 FARINGITIS ACUT
3 SURYADI 1642853722 FARINGITIS ACUT
4 PARIS 1475961456 EPITAXIS
5 ROATIN 1196794067 LIMPADENOPATI
6 EDY SUBAGYO 1335767185 DISLIPIDEMIA,GASTRITIS
7 RR.RETNO 1258454248 MYALGIA
8 YUSUF 47770402 CEPHALGIA,KATARAK
9 ERLINA 1866048748 FARINGITIS ACUT
10 TRI NURASTUTI 1474257688 DERMATITIS
11 GUSTIAWAN 1632792431 HEMOROID
12 NURSASI 73050592 MYALGIA
13 ARWINSYAH 1457173743 BATUK
14 WALIK W 1631371814 MYALGIA
15 FITRIANI 1326726461 ABSES
16 PURWANINGSIH 1631371825 GASTRITIS ACUT
17 IRWAN S 1655124401 ISPA
18 DIMAS 1840089115 MYOPIA
19 JIKI JULIANTO 1641896684 FARINGITIS ACUT
20 WAHIDIN 1454537215 DM INSULIN
21 BAGUS 489970743 CAMPAK
22 MEGI 1152591412 DEMAM
23 MARGO 1079678733 HEMIPLEGIA
24 MUCHLASIN 1434306791 ISPA
25 SANDI AKBAR 1858231383 FARINGITIS ACUT
26 DAFFA 1798342863 CONJUNGTIVITIS
27 FATIH 1477015929 RHINITIS

KODE FKTP: 10140601
Bulan 6 november 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 KARNI 1439973055 CYSTITIS
2 EMUNG 1470249472 STROKE
3 KURNIAWAN 1637379235 ISPA,GASTRITIS
4 NURAINI 1637379246 GASTRITIS
5 ONYAH 1011203212 GASTRITIS
6 NEWIN 1159560505 TB PARU
7 MUHIDA MUHTAR 72330838 DM INSULIN
8 SURIAH 1791649383 DERMATITIS
9 ROHIYAH 17177063648 MYALGIA
10 WIWI 1717063604 MYALGIA
11 YUYUN 1717025589 CEPHALGIA
12 VERA DWI S 1516617044 SINUSITIS
13 HENDRIK 1803692799 HIPERTENSI,MYOPIA
14 NAPSIAH 489840491 CEPHALGIA,DISLIPIDEMIA
15 ZEPANYA GABRIEL 1803696726 KUSTA
16 ELISWATI 1453913313 ASMA
17 NENG IRA 490178531 DERMATITIS
18 ADE WAWAN 72848924 DISLIPIDEMIA

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 EDIANAR 1129415343 BRONCHITIS
2 ZUBAEDAH 1436503184 OTHER COLISITIASIS
3 ENING 1260294827 DERMATITIS
4 ST MARGANI 1631828676 FARINGITIS ACUTE
5 SUCI SITO MARDANI 722966076 GASTERITIS ACUTE
6 ANDIHKA 1657041333 OTITIS MEDIA
7 LASIDAH 1837694439 GASTRITIS ACUTE
8 TARMINAH 1337159643 FARINGITIS ACUTE
9 ISMAIL 1837694351 GASTER ITIS CRONIS
10 LIMHANA 1454477556 DM DGN INSULIN
11 ERINAWATI 1335359316 CEPALGIA
12 HJ SUMARNI 1271159763 KONTROL POST OF
13 HASNIYATI 1271159763 CH F
14 LAMAH 1011206496 CONJUNGTIVITIS
15 KRISTIAN 1379997472 KONTROL FRAKTUR PEMUR DEXTRA
16 FINA MALIKHA 1631371847 DERMATITIS
17 PURWANINGSIH 1631371825 GADSTYERITIS ACUTE
18 SUPARMAN 723202207 FARINGITIS ACUTE

19 KUSTAJI 1375313455 FARINGITIS ACUTE

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 arya 1619766437 gasteritis acutye
2 DEWI 1619766448 gasteritis acutye
3 AMIN FAUZI 1643504545 FARINGITIS ACUTE
4 ST NURHAYATI 1176094427 gasteritis acutye
5 H SARJONO 1388073126 HIPERTENSI ,ISPA
6 ARMANIH 1637936098 gasteritis acutye
7 KUSNADI 1610194149 FARINGITIS ACUTE
8 TUMARI 1641900543 GATAL DEMAM
9 SABARYANTO 1455269714 HEMIPLEGIA
10 WAWAT WATI 1656390554 MYALGIA
11 HANDI 1858969326 MYALGIA DISLIPIDEMIA
12 ATMADIYO 1443211716 gasteritis acutye
13 budi kusmanto 1641896223 gasteritis acutye
14 DIDING 58122314 C H F
15 JOEL SIREGAR 1465594277 FARINGITIS ACUTE
16 SOEKASIH 1650322776 DM
17 ASMUNIH 143332222966 KONTROL POST OP
18 EDY 1335767185 MYALGIA
19 ZOEL ILHAM 490555866 MORBILI
20 TRI MUJI 490717678 GE
21 ISAK SAPUTRA 1643508281 GE
22 RIZQY 1176094438 BATUK
24 ZARDAN 1516881824 GATAL GE
25 SRI HANDIATI 1516882127 BATUK
26 TUMARI 1641900543 DERMATITIS
27 RATIH 1810838046 TUBERCOLOSIS PERIPHARAL LYMPHADENOPATY

KODE FKTP: 10140601
10-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 ST LESTARI 1428117715 CEPALGIA
2 IMAS YULIE 1813690315 PRESBIOPIA
3 ONYAH 1011203212 DEMAM
4 ALI M 1824192494 DM TANPA INSULIN
5 SUTINI 1308716673 DEPRESI
6 NURSASI 73050592 HIPERTYENSI DISPLIDEMIA
7 SUKAENAH 1471894378 MYALGIA
8 LUCIANA 1316948005 GASTERITIS CRONIS
9 AMUNG 1471894367 HIPERTENSI
10 DESI NURHIDAYAT 1078407369 MYOPIA
11 SRI 46119532 MYALGIA
12 DIMYATI 72690322
13 SATEM 12996343367 FARINGITIS ACUTE
14 NUR RIFAIZ 1299633142 FA RINGITIS ACUTE DERMATITIS
15 NASIR 1461315712 SHIZOPRENIA PARANOID
16 elis anisah 1633409943 FAR INGITIS ACUTE GASTERITIS ACUTE
17 M RIKI 1624305194 GASTERITIS ACUTE

KODE FKTP: 10140601
Bulan 11 November 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
11 11 2015
1 AIDIHIM 1409647094 MYALGIA
2 HM HASYYM 1279947947 GGK
3 SILVI 489918846 FARINGITIS ACUTE
4 AMA WAMA 72984835 MYALGIA
5 TB DEDEN 1336733739 TUBERCOLOSIS LYMPHADENITIS
6 MUARIPAH 1159403692 HIPERTENSI
7 ELA MARYANI 1630549866 DM HIPERTENSI
8 AGUS HARTONO 1456171389 DM
9 ST MUFLIKHA 1264135094 CELPALGIA
10 ST NURHAYATI 1176094427 MYA LGIA GASTERITIS
11 INYOMAN 1892297193 HIPERTENSI DM DISLIPEDEMIA
12 ROHMAT 1635521725 GASTERITIS ACUTE
13 MARSIH 490363571 FARINGITIS ACUTE
14 WAHIDIN 1454537215 GGK
15 LUCIANA 1316948605 ARTRITIS
16 BIBIT 1133284612 DERMATITIS
17 SUTINI 1368716673 C H F
18 EFENDI 1379330526T TINEA PORPORIS
19 MOHYANI 1901652377 HIPERTENSI GASTYERITIS MYALGIA
20 HJ EROM 47575967 FARINGITIS ACUTE

21 SRI HARTATI 17127309293 DERMATITIS
22 RIZQY MAULANA 1176094438 PAROTITIS
23 RUKIYATI 73151313 FARINGITIS ACUTE
24 PARLIAN MARBUN 132887866 C H F
25 LINDAWATI 1454504297 GGK
26 MUSAMAH 1608616012 FARINGITIS ACUTE
27 NAZNEEN H 1190533331 DEMAM
28 ARIP BUDIMAN 1645878532 GASTERITIS ACUTE
29 NAUFAL 1657985668 GE

KODE FKTP: 10140601
12-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
11/12/2015
1 RINI SETIAWATI 1837802474 ABSES
2 PARLILIAN MARBUN 1328878866 GASTERITIS ACUTE
3 HERMANUS 172167611373 COLISISTITIS CRONIK
4 M RAMDANI 1289574821 EPILEPSI
5 YAYAN MULYANA 72732958 PILEK
6 ERNIDA 72432189 CEPALGIA
7 KHOLIFATUNISA 1878110-482 DEMAM
8 WAWAT WATI 1656390554 MYALGIA
9 BAHRONI 1453855904 DM NON INSULIN
10 SOBRI SIDIK 47769243 ISPA
11 M RIZQY 1393100177 KOSULTASI CE K LAB
12 SUMISIH 44095623 DM MYALGIA
13 ST HAIMAH 1434871222 DM
14 ABAY 490721815 DM
15 WAHIDIN 1454537213 GGK
16 NURJANAH 1376365869 FARINGITIS MYAGIA
17 BUNAWAN 73159773 CEPALGIA
18 M RIANDANI 1393100199 FARINGITIS ACUTE
19 DEWI 173553671 APLASI ANEMIA
20 MARJUK MARDIANTO 47767083 HIPERTENSI FARINGITIS
21 NANDANG 1426195258 MYALGIA
22 MIRAH 230486789 MYALGIA
23 SAPTO 1836570093 G E
24 HERI 1388601412 HODGKINS DEASE UNSPEWCIFIED
25 ABDUL SYUKUR 1655706003 FARINGITIS ACTE
26 ALIF MUHAROM 1653937086 POSTOF APP
27 ASMIATI 1432131693 G E
28 I NYOMAN 1892297193 BRONCOPNEMONIA


KODE FKTP: 10140601
13-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 NUSAM 210747036 CEPALGIA
2 AMALIA LUTFI 1640360024 FARINGITIS ACUTE

3 AIDIHIM 14096347094 MYALGIA
4 KUSNADI 1610194149 SAKIT PADA TELINGA
5 DEWI ANDAYANI 1637460448 JATUH DARI MOTOR
6 HANIFAH 1854223626 BRNCHOPNEMONIA
7 WAHIDIN 1454537215 DM DEPENDENT DGN INSULIN
8 ROHANI 1473254684 DM DGN INSULIN
9 SULADSTRI 1610194151 CEPALGIA
10 ODIH 72531132 HAEMOROID
11 ATIN 723294276 MYAL;GIA

12 ROATIN 1196794067 SAKIT KEPALA
13 GOPUR 1626167125 FARINGITIS ACUTE

14 AZQIAN 72391689 INFECTION DERMATITRIS

KODE FKTP: 10140601
14-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 KUSNADI 189215066 HIPERTENSI
2 NENENG 181921613 MYALGIA
3 NAILAH RAYA 1273221887 VARICELLA
4 YARDI 1624303484 MYALGIA
5 M HUSNI 71374157 KATARAK
6 SURIAH 1791649383 ISPA ,GATAL
7 BAHRUDIN 1887026372 BATUK
8 EKA RAHAYU 1608623199 HERNIA INGUINALIS
9 URIP 20165996 MYALGIA
10 GUSTIAWAN 1632792431 CEPALGIA
11 ARI 1632792442 BA TUK GATAL
12 SANUSI 1292876976 JHIPERTENSI
13 RANTA 1864573161 HIPERTENSI
14 RIKO 1290168009 ABSES
15 M ILIYAS 1187013453 ISPA
16 SITI G 47769208 HIPERTENSI
17 fitriani 1326726461 MYALGIA
18 NURSITI 1634095396 KONSULTASII
19 LAMIN 1011206496 HIPERTYENSI GASTERITIS ACUTE
20 NAMUN 1011306496 SUSPEC TYPOID
21 INAH 1655124401 ISPA
22 CATIKA 72694089 DM
23 TENTI 1640444973 MYALGIA
24 YUSUF 1385722034 HIPERTENSI
25 IDA RAHAYU 1662750088 MYALGIA
26 DENTI 1642069517 GASTERITIS ACUTE
27 TUTI ALAWIYAH 1642069517 GASTERITIS ACUTE

KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
Kesehatan
11/16/2015
1 SRI ROHADI 1862213422 MYALGIA
2 ALRIZQY 1870248892 KWASIORKOR
3 MAURADIKA ARSILA 1862219158 BATUK PILEK DERMATITIS
4 KADARSIH 72692504 MYALGIA
5 LAVINDA 148136319 GGASTERITIS ACUTE
6 M NUR IMBAR 490178428 GASTERITIS ACUTE
7 UMAR SETIAWAN 1093844878 GASTERITIS ACUTE
8 MUHANI ALMUHANI 19016523777 HIPERTENSI
9 YADIH 1877535189 GASTERITIS ACUTE
10 LUTFI ADI 173029083 CH F
11 ENCIH 1877535191 GASTERITIS ACUTE,DM
13 ANA SAFITRI 1649823265 FARINGITIS ACUTE
14 LEMBAH ,MANAH 1655215413 FARINGITIS ACUTE
15 TAMARIA 1299222718 DERMATITIS MYALGIA
16 ST HASANAH 1870760441 MYALGIA
17 GOPUR 1626167125 CEDERA MATA
18 SUWINI 1305456751 MYALGIA
19 TIMO TINUS 1305455613 GASTERITIS ACUTE
20 PATANDIAN PB 1387434161 CEPALGIA
21 SURYA PUTRA ESTRA 1387433518 DERMATITIS

22 SUGIANTO 1328171265 MYALGIA
23 MUSONAH 1608616012 FARINGITIS ACUTE
24 YUHARMI 1623670389 FARINGITIS ACUTE
25 RAFLIZ ZAKIAH 1623670391 FARINGITIS ACUTE
26 SOBRI 47769243 CEPALGIA DM FARINGITI HIPERTENSI

27 ST JULAEHA 1339212636 CEPALGIA
28 MUSLIM SETIAWAN 1339212636 TUBERCOLOSIS
29 SUMIYATI 1431080122 DERMATITIS
30 ST MUFLIKHA 1264135094 HIPERTENSI
31 EKI PARAMITASARI 1644400034 BRONCHITIS
32 WARSIH 1432730215 GASTERITIS ACUTE MYALGIA
33 SUNARTI 1634295396 FARINGITIS ACUTE
34 SUHAENI 1011209332 HIPERYTENSI DM
35 A ZULKIPLI 72563679 KONTROLTENSI
36 RATU ADE 1320678549 KONTROL P MATA
KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 EDY SUBAGYO 1335767185 DEMAM
2 LILIS SETIAWATI 72377144 MYALGIA
3 ABDUL GANI 1900598951 PNEMOTHORAK UNSPECIFIED
4 ST HAFSAH 73492929 MYALGIA
5 H ABDUL RAHMAN 1271160268 ABSES
6 ARMANIH 1637936098 DEMAM
7 ABDRURAHMAN 1816432885 HIPERTIROID
8 I NYOMAN 1892297193 BROCHITIS DM
9 AMOH 1886785108 MYALGIA

10 ARMIH 490734808 MYALGIA
11 MIKSAM 1889161367 POST HERPES
12 DJARIMAN 72490094 CEPALGIA
13 ALIAN 29501818 DM DGN RENAL COMPLICATION

14 H RUSLAN 1461115956 C H F
15 RANI 47764383 FARINGITIS ACUTE
16 SRI 1806756636 ASMA
17 FIFI APRIYANI 1258881851 CEPALGIA
18 ZIVANA 1885338999 FARINGITIS ACUTE

