REG - GIGI Baru

LAPORAN HARIAN BP.
GIGI PUSKESMAS KARANGANYAR KOTA TASIKMALAYA

BULAN MARET TAHUN 2018
UMUR JENIS KUNJUNGAN KELURAHAN
Luar Wilayah
KARANGANYAR
TANGGAL
CILAMAJANG
NO. NAMA PASIEN NO. KARTU KIS ALAMAT bb tb
CIBEUTI
suhu
nadi
L P L P
B L B L L P L P L P L P
1 31 NY mudiroh 2146/12 28 1 cibuluh
2 ny resmiat 2753/12 514651241 33 1 segleng
3 tn dede sobandi 16102160/16 514267942 43 1 cibogo
4 rafi nur 1759/12 515298069 11 1 gn malang 4/9
5 m giann 4513/10 513954088 7 1 conggeang
6 ny susi 0566/11 514227857 31 1 tambir
7 yeni nuraeni 18000224/2018 36 1 tanjung 4/3
8 ira sulastri 16001430/16 514600042 35 1 cibogo 2/5
9 sit juliant 513635016 28 1 sk senang
10 01 m. Azhar 12933/2015 10 1 SAGULING PANJANG 1/6
11 sit aminah 1272/12 513778656 27 1 SUKAASIH 04/5
12 ibni 7026/14 3 1 TAMANSARI02/03
13 02 alfin 389/11 1669109556 16 1 bojong gaok
14 ny lian 18000214/18 513474311 22 1 conggeang
15 haevia nafisah 514384953 15 1 asta lebak 1/8
16 ridwan 1578/10 513607048 10 1 tambir br 3/5
17 deden danial 18100239/18 25 1 cibeut 1/6
18 aceng 11296/15 33 1 tambir 5/5
19 04 nuri fitri 7599/14 1667625434 3 1 cihonje 4/2
20 Enur hasanah 793/12 515162226 11 1 karangtengah
21 rika 4031/10 514294503 13 1 gn bitung 3/8
22 pipit ny 17002187/2017 26 1 genteng 01/11
23 05 nana sutsna 2712/10 1669109646 44 1 tambir baru
24 m arkan 16001057/16 18 bln 1 cicondong 3/9
25 rizki 12 1 gn bitung
26 06 Hest suryat 18000259/18 513834276 23 1 nagrog 2/2
27 ny maspupah 139/14 38 1 selaawi
28 sanny nuraeni 16978/16 6 1 cibuyut 1/rw01
29 07 mamun 2158/12 1667628314 62 1 karangtengah 3/4
30 nizam 320/13 5 1 bojong
31 iqbal 18100263/18 4 1 sk dana
32 aneu yulia 18100264/18 26 1 conggeang
33 tn usep 10741/15 39 1 cicondong 3/6
34 rika 4031/10 514294503 13 1 gn bitung 3/8
35 yet 33/13 51429752 35 1 gn bitung 2/8
36 08 putri fortuna 1609/12 5 1 sk dana
37 mila 758/13 514481108 25 1 gn bitung
38 09 nana sutsna 2712/10 1669109646 44 1 tambir baru
39 Dedi supriyadi 3695/11 513814116 53 1 bojong gaok 3/1
40 ny maspupah 139/14 513870851 38 1 selaawi
41 11 ny lastri 1753/12 513777914 51 1 genteng 2/1
42 fathir 17101297/17 514573198 8 1 nagrog 2/2
43 tn saepuloh 212/13 515077402 37 tambir 1/5
44 tn ali 18100290/18 23 1 cicondong 3/9
45 rika nuraeni 4031/10 514294503 12 1 gn bitung 3/8
46 ani 37 1 gn subang 2/12
47 12 jalaludin 18100303/18 45 1 asta lebak
48 nopal 18100305/18 18 1 cikedewul 1/6
49 diah ayu lestri, ny 6310/14 25 1 cijeruk hilir
50 resi 18000001/18 25 1 sukaluyu
51 risna 18000308/18 513848564 7 1 cibogo 4/3
52 m faris 18100307/18 11 1 cikedewul 1/6
53 13 ihah solihah, ny 9036/14 77 1 cijerah 2/3
54 kaka ridho, an 9678/14 11 1 selaawi 3/5
55 rendi, an 4262/10 7 1 sk sirna 5/4
56 nana sutsna, tn 2712/10 1669109646 44 1 tambir baru
57 14 ripa 16/2012 10 1 bojong
58 anindira 18000315/18 10 1 negla
59 resika nuraeni 18000314/18 10 1 negla
60 ny evi 7280/14 31 1 sk senang
61 16 wawa 3001/11 514360449 52 1 cijerah 4/3
62 yani 300/12 514152753 47 1 gn bitung 4/8
63 18 ny yant 18000324/18 28 1 cihonje 4/2
64 tn didin saidin 18100190/18 64 1 cihonje 1/2
65 ny evi 7280/14 31 1 sk senang
66 tn barnas 18100326/18 59 1 asta lebak 2/8
67 irma s. 3214/11 30 1 segleng 1/9
68 n. Aat 18000333/18 45 1 cikedewul 1/7
69 19 ny adah 498/10 513040858 59 1 sk senang 4/7
70 tn uyu 56 1 selaawi 1/12
71 ny heri 16001419/16 41 1 gn subanng
72 paidah 12199/15 18 1 sk asih 2/6
73 ny ia darsini 3518/2011 31 1 sk senang 1/7
74 m robi 4521/10 8 1 cikedewul 03/07
75 20 tn sodikin 2743/12 514518682 54 1 asta baru
76 m ilham 3302/10 514333528 9 1 asta pasir
77 m haikal 17583/16 5 1 negla 3/11
78 hasan sohib 18100345/18 1667482446 28 1 saguling pnjg 1/7
79 ny dede 3835/10 513979659 42 1 cicondong 3/6
80 khayla 11716/15 6 1 cikedewul 1/7
81 dina 3036/10 200604429 16 1 cijerah
82 n. Aat 18000333/18 45 1 cikedewul 1/7
83 risna 18000308/18 513848564 7 1 cibogo 4/3
84 ucu 11946/15 514497418 45 rc.bungur
85 enah 18000007/18 64 cibogo 4/3
86 21 raya ayuning 217/10 513593638 9 psr wangi
87 ADE RUSLAN 2424/10 514075544 50 1 PASIR WANGGI RT 2/01
88 22 dadang 18100353/18 64 1 saguling pjg
89 ADE RUSLAN 2424/10 514075544 50 1 PASIR WANGGI RT 2/01
90 ny mimin 801/2013 514667002 47 1 karang tengah 3/4
91 muta 803/2010 514075544 8 1 karangtengah 3/4
92 23 jalil 1895/13 514062145 77 1 cibuyut 2/1
93 yant nurazizah 1711/10 513856192 23 1 cijeruk girang
94 dina 3036/10 200604429 16 1 cijerah
95 25 dadang 18100353/18 64 1 saguling pjg
96 yuyus rosmiat 39 1 cibeut 1/6
97 tn m. Rahman 1513/12 62 1 cihonje
98 ny kokom 22/2014 34 1 negla 2/11
99 tn uyu 56 1 selaawi 1/12
100 sinta 2863/11 515063338 11 1 cijeruk hilir
101 assef pizar 863/10 514261012 10 1 cibuluh
102 imat ruhimat 40 1 gn lingga 3/3
103 26 NY UPIT 8113/14 514351067 46 1 gn lingga 1/3
104 ny nuning 18000368/18 1667629686 26 1 bj gaoj
105 aat rohayat 2668/12 514035066 34 1 selaawi 1/3
106 elin 1
107 27 susi susilawat 1566/11 514227857 32 1 tambir
108 E ROMDAYAH 824 1667625322 59 1 RC GEDE
109 SITI RO'I NURAENI 33 1 CIJERUK HILIR 01/01
110 AI METI 1366/2011 513980357 22 1 CICONDONG 03/06
111 ALFIN 3891/2011 16 1 BOJONGGAOK 03/01
Mengetahui
Kepala puskesmas karanganyar
H Enjang Nurjamil,S .Kep.Ners.MHKes

NIP: 19740424 199503 1 002
respirasi YA
TENSI DARAH
BUMIL
APRAS
L
P
Nama SD & kls
UKGS
L
P
RIWAYAT PENYAKIT
DIAGNOSA
ICD 10
PENAMBALAN
TINDAKAN
PENCABUTAN
L
TUMPATAN
P
GIGI TETAP
L
TUMPATAN
P
GIGI SULUNG
L
PENGOBATAN
PULPA
P
L
EXO GIGI TETAP

P
JENIS KEGIATAN
EXO GIGI
SULUNG
P
L
PENGOBATAN
PERIAPIKAL
PENGOBATAN
PERIAPIKAL
P
L
LAIN-LAIN
P
L
KARIES GIGI
P
L
KELAINAN
PULPA
P
L
KEL.PULPA &
JARINGAN
PERIODONTAL
P
JENIS KELAINAN
KEL.
DENTOFACIAL
MALOKLUSI
P
L
PENYAKIT
LAIN-LAIN
P
P (Planning) /
RENCANA TERAPI
Ya
TERAPI
(sesuai)
Tdk
RESEP
UMUM
P
L
KIS
P
KET
Tasikmalaya , 2018
Penanggungjawab BP Gigi
drg. Ameilia Hendra Kania

NIP 19820531 201503 2 002
Jenis
Kelamin
TANGGAL
NO. NAMA PASIEN NO. KARTU KIS Usia
L P
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Monitoring Tindakan di BP Gigi
Puskesmas Karanganyar
Bulan April Tahun 2018
Informed Cuci APD Anastesi

Consent Tangan
Riwayat Penyakit
Pre Anastesi Pasca Anastesi
TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Diagnosa
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Nadi
TD
TD
Anastesi Pencabutan
Pasca Anastesi Pre Pencabutan Pasca Pencabutan

Kesadaraan
Kesadaraan
Kesadaraan
Akral
Akral
Akral
Nadi
Nadi
Nadi
TD
TD
LAPORAN HARIAN BP. GIGI PUSKESMAS KARANGANYAR KOTA TASIKMALAYA
BULAN MARET TAHUN 2018
UMUR JENIS KUNJUNGAN
TANGGAL
NO. NAMA PASIEN NO. KARTU KIS
L P L P
B L B L
1 31 ny yuli yuliant 153/2012 37 1
2 tn sutsna 546/12 514649564 73 1
3 ny yuyus 18000378/18 39 1
4 evi 1
5 ny ai handayani 16001745/16 1667476822 29 1
6 naura 10848/15 1832014394 6 1
7 01 rifa 286/11 514447558 7 1
8 tn yana 1310/10 513959433 37 1
9 ADAM 1236/13 513997571 14 1
10 hj nonoh 2038/14 1400073873 53 1
11 inda 787/14 36 1
12 02 m fasya syabana 17100359/17 12 1
13 ny yet suyet 1122/11 1667612338 43 1
14 ai inda 1313/13 514439728 1
15 susi susilawat 1672/13 514542036 20 1
16 susi susilawat 566/11 514227857 31 1
17 dina 3036/10 200604429 16 1
18 04 sit juliant 1278/13 513635016 28 1
19 dandan 780/10 514619526 12 1

20 assef pizar rahmat 863/10 514261012 10 1
21 daiva 18100399/18 9 1
22 an khadafi 16101226/16 1667479026 10 1
23 05 m fasya syabana 17100359/17 12 1
24 sit roi nuraeni 2369/12 37 1
25 ny uas 25/13 57 1
26 ny ai handayani 16001745/16 1667476822 29 1
27 ny yet 33/13 514529752 35 1
28 ny yant 17001805/17 34 1
29 ziyan 18100409/18 18 1
30 06 susi susilawat 1672/13 514542036 20 1
31 sit marya ulfa 14736/15 21 1
32 m.azwar 1451/11 514386224 7 1
33 erpan maulana 2674/2013 6 1
34 alvin imanullah 3891/11 1669109556 16 1
35 07 ny idar 531/12 514461014 32 1
36 tna nurjanah 11195/15 513861906 30 1
37 cucum sumiat 15355/15 514523171 33 1
38 m ref 305/12 6 1
39 ny leni 2618/11 514830598 27 1
40 yolanda 033/10 514420514 9 1
41 nurfauzan 18100420/18 514540506 15 1
42 08 devi selpiyana 18000421/18 515056869 19 1
43 tn ma'sum 4550/14 514351697 57 1
44 tn sekar 17102056/17 1669107082 40 1
45 09 ilham 2396/12 514631687 12 1

46 tn asep muhtadin 1786/12 513420895 34 1
47 chandra aji 2554/12 513863976 16 1
48 11 tna nurjanah 11195/15 513861906 30 1
49 tn mahpudin 2658/12 514300217 72 1
50 tetep maulana 2761/2014 514511008 21 1
51 febi khoirunnisa 1701909/17 513866957 7 1
52 NY ELIS JULAEHA 147/11 43 1
53 12 dede rukaenah 2791/12 55 1
54 sinta carlin 1010/13 1831276719 22 1
55 raisa 18000439/18 8 1
56 ny ernawat 937/12 515051291 39 1
57 ny aneu yulia 18100264/18 27 1
58 tn yudi 12161/15 515284042 39 1
59 13 Tn misan 18100441 513843221 67 1
60 alvin imanullah 3891/2011 1669109556 17 1
61 M Azwar 1451/2011 8 1
62 Sit Munawaroh 17001241/2017 18 1
63 ade ny 2112/12 43 1
64 14 ny dedeh 18000343/18 45 1
65 rahma ayu 8960/14 3 1
66 ai sumartni 615/13 1667613341 35 1
67 tn jana 2522/13 58 1
68 mira 18100455/18 6 1
69 tetep maulana 2761/2014 514511008 21 1
70 15 nadira 2282/2012 7 1
71 513851512 44 1
72 nurmalita 514275658 16 1
73 18 NY Dede 2791/2012 55 1
74 rizki 17100662/17 514183094 23 1
75 laras 1752/17 513778634 17 1
76 lastri 1753/12 513777914 51 1
77 tna nurjanah 11195/2015 513861906 30 1
78 najwa 18000469/2018 8 1
79 nabila 18000468/2018 12 1
80 naila 18000470/2018 16 1
81 elsa 140/2011 514345138 20 1
82 reni 4232/10 513562375 42 1
83 sit maryam 9333/2014 513754064 29 1
84 ade ny 2112/12 43 1
85 19 ny susi 566/2011 31 1
86 INTAN PADILAH 327801018000475 514227857 17 1
87 arum safitri 16001567/17 514317497 7 1
88 tn tatang solihin 18100032/18 38 1
89 20 azkia 17100470 5 1
90 dudit hudaya 18100480/18 11 1
91 alvin imanullah 3891/2011 1669109556 17 1
92 elsa dea 140/2011 514345138 20 1
93 nabila 2003/12 514345814 11 1
94 21 ny ernawat 937/12 515051291 39 1
95 ny sumiat 2390/10 50 1
96 ny rina 1765/10 514610515 35 1
97 ny adah 498/10 513040858 59 1
98 22 tna nurjanah 11195/2015 513861906 30 1
99 ny eem 188/2010 1514432067 44 1
100 shopi 3297/2010 514598139 13 1
101 alvin imanullah 3891/2011 1669109556 17 1
102 ny rian rosiana 17728116/2018 32 1
103 23 NY Dede 2791/2012 55 1
104 tn nana 2416 514516961 53 1
105 dudit hudaya 18100480/18 11 1
106 idah, ny 1079/12 514011609 44 1
107 elsa dea 140/2011 514345138 20 1
108 25 iis istyanah 18000028/18 31 1
109 tna nurjanah 11195/2015 513861906 30 1
110 rizki 17100662/17 514183094 23 1
111 ny ernawat 937/12 515051291 39 1
112 elsa 140/2011 514345138 21 1
113 onah ny 734/2013 513667787 60 1
114 elin 1272/2010 2120629296 34 1
115 anton 18100496/2018 2305929587 30 1
116 gebu azra 18000497/2018 2305929587 15 1
117 laila aida 3 1
118 dede sobari 16102160/2016 514267942 43 1
119 26 sit komala 17002299 514260573 45 1
120 yuni 3855/2011 513480699 38 1
121 ny rian rosiana 17728116/2018 32 1
122 shinta amelia 8147/2014 dr tt 8 1
123 tn tatang solihin 18100032/18 38 1
124 27 iis istyanah 18000028/18 31 1
125 alvin imanullah 3891/2011 1669109556 17 1
126 Asep suparman 18100505/18 11105331051 55 1
127 wartmah 456/11 64 1
128 28 tn osminsyah 18100511/2018 60 1
129 dede sobari 16102160/2016 514267942 43 1
130 ny ernawat 937/12 515051291 39 1
131 yayah 2554/2013 166762582 54 1
132 30 winta aulia 1657/10 11 1
133 tn irpan 17100709/17 32 1
134 m ilham 3302/10 514333528 9 1
135 absari matamanggala 18100306/18 515042774 57 1
136 m. Azka 256/11 513536117 8 1
137 tatang 39 1
jml 137 48 89 33 15 59 30
Mengetahui

NIP: 19740424 199503 1 002
KELURAHAN
Luar Wilayah
KARANGANYAR
CILAMAJANG
respirasi
ALAMAT bb tb TENSI DARAH BUMIL
CIBEUTI
suhu
nadi
L P L P L P L P
nagrog 3/2 1 72 152 37 67 16 120/70
genteng 3/11 1 52 158 36 80 17 170/90
cibeut 1/6 1 52 152 36 80 17 120/80
36
cibogo 2/3 1 47 150 36 70 16 140/90
bj gaok 3/1 1 26 127 36 115 20 105/60
cibuluh 4/11 1 28 128 36 115 20 105/60
cicondong 2/9 1 75 162 36 75 18 120/80
selaawi 5/4 1 46 150 65 14
selaawi 2/12 1 60 154 36 65 15 120/80
karikil 1 52 152 36 80 17 120/70
cibeut 1/6 1 33 131 36 60 20 110/70
negla 1/11 1 52 152 36 80 17 120/70
cibuyut 2/3 1 44 149 36 80 18 100/70
palasari 3/10 1 47 150 36 70 16 110/90 4 BLN 1
tambir 4/5 1 67 154 36 70 18 120/70
cijerah 1/3 1 36 135 36 70 16 100/80
sk senanng 1/7 1 45 120/80
negla 3/11 1 32
cibuluh 4/11 1
cibuyut 2/1 1
cibogo 1/3 1 29
cibeut 1/6 1 33 131 36 60 20 100/60
cijeruk hilir 1
gn subang 1/12 1 180/100
cibogo 2/3 1 47 150 36 70 16 110/70
gn bitung 2/8 1 90/60
cijeruk girang 3/4 1 90/70
palasari 3/10 1 47 150 36 70 16 110/90 4 BLN 1
saguling pjg 1 56 154 36 120/70
cicondong 1/9 1 24 125 36
cihonje 1/2 1 18 120 36
bg gaok 3/1 1
segleng 1 50
genteng 3/11 1 54
selaawi 3/12 1 47 8 bln 1
gn bitung 1/8 1 14
gn bitung 1/8 1 69
gn batu 1 25
cibeut 2/6 1 34
sk sirna 5/4 1 66 158 36 70 18 120/80
gn lingga 1 58 152 36 70 16 140/90
genteng 1/11 1 55 150 37 120/80
gn bitung 3/8 1 25
asta lebak 2/8 1
asta lebak 4/8 1
genteng 3/11 1 54
gn bitung 2/8 1
sk dana 2/4 1
genteng 2/1 1
cijerah 1/3 1 60
cijeruk girang 4/4 1
cijerah 4/3 1
bg gaok 3/1 1
cihonje 1/2 1
conggeang 3/11 1
cibuyut 4/1 1
gn lingga 1 120/80
bojong gaok03/01 1
cicondong 1/9 1
nogrog3/2 1 110/70
bojong padasuka 1 130/80
cijeruk hilir 3/1 1 90/60
tambir 5/5 1
cibogo 1/5 1
rc bungur 1
negla 1
sk dana 2/4 1
cijeruk girang 1
saguling infres 1
genteng 1
genteng 2/1 1 120/80
genteng 2/1 1 110/70
genteng 2/1 1 130/80
genteng clng3/11 1 120/80
cikedewul 1
cikedewul 1
cikedewul 1
selawi 4/5 1 100/70
cihonje 1 130/80
bojong padasuka 1 90/60
Tambir 1
segleng 3/9 1
gn subang 2/12 1 21
saguling pjg 1/6 1
cibogo cilamajang 1
saguling pjg 2/8 1
bojong gaok03/01 1
selaawi 05/04 1 110/70
selaawi 05/04 1
cihonje 1/2 1
cijeruk giranng 3/4 1
asta gn batu 3/8 1
sk senang 4/7 1
cicondong 3/9 1 140/80
tambir 03/05 1
bojong gaok03/01 1
asta baru 01/10 1
gn lame 4/6 1
saguling pjg 2/8 1
rc bungur 4/4 1 130/80
selaawi 05/04 1 90/60
sukarame 27/10 1 120/80
genteng 2/1 1 100/70
cihonje 1/2 1 120/70
seawi cibeut4/5 1 110/70
genteng 1 140/90
sk asih 2/6 1 120/70
nagrog01/02 1 90/70
90/70
cibogo genteng 1
cibogo 4/3 1 90/70
genteng 2/1 1 140/90
gn bitung 02/08 1 120/80
asta baru 01/10 1 120/70
gn subang 3/2 1
saguling pjg 1/6 1 100/70
sukarame 27/10 1
bojong gaok03/01 1
cibuyut 05/1 1 120/80
gn bitung1/8 1
cibogo 4/3 1 110/70
cihonje 1/2 1 120/70
cijerah 2/3 1 120/80
asta lebak 1/8 1
cikedewul 2/7 1
asta pasir 2/10 1
gn subang 2/2 1
segleng 1/9 1
saguling pnjg 1/16 1
17 36 11 19 18 28 2 4 3
TINDAKAN
RIWAYAT PENYAKIT
PENAMBALAN
PENCABUTAN
ICD 10
GIGI TETAP
TUMPATAN
APRAS UKGS DIAGNOSA
L P Nama SD & kls L P L P

48 pulp k04.0
48 abses k04.7
14 gp,tkf k04.2 1
17tkf k05.3 1
37 pak k.04.4
tk al-anwar 1 74 gp k04.1
sd kr.anyar 1 1 51 persistensi k00.6 1
37 pulp k04.0
36 abses k04.7
17 pak k04.4
15 gr, 38-37 gr k08.3 3
cibeut1 kls 5 1 36 pp k04.1
44 hp/gic k02.1 1 1
46 gp k05.3
48 gp k05.3
38 gp k05.3
sma 4 TSM 24 tkf k05.3 1 1
48 abses,mukosa k01.1
pipi tergigit
sd kr.anyar 6 1 36 gp k04.4
mi cijerah 4 1 46 gp k04.4
1 63 pst k00.6 1
55 pst k00.6 1
cibeut1 kls 5 1 36 pp k04.1 1
15 gp k04.2 1 1
45-46 gr k08.3
37 pak k.04.4 1
37 gr abses ko4.7
24 gr/exo ko8.3 1
11 gp abses ko4.7
48 gp k05.3
46 gp k04.7
sd trtawening kls 1 1 51 exo k00.6 1
1 75 pp k04.0
16 pak, tkf k04.4 1
37 pak k04.4
21 tkf k04.0 1
38 pak k04.4
mucocele a.r 61-
1 k11.7
62
35 pak k04.4
sd bantarsari kls 3 1 54 pst k00.6 1
36 pak k04.4
28 perikoronits k12.1
38 pak k04.4
18-17 selulits k12.1
fasialis
mi miftahul falah 6 1 46 pulp k04.0
18 pulp k04.0
gmkg, 35 gic k02.52 1 1
21 chkm k04.1 1 1
21 gr III k05.2
16, 26 pak gp k04.4
sd darmajaya kl 1 1 82 pst k00.6 1
36 pak k04.4
22hp,23 gp tkp k04.0 2 2
35 k04.0 1 1
sd kr tengah kls 3 1 51 pst k06.00 1
devit 1 1
11 gi k02.62 1 1
15 abses k04.7
33 period k05.3 1
16 devi k04.1 1 1
sd trtawening 1 61 pst/exo k006 1
27 gp/ exo k006 1
36,37,gr k04.4
14 gr k04.7
85 gp k04.7
48 gr k04.7
37 pulp k04.0
paud nurulaeni 1 81 pst k00.6 1
27 pak k04.7
paud st maryam 1 paud st maryam 61 pst/exo k006 1
pro scaling
smk pui saguling 21 fraktur
23 gp/chkm K004 1 1
46 calcyl k02.52 1 1
27 hp,37 hp gic k02.52 2 2
26 cervikal,15,17 k02.62
21gp cress k04.0 1 1
82pst k00.6 1
64 pst k00.6 1
11,21 hp k02.62 2 2
46 gp k04.7
46 gp/abses k04.7
36,37,38 gr ko4.4
36,37,gr k04.4
28,27 pulp k04.0
47 pulp k04.0
darmajaya kls 1 1 51 pst k00.6 1
36 pulp irrev,tkf k04.01 1 1
ra pui saguling 1 85 pak ec gp k04.4
mi saguling kls 5 1 73 pst K00.6 1
16 k04.1
46 gp abses k04.7
65 polip K04.1
26 tkf k04.01 1 1
36 pak k04.4
21 gi k02.62 1 1
47 pulp k04.01
21gp cabses k04.7
46 abses k04.7
16 pp k04.01
16 gp/edo metason k04.1 1 1
46 GI k02.52 1 1
23 gp/gic K004 1 1
16 abses k04.7
mi saguling kls 5 1 53,52 pst K00.6 2
48 pulp k04.1
46 gp abses k04.7
38 GP/ipakted k01.17
11,21 GI k04.2 2 2
46 gi k04.2 1 1
26 chkm/flc k04.1 1 1
46 gp k04.1 1
27,28 gr abses k04.7
45 pp k04.01
16gp abses k04.7
46 gp,36 gr k04.4
61 ulcus abses k00.6
16 gr abses k04.7
38 gp k04.4
37,38 gr k04.4
46 post gi + k02.52
sd darmajaya 1 61 pst exo k00.6 1
45 hp/gi,36 chkm k04.2 2 2
38 GP/ipakted k01.17
16 gp/gi k04.2 1 1
44 gp/exo k04.1 1
36,37,38 gr/abs k04.7
stroke 46 gp/abs k04.7
16gp/exo k04.1 1
26 gp k04.2 1 1
15gp/exo k04.1 1
sd bantarsari kls 6 1 36 pulp k04.0
13 pulp rev k02.62 1 1
sd bantarsari kls 3 1 46 pulp irrev k04.0
18 period k05.3
mi cijerah 1 51 pst k00.6 1
36 gp k05.3 1 1
2 4 11 8 37 30 11 23
L
TUMPATAN
P
GIGI SULUNG
1
1
1
1
1
PENGOBATAN
PULPA
1
1
1
1
1
1
1
L
1
EXO GIGI TETAP
P
1
1
3
JENIS KEGIATAN
1
1
EXO GIGI
SULUNG
P
1
1
L
1
PENGOBATAN
PERIAPIKAL
P
1
1
1
1
L
1
1
LAIN-LAIN
P
1
1
1
1
1
1
1
1
1
1
L
KARIES GIGI
P
1
1
1
1
1
1
1
L
1
KELAINAN
PULPA
P
1
1
1
1
1
1
1
1
1
1
L
1
1
1
KEL.PULPA &
JARINGAN
PERIODONTAL
P
1
1
1
1
JENIS KELAINAN
KEL.
DENTOFACIAL
MALOKLUSI
P
1
L
1
1
1
1
PENYAKIT
LAIN-LAIN
P
1
1
1
3
1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1
1 1
1 1
1 1
1 1
2
1
1 1
1
1
1 1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1
1
2
1 1
1
1 1
1 1
2
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
1 1
1 1
1
1 1
1
1 1
1 1
1 1
1 1
1
1
1
1 1
2 2
1 1
1 1
1 1
2
1
1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
2
1 1
1
1 1
1 1
1 1
1 1
1
1 1
1 1
1
1 1
1 1
1 1
1
0 1 6 13 4 8 7 10 9 20 10 20 4 19 14 25 17 27 1 1 11 23
Tasikmalaya , 2018

NIP 19820531 201503 2 002
UMUM
P (Planning) / TERAPI
RESEP KET
KIS
RENCANA TERAPI (sesuai)
Ya Tdk L P L P
1 amox,pct,dexa 1
1 amox,pct,ctm,b com c 1
1 pct 1 20
1
1 klinda,pct,ctm,dexa 1
1 pct syr 1
1 pct 1
1 amox,pct,ctm,dexa 1
1 klinda,pct 1
3 amox,pct,ctm,dexa 1 200
1 pct,bcom 1
1 amox,pct 1
1 amox,pct,ctm 20
1 cefad,asmef,dexa,b com c
1
1 pct,dexa 1
1 r/-- 1 25
1 pct 1
1 r/-- 1 30
1 amox,pct,amlod 1
1 amox,pct,ctm.dexa 1
1 amox,pct,selesbion 1
1 amox,pct,ctm.dexa 1 50
1 amox,asmt,ctm,dexa 1
1 pct,b.com 1
1 amoxpctmctm,dexa 1
1 pct 1
1 r/-- 1 rujuk dr mtbs
1 klinda,pct,dexa 1 20
1 pct,dexa 1 20
1 cefad,pct,b com c 1
1 amox syr,pct,dexa,truvit 1
1 klinda,asmef,ctm,dexa 1
1 pct,b com c 1
1 cefad,asmef,b com c 1
1 amox,metro,asmef,ctm,d
xa,b com c 1
1 amox,asmef,ctm,dexa 1
1 b com c 1 230
1 b com c 1 20
1 amox,pct,ctm,selesb 1
1 r/-- 1
2 klinda,pct 1 50
1 r/-- 1
1 pct 1 25
1 klinda,pct 1 20
1 r/-- 1 30
1 amox,asmef,ctm,dexa 1
1 amox,pct,dexa
1 amox,pct,dexa,ctm 1 20
1 amox,pct,beta sk 1
1 amox,pct,ctm,dexa
1 amox,pct,selesbion 1
1 amox syr,pct,ctm,dexa 1
1 amox,pct,b com c 1
1 pct 1 25
1 cefad,asmef,ctm,dexa 1
1 pct syr 1 25
1 amo,pct,ctm,dexa 1
1 amox,pct,beta sk 1
1 pct 1 20
1 pct,dexa 1 20
2 pct,dexa 1 30
1 pct 20
1 pct 1 25
1 pct 1 25
2 r/- 1 60
1 klinda,pct 1
1 amox,pct, 1
1 amox,pct,dexa,selesbion 1
konserv 27 1 klinda,asmef,dexa 1
konserv 47 1 cefad,pct,dexa,b com c 1
exo 51 1 pct 1
endo 36 1 asmef,dexa 1 20
endo 1 amo,pct,dexa.ctm 1
exo 73 1 pct 1
endo 16 1 cefad,pct,dexa,b com c 1
exo 1 amox,pct,dexa,b com c 1
exo 1 r/-- 1 dari bp
endo 26 1 r/-- 1 20
exo 1 klinda,pct,dexa 1
konserv 21 1 r/-- 1
exo 1 amox,pct,dexa 1
endo 1 amox,dexa 1
exo 1 amox,pct,ctm,dexa 1
endo 1 SELOMC 1
endo 1 PCT.SELCOMCE 1 20
konserv 46 1 r/-- 1
endo 1 asmef 1
exo 1 amox,pct,ctm,b com c 1
exo 2 pct 1 50
konserv 1 klinda,pct,dexa 1
exo 1 selesb 1
exo 1 rujuk BM
konserv 2 SELCOM 1 30
konserv 1 pct,selcon c 1
konserv 1 pct,selcon c 1 20
exo 46 1 klinda,pct,ctm,dexa 1
exo 1 amox,pct,ctm 1
endo 1 amox,pct,ctm 1
exo 1 amox,asmet,ctm,dexa 1
1 amox srp,pct,srp 1
1 amo,pct,ctm,dexa 1
konserv 1 amox,pct,ctm,dexa 1
exo 61 1 pct,bcom 1 25 dr tt
2 selcom c,pct 1 50
1 r/ rujuk
konserv 1 pct,selcom 1
exo 44 1 amo,asmet,ctm,dexa 1
1 cepa,pct,amlodin,ctm 1
exo 1 amox,pct,ctm,dexa 1
conserv 1 pct 1
1 amox,pct,ctm,dexa
endo 1 amox,pct,ctm,dexa 1
konserv 1 r/-- 1
endo 1 amox,pct,dexa 1
exo 1 amox,pct 1
exo 1 pct 1
pengisian+gic 1 r/-- 1 50
69 76 20 22 32 55
Jenis
Kelamin
TANGGAL
NO. NAMA PASIEN NO. KARTU KIS Usia Diagnosa
L P
1 03 m ikmal 441/12 8 1 51, 74 pst

2 05 enur hasanah 793/12 515162226 11 1 53 pst
3 raka 236/12 513484031 14 1 75 persist
4 salma 1869/2011 7 1 51,52/exo
5 08 daiva 18100399/18 10 1 55, 85 pst
6 m revandi 17101983 6 1 85 ulkus
7 09 ny enok 18000550 513320747 57 1 44pd
8 12 ny wat 8860/14 60 1 21 pulp
9 asep sandra 1810056 31 1 47 pi
10 15 ny wat 8860/14 60 1 11 gr
11 m rojihi 5267/14 513324099 7 1 71, 81 pst
12 ny ipah 15259/15 49 1 18 pulp
13 raska 3294/10 514890663 8 1 84 ulkus
14 17 ny wat 8860/14 60 1 22 gr
15 18 gina 345/12 6 1 84 pst
16 19 ny wat 8860/14 60 1 12 gr
17 22 m nazmi 1230/13 6 1 51 ulcus
18 25 ny wat 8860/14 60 1 23 gr
19 26 lilian 7378/2014 512586527 9 1 84 gr
20 27 ny mumun 1052/2010 48 1 31,41 gp
21 heri chandra 2443/2010 45 1 36 gr
22 30 ny empat 1597/10 514137598 44 1 46 gp
23 an fauzan 1261/13 5 1 61 ulkus
24 ny yayah 2554/13 1667625682 55 1 24,21,22 gp
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Bulan April Tahun 2018
Informed Cuci Tangan APD Anastesi

