Anda di halaman 1dari 132

KUNJUNGAN PASIEN RAWAT JALAN UMUM UPT PUSKESMAS PANCENG

Pelayanan dari Tanggal 01 Mei 2017 s/d 31 Mei 2017

Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1 2 3 4 5 6 7 8 9 10 11 12

1 Jannatin Ma'rifah 0001350-2206.2015 33.3 P 2/5/2017 Z34 Rp 5,000

2 Afifatul Ambarini 0002059-2201.2017 18.5 P 2/5/2017 Z02.7 Rp 5,000

3 Mukaromah Binti Kromo 0002065-2201.2017 45.8 P 2/5/2017 M79.1 Rp 5,000

4 fahrudin 0001378-2225.2016 38.2 L 2/5/2017 J31 Rp 5,000

5 Nazil Ilham Putra ,A.R. 0002068-2201.2017 7.3 L 2/5/2017 A01.0 Rp 5,000

6 Mufariroh 0000001-03.2015 32.1 P 2/5/2017 M06 Rp 5,000

7 NGADIPAN 0000013-2201.2014 51.8 L 2/5/2017 M79.1 Rp 5,000

8 UMAMI 0000786-2201.2014 45.9 P 2/5/2017 J31 Rp 5,000

9 hj sama 0002115-2206.2017 61 P 2/5/2017 M79.1 Rp 5,000

10 maimun bin 0001478-2204.2017 65.1 L 2/5/2017 M79.1 Rp 5,000

11 Saiful Bin Mat Tadhi 0005878-2203.2015 54.2 L 2/5/2017 Z71 Rp 5,000

12 kholil/ Kholil 0002172-2205.2017 47 L 2/5/2017 M06 Rp 5,000

13 ASMAUL FITRIYAH 0002195-2203.2017 29.1 P 2/5/2017 Z30 Rp 5,000

14 piyatun piyatun 0002872-2206.2014 67.4 P 2/5/2017 I10 Rp 5,000

15 rohmawati c 0002882-2206.2016 29.9 P 2/5/2017 M79.1 Rp 5,000

16 NURSUSILOWATI 0000964-2201.2013 46.5 P 2/5/2017 K02 Rp 10,000

17 AFIYAH WIJI RAHAYU 0001716-2201.2013 21.8 P 2/5/2017 M79.1 Rp 5,000

18 RAFI ARDI 0000983-2201.2013 5.7 L 2/5/2017 K04 Rp 7,500

19 Asromah 0001006-2201.2017 45.9 P 2/5/2017 J20 Rp 5,000

20 Syafira Az Zahra 0001809-2201.2016 1.3 P 2/5/2017 L22 Rp 5,000

21 NI'MATUL LAILIYAH 0001082-2201.2013 33.8 P 2/5/2017 L23 Rp 5,000

22 MUHAR 0000557-2201.2013 64.1 L 2/5/2017 I10 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
23 Elina Nada Zafira 0005005-2205.2015 15.3 P 2/5/2017 A09 Rp 5,000

24 Sukarni 0000603-2228.2015 72.3 P 2/5/2017 M79.1 Rp 5,000

25 Mohammad danny prasetyo 0007411-2201.2015 9.3 L 2/5/2017 A01.0 Rp 5,000

26 AIN 0001971-2201.2013 9.6 P 2/5/2017 L23 Rp 5,000

27 SEVINTAN LAILA CAHYAN0001282-2201.2012 13.6 P 2/5/2017 J02 Rp 5,000

28 karomah 0002526-2202.2014 54.9 P 2/5/2017 M79.1 Rp 5,000

29 Bisma Mahardika Alfaruk 0001300-2201.2016 3.8 L 2/5/2017 R50.1 Rp 5,000

30 Erni Fitriyani 0000657-2201.2015 34.9 P 2/5/2017 M79.1 Rp 5,000

31 sodiqin 0003669-2204.2014 36.4 L 2/5/2017 M79.1 Rp 5,000

32 Mariyamah 0003704-2202.2014 70.4 P 2/5/2017 M06 Rp 5,000

33 Ar Sakha Ransi Aldan 0002060-2201.2017 2.2 L 2/5/2017 R50.1 Rp 5,000

34 Zainul Arifin Bin Imron 0003802-2205.2015 42.2 L 2/5/2017 E78 Rp 5,000

35 musiyatun 0003902-2202.2016 60.8 P 2/5/2017 K12 Rp 5,000

36 sigit octavian 0000784-2225.2015 9.3 L 2/5/2017 A01.0 Rp 5,000

37 niki suciyati 0002116-2206.2017 9 P 2/5/2017 K29 Rp 5,000

38 Arianil Ihwan 0001528-2233.2017 23.8 P 2/5/2017 Z34 Rp 5,000

39 nur anisa 0000826-2208.2015 42.9 P 2/5/2017 M79.1 Rp 5,000

40 Muhammad fajrul I 0001533-2201.2015 12.8 L 2/5/2017 B35 Rp 5,000

41 ANISKAROTIN 0001545-2201.2011 31.8 P 2/5/2017 M79.1 Rp 5,000

42 ABDUL ROSYID 0006057-2223.2015 28.8 L 2/5/2017 J31 Rp 5,000

43 ABDUL KHAYI 0002199-2203.2017 60 L 2/5/2017 M79.1 Rp 5,000

44 SUMIASEH 0002908-2201.2011 5.4 P 2/5/2017 J31 Rp 5,000

45 RAFI ARDI 0000983-2201.2013 5.7 L 2/5/2017 K04 Rp 7,500

46 Umiyah 0001797-2201.2016 43.1 P 2/5/2017 K04 Rp 7,500

47 Laras Widya Ning Tias 0000379-2201.2016 3.2 P 2/5/2017 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
48 MUDASIROH 0001054-2201.2013 48 P 2/5/2017 M79.1 Rp 5,000

49 MUYASAROH 0003222-2205.2014 62.4 P 2/5/2017 J31; I10 Rp 5,000

50 Era Fazira 0001082-2201.2016 16.2 P 2/5/2017 J02 Rp 5,000

51 Wafa Setiawan Saputra 0007198-2205.2015 2.9 L 2/5/2017 J02 Rp 5,000

52 mutriam 0005044-2206.2015 66.9 P 2/5/2017 M79.1 Rp 5,000

53 Rodhiyah 0007424-2201.2015 52.7 P 2/5/2017 M79.1 Rp 5,000

54 Jovian Reyhandika ,Al, 0007687-2201.2015 6.5 L 2/5/2017 K04 Rp 7,500

55 KARIMAH 0000650-2201.2011 55 P 2/5/2017 M79.1 Rp 5,000

56 KANAH k 0005288-2206.2014 72.2 P 2/5/2017 M79.1 Rp 5,000

57 sumirah 0001319-2206.2016 71.2 L 2/5/2017 M79.1 Rp 5,000

58 Nur Ainiyah 0005349-2208.2015 33.9 P 2/5/2017 M79.1 Rp 5,000

59 Mohammad izwan al F 0003721-2201.2016 7.3 L 2/5/2017 K00 Rp 12,000

60 Zidatin Ni'mah 0001354-2201.2017 1.2 P 2/5/2017 J13 Rp 5,000

61 Safira Wahyu Pratiwi 0002061-2201.2017 17.2 P 2/5/2017 A01.0 Rp 5,000

62 Putri Ayu Sholiha 0002066-2201.2017 0.1 P 2/5/2017 J00 Rp 5,000

63 IHhya'ul ulum 0002075-2201.2017 23.8 L 2/5/2017 K29 Rp 5,000

64 ninik 0002118-2206.2017 27 P 2/5/2017 Z30 Rp 5,000

65 Mohammad Labib Faiq 0004040-2201.2015 2.8 L 2/5/2017 L22 Rp 5,000

66 KUTI'AH 0002755-2201.2011 65.4 P 2/5/2017 M79.1 Rp 5,000

67 muaman 0002173-2205.2017 43 L 2/5/2017 M79.1 Rp 5,000

68 Wahyudin 0000913-2201.2016 34.4 L 2/5/2017 K04 Rp 7,500

69 ANAMI GHOZIYAH 0001621-2201.2013 30.8 P 2/5/2017 Z02.7 Rp 5,000

70 MAYA 0000355-2201.2011 61.1 P 2/5/2017 E78 Rp 5,000

71 Aga Farid Pratama 0001790-2201.2017 2.3 L 2/5/2017 J00 Rp 5,000

72 SITI NUR AZIZAH 0000639-2201.2012 7 L 2/5/2017 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
73 Sufa'atun nisak 0001305-2201.2015 9.4 P 2/5/2017 K00 Rp 12,000

74 Subandriyo Bin Ngatmiun 0002064-2201.2017 47.9 L 2/5/2017 M79.1 Rp 5,000

75 Ahmad Rodli 0002067-2201.2017 38.8 L 2/5/2017 T15 Rp 5,000

76 Basilah Silmi 0002079-2201.2014 22.1 P 2/5/2017 Z71 Rp 5,000

77 H srimonah 0005605-2220.2014 77.2 P 2/5/2017 I10 Rp 5,000

78 musaadah 0000780-2225.2015 53.3 P 2/5/2017 M06 Rp 5,000

79 NGADIPAN 0000013-2201.2014 51.8 L 2/5/2017 M79.1 Rp 5,000

80 Ahmad Syahrul Nizam 0001437-2201.2011 6 L 2/5/2017 J02 Rp 5,000

81 nurfebrian 0002114-2206.2017 52 P 2/5/2017 M79.1 Rp 5,000

82 MAIMUNAH 0002620-2201.2013 72.3 P 2/5/2017 M79.1 Rp 5,000

83 Nur Lathifah 0005718-2201.2015 42.6 P 2/5/2017 K04 Rp 7,500

84 MAT RONI 0001606-2201.2012 53.3 L 2/5/2017 M79.1 Rp 5,000

85 Sureni 0006038-2201.2016 42.4 P 2/5/2017 J31 Rp 5,000

86 NAFI'UDIN 0001693-2201.2012 34.6 L 2/5/2017 H81 Rp 5,000

87 Srimuna ima 0001702-2201.2014 48.8 P 2/5/2017 E11 Rp 5,000

88 samona 0001011-2222.2017 65.2 P 2/5/2017 Z71 Rp 5,000

89 Anwar 0002457-2203.2015 32.2 L 2/5/2017 M06 Rp 5,000

90 Achmad Koirun Najih 0006269-2201.2016 4.5 L 2/5/2017 A09 Rp 5,000

91 Marfungah 0006396-2201.2016 32 P 2/5/2017 J03 Rp 5,000

92 Sindy ayu livia P 0003400-2201.2016 18.2 P 2/5/2017 K04 Rp 7,500

93 Irodatin Niharo 0000614-2201.2015 24.9 P 2/5/2017 Z34 Rp 5,000

94 Ainur Rofiah 0007450-2201.2015 30.2 P 2/5/2017 Z02.7 Rp 5,000

95 Mohammad Aqilusalim 0001970-2201.2016 5 L 2/5/2017 R50.1 Rp 5,000

96 kotimaroh 0002016-2206.2014 52.5 P 2/5/2017 M79.1 Rp 5,000

97 KOMARI 0002581-2209.2014 52.8 P 3/5/2017 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
98 Nurali 0000007-2201.2017 57.7 L 3/5/2017 A16.0 Rp 5,000

99 Heni Suprihatin 0002106-2201.2017 35.5 P 3/5/2017 A16.0 Rp 5,000

100 putri ayu syaatin nadiy 0002108-2202.2017 6.3 P 3/5/2017 J02 Rp 5,000

101 mukiyah 0002119-2206.2017 47 P 3/5/2017 Z30 Rp 5,000

102 Arif Rohman 0005688-2201.2016 27.7 L 3/5/2017 A16.0 Rp 5,000

103 Mokesri 0004006-2206.2014 72.4 P 3/5/2017 M79.1 Rp 5,000

104 aisyah rizki zafira 0002386-2206.2017 0 P 3/5/2017 Z24.6 Rp 5,000

105 robiah nur hidayah 0004126-2230.2016 37.8 L 3/5/2017 Z00 Rp 5,000

106 Miftahul Kanjil 0002175-2205.2017 4 L 3/5/2017 J31 Rp 5,000

107 adinda olivia g 0002785-2202.2015 2.7 P 3/5/2017 L23 Rp 5,000

108 DIVIRA OKTAVIA A 0002185-2201.2012 5.5 P 3/5/2017 A09 Rp 5,000

109 Ahmad Masruki 0006142-2201.2016 25.6 L 3/5/2017 A16.0 Rp 5,000

110 SUWARTI 0000991-2201.2013 59 P 3/5/2017 M79.1 Rp 12,500

111 Kumanisah 0004563-2201.2015 48.5 P 3/5/2017 K29 Rp 5,000

112 malaikati 0002977-2202.2014 63 P 3/5/2017 J45 Rp 5,000

113 Ahmad Willy Candra W 0001792-2201.2017 2.8 L 3/5/2017 Z71 Rp 5,000

114 Zuliyati 0006353-2201.2014 42.8 P 3/5/2017 K04 Rp 7,500

115 qodiron 0006492-2203.2015 41.7 L 3/5/2017 J02 Rp 5,000

116 MOH.AUFA BARIZ 0002264-2203.2017 2 L 3/5/2017 J02 Rp 5,000

117 nasiroh 0002276-2225.2017 49 P 3/5/2017 M79.1 Rp 5,000

118 warkiyatun 0003472-2202.2015 62.1 P 3/5/2017 M79.1 Rp 12,500

119 ZAIBA 0000641-2201.2012 6.5 P 3/5/2017 J02 Rp 5,000

120 karsiah 0007578-2202.2015 49.9 P 3/5/2017 M79.1 Rp 5,000

121 Sri Widarti 0003566-2208.2016 32.9 P 3/5/2017 Z71 Rp 5,000

122 Viky Hendra Setiawan 0001342-2201.2017 25.3 L 3/5/2017 A15 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
123 Siti Zalehah 0000709-2208.2017 21 P 3/5/2017 J02 Rp 5,000

124 kaspaat 0002109-2202.2017 59.9 L 3/5/2017 L23 Rp 5,000

125 KUMAIYAH 0000033-2201.2012 53.8 P 3/5/2017 E11 Rp 5,000

126 sokran 0002120-2206.2017 63 L 3/5/2017 J00 Rp 5,000

127 Muhammad Adi Fudiyanto 0002649-2202.2015 22 L 3/5/2017 Z02.7 Rp 5,000

128 H. MASDUQI 0002771-2201.2011 65.3 L 3/5/2017 L13.1 Rp 5,000

129 AGUNG PUTRA WIBOWO 0000909-2201.2011 6.9 L 3/5/2017 J02 Rp 5,000

130 Daffa Arya G 0005978-2201.2015 2.1 L 3/5/2017 L23 Rp 5,000

131 Raeza Alvin Hidayah 0001634-2219.2016 4.7 P 3/5/2017 J12 Rp 5,000

132 ZULAIHAH 0002228-2203.2017 37.5 P 3/5/2017 I10 Rp 5,000

133 fadholi 0004722-2219.2016 50.7 L 3/5/2017 Z71 Rp 5,000

134 Usmawati 0003134-2202.2016 39.9 P 3/5/2017 J02 Rp 5,000

135 SADIYAH 0002262-2203.2017 35 P 3/5/2017 J02 Rp 5,000

136 Umi Hanik 0005006-2205.2015 38.8 P 3/5/2017 H10 Rp 5,000

137 Silmi Mauhibah Asila A 0005232-2201.2014 10.9 P 3/5/2017 J02 Rp 5,000

138 kuminten 0002057-2219.2017 46.1 P 3/5/2017 K29 Rp 5,000

139 Ahmad Faris Hamizan 0002103-2201.2017 1.3 L 3/5/2017 R50.1 Rp 5,000

140 ANISKAROTIN 0001545-2201.2011 31.8 P 3/5/2017 L13.1 Rp 5,000

141 maroah 0004208-2230.2015 61 P 3/5/2017 I10 Rp 5,000

142 ahmad faiz hidayat 0002771-2202.2015 2.3 L 3/5/2017 J02 Rp 5,000

143 MALANAH 0000938-2201.2011 51.5 P 3/5/2017 M79.1 Rp 5,000

144 AMALAH 0000304-2201.2013 59.2 P 3/5/2017 M79.1 Rp 5,000

145 AH. MILATA ALAYUBI 0002229-2203.2017 1 L 3/5/2017 J02 Rp 5,000

146 Sarif Hidayatulloh 0003106-2201.2016 60.8 L 3/5/2017 B16 Rp 5,000

147 ISTIANA 0001853-2201.2011 46.2 P 3/5/2017 M79.1 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
148 UMAYAH 0001084-2201.2014 49.6 P 3/5/2017 K29 Rp 5,000

149 Sukanan 0005017-2201.2015 49.5 L 3/5/2017 M79.1 Rp 5,000

150 dasri 0005042-2206.2015 67.9 P 3/5/2017 I10 Rp 5,000

151 WINDI HILYATUL FUADA 0000634-2201.2011 13.7 P 3/5/2017 K02 Rp 7,500

152 Tsaqifah Firdaus 0007525-2201.2015 2.6 P 3/5/2017 R50.1 Rp 5,000

153 Siti Rohmatul Umah 0002016-2201.2015 30.6 P 3/5/2017 R51 Rp 5,000

154 Maifatun 0001320-2201.2015 47.3 P 3/5/2017 J02 Rp 5,000

155 Istirochah 0008378-2201.2015 61.3 P 3/5/2017 A15 Rp 5,000

156 Yohana Afni Susanti 0002107-2201.2017 18.8 P 3/5/2017 Z02.7 Rp 5,000

157 ninik 0002118-2206.2017 27 P 3/5/2017 Z30 Rp 5,000

158 intan ayu diah 0002671-2226.2016 13.1 P 3/5/2017 J00 Rp 5,000

159 samilah 0002740-2202.2014 66.9 P 3/5/2017 E11 Rp 5,000

160 Finda Fahirah 0002174-2205.2017 16 P 3/5/2017 V22 Rp 5,000

161 SITI MUKHOLIFAH 0002911-2201.2011 36.4 P 3/5/2017 Z71 Rp 5,000

162 Muhammad Farhan A. 0006122-2201.2015 1.9 L 3/5/2017 K59.1 Rp 5,000

163 MIFTAHULLUTFI 0006320-2204.2014 4.1 L 3/5/2017 L13.1 Rp 5,000

164 NU'EM NUZULA 0001882-2201.2011 30.3 P 3/5/2017 J02 Rp 5,000

165 Afif Andi Yusuf 0001888-2201.2014 29.9 L 3/5/2017 K05 Rp 7,500

166 sadenan 0001931-2201.2017 70.5 L 3/5/2017 S51 Rp 5,000

167 nur faizah 0005210-2202.2014 37.2 P 3/5/2017 J45 Rp 5,000

168 Firda 0003761-2225.2014 3.4 P 4/5/2017 Z00.1 Rp 5,000

169 Nada Firsya Maulidiyah 0005487-2201.2016 1.3 P 4/5/2017 Z71 Rp 5,000

170 GIBRAN AHMAD AL HUBB0003903-2225.2016 0.8 L 4/5/2017 Z00.1 Rp 5,000

171 Muhammad Nurul Faizi 0003939-2203.2016 18.1 L 4/5/2017 Z02.7 Rp 5,000

172 Kasmunti 0005629-2201.2016 68.4 P 4/5/2017 M79.1 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
173 JUWARIYAH 0000041-2201.2012 77.3 P 4/5/2017 K29 Rp 5,000

174 Muhammad Ziyad 0002124-2201.2017 29.9 L 4/5/2017 Z02.7 Rp 5,000

175 Dwi Usmawati 0002144-2201.2017 17.6 P 4/5/2017 Z02.7 Rp 5,000

176 carisma 0002160-2206.2017 5 P 4/5/2017 J00 Rp 5,000


Z27;
177 NAMIRA HAZNA AZ ZAHR 0001587-2240.2017 0.2 P 4/5/2017 Z24.0 Rp 5,000

178 Azza Sasmita Abhirama 0005975-2225.2014 3.3 P 4/5/2017 Z00.1 Rp 5,000

179 Kadar 0000216-2201.2016 61.3 L 4/5/2017 M79.1 Rp 5,000

180 Adi Jayadi 0000325-2219.2017 20.9 L 4/5/2017 R50.1 Rp 5,000


Z27;
181 Almahira Mishall Qiran 0001016-2225.2017 0.3 P 4/5/2017 Z24.0 Rp 5,000

182 MARDHIYAH 0003100-2205.2014 52.6 P 4/5/2017 M79.1 Rp 5,000

183 Bisma 0003200-2225.2014 3.7 L 4/5/2017 Z00.1 Rp 5,000

184 QUENZY 0007129-2225.2015 3.1 P 4/5/2017 Z00.1 Rp 5,000

185 ABEL 0005206-2225.2014 2.6 P 4/5/2017 Z00.1 Rp 5,000

186 Nikmatul Zuhro 0008137-2201.2015 32.4 P 4/5/2017 Z30 Rp 5,000

187 AMAROH 0005283-2206.2014 69.2 P 4/5/2017 M79.1 Rp 5,000

188 rafela 0000820-2225.2015 4.5 P 4/5/2017 Z00.1 Rp 5,000

189 Tsania Nidaul Mas'udah 0002125-2201.2017 7 P 4/5/2017 K04 Rp 7,500

190 NAUFAL WILDATUL MAHI 0005777-2225.2016 0.4 P 4/5/2017 Z24.0 Rp 5,000

191 kanaya 0004095-2225.2014 4.8 P 4/5/2017 Z00.1 Rp 5,000

192 HARIS 0002754-2201.2011 75.5 L 4/5/2017 M79.1 Rp 5,000

193 KAMIL 0005927-2225.2014 5.1 L 4/5/2017 Z00.1 Rp 5,000

194 Kayla Aura Zaskiyah 0002176-2205.2017 0.3 P 4/5/2017 L27 Rp 5,000

195 KASMU'AH 0000279-2201.2013 59.2 P 4/5/2017 M79.1 Rp 5,000

196 SABIQ AL FATIH 0006089-2225.2016 0.5 L 4/5/2017 Z24.0 Rp 5,000


Z27;
197 Farkhan Maulana Muzaky 0001017-2225.2017 0.3 L 4/5/2017 Z24.0 Rp 5,000
Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
198 Sakinatun Nurin Najwa 0004748-2201.2014 3.9 P 4/5/2017 K02 Rp 10,000

