Jamkesmas Noval

DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMAS DI P
PROPINSI JAWA TENGAH

KAB/KOTA BREBES
Kepada Yth
Kepala Dinas Kesehatan Kab/Kota BREBES
di- Tempat
Bersama ini Kami ajukan tagihan Klaim Pelayanan Kesehatan Umum Rawat Jalan Peserta Jamkesmas
No. KARTU JENIS

UMUR KELA
No. NAMA PASIEN PESERTA alamat MIN
(Thn)
JAMKESMAS (L/P)
(1) (2) (3) (4) (5)
1 suparti 0000638306632 kramat rt 08 rw 02 44 th P

2 ratini 0000638666804 pds lohor rt 16 rw 04 65 th P
3 m deni 0000639481419 janegara rt 08 rw 01 4 th L
4 tahri 0000639180573 janegara rt 01 rw 01 73 th L
5 sumitri 0001032402622 jakid rt 04 rw 01 80 th P
6 daryono 0000638606132 jalor rt 04 rw 01 53 th L
7 asriyani 0000636286466 karanglo rt 06 rw 02 20 th P
8 edy sudiono 0000639036494 jakid rt 03 rw 03 66 th L
9 yogo 0000639506569 dk maja rt 05 rw 05 6 th L
10 putri 0000639509574 dk maja rt 05 rw 05 12 th P
11 washadi 0000638261673 kb nagung rt 05 rw 02 40 th L
12 baedah 0001032400407 jakid rt 06 rw 02 80 th P
13 titin 0001032407741 jakid rt 03 rw 02 46 th P
14 karnijah 0000636114905 karanglo rt 05 rw 01 76 th P
15 kartini 0000639210321 jakid rt 03 rw 10 60 th P
16 toinah 0000636307142 jakid rt 03 rw 04 60 th P
17 calon 0000638382122 tg wulung rt 10 rw 04 58 th L
18 kasriah 0000638944412 jakid rt 02 rw 12 37 th P
19 dini fitriana 0000636128036 jalor rt 05 rw 05 9 th P
20 faozi 0001032638622 glonggong rt 02 rw 03 55 th L
21 m fahrizal 0000637939956 jalor rt 03 rw 02 21 th L
22 anis 0000636429396 kr sembung rt 03 rw 05 11 th P
23 titin 0000632866068 rg pendawa rt 03 rw 02 2 th P
24 zahrotun 0000638612202 wana cala rt 03 rw 08 5 th P
25 khaerudin 0000636127982 jalor rt 08 rw 06 29 th L
26 syahkia 0000638778334 wana cala rt 03 rw 03 5 th P
27 sri mulyati 0000638707937 km amba rt 08 rw 02 19 th P
28 kalpiyah 0000638684466 kts yasa rt 01 rw 02 30 th P
29 nur amalia 0000638486926 kts yasa rt 01 rw 02 30 th P
30 slamet 0000638943656 jakid rt 03 rw 02 56 th L
31 karidah 0000639543918 jakid rt 03 rw 02 50 th P
32 nur halimah 0000626088207 kd sugih rt 02 rw 01 42 th P
33 riski 0000637116987 jakid rt 02 rw 03 8 th L
34 m saputra 0000625091477 kd sugih rt 02 rw 01 8 th L
35 st salsa 0000625069846 kd sugih rt 02 rw 01 2 th P
36 khotimah 0000639151426 kts yasa rt 04 rw 04 42 th P
37 anitya 0000638454803 kts yasa rt 03 rw 01 9 th P
38 nurwadi 0000639266138 kl pucang rt 17 rw 04 41 th L
39 umi 0000639061026 jakid rt 04 rw 01 30 th P
40 rodiyah 0000639050927 jakid rt 04 rw 01 55 th P
41 nuridah 0001032401668 km amba rt 01 rw 01 51 th P
42 kasih 0000638023910 karanglo rt 05 rw 01 50 th P
43 nawiroh 0000637096307 jakid rt 02 rw 01 30 th P
44 ramlah 0000638231129 karanglo rt 13 rw 03 70 th P
45 ropikha 0000639296164 jakid rt 02 rw 03 50 th P
46 suhandi 0000637980270 dk maja rt 03 rw 05 67 th L
47 mulyawati 0000638630671 km amba rt 04 rw 02 32 th P
48 muslikha 0000638011866 jalor rt 01 rw 04 34 th P
49 sumitri 0000636183873 kd tukang rt 14 rw 05 60 th P
50 korinah 0000636157416 kd tukang rt 14 rw 05 30 th P
51 damen 0000636263956 kr sembung rt 04 rw 04 70 th P
52 ghofar 0000639086717 jakid rt 03 rw 03 30 th L
53 nur khamdan 0000637812344 jakid rt 04 rw 05 10 th L
54 ropikoh 0000637612603 jakid rt 04 rw 05 3 th P
55 silviana 0000638942519 tembelang rt 14 rw 03 7 th P
56 marisah 0001032399336 kb nagung rt 01 rw 06 50 th P
57 khambali 0000636877082 jalor rt 04 rw 02 66 th L
58 erni purwanti 0000639022983 pamengger rt 05 rw 04 37 th P
59 salkhatun 0000637573222 pamengger rt 05 rw 04 30 th P
60 kaisah 0000637916095 pamengger rt 05 rw 04 50 th P
61 wardinah 0000103417437 pamengger rt 05 rw 04 50 th P
62 rustinah 0000638827797 jakid rt 08 rw 03 50 th P
63 masdaris 0000639038938 tembelang rt 03 rw 02 16 th L
64 juriyah 0000637739706 kts yasa rt 02 rw 03 50 th P
65 sairah 0000637178463 jakid rt 01 rw 07 49 th P
66 nur oktaviani 0000637933347 jakid rt 03 rw 03 3 th P
67 popon 0000637181396 jakid rt 05 rw 05 41 th L
68 baroyah 0000637066476 jakid rt 02 rw 01 32 th P
69 koprawi 0000639150164 jakid rt 02 rw 07 60 th L
70 taripah 0000636169748 tg wulung rt 18 rw 04 47 th P
71 sri yati 0000639159816 kts yasa rt 07 rw 04 52 th P
72 wastiah 0001033423489 janegara rt 01 rw 04 37 th P
73 radiyah 0000624857916 kd sugih rt 01 rw 04 43 th P
74 m topik 0000637893289 jakid rt 06 rw 08 42 th L
75 eliyah 0000638697879 jakid rt 04 rw 02 48 th P
76 nadia 0000639148924 jalor rt 04 rw 01 6 th P
77 sarwono 0000637608284 pds lohor rt 16 rw 04 52 th L
78 maulidin 0000639226034 jalor rt 06 rw 05 12 th L
79 dasan 0000638826174 jalor rt 06 rw 05 46 th L
80 rohani 0000638612819 karanglo rt 10 rw 04 40 th P
81 slamet 0000638611916 kr sembung rt 03 rw 03 6 th L
82 suyanto 0000638376714 klampis rt 06 rw 02 40 th L
83 ramidah 0000636887342 kb gadung rt 01 rw 02 43 th P
84 kasri 0000638349927 rd sari rt 07 rw 02 60 th P
85 rosa dwi 0001032397356 kts yasa rt 04 rw 02 8 th P
86 mardiyanti 0000626062622 karanglo rt 02 rw 01 31 th P
87 warsinah 0000637728784 kts yasa rt 04 rw 01 50 th P
88 zaenal 0000639089919 kts yasa rt 05 rw 04 32 th L
89 soliha 0000638847704 jakid rt 02 rw 09 49 th P
90 suwarto 0000638963875 jakid rt 10 rw 02 42 th L
91 suripah 0000638802099 jalor rt 06 rw 05 45 th P
92 izul 0000637806925 jakid rt 06 rw 03 11 th P
93 kharisma 0000638877903 tembelang rt 17 rw 03 3 th P
94 melvian 0000638620919 jakid rt 08 rw 02 6 th P
95 diyanti 0000639046368 kts yasa rt 04 rw 04 20 th P
96 nur atikoh 0000639046368 km amba rt 04 rw 02 6 th P
97 warti 0000103248936 km amba rt 04 rw 02 37 th P
98 waesah 0000636714141 jakid rt 01 rw 09 34 th P
99 rosa 0000638717834 tg wulung rt 16 rw 04 10 th P
101 warisah 0000638374629 kts yasa rt 03 rw 03 70 th P
102 wasnari 0000638073812 jt wangi rt 02 rw 02 32 th L
103 sunarto 0000638416593 tembelang rt 08 rw 02 42 th L
104 ariel 0000632188155 kts yasa rt 01 rw 03 76 th L
105 elok 0000638668133 tembelang rt 08 rw 02 53 th P
106 azam 0000637719766 kts yasa rt 01 rw 03 16 th L
107 rahayu slamet 0000638312422 klampis rt 12 rw 04 12 th P
108 kasri 0000638931183 jalor rt 09 rw 01 61 th P
109 hindun 0000637893232 jalor rt 09 rw 01 70 th P
110 asiyah 0000637329966 bojong rt 08 rw 02 33 th P
111 komisah 0000638240377 jalor rt 05 rw 05 50 th P
112 m usman 0000638668785 jakid rt 01 rw 05 14 th L
113 susmari 0000638226212 kb nagung rt 09 rw 02 46 th L
114 m zaka 0000639110722 kts yasa rt 05 rw 03 17 th L
115 ismaun 0000637904924 tg wulung rt 02 rw 01 62 th L
116 sahar 0000638020397 karanglo rt 04 rw 10 70 th L
117 suearno 0000638596427 jalor rt 13 rw 06 54 th L
118 satrio 0000638260908 jalor rt 03 rw 06 5 th L
119 ulfatun 0000632090936 rg pendawa rt 11 rw 02 7 th P
120 irfan 0000638630373 kts yasa rt 02 rw 02 5 th L
121 ida rosida 0000637108076 jakid rt 05 rw 06 16 th P
122 salimah 0000637925501 jakid rt 05 rw 01 51 th P
123 wasud 0000637444541 tembelang rt 08 rw 03 38 th L
124 rohayati 0000638919326 jalor rt 06 rw 02 41 th P
125 sepudin 0000638242748 jakid rt 02 rw 09 3 th L
126 siti 0001033408131 jalor rt 05 rw 05 63 th P
127 parukhi 0000638852667 janegara rt 11 rw 04 36 th L
128 abu bakar 0000638191993 kts yasa rt 03 rw 03 70 th L
129 hafis 0000638959689 kts yasa rt 03 rw 03 4 th L
130 solidatul 0000638379167 kts yasa rt 01 rw 03 7 th P
131 sofa 0000638485938 kts yasa rt 05 rw 03 2 th P
132 warsito 0000638489894 jalor rt 02 rw 01 40 th L
133 waryani 0000638763062 tembelang rt 16 rw 03 2 th P
134 marsiti 0000638761443 tembelang rt 16 rw 03 84 th P
135 roamsah 0000638633272 tembelang rt 10 rw 03 36 th P
136 sainah 0000637386986 wana cala rt 03 rw 07 33 th P
137 susi marleni 0000639127923 kts yasa rt 01 rw 03 26 th P
138 mulud 0000637781436 jakid rt 02 rw 06 10 th L
139 st inayah 0000637869496 dk maja rt 06 rw 07 9 th P
140 m akil maulana 0000639344667 kts yasa rt 06 rw 04 12 th L
141 saisah 0001032404343 jakid rt 03 rw 08 52 th P
142 st rodiyah 0000638986482 dk maja rt 02 rw 12 24 th P
143 wulidah 0000638446432 kts yasa rt 01 rw 02 40 th P
144 tri alfarizi 0000638483466 jalor rt 06 rw 03 10 th L
145 indah 0000632762801 rg pendawa rt 08 rw 02 6 th P
146 st kaeni 0000637947806 jakid rt 02 rw 01 54 th P
147 andi saputra 0000639227272 dk maja rt 09 rw 02 8 th L
148 sobri 0000638741766 jakid rt 03 rw 01 6 th L
149 st maslikha 0000638253596 jakid rt 03 rw 01 49 th P
150 helen 0000638206299 cenang rt 04 rw 06 10 th P
151 dana 0000638319903 klampis rt 06 rw 02 53 th L
152 tarmono 0000638112622 karanglo rt 05 rw 01 43 th L
153 safa 0000638432936 kts yasa rt 02 rw 06 2 th P
154 nur fitriyah 0000639116649 jakid rt 04 rw 05 16 th P
155 khalimah 0000638277838 jalor rt 02 rw 05 74 th P
156 sumarni 0000638805205 kb gadung rt 08 rw 02 50 th P
157 umi sadiyah 0000632115011 rg pendawa rt 06 rw 04 40 th P
158 putri 0000632158868 rg pendawa rt 05 rw 04 15 th P
159 ramidah 0000638887342 kr sembung rt 03 rw 09 43 th P
160 maskanah 0000631984556 rg pendawa rt 01 rw 05 60 th P
161 janatin 0000632683813 rg pendawa rt 03 rw 02 46 th P
162 kaniti 0000638842646 kr sembung rt 02 rw 06 32 th P
163 syarifatul laela 0000638646494 buaran rt 01 rw 01 4 th P
164 jumirah 0001032414737 jalor rt 05 rw 05 59 th P
165 nafisah 0000637916364 jalor rt 09 rw 01 53 th P
166 winten 0000638332346 bojong rt 15 rw 03 46 th P
167 abd sukur 0000638722663 bojong rt 15 rw 03 30 th L
168 abidin 0000638147658 jakid rt 03 rw 10 36 th L
169 nur hidayah 0000638119069 jakid rt 05 rw 05 42 th P
170 edi purwanto 0000637659617 jakid rt 05 rw 06 40 th L
171 muslikha 0001032408617 karanglo rt 11 rw 11 65 th P
172 devi 0000639616676 janegara rt 01 rw 01 17 th P
173 khomisah 0000638240371 jalor rt 04 rw 06 60 th P
174 mundahir 0000639216326 jalor rt 02 rw 08 50 th L
175 masruri 0000638118944 jalor rt 05 rw 02 50 th L
176 saputra 0000638190541 jakid rt 02 rw 03 50 th L
178 sumiah 0000637717937 kts yasa rt 01 rw 03 50 th P
179 tarikoh 0000638233236 kts yasa rt 01 rw 04 36 th P
180 sutinah 0000103240432 jakid rt 02 rw 04 60 th P
181 taisah 0000636021024 cenang rt 01 rw 02 30 th P
182 dava 0000638021465 cenang rt 01 rw 02 12 th L
183 mujibah 0000636665736 cenang rt 01 rw 02 60 th P
184 aryati 0000638811841 jalor rt 01 rw 02 38 th P
185 subur sumiati 0000639275679 janegara rt 01 rw 01 42 th P
186 wantiha 0000637952656 kts yasa rt 09 rw 03 46 th P
187 wiji 0000638648421 jalor rt 05 rw 05 46 th P
188 suniti 0001032411677 jalor rt 08 rw 01 62 th P
190 manah 0000638117583 jalor rt 06 rw 03 70 th P
191 fahmi 0000638606608 karanglo rt 15 rw 03 2 th L
192 selviani 0000638786942 jakid rt 03 rw 10 2 th P
193 tohiroh 0000638730326 jakid rt 03 rw 02 60 th P
194 suriyah 0000637794418 kts yasa rt 05 rw 02 55 th P
195 tarsinah 0000638626633 jakid rt 02 rw 04 68 th P
196 karmen efendi 0000638288976 jakid rt 03 rw 09 50 th L
197 kharisma 0000638291676 jakid rt 02 rw 09 17 th P
198 yuliana 0000638775516 km amba rt 07 rw 01 6 th P
199 rumini 0000637607807 jakid rt 02 rw 07 70 th P
200 sutarno 0000637515506 jakid rt 03 rw 06 60 th L
201 waitah 0000638242366 jakid rt 02 rw 08 61 th P
202 nur maula 0000637841947 jakid rt 04 rw 06 48 th L
203 putri sinar 0000639164373 jakid rt 03 rw 03 2 th P
204 adi saputra 0000638812272 dk maja rt 02 rw 03 12 th L
205 ulpatul 0000632696936 rg pendawa rt 07 rw 03 6 th P
206 dedi ismail 0000636158421 jakid rt 03 rw 10 32 th L
207 ana setiasih 0000636225919 kb nagung rt 09 rw 02 12 th P
208 laelatul zamroh 0000638189117 jakid rt 03 rw 10 10 th P
209 m syarifudin 0000103239144 dk maja rt 05 rw 06 5 th L
210 taufik 0000638484546 klampis rt 09 rw 03 3 th L
211 m husen 0000638549986 kb nagung rt 05 rw 01 7 th L
212 maesaroh 0000638547466 kb nagung rt 05 rw 01 50 th P
213 sutri 0000638757415 jakid rt 01 rw 08 62 th P
215 nur faozah 0000638232672 jakid rt 01 rw 03 33 th P
216 khaerul 0000638116208 jalor rt 04 rw 02 6 th L
217 abd rohman 0000639470428 klampis rt 03 rw 05 48 th L
218 rikanah 0000638346777 kb nagung rt 10 rw 02 47 th P
219 kartini 0000638384996 kts yasa rt 04 rw 03 70 th P
220 khalimah 0001032420385 kts yasa rt 01 rw 04 60 th P
221 baedah 0001032402407 kts yasa rt 03 rw 02 80 th P
223 maani 0001032407616 jakid rt 02 rw 01 70 th P
224 abu khaeri 0000637262276 wn tawang rt 02 rw 03 70 th L
225 st waesah 0000638186837 tg wulung rt 02 rw 01 48 th P
226 waedah 0000638637546 kr sembung rt 01 rw 08 36 th P
227 aji maftuhin 0001032401463 km amba rt 03 rw 02 23 th L
228 saryuah 0000638951564 kts yasa rt 01 rw 05 44 th P
229 siska 0000631362406 rg pendawa rt 14 rw 01 11 th P
230 hartiwi 0000631360032 rg pendawa rt 14 rw 07 48 th P
232 ulfa 0000638694999 jakid rt 01 rw 05 11 th P
233 solikha 0000638478764 kts yasa rt 01 rw 02 48 th P
234 abd wahid 0000638671363 jalor rt 04 rw 04 56 th L
235 muspipah 0000632608100 rg pendawa rt 02 rw 09 58 th P
236 masriah 0000638944413 jakid rt 02 rw 12 37 th P
237 namira 0000638553666 kts yasa rt 01 rw 06 7 th P
238 dini f 0000638128034 jalor rt 06 rw 06 9 th P
239 nur amaliah 0000638127869 jalor rt 08 rw 06 28 th P
240 kartini 0000637547187 karanglo rt 03 rw 02 60 th P
242 setiadi 0000637984332 karanglo rt 20 rw 04 12 th L
243 sainah 0000639402161 karanglo rt 20 rw 04 48 th P
244 sopuroh 0001032414039 jalor rt 07 rw 05 37 th P
245 a fadli 0000638497361 jalor rt 05 rw 03 9 th L
246 kamah 0001032421259 kts yasa rt 02 rw 05 73 th P
247 waman 0000638524225 kts yasa rt 01 rw 01 73 th L
248 lukman faozi 0000637968489 jakid rt 02 rw 11 11 th L
249 nur khasanah 0000637959539 jakid rt 02 rw 11 48 th P
250 janah 0000637938246 jalor rt 02 rw 02 50 th P
251 rohati 0000637621082 jalor rt 03 rw 02 60 th P
252 sudirgo 0000638456634 kr sembung rt 03 rw 07 45 th L
253 ifrad 0000636357281 jakid rt 01 rw 06 76 th L
254 roidah 0000636368479 jakid rt 06 rw 05 38 th P
255 mamuri 0000637717646 kts yasa rt 01 rw 03 53 th L
256 sobari 0000638347397 dk maja rt 01 rw 01 48 th L
257 m nizar 0000639194661 jalor rt 05 rw 01 9 th L
259 muslikha 0000637611174 jakid rt 04 rw 06 37 th P
262 syafira 0000638161143 jakid rt 05 rw 09 2 th P
263 iis sundari 0000639848879 karanglo rt 10 rw 04 21 th P
264 helen 0000639084847 karanglo rt 10 rw 04 2 th L
265 wurdiyanto 0000636758046 km amba rt 02 rw 04 50 th L
266 tio nugroho 0000638316944 jalor rt 06 rw 05 2 th L
268 rodotul janah 0000638622677 jakid rt 02 rw 09 21 th P
269 waitah 0000636302220 jalor rt 08 rw 04 67 th P
270 m faturohman 0000638482299 jalor rt 01 rw 04 5 th L
271 rustiyah 0000638782921 jakid rt 02 rw 05 37 th P
273 sumarni 0000637862242 kr sembung rt 02 rw 03 50 th P
274 tumirah 0001032481147 km amba rt 01 rw 01 53 th P
275 samsul 0000637990633 jakid rt 06 rw 06 14 th L
276 wulandari 0000638226536 kb nagung rt 09 rw 02 7 th P
277 wasripah 0000637287936 kr sembung rt 08 rw 02 40 th P
278 suparti 0000638464536 klampis rt 10 rw 03 50 th P
280 supardi 0000638702637 karanglo rt 01 rw 04 42 th L
281 rodiyah 0000638247116 jalor rt 06 rw 01 55 th P
282 muadah 0000638344373 jalor rt 03 rw 01 50 th P
284 teguh 0000637584686 jakid rt 04 rw 02 45 th L
285 herawati 0000637884584 jakid rt 04 rw 02 33 th P
286 musliha 0001032419981 kts yasa rt 04 rw 02 40 th P
287 musripah 0000637275564 kr sembung rt 03 rw 06 33 th P
288 muhtadi 0000638273463 jalor rt 05 rw 03 50 th L
289 m fadilah 0000638501466 km amba rt 02 rw 03 12 th L
290 raswi 0000638500948 km amba rt 02 rw 03 50 th P
291 uswatun khasanah 0000639388899 kts yasa rt 01 rw 04 30 th P
292 waryati 0000637955177 jalor rt 03 rw 02 47 th P
293 kasmi 0000638273294 jakid rt 02 rw 04 62 th P
294 romsah 0000639149074 jakid rt 02 rw 07 52 th P
295 waidah 0000638011394 bojong rt 09 rw 02 48 th P
296 mulyono 0000638011179 bojong rt 09 rw 02 53 th L
297 m adrian 0000638736165 tembelang rt 01 rw 01 9 th L
298 mulyati 0000638587258 jalor rt 02 rw 01 47 th P
299 saripah 0000638132233 wn tawang rt 03 rw 05 45 th P
300 nawi 0000637693626 kts yasa rt 06 rw 01 80 th L
302 khunaenah 0001032400464 jakid rt 01 rw 07 32 th P
303 wasri 0000638937743 tembelang rt 16 rw 03 60 th P
304 musripah 0000638378861 kts yasa rt 02 rw 02 32 th P
305 sunari 0000638770612 dk maja rt 01 rw 03 21 th L
306 kitam 0000637978499 bojong rt 13 rw 02 36 th L
307 darto 0000637789424 janegara rt 11 rw 04 60 th L
308 sijah 0000638963516 pamengger rt 06 rw 03 43 th P
309 rohmat 0000636767189 kr sembung rt 09 rw 02 55 th L
310 fahruludin 0000639176796 dk maja rt 01 rw 01 12 th L
311 yanwar 0000637396259 kts yasa rt 02 rw 03 7 th L
312 kartini 0001032411644 jalor rt 06 rw 01 32 th P
313 irpan 0000638289524 jalor rt 03 rw 02 44 th L
315 khotipah 0000638271636 jakid rt 02 rw 10 50 th P
316 warno 0000632633329 rg pandawa rt 04 rw 02 50 th L
317 asmari 0000638090267 kr sembung rt 09 rw 02 50 th L
318 st maryam 0001038228321 kts yasa rt 01 rw 06 62 th P
319 dasripah 0000638638678 kr sembung rt 02 rw 08 52 th P
320 st ropidah 0000639043244 jakid rt 09 rw 10 36 th P
321 taipah 0000638864673 jalor rt 07 rw 03 36 th P
322 fungki 0000637621999 songgom rt 03 rw 02 13 th P
323 riskiani indah 0000638184836 jakid rt 05 rw 05 13 th P
325 ramadani 0000638164689 jalor rt 04 rw 01 3 th L
326 jahrotun 0000638967474 jakid rt 01 rw 05 9 th P
327 waetun 0000638667798 jakid rt 01 rw 05 30 th P
328 sandi maulana 0000638026986 jakid rt 05 rw 08 12 th L
329 dakonah 0000639026993 jakid rt 03 rw 08 40 th P
330 m miftahul 0000639243323 pamengger rt 05 rw 04 5 th L
331 masirah 0000637748471 dk maja rt 04 rw 07 50 th P
332 gunawan 0000638463269 tembelang rt 02 rw 01 9 th L
333 tarini 0000639593741 dk maja rt 02 rw 02 44 th P
334 sayuti 0000638136132 karanglo rt 10 rw 04 58 th P
335 samdani 0000638796922 kts yasa rt 08 rw 06 70 th L
336 windi 0000638868808 tembelang rt 11 rw 02 13 th P
337 desi 0000637836126 bojong rt 07 rw 02 24 th P
338 satria 0000637368868 kts yasa rt 02 rw 01 4 th L
339 rojiun 0000639999187 jakid rt 03 rw 08 29 th L
340 witri 0001032397899 klampis rt 04 rw 02 55 th P
341 aspuri 0000103236179 klampis rt 04 rw 02 60 th L
342 konipah 0001032408827 karanglo rt 02 rw 09 60 th P
343 rukmini 0000638849563 karanglo rt 01 rw 01 50 th P
344 ulfifanti 0000637737319 dk maja rt 04 rw 05 10 th P
345 fariyah 0000638729361 klampis rt 01 rw 01 44 th P
346 m fahri 0000639926579 jalor rt 04 rw 02 3 th L
347 umi kulsum 0000639261563 jalor rt 04 rw 02 40 th P
348 zaskiyah 0000636246991 klampis rt 01 rw 01 2 th P
349 fadilatul 0000633319564 rg pandawa rt 09 rw 02 8 th P
350 taswi 0001032403149 jakid rt 02 rw 01 70 th P
351 dewi 0001032415446 jalor rt 06 rw 01 17 th P
352 st salisa 0000626091546 kd sugih rt 02 rw 01 2 th P
354 kurdi 0000638947723 kts yasa rt 07 rw 04 40 th L
355 syariah 0000639289862 kts yasa rt 05 rw 06 60 th P
356 nur sela 0000638255621 jalor rt 01 rw 01 3 th P
357 nur afin 0000636961781 tembelang rt 18 rw 03 16 th P
358 wartini 0000636961026 tembelang rt 18 rw 03 50 th P
359 rosikin 0000638458426 jalor rt 06 rw 06 46 th L
360 tokhil 0001032405139 jakid rt 02 rw 06 70 th L
361 rusmani 0000638868876 kts yasa rt 07 rw 02 42 th L
362 rasmali 0000638876886 jalor rt 03 rw 03 53 th L
363 firutul 0000639488772 janegara rt 01 rw 07 12 th P
364 puryoto 0000638342189 dk maja rt 04 rw 02 40 th L
365 m ilham 0000638368791 jakid rt 03 rw 08 39 th L
366 zulfa 0000637986387 jalor rt 07 rw 03 1 th P
367 tariyah 0000638994868 kts yasa rt 07 rw 04 60 th P
368 raminah 0001024202247 kts yasa rt 07 rw 04 70 th P
369 fitri 0000638278805 jakid rt 02 rw 04 30 th P
370 rodiyah 0001032391749 dk maja rt 02 rw 05 60 th P
371 nasir haryono 0000638774673 jakid rt 03 rw 03 57 th L
372 rohandi 0000636373903 kts yasa rt 03 rw 02 52 th L
373 riopiah 0001032407414 jakid rt 03 rw 10 50 th P
374 sopiyah 0000638658775 tg wulung rt 11 rw 02 40 th P
375 waenuroh 0000638747738 janegara rt 11 rw 04 46 th P
376 hendrik 0000638476898 klampis rt 02 rw 01 7 th L
377 khalimi 0000638230634 karanglo rt 18 rw 01 70 th L
378 khuwaroh 0000638276398 km amba rt 04 rw 02 30 th P
379 roidah 0001032446384 kl alang rt 01 rw 01 27 th P
380 putri 0000638932844 jakid rt 02 rw 06 21 th P
381 afrinda 0000639402264 janegara rt 02 rw 01 8 th P
383 takyadi 0000638677157 tembelang rt 08 rw 08 66 th L
384 rendi 0000637871861 cenang rt 05 rw 01 2 th L
385 rositah 0000638318777 kb nagung rt 04 rw 02 48 th P
387 suinah 0000638898446 jakid rt 03 rw 01 45 th P
388 ramini 0000103401056 bojong rt 11 rw 08 58 th P
390 riyana 0000637116346 jakid rt 02 rw 03 35 th P
391 mayadatul 0000638676986 kb nagung rt 01 rw 04 22 th P
393 m.maulana 0000638191269 jalor rt 03 rw 08 2 th L
394 siti rokhani 0000638818919 jalor rt 08 rw 05 40 th P
395 slamet darsono 0000639811918 jalor rt 08 rw 06 60 th L
397 nuryati 0000638638836 kr sembung rt 07 rw 01 29 th P
398 ida rosidah 0000638292676 kr sembung rt 02 rw 03 28 th P
399 rahmadani 0000638282666 kr sembung rt 02 rw 04 6 th L
400 rinda 0000637767391 dk maja rt 01 rw 04 28 th P
401 kasirah 0000638287896 tembelang rt 10 rw 04 60 th P
402 adnan 0000638499383 jalor rt 06 rw 08 3 th L
403 m.topik 0000639509867 jakid rt 05 rw 08 46 th L
404 adi firman 0000638612256 jalor rt 01 rw 04 5 th L
405 rusbad 0000639481724 janegara rt 01 rw 01 80 th L
406 yatin 0000632564019 rg pandawa rt 02 rw 02 35 th P
407 kamah 0001032418372 pamengger rt 04 rw 01 62 th P
408 triningsih 0001032418348 pamengger rt 04 rw 01 41 th P
409 agus 0000638293375 jakid rt 04 rw 01 10 th L
410 tupiyah 0000638896369 jakid rt 02 rw 04 65 th P
411 firman 0000638141343 jalor rt 02 rw 03 8 th L
412 daimah 0000638777996 tembelang rt 06 rw 02 59 th P
413 desisaesa 0000638730314 dk maja rt 02 rw 03 9 th P
415 supriyadi 0000638427115 janegara rt 05 rw 03 16 th L
418 torinah 0000639147532 janegara rt 05 rw 10 60 th P
420 tundiroh 0000637491791 tembelang rt 03 rw 01 40 th P
421 sunitah 0000638741327 klampis rt 05 rw 06 50 th P
422 tajo 0000637966563 tg wulung rt 07 rw 02 46 th L
423 jariyah 0000639343434 janegara rt 03 rw 02 28 th P
424 susyanti 0000638610647 buaran rt 02 rw 04 10 th P
425 rizki 0000638107726 buaran rt 03 rw 05 10 th L
426 m.diwan 0001032418923 pamengger rt 06 rw 01 7 th L
427 rahmat 0000638553126 pamengger rt 02 rw 06 29 th L
428 neng sumrotun 0000637573713 dk maja rt 03 rw 02 41 th P
429 sena 0000633056501 rg pandawa rt 06 rw 03 31 th P
430 kholifahtun 0000638855086 jalor rt 11 rw 05 8 th P
431 rizkimubarok 0000637437622 tembelang rt 01 rw 01 4 th L
432 laeli 0000637437745 tembelang rt 01 rw 01 40 th P
433 kuryoto 0000638243189 dk maja rt 04 rw 02 62 th L
434 sopiyah 0000639093497 kts yasa rt 01 rw 03 60 th P
435 suadah 0000637435686 kr sembung rt 05 rw 04 60 th P
436 m.rizki 0000624764248 mulyo harjo rt 03 rw 02 4 th L
437 wasriah 0000624762134 mulyo harjo rt 03 rw 02 40 th P
438 musrifah 0000638897264 jalor rt 05 rw 03 70 th P
439 ah.fadli 0000638497361 jalor rt 05 rw 03 9 th L
440 khojiah 0000638177286 jakid rt 04 rw 05 9 th P
441 khodijah 0000638729537 km amba rt 03 rw 04 62 th P
442 aminah 0000638005116 cenang rt 03 rw 02 35 th P
443 fariz 0000639005555 cenang rt 03 rw 02 4 th L
444 aelmira 0000639074907 jakid rt 02 rw 09 11 th P
447 hindun 0000638148644 kramat rt 12 rw 04 41 th P
449 evah 0000639118315 kts yasa rt 07 rw 04 13 th P
450 sainah 0000637728759 kts yasa rt 04 rw 02 70 th P
452 sri mardiyati 0000637996241 karanglo rt 15 rw 03 42 th P
453 soimah 0000638337666 klampis rt 13 rw 04 34 th P
454 siti maryam 0000639160997 jakid rt 05 rw 06 66 th P
455 setyawati 0000638316257 jakid rt 05 rw 05 35 th P
456 nurhikmah 0000638316494 jakid rt 05 rw 05 16 th P
457 ratinah 0000637903607 jakid rt 03 rw 09 38 th P
458 m.roeyhan 0000637513571 jakid rt 02 rw 09 13 th L
459 sopuroh 0000637512794 jakid rt 02 rw 09 43 th P
460 mukhlas 0000638770814 jakid rt 02 rw 04 60 th L
461 waedah 0000636811143 glonggong rt 04 rw 02 50 th P
462 emi baroyah 0000637086475 jakid rt 05 rw 03 33 th P
463 sahlan 0000638378777 kts yasa rt 02 rw 03 57 th L
464 salamah 0000638879786 songgom rt 05 rw 01 50 th P
465 gilang 0000637830111 dk maja rt 02 rw 01 13 th L
466 rambat 0001032881114 km amba rt 05 rw 08 70 th L
468 tarwi 0001032442047 pds lohor rt 03 rw 04 74 th P
469 ah taukhid 0000638194661 kts yasa rt 02 rw 01 30 th L
470 ah drajat 0000639256712 jalor rt 05 rw 05 60 th L
471 jenal 0000638020303 jakid rt 05 rw 04 41 th L
472 m deca 0001032401924 km amba rt 02 rw 01 70 th L
473 rukiyah 0000639327723 pamengger rt 03 rw 06 60 th P
474 sudirjo 0000639110441 jakid rt 02 rw 02 56 th L
475 komisah 0000639240377 jalor rt 02 rw 03 56 th P
476 bagus 0000639544149 jalor rt 03 rw 01 12 th L
477 ah nur rois 0000637153637 jakid rt 01 rw 02 29 th L
478 kasmawi 0000637706926 kts yasa rt 02 rw 05 51 th L
479 taronah 0000636371103 klampis rt 01 rw 02 50 th P
480 ulfifanti 0000638903362 kts yasa rt 01 rw 01 5 th P
481 agus 0000636926334 jalor rt 06 rw 02 41 th L
482 listiana 0000636912026 jt rokeh rt 01 rw 03 6 th P
483 khasanah 0000638426706 janegara rt 01 rw 01 38 th P
484 bintang 0000636063061 rd sari rt 07 rw 02 2 th P
486 tonisah 0000638248497 jalor rt 01 rw 06 40 th P
487 samrotun 0000637819187 jakid rt 02 rw 01 15 th P
489 umayah 0000637786061 cenang rt 03 rw 03 45 th P
490 cindi alia 0000638680253 klampis rt 12 rw 03 11 th P
491 aksan 0000637696616 kts yasa rt 04 rw 01 9 th L
493 taswi 0000637861869 kts yasa rt 07 rw 04 60 th P
494 kurniati 0000638929236 karanglo rt 03 rw 01 30 th P
495 tarimah 0000639022239 dk maja rt 01 rw 07 38 th P
496 khaerun 0000639104631 janegara rt 11 rw 04 26 th L
497 asmawi 0000637861033 tg wulung rt 02 rw 11 62 th L
498 sakilah 0000636523112 bojong rt 11 rw 03 55 th P
499 darto 0000639376663 kts yasa rt 02 rw 05 36 th L
500 ali tahrudin 0000639117448 kts yasa rt 07 rw 04 22 th L
501 tarjani 0000639115994 kts yasa rt 07 rw 04 42 th L
502 aza almira 0000316677279 rg pandawa rt 07 rw 02 5 th P
503 sri ayati 0000639677023 janegara rt 15 rw 03 51 th P
504 tanuri 0000629676679 janegara rt 06 rw 03 53 th L
505 rojinah 0001032407717 jakid rt 03 rw 09 50 th P
506 sartini 0000638761783 dk maja rt 03 rw 02 40 th P
507 sopiyah 0000103241850 jalor rt 06 rw 01 55 th P
508 sopuroh 0000638381613 kts yasa rt 02 rw 01 35 th P
509 widarto 0000638733948 km amba rt 01 rw 03 24 th L
510 m aldi 0000638969623 karanglo rt 03 rw 04 54 th L
511 wutuh 0000636919364 kr anyar rt 04 rw 02 70 th P
512 ramini 0000638416046 dk maja rt 03 rw 03 47 th P
513 aisyah 0000637730706 kts yasa rt 01 rw 01 34 th P
514 nur fadilah 0000637731663 kts yasa rt 01 rw 01 9 th P
515 sukarmo 0000640158581 kl alang rt 10 rw 01 42 th L
516 minal uyun 0000639127676 dk maja rt 02 rw 03 13 th P
517 m mahfud 0000638886534 jalor rt 05 rw 05 2 th L
518 daryati 0000637620721 jakid rt 02 rw 06 51 th P
519 khalimah 0000637986772 karanglo rt 02 rw 06 39 th P
520 harti 0000638481442 dk maja rt 01 rw 01 40 th P
521 haris 0000639096661 jakid rt 02 rw 02 16 th L
522 fatikhur riski 0000103241371 jalor rt 02 rw 02 4 th L
523 jenal arifin 0000639068916 karanglo rt 02 rw 01 23 th L
524 lindayati 0000638630806 dk maja rt 02 rw 01 30 th P
525 kartinem 0000638761783 dk maja rt 03 rw 02 43 th P
526 kasidin 0000638837827 jalor rt 03 rw 01 53 th L
527 karyamah 0001032089627 kr sembung rt 02 rw 07 80 th P
528 ananda 0000637809829 jalor rt 05 rw 01 6 th P
529 sutari 0000638319881 dk maja rt 03 rw 08 43 th P
530 salfa 0000638322941 dk maja rt 03 rw 08 6 th P
531 apri 0000638321162 dk maja rt 03 rw 08 19 th P
532 dimas 0000638946376 kts yasa rt 06 rw 04 7 th L
534 dwi cahyani 0000637986079 jalor rt 03 rw 01 3 th P
536 m ikbal 0000638487462 kts yasa rt 05 rw 01 8 th L
537 aliyah 0000636279563 jalor rt 05 rw 05 43 th P
538 mawarti 0000637816443 jakid rt 03 rw 02 40 th P
539 sunari 0000638779612 dk maja rt 01 rw 02 21 th P
540 warlinah 0000637728704 kts yasa rt 04 rw 02 55 th P
541 wantikha 0000637962355 kts yasa rt 08 rw 03 45 th P
542 dewi 0000637906723 jakid rt 03 rw 09 17 th P
545 rina 0000638267821 jalor rt 05 rw 01 2 th P
546 maryam 0000103242159 kts yasa rt 01 rw 04 63 th P
547 tasripah 0000638138141 jakid rt 01 rw 02 38 th P
548 khasanah 0000638621363 jalor rt 06 rw 04 50 th P
550 dasri 00001031793592 rg pandawa rt 02 rw 02 40 th P
552 hartinah 0000103242081 kts yasa rt 04 rw 01 56 th P
553 krismaya 0000638347374 jakid rt 03 rw 08 37 th P
555 suharno 0000638869918 tg wulung rt 01 rw 01 34 th L
556 serli 0000638934024 klampis rt 03 rw 01 11 th P
557 sri wahyuningsih 0000639069216 jakid rt 01 rw 06 12 th P
558 mamah 0000639906468 jakid rt 01 rw 05 40 th P
559 m zidan 0000639007796 tg wulung rt 02 rw 01 3 th L
560 sarah 0000636417488 klampis rt 02 rw 01 57 th P
561 tariyah 0000638376843 klampis rt 02 rw 03 53 th P
562 muzaki 0000638616486 karanglo rt 10 rw 04 6 th L
563 suyat 0000637999761 karanglo rt 06 rw 03 60 th L
564 solikha 0000639078546 karanglo rt 04 rw 01 36 th P
565 waturoh 0000637838414 wn tawang rt 06 rw 03 33 th P
566 zulfa 0000639114494 jakid rt 05 rw 05 12 th P
567 fauzan 0000638623697 karanglo rt 05 rw 01 2 th L
569 indah 0000638448107 janegara rt 01 rw 01 14 th P
570 koah 0000639197981 wn cala rt 10 rw 06 60 th P
571 m irfan 0000637865853 jakid rt 03 rw 07 9 th L
572 muinah 0000637663208 jakid rt 03 rw 07 50 th P
573 lukman 0000637568763 jakid rt 03 rw 07 10 th L
575 madesta 0000637137459 jakid rt 05 rw 05 7 th L
577 muslikha 0001032419981 kts yasa rt 04 rw 02 69 th P
578 khotimah 0000638370626 jakid rt 02 rw 04 36 th P
579 munawaroh 0000639029870 dk maja rt 01 rw 01 9 th P
580 junenah 0000639130901 dk maja rt 01 rw 01 4 th P
581 warna 0000103230768 dk maja rt 03 rw 06 70 th L
582 rusyanto 0000637626269 jakid rt 04 rw 01 16 th L
583 rosikhin 0000637952927 jakid rt 03 rw 01 14 th L
584 daryati 0000638693188 klampis rt 04 rw 02 32 th P
585 rolah 0000638527757 kb nagung rt 03 rw 01 29 th P
586 imah 0000639269223 jakid rt 01 rw 03 36 th P
587 junaeni 0000636749719 klampis rt 03 rw 01 50 th P
589 waisah 0000636789396 jakid rt 04 rw 03 60 th P
590 rawen 0001032417977 pamengger rt 07 rw 03 70 th L
591 deni 0000638662959 karanglo rt 04 rw 01 7 th L
592 aenun 0000638276538 kb nagung rt 09 rw 02 7 th P
594 khotimah 0000638522817 kr sembung rt 02 rw 01 55 th P
595 warningsih 0000638434807 kr sembung rt 04 rw 01 30 th P
596 ismi 0000638082801 kts yasa rt 01 rw 02 11 th P
599 hilda 0000638926626 jalor rt 06 rw 02 14 th P
600 sri sugiarti 0000628920803 jalor rt 06 rw 02 40 th P
601 wirati 0001032421676 kts yasa rt 07 rw 04 47 th P
603 alpiyah 0000637672919 kr sembung rt 04 rw 05 29 th P
604 rahmawati 0000638389616 kts yasa rt 01 rw 01 13 th P
605 umyati 0000638813343 dk maja rt 02 rw 05 52 th P
607 wastam 0000638365137 kts yasa rt 03 rw 03 45 th L
608 musyarofah 0000639302804 janegara rt 02 rw 01 15 th P
609 supenah 0000637755662 kts yasa rt 01 rw 04 78 th P
610 tika 0000638464868 dk maja rt 02 rw 02 10 th P
611 suherman 0000638646468 klampis rt 06 rw 02 43 th L
612 anis 0000639171314 wn cala rt 04 rw 01 4 th P
613 vivi 0000103241916 jalor rt 03 rw 02 32 th P
614 sukiyah 0000639121161 janegara rt 01 rw 01 50 th P
615 haryanti 0000638349908 dk maja rt 01 rw 01 43 th P
616 maria 0000638349306 dk maja rt 01 rw 01 22 th P
617 ulfah 0000638349307 dk maja rt 02 rw 02 23 th P
618 ainun wulandari 0000638226565 kb nagung rt 02 rw 06 7 th P
619 carmid 0000639530264 tembelang rt 05 rw 01 50 th L
620 karomah 0000638347718 dk maja rt 04 rw 02 32 th P
621 darningsih 0000639098094 dk maja rt 04 rw 02 27 th P
622 m rehan 0000638763845 dk maja rt 04 rw 02 6 th L
623 m irfan 0001034209688 kts yasa rt 04 rw 04 9 th L
624 muskonah 0000103239909 kb nagung rt 07 rw 01 48 th P
626 desi 0000639376276 janegara rt 02 rw 01 16 th P
627 waidah 0000639129262 kts yasa rt 06 rw 02 55 th P
628 sariah 0000639289665 kts yasa rt 05 rw 02 60 th P
629 sripah 0000637248248 kts yasa rt 03 rw 01 50 th P
630 waan 0000637436424 bojong rt 02 rw 01 36 th L
631 wiyati 0000637476103 bojong rt 02 rw 01 36 th P
632 oktaviani 0000637641932 jakid rt 02 rw 04 14 th P
633 madiyo 0000638514797 pamengger rt 03 rw 01 52 th L
634 teguh 0000638667717 klampis rt 04 rw 02 6 th L
635 aryanti 0000638693186 klampis rt 04 rw 02 30 th P
637 sopuroh 0000639040493 kr sembung rt 03 rw 03 50 th P
638 kasman 0000639046596 kr sembung rt 03 rw 03 60 th L
639 irwan 0000639034063 kr sembung rt 04 rw 06 33 th L
640 novi 0000638617343 jalor rt 02 rw 02 21 th P
641 kasiri 0000637676901 kts yasa rt 04 rw 03 43 th P
642 zaenal 0000638835303 jakid rt 05 rw 05 26 th L
643 jamilah 0000639588826 klampis rt 02 rw 03 49 th P
644 suridah 0000103240186 km amba rt 01 rw 01 50 th P
645 erliyah 0000638599184 km amba rt 02 rw 03 41 th P
646 sairoh 0000638715699 kts yasa rt 04 rw 04 55 th P
647 rosid 0000638725667 klampis rt 03 rw 01 34 th L
648 sriarum 0000638802302 jakid rt 03 rw 02 17 th P
649 musiam 0000638263416 jakid rt 03 rw 04 21 th P
650 romlah 0000638262281 jakid rt 03 rw 04 40 th P
651 rokhidin 0000638304129 jakid rt 02 rw 02 23 th L
652 maryadi 0000638676887 jakid rt 01 rw 02 6 th L
653 dian 0000638676415 jakid rt 01 rw 02 12 th P
654 wasriah 0000634762124 mulyo harjo rt 03 rw 02 40 th P
655 tachril 0001032401529 jakid rt 02 rw 09 50 th L
656 toipah 0000638285936 jakid rt 05 rw 05 40 th P
659 sutoro 0001032413894 jalor rt 03 rw 05 46 th L
661 heni 0000639104106 kts yasa rt 03 rw 02 12 th P
662 suswanti 0000637737815 dk maja rt 05 rw 02 42 th P
663 sakuroh 0000638704585 klampis rt 10 rw 03 31 th P
664 suta pambayun 0000639218867 dk maja rt 01 rw 01 4 th L
665 khasanah 0000103240101 km amba rt 03 rw 02 70 th P
667 ajeng 0000638320386 jalor rt 01 rw 01 17 th P
668 sri hardiningsih 0000638319914 jalor rt 01 rw 01 60 th P
669 surtini 0000638883369 jalor rt 03 rw 02 35 th P
670 al fukron 0000638860873 bojong rt 06 rw 03 4 th L
672 reza 0000637775477 kts yasa rt 08 rw 02 17 th L
674 rasiwan 0000638556026 km amba rt 03 rw 02 68 th L
676 tuti 0000637250991 dk maja rt 02 rw 02 41 th P
677 tasari 0000637867819 jakid rt 08 rw 06 63 th L
678 sri inayah 0000638288561 jakid rt 06 rw 05 12 th P
679 martini 0000638998414 jt rokeh rt 02 rw 01 31 th P
680 romlah 0001032480243 jakid rt 03 rw 10 33 th L
681 daryono 0000638434496 kr sembung rt 04 rw 01 38 th P
682 yulina 0000639182338 jakid rt 05 rw 05 4 th P
683 dewi arini 0000103414445 jalor rt 06 rw 01 17 th L
684 m mahfud kafa 0000638854536 jalor rt 05 rw 05 2 th P
685 rosa 0000638717834 km amba rt 04 rw 02 9 th L
686 abd rosid 0000638114263 karanglo rt 05 rw 01 36 th P
687 unarmi 0000638778806 jakid rt 03 rw 10 55 th P
688 suniti 0000638115939 karanglo rt 18 rw 04 50 th P
689 rojinah 0000638154573 km amba rt 02 rw 01 35 th P
690 maulana 0000637986504 kr sembung rt 01 rw 06 3 th L
691 umrotun 0000637964187 kr sembung rt 01 rw 08 33 th P
692 adi purwanto 0000638755503 km amba rt 04 rw 02 6 th L
693 doniati 0000637651473 jalor rt 08 rw 01 38 th P
694 ulya 0000103241079 pamengger rt 03 rw 01 4 th P
695 sairah 0000638386787 pds lohor rt 13 rw 10 61 th P
696 zulfaruk 0000103243772 rg bandung rt 03 rw 02 2 th L
697 saedah 0000638449589 janegara rt 03 rw 01 40 th P
698 alvin 0000638131211 jakid rt 03 rw 10 2 th L
699 mujiatun 0000639931206 jakid rt 05 rw 06 29 th P
700 rohanah 0000637919132 jakid rt 04 rw 04 23 th P
702 daryono 0000638223647 jakid rt 01 rw 04 60 th L
703 tarisah 0000637627814 kts yasa rt 05 rw 01 45 th P
704 masriyah 0000638944412 jakid rt 02 rw 02 37 th P
706 sandi 0000637988381 kr sembung rt 04 rw 01 5 th L
709 st kasiri 0000637947086 jakid rt 05 rw 01 55 th P
710 kasmadi 0000638211813 janegara rt 01 rw 01 76 th L
711 ria faisah 0000637978771 jakid rt 01 rw 01 34 th P
712 darpi 0000636106747 jakid rt 03 rw 02 66 th P
713 sodah 0000638498259 pamengger rt 03 rw 02 65 th P
716 tuti 0000637801451 jalor rt 09 rw 01 55 th P
717 rambat 0001032401114 km amba rt 02 rw 01 61 th P
718 wasriah 0000638477717 klampis rt 02 rw 01 23 th P
720 tunisah 0000103789163 kb nagung rt 02 rw 01 42 th P
721 rokhidah 0000639102824 kts yasa rt 02 rw 03 30 th P
722 nurul ayu 0000637650010 kts yasa rt 02 rw 02 8 th P
724 surifah 0000638368317 jakid rt 02 rw 01 3 th P
725 esti 0000637703094 jalor rt 06 rw 01 30 th P
726 aji maulana 0000632987691 kubang sari rt 01 rw 04 14 th L
727 sufi 0000638616633 jalor rt 06 rw 06 19 th P
728 m fajar r 0001032402522 jakid rt 02 rw 10 6 th L
729 nur aeni 0000638496616 wn tawang rt 06 rw 03 37 th P
731 khojanah 0001033419892 jalor rt 03 rw 08 34 th P
732 ridah 0000637842637 wn cala rt 01 rw 03 70 th P
733 surtijah 0000637881982 jakid rt 02 rw 01 80 th P
735 zahra 0000637849807 jakid rt 02 rw 10 4 th P
736 seger 0001032402306 jakid rt 04 rw 08 56 th L
737 atoni 0001032406101 jakid rt 02 rw 01 55 th L
738 m faizal 0000638789602 jakid rt 01 rw 06 2 th L
739 ridah 0000638040234 kr sembung rt 03 rw 12 55 th P
741 sukri 0000638178863 jakid rt 03 rw 01 40 th L
743 abdul duhri 0000638776126 km amba rt 01 rw 01 40 th L
744 nurhayati 0000636427178 jakid rt 01 rw 04 28 th P
745 krismanto 0000638496723 pamengger rt 03 rw 05 60 th L
747 ira irawan 0000639034052 kr sembung rt 04 rw 05 33 th L
748 zidny 0000638276165 jakid rt 02 rw 04 4 th L
749 sopiyani 0000637129473 jakid rt 02 rw 01 16 th P
750 widiya 0000637918071 jalor rt 02 rw 03 13 th P
752 m fifqi zaman 0000637924217 jakid rt 03 rw 06 12 th L
753 maslikha 0000638639389 kb nagung rt 04 rw 12 60 th P
756 mugiroh 0000638662226 klampis rt 10 rw 03 47 th P
757 tarnuri 0000637553376 jakid rt 01 rw 11 56 th L
758 suid 0000626968693 rg wesi rt 02 rw 01 52 th L
759 nur aeni 0000638149661 jalor rt 02 rw 01 57 th P
760 rosidah 0000637963498 jakid rt 03 rw 08 37 th P
761 karso 0000638781603 pamengger rt 07 rw 03 71 th L
762 komita 0000638391196 dk maja rt 08 rw 02 2 th P
763 munawaroh 0000638312793 jalor rt 05 rw 05 23 th P
764 m fajarun 0000639588688 janegara rt 02 rw 01 11 th L
765 m agus 0000639577711 janegara rt 02 rw 01 37 th L
766 oom komariyah 0000639588497 janegara rt 02 rw 01 32 th P
767 sukyadi 0000638913148 tg wulung rt 12 rw 03 70 th L
768 tasdik 0000639156227 jakid rt 01 rw 05 35 th L
769 sukarmo 0000640188581 kl alang rt 01 rw 01 42 th L
770 nur aisah 0000638267163 jakid rt 03 rw 04 10 th P
771 mujiono 0000638829562 jalor rt 03 rw 02 40 th L
772 khasanah 0000638134296 jakid rt 04 rw 06 50 th P
773 wiwin 0000638951861 kts yasa rt 04 rw 01 13 th P
774 safinatun najah 0000638510306 kts yasa rt 04 rw 01 9 th P
777 karpi 0000638476176 pamengger rt 02 rw 04 75 th P
778 ropii 0001032408178 jakid rt 04 rw 03 36 th L
779 taminah 0000637730313 janegara rt 11 rw 04 60 th P
780 eva 0000637002969 jakid rt 03 rw 08 12 th P
782 m topik 0000638136416 kts yasa rt 07 rw 04 3 th L
783 jawawi 0000638108021 jalor rt 06 rw 01 55 th L
784 khotipah 0000637930991 dk maja rt 01 rw 04 40 th P
785 sumarni 0000638320503 jakid rt 02 rw 04 50 th P
787 ita 0000637317644 wana sari rt 10 rw 04 33 th P
788 selviana 0000638170097 jakid rt 04 rw 01 12 th P
790 roisah 0000638207826 jakid rt 03 rw 04 26 th P
791 sitinah 0000638802797 jakid rt 01 rw 03 47 th P
792 bunga 0000638404609 pamengger rt 02 rw 01 6 th P
793 susmarni 0000638225212 kb nagung rt 09 rw 03 45 th P
794 wasripah 0000638218899 jakid rt 05 rw 01 36 th P
795 riska fatikha 0000638219215 jakid rt 05 rw 01 5 th P
796 sri mulyani 0000638727129 jakid rt 05 rw 01 25 th P
797 toipah 0000638864673 jalor rt 02 rw 01 36 th P
798 musripah 0000638897264 jalor rt 05 rw 03 70 th P
800 surya 0000638922103 kr sembung rt 03 rw 05 70 th L
803 rokhimi 0000638033692 kr sembung rt 03 rw 05 45 th P
804 darto 0000637840113 dk maja rt 06 rw 05 55 th L
805 zaenudin 0000638652835 jalor rt 04 rw 05 12 th L
806 m fakih 0000639395816 kts yasa rt 06 rw 04 9 th L
807 maskuri 0000639750853 jakid rt 02 rw 07 50 th L
808 st khopidoh 0000639043244 jakid rt 03 rw 10 26 th P
810 raidah 0001032391743 dk maja rt 02 rw 04 55 th P
811 sanuri 0000638501826 km amba rt 04 rw 02 65 th L
812 st subbiah 00006391778561 janegara rt 01 rw 01 3 th P
813 kamini 0000637178136 janegara rt 01 rw 01 43 th P
814 rahmalia 0000639289768 dk maja rt 03 rw 03 6 th P
816 ayunda 0000638322131 dk maja rt 03 rw 03 9 th P
818 sumiati 0000639093261 dk maja rt 01 rw 03 32 th P
819 evah s 0000639118316 kts yasa rt 01 rw 04 13 th P
820 kasrih 0000631352586 kedawon rt 14 rw 07 30 th P
821 suniti 0000638284858 km amba rt 02 rw 03 44 th P
822 m riyanto 0000638279008 jakid rt 02 rw 10 28 th L
823 aliyah 0000638273856 jakid rt 05 rw 03 43 th P
824 rima irna 0000637850711 dk maja rt 11 rw 01 9 th P
826 raswan 0000637815677 kr sembung rt 04 rw 05 70 th L
827 koridah 0000638458661 jalor rt 01 rw 02 40 th P
829 bagus 0000639544149 klampis rt 03 rw 01 12 th L
830 wanisah 0000638074629 tg wulung rt 18 rw 04 55 th P
831 sobirin 0000638299552 jalor rt 03 rw 02 70 th L
832 subur s 0000639275679 janegara rt 01 rw 01 46 th L
833 rositin 0000637607733 tg wulung rt 04 rw 08 42 th P
834 rohyati 0000639192636 jalor rt 05 rw 01 44 th P
835 kristina 0000638055505 kr sembung rt 04 rw 05 40 th P
836 sopiyah 0001032404758 jakid rt 02 rw 01 55 th P
837 safira 0000638161143 jakid rt 03 rw 09 3 th P
838 wastiah 0000637642495 kts yasa rt 01 rw 04 40 th P
839 rehan 0000637644588 kts yasa rt 01 rw 04 5 th L
840 yuliana 0000638644187 jalor rt 01 rw 08 9 th P
841 mansur 0000638316191 jakid rt 05 rw 05 57 th L
842 sarah 0000639182338 jakid rt 05 rw 05 4 th P
843 ah ikbal 0000639181372 jakid rt 05 rw 05 7 th L
844 iza halki 0000638059375 tg wulung rt 04 rw 01 3 th L
846 salfa 0000638347274 jakid rt 05 rw 03 25 th P
848 defi rizki 0000637151578 jakid rt 02 rw 01 3 th P
849 muisah 0000637941791 kts yasa rt 03 rw 04 61 th P
851 fajar rizki a 0000638688453 dk maja rt 01 rw 03 4 th L
852 desi triasih 0000638510332 bojong rt 02 rw 03 8 th P
854 warningsih 0001032411756 jalor rt 05 rw 01 63 th P
855 surati 0000638639291 jalor rt 03 rw 01 45 th P
856 tauroh 0000639466822 klampis rt 04 rw 02 45 th P
857 bunga aulia 0000639462723 klampis rt 04 rw 02 16 th P
858 fania putri 0000637952185 jakid rt 03 rw 01 8 th P
859 darningsih 0000638709309 jakid rt 03 rw 01 38 th P
860 st masruroh 0000639092272 jakid rt 02 rw 09 21 th P
861 supriyati 0000638667123 tg wulung rt 01 rw 01 33 th P
862 ah ade riyanto 0000637752014 dk maja rt 03 rw 03 7 th L
863 mawardi 0000638842761 karanglo rt 12 rw 01 63 th L
866 saminah 0000632847882 sitanngal rt 01 rw 09 36 th P
867 sumirah 0000638579463 dk maja rt 08 rw 05 50 th P
868 afriyatun 0000638810572 wn cala rt 01 rw 03 20 th P
869 salamah 0000637700432 kts yasa rt 03 rw 01 55 th P
870 wasitoh 0000638729954 km amba rt 04 rw 02 30 th P
871 st khamimah 0000639119654 jakid rt 02 rw 05 59 th P
872 warti 0000639289618 jakid rt 02 rw 05 43 th P
873 widia s 0000632399117 rg pendawa rt 08 rw 03 4 th P
874 dina s 0000637156256 kr sembung rt 03 rw 04 10 th P
875 washeri 0000639119633 kts yasa rt 02 rw 01 54 th P
876 musdalifah 0000637969691 jalor rt 03 rw 01 21 th P
877 sandi 0000638210833 karanglo rt 05 rw 02 7 th L
878 maliha 0001032401924 km amba rt 02 rw 01 42 th P
879 bela diana 0000639267434 jalor rt 01 rw 08 12 th P
881 darus 0000637538914 jakid rt 02 rw 07 55 th L
882 nada nadia 0000639146924 kts yasa rt 04 rw 02 6 th P
883 warso 0000639026246 dk maja rt 04 rw 02 70 th L
884 sugiarto 0000638788994 jakid rt 03 rw 09 36 th L
885 laelatus sarifah 0000638673118 jalor rt 04 rw 02 31 th P
886 ica mutia 0000638348027 kd tukang rt 16 rw 03 5 th P
887 novita a 0000638866102 karanglo rt 15 rw 03 7 th P
888 safira 0000638684653 dk maja rt 03 rw 02 3 th P
889 m kheruman 0000637894256 dk maja rt 03 rw 08 12 th L
890 subur sumiati 0000639275024 janegara rt 01 rw 01 46 th L
891 numan abd hakim 0000636043784 jakid rt 02 rw 01 8 th L
892 suminah 0000637732304 janegara rt 01 rw 01 54 th P
894 azmiah s 0000637954694 jakid rt 05 rw 08 7 th P
895 silkha 0000638478764 kts yasa rt 01 rw 03 50 th P
896 surwad 0000638191337 karanglo rt 15 rw 03 70 th L
897 rahmad afriza 0000638553126 pamengger rt 03 rw 01 8 th P
898 daniroh 0000632197901 rg pendawa rt 02 rw 11 40 th P
899 st nurhayati 0000637747042 dk maja rt 03 rw 03 30 th P
901 astriyani 0000638285466 karanglo rt 08 rw 02 20 th P
902 soipah 0000637346246 kts yasa rt 03 rw 01 34 th P
903 namira 0000638957856 jakid rt 01 rw 05 7 th P
AT JALAN JAMKESMAS DI PELAYANAN DASAR
BULAN : APRIL TAHUN : 2013

