DAFTAR HADIR PESERTA EDUKASI & SENAM DIABETES

BAGI PESERTA BPJS YANG MENDERITA DIABETES MIELITUS & HIPERTENSI

Nama Dokter : dr.WIWIK KUSNUL LATIFAH

Nama Paguyuban/Club Prolanis : Kemlagi DM & HIPERTENSI CLUB
Tempat Kegiatan : Ruang Pertemuan Puskesmas kemlagi
Tanggal Pertemuan : SABTU, 08-JULI-2017

NO NAMA NO.KARTU ALAMAT NO.TELP TANDA TANGAN

1 SUNI (P) 0000727270558 MOJOWONO 1

2 RAHAYU (P) 0000098827165 MOJODADI 2

3 KASTURAH (P) 0001433574336 MOJOWONO 3

4 FATIMAH (P) 0000726005013 MOJODADI 4

5 UMI SALAMAH (P) 0001448225774 KEMLAGI 5

6 NASRI (P) 0001338373539 MOJOWONO 6

7 MUSLIKAH (P) 0001043797869 MOJODADI 7

8 MENIK MEI PURWANTI, A.MD.K

0000148777132 BERAT KULON 8

9 NGATAWI (L) 0000726661045 MOJOKUMPUL 9

10 ANIK (P) 0000099424304 MOJODADI 10

11 TUMIATI (P) 0000727103169 TANJUNGAN 11

12 SUWANA UFIYAH (P) 0001043797803 MOJODADI 12

13 TARIMAN (L) 0000099424293 MOJODADI 13

14 TRI RAHAYU (P) 0000726765996 MOJOPILANG 14

15 O E M B A R (L) 0000098643306 MOJODADI 15

16 SRIANAH (P) 0001302539815 KEMLAGI 16

17 SITI MUNAWAROH (P) 0001471093121 MOJODADI 17

18 SIGAM (P) 0000098501635 MOJOGEBANG 18

19 WIDATI JD MOESTAKIM (P) 0000101875004 PANDANKRAJAN 19

20 MUJIAH (P) 0002002299895 MOJODADI 20

21 SUPARDI KARTOADI P(L) 0000098827154 MOJODADI 21

22 MUHAMMAD KHOIRI (L) 0000098607723 KEMLAGI 22

23 SUHARTIN (P) 0001043798591 KEMLAGI 23

24 HARTATIK (L) 0000098603111 KEMLAGI 24

25 NGATIANI (P) 0000098499036 MOJOWATESREJO 25

26 WALIYAH (P) 0000726808757 MOJOPILANG 26

27 HARDI (L) 0000098495245 MOJOWONO 27

28 TARTATIK (P) 0000163045607 MOJODADI 28

29 SUMINTEN (P) 0000726337991 MOJOREJO 29

30 SRIASIH (P) 0000727535474 MOJOKUSUMO 30

31 SITI BADRIYAH (P) 0001043798499 KEMLAGI 31

32 SUNYADI (L) 0002002299963 MOJODADI 32

33 SUKEMI (P) 0000725662304 MOJODADI 33

34 SRIWATI (P) 0000727281055 MOJOWONO 34

35 PARDI (L) 0001302536452 KEMLAGI 35

36 SU'AH (P) 0000727155865 TANJUNGAN 36

37 GANI (P) 0000725673734 MOJODADI 37

38 SIDI,BSC (L) 0000098826557 MOJODADI 38

39 SARNI (P) 0000726566949 MOJOPILANG 39

40 EKOM MISKAM (L) 0001321739739 KEMLAGI 40

41 MUSTAKIM (L) 0001815108412 KEMLAGI 41

42 BAMBANG SETYAWAN (L) 0000098492916 MOJOGEBANG 42

43 SITI MUALIFAH (P) 0001535154175 MOJOWONO 43

44 SANI'AH (P) 0000726008152 MOJODADI 44

45 MAISYAROH(P) 0001899372622 MOJOPILANG 45

46 MULYATI (P) 0000725811513 MOJOKUSUMO 46

47 SUPENI (P) 0001430598791 JAPANAN 47

48 TONI MULYONO (L) 0000098505933 KEMLAGI 48

49 NUR ISNAINI (P) 0000098499532 KEMLAGI 49

50 RINI RISTANTI S. (P) 0000098491746 MOJOKERTO 50

51 SUMIYAR (P) 0000726028749 MOJOWATESREJO 51

