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DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA STATUS PRB PROLANIS
PULANG

1 31-08-2019 132117020819Y000520 0000109127632 INGGIT RETNA PALUPI P PEGAWAI SWASTA Supervision of other Rujuk Vertikal
high-risk pregnancies
2 31-08-2019 132117020819Y000516 0000727780094 MUKMINATUS SHOLIKAH P PBI (APBN) Dental caries Berobat Jalan

3 31-08-2019 132117020819Y000522 0000728469538 AYU HUSNUL ROSYIDAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
4 31-08-2019 132117020819Y000523 0000729312704 DWI ANDARI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
5 31-08-2019 132117020819Y000517 0002288422473 SITI NUR HALIMAH P PEKERJA MANDIRI Headache Berobat Jalan

6 31-08-2019 132117020819P000514 0002439079841 SITI MASRUKAH P PEKERJA MANDIRI Other specified diabetes Rujuk Vertikal
mellitus
7 31-08-2019 132117020819P000519 0002770168004 GILANG DWI MAUZZA L PBI (APBN) Fever, unspecified Rujuk Vertikal

8 31-08-2019 132117020819P000518 0002773592346 MOCH PUTRA ERLANGGA L PBI (APBN) Routine child health Berobat Jalan
examination
9 30-08-2019 132117020819Y000509 0000727789353 SUMAIYAH P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
10 30-08-2019 132117020819Y000508 0000727952894 SITI FATIMAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
11 30-08-2019 132117020819Y000521 0000728058611 IMROATUL HASANAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
12 30-08-2019 132117020819Y000513 0000728225741 NURALI L PBI (APBN) Iron deficiency anaemia Berobat Jalan

13 30-08-2019 132117020819Y000512 0000729570666 WARSI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
14 30-08-2019 132117020819P000507 0001043995476 SUPRIADI L PBI (APBN) Inguinal hernia Rujuk Vertikal

15 30-08-2019 132117020819Y000510 0002007481263 PONITI P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
16 30-08-2019 132117020819Y000511 0002159932329 HUSAINI P PBI (APBD) Dizziness and giddiness Berobat Jalan

17 29-08-2019 132117020819Y000451 0000098792987 SUPINAH P VETERAN Low back pain Rujuk Vertikal

18 29-08-2019 132117020819Y000448 0000196481114 MUH. FATCHUROHMAN L PNS PUSAT Stroke, not specified as Rujuk Vertikal
haemorrhage or infarction
19 29-08-2019 132117020819Y000453 0000726374081 SITI NURAFIFAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

20 29-08-2019 132117020819Y000449 0000727684694 ZAHROTUL INSIYAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

21 29-08-2019 132117020819Y000464 0000727737895 SAMPE L PBI (APBN) Orchitis, epididymitis and Rujuk Vertikal
epididymo-orchitis without
abscess
22 29-08-2019 132117020819Y000503 0000727739469 HIDAYATI P PBI (APBN) Necrosis of pulp Berobat Jalan

23 29-08-2019 132117020819Y000499 0000727773456 ZETI FIDIA RINI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
24 29-08-2019 132117020819Y000505 0000728254337 AMENAH P PBI (APBN) Myalgia Berobat Jalan

25 29-08-2019 132117020819Y000504 0000728269975 MUDMAINAH P PBI (APBN) Myalgia Berobat Jalan

26 29-08-2019 132117020819Y000500 0000729559506 ZUBAIDAH P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
27 29-08-2019 132117020819Y000455 0001043976846 SAYANA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
28 29-08-2019 132117020819Y000452 0001897721368 DITA INEKE PUTRI P PEGAWAI SWASTA Supervision of high-risk Berobat Jalan
pregnancy, unspecified
29 29-08-2019 132117020819P000524 0002007461643 NUR FADILAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
30 29-08-2019 132117020819Y000515 0002007461924 WIJIATI P PBI (APBN) Essential (primary) Berobat Jalan Diabetes
hypertension Mellitus
31 29-08-2019 132117020819Y000502 0002007463577 ZAINAL ARIFIYANTO L PBI (APBN) Respiratory tuberculosis, Berobat Jalan
bacteriologically and
histologically confirmed
32 29-08-2019 132117020819Y000450 0002007478427 KARTIYAM P PBI (APBN) Other arthritis Berobat Jalan

33 29-08-2019 132117020819Y000447 0002059517744 TINI SAIDAH P PEKERJA MANDIRI Atherosclerotic heart Rujuk Vertikal
disease
34 29-08-2019 132117020819Y000501 0002765055936 MUHAMMAD RIDWAN L PBI (APBN) Acute upper respiratory Berobat Jalan
RAMADHAN infections of multiple and
unspecified sites
35 28-08-2019 132117020819Y000433 0000108807568 NYOTO ROHADI L PNS DAERAH Secondary hypertension, Rujuk Vertikal
unspecified
36 28-08-2019 132117020819Y000431 0000727589204 MARIANIK P PBI (APBN) Other cataract Rujuk Vertikal

37 28-08-2019 132117020819Y000437 0000727637668 NING SOLIHAH P PBI (APBN) Myalgia Berobat Jalan

38 28-08-2019 132117020819Y000442 0000727639705 KASMUNAH P PBI (APBN) Other acute gastritis Berobat Jalan

39 28-08-2019 132117020819Y000444 0000727641167 AGUSTAMI SUPRIHATIN P PBI (APBN) Allergic contact dermatitis Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

40 28-08-2019 132117020819Y000440 0000727642337 SALSABILA VICA R P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
41 28-08-2019 132117020819Y000438 0000727694559 SALEH L PBI (APBN) Other acute gastritis Berobat Jalan

42 28-08-2019 132117020819P000446 0000727720165 WIWIK INDAH SARI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
43 28-08-2019 132117020819Y000495 0000727784076 ARISTA PUTRI OKTAVIA P PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
44 28-08-2019 132117020819Y000432 0000728170817 EDI SUSTRIANTO L PBI (APBN) Epidural haemorrhage Rujuk Vertikal

45 28-08-2019 132117020819Y000427 0000728173776 SITI NUR FADILAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

46 28-08-2019 132117020819Y000435 0000728223906 YULIS SETYO WATI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
47 28-08-2019 132117020819Y000441 0000728250838 SUPARTI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
48 28-08-2019 132117020819Y000445 0000728347037 NGATENI P PBI (APBN) Myalgia Berobat Jalan

49 28-08-2019 132117020819Y000494 0000728432234 RIAMAT L PBI (APBN) Dizziness and giddiness Berobat Jalan

50 28-08-2019 132117020819P000443 0000728617094 YULI RAHMAWATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
51 28-08-2019 132117020819P000430 0000728676235 PURYONO L PBI (APBN) Pneumonia due to other Rujuk Vertikal
infectious organisms, not
elsewhere classified
52 28-08-2019 132117020819Y000497 0000728713359 ARLINAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
53 28-08-2019 132117020819Y000496 0000728716004 UUT DAYANTI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
54 28-08-2019 132117020819Y000506 0001043995432 SUSILOWATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
55 28-08-2019 132117020819Y000429 0001860805484 SUPARMAN L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
56 28-08-2019 132117020819Y000467 0002007453429 YAYUK SETYO WAHYU P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
57 28-08-2019 132117020819Y000471 0002007475593 ALIYAH P PBI (APBN) Surveillance of Berobat Jalan Diabetes
contraceptive drugs Mellitus
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

58 28-08-2019 132117020819Y000436 0002020481638 DENI ANANDA SEPTIANI P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
59 28-08-2019 132117020819Y000474 0002219015024 KHASANUN NIKMAH P PEKERJA MANDIRI General counselling and Berobat Jalan
advice on contraception
60 28-08-2019 132117020819P000428 0002308398671 SUKIRMAN L PEKERJA MANDIRI Respiratory tuberculosis, Rujuk Vertikal
bacteriologically and
histologically confirmed
61 28-08-2019 132117020819Y000498 0002593507015 APRILIA DWI RAHAYU P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
62 27-08-2019 132117020819Y000420 0000109127619 RINA EKO HENDRIANI P PNS DAERAH Carpal tunnel syndrome Rujuk Vertikal

63 27-08-2019 132117020819P000415 0000195142274 AN'IMATUL FAIZAH P PNS DAERAH Other arthritis Rujuk Vertikal

64 27-08-2019 132117020819P000418 0000727768001 DJAMINTEN P PBI (APBN) Congestive heart failure Rujuk Vertikal

65 27-08-2019 132117020819Y000493 0000727929505 KAMIN L PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
66 27-08-2019 132117020819P000421 0000728563645 SUPIATIN P PBI (APBN) Dyspepsia Rujuk Vertikal