Consent
Riwayat Penyakit

TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Kesadaraan
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Akral
Nadi
Nadi
TD
TD
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 130/80 65 cm n 130/80 65 cm n
1 1 1 140/80 68 cm n 140/80 68 cm n
1 1 1 120/80 72 cm n 120/80 72 cm n
1 1 1 140/90 65 cm n 140/90 65 cm n
1 1 1
1 1 1 140/80 68 cm n 140/80 68 cm n
1 1 1
1 1 1 140/80 65 cm n 140/80 65 cm n
1 1 1
1 1 1 140/80 68 cm n 140/80 68 cm n
1 1 1
1 1 1 140/80 70 cm n 140/80 70 cm n
1 1 1
1 1 1 130/80 67 cm n 130/80 67 cm n
1 1 1 120/80 74 cm n 120/80 74 cm n
1 1 1 120/80 70 cm n 120/80 70 cm n
1 1 1
1 1 1 110/70 65 cm n 110/70 65 cm n
Pencabutan
Pre Pencabutan Pasca Pencabutan
Kesadaraan
Kesadaraan
Akral
Akral
Nadi
Nadi
TD
TD
80 cm n 75 cm n
76 cm n 75 cm n
77 cm n 77 cm n
75 cm n 74 cm n
80 cm n 78 cm n
78 cm n 79 cm n
130/80 67 cm n 130/80 66 cm n
140/80 67 cm n 130/80 67 cm n
120/80 72 cm n 120/80 75 cm n
140/90 65 cm n 140/90 65 cm n
70 cm n 70 cm n
140/80 68 cm n 140/80 66 cm n
70 cm n 72 cm n
140/90 67 cm n 140/80 66 cm n
72 cm n 72 cm n
140/80 68 cm n 140/80 67 cm n
70 cm n 70 cm n
140/80 70 cm n 140/80 68 cm n
72 cm n 70 cm n
130/80 67 cm n 130/80 68 cm n
120/80 74 cm n 120/80 72 cm n
120/80 70 cm n 120/80 68 cm n
73 cm n 70 cm n
110/70 65 cm n 110/70 66 cm n
Jenis
Kelamin
TANGGAL
L P
1 31 ny yuli yuliant 153/2012 0 √ 48 pulp

2 tn sutsna 546/12 514649564 √ 48 abses
3 ny yuyus 18000378/18 0 √ 14 gp,tkf
4 evi 0 0 √ 17tkf
5 ny ai handayani 16001745/16 1667476822 √ 37 pak
6 naura 10848/15 1832014394 √ 74 gp
7 01 rifa 286/11 514447558 √ 51 persistensi
8 tn yana 1310/10 513959433 √ 37 pulp
9 ADAM 1236/13 513997571 √ 36 abses
10 hj nonoh 2038/14 1400073873 √ 17 pak
11 inda 787/14 0 √ 15 gr, 38-37 gr
12 02 m fasya syabana 17100359/17 0 √ 36 pp
13 ny yet suyet 1122/11 1667612338 √ 44 hp/gic
14 ai inda 1313/13 514439728 √ 46 gp
15 susi susilawat 1672/13 514542036 √ 48 gp
16 susi susilawat 566/11 514227857 √ 38 gp
17 dina 3036/10 200604429 √ 24 tkf
18 05 daiva 18100399/18 √ 63 pst
19 an khadafi 16101226/16 1667479026 √ 55 pst
20 6 m fasya syabana 17100359/17 √ 36 gp
21 ny ai handayani 16001745/16 1667476822 √ 37 gp
22 ny yant 17001805/17 √ 24 gr
23 7 m.azwar 1451/11 514386224 7 √ 51 pst
24 8 yolanda 033/10 514420514 9 √ 54 pst
25 12 febi khoirunnisa 1701909/17 513866957 7 √ 82 pst
26 13 raisa 18000439/18 8 √ 51 pst
27 14 Tn misan 18100441 513843221 67 √ 33 period
28 M Azwar 1451/2011 8 √ 61 pst
29 Sit Munawaroh 17001241/2017 18 √ 27 gp
30 15 mira 18100455/18 6 √ 81 pst
31 16 nadira 2282/2012 7 √ 61 pst
32 19 najwa 18000469/2018 8 √ 82 pst
33 nabila 18000468/2018 12 √ 64 pst
34 20 arum safitri 16001567/17 514317497 7 √ 51 pst
35 21 dudit hudaya 18100480/18 11 √ 73 pst
36 24 dudit hudaya 18100480/18 11 √ 53,52 pst
37 26 elsa 140/2011 514345138 21 √ 46 gp
38 27 shinta amelia 8147/2014 dr tt 8 √ 61 pst
39 28 Asep suparman 18100505/18 11105331051 55 √ 44 gp
40 29 dede sobari 16102160/2016 514267942 43 √ 16 gp
41 yayah 2554/2013 166762582 54 √ 15 gp
42 31 m. Azka 256/11 513536117 8 √
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Bulan Maret Tahun 2018

Consent Tangan
Riwayat Penyakit
Pre Anastesi Pasca Anastesi Pre Penca

TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Kesadaraan
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Akral
Nadi
Nadi
TD
TD
TD
√ √ √
√ √ √
1 √ √
1 √ √
√ √ √
√ √ √
1 √ √ 105/60 115 CM N 105/60 115 CM N 105/60
√ √ √
√ √ √
√ √ √
1 √ √ 120/70 80 CM N 120/70 80 CM N 120/70
√ √ √
1 √ √
√ √ √
1 √ √
1 √ √
1 √ √
1 √
1 √
1 √ 100/60 60 cm n 100/60 65 cm n 100/60
1 √ 110/70
1 √ 100/70
√ √
1 √
1 √
1 √
1 √ 130/80 70 cm N 130/80 70 cm N 130/80
√ √
1 √ 110/70 65 cm n 110/70 68 cm n 110/70
√ √
√ √
√ √
√ √
√ √
√ √
√ √
1 √ √ 110/70 65 cm n 110/70 66 cm n 110/60
√ √
1 √ √ 120/80 75 cm n 120/70 75 cm n 120/70
1 √ √ 120/80 76 cm n 120/80 76 cm n 120/70
1 √ √ 120/80 68 cm n 120/80 68 cm n 120/70
√ √
17
Pencabutan
Kesadaraan
Kesadaraan
Akral
Akral
Nadi
Nadi
TD
115 CM N 105/60 115 CM N
80 CM N 120/70 80 CM N
65 cm n 100/70 65 cm n
68 cm N 130/80 68 cm N
68 cm n 110/70 68 cm n
65 cm n 110/70 65 cm n
72 cm n 120/70 70 cm n
75 cm n 120/70 75 cm n
65 cm n 120/70 75 cm n
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
TANGGAL
CILAMAJANG
suhu
CIBEUTI
L P L P
1 01 kiki sakinah 1029/10 514298338 18 1 genteng 3/1 1 42 155
2 m alfan 1453/11 2127530136 7 1 rancabungur 4/4 1 febris
3 rizki 17100662/17 514183094 23 1 genteng 2/1 1
4 TN TASLIM 17100608/2017 514326341 1 1
5 ny iim rohimah 3834/11 1 saguling panjang 4/6 1
6 ny nia 15236/15 514604125 36 1 cibeut 02/06 1
7 mamat rohimat 2665/12 49 1 tambir lapang 1/5 1
8 ny tet 1474/11 34 1 cijeruk hilir 1/1 1
9 02 tn ucun 2141/11 1667613521 45 1 cijeruk girang 1/4 1
10 03 nining nurhayat 2781/10 514702743 40 1 gn bitung 02/08 1
11 idan 16100411/16 514328139 29 1 selaawi 1/3 1
12 roni sahroni 18100001/18 41 1 gayam sari 1/semarang 1 71
13 ari ahmad sobari 786/11 514447312 15 1 cibuluh 4/11 1 46
14 m ikmal 441/12 8 1 cibeut pabrik 4/6 1
15 04 SUSI susilawat 1672/13 514542036 20 1 palasari 3/10 1
16 idah 2131/11 514073114 43 1 gn bitung 5/8 1
17 05 atang 215/11 513977308 46 1 cicondong 1/9 1 8.20 8.27
18 enur hasanah 793/12 515162226 11 1 kr.tengah 3/4 1 8.32 8.40
19 silmi rahmaaeni 18100540/18 514323595 14 1 bj gaok 3/1 1 08.45 8.49
20 aen 1192/13 513960884 38 1 segleng 2/9 1 9.00 9.07
21 raka 236/12 513484031 14 1 1 cibuyut 1/1 1 9.09 9.17
22 gisa 3643/2010 10 1 cibuyut2/1 1 9.17 9.27
+ tn enda 17101274/2017 513400342 28 1 cibogo 5/2 1 9.20 9.35
24 salma 1869/2011 7 1 cijeruk girang 1/4 1 912 9.40
25 06 ny enok 18000550 513320747 57 1 gn subang 3/3 1 10.26 10.31
26 aqila nafisah 18000551/18 4 1 genteng 1/11 1 11.15 11.18
27 08 tn dadan 18100556/2018 36 1 rc gede 2/10 1 9.51 10.05 57 36
28 amir 1000/2010 514939577 46 1 genteng 02/01 1 10.11 10.16 52 36
29 anhar 14107463 514352248 24 1 cibogo 5/3 1 10.31 10.45 52 36
30 lestari utami 514855585 12 1 gn lingga 6/3 1
31 daiva 18100399/18 10 1 cibuyut 2/1 1 10.38 10.57 40 36
32 azhar 1625/12 2127529539 5 1 tambir 1/5 1 10.59 11.03 17 36
33 m revandi 17101983 6 1 gn subang 3/12 1 11.14 11.30 36
34 09 ny enok 18000550 513320747 57 1 gn subang 3/3 1 9.00 9.29
35 10 asep sandra 1810056 31 1 cibeut 1/6 1 9.21 9.33 57
36 ny wat 8860/14 60 1 cijeruk girang4/4 1 9.22 9.43 42
37 11 amir 1000/2010 514939577 46 1 genteng 02/01 1
38 12 ny wat 8860/14 60 1 cijeruk girang4/4 1 7.50 8.13 42 36
39 asep sandra 1810056 31 1 cibeut 1/6 1
40 CHRIS nur salam 2455/13 513815196 21 1 bj gaok 3/1 1 10.13
41 15 ny wat 8860/14 60 1 cijeruk girang4/4 1 7.50 8.19 42 36
42 ny elin 1013/13 2120638814 35 1 cijerah 3/3 1 8.57 9.01 50 148 36
43 m bari 356/13 514375697 9 1 cibeut 4/6 1 9.20 9.25 24
44 mirnasari 007/12 514505687 24 1 gn bitung 4/8 1 9.27 9.45
45 yani suryani 272/12 514234787 39 1 palasari 3/10 1 9.29 9.35 47 36
46 m rojihi 5267/14 513324099 7 1 gn bitung 3/8 1 10.07 10.13
47 ny ipah 15259/15 49 1 batubeulah 21/5 1 10.45 11.14 72 158 36
48 ade muhammad 18100586 36 1 cijeruk girang 1/4 1 11.14 11.20
49 kaffa 16811/16 6 1 genteng 2/1 1 11.35 11.40 23
50 raska 3294/10 514890663 8 1 tambir 2/5 1 11.38 11.42 20
51 ipah nurhopipah 18000588/18 1667626389 43 1 segleng 3/9 1 11.55 12.05 42
52 tn obing 72/11 514722475 65 1 cijeruk hilir 3/1 1 12.20 12.30 55
53 absari 18100306 57 1 gn subang 2/2 1 12.15 12.35 57
54 16 ny neneng 16982/16 1667628718 28 1 cihonje 2/2 1 9.20 9.57
55 ny sit marliah 4703/10 514573571 35 1 kr tengah 3/4 1 10.16 10.22
56 tn heri 2443/10 46 1 segleng 1/9 1 11.05 11.30
57 ahmad bani 16154/16 513506643 43 1 cikedewul 3/7 1 11.12 11.42
58 17 ny wat 8860/14 60 1 cijeruk girang4/4 1 7.53 8.20
59 ny et roswat 13364/15 513696453 34 1 gn malang 4/9 1 10.23 10.28
60 CHRIS nur salam 2455/13 513815196 21 1 bj gaok 3/1 1
h uus kusnadi 72193645 56 1 cihonje rt 03 /002 1 30/80
61 18 gina 345/12 6 1 rc bungur 1 10.07 10.20 20 36
62 nabila 15102/15 15 1 cikedewul 3/7 1 10.34 10.41 59 160 36
63 ny yet 33/13 514529752 35 1 gn bitung 2/8 1 10.41 10.47 38 150 36
64 19 m farhan 18100599/18 8 1 cicondong 2/9 1 7.57 8.14
65 ny wat 8860/14 60 1 cijeruk girang4/4 1 8.15
66 ny neneng 16982/16 1667628718 28 1 cihonje 2/2 1 9.17
67 dewi 3631/10 20 1 cicondong 2/9
68 20 tn uyu taryudin 18100336/18 2445660977 56 1 selaawi 1/12 1 8.34 8.43
69 22 ny mumu 1052/10 48 1 asta i/10 1 8.25 8.27 59 165 37
70 m nazmi 1230/13 6 1 cibuyut 1 08.50 09.43
71 yuyu 292/10 514218385 18 1 segleng 3/9 1 10.07 10.13
72 tn heri 2443/10 46 1 segleng 1/9 1 11.05 11.30
73 23 ana 1812/2014 1275783186 20 1 tambir 4/5 1 08.46 08.48 58 160 36
74 tn uyu taryudin 18100336/2018 2445660977 57 1 selaawi 1/12 1 920 09.32 54 157 36
75 lilian 7378/14 512586527 9 1 cibeut pasar4/6 1 10.23 10.58 27 125 36
76 24 ny wat 8860/14 60 1 cijeruk girang4/4 1 07.50 8.13
77 risma 1804 1667624703 16 1 cibuyut 2/2 1 08.16 08.40
78 alif arfiansyah 18100618/18 7 1 cibuyut 1/1 1 08.31 08.45
79 ny ade muslihah 271/13 514865272 63 1 sksenang 1 08.45 09.00
80 n atk 42 1 saguling cje 02/10 1
81 tn yana 513925176 36 1 gn subang 2/12 1
82 ny ahsinu i s 18000623/18 42 1 1 cikedewul 3/7 1 12.09 12.20
83 h deni cikedewul 3/7 1 12.25 12.30
84 25 lilian 7378/2014 512586527 9 1 cibeut4/6 1 10.23 10.58
85 IIS Basiroh 1011/2011 514998731 42 selaawi 1/3 1 11.30 11.35
86 mulyadi 4147/10 513592312 35 1 palasari 02/11 1 11.00 11.36
87 tn obing 72/11 514722475 65 1 cijeruk hilir 3/1 1 10.22 11.00
88 usman 1450/2010 514242955 68 1 tambir 4/5 1 10.33 10.42
89 empat 1597/2010 1 cicondong 2/9 1 10.31 12.00
90 26 ny mumun 1052/2010 48 1 asta i/10 1 07.45 08.27
91 dea noviant 590/2014 6 1 bojong 18/05 1 09.00 09.15
92 erni 1571/2011 17 gn bitung 1/8 1 09.25 09.30
93 gina 2294/13 514951233 13 congeang 3/11 1 09.47 10.00
94 wiwit sinta 15083/2015 514195334 16 segleng 3/9 1 08.30 08.45
95 oni agus 8415/2014 213390464 43 cicondong 1/9 1 10.19 11.13
102 risma 1804/11 1667624703 16 1 cibuyut 2/2 1 9.41
103 29 ny empat 1597/10 514137598 44 1 cicondong 2/9 1 8.46 9.20 37 36
104 tn uyu taryudin 18100336/2018 2445660977 57 1 selaawi 1/12 10.01 10.06 36
105 an fauzan 1261/13 5 1 tambir desa 1 10.12 10.30 17
106 ny yayah 2554/13 1667625682 55 1 cijerah 2/3 1 10.18 10.55
107 ny elin 1272/10 2120629296 34 1 sk asih 2/6 1 10.56 11.00
108 rahma 2320/11 513856708 9 1 cijeruk girang 2/4 1 10.58 11.05
109 ny sumiat 2390/10 50 1 cijeruk girang 3/8 1 10.59 11.10
110
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Mengetahui
NIP: 19740424 199503 1 002
BULAN APRIL TAHUN 2018
TINDAKAN JENIS KEGIATAN
RIWAYAT PENYAKIT
EXO GIGI TETAP

PENAMBALAN
PENGOBATAN
PENCABUTAN
GIGI SULUNG
respirasi
ICD 10
GIGI TETAP
TUMPATAN
TUMPATAN
nadi
EXO GIGI
SULUNG
TENSI DARAH BUMIL APRAS UKGS DIAGNOSA
PULPA
L P Nama SD & kls L P L P L P L P L P L
100/70 16 gp, k04.2 1 1 1
1 72 mobil k00.6
100/70 46 gi k04.2
31 gtsl k08.12
36-38 gr k04.4
38 gr, 46 pulp k04.4
27-28 gr k04.4
28 gp k04.01 1
46 gp k04.4 1
100/60 12 abses ko4.1
38 gp k04.4
110/70 28 gp k04.4
90/60 24 abses k04.7
cibeut 1 kls 2 1 51, 74 exo k00.6 2 1
4 bln 1 48 impaksi k01.1
38 pak k04.4 1
17 pak k04.4 1
kr.anyar kls 5 1 53 pst k00.6 1
36 abses k04.7
28 pak ec gp k04.4
75 persist k00.6 1 1
1 64/gp abses k04.5
37 gp k04.4
1 51,52/exo k00.6 2
150/90 44 period k05.3
75-73 gp k04.4
75 18 120/70 37,gp,36 gr k04.01 1
75 17 120/80 46 abses k04.7
75 15 110/70 36 pulp k04.01 1
1 16,36,46 k04.01 1
74 16 55, 85 pst k00.6 2
80 20 1 74-75 abses k04.7
80 18 1 85 ulkus k00.6 1 1
44pd k05.3 1
47 pulp k04.2 1
150/90 13-11 gr k04.4
46 pi k04.01
140/80 21 pulp k04.01 1 1
47 pi K04.2 1 1
47 hp k02.62
65 17 140/90 11 gr k08.3 1 1
68 16 130/80 46 pak k04.4
65 abses k04.7
33-34 pi, arsen k04.01 2 1
75 20 148/83 38 pulp k04.01
1 71, 81 pst, 75 gp k00.6 2 2
68 14 140/80 18 pulp k04.01 1 1
48 abses, gr k04.7
1 51 gr, abses k04.07
1 84 pst k00.6 1
24-25 abses, gr ko04.6
dislokasi tmj k07.6
38 abses k04.4
47 gr k04.4
26 gr k04.4
28 eug k04.01 1 1
26 pulp k04.01 1
22 gr k08.3 1 1
16 gp k04.4 1
37hp k02.62
25 gp ko4.4
72 14 1 72 pst k00.6 1
68 16 110/70 46 gr k04.4
62 16 100/70 18 gr, 36 gr k04.4
1 55 pulp, 65 gp abses k04.4
12 gr k08.3 1 1
47 k04.4
27 pak k04.4
70 18 170/100 31,41 gp ko4.4
1 51 ulcus/exo koo.6 1 1
47gp k04.4
28 gi k04.2 1 1
70 18 110/70 47gp,.36pp k04.2
70 18 160/90 27 pd k05.6
70 16 1 46 pp egnol k04.2 1 1
140/80 23 gr/exo k04.1 1 1
110/80 36,37 hp gi k04.2 2 2
1 52abs k04.1
180/90 45gp,35gp abs k04.4
46 gp k04.1
46 gp k04.1
15 hp gi k04.2 1 1
47 gp k04.1
1 46 pp,84 exo k04.0 1 1 1
34 gp k04.4
26 gp k04.4
120/70 tmj dislokasio k07.4
16 gp/abs k04.1
120/70 46 gp k04.1
130/80 41,31 gp/exo k04.4 2 2
1 74,75 gp k08.8 1
46 gp k04.1
46 gp k04.1 1
46 gp k05.6
16 gr k04.8
36-37 gi, kontrol k02.51
70 18 130/80 46 gp k04.1 1 1
stroke 23 pulp k04.2
1 61 ulkus k006 1 1
24 gp, 21-22 gr k04.1 3 3
45 k04.1 1
1 46 pulp k04.2 1
46gp,36 pd k04.1
11 31
GIATAN JENIS KELAINAN
PERIODONTAL
UMUM
PENGOBATAN
DENTOFACIAL
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
JARINGAN
KELAINAN
LAIN-LAIN
LAIN-LAIN
RESEP
EXO GIGI
PENYAKIT
SULUNG
KET
KIS
PULPA
Rencana Terapi (sesuai)
KEL.
P L P L P L P L P L P L P L P Ya Tidak L P L P
1 konserv 1 amo,pct,ctm,dexa 1
1 1 exo 1 amox,flunax 1
1 1 1 cefad,b com c,flucadex 1
1 1 gtsl 1 r/-- 1 0
1 1 exo 1 amox,pct,ctm,dexa 1
1 1 endo 1 klinda,pct,dexa 1
1 exo 1 klinda,pct,ctm,dexa 1
1 exo 1 klinda,asmef,ctm,dexa 1
1 1 exo 1 amox,pct,dexa 1
1 1 exo 1 amox,asmef,ctm,dexa 1
1 exo 2 pct 1
1 1 exo 1 cefad,pct 1
1 exo 1 amox,asmef,dexa 1
1 exo 1 amo,pct,ctm,dexa 1
1 1 exo 1 pct 1
1 1 endo 1 amox,pct,ctm,dexa 1
1 exo 1 pct 1
1 1 observ 1 pct,ctm,dexa,amox 1
2 2 exo 2 pct 1
1 1 exo 1 amox,pct,ctm,b com c 1
1 1 endo 1 amox syr,pct,ctm,dexa 1
1 endo 37 1 klinda,asmet,ctm,dexa 1
1 1 exo 1 amox,pcr,ctm,dexa 1
1 endo 1 klinda,asmef,ctm,dexa 1
1 endo 1 amox,pct,ctm,dexa 1
2 2 exo 2 pct 1 50
1 1 endo 1 amox syr,pct,ctm,dexa 1
1 exo 1 amox syr,pct,dexa 1 25
1 1 exo 1 amox,pct.ctm.dexa 1
1 endo 1 klinda,asmef,dexa 1
1 1 exo 1 amox,pct,amlod 1
1 1 exo 1 amox,asmef,ctm,dexa 1
1 exo 1 cefad,pct,dexa 1 50
1 EXO 1 amox,asmef,ctm,dexa 1 50
1 1 konserv 1 r/-- 1 82218128964
1 exo 1 cefad,pct,dexa,amlod 1
1 1 exo 1 klinda,pct,ctm,dexa 1
1 1 observ 1 amox,pct,dexa,b com c 1
1 endo 2 klinda,pct,ctm,dexa 1 40
2 exo 2 amox,pct 1
1 exo 1 amox,asmef,ctm,dexa 1 100
1 1 exo 1 cefad,pct,ctm,dexa,b com 1
1 1 observ 1 amox,pct 1
1 1 exo 1 pct 1
1 1 exo 1 amox,metro,pct,ctm,dexa,b com c 1
1 1 observ 1 amox,asmef 1
1 1 exo 1 amox,asmef 1
1 1 exo 1 amox,asmef,dexa 1
1 endo 1 asmef,dexa 1
1 endo 1 klinda,asmef,ctm,dexa 1
1 exo 1 cefad,ctm,dexa 1 50
1 exo 1 klinda,pct,dexa 1
1 1 konserv 1 r/-- 1 rujuk
1 exo 1 amox,asmet,selcom 50
1 1 exo 1 pct 1 25
1 1 amox,pct,dexa 1
1 vit b complek 1 50
1 1 1
1
1 1 exo 1 klinda,asmef,b com c 1
1 1 1 amox.pct,ctm,dexa 1
1 exo 1 pct srp 1 25
1 1 1 amox.pct,ctm,dexa 1
1 konserv 1 amox.pct,ctm,dexa 1 30
1 1 1 amo,asmet 1
1 1 1 cepa,asmet,ctm,dexa 1
1 endo 1 amox,pct,ctm,dexa 1
1 exo 1 cepa,pct,,ctm,amlodp 1 50
2 konserv 2 pct,b com 1 30
1 1 1 pct srp,amox srp 1
1 1 1 amox,pct,ctm,apodifin 1
1 1 1 amx,pct,ctm.dexa gr kader
1 1 1 amox,pcr,ctm,dexa 1 gr kader
1 konserv 1 amox,pct 1 30
1 1 1 cepa,asmet,ctm, 1
1 1 1 2 amoxpct,ctm,dexa 1
1 1 1 klinda,asmef,b com c 1
1 1 1 amox,pct,ctm,dexa 1
1 1 1 amox,asmet,ctm,dexa 1
1 1 1 amoxpct,ctm,dexa 1
2 exo 2 amox,pct,ctm 1 50
1 1 amox,pct,ctm,dexa 1
1 1 1 amox,pct.ctm,dexa 1
1 1 1 b complex 1
1 exo 1 amox,pct,ctm,dexa,hidro 1
1 1 1 asmet,amlodipin 1
1 exo 1 amox,pct 1 25
3 exo 3 amox,pct,ctm,dexa 1 100
1 1 klinda,pct,ctm,dexa 1
1 1 amox,plunak 1
2 8 7 12 24 27 0 1 17 19
Tasikmalaya , 2018
NIP 19820531 201503 2 002
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
TANGGAL
CILAMAJANG
suhu
CIBEUTI
L P L P
1 01 tn abum 1350/2013 514570408 48 1 segleng 3/9 1 8.03 8.11
2 tn otong 106/10 514443003 59 1 conggeangb 3/11 1 9.23 9.36
3 tn budi sofyan 18100642/18 44 1 saguling pjg 4/5 1 10.31 10.34
4 ny eha julaeha 2236/13 64 1 gn lingga 1 10.47 11.00
5 ny iin setawat 18000643/18 33 1 cibuyut 2/1 1 10.48 11.16
6 ny ade ernawat 1603/11 513782201 45 1 tambir 3/5 1 11.44 11.50
7 02 daiva 18100309/18 9 1 cibuyut 2/1 1 8.33 8.41
8 nova tara 4500/10 513484672 6 1 conggeang 3/11 1 8.45 8.55
9 ny endang 459/11 31 1 cicondong 2/9 1 8.57 9.20
10 tn eris riana 18100241/18 514852862 30 1 saguling pjg 1/8 1 10.26 10.33
11 gina nazhifa 345/12 6 1 rc bungur 4/4 1 10.33 10.56 20
12 pelangi 162/13 6 1 saguling pjg 2/4 1 11.27 11.38 17
13 03 raisya 3282/11 514391692 7 1 asta pasir 2/10 1 09.45 09.50
14 04 yuni 25 1 negla3/11 1 09.00 09.20
15 sapatunazah 264/2012 1667612182 8 1 cijeruk girang 3/4 1 09.25 09.30
16 rafla pajira 0864/2012 2126528649 9 1 ranca bungur 04/04 1 09.49 09.52
17 rina 7220/2014 1 asta pasir 3/10 1 10.44 10.47
18 yudi 12161/2015 515284042 1 cibuyut 4/1 1 10.48 1053
06 tn budi sofyan 18100642/18 44 1 saguling pjg 4/5 1 9.11
20 tn uyu taryudin 18100336/2018 2445660977 57 1 selaawi 1/12 1
21 ny endang 459/11 31 1 cicondong 2/9 1
22 ny dede ipah 18000656/18 513771401 43 1 saguling pjg 1/7 1
23 mirnasari 007/2012 514505687 25 1 gn bitung 4/8 1
24 an zamzam 17100883/17 1 1 nagrog 2/2 1
25 ny susi 566/11 31 1 tambir 4/5 1
26 ny yayah 2554/13 1667625682 55 1 cijerah 2/3 1
27 07 Yudi pemana 12161/2015 515284042 40 1 CIBUYUT 4/1 1 09.50 10.00
28 alya tazqia rahma 15725/2016 2 1 cijeruk girang 3/4 1 10.00 10.29
29 dede sit 2324/2010 38 1 cikedewul 3/7 1 10.10 1020
30 tn usep 5848/2014 513745389 32 1 asta 1/10 1 1028 11.09
31 rizki 2132/2012 1667477687 11 1 cibogo clmj 1 11.10 11.30
32 08 ny eneng epih 1015/2013 39 1 palasari 1 9.35 1031
33 ny ihat 3269/2010 514292771 40 1 pasirwangi 2/11 1 11.05 11.35
34 tn uyu taryudin 18100336/2018 2445660977 57 1 selaawi 1/12 1 11.40 11.50
35 10 yuni 18000652/2018 25 1 negla3/11 1 9.20
36 ny eha julaeha 2236/13 64 1 gn lingga 1 9.47

37 ny endang 459/11 31 1 cicondong 2/9 1
38 ny dede ipah 18000656/18 513771401 43 1 saguling pjg 1/7 1
39 ny iyos 4773/2010 514637781 61 1 pasir wangi 1 10.10
41 m husna 3784/14 23 1 cihonje 1/2 1
42 ny yayah udayah 18000034/18 515065544 44 1 sk sirna 1/4 1
43 11 enur nurliah 10452/15 514491309 35 1 tambir lapang 1/5 1 8.37 8.45
44 dede heni 18000671/18 25 1 kr tengah 3/4 1 10.40 10.50
45 13 ny endang 459/11 31 1 cicondong 2/9 1
46 tn yana 1310/10 513959433 37 1 cicondong 2/9 1
47 rizka 2801/10 1014708014 9 1 sk sirna 1/4 1
48 aril aziz 17100424/17 13 1 gn subang 3/2 1 10.26
49 felicya putri 14983/15 11 1 gn subang 3/2 1
50 raisa 18000679/18 12 1 saguling pjg 2/4 1
51 ny yayah 2554/13 1667625682 55 1 cijerah 2/3 1
52 tn yudi permana 12161/15 515284042 39 1 cibuyut 4/1 1
53 ny lena 2753/12 514651241 33 1 segleng 2/9 1
54 ny eneng epih 1015/2013 39 1 palasari 1
55 ny sit juliant 1278/13 513635016 28 1 sk senang 1/7 1
56 14 ny iin basiroh 1011/2011 514998731 1 selaawi 1/12 1 9.10 9.15
57 15 nunung 3969/11 22 1 bojong 1 8.55 09.00
58 lilian 7378/2014 512586527 9 1 cibeut4/6 1 09.20 09.25
59 ny lena 2753/12 514651241 33 1 segleng 2/9 1 09.29 09.30
60 Rama ilham 17101515/2017 513828055 8 1 asta pasir 1 09.31 09.44
61 ai septani 18000045/18 28 1 kp lembur gunung 25/9 1 10.09 10.18
62 rifa aripatul 0586/11 514447558 7 1 cibuluh 1 10.19 10.25
63 16 tn yana 1310/10 513959433 38 1 cicondong 2/9 1 10.51 11.00
64 17 ny solaikah 1892/12 513999933 44 1 cijerah 2/3 1 9.17 9.25
65 ny eneng epih 1015/2013 39 1 palasari 1 10.31 10.40
66 18 ny eneng epih 1015/2013 39 1 palasari 09.40 09.50
67 dede hadimah 9598/2014 512585583 48 1 cibeut4/6 1 09.09 09.30
68 lilian 7378/2014 512586527 9 1 cibeut4/6 09.16 09.35
69 yuni 18000652/2018 25 1 negla3/11 1 10.00 10.40
70 aris nurhakim 17101210/17 13 bln 1 ranca bungur 04/04 1
71 emil 10801/2016 514199474 35 1 genteng 3/1 1
72 20 atang abdul karim 18100703/18 515239031 40 1 asta lebak 2/8 1 9.51 10.00 45
73 yayah rohayat 3416/10 513823691 58 1 segleng 2/9 1 10.07 10.15
74 ny iir irah 18000707/18 67 1 gn lingga 2/12 1 11.12 11.17
75 ny yet 033/13 514529752 35 1 gn bitung 2/8 1 11.39 11.45
76 ai inda 1313/13 514439728 20 1 cibuyut 2/1 1 11.49 11.56
77 21 ny eneng epih 1015/2013 39 1 palasari 1 8.37
78 erni patmawat 13731/15 514607354 26 1 negla 2/11 1 8.38
79 emil 10801/2016 514199474 35 1 genteng 3/1 1
80 22 yuni 18000652/2018 25 1 negla3/11 1 10.02 10.30
81 ny yayah 2554/13 1667625682 55 1 cijerah 2/3 10.25 11.00
82 23 lilian 7378/2014 512586527 9 1 cibeut4/6 1 11.04 11.24
83 ny. amelia robiana 18000002/18 18 1 sukaraja 1 11.20 11.30
84 tn usep mulyana 10741/15 39 1 cicondong 3/6 1 11.38 11.44
85 ai inda 1313/13 514439728 20 1 cibuyut 2/1 1 11.41 11.50
86 24 fitrah nur 2098/10 513478585 8 1 bj gaok 3/1 1 9.46 9.54
87 25 ny sit aminah 1059/11 5151613697 35 1 kr tengah 3/4 1 8.26 8.33
88 erni patmawat 13731/15 514607354 26 1 negla 2/11 1 9.10 9.53
89 ny eneng epih 1015/2013 39 1 palasari 1 10.10 10.20
90 maulana 902/14 514557955 14 1 cihonje 5/2 1 10.55 11.00
91 27 Naila nur 455/2011 513899291 1 10.30 10.37
92 nasywa 17100179 9 1 10.40 10.48
93 diki fauzi r 18100025/18 19 1 cibuyut lebak 4/6 1 11.12 11.20
94 29 erni patmawat 13731/15 514607354 26 1 negla 2/11 1 9.00 9.30
95 m fajar 895/13 514321244 7 1 sukasenang 1/7 1 09.35 09.48
102 sit hotmah 16001036 1667482942 35 1 saguling 2/4 1 10.18 10.30
103 yuli 17607/16 32 1 segleng 3/9 1 10.28 10.35
104 oneng ny 837/2013 46 1 sindangsari 001/010 1 10.42 10.52
105 30 yant 2835/10 513396459 33 1 gn malang 4/9 1 8.47 9..15
106 sela padilah 2078/12 2127529372 5.9 1 segleng 2/9 1 9.20 9.25
107 yani suryani 272/12 40 1 palasari 3/10 1 9.17 9.22
108 ny yant 3192/14 514105716 31 1 pasirwangi 1/11 1 10.17 10.36
109 16 10 40 35
110 jml 108
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126 H Enjang Nurjamil,S .Kep.Ners.MHKes
127 NIP: 19740424 199503 1 002
128
129
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131
132
133
134
135
136
137
138
139
140
141
142
143
144
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146
147
148
149
150
151
152
153
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159
160
161
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165
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BULAN MEI TAHUN 2018
RIWAYAT PENYAKIT
EXO GIGI SULUNG