KODE FKTP: 10140601
BULAN 18NOPEMBER 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 NURSASI 73050592 HIPERTENSI MYALGIA
2 YAYU SRI 72732993 DEMAM
3 PADLAN PERMATA 1192661381 FARINGITIS ACUTE
4 ANI M 1632792443 DERMATITIS
5 ODIH 1623670367 G E
6 USUP 490251104 POST OP HERNIA INGUINALIS
7 WAHYU 1641900576 DEMAM
8 INTAN 1425977616 ABSES
9 REIHAN 1646810403 DEM,AM
10 SURYADI 1460839072 C H F
11 SIANI 1841553966 MYALGIA
13 SUKAESIH 1650322776 ISPA
14 ASMABOTI 1082193423 DM DNGN KOMPLIKASI
15 PARTIMAN 1471514016 PRESBIOPIA
16 H SUANDI 1448029023 /CISTITIS HIPERTENSI PRESBIOPIA AMLODIPIN1X1 B63X1 ASMET 3X1

17 EDY DAMANIH 38623656 DM INSULIN
18 TRIANA SARI 1825602625 GASTERITIS
19 ROMLAH 489093535 CONJUNGTIVITIS
20 YULIAWATI 1463865614 MYALGIA
21 ENGKOS 489909519 KATARAK

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 UNIYAH 1638703989 MYALGIA
2 URIP 201659196 POST OP KATARAK
3 SANEM 1472802366 CEPALGIA
4 UMAR SETIAWAN 1093844878 GASTERITIS ACUTE
5 H ABDURAHMAN 1271160268 GANTI BALUTAN
6 LIYANI 1874202434 KONTROL TB PARU
7 SALSABILA 167259835 HEPATITIS
8 WARSIH 1432730215 GASTERITIS ACUTE ,FARINGITIS ACUTE MYALGIA SANADRIL SY PCT 3X1 RANITIDIN2X1 ,2X1 MOLACRIM 1
9 HASBULLOH 1259864829 HEMIPLEGIA
10 CANTIKA 72604089 FARINGITIS DM
11 ZIVANA 1885338999 DEMAM
12 LUSTA 1850214 DM
13 ABAY 490721815 DM ,GDS 175 MG
14 ANAH 18867852108 MYALGIA
15 DECKY 1516469916 GE ,GASTERITIS ACUTE
16 SOBRI SIDIK 47769243 DM
17 FADLI 1626584703 ISPA
18 ST AMINAH 1464942609 HIPERTENSI
19 RAH IBRA ADI 1637460459 ASMA BRONCHIALE

20 SAPARYATI 1011207273 MYALGIA
21 ERISNAWATI 1335359316 MYOPIA
22 H SOBARI 1464942598 FARINGITIS ACUTE
23 SUGIYANTO 1338171265 CEPALGIA
24 ENDARMOKO 1472455776 FARINGITIS ACUTE
25 NAMIRA 1609437295 FARINGITIS ACUTE
26 JHOVANZA 1174210018 DERMATITIS
27 ANZELLA 1375758729 DERMATITIS
28 SIAMI 1841558966 CHF

KODE FKTP: 10140601
DATA PESERTA
Nama Pasien
Kesehatan
1 SIMAH 1011189903 DM
2 SITI HABSAH 72604023 HIPERTENSI
3 GEMA 1811811699 CONJUNGTIVITIS
4 RONI 47764383 FARINGITIS CRONIS
5 ST HASANAH 187076441 MYALGIA HIPERTENSI
6 DODI J 1642139302 FARINGITIS ACUTE
7 NURAINI 490550253 GASTERITIS ACUTE
8 UMROH 490548148 SAKIT GIGI
9 LUCIANA 1316948005 DISLIPIDENIA GASTERITIS ACUTE

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 NURLINDA 1282509549 DM,BATUK
2 LILI S 1107508623 DERMATITIS
3 DIYAH EKAWATI 1816724766 FARINGITIS
4 LATIF HIDAYAT 1516224104 FARINGITIS ACUTE
5 KODAM SARI 1641974815 MYALGIA
6 DRS RINJAM 73333552 DERMATITRIS
7 RAFIQ 1290168009 ABSES
8 NI KETUT VERAWATI 1892298868 MYALGIA
9 MUSTOPA 1636932914 BATUK PILEK
10 MIDAN 490373638 CATARAK
11 H DARUS SALAM 1272363906 DM
12 DESI 1224255226 ISPA
13 FAUZIAH 1835872378 ISPA
14 H IDRIS 47765709 CHF
15 ANGGITA 1697679172 PENYAKIT KULIT LAIN
16 YULIANTI 1643504657 TB PARU
17 NANI 1807256924 ,DM
18 YESI ROSDIANA 1335842006 KELOID
19 H ABDURAHMAN 1271160268 GB
20 ABDURAHMAN 1376365347 MYALGIA
21 MARSIH 490363571 GASTERITIS
22 ISMAIL FAHMI 1837694351 GASTERITIS
23 LASIDAH 1837694439 GASTERITIS
24 INYOMAN 1892297193 DM HIPERTENSI MYALGIA
25 AMA WASMA 72984835 MYALGIA ,GASTERITIS ACUTE
26 FIRENDA 1655419869 MIOPIA
27 ZUBAEDAH 1436503184 ,MYALGIA GASRERITIS ACUTE
28 SUKEMI 1849285866 CHF

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 SUMRNII 1271159763 C H F
2 ASMUNIH 1433322966 ISPA
3 UUM 1466657774 ARTITIS
4 ERNA 1789328812 GASTERITIS ACUTE ,HIPERTENSI
5 WARNIH 1432730215 GASTERITIS ACUTE ,
6 SALWA 200012951 GRANULOMA
7 SUWANDI 1448029023 KONSULTASI
8 WINDI AYEM 1455816475 CGASTERITIS
9 DARA 1311965302 CMEN COOL
10 SANAM 1472802366 MYOPIA
11 ACAH AFSAH 47769254 GASTERITIS
12 SOBRI SIDIK 47769253 DM,
13 NELI 1795186157 LYMPADENITIS TB
14 TITI SUNDARI 72501159 MYOCAR INFARK
15 KASNING 45970356 MYALGIA ,DERMATITIS
16 SIMAH 1011189903 DM,
17 SUPRAPTI 18374473 MYALGIA ,
18 ANISA 1258696001 FARINGITIS ACUTE
19 RAHMI 1635582157 ISPA
20 JAANIH 1625054916 APP ACUTE
21 AHYADI 1269938215 HERNIA INGUINALIS
22 LUTFI 173029083 DERMATITRIS
23 NINING 173028969 MYALGIA
24 M.FAZRI 188102152 FARINGITIS ACUTE
25 SANDY H 1210969203 FARINGITIS ACUTE
26 M. SOLEH 60810153 KATARAK
27 KARLINA 1457176015 CEPHALGIA
28 RIZALUL FAHMI 1457176375 FARINGITIS ACUTE
29 KASMAH 1304833015 DM,

KODE FKTP: 10140601
Bulan 24-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 IMAS MASTUROH 1805197634 FARINGITIS ACUTE
2 FADLAN 1818251043 FARINGITIS ACUTE
3 CH SUPARTINAH 72678464
4 SOROTO 1869196588 HIPERTENSI
5 MURSASI 73050592 HIPERTENSI ,MYALGIA
6 ZAPAR 1467187209 FARINGITIS ACUTE,POST OP HERNIA
7 YUYUM 1465612209 PRESBIOPIA
8 ABDURAHMAN 1271160268 GANTI BALUTAN
9 DIYAH 1816724766 FARINGITIS ACUTE
10 ANIS 1224289517 CEPALGIA
11 SUPRAPTI 127329006 FARINGITIS ACUTE
12 AMIN FAUZI 1643504543 FARINGITIS ACUTE
13 SLAMET 1461307983 DERMATITIS ,MASTOIDENITIS
14 YUSUF HIDAYAT 1461449564 DERMATITIS FARINGITIS ACUTE
15 MARTHEN 1273029096 MENTAL AND BEHEVIDORAL
16 PURWO SULISTIO 1224289473 FARINGITIS ACUTE

KODE FKTP: 10140601
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 ANE ISTIANA 1146222055 DISORDER OF EAR UNSPECIFIED

2 SANDI HENGKI 489942347 CHEPALGIA
3 M.ZAENI 490634066 GASTRITIS
4 ST.LESTARI 1428117715 KONSULTASI
5 SUDARSIH 60810175 MYALGIA
6 CAHYA 1305296414 DISLIPIDEMIA,DM

7 SISWOTO 1608940012 DM
8 NAMIRA 1428118806 FARINGITIS ACUTE
9 MARYANI 163750507687 TB PARU RUJUK KE PUSKESMADS SETU 2
10 TRI MURYANI 1177325572 MYALGIA
11 ALIFA 1642124507 EPILEPSI
12 M BASORI 1460315428 HEMI PLEGI ,UNSPECIFIED
13 M NUR SOPIAN 1629504257 FARINGITIS ACUTE
14 NENG IRA 490178531 DERMATITIS
15 NOVIA 1169397753 KONSULTSI
16 HARTATI 1169397742 EPILEPSI
17 DARYONO 1657484594 GASTRITIS
18 IYAN 1403964197 CHEPALGIA

KODE FKTP: 10140601
Bulan 26-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 EDY SUBAGYO 1335767185 GASTERITIS ACUTE
2 UMIH 1474493951 FARINGITIS ACUTE
3 SUHARMI 1428646937 MYALGIA
4 DJOKO 1625046895 GASTERITIS ACUTE
5 GITA 1437103181 DERMATITIS
6 VEERZA 1437104013 DERMATITIS
7 KASNING 45970356 MYALGIA
8 SURYATI 1832582542 C H F
9 H MUHADI 1832582529 C H F
10 SAMSAN 1427640041 HEMIPLEGIA
11 NAZA 72450696 C H F
12 RUSTINI 1451018902 OMA
13 UMAR 1093844878 GASTERITIS ACUTE
14 ACAH AFSAH 47769254 GASTERITIS ACUTE
15 NENENG MARNINGSIH 1819216113 DERMATITIS
16 SOBARI SIDIK 47769243 HIPERTENSI DM
17 MARLIAH 1880637930 MYALGIA
18 ABDUL KODIR 1895374124 HERNIA
19 KUSNADI 1819215066 HAEMIROID
20 MARINAH 47769017 DERMATITIS CH F
21 LEMBAH MARIYAH 1655215413 HIPERTENSI DM
22 FINA 1628961377 FARINGITIS ACUTE
23 AMINAH 1637936098 TB PARU
24 HJ EROM 1429428216 COLISISTITIS ACUTE
KODE FKTP: 10140601
Bulan November 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
11/27/2015
1 MARWATI 489017068 CEPALGIA
2 NUR KYLA 1517849087 FARINGITIS ACUTE
3 MASAN 1293998681 C HF
4 SUJIANTO 1373358830 DISLIPIDENIA
5 ROBIAH 1373358936 DISLIPIDENIA
6 ST RODIYAH 72484661 CEPALGIA
7 EMAD 1148112641 ASMA
8 MUHAMAD FAZRI 1881021521 FARINGITIS ACUTE
9 DIANA SARI 1825602625 DEMAM
10 TONI HARTONO 1645185701 FARINGITIS ACUTE
11 AQILHA FATHA 1380955329 TB PARU
12 ADIRA 1610532077 HERVES LOZTER
13 NAMAN 490748943 PRESBIPIA
14 BUNGA 1311592228 TB PARU
KODE FKTP: 10140601
28-Nov-15
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 DEWI RUTH 1308387431 FARINGITIS ACUTE
2 ADE WAWAN 72848924 GASTERITIS ACUTE
3 ZUBAEDAH 1436503184 SISTITIS
4 JESICA 165056001 MYALGIA
5 PUPUT 489992938 ISPA
6 QAITYAH 1642909061 ISPA
7 TRI MUR YANI 1177325572 GASTERITIS ACUTE
8 SAIDAH 72614823 HIPERTENSI
9 SOROTO 1869196588 HIPETRTYENSI
10 DIAN SUK MAWATI 1463271243 ISPA
11 EDY SUBAGYO 1335767185 GASTERITIS ACUTE
12 MIKAM 1889161367 GASTERITIS CRONIS UNSPECIFIED
13 BADRUDIN JAMIL 1887025972 KIR DOKTER
14 TIMAWAN 1308385539 DERMATITIS CRONIS
KODE FKTP: 10140601
30 N0P 2015
DATA PESERTA
No DIAGNOSA
No. Kartu BPJS
Nama Pasien
Kesehatan
1 ABDUL HARIS 1623848938 VARICELA
2 TRI MURYANI 1177325572 GASTERITIS ACUTE
3 IKIN 489023155 CRF
4 EDIKUSNADI 1385815285 C H F
5 H RUJITO 1263835888 HEMIPLEGI
6 SOBRI SIDIK 47769243 DM HIPERTENSI FARINGITIS
7 IIN ROSDIANA 1639546839 G E
8 ST JUBAEDAH 455396009 KATARAK
9 LAMAH 1011206496 GASTERITIS ,PRESBIOPIA
10 GUNAWAN 1105283474 FARINGITIS ACUTE
11 NADIH 490316751 BATUK
12 H SARJONO 1388073126 ULCUS LACERATUM
13 TIANUR 1284835498 SHIZOPRENIA
14 JIKI JULIANTO 1641896684 GE
15 INTAN AMALIA 1631371858 FARINGITIS ACUTE
16 NARDI 1648394594 MYALGIA
17 RENI ARYANI 1870918705 DERMATITIS ACUTE
18 ALMIRA 1870920101 DERMATITIS ACUTE
19 SUTRISNO 1638975611 DERMATITIS ACUTE
20 SUMINI 1450236971 BA TUK PILEK
21 SANTI SURYANI 1637937202 DEMAM
22 ABAY 490721815 DM
23 SUPRAPTI 127329006 BATUK
24 SUHARNI 1428646937 MYALGIA
25 M ZAENI 490634065 GASYTRITIS CRONIS
26 SUKAESIH 1650322736 DM
27 IPAH 490189364 C R F
28 WALIK MUJIANTO 1631371814 MYALGIA
29 MAWARDI 129588861 MYALGIA
30 ZAKI 1637979524 GASTERITIS
31 TUKINO 1455052206 APP ACUTE
32 NURIFAIZ 1299633142 ABSES
33 LARASARI 1460539923 DEMAM
34 RIZKY NUR ILHAM 207980436 GASTERITTIS CRONIS
dr. Suhaimi
Nip.1965090620003005
RUJUKAN
OBAT RS TUJUAN
PCT 3X1 CTM 3X1 OBH SY
AMOX 3X1 PCT 3X1 GLIBEKLAMID 1X1 SELCOMC 1X1 OBH SY
AMOX 3X1 PCT 3X1 BC 3X1 OBH SY
RANITIDIN 2X1 ANTASID 3X1 ,PCT 3X1 BC 3X1
ANTASID 3X1 ,PCT 3X1 RANITIDIN 2X1
AMOX 3X1 PCT 3X1 OBH SY SDM
TMERLA 3X3TTS ,AMOX 3X1 PCT 3X1
P TH T RSUD KAB BKS

PCT 3X1 AMOX 3X1 BCOMC 1X1
P DLM RS H GW
P JIWA RSUD KAB BKS
P JIWA RSUD KAB BKS
ANTASID 3X1 PCT 3X1 RANITIDIN2X1 KALIUM D 2X1
PCT 3X1 CTM 3X1 AMBROXOL 3X1 ANTASID 3X1
CETIRIZIN 1X1 ,DEX 3X1 BCOMC 1X1 SALICIL TALK
ANTASID 3X1 ,SELCOMC 1X1 KALIUMD 2X1
ASMET 3X1 PIROXICAM 2X1 B1 3X1KALIUD 2X1
ORT RS H GW
P PARU RS H GW
P MATA RS MEDIROSA
ANTASID 3X1 ,RANITIDIN 2X1 ,AMOX 3X1 PC 3X1