67 27-08-2019 132117020819Y000416 0000728612831 MUSRIFATIN P PBI (APBN) Cellulitis of other parts of Rujuk Vertikal Diabetes
limb Mellitus
68 27-08-2019 132117020819Y000417 0000729311916 NURUL ISTIJANAH P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
69 27-08-2019 132117020819Y000492 0000729565615 SUWARTIK P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
70 27-08-2019 132117020819Y000424 0001043993891 FADLOLI MA'DUM L PBI (APBN) Other peripheral vertigo Berobat Jalan

71 27-08-2019 132117020819Y000422 0001985091131 SUPIRAH P PBI (APBN) Acute bronchitis Berobat Jalan

72 27-08-2019 132117020819Y000458 0002007437578 RONDIYAH P PBI (APBN) Contraceptive Berobat Jalan


management, unspecified
73 27-08-2019 132117020819Y000425 0002602632295 ISTI SETIOWATI P PBI (APBN) Routine postpartum Berobat Jalan
follow-up
74 27-08-2019 132117020819Y000426 0002612424745 FAISOL L PEKERJA MANDIRI Respiratory tuberculosis, Berobat Jalan
bacteriologically and
histologically confirmed
75 27-08-2019 132117020819Y000419 0002759050078 DWI FITRIA P PEKERJA MANDIRI Multiple gestation Rujuk Vertikal

76 27-08-2019 132117020819Y000423 0002809027719 MISTIANI P PBI (APBN) Care and examination Berobat Jalan
immediately after delivery
77 26-08-2019 132117020819Y000405 0000109130962 DJONI MULJANTO L PNS DAERAH Other specified diabetes Rujuk Vertikal
mellitus
78 26-08-2019 132117020819Y000414 0000727622908 SUSIATI P PBI (APBN) Cough Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

79 26-08-2019 132117020819Y000413 0000727627948 RUBIAH P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
80 26-08-2019 132117020819P000439 0000727652812 KHOTIM P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
81 26-08-2019 132117020819Y000491 0000727773456 ZETI FIDIA RINI P PBI (APBN) Dizziness and giddiness Berobat Jalan

82 26-08-2019 132117020819Y000486 0000727815993 ALFIYAH P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
83 26-08-2019 132117020819Y000406 0000727885541 DIANA NUR SHOLIKHAH P PBI (APBN) Pregnancy confirmed Rujuk Vertikal

84 26-08-2019 132117020819Y000485 0000727888533 ASMAUL HUSNAH P PBI (APBN) Dizziness and giddiness Berobat Jalan

85 26-08-2019 132117020819Y000412 0000728002989 MUJI LUGITA A P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
86 26-08-2019 132117020819Y000487 0000728399147 PURNOMO L PBI (APBN) Acute dilatation of Berobat Jalan
stomach
87 26-08-2019 132117020819Y000489 0000728426316 ACHMAD SUYANTO L PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
88 26-08-2019 132117020819Y000490 0000728426351 CHUSNUL CHOTIMAH P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
89 26-08-2019 132117020819Y000411 0000728513133 THUTHUS PRAHERNA P PBI (APBN) Unspecified maternal Rujuk Vertikal
hypertension
90 26-08-2019 132117020819Y000488 0000729526959 YANAH P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
91 26-08-2019 132117020819Y000410 0000771927096 MU'LIMA P PBI (APBN) Supervision of high-risk Rujuk Vertikal
pregnancy, unspecified
92 26-08-2019 132117020819Y000401 0001043972741 MOCHAMMAD YUNUS L PBI (APBN) Viral warts Rujuk Vertikal

93 26-08-2019 132117020819Y000454 0001043976846 SAYANA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
94 26-08-2019 132117020819Y000409 0001043993013 SIH MAWANTU P PBI (APBN) Other arthritis Berobat Jalan

95 26-08-2019 132117020819Y000404 0001043993204 RINDA MARTANDANI P PBI (APBN) Acute bronchitis Berobat Jalan

96 26-08-2019 132117020819Y000402 0001315145316 RINA PURWATI P PEKERJA MANDIRI Schizophrenia Rujuk Vertikal

97 26-08-2019 132117020819Y000403 0001897744318 ERNAWATI P PEKERJA MANDIRI Prolonged pregnancy Rujuk Vertikal

98 26-08-2019 132117020819Y000434 0002007437703 DUWI KARTIKA DIYAH SARI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

99 26-08-2019 132117020819Y000407 0002007464117 SUCIATI P PBI (APBN) Malignant neoplasm of Rujuk Vertikal
breast
100 26-08-2019 132117020819P000408 0002292629501 SUPINI P PEKERJA MANDIRI Congestive heart failure Rujuk Vertikal

101 26-08-2019 132117020819Y000457 0002417075302 NASI FATIN P PBI (APBD) Essential (primary) Berobat Jalan
hypertension
102 26-08-2019 132117020819Y000456 0002768985077 RIDANTI P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy, unspecified
103 24-08-2019 132117020819Y000395 0000109248344 ARINDA PADMA MATISTA P PNS DAERAH Pregnancy confirmed Rujuk Vertikal

104 24-08-2019 132117020819Y000389 0000727484207 SARTIKA P PBI (APBN) Headache Berobat Jalan

105 24-08-2019 132117020819Y000400 0000727684255 SOLIKATI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
106 24-08-2019 132117020819Y000397 0000727750899 SUNARYO L PBI (APBN) Myalgia Berobat Jalan

107 24-08-2019 132117020819Y000399 0000727753419 SANG PANGERAN L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
108 24-08-2019 132117020819Y000394 0000728271077 TITIN AGUSTINAH P PBI (APBN) Essential (primary) Berobat Jalan Diabetes
hypertension Mellitus
109 24-08-2019 132117020819Y000383 0000728329432 UNTUNG L PBI (APBN) Calculus of kidney Rujuk Vertikal

110 24-08-2019 132117020819Y000398 0000728445587 WINAYAH P PBI (APBN) Myalgia Berobat Jalan

111 24-08-2019 132117020819Y000459 0000728501095 MIFTAKHUL JANNAH P PBI (APBN) Follow-up examination Berobat Jalan
after surgery for other
conditions
112 24-08-2019 132117020819Y000391 0000729135652 MULYONO L PBI (APBN) Asthma Berobat Jalan

113 24-08-2019 132117020819P000390 0002007480093 MAI AGUSTI RAHAYU P PBI (APBN) Supervision of other Rujuk Vertikal
high-risk pregnancies
114 24-08-2019 132117020819Y000393 0002007502334 SAMSUL MUNIR L PBI (APBN) Essential (primary) Berobat Jalan
hypertension
115 24-08-2019 132117020819Y000392 0002424919871 MARIJADI L PEKERJA MANDIRI Unspecified diabetes Rujuk Vertikal
mellitus without
complications
116 24-08-2019 132117020819Y000382 0002431472714 SUPARTI P PEKERJA MANDIRI Atherosclerotic heart Rujuk Vertikal
disease
117 23-08-2019 132117020819Y000461 0000727542112 NUR EVAYANTI P PBI (APBN) Routine postpartum Berobat Jalan
follow-up
118 23-08-2019 132117020819Y000387 0000727626701 NING SURATI P PBI (APBN) Myalgia Berobat Jalan

119 23-08-2019 132117020819Y000371 0000727706856 INDRA WAHYUNI P PBI (APBN) Supervision of high-risk Rujuk Vertikal
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

120 23-08-2019 132117020819Y000385 0000727737333 KARMI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
121 23-08-2019 132117020819Y000484 0000727885541 DIANA NUR SHOLIKHAH P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
122 23-08-2019 132117020819Y000460 0000728168782 ANIS MUSTIKA RINI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
123 23-08-2019 132117020819Y000388 0000728243864 WAJIB L PBI (APBN) Essential (primary) Berobat Jalan
hypertension
124 23-08-2019 132117020819Y000378 0000729122591 SUNARSIH P PBI (APBN) Injury of unspecified body Berobat Jalan
region
125 23-08-2019 132117020819P000374 0000729269076 AGUS SANTOSO L PBI (APBN) Dyspepsia Rujuk Vertikal

126 23-08-2019 132117020819P000381 0001043974697 AGUSTIN P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
127 23-08-2019 132117020819Y000386 0001043995072 ELIS SUSANA P PBI (APBN) Cough Berobat Jalan

128 23-08-2019 132117020819Y000370 0001535804458 HADIE KURNIANTO L PEGAWAI SWASTA Stroke, not specified as Rujuk Vertikal
haemorrhage or infarction
129 23-08-2019 132117020819Y000379 0002007442653 SITI AISAH P PBI (APBN) Unspecified acute lower Berobat Jalan
respiratory infection
130 23-08-2019 132117020819Y000384 0002007501794 ASROTIN P PBI (APBN) Hypotension Berobat Jalan

