No Nama/MedRec Umur Telp Jaminan Diagnosa

G4P3A0 hamil 37 Tindakan DPJP Tgl Operan Tgl Terjadwal OK Keterangan

minggu belum
Rosalia Rubini/ 1/1/1982 085380072376 BPJS 3 inpartu dan PPT SC + tubektomi AP 24/5/2017 31/5/2017 COT SAT-SRI
1007 akreta, JTH
Ela Wahyuniz/ 18/8/2008 085266375852 preskep
BPJS 2 NOK Laparoskopi VC AM 26/05/17 31/07/2017 COT SAT-SPM
10062702

Mardiana binti Adenomioma

Ismail Kopli/ 5/8/1974 081272823925 BPJS 1 uteri + infertil HDLO KY 26/05/2017 15/8/2017 Graha SAT-PLM
1007131 primer 7 tahun

Nur Rahmah
Amaliyah/ 30/4/1997 082282500952 BPJS 3 NOK bilateral Laparoskopi VC KY 26/05/2017 16/8/2017 Graha SAT-RIC
1007236

Meidina Nadiah 9/5/1996 Kista

082176631912 BPJS 1 LO KY 29/05/2017 21/6/2017 Graha SAT-SBE
Iman/1006809 endometrium

Fadina Ria Sari/ 8/8/1976 081278262527 BPJS 2 PUA ec L1 LO KY 29/05/2017 15/6/2017 Graha SAT-KY
1007455
Nawiyah binti
Pranoto/100701 30/6/1965 085268363433 BPJS 3 Mioma uteri Histerektomi RS 29/05/2017 20/7/2017 COT SAT-IBE
2
Sri Mamyah 3/9/1953 0711540069 LGSIL LEEP IS 29/05/2017 21/07/2017 Graha SAT-IY
Yohanah
histeroskopi
Dwi Anggraini/ dnc
8/2/1983 081377826867 VIP PUA ec P1 RS 29/05/2017 20/7/2017 Graha SAT-IBE
1009760
 NOK musinosin
bilateral + infertil
Sumarni binti
Nuran/ 1007570 1/11/1973 082186866602 BPJS 3 primer 3 tahun + HDLO + VC IS 30/5/17 21/8/17 Graha SAT-UH
perlengketan
genitalia interna

Suparni binti NOK campuran

Towel/ 1007075 5/12/1962 082306247525 BPJS 3 padat dan kistik Laparoskopi VC RS 30/5/2017 14/8/2017 COT SAT-SDM

Histerektomi
Adenomioma
R.Ayu Halimah/ 25/9/1973 082177689497 uteri + kista
BPJS 1 KY 30/5/2017 3/8/17 COT SAT-AL
1007148 endometrium +
NOK

Kista
Musiati binti
Masjid/1007756 7/2/1983 085247080318 BPJS 2 endometrium HDLO AC 30/5/2017 7/9/2017 COT SAT-AU
bilateral

Parni binti Rita 13/4/1965 085378127773 BPJS 3 NOK dan NOP Laparoskopi VC AM 30/5/2017 22/8/2017 Graha SAT-ADT
Rejo/ 100746

Fajriawati, Spd 2/2/1980 081367312669 BPJS 1 NOK PDLU + VC IS 30/5/2017 23/8/2017 Graha SAT-LIN

Ririn Siti repair

Nurhasanah/ 12/10/01 Ruptur perineum AF 30/5/2017 2/6/17 COT SAT-SPM
perineum
977441

Ca Serviks +
Paeni binti Kano hiperplasia
Kromo/ 12/09/1959 081373322325 BPJS 3 Histerektomi AS 30/5/2017 17/7/2017 COT SAH-SPM
endometrium +
1004508 NOK

Sri Secondary
Wahyu/800082 18/07/1969 082379658932 BPJS 3 Ca ovarium AT 30/5/2017 24/7/17 COT SAH-SPM
Debelly
Fatmawati binti Miomektomi +
Madani/ 18/11/78 085368938893 BPJS 3 PUA ec L1 FY 30/5/2017 12/7/2017 COT SAH-SGH
histerektomi
1007794