CTM 3X1 ,BCOM C1X1 SK NISAGON

RUJUKAN
OBAT RS TUJUAN
BC 3X1 PCT 3X1 AMO X3X1 SANADRIL 3X1
OBH 3X1 ,ASMET 3X1 BC 3X1
PCT 3X1 AMOX 3X1 CTM 3X1 GG 3X1 ANTASID 3X1
P MATA RS H G W
P DLM RS H G W
AMOX 3X1 TUZALOS GG 3X1 ANTASID 3X1 BC 3X1
ACICLOVIR 4X1 ,PCT 3X1 CTM 3X1,SALISI LTALK SELCOMC1X1
AMLODIPIN1X1 ,B1 3X1 PIROXICAM 2X1 KALIUM 2X1
ASMET 3X1 BC 3X1 RANITIDIN 2X1
KALIUM 2X1 ,RANITIDIN 2X1 BC 3X1
GLIBEN 1X1,SELCOM C 1X1
P JANTUNG RS H GW
P ORT RS H GW
PCT 3X1, AMOX 3X1,CETIRIZIN 1X1
AMOX 3X1/2, BC 3X1/2,PCT 3X1/2
KOTRI 2X2,SELCOM C 1X1
AMOX 3X1,CTM 3X1,GG 3X1,BC 1X1,SALBUTAMOL 3X1
AMOX 3X1,TUZALOS 3X1,DEXA 3X1,SELCOM C 1X1
ANTASID 3X1,RANITIDIN 2X1,PCT 3X1
AMOX 3X1,TUZALOS 3X1,GG 3X1,SELCOM C 1X1
P JANTUNG RS H GW
P ORT RS H GW
AMOX 3X1,TUZALOS 3X1,DEXA 3X1,
CETIRIZIN 1X1,DEXA 3X1,MIKONAZOL 3X1

RUJUKAN
OBAT RS TUJUAN
P PARU RSUD KAB BKS

ASMET 3X1 AMOX 3X1 BC 3X1
AMOX 3X1 PCT 3X1 GG 3X1 CTM 3X1
AMOX 3X1 PCT 3X1 GG 3X1 CTM 3X1
ANTASID 3X1 RANITIDIN2X1 PCT 3X1 BC 3X1
PCT 3X1 ANTASID 3X1 RANITIDIN 2X1 SELCOM C1X1
P BEDAH RS H G W
PCT 3X1/2 AMOX 3X1/2 LITACUR SY
KALIUM D 2X1 ASMET 3X1 BC 3X1
AMOX 3X1 PCT 3X1 SELCOMC 1X1
P JANTUNG RS H G W
AMOX 3X1 PCT 3X1 SANADRIL SY 3X1SDM
SM ERLA AMOX 3X1 PCT 3X1 CTM 3X1
SIMPASTATIN 1X1 ASMET 3X1 BC 3X1
AMLODIPIN 1X1 ASMET 3X1 BC 3X1
CREM CETOCONAZOL ,PCT BC 3X1 CTM 3X1
AMOX 3X1 GG 3X1 CTM 3X1 LITACUR SY
ASMET 3X1SELCOMC 1XQ1

RUJUKAN
OBAT RS TUJUAN
ASMEF 3X1,BECOM C 1X1
SANADRYL 3X1,AMOX 3X1,PCT 3X1,BC 3X1
SANADRYL 3X1,AMOX 3X1,PCT 3X1,SELCOM C 1X1
AMOX 3X1/2,DEXA 3X1/2,BC 3X1
P BEDAH RS MITRA MEDIKA

ASMEF 3X1,SIMVASTATIN 1X1,ANTASID 3X1,RANITIDIN 2X1
P SYARAF RS RW LUMBU
ASMEF 3X1,BECOM C 1X1 P MATA RSUD KAB BEKASI
SANADRYL 3X1,AMOX 3X1/2,PCT 3X1/2,VITCUR 1X1
CTM 3X1,PCT 3X1,KETOKONAZOL 3X1
METRO 3X1,ASMEF 3X1,B6 3X1
ALLOPURINOL 3X1,KALIUM D 3X1,SELCOM C 1X1
AMOX 3X1/2PCT 3X1/2,DOMPERIDON 3X1/2,SANADRYL 3X1
KALIUM D 3X1,B1 3X1
AMOX 3X1,PCT 3X1,DEXA 3X1,SK BEVALEX 3X1
ANTASID 3X1,RANITIDN 2X1,KALIUM D 3X1
AMOX 3X1,PCT 3X1,SANADRYL3X1
P MATA RS H GW
SANADRYL 3X1,AMOX 3X1,PCT 3X1
P DALAM RSUD KAB BEKASI

AMOX 3X1/2,PCT 3X1/2,CTM 3X1/2,SALICYL 3X1,LITACUR 1X1
AMOX 3X1,PCT 3X1,GG 3X1
KONTROL ULANG
AMOX 3X1,PCT 3X1,SANADRYL3X1
AMOX 3X1,TUZALOS 3X1,DEXA 3X1,GG 3X1
AMOX 3X1/2,TUZALOS 3X1/2,SELCOM C 1X1/2,SM KLORO 3X1
CTM 3X1/2,PCT 3X1/2VIT C 1X1
RUJUKAN
OBAT RS TUJUAN
COTRI 2X2,ASMEF 3X1,DEXA 3X1
P SYARAF RS MITRA MEDIKA

AMOX 3X1,PCT 3X1,GG 3X1,ANTASID 3X1
ANTASID 3X1,RANITIDIN 2X1,PCT 3X1
ANTASID 3X1,AMOX 3X1,PCT 3X1

P DALAM RSUD KOTA BEKASI
CTM 3X1,SALYCIL 3X1
PIROX 1X1,KALIUM D 3X1,B1 3X1
KALIUM D 3X1,B1 3X1
PCT 3X1,RAMABION 1X1
P THT RS H GW
CAPT 2X1/2,PCT 3X1 P MATA RS H GW
ASMEF 3X1,SELCOM C 1X1,SIMVASTATIN 1X1
P KULIT RS H GW
P PARU RS ANNISA
AMOX 3X1/2CTM 3X1/2,BEVALEX 3X1
SIMVASTATIN 1X1,ASMEF 3X1,SELCOM C 1X1
RUJUKAN
OBAT RS TUJUAN
SANSADRIL 3X1SDM AMBROXOL 3X1 SELCOMC 1X1
P BEDAH RS MEDIROSA BKS

LORATADIN 1X1 ,PCT 3X1/2 BCOMC 1X1/2
AMOX 3XQ1 PCT 3X1 SANADRIL SY 3X1SDM
OMZ 1X1 ,RANITIDIN 2X1 ,PCT 3X1 BC 3X1
AMOX 3X1/2 PCT 3X1/2 TK KLORO 3X3TTS
AMOX 3X1 ANTASID 3X1 RANITIDIN2X1 PCT 3X1
AMOX 3X1 PCT 3X1 BC 3X1 SANAdril sy 3x1sdm
ANTASID SY 3X1SDM RANITIDIN2X1 BC 3X1
P DLM RS H G W
ASMEYT 3X1 BC 3X1
P BEDAH RSUD KOTA BKS

P JANTUNG RS H G W
AMOX 3X1 PCT 3X1 SMERLA
ORT RSUD KOTA BKS

LORATADIN 1X1 SK HIDROCORTISON
ANTASID 3X1 PCT 3X1 RANITIDIN 2X1
CIPRO 2X1 SELCOMC 1X1 PIROXICAM 2X1 ASMET 3X1 AMBROXOL 3X1
PCT 3X1 SELCOMC 1X1 AMOX 3X1

RUJUKAN
OBAT RS TUJUAN
antasid 3x1 ranitidin2x1 pct 3x1 b c 3x1
PCT 3X1 ANTASID 3X1 RANITIDIN2X1 BCOMC 1X1
PCT 3X1 AMOX 3X1CTM 3X1 ANTASID 3X1 SANADRIL SY
ANTASID 3X1 RANITIDIN 2X1 B6 3X1
ASMET 3X1 CIPRO 2X1 CTM3X1 SAMNADRIL
ANTASID SY ,3X1SDM RANITIDIN 2X1 CTM PCT 3X1
AMOX 3X1 TUZALOS 2X1 ,DEX 3X1
AMOX 3X1 CTM 3X1 PCT 3X1 SALISIL TALK
P SYARAF RS H G W
KALIUM D 2X1 ASMET 3X1 SELCOMC1X1
KALIU 2X1 SELCOMC 1X1
ANTASID 3X1 PCT 3X1 Ranitidin 2x1
ANTASID 3X1 ,PCT 3X1 RANITIDIN 2X1

PCT 3X1 AMOX 3X1 BC 3X1
GLIBENKLAMIDE 1X1 ASMET 3X1 SELCOM 1X1

ASMET 3X1 KALIUM D2X1 SELCOMC 1X1
AMOX3X1/2 PC TT 3X1/2 CTM 3X1/2 SALISILTALK
MOLAGIT 3X1/2 PCT 3X1/2 CTM 3X1/2
MOLAGIT 3X1PCT 3X1 ANTASID 3X1 ORALIT
AMOX 3X1 PCT 3X1 GG 3X1
KALIUM D 2X1 FIROXICAM 2X1 ASMET 3X1
NEOCOMINAL SY CTM 3XQ1 SK BEVALEX
AMOX 3X1 CTM 3X1 SELCOPM C1X1 AMBROXOL 3X1
AMOX 3X1 CTM 3X1 PCT 3X1 SALISILTALK
RUJUKAN
OBAT RS TUJUAN
P SYARAF RS H G W
P MATA RS H G W
P DALAM RS MITRA MEDIKA
METPORMIN 1X1 BC 3X1
P JIWA RSUD KAB BKS

SISPASTATIN 1X1 ALUPURINOL 2X1 KALIUM D 2X1
ASMET 3X1 KALIUM D 2X1 FIROXICAM 2X1
ANTASID 3X1 B6 3X1
KALIUM D 2X1 B1 3X1 FIROXICAM 2X1 AMLODIPIN 1X1
P MATA RS H G W
P SYARAF RS H G W
AMOX 3X1 DEX 3X1 CTM 3X1 AMBROXOL 3X1
SANADRIL 3X1SDM ,CTM 3X1 DEX 3X1 SK HIDROCORTISON
P JIWA RSUD KAB BKS

AMOX 3X1 PCT 3X1 ANTASID 3X1 RANITIDIN2X1
ANTASID SY 3X1SDM RANITIDIN 2X1/2 PCT 3X1/2 CTM 3X1/2
RUJUKAN
OBAT RS TUJUAN
P DLM RS KARYA MEDIKA

HAEMODELISA RS MEDIROSA
PCT 3X1 AMOX 3X1 SANADRIL SY 3X1SDM
KALIUM D 2X1 SELCOMC 1X1 CREM MULAKRIM
P DLM RSUD KAB BKS

AMLODIPIN 1X1 SELCOMC 1X1 PCT 3X1
METFORMIN 1X1 PCT 3X1 CTM, 3X1 BC 3X1 P DLM RS H G W
P SYARAF RS UD KAB BKS

ASMET 3X1 ,ANTASID 3X1 RANITIDIN 2X1 BC 3X1
MET FORMIN 1X1 SIMPASTATIN1X1 AMLOPIDIN 1X1
ANTASID 3X1 PCT 3X1 RANITIDIN 2X1
AMOX 3X1,PCT 3X1 CTM 3X1SELCOM C1X1SANADRIL3X1SDM
HAEMODELISA RSUD KOTA BKS

P DLM RSUD KAB BKS
AMOX 3X1 PCT 3X1 LORATADIN 1X1
P JANTUNG RS H G W
GLISOPULVIN CTM SK KETOKONAZOLE
ANTASID 3X1 VIT B1 3X1 AMLODIPIN 1X1 PIROXICAM 2X1
AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY
LORATADIN 1X1 PCT 3X1 BC 3X1
LITACUR SY AMOX 3X1/2 PCT 3X1/2
PCT 3X1 ANTASID 3X1 SANADRIL SY 3X1SDM TM ERLA
P JANTUNG RS H G W
P DLM RS ANNA
AMOX 3X1 PCT 3X1 SANADRIL SY 3X1SDM
KONSULTASI
ANTSASID 3X1 PCT 3X1 RANITIDIN2X1
MOLAGIT 3XQ1 CTM 3X1 COTRI D 2X2

RUJUKAN
OBAT RS TUJUAN
AMOX 3X1 CTM 3X1 SELCONC 1X1 SK BEVALEX
ANTASID 3X1 RANITIDIN2X1
P DLM RS HG W
P SYARAF RS H GW
TUZALOS 2X1 GENTIAN VIOLET
ASMET 3X1 SELCOM C1X1
AMOX 3X1 PCT 3X1
KALIUM D 2X1 SELCOM C 1X1
P DLM RHGW
PCT 3X1 SELCOMC 1X1 OBH SY
KALIUM D2X1 SELCOMC 1X1
P DLM RS CIBITNG MEDIOKA

METFORMIN 1X1 SELCOMC 1X1
HD RS KARTIKA HUSADA
ASMET 3X1 AMOX 3X1 PIROXICAM CTM 3X1
PSYARAF RSUD KAB BKS

AMOX 3X1/2 PCT 3X1/2 SANADRIL SY 3X1SDK
P DLM RSUDKAB BKS

OBH AMOX 3X1 PCT 3X1 CATOPRIL 2X1/2
P SYARAF RS H G W
ASMET 3X1 BC 3X1
COTRI 2X2 [PCT 3X1 BC 3X1 CTM 3X1
P DLM RSUD KAB BKS

AMOX 3X1 PCVT 3X1 SELCOPMC 1X1 P BEDAH
RS KARYA MEDIKA
COTRI 2X2 MOLAGIT 3X1 ANTASID 3X1 CTM 3X1
COTRI 2X1 DEX 3X1 AMBROXOL 3X1 SIMPASTATI 1X1 AMLODIPIN 1X1 METFORMIN
1X1
RUJUKAN
OBAT RS TUJUAN
ASMET 3X1 SELCOM1X1 KALIUMD 2X1
AMOX 3X1 /2 PCT 3X1/2 CTM 3X1/2 ANTASID 3X1/2 SANADRIL SY

ASMET 3X1 CTM 3X1
ASMET 3X1 DEX 3X1 AMOX 3X1
COTRI D 2X2 CTM 3X1 PCT 3X1
P DLM KARTIKA HUSADA

P DLM RS H G W
P SYARAF RS H G W
CETIRIZIN 1X1 SELCOMC 1X1
PIROXICVAM 2X1 KALIUM D 2X1 ASAM URAT 8 MG GDS 141 MG
ASMET 3X1
AMOX 3X1 ANTASID 3X1 SELCOMC 1X1PCT 3X1 SANADRIL SY
P KULIT RS H G W
RUJUKAN
OBAT RS TUJUAN
ASMET 3XQ1 PIROXICAM 2X1 BCOM C1X1
PCT 3X1 CTM 3X1 DEX 3X1 VITC3X1 ACICLOPIR
ASMET 3X1 BCOMC 1X1
P MATA RS BH KARTINI
OBH CTM3X1 DEX 3X1 BCOMC 1X1
ASMET 3X1 SELCOMC 1X1
PBEDAH RS KARTIKA HUSADA

PIROXICAM 2XQ1 ASMET3X1 VIT C3X1 OBH 3X1SDM
ASMET 3X1 BCOMC 1X1
AMBROXOL 3X1 ASMET 3X1 PIROXICAM 2X1
ASMET 3X1 ,BCOMC 1X1 CATOPRIL12,5MG 1X1
ASMET 3X1 BC 3X1
AMOX 3X1 DEX 3X1 SK BACITRACIN
GG3X1 CTM 3X1
AMLODIPIN 1X1 CTM 3X1 ASMET3X1
ASMET 3X1 ANTASID 3XQ1 RANITIDION2X1 SELCOMC 1X1
KONSULTASI
THIAMPENICOL 3X1 ANTASID 3X1 RANITIDIN 2X1 CTM 3X1 P
GG 3X1 SELCOMC 1X1 PCT 3X1
METPORMIN 3X1 PCT 3 X1
ASMET 3X1 BCOMC 1X1
CTM 3X1 DEX 3X1 SM KLORO CATOPRIL 12,5MG
ASMET 3X1 BCOMC 1X1
KONSULTASI