131 23-08-2019 132117020819Y000380 0002417073265 RINA KURNIATI P PBI (APBD) Acute nasopharyngitis Berobat Jalan
[common cold]
132 23-08-2019 132117020819Y000369 0002809033222 MARKAMAH P PBI (APBN) Other cataract Rujuk Vertikal

133 22-08-2019 132117020819P000343 0000108854662 MUHAMMAD IBNU SULTONIK L PNS PUSAT Respiratory tuberculosis, Rujuk Vertikal
not confirmed
bacteriologically or
histologically
134 22-08-2019 132117020819Y000350 0000726864467 MOH FAHRI L PBI (APBN) Injury of unspecified body Berobat Jalan
region
135 22-08-2019 132117020819Y000345 0000727554306 AHMAD MUJIONO L PBI (APBN) Fracture of femur Rujuk Vertikal

136 22-08-2019 132117020819Y000344 0000727574185 WARGI L PBI (APBN) Pleural effusion, not Rujuk Vertikal
elsewhere classified
137 22-08-2019 132117020819Y000482 0000727629478 RIAMAH P PBI (APBN) Dizziness and giddiness Berobat Jalan

138 22-08-2019 132117020819Y000396 0000727811368 SRI RAHAYU P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
139 22-08-2019 132117020819Y000367 0000727908423 SETYAWATI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

140 22-08-2019 132117020819Y000376 0000728191675 LAILATUL VAIZAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
141 22-08-2019 132117020819Y000338 0000728238936 SUPARMI P PBI (APBN) Person consulting on Berobat Jalan
behalf of another person
142 22-08-2019 132117020819Y000348 0000728256238 SUPARTI P PBI (APBN) Myalgia Berobat Jalan

143 22-08-2019 132117020819Y000483 0000728426981 ALY MUCHDHOR L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
144 22-08-2019 132117020819Y000480 0000728443089 NUR FADILAH P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
145 22-08-2019 132117020819Y000352 0000728563645 SUPIATIN P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
146 22-08-2019 132117020819Y000373 0000728615496 SITI MUNIROH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
147 22-08-2019 132117020819Y000341 0000728827086 KANIA SYARAH P PBI (APBN) Acute bronchitis Berobat Jalan

148 22-08-2019 132117020819Y000340 0000729201238 YULIANA P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
149 22-08-2019 132117020819Y000372 0000729294309 MARMI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
150 22-08-2019 132117020819Y000351 0000729679307 KUSNUL KHOTIMAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
151 22-08-2019 132117020819Y000368 0000752656858 AGUS WIBOWO L PBI (APBN) Acute dilatation of Berobat Jalan
stomach
152 22-08-2019 132117020819Y000366 0001043991865 SABRINA AISYAH FITRI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
153 22-08-2019 132117020819Y000342 0001705484518 INTARTI P PBI (APBD) Acute dilatation of Berobat Jalan
stomach
154 22-08-2019 132117020819Y000361 0001706888474 ANITA ATRIA WATI P PBI (APBD) Supervision of high-risk Rujuk Vertikal
pregnancy, unspecified
155 22-08-2019 132117020819Y000358 0001725792928 NINIS RETNOWATI P PEKERJA MANDIRI Supervision of high-risk Berobat Jalan
pregnancy, unspecified
156 22-08-2019 132117020819Y000339 0001827122826 RONA AFRILIA P PEGAWAI SWASTA Supervision of other Rujuk Vertikal
high-risk pregnancies
157 22-08-2019 132117020819Y000347 0001832404285 SULIANAH P PEKERJA MANDIRI Acute bronchitis Berobat Jalan

158 22-08-2019 132117020819Y000375 0001897721368 DITA INEKE PUTRI P PEGAWAI SWASTA Supervision of normal Berobat Jalan
pregnancy, unspecified
159 22-08-2019 132117020819Y000355 0002007465849 PUJI NUR CHAYATI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

160 22-08-2019 132117020819Y000481 0002007480352 MUTMAINAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
161 22-08-2019 132117020819Y000346 0002417072995 YULIA NURFARIDA P PBI (APBD) Pregnancy, not (yet) Rujuk Vertikal
confirmed
162 22-08-2019 132117020819Y000349 0002584839071 ASYIFA DESI ANGGRAINI P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
163 22-08-2019 132117020819Y000365 0002759050078 DWI FITRIA P PEKERJA MANDIRI Unspecified maternal Rujuk Vertikal
hypertension
164 22-08-2019 132117020819Y000377 0002775165693 ELIS MUZAIDAH P PEKERJA MANDIRI Supervision of high-risk Berobat Jalan
pregnancy, unspecified
165 21-08-2019 132117020819P000324 0000109187807 TUTI WIDIATI P PNS DAERAH Dyspepsia Rujuk Vertikal

166 21-08-2019 132117020819P000323 0000109187818 MOCH. IN'AM L PNS DAERAH Stroke, not specified as Rujuk Vertikal
haemorrhage or infarction
167 21-08-2019 132117020819Y000336 0000727610038 SITI ZULAIKAH P PBI (APBN) Cough Berobat Jalan

168 21-08-2019 132117020819Y000335 0000727622908 SUSIATI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
169 21-08-2019 132117020819Y000333 0000727636779 SAMIASIH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
170 21-08-2019 132117020819Y000354 0000727696675 YENI SAPUTRI P PBI (APBN) Surveillance of Berobat Jalan
(intrauterine) contraceptive
device
171 21-08-2019 132117020819Y000337 0000727739469 HIDAYATI P PBI (APBN) Cough Berobat Jalan

172 21-08-2019 132117020819P000328 0000727753072 KADARWATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
173 21-08-2019 132117020819Y000479 0000727820741 KASIH P PBI (APBN) Dizziness and giddiness Berobat Jalan

174 21-08-2019 132117020819Y000477 0000727882683 SUNANIK P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
175 21-08-2019 132117020819Y000334 0000728269975 MUDMAINAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
176 21-08-2019 132117020819Y000327 0000728470473 MISTI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
177 21-08-2019 132117020819Y000478 0000729634465 ROKHAYATI P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
178 21-08-2019 132117020819Y000325 0001043976835 SAYATI P PBI (APBN) Congestive heart failure Rujuk Vertikal

179 21-08-2019 132117020819P000326 0002007514247 GIRAH P PBI (APBN) Nausea and vomiting Rujuk Vertikal
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

180 21-08-2019 132117020819Y000476 0002748882925 MOHAMAD ALFIAN PRASETYA L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
181 21-08-2019 132117020819P000329 0002809033266 JUREMI P PBI (APBN) Inguinal hernia Rujuk Vertikal

182 20-08-2019 132117020819P000291 0000094294596 SAUDAH P PENERIMA PENSIUN Conductive and Rujuk Vertikal
PNS sensorineural hearing loss

183 20-08-2019 132117020819Y000310 0000727428238 BATINAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
184 20-08-2019 132117020819Y000309 0000727542112 NUR EVAYANTI P PBI (APBN) Routine postpartum Berobat Jalan
follow-up
185 20-08-2019 132117020819Y000466 0000727699105 KHORIYAH P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
186 20-08-2019 132117020819Y000470 0000727784381 RUMANTI P PBI (APBN) Dizziness and giddiness Berobat Jalan

187 20-08-2019 132117020819Y000304 0000727857123 DWI FORTUNA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
188 20-08-2019 132117020819Y000473 0000727882683 SUNANIK P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
189 20-08-2019 132117020819Y000353 0000727954165 KATI P PBI (APBN) General counselling and Berobat Jalan
advice on contraception
190 20-08-2019 132117020819Y000468 0000728426351 CHUSNUL CHOTIMAH P PBI (APBN) Dizziness and giddiness Berobat Jalan

191 20-08-2019 132117020819Y000305 0000728611402 KHOIROH UMMA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
192 20-08-2019 132117020819Y000292 0000728715734 SUKARTI P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
193 20-08-2019 132117020819P000290 0000728716746 SUTIKNO L PBI (APBN) End-stage renal disease Rujuk Vertikal

194 20-08-2019 132117020819Y000301 0000729094184 ISMIANAH P PBI (APBN) Low back pain Rujuk Vertikal

195 20-08-2019 132117020819Y000472 0000729532361 SUYANI P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
196 20-08-2019 132117020819P000303 0001043975968 SUTRI P PBI (APBN) Vertigo of central origin Rujuk Vertikal Diabetes
Mellitus
197 20-08-2019 132117020819Y000307 0001043993125 MARINI P PBI (APBN) Routine postpartum Berobat Jalan
follow-up
198 20-08-2019 132117020819Y000469 0001043995432 SUSILOWATI P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
199 20-08-2019 132117020819Y000302 0001320111865 MUJAYANAH P PEKERJA MANDIRI Atherosclerotic heart Rujuk Vertikal
disease
200 20-08-2019 132117020819Y000295 0001822609225 IMAM CHARIRI L PEKERJA MANDIRI Low back pain Rujuk Vertikal
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

