LAPORAN PELAYANAN RAWAT JALA

BULAN JUN
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3003 ABRAR NAUFAL MUFLIH 1 K30, R11 1

2 3002 AHMAD HILMAN AFANDI 1 K30 1
3 3001 DES AMSIR HAMID 1 K21, A09 1
4 3005 SUDARWITO 1 B35.4 1
5 3007 WAGIRIN 1 Z00 1
6 3006 SUDIYATI 1 H10 1
7 3008 LUTFI 1 J02 1
8 3010 NUR HIDAYAH ( GA1034.21 ) 1 Z00 1
9 3009 SULIYATI 1 I10 1
10 3004 ANA FATMAYANI 1 L50 1
11 3013 I NYOMAN SUIDA 1 J06 1
12 3012 ENDANG SURYAWATI 1 I10 1
13 3011 EKO SUHARIANIK 1 I10 1
14 3017 DIDIK TAMTOMO HARI 1 a09 1
15 3016 ILHAM AKBAR D 1 L20 1
16 3015 HINDA SRI UTATI 1 J06 1
17 3014 MOH KHOLIDI, ST 1 G44 1
18 3019 ASTUTI HANDAYANI 1 I10 1
19 3020 SHAFIRA AYU N 1 J06,8,K30 1
20 3026 ENDANG TRI BUDIASTUTI 1 I10,I84 1
21 3022 SUWARNO RAWAN 1 J06,8,K30 1
22 3023 YUNDIATI MASFUFAH 1 R42 1
23 3021 REGINA ASTRI 1 R50,K30 1
24 3027 KHANSA CENDRA BUNGA 1 K29 1
25 3033 HARLAMBANG WAHYU 1 L20 1
26 3032 ARJUNA ALFATIH 1 H10 1
27 3031 INTAN FAHDIANA 1 R10,K29 1
28 3030 ATHAZAKY GHANI 1 J06,8,K30 1
29 3028 ADHITYA GHALY 1 J06,8,K30 1
30 3036 M ARFA ARIF 1 L50 1
31 3035 PANDU PAKARTI 1 M77,5 1
32 3034 SUWARNO 1 J02,9 1
33 3037 M ZAKKY PRASETYO 1 L08,0 1
34 3039 DAHLIA MAGDALENA 1 I10 1
35 3040 NEMANZA ADITYA NUGRAHA 1 J06,R50 1
36 3043 AJENG RETNANING P 1 M51 1
37 3046 1 J06 1
38 3049 MUHAMMAD RIZKY H 1 R11 1
39 3048 INDRIANI DWI A 1 J30 1
40 3041 ANDRI PRANATA 1 M79.1 1
41 3042 DITA DINI SARI 1 J06 1
42 3050 1 N39 1
43 3055 1 j06,J02 1
44 3054 LUTHFI UTAMA PUTRA 1 J06,R63.8 1
45 3053 AULIA FATIMAH 1 J06,H10 1
46 3052 SAADAH 1 K30 1
47 3051 GUNTUR ISWANDI 1 K30 1
48 3061 MUTMAINAH 1 H72.8 1
49 3060 KUSAENI 1 I10 1
50 3070 NAURUN NISA 1 J06 1
51 3069 HENDRA HARIYADI 1 R50,J06 1
52 3071 MUHAMMAD ARSYAD 1 T14 1
53 3068 MALIKHA AZALEA SAKHI 1 R11,A09 1
54 3064 YAYUK SUHARMINI 1 M54.5 1
55 3063 SUMIYATI 1 J02,K30 1
56 3062 FITRIA SARI 1 R50,K30 1
57 3058 MUH HAFIZ A 1 R50 1
58 3059 ARSYFA CHALIE M 1 R50 1
59 3073 ABDUL HONI 1 K30,R42 1
60 3082 EMAWATI 1 K30 1
61 3081 IDA ARIYANTI 1 K30,A09 1
62 3080 AISYAH NABILAH 1 A09,R11 1
63 3079 ERINDRA MALIQU' L 1 J06 1
64 3078 ERINDRA JANITRA ADAM 1 J06 1
65 3087 SYAKILA ADIVA 1 R11,R50 1
66 3084 MOCH AL FATHIR K 1 J06 1
67 3076 KARNOWATI 1 E78,I10 1
68 3077 PRIYANTO 1 E78,E79 1
69 3074 ISMONO 1 J06 1
70 3075 NENY SUSANTI 1 H60 1
71 3058 MUHAMMAD HAFIZH ADKAZY M 1 R50 1
72 3072 DEFA OKTAVIANI PUTRI 1 J00.J06 1
73 3085 DESI NILA 1 G44 1
74 3086 RIZKY KUSUMAWATI 1 J06 1
75 3088 SUPRAYOGI 1 I11 1
76 3089 ALFIAN T 1 J06,M79.1 1
77 3094 MUKAROMAH 1 T14 1
78 3091 EDSEL HAIDAR AURELLIO 1 J06 1
79 3090 EVELYN HAZZA AURELLIA 1 J06 1
80 3092 ARSYILA NAZIFA F 1 J06 1
81 3093 FARZA ASHFI MAULIDA 1 K30 1
82 3095 DIKA PRASETYO 1 R50,G44 1
83 3096 SIADI PRAYITNO 1 T14 1
84 3097 KHUSNUL KHOTIMAH 1 M54.5 1
85 3102 WARYANTI 1 J06 1
86 3100 SARIMAN 1 N39 1
87 3099 AERILYN BELVANIA 1 H10 1
88 3098 PRICCI PURNOMO 1 K30 1
89 3103 DZAKY SHAHID ZIDANE 1 J02 1
90 3047 RENDRA YANUARSAH 1 H10 1
91 3101 REUBEN ARSHAKA PRAM 1 T16 1
92 3104 AQILA ALYA RACHMA 1 K30 J06 1
93 92
94
95 92 0 0 0 92 0
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
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RUJUK J P K P G M P T W I
K 3 S C SURI
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B.PR PLAV D P M M G TANI
K K G A L L H
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0 6 0 3 13 0 32 0 0 0 0 0 21 3 0 1 4 0 2 0 1 1

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PER ADMED
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RL 6/3/2022

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1 GOLD COIN IND

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 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3003 DAMAYANTI 1 R11 1