52 DJUMANI (P) 0000098493805 MOJOKUMPUL 52

53 SUHARTO 0001296365589 MOJOWONO 53

54 FATEMI 0000098834466 KEMLAGI 54

55 SURIANI 0001296365861 KEMLAGI 55

56 SUMANI 0000727308729 MOJOWONO 56

57 SAIDAH 0000726650381 KEMLAGI 57

58 RIAMAH 0000727237833 MOJOWONO 58

59 SUMIATI 0001296365589 MOJOWONO 59

60 SUMIANI 0001839042909 MOJOWONO 60

61 SITI ASLIKHAH 0001478878424 MOJOWONO 61

62 SUKARNI SULIS 0000726546554 MOJOWONO 62

63 MARSINI 0000726379514 MOJOREJO 63

64 CANDRA WIJAYATI 0001309817417 KEMLAGI 64

65 UMI MAZIDAH 0000726400901 MOJOPILANG 65

66 PAITUN 0000726404218 MOJOREJO 66

67 SUKIYAH 0000727363528 KEMLAGI 67

68 DJARIYAH 0000726408156 KEMLAGI 68

69 SRIAH 0000727209595 TANJUNGAN 69

70 SRIMUANAH 0001959417821 MOJOKUSUMO 70

71 MUKHAYANAH 0000726612524 KEMLAGI 71

72 RANTIMAH 0001043795823 MOJOKUMPUL 72

73 TIWIK 0000725971278 MOJOREJO 73

74 RATI 0001426260352 MOJOPILANG 74

75 ANA OKTALIYAH 0000726356215 MOJOPILANG 75

76 ASLIKAH 0002081550104 MOJOWONO 76

77 NIKMAH 0002062655493 MOJOWONO 77

78 SUTASWI 0001291356516 JAPANAN 78

79 wiwit 0002062655493 MOJOPILANG 79

 LAPORAN KLAIM GDP & GDPP
UPT PUSKESMAS KEMLAGI
BULAN JUNI 2017

NO NAMA ALAMAT NO.KARTU L/P UMUR GULA DARAH TARIF GDP/

GDPP TOTAL BIAYA
PUASA GDPP
1 Suni Mojowono 0000727270558 P 64 Rp 10,000
2 Rahayu Mojadadi 0000098827165 P 64 Rp 10,000
3 Kasturah Mojowono 0001433574336 L 70 Rp 10,000
4 Fatimah Mojodadi 0000728005013 P 45 Rp 10,000
5 Umi salamah Kemlagi 0000726005013 P 63 Rp 10,000
6 Nasri Mojowono 0001338373539 P 51 Rp 10,000
7 Muslikah Mojodadi 0001043797869 P 64 Rp 10,000
8 Menik Mei P Beratkulon 0000148777132 P 35 Rp 10,000
9 Ngatawi Mojokumpul 0000726661045 P 76 Rp 10,000
10 Anik Beratkulon 0000099424304 P 65 Rp 10,000
11 Tumiati Mojokumpul 0000727103169 L 44 Rp 10,000
12 Suwana Ufiyah Mojodadi 0001043797803 L 46 Rp 10,000
13 Tariman Mojodadi 0000099424293 P 76 Rp 10,000
14 Tri Rahayu Mojopilang 0000726765996 P 53 Rp 10,000
15 Oembar Mojodadi 0000098643306 L 73 Rp 10,000
16 Srianah Kemlagi 0001302539815 P 70 Rp 10,000
17 Siti Munawaroh Mojodadi 0001471093121 P 57 Rp 10,000
18 Sigam Kemlagi 0000098501635 P 55 Rp 10,000
19 Widati jd Moetakim pandankrajan 0000101875004 P 73 Rp 10,000
20 Mujiah Mojodadi 0002002299895 P 46 Rp 10,000
21 Supardi Mojodadi 0000098827154 P 73 Rp 10,000
22 M.Khoiri Kemlagi 0000098607723 P 48 Rp 10,000
23 Suhartini Kemlagi 0001043798591 P 55 Rp 10,000
24 Hartatik Kemlagi 0000098603111 L 60 Rp 10,000
25 Ngatiani MojowatesRejo 0000098499036 P 51 Rp 10,000
26 Waliyah Mojopilang 0000726808757 L 44 Rp 10,000
27 Hardi Mojowono 0000098495245 L 56 Rp 10,000