201 20-08-2019 132117020819Y000300 0002007453429 YAYUK SETYO WAHYU P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
202 20-08-2019 132117020819Y000293 0002417073388 SA'I L PBI (APBD) Other cataract Rujuk Vertikal

203 20-08-2019 132117020819P000289 0002435738624 MUDJITO AZIZ L PEKERJA MANDIRI Dyspepsia Rujuk Vertikal

204 20-08-2019 132117020819Y000475 0002457857452 MUHAMMAD NURUL FITROH L PEKERJA MANDIRI Acute nasopharyngitis Berobat Jalan
[common cold]
205 20-08-2019 132117020819Y000306 0002602632295 ISTI SETIOWATI P PBI (APBN) Routine postpartum Berobat Jalan
follow-up
206 20-08-2019 132117020819Y000294 0002809028294 SRI WAHYUNI P PBI (APBN) Supervision of high-risk Rujuk Vertikal
pregnancy, unspecified
207 19-08-2019 132117020819Y000288 0000108924985 SRI WARAS P PNS DAERAH Herpesviral [herpes Berobat Jalan
simplex] infections
208 19-08-2019 132117020819Y000287 0000109135359 BAYU INDRA PRATAMA L PEKERJA MANDIRI Herpesviral [herpes Berobat Jalan
simplex] infections
209 19-08-2019 132117020819P000275 0000727607079 MUNIKAH P PBI (APBN) Heart failure Rujuk Vertikal

210 19-08-2019 132117020819Y000282 0000727608609 SAMI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
211 19-08-2019 132117020819Y000283 0000727609105 NUR HAMIDAH P PBI (APBN) Cough Berobat Jalan

212 19-08-2019 132117020819P000278 0000727643384 DAVID DIAN ADI SAPUTRO L PBI (APBN) Other acute predominantly Rujuk Vertikal
delusional psychotic
disorders
213 19-08-2019 132117020819Y000280 0000727849631 JUWARIYAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
214 19-08-2019 132117020819P000271 0000728215018 SALAMAH P PBI (APBN) Congestive heart failure Rujuk Vertikal

215 19-08-2019 132117020819Y000286 0000728278323 SUDARI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
216 19-08-2019 132117020819Y000284 0000728337789 MUHAMMAD SETYAWAN L PBI (APBN) Acute nasopharyngitis Berobat Jalan
CAHYADI [common cold]
217 19-08-2019 132117020819Y000363 0000728426316 ACHMAD SUYANTO L PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
218 19-08-2019 132117020819P000277 0000729206313 SITI nurlikah P PBI (APBN) Chest pain, unspecified Rujuk Vertikal

219 19-08-2019 132117020819Y000308 0001043976846 SAYANA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
220 19-08-2019 132117020819Y000297 0001043994982 LILIK KOMSIAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

221 19-08-2019 132117020819Y000298 0001897744318 ERNAWATI P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy, unspecified
222 19-08-2019 132117020819P000276 0001900475436 NATASYA MAULIDIA AGUSTIN P PEKERJA MANDIRI Bronchitis, not specified as Rujuk Vertikal
acute or chronic
223 19-08-2019 132117020819P000274 0001907528354 NADIRA MAULIDIA AGUSTIN P PEKERJA MANDIRI Bronchitis, not specified as Rujuk Vertikal
acute or chronic
224 19-08-2019 132117020819P000279 0002007426846 NADIA SAFAROTUL AMALIA P PBI (APBN) Acute sinusitis Rujuk Vertikal

225 19-08-2019 132117020819P000273 0002007465276 SRI ISWIDAYATI P PBI (APBN) Essential (primary) Rujuk Vertikal
hypertension
226 19-08-2019 132117020819Y000364 0002007481105 SITI ROHIMAH P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
227 19-08-2019 132117020819Y000331 0002272886965 BADRIATI P PEKERJA MANDIRI Surveillance of Berobat Jalan Diabetes
contraceptive drugs Mellitus
228 19-08-2019 132117020819Y000362 0002417074121 NINA RISAWATI P PBI (APBD) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
229 19-08-2019 132117020819P000272 0002468777455 DAVIN KRISTIAN NUGROHO L PEGAWAI SWASTA Bronchopneumonia, Rujuk Vertikal
unspecified
230 19-08-2019 132117020819Y000281 0002475575504 TATIK MUBARIKAH P PEKERJA MANDIRI Surveillance of Berobat Jalan
(intrauterine) contraceptive
device
231 19-08-2019 132117020819Y000285 0002620297258 MUTA'AWANAH P PEKERJA MANDIRI Allergic contact dermatitis Berobat Jalan

232 19-08-2019 132117020819Y000296 0002776081476 SITI RIZQI MUAFIQOH P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy, unspecified
233 16-08-2019 132117020819P000259 0000675095242 RIRIN SETIYORINI P PBI (APBN) Routine postpartum Rujuk Vertikal
follow-up
234 16-08-2019 132117020819P000262 0000727968666 HARTATIK P PBI (APBN) Insulin-dependent Rujuk Vertikal
diabetes mellitus
235 16-08-2019 132117020819Y000268 0000728130767 WIDAYAT L PBI (APBN) Melaena Rujuk Vertikal

236 16-08-2019 132117020819Y000360 0000728461901 MUSALAMAH P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
237 16-08-2019 132117020819Y000465 0000729525508 TERRY WAHYU SILVI P PBI (APBN) Postpartum care and Berobat Jalan
examination
238 16-08-2019 132117020819Y000299 0001636948877 ANGGIA OKTAVIANTI ADE IRMA P PEGAWAI BUMN Supervision of normal Berobat Jalan
pregnancy, unspecified
239 16-08-2019 132117020819Y000258 0002007425856 SARBI L PBI (APBN) Malignant neoplasm of Rujuk Vertikal
skin of other and
unspecified parts of face
240 16-08-2019 132117020819Y000359 0002007480352 MUTMAINAH P PBI (APBN) Dizziness and giddiness Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

241 16-08-2019 132117020819Y000269 0002272886965 BADRIATI P PEKERJA MANDIRI Heart failure Rujuk Vertikal Diabetes
Mellitus
242 15-08-2019 132117020819Y000240 0000108835301 HARIS SUKMO HANTORO L PEKERJA MANDIRI Cushing's syndrome, Rujuk Vertikal
unspecified
243 15-08-2019 132117020819Y000263 0000727542112 NUR EVAYANTI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
244 15-08-2019 132117020819P000249 0000727606056 ARPAH P PBI (APBN) Chronic kidney disease Rujuk Vertikal

245 15-08-2019 132117020819Y000252 0000727680284 ERISA OKTAVIA P PBI (APBN) Cough Berobat Jalan

246 15-08-2019 132117020819P000238 0000727681781 GASAR L PBI (APBN) Dyspepsia Rujuk Vertikal

247 15-08-2019 132117020819Y000253 0000727709242 SUWATI P PBI (APBN) Myalgia Berobat Jalan

248 15-08-2019 132117020819Y000257 0000727709422 IKA MUJILAH P PBI (APBN) Surveillance of Berobat Jalan
contraceptive drugs
249 15-08-2019 132117020819Y000256 0000728311724 SUMIATI P PBI (APBN) Cough Berobat Jalan

250 15-08-2019 132117020819Y000255 0000728320015 WATINI P PBI (APBN) Myalgia Berobat Jalan

251 15-08-2019 132117020819Y000254 0000728379729 SANIK P PBI (APBN) Other acute gastritis Berobat Jalan

252 15-08-2019 132117020819Y000356 0000728399507 SUGIARTI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
253 15-08-2019 132117020819Y000261 0000728433472 NAISYA HILDA LESTARI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
254 15-08-2019 132117020819Y000239 0000728605629 SENENTI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
255 15-08-2019 132117020819Y000357 0000729634465 ROKHAYATI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
256 15-08-2019 132117020819Y000250 0000729652522 ANDRIANI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
257 15-08-2019 132117020819P000251 0000976614502 NITA FADHILA UMA P PNS PUSAT Supervision of high-risk Rujuk Vertikal
pregnancy, unspecified
258 15-08-2019 132117020819P000330 0001043977566 WIJI UTAMI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
259 15-08-2019 132117020819Y000265 0001595508963 PUSRIANIS P PEKERJA MANDIRI Supervision of high-risk Berobat Jalan
pregnancy, unspecified
260 15-08-2019 132117020819Y000264 0001706888474 ANITA ATRIA WATI P PBI (APBD) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
261 15-08-2019 132117020819Y000260 0002007502525 BINTI MASLICHAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