PUSKESMAS JATIBARANG ( LOKET )
at Jalan Peserta Jamkesmas
Pelayanan Kes dan Besaran Tarif sesuai dengan PERDA (Rp) *))
TANDA
TANGGAL TOTAL
DIAGNOSA Poli Pemeriks TANGAN
KUNJUNGAN Poli Gigi Poli KIA Tindakan BIAYA
Umum aan LAB PASIEN
(6) (7) (8) (9) (10) (11) (12) 13 = (8+9+10+11+12) 14
01-04-2013 batuk Rp,5000

pegel Rp,5000
panas Rp,5000
pegel Rp,5000
gatal Rp,5000
pusing Rp,5000
panas Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
peroid 74 Rp,5000 Rp,11750
batuk Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
pegel Rp,5000
hipertensi Rp,5000
panas Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
panas Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
hipertensi Rp,5000
bta Rp,5000 Rp,4500
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
panas Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
peroid 76 Rp,5000 Rp,55000
gatal Rp,5000
panas Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
au Rp,5000 Rp,3000
persistensi Rp,5000 Rp,17000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
02-04-2013 panas Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000 Rp,17000
hb,golda Rp,5000 Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
pegel Rp,5000
pulpa polip Rp,5000 Rp,55000
pegel Rp,5000
hipertensi Rp,5000
gatal Rp,5000
panas Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
batuk Rp,5000
03-04-2013 panas Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
batuk Rp,5000
gatal Rp,5000
pulpapolip Rp,5000
hipertensi Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
period 75 Rp,5000 Rp,11750
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
panas Rp,5000
hipertensi Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
period 74 Rp,5000 Rp,11750
gatal Rp,5000
panas Rp,5000
04-04-2013 abses Rp,5000 Rp,55000
batuk Rp,5000
pegel Rp,5000
hb,golda Rp,5000 Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
batuk Rp,5000
dr Rp,5000 Rp,8000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
hipertensi Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
kariesdentil Rp,5000 Rp,27500
batuk Rp,5000
pegel Rp,5000
05-04-2013 gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
abses Rp,5000 Rp,55000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
gatal Rp,5000
period Rp,5000 Rp,11750
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
06-04-2013 panas Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
panas Rp,5000
batuk Rp,5000
panas Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
08-04-2013 hipertensi Rp,5000
batuk Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
gatal Rp,5000
batuk Rp,5000
gatal Rp,5000
panas Rp,5000
gatal Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
pegel Rp,5000
gatal Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
pegel Rp,5000
pegel Rp,5000
batuk Rp,5000
hipertensi Rp,5000
panas Rp,5000
panas Rp,5000
gatal Rp,5000
panas Rp,5000
batuk Rp,5000
panas Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
abses 36 Rp,5000 Rp,55000
batuk Rp,5000
09-04-2013 batuk Rp,5000
dr Rp,5000 Rp,8000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
panas Rp,5000
panas Rp,5000
pusing Rp,5000
pegel Rp,5000
hipertensi Rp,5000
gatal Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
gatal Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
panas Rp,5000
pegel Rp,5000
persistensi Rp,5000 Rp,5000 Rp,17000
batuk Rp,5000
pegel Rp,5000
10-04-2013 batuk Rp,5000
pegel Rp,5000
gds Rp,5000 Rp,3000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
batuk Rp,5000
gatal Rp,5000
pegel Rp,5000
pegel Rp,5000
pusing Rp,5000
pegel Rp,5000
hipertensi Rp,5000
gatal Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
11-04-2013 pegel Rp,5000
panas Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
pusing Rp,5000
pusing Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
pusing Rp,5000
pusing Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
radices Rp,5000 Rp,17000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
panas Rp,5000
abses 84 Rp,5000 Rp,11750
hipertensi Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
gatal Rp,5000
batuk Rp,5000
batuk Rp,5000
panas Rp,5000
gatal Rp,5000
batuk Rp,5000
12-04-2013 hipertensi Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
panas Rp,5000
batuk Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
pusing Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
13-04-2013 panas Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
pusing Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
pusing Rp,5000
pegel Rp,5000
pegel Rp,5000
hipertensi Rp,5000
15-04-2013 pegel Rp,5000
panas Rp,5000
batuk Rp,5000
gangren pulpa Rp,5000 Rp,11750
hipertensi Rp,5000
batuk Rp,5000
panas Rp,5000
period 36 Rp,5000 Rp,11750
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
pusing Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
gingivitis Rp,5000 Rp,11750
pusing Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
pusing Rp,5000
batuk Rp,5000
pusing Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
panas Rp,5000
hipertensi Rp,5000
batuk Rp,5000
batuk Rp,5000
16-04-2013 batuk Rp,5000
bta Rp,5000 Rp,4500
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000 Rp,32500
gds Rp,5000 Rp,3000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
17-04-2013 batuk Rp,5000
panas Rp,5000
hipertensi Rp,5000
perikonotitis Rp,5000 Rp,55000
pegel Rp,5000
gatal Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
hipertensi Rp,5000
dr Rp,5000 Rp,8000
pegel Rp,5000
gatal Rp,5000
panas Rp,5000
panas Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
gatal Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
persistensi Rp,5000
batuk Rp,5000
panas Rp,5000 Rp,55000
batuk Rp,5000
18-04-2013 pegel Rp,5000
period Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
panas Rp,5000
hipertensi Rp,5000
pegel Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
gatal Rp,5000
GP period Rp,5000 Rp,11750
pusing Rp,5000
pegel Rp,5000
hipertensi Rp,5000
panas Rp,5000
panas Rp,5000
gatal Rp,5000
panas Rp,5000
4/19/2013 panas Rp,5000
gatal Rp,5000
gatal Rp,5000
panas Rp,5000
pegel Rp,5000
pegel Rp,5000
panas Rp,5000
panas Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
4/20/2013 pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
pusing Rp,5000
panas Rp,5000
panas Rp,5000
pegel Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
4/22/2013 batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
persistensi Rp,5000
radices 46 Rp,5000 Rp,23500
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
persistensi Rp,5000
pusing Rp,5000
pegel Rp,5000
persistensi Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
panas Rp,5000
4/23/2013 batuk Rp,5000
pegel Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
pusing Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
panas Rp,5000
persistensi Rp,5000
hipertensi Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
panas Rp,5000
pegel Rp,5000
bb Rp,5000
batuk Rp,5000
gds Rp,5000 Rp,3000
batuk Rp,5000
pegel Rp,5000
pegel Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
batuk Rp,5000
hipertensi Rp,5000
4/24/2013 batuk Rp,5000
pegel Rp,5000
dr Rp,8000
gatal Rp,5000
batuk Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
hipertensi Rp,5000
batuk Rp,5000
panas Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
hipertensi Rp,5000
batuk Rp,5000
pegel Rp,5000
gatal Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
hipertensi Rp,5000
batuk Rp,5000
creat Rp,3000
panas Rp,5000
panas Rp,5000
panas Rp,5000
hipertensi Rp,5000
batuk Rp,5000
batuk Rp,5000
panas Rp,5000
4/25/2013 pegel Rp,5000
batuk Rp,5000
pegel Rp,5000
hipertensi Rp,5000
pegel Rp,5000
panas Rp,5000
batuk Rp,5000
gatal Rp,5000
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DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMA

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA
(Thn)
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6)