2 3006 DEWI ASIYAH 1 M79.1 1
3 3005 ACH DWI FAKHRUDIN 1 K30 A09 1
4 3004 NUR LAILI 1 J02 1
5 3106 MUHAMMAD DENNY 1 M79.1 1
6 3014 ABDUL ROZAQ 1 N40 1 URO
7 3013 ANDRE PRATAMA 1 J06 1
3010/3
8 1 I10 1
011 NUZULLISTIATI
9 3007 MUHAMMAD ASRAF 1 K30 A09 1
10 3018 ZULKIFLI 1 E11,7 1 DALAM
11 3016 BAMBANG HERU 1 E88 1 DALAM
12 3017 RAHMA HIDAYATI 1 E88 1 DALAM
13 3060 ANA FATMAYANI 1 H52.5 1 MATA
14 3038 SUHARTIK 1 E11.8 1 DALAM
15 3039 SRI SUMARYANI 1 M19 1 ORTHO
16 3031 SUDJONO 1 N40 1 URO
17 3043 KHIRUL ANAM 1 H52.5 1 MATA
18 3029 AISYAH NURURROHMAH 1 A09 1
3025/3
19 1 G44 1
027 SURYANI
20 3057 RISBIAN TOHA 1 E11 1
21 3062 DIMAS ARGO P 1 R73 1 DALAM
22 3040 ANIFAH WIJAYANTI 1 A09 1
23 3075 PRITA PUTRI ADITYA 1 J45 1
30254/
24 1 J06 1
3026 SHOFI RAHMADANI
3019/3
25 1 J06 1
021 RAKHMAT WAHYU SAPUTRA
26 3020 NUR CHUDAIFAH 1 Z00 1
27 3078 SITI NUR SYAMSIYAH 1 E03.9 1 DALAM
28 3082 SUWANTOYO 1 H52.5 1 MATA
29 3137 CHUSNUL MUFIDAH 1 E11.7 1 DALAM
30 3132 YULIS NUR AINI 1 K27 1 DALAM
31 3140 NUR LAILAH HIDAYATI 1 D21.6 1 BEDAH
 LUTHFI MUHAMMADNUR
32 3138 1 M54.5 1 SARAF
AL-HARIS K.R.L
33 3124 MOH KHUSDIANTO 1 M17 1 ORTHO
34 3098 RA. SRI LESTARI 1 R02 1 BEDAH
35 3090 SITI AISYAH 1 T14 1
36 3111 ALFA MAROH 1 I25 1 JP
37 3107 SRI WIJI LESTARI 1 B18.0 1 DALAM
38 3100 ROFAATUL UMMAH 1 F32 1 JIWA
39 3116 LISNAWATI 1 I10 1
40 3067 JUWARIYAH 1 A09, K30 1
41 3063 EVANGELINE EFRATA NGRLO 1 A09, K30 1
42 3149 BEBY CELIA AZURA 1 H16 1 MATA
43 3071 1 J06 1
WAHYU AGUNG SETIAWAN
44 3173 EDY RIYANTO 1 A20.2 1
45 3143 NURUL HIDAYAH 1 E11 1
46 3142 M ZAINI 1 E11 1
47 3115 ROCHIMAH 1 A15.3 1
M. THARIQ AKHTAR
48 3058 1 J06 1
GHAISAN
49 3056 SITI JAMILAH 1 K29 1
50 3052 SHANINA GHARA JUNAEDI 1 J06 1
51 3051 FANANI LESTARI 1 H65 1
52 3097 SUKARNO 1 M17 1 ORTHO
53 3085 ISSUSILANINGTYAS 1 I25.9 1 JP
MUHAMMAD MUCHLAS
54 3046 1 l23 1
DWIWAHYU
BAMBANG TRIYONO
55 3042 1 A09 1
RAHARJO
MAQDALENA MOCHAMAD
56 3037 1 J06 1
NOOR
57 3032 FERRO FIRMANSYAH 1 K30 1
58 3047 DEWI SULISTIOWATI 1 J06 1
59 3130 FREDY HADI SAPUTRA 1 R50 1
60 3126 SUCIK HARINI 1 J06 1
61 3125 AULIA PUTRI H 1 J06 1
MUHAMMAD NOVAL PUTRA
62 3123 1 J06 1
HARTONO
AISYAH GRISSEE
63 3099 1 H10 1
CANDRAKIRANA
64 3104 1 H10 1
ALINEA DEEMA PRANEDYA
65 3174 ika haninggar silvia 1 J02 1
AL GHAZALI TSAQIEB
66 3069 1 J06 1
ABDULLAH
MUHAMAD HANIF
67 3065 1 J06 1
FIRMANSYAH
68 3141 FEANDRA LETISHA P 1 L50 1
69 3120 FILZAH NAILAL HUSNA 1 J06.9 1
70 3106 SHABRINA AULIA 1 L30 1
71 3109 ZIYA IBRIZAH 1 Z00 1
72 3103 KHOLISAH HANIFAH AZKADINA
1 J06.9
1
73 3095 ALIZA FARA DINA 1 J02 1
74 3092 VIVIN CHRISTANTI 1 J06.9 1
75 3154 PUJI ASTUTIK 1 H81.8 1 SARAF
76 3050 TASMIRAH 1 K21.9 1
77 3083 SJAIFUL CHAQ 1 H25 1
78 3048 INTAN MAGHFIROH 1 R11 1
79 3049 1 T14 1
RISTA ANGGRAENI SANNANU
80 3087 NUR FARIKHA 1 J02 1
FARIDATUN FATHONAH
81 3015 ( 454903 )
1 1 K30 1
82 3182 SUSILONINGSIH 1 I25 1 JP
83 3181 M CHAFIT 1 K22.2 1 BEDAH
84 3209 ALFIYAH 1 K29.9 1 DALAM
3171/3
85 1 I25.9 1 JP
172 SLAMET WIDODO
86 3201 YULIANA 1 I25 1 JP
87 3202 MUHAMMAD DJUFRI. BE 1 A09 1
ANA VEBRI RAHMADINI
88 3179 1 K21 1
NENGTYAS
89 3173 ARJUNA KENZIE AZRAQI 1 J06 1
90 3164 SRI WAHYUNI AGUSTIN. 1 H10 1
91 3155 1 J06 1
SENA ARUNDAYA REANDRA
92 3041 THAARUF CHOIRUDDIN 1 A01.0 1
93 3135 SHOFIYAH 1 K30 1
94 3134 M ROFIK 1 A09 1
HAUZAN SAFIG ABIYYAH AL
95 3133 QODIR
1 H10 1
96 3131 sayu ketut sarini 1 K30 1
97 3153 ARIS DWIATMANTO 1 R50.9 1
98 3217 Cinta Naura Hasna Kamilah 1 S13 1 SARAF
99 3216 SISMIATI 1 I25 1 JP
RIZKY ROMADHONA
100 3215 1 H52.5 1 MATA
AISYAH SYAFIDAH
muhammad rafardhan azka
101 3211 1 F80 1 ANAK
pratama
102 3220 SIFA' FAUZIAH 1 J06 1
103 3008 NABILA MALIK 1 M10 1
104 3218 ERIC AFDILLAH 1 J06 1
MUHAMMAD FURQON AL
105 3214 1 J06 1
FARISI
 MUHAMMAD FURQON AL
106 3213 1 A01.0 1
FARISI
107 3212 1 J06 1
ARSY SHAKAYLA AZZAHRA
108 3206 MUHAMMAD ALI MACHFUD 1 R50.9 1
109 3086 NURYATMINI 1 E78.1 1
110 3198 ngarsi 1 M10 1
111 3197 SHEZA EMIERA ASSYRAZI 1 J06 1
112 3196 MAYDITA INDAH WULAN 1 L23 1
SHUFYI MAKRIFATUL
113 3193 1 J02 1
SUKMA
MUHAMMAD KASYIFUL
114 3189 1 J06 1
QOLBY
115 3072 Nur Kholilah 1 J06 1
116 3192 LESTARI AYU WINATA 1 J02
117 3191 ISRO'ATIN MUAMILAH 1 H10,3
118 3190 SUNOTO 1 L20
119 3188 YULIAH 1 M79,1
120 3079 SRI MULYATI 1 E11
121 3187 SYAIFULLOH 1 T14
122 3184 MUHAMMAD HAFIDZ ARDIANSYAH 1 R50
123 3183 SUJUD 1 M79,1
124 3169 RAKIMIN 1 E78.1
125 3219 ALWI ZUBAIR 1 F80 1 ANAK
3221/3
126 1 I10,E11 1
250 SUKRISWATI
127 3102 EMAWATI 1 M79,1
128 3168 MOCH SATRIO MAULUDY 1 H10,3
129 3167 UMAMAH 1 E11
130 3166 MUDJIHARTO 1 M19,9
3161/3
131 1 M79,1 1
162 rochayati
3160/3
132 1 I10 1
163 ARABI GIMANTORO
133 3152 1 I10
MURA HARTI BINTI ABDUL
KIMBERLY AISYAH ZARINA
134 3251 1 F80 1 ANAK
MOHTAR
135 3249 MUHAMMAD AHSAN ALFARID
1 R50
136 3245 SITI MIFTAHUL FEBRIANI 1 J01.9 1 THT
137 3249 MUHAMMAD AHSAN ALFARID
1 R50 1
138 3247 M ALIF FIRMANSYAH 1 J06.9 1
139 3210 SRI HARTATIK (GA1030.71) 1 J06.9 1
140 3208 KEN FERNALDI ZAIDAN 1 R05 1
141 3207 ERNAWATI 1 H10.3 1
142 3205 KAYANAH 1 T16 1
143 3151 SISWO PAMUDJI BIN SOEJOTO
1 M79.1 1
144 3150 ALIF 1 J02 1
145 3033 KEISHA ZAHRA APB 1 A09 1
146 3246 RIKA FITRIA 1 J06 1
FARHANAH SYAMILAH
147 3234 1 A09 1
RAHMA
148 3226 AURIGA MINTAKA ADAM 1 R50 1
149 3176 MIRA FRIDA SAVINA 1 K30 1
MUHAMMAD HARISUDDIN
150 3177 JAMILY
1 K21 1
JASMINE MUMTAZAH
151 3244 HUMAIRA
1 B35.4 1
152 3231 SYARIFUDDIN 1 I10 1
153 3174 ARALYN RAISYA FEBVIANA 1 R50.9 1
NINIK EKO NURHAYATI
154 3224 (GA1017.71)
1 E11 1
155 3227 SURIPNO SUBALI 1 I25 1
MUHAMMAD FATHIR
156 3178 1 R50 1
AZZAMY
HERJUNO RAFANDRIA
157 3235 RAFFASYA GUSTINENDA
1 J06 1
AFTA ALTHAFFARO
158 3236 GUSTINENDA
1 J06 1
159 3264 NURBAYANI SIREGAR 1 M75.0 1 DALAM
160 3257 NUR AZIZAH 1 D26 1 OBGYN
161 3258 NUR KHUZAIMAH 1 E11.7 1 DALAM
MUNADJID SUWANTO
162 3263 (GA1024.50)
1 I10 1
163 3262 AUZAN ARIF FADHLI 1 T14 1
164 3259 AHMAD SYAFII 1 I63 1 SARAF
165 3195 FARZA ASHFI MAULIDA 1 K59.0 1
MACHSHUSHIYAH
166 3261 1 H52.5 1 MATA
MUMTAZAH
167 3255 MULYONO 1 I25 1 JP
1683233/3243 DJUWARI 1 R73 1
1693232/3242 ARIFIN 1 G44 1
1703230/3241 SRI SUPRIJATI (GA0756.81) 1 R73 1
1713229/3240WALUYO 1 G44 1
1723228/3239MAS'UD 1 J06 1
1733223/3238 MUDJIANTO 1 I84 1
1743222/3237SUDJITO 1 E78.2 1
175 3265 ABDUL JALAL 1 A09 1
MUHAMMAD MIRZA EZIO
176 3256 1 H10 1
AHZA IHSAN
MUHAMMAD RASYID
177 3253 1 A09 1
Ramadhan
1783266/3267 MUHAMMAD HAMKA 1 H04 1
179 3148 AZZAHRA DEWI AYUNINGRA 1 R05 1
180 3282 SHAFA AZZAHRA 1 K30 1
181 3290 ADI PUSPITO 1 H52.5 1 MATA
182 3292 MUSYAROFAH 1 I10 1
183 3269 AZHAR 1 I25 1 JP
184 3294 RAMINING 1 I10 1
185 3288 NUR YONO 1 M79.1 1
186 3287 SHANAZ SHAINA 1 J06 1
187 3293 RESA YUANITA 1 R10 1
188 3289 NUURL KRISDIYANTO 1 J06, G44.2 1
189 3199 MEGA RAHAYU 1 J06 1
TABITHA MELKIALIMA
190 3276 1 R05 1
TAMBUNAN
191 3277 PALUPI IDA 1 E11 1
192 3299 1 J06 1
FAKHRIE ZHAFRAN KHOIRI
193 3284 M.HAFIZH ADZAKY 1 L081 1
194 3272 RIA KRISTANTI 1 K27 1
195 3271 IFAN BAGUS ADI 1 K27 1
196 3307 JEFRI ARI SAPUTRO 1 J02 1
197 3302 ARIS SUNANDAR 1 R42 1
198 3296 AYUB ARDIANSYAH 1 A09 1
199 3304 PUJIANA 1 Z00 1
200 3301 ANIS FARIDA 1 E11, I10 1
2013309/3310 siti zulicha 1 H52.5 `1 MATA
202 3313 HARI KRISNANTO 1 I25 1 JP
203 3185 SAMSUL HADI 1 L20 1
MUHAMMAD ZIDAN RAKA
204 3314 1 J02 1
ARDIANSYAH
205 3254 SITI NURJANAH 1 E79 1
ALESHA SHANUM NUR
206 3312 1 R50 1
SUHADAK
207 3311 NURUL MAGFUROH 1 R42 1
208 3306 MITA DWI LESTARI 1 J02, K30 1
209 3316 ABDUL KHOLIM 1 J02 1
210 3320 AZKIYAH FATIMAH 1 L30 1
211 3326 ADISTI SUKMA RENJANA 1 R11 1
212 3325 WILBERT WONG 1 G40 1 ANAK
213 3339 HARIYANTO 1 A15, J44 1 PARU
214 338 ASPIAH 1 K25 1 DALAM
215 3343 HAMIDAH 1 G54.2 1 SARAF
216 3300 DES AMSIR 1 1 I25, K29 1
2173351/3365HAMIDAH 1 E10 1 DALAM
218 3354 ALI MASHUR 1 K29 1
219 3353 MUNAWARO 1 H10 1
220 3337 1 J06 1
VANZA OKTALISA HARIYADI
221 3336 ANY DANIATI 1 J02 1
222 3297 ARDHI IRAWAN 1 T14 1
223 3344 SAFAROTUL INDARI 1 H10 1
224 3340 SINI 1 M54.5 1
225 3341 Fahmi Ilmiyati 1 K30 1
ANNI RUFAYDAH IZZATUL
226 3335 1 J02 1
MUFIDAH
227 3329 SARONI 1 J02 1
228 3328 1 R50 1
GIBRAN AQSA CHOIRUDDIN
229 3327 1 J06 1
GURUH PRASETYA PUTRA
230 3324 AIYRA FARZANA SHEZA 1 J02 1
231 3323 ANDI HERAWANTO 1 J02 1
232 3322 BUNGA SALSABILA 1 A09 1
233 3321 VANESA RIVAYA 1 J02 1
234 3319 YASMINE SAFA AULIA 1 J06 1
235 3318 ANNETTE WULANSARI 1 K29 1
236 3317 ZULAIKHA ARSYLIA 1 R11 1
237 3295 SYAKILA ADIVA 1 A09 1
238 3315 YOFITA WAHYU 1 K35 1
2393359/3361ENDAH RAHAYU 1 I10 1
2403345/3346ALI FARMADI 1 J02 1
241 3342 FARHAN FUADI 1 R50 1
242 3348 MARIJADI 1 I10 1
243 3350 WAFIK AZIZAH 1 G44 1
244 3366 DEFANTYO MAHENDRA 1 H10 1
245 3379 ABULLAH YUSUB ALI 1 N45 1 URO
246 3346 RIMA FATWA 1 M45 1 DALAM
247 3375 UWAIS ABDUL AZIZ 1 M41.9 1 ORTHO
248 3355 YAMSU 1 R05 1
249 3347 IMANUEL FERNANDO 1 H10 1
250 3352 IMANUELA VEERANDA 1 J06 1
251 3349 AGUSTINUS TANDANG 1 J06 1
252 3356 SINTA MAHARANI 1 R10 1
253 3362 FARIZKI ARDIAYANSA 1 T15 1
254 3364 RATNA DEWI 1 H66 1
255 3369 RAIHANAH MARDLIYAH 1 R50 1
256 3368 MUHAMMAD EIQWAN 1 J06 1
257 3370 NATAKA DANTA 1 L02 1
258 3374 PANDJI ROCKY 1 L02 1
259 3363 YUSRATUL JANNAH 1 H52.5 1 MATA
260 3383 NABILA ARISTA 1 H60 1
261 3385 ANISA FARADILLA 1 R42 1
262 3386 MUHAMMAD SATRIA 1 H10 1
263 3389 HAIDAR PUTRA 1 J11 1
264 3390 KHOIRIYAH 1 L50 1
265 3388 ANANDA IRAAWAN 1 R50 1
266 3387 FIRA RISKY 1 J30 1
267 3396 BETARDO HIJRIAN 1 J06 1
268 3397 ARINA DEWI 1 J06 1
269 3391 MUHAMMAD ZULFAN AZKA 1 H10 1
270 3392 FELLA ZAHIRA 1 H10 1
271 3393 KHOZANATUL ILMI 1 J06 1
272 3404 DWI PERMATA 1 I10 1
273 3400 DIKA PRASETYO 1 A09 1
274 3395 RIFKI BAGUS 1 K12 1
275 3394 IDA AYU IRAWATI 1 J06 1
276 3402 SRI MURTANTO 1 M22 1 ORTHO
277 3398 RAFI AHMAD 1 G40 1 SARAF
278 3399 RUSIDA 1 I64 1 SARAF
279 3410 DINDA AMELIA 1 J06 1
280 3409 M NUR MUAMAR 1 J06,9 1
281 3407 ULYA TSANI 1 A09 1
282 3406 AHMAD CHAZIM FARCHAN 1 A09 1
283 3403 MUHAMMAD WAHYU 1 J02 1
284 3411 SYUKUR 1 A09 1
285 3408 ANIFAH WIJAYANTI 1 K30 1
286 3413 MUHAMMAD HUDAN 1 K29
287 3401 MOCHAMMAD AGUS 1 M50
288 18 269 0 57 212 0
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
PELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