199 Nafla Syakira Putri 0000547-2219.2017 4.4 P 4/5/2017 L23 Rp 5,000

200 ANWAR 0000558-2201.2013 40.8 L 4/5/2017 M79.1 Rp 5,000

201 BARIQLANA 0007133-2225.2015 2.6 L 4/5/2017 Z00.1 Rp 5,000

202 A.HAFIDH A.FATHIR 0001151-2225.2016 3.7 L 4/5/2017 Z00.1 Rp 5,000

203 SUKNAH 0000608-2223.2015 65.3 P 4/5/2017 M79.1 Rp 5,000

204 Laila Nur Syafiqa 0003453-2201.2016 4.6 P 4/5/2017 J02 Rp 5,000

205 DAFFA 0005207-2225.2014 2.6 L 4/5/2017 Z00.1 Rp 5,000

206 Bisma Mahardika Alfaruk 0001300-2201.2016 3.8 L 4/5/2017 Z71 Rp 5,000

207 sukarti 0002529-2202.2014 42.8 P 4/5/2017 Z30 Rp 5,000

208 ERLITA ARSIFA SALSABIL 0008192-2225.2015 1.9 P 4/5/2017 Z00.1 Rp 5,000

209 Rani vitaloka 0005291-2225.2014 2.8 P 4/5/2017 Z00.1 Rp 5,000

210 NURUL FITRIYAH 0005403-2225.2016 32.6 P 4/5/2017 Z71 Rp 5,000

211 Aqilla 0003757-2225.2014 2.9 P 4/5/2017 Z00.1 Rp 5,000

212 Khayla pramesti 0001384-2201.2014 3.9 P 4/5/2017 J00 Rp 5,000

213 Insan Budi Aji 0003842-2206.2014 15.2 L 4/5/2017 G40 Rp 5,000

214 NILAM 0002366-2201.2013 4 P 4/5/2017 J02 Rp 5,000

215 Abd Kholik 0001454-2201.2014 55.8 L 4/5/2017 F20 Rp 5,000

216 syafira jihan amira 0002635-2225.2016 4.5 P 4/5/2017 Z00.1 Rp 5,000


Z27;
217 KAYYISA HUMAIRA IKHW 0000047-2225.2017 0.3 P 4/5/2017 Z24.0 Rp 5,000

218 Henny Fauziyah 0002122-2201.2017 15.9 P 4/5/2017 J02; K29 Rp 5,000

219 Felia Nailusy Syifa 0002126-2201.2017 18.6 P 4/5/2017 Z02.7 Rp 5,000

220 Supiyatun Binti Siban 0002388-2202.2015 57.3 P 4/5/2017 J00 Rp 5,000

221 az zahra 0000824-2225.2015 2.5 P 4/5/2017 Z00.1 Rp 5,000

222 RANI DAHLIA FIRNANDA 0005758-2205.2014 14.1 P 4/5/2017 L27 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
223 Joko Sari 0002130-2201.2017 60 L 4/5/2017 T15 Rp 5,000

224 hanna 0004182-2225.2014 5 P 4/5/2017 Z00.1 Rp 5,000

225 WARDATUL JANNAH 0000862-2201.2013 18 P 4/5/2017 Z02.7 Rp 5,000

226 Nurul Aini 0000930-2201.2017 2.1 P 4/5/2017 J02 Rp 5,000

227 M . AL FATIH 0006090-2225.2016 0.6 L 4/5/2017 Z24.0 Rp 5,000

228 SUDARMI 0002910-2201.2011 41.4 P 4/5/2017 Z71 Rp 5,000

229 satriya 0006120-2225.2015 3.8 L 4/5/2017 Z00.1 Rp 5,000

230 ARIFIN.SPDI 0000315-2201.2013 39.9 L 4/5/2017 M79.1 Rp 5,000

231 niami b 0003049-2202.2014 63.2 P 4/5/2017 M79.1 Rp 5,000


Z27;
232 Fara Raisa Thafana 0001018-2225.2017 0.3 P 4/5/2017 Z24.0 Rp 5,000

233 Faiq Fakri Musyaddad 0002234-2201.2016 23.9 L 4/5/2017 J02 Rp 5,000

234 Putri Arzetty Afifi 0006326-2201.2016 1.3 P 4/5/2017 R50.1 Rp 5,000

235 Nugi Syafak 0003206-2201.2015 5.8 L 4/5/2017 S80 Rp 5,000

236 KEISHA AZKIA ALY 0000516-2225.2015 2.3 P 4/5/2017 Z00.1 Rp 5,000

237 ALARIK 0000547-2225.2015 4.9 L 4/5/2017 Z00.1 Rp 5,000

238 FITROTUL ILMIAH 0002270-2201.2013 4.5 P 4/5/2017 J02 Rp 5,000

239 KHUMAIRAH AZ ZAHRA 0001154-2225.2016 2.4 P 4/5/2017 Z00.1 Rp 5,000

240 Azliena Agustin Maula 0007222-2205.2015 3.7 P 4/5/2017 J31 Rp 5,000

241 matrokan 0002278-2225.2017 L 4/5/2017 M06 Rp 5,000

242 Saufa 0003759-2225.2014 3.2 P 4/5/2017 Z00.1 Rp 5,000

243 Indana 0003769-2225.2014 3.3 P 4/5/2017 Z00.1 Rp 5,000

244 Habibi 0003783-2225.2014 2.9 L 4/5/2017 Z00.1 Rp 5,000

245 Sakila naura R 0003943-2201.2015 3.6 P 4/5/2017 J02 Rp 5,000


Z27;
246 FAKHRIL ZHAFRAN AFIQ 0000048-2225.2017 0.3 L 4/5/2017 Z24.0 Rp 5,000

247 Zahrotul Firdaus 0002123-2201.2017 17.7 P 4/5/2017 Z02.7 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
248 citra kirana 0004073-2225.2014 3.4 P 4/5/2017 Z00.1 Rp 5,000

249 Ahmad Fawaz Al Fasa 0002148-2240.2017 1.5 L 4/5/2017 Z27 Rp 5,000

250 Devin Hamdi Al Farabi 0004247-2201.2015 2.9 L 4/5/2017 L23 Rp 5,000

251 Ahmad sandya abhirama 0005974-2225.2014 3.3 L 4/5/2017 Z00.1 Rp 5,000

252 Echa auliyah rahmah 0004277-2230.2014 5.6 P 4/5/2017 J02 Rp 5,000

253 Putra Prayoga 0002177-2205.2017 8 L 4/5/2017 Y28 Rp 5,000

254 DESSY HARTIN EKAYANTI0000206-2201.2011 38.3 P 4/5/2017 M79.1 Rp 5,000

255 PUTRA ILMAN NAFIAN 0006085-2225.2016 0.5 L 4/5/2017 Z24.0 Rp 5,000

256 AGUNG 0004485-2225.2015 2 L 4/5/2017 Z24.4 Rp 5,000

257 NENENG\ 0002903-2201.2011 32.4 P 4/5/2017 Z71 Rp 5,000

258 Muhammad Arief Agustin 0000334-2201.2016 20.7 L 4/5/2017 J02 Rp 5,000

259 NOR KHABIBAH 0001809-2201.2013 19.1 P 4/5/2017 J02 Rp 5,000

260 satria bagus 0003110-2225.2015 4.6 L 4/5/2017 Z00.1 Rp 5,000

261 M.AINUL NAZRIL 0000551-2225.2015 4.6 L 4/5/2017 Z00.1 Rp 5,000

262 M.NUR RAMADHAN JUNAI0001150-2225.2016 3.8 L 4/5/2017 Z00.1 Rp 5,000

263 HAFSA 0001156-2225.2016 1.8 P 4/5/2017 Z00.1 Rp 5,000

264 Suhardi 0000695-2203.2015 52.3 L 5/5/2017 I10 Rp 5,000

265 Zawawi 0004089-2230.2015 61.8 L 5/5/2017 H61.2 Rp 5,000

266 Agung Fariq Abdillah 0002151-2201.2017 17.8 L 5/5/2017 J02 Rp 5,000

267 Nur syafa azlinda 0005882-2201.2016 16.4 P 5/5/2017 L27 Rp 5,000

268 khutmiroh 0002198-2206.2017 49 P 5/5/2017 L23 Rp 5,000

269 Yeni Safiroh 0001721-2201.2015 21.9 P 5/5/2017 Z02.7 Rp 5,000

270 najwa salsabila ali 0006278-2228.2015 7.2 P 5/5/2017 A01.0 Rp 5,000

271 annora aureliya 0004762-2206.2015 3.3 P 5/5/2017 J00 Rp 5,000

272 MASLIHATIN 0001202-2201.2011 28.1 P 5/5/2017 K05.0; J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
273 ruaiyah 0003585-2225.2015 47.1 P 5/5/2017 J31 Rp 5,000

274 AKBAR 0001306-2201.2011 10.3 L 5/5/2017 K00 Rp 12,000

275 kotimaroh 0002016-2206.2014 52.5 P 5/5/2017 I84 Rp 5,000

276 M Najadul Khoir 0003951-2205.2014 4.8 L 5/5/2017 K05.0 Rp 5,000

277 Ridluan Bin Kamsir 0002145-2201.2017 57.9 L 5/5/2017 E11; E78 Rp 5,000

278 rusmi 0002700-2206.2014 52.4 P 5/5/2017 M79.1 Rp 5,000

279 Saiful Bin Mat Tadhi 0005878-2203.2015 54.2 L 5/5/2017 H61.2 Rp 5,000

280 Lailatul Na'im 0002161-2201.2017 32.1 P 5/5/2017 Z71 Rp 5,000

281 Ma'rifah 0001561-2201.2017 37 P 5/5/2017 K29 Rp 5,000

282 jumantun 0002180-2206.2014 58.5 P 5/5/2017 M79.1 Rp 5,000

283 ANIFAH 0001615-2201.2012 40.3 P 5/5/2017 K29 Rp 5,000

284 SAMID 0000950-2201.2011 64.3 L 5/5/2017 M79.1 Rp 5,000

285 bagas kelana tristan 0006029-2219.2014 3.2 L 5/5/2017 R50.1 Rp 5,000

286 Ulfiyah Binti Kasrim 0001059-2201.2017 66.1 P 5/5/2017 I10 Rp 5,000

287 CINTA ADELIYA 0001956-2201.2011 6.5 P 5/5/2017 J02 Rp 5,000

288 Munijah, Hj 0002286-2201.2011 76.3 P 5/5/2017 M79.1 Rp 5,000

289 Selvi Ayu Andriani 0003515-2201.2014 3.8 P 5/5/2017 J00 Rp 5,000

290 CINDRA HADI SETIAWAN 0002564-2201.2012 26.5 L 5/5/2017 M79.1 Rp 5,000

291 sati,ah 0000082-2206.2017 P 5/5/2017 L23 Rp 5,000

292 Muhammad Saifi Rosyad 0002147-2201.2017 28 L 5/5/2017 Z02.7 Rp 5,000

293 julaikah 0001542-2204.2017 61.1 P 5/5/2017 M79.1 Rp 5,000

294 Misa Yusma Audina 0002152-2201.2017 18.4 P 5/5/2017 Z02.7 Rp 5,000

295 Khoirun Nasih Bin Mutro 0002167-2201.2017 31.8 L 5/5/2017 Z02.7 Rp 5,000

296 NUR HEPY KURNIAWATI 0002934-2205.2014 25.6 P 5/5/2017 J31 Rp 5,000

297 mudayati 0004761-2202.2014 42.8 P 5/5/2017 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
298 Mutmainah 0006642-2225.2015 43.2 P 5/5/2017 J31 Rp 5,000

299 Niswatun 0000567-2226.2017 59.3 P 5/5/2017 E78 Rp 5,000

300 tamari 0003395-2202.2014 68 L 5/5/2017 K29 Rp 5,000

301 SRI MONA 0000610-2223.2015 67.3 P 5/5/2017 I10 Rp 5,000

302 Mikaila Adiba Khilda 0003466-2201.2016 1.4 P 5/5/2017 J02 Rp 5,000

303 Syafi'i 0007976-2201.2015 53 L 5/5/2017 E11.8 Rp 5,000

304 Fahril Maulana 0002332-2205.2014 5 L 5/5/2017 J31 Rp 5,000

305 Winarni 0005418-2201.2016 38 P 5/5/2017 Z35 Rp 5,000

306 Joko Sari 0002130-2201.2017 60 L 5/5/2017 T15 Rp 5,000

307 Iskan 0002163-2201.2017 58.9 L 5/5/2017 A15 Rp 5,000

308 Srikanah 0002748-2206.2014 72.4 P 5/5/2017 M79.1 Rp 5,000

309 Adiguna Pranata 0001555-2201.2014 3.2 L 5/5/2017 Z00 Rp 5,000

310 Nailatul Saidah 0005923-2205.2015 2.1 P 5/5/2017 J31 Rp 5,000

311 moh sairozi 0002194-2206.2017 71 L 5/5/2017 M79.1 Rp 5,000

312 eko wahyudi 0002202-2206.2017 0 L 5/5/2017 M79.1 Rp 5,000


M79.1;
313 Niswatin 0002229-2205.2014 57.5 P 5/5/2017 K29 Rp 5,000

314 H. MUHAMMAD SUBEKAN0001108-2201.2011 65.3 L 5/5/2017 J02; L27 Rp 5,000

315 JUWARIYAH 0001222-2201.2011 49.5 P 5/5/2017 E78 Rp 5,000

316 YUNIAR FADLAH HADI 0001996-2201.2012 8.8 P 5/5/2017 L27 Rp 5,000

317 HALIMATUS SAKDIYAH 0001312-2201.2011 37.4 P 5/5/2017 L23 Rp 5,000

318 Arsad 0003688-2203.2016 60.8 L 5/5/2017 Z00 Rp 5,000

319 M seno Ar Rofi 0002345-2205.2017 0.7 L 6/5/2017 J31 Rp 5,000

320 Delly Rodli Al kautsar 0003898-2201.2016 21.3 L 6/5/2017 I84 Rp 5,000

321 H munziyah 0005606-2220.2014 67.2 P 6/5/2017 R51 Rp 5,000

322 jono 0002683-2202.2014 72.9 L 6/5/2017 M17 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
323 Yarokah 0002178-2201.2017 59 P 6/5/2017 M79.1 Rp 5,000

324 kasirah 0006046-2204.2014 61.4 P 6/5/2017 M79.1 Rp 5,000

325 ru,ainah 0002203-2206.2017 42 P 6/5/2017 J00 Rp 5,000

326 Rumaysha' 0004511-2201.2016 0.9 P 6/5/2017 K59.1 Rp 5,000

327 Sriyati 0003177-2202.2014 77.4 P 6/5/2017 I10; H81 Rp 5,000

328 Al Muhtarom 0004849-2201.2016 31.3 L 6/5/2017 L29 Rp 5,000

329 Khusnul KH/suud 0006551-2204.2014 44.2 P 6/5/2017 M79.1 Rp 5,000

330 moh.haris 0002498-2216.2017 1.6 L 6/5/2017 K05 Rp 5,000

331 sadenan 0001931-2201.2017 70.5 L 6/5/2017 S51 Rp 5,000

332 AZAHROTUN NAJWA 0002302-2203.2017 6.5 P 6/5/2017 J02 Rp 5,000

333 Nada Firsya Maulidiyah 0005487-2201.2016 1.3 P 6/5/2017 J31 Rp 5,000

334 YAMENAN 0002066-2201.2011 57.4 L 6/5/2017 M06 Rp 5,000

335 AZUAN 0002604-2201.2011 6.8 L 6/5/2017 B26 Rp 5,000

336 mirza ardhani narendra 0005657-2230.2016 1.6 L 6/5/2017 J31 Rp 5,000

337 MA'RUFAH 0002637-2201.2011 41.8 P 6/5/2017 L27 Rp 5,000

338 Amanda Chuby Hati Nur 0005866-2230.2016 0.8 P 6/5/2017 J02 Rp 5,000

339 Agung Fariq Abdillah 0002151-2201.2017 17.8 L 6/5/2017 Z02.7 Rp 5,000

340 Siti Hardiyanti 0002196-2201.2017 25.6 P 6/5/2017 K04 Rp 12,500

341 SRI WIDATI 0000315-2201.2011 53.9 P 6/5/2017 L02 Rp 5,000

342 Muhammad Fajriyan Sidqi 0004559-2201.2016 13.4 L 6/5/2017 B37 Rp 5,000

343 FITA KHOLILAH 0002234-2201.2013 36.5 P 6/5/2017 T15; J00 Rp 5,000

344 sokib 0001841-2202.2016 47.4 L 6/5/2017 J00 Rp 5,000

345 azza fayyadh abrisam 0002491-2216.2017 0.9 L 6/5/2017 K29 Rp 5,000

346 Zunaidah 0001329-2201.2014 38.1 P 6/5/2017 I95 Rp 5,000

347 NABILAH 0002343-2205.2014 3.9 P 6/5/2017 K29 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
348 Zainul Arifin Bin Imron 0003802-2205.2015 42.3 L 6/5/2017 E78 Rp 5,000

349 musiyatun 0003902-2202.2016 60.8 P 6/5/2017 K12 Rp 5,000

350 Adrian Pradipta Rohman 0005784-2201.2016 1.3 L 6/5/2017 K59.1 Rp 5,000

351 MIYATUN. 0001534-2203.2017 57.5 P 6/5/2017 F23 Rp 5,000

352 SHOKHIFATUL IZAH 0000888-2201.2012 30 P 6/5/2017 K02 Rp 20,000

353 Masro'in 0002181-2201.2017 36.6 L 6/5/2017 H81 Rp 5,000

354 bakri 0002822-2204.2015 52.2 L 6/5/2017 M79.1 Rp 5,000

355 zulaiha 0002197-2202.2017 37.7 P 6/5/2017 Z30 Rp 5,000

356 Mohammad Rifqi Syauqill 0002200-2201.2017 3.8 L 6/5/2017 R50.1 Rp 5,000

357 samona 0001011-2222.2017 65.2 P 6/5/2017 M79.1 Rp 5,000

358 ZULIYATI 0000385-2201.2012 42.8 P 6/5/2017 M79.1 Rp 5,000

359 wiwid sulistinah 0006369-2230.2015 38.8 P 6/5/2017 I95 Rp 5,000

360 Nihayatul Fahmiya 0004841-2230.2015 2.5 P 6/5/2017 Z00 Rp 5,000

361 MUKLATIM 0004856-2202.2014 58.1 L 6/5/2017 M79.1 Rp 5,000

362 Haisya Hanum 0001126-2205.2017 0.6 P 6/5/2017 J31 Rp 5,000

363 Safiq As Syarani 0002344-2205.2017 3 L 6/5/2017 J31 Rp 5,000

364 Rosyihin 0005506-2201.2016 51.3 L 6/5/2017 M79.1 Rp 5,000

365 Firdianita Fujiatus 0000004-2201.2017 26.9 P 6/5/2017 M79.1 Rp 5,000

366 ABDI 0002638-2201.2013 4 L 6/5/2017 L02 Rp 5,000

367 AHMAD SOKIB 0002414-2201.2011 36.6 L 6/5/2017 M79.1 Rp 5,000

368 Govaldo Ircham Maulana 0004845-2230.2015 18.6 L 6/5/2017 Z02.7 Rp 5,000

369 HINDUN HIDAYATI 0001847-2201.2012 33.3 P 6/5/2017 J02 Rp 5,000

370 eni faridah 0006523-2208.2014 35.9 P 6/5/2017 K05 Rp 7,500

371 Suparti 0002497-2202.2014 63 P 6/5/2017 M79.1 Rp 12,500

372 Muftilatin 0005030-2201.2015 55.3 P 6/5/2017 E11 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
373 buhin 0003538-2204.2015 40.1 L 6/5/2017 M79.1 Rp 5,000

374 Syafi'i 0007976-2201.2015 53 L 6/5/2017 E11.8 Rp 5,000

375 AHMAD MASHUDI MUZAK0001920-2201.2013 22.2 L 7/5/2017 M79.1 Rp 5,000

376 defri panduwinata 0001629-2202.2015 5.3 L 7/5/2017 J02 Rp 5,000

377 Erwin Dwi Kurniati 0005517-2201.2015 34.7 P 8/5/2017 H60 Rp 5,000

378 Asriah 0003803-2230.2015 59.1 P 8/5/2017 M79.1 Rp 5,000

379 kapti Binti H, Hamid 0001391-2201.2014 62.8 P 8/5/2017 L27 Rp 5,000

380 MUTOHARO 0000764-2201.2011 39.7 P 8/5/2017 K04 Rp 7,500


J31;
381 NGARSIM 0000081-2201.2011 76.1 L 8/5/2017 M79.1 Rp 5,000

382 Nailatul Saidah 0005923-2205.2015 2.1 P 8/5/2017 A01.0 Rp 5,000

383 Devin Hamdi Al Farabi 0004247-2201.2015 2.9 L 8/5/2017 L23 Rp 5,000

384 Aminah 0002209-2201.2017 31 P 8/5/2017 Z71 Rp 5,000

385 Alfredo Aditya Putra 0002217-2201.2017 0.3 L 8/5/2017 J00 Rp 5,000

386 Rina Rosidatul Rozi 0006144-2201.2016 1018.3 P 8/5/2017 Z02.7 Rp 5,000

387 Islahiyatul Hidaya 0002220-2201.2017 36.8 P 8/5/2017 K04 Rp 19,000

388 Muhammad Rafa Azka S 0006257-2201.2016 0.3 L 8/5/2017 R50.1 Rp 5,000

389 laikhah 0002232-2206.2017 40 P 8/5/2017 I10 Rp 5,000

390 Marfungah 0006396-2201.2016 32 P 8/5/2017 J03 Rp 5,000

391 Ruchi azuhro S 0006687-2201.2015 6.3 P 8/5/2017 J02 Rp 5,000

392 Ailen Nathania Winata 0001903-2201.2017 0.7 P 8/5/2017 R50.1 Rp 5,000

393 samiyatun 0005043-2206.2015 61.9 P 8/5/2017 R51 Rp 5,000

394 KARIMAH 0000650-2201.2011 55 P 8/5/2017 J02 Rp 5,000

395 Syafi'i 0007976-2201.2015 53 L 8/5/2017 E11.8 Rp 5,000

396 Zaro'ah 0001351-2201.2016 66.4 P 8/5/2017 K04 Rp 5,000

397 Muhammad Faisol 0005465-2201.2016 12 L 8/5/2017 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
398 Andre Ahmad Hafizi 0002055-2201.2013 6.8 L 8/5/2017 K00 Rp 12,000

399 SAROFATUL 0000756-2201.2013 39.8 P 8/5/2017 K29 Rp 5,000

400 MUHIMATUL UMAH 0003978-2205.2014 38.6 P 8/5/2017 M79.1 Rp 5,000

401 SUMIYATI 0000094-2201.2012 55.3 P 8/5/2017 J31 Rp 5,000

402 SUMIYATUN 0002732-2201.2011 45.5 P 8/5/2017 K29 Rp 5,000

403 Andini Aura Hadi putri 0004194-2201.2016 7.5 P 8/5/2017 J02 Rp 5,000

404 Tazkiyatun Nufus 0004497-2201.2014 8.4 P 8/5/2017 K00 Rp 12,000

405 KHOIRUL UMAM 0002205-2201.2017 57.8 L 8/5/2017 I25 Rp 5,000

406 NURSUSILOWATI 0000964-2201.2013 46.5 P 8/5/2017 K02 Rp 20,000

407 Anis Rohmatul Ummah 0002211-2201.2017 26.9 P 8/5/2017 Z34 Rp 5,000

408 Ovie Tamara Ul khusna 0002221-2201.2017 15.9 P 8/5/2017 K02 Rp 5,000

409 ziyadatul muarifah 0003102-2230.2015 48.2 P 8/5/2017 M06 Rp 5,000

410 Mustiyam.Binti Rejo 0003394-2202.2014 63.2 P 8/5/2017 M79.1 Rp 12,500

411 dalifah kanadi 0001170-2230.2016 46.2 P 8/5/2017 K29 Rp 5,000

412 DIAN0 0002304-2203.2017 21 L 8/5/2017 K25 Rp 5,000

413 Fatimah Azzahro 0002588-2201.2015 11.1 P 8/5/2017 J02 Rp 5,000

414 SAMINAH 0003941-2205.2014 48.4 P 8/5/2017 J31 Rp 5,000

415 Keisha Anindita Zahra 0004139-2201.2016 1.5 P 8/5/2017 J02 Rp 5,000

416 MOH ,IRFAN MAULANA 0000120-2201.2014 3.3 L 8/5/2017 Z71 Rp 5,000

417 Khafitri Shobiha 0005902-2203.2016 6.1 P 8/5/2017 K04 Rp 7,500

418 alysa canda 0006078-2202.2014 4 P 8/5/2017 J00 Rp 5,000

419 khabibur rohman 0002214-2202.2017 9.3 L 8/5/2017 J02 Rp 5,000

420 Indi Sholihatin Ningrum 0002218-2201.2017 10.8 P 8/5/2017 K04 Rp 7,500

421 kasti 0002966-2202.2014 62.6 P 8/5/2017 M79.1 Rp 5,000

422 khoirul anam 0004599-2223.2014 52.3 L 8/5/2017 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
423 Ovie Tamara Ul khusna 0002221-2201.2017 15.9 P 8/5/2017 K02 Rp 5,000