TUMPATAN GIGI
TUMPATAN GIGI
EXO GIGI TETAP

PENAMBALAN
PENGOBATAN
PENCABUTAN
respirasi
ICD 10
nadi
SULUNG
PULPA
TETAP
90/70 46 pak k04.4
180/100 33-42 abses periapikal k04.7
47 gp,polip k04.2
160/100 37 abses k04.7
110/70 21-22,gp k04.1 2 2
26 pak k04.4
64 pst k00.6 1
16 tkf k04.01 1 1
47 pak k04.4 1
1 82 pst k00.6 1
1 51-62 pst k00.6 3
1 71 pst k00.6 1
44 gp-36 gp tkp/flc k04.1 2 2
1 71pst/exo k00.6 1
1 71 pst/exo k006 1
65 abses k04.1
15 gr abs k04.8
47 gr k04.4
166/94 23 pulp k04.01 1
16 chkm k04.01 1 1
16 gp k04.4 1
44 devit, 43 gi k04.01 2 2
pre erupsi 72,82 k00.9
27 pak k04.4 1
14 gr, exo k04.8 1 1
15,GR,18GP k04.1 1
54.53.52,51gp k04.1 1
12 post tambal k04.1 1 1
47 gp,polip k04.1 1 1
11 flaktur abses k04.1
13 gr k04.8 1 1
17,16 gr exo k04.8 2 2
rujuk rs jk dalam k04.01 1
44 gp-36 gp chkm/flc, k04.01 2 2
skeling ra
150/100 37, period k05.3
16, open bor k04.01
16 pak k04.4 1
16, 47 gp k04.4 1
46 devit k04.01 1 1
DM 23 abses k04.06
48 pulp k04.01 1
48 impaksi k01.0
16 pi, tkf k04.01 1 1
90/60 37 pak k04.4 1
53 pst k00.6 1 1
1 84 pst k00.6 1
1 72 pst k00.6 1
13 gr K08.3
15 gr K08.3
16 gp K04.2 1
24,25 gr, abses K04.7
48 perikoronits K05..4
34 gp k04.1 1
48 pulp K04.1 1
1 46 CHKM/ K04.1 1 1
16 pulp k04.01 1
1 71,81 PST/EXO K006 2 2
48 gr k04.7
1 61 pst k00.6 1
47 gp,polip k04.1 1
11 pulp k04.0 1
25-24 radiks k08.3
25-24 gr k08.3
16 gp k04.4
1 46 cres/semen k04.2 1 1
44,36 chkm,55 exo k04.01 2 1 2
intrusi 51-61
46 devit k04.01 1 1
110/70 phleghmon k04.9
130/80 15 pak k04.4
140/90 28-26 gr k04.4
100/70 18 gr, 37 gr abses k04.4
100/70 46 abses k04.7
100/70 25-24 gr k08.3 2 2
21 tkf, 11 eug k04.01 2 2
46 tkf k04.2 1 1
44,36,25 gp k04.1 3
15 gr/exo k04.8 1
1 46 gi k04.2 1 1
36 abses, gr k04.7
38 abses k04.7
46 pak k04.4
1 65 gp, abses k04.7
26 pak k04.4
11 gi, 21 chkm k04.2 2 2
kontro post exo 4,017
36 pulp irrev k04.01 1
SD CIBEUTI 1 KLS 1 1 61 PST K006 1
1 k00.6 1
36 pak k04.4
21 gp k04.2 1 1
1 65 abses k04.7
21 hp,22,23 gp/exo k04.2 1 1
16gp,26gp k04.4 1
23 gr,26 gr abses k04.7
21 pulp rev k02.52 1 1
1 84 pak k04.4 1
150/90 37 pak k04.4
14 gp k04.2 1
28 30
ODONTOGRAM
KEL. DENTOFACIAL
EXO GIGI SULUNG
KELAINAN PULPA
PENYAKIT LAIN-
PERIODONTAL
UMUM
PENGOBATAN
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
JARINGAN
LAIN-LAIN
RESEP KET
KIS
LAIN
P L P L P L P L P L P L P L P Ya Tidak Ya Tidak L P L P
1 1 1 amox,pct,ctm,b com c,amlod
1 1 1 amox,pct,dexa 1
1 1 1 1
2 2 amox,pct,ctm,dexa 1 100
1 1 1 1
1 1 exo 1 r/-- 1 25
1 1 exo 1 r/-- 1
1 endo 1 amox,pct,dexa 1
1 1 exo 1 amox,pct,dexa 1 25
3 3 exo 3 pct 1
1 1 exo 1 pct 1
2 endo 2 amox,pct,ctm,dexa 1 50
1 1 exo 1 pct 1
1 1 exo 1 amo,pct,ctm,dexa 1
1 1 exo 1 amox,pcty,ctm,dexa 1
1 1 endo 1
1 exo 1 r/-- 1 rujuk jk, pro exo
1 endo 1 pct,dexa 1
2 2 amox,pct,dexa 1
1 1 1 r/-- 1 rujuk mtbs
1 1 amox,asmef,dexa 1
1 1 amox,pct,dexa 1
1 1 Kinda,pct,dexa 1
1 1 amx,pct,cet,dexa 1
1 1 pct,dexa 1 30
1 exo 1 amox,pct,ctm,dexa 1
1 exo 1 amoxpct,ctm,dexa 1 50
2 exo 2 amox,asmetc\,ctm,dexa 1
1 1 r/-- 1 rujuk jk, pro exo
2 endo 2
pct,dexa 1
1 1 1 amox,pct,amlod 1
1 1 pct,dexa 1
1 1 amox,asmef,dexa 1
1 endo 1 klinda,pct,dexa 1
1 1 1 amox,pct,dexa,b com c 1
1 1 cefad,pct,ctm,dexa 1
1 1 1 klinda,asmef 1
1 endo 1 pct 1 20
1 1 exo 1 pct 1
1 exo 1 pct 1 25
1 1 exo 1 pct 1 25
1 1 exo 1 pct 1 dr tt (25)
1 1 1 amox,asmef,ctm,dexa 1
1 1 pct,amlod 1
1 1 1 cefad,asmef,dexa,b com c 1
1 1
1 1 1
1 endo 1 pct,dexa 1 20
1 1 Amlodipin ,pct 1
2 exo 2 pct 1 25
1 1 exo 1 pct 1
1 1 amox,pct,ctm,ctm 1
1 1 amox,pct,dexa 1
1 1 1 selesb 1
1 1 1 pct,b com c
1 1 1
1 1
1 2 1 3
1 1 1 1
1 1 klinda,pct 1 20
1 1 1 amox,metro,asmef,dexa,b comc 1
1 1 1 amox,asmef 1
1 1 1 cefad,pct,ctm,dexa 1
1 1 1 amox,pct,dexa,antasid 1
2 exo 2 amox,pct,ctm,dexa 1 150
3 3 1
1 1
1 konserv 1 r/-- 1
1 1 1 klinda,asmef,ctm,dexa 1
1 1 1 cefad,asmef,dexa 1
1 1 exo 1 amox,pct,dexa,antasid 1
1 1 1 klinda,asmef,ctm,dexa 1
2 2 b com c 1
1 1 1 cefad,pct,dexa,b com c 1
1 1 asmef 1 rujukn dr BP
1 1 PCT 1
1 1
1 1 1 cepa,asmet,ct,dexa 1
1 1 22 gp/fuji 1 20
1 1 1 amox,pct,dexa,ctm 1
1 1 amox,pct,dexa,ctm 1 80
1 1 amox,pct,dexa,ctm 1
1 1 1 amox,pct,dexa,ctm 1
1 1 b com c 1
1 1 amox,pct,dexa,ctm 1
1 1 1 amox,pct,ctm,amlod
1 1 1 pct,dexa 1
1 10 8 33 14 19 0 0 7 24 104 12

NIP 19820531 201503 2 002
Jenis
Kelamin
TANGGAL
L P
1 01 ny iin setawat 18000643/18 33 1 21-22 gp

2 02 daiva 18100309/18 9 1 64 persist
3 nova tara 4500/10 513484672 6 1 51 persist
4 gina nazhifa 345/12 6 1 82 persist
5 pelangi 162/13 6 1 51-62 pst
6 03 raisya 3282/11 514391692 7 1 71 pst
7 04 sapatunazah 264/2012 1667612182 8 1 71 pst
8 rafla pajira 0864/2012 2126528649 9 1 71 pst
9 06 ny yayah 2554/13 1667625682 55 1 14 gr
10 07 tn usep 5848/2014 513745389 32 1 47 gp
11 08 ny eneng epih 1015/2013 39 1 13 gr
12 ny ihat 3269/2010 514292771 40 1 17,16 gr exo
13 13 rizka 2801/10 1014708014 9 1 62 pst
14 aril aziz 17100424/17 13 1 53 pst
15 felicya putri 14983/15 11 1 84 pst
16 raisa 18000679/18 12 1 72 pst
17 15 Rama ilham 17101515/2017 513828055 8 1 71,81 PST/EXO
18 rifa aripatul 0586/11 514447558 7 1 61 pst
19 19 yuni 18000652/2018 25 1 55 persist
20 22 ny eneng epih 1015/2013 39 1 24-25 gr
21 28 Naila nur 455/2011 513899291 6 1 61 pst
22 30 sit hotmah 16001036 1667482942 35 1 23 gp
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Bulan Mei Tahun 2018

Consent Tangan
Riwayat Penyakit

TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Kesadaraan
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Akral
Nadi
Nadi
TD
TD
1 1 1 110/70 68 cm n 110/70 68 cm n
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 110/70 70 cm n 110/70 70 cm n
1 1 1 120/80 72 cm n 120/80 72 cm n
1 1 1 110/70 64 cm n 110/70 64 cm n
1 1 1 120/80 70 cm n 120/80 70 cm n
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 110/70 68 cm n 110/70 68 cm n
1 1 1 100/70 65 cm n 100/70 65 cm n
1 1 1
1 1 1 110/70 67 cm n 110/70 67 cm n
9 13 22 22
Pencabutan
Kesadaraan
Kesadaraan
Akral
Akral
Nadi
Nadi
TD
TD
110/70 67 cm n 110/70 67 cm n
72 cm n 72 cm n
68 cm n 67 cm n
70 cm n 72 cm n
68 cm n 67 cm n
65 cm n 65 cm n
67 cm n 66 cm n
68 cm n 67 cm n
110/70 70 cm n 110/70 70 cm n
120/80 72 cm n 120/80 72 cm n
110/70 65 cm n 110/70 65 cm n
120/80 70 cm n 120/80 70 cm n
64 cm n 64 cm n
67 cm n 67 cm n
62 cm n 62 cm n
63 cm n 63 cm n
65 cm n 65 cm n
64 cm n 64 cm n
110/70 68 cm n 110/70 68 cm n
100/70 65 cm n 100/70 67 cm n
64 cm n 64 cm n
110/70 67 cm n 110/70 67 cm n
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
TANGGAL
CILAMAJANG
suhu
CIBEUTI
L P L P
1 01 nining 107/11 72192879 49 1 cijerah 2/3 1 10.06 10.30
2 ny yant 2792/12 26 1 cijeruk girang 4/4 1 10.07 10.12
3 Tn masum 3480/10 42 1 cijerah 2/3 1 10.41 10.47
4 wulan 18000001/18 20 1 sagobog 1 11.10 11.16
5 03 ny oneng 837/13 1667627458 46 1 sd sari 1/10 1 8.10 8.15
6 desi 713/11 1667613554 8 1 cijeruk girang 1/4 1 8.43 8.58
7 tn mamat 12932/15 515107359 58 1 sk senang 3/7 1 9.44 9.58
8 aditya 6003/14 514803609 8 1 genteng 1/11 1 11.21 11.25
9 04 dwi irnawat 18000762/18 43 1 saguling inpres 1/4 1 9.15 9.22
10 ny yani maryani 17607/16 31 1 segleng 3/9 1 9.35 10.45
11 ny nining 232/2011 514702001 48 1 rc bubguur 4/4 1 941 09.52
12 salman 17100896/2017 515094012 20 1 cibogo 5/3 1 10.28 10.59
13 05 sipa aulia 7199/14 3 1 sd sari 1/10 1 8.23 8.30
14 DIDI 17102263/2017 55 1 CIBOGO 2/5 1 10.45 10.50
15 06 ny mumun 1052/10 514040218 47 1 asta baru 1/10 1 8.57 9.02
16 nuri 1540/11 7 1 bojong 1 9.38 9.43
17 07 eka fauziah ny 4485/10 513391116 23 1 cicondong 3/9 1 930 9.36
18 ny eneng epih 1015/13 38 1 palasari 3/10 1 10.02 10.40
ny sit juliant 1278/13 513635016 41 1 sk senang 1/7 1 10.38 10.45
20 20 yunita 17001152/17 513797736 7 1 gn subang 3/3 1 9.49 9.57
21 dede ropah 17001608/17 514665955 25 1 gn bitung 3/8 1 10.05 10.10
22 salma maisa 11057/15 10 1 asta baru 1/10 1 10.35 10.42
23 ny nurhayat 1699/12 513519996 41 1 rc gede 2/10 1 11.13 11.31
24 h. Anung 18100779/18 1725010874 67 1 cikedewul 3/7 1 11.14 11.35
25 zulfa 4621/10 513711066 7 1 cikedewul 3/7 1 12.03 12.10
26 cinta 1738/12 1667626468 6 1 cijerah 2/3 1 12.13 12.17
27 21 ny elis julaeha 147/11 44 1 cijerah 1/3 1 8.20 8.25
28 ny dede 1502/10 513744726 31 1 asta baru 1/10 1 10.30 10.42
29 ismail 2463/10 17 1 11.03 11.10
30 22 viviana 170011291/17 21 1 cibeut 1/6 1 9.08 9.25
31 24 ta rustyana 16002133/16 15 1 negla 3/11 1 8.45 9.02
32 nasywa 17100179/17 9 1 negla 3/11 1 8.45 8.51
33 tn nano taryono 18100793 513839452 83 1 cibogo 4/3 1 10.35 10.48
34 an zaky nurzaman 269/12 6 1 cijerah 3/3 1 11.02 11.12
35 ny nurhayat 1699/12 513519996 41 1 rc gede 2/10 1 11.21 11.40
36 adit divo 203/10 514451104 17 1 rc bungur 4/4 1 11.22 11.33
37 an azka 18100795/18 9 1 cijeruk girang 1/4 1 11.35 11.45
38 tn iwan 15169/15 50 1 cikedewul 3/7 1 11.50 11.56
39 25 ny isam 180000801 47 1 negla 1/11 1 8.06 8.38
41 ny dede 1502/10 513744726 31 1 asta baru 1/10 1 9.12 9.28
42 dede riyan 18100803 23 1 gn bitung 3/8 1 9.29 9.33
43 m husna 3748/14 72081663 23 1 cihonje 1/2 1 10.15 10.30
44 Anisa penta 16000005/2016 16 1 mangkubumi rt 01/01 1 12.15 12.30
45 tna herlina 18000808/2018 34 1 genteng 02/01 1 12.30 12.45
46 ziyan atkiyah 18100409/2018 20 1 cijeruk girang 3/4 12.47 12.50
47 aat rohayat 2668/2012 514035066 35 1 selawi 13.20 13.30
48 27 riyadul 2753/10 514253261 18 1 segleng 1/9 1 9.35
49 riska 18000815/18 513927562 1 cibeut 2/6 1 10.00 10.11
50 Risky Aditya 153/14 1667614961 1 gn malang 4/9 1 945
51 afrizul 3215/10 1667624649 1 segleng 3/9 1
52 ny eneng epih 1015/2013 39 1 palasari 1
53 tn warli 4946/14 515110511 52 1 segleng 3/9 1
54 nuriah ny 1245/13 1014708857 49 1 gn subang 1/2
55 tantri 17000609/17 7 1 rancabungur 4/4 1 10.51 10.54
56 diannisa 3083/2011 514510468 21 1 asta baru 1/10 1
57 satria 2991/111 5145110221 1
58 iwan 15169/2015 514613147 1
59 viviana 17001129/17 1
60 safatuzanah 264/2012 1667612182 1
61 ny iis 17000472 1
62 28 arbi buniarsyah 3687/10 514333271 17 1 asta pasir 2/10 1 8.50 8.54
63 ta rustyana 16002133/16 15 1 negla 3/11 1 8.54 9.10
64 pandi nurul 778/10 514433676 18 1 segleng 2/9 1 9.47 9.52
65 29 nuriah ny 1245/13 1014708857 49 1 gn subang 1/2 1 9.43
66 rendi 18100830/2018 514142785 7 cibogo 5/3
67 riyadul 2753/10 514253261 18 segleng 1/9
68
69
70
71
72
73
74
75 19 4 22 19 11 13 3 5 4 16 1 2
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
127 NIP: 19740424 199503 1 002
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
BULAN JUNI TAHUN 2018
RIWAYAT PENYAKIT
EXO GIGI SULUNG

TUMPATAN GIGI
TUMPATAN GIGI
EXO GIGI TETAP

PENAMBALAN
PENGOBATAN
PENCABUTAN
respirasi
ICD 10
nadi
SULUNG
PULPA
TETAP
21 FUJI k02.62 1 1
38 pak k04.4
190/130 25 hp k04.01 1
120/80 36 gr,37 polip k04.4 1
187/110 26 GR k04.4
1 62 pst k00.6 1
150/100 12 abses k 04.7
1 75 pak k04.4
100/70 16 pak k04.4 1
17 pak k04.4
26-28 pak k04.4
37,47 gic, skeling k02.52 2 2
85 pak K04.4
170/97 47 GP ABSES K04.1
31-41 missing
65 abses k04.7
120/70 35 gp abses k04.7
26,37 gic 38 eug 3 3
48 abses
sd darmajaya 1 51,61 pst /exo 2
46 abses
sd trta wening 1 55 pst
15 chkm 1
31, 41 period 2
sd cibeut 1 81 pst 1
1 75 gp
36 pak k04.4
48 tkf 1
dislok tmj
46,47 gp, open bor
46 tkf 1
75 gp, abses
24 period
exo 81 1 1
15 gic 1
36 tkf 1
1 51-52 pst 2
35-34 pak
14 pi 1
48 chkm 1
13 malposisi
46 tkf 1
46 gr/exo 1
44 gr/exo 1
11 flaktur
36,45 pulpits
36 gr,
11 hp 1
75 abses
46 abses k04.1
38 fuji k04.1 1
26 pi k04.1
35 fuji, 47 gr k04.1 1
1 51,61 pst /exo k00.6 2
17 hp k0 1
13 erupsi k01.1
35 gp /exo k04.1 1
46,47 gp tkp tetes k04.1
1 61 pst/exo k00.6 1
35 gr k04.8
36 gp, polip
46 chkm 1
48 pre erupsi
47 gr 1
1 75 exo 1 1
36 gr 1
1 5 18 19 2 4 1 2 2
3
ODONTOGRAM
KEL. DENTOFACIAL
EXO GIGI SULUNG
KELAINAN PULPA
PENYAKIT LAIN-
PERIODONTAL
UMUM
PENGOBATAN
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
JARINGAN
LAIN-LAIN
RESEP KET
KIS
LAIN
P L P L P L P L P L P L P L P Ya Tidak Ya Tidak L P L P
1 konserv 1 b com c
1 1 1 amox,pct,dexa
1 1 pct,amlod,amox
1 1 cefad,pct,ctm,dexa
1 1 1 1 amox,pct,amlodip 1
1 1 1 1 1 pct 1
1 1 1 1 amox,pct,ctm,amlod 1
1 1 1 1 amox,pct,dexa 1
1 1 amox,pct,dexa 1
1 1 1 1 amox,pct,ctm,dexa
2 2 1 pct,b com c 1 230
1 1 1 1 amox syr,pct,ctm, dexa 1
1 1 1 1
1 1 1 1 r/-- 1
2 1 3 pct,dexa 1 80
1 1 amox,pct,dexa,b com c 1
2 2 2 1 pct 1
1 1 amox,pct,dexa 1
1 asmef,dexa 1
1 1 r/-- 1
1 amox,pct,dexa 1
1 amox,pct,dexa 1
1 asmef,b com c 1
1 cefad,asmef,dexa,b comm 1
1 amox,asmef,dexa 1
1 1 1 pct,dexa 1
1 amox,pct,amlodip 1
1 pct 1
1 pct,b complex 1
1 asmef,dexa 1
2 2 pct 1
1 klinda,pct,dexa
1 1 asmef 1
1 r/-- 1
1 1 asmef,dexa 1
1 amoxpct,ctm,b com 1 1 50
1 amox,pct,ctm,b com 1
1 amox,pct,b com 1
1 amox,pct,dexa 1
1 r/-- 1
1 amox.pct,ctm,deaxa 1
1 selcom c 1 30
2 2 pct 1 50
1 pct 1
1 amox,pct 1
1 r/ 1
1 klinda,pct,ctm,gg 1
1 1 cepa,pct 1 10
1 pct 1
1 1 amox,asmef dexa 1
1 1 b com c 1
1 amox,asmef,dexa,ctm 1
1 amox,pct,dexa 1
1 amox,pct
1 amox,asmef,ctm,dexa
9 3 12 3 10 13 13 1 0 5 12 6 10
NIP 19820531 201503 2 002
Jenis
Kelamin
TANGGAL
NO. NAMA PASIEN NO. KARTU KIS Usia
L P
1 03 desi 713/11 1667613554 8 1

2 20 yunita 17001152/17 513797736 7 1
3 h. Anung 18100779/18 1725010874 67 1
4 zulfa 4621/10 513711066 7 1
5 24 an zaky nurzaman 269/12 6 1
6 an azka 18100795/18 9 1
7 25 ny isam 180000801 47 1
8 Anisa penta 16000005/2016 16 1
9 tna herlina 18000808/2018 34 1
10 27 tantri 17000609/17 7 1
11 iwan 15169/2015 514613147 27 1
12 safatuzanah 264/2012 1667612182 7 1
13 29 nuriah ny 1245/13 1014708857 49 1
14 rendi 18100830/2018 514142785 7 1
15 riyadul 2753/10 514253261 18 1
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Bulan Juni Tahun 2018

Consent Tangan
Riwayat Penyakit
TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Diagnosa
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Nadi
Nadi
TD
TD
62 pst 1 1 1
51,61 pst 1 1 1
31, 41 period 1 1 1 110/70 68 cm n 110/70 68
81 pst 1 1 1
81 pst 1 1 1
51-52 pst 1 1 1
14 pi 1 1 1 120/80 70 cm n 120/80 70
46 gr 1 1 1 100/70 65 cm n 100/70 65
44 gr 1 1 1 120/70 72 cm n 120/70 72
51,61 pst 1 1 1
35 gp 1 1 1 120/80 71 cm n 120/80 71
61 pst 1 1 1
47 gr 1 1 1 120/70 67 cm n 120/70 67
75 gr 1 1 1
36 gr 1 1 1 100/70 65 cm n 100/70 65
Anastesi Pencabutan
Pasca Anastesi Pre Pencabutan Pasca Pencabutan