262 15-08-2019 132117020819Y000241 0002263774173 YENI SURYANINGSIH P PEKERJA MANDIRI Supervision of high-risk Rujuk Vertikal
pregnancy, unspecified
263 15-08-2019 132117020819Y000267 0002772688364 ASIAH P PEKERJA MANDIRI Pre-eclampsia, Berobat Jalan
unspecified
264 14-08-2019 132117020819P000234 0000109130174 WIWIK ISTANTINAH P PNS DAERAH Disorders of refraction and Rujuk Vertikal
accommodation
265 14-08-2019 132117020819Y000232 0000109136092 WIDIYANTORO L PNS DAERAH Stroke, not specified as Rujuk Vertikal
haemorrhage or infarction
266 14-08-2019 132117020819Y000319 0000727812516 SITI SUHARNI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

267 14-08-2019 132117020819Y000233 0000728721821 lasmi P PBI (APBN) Unspecified diabetes Rujuk Vertikal
mellitus with peripheral
circulatory complications
268 14-08-2019 132117020819Y000242 0000729110204 NUR HEPI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
269 14-08-2019 132117020819Y000322 0000729525071 LAILI EVA NURKHAMIDAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
270 14-08-2019 132117020819Y000320 0001043995353 MUSLIKAH P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
271 14-08-2019 132117020819Y000317 0001705485194 ARIPIN L PBI (APBD) Dizziness and giddiness Berobat Jalan

272 14-08-2019 132117020819Y000321 0001705485227 LAILATUZA ZAHRUH P PBI (APBD) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
273 14-08-2019 132117020819Y000318 0002007481498 PONISIH P PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
274 14-08-2019 132117020819Y000316 0002007481656 SUHADI L PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
275 14-08-2019 132117020819Y000236 0002162191779 KHOLIFAH P PBI (APBD) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
276 14-08-2019 132117020819P000235 0002293991436 IDRIS IMBRANI L PEKERJA MANDIRI Other cataract Rujuk Vertikal

277 14-08-2019 132117020819P000237 0002464039181 SITI AISA AZZAHRA P PEKERJA MANDIRI Epilepsy Rujuk Vertikal

278 13-08-2019 132117020819P000214 0000727554352 MUNTARTI P PBI (APBN) Dyspepsia Rujuk Vertikal

279 13-08-2019 132117020819Y000231 0000727610769 WAGIMIN P PBI (APBN) Myalgia Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

280 13-08-2019 132117020819Y000226 0000727680497 MUAH P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
281 13-08-2019 132117020819P000270 0000727729031 NUR HIDAYAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
282 13-08-2019 132117020819Y000225 0000727739469 HIDAYATI P PBI (APBN) Cough Berobat Jalan

283 13-08-2019 132117020819Y000212 0000727745949 SITI NUR KHOLIS P PBI (APBN) Fracture of clavicle Rujuk Vertikal

284 13-08-2019 132117020819Y000311 0000727763444 MOH SUMARI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

285 13-08-2019 132117020819Y000227 0000727987015 SUPINI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
286 13-08-2019 132117020819Y000228 0000728214838 SALAMUN L PBI (APBN) Essential (primary) Berobat Jalan
hypertension
287 13-08-2019 132117020819Y000230 0000728371451 UMI KHOMSATUN P PBI (APBN) Myalgia Berobat Jalan

288 13-08-2019 132117020819Y000313 0000728413132 SHOLIKAH P PBI (APBN) Surveillance of Berobat Jalan
contraceptive drugs
289 13-08-2019 132117020819Y000315 0000728426316 ACHMAD SUYANTO L PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
290 13-08-2019 132117020819Y000312 0000729525508 TERRY WAHYU SILVI P PBI (APBN) Other diseases of stomach Berobat Jalan
and duodenum
291 13-08-2019 132117020819Y000247 0001543172319 SRI WINARSIH P PEGAWAI SWASTA Supervision of normal Berobat Jalan
pregnancy, unspecified
292 13-08-2019 132117020819Y000229 0001918931117 MUHAMMAD ADJIE L PBI (APBN) Acute nasopharyngitis Berobat Jalan
FIRMANSYAH [common cold]
293 13-08-2019 132117020819Y000314 0002007480521 NUR LAILIS SA'ADAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
294 13-08-2019 132117020819Y000246 0002007501985 ZULI NURFARICHAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
295 13-08-2019 132117020819P000213 0002019502653 NATHASYA AULADA P PBI (APBN) Otitis externa, unspecified Rujuk Vertikal

296 13-08-2019 132117020819Y000248 0002217647362 ANIS HIDAYATI P PEKERJA MANDIRI Routine postpartum Berobat Jalan
follow-up
297 12-08-2019 132117020819P000175 0000109248311 H.M.INSAN L PNS DAERAH Hypertensive heart Rujuk Vertikal
disease without
(congestive) heart failure
298 12-08-2019 132117020819Y000210 0000726414704 MUSRIATIN P PBI (APBN) Dizziness and giddiness Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

299 12-08-2019 132117020819Y000211 0000726437621 FATKUR ROCHMAN L PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
300 12-08-2019 132117020819P000525 0000727790387 SITI MAR'ATUL LATIFAH P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
301 12-08-2019 132117020819Y000177 0000727829458 PITONO L PBI (APBN) Unspecified diabetes Rujuk Vertikal
mellitus with unspecified
complications
302 12-08-2019 132117020819Y000216 0000727829515 IKE MUDIANTI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
303 12-08-2019 132117020819Y000208 0000727868182 AGUS SANTOSO L PBI (APBN) Other diseases of stomach Berobat Jalan
and duodenum
304 12-08-2019 132117020819Y000215 0000728013521 SRI UTAMI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
305 12-08-2019 132117020819Y000332 0000728378346 HELKE YULIA ATMALA P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
306 12-08-2019 132117020819Y000218 0000728442347 ENDANG SETIAWATI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
307 12-08-2019 132117020819Y000174 0000729087884 SUPAR L PBI (APBN) Injury of extensor muscle Rujuk Vertikal
and tendon of other finger
at wrist and hand level

308 12-08-2019 132117020819Y000243 0000729338872 LILIK SUWATI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
309 12-08-2019 132117020819Y000219 0000729525508 TERRY WAHYU SILVI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
310 12-08-2019 132117020819Y000224 0000729634465 ROKHAYATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
311 12-08-2019 132117020819Y000220 0000730265387 NAILY SA'IDAH P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
312 12-08-2019 132117020819Y000182 0001043897286 RURIN AL ASHARI P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
313 12-08-2019 132117020819Y000244 0001043976846 SAYANA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
314 12-08-2019 132117020819Y000178 0001865555111 NININ SAPUTRI P PEKERJA MANDIRI Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
315 12-08-2019 132117020819Y000245 0001897744318 ERNAWATI P PEKERJA MANDIRI Supervision of high-risk Berobat Jalan
pregnancy, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

316 12-08-2019 132117020819Y000221 0002007462554 RINA RESTIANA A. P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
317 12-08-2019 132117020819Y000223 0002007480521 NUR LAILIS SA'ADAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
318 12-08-2019 132117020819Y000463 0002007481263 PONITI P PBI (APBN) Acute dilatation of Berobat Jalan
stomach
319 12-08-2019 132117020819Y000209 0002007481443 WHINI LULUK MUTHOHAROH P PBI (APBN) Dizziness and giddiness Berobat Jalan

320 12-08-2019 132117020819Y000217 0002273690799 ARI SETYORINI P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy, unspecified
321 12-08-2019 132117020819P000176 0002285826658 MARISA ANINDYA FAUZIYAH P PBI (APBN) Developmental disorder of Rujuk Vertikal
speech and language,
unspecified
322 10-08-2019 132117020819Y000168 0000727327866 BAJI L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
323 10-08-2019 132117020819P000136 0000727643867 SITI MUSLIKAH P PBI (APBN) Non-insulin-dependent Rujuk Vertikal
diabetes mellitus
324 10-08-2019 132117020819P000135 0000727673602 DWI RAHAYU PUTRI L PBI (APBN) Myopia Rujuk Vertikal

325 10-08-2019 132117020819P000154 0000727736231 KUSTIANI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
326 10-08-2019 132117020819Y000165 0000727757627 MUHAMMAD NOER ILMAN L PBI (APBN) Myalgia Berobat Jalan
SIDIK
327 10-08-2019 132117020819Y000134 0000727770093 BUDIAN L PBI (APBN) Retention of urine Rujuk Vertikal

