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REKAP KESELURUHAN PESERTA PRB

Nama FKTP : PUSKESMAS RANCABALI


Duta Prolanis : dr. MISYROFAH
Alamat : JL. TAMAN UNYIL NO.7 DS.ALAMENDAH KEC.RANCABALI
No Tlp./HP : 087855571305
dr./FKTP Pembina : dr. MISYROFAH

NO NAMA NO KARTU PST L/P P/I/S/A DIAGNOSA ALAMAT

1 Pulan 1234567890 L P HT xxxxxx

nb : Jika tidak ada perubahan signa dan jenis obat, maka laporan ini hanya tidak perlu dilakuka
ERTA PRB

NO TELP/HP NAMA OBAT SIGNA JUMLAH

123 amlodipin 3x1 90

nya tidak perlu dilakukan perubahan


Nama FKTP : PUSKESMAS RANCABALI
Duta Prolanis : dr. FIKIAWATI
Alamat : JL. TAMAN UNYIL NO.7 DS.ALAMENDAH KEC.RANCABALI
No Tlp./HP : 085220996633
dr./FKTP Pembina : dr. FIKIAWATI

19 NAMA NO KARTU PST L/P P/I/S/A DIAGNOSA

1 TARMINI 1089308259 P P HT+DM

2 ASEP RUSTIAWAN 1089297909 L P HT


3 AISAH 410205554 P P HT
4 TITIN 1002781528 P P HT
5 HATI 410513398 P P HT

6 WATI 409226624 P P HT+DM

7 DIDI 410244208 L P HT
8 MAMAN SUPARMAN 410017173 L P HT
9 DAMAN 1819642048 L P HT
10 MARYATI 1089300205 P P HT
11 NANI SURYANI 408791788 P P HT
12 IDAR A 409805076 P P HT
13 OSIH 1089303254 P P HT
14 TARMINI 1089301329 P P HT+DM

15 OOM 409580267 P P HT
16 ANIH 1002779392 P P HT
17 CARMANAH 410252455 P P HT

18 MARIAM 408945374 P P HT+DM

19 SOPIAH 407988336 P P HT
20 EROS 1089296109 P P HT
21 SUMIATI 409460883 P P HT
22 ROHATI 409190815 P P HT
23 VERONICA W 410014203 P P HT
24 WATI 1340332795 P P HT
25 AJO SUBAGIO 53798837 L P HT
26 RASWATI 409831773 P P HT
27 ICIN 1002779155 P P HT
28 IDAR 409275764 P P HT
29 ROHAYATI 409237806 P P DM
30 ENOK 409814008 P P HT
31 ABAN 1002780909 L P HT
32 SUMARNI 409788753 P P HT
33 TOTO 408739498 L P HT
34 MIMI 1286635926 P P HT+DM

35 UKA 1002780843 P P HT
36 ENAH SUHAENAH 410017206 P P HT
37 ETI 1002781743 P P HT
38 OPID 409116993 L P HT
39 CUCU WILAYATI 409114721 P P HT
40 OKOM 408867041 P P HT
41 ENIH 409198318 P P HT
42 IIM HASANAH 1340804452 P P HT
43 MIMIK 408789123 P P HT
44 CUCU SUMIATI 408638531 P P HT
45 IRAH RODIAH 409314982 P P HT
46 EULIS TATI 1341065531 P P HT
47 KOKOY 409792781 P P HT
48 NENIH 409959145 P P HT
49 YAYAH R 53043974 P P HT
50 NENAH 1002774835 P P HT
51 DEDE HATIJAH 2250820405 P P HT
52
IDA ROSIDA 1340384578 P P HT+DM
53
AI HERDIATIE 2072167795 P P HT+DM
54 TRISNAWATI 1462994357 P P HT
55 YANI 409210762 P P HT
56
BARNA SOBARNA 409869358 L P HT
57 KOMARIAH 409706043 P P HT
58 ASIH 409030931 P P HT
59 WINTARSIH 408751323 P P HT
60 MUMUN SOLIHAT 409278475 P P HT
61 MIMIN 409794265 P P HT
62 DADANG 1340911967 L P HT
63 TATI 2016790762 P P HT
64 ATIK 410050449 P P HT
65 YAYAH 409819656 P P HT
66 DASIH 1002780808 P P HT
67 NANI 1340911484 P P HT
68 TUTI MARYATI 409367744 P P HT
69 DEDEH JUBAEDAH 408899889 P P HT
70 AI KARTINI 1876427151 P P HT
71 LIAH 1340434541 P P HT
72 KARYATI 409199769 P P DM
73 DASIMAH 2248894359 P P HT
74 SITI HOPSAH 409013886 P P HT
75 WAWA 1340911462 P P HT
76 LILIS 409825124 P P HT
77 ENTIN WARTINI 1341055107 P P HT
78 ATING 1340912711 P P HT
79 MIMIN 53437566 P P HT
80 ENDANG 409220346 P P HT
81 AYI 410046579 P P HT
82 IIM MARYATI 3539597 P P HT
83 NANI SUPARTINI 408815741 P P HT
84 DEDAH 409353669 P P HT
85 YATI KUSMIATI 410537035 P P HT
86 SURYANA 409688482 P P HT
87 AMRAN 409587326 L P HT
88 E. SUTRISNI 53437476 P P HT
89 JUHAROH 409238122 P P HT
90 MA UJU 408744077 P P HT
C.RANCABALI