RUJUKAN
OBAT RS TUJUAN
P SYARAF RS H G W
P ANAK RS CIBITUNG MEDIKA
PCT 3X1/2 CTM 3X1/2 PCT 3X1/2
ASMET 3X1 BCOM 1X1
ANTASID SY RANITIDIN21 PCT 3X1 OBH SY
ANTASID 3X1 PCT 3X1 SELCOMC 1X1
ANTASSID 3X1 RANITIDIN2X1 BC 3X1
AMLODIPIN 1X1 ANTASID 3X1 PCT 3X1 BC 3X1
SANADRIL SY 3X1SDM RANITIDIN 2X1 PC T 3X1 BC 3X1
AMOX 3X1 RANITIDIN2X1 PCT 3X1 P JANTUNG RSUD KAB BKS
PCT 3X1 RANITIDIN2X1 ANTASID 3X1 GLIBEKLAMID 1X1
ASMET 3X1 ,SELCOMC1X1
OBH AMOX 3X1 PCT 3X1BC 3X1
SANADRIL SY 3X1
ASMET 3X1 BC 3X1 DEX 3X1 SK MICONAZOLE
KALIUD 2X1 BC 3X1 RANITIDIN2X1
P MATA MITRA MEDIKA

ASMET 3X1BC 3X1 MOLAK KRIM 1
ANTASID 3X1/2 BC3X1
ASMET 3X1 BC 3X1
CETIRIZIN 1X1 CLARIMICIN 3X1 SANADRIL 3X1SDM SK GENTAMICIN
KALIUMD 2X1 BC3X1 DEX 3X1 MOLAKRIM

AMOX 3X1 PCT 3X1 SANADRIL SY
AMOX 3X1 BC 3X1 OBH SY 3X1SDM
AMOX 3X1/2 PCT 3X1/2 SANADRIL SY
GLIBENKLAMIDE BC 3X1 CATOPRIL 12MG 1X1 OBH 31SY 3X1SDM
ASMET 3X1 BC 3X1
P PARU RS RAWA LUMBU

AMOX 3X21 PCT 3X1 SK HIDROCORTISON
CATOPRIL 12,5MG PCT 3X1 BC 3X1
SANADRIL SY AMOX 3X1 PCT 3X1 BC 3X1
PCT 3X1 ANTASID 3X1 BC 3X1 RANITIDIN 2X1
PCT 3X1 SELCOMC 1X1 OBH SY
AMLODIPIN 1X1 METPORMIN3X1 ASMET 3X1 SIMPASTATIN1X1
SELCOMC 1X1
P MATA RS H G W
RUJUKAN
OBAT RS TUJUAN
PCT 3X1 DSELCOMC 1X1
ASMET 3X1 BC 3X1

ASMET 3X1 BC 3X1
AMOX 3X1 SELCOM 1X1

P DALAM RS H G W
OBH SY METFORMIN3X1 SIMPASTATIN 1X1 AMLODIPIN 1X1 ANTASID 3XQ
ASMET 3X1 SELCOMC1X1 RANITIDIN2X1

ASMET 3X1 BC 3X1
ASMET 3X1 SELCOM C1X1
PCT 3X1 SELCOMC 1X1
P DA LAM RS H G W
P JANTUNG RS H G W
AMOX 3X1 PCT 3X1 SELCOMC 1X1 SANADRIL SY 3X1SDM
P PARU RSUD KAB BKS

PCT 3X1 CTM 3X1 AMOX 3X1 AMBROXOL 3X1
AMOX 3X1 PCT 3X1 CTM 3X1 AMBROXOL 3X1
RUJUKAN
OBAT RS TUJUAN
PCT 3X1 CATOPRIL 12,5MG SIMPASTATIN 1X1
P DALAM RS BH KARTINI
SANADRIL SY SALBUTAMOL 3X1 PCT 3X1 AMOX 3X1
CTM 33X1 BC 3X1 SK BEVALEX 1
KOTRI D 2X2 PCT 3X1 CTM 3X1 BC 3X1

AMOX 3X1 PCT 3X1 ANTASID 3X1
CLARITROMICIN 5003X1 PCT 3X1 SK BEVALEX
AMOX 3X1 PCT 3X1 /2 VITAKUR SY
PJNTNG RSUD KOTA BKS

ASMET 3X1 SELCOMC 1X1 RANITIDIN 2X1

PCT 3X1 CTM 3X1 AMBROXOL 3X1 METFORMIN 3X1
P DLM RS H G W
P MATA RS H G W
N1X1 B63X1 ASMET 3X1 P MATA RS H G W

P DLM RS BH KARTINI
PCT 3X1 ANTASID 3X1 RANITIDIN2X1 OMZ 1XQ
AMOX 3X1 CTM 3X1 PCT 3X1 SALEP MATA KLORO
ASMET 3X1 BC 3X1 CATOPRIL 12,5MG 2X1
P MATA RS MEDIROSA

RUJUKAN
OBAT RS TUJUAN
ASMET 3X1 SELCOMC1X1 MOLAKRIM
P MATA RSUD KAB BKS

ASMET 3X1 SELCOMC 1X1 RANITIDIN 2X1
ANTASID V3X1 RANITIDIN 2X1 BC 3X1
0
P PARU RSUD KAB BKS

P ANAK RS H G W
IA SANADRIL SY PCT 3X1 RANITIDIN2X1 ,2X1 MOLACRIM 1
TUZALOS 2X1 SELCIMC 1X1 P DLM RSUD KAB BKS
P ANAK RS H G W
METFORMIN 3X1 KALIUM D 2X1 SELCOMC 1X1
METFORMIN 3X1 SELCOMC 1X1 KALIUM D 2X1 ASMET 3X1
ASMET 3X1 SELCOMC 1X1 RANITIDIN2X1
DONPERIDON 3X1 RANITIDIN 2X1
METFORMIN 3X1 SELCOMC 1X1 OBH SY
AMOX 3X1 CTM 3X1AMBROXOL 3X1
AMLODIPIN 1X1 ,ASMET 3X1 AMBROXOL 3X1
PCT 3X1 SALBUTAMOL 2X1 DEX 3X1 AMOX 3X1 SANADRIL SY 3X1SDM
P MATA RSUD KAB BKS

AMOX 3X1 TUZALOS 2X1 KALIUM D 2X1 OBH SY
ASMET3X1 KALIUM D2X1 SELCOMC 1X1
AMOX 3X1,PCT 3X1,CTM 3X1,SELCOM C 1X1,SANADRYL 3X1
AMOX 3X1/2,PCT 3X1/2,C 1X1,SANADRYL 3X1
AMOX 3X1/2,CTM 3X1/2,DEXA1X1/2BEVALEX3X1
P KULIT RS H GW
P JANTUNG RS MITRA MEDIKA

OBAT RUJUKAN
RS TUJUAN
PCT 3X1,METFORMIN 3X1,BC 1X1
ASMEF 3X1,CAPT 1X1,BECOM C 1X1
AMOX 3X1,CTM 3X1,DEXA 3X1,ASMEF 3X1,SM KLORO
P THT RS H G W
ASMET 3X1 BC 3X1 CATOPRIL 12,5MG 1X1
SANADRIL SY AMOX 3X1 PCT 3X1BC 3X1
ANTASID 3X1 BC 3X1 PCT 3X1 RANITIDIN2X1
AMOX 3X1 DEX 3X1 ASMET 3X1
OMZ 1X1 SIMPASTATIN 1X1 BC 3X1
RUJUKAN
OBAT RS TUJUAN
AMOX 3X1 CTM 3X1 AMBROXOL 3X1 METPORMIN 3X1
CETIRIZIN 1X1 DEX 3X1 SELCOMC 2X1
AMOX 3X1 ASMET3X1 CTM 3X1 SELCOMC 1X1
PC T 3X1 AMOX 3X1 SANADRIL SY 3X1DSM
LORATADIN 1X1 BC 3X1 SK HIDROCORTISON
AMOX 3X1 LITACUR SY 1X1SDM SK HIDROCORTISON
ASMET 3X1 KALIUM D 2X1
TUZALOS 2X1 SELCOMC 1X1
P MATA RS MEDIROSA
METPORMIN 3X1 LORATADIN 2X1 BC 3X1
PCT 3X1 CTM 3X1 AMBROXOL 3X1 RANITIDIN2X1
AMOX 3X1 CTM 3X1 OBH

ASMET 3X1 BC 3X1
PARU RS H G W
METFORMIN 3X1 ASMET 3X1 LORATADIN 1X1 BC 3X1
P KULIT RS H G W
AMOX 3X1
KALIUM D2X1 ,ASMET 3X1 RANITIDIN2X1 BC 3X1
ANTASID 3X1 RANITID 2X1 PCT 3X1 BC 3X1
ANTASIDV3X1 RANITIDIN 2X1 LORATADIN 1X1
PCT 3X1 RANITIDIN 2X1 SELCOMC 1X1 ANTASID 3X1
METPORMIN 3X1 PCT 3X1 BC 3X1
P MATA RS H G W
ANTASID 3X1 RANITID 2X1 PCT 3X1 BC 3X1

RUJUKAN
OBAT RS TUJUAN

AMOX 3X1 PCXT 3X1 CTM 3X1 SANADRIL SY 3X1SDM
P DALAM RS H G W
CATOPRIL 12,5MG PCT 3X1 RANITIDIN2X1 ANTASID 3X1 BC 3X1
ANTASID 3X1 RANITIDIN 2X1 BC 3X1
ANTSASID 3X1 RANITIDIN 2X1 PCT 3X1

SANADRIL 3X1SDT ,LITAKUR 1X1

PCT 3X1 SELCOMC 1X1
METPORMIN 3X1 BC 3X1 ASMET 3X1
P PARU RSUD KAB BKS

P JANTUNG RS H G W
ASMET 3X1 BC 3X1 LORATADIN 1X1
METPORMIN 3X1 ASMET 3X1 SECOMC 1X1
SANADRIL 3X1SDT AMIOX 3X1 PCT 3X1,OBH
PCT 3X1 GG 3X1/2 VITC 3X1/2
P BEDAH MITRA MEDIKA

P BEDAH RS H G W
P KULIT RSUD KOTA BKS
ASMET 3X1 BC 3X1
PCT 3X1,AMOX 3X1
SANADRYL 3X1,PCT 3X1,BC 3X1,AMOX 3X1
P MATA RS RW LUMBU
ANTASID 3X1, ASMEF 3X1, BC 3X1
SANADRYL 3X1,PCT 3X1,,AMOX 3X1
METFORMIN 3X1,B1 3X1

RUJUKAN
OBAT RS TUJUAN
OBH 3X1SDM RANITIDIN 2X1 BC 3X1 CTM 3X1
SANADRIL SY 3X1 SDM PCT 3X1 AMOX 3X1
P DLM RSUD KAB BKS

ASMDET 3X1 SIMPASTATIN 1X1 ,AMLODIPIN 1X1 BC 3X1
AMOX 3X1 PCT 3X1 BC 3X1 OBH 3X1DDM P BEDAH RS RAWA LUMBU
P MATA RS H G W
AMOX 3XQ ASMET 3X1 BC 3X1
AMOX 3X1 PCT 3X1 DEX 3X1 OBH SY 3X1SDM
PCT 3X1 RANITIDIN2X1 BC 3X1
SANADRIL SY 3X1SDM PCT 3X1 AMOX 3X1 BC 3X1
AMOX 4X1 PCT 3X1 BC 3X1 SANADRIL SY 3X1SDM
AMOX 3X1 LORATADIN 1X1 SK 24 TK KLORO 3X3XTTS
BC 3X1 CTM 3X1 POBH SY 3X1SDM
P JIWA RSUD KAB BKS

RUJUKAN
OBAT RS TUJUAN
P THT RS H GW
ASMEF 3X1,SELCOM C 1X1
SCOPMA 2X1,ANTASID 3X1,PCT 3X1,RANITIDIN 2X1
ANTASID 3X1,KALIUM D 3X1,PCT 3X1,B1 3X1

ALLOPURINOL 3X1,KALIUM 3X1,SIMVASTATIN 1X1,METFORMIN 3X1
P DALAM RS H GW
AMOX 3X1/2,PCT 3X1/2,CTM 3X1/2,SANADRYL 3X1
KALIUMD 2X1 DEX 3X1 SELCOMC 1X1
PANAK RS H GW
P SYARAF RS KOTA BKS
AMOX 3X1 TUZALOS 2X1 DEX 3X1 SELCOMC 1X1
AMOX 3X1 CTM 3X1 DEX 3X1 SALICIL TALK
PSYARAF RSUD KOTA BKS

ANTASID 3X1, RANITIDIN 2X1 ASMET 3X1
ASMET 3X1 SELCOMC 1X1 VIT B1 3X1
RUJUKAN
OBAT RS TUJUAN
ANTASID 3X1 RANITIDIN 2X1 PCT 3X1BC 3X1
AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY
ASMET 3X1 DEX 3X1BC 3X1
SK BETAMETASON 1 LORATADIN 1X1
CTM 3X1 LITACUR SY OBH
ASMET 3X1 CTM 3X1 BC 3X1
P JANTUNG RS H G W
P JANTUNG RS H G W
PSYARAF RSRSUD KAB BKS
AMOX 3X1 PCT 3X1 TK KLORO 3X3
RANITIDIN 2X1 ANTASID 3X1BC 3X1
CTM 3X1 DEX 3X1 SK MICONAZOLE
FUROCEMID METFORMIN 3X1 ASMET 3X1 SANADRIL SY 3XSDM
KALIMUD 2X1 BC 3X1

P BEDSAH RS H G W
PCT 3X1 DEX 3X1 PCT 3X1 SK MICONAZOLE P JANTUNG RS G H GW
AMOX 3X1 CTM 3X1 TM KLORO
AMOX 3X1 CTM 3X1 DEX 3X1 SANADRIL SK BEVALEX


RUJUKAN
OBAT RS TUJUAN
PCT 3X1 RANITIDIN 2X1 ANTASID 3X1

PCT 3X1 CTM 3X1 DEX 3X1 AMOX 3X1
P JANTUNG RSUD KAB BKJS

SIMPASTATIN 1X1, ASMETY3X1 KALIUM D 2X1
SIMPASTATIN 1X1, ASMETY3X1 SELCOM C 1X1
CTM 3X1 DEX 3X1 AMBROXO, 3X1 PCT 3X1
SALBUTAMOL 2MG 3X1 CTM 3X1 DEX 3X1 ASMET 3X1 OBH
AMOX 3X1 PCT 3X1 CTM 3X1 AMBROXOL 3X1
P DALAM RS H G W
AMOX 3X1 PCT 3X1 CTM 3X1 SELCOM C 1X1
P ANAK RSUD KOTA BKS

AMOX 3X1/2 PCT 3X1/2 ACIKLOVIR CREM CTM 3X1/2
KALIUM D2X1 ASMST 3X1 AMLODIFIN 1X1 P MATA RS MEDIROSA
P ANAK RS H G W

RUJUKAN
OBAT RS TUJUAN
PCT 3X1 AMOXZ 3X1 CTM 3X1 GG 3X1
PCT 3X1 ANTASID 3X1 RANITIDIN 2X1 SOIMPASTATIN 1S1
COTRI D 2X2 ASSMET 3X1 DEX 3X1
PCT 3X1 CTM 3X1 VIT C3X1
PCT 3X1 CTM 3X1 OBH SY
AMOX 3X1 PCT 3X1 CTM3X1
OMZ 1X1 SCOPMAH ANTASID 3X1
AMLODIPIN 1X1,PCT 3X1 RANITIDIN 2X1 ANTASID V3X1
AMLODIPIN 1X1 ASMET 3X1 VIT B1 3X1
TUZALOS 2X1 VITC 3X1
PCT 3X1 ANTASID 3X1 RANITIDIN 2X1
P DLM RS H G W
DEX 3X1 ,CTM 3X1 SKBETAMETASON 1