Shinta Kista
Oktariyani Boxy/ 12/10/1988 085267514133 BPJS 2 endometrium HDLO + VC LS 31/5/2017 24/8/2017 Graha SAT-RIC
1007807 bilateral DD/NOK

NOK tipe
Sri Maryani/ 3/3/1987 08229598259 BPJS 3 musinosin Laparoskopi VC AT 31/5/2017 25/8/2017 Graha SAT-SPM
1007729 bilateral

Kista
Mira Sukarto/ 16/2/1978 085838614865 BPJS 2 endometrium LO RS 2/6/2017 24/7/2017 Graha SAT-UH
681729 bilateral

Kista
Nurhalima
Sodikin/ 750212 3/11/1991 085368404048 BPJS 3 endometrium kiri HDLO KY 2/6/17 7/8/17 Graha SAT-UH
+ infertil 5 tahun

Alimah binti
Sohat/ 1008433 3/6/1975 085269065913 BPJS 2 PUA ec L1A1 HDLO RS 2/6/2017 28/8/2017 Graha ST-ADT

Utami binti Kista

Jasman/ 23/3/1983 082378553761 BPJS 2 HDLO KY 2/6/2017 29/8/2017 Graha SAT-ADT
endometrium
1108327

Suryadi binti Heteroskopi

Mashud/ 26/12/1966 085769879480 BPJS 3 PUA ec A1 RS 2/6/17 11/8/2017 Graha SAT-SGH
DnC
1008273

Nabila binti
Syamsul Ishak/ 9/5/2003 081368156350 BPJS 3 NOP suspek ganas Laparoskopi VC AM 2/6/2017 21/8/2017 COT SAT-ACI
1003210
 Sulailah binti
Andika/ 12/7/2017 081272610238 BPJS 3 NOK bilateral Laparoskopi VC AM 2/6/2017 22/8/2017 COT SAT-ACI
1005289
1 Veralia 7/9/1985 081278691414 G2P1A0 dengan Laparoskopi
Puspitasari KE AF 05/6/2017 Graha ANG-AF
2 Ernita Binti 1/3/1971 081368853002 NOK Laparotomi
Nurhajan IS 05/6/2017 COT ANG-SUR
3 Rista Afika 12/11/1971 081273749432 Ca Ovarium Surgical Staging
Inadequate IS 05/6/2017 COT ANG-SPM
Staging

4 RA Rodiah 12/11/1971 08532862491 PUA ec M1 Histereskopi

DnC RS 05/6/2017 Graha ANG-SPM
5 Yuliani Binti 16/7/1975 08522044312 NOP campur kistik Laparatomi VC
Sopian suspek ganas RS 05/6/2017 COT ANG-SUR

6 Irma Kartika 7/5/1987 081373470974 PUA ec P1 HDLO RS 5/6/2017 Graha ANG-CIH

7 Bong Sun Kim/ 18/7/1971 085268011916 Suspek NOK Laparotomi VC
1008479 bilateral + Ascites AT 6/6/2017 COT ANG-SUR
masif

8 Zufli Zamala 082177509619 Kista LO

Dewi Endometriosis KY 7/6/2017 Graha ANG-LAT
9 Ritawaty 081379296565 Translokasi IUD Histeroscopy SME - EDP
IS 7/6/2017 Graha (GIN)
10 Nopela Sapta 0813367285237 NOK LO
Pahlawani AT 7/6/2017 Graha ANG-LAT
11 Sri Masriyem/ 087897040720 LEEP
940069
IS 5/6/2017 Graha ANG-IS

Fajra Wati 085368009717 Kista HOLD

Endometrium IS 5/6/2017 Graha ANG-IS
1 Sumarni 082186866602 Kista HOLD
Endometrium IS 5/6/2017 Graha ANG-IS

2 Shinta 085267514133 Kista LO

Oktariyani endometriosis IS 5/6/2017 Graha ANG-IS
bilateral

3 Rista Afika 081273749432 Ca Ovarium Laparoskopi

Inadequate IS 5/6/2017 Graha ANG-IS
Staging
No Nama/MedRec umur nope jaminan dx tx dpjp
4 Fera Susanti 11/7/1990 08576446301 G2P1A0 SC
6 hamil 38
minggu
belum
inpartu
dengan
bekas SC IS
1x JTH
preskep

