umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Februari 2018
1 Rahmadi 36 Kalumpang Susp PPOK Susp PPOK √ 2/1/2018 2/6/2018 1 U
2 Norhayati 8 Asam KLL KLL √ 2/1/2018 2/4/2018 4 U
3 Syarifah Nurjanah 50 Sei.kacil Gastritis Gastritis √ 2/5/2018 2/1/2018 1 U
4 Kusasi 72 Pantai Ulin Diare Akut Diare Akut √ 2/9/2018 2/12/2018 3 U
5 Rusnah 55 Kalumpang Diare Akut Diare Akut √ 2/10/2018 2/11/2018 1 U
6 Maulida 10 Tamiang Intoleransi Obat Intoleransi Obat √ 2/10/2018 2/12/2018 2 U
7 St. Juleha 52 Tebing Tinggi Gastritis Gastritis √ 2/13/2018 2/15/2018 2 U
8 Samsul Bahri 40 Panj Bahagia ISK Obs Abd Pain √ 2/18/2018 2/19/2018 1 U
9 Lidia 38 Amawang Kanan Gastritis Gastritis √ 2/25/2018 2/27/2018 1 U
10 Ridiansyah 26 Pantai Ulin Obs Febris Obs Febris √ 2/26/2018 2/27/2018 1 U
11 Muhammad 70 Kapuh Obs Chest Pain Obs Chest Pain √ 2/26/2018 2/26/2018 1 U
12 Maisir 60 Tebing Tinggi Gastritis Gastritis √ 2/26/2018 2/27/2018 1 U
13 Alfia Syahrina 5 Garunggang Obs Vomitus Obs Vomitus √ 2/2/2018 2/4/2018 2 KIS(non PBI) 2218728734
14 Jumadi 43 Karang Bulan Gastritis Gastritis √ 2/5/2018 2/8/2018 3 KIS(PBI) 892081405
15 Ardiansyah 36 Bago Gastritis Gastritis √ 2/5/2018 2/6/2018 1 KIS(PBI) 232496294
16 Darkasi 80 Tebing Tinggi Vertigo Vertigo √ 2/7/2018 2/9/2018 2 KIS(PBI) 2214941635
17 Suriansyah 56 Tebing Tinggi GERD GERD √ 2/10/2018 2/11/2018 1 KIS(non PBI) 124467377
18 H.Adam 70 Garunggang Diare Akut Diare Akut √ 2/4/2018 2/5/2018 1 KIS(non PBI) 2307196315
19 Nawiyah 73 Kapuh Krisis Hipertensi Hipertensi √ 2/15/2018 2/16/2018 1 KIS(PBI) 892396517
20 Basniah 55 Asam Vomitus + Gastritis Gastritis √ 2/14/2018 2/15/2018 1 KIS(PBI) 19609022
21 Hj. Bahriah 58 Hanau Anorexia + Post SNH Post SNH + Abd Pain √ 2/18/2018 2/21/2018 3 KIS(PBI) 1929398308
22 M. Arsyad 71 Simpur Obs Vomitus Obs Vomitus √ 2/19/2018 2/21/2018 2 KIS(PBI) 1065606309
23 Ahmad Jayadi 10 Kapuh Obs Febris H10 DHF Grade I √ 2/18/2018 2/21/2018 3 KIS(PBI) 891941446
24 Norhikmah 15 Hanau ISK ISK √ 2/24/2018 2/25/2018 1 KIS(PBI) 892193466
25 Rusmani 50 Amparaya CHF + IHD CHF + IHD √ 2/23/2018 2/24/2018 1 KIS(PBI) 1929395081
26 Norayuni 7 Wasah Hilir Asma Bronkhial Asma Bronkhial √ 2/25/2018 2/26/2018 1 KIS(PBI) 1929417669
27 Sehanik 38 Sirih Gastritis Gastritis √ 2/21/2018 2/22/2018 1 KIS(non PBI) 2091498412
28 Elva Rahmah 15 Amparaya Status Asmatikus Asma Bronkhial √ 2/26/2018 2/27/2018 1 KIS(PBI) 1929408816
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 umur Diagnosa Px Keluar Jlh Hari
No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Maret 2018
1 Masruba 79 Tamiang Hipertensi Hipertensi √ 2/28/2018 3/3/2018 3 U
2 A.Yajidi 49 Baru Abdominal Pain Abdominal Pain √ 2/27/2018 2/28/2018 1 U
3 Attailah 5 Wasah Tengah Sind Ekstral Pyramidal Sind Ekstral Pyramidal √ 2/25/2018 2/28/2018 3 U
4 Nor hafizah 13 Wasah Hilir Abdominal Pain Abdominal Pain √ 2/28/2018 3/1/2018 1 KIS(PBI) 1961596348
5 Badar 67 Kapuh Abdominal Pain Abdominal Pain √ 3/3/2018 3/8/2018 5 KIS(PBI) 891871648
6 M.Rani 60 Simpur Artritis GOUT Artritis GOUT √ 3/3/2018 3/6/2018 3 KIS(PBI) 2218740478
7 Abdul Gani 84 Sirih Abdominal Pain Abdominal Pain √ 3/17/2018 3/19/2018 2 KIS(non PBI) 158418887
8 Dahlia 49 Sarang Halang Gastritis ec Vertigo Gastritis ec Vertigo √ 3/2/2018 3/8/2018 6 U
9 Norsiah 70 Panj Bahagia Gastritis Gastritis √ 3/9/2018 3/10/2018 1 KIS(PBI) 2437919199
10 Ahmaduddin Noor 58 Wasah Hilir Abdominal Pain Abdominal Pain √ 3/10/2018 3/12/2018 2 Askes 124458963
11 Noor asyikin 54 Wasah Hulu Gastritis Gastritis √ 3/10/2018 3/11/2018 1 Askes 124471945
12 Saladeri 65 Baru Artritis GOUT Artritis GOUT √ 3/11/2018 3/13/2018 2 Askes 124339972
13 Rusdi 71 Wasah Tengah Hipertensi Hipertensi √ 3/14/2018 3/16/2018 2 KIS(PBI) 892715027
14 Maslina 30 Ambutun Gastritis Gastritis √ 3/14/2018 3/16/2018 2 KIS(PBI) 2034911889
15 Kiki Amalia 1 th Asam Obs Febris Obs Febris √ 3/15/2018 3/17/2018 2 U
16 Saladeri 65 Baru Artritis GOUT Artritis GOUT √ 3/18/2018 3/21/2018 3 Askes 124339972
17 M.Rizqun 7 Tamiang Obs Febris Obs Febris √ 3/19/2018 3/21/2018 2 KIS(PBI) 892593742
18 Arifin 11 Simpur Obs Febris Obs Febris √ 3/19/2018 3/22/2018 3 KIS(PBI) 893165951
19 H.Ajam 68 Amparaya Obs Abdominal RFA 5 + ISK Obs Abdominal RFA 5 + ISK √ 3/19/2018 3/22/2018 3 KIS(non PBI) 2426936602
20 Murhaniah 40 Panj Bahagia Obs Febris Obs Febris √ 3/13/2018 3/15/2018 2 U
21 Hairin Nahwan 49 Simpur SNH SNH √ 3/21/2018 3/23/2018 2 U
22 Naufal Al Zufri 18 Pantai Hambawang Diare Akut Diare Akut √ 3/24/2018 3/26/2018 2 U
23 Ahmad Khuzaifah 9 Wasah Hulu Asma Brokhiale Asma Brokhiale √ 3/24/2018 3/26/2018 2 KIS(PBI) 2306997909
24 Saladeri 65 Baru Artritis GOUT Artritis GOUT √ 3/25/2018 3/26/2018 1 Askes 124339972
25 Mirnawati 20 Panj Bahagia Diare Akut Diare Akut √ 3/26/2018 3/28/2018 2 U
26 Nurmansyah 61 Wasah Hulu SNH SNH √ 3/28/2018 3/29/2018 1 U
27 Hj. Mardiana 55 Sarang Halang Gastritis Gastritis √ 3/26/2018 3/29/2018 3 U
28 Mona Datul Hasanah 20 Pantai Ulin Obs Vomitus Obs Vomitus √ 3/29/2018 3/31/2018 2 U
29 M.Ihsan Taufiq 1 Batang Kulur Obs Vomitus Obs Vomitus √ 3/31/2018 4/2/2018 2 KIS(non PBI) 2196233548
30 M.Zulfi 2 Sarang Halang Diare Akut Diare Akut √ 3/31/2018 4/2/2018 2 KIS(PBI) 1926958691
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 umur Diagnosa Px Keluar Jlh Hari
No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : April 2018
1 Rusmani 68 Amparaya Gastritis Gastritis √ 3/30/2018 4/1/2018 2 PBI/APBD 1929395081
2 Syaiful Rahman 50 Garunggang Gastritis Gastritis √ 3/29/2018 4/2/2018 4 PBI/APBN 1065837238
3 Hasnah Afsari 40 Baru Hiperemesis Grav Hiperemesis Grav √ 3/30/2018 4/2/2018 3 BPJS Non Aktif 2445497122
4 Diansyah 50 Asam Post Retensio urin Post Retensio urin √ 4/3/2018 4/4/2018 1 U
5 Ardiansyah 35 Bago Tanggul Gastritis Gastritis √ 4/3/2018 4/4/2018 1 PBI/APBD 2324396294
6 St. Raudatul Madinah 14 Kapuh Obs Febris Obs Febris √ 4/2/2018 4/3/2018 1 U
7 M.Salamudin 9 Pantai Ulin Obs Febris Obs Febris √ 4/2/2018 4/4/2018 2 PBI/APBN 892642847
8 Suriansyah 56 Tebing Tinggi Gastritis Gastritis √ 4/6/2018 4/7/2018 1 ASKES 124467377
9 Tuhfah 60 Simpur Hipertensi Hipertensi √ 4/6/2018 4/7/2018 1 U
10 Ummi Hani 23 Wasah Hilir Hiperemesis Grav Hiperemesis Grav √ 4/6/2018 4/9/2018 3 Jampersal
11 Sadariah 60 Tebing Tinggi Hipertensi Hipertensi √ 4/10/2018 4/11/2018 1 BPJS/Mandiri 2223396371
12 Helda Elfina 29 Bago Tanggul Gastritis Gastritis √ 4/8/2018 4/11/2018 3 U
13 Harmah 16 Sirih Obs Vomitus Obs Vomitus √ 4/10/2018 4/11/2018 1 U
14 M.Hery Fadillah 7 Simpur Obs Vomitus Obs Vomitus √ 4/14/2018 4/16/2018 2 U
15 Supriyanto 53 Wasah Tengah Hipertensi Hipertensi √ 4/16/2018 4/21/2018 5 PBI/APBD 2265330126
16 Salwatin Nazwa 7 Kalumpang Obs Febris Obs Febris √ 4/16/2018 4/19/2018 3 BPJS/Mandiri 1425313901
17 Raihanah 27 Kalumpang Obs Abdominal Pain Obs Abdominal Pain √ 4/17/2018 4/19/2018 2 BPJS/Mandiri 2209405836
18 Salhah 50 Wasah Tengah Obs Anoreksia Obs Anoreksia √ 4/14/2018 4/18/2018 4 U
19 Siti Salmiyah 20 Wasah Hulu Obs Febris Obs Febris √ 4/18/2018 4/21/2018 3 PBI/APBN 892245442
20 Fikri Ahmad 10 Sirih Obs Febris Obs Febris √ 4/19/2018 4/20/2018 1 U
21 Helda Elfina 29 Bago Tanggul Hipoglikemi Hipoglikemi √ 4/17/2018 4/20/2018 3 U
22 Helda Inayah 40 Simpur Diare Akut Diare Akut √ 4/19/2018 4/20/2018 1 PBI/APBN 892391049
23 Raihanah 36 Simpur ASMA ASMA √ 4/18/2018 4/20/2018 2 PBI/APBN 1082923389
24 Arianto 32 Simpur ISK ISK √ 4/20/2018 4/22/2018 2 PBI/APBD 2194521906
25 Nor Afifa Naila 2 Kalumpang Obs Vomitus Obs Vomitus √ 4/22/2018 4/23/2018 1 U
26 Rusdian 60 Kalumpang Obs Abdominal Pain Obs Abdominal Pain √ 4/21/2018 4/23/2018 2 PBI/APBN 892238466
27 Helda Elfina 29 Bago Tanggul Obs Dyspepsia Obs Dyspepsia √ 4/21/2018 4/23/2018 3 U
28 Basri 60 Wasah Hilir Obs Dipsneu+CHF Obs Dipsneu+CHF √ 4/24/2018 4/25/2018 1 U
29 Murjani 55 Asam Hipertensi+Hemmel Hipertensi+Hemmel √ 4/23/2018 4/24/2018 1 ASKES 124429318
30 Muhammad 55 Tebing Tinggi Obs Hemmel+anoreksia Obs Hemmel+anoreksia √ 4/21/2018 4/22/2018 1 ASKES 124448396
31 Muslimah 50 Sei Kacil Gastritis Gastritis √ 4/23/2018 4/26/2018 3 PBI/APBD 1929391378
32 Isa 60 Sirih Syndrom Dispepsia Syndrom Dispepsia √ 4/23/2018 4/26/2018 3 BPJS Non Aktif 2300739208
33 Husin 56 Panj Bahagia Susp TB Paru+anoreksia Susp TB Paru+anoreksia √ 4/21/2018 4/24/2018 3 PBI/APBN 892166635
34 M.Alfianor 27 Kapuh Demam Thypoid Demam Thypoid √ 4/21/2018 4/26/2018 5 U
35 Suaibatul Aslamiah 61 Kapuh Diare Akut Diare Akut √ 4/26/2018 4/30/2018 4 PBI/APBN 891870096
 36 M.Azril 3 Karang Paci Obs Febris Obs Febris √ 4/28/2018 5/2/2018 5 U
37 M.Ramli 64 Ulin Ulkus Diabetikum Ulkus Diabetikum √ 4/25/2018 4/30/2018 5 BPJS Mandiri 2444804853
38 Basran 60 Kapuh Obs Febris+Anemia Obs Febris+Anemia √ 4/28/2018 4/30/2018 2 U
91