Kesadaraan
Kesadaraan
Kesadaraan
Akral
Akral
Akral
Nadi
Nadi
TD
TD
82 cm n 80 cm n
81 CM n 80 cm n
cm n 110/70 68 cm n 120/70 70 cm n
83 cm n 84 cm n
84 cm n 84 cm n
85 cm n 85 cm n
cm n 120/80 70 cm n 120/80 72 cm n
cm n 100/70 65 cm n 110/70 68 cm n
cm n 120/70 72 cm n 110/70 70 cm n
87 cm n 86 cm n
cm n 120/80 71 cm n 120/80 70 cm n
85 cm n 85 cm n
cm n 120/70 67 cm n 120/70 68 cm n
88 cm n 88 cm n
cm n 100/70 65 cm n 100/70 67 cm n
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
TANGGAL
CILAMAJANG
CIBEUTI
L P L P
1 01 tn warli 4946/14 515110511 52 1 segleng 3/9 1 7.49 8.20
2 tn herman 8856/14 1667629787 46 1 tambir 2/5 1 9.08 9.14
3 ny dede rohimah 560/12 514885274 44 1 sk asih 2/6 1 9.55 9.59
4 m rojihi 5267/14 513324099 8 1 gn bitung 1/8 1 11.00 11.10
5 soni indra 1443/11 514667182 13 1 cijeruk hilir 1/1 1 11.11 11.16
6 viviana 17001129/17 21 1 cibeut 1/6 1 11.20 11.40
7 ziyan azkiya 18100409/18 18 1 cijeruk girang 3/4 1 11.56
8 02 Dede yuliant 1502/2010 513744726 31 1 asta baru 1/10 1 08.38 09.00
9 m husna 3748/14 72081663 23 1 cihonje 1/2 1 10.15 10.30
10 ta rustyana 16002133/2016 26 1 negla 3/11 1 10.45 10.51
11 03 ny jujuh 3163/2010 56 1 cijeruk girang04/04 1 08.45. 08.60
12 ilman abdul 993/2012 514046305 14 1 cijeruk girang 3/4 1 08.50 08.59
13 siska diana 180008843/18 8 1 saguling pjng 2/8 1 9.06 9.10
14 amir 1000/10 54 1 genteng 2/1 1 9.15 9.27
15 ny wawa 14000798 40 1 sk rame belah batu 20/5 1 1058 11.03
16 04 ny rose 514141301 32 1 cibogo 1/3 1 8.42 8.55
17 ny elly haryani 16000302/16 36 1 genteng 2/11 1 9.51 10.24
18 ny rany 2700/13 513468922 29 1 sk senang 1 10.05 10.14
19 tn memed 18100854/18 513904274 56 1 gn malang 4/9 1 10.36
20 safatuzanah 264/2012 1667612182 8 1 cijeruk girang 3/4 1 11.07 11.13
21 nida noor hidayat 2273/13 14 1 ranca gede 2/10 1 11.47 12.08
22 ny solehah 16001865/16 2199947141 82 1 selaawi 1/3 1 11.57
23 05 fredi rizal 18100860/18 26 1 tambir 4/5 1 8.49 8.56
24 ny dede sit 2324/10 29 1 cikedewul 3/7 1 9.20 10.06
25 ny sit mudrikah 13065/15 55 1 bojong parang 1 10.07 10.13
26 06 soni indra 1443/11 514667182 13 1 cijeruk hilir 1/1 1 9.08 9.22 41
27 ny neni nuraeni 4630/10 28 1 tambir 3/5 1 9.40 9.45 53
28 raisya sit 10090/14 12 1 sk senang 2/7 1 9.49 9.54 45
29 viviana 17001129/17 21 1 cibeut 1/6 1 10.10 10.25 80
30 08 ny aan 2681/13 514360945 43 1 negla 2/11 1 8.40 8.43
31 ny heni 936/10 1667625917 33 1 tambir 2/5 1 8.50 8.55
32 dedah nuhaedah 18005120/18 514443385 40 1 sk senang 3/7 1 9.37 9.45 59 149
33 m husna 3748/14 7081663 22 1 cihonje 1/2 1 9.46 9.52 54 160
34 endah sri 16001631/16 19 1 cibuluh 4/11 1 9.58 10.15 41 148
35 assef pizar 863/10 514261012 10 1 cibuluh 4/3 1 11.08 11.18 32 138
36 09 ny dede sit 2324/10 29 1 cikedewul 3/7 1
37 mamat rahmat 8421/14 66 1 bj gaok 3/11 1 9.16 9.30
38 ny nining herlina 107/11 49 1 cijerah 2/3 1 10.26
39 ny iis 17000472 1 cibeut 1/6 1 11.13 11.16
41 viviana 17001129/17 21 1 cibeut 1/6 1
42 10 ny lia 651/12 1669938726 31 1 cijerah 2/3 1 9.34
43 shofi 18100883/18 11 1 bojong gaok 3/1 1 9.52 10.21
45 hj. Noor aisyah 128/2014 48 1 ranca gede 2/10 1 10.49 11.20
46 11 Sahira fitrai 4749/2010 1669938737 9 1 cijerah 2/3 1 10.20 10.30
47 sit marya 14736/2015 22 1 saguling pjng 2/4 1 10.50 11.00
48 ria lindasari 18000891/18 17 1 cijeruk hilir 1/1 1 11.15 11.30
49 evi nurafifah ny 3667/2011 1667629438 29 1 ranca gede 2/10 1 12.00 12.15
50 12 ny yat suviyat 4448/14 513647392 33 1 gn lame 4/6 1 08.30 08.36
51 TN Dian herdiana 16100053 48 1 belah batu sk rame 020/05 1 11.00 11.11
52 Soni indra komara 1443/2011 13 1 cijeruk hilir 1/1 1 11.11 11.20
53 ny aan 2681/2013 44 1 negla rt 2/11 1 11.15 11.25
54 13 fitrah nur 2098/10 513478585 8 1 bojong gaok 3/1 1 8.23 8.29
55 m ramdan 17101239 515171024 23 1 gn lame 4/6 1 9.20 9.27 45
56 m alvin 3092/10 514377617 11 1 cibeut 4/6 1 9.56 10.00 25
57 tn nana 18100901/18 515232573 40 1 cicondong 3/9 1 10.10 10.19 60
58 15 dedah nuhaedah 18005120/18 514443385 40 1 sk senang 3/7 1 9.40 10.00
59 viviana 17001129/17 21 1 cibeut 1/6 1 10.13 10.42
60 nabilatul h. 6066/14 1667630856 4 1 cijerah 2/3 1 11.34 11.41
61 16 ny ai sukmawat 5921/14 514016335 40 1 cikedewul 3/7 1 10.18 10.25
62 Soni indra komara 1443/2011 13 1 cijeruk hilir 1/1 1 10.26 10.42
63 an hizam ahmad 1132/13 1667629449 6 1 rc gede 2/10 1 11.12 11.17
65 18 tatang 3175/2010 513868566 50 1 cibeut rt 02/06 1 08.22 08.27 76
66 ny endang 459/11 31 1 cicondong 2/9 1 8.48 9.02 64
67 ny inik 111/10 514611966 72 1 sukadana 2/4 1 10.11 10.17 42
68 tn mulyadi 18100930/18 513715599 50 1 nagrog 3/2 1 10.26 10.31 70
69 an zaky nurzaman 269/12 6 1 cijerah 3/3 1 10.50 10.58
70 Zahra ramadan 1900/10 514483964 8 1 gn bitung 4/8 1 12.00 12.05
71 19 tatang suherman 48 1 tanjung rt 02/003 1
72 ny iim 18000033/18 48 1 sudimara 2/8 1 8.33
73 Soni indra komara 1443/2011 514667182 13 1 cijeruk hilir 1/1 1 9.10 9.30
74 20 nazira 3.5 1 saguling cilamajang 1 8.00 8.20
75 ny een 221/2013 51440073 47 1 cibeut 1/1 1 08.29 08.35
76 nida noor hidayat 2273/13 14 1 ranca gede 2/10 1 11.20
77 genta reibuana 1667476664 9 1 cibogo 2/3 1 10.38
78 m ramdan 17101239 515171024 23 1 gn lame 4/6 1
79 22 ny nuriah 1245/13 1014708857 49 1 gn subang 1/2 1 8.28 9.20
80 ny jubaedah 18000520/18 514443385 40 1 sk senang 3/7 1 9.23 9.35
81 ny nanih 93/14 37 1 cijerah 4/3 1 9.27 9.34 55
82 umidah 2103/12 45 1 gn subang 1 10.12 12.00
83 Zulfa 4621/10 513711066 7 1 cikedewul 1 11.33 12.23
84 tn mulyadi 18100930/18 513715599 50 1 nagrog 3/2 1 12.13 12.2
85 23 ny iim 18000033/18 48 1 sudimara 2/8 1 8.16 8.39
86 ny eha 1875/13 514156241 68 1 segleng 2/9 1 8.39
87 Febi 17001961 513866957 7 1 genteng 2/1 1
88 m ramdan 17101239 515171024 23 1 gn lame 4/6 1 9.27
89 ny eem maemunah 221/13 514400073 47 1 cijeruk hilir 1/1 1 45
90 rafi hasbi 14108569/14 8 1 tambir 2/5 1
91 24 TN Dian herdiana 16100053 48 1 belah batu sk rame 020/05 1 8.00 815
92 adhiya laila rahma 18000960/2018 11 1 saguling pang 4/6 1 10.15 10.20
93 ny endang 14011772/2011 31 1 cicondong 2/9 1 10.25 11.03
94 een 14010769/2011 513746111 54 1 sk senang 2/7 1 11.00 11.05
95 elin herlina 1272/2010 1 sk asih 2/6 1
102 sit marya ulfah 14736/2015 1 saguling pnjang 2/4 1
103 soni indra komara 1443/2011 514667182 1 cijeruk hilir 1/1 1
104 ai sit 8543/2011 1 cikedewul 1/7 1
105 marsit 18000212/2018 1 genteng 3/5 1
106 25 sasabila askana 12028/15 3 1 sk senang 3/2 1 08.00 08.37
107 tn mulyadi 18100930/18 513715599 50 1 nagrog 3/2 1 11.09
108 26 ny yayah 3122/11 44 1 selaawi 3/5 1 8.33 8.40 62
109 ny elis nurasiah 0240/11 1667613508 65 1 cijeruk girang 3/4 1 8.41 8.50 64
tn oman 655/11 514531989 44 1 cibuluh 4/11 1 9.00 9.09 52
111 ny paidah 12199/15 1667624692 18 1 sk asih 2/6 1 10.04 10.09 50
112 27 ny yet 33/2013 514529752 35 1 gn bitung 2/8 1 8.51 8.58 50
113 m azka affandi 1238/2013 5 1 cijeruk hilir 1/2 1 9.27 9.32 15
114 ny rosidah 1857/10 42 1 asta lebak 1 9.42 9.50 51
115 cucu 14014216 515047162 36 1 pasir wangi 01/11 1 11.11 11.20 53
116 29 aas sihabudin 4921/11 50 1 karang tengah 1 9.06 9.12
117 m ramdan 17101239 515171024 23 1 gn lame 4/6 1 9.12 9.34
118 yusmayat 0562/11 34 1 cibeut 4/4 1 9.35 9.49
119 selamah 17000473/17 51375911 10 1 cikedewul 3/7 1 11.11 11.23 22
120 ny jubaedah 18000520/18 514443385 40 1 sk senang 3/7 1 11.23 11.47
121 ny tut 3353/10 513829787 45 1 sd sari 1/10 1 11.40 11.55 80
122 Zulfa 4621/10 513711066 7 1 cikedewul 1 12.36 18
123 30 tn aripudin 18100987/18 2426955164 36 1 cikadu 1/2 1 9.10 9.22
124 ny mulyat 16000057/16 53 1 bj parang 1 9.48 9.52
116 24 17 44 32 18 33 1 9 16 31 4 5
117 jml pasien gigi 117
118 B
119 L
120
121
122
123
124
125
127 NIP: 19740424 199503 1 002
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
BULAN JULI TAHUN 2018
RIWAYAT PENYAKIT
TUMPATAN GIGI
TUMPATAN GIGI
PENAMBALAN
PENGOBATAN
PENCABUTAN
respirasi
ICD 10
suhu
nadi
SULUNG
PULPA
TETAP
L P Nama SD & kls L P L P L P L
120/70 26 pi k04.01 1
100/70 15 pak k04.04
16,25 pak k04.4
1 54 abses k04.07
45 pulp irrev k04.01 1
46 47 chkm k04.02 2 2
11 fraktur s02.5 1
48 gp/fuji k04.01 1 1
47 chkm k04.01 1 1 1
46 gp/fuji k04.01 1 1
34 gp k04.2
36 gp k04.2
1 52,51,61 k006 3
46 gp k04.4
47 gp abses k04.7
180/130 44-45 gp k04.4
24-25 pulp rev k02.52 2 2
46 radix k04.4
31 period k05.3 1
1 51 pst k00.6 1
36 pulp irrev, tkf k04.01 1 1
11, 33gp k04.2
140/90 38 pak k04.4
2 bl 1 15 eug, 21 gic k04.01 2 2
43 pulp k04.01
45 pulp irrev, tkf k04.01 1 1 1
160/100 48 pulp, impacted k04.01
16 pulp irrev k04.01
46-47 gp, tkf k04.2 2 2
46-47 gr, 16 gr k04.4
38 impaksi k01.1
36 70 18 120/80 46 hp/ eug k02.1 1 1
36 70 18 110/80 47 gp/pengisian+gic k05.3 1 1 1
36 70 18 96/57 16 gp k04.1 1
36 75 16 90/65 kls 4 1 46 gp k05.3 1
2 bl 1 15 GIC k02.52 1 1
28 period k05.3 1
23 k02.62 1 1
120/90 35 gr k04.4
46,47 chkm k04.2 2 2
26 pulp arsen/flcr k04.01 1 1
1 11 pulp, calcyl k04.01 1 1
36 chkm k04.2 1 1
48 pulp, gic k04.01 1 1
1 36 gp tkp k04.2 1 1
110/70 46 gp k04.4
23.11 pro orto k07.2
36,26 gr k04.4
110/70 18 gp k04.4
90/70 47gp k04.4
45 chkm/flc k04.4 1 1 1
180/90 16,15abses k04.7
1 62 persist,exo k00.6 1
110/70 36 gp k04.4
1 Stomatts a.r dorsal lidah k12.0
38-37 pulp irrev k04.01
46 gi, 26 eug k04.1 2 2
46-47 gic k04.01 2 2
1 85 pulp k04.01
25 gr, 34 pulp k04.4
45 pak, tkf k04.4 1 1
1 51-61 gr, observ k08.3
36 pulp irrev, endometh k04.01 1 1
120/80 34 pulp k04.01
16 gp, open bor k04.2
130/80 13 abses period k04.5
140/90 46 pak ec gp k04.4
1 71 pst k00.6 1
1 75,74 ABS k04.7
35 gp k04.2 1
DM 24-25 pulp irrev k04.1 2 2
45 chkm k04.2 1 1 1
84,85 fuji,75 egl k04.01 3 3
15,16,17 gp k04.4
36 gic k04.01 1 1
1 51 pst k00.6 1
36 k04.4
34 pak k04.4 1
26 eug k04.1 2 2
120/80 46-47 gr, abses k04.7
38 gr k08.3
1 51 pst k00.6 1
46 pak ec gp k04.4
DM 24-25 gic k04.1 2 2
DM, JANTUNG 48 PERIOD k05.3
1 51.61 k00.6 2
36 k04.4
140/80 17-15 gp k04.4
1 51 pst k00.6 1
120/70 36 GP/EXO k04.1 1
1 85 pst k04.1 1
110/70 16 tkp/flc k04.4 1 1
120/70 36,35,34 gp /abs k04.7
120/80 18 gp abses k04.1
110/70 46 gp abses k04.7
100/70 46 gi k04.2 1 1 1
1 51 pst k00.6 1
dm 23,24 gr abs k04.7
75 eug k04.01 1 1
46 gp, exo k04.1 1
180/100 45 gp, abses k04.7
140/80 35 gp, abses bukal k04.7
100/60 38 gr, abses k04.4
120/80 46 pak ec gp k04.4
110/80 37 abses gr k04.7
1 54 abses k04.7
150/90 46 abses gp k04.7
90/60 37,38 gp trismus k04.7
16 fraktur s02.5
36 gp k04.2
12 gic k02.62 1 1
1 71 pst k00.6 1
26 chkm k04.0 1 1
150/100 24 abses k04.6
1 71 pst k00.6 1
16 pulp, tkf k04.0 1 1 1
44 pulp, stomatts a.r sudut bibir k04.0
2 8 11 48 24 8 36 0 4 9
JENIS KEGIATAN JENIS KELAINAN
ODONTOGRAM
KEL. DENTOFACIAL
EXO GIGI SULUNG
KELAINAN PULPA
PENYAKIT LAIN-
EXO GIGI TETAP
PERIODONTAL
UMUM
PENGOBATAN
PENGOBATAN
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
JARINGAN
LAIN-LAIN
RESEP
KIS
PULPA
LAIN
P L P L P L P L P L P L P L P L P L P Ya Tidak Ya Tidak L P L P
1 1 pro endo 1 1 amox,pct,ctm,dexa 1
1 1 1 klinda,pct,ctm,dexa 1
1 pro endo 1 klinda,pct,dexa 1
2 2 pct,dexa 1
1 1 asmet,amox 1
1 1 selcom,asmet 1
1 1 pct,b com 1
1 1 1 ampct,ctm,dexa 1
3 3 3 amox pct 1
1 1 1 cepa,pct,dexa,ctm 1
1 1 1 1
1 1 1 1 amlod,b com c 1
2 2 pct, b com c 1
1 1 1 1 amox,asmef,dexa 1
1 1 pct 1
1 1 1 pct,dexa 1
1 1 1 pct, b complex 1
1 1 1 dexa 1
1 1 1 2 pct,b com c 1
1 1 1 pct,dexa 1
1 1 1 1 klinda,pct,ctm 1
1 1 1 1 klinda,pct,ctm,dexa 1
2 2 1 asmef,b com c 1
1 1 1 pct, b com c 1
1 1 1 selcom c, asmef 1
1 1 1 1 amox,pct,ctm,dexa 1
1 1 1 R/-- 1
1 1 pct,b com c 1
1 1 1 1 amoxpct,ctm,dexa 1
2 2 2 asmet,b co 1
1 1 1 pct,dexa 1
1 1 1 pct,dexa 1
1 1 1 1 b com c, pct 1
1 1 1 b com c 1
1 1 1 amoxpct,ctm,gg 1
1 1 1 R/-- 1
1 1 1 amox,pct,amlodipin,selcom 1
1 1 1 cepa,pct,ctm,dexa 1
1 1 pct,b com c 1
1 1 1 amox,pct,ctm,amlodipin 1
1 1 1 pct 1
1 1 1 amox,asmef,dexa 1
1 1 1 b com c 1
1 1 1 amox,asmef,dexa 1
2 2 2 pct,dexa 1
2 2 2 pct,b com c 1
1 1 pro endo 1 amox,pct,ctm,dexa 1
1 1 1 1 1 1 cefad,asmef,dexa,ranit 1
1 1 1 1 dexa,b com c 1
1 1 1 1 r/-- 1
1 1 1 1 pct,dexa 1
1 1 1 1 klinda,asmet,ctm,dexa 1
1 1 1 klinda,asmet,ctm,dexa 1
1 1 1 pct 1
1 1 1 1
1 1 1 cepa,asmes,ctm,selcom c 1
2 2 1
1 1 1 r/-- 1
3 3 amox,pct 1
1 1 1 amox,pct,ctm,dexa,ants 1
1 1 b com c 1
1 1 1 pct 1
1 1 1 1
2 2 2 dexa 1
1 1 1 amox,quantdex,dexa 1
1 1 1 pct, bcom c 1
1 1 1 pct 1
1 1 1 amox,asmef,dexa,b com c 1
2 2 2 B COM C 1
1 1 1 AMOX,PCT 1
2 2 2 pct 1
1 1 1 cefad,asmef,ctm,dexa
1 1 1 amox,pct,dexa,antasid
1 1 1 pct
1 1 1 cefad,asmef,ctm,dexa 1
1 1 1 amox.pct 1
1 1 r/ 1
1 1 1 amo srp.pct srp 1
1 1 1 amox,pct 1
1 1 1 1 amox,pct 1
1 1 1 1 amox,metro,pct,dexa,bcom c 1
1 1 1 1 klinda,pct,dexa,b com c 1
1 1 1 1 cefad,pct,ctm,dexa 1
1 1 1 1 amox syr,pct,ctm,dexa 1
1 1 1 1 amox,quantdex,b comc 1
1 1 1 amox.pct,dexa,selcon c 1
1 1 1 1 cefad,asmef,dexa,b comc 1
1 1 1 pct, b comc 1
1 1 1 1 pct 1
1 1 1 1 b com c 1
1 1 1 1 amox,pct,b com c, amlod 1
1 1 1 1 pct 1
1 endo 1 1 klinda,asmef,dexa 1
1 1 1 1 b com c 1
24 7 2 4 11 17 27 3 10 2 13 9 36 20 28 0 0 9 15 124 10 35 89
NIP 19820531 201503 2 002
KET
250
20
30
50
50
20
20
20
30
50
50
30
40
20
20
50
70
20
50
25
20
Jenis
Kelamin
TANGGAL
L P
1 01 tn warli 4946/14 515110511 52 1 26 pi

2 ziyan azkiya 18100409/18 18 1 11 fraktur
3 03 siska diana 180008843/18 8 1 52,51,61 pst
4 04 tn memed 18100854/18 513904274 56 1 31 period
5 safatuzanah 264/2012 1667612182 8 1 51 pst
6 08 endah sri 16001631/16 19 1 16 gp
7 09 mamat rahmat 8421/14 66 1 28 period
8 13 fitrah nur 2098/10 513478585 8 1 62 persist,exo
9 18 an zaky nurzaman 269/12 6 1 71 pst
10 19 tatang suherman 48 1 35 gp
11 20 genta reibuana 1667476664 9 1 51 pst
12 22 ny nuriah 1245/13 1014708857 49 1 34 pak
13 Zulfa 4621/10 513711066 7 1 51 pst
14 23 Febi 17001961 513866957 7 1 51,61 pst
15 rafi hasbi 14108569/14 8 1 51 pst
16 24 TN Dian herdiana 16100053 48 1 36 GP/EXO
17 adhiya laila rahma 18000960/2018 11 1 85 pst
18 ai sit 8543/2011 8 1 51 pst
19 26 tn mulyadi 18100930/18 513715599 50 1 46 gp, exo
20 30 selamah 17000473/17 51375911 10 1 71 pst
21 Zulfa 4621/10 513711066 7 1 71 pst
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Bulan Juli Tahun 2018

Consent Tangan
Riwayat Penyakit

TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Kesadaraan
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Akral
Nadi
Nadi
TD
TD
1 1 1 120/70 70 cm n 120/70 70 cm n
1 1 1 110/70 65 cm n 110/70 65 cm n
1 1 1
1 1 1 120/80 68 cm n 120/80 68 cm n
1 1 1
1 1 1 100/60 64 cm n 100/60 64 cm n
1 1 1 120/80 71 cm n 120/82 71 cm n
1 1 1
1 1 1
1 1 1 130/80 72 cm n 130/80 72 cm n
1 1 1
1 1 1 110/70 65 cm n 110/70 65 cm n
1 1 1
1 1 1
1 1 1
1 1 1 120/70 65 cm n 120/70 65 cm n
1 1 1
1 1 1
1 1 1 130/80 75 cm n 130/80 75 cm n
1 1 1
1 1 1
Pencabutan
Kesadaraan
Kesadaraan
Akral
Akral
Nadi
Nadi
TD
TD
120/70 70 cm n 120/70 68 cm n
110/70 65 cm n 110/70 67 cm n
84 cm n 84 cm n
120/80 68 cm n 120/80 70 cm n
88 cm n 87 cm n
100/60 64 cm n 100/70 66 cm n
120/80 71 cm n 120/80 70 cm n
86 cm n 89 cm n
87 cm n 90 cm n
130/80 72 cm n 130/80 70 cm n
87 cm n 87 cm n
110/70 65 cm n 110/70 67 cm n
92 cm n 92 cm n
88 cm n 88 cm n
90 cm n 92 cm n
120/70 65 cm n 120/80 68 cm n
95 cm n 95 cm n
90 cm n 90 cm n
130/80 75 cm n 130/80 70 cm n
94 cm n 94 cm n
92 cm n 92 cm n
TANGGAL
NO. NAMA PASIEN NO. KARTU KIS

L P L P
B L B L
1 31 ny delis 18000995/18 23 1
2 sit mumut 14001269/14 514942525 20 1
3 embing tn 14102096/2014 72 1
4 NY JUJU 14011959/14 514044675 46 1
5 GALANG R 14105317 1879948888 9 1
6 01 ny endang 14011772/2011 31 1
7 aas sihabudin 4921/2011 50 1
8 m ramdan 17101239 515171024 16 1
9 evi sit aisyah 14013429 514455153 31 1
10 02 salma sabila 1869/11 8 1
11 tn ali nurdin 18101003/18 513550721 35 1
12 naufal 16100061/16 13 1
13 tn kasmita 18101005 25 1
14 bagus 14105596 2127529236 6 1
15 03 istqomah 514041671 27 1
16 tn aripudin 18100987/18 2426955164 36 1
17 yayah 14014524 48 1
18 fitriyani 14005142 514400567 25 1
19 euis rosniawat 18001010 38 1
20 05 Ujang saepul 18101021/18 2467220962 18 1
21 tn saripudin 14103465/14 514630146 54 1
22 ny delis 18000995/18 23 1
23 tn ali nurdin 18101003/18 513550721 35 1
24 zainal abidin 14115860/14 166749961 49 1
25 iwan ridwan 18101012/18 42 1
26 saskia 14005909 1667626683 1
27 ny jubaedah 18000520/18 514443385 40 1
28 ilham pajri 14107743 16 1
29 06 anwar latf 14101366/14 20 1
30 tn aripudin 18100987/18 2426955164 36 1
31 tn uyyu 18100336 2445660977 57 1
32 yayah 14014524 48 1
33 revan 18101017 4 1
34 tn embing 14102096 72 1
35 07 ny endang 14011772/2011 31 1
36 rina rihadatuais 14006159/11 2120638318 9 1
37 08 fitriyani 14005142 514400567 25 1
38 tn nursalim 13284/15 513807884 62 1
39 ny yat 14010559 513807917 48 1
41 salman ali 17100896 515094052 20 1
42 ai sit 8543/11 9 1
43 ny mimin 17000935/17 514958117 26 1
44 dede rel 14101049 54 1
45 09 een 14010769/14 513746111 54 1
46 tn rustandi 18100075 25 1
47 10 amelia agista 14005292 515066387 7 1
48 iwan ridwan 18101012/18 41 1
49 12 yadi mulyadi 14102452 514466741 44 1
50 Ujang saepul 18101021/18 2467220962 18 1
51 zainal abidin 14115860/14 166749961 49 1
52 robi nur 14101216 513323425 11 1
53 13 ny inik 140111130/14 514611966 72 1
54 tn rustandi 18100075 25 1
55 lia lihayat 17001209/17 513520108 1
56 ny mimin 17000935/17 514958117 26 1
57 inin 17100045/17 40 1
58 safa'atunnazah 264/12 1667612182 8 1
59 n. Sulihat 14000069/16 57511719 52 1
60 fitriyani 14005142 514400567 1
61 14 M Bachtar 14105291/14 4.5 1
62 iis nurhayat 14012335/14 513805127 42 1
63 ilyas abdul azis 7426/2014 213390609 9 1
64 15 ny ani anita 14012783 43 1
65 tn agus sutawan 6020/14 1667629618 51 1
66 17 ny inik 140111130/14 514611966 72 1
67 robi nur 14101216 513323425 11 1
68 ny toto 2349/10 515018182 43 1
69 fitriyani 14005142 514400567 25 1
70 keisya 18001056 7 1
71 doni romdoni 4955/14 513619953 41 1
72 ny sit juliant 1278/13 31 1
73 19 Ujang saepul 18101021/18 2467220962 18 1
74 tn agus sutawan 6020/14 1667629618 51 1
75 zainal abidin 14115860/14 166749961 49 1
76 ny enok 17000624/17 72131916 56 1
77 20 fitriyani 14005142 514400567 25 1
78 robi nur 14101216 513323425 11 1
79 zihan 14101833/16 11 1
80 GALANG R 14105317 9 1
81 abul makbud 17100132 70 1
82 22 tn agus sutawan 6020/14 1667629618 51 1
83 Ujang saepul 18101021/18 2467220962 18 1
84 adnan 18100001/18 13 1
85 ernawat 14011376/14 515051291 40 1
86 23 NY HENI 14014206/13 513947766 29 1
87 fitriyani 14005142 514400567 25 1
88 24 robi nur 14101216 513323425 11 1
89 tn mamur rustam 17101722 513525407 48 1
90 rhasya 2013/2127 11 1
91 ta latfah 14011799/14/5765 1667480589 1
92 encep gunawan 18100001/18 23 1
93 tn asep 14115830/14/6508 513804925 1
94 ny makmun 1
95 26 Ujang saepul 18101021/18 2467220962 18 1
96 ny yat rohayat 17001246 45 1
97 raisa 18000679 13 1
98 tn anwar 18101087 65 1
99 ny dede rukmanah 14012398 55 1
40 ny susilawat 14014348 166729708 31 1
100 28 Silmi Rahma Aini 18100540/18 514323595 11 1
101 jenisa khoirul 14004659 514942749 10 1
102 ny yat rohayat 17001246 45 1
103 ny enok 17000624/17 72131916 56 1
104 rafi hasbi 14108569 8 1
105 ny ani nuryani 14010019 29 1
106 28 robi nur 14101216 513323425 11 1
107 agung maulana 14109167/11 514313019 22 1
108 nunih ny 14011960/11/984 514249929 50 1
109 29 lilis 870/12 6 1
110 fitriyani 14005142 514400567 25 1
111 salman ali 17100896/17 515094052 20 1
112 tn u. Suryana 18101100 60 1
113 agus hasyim 16940/16 48 1
114 rath ratnasari 17002022/17 514222918 25 1
115
116 35 25 27 27
117
118
119
120
121
122
123
124
116
117
118
119
120
121
122
123
124
125
127 NIP: 19740424 199503 1 002
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
KELURAHAN
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
CILAMAJANG
respirasi
suhu
nadi
ALAMAT bb tb
CIBEUTI
L P L P L P L P
cukang 2/5 1 8.10 8.20 55 151 36˚C 80 20

genteng 2/1 1 9.11 9.15 37 149 36˚C 75 20
cihonje 5/02 1 9.20 9.35 65 167 37˚C 80 20
CIJERUK GIRANG 4/4 1 10.20 10.35 63 157 36˚C 85 20
CIJERUK GIRANG 03/4 1 10.40 10.55 22 123 35˚C 120 18
cicondong 2/9 1 8.20 8.32 65 165 37˚C 70 20
karang tengah 3/4 1 8.33 8.55 75 165 36˚C 85 18
gn lame 4/6 1 9.00 9.38 45 147 36˚C 70 20
cibuyut 1/1 1 10.22 10.30 52 149 37˚C 70 20
cijeruk girang 1 8.15 8.25 18 140 36˚C 100 20
tambir 2/5 1 9.05 9.15 56 162 36˚C 75 20
cijeruk girang 1/4 1 10.22 10.40 29 125 37˚C 80 20
cibuyut 1/1 1 10.25 10.36 50 162 36˚C 65 20
cihonje 5/02 1 10.36 10.45 35 140 36˚C 100 18
gn lingga 3/3 1 8.21 8.32 76 37˚C 70 20
cikadu 1/2 1 8.49 9.10 36˚C 85 18
cibuluh 4/11 1 9.22 9.33 53 155 36˚C 80 20
cijeruk hilir 1/1 1 10.00 10.12 68 156 37˚C 88 20
cibeut 3/6 1 12.01 12.09 43 36˚C 80 20
tambir 4/5 1 8.01 8.33 42 152 36˚C 75 20
tamansari 5/3 1 8.56 9.05 58 157 37˚C 80 20
cukang 1 9.12 9.40 36˚C 65 20
tambir 2/5 1 10.05 10.30 55 154 36˚C 60 18
saguling panyandu 5/4 1 10.36 10.45 65 162 37˚C 70 20
sk.asih 2/6 1 11.18 11.23 65 163 36˚C 85 18
11.25 11.30 18 116 36˚C 70 20
sk senang 3/7 1 11.32 11.45 59 149 36˚C 70 20
segleng 3/9 1 11.52 11.58 35 149 36˚C 75 20
cibuyut 2/1 1 8.49 9.41 36˚C 80 20
cikadu 1/2 1 9.41 37˚C 65 20
SELAAWI 1/12 1 36˚C 60 18
cibuluh 4/11 1 36˚C 70 20
saguling panyd 1 37˚C 85 18
cihonje 5/2 1 36˚C 70 20
cicondong 2/9 1 8.32 9.07 60 157 36˚C 68 14
selaawi 1/3 1 10.04 10.10 19 124 37˚C 120 24
cijeruk hilir 1/1 1 9.12 9.36 66 37˚C 80 20
segleng 3/9 1 9.56 10.11 50 37˚C 75 20
segleng 3/9 1 9.57 10.13 60 37˚C 80 20
cibogo 5/3 1 10.23 37˚C 65 20
cikedewul 3/7 1 11.31 36˚C 60 18
selaawi 2/12 1 37˚C 70 20
babakan kalong 1 37˚C 85 18
sk senang 3/7 1 9.14 9.20 53 36˚C 70 20
sangkali 1 10.08 10.12 51 168 36˚C 70 20
cijeruk hilir 1/1 1 8.56 9.05 15 36˚C 80 20
sukaasih 2/6 1 10.01 10.25 36˚C 65 18
cicondong03/06 1 8.41 9.00 65 165 38˚C 70 18
tambir 4/5 1 9.00 9.20 42 152 36˚C 70 18
saguling panyandu 5/4 1 10.12 10.23 68 158 36˚C 60 20
cijerah 2/3 1 10.23 1032 35 148 37˚C 60 20
sukadana 2/4 1 8.37 8.47 42 36˚C 60 18
sangkali 1 8.51 8.46 36˚C 60 20
rc.gede 2/10 1 8.47 9.01 52 37˚C 80 20
selaawi 2/12 1 9.16 9.40 37 36˚C 60 18
neglasari 27/10 sk.rame 1 9.15 9.50 51 157 36˚C 80 20
cijeruk girang 3/4 1 10.24 10.30 20 116 36˚C 85 24
asta gn batu 3/8 1 11.20 11.26 36˚C 60 18
cijeruk hilir 1/1 1 11.00 11.45 36˚C 60 20
cihonje 2/2 1 8.56 9.05 16 38˚C
cijeruk hilir 1/1 1 9.28 9.32 46 146 36˚C 70 16
cijerah 3/3 10.25 10.35 25 121 36˚C
selaawi 1/3 1 9.00 9.06 69 36˚C
sk sennang 2/7 1 10.47 10.55 62 162 36˚C 74 19
sukadana 2/4 1 8.51 9.10 68 152 36˚C 80 20
cijerah 2/3 1 9.00 9.25 35 148 36˚C 60 16
conggeang 3/11 1 9.20 9.31 36˚C
cijeruk hilir 1/1 1 9.55 10.14 46 148 36˚C 80 20
sk asih 2/6 1 10.00 10.15 15 120 36˚C 60 18
cijerah 2/3 1 10.30 10.45 56 168 36˚C 60 18
sk senang 1/7 1 10.55 11.25 48 148 36˚C 60 18
tambir 4/5 1 8.48 9.00 42 152 36˚C 60 18
sk sennang 2/7 1 36˚C 60 18
saguling panyandu 5/4 1 9.34 9.43 36˚C 60 18
cihonje 1/2 1 10.45 36˚C 60 18
cijeruk hilir 1/1 1 8.28 8.42 36˚C 60 18
cijerah 2/3 1 8.38 8.50 35 148 36˚C
asta pasir 2/10 1 9.10 9.30 36˚C
cijeruk girang 1 9.35 9.41 31 135 38˚C 65 14
sk menak 28/10 12.2 12 36˚C
sk sennang 2/7 1 36˚C
tambir 4/5 1 8 .59 42 152 36˚C 75 20
cisurupan/cikedewul 1 10.55 11.01 26 135 38˚C 60 14
cihonje 1/2 1 11.30 11.55 59 165 36˚C 70 18
tambir 1/5 1 9.10 9.18 36˚C
cijeruk hilir 1/1 1 10.26 36˚C
cijerah 2/3 1 9.27 35 148 36˚C
palasari 3/1 1 10.00 10.30 60 175 36˚C
sk asih 2/6 9.20 9.30 36˚C
saguling pnjng 2/7 10.50 10.59 36˚C
cikalong 1/2 11.15 11.30 36˚C
conggeang 3/11 12.15 12.30 36˚C
mangubumi 36˚C
tambir 4/5 8.12 8.40 42 36˚C
tambir 1/5 1 10.20 10.38 52 36˚C
saguling pjg 2/4 1 10.24 10.37 36˚C
selaawi 2/12 1 10.35 10.53 52 36˚C
cijeruk girang 4/4 1 10.52 11.15 36˚C
bj gaok 3/1 1 11.23 11.44 36˚C
bj gaok 3/1 9.11 9.15 37 36˚C
genteng 2/1 1 10.30 10.38 27 36˚C
tambir 1/5 1 10.20 10.58 36˚C
cihonje 1/2 1 11.03 11.12 36˚C
tambir 2/5 11.04 11.18 36˚C
cikedewul 3/7 1 11.15 11.20 36˚C
cijerah 2/3 1 8.30 8.45 35 148 36˚C 60 18
asta pasir 3/10 9.36 9.4 36˚C
cicondong 2/9 11.00 11.11 36˚C
conggeang 3/11 1 8.20 8.28 15 36˚C
cijeruk hilir 1/1 1 8.43 8.50 36˚C
cibogo 5/3 1 9.43 10.00 36˚C
cibuyut 5/1 1 9.45 10.25 36˚C
asta pasir 2/10 1 11.00 11.25 68 156 36˚C 80 20
cibogo 5/3 1 11.28 11.53 41 148 36˚C 80 20
BULAN AGUSTUS TAHUN 2018
RIWAYAT PENYAKIT
TENSI DARAH BUMIL APRAS UKGS
Nama
L P Nama SD & kls L P
120/80
110/70
180/80
120/80
123/60 1
120/80
110/70
120/80
120/80
90/70 1
130/80
100/60
100/70
90/60 1
90/60
100/70
130/90
120/70
110/80
110/70
170/100 stroke
110/70
100/80
100/70
110/80
90/60 1
130/80
100/70
110/80
100/60 mi al ma'arif 1
100/70
120/80
120/70
100/60
100/65 1
120/80
120/80
130/70
110/71
1
120/80
110/60
120/70
120/80
100/60 1
150/90
100/70
100/70 1
100/80
110/70
110/80
120/70
tk almuttahid 1
120/80
mi al maarip kls 3
110.70
150/80
120/80
90/65 1
120/80
110/80
85/60
120/80
110/60
160/100
150/100
140/
110/70
90/60
153/97
110/70
90/60
120/70
110/70
110/70
sd karanganyar 1
90/70
110/70
120/70
170/100
120/80
100/70
130/80
1
130/80
160/80
100/60
ANGANYAR KOTA TASIKMALAYA
UN 2018
TUMPATAN GIGI
TUMPATAN GIGI
EXO GIGI TETAP