RUJUKAN
OBAT RS TUJUAN
SK ACICLOVIR ,PCT 3X1 CTM 3X1 SALISIL TALK
P DLM RS H G W
URO RSUD KAB BKS
P JNTNG RS H G W
AMOX 3X1 TUZALOS 2X1 METFORMIN ,CATOPRIL 12,5 MG 2X1
CTM 3X1 PCT 3X1 BC 3X1
P MATA RS H G W
PCT 3X1 RANITIDIN 2X1 BC 3X1 CATOPRIL 2X1 P MATA RS H G W
PCT 3X1 AMOX 3X1 BC 3X1 SANADRIL SY
OBH SY
PCT 3X1 AMOX 3X1 BC 3X1 DEX 3X1
P JIWA RSUD KAB BKS

COTRID 2X2 CTM 3X1 PCT 3X1 AMNTASID 3X1
AMOX 3X1 PCT 3X1 SANADRIL SY
KALIUM D 2X1 BC 3X1 ASMET 3X1
CTM 3X1BC 3X1 SK HIDROCORTISON 1
AMOX 3X1/2 SK BACITRACIN
LORATADIN 1X1 BC 3X1 SK WHITWIL 1
TUZALOS 2X1 DEX 3X1
ASMET 3X1 METFORMIN 3X1 BC 3X1
CTM 3X1 AMOX 3X1 AMBROXOL 3X1 [PCT 3X1
KALIUM D 2X1 BC 3X1 PRITAGESIK 3X1
P DLM RS MITYRA MEDIKA

GLIBENKLAMID 1X1 ASMET 3X1 BC 3X1
HAEMODELISA RSUD KOTA BKS

ASMET 3X1 SELCOMC 1X1 FIROXICAM 2X1
ASMET 3X1 VIT B1 X3X1
PCT 3X1 ANTASID 3X1
P BEDAH RS H G W
AMOX 3X1 CTM 3X1 GENTAMICIN 1

P ANAK RS H G W
H. Agus Sarin, S.AP

Nip. 196507041987031010
POLI UMUM
KODE FKTP: 10140601
Bulan : 1 DESEMBER 2015
OBAT
DATA PESERTA
Nama Pasien
Kesehatan
1 WAHYUDI 1625379309 RHEUMATISM
2 IKA KURNIAWATI FARINGITIS ACUTE AMOX 3X1,BC 3X1,SK HIDRO 3X1,ABOTYL
1887867112
3 EDY S 1335767185 GASTRITIS ACUTE RANITIDIN 2X1,OMZ 1X1
4 AMINAH 1477926189 DERMATITIS CTM 3X1,SALYCIL TALK 3X1
5 ASEP 1464046198 FR TIBIA
6 SITI NURHAYATI 1176094427 FEBRIS AMOX 3X1,BC 3X1,PCT 3X1
7 TOIN GASTRITIS ACUTE ANTASID 3X1,RANITIDIN 2X1,PCT 3X1 BC 3X1
490065265
8 KRISTANTO 1655736726 DEMAM AMOX 3X1,PCT 3X1,BC 3X1
9 JANIH 47516902 CHEPALGIA PRITAGESIC 3X1,BC 3X1
10 SUMARNI FARINGITIS ACUTE AMOX 3X1,PCT 3X1,BC 3X1,LORATADIN 3X1
1297981899
11 MAROH DERMATITIS LORATADIN 1X1 DEX 3X1 FIROXICAM 2X1
490716101 SALISILTALK
12 ENGKAH
489455019 TB PARU
13 VENIA BC 3X1 PCT 3X1 ANTASID 3X1 RANITIDIN 2X1
14 RUSTAM
1618178308 MYALGIA
15 SUPAD 43960432 C H F
16 CLARISA
17 LINDAWATI CRF
1454504297 C H F
18 ACHYADI GB
1269938215 POS OP HERNIA
19 IDA R AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY
1642124485 FARINGITITS
20 DAFFA AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY
21 KARNI 1439973055 CISTITIS MYALGIA COTRID 2X2 KAL;IUM D 2X1 PCT 3X1 CTM 3X1
22 ASAM
1716871342 HEMI PLEGI
23 JHONATAN KALIUM D2X1 ,ASMET 3X1 BC E3X1 SANADRIL
1658325881 MYALGIA SY

POLI UMUM

KODE FKTP: 10140601
No. Kartu BPJS DIAGNOSA
Nama Pasien
Kesehatan
1 M DESTA ARYANTO AMOX 3X1/2 PCT 3X1/2 SANADRIL SY
2 ABD MANAF 1646795215 DERMATITIS SKAAV AMOX 3X1 CTM3X1
3 SAIBINI 1158234698 DERMATITIS SK BACITRACIN LITACUR SY
4 IQBAL MAULANA AMOX 3X1 DEX3X1 PCT 3X1 SK
1540736155 ABSES HIDROCORTISON 1
5 AIF KOSWARA 1264317546 CISTITIS AMOX 3X1 BC 3X1 BRITAGESIK
6 MININ 4899125663 GASTERITISA ANTASID 3X1 BC 3X1 PCT 3X1
7 MARDSA CHBI 1294562531 FARINGITIS ACUTE AMOX 3X1 PCT 3X1 SANADRIL SY
8 BUNYAMIN 72436094 CEPALGIA ASMET 3X1 BC 3X1
9 SANIH 1469071012 ARTITMIA
10 STROHMAH 72732666 EXTERPASI /CABUT KUKU AMOX 3X1 ASMET 3X1 /TINDAKAN
11 ROSITA 1428069778 DM NON INSULIN ANTASID 3X1 BC 3X1 PCT 3X1
12 WIDARWATI PRITAGERSIK 3X1 RANITIDIN 2X1 BC 3X1
18403438304 GASTERITISA SIMPAS1X1
13 FAHIRA 1641976121 ABSES PCT 3X1/ ,DEX 3X1/2 CTM 3X1/2
14 RAFIQ RIZKY 1635423401 FARINGITIS ACUTE SANADRIL ,AMOX 3X1 PCT 3X1
15 SUHAENI AMLODIPIN 1X1 PRITYAGESIK 3X1 ,ANTASID 3X1
1011209332 HIPERYTENSI KALIUMD 2X1
16 HADI PRAYITNO 1638703923 DEMAM PCT 3X1 CTM 3X1 ,AMBROXOPL 3X1
17 NURHAYATI 72554501 CEOLESISTITIS
18 FATANDIANAN 1387434161 C H F
19 ST FARIDAH 72670599 PRESBIPIA
20 SABRINA 1167520065 M79,MYALGIA
21 MANIK INDRA MAJA 1129462402 TARSAL TUNNEL SYNDROM
POLI UMUM
KODE FKTP: 10140601
Nama Pasien
Kesehatan
1 TINI RUSTINI 1459121916 DERMATITIS GE PCT 3X1 CTM 3X1 BC 3X1 COTRID 2X1
2 DUMARIYANI 1458761319 CEPA;GIA
3 ROSTINA 1641898991 EXTERVASI
4 SOBRI SIDIK OBH 3X1 ,CATOPRIL ,METPORMIN 3X1 FUROSEMID
478769243 DM ,HIPERTENSI 1X1
5 CECEP JUANDA 490552942 CERUMEN FROP ASMET 3X1 TK PENOL GLISERIL
6 DAFA SATIA 1458765347 DERMATITIS DEX 3X1 CTM 3X1 SK HIDRO
7 ENCIK METPORMIN 3X1 GLIBENKLAMID 1X1 RANITIDIN2X1
1877535191 DM PCT 3X1 SIMPASTATIN 1X1

8 NAILAH 1273221887 ISPA amox 3x1 tuzalos 3x1 c 3x1 dex 3x1/2
9 sunarti ANTASID 3X1 RANIYIDIN2X1 FIROXICAM 2X1 SELCOM
1888949529 GASTRITIS 1X1
10 SUFDARSIH FIROXICAM 2X1 ASMET 3X1 DEX3X1 CTM 3X1
1717137832 MYALGIA
11 IWAN SETIAWAN 1406381398 FARINGITIS KONSULTASI
12 UNTUNG A CIPRO 2X1 DEX 3X1 PCT E3X1 SK BACITRACIN
13 AMUNG ASMET 3X1 BC 3X1 CTM 3X1 AMLODIPIN 1X1
1471894367 ,MYALGIA ,HIPERTENSI
14 WULAN DARI 1893366033 CEPALGIA PCT 3X1 BC 3X1
15 BUNAWAN 73159773 HEMIPLEGI
16 YAYA RANITIDIN2X1 PCT 3X1 BC 3X1 AMLODIPIN 1X1
72484659 HIPERTENSI ,GASTERITIS
17 ANITA 977431961 DERMATITIS CTM3X1 DEX 3X1 SK HIDRO
18 NYARNO AMOX 3X1 PCT 3X1 BC 3X1 TK KLORO 3X3
1648008584 MASTOID
19 NURAENI 637379246 GASTERITIS PCT 3X1 ANTSASID 3X1 RANITIDIN2X1
20 AMIH ANTASID 3X1 RANIYIDIN2X1 ,KALIUM D 2X1 PROGESIK
1011189848 GASTERITIS 3X1
21 M KHOERUL AMOX 3X1 PCT 3X1CTM 3X1 ANTASID 3X1/2 LITACUR
1011189879 ISPA SY
22 ANJELA 1375758729 KONSULTASI
23 ENI SYASIATI 1375758404 FARINGITIS PCT 3X1 AMOX 3X1 DSANADRIL SY
24 FAUZIAH 1835872378 FARINGITIS PCT 3X1 AMOX 3X1 DSANADRIL SY
25 ROS METPORMIN 3X1 GLIBENKLAMID 1X1CATOPRIL 2X1
14731043595 DM OMZ 1X1
26 INTAN AMELIA 1631371858 FARINGITIS SANADRIL 3X1 AMOX 3X1 PCT 3X1
27 ILAH RAYA 127322188 VARICELLA PCT 3X1 CTM 3X1 DEX 3X1 ACICLOPIR
28 sunarti 1888949529 MYALGIA KALIUM D 2X1 ASMET 3X1 NBC 3X1
POLI UMUM
KODE FKTP: 10140601
Nama Pasien
Kesehatan
1 YUYUM BINTI MUHI CTM 3X1 KALIUM D 2X1 SALICIL TALK
2 ROMIN 490376643 KJONSULTASI
3 SUMINI AMOX 3X1 VITC 3X1 TUZALOS 2X1
1450236971 FARINITIS
4 ANITA RATNA CETIRIZIN1X1
5 HJ ST NAPSIAH ASMET 3X1 DEX 3X1
73492929 MYALGIA
6 ANISA AMOX 3X1 ANTSID 3X1
1195385128 FARINITIS GASTERITIS
7 KASUMUD 72614788 LBP
8 SUPAR ASMET 3X1 CATOPRIL ,SIMPASTATIN 1X1
1806753519 HIPERTENSI ,DISLIPIDEMIA
9 LINDAWATI 15407336144 C R F
10 SRI Y PCT 3X1 B1 3X1 SIMPASTATIN 1X1
18067566336 MYALGIA
11 IRSADUL IBAD ANTASID 3X1 PCT 3X1 AMBROXOL 3X1
12 NASIH 1403964202 MYALGIA ASMET 3X1 SELCOM C 1X1
13 ARIPIN 1472717608 C H F
14 HASNIATI 1261050917 CATARAK
POLI UMUM
KODE FKTP: 10140601
Nama Pasien
Kesehatan
1 MARSIH PROPITAGESIK 3X1 CTM 3X1 FIROXICAM 2X1
490363571 MYALGIA SANADRIL SY 3X1
2 SYAHRIAL KOTRID 2X1 CTM 3X1PCT 3X1 ANTASID 3X1
1626427135 ISPA SANADRIL SY
3 NIAN 1516470085 DERMAtitis CTM3X1 DEX 3X1 SKHIDRO
4 FATHANDIAN VICTOR 1387434161 C H F
5 EDUARD AMOX 3X1 ASMET 3X1 SELCOMC 1X1 SANADRIL
1385182067 IS PA MASTOIDENITIS SY
6 MUHAMAD ALWAN PCT 3X21 CTM 3X21 ANTASID 3X12 SANADRIL SY
12924582364 ISPA
7 AISYAH AMOX 3X1 ASMET 3X1 SELCOMC 1X1 SANADRIL
1294559717 C H F FARINGITIS SY P JNTNG
8 EMAD SALBUTAMOL 2X1 CTM 3X1 DEX 3X1 AMBROXOL
1148112641 ASMA BRONCHIALE 3X1
9 LINGGA AMOX 3X1 PCT 3X1 ANTASID 3X1 GG 3X1
1657428434 FARINGITIS AMBROXOL 3X1
10 SYAPRUDIN 1301553314 MYALGIA PCT 3X1 B13X1 AMLODIPIN 1X1
11 WAHIDIN 1454537215 DM NON INSULIN
12 DINDA 1454803683 DEMAM AMOX 3X1 PCT 3X1
13 SIMAH 101189903 DM NON INSULIN METFORMIN 3X1
14 LUCIANA 1316948005 DERMATITIS CARDIOMEGALI
15 IDA FARIDA 1622742063 ISPA PCT 3X1 CTM 3X1 AMBROXOL 3X1
16 SRI R 1646802022 GASTERITITS ACUTE PCT 3X1 B6 3X1 RANITIDIBN 2X1
17 KASNAH METFORMIN 3X1 ANTASID 3X1 BC 3X1
1304833015 DM NON INSULIN
POLI UMUM
KODE FKTP: 10140601
1 PENDI 1646810368 GASTERITIS ACUTE ANTASID 3X1 RANITIDIN2X1 PCT 3X1
2 NADIH COTRI 2X2 CTM 3X1 ANTASID 3X1 OBH SY
490336751 BRONCHOPPNEMONIA
3 SURIAH 1791649383 C H F
4 SOBRI SIDIK METFORMIN 3X1 ,ANTASID 3X1 CATOPRIL 2X1
47769243 DM NON INSULIN OBH SY
5 ZUBAEDAH KALIUM D 2X1 PRITAGESIK 3X1 ,SIMPASTATIN
1436503183 DILIPIDENIA 1X1 MALAM
6 SANEM 1472802366 CEPALGIA ASMET 3X1 KALIUM,D 2X1
7 TSURIAIYA KALIUM D 2X1 PRITAGESIK 2X1 B1 3X1
1398100188 MYALGIA
8 ENGKON 72411592 CH F
9 ROKAYAH 47768692 C H F
10 ST NURHAYATI 1176094427 PAROTITIS AMOX 3X1 PCT 3X1 SELCOMC 1X1
11 ERISNAWATI ANTASID 3X1 RANITIDIN2X1 PRITAGESIK 3X1
12 RACDMATULLOH ANTASID 3X1 RANITIDIN 2X1 PRITAGESIK 2X1
13 AAM 489681279 MYALGIA
14 M IBROHIM 14228005162 TB PARU
15 ABDUL KODIR LORATADI N 1X1 ANTASID 3X1 LOPAMID 3X1
47763922 DERMATITIS GE ,GASTERITIS CATOPRIL 2X1
16 YAYA MULYANA ANTASID 3X1 PCXT 3X1 CTM 3X1 CATOPRIL 2X1
72484659 GE ,HIPERTENSI ,GASTERITIS ACUTE
17 ST FATIMAH 1858471622 MYALGIA KALIUD 2X1 PRITAGESIK 3X1
18 SAPNAH 1464652765 CEPALGIA PRITAGESIK 2X1 SELCOM C 1X1
19 NANYIH 1865782405 ANEMIA
20 HENDRIYETI 1278893856 C H F
21 IWAN KALIUD 2X1 PRITAGESIK 2X1 SANADRIL SY
1655124401 BATUK
22 SUKIRAN 1903863532 NEPRITIS
23 ENDI 1837834334 MYALGIA ASMET 3X1 SELCOMC 1X1
24 NURSANTI 146402292 DERMATITIS CTM,3X1 DEX 3X1 SANADRIL SY
POLI UMUM
KODE FKTP: 10140601
1 H.ABDURRAHMAN AMOX 3X1,ASMEF 3X1,SELCOM C 1X1