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Mei 2018
1 Sateriadi 40 Sirih ASMA ASMA √ 5/3/2018 5/4/2018 1 U
2 Tihamah 71 Kapuh Hipertensi Hipertensi √ 4/29/2018 5/3/2018 4 891945685
3 Hj.Murlan 75 Asam Hipertensi Hipertensi √ 4/29/2018 5/3/2018 4 2222507057
4 Samlan 40 Simpur ISK ISK √ 5/3/2018 5/4/2018 1 U
5 Fauzan 9 Balai Amas Obs Febris Obs Febris √ 5/2/2018 5/3/2018 1 U
6 Kursani 60 Amparaya Synkoke+Dyspepsia Synkoke+Dyspepsia √ 5/3/2018 5/4/2018 1 U
7 Balim 71 Karangan ASMA ASMA √ 5/4/2018 5/5/2018 1 U
8 Helda Inayah 24 Kapuh Obs Abdominal Pain Obs Abdominal Pain √ 5/5/2018 5/6/2018 1 892312503
9 Kurbayah 52 Simpur Gastritis Gastritis √ 5/3/2018 5/4/2018 1 U
10 M.Sabiri 72 Paring Agung Obs Abdominal Pain Obs Abdominal Pain √ 5/3/2018 5/5/2018 2 U
11 M.Akmal 3 Sirih Diare Akut Diare Akut √ 5/6/2018 5/8/2018 2 U
12 Naila Savitri 8 bl Bumi Berkat Obs Febris Obs Febris √ 5/5/2018 5/8/2018 3 U
13 Raudah 46 Pasar Baru Anoreksia Anoreksia √ 5/7/2018 5/9/2018 2 U
14 M.Wahyu 4 Tambingkar Obs Febris Obs Febris √ 5/13/2018 5/14/2018 1 1926958656
15 Nor Rizkia 12 Karang Paci Obs Febris Obs Febris √ 5/8/2018 5/11/2018 3 892214256
16 Fahrurazi 29 Kalumpang Obs Vomitus Obs Vomitus √ 5/11/2018 5/13/2018 2 U
17 Hj. Masja 64 Batang Kulur Anoreksia+DM type 2 Anoreksia+DM type 2 √ 5/10/2018 5/13/2018 3 2229192663
18 Surgani 38 Asam Hiperglikemi+DM type 2 Hiperglikemi+DM type 2 √ 5/12/2018 5/15/2018 3 2314945541
19 Samsul Bahri 40 Panj Bahagia Obs Abdominal Pain Obs Abdominal Pain √ 5/14/2018 5/15/2018 1 U
20 Norhasanah 57 Wasah Hilir HT + GERD HT + GERD √ 5/10/2018 5/15/2018 5 1082761582
21 Aisyah 55 Panj Bahagia Gastritis Kronis Gastritis Kronis √ 5/13/2018 5/17/2018 4 1929397061
22 Masliana Masqi 51 Kapuh Dyspepsia Dyspepsia √ 5/15/2018 5/17/2018 2 2194627004
23 Wahbah 40 Wasah Hilir Gastritis Kronis Gastritis Kronis √ 5/11/2018 5/16/2018 5 891172135
24 Sanah 24 Simpur Anemia Anemia √ 5/10/2018 5/11/2018 1 U
25 Jami'ah 61 Amparaya Obs Febris Obs Febris √ 5/8/2018 5/13/2018 5 2213066439
26 Barniah 60 Kalumpang Anoreksia+ HT grade I Anoreksia+ HT grade I √ 5/20/2018 5/23/2018 3 1082830252
27 Widya Maulina 21 Asam Seranggan DHF DHF √ 5/25/2018 5/26/2018 1 2324446391
28 Keplianor 35 Kalumpang Diare Akut Diare Akut √ 5/24/2018 5/26/2018 2 1926958533
29 Acil 74 Tebing Tinggi Diare Akut Diare Akut √ 5/21/2018 5/24/2018 3 169567997
30 Tri Hartati Ningsih 28 Hamalau Anoreksia+Parotitis Anoreksia+Parotitis √ 5/26/2018 5/28/2018 2 1738888132
31 Nor Annisa 11 Garunggang Obs Abdominal Pain Obs Abdominal Pain √ 5/24/2018 5/25/2018 1 U
32 Nor Asyikin 54 Wasah Hulu Obs Abdominal Pain Obs Abdominal Pain √ 5/27/2018 5/28/2018 1 124471945
33 A. Ramadani 26 Simpur TB Paru + dyspepsia TB Paru + dyspepsia √ 5/26/2018 5/30/2018 4 2259789164
 34 Makiah 18 Bago Tanggul Syndroma Dyspepsia Syndroma Dyspepsia √ 5/28/2018 5/31/2018 3 892639056
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79