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 LAPORAN PELAYANAN RAWAT JAL
BULAN JUN
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3022 PIPT FITRIANA 1 N17 1 DALAM

2 3027 MUCHAMMAD HANAFI 1 H81 1
3 3021 FABIANO ALIM 1 J06 1
3019/3
4 1 J06 1
020 SUTANTO
5 3017 MIFTAKHUDDIN 1 L20 1
6 3032 M ZEN ZAYYAN AL 1 J45 1
7 3039 SWASITO 1 N40 1 URO
8 3042 DWI INDIASTUTI 1 B30 1
9 3038 SAVEENAH AN NAJAH 1 R50 1
10 3054 m. sa'ud 1 I25 1
11 3058 SUGIONO 1 I25 1 JP
12 3074 ALDIAS WINDY NAURI B 1 I10 1
13 3072 DJOKO KUSSUBANDRIO 1 H52.5 1 MATA
14 3070 ACHMAD ZARKASI R 1 H52.5 1 MATA
15 3084 SUHARTO 1 I11 1 JP
16 3069 DARWATI 1 H52.5 1 MATA
17 3067 ELVI LESTARI 1 H52.5 1 MATA
18 3063 ENDANG HARUMI 1 I10 1
19 3077 KHOIRINA AZZAHRA P 1 F82 1 ANAK
20 3049 SYAIFUL ANWAR 1 G44, I10 1
VALENCIA JENNIFER PUTRI
21 3043 NORA
1 L23 1
ALMEER GIANDRA
22 3046 1 K30 1
PRATAMA
23 3060 MAIMUNAH  1 I25 1 JP
24 3053 ANA FITRO TUNNISSA 1 H60 1
25 3113 arumi 1 I11 1 JP
26 3111 UWAIS 1 R11 1
ALESHA SHANUM NUR
27 3057 1 A09, J06 1
SUHADAK
28 3062 ELIA ROSA 1 A09 1
29 3075 1 J06 1
ACHMAD BASIR ABDULLAH
30 3076 1 J06 1
ACHMAD BASIR ABDULLAH
31 3149 NURLINDA SITOMPUL 1 I10 1
32 3138 RAKHMAT ADI SAPUTRO 1 T14 1
33 3131 AYU FATIMAH AZZAHRA 1 D26 1 BEDAH
34 3071 SAYU KETUT SARINI 1 K29.9 1 DALAM
35 3096 M ZAINUL ABIDIN 1 L20 1 KK
36 3098 NURUS SHOBAH 1 L20 1 KK
37 3121 SUNDARI 1 L20 1
38 3145 BACHTIAR EFFENDI 1 T14 1
39 3114 ROMADHON 1 T14 1
40 3155 ZAWIYATUS SHOLIKHAH 1 T14 1
41 3166 HERI FEBRIAN 1 L60 1
3087/3 ELIS DIANA
42 1 N39 1
090
43 3073 IRENE SEREAN NATABUANA 1 A09, R50 1
44 3066 LUKY RACHMANINGTYAS 1 A09, J06 1
45 3061 RHENDI WENDAH KUSUMA 1 J06, G44 1
3052/3
46 1 N140 1 URO
175 WALUYO
47 3165 DINUL QOYIMAH 1 N83.2 1 OBGYN
48 3168 1 L20 1
WILDAN ARIF WICAKSONO
EKA AJENG
49 3164 1 M79,1 1
SETIARININGTIYAS
50 3162 MAHARANY DAMAYANTHY 1 G44,2 1
51 3183 MAHMUDAH 1 E11,7 1
52 3184 MAT THOHIR 1 E11,7 1
53 3186 AFANDIK 1 N40 1
54 3162 MAHARANY DAMAYANTHY 1 G44,2 1
EKA AJENG
55 3164 1 M79,1 1
SETIARININGTIYAS
56 3168 1 L20 1
WILDAN ARIF WICAKSONO
57 3157 fiando zacky ardhani 1 J06 1
MUHAMMAD FALIH
58 3154 1 J06 1
ZAHRAIN ATHAYA
59 3153 YOLANDA MAULIDA LIDYA 1 J06 1
GREIS ULLY DAMAIYANTY
60 3144 1 H10,3 1
GULTOM
61 3189 REGIS ASRAF MUFAZZAL 1 R59,A18,2 1 ANAK
CALLISTA AZZAHRA PUTRI
62 3148 1 J06 1
MUZAKKI
63 3147 ISMAILAH 1 J02 1
AL KAHFI PUTRA
64 3146 1 J06 1
FAKHRIANSYAH
65 3139 RIFQI AINI 1 R42 1
MALAEKA AFIZAH ARSYILA
66 3137 1 J06 1
EIMEAR
67 3136 RUSMARIYANA 1 J06 1
NADHIRA AZMI FALISHA
68 3134 1 J02 1
PRASETIYA
MUHAMMAD AIDAN SYAHM
69 3124 1 J06 1
AL GHIFARI
70 3123 SALMA NUR FIADINDA 1 L30 1
71 3117 AQILANITA DWI FAIQOH 1 B86 1
72 31150 1 T14 1
YOKO TEDDY HERWANTO
73 3089 SUHARTATIK 1 M79,1 1
74 3088 RISTIAN CHANIAGO 1 K30 1
75 3086 NANANG LISTIONO 1 H00,0 1
76 3085 MUNIROH MAHMUDAH 1 G44,2 1
77 3171 OKKY GITA PUSPITA 1 J06 1
78 3170 1 J06 1
HANS TANDRA NARESWARA
79 3169 1 J06 1
HATTA DZAKIR NARESWARA
80 3167 FIRMAN KHARISMA 1 J06 1
81 3143 ELAFIDA 1 K30 1
82 3163 ILHAM ANDRANSYAH 1 J06,M79,1 1
83 3135 BOEDI SOEKMONO 1 I10 1
84 3133 HERY MUHAMMAD SUTAN 1 G44 1
85 3150 SUKARSIH 1 M54,5 1
86 3033 SULIYATI 1 M13 1
3151/3
87 1 G44 1
152 HARIYANTO
88 3127 FAUZIAH 1 H10,3 1
3118/3
89 1 K30 1
120 SUHARMANIK AK
90 3099 IFFAN AL BAIHAQI 1 J06 1
91 3097 1 A09 1
AYUNDA YASMIN ELSANUM
92 3093 AMINATUZ ZURIAH 1 E11,7 1
93 3196 BAMBANG TRIYONO 1 K30 1
MUHAMMAD IBRAH RAYYAN
94 3192 1 J06 1
IKHWAN
95 3211 KHUSNUL KHOTIMAH 1 M51.0 1 SARAF
3214/3
96 1 E11.7 1 DALAM
215 FARIN PRIHARTINI
97 3219 SIADI PRAYITNO 1 E11 1
98 3223 M ADZAM RUDIYANTO 1 H10 1
99 3222 NAFIATUL LAILIYAH 1 H60 1
100 3220 SHOCIB 1 J06 1
101 3212 SUKARELAWATI, RR 1 T30 1
102 3086 NANANG LISTIONO 1 H00.1 1 MATA
103 3204 NUR CHUDAIFAH 1 J06 1
104 3209 SITI ASKAH 1 R50.9, G44 1
105 3208 MAMIK SUPAMI 1 R50.9 1
106 3100 FADELAN 1 E78 1
107 3173 ROSNIA RATNA DEWI 1 J06 1
MUHAMMAD AGASHA
108 3172 1 O74.3 1
KAREEF AL FATIH
109 3128 LAMISRI 1 k30 1
110 3126 ABADI 1 N39, H10 1
111 3116 MOH. MAIMUN 1 K30, A09 1
112 3056 BUDI SANTOSO 1 J06 1
 MUHAMMAD KEVIN
113 3055 1 J06, A09 1
ALVARENDRA
114 3228 SAODAH ROESMINI 1 H60 1
115 3185 NUSICHAH 1 K30 1
116 3187 ISTINING RAHMAWATI 1 L23 1
BAYI NYONYA ISTINING
117 3188 RAHMAWATI
1 L23 1
118 3210 SUYITNO 1 I25, I63 1 JP
119 3037 FREYA MAHARANI FILANO 1 J06.9 1
120 3040 CITRA WISUDAWATI SURYA 1 J06.9 1
121 3225 MUHAMMAD ISMAIL 1 A09 1
122 3221 HUSNUL WIDAD 1 J02 1
MOCH FERRY AWAN TRIE
123 3216 PUTRA
1 G44 1
MOCH FERRY AWAN TRIE
124 3216 PUTRA
1 G44 1
125 3218 IMAM SANTOSO 1 G44 1
126 3217 SITI RAHAYU 1 G44 1
127 3065 SRI ENDAH RAHAYU 1 E11 1
128 3224 SUBKI IBNU MISBARI 1 A88.1, A09 1
129 3226 1 J06 1
PUTRI KARTIKA WARDHANI
MUHAMMAD ABDULLAH AR-
130 3232 1 L23 1
RAFI
131 3228 SAODAH ROESMINI 1 H61 1
132 3227 LINDA SURYANI 1 A88.1 1
133 3233 DJAMIAH 1 I11 1 JP
134 3236 Drs. GIRI ROSANTO 1 H25.9 1 MATA
135 3234 amil yalis 1 M79 1
136 3238 MUDZOFAR 1 L60.9 1
137 3240 ROZZALINA MAHBUBAH 1 G44 1
ARASELLY MASHELA
138 3241 1 R50, J06 1
NAZEEFAH
139 3242 SAFIRINA FEBRYANTI 1 L20 1
140 3248 ARIYANTI 1 C50.2, N20.0 1 B. ONK
ZAHRA TZABITAH HARFI
141 3268 RAMADHANI
1 n92.1 1 OBGYN
142 3266 EVI KUSUMAWATI 1 E11 1 DALAM
143 3235 GENI BRAMASTA 1 A09 1
144 3246 KHUSNUR ROFIK 1 I10 1
145 3247 NUR HALIMAH 1 M79.1 1
MUHAMMAD ERVINO
146 3249 1 R11 1
WAHYU RAMADHAN
147 3250 LUSI KURNIAWATI 1 J06 1
148 3251 SLAMET BUDIONO 1 G44.2 1
149 3255 ISMATUL MAULUDIYAH 1 J06 1
150 3253 M.FARDAN SAPUTRA 1 R50 1
151 3252 FARIZKI APRILIANA 1 J30 1
152 3267 AKHIYAT 1 I10 1
153 3269 ARIF RAHMAN HAKIM 1 H10 1
MUHAMMAD NAFIS
154 3257 1 R50 1
SAPUTRA
155 3270 rania sheza azzahra 1 K30 1
156 3290 FAIRATUS S 1 T14 1
157 3264 MUSTAMIDAH, ST 1 R51 1
158 3275 FARAH RISKY OKINAWATI 1 H66 1
159 3279 ISMAILAH 1 J06, K30 1
UWAIS AL QORNI
160 3287 1 F82, E46 1 ANAK
ANSHORULLOH
161 3261 FATIMAH SABRINA 1 J06 1
162 3260 TUTY WILUJENG 1 M79.1 1
163 3293 PRIEHASTINI OCTAVIANA DEVI 1 M79.1, G44.2 1
164 3299 AYDIN RAZKA BASTOMI 1 L20 1
165 3292 MUHAMMAD NAZRIL NIZAM 1 R50 1
166 3288 MILLATI AZKA 1 H26 1
167 3286 FARIHATUN NABILA 1 J06 1
168 3245 1 H66 1
muhammad abizar arfan raqila
169 3285 JUMAIDAH 1 B35 1
170 3284 IKA PUTRI WIJAYANTI 1 J06 1
MUHAMMAD RAFASYA
171 3277 1 B86 1
ARFAN
172 3276 CHUDERON 1 M54.5 1
173 3256 MARIYATUN 1 H61 1
174 3307 FAIZAL ADJI WICAKSONO 1 T13.2 1 ORT
175 3304 ACHMAD SIDIQ 1 T14 1
MOCHAMMAD AWALUDIN
176 3312 NASUTION
1 S43 1
177 3310 WAHYUDIN AZHARI 1 M79.1 1
178 3309 MAULIDATUL IZZA 1 H10 1
179 3308 MASKAN 1 J06,M79.1 1
180 3321 1 E11 1
AHSANATUL MUNAWAROH
181 3323 MARSINI 1 H36.0 1 MATA
1823341/3314 MAS SITI AISYAH 1 I25, I63 1 JP
CAYLA JOVANKA
183 3326 1 L50 1
RAHMADANI
MUHAMMAD ZIDAN ABQARI
184 3324 1 R11 1
RAFLY
185 3303 NUR SYBIL IRFAN 1 J03 1
186 3313 LUSIANA 1 J06 1
187 3316 MUJI WIDODO 1 E78 1
188 3315 SUMIYATI 1 E11 1
189 3334 SUTINAH 1 I10 1
190 3320 FARIDA HANIM 1 E11 1
191 3335 AKHMAD FAUZAN SATIBI 1 J06 1
192 3319 TRIYALDI FAKHRY 1 E929 1
193 3305 M UMAR ALFATIH 1 H10 1
194 3296 MUHAMMAD AZZAM KHOIRURROSYID 1 J06 1
195 3311 HARTOKO SEPRADANI 1 E11.7 1 DALAM
196 3333 SRI ANI 1 I11 1 JP
197 3337 IMAM EFENDI 1 I50 1 JP
198 3366 INDRA SARIFUDIN 1 E11, E78 1
 MUHAMMAD AL GHAZALI
199 3344 1 J06 1
RAMADHANI
200 3345 M.HAFIZ FATUR 1 J06 1
201 3343 ATIKA ZAHRA NIRMALA 1 J02 1
202 3342 NAILA ALMAHIRA 1 H10 1
203 3340 SUGENG SANTOSO 1 J02 1
204 3339 ELLY INDAH 1 J02 1
205 3338 LINTANG ARINY 1 J02 1
206 3336 ENY RIZA 1 L50 1
207 3332 SITI ALFIATUL 1 H10 1
208 3331 ALLENA ALIFIA 1 J02 1
209 3322 ZHAFIRA KURNIA 1 R11 1
210 3330 FARIDA RAHMAWATI 1 K29 1
211 3329 INDAH CHAHYANI 1 J02 1
212 3328 DIAH AMBARWATI 1 M79.1 1
213 3289 M.TURKAN 1 E78 1
214 3327 LATHI ATMADEVA 1 L20 1
215 3349 HAFIDZ DWI PRAWIRA 1 B18 1 DALAM
ANNASYAH KEYLA AURIZKA
216 3347 1 R50, J06 1
SYAWALUDIN
217 3350 ARYANTI 1 I10,E11 1
218 3365 ABDUL MUIN, SE. 1 R07 1
219 3355 MUNANDAR 1 I64 1 SARAF
220 3363 ZAINAL A 1 I64 1
221 3372 KHUSNUL KHOTIMAH 1 J06 1
222 3371 FAKHRUR ROZI 1 J06 1
KEMBARA RIZAL ROMADHONI
223 3370 (P222010)
1 L50 1
224 3369 YENI DAMAYANTI 1 H60 1
225 3358 SACHI PARISYA SYAHPUTRI 1 J06,H10 1
226 3357 DEVANO RIZKY ALVARENDRA
1 J06 1
227 3356 DWI NOVITA ARIYANTI 1 K30,J02 1
228 3374 M ALIIR RIDHO 1 J06 1
229 3373 MASHFUFATUN 1 J06 1
ANGELIANSYA PUTRI NASIR
230 3378 DELIMA
1 L30 1
231 3376 RATIH AYU PURWANINGRUM 1 J06 1
232 3375 ANUGERAH PRATAMA BRATA
1 L30 1
233 3367 YUSWANTO 1 J06 1
234 3368 REJI FITRA FIRMANSYAH 1 J06 1
235 3379 MUKHAMMAD KHUSAIRI ABAS
1 K30,R50 1
236 3381 SRI INDRIYATI 1 K30 1
237 3377 ACHMAD RIZKY KARUNIAWAN
1 J06 1
238 3382 MOHAMMAD MASKANIF 1 L03 1
239
240
241
242
243 4 234 36 202
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
PELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
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P PROKES K
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 KET./
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TGL KONTROL
PER ADMED
TINDAKAN
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INJ

