LAPORAN REKAPITULASI DATA SKRINING RIWAYAT KESEHATAN

FKTP KLINIK CITRA 18

BULAN APRIL TAHUN 2017

NO. TANGGAL PEL NOMOR KARTU NAMA PASIEN BPJS BIAYA

1 ### 0001125995714 SAMIJO Rp 1,000

2 ### 0001125998166 FATHUR ROHIM Rp 1,000
3 ### 0001127239986 IIN LESTARI Rp 1,000
4 ### 0001127736347 HARTADI Rp 1,000
5 ### 0001151663229 ARIF HIDAYAT Rp 1,000
6 ### 0001152329635 WAHYU BAROTO Rp 1,000
7 ### 0001152944493 YOSO Rp 1,000
8 ### 0001153664741 MOCH YAHYA BAGUS P. Rp 1,000
9 ### 0001194299943 SULASTRI Rp 1,000
10 ### 0001197871536 MEGA SEPTYA Rp 1,000
11 ### 0001294779993 MULYADI Rp 1,000
12 ### 0001294780048 SULIS SIYANI Rp 1,000
13 ### 0001821535209 DWI HARJANTO Rp 1,000
14 ### 0001878234996 melina ika yuliarsih Rp 1,000

PROBOLINGGO , 30 APRIL 2017

Penanggung Jawab KLINIK CITRA 18

( dr. Lusi Tri Wahyuli )

 LAPORAN REKAPITULASI DATA SKRINING RIWAYAT KESEHATAN
FKTP KLINIK CITRA 18
BULAN MEI TAHUN 2017

TANGGAL
NO. NOMOR KARTU NAMA PASIEN BPJS BIAYA NO.
ENTRY

1 ### 0000171603573 IRLA ZULIATI, S.SI Rp 1,000 46

2 ### 0001125537017 SeLAMET Rp 1,000 47
3 ### 0001125995758 EDI WAHYONO Rp 1,000 48
4 ### 0001125996895 SAIFUL BAHRI Rp 1,000 49
5 ### 0001125998199 BAMBANG HERMANTO Rp 1,000 50
6 ### 0001126325316 SUTOMO Rp 1,000 51
7 ### 0001126325406 SAMSUL ANAM Rp 1,000 52
8 ### 0001126423023 HOLILI Rp 1,000 53
9 ### 0001127179539 AKHMAD SULAIMAN Rp 1,000 54
10 ### 0001127239931 ELVI RIYATI Rp 1,000 55
11 ### 0001127767026 SOnNY BAGoeS wicaksono Rp 1,000 56
12 ### 0001127920026 SUPRIHATIN Rp 1,000 57
13 ### 0001130220009 WAHYU PRIHANDONO Rp 1,000 58
14 ### 0001130415311 EDY PURWANTO Rp 1,000 59
15 ### 0001132527824 INDAH CAHYA PUTRI Rp 1,000 60
16 ### 0001139681709 MOHAMMAD SOLEH Rp 1,000 61
17 ### 0001143464117 SULISTYONINGSIH Rp 1,000 62
18 ### 0001145924526 TIDAR WAHYU HARIYANTO Rp 1,000 63
19 ### 0001147283155 MIYANTORO Rp 1,000 64
20 ### 0001150065022 ANDREAS SETYO HERLAMBANG Rp 1,000 65
21 ### 0001151676505 MUHAMMAD ROHIM Rp 1,000 66
22 ### 0001151676538 SUJOKO Rp 1,000 67
23 ### 0001151676549 SRI MIDAYANI Rp 1,000 68
24 ### 0001151687586 DWI ERFINNINGRUM Rp 1,000
25 ### 0001151719334 AHMADI Rp 1,000
26 ### 0001151895767 SULASTRI JAYATI Rp 1,000
27 ### 0001152329804 SULUNG WAHYUDI Rp 1,000
28 ### 0001155832378 LARAS WATI Rp 1,000
29 ### 0001162733861 JUMA'IYAh Rp 1,000
30 ### 0001162851063 ENDANG WIDAYATI Rp 1,000
31 ### 0001176197938 MAMIK HARIYATI Rp 1,000
32 ### 0001176931855 SITI MARYAM Rp 1,000
33 ### 0001176955435 NURLeLA Rp 1,000
34 ### 0001181234889 JUARIYAH Rp 1,000
35 ### 0001181912141 WIWIN HANDAYANI Rp 1,000
36 ### 0001182408952 UNUN SOFFIA Rp 1,000
37 ### 0001183278216 BAKTI NURJAYA Rp 1,000
38 ### 0001184001906 PUJI LESTARI Rp 1,000
39 ### 0001194392417 SUDARMIN Rp 1,000
40 ### 0001195535608 RINI WULANDARI Rp 1,000
41 ### 0001196119203 HOLIFA Rp 1,000
42 ### 0001196646748 SUYATIN Rp 1,000
43 ### 0001197505383 SUMAIDAH Rp 1,000
44 ### 0001197590747 SUHENI Rp 1,000
45 ### 0001197627759 NURHASANAH Rp 1,000
TANGGAL PEL NOMOR KARTU NAMA PASIEN BPJS BIAYA