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Juni 2018
1 Yusran 58 Baru Diare Akut Diare Akut √ 6/23/2018 6/24/2018 1 2286676304
2 Masnun 56 Tebing tinggi Obs Febris Obs Febris √ 6/22/2018 6/26/2018 4 2466058228
3 Rabiatul Adawiyah 56 Panj Bahagia Gastritis Gastritis √ 6/22/2018 6/23/2018 1 892659587
4 Bahrianor 25 Tembingkar Obs Febris Obs Febris √ 6/19/2018 6/21/2018 2 1083444715
5 Fahrurazi 33 Asam Obs Abd Pain Obs Abd Pain √ 6/21/2018 6/22/2018 1 U
6 Kusnadi 37 Ulin Gastritis Gastritis √ 6/24/2018 6/26/2018 2 1101848084
7 Basniah 71 Ulin Gastritis Gastritis √ 6/19/2018 6/21/2018 2 891690219
8 Majidi 53 Balanti Vertigo Vertigo √ 6/20/2018 6/21/2018 1 892256815
9 Mustika Mulianti 19 Simpur Obs Febris Obs Febris √ 6/18/2018 6/19/2018 1 198953739
10 Supian Maulana 6 Amparaya Obs Febris Obs Febris √ 6/8/2018 6/9/2018 1 U
11 Ardiansyah 35 Bago Tanggul Obs Abd Pain Obs Abd Pain √ 6/8/2018 6/9/2018 1 2324396294
12 Asyari Salim 84 kapuh Diare Akut+Geriatri Diare Akut+Geriatri √ 6/21/2018 6/29/2018 8 159122586
13 Norfaizah 35 Bago Tanggul Diare Akut Diare Akut √ 6/28/2018 6/29/2018 1 892638077
14 M.Rizki Mubarak 1 Tebing tinggi Obs Febris Obs Febris √ 6/27/2018 6/30/2018 3 2369881642
15 M.Subhi 1 Panj Bahagia Diare Akut Diare Akut √ 6/29/2018 6/30/2018 1 U
16 Mulkani 47 Tebing tinggi Obs Abd Pain Obs Abd Pain √ 6/8/2018 6/9/2018 1 891849543
17 Afifah 13 Asam Obs Abd Pain Obs Abd Pain √ 6/25/2018 6/27/2018 2 U
18 Mita Musliana 29 Tebing tinggi Vertigo(gastritis) Vertigo √ 6/6/2018 6/7/2018 1 1823591766
19 Adelian 68 Bago Tanggul Gastritis Gastritis √ 6/8/2018 6/9/2018 1 U
20 Urpiah 73 Balanti Obs Abd Pain Obs Abd Pain √ 6/6/2018 6/7/2018 1 892532553
21 Rabiawati 34 Balanti Gastritis Gastritis √ 6/6/2018 6/7/2018 1 171853672
22 Juana 40 Asam Obs Abd Pain Obs Abd Pain √ 6/6/2018 6/7/2018 1 U
23 Nursinah 70 Wasah Tengah Dispepsia Dispepsia √ 6/3/2018 6/6/2018 3 U
24 Masitah 34 Panj Bahagia Diare Akut Diare Akut √ 6/5/2018 6/7/2018 2 U
25 Sinah 68 Asam Gastritis Gastritis √ 6/3/2018 6/7/2018 4 U
26 Masliani 41 Baluti Bronchitis Kronis Bronchitis Kronis √ 6/4/2018 6/5/2018 1 891891369
27 Basinah 59 Sarang Halang Obs Febris Obs Febris √ 6/3/2018 6/4/2018 1 2275294228
28 Amberi 45 Sungai Tarap Gastritis Gastritis √ 6/1/2018 6/3/2018 2 2255388805
29 Arbainah 29 Sirih Dispepsia Dispepsia √ 5/30/2018 6/4/2018 5 893394843
30 Ismail 49 Kapuh Hipertensi Hipertensi √ 5/31/2018 6/2/2018 2 892397856
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58