1271160268 ABSES
2 SALAMAH AMOX 3X1,LORATADIN 3X1,SELCOM C 1X1,DEXA
1157498976 DERMATITIS 3X1,SK BEVALEX 3X1
3 ANNISA KOTRI SYR 2X1,ANTASID SYR 3X1,N KAOMINAL
1648903893 DIARE 3X1,PCT 3X1/2
4 WIDARTI ANTASID 3X1 RANITIDIN 2X1 SELCOMC 1X1
5 MUMUN 1828965339 SHIZEPRENIA
6 KASNING 45970356 MYALGIA PRITAGESIK 21X1 KALIUMD 2X1
7 UTAR 72432753 CH F
8 AGUS WIRANTO 1828964507 CEPALGIA ASMET 3XQ1 BC 3X1
9 ASANAH 1876951012 BATUK PILEK PCT 3X1 CTM 3X1 SANADRIL SY
10 UNTUNG CIPRO2X1 CTM 3X1DEX 3X1 PCT 3X1 SK
1830167032 DERMATITIS BEVALEX 1
11 ARIPAH AMOX 3X1 PCT 3X1 ANTASID 3X1 CTM 3X1
1876949548 DERMATITIDS CEPLGIA ,BATUK SANADRIL SY
12 SAROH 1321420083 HEMIPLEGI
13 ST NUR LILAH AMOX 3X1 PCT 3X1 CVTM 3X1 ANTASID 3X1
489274773 BATUK GASTERITIS SANADRIL 3X1
14 ACHMAD 1652340249 CEPAGIA
15 DITASARI AMOX3X1 PCT 3X1 CTM 3X1 SANADTRIL SY
1607527304 ISPA
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
No No. Kartu BPJS Kesehatan DIAGNOSA
Nama Pasien
1 Rudi 1271160268 abses amox,asmet,selcom c

2 warmis 1439304006 mialgia
3 iwan sukmawan 1655124401 Aritmia
4 jumalik 1636932756 gastritis asmet,antasid,ranitidine
5 sriyati 1871411679 mialgia antasid,kalum,ranitidine
6 mulyadi 1336762462 tb paru
7 cecep juanda 490552942 pebris amox,ctm,dexa,pct,gentamicin
8 wahidin 145437215 konsultasi 0
9 dinda devina 1454803683 demam amox 3x1 pct 3x1 ctm 3x1 sanaril sy
10 sumini 1450236971 sinusitis
11 KUSNADI 1819215066 HIPERYTENSI .POST OP HAEMOROID CIPRO 2X1 AMLODIPIN 2X1
12 DARA KURANISA 13111965302 BATUK CTM 3X1/2 OBH SY
13 MARLINDA WATI AMOX 3X1 PCT 3X1 CTM 3X1 AMBROXOL 3X1
1311964694 ISPA
14 H ABURAHMAN 12871160268 GB
15 AAN A KOSIM 72431627 CERUMEN PROP
16 FAUZI 1623671065 EPILEPSI
17 MAROH LORATADINE ,DEX 3X1 ANTASID 3X1
490716101 DERMATITIS ,SALISILTALK
18 DARMO 1379487438 hemiplegi
19 NOOR SARINAH 1888788998 GASTERIRTIS ANTASID 3X1 RANITIDIN 2X1
20 M RAMADHANI 1289574821 EPILEPSI
21 IPAY SALIH PCT 3X1 DEX 3X1 CLARITROMICIN 3X1
22 LINDAWATI 1454504297 HIPERTENSI AMLODIPIN 1X1 , PCT 3X1
23 SYAFRUDIN MOLAGIT 3X1 DONPERIDON 3X1 PCT 3X1
1301553314 GE
24 MARLON 1306035033 DEPRESI
25 RIKI RUMAHORBO 1862918188 SHIZOPRENIA
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 MURTYORINI ASMEF 3X1,AMOX 3X1,DEXA 3X1,C 1X1,GENTIAN

18813003374 MYALGIA V 3X1
2 LUSITA 1850214508 DM METFORMIN 3X1,KALIUM D 3X1,BC
3 VIDIA THYAMPENIKOL 3X1,PCT 3X1,ANTASID
1020940716 THYPUS 3X1,RANITIDIN 2X1
4 ST MUNAWAROH CLARITROMICIN 3X1,CTM 3X1,PCT 3X1,ANTASID
1396893475 FARINGITIS 3X1
5 WIWI MARWAH ASMEF 3X1,KALIUM D 3X1,PIROX 1X1,ANTASID
1717063604 MYALGIA 3X1
6 UJANG KOSWARA 1905792221 A15 CEK BTA
7 EMAD CTM 3X1,DEXA 3X1,SALBUTAMOL 3X1,ASMEF
1148112641 ASMA 3X1
8 MAHMUD S KOTRI 2X2,CTM 3X1,PCT 3X1,ANTASID
1517849032 DIARE 3X1,LOPAMID 3X1
9 EROM 1835121158 CHF
10 KUSNIRAH 1422539177 PRESBYOPIA
11 ST HINDUN AMOX 3X1,ANTASID 3X1,PCT 3X1,CTM
47769208 GASTRITIS,FARINGITIS 3X1,SANADRYL 3X1
12 DEWI SRIJAYANTI 173553671 ANEMIA APLASTIC
13 RAHMAT 490737993 MATA KENA PAKU
14 CAHYADI 1440961942 GASTRODUODENITIS
15 WINA PCT 3X1,ANTASID 3X1,MOLAGIT 3X1,BC 3X1
1371314158 GASTRITIS
16 DINDA 1454803683 DEMAM
17 WAHIDIN 1454537215 CRF
18 ENEN 72562904 DM
19 INDAH AMOX 3X1/2,DEXA3X1/2,PCT 3X1/2,,SANADRYL
1716803897 ISPA 3X1
20 SAMAN AMOX 3X1,C 3X1,PCT 3X1,CTM 3X1,SANADRYL
489093052 FARINGITIS 3X1
21 MH NASUN 72411423 ABSES
POLI UMUM
KODE FKTP: 10140601
1 NADIH 490336751 GG 3X1,CTM 3X1,PCT 3X1,ANTASID 3X1

GASTRITIS,ISPA
2 NURHAYATI 489993783 KONSULTASI

3 NURCHOLID 1128922468 CTM 3X1,DEXA 3X1,KETOKONAZOLE 3X1
DERMATITIS
4 SUWANTO 151940648 KONSULTASI

5 TALITHA 1431075442 ISPA AMBROXOL 3X1,CTM 3X1,PCT 3X1
6 NANI 1807256924 DM
7 H ABDUROHMAN 1271160268 CIPRO 2X1,DEXA 3X1,CTM 3X1,ASMEF 3X1
ABSES
8 SULAMAH 1157498976 DERMATITIS

9 I NYOMAN 1892297193 CAPT 1X1,METFORMIN 1X1,PIROX 1X1,ASMEF
HT,DM
3X1,B1 3X1
10 UMAR 1093844878 ANTASID 3X1,RANITIDIN 2X1,BECOM C 1X1
GASTRITIS
11 YAHYA 1630453094 AMOX 3X1,PCT 3X1,DEXA 3X1,OBH 3X1

ISPA
12 SUTHAN 1822975075 ACICLOVIR 4X1 CTM 3X1 DEX 3X1 ,SK
VARICELLA
BETAMETASON
13 WASNO 1145683697 HIPRTENSI B1 3X1 ASMET 3X1 CATOPRIL 2X1
14 JUMALIK 163932716 ISPA AMBROSOL 3X1 DEX 3X1 ASMET 3X1
15 GOTDI 1863691795 STROKE
16 NURLINDA 1282509549 CEPALGIA ASMET 3X1 CTM 3X1
17 BUNAWAN 73159771 AMOX 3X1 As,met 3x1 ctm 3x1 sk bacitracin
ABSES
18 SRI Y 1806756636 MYALGIA KALK 3X1 ,FIROXICAM 2X1 B1 3X1

19 MASDONI 1387465637 MYALGIA ASMET 3XQ1 BCOM C 1X1
POLI UMUM
KODE FKTP: 10140601
BULAN 14 DESEMBER 2015
1 HARLIZA ANTASID 3X1 RANITIDIN 2X21 PCT 3X1 BC 3X1

2 ADITIA NA 1610532077 DERMATITOS SK BACITRACIN 1 AMOX 3X1
3 MAMAN FIRMANSYAH 49113176555 OTHER ACIUTE OSTEOMYELITIS
4 ONIH 490040638 MYALGIA ASMET 3X1 BC 3X1
5 SELLY FAJRIAH 72791515 CEPALGIA
6 DAMAN A AMOX 3X1 CTM 3X1 PCT 3X1 SANADRIL SY
7 BASUKI HARTONON 1284281021 SUSP LYPOMA SK HIDROCORTISON DEX3X1 BC 3X1
8 EMAD 1148112641 ASMA KONSULYTASI
9 DESTI 4888366631 GASTERITIS PCT 3X1 BC 3X1 RANITIDIN 2X1
10 SAMAH 490860347 KONSULTSASI
11 KARTI 1311854793 BROCHITIS
12 H ABDURAHMAN 1271160268 ABSES GB
13 UJANG ASMET 3X1,KALIM D 2X1 RANITIDIN 2X1NBC 3X1
1258680824 MYALGIA
14 UJANG KOSWARA 1905792221 FARINGITIS ACUTE OBH PCT 3X1 BC 3X1
15 MASYATI CLARITROMICIN 3X1 DEX 3X1 CTM 3X1
1199692001 FARINGITIS ACUTE SANADRIL SY
16 WIDIA 1477214998 NEOROFIBROMA
17 EEN 189935496 CEPALGIA
18 ENDRIK 490025586 TB PARU
19 MURTI PREDNISON 1X1 ASMEYT 3X1 RANITIDIN 2X1BC
490463283 KUSTA 3X1
20 ISYANANDA 1465865654 FARINGITIS ACUTE AMOX 3X1 SANADRIL SY
21 SITI HA IMAH 1434372222 DM
22 MAHARANI CATOPRIL 1X1 PRIYAGESIK 3X1 BC 3X1
23 ELA MARYANI LORATADIN 1X1 METPORMIN 1X1 DSALICIL TALK
163054498666 ,DM ,PENYAKIT KULIT LAIN
24 SAPNIH ANTSASID 3X1 RANITIDIN 2X1,PCT 3X1 BC 3X1
25 RASIH 490125802 MYALGIA ASMET 3X1 BC 3X1
26 MAULANA H 1447007692 FARINGITIS ACUTE AMOX 3X1,PCT 3X1,SANADRYL
27 RUDI PCT 3X1, BC 3X1, RANITIDIN 2X1,ANTASID 3X1
28 NURSASI SIMVASTATIN 1X1,CAPTOPRIL 1X1,BC 3X1
73050592 DISLIPIDEMIA
29 KARTINI 1896346012 GASTERITIS RANITIDIN 2X1,PCT 3X1,BC 3X1
30 HJ MARIAM 1262506026 CRF
31 ST JULAEHA 1339212036 CEPALGIA PCT 3X1,SELKOM C 1X1
32 ROSITA 1428069778 TB PARU
33 H TAMPUBOLON 1864572322 DIARE CTM 3X1,
34 KUSNIAH 147169133 FARINGITIS ACUTE asmet 3x1 sanadril 3xz1 sy
35 KONAR G 1649112208 GASTERITIS
36 M NASIR 1461315712 SHIZOPRENIA
POLI UMUM
KODE FKTP: 10140601
BULAN 15 DESEMBER 2015
1 AMIN FAUZI 1643504545 CONJUNGTIVITIS TM AILIN ,SELCOM C 1X1 DEX 3X1

2 ST HALIMAH 1434571222 HIPERTENSI
3 ILHAM MARYA 1634479683 TB PARU
4 YUYUM 1465612209 TB PARU
5 YOHANES AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY
1889959882 ISPA
6 FITRIA 1871021979 GASTERITIS ANTASID 3X1 RANITIDIN 2X2,B6 3X11
7 FAUZI 1623671065 EPILEPSI
8 FAYYATHA 1634479716 TONSILITIS ACUTE SANADRIL SY BC 3X1
9 DESI 1621944584 KONSULTASI
10 AMA WASMA 72984835 MYALGIA KALIUM D 2X1 ASMET 3X1 BC 3X1
11 MIRJA AMOX 3X1 PCT 3X1 BC 3X1 SANADRIL SY
12 ENCIH 1877535191 DM GLIBENKLAMIDE 1X1
13 ENEN 72562904 DM
14 HARNILA 1273038783 DERMATITOS
15 MALIK 1475907096 FARINGITIS ACUTE AMOX 3X21 PCT 3X1 SANADRIL SY
16 M ZABAD 1475907412 GASTERITIS ANTASID 3X1
17 WAHIDIN 1454537215 CRF
18 ANJANI 1300311088 B 20
19 DARTI 91952324 DEMAM PCT 3X1 CTM 3X1 GG 3X1
20 ASNI 4898148 GASTERITIS ANTASID 3X1 PCT 3X1 RANITIDIN 2X1
21 FAUZI 1634479705 BATUK SANADRIL SY
22 SIDIJO AMOPX 3X1 PCT 3X1 CTM 3X1 SANADRIL SY
43148349 DEMAM
23
POLI UMUM
KODE FKTP: 10140601
Bulan 16 DESEMBER 2015
DATA PESERTA OBAT
Nama Pasien
1 ratu ade 1320678549 myalgia

2 VIDIA 1020940716 DEMAM
3 YUSMAN 1648809195 ISPA AMOX 3X1 PCT 3X1 CTM 3X1 AMBROXOL 3X1
4 SANDI KALIM D 2X1 ASMET 3X1 RANITIDIN2X1 BC 3X1

489942347 myalgia
5 KUSNADI 1610194149 PENYAKIT LAIN PRENAMIA 1
6 RUDI 1465661799 CEPALGIA ASMET 3X1 BC 3X1
7 M LUTFI 1290605444 GANGGUAN BICARA

8 NUR 1469799527 KONTROL ULANG NEOROLOGI
9 CAMARA AMOX 3X1/2 PCT 3X1/ CTM 3X1/2 SANADRIL Y
1011207879 ISPA
10 LINDAWATI 1454504297 CRF
11 A KOSASIH 1608589225 FARINGITIS AMOX 3X1 DEX3X1 ,TUZALOS 2X1
12 ST ZUBAEDAH 45396009 CATARAK

13 SUDARSIH 1717137832 myalgia ANTALGIN3X1 RANITIDIN 2X1 PIROXICAM 2X1
14 DAMAYANTI 490393045 CONJUNGTIVITIS ASMET 3X1 CTM 3X1 TM AILIN 3X3
15 LASManah 101107813 myalgia ASMET 3X1 BC 3X1
16 TIA 1632949931 BATUK AMOX 3X1 PCT 3X1 CTM 3X1 AMBROXOL 3X1
17 SIAMI 1841553966 KONSULTSASI

18 CASKA 1632949009153 BATUK SANADRIL SY
19 ST LESTARI 1428112715 KOTROL POST PO SINUSITIS

20 ZUBAEDAH ASMET 3X1 ANTASID 3X1 RANITIDIN 2X1 KALIUM D 2X1
1436503184 M,YALGIA GASTERITIS
21 SUINAH ASMET 3X1 KALIUM D2X1 ALUPURINOL 3X1 CATOPRIL 2X1
1272364097 HIPERTENSI MYALGIA
22 SAHRUL SIDIK 1649399758 ISPA AMOX 3X1 PCT 3X1 CTM 3X1 SANADRIL SY
23 YAYANG R 72484672 FRATUR TIBIA