5 Putri 30 08535773333 G3P1A1

7 hamil 38
minggu
bekas SC NS
1x JTH
preskep

6 Bong Sun Kim/ 38 08526801191 Suspek Lap VC

1008479 6 NOK
bilateral +
Ascites AT
masif

7 Suaparti binti 18/3/1974 08237572016 Kista HOLD

Warisno 0 endometr
iosis +
polip
endometr
ium +
inferti KY
primer 3
tahun

8 Sudarmi Asih 12/6/1975 08535769044 BPJS 3 HGSIL Laparosco

Binti Kamijo 1 py +
histerekto AT
my

9 Sefty Andini 6/9/1987 08137368333 Ca Secondar

2 Ovarium y
Residif debulking
RS

10 Nani Arnani 8/11/1973 08583279928 Adenomi Reseksi

2 osis uteri Adenomi KY
osis

11 Nuro binti BPJS 3 08536730352 Suspek Laparoto AT

Nanguning 1 NOP mi VC
DD/Miom
a uteri
12 Nur Kholbi 08230638397 Kista LO
7 endometr KY
ium

13 Zelina 13/1/1971 08238000571 HT

9 Radikal AT
14 Irma Kartika 7/5/1987 08228155221 PUA ec HOLD
2 P1 IZ
15 Nurul Lani 08137318391 Kista Laparoto
3 Ovarium mi VC RS
16 Esih Contiasih 08576459559 Ca HT
4 Endometr Laparosko RS
ium pi

Ina Marya 30/6/1968 08536932926 Ca Cx Lib Secondar

0 y
debulking IS

Ratnawaty 18/3/1976 08228176121 Ca Secondar

2 Ovarium y
Inadequa debulking
te Staging AM

1 Aida Holidin Ca Cervix Radikal

post HT Tracheost IS
omy

2 Mardiana binti 08127321218 Endoetrio HOLD

Musa 5 sis
recurrent RS

3 Evi Pusrspitasari 08772999383 Mioma HDLO

0 uteri +
infertil
primer 2 AA
tahun

4 Megawati binti 08536799841 NOK Laparoto

Akir 4 multiklok mi VC RS
uler

0 Rista Afika 08127374943 Ca Laparoto

2 Ovarium my
Inadequa surgical
te Staging staging IS

Evriyani binti PUA ec histerosk

Syakroni P1 opi d n c KY
21/2/1975 085273732075
Maryam Binti Adenomi Laparoto
Gadimu osis uteri mi
histerekto AT
mi
085269032013KIS
Nuriani binti Ca histerosk
Hmatalon Endometr opi d n c AM
ium
10/11/1953 081273710660
Sumiarni Kista HOLD
endometr
iosis
bilateral +
infertil AC
primer 7
tahun

8/1/1980 081367071824
Hotdor Maida PS NOK Laparoto
campur mi VC IS
padat
8/7/1979
Ismuryati binti Infertil HDLO
Ibnu Hajar primer 10 AT
tahun
1/10/1976 081377604208BPJS 1
Nurlela binti Kista HDLO
Achmad endomer
tiosis +
adenomi HE
osis
081271022444BPJS 3
Nurainun binti Multipel Laparoto
A.Rahman mioma my
uteri miomekt KY
omi
14/1/1974 081367115004BPJS 2
Mira Binti Kista HDLO
Maskum endometr KY
iosis
17/6/1988 085384042006BPJS 2
Fifi Astuti Disminor HDLO
e berat ec
endometr
iosis uteri RS

2/2/1988 085384042006
Ismiyati binti kista HDLO
Purwoto endometr
iosis +
inferti HE
sekunder
3 tahun