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RL 6/7/2022
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RL 6/8/2022
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 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3004 SYAFII 1 K30 1

2 3010 NINIK SETYAWATI 1 C50 1 BEDAH ONK
3 3009 ANISYAH 1 M13,E11 1
4 3008 NURMAN HAYOTO 1 H60 1
5 3006 ANI 1 M13 1
6 3005 LUTFIAH INDASARI 1 J06 1
7 3014 LILIK SUMARNI
MUSLICHAH 1 H52.5 1 MATA
8 3029 1 K30 1
9 3024 ANANG DJUMADI 1 I63 1 SARAF
10 3013 NURUL HUDAYAH 1 E11 1
11 3011 PUTRA YUDA RIFAWAN 1 K30 1
12 3012 MUHAMMAD SYAIFUDIN ZUHRI
1 J02 1
13 3049 HAYATUDIN 1 I10 1
14 3056 SRI PALUPI 1 E11,I10 1
15 3057 WINARSIH 1 N20 1 DALAM
16 3047 ELLY INDAYANTI 1 K29 1
17 3023 LINAH 1 R73 1
18 3035 Nelliana Anece S 1 H10 1
19 3022 KHASBI EL BARR 1 J06 1
NYOMAN KEINO RADHIKA
20 3021 1 J06 1
ADITYAWAN
21 3070 ZAINUL ABROR 1 R72 1 DALAM
22 3065 AMIRA KHAMDANIYAH 1 J06 1
23 3063 m sulaiman 1 J02 1
24 3048 1 A09,R11 1
BAYI NYONYA TIKA YUNITA
FAIRUZAH SHOFIYAH
25 3072 1 A09 1
RAHMI
26 3017 KARTIANI 1 J06 1
ANDRA HANAN
27 3016 1 R50 1
BAGASDITYA
28 3075 AFANDI 1 I25 1 JANTUNG
29 3068 supartin 1 E11,I11 1
30 3086 ZULIANA 1 E11.7 1 DALAM
31 3106 SHOBRON ASCHABULLAH 1 E11 1
32 3102 AHMAD HANIF AZHAR 1 J02 1
33 3101 SITI NUR MASRUAH 1 J02 1
34 3097 SRI REJEKI (GA1023.11) 1 E78 1
AHMAD HASAN BASRI
35 3098 (GA1023.10)
1 J06 1
36 3096 YANUAR RINALDI 1 N28.0 1
MOCHAMMAD ZULFI
37 3073 MOESTHOFA
1 J02 1
38 3069 TITIK BENASTITI 1 A09 1
39 3071 LELY OKTAVIA 1 J02 1
40 3078 SRI WAHYU WIDAYANA 1 J02 1
41 3089 PAIDJAN 1 J02 1
SENJA AUDY INARA NIN
42 3112 1 J02 1
FIRDAUSA
43 3100 LILIK ENDANG SUMIATI 1 H26 1 MATA
44 3103 CHUNAINA 1 R50 1
45 3118 JUMANI 1 M79.1 1
PURMIASIH WAHYUNING
46 3116 UTAMI
1 G62 1 SARAF
47 3115 TJA NYAT NGO 1 I10 1
MUHAMMAD DZAKKA TRI
48 3111 YUANSYAH
1 J06 1
49 3110 NETI SUDARMOWATI 1 J02 1
50 3109 MIMIN LAILATUL ZAZEMIN 1 J02 1
51 3108 HAFEEZA RAFHANAH 1 J06,J02 1
52 3107 DURROTUS SA'ADAH 1 K30 1
53 3099 ADAM MAULANA 1 J42 1
54 3095 FELICIA AMIRAH LASHIRA 1 J06 1
55 3093 M SULTAN NAZIRUL A 1 H10 1
VIZCARRA MUSTIKA PUTRI
56 3092 APRILIA
1 A09,R11 1