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Juli 2018
1 Mariyati 40 Simpur Gastritis Gastritis √ 7/26/2018 7/27/2018 1 U
2 Utuhan 69 Karang Bulan Cephalgia Cephalgia √ 7/27/2018 7/28/2018 1 Askes 118450776
3 Norsan Heriyanto 45 Batang Kulur Obs Febris + Diare Akut Obs Febris √ 7/27/2018 7/29/2018 2 124146295
4 Sugianor 35 Bago Tanggul ISK ISK √ 7/27/2018 7/28/2018 1 892885634
5 Mila Aryanti 20 Sirih Obs Febris Obs Febris √ 7/25/2018 7/27/2018 2 892603945
6 Khairillah 6 Amparaya Diare Akut Diare Akut √ 7/24/2018 7/27/2018 3 2224770298
7 Khairullah 6 Amparaya Diare Akut Diare Akut √ 7/24/2018 7/27/2018 3 2224770837
8 Rahimah 3 Baru Asma Bronkhiale Asma Bronkhiale √ 7/24/2018 7/27/2018 3 2219090837
9 Hj. Aisyah 60 Lokpaikat Obs Vomitus + HT Obs Vomitus + HT √ 7/24/2018 7/26/2018 2 1877999769
10 Mahmudah 51 Simpur Infeksi Pedis Dx Infeksi Pedis Dx √ 7/20/2018 7/25/2018 5 Askes 124083066
11 Rafatul Mahmudah 24 Panj Bahagia Gastritis Gastritis √ 7/23/2018 7/25/2018 2 1929397937
12 Fikri Ahmad 7 Sirih Diare Akut Diare Akut √ 7/21/2018 7/24/2018 3 U
13 M.Yasir Hasan 3 Wasah Hilir Diare Akut Diare Akut √ 7/23/2018 7/24/2018 1 236974903
14 Riduan 44 Amparaya Obs Abd Pain Obs Abd Pain √ 7/21/2018 7/24/2018 3 1929392954
15 Artijah 70 Sirih HT Urgensi HT Urgensi √ 7/18/2018 7/21/2018 3 U
16 Ahmad Salimi 12 Wasah Hulu Obs Febris Obs Febris √ 7/10/2018 7/12/2018 2 892247027
17 Saidina Abbas 73 Pantai Ulin Obs Dispneu+Susp TB Obs Dispneu+Susp TB √ 7/7/2018 7/9/2018 2 U
18 Arniah 59 Garunggang Gastritis Gastritis √ 7/7/2018 7/10/2018 3 1065606974
19 Mugni 50 Ida Manggala ISK ISK √ 7/7/2018 7/10/2018 3 U
20 M. Irsani Mirza 2 Wasah Hilir Obs Febris Obs Febris √ 6/30/2018 7/2/2018 2 U
21 M. Rizki 7 Wasah Hulu Obs Vomitus Obs Vomitus √ 6/30/2018 7/2/2018 2 U
22 Armi Amilia 14 Asam Demam Typoid Demam Typoid √ 7/16/2018 7/19/2018 3 U
23 Ali Nafarin 46 Wasah Tengah Obs Abd Pain Obs Abd Pain √ 7/17/2018 7/19/2018 2 U
24 Hj. Erni Elawati 55 Batang Kulur Diare Akut Diare Akut √ 7/1/2018 7/3/2018 2 124339926
25 Siti Rahmah 38 Tebing Tinggi CKR CKR √ 7/17/2018 7/19/2018 2 U
26 Burhan 82 Tambingkar Anoreksia Geriatri+GERD Anoreksia Geriatri+GERD √ 7/15/2018 7/18/2018 3 U
27 St. Ramlah 54 Tamiyang Diare Akut Diare Akut √ 7/1/2018 7/2/2018 2 124356655
28 Ira Hayatun N 19 Simpur Diare Akut Diare Akut √ 7/2/2018 7/4/2018 2 2277765382
29 Acil 61 Bumi Berkat Asma Bronkhiale Asma Bronkhiale √ 7/3/2018 7/5/2018 2 2289347651
 30 Hj. Dinar 71 Simpur Anoreksia geriatri/HT Anoreksia geriatri/HT √ 7/5/2018 7/10/2018 5 2279716558
31 Fitriadi 34 Bumi Berkat Diare Akut Diare Akut √ 7/4/2018 7/6/2018 2 2207288531
32 Kasrah 68 Simpur Diare Akut Diare Akut √ 7/7/2018 7/10/2018 3 2425255503
33 Irhamni 41 Batang Kulur Angina vektoris Angina vektoris √ 7/14/2018 7/15/2018 1 892012026
34 Arifin 66 Garunggang Asma Bronkhiale Asma Bronkhiale √ 7/11/2018 7/15/2018 4 1322003553
35 Masniah 76 Simpur SNH SNH √ 7/10/2018 7/11/2018 1 U/BPJS -
36 M. Akbar R 22 Tamiyang Obs Febris Obs Febris √ 7/19/2018 7/21/2018 2 U/BPJS -
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umur Diagnosa Px Keluar Jlh Hari
No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Agustus 2018
1 Nursihan 70 Simpur Bronchitis+Stomatitis Bronchitis+Stomatitis √ 8/11/2018 8/12/2018 1 U
2 Masnun 56 Tebing Tinggi Gastritis Gastritis √ 8/10/2018 8/12/2018 2 2466058228
3 Syaina Norkhatimah 23 Simpur Asma Bronkhiale Asma Bronkhiale √ 8/5/2018 8/6/2018 1 U
4 Adul 70 Wasah Hilir Obs CKR Obs CKR √ 8/12/2018 8/13/2018 1 U
5 Jarmiah 47 Tambingkar Vertigo+Anoreksia Vertigo+Anoreksia √ 8/19/2018 8/21/2018 2 U
6 M.Aufar Ramadhani 3 Garunggang Diare Akut Diare Akut √ 8/6/2018 8/8/2018 2 1866872518
7 Khusnul Khatimah 18 Wasah Hulu Susp Abses Maxilla Susp Abses Maxilla √ 8/5/2018 8/8/2018 3 892556919
8 Fitriani 22 Bayur Diare Akut Diare Akut √ 8/7/2018 8/8/2018 1 2308727845
9 M.Rifani Rahman 14 Ulin Obs Febris Obs Febris √ 8/4/2018 8/8/2018 4 1083007293
10 Hasnelli M 2 Garunggang Sindr Kejang Demam(KDS) Sindr Kejang Demam(KDS) √ 8/6/2018 8/7/2018 1 2261728135
11 Salamat 75 Tamiang ISK ISK √ 8/5/2018 8/7/2018 2 1844674773
12 Siti Mahfiah 54 Wasah Hilir Hipertensi Emergensi Hipertensi Emergensi √ 8/6/2018 8/7/2018 1 2213589778 non aktif
13 Bastiah 57 Simpur Asma Bronkhiale Asma Bronkhiale √ 8/1/2018 8/2/2018 1 892419579
14 Mahmudah 42 Simpur Diare Akut Diare Akut √ 8/6/2018 8/10/2018 4 124083066
15 Normiati 32 Bumi Barkat Obs CKR Obs CKR √ 8/19/2018 8/20/2018 1 U
16 Marsiah 22 Amparaya Gastritis Gastritis √ 8/18/2018 8/20/2018 2 U
17 Salabiah 74 Tebing Tinggi Diare Akut Diare Akut √ 8/19/2018 8/20/2018 1 892400714
18 Pandi 68 Tebing Tinggi ISK ISK √ 8/18/2018 8/20/2018 2 2242643861
19 Aminah 44 Simpur Anoreksia Anoreksia √ 8/15/2018 8/16/2018 1 892366547
20 Abdul Karim 18 bl Wasah Hilir Diare Akut Diare Akut √ 8/27/2018 8/29/2018 2 U
21 Hamdah 58 Wasah Hilir Diare Akut Diare Akut √ 8/29/2018 8/30/2018 1 2429020247
22 Hana Faida 4 Amparaya Obs Febris Obs Febris √ 8/26/2018 8/29/2018 3 U
23 Helmina Diniyati 17 Simpur Diare Akut Diare Akut √ 8/18/2018 8/20/2018 2 U
24 Nor afifah 4 Bukhari Obs Febris Obs Febris √ 8/15/2018 8/16/2018 1 1930458317
25 Faridah 48 Asam Tamiang Obs Febris Obs Febris √ 8/4/2018 8/5/2018 1 124467063
26 Nurasyikin 50 Wasah Hulu Gastritis Gastritis √ 8/21/2018 8/22/2018 1 U
27 St.Sofiah 23 Kapuh Diare Akut Diare Akut √ 8/21/2018 8/22/2018 1 U
 28 Masmurah 71 Simpur Hipertensi Emergensi Hipertensi Emergensi √ 8/20/2018 8/21/2018 1 2218740783
29 Misran 47 Kalumpang V.Laceratum femur Dx V.Laceratum femur Dx √ 8/19/2018 8/21/2018 2 892309566
30 Sahrul Yamani 31 Kalumpang Obs Febris Obs Febris √ 8/20/2018 8/21/2018 1 892315146
31 Misbah 19 Asam Diare Akut Diare Akut √ 8/24/2018 8/25/2018 1 892013387
32 Norsihan 56 Simpur Anoreksia Anoreksia √ 8/23/2018 8/25/2018 2 1065606311
33 Mawardi 31 Wasah Hilir Gastritis Gastritis √ 8/24/2018 8/25/2018 1 171927911
34 St.Bilqis 37 Amparaya Obs Dipsneu Obs Dipsneu √ 8/25/2018 8/26/2018 1 U
35 Ahmad Bisrul 11 Kapuh Diare Akut Diare Akut √ 8/24/2018 8/25/2018 1 892317519
36 Nor Jani 35 Simpur Obs Abd Pain Obs Abd Pain √ 8/24/2018 8/25/2018 1 U
37 Monalisa 24 Bago Tanggul Diare Akut Diare Akut √ 8/23/2018 8/24/2018 1 2230593592
38 Masjam 51 Simpur Hipertensi Emergensi Hipertensi Emergensi √ 8/26/2018 8/27/2018 1 1065607795