24 ELI 72484672 COMN COLD AMOX 3X1 PCT 3X1 CTM 3X1
25 GERI FARI 451008777 CONM COLD AMOX 3X1 CTM 3X1 PCT 3X1
26 M AMIN 1647298664 DEMAM AMOX 3X1 PCT 3X1
27 RENTA 1864573165 ASMA SALBUTAMOL 3X1 CTM 3X1 BC 3X1
28 RATIH 1810838046 KONSULTSASI

29 LINDAWATI 1454504297 CH F PPDLM
30 ST RODIYAH 72484661 CEPALGIA ASMET 3X1 PRENAMIA
31 RAHMAT 16451882665 FARINGITIS AMOX 3X1 CTM 3X1 PCT 3X1 AMBROXOL 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 DIDING 58122314 CHF

2 SUNARTO PCT 3X1 RANITIDIN 2X1 SIMPADTATIN 1X1
1895227839 GSRTERITIS
3 KRISHANTI 16493212109 GIGIT ANJING
4 ST ALPIAH 1649833514 MASTOID AMOX 43X1PCT 3X1 TK KLORO
5 KRISHANTO KOTRI D2X2 CTM 3X1 PCT 3X1 RANITIDIN 2X1
1655736726 GE
6 NAZRILMIRZA 1426802556 ISPA AMOX 3X1 CTM 3X1 AMBROXOL 3X1
7 WIDIA 1477214998 Q85
9 KUSMAWATI 1903863745 HIPERTENSI PCT 3X1 AMLIDIPIN 1X1
10 FUZI HASTUTI 1256792073 KONSULTASI
11 TANA 49034156 KONSULTASI
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 YUSUF 47770402 HAEMOROID PCT 3C1 DEX 3X1 BC 3X1

2 FAUZI Hstiti 12567902073 colitis
3 SULAMAH 1157498976 DERMATITS
4 NAQILA 1716001007 FARINGITIS ACUTE AMOX 3X1/2,PCT 3X1/2,LITACUR 1X1
5 WIDARWATI ANTASID 3X1,PCT 3X1,RANITIDIN 2X1,BC 3X1
6 M LUTFI 1290605444 GGN BICARA
7 NYARNO 1648008584 DERMATITS
8 NANYIH 1865782405 GGK
9 H ABDURAHMAN 1271160268 GANTI BALUTAN
10 ST LESTARI 1428117715 FARINGITIS ACUTE
11 IRMA SOLEHA AMOX 3X1/2,PCT 3X1/2,AMBROXOL 3X1/2
12 SIAMI 1841553966 MYALGIA
13 MIMI 47575934 MYALGIA PRITAGESIC 3X1,BC 3X1
14 NURSAINI SIMVASTATIN 1X1,CAPTOPRIL 1X1,PRITAGESIC
1328879384 HT,DISLIPIDEMIA 3X1,BC 3X1
15 JAMONO 1657484594 FARINGITIS ACUTE OBH 3X1,AMOX 3X1,PCT 3X1,BC 3X1
16 NURLANI 1787072433 MYALGIA KALIUM D 3X1,RANITIDIN 2X1,BC 3X1
17 SAMSUL 1471992142 HIPERTENSI CAPTOPRIL 1X1,ASMEF 3X1,BC 3X1
18 KODAM SAMSI KALIUM D 3X1,PRITAGESIC 3X1,CTM3X1,PIROX
1641974815 MYALGIA 1X1
19 HASNIYATI 1261050917 CHF
POLI UMUM
KODE FKTP: 10140601
Bulan : 19DESEMBER 2015
DATA PESERTA OBAT
No No. Kartu BPJS Kesehatan
DIAGNOSA
Nama Pasien
1 KUSNADI CAPT 1X1,ASMEF 3X1,MOLAKREAM 3X1

2 PUTRA A RAMADHAN 1655868453 ISPA PCT 3X1/2,CTM 3X1/2,GG 3X1/2,C 1X1
3 NASIH BT KINUN 1299632679 CEPHALGIA PCT 3X1,PRENAMIA 3X1
4 YULIARTI 1643504657 TB PARU
5 LAMRIA 1439147182 ISPA PCT 3X1,GG 3X1,C 1X1
6 NURHAYATI ANTASID 3X1,PCT 3X1,RANITIDIN 2X1,BC 3X1
46476224
GASTRITIS
7 AURA 1100072081 DEMAM
8 IIN SOLIHAH ANTASID 3X1,PCT 3X1,RANITIDIN 2X1,GG 3X1
1645517114
GASTRITIS
9 SUKEMI 1849285866 CHF
10 FITRI FAJAR 1650564999 ISPA PCT 3X1,GG 3X1,C 1X1
11 BINTANG FAJAR PCT 3X1,GG 3X1,CTM 1X1,ANTSD 3X1,DEXA 3X1
1645517136
GASTRITIS,ISPA
12 ST SUTIYAH 46138702 CHF
13 SUWANDI 1448029023 ISPA PCT 3X1,GG 3X1
14 AGUS WIRANTO 1828964507 HIPERTENSI ASMEF 3X1,CAPT 1X1,BECOM C 1X1
15 YAYANG RIZKY PCT 3X1,DEXA 3X1,CTM 3X1,C
72484672
PILEK,DERMATITIS 1X1,BETAMETASON 3X1
16 ST RODIYAH PCT 3X1,CTM 3X1,C 1X1,SCOPMA 2X1
72484661
PILEK,DISMENORE
17 RUMSIH 1191544918 PILEK PCT 3X1,CTM 3X1,C 1X1,GG3X1
18 RONYA PCT 3X1,ANTASID 3X1,RANITIDIN 2X1,CAPT
1011205383
HIPERTENSI,GASTRITIS 1X1,SALICYL
19 FITRIA 1871021979 GASTRITIS ANTASID 3X1,RANITIDIN 2X1,B6 3X1
20 SUCI SITO 72296076 MYOPIA
POLI UMUM
KODE FKTP: 10140601
Bulan: 21 DESEMBER 2015
DATA PESERTA OBAT
Nama Pasien
1 WAHIDIN 1454537215 KONSUL

2 DAYU EKO ANTASID 3X1,SPASMAL 2X1,MOLAGIT 3X1
1622679276 DIARE
3 ERNAWATI 1655927403 GASTRITIS ANTASID 3X1,ASMEF 3X1
4 M RAHMAT 40715493 KELOID
5 BADRI N 1717516089 CONJUNGTIVITIS TM AILIN 3X1,CTM 3X1,DEXA 3X1
6 NELI S 1795186157 TB LYMPADENOPATY
7 CANTIKA N 72604089 DM
8 SURIAH PCT 3X1,CTM 3X1,GG 3X1,SELCOM C 1X1
1791649383 ISPA
9 RAFFY AMOX 3X1/2,PCT 3X1/2,CTM 3X1/2,GG 3X1/2,DEXA
1190561736 FARINGITIS ACUTE 3X1/2
10 ANE ISTIANA 1146222055 PENY TELINGA LAIN
11 RUDY ANTASID 3X1,RANITIDIN 2X1,PCT 3X1
12 ST AISYAH AMOX 3X1,PCT 3X1
490994289 HIPERTENSI/ GANTI VERBAN
13 NADYA ARTHA AMOX 3X1,CTM3X1,AMBROXOL 3X1
1273221663 ISPA
14 KASNAH METFORMIN 3X1,ASMEF 3X1,BC 3X1
1304833015 DM
15 SIMAH METFORMIN 3X1,BC 3X1
1011189903 DM
16 NAILLAH AMOX 3X1,CTM3X1,AMBROXOL 3X1
1273221887 ISPA
17 SUPARJO AMOX 3X1,OBH 3X1,PCT 3X1,BC 3X1
18 ACHYADI AMOX 3X1,CTM3X1,DEXA 3X1,SALICYL 3X1
19 YOANA CAPT 1X1,PCT 3X1,ANTASID 3X1,RANITIDIN 2X1
20 INDAH PCT 3X1,SANADRYL3X1,ANTASID 3X1,MOLAGIT 3X1
1716803897 ISPA
21 MOHANI CAPT 1X1,KALIUM 3X1,B1 3X1
22 KARTINI 1896346012 GASTRITIS PCT 3X1,RANITIDIN 2X1
23 ROHATI 1454923282 MYALGIA KALIUM 3X1,B1 3X1
ANTASID 3X1,RANITIDIN 2X1,PCT 3X1,BC 3X1
24 TUMARI 1641900543 GASTRITIS
25 SUGENG 1626548117 CEPHALGIA RANITIDIN 2X1,PRITAGESIC 3X1,BC 3X1

26 GOFUR 1626167125 BATUK CTM 3X1,GG 3X1
ERITROMICIN 3X1,PCT 3X1,BC 3X1,CTM 3X1
27 SAHRUL SIDIK 1649399758 DEMAM
28 SUTINI 1308716673 CHF

CAPT 1X1,CTM 3X1,SALBU 2X1,RANITIDIN 2X1
29 EMAD 1148112641 ASMA,HIPERTENSI
30 MUSTOFA 1636932914 MYALGIA KALIUM 3X1,B1 3X1

POLI UMUM
DATA PESERTA OBAT
Nama Pasien
1 NANA M 1645448883 GASTERITIS ANTASID 3X1 PCT 3X1 RANITIDIN2X1

2 NADYA 854525892 GASTERITIS ANTASID 3X1 PCT 3X1 RANITIDIN2X1
3 MARISMA ANTASID 3X1T 3X1 RANITIDIN2X1 BC 3X1
GASTERITIS
1460845056
4 DUMARIS 1854529209 MYALGIA ASMET3X1 BC 3X1
5 NURLINDA 72330838 DM
6 SURYAMIN CTM 3X1 AMBROXOL 3X1 SALBUTAMOL 3X1
1886784794 BATUK
7 ANAH ANTASID 3X1 PCT 3X1 RANITIDIN2X1 BC3X1
8 ENING 1260294827 DERMATITIS PCT 3X1 CTM 3X1 DEX 3X1 GG 3X12
9 ARDINI 1382193909 FARINGITIS AMOX 3X1
10 FADNILAH 1386260998 FARINGITIS AMOX 3X1 PCT 3X1 OBH
11 EET RUAETI 1836949274 FARINGITIS AMOX 3X1 PCT 3X1 OBH
12 BUDI 1476746212 CH F
13 TOIN ANTASID 3X1 PCT 3X1 RANITIDIN 2X1 BC 3X1
14 SUMIYATI 1431080122 KONSULTASI
15 ROHMIYATI 55604283 CEPALGIA ASMET3X1 BC 3X1
17 LINGGA PCT 3X1 CTM 3X1 B6 3X1 AMBROXOL 3X1
1657428434 ISPA
18 NURLIENI 1787072433 MYALGIA KALIUM 2X1 RANITIDIN2X1
19 AMIN FAUZI 1643504545 GASTERITIS SCOPMA 2X1 RANITIDIN 2X1
20 SUMIYATI 1386260662 BATUK PCT 3X1 CTM 3X1 AMBROXOL 3X1
21 DEWI SARTIKA 1619766448 PERTIGO
22 EEN 1899354396 EPILEPSI
23 ENUR 14697999527 TB PARU
24 RATNAWATI 1854547637 MYALGIA
25 M HANASUN 72411423 FR OF THALUS
26 BUDI 1 1679275625 CISTITIS CLARITOMICIN 3X1 PCT 3X1 BC 3X1
27 SATRIO BAWONO 1625049325 GE CTM 3X1 PCT 3X1 BC 3X1 COTRI 2X2
ANTASID 3X1 PCT 3X1 RANITIDIN 2X1 BC 3X1
28 TOBRI 489805468
GASTERITIS
29 NYAMU 490186798 MYALGIA ASMET3X1 BC 3X1RANITIDIN 3X1
30 RATIH 1810838046 LYMPHADENITIS
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 nanya 4899736001 MYALGIA ASMET 3X1 BC 3X1

2 TIOLINA 1276384149 VERTIGO
3 EVELINA 1276385051 ISK AMOX 3X1 PCT 3X1 BC 3X1
4 M NOSIN AMOX 3X1 CM 3X1 PCT 3X1 AMBROXOL 3X1
FSARINGITIS ACUTE
1483170333
5 ENIH ANTASID 3X1 RANITIDIN 2X1 PCT 3XQ1 BC 3X1
GASTERITIS
490017622
6 AHMADIYO AMOX 3X1 PCT 3X1 DEX 3X1 SK BACITRACIN
7 ENTAY SALBUTAMOL 3X1 BC 3X1 SALBUTAMOL
490293966 ASMA
8 SUKAESIH GLIBENKLAMID 1X1 METFORMIN 3X1 KALIUM D
1650322776 DM 2X1 PRENAMIA 1X1
9 INA ARYSANI 1622244699 GASTERITIS ANTASID 3X1 RANITIDIN 2X1 BC 3X1
10 BUNAWAN AMOX 3X1 PCT 3X1QCTM 3X1 BACIYTRACIN
73159773 ABSES
11 WAWAN 1643363774 MYALGIA ASMET 3X1 BC 3X1
12 LANSIA 1439147182 MYALGIA ASMET 3X1 BC 3X1 AMBROXOL 3X1
13 H ABDURAHMAN 1271160268 ABSES DEX3X1 CTM 3X1 C 3X1
14 PAULUS 1305455297 FSARINGITIS ACUTE AMOX 3X1 PCT 3X1 CTM 3X1 BC 3X1
15 REIHAN 1646810403 ABSES AMOX 3X1 DEX 3X1 IBU F 2X1
16 MARNAH 1646810381 GE ANTASID 3X1 CTM 3X1 MOLAGIT 3X1
17 NINING 1624334084 BATUK PCT 3X1 CTM 3X1 GG 3X1 B13X1
18 ZUBAEDAH 1436503184 MYALGIA ASMET 3X1 PRITAGESIK 2X1
19 OMAN ASMET 3X1 METFORMIN 3X1 GLIBENKLAMID 1X1
1872137272 DM BQ1 3X1
20 QIUNSHA 1633876119 GASTERITIS PCT 3X1 ANTASID 3X1
21 EKO PRAMONO 1633826097 GASTERITIS PCT 3X1 ANTASID 3X1RANITIDIN 2X1
22 UJANG KOSWARA ASMET 3X1 SELCOM C1X1 AMOX 3X1
1965792221 MYALGIA
23 SA,AMAH 490860347 SIROSIS HEPATIS
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 UJANG KOSWARA 1905792221 MYALGIA

2 SANRDO 1437984077 APP ACUTE
3 TUNIH 490113123 BP KONSULTASI
4 YULIAWATI AMOX 3X1 CTM 3XQ1 PCT 3X1 AMBROXOL 3X1
5 SETWAN 146385604 MYALGIA PRITAGESIK 3X1 SELCOM C 1X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 EEN METFORMIN 3X1 PRITAGESIK 3X1 CTM 3XQ1