57 3085 MUHAMMAD HAIKAL KHOIRON

1 J06 1
58 3090 ARDHI IRAWAN 1 T14 1
59 3091 DEVI INTAN 1 M79.1 1
HELENA ENDANG LUKRI
60 3088 (GA0726.51)
1 M79.1 1
61 3062 SRI REDJEKI DWIHARISWATI 1 H10 1
62 3058 MUDJIATI NAIMAH 1 M54.5 1
63 3055 SITI RUSMIYATI 1 M19 1
64 3054 MULYONO 1 K24 1
HARUN AL RASYID
65 3015 (GA1026.50)
1 M19 1
66 3083 YULIYAH 1 E78 1
SINTA WAHYU SALSABILA
67 3077 (T03203)
1 J02 1
68 3105 JUNIATI 1 H26 1 MATA
69 3123 MARISSA ALFIA RACHMAH 1 H10,K29 1
70 3125 MIFTAHUL HUDA 1 K30 1
71 3134 RIAWAN 1 Z96.1 1 MATA
72 3141 DHAKIYAH YAYUK 1 h52.5 1 mata
3120/3
73 1 H81 1
121 EMMAWATI ANGGRAENI, IR
74 3139 NONING TOYIBA ( 285872 ) 1 K29 1
75 3130 NADIA AYU KARTIKA 1 J06,H10 1
76 3146 SUNARWAN 1 I10 1
SAMUEL CHRISTEVAN
77 3154 1 T14 1
ABEDNEGO
78 3150 NENENG ISTIANAH 1 R50 1
79 3149 EMA APRILIA 1 J02 1
3151/3
80 1 N73 1
152 SITI DJANNATUN
3148/3
81 1 J06 1
153 NANIK DWI ARTI
82 3147 ANNISSA DWI SAPUTRI 1 J06 1
83 3140 ENDANG DWITASARI 1 R50 1
84 3136 QURROTUL AINI ( 424906 ) 1 M79.1 1
ATIK WIJAYANTI
85 3131 1 R50 1

86 3127 MUHAMMAD ZULFAN AZHAR R

1 A09 1
87 3132 AISATUN NIKMAH 1 J06 1
88 3129 DAVINA SARAH SALSABILA 1 J06 1
89 3155 ACHMAD RIFQI HIDAYAT 1 N70 1
MUHAMMAD ALFA GIBRAN
90 3157 1 L80 1 KK
ACHMAD ROZAINI
91 3162 1 H33 1 MATA
SHOBRON
92 3163 ARIF WILDAN AL HAKIM 1 H10 1 MATA
93 3165 FADLAN 1 R11,R50,A09 1
94 3169 ARIF WILDAN AL HAKIM 1 T14 1
3160/3
95 1 H10 1
161 WINARNO
ABDILLAH SATRIA
96 3164 1 M96.6 1 ORT
PANATAGAMA
MUHAMMAD SULTAN SYAHIR
97 3159 ABQARY
1 J06 1
98 3156 MUHAMMAD RIDHA 1 J06,R50.9 1
99 3173 WINNIE KARTIKASARI 1 N60 1 BEDAH
100 3178 DEFSYANA 1 I63 1 SARAF
101 3181 NOVILIA ROSYADI 1 H52,5 1 MATA
102 3171 PRADIPTA KEENAN BARRA 1 R50.9 1
103 3170 BOBBY SETIAWAN 1 L23 1
104 3168 LILIK ISMIATI 1 K30 1
105 3172 ABDILLAH HAVI 1 K30 1
106 3177 MUHAMMAD HAFIZH 1 K30 1
107 3182 SIROTUL ULA 1 G54,2 1
108 3166 MARTHA KUSUMA 1 H10 1
109 3180 ALOYSIUS TITAN 1 A88.1 1
110 3190 M JUNAEDY ABDILLAH 1 H60 1
111 3174 MUHAMMAD ZORAN 1 J06 1
112 3176 YUWANITA TRI 1 J06 1
113 3050 WORO HASTUTI 1 E78.5 1
114 3179 LAILY HIKMAWATI 1 N39 1
115 3193 RONY SETIAWAN 1 K80 1 DALAM
116 3207 DWI ANTO 1 I10 1
117 3206 AFNAN 1 J02 1
118 3205 SLAMET ABDUR 1 H10 1
119 3204 MUHAMMAD HAMIM ARIF 1 R50 1
120 3201 M HARUN 1 J06 1
121 3199 PUTRI AISYAH 1 J06 1
122 3197 RAEYATMI 1 L22 1
123 3198 MUHAMMAD YUSRIAL 1 L23 1
124 3200 MUHAMMAD ABRAR 1 J06 1
125 3194 MARTHA ARIATRI 1 M79.1 1
126 3192 MUHAMMAD ABRISMA 1 J06 1
127 3189 CICIN NILAWATI 1 L23 1
128 3188 SUNARKO 1 M79.1 1
129 3187 BUSTANUL AKBAR 1 J02 1
130 3186 A SAFUAN 1 M79,1 1
131 3185 HARTIK AGUSTINI 1 J02 1
3183-
132 1 M79.1 1
3184 MUHAMMAD MASTURI
133 3221 DYAH KURNIAWATI 1 A09 1
134 3219 MUHAMMAD FATHIR AL RIZKY 1 R50 1
135 3218 AYUNI MAUDATUR 1 A88.1 1
136 3215 HERY RATNO 1 A09 1
137 3214 ZAKY AHMAD 1 J06 1
138 3213 ANNISA KAMILA 1 R50 1
139 3212 MUHAMMAD FAKHRI 1 H10 1
140 3210 AISYAH ALEXANDRA 1 J06 1
141 3209 JIMY SAPUTRA 1 G54,2 1
142 3228 NAYLA AFRAYIM 1 J02 1
143 3223 SUTAJI 1 J44 1 PARU
144 3227 AYU PRATIWI 1 K21 1
145 3226 SYAKIRA NAJWA 1 L23 1
146 3224 FARZAN AHZA 1 J06 1
147 3222 APRILIA DIAN 1 A88.1 1
148 3228 NAYLA AFRAYIM 1 J02 1
149 3227 AYU PRATIWI 1 K21 1
150 3226 SYAKIRA NAJWA 1 L23 1
151 3224 FARZAN AHZA 1 J06 1
152 3222 APRILIA DIAN 1 A88.1 1
153 3237 HARIYATI 1 E11.7 1 DALAM
154 3242 SITI KHALIMAH 1 I63 1 SARAF
155 3251 SINTA MAHARANI 1 K35 1 BEDAH
156 3240 MUHAMMAD REFANZA 1 R50 1
157 3239 SUDJOK 1 H10 1
158 3229 MUHAMMAD FELDA 1 R50 1
159 3220 ALI WAFA 1 J06 1
160 3216 SUGENG HARYADI 1 J02 1
161 321 TASLIM 1 K30 1
162 3208 ANIK HARIJATI 1 M15,4 1
163 3202 SITI KOMARIYAH 1 K30 1
164 3196 INTAN PUTRI RAHAYU 1 R42 1
165 3195 HANS TANDRA 1 H10 1
166 3249 1 J02 1
MIRANDRA RAHMA APRILIYA
167 3233 SITI ROBIAH 1 K05 1
168 3232 ISRAZUL AJI PRATAMA 1 M79.1 1
169 3236 AZIZAH 1 I10 1
170 3235 SUDJAIYAH 1 J06 1
171 3234 MUHAMMAD DANIAL 1 R50 1
172 3254 RIZQI ADHIKA 1 J06 1
173 3250 MUHAMMAD RIZQI 1 R50 1
174 3248 ADE GHITA 1 J06 1
175 3247 ATIYATUL JAZILAH 1 J45 1
176 3246 AHMMAD ALLAND 1 J06 1
177 3245 HARIYANTO 1 J06 1
178 3244 MUHAMAD AL FAYED 1 K12 1
179 3243 KHOIRUL MUFIDAH 1 J06 1
180 3241 FREDI HADI 1 R50 1
181 3231 SLAMET SANTOSO 1 A09 1
182 3263 CHAVALULA KAMANIA 1 A09 1
183 3262 MARSYA FAUZIA 1 K05 1
184 3260 RAHMAD KURNIAWAN 1 M79.1 1
185 3261 MUHAMMAD FADHIL 1 H10 1
186 3259 SALISA NUR RAHMA 1 H61,2 1
187 3258 LAREINA DEWI 1 J00 1
188 3256 ENY SUHARTATIK 1 E78.5 1
189 3257 HERRY SOEWANDI 1 R42 1
190 3255 JULIO PURNANUGRAHA 1 J06 1
191 3253 SYIFAUR ROHMAH 1 K29 1
192 3252 NISWATIN KASANAH 1 J02 1
193 3266 DWI AYU SUSANTI 1 J02 1
194 3271 1 M54.5 1
RUDY ARIANTO MUNTAHIR
195 3175 M YURISCO RAFIRTSYAH 1 J06 1
196 3270 M FARIT AL ASRAF 1 J00 1
197 3269 AHMAD RAIF ANAQIE 1 J06 1
198 3267 AYU IRLIANTI 1 J06 1
199 3268 1 S60 1
ADZKIYA NADHIRA HARJONO
200 3264 AZKIYA NAYLA ZAHRANI 1 R50.9 1
201 3278 FITRI KINANTI 1 N91.2 1 OBGYN
202 3283 HADI WAHYUNARNO 1 A09, K30 1
203 3282 M RAVA ATTHAALLAH 1 L30 1
204 3281 RAYNAND MUHBITA 1 R11 1
205 3280 ACHMAD RAFSANJANI 1 L30 1
206 3279 IMELDA VERONIKA 1 L30, J06 1
207 3277 ANNISA JIHAN ZAHIRA 1 J06 1
208 3275/3276MUAMMALAH 1 M13 1
209 3273/3274PAMBUDI 1 I11 1
210 3285/3286 IVONNE YUNEKE 1 J06, M13 1
211 3284 MOH ROBY SUHAIRI 1 L30 1
212 3287/3288 AGUS DJAFAR 1 J06 1
213 3289 ABD ROHIM 1 K92.1, K30 1 DALAM
214
215 9 204 26 187
216
217
218
219
220
221
222
223
224
225
226
227
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
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294 1 1
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BULAN JUNI 2022

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 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

