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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 ALAMAT NO TELP/HP NAMA OBAT SIGNA JUMLAH

1 TARMINI 1089308259 P P HT+DM NGAUBAN 01/29 Amlodipin 10 mg 1X1 28

2 ASEP RUSTIAWAN 1089297909 L P HT CIPANAWA 03/06


3 AISAH 410205554 P P HT SINAPEUL 04/12
4 TITIN 1002781528 P P HT CIKONENG 02/28 Captopril 12,5 mg 2X1 56
5 HATI 410513398 P P HT CILASTARI 01/23
Amlodipin 5 mg 1x1 28
6 WATI 409226624 P P HT+DM ARCA 02/27 Glibenklamid 5 mg 1x1 28
Metformin 500mg 1x1 84

7 DIDI 410244208 L P HT PASIR LUHUR 03/19


8 MAMAN SUPARMAN 410017173 L P HT CIKAREO 03/26 Amlodipin 5 mg 1x1 28
9 DAMAN 1819642048 L P HT CIBODAS 04/05 Amlodipin 10 mg 1x1 28
10 MARYATI 1089300205 P P HT BABAKAN JAMPANG 01/15
11 NANI SURYANI 408791788 P P HT LEGOK KONDANG 03/18
12 IDAR A 409805076 P P HT ARCA 01/27 Amlodipin 10 mg 1x1 28
13 OSIH 1089303254 P P HT KARAMAT 01/25 Amlodipin 5 mg 1x1 28
14 TARMINI 1089301329 P P HT+DM CILASTARI 03/23
15 OOM 409580267 P P HT BABAKAN JAMPANG 03/15
16 ANIH 1002779392 P P HT ARCA 01/27
17 CARMANAH 410252455 P P HT NGAUBAN 02/29
Metformin 500mg 3x1 84
18 MARIAM 408945374 P P HT+DM CILASTARI 03/24 Glienklamid 5mg 1x1 28
Amlodipin 5mg 1x1 28
19 SOPIAH 407988336 P P HT CIKAREO 05/26
20 EROS 1089296109 P P HT SINAPEUL 05/12 Amlodipin 5 mg 1X1 28
21 SUMIATI 409460883 P P HT NGAUBAN 02/29
22 ROHATI 409190815 P P HT BUNINAGARA 01/08
23 VERONICA W 410014203 P P HT CIOLE-OLE 01/04
24 WATI 1340332795 P P HT DATAR PUSPA 03/13
25 AJO SUBAGIO 53798837 L P HT PASIR LUHUR 02/19 Amlodipin 10 mg 1x1 28
26 RASWATI 409831773 P P HT NGAUBAN 03/29
27 ICIN 1002779155 P P HT BAYONGBONG 01/05 Amlodipin 10 mg 1x1 28
28 IDAR 409275764 P P HT BABAKAN JAMPANG 01/15
29 ROHAYATI 409237806 P P DM BABAKAN JAMPANG 04/15 Amlodipin 5mg 1x1 28
30 ENOK 409814008 P P HT ARCA 03/27 Amlodipin 10 mg 1x1 28
31 ABAN 1002780909 L P HT BABAKAN JAMPANG 04/15
32 SUMARNI 409788753 P P HT BABAKAN JAMPANG 02/15
33 TOTO 408739498 L P HT SINAPEUL 04/12
Amlodipin 5 mg 1x1 28
34 MIMI 1286635926 P P HT+DM CIKAREO 03/26 28
Glibenklamid 5 mg 1x1
35 UKA 1002780843 P P HT CIBODAS 04/05
36 ENAH SUHAENAH 410017206 P P HT CIKAREO 03/26
37 ETI 1002781743 P P HT CIASIN 01/09
38 OPID 409116993 L P HT DATAR PUSPA 04/13
39 CUCU WILAYATI 409114721 P P HT ARCA 03/27
40 OKOM 408867041 P P HT NGAUBAN 03/29
41 ENIH 409198318 P P HT ARCA 02/27
42 IIM HASANAH 1340804452 P P HT KIARA 02/01
43 MIMIK 408789123 P P HT CIASIN 03/09 Amlodipin 5 mg 1x1 28
44 CUCU SUMIATI 408638531 P P HT CILASTARI 02/30
45 IRAH RODIAH 409314982 P P HT LANGKOB 02/07 Captopril 25 mg 2X1 56
46 EULIS TATI 1341065531 P P HT DATAR PUSPA 04/01
47 KOKOY 409792781 P P HT CIBODAS 02/05
48 NENIH 409959145 P P HT SINAPEL 5/12 Captopril 12,5mg 2X1 56
49 YAYAH R 53043974 P P HT BARUTUNGGUL
50 NENAH 1002774835 P P HT MEKARSARI 1/17
51 DEDE HATIJAH 2250820405 P P HT BABAKAN JAMPANG 1/15 Amlodipin 10mg 1x1 28
52
IDA ROSIDA 1340384578 P P HT+DM BARUTUNGGUL 6/1
Amlodipin 5 mg 1x1
53 Glibenklamid 5 mg 1x1
AI HERDIATIE 2072167795 P P HT+DM BARUTUNGGUL 6/1 Metformin 500mg 1x1 28
54 TRISNAWATI 1462994357 P P HT BABAKAN JAMPANG 4/15
55 YANI 409210762 P P HT MEKARJAYA 2/11
56
BARNA SOBARNA 409869358 L P HT BABAKAN JAMPANG 1/15
57 KOMARIAH 409706043 P P HT CIOLE-OLE 02/04
58 ASIH 409030931 P P HT CIBODAS 1/5
59 WINTARSIH 408751323 P P HT CIBODAS 1/5
60 MUMUN SOLIHAT 409278475 P P HT PASIRLUHUR 3/19
61 MIMIN 409794265 P P HT RANCABALI 2/3
62 DADANG 1340911967 L P HT BABAKANJAMPANG 4/15
63 TATI 2016790762 P P HT HANJUANGBEREM 1/14