2 adinda 0000638388701 kb nagung rt 04 rw 03 8 th P
3 endang 0000638881626 kts yasa rt 07 rw 04 19 th P
4 riana 0000637118246 jakid rt 02 rw 03 36 th P
5 m ramdani 0000637118289 jakid rt 02 rw 03 13 th L
6 ramlawi 0000637612391 jalor rt 01 rw 04 62 th L
7 faturahman 0000637613638 jalor rt 01 rw 04 10 th L
8 sunardi 0000638626017 jakid rt 05 rw 06 63 th L
9 kusnah 0000639272013 jakid rt 02 rw 08 48 th P
11 satno 0000638606886 jalor rt 03 rw 05 51 th L
12 komariyah 0000637523368 kr sembung rt 04 rw 02 33 th P
13 ah solihin 0000637624167 kr sembung rt 04 rw 02 8 th L
14 dainah 0000638114062 dk maja rt 01 rw 04 39 th P
15 kaimah 0000638842168 karanglo rt 20 rw 04 60 th P
16 khalimah 0000637823676 jakid rt 03 rw 08 43 th P
17 kariyah 0000637620063 kr sembung rt 05 rw 06 33 th P
18 suirah 0000638385521 kr sembung rt 05 rw 06 66 th P
19 ardi 0000638612268 jakid rt 01 rw 08 5 th L
21 komariyah 0000638067876 wn tawang rt 04 rw 04 42 th P
22 m rehan 0000637850246 jalor rt 01 rw 04 10 th L
23 nur azizah 0000638486881 klikiran rt 06 rw 02 9 th P
24 musridah 0000632808108 rg pendawa rt 02 rw 09 60 th P
28 aryanto 0000638499632 jalor rt 05 rw 03 9 th L
29 kuryono 0000638326137 jakid rt 03 rw 04 40 th L
30 kholisoh 0000636264316 jalor rt 01 rw 01 14 th P
31 oktaviana 0000637894496 kr sembung rt 04 rw 05 3 th P
33 suharsih 0000638607363 buaran rt 03 rw 02 36 th P
34 warti 0000639223727 buaran rt 03 rw 02 40 th P
35 mursipah 0000638897284 jalor rt 06 rw 03 70 th P
36 fadil 0000638497361 jalor rt 05 rw 03 9 th L
38 tarkiyah 0000638376943 klampis rt 05 rw 02 53 th P
39 farhan 0000632368492 sitanggal rt 03 rw 09 10 th L
41 sumarto 0000638110834 kts yasa rt 01 rw 05 24 th L
42 dainah 0000638777538 tembelang rt 03 rw 02 50 th P
43 wijah 0000638963616 pamengger rt 08 rw 03 40 th P
45 cantika 0000638072741 pamengger rt 03 rw 01 11 th P
46 faridah 0000637649106 kts yasa rt 02 rw 02 31 th P
48 ramdan 0000638955145 jakid rt 02 rw 01 40 th L
50 asrofi 0000638129338 jakid rt 05 rw 05 50 th L
51 wainah 0000639569981 janegara rt 01 rw 01 40 th P
53 najwanti 0000637854232 dk maja rt 06 rw 07 45 th P
54 harti 0000638147529 jakid rt 04 rw 03 10 th P
56 soliha 0000638622497 km amba rt 04 rw 04 36 th P
57 fitri amulida 0000638561106 jalor rt 02 rw 02 3 th P
58 murni 0000637163493 wn tawang rt 04 rw 03 50 th P
59 fatimah 0000637832081 dk maja rt 04 rw 02 54 th P
60 rohani 0000638612019 jalor rt 05 rw 06 40 th P
61 aji pangestu 0000638717182 jakid rt 06 rw 05 16 th L
62 m rizki 0000624764248 mulyoharjo rt 02 rw 04 4 th L
63 supardi 0000637863039 dk maja rt 05 rw 01 48 th L
64 bahrudin 0000637907253 jalor rt 05 rw 03 18 th L
66 sewi 0000637727206 kr sembung rt 02 rw 05 37 th P
67 m agus 0000637727506 kr sembung rt 02 rw 05 13 th L
68 danisah 0000631761548 rg pendawa rt 02 rw 03 48 th P
69 wasirah 0000637963846 jt makmur rt 05 rw 01 55 th P
70 nokiroh 0000637944001 jt makmur rt 05 rw 01 19 th P
71 sumrah 0000637209314 kr sembung rt 02 rw 04 48 th P
72 sumriyah 0000638941889 tembelang rt 02 rw 01 28 th P
73 ayu 0000636227098 kb nagung rt 02 rw 04 22 th P
74 saripah 0000639890411 dk maja rt 03 rw 03 33 th P
75 dwi 0000637696563 jalor rt 08 rw 01 23 th P
76 nazwa 0000639139978 dk maja rt 04 rw 07 6 th P
80 jamilah 0000637868351 jakid rt 01 rw 07 50 th P
81 tarpiah 0000638212138 janegara rt 01 rw 01 50 th P
82 hartinah 0001032420971 janegara rt 04 rw 01 56 th P
84 m irpan 0000637665758 jakid rt 03 rw 07 11 th L
85 suwarto 0000638953076 kts yasa rt 05 rw 04 43 th L
86 maanah 0001032407559 jakid rt 02 rw 09 55 th P
87 khaerunisa 0000637579089 kr sembung rt 04 rw 05 4 th P
90 fera 0000639164146 kts yasa rt 01 rw 03 2 th P
91 m wahyu 0000639108988 kts yasa rt 01 rw 03 6 th L
92 rihanah 0000633490268 rg pendawa rt 07 rw 02 47 th P
93 casminah 0000638494569 tembelang rt 18 rw 03 41 th P
94 kunyati 0000638866133 tembelang rt 06 rw 02 33 th P
95 joko pramono 0001032414939 jalor rt 05 rw 02 34 th L
96 edi sudiyaono 0000639036494 jakid rt 05 rw 05 72 th L
97 kalimah 0001032413182 jalor rt 08 rw 01 62 th P
98 wadi 0000638486274 jalor rt 08 rw 01 76 th L
99 nuridah 0000638126087 jakid rt 08 rw 10 47 th P
100 warsiti 0001032464212 kramat rt 04 rw 02 49 th P
101 rintono 0000638672771 jalor rt 04 rw 04 29 th L
103 durmad 0000639470306 janegara rt 02 rw 01 41 th L
104 suhadi 0000638163684 dk maja rt 02 rw 01 69 th L
105 tarpiah 0000638262527 karanglo rt 02 rw 10 58 th P
106 diska 0000638703821 km amba rt 02 rw 03 7 th P
107 ayu mulyasari 0000638199617 jakid rt 03 rw 04 10 th P
109 warso 0000637426968 bojong rt 05 rw 01 50 th L
111 wartiah 0000638930306 jalor rt 01 rw 01 60 th P
116 m irfa 0000638775044 jakid rt 02 rw 04 16 th L
117 wahutoh 0000637836414 wn tawang rt 06 rw 03 24 th P
118 zahra 0000637840844 wn tawang rt 06 rw 03 7 th P
119 mairah 0000638216334 janegara rt 02 rw 01 80 th P
121 reza rofaul 0000639119812 dk maja rt 01 rw 01 8 th L
122 anisul fuad 0000638262336 jalor rt 03 rw 04 20 th L
123 agustiya 0000638286397 jakid rt 02 rw 04 32 th P
124 tahri 0000639180873 jalor rt 01 rw 01 36 th L
125 cayi 0000638286392 karanglo rt 16 rw 03 55 th P
127 m ragil 0000636618046 km amba rt 02 rw 03 10 th L
128 leni oktorina 0000636616717 km amba rt 02 rw 03 17 th P
129 nurul maulida 0000638517326 km amba rt 02 rw 03 14 th P
130 santi 0000638694223 bojong rt 01 rw 01 2 th P
131 m ramdon 0000637641637 jalor rt 02 rw 04 16 th L
132 nur azizah 0000637611613 jakid rt 04 rw 05 13 th P
133 hawadan 0000636161658 jalor rt 01 rw 03 36 th P
134 khozanah 0001032415862 jalor rt 03 rw 05 34 th P
135 sulianah 0000638485053 wanacala rt 04 rw 01 17 th P
137 sopiri 0000636800676 kr sembung rt 02 rw 07 52 th L
138 daeni 0001032402969 jakid rt 05 rw 08 36 th P
140 gilang 0000637651124 kts yasa rt 02 rw 02 5 th L
141 dwi wulan 0000637652182 kts yasa rt 02 rw 02 3 th P
143 raswen 0000638966347 tembelang rt 14 rw 03 70 th L
144 sahitah 0000637899881 kts yasa rt 06 rw 04 50 th P
146 daimah 0000637983841 kts yasa rt 03 rw 01 60 th P
147 deni putra 0000638487617 jalor rt 02 rw 01 12 th L
148 delen 0000638420826 dk maja rt 05 rw 02 10 th L
149 david 0000638428769 dk maja rt 03 rw 03 12 th L
150 darmanto 0000637236156 bojong rt 06 rw 02 60 th L
152 latipah 0000638490126 jalor rt 03 rw 02 23 th P
153 turiah 0000637316636 dk maja rt 05 rw 07 60 th P
154 saimah 0000637969969 wanacala rt 02 rw 03 33 th P
155 mistinah 0000639121916 wn tawang rt 01 rw 04 30 th P
156 egis 0000638886731 tembelang rt 01 rw 02 5 th L
157 windi 0000638886606 tembelang rt 01 rw 02 13 th P
158 evi yuli 0000638236786 jakid rt 04 rw 01 24 th P
159 rohati 0000638713631 klampis rt 01 rw 01 36 th P
160 pramesti 0000638714318 klampis rt 01 rw 01 6 th P
161 m nasirin 0000637247116 kts yasa rt 05 rw 01 12 th L
165 deni adi 0000638849109 dk maja rt 01 rw 04 3 th L
166 kasroi 0000637876901 kts yasa rt 04 rw 05 43 th L
168 arifiyah 0000639126783 kts yasa rt 04 rw 01 60 th P
169 rohayah 0000639192363 jalor rt 09 rw 01 41 th P
170 nunung 0000639330164 buaran rt 02 rw 01 32 th P
171 rokayah 0000638099816 kts yasa rt 05 rw 04 50 th P
172 riyanti 0000639100674 kts yasa rt 05 rw 03 22 th P
173 koidah 0000638496739 kts yasa rt 03 rw 01 24 th P
174 waisah 0000638482228 kts yasa rt 01 rw 02 36 th P
175 m syarifudin 0001032911844 dk maja rt 06 rw 05 5 th L
177 dairah 0000638140252 jalor rt 02 rw 03 31 th P
179 novi 0001032401066 klampis rt 05 rw 02 15 th P
180 joko sutanto 0001032414603 jalor rt 01 rw 01 40 th L
182 susanti 0000638106223 jalor rt 06 rw 02 37 th P
183 warnengsih 0001033411786 jalor rt 06 rw 01 60 th P
184 maani 0001032407506 jakid rt 02 rw 01 70 th P
185 jelin 0000638661766 kr sembung rt 02 rw 01 3 th P
187 roisah 0001032363976 songgom rt 03 rw 02 50 th P
188 imam 0001032422486 janegara rt 08 rw 03 14 th L
189 kasripah 0000638034096 kr sembung rt 02 rw 01 50 th P
192 rahayu slamet 0000638312422 klampis rt 12 rw 04 12 th L
194 eva wulandari 0000637780677 kr sembung rt 01 rw 06 7 th P
195 ibadah 0000637941296 kts yasa rt 05 rw 03 70 th P
197 sahri 0000638131646 kb nagung rt 02 rw 03 76 th L
198 mudasir 0000638547827 jalor rt 05 rw 04 70 th L
199 santi eka 0000638599223 bojong rt 01 rw 01 26 th P
203 tonah 0000639078366 dk maja rt 02 rw 02 50 th P
205 riska 0000638219315 jakid rt 05 rw 01 6 th P
208 melani 0000638501646 bojong rt 01 rw 01 10 th P
209 suroh 0000638500353 bojong rt 01 rw 01 50 th P
210 ah faisal 0000638796699 jakid rt 04 rw 01 11 th L
212 anas 0000637909289 jakid rt 02 rw 04 6 th L
214 abdul rohim 0001032406170 jakid rt 04 rw 08 45 th L
216 lilis 0000626086786 kd sugih rt 02 rw 01 14 th P
218 henu akbar 0000639101215 kts yasa rt 01 rw 03 35 th L
219 nurhikmah 0000639178119 janegara rt 02 rw 01 31 th P
220 kasdum 0000637130226 jakid rt 03 rw 04 80 th L
221 abd rohim 0000638833588 jalor rt 03 rw 03 70 th L
222 supriyadi 0000638038892 jakid rt 02 rw 01 57 th L
223 slamet s 0001032407096 jakid rt 02 rw 05 40 th L
224 taupik 0000638468549 klampis rt 09 rw 02 3 th L
226 munirah 0000638871769 wn tawang rt 07 rw 01 50 th P
227 mundirin 0000638863018 kts yasa rt 05 rw 03 39 th L
229 atika 0000637637162 jalor rt 08 rw 01 8 th P
231 st taimah 0000637906263 kr sembung rt 02 rw 01 66 th P
232 krisnawati 0000638933691 jakid rt 03 rw 08 50 th P
233 tasmuri 0000637665378 jakid rt 01 rw 11 60 th L
235 khariah 0000637899513 jalor rt 03 rw 05 39 th P
238 eti purwanti 0000638934386 jakid rt 03 rw 08 26 th P
241 waesah 0000638717141 km amba rt 04 rw 02 34 th P
242 resti 0000638489316 dk maja rt 02 rw 05 6 th P
244 sairah 0000637881996 kts yasa rt 02 rw 03 45 th P
245 tarjono 0000637632981 kts yasa rt 01 rw 04 55 th L
246 syarif 0001032408637 karanglo rt 02 rw 09 9 th L
247 ronipah 0001032408637 karanglo rt 02 rw 09 60 th P
248 sutiah 0000632508131 rg pendawa rt 13 rw 02 70 th P
249 fatiha 0000637790466 kts yasa rt 01 rw 02 38 th P
250 rohilah 0000637993946 jalor rt 07 rw 03 40 th P
252 reyhan 0000638161425 km amba rt 04 rw 02 7 th L
253 salfi 0000637649903 kts yasa rt 02 rw 02 12 th P
254 rosikhin 0000638354107 jalor rt 02 rw 02 40 th L
256 wahyu 0001032404804 jakid rt 08 rw 06 11 th P
257 nurjanah 0001032404782 jakid rt 08 rw 06 36 th P
258 haryanto 0000639043806 jakid rt 03 rw 02 60 th L
259 bagas 0000638362496 kramat rt 12 rw 04 11 th L
260 kasnudin 0001032411374 jalor rt 06 rw 01 33 th L
261 ramadani 0000637835049 dk maja rt 02 rw 01 6 th L
262 maenah 0000638170806 jakid rt 01 rw 02 60 th P
263 ari purwanto 0000638755503 km amba rt 04 rw 02 6 th L
264 ah haris 0000638658832 jalor rt 07 rw 05 15 th L
266 koniatur 0000637364709 kts yasa rt 01 rw 01 35 th P
267 khadibah 0000638274746 km amba rt 03 rw 02 37 th P
268 suhanah 0000638319947 jakid rt 03 rw 10 50 th P
271 sutarwo 0001032399641 klampis rt 03 rw 01 48 th L
273 efah supriyatin 0000639118315 kts yasa rt 07 rw 04 13 th P
274 winten 0000638332345 bojong rt 15 rw 03 40 th P
275 yogo saputra 0000639509589 dk maja rt 05 rw 05 6 th L
276 sukar 0000638171661 km amba rt 02 rw 03 60 th L
277 barkah 0001032404499 jakid rt 03 rw 04 68 th P
278 nurdinda 0000638818244 jakid rt 01 rw 06 2 th P
279 sopiyah 0000638065316 wn tawang rt 02 rw 01 67 th P
280 ali munawar 0000637996094 tg wulung rt 06 rw 01 46 th L
281 tuniroh 0001032401147 km amba rt 01 rw 01 55 th P
282 miswati 0000638616173 jalor rt 05 rw 01 38 th P
283 susi agustina 0000638616633 jalor rt 05 rw 01 19 th P
284 sumarto 0000637825972 geger kunci rt 08 rw 02 48 th L
285 zaenal abidin 0000638838303 jakid rt 05 rw 05 26 th L
286 daimah 0000639070749 jakid rt 10 rw 02 50 th P
288 tiro 0000638316944 jalor rt 05 rw 05 2 th L
289 khozanah 0000638202802 jakid rt 03 rw 06 30 th P
290 rohayah 0000638698516 kts yasa rt 05 rw 03 50 th P
291 siti 0001032406131 jakid rt 02 rw 09 60 th P
292 kholifatun 0000638880023 jalor rt 05 rw 04 33 th P
293 sri mimah 0000638809367 jakid rt 05 rw 06 41 th P
295 tarmad 0000639236824 pamengger rt 04 rw 01 70 th L
296 kartono 0001032411947 jalor rt 08 rw 02 65 th L
297 subur 0000638276679 janegara rt 01 rw 01 48 th L
298 zaenal abidin 0000638164885 janegara rt 01 rw 03 46 th L
299 sulfa 0000638322541 dk maja rt 03 rw 02 6 th L
301 sukirah 0000638396997 dk maja rt 01 rw 01 43 th P
302 andre 0000638396938 dk maja rt 01 rw 01 12 th L
303 suirah 0000638688521 jakid rt 01 rw 04 70 th P
304 usman 0000638431447 klampis rt 11 rw 04 63 th L
305 wasripah 0000637919944 kts yasa rt 04 rw 03 40 th P
306 tunirah 0000638486864 jalor rt 02 rw 01 33 th P
308 nurhayati 0000635427178 kts yasa rt 01 rw 04 28 th P
309 jumriyah 0000638931116 dk maja rt 05 rw 02 60 th P
310 neng sumita 0000638789422 jakid rt 01 rw 09 37 th P
312 melina 0000637758336 dk maja rt 01 rw 04 4 th P
313 sairah 0000638674852 tembelang rt 16 rw 03 30 th P
314 eva 0000638624851 dk maja rt 01 rw 07 8 th P
315 khamidah 0000637890489 jakid rt 05 rw 05 53 th P
316 ah topik 0000638877946 karanglo rt 04 rw 01 70 th L
317 taruni 0000638622908 karanglo rt 04 rw 01 50 th P
321 nur khasanah 0000637732743 janegara rt 01 rw 01 32 th P
322 khaliyah 0000638569967 jalor rt 02 rw 05 36 th P
323 ayu 0000637356723 kts yasa rt 03 rw 03 13 th P
325 taripah 0000638132141 jakid rt 04 rw 02 40 th P
326 yuni mur 0000638098847 jalor rt 05 rw 03 19 th P
327 natasya 0000638875064 kb nagung rt 08 rw 02 4 th P
328 sandi 0000638028968 jakid rt 03 rw 06 12 th L
329 asari 0000638319741 jakid rt 08 rw 05 42 th L
333 m mirza 0001032415209 jakid rt 05 rw 05 3 th L
334 khotimah 0001032418186 jalor rt 05 rw 05 43 th P
336 daenah 0001032414675 jalor rt 02 rw 06 60 th P
337 misbarudin 0000638108136 kts yasa rt 01 rw 03 10 th L
338 misbahudin 0000639189624 kts yasa rt 07 rw 04 48 th L
339 jamilah 0000637868261 jalor rt 01 rw 07 50 th P
342 putri nur sifa 0000638932544 jakid rt 02 rw 05 18 th P
344 saodah 0000639803469 janegara rt 01 rw 01 43 th P
346 darsini 0001032406481 jakid rt 01 rw 07 70 th P
347 warkinah 0000639271844 jakid rt 05 rw 08 60 th P
348 nadiroh 0000637741146 kts yasa rt 03 rw 02 52 th P
349 syahrul 0000638811314 jakid rt 02 rw 09 2 th L
351 abdul ropi 0000638406215 kts yasa rt 01 rw 04 50 th L
353 nur azmi 0000637733452 janegara rt 01 rw 01 7 th L
354 m ayudatul 0000638472892 kr sembung rt 01 rw 04 52 th L
356 riski 0000637681239 kts yasa rt 05 rw 04 4 th L
358 januri 0000633075096 rg pendawa rt 02 rw 11 30 th L
360 hindun 0000638332819 jakid rt 05 rw 08 51 th P
361 a hasim 0000638337296 jakid rt 02 rw 05 30 th L
362 warkonah 0000637956921 kr sembung rt 01 rw 07 37 th P
363 wahyu 0000637329089 kr sembung rt 01 rw 07 9 th P
364 kartika 0000638240243 jakid rt 03 rw 01 13 th P
366 tarno 0000637615506 jakid rt 02 rw 06 62 th L
367 wahyudi 0000638654782 klampis rt 01 rw 01 7 th L
368 murtado 0000638211047 kb nagung rt 04 rw 03 16 th L
370 rahmat afiza 0000638683126 pamengger rt 03 rw 01 8 th L
371 abd muin 0000639126056 dk maja rt 01 rw 08 55 th L
372 khaerullah 0000638116259 jalor rt 04 rw 02 7 th L
375 rusbad 0000638808311 jakid rt 01 rw 05 72 th L
376 calem 0000638325966 jakid rt 02 rw 01 80 th P
377 sakurah 0000638784886 klampis rt 03 rw 05 31 th P
378 juanah 0000637402874 kts yasa rt 02 rw 01 22 th P
379 wamen 0000638879902 pamengger rt 07 rw 05 40 th P
380 rawen 0001032447997 jakid rt 01 rw 01 70 th P
381 haryati 0001032408047 kts yasa rt 01 rw 01 31 th P
383 ah abdullah 0000638168962 jakid rt 03 rw 08 3 th L
384 andre 0001032402442 jakid rt 03 rw 08 9 th L
387 agus saputra 0000638723697 kr sembung rt 03 rw 02 7 th L
388 alam 0000638780982 jakid rt 06 rw 05 8 th L
389 khatipah 0000638271636 jakid rt 02 rw 10 46 th P
390 hera 0000639591186 kr sembung rt 03 rw 04 8 th P
392 dasri 0000632263566 rg pendawa rt 02 rw 02 40 th P
393 m akbar 0001032415614 jalor rt 03 rw 12 3 th L
394 sodikin 0000638704202 jakid rt 01 rw 02 55 th L
396 nuryati 0001032413321 jalor rt 02 rw 06 33 th P
397 sri rohani 0000637161287 jakid rt 06 rw 05 32 th P
398 revan 0000638470146 tembelang rt 12 rw 07 2 th L
399 wanuroh 0000639628346 tembelang rt 14 rw 03 21 th P
400 wasitah 0000638729964 km amba rt 02 rw 04 3 th P
401 saipah 0000637340246 kts yasa rt 03 rw 01 33 th P
402 ninda suci aulia 0000638074136 kr sembung rt 04 rw 01 3 th P
403 lukmanul 0001032420982 kts yasa rt 04 rw 01 33 th L
404 m riski 0000638220326 jakid rt 01 rw 05 2 th L
406 titin 0000638354562 kts yasa rt 05 rw 04 30 th P
408 rositah 0001032415761 jalor rt 08 rw 01 8 th P
410 solikha 0000637876445 jalor rt 03 rw 03 55 th P
413 muniroh 0001032400271 klampis rt 13 rw 04 70 th P
415 turipah 0000637513446 wn tawang rt 04 rw 04 65 th P
416 eka maulida 0000639708813 janegara rt 03 rw 01 7 th P
417 eriyah 0000638697879 jakid rt 04 rw 02 48 th P
418 teguh a 0000638693717 klampis rt 04 rw 02 7 th L
421 raan kelana 0000639379563 janegara rt 02 rw 01 46 th L
422 rofa dimas 0000637983494 jalor rt 03 rw 01 7 th L
425 kasiroh 0000638302364 klampis rt 12 rw 04 50 th P
426 watni 0001032415391 jalor rt 04 rw 05 70 th P
427 roinah 0000637107412 jakid rt 05 rw 08 51 th P
428 ida rosidah 0000637109076 jakid rt 05 rw 08 16 th P
429 suniti 0000638284585 km amba rt 02 rw 01 44 th P
431 sunidah 0000639166457 kts yasa rt 01 rw 03 45 th P
432 moh.wahyu s 0000639108988 kts yasa rt 01 rw 03 5 th L
435 rohanah 0000639067746 jalor rt 02 rw 05 24 th P
436 tanirah 0000638486223 rg bandung rt 05 rw 01 33 th P
437 ah nur fahmi 0000638488078 rg bandung rt 05 rw 01 5 th L
438 zidan 0000638441818 rg bandung rt 02 rw 03 8 th L
440 salkha 0000638104478 jalor rt 04 rw 01 47 th P
441 rokhayah 0000639099516 kts yasa rt 05 rw 03 50 th P
442 masruroh 0000638487898 kendawa rt 06 rw 02 50 th P
443 lia amelia 0000638487989 kts yasa rt 05 rw 07 8 th P
445 melvi inayah 0000637699566 kts yasa rt 01 rw 01 65 th P
446 surati 0000637650922 geger kunci rt 06 rw 05 60 th P
447 uswatun 0000639388899 kts yasa rt 01 rw 04 21 th P
448 wiyati 0000638811641 jalor rt 03 rw 02 28 th P
449 suwarno 0000638596427 jalor rt 02 rw 01 58 th L
450 moh.fahrurozi 0000638492589 km amba rt 01 rw 03 27 th L
453 nur anisa fitri 0000637635554 jalor rt 01 rw 08 6 th P
454 saesah 0000638449869 janegara rt 01 rw 02 40 th P
456 marinah 0000638294126 kr sembung rt 02 rw 01 50 th P
457 agus 0000637410036 wanacala rt 05 rw 05 15 th L
460 sumirah 0000639105716 jakid rt 04 rw 01 46 th P
461 sutijah 0001032412779 jalor rt 02 rw 05 57 th P
462 komarudin 0000639350164 wanacala rt 01 rw 01 35 th L
464 waah 000103240411 karanglo rt 04 rw 01 55 th P
466 kasnari 0000638609411 karanglo rt 04 rw 01 71 th L
467 rohadi 0000638837903 kts yasa rt 03 rw 01 52 th L
469 waenuroh 0000639674738 jakid rt 04 rw 03 46 th P
471 roipiah 0000637182167 jakid rt 01 rw 03 50 th P
474 slamet haryanto 0000639043856 jakid rt 03 rw 02 50 th L
476 ragil 0000639544421 klampis rt 03 rw 01 9 th L
477 amir 0000638334099 klampis rt 01 rw 01 11 th L
479 kristamah 0000638662218 jalor rt 06 rw 04 42 th P
480 wiharti 0000638812382 pamengger rt 06 rw 02 25 th P
481 st kalipah 0000638811767 pamengger rt 06 rw 02 44 th P
483 sunarto 0000639110834 kts yasa rt 01 rw 06 24 th L
484 gilang 0000638138992 jakid rt 01 rw 05 8 th L
485 mumin 0000638690152 tembelang rt 15 rw 03 28 th L
486 mugenah 0000637988686 jalor rt 01 rw 08 43 th P
487 taripah 0000638183746 tg wulung rt 16 rw 04, 46 th P
488 soinah 0000639056693 karanglo rt 01 rw 01 48 th P
489 taryunah 0000639030062 kr sembung rt 02 rw 07 46 th P
490 asifa 0000637637103 jalor rt 06 rw 01 8 th P
492 fauziyah 0000638268706 jakid rt 03 rw 06 42 th P
495 sopiyah 0000637660204 kr sembung rt 02 rw 01 43 th P
496 yeyen mardiana 0000638509781 km amba rt 01 rw 01 58 th P
498 umar farukhi 0000638484982 klampis rt 10 rw 03 12 th L
499 suratmi 0000637766897 jt makmur rt 01 rw 05 50 th P
500 latifah 0000637115927 jakid rt 02 rw 06 35 th P
503 kasiah 0001032402576 jakid rt 03 rw 08 70 th P
504 fitri hamdani 0000638275503 jakid rt 02 rw 04 3 th P
505 zaenudin 0000637893887 jalor rt 01 rw 04 57 th L
506 m zodi 0000638785405 jakid rt 02 rw 09 18 th L
507 aminah 0000638338053 dk maja rt 01 rw 01 36 th P
508 rastiyah 0000638783921 jakid rt 02 rw 09 37 th P
510 rojanah 0000638437285 janegara rt 01 rw 01 37 th P
511 daisah 0001032412304 pamengger rt 03 rw 04 63 th P
512 jamilah 0000637782841 kts yasa rt 04 rw 04 41 th P
513 suroti 0000637650922 geger kunci rt 04 rw 03 60 th P
514 tri ningsih 0000639628968 jalor rt 05 rw 08 49 th P
515 rendi 0000639686662 tembelang rt 17 rw 03 6 th L
516 ah fahri 0000637126705 jakid rt 01 rw 05 2 th L
517 hanung 0000638299268 jakid rt 04 rw 01 6 th L
519 m rizal 0000639053344 jakid rt 04 rw 01 8 th L
520 anis 0000638547827 jalor rt 05 rw 04 70 th P
521 popon 0000637161398 jakid rt 05 rw 05 41 th P
522 zahra 0000638906859 pamengger rt 04 rw 01 5 th P
523 suci 0000638906638 pamengger rt 04 rw 01 33 th P
524 kasirah 0000638282364 klampis rt 12 rw 04 50 th P
525 st mnur azizah 0000636961926 tembelang rt 18 rw 03 9 th P
529 dirjo 0000636430671 kr sembung rt 04 rw 05 63 th L
530 juanah 0000637402814 kts yasa rt 01 rw 06 31 th P
532 dimas 0001032396633 klampis rt 03 rw 01 11 th L
533 sutarwo 0000103239641 klampis rt 03 rw 01 49 th L
534 suparno 0000638710727 kts yasa rt 04 rw 05 67 th L
536 rahayu 0000638312422 klampis rt 12 rw 04 11 th P
538 soleh 0000638826667 jakid rt 02 rw 06 60 th L
541 jayus 0000638933486 jakid rt 03 rw 08 56 th L
542 nuridin 0000638551089 karanglo rt 02 rw 01 70 th L
543 sandy 0000639377286 karanglo rt 19 rw 04 10 th L
544 melvian 0000638826011 jakid rt 06 rw 05 6 th L
545 intan 0000638161391 tg wulung rt 02 rw 01 5 th P
546 fatimah 0001032403307 jalor rt 02 rw 05 73 th P
547 tri ningsih 0000638321286 jakid rt 04 rw 03 60 th P
548 komisah 0000638961208 pamengger rt 08 rw 01 36 th P
551 tarso 0000638940462 rg bandung rt 04 rw 01 70 th L
552 muharudin 0000638244184 jalor rt 03 rw 05 42 th L
554 panji 0000638816926 jalor rt 06 rw 01 14 th L
556 bunayah 0000638191968 jakid rt 02 rw 04 60 th P
557 saman 0001032418634 jalor rt 01 rw 01 13 th L
558 tuminah 0000637967674 jalor rt 01 rw 05 60 th P
560 dwi safitri 0000638321136 klampis rt 08 rw 02 24 th P
561 naelatun 0000637716363 kts yasa rt 04 rw 04 9 th P
565 tarsitah 0000637846571 kts yasa rt 03 rw 04 49 th P
566 m erwin 0000638942272 songgom rt 05 rw 04 16 th L
567 eliyah 0000638993298 dk maja rt 04 rw 05 40 th P
568 ah muzaki 0000638456117 kts yasa rt 04 rw 03 9 th L
569 ismani 0000637386624 tg wulung rt 02 rw 01 62 th L
570 saudah 0000639603469 janegara rt 01 rw 01 43 th P
571 sefiyatun 0001032412926 jalor rt 03 rw 02 10 th P
572 nurali 0000637704334 kts yasa rt 04 rw 01 7 th L
573 sumitri 0000637944384 dk maja rt 05 rw 07 50 th P
574 sayunah 0000638961584 kts yasa rt 01 rw 05 44 th P
575 maria 0000637596744 jalor rt 01 rw 01 15 th P
576 aminah 0000638472110 kr sembung rt 01 rw 08 60 th P
577 sumarni 0000638228312 kb nagung rt 08 rw 02 45 th P
580 taripah 0000639220196 jalor rt 02 rw 05 57 th P
581 nur anisa fitri 0000639903362 kts yasa rt 01 rw 01 50 th P
583 nur aeni 0000637348823 kts yasa rt 05 rw 02 17 th P
584 sumirah 0000637348217 kts yasa rt 05 rw 02 38 th P
586 nurul 0000638468367 klampis rt 10 rw 05 9 th P
588 roidah 0000638359479 janegara rt 05 rw 08 37 th P
590 mia s 0000638481723 dk maja rt 01 rw 01 8 th P
593 sayim 0000638649201 pamengger rt 03 rw 01 58 th L
594 wasriyati 0000638622797 karanglo rt 05 rw 01 23 th P
595 sopan 0000638577146 ganda suli rt 05 rw 02 58 th L
596 tarso 0000638940463 rg bandung rt 03 rw 01 58 th L
597 jaroh 0000637840732 dk maja rt 04 rw 05 50 th P
598 titin 0000637859936 dk maja rt 04 rw 07 37 th P
599 sapri 0000663131846 kb nagung rt 02 rw 03 70 th L
600 suhesti 0000638742836 jakid rt 05 rw 06 47 th P
601 sriatun 0000638743676 jakid rt 05 rw 08 20 th P
603 rusmini 0000638350198 kl pucang rt 03 rw 01 54 th P
605 kasmuah 0000639859834 karanglo rt 10 rw 04 32 th P
606 ardela 0000637116076 janegara rt 02 rw 01 11 th P
607 sopuan 0000637860093 jakid rt 03 rw 08 54 th L
610 mutamimah 0000637886693 jakid rt 02 rw 01 21 th P
611 solikha 0000637841812 jakid rt 01 rw 01 40 th P
612 sari 0000637844930 jakid rt 01 rw 01 10 th P
613 m soleh 0000638826637 jakid rt 03 rw 03 50 th L
614 tio n 0000638316948 jalor rt 05 rw 06 2 th L
615 sugiono 0000639400768 karanglo rt 04 rw 01 3 th L
616 sri harti 0000633440542 rg pendawa rt 07 rw 02 50 th P
619 kherudin 0000637824476 kts yasa rt 02 rw 05 11 th L
620 tasdikin 0000637565849 kb nagung rt 02 rw 03 46 th L
623 watmi 0001032415391 jalor rt 04 rw 06 74 th P
626 faturozak 0000638493851 jalor rt 02 rw 06 4 th L
627 darna 0000637938245 jalor rt 03 rw 02 50 th L
631 pandu irawan 0000637791921 pamengger rt 02 rw 01 3 th L
632 susan 0000636271814 jakid rt 02 rw 10 19 th P
634 slamet haryanto 0000637981473 jalor rt 08 rw 12 60 th L
635 slamet 0000638611916 jalor rt 08 rw 06 60 th L
636 kartini 0000638686967 klampis rt 09 rw 03 58 th P
637 surwad 0000638191337 karanglo rt 15 rw 03 60 th L
638 salimah 0000638191798 karanglo rt 15 rw 03 60 th P
639 sakri 0000638189233 jakid rt 01 rw 02 63 th L
641 susyanti 0000638676607 jalor rt 06 rw 05 30 th P
642 carsih 0000638251726 jakid rt 02 rw 04 45 th P
643 adi saryo 0000638626741 tembelang rt 14 rw 13 16 th L
644 suryadi 0000637587867 kb nagung rt 02 rw 02 31 th L
645 dian 0000638676314 jakid rt 02 rw 02 12 th P
646 solekhudin 0000637827232 jakid rt 01 rw 09 10 th L
647 karja 0000638279918 klampis rt 07 rw 03 62 th L
648 khunaeni 0000639350194 kts yasa rt 01 rw 01 48 th P
649 warkonah 0000637966921 tembelang rt 01 rw 07 37 th P
650 wahyu 0000637967089 tembelang rt 01 rw 07 7 th P
651 saimah 0000637647309 jalor rt 01 rw 03 50 th P
652 tasdikin 0000638216130 jakid rt 01 rw 05 38 th L
654 nia ayu 0000639619392 klampis rt 04 rw 02 8 th P
655 faturohim 0000627907247 kd sugih rt 05 rw 03 8 th L
656 st safitri 0000637305402 songgom rt 05 rw 01 13 th P
657 bima 0000637401163 karanglo rt 04 rw 01 6 th L
658 koriah 0000639400342 karanglo rt 04 rw 01 40 th P
659 rasmali 0000637847046 jakid rt 02 rw 02 50 th L
660 nur hayati 0000635427178 tengguli rt 01 rw 04 28 th P
661 eni p 0000637977813 jalor rt 03 rw 02 34 th P
662 warkinah 0000637677279 wn tawang rt 01 rw 01 45 th P
665 sunarto 0000637825974 cenang rt 08 rw 02 47 th L
666 jasum 0000637847504 dk maja rt 05 rw 07 9 th L
667 alip 0000637277174 kr sembung rt 03 rw 05 3 th L
668 puput 0000637375695 kr sembung rt 03 rw 05 10 th P
671 husni 0000639192968 jakid rt 04 rw 01 11 th L
672 nurini 0000637163493 wn tawang rt 04 rw 03 50 th P
673 sodikin 0000637163286 wn tawang rt 04 rw 03 60 th L
675 bela 0000638966168 kts yasa rt 05 rw 01 11 th P
676 dafa 0000638290305 km amba rt 04 rw 02 4 th L
677 ah tokhid 0000639104061 kts yasa rt 03 rw 04 41 th L
678 tio n 0000638316946 jalor rt 05 rw 05 2 th L
679 suyati 0000638702717 km amba rt 02 rw 03 51 th P
680 badriyah 0000638887193 karanglo rt 06 rw 02 40 th P
681 warsiti 0000637716701 kts yasa rt 01 rw 01 60 th P
682 asiyah 0000637730706 kts yasa rt 01 rw 01 40 th P
683 m nur sidik 0000638404504 klampis rt 01 rw 05 30 th L
684 junaenah 0000639091901 dk maja rt 01 rw 04 45 th P
685 rupinah 0000636220622 janegara rt 01 rw 01 50 th P
686 khojanah 0000639282588 jakid rt 03 rw 05 34 th P
687 istikharoh 0000639123964 dk maja rt 04 rw 07 12 th P
688 junaenah 0000639194854 janegara rt 02 rw 04 46 th P
689 mukti mulia 0000638737558 jakid rt 02 rw 09 11 th L
690 kasiroh 0000638756241 jakid rt 02 rw 09 46 th P
691 wawan 0000638909818 tg wulung rt 16 rw 03 23 th L
692 nurohim 0000638686973 kts yasa rt 05 rw 01 20 th L
693 tian 0000638936774 tg wulung rt 01 rw 01 60 th P
694 kaerudin 0000639241997 jalor rt 05 rw 05 42 th L
696 khasanah 0000637872920 bojong rt 11 rw 03 80 th P
697 darjo 0000638430671 janegara rt 11 rw 04 80 th L
698 sri herawati 0000638676167 dk maja rt 01 rw 01 24 th P
700 susiyati 0000638787799 dk maja rt 01 rw 07 36 th P
702 adi muya 0000638929427 dk maja rt 05 rw 07 11 th P
703 suci r 0000639228317 dk maja rt 03 rw 02 3 th P
704 st aminah 0000639226161 dk maja rt 03 rw 02 32 th P
705 sujai 0000637924814 jakid rt 01 rw 01 50 th L
708 rosita 0000637463844 kr sembung rt 01 rw 04 23 th P
709 sainah 0000638117363 dk maja rt 04 rw 02 50 th P
710 ade setiawan 0001032402442 jakid rt 03 rw 08 12 th L
711 andi 0000639206414 kb gadung rt 05 rw 04 16 th L
712 tasriah 0000637969803 kl pucang rt 15 rw 04 40 th P
713 putri 0000637650011 kts yasa rt 02 rw 02 10 th P
714 rosa 0000638717534 km amba rt 04 rw 02 9 th P
715 wastap 0001032421262 kts yasa rt 05 rw 01 60 th L
716 sodikin 0000633159369 rg pendawa rt 03 rw 03 60 th L
718 tanti 0000639584065 janegara rt 01 rw 01 16 th P
721 urip m 0000638797885 pamengger rt 06 rw 01 6 th L
722 eka mujiana 0000638791918 pamengger rt 06 rw 01 5 th P
723 sri aryati 0000639577013 janegara rt 08 rw 03 50 th P
724 khodijah 0000638602457 jalor rt 03 rw 05 50 th P
725 nur amalia 0000638127898 jalor rt 06 rw 05 28 th P
727 ah tokhid 0000639104061 kts yasa rt 03 rw 04 30 th L
729 ani 0000638339196 dk maja rt 01 rw 01 2 th P
732 irma 0000638863964 klikiran rt 02 rw 01 18 th P
733 toinah 0000639047992 karanglo rt 11 rw 04 65 th P
735 aldi 0000639682172 tembelang rt 18 rw 03 7 th L
737 kariska 0000638634416 km amba rt 04 rw 12 7 th P
738 solikha 0000638623437 km amba rt 04 rw 12 36 th P
739 tarisah 0000638861568 klampis rt 06 rw 02 42 th P
742 tasirah 0000638302304 klampis rt 12 rw 04 50 th P
743 st aminah 0000638322368 jakid rt 03 rw 01 32 th P
744 aditya 0000638162256 kb nagung rt 10 rw 02 3 th L
745 lintang 0000624547226 kr anyar rt 03 rw 04 13 th P
746 roidah 0001032497443 dk maja rt 02 rw 04 55 th P
747 faoziyah 0000638296732 jalor rt 05 rw 02 57 th P
748 rawuh 0000637941892 dk maja rt 01 rw 01 28 th P
749 soimah 0000624546156 kr anyar rt 03 rw 04 45 th P
751 mayadatul 0000638473994 kr sembung rt 01 rw 04 22 th P
752 dini 0000638128034 jalor rt 06 rw 05 9 th P
754 tasya 0000638195038 janegara rt 02 rw 01 5 th P
756 maenah 0000638579248 karanglo rt 04 rw 01 41 th P
757 tasdik 0000638216726 jakid rt 04 rw 02 38 th L
758 maroatun 0000638534081 jt rokeh rt 01 rw 02 18 th P
759 sumiati 0000638932963 klampis rt 03 rw 01 36 th P
760 drajat 0000638129604 jakid rt 03 rw 08 14 th L
761 turiyah 0000638178772 jakid rt 03 rw 08 50 th P
762 karmen e 0000638628076 jalor rt 03 rw 09 51 th L
764 sariah 0000639306123 buaran rt 04 rw 02 51 th P
765 tiara 0000638103317 buaran rt 04 rw 02 6 th P
768 saropah 0000637778608 dk maja rt 03 rw 03 32 th P
769 khaerul rizal 0000638196667 jakid rt 05 rw 09 10 th L
771 riana 0000637508294 jt rokeh rt 01 rw 02 40 th P
773 jamal 0000637859384 jakid rt 05 rw 05 19 th L
775 tarsinah 0001032399944 klampis rt 13 rw 04 60 th P
777 masrukhin 0000637821898 kr sembung rt 01 rw 08 70 th L
778 rubin 0000638989457 klikiran rt 02 rw 01 56 th L
780 tamirah 0000638486864 jalor rt 02 rw 01 33 th P
781 ropikha 0000638009932 jalor rt 03 rw 02 39 th P
782 m nur maulana 0000638101268 jalor rt 03 rw 02 2 th L
783 sinta 0000637780677 kr sembung rt 01 rw 01 7 th P
784 tarsono 0000639067108 jakid rt 05 rw 01 60 th L
786 sri sugiarti 0000638303679 karanglo rt 04 rw 05 19 th P
787 nur aeni 0000638701734 pamengger rt 04 rw 03 31 th P
789 yeyen 0000638509781 km amba rt 01 rw 01 58 th P
791 popon 0000637151398 jakid rt 05 rw 05 41 th P
792 kusmi 0000638386136 dk maja rt 04 rw 01 70 th P
794 rodah 0000638950027 pamengger rt 01 rw 04 50 th P
795 kamali 0000637730921 janegara rt 03 rw 01 39 th L
796 khodijah 0000638413885 dk maja rt 02 rw 06 36 th P
797 m rifki 0000638631448 pamengger rt 05 rw 01 2 th L
798 rio irawan 0000638238286 klampis rt 13 rw 04 13 th L
800 rusmini 0000638360198 kr sembung rt 03 rw 01 55 th P
801 faridah 0000639194859 jalor rt 08 rw 03 46 th P
802 hana 0000639196488 jalor rt 08 rw 03 11 th P
804 kurisah 0000638677354 tembelang rt 18 rw 03 60 th P
805 suimah 0001032406311 jakid rt 02 rw 09 58 th P
807 faturohman 0000624987247 kd sugih rt 05 rw 03 8 th L
809 jawawi 0000638464599 klampis rt 10 rw 03 50 th L
810 dairah 0000636273864 km amba rt 02 rw 04 50 th P
811 sri suhanah 0000638809367 jakid rt 06 rw 06 41 th P
812 umyati 0000638611641 jalor rt 01 rw 02 50 th P
816 kesih 0000637960184 kr sembung rt 01 rw 07 70 th P
817 sulami 0000638887196 karanglo rt 01 rw 07 41 th P
820 riski ahmad 0000638456117 kts yasa rt 04 rw 03 9 th L
821 mulyadi 0000638831169 jalor rt 03 rw 02 7 th L
824 fitriyani 0000638286466 karanglo rt 08 rw 02 20 th P
825 tarnyu 0000638832568 klampis rt 05 rw 01 68 th P
826 nunung 0000638686212 tembelang rt 11 rw 02 13 th P
827 munasir 0000638854327 jalor rt 05 rw 04 70 th L
830 waenah 0000637986883 bojong rt 01 rw 01 26 th P
831 sukron amin 0000638776809 jakid rt 03 rw 01 11 th L
832 saripah 0000638776347 jakid rt 03 rw 01 61 th P
834 azizi 0000637188463 jakid rt 05 rw 05 12 th P
836 saminah 0000632847882 sitanggal rt 01 rw 09 36 th P
837 romlah 0000637909997 kr sembung rt 08 rw 02 60 th P
838 aulia sahada 0000637918986 kts yasa rt 04 rw 03 5 th L
840 ilman maulana 0001032403059 jakid rt 03 rw 10 12 th L
842 warmi 0000639303161 kr sembung rt 02 rw 07 75 th P
843 dirjo 0000638430671 janegara rt 11 rw 04 70 th L
844 elisiawati 0000639018059 klikiran rt 05 rw 02 6 th P
845 astriani 0000638286466 karanglo rt 08 rw 02 18 th P
849 kholidah 0000639113376 jakid rt 04 rw 05 41 th P
851 hanipah 0000639144561 jakid rt 04 rw 08 60 th P
852 nurul aeni 0000639146079 jakid rt 04 rw 08 20 th P
853 kosim 0000632197876 rg pendawa rt 02 rw 01 48 th L
855 aidah 0001032413106 jalor rt 03 rw 02 44 th P
856 solikhin 0001032413139 jalor rt 03 rw 02 9 th L
857 nuvus 0001032399011 kb nagung rt 07 rw 01 9 th L
858 muskanah 0001032399009 kb nagung rt 07 rw 01 69 th P
859 mahmudah 0000638712662 jakid rt 01 rw 07 47 th P
860 iwan 0000638629514 karanglo rt 04 rw 01 14 th L
861 salamah 0000637903102 jalor rt 02 rw 02 65 th P
862 nursalim 0000638217033 kb nagung rt 08 rw 02 10 th L
863 tasdikin 0000637566849 kb gadung rt 02 rw 03 45 th L
866 sokhanah 0000638319947 jakid rt 03 rw 10 50 th P
867 ah sandy 0000638026986 jakid rt 03 rw 06 12 th L
868 karminah 0001032441311 tembelang rt 16 rw 03 60 th P
869 rizal 0000638170628 jakid rt 04 rw 01 5 th L
870 waeni 0000639027794 jakid rt 04 rw 05 32 th P
874 m agim 0000638870872 pamengger rt 07 rw 12 10 th L
876 suyud 0000638924927 klikiran rt 04 rw 02 50 th L
877 hera 0000639054186 kr sembung rt 03 rw 04 8 th P
878 sarkonah 0000637612976 dk maja rt 01 rw 07 60 th P
879 taipah 0000638286936 jakid rt 05 rw 08 38 th P
880 sopiani 0000637129473 jakid rt 02 rw 02 16 th P
881 astuti 0000638091929 cenang rt 02 rw 07 16 th P
882 tumiroh 0001032401147 km amba rt 01 rw 01 50 th P
883 abu bakar 0000638191058 janegara rt 11 rw 04 63 th L
884 febi 0000639248984 dk maja rt 03 rw 02 16 th P
885 faris 0000639260211 dk maja rt 03 rw 02 8 th L
887 juli 0000637402037 wn tawang rt 04 rw 04 11 th L
888 musripah 0000638897264 jalor rt 05 rw 03 70 th P
889 fadli 0000638497361 jalor rt 05 rw 03 9 th L
891 aisah 0000637730706 kts yasa rt 01 rw 01 34 th P
893 kasri 0000637937066 jakid rt 06 rw 05 60 th P
894 wanah 0000639586094 jakid rt 03 rw 10 23 th P
896 hasanadin 0000637823147 jakid rt 03 rw 08 70 th L
897 maesaroh 0000638547486 kb nagung rt 01 rw 01 50 th P
898 m husin 0000638548594 kb nagung rt 01 rw 01 8 th L
899 nuryati 0000103241412 jakid rt 06 rw 01 50 th P
900 ah solikhin 0000638053886 rg bandung rt 04 rw 02 50 th L
901 suyatin 0000638053334 rg bandung rt 04 rw 02 50 th P
903 waisah 0000638067259 kr sembung rt 04 rw 01 80 th P
904 durwinah 0000103138556 wn tawang rt 03 rw 02 39 th P
906 soliha 0000638478764 kts yasa rt 01 rw 02 50 th P
908 nur dinda 0000638818244 jakid rt 01 rw 08 2 th P
912 ramdani 0000638292868 kr sembung rt 03 rw 05 5 th L
915 khotimah 0001032409211 karanglo rt 06 rw 02 60 th P
916 ika fajar 0000639321063 karanglo rt 12 rw 02 18 th P
917 kaesah 0000639024129 karanglo rt 04 rw 01 51 th P
918 bela 0000638628684 kr sembung rt 04 rw 05 10 th P
919 rafan 0000638853816 jalor rt 05 rw 05 5 th L
927 kotimah 0000637235424 kr sembung rt 03 rw 01 40 th P
928 eep hertanto 0000637431884 tembelang rt 12 rw 01 25 th L
930 suharmo 0000640158581 kl alang rt 01 rw 01 42 th L
931 triasih wati 0000637166136 jakid rt 03 rw 04 31 th P
933 putri 0001032401136 km amba rt 02 rw 01 13 th P
934 agung 0000631947251 rg pendawa rt 14 rw 05 10 th L
936 st aminah 0000637737096 kts yasa rt 04 rw 02 43 th P
937 armalah 0000638356961 klampis rt 05 rw 02 42 th P
938 dewi 0000638269202 klampis rt 05 rw 02 8 th P
940 ika lutfiani 0000638258366 jakid rt 03 rw 01 15 th P
941 kastari 0000638012193 kl pucang rt 03 rw 01 37 th P
942 fahri 0000638613843 karanglo rt 04 rw 01 3 th L
944 azmiah 0000637954694 jakid rt 05 rw 05 7 th P
945 aji santoso 0000639276568 jalor rt 02 rw 01 12 th L
946 suri 0000638767967 tembelang rt 04 rw 01 70 th P
947 aditya 0000638162256 kb nagung rt 10 rw 02 3 th L
948 warkinah 0001031792816 rg pendawa rt 02 rw 02 50 th P
950 sunarto 0000637826972 cenang rt 08 rw 02 46 th L
951 salamah 0000638633776 rg bandung rt 01 rw 03 50 th P
954 m zulfa 0000638632113 jalor rt 03 rw 01 12 th L
956 abdulah 0001032401226 km amba rt 02 rw 04 30 th L
957 sifaul husna 0001032411666 jalor rt 01 rw 08 10 th L
958 kartini 0001032411644 jalor rt 01 rw 08 37 th P
960 dairoh 0000638140262 jalor rt 02 rw 03 30 th P
M RAWAT JALAN JAMKESMAS DI PELAYANAN DASAR
BULAN : MEI TAHUN

wat Jalan Peserta Jamkesmas
TANGGAL
DIAGNOSA Poli Pemeriks
KUNJUNGAN Poli Gigi Poli KIA Tindakan
Umum aan LAB
(7) (8) (9) (10) (11) (12) (13)

01-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
DR Rp,5000 Rp,8000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Period 47 Rp,5000 Rp,11750
Rp,5000
Rp,5000
GDS Rp,5000 Rp,3000
Gingivitis Rp,5000 Rp,22500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
02-05-2013 Rp,5000
Abses Rp,5000 Rp,55000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Gp fisture Rp,5000 Rp,11750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
03-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Persistensi Rp,5000 Rp,17000
Pulpa polip Rp,5000 Rp,55000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
04-05-2103 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Period 47 Rp,5000 Rp,11750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
06-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
DR Rp,5000 Rp,8000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Gangrenpulpa Rp,5000 Rp,12750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
AU Rp,5000 Rp,3000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
07-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Radices 35 Rp,5000 Rp,32500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
08-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
GDS Rp,5000 Rp,3000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
10-05-2013 Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Persistensi 62 Rp,5000 Rp,17000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
11-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
13-05-2013 Rp,5000
Rp,5000
Rp,5000
Gingivitis Rp,5000 Rp,23500
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Kariesdentil Rp,5000 Rp,27500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
GDS Rp,5000 Rp,3000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Radices 34 Rp,5000 Rp,32500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
14-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
15-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
GDS Rp,5000 Rp,3000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
16-05-2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
AU + CHOL Rp,5000 Rp,6000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
GDS Rp,5000 Rp,3000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
17-05-2013 DL Rp,5000 Rp,12500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/18/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
DL Rp,5000 Rp,12500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/20/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
DL Rp,5000 Rp,12500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/21/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
GDS Rp,5000 Rp,3000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/22/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Luxasi 47 Rp,5000 Rp,32500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
DL Rp,5000 Rp,12500
Rp,5000
HB Rp,5000 Rp,2000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
DL Rp,5000 Rp,12500
Rp,5000
5/23/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Pulpa polip 26 Rp,5000 Rp,12750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Luxasi 47 Rp,5000 Rp,32500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Gp period Rp,5000 Rp,12750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/24/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
HB + golda Rp,5000 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
Rp,5000
Pulpa polip 48 Rp,5000 Rp,55000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/27/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Radices Rp,5000 Rp,11750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
BTA Rp,5000 Rp,4500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/28/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/29/2013 Rp,5000
Rp,5000
DL Rp,5000 Rp,14000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/30/2013 DL Rp,5000 Rp,12500
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Pulpitis Rp,5000 Rp,12750
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
5/31/2013 Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
Rp,5000
: 2013
TANDA
TOTAL BIAYA TANGAN
PASIEN
14 = (9+10+11+12+13) 15
DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMAS

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA TANGGAL
(Thn) KUNJUNGAN
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6) (7)