424 Zawawi 0002230-2201.2017 68.2 L 8/5/2017 K29 Rp 5,000

425 RUKSAN 0000448-2201.2014 55 L 8/5/2017 M79.1 Rp 5,000

426 Karmuntik 0003176-2201.2016 54.8 P 8/5/2017 I10; E11 Rp 5,000

427 Ma'rifah 0000558-2201.2016 38.3 P 8/5/2017 K04 Rp 7,500

428 Nurul Hayati 0001949-2201.2016 52 P 8/5/2017 J02 Rp 5,000


M79.1;
429 sumiati 0007431-2228.2015 66.6 P 8/5/2017 K29 Rp 5,000

430 MUSLIKAH 0000663-2201.2014 58 P 8/5/2017 M79.1 Rp 5,000

431 Abdullah izzul haq 0003675-2202.2015 2.1 L 8/5/2017 J00 Rp 5,000

432 umilatun 0005581-2202.2015 52 P 8/5/2017 J02 Rp 5,000

433 Ulil absor 0003933-2201.2015 17 L 8/5/2017 A16 Rp 5,000

434 kartim 0004053-2202.2015 62 L 8/5/2017 M79.1 Rp 5,000

435 HADI PURNOMO 0001507-2201.2013 41.2 L 8/5/2017 J02 Rp 5,000

436 Jumanisah 0004123-2201.2016 47.8 P 8/5/2017 M79.1 Rp 5,000

437 Hisbullah halim 0004141-2201.2016 27.6 L 8/5/2017 K04 Rp 7,500

438 mujtahida R 0002153-2202.2016 36.9 P 8/5/2017 Z30 Rp 12,500

439 Ahmad nufail al rasyidi 0001587-2232.2015 2.6 L 8/5/2017 H10 Rp 5,000

440 MARIYATI 0000163-2201.2011 86.1 P 8/5/2017 J31 Rp 5,000

441 Melani Diah Kustina 0002868-2201.2011 8.7 P 8/5/2017 A01.0 Rp 5,000

442 Mohammad Arjuna N 0002208-2201.2017 1.9 L 8/5/2017 R50.1 Rp 5,000

443 Zafiratus Safitri 0002216-2201.2017 10.5 P 8/5/2017 K00 Rp 12,000

444 Umah Muslamiyah 0002219-2201.2017 34.6 P 8/5/2017 K04 Rp 10,000

445 tolani 0002234-2206.2017 65 P 8/5/2017 I10 Rp 5,000

446 KUMAIYAH 0001055-2201.2011 46 P 8/5/2017 J00 Rp 5,000

447 Maula Nuzulu S 0004858-2201.2015 16.9 P 8/5/2017 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
448 Nasipah 0001853-2201.2017 50 P 8/5/2017 M06 Rp 5,000

449 ARIF ROHMAN HAKIM 0001086-2201.2014 32 L 8/5/2017 J02 Rp 5,000

450 WINDI HILYATUL FUADA 0000634-2201.2011 13.7 P 8/5/2017 K02 Rp 10,000

451 Samsul 0001950-2201.2016 56.7 L 8/5/2017 M79.1 Rp 5,000

452 Sufa'atun nisak 0001305-2201.2015 9.5 P 8/5/2017 K00 Rp 12,000

453 Mukayah 0008280-2201.2015 51.3 P 8/5/2017 R51; K29 Rp 5,000

454 Umarofah Binti Marwi 0005426-2206.2014 63.8 P 9/5/2017 M79.1 Rp 5,000

455 KHOMSIATI 0002038-2206.2015 44.3 P 9/5/2017 M79.1 Rp 5,000

456 TUMNAH 0000820-2201.2012 55.5 P 9/5/2017 I10; L27 Rp 5,000

457 Ahmad jaya 0005870-2230.2016 5.7 L 9/5/2017 Z00 Rp 5,000

458 Abd Wahab 0004555-2206.2014 62.3 L 9/5/2017 M79.1 Rp 5,000

459 sumarmah 0006164-2219.2014 57.2 P 9/5/2017 Z71 Rp 5,000

460 Nur Widayati 0004715-2201.2016 38.3 P 9/5/2017 M79.1 Rp 5,000

461 Andini Naura Arifin 0002239-2201.2017 0.4 P 9/5/2017 J00 Rp 5,000

462 nur hamidah 0004808-2226.2016 30.7 P 9/5/2017 K29 Rp 5,000

463 HUSNUL KHOLILAH 0000451-2201.2011 37.2 P 9/5/2017 B37.3+ Rp 5,000

464 Kevin Harirotus shobah 0002244-2201.2017 19.4 P 9/5/2017 Z02.7 Rp 5,000

465 aminatun 0000509-2203.2016 61.3 P 9/5/2017 K29 Rp 5,000

466 Dwi Iis Farikhah 0003214-2201.2011 26.5 P 9/5/2017 K29 Rp 5,000

467 Sindy ayu livia P 0003400-2201.2016 18.2 P 9/5/2017 K00 Rp 7,500

468 h.sukariyah 0003450-2220.2014 67.4 P 9/5/2017 M79.1 Rp 5,000

469 moh.fajar mahardika 0005210-2230.2016 1.5 L 9/5/2017 Z00 Rp 5,000

470 Thobi Reyhan Al Ayyubi 0005218-2230.2016 1.1 L 9/5/2017 Z00 Rp 5,000

471 JUNAIDI SALIM 0001979-2223.2016 4.1 L 9/5/2017 L23 Rp 5,000

472 m raka aditya 0002291-2226.2017 1 L 9/5/2017 A68.9 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
473 MAKRI 0002563-2206.2014 70.5 L 9/5/2017 M79.1 Rp 5,000

474 Siti Zaenab 0002358-2205.2014 45.5 P 9/5/2017 I95 Rp 5,000

475 sukaeni 0000769-2220.2015 46.3 P 9/5/2017 R51 Rp 5,000

476 Danil Arzak 0001447-2201.2014 10.6 P 9/5/2017 J02 Rp 5,000

477 martiah 0001479-2205.2016 P 9/5/2017 M79.1 Rp 5,000

478 EHSAN. 0001502-2203.2017 67.2 L 9/5/2017 I10 Rp 5,000

479 nur aini syafitri 0004059-2226.2016 6.8 P 9/5/2017 A68.9 Rp 5,000

480 Ahmad Fahri Attala 0002743-2201.2016 2 L 9/5/2017 Z71 Rp 5,000

481 Mohammad Jalaludin ,L. 0000182-2201.2016 2.9 L 9/5/2017 J13 Rp 5,000

482 akbar rozik 0001009-2206.2017 12.2 L 9/5/2017 A09 Rp 5,000

483 Titin 0002465-2209.2014 27.6 P 9/5/2017 Z71 Rp 5,000

484 Iswah yudi 0002243-2201.2017 1021.2 L 9/5/2017 Z71 Rp 5,000

485 Moh Ruky septiandhika 0002248-2201.2017 17.6 L 9/5/2017 Z02.7 Rp 5,000

486 Sri Murniyati 0002481-2201.2014 46.8 P 9/5/2017 J02 Rp 5,000

487 m shokib 0005069-2220.2016 48.6 L 9/5/2017 E78 Rp 5,000

488 dwi indra firmansyah 0003476-2202.2015 13.7 L 9/5/2017 R50.1 Rp 5,000

489 kenzie abyan putra kana 0005212-2230.2016 1.3 L 9/5/2017 Z00 Rp 5,000

490 haidar tsani al wafi 0005220-2230.2016 4.4 L 9/5/2017 Z00 Rp 5,000

491 Sri Widarti 0003566-2208.2016 32.9 P 9/5/2017 Z71 Rp 5,000

492 warsiah 0002292-2226.2017 60 P 9/5/2017 M79.1 Rp 5,000

493 nur laili a 0003592-2226.2016 6.8 P 9/5/2017 K29 Rp 5,000

494 A.RAFIQ 0002305-2203.2017 40.1 L 9/5/2017 M79.1 Rp 5,000

495 suparti 0002346-2205.2017 46 P 9/5/2017 J31 Rp 5,000

496 Ahmad Hafis Al Akbar 0005601-2226.2016 1.6 L 9/5/2017 A68.9 Rp 5,000

497 Puji handayani 0003915-2213.2014 23 P 9/5/2017 K29 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
498 TSANI SHOFIYULLOH 0002379-2201.2016 21.3 P 9/5/2017 J02 Rp 5,000
I10;
499 SUMARNI 0000821-2201.2012 41.3 P 9/5/2017 M79.1 Rp 5,000

500 Amanda Chuby Hati Nur 0005866-2230.2016 0.8 P 9/5/2017 Z00 Rp 5,000

501 nada da'waatul karima 0005878-2230.2016 4.8 P 9/5/2017 Z00 Rp 5,000

502 Iin eka mujirahayu 0001593-2201.2014 30.4 P 9/5/2017 K29 Rp 5,000

503 Sumarmi 0001683-2201.2014 52.6 P 9/5/2017 I15 Rp 5,000

504 KAEROM 0002456-2206.2015 67.3 L 9/5/2017 M79.1 Rp 5,000

505 Agel rahmadani 0002240-2201.2017 9.1 L 9/5/2017 J02 Rp 5,000

506 Jani 0002243-2202.2014 73.3 P 9/5/2017 M79.1 Rp 5,000

507 Ita Ma'rufah 0006398-2201.2016 36.6 P 9/5/2017 R51 Rp 5,000

508 Ahmad Munjil Anwar 0002246-2201.2017 17.3 L 9/5/2017 Z02.7 Rp 5,000

509 MOHAMMAD YUSRI BAGAS


0002252-2201.2013 4.3 L 9/5/2017 L13.1 Rp 5,000

510 SRITAMI 0000530-2201.2013 74.2 P 9/5/2017 I10 Rp 5,000

511 Istiana 0002254-2206.2017 46 P 9/5/2017 M79.1 Rp 5,000

512 reyhan aqhya mahera 0005208-2230.2016 0.8 L 9/5/2017 Z00 Rp 5,000

513 qweenera azzahra meccay 0005216-2230.2016 1.2 P 9/5/2017 Z00 Rp 5,000

514 Khilya Zalfa Hasna 0008027-2201.2015 2.1 P 9/5/2017 J31 Rp 5,000

515 jihan thalita ulfa 0005254-2226.2016 3.6 P 9/5/2017 A68.9 Rp 5,000

516 ASEH 0002550-2201.2011 36.8 P 9/5/2017 M79.1 Rp 5,000

517 EFNUL ISWANTO 0001386-2201.2012 33.7 L 9/5/2017 A09 Rp 5,000

518 Raisa Elisia Sadira R 0001475-2201.2014 3 P 9/5/2017 J02 Rp 5,000

519 Qoniatun nisa' 0005869-2230.2016 4.8 P 9/5/2017 Z00 Rp 5,000

520 jauharul mahnuna 0005876-2230.2016 4.6 P 9/5/2017 Z00 Rp 5,000

521 zumaroh 0005997-2226.2016 48.5 P 9/5/2017 M79.1 Rp 5,000

522 nur aini silvia 0002431-2228.2017 8 P 9/5/2017 J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
523 MILATUN 0000378-2201.2011 56.1 P 9/5/2017 E78; M06 Rp 5,000

524 Nailik luknawati 0002242-2201.2017 39.2 P 9/5/2017 K29 Rp 5,000

525 Faizuddaro'in 0002249-2201.2017 18.2 L 9/5/2017 Z71 Rp 5,000

526 Samsudin 0006936-2201.2015 51.6 L 9/5/2017 J02 Rp 5,000

527 queensha mahadewi 0001127-2202.2016 6.1 P 9/5/2017 K59.1 Rp 5,000

528 MOHAMMAD ALFAN 0000603-2201.2014 5.9 P 9/5/2017 J02 Rp 5,000

529 Panji 0005091-2213.2014 17 L 9/5/2017 A68.9 Rp 5,000

530 Moh. ahsanul khuluq 0005202-2230.2016 2.3 L 9/5/2017 Z00 Rp 5,000

531 ahmad sulthan nazhirul 0005217-2230.2016 0.8 L 9/5/2017 Z00 Rp 5,000

532 elisa fida marela 0005221-2230.2016 3.8 P 9/5/2017 Z00 Rp 5,000

533 rili iis 0002290-2226.2017 28 P 9/5/2017 K29 Rp 5,000

534 matkuri 0002095-2219.2016 67.2 L 10/5/2017 M79.1 Rp 5,000

535 Ida Fitriyanah 0002624-2206.2015 16.5 P 10/5/2017 K29 Rp 5,000

536 Nur Zila Wati 0000059-2201.2016 18.9 P 10/5/2017 Z02.7 Rp 5,000

537 Marjilan Bin Sirun 0001502-2202.2016 66.2 L 10/5/2017 M79.1 Rp 5,000

538 Mohammad Chalim Rosyid 0000821-2201.2015 2.9 L 10/5/2017 J13 Rp 5,000

539 MUNTAMAH 0000130-2201.2011 61.1 P 10/5/2017 K29; L27 Rp 5,000

540 SITI ARIFAH 0001575-2201.2013 53.8 P 10/5/2017 M79.1 Rp 5,000

541 Siti Tarofah 0000146-2201.2012 41.5 P 10/5/2017 Z30 Rp 5,000

542 YULI ROHMAWATI 0000947-2201.2011 48.1 P 10/5/2017 Z34 Rp 5,000

543 napilah 0003032-2220.2014 87.4 P 10/5/2017 I10 Rp 5,000

544 SUTAR 0003059-2201.2011 60.4 L 10/5/2017 J45 Rp 5,000

545 SUSMITA RAHAYU 0001037-2201.2012 5.9 P 10/5/2017 K04 Rp 7,500

546 Nafiatun 0003170-2206.2014 62.4 P 10/5/2017 M79.1 Rp 5,000

547 Wirga Satriadhi Mujahid 0001850-2202.2016 1.2 L 10/5/2017 J00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
548 Faizuddaro'in 0002249-2201.2017 18.2 L 10/5/2017 Z02.7 Rp 5,000

549 Nasipah 0001853-2201.2017 50 P 10/5/2017 M06 Rp 5,000

550 SANIA 0001868-2201.2012 5.3 P 10/5/2017 R50.1 Rp 5,000

551 Mohammad Alfaf Ansya'i 0002256-2201.2017 18.5 L 10/5/2017 Z02.7 Rp 5,000

552 MUSDAL 0003286-2201.2011 51.9 L 10/5/2017 J02 Rp 5,000

553 susi liswati 0002261-2202.2017 21.5 P 10/5/2017 Z30 Rp 12,500

554 Erna widiawati 0005224-2201.2016 32.8 P 10/5/2017 A15 Rp 5,000

555 Shifa Elnesa 0003745-2219.2016 16.2 P 10/5/2017 I95 Rp 5,000

556 Saskia Auliya 0005525-2205.2015 8.1 P 10/5/2017 J31 Rp 5,000

557 Heni Suprihatin 0002106-2201.2017 35.5 P 10/5/2017 A16.0 Rp 5,000

558 MUALIFAH 0000131-2201.2011 37.3 P 10/5/2017 R51 Rp 5,000

559 ZULAIFAH 0000147-2223.2015 116.3 P 10/5/2017 R51 Rp 5,000

560 piyatun piyatun 0002872-2206.2014 67.4 P 10/5/2017 M79.1 Rp 5,000

561 Jamil hasim 0000333-2201.2016 49.5 L 10/5/2017 K29 Rp 5,000

562 Marfiati 0001038-2205.2017 70.3 P 10/5/2017 I10 Rp 5,000

563 Kevin Harirotus shobah 0002244-2201.2017 19.4 P 10/5/2017 Z02.7 Rp 5,000

564 munazila 0003204-2202.2014 38.4 L 10/5/2017 K04 Rp 7,500

565 Istianah 0006552-2201.2015 66.4 P 10/5/2017 I10; E78 Rp 5,000

566 Murjadi 0002257-2201.2017 59 L 10/5/2017 M79.1 Rp 5,000

567 Luna Riana Nafalia 0001145-2201.2014 4.8 P 10/5/2017 K04 Rp 7,500

568 Roziqin Bin Karnadi 0000672-2201.2011 42.1 L 10/5/2017 A15 Rp 5,000

569 Ilmiyatuz Zakiyah 0008450-2201.2015 22.8 P 10/5/2017 Z02.7 Rp 5,000

570 Syakirah azzalea putri 0002553-2201.2016 3.6 P 10/5/2017 R50.1 Rp 5,000

571 Heti 0005493-2213.2015 26.8 P 10/5/2017 Z34 Rp 5,000

572 SAIDATUL BARIROH 0000773-2201.2012 28.9 P 10/5/2017 Z34 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
573 Dicki Putra Kurniawan 0001582-2201.2011 17.8 L 10/5/2017 Z02.7 Rp 5,000

574 Kayla Aura Zaskiyah 0002176-2205.2017 0.3 P 10/5/2017 J31 Rp 5,000

575 mukahar 0004774-2202.2014 81.7 L 10/5/2017 M79.1 Rp 5,000

576 sukariyah 0003147-2220.2014 59.4 P 10/5/2017 K29 Rp 5,000

577 Mukiyati 0003187-2203.2014 42.5 P 10/5/2017 K29 Rp 5,000

578 Moh Ruky septiandhika 0002248-2201.2017 17.6 L 10/5/2017 Z02.7 Rp 5,000

579 A.chemal A 0001881-2201.2014 3.3 L 10/5/2017 L23 Rp 5,000

580 sasmaini 0002489-2216.2017 70 P 10/5/2017 M79.1 Rp 5,000

581 Ahmad Wildan 0002259-2201.2017 9.6 L 10/5/2017 L27 Rp 5,000

582 Luna Riana Nafalia 0001145-2201.2014 4.8 P 10/5/2017 K04 Rp 7,500

583 Sri Widarti 0003566-2208.2016 32.9 P 10/5/2017 Z34 Rp 5,000

584 MUHAMMAD MARDHI . S 0002297-2201.2013 29.1 L 10/5/2017 K29 Rp 5,000

585 sutrami 0005678-2206.2015 61.8 P 10/5/2017 M79.1 Rp 5,000

586 ghonimah 0002127-2219.2015 52.3 P 10/5/2017 M79.1 Rp 5,000

587 LIA ROLIKHA 0000825-2201.2011 18.5 P 10/5/2017 J02 Rp 5,000

588 TASEMAN bin kasmari 0002416-2201.2012 59.3 L 10/5/2017 M06; K29 Rp 5,000

589 Tantoni 0000987-2201.2016 4.7 L 10/5/2017 J13 Rp 5,000

590 KASIYATI 0003089-2201.2011 40.1 P 10/5/2017 J02 Rp 5,000

591 Ahmad Munjil Anwar 0002246-2201.2017 17.3 L 10/5/2017 Z02.7 Rp 5,000

592 Lilik Herliani 0002255-2201.2017 36.9 P 10/5/2017 Z71 Rp 5,000

593 QOWIYAH 0003277-2201.2011 57.3 P 10/5/2017 H61.2 Rp 5,000

594 Delvind Arsya Francello 0004951-2230.2016 9.1 L 10/5/2017 A09 Rp 5,000

595 Khoirul Umam 0002263-2201.2017 57.8 L 10/5/2017 Z71 Rp 5,000

596 Cholib nanang fitoni 0002277-2201.2014 21.9 L 10/5/2017 J02 Rp 5,000

597 SITI KUSNIA 0007403-2223.2015 33.6 P 10/5/2017 R51 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
598 Siti Umami 0003442-2201.2015 49.3 P 10/5/2017 J02 Rp 5,000

599 kastep 0000643-2219.2017 36.3 L 10/5/2017 M79.1 Rp 5,000

600 KHUSNUL IMAM 0002583-2202.2017 41 L 11/5/2017 I64 Rp 7,500

601 kholisayidah 0003768-2219.2015 35.8 P 11/5/2017 Z71 Rp 5,000

602 Luky. 0004105-2203.2016 26.8 P 11/5/2017 Z00 Rp 5,000

603 ROSYADAH 0000701-2201.2012 37.1 P 11/5/2017 Z00 Rp 5,000

604 mardiyah 0006024-2219.2016 1.5 P 11/5/2017 Z71 Rp 5,000

605 Safiatin 0004548-2203.2014 47.3 P 11/5/2017 Z00 Rp 5,000

606 NURUL AZLINA 0000400-2201.2013 20.9 P 11/5/2017 Z00 Rp 5,000

607 Sukaeri Bin Muhsan 0003739-2201.2016 79.8 L 12/5/2017 J00 Rp 5,000

608 WARSIYATUN 0002338-2201.2013 63.5 P 12/5/2017 I10 Rp 5,000

609 TALIAH STABITA Z 0000701-2222.2017 3.4 P 12/5/2017 Z00 Rp 5,000

610 Aulia izatul nisa 0000708-2208.2017 2.8 P 12/5/2017 Z00 Rp 5,000

611 Wulang Ghozali 0002348-2205.2017 7 L 12/5/2017 J31 Rp 5,000

612 enjelita rasya arsanti 0000716-2228.2016 1.5 P 12/5/2017 Z71 Rp 5,000

613 novi septiana dewi 0005550-2228.2014 2.5 P 12/5/2017 Z71 Rp 5,000

614 fatima azahro 0005587-2228.2014 3 P 12/5/2017 Z71 Rp 5,000

615 RENA SHOFIYAH EL ADHI 0000775-2222.2017 1.5 P 12/5/2017 Z00 Rp 5,000

616 muzaolah 0002636-2225.2016 43.1 P 12/5/2017 K29 Rp 5,000

617 NINDY FERA AZAROH 0002640-2201.2012 11.1 P 12/5/2017 J02; L60 Rp 5,000

618 FIONA PUTRI AZ ZAHRA 0000825-2222.2017 2.7 P 12/5/2017 Z00 Rp 5,000

619 Mohammad sholeh 0001533-2201.2014 59 L 12/5/2017 Z02.7 Rp 5,000

620 alwi hidayatullah 0005791-2228.2016 3.8 L 12/5/2017 Z71 Rp 5,000

621 Qomaroh 0000857-2220.2015 53.3 P 12/5/2017 Z00 Rp 5,000

622 M. Mufin 0004154-2205.2016 6.8 L 12/5/2017 J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
623 QYARA NISWASITA 0000859-2222.2017 1.5 P 12/5/2017 Z00 Rp 5,000