64 ATIK 410050449 P P HT PASIRLUHUR 4/19
65 YAYAH 409819656 P P HT CIASIN 2/9 Amlodipin 5mg 1x1 28
66 DASIH 1002780808 P P HT CIBARIBIS 3/21
67 NANI 1340911484 P P HT BARUTUNGGUL 2/2
68 TUTI MARYATI 409367744 P P HT PASIRLUHUR 2/20
69 DEDEH JUBAEDAH 408899889 P P HT BABAKANJAMPANG 1/17 Amlodipin 5mg 1x1 28
70 AI KARTINI 1876427151 P P HT LANGKOB 4/7
71 LIAH 1340434541 P P HT PASANGGRAHAN 2/9 Amlodipin 5mg 1x1 28
72 KARYATI 409199769 P P DM CIASIN 1/9 Metformin 500mg 1x1 28
73 DASIMAH 2248894359 P P HT KARAMAT 1/25
74 SITI HOPSAH 409013886 P P HT ARCA 4/27
75 WAWA 1340911462 P P HT BARUTUNGGUL 2/2
76 LILIS 409825124 P P HT KARAMAT 2/25
77 ENTIN WARTINI 1341055107 P P HT SINAPEL 5/12
78 ATING 1340912711 P P HT CIBURIAL 4/10 Amlodipin 10mg 1x1 28
79 MIMIN 53437566 P P HT CILASTARI 2/23 Amlodipin 5mg 1x1 28
80 ENDANG 409220346 P P HT HANJUANGBEREM 1/14
81 AYI 410046579 P P HT CIPANGISIKAN 3/8
82 IIM MARYATI 3539597 P P HT SINAPEL 5/12
83 NANI SUPARTINI 408815741 P P HT LANGKOB 2/6 Captopril 25 mg 3x1 84
84 DEDAH 409353669 P P HT LANGKOB 3/7 Amlodipin 5mg 1x1 28
85 YATI KUSMIATI 410537035 P P HT CIKAREO 3/25
86 SURYANA 409688482 P P HT CIPANAWA 2/6
87 AMRAN 409587326 L P HT CIPARAY 4/7
88 E. SUTRISNI 53437476 P P HT BARUTUNGGUL 4/1
89 JUHAROH 409238122 P P HT SINAPEUL 12/4
90 TRESNAWATI 408669344 P P HT HANJUANGBEUREUM 2/14 Captropil 12,5 3x1 84
91 NINGRUM 408817451 P P HT IRIGASI 3/21 Amlodipin 5mg 1x1 28
92 TINI 410338416 P P HT NGAUBAN 1/29 Amlodipin 5mg 1x1 28
93 ELI 2286645254 P P HT SINAPEUL 5/11 Amlodipin 5mg 1x1 28
94 DEDI 2286645219 P P HT SINAPEUL 5/11 Amlodipin 5mg 1X1 28
95 AMANAH 410048482 P P HT MEKAR BARU 5/3
96 CICIH 408576521 P P HT PASANGRAHAN 1/9 Captropil 12,5 3x1 115
97 MA ESIH 408552568 P P HT MEKAR BARU 3/3
98 SAHRUM 409034531 P P HT CIASIN 9/1 Amlodipin 5mg 1X1 35
99 EHA 1002782316 P P HT CIOLEOLE 1/9 Captopril 12,5 mg 1X1 115
100 IDA ROSIDA 134038478 P P HT BARUTUNGGUL 6/1
101 II SUTARLI 2275981288 P P HT SINAPEUL AMlodipin 10mg 1X1 35
102 EMPON 2232116673 P P HT HANJUANGBEREM 1/14
103 UMAH 1002781866 P P HT MEKARBARU 4/3
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 DESEMBER
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
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
6 WATI 409226624 P P HT+DM 144 55
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
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
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
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
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
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 TRESNAWATI 408669344 P P HT 155 52
91 NINGRUM 408817451 P P HT 151 52
92 TINI 410338416 P P HT 156 52
93 ELI 2286645254 P P HT 156 55
94 DEDI 2286645219 P P HT 150 51
95 AMANAH 410048482 P P HT 146 50
96 CICIH 408576521 P P HT 149 55
97 MA ESIH 408552568 P P HT 151 38
98 SAHRUM 409034531 P P HT 163 55
99 EHA 1002782316 P P HT 147 47
100 IDA ROSIDA 134038478 P P HT 151 59
101 II SUTARLI 2275981288 P P HT 165 68
102 EMPON 2232116673 P P HT 152 59
103 UMAH 1002781866 P P HT 149 46
TEK. DARAH TTD PESERTA
DIASTOLE
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

DESEMBER 2017
Peserta Biaya-Biaya
No Tanggal Kegiatan Jenis Kegiatan Nama Klub Risti Materi Edukasi Risti Pemberi Materi Terdaftar Hadir Total Biaya
dalam Club Honor Mamin Biaya Lain
1 28/12/2017 EDUKASI PERSIB HIPERLIPIDEMIA dr Fikiawat 79 39 200,000 312,000 512,000
2
3
4
5
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 DESEMBER 1 edukasi 28 39