PENAMBALAN
PENGOBATAN
PENCABUTAN
ICD 10
SULUNG
DIAGNOSA
PULPA
TETAP
L P L P L P L P
38 gp k04.2
36 gp,pro exo k04.2
38 gp abses ko4.7
48 GP,35 GP K04.1
46,84 85 GP ABS KO4.4
16 gp/ chkm K04.01 1 1 1
16 gp/exo k04.1 1 1
36 gp/exo k04.1 1 1
44 pulp K04
malposisi 11 k07.3
37 period k05.3
36 pak k04.4
48 pulp k04.0
71,81 exo k00.6 2
28 pulp k04.01
16 chkm k04.01 1 1 1
27 pak ec gr k04.4
37 pulp/ tkf k04.2 1 1 1
48 pulp k04.01
16 pulp, eug k04.01 1 1 1
16 period k05.3
37 gp k04.1 1 1
37 exo k04.1 1 1
47 pulp k04.01 1
24 gp /tkp k04.1 1 1 1
51 pst/exo k006 1
26 hp/ fuji k02.1 1 1
46 gp k04.4
gmkg rb k05.0
16 gi k04.2 1 1 1
stomatts k13.0
27, 26 gr k08.3 2 2
51.61 k08.3 2
38 gp k04.1
16 k.profunda/pengisian&gic k02.8 1 1
74 gr k00.6 1
37 chkm k04.1 1 1 1
27 period k05.3
gmkg k03.6
46 gi k02.1 1 1
82 pst k00.6 1
47 gp k05.3 1
31 pd/exo k04.1 1 1
36 gr/premed k08.2
44 gr k08.2 1
51 pst k00.6 1
24 chkm k04.2 1 1 1
38 embedded & impacted/abses k01/k09.0
16 tkf k04.2 1 1 1
47 pak k04.1
46 tkf k04.2 1 1 1
13 abs period k05.21
44 gr/exo k04.1 1 1
35 abses period+gingivits kronik k05.2/k05.1
47 gp/exo k04.1 1 1
27 hp/ gic k02.1 1 1
82 pst/exo k00.6 1 1
27 gr k08.3
37 gp/ devit+ts k04.0 1 1
54 pulpits k04.1 1
24,25,26,27 gr + gingivits k04.4
46 hp,55,54,53 gp k02.1 1 1
26 gp, 46 gr k04.4
27 pulp k04.0 1
13 period k04.1 1 1
46 open bor k04.2
38 pak k04.4
37 gp/ devit+ts k04.0 1 1 1
51, 71,81 pst/exo k00.6 3
16 pulp k04.0 1
48 perkoronits k01
16 open bor k04.2 1
27 pulp k04.01
47 pak k04.1
46 gr abses k04.7
37 chkm k04.2 1 1 1
46 chkm/flc k04.2 1 1 1
46 eug,36 devit k04.01 2 2 2
46 gp, polip k04.4
21 exo k04.1 1 1
27 pulp k04
16 chkm+flc k04.2 1 1 1
47 post erupsi/gingival abs k05.0
27 abrasi-gic/14 hp-gic k02.1/k03.1 2 2
37-36 pak ec gr k04.4
37 gi k04.2 1 1 1
46 tkp/tetes k04.01 1
46 devit k04.01 1 1 1
36,46 devit k04.01 2 2 2
45 gr abse k04.7
37tkp/36 gr k04.01 k04.8 1 1 1
37 gi,46 gp k04.01 1 1
45 gp/exo k04.1 1 1
16 gic k04.2 1 1 1
17 period k05.3 1 1
83,84 pst k00.6 2
38 period k05.3
22,23 gic k02.52 2 2
48 gr k08.3 1
36 ABSES k04.1
36 pulp k04.01 1
13-11,21 period k05.3 4 4
48 abses k04.7
52 pst k00.6 1
45 gp k04.4
46 gp k04.1
46 pp k04.2 1
36,37 gp k04.1
64,65 abses k04.7
37 gi, kontro post tambal
46, 47, 37 gic k02.52 3 3
48 gp k04.2 1 1
RA/RB (macro scalling) k05.0
16 k05.3 1
36 35 23 12 0 1 24 9 7 11
NIS KEGIATAN JENIS KELAINAN
ODONTOGRAM
KEL. DENTOFACIAL
EXO GIGI SULUNG
KELAINAN PULPA
PENYAKIT LAIN-
PERIODONTAL
PENGOBATAN
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
JARINGAN
LAIN-LAIN
LAIN
L P L P L P L P L P L P L P L P Ya Tidak Ya
1 1 1 1
1 1 1 1
1 1 1
2 2 1 1
3 3 3
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
2 2 2 2
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 open bor 1
1 1 1
1 1 1 1 1
1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
2 1 1
2 2 2
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 pro rujuk 1 1
1 1 1
1 1 1
1 1 1 1
1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
3 3 3 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1
2 2 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
2 2
1 1 1 1
1 1 1
1 1 1
1 1 1
2 2 1
1 1 1 1
1 1
1 1 1
1 1
1 1 1
1 1 1
1 1 1 1
1 1 1 1
2 2 1
1 1 1
1 1 1 1
1 1 1
4 4 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1
1 1 1 1
1 1 1 1
3 3 1
1 1 1
1 1 1 1
1 1 1 1
5 9 17 21 10 11 10 9 22 7 22 25 0 0 10 20 119 10 95
NIP 19820531 201503 2 002
ODONTOGRAM
UMUM
RESEP KET
KIS
Tidak L P L P
amox,pct,dexa,b com c 1
1 amox,pct,dexa,b com c 1
1 amox,pct,dexa,CTM 1
r/-- 1
amox,pct,ctm,dexa,b comc 1
cefad,asmef,ctm,dexa 1
klinda,pct,ctm,dexa 1
r/-- 1
amox,pct,dexa 1
amox,pct,ctm,dexa 1
klinda,asmef,ctm,dexa 1
1 pct syr 1
asmef 1
amox,pct,bcom c 1
asmef,b com c 1
amox,asmef,dexa 1
amox,quant,amlod 1
amox,pct,ctm,dexa 1
amox,pct,ctm,dexa 1
1 asmef 1
pct,dexa 1 20
pct 1
1 b com c 1
amox,pct,ctm,dexa 1
b com c 1
r/-- 1
1 b com c 1
amox,pct,ctm,dexa 1
1 amox,pct 1
1 pct, amlod 1
pct,b.com 1 30
pct 1
asmef,dexa 1
amox,pct,ctm,dexa 1
pct,dexa 1
b com c 1 30
pct syr 1
amox,pct,dexa 1
amox,pct,ctm,dexa 1 50
amox,pct,ctm,dexa 1
amox,pct,ctm,dexa 1
pct syr 1
pct,dexa 1 20
1 amox,metro,selcom,pct 1 rsu dr sukarjo
asmef 1
klinda,asmef,ctm,dexa 1
amox,pct,ctm,dexa
amox,pct,dexa 1
amox,asmef,ctm,dexa 1 50
amox,pct,b com c 1
cefad,pct,dexa 1
bcom 1 30
pct 1
r/-- 1
amox,asmef,ctm,dexa 1
amox sy,pct,ctm,dexa (pulv) 1
cefad,pct,dexa,b.com 1
1
amox,pct,ctm,dexa 1
klinda,pct,b com c 1
amox,pct,ctm,dexa 1
pct,dexa 1
1 amox,pct,ctm,dexa,bcom c
asmef,dexa
pct 1 75
klinda,pct,dexa,cetrizin 1
amox,pct,dexa,b comc 1
amox,pct,dexa,b comc 1
amlod 1
asm,amlod 1
amox,pct,ctm,dexa 1
b com c 1
b com c 1
klinda,pct,dexa 1
1 amox,pct 1
amoxpct b com 1 50
amlod 1
dexa.b.com 1
1 pct, dexa 1
1 pct, bcom 1 30
amox,pct,ctm,dexa 1
asmef,dexa 1
amox,pct,ct,dexa 1 20
amox,asmet,ctm,dexa 20
amo,pcr,ctm,dexa 1 40
amox,pct,ctm,dexa 1
1 amox,asmet,ctm,dexa 1 20
amox,asmet,ctm,dexa 1
1 amox,pct,ctm,dexa grt
asmef 1
amox,pct,ctm.dexa 1 50
asmef 1
amox,pct,ctm,amlod 1
b complex 1
1 amox,asmef,ctm,dexa 1 100
amo,asmet,ctm,dexa,b comce 1
pct,dexa 1
amox,pct,ctm,dexa 1
amox,pct,ctm,amlod 1
pct 1
amox,dexa,b com c 1
amox,asmetdexa,ct, 1
amox syr,pct,ctm,dexa 1
r/-- 1
b com c 1 60
amox,asmef,ctm,dexa 1 150
asmef,dexa 1 100
amox,asmef,ctm,dexa
19
Jenis
Kelamin
TANGGAL
L P
1 01 aas sihabudin 4921/2011 50 1 16 gp

2 m ramdan 17101239 515171024 16 1 36 gp
3 02 bagus 14105596 2127529236 6 1 71,81 pst
4 05 ny delis 18000995/18 23 1 37 gp
5 tn ali nurdin 18101003/18 513550721 35 1 37 period
6 ssakia 14005909 1667626683 7 1 51 pst
7 06 yayah 14014524 48 1 27, 26 gr
8 revan 18101017 4 1 51,61 gr
9 07 rina rihadatuais 14006159/11 2120638318 9 1 74 gr
10 08 ai sit 8543/11 9 1 82 pst
11 dede rel 14101049 54 1 31 pd/exo
12 10 amelia agista 14005292 515066387 7 1 51 pst
13 13 tn rustandi 18100075 25 1 44 gr
14 ny mimin 17000935/17 514958117 26 1 47 gp
15 safa'atunnazah 264/12 1667612182 8 1 82 pst
16 17 ny inik 140111130/14 514611966 72 1 13 period
17 keisya 18001056 7 1 51, 71,81 pst
18 21 abul makbud 17100132 70 1 21 period
19 25 ny makmun 1 45 gp
20 27 ny yat rohayat 17001246 45 1 17 period
21 raisa 18000679 13 1 83,84 pst
22 ny susilawat 14014348 166729708 31 1 48 gr
23 28 ny yat rohayat 17001246 45 1 13-11,21 period
24 rafi hasbi 14108569 8 1 52 pst
25 30 tn u. Suryana 18101100 60 1 48 gp
26 rath ratnasari 17002022/17 514222918 25
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Bulan Agustus Tahun 2018

Consent Tangan
Riwayat Penyakit

TL (Tidak Lengkap)
TA (Tidak Ada)
L (Lengkap)
Kesadaraan
Kesadaraan
Tidak
Tidak
Ya
Ya
Akral
Akral
Nadi
Nadi
TD
TD
1 1 1 110/70 66 cm n 110/70 66 cm n
1 1 1 120/80 70 cm n 120/80 70 cm n
1 1 1
1 1 1 110/70 64 cm n 110/70 64 cm n
1 1 1 120/80 70 cm n 120/80 70 cm n
1 1 1
1 1 1 130/80 74 cm n 130/80 74 cm n
1 1 1
1 1 1
1 1 1
1 1 1 120/80 72 cm n 120/80 72 cm n
1 1 1
1 1 1 100/70 67 cm n 100/70 67 cm n
1 1 1 100/80 68 cm n 100/80 68 cm n
1 1 1
1 1 1 120/80 67 cm n 120/80 67 cm n
1 1 1
1 1 1 120/80 70 cm n 120/80 70 cm n
1 1 1 120/70 71 cm n 120/70 71 cm n
1 1 1 110/70 66 cm n 110/70 66 cm n
1 1 1
1 1 1 120/80 72 cm n 120/80 72 cm n
1 1 1 120/80 70 cm n 120/80 70 cm n
1 1 1
1 1 1 130/80 73 cm n 130/80 73 cm n
1 1 1
21 5
Pencabutan
Kesadaraan
Kesadaraan
Akral
Akral
Nadi
Nadi
TD
TD
110/70 66 cm n 110/80 68 cm n
120/80 70 cm n 120/70 68 cm n
94 cm n 94 cm n
110/70 64 cm n 110/70 65 cm n
120/80 70 cm n 120/80 68 cm n
86 cm n 86 cm n
130/80 74 cm n 130/80 74 cm n
96 cm n 95 cm n
85 cm n 85 cm n
86 cm n 86 cm n
120/80 72 cm n 120/70 74 cm n
95 cm n 95 cm n
100/70 67 cm n 100/70 67 cm n
100/80 68 cm n 110/80 68 cm n
87 cm n 89 cm n
120/80 67 cm n 120/80 67 cm n
90 cm n 91 cm n
120/80 70 cm n 120/80 71 cm n
120/70 71 cm n 120/70 73 cm n
110/70 66 cm n 110/70 68 cm n
73 cm n 74 cm n
120/80 72 cm n 120/80 71 cm n
120/80 70 cm n 120/80 71 cm n
85 cm n 88 cm n
130/80 73 cm n 130/80 71 cm n
TANGGAL
NO. NAMA PASIEN NO. KARTU KIS ALAMAT

L P L P
B L B L
1 01 heni ny 14014206 513947766 26 1 karanganyar 01/05
2 01 roby nur awal 14101216 513323425 11 1 cijerah 2/3
3 ila aulia 14004416 11 1 cijeruk girang 4/4
4 andriyana c 18100001 31 1 garut
5 3 indra jaelani 14116296/14 514339828 35 1 asta lebak 2/8
6 03 jamal 18101119/18 514032467 18 1 segleng 1/9
7 heni ny 14014206/14 513947766 26 1 karanganyar 01/05
8 yani 14012784/14 513788139 41 1 segleng 3/9
9 andriyana c 18100001/18 31 1 garut
10 dede asiroh 14011932/14 49 1 cihonje 1/2
11 rafa khairul anam 16100582/16 7 1 selaawi 4/5
12 04 ayi noer 17001808 1667482964 12 1 saguling pjg
13 roby nur awal 14101216 513323425 11 1 cijerah 2/3
14 rath ratnasari 17002022/17 514222918 25 1 cibogo 5/3
15 ny elis royani 16000048 513953526 34 1 conggeng 3/11
16 m gian 14105561 513954088 7 1 conggeng 3/11
17 05 husni mubarok 16100281 8 1 palasari 3/10
18 ny robiah 1401212133 513474129 44 1 conggeang 3/11
19 sania nurwulida 16001350 515139748 12 1 psr wangi 2/8
20 m syafei 18100684 79 1 genteng 1/1
21 yadi heryadi 18101135 39 1 tambir 4/5
22 06 lili tarli 16100450/16 514127485 67 1 gn subang 2/12
23 ny iis maesaroh 14015291 246898192 55 1 cibogo 1/5
24 sit shofiyatul 14004606 5 1 segleng 1/9
25 07 ny karmila 3529/11 28 1 segleng 2/9
26 athifa 18001140 7 1 asta lebak 1/8
27 ayi noer 17001808 1667482964 12 1 saguling pjg
28 09 roby nur awal 14101216/2011 513323425 11 1 cijerah 2/3
29 zahra rahma 1239/13 5 1 gn subang 4/8
30 agus mulyadi 2651/2011 514506622 40 1 tambir 3/5
31 anissa mahardika 17001267 21 1 gn lingga 3/3
32 tantan hidayat 18100084 22 1 bojong 21/5
33 dewi lestari 3631/10 514484008 20 1 cicondong 2/9
34 aufa 18001148 6 1 saguling pjg 1/4
35 11 ny elis nurasiah 0240/11 1667613508 65 1 cijeruk girang 3/4
36 ny Sali maryat 14011842 1667628876 39 1 gn bitung 1/8
37 sania nurwulida 16001350 515139748 12 1 psr wangi 2/8
38 ny yent 17002357 20 1 psr wangi 2/11
39 rina 14006159 2120638318 9 1 selaawi 1/3
41 ny empat patmah 14010704 513390756 1
42 12 tn nana suryana 14102520 514021263 57 1
43 13 agus mulyono 2651/2011 514506622 40 1 tambir 3/5
44 ny euis rosniawat 18001010 38 1 cibeut 3/6
45 tn dede supriatna 14103373 514721981 41 1 cibogo 5/3
46 14 fahmi 16101510 13 1 asta lebak
47 iis isnaawat 47 1 saguling
48 16 rahmi sit 16000818 18 1 cijeruk girang 3/4
49 ast rizkia 18001166/18 17 1 gn lame 1/6
50 jue 14011597 51442836 52 1 cikedewul 3/7
51 albi 14106318 514427387 15 1 cikedewul 3/8
52 NAURA 14007595 1832014394 8 1 BOJONG gaok
53 17 sifa nurainiah 18101172/18 515290757 13 1 gn bitung 1/8
54 nasir 10391/15 513528647 21 1 cijeruk hilir 3/1
55 sit maryat 14002351 514609863 33 1 cicondong 2/9
56 nidda awaliya 14004546 514610278 7 1 cicondong 2/9
57 mimi rusmini 14014344 514923208 51 1 saguling inpres 1/9
58 akifa naila 18001176 4 1 gn bitung 1/8
59 18 yoyoh sopiah 14011583 1667627864 64 1 tambir 4/5
60 adzfar 14100419 9 1 bj parang
61 artka 16000978 513544735 8 1 segleng 1/9
62 asa nur 14005997 1667624523 5 1 cijerah 2/3
63 19 rani maryaningsih 18000001 27 1 dusun compreng 2/1
64 20 intan sri 18001188 1669107093 14 1 genteng 1/11
65 ny iin marlina 18001189 1669937231 34 1 genteng 1/11
66 21 ast rizkia 18001166/18 17 1 gn lame 1/6
67 ahmad raya 813/13 2127528911 7 1 asta baru 1/10
68 adzfar 14100419 9 1 bj parang
69 pentang 16000097 32 1 bj parang
70 salsabila 18001191 7 1 cikedewul 3/7
71 23 lilis lismayat 18001195/18 38 1 cukang 2/5
72 ny sumarni 18001199 515036709 42 1 cibogo 1/3
73 minart amirant 18101200 514807413 28 1 saguling inpres 2/9
74 tn undang 14102922 1667630103 71 1 cihonje 2/2
75 acep fajar 14101646/14 515044045 17 1 cihonje 4/2
76 ny ayi 14011448 514450899 47 1 rc bungur 4/4
77 ny n. Karsih 18001202 513714778 64 1 cikedewul 1/7
78 nazwa rohiatul 18000090 6 1 neglasari
79 m fajar 14104331 6 1 asta pasir
80 agni 14005960 7 1 ASTA lebak 1/8
81 24 aning 18000476 58 1 citamiang 2/8 tanjung
82 amas 181101206 26 1 citamiang 2/8 tanjung
83 fasrisa 14000530 3.5 1 bojong 17/5
84 rani farida nurani 14001634 513203231 18 1 sukasenang 4/7
85 ny dedeh hasanah 14010917 515040974 37 1 pasirwngi 1/11
86 resiana 18001209 6 1 cijeruk girang 2/4
87 kezia azifa 14006605 6 1 asta pasir 2/10
88 m. Galih f 14696498 514696498 18 1 cijeruk hilir 3/1
89 marsha nailatul 14005858 7 1 cijeruk girang 4/4
90 husna m irpan 18101210 7 1 cijeruk girang 4/4
91 agustna aprililla 18001212 7 1 asta batu 3/8
92 adam 18101211 7 1 cijeruk girang 2/4
93 25 lihah 14012702/14 514266884 47 1 pasirwangi 1/11
94 agus mulyono 2651/2011 514506622 40 1 tambir 3/5
95 26 heni ny 14014206/14 513947766 26 1 karanganyar 01/05
40 nazwa rohintul 18000090/18 6 1 neglasari 27/10
96 uum 14014534/15 513879816 73 1 genteng 3/11
97 hanif 18101220/18 5 1 gn.subang 3/2
98 maryam 14012867 514376368 51 1 sk.dana 2/4
99 tsya 18001223/18 7 1 asta lebak 2/8
100 27 rani farida nurani 14001634 513203231 18 1 sukasenang 4/7
101 m husna 17100194/17 8 1 saguling 1/6
102 28 nina k 3144/2011 37 1 tambir desa 2/5
103 rida 18000709/18 515112129 15 1 segleng 3/9
104 robi 14104862/14 1667614386 7 1 asta lebak 2/8
105 diana kaila 14008986/14 3 1 cijerah
113
114 L P
115 jumalah pasien 37 68 29 8 51 17
116
117 B : 80
118 L : 25
119
120
121
122
123
124
116
117
118
119
120
121
122
123
124
125
127 NIP: 19740424 199503 1 002
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
L
KELURAHAN
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
CILAMAJANG
respirasi
suhu
nadi
bb tb TENSI DARAH BUMIL APRAS
CIBEUTI
L P L P L P L P L
1 8.15 8.23 45 154 37˚C 70 18 110/70
1 8.48 9.10 25 128 36˚C 100 20 90/60
1 9.05 9.15 23 129 37˚C 100 20 85/60
1 11.00 11.10 65 158 36˚C 80 20 110/70
1 11.21 11.40 120 168 36˚C 80 22 120/80
1 8.56 9.20 51 156 36˚C 70 20 110/70
1 9.22 9.39 45 154 36˚C 70 20 110/70
1 9.40 9.45 75 151 36˚C 80 18 110/80
1 10.15 10.35 65 158 36˚C 80 20 110/70
1 10..40 11.05 65 152 36˚C 75 20 120/80
1 11.10 11.20 35 140 36˚C 100 18 90/60
1 10.42 10.51 43 152 36˚C 72 20 100/80
1 10.50 11.02 25 128 36˚C 100 20 90/60
1 10.56 11.13 42 148 36˚C 65 16 110/60
1 11.03 11.27 56 151 36˚C 65 18 110/70
1 12.06 12.36 22 120 36˚C 85 18 90/60
1 9.57 10.00 17 115 36˚C 87 26 90/60
1 10.01 10.06 60 148 36˚C 74 18 140/90
1 10.12 10.25 37 147 37˚C 81 21 100/60
1 10.20 10.33 60 162 37˚C 75 20 180/90
1 11.30 11.36 36˚C 85 18 110/80
1 8.32 8.47 37 36˚C 87 26 140/80
1 9.51 10.03 36˚C 74 18 120/80
1 10.09 10.12 36˚C 81 21
1 8.57 9.04 42 36˚C 75 20 110/70
1 9.10 9.20 36˚C 85 18 80/60
1 10.10 10.15 36˚C 87 26 90/60
1 9.41 9.50 36˚C 74 18 90/65
1 10.25 10.30 17 36˚C 81 21
1 9.38 9.55 53 36˚C 75 20 120/80
1 10.35 11.35 49 36˚C 85 18 120/70
1 10.55 12.13 36˚C 87 26 120/80
1 11.51 12.02 36˚C 74 18 120/75
1 12.25 12.33 36˚C 81 21
1 8.46 8.54 65 36˚C 75 20 130/80
1 9.20 9.50 36˚C 85 18 110/60
1 10.40 10.50 36˚C 87 26
1 10.52 10.54 36˚C 74 18 110/70 8 bl
1 10.59 11.02 36˚C 81 21 90/65
11.04 11.10 36˚C 75 20
10.20 10.25 36˚C 85 18 120/75
1 8.20 8.25 53 165 36˚C 87 26 120/80
1 8.56 9.06 45 150 36˚C 74 18 120/60
1 9.05 9.35 50 150 36˚C 81 21 120/80
1 10.20 10.26 35 145 36˚C 75 20 1280
1 10.30 10.35 55 150 36˚C 85 18 120/80
1 8.43 8.50 65 36˚C 87 26 120/80
1 9.44 9.48 36˚C 74 18 110/65
1 10.49 10.51 36˚C 81 21 130/80
1 10.52 10.55 36˚C 75 20 100/60
1 8.15 8.20 36˚C 85 18 90/60
1 8.21 8.24 36˚C 87 26 100/60
1 8.25 8.29 36˚C 74 18 120/60
1 9.30 9.42 36˚C 81 21 110/80
1 9.43 9.46 36˚C 75 20
1 10.45 10.55 36˚C 85 18 120/80
1 11.05 11.19 36˚C 87 26
1 10.15 10.30 49 150 36˚C 74 18 130/70
1 10.34 10.40 29 118 36˚C 81 21 100/70
1 10.45 10.47 25 112 36˚C 75 20 90/60
1 11.21 11.28 19 110 36˚C 85 18 80/70
1 11.50 11.57 36˚C 87 26 120/70
1 10.01 10.10 36˚C 74 18 100/60
1 10.01 10.26 36˚C 81 21 120/80
1 9.29 9.35 36˚C 75 20 110/60
1 10.27 10.35 36˚C 85 18
1 10.38 10.43 35 125 36˚C 87 26 100/65
1 10.45 10.50 47 152 38˚C 74 18 110/75
1 11.00 11.06 20 110 36˚C 81 21 80/60
1 9.25 9.34 63 162 36˚C 75 20 140/80
1 10.04 10.05 49 143 36˚C 85 18 120/60
1 10.07 10.18 50 161 37˚C 87 26 110/70
1 10.20 10.25 43 169 36˚C 74 18 190/110
1 10.58 11.03 45 160 36˚C 81 21 100/70
1 11.05 11.10 68 151 36˚C 75 20 130/90
1 11.20 11.30 40 150 36˚C 85 18 120/80
1 11.58 12.02 21 111 37˚C 87 26 90/60
1 12.38 12.45 20 110 36˚C 74 18 90/65
1 12.55 13.00 25 115 36˚C 81 21 90/70
1 08.00 08.15 60 154 36˚C 75 20 120/80
1 08.15 09.30 65 160 36˚C 80 22 120/80
1 09.30 09.39 10 36˚C 70 20
1 9.40 9.45 49 160 36˚C 70 20 100/70
1 10.15 10.20 59 150 36˚C 80 18 120/80
1 10.29 10.37 22 115 36˚C 80 20 120/80
1 10.52 11.02 21 110 36˚C 80 22 90/60
1 11.05 11.26 45 157 36˚C 70 20 100/60
1 11.43 11.46 30 115 36˚C 70 20 80/60
1 11.50 11.54 31 118 36˚C 80 18 90/65
1 11.57 12.00 30 115 36˚C 80 20 80/65
1 12.00 13.00 30 120 36˚C 87 26 90/60
1 9.50 9.56 54 152 36˚C 74 18 120/80
1 10.40 10.55 53 165 36˚C 70 20 103/88
1 8.05 8.20 45 154 36˚C 70 20 103/68
1 08.25 08.40 15 110 36˚C 70 20
1 9.36 9.42 40 147 36˚C 70 20 135/68
1 10.02 10.15 15 115 36˚C 70 21 1
1 10.40 10.55 57 140 36˚C 80 20 158/95
1 11.17 11.25 30 130 36˚C 75 17
1 9.15 9.25 53 147 36˚C 70 20 100/60
1 9.26 9.30 45 36˚C 70 20
1 811 8.20 46 36˚C 70 17
1 8.22 8.27 38 152 36˚C 72 17
1 8.30 8.45 25 112 36˚C 70 20 80/70
1 9.05 9.10 13 120 37,9˚C 72 32 80/70
12 31 4 9 13 21 5 8 1
BULAN SEPTEMBER TAHUN 2018
TINDAKAN
RIWAYAT PENYAKIT
TUMPATAN GIGI
PENAMBALAN
PENCABUTAN
ICD 10
RAS UKGS DIAGNOSA
TETAP
P Nama SD & kls L P L P
gasrits 36,37, gp abs k05.3
mi cijerah 1 46 gp/ tkp k04.1 1
mi cijeruk girang 1 36,46 pp k04
47 gp k04.1
36 gr/exo k08.3 1
36 gr/exo k08.3 1
gasrits 36,37 gp /exo k04.1 1
26 pulp k04.0
36 pulp/devit+ts k04.0 1
12 gr/exo k04.1 1
1 61 ulkus d/ exo k00.6 1
46 gp k04.4
1 46 chkm k04.2 1 1
35 gic k02.52 1 1
36 gic k04.2 1 1
1 46 gic k02.52 1 1
1 51, 61 pst k00.6 2
35 gr k08.3
36 gp abses '2 k04.4
35-33 gr k08.3
38 gp k05.3
16 gr k08.3
14 pulp/ts k04.0 1
1 84-85 abses k04.7
37 gr k04.4
1 51 pst k00.6 1
1 46 gi k021 1 1
1 75 gp k04.4
36 abses k04.7
scalling + 46 gic k05.0/k02.1 1 1
scalling k05.0
38 embedded k01.0
1 71,81 pst k00.6 2
17-16 abses,gr k04.6
14,24 hp k02.1 2 2
36 '2/exo k05.4 1
47 gp k05.3
1 65 pst k00.6 1
18-16 gr, pak k08.3
46 abses k04.7
36 abses k04.7
48 gp k05.3
27 gp k05.3 1
36 abses k04.7
46 gp k05.2
38 pre erupsi k01.0
24 pulp rev k02.1 1
17 pulp,18 gr k04, k08.3
37 pak k05.0
1 81 pst k00.6 1
16 abses k04.7
post trauma ant bawah s03
42 malposisi k04.1 1
85 gr, abses k04.7
38 pulp k04.0
85 gic k02.1 1
14 gic k02.1 1 1
1 54 persist k00.6 1
1 36 pulp k04.0
1 74,75,84,85 gp k05.3
45 pulp k04.0
46 pulp k04.0
11, 21 gic k02.1 2 2
24 gic k02.1 1 1
1 71,81 pst k00.6 2
1 54,55 pst k00.6 2
38 abses k04.7
1 81 pst k00.6 1
38 pulp k04.01
47 gp k05.3 1
36 pulp k04.0
12 periodontts k05.2
46 dislokasi mandibula s03
46 gp, abses k04.7
35, 34 abses?? Susp malignan k13.7
74 gp k05.3
1 51 pst k00.6 1
1 61 pst k00.6 1
44 pulp, tkf k05.3 1 1
16,26,36,46 gic k02.1 4 4
74 abses k04.7
46 pulp, tkf k04 1 1
21 distal gic k02.1 1 1
1 71 pst k00.6 1
1 72 pst k00.6 1
11 gp/tkf k05.3 1 1
1 51 pst k00.6 1
1 pre erupsi 42 k01.1
1 61 pst k00.6 1
1 51,61 pst k00.6 2
26 period k05.4
36 gp k05.3
gasrits 33 gp /exo k04.1 1
1 74 gp/exo k00.6 1
32,33 periodontosis k05.4 2 2
51,61 ulkus decubitus k00.6
16 hp k02.1 1 1
1 63 pst k00.6 1
46/devit k05.3 1 1
1 46 gp k04.4
11 gi k04.4 1
36 abses k04.7
1 51,61 pst k00.6 2
abs mandibula 84 k04.7
3 14 14 105 28 37 4 20
L
TUMPATAN GIGI
P
SULUNG
1
1
1
1
1
PENGOBATAN
PULPA
1
1
1
1
2
L
1
1
EXO GIGI TETAP
1
1
JENIS KEGIATAN
2
1
EXO GIGI SULUNG
P
2
1
L
1
1
PENGOBATAN
PERIAPIKAL
P
1
1
1
1
1
L
1
1
LAIN-LAIN
P
1
1
L
1
1
KARIES GIGI
P
1
1
1
L
1
1
1
1
1
KELAINAN PULPA
P
1
1
1
L
1
KEL.PULPA &
JARINGAN
PERIODONTAL
P
1
1
1
1
2
JENIS KELAINAN
1
KEL. DENTOFACIAL
MALOKLUSI
P
1
1
L
1
1
1
1
PENYAKIT LAIN-
LAIN
P
1
2
1
1
2
1
1
2
1 1
1 1
1 1
2 2
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1
1 1
1 1
4 4
1 1
1 1
2
1
2 2
2 2
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
2 2
1 1
1 1
1 1
1
4
1 1
1
1
1 1
1 1
1
1 1
1 1
1 1
2 2
1 1
1 1
1 1
1 1
2
2 2
1
1 1
1
1 1
1
1
2 2
1 1
0 2 7 23 3 4 14 11 5 16 8 8 2 17 8 18 5 11 5 6 20 29
NIP 19820531 201503 2 002
ODONTOGRAM
UMUM
RESEP KET
KIS
Ya Tidak Ya Tidak L P L P
1 1 amox,pct,ctm 1
1 1 pct,ctm,b com 1 20
1 1 cefad,asmef,dexa,ctm 1
1 1 cefad,asmef,dexa,ctm 1
1 1 cefad,pct,dexa,ctm 1
1 1 cefad,asmef,dexa,ctm 1 20
1 1 pct sy 1 25
1 1 amox,pct,dexa 1
1 1 dexa,b com c 1
1 1 pct,dexa 1
1 1 paracet,b com c 1
1 1 pct 1
1 1 pct 1 25
1 1 amox,pct,ctm 1 1
1 1 amox,pct,ctm,amlod 1
1 1 klinda,pct,dexa 1
1 1 amox,pct,ctm,dexa,becom 1
1 1 pct,dexa 1
1 1 amox syr,pct.ctm,dexa 1
1 1 amox,pct,dexa 1
1 1 pct 1
1 1 amox,pct,dexa,b com 1
1 1 r/-- 1
1 1 amoxpct,ctm,dexa 1
1 1 amoxpct,ctm,dexa metro 1
1 1 b complex 1
1 1 b complex 1
1 1 amox,pct,dexa,b com 1
1 1 pct syr 1
1 1 amox,metro,pct,ctm,dexa,becom c 1
1 1 r/-- 1
1 1 amox,pct,ctm,dexa
1 1 amox
1 1 pct
1 1 amox,pct,ct,.dexa
1 1 amox,pct,dexa,becom c 1
1 1 amox,asmef,dexa,ctm 1
1 1 amox,pct,dexa
1 1 amox,pct,dexa,becom c 1
1 1 pct, dexa 1 20
1 1 amox,pct,ct,.dexa 1
1 1 amox,pct,dexa 1
1 1 pct 1
1 1 amox syr,pct,dexa 1
1 1 r/-- 1
1 1 pct 1
1 1 pct, amox 1
1 1 pct 1
1 1 amox,pct 1
1 1 klinda,pct,dexa,ctm 1
1 1 klinda,pct,dexa,ctm 1
1 1 r/-- 1
1 1 pct,dexa 1
1 1 1
1 1 amox, pct
1 1 amox,metro,pct,ctm,dexa,becom c
1 1 r/--
1 1 klinda,asmef,ctm,dexa 1
1 1 amox,pct,amlod 1
1 1 amox 1
1 1 amox,pct,becom c 1
1 1 amox,metro,asmef,ctm,dexa,becom c 1
1 1 amox sy, pct,ctm,dexa 1
1 1 r/-- 1
1 1 pct 1
1 1 klinda, pct 1
1 1 r/-- 1
1 1 amox syr,pct,ctm,dexa 1
1 1 pct,dexa 1
1 1 r/-- 1
1 1 pct 1
1 1 r/-- 1
1 1 pct,dexa 1
1 1 r/-- 1
1 1 r/-- 1
1 1 pct 1
1 1 pct 1
1 1 r/-- 1
1 1 amox, pct,ctm,dexa 1
1 1 amox,pct,dexa 1
1 1 amox,pct,ctm 1
1 1 amox,pct,b.com 1
1 1 r/-- 1
1 1 pct,amlod,bcom 1
1 1 amox sy, pct sy 1
1 1 pct,dexa
1 1 amox, pct,dexa
1 1 amo,pct,ctm 1
1 1 klinda,pct,dexa 1
1 1 pct 1
1 1 cefad 1
109 2 106 5
Usia
Jam Datang
Tanggal No. Nama Pasien No. RM Alamat
L P
1 8.15 heni ny 14014206 karanganyar 01/05 - 26

9/1/2018
2 8.48 roby nur awal 14101216 cijerah 2/3 11 -
3 9.05 ila aulia 14004416 cijeruk girang 4/4 - 11
4 11.00 andriyana c 18100001 garut 31 -
9/3/2018 5 11.21 indra jaelani 14116296/14 asta lebak 2/8 35 -
9/4/2018 6 8.56 jamal 18101119/18 segleng 1/9 18
7 9.22 heni ny 14014206/14 karanganyar 01/05 - 26
8 9.40 yani 14012784/14 segleng 3/9 - 41
9 10.15 andriyana c 18100001/18 garut 31 -
10 10..40 dede asiroh 14011932/14 cihonje 1/2 - 49
11 11.10 rafa khairul anam 16100582/16 selaawi 4/5 7 -
9/5/2018 12 10.42 ayi noer 17001808 saguling pjg - 12
13 10.50 roby nur awal 14101216 cijerah 2/3 11 -
14 10.56 rath ratnasari 17002022/17 cibogo 5/3 - 25
15 11.03 ny elis royani 16000048 conggeng 3/11 - 34