58

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Agustus 2018
39 Basmah 68 Sungai Kali Anoreksia Geriatri Anoreksia Geriatri √ 8/27/2018 8/29/2018 2 892139602
40 Aslamiah 65 Panj Bahagia Ishialgia+Art Multifel Join Ishialgia+Art Multifel Join √ 8/6/2018 8/8/2018 2 892648169
41 Wulya Noor Hikmah 3 Balimau Obs Vomitus Obs Vomitus √ 8/11/2018 8/12/2018 1 2294781129
42 Zahratul Husna 4 Wasah Hilir Diare Akut Diare Akut √ 8/28/2018 8/30/2018 2 2486503361
43 Norhidayati Ahmad 17 Simpur Gastritis Gastritis √ 8/29/2018 8/30/2018 1 U
44 M.Nor Maulana 19 Sirih Demam Typoid Demam Typoid √ 8/27/2018 8/30/2018 3 2438502478
45 M.Ilham 9 Balanti Anoreksia Anoreksia √ 8/28/2018 8/30/2018 2 2486142549
46 Rusdiah 40 Simpur Kemoterapi Ca Mamae Kemoterapi Ca Mamae √ 8/9/2018 8/10/2018 1 1871941882
47 M.Iqri Firmansyah 12 Simpur Obs Febris Obs Febris √ 8/16/2018 8/17/2018 1 892590017
48 Maulida 11 Tamiang Obs Febris Obs Febris √ 8/16/2018 8/17/2018 1 U
49 Ahmad Syairi 15 Pantai Ulin Obs Febris Obs Febris √ 8/16/2018 8/17/2018 1 2369880426
50 Mastika 41 Tebing Tinggi Diare Akut Diare Akut √ 8/18/2018 8/20/2018 2 891841184
51 Samsul Arifin 17 Asam Diare Akut Diare Akut √ 8/15/2018 8/16/2018 1 892028226
52 Hamdiah 61 Tebing Tinggi Obs Takipneu ec edema pul Obs Takipneu ec edema pul √ 8/13/2018 8/14/2018 1 U
53 Aluhan 50 Simpur Gastritis Gastritis √ 8/27/2018 8/31/2018 4 124434663
54 Nina 70 Bayur CHF CHF √ 8/28/2018 8/29/2018 1 2294846897
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84 509
umur Diagnosa Px Keluar Jlh Hari
No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : September 2018
1 M.Rifki Rafida 6 Amparaya Diare Akut Diare Akut √ 9/6/2018 9/8/2018 2 1929394844
2 Kherleyani 40 Amparaya Anoreksia Anoreksia √ 9/3/2018 9/4/2018 1 1929392471
3 Hamdan 55 Amparaya Gastritis Gastritis √ 9/4/2018 9/5/2018 2 1929395553
4 Salasiah 20 Panj Bahagia Vertigo Vertigo √ 9/3/2018 9/5/2018 2 U
5 Amalia Shadrina 15 Batang Kulur Gastritis Gastritis √ 9/3/2018 9/5/2018 2 200192826
6 Sabdin 59 Balanti Anoreksia Anoreksia √ 9/1/2018 9/5/2018 4 892565638
7 Rika Amelia 5 Batang Kulur Diare Akut Diare Akut √ 9/3/2018 9/4/2018 1 U
8 Masnun 56 Tebing Tinggi Gastritis Gastritis √ 9/10/2018 9/12/2018 3 2466058228
9 Wawan Murdiani 18 Tambingkar Psikosomatis Psikosomatis √ 9/3/2018 9/4/2018 1 U
10 M.Abduh 5 Sirih Hulu Cephalgia Cephalgia √ 9/2/2018 9/3/2018 1 U
11 Rusian 60 Simpur Gastritis Gastritis √ 9/5/2018 9/6/2018 1 U
12 Hj. Diah 77 Amparaya Vertigo Vertigo √ 9/5/2018 9/7/2018 2 1065607481
13 Payansyah 51 Wasah Tengah Hipertensi grade II Hipertensi grade II √ 9/5/2018 9/7/2018 2 2454889386
14 Siska Nabila 10 Amparaya Gastritis Gastritis √ 9/10/2018 9/11/2018 1 1929394675
15 M.Sauki 22 Garunggang Hipertensi grade II Hipertensi grade II √ 9/10/2018 9/12/2018 2 U
16 Halipah 71 Amparaya Anoreksia Anoreksia √ 9/10/2018 9/12/2018 2 1929394596
17 Sumaisah 25 Amparaya Obs Febris Obs Febris √ 9/13/2018 9/14/2018 1 U
18 Safia Nadila 3 Kalumpang Diare Akut Diare Akut √ 9/12/2018 9/14/2018 2 1959943375
19 M.Iqbal 4 Kalumpang Obs Vomitus Obs Vomitus √ 9/13/2018 9/14/2018 1 U
20 M.Ikhwan R 11 Sirih Hulu Obs Vomitus Obs Vomitus √ 9/11/2018 9/14/2018 3 2209406218
21 Amirul Amin 7 Simpur Obs Febris Obs Febris √ 9/12/2018 9/13/2018 1 2324502347
22 Naura fitri andini 3 Asam Diare Akut Diare Akut √ 9/11/2018 9/13/2018 2 2194499182
23 Maria Ulfah 6 Simpur Obs Chest Pain Chest Pain √ 9/14/2018 9/15/2018 1 892729901
 24 Syamsudin 56 Amparaya Gastritis Gastritis √ 8/30/2018 9/1/2018 2 2231294488
25 Masran 55 Bago Tanggul TB Paru+anoreksia TB Paru+anoreksia √ 9/11/2018 9/13/2018 2 1065609549
26 Norhayati 61 Asam Diare Akut Diare Akut √ 9/19/2018 9/21/2018 2 2264080544
27 Mastaliah 48 Tamiang Diare Akut Diare Akut √ 9/22/2018 9/24/2018 2 U
28 Aluhan 54 Simpur Gastritis Gastritis √ 9/19/2018 9/21/2018 2 892354768
29 Zahrah 70 Balimau Diare Akut Diare Akut √ 9/20/2018 9/21/2018 1 892439987
30 St.Fatimah 40 Kapuh Chest Pain Chest Pain √ 9/14/2018 9/15/2018 1 U
31 St.Aisyah 51 Wasah Hilir Gastritis Gastritis √ 9/15/2018 9/17/2018 2 2369875419
32 Sukranadi 17 Simpur Obs Febris Obs Febris √ 9/15/2018 9/17/2018 2 2262404035
33 Abdul Hamid 71 Tamiang Diare Akut Diare Akut √ 9/14/2018 9/16/2018 2 2264079249
34 Patriah 62 Wasah Hilir Obs Febris Obs Febris √ 9/14/2018 9/15/2018 1 124439512
35 Norhayati 50 Garunggang Obs Vomitus Obs Vomitus √ 9/15/2018 9/17/2018 2 891862211
36 Hamdiah 47 Simpur Mialgia Mialgia √ 9/16/2018 9/18/2018 2 1632231685
37 Mutia Riska 1 Bumi Berkat Obs Febris Obs Febris √ 9/23/2018 9/24/2018 1 U
38 Jamri 63 Kalumpang KLK Mialgia √ 9/24/2018 9/25/2018 1 U