624 Ilmin 0004279-2222.2015 2.3 L 12/5/2017 Z00 Rp 5,000

625 Atok Rohman 0001658-2201.2014 37.5 L 12/5/2017 H10 Rp 5,000

626 Nazwa Anandira p 0002923-2201.2016 1.2 P 12/5/2017 R50.1 Rp 5,000

627 Niswatin 0002229-2205.2014 57.6 P 12/5/2017 M79.1 Rp 5,000

628 Mohammad Rafa Adrian 0001047-2201.2017 0.8 L 12/5/2017 K59.1 Rp 5,000

629 NURIN AUFA PUTRI 0001053-2222.2017 4.9 P 12/5/2017 Z00 Rp 5,000

630 RAHMA AZKAL AZKIYAH 0001055-2222.2017 4.3 P 12/5/2017 Z00 Rp 5,000

631 SIFANAIL MAKNUN 0001058-2222.2017 4.7 L 12/5/2017 Z71 Rp 5,000

632 Ahmad Munjil Anwar 0002246-2201.2017 17.3 L 12/5/2017 Z02.7 Rp 5,000

633 DIFA CHALLYSTA PUTRI A 0001073-2222.2017 5.4 P 12/5/2017 Z00 Rp 5,000

634 alisa dafita fahmi 0006604-2206.2015 2.3 P 12/5/2017 J00 Rp 5,000

635 putri akila naila 0004900-2228.2015 2.6 P 12/5/2017 Z71;


Z71 Rp 5,000
Z24.0;
636 aisyah khumairah A 0000534-2228.2017 0.9 P 12/5/2017 Z27 Rp 5,000

637 m.wildan asfi ubaidilla 0004956-2228.2015 1.9 L 12/5/2017 Z71 Rp 5,000

638 Rafa 0001144-2201.2014 2.9 L 12/5/2017 J00 Rp 5,000

639 Dini Intan Fajriyah 0002272-2201.2017 17.7 P 12/5/2017 Z02.7 Rp 5,000

640 ahmad azam alfarisi 0007163-2228.2015 5 L 12/5/2017 Z71 Rp 5,000


Z71; Z27;
641 A. makimudin al-amin 0001161-2228.2017 0.3 L 12/5/2017 Z24.0 Rp 5,000

642 Brandonexer A .Ches 0002277-2201.2017 0.6 L 12/5/2017 Z71 Rp 5,000

643 katipah 0002282-2219.2017 0.1 P 12/5/2017 Z71;


J02 Rp 5,000
Z23.2;
644 Harun Ar-Rosyid 0002285-2228.2017 0 L 12/5/2017 Z71;
Z24.0 Rp 5,000
Z23.2;
645 Luthfia Zhafira 0002288-2228.2017 0 P 12/5/2017 Z24.0 Rp 5,000

646 RENITA ALMIRA FIZANA 0000685-2222.2017 2.9 P 12/5/2017 Z00 Rp 5,000

647 TSANIA ATIYA HAMIDAH 0000702-2222.2017 3.4 P 12/5/2017 Z00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
648 Ahmad Janul Nizam 0002349-2205.2017 6 L 12/5/2017 J31 Rp 5,000

649 lianah 0001383-2222.2016 1.2 P 12/5/2017 Z71 Rp 5,000

650 zahwa erina mahabbah 0005594-2228.2014 3 P 12/5/2017 Z71 Rp 5,000

651 ANNAILA MAKHARIZA 0000777-2222.2017 0.3 P 12/5/2017 Z00 Rp 5,000

652 INAMAROH 0001461-2201.2012 42.5 P 12/5/2017 R51 Rp 5,000

653 WANDA NUR KHOFIFAH 0000812-2222.2017 2.1 P 12/5/2017 Z00 Rp 5,000

654 m.fattan wildan habibi 0004036-2228.2016 0.8 L 12/5/2017 Z71 Rp 5,000

655 M RIDHO AIMAN 0000823-2222.2017 1.9 L 12/5/2017 Z00 Rp 5,000

656 moh. ikbal 0002128-2206.2016 11.1 L 12/5/2017 A09 Rp 5,000


Z27;
657 MUSLIKHATUN 0000847-2222.2017 0.3 P 12/5/2017 Z24.0 Rp 5,000

658 M Risyaf Al Wahyuda 0004119-2205.2014 11 L 12/5/2017 Z71;


J31 Rp 5,000
Z24.0;
659 ahmad quinzio atma 0000105-2228.2017 0.3 L 12/5/2017 Z27 Rp 5,000

660 ARJUNA NAFIS .AL. 0000142-2201.2014 3.9 L 12/5/2017 J02 Rp 5,000

661 M AZKA ALI 0001717-2237.2017 1.8 L 12/5/2017 Z00 Rp 5,000

662 SHOFIYATI 0002446-2201.2011 36.1 P 12/5/2017 J02 Rp 5,000

663 Alfiyatun Suwarnan 0002946-2206.2014 67.4 P 12/5/2017 M79.1 Rp 5,000

664 ARZAKIL RAMADAN ADIT0001721-2237.2017 1.8 P 12/5/2017 Z00 Rp 5,000

665 SUWARTI 0000991-2201.2013 59 P 12/5/2017 M79.1 Rp 5,000

666 amanda rafania 0006152-2228.2016 0.8 P 12/5/2017 Z71 Rp 5,000

667 NUWARDI 0001768-2201.2013 63.8 L 12/5/2017 K29; I10 Rp 5,000

668 m.wahyu kurniawan 0006176-2228.2015 2.7 L 12/5/2017 Z71 Rp 5,000

669 QUINN KHANSA RACHEL A0001051-2222.2017 4.6 P 12/5/2017 Z00 Rp 5,000

670 Sakinatun 0004810-2206.2014 55.3 P 12/5/2017 K04 Rp 10,000

671 RIZKI OLIVIA SARI 0001056-2222.2017 6.3 P 12/5/2017 Z00 Rp 5,000

672 Faizuddaro'in 0002249-2201.2017 18.2 L 12/5/2017 Z02.7 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
673 abd hafid 0002253-2206.2014 42.5 L 12/5/2017 R51 Rp 5,000

674 Fitriya rizki 0001872-2201.2014 4.8 P 12/5/2017 Z71 Rp 5,000

675 AISYAH FARHANA 0001089-2222.2017 3.3 P 12/5/2017 Z00 Rp 5,000

676 Nur Faidah 0003293-2201.2016 41.7 P 12/5/2017 K05.0 Rp 5,000

677 m.galang syahru ramadha 0004971-2228.2015 3.8 L 12/5/2017 Z71 Rp 5,000

678 Jihan Ana Khoiriyah 0002267-2201.2017 18.1 P 12/5/2017 R50.1 Rp 5,000

679 dea emilia arsya 0003407-2228.2016 1.2 P 12/5/2017 Z71 Rp 5,000

680 Setigi Roudhotus S 0001232-2201.2014 3.8 L 12/5/2017 R50.1 Rp 5,000


Z71;
681 indah lu'lu'aina 0002289-2228.2017 0 P 12/5/2017 Z23.2 Rp 5,000

682 M ABIZAR HIDAYAT 0000681-2222.2017 3 L 12/5/2017 Z00 Rp 5,000

683 MEISYAH NAILATUL K 0000688-2222.2017 3 P 12/5/2017 Z00 Rp 5,000

684 aisah sakira gilfah 0008283-2228.2015 1.5 P 12/5/2017 Z71; Z27 Rp 5,000
L27;
685 DENDIS PRATAMA 0002018-2201.2011 23.3 L 12/5/2017 M79.1 Rp 5,000

686 NUR FIFATIN NAZIDAH 0000699-2222.2017 3.8 P 12/5/2017 Z00 Rp 5,000

687 Mohammad Zein Kafi S 0008365-2206.2015 3.3 L 12/5/2017 N34 Rp 5,000

688 DAFI ZAIDAN AR RAFIF 0000705-2222.2017 0.6 L 12/5/2017 Z00 Rp 5,000

689 Zaro'ah 0001351-2201.2016 66.4 P 12/5/2017 K04 Rp 7,500

690 Shofiyah Zanzabilah 0000713-2228.2016 1.3 P 12/5/2017 Z71 Rp 5,000

691 Nazilatur Ryqiyah 0000737-2201.2017 0.6 P 12/5/2017 R50.1 Rp 5,000

692 ALMUKTARIL 0000758-2201.2011 7.5 L 12/5/2017 K02 Rp 20,000

693 AHMAD ROBIETA MAULA 0000778-2222.2017 1.3 L 12/5/2017 Z00 Rp 5,000

694 MUNAWAROH 0000019-2201.2011 66.1 P 12/5/2017 J00 Rp 5,000

695 KUMAIYAH 0000033-2201.2012 53.8 P 12/5/2017 E11 Rp 5,000


Z71;
696 raka ahmad el-rafif 0005631-2228.2016 0.5 L 12/5/2017 Z24.0 Rp 5,000

697 DINDA APRILIA ALFIANI 0000813-2222.2017 0.3 P 12/5/2017 Z00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
698 KAMILATUN 0000071-2201.2012 63.1 P 12/5/2017 I10; J31 Rp 5,000

699 FRISKA MAHDALENA 0001531-2201.2011 6.9 P 12/5/2017 J02 Rp 5,000

700 AHMAD RAFI AL BAIHAQI 0000832-2222.2017 1.1 L 12/5/2017 Z00 Rp 5,000


Z27;
701 KHUMAIROTUS SHOFA 0000849-2222.2017 0.3 P 12/5/2017 Z24.0 Rp 5,000

702 Qomaroh binti 0000858-2220.2015 50.3 P 12/5/2017 Z00 Rp 5,000

703 Abdul Fatah 0004357-2201.2016 31.8 L 12/5/2017 J02 Rp 5,000

704 Alysa Canda Assabia 0001635-2202.2015 4 P 12/5/2017 J13 Rp 5,000

705 sukarti m 0000225-2202.2017 55 P 12/5/2017 R51 Rp 5,000

706 MARSYA INDAH HIDAYAT 0000957-2222.2017 4.1 P 12/5/2017 Z00 Rp 5,000

707 DESI AULIYA APRIANI 0001714-2237.2017 2.3 P 12/5/2017 Z00 Rp 5,000

708 A RAFA AZKA ROMADHON0001718-2237.2017 11.8 L 12/5/2017 Z00 Rp 5,000

709 Ahmad Azam Arifuddin 0000984-2201.2016 6.7 L 12/5/2017 J02 Rp 5,000

710 NANDANA AGIL TSANI WI 0001722-2237.2017 1.8 L 12/5/2017 Z00 Rp 5,000

711 Mohammad Aidil Adkha 0000996-2201.2017 9.3 L 12/5/2017 Z00 Rp 5,000


Z71;
712 syeril nisaul 0006153-2228.2016 0.4 P 12/5/2017 Z24.0 Rp 5,000

713 ARGHI RAFISGY ALFATH 0001773-2237.2017 0.9 L 12/5/2017 Z00 Rp 5,000

714 Galang taruna W 0006198-2201.2015 2.1 L 12/5/2017 J31 Rp 5,000

715 Sumarni 0004691-2201.2015 46.5 P 12/5/2017 M06; H10 Rp 5,000

716 zahwa erina mahabah 0002465-2228.2017 3 P 12/5/2017 J31 Rp 5,000

717 NISRINA DITA KHALISAH 0001054-2222.2017 4.7 P 12/5/2017 Z00 Rp 5,000

718 Muhammad Arif Sauddin 0001846-2201.2017 27.3 L 12/5/2017 J02 Rp 5,000

719 WAHYU HINDRA FIRMAN 0001063-2222.2017 6 L 12/5/2017 Z00 Rp 5,000

720 sukimah 0004887-2202.2016 45.8 P 12/5/2017 J00 Rp 5,000

721 DIYANDRA AL MAHIRAH 0001090-2222.2017 3.2 P 12/5/2017 Z00 Rp 5,000

722 mundiyah 0006959-2219.2015 46.8 P 12/5/2017 J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
723 Mu'amar Gading Faidhur 0002273-2201.2017 4.8 L 12/5/2017 B08.5 Rp 5,000

724 m.abdul fattah 0003409-2228.2016 1.2 L 12/5/2017 Z71;


Z71 Rp 5,000
Z24.0;
725 m. arsyad hanif al-amin 0000626-2228.2017 0.3 L 12/5/2017 Z27 Rp 5,000

726 Abdul Rahman Nafis 0002280-2201.2017 19 L 12/5/2017 Z02.7 Rp 5,000

727 Malidatul 0002283-2206.2017 23 P 12/5/2017 K29 Rp 5,000

728 Marisa salsabilah 0002286-2206.2017 12 P 12/5/2017 A01.0 Rp 5,000


M79.1;
729 Maisaroh 0003531-2228.2014 59.4 P 12/5/2017 L20 Rp 5,000

730 KANAH k 0005288-2206.2014 72.2 P 12/5/2017 M79.1 Rp 5,000

731 Fudhil Al Akbar 0001311-2201.2014 4.1 L 12/5/2017 J00 Rp 5,000

732 ATIKA SYAWALIA AGUSTI 0000682-2222.2017 2.7 P 12/5/2017 Z00 Rp 5,000

733 SITI ROKAYAH 0000693-2201.2011 58.3 P 12/5/2017 H60; K29 Rp 5,000

734 ST SAROPAH 0002306-2206.2017 40 P 12/5/2017 L23 Rp 5,000

735 M Iqbal Habib 0002347-2205.2017 6 L 12/5/2017 B26 Rp 5,000

736 zuhaira aliyah 0000714-2228.2016 2001.3 P 12/5/2017 Z71 Rp 5,000

737 Siti Nasi'ah 0002350-2205.2017 48 P 12/5/2017 M79.1 Rp 5,000

738 khaila almira M 0000774-2222.2017 1.5 P 12/5/2017 Z00 Rp 5,000

739 M AZHAR HAFIZUDIN 0000814-2222.2017 2 P 12/5/2017 Z00 Rp 5,000

740 MUHAMMAD OKTAVIAN 0000089-2201.2014 3.5 L 12/5/2017 J00 Rp 5,000

741 KOIRUL BARIYAH 0002716-2201.2011 22.8 P 12/5/2017 K02 Rp 20,000

742 Musthofah 0000857-2201.2016 22.8 L 12/5/2017 A09 Rp 5,000

743 Mohammad Dedy Khoiruman 0000117-2201.2017 8.8 L 12/5/2017 S81 Rp 5,000

744 ANINDYA ZAHIRA QOLBI 0000858-2222.2017 2 P 12/5/2017 Z00 Rp 5,000

745 Moh.bayu settya mahendr 0001562-2201.2016 6 L 12/5/2017 K12 Rp 5,000

746 MOH. WAFIQ HIDAYATUL 0000958-2222.2017 3.9 L 12/5/2017 Z00 Rp 5,000

747 M RIKI AHSANUL KHULU 0001715-2237.2017 2.2 L 12/5/2017 Z00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
748 SUMARNING 0000308-2219.2017 P 12/5/2017 M79.1 Rp 5,000

749 JAMALUDIN ASEGAF 0001719-2237.2017 1.8 L 12/5/2017 Z71 Rp 5,000

750 sholahudin Al Ayubi 0006143-2222.2015 1.8 L 12/5/2017 Z00 Rp 5,000

751 NURIN FADIHATUR RAHM 0001791-2237.2017 3.3 P 12/5/2017 Z00 Rp 5,000

752 ismawati t 0004738-2206.2016 40.8 P 12/5/2017 K29 Rp 5,000

753 aisya syakira belva 0002466-2228.2017 1.6 P 12/5/2017 R50.1 Rp 5,000

754 NUZZILA KHOIRUN NISA 0001052-2222.2017 5.7 P 12/5/2017 Z00 Rp 5,000

755 KONATIN 0000409-2201.2011 44.3 P 12/5/2017 L23 Rp 5,000


R50.1;
756 ALFA HUBBI ULLA 0000450-2201.2011 7.3 L 12/5/2017 L02 Rp 5,000

757 SHALWA MEILDA CAHYAN0001057-2222.2017 6 P 12/5/2017 Z00 Rp 5,000

758 A. alyno arsyad 0000533-2228.2017 1.4 L 12/5/2017 Z71 Rp 5,000

759 SHIFA NABILA IHWAN 0001092-2222.2017 3.3 P 12/5/2017 Z00 Rp 5,000

760 Fatimah Binti Amrulloh 0002274-2201.2017 0 P 12/5/2017 Z71 Rp 5,000

761 M Aditya Pratama 0007348-2201.2015 4.8 L 12/5/2017 L27 Rp 5,000

762 Hamdan Khafi Mubarok 0000627-2201.2011 11.3 L 12/5/2017 H10 Rp 5,000

763 lisayidah 0002284-2206.2017 8 P 12/5/2017 Z71;


A01.0 Rp 5,000
Z23.2;
764 Reyhan bagas septian 0002287-2228.2017 0 L 12/5/2017 Z24.0 Rp 5,000

765 UMU SHOLIHANAH 0005259-2205.2014 37.9 P 12/5/2017 Z30 Rp 5,000

766 M ZAHIN ZAFRAN 0000684-2222.2017 2.7 L 12/5/2017 Z00 Rp 5,000

767 Alzah 0002307-2206.2017 5 P 13/05/17 J00 Rp 5,000

768 raikhan abdan sakuran 0005464-2228.2014 5 L 13/05/17 Z71 Rp 5,000

769 Siti Nasi'ah 0002350-2205.2017 48 P 13/05/17 M79.1 Rp 5,000

770 Nur Alifatul Kholisani 0001404-2201.2017 1.8 P 13/05/17 Z71 Rp 5,000

771 NAUFAL AFKAR ROZAQ 0001429-2232.2017 0.4 L 13/05/17 Z00 Rp 5,000

772 ainayyah 0005621-2228.2016 1.8 P 13/05/17 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
773 SALSABILA NURMA 0002372-2232.2017 2.7 P 13/05/17 Z00 Rp 5,000

774 DEWI SEKAR ARUM 0002377-2232.2017 2.8 P 13/05/17 Z00 Rp 5,000

775 rizqiyah audy 0005649-2230.2015 2 L 13/05/17 Z00 Rp 5,000

776 nazwa sakila 0002675-2206.2016 1.2 P 13/05/17 Z24.4 Rp 5,000


Z23.2;
777 moh.linggar aditya 0002388-2206.2017 0 L 13/05/17 Z24.0 Rp 5,000

778 sakha 0001550-2206.2016 1.2 L 13/05/17 Z71 Rp 5,000

779 tsalistia rahma 0004378-2230.2014 5.6 P 13/05/17 Z00 Rp 5,000

780 mauriza saqwina el muhs 0002451-2206.2016 1.1 P 13/05/17 Z71 Rp 5,000

781 FINO DWI AL F 0001827-2232.2017 1.1 L 13/05/17 Z00 Rp 5,000

782 AYSAR MIRZA A 0001830-2232.2017 0.9 L 13/05/17 Z00 Rp 5,000

783 andika rizky 0004817-2230.2015 2 L 13/05/17 Z00 Rp 5,000


Z24.0;
784 shafa salsabilah al mar 0002487-2244.2017 0.3 P 13/05/17 Z27 Rp 5,000

785 alleya shakila abdullah 0001883-2206.2016 1.1 P 13/05/17 Z24.4 Rp 5,000

786 Nur Faidah 0003293-2201.2016 41.7 P 13/05/17 K05.0 Rp 5,000

787 aril abdillah 0001115-2228.2017 2.8 L 13/05/17 Z71 Rp 5,000

788 AMRI VAHYA ar-r 0005032-2230.2014 3.1 L 13/05/17 Z00 Rp 5,000

789 M Aditya Pratama 0007348-2201.2015 4.8 L 13/05/17 L27 Rp 5,000

790 nazima huwaidah 0005100-2228.2016 3.6 P 13/05/17 Z71 Rp 5,000

791 Rahmad Guntur Syaputra 0002295-2201.2017 0.5 L 13/05/17 J00 Rp 5,000

792 Izza Azzahro F 0000677-2228.2015 6.1 P 13/05/17 Z71 Rp 5,000

793 FIRDAUS FIRMANSYAH 0001315-2201.2012 24 L 13/05/17 J02 Rp 5,000

794 m.rizki syaputra 0000718-2228.2016 1.3 L 13/05/17 Z71 Rp 5,000

795 MOH IRFAN 0001367-2201.2012 6.1 L 13/05/17 A91 Rp 5,000

796 Bilqis Febri Anailah R 0002071-2201.2014 3.3 P 13/05/17 Z00 Rp 5,000

797 IMROATUL LATIFAH 0001396-2201.2011 35.5 P 13/05/17 K29 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
798 m.azril adiwansyah 0005625-2228.2016 1 L 13/05/17 Z71 Rp 5,000

799 Mirza Rofif Saji 0003939-2206.2014 2.7 L 13/05/17 Z71 Rp 5,000

800 ALFIAN SURYA 0002373-2232.2017 1.1 L 13/05/17 Z00 Rp 5,000

801 ALFIYANO CIKO DWI S 0002378-2232.2017 6.1 L 13/05/17 Z00 Rp 5,000


Z23.2;
802 avianisa anindiya 0002384-2206.2017 0.1 P 13/05/17 Z24.0 Rp 5,000
Z23.2;
803 almira fahana rasyid 0002387-2206.2017 0.1 P 13/05/17 Z24.0 Rp 5,000

804 daehan arzanka ibrahim 0002678-2206.2016 1.5 L 13/05/17 Z71 Rp 5,000


Z23.2;
805 ahmad arsha hamdan al h 0002389-2206.2017 0.1 L 13/05/17 Z71;
Z24.0 Rp 5,000
Z24.0;
806 ahmad maulana 0002400-2228.2017 0 L 13/05/17 Z23.2 Rp 5,000

807 M. Mufin 0004154-2205.2016 6.8 L 13/05/17 J31 Rp 5,000

808 Danie affan pradita 0005920-2228.2014 2.7 L 13/05/17 Z71 Rp 5,000

809 Ecik Desinta Ajraini 0002186-2201.2016 2.1 P 13/05/17 R50.1 Rp 5,000

810 ahmad arsyat haidar 0004516-2230.2015 5.2 L 13/05/17 Z00 Rp 5,000

811 malaikati 0002977-2202.2014 63.1 P 13/05/17 J45 Rp 5,000

812 A Agung Tripratama 0004687-2205.2014 13.5 L 13/05/17 A09 Rp 5,000

813 m. bintang aska putra 0006325-2228.2015 2 L 13/05/17 Z71 Rp 5,000

814 RAHADIAN 0001831-2232.2017 1.6 L 13/05/17 Z00 Rp 5,000

815 Nuri 0000453-2201.2015 3.5 P 13/05/17 Z71 Rp 5,000


Z71;
816 dewi winda fatihatul 0001851-2228.2017 2.1 P 13/05/17 Z24.4 Rp 5,000
Z24.0;
817 redafa rahmad azam sale 0002483-2244.2017 0.8 L 13/05/17 Z27 Rp 5,000