16 12.06 m gian 14105561 conggeng 3/11 7 -
9/6/2018 17 9.57 husni mubarok 16100281 palasari 3/10 8 -
18 10.01 ny robiah 1401212133 conggeang 3/11 - 44
19 10.12 sania nurwulida 16001350 psr wangi 2/8 - 12
20 10.20 m syafei 18100684 genteng 1/1 79 -
21 11.30 yadi heryadi 18101135 tambir 4/5 - 39
9/7/2018 22 8.32 lili tarli 16100450/16 gn subang 2/12 67 -
23 9.51 ny iis maesaroh 14015291 cibogo 1/5 - 55
24 10.09 sit shofiyatul 14004606 segleng 1/9 - 5
9/8/2018 25 8.57 ny karmila 3529/11 segleng 2/9 28 -
26 9.10 athifa 18001140 asta lebak 1/8 - 7
27 10.10 ayi noer 17001808 saguling pjg - 12
9/10/2018 28 9.41 roby nur awal 14101216/2011 cijerah 2/3 11 -
29 10.25 zahra rahma 1239/13 gn subang 4/8 - 5
30 9.38 agus mulyadi 2651/2011 tambir 3/5 40 -
31 10.35 anissa mahardika 17001267 gn lingga 3/3 - 21
32 10.55 tantan hidayat 18100084 bojong 21/5 22 -
33 11.51 dewi lestari 3631/10 cicondong 2/9 - 20
34 12.25 aufa 18001148 saguling pjg 1/4 - 6
9/12/2018 35 8.46 ny elis nurasiah 0240/11 cijeruk girang 3/4 - 65
36 9.20 ny Sali maryat 14011842 gn bitung 1/8 - 39
37 10.40 sania nurwulida 16001350 psr wangi 2/8 - 12
38 10.52 ny yent 17002357 psr wangi 2/11 - 20
39 10.59 rina 14006159 selaawi 1/3 - 9
40 11.04 ny empat patmah 14010704 0% - -
9/13/2018 41 10.20 tn nana suryana 14102520 0% 57 -
9/14/2018 42 8.20 agus mulyono 2651/2011 tambir 3/5 40 -
43 8.56 ny euis rosniawat 18001010 cibeut 3/6 - 38
44 9.05 tn dede supriatna 14103373 cibogo 5/3 41 -
9/15/2018 45 10.20 fahmi 16101510 asta lebak 13 -
46 10.30 iis isnaawat 0 saguling - 47

9/17/2018 47 8.43 rahmi sit 16000818 cijeruk girang 3/4 - 18
48 9.44 ast rizkia 18001166/18 gn lame 1/6 - 17
49 10.49 jue 51442836 cikedewul 3/7 - 52
50 10.52 albi 14106318 cikedewul 3/8 15 -
51 8.15 NAURA 14007595 BOJONG gaok - 8
9/18/2018 52 8.21 sifa nurainiah 18101172/18 gn bitung 1/8 - 13
53 8.25 nasir 10391/15 cijeruk hilir 3/1 21 -
54 9.30 sit maryat 14002351 cicondong 2/9 - 33
55 9.43 nidda awaliya 14004546 cicondong 2/9 - 7
56 10.45 mimi rusmini 14014344 saguling inpres 1/9 - 51
57 11.05 akifa naila 18001176 gn bitung 1/8 - 4
9/19/2018 58 10.15 yoyoh sopiah 14011583 tambir 4/5 - 64
59 10.34 adzfar 14100419 bj parang 9 -
60 10.45 artka 16000978 segleng 1/9 - 8
61 11.21 asa nur 14005997 cijerah 2/3 - 5
62 11.50 rani maryaningsih 18000001 dusun compreng 2/1 - 27

9/20/2018
9/21/2018 63 10.01 intan sri 18001188 genteng 1/11 - 14
64 10.01 ny iin marlina 18001189 genteng 1/11 - 34
9/22/2018 65 9.29 ast rizkia 18001166/18 gn lame 1/6 - 17
66 10.27 ahmad raya 813/13 asta baru 1/10 7 -
67 10.38 adzfar 14100419 bj parang 9 -
68 10.45 pentang 16000097 bj parang - 32
69 11.00 salsabila 18001191 cikedewul 3/7 - 7
9/24/2018 70 9.25 lilis lismayat 18001195/18 cukang 2/5 38 -
71 10.04 ny sumarni 18001199 cibogo 1/3 - 42
72 10.04 minart amirant 18101200 saguling inpres 2/9 - 28
73 10.05 tn undang 14102922 cihonje 2/2 71 -
74 10.58 acep fajar 14101646/14 cihonje 4/2 17 -
75 11.05 ny ayi 14011448 rc bungur 4/4 - 47
76 11.20 ny n. Karsih 18001202 cikedewul 1/7 - 64

77 11.58 nazwa rohiatul 18000090 neglasari - 6
78 12.38 m fajar 14104331 asta pasir 6 -
79 12.55 agni 14005960 ASTA lebak 1/8 - 7

citamiang 2/8
80 08.00 aning 18000476 - 58
9/25/2018 tanjung
citamiang 2/8
81 08.15 amas 181101206 26 -
tanjung
82 09.30 fasrisa 14000530 bojong 17/5 - 3.5
83 9.40 rani farida nurani 14001634 sukasenang 4/7 - 18
84 10.15 ny dedeh hasanah 14010917 pasirwngi 1/11 - 37
85 10.29 resiana 18001209 cijeruk girang 2/4 - 6
86 10.52 kezia azifa 14006605 asta pasir 2/10 - 6
87 11.05 m. Galih f 14696498 cijeruk hilir 3/1 18 -
88 11.30 marsha nailatul 14005858 cijeruk girang 4/4 - 7
89 11.50 husna m irpan 18101210 cijeruk girang 4/4 7 -
90 11.57 agustna aprililla 18001212 asta batu 3/8 - 7
91 12.00 adam 18101211 cijeruk girang 2/4 7 -
9/26/2018 92 9.50 lihah 14012702/14 pasirwangi 1/11 - 47
93 10.40 agus mulyono 2651/2011 tambir 3/5 40 -
9/27/2018 94 8.05 heni ny 14014206/14 karanganyar 01/05 - 26
95 08.25 nazwa rohintul 18000090/18 neglasari 27/10 - 6
96 9.36 uum 14014534/15 genteng 3/11 - 73
97 10.02 hanif 18101220/18 gn.subang 3/2 5 -
98 10.40 maryam 14012867 sk.dana 2/4 - 51
99 11.17 tsya 18001223/18 asta lebak 2/8 - 7
9/28/2018 100 9.15 rani farida nurani 14001634 sukasenang 4/7 - 18
101 9.26 m husna 17100194/17 saguling 1/6 8 -
9/29/2018 102 811 nina k 3144/2011 tambir desa 2/5 - 37
103 8.22 rida 18000709/18 segleng 3/9 - 15
104 8.30 robi 14104862/14 asta lebak 2/8 7 -
105 9.05 diana kaila 14008986/14 cijerah - 3

PEMERINTAH KOTA TASIKMALAYA
DINAS KESEHATAN
UPTD PUSKESMAS KARANGANYAR
Jln. Tambir Karanganyar Kec. Kawalu Telp. (0265) 347187
Kota Tasikmalaya
Pelayanan Kesehatan Gigi dan Mulut

Bulan September Tahun 2018
Kelengkapan Tindakan
Melaksanaka Pengisian Formulir
Penggunaan sesuai
n Hand Pembedahan dan
Jam Tindakan
APD dengan
Jam Selesai
Hygiene Anastesi (Form Prosedur

Tindakan)
Diagnosa Jenis Tindakan
Tidak Ada
Lengkap
Lengkap
Tidak
Tidak
Tidak
Ya
Ya
Ya
36,37, gp abs 8.17 8.23 premed 1 1
46 gp/ tkp 8.50 9.45 endo 1 1 1
36,46 pp 9.15 10.35 premed 1 1

47 gp 11.02 11.10 premed 1 1
36 gr/exo 11.25 11.40 extraksi 1 1 1 1
36 gr/exo 9.00 9.20 extraksi 1 1 1 1

36,37 gp /exo 9.25 9.39 extraksi 1 1 1 1
26 pulp 9.41 9.45 premed 1 1
36 pulp/devit+ts 10.18 10.35 endo 1 1 1
12 gr/exo 10.45 11.05 extraksi 1 1 1 1
61 ulkus d/ exo 11.12 11.20 extraksi 1 1 1 1
46 gp 10.44 10.51 premed 1 1
46 chkm 10.51 11.02 endo 1 1 1
35 gic 11.03 11.13 konserv 1 1 1
36 gic 11.14 11.27 konserv 1 1 1
46 gic 12.07 12.36 konserv 1 1 1
51, 61 pst 9.58 10.00 extraksi 1 1 1
35 gr 10.02 10.06 premed 1 1
36 gp abses '2 10.15 10.25 premed 1 1
35-33 gr 10.28 10.33 premed 1 1
38 gp 11.31 11.36 premed 1 1
16 gr 8.40 8.47 premed 1 1
14 pulp/ts 9.52 10.03 endo 1 1 1
84-85 abses 10.10 10.12 premed 1 1
37 gr 8.58 9.04 premed 1 1
51 pst 9.11 9.20 extraksi 1 1 1
46 gp 10.11 10.15 premed 1 1
46 gi 9.42 9.50 konserv 1 1 1
75 gp 10.26 10.30 premed 1 1
36 abses 9.50 9.55 premed 1 1
scalling + 46 gic 10.37 11.35 konserv+skeling 1 1 1
scalling 11.36 12.13 scalling 1 1 1
38 embedded 11.53 12.02 premed 1 1
71,81 pst 12.26 12.33 extraksi 1 1 1
17-16 abses,gr 8.48 8.54 premed 1 1
14,24 hp 9.22 9.50 konserv 1 1 1
36 '2/exo 10.42 10.50 extraksi 1 1 1 1
47 gp 10.52 10.54 premed 1 1
65 pst 10.59 11.02 extraksi 1 1 1
18-16 gr, pak 11.05 11.10 premed 1 1
46 abses 10.20 10.25 premed 1 1
36 abses 8.20 8.25 premed 1 1
48 gp 9.00 9.06 premed 1 1
27 gp 9.07 9.35 extraksi 1 1 1 1

36 abses 10.21 10.26 premed 1 1
46 gp 10.30 10.35 premed 1 1
38 pre erupsi 8.45 8.50 premed 1 1
24 pulp rev 9.44 9.48 endo 1 1 1

17 pulp,18 gr 10.49 10.51 premed 1 1
37 pak 10.52 10.55 premed 1 1
81 pst 8.15 8.20 extraksi 1 1 1
16 abses 8.21 8.24 premed 1 1
post trauma ant bawah 8.25 8.29 premed 1
1
42 malposisi 9.31 9.42 extraksi 1 1 1 1
85 gr, abses 9.43 9.46 premed 1 1
38 pulp 10.48 10.55 premed 1 1
85 gic 11.06 11.19 konserv 1 1 1
14 gic 10.15 10.30 konsev 1 1 1
54 persist 10.34 10.40 extraksi 1 1 1
36 pulp 10.45 10.47 premed 1 1
74,75,84,85 gp 11.26 11.28 premed 1 1
45 pulp 11.51 11.57 premed 1
1
46 pulp 10.02 10.10 premed 1 1
11, 21 gic 10.10 10.26 konseerv 1 1 1
24 gic 9.29 9.35 konserv 1 1 1
71,81 pst 10.28 10.35 extraksi 1 1 1
54,55 pst 10.39 10.43 extraksi 1 1 1
38 abses 10.43 10.50 premed 1 1
81 pst 11.00 11.06 extraksi 1 1 1
38 pulp 9.26 9.34 premed 1 1
47 gp 10.05 10.35 extraksi 1 1 1 1
36 pulp 10.09 10.18 premed 1 1
12 periodontts 10.36 10.42 premed 1 1
46 dislokasi mandibula 10.58 11.03 premed 1 1
46 gp, abses 11.05 11.10 premed 1 1
35, 34 abses?? Susp 11.20 11.30 premed 1
malignan 1
74 gp 11.58 12.02 premed 1 1
51 pst 12.39 12.45 extraksi 1 1 1
61 pst 12.55 13.00 extraksi 1 1 1
44 pulp, tkf 08.02 08.15 endo 1
1 1
16,26,36,46 gic 08.16 09.30 konserv 1
1 1
74 abses 09.32 09.39 premed 1 1
46 pulp, tkf 09.40 9.45 endo 1 1 1
21 distal gic 10.15 10.20 konserv 1 1 1
71 pst 10.30 10.37 extraksi 1 1 1
72 pst 10.55 11.02 extraksi 1 1 1
11 gp/tkf 11.05 11.26 endo 1 1 1
51 pst 11.40 11.46 extraksi 1 1 1
pre erupsi 42 11.50 11.54 observ 1 1
61 pst 11.58 12.05 extraksi 1 1 1

51,61 pst 12.07 12.15 extraksi 1 1 1
26 period 9.50 9.56 premed 1 1
36 gp 10.48 10.55 premed 1 1
33 gp /exo 8.05 8.20 extraksi 1 1 1 1
74 gp/exo 8.25 08.40 extraksi 1 1 1
32,33 periodontosis 9.36 9.42 extraksi 1 1 1 1
51,61 ulkus decubitus 10.05 10.15 premed 1 1
16 hp 10.42 10.55 konserv 1 1 1
63 pst 11.18 11.25 extraksi 1 1 1
46/devit 9.15 9.25 endo 1 1 1
46 gp 9.26 9.30 premed 1 1
11 gi 8.11 8.20 konserv 1 1 1
36 abses 8.22 8.27 premed 1 1
51,61 pst 8.31 8.45 extraksi 1 1 1
abs mandibula 84 9.05 9.10 premed 1 1
Tindakan Waktu P
Ketepatan Pengisian Penanganan
sesuai Kelengkapan Tunggu (Planning) / Penyakit
Identfikasi Rawat Jalan < Rencana Odontogra Terbanyak
dengan Inform Consent Pasien m
Prosedur 60 menit Terapi sesuai SOP
Tidak Ada
Lengkap
Lengkap
Sesuai
Sesuai
Sesuai
Sesuai
Sesuai
Sesuai
Sesuai
Sesuai
Tidak
Tidak
Tidak
Tidak
Tidak
Tidak
Tidak
Ya
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1
1 1 1
1 1 1 1 1
1 1 1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1
1 1
1 1 1 1 1
1 1
1 1
1 1
1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1 1 1 1
1 1
1 1
1 1
1 1 1
1 1 1 1 1
1 1
1 1 1
1 1 1 1 1
1 1
1 1
1 1
1 1
1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1
1 1
1 1
1 1 1
1 1
1 1
1 1 1 1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1
1 1
1 1 1 1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1
1 1 1
1 1
1 1 1
1 1 1 1 1
1 1
1 1 1
1 1
1 1
1 1 1 1 1
1 1
1 1
1 1 1 1 1
1 1
1 1
1 1 1 1 1
1 1
1 1
1 1 1 1
1 1
1 1 1
1 1
1 1 1
1 1
1 1
1 1
1 1
1 1 1 1 1
1 1 1 1
1 1
1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1 1
1 1 1 1
Jam Tindakan
Luar Wilayah
Jam Datang
Jam Selesai
KARANGANYAR
TANGGAL
CILAMAJANG
CIBEUTI
L P L P
1 31 rani farida 14001634 513203231 18 1 sk senang 4/7 1 10.18 10.32 53 147
2 aan komala 14012766/13 1089791807 57 1 genteng 3/1 1 10.35 10.40 58 152
3 aam, sdr 97/13 512915196 25 1 genteng 1/1 1 10.45 10.50 56 158
4 m. Galih f 14696498 514696498 18 1 cijeruk hilir 3/1 1 11.44 11.58
5 agni 14005960 7 1 asta lebak 1/8 1 12.00 12.06 16
6 01 ade yuansah 18101240 24245333319 8bl 1 gn bitung 3/8 1 10.45 10.55
7 amelia agista 14005292 515066387 7 1 cijeruk hilir 1/1 1 11.01 11.05 16
8 sashie 14009306 514832534 12 1 gn subang 3/3 1 11.07 11.12
9 syifa naila 14004667 514557911 9 1 bj gaok 3/1 1 11.48 11.54 35 140
10 02 enung 14012263/18 513391004 42 1 cicondong 3/9 1 9.58 10.03 40 140
11 iim 18100042/18 42 1 mangkubumi 1 10.58 11.04 75 155
12 yadi mulyadi 14102452 514466741 44 1 cicondong 3/6 1
13 03 dian herdiana 14012740/14 1014709645 26 1 mekarjaya 6/1 1 8.28 8.32 70 155
14 aam, sdr 97/13 512915196 25 1 genteng 1/1 1 8.40 8.55 56 158
15 zidane 14106784/14 4 1 cikedewul 3/7 1 9.08 9.15 12 110
16 nina herlina 14015601/13 26 1 cikedewul 3/7 1 9.20 9.30 57 155
17 solihin 14103977 73 1 segleng 2/9 1 9.55 10.00 52 151
18 yoga 14105410/11 513557291 12 1 tambir 3/5 1 10.23 10.28 32 140
19 hj nonoh 14010552/14 1400073873 53 1 selaawi 2/12 1 10.42 10.48 53 153
20 rani farida 14001634 513203231 18 1 sk senang 4/7 1 10.55 11.06 53 147
21 nur ilham 14106541/12 514377729 13 1 sk dana 2/4 1 11.34 11.40 40 141
22 ilham 14107414/12 7 1 segleng 3/9 1 11.45 11.50 16 135
23 ainiah rona 18001250/18 17 1 cikondang 1/3 1 11.55 12.07 42 150
24 04 iim rohimah 18001251 38 1 cibeut 2/6 1 8.23 8.36 55
25 nurmalita sari 18001255 514275658 16 1 genteng 3/11 1 9.12 9.28 41
26 amira fahami 18001257 2201638937 8 1 negla 1/11 1 9.52 9.59 23
27 07 rani farida 14001634 513203231 18 1 sk senang 4/7 1 8.04 8.23 48
28 dicki jamjam 16100477 2083593 21 1 selaawi 3/12 1 9.18 9.25 47
29 zilvana almani 18001262 1667614408 6 1 cibeut 3/6 1 9.35 9.46 20
30 asyifa 14006319 6 1 selaawi 1/3 1 9.46 9.58 15
31 ujang ruswandi 18101266 58 1 cijerah kulon 4/3 1 10.06 10.19 75
32 zahra 16001536 513590051 10 1 bj gaok 3/1 1 11.30 11.34 35
33 08 syahrul sidik 17102130/17 21 1 asta baru 1/10 1 10.00 10.05 44 163
34 tni kartni 14000598/10 513225911 73 1 segleng 2/9 1 11.15 11.20 47 138
35 10 rani farida 14001634 513203231 18 1 sk senang 4/7 1 8.04 8.23 48 147
36 aam, sdr 97/13 512915196 25 1 genteng 1/1 1 8.40 8.55 56 158
37 nina herlina 14015601/13 26 1 cikedewul 3/7 1 10.10 10.20 57 155
38 tn khofidul 18101282 131227876 42 1 rc bungur 21/4 1 11.00 11.10 66 167
39 want 16000233/16 1014708868 26 1 gn subang 3/3 1 10.40 10.54 45 158
40 11 susi susilawat 566/2011 514227857 32 1 tambir 4/5 1 08.10 18.22 59 147
41 12 m madintan 16102143/16 14 1 cicondong 3/6 1 9.46 9.51 36 137
42 m rizki 18100001/18 7 1 paseh bojongsari 2/9 1 9.56 10.05 20 125
43 nabilatul hamidah 6066/14 4 1 cijerah 2/3 1 10.51 10.55 13 95
44 khalifa f.s 17779/16 2399175919 4 1 cijerah 2/3 1 11.00 11.05 15 110
45 14 idah 14011883/12 514011609 49 1 rancabungur 4/4 1 8.30 8.38 68 144
46 maskanah 14012744/11 515100262 42 1 tamansari 2/3 1 8.52 9.10 65 146
47 nafisah 18001296/18 514635658 20 1 gn subang 1/12 1 9.48 10.05 56 151
48 kiswa 14109230/14 515118802 8 1 gn subang 3/2 1 11.02 11.07 22 120
49 jajad 14115720/14 515114976 37 1 gn subang 3/3 1 11.08 11.15 72 172
50 15 keisa 14001298/18 6 1 sk asih 2/6 1 8.00 8.30 20 115
51 tta latfah 18001298/18 26 1 tambir lebak 4/5 1 9.00 9.18
52 nadin 16000900/16 513836054 23 1 cibeut 3/6 1 9.00 9.20 65 156
53 cucu 1940/10 1667627831 36 1 cihonje 3/6 1 9.10 9.33 66 155
54 lilis 1469/14 515099799 36 1 cihonje 3/6 1 9. 35 10.00 65 156
55 et 2488/10 37 1 cijeruk girang 3/4 1 10.23 10.30 61 144
56 uu nurdin 18101302/18 514161448 44 1 sk sirna 5/4 1 11.30 11.46 56 156
57 16 dani 18101304/2010 515170102 16 1 segleng 2/9 1 8.40 8.45 56 158
58 raisya 14004576/11 514391692 8 1 asta pasir 2/10 1 8.55 9.05 20 120
59 iyan supiyan 14103266/15 230929554 50 1 cibuyut 5/1 1 9.10 9.15 55 153
60 tat ruhaet 18001307/18 64 1 cijeruk hilir 1/1 1 10.42 10.50 45 147
61 bilqis n 18001309/18 8 1 sk asih 2/6 1 11.20 11.30 26 125
62 17 engkoy 3538/11 51438064 54 1 cibuyut 2/1 1 08.00 08.08 64 158
63 susi 566/11 514227857 30 1 tambir 4/5 1 10.25 10.30 55 152
64 18 usep 5848/14 513745389 33 1 asta baru 1/10 1 8.44 8.51 45 160
65 19 ny nisa 16000598 513649697 25 1 tambir 4/5 1 8.00 8.10 60 120
66 anisa 18001257 9 1 negla 1/11 1 8.20 8.30 23
67 danda 14104661 514619526 13 1 negla 1/11 1 9.00 9.10 35 145
amira fahami 8 negla 1/11 1 9.20 9.35 25 115
68 21 usep 5848/2014 513745389 35 1 asta baru 1/10 1 9.00 9.16 45 160
69 galang rehansyah 14105317 8 1 cijerukgirang 1 9.20 9.30 22 122
70 tn kingking 14103951 51390178 75 1 gn subang3/9 1 9.35 9.50 54 167
71 paidah 12199 1667624692 18 1 sk asih 2/6 1 10.00 10.10 46 154
72 fahma sahlah 1800004 4 1 jln ampera 1/6 1 10.20 11.25 13 100
73 ny enok 18000001/2018 55 1 batu tumbang 7/9 1 11.53 11.60 68 175
ai sukmawat 5921/14 514016335 41 1 cikeundewul 3/7 1 12.00 12.15 65 151
74 ilma hilyatul 14004701 4 1 cihinje2/2 1 12.30 12.45 15 108
75 22 mitha 14001818 514034559 22 1 cikedewul 3/7 1 08.00 08.10 45 155
76 23 alit 14101148 519440753 24 1 cihonje 5/2 1 09.00 09.10 49 156
77 ny nisa 16000598 513649697 25 tambir 4/5 09.10 9.30 60 175
78 widi widiyawat 6966/2014 1667481568 6 saguling cihonje 3/10 10.58 11.03 20 125
79 isep 18101330 514210511 39 saguling pjg 3/4 11.56 12.10 69 170
80 24 iyan supiyan 112118/15 50 1 cibuyut 5/1 12.20 12.35 70 162
tta tarwiyah 21 asta baru 1/10 12.37 12.42 65 150
25 wat 8860/2014 61 1 cijeruk girang 4/4 12.45 12.55 60 151
81 raisya 14004576/11 514391692 8 1 asta pasir 2/10 1 80.10 8.21 20 120
82 26 tn alan 18101357 513718751 30 1 cibogo 2/9 1 10.05 10.15 65 163
ani suparni 1953/2011 42 1 sukaasih 2/6 1 10.20 10.25 65 160
sit roi nuraeni 14664/2015 34 1 cijeruk hilir 1/1 10.30. 10.45 65 150
paidah 12199/2015 18 1 sukaasih 2/6 10. 50 10.55 50 160
eem maemunah 221/2013 47 1 cijeruk hilir 1/1 1 10.60 11.10 63 161
83 ny nurmala 14010728 513718863 30 1 cibogo 5/2 1 11.20 11.35 48 150
84 28 raka wiranata 14104621 2127529067 5 1 selaawi 1/3 1 9.00 9.08 16 120
85 lastri 1753/12 513777914 52 1 genteng 1/2 1 9.34 10.15 65 161
86 tn akik 14104188 515091082 51 1 selaawi 1/3 1 9.40 10.24 57 162
87 aira arasy 16000653 9 1 gn subang 3/2 1 9.48 10.30 27 120
155 Indi nurisma 14100784 51914568 15 cibuyut 1/1 1 9.57 10.35 57 155
para alit kurnia 14101148 514440753 24 1 cihonje 5/2 1 10.04 10.40 52 156
90 ny uyum 14010047 52 1 gn subang 2/2 1 11.12 11.21 75
91 29 ny eem 16001161 514400073 47 1 cijeruk hilir 1/1 1 10.05 10.14 47
92 amelia robiana 18000002 18 1 sukaraja 1 10.43 10.49 57
93 zahra 16001536 513590051 11 1 bj gaok 3/1 1 10.40 10.55 36
94 arif syaripudin 14115820 1089786003 57 1 cikedewul 2/7 1 11.20 52 163
95 30 enur nurhayat 14012204 513863627 37 1 asta lebak 4/8 1 8.38 8.44 9.05 43 150
96 dadan suhendar 14116146 33 1 cibuluh 4/11 1 11.20 11.32 11.40 45
95
96 24 8 43 23 15 31 5 9 7 24 1 4
97
98
99
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
140 NIP: 19740424 199503 1 002
141
142
143
144
145
146
147
148
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
BULAN OKT TAHUN 2018
TINDAKAN JENIS
RIWAYAT PENYAKIT
Inform Consent
TUMPATAN GIGI
TUMPATAN GIGI
PENAMBALAN
PENCABUTAN
respirasi
ICD 10
suhu
nadi
SULUNG
TETAP
L P Nama SD & kls L P Ya Tidak L P L P
36˚C 70 18 100/60 46 devit k05.3 1 1

36˚C 70 20 110/80 27 fraktur s02.50 1
36˚C 70 17 110/80 37 pulpits/devit k05.3 1 1
36˚C 70 20 100/70 11 gi k02.1 1 1
36˚C 90 20 1 51 pst k00.6 1
36˚C 1 labio-palato schizis q35.9
36˚C 85 20 100/80 1 61 pst k00.6 1
38˚C 70 20 100/70 25, 24 abses k04.7
36˚C 70 18 100/60 1 74-75 gingival polip k06.1
36˚C 71 17 120/70 46 gp k05.3
36˚C 73 19 160/90 17 gr k08.3
36˚C 70 20 38 impaksi k01.1
36˚C 73 18 100/70 37 pulpa polip k04.3
36˚C 70 17 110/80 37 pulpits/chkm k05.3 1 1
36˚C 70 20 74,75 pulpits k04.0
36˚C 70 20 90/70 28 gp, 36 gr k05.3, k08.3
36˚C 70 20 150/70 44 period k05.4 1
36˚C 80 22 100/60 sdn karanganyar 1 36 GP k05.3
36˚C 80 20 140/80 17 post endo-kontrol jk k05.3
36˚C 70 18 100/60 46 gp/ chkm k05.3 1 1
36˚C 70 18 100/70 74, 75 pst '3 k00.6 1
36˚C 70 18 90/60 sdn karangtengah 1 71, 81 pst '2 k00.6 1
36˚C 80 18 100/70 25 abrasi gigi k03.1 1 1
36˚C 140/90 susp tumor lidah k14.9
36˚C 21 gic k02.52 1 1
36˚C 1 72, 82 exo k00.6 1
36˚C 46 tkf k04.2 1 1
36˚C 36 post exo 4017
36˚C 1 51 ulkus k00.6
36˚C 1 71,81 pst k00.6 1
36˚C 150/90 37 fraktur lingual, abses k04.7
36˚C 1 36 pak k04.4
36˚C 20 120/70 46 pulp k04.0
36˚C 80 22 161/87 22 gr k08.3
36˚C 80 20 110/80 46 tkf k02.8 1 1
36˚C 70 17 110/80 37 pulpits/chkm k05.3 1 1
36˚C 70 20 90/70 28 gp, 36 gr k05.3, k08.3
36˚C 80 18 100/70 36 gp k04.1 1
36˚C 70 18 90/70 26 hp k02.1 1 1
36˚C 72 20 90/70 26 gp k05.2
37˚C 85 17 90/60 36 pulpa polip k04.4
36˚C 85 18 90/65 1 51 ulkus k00.6
36˚C 88 25 80/50 84, 85 gp k05.2
36˚C 82 20 80/55 74 hp kontrol k02.0
36˚C 74 20 179/108 16 period k05.4
36˚C 67 17 145/96 15 fraktur/exo s02.5 1
36˚C 72 17 120/70 36 gp k05.3
36˚C 85 18 90/60 1 47 erupsi k00.6
36˚C 80 17 120/80 48 impaksi k01.1
36˚C 70 20 90/60 1 52 pst/ exo K06 1
36˚C 46,47 GI,16 DEVIT K04.01 1 3
36˚C 72 20 120/80 27 gp/ devit k05.3 1 1
36˚C 70 17 132/60 46 gp/exo K04.01 1
36˚C 80 20 126/80 36 gr/ exo k08.3 1
37˚C 82 22 122/60 46 gr abs k08.3
36˚C 74 20 120/80 37 period k05.3
37˚C 70 17 110/70 35 gp abs k04.7
36˚C 85 18 85/60 1 51 pst/ exo k00.6 1
36˚C 80 17 120/70 23 period k05.4
36˚C 72 17 188/110 45 gp ˚3 k05.4
36˚C 72 18 85/60 1 51 pst/ exo k00.6 1
36˚C 80 20 130/80 15 pulp k04.0
36˚C 72 20 110/70 27 gp K05.2
37˚C 72 20 130/80 37 gp abses k04.7
36˚C 70 20 120/80 37 pp k04.1 1 1
36˚C konsultasi br.002
36˚C 70 20 120/70 37 gp abses k04.1
36˚C 70 20 80/70 46 gp k04.1
36˚C 64 20 104/64 37 gp/exo k04.1 1
36˚C 60 20 120/80 1 46 gp k04.1
36˚C 96 20 167/96 25 gp k04.1
36˚C 70 20 120/70 46 gp k04.1
36˚C 70 16 80/60 75 74 abses k04.7
36˚C 96 20 197/96 27 gr abs k04.7
36˚C 80 16 110/70 27 gp k05.2
36˚C 70 20 80/70 74,75 abses k04.7
36˚C 76 20 100/76 46 gp/exo k04 1
36˚C 70 20 90/70 36 gp abses k04
36˚C 70 20 120/70 37 gp/exo k04.1 1
36˚C 70 20 70/60 51 exo k06 1
36˚C 70 20 100/80 48 gp k04
36˚C 70 20 120/70 46 period k05.3
36˚C 70 20 130/70 35 pak k04.4
36˚C 70 20 110/70 26 pulp k04.0
36˚C 85 18 85/60 82 pst/ exo k00.6 1
36˚C 70 20 110/70 37 period k05.3
36˚C 70 20 120/80 46 gp k04.1
36˚C 70 20 130/70 46 gr, abses k04.7
36˚C 70 20 120/70 17 gr k08.3
36˚C 70 20 120/80 36 pak k04.4
36˚C 70 20 123/63 47 pak ec gp k04.4
36˚C 70 18 80/60 selulits facialis a.r max sin 65 k12.2
36˚C 70 20 160/80 26 hp, gi k02.1 1 1
36˚C 60 18 170/100 38 period, gr.III k05.3
36˚C 70 20 80/60 26 pulp irrev, arsen k04.01 1 1
36˚C 70 20 120/80 46 gr, abses k04.7
36˚C 70 20 120/80 36 pulp irrev k04.01
36˚C 160/80 27 pulp irrev, fraktur s02.5
36˚C 130/80 18,16-15 pulp irrev k04.01
36˚C 120/70 36 gr, abses k04.7
36˚C 36 pak k04.4
36˚C 70 20 120/80 38 pak ec gp k04.4
36˚C 70 110/70 51 grk k00.6
36˚C 120/80 37 pak k04.4
1 0 4 11 16 20 4 14
ODONTOGRAM
KEL. DENTOFACIAL
EXO GIGI SULUNG
KELAINAN PULPA
PENYAKIT LAIN-
EXO GIGI TETAP
PERIODONTAL
UMUM
PENGOBATAN
PENGOBATAN
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
JARINGAN
LAIN-LAIN
RESEP
KIS
PULPA
LAIN
L P L P L P L P L P L P L P L P L P L P Ya Tidak Ya Tidak L P L P
1 1 1 pct,dexa 1
1 1 1 klinda,pct,dexa 1
1 1 1 becom,dexa 1
1 1 1 1 pct 1
1 1 1 1 r/-- 1
1 1 1 1 r/-- 1
1 1 1 1 amox,asmef,ctm,dexa 1
1 1 1 1 1 amox,pct,dexa 1
1 1 1 1 amox,pct,amlod 1
1 1 1 1 cefad,pct,dexa 1
1 1 1 1 amox sy, pct,ctm,dexa 1
1 1 1 1 1 1 amox,pct,ctm,dexa 1
1 1 1 1 r/-- 1
1 1 1 pct,dexa 1
2 1 1 1 amox, pct 1
2 1 1 1 amox sy, pct sy 1
1 1 1 bcom 1
1 1 1 1 amox,metro,pct,becom c 1
1 1 1 pct,dexa 1
2 2 1 1 pct 1
1 1 1 dexa 1
1 1 1 1 truvit 1
2 2 1 1 amox,pct 1
1 1 1 1 amox,pct 1
1 1 1 dexa 1
1 1 1 1 1 1 amox,pct,ctm,dexa 1
1 1 1 r/--
1 1 1 1 amox,pct 1
1 1 1 1 amox,pct 1
2 2 1 1 amox sy,pct,ctm,dexa(pulv)
1 1 1 1 r/-- 1
1 1 1 1 amox,pct,ant,amlod 1
1 1 1 1 r/-- 1
1 1 1 1 pct 1
1 1 1 1 pct sy 1
3 1 1 amox,pct 1
1 1 1 amox,pct 1
1 1 1 1 pct 1
1 1 1 1 cefad,asmef,ctm,dexa 1
1 1 1 1 pct 1
1 1 1 1 pct, bcom 1
1 1 1 1 klinda,asmef,ctm,dexa 1
1 1 r/-- 1
1 1 1 1 1
1 1 amoxsyp,pct,ctm,dxa
1 1 1 1 amox,pct,ctm,dxa 1
1 1 1 1 pct, dxa
1 1 1 1 amox srp/pct srp 1
1 1 1 1 cepa,pct,dexa.ctm 1
1 1 1 1 cefad,asmef,ctm,dexa
1 1 1 1 cefad,asmef,ctm,dexa
1 1 1 1 1 pct 1
1 1 1 1 r/-- 1
1 1 1 1 amox,pct,dexa
1 1 1 1 amox,pct,amlod
1 1 1 1 amox,pct,dexa
1 1 1 1 amox,asmef,dexa 1
1 1 1 1 amox syr,pct,ctm,dexa,truvit 1
1 1 1 asmef,ranitdine 1
1 1 1 1 amox,metro,pct,ctm,dexa,becomc 1
1 1 1 1 cefad,pct,ctm,amlod 1
1 1 1 1 klinda,pct,ctm,dexa,antasid 1
1 1 1 1 amox,pct,becom c 1
1 1 1 1 cefad,pct,ctm,amlod 1
5 15 3 6 4 10 14 19 7 13 1 4 8 18 16 26 8 26 101 2 92 11
NIP 19820531 201503 2 002
KET
rujuk bm
rujuk gigi
rujuk rs
inform -
36 gr(tdak mau cabut)
anak tdk kooperatf
25
70
20
Usia
Jam Datang
L P
12/31/1899 1 0 rani farida 14001634 sk senang 4/7 - 18
12/30/1899 2 0 aan komala 14012766/13 genteng 3/1 - 57
12/30/1899 3 0 aam, sdr 97/13 genteng 1/1 25 -
12/30/1899 4 0 m. Galih f 14696498 cijeruk hilir 3/1 18 -
12/30/1899 5 0 agni 14005960 asta lebak 1/8 - 7
1/1/1900 6 0 ade yuansah 18101240 gn bitung 3/8 8bl -
12/30/1899 7 0 amelia agista 14005292 cijeruk hilir 1/1 - 7
12/30/1899 8 0 sashie 14009306 gn subang 3/3 - 12
12/30/1899 9 0 syifa naila 14004667 bj gaok 3/1 - 9
1/2/1900 10 0 enung 14012263/18 cicondong 3/9 - 42
12/30/1899 11 0 iim 18100042/18 mangkubumi - 42
12/30/1899 12 0 yadi mulyadi 14102452 cicondong 3/6 44 -
1/3/1900 13 0 dian herdiana 14012740/14 mekarjaya 6/1 - 26
12/30/1899 14 0 aam, sdr 97/13 genteng 1/1 25 -
12/30/1899 15 0 zidane 14106784/14 cikedewul 3/7 4 -
12/30/1899 16 0 nina herlina 14015601/13 cikedewul 3/7 - 26