65

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : September 2018
39 Ari Misranto 22 Wasah Hilir Asma Bronkhiale Asma Bronkhiale √ 8/31/2018 9/1/2018 1 U
40 M.Arsyad 66 Amparaya Hipertensi Emergensi Hipertensi Emergensi √ 9/28/2018 9/29/2018 1 2325068785
41 Aslamiah 59 Simpur Anoreksia Anoreksia √ 9/25/2018 9/29/2018 4 2470259799
42 Mastiah 58 Gambut Hipertensi Emergensi Hipertensi Emergensi √ 9/26/2018 9/27/2018 1 U
43 Nor Afika 5 Sungai Raya Diare Akut Diare Akut √ 9/27/2018 9/28/2018 1 1921079856
44 Murdianto 34 Sumber rejo Malaria Vivax Malaria Vivax √ 9/25/2018 9/28/2018 3 U
45 Herlina 26 Kapuh Obs Abdominal Pain Obs Abdominal Pain √ 9/28/2018 9/29/2018 1 892312378
46 Nuril Azkia 4 Wasah Hilir Diare Akut Diare Akut √ 9/27/2018 9/28/2018 1 U
47 Hairul 32 Panj Bahagia Obs Febris Obs Febris √ 9/24/2018 9/25/2018 1 892664471
48 Norhasanah 43 Tamiang Obs Vomitus Obs Vomitus √ 9/23/2018 9/25/2018 2 2494235799
49 Norsiah 70 Panj Bahagia Obs Vomitus Obs Vomitus √ 9/19/2018 9/21/2018 2 2437919199
50 Basiah 68 Amparaya Obs Febris Obs Febris √ 9/19/2018 9/21/2018 2 U
51 St.Jubaidah 51 Sirih Chest Pain Chest Pain √ 9/20/2018 9/21/2018 1 U
52 Yuna.M 5 Tebing Tinggi Obs Vomitus Obs Vomitus √ 9/27/2018 9/28/2018 1 2256758144
53 Pahrul Fauzi 35 Palangkaraya Malaria Mix Malaria Mix √ 9/27/2018 9/29/2018 2 U
54
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89 598
umur Diagnosa Px Keluar Jlh Hari
No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Oktober 2018
1 H. Saniah 58 Wasah Hilir Diare Akut Diare Akut √ 9/30/2018 10/1/2018 1 U
2 Majidi 52 Amparaya DM Type 2 DM Type 2 √ 10/3/2018 10/7/2018 4 2496278011
3 M.Yasir 6 Pantai Ulin Typoid Fever Typoid Fever √ 10/6/2018 10/9/2018 3 1929417963
4 Ahmad Fikri 3 Asam tamiang Obs Febris Obs Febris √ 9/30/2018 10/1/2018 1 U
5 Dafa Rizky Syahreza 4 Amparaya Diare Akut Diare Akut √ 10/1/2018 10/3/2018 2 2045109532
6 M. Nizham 3 Sirih Diare Akut Diare Akut √ 9/30/2018 10/1/2018 1 U
7 H. Nurdin 63 Wasah Hilir CHF CHF √ 10/1/2018 10/2/2018 1 U
8 Salabiah 69 Garunggang Obs Febris Obs Febris √ 9/30/2018 10/2/2018 2 891876565
9 Suriadi 37 Wasah Hilir PPOK PPOK √ 9/30/2018 10/2/2018 2 1961607543
10 Murhan 51 Kapuh Obs Abd Pain Obs Abd Pain √ 10/1/2018 10/2/2018 1 U
11 Ishak 33 Kalumpang Dispepsia Dispepsia √ 10/2/2018 10/3/2018 1 U
12 Ahmad Zein Fuadi 3 Wasah Tengah Obs Febris Obs Febris √ 10/2/2018 10/4/2018 2 2194499867
13 Kusnadi 38 Halayung Malaria Mix Malaria Mix √ 10/1/2018 10/3/2018 2 1101848084
14 Nor Inayah 7 Sirih Obs Febris Obs Febris √ 10/2/2018 10/3/2018 1 U
15 Nizam Muhammad.K 1 Sirih KDS KDS √ 10/2/2018 10/4/2018 2 U
16 Supriadi 19 Amparaya Gastritis Gastritis √ 10/4/2018 10/6/2018 2 892485459
17 Miftahul Jannah 5 Amparaya KDS KDS √ 10/7/2018 10/8/2018 1 2192765409
18 M.Heri Fadillah 7 Sungai kacil Obs Febris Obs Febris √ 10/5/2018 10/7/2018 2 U
19 Rahmaniah 13 Kapuh Obs Febris Obs Febris √ 10/5/2018 10/7/2018 2 U
 20 M. Ramadhan 35 Sirih Diare Akut Diare Akut √ 10/6/2018 10/8/2018 2 U
21 Badri 65 Kalumpang Gastritis Gastritis √ 10/1/2018 10/3/2018 2 U
22 Milawati 31 Balimau Obs Abd Pain Obs Abd Pain √ 10/1/2018 10/2/2018 1 U
23 Sumalia.W 20 Wasah Hilir Dispepsia Dispepsia √ 10/8/2018 10/10/2018 2 2497493823
24 Fahrul Raji 20 Kapuh Cephalgia Cephalgia √ 10/8/2018 10/10/2018 2 892326159
25 Habibah Nurani 2 Tambingkar Diare Akut Diare Akut √ 10/7/2018 10/9/2018 2 U
26 Masmurah 57 Kalumpang Dispepsia Dispepsia √ 10/5/2018 10/6/2018 1 891893744
27 M. Raihan 1 Asam KDS KDS √ 10/3/2018 10/5/2018 2 U
28 Salmah 46 Simpur TB Paru TB Paru √ 10/12/2018 10/15/2018 3 2496725818
29 Norsiah 50 Amparaya Obs Vomitus Obs Vomitus √ 10/10/2018 10/12/2018 2 2231294567
30 Safrudin 41 Wasah Tengah Obs Hematemesis Mel Obs Hematemesis Mel √ 10/10/2018 10/11/2018 1 2498456485
31 Ramnah 62 Balimau Diare Akut Diare Akut √ 10/16/2018 10/18/2018 2 2369859851
32 Mastura 81 Asam Diare Akut Diare Akut √ 10/23/2018 10/26/2018 3 2501717859
33 Masliana 57 Amparaya Post Mastektomi Ca Mamae Post Mastektomi Ca Mamae √ 10/21/2018 10/26/2018 5 2439801896
34 Isnaniah 18 Paring Agung Anoreksia Anoreksia √ 10/24/2018 10/26/2018 2 U
35 Annisa Rahmawati 21 kapuh Demam Dengue Demam Dengue √ 10/24/2018 10/26/2018 2 U
36 Aisya Fitria 15 Amawang Sinkope+Gastritis Sinkope+Gastritis √ 10/24/2018 10/25/2018 1 U
37 Huzaimah 31 Tebing Tinggi Demam Dengue+Bumil Demam Dengue+Bumil √ 10/24/2018 10/25/2018 1 U
38 Mona datul Hasanah 21 Pantai Ulin Demam Dengue Demam Dengue √ 10/22/2018 10/24/2018 2 892679747

71

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Oktober 2018
39 Zubaidah 65 Kapuh Diare akut Diare Akut √ 10/23/2018 10/25/2018 2 U
40 Zulfa Al Ihda 8 Kapuh Gastritis Gastritis √ 10/24/2018 10/25/2018 1 U
41 M.Yusuf 56 Kapuh Anemia Anemia √ 10/15/2018 10/16/2018 1 891811978
42 Norjanah 26 Asam Gastritis Gastritis √ 10/11/2018 10/14/2018 3 U
43 Asmawati 35 Panj Bahagia Dispepsia Dispepsia √ 10/14/2018 10/16/2018 2 1065607841
44 Jamnah 50 Panj Bahagia HT Emergensi HT Emergensi √ 10/13/2018 10/15/2018 2 1929400738
45 Muhibah 35 Balimau Dispepsia Dispepsia √ 10/12/2018 10/15/2018 3 892435241
46 Samsi Bahrun 55 Wasah Tengah HT Emergensi HT Emergensi √ 10/13/2018 10/14/2018 1 892301308
47 M.Busyairi 26 Panj Bahagia Obs Febris H1 Obs Febris H1 √ 10/13/2018 10/15/2018 2 U
48 M.Irham Hairy 15 Tamiang Obs Febris H2 Obs Febris H2 √ 10/12/2018 10/13/2018 1 1815192393
49 Rahmadani 33 Wasah Hilir Diare akut Diare Akut √ 10/6/2018 10/12/2018 6 U
50 Fikri Ahmad 8 Kalumpang Obs Febris H2 Obs Febris H2 √ 10/7/2018 10/10/2018 3 1925630893
51 Maulida 3 Balimau Diare akut Diare Akut √ 10/9/2018 10/10/2018 1 U
52 M.Rafa Akbar 4 Kalumpang Obs Abd Pain Obs Abd Pain √ 10/18/2018 10/19/2018 1 2369857285
53 Herliyani 19 Wasah Hilir Diare akut Diare Akut √ 10/21/2018 10/23/2018 2 892510244
54 Siti Hafsah 54 Hariti Anoreksia Anoreksia √ 10/27/2018 10/30/2018 3 2503428096
55 Abdurrahman 78 Panj Bahagia Demam Dengue Demam Dengue √ 10/29/2018 10/30/2018 1 1829396628
 56 Samawi 34 Tamiang Obs Febris Obs Febris √ 10/28/2018 10/30/2018 2 892416543
57 M.Fadhil arridha 19 Tebing Tinggi Obs Febris Obs Febris √ 10/29/2018 10/31/2018 2 163991867
58 Jumberiah 56 Baru HT Emergensi HT Emergensi √ 10/27/2018 10/28/2018 1 2266194789
59 Masnun 56 Tebing Tinggi Dispepsia Dispepsia √ 10/13/2018 10/15/2018 2 2466058228
60 M.Zikri Hidayatullah 15 Simpur Obs Febris Obs Febris √ 10/21/2018 10/23/2018 2 1929049176
61 M.Rapiki 43 Wasah Tengah Gastritis Gastritis √ 10/19/2018 10/22/2018 3 2501197762
62 Hj. Hamsah Awal 72 Wasah Hilir Dispepsia Dispepsia √ 10/20/2018 10/23/2018 3 124411612
63 Ramnah 62 Balimau Diare akut Diare Akut √ 10/16/2018 10/18/2018 2 2369859851
64 Nazela Mahmudah 2 Asam Diare akut Diare Akut √ 10/16/2018 10/17/2018 1 U
65 Rina 30 Simpur Diare akut Diare Akut √ 10/20/2018 10/23/2018 3 892364433
66 Syahrani 40 Sirih Hulu ISK ISK √ 10/20/2018 10/22/2018 2 2230598327
67 Udul 58 Karang Bulan Dispepsia Dispepsia √ 10/20/2018 10/22/2018 2 892103815
68 A. Rijani 34 Amparaya Vertigo Vertigo √ 10/19/2018 10/22/2018 3 1929392752
69 M.Yasir 6 Pantai Ulin Typoid Fever Typoid Fever √ 10/26/2018 10/27/2018 1 1929417963
70 Suriansyah 48 Asam Anoreksia Anoreksia √ 10/25/2018 10/29/2018 4 1928686015
71 Ahmad Rizaldi 15 Amparaya Demam Dengue Demam Dengue √ 10/25/2018 10/29/2018 4 1929393112
72 Rusdian Akbar 14 Pantai Ulin Demam Dengue Demam Dengue √ 10/24/2018 10/29/2018 5 2502851668
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148
umur Diagnosa Px Keluar Jlh Hari
No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Nopember 2018
1 Ike Norlinda 14 Panj Bahagia/Hanau Obs Febris Obs Febris √ 10/29/2018 11/1/2018 3 1065607997
2 Ujang 74 Kalumpang Susp Tb Paru Susp Tb Paru √ 11/2/2018 11/3/2018 1 892395562
3 Ardiansyah 36 Bago Tanggul Gastritis Gastritis √ 11/2/2018 11/4/2018 2 2324396294
4 Safatul Uzma 2 Bago Tanggul KDS+Varicella KDS+Varicella √ 11/3/2018 11/4/2018 1 2285088456
5 Ridawati 22 Balimau Dispepsia Dispepsia √ 11/3/2018 11/6/2018 3 1547393477
6 M.Hafi Zain 1 Sirih Diare Akut Diare Akut √ 11/5/2018 11/6/2018 1 U
7 Rusmini 39 Hanau DHF DHF √ 11/5/2018 11/6/2018 1 1065607984
8 Suryani 38 Pantai Hambawang Dispepsia Dispepsia √ 11/5/2018 11/6/2018 1 U
9 Fahrul Razi 29 Kalumpang Gastritis Gastritis √ 11/5/2018 11/6/2018 1 U
10 Mutmainah 58 Balimau DM Type 2 DM Type 2 √ 11/4/2018 11/6/2018 2 2611529109
11 Syahrudinoor 26 Kapuh Susp Tb Paru Susp Tb Paru √ 10/31/2018 11/1/2018 1 892381915
12 Ratna 26 Panj Bahagia/Hanau Obs Febris Obs Febris √ 11/1/2018 11/3/2018 2 1929400481
13 Malikatus Solehan 10 Panj Bahagia/Hanau Obs Febris Obs Febris √ 11/1/2018 11/3/2018 2 892117642
14 Napsiah 39 Panj Bahagia/Hanau Obs Febris Obs Febris √ 11/1/2018 11/3/2018 2 892115785
15 Zahira Maulida 7 Ulin Obs Febris Obs Febris √ 10/30/2018 11/2/2018 3 891712001
 16 Ayu Salfina 17 Hariti Gastritis Gastritis √ 11/1/2018 11/3/2018 2 1442465256
17 Abdurrahman 51 Asam Tamiang DHF DHF √ 11/2/2018 11/3/2018 1 U
18 M.Wildan 9 Wasah Tengah Obs Febris Obs Febris √ 10/29/2018 11/1/2018 3 2194499878
19 M.Ihsan 7 Pantai Ulin Obs Febris Obs Febris √ 11/2/2018 11/4/2018 2 U
20 Linda E.S 17 Ulin Obs Febris Obs Febris √ 11/3/2018 11/5/2018 2 891643961
21 Salamat 75 Batang Kulur Anoreksia Anoreksia √ 10/30/2018 11/2/2018 3 1844674773
22 Nurhafizah 16 Tamiang Obs Febris Obs Febris √ 11/5/2018 11/8/2018 3 892593639
23 Ekry Prayetno 29 Simpur Parotitis Parotitis √ 11/4/2018 11/8/2018 4 1632231382
24 Muhammad Danil 4 Wasah Tengah DHF DHF √ 11/7/2018 11/8/2018 1 1929389927
25 Herlina 26 Kapuh Abdominal Pain Abdominal Pain √ 11/7/2018 11/8/2018 1 U
26 Khairunnisa 17 Wasah Tengah DHF DHF √ 11/7/2018 11/8/2018 1 U
27 Siti Halidah 31 Kapuh DHF DHF √ 11/7/2018 11/8/2018 1 891900665
28 Susiyanti 25 Padang Batung Anoreksia Anoreksia √ 11/7/2018 11/9/2018 2 2242825492
29 Maskanah 45 Garunggang Dispepsia Dispepsia √ 11/15/2018 11/17/2018 2 2000474166
30 Murdiah 60 Amparaya CKR CKR √ 11/14/2018 11/16/2018 2 1929392943
31 Wahdiah 46 Tebing Tinggi Obs Febris Obs Febris √ 11/13/2018 11/15/2018 2 891849622
32 Sarbaini 35 Wasah Tengah DHF DHF √ 11/13/2018 11/16/2018 3 892299069
33 Zainudin 60 Tebing Tinggi CHF CHF √ 11/16/2018 11/17/2018 1
34 Fahruraji 33 asam Obs Abdominal Pain Obs Abdominal Pain √ 11/15/2018 11/16/2018 1 2480237302
35 Dessy Mayasari 6 Simpur Obs Febris Obs Febris √ 11/14/2018 11/15/2018 1 U
36 Zaini 59 Balimau DHF DHF √ 11/10/2018 11/15/2018 5 2611528705
37 M.Ihsanurrahman 13 Garunggang DHF DHF √ 11/11/2018 11/15/2018 4 2489469287
38 Fikri Ahmad 10 Sirih Obs Febris Obs Febris √ 11/13/2018 11/15/2018 2 1925630897