28 Tartatik Mojodadi 0000163045607 P 61 Rp 10,000
29 Suminten Mojorejo 0000726337991 P 54 Rp 10,000
30 Sriasih Mojokusumo 0000727535474 L 74 Rp 10,000
31 Siti Badriyah Kemlagi 0001043798499 P 53 Rp 10,000
32 Sunyadi Mojodadi 0002002299963 P 47 Rp 10,000
33 Sukemi Mojodadi 0000725662304 P 65 Rp 10,000
34 Sriwati Mojowono 0000727281055 P 49 Rp 10,000
35 Pardi Kemlagi 0001302536452 P 57 Rp 10,000
36 Suah Tanjungan 0000727155865 P 47 Rp 10,000
37 Gani Mojodadi 0000725673734 L 62 Rp 10,000
38 Sidi Mojodadi 0000098826557 P 71 Rp 10,000
39 Sarni Mojopilang 0000726566949 P 60 Rp 10,000
40 Ekom Miskan Kemlagi 0001321739739 L 66 Rp 10,000
41 Mustakim Mojodadi 0001815108412 P 57 Rp 10,000
42 Bambang S Mojogebang 0000098492916 P 46 Rp 10,000
43 Siti Mualifah Mojowono 0001535154175 L 40 Rp 10,000
44 Sani'ah Mojodadi 0000726008152 P 69 Rp 10,000
45 Maisyaroh Mojopilang 0001899372622 P 56 Rp 10,000
46 Mulyati Mojokusumo 0000725811513 P 46 Rp 10,000
47 Supeni Japanan 0001430598791 p 54 Rp 10,000
48 Toni Mulyono Kemlagi 0000098505933 L 56 Rp 10,000
49 Nurisnaini Kemlagi 0000098499532 P 39 Rp 10,000
50 Rini ristanti Mojokerto 0000098491746 P 46 Rp 10,000
51 Sumiyar MojowatesRejo 0000726028749 L 61 Rp 10,000
52 Djumani Mojokumpul 0000098493805 L 58 Rp 10,000
53 Suharto Kemlagi 0001296365589 L 55 Rp 10,000
54 fatemi Kemlagi 0000098834466 P 61 Rp 10,000
55 Suriani Kemlagi 0001296365861 P 52 Rp 10,000
56 Sumani Mojowono 0000727308729 P 53 Rp 10,000
57 Saidah Kemlagi 0000726650381 P 55 Rp 10,000
58 Riamah Mojowono 0000727237833 P 58 Rp 10,000
59 Sumiati Kemlagi 0000726505391 L 67 Rp 10,000
60 Sumiani Mojowono 0001839042909 P 50 Rp 10,000
61 Siti Aslikhah Mojowono 0001478878424 P 47 Rp 10,000
62 Sukarni Sulis Mojowono 0000726546554 P 48 Rp 10,000
63 Marsini Mojorejo 0000726379514 P 64 Rp 10,000
64 Candra Wijayati Kemlagi 0001309817417 P 60 Rp 10,000
65 Umi Mazidah Mojopilang 0000726400901 P 52 Rp 10,000
66 Paitun Mojorejo 0000726404218 P 50 Rp 10,000
67 Sukiyah Kemlagi 0000727363528 P 65 Rp 10,000
68 Djariyah Kemlagi 0000726408156 P 57 Rp 10,000
69 Sriah Tanjungan 0000727209595 P 46 Rp 10,000
70 Srimuanah Mojokusumo 0001959417821 P 60 Rp 10,000
71 Mukhayanah Kemlagi 0000726612524 P 58 Rp 10,000
72 Rantimah Mojokumpul 0001043795823 P 58 Rp 10,000
73 Tiwik Mojorejo 0000725971278 P 63 Rp 10,000
74 Rati Mojopilang 0001426260352 P 63 Rp 10,000
75 Ana oktaliyah Mojopilang 0000726356215 P 40 Rp 10,000
76 Aslikah Mojowono 0002081550104 P 53 Rp 10,000
77 Nikmah Mojowono 0002062655493 P 48 Rp 10,000
78 Sutaswi Japanan 0001291356516 L 66 Rp 10,000
79 Wiwit Mojopilang 0002062655493 p 36 Rp 10,000