### 0001197632621 SUPLANA Rp 1,000

### 0001200583383 LAMIJAH Rp 1,000
### 0001200583664 ika yunianingsih Rp 1,000
### 0001204226526 ANIK INDRASwARI Rp 1,000
### 0001280607849 RIO MARTHA LOKA Rp 1,000
### 0001290332351 DAMIATI RAVIKADURI Rp 1,000
### 0001297757913 HUSNUL HOTIMAH Rp 1,000
### 0001310986506 EKO MOHAMMADYANI Rp 1,000
### 0001310987283 NANIK DWI SUSANTI Rp 1,000
### 0001319358508 TUKIYAH Rp 1,000
### 0001326625086 MUSTOFA Rp 1,000
### 0001379254814 ISTIANAH Rp 1,000
### 0001423196199 ARIS SETIAWAN Rp 1,000
### 0001425356864 SAFIRA NUR AFNI Rp 1,000
### 0001430049137 ENDANG YULIASTUTIK Rp 1,000
### 0001478191465 ENDAH SUPRIYATIN Rp 1,000
### 0001538545364 Eky Trisnaini Rp 1,000
### 0001538940058 HAPPY ANANTO CAHYONO.ST Rp 1,000
### 0001632568138 ACHMAD SYAIFUDIN Rp 1,000
### 0001826273801 MUAiYeNA Rp 1,000
### 0001888282675 JUMINA Rp 1,000
### 0002044603912 muzayanah Rp 1,000
### 0002241998289 SITI ASIA Rp 1,000

PROBOLINGGO , 31 MEI 2017

Penanggung Jawab KLINIK CITRA 18

( dr. Lusi Tri Wahyuli )