818 yuliatus s 0006626-2228.2015 6.3 P 13/05/17 Z71 Rp 5,000

819 abbad nailum nabhan 0004914-2228.2015 2.2 L 13/05/17 Z71 Rp 5,000


Z24.0;
820 ahmad saud al muaffaq 0002488-2244.2017 0.2 L 13/05/17 Z27 Rp 5,000

821 Murni cahayati 0006716-2201.2015 4.3 P 13/05/17 Z00 Rp 5,000

822 albi lutfi hakim 0001884-2206.2016 1.1 L 13/05/17 Z24.4 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
823 mundiyah 0006959-2219.2015 46.8 P 13/05/17 Z30 Rp 5,000
J02;
824 Afifah 0003328-2201.2016 43.6 P 13/05/17 M79.1 Rp 5,000

825 engelina sulaiman 0001116-2228.2016 1.5 P 13/05/17 Z71 Rp 5,000

826 ahmad ardhani fairuz s 0002505-2216.2017 1.2 L 13/05/17 A03 Rp 5,000

827 mukiyati/muasam 0005038-2230.2014 60.3 P 13/05/17 M79.1 Rp 5,000

828 nahda azkayra 0000631-2228.2017 0.4 P 13/05/17 Z71 Rp 5,000

829 m.dwiki aryusman 0005141-2228.2015 3.7 L 13/05/17 Z71 Rp 5,000

830 khosida akila naila 0001979-2228.2015 2.3 P 13/05/17 Z71 Rp 5,000

831 Mohammad Latif Julianto 0002296-2201.2017 5.8 L 13/05/17 Z54.0 Rp 5,000

832 suliah b 0002298-2202.2017 55.1 P 13/05/17 I10 Rp 5,000

833 m bayu amala 0005466-2228.2014 4.4 L 13/05/17 Z71 Rp 5,000

834 Ahmad Janul Nizam 0002349-2205.2017 6 L 13/05/17 H70.1 Rp 5,000

835 az zahra asyila rahma 0000721-2228.2016 1.4 P 13/05/17 Z71 Rp 5,000

836 NUR HIDAYATUN 0001396-2232.2017 37.2 P 13/05/17 Z71 Rp 5,000

837 arista sheela azahra 0005617-2228.2016 0.6 P 13/05/17 Z71 Rp 5,000

838 HENDRI ARDIANSAH 0002112-2203.2017 6.1 L 13/05/17 A01.0 Rp 5,000

839 ALEANING DYA WAHONO 0002375-2232.2017 0 L 13/05/17 Z00 Rp 5,000

840 LILIS NIKMA WATI 0000796-2201.2012 36.3 P 13/05/17 J02 Rp 5,000

841 Hafizh Arrasyid 0003966-2206.2014 3.4 L 13/05/17 Z71 Rp 5,000

842 NAURA 0001468-2201.2013 4 P 13/05/17 J02 Rp 5,000


Z23.2;
843 melati adroul mahmuda 0002385-2206.2017 0 P 13/05/17 Z24.0 Rp 5,000

844 moh.rizki al mudhoffar 0002392-2244.2017 2.1 L 13/05/17 Z24.4 Rp 5,000

845 dinda khumaira 0002137-2206.2016 1 P 13/05/17 Z24.4 Rp 5,000

846 Ahmad faril raditiya pr 0005921-2228.2014 2.7 L 13/05/17 Z71 Rp 5,000

847 Sani hafid alamin 0004272-2228.2015 4.1 L 13/05/17 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
848 Supiyanah 0000975-2208.2016 50.3 P 13/05/17 M06 Rp 5,000

849 dimas rafael 0004521-2230.2015 5.1 L 13/05/17 Z00 Rp 5,000

850 Muhammad Fajriyan Sidqi 0004559-2201.2016 13.5 L 13/05/17 B37 Rp 5,000

851 aditya naufal arif abiy 0002450-2206.2016 1.1 L 13/05/17 Z71 Rp 5,000

852 aliya putri mahzah 0001803-2228.2017 5.3 P 13/05/17 Z71;


Z71 Rp 5,000
Z23.2;
853 M. Arkana A. S 0002461-2228.2017 0 L 13/05/17 Z24.0 Rp 5,000

854 MAS FAWAS ZUHAD A 0001825-2232.2017 0.6 L 13/05/17 Z00 Rp 5,000

855 IHTINA DWINDRA 0001828-2232.2017 1.5 P 13/05/17 Z00 Rp 5,000

856 Ahmad Nizam .Z. 0006501-2201.2015 9.3 L 13/05/17 J02 Rp 5,000

857 Sumariyah 0001857-2201.2014 50.3 P 13/05/17 I10; R51 Rp 5,000


Z27;
858 hilman rafif purwanto 0002485-2244.2017 0.5 L 13/05/17 Z24.0 Rp 5,000

859 kalista ardelia afrilia 0004915-2228.2015 2 P 13/05/17 Z71 Rp 5,000

860 Faidzul Arsyad Al Ghoni 0001887-2206.2016 4.6 L 13/05/17 Z71 Rp 5,000

861 ahmad ridho hadi kusuma 0002501-2216.2017 5.8 L 13/05/17 R50.1 Rp 5,000

862 Umu Latifah 0007379-2201.2015 33 P 13/05/17 J02 Rp 5,000

863 MAHMUDAH 0001215-2201.2012 48.3 P 13/05/17 Z71 Rp 5,000

864 rendi syaputra 0001969-2228.2015 2.4 L 13/05/17 Z71 Rp 5,000

865 HAZIZAH 0001288-2206.2015 2.5 P 13/05/17 Z71 Rp 5,000

866 zamaroh 0001989-2216.2017 37.1 P 13/05/17 Z71 Rp 5,000

867 m zaim azka asyafani 0008258-2228.2015 2.9 L 13/05/17 Z71 Rp 5,000

868 Mohammad Rofiqi Uddin 0002301-2201.2017 27.9 L 13/05/17 K04 Rp 7,500

869 aliyana aini 0008285-2228.2015 1.5 P 13/05/17 Z71; Z27 Rp 5,000

870 AZMI 0002048-2201.2012 6.6 L 13/05/17 A01.0 Rp 5,000

871 eris 0005474-2228.2014 3.8 P 13/05/17 Z71 Rp 5,000

872 Chesa 0000762-2228.2015 3.7 P 13/05/17 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
873 NUR FADLILAH 0001421-2201.2012 30.3 P 13/05/17 J02 Rp 5,000

874 rasya azam syaputra 0005620-2228.2016 0.5 L 13/05/17 Z71 Rp 5,000


Z71;
875 malaatussholihah 0005628-2228.2016 0.6 P 13/05/17 Z24.0 Rp 5,000

876 NAHDA AFIQOH RAHMA 0002376-2232.2017 0 P 13/05/17 Z00 Rp 5,000

877 Naura Nur Salsabilah 0003967-2228.2016 2.4 P 13/05/17 Z71 Rp 5,000

878 NAURA RISKA S 0002636-2201.2013 3.4 P 13/05/17 J02 Rp 5,000

879 RENATA DWI ARISTA 0002379-2232.2017 0 P 13/05/17 Z00 Rp 5,000


Z23.2;
880 aisyah rizki zafira 0002386-2206.2017 0 P 13/05/17 Z24.0 Rp 5,000

881 KAMILATUN 0000071-2201.2012 63.1 P 13/05/17 I10; J31 Rp 5,000

882 afkar abdullah al insan 0002138-2206.2016 1 P 13/05/17 Z24.4 Rp 5,000

883 Mohammad Risky Maulana 0000913-2201.2017 2.8 L 13/05/17 J02 Rp 5,000

884 Nurul Aini 0000930-2201.2017 2.1 P 13/05/17 K59.1 Rp 5,000

885 duwi meliana azahra 0001645-2228.2015 4.5 P 13/05/17 Z71 Rp 5,000

886 AHMAD ALIL MAFAHIR 0000227-2201.2014 6.6 L 13/05/17 J02 Rp 5,000

887 muhammad bima alqozali 0004501-2228.2016 0.7 L 13/05/17 Z71 Rp 5,000

888 elvira eka putri 0002940-2206.2016 0.9 P 13/05/17 Z24.4 Rp 5,000


Z71;
889 ahmad arizal arifin 0006160-2228.2016 0.4 P 13/05/17 Z24.0 Rp 5,000

890 mudayati 0004761-2202.2014 42.9 P 13/05/17 Z30 Rp 12,500

891 AH.ARDHANI FAIRUZ 0001826-2232.2017 1.2 L 13/05/17 Z00 Rp 5,000

892 FAIZ RIZWAN 0001829-2232.2017 2.8 L 13/05/17 Z00 Rp 5,000


Z23.2;
893 aldan fahreza 0002486-2244.2017 0.1 L 13/05/17 Z24.0 Rp 5,000

894 agam abdillah 0004917-2228.2015 2.6 L 13/05/17 Z71 Rp 5,000

895 azahra asilah 0007078-2228.2015 1.7 P 13/05/17 Z71 Rp 5,000

896 EMANIA AGATHA 0001290-2206.2015 2.5 P 13/05/17 Z71 Rp 5,000

897 NURAMAT 0000667-2201.2011 65.8 L 13/05/17 I15 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
898 Aurel Isabela 0002293-2201.2017 2.1 P 13/05/17 H10 Rp 5,000

899 Mohammad Yusril 0002297-2201.2017 18.3 L 13/05/17 L27 Rp 5,000

900 AIRISH EL QUIN MOEHAN 0000952-2222.2017 4.2 L 14/05/17 Z00 Rp 5,000

901 salman 0006951-2222.2015 4.9 L 14/05/17 Z00 Rp 5,000

902 HARI HARDONO 0000956-2222.2017 3.6 L 14/05/17 Z00 Rp 5,000

903 FAIRUS A FATN 0000851-2222.2017 0.4 L 14/05/17 Z00 Rp 5,000

904 AHMAD LAINUFAR F 0000950-2222.2017 4.2 L 14/05/17 Z00 Rp 5,000

905 DANIA NOR FEBIYANA 0000955-2222.2017 4.3 P 14/05/17 Z00 Rp 5,000

906 DARIS ZAHIT RAMDANI 0001072-2222.2017 5.7 L 14/05/17 Z00 Rp 5,000

907 AF'IDATUL UMROH 0001341-2201.2012 29.5 P 15/05/17 A09 Rp 5,000

908 Rif'atul Khoiriyah 0002314-2201.2017 17.8 P 15/05/17 Z02.7 Rp 5,000

909 Mohammad Maulana Bisri 0002319-2201.2017 0.3 L 15/05/17 L23 Rp 5,000

910 Mutaqin 0002323-2201.2017 35.5 L 15/05/17 K04 Rp 5,000

911 Sholik Bin Kasmin 0002328-2201.2017 50.6 L 15/05/17 K04 Rp 10,000

912 Anisah 0003944-2201.2015 28.3 P 15/05/17 Z71 Rp 5,000

913 HADI PURNOMO 0001507-2201.2013 41.3 L 15/05/17 J02 Rp 5,000

914 ROSITA FANIA BELA 0001542-2201.2013 6.9 P 15/05/17 K00 Rp 7,500

915 Mohammad Dedy Khoiruman 0000117-2201.2017 8.8 L 15/05/17 S81 Rp 5,000

916 samilah 0002740-2202.2014 67 P 15/05/17 E11 Rp 5,000

917 Sumaroh 0005908-2205.2015 46.8 P 15/05/17 M06 Rp 5,000

918 Ahmad Ardani Fairuz 0004217-2201.2016 1.2 L 15/05/17 K59.1 Rp 5,000

919 Anis Soidah 0002903-2206.2014 37.5 P 15/05/17 R51 Rp 5,000

920 Munzarotin 0004683-2206.2014 42.3 P 15/05/17 Z30 Rp 5,000

921 m.alif fahri alhaidar 0002467-2228.2017 9 L 15/05/17 L02 Rp 5,000

922 MOH.ERIK 0001914-2201.2012 4.9 L 15/05/17 L23 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
923 Zarawanda Faradisa el 0000630-2201.2016 18.8 P 15/05/17 Z02.7 Rp 5,000

924 reva umay fakhriyah 0003513-2230.2016 1.4 P 15/05/17 Z00 Rp 5,000

925 HABIBI MAS,UD 0000668-2203.2017 29.3 L 15/05/17 J02 Rp 5,000

926 Sholeh Bin Marda'i 0002329-2201.2017 69.5 L 15/05/17 J02 Rp 5,000

927 Suhad Afiadin 0002311-2201.2017 27.8 L 15/05/17 K29 Rp 5,000

928 Muntana 0002316-2201.2017 54.9 P 15/05/17 L27 Rp 5,000

929 MAULANA ILHAM 0002346-2205.2014 5.6 L 15/05/17 J31 Rp 5,000

930 Elivia Azlina 0002320-2201.2017 6.7 P 15/05/17 K00 Rp 7,500

931 Mohammad Iswanto 0002325-2201.2017 41.9 L 15/05/17 J02 Rp 5,000

932 Umaiyah 0002564-2225.2015 50.3 P 15/05/17 M06 Rp 5,000

933 Mohammad Husain Ardani 0002367-2201.2017 1.9 L 15/05/17 L23 Rp 5,000

934 zovi elvino nasrullah f 0005873-2230.2016 4.4 L 15/05/17 Z00 Rp 5,000

935 MUNTAMAH 0000130-2201.2011 61.1 P 15/05/17 M06 Rp 5,000

936 MUNAWAROH 0000953-2201.2011 55.1 P 15/05/17 M06 Rp 5,000

937 NAJWA 0001695-2201.2011 7.8 P 15/05/17 J03 Rp 5,000

938 Mohammad azhar S 0001914-2201.2014 6.9 L 15/05/17 K00 Rp 7,500

939 SUPENI 0002277-2201.2013 53.5 P 15/05/17 K29 Rp 5,000

940 anis sholikhaa 0008023-2206.2015 24.5 P 15/05/17 M79.1 Rp 5,000

941 Irma Sholihah 0002330-2201.2017 25 P 15/05/17 H52.4 Rp 5,000

942 Sayyidah Aisyah An Najw 0002312-2201.2017 1 P 15/05/17 B08.5 Rp 5,000

943 Mohammad Maulana I 0005430-2201.2014 2.7 L 15/05/17 J02 Rp 5,000

944 Dimas Titan Al finas A 0002317-2201.2017 18.4 L 15/05/17 Z02.7 Rp 5,000

945 Wiwin Nur Maidah 0002321-2201.2017 20.1 P 15/05/17 Z32.1 Rp 5,000

946 Zumrotin 0002326-2201.2017 38.1 P 15/05/17 K29 Rp 5,000


I10;
947 Syamsiyani 0005561-2205.2014 90.2 P 15/05/17 M79.1 Rp 5,000
Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
948 Nurabaniyah 0002362-2206.2017 26 P 15/05/17 Z30 Rp 5,000

949 SULAMI 0001432-2201.2013 68.8 P 15/05/17 M79.1 Rp 5,000

950 SITI ASMAUL HUSNAH 0000785-2201.2012 28.3 P 15/05/17 Z02.7 Rp 5,000

951 Subakin 0001489-2201.2014 43.7 L 15/05/17 H10 Rp 5,000

952 mareta widya eka fatma 0005874-2230.2016 3.2 P 15/05/17 Z00 Rp 5,000

953 IMROATUL FAUZIA 0001554-2201.2013 21.7 P 15/05/17 J02 Rp 5,000

954 Nafsiyah 0000161-2201.2017 37.3 P 15/05/17 R51 Rp 5,000

955 Juwarni 0002206-2201.2016 60.3 P 15/05/17 H10; I10 Rp 5,000


M79.1;
956 AISYAH 0004992-2205.2014 62 P 15/05/17 I25 Rp 5,000

957 FATIMATUS ZAHROH 0003381-2201.2011 34.8 P 15/05/17 L27 Rp 5,000

958 Munjaroh 0005146-2201.2014 57.4 P 15/05/17 M79.1 Rp 5,000

959 Dewi Sekar Arum 0003732-2201.2014 2.8 P 15/05/17 H66 Rp 5,000

960 Sahid Abdullah 0002318-2201.2017 0.8 L 15/05/17 A01.0 Rp 5,000

961 Fenti Eka Azkiyah 0002322-2201.2017 17.6 P 15/05/17 K05 Rp 7,500

962 Safari 0002327-2201.2017 37.3 L 15/05/17 B23.0 Rp 5,000

963 musiyatun 0003902-2202.2016 60.8 P 15/05/17 K12 Rp 5,000

964 sribek 0000023-2206.2017 P 15/05/17 A01.0 Rp 5,000

965 AJENG KIRANIA 0000806-2201.2012 7.6 P 15/05/17 H65.0 Rp 5,000

966 adiba auliyah 0005645-2230.2015 3 P 15/05/17 Z00 Rp 5,000

967 Uyun arifah 0001541-2201.2014 18 P 15/05/17 Z02.7 Rp 5,000

968 Syahidah Atiqah Ibrahim 0000977-2201.2015 3.2 P 15/05/17 J02 Rp 5,000

969 Azalea kholiqo dazhin 0002227-2201.2017 0.3 P 15/05/17 Z71 Rp 5,000

970 MAYA 0000355-2201.2011 61.1 P 15/05/17 E78; I10 Rp 5,000

971 Suwandi 0006236-2203.2016 37.4 L 15/05/17 M06 Rp 5,000

972 Ahmad Istas Maulana 0004703-2201.2016 1.1 L 15/05/17 J00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
973 Zawawi 0002230-2201.2017 68.2 L 15/05/17 K29 Rp 5,000

974 Abdul Majid Azzuhud 0001043-2205.2017 1.3 L 15/05/17 A01.0 Rp 5,000

975 Abdullah Masduki 0000517-2201.2011 13.8 P 15/05/17 H65.0 Rp 5,000

976 Mohammad afisena Akbar 0001899-2201.2017 7.9 L 15/05/17 J02 Rp 5,000

977 Inakah 0002279-2202.2015 44.8 P 15/05/17 A16 Rp 5,000

978 Nurul Hayati 0001949-2201.2016 52 P 15/05/17 E11 Rp 5,000

979 inakah b 0002280-2202.2015 44.8 P 15/05/17 Z30 Rp 12,500

980 Dzakiyyatul Aqliyah 0001261-2201.2014 19 P 15/05/17 Z02.7 Rp 5,000

981 Binti Roudlotul Jannah 0003572-2208.2016 7.2 P 15/05/17 K00 Rp 7,500

982 Ahshon Maulana 0008122-2201.2015 19.6 L 15/05/17 J02 Rp 5,000

983 nayla khairana s 0005324-2219.2016 1.3 P 15/05/17 J02 Rp 5,000

984 nida ulfa faricha 0002355-2202.2017 7.9 P 16/05/17 K29 Rp 5,000

985 Nihla Zahira Afthoniyah 0002358-2201.2017 3.6 P 16/05/17 J02 Rp 5,000

986 st zulaidah 0002363-2206.2017 46 P 16/05/17 M79.1 Rp 5,000

987 Bunga Suci Mardlotillah 0000869-2201.2017 2 P 16/05/17 K59.1 Rp 5,000

988 SUKRIYATUN 0000298-2201.2011 56.1 P 16/05/17 M06 Rp 5,000

989 MARFUAH 0000424-2206.2015 45.6 P 16/05/17 M79.1 Rp 5,000

990 BASIROH 0002243-2201.2012 30.3 P 16/05/17 M79.1 Rp 5,000

991 LUTFIYAH FILZANA 0002472-2232.2017 0.9 P 16/05/17 Z24.4 Rp 5,000


Z23.2;
992 AFFAN AHMAD RAZIZAM 0002476-2232.2017 0 L 16/05/17 Z24.0 Rp 5,000
Z27;
993 MARVIN ZAMIYASA 0002480-2232.2017 0.3 L 16/05/17 Z24.0 Rp 5,000

994 NISWATIN HIDAYAH 0000528-2201.2013 43.1 P 16/05/17 I10 Rp 5,000

995 syamsiyadah 0003375-2201.2016 50.8 P 16/05/17 M79.1 Rp 5,000

996 m.setyo aji 0002510-2225.2017 L 16/05/17 J31 Rp 5,000

997 Safira Haqiqotul 0001918-2205.2017 P 16/05/17 J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register
(Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
998 WINDI HILYATUL FUADA 0000634-2201.2011 13.7 P 16/05/17 K02 Rp 20,000

999 Lilik Fadlilah 0001327-2201.2014 42.1 P 16/05/17 H10 Rp 5,000

1000 matarun 0003763-2204.2015 62.1 L 16/05/17 M79.1 Rp 5,000

1001 Khoirotun Binti Mata'il 0002352-2201.2017 33.7 P 16/05/17 Z34 Rp 5,000

1002 Nila Suhailah 0002356-2201.2017 15.6 P 16/05/17 Z02.7 Rp 5,000

1003 Adiba kanza az zahra 0003819-2201.2015 3.3 P 16/05/17 J02 Rp 5,000

1004 MOH SYAHRUN NIZAM 0000004-2201.2012 12.3 L 16/05/17 A01.0 Rp 5,000

1005 Riski 0002364-2206.2017 8 L 16/05/17 L23 Rp 5,000


Z27;
1006 NAUFAL AFKAR ROZAQ 0001429-2232.2017 0.5 L 16/05/17 Z24.0 Rp 5,000

1007 Kasmunti 0005629-2201.2016 68.5 P 16/05/17 M79.1 Rp 5,000

1008 Moh.zulfan azhar al A 0002626-2201.2014 5.1 L 16/05/17 K12 Rp 5,000

1009 indunah 0005999-2202.2014 62.2 P 16/05/17 M79.1 Rp 5,000

1010 KEISYA 0004351-2204.2015 20 P 16/05/17 L13.1 Rp 5,000

1011 Sutan Faqih Ramadhan 0001681-2231.2016 3.8 L 16/05/17 L23 Rp 5,000

1012 MOH EKA RAMDHANI 0001714-2201.2013 4.8 L 16/05/17 J02 Rp 5,000

1013 Julinus Rizki 0002450-2205.2017 10 L 16/05/17 H70.1 Rp 5,000

1014 SITI ASIYAH 0000360-2201.2014 30.8 P 16/05/17 Z71 Rp 5,000


Z23.2;
1015 AIRINA TIARA KASI APRIL0002473-2232.2017 0 P 16/05/17 Z24.0 Rp 5,000

1016 Mumtas Cakra Magholi 0004818-2201.2016 0.8 L 16/05/17 J00 Rp 5,000


Z24.0;
1017 ADI KUSUMA AFRAN SYA 0002477-2232.2017 0.3 L 16/05/17 Z27 Rp 5,000

1018 Ahmad Haidar Baihaqi 0006495-2208.2014 18.5 L 16/05/17 Z02.7 Rp 5,000

1019 MOH SUKAERI 0001854-2201.2012 60.3 L 16/05/17 M79.1 Rp 5,000

1020 Ahmad Bilal Usman 0003241-2205.2015 3.2 L 16/05/17 J13 Rp 5,000


I10;
1021 SONAH 0000566-2201.2011 75.3 P 16/05/17 M79.1 Rp 5,000

1022 Mu'ali Bin Saipin 0002354-2201.2017 53.9 L 16/05/17 J30.1 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1023 Nur Cahyani Ningsih 0002357-2201.2017 0.1 P 16/05/17 J00 Rp 5,000