72

umur Diagnosa Px Keluar Jlh Hari

No Nama Alamat Tgl Masuk Tgl Keluar Prtwn Ket Jaminan Nomor Kartu
L P Awal Akhir BLPL Rujuk APS Meninggal
Bulan : Nopember 2018
39 Marzuki 15 Amparaya DHF DHF √ 11/14/2018 11/18/2018 4 2614196597
40 M.Rusni 74 Asam Diare Akut Diare Akut √ 11/13/2018 11/15/2018 2 1928685835
41 Mariam 59 Sirih Hulu Melena+Keto diabet Melena+Keto diabet √ 11/12/2018 11/13/2018 1 2300739355
42 Riduan 36 Simpur Tonsilitis+Faringitis Tonsilitis+Faringitis √ 11/14/2018 11/16/2018 2 2206598984
43 Rusiana 15 Simpur Obs Febris Obs Febris √ 11/12/2018 11/13/2018 1 U
44 Jumayah 55 Amparaya Susp TB Paru Susp TB Paru √ 11/12/2018 11/13/2018 1 U
45 M.Alfianor 20 Simpur Obs Febris Obs Febris √ 11/8/2018 11/11/2018 2 892427095
46 Juriah 38 Panj Bahagia Diare Akut Diare Akut √ 11/10/2018 11/12/2018 2 1929400427
47 A.fadilah 17 Balanti Post KLL Post KLL √ 11/17/2018 11/18/2018 1 U
48 Rusmiati 49 Balimau Susp TB Paru Susp TB Paru √ 11/15/2018 11/17/2018 2 891900134
49 M.Khairiza hafif 12 Ulin Obs Febris Obs Febris √ 11/9/2018 11/12/2018 3 124316965
50 Rezka Nor Elma 11 Karang paci Obs Febris Obs Febris √ 11/8/2018 11/12/2018 4 892122592
51 Hadijah 16 Amparaya Obs Febris Obs Febris √ 11/9/2018 11/12/2018 3 892218609
52 M.Syaiful Anwar 19 Bumi Berkat Dispepsia Dispepsia √ 11/9/2018 11/12/2018 3 2324789414
53 Nurfadliah 23 Tamiang Post KLL Post KLL √ 10/31/2018 11/1/2018 1 U
54 Muhammad 55 Tebing Tinggi Diare Akut Diare Akut √ 11/17/2018 11/19/2018 2 124448898
55 M.Syauqi Azhar 2 Sirih Diare Akut Diare Akut √ 11/6/2018 11/10/2018 4 2272827519
56 Auliah 44 Panj Bahagia Diare Akut Diare Akut √ 11/9/2018 11/11/2018 2 1929398196
57 Muhammad Izza A 15 Simpur Obs Febris Obs Febris √ 11/17/2018 11/19/2018 2 2217456933
58 Miniriani 27 Ulin Obs Febris Obs Febris √ 11/18/2018 11/19/2018 1 891687677
59 Raihanatil Janah 14 Tamiang Gastritis Gastritis √ 11/17/2018 11/19/2018 2 892384288
60 Tina Nawarti 26 Bayur Dispepsia Dispepsia √ 11/18/2018 11/19/2018 1 1929401403
61 Novi Kasmiati 15 Simpur DHF DHF √ 11/19/2018 11/21/2018 2 892406406
62 Busyra 29 Panj Bahagia Obs Abd Pain Obs Abd Pain √ 11/19/2018 11/21/2018 2 1929397612
63
64
65
66
67
68
69
70
71
72
73
74
75
76

