No Register :

Nama Klub : Mengger Ceria I (Hipertensi)

Duta Prolanis :
Tempat Kegiatan : Puskesmas Mengger
Alamat : Jl. Sukamanah No 32
No Tlp/ Hp : (022) 5223729
dr/FKTP pembina : dr. Rita Irmawaty
Tgl Terbentuk : 8 Oktober 2014

NO NAMA UMUR NO KARTU BPJS JK STATUS

P/I/S/A NAMA OBAT (SIGNA DAN JUMLAH Keterangan

1 Acih 67 0000503175194 P I Amlodipine 5mg 1x1 (30) HT

2 Ai Kartini 62 0001013168294 P I Amlodipine 5mg 1x1 (30) HT

3 Ai Rukmini 59 0001338691623 P I Amlodipine 5mg 1x1 HT

4 Ai Saodah 63 0001336256482 P I Micardis 40mg 1x1 (pagi) (30) HT

Amlodipine 10mg 1x1 (30)
Bisoprolol 5mg 1x1/2
(siang) (15)
5 Akep 50 0001448824522 L P Amlodipine 5mg 1x1 (30) HT

6 Azuryati 56 0000055336397 P P Amlodipine 5mg 1x1 (30) HT

7 Encum 65 0000503845132 P I Amlodipine 5mg 1x1 (30) HT

8 Euis Juarsih 56 0001422955451 P I Captopril 12,5mg 2x1 (60) HT

9 Icun 68 0000503589543 P I Captopril 12,5mg 2x1 (60) HT

10 Iing Juariyah 44 0001448825016 P I Amlodipine 5mg 1x1 (30) HT

11 Iting 69 0001013168913 P I Amlodipine 5mg 1x1 (30) HT

12 Karmini 66 0000504170278 P I Amlodipine 5mg 1x1 (30) HT

13 Karsilah 51 0000055696634 P I Amlodipine 5mg 1x1 (30) HT

14 Kusnadi 65 0001389442544 L P Amlodipine 5mg 1x1 (30) HT

15 Kuspita 72 0000057194324 P I Amlodipine 5mg 1x1 (30) HT

16 Lasmanah 53 0000503162717 P I Amlodipine 5mg 1x1 (30) HT

17 Lilis 49 0000503909651 P I Amlodipine 5mg 1x1 (30) HT

18 Mala 65 0000503170345 P I Amlodipine 5mg 1x1 (30) HT

19 Nani R 51 0001448117065 P I Amlodipine 5mg 1x1 (30) HT

20 Nenden 43 0000503749923 P I Amlodipine 5mg 1x1 (30) HT

21 Neneng Yundini 59 0001440990718 P I Amlodipine 5mg 1x1 (30) HT

22 Nia 35 0000503120709 P I Amlodipine 5mg 1x1 (30) HT

23 Nia Kurniawati 40 0001439283892 P I Amlodipine 5mg 1x1 (30) HT

24 Ocah 70 0000503601118 P I Amlodipine 5mg 1x1 (30) HT

25 Oma 90 0000160422704 L P Amlodipine 5mg 1x1 (30) HT

26 Paulina Rotua 59 0000055365028 P I Amlodipine 5mg 1x1 (30) HT

27 Ronengsih 61 0000503183981 P I Amlodipine 5mg 1x1 (30) HT

28 Rukmana 63 0000503555883 L P Amlodipine 5mg 1x1 (30) HT

29 Sainah 62 165383(JAMKESDA)/ P I Amlodipine 5mg 1x1 (30) HT
0001449859544/
NIK
3273215206550001
30 Siti Badriah Maria F 55 0001262422091 P I Amlodipine 5mg 1x1 (30) HT

31 Siti Sajaah 61 0001321180907 P I Amlodipine 5mg 1x1 (30) HT

32 Suprijono 65 0001267530388 L P Amlodipine 5mg 1x1 (30) HT

Micardis 80mg 1x1 (30)

33 Tatang Sumantri 49 0001326074883 L P Amlodipine 5mg 1x1 (30) HT

34 Teti Rubianti 43 0000501294758 P I Amlodipine 5mg 1x1 (30) HT

35 Uta 63 0000503854841 P I Amlodipine 5mg 1x1 (30) HT

36 Kastinah 49 0001183016564 L I Amlodipine 5mg 1x1 (30) HT

37 Poniran 57 0001143170109 P P Amlodipine 5mg 1x1 (30) HT

38 Euis Haryati 52 0001397859399 P I Amlodipine 10mg 1x1 (30) HT

Vit BC 50 mg 1x1 (30)