MUHAMMAD ILHAM
1 3001 1 J06 1
SAPUTRA
2 3002 ROCHIMAH 1 A15.3, R06.0 1
3 3004 ABDUL ROUF 1 A09 1
4 3005 ALWI ABDULLAH ALTHAF 1 J06, H60 1
5 3009 1 E11 1
MUHAMMAD ABYAN
6 3008 1 A09, K30 1
QOWIYYUL HAQ
7 3011 LILIK SUMARNI 1 I10 1
8 3013 AJMAIN 1 N20 1 URO
9 3012 ANTON WAHYU HIDAYAT 1 M13 1
10 3010 YULIANTO 1 J02 1
11 3016 BAMBANG 1 E11 1
12 3022 ABDUL YASICH 1 E11 1
13 3021 MAFTUHAH 1 H52,5 1
14 3033 RUPIAH 1 E11.6 1 DALAM
15 3019 SURYANINGSIH 1 K30 1
16 3029 BUNAYAH 1 I11 1
17 3035 HANAN FATIH AR RAYYAN 1 J06 1
18 3034 DWI SINARIATI 1 J30 1
19 3032 CALVIN NBANGKA 1 J06 1
20 3024 FERREL ATHARIZZ KHALIEFAH 1 H10 1
21 3026 RADITYA FEBRIAN 1 H10 1
22 3025 PUPUT ARISKA PUTRI 1 H10 1
23 3023 EVI KHOIRUN NISA 1 O21 1
24 3020 AGUNG PRIHANTO 1 A88 1
25 3018 ACHMAD FADA 1 H10 1
26 3015 PURWANO 1 G44.2 1
27 3073 IRMA NUR FITRIA 1 S82.0 1 ORTO
28 3065 SHEILA MARINA 1 R10 1
29 3049 MUHAMMAD ADI PRIANTO 1 R50 1
30 3014 ENDANG DWITASARI 1 R50 1
31 3064 MUHAMMAD ELLARDO 1 J02 1
32 3063 AHMAD TSABBIT AL 1 J06 1
33 3062 MUHAMMAD FIRDAUS 1 J06 1
34 3031 SUHARTININGSIH 1 I11 1
35 3060 MARTINI SUSIAWATI 1 K30 1
36 3056 SURITNO 1 I11 1
37 3057 MOHAMED RAVI 1 L20 1
38 3054 TUTIK SETIAWAN 1 J06 1
39 3053 REVA SALSABILAH 1 J06 1
40 3055 RUSMIYATI 1 K30 1
41 3046 WIWIK PRIYATIN 1 I11 1
42 3045 PUSPITA RAHMADANI 1 B30 1
43 3044 NASWA ADELLA 1 J06 1
44 3038 NUR JANAH 1 J06 1
45 3037 IFFA WILDAH QONITA 1 A09 1
46 3069 MEINGGAN VILIAN SARI 1 H52,5 1 MATA
3074/3
47 MUHAMMAD YASAK 1 M79.1 1
075
48 3051 DIDIK TAMTOMO 1 A88 1
49 3072 MUHAMMAD RIFKY 1 J06 1
50 3070 AZKA RIDWAN 1 J06 1
51 3087 DIKA ADINTA 1 J06 1
52 3083 ELIS NUR RACHMAWATI 1 J06 1
53 3082 ERNIYATI 1 J06 1
54 3031 NONING TOYIBA 1 K30 R50 1
55 3081 INDRIANI DWI AGUSTINE 1 J06 1
3076/3
56 SUPRIYATI 1 K30 1
077
57 3065 SHEILA MARINA 1 R10 1
58 3071 PUJIE KOEKSING 1 G44.2 1
59 3067 SOEDJATI PRIHATIN 1 L02 1
60 3066 BUDI SANTOSO 1 J06 1
61 3079 KINANTI LETIZIA 1 Q21 1 ANAK
62 3085 MARTHA ARIATRI 1 H65,0 1 THT
63 3088 YAYUK 1 H52.5 1 MATA
64 3096 AISYAH AYU FARINSYA 1 J06 1
65 3089 HERJUNO RAFANDRIA 1 J06 1
66 3039 ALFA PRIMASATYA 1 J06 1
67 3040 MARIESKA DEVIE 1 J06 1
68 3095 GANESA RAMADHANI 1 J06 1
69 3097 MUCHAMMAD YURICO 1 R50 1
70 3094 FANLEK ARDI 1 J02 1
71 3093 WIMA NOVIANDI 1 L20 1
72 3092 HEPPY VIVITA 1 H81,1 1
73 3091 ACHMAD MASRURI 1 M79.1 1
74 3090 NAYYIROTUS SAADAH 1 J06 1
75 3084 JODI RAMADHANI 1 J06 1
76 3080 MUHAMMAD EMIR 1 B30 1
77 3042 DWI SISKA PUTRI 1 N70 1
78 3078 MUHAMMAD ELVANO 1 J06 1
79 3030 AZKIYA NAYLA 1 R50 1
80 3103 NURUL MASRIFAH 1 R50 1
3101/3
81 1 L20 1
102 KHASIATUL FAUZIYAH
82 3099 RATNA JUWITA 1 R50 1
83 3048 RISTYA DWI KINASIH 1 R50 1
84 3098 ARDIYAN EKO BUDI 1 B30 1
85 3104 NATHISA IXORA 1 J06 1
86 3105 FITYAH AMARYLUS 1 J06 1
87 3107 HUSNIYAH ARTANANDA 1 K25 1
88 3108 MUTHIAH ANAPHALIS 1 J06 1
89 3106 SUTOMO TIKABRATA 1 J06 1
90 3109 NUR ISTINAH 1 B37 1
91 3113 SHOFIYAH 1 M79.1 1
92 3125 MASFIYAH 1 K30 1
93 3111 MUH.GHAFFI AMMAR ABQORY
1 R50.9 1
94 3110 ETA PRILIA ARISTA 1 L20 1
95 3116 HJ.NUR ASIYA 1 K30 1
H.SISWANTO
96 3118 1 J44 1 PARU
97 3119 TELLY ROZANI AMANIAH 1 T11.0 1 BS
98 3121 SURADI 1 I25 1 JP

99 3133 EKO SRI WARDANY 1 E11 1

100 3126 DAVID SETYONO KURNIAWAN

1 J06 1
ARYA MAULANA PANDHU
101 3124 PRADHANA
1 J06 1
102 3123 MARIA ULFA 1 J06 1
103 3127 LIE GOET TAI 1 M79.1 1
104 3120 NIMAS DWI HAFIZHAH 1 J06 1
105 3117 INDAH SUSANTI 1 J00 1

106 3115 SYAFINA CAHYANI MAULIDYA 1 J06,L23 1

107 3114 BINTANG ANDARU SYMPHONY

1 R50 1
108 3112 AMIRA AINUN MAHYA 1 J00 1
109 3156 YUDA HERI PRASETIO 1 e04 1
110 3160 TIRTA MUHAMMAD AL FATIH 1 t16 1
111 3150 MAKAYLA SAFA DIANY 1 K30 1
112 3146 M ADNAN 1 T14 1
113 3138 ARASHEL GABRIELA HEDVA 1 H10 1
114 3134 YULISTIAWAN 1 L23 1
MUHAMMAD RAFLY
115 3132 ANDRIANSYAH
1 J06 1
116 3131 CIELLO PUTRI AURISTELA 1 H10 1
117 3129 ALBY ARSYA VIRENDRA S 1 S60 1
 ANNISA KHAFSAH
118 3135 FAJRINAZZAHRA
1 L23 1
119 3161 HESTY DWI FEBRIANI 1 K30 1
120 3165 SYAIFUDDIN ZUHRI 1 E11 1
121 3164 DIDIT ANDRIYANTO 1 K30 1
122 3167 DWI BUDI UTOMO 1 J00 1
123 3166 AHMAD SYAFI I (U117054) 1 J00 1
DIDIT ANDRIYANTO
124 3164 1 K30 1

125 3162 HADI WAHYUNARNO (U113582)

1 K30,A09 1
126 3161 HESTY DWI FEBRIANI 1 K30 1
127 3157 ROFIAH 1 R50,I10 1
128 3159 MUHAMMAD NASHIHUL AMIN 1 S90 1
129 3156 CHUDERON 1 M51,J06 1
130 3155 DWI DAMAYANTI 1 L23 1
131 3154 MUHAMMAD AKIF BAKHTIYAR
1 J06 1
132 3149 SYAHIRA ALESHA BUSTAMI 1 J06,L23 1
3176/3
133 1 K30 1
177 SOEMARNI
134 3185 SOEGIJANTO 1 G56.0 1 SARAF
135 3187 HERY ARIFIN 1 K30 1
IBNU KHOIRUMAN
136 3179 1 J45 1
137 3180 MUHAJIR 1 H52.5 1 MATA
138 3152 BAHARUDIN 1 J06 1
SHOHIBATUL ISLAMIYAH
139 3151 1 A09,K30 1
140 3165 SYAIFUDDIN ZUHRI 1 E11 1
141 3052 FITRIYAH 1 N39 1
142 3174 MUHAMMAD FAIZ RAMADHAN
1 J02 1
143 3173 ASPIAH 1 J06 1
144 3163 ARETHA KHANZA ZAYNA 1 R50 1
3141/3
145 1 M17 1
142 DWI WAHYUNI
3139/3
146 1 L02 1
140 WIGNYO PRANOTO
147 3136 SLAMET 1 I10 1
148 3130 LULUS KANTHI 1 K29 1
149 3172 ARIF S 1 K29 1
150 3170 HALWA AZKADINA SHAFA 1 J06 1
151 3171 IBNU SINA ALKAUTSAR 1 H10 1
152 3169 AZIS SUWARYAT 1 N39 1
NAZAR BHAKTI, ST
153 3168 1 J06 1
154 3153 AULA ALNAIRA 1 R50 1
155 3148 CHOIROTUN NAZILAH 1 M19 1
156 3144 MUTMAINAH 1 E11 1
157 3137 ALFAN EL MAGHFUR 1 J06 1
158 3143 BASO YAHYA MUKRAMIN 1 R05 1
159 3147 1 H81,1 1
160 3192 ABRIZAM YUSUF MAULANA 1 J02 1
161 3195 1 K30 1
FAZA FAIDUZ ZAKA
162 3203 1 R55 1
163 3199 SURTINAH 1 M79.1 1
164 3198 MUHAMMAD HAIKAL FAIZ 1 J06 1
165 3197 LIDIA SAFIRA ADIBAH (362613)
1 A09 1
166 3194 TITIK PURWATI 1 J06 1
GHAISANI INTAN
167 3193 MARTIKASARI F
1 J06 1
168 3191 QURRATUL AINI 1 J02 1
169 3190 RAFANDA WANI HAFIDZAH 1 J06 1
170 3188 SURAYATUL CHASANAH 1 J06 1
171 3189 SOEHERMADI 1 M79.1 1
172 3186 TSANIA KAYLA AZZAHRA 1 J06 1
173 3184 EDY MA'ARIF 1 M79.1 1
SURYA PRANGGA YUNIOR
174 3183 PUTRA
1 J02 1
NATASHA KHARMELIA
175 3182 ZAHRAH
1 J06 1
176 3181 NAYLA RAHMANIA AISYAH 1 H10,J06 1
177 3178 AKH SHOLIKUN HUDA 1 J06 1
178 3175 SRI WAHYUNI 1 K30,A09 1
RENATA MAHENDRA
179 3200 OCTORINA
1 L50 1
180 3205 ELISA DWI AYU LESTARI 1 K30 1
181 3206 SUPRIYONO 1 Z00 1
182 3203 DEDIE CANDRA 1 M79.1 1
183 3207 NYANARA RIZKY 1 K30 1
184 3208 M. IRVAN NURDIANSYAH 1 R11 1
185 3210 ZULFIANI MARWAH 1 R42, K30 1
186 3209 NUR HABIBAH 1 E11, I11 1
187 3212 SYAHRONI ABROR 1 J02, G44 1
188 3211 M HASAN BASRI 1 J06, J02 1
189 3214 HARTO AGIANTO, DRS 1 K30 1
190 3213 NIKEN PRASETYA PURI 1 J02 1
191 3215 ACHMAD RIZAL SETIAWAN 1 M79.1 1
192 3216 ALFI SYAHRO 1 K30 1
193
194 16 176 13 179
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
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242 1 1
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244 1 1
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248 1 1
249 1 1
250 1 1
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252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
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1
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TGL KONTROL
ADMED
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LAIN

INJ
INJ
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1 PERTAMEDIKA

APS MRS
 INJ

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AMBIL BENDA ASING DI TELINGA

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3
 LAPORAN PELAYANAN RAWAT JAL
BULAN JUN
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3028 HINDI HARINI 1 A09, K30 1