1 baedah 0001032402407 jakid rt 03 rw 01 80 th P 01-06-2013
2 fitri maulina 0000638555196 jalor rt 02 rw 02 3 th P
3 zahra 0000638840607 jakid rt 02 rw 10 4 th P
5 asriyah 0000637969059 kr sembung rt 01 rw 01 10 th P
11 dasem 0000638377154 klampis rt 13 rw 04 66 th P
12 imam tobari 0000638741395 jakid rt 03 rw 01 10 th L
13 heni kuswiyanti 0001032413703 jalor rt 07 rw 01 29 th P
14 ning sumita 0000638789422 jakid rt 03 rw 09 37 th P
15 dairoh 0000637384948 kts yasa rt 04 rw 03 50 th P
16 darti 0000637390866 kts yasa rt 04 rw 03 45 th P
18 royati 0000638089949 tembelang rt 13 rw 05 43 th P
21 ulfi nur amalia 0000633903362 kts yasa rt 01 rw 01 5 th P
22 moh syaefudin 0000638242749 jalor rt 06 rw 02 3 th L
24 ismarlina 0001032415582 jalor rt 03 rw 01 33 th P
25 selviana 0000638170097 jakid rt 04 rw 01 13 th P
26 mukhidin 0000637166722 jakid rt 05 rw 05 43 th L
28 nawi 0000637693626 kts yasa rt 02 rw 01 80 th L 03-06-2013
29 sri hendrawati 0000638676167 dk maja rt 01 rw 01 24 th P
30 torikoh 0000631912298 kts yasa rt 02 rw 02 39 th P
31 tanjung 0000638064347 wn tawang rt 07 rw 01 10 th L
32 tofani 0000638064213 wn tawang rt 07 rw 01 12 th L
33 sariah 0000638024668 wn tawang rt 07 rw 01 54 th P
34 tokhidin 0000637591437 kb gadung rt 03 rw 01 33 th L
35 st suherti 0000638635544 karanglo rt 02 rw 03 28 th P
36 nika arkita 0000638933264 jakid rt 02 rw 05 12 th P
37 taryumi 0000639260684 jalor rt 07 rw 03 56 th P
38 ramli 0000638906916 jalor rt 01 rw 02 76 th L
40 wartiah 0000639187426 dk maja rt 03 rw 03 50 th P
42 tarsiyah 0000637846571 kts yasa rt 04 rw 01 3 th P
43 rahmat 0001032346466 kb gadung rt 04 rw 03 53 th L
45 miftahul janah 0000638704678 jalor rt 03 rw 03 12 th P
46 junenah 0000638728402 km amba rt 03 rw 02 46 th P
47 ade nikmatul 0000638728659 km amba rt 03 rw 02 18 th P
49 syahkia 0000638776336 wn cala rt 03 rw 03 5 th P
50 suimah 0000639641179 janegara rt 03 rw 09 53 th P
51 darto 0000638430671 janegara rt 11 rw 04 60 th L
55 sadikin 0000633159309 rg pendawa rt 03 rw 03 50 th L
56 suyati 0000638702717 km amba rt 02 rw 03 51 th P
57 riame 0000637118246 jakid rt 02 rw 03 36 th P
58 aikfa 0000638072695 jalor rt 02 rw 05 8 th P
59 edi sudiono 0000639036494 jakid rt 05 rw 02 70 th L
61 rahayu 0000638312422 klampis rt 12 rw 04 11 th P
62 desi wulandari 0000638269751 km amba rt 04 rw 02 19 th P
63 tasari 0000638012193 kl pucang rt 03 rw 01 37 th L
64 setiawati 0000638316257 jakid rt 05 rw 03 34 th P
66 m firdaus 0000638826568 jakid rt 02 rw 05 30 th L 04-06-2013
67 khanifah 0000632222194 rg pendawa rt 02 rw 07 50 th P
68 rusnani 0001032422714 janegara rt 03 rw 01 44 th P
70 suherti 0000638832406 dk maja rt 08 rw 02 33 th P
71 sumirah 0000638076606 kr sembung rt 03 rw 04 72 th P
73 riski ramadani 0000638610469 jakid rt 04 rw 01 3 th L
74 eliyah 0000638687879 kr sembung rt 02 rw 08 48 th P
75 salamah 0000638088786 jakid rt 05 rw 06 36 th P
76 khodijah 0000637690505 wn cala rt 05 rw 06 55 th P
77 suimah 0000638309928 wn cala rt 04 rw 02 31 th P
78 bima 0000639401163 karanglo rt 04 rw 01 6 th L
79 kariah 0000639400163 karanglo rt 04 rw 01 38 th P
80 sumarno 0001032409608 karanglo rt 11 rw 11 70 th L
81 ropiah 0000637182167 jakid rt 01 rw 03 50 th P
82 ciajeng 0000639151723 jakid rt 01 rw 03 13 th P
83 warmo 0001032369826 cenang rt 10 rw 02 52 th L
85 reni 0000639472916 janegara rt 02 rw 01 16 th P
87 st aminah 0000639226181 dk maja rt 03 rw 02 30 th P
88 nabila 0000639227171 dk maja rt 03 rw 02 11 th P
89 lanang 0001032402339 jakid rt 01 rw 03 37 th L
90 suinah 0000638223726 kr sembung rt 02 rw 02 60 th P
92 bagas 0000638171829 karanglo rt 02 rw 09 8 th L
93 ika fajar 0000639321063 karanglo rt 02 rw 09 12 th P
94 aminah 0001032411036 tg wulung rt 20 rw 04 82 th P
96 topani 0000638314383 jakid rt 04 rw 03 24 th L
97 muji irawan 0000638316324 jakid rt 04 rw 03 9 th L
98 m mizar 0001034030094 jakid rt 02 rw 07 12 th L
99 mario 0000637899446 jakid rt 03 rw 10 5 th L
100 sudiah 0000638738283 tembelang rt 01 rw 01 50 th P
101 riyanto 0000638279008 jakid rt 02 rw 10 60 th L
102 khamali 0000637730921 janegara rt 05 rw 01 28 th L
103 rasto 0000638506911 klampis rt 05 rw 02 39 th L
104 m kelvin 0000637919223 kts yasa rt 05 rw 03 37 th L
105 jarodah 0001032420462 kts yasa rt 05 rw 03 4 th P
108 ropiah 0000638846479 pamengger rt 05 rw 04 22 th P
109 afita 0000638840276 pamengger rt 05 rw 04 40 th P
112 denah 0000638544572 kr sembung rt 02 rw 06 55 th P
113 sumar 0000638044402 kr sembung rt 02 rw 06 50 th L
114 sopan 0000638677148 gandasuli rt 02 rw 06 55 th L
115 sunarti 0000637628681 kr sembung rt 02 rw 01 14 th P
116 reni 0000637629039 kr sembung rt 02 rw 01 58 th P
117 evi lutfiyah 0000637640804 jalor rt 02 rw 03 40 th P
121 murniati 0000638290203 karanglo rt 01 rw 01 46 th P
122 melisa 0000638290269 karanglo rt 01 rw 01 22 th P
123 amar 0000638151772 jalor rt 05 rw 03 11 th L
125 diana 0000638588902 karanglo rt 10 rw 04 2 th P
126 st rohani 0000639612812 jalor rt 05 rw 05 40 th P
127 dimas 0000638626498 jakid rt 03 rw 01 8 th L
129 marwadi 0000638842781 karanglo rt 12 rw 03 57 th L
130 ali murtado 0000637119123 jakid rt 02 rw 04 66 th L 05-06-2013
131 nayla 0001032399977 klampis rt 03 rw 01 5 th P
133 emi 0000637935446 kr sembung rt 04 rw 01 50 th P
134 heru 0001032415716 jalor rt 04 rw 03 30 th L
135 dairah 0000637479695 bojong rt 08 rw 02 29 th P
137 nururl hidayah 0000639573086 janegara rt 02 rw 08 27 th P
139 laelatus 0001032420261 kts yasa rt 05 rw 01 2 th P
140 mursaid 0000638363366 wn tawang rt 02 rw 01 60 th L
141 ratini 0000638602222 karanglo rt 04 rw 04 70 th P
144 siska 0000637917399 jalor rt 08 rw 01 11 th P
145 anwar rifai 0000632039837 rg pendawa rt 07 rw 04 16 th L
146 mulyati 0000638980918 dk maja rt 01 rw 01 55 th P
147 tayib 0000639516283 tembelang rt 15 rw 03 62 th L
149 aisah 0000637730706 kts yasa rt 01 rw 01 34 th P
150 tia nur fadilah 0000637731562 kts yasa rt 01 rw 01 10 th P
151 tunirah 0001032401147 km amba rt 01 rw 01 50 th P
152 nurjanah 0000638657278 jalor rt 04 rw 05 50 th P
154 sobirin 0001032411767 jalor rt 02 rw 02 55 th L
156 abdul rohman 0000637411397 kr sembung rt 03 rw 02 60 th L
157 saridah 0000638381733 wn tawang rt 05 rw 03 15 th P
158 rosmiyati 0000637756176 kts yasa rt 01 rw 04 19 th P
161 maskuri 0000637507855 jakid rt 02 rw 07 51 th L 07-06-2013
162 nur laeli 0000637987746 jalor rt 02 rw 01 18 th P
165 lukman 0000639263687 jalor rt 07 rw 03 24 th L
166 ransah 0000639636107 tembelang rt 18 rw 03 46 th P
167 rahmat nurjaman 0000639637042 tembelang rt 18 rw 03 15 th L
168 rohayatun 0000638677664 tembelang rt 18 rw 03 19 th P
169 masumah 0000625732288 kt harja rt 07 rw 13 20 th P
173 junirah 0001032414737 jalor rt 03 rw 05 50 th P
174 tariska 0000638624416 km amba rt 04 rw 02 7 th P
175 warsiti 0000638194882 kb nagung rt 07 rw 01 50 th P
177 munawaroh 0001031375956 wn tawang rt 01 rw 04 33 th P
178 lanang 0000638796241 jakid rt 04 rw 01 42 th L
179 riski ramadani 0000638456117 kts yasa rt 04 rw 03 9 th L
181 windah 0000637747604 dk maja rt 03 rw 03 10 th P
183 agas 0000638723697 kr sembung rt 03 rw 02 7 th L
184 topik 0000638468598 klampis rt 09 rw 03 4 th L
185 eni puji 0000637977813 jalor rt 03 rw 02 33 th P
186 safik 0000637346744 kts yasa rt 03 rw 01 6 th L
187 rumiah 0000637716073 kts yasa rt 02 rw 03 66 th P
188 lukman hakim 0000638864934 jalor rt 02 rw 02 11 th L
189 maftukha 0000638674334 karanglo rt 06 rw 01 30 th P
190 suhari 0000639100327 kts yasa rt 05 rw 01 63 th L
191 rina 0000637850711 dk maja rt 01 rw 01 39 th P
192 kastari 0000638012193 kl pucang rt 03 rw 01 20 th P
193 herti 0000638481442 dk maja rt 01 rw 01 37 th P
194 karmen efendi 0000638288076 jalor rt 03 rw 09 41 th L
197 munisah 0000639039328 jakid rt 03 rw 07 30 th P
200 farah 0000638180836 jakid rt 03 rw 09 3 th P
201 guntur 0000624487048 kr anyar rt 04 rw 02 13 th L
202 helen 0000639049847 karanglo rt 04 rw 10 16 th P
203 eka esti 0000638137896 karanglo rt 18 rw 04 20 th P
206 m lutfu 0000638596147 jalor rt 02 rw 01 8 th L 08-06-2013
207 ani junaedi 0000638775712 km amba rt 02 rw 04 30 th L
208 st masikha 0000638254596 jakid rt 02 rw 08 60 th P
209 st fatimah 0000638101834 jalor rt 03 rw 02 8 th P
210 surinah 0000639226293 janegara rt 01 rw 01 70 th P
211 tri roimatul 0000639226881 janegara rt 01 rw 01 18 th P
212 adi suriaji 0000637476186 bojong rt 02 rw 01 12 th L
213 wastiah 0001032404501 jakid rt 02 rw 11 80 th P
215 dasem 0000638377154 klampis rt 13 rw 04 70 th P
217 m rifki 0000637662169 kr sembung rt 02 rw 04 7 th L
219 dastam 0000637727396 dk maja rt 01 rw 03 44 th L
220 aska 0001032430263 bojong rt 07 rw 02 6 th P
221 jerah 0000639494407 janegara rt 08 rw 01 55 th P
222 nurul 0000638291586 jakid rt 02 rw 03 19 th P
223 sopuroh 0000638190641 jakid rt 02 rw 01 51 th P
224 kasti 0000639032265 kr sembung rt 04 rw 05 40 th P
225 tasriyah 0000637846671 kts yasa rt 03 rw 04 50 th P
226 saski 0000637928111 jakid rt 01 rw 08 3 th P
227 sriyati 0000639159816 kts yasa rt 07 rw 04 50 th P
230 taripah 0000638132148 jakid rt 04 rw 03 30 th P
234 lutfi nur azizah 0000636961926 tembelang rt 18 rw 03 8 th P
235 umyati 0000639581343 songgom rt 02 rw 05 52 th P
237 maslikha 0000639121882 dk maja rt 04 rw 07 40 th P
238 imam bukori 0000637630366 jakid rt 02 rw 05 22 th L
241 fajar 0000638680462 dk maja rt 01 rw 03 4 th L 10-06-2013
242 m amrudin 0000637671237 jakid rt 02 rw 08 5 th L
243 taryumi 0000639260684 jalor rt 07 rw 03 56 th P
244 tasriah 0000638706003 klampis rt 11 rw 04 36 th P
245 kiwen 0000638626689 kendawa rt 06 rw 02 70 th P
247 rukiayh 0000639327723 pamengger rt 03 rw 05 66 th P
249 ajizah 0000639693616 tembelang rt 15 rw 03 40 th P
251 wartiah 0000639197426 dk maja rt 03 rw 03 50 th P
252 karsih 0000637637736 kr sembung rt 04 rw 02 40 th P
253 sariah 0000638192979 jt makmur rt 04 rw 05 33 th P
254 ayatul 0000638193362 jt makmur rt 04 rw 05 2 th P
255 hikmah 0000639548564 dk maja rt 07 rw 02 50 th P
257 lindawati 0001032401237 km amba rt 02 rw 02 27 th P
259 darkonah 0000639902091 jakid rt 03 rw 08 40 th P
260 saidah 0001032404243 jakid rt 03 rw 09 52 th P
261 soipha 0000638197166 jakid rt 02 rw 03 50 th P
263 eni puji astuti 0000637977813 jalor rt 03 rw 02 33 th P
264 nuryadi 0000638377063 klampis rt 13 rw 04 9 th L
265 marwati 0000637916443 jakid rt 03 rw 03 40 th P
272 sutinah 0000638736806 km amba rt 02 rw 04 63 th P
273 rukoyah 00006385998516 kts yasa rt 05 rw 02 50 th P
274 riska 0000639102745 kts yasa rt 06 rw 03 12 th P
275 durpi 0000638106747 jakid rt 03 rw 02 64 th P
276 nadiroh 0000639086891 jakid rt 05 rw 08 21 th P
277 tariska 0000638524416 km amba rt 04 rw 02 7 th P
278 klarisa 0000638430131 kts yasa rt 02 rw 12 6 th P
280 rugasih 0000632670842 rg pendawa rt 01 rw 02 22 th P
281 m efendi 0000632287281 rg pendawa rt 01 rw 02 26 th L
283 rohayati 0000639039418 jakid rt 03 rw 07 20 th P
284 azam 0000637605876 kb gadung rt 05 rw 01 7 th P
285 soimah 0001032415676 jalor rt 02 rw 05 41 th P
286 mugi 0001032415616 jalor rt 02 rw 05 40 th L
287 karumi 0000638560909 kr sembung rt 02 rw 02 50 th P
288 sutarno 0000637719783 kts yasa rt 01 rw 05 60 th L
289 sumirah 0000639105715 jakid rt 04 rw 01 45 th P
290 m aryan 0000637880951 kr sembung rt 02 rw 03 60 th L
294 ferdi saputra 0000638969207 kts yasa rt 01 rw 04 6 th L
295 kholisoh 0000638969073 kts yasa rt 12 rw 04 26 th P
296 khaerunisa 0000637579089 kr sembung rt 05 rw 02 5 th P 11-06-2013
297 alfiyah 0000637577913 kr sembung rt 05 rw 02 29 th P
299 munawar rt rw 27 th L
300 tarnyu rt rw 65 th P
301 dirjo rt rw 70 th L
302 torikhin rt rw 47 th L
303 kasriah rt rw 45 th P
304 anis matoyah rt rw 40 th P
305 nur aeni rt rw 31 th P
306 sehatun rt rw 50 th P
307 munasoh rt rw 36 th P
308 deni setiawan rt rw 12 th L
309 tiyah rt rw 65 th P
310 m syaefudin rt rw 3 th L
311 nur auliayh rt rw 7 th P
312 m febriyanto rt rw 4 th L
313 taswi rt rw 60 th P
314 aisyah rt rw 34 th P
315 malekha rt rw 41 th P
316 rusbad rt rw 80 th L
317 maudi nur rt rw 4 th P
318 abdulah rt rw 12 th L 12-06-2013
319 toha rt rw 55 th L
320 zamroni rt rw 34 th L
321 rambat rt rw 60 th L
322 sobirin rt rw 23 th L
323 hindun rt rw 70 th P
324 maryam rt rw 70 th P
325 turiyah rt rw 60 th P
326 vina rt rw 6 th P
327 asikin rt rw 50 th L
328 amriti rt rw 30 th P
329 revalina rt rw 50 th P
330 wastiah rt rw 30 th P
331 saskiah rt rw 2 th P
332 wamen rt rw 46 th P
333 soitah rt rw 67 th P
334 waryati rt rw 47 th P
335 rohadi rt rw 52 th L
336 sakri rt rw 63 th L
337 lindawati rt rw 27 th P
338 rasya rt rw 4 th P
339 gustin rt rw 52 th P
340 tanuri rt rw 51 th L
341 waenuroh rt rw 45 th P
342 lili rt rw 24 th P
343 toipah rt rw 55 th P
344 waitah rt rw 60 th P
345 febri rt rw 53 th L 13-06-2013
346 sunarto rt rw 52 th L
347 tarnijah rt rw 50 th P
348 casminah rt rw 60 th P
349 muslikha rt rw 6 th P
350 fika rt rw 60 th P
351 sutarno rt rw 36 th L
352 rahayu rt rw 50 th P
353 jawawi rt rw 36 th L
354 wasripah rt rw 46 th P
355 daimah rt rw 37 th P
356 slamet s rt rw 37 th L
357 vivi rt rw 32 th P
358 rizki rt rw 3 th L
359 surtijah rt rw 75 th P
360 solikha rt rw 38 th P
361 kayem rt rw 75 th P
362 daryati rt rw 50 th P
363 surinah rt rw 40 th P
364 sukarmo rt rw 50 th L
365 tuti rt rw 22 th P
366 ropidoh rt rw 36 th P
367 ratinah rt rw 40 th P
368 karidah rt rw 58 th P
369 nur catimah rt rw 31 th P
370 nurwadi rt rw 60 th L
371 khalimah rt rw 40 th P
372 wahyu rt rw 13 th L
373 solikha rt rw 43 th P
374 ratmono rt rw 61 th L
375 m mahfud rt rw 2 th L
376 tarodin rt rw 57 th L
377 solikhin rt rw 48 th L
378 suhartini rt rw 50 th P
379 tarsian rt rw 67 th L
380 mastiah rt rw 56 th P
381 suhartini rt rw 40 th P
382 nurkhasanah rt rw 38 th P
383 mufti bagus rt rw 7 th L
384 aeni rt rw 60 th P
385 sumarto rt rw 36 th L 14-06-2013
386 sakri rt rw 63 th L
387 neza aulia rt rw 3 th P
388 nurohman rt rw 10 th L
389 wantika rt rw 40 th P
390 roilah rt rw 26 th P
391 salimah rt rw 41 th P
392 syaadah rt rw 48 th P
393 khotimah rt rw 42 th P
394 susmarni rt rw 45 th P
395 abdullah rt rw 30 th L
396 kasmi rt rw 60 th P
397 maanah rt rw 60 th P
398 suirah rt rw 67 th P
399 topik rt rw 52 th L
400 m deni rt rw 4 th L
401 rafan rt rw 50 th L
402 septi lisa rt rw 9 th P
403 suyanti rt rw 30 th P
404 sairah rt rw 26 th P
405 saripin rt rw 32 th L
406 kasmudin rt rw 32 th L
407 siti rt rw 60 th P
408 khadijah rt rw 43 th P
409 suminto rt rw 37 th L
410 windarti rt rw 18 th P
411 khotimah rt rw 42 th P 15-06-2013
412 kasmi rt rw 44 th P
413 marsitah rt rw 68 th P
414 sukiyah rt rw 50 th P
415 samsuri rt rw 18 th L
416 duersih rt rw 40 th P
417 khalimi rt rw 54 th L
418 tariah rt rw 60 th P
419 nur kholik rt rw 23 th L
420 dahliana rt rw 4 th P
421 tri ningsih rt rw 30 th P
422 devi rt rw 3 th P
423 sutarmo rt rw 60 th L
424 rumini rt rw 66 th P
425 m riski rt rw 2 th L
426 tarisa rt rw 12 th P
427 m saleh rt rw 55 th L
428 st aminah rt rw 63 th P
429 sutati rt rw 38 th P
430 masriah rt rw 38 th P
431 dewi muniha rt rw 17 th P
432 m irpa rt rw 14 th L
433 kartini rt rw 46 th P
434 putri nursifa rt rw 20 th P
435 faseha rt rw 23 th P
436 murni rt rw 46 th P
437 eliyah rt rw 48 th P
438 sairah rt rw 49 th P
439 alisa wijaya rt rw 6 th P
440 khusnah rt rw 50 th P
441 umar rt rw 51 th L
442 abd wakhid rt rw 11 th 17-06-2013
443 nawi rt rw 80 th
444 darja rt rw 50 th
445 sekhatun rt rw 35 th
446 m zamroni rt rw 35 th
447 maspipah rt rw 58 th
448 salma nabila rt rw 3 th
449 saodah rt rw 43 th
450 casriyah rt rw 70 th
451 rumiah rt rw 66 th
452 karisma rt rw 7 th
453 maani rt rw 70 th
454 reni rt rw 3 th
455 melpi rt rw 6 th
456 subur rt rw 47 th
457 wirati rt rw 47 th
458 wasripah rt rw 36 th
459 kheriyah rt rw 50 th
460 ropii rt rw 40 th
461 kusnadi rt rw 46 th
462 nadiroh rt rw 46 th
463 nurohim rt rw 32 th
464 m ibnu ubaedah rt rw 7 th
465 sunari rt rw 69 th
466 rojanah rt rw 37 th
467 herdias rt rw 6 th
468 renaldi rt rw 16 th
469 sutikha rt rw 29 th
470 slamet s rt rw 43 th
471 krisnawati rt rw 52 th
472 sopuroh rt rw 37 th
473 silkha rt rw 17 th
474 sri mulyati rt rw 43 th
476 musrifah rt rw 19 th
477 fahri rt rw 3 th
478 musrikha rt rw 49 th
479 m fajrul rt rw 9 th
480 gustin rt rw 52 th
481 khotimah rt rw 42 th
482 solikha rt rw 50 th
483 farkhan rt rw 11 th 18-03-2013
484 erliva rt rw 18 th
485 sri puji rt rw 5 th
486 kahadi rt rw 24 th
487 waesah rt rw 70 th
488 wasitoh rt rw 30 th
489 astriyati rt rw 20 th
490 mamuri rt rw 53 th
491 ah taukhid rt rw 31 th
492 alam maulana rt rw 10 th
493 m riski rt rw 9 th
494 waenuroh rt rw 48 th
495 julekha rt rw 35 th
496 rokhani rt rw 38 th
497 dian rt rw 16 th
499 rokayah rt rw 50 th
500 riyanti rt rw 23 th
501 sodikin rt rw 65 th
502 sugitmo rt rw 18 th
503 fira ayu rt rw 4 th
504 sri puji rt rw 33 th
505 m sobhib rt rw 9 th
506 khozanah rt rw 30 th
507 topik rt rw 50 th
508 sayidin rt rw 50 th
509 kusnirah rt rw 50 th 19-06-2013
510 muslikatun rt rw 7 th
511 ardi purnawan rt rw 12 th
512 raidah rt rw 55 th
513 popon r rt rw 42 th
514 sri ningrum rt rw 13 th
515 alipah rt rw 8 th
516 nuridah rt rw 52 th
518 siti rt rw 40 th
520 nur devi rt rw 9 th
521 kamilah rt rw 39 th
522 dirjo rt rw 70 th
523 sefiyatun rliza rt rw 10 th
524 miftahul husro rt rw 6 th
525 daryati rt rw 26 th
526 nadia rt rw 42 th
527 kasirah rt rw 46 th
528 urip mulyati rt rw 6 th
529 tuminah rt rw 60 th
530 kasdum rt rw 80 th
531 sumarti rt rw 50 th
532 munikha rt rw 50 th
533 dewanti rt rw 27 th
534 mashuri rt rw 35 th
535 nurjanah rt rw 16 th
536 fahrudin rt rw 12 th
537 m zobi rt rw 13 th
538 sairoh rt rw 50 th
539 badriah rt rw 22 th
540 afri sugiarti rt rw 19 th
541 m zenal rt rw 20 th
542 widi rt rw 80 th
543 sorikha rt rw 51 th
544 sijah rt rw 63 th ###
545 adkha isna aji rt rw 4 th
546 ajihan laeli rt rw 4 th
548 turaeni rt rw 54 th
549 ratini rt rw 70 th
550 tirto rt rw 7 th
552 rafa dwi rt rw 10 th
553 darsono rt rw 60 th
554 laura rt rw 7 th
556 maryati rt rw 53 th
557 nok sumyati rt rw 50 th
558 rupiah rt rw 41 th
559 anggi rt rw 11 th
560 royanah rt rw 46 th
561 rubin rt rw 55 th
562 sopiyati rt rw 32 th
563 sukardi rt rw 66 th
564 saripah rt rw 60 th
565 darkini rt rw 50 th
567 riska rt rw 35 th
568 khaerul muzaki rt rw 6 th
569 isyri nafisah rt rw 4 th
570 sutikha rt rw 18 th
571 mulyadi rt rw 29 th
572 sri rahayu rt rw 7 th
573 falikha rt rw 57 th
574 muriah rt rw 52 th
575 tawud rt rw 55 th
576 manah rt rw 80 th
577 ananda iskhak rt rw 6 th
578 farah lestiana rt rw 12 th
579 dariah rt rw 38 th
580 edi santoso rt rw 32 th
581 muslikha rt rw 52 th
583 titin rt rw 46 th ###
584 kasmi rt rw 65 th
585 dewi rt rw 24 th
586 aditya rt rw 5 th
587 tasjan rt rw 75 th
588 nurul rt rw 2 th
590 marwati rt rw 37 th
592 wastam rt rw 50 th
593 m irfa rt rw 14 th
594 kartini rt rw 46 th
595 satrio rt rw 50 th
596 uswatun rt rw 30 th
597 rosilah rt rw 40 th
599 topik s rt rw 45 th
600 rugayah rt rw 70 th
601 nur amaliyah rt rw 7 th
602 aliyah rt rw 30 th
603 suniti rt rw 62 th
604 roiskin rt rw 40 th
605 sunarto rt rw 34 th
606 waten rt rw 10 th
607 sanatun rt rw 45 th
608 fifi rt rw 13 th
609 riyanti rt rw 23 th
610 sutri rt rw 62 th
611 karsiwen rt rw 70 th ###
612 riski p rt rw 2 th
613 akroni rt rw 72 th
614 syahkia a rt rw 5 th
615 kusriyati rt rw 42 th
616 sawi rt rw 45 th
617 musyarofah rt rw 45 th
618 mardiyanti rt rw 33 th
619 samlawi rt rw 62 th
620 khoerun nur rt rw 26 th
621 roisah rt rw 25 th
622 widya ayu rt rw 5 th
623 khalimah rt rw 60 th
624 anisatul f rt rw 26 th
625 umar farukhi rt rw 12 th
626 nur kholidah rt rw 35 th
627 sutinah rt rw 65 th
628 anwar rt rw 70 th
629 junenah rt rw 41 th
630 wariyah rt rw 52 th
631 rasmali rt rw 61 th
632 rarukhi rt rw 36 th
633 topik rt rw 50 th
634 aji pamungkas rt rw 21 th ###
635 tanari rt rw 55 th
636 aji sumantri rt rw 55 th
637 tasripin rt rw 50 th
638 mia ayu rt rw 8 th
639 m zidni rt rw 4 th
640 khilu rt rw 2 th
641 tuti ayati rt rw 30 th
642 m ilya rt rw 9 th
643 wastiah rt rw 40 th
644 siswanti rt rw 47 th
645 nur aeni rt rw 6 th
646 saenudin rt rw 57 th
647 surikha rt rw 51 th
648 tarsinah rt rw 70 th
649 satriah rt rw 24 th
650 roinah rt rw 50 th
651 rusbad rt rw 70 th
652 rodiyah rt rw 55 th
653 farikhatun rt rw 32 th
654 dasman rt rw 59 th
655 sulastri rt rw 48 th
656 maslikha rt rw 46 th
657 aji maulana rt rw 14 th
658 muadah rt rw 46 th
659 nur afni rt rw 15 th
660 wartini rt rw 50 th
661 salamah rt rw 50 th
662 m febianto rt rw 4 th
663 rendi rt rw 2 th
665 nurul rt rw 8 th
666 gilang rt rw 5 th
667 dewi rt rw 2 th
668 saeni rt rw 37 th
669 tarsoni rt rw 69 th
670 wirati rt rw 47 th
672 rugayah rt rw 85 th
673 sukeyadi rt rw 76 th
674 rahayu rt rw 11 th
675 waisah rt rw 53 th
676 jenal rt rw 56 th
677 rosikhin rt rw 22 th
678 barudin rt rw 42 th
679 nuryati rt rw 48 th
680 nawi rt rw 70 th ###
681 daimah rt rw 60 th
682 rasid rt rw 38 th
683 kasih rt rw 30 th
684 fredy rt rw 11 th
685 toprik rt rw 29 th
686 saimah rt rw 37 th
687 rambat rt rw 60 th
688 sugiyono rt rw 12 th
689 jamilah rt rw 50 th
690 fifi rt rw 8 th
691 sairah rt rw 63 th
692 danisah rt rw 80 th
693 sulis rt rw 48 th
694 wastam rt rw 9 th
695 silviana rt rw 50 th
696 tariyah rt rw 7 th
698 taripah rt rw 60 th
699 rizal rt rw 37 th
700 nur sifa rt rw 38 th
701 sopityatun rt rw 10 th
702 salimah rt rw 43 th
703 suirah rt rw 10 th
704 suwarmo rt rw 54 th
706 sumitri rt rw 66 th
708 mahesa rt rw 5 th
709 nadilatun rt rw 3 th
710 sutarno rt rw 62 th
711 sopiyah rt rw 60 th
712 m adam rt rw 9 th
713 mustajab rt rw 30 th
714 carwinah rt rw 70 th
715 khotimah rt rw 60 th
716 leni rt rw 32 th
717 kalimi rt rw 70 th
718 abu nakar rt rw 60 th
719 m ali rt rw 3 th
720 rahmawati rt rw 10 th
721 taipah rt rw 39 th
722 popon rt rw 73 th
723 tarpiah rt rw 50 th
724 dirjo rt rw 70 th
725 nurohim rt rw 32 th ###
726 suparta rt rw 31 th
727 ramlah rt rw 65 th
728 muslihatun rt rw 7 th
729 kasmi rt rw 50 th
730 rusmi rt rw 70 th
731 amrini rt rw 34 th
732 slamet mufroni rt rw 60 th
734 nastuti rt rw 47 th
735 rohati rt rw 50 th
736 wastiah rt rw 51 th
737 tarinah rt rw 56 th
739 rustinah rt rw 60 th
740 nuraeni rt rw 12 th
742 evan rt rw 4 th
743 nur amaliyah rt rw 28 th
744 wasitah rt rw 30 th
745 khofifah rt rw 10 th
746 raimah rt rw 68 th
747 nur aidah rt rw 42 th
748 st farkhatun rt rw 7 th
749 m ilham rt rw 6 th
750 turiyah rt rw 51 th
751 sanudin rt rw 60 th
752 roisah rt rw 27 th
753 wiyati rt rw 60 th
754 sriani rt rw 2 th
755 arifudin rt rw 27 th
756 musrifah rt rw 32 th
757 rosid rt rw 38 th
758 tanuri rt rw 53 th
759 sri ayati rt rw 50 th
760 musripah rt rw 70 th
761 sopuroh rt rw 37 th
762 m roichan rt rw 13 th
763 ita purnawati rt rw 23 th
764 sri mulyati rt rw 19 th
765 dul mukti rt rw 60 th
766 musarofah rt rw 43 th
767 sugitno rt rw 19 th
768 saroh sifa rt rw 3 th
769 tubagus fahmi rt rw 5 th ###
770 kusmi rt rw 70 th
771 relva rt rw 3 th
772 setia santoso rt rw 26 th
773 satriyah rt rw 24 th
774 tika rt rw 9 th
775 dasripah rt rw 52 th
776 farhatun rt rw 50 th
777 rodah rt rw 57 th
778 badriyah rt rw 57 th
779 sri rahayu rt rw 51 th
781 laura rt rw 7 th
782 fajar riski rt rw 4 th
783 slamet rt rw 54 th
784 zaenudin rt rw 57 th
785 m rafa rt rw 3 th
786 waetun rt rw 30 th
787 suirah rt rw 70 th
788 dika rt rw 4 th
789 samsu rt rw 6 th
790 sopikha rt rw 5 th
791 yopir rt rw 9 th
792 santi setiowati rt rw 32 th
793 sumarto rt rw 26 th 6/28/2013
794 aripin rt rw 7 th
795 selvian rt rw 3 th
796 m fatih rt rw 8 th
797 imam santoso rt rw 23 th
798 marinah rt rw 59 th
799 karpi rt rw 76 th
800 yanuar edi rt rw 7 th
801 a nurois rt rw 30 th
802 laelatus saripah rt rw 26 th
803 titin rt rw 46 th
804 susmarni rt rw 46 th
806 fais rt rw 3 th
807 solikhin rt rw 48 th
808 masruri rt rw 50 th
809 mahyani rt rw 4 th
810 zahra nur rt rw 2 th
811 lutfiyah rt rw 6 th
812 roidah rt rw 30 th
813 ade wijayana rt rw 12 th
814 suimah rt rw 60 th
815 tio rt rw 2 th
816 puput riski rt rw 4 th
817 suwatno rt rw 46 th
818 datun rt rw 46 th
819 farhatun rt rw 50 th
820 karmen rt rw 50 th
821 neng ulfa rt rw 60 th
822 maulidin rt rw 13 th
823 amirudin rt rw 4 th
824 tamilah rt rw 40 th
825 sudarwono rt rw 43 th
826 saisah rt rw 61 th
827 irhamna rt rw 12 th
828 melviana rt rw 6 th
829 mujiana rt rw 38 th
830 sobirin rt rw 68 th
832 wasitah rt rw 30 th
833 durmad rt rw 42 th 6/29/2013
834 m deni rt rw 4 th
835 aldi rt rw 12 th
836 dairah rt rw 50 th
837 rohani rt rw 56 th
838 jamilah rt rw 50 th
839 slamet sidik rt rw 50 th
840 m kkhotin rt rw 5 th
841 kasan rt rw 70 th
842 dian nurman rt rw 24 th
843 mujib rt rw 71 th
844 m topik rt rw 3 th
845 nuryati rt rw 41 th
846 defi rt rw 4 th
847 rasiwan rt rw 8 th
848 nok santi rt rw 23 th
849 adnan rt rw 3 th
850 rosidah rt rw 37 th
851 tarini rt rw 27 th
852 nurul hidayah rt rw 3 th
853 riska rt rw 6 th
854 wasriah rt rw 36 th
856 supriyanto rt rw 12 th
857 rohayah rt rw 55 th
858 winda rt rw 9 th
859 rasid rt rw 38 th
860 khalimah rt rw 60 th
861 komari rt rw 45 th
862 rohimah rt rw 24 th
863 haris rt rw 35 th
864 arifudin rt rw 16 th
865 wartiah rt rw 50 th
866 m asila rt rw 3 th
867 daeri rt rw 38 th
868 ropiah rt rw 41 th
869 ade rohayati rt rw 35 th
870 wariyah rt rw 32 th
871 nur failah rt rw 34 th
872 aji maulana rt rw 14 th
873 m adam rt rw 9 th
874 warisah rt rw 40 th
875 saryunah rt rw 46 th
876 fitriyani rt rw 29 th
877 nazyah a rt rw 5 th
878 wadi rt rw 70 th
879 warningsih rt rw 35 th
880 st solekha rt rw th
LAN JAMKESMAS DI PELAYANAN DASAR
BULAN : MEI TAHUN : 2013

rta Jamkesmas
TANDA
DIAGNOSA Poli Pemeriks TOTAL BIAYA TANGAN
Poli Gigi Poli KIA Tindakan PASIEN
Umum aan LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13) 15
Rp 5,000
DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMAS D

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA TANGGAL
(Thn) KUNJUNGAN
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6) (7)