12/30/1899 17 0 solihin 14103977 segleng 2/9 73 -
12/30/1899 18 0 yoga 14105410/11 tambir 3/5 12 -
12/30/1899 19 0 hj nonoh 14010552/14 selaawi 2/12 - 53
12/30/1899 21 0 nur ilham 14106541/12 sk dana 2/4 13 -
12/30/1899 22 0 ilham 14107414/12 segleng 3/9 7 -
12/30/1899 23 0 ainiah rona 18001250/18 cikondang 1/3 - 17
1/4/1900 24 0 iim rohimah 18001251 cibeut 2/6 - 38
12/30/1899 25 0 nurmalita sari 18001255 genteng 3/11 - 16
12/30/1899 26 0 amira fahami 18001257 negla 1/11 - 8
12/30/1899 28 0 dicki jamjam 16100477 selaawi 3/12 21 -
12/30/1899 29 0 zilvana almani 18001262 cibeut 3/6 - 6
12/30/1899 30 0 asyifa 14006319 selaawi 1/3 - 6
12/30/1899 31 0 ujang ruswandi 18101266 cijerah kulon 4/3 58 -
12/30/1899 32 0 zahra 16001536 bj gaok 3/1 - 10
1/8/1900 33 0 syahrul sidik 17102130/17 asta baru 1/10 21 -
12/30/1899 34 0 tni kartni 14000598/10 segleng 2/9 - 73
12/30/1899 36 0 aam, sdr 97/13 genteng 1/1 25 -
12/30/1899 37 0 nina herlina 14015601/13 cikedewul 3/7 - 26
12/30/1899 38 0 tn khofidul 18101282 rc bungur 21/4 42 -
12/30/1899 39 0 want 16000233/16 gn subang 3/3 - 26
1/11/1900 40 0 susi susilawat 566/2011 tambir 4/5 - 32
1/12/1900 41 0 m madintan 16102143/16 cicondong 3/6 14 -
42 0 m rizki 18100001/18 paseh bojongsari 7 -

12/30/1899 2/9
12/30/1899 43 0 nabilatul hamidah 6066/14 cijerah 2/3 - 4
12/30/1899 44 0 khalifa f.s 17779/16 cijerah 2/3 - 4
1/14/1900 45 0 idah 14011883/12 rancabungur 4/4 - 49
12/30/1899 46 0 maskanah 14012744/11 tamansari 2/3 - 42
12/30/1899 47 0 nafisah 18001296/18 gn subang 1/12 - 20

12/30/1899 48 0 kiswa 14109230/14 gn subang 3/2 - 8
12/30/1899 49 0 jajad 14115720/14 gn subang 3/3 37 -
1/15/1900 50 0 keisa 14001298/18 sk asih 2/6 - 6
12/30/1899 51 0 tta latfah 18001298/18 tambir lebak 4/5 - 26
12/30/1899 52 0 nadin 16000900/16 cibeut 3/6 - 23
12/30/1899 53 0 cucu 1940/10 cihonje 3/6 - 36
12/30/1899 54 0 lilis 1469/14 cihonje 3/6 - 36
12/30/1899 55 0 et 2488/10 cijeruk girang 3/4 - 37
12/30/1899 56 0 uu nurdin 18101302/18 sk sirna 5/4 44 -
1/16/1900 57 0 dani 18101304/2010 segleng 2/9 16 -
12/30/1899 58 0 raisya 14004576/11 asta pasir 2/10 - 8
12/30/1899 59 0 iyan supiyan 14103266/15 cibuyut 5/1 50 -
12/30/1899 60 0 tat ruhaet 18001307/18 cijeruk hilir 1/1 - 64
12/30/1899 61 0 bilqis n 18001309/18 sk asih 2/6 - 8
1/17/1900 62 0 engkoy 3538/11 cibuyut 2/1 - 54
12/30/1899 63 0 susi 566/11 tambir 4/5 - 30
1/18/1900 64 0 usep 5848/14 asta baru 1/10 33 -
1/19/1900 65 0 ny nisa 16000598 tambir 4/5 - 25
12/30/1899 66 0 anisa 18001257 negla 1/11 - 9
12/30/1899 67 0 danda 14104661 negla 1/11 13 -
1/21/1900 68 0 usep 5848/2014 asta baru 1/10 - 35
12/30/1899 69 0 galang rehansyah 14105317 cijerukgirang 8 -
12/30/1899 70 0 tn kingking 14103951 gn subang3/9 75 -
12/30/1899 71 0 paidah 12199 sk asih 2/6 - 18
12/30/1899 72 0 fahma sahlah 1800004 jln ampera 1/6 - 4
12/30/1899 73 0 ny enok 18000001/2018 batu tumbang 7/9 - 55
12/30/1899 74 0 ilma hilyatul 14004701 cihinje2/2 - 4
1/22/1900 75 0 mitha 14001818 cikedewul 3/7 - 22
1/23/1900 76 0 alit 14101148 cihonje 5/2 - 24
12/30/1899 77 0 ny nisa 16000598 tambir 4/5 - 25
78 0 widi widiyawat 6966/2014 saguling cihonje - 6

12/30/1899 3/10
12/30/1899 79 0 isep 18101330 saguling pjg 3/4 39 -
1/24/1900 80 0 iyan supiyan 112118/15 cibuyut 5/1 50 -
12/30/1899 81 0 raisya 14004576/11 asta pasir 2/10 - 8
1/26/1900 82 0 tn alan 18101357 cibogo 2/9 30 -
12/30/1899 83 0 ny nurmala 14010728 cibogo 5/2 - 30
1/28/1900 84 0 raka wiranata 14104621 selaawi 1/3 5 -
12/30/1899 85 0 lastri 1753/12 genteng 1/2 - 52
12/30/1899 86 0 tn akik 14104188 selaawi 1/3 51 -
12/30/1899 87 0 aira arasy 16000653 gn subang 3/2 - 9
12/30/1899 155 0 Indi nurisma 14100784 cibuyut 1/1 - 15
12/30/1899 para 0 alit kurnia 14101148 cihonje 5/2 24 -
12/30/1899 90 0 ny uyum 14010047 gn subang 2/2 - 52
1/29/1900 91 0 ny eem 16001161 cijeruk hilir 1/1 - 47
12/30/1899 92 0 amelia robiana 18000002 sukaraja - 18
93 0 zahra 16001536 bj gaok 3/1 - 11

12/30/1899
12/30/1899 94 0 arif syaripudin 14115820 cikedewul 2/7 57 -
95 8.38 enur nurhayat 14012204 asta lebak 4/8 - 37

1/30/1900
12/30/1899 96 11.20 dadan suhendar 14116146 cibuluh 4/11 33 -

DINAS KESEHATAN
Kota Tasikmalaya

Bulan Oktober Tahun 2018
Kelengkapan
Pengisian Formulir
Penggunaan Melaksanakan Pembedahan dan
Jam Tindakan
APD Hand Hygiene

Jam Selesai
Anastesi (Form
Tindakan)
Tidak Ada
Lengkap
Lengkap
Tidak
Tidak
Tidak
Ya
Ya
46 devit 10.18 10.32
27 fraktur 10.35 10.40
37 pulpits/devit 10.45 10.50
11 gi 11.44 11.58
51 pst 12.00 12.06
labio-palato schizis 10.45 10.55
61 pst 11.01 11.05
25, 24 abses 11.07 11.12
74-75 gingival polip 11.48 11.54
46 gp 9.58 10.03
17 gr 10.58 11.04
38 impaksi 0 0
37 pulpa polip 8.28 8.32
37 pulpits/chkm 8.40 8.55
74,75 pulpits 9.08 9.15
28 gp, 36 gr 9.20 9.30

44 period 9.55 10.00
36 GP 10.23 10.28
17 post endo-kontrol jk 10.42 10.48
46 gp/ chkm 10.55 11.06
74, 75 pst '3 11.34 11.40
71, 81 pst '2 11.45 11.50
25 abrasi gigi 11.55 12.07
susp tumor lidah 8.23 8.36
21 gic 9.12 9.28
72, 82 exo 9.52 9.59
46 tkf 8.04 8.23
36 post exo 9.18 9.25
51 ulkus 9.35 9.46
71,81 pst 9.46 9.58
37 fraktur lingual, abses 10.06 10.19
36 pak 11.30 11.34
46 pulp 10.00 10.05
22 gr 11.15 11.20
46 tkf 8.04 8.23
37 pulpits/chkm 8.40 8.55
28 gp, 36 gr 10.10 10.20
36 gp 11.00 11.10
26 hp 10.40 10.54
26 gp 08.10 18.22
36 pulpa polip 9.46 9.51
51 ulkus 9.56 10.05
84, 85 gp 10.51 10.55
74 hp kontrol 11.00 11.05
16 period 8.30 8.38
15 fraktur/exo 8.52 9.10
36 gp 9.48 10.05
47 erupsi 11.02 11.07
48 impaksi 11.08 11.15
52 pst/ exo 8.00 8.30
46,47 GI,16 DEVIT 9.00 9.18
27 gp/ devit 9.00 9.20
46 gp/exo 9.10 9.33
36 gr/ exo 9. 35 10.00
46 gr abs 10.23 10.30
37 period 11.30 11.46
35 gp abs 8.40 8.45
51 pst/ exo 8.55 9.05
23 period 9.10 9.15
45 gp ˚3 10.42 10.50
51 pst/ exo 11.20 11.30
15 pulp 08.00 08.08
27 gp 10.25 10.30
37 gp abses 8.44 8.51
37 pp 8.00 8.10
konsultasi 8.20 8.30
37 gp abses 9.00 9.10
37 gp/exo 9.00 9.16
46 gp 9.20 9.30
25 gp 9.35 9.50
46 gp 10.00 10.10
75 74 abses 10.20 11.25
27 gr abs 11.53 11.60
74,75 abses 12.30 12.45
46 gp/exo 08.00 08.10
36 gp abses 09.00 09.10
37 gp/exo 09.10 9.30
51 exo 10.58 11.03

48 gp 11.56 12.10
46 period 12.20 12.35
82 pst/ exo 80.10 8.21
37 period 10.05 10.15
47 pak ec gp 11.20 11.35
selulits facialis a.r max sin 659.00 9.08
26 hp, gi 9.34 10.15
38 period, gr.III 9.40 10.24
26 pulp irrev, arsen 9.48 10.30
46 gr, abses 9.57 10.35
36 pulp irrev 10.04 10.40
27 pulp irrev, fraktur 11.12 11.21
18,16-15 pulp irrev 10.05 10.14
36 gr, abses 10.43 10.49
36 pak 10.40 10.55
38 pak ec gp 0 11.20
51 grk 8.44 9.05
37 pak 11.32 11.40

Tindakan Waktu Penanganan
Ketepatan
sesuai Kelengkapan Inform Tunggu Pengisian Penyakit
Identfikasi
dengan Consent Rawat Jalan < Odontogram Terbanyak
Pasien
Prosedur 60 menit sesuai SOP
Tidak Ada
Lengkap
Lengkap
Sesuai
Sesuai
Sesuai
Sesuai
Sesuai
Sesuai
Tidak
Tidak
Tidak
Tidak
Tidak
Tidak
Ya
0 Ya 1
0 1
0 1
0 1
0 1
0 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 0
0 1
0 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 0
0 0
0 0
0 1
0 1
0 1
0 1
0 1
0 0
0 1
0 1
0 0
0 0
0 1
0 1
0 1
0 1
0 0
0 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
Jam Tindakan
Luar Wilayah
Jam Datang
Jam Selesai
TANGGAL
KARANGANYAR
CILAMAJANG
CIBEUTI
L P L P
1 31 sit roi 14014646 34 1 cijeruk hilir 1/1 1 08.40 8.45 09.04 69 152
2 an galang 14105317 9 1 cijeruk girang 3/7 1 08.50 8.55 09.00 22 122
3 paidah 12199 1667624692 18 1 sukaasih 2/6 1 08.30 08.34 08.50 52 156
4 uyum 14010047 52 1 gunung subang 2/2 1 10.25 10.30 10.41 75 152
5 endah 513866924 1 ASTA PASIR 04/10 1 10.40 10.55 11.00 60 151
5 nina herlina 14015601 36 1 cikedewul 3/7 1 10.45 10.52 11.00 58 156
6 01 herman 18101386 513875799 53 1 genteng 2/1 1 8.29 8.34 8.38 40 156
7 aso 18100092 514491816 49 1 cijerah 4/3 1 8.46 9.05 9.15 48 155
8 02 uyum 14010047 52 1 gunung subang 2/2 1 8.30 8.55 9.05 75 152
50 sulastri ningsih 14014108 28 1 genteng 3/11 1 8.34 8.45 8.55 50 153
10 aulia intan 14006195 5 1 sukasenang 4/7 1 9.16 9.24 9.29 15 121
11 sukirman 18100996 513958026 73 1 cihonje 4/2 9.55 10.05 10.15 47 154
12 04 jihan lailatun N 17100106 8 1 selaawi 1/12 1 08.00 08.06 08.15 23 122
13 elin nurlina 17000174 44 1 selaawi 1/12 08.00 08.18 8. 25 59 148
14 asa nurkamila 14005997 1667624523 7 1 cijerah 2/3 1 8.30 08.31 08.36 15 108
15 herman 18101386 513875799 53 1 genteng 2/1 1 10.40 10.55 11.15 40 156

16 05 azka afrizan 6 1 cicondong 3/6 1 8.00 08.04 08.14 19 119
17 indi anggraeni 14005863 1669938693 6 1 tambir 4/5 1 9.46 9.50 9.55 17 108
18 06 rendi 1453/2015 8 1 sukaasih 2/6 1 08.15 9.25 09.32 19 119
19 paidah 12199/2015 18 1 cicondong 3/6 1 08.15 9.36 10.00 52 156
20 agung maulana 14109167 514313019 22 1 asta pasir 3/10 1 8.15 9.43 9.50 53 165
21 lisna fitriani 14014182 515017429 25 1 cicondong 3/6 1 10.30 10.35 10.55 51 148
22 07 nina kurnia 2011/3144 37 1 tambir 2/5 1 7.50 08.10 08.23 47 148
23 eem maemunah 221/243 47 1 cijeruk hilir 01/01 1 08.45 9.00 9.15 47 145
24 susi susilawat 2011/566 32 1 tambir 4/5 1 9.25 09.07 9.25 50 151
11 asa nurkamila 14005994 6 1 cijerah 2/3 1 10.20 10.40 10.50 15 108
26 tedi anwar 18101412 23 1 cikedewul 3/7 1 11.05 11.13 12.00 69 175
27 12 mamun 17100076 1667628314 59 1 karangtengah 3/4 1 08.00 08.05 8.15 46 155
28 gusma dewi 18001414 gunung lingga 2/3 1 80.30 80.35 80.40 48 158
29 salsabila 18001191 7 1 cikedewul 3/7 1 10.25 10.29 10.35 21 120
30 lisda n 11580/2015 513785638 8 1 cibeut 3/6 1 11.00 11.02 11.07 42 150
31 tedi anwar 18101412 23 1 cikedewul 3/7 1 11.05 12.22 12.00 69 175
32 resa herawat 4433/2010 515000046 17 1 selaawi 1/3 1 11.20 11.40 11.50 38 169
33 13 iyos 4773/2010 514687781 60 1 pasir wangi 1/1 9.10 9.15 9.20 43 147
34 apip 798/2012 515040377 42 1 pasir wangi 1/11 1 9.11 9.22 9.40 60 165
35 dedeh hasanah 14010917 51504074 37 1 pasir wangi 1/11 1 9.11 9.41 9.50 53 150
36 lisna fitriani 506/2013 515017427 25 1 cicondong 3/6 1 9.35 9.55 10.10 48 146
37 lina marlina 14013530 514616736 33 1 Gn lingga 03/03 1 9.45 10.15 10.30 52 158
38 rafa khairul 16100582 8 1 selaawi 4/5 1 10.10 10.25 10.30 21 121
39 14 dodoh 18001427 5144086704 Selaawi 2/12 1 9.45 10.10 11.05 50 149
41 kenda 8061/2014 514789457 genteng 2/11 10.53 11.10 11.21 52 165
42 15 haevia 18000216 514384953 16 1 asta lebak 01/08 9.45 10.05 10.10 45 150
43 16 ending 18101441/18 79 bojong parang 08.50 09.00 09.58 59 165
44 atk 1255/2012 cicondong 3/9 08.05 09.00 10.00 54 155
45 ai sit aisyah 14011441 514875431 27 1 tambir 3/5 1 08.00 09.00 10.30 55 157
1 18 susi susilawat 2011/566 514227857 32 1 tambir 4/5 08.00 08.05 08.10 58 148
47 yuda juanda 18101446 24 1 gn lingga 3/3 1 08.06 08.14 08.41 51 161
48 lastri 1753/2012 genteng 2/1 09.06 9.10 9.15 65 150
syafa atka 14008894 gunung subang 3/2 9.40 10.05 10.10 13 139
50 saeful rizal 18001455 1667612518 14 1 gunung subang 3/2 10.15 10.25 10.30 45 161
51 lina marlina 14013530 514616736 33 1 gunung lingga 3/3 10.13 10.35 10.55 52 158
52 kezia azifa 14006605 7 asta pasir 2/10 11.15 11.20 11.30 29 121
53 rath 1800003 31 kp bunter 2/6 11.20 11.30 12.00 45 150
54 20 haevia 18000216 514384953 16 1 asta lebak 01/08 1 09.00 09.15 09.45 45 150
55 julfa 14105391 2131228833 7 1 gn lame 4/6 1 9.58 10.00 10.06 15 125
56 rani nuraeni 18001462 514414482 26 1 negla 1/11 1 10.02 10.10 10.27 50 165
57 ny empat 14009982 514137598 44 1 cicondong 2/9 1 10.10 10.20 10.30
58 salma mutara 5055/2014 14 gn bitung 4/8 10.00 10.45 10.57 64 160
59 lisna fitriani 14014182 515017427 25 1 cicondong 3/6 1 10.45 11.00 11.26 60 165
60 zahra 16001536 513590051 11 1 bj gaok 3/1 1 11.15 11.20 11.30 35 140
61 21 sit muhibah 16000625 513322626 24 1 Selaawi 2/12 1 08.30 08.45 10.10 41 145
62 alfi 10785/15 genteng 3/11 8.46. 8.50 8.55 20 116
63 eem maemunah 16002261 514400073 47 1 cijeruk hilir 1/1 8.45 9.50 10.00 45 160
64 wika widinda 14009168 3 1 asta pasir 3/10 1 9.27 9.40 11 80
65 ny oni 16000492 514212131 63 1 genteng 1/1 1 9.43 9.58 46 150
66 22 ai suryani 14014293/11 30 1 sk.senang 4/7 1 8.25 8.28 8.30 56 149
67 bahrul ulum 1611/10 8 1 rc bungur 4/4 1 8.38 8.40 8.45 24 120
68 syafa 8894/14 4 1 gn subang 3/2 1 9.40 9.42 9.55 13 139
69 23 Linda nuraisah 101400243 514013556 20 rancabungur 4/4 9.50 9.55 10.10 50 165
70 aditya miftahul f 14105506 513806095 15 congeang 3/11 45 156
71 26 ny yani 14010757 513777407 36 1 sk sirna 1/4 1 8.04 8.15 8.24 47 150
72 fitri sulastri 14003670 1667626784 34 1 congeang 3/11 8.30 8.40 8.45 64 154
73 dirham 16100951 513463634 9 1 gn subang 2/2 08.50 9.00 9.12 28 137
74 m. Nadjil 2709/2014 7 1 gunung malang 4/9 9.40 9.50 10.02 20 119
75 ufaira 14004964 5 sindangsari 1/10 10.15 10.27 10.36 12 110
76 erni patmawat 13731/2015 514607354 28 1 negla 2/11 1 11.00 11.10 11.21 49 149
77 lilian herliani 2014/7378 512586527 11 1 cibeut 4/6 1 11.20 11.25 11.45 30 135
78 cucu supyan 2010/915 1667613576 55 1 cibeut 1/6 11.35 11.50 11.55 70 175
79 27 ade leni 11383/10 514996817 12 1 cicondong 3/6 9.10 9.15 9.45 35 140
80 aditya miftahul f 14105506 513806095 15 1 congeang 3/1 9.50 9.55 10.00 45 156
81 wiwin winarsih 17001329 1667625219 33 1 bojong goak 3/1 10.05 10.15 10.30 45 150
82 iim 18100042 42 1 kp posok 1/10 11.45 11.50 12.00 75 160
83 28 nisa nursela 16000598 51364969 25 1 tambir 4/5 8.50 9.00 9.14 60 165
84 yani 1465/11 35 1 sindangsari 1/10 9.30 9.35 10.8 47 153
85 indri 322/12 1669938693 6 1 tambir 4/5 1 11.16 11.20 11.25 17 120
86 29 ai suryani 14014293 515251031 30 1 sukasenang 4/7 08.32 8.40 8.55 50 157
87 sela oktaviant 7513/14 10 1 saguling panjang 2/8 9.00 10.10 10.15 33 136
88
89
90
91
92
93
94
95
102
103
104
105
106
107
108
109
111
112
113
114
115
116
117
118
119
120
121
122
123
124
116
117
118
119
120
121
122
123
124
125
127 NIP: 19740424 199503 1 002
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
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BULAN NOVEMBER TAHUN 2018
Inform
TINDAKAN consent
RIWAYAT PENYAKIT
TUMPATAN GIGI
respirasi
PENAMBALAN
PENCABUTAN
ICD 10
suhu
nadi
TETAP
Tidak
Ya
36˚C 65 17 110/70 15 GP K04.2 1 1

36˚C 100 20 90/70 1 52, 62 persistensi k00.6 2 1
36˚C 70 20 110/70 46 gp k04.1
36˚C 75 20 150/80 27 fraktrur k05.
36˚C 70 20 120/80 26 periodontts k05.3
36˚C 70 18 120/80 28 pulpits k0401
36˚C 71 19 140/90 44 perodontts k05.3
36˚C 70 20 110/70 15 periodontts k05.3 1 1
36˚C 75 20 140/76 28 fraktur so2.5 1 1 1
36˚C 70 20 100/70 37 pulpits k04.0
36˚C 80 17 80/60 84 pulpits k04.1
36˚C 70 20 120/80 25 pak k04.4
36˚C 70 20 90/60 54,84 pst k00.6 2 1
36˚C 70 20 110/70 47 gp k04.1
36˚C 70 20 85/60 71,81 pro exo k00.6
36˚C 71 19 130/80 44 perodontts k04.1 1

36˚C 70 20 80/60 74 ulkus k00.6 1 1
36˚C 70 20 70/60 74 gp k04.1
36˚C 80 18 80/70 61 abses k04.7
36˚C 70 20 110/70 46 gp k04.2 1 1
36˚C 70 20 110/70 46 pulp irrev k04.1
36˚C 70 20 120/80 46 tkf k04.0 1 1
36˚C 82 20 100/70 11 abses k04.7
36˚C 70 20 136/81 38.18 gr k08.3
36˚C 70 20 90/70 18 gp,48 k04.1
36˚C 70 20 85/60 71.81 exo k00.6 2 1
36˚C 70 20 120/80 scaling rb k05.0
36˚C 70 20 110/80 24,25 pak k04.4
36˚C 90 23 130/80 18 gp k04.1
36˚C 88 26 110/80 71 pst k00.6 1 1
36˚C 70 20 110/70 36 gp k04.1
36˚C 70 20 120/80 scaling ra k05.0
36˚C 70 20 110/70 47 gp k04.1
36˚C 68 18 140/80 16 rdk k04.4
36˚C 70 20 120/80 11,21 hp k02.1 2 1
36˚C 70 20 110/70 11 hp k02.1 1 1
36˚C 90 20 100/70 1 46 pulp irrev chkm k04.1 1 1
36˚C 70 18 120/80 12 gi, 11 tkf k02.1 1 1
36˚C 70 20 110/70 sd cibeut 1 51 ulkus k00.6 1 1
36˚C 70 20 130/80 38 pulp k04.0 1 1
36˚C 70 20 130/80 28 fraktur s02
36˚C 70 20 110/70 46 gp abses k04.1
36˚C 90 20 220/100 47 gp k04.1
36˚C 70 20 120/70 37 gp/exo k04.1
36˚C 70 20 110/70 16 hp, 37 hp k02.1 2 2
36˚C 72 20 110/70 18 gp k04.1
36˚C 70 20 120/80 36 hp,gi k02.1
36˚C 70 20 130/80 37 gp k04.1
36˚C 70 20 90/60 paud jabarohmah 51 ulkus k00.6
36˚C 70 20 90/60 36 gp k04.1 1
36˚C 70 18 120/80 11 gp gi k02.1
36˚C 70 20 110/70 51 persistensi k00.6 1
36˚C 70 20 120/80 11,21 hp gi k02.1
36˚C 70 18 100/70 46 pak k04.4
36˚C 80 20 90/80 61 pst k00.6 1 1
36˚C 70 20 120/80 37 gp k04.2 1 1
36˚C 47 pulp k04.1
36˚C 70 20 110/70 11,21,22 gp k04.4
36˚C 70 20 120/80 46 fuji k04.2 1
36˚C 70 20 90/80 46 fuji, 36 pak k02.1 1
36˚C 70 20 120/80 scalling RB RA , 36 gp tkf k05.0
36˚C 75 18 110/90 71-81 pst k00.6 2 2
36˚C 70 20 120/70 15, 16, 27 gp k04.1
36˚C 80 18 90/60 75 pulp k04.0
36˚C 70 20 170/90 47 pulp k04.0
37˚C 70 20 110/70 47 gp, 48 gr k04.7
36˚C 108 26 90/80 sdn karanganyar/kls 3 1 72,82 pst k00.6
36˚C 90 20 90/80 paud 1 51 ulkus decubitus k00.6
36˚C 80 20 120/80 47 gp k04.1 1
36˚C 70 20 110/70 36 gp k04.1
36˚C 70 20 120/60 18,48 pak k04.4
36˚C 70 20 150/80 32-42 gingivits k05.0
36˚C 84 25 110/90 16 gp abses k04.7
36˚C 85 25 90/80 65 pak gp k04.4
36˚C 84 25 90/80 85rev k04.0
36˚C 70 18 110/70 21 gp chkm k04.2
36˚C 84 24 110/80 84-85 gr persis k00.6 2
36˚C 71 18 110/70 13 pulp irrev k04.0
36˚C 70 20 120/80 21 hp gic k02.1
36˚C 70 20 100/70 36 gp k04.1 1 1
36˚C 70 17 120/80 38 gp k04.1 1 1
36˚C 70 18 141/80 17 gr k08.3 1 1
36˚C 70 20 125/85 16 gp k04.1 1 1
36˚C 70 20 128/70 46 gp k04.1 1
36˚C 85 18 90/80 sdn karanganyar/kls 1 1 75 gp,85 gr k05.2
65 20 120/80 46 gi 36 chkm k04.1 1
85 18 110/80 53,84,85 pesis k00.6 3 3
ODONTOGRAM
KEL. DENTOFACIAL
EXO GIGI SULUNG
KELAINAN PULPA
PENYAKIT LAIN-
TUMPATAN GIGI
UMUM
EXO GIGI TETAP
PERIODONTAL
PENGOBATAN
PENGOBATAN
KEL.PULPA &
KARIES GIGI
MALOKLUSI
PERIAPIKAL
RESEP
JARINGAN
LAIN-LAIN
SULUNG

PULPA
LAIN
L P L P L P L P L P L P L P L P L P L P L P Ya Tidak Ya Tidak L P
1 1 1 1 amox, pct, dx 1
2 2 1 1 pct
1 1 1 1 amox, pct, ctm, dx
1 1 1 1 cefadroxil,pcm,dx 1
1 1 1 amox, asmet, ctm, dx 1
1 1 1 amox,pct,dexa
1 1 1 cefadroxil,pcm,dx 1
1 1 1 1 amox, pct, ctm, dx 1
1 1 1 1 amox, pct,dx, trufit 1
1 1 1 1 amox, pct,ctm,dx
2 1 1 amox syp, pct syp 1
2 2 1 1
amox sy, pct,dexa,ctm (pulv)
1 1 1 1 1 amox, pct, dx
1 1 1 amox , pct, trufit syp 1
1 1 1 1 amox, pct dx
1 1 1
1 1 1 1 klinda,pct,ctm,dexa
1 1 1 1 amox,asmet,ctm,dexa
1 1 1 amoxpct,dxa
2 2 1 1 pct syp
1 1 1 1 amox,pct,selcom c 1
1 1 1 1 amox, asmet, ctm dexa
1 1 1 1 amox 1
1 1 1 amox.pct,crtm,ddexa
1 1 selcom c
1 1 1 1 amox,pct,ctm,dxa
1 1 1 1 amox,pct ctm dxa
1 1 1 r/
1 1 1 r/
1 1 1 pct
1 1 1 r/
1 1 1 amox syp,pct 1
1 1 amox,pct,ctm,dxa
1 1 amox,asmet,ctm,dexa
1 1 amo,pct,ctm,dexa
2 1 1 amox,pct,ceterizin,sk
1 1 pct, bcom
1 1 asmet,pct 1
1 1 asmef,ranit 1
1 1 amox syrp, pct,dxa puyer 1
1 1 1 asmef,dxa
1 1 r/
1 1 pct syp 1
1 1 amox, pct, selcom c 1
1 1 1 amox,pct,ctm,dexa
1 1 pct
1 1 amox,pct,ctm,dexa,hydro salep
1 1 r/--
1 1 amox,pct,dexa
1 1 1
1 1 1 r/-- 1
1 1 amox,pct,ctm,dxa 1
1 1 amox syr,pct,dexa,truvit 1
1 1 amox,pct,amlod
2 2 1 1 r/--
1 1 1 1 amox sy, pct sy 1
1 1 1 1 cefad,pct,ctm,dxa
1 1 1 1 amox, pct, dexa
1 1 1 1 klinda,pct,ctm,dexa
1 1 1 1 bcom c
1 1 amox,pct,ctm,dxa
1 1 amox,pct,ctm,dxa,trufit 1
1 1 r/
1 1 becom c
2 2 1 1 amox,pct
1 1 klinda,pct,ctm,dexa
1 1 dxa,bcom
1 1 1 1 cefad,ctm,dxa,asmet
1 1 1 1 amlod,pct,amox 1
1 1 1 1 cefad,ctm,dxa,asmet
1 1 1 1 cefad,ctm,dxa,pct 1
2 2 1 1 pct sy, truvit sy
1 1 1 pct, selcom c
3 3 1 1 amox,pct,ctm qq
NIP 19820531 201503 2 002
KET
KIS
L P
1
1
1
1
gigi anak sdh goyang, tpi ortu tdk mau dicabut dgn
1 alasan anak msh panas
1
1
1
1
1
150
1
150
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Usia
Jam Datang