1225105626 DM SALICIL TALK 1
2 NABIL A 793489321 793489321 FARINGITIS ACUTE GG 3X1 CTM 3X1 C 3X1
3 ESA PSALASHA 1793488612 FARINGITIS ACUTE GG 3X1 CTM 3X1 C 3X1
4 SUSAYAT AMOX 3X1 CTM 3X1 AMBROXOL 3X1 CTM 3X21
1450235373 FARINGITIS ACUTE AMBROXOL 3X1
5 EVELIN A 1276385051 MYALGIA ,KATARAK KALIUM D 2XQ1 PRITAGESIK 3X1
6 ARMAIN 489997236 CHF
7 ENUR 1469799527 HYPERR PLASIA OF PROSTATE
8 EKA ANTASID 3X1 KALIUM D 2X1 PRITAGESIK 3X1
1456471438 MYALGIA ,
9 MAYA 976022897 DM
10 SUMARNI 1271159763 ISPA TUZALOS 3X1
11 YUSUF AMOX 3X1 CTM 3X1 AMBROXOL 3X1 CTM 3X21
490173085 ISPA AMBROXOL 3X1
12 TUNIH 490113123 BROCHOPNEMONIA
13 ASMIAH 1432131693 BATUK CTM 3X1 AMBROXOL 3X1
14 ETY AMOX 3X1 PRITAGESIK 3XQ KALIUM D 2X1
1608940023 MYALGIA FARINGITIS AMBROXOL 3X1
15 MINAH CTM 3X1 LOPAMID 3X1 RANITIDIN 2X1
1649400581 ge
16 RAHMAT SOLEH 1621685452 GASTRITIS
17 ENI K ASMET 3X1 CALIUM 2X1 VITAGESIK 3X1
72732249 MYALGIA
18 EKA LESTARI VITAGESIK 3X1 CALIUM 2X1 ANTASID 3X1
1456471438 MYALGIA
19 A RAHMAN 1271160268 GB
20 NIMAH PCT 3X1 ANTASID 3X1 BCOMPLEX 3X1
1011202648 SEPALGIA
21 JHOPANSA 1174210018 PARINGITIS AMOX 3X1 CTM 3X1 AMBROXOL3X1
22 NANA AMOX 3X1 CTM 3X1 PCT 3X1 AMBROKSOL 3X1
164544883 ISPA
23 M WAWAN 1873863911 BATUK LITcur 1X1 SANADRIL 3X1
24 ENCIH METFORMIN 3X1 ANTASID 3X1 PCT 3X1
1877535191 DM
25 DAYIH 72603898 KONGNYUTIVITIS CTM 3X1 ERLA SALEP
26 NADIH 490336751 ISPA PCT 3X1 CTM 3X1 AMBROKSOL 3X1
27 SEPTI INDRA 16018940034 ABSES ASMET 3X1 AMOX 3X1 DEXA 3X1
28 TITI S 72561159 MIOPIA
29 GILANG 1659371152 TB PARU
30 HARMAT 489261082 KOLISTITITS
31 AGUS SUHENDAR 72614452 UROLITILIASIS
32 kurniA 1448201272 GE
33 SOBRI 47769243 PENDENGARAN KURANG JELAS
34 LISTIAWATI CTM 3X1 RANTIDIN 3X1 VITAGESIK 3X1 OBH 3X1
200852760 GASTRITIS
35 ACAH 47269254 HEMOROID
36 TIOLINA 1276384149 KATARAK
37 ESYA FALASA 1793488612 PARINGITIS CTM 3X1 VIT 3X1 GG 3X1
38 TITIN 1618444212 SEPALGIA ASMET 3X1 PRENAMIA 3X1
39 KASMANAH 1422539177 MIOPIA
40 DANI LIANA 1311627655 KONSILITIS AMOX 3X1 DEXA 3X1 ASMET 3X1
41 KARTINI 1896346012 GASTRITIS
42 KOSIM 489319648 MYALGIA AMOX 3X1 PCT 3X1 DEXA 3X1
43 RASIH 490125802 MYALGIA ASMET 3X1 CALIM 3X1 KALK 1X1
44 SUHAEMI 1011209332 DM METPORMIN 3X1 ASMET 3X1
45 BOSIH 72391656 KEPUTIHAN
46 BUNAWAN 73159773 URTIKARIA CETIRIZIN 1X1 SALISIL
47 ICAN 4908600101 BATUK ASMET 3X1 CTM 3X1 GG 3X1
48 M AZKIA 72391689 DERMATITIS
49 ROHAMI 490352308 SEPALGIA
50 SUNARTI 1888949529 DERMATITIS CETIRIZIN 1X1 DEXA 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 JUMIATUN 1961036188 PARINGITIS CTM 3X1 DEXA 3X1 VIT C 1X1

2 RASMI 11257674433 DM
3 AYU LESTARI 48971415 NYERI PD TELINGA ASMET 3X1 DEXA 3X1
4 POPI KOMALA 1636265417 GASTRITIS ANTASID 3X1 PCT 3X1 RANTIDIN 2X1
5 WALIK W 1631371814 DERMATITIS CETIRIZIN 1X1 SALEP MEKONAZOL
6 LUSITA PCT 3X1 METFORMIN 3X1 PRENAMIA 3X1
1850210548
DM TUNZALOS 3X1
7 ZUBAEDAH PCT 3X1 AMBROKSOL 3X1 PRENAMIA 1X1
1436503184
PARINGITIS
8 SLAMET 1461307983 SERUMEN AMOX 3X1 DEXA 3X1 ASMET 3X1
9 AISYAH RANITIDIN 2X1 ANTASID 3X1 SPASMINAL 3X1
1294559737
GASTRITIS
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 OPI KOMALASARI 1636262417 DEMAM

2 KARMIN KUROSEMID 1X1 AMBROKSOL 3X1 ASMET 3X1
1462369623 HIPERTENSI AMLODIFIN 3X1
3 ALGIBRAN 1647880479 KONSILITIS AMOX 3X1 DEXA 3X1 ASMET 3X1
4 SATAR 1659325059 DERMATITIS AMOX 3X1 DEXA 3X1 ASMET 3X1
5 RAHMADIKA 1862218822 PARINGITIS AMOX 3X1 DEXA 3X1 PCT 3X1
6 YUDI 1649402199 ISPA PCT 3X1 AMOX 3X1 CTM 3X1 GG 3X1
7 ADITYA RANDIKA 1657324348 DM
8 LILIS PCT 3X1 BCOMPLEK 3X1 RANTIDIN 2X1
1793627717 MYALGIA
9 NUR AINUN 1622848972 ABSES AMOX 3X1 DEXA 3X1 ASMET 3X1
10 KARTI 1311854793 DM
11 SATEM PCT 3X1 B6 3X1 RANTIDIN 2X1 SALEP
1299634367 GASTRITIS GENTAMICIN
12 YUYUN 1465612209 DERMATITIS CETIRIZIN 1X1 CALIUM 2X1 B1 3X1
13 GHIFARI CETIRIZIN 1X1 ASMET 3X1 CTM 3X1 SALEP MATA
45100877 KONYUTIVITIS KLORO
14 NURIFANI Z KOTRI 3X1 NEOKOMINAL 3X1 ORALIT 3X1
1299633142 GE
15 ST ARIFAH AMBROKSOL 3X1 CTM 3X1 CALIUM 3X1
1311945802
BATUK
16 SURAHMAN 1436502802 MYALGIA ASMET 3X1 BCOMPLEK 3X1
17 H DARUSALAM CETRIZIN 1X1 METFORMIN 3X1 ASMET 3X1
1272363906 DM
18 AISYAH AMOX 3X1 PCT 3X1 CTM 3X1 AMBROKSOL 3X1
1294559717 PARINGITTIS
19 SUMARNA 1437355434 DEMAM AMLOX 3X1 PCT 3X1 BCOMPLEX 3X1
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
1 ONYAH KOTRI 2X2 ANTASID 3X1 SPASMINAL 3X1

1011203212 GE MOLAGIT 3X1
2 GIARTI CALIUM 2X1 GLIBERN 1X1 CATOPRIL 1X1
1861623865 MYALGIA
4 SITI 489775645 KONSULTASI
5 ASIH 490433286 SESAK
6 SAMSIAH ASMET 3X1 AMOX 3X1 AMBROKSOL 3X1
1641976086 PARINGITIS BCOMPLEK 3X1
7 WIDA NENGSIH 1634533582 SEPALGIA ASMET 3X1 BCOMPLEK 3X1
8 SRI REZEKI PCT 3X1 OMZ 1X1 RANTIDIN 2X1 ANTASID 3X1
9 ZUMIATUN 1961036188 SERUMEN
10 SAMAN HUDI 40715471 TONSILITIS
11 H ENUNG 1429428216 KOLISTITIS
12 ALFIRA 128118603 MIOPIA
13 KASNIAH 1261050917 KONSULTASI
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
POLI UMUM
KODE FKTP: 10140601
DATA PESERTA OBAT
Nama Pasien
dr. Suhaimi
Nip.1965090620003005
DAPATKAN OBAT DARI FKTP
IONAL IV
ASI
RUJUKAN
RS TUJUAN
P DALAM RS H GW
P ORTOPEDI RS H GW
P DALAM RS H G W
P JNTNG RS UD KOTA BKS
P DLM RS H G W
HAEMODELISA RS ANNA
P SYARAF RS H G W
IONAL IV
ASI
RUJUKAN
RS TUJUAN
PJANTUNG MITRA MEDIKA
P DLM RS H G W
P JNTNG RS H G W
P MATA RS H G W
P ORT RS KARYA MEDIKA
P ORT RS KARYA MEDIKA

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P SYARAF RS H G W
P SYARAF RS RAWA LUMBU

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P SYARAF RS UD KAB BLKS
ORT RS MEDIROSA
P DLM RS ANNA
P MATA RS MEDIROSA

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P JNTNG RS RSUD KAB BKS

P DLM RS RSUD KOTA BKS
P JNTNG RS CIBITUING MEDIKA

IONAL IV
ASI
RUJUKAN
RS TUJUAN


P PARU RS RSUD KAB BKS

P JNTNG RS RSUD KOTA BKS
URO RSUD KAB BKS

IONAL IV
ASI
RUJUKAN
RS TUJUAN
PMATA RS H GW
P JIWA RSUD KAB BK S
P SYARAF
P SYARAF RS H GW
IONAL IV
ASI
RUJUKAN
RS TUJUAN
syarap rsud kab bekasi

jantung rs hermina grand wisata
paru rsud kab bekasi
P TH T RS H GW
P THT R S RAWA LUMBU

PSYARAF RS H G W
P JIWA RSUD KAB BKS
P JIWA RSUD KAB BKS

IONAL IV
ASI
RUJUKAN
RS TUJUAN

P MATA RSUD KOTA BEKASI

P DALAM RS H GW
P HAEMODIALISA RSUD KOTA BEKASI
P BEDAH RS RW LUMBU

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P KULIT RS H GW
P SYARAF RS MITYRA MEDIKA

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P ORT RS H G W
P SYARAF RS H G W
P PARU RS MEDIROSA
P BEDAH RS RSUD KAB BKS

BHAKTI KARTINI P SYARAF
P ARU RS MEDIROSA
P HAEMODIALISA RS HERMINA GALAXY
P PARU RSUD KAB BEKASI
P DLM RS H G W
P JIWA RS RSUD KAB BKS
IONAL IV
ASI
RUJUKAN
RS TUJUAN

P PARU RS H G W
P PARU RS H G W
P SYARAF RSKARYA MEDIKA
P DLM RS RSUD KAB BKS

P KULIT RS H G W
HD RS RSUD KOTA BKS

P ANAK RS RSUD KOTA BKS

IONAL IV
ASI
RUJUKAN
RS TUJUAN
p dalam HGW
p dalam RS RSUD KAB BKS
P ANAK RS H G W
P SYARAF RS RSAUD KAB BKS
HD P DLM RS ANNA
P MATA RS H G W
P THT RS H G W
ORT RSUD KOTA BKS

P DLM RS ANNA

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P JANTUNG PDALM RS ANNA
IGD RSUD KABBKS

IONAL IV
ASI
RUJUKAN
RS TUJUAN

P KULIT RS HG W
P ANAK RS H GW
P KULIT RS H GW
P HD RS MITRA MEDIKA
P THT RS H GW

P JANTUNG RS H GW

ONAL IV
SI
RUJUKAN
RS TUJUAN
P PARU RS H GW
P ANAK RS H GW
P JANTUNG RSUD KOTA BEKASI
P MATA RS H GW

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P BEDAH RS RW LUMBU

P THT RS H GW
P JANTUNG RS H GW

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P DLM RSUD KOTA BKS
PCT 3X1 OBH
P JANTUNG RS RSUD KOYA BKS
P SYARAP RSUD KAB BKS

P SYARAP RS BHAKTI KARTININ
P PARU RSUD KAB BKS
P DLM RS H G W

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P SYARAF RS HGW
RSUD KOTA BKS P DLM

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P DLM RS KAB BKS

P BEDAH RS KARYA MEDIKA
IONAL IV
ASI
RUJUKAN
RS TUJUAN
P MATA RS H G W
P JANTUNG RSUS KAB BKS
P BEDAH RSUD KOTA BKS
P DLM RS H GW
P PARU RSUD KAB BKS

P MATA RS HGW
P PARU RS HGW
P DALAM RS HGW
P DALAM RS HGW
P DALAM RS HGW
P THT RS HGW
P BEDAH RS HGW
P MATA RS HGW
P MATA RS HGW
P DALAM RS HGW
P KULIT RS HGW
P KULIT RS HGW
P SYARAF RS HGW
IONAL IV
ASI
RUJUKAN
RS TUJUAN
P DALAM RSUD KAB BKS

IONAL IV
ASI
RUJUKAN
RS TUJUAN

P DALAM RS HGW
P DALAM RS MEDIROSA

IONAL IV
ASI
RUJUKAN
RS TUJUAN
P SYARAF RS RW LUMBU
P JANTUNG RS HGW
P THT RS HGW
P THT RS HGW
P URO RS CIBITUNG MEDIKA

IONAL IV
ASI
RUJUKAN
RS TUJUAN
IONAL IV
ASI
RUJUKAN
RS TUJUAN
Bekasi, 4 DESEMBER 2015
H. Agus Sarin, S.AP

Nip. 196507041987031010

Data pasien dengan diagnosa PRB

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Data pasien dengan diagnosa PRB

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DATA PASIEN DENGAN DIAGNOSA PRB YANG MENDAPATKAN OBAT DARI FKTP

BPJS KESEHATAN DIVISI REGIONAL IV

NAMA FKTP : PUSKESMAS SETU I

21 LILIS M 1793627717 DERMATITIS

25 ST HINDUN 47769208 GASTRITIS

26 RAHMAT SOLEH 1621685452 KONSULTASI

27 NURHAYATI 725545501 COLISITITIS

28 H ABDURAHMAN 1271160268 ABSES

30 UMAY 1645858078 ASSMA BRONCHIALE

32 YOYOH 47576171 MYALGIA

33 DEA AULIA 1788900535 DEMAM

34 SUNARTI 1888949529 CEPHALGIA

35 TUMPUN 1906652878 FARINGITIS ACUTE

36 YOAMA 1716803886 GASTRITIS

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

NAMA FKTP : PUSKESMAS SETU I

P PARU RS MITRA MEDIKA

P JANTUNG RSUD KAB BEKASI

P URO RSUD KAB BEKASI

COTRI D 2X2 ,SPASMINAL 3X1 CTM 3X1 BC 3X1

P ANAK RS MITRA MEDIKA

B1 3X1 ALUPURINOL 3X1 KSLIUM D 2X1

AMOX 3X1 CTM SK BACITRACIN 1

AMOX 3X1 PCT 3X1 BC 3X1 OBH SY

P MATA RS MITRA MEDIKA

PCT 3X1 RANITIDIN 2X1 ANTASID 3X1 BC 3X1

P PARU RSUD KAB BKS

ASMET 3X1 METFORMIN 3X1 BC 3X1

KALIUM D 2X1 RANITIDIN 2X1 BVC 3X1

P ANAK MITRA MEDIKA

ASMET 3X1 C 3X1

ANTASID 3X1 PCT 3X1 RANITIDIN 2X1 BC 3X1 OBH SY

NGAN DIAGNOSA PRB YANG MENDAPATKAN OBAT DARI FKTP

P PARU RSUD KAB BKS

RUSUD KAB BKS

P ANSK RS CENTRA MEDIKA

P DLM RS RAWA LUMBU

P JANTUNG RSUD KAB BEKASI

H. Agus Sarin, S.AP

DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALIS

DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALIS

DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALIS

DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALIS

DAFTAR RUJUKAN SPESIALIS DAN NON SPESIALIS