328 10-08-2019 132117020819Y000149 0000727790387 SITI MAR'ATUL LATIFAH P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
329 10-08-2019 132117020819Y000145 0000727845513 SULIASIH BT JUPRI P PBI (APBN) Supervision of high-risk Berobat Jalan
SURATEMAN pregnancy, unspecified
330 10-08-2019 132117020819Y000207 0000727865201 AMRUL MUBMININ MUKHLIS L PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
331 10-08-2019 132117020819Y000133 0000727927841 SUWARNI P PBI (APBN) Essential (primary) Rujuk Vertikal
hypertension
332 10-08-2019 132117020819Y000222 0000728325347 ANING SEPTIANI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
333 10-08-2019 132117020819Y000205 0000729630977 JANJI L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
334 10-08-2019 132117020819Y000160 0001043975193 BINTI FATICHATUS SOLICHAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
335 10-08-2019 132117020819P000138 0001705484327 SUDARNI P PBI (APBD) Other arthritis Rujuk Vertikal
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

336 10-08-2019 132117020819Y000144 0002007419488 RIZQIA MUSTAINAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
337 10-08-2019 132117020819Y000158 0002007462251 SITI MUHAYANAH P PBI (APBN) Myalgia Berobat Jalan

338 10-08-2019 132117020819Y000161 0002007477448 RUM P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
339 10-08-2019 132117020819Y000147 0002007481689 SUS SOMAH P PBI (APBN) Atopic dermatitis Berobat Jalan

340 10-08-2019 132117020819Y000206 0002614955962 QANITA MYSHA PRAMESTI P PEKERJA MANDIRI Acute nasopharyngitis Berobat Jalan
[common cold]
341 10-08-2019 132117020819P000132 0002759971667 MUHADI L PEKERJA MANDIRI Congestive heart failure Rujuk Vertikal

342 09-08-2019 132117020819P000119 0000107818209 KASIANINGATI P PENERIMA PENSIUN TNI Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
343 09-08-2019 132117020819P000113 0000107818323 NGADERI L VETERAN Unspecified diabetes Rujuk Vertikal Diabetes Mellitus
mellitus without
complications
344 09-08-2019 132117020819P000120 0000107947304 RUCHOIYAH P PENERIMA PENSIUN Unspecified diabetes Sembuh Diabetes
PNS mellitus Mellitus
345 09-08-2019 132117020819P000153 0000108921082 RR TYAS GONDOWATI P PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
346 09-08-2019 132117020819P000150 0000108924671 AGUS SUBIYANI L PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
347 09-08-2019 132117020819P000152 0000108924827 NURMARDIANING P PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
348 09-08-2019 132117020819P000143 0000108924941 SRI AMBARWATI P PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
349 09-08-2019 132117020819P000148 0000108924996 SUGIARTO L PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
350 09-08-2019 132117020819P000146 0000108930969 IDA DWI PANTI ARINI P PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
351 09-08-2019 132117020819P000155 0000108934154 EMMA FARADINA P PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
352 09-08-2019 132117020819P000167 0000726864974 JAMILAH P PBI (APBN) Unspecified diabetes Sembuh
mellitus
353 09-08-2019 132117020819Y000112 0000727312206 SUMARDI L PBI (APBN) Unspecified abdominal Rujuk Vertikal
hernia without obstruction
or gangrene
354 09-08-2019 132117020819P000116 0000727565196 SITI MAUDU'AH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
355 09-08-2019 132117020819Y000129 0000727606146 HARTATIK P PBI (APBN) Other acute gastritis Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

356 09-08-2019 132117020819P000117 0000727674399 SUPARTINI P PBI (APBN) Haemoptysis Rujuk Vertikal

357 09-08-2019 132117020819P000169 0000727767281 INDAH YANI P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
358 09-08-2019 132117020819Y000124 0000727811368 SRI RAHAYU P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
359 09-08-2019 132117020819P000157 0000727846413 SRIANAH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
360 09-08-2019 132117020819P000151 0000727865109 MUNAWAROH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
361 09-08-2019 132117020819Y000202 0000727873547 IRAWATI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
362 09-08-2019 132117020819Y000201 0000727875707 SITI ZAHROTUL KHASANAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
363 09-08-2019 132117020819Y000128 0000728209574 SITI KHUMAIROH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
364 09-08-2019 132117020819Y000125 0000728263168 MASNING P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
365 09-08-2019 132117020819P000159 0000728271077 TITIN AGUSTINAH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
366 09-08-2019 132117020819P000114 0000728528152 DARSIN L PBI (APBN) Other cataract Rujuk Vertikal

367 09-08-2019 132117020819P000166 0000728544688 SITI.MAIMUNAH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
368 09-08-2019 132117020819P000164 0000729067678 NUR ROIFATIN P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
369 09-08-2019 132117020819P000170 0000729212365 SUGATI P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
370 09-08-2019 132117020819Y000203 0000729620875 SITI ALIMAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
371 09-08-2019 132117020819Y000126 0001043975013 SUMINEM P PBI (APBN) Myalgia Berobat Jalan

372 09-08-2019 132117020819P000162 0001043991639 SAMIRAH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
373 09-08-2019 132117020819P000173 0001043991911 MUSILAH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
374 09-08-2019 132117020819P000171 0001082355535 KAMINI P PENERIMA PENSIUN TNI Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
375 09-08-2019 132117020819P000156 0001705664463 WAGIATIN P PBI (APBD) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

376 09-08-2019 132117020819P000123 0001821486284 SULISIYAH P PNS DAERAH Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
377 09-08-2019 132117020819P000137 0002007442653 SITI AISAH P PBI (APBN) Glaucoma Rujuk Vertikal

378 09-08-2019 132117020819P000163 0002007475593 ALIYAH P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
379 09-08-2019 132117020819Y000200 0002007480521 NUR LAILIS SA'ADAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
380 09-08-2019 132117020819P000172 0002007502457 SRI INDAYATI P PBI (APBN) Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
381 09-08-2019 132117020819Y000115 0002023904147 MUHAMMAD ROHAN AKHRAM L PBI (APBN) Myopia Rujuk Vertikal

382 09-08-2019 132117020819P000118 0002272886965 BADRIATI P PEKERJA MANDIRI Unspecified diabetes Sembuh Diabetes
mellitus Mellitus
383 09-08-2019 132117020819P000122 0002417075504 SRI WAHYUNI RAHMATULLOH P PBI (APBD) Glaucoma Rujuk Vertikal

384 09-08-2019 132117020819Y000204 0002419338093 MUHAMMAD ZAKI NUR MALIKI L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
385 09-08-2019 132117020819P000121 0002458807536 MUNTIANAH P PEKERJA MANDIRI Unspecified diabetes Sembuh
mellitus
386 09-08-2019 132117020819P000111 0002612728361 SAMAIRA NAFISA PRASTYA P PBI (APBN) Human immunodeficiency Rujuk Vertikal
virus [HIV] disease
resulting in infectious and
parasitic diseases

387 08-08-2019 132117020819P000105 0000109132569 MUKHAMAD FARHAN SY L PNS DAERAH Atopic dermatitis Rujuk Vertikal

388 08-08-2019 132117020819Y000109 0000727622908 SUSIATI P PBI (APBN) Hypotension Berobat Jalan

389 08-08-2019 132117020819Y000199 0000727763444 MOH SUMARI L PBI (APBN) Other diseases of stomach Berobat Jalan
and duodenum
390 08-08-2019 132117020819Y000127 0000727776674 MUHAMAD TRIFANANI L PBI (APBN) Other joint disorders, not Berobat Jalan
elsewhere classified
391 08-08-2019 132117020819P000103 0000727801378 MISTIANI P PBI (APBN) Congestive heart failure Rujuk Vertikal

392 08-08-2019 132117020819P000102 0000727891773 TUMINAH P PBI (APBN) Follow-up examination Rujuk Vertikal
after treatment for
conditions other than
malignant neoplasms
393 08-08-2019 132117020819Y000110 0000727985722 KARSIM L PBI (APBN) Myalgia Berobat Jalan

394 08-08-2019 132117020819Y000108 0000728278323 SUDARI P PBI (APBN) Myalgia Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

395 08-08-2019 132117020819Y000198 0000729514809 ESTUTIK P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
396 08-08-2019 132117020819Y000139 0000729610018 YULI SUSANTI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
397 08-08-2019 132117020819Y000140 0001706888474 ANITA ATRIA WATI P PBI (APBD) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
398 08-08-2019 132117020819P000104 0001801298485 ACHMAD HIKAM SURYA CIPTA L PNS DAERAH Impacted teeth Rujuk Vertikal

399 08-08-2019 132117020819Y000141 0001897721368 DITA INEKE PUTRI P PEGAWAI SWASTA Supervision of normal Berobat Jalan
pregnancy, unspecified
400 08-08-2019 132117020819P000106 0002007515316 ANSHORI L PBI (APBN) Other cataract Rujuk Vertikal