L P
12/31/1899 1 08.40 sit roi 14014646 cijeruk hilir 1/1 - 34

12/30/1899 2 08.50 an galang 14105317 cijeruk girang 3/7 9 -
12/30/1899 3 08.30 paidah 12199 sukaasih 2/6 - 18
12/30/1899 4 10.25 uyum 14010047 gunung subang 2/2 - 52
12/30/1899 5 10.45 nina herlina 14015601 cikedewul 3/7 - 36
1/1/1900 6 8.29 herman 18101386 genteng 2/1 53 -
12/30/1899 7 8.46 aso 18100092 cijerah 4/3 49 -
1/2/1900 8 8.30 uyum 14010047 gunung subang 2/2 - 52
12/30/1899 50 8.34 sulastri ningsih 14014108 genteng 3/11 - 28
12/30/1899 10 9.16 aulia intan 14006195 sukasenang 4/7 - 5
12/30/1899 11 9.55 sukirman 18100996 cihonje 4/2 73 -
1/4/1900 12 08.00 jihan lailatun N 17100106 selaawi 1/12 - 8
12/30/1899 13 08.00 elin nurlina 17000174 selaawi 1/12 - 44
12/30/1899 14 8.30 asa nurkamila 14005997 cijerah 2/3 - 7
12/30/1899 15 10.40 herman 18101386 genteng 2/1 53 -
1/5/1900 16 8.00 azka afrizan 0 cicondong 3/6 6 -
12/30/1899 17 9.46 indi anggraeni 14005863 tambir 4/5 - 6
1/6/1900 18 08.15 rendi 1453/2015 sukaasih 2/6 8 -
12/30/1899 19 08.15 paidah 12199/2015 cicondong 3/6 - 18
12/30/1899 20 8.15 agung maulana 14109167 asta pasir 3/10 22 -
12/30/1899 21 10.30 lisna fitriani 14014182 cicondong 3/6 - 25
1/7/1900 22 7.50 nina kurnia 2011/3144 tambir 2/5 - 37
12/30/1899 23 08.45 eem maemunah 221/243 cijeruk hilir 01/01 - 47
12/30/1899 24 9.25 susi susilawat 2011/566 tambir 4/5 - 32
1/11/1900 0 10.20 asa nurkamila 14005994 cijerah 2/3 - 6
12/30/1899 26 11.05 tedi anwar Err:509 cikedewul 3/7 23 -
1/12/1900 27 08.00 mamun 18101412 karangtengah 3/4 59 -
12/30/1899 28 80.30 gusma dewi 18001414 gunung lingga 2/3 - -
12/30/1899 29 10.25 salsabila 18001191 cikedewul 3/7 - 7
12/30/1899 30 11.00 lisda n 11580/2015 cibeut 3/6 - 8
12/30/1899 31 11.05 tedi anwar 18101412 cikedewul 3/7 23 -
12/30/1899 32 11.20 resa herawat 4433/2010 selaawi 1/3 - 17
1/13/1900 33 9.10 iyos 4773/2010 pasir wangi 1/1 - 60
12/30/1899 34 9.11 apip 798/2012 pasir wangi 1/11 42 -
12/30/1899 35 9.11 dedeh hasanah 14010917 pasir wangi 1/11 - 37
12/30/1899 36 9.35 lisna fitriani 506/2013 cicondong 3/6 - 25
12/30/1899 37 9.45 lina marlina 14013530 Gn lingga 03/03 - 33
12/30/1899 38 10.10 rafa khairul 16100582 selaawi 4/5 8 -
1/14/1900 39 9.45 dodoh 18001427 Selaawi 2/12 - -
12/30/1899 41 10.53 kenda 8061/2014 genteng 2/11 - -
1/15/1900 42 9.45 haevia 18000216 asta lebak 01/08 - 16
1/16/1900 43 08.50 ending 18101441/18 bojong parang 79 -
12/30/1899 44 08.05 atk 1255/2012 cicondong 3/9 - -
12/30/1899 45 08.00 ai sit aisyah 14011441 tambir 3/5 - 27
1/18/1900 1 08.00 susi susilawat 2011/566 tambir 4/5 - 32
12/30/1899 47 08.06 yuda juanda 18101446 gn lingga 3/3 24 -
12/30/1899 48 09.06 lastri 1753/2012 genteng 2/1 - -
0 9.40 syafa atka 14008894 gunung subang 3/2 - -

12/30/1899
50 10.15 saeful rizal 18001455 gunung subang 3/2 14 -
12/30/1899
12/30/1899 51 10.13 lina marlina 14013530 gunung lingga 3/3 - 33
12/30/1899 52 11.15 kezia azifa 14006605 asta pasir 2/10 - 7
12/30/1899 53 11.20 rath 1800003 kp bunter 2/6 - 31
1/20/1900 54 09.00 haevia 18000216 asta lebak 01/08 - 16
12/30/1899 55 9.58 julfa 14105391 gn lame 4/6 7 -
12/30/1899 56 10.02 rani nuraeni 18001462 negla 1/11 - 26
12/30/1899 57 10.10 ny empat 14009982 cicondong 2/9 - 44
12/30/1899 58 10.00 salma mutara 5055/2014 gn bitung 4/8 - 14
12/30/1899 59 10.45 lisna fitriani 14014182 cicondong 3/6 - 25
12/30/1899 60 11.15 zahra 16001536 bj gaok 3/1 - 11
1/21/1900 61 08.30 sit muhibah 16000625 Selaawi 2/12 - 24
12/30/1899 62 8.46. alfi 10785/15 genteng 3/11 - -
12/30/1899 63 8.45 eem maemunah 16002261 cijeruk hilir 1/1 - 47
12/30/1899 64 9.27 wika widinda 14009168 asta pasir 3/10 - 3
12/30/1899 65 9.43 ny oni 16000492 genteng 1/1 - 63
1/22/1900 66 8.25 ai suryani 14014293/11 sk.senang 4/7 - 30
12/30/1899 67 8.38 bahrul ulum 1611/10 rc bungur 4/4 8 -
12/30/1899 68 9.40 syafa 8894/14 gn subang 3/2 - 4
1/23/1900 69 9.50 Linda nuraisah 101400243 rancabungur 4/4 - 20
12/30/1899 70 0 aditya miftahul f 14105506 congeang 3/11 15 -
1/26/1900 71 8.04 ny yani 14010757 sk sirna 1/4 - 36
12/30/1899 72 8.30 fitri sulastri 14003670 congeang 3/11 - 34
12/30/1899 73 08.50 dirham 16100951 Err:509 9 -
74 9.40 m. Nadjil 2709/2014 gunung malang 4/9 7 -
12/30/1899
12/30/1899 75 10.15 ufaira 14004964 sindangsari 1/10 - 5
12/30/1899 76 11.00 erni patmawat 13731/2015 negla 2/11 - 28
12/30/1899 77 11.20 lilian herliani 2014/7378 cibeut 4/6 - 11
12/30/1899 78 11.35 cucu supyan 2010/915 cibeut 1/6 55 -
1/27/1900 79 9.10 ade leni 11383/10 cicondong 3/6 - 12
12/30/1899 80 9.50 aditya miftahul f 14105506 congeang 3/1 15 -
12/30/1899 81 10.05 wiwin winarsih 17001329 bojong goak 3/1 - 33
12/30/1899 82 11.45 iim 18100042 kp posok 1/10 - 42
1/28/1900 83 8.50 nisa nursela 16000598 tambir 4/5 - 25
12/30/1899 84 9.30 yani 1465/11 sindangsari 1/10 - 35
12/30/1899 85 11.16 indri 322/12 tambir 4/5 - 6
1/29/1900 86 08.32 ai suryani 14014293 sukasenang 4/7 - 30
saguling panjang
87 9.00 sela oktaviant 7513/14 - 10
12/30/1899 2/8
12/30/1899 88 0 0 0 0% - -
12/30/1899 89 0 0 0 0% - -
12/30/1899 90 0 0 0 0% - -
12/30/1899 91 0 0 0 0% - -
12/30/1899 92 0 0 0 0% - -
12/30/1899 93 0 0 0 0% - -
12/30/1899 94 0 0 0 0% - -
12/30/1899 95 0 0 0 0% - -
12/30/1899 96 0 0 0 0% - -
12/30/1899 97 0 0 0 0% - -
12/30/1899 98 0 0 0 0% - -
12/30/1899 99 0 0 0 0% - -
12/30/1899 100 0 0 0 0% - -
12/30/1899 101 0 0 0 0% - -
12/30/1899 102 0 0 0 0% - -
12/30/1899 103 0 0 0 0% - -
12/30/1899 104 0 0 0 0% - -
12/30/1899 105 0 0 0 0% - -
12/30/1899 106 0 0 0 0% - -
12/30/1899 107 0 0 0 0% - -
12/30/1899 108 0 0 0 0% - -
12/30/1899 109 0 0 0 0% - -
12/30/1899 0 0 0 0% - -
12/30/1899 111 0 0 0 0% - -
12/30/1899 112 0 0 0 0% - -
12/30/1899 113 0 0 0 0% - -
12/30/1899 114 0 0 0 0% - -
12/30/1899 115 0 0 0 0% - -
12/30/1899 116 0 0 0 0% - -
12/30/1899 117 0 0 0 0% - -
12/30/1899 118 0 0 0 0% - -
12/30/1899 119 0 0 0 0% - -
12/30/1899 120 0 0 0 0% - -
12/30/1899 121 0 0 0 0% - -
12/30/1899 122 0 0 0 0% - -
12/30/1899 123 0 0 0 0% - -
12/30/1899 124 0 0 0 0% - -
12/30/1899 116 0 0 0 0% - -
12/30/1899 117 0 0 0 0% - -
12/30/1899 118 0 0 0 0% - -
12/30/1899 119 0 0 0 0% - -
12/30/1899 120 0 0 0 0% - -
12/30/1899 121 0 0 0 0% - -
12/30/1899 122 0 0 0 0% - -
12/30/1899 123 0 0 0 0% - -
12/30/1899 124 0 0 0 0% - -
12/30/1899 125 0 0 0 0% - -
H Enjang
Nurjamil,S
126 0 0 .Kep.Ners.MHKe 0% - -
s
12/30/1899
0 NIP: 19740424
127 0 0% - -
12/30/1899 199503 1 002
12/30/1899 128 0 0 0 0% - -
12/30/1899 129 0 0 0 0% - -
12/30/1899 130 0 0 0 0% - -
DINAS KESEHATAN
Kota Tasikmalaya

Bulan November Tahun 2018
Penggunaa Melaksana Pengisian Formulir

kan Hand Pembedahan dan
n APD Hygiene Anastesi (Form
Jam Tindakan
Jam Selesai
Tidak Lengkap
Tidak Ada
Lengkap
Tidak
Tidak
Ya
Ya
15 GP 8.45 09.04
52, 62 persistensi 8.55 09.00
46 gp 08.34 08.50
27 fraktrur 10.30 10.41
28 pulpits 10.52 11.00
44 perodontts 8.34 8.38
15 periodontts 9.05 9.15
28 fraktur 8.55 9.05
37 pulpits 8.45 8.55
84 pulpits 9.24 9.29
25 pak 10.05 10.15
54,84 pst 08.06 08.15
47 gp 08.18 8. 25
71,81 pro exo 08.31 08.36
44 perodontts 10.55 11.15
74 ulkus 08.04 08.14
74 gp 9.50 9.55
61 abses 9.25 09.32
46 gp 9.36 10.00
46 pulp irrev 9.43 9.50
46 tkf 10.35 10.55
11 abses 08.10 08.23
38.18 gr 9.00 9.15
18 gp,48 09.07 9.25
71.81 exo 10.40 10.50
scaling rb 11.13 12.00
24,25 pak 08.05 8.15
18 gp 80.35 80.40
71 pst 10.29 10.35
36 gp 11.02 11.07
scaling ra 12.22 12.00
47 gp 11.40 11.50
16 rdk 9.15 9.20
11,21 hp 9.22 9.40
11 hp 9.41 9.50
46 pulp irrev chkm 9.55 10.10
51 ulkus 10.15 10.30
Err:509 10.25 10.30
38 pulp 10.10 11.05
28 fraktur 11.10 11.21
46 gp abses 10.05 10.10
47 gp 09.00 09.58
37 gp/exo 09.00 10.00
16 hp, 37 hp 09.00 10.30
18 gp 08.05 08.10
36 hp,gi 08.14 08.41
37 gp 9.10 9.15
51 ulkus 10.05 10.10
36 gp 10.25 10.30
11 gp gi 10.35 10.55
51 persistensi 11.20 11.30
11,21 hp gi 11.30 12.00
61 pst 09.15 09.45
Err:509 10.00 10.06
37 gp 10.10 10.27
47 pulp 10.20 10.30
11,21,22 gp 10.45 10.57
46 fuji 11.00 11.26
46 fuji, 36 pak 11.20 11.30
scalling RB RA , 36 gp tkf 08.45 10.10
71-81 pst 8.50 8.55
15, 16, 27 gp 9.50 10.00
75 pulp 0 9.40
47 pulp 0 9.58
47 gp, 48 gr 8.28 8.30
72,82 pst 8.40 8.45
51 ulkus decubitus 9.42 9.55
47 gp 9.55 10.10
36 gp 0 0
18,48 pak 8.15 8.24
32-42 gingivits 8.40 8.45
16 gp abses 9.00 9.12
65 pak gp 9.50 10.02
85rev 10.27 10.36

21 gp chkm 11.10 11.21
84-85 gr persis 11.25 11.45
13 pulp irrev 11.50 11.55
21 hp gic 9.15 9.45
36 gp 9.55 10.00
38 gp 10.15 10.30
17 gr 11.50 12.00
16 gp 9.00 9.14
46 gp 9.35 10.8
75 gp,85 gr 11.20 11.25
46 gi 36 chkm 8.40 8.55
53,84,85 pesis 10.10 10.15
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Penanganan
Tindakan Ketepatan Waktu Tunggu P (Planning) /
sesuai dengan Kelengkapan Inform Pengisian Penyakit
Identfikasi Rawat Jalan < Rencana Terapi Odontogram Terbanyak
Consent sesuai
Prosedur Pasien 60 menit SOP
Tidak Lengkap
Tidak Sesuai
Tidak Sesuai
Tidak Sesuai
Tidak Ada
Lengkap
Sesuai
Sesuai
Sesuai
Sesuai
Tidak
Tidak
Ya
Ya
1
1
0
0
0
0
1
1
0
0
0
1
0
0
1
1
0
0
1
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Penanganan
Penyakit
Terbanyak sesuai
SOP
Tidak Sesuai
Jam Tindakan
Luar Wilayah
Jam Datang
Jam Selesai
TANGGAL
KARANGANYAR
CILAMAJANG
CIBEUTI
L P L P
1 31 erni patmawat 13731/2015 514607354 28 1 negla 2/11 9.36 10.00 49 149
2 dedeh hasanah 1886/2011 515040974 38 1 pasar wangi 1/11 11.15 11.35 45 150
3 02 ny ria 16002046 31 1 sukasirna 1/4 1 8.09 8.15 8.31 54 158
4 09.40 9.45 9.55 37 150
5
5
6
7
8
50
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
26
27
28
29
30
31
32
33
34
35
36
37
38
39
41
42
43
44
45
1
47
48
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
102
103
104
105
106
107
108
109
111
112
113
114
115
116
117
118
119
120
121
122
123
124
116
117
118
119
120
121
122
123
124
125
127 NIP: 19740424 199503 1 002
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
BULAN DESEMBER TAHUN 2018
Inform
TINDAKAN consent
RIWAYAT PENYAKIT
TUMPATAN GIGI
respirasi
PENAMBALAN
PENCABUTAN
ICD 10
suhu
nadi
TETAP
Tidak
Ya
36 75 18 120/80 21 gp k04.2 1 1
36 75 18 110/80 11 hp k02.1 1 1
36 70 17 110/70 47 pulp k04.0 1
36 75 18 120/80 13 period kalkulus k05.3
L
TUMPATAN GIGI
P
SULUNG
L
PENGOBATAN
PULPA
P
L
EXO GIGI TETAP
P
JENIS KEGIATAN
EXO GIGI SULUNG

P
L
PENGOBATAN
PERIAPIKAL
P
1
L
LAIN-LAIN
P
L
KARIES GIGI
P
1
1
L
KELAINAN PULPA
P
L
KEL.PULPA &
JARINGAN
PERIODONTAL
P
JENIS KELAINAN
KEL. DENTOFACIAL
MALOKLUSI
P
1
L
PENYAKIT LAIN-
LAIN
P
P (Planning) /
Rencana Terapi
1
1
1
1
Ya
TERAPI
(sesuai)
Tidak
1
1
1
1
Ya
ODONTOGRAM
Tidak
r/
pct,dexa
pct, selcom c
pct,dexa,ctm,amox
RESEP
UMUM
P
NIP 19820531 201503 2 002
KET
KIS
L P
1
1
1
Usia
Jam Datang
L P
31/12/1899 1 9.36 erni patmawat 13731/2015 negla 2/11 - 28

30/12/1899 2 11.15 dedeh hasanah 1886/2011 pasar wangi 1/11 - 38
02/01/1900 3 8.09 ny ria 16002046 sukasirna 1/4 - 31
30/12/1899 4 09.40 0 0 0% - -
30/12/1899 5 0 0 0 0% - -
30/12/1899 5 0 0 0 0% - -
30/12/1899 6 0 0 0 0% - -
30/12/1899 7 0 0 0 0% - -
30/12/1899 8 0 0 0 0% - -
30/12/1899 50 0 0 0 0% - -
30/12/1899 10 0 0 0 0% - -
30/12/1899 11 0 0 0 0% - -
30/12/1899 12 0 0 0 0% - -
30/12/1899 13 0 0 0 0% - -
30/12/1899 14 0 0 0 0% - -
30/12/1899 15 0 0 0 0% - -
30/12/1899 16 0 0 0 0% - -
30/12/1899 17 0 0 0 0% - -
30/12/1899 18 0 0 0 0% - -
30/12/1899 19 0 0 0 0% - -
30/12/1899 20 0 0 0 0% - -
30/12/1899 21 0 0 0 0% - -
30/12/1899 22 0 0 0 0% - -
30/12/1899 23 0 0 0 0% - -
30/12/1899 24 0 0 0 0% - -
30/12/1899 0 0 0 0 0% - -
30/12/1899 26 0 0 0 0% - -
30/12/1899 27 0 0 0 0% - -
30/12/1899 28 0 0 0 0% - -
30/12/1899 29 0 0 0 0% - -
30/12/1899 30 0 0 0 0% - -
30/12/1899 31 0 0 0 0% - -
30/12/1899 32 0 0 0 0% - -
30/12/1899 33 0 0 0 0% - -
30/12/1899 34 0 0 0 0% - -
30/12/1899 35 0 0 0 0% - -
30/12/1899 36 0 0 0 0% - -
30/12/1899 37 0 0 0 0% - -
30/12/1899 38 0 0 0 0% - -
30/12/1899 39 0 0 0 0% - -
30/12/1899 41 0 0 0 0% - -
30/12/1899 42 0 0 0 0% - -
30/12/1899 43 0 0 0 0% - -
30/12/1899 44 0 0 0 0% - -
30/12/1899 45 0 0 0 0% - -
30/12/1899 1 0 0 0 0% - -
30/12/1899 47 0 0 0 0% - -
30/12/1899 48 0 0 0 0% - -
30/12/1899 0 0 0 0 0% - -
30/12/1899 50 0 0 0 0% - -
30/12/1899 51 0 0 0 0% - -
30/12/1899 52 0 0 0 0% - -
30/12/1899 53 0 0 0 0% - -
30/12/1899 54 0 0 0 0% - -
30/12/1899 55 0 0 0 0% - -
30/12/1899 56 0 0 0 0% - -
30/12/1899 57 0 0 0 0% - -
30/12/1899 58 0 0 0 0% - -
30/12/1899 59 0 0 0 0% - -
30/12/1899 60 0 0 0 0% - -
30/12/1899 61 0 0 0 0% - -
30/12/1899 62 0 0 0 0% - -
30/12/1899 63 0 0 0 0% - -
30/12/1899 64 0 0 0 0% - -
30/12/1899 65 0 0 0 0% - -
30/12/1899 66 0 0 0 0% - -
30/12/1899 67 0 0 0 0% - -
30/12/1899 68 0 0 0 0% - -
30/12/1899 69 0 0 0 0% - -
30/12/1899 70 0 0 0 0% - -
30/12/1899 71 0 0 0 0% - -
30/12/1899 72 0 0 0 0% - -
30/12/1899 73 0 0 0 0% - -
30/12/1899 74 0 0 0 0% - -
30/12/1899 75 0 0 0 0% - -
30/12/1899 76 0 0 0 0% - -
30/12/1899 77 0 0 0 0% - -
30/12/1899 78 0 0 0 0% - -
30/12/1899 79 0 0 0 0% - -
30/12/1899 80 0 0 0 0% - -
30/12/1899 81 0 0 0 0% - -
30/12/1899 82 0 0 0 0% - -
30/12/1899 83 0 0 0 0% - -
30/12/1899 84 0 0 0 0% - -
30/12/1899 85 0 0 0 0% - -
30/12/1899 86 0 0 0 0% - -
30/12/1899 87 0 0 0 0% - -
30/12/1899 88 0 0 0 0% - -
30/12/1899 89 0 0 0 0% - -
30/12/1899 90 0 0 0 0% - -
30/12/1899 91 0 0 0 0% - -
30/12/1899 92 0 0 0 0% - -
30/12/1899 93 0 0 0 0% - -
30/12/1899 94 0 0 0 0% - -
30/12/1899 95 0 0 0 0% - -
30/12/1899 96 0 0 0 0% - -
30/12/1899 97 0 0 0 0% - -
30/12/1899 98 0 0 0 0% - -
30/12/1899 99 0 0 0 0% - -
30/12/1899 100 0 0 0 0% - -
30/12/1899 101 0 0 0 0% - -
30/12/1899 102 0 0 0 0% - -
30/12/1899 103 0 0 0 0% - -
30/12/1899 104 0 0 0 0% - -
30/12/1899 105 0 0 0 0% - -
30/12/1899 106 0 0 0 0% - -
30/12/1899 107 0 0 0 0% - -
30/12/1899 108 0 0 0 0% - -
30/12/1899 109 0 0 0 0% - -
30/12/1899 0 0 0 0% - -
30/12/1899 111 0 0 0 0% - -
30/12/1899 112 0 0 0 0% - -
30/12/1899 113 0 0 0 0% - -
30/12/1899 114 0 0 0 0% - -
30/12/1899 115 0 0 0 0% - -
30/12/1899 116 0 0 0 0% - -
30/12/1899 117 0 0 0 0% - -
30/12/1899 118 0 0 0 0% - -
30/12/1899 119 0 0 0 0% - -
30/12/1899 120 0 0 0 0% - -
30/12/1899 121 0 0 0 0% - -
30/12/1899 122 0 0 0 0% - -
30/12/1899 123 0 0 0 0% - -
30/12/1899 124 0 0 0 0% - -
30/12/1899 116 0 0 0 0% - -
30/12/1899 117 0 0 0 0% - -
30/12/1899 118 0 0 0 0% - -
30/12/1899 119 0 0 0 0% - -
30/12/1899 120 0 0 0 0% - -
30/12/1899 121 0 0 0 0% - -
30/12/1899 122 0 0 0 0% - -
30/12/1899 123 0 0 0 0% - -
30/12/1899 124 0 0 0 0% - -
30/12/1899 125 0 0 0 0% - -
30/12/1899 126 0 0 0% - -
30/12/1899 127 0 0 0% - -
30/12/1899 128 0 0 0 0% - -
30/12/1899 129 0 0 0 0% - -
DINAS KESEHATAN
Kota Tasikmalaya

Bulan Desember Tahun 2018
Kelengkapan
Melaksana Pengisian Formulir
Penggunaa kan Hand Pembedahan dan
n APD Hygiene Anastesi (Form
Jam Tindakan
Jam Selesai
Tindakan)
Tidak Lengkap
Tidak Ada
Lengkap
Tidak
Tidak
Ya
Ya
21 gp 0 10.00
11 hp 0 11.35
47 pulp 8.15 8.31
13 period kalkulus 9.45 9.55
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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0 0 0
0 0 0
Penanganan
Tindakan Ketepatan Waktu Tunggu P (Planning) /
sesuai dengan Kelengkapan Inform Pengisian Penyakit
Identfikasi Rawat Jalan < Rencana Terapi Odontogram Terbanyak
Consent sesuai
Prosedur Pasien 60 menit SOP
Tidak Lengkap
Tidak Sesuai
Tidak Sesuai
Tidak Sesuai
Tidak Ada
Lengkap
Sesuai
Sesuai
Sesuai
Sesuai
Tidak
Tidak
Ya
Ya
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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0 0 0 0 0
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0 0 0 0 0
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0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
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Penanganan
Penyakit
Terbanyak sesuai
SOP
Tidak Sesuai
LAPORAN PROGRAM KESEHATAN GIGI DAN MULUT
DINAS KESEHATAN KOTA TASIKMALAYA
Puskesmas : Karanganyar 2018
No KEGIATAN Januari Februari Maret April Mei
I. KUNJUNGAN PUSKESMAS
1 Jumlah penduduk wilayah
2 Jumlah kunjungan baru rawat jalan gigi ke puskesmas 92
3 Jumlah kunjungan lama rawat jalan gigi ke puskesmas 45
4 Jumlah kunjungan BRJG luar gedung (UKGS+UKGMD)
5 Jumlah kunjungan LRJG luar gedung ( UKGS+UKGMD)
6 Jumlah BUMIL di wilayah kerja puskesmas
7 Jumlah kunjungan BRJG Bumil
8 Jumlah kunjungan LRJG Bumil
9 Jumlah anak prasekolah di wilayah kerja Puskesmas
10 Jumlah kunjungan BRJG anak prasekolah
11 Jumlah kunjungan LRJG anak prasekolah
12 Jumlah kunjungan BRJG SD/MI
13 Jumlah kunjungan LRJG SD/MI
II. DIAGNOSA/JENIS KELAINAN PEL. MEDIK GIGI

1 Karies gigi
2 Penyakit pulpa dan jaringan periapikal
3 Gingvitis dan jaringan periodontal
4 Gangguan gigi dan jaringan lainnya
5 Penyakti rongga mulut
III. JENIS KEGIATAN PELAYANAN MEDIS GIGI

1 Tumpatan gigi tetap
2 Pencabutan gigi tetap
3 Tumpatan gigi sulung
4 Pencabutan gigi sulung
5 Pengobatan pulpa
6 Pengobatan periodontal
7 Pembersihan karang gigi
8 Pengobatan lain-lain
9 Jumlah rujukan
IV. PROGRAM PROMOTIF DAM PREVENTIF UKGS

1 Jumlah SD/MI di wilayah kerja puskesmas
2 Jumlah SD/MI UKGS binaan
3 Jumlah Frekuensi kunjungan petugas ke SD/MI UKGS Binaan
4 Penyuluhan kesgilut di SD UKGS
5 Jumlah SD/MI yang melaksanakan sikat gigi masal
6 Pelayanan asuhan pada anak SD UKGS
a. Tahap I (Paket minimal)

b. Tahap II (Paket optimal)
c. Tahap III (Paket Paripurna)
7 Jumlah murid SD/MI yang diperiksa
V. PROGRAM KURATIF SD UKGS

1 Murid kelas selektif yang membutuhkan perawatan
2 Murid kelas selektif yang mendapat/selesai perawatan
3 Tumpatan gigi tetap
4 Tumpatan gigi sulung
5 Pengobatan Pulpa
6 Pengobatan periodontal
7 Pembersihan karang gigi
8 Rujukan ke Puskesmas/RS/dll
VI. PROGRAM UKGMD

1 Jumlah desa diwilayah kerja
2 Jumlah Desa binaan/UKGMD
3 Jumlah frekuensi penyuluhan kesgilut ke desa
4 Jumlah posyandu dengan UKGMD :
a. Pratama
b. Madya
c. Purnama
d. Mandiri
5 Jumlah kunjungan petugas ke Posyandu
6 Jumlah masyarakat yang diperiksa
7 Jumlah Balita yang diperiksa
8 Peragaan sikat gigi massal pada Balita (Jml Sasaran)
9 Jumlah penderita yang dirujuk ke Puskesmas
a. Dewasa
b. Anak Balita
VII. RUJUKAN GIGI

1 Rujukan gigi ke rumah sakit
2 Rujukan gigi ke unit lain
3 Rujukan gigi dari rumah sakit
4 Rujukan gigi dari unit lain
VIII. DATA USAHA KESEHATAN SEKOLAH

1 Tujuan TK ke Pemerintah/negeri
2 Jumlah TK swasta
3 Jumlah TK binaan
4 Jumlah siswa TK yang diperiksa
5 Jumlah siswa TK yang membutuhkan perawatan
6 Jumlah siswa TK yang selesai perawatan
7 Jumlah SD/MI (SD UKS) Pemerintah/Negeri
8 Jumlah SD/MI swasta
9 Jumlah murid kelas I-VI
10 Jumlah murid kelas selektif
a. Kelas I
b. Kelas III
c. Kelas V
11 Pelayanan Asuhan pada SD/MI UKGS
a. Tahap I (Paket Minimal)

b. Tahap II (Paket Optimal)
c. Tahap III (Paket Paripurna)
IX. DATA TENAGA DAN SARAN UKGS

1 Kader UKGS (Dokter kecil)
2 ART Set
X. DATA DASAR PERAN SERTA MASYARAKAT

1 Jumlah penduduk kecamatan
2 Jumlah desa di wilayah kerja
3 Jumlah Posyandu di wilayah kerja
a. Pratama
b. Madya
c. Purnama
d. Mandiri
XI. DATA TENAGA

1 Dokter gigi
2 Perawat gigi/sukwan
XII. DATA SARANA

1 Dental unit set
2 Dental unit mobile
3 Dental unit high speed
4 Dental unit elektrik
5 ART Set
6 Hand Instrument
7 Kader Set
8 Sterilisator listrik
Mengetahui,
Kepala Puskesmas Karanganyar
H Enjang Nurjamil , S. Kep. Ners,MH.Kes

NIP. 19740424 199503 1 002
EHATAN GIGI DAN MULUT
KOTA TASIKMALAYA
Juni Juli Agustus September Oktober Nopember Desember Jumlah

Tasikmalaya,
Program Kesehatan Gigi dan Mulut
Euis Nuryani , S T
NIP : 19740720 199803 2 006

REG - GIGI Baru

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LAPORAN HARIAN BP.

GIGI PUSKESMAS KARANGANYAR KOTA TASIKMALAYA

UMUR JENIS KUNJUNGAN KELURAHAN

H Enjang Nurjamil,S .Kep.Ners.MHKes

EXO GIGI TETAP

drg. Ameilia Hendra Kania

NO. NAMA PASIEN NO. KARTU KIS Usia

Informed Cuci APD Anastesi

Pre Anastesi Pasca Anastesi

Pasca Anastesi Pre Pencabutan Pasca Pencabutan

UMUR JENIS KUNJUNGAN

18 04 sit juliant 1278/13 513635016 28 1

19 dandan 780/10 514619526 12 1

44 tn sekar 17102056/17 1669107082 40 1

45 09 ilham 2396/12 514631687 12 1

H Enjang Nurjamil,S .Kep.Ners.MHKes

sk senanng 1/7 1 45 120/80

genteng 1/11 1 55 150 37 120/80

L P Nama SD & kls L P L P

drg. Ameilia Hendra Kania

NO. NAMA PASIEN NO. KARTU KIS Usia Diagnosa

1 03 m ikmal 441/12 8 1 51, 74 pst

Informed Cuci Tangan APD Anastesi

Pre Anastesi Pasca Anastesi

Pre Pencabutan Pasca Pencabutan

NO. NAMA PASIEN NO. KARTU KIS Usia Diagnosa

1 31 ny yuli yuliant 153/2012 0 √ 48 pulp

Informed Cuci APD Anastesi

Pre Anastesi Pasca Anastesi Pre Penca

Pre Pencabutan Pasca Pencabutan

115 CM N 105/60 115 CM N

TINDAKAN JENIS KEGIATAN

EXO GIGI TETAP

35 10 yuni 18000652/2018 25 1 negla3/11 1 9.20

36 ny eha julaeha 2236/13 64 1 gn lingga 1 9.47

TINDAKAN JENIS KEGIATAN

EXO GIGI SULUNG

EXO GIGI TETAP

drg. Ameilia Hendra Kania

NO. NAMA PASIEN NO. KARTU KIS Usia Diagnosa

1 01 ny iin setawat 18000643/18 33 1 21-22 gp

Informed Cuci APD Anastesi

Pre Anastesi Pasca Anastesi

Pre Pencabutan Pasca Pencabutan

TINDAKAN JENIS KEGIATAN

EXO GIGI SULUNG

EXO GIGI TETAP

NO. NAMA PASIEN NO. KARTU KIS Usia

1 03 desi 713/11 1667613554 8 1

Informed Cuci APD Anastesi

Pre Anastesi Pasca Anastesi

Pasca Anastesi Pre Pencabutan Pasca Pencabutan

TINDAKAN JENIS KEGIATAN

Rencana Terapi (sesuai)

NO. NAMA PASIEN NO. KARTU KIS Usia Diagnosa

1 01 tn warli 4946/14 515110511 52 1 26 pi

Informed Cuci APD Anastesi

Pre Anastesi Pasca Anastesi

Pre Pencabutan Pasca Pencabutan

NO. NAMA PASIEN NO. KARTU KIS

cukang 2/5 1 8.10 8.20 55 151 36˚C 80 20

TINDAKAN JENIS KEGIATAN

EXO GIGI TETAP