1 insyafatul 0000637907883 jalor rt 02 rw 05 14 th P 01-07-2013
4 naza aulia 0000638730641 dk maja rt 05 rw 05 3 th P
5 tumirah 0000638480864 jalor rt 02 rw 01 33 th P
7 eliyah 0000638697879 jalor rt 04 rw 02 48 th P
8 wasni 0000638487033 rg bandung rt 03 rw 03 57 th P
9 mastro 0000639126954 kr sembung rt 02 rw 01 80 th L
11 imam k 0000637910381 jakid rt 02 rw 09 25 th L
12 torikin 0000638766717 jakid rt 02 rw 04 33 th L
13 sutiah 0001032381336 wn tawang rt 05 rw 03 55 th P
18 zahra maulidia 0000639161537 kts yasa rt 07 rw 04 4 th P
19 soipah 0000638025017 wn tawang rt 04 rw 04 37 th P
20 nur aeni 0000633329177 sitanggal rt 01 rw 07 40 th P
21 julekha 0000638711066 jakid rt 02 rw 04 35 th P
22 jaimah 0000637680802 kts yasa rt 05 rw 04 37 th P
24 sukarno 0000638367614 jakid rt 11 rw 04 75 th L
25 ah akmaludin 0000638163538 jakid rt 03 rw 08 17 th L
27 santi 0000637925501 jakid rt 08 rw 01 50 th P
29 aji murbani 0000638344293 kts yasa rt 05 rw 03 11 th P
30 m azil 0000639110169 dk maja rt 03 rw 03 3 th L
31 sopuroh 0000638322311 cenang rt 03 rw 03 46 th P
32 ramen 0000638322727 pamengger rt 02 rw 04 60 th P
34 mario 0000637899446 jakid rt 03 rw 10 5 th L
35 masamah 0000638378133 dk maja rt 03 rw 03 44 th P
36 m aziz 0000632383492 rg pendawa rt 03 rw 12 9 th L
37 riski 0000637046636 tg gandu rt 01 rw 08 9 th L
38 desi nur asih 0000637892616 jalor rt 02 rw 01 19 th P
39 adi mulyana 0000638929427 dk maja rt 05 rw 01 11 th L
40 solihin 0001032421667 kts yasa rt 01 rw 04 48 th L
42 amriti 0001032400606 klampis rt 13 rw 04 30 th P
43 dirjo 0000638430671 janegara rt 11 rw 04 70 th L
44 ramini 0000638416046 dk maja rt 03 rw 03 47 th P 02-07-2013
45 siska 0000637917399 jalor rt 04 rw 01 11 th P
46 nafisah 0000637916354 jalor rt 09 rw 01 43 th P
47 marup 0000625248156 kr anyar rt 03 rw 03 66 th L
48 safira 0000633180317 dk rantam rt 10 rw 04 15 th P
49 putri 0000639164373 jakid rt 03 rw 03 2 th P
50 rojali 0000638520917 kts yasa rt 05 rw 03 11 th L
51 zaenal 0000637996407 jalor rt 06 rw 02 45 th L
52 tati setiawati 0000638120632 jalor rt 01 rw 03 32 th P
53 senah 0000633120501 rg pendawa rt 02 rw 03 40 th P
54 firman 0000638606135 tembelang rt 08 rw 02 40 th L
57 marwah 0000639532617 dk maja rt 01 rw 01 50 th P
58 dea safitri 0000638713675 dk maja rt 01 rw 01 7 th P
59 desi nur asih 0000638795654 jakid rt 04 rw 03 18 th P
61 waedah 0000636811143 glonggong rt 04 rw 02 40 th P
62 kusen 0001032425289 kendawa rt 05 rw 01 66 th L
64 eka maulida 0000639670813 kts yasa rt 01 rw 01 8 th P
66 m nur maulana 0000636101266 jalor rt 03 rw 02 2 th L
67 ropiha 0000638099932 jalor rt 03 rw 02 39 th P
68 ramlah 0000638098122 kramat rt 12 rw 04 36 th P
69 casmiah 0000624664113 kd sugih rt 04 rw 03 46 th P
71 umarah 0000639662286 klampis rt 06 rw 02 28 th P
72 wahyudin 0000638170256 jakid rt 04 rw 01 11 th L
73 malekha 0001032401924 km amba rt 02 rw 01 41 th P
75 torikin 0000638766717 jakid rt 02 rw 04 40 th L
77 nur fatikhatur 0000638492682 jalor rt 02 rw 05 10 th L
78 baedah 0001032402407 jalor rt 03 rw 02 80 th P
81 sanidah 0000639104457 kts yasa rt 08 rw 03 46 th P
82 nani 0000638028191 karanglo rt 15 rw 03 13 th P
83 krisdianto 0000637920202 jakid rt 04 rw 01 21 th L
84 santi 0000639386706 kts yasa rt 05 rw 01 21 th P
85 abd rohim 0000638833588 jakid rt 03 rw 03 70 th L
86 kasiwi 0001032425134 klikiran rt 05 rw 02 57 th P
87 m adam 0000638971817 kl pucang rt 03 rw 01 9 th L
88 m sunanto 0000639278807 jakid rt 01 rw 09 17 th L
89 sutarmo 0000637516609 jakid rt 02 rw 05 66 th L
93 sutijah 0001032412778 jakid rt 03 rw 04 57 th P
94 rosmiati 0000637766176 kts yasa rt 01 rw 04 18 th P
95 ras 0000637943837 pamengger rt 05 rw 03 13 th P
96 anwar rifai 0000632039837 kedawon rt 16 rw 07 6 th L
97 wenti 0000632039747 kedawon rt 16 rw 07 36 th P
98 fitriyani 0000639213783 jalor rt 07 rw 01 30 th P
100 ah sukron 0000637152546 jakid rt 05 rw 05 9 th L
101 suhartini 0000637700602 kts yasa rt 03 rw 01 35 th P
102 kiki 0000638288964 jakid rt 06 rw 05 6 th P
103 komita 0000638339196 dk maja rt 01 rw 01 2 th P
104 samlawi 0000639087806 jakid rt 03 rw 08 62 th L 03-07-2013
105 wasri 0000638779601 km amba rt 02 rw 04 39 th P
106 kusmirah 0000638279278 jakid rt 05 rw 06 50 th P
107 tansa 0000638001477 kd tukang rt 13 rw 06 70 th P
109 turiah 0000637731839 dk maja rt 05 rw 07 60 th P
110 rusmi 0000638501873 kd tukang rt 13 rw 08 66 th P
111 luwiyah 0000637641704 kr sembung rt 02 rw 09 46 th P
112 meti 0000637653352 kr sembung rt 02 rw 09 3 th P
114 tri nengsih 0000637954694 jakid rt 05 rw 08 72 th P
115 marwah 0000639522617 dk maja rt 01 rw 01 60 th P
116 dasirah 0000632324543 dk bokor rt 08 rw 04 70 th P
118 wartini 0000625605849 kr anyar rt 03 rw 02 60 th P
119 syahra 0000638340456 bojong rt 01 rw 01 5 th P
120 m radi 0000638687079 dk maja rt 01 rw 03 37 th L
122 munaim 0000638236281 jakid rt 01 rw 03 55 th L
124 junarsih 0000638847988 pamengger rt 06 rw 03 38 th P
125 nurul hidayah 0000638486367 klampis rt 10 rw 03 9 th P
126 rainah 0000638642158 karanglo rt 04 rw 20 62 th P
127 rohadi 0000638373903 kts yasa rt 03 rw 03 52 th L
128 sumitri 0001032402622 jalor rt 04 rw 01 70 th P
129 fifi ulfianah 0000638716074 pamengger rt 07 rw 12 7 th P
130 riski pratama 0000638751328 jakid rt 01 rw 09 3 th L
131 ridah 0000637780026 wn tawang rt 02 rw 04 45 th P
133 rohayah 0000638262066 jalor rt 07 rw 03 12 th P
135 rugayah 0001032414862 jalor rt 05 rw 02 85 th P
136 m safrudin 0000638242749 jalor rt 05 rw 02 8 th L
137 amrina 0000638889118 kts yasa rt 05 rw 01 21 th P
138 sairah 0001032415784 jalor rt 05 rw 06 60 th P
139 raswen 0001032415829 klikiran rt 05 rw 02 60 th P
140 maripah 0000638841206 jakid rt 02 rw 10 42 th P 04-07-2013
142 ali sodikin 0000637652316 jalor rt 06 rw 02 45 th L
143 intan nur ali 0000637652946 jalor rt 06 rw 02 4 th P
144 kaspuri 0000637563908 songgom rt 01 rw 03 45 th L
147 sokamah 0000638310947 jakid rt 03 rw 10 50 th P
149 khamim 0000638220506 jakid rt 01 rw 02 55 th L
150 warningsih 0000638320969 jakid rt 01 rw 02 50 th P
151 naela 0000637416612 rg pendawa rt 06 rw 07 2 th P
152 suhari 0000639100337 kts yasa rt 05 rw 01 36 th L
153 jenah 0000637836246 jalor rt 03 rw 02 51 th P
154 jarudin 0000637766766 jt makmur rt 01 rw 04 50 th L
155 suratmi 0000637766897 jt makmur rt 01 rw 05 50 th P
156 m arpan 0000637894378 dk maja rt 02 rw 07 4 th L
159 suwandi 0000639174916 jakid rt 05 rw 05 16 th L
161 delen 0000638420826 dk maja rt 03 rw 03 6 th P
162 nur aeni 0000638976194 dk maja rt 05 rw 07 46 th P
163 sorikha 0001032406389 jakid rt 03 rw 07 51 th P
165 wasripah 0000637852026 dk maja rt 05 rw 07 30 th P
166 solikhin 0000103242026 kts yasa rt 01 rw 04 40 th L
168 gilar 0001032415637 jalor rt 02 rw 05 17 th L
169 urip 0000638293079 jakid rt 01 rw 02 9 th L
170 andika 0000637991392 kr sembung rt 01 rw 01 11 th P
171 panji 0000638616926 jalor rt 05 rw 01 14 th L
173 sukarno 0000640158581 kl alang rt 01 rw 01 42 th L
176 dariah 0000637781769 wn tawang rt 02 rw 04 38 th P
177 suniti 0000638186276 jakid rt 01 rw 02 61 th P
178 ari setiawati 0000638186298 jakid rt 01 rw 02 22 th P
179 tia karyati 0000638081336 dk maja rt 01 rw 02 40 th P
180 fikih 0000638081826 dk maja rt 01 rw 02 12 th L 05-07-2013
182 nur hasanah 0000637988889 jakid rt 02 rw 11 48 th P
184 alisa suci 0000638792561 dk maja rt 04 rw 02 4 th P
185 rosita 0001032415751 jalor rt 03 rw 03 8 th P
186 moh talkhis 0000637875315 jalor rt 03 rw 03 38 th L
187 kesih 0000637960184 kr sembung rt 01 rw 07 60 th P
189 warhadi 0000638641139 dk maja rt 01 rw 07 50 th L
190 aris 0000638161859 rg bandung rt 01 rw 03 10 th P
191 surniah 0000638161184 rg bandung rt 01 rw 03 50 th P
193 wahyudin 0001032415654 jalor rt 05 rw 01 3 th L
194 kartini 0000637843814 dk maja rt 03 rw 02 60 th P
195 soipah 0001032412004 jalor rt 04 rw 01 59 th P
196 umi zaenab 0000637933556 jalor rt 05 rw 05 30 th P
197 faris 0000638005556 cenang rt 03 rw 02 5 th L
200 resti 0000638767517 km amba rt 04 rw 02 50 th P
201 tari 0000638147171 janegara rt 03 rw 07 80 th P
203 m fahmi 0000638813192 pamengger rt 06 rw 02 11 th L
204 m adam 0000638971817 kl pucang rt 03 rw 01 9 th L
205 ana setiasih 0000638226319 kb nagung rt 09 rw 02 12 th P
206 ah fahri 0000637126704 jakid rt 01 rw 06 2 th L
207 ulpiyah 0000639076836 jakid rt 05 rw 05 30 th P
209 st nurdiana 0000637978564 kr sembung rt 03 rw 05 3 th P
210 dwi prayitno 0000637978061 kr sembung rt 03 rw 05 3 th L
213 widya indah 0000638102849 jakid rt 05 rw 02 8 th P
214 jaenudin 0000637893887 jalor rt 01 rw 04 57 th L
215 st fatikha 0000638689127 buaran rt 04 rw 02 17 th P
216 ah sukron 0000637152546 jakid rt 05 rw 05 9 th L
218 sutirah 0000637786639 kts yasa rt 02 rw 05 57 th P
219 st rini 0000639321366 pamengger rt 02 rw 04 7 th P
221 ronidah 0000638172303 jakid rt 03 rw 01 45 th P
223 nur casidah 0000638373191 km amba rt 02 rw 04 35 th P
225 ardela 0000638166184 jakid rt 03 rw 10 16 th P 06-07-2013
227 tarsinah 0000637908904 jt makmur rt 03 rw 04 72 th P
228 sutari 0000637998499 wn tawang rt 03 rw 01 50 th P
229 umi zaenab 0000639051826 jakid rt 04 rw 01 30 th P
230 kusen 0001032422899 kendawa rt 05 rw 01 66 th L
231 suwali 0000639246744 jalor rt 02 rw 01 78 th L
233 kamilah 0000638756618 km amba rt 04 rw 02 39 th P
234 royanah 0000637278243 kr sembung rt 03 rw 04 46 th P
235 muflikhatun 0000637833296 kr sembung rt 03 rw 07 7 th P
236 eem suhartini 0000637013084 jalor rt 01 rw 04 50 th P
238 erni witati 0000638238735 jakid rt 03 rw 10 32 th P
239 toha 0000639181678 kb gadung rt 05 rw 04 50 th L
244 warti 0001032420936 kts yasa rt 04 rw 04 38 th P
246 leni yuliani 0000638194509 janegara rt 03 rw 02 32 th P
248 tasya 0000639187446 dk maja rt 02 rw 03 60 th P
249 taryumi 0000639187446 dk maja rt 02 rw 03 18 th P
250 den bagus 0000638555634 kts yasa rt 03 rw 02 18 th L
251 Sali sunami 0001032413139 jalor rt 03 rw 02 9 th P
253 marwati 0001032401057 klampis rt 09 rw 02 46 th P
254 m nurul 0000638256826 klampis rt 06 rw 02 4 th L
255 kalimah 0001032413182 jalor rt 08 rw 01 60 th P 08-07-2013
259 sutijah 0000638792504 jakid rt 04 rw 07 65 th P
260 salamah 0000638060798 kr sembung rt 08 rw 03 36 th P
261 suinah 0000638358829 wn cala rt 04 rw 02 30 th P
262 rahayu 0001032401485 km amba rt 03 rw 02 38 th P
263 asmawi 0000637270863 kr sembung rt 01 rw 04 30 th L
265 safitri 0000638914948 bojong rt 04 rw 02 9 th P
266 fatikha 0000638913993 bojong rt 06 rw 02 32 th P
267 tawi 0000637449867 jt makmur rt 04 rw 08 56 th P
268 suprapti 0000638466162 kts yasa rt 04 rw 03 48 th P
269 rawen 0001032417977 pamengger rt 07 rw 13 60 th P
270 alpiyah 0000639507532 dk maja rt 05 rw 05 37 th P
271 titin 0000637859835 dk maja rt 04 rw 07 36 th P
272 aliska 0000638792561 dk maja rt 04 rw 02 4 th P
273 st mujenah 0000638527285 dk maja rt 01 rw 04 29 th P
274 tanuroh 0000639460822 klampis rt 04 rw 02 41 th P
275 rohimi 0000638033692 kr sembung rt 03 rw 05 44 th L
277 wiyem 0000637281462 tg wulung rt 02 rw 01 70 th P
278 daisah 0000639287627 jalor rt 03 rw 03 50 th P
279 muslimin 0000638966889 dk maja rt 02 rw 07 29 th L
281 sumarni 0000637694824 kts yasa rt 05 rw 04 40 th P
282 sahir 0000638333122 jt makmur rt 04 rw 04 3 th L
283 aji lesmana 0000639206471 kb gadung rt 05 rw 04 10 th L
284 raminah 0000639206144 kb gadung rt 05 rw 04 41 th P
286 jihan 0000638154033 km amba rt 04 rw 02 4 th P
287 nurul 0000638465387 km amba rt 10 rw 03 9 th P
288 carim 0000639206863 kb gadung rt 05 rw 04 46 th L
291 leni yuliani 0000638188931 kb nagung rt 09 rw 02 32 th P
292 riski 0000638188402 kb nagung rt 09 rw 02 7 th L
293 herti 0000638481442 dk maja rt 01 rw 01 41 th P
294 kasnadi 0000638211813 janegara rt 01 rw 01 76 th L
295 abd hanan 0000638956269 jakid rt 01 rw 05 40 th L
296 rainha 0000638972149 kl pucang rt 03 rw 01 50 th P
297 sayidin 0000638474423 kb nagung rt 01 rw 04 70 th L
298 m irpan 0001032401248 km amba rt 04 rw 02 7 th L
299 dewi indah 0000637970387 jalor rt 02 rw 01 14 th P
300 anton 0000639300317 tembelang rt 12 rw 03 4 th L
301 fakhrurozi 0000639551068 janegara rt 01 rw 01 17 th L
302 sodikin 0000638656896 jalor rt 04 rw 05 60 th L
303 efi rahayu 0000638284779 jalor rt 01 rw 03 25 th P
304 tarmen 0000638223041 karanglo rt 02 rw 06 59 th P
305 m faizal 0000638759992 jakid rt 01 rw 06 2 th L
306 khunenah 0001032402484 jakid rt 01 rw 07 40 th P
307 rizal 0000639379146 kb nagung rt 07 rw 01 9 th L
308 nur khikmah 0001032412781 jalor rt 02 rw 06 35 th P
309 m auliansyah 0000637911382 jalor rt 08 rw 01 4 th L
310 nazah aminatun 0000637911099 jalor rt 08 rw 01 6 th P
313 ayu fadilah 0000638967866 jakid rt 01 rw 05 4 th P 09-07-2013
314 fahrotun 0000638987478 jakid rt 01 rw 05 9 th P
315 dwi riski 0000638676786 jalor rt 04 rw 05 5 th P
316 masitoh 0000638076071 jalor rt 04 rw 08 37 th P
317 nur anisah 0000637987432 jalor rt 02 rw 01 18 th P
322 taufik 0000638469548 klampis rt 09 rw 03 4 th L
323 badriyah 0000639417643 kts yasa rt 04 rw 04 48 th P
324 warlinah 0000638812822 wn cala rt 06 rw 01 70 th P
325 sutinah 0000638414021 klampis rt 05 rw 02 64 th P
326 musyarofah 0001032395469 kb gadung rt 05 rw 01 43 th P
327 anita 0000638846278 pamengger rt 05 rw 04 9 th P
329 riwi 0000637932836 wn tawang rt 06 rw 02 45 th P
330 m topik 0000637716621 kts yasa rt 01 rw 01 58 th L
331 srimulyati 0001032406764 jakid rt 01 rw 02 43 th P
332 samsudin 0001032407403 jakid rt 101 rw 03 53 th L
333 st maflikha 0000638254596 jakid rt 02 rw 04 60 th P
334 fabio 0000638632574 tembelang rt 17 rw 03 5 th P
337 rosikin 0000638123657 jakid rt 02 rw 01 51 th L
340 st rosita 0000639200011 pamengger rt 01 rw 05 3 th P
341 kumirah 0001032415762 jalor rt 02 rw 02 50 th P
342 ulfi nur azizah 0000636961626 tembelang rt 18 rw 03 8 th P
344 farukhi 0000638852667 jalor rt 05 rw 05 37 th L
345 nanda 0000638927504 jalor rt 05 rw 02 12 th P
347 haris 0000638937596 jakid rt 05 rw 08 34 th L
348 kustati 0000638200912 kb nagung rt 08 rw 02 43 th P
350 windi 0000638483905 jakid rt 01 rw 04 7 th P 10-07-2013
351 yuda 0000639596003 jakid rt 05 rw 08 18 th L
353 sanapi 0000638510681 kts yasa rt 03 rw 03 58 th L
354 warsan 0000639021958 pamengger rt 02 rw 04 60 th L
355 sugiarti 0000638758337 janegara rt 11 rw 04 45 th P
356 abd jafar 0000638111722 jalor rt 05 rw 03 4 th L
357 suratmi 0000638116427 jalor rt 05 rw 03 38 th P
359 mukhtadi 0000638273463 jalor rt 05 rw 03 50 th L
360 raimah 0000638129158 km amba rt 02 rw 03 53 th P
361 rainah 0001032411958 jalor rt 03 rw 02 60 th P
363 jasum 0000637847504 dk maja rt 05 rw 07 7 th L
364 junirah 0001032414737 jalor rt 03 rw 05 60 th P
368 fidya ayu 0000638126188 jakid rt 03 rw 10 23 th P
371 suharti 0000638742835 jakid rt 05 rw 08 45 th P
372 sri atun 0000638743678 jakid rt 05 rw 08 23 th P
373 rahma 0000639205953 wn cala rt 03 rw 01 8 th P
374 sakuri 0000639497957 janegara rt 01 rw 01 42 th L
376 jumeri 0000638202306 jakid rt 03 rw 06 37 th P
377 tainah 0000639047992 karanglo rt 02 rw 01 50 th P
378 amrina rosada 0000638889118 kts yasa rt 05 rw 01 24 th P
379 urip satori 0000637907174 jakid rt 02 rw 01 48 th L
380 suriyah 0000637754319 kts yasa rt 05 rw 02 50 th P 11-07-2013
382 mukri 0000638189335 kb nagung rt 09 rw 02 70 th L
383 latifah 0000638567199 kb nagung rt 09 rw 02 41 th P
385 sri hidayaningsih 0000638204476 jalor rt 05 rw 05 53 th P
386 ah rosidi 0000639122657 kts yasa rt 02 rw 03 45 th L
387 resti destiani 0000638489316 dk maja rt 02 rw 06 6 th P
389 darwanti 0000638480654 kts yasa rt 01 rw 02 23 th P
391 prayitno 0000638217134 jakid rt 03 rw 10 9 th L
392 darja 0000638491094 km amba rt 04 rw 02 70 th L
393 darni 0001032402969 jakid rt 02 rw 01 36 th P
394 rinita 0000638527588 jalor rt 06 rw 05 3 th P
395 waitah 0000637844016 kr sembung rt 03 rw 05 16 th P
396 tinah 0000637841529 kr sembung rt 03 rw 05 50 th P
397 ega yuliditira 0000638237507 jakid rt 04 rw 01 5 th L
398 soripah 0000639590411 dk maja rt 03 rw 03 33 th P
399 suparno 0000638107727 kts yasa rt 04 rw 03 56 th L
400 pandi 0000638366242 kb nagung rt 09 rw 02 3 th L
401 kusriah 0000638339962 bojong rt 11 rw 03 50 th P
402 hana nazwa 0000637977993 cenang rt 09 rw 04 7 th P
403 tasori 0000637857819 jakid rt 05 rw 09 63 th L
404 ngatini 0001032413005 jalor rt 04 rw 02 54 th P
406 toriyah 0000638994868 kts yasa rt 07 rw 04 60 th P
407 ridayatu syafira 0000637940889 kts yasa rt 07 rw 04 2 th P
408 rolah 0001032403331 jakid rt 02 rw 04 73 th P
409 carwinah 0001032413376 jalor rt 01 rw 05 70 th P
410 sutirah 0000637905532 kts yasa rt 04 rw 04 50 th P
411 solikha 0000638302138 jakid rt 03 rw 10 55 th P
412 nurul hidayah 0000638465387 klampis rt 10 rw 03 9 th P
413 atika jahrotun 0000638469887 wn tawang rt 04 rw 04 9 th P
414 fabio 0000638632574 tembelang rt 17 rw 03 7 th L
415 fadilah 0000638321179 tembelang rt 17 rw 03 27 th P
416 taenyah 0000637728219 kts yasa rt 06 rw 03 42 th P
417 kotimah 0000638574467 kb nagung rt 08 rw 02 43 th P 12-07-2013
420 rumiah 0000637718073 kts yasa rt 02 rw 03 65 th P
421 rijah 0000638618916 karanglo rt 19 rw 04 65 th P
422 lenawati 0000637850036 dk maja rt 01 rw 01 31 th P
423 rina irmayanti 0000637850711 dk maja rt 01 rw 01 10 th P
425 sri susilawati 0000638300507 jakid rt 04 rw 01 22 th P
426 sukiroh 0001032388334 kr sembung rt 05 rw 01 47 th P
427 yudi 0001032388835 kr sembung rt 01 rw 05 17 th L
428 saskiyah 0000638245991 klampis rt 01 rw 01, 2 th P
429 torikoh 0000639123298 kts yasa rt 02 rw 02 29 th P
430 taripah 0000638168152 kb nagung rt 10 rw 02 31 th P
432 sikyadi 0000638913148 tg wulung rt 14 rw 03 75 th L
433 popon r 0000637151338 jakid rt 05 rw 05 42 th P
434 suprapti 0000638449525 kts yasa rt 01 rw 05 52 th P
435 ainun nafisah 0001032413185 jalor rt 05 rw 01 6 th P
437 faturohman 0000637613638 jalor rt 01 rw 04 10 th L
438 fahmi amrilah 0000638112234 dk maja rt 07 rw 02 17 th L
439 agus baikhaki 0000638926334 jalor rt 05 rw 02 42 th L
441 nurjanah 0000638657278 jalor rt 04 rw 05 62 th P
442 warja 0000638324998 jakid rt 03 rw 10 75 th L
443 alvin 0000638341211 jakid rt 03 rw 10 2 th L
446 wiji khoiriyah 0000638648471 jalor rt 06 rw 05 45 th P
447 tusriyah 0000638741204 jakid rt 03 rw 01 35 th P
449 dunah 0000638044662 kr sembung rt 02 rw 05 50 th P
450 anastasya 0000638350931 kl pucang rt 03 rw 01 12 th P
451 anisa 0000639298282 jakid rt 03 rw 10 10 th P
453 karyono 0000638802137 jalor rt 03 rw 04 41 th L
454 tunirah 0000638979096 dk maja rt 01 rw 01 30 th P 13-07-2013
455 maria ulfa 0000638348308 dk maja rt 01 rw 01 22 th P
456 sibari 0000638347397 dk maja rt 01 rw 01 47 th L
457 zakiyah 0001032440409 tembelang rt 15 rw 03 5 th P
458 adi riyanto 0000638323503 jakid rt 03 rw 01 3 th L
460 waisah 0000638/768395 jakid rt 04 rw 03 56 th P
461 karumi 0000638550909 kr sembung rt 02 rw 02 52 th P
465 salma nabila 0000638414168 karanglo rt 04 rw 01 31 th P
466 st sarah 0000638123302 jalor rt 06 rw 05 7 th P
467 nur amaliah 0000638127898 jalor rt 06 rw 05 2 th P
468 khotimah 0000637847853 dk maja rt 05 rw 07 23 th P
470 muadah 0000638344372 klampis rt 03 rw 01 63 th P
472 nur aisyah 0000638471981 dk maja rt 03 rw 03 32 th P
473 anwar 0000637629344 jalor rt 04 rw 01 80 th L
474 taipah 0000638628936 jakid rt 06 rw 06 38 th P
475 m fahmi 0000638881162 pamengger rt 05 rw 02 11 th L
477 st maryam 0000637887172 jalor rt 02 rw 01 20 th P
478 kusriah 0000638210183 jalor rt 08 rw 01 61 th P
480 nur diana 0000638816244 jakid rt 01 rw 06 2 th P
481 sairil 0000638124219 jalor rt 02 rw 05 58 th L
482 warisah 0000637714369 dk maja rt 01 rw 01 40 th P
483 mutiara anisa 0000637716306 dk maja rt 01 rw 01 13 th P
484 cindi permatasari 0000637718317 dk maja rt 01 rw 01 9 th P
485 fatonah 0000638867072 pamengger rt 04 rw 04 65 th P
487 mutikha 0000638140893 jakid rt 03 rw 07 60 th P
488 khosilah 0000638969073 kts yasa rt 01 rw 04 26 th P
489 wiranto 0001032399437 klampis rt 06 rw 02 14 th L 15-07-2013
490 maryatun 0000637270736 kr sembung rt 11 rw 04 28 th P
491 rahma 0000638840199 kb nagung rt 09 rw 02 3 th P
493 winem 0000638202093 kr sembung rt 04 rw 02 70 th P
494 taripah 0000638169746 tg wulung rt 18 rw 04 45 th L
495 wildani 0000630826264 jakid rt 06 rw 01 16 th P
496 nur maulana 0000638101258 jalor rt 03 rw 02 2 th L
497 komar 0001032421476 kts yasa rt 01 rw 01 57 th L
498 rohani 0001032421487 kts yasa rt 01 rw 01 61 th P
499 m rafa 0000637881446 pamengger rt 03 rw 02 3 th L
500 rohayati 0000639146586 kts yasa rt 05 rw 04 30 th P
501 taufik 0001032407291 jakid rt 02 rw 03 41 th L
502 ali fauzan 0000637474454 kr sembung rt 01 rw 09 5 th L
505 senah 0000633058501 rg pendawa rt 03 rw 02 40 th P
507 sukarto 0001032412239 jalor rt 01 rw 08 69 th L
508 sarah 0000639182236 jakid rt 04 rw 05 4 th P
510 wasrun 0001032390213 kr sembung rt 01 rw 01 72 th L
511 tasini 0001032390324 kr sembung rt 01 rw 01 70 th P
513 ranbat 0001032401114 km amba rt 02 rw 01 60 th L
514 kusnadi 0000638279807 jalor rt 04 rw 03 43 th L
515 handayani 0000638117572 kd tukang rt 19 rw 06 31 th P
516 khodijah 0000639150399 jakid rt 02 rw 07 60 th P
518 cindi permatasari 0000638314198 jakid rt 02 rw 04 17 th P
519 fahriatus zahra 0000638613843 karanglo rt 04 rw 01 3 th P
521 prima tiara indah 0000638324908 jakid rt 04 rw 03 8 th P 16-07-2013
523 wirnaningsih 0000638553334 jakid rt 03 rw 10 30 th P
524 supruyadi 0000638427115 janegara rt 11 rw 04 17 th L
525 malikha 0001032401924 km amba rt 02 rw 01 41 th P
527 fahmi amrilah 0000638456444 klampis rt 01 rw 01 4 th L
529 tika 0000637599047 kr sembung rt 02 rw 01 5 th P
530 khunenah 0001032402464 jakid rt 01 rw 07 35 th P
531 wanitah 0000639572859 dk maja rt 03 rw 02 41 th P
532 sutriyah 0000638036976 kr sembung rt 02 rw 01 55 th P
533 rizal 0000638037011 kr sembung rt 02 rw 01 13 th L
534 sefiatun eliza 0001032412926 jalor rt 03 rw 02 10 th P
535 tuminah 0000638519163 km amba rt 04 rw 02 64 th P
537 surtamah 0000639250391 janegara rt 08 rw 03 60 th P
539 sunadi 0000638153684 dk maja rt 02 rw 03 67 th L
540 khositin 0000632420469 rg pendawa rt 04 rw 04 50 th L
541 taripah 0000638418982 dk maja rt 03 rw 03 40 th P
542 musrikha 0000639029054 jakid rt 02 rw 07 59 th P
543 romsah 0000639149084 jalor rt 06 rw 01 52 th P
545 muhandes 0000638523509 jakid rt 01 rw 05 11 th L
546 vena 0000639079367 kts yasa rt 05 rw 01 16 th P
547 soleh 0001032421904 dk maja rt 01 rw 01 40 th L
549 m agus 0000638293375 jakid rt 04 rw 01 76 th L
553 tumrah 0000638971366 dk maja rt 01 rw 01 57 th P
555 sulki 0000638134566 km amba rt 04 rw 02 60 th P
557 reza 0000639119812 dk maja rt 01 rw 01 9 th L
559 suhaeni 0000638095443 jalor rt 08 rw 03 25 th P
561 nur fitriah 0000639116649 jakid rt 04 rw 05 16 th P
562 nurois 0000637153637 jakid rt 04 rw 02 30 th L
563 sariman 0000638321253 jakid rt 04 rw 02 52 th L
566 st rahayu 0001032415734 jalor rt 01 rw 08 36 th P
567 sakuri 0000638982572 kts yasa rt 02 rw 03 31 th L
568 maani 0001032407515 jakid rt 02 rw 01 70 th P 17-07-2013
570 sainah 0000637358826 tg wulung rt 03 rw 01 55 th P
571 darojah 0000638656964 klampis rt 04 rw 02 58 th P
574 alfiyah 0000637577919 kr sembung rt 04 rw 05 29 th P
575 dahuri 0000637869723 dk maja rt 05 rw 02 30 th L
577 anastasya 0000638350931 kl pucang rt 03 rw 01 12 th P
580 st romlah 0001032415481 jalor rt 03 rw 02 41 th P
582 jainah 0000637680802 kts yasa rt 06 rw 04 37 th P
583 bela 0000639321535 wn cala rt 07 rw 02 6 th P
584 dewi safitri 0000638321139 klampis rt 06 rw 02 24 th P
585 sopikha 0000638198987 jt makmur rt 03 rw 01 60 th P
586 slamet 0000637948633 pamengger rt 03 rw 05 42 th L
587 sofan 0000638577148 gandasuli rt 06 rw 02 58 th L
589 jenal 0000638838303 jakid rt 05 rw 05 26 th L
590 jumiyati 0000639881343 dk maja rt 02 rw 05 52 th P
591 rinto 0000638486459 dk maja rt 05 rw 17 9 th L
592 iti suhesti 0000638355544 karanglo rt 03 rw 02 28 th P 7/18/2013
593 puput 0000638227513 jakid rt 03 rw 01 9 th P
595 kasmuri 0000638257184 jakid rt 03 rw 09 80 th L
596 wasriah 0000639141292 kts yasa rt 06 rw 04 30 th P
599 ah riyadi 0000639138104 jakid rt 04 rw 05 13 th L
600 fatonah 0001032391114 kr sembung rt 04 rw 05 60 th P
601 rehan rosikin 0000638147675 wn cala rt 02 rw 03 3 th L
602 m irfan 0001032401248 km amba rt 04 rw 02 3 th L
603 royati 0000637131238 jakid rt 03 rw 01 8 th P
605 imam aziz 0000638414998 rg bandung rt 01 rw 01 90 th L
606 m ardi 0000638241772 jakid rt 04 rw 03 9 th L
607 saprudin 0000638934052 kts yasa rt 04 rw 03 5 th L
608 rosikhatun 0000637913013 jalor rt 02 rw 05 15 th P
609 khafid 0000638874551 jalor rt 02 rw 02 35 th L
610 haikal 0000638874099 jalor rt 02 rw 02 2 th L
611 dasirah 0000632324643 kd bokor rt 08 rw 04 11 th P
616 sutijah 0001032412779 jalor rt 02 rw 05 7 th P
617 rohyaningsih 0000638928595 jakid rt 03 rw 04 50 th P
620 maryam 0000637880961 kr sembung rt 02 rw 03 62 th P
621 nurul hidayah 0000638466387 klampis rt 10 rw 03 9 th P 7/19/2013
622 rivaldi 0000639417993 klampis rt 11 rw 04 7 th L
623 afinda 0000639482264 janegara rt 02 rw 01 9 th P
624 sopari 0000638702537 karanglo rt 04 rw 01 43 th L
625 karpi 0000638476176 jalor rt 01 rw 01 75 th P
626 wartiah 0000638111979 jakid rt 04 rw 05 60 th P
627 baenah 0001032402317 jalor rt 01 rw 01 50 th P
629 m lopi 0000638800536 jakid rt 02 rw 09 58 th L
631 roheti 0000638258837 jalor rt 07 rw 03 41 th P
633 wati sastra 0000638231452 jakid rt 01 rw 03 35 th L
634 m topik 0000639309057 jakid rt 03 rw 08 45 th P
635 parikha 0000637913017 kr sembung rt 01 rw 05 37 th P
639 sumirah 0000637348217 kts yasa rt 05 rw 02 38 th P
640 khoirunisa 0000638258949 jalor rt 07 rw 03 24 th P
641 susilawati 0000639081202 jakid rt 08 rw 07 22 th P
644 juinah 0000639560981 janegara rt 01 rw 01 50 th P
647 irkhamudin 0001032405197 jakid rt 03 rw 04 21 th L
649 adom 0000638017717 jakid rt 02 rw 04 10 th L
651 sopiyah 0000638712505 dk maja rt 01 rw 01 40 th P 7/20/2013
652 dea safitri 0000638713675 dk maja rt 01 rw 01 8 th P
653 sumar 0000638044402 kr rt 02 rw 02 50 th L
654 rosita ramadhani 0001032415751 jalor rt 01 rw 08 8 th P
656 fajar riski 0000638688453 dk maja rt 01 rw 03 4 th L
657 fatimah 0000638559461 kts yasa rt 03 rw 03 60 th P
658 faozi 0000637908671 kts yasa rt 03 rw 02 16 th L
660 ah sandy 0000639028956 jakid rt 03 rw 08 12 th L
661 rositah 0000637538844 kr sembung rt 01 rw 01 23 th P
662 ari purwanto 0000638766802 km amba rt 02 rw 02 7 th L 7/22/2013
664 taripah 0000637804787 dk maja rt 01 rw 02 45 th P
667 bela 0000639321535 wn cala rt 07 rw 02 6 th P
669 saskiyah 0000638248991 klampis rt 01 rw 01 3 th P
670 sukwad 0000638696094 dk maja rt 01 rw 03 70 th L
671 taryunah 0000638030082 kr sembung rt 02 rw 01 40 th P
673 daim 0000638759749 jakid rt 04 rw 01 43 th L
675 rina 0000637880711 dk maja rt 01 rw 01 10 th P
678 karmuah 0000638881665 klampis rt 06 rw 02 60 th P
679 kayem 0000638105367 klampis rt 06 rw 02 20 th P
682 rini 0000637956979 jalor rt 03 rw 01 9 th P
684 m riski 0000637602952 jalor rt 01 rw 08 7 th L
687 dakmanto 0000639121836 wn tawang rt 08 rw 01 30 th L
689 st maryam 0000637180997 jakid rt 03 rw 03 60 th P
690 saenah 0000639166072 jakid rt 04 rw 03 60 th P
693 warto 0000638749564 pamengger rt 02 rw 04 70 th L
694 azizah 0000639638616 tembelang rt 10 rw 02 40 th P
695 alfin 0000638341211 jakid rt 03 rw 10 2 th L
696 samlawi 0000638908806 jakid rt 03 rw 08 66 th L
697 abd gofur 0000638417676 kts yasa rt 03 rw 05 13 th L
699 denti arini 0001032414465 jalor rt 06 rw 01 17 th P
700 tarmu 0000637821696 wn cala rt 03 rw 02 21 th P
701 nur faikoh 0000637613728 jalor rt 05 rw 04 32 th P
702 untung 0000639537862 janegara rt 01 rw 01 37 th L
703 fatirah 0000639017662 jakid rt 04 rw 02 42 th P
704 rudiyanto 0000639482126 janegara rt 02 rw 01 39 th L
705 fatimah 0001032403307 jakid rt 02 rw 05 73 th P 7/23/2013
706 faizatul fitri 0000638233389 jakid rt 02 rw 04 12 th P
708 muh riski 0000638368119 jakid rt 04 rw 02 13 th L
709 kokom 0000638367928 jakid rt 04 rw 02 36 th P
710 faridah 0000638798591 jakid rt 04 rw 02 48 th P
713 abd rokhim 0000637693402 kts yasa rt 03 rw 01 12 th L
715 ardiansyah 0000638723632 kr sembung rt 03 rw 02 5 th L
716 nur soleh 0000638237283 jakid rt 03 rw 01 12 th L
717 m zalfaruk 0001032437722 rg bandung rt 03 rw 03 7 th L
719 ridah 0001032403511 wn cala rt 01 rw 03 80 th P
720 irfan hidayat 0000637942037 kts yasa rt 02 rw 02 10 th L
721 wakhidin 0000639526601 dk maja rt 03 rw 07 40 th L
722 riski 0000639527951 dk maja rt 03 rw 07 10 th L
725 desy nurmania 0000638772928 jakid rt 02 rw 04 24 th P
726 kuniroh 0001032415762 jalor rt 02 rw 02 58 th P
728 sutriyah 0000638036976 kr sembung rt 02 rw 01 53 th P
729 m zidny 0000638276185 jakid rt 02 rw 04 4 th L
730 lailatul fahiroh 0000638828302 jakid rt 01 rw 05 13 th P
731 ardi firman 0000638612256 jalor rt 01 rw 04 5 th L
732 wasni 0000638203983 jakid rt 03 rw 06 75 th P
733 musrifah 0001032405355 jakid rt 02 rw 04 55 th P
734 darmoyo 0000638970704 kl pucang rt 03 rw 01 45 th L
735 maulidiya anisa 0000639173788 janegara rt 01 rw 01 9 th P
736 sairil 0000638124219 jalor rt 02 rw 05 6 th P
737 sandi 0000637958351 kr sembung rt 04 rw 01 6 th L 7/24/2013
741 dairoh 0000638484017 pamengger rt 05 rw 02 30 th P
744 watriah 0000639287559 jakid rt 02 rw 05 50 th P
748 nurohim 0000637730807 dk maja rt 05 rw 07 30 th L
751 faoziyah 0000638299732 jalor rt 05 rw 02 73 th P
753 atika s 0000637637163 jalor rt 06 rw 01 47 th P
754 taripah 0000638468752 pamengger rt 07 rw 02 9 th P
755 asmui 0001032422877 janegara rt 02 rw 04 40 th L
756 khalimi 0000637968317 jalor rt 05 rw 02 80 th P
757 nova r 0000638514461 jakid rt 05 rw 01 55 th L
761 sukiyah 0000639121151 janegara rt 01 rw 01 50 th P 7/25/2013
764 marwati 0000637164443 jakid rt 03 rw 02 40 th P
765 masripah 0000637130226 jakid rt 02 rw 01 34 th P
766 sri atun 0000638743676 jakid rt 05 rw 06 26 th P
770 joko s 0000639397517 karanglo rt 01 rw 02 45 th L
772 ani nuriyah 0001032420622 kts yasa rt 02 rw 01 11 th P
774 syania 0001032413916 jalor rt 02 rw 03 13 th P
775 marah 0000638771095 jakid rt 03 rw 01 60 th P
776 sri purwanti 0000638775436 jakid rt 02 rw 03 20 th P
777 nur inayah 0000638327114 jakid rt 02 rw 01 40 th P
779 watmah 0000638533877 jt rokeh rt 03 rw 01 47 th P
780 tubagus fahmi 0001032407122 jakid rt 02 rw 03 2 th L 7/26/2013
781 septi mutiara 0000639542474 janegara rt 03 rw 09 19 th P
782 nurohim 0000637739807 dk maja rt 06 rw 07 32 th L
783 muawanah 0000638137826 km amba rt 02 rw 03 38 th P
784 suvian 0000638765942 jakid rt 03 rw 10 3 th L
789 ismawi 0000637398024 tg wulung rt 02 rw 01 62 th P
790 maesaroh 0000638989240 pamengger rt 01 rw 03 30 th P
791 sifatul 0000638215962 kr sembung rt 01 rw 03 9 th P
792 asepudin 0001032430632 kts yasa rt 01 rw 02 7 th L
797 ane 0000638324274 klampis rt 11 rw 04 4 th P
800 abdullah 0000637422887 bojong rt 14 rw 03 27 th L
801 imam santoso 0000639287156 jalor rt 08 rw 01 23 th L 7/27/2013
802 rosimun 0000638466826 jalor rt 01 rw 01 55 th L
803 novi 0000638969932 jakid rt 02 rw 04 9 th P
804 eliyah 0000638897879 jalor rt 02 rw 01 48 th P
805 malawi 0000637978876 kr sembung rt 03 rw 06 3 th L
806 rohanah 0000637975976 kr sembung rt 03 rw 06 40 th P
808 watinah 0000638207862 jakid rt 02 rw 06 56 th P
810 rodiyah 0000632400546 sitanggal rt 03 rw 03 73 th P
811 didin 0000637617587 jalor rt 02 rw 04 18 th L
812 sami maulana 0001032407336 jakid rt 02 rw 03 9 th L
813 slamet 0000637681004 kts yasa rt 06 rw 04 67 th L
814 deska 0000638703821 km amba rt 02 rw 03 7 th P
817 musyarofah 0000637984686 jakid rt 03 rw 07 29 th P
819 st rohani 0000638613913 jalor rt 06 rw 03 30 th P
821 tarsih 0000632019587 rg pendawa rt 02 rw 02 50 th P
823 tika permana 0000637599049 kr sembung rt 02 rw 01 5 th P
824 elma silfa 0000639372609 kts yasa rt 06 rw 04 3 th P
825 ratinah 0000637679394 kr sembung rt 02 rw 07 50 th P 7/29/2013
826 nurul hidayah 0000638527408 dk maja rt 01 rw 04 7 th P
827 ramlah 0000639098132 jakid rt 02 rw 10 35 th P
JALAN JAMKESMAS DI PELAYANAN DASAR
BULAN : JULI TAHUN : 2013

eserta Jamkesmas
TANDA
DIAGNOSA Poli Pemeriks TOTAL BIAYA TANGAN
Poli Gigi Poli KIA Tindakan PASIEN
Umum aan LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13) 15
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
radices Rp5,000 Rp32,500
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
period 46 Rp5,000 Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
period 36 Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
radices 23 Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gangren pulpa 26 Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
persistensi 61 Rp5,000 Rp8,250
karisdentil Rp5,000 Rp27,500
Rp5,000
Rp5,000
hb, golda Rp5,000 Rp5,000
Rp5,000
abses Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
persistensi Rp5,000 Rp17,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
tambal Rp5,000 Rp27,500
Rp5,000
Rp5,000
Rp5,000
premed Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
pulpitis Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gingivitis Rp5,000 Rp23,500
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gds Rp5,000 Rp3,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gp period Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
grinding 36 Rp5,000 Rp11,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
pulpitis Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
perforasi radix Rp5,000 Rp17,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gangren pulpa36 Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
grinding Rp5,000 Rp11,750
Rp5,000
ulcus 84 Rp5,000 Rp17,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
ulcus 51 Rp5,000 Rp17,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gangren pulpa Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
gds Rp5,000 Rp3,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
hb Rp5,000 Rp2,000
pulpapolip Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
bta Rp5,000 Rp4,500
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
pulpapolip Rp5,000 Rp12,750
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
luksasi Rp5,000 Rp22,500
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
luksasi Rp5,000 Rp5,000 Rp22,500
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
Rp5,000
DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMAS D

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA TANGGAL
(Thn) KUNJUNGAN
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6) (7)

1 titin 0000632586069 rg pendawa rt 02 rw 05 26 th P 01-08-2013
2 nurokhim 0000637730807 dk maja rt 05 rw 02 33 th L
3 nur leli 0000637987106 jalor rt 02 rw 01 28 th P
4 ulfi nur amalia 0000638903362 kts yasa rt 01 rw 01 5 th P
5 triningsih 0000638628985 jalor rt 03 rw 02 44 th P
8 khasanah 0000638428702 janegara rt 01 rw 01 38 th P
10 umi magfiroh 0000637573149 jakid rt 03 rw 10 6 th P
12 nasikha 0000638768092 jakid rt 03 rw 01 33 th P 02-08-2013
13 efi ayu k 0001032421926 kts yasa rt 05 rw 01 14 th P
14 nurdinda a 0000638818244 jakid rt 01 rw 06 2 th P
15 edi sutriyono 0000637635947 jalor rt 06 rw 01 35 th L
16 moh nasikhin 0000637630446 kts yasa rt 05 rw 01 13 th L
18 salsabila 0000637161513 jakid rt 05 rw 05 4 th P
21 sidik 0000638446937 kr sembung rt 04 rw 05 40 th L
22 edi bayu 0000637746581 sidamulya rt 02 rw 08 7 th L
24 slamet surakhman 0001032407098 jakid rt 02 rw 03 43 th L
25 st rosita 0000638920001 pamengger rt 01 rw 01 3 th P
27 solikha 0000638156709 janegara rt 02 rw 01 42 th P
28 wati sastra 0000638231523 jakid rt 01 rw 03 35 th P
29 widya ayu l 0000637872456 jakid rt 03 rw 10 5 th P
31 alim m 0000638105758 tg wulung rt 05 rw 01 26 th L
32 haris 0000638937595 jakid rt 03 rw 01 35 th P
33 sri mulyani 0000637910864 jalor rt 08 rw 01 27 th P
34 m aulia 0000637911382 jalor rt 08 rw 01 4 th L
35 nazyah 0000637911099 jalor rt 08 rw 01 5 th P
37 rokhani 0000637565692 kr sembung rt 03 rw 08 40 th P
38 maripah 0000638841206 jakid rt 02 rw 01 42 th P 03-08-2013
40 sutati 0000638742892 km amba rt 04 rw 02 38 th P
41 rosidah 0000639251289 wn tawang rt 02 rw 04 60 th P
42 raffa 0000638538818 jalor rt 05 rw 05 5 th L
43 septi 0000638885328 jalor rt 06 rw 06 9 th P
45 latifah 0000637727883 dk maja rt 01 rw 03 30 th P
49 m adnan 0000639297696 kts yasa rt 06 rw 04 6 th L
52 retno 0000638747861 klampis rt 10 rw 04 2 th P
54 m saleh 0000638826687 jakid rt 02 rw 05 53 th L
58 musarofah 0000638357358 jakid rt 02 rw 06 50 th P 05-08-2013
59 m zaki 0000638360186 jakid rt 04 rw 02 6 th L
62 kartika 0000638240343 jakid rt 03 rw 10 12 th P
64 lutfi alman 0000637185993 jakid rt 04 rw 08 2 th L
66 ainur 0001032413163 jalor rt 06 rw 01 7 th P
67 umi magfiroh 0001032413164 jalor rt 06 rw 01 3 th P
69 egi 0000637136301 jakid rt 02 rw 09 7 th L
70 tiwi 0000637456262 kr sembung rt 01 rw 03 50 th P
72 ahmad 0000637934872 jalor rt 05 rw 05 4 th L
73 umi zaenab 0000637833566 jalor rt 05 rw 05 32 th P
74 darwinah 0000638971483 kl pucang rt 03 rw 01 31 th P
75 darmoyo 0000638970704 kl pucang rt 03 rw 01 46 th L
77 mumin 0000638901152 tembelang rt 05 rw 02 27 th L
78 dasri 0000638361393 kb nagung rt 04 rw 03 60 th P
80 taruni 0000637940864 jalor rt 03 rw 03 50 th P
84 hertiawati 0000638384323 kts yasa rt 06 rw 04 36 th P
85 muis 0000638396032 kts yasa rt 06 rw 04 16 th L
87 rohman 0001032405761 jakid rt 04 rw 03 40 th L
89 umrah 0000639107828 jakid rt 01 rw 07 30 th P 06-08-2013
91 rizal 0000638170626 jakid rt 04 rw 01 6 th L
93 taufik 0001032407321 jakid rt 02 rw 03 45 th L
94 tumirah 0000638979098 dk maja rt 01 rw 01 99 th P
96 rubin 0000638998457 klikiran rt 03 rw 03 45 th L
98 tarpiah 0001032419789 rg pendawa rt 03 rw 05 58 th P
108 tasuri 0000637807419 jakid rt 02 rw 08 60 th P
109 alip 0000638242983 jakid rt 04 rw 01 3 th L 07-08-2013
110 m agus 0000638293376 jakid rt 04 rw 01 10 th L
112 rayhan akbar 0000638946663 kts yasa rt 08 rw 04 3 th L
114 m taufik 0000638218993 jakid rt 01 rw 05 36 th L
117 novita sari 0001032400191 jalor rt 03 rw 02 22 th P
118 rahayu 0000638601459 sitanggal rt 06 rw 07 40 th P
119 st solikha 0000638193227 tg wulung rt 06 rw 01 23 th P
120 mashudi 0000639275488 jakid rt 04 rw 03 52 th L 10-08-2013
121 m saleh 0000638828887 jakid rt 02 rw 08 56 th L
123 sarifah 0000638348319 jakid rt 01 rw 05 3 th P
124 khalimah 0001032420389 kts yasa rt 01 rw 04 60 th P 12-08-2013
125 sri mulyati 0001032406784 jakid rt 01 rw 02 43 th P
129 mulyati 0000639256094 jalor rt 06 rw 05 9 th P
131 janatin 0000638256622 jalor rt 01 rw 05 57 th P
132 rodayah 0001032613879 jalor rt 08 rw 03 48 th P
136 kariah 0000637620063 kr sembung rt 05 rw 06 36 th P
138 mutmainah 0000638802068 km amba rt 01 rw 01 46 th P
140 taruni 0000637946864 jalor rt 03 rw 03 53 th P
141 rojah 0000638894432 jakid rt 02 rw 01 66 th P
142 kumirah 0001032415762 jalor rt 02 rw 02 58 th P
144 jamaludin 0000637964486 tg wulung rt 01 rw 01 30 th L
145 sainah 0000638633661 kendawa rt 06 rw 02 60 th P
146 ainur nafis 0001032413185 jalor rt 06 rw 01 7 th P 13-08-2013
148 ah taufik 0000637716521 kts yasa rt 01 rw 01 50 th L
150 fajar 0000638688453 dk maja rt 01 rw 03 4 th L
151 widia 0000632394117 rg pendawa rt 08 rw 03 5 th P
152 mafrikha 0001032405186 jakid rt 03 rw 04 53 th P
153 wati sastra 0000638231532 jakid rt 01 rw 03 35 th P
154 saadah 0000639276164 jakid rt 04 rw 03 45 th P
155 vivi sumantri 0001032412915 jalor rt 03 rw 02 32 th P
158 fian febriani 0000637896543 jakid rt 01 rw 02 6 th P
159 m asila 0000639110169 dk maja rt 03 rw 02 3 th L
160 wahyu anom 0001032415604 jalor rt 03 rw 01 5 th L
161 m oni 0000638261695 jalor rt 07 rw 03 15 th L
164 laura 0000638879968 dk maja rt 01 rw 03 7 th P 14-08-2013
166 eka s 0000638359086 wn cala rt 04 rw 02 12 th P
169 tutwuri bimas 0000637886452 jakid rt 01 rw 01 38 th P
170 mu'min 0000638690152 tembelang rt 15 rw 03 29 th L
171 nur wahid 0000638348218 dk maja rt 01 rw 01 25 th L
173 suijah 0000638878973 km amba rt 03 rw 02 50 th P
175 kholifah 0000639253427 janegara rt 03 rw 07 19 th P
176 toha farera 0000631251739 janegara rt 03 rw 07 50 th L
180 sulistia n 0000638288379 jakid rt 05 rw 05 16 th P
181 mulyati 0000638980918 dk maja rt 01 rw 01 52 th L
183 uripah 0000638894349 kts yasa rt 01 rw 01 32 th P
185 zahra m 0000639161537 kts yasa rt 07 rw 04 4 th P
186 tumirah 0000638659984 karanglo rt 19 rw 04 40 th P
187 ari dwi a 0000638661273 karanglo rt 18 rw 04 5 th L
189 evi lutfiani 0000637646804 jalor rt 02 rw 03 10 th P
190 yunika 0000638294242 km amba rt 02 rw 03 34 th P
191 kamah 0001032418372 pamengger rt 04 rw 01 65 th P 15-08-2013
192 tri nengsih 0001032418348 pamengger rt 04 rw 01 41 th P
194 brian fathir 0000639469585 klampis rt 02 rw 01 6 th L
195 popon r 0000637151398 jakid rt 05 rw 05 42 th P
198 roisah 0001032353976 songgom rt 03 rw 02 56 th P
200 aminah 0000638839282 jakid rt 02 rw 09 70 th P
203 karini 0000639284163 jakid rt 01 rw 02 43 th P
204 ardias diansyah 0000639286637 jakid rt 01 rw 03 3 th L
205 ah fakih 0000639181091 jakid rt 05 rw 05 13 th L
207 masruroh 0000637878802 jakid rt 01 rw 07 58 th P
208 citra dewi 0000639608051 janegara rt 01 rw 03 30 th P
209 riski s 0000639608477 janegara rt 01 rw 03 7 th L
211 darmali 0000637928212 jakid rt 02 rw 05 55 th L
213 umar f 0000638464983 klampis rt 03 rw 03 12 th L
215 st rokhani 0000638612019 janegara rt 03 rw 01 57 th P
216 khodijah 0000639238882 janegara rt 03 rw 01 57 th P
219 anisya 0000639022408 kr sembung rt 01 rw 05 14 th P
220 m roikhan 0000637518571 jakid rt 02 rw 09 13 th L
221 haryati 0000103240567 jakid rt 01 rw 01 36 th P
222 wartiah 0000638111979 jalor rt 01 rw 01 65 th P 16-08-2013
223 wasnuroh 0001032413905 jalor rt 05 rw 05 40 th P
224 m takurkhan 0000639029936 jakid rt 03 rw 08 10 th L
225 ah faesol 0000637969961 jalor rt 08 rw 01 19 th L
226 warja 0000638324998 jakid rt 03 rw 06 70 th P
228 selvia nurul 0000638755942 jakid rt 03 rw 10 3 th P
229 sairoh 0000637175463 jakid rt 02 rw 01 49 th P
231 muhasir 0000638547827 jalor rt 05 rw 04 70 th L
233 nur aeningsih 0000637958171 kr sembung rt 04 rw 01 35 th P
236 sarifah l 0000638348319 jakid rt 01 rw 03 3 th P
237 muntaripin 0000637883492 kts yasa rt 01 rw 03 50 th L
241 robiah 0000640133618 kl alang rt 01 rw 01 55 th P
242 m kaherul 0000637850362 dk maja rt 01 rw 01 5 th L
243 st rokhani 0000639138328 kts yasa rt 03 rw 02 48 th P
245 khaerul 0000637850362 dk maja rt 01 rw 01 15 th L
246 sutoyo 0000638247699 jakid rt 02 rw 02 54 th L
250 rohanah 0000637966768 jalor rt 02 rw 06 24 th P 19-08-2013
252 salsabila 0000637181619 jalor rt 05 rw 05 4 th P
254 m zamroni 0000637176368 jakid rt 03 rw 08 36 th L
257 nurita 0000638616384 pamengger rt 02 rw 01 2 th P
258 m nur ali 0000638316663 jakid rt 05 rw 05 8 th L
259 khasanah 0000639212378 tembelang rt 18 rw 03 60 th P
261 st solikha 0000638904942 tg wulung rt 06 rw 01 23 th P
263 taurah 0000639460822 klampis rt 04 rw 02 47 th P
264 kartono 0000639948663 klampis rt 04 rw 02 47 th L
265 nur awanah 0000639086094 jakid rt 03 rw 09 23 th P
266 fatimah 0001032407493 jakid rt 03 rw 07 58 th P
267 tarlinah 0000638320832 jakid rt 02 rw 05 80 th P
268 m imam 0000640034228 kl pucang rt 07 rw 07 17 th L
269 kabul 0000640083543 kl pucang rt 07 rw 07 47 th L
271 dwi sinta 0000637842699 jakid rt 01 rw 01 19 th P
274 magfiroh 0000638862220 klampis rt 10 rw 02 48 th P
275 maryatun 0000637270736 kr sembung rt 01 rw 04 28 th P
276 edi sudiyono 0000639036494 jakid rt 05 rw 05 50 th L 20-08-2013
277 solikul amri 0001032413159 jalor rt 03 rw 02 9 th L
278 aida 0001032413106 jalor rt 03 rw 02 44 th P
279 suleman 0001032413095 jalor rt 03 rw 02 47 th L
282 jabidin 0000638729324 jakid rt 03 rw 02 68 th L
283 slamet surakhman 0001032407098 jakid rt 02 rw 03 40 th L
284 turliyah 0000637500666 kr sembung rt 02 rw 02 70 th P
285 dumrotin 0000635207398 tg gandu rt 01 rw 07 45 th P
290 ana setia 0000638225919 kb nagung rt 09 rw 02 14 th P
292 dani maulana 0000638651406 jalor rt 04 rw 05 10 th L
293 nada khaerunisa 0000638651553 jalor rt 04 rw 05 3 th P
294 kuniroh 0001032415762 jalor rt 02 rw 02 58 th P
298 surtijah 0000637918852 jakid rt 02 rw 01 70 th P
302 khilu nur fadilah 0000638276714 kts yasa rt 02 rw 04 3 th P
303 mei yuniarti 0001032393824 kb gadung rt 05 rw 01 32 th P
306 gifan 0000638187381 dk maja rt 01 rw 01 12 th L 21-082013
308 st eli 0001032403206 jakid rt 03 rw 07 35 th P
309 hani s 0000639220252 dk maja rt 01 rw 01 29 th P
310 nurul 0000638191686 jakid rt 02 rw 03 20 th P
313 tumirah 0000638659711 karanglo rt 14 rw 04 40 th P
315 kanapi 0001032414838 jakid rt 05 rw 02 44 th L
316 konaah 0000637937133 kendawa rt 06 rw 01 40 th P
317 abd khanan 0000638956269 jakid rt 01 rw 05 47 th L
320 kabul 0000640083543 kl pucang rt 07 rw 02 50 th L
321 ujang m 0000638235516 jakid rt 01 rw 03 22 th L
323 khasanah 0000639212376 tembelang rt 16 rw 03 60 th P 22-08-2013
324 tasdikin 0000637566849 kb gadung rt 02 rw 03 46 th L
325 tuminah 0000638519163 km amba rt 04 rw 02 62 th P
326 raidi 0000637514774 kr sembung rt 04 rw 05 50 th L
327 wasih 0001032392316 dk maja rt 03 rw 03 40 th P
328 ragil 0001032313222 pamengger rt 02 rw 01 20 th L
329 rose kusuma 0000638194757 kb nagung rt 02 rw 03 11 th P
330 waimah 0000638166001 tg wulung rt 03 rw 02 58 th P
333 khurotul aeni 0000639049196 kr sembung rt 02 rw 03 10 th P
336 rosikin 0000638648426 jalor rt 06 rw 05 45 th P
342 laura 0000638687968 dk maja rt 08 rw 03 7 th P
344 nurhayati 0000635427178 tengguli rt 01 rw 04 28 th P 23-08-2013
346 karpi 0000638476176 pamengger rt 02 rw 04 75 th P
347 m irkhamna 0000639003352 kts yasa rt 07 rw 04 12 th L
348 maktub 0000639540933 janegara rt 09 rw 03 55 th L
353 sainah 0000637960909 wn cala rt 03 rw 03 50 th P
354 hartati 0000638147599 jakid rt 03 rw 10 39 th P
355 izah 0000591568143 kl alang rt 04 rw 09 50 th P
356 badrul labib 0000639230163 tembelang rt 15 rw 03 5 th L
357 karyati 0000639229735 tembelang rt 15 rw 03 35 th P
359 ridwan 0000637820609 kts yasa rt 07 rw 04 51 th L
360 tarhadi 0000638808269 klampis rt 09 rw 03 60 th L
363 jetun 0000638723519 km amba rt 02 rw 03 44 th P
364 ratini 0000638602222 karanglo rt 04 rw 10 73 th P 24-08-2013
365 abd ghoni 0000639619798 jakid rt 02 rw 01 13 th L
368 sapnah 0000639058698 karanglo rt 01 rw 01 47 th P
369 neng 0000637896014 jakid rt 01 rw 04 35 th P
370 karyati 0000639329736 tembelang rt 05 rw 01 23 th P
371 rokhim 0000638832868 jakid rt 03 rw 03 70 th L
372 maktub 0000639640933 janegara rt 03 rw 08 55 th L
373 nur leli 0001032407942 jakid rt 04 rw 01 26 th P
374 sumari 0000638813443 karanglo rt 04 rw 01 23 th L
375 marpuah 0000638313848 jt makmur rt 02 rw 01 28 th P
379 suhawiyono 0000637936569 kendawa rt 01 rw 01 48 th L
380 desi 0000638961783 jalor rt 02 rw 03 19 th P
381 riski s 0000637789231 kts yasa rt 03 rw 02 4 th L
382 wakyad 0000638363934 kl pucang rt 02 rw 03 81 th L
384 jumaiyah 0000637915296 kts yasa rt 07 rw 04 47 th P
385 sifa uljanah 0000638371484 kts yasa rt 02 rw 03 10 th P
386 nurilah 0000637734082 kts yasa rt 07 rw 04 42 th P
387 rokhim 0000638709029 jalor rt 03 rw 03 77 th L
388 intan 0000638709759 jakid rt 03 rw 01 11 th P
389 ratini 0000639227788 kl pucang rt 02 rw 05 41 th P
390 dwi wulan s 0000637652182 kts yasa rt 02 rw 02 3 th P
392 anisabatul 0000639348794 kts yasa rt 01 rw 04 7 th P
393 tuti riyanti 0000639347567 kts yasa rt 01 rw 04 38 th P
395 sanusi 0000638778947 dk maja rt 01 rw 02 27 th L
396 ratningsih 0000638312185 klampis rt 12 rw 04 40 th P
397 rastinah 0000637451965 bojong rt 13 rw 03 50 th P
400 efa 0000638201564 kb nagung rt 09 rw 02 12 th P
401 umar 0000638404962 jakid rt 02 rw 08 12 th L
403 supriyatin 0001032411611 tg wulung rt 08 rw 02 57 th P
404 wasri 0000638779601 km amba rt 02 rw 04 30 th P 27-08-2013
407 dinda 0000639121948 wn tawang rt 01 rw 08 9 th P
408 wahidin 0000637386063 kts yasa rt 02 rw 03 35 th L
409 yanuar 0000637396268 kts yasa rt 02 rw 03 8 th L
410 mudrikha 0001032409236 karanglo rt 15 rw 03 37 th P
412 sulistio 0000639396816 kts yasa rt 05 rw 02 11 th L
415 afita 0000638846278 pamengger rt 05 rw 04 9 th P
417 dumrotin 0000636207398 tg gandu rt 01 rw 07 53 th P
418 mamur r 0000637946569 jalor rt 02 rw 02 56 th L
419 ah azizi 0000637168442 jakid rt 03 rw 05 12 th L
421 saripin 0000638600196 jalor rt 02 rw 09 36 th L
422 castro 0000638722694 tembelang rt 08 rw 02 30 th L
423 ruminah 0000638318687 jakid rt 01 rw 03 72 th P
424 m ilmi 0000638476773 jalor rt 04 rw 05 10 th L
425 sri rejeki 0000637593603 jalor rt 05 rw 01 52 th P
426 rasto 0000639253984 kramat rt 04 rw 02 40 th L
427 heny 0000637896014 jakid rt 01 rw 02 30 th P
428 sri mulyati 0001032406784 jakid rt 01 rw 02 43 th P
429 wasih 0000638915769 jakid rt 03 rw 04 65 th P
432 jaenah 0000637928246 jalor rt 03 rw 02 51 th P
434 jihan 0000638361216 kts yasa rt 04 rw 03 4 th P
435 adka isma 0000638526081 kts yasa rt 04 rw 03 4 th P
436 kartini 0000637843814 dk maja rt 03 rw 02 60 th P
440 baenah 0000638186072 jakid rt 02 rw 03 60 th P
443 fajar 0000638686453 dk maja rt 01 rw 03 5 th L
445 m sahrul 0000638308882 jakid rt 04 rw 03 12 th L
448 hisam 0000637238418 kts yasa rt 01 rw 01 8 th L
449 kharidah 0001032407604 jakid rt 04 rw 01 58 th P
450 nur khotimah 0001032407696 jakid rt 04 rw 01 31 th P
451 fahrudin 0000638852567 jalor rt 06 rw 05 37 th L 28-08-2013
453 nayla 0000638260243 jalor rt 02 rw 05 8 th P
454 ah sauki 0000637639727 jalor rt 06 rw 03 68 th L
455 sehatun 0000639096423 jakid rt 02 rw 08 50 th P
460 sunanti 0000637304709 tg wulung rt 02 rw 01 62 th P
462 salsabila 0000639174989 janegara rt 01 rw 01 7 th P
463 siti 0000637946732 pamengger rt 01 rw 04 35 th P
465 ah taufik 0000637710621 jakid rt 01 rw 04 50 th L
467 waisah 0000638482226 kts yasa rt 01 rw 02 36 th P
468 windi 0000638483996 kts yasa rt 01 rw 02 7 th P
470 iskak 0000637682141 kts yasa rt 06 rw 04 36 th L
471 sanusi 0000637789947 dk maja rt 01 rw 01 27 th L
473 tika 0000637899047 kr sembung rt 02 rw 01 3 th P
474 sukimi 0000637699662 kr sembung rt 02 rw 01 32 th L
476 saobiroh 0000630820392 jakid rt 02 rw 04 27 th P
477 nadilatul 0000632872416 rg pendawa rt 01 rw 02 3 th P
478 nur leli 0000638733071 jakid rt 02 rw 05 24 th P
479 kasmi 0000639279204 jakid rt 02 rw 04 60 th P 29-08-2013
480 rosita 0000638920001 pamengger rt 01 rw 01 3 th P
481 wahyanto 0000637694396 jalor rt 01 rw 04 30 th L
483 mulyono 0000638140049 jalor rt 02 rw 02 38 th L
484 karyono 0000638328137 jakid rt 03 rw 04 41 th L
486 sunarti 0000630168807 pamengger rt 05 rw 02 42 th P
488 khadibah 0000638274745 km amba rt 02 rw 03 38 th P
489 faris 0000638274791 km amba rt 02 rw 03 12 th L
490 wahidah 0000638610208 tg wulung rt 02 rw 03 40 th P
492 agus 0000638687711 janegara rt 02 rw 01 37 th L
495 tahrul 0001032406122 jakid rt 02 rw 03 78 th L
499 fitri hamdani 0000638278519 jakid rt 07 rw 01 31 th P
503 riski s 0000638188402 kb nagung rt 09 rw 02 7 th L
504 sri hardiningsih 0000638188277 kb nagung rt 09 rw 02 30 th P
505 watni 0000637403240 jakid rt 04 rw 02 43 th P
506 aliya 0000637686783 jakid rt 04 rw 02 7 th P
507 imam bikari 0000637639369 jakid rt 02 rw 06 23 th L
508 junenah 0000639194804 janegara rt 06 rw 02 46 th P
509 rohaeni 0000638138224 kts yasa rt 03 rw 02 50 th P
510 wastam 0000638366137 jakid rt 01 rw 03 55 th L
511 sunaryo 0000639191301 jakid rt 01 rw 03 50 th L
512 talam 0000637271921 kr sembung rt 02 rw 05 60 th L
513 fatimah 0001032407493 jakid rt 03 rw 07 58 th P 30-08-2013
514 rousikha 0001032402723 jakid rt 01 rw 06 46 th P
515 mustainah 0000637689683 jakid rt 02 rw 01 41 th P
516 karnoyo 0000638433674 kts yasa rt 04 rw 01 70 th L
521 mulidah 0000638446432 kts yasa rt 02 rw 01 41 th P
523 dasri 0001032409430 karanglo rt 02 rw 10 65 th P
526 nani 0000637937728 kendawa rt 01 rw 01 20 th P
527 haryono 0000638398562 klampis rt 10 rw 02 44 th L
528 kusri 0000638310183 jalor rt 08 rw 01 60 th P
531 daffa f 0000638139317 jakid rt 01 rw 05 6 th L
537 wirso 0000638796903 km amba rt 01 rw 01 46 th L
539 khotmi 0001032412927 jalor rt 05 rw 06 51 th P
540 selvian 0000638786942 jakid rt 03 rw 10 3 th L
542 tarlinah 0000638326833 jakid rt 02 rw 04 85 th P
545 tayumi 0000639187448 dk maja rt 02 rw 03 62 th P
547 abdullah 0000631694476 sirampog rt 03 rw 03 28 th L
548 suhirah 0000637802131 jalor rt 01 rw 03 14 th P
550 faturohim 0000639060783 jakid rt 01 rw 05 48 th L 31-08-2013
552 aliya 0000638828494 jakid rt 02 rw 04 18 th P
553 tarso 0000632132921 rg pendawa rt 11 rw 03 62 th L
556 gono 0000638794877 pds lohor rt 15 rw 04 77 th L
558 lula artika 0000639105445 jakid rt 03 rw 06 11 th P
559 m rizki f 0000693819178 jakid rt 02 rw 01 9 th L
564 wahyudin 0000638178206 jakid rt 04 rw 01 10 th L
565 mar'uf 0000638743061 klampis rt 12 rw 04 49 th L
567 kasirah 0000637099031 jakid rt 06 rw 02 45 th P
568 sutiyah 0000637499204 kr sembung rt 03 rw 02 70 th P
569 sanudin 0000639181044 jakid rt 02 rw 10 60 th L
570 st rahaetun 0000638182438 jakid rt 02 rw 10 60 th P
571 tafrikhatun 0000632563502 rg pendawa rt 08 rw 02 18 th P
573 saimah 0000639116921 kts yasa rt 02 rw 04 46 th P
574 sairah 0000639013149 dk maja rt 05 rw 02 20 th P
576 wiji khaeriyah 0000638648471 jalor rt 06 rw 05 45 th P
577 ardias 0000639286637 jakid rt 02 rw 01 3 th L
579 ayu 0000639649562 janegara rt 01 rw 01 15 th P
580 torikoh 0000638211993 jalor rt 02 rw 05 17 th P
581 manirah 0000637660006 jalor rt 05 rw 02 40 th P
584 sri ikomawati 0000638227631 kts yasa rt 02 rw 01 34 th P
586 rustianah 0000638918302 pamengger rt 06 rw 01 39 th P
588 maria 0000637698744 jalor rt 09 rw 01 15 th P
590 nur lita 0000638233556 kb nagung rt 09 rw 02 3 th P
591 dinda 0000639188873 jakid rt 04 rw 02 7 th P
593 suyono 0001032402776 jakid rt 02 rw 03 60 th L
594 kasnari 0000638450891 kts yasa rt 03 rw 01 58 th L
595 aenur 0001032413186 jalor rt 06 rw 01 6 th P
596 wasriah 0000639297689 jakid rt 02 rw 09 50 th P
598 robiah 0000640133832 kl alang rt 01 rw 01 56 th P
599 yuliana 0000638837870 wn tawang rt 02 rw 01 20 th P
600 sokhanah 0000638319947 jakid rt 03 rw 10 50 th P
601 sudirah 0000638831121 klampis rt 10 rw 03 54 th P
603 ngatini 0001032413006 jalor rt 04 rw 02 55 th P
604 jaenudin 0000637893867 jalor rt 01 rw 04 51 th L
605 arum 0000638833307 jakid rt 02 rw 04 11 th P
606 rasbi 0000638488863 pamengger rt 08 rw 01 47 th L
607 tanirah 0000638920416 jalor rt 01 rw 05 42 th P
BULAN : AGUSTUS TAHUN : 2013