2 3029 AIN'NURIS FARIDA 1 B35.6 1
3 3021 DANISH AHMAD FAISHAL 1 K30, A09 1
4 3020 1 J06 1
MUHAMMAD MALIK ALVARO
5 3019 M AMIN MAIZUN 1 J06 1
6 3018 EKO CAHYONO 1 J06, J45 1
7 3035 YUSRATUL JANNAH 1 G44.2, F41, I25 1 SARAF
8 3030 QAIREEN ADZKIA D 1 J45, T61.8 1
9 3053 MASKAN 1 I11 1
10 3054 SUHARSIH 1 R72 1 DALAM
11 3061 DJULIATI 1 R73 1 DALAM
12 3071 USMAN 1 I11 1
13 3063 SUNARTI 1 M51,8 1 SARAF
14 3074 DJAMILATU 1 I25 1 JP
15 3076 SUNYOTO 1 I25 1 JP
16 3087 DWI SISKA 1 M32.9 1 DALAM
17 3093 SITI FATIMAH 1 M22 1 ORTHOPEDI
18 3088 RA SRI LESTARI 1 E10 1 DALAM
19 3109 HADIDAH 1 I25 1 JP
20 3127 SITI AISAYAH 1 T14 1
21 3111 NURUL HIDAYAT 1 I25 1 JP
22 3121 HARI BUDI SETIJONO 1 BPH 1 URO
23 3120 MAWAN DARSONO 1 L90 1 KK
24 3123 SAYYIDATUNNISA 1 F81.3 1 KJ
25 3058 YENI DAMAYANTI 1 H66,3 1 THT
26 3128 LINA WIDIASTUTI 1 H52,5 1 MATA
27 3146 NASWA ARISTA 1 H52,5 1 MATA
28 3129 MAHBUB 1 T14 1
29 3203 MUNIROH 1 I11 1
30 3195 FAIRATUS 1 T14 1
31 3193 BAYI NYONYA MUFLICHA 1 P58.2 1 ANAK
32 3155 MUTIARA ILMA 1 F40 1 JIWA
33 3185 AGUS SETIYANTO 1 I11 1
34 3188 JULAEKHAH 1 OA 1 ORTHOPEDI
35 3159 RILLES EKO 1 L03,0 1 BEDAH
36 3104 DWI AYU SUSANTI 1 A09, K30 1
37 3075 SJAIFUL CHAQ 1 H66,3 1
38 3070 GATOT SUBROTO 1 A88 1
39 3081 WIWIK SOEMARNI 1 J02 1
40 3084 SRI HARYA 1 J00 1
41 3095 AGUS PRAMONO 1 H10 1
42 3098 ARIS FAISOL 1 J02 1
43 3134 WAHYU PURBA 1 H10 1
44 3215 DEWI MARYAM 1 M54,5 1 SYARAF
45 3204 MUJAYATI 1 M79.1 1
46 3194 MOHAMMAD MAKHIN 1 J06 1
47 3022 NASWA ADELLA 1 J06 1
48 3184 SADHANA YULYAS 1 J06 1
49 3183 ARASELLY MASHELA 1 J06 1
50 3153 MOHAMMAD AZMI 1 G44 1
51 3154 MUHAMMAD ABRISAM 1 J06 1
52 3041 ROZZALINA 1 M79.1 1
53 3158 MUHAMMAD NUR ALI 1 J06 1
54 3094 ROFIAH 1 J44 1
55 3148 ABDUL MAJID 1 J06 1
56 3055 ABDUL MUIN 1 M79.1 1
57 3131 DJAKA WALUJA 1 L50 1
58 3144 ANJAR WIDYANINGRUM 1 L20 1
59 3143 AISYAH AZZAHRAH 1 550 1
60 3142 GITTA PUSPITASARI 1 J06 1
61 3139 AL ZAIDAN 1 J06 1
62 3130 HAFIZH MAHARDIKA 1 J06 1
63 3125 MUHAMMAD RAFAEL DWI 1 J06 1
64 3124 ARIF MASRUR 1 J06 1
65 3118 RUDI SETIAWAN 1 A88 1
66 3115 AHMAD MARZUKI 1 J06 1
67 3114 MUHAMMAD ABIL AL FATIH 1 L20 1
68 3112 AHMAD RAIF 1 J06 1
69 3108 ARJUNA NUHA 1 R05 1
70 3107 DICKY SUSANTO 1 G44 1
71 3090 FERRY MAHARDIKA 1 J06 1
72 3086 ABQORIYAH YUMMA 1 L02 1
73 3080 FARAH 1 A09, K30 1
74 3049 KUKUH WAHYU 1 K30, A09 1
75 3048 MAYDITA INDAH 1 L84 1
76 3042 CIFFANA 1 H10 1
77 3032 YUSUF PRIHANTONO 1 I10 K30 1
78 3113 ENDANG PUDJI 1 G54,2 1
79 3105 MUDZOFAR 1 T14 1
80 3103 SUTOPO 1 K12 1
81 3092 SARONI 1 M79,1 1
82 3085 SUHARTONO 1 B30 1
83 3077 MUHAMMAD ARKA 1 J06 1
84 3062 DARMA KRISMANINGRUM 1 H81 1
85 3060 MICHIO ARKA 1 T14 1
86 3213 VAYAKUN EL ARDANO 1 T14 1
87 3219 AGUSTIAWATI 1 D17 1 BEDAH
88 3239 HAFIZA ZAKIYA PUTRI 1 T14 1
89 3218 IRMA NURDIANTIKA 1 N94 1
90 3217 ALKHAKLIFI ZAKI 1 J06 1
91 3196 RAISA WANI 1 J06 1
92 3238 SITI NUIR CHUSNAH 1 J06 1
93 3235 AQILA RIZNA 1 J06 1
94 3226 REYHAN ARRAFIF 1 J06 1
95 3212 CHOIRUL ANWAR 1 K30, A09 1
96 3200 CARINA WAHYU 1 J02 1
97 3198 SAIFUL AHMAD 1 J06 1
98 3161 ALLAN SEPTIAN 1 J06 1
99 3191 MUHAMMAD HAFIZH 1 A09 1
100 3187 DZICKY FADLI 1 T16 1
101 3186 AUZAN ARIF 1 T14 1
102 3160 KEENAN ALSAKHIY 1 J06 1
103 3254 KHOZANATUL ILMI 1 M51,8 1 SYARAF
104 3207 SUTRISNO 1 J06
105 3205 SUJIATI 1 E78 1
106 3211 ZAFIRA FATYA 1 T14 1
107 3179 SILVI DWI NUR 1 R11 1
108 3255 SUDIYONO 1 I11 1
109 3170 FATIMAH 1 E78 1
110 3145 MUHAMMAD AMIR 1 J02 1
111 3253 MUHBUB IKHASAN 1 B30 1
112 3249 ABA YAZID 1 J06 1
113 3247 ABIDAH 1 J06 1
114 3237 DODY IRAWAN 1 R50 1
115 3146 HABIBATUL 1 J06 1
116 3245 TALITHA TASBIH 1 J06 1
117 3210 TSANIA KAYLA 1 J06 1
118 3263 NABILA AMIROTUL HASNA 1 L08 1 SEMEN
119 3236 AQILLA HAYYATUN N 1 J45,R51
120 3234 ANISAH 1 J06
121 3228 JUMISRI 1 A09
122 3230 MUHAMMAD DASTAN AL BIRUNY 1 J02
123 3231 MUHAMMAD SHAWWAL AL FATIH 1 J02
124 3208 IMAM BUKHORI 1 K30
125 3248 ALVIN FELLA NEVILIA 1 G54,2
KANZA ALENCIA SHAQEELA
126 3244 1 H10,R50
MECCA
127 3242 KANAYA AUXILLA SHAQEELA 1 H10,R50
128 3268 S FARIDAH 1 I11 1
129 3241 GAGAT NUR IMANU 1 J06
130 3168 HASBY MAULANA RIZQI 1 J02
131 3165 MAULUDIL ISTIQOMAH 1 G54,2
132 3164 NURHADI 1 J02
133 3172 WULAN DEWI ANDRIANI 1 R11,A09
134 3214 PRAMITA NOVIANTI 1 L23
135 3272 CHOIRUN NISAH 1 M22 1 ORTHOPEDI
136 3283 MUKAROMAH 1 T30 1
137 3274 MASRUROH 1 J40 1
138 3280 NAJWA AIEYDA ASSYIFA 1 A01.1 1
139 3292 RIS SUBAGIO 1 A09 1
140 3289 WASIATUR ROHMAH 1 R50.9 1
141 3288 MOH. MAIMUN 1 K30 1
142 3287 WIDYASI TIARA HAPSARI 1 A88.1 1
PUTRANDA MIFTAHUL
143 3286 1 I84 1
AMANATA
144 3295 NURMUVIDA SETYAWATI 1 I10 1
3284/3
145 1 J06 1
285 TASMINAH
146 3278 EDI ADE SHOMAD 1 K30 1
MUHAMMAD GHILBY AL
147 3275 1 J06 1
YAFI
148 3299 AHMAD LAAROIBA FIIH 1 H52.5 1 MATA
149 3303 NENENG ISTIANAH 1 J02 1
150 3302 AQILA ALYA RAKHMAH 1 J06 1
151 3297 1 T14 1
HARI SUSKIONO SANTOSO
SHAREN NAURA HASNA
152 3294 1 R50.9 1
VIANNIDA
153 3298 MUCHLAS 1 J06 1
MUHAMMAD DZAKKA TRI
154 3300 1 H10 1
YUANSYAH
MOCH HAECHAL
155 3296 ABDURROHMAN
1 J06 1