ALAMAT NO TELP/HP NAMA OBAT SIGNA JUMLAH

NGAUBAN 01/29

CIPANAWA 03/06 Amlodipin 5 mg 1x1 29


SINAPEUL 04/12 Amlodipin 10 mg 1x1 29
CIKONENG 02/28 Captopril 12,5 mg 2X1 58
CILASTARI 01/23 Amlodipin 10 mg 1x1 29
Amlodipin 5 mg 1x1 29
ARCA 02/27 Glibenklamid 5 mg 1x1 29
Metformin 500mg 1x1 29

PASIR LUHUR 03/19 Amlodipin 5mg 1x1 29


CIKAREO 03/26 Amlodipin 5 mg 1x1 29
CIBODAS 04/05 Amlodipin 10 mg 1x1 29
BABAKAN JAMPANG 01/15 Amlodipin 5mg 1x1 29
LEGOK KONDANG 03/18 Amlodipin 5mg 1x1 29
ARCA 01/27 Amlodipin 10 mg 1x1 29
KARAMAT 01/25 Amlodipin 5 mg 1x1 29
CILASTARI 03/23

BABAKAN JAMPANG 03/15 Amlodipin 10mg 1x1 29


ARCA 01/27
NGAUBAN 02/29 Amlodipin 5mg 1x1 29
Metformin 500mg 3x1 87
CILASTARI 03/24 Glienklamid 5mg 1x1 29
Amlodipin 5mg 1x1 29

CIKAREO 05/26
SINAPEUL 05/12 Amlodipin 5 mg 1x1 29
NGAUBAN 02/29
BUNINAGARA 01/08 Amlodipin 10 mg 1x1 29
CIOLE-OLE 01/04 Amlodipin 10 mg 1x1 29
DATAR PUSPA 03/13 Captopril 25mg 2x1 58
PASIR LUHUR 02/19 Amlodipin 10 mg 1x1 29
NGAUBAN 03/29
BAYONGBONG 01/05 Amlodipin 10 mg 1x1 29
BABAKAN JAMPANG 01/15 Amlodipin 10mg 1x1 29
BABAKAN JAMPANG 04/15 Amlodipin 5mg 1x1 29
ARCA 03/27 Amlodipin 10 mg 1x1 29
BABAKAN JAMPANG 04/15 Amlodipin 10 mg 1x1 29
BABAKAN JAMPANG 02/15
SINAPEUL 04/12 Amlodipin 10 mg 1x1 29
Amlodipin 5 mg 1x1 29
CIKAREO 03/26
Glibenklamid 5 mg 1x1 29
CIBODAS 04/05 Captopril 25 mg 2X1 58
CIKAREO 03/26 Amlodipin 5 mg 1x1 29
CIASIN 01/09 amlodipin 5mg 1x1 29
DATAR PUSPA 04/13
ARCA 03/27 Amlodipin 5mg 1x1 29
NGAUBAN 03/29
ARCA 02/27 Amlodipin 5 mg 1x1 29
KIARA 02/01
CIASIN 03/09 Amlodipin 5 mg 1x1 29
CILASTARI 02/30
LANGKOB 02/07 Captopril 25 mg 2x1 58
DATAR PUSPA 04/01
CIBODAS 02/05
SINAPEL 5/12 Captopril 12,5mg 3x1 87
BARUTUNGGUL Amlodipin 5mg 1x1 29
MEKARSARI 1/17 Amlodipin 10mg 1x1 29
BABAKAN JAMPANG 1/15 Captopril 12,5mg 1x1 29
Amlodipin 5 mg 1X1 29
BARUTUNGGUL 6/1 Metformin 500mg 1x1 29
Glibenklamid 5mg
BARUTUNGGUL 6/1 Amlodipin 5mg 1x1 29
BABAKAN JAMPANG 4/15
MEKARJAYA 2/11