1024 Firdianita Fujiatus 0000004-2201.2017 27 P 16/05/17 L13.1 Rp 5,000

1025 Mohammad Izzad Aiman 0002736-2201.2016 2.3 L 16/05/17 J02 Rp 5,000

1026 karnab 0006030-2204.2014 67.4 P 16/05/17 M79.1 Rp 5,000

1027 Sakinatun 0004810-2206.2014 55.3 P 16/05/17 K04 Rp 25,000


Z27;
1028 RAIHAN SAKHI AZZAHIR 0002478-2232.2017 0.2 L 16/05/17 Z24.0 Rp 5,000

1029 N.fatihah nadinatul A. 0003252-2202.2016 2.9 P 16/05/17 R50.1 Rp 5,000

1030 Nur Faidah 0003293-2201.2016 41.7 P 16/05/17 K02 Rp 10,000

1031 Suliyadi 0002509-2201.2011 35.8 L 16/05/17 Z02.7 Rp 5,000

1032 AHMAD MASHUDI MUZAK0001920-2201.2013 22.3 L 16/05/17 M79.1 Rp 5,000

1033 Mohammad Yogi Agung P 0005353-2201.2016 0.8 L 16/05/17 Z24.4 Rp 5,000

1034 Zaro'ah 0001351-2201.2016 66.4 P 16/05/17 K04 Rp 25,000

1035 Supiyatun Binti Siban 0002388-2202.2015 57.3 P 16/05/17 K04 Rp 7,500

1036 julaikah 0001542-2204.2017 61.2 P 16/05/17 M79.1 Rp 5,000

1037 Dafa Kevin Rizkulloh 0000868-2201.2016 1.6 L 16/05/17 J02 Rp 5,000

1038 Fadlil Murtadloh 0002771-2203.2014 39.9 L 16/05/17 K04 Rp 10,000

1039 AMALIN 0002776-2201.2011 36.1 L 16/05/17 M79.1 Rp 5,000

1040 Abdul Fatah 0004357-2201.2016 31.8 L 16/05/17 J02 Rp 5,000

1041 TAHSAN 0002423-2203.2017 58 L 16/05/17 J02 Rp 5,000

1042 MUSAMAH 0000295-2201.2011 63.1 P 16/05/17 J31 Rp 5,000

1043 RAFI ROSIDUL ARSAT 0000325-2201.2011 12.7 L 16/05/17 R50.1; J02 Rp 5,000

1044 Umiyah 0001000-2202.2016 49.2 P 16/05/17 Z71 Rp 5,000

1045 kartiah 0004660-2202.2015 46.9 P 16/05/17 M79.1 Rp 12,500


E11; I10;
1046 Karmuntik 0003176-2201.2016 54.8 P 16/05/17 E78 Rp 5,000
Z23.2;
1047 IFFAN AHMAD RAZIZAM 0002475-2232.2017 0 L 16/05/17 Z24.0 Rp 5,000
Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1048 marzanah 0003194-2202.2016 56.8 P 16/05/17 M79.1 Rp 5,000
Z27;
1049 HITHNA BISSA'ADAH 0002479-2232.2017 0.2 P 16/05/17 Z24.0 Rp 5,000
Z27;
1050 ADIBA SYAQILA 0002481-2232.2017 0 P 16/05/17 Z24.0 Rp 5,000

1051 Suari 0006590-2204.2014 78.2 P 16/05/17 M79.1 Rp 5,000

1052 ahmad ridho hadikusumo 0006671-2230.2015 5.8 L 16/05/17 Z00 Rp 5,000

1053 Nur Faidah 0003293-2201.2016 41.7 P 16/05/17 K02 Rp 7,500

1054 moh.faiqul fayyadh 0002509-2216.2017 5 L 16/05/17 J31 Rp 5,000

1055 musthofa husnan 0005055-2230.2014 67.3 L 16/05/17 M79.1 Rp 5,000

1056 mazida rifah 0003412-2202.2014 24.5 P 16/05/17 K02 Rp 5,000


Z27;
1057 Aqila Khumaira Az Zahra 0001184-2201.2017 0.3 P 16/05/17 Z24.0 Rp 5,000

1058 MUHAMMAD SETYO AJI 0007789-2225.2015 1.6 L 16/05/17 J31 Rp 5,000

1059 intan nuraini 0003578-2204.2014 53.4 P 16/05/17 M79.1 Rp 5,000

1060 Kadir Zainuri 0003657-2201.2016 57.5 L 16/05/17 M79.1 Rp 5,000

1061 Mohammad Rofiqi Uddin 0002301-2201.2017 27.9 L 16/05/17 K04 Rp 25,000

1062 Qurotun Nada 0002019-2234.2017 6.3 P 17/05/17 Z00 Rp 5,000

1063 Istirochah 0008378-2201.2015 61.3 P 17/05/17 A15 Rp 5,000

1064 munthobiah 0003773-2230.2014 58.4 P 17/05/17 H10 Rp 5,000

1065 AZMI 0002048-2201.2012 6.6 L 17/05/17 A01.0 Rp 5,000

1066 Kusni. 0003777-2203.2014 32.4 L 17/05/17 J02 Rp 5,000

1067 Candra Maulana 0003792-2203.2016 4.8 L 17/05/17 J02 Rp 5,000

1068 Umaiyah 0002564-2225.2015 50.3 P 17/05/17 I10; E78 Rp 5,000

1069 musaadah 0000780-2225.2015 53.3 P 17/05/17 K29 Rp 5,000

1070 Mohammad Abidin 0001446-2206.2015 37.8 L 17/05/17 A01.0 Rp 5,000

1071 putri nurfatika 0001459-2206.2017 7.2 P 17/05/17 L23 Rp 5,000

1072 AJENG KIRANIA 0000806-2201.2012 7.7 P 17/05/17 H65.0 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1073 Ulfiana alzah 0002381-2206.2017 4 P 17/05/17 A01.0 Rp 5,000
Z27;
1074 Aulia humairoh a 0000842-2219.2017 0.3 P 17/05/17 Z24.0 Rp 5,000
Z27;
1075 Hazelin gusti maharani 0000853-2219.2017 0.3 P 17/05/17 Z24.0 Rp 5,000

1076 Iskan 0002163-2201.2017 58.9 L 17/05/17 A15 Rp 5,000

1077 karmisih 0002762-2202.2015 62.2 P 17/05/17 M79.1 Rp 5,000

1078 NI'AMAROH 0002415-2201.2012 47.1 P 17/05/17 K29 Rp 5,000

1079 sukamah 0001713-2206.2014 65.6 P 17/05/17 M79.1 Rp 5,000

1080 Wulida Salist Ayuni 0001761-2201.2015 11.3 P 17/05/17 L27 Rp 5,000

1081 Diyanah Adibah Nashir 0000341-2201.2016 1.8 P 17/05/17 J13 Rp 5,000

1082 Sholihah 0004742-2205.2014 57.4 P 17/05/17 M79.1 Rp 5,000

1083 Suliana 0004880-2201.2016 41.3 P 17/05/17 I95 Rp 5,000

1084 Harun arrosid 0004928-2201.2016 4 L 17/05/17 J13 Rp 5,000

1085 Armaed Arya Prasetyo 0003434-2205.2015 14.9 L 17/05/17 B86 Rp 5,000

1086 Inakah 0002279-2202.2015 44.8 P 17/05/17 A16 Rp 5,000

1087 Binti Roudlotul Jannah 0003572-2208.2016 7.2 P 17/05/17 K00 Rp 5,000

1088 Aisyah Maulidah 0001999-2234.2017 6.3 P 17/05/17 Z00 Rp 5,000

1089 Muhammad Aska 0002528-2219.2017 0 L 17/05/17 Z24.6 Rp 5,000

1090 Sufa'atun nisak 0001305-2201.2015 9.5 P 17/05/17 K00 Rp 19,000

1091 M.Hafid Firmansyah 0002009-2234.2017 6.1 L 17/05/17 Z00 Rp 5,000

1092 FARDAN GHOSSAN 0002537-2203.2017 6 L 17/05/17 J02 Rp 5,000

1093 ESti Setyaningtyas 0002016-2234.2017 6.2 P 17/05/17 Z00 Rp 5,000

1094 LAILITUS NIKMA 0002543-2203.2017 31 P 17/05/17 Z30 Rp 5,000

1095 Raesa Asyafa, 0002020-2234.2017 6.2 P 17/05/17 Z00 Rp 5,000

1096 Kusni. 0003777-2203.2014 32.4 L 17/05/17 J02 Rp 5,000

1097 Kusni. 0003777-2203.2014 32.4 L 17/05/17 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1098 Nurali 0000007-2201.2017 57.7 L 17/05/17 A16.0 Rp 5,000

1099 SOIM 0002590-2201.2011 39.3 L 17/05/17 K29 Rp 5,000

1100 Arif Rohman 0005688-2201.2016 27.8 L 17/05/17 A16.0 Rp 5,000

1101 jono 0002684-2202.2014 73 L 17/05/17 M79.1 Rp 5,000


Z27;
1102 Ghina qalbu th0hir 0000860-2219.2017 0.3 P 17/05/17 Z24.0 Rp 5,000

1103 Sri Rahayu 0005901-2203.2016 24.5 P 17/05/17 Z30 Rp 5,000

1104 Ahmad Ardani Fairuz 0004217-2201.2016 1.2 L 17/05/17 K59.1 Rp 5,000

1105 Hana wahyu negseh 0002173-2205.2014 22 P 17/05/17 J31; I95 Rp 5,000

1106 widatin 0002793-2228.2016 36 P 17/05/17 Z30 Rp 5,000

1107 Ahmad Masruki 0006142-2201.2016 25.6 L 17/05/17 A16.0 Rp 5,000

1108 RAHEL AMANDA 0002240-2201.2013 4.1 P 17/05/17 J00 Rp 5,000

1109 muntayah 0004850-2202.2014 43 P 17/05/17 Z30 Rp 12,500

1110 Rukayah 0003376-2202.2014 56.5 P 17/05/17 K29 Rp 5,000

1111 kuseno 0002511-2225.2017 L 17/05/17 M79.1 Rp 5,000

1112 Mohammad Raditya W 0001205-2201.2017 23.8 L 17/05/17 L02 Rp 5,000

1113 Muhammad Arvie 0002526-2219.2017 0 L 17/05/17 Z24.6 Rp 5,000

1114 Amira Nazihah 0002000-2234.2017 6 P 17/05/17 Z00 Rp 5,000

1115 Nadhira Rahma 0002011-2234.2017 6.3 P 17/05/17 Z00 Rp 5,000

1116 Khotimah 0001308-2201.2014 52.7 P 17/05/17 I10 Rp 5,000

1117 moh. abit aqilah pranaj 0003674-2202.2016 3.9 L 17/05/17 K02 Rp 5,000

1118 Nadiatus Saadah 0002015-2234.2017 6.2 P 17/05/17 Z00 Rp 5,000

1119 Kusni. 0003777-2203.2014 32.4 L 17/05/17 J02 Rp 5,000

1120 Kusni. 0003777-2203.2014 32.4 L 17/05/17 J02 Rp 5,000

1121 Siti Muniroh 0002369-2201.2017 56.8 P 17/05/17 I10; L27 Rp 5,000

1122 Safika ramadhani R 0002611-2201.2016 2.8 P 17/05/17 H66 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1123 suwanah 0002653-2206.2014 48.5 P 17/05/17 M79.1 Rp 5,000

1124 Ayu ramadhani 0005989-2219.2014 5.8 P 17/05/17 Z00 Rp 5,000

1125 piyatun piyatun 0002872-2206.2014 67.5 P 17/05/17 I10 Rp 5,000

1126 MUNAWAROH 0000953-2201.2011 55.1 P 17/05/17 M79.1 Rp 5,000

1127 Lejar :Lestari 0004479-2203.2015 32.3 P 17/05/17 Z32.1 Rp 5,000

1128 MATRIAH 0002901-2201.2011 75.5 P 17/05/17 M06 Rp 5,000

1129 Hanafiyah 0000285-2238.2015 35.3 P 17/05/17 A15 Rp 5,000

1130 AHMAD SAHRIL IRSYAT 0001052-2201.2011 7 L 17/05/17 A09 Rp 5,000


Z27;
1131 m alfatihfirdaus 0001836-2234.2017 0.3 L 17/05/17 Z24.0 Rp 5,000

1132 arini zahrotus 0006921-2219.2015 6.2 P 17/05/17 Z00 Rp 5,000

1133 MOH. NUR IZAM 0001906-2201.2012 6 L 17/05/17 J02 Rp 5,000

1134 dwi indra firmansyah 0003476-2202.2015 13.7 L 17/05/17 L23 Rp 5,000

1135 Refandi Jauhar Sulthan 0002290-2201.2016 11.8 L 17/05/17 A01.0 Rp 5,000

1136 Nur Fatimah Tusya 0002527-2219.2017 0 P 17/05/17 Z24.6 Rp 5,000

1137 Ardita Pramesti 0002005-2234.2017 5.7 P 17/05/17 Z00 Rp 5,000

1138 Waliyuningrum 0002529-2219.2017 0 P 17/05/17 Z24.6 Rp 5,000

1139 Naura Fatihatun 0002012-2234.2017 6.1 P 17/05/17 Z00 Rp 5,000

1140 Nur Faizah a 0005295-2205.2015 30.6 P 17/05/17 I95 Rp 5,000

1141 Pramana 0002018-2234.2017 6.3 L 17/05/17 Z00 Rp 5,000

1142 SAHRUL NI'AM 0002545-2203.2017 13 L 17/05/17 J02 Rp 5,000

1143 Kusni. 0003777-2203.2014 32.4 L 17/05/17 J02 Rp 5,000

1144 Siti Aniyah 0000739-2201.2015 57.3 P 17/05/17 D50 Rp 5,000

1145 Mohammad Faqihudin Prad 0001401-2201.2013 10 L 17/05/17 J02 Rp 5,000

1146 Mohammad Husain Ardani 0002367-2201.2017 1.9 L 17/05/17 L23 Rp 5,000

1147 Mohammad Jatiaji Bramas 0002370-2201.2017 0.4 L 17/05/17 J00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1148 Mohammad Nabil Rusydi 0004212-2228.2014 15.7 L 17/05/17 B35.4 Rp 5,000

1149 Raehan Rizki adiyatma 0002762-2201.2016 0.9 L 17/05/17 J20 Rp 5,000

1150 Elviya 0000943-2203.2017 29.3 P 17/05/17 Z32.1 Rp 5,000

1151 MUMTAZAH NAURA 0000261-2201.2012 5.8 L 17/05/17 Z00 Rp 5,000

1152 FADHILAH 0001023-2201.2011 54 P 17/05/17 H10 Rp 5,000

1153 JALI 0002253-2201.2012 61.7 L 17/05/17 J45 Rp 5,000

1154 Ihda Shinta Kaysah 0003366-2201.2011 14.7 P 17/05/17 J02 Rp 5,000

1155 musonapah 0003496-2202.2014 57.2 P 17/05/17 J00 Rp 5,000

1156 Sugeng Widodo 0001978-2201.2017 36.3 L 17/05/17 I10; L27 Rp 5,000

1157 saddam alghifany 0002525-2219.2017 5.5 L 17/05/17 Z00 Rp 5,000

1158 Nur Fatimah Tusya 0002527-2219.2017 0 P 17/05/17 Z24.6 Rp 5,000

1159 M.Aditya Pranata 0002007-2234.2017 5.9 L 17/05/17 Z00 Rp 5,000

1160 Adinda Arzani 0002530-2219.2017 0 P 17/05/17 Z24.6 Rp 5,000


Z27;
1161 hana zahra azma 0001305-2219.2017 0.3 P 17/05/17 Z24.0 Rp 5,000

1162 ZULAIKHO 0002541-2203.2017 32 P 17/05/17 Z30 Rp 5,000

1163 Mohammad Husain Ardani 0002367-2201.2017 1.9 L 18/05/17 K59.1 Rp 5,000

1164 SUADAH 0000071-2201.2011 51.7 P 18/05/17 I15 Rp 5,000

1165 Ikhsan Nur Ridlo 0002394-2201.2017 6.4 L 18/05/17 K00 Rp 5,000

1166 Aulia Citra Chasih 0002399-2201.2017 17.6 P 18/05/17 Z02.7 Rp 5,000

1167 Suparmi Binti Matrap 0002404-2201.2017 41.1 P 18/05/17 L29 Rp 5,000

1168 Rima Cahya Fathihah 0002421-2201.2011 9.7 P 18/05/17 L27 Rp 5,000

1169 DINDA DEWI AGUSTINA 0002423-2205.2014 4.5 P 18/05/17 J31 Rp 5,000

1170 DINAR 0000229-2201.2013 5.6 P 18/05/17 L29 Rp 5,000

1171 SUPIYATUN 0000956-2201.2013 64 P 18/05/17 L29 Rp 5,000

1172 siti aisyah 0004493-2202.2014 19.3 P 18/05/17 K05.0 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1173 nafisatuz zakiyah 0006110-2202.2014 4.3 P 18/05/17 H10 Rp 5,000

1174 Mayang Ghozali 0002454-2205.2017 2 P 18/05/17 J31 Rp 5,000

1175 MOH ERIKUL 0000357-2201.2013 21.4 L 18/05/17 J31 Rp 5,000

1176 syamsul hadi 0003392-2202.2014 67.2 L 18/05/17 M79.1 Rp 5,000

1177 ALMAR RAFA PUTRA 0002519-2203.2017 2.5 L 18/05/17 K12 Rp 5,000

1178 MAFRUDLOH 0002521-2203.2017 32 P 18/05/17 M79.1 Rp 5,000

1179 Mukayah 0008280-2201.2015 51.4 P 18/05/17 E78 Rp 5,000

1180 Raden Azka B.A 0005375-2201.2015 5.1 L 18/05/17 J02 Rp 5,000

1181 Muhammad Nurudin .H W, 0008321-2201.2015 2 L 18/05/17 J02 Rp 5,000

1182 Sutikah 0005551-2201.2016 51.5 P 18/05/17 M06 Rp 5,000

1183 Wiwik Isnawati 0005746-2201.2015 37 P 18/05/17 H66.0 Rp 5,000

1184 Lusianah 0002395-2201.2017 32.7 P 18/05/17 H65.0 Rp 5,000

1185 Andika Ahmad Fikri 0002397-2201.2017 11.6 L 18/05/17 R50.1 Rp 5,000

1186 NOVITA ADELIA PUTRI 0000299-2201.2012 5.5 P 18/05/17 J31 Rp 5,000

1187 alung 0006262-2230.2014 7.2 L 18/05/17 J31 Rp 5,000

1188 Niswatin 0002229-2205.2014 57.6 P 18/05/17 M79.1 Rp 5,000

1189 hj. umaroh 0003175-2202.2014 51.3 P 18/05/17 M79.1 Rp 5,000

1190 Fitri Indah Sari 0007058-2201.2015 26 P 18/05/17 J30.1 Rp 5,000

1191 Nadia Nury maulidah 0003438-2201.2016 5 P 18/05/17 J02 Rp 5,000

1192 ALMAR RAFA PUTRA 0002519-2203.2017 2.5 L 18/05/17 K12 Rp 5,000

1193 MAFRUDLOH 0002521-2203.2017 32 P 18/05/17 M79.1 Rp 5,000

1194 AIN 0001971-2201.2013 9.6 P 18/05/17 K00 Rp 5,000

1195 razif 0005352-2225.2015 7.9 L 18/05/17 A09 Rp 5,000

1196 MOH IRFAN 0001367-2201.2012 6.1 L 18/05/17 J02 Rp 5,000

1197 Masfayik Surya Darma 0004067-2201.2016 3.8 L 18/05/17 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1198 MUNASIROH A 0002682-2202.2016 52 P 18/05/17 Z30 Rp 12,500

1199 juwariyah 0002401-2202.2017 30.4 P 18/05/17 Z30 Rp 12,500

1200 MUNTAMAH 0000130-2201.2011 61.1 P 18/05/17 B00 Rp 5,000

1201 MUALIFAH 0000131-2201.2011 37.3 P 18/05/17 L27 Rp 5,000

1202 USFAINI 0003063-2201.2011 38.8 P 18/05/17 J02 Rp 5,000

1203 Rifaah 0006312-2203.2014 33.2 P 18/05/17 K29 Rp 5,000

1204 ALMAR RAFA PUTRA 0002519-2203.2017 2.5 L 18/05/17 K12 Rp 5,000

1205 MAFRUDLOH 0002521-2203.2017 32 P 18/05/17 M79.1 Rp 5,000

1206 Mohammad Miftahul Ilmi 0002363-2201.2015 2.5 L 18/05/17 R50.1 Rp 5,000

1207 ROMDA 0000037-2201.2012 65.3 P 18/05/17 M79.1 Rp 5,000

1208 Mohammad Adi Candra 0002393-2201.2017 11.1 L 18/05/17 A01.0 Rp 5,000

1209 Kundhori Bin Karmat 0002398-2201.2017 70.8 L 18/05/17 K29 Rp 5,000

1210 Abdul Munif 0002403-2201.2017 45.5 L 18/05/17 L29 Rp 5,000

1211 Murni Noviani 0002453-2205.2017 26.8 P 18/05/17 J02 Rp 5,000

1212 Ahmad gilang 0006400-2201.2016 0.8 L 18/05/17 A01.0 Rp 5,000

1213 Ma'rifah 0000558-2201.2016 38.3 P 18/05/17 K04 Rp 25,000

1214 FATIMATUS ZAHROH 0003381-2201.2011 34.8 P 18/05/17 L27 Rp 5,000

1215 ALMAR RAFA PUTRA 0002519-2203.2017 2.5 L 18/05/17 K12 Rp 5,000

1216 MAFRUDLOH 0002521-2203.2017 32 P 18/05/17 M79.1 Rp 5,000

1217 Elina Nafilatuz Zakiyah 0002412-2201.2017 13.4 P 19/05/17 B86 Rp 5,000

1218 Amir Khoirudin 0000895-2201.2017 15.3 L 19/05/17 L27 Rp 5,000

1219 Fadlil Murtadloh 0002771-2203.2014 39.9 L 19/05/17 K02 Rp 7,500

1220 CHUMAIDAH 0001609-2201.2013 35.1 P 19/05/17 J00 Rp 5,000

1221 SUNARTI 0000169-2201.2011 45.1 P 19/05/17 R51 Rp 5,000

1222 Miftah Fardani 0002843-2205.2016 26 L 19/05/17 J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1223 siswati 0001781-2205.2016 30.8 P 19/05/17 I95 Rp 5,000