eserta Jamkesmas
Pelayanan Kes dan Besaran Tarif sesuai dengan PERDA (Rp) *)) TANDA
DIAGNOSA Pemeriksa TOTAL BIAYA TANGAN
Poli Umum Poli Gigi Poli KIA Tindakan PASIEN
an LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13) 15
pegel Rp 5,000
gatal Rp 5,000
pusing Rp 5,000
panas Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
bta Rp 5,000 Rp 4,500
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pulpitis Rp 5,000 Rp 12,750
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
kariesdentil Rp 5,000 Rp 27,500
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
persistensi Rp 5,000 Rp 8,250
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
radices Rp 5,000 Rp 11,750
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
bta Rp 5,000 Rp 4,500
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gingivitis Rp 5,000 Rp 11,750
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
gingivitis Rp 5,000 Rp 11,750
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
period Rp 5,000 Rp 12,750
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
panas Rp 5,000
bta Rp 5,000 Rp 4,500
batuk Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
flek Rp 5,000 Rp 12,750
batuk Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
gp period Rp 5,000 Rp 12,750
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
abses Rp 5,000 Rp 11,750
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
gds Rp 5,000 Rp 3,000
abses Rp 5,000 Rp 11,750
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
pegel Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
abses Rp 5,000 Rp 12,750
pegel Rp 5,000
panas Rp 5,000
gds Rp 5,000 Rp 3,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
abses Rp 5,000 Rp 23,500
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
abses Rp 5,000 Rp 11,750
gatal Rp 5,000
panas Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
gatal Rp 5,000
panas Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
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dl Rp 5,000 Rp 12,500
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gangren pulpa Rp 5,000 Rp 12,750
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abses Rp 5,000 Rp 11,750
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gds Rp 5,000 Rp 3,000
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pulpa polip 26 Rp 5,000 Rp 55,000
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KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA TANGGAL
(Thn) KUNJUNGAN
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6) (7)

1 nasir 0000638774873 rt rw th L 02-09-2013
2 saripah 0000638776347 rt rw th P
3 sukron 0000638776889 rt rw th L
4 puput amelia 0000638737813 rt rw th P
5 evi 0000638937786 rt rw th P
6 supriyadi 0000638842116 rt rw th L
7 solikha 0000638840764 rt rw th P
8 titin 0001032409761 rt rw th P
9 sunardi 0000638826017 rt rw th L
10 karinah 0000638167418 rt rw th P
11 edi sudiono 0000639036494 rt rw th L
12 wirati 0001032421678 rt rw th P
13 sumitri 0000638163879 rt rw th P
14 tarso 0000638132921 rt rw th L
15 nur wahid 0000638348218 rt rw th L
16 sobari 0000638348387 rt rw th L
17 hakim 0000638593786 rt rw th L
18 taufik 0000638846944 rt rw th L
19 samlawi 0000639087905 rt rw th L
20 tarpiah 0001031789768 rt rw th P
21 ah taufik 0000637716521 rt rw th L
22 tapsinah 0000638326833 rt rw th P
23 ropiah 0000637182167 rt rw th P
24 ade irawan 0000638321466 rt rw th L
25 umi kulsum 0000638281683 rt rw th P
26 muslim 0001032406073 rt rw th P 03-09-2013
27 ana musofa 0001032407921 rt rw th P
28 ah zaidan 0000637934572 rt rw th L
29 khotimah 0000638674487 rt rw th P
30 faridah 0000638798691 rt rw th P
31 rokhidin 0000637529117 rt rw th L
32 hamam 0000637840270 rt rw th L
33 zahra 0000637840607 rt rw th P
34 kotib 0000637889876 rt rw th L
35 emil baroyah 0000637864475 rt rw th P
36 muheti 0000637878871 rt rw th P
37 salimah 0000639179991 rt rw th P
38 zahra 0000639182838 rt rw th P
39 wartiah 0000638930305 rt rw th P
40 st rahayah 0000637101549 rt rw th P
41 st masitah 0000638076071 rt rw th P
42 riski 0000638076789 rt rw th L
43 nurohmah 0000638860373 rt rw th P
44 salha 0000639601199 rt rw th P
45 riski 0001032406762 rt rw th L
46 roisah 0001032406751 rt rw th P
47 khusnah 0000638826502 rt rw th P
48 rolah 0001032403331 rt rw th P
49 subur sumiati 0000639275679 rt rw th P 04-09-2013
50 m fahrizal 0000637939956 rt rw th L
51 wainah 0000639569981 rt rw th P
52 eka maulidia 0000639570813 rt rw th P
53 anzilir r 0000638894654 rt rw th P
54 rokhmah 0000637961725 rt rw th P
55 waah 0001032402767 rt rw th P
56 zaenal arifin 0000638230724 rt rw th L
57 ratini 0000638602222 rt rw th P
58 khomisah 0000639240377 rt rw th P
59 komariyah 0000638030496 rt rw th P
60 sutari 0000637358499 rt rw th P
61 suwarno 0000638596427 rt rw th L
62 reni dwi 0000637985079 rt rw th P
63 wati satra 0000638231523 rt rw th P
64 maryati 0000638920157 rt rw th P
65 rusikha 0001032402723 rt rw th P
66 eka rosiana 0000638444619 rt rw th P
67 m ardi 0000638241772 rt rw th L
68 sutarno 0000637515505 rt rw th L
69 siti kasri 0000637947066 rt rw th P
70 dairoh 0000638576436 rt rw th P
71 sodikin 0000633159369 rt rw th L
72 haris efendi 0000638937595 rt rw th L
73 slamet s 0001032407098 rt rw th L
74 nur cahyati 0000637933509 rt rw th P
75 tarodin 0000638802074 rt rw th L
76 nurjanah 0001032407321 rt rw th P
77 hertiawati 0000638394223 rt rw th P
78 tasdikin 0000637566849 rt rw th L 05-09-2013
79 raminah 0001032414581 rt rw th P
80 yuli antika 0000639287526 rt rw th P
81 waitah 0000638242356 rt rw th P
82 safitri 0000638914748 rt rw th P
83 marwadi 0000638842781 rt rw th L
84 sanusi 0000638778947 rt rw th L
85 sopiyah 0000638066316 rt rw th P
86 solikha 0000638523437 rt rw th P
87 m mahfud 0000638854536 rt rw th L
88 dimas 0000638944536 rt rw th L
89 wira astuti 0000637572519 rt rw th P
90 sunaryo 0000639151301 rt rw th L
91 kartini 0000638770961 rt rw th P
92 siti maslikha 0000638354596 rt rw th P
93 rizki abdullah 0000638840395 rt rw th L
94 m ainur rofiq 0000637628038 rt rw th L
95 daryati 0000637529782 rt rw th P
96 sobiroh 0000638820393 rt rw th P
97 nur laeli 0000637987105 rt rw th P
98 karomah 0000638343718 rt rw th P
99 rehan 0000638343854 rt rw th L
100 dahliana 0001032412274 rt rw th P
101 nuriyah 0000632519133 rt rw th P
102 nur intan 0000633180161 rt rw th P
103 m riski 0000638220323 rt rw th L 06-09-2013
104 sukar 0000638171651 rt rw th L
105 calem 0000638269986 rt rw th P
106 diah nur atika 0000639846356 rt rw th P
107 maryatun 0000637270736 rt rw th P
108 masruri 0000638118944 rt rw th L
109 vita 0000638261638 rt rw th P
110 susworo 0000638672624 rt rw th L
111 sri arum 0000638803267 rt rw th P
112 toriyah 0000638904864 rt rw th P
113 suparti 0000638306931 rt rw th P
114 dausri 0000638931194 rt rw th P
115 sofira 0000633160317 rt rw th P
116 khusnul khotimah 0001032403127 rt rw th P
117 nanda lutfiana 0001324103138 rt rw th P
118 kasripah 0000638034096 rt rw th P
119 waisah 0000638768395 rt rw th P
120 wadi 0000638486278 rt rw th L 07-09-2013
121 soleh 0001032421904 rt rw th L
122 tarmono 0000638112622 rt rw th L
123 solikha 0000638278864 rt rw th P
124 wakhidin 0000639526601 rt rw th L
125 umi maskanah 0000639526634 rt rw th P
126 toipah 0000638285938 rt rw th P
127 bunga sinta 0000638404604 rt rw th P
128 sanuri 0000638501826 rt rw th L
129 aliyah 0000638273856 rt rw th P
130 tuti ayati 0000638275961 rt rw th P
131 waitah 0000638242356 rt rw th P
132 umar farukhi 0000638464983 rt rw th L
133 m fahrizal 0000637939956 rt rw th L
134 saripah lutfi rt rw th P
135 nasir haryono rt rw th L
136 sazkiyah rt rw th P
137 masriah rt rw th P
138 marpuah rt rw th P
139 sriyati rt rw th P
140 zahra maulidina rt rw th P
141 sarah rt rw th P
142 suaeni rt rw th P
143 kholifatul azizah rt rw th P
144 feby ayu t rt rw th P
145 susmarni rt rw th P
146 ainun wulandari rt rw th P
147 maftukhi rt rw th L
148 aminah rt rw th P
149 sopuroh rt rw th P
150 moh roikhan rt rw th L
151 siti rt rw th P
152 warti rt rw th P
153 ah taufik rt rw th L
154 siska rt rw th P
155 sobri rt rw th L
156 daimah rt rw th P 09-09-2013
157 sumarno rt rw th L
158 dwi sandi rt rw th L
159 rusbad rt rw th L
160 mulyani rt rw th P
161 ayunda rt rw th P
162 taripah rt rw th P
163 fajar budi rt rw th L
164 sudiarti rt rw th P
165 tanuri rt rw th L
166 toipah rt rw th P
167 sumitri rt rw th P
168 kasdum rt rw th L
169 wartiah rt rw th P
170 dairah rt rw th P
171 aedo purnawan rt rw th L
172 mabruroh rt rw th P
173 tri ningsih rt rw th P
174 ah ziadan rt rw th L
175 sutiah rt rw th P
176 wakhidah rt rw th P
177 kayusuf maulana rt rw th L
178 putri sinar aulia rt rw th P
179 sri rejeki rt rw th P
180 abdilah rt rw th L
181 khotimah rt rw th P
182 tauroh rt rw th P
183 sri mola rt rw th P
184 tamin rt rw th L
185 indah p rt rw th P
186 sazkiyah rt rw th P
187 soimah rt rw th P
188 m mahfud rt rw th L
189 solikha rt rw th P
190 thoimah rt rw th P 10-09-2013
191 rohani rt rw th P
192 yanuar rt rw th L
193 suriyah rt rw th P
194 tauroh rt rw th P
195 nur aeni rt rw th P
196 abd rohim rt rw th L
197 sarmid rt rw th L
199 sutar rt rw th L
200 dwi resti rt rw th P
201 sukyadi rt rw th L
202 retno rt rw th P
203 mundahir rt rw th L
204 wasripah rt rw th P
205 m riski rt rw th L
206 riska rt rw th P
207 karinah rt rw th P
208 sumitri rt rw th P
209 sutarno rt rw th L
210 tupiah rt rw th P
211 suidah rt rw th P
212 st khaerunisa rt rw th P
213 fani rt rw th P
214 sakup rt rw th L
215 sumiati rt rw th P
216 slamet s rt rw th L 11-09-2013
217 warsiti rt rw th P
218 ramlah rt rw th P
219 salamah rt rw th P
220 sainah rt rw th P
221 tahri rt rw th L
222 munaim rt rw th L
223 st eli rt rw th P
224 dasan rt rw th L
225 raidah rt rw th P
226 kurotun ayumi rt rw th P
227 ropiah rt rw th P
228 kartika dwi rt rw th P
229 abu bakar rt rw th L
230 warsan rt rw th L
231 m fajrul falah rt rw th L
232 taufik rt rw th L
233 roidah rt rw th P
234 m syarifudin rt rw th L
235 fitriyanti rt rw th P
236 rohani rt rw th P
237 suhadi rt rw th L 12-09-2013
238 yanuar rt rw th L
239 cayi rt rw th P
240 jarudin rt rw th L
241 suratmi rt rw th P
242 alfan rt rw th L
243 ratini rt rw th P
244 sulastri rt rw th P
245 ah sandi rt rw th L
247 kokom rt rw th P
249 rokhilah rt rw th P
250 fuad rt rw th L
251 sumarni rt rw th P
252 enin melani rt rw th P
253 sopuroh rt rw th P
254 susanti rt rw th P 13-09-2013
255 kartini rt rw th P
256 tarminah rt rw th P
257 astriyani rt rw th P
258 khojiyah rt rw th P
259 drajat rt rw th L
260 turiyah rt rw th P
261 tobaroh rt rw th P
262 urip rt rw th L
263 musrifah rt rw th P
264 desi rahmawati rt rw th P
265 sodikin rt rw th L
267 st alwiyah rt rw th P
268 darningsih rt rw th P
269 kasirah rt rw th P
270 nur ayati rt rw th P
271 qonita rt rw th P
272 kasri rt rw th P
273 alia rt rw th P
274 nasikhin rt rw th L 14-09-2013
275 raan rt rw th L
276 durpi rt rw th P
277 m isfah rt rw th L
278 wiyati rt rw th P
279 nur afiatun rt rw th P
280 rizal rt rw th L
282 kartono rt rw th L
283 salimah rt rw th P
284 sutanah rt rw th P
285 musakiroh rt rw th P
286 khaerul rt rw th L
287 zulfa rt rw th P
288 ah taufik rt rw th L
289 wira astuti rt rw th P
290 ah syarif rt rw th L
291 riame rt rw th P
292 st rahayu rt rw th P
293 tursinah rt rw th P
294 rusbad rt rw th L
295 saman rt rw th L 16-09-2013
296 bela diana rt rw th P
297 kokom rt rw th P
298 intan rt rw th P
299 nastuti rt rw th P
300 tarnyu rt rw th P
301 warsiti rt rw th P
302 eka rt rw th P
303 sutinah rt rw th P
304 rukayah rt rw th P
305 giar erma rt rw th P
306 khodijah rt rw th P
307 marah rt rw th P
308 urip rt rw th L
309 maftub rt rw th L
310 marfuah rt rw th P
311 lukman rt rw th L
312 surtijah rt rw th P
313 krisnawati rt rw th P
314 rio irawan rt rw th L 17-09-2013
316 haerwati rt rw th P
317 rodiyah rt rw th P
318 faridah rt rw th P
319 umi ulfah rt rw th P
320 suleman rt rw th L
321 mudrikha rt rw th P
322 roidah rt rw th P
323 solekha rt rw th P
324 m ilham amrullah rt rw th L
325 wirnaningsih rt rw th P
326 sunarko rt rw th L
327 herlina rt rw th P
328 st maryam rt rw th P
329 nur hayati rt rw th P
330 sanidah rt rw th P
331 makrus rt rw th L
332 sinta maharani rt rw th P
333 titin rt rw th P
334 rolah rt rw th P
335 khunaenah rt rw th P
336 m fadil rt rw th L
337 m ikbal rt rw th L
338 jamaludin rt rw th L
339 musakirah rt rw th P
340 kasirah rt rw th P
341 sucahyo rt rw th L
342 rokhanah rt rw th P
343 subekhi rt rw th L
344 sopan rt rw th L
345 sri nuraeni rt rw th P
346 samlawi rt rw th L
348 lili kholifah rt rw th P
349 mafrica rt rw th P
350 riski aulia maskur rt rw th L 18-09-2013
351 riskika ameliani rt rw th P
352 kusnah rt rw th P
353 rainah rt rw th P
354 st rohani rt rw th P
355 slamet rt rw th L
357 sobirin rt rw th L
358 jawawi rt rw th L
359 suirah rt rw th P
360 arum setyo rt rw th P
361 tawan rt rw th L
362 slamet s rt rw th P
363 suniti rt rw th P
364 sami maulana rt rw th L
365 isyri nafisah rt rw th P
366 desi rahmawati rt rw th P
367 fatkhurrohman rt rw th L
368 karyati rt rw th P
369 maulana bayu rt rw th L
370 tarodin rt rw th L
371 soripah rt rw th P 19-09-2013
372 sopiyah rt rw th P
373 amir rt rw th L
374 rosidi rt rw th L
375 nasipah rt rw th P
376 ramini rt rw th P
377 rizal mulyadi rt rw th L
378 tahri rt rw th L
379 kunyati rt rw th P
380 calon rt rw th L
381 rafan nabig rt rw th L
382 septi lisa rt rw th P
383 waitah rt rw th P
384 jenal arifin rt rw th L
385 teguh santoso rt rw th L
386 sarinah rt rw th P
387 maskuri rt rw th L
389 a efendi rt rw th L
390 suaeni rt rw th P
391 umar farukhi rt rw th L
392 tanuri rt rw th L
394 yunika elawati rt rw th P
395 taruno rt rw th L
396 mulyono rt rw th L
397 nurwati rt rw th 20-09-2013
398 ardias rt rw th
399 rohani rt rw th
400 popon rt rw th
401 wajran rt rw th
402 sukirah rt rw th
403 umayah rt rw th
404 faturohim rt rw th
405 sopuroh rt rw th
406 waitah rt rw th
407 aminah rt rw th
408 aisah rt rw th
409 fifi rt rw th
410 salimah rt rw th
411 aji rt rw th
412 putri rt rw th
413 rositah rt rw th
414 m adnan basit rt rw th
415 ah riski rt rw th
416 suriyah rt rw th
417 khojanah rt rw th
418 farhatun rt rw th
419 arif basuki rt rw th
420 ah zizi fadilah rt rw th 21-09-2013
421 dewi sriyanti rt rw th
422 reza adi rt rw th
423 rusbad rt rw th
424 sopiyah rt rw th
425 m rifki rt rw th
426 nurul hikmah rt rw th
427 suwali rt rw th
428 kartini rt rw th
429 slamet jawawi rt rw th
430 dimas wildan rt rw th
431 khaerudin rt rw th
432 warsan rt rw th
433 ropii rt rw th
434 taipah rt rw th
435 kasmi rt rw th
436 maslikha rt rw th
437 roidah rt rw th
438 putri amalia rt rw th
439 hentin k rt rw th
440 m soleh rt rw th
441 maesaroh rt rw th
442 fikri rt rw th
443 salamah rt rw th 23-09-2013
444 sutinah rt rw th
445 nur fitriyah rt rw th
446 kholidah rt rw th
447 nurjanah rt rw th
448 m rehan rt rw th
449 dandi setiadi rt rw th
450 st eli assidah rt rw th
451 andini aulia rt rw th
452 seger rt rw th
453 ramlah rt rw th
454 lisa ayu nabila rt rw th
455 st nur hikmah rt rw th
456 nasroh rt rw th
457 m riski rt rw th
458 maani rt rw th
459 khoridah rt rw th
460 nur khotimah rt rw th
461 rohmat rt rw th
462 jamilah rt rw th
463 musyati rt rw th
464 suirah rt rw th
465 efendi rt rw th
466 natuti rt rw th
467 tarnyu rt rw th
468 waryati rt rw th
469 kurdi rt rw th
470 toto rt rw th
471 sodikin rt rw th
472 elya yuliana rt rw th
473 sumiati rt rw th
474 rizka rt rw th
475 devi rt rw th
476 wasem rt rw th
477 anton rt rw th
478 sukar rt rw th
479 ropiah rt rw th
480 henu rt rw th
481 lili rt rw th
482 wasni rt rw th
483 nuryati rt rw th
484 khusnah rt rw th
485 rahayu s rt rw th
486 lutfiyah rt rw th
487 nur solikha rt rw th
488 laela rofiqoh rt rw th
489 slamet rt rw th 24-096-2013
490 fina febriani rt rw th
491 agus kunandar rt rw th
492 rt rw th
493 rt rw th
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BULAN : SEPTEMBER TAHUN : 2013

eserta Jamkesmas
Pelayanan Kes dan Besaran Tarif sesuai dengan PERDA (Rp) *)) TANDA
DIAGNOSA Pemeriksa TOTAL BIAYA TANGAN
Poli Umum Poli Gigi Poli KIA Tindakan PASIEN
an LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13) 15
DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESM

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA TANGGAL
(Thn) KUNJUNGAN
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6) (7)

1 sopuroh 0001032614039 jalor rt 07 rw 05 37 th P 01-10-2013
2 kasripah 0000638574886 kr sembung rt 01 rw 04 39 th P
3 soleha 0000638627887 songgom rt 01 rw 02 39 th P
5 muhajir 0000639680937 dk maja rt 02 rw 04 67 th L
6 dwi rifki 0000638076789 jalor rt 04 rw 08 4 th L
8 sukarto 0001032412236 jalor rt 01 rw 02 49 th L
12 sabarudin 0000638178638 kramat rt 07 rw 03 32 th L
14 cindi 0000637716317 songgom rt 01 rw 01 9 th P
15 dimas abdul 0000637716464 songgom rt 01 rw 01 6 th L
16 warisah 0000637714369 songgom rt 01 rw 01 42 th P
20 roati 0000638572634 kb nagung rt 07 rw 01 30 th P
21 nurhikmah 0000638316494 jakid rt 05 rw 05 17 th P
23 m fatih 0000638176373 jakid rt 03 rw 06 8 th L
25 mutiara 0000637668019 kb gadung rt 02 rw 03 5 th P
26 tubagus fahmi 0001032407122 jakid rt 02 rw 03 5 th L
27 misfah 0000638612012 jalor rt 01 rw 02 16 th P
28 m rohman 0000638981852 pamengger rt 04 rw 01 8 th L
30 gilang 0000632618392 rg pendawa rt 09 rw 03 8 th L
32 nurkhotimah 0001032407696 jakid rt 04 rw 01 50 th P
35 robiah 0000640133019 kl pucang rt 01 rw 01 60 th P
38 warningsih 0000638220969 jakid rt 01 rw 02 50 th P
39 khusnah 0000638826502 jakid rt 02 rw 06 52 th P
41 mario 0000638147092 kb nagung rt 05 rw 01 45 th L 02-10-2013
42 irma lestari 0000638967485 karanglo rt 04 rw 01 11 th P
44 tarini 0000638522908 karanglo rt 04 rw 01 50 th P
46 darmo 0000638319846 jakid rt 03 rw 10 55 th L
47 dwi wulan 0000637662182 jakid rt 02 rw 01 3 th P
51 roheti 0000638258837 jakid rt 07 rw 03 45 th P
53 nurwandi 0000639266138 kl pucang rt 07 rw 04 41 th L
54 tanisah 0000638430445 tembelang rt 06 rw 02 60 th P
57 andika 0001032405254 jakid rt 03 rw 03 8 th L
59 syahkia 0000638778334 wn cala rt 03 rw 03 5 th P
61 warti 0001032489936 km amba rt 04 rw 02 37 th P
62 kharisma 0000638877903 tembelang rt 17 rw 03 3 th P
64 salma nabila 0000638614168 karanglo rt 04 rw 01 2 th P
70 dewi ratna 0000637191167 jt rokeh rt 03 rw 01 8 th P
75 uswatun kh 0000638689368 jalor rt 02 rw 06 30 th P
76 fathan 0000639002417 pamengger rt 06 rw 01 6 th L
78 mufrodi 0000638782053 jalor rt 01 rw 02 70 th L
80 warningsih 0000638343268 kl pucang rt 04 rw 01 52 th P
81 sandi 0000637958351 kr sembung rt 04 rw 01 6 th L 03-10-2013
82 khotimah 0000638574467 kb nagung rt 08 rw 02 43 th P
83 anggi saraswati 0000639254777 tembelang rt 12 rw 02 15 th P
87 nur atikoh 0000639046368 km amba rt 04 rw 02 6 th P
88 slamet 0000638611916 kr sembung rt 03 rw 03 60 th L
90 waesah 0000636714141 jakid rt 01 rw 09 34 th P
92 ismaun 0000637904924 tg wulung rt 02 rw 01 62 th P
93 wasud 0000637494541 tembelang rt 08 rw 03 38 th L
96 m rifki 0000637662159 kr sembung rt 02 rw 01 6 th L
98 sri harsih 0000638747032 jakid rt 04 rw 05 40 th P
99 sukaeri 0000639309778 jakid rt 04 rw 05 50 th P
101 dewi kurnia 0000638708736 klampis rt 09 rw 03 17 th P
103 asikin 0001032391135 kr sembung rt 02 rw 01 55 th L
104 musyati 0000637950982 kts yasa rt 05 rw 02 50 th P
105 sulastri 0000639174341 wn tawang rt 02 rw 03 35 th P
106 toto raharjo 0000636871342 wn cala rt 07 rw 03 46 th L
107 ulfiyah 0000639076836 jakid rt 05 rw 08 33 th P
109 moh zenal 0000638294589 km amba rt 04 rw 02 30 th L
110 muhajir 0000639580937 dk maja rt 02 rw 05 58 th L
113 karmuah 0000638002289 klampis rt 06 rw 02 45 th P 04-10-2013
115 jamroh 0000639113418 kts yasa rt 01 rw 04 42 th P
116 darsripah 0000638638678 kr sembung rt 03 rw 08 52 th P
117 warno 0000632263332 rg pendawa rt 02 rw 08 50 th L
121 putri amelia 0000638138031 dk maja rt 04 rw 07 7 th P
122 hentin k 0000638638836 kr sembung rt 07 rw 01 28 th P
123 yatin 0000632564019 rg pendawa rt 02 rw 02 36 th P
126 kuryoto 0000638243189 dk maja rt 04 rw 02 62 th P
128 st khotayah 0000637841249 dk maja rt 08 rw 05 12 th P
129 sukwad 0000637900366 jalor rt 02 rw 08 70 th L
130 muhiroh 0000637183991 jakid rt 04 rw 05 52 th P
133 joni 0000638153403 km amba rt 01 rw 01 7 th L
134 desi salsa 0000638730314 dk maja rt 06 rw 05 10 th P
138 rifsa n 0000637881412 kts yasa rt 04 rw 03 6 th P
139 falalia n 0000637860521 jalor rt 02 rw 01 16 th P
140 munayah 0000638740642 jakid rt 01 rw 02 65 th P 05-10-2013
141 m yusup 0000638820238 kb nagung rt 07 rw 01 13 th L
143 muryati 0000638189373 km amba rt 04 rw 02 43 th P
144 wasih 0000638916769 jakid rt 03 rw 04 66 th P
145 putri nursifa 0000638932544 jakid rt 02 rw 05 21 th P
146 andriansyah 0000637725622 kr sembung rt 03 rw 02 6 th L
147 ropii 0000638476299 jalor rt 04 rw 05 39 th L
149 tarkim 0000638446284 klampis rt 12 rw 04 45 th L
150 washadi 0000638531156 km amba rt 02 rw 01 71 th L
151 nur khotimah 0001032407695 jakid rt 04 rw 01 31 th P
152 khoridah 0001032407684 jakid rt 04 rw 01 58 th P
155 arif basuki 0000638749629 jakid rt 05 rw 05 27 th L
158 sriyati 0000638276141 jakid rt 02 rw 06 35 th P
159 waris efendi 0000638937696 jakid rt 05 rw 08 34 th L
160 wasih 0001032417213 pamengger rt 08 rw 01 30 th P
163 cindi 0000637716317 dk maja rt 01 rw 01 9 th P
164 suhibi 0000637692669 kts yasa rt 03 rw 01 35 th L
165 dhinu fatir 0000638412873 dk maja rt 01 rw 01 4 th L 07-10-2013
166 akbar maulana 0000638667828 karanglo rt 04 rw 09 4 th L
167 wastiah 0000637136257 jagalempeni rt 02 rw 01 53 th P
168 abd rohman 0000638200069 jakid rt 02 rw 03 43 th L
171 sumardi 0000638779612 dk maja rt 01 rw 02 31 th L
172 soliha 0000639178546 karanglo rt 04 rw 01 36 th P
173 kasri 0000638682724 tg wulung rt 01 rw 02 37 th P
176 aris 0000639171314 wn cala rt 04 rw 01 4 th L
179 ulpah 0000638349309 dk maja rt 02 rw 02 23 th P
181 nunung 0000638618964 jakid rt 05 rw 06 36 th P
185 rosikhin 0000637677306 kts yasa rt 05 rw 04 40 th L
186 solikhin 0000638349356 songgom rt 01 rw 04 37 th L
187 suhari 0000638171693 tg wulung rt 19 rw 04 50 th L
189 kasmuri 0000638267184 jakid rt 03 rw 08 70 th L
193 sulastri 0000638471316 rg bandung rt 03 rw 03 50 th P
197 triyana pradewi 0000638522684 kts yasa rt 01 rw 03 25 th P
200 dinda ayu f 0000639168873 jakid rt 04 rw 02 7 th P
201 gesa ayu 0000638164675 karanglo rt 02 rw 01 2 th P
202 muhajir 0000639680037 karanglo rt 05 rw 02 60 th L
203 trisnawati 0000638935191 jakid rt 03 rw 08 50 th P
205 juriyah 0000638716228 dk maja rt 04 rw 02 51 th P
206 santi 0000639063472 jakid rt 02 rw 04 41 th P
207 damad 0000639073236 jakid rt 04 rw 03 70 th L
208 st kusnaeni 0000638437522 tembelang rt 05 rw 01 29 th P
210 khaerul muzaki 0000637509554 jt rokeh rt 01 rw 02 5 th L
211 kinanah 0000637508294 jt rokeh rt 01 rw 02 40 th P
212 nela ayu n 0000637456342 bojong rt 12 rw 03 21 th P
213 sairoh 0000639013148 dk maja rt 05 rw 02 40 th P
216 sutirah 0000637762818 jakid rt 02 rw 04 66 th P 08-10-2013
217 waeroh 0000626811143 glonggong rt 04 rw 02 50 th P
220 st sutinah 0000638181977 jakid rt 02 rw 10 62 th P
222 indah wati 0000638946116 tembelang rt 08 rw 02 30 th P
224 arif basuki 0000639116964 jakid rt 04 rw 06 21 th L
225 rosikhin 0000637677303 kts yasa rt 04 rw 05 43 th L
226 tuyem 0000638111606 jakid rt 05 rw 05 38 th P
228 tiwi 0000637466262 kr sembung rt 01 rw 03 50 th P
230 wage 0000637156480 jakid rt 03 rw 10 70 th L
231 wasriah 0000638944410 jakid rt 02 rw 12 38 th P
234 ibnu irwanto 0000638929326 kramat rt 11 rw 08 9 th L
235 jarukhi 0000638927430 kramat rt 11 rw 08 40 th L
238 ibadah 0000637941296 kts yasa rt 06 rw 01 70 th P 09-10-2013
239 maulana 0000635427347 tengguli rt 01 rw 04 6 th L
240 elsa 0000638775816 km amba rt 01 rw 01 5 th P
241 sumari 0000638770612 dk maja rt 01 rw 03 21 th L
242 warno 0000632633329 rg bandung rt 04 rw 02 50 th L
243 tarisah 0000638169766 tg wulung rt 02 rw 03 53 th P
245 yatin 0000632564019 rg pendawa rt 02 rw 02 35 th L
248 sopiyah 0000638658775 tembelang rt 11 rw 02 40 th P
249 soliha 0000637663701 kr sembung rt 03 rw 02 41 th P
250 sumarti 0000638779612 cenang rt 08 rw 02 21 th P
251 aminah 0000638006116 jalor rt 07 rw 01 36 th P
252 mashuri 0000639286255 kts yasa rt 06 rw 04 40 th L
253 riski maulana 0000637681239 kts yasa rt 06 rw 04 4 th L
257 laelatul 0000638311451 jakid rt 05 rw 05 5 th P
258 fadiyah 0000638246017 jakid rt 02 rw 04 21 th P
259 komariyah 0000632076377 rg pendawa rt 11 rw 02 30 th P 10-10-2013
260 riyan 0000639064268 dk maja rt 05 rw 07 8 th L
261 sarti 0000639906962 dk maja rt 05 rw 07 30 th P
263 maryam 0000639180991 jakid rt 03 rw 03 70 th P
264 amanda 0000637696826 jalor rt 06 rw 01 5 th P
265 arifiyan 0000639115964 jakid rt 04 rw 05 21 th L
266 sujono 0001032402778 jakid rt 02 rw 03 65 th L
267 qonita 0000638339196 dk maja rt 01 rw 01 3 th P
270 raniti 0000638487279 tembelang rt 07 rw 02 32 th P
271 turah 0001032401664 km amba rt 01 rw 01 60 th P
272 masitoh 0000639639649 tembelang rt 04 rw 01 45 th P
275 setiowati 0000638799749 km amba rt 04 rw 02 32 th P
278 kasan 0000639002417 pamengger rt 06 rw 01 60 th L
283 daimah 0000638786749 jakid rt 04 rw 01 45 th P
284 prinawati 0000638896867 kts yasa rt 05 rw 01 37 th P
285 abdilah 0000638078787 jakid rt 03 rw 06 56 th L
286 nurharudin 0000638244189 jalor rt 08 rw 05 35 th L
287 sutono 0000638616729 jalor rt 02 rw 02 44 th L
288 karsun 0000638979827 pamengger rt 04 rw 01 66 th L
291 st masruroh 0000638989546 pamengger rt 01 rw 03 30 th P
293 fungki 0000637621999 songgom rt 03 rw 02 13 th L
294 gunawan 0000638463269 tembelang rt 02 rw 01 9 th L
295 fariyah 0000638729631 klampis rt 01 rw 01 44 th P
301 kuryoto 0000638243189 dk maja rt 04 rw 02 62 th L
302 ah rosikhin 0000637815987 jakid rt 02 rw 02 52 th L
303 ruidah 0001032391743 dk maja rt 02 rw 04 55 th P
304 fuji 0001032351954 dk maja rt 02 rw 04 20 th P
305 tarsih 0000638251795 jakid rt 02 rw 04 50 th P
306 tursinah 0001032404973 jakid rt 01 rw 02 60 th P
308 rifki 0000636749901 jt rokeh rt 01 rw 03 4 th L
309 koanah 0000637937133 kendawa rt 05 rw 01 40 th P
311 sarudin 0001032414401 jalor rt 09 rw 01 56 th L
313 riski maulidiana 0000638842623 jakid rt 02 rw 09 12 th L 12-10-2013
314 marinah 0001032408868 jakid rt 04 rw 02 60 th P
321 riskiyanah 0000638887509 kr sembung rt 03 rw 05 9 th P
324 tariah 0000638994868 kts yasa rt 07 rw 04 60 th P
326 watni 0000638786481 jakid rt 04 rw 09 43 th P
327 ramini 0000638416046 dk maja rt 03 rw 03 47 th P
328 umayah 0000637786061 cenang rt 03 rw 02 46 th P
329 sunarti 0000637318193 songgom rt 04 rw 02 40 th P
330 sakilah 0000636523112 bojong rt 11 rw 03 55 th P
333 widia ayu 0000637872456 jakid rt 03 rw 10 5 th P
339 wahyu anom 0001032415604 jalor rt 05 rw 01 3 th L
340 winda 0000638251828 jakid rt 02 rw 04 23 th P
341 dimas andrian 0000638825499 jakid rt 03 rw 01 9 th L
342 m jaiz fikri 0000638752241 pamengger rt 08 rw 02 8 th L
343 irmania 0000638359806 jakid rt 05 rw 08 14 th P
346 khotimah 0000638574467 kb nagung rt 08 rw 02 43 th P 14-10-2013
348 resti restiana 0000638489316 dk maja rt 02 rw 06 10 th P
352 muji irawan 0000638615324 jakid rt 04 rw 03 11 th L
353 mafrikha 0000638314075 jakid rt 04 rw 03 50 th P
354 samroh 0001032355787 geger kunci rt 08 rw 04 33 th P
355 titn 0001032407741 jakid rt 03 rw 02 47 th P
358 sugeng a 0000638283262 karanglo rt 08 rw 02 22 th P
359 khodijah 0000638521108 songgom rt 01 rw 04 30 th P
360 solikhin 0000638349355 jakid rt 02 rw 09 34 th L
362 m dino 0001032403061 jakid rt 03 rw 10 5 th L
363 m rafi 0000637679542 kts yasa rt 05 rw 04 6 th L
364 sutono 0000638616723 jalor rt 02 rw 02 44 th L
365 ainiur nafisah 0001032413185 jalor rt 06 rw 01 7 th P
367 m imron 0000639571961 janegara rt 06 rw 07 34 th L
372 haryati 0001032405647 jakid rt 01 rw 01 36 th P
373 sri esti 0000638738739 klampis rt 04 rw 02 40 th P
374 afif setia budi 0000638740282 klampis rt 04 rw 02 19 th L
376 rokhanah 0000639302218 jakid rt 03 rw 10 45 th P
377 tasripah 0000638694314 karanglo rt 15 rw 03 65 th P 16-10-2013
379 tohari 0000637899467 jalor rt 03 rw 05 39 th L
380 khoriah 0000637899513 jalor rt 03 rw 05 39 th P
382 riskika amelia 0000637118987 jakid rt 02 rw 03 8 th P
384 zulfah 0000637995339 jalor rt 07 rw 03 2 th P
385 sri hayati 0000638345147 klampis rt 03 rw 01 25 th P
386 musfirotunnisa 0000638345395 klampis rt 03 rw 01 8 th P
387 fina febriani 0000637896543 jakid rt 01 rw 02 6 th P
388 heni 0000637896014 jakid rt 01 rw 02 35 th P
389 esti purwanti 0000639390475 karanglo rt 02 rw 09 16 th P
391 sri nuraeni 0001032423173 bojong rt 02 rw 01 32 th P
393 ah afis 0000638809391 jalor rt 02 rw 04 18 th L
394 soliha 0000638071861 jakid rt 02 rw 05 43 th P
395 khaerul azmi 0000639291813 jakid rt 02 rw 05 11 th L
396 ah subekhi 0000639290946 jakid rt 02 rw 01 13 th L
398 musrifah 0000637275554 kr sembung rt 02 rw 05 32 th P
399 amriti 0001032400606 klampis rt 13 rw 04 30 th P
400 witri 0000638755402 km amba rt 04 rw 02 35 th P
402 alif 0000638921711 jakid rt 06 rw 02 7 th L
403 siska fitriani 0000638119476 janegara rt 01 rw 01 20 th P
405 rositah 0000637453844 kr sembung rt 01 rw 01 23 th P
406 arif 0000639116964 jakid rt 04 rw 06 21 th L
407 rohanah 0000637975976 kr sembung rt 04 rw 06 40 th P
408 a alwi 0000637978875 kr sembung rt 03 rw 05 3 th P
409 urip 0000638383376 jakid rt 04 rw 06 9 th L
413 kasdum 0000637130226 jakid rt 03 rw 04 80 th L 17-10-2013
416 moh jafar 0000638466652 dk maja rt 01 rw 07 6 th L
417 tarimah 0000639022239 dk maja rt 01 rw 07 39 th P
418 efi nuryani 0000639024928 dk maja rt 01 rw 07 8 th P
419 eva nuryanah 0000639024851 dk maja rt 01 rw 07 8 th P
420 maryamah 0001032392305 dk maja rt 02 rw 06 40 th P
421 nurwati 0000638297829 karanglo rt 19 rw 04 28 th P
422 warkinah 0001031792815 rg pendawa rt 02 rw 02 40 th P
425 fikih apriyanto 0000639146305 jakid rt 04 rw 06 13 th L
432 waeni 0000639033794 kr sembung rt 04 rw 05 32 th P
433 abu khaeri 0000637262276 wn tawang rt 02 rw 03 70 th L
437 siska fitriani 0000631362406 rg pendawa rt 14 rw 01 11 th P
439 sumarni 0000637862242 klampis rt 10 rw 03 50 th P
440 suparti 0000638464536 jalor rt 01 rw 01 50 th P
441 sri hardiningsih 0000638319914 km amba rt 03 rw 02 60 th P
442 sudiarti 0001032401709 km amba rt 03 rw 02 33 th P
443 dahuri 0001032401698 jakid rt 03 rw 08 37 th L
444 resti amalia 0000639308698 jakid rt 02 rw 04 12 th P
445 alia anfika 0000638838404 jakid rt 02 rw 04 17 th P
446 suidah 0000639191384 jakid rt 04 rw 01 38 th P
448 aisah febriyani 0000637929898 jt rokeh rt 01 rw 03 75 th P
450 m zenal 0000638794589 km amba rt 04 rw 02 20 th L
451 wasrob 0000637128731 jakid rt 10 rw 02 74 th L
452 caskia nur azizah 0000638429692 pamengger rt 01 rw 03 7 th P
453 moh jais 0000638775241 pamengger rt 06 rw 02 8 th L
455 suleman 0001032413095 jalor rt 03 rw 02 48 th P
456 tanuri 0000639576821 janegara rt 08 rw 03 52 th L 18-10-2013
457 moh syaefudin 0000638242749 jalor rt 06 rw 02 3 th L
458 nur amiyah 0000638247768 jalor rt 06 rw 02 7 th P
459 khotimah 0000638574467 kb nagung rt 08 rw 02 43 th P
460 evah supriyatin 0000639118315 kts yasa rt 07 rw 04 13 th P
464 rosidi asroni 0000637571576 jakid rt 03 rw 10 50 th L
467 ah khaerudin 0000637628117 jakid rt 03 rw 07 9 th L
472 ariffiyan nuryasin 0000639115964 jakid rt 04 rw 05 20 th L
473 m dino 0001032403061 jakid rt 03 rw 10 5 th L 19-10-2013
474 miftakhul maulana 0000638258589 jakid rt 03 rw 01 13 th L
477 rastinah 0000637451965 bojong rt 13 rw 03 60 th P
478 dede dwi m 0000637499507 jakid rt 02 rw 03 8 th L
479 wisit wiharto 0001032417213 pamengger rt 08 rw 01 31 th L
480 rokayah 0000639099516 jakid rt 05 rw 03 53 th P
481 fitri amanati 0000637165541 jakid rt 02 rw 03 18 th P
482 warga 0000638164304 jakid rt 03 rw 10 60 th L
483 mariah 0000638944413 jakid rt 02 rw 12 30 th P
485 ulfi oktafiani 0000638693651 jakid rt 01 rw 05 20 th P
487 yunika elawati 0000638294242 jakid rt 03 rw 08 34 th P
489 sulastri 0000637195577 jakid rt 05 rw 08 30 th P 21-10-2013
490 m sukma 0000638189818 jakid rt 02 rw 02 8 th L
494 denisa erika aulia 0000638640843 jalor rt 05 rw 01 4 th P
495 ghea nila 0000639203624 jalor rt 05 rw 01 5 th P
499 majroh 0000639189753 dk maja rt 01 rw 07 32 th P
500 st khodijah 0000637171896 jakid rt 05 rw 05 17 th P
501 muh fadil 0000637835624 dk maja rt 02 rw 07 5 th L
502 aji sumantri 0000639581771 dk maja rt 01 rw 01 58 th L
507 sasiq akil 0000637346744 kts yasa rt 03 rw 01 7 th L
508 m zaki s 0000638368198 jakid rt 04 rw 02 6 th L
509 ah satrio 0000638600556 jalor rt 03 rw 05 7 th L
511 alia anfika 0000638838404 jakid rt 02 rw 04 17 th P
512 maulidia 0001032415874 jakid rt 03 rw 05 9 th P
513 tolikha 0000638247792 jakid rt 03 rw 01 37 th P
514 sehatun 0000638837965 jakid rt 02 rw 04 50 th P
515 ali murtado 0000638211047 kb nagung rt 04 rw 03 15 th L
521 m ridwan 0000639017482 jakid rt 04 rw 02 48 th L
522 warmi 0000638834286 kl pucang rt 04 rw 01 51 th P
523 slamet 0000638418396 klampis rt 01 rw 01 55 th L 22-10-2013
527 kamal abd aziz 0000637677426 kts yasa rt 05 rw 02 10 th L
528 jumaroh 0000638793415 jakid rt 01 rw 01 50 th P
531 jenalarifin 0000639089919 karanglo rt 02 rw 01 23 th L
533 khoerul anwar 0000637613583 jalor rt 01 rw 04 13 th L
534 slamet surahman 0001032407098 jakid rt 02 rw 03 42 th L
535 a azizi 0000637168443 jakid rt 05 rw 05 12 th L
537 m ramedon 0000637118199 jakid rt 02 rw 03 41 th L
538 m samim 0001032407335 jakid rt 02 rw 03 9 th L
539 arifudin 0000639458903 janegara rt 01 rw 01 25 th L
543 roja 0000638448186 pamengger rt 05 rw 03 44 th L
544 rofianah 0000638727794 jakid rt 01 rw 05 24 th P
545 nurohman 0000638927471 jakid rt 03 rw 04 70 th L 10/23/2013
546 deni riyanto 0000638662959 karanglo rt 04 rw 01 7 th L
547 ririn p 0000637981792 karanglo rt 02 rw 06 7 th P
549 nur aeni f 0000637348923 kts yasa rt 05 rw 02 19 th P
552 sunarti 0000638131252 buaran rt 05 rw 01 48 th P
553 sinta wahyu 0000638131882 buaran rt 05 rw 01 13 th P
554 khalimi 0000637968317 jalor rt 08 rw 01 55 th L
555 muirah 0000637183991 jakid rt 04 rw 08 52 th P
556 sakwad 0000637900356 jalor rt 03 rw 05 70 th L
560 witri 0001032399786 klampis rt 04 rw 02 47 th P
563 maria ulfa 0000638684234 kts yasa rt 02 rw 01 5 th P
564 sardi 0000638798567 pds lohor rt 02 rw 01 62 th L
566 tahroni 0000638656119 jalor rt 04 rw 04 50 th L
568 jumroh 0000638793415 juak rt 01 rw 01 50 th P
569 daffa febrian 0000638139317 jakid rt 01 rw 05 6 th L
570 saenah 0000639166072 jakid rt 04 rw 03 60 th P
571 dahliana 0001032412274 jalor rt 01 rw 05 4 th P
574 khamim 0000638220508 jakid rt 01 rw 02 65 th L 10/24/2013
577 waedah 0000638637654 kr sembung rt 01 rw 08 36 th P
578 waman 0000638524225 kts yasa rt 01 rw 01 73 th L
581 kitam 0000637978499 bojong rt 13 rw 02 36 th L
583 nurul aeni 0000639146079 jakid rt 04 rw 08 21 th P
585 m miftakhul 0000639243323 pamengger rt 05 rw 04 5 th L
586 dakonah 0000639026993 jakid rt 03 rw 08 40 th P
587 a hasim adnan 0000638337295 jakid rt 02 rw 05 10 th L
591 fara nadia 0000638757786 jakid rt 04 rw 02 20 th P
592 muhaimi 0000638244821 jalor rt 03 rw 05 37 th L
595 abdilah 0000639076767 jakid rt 05 rw 08 56 th P
597 tolicha 0000638824792 jakid rt 03 rw 01 37 th P
598 moh ramedon 0000637118199 jakid rt 02 rw 03 35 th L
599 muh rizqi sidik 0000638220328 jakid rt 05 rw 01 2 th L
600 karumi 0000638990123 kl pucang rt 01 rw 01 30 th L
601 khusnah 0000638826502 jakid rt 02 rw 05 52 th P
602 heru nelia 0000637374431 kts yasa rt 05 rw 01 31 th L
603 kasdum 0000637130226 jakid rt 03 rw 04 80 th L 10/25/2013
604 indah asmara 0000637867948 kr sembung rt 03 rw 05 27 th P
605 m ripki 0000637682169 kr sembung rt 02 rw 01 7 th L
608 kamal abd aziz 0000637677424 kts yasa rt 06 rw 02 10 th L
609 yuni nur hidayah 0000638098547 jalor rt 05 rw 03 20 th P
610 dahuri 0001032401698 km amba rt 03 rw 02 33 th L
612 sutikno 0000639944209 jakid rt 02 rw 12 69 th L
613 dimas andrian 0000638944536 jakid rt 02 rw 12 11 th L
616 iis handayani 0000638549673 pamengger rt 03 rw 01 17 th P
618 anggun 0000637828826 dk maja rt 01 rw 07 18 th P
619 tarodin 0000638802674 jakid rt 01 rw 03 50 th L
620 sultan latif a 0000638347386 jakid rt 01 rw 05 11 th L
621 raswi 0000638500948 km amba rt 02 rw 03 50 th P 10/26/2013
623 soliha 0000639076942 tg wulung rt 05 rw 01 30 th P
624 serin nur apiyah 0000638961847 pamengger rt 06 rw 03 4 th P
625 jamroh 0000639113411 kts yasa rt 01 rw 04 42 th P
626 tantowi 0000639114973 kts yasa rt 01 rw 04 14 th L
628 tohayah 0000638898041 jalor rt 05 rw 03 31 th P
631 mario adinata 0000637899445 jakid rt 03 rw 10 5 th L
632 komah 0000638443886 janegara rt 11 rw 04 60 th P
635 astuti 0000638962263 tembelang rt 13 rw 02 30 th P
636 kotimah 0000638674467 kb nagung rt 08 rw 02 43 th P 10/28/2013
637 masitoh 0000639693649 tembelang rt 04 rw 02 46 th P
640 zaetun 0000637930136 jakid rt 04 rw 01 52 th P
641 dartono 0000637109964 jakid rt 03 rw 09 50 th L
642 roisah 0000639103334 kr sembung rt 04 rw 02 27 th P
644 athayatul maulana 0000639043615 jakid rt 03 rw 10 10 th L
645 warsiti 0000638256914 jalor rt 03 rw 05 53 th P
646 m sofian 0000639311679 jakid rt 04 rw 05 6 th L
647 sukaeri 0000639309778 jakid rt 04 rw 05 50 th L
648 khusnul khotimah 0000637829267 kts yasa rt 07 rw 04 26 th P
650 warnadi 0000638165327 km amba rt 02 rw 01 43 th L
652 ani junaedi 0000638778712 km amba rt 04 rw 02 52 th P
653 rojanah 0000638437285 janegara rt 01 rw 01 37 th L
654 umar farukhi 0000638464983 kts yasa rt 03 rw 03 12 th L
655 wariyah 0000637684593 kts yasa rt 03 rw 03 60 th P
656 nuryati 0000637846479 dk maja rt 05 rw 03 50 th P
657 krisnawati 0000638933591 jakid rt 03 rw 08 50 th L
659 m irfan 0001032407324 jakid rt 02 rw 03 20 th P
660 siska dwi 0001032402338 jakid rt 04 rw 05 20 th P
661 maryati 0000638920157 jakid rt 05 rw 05 47 th P
662 alif nayla 0000638921751 jakid rt 05 rw 05 7 th P
663 saimah 0000637708601 jakid rt 05 rw 05 30 th P
664 nur khasanah 0000637988589 jakid rt 02 rw 11 48 th L
665 lukman faozi 0000637989489 jakid rt 02 rw 11 12 th P
666 daimah 0000638110348 klampis rt 06 rw 02 46 th P
667 sarifah lutfi 0000638348319 jakid rt 05 rw 01 3 th P
668 khilu nur fadilah 0000638276714 jakid rt 02 rw 04 3 th P
669 yunika elawati 0000638294242 km amba rt 04 rw 02 34 th L
671 ah kuswanto 0000637501599 jakid rt 05 rw 05 21 th L
673 jeje 0000637862007 jalor rt 03 rw 03 49 th L
674 ilfa 0000639237787 jakid rt 12 rw 05 25 th L
676 uung 0000638673963 jakid rt 01 rw 02 41 th L
677 maryadi ibnu 0000638676887 jakid rt 01 rw 02 8 th L
678 warah 0000637681566 kts yasa rt 06 rw 04 70 th P
679 rehan 0000639281168 jakid rt 02 rw 03 13 th L 10/29/2013
680 indah 0000637807048 kr sembung rt 03 rw 05 27 th P
682 kasri 0000639032365 kr sembung rt 04 rw 05 50 th P
683 irfan 0000639936291 kr sembung rt 04 rw 05 14 th L
684 mastiyati 0000639022746 jakid rt 04 rw 05 53 th P
685 hertati 0000638147529 jakid rt 03 rw 10 40 th P
686 riski mubarok 0000637437622 tembelang rt 01 rw 01 9 th L
687 suheni 0000637436441 tembelang rt 01 rw 01 34 th P
688 duriyah 0000638366725 rg bandung rt 03 rw 03 41 th P
691 ratningsih 0000638312185 klampis rt 12 rw 04 43 th P
693 wasripah 0000638218899 jakid rt 08 rw 01 36 th L
694 m riski 0000638320326 jakid rt 08 rw 01 2 th P
695 warkonah 0000637956921 kr sembung rt 01 rw 05 37 th P
696 desi 0000637966279 kr sembung rt 01 rw 05 17 th P
697 yunita dwi mutiara 0000639269144 jalor rt 05 rw 01 18 th L
698 damun 0001032442962 pds lohor rt 01 rw 02 72 th L 10/30/2013
699 tahril 0000638281692 jakid rt 02 rw 04 52 th P
700 soimah 0000638834477 jakid rt 03 rw 08 50 th P
704 siti umroh 0000638375747 pamengger rt 05 rw 03 50 th P
705 kiyah 0000638915995 pamengger rt 06 rw 01 86 th P
706 alfiyah 0000637577919 kr sembung rt 04 rw 05 29 th L
707 gilang r 0000638696226 kts yasa rt 03 rw 01 13 th P
708 solikha 0000638523437 km amba rt 04 rw 02 35 th L
709 slamet haryanto 0000639043806 jakid rt 03 rw 02 55 th P
710 khodijah 0000639043918 jakid rt 03 rw 02 40 th L
712 zaenal aripin 0000638239724 jakid rt 02 rw 04 50 th L
713 m tri wijayanto 0000638253729 jakid rt 04 rw 02 20 th L
714 ariffiyan nuryasin 0000639115964 jakid rt 04 rw 05 21 th P
715 winda 0000638251828 jakid rt 02 rw 04 23 th L
716 akhmad kharis 0000638865832 jalor rt 07 rw 03 15 th P
717 rokayah 0000639099516 kts yasa rt 05 rw 03 50 th L
719 ardi firman m 0000638612256 jalor rt 01 rw 04 5 th P
722 eva ifana 0000639016378 jakid rt 02 rw 01 30 th P
724 ah muzaki 0000638618455 karanglo rt 11 rw 04 6 th L
725 julian elino 0000638353901 jakid rt 04 rw 03 6 th L
726 tapsirah 0000638326438 jakid rt 03 rw 10 29 th P
727 riko maulana 0001032401235 pamengger rt 08 rw 01 6 th L
729 rakhman 0001032405761 jakid rt 04 rw 03 50 th L
730 slamet m 0000637153479 jakid rt 04 rw 02 52 th L
732 st maryam 0001032421599 kts yasa rt 01 rw 04 62 th P
735 saripah 0001032399516 klampis rt 12 rw 04 26 th P
736 srimulyati 0001032406784 jakid rt 01 rw 02 43 th P
738 st rokhani 0000638611918 jalor rt 06 rw 05 46 th P
741 farikha 0001032419373 kts yasa rt 05 rw 01 60 th P
742 saripah 0001032395166 klampis rt 12 rw 04 26 th P
744 m firza nur 0000638141139 jalor rt 02 rw 03 15 th L
746 maesaroh 0000638327305 jakid rt 02 rw 09 50 th P
T JALAN JAMKESMAS DI PELAYANAN DASAR
BULAN : OKTOBER TAHUN : 2013