BABAKAN JAMPANG 1/15


CIOLE-OLE 02/04
CIBODAS 1/5
CIBODAS 1/5
PASIRLUHUR 3/19
RANCABALI 2/3 Amlodipin 5mg 1x1 29
BABAKANJAMPANG 4/15 Amlodipin 5mg 1x1 29
HANJUANGBEREM 1/14 Amlodipin 10mg 1x1 29
PASIRLUHUR 4/19
CIASIN 2/9
CIBARIBIS 3/21
BARUTUNGGUL 2/2
PASIRLUHUR 2/20
BABAKANJAMPANG 1/17
LANGKOB 4/7
PASANGGRAHAN 2/9 Amlodipin 5mg 1x1 29
CIASIN 1/9 Metformin 500mg 1x1 29
KARAMAT 1/25
ARCA 4/27
BARUTUNGGUL 2/2
KARAMAT 2/25
SINAPEL 5/12 Amlodipin 5mg 1x1 29
CIBURIAL 4/10
CILASTARI 2/23 Amlodipin 5mg 1x1 29
HANJUANGBEREM 1/14
CIPANGISIKAN 3/8
SINAPEL 5/12
LANGKOB 2/6 Metildopa 250mg 3x1 87
LANGKOB 3/7 Amlodipin 5mg 1x1 29
CIKAREO 3/25
CIPANAWA 2/6 Amlodipin 5mg 1x1 29
CIPARAY 4/7 Amlodipin 5mg 1x1 29
BARUTUNGGUL 4/1 Amlodipin 5mg 1x1 29
SINAPEUL 12/4 Amlodipin 10mg 1x1 29
MEKARBARU5/3 Amlodipin 10mg 1x1 29
REKAP DATA PEMANTAUAN KESEHATAN
PESERTA PROLANIS CLUB (PERSIB)

No Register Club Prolanis : diisi petugas BPJS

Nama FKTP : PUSKESMAS RANCABALI


Duta Prolanis : dr. FIKIAWATI TRIANA
Alamat : JL. TAMAN UNYIL NO.7 DS. ALAMENDAH KEC.RANCABALI
No Tlp./HP : 085220996633
dr./FKTP Pembina : dr. FIKIAWATI TRIANA