TOTAL

Mojokerto, 16 JUNI 2017

KEPALA UPT PUSKESMAS KEMLAGI

dr.WIWIK KUSNUL LATIFAH

NIP:197111042002122003
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 LAPORAN PEMERIKSAAN KEGIATAN PROLANIS
BULAN JUNI 2017
FKTP PUSKESMAS KEMLAGI

No Nama No. Kartu L/P Umur BB TB TB (m) TB2 IMT GDP GDPP TD Sebelum Senam

1 Suni 0000727270558 P 64 136 1.36 1.8496 0

2 Rahayu 0000098827165 P 64 155 1.55 2.4025 0

3 Kasturah 0001433574336 P 70 140 1.4 1.96 0

4 Fatimah 0000728005013 P 45 155 1.55 2.4025 0

5 Umi salamah 0000726005013 P 63 157 1.57 2.4649 0

6 Nasri 0001338373539 P 51 153 1.53 2.3409 0

7 Muslikah 0001043797869 P 64 148 1.48 2.1904 0

8 Menik Mei P 0000148777132 P 35 160 1.6 2.56 0

9 Ngatawi 0000726661045 L 76 165 1.65 2.7225 0

10 Anik 0000099424304 P 65 150 1.5 2.25 0

11 Tumiati 0000727103169 P 44 153 1.53 2.3409 0

12 Suwana Ufiyah 0001043797803 P 46 149 1.49 2.2201 0

13 Tariman 0000099424293 L 76 162 1.62 2.6244 0

14 Tri Rahayu 0000726765996 P 53 155 1.55 2.4025 0

15 Oembar 0000098643306 L 73 164 1.64 2.6896 0

16 Srianah 0001302539815 P 70 148 1.48 2.1904 0

17 Siti Munawaroh 0001471093121 P 57 149 1.49 2.2201 0

18 Sigam 0000098501635 P 55 160 1.6 2.56 0

19 Widati jd Moetakim 0000101875004 P 73 152 1.52 2.3104 0

20 Mujiah 0002002299895 P 46 157 1.57 2.4649 0

21 Supardi 0000098827154 L 73 161 1.61 2.5921 0

22 M.Khoiri 0000098607723 L 48 165 1.65 2.7225 0

23 Suhartini 0001043798591 P 55 150 1.5 2.25 0

24 Hartatik 0000098603111 p 60 150 1.5 2.25 0

25 Dewi Mei Nawang 0000726143376 P 31 158 1.58 2.4964 0

26 Ngatiani 0000098499036 P 51 158 1.58 2.4964 0

27 Waliyah 0000726808757 P 44 158 1.58 2.4964 0

28 Hardi 0000098495245 L 56 155 1.55 2.4025 0

29 Tartatik 0000163045607 P 61 150 1.5 2.25 0

30 Suminten 0000726337991 P 54 150 1.5 2.25 0

31 Sriasih 0000727535474 P 74 153 1.53 2.3409 0

32 Siti Badriyah 0001043798499 p 53 167 1.67 2.7889 0

33 Sunyadi 0002002299963 L 47 158 1.58 2.4964 0

34 Sukemi 0000725662304 P 65 151 1.51 2.2801 0

35 Sriwati 0000727281055 P 49 152 1.52 2.3104 0

36 Pardi 0001302536452 L 57 160 1.6 2.56 0

37 Suah 0000727155865 P 47 156 1.56 2.4336 0

38 Gani 0000725673734 P 62 158 1.58 2.4964 0