eserta Jamkesmas
DIAGNOSA Pemeriksaa TOTAL BIAYA
Poli Umum Poli Gigi Poli KIA Tindakan
n LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13)
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
panas Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
luksasi Rp 5,000 Rp 22,500
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
abses Rp 5,000 Rp 11,750
abses Rp 5,000 Rp 11,750
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
kariesdentin Rp 5,000 Rp 27,500
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
scalling Rp 5,000 Rp 11,750
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
fraktur Rp 5,000 Rp 11,750
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
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panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
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pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
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panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
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batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
pulpa polip Rp 5,000 Rp 12,750
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
abses Rp 5,000 Rp 55,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
bta Rp 5,000 Rp 4,500
panas Rp 5,000
grinding Rp 5,000 Rp 5,000 Rp 11,750
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
abses Rp 5,000 Rp 17,000
abses Rp 5,000 Rp 11,750
pusing Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
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pusing Rp 5,000
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hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
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panas Rp 5,000
batuk Rp 5,000
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pegel Rp 5,000
panas Rp 5,000
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panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
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pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
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panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
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pegel Rp 5,000
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panas Rp 5,000
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batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
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panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
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panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
hb Rp 5,000 Rp 2,000
batuk Rp 5,000
pegel Rp 5,000
gds Rp 5,000 Rp 3,000
batuk Rp 5,000
bta Rp 5,000 Rp 4,500
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
gds Rp 5,000 Rp 3,000
pegel Rp 5,000
hipertensi Rp 5,000
abses Rp 5,000 Rp 55,000
batuk Rp 5,000
gds Rp 5,000 Rp 3,000 Rp 32,500
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
hb Rp 5,000 Rp 2,000
dl Rp 5,000 Rp 12,500
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
dl Rp 5,000 Rp 12,500
dr Rp 5,000 Rp 8,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
grinding Rp 5,000 Rp 11,750
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
bta Rp 5,000 Rp 4,500
dl Rp 5,000 Rp 12,500
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
dl Rp 5,000 Rp 12,500
dl Rp 5,000 Rp 12,500
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
kariesdentin Rp 5,000 Rp17,000
luksasi Rp 5,000 Rp22,500
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
dr Rp 5,000 Rp8,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
gangren pulpa Rp 5,000 Rp12,750
bta Rp 5,000 Rp4,500
dl Rp 5,000 Rp12,500
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
bta Rp 5,000 Rp4,500
batuk Rp 5,000
batuk Rp 5,000
dr Rp 5,000 Rp8,000
dl Rp 5,000 Rp12,500
batuk Rp 5,000
pegel Rp 5,000
dl Rp 5,000 Rp12,500
dl Rp 5,000 Rp12,500
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
bta Rp 5,000 Rp4,500
dl Rp 5,000 Rp12,500
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
dl Rp 5,000 Rp12,500
dl Rp 5,000 Rp12,500
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
persistensi Rp 5,000 Rp8,250
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
dr Rp 5,000 Rp8,000
pegel Rp 5,000
dr Rp 5,000 Rp8,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
bta Rp 5,000 Rp4,500
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
bta Rp 5,000 Rp4,500
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
kariesdentin Rp 5,000 Rp27,500
dl Rp 5,000 Rp12,500
dl Rp 5,000 Rp12,500
dl Rp 5,000 Rp12,500
panas Rp 5,000
pegel Rp 5,000
panas Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pegel Rp 5,000
TANDA
TANGAN
PASIEN
15
DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMA

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS TANGGAL

UMUR KELA
No. NAMA PASIEN PESERTA alamat MIN KUNJUNGA
(Thn)
JAMKESMAS (L/P) N
(1) (2) (3) (4) (5) (6) (7)
1 suhadi 0000638183684 dk maja rt 02 rw 03 67 th L 01-11-2013
6 selvia 0000638756942 jalor rt 03 rw 10 3 th P
7 aedy sudiono 0000639033494 jakid rt 05 rw 05 72 th L
9 badriyah 0000639417543 kts yasa rt 04 rw 04 49 th P
10 reynovalentino 0000638747561 klampis rt 12 rw 04 3 th L
11 moh topik 0000638930857 jakid rt 03 rw 08 45 th L
12 galang dimas 0000638138992 jakid rt 01 rw 05 8 th L
13 nur khotim 0000638931519 jalor rt 01 rw 04 45 th P
14 sardi 0000638798567 psd lohor rt 12 rw 03 51 th L
15 sodikin 0001032412814 jalor rt 03 rw 03 40 th L
16 kotimah 0000638744467 kb nagung rt 06 rw 02 43 th P 02-11-2013
17 tutik ainun 0000638123242 jakid rt 03 rw 10 2 th P
18 daim hendiyoso 0000638755747 jakid rt 04 rw 01 43 th L
19 siti inayah 0000637849495 dk maja rt 05 rw 07 10 th P
20 eka handayani 0000639389744 kts yasa rt 05 rw 02 23 th P
22 waah 0001032402767 jakid rt 01 rw 09 60 th P
24 m febriyanto 0001032405568 jakid rt 03 rw 10 5 th L
25 fitriyanti 0001032419057 pamengger rt 03 rw 01 30 th P
27 nur auliyah 0000638242468 jalor rt 06 rw 02 7 th P
31 ikin sodikin 0001032412814 jalor rt 03 rw 03 46 th L
32 wahyudi 0000638654782 klampis rt 01 rw 01 8 th L
33 rofii 0000638476299 jalor rt 04 rw 05 29 th L
37 yunika elawati 0000638294242 km amba rt 04 rw 01 34 th P
40 suindah 0000638969668 kts yasa rt 03 rw 03 33 th P 04-11-2013
41 m alfarizi 0000638972054 kts yasa rt 03 rw 03 11 th L
43 zahro 0000637932317 jakid rt 04 rw 01 15 th P
44 zaetun 0000637930135 jakid rt 04 rw 01 50 th P
49 m alfarizi 0000638972054 kts yasa rt 03 rw 03 11 th L
52 faizal amir 0001032401171 km amba rt 01 rw 01 33 th L
54 selvian nurul a 0000638755942 jakid rt 03 rw 10 2 th P
56 ah khubaebur rohman 0001032424615 janegara rt 04 rw 02 4 th L
61 m alim maulana 0000637822675 jakid rt 02 rw 10 7 th L
62 soipah 0000637822354 jakid rt 02 rw 10 40 th P
63 rokhanah 0000639302218 jakid rt 03 rw 10 60 th P
65 dewi arini 0001032414445 jalor rt 06 rw 01 17 th P
66 imam bukhori 0000637530366 jakid rt 02 rw 06 23 th L
68 daimah 0000638110348 klampis rt 02 rw 05 46 th P
69 ah sulki 0000639290948 jakid rt 02 rw 05 12 th L
71 roipah 0000638845479 pamengger rt 05 rw 04 41 th P
73 endang kinanti 0000639239938 jalor rt 05 rw 05 40 th P
74 sri hardiningsih 0000638319914 jalor rt 01 rw 01 60 th P 06-11-2013
79 tarsa 0000638886061 tembelang rt 05 rw 07 80 th L
80 galih 0001032418069 jalor rt 02 rw 08 11 th L
82 dahrowi 0001032416841 jalor rt 03 rw 05 36 th L
83 rodiah 0000638247116 jalor rt 06 rw 01 55 th P
85 faik 0000638331270 jakid rt 03 rw 04 3 th L
87 salha 0000639601389 wn cala rt 02 rw 03 50 th P
88 hefita 0000637781445 wn tawang rt 02 rw 04 23 th P
89 dariah 0000637781765 wn tawang rt 02 rw 04 28 th P
90 warma 0001032403558 jakid rt 04 rw 02 50 th L
91 haris efendi 0000638937695 jakid rt 05 rw 08 34 th L
92 m syaefudin 0000638242749 jalor rt 06 rw 02 4 th L
93 wastiah 0000639729382 tembelang rt 14 rw 03 51 th P
94 m fakih 0000637188524 jakid rt 02 rw 01 8 th L
95 cantika 0000638128236 kb nagung rt 10 rw 02 4 th P
96 a jazuli 0000632421707 rg pendawa rt 05 rw 04 25 th L
97 suharto 0001032413973 jalor rt 04 rw 06 45 th L
98 mafrikha 0001032405186 jalor rt 03 rw 04 50 th P
99 yunika elawati 0000638294242 km amba rt 02 rw 04 34 th P 07-11-2013
100 kiki 0000638222308 janegara rt 07 rw 03 20 th P
101 mastro 0000639126934 kr sembung rt 02 rw 01 70 th L
102 soimah 0000637969969 wn cala rt 03 rw 03 33 th P
104 m rusman 0000638693785 jakid rt 01 rw 05 14 th L
105 rohimah 0000638125166 jalor rt 02 rw 05 20 th P
106 sumirah 0000638124456 jalor rt 02 rw 05 43 th P
107 tubagus fahmi 0001032407122 jakid rt 02 rw 03 6 th L
108 maryam 0000639169997 jakid rt 03 rw 03 70 th P
109 jumeri 0000638202306 jakid rt 03 rw 05 37 th P
110 abd khanan 0000638220963 jakid rt 02 rw 03 43 th L
111 sarinah 0000637986305 tg wulung rt 08 rw 02 60 th P
112 sri mulyani 0000638948867 jakid rt 05 rw 05 21 th P
113 casmi 0000637856337 kr sembung rt 03 rw 05 50 th P
115 roisah 0000637800434 dk maja rt 01 rw 01 39 th P
116 st rohmah 0000637601626 dk maja rt 01 rw 01 14 th P
119 dahuri 0001032401696 km amba rt 03 rw 02 33 th L
121 ade 0000638638364 jalor rt 04 rw 01 20 th L
122 khumaedi 0000638322052 bojong rt 10 rw 02 10 th L
124 ikin sodikin 0001032412314 jalor rt 03 rw 03 47 th L
126 koneri 0000637826679 wn cala rt 03 rw 03 38 th P
128 mudrikah 0001032409236 karanglo rt 15 rw 03 38 th P
129 tonirah 0001032401147 km amba rt 01 rw 01 50 th P
130 prinawati 0000638895857 kts yasa rt 05 rw 01 36 th P
131 warmi 0000638343268 kl pucang rt 04 rw 01 51 th P
136 ihfa maula 0000638072695 jalor rt 02 rw 05 6 th P 08-11-2013
137 erfiyani 0000638071481 jalor rt 02 rw 05 18 th P
138 bunyamin 0001032405636 jakid rt 05 rw 01 43 th L
139 anwar 0000637629344 jalor rt 04 rw 01 70 th L
140 hestiawati 0000639394432 kts yasa rt 04 rw 04 37 th P
141 m yasir 0000638244448 klampis rt 01 rw 01 15 th L
142 rohimah 0000638927996 kts yasa rt 02 rw 02 40 th P
143 irfan 0000638930373 kts yasa rt 02 rw 02 11 th L
145 rosikin 0000638368345 kts yasa rt 03 rw 03 45 th L
146 m zulfikri 0000638369805 kts yasa rt 03 rw 03 11 th L
148 maunah 0000638691806 jakid rt 01 rw 05 46 th P
151 sri mardiyati 0000637996241 karanglo rt 15 rw 03 42 th P
152 wasriah 0000639414292 kts yasa rt 05 rw 04 30 th P
153 warah 0000637681566 kts yasa rt 05 rw 04 80 th P
154 imam bukhori 0000638630366 jakid rt 02 rw 06 20 th L
158 karmen efendi 0000638280076 jakid rt 03, rw 09 60 th L
160 sri yatimah 0000637811133 kr sembung rt 03 rw 05 40 th P
162 sugiarti 0000638758337 janegara rt 11 rw 04 46 th P
164 kiki 0000638280954 jakid rt 05 rw 06 6 th P
165 sumirah 0000638104713 tg wulung rt 03 rw 03 46 th P
166 husni 0000639192968 jakid rt 04 rw 01 11 th L
168 suidah 0000639191384 jakid rt 04 rw 01 39 th P
169 st nuramah 0000638660373 karanglo rt 10 rw 04 20 th P
170 tunisah 0000638669811 karanglo rt 10 rw 04 40 th P
171 isyri hanifah 0000637651721 jalor rt 01 rw 08 19 th P
173 ramdani 0000638210812 jakid rt 03 rw 04 20 th L 09-11-2013
174 tirto pribowo 0000639408903 kts yasa rt 02 rw 03 20 th L
175 indahwati 0000636948118 tembelang rt 06 rw 02 25 th P
176 zahwa 0000638816307 jakid rt 01 rw 02 7 th P
179 a jazuli 0000632421707 rg pendawa rt 05 rw 04 25 th L
180 anggi saraswati 0000639254777 tembelang rt 12 rw 02 15 th P
182 kardo 0000638756636 klampis rt 02 rw 01 70 th L
187 nurul fitriani 0000638185792 jakid rt 05 rw 05 5 th P
192 suprianti 0000638379122 jakid rt 02 rw 10 25 th P 11-11-2013
194 ida rosida 0000637109076 jakid rt 05 rw 08 17 th P
197 sutinah 0000639528028 janegara rt 01 rw 1 55 th P
198 ade setiawan 0000638898359 jalor rt 04 rw 01 20 th L
199 m riski 0000638691787 jalor rt 02 rw 03 9 th L
203 sochanah 0000638319947 jakid rt 03 rw 10 50 th P
204 dina 0000638814802 jakid rt 03 rw 10 23 th P
207 m yatin 0000638244448 klampis rt 01 rw 01 15 th L
209 naela r 0000637943049 jakid rt 04 rw 03 21 th P
212 sofikha 0000638198987 jt makmur rt 03 rw 01 50 th P
214 suharso 0000638742835 jakid rt 06 rw 08 46 th P
215 atun 0000638743678 jakid rt 03 rw 08 20 th P
216 topik 0000639308057 kts yasa rt 04 rw 02 45 th L
218 warnisah 0000639076779 jakid rt 06 rw 08 48 th P
221 waemuroh 0000639674736 janegara rt 11 rw 04 47 th P
224 indah fitriasih 0000638374858 klampis rt 04 rw 02 7 th P
225 roisah 0000638374241 klampis rt 04 rw 02 27 th P
226 rosikin 0000638148341 dk maja rt 01 rw 01 37 th L
230 soid 0001032393205 dk maja rt 01 rw 01 70 th L
231 maulana bayu 0000636849472 kb gadung rt 02 rw 03 9 th L
233 kholipah 0000638008931 kr sembung rt 03 rw 05 10 th P
235 toto sutrisno 0000638274532 km amba rt 02 rw 03 34 th L
236 firman muzaki 0000639206853 janegara rt 01 rw 01 7 th L
239 nur fasikhatun 0000638970028 kts yasa rt 03 rw 03 12 th P
241 mainah 0000637563205 jakid rt 03 rw 07 50 th P
242 saimah 0000638300553 jalor rt 08 rw 01 39 th P
244 sarmid 0001032406727 jakid rt 02 rw 10 70 th L
245 teguh aryanto 0000636693717 klampis rt 04 rw 02 8 th L
246 raswen 0000638963347 tembelang rt 14 rw 05 70 th L 13-11-2013
247 waraeningsih 0000637958171 kr sembung rt 04 rw 01 36 th P
249 m sandi 0000637966361 kr sembung rt 04 rw 01 6 th L
250 zenal arifin 0000638230724 jakid rt 02 rw 04 50 th L
251 suharsih 0000638951466 jakid rt 04 rw 05 43 th P
253 windarti 0000638799941 jakid rt 04 rw 02 18 th P
254 m sopyan 0000638923671 klampis rt 10 rw 03 11 th L
255 m rusman 0000638693786 klampis rt 01 rw 06 14 th L
256 m fahri ramadan 0000637125704 jakid rt 01 rw 05 2 th L
260 endang dwi 0000638035299 kr sembung rt 04 rw 05 38 th P
261 puji irawan 0000638315324 jakid rt 04 rw 03 10 th L
263 hayatun rohmah 0000638976159 dk maja rt 02 rw 04 10 th P
264 khuneni 0000639180729 dk maja rt 02 rw 04 51 th P
265 miftahus z 0000637805485 jakid rt 02 rw 10 13 th P
266 naela r 0000637943049 jakid rt 04 rw 03 21 th P
268 st masitoh 0000638076071 jalor rt 04 rw 01 37 th P
269 tumirah 0000637866134 dk maja rt 02 rw 02 37 th P
270 masrifah 0000638676806 kb nagung rt 05 rw 02 60 th P 14-11-2013
272 rakman 0001032405761 jakid rt 04 rw 03 50 th L
274 jamali 0000638908826 jakid rt 02 rw 01 52 th L
275 m abdan dusmi 0000638808063 pamengger rt 03 rw 02 5 th L
276 dusmi 0000637455925 bojong rt 12 rw 03 40 th P
277 wartiah 0000639289618 jakid rt 02 rw 05 45 th P
278 a subhi 0000639290946 jakid rt 02 rw 05 13 th L
281 yoga indra 0000638278108 kts yasa rt 03 rw 04 5 th L
282 makrus 0001032420554 klampis rt 02 rw 01 63 th L
284 fahrurozi 0001032414895 jalor rt 04 rw 05 31 th L
285 eli supriati 0000638375624 kts yasa rt 03 rw 06 20 th P
287 ropiah 0000637182167 jakid rt 01 rw 03 40 th P 15-11-2013
288 catur 0000638747724 jakid rt 04 rw 05 6 th L
289 mulyani 0000638720144 kts yasa rt 05 rw 04 37 th P
290 suwarto 0000638953075 jalor rt 05 rw 04 43 th L
291 moh slamet 0000638548604 jalor rt 05 rw 04 36 th L
292 akrani 0001032406989 jakid rt 03 rw 10 72 th L
294 saefudin 0000638329083 jakid rt 03 rw 04 23 th L
296 rohaeni 0000637596944 jakid rt 09 rw 01 50 th P
298 tantri 0000638023522 karanglo rt 05 rw 01 11 th P
299 darningsih 0000638021305 karanglo rt 05 rw 01 33 th P
301 firman muzaki 0000638141342 jalor rt 02 rw 03 8 th L
302 ani junaedi 0000638778712 km amba rt 04 rw 02 35 th P
303 karoni 0000638990122 kl pucang rt 01 rw 01 32 th L
309 elsa yuliana 0000638775516 km amba rt 01 rw 01 4 th P
310 zenal arifin 0000638230724 jakid rt 02 rw 04 55 th L
311 suharso 0001032414873 jalor rt 04 rw 05 45 th L
313 afitta 0000638846278 pamengger rt 05 rw 04 9 th P
314 m khaerul anam 0000638846302 pamengger rt 05 rw 04 6 th L
315 rizal 0000632230042 rg pendawa rt 08 rw 08 10 th L
319 rohati 0000638713631 klampis rt 01 rw 01 37 th P
322 dasri 0000638142118 tg wulung rt 08 rw 02 76 th P
324 fojiyah 0000638288706 jakid rt 03 rw 06 42 th P
325 pipit iryani 0000638270796 jakid rt 03 rw 06 11 th P
326 ciajeng 0000639151773 jakid rt 01 rw 03 13 th P
327 teguh santoso 0000637530401 jakid rt 02 rw 06 20 th L
328 warnayanti 0000638288786 dk maja rt 01 rw 03 30 th P
330 kotimah 0000638574467 kb nagung rt 08 rw 02 43 th P
331 ah muhidin 0000638884898 klampis rt 05 rw 01 17 th L
332 abd muin 0000639126006 dk maja rt 01 rw 03 48 th L
333 wiyani 0000638795529 jakid rt 04 rw 03 43 th P
334 rohanah 0000638308451 jakid rt 02 rw 04 33 th P 18-11-2013
335 masanah 0000638194296 jakid rt 04 rw 06 60 th P
336 st muawanah 0000638137822 km amba rt 03 rw 02 38 th P
338 masriah 0000638676806 kb nagung rt 08 rw 02 60 th P
341 alip 0000638921711 jakid rt 06 rw 05 7 th L
342 maryati 0000638920157 jakid rt 05 rw 05 37 th P
343 hasanudin 0000637823147 jakid rt 03 rw 08 70 th L
347 waisah 0000638482228 janegara rt 01 rw 02 76 th P
348 kasriyah 0000638684458 kts yasa rt 01 rw 02 30 th P
349 rohaeti 0000637696806 kts yasa rt 05 rw 04 36 th P
355 tasari 0000637857819 jalor rt 05 rw 08 63 th P
357 kasnadi 0000639016265 jakid rt 03 rw 08 55 th L
358 rizal 0000638037011 kr sembung rt 02 rw 01 12 th L
359 nur khotim 0001032407695 jakid rt 04 rw 01 31 th P
360 st aminah 0000637455925 jakid rt 01 rw 05 30 th P
362 ari dwi andika 0000638661273 karanglo rt 19 rw 04 5 th L
363 tuminah 0000638659811 karanglo rt 19 rw 04 40 th P
364 tanuri 0000638659115 karanglo rt 19 rw 04 58 th L
365 wati 0000638081227 sitanggal rt 01 rw 07 41 th P
366 gifan 0001032415648 jalor rt 02 rw 05 14 th L
367 tri ningsih 0000639205389 janegara rt 01 rw 01 30 th P 19-11-2013
368 januri 0000633075096 rg pendawa rt 11 rw 02 32 th L
369 m fakih 0000639395616 kts yasa rt 06 rw 04 11 th L
370 saripah 0000638328205 jakid rt 02 rw 08 19 th P
372 rova dimas 0000637983494 jalor rt 03 rw 01 7 th L
373 alamsyah 0000638362764 jakid rt 04 rw 03 12 th L
374 kurotul rosidah 0000639226337 jalor rt 01 rw 04 7 th P
376 m adi slamet 0000639020272 kts yasa rt 03 rw 04 30 th L
378 darto 0000638378063 kts yasa rt 02 rw 06 45 th L
380 rohimi 0000638033682 kr sembung rt 03 rw 06 4 th L
381 bunga 0000638934755 kr sembung rt 03 rw 06 9 th P
382 sunarti 0000639276704 jakid rt 01 rw 09 30 th P
384 ardias 0000639286637 jakid rt 02 rw 01 3 th L
386 eem s 0000637613054 jalor rt 01 rw 04 50 th P
387 faturohman 0000637631638 jalor rt 01 rw 04 9 th L
388 sardi 0000638796587 pds lohor rt 12 rw 03 60 th L
390 hilal 0000638369032 kts yasa rt 03 rw 03 14 th L
392 zaskia 0000638472778 dk maja rt 03 rw 03 7 th P
393 eni puji 0000638797813 jalor rt 03 rw 02 32 th P
394 waenah 0000639081461 jakid rt 01 rw 07 66 th P
397 maslikha 0000637704189 kts yasa rt 03 rw 02 53 th P
398 suwarti 0000638775437 km amba rt 01 rw 01 41 th P
400 lenawati 0000637850035 dk maja rt 01 rw 01 32 th P
401 m khaerullah 0000638116209 jalor rt 04 rw 02 7 th L
402 m wafi 0000638264283 jalor rt 07 rw 01 6 th L 20-11-2013
403 sefia amalia 0000638377007 pamengger rt 05 rw 03 11 th P
413 munikha 0000637859248 jalor rt 02 rw 01 46 th P
414 m sami maulana 0001032407325 jakid rt 02 rw 03 9 th L
415 mursiyah 0000637968846 kr sembung rt 02 rw 02 80 th P
416 khasanah 0000639376806 karanglo rt 04 rw 19 38 th P
420 tri ningsih 0000638628985 jalor rt 02 rw 03 49 th P
422 dwi awaludin 0000638937819 tg wulung rt 10 rw 04 38 th L
423 tuti alawiyah 0000637908366 jakid rt 02 rw 04 31 th P
424 mundahir 0001032918332 jalor rt 02 rw 06 60 th L 21-11-2013
425 kotimah 0000638574467 kb nagung rt 08 rw 02 60 th P
426 sri haryati 0001032399246 kb nagung rt 09 rw 02 43 th P
427 m rusman 0000638693785 jakid rt 01 rw 05 43 th L
428 rofikha sarban 0000637860903 jakid rt 01 rw 02 14 th L
429 saeful maulana 0000637914374 kts yasa rt 03 rw 04 12 th L
430 syahroni 0000637913766 kts yasa rt 03 rw 04 9 th L
431 andi suandi 0000638445576 kr sembung rt 03 rw 02 42 th L
433 tonipah 0000638533131 glonggong rt 03 rw 04 60 th P
435 taurah 0000639460822 klampis rt 04 rw 02 49 th P
437 dela 0000638325325 kts yasa rt 06 rw 04 20 th P
438 warniyati 0000637616979 jalor rt 02 rw 04 9 th P
441 janatun 0000638957497 tembelang rt 15 rw 03 46 th P
442 waeni 0000639033794 kr sembung rt 04 rw 05 29 th P
443 nanda 0001032403138 jakid rt 02 rw 04 8 th P
445 rusmini 0000638733020 janegara rt 10 rw 04 40 th P 22-11-2013
446 sakwad 0000637900356 jalor rt 03 rw 05 70 th L
447 wirja 0000637782208 cenang rt 04 rw 01 51 th L
450 ramdan 0000638951145 jalor rt 07 rw 03 2 th L
451 ah faesol 0000637969961 jalor rt 08 rw 01 38 th L
453 ramadani estiningsih 0000637835049 dk maja rt 01 rw 01 30 th P
455 janatin 0000638256622 jakid rt 01 rw 05 34 th P
460 ramelon 0000639095613 jakid rt 01 rw 07 67 th L
461 janudin 0000638549493 kr sembung rt 02 rw 05 50 th L
463 fira ayu fadilah 0000638957865 jakid rt 01 rw 05 5 th P
465 m nasikhin 0000637630446 kts yasa rt 05 rw 01 12 th L 23-11-2013
466 saadah 0000638943107 kts yasa rt 05 rw 03 26 th P
467 irsad 0000638418327 kts yasa rt 08 rw 02 11 th L
468 abdul manaf 0000638706306 karanglo rt 06 rw 02 45 th L
469 karisah 0000638706686 karanglo rt 06 rw 02 50 th P
470 sri hayati 0000638348147 klampis rt 03 rw 01 26 th P
471 raan kelana 0000639379563 janegara rt 02 rw 01 47 th L
472 khalidah 0000639043819 jakid rt 03 rw 02 40 th P
473 diyah 0000639046368 jakid rt 03 rw 02 8 th P
475 misfah 0000638812012 jalor rt 01 rw 02 16 th P
477 m nur setiaji 0000638756841 jakid rt 03 rw 10 10 th L
479 wafik 0000639667961 klampis rt 11 rw 04 9 th L
481 junaenah 0000639194804 janegara rt 06 rw 02 40 th P
482 bagus 0000638673342 kb nagung rt 07 rw 01 7 th L
483 sampang 0001032446081 kl pucang rt 08 rw 02 40 th L
485 m saeful bahri 0000639102172 jakid rt 03 rw 08 8 th L
487 sunarti 0000639276704 tembelang rt 12 rw 02 30 th P
488 masroni 0000637431377 tembelang rt 12 rw 02 31 th L
489 eep hastanto 0000637431884 tembelang rt 14 rw 03 28 th L
490 santoso 0000636978328 kts yasa rt 05 rw 01 38 th L
491 dainah 0000637693841 kts yasa rt 03 rw 01 60 th P 25-11-2013
492 nawi 0000637693626 jakid rt 03 rw 04 70 th L
493 irhanudin 0001032406197 jakid rt 01 rw 03 21 th L
495 daim 0000638755746 jakid rt 04 rw 01 47 th P
496 ah taufik 0000637114926 jakid rt 02 rw 05 51 th L
499 tutik 0000638123242 jakid rt 03 rw 10 28 th P
504 saryuah 0000638296568 kts yasa rt 01 rw 03 60 th P
505 wasniyati 0000638622797 karanglo rt 05 rw 01 25 th P
508 idris sardi 0000638798567 pds lohor rt 12 rw 03 50 th L
510 sri yanti 0000639159816 kts yasa rt 07 rw 04 50 th P
511 zahra 0000639161537 kts yasa rt 07 rw 04 41 th P
512 soimah 0001032415626 jakid rt 02 rw 05 30 th P
516 warti 0001032420936 kts yasa rt 04 rw 04 38 th P
517 ulfi oktafiani 0000638693661 jakid rt 01 rw 05 19 th P
518 raoti 0000638572634 kb nagung rt 07 rw 01 30 th P
519 edi darmawan 0000638621032 jalor rt 02 rw 02 32 th L
521 ramelon 0000639095613 jakid rt 01 rw 07 70 th L 26-11-2013
523 lutfiana munawaroh 0000638365882 kts yasa rt 02 rw 03 11 th P
525 nur solikha 0000638177185 jakid rt 03 rw 03 25 th P
526 sumarni 0001032380515 wn tawang rt 01 rw 01 26 th P
527 ulfi ikn m 0000633279093 sitanggal rt 09 rw 08 26 th P
528 muoh rifki 0000637662159 kr sembung rt 02 rw 01 7 th L
529 nurkhayah 0000639259143 tembelang rt 13 rw 02 28 th P
530 sugiri 0001032412768 jalor rt 03 rw 05 60 th L
531 fatimah turah 0001032403307 jakid rt 02 rw 05 76 th P
532 soipah 0000637822359 jakid rt 10 rw 02 39 th P
533 anggi ayu l 0000637822517 jakid rt 10 rw 02 14 th P
535 darkonah 0000639028091 jakid rt 03 rw 08 42 th P
536 nurwati 0000638297829 karanglo rt 19 rw 04 28 th P
537 dakhrowi 0001032415841 jalor rt 03 rw 054 37 th L
541 dewi safitri 0000638321139 klampis rt 06 rw 02 24 th P
542 susmono 0000638116468 karanglo rt 18 rw 04 40 th L
543 indriyanti 0000639287842 jalor rt 03 rw 03 20 th P
544 naskhayatun 0000638321984 kl pucang rt 01 rw 01 21 th P
547 teguh aryo 0000637884696 jakid rt 04 rw 02 15 th L
548 m sholeh 0000638825657 jakid rt 02 rw 05 62 th L
549 eko yulianto 0000637190526 jt rokeh rt 01 rw 03 17 th L
550 m oni 0000638261695 jalor rt 07 rw 03 15 th L
551 solekha 0000639293229 jakid rt 04 rw 03 52 th P
552 maprikha 0000638314075 jakid rt 04 rw 03 50 th P
556 roja 0000638448186 pamengger rt 05 rw 03 53 th L 27-11-2013
558 umi latifah 0000637448945 kr sembung rt 02 rw 01 7 th P
559 muiroh 0000637183991 jakid rt 04 rw 08 52 th P
560 alvin maulana 0000638341211 jakid rt 03 rw 10 2 th L
561 imelda 0000638059904 kr sembung rt 02 rw 08 14 th P
563 banu syarifah 0000638756842 jakid rt 04 rw 01 18 th P
565 sainah 0000639402107 karanglo rt 20 rw 04 46 th P
568 munikha 0000637859248 jalor rt 02 rw 01 46 th P
569 nurlela 0000638611727 karanglo rt 04 rw 01 22 th P
570 sunam 0000639224436 kb gadung rt 04 rw 04 60 th L
571 roheti 0000639126303 kts yasa rt 01 rw 03 47 th P
574 eem suhartini 0000637613054 jalor rt 01 rw 04 52 th P
576 roaedi 0000638206749 jakid rt 01 rw 09 42 th L
577 m rizaludin 0000637928447 kts yasa rt 02 rw 04 50 th L
579 nur soliha 0000638177185 jakid rt 03 rw 03 32 th P
580 sri arum 0000638032282 jakid rt 02 rw 09 25 th P
581 wasni 0000638203983 jakid rt 03 rw 06 19 th P
582 riyan m 0000639065992 dk maja rt 04 rw 07 8 th L
583 nurilah 0000637340082 kts yasa rt 07 rw 04 45 th P
584 tuti kholiyah 0000637734227 kts yasa rt 07 rw 04 18 th P
585 wisit wiharto 0001032417213 pamengger rt 08 rw 01 30 th L
586 faridah 0000637870634 kts yasa rt 03 rw 01 45 th P
587 masripah 0000638575806 kb nagung rt 08 rw 02 70 th P 11/28/2013
588 toipah 0000639251842 janegara rt 07 rw 03 43 th P
589 slamet 0000638418396 klampis rt 01 rw 01 58 th L
592 m amarudin 0000637871321 jakid rt 02 rw 09 6 th L
596 nur auliyah 0000638242468 jalor rt 06 rw 02 7 th P
598 st nur azizah 0000638456681 klikiran rt 06 rw 02 8 th P
599 tarimah 0000639718457 tembelang rt 15 rw 03 70 th P
600 siswanto 0000639612696 janegara rt 10 rw 04 17 th L
602 wafiq 0000639562961 klampis rt 11 rw 04 8 th L
604 ade irma 0000639196547 janegara rt 06 rw 02 21 th P
605 wasni 0000638343268 kl pucang rt 04 rw 01 51 th P
606 masroni 0000637431377 tembelang rt 12 rw 02 31 th L
609 melvian ayu 0000638820011 jakid rt 05 rw 05 9 th P 11/29/2013
610 nunung d 0000638818964 jakid rt 05 rw 05 32 th P
613 siti nur hidayati 0000638910066 jakid rt 02 rw 01 10 th P
614 fatonah 0010323911466 kr sembung rt 02 rw 01 60 th P
615 nur oktaviani 0000637933847 jakid rt 03 rw 03 3 th P
618 ah faqih 0000638181091 jakid rt 05 rw 05 13 th L
619 m zalfaruq 0001032437722 rg bandung rt 03 rw 03 7 th L
620 m zidny 0000638276185 jakid rt 02 rw 04 5 th L
624 moh tofik 0000639308057 jakid rt 03 rw 08 40 th L
626 sumarni 0001032380515 wn tawang rt 01 rw 01 26 th P
627 ramelon 0000639095613 jakid rt 01 rw 07 73 th P 11/30/2013
628 jariyah 0000637909119 pamengger rt 04 rw 03 55 th P
629 warsiti 0000638256914 jalor rt 03 rw 05 53 th P
630 moh adnan 0000639135022 kts yasa rt 02 rw 01 5 th L
631 dewi rahayu 0000638294534 jalor rt 01 rw 08 28 th P
632 abd aziz 0000638327283 kts yasa rt 01 rw 03 34 th L
635 roheti 0000638258837 jalor rt 07 rw 03 41 th P
636 kartika dwi 0000637949158 pamengger rt 01 rw 04 5 th P
638 m rifki 0000637924217 jakid rt 03 rw 08 12 th L
642 yoga indra 0000638278108 jakid rt 03 rw 02 5 th L
645 wahab 0000639056531 karanglo rt 02 rw 05 50 th L
646 nur afiatun 0000637924149 jakid rt 03 rw 08 21 th P
648 indri yuliani 0000637504053 jakid rt 04 rw 03 22 th P
649 aliya wulan 0000638505763 jakid rt 04 rw 03 7 th P
650 mastiyati 0000639022746 jakid rt 04 rw 05 55 th P
651 nur kholisoh 0000639310465 jakid rt 04 rw 05 18 th P
653 rokhaeningsih 0000638687755 dk maja rt 01 rw 03 26 th P
654 nurlela 0000638611727 karanglo rt 04 rw 01 22 th P
657 nur afiyah 0001032422049 kts yasa rt 01 rw 03 20 th P
658 marinah 0001032403858 jakid rt 04 rw 02 60 th P
659 wahyu muzamil 0000638129373 karanglo rt 09 rw 02 9 th L
660 amilatussadiyah 0000638172832 janegara rt 02 rw 01 23 th P
661 firman nur alam 0000638141343 jalor rt 02 rw 03 8 th L
663 titi anika 0000639260796 tembelang rt 08 rw 02 20 th P
BULAN : NOVEMBER TAHUN : 2013