156 3301 YAYAN ROHMAD AFRITIYONO

1 J06 1
157 3308 INDRA BAYU 1 H10 1
1583305/3309 TULUS BUDIONO 1 G44, K30 1
159 3273 SITI AISYAH 1 M51 1
160 3312 QURROTUL AINI 1 E78 1
161 3313 MUHAMMAD JAWARI 1 I10 1
162 3304 IQBAL RAZIF 1 J05 1
163 3323 YOFITA WAHYU ASTUTI 1 K35 1 BEDAH
164 3316 1 J06 1
SABRINA ARSYILA RAHMAH
165 3317 1 R50.9, J06 1
AISYAH HAFIDZIA AZZAHRA
166 3318 WINDA TRIANA SARI 1 N94.6 1
167 3324 AHMAD SAHLUL KHULUQI 1 J06 1
168 3325 SUTIKNO 1 J06 1
169 3307 HUSNA ULINNUHA 1 Z00 1
170 3306 TRISTY ARDHYANA KUSWANDANI 1 Z00 1
171 3314 VINA SAYYIDATUL S 1 J02 1
172 3311 RANGGA KUSUMA NEGARA 1 Z00 1
173 3310 SUNYOTO 1 Z00 1
174 3319 M ILHAM MAULANA 1 L20 1
175 3331 NINIK SETYAWATI 1 D21 1 BEDAH
176 3337 RISDA SUFIDIANA 1 O20 1 OBGYN
177 3344 ARIF MASYHAR 1 I63,9 1 SARAF
178 3334 SITI KHANIFAH 1 A09 1
179 3346 MUHAMMAD HAMIZAN AL CHAKIM 1 J06,9,R11 1
180 3333 ZAHWA SARAH AMANI 1 K55 1
 PANDJI ROCKY PRIHADI
181 3330 1 D17.6 1 BEDAH
DARMINTO
1823327/3328 KHUSNUL KHOTIMAH 1 K29.1 1
183 3352 MUH NURDIN ALHAFID 1 K30 1
184 3351 FARICHATUL AULIYA 1 J06 1
185 3350 ANINDYA ZILFATUL AKHFA 1 J06 1
186 3345 ASMAUL ALIYAH 1 M10 1
187 3342 RESA YUANITA 1 K30 1
MOHAMMAD ARIKUL
188 3338 1 J45 1
KHASAN
189 3336 ANDI SYAHPUTRA 1 J45 1
MARYAM KONSTANTINA
190 3335 1 H10 1
ARRAHMA
191 3332 FITA INDAH SEKAR Sari 1 J06, A88.1 1
192 3329 NATAKA DANTA GAVIN 1 S90 1
193 3327 1 J06 1
DIAN MAYA SETYAKUSUMA
RAFA ABID ABQORY
194 3360 1 J06 1
SURYONO
MUHAMMAD HAFIDZ
195 3359 1 J02 1
RAMADHAN
196 3354 1 L20 1
DZAKY ABIYYU SETYAWAN
197 3363 EMILIA LUSY ANNA 1 E78.4 1
198 3362 JASMINE NUR AZIZAH 1 R50 1
199 3347 ZULFICAR AGAM SUMANTRI 1 J02 1
200 3372 ABDUL HAKIM 1 K30 1
201 3366 AZZAHRA AYU SHAFIRA 1 J02 1
202 3367 DWI REDI SUDARMAJI 1 L30 1
203 3365 SALSABILLA EKA OKTAVIA 1 J06 1
MUHAMMAD RANGGA AMAL
204 3370 1 J06 1
FIRDAUS
205 3368 GHAZI AHMAD HAMIZAN 1 J02 1
206 3383 SRI INDRIYATI 1 K30 1
207 3380 1 J45 1
PUTRI KARTIKA WARDHANI
208 3379 RUSLAN 1 J06 1
209 3376 ADZKIA NISA DHAFITA 1 J02 1
ANNISA RESTU
210 3375 1 A88.1 1
RAHMADHANI
211 3374 1 L23 1
MOCHAMMAD FARIS HAKIM
212 3220 ANNISAH FELCYA IRAWAN 1 A90 1
213 3373 ANISATUR ROHMAH 1 J02 1
214 3371 SITI MADRIYAH 1 H10 1
215 3386 YUYUN OKTAVIA 1 K30, J06 1
216 3385 ANNA KRESENTIA ADISTI 1 R50, K29 1
217 3381 HANNITYA SAFITRI 1 K29.1 1
218 3384 NINDA AYU BISTANOVA SARI 1 J30 1
219 3377 SANJANA ALICIA 1 J06.9 1
220 3389 SUSANTI 1 B02 1
221 3388 SAMBA APRAKA 1 D17.6 1
222 3387 WASIATUR ROHMAH 1 K30 1
223 3266 MUMAYYIROTUL FITRIYAH 1 J06 1
HAFIZHAH AZKADINA
224 3265 1 J06 1
FADHILLA
MUHAMMAD RADIT AL
225 3260 1 J06 1
FATIH
AYRA NALADHIPA
226 3390 1 j06 1
WAHYUNING JATI
Muhammad Haidar Aksa
227 3391 1 j06 1
Maulana
228 3392 1 K30 1
RETNO AYU NUR INDRIANI
229 3394 JUHRI BASTOMI 1 L20 1
MUHAMMAD FARREL
230 3393 1 J06 1
FEBRIANSYAH
231 3396 IDA YANI 1 I10 1
232 3398 ROSSA SYCILLIA 1 K30, R11 1
233 3399 JUMIATI ISDIYAH 1 R05 1
234 3400 ARIS MAULANA 1 K30 1
235 3401 MICAILA AZZAHRA 1 R50
236
237 0 0 8 227 32 186 0
238
239
240
241
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
PELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
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 LAPORAN PELAYANAN RAWAT
BULAN
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
NO NO REG NAMA PESERTA R P DX
S J M O
YA TDK
K E L
K D I

1 3005 DONI WIKASRYADI 1 A09, R11 1

2 3032 SULAIMAH 1 M79.1 1
3 3017 EMILIA ZAIN 1 R11 1
4 3021 WASITO 1 E11, I10 1
5 3005 KARTIANI 1 E11 1
6 3013 USMAN KHOLIM 1 H10 1
3014/3
7 1 I25 1
015 SUMARMI
8 3022 ARSY ARFAN ALVARO 1 A09 1
9 3025 ahmad nafik 1 T14 1
10 3019 CALVIN BANGKA 1 R11, R06 1
3033/3
11 1 Z30 1
034 MUBAROKAH
12 3035 AFNAN 1 M79.1 1
13 3039 RUDIANTO 1 I63 1
14 3040 HARIYADI 1 E11 1
15 3051 KARTIKA DYAH 1 T14 1
16 3036 1 K30 1
17 3047 ASLAM HALIM 1 I10 1
18 3030 NABILLAH RACHMAWATI 1 J02, K30 1
3027/3
19 1 HG56.0 1
028 WAHYUNI WIDODOSARI
20 3026 ACHMAD MUNIB 1 J06 1
21 3045 SITI R 1 J06 1
22 3043 EDY YUSUF 1 M79,1 1
23 3049 MAHBUB IKHSAN 1 H10 1
24 3059 ALFA MAROH 1 E11.7 1
25 3057 ANIK HARTINI 1 E11.7 1
26 3058 RAKHMAT ADI SAPUTRO 1 T14 1
27 3041 MAKAYLA SAFA DIANY 1 J06 1
28 3037 WIWIK RAHAYU 1 J06 1
29 3065 CHUDERON 1 M54.5 1
30 3061 AISYAH QYRANI ARUN 1 A09, R11 1
ALYA FAUZIYATUL
31 3062 1 A09 1
MARDHIYAH MAHARANI
32 3087 JOKO SUSENO 1 I25 1
33 3094 ANNA MARLIANA 1 T14 1
34 3071 SUDARTO EFENDI 1 E11,I10 1
 3088/3
35 1 J40 1
089 SUNARNO
36 3081 NABILA SALSABILA 1 R11 1
3069/3
37 1 D27 1
070 PUDJIANTO
38 3093 MENTHIK 1 M65 1
39 3099 WIWIEK PRAVITASRI 1 J02, K29 1
40 3096 DWI RUSDIYANA 1 E11, I10 1
41 3097 TUJI HARTONO 1 K40 1
42 3102 MUKHAMAD SYAIKU 1 K40 1
ACHMAD ALDEN ARSA
43 3105 1 H33.2 1
TRASTIA
3106/3
44 1 E10.7 1
115 parmiadi utomo
45 3109 RADIKAL KURNIA HADI 1 R10 1
46 3110 SUGIONO 1 J02 1
47 3108 MUHAMMAD ALI MAHMUD 1 H10 1
48 3098 SUNARDI 1 H10 1
49 3092 KHAJID ABIDAH 1 J06 1
50 3074 BIAN NAZNEEN ADHA 1 R50 1
51 3058 HENITA WIDIASTUTIK 1 A09,K30 1
52 3114 SITI NUR CHUSANAH 1 H10 1
53 3066 CHRISTIN PUJI RATNA 1 G44 1
3116/3
54 1 I11 1
122 PIPIT MUSAHADAH
55 3107 WAHYONO ADI 1 J02 1
3103/3
56 1 L02 1
112 WIDIATMOKO
57 3104 ALIYAH 1 J40 1
58 3106 PERMIADI UTOMO 1 E10.7 1
59 3123 RAHMAD ALI HANAFI 1 F48 1
60 3113 M NABIL ANNUR 1 J06 1
61 3111 MUHAMMAD TEGAR PRAKOSO
1 J06 1
62 3091 ENDANG HERAWATI 1 K29 1
WIWIEK PRAVITASARI
63 3091 1 J02 1
ROSALIA
64 3155 MUHAMMAD ARSYAD 1 T14 1
65 3138 MOCH.CHUSNUN UZAL 1 I85.9 1
66 3139 SUMIATI 1 C25.1 1
67 3147 TAZKIYYATUN NAFSIYYAH 1 T14 1
68 3137 MARTHA SONDAK 1 F41.1 1
69 3159 SUSANTYO ARIONO 1 I25 1
70 3164 CHUSNUL AIN 1 I63 1
3157/3
71 RISWANDI 1 J45 1
158
72 3140 LIGA FILSAFATI 1 E11,7 1
73 3165 1 F80 1
ARSYFA SHAFIRA RAMADHAN
74 3183 HERI FEBRIAN 1 T14 1
75 3163 ACHMAD FAWWAZ ZAKI 1 L02.4 1
76 3178 JELANI 1 N17.9 1
77 3170 NUR AINI 1 J06 1

78 3120/3 1 N39 1
124 AGUSTINA DIAH
79 3190 NURIA ANINDITA PUTRI 1 K30 1
80 3194 CANDRA ADI SETIAWAN 1 K30 1
81 3176 DEDE SRI GINANJAR (PB) 1 M13 1
82 3196 SRI WIDJAJANI 1 K27 1
3120/3
83 1 N39 1
124 AGUSTINA DIAH LARASATI
84 3158 BAGUS INDRA PRASETYA 1 B35 1
85 3156 MOHAMMAD HUSNUL FUADIE
1 H10 1
86 3090 TRI MURTININGSIH (150256) 1 R50 1
87 3135 NUR NOVIANTI 1 R11 1
88 3133 CAROLINA INDRIAN 1 R51 1
3128/3
89 1 M19 1
150 HERRY SOEWANDI
3127/3
90 1 R73 1
148 MARIONO, DRS
91 3125 DIAH FATMAWATI 1 A09 1
92 3126 MUHAMMAD ZAIN HAMIZAN 1 R50 1
93 3117 BASUNI 1 J44 1
94 3167 HJ ASMAUL ALIYAH 1 E79 1
95 3166 M ADIB 1 J02 1
H NUR AINI
96 3170 1 E78 1
97 3203 M FEBRIANDA GIRI M 1 J06 1
98 3201 SEPTYA EKA SANIKA 1 G44 1
MUCHAMMAD YURISCO
99 3198 RAFIRTSYAH
1 J06 1
100 3197 BY NY LAILIA DWI WIDIYANTI 1 J06 1
101 3182 MUSLIM BOSNIA 1 J02 1
102 3180 YULIANI 1 M79.1 1
MUHAMMAD AZRIL DWI
103 3160 FIRMANSYAH
1 J02 1
104 3153 AHMAD ABDUL MAJID 1 J02 1
RODI YANA
105 3146 1 M79.1 1

106 3145 ANINDITA ZAHRA RAMADHANI

1 J45 1
107 3143 AINUR ROFIK 1 M79.1 1
108 3141 ROHMATUL UMMAH 1 H10 1
109 3154 NURUL FAUZIATUL ARIEF 1 J02 1
110 3199 HAFIZH MAHARDIKA 1 1 R11,R50 1
111 3204 DAVA JUAN SHAKTI D (072567)
1 H60 1
112 3161 TATIK WIDIYAWATI 1 M79.1 1
NURUL AULIA ABADIYAH
113 3171 1 J02 1
114 3172 M RAZKA ALFARIZI 1 A09 1
115 3173 CANTIKA AZZAHRA FITRIANI 1 J02 1
ADINDA AYU WULANSARI
116 3174 1 J06 1
117 3175 AL FATIH GIBRAN M 1 J06 1
118 3177 AGHNIA SALWA MAHFUD 1 J06 1
119 3192 DAIMATUL KHOTIMAH 1 A09 1
120 3046 MOHAMMAD SONI WIJAYA 1 E78,E79 1
3205/3
121 1 A09 1
206 SUMILAH
122 3224 TUTIK 1 J06,K30 1
123 3228 TARTI AFIYAH 1 L40 1
124 3230 SOKHIFUL ARIF 1 R42 1
125 3234 ZHANANDA BAGUS P A 1 T14 1
3223/3
126 1 N21 1
235 SUNYOTO
127 3231 MUHAMMAD AZHIIMI ROFI 1 I10 1
128 3226 SITI BUNGAIDJA 1 R11 1
129 3259 siswanto 1 T14 1
3253/3
130 1 I25 1
254 ABU SUYANTO
131 3251 CHUZAENAH 1 I63 1
132 3245 HENDRO YUWONO 1 S32.0 1
133 3249 ENNY CHRISTINAWATI 1 I11 1
134 3