401 08-08-2019 132117020819Y000107 0002059516912 ACHMAD SUBADI L PEKERJA MANDIRI After-cataract Rujuk Vertikal

402 08-08-2019 132117020819Y000142 0002417069968 SRI WAHYUNINGSIH P PBI (APBD) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
403 07-08-2019 132117020819P000092 0000081286964 A. NIDHOM L PENERIMA PENSIUN Dyspnoea Rujuk Vertikal
PNS
404 07-08-2019 132117020819P000090 0000149551997 YOYON AGUS ALBERI. A.MA L PNS DAERAH Chronic renal failure, Rujuk Vertikal
unspecified
405 07-08-2019 132117020819Y000096 0000727381585 HERUWATI P PBI (APBN) Asthma Berobat Jalan

406 07-08-2019 132117020819Y000462 0000727789353 SUMAIYAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
407 07-08-2019 132117020819Y000101 0000728146811 SELA P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy
408 07-08-2019 132117020819P000089 0000728157982 ERIKE PRIYANTIANA P PBI (APBN) Thyrotoxicosis, Rujuk Vertikal
unspecified
409 07-08-2019 132117020819Y000098 0000728263269 SITI DWI NOFIANTI P PBI (APBN) Surveillance of Berobat Jalan
(intrauterine) contraceptive
device
410 07-08-2019 132117020819P000091 0000728337251 ANTONI FEBRIANSAH L PBI (APBN) Fracture of femur, part Rujuk Vertikal
unspecified
411 07-08-2019 132117020819Y000095 0000728426316 ACHMAD SUYANTO L PBI (APBN) Atopic dermatitis Berobat Jalan

412 07-08-2019 132117020819Y000194 0000728713359 ARLINAH P PBI (APBN) Other diseases of stomach Berobat Jalan
and duodenum
413 07-08-2019 132117020819Y000195 0000728716004 UUT DAYANTI P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
414 07-08-2019 132117020819Y000197 0000728728086 DWI SUSANTI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

415 07-08-2019 132117020819P000093 0000729368572 LILIS FARIDA P PBI (APBN) End-stage renal disease Rujuk Vertikal

416 07-08-2019 132117020819Y000196 0000729502975 NASRULLOH L PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
417 07-08-2019 132117020819Y000193 0000729516835 NUR ABIDAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
418 07-08-2019 132117020819Y000099 0001043992754 ANI TRISNAWATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
419 07-08-2019 132117020819Y000094 0001899647335 IMAM MULYONO L PEKERJA MANDIRI Injury of unspecified body Berobat Jalan
region
420 07-08-2019 132117020819P000097 0002007500411 SRI PANGESTI P PBI (APBN) Benign neoplasm of Rujuk Vertikal Diabetes
thyroid gland Mellitus
421 07-08-2019 132117020819Y000100 0002759050078 DWI FITRIA P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy
422 06-08-2019 132117020819P000061 0000107957507 PETRUS SUMARNO L PENERIMA PENSIUN Asthma Rujuk Vertikal
PNS
423 06-08-2019 132117020819P000060 0000108807131 SITI RAHAYU P PENERIMA PENSIUN Sciatica Rujuk Vertikal
PNS
424 06-08-2019 132117020819P000062 0000727766425 NURHAYATI P PBI (APBN) Other arthritis Rujuk Vertikal

425 06-08-2019 132117020819Y000084 0000727817894 ANIK FITRIANI P PBI (APBN) Surveillance of Berobat Jalan
contraceptive drugs
426 06-08-2019 132117020819Y000080 0000728024714 WINARTI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
427 06-08-2019 132117020819P000059 0000728502603 MAHMUD MIFTAH L PBI (APBN) Non-insulin-dependent Rujuk Vertikal
diabetes mellitus with
unspecified complications
428 06-08-2019 132117020819Y000081 0000729265252 RENI WAHYUNI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
429 06-08-2019 132117020819Y000079 0000729265476 FINA SETIANI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
430 06-08-2019 132117020819Y000189 0000729516835 NUR ABIDAH P PBI (APBN) Surveillance of Berobat Jalan
contraceptive drugs
431 06-08-2019 132117020819Y000082 0001535206825 LENI SETYOWATI P PEGAWAI SWASTA General counselling and Berobat Jalan
advice on contraception
432 06-08-2019 132117020819Y000191 0001705485609 INDAYAH P PBI (APBD) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
433 06-08-2019 132117020819Y000192 0002007480993 AGUS PURWANTO L PBI (APBN) Injury of unspecified body Berobat Jalan
region
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

434 06-08-2019 132117020819Y000190 0002007481263 PONITI P PBI (APBN) Dizziness and giddiness Berobat Jalan

435 06-08-2019 132117020819Y000083 0002007501309 INDRA TRI UTAMI P PBI (APBN) Routine postpartum Berobat Jalan
follow-up
436 06-08-2019 132117020819Y000078 0002417069542 TUNAH P PBI (APBD) Essential (primary) Berobat Jalan
hypertension
437 05-08-2019 132117020819Y000051 0000726374081 SITI NURAFIFAH P PBI (APBN) Pregnancy confirmed Rujuk Vertikal

438 05-08-2019 132117020819Y000063 0000727566129 IKA SUSANTI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy
439 05-08-2019 132117020819Y000055 0000727595965 NADYA PUTRI F P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
440 05-08-2019 132117020819Y000056 0000727597359 PARTINI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
441 05-08-2019 132117020819Y000057 0000727608609 SAMI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
442 05-08-2019 132117020819Y000058 0000727643182 WAGIMAH P PBI (APBN) Other acute gastritis Berobat Jalan

443 05-08-2019 132117020819Y000065 0000727646163 AYI NENENG SOPIAH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
444 05-08-2019 132117020819P000042 0000727694559 SALEH L PBI (APBN) Iridocyclitis Rujuk Vertikal

445 05-08-2019 132117020819Y000044 0000727698148 LENI SUSANTI P PBI (APBN) Keratitis, unspecified Rujuk Vertikal

446 05-08-2019 132117020819Y000131 0000727762871 SRI ENDAH WAHYUNINGSIH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
447 05-08-2019 132117020819Y000187 0000727815993 ALFIYAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
448 05-08-2019 132117020819Y000052 0000727985722 KARSIM L PBI (APBN) Myalgia Berobat Jalan

449 05-08-2019 132117020819Y000048 0000728002989 MUJI LUGITA A P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
450 05-08-2019 132117020819Y000185 0000728110427 CHUS CHUJAIMAH P PBI (APBN) Other local infections of Berobat Jalan
skin and subcutaneous
tissue
451 05-08-2019 132117020819P000088 0000728175947 SUMIRAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
452 05-08-2019 132117020819P000266 0000728380899 KHOIRUNNISA P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
453 05-08-2019 132117020819Y000188 0000728440211 SRI WULAN DARI P PBI (APBN) Surveillance of Berobat Jalan
contraceptive drugs
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

454 05-08-2019 132117020819P000043 0000728485795 KASIATI P PBI (APBN) Nontoxic goitre, Rujuk Vertikal
unspecified
455 05-08-2019 132117020819Y000069 0000728533102 YENI SEKARSARI P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
456 05-08-2019 132117020819Y000073 0000728615496 SITI MUNIROH P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
457 05-08-2019 132117020819Y000046 0000728881514 ARFIKA KIRANA PUSPITA P PBI (APBN) Pregnancy confirmed Rujuk Vertikal

458 05-08-2019 132117020819P000045 0000728921992 SUPI P PBI (APBN) Fracture of shaft of Rujuk Vertikal
humerus
459 05-08-2019 132117020819Y000076 0000729291464 SARI SURYANTI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
460 05-08-2019 132117020819P000086 0000760622657 SITI RUWAIDAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
461 05-08-2019 132117020819Y000068 0001043974945 MAS AYU P. P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
462 05-08-2019 132117020819Y000130 0001043975384 SITI ALIFAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
463 05-08-2019 132117020819Y000054 0001043993902 SITI SYAMSIYAH ALFIYATIN P PBI (APBN) Myalgia Berobat Jalan