BULAN AGUSTUS
L/P PISA BULAN MULAI
NO NAMA PESERTA NO KARTU TERDAFTAR DIAGNOSA IMT TEK. DARAH
TB BB GDP GDPP GDS HBA1C CHOL TOTAL CHOL LDL CHOL HDL TRIGLISERIDA
(Kg/m2) SISTOLE DIASTOLE
1 TARMINI 1089308259 P P HT+DM 146 46
2 ASEP RUSTIAWAN 1089297909 L P HT 160 86
3 AISAH 410205554 P P HT 140 54
4 TITIN 1002781528 P P HT 145 60
5 HATI 410513398 P P HT 151 46 Mohon diisi apabila peserta melakukan cek laboratorium.
Jika tidak pernah melakukan cek lab Profilipid dan HBA1C
6 WATI 409226624 P P HT+DM 144 55 145 maka biarkan kolom ini seperti ini
7 DIDI 410244208 L P HT
8 MAMAN SUPARMAN 410017173 L P HT 163 67
9 DAMAN 1819642048 L P HT 157 55
10 MARYATI 1089300205 P P HT
11 NANI SURYANI 408791788 P P HT 149 60
12 IDAR A 409805076 P P HT 136 40
13 OSIH 1089303254 P P HT+DM 150 61 115
14 TARMINI 1089301329 P P HT+DM 151 48
15 OOM 409580267 P P HT
16 ANIH 1002779392 P P HT
17 CARMANAH 410252455 P P HT
18 MARIAM 408945374 P P HT+DM 142 52 127
19 SOPIAH 407988336 P P HT
20 EROS 1089296109 P P HT 151 49
21 SUMIATI 409460883 P P HT 146 51
22 ROHATI 409190815 P P HT
23 VERONICA W 410014203 P P HT 159 77
24 WATI 1340332795 P P HT 144 56
25 AJO SUBAGIO 53798837 L P HT 164 70
26 RASWATI 409831773 P P HT
27 ICIN 1002779155 P P HT 151 74
28 IDAR 409275764 P P HT 154 62
29 ROHAYATI 409237806 P P DM 152 55 120
30 ENOK 409814008 P P HT 146 55
31 ABAN 1002780909 L P HT 160 40
32 SUMARNI 409788753 P P HT 155 74
33 TOTO 408739498 L P HT 149 44
34 MIMI 1286635926 P P HT+DM 145 47 135
35 UKA 1002780843 P P HT 145 51
36 ENAH SUHAENAH 410017206 P P HT 145 50
37 ETI 1002781743 P P HT 157 50
38 OPID 409116993 L P HT
39 CUCU WILAYATI 409114721 P P HT 149 70
40 OKOM 408867041 P P HT
41 ENIH 409198318 P P HT 150 59
42 IIM HASANAH 1340804452 P P HT
43 MIMIK 408789123 P P HT 150 50
44 CUCU SUMIATI 408638531 P P HT
45 IRAH RODIAH 409314982 P P HT 156 39
46 EULIS TATI 1341065531 P P HT
47 KOKOY 409792781 P P HT
48 NENIH 409959145 P P HT 158 104
49 YAYAH R 53043974 P P HT 155 63
50 NENAH 1002774835 P P HT 152 54
51 DEDE HATIJAH 2250820405 P P HT 158 104
52 IDA ROSIDA 1340384578 P P HT 158 104
53 AI HERDIATIE 2072167795 P P HT 158 104
54 TRISNAWATI 1462994357 P P HT
55 YANI 409210762 P P HT
56 BARNA SOBARNA 409869358 L P HT
57 KOMARIAH 409706043 P P HT
58 ASIH 409030931 P P HT
59 WINTARSIH 408751323 P P HT
60 MUMUN SOLIHAT 409278475 P P HT
61 MIMIN 409794265 P P HT 158 104
62 DADANG 1340911967 L P HT
63 TATI 2016790762 P P HT
64 ATIK 410050449 P P HT
65 YAYAH 409819656 P P HT 155 55
66 DASIH 1002780808 P P HT
67 NANI 1340911484 P P HT
68 TUTI MARYATI 409367744 P P HT
69 DEDEH JUBAEDAH 408899889 P HT
70 AI KARTINI 1876427151 P HT
71 LIAH 1340434541 P HT
72 KARYATI 409199769 P DM 150 50 115
73 DASIMAH 2248894359 P HT
74 SITI HOPSAH 409013886 P HT
75 WAWA 1340911462 P HT
76 LILIS 409825124 P P HT 145 55
77 ENTIN WARTINI 1341055107 P P HT 122 36
78 ATING 1340912711 P P HT 146 55
79 MIMIN 53437566 P P HT 137 49
80 ENDANG 409220346 P P HT 140 50
81 AYI 410046579 P P HT 154 55
82 IIM MARYATI 3539597 P P HT 142 61
83 NANI SUPARTINI 408815741 P P HT 157 68
84 DEDAH 409353669 P P HT 150 70
85 YATI KUSMIATI 410537035 P P HT 149 60
86 SURYANA 409587326 L P HT 155 67
87 AMRAN 408815741 P P HT 157 64
88 E. SUTRISNI 404304640001 P P HT 159 75
89 JUHAROH 1286735926 P P HT 145 49
90 MA UJU 4101580072 P P HT 157 65
TTD PESERTA
REKAP KEGIATAN PROLANIS
PESERTA PROLANIS CLUB (PERSIB)

Nama FKTP : PUSKESMAS RANCABALI


Duta Prolanis : dr. FIKIAWATI TRIANA
Alamat : JL. TAMAN UNYIL NO.7 DS.ALAMENDAH KEC.RANCABALI
No Tlp./HP : 085220996633
dr./FKTP Pembina : dr. FIKIAWATI TRIANA
REKAP KEGIATAN KELOMPOK
PESERTA PROLANIS CLUB (PERSIB)

Nama FKTP : PUSKESMAS RANCABALI


Duta Prolanis : dr. FIKIAWATI TRIANA
Alamat : JL. TAMAN UNYIL NO.7 DS.ALAMENDAH KEC.RANCABALI
No Tlp./HP : 085220996633
dr./FKTP Pembina : dr. FIKIAWATI TRIANA

KEGIATAN TTD
NO BULAN JUMLAH YG HADIR
JENIS TGL PEMBINA
1 SEPTEMBER 1 edukasi 28 52