1224 kholikul azmi 0001106-2201.2014 16.6 L 19/05/17 S81 Rp 5,000

1225 samiyanto 0006988-2206.2015 46.7 L 19/05/17 M79.1 Rp 5,000

1226 NILAM 0000618-2201.2012 7.8 P 19/05/17 A01.0 Rp 5,000

1227 Nurul Hayati 0001949-2201.2016 52 P 19/05/17 A16; M54 Rp 5,000

1228 ROSITA FANIA BELA 0001542-2201.2013 6.9 P 19/05/17 K00 Rp 5,000

1229 Mohammad Dedy Khoiruman 0000117-2201.2017 8.8 L 19/05/17 S81 Rp 5,000

1230 AZMA HANINA 0001552-2201.2013 18.7 P 19/05/17 L27 Rp 5,000

1231 Waris 0002407-2201.2017 59.1 L 19/05/17 A16 Rp 5,000

1232 Mohammad Zaky Afifur R 0002409-2201.2017 10.6 L 19/05/17 J02 Rp 5,000

1233 Amirul Zamharir 0001592-2201.2017 24.9 L 19/05/17 Z02.7 Rp 5,000

1234 sumariyati 0004385-2220.2016 58.8 P 19/05/17 M79.1 Rp 5,000

1235 AINUL HIKMIYAH 0000401-2201.2014 25.8 P 19/05/17 Z71 Rp 5,000

1236 Zuliyati 0006353-2201.2014 42.8 P 19/05/17 K00 Rp 7,500

1237 Marfungah 0006396-2201.2016 32 P 19/05/17 N34 Rp 5,000

1238 Qathrun Nada Habibi 0000483-2201.2016 6.3 P 19/05/17 R50.1 Rp 5,000

1239 Suliana 0004880-2201.2016 41.3 P 19/05/17 I95; R51 Rp 5,000

1240 Ailen Nathania Winata 0001903-2201.2017 0.8 P 19/05/17 J00 Rp 5,000

1241 Inakah 0002279-2202.2015 44.8 P 19/05/17 A16 Rp 5,000

1242 ZAIBA 0000641-2201.2012 6.6 P 19/05/17 K00 Rp 5,000

1243 Binti Roudlotul Jannah 0003572-2208.2016 7.2 P 19/05/17 K00 Rp 20,000

1244 Sufa'atun nisak 0001305-2201.2015 9.5 P 19/05/17 K00 Rp 5,000

1245 Elis 0005531-2201.2016 34.2 P 19/05/17 K04 Rp 7,500

1246 AMINUDDIN 0002580-2201.2011 38 L 19/05/17 M79.1 Rp 5,000

1247 samsolah 0002687-2206.2014 57.2 P 19/05/17 M79.1 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1248 rusmi 0002700-2206.2014 52.5 P 19/05/17 M79.1 Rp 5,000

1249 Ma'rifah 0001561-2201.2017 37.1 P 19/05/17 K29 Rp 5,000

1250 Ihwatul Anisa 0002410-2201.2017 42.1 P 19/05/17 J02 Rp 5,000

1251 Madalil 0004287-2203.2016 55.8 L 19/05/17 M79.1 Rp 5,000

1252 Luluk Faridah 0004727-2205.2016 33.7 P 19/05/17 M79.1 Rp 5,000

1253 MU'AWANAH 0001057-2201.2013 39.6 P 19/05/17 M79.1 Rp 5,000

1254 MUKSRI 0002262-2223.2015 67.3 P 19/05/17 A09 Rp 5,000

1255 Mohammad azhar S 0001914-2201.2014 6.9 L 19/05/17 K00 Rp 5,000

1256 MU'ARIFAH 0002516-2201.2012 44.8 P 19/05/17 K29 Rp 5,000

1257 musriah 0001973-2206.2014 47.6 P 19/05/17 M79.1 Rp 5,000

1258 Sufa'atun nisak 0001305-2201.2015 9.5 P 19/05/17 K00 Rp 5,000

1259 Miftakhul Amin 0005440-2202.2014 23.3 L 19/05/17 Z02.7 Rp 5,000

1260 Wiwin Widaningsih 0005543-2205.2016 45.6 P 19/05/17 K05.0 Rp 5,000

1261 ARIMAN 0002588-2203.2017 55.5 L 19/05/17 I10 Rp 5,000

1262 MUNASIROH A 0002682-2202.2016 52 P 19/05/17 R51 Rp 5,000

1263 Nuruddin Bin Kaserat 0004109-2202.2014 40.7 L 19/05/17 M79.1 Rp 5,000

1264 Hj. Khoirotun 0002168-2205.2016 61.1 P 19/05/17 M06 Rp 5,000

1265 Mansurya 0002411-2201.2017 51 P 19/05/17 M06 Rp 5,000

1266 SHOKHIFATUL IZAH 0000888-2201.2012 30 P 19/05/17 K02 Rp 20,000

1267 DIVIRA OKTAVIA A 0002185-2201.2012 5.5 P 19/05/17 B86 Rp 5,000

1268 KEMIJO 0001776-2203.2017 71.2 L 19/05/17 I10 Rp 5,000

1269 Putri Arzetty Afifi 0006326-2201.2016 1.3 P 19/05/17 R50.1 Rp 5,000

1270 sukariyah 0003147-2220.2014 59.5 P 19/05/17 I10 Rp 5,000

1271 SUMARMI 0002490-2223.2017 43 P 19/05/17 H10 Rp 5,000

1272 MOH. NUR IZAM 0001906-2201.2012 6 L 19/05/17 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1273 SITI NUR AZIZAH 0000639-2201.2012 7.1 L 19/05/17 A09 Rp 5,000

1274 Insana 0001322-2201.2014 58.8 P 19/05/17 K29 Rp 5,000

1275 Ilaikah 0003972-2203.2016 47.8 P 20/05/17 J46 Rp 5,000

1276 WINDIYA 0000091-2201.2012 22 P 20/05/17 J02 Rp 5,000

1277 Maullidina Beby zein 0002416-2201.2017 18.8 P 20/05/17 Z34 Rp 5,000

1278 Rini Safitri 0000400-2205.2017 P 20/05/17 L23 Rp 5,000

1279 zuni nur farida 0003114-2202.2014 29.9 P 20/05/17 Z30 Rp 12,500


Z23.2;
1280 abdur rohman y 0001838-2234.2017 0.1 L 20/05/17 Z24.0 Rp 5,000

1281 Samsul 0001950-2201.2016 56.8 L 20/05/17 M79.1 Rp 5,000


Z27;
1282 Hikam ai fatih 0000855-2219.2017 0.3 L 20/05/17 Z24.0 Rp 5,000

1283 Ma'rifatul Ima 0002421-2201.2017 22.3 P 20/05/17 Z02.7 Rp 5,000

1284 DINDA DEWI AGUSTINA 0002423-2205.2014 4.5 P 20/05/17 J31 Rp 5,000

1285 Nurul Hayati 0001949-2201.2016 52 P 20/05/17 E11 Rp 5,000

1286 Muhammad Hambali 0002396-2201.2017 43.3 L 20/05/17 M79.1 Rp 5,000

1287 Andika Ahmad Fikri 0002397-2201.2017 11.6 L 20/05/17 R50.1 Rp 5,000

1288 Waris 0002407-2201.2017 59.1 L 20/05/17 A16 Rp 5,000

1289 Mohammad Kendra Maulana 0002415-2201.2017 3.2 L 20/05/17 J02 Rp 5,000

1290 Muafatin Binti Markasim 0002418-2201.2017 57.3 P 20/05/17 M06 Rp 5,000

1291 Mohammad Jalaludin ,L. 0000182-2201.2016 2.9 L 20/05/17 J13 Rp 5,000

1292 Kayyis Fathina Abidin 0002422-2201.2017 0.3 P 20/05/17 L23 Rp 5,000


Z27;
1293 adifa zidni ilma 0000333-2219.2017 2002.3 P 20/05/17 Z24.0 Rp 5,000

1294 Sri Murniyati 0002481-2201.2014 46.9 P 20/05/17 A16 Rp 5,000

1295 patemi 0001362-2225.2017 P 20/05/17 M06 Rp 5,000

1296 Muslihun 0002828-2205.2015 48 L 20/05/17 I10 Rp 5,000

1297 Siti Zumaroh Binti Suro 0002419-2201.2017 47.3 P 20/05/17 R51 Rp 5,000
Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1298 munijah 0002978-2202.2014 63.3 P 20/05/17 Z23.2;
M79.1 Rp 5,000
Z23.2;
1299 Hamba al nur 0001837-2234.2017 0.2 L 20/05/17 Z24.0 Rp 5,000

1300 Aslamiyah 0003235-2205.2015 31 P 20/05/17 H10 Rp 5,000

1301 Kusyanto Prasetyo 0002259-2230.2015 34.3 L 20/05/17 A16 Rp 5,000

1302 sholeh 0006961-2219.2015 59.8 L 20/05/17 M06 Rp 5,000

1303 Srikanah 0002748-2206.2014 72.5 P 21/05/17 M79.1 Rp 5,000

1304 Ani sudarwati 0002445-2206.2017 30 P 21/05/17 R51 Rp 5,000

1305 MADELI 0002572-2201.2013 53.4 L 21/05/17 M79.1 Rp 5,000

1306 KARTIYEM 0002638-2201.2011 57.2 P 21/05/17 M79.1 Rp 5,000

1307 mutmainah 0004398-2230.2015 62 P 21/05/17 M79.1 Rp 5,000

1308 DAFA 0002447-2206.2017 9 L 21/05/17 A09 Rp 5,000

1309 rafli putra 0003331-2206.2015 15.1 L 21/05/17 A01.0 Rp 5,000

1310 mardiyah 0002697-2206.2014 51.5 P 21/05/17 M79.1 Rp 5,000

1311 adi saputra 0001546-2220.2016 9.2 P 21/05/17 J02 Rp 5,000

1312 Fasihatun 0004562-2201.2015 43.7 P 21/05/17 K29 Rp 5,000

1313 Insana 0001322-2201.2014 58.8 P 22/05/17 A01.0 Rp 5,000

1314 Sulimah Binti Warsitin 0000748-2208.2015 44.8 P 22/05/17 M06 Rp 5,000

1315 FAQIHAN 0002589-2203.2017 46.1 L 22/05/17 J02 Rp 5,000

1316 Kaspanji 0000099-2208.2015 54 L 22/05/17 R51 Rp 5,000

1317 Mohammad Iswahyuddin 0000134-2201.2017 2.3 L 22/05/17 L23 Rp 5,000

1318 REZA MAULANA Azhar 0000933-2201.2011 6.9 L 22/05/17 R50.1 Rp 5,000

1319 Adeeva Afseen Meisya 0004315-2201.2016 5.1 P 22/05/17 J02 Rp 5,000

1320 Almu 0002432-2201.2017 53.9 P 22/05/17 E11 Rp 5,000

1321 Zumaroh Binti Ruskan 0002439-2201.2017 52.1 P 22/05/17 I10; J02 Rp 5,000

1322 m zazin abdullah 0002449-2226.2017 7 L 22/05/17 A68.9 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1323 Siti Nasilah 0002457-2205.2017 48 P 22/05/17 M06 Rp 5,000
N34;
1324 SAMSUNI 0001088-2201.2012 69.9 P 22/05/17 M79.1 Rp 5,000

1325 muzaroh 0000565-2226.2017 32.3 L 22/05/17 K29 Rp 5,000

1326 SITI UMAYAH 0001223-2201.2013 33.8 P 22/05/17 A30 Rp 5,000

1327 TASMURI 0005290-2206.2014 77 P 22/05/17 A09 Rp 5,000

1328 Nur Khasan 0005326-2225.2014 0 P 22/05/17 I10 Rp 5,000

1329 NUR KHOYUMAH 0002340-2205.2014 58.2 P 22/05/17 I25 Rp 5,000

1330 Muntikah 0001353-2201.2014 52.7 P 22/05/17 J02 Rp 5,000

1331 matkuri 0002095-2219.2016 67.2 L 22/05/17 M79.1 Rp 5,000

1332 Naura berlian 0003911-2213.2014 4 P 22/05/17 A68.9 Rp 5,000

1333 Musarofah M 0000018-2203.2017 P 22/05/17 M79.1 Rp 5,000

1334 abdul azizi 0004129-2206.2015 4.4 L 22/05/17 A09 Rp 5,000

1335 NUR LIDYAWATI 0002413-2201.2013 21.5 P 22/05/17 L27 Rp 5,000

1336 Fadlil Murtadloh 0002771-2203.2014 39.9 L 22/05/17 K02 Rp 10,000

1337 Moh Rifa'i 0000921-2201.2016 25.9 L 22/05/17 A01.0 Rp 5,000

1338 ulfi kurnia sari 0002899-2206.2014 23.5 P 22/05/17 Z02.7 Rp 5,000

1339 Na'imah 0002435-2201.2017 62 P 22/05/17 K04 Rp 7,500

1340 Matasir 0002440-2201.2017 65.2 L 22/05/17 H25 Rp 5,000

1341 Ahmad Fathiyan Akbar 0006112-2202.2014 4.1 L 22/05/17 J00 Rp 5,000

1342 endang hidatati 0002451-2226.2017 36 P 22/05/17 K29 Rp 5,000

1343 M Fadil Ulul Azmi 0002456-2205.2017 3 L 22/05/17 A01.0 Rp 5,000

1344 SUTAR 0003059-2201.2011 60.4 L 22/05/17 J45 Rp 5,000

1345 kholikul azmi 0001106-2201.2014 16.6 L 22/05/17 T25 Rp 5,000

1346 Zulaekah Binti Kastam 0001893-2201.2017 53 P 22/05/17 E11 Rp 5,000

1347 Faridatus Sholihah 0000624-2201.2016 21.6 P 22/05/17 R51 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1348 katipah 0002282-2219.2017 0.1 P 22/05/17 I15 Rp 5,000

1349 Mukayah 0008280-2201.2015 51.4 P 22/05/17 K29 Rp 5,000

1350 warkiyamah 0002746-2202.2015 55.8 P 22/05/17 M79.1 Rp 5,000

1351 Ainur Rofiq 0002413-2201.2017 27.4 L 22/05/17 Z71 Rp 5,000

1352 Sriati 0006003-2213.2014 52.3 P 22/05/17 M79.1 Rp 5,000

1353 MAULIDATUL KARIMAH 0000950-2201.2012 23 P 22/05/17 K29 Rp 5,000

1354 Abdul Na'im 0002430-2201.2017 55 L 22/05/17 I10; R51 Rp 5,000

1355 Setikah 0002437-2201.2017 60.6 P 22/05/17 K04 Rp 7,500

1356 Latifah Binti Muhidin 0002443-2201.2017 36.5 P 22/05/17 J02 Rp 5,000

1357 malaikati 0002977-2202.2014 63.1 P 22/05/17 J45 Rp 5,000

1358 tio adi harianto 0002452-2226.2017 5 L 22/05/17 A68.9 Rp 5,000

1359 MOH. AZAM 0001895-2202.2016 30.2 L 22/05/17 S91.0 Rp 5,000

1360 Mutamimah 0007059-2201.2015 42.8 P 22/05/17 R51 Rp 5,000

1361 SUPENI 0002277-2201.2013 53.5 P 22/05/17 M79.1 Rp 5,000

1362 SUKARTI 0000641-2203.2017 50.3 P 22/05/17 M79.1 Rp 5,000

1363 abdul latif 0007708-2206.2015 19.6 L 22/05/17 L23 Rp 5,000

1364 warsiah 0002292-2226.2017 60.1 P 22/05/17 M79.1 Rp 5,000

1365 KHOTIJAH 0002036-2201.2012 47.6 P 22/05/17 M35 Rp 5,000

1366 SUHEL 0000708-2201.2013 5.9 L 22/05/17 J02 Rp 5,000

1367 kuminten 0002057-2219.2017 46.2 P 22/05/17 M79.1 Rp 5,000

1368 juwariyah 0001370-2226.2017 75.2 P 22/05/17 A68.9 Rp 5,000

1369 Insan Budi Aji 0003842-2206.2014 15.3 L 22/05/17 J02 Rp 5,000

1370 NANIK HIDAYANI 0002591-2203.2017 37 P 22/05/17 K02 Rp 5,000

1371 SUMARNI 0000821-2201.2012 41.3 P 22/05/17 I15 Rp 5,000

1372 Marmuatun 0005879-2201.2015 44.1 P 22/05/17 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1373 MUNTAMAH 0000130-2201.2011 61.2 P 22/05/17 B00 Rp 5,000

1374 MUALIFAH 0000131-2201.2011 37.3 P 22/05/17 L27 Rp 5,000

1375 musa 0002197-2206.2014 68.6 P 22/05/17 M79.1 Rp 5,000

1376 Hanik Al Mardiyah 0002438-2201.2017 1.9 P 22/05/17 J02 Rp 5,000

1377 Khodijah Binti Warisan 0002444-2201.2017 78 P 22/05/17 G46.4* Rp 5,000

1378 fifin fitriani 0002448-2206.2017 25 P 22/05/17 K29 Rp 5,000

1379 kasti 0002966-2202.2014 62.6 P 22/05/17 K29 Rp 5,000

1380 Nur Sulaikah 0003058-2213.2014 42.5 P 22/05/17 M79.1 Rp 5,000

1381 salamah 0000478-2226.2017 50.3 P 22/05/17 M79.1 Rp 5,000

1382 AISYAH 0004992-2205.2014 62 P 22/05/17 J31 Rp 5,000

1383 dasri 0005042-2206.2015 68 P 22/05/17 M79.1 Rp 5,000

1384 Mohammad azhar S 0001914-2201.2014 6.9 L 22/05/17 K00 Rp 12,000

1385 seliya anindi ridho sep 0008288-2202.2015 1.7 P 23/05/17 R50.1 Rp 5,000

1386 Zaro'ah 0001351-2201.2016 66.4 P 23/05/17 K03 Rp 7,500

1387 Mohammad alby 0001363-2201.2015 4 L 23/05/17 R50.1 Rp 5,000

1388 syaiful karim 0002592-2203.2017 32.5 L 23/05/17 J46 Rp 5,000

1389 ghonimah 0002127-2219.2015 52.3 P 23/05/17 M79.1 Rp 5,000

1390 Nuruddin Bin Kaserat 0004109-2202.2014 40.7 L 23/05/17 M79.1 Rp 5,000

1391 Azril Yasir Aizi 0004466-2201.2016 7.6 L 23/05/17 J02 Rp 5,000

1392 Rohman riadi 0006088-2201.2015 48.1 L 23/05/17 H66 Rp 5,000

1393 Azalea kholiqo dazhin 0002227-2201.2017 0.3 P 23/05/17 A15 Rp 5,000

1394 Dewi Firdanis 0002464-2201.2017 17.7 P 23/05/17 J02 Rp 5,000

1395 Mu'asim Bin Sarman 0001888-2201.2017 68.4 L 23/05/17 D50 Rp 5,000

1396 diana adiba 0002504-2220.2017 2 P 23/05/17 J31 Rp 5,000

1397 Umarofah Binti Marwi 0005426-2206.2014 63.9 P 23/05/17 E11 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1398 ULIYAH NUSADIYAH 0002167-2201.2012 37.7 P 23/05/17 K29; M06 Rp 5,000

1399 Riana Dewi Mayasari 0004259-2201.2016 27.8 P 23/05/17 J02 Rp 5,000

1400 ACH.AFIN L.F 0000933-2201.2013 8.9 L 23/05/17 J02 Rp 5,000

1401 TITIK RIHAWATI 0000235-2201.2013 30.3 P 23/05/17 R51; K29 Rp 5,000

1402 Muamah 0004471-2203.2016 50.8 P 23/05/17 M79.1 Rp 5,000

1403 muntasiro 0003041-2220.2014 62.5 P 23/05/17 I10 Rp 5,000

1404 Basuki Rachmad 0002458-2201.2017 38.3 L 23/05/17 Z71 Rp 5,000

1405 Syakirah Tsaniyah 'aisy 0006285-2201.2016 1.3 P 23/05/17 Z71 Rp 5,000

1406 Qurrota Ayyun 0001813-2220.2017 1.4 P 23/05/17 J31 Rp 5,000

1407 Sriyati 0003177-2202.2014 77.5 P 23/05/17 I10; H81 Rp 5,000

1408 Indah 0002278-2201.2016 56 P 23/05/17 E11 Rp 5,000

1409 SITI UMAYAH 0001223-2201.2013 33.8 P 23/05/17 A30.1 Rp 5,000

1410 SAMI'AH 0007857-2228.2015 61.6 P 23/05/17 E78 Rp 5,000

1411 trisno 0002533-2225.2017 L 23/05/17 I10 Rp 5,000

1412 SUKANAH 0002591-2201.2013 73.4 P 23/05/17 M79.1 Rp 5,000

1413 Wuriah 0000062-2201.2015 50.4 P 23/05/17 M06 Rp 5,000

1414 MOH ADITIYA PRATAMA 0002867-2201.2011 5.8 L 23/05/17 J02 Rp 5,000

1415 IIN NOVITA SARI 0001699-2201.2013 35.2 P 23/05/17 B37.3+ Rp 5,000

1416 Matrikan 0006264-2228.2015 65.1 P 23/05/17 D50 Rp 5,000

1417 Karnadah 0001495-2201.2015 43.9 P 23/05/17 M79.1 Rp 5,000

1418 Markhaban 0000063-2201.2015 61.3 L 23/05/17 R51 Rp 5,000

1419 Adrian Pradipta Rohman 0005784-2201.2016 1.4 L 23/05/17 A09 Rp 5,000

1420 Muhammad Hambali 0002396-2201.2017 43.3 L 23/05/17 S60.1 Rp 5,000

1421 dason 0005904-2219.2016 55.6 L 23/05/17 M79.1 Rp 5,000

1422 fatiyatul laili 0006096-2202.2014 5 P 23/05/17 Z71 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1423 Vianita Nurdiana 0002451-2201.2015 16.4 P 23/05/17 Z71 Rp 5,000

1424 Edy Saputro 0002463-2201.2017 22.4 L 23/05/17 R51 Rp 5,000

1425 nadia najah 0001077-2202.2015 10.3 P 23/05/17 J00 Rp 5,000

1426 Sumariyah 0001857-2201.2014 50.3 P 23/05/17 J02 Rp 5,000

1427 Ahmad Fathoni As 0002503-2220.2017 5.1 L 23/05/17 H66.0 Rp 5,000

1428 ROHMAN DANI 0002272-2201.2012 9.9 L 23/05/17 J02 Rp 5,000

1429 Kaserun 0005766-2203.2016 57.8 L 24/05/17 I10 Rp 5,000

1430 Siti Zumaidah 0002731-2209.2014 26.2 P 24/05/17 Z35 Rp 5,000

1431 Sulikah 0004185-2203.2016 52.8 P 24/05/17 M06 Rp 5,000

1432 SUMARNING 0000308-2219.2017 P 24/05/17 M79.1 Rp 5,000

1433 MILATUN 0000378-2201.2011 56.1 P 24/05/17 I10; K29 Rp 5,000

1434 Nur Suci Mufidah 0002482-2201.2017 11.8 P 24/05/17 K04 Rp 7,500

1435 YULIATI 0000044-2201.2011 39.2 P 24/05/17 Z30 Rp 5,000

1436 SITI SOBRINA 0000060-2201.2013 12.8 P 24/05/17 B86 Rp 5,000

1437 Hanan Al Muntas 0002137-2201.2014 21.6 L 24/05/17 L23 Rp 5,000

1438 Maullidina Beby zein 0002416-2201.2017 18.8 P 24/05/17 Z34 Rp 5,000

1439 Sukarji 0004587-2206.2014 62.3 L 24/05/17 A15 Rp 5,000

1440 Muhammad Thoyin 0002469-2201.2017 60.8 L 24/05/17 I10 Rp 5,000

1441 WINDI HILYATUL FUADA 0000634-2201.2011 13.8 P 24/05/17 K00 Rp 7,500

1442 Viky Hendra Setiawan 0001342-2201.2017 25.3 L 24/05/17 A15 Rp 5,000

1443 Heni Suprihatin 0002106-2201.2017 35.5 P 24/05/17 A16.0 Rp 5,000

1444 Subihah 0003979-2203.2014 57 P 24/05/17 I10 Rp 5,000

1445 Sutomo 0002474-2203.2016 48.1 L 24/05/17 T15 Rp 5,000

1446 khoirotul irmah 0000496-2204.2015 24.9 P 24/05/17 Z51 Rp 5,000

1447 Muhammad Nuryaqin 0004947-2201.2016 44.9 L 24/05/17 M10 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1448 Eko arianto 0002519-2201.2015 25.8 L 24/05/17 L60 Rp 5,000