46
Rp1,980,000
3,780,000
Februari
Badar 67 3/3/2018 Kapuh AbdominalAbdominal Pain √ 3/8/2018 5 KIS(PBI) 8.92E+08
M.Rani 60 3/3/2018 Simpur Artritis GOArtritis GO √ 3/6/2018 3 KIS(PBI) 2.22E+09
Abdul Gani 84 ### Sirih AbdominalAbdominal √ ### 2 KIS(non PBI) 1.58E+08
Dahlia 49 3/2/2018 Sarang HalGastritis e Gastritis e √ 3/8/2018 6 U
Norsiah 70 3/9/2018 Panj BahagGastritis Gastritis √ ### 1 KIS(PBI) 2.44E+09
Ahmaduddin N 58 ### Wasah HiliAbdominalAbdominal Pain √ ### 2 Askes 1.24E+08
Noor asyikin 54 ### Wasah HulGastritis Gastritis √ ### 1 Askes 1.24E+08
Saladeri 65 ### Baru Artritis GOArtritis GO √ ### 2 Askes 1.24E+08
Rusdi 71 ### Wasah TenHipertensi Hipertensi √ ### 2 KIS(PBI) 8.93E+08
Maslina 30 ### Ambutun Gastritis Gastritis √ ### 2 KIS(PBI) 2.03E+09
Kiki Amalia 1 th ### Asam Obs Febris Obs Febris √ ### 2 U
Saladeri 65 ### Baru Artritis GOArtritis GO √ ### 3 Askes 1.24E+08
M.Rizqun 7 ### Tamiang Obs Febris Obs Febris √ ### 2 KIS(PBI) 8.93E+08
Arifin 11 ### Simpur Obs Febris Obs Febris √ ### 3 KIS(PBI) 8.93E+08
H.Ajam 68 ### Amparaya Obs Abdomin Obs Abdominal regio F √ ### 3 KIS(non PBI) 2.43E+09
Murhaniah 40 ### Panj BahagObs Febris Obs Febris √ ### 2 U
Hairin Nahwan 49 ### Simpur SNH SNH √ ### 2 U
Naufal Al Zufri 18 ### Pantai Ha Diare AkutDiare Akut √ ### 2 U
Ahmad Khuzai 9 ### Wasah HulAsma BrokhAsma Brokh √ ### 2 KIS(PBI) 2.31E+09
Saladeri 65 ### Baru Artritis GOArtritis GOUT √ ### 1 Askes 1.24E+08

April

Rp3,060,000
4,050,000
 Rusmani PBI/APBD
Syaiful Rahman PBI/APBN
Hasnah Afsari BPJS Non Aktif
Diansyah
Ardiansyah
St. Raudatul Madinah
M.Salamudin PBI/APBN
Suriansyah
Tuhfah
Ummi Hani Jampersal
Sadariah BPJS/Mandiri
Helda Elfina
Harmah
M.Hery Fadillah
Supriyanto
Salwatin Nazwa BPJS/Mandiri
Raihanah BPJS/Mandiri
Salhah
Siti Salmiyah PBI/APBN
Fikri Ahmad
Helda Elfina
Helda Inayah
Raihanah
Arianto PBI/APBD
Nor Afifa Naila
Rusdian

dr.Puja ASKES

BPJS Non Aktif

Rp4,095,000
5,130,000

U
PBI/APBN
BPJS Mandiri
U
U
U
U
PBI/APBN
U
U
U
U
U
BPJS Mandiri
PBI/APBN
U
BPJS Mandiri
BPJS Mandiri
U
PBI/APBN
PBI/APBD
PBI/APBD
PBI/APBN
U
BPJS Mandiri
PBI/APBN
PBI/APBD
BPJS Mandiri
ASKES
BPJS Mandiri
U
ASKES
PBI/APBD
 PBI/APBN

Rp3,555,000
4,590,000

BPJS Mandiri
BPJS Mandiri
PBI/APBN
PBI/APBN
U
ASKES/TNI
PBI/APBN
PBI/APBN
Askes/PNSD
U
PBI/APBD
Pensiunan
PBI/APBN
PBI/APBD
U
PBI/APBD
U
BPJS Mandiri
U
PBI/APBN
ASKES/PNS Pusat
U
U
U
U
PBI/APBN
BPJS Mandiri
BPJS Mandiri tidak Aktif
PBI/APBN
PBI/APBN
 Rp2,610,000
4,455,000

Non aktif BPJS

Rp3,825,000
4,455,000
22,905,000 Rp3,780,000
26,910,000 4005000
6660000
0
0
 PEMERINTAH KABUPATEN HULU SUNGAI SELATAN
DINAS KESEHATAN
UPTD PUSKESMAS SIMPUR
Jalan : Pamujaan Desa Simpur Kec. Simpur – 71261
Email : pkm.simpurhss@gmail.com
Nama : JK : L / P No MR :

Umur : Ruang Rawat Inap : Pria / Wanita Status :

Tanggal/Jam Intervensi/Rencana Tindakan Keperawatan Implementasi/Tindakan Keperawatan Paraf Petugas
 PEMERINTAH KABUPATEN HULU SUNGAI SELATAN
DINAS KESEHATAN
UPTD PUSKESMAS SIMPUR
Jalan : Pamujaan Desa Simpur Kec. Simpur – 71261
Email : pkm.simpurhss@gmail.com
Nama : JK : L / P No MR :

Umur : Ruang Rawat Inap : Pria / Wanita Status kepesertaan :

Tanggal/Jam Intervensi/Rencana Tindakan Keperawatan Implementasi/Tindakan Keperawatan Paraf Petugas
 LEMBAR OBSERVASI PASIEN
Hasil
Tanggal Jam
TD T R N

LEMBAR OBSERVASI PASIEN

Hasil
Tanggal Jam
TD T R N
 umur Diagnosa Px Keluar
No Nama Alamat
L P Awal Akhir BLPL Rujuk APS
Bulan : Oktober 2018
1 M. Nizham 3 Sirih Diare Akut Diare Akut √
2 Ishak 33 Kalumpang Dispepsia Dispepsia √
3 Nor Inayah 7 Sirih Obs Febris Obs Febris √
4 Nizam Muhammad.K 1 Sirih KDS KDS √
5 M. Ramadhan 35 Sirih Diare Akut Diare Akut √
6 Badri 65 Kalumpang Gastritis Gastritis √
7 Milawati 31 Balimau Obs Abd Pain Obs Abd Pain √
8 Habibah Nurani 2 Tambingkar Diare Akut Diare Akut √
9 Masmurah 57 Kalumpang Dispepsia Dispepsia √
10 Ramnah 62 Balimau Diare Akut Diare Akut √
11 Muhibah 35 Balimau Dispepsia Dispepsia √
12 Fikri Ahmad 8 Kalumpang Obs Febris H2 Obs Febris H2 √
13 Maulida 3 Balimau Diare akut Diare Akut √
14 M.Rafa Akbar 4 Kalumpang Obs Abd Pain Obs Abd Pain √
15 Ramnah 62 Balimau Diare akut Diare Akut √
16 Syahrani 40 Sirih Hulu ISK ISK √
17 Udul 58 Karang Bulan Dispepsia Dispepsia √

umur Diagnosa Px Keluar

No Nama Alamat
L P Awal Akhir BLPL Rujuk APS
Bulan : Nopember 2018
1 Ujang 74 Kalumpang Susp Tb Paru Susp Tb Paru √
2 Ardiansyah 36 Bago Tanggul Gastritis Gastritis √
3 Safatul Uzma 2 Bago Tanggul KDS+Varicella KDS+Varicella √
4 Ridawati 22 Balimau Dispepsia Dispepsia √
5 M.Hafi Zain 1 Sirih Diare Akut Diare Akut √
6 Rusmini 39 Hanau DHF DHF √
7
8
9
10
11
12
13
14
15
16
x Keluar Ket
Jlh Hari
Mening Tgl Masuk Tgl Keluar Prtwn Jamina Nomor Kartu
gal n

9/30/2018 10/1/2018 1 U
10/2/2018 10/3/2018 1 U
10/2/2018 10/3/2018 1 U
10/2/2018 10/4/2018 2 U
10/6/2018 10/8/2018 2 U
10/1/2018 10/3/2018 2 U
10/1/2018 10/2/2018 1 U
10/7/2018 10/9/2018 2 U
10/5/2018 10/6/2018 1 891893744
10/16/2018 10/18/2018 2 2369859851
10/12/2018 10/15/2018 3 892435241
10/7/2018 10/10/2018 3 1925630893
10/9/2018 10/10/2018 1
10/18/2018 10/19/2018 1 2369857285
10/16/2018 10/18/2018 2 2369859851
10/20/2018 10/22/2018 2 2230598327
10/20/2018 10/22/2018 2 892103815

x Keluar Ket
Jlh Hari
Mening Tgl Masuk Tgl Keluar Prtwn Jamina Nomor Kartu
gal n

11/2/2018 11/3/2018 1 892395562

11/2/2018 11/4/2018 2 2324396294
11/3/2018 11/4/2018 1 2285088456
11/3/2018 11/6/2018 3 1547393477
11/5/2018 11/6/2018 1 U
11/5/2018 11/6/2018 1 1065607984