39 Sidi 0000098826557 L 71 160 1.6 2.56 0

40 Sarni 0000726566949 P 60 156 1.56 2.4336 0

41 Ekom Miskan 0001321739739 L 66 156 1.56 2.4336 0

42 Mustakim 0001815108412 L 57 156 1.56 2.4336 0

43 Bambang S 0000098492916 L 46 160 1.6 2.56 0

44 Siti Mualifah 0001535154175 P 40 160 1.6 2.56 0

45 Sani'ah 0000726008152 P 69 164 1.64 2.6896 0

46 Maisyaroh P 56 153 1.53 2.3409 0

47 Mulyati 0000725811513 P 46 154 1.54 2.3716 0

48 Supeni 0001430598791 P 54 150 1.5 2.25 0

49 Toni Mulyono 0000098505933 L 56 167 1.67 2.7889 0

52 Nurisnaini 0000098499532 P 39 157 1.57 2.4649 0

53 Rini ristanti 0000098491746 P 46 160 1.6 2.56 0

57 Sumiyar 0000726028749 P 61 154 1.54 2.3716 0

58 Djumani 0000098493805 P 58 153 1.53 2.3409 0

59 Suharto 0001296365589 L 55 153 1.53 2.3409 0

60 fatemi 0000098834466 P 61 150 1.5 2.25 0

61 Suriani 0001296365861 P 52 157 1.57 2.4649 0

62 Sumani 0000727308729 p 53 167 1.67 2.7889 0

63 Saidah 0000726650381 P 55 155 1.55 2.4025 0

64 Riamah 0000727237833 L 58 150 1.5 2.25 0

65 Sumiati 0000726505391 P 67 157 1.57 2.4649 0

66 Sumiani 0001839042909 P 50 158 1.58 2.4964 0

67 Siti Aslikhah 0001478878424 P 47 157 1.57 2.4649 0

68 Sukarni Sulis 0000726546554 P 48 157 1.57 2.4649 0

69 Marsini 0000726379514 P 64 153 1.53 2.3409 0

70 Candra Wijayati 0001309817417 P 60 160 1.6 2.56 0

72 Umi Mazidah 0000726400901 P 52 153 1.53 2.3409 0

73 Paitun 0000726404218 P 50 154 1.54 2.3716 0

74 Juanik 0001537552552 P 58 154 1.54 2.3716 0

75 Sukiyah 0000727363528 P 65 152 1.52 2.3104 0

76 Djariyah 0000726408156 L 57 153 1.53 2.3409 0

77 Sriah 0000727209595 P 46 156 1.56 2.4336 0

78 Dimyati 0000727347993 L 73 155 1.55 2.4025 0

79 Srimuanah 0001959417821 P 60 156 1.56 2.4336 0

80 Mukhayanah 0000726612524 p 58 150 1.5 2.25 0

81 Rantimah 0001043795823 P 58 148 1.48 2.1904 0

82 Tiwik 0000725971278 P 63
83 Rati 0001426260352 P 63

84 Ana oktaliyah 0000726356215 P 40

85 Aslikah 0002081550104 P 53

86 Nikmah 0002062655493 P 48

87 Sutaswi 0001291356516 L 66

MOJOKERTO,08 juli 2017

Kepala UPT Puskesmas Kemlagi

dr.WIWIK KUSNUL LATIFAH

NIP:197111042002122003
TD Sesudah Senam
08 juli 2017

smas Kemlagi