 LAPORAN REKAPITULASI DATA SKRINING RIWAYAT KESEHATAN
FKTP KLINIK CITRA 18
BULAN JUNI TAHUN 2017

NO. TANGGAL PEL NOMOR KARTU NAMA PASIEN BPJS BIAYA

z
1 ### 0001126010114 AKUS Rp 1,000
2 ### 0001126011734 JOKO PURNOMO Rp 1,000
3 ### 0001126325362 IMAM SYAFII Rp 1,000
4 ### 0001127239964 ABU SISWANTO Rp 1,000
5 ### 0001130219919 PALIL Rp 1,000
6 ### 0001130238731 KASIyADI Rp 1,000
7 ### 0001132566074 NURUL CAHYONO Rp 1,000
8 ### 0001132635148 DIANA RISDARJANTI M Rp 1,000
9 ### 0001137090947 EKO SUGIANTO Rp 1,000
10 ### 0001139676524 SUGENG BUDI HARTONO Rp 1,000
11 ### 0001139676546 DJOKO TRISNO Rp 1,000
12 ### 0001147577916 BAINASSALAMAH Rp 1,000
13 ### 0001151679947 ADI PURNOMO Rp 1,000
14 ### 0001151687722 BEBUN Rp 1,000
15 ### 0001151789984 ADOL FINA DARONGKE Rp 1,000
16 ### 0001152329872 ACHMAD FATURROZID SIDIQ Rp 1,000
17 ### 0001155837317 NURHAYATI Rp 1,000
18 ### 0001162718684 BUDI HERWIYANTINI Rp 1,000
19 ### 0001162734658 NURUL ASHA Rp 1,000
20 ### 0001162861389 RIRIN EKAWATI Rp 1,000
21 ### 0001176805102 ENDANG PRIHATINING Rp 1,000
22 ### 0001179179098 ENDANG BUYAMI Rp 1,000
23 ### 0001194392452 WIWIK SUDIARTI Rp 1,000
24 ### 0001195429882 MUSDOLIFAH Rp 1,000
25 ### 0001195666661 SULHANA Rp 1,000
26 ### 0001195867686 RIKA SETYAWAn Rp 1,000
27 ### 0001196922982 TRI WULANDARI Rp 1,000
28 ### 0001201827699 ABD. MARUM Rp 1,000
29 ### 0001201905472 ATIK RAHMAWATI Rp 1,000
30 ### 0001204963942 DESYI IRMAWATI Rp 1,000
31 ### 0001282542772 ARIEF Rp 1,000
32 ### 0001303831642 LULUK MUKAROMAH Rp 1,000
33 ### 0001310081095 OKTARIANI DWI PUSPITASARI Rp 1,000
34 ### 0001318948299 MAISAROH Rp 1,000
35 ### 0001385533901 SRI WAHYUNI Rp 1,000
36 ### 0001424528548 suyono saputra Rp 1,000
37 ### 0001600234053 MASLINDA SUSIATI Rp 1,000
38 ### 0001807916218 CAECILIA SUDHARWATI Rp 1,000
39 ### 0001816922979 wirawan setioandiko Rp 1,000
40 ### 0001821600808 MULYADI Rp 1,000
41 ### 0001842455507 ANDISYAH BEBI ARINDA Rp 1,000
42 ### 0001867989644 KOESTIJAH Rp 1,000

PROBOLINGGO , 30 JUNI 2017

Penanggung Jawab KLINIK CITRA 18
( dr. Lusi Tri Wahyuli )
NO. TANGGAL PEL NOMOR KARTU NAMA PASIEN BPJS BIAYA

PROBOLINGGO , 30 JUNI 2017

Penanggung Jawab KLINIK CITRA 18

( dr. Lusi Tri Wahyuli )