464 05-08-2019 132117020819Y000064 0001043993968 SULIS SETIORINI P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
465 05-08-2019 132117020819Y000074 0001433090046 INAMAH P PEGAWAI SWASTA Supervision of high-risk Berobat Jalan
pregnancy, unspecified
466 05-08-2019 132117020819Y000070 0001595508963 PUSRIANIS P PEKERJA MANDIRI Supervision of high-risk Berobat Jalan
pregnancy, unspecified
467 05-08-2019 132117020819Y000066 0001897744318 ERNAWATI P PEKERJA MANDIRI Supervision of high-risk Berobat Jalan
pregnancy, unspecified
468 05-08-2019 132117020819Y000072 0002007462666 SILVIA CHOIROTUL ARISKA P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
469 05-08-2019 132117020819Y000067 0002007480093 MAI AGUSTI RAHAYU P PBI (APBN) Supervision of normal Berobat Jalan
pregnancy, unspecified
470 05-08-2019 132117020819Y000075 0002007481689 SUS SOMAH P PBI (APBN) Surveillance of Berobat Jalan
(intrauterine) contraceptive
device
471 05-08-2019 132117020819Y000047 0002007501287 SRI UTAMI P PBI (APBN) Surveillance of Berobat Jalan
contraceptive drugs
472 05-08-2019 132117020819Y000050 0002019610462 FARADINA MAULIDIYA P PBI (APBN) Other acute gastritis Berobat Jalan

473 05-08-2019 132117020819P000087 0002025793855 ANGELINA ELFARA FEBRIANA P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

474 05-08-2019 132117020819Y000077 0002229924431 FATTIA RIZKY PRAMESWARI P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy, unspecified
475 05-08-2019 132117020819Y000053 0002417069463 NURHIDAYAH P PBI (APBD) Myalgia Berobat Jalan

476 05-08-2019 132117020819Y000049 0002417069744 MAIRUM DWI HARTATIK P PBI (APBD) Contraceptive Berobat Jalan
management, unspecified
477 05-08-2019 132117020819Y000033 0002454925421 SAINAH P PEKERJA MANDIRI Low back pain Rujuk Vertikal

478 05-08-2019 132117020819Y000186 0002457857452 MUHAMMAD NURUL FITROH L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
479 05-08-2019 132117020819P000035 0002741551975 MOHAMMAD ALI IMRON L PEKERJA MANDIRI Acute hepatitis B Rujuk Vertikal

480 05-08-2019 132117020819P000040 0002759967821 ISLAN L PEKERJA MANDIRI Chronic renal failure, Rujuk Vertikal
unspecified
481 05-08-2019 132117020819Y000071 0002776081476 SITI RIZQI MUAFIQOH P PEKERJA MANDIRI Supervision of normal Berobat Jalan
pregnancy, unspecified
482 03-08-2019 132117020819Y000031 0000727510871 SUPIANI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
483 03-08-2019 132117020819Y000026 0000727783852 RIKA NURHAYATI P PBI (APBN) Excessive and frequent Rujuk Vertikal Diabetes
menstruation with regular Mellitus
cycle
484 03-08-2019 132117020819Y000184 0000727789353 SUMAIYAH P PBI (APBN) Other diseases of stomach Berobat Jalan
and duodenum
485 03-08-2019 132117020819Y000181 0000727845513 SULIASIH BT JUPRI P PBI (APBN) Supervision of high-risk Berobat Jalan
SURATEMAN pregnancy, unspecified
486 03-08-2019 132117020819P000028 0000728243796 ASKAN L PBI (APBN) Acute transmural Rujuk Vertikal
myocardial infarction of
unspecified site
487 03-08-2019 132117020819Y000183 0000729516835 NUR ABIDAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
488 03-08-2019 132117020819P000029 0000729606115 KARINTEN P PBI (APBN) Disorders of refraction and Rujuk Vertikal
accommodation
489 03-08-2019 132117020819Y000085 0002007480857 IKE YULIANA P PBI (APBN) Surveillance of Berobat Jalan
(intrauterine) contraceptive
device
490 03-08-2019 132117020819P000032 0002264008037 MA'UNAH P PEKERJA MANDIRI Gonarthrosis, unspecified Rujuk Vertikal

491 03-08-2019 132117020819P000027 0002741551975 MOHAMMAD ALI IMRON L PEKERJA MANDIRI Acute hepatitis B Rujuk Vertikal

492 02-08-2019 132117020819P000017 0000108816726 LILIK SRI ASTUTIK P PNS PUSAT After-cataract Rujuk Vertikal
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

493 02-08-2019 132117020819Y000022 0000727595392 UMI P PBI (APBN) Cough Berobat Jalan

494 02-08-2019 132117020819Y000023 0000727597168 NURLIKAH P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
495 02-08-2019 132117020819Y000019 0000727642337 SALSABILA VICA R P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
496 02-08-2019 132117020819Y000020 0000727732721 SITI SHOLIKATUN P PBI (APBN) Hypotension Berobat Jalan

497 02-08-2019 132117020819Y000025 0000727994305 HADI SUCIPTO L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
498 02-08-2019 132117020819Y000015 0000728145156 SUYATMI P PBI (APBN) Congestive heart failure Rujuk Vertikal

499 02-08-2019 132117020819Y000024 0000728214838 SALAMUN L PBI (APBN) Essential (primary) Berobat Jalan
hypertension
500 02-08-2019 132117020819Y000180 0000729570666 WARSI P PBI (APBN) Acute upper respiratory Berobat Jalan
infections of multiple and
unspecified sites
501 02-08-2019 132117020819Y000016 0000921641321 MARYANA L PBI (APBN) Non-insulin-dependent Berobat Jalan Diabetes Mellitus
diabetes mellitus
502 02-08-2019 132117020819Y000041 0002007501309 INDRA TRI UTAMI P PBI (APBN) Care and examination Berobat Jalan
immediately after delivery
503 02-08-2019 132117020819Y000021 0002237355494 SAVINA ROSMALINA PUTRI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
504 02-08-2019 132117020819Y000018 0002456220936 FARHANA GHANIAH ZAHIRA P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
505 01-08-2019 132117020819P000001 0000109130938 DJOKO SUSENO L PNS DAERAH Chronic kidney disease Rujuk Vertikal

506 01-08-2019 132117020819Y000009 0000727580801 SAMIATI P PBI (APBN) Myalgia Berobat Jalan

507 01-08-2019 132117020819Y000010 0000727582015 MAFTUKHAH P PBI (APBN) Hypotension Berobat Jalan

508 01-08-2019 132117020819Y000012 0000727589204 MARIANIK P PBI (APBN) Allergic contact dermatitis Berobat Jalan

509 01-08-2019 132117020819Y000014 0000727592005 ENY MAS'UDAH P PBI (APBN) Cough Berobat Jalan

510 01-08-2019 132117020819Y000011 0000727680497 MUAH P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
511 01-08-2019 132117020819Y000013 0000727960274 ISTI ROCHAH P PBI (APBN) Hypotension Berobat Jalan

512 01-08-2019 132117020819Y000039 0000727981424 ANIS SULALAH P PBI (APBN) Supervision of other Berobat Jalan
high-risk pregnancies
513 01-08-2019 132117020819Y000008 0000728331614 SRI WAHYUNI P PBI (APBN) Cough Berobat Jalan

514 01-08-2019 132117020819Y000007 0000728332031 ELLO PRADANA DWI L PBI (APBN) Acute nasopharyngitis Berobat Jalan
SUPRAPTO [common cold]
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : KESAMBEN NGORO - 13211702

515 01-08-2019 132117020819Y000004 0000728439377 DEWI ANGGRAENI P PBI (APBN) Pregnancy, not (yet) Rujuk Vertikal
confirmed
516 01-08-2019 132117020819Y000030 0000728588924 ZUMROTUN NASIKAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
517 01-08-2019 132117020819Y000037 0000728615496 SITI MUNIROH P PBI (APBN) Supervision of other Berobat Jalan
high-risk pregnancies
518 01-08-2019 132117020819Y000034 0000771927096 MU'LIMA P PBI (APBN) Supervision of high-risk Berobat Jalan
pregnancy, unspecified
519 01-08-2019 132117020819Y000038 0001043992271 ERZA MARATUSOFIA P PBI (APBN) Supervision of other Berobat Jalan
normal pregnancy
520 01-08-2019 132117020819Y000179 0001484532101 TRI MULYANINGSIH P PEGAWAI SWASTA Dizziness and giddiness Berobat Jalan

521 01-08-2019 132117020819Y000036 0001725792928 NINIS RETNOWATI P PEKERJA MANDIRI Supervision of other Berobat Jalan
normal pregnancy
522 01-08-2019 132117020819Y000006 0002007465052 ZAINATUR ROSIDAH P PBI (APBN) Supervision of pregnancy Berobat Jalan
with history of insufficient
antenatal care
523 01-08-2019 132117020819Y000005 0002007475931 SULASTRI P PBI (APBN) Chronic obstructive Rujuk Vertikal
pulmonary disease with
acute lower respiratory
infection
524 01-08-2019 132117020819Y000002 0002007514541 SUYOTO L PBI (APBN) After-cataract Rujuk Vertikal

525 01-08-2019 132117020819P000003 0002285826658 MARISA ANINDYA FAUZIYAH P PBI (APBN) Developmental disorder of Rujuk Vertikal
speech and language,
unspecified