1449 KARIMAH 0000650-2201.2011 55.1 P 24/05/17 K12; M06 Rp 5,000

1450 Roziqin Bin Karnadi 0000672-2201.2011 42.1 L 24/05/17 A15 Rp 5,000

1451 Ukhti Khoiro Maisyah 0001345-2201.2013 16.3 P 24/05/17 Z71 Rp 5,000

1452 Mu'ali Bin Saipin 0002354-2201.2017 53.9 L 24/05/17 J30.1 Rp 5,000

1453 NAJIKH 0001457-2201.2011 57.7 L 24/05/17 M06 Rp 5,000

1454 Kaserun 0005766-2203.2016 57.8 L 24/05/17 I10 Rp 5,000

1455 Sulikah 0004185-2203.2016 52.8 P 24/05/17 M06 Rp 5,000

1456 Martonah 0002877-2203.2016 63.2 P 24/05/17 I10 Rp 5,000

1457 Laxamana Setya Bekti 0004782-2230.2015 7.4 L 24/05/17 J02 Rp 5,000

1458 Kharismatul Mamudah 0002471-2201.2017 19.9 P 24/05/17 Z71 Rp 5,000

1459 Nugi Syafak 0003206-2201.2015 5.8 L 24/05/17 R50.1 Rp 5,000

1460 Firda Nurviyanti 0007156-2201.2015 27.3 P 24/05/17 Z30 Rp 5,000

1461 Nukminatin 0003469-2203.2016 35.9 P 24/05/17 Z30 Rp 5,000

1462 Srimintarsih 0002013-2201.2012 48.7 P 24/05/17 I10; R51 Rp 5,000

1463 moh.arsyil adhim 0006573-2230.2015 2.3 L 25/05/17 A01.0 Rp 5,000

1464 safari 0000027-2201.2015 48.3 L 26/05/17 E11 Rp 5,000

1465 Muhammad Hambali 0002396-2201.2017 43.3 L 26/05/17 S60.1 Rp 5,000

1466 JALI 0002253-2201.2012 61.7 L 26/05/17 J45 Rp 5,000

1467 Arsayadan ridho AL 0005057-2201.2015 16.8 L 26/05/17 L27 Rp 5,000

1468 Siti Sutatik 0001232-2201.2011 39.4 P 26/05/17 J02 Rp 5,000

1469 Mohammad Yusril 0002297-2201.2017 18.3 L 26/05/17 L27 Rp 5,000

1470 Mohammad salman Ali 0002015-2201.2014 4 L 26/05/17 R50.1 Rp 5,000

1471 Mohammad Syaiful arif 0004285-2220.2014 8.7 L 26/05/17 K00 Rp 12,000

1472 AHC. DANI MAULANA 0000222-2201.2013 10.8 L 26/05/17 J02 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1473 Nazwa Anandira p 0002923-2201.2016 1.3 P 26/05/17 L23 Rp 5,000

1474 ANISWATIN 0001785-2201.2011 37.8 P 26/05/17 J02 Rp 5,000

1475 HENI 0001828-2201.2013 25.1 P 26/05/17 J03 Rp 5,000

1476 NADIA 0000446-2201.2014 5.7 P 26/05/17 K00 Rp 12,000

1477 RAHMA PUTRI 0000514-2201.2014 5.7 P 26/05/17 J02 Rp 5,000

1478 Uswatun Hasanah Binti M 0002500-2201.2017 39 P 26/05/17 E11 Rp 5,000

1479 Wawan Hermawan 0000585-2201.2017 36.5 L 26/05/17 J02 Rp 5,000

1480 DYLAN 0000659-2201.2014 5 L 26/05/17 A01.0 Rp 5,000

1481 Apriliya Rida Nabila 0002043-2201.2017 18.1 P 26/05/17 J02 Rp 5,000

1482 Mochammad Ali Reza ,P 0001043-2201.2014 21.5 L 26/05/17 Z02.7 Rp 5,000

1483 Sulthan Haidar Yahya 0002492-2201.2017 0.7 L 26/05/17 K59.1 Rp 5,000

1484 kholikul azmi 0001106-2201.2014 16.6 L 26/05/17 T25 Rp 5,000

1485 fathonah 0005044-2230.2014 60.3 P 26/05/17 J31 Rp 5,000

1486 Erma Fatmawati 0003440-2201.2015 30.6 P 26/05/17 J02 Rp 5,000

1487 Fabiyanti Maisena 0005221-2201.2014 7.1 P 26/05/17 J02 Rp 5,000

1488 Rijalul akmal 0003601-2202.2015 2.7 L 26/05/17 J00 Rp 5,000

1489 Anggy twodestria Cahya 0001337-2201.2015 18.4 P 26/05/17 J02 Rp 5,000

1490 Zainul Arifin Bin Imron 0003802-2205.2015 42.3 L 26/05/17 E78 Rp 5,000

1491 Nur Cahyani Ningsih 0002357-2201.2017 0.1 P 26/05/17 J02 Rp 5,000

1492 wulan anda dari 0000785-2202.2015 9.3 P 26/05/17 J02 Rp 5,000

1493 IMAIN 0000095-2201.2014 60.1 L 26/05/17 M79.1 Rp 5,000

1494 MUSAFA ' AH 0000125-2201.2012 50.7 P 26/05/17 K04 Rp 7,500

1495 Nayla Durrotul Fuaddah 0004402-2230.2015 1.9 P 26/05/17 J00 Rp 5,000

1496 ZUAN PRATAMA 0000507-2201.2011 6.4 L 26/05/17 A09 Rp 5,000

1497 fauqo najwa almira 0004893-2230.2016 7.8 P 26/05/17 J31 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register(Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1498 BENING DANIATUS ZUKR 0000672-2201.2014 5.2 P 26/05/17 J00 Rp 5,000

1499 Nuraisya Azrina Sazfa 0005288-2208.2016 1.1 L 26/05/17 Z71 Rp 5,000

1500 sumiatun 0002547-2219.2017 0.1 P 27/05/17 M79.1 Rp 5,000

1501 MUNTAMAH 0000130-2201.2011 61.2 P 27/05/17 B00 Rp 5,000

1502 Muhlisin 0005999-2201.2015 22.8 L 27/05/17 S51 Rp 5,000

1503 NAFI'UDIN 0001693-2201.2012 34.6 L 27/05/17 L27 Rp 5,000

1504 Mohammad Yunus Dwi Al 0003237-2202.2014 19.9 L 27/05/17 J02 Rp 5,000

1505 Kevin Orlandho Aditiyah 0002514-2201.2017 0.1 L 27/05/17 Z71 Rp 5,000

1506 Rislatin 0002520-2201.2017 26.5 P 27/05/17 J02 Rp 5,000

1507 Vinda Damia Firzanah 0002042-2201.2017 4.5 P 27/05/17 J02 Rp 5,000

1508 Nur fadilah 0005610-2201.2015 32.6 P 27/05/17 Z30 Rp 5,000

1509 Moh Roihanun Nehanunnaj 0002515-2201.2017 4 L 27/05/17 A01.0 Rp 5,000

1510 Nizam Maulanah 0002517-2201.2017 0.3 L 27/05/17 Z71 Rp 5,000

1511 Eka Feby Andriyah 0002523-2201.2017 14.3 P 27/05/17 J02 Rp 5,000

1512 SEVINTAN LAILA CAHYAN0001282-2201.2012 13.7 P 27/05/17 L27 Rp 5,000

1513 Amanda Syakira 0005626-2228.2016 0.7 P 27/05/17 A01.0 Rp 5,000

1514 NIHAYATUL IFLAHIYAH 0001505-2201.2012 22.8 P 27/05/17 Z30 Rp 5,000

1515 ARJUNA NAFIS .AL. 0000142-2201.2014 4 L 27/05/17 R50.1 Rp 5,000

1516 Nur Azizah Binti Madeli 0002512-2201.2017 44.9 P 27/05/17 N91 Rp 5,000

1517 Ahmad Rafif Barik Al. 0001176-2201.2014 3 L 27/05/17 J13 Rp 5,000

1518 aurora pradipta amelia 0002524-2216.2017 0 P 27/05/17 J31 Rp 5,000

1519 Shofiyah 0002513-2201.2017 53 P 27/05/17 M79.1 Rp 5,000

1520 Desi Novita Mayang sari 0002516-2201.2017 21.4 P 27/05/17 Z71 Rp 5,000

1521 FAISOL AMIR 0000650-2201.2014 32.9 L 27/05/17 J02 Rp 5,000

1522 Nurul Ismawati 0002542-2201.2017 28.4 P 29/05/17 K04 Rp 7,500


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1523 MUTIYAM 0000725-2201.2011 66.1 P 29/05/17 Z71 Rp 5,000

1524 Nadia nafis kamilah 0004055-2201.2015 4.5 P 29/05/17 Z71 Rp 5,000

1525 NUR AZIDAH 0002699-2201.2012 33.8 P 29/05/17 J02 Rp 5,000

1526 DIANI INDAH ROHMAWATI0000917-2201.2014 26.3 P 29/05/17 K29 Rp 5,000

1527 mardiyah 0006024-2219.2016 1.6 P 29/05/17 Z71 Rp 5,000

1528 Idatul Isnah 0006322-2201.2015 32 P 29/05/17 Z32.1 Rp 5,000

1529 Balqes Sendayu SN 0000481-2201.2016 L 29/05/17 A09 Rp 5,000

1530 Nurihan 0000575-2201.2016 46.8 L 29/05/17 K04 Rp 5,000

1531 Desi Novita Mayang sari 0002516-2201.2017 21.4 P 29/05/17 Z32.1 Rp 5,000

1532 Alfiyatun 0007470-2201.2015 45 P 29/05/17 H10; K29 Rp 5,000

1533 Sabikhul Alim 0007802-2201.2015 21.5 L 29/05/17 S80 Rp 5,000

1534 Pitono 0002531-2201.2017 43.1 L 29/05/17 R50.1 Rp 5,000

1535 Mukayah 0008280-2201.2015 51.4 P 29/05/17 N40 Rp 5,000

1536 farida setiawati 0002548-2219.2017 39 P 29/05/17 I15 Rp 5,000

1537 TEGUH FIRMANSYAH 0000790-2201.2011 15.3 L 29/05/17 L23 Rp 5,000

1538 MUKAYATUN 0000858-2201.2013 48.9 P 29/05/17 J45 Rp 5,000

1539 SITI ARIFAH 0001575-2201.2013 53.8 P 29/05/17 M79.1 Rp 5,000

1540 DICKY ILMANSYAH 0001076-2201.2014 16.6 L 29/05/17 Z02.7 Rp 5,000

1541 Mohammad Abdil Zikri 0004945-2201.2016 1.2 L 29/05/17 J02 Rp 5,000

1542 Romenah 0001933-2201.2016 56.1 P 29/05/17 I10; M06 Rp 5,000

1543 MOH NURUL HUDA 0002540-2201.2011 43.9 L 29/05/17 K12 Rp 5,000

1544 Masmuk Binti Kasnan 0002544-2201.2017 54.9 P 29/05/17 Z71 Rp 5,000

1545 sutrami 0005678-2206.2015 61.8 P 29/05/17 K29 Rp 5,000

1546 Farhat Al maliki 0004120-2201.2015 11.9 L 29/05/17 Z71 Rp 5,000

1547 Nur Fahmi Hidayatulloh 0000113-2201.2017 0.9 L 29/05/17 J13 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1548 Lailatul Na'im 0002161-2201.2017 32.1 P 29/05/17 Z34 Rp 5,000

1549 Prio Dadang .SW, 0004221-2230.2015 9.9 L 29/05/17 J00 Rp 5,000

1550 Restu 0005937-2201.2016 32.8 L 29/05/17 A09 Rp 5,000

1551 Fadlil Murtadloh 0002771-2203.2014 39.9 L 29/05/17 K02 Rp 20,000

1552 ABRUL RIZAL 0001077-2201.2014 17.6 L 29/05/17 Z02.7 Rp 5,000

1553 Sabila Syfa Ayu 0003233-2202.2016 5.4 P 29/05/17 J20 Rp 5,000

1554 Nadine Ramadhani 0007150-2201.2015 7.7 P 29/05/17 K04 Rp 7,500

1555 Nurul Hayati 0001949-2201.2016 52 P 29/05/17 E11 Rp 5,000

1556 Irsyadul Ibad Arrosyidi 0002535-2201.2017 12.7 L 29/05/17 B86 Rp 5,000

1557 Ahmad Roy Hanafi 0002540-2201.2017 13.9 L 29/05/17 J02 Rp 5,000

1558 ANDINI 0002313-2201.2013 5.9 P 29/05/17 R50.1; J02 Rp 5,000

1559 susi nuraida ashuri 0002564-2219.2017 32 P 29/05/17 Z71 Rp 5,000

1560 Ahmad Faris Hamizan 0002103-2201.2017 1.3 L 29/05/17 J00 Rp 5,000

1561 JANATUL FIRDAUS 0000837-2201.2013 22.8 P 29/05/17 Z32.0 Rp 5,000

1562 Waris 0002407-2201.2017 59.1 L 29/05/17 M79.1 Rp 5,000

1563 Rino Indra 0001732-2201.2016 17.5 L 29/05/17 J02 Rp 5,000

1564 BRIAN ATHA ABISTA N 0000575-2201.2014 3.6 L 29/05/17 R50.1 Rp 5,000

1565 Muhammad Natiq 0002536-2201.2017 36.8 L 29/05/17 Z02.7 Rp 5,000

1566 Mohammad Robakhul Khu 0002550-2201.2017 18.1 L 30/05/17 B01 Rp 5,000

1567 Siti Arokah 0002554-2201.2017 57.8 P 30/05/17 I10; E78 Rp 5,000

1568 Ahmad Sultan syahrir Ra 0002563-2201.2017 6.8 L 30/05/17 K02 Rp 5,000

1569 MALIKHA 0002135-2201.2012 25.9 P 30/05/17 K04 Rp 7,500

1570 Khalifi Abad Al Robani 0001543-2201.2014 3.2 L 30/05/17 B86 Rp 5,000

1571 Mohammad Fathi 0001631-2225.2017 0.7 L 30/05/17 J00 Rp 5,000

1572 Fathimah Azzahrah 0000267-2201.2017 1.1 P 30/05/17 J00 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1573 Mohammad Wafiq 0002943-2201.2014 7.1 L 30/05/17 J02 Rp 5,000

1574 ISMAIL 0002491-2205.2014 44 L 30/05/17 E78 Rp 5,000

1575 JAUHAR DANES FAHRIAN 0000698-2201.2014 7.8 L 30/05/17 K00 Rp 12,000

1576 Masholil Bin H .Hodari 0002551-2201.2017 57 L 30/05/17 R50.1 Rp 5,000

1577 Samsul Hadi 0002561-2201.2017 47 L 30/05/17 K29 Rp 5,000

1578 Kintan Shilvi Rizqiah 0000736-2201.2017 17.8 P 30/05/17 K29 Rp 5,000

1579 Syafa'atul Dwi Mahfudah 0001407-2201.2017 1.3 P 30/05/17 J00 Rp 5,000

1580 SUADAH 0000071-2201.2011 51.7 P 30/05/17 I84 Rp 5,000

1581 PUTRI AIRIL NAJUK M 0000081-2201.2012 7.8 P 30/05/17 K00 Rp 12,000

1582 Alfredo Aditya Putra 0002217-2201.2017 0.3 L 30/05/17 J00 Rp 5,000

1583 NISWATIN HIDAYAH 0000528-2201.2013 43.1 P 30/05/17 I10 Rp 5,000

1584 Muhammad Yusuf Alkindi 0002024-2228.2015 3.9 L 30/05/17 J02 Rp 5,000

1585 Mohammad Luky Al Faruh 0002549-2201.2017 1.7 L 30/05/17 J00 Rp 5,000

1586 Aulin Nikma Alfiyan 0002562-2201.2017 0.6 P 30/05/17 J00 Rp 5,000

1587 AMEL 0000407-2201.2012 7 P 30/05/17 H60 Rp 5,000

1588 Muhammad Thoyin 0002469-2201.2017 60.8 L 30/05/17 I10 Rp 5,000

1589 ANA FIJRIYAH 0001226-2201.2011 33.8 P 30/05/17 K04 Rp 10,000

1590 Sumarmi 0001245-2201.2014 54.3 P 30/05/17 R51 Rp 5,000

1591 Supriyah Binti Ismail 0002553-2201.2017 50 P 30/05/17 E78; I10 Rp 5,000

1592 Ahmad Sultan syahrir Ra 0002563-2201.2017 6.8 L 30/05/17 K02 Rp 5,000

1593 Abdul Khafi Khozailul I 0000723-2201.2015 7.9 L 30/05/17 L27 Rp 5,000

1594 ARJUNA NAFIS .AL. 0000142-2201.2014 4 L 30/05/17 K04 Rp 7,500

1595 Mohammad Alfiansyah 0004314-2201.2016 0.8 L 30/05/17 J00 Rp 5,000

1596 Sakinatun 0004810-2206.2014 55.3 P 30/05/17 K29 Rp 5,000

1597 ATAHAL 0002244-2201.2011 68.8 L 30/05/17 I10 Rp 5,000


Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1598 Eko arianto 0002519-2201.2015 25.8 L 30/05/17 L60 Rp 5,000

1599 ANA FIJRIYAH 0001226-2201.2011 33.8 P 30/05/17 K04 Rp 15,000

1600 Azzara asila rahma 0007563-2219.2015 2 P 30/05/17 A01.0 Rp 5,000


I10; J45;
1601 SITI ROKAYAH 0000693-2201.2011 58.3 P 30/05/17 J02 Rp 5,000

1602 Hanik Khusniati 0005373-2230.2014 48.9 L 31/05/17 J20 Rp 5,000

1603 Lara Khoirula Duta 0002578-2201.2017 15 P 31/05/17 K04 Rp 7,500

1604 Kayra Arta Zuhaira 0005733-2201.2016 1.1 P 31/05/17 J02 Rp 5,000

1605 Munziyah Binti Kemisan 0001559-2201.2013 54.4 P 31/05/17 I10; E78 Rp 5,000

1606 Waris 0002407-2201.2017 59.1 L 31/05/17 J20 Rp 5,000


I10; E78;
1607 KASMUAH 0001151-2201.2012 59.9 P 31/05/17 E79 Rp 5,000

1608 Rusmini 0003708-2203.2016 40.9 P 31/05/17 K04 Rp 7,500

1609 Istirochah 0008378-2201.2015 61.4 P 31/05/17 A15 Rp 5,000

1610 A, Zainul Afandi 0002579-2201.2017 39 L 31/05/17 K04 Rp 5,000

1611 SYAFIQOTUR 0000873-2201.2013 6.7 P 31/05/17 A01.0 Rp 5,000

1612 NI'AMAROH 0002415-2201.2012 47.1 P 31/05/17 R51 Rp 5,000

1613 Siti nahdiyah 0002848-2201.2015 33.4 P 31/05/17 J02; E78 Rp 5,000

1614 Nur Zahrotin 0000347-2201.2011 44 P 31/05/17 J02 Rp 5,000

1615 Mohammad.Nazril 0004768-2203.2016 0.7 L 31/05/17 J02 Rp 5,000

1616 Asri 0002273-2201.2014 56.7 P 31/05/17 I10; M06 Rp 5,000

1617 Robiatun 0007365-2201.2015 35.1 P 31/05/17 K02 Rp 10,000

1618 Zidni Alfian Barik 0007515-2201.2015 24 L 31/05/17 K02 Rp 10,000

1619 Lutfianah 0001413-2205.2017 41.5 P 31/05/17 M06 Rp 5,000

1620 Nurali 0000007-2201.2017 57.7 L 31/05/17 A16.0 Rp 5,000

1621 Arif Rohman 0005688-2201.2016 27.8 L 31/05/17 A16.0 Rp 5,000


J02;
1622 ROKATI 0000095-2201.2011 56.2 P 31/05/17 M79.1 Rp 5,000
Umur POLI
Jenis Tgl
No Nama Register (Tahun Diagnosa
Kel Kunjungan Umum Gigi Anak KIA/KB UGD
)
1623 IFA RA'AIDA 0000856-2201.2014 43.2 P 31/05/17 K00 Rp 7,500

1624 Ecik Desinta Ajraini 0002186-2201.2016 2.2 P 31/05/17 J02 Rp 5,000

1625 Khayatun 0000241-2201.2017 55.9 P 31/05/17 E11; I10 Rp 5,000

1626 Analis Anindia l 0004497-2230.2015 5.9 P 31/05/17 B26 Rp 5,000

1627 Ahmad Masruki 0006142-2201.2016 25.7 L 31/05/17 A16.0 Rp 5,000

1628 Ma'nawi sukma dewi 0000371-2201.2017 11.7 P 31/05/17 K04 Rp 5,000

1629 BIAUNIK NISHCHI 0000461-2201.2012 6.8 P 31/05/17 J20 Rp 5,000

1630 SUKAEMI 0000595-2201.2013 64.2 P 31/05/17 M06; I10 Rp 5,000

1631 Alwi Hasan 0005073-2201.2014 36.7 L 31/05/17 J30.1 Rp 5,000

1632 Muhammad Farel Ihsandi 0003577-2208.2016 3.3 L 31/05/17 J02 Rp 5,000

1633 Brisha Alnamira S 0002572-2201.2017 0.9 P 31/05/17 A01.0 Rp 5,000

1634 Ichwan Mauludin Nugraha 0002581-2201.2017 18.8 L 31/05/17 Z02.7 Rp 5,000

1635 Sri Antun Binti Sarkadi 0004004-2230.2015 51.3 P 31/05/17 E11; J02 Rp 5,000

1636 RANA DIANA 0001531-2201.2013 15.8 P 31/05/17 J02 Rp 5,000

Jumlah Rp 6,765,000 Rp 1,027,000 Rp 780,000 Rp 215,000 Rp -


Pemriksaa Keterangan
Total
n Lab Lab/Tindakan
13 14 15

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 19,000 Rp 14,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 25,000 Rp 20,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 25,000 Rp 20,000

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 25,000 Rp 20,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 19,000 Rp 14,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 12,500 Rp 7,500

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 25,000 Rp 20,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,500 Rp 7,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 20,000 Rp 15,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 12,000 Rp 7,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 5,000 Rp -

Rp - Rp 15,000 Rp 10,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 10,000 Rp 5,000

Rp - Rp 10,000 Rp 5,000

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -
Pemriksaa Keterangan
Total
n Lab Lab/Tindakan

Rp - Rp 7,500 Rp 2,500

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - Rp 5,000 Rp -

Rp - ### Rp 607,000

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