 LAPORAN REKAPITULASI DATA SKRINING RIWAYAT KESEHATAN
FKTP KLINIK CITRA 18
BULAN JULI TAHUN 2017

NO. TANGGAL PEL NOMOR KARTU NAMA PASIEN BPJS BIAYA

1 ### 0000112152519 BENING MARYATI Rp 1,000

2 ### 0001126020183 SUSILA Rp 1,000
3 ### 0001126327937 SUHERIYANTO Rp 1,000
4 ### 0001126333901 SAMHADI Rp 1,000
5 ### 0001127221852 NURUL FATHONI Rp 1,000
6 ### 0001127240155 SINGGONO Rp 1,000
7 ### 0001127741242 CHUSNUL CHOTIMAH Rp 1,000
8 ### 0001127964633 AINUL FATONI Rp 1,000
9 ### 0001130235118 MOCH CHOLIQ Rp 1,000
10 ### 0001131204835 HULUN ANDHAWATI Rp 1,000
11 ### 0001133181156 EDY PURNOMO Rp 1,000
12 ### 0001137090879 SUDARMAJI Rp 1,000
13 ### 0001140104035 MUFARIDA Rp 1,000
14 ### 0001141547332 WINARNO Rp 1,000
15 ### 0001150421174 JUARTININGSIH Rp 1,000
16 ### 0001151657594 MOCH SOLEH Rp 1,000
17 ### 0001151662307 MUHAMMAD JUARI Rp 1,000
18 ### 0001151666919 MOCH AMOKO Rp 1,000
19 ### 0001151687564 JULAIKA Rp 1,000
20 ### 0001151716498 ALFIAN Rp 1,000
21 ### 0001154853472 NORMALA SITI ANISA Rp 1,000
22 ### 0001178430862 MARIA UTAMI Rp 1,000
23 ### 0001193293427 WIWIN MIRGAWATI Rp 1,000
24 ### 0001194100896 MISWATUN HASANAH Rp 1,000
25 ### 00001196119179 USaNAWIYAH Rp 1,000
26 ### 00001197107943 TITIK RUSMI Rp 1,000
27 ### 00001197505517 ISMIYATUN Rp 1,000
28 ### 00001197627513 DESY SUSANTI Rp 1,000
29 ### 0001200080518 SRI PUJIATI Rp 1,000
30 ### 0001200156052 NOFITA YULIASTUTIK Rp 1,000
31 ### 0001445441951 ADI SUSANTO Rp 1,000
32 ### 0001636578268 ABDUL GOFUR Rp 1,000
33 ### 0001789659224 hasim munir Rp 1,000
34 ### 0001800933996 subarjo Rp 1,000
35 ### 0001838331167 siti aminah Rp 1,000
36 ### 0001855674742 HERY SUSILO Rp 1,000
37 ### 0002072965206 DJUWAR LILIK Rp 1,000

PROBOLINGGO , 31 JULI 2017

Penanggung Jawab KLINIK CITRA 18
( dr. Lusi Tri Wahyuli )
17070127300 7/17/2017 112152519
17070061114 7/10/2017 1126020183
17070027360 7/4/2017 1126327937
17070104913 7/11/2017 1126333901
17070127239 7/17/2017 1127221852
17070224298 7/27/2017 1127240155
17070127050 7/17/2017 1127741242
17070155657 7/19/2017 1127964633
17070104889 7/11/2017 1130235118
17070058483 7/5/2017 1131204835
17070104946 7/12/2017 1133181156
17070127202 7/17/2017 1137090879
17070027446 7/3/2017 1140104035
17070138303 7/18/2017 1141547332
17070104937 7/12/2017 1150421174
17070060520 7/10/2017 1151657594
17070104950 7/12/2017 1151662307
17070058516 7/5/2017 1151666919
17070173252 7/22/2017 1151687564
17070235210 7/28/2017 1151716498
17070027468 7/3/2017 1154853472
17070060407 7/10/2017 1178430862
17070224368 7/27/2017 1193293427
17070027389 7/3/2017 1194100896
17070058447 7/5/2017 1196119179
17070104925 7/11/2017 1197107943
17070248286 7/31/2017 1197505517
17070155562 7/19/2017 1197627513
17070231002 7/28/2017 1200080518
17070155605 7/19/2017 1200156052
17070027498 7/3/2017 1445441951
17070138281 7/18/2017 1636578268
17070224256 7/27/2017 1789659224
17070027422 7/3/2017 1800933996
17070173211 7/22/2017 1838331167
17070060680 7/10/2017 1855674742
17070245541 7/31/2017 2072965206
BENING MARYATI
SUSILA
SUHERIYANTO
SAMHADI
NURUL FATHONI
SINGGONO
CHUSNUL CHOTIMAH
AINUL FATONI
MOCH CHOLIQ
HULUN ANDHAWATI
EDY PURNOMO
SUDARMAJI
MUFARIDA
WINARNO
JUARTININGSIH
MOCH SOLEH
MUHAMMAD JUARI
MOCH AMOKO
JULAIKA
ALFIAN
NORMALA SITI ANISA
MARIA UTAMI
WIWIN MIRGAWATI
MISWATUN HASANAH
USaNAWIYAH
TITIK RUSMI
ISMIYATUN
DESY SUSANTI
SRI PUJIATI
NOFITA YULIASTUTIK
ADI SUSANTO
ABDUL GOFUR
hasim munir
subarjo
siti aminah
HERY SUSILO
DJUWAR LILIK