28/11/1983 085841117398BPJS 3
Wahyuni binti Endometr HDLO
H.Jailani iosis KY
081273780997BPJS 1
Iin Hairani Mioma Laparoto
uteri mi AA
081278031274BPJS 3
Mardiana binti Adenomi HDLO
Ismail Kopli osis uteri
+ infertil
primer 17 KY
tahun
5/8/1974 081272823925BPJS 1
Nur Rahmah NOK Laparosko
Awaliyah suspek pi VC KY
bilateral
30/4/1997 082282500952BPJS 3
Fatmawati binti Kista LO
Jahya endometr RS
iosis
082186887172KIS
Gustia Rini Kista HDLO
endometr IS
iosis
8/8/1981 085367226586BPJS
Ernita binti NOK Laparosko
Nurhasana multiklok pi
uler IS
dekstra
081368853002BPJS 1
Yuhana Mulyadi Ca Secondar
Ovarium y RS
residif
082177652221BPJS 1
Mery Triana / LGSIL histerosk
1005281 opi d n c AM
20/3/1976 08136667570 JKS
Astiana binti NOK Laparoto
Yusuf suspek mi VC RS
ganas
12/5/1954 082379730407BPJS 3
Rani binti Guntur/ LGSIL LEEP
1008311 IS
9/1/1990 085266775004
Suhartini binti HGSIL histerosk
Johan opi d n c RS
22/2/1959 081278272763BPJS 1
Putri Rahmi Yanti Kista Laparoto
endometr mi +
iosis kistektom IS
i
085369328151
Fatimah binti NOK Laparoto
Rumli multiokul mi VC AM
er
23/11/1947 085368513163
Meriyani binti NOK Laparoto
A.Kadir/ 993507 Permagna mi VC
dengan
perlengke RS
tan
081271911138
Rosidah binti HGSIL LEEP
Zakaria/ 1008462 IS
9/12/1971 082372079118
Ida Safriani, Spd Adenomi Histerekt
osis uteri omi
+Kista
endometr RS
iosis kiri
41 085367893488BPJS 1
Yuliani binti NOP Laparoto
Sopian campur mi VC
kistik
suspek RS
ganas
16/7/1975 085220433124
Romlah binti Mioma + Surgical
Ramzi/ 996725 NOP staging AT
081278791563BPJS 2
Vivi Susana NOP Laparoto
Ndolu/ 996190 suspek mi vc RS
ganas
081278253426BPJS 2
Fatmawati binti Ca Cervix HT
Kosim/ 998289 stadium IS
IIB
085273502977
Nurkholbi Disminor Laparosko
Holidiah/ 999043 e ec pi
suspek operatif
kista
endometr
iosis

08230633977
Hj.Zawahir SH Ca Surgical
bntin H.Zaini/ endometr stagging AT
996574 ium
BPJS 2
Tri idayati/ PUA ec HTSDU
999433 L1M1 +
Kista
endometr
iosis
bilateral
infertil RS
sekunder
13 thaun
Ernawati/ 886995 PUA ec L1 LO
HE
18/4/1973 085381517675BPJS 2
Indah binti Abdul Pseudo Laparoto
Hamid/ 702106 myxoma mi RS
peritonil
085367291113
Nurhayati binti Ca Cx IIIB Ht radikal
Abdul Cholik AT
29/6/1972
Emi binti Malia/ NOK Laparoto
996674 campur mi VC
padat
suspek RS
ganas

Masna Maria Mioma Laparoto

Marta uteri mi VC IS
5/12/1978 085789741099
Masmorlindo Kista Laparoto
binti Masud Ali/ endometr mi +
834862 iosis histerekto AA
mi
085380146197
Lismaria binti NOP Laparoto
Ibrahim/ 1006946 campur mi VC FY
kistik
12/8/1970 081272141903
Susiana binti Dismenor HDLO
Suhaili/ 1000028 hea ec
suspek
kista
endometr
iosis +
infertil IZ
primer 15
tahun

082307662835
Yusnita binti Adenomi Histerekt
Ismail/ 997359 osis + omi
mioma RS
uteri
081272569662
Farida binti
Umar/ 99904
8/12/1970 082182577975 Ca Cervix sHT RadikalRS
Marsuna binti
Ismail Abidin/
996944
085766768878 AdenimiosiLaparotomRS
Kismawaty binti
Sersam/1010845