39 Abdurahman 67 0001799197255 L P Amlodipine 5mg 1x1 (30) HT

40 Enab 68 0001397859208 P I Amlodipine 5mg 1x1 (30) HT

41 Enung 45 0001013169172 P I Amlodipine 5mg 1x1 (30) HT

42 Upit Rohanah 54 0001397861741 P I Amlodipine 5mg 1x1 (30) HT

43 Iin Widianingsih 52 0000503784718 P I Amlodipine 5mg 1x1 (30) HT

44 Ai Rohaeni 58 0000503793336 P I Amlodipine 5mg 1x1 (30) HT

45 Uhi 55 0001013168204 L P Amlodipine 5mg 1x1 (30) HT

46 Rokaesih 53 0001013169969 P I Amlodipine 5mg 1x1 (30) HT

47 Rokayah 74 0000503127595 P I Amlodipine 5mg 1x1 (30) HT

48 Tintin Rostini 58 0001311132846 P I Amlodipine 5mg 1x1 (30) HT

49 Wiwin Warnasari 49 0001397872809 P I Amlodipine 5mg 1x1 (30) HT

50 Nanan 58 0000503786529 P I Amlodipine 5mg 1x1 (30) HT

51 Adang Sutara 61 0001811542836 L P Captopril 12,5mg 2x1 (60) HT

52 Nurhaedah 45 0001474113486 P I - HT
 53 Apong Maryati 59 0001397875961 P I - HT

54 Mimin Jubaedah 42 00005038511005 P I - HT

KETERANGAN:
TOTAL 54 ORANG
No Register :

Nama Klub : Mengger Ceria II

Duta Prolanis : Dedi Hermawan
Tempat Kegiatan : Puskesmas Mengger
Alamat : Jl. Sukamanah No 32
No Tlp./HP : 022-5223729
dr./FKTP Pembina : dr. Rita Irmawaty
Tgl. Terbentuk : 9 September 2015

STATUS JK
NO NAMA PESERTA UMU NO KARTU ALAMAT NO TELP/HP DIAGNOSA OBAT (signa&jumlah)
R P/I/S/A
1 Acih 57 0000503804182 I P Sukamulya RT 02/04 DM+HT Captopril 12,5 mg 2x1 (60)
Metformin 500mg 3x1 (90)

2 Aminah 59 164511 (JAMKESDA)/ I P Sukamanah RT 01/02 082318309856 DM Metformin 500mg 3x1 (90)
0001449865462/ Vit B12 50mg 1x1 (30)
NIK 3273214806520001
3 Dedi Hermawan 58 0001440990055 P L Batununggal Mulia IX No 26 08522300814 DM Metformin 500mg 3x1 (90)

4 Endang 65 2929 (JAMKESDA)/ P L Cipagalo RT 04/03 DM+HT Glicab 80mg 1x1 (30)
0001298909867/ Aptor 1x1 (30) Bisoprolol
NIK 3273211011520001 1x1 (30) Metformin
500mg 3x1 (90)

5 Euis Rokayah 72 0000503153392 P P Sukamulya RT 05/04 DM+HT Amlodipine 5mg 1x1 (30)
Merformin 500mg 3x1 (90)

6 Kuntoro 72 0000057190972 I P Sukamanah RT 03/02 DM+HT masih di PPK II

 7 Tatang 59 165382 (JAMKESDA)/ I L Sukamulya RT 03/04 DM+Glukoma Metformin 500mg 3x1 (90)
0001449856539/ +HT Amlodipine 10mg 1x1 (30)
NIK 3273211812450002
8 Ceceh 59 0000503897512 P L Jl. Sukamanah RT 03/07 DM Glimepiride 2mg 1x1 (30)
Vit B12 50mg 1x1 (30)

9 Yulia Mellyani 73 0001457577279 P P Mengger Tengah RT 05/01 DM+HT Amlodipine 5mg 1x1 (30)
Metformin 500mg 2x1 (60)
Glimepiride
1mg 1x1 (30)
10 Mamah 65 0001460242023 I P Batununggal Mulia XII No 14 DM+HT Amlodipine 5mg 1x1 (30)

11 Karyati 59 0001397857858 I P Sukamulya RT 02/04 HT+DM Metformin 500mg 3x1 (90)

Captopril 12,5mg 2x1 (60)

12 Tati Tri Susanti 68 0001397875509 I P Sukamanah RT 02/02 DM Metformin 500mg 3x1 (90)

Di bawah ini peserta yang terdaftar baru mulai April 2017

No Nama UMU No. BPJS P/ I/ S/ A JK Alamat No. Hp Diagnosa Therapi
R
1 Oneng Suryani 70 0001397861346 I P Sukamanah RT 03/02 DM Metformin 500mg 3x1
Glimepiride 2mg 1x1

KETERANGAN:
JUMLAH PESERTA YANG BARU +1 ORANG
TOTAL 13 ORANG