rta Jamkesmas
DIAGNOSA Pemeriksaa TOTAL BIAYA
n LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13)
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
hb,golda Rp5,000 Rp5,000
pusing Rp 5,000
panas Rp 5,000
gatal Rp 5,000
pegel Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
abses Rp 5,000 Rp 11,750
pegel Rp 5,000
persistensi Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
radices Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
abses Rp 5,000 Rp 11,750
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
abses Rp 5,000 Rp 11,750
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pulpitis Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
abses Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
panas Rp 5,000
gds Rp5,000 Rp3,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
batuk Rp 5,000
abses Rp 5,000 Rp 11,750
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
gds Rp5,000 Rp3,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
abses Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
panas Rp 5,000
period Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
gds Rp5,000 Rp3,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
gangren pulpa Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
gds Rp5,000 Rp3,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
kariesdentin Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
gds Rp5,000 Rp3,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
bta Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
dr Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
batuk Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
grinding Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
kariesdentin Rp 5,000
luksasi Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
au Rp5,000 Rp3,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
gangren pulpa Rp 5,000
bta Rp 5,000
period Rp5,000 Rp11,750
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
bta Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
au Rp5,000 Rp3,000
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
bta Rp5,000 Rp4,500
pusing Rp 5,000
batuk Rp 5,000
panas Rp 5,000
panas Rp 5,000
panas Rp 5,000
batuk Rp 5,000
au Rp5,000 Rp3,000
batuk Rp 5,000
panas Rp 5,000
batuk Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
panas Rp 5,000
batuk Rp 5,000
bta Rp5,000 Rp4,500
panas Rp 5,000
pusing Rp 5,000
pegel Rp 5,000
hipertensi Rp 5,000
panas Rp 5,000
batuk Rp 5,000
pegel Rp 5,000
au Rp5,000 Rp3,000
TANDA
TANGAN
PASIEN
15

KAB/KOTA BREBES
Kepada Yth
di- Tempat
No. KARTU JENIS

UMUR KELA TANGGAL
(Thn) KUNJUNGAN
JAMKESMAS (L/P)
(1) (2) (3) (4) (5) (6) (7)

1 sepudin 0000638242748 jakid rt 02 rw 09 3 th L 02-12-2013
2 siti 0001033408131 jalor rt 05 rw 05 63 th P
3 parukhi 0000638852667 janegara rt 11 rw 04 36 th L
4 abu bakar 0000638191993 kts yasa rt 03 rw 03 70 th L
5 hafis 0000638959689 kts yasa rt 03 rw 03 4 th L
6 solidatul 0000638379167 kts yasa rt 01 rw 03 7 th P
7 sofa 0000638485938 kts yasa rt 05 rw 03 2 th P
8 warsito 0000638489894 jalor rt 02 rw 01 40 th L
9 waryani 0000638763062 tembelang rt 16 rw 03 2 th P
10 marsiti 0000638761443 tembelang rt 16 rw 03 84 th P
12 sainah 0000637386986 wana cala rt 03 rw 07 33 th P
14 mulud 0000637781436 jakid rt 02 rw 06 10 th L
16 m akil maulana 0000639344667 kts yasa rt 06 rw 04 12 th L
18 st rodiyah 0000638986482 dk maja rt 02 rw 12 24 th P
19 wulidah 0000638446432 kts yasa rt 01 rw 02 40 th P
20 tri alfarizi 0000638483466 jalor rt 06 rw 03 10 th L
21 indah 0000632762801 rg pendawa rt 08 rw 02 6 th P
22 st kaeni 0000637947806 jakid rt 02 rw 01 54 th P
23 andi saputra 0000639227272 dk maja rt 09 rw 02 8 th L
26 helen 0000638206299 cenang rt 04 rw 06 10 th P
27 dana 0000638319903 klampis rt 06 rw 02 53 th L
28 tarmono 0000638112622 karanglo rt 05 rw 01 43 th L
33 janah 0000637938246 jalor rt 02 rw 02 50 th P
37 roidah 0000636368479 jakid rt 06 rw 05 38 th P 03-12-2013
40 m nizar 0000639194661 jalor rt 05 rw 01 9 th L
46 iis sundari 0000639848879 karanglo rt 10 rw 04 21 th P
47 helen 0000639084847 karanglo rt 10 rw 04 2 th L
48 wurdiyanto 0000636758046 km amba rt 02 rw 04 50 th L
71 maryam 0000103242159 kts yasa rt 01 rw 04 63 th P 04-12-2013
85 kasmadi 0000638211813 janegara rt 01 rw 01 76 th L
86 ria faisah 0000637978771 jakid rt 01 rw 01 34 th P
87 darpi 0000636106747 jakid rt 03 rw 02 66 th P
88 sodah 0000638498259 pamengger rt 03 rw 02 65 th P
92 rambat 0001032401114 km amba rt 02 rw 01 61 th P
95 tunisah 0000103789163 kb nagung rt 02 rw 01 42 th P
96 rokhidah 0000639102824 kts yasa rt 02 rw 03 30 th P
99 surifah 0000638368317 jakid rt 02 rw 01 3 th P 05-12-2013
100 esti 0000637703094 jalor rt 06 rw 01 30 th P
101 aji maulana 0000632987691 kubang sari rt 01 rw 04 14 th L
102 sufi 0000638616633 jalor rt 06 rw 06 19 th P
103 m fajar r 0001032402522 jakid rt 02 rw 10 6 th L
104 nur aeni 0000638496616 wn tawang rt 06 rw 03 37 th P
107 defi rizki 0000637151578 jakid rt 02 rw 01 3 th P
108 muisah 0000637941791 kts yasa rt 03 rw 04 61 th P
110 fajar rizki a 0000638688453 dk maja rt 01 rw 03 4 th L
111 desi triasih 0000638510332 bojong rt 02 rw 03 8 th P
117 fania putri 0000637952185 jakid rt 03 rw 01 8 th P
120 supriyati 0000638667123 tg wulung rt 01 rw 01 33 th P
121 ah ade riyanto 0000637752014 dk maja rt 03 rw 03 7 th L
126 sumirah 0000638579463 dk maja rt 08 rw 05 50 th P 06-12-2013
131 warti 0000639289618 jakid rt 02 rw 05 43 th P
137 maliha 0001032401924 km amba rt 02 rw 01 42 th P
138 bela diana 0000639267434 jalor rt 01 rw 08 12 th P
141 nada nadia 0000639146924 kts yasa rt 04 rw 02 6 th P
144 laelatus sarifah 0000638673118 jalor rt 04 rw 02 31 th P
145 ica mutia 0000638348027 kd tukang rt 16 rw 03 5 th P
146 novita a 0000638866102 karanglo rt 15 rw 03 7 th P
148 m kheruman 0000637894256 dk maja rt 03 rw 08 12 th L
149 subur sumiati 0000639275024 janegara rt 01 rw 01 46 th L
150 numan abd hakim 0000636043784 jakid rt 02 rw 01 8 th L
155 sumirah 0000638579463 dk maja rt 08 rw 05 50 th P
160 warti 0000639289618 jakid rt 02 rw 05 43 th P 07-12-2013
172 asriyani 0000636286466 karanglo rt 06 rw 02 20 th P
173 edy sudiono 0000639036494 jakid rt 03 rw 03 66 th L
174 yogo 0000639506569 dk maja rt 05 rw 05 6 th L
175 putri 0000639509574 dk maja rt 05 rw 05 12 th P
176 washadi 0000638261673 kb nagung rt 05 rw 02 40 th L
181 toinah 0000636307142 jakid rt 03 rw 04 60 th P
187 anis 0000636429396 kr sembung rt 03 rw 05 11 th P
188 titin 0000632866068 rg pendawa rt 03 rw 02 2 th P
189 zahrotun 0000638612202 wana cala rt 03 rw 08 5 th P
191 syahkia 0000638778334 wana cala rt 03 rw 03 5 th P
192 sri mulyati 0000638707937 km amba rt 08 rw 02 19 th P
193 kalpiyah 0000638684466 kts yasa rt 01 rw 02 30 th P
194 nur amalia 0000638486926 kts yasa rt 01 rw 02 30 th P
196 karidah 0000639543918 jakid rt 03 rw 02 50 th P
197 nur halimah 0000626088207 kd sugih rt 02 rw 01 42 th P 09-12-2013
200 st salsa 0000625069846 kd sugih rt 02 rw 01 2 th P
202 anitya 0000638454803 kts yasa rt 03 rw 01 9 th P
206 nuridah 0001032401668 km amba rt 01 rw 01 51 th P
207 kasih 0000638023910 karanglo rt 05 rw 01 50 th P
208 nawiroh 0000637096307 jakid rt 02 rw 01 30 th P
217 ghofar 0000639086717 jakid rt 03 rw 03 30 th L
220 silviana 0000638942519 tembelang rt 14 rw 03 7 th P
224 salkhatun 0000637573222 pamengger rt 05 rw 04 30 th P
225 kaisah 0000637916095 pamengger rt 05 rw 04 50 th P
226 wardinah 0000103417437 pamengger rt 05 rw 04 50 th P
228 masdaris 0000639038938 tembelang rt 03 rw 02 16 th L 10-12-2013
233 waitah 0000636302220 jalor rt 08 rw 04 67 th P
234 m faturohman 0000638482299 jalor rt 01 rw 04 5 th L
239 samsul 0000637990633 jakid rt 06 rw 06 14 th L
240 wulandari 0000638226536 kb nagung rt 09 rw 02 7 th P
241 wasripah 0000637287936 kr sembung rt 08 rw 02 40 th P
242 suparti 0000638464536 klampis rt 10 rw 03 50 th P
244 supardi 0000638702637 karanglo rt 01 rw 04 42 th L
246 muadah 0000638344373 jalor rt 03 rw 01 50 th P
248 teguh 0000637584686 jakid rt 04 rw 02 45 th L
249 herawati 0000637884584 jakid rt 04 rw 02 33 th P
250 musliha 0001032419981 kts yasa rt 04 rw 02 40 th P
253 deni 0000638662959 karanglo rt 04 rw 01 7 th L
254 aenun 0000638276538 kb nagung rt 09 rw 02 7 th P 11-12-2013
258 ismi 0000638082801 kts yasa rt 01 rw 02 11 th P
261 hilda 0000638926626 jalor rt 06 rw 02 14 th P
266 rahmawati 0000638389616 kts yasa rt 01 rw 01 13 th P
267 umyati 0000638813343 dk maja rt 02 rw 05 52 th P
271 supenah 0000637755662 kts yasa rt 01 rw 04 78 th P
272 tika 0000638464868 dk maja rt 02 rw 02 10 th P
273 suherman 0000638646468 klampis rt 06 rw 02 43 th L
274 anis 0000639171314 wn cala rt 04 rw 01 4 th P
277 haryanti 0000638349908 dk maja rt 01 rw 01 43 th P
278 maria 0000638349306 dk maja rt 01 rw 01 22 th P
279 ulfah 0000638349307 dk maja rt 02 rw 02 23 th P
281 carmid 0000639530264 tembelang rt 05 rw 01 50 th L
283 darningsih 0000639098094 dk maja rt 04 rw 02 27 th P
286 muskonah 0000103239909 kb nagung rt 07 rw 01 48 th P
288 desi 0000639376276 janegara rt 02 rw 01 16 th P 12-12-2013
290 sariah 0000639289665 kts yasa rt 05 rw 02 60 th P
291 sripah 0000637248248 kts yasa rt 03 rw 01 50 th P
294 oktaviani 0000637641932 jakid rt 02 rw 04 14 th P
297 aryanti 0000638693186 klampis rt 04 rw 02 30 th P
299 sopuroh 0000639040493 kr sembung rt 03 rw 03 50 th P
300 kasman 0000639046596 kr sembung rt 03 rw 03 60 th L
302 novi 0000638617343 jalor rt 02 rw 02 21 th P
303 kasiri 0000637676901 kts yasa rt 04 rw 03 43 th P
305 jamilah 0000639588826 klampis rt 02 rw 03 49 th P
307 erliyah 0000638599184 km amba rt 02 rw 03 41 th P
309 rosid 0000638725667 klampis rt 03 rw 01 34 th L
310 sriarum 0000638802302 jakid rt 03 rw 02 17 th P
311 musiam 0000638263416 jakid rt 03 rw 04 21 th P
315 fadilatul 0000633319564 rg pandawa rt 09 rw 02 8 th P 13-12-2013
317 dewi 0001032415446 jalor rt 06 rw 01 17 th P
323 nur afin 0000636961781 tembelang rt 18 rw 03 16 th P
326 tokhil 0001032405139 jakid rt 02 rw 06 70 th L
328 rasmali 0000638876886 jalor rt 03 rw 03 53 th L
329 firutul 0000639488772 janegara rt 01 rw 07 12 th P
334 raminah 0001024202247 kts yasa rt 07 rw 04 70 th P
335 fitri 0000638278805 jakid rt 02 rw 04 30 th P
337 nasir haryono 0000638774673 jakid rt 03 rw 03 57 th L
338 rohandi 0000636373903 kts yasa rt 03 rw 02 52 th L
339 riopiah 0001032407414 jakid rt 03 rw 10 50 th P
343 khalimi 0000638230634 karanglo rt 18 rw 01 70 th L
344 khuwaroh 0000638276398 km amba rt 04 rw 02 30 th P
345 roidah 0001032446384 kl alang rt 01 rw 01 27 th P
346 putri 0000638932844 jakid rt 02 rw 06 21 th P 14-12-2013
349 takyadi 0000638677157 tembelang rt 08 rw 08 66 th L
354 ramini 0000103401056 bojong rt 11 rw 08 58 th P
356 riyana 0000637116346 jakid rt 02 rw 03 35 th P
357 mayadatul 0000638676986 kb nagung rt 01 rw 04 22 th P
359 m.maulana 0000638191269 jalor rt 03 rw 08 2 th L
360 siti rokhani 0000638818919 jalor rt 08 rw 05 40 th P
363 nuryati 0000638638836 kr sembung rt 07 rw 01 29 th P
364 ida rosidah 0000638292676 kr sembung rt 02 rw 03 28 th P
365 rahmadani 0000638282666 kr sembung rt 02 rw 04 6 th L
366 rinda 0000637767391 dk maja rt 01 rw 04 28 th P
367 kasirah 0000638287896 tembelang rt 10 rw 04 60 th P
369 m.topik 0000639509867 jakid rt 05 rw 08 46 th L
370 adi firman 0000638612256 jalor rt 01 rw 04 5 th L
372 yatin 0000632564019 rg pandawa rt 02 rw 02 35 th P
374 triningsih 0001032418348 pamengger rt 04 rw 01 41 th P
379 desisaesa 0000638730314 dk maja rt 02 rw 03 9 th P
380 titin 0001032407741 jakid rt 04 rw 01 46 th P 16-12-2013
384 torinah 0000639147532 janegara rt 05 rw 10 60 th P
386 tundiroh 0000637491791 tembelang rt 03 rw 01 40 th P
387 sunitah 0000638741327 klampis rt 05 rw 06 50 th P
388 tajo 0000637966563 tg wulung rt 07 rw 02 46 th L
389 jariyah 0000639343434 janegara rt 03 rw 02 28 th P
390 susyanti 0000638610647 buaran rt 02 rw 04 10 th P
391 rizki 0000638107726 buaran rt 03 rw 05 10 th L
392 m.diwan 0001032418923 pamengger rt 06 rw 01 7 th L
394 neng sumrotun 0000637573713 dk maja rt 03 rw 02 41 th P
395 sena 0000633056501 rg pandawa rt 06 rw 03 31 th P
396 kholifahtun 0000638855086 jalor rt 11 rw 05 8 th P
397 rizkimubarok 0000637437622 tembelang rt 01 rw 01 4 th L
398 dava 0000638021465 cenang rt 01 rw 02 12 th L
400 aryati 0000638811841 jalor rt 01 rw 02 38 th P
402 wantiha 0000637952656 kts yasa rt 09 rw 03 46 th P
407 fahmi 0000638606608 karanglo rt 15 rw 03 2 th L
408 selviani 0000638786942 jakid rt 03 rw 10 2 th P
412 karmen efendi 0000638288976 jakid rt 03 rw 09 50 th L 17-12-2013
415 rumini 0000637607807 jakid rt 02 rw 07 70 th P
418 nur maula 0000637841947 jakid rt 04 rw 06 48 th L
422 kartinem 0000638761783 dk maja rt 03 rw 02 43 th P
423 kasidin 0000638837827 jalor rt 03 rw 01 53 th L
443 maryam 0000103242159 kts yasa rt 01 rw 04 63 th P
445 khasanah 0000638621363 jalor rt 06 rw 04 50 th P 18-12-2013
458 tariyah 0000638376843 klampis rt 02 rw 03 53 th P
459 muzaki 0000638616486 karanglo rt 10 rw 04 6 th L
460 suyat 0000637999761 karanglo rt 06 rw 03 60 th L
461 solikha 0000639078546 karanglo rt 04 rw 01 36 th P
466 indah 0000638448107 janegara rt 01 rw 01 14 th P
467 koah 0000639197981 wn cala rt 10 rw 06 60 th P
468 m irfan 0000637865853 jakid rt 03 rw 07 9 th L
470 lukman 0000637568763 jakid rt 03 rw 07 10 th L 19-12-2013
475 heni 0000639104106 kts yasa rt 03 rw 02 12 th P
477 sakuroh 0000638704585 klampis rt 10 rw 03 31 th P
478 suta pambayun 0000639218867 dk maja rt 01 rw 01 4 th L
479 khasanah 0000103240101 km amba rt 03 rw 02 70 th P
481 ajeng 0000638320386 jalor rt 01 rw 01 17 th P
483 surtini 0000638883369 jalor rt 03 rw 02 35 th P
484 al fukron 0000638860873 bojong rt 06 rw 03 4 th L
486 reza 0000637775477 kts yasa rt 08 rw 02 17 th L
490 tuti 0000637250991 dk maja rt 02 rw 02 41 th P
492 sri inayah 0000638288561 jakid rt 06 rw 05 12 th P
493 martini 0000638998414 jt rokeh rt 02 rw 01 31 th P
494 romlah 0001032480243 jakid rt 03 rw 10 33 th L
495 daryono 0000638434496 kr sembung rt 04 rw 01 38 th P
496 yulina 0000639182338 jakid rt 05 rw 05 4 th P 20-12-2013
497 dewi arini 0000103414445 jalor rt 06 rw 01 17 th L
498 m mahfud kafa 0000638854536 jalor rt 05 rw 05 2 th P
499 rosa 0000638717834 km amba rt 04 rw 02 9 th L
500 abd rosid 0000638114263 karanglo rt 05 rw 01 36 th P
501 unarmi 0000638778806 jakid rt 03 rw 10 55 th P
502 suniti 0000638115939 karanglo rt 18 rw 04 50 th P
504 maulana 0000637986504 kr sembung rt 01 rw 06 3 th L
505 umrotun 0000637964187 kr sembung rt 01 rw 08 33 th P
506 adi purwanto 0000638755503 km amba rt 04 rw 02 6 th L
507 doniati 0000637651473 jalor rt 08 rw 01 38 th P
511 adinda 0000638388701 kb nagung rt 04 rw 03 8 th P
512 endang 0000638881626 kts yasa rt 07 rw 04 19 th P
513 riana 0000637118246 jakid rt 02 rw 03 36 th P
514 m ramdani 0000637118289 jakid rt 02 rw 03 13 th L
516 faturahman 0000637613638 jalor rt 01 rw 04 10 th L
518 kusnah 0000639272013 jakid rt 02 rw 08 48 th P
520 satno 0000638606886 jalor rt 03 rw 05 51 th L
521 komariyah 0000637523368 kr sembung rt 04 rw 02 33 th P
522 ah solihin 0000637624167 kr sembung rt 04 rw 02 8 th L
523 dainah 0000638114062 dk maja rt 01 rw 04 39 th P
524 kaimah 0000638842168 karanglo rt 20 rw 04 60 th P
526 kariyah 0000637620063 kr sembung rt 05 rw 06 33 th P 21-12-2013
527 suirah 0000638385521 kr sembung rt 05 rw 06 66 th P
528 ardi 0000638612268 jakid rt 01 rw 08 5 th L
530 komariyah 0000638067876 wn tawang rt 04 rw 04 42 th P
531 m rehan 0000637850246 jalor rt 01 rw 04 10 th L
533 musridah 0000632808108 rg pendawa rt 02 rw 09 60 th P
537 aryanto 0000638499632 jalor rt 05 rw 03 9 th L
538 kuryono 0000638326137 jakid rt 03 rw 04 40 th L
539 kholisoh 0000636264316 jalor rt 01 rw 01 14 th P
540 oktaviana 0000637894496 kr sembung rt 04 rw 05 3 th P
544 mursipah 0000638897284 jalor rt 06 rw 03 70 th P
545 fadil 0000638497361 jalor rt 05 rw 03 9 th L
547 sopiri 0000636800676 kr sembung rt 02 rw 07 52 th L
550 gilang 0000637651124 kts yasa rt 02 rw 02 5 th L
551 dwi wulan 0000637652182 kts yasa rt 02 rw 02 3 th P
553 raswen 0000638966347 tembelang rt 14 rw 03 70 th L
554 sahitah 0000637899881 kts yasa rt 06 rw 04 50 th P
557 deni putra 0000638487617 jalor rt 02 rw 01 12 th L
558 delen 0000638420826 dk maja rt 05 rw 02 10 th L
560 darmanto 0000637236156 bojong rt 06 rw 02 60 th L
561 roamsah 0000638633272 tembelang rt 16 rw 03 36 th P 23-12-2013
565 zahra 0000637840844 wn tawang rt 06 rw 03 7 th P
566 mairah 0000638216334 janegara rt 02 rw 01 80 th P
568 reza rofaul 0000639119812 dk maja rt 01 rw 01 8 th L
569 anisul fuad 0000638262336 jalor rt 03 rw 04 20 th L
570 agustiya 0000638286397 jakid rt 02 rw 04 32 th P
571 tahri 0000639180873 jalor rt 01 rw 01 36 th L
572 cayi 0000638286392 karanglo rt 16 rw 03 55 th P
575 leni oktorina 0000636616717 km amba rt 02 rw 03 17 th P
577 santi 0000638694223 bojong rt 01 rw 01 2 th P
578 m ramdon 0000637641637 jalor rt 02 rw 04 16 th L
580 hawadan 0000636161658 jalor rt 01 rw 03 36 th P
582 sulianah 0000638485053 wanacala rt 04 rw 01 17 th P
585 farhan 0000632368492 sitanggal rt 03 rw 09 10 th L
588 dainah 0000638777538 tembelang rt 03 rw 02 50 th P
589 wijah 0000638963616 pamengger rt 08 rw 03 40 th P
591 cantika 0000638072741 pamengger rt 03 rw 01 11 th P
592 faridah 0000637649106 kts yasa rt 02 rw 02 31 th P 24-12-2013
599 najwanti 0000637854232 dk maja rt 06 rw 07 45 th P
600 harti 0000638147529 jakid rt 04 rw 03 10 th P
603 fitri amulida 0000638561106 jalor rt 02 rw 02 3 th P
604 murni 0000637163493 wn tawang rt 04 rw 03 50 th P
607 aji pangestu 0000638717182 jakid rt 06 rw 05 16 th L
608 m rizki 0000624764248 mulyoharjo rt 02 rw 04 4 th L
609 supardi 0000637863039 dk maja rt 05 rw 01 48 th L
610 bahrudin 0000637907253 jalor rt 05 rw 03 18 th L
613 m agus 0000637727506 kr sembung rt 02 rw 05 13 th L
614 danisah 0000631761548 rg pendawa rt 02 rw 03 48 th P
615 wasirah 0000637963846 jt makmur rt 05 rw 01 55 th P
616 nokiroh 0000637944001 jt makmur rt 05 rw 01 19 th P
617 sumrah 0000637209314 kr sembung rt 02 rw 04 48 th P
619 ayu 0000636227098 kb nagung rt 02 rw 04 22 th P
621 dwi 0000637696563 jalor rt 08 rw 01 23 th P
622 nazwa 0000639139978 dk maja rt 04 rw 07 6 th P
626 jamilah 0000637868351 jakid rt 01 rw 07 50 th P 26-12-2013
627 tarpiah 0000638212138 janegara rt 01 rw 01 50 th P
628 hartinah 0001032420971 janegara rt 04 rw 01 56 th P
637 m wahyu 0000639108988 kts yasa rt 01 rw 03 6 th L
638 rihanah 0000633490268 rg pendawa rt 07 rw 02 47 th P
639 casminah 0000638494569 tembelang rt 18 rw 03 41 th P
641 joko pramono 0001032414939 jalor rt 05 rw 02 34 th L
642 edi sudiyaono 0000639036494 jakid rt 05 rw 05 72 th L
646 warsiti 0001032464212 kramat rt 04 rw 02 49 th P
647 rintono 0000638672771 jalor rt 04 rw 04 29 th L
651 tarpiah 0000638262527 karanglo rt 02 rw 10 58 th P
652 diska 0000638703821 km amba rt 02 rw 03 7 th P
653 ayu mulyasari 0000638199617 jakid rt 03 rw 04 10 th P
654 sopiyah 0001032415571 jalor rt 06 rw 01 60 th P 27-12-2013
655 warso 0000637426968 bojong rt 05 rw 01 50 th L
663 wahutoh 0000637836414 wn tawang rt 06 rw 03 24 th P
667 eva wulandari 0000637780677 kr sembung rt 01 rw 06 7 th P
670 sahri 0000638131646 kb nagung rt 02 rw 03 76 th L
671 mudasir 0000638547827 jalor rt 05 rw 04 70 th L
676 tonah 0000639078366 dk maja rt 02 rw 02 50 th P
681 melani 0000638501646 bojong rt 01 rw 01 10 th P
682 suroh 0000638500353 bojong rt 01 rw 01 50 th P
683 ah faisal 0000638796699 jakid rt 04 rw 01 11 th L
685 anas 0000637909289 jakid rt 02 rw 04 6 th L 28-12-2013
687 abdul rohim 0001032406170 jakid rt 04 rw 08 45 th L
689 lilis 0000626086786 kd sugih rt 02 rw 01 14 th P
691 henu akbar 0000639101215 kts yasa rt 01 rw 03 35 th L
692 nurhikmah 0000639178119 janegara rt 02 rw 01 31 th P
694 abd rohim 0000638833588 jalor rt 03 rw 03 70 th L
695 supriyadi 0000638038892 jakid rt 02 rw 01 57 th L
696 slamet s 0001032407096 jakid rt 02 rw 05 40 th L
697 taupik 0000638468549 klampis rt 09 rw 02 3 th L
699 munirah 0000638871769 wn tawang rt 07 rw 01 50 th P
700 mundirin 0000638863018 kts yasa rt 05 rw 03 39 th L
702 atika 0000637637162 jalor rt 08 rw 01 8 th P
704 st taimah 0000637906263 kr sembung rt 02 rw 01 66 th P
715 resti 0000638489316 dk maja rt 02 rw 05 6 th P
717 sairah 0000637881996 kts yasa rt 02 rw 03 45 th P 30-12-2013
718 tarjono 0000637632981 kts yasa rt 01 rw 04 55 th L
719 syarif 0001032408637 karanglo rt 02 rw 09 9 th L
720 ronipah 0001032408637 karanglo rt 02 rw 09 60 th P
721 sutiah 0000632508131 rg pendawa rt 13 rw 02 70 th P
722 fatiha 0000637790466 kts yasa rt 01 rw 02 38 th P
726 subur 0000638276679 janegara rt 01 rw 01 48 th L
727 zaenal abidin 0000638164885 janegara rt 01 rw 03 46 th L
728 sulfa 0000638322541 dk maja rt 03 rw 02 6 th L
731 andre 0000638396938 dk maja rt 01 rw 01 12 th L
733 usman 0000638431447 klampis rt 11 rw 04 63 th L
735 tunirah 0000638486864 jalor rt 02 rw 01 33 th P
737 nurhayati 0000635427178 kts yasa rt 01 rw 04 28 th P
738 jumriyah 0000638931116 dk maja rt 05 rw 02 60 th P
739 neng sumita 0000638789422 jakid rt 01 rw 09 37 th P
741 melina 0000637758336 dk maja rt 01 rw 04 4 th P
742 sairah 0000638674852 tembelang rt 16 rw 03 30 th P
743 eva 0000638624851 dk maja rt 01 rw 07 8 th P
744 khamidah 0000637890489 jakid rt 05 rw 05 53 th P
746 taruni 0000638622908 karanglo rt 04 rw 01 50 th P
752 khaliyah 0000638569967 jalor rt 02 rw 05 36 th P
753 ayu 0000637356723 kts yasa rt 03 rw 03 13 th P
755 taripah 0000638132141 jakid rt 04 rw 02 40 th P 31-12-2013
756 yuni mur 0000638098847 jalor rt 05 rw 03 19 th P
757 natasya 0000638875064 kb nagung rt 08 rw 02 4 th P
758 sandi 0000638028968 jakid rt 03 rw 06 12 th L
763 m mirza 0001032415209 jakid rt 05 rw 05 3 th L
767 misbarudin 0000638108136 kts yasa rt 01 rw 03 10 th L
772 putri nur sifa 0000638932544 jakid rt 02 rw 05 18 th P
776 darsini 0001032406481 jakid rt 01 rw 07 70 th P
779 syahrul 0000638811314 jakid rt 02 rw 09 2 th L
781 abdul ropi 0000638406215 kts yasa rt 01 rw 04 50 th L
783 nur azmi 0000637733452 janegara rt 01 rw 01 7 th L
784 m ayudatul 0000638472892 kr sembung rt 01 rw 04 52 th L
BULAN : DESEMBER TAHUN : 2013

eserta Jamkesmas
DIAGNOSA Pemeriksa TOTAL BIAYA
an LAB
(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13)
hipertensi Rp5,000
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
period 74 Rp5,000 Rp11,750
gatal Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
pegel Rp5,000
dl Rp5,000 Rp12,500
hipertensi Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
gds Rp5,000 Rp3,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
hipertensi Rp5,000
panas Rp5,000
gds Rp5,000 Rp3,000
gatal Rp5,000
panas Rp5,000
batuk Rp5,000
panas Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
abses 36 Rp5,000 Rp5,000 Rp55,000
batuk Rp5,000
batuk Rp5,000
gds Rp5,000 Rp3,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
pegel Rp5,000
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
bta Rp5,000 Rp4,500
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
bta Rp5,000 Rp4,500
gatal Rp5,000
GP period Rp5,000 Rp11,750
pulpa polip Rp5,000 Rp55,000
pusing Rp5,000
pegel Rp5,000
hipertensi Rp5,000
panas Rp5,000
hipertensi Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
bta Rp5,000 Rp4,500
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
creat Rp3,000
panas Rp5,000
panas Rp5,000
panas Rp5,000
hipertensi Rp5,000
bta Rp5,000 Rp4,500
batuk Rp5,000
panas Rp5,000
pegel Rp5,000
panas Rp5,000
panas Rp5,000
batuk Rp5,000
panas Rp5,000
panas Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
gds Rp5,000 Rp3,000
pusing Rp5,000
panas Rp5,000
hipertensi Rp5,000
batuk Rp5,000
bta Rp5,000 Rp4,500
gatal Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
au Rp5,000 Rp3,000
batuk Rp5,000
pusing Rp5,000
pegel Rp5,000
panas Rp5,000
panas Rp5,000
pegel Rp5,000
panas Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
gatal Rp5,000
gatal Rp5,000
hipertensi Rp5,000
dl Rp5,000 Rp12,500
gatal Rp5,000
panas Rp5,000
panas Rp5,000
au Rp5,000 Rp3,000
batuk Rp5,000
pusing Rp5,000
panas Rp5,000
pegel Rp5,000
pusing Rp5,000
dr Rp5,000 Rp8,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
au Rp5,000 Rp3,000
batuk Rp5,000
pusing Rp5,000
pegel Rp5,000
panas Rp5,000
panas Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
gatal Rp5,000
pusing Rp5,000
panas Rp5,000
dl Rp5,000 Rp12,500
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
batuk Rp5,000
pegel Rp5,000
hipertensi Rp5,000
peroid 74 Rp5,000 Rp11,750
batuk Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
pegel Rp5,000
hipertensi Rp5,000
panas Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
gatal Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
hipertensi Rp5,000
bta Rp5,000 Rp4,500
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
peroid 76 Rp5,000 Rp55,000
gatal Rp5,000
panas Rp5,000
panas Rp5,000
dl Rp5,000 Rp12,500
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
au Rp5,000 Rp3,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
abses 36 Rp5,000 Rp55,000
batuk Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
panas Rp5,000
panas Rp5,000
pusing Rp5,000
pegel Rp5,000
hipertensi Rp5,000
gatal Rp5,000
batuk Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
dl Rp5,000 Rp12,500
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
pegel Rp5,000
pusing Rp5,000
panas Rp5,000
dr Rp5,000 Rp8,000
pegel Rp5,000
hipertensi Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
hipertensi Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
dl Rp5,000 Rp12,500
gatal Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
persistensi Rp5,000
radices 46 Rp5,000 Rp23,500
panas Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
gds Rp5,000 Rp3,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
persistensi Rp5,000
pusing Rp5,000
pegel Rp5,000
persistensi Rp5,000
batuk Rp5,000
abses 84 Rp5,000 Rp11,750
hipertensi Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
gatal Rp5,000
batuk Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
gatal Rp5,000
batuk Rp5,000
gds Rp5,000 Rp3,000
hipertensi Rp5,000
panas Rp5,000
hipertensi Rp5,000
hipertensi Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
gds Rp5,000 Rp3,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
pusing Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
dr Rp5,000 Rp8,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
gds Rp5,000 Rp3,000
panas Rp5,000
batuk Rp5,000
gds Rp5,000 Rp3,000
batuk Rp5,000
pusing Rp5,000
pegel Rp5,000
pegel Rp5,000
panas Rp5,000
dr Rp5,000 Rp8,000
hipertensi Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
pusing Rp5,000
pegel Rp5,000
panas Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
batuk Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
period 36 Rp5,000 Rp11,750
pegel Rp5,000
panas Rp5,000
gds Rp5,000 Rp3,000
batuk Rp5,000
batuk Rp5,000
pusing Rp5,000
hipertensi Rp5,000
pegel Rp5,000
batuk Rp5,000
period Rp5,000 Rp11,750
batuk Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
hipertensi Rp5,000
panas Rp5,000
gds Rp5,000 Rp3,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
dr Rp5,000 Rp8,000
batuk Rp5,000
panas Rp5,000
gds Rp5,000 Rp3,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
gds Rp5,000 Rp3,000
batuk Rp5,000
pegel Rp5,000
period Rp5,000
panas Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
hipertensi Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
gds Rp5,000 Rp3,000
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
dr Rp5,000 Rp8,000
pegel Rp5,000
gds Rp5,000 Rp3,000
pegel Rp5,000
gatal Rp5,000
GP period Rp5,000 Rp11,750
pusing Rp5,000
panas Rp5,000
hipertensi Rp5,000
panas Rp5,000
panas Rp5,000
gatal Rp5,000
dr Rp5,000 Rp8,000
panas Rp5,000
gatal Rp5,000
gatal Rp5,000
panas Rp5,000
pegel Rp5,000
pegel Rp5,000
panas Rp5,000
gds Rp5,000 Rp3,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
dr Rp5,000 Rp8,000
batuk Rp5,000
pegel Rp5,000
abses Rp5,000
panas Rp5,000
pusing Rp5,000
hipertensi Rp5,000
gds Rp5,000 Rp3,000
pegel Rp5,000
gatal Rp5,000
panas Rp5,000
persistensi Rp5,000
persistensi Rp5,000
panas Rp5,000
batuk Rp5,000
hipertensi Rp5,000
dr Rp5,000 Rp8,000
pegel Rp5,000
persistensi Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
panas Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
gds Rp5,000 Rp3,000
batuk Rp5,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
pusing Rp5,000
DR Rp5,000 Rp8,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
dl Rp5,000 Rp12,500
batuk Rp5,000
batuk Rp5,000
batuk Rp5,000
Period 47 Rp5,000 Rp11,750
pegel Rp5,000
panas Rp5,000
GDS Rp5,000 Rp3,000
Gingivitis Rp5,000 Rp22,500
panas Rp5,000
panas Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
dl Rp5,000 Rp12,500
panas Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
panas Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
panas Rp5,000
batuk Rp5,000
dl Rp5,000 Rp12,500
pegel Rp5,000
gatal Rp5,000
Period 47 Rp5,000 Rp11,750
pegel Rp5,000
hipertensi Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
gatal Rp5,000
Pulpa polip Rp5,000 Rp55,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
hipertensi Rp5,000
panas Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
dl Rp5,000 Rp12,500
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
Abses Rp5,000 Rp55,000
pegel Rp5,000
pegel Rp5,000
pegel Rp5,000
pusing Rp5,000
batuk Rp5,000
gatal Rp5,000
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
Gp fisture Rp5,000 Rp11,750
pegel Rp5,000
hipertensi Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
dl Rp5,000 Rp12,500
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
pegel Rp5,000
panas Rp5,000
panas Rp5,000
batuk Rp5,000
DR Rp5,000 Rp8,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
dl Rp5,000 Rp12,500
hipertensi Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
Persistensi Rp5,000 Rp17,000
pegel Rp5,000
pegel Rp5,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
Abses Rp,5000 Rp55,000
batuk Rp5,000
pusing Rp5,000
batuk Rp5,000
hipertensi Rp5,000
DR Rp5,000 Rp8,000
panas Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
pusing Rp5,000
pegel Rp5,000
pegel Rp5,000
Gangrenpulpa Rp5,000 Rp12,750
pegel Rp5,000
pegel Rp5,000
hipertensi Rp5,000
panas Rp5,000
batuk Rp5,000
hipertensi Rp5,000
batuk Rp5,000
batuk Rp5,000
hipertensi Rp5,000
pusing Rp5,000
AU Rp5,000 Rp3,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
pe Rp5,000
Gp fisture Rp5,000 Rp11,750
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
pusing Rp5,000
batuk Rp5,000
batuk Rp5,000
panas Rp5,000
gatal Rp5,000
Radices 35 Rp5,000 Rp32,500
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
hipertensi Rp5,000
pusing Rp5,000
pusing Rp5,000
pegel Rp5,000
BTA Rp5,000 Rp4,500
pusing Rp5,000
panas Rp5,000
pegel Rp5,000
pusing Rp5,000
Persistensi 62 Rp5,000 Rp17,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
pegel Rp5,000
hipertensi Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
panas Rp5,000
hipertensi Rp5,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
pegel Rp5,000
gatal Rp5,000
BTA Rp5,000 Rp4,500
BTA Rp5,000 Rp4,500
pusing Rp5,000
panas Rp5,000
pegel Rp5,000
panas Rp5,000
batuk Rp5,000
batuk Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
panas Rp5,000
batuk Rp5,000
pegel Rp5,000
pegel Rp5,000
batuk Rp5,000
batuk Rp5,000
gatal Rp5,000
BTA Rp5,000 Rp4,500
batuk Rp5,000
panas Rp5,000
pegel Rp5,000
DR Rp5,000 Rp8,000
hipertensi Rp5,000
pegel Rp5,000
hipertensi Rp5,000
batuk Rp5,000
pegel Rp5,000
panas Rp5,000
pegel Rp5,000
BTA Rp5,000 Rp4,500
batuk Rp5,000
panas Rp5,000
pegel Rp5,000
TANDA
TANGAN
PASIEN
15

Jamkesmas Noval

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Jamkesmas Noval

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DAFTAR TAGIHAN KLAIM RAWAT JALAN JAMKESMAS DI P

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5)

1 suparti 0000638306632 kramat rt 08 rw 02 44 th P

BULAN : APRIL TAHUN : 2013

at Jalan Peserta Jamkesmas

(6) (7) (8) (9) (10) (11) (12) 13 = (8+9+10+11+12) 14

01-04-2013 batuk Rp,5000

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6)

BULAN : MEI TAHUN

wat Jalan Peserta Jamkesmas

(7) (8) (9) (10) (11) (12) (13)

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6) (7)

BULAN : MEI TAHUN : 2013

(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13) 15

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6) (7)

BULAN : JULI TAHUN : 2013

(8) (9) (10) (11) (12) (13) 14 = (9+10+11+12+13) 15

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6) (7)

BULAN : AGUSTUS TAHUN : 2013

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6) (7)

BULAN : SEPTEMBER TAHUN : 2013

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6) (7)

BULAN : OKTOBER TAHUN : 2013

PROPINSI JAWA TENGAH

No. KARTU JENIS TANGGAL

BULAN : NOVEMBER TAHUN : 2013

PROPINSI JAWA TENGAH

No. KARTU JENIS

(1) (2) (3) (4) (5) (6) (7)

BULAN : DESEMBER TAHUN : 2013

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