6/10/1954 081373934477 NOP kananLaparotomiAT

Emi binti Malia/
996674
081377803678 NOK campu
LaparotomRS
Masnah Maria
Marta
5/12/1978 085789741099 Mioma uteLaparotomIS
Masmorlindo
binti Masud Ali/
834862
085380146197 Kista EndoLaparotomiAA
Lismaria binti
Ibrahim/ 1006946
12/8/1970 081272141903 NOP campur
LaparotomFY
Susiana binti
Suhaili/ 1000028
082307662835 Dismenorha
HDLO IZ
Yusnita binti
Ismail/ 997359
081272569662 Adenomiosi
Histerekto RS
Farida binti
Umar/ 99904
082182577973 Ca Cervix sHT radikal RS
Marsuna binti
Ismail Abidin/
996944
085766768878 Adenomiosi
LaparotomRS
Kismawaty binti
Sersam/1010845

6/10/1954 081373934477 NOP kananLaparotomAT

tgl dk jelas1 tgl dk jelas2 tgl tindakan ket

18 November
42862 17/7/2017 COT ANG-IS
3763

Perawat
17/7/2017 COT Rupit

18/7/2017 COT

Pasien
kontrol
ulang dan
sementar
27 Desember
42769 18/7/2017 Graha a
2017 menolak
op dari
tanggal
8/5/2017

22 September
42850 18/7/2017 Graha
4644

jangan
10 Februari diundur,
19//7/2017 COT
4424 dari bulan
4 SME

8 September 19/7/2017 COT

4659
Jalan
29 Maret 4342 19/7/2017 COT rusak
 Graha

10 Februari 20/7/2017 COT ANG-SUR

4665

21/7/2017 COT ANG

31//7/2017 COT

31/7/2017 Graha

SME -
1/8/2017 COT RZM

2/8/2017 COT ANG-TRI

42862 3/8/2017 COT ANG-BAR

28 November 4/8/2017 Graha

4302

23 Januari 4/8/2017 Graha ANG-ABR

4669

9 April 4654 24/7/2017 COT b

24/7/2017 COT ANG-ALH

24/7/2017 Graha
 25/7/2017 COT ANG-SUR

26/7/2017 Graha ANG-SUR

28/7/2017 Graha ANG-LIH

7/8/2017 COT ANG-TRI

Graha ANG-AT
42862 7/8/2017

Graha ANG-ABR

7/8/2017

COT ANG-ABR

8/8/2017

Graha
9/8/2017

Konsul
katanya
Graha sudah,
tapi
pastikan
42889 11 Februari 462 11/8/2017

Graha

27 maret 2394 23 juli 4655 14/8/2017

 Graha
14/8/2017
COT
15/8/2017

8 April 2613 5 Juni 4657 15/8/2017

8 April 2613 8 september 4615//8/2017

Graha
16/8/2017 ANG-NIC

Graha
6/7/2017 16/6/2017 ANG-IS

Graha

6/5/2017 22/8/2017 ANG-SGH

COT
23/8/2017
Graha
23/8/2017

COT
13 Desember 4 24/8/2017

Graha
25/8/2017 ANG-SAT
Graha
25/8/2017 ANG-ALH

COT

28/8/2017

COT
29/8/2017 ANG-ALH
 COT

30/8/2017 FTA-AJG jangan dipindah

Graha
30/8/2017 tidak bisa dibuhungi

COT

21 Maret 3406 31/8/2017 jangan dipindah lagi

COT

31/8/2017 ANG
COT
13/3/2017 4/9/2017

COT
13/3/2017 5/9/2017

COT
5/9/2017

Graha

5/9/2017

6/9/2017

3/3/2017 6/9/2017
 6/9/2017

14/3/17 7/9/2017

19 Juli 4553 7/9/2017

14/3/2017 11/9/2017

5/7/2017 11/9/2017 Menunggu NAC 3 seri

14/3/2017 12/9/2017

6/7/2017 12/9/2017 ANG-AT

4/4/2017 12/9/2017 KL-3-17

6/7/2017 13/9/2017 ANG-FEL

6/7/2017 13/9/2017 COT

14/3/2017 14/9/2017 COT

5/7/2017 14/9/2017 COT

14/3/2017 11/9/2017 COT

6/7/2017 11/9/2017 COT ANG-AT

4/4/2017 12/9/2017 COT

15/3/2017 12/9/2017 COT ANG_FEL

6/7/2017 12/9/2017 Graha

15/3/2017 13/9/2017 COT

6/7/2017 13/9/2017 COT

15/3/2017 14/9/2017 COT

6/7/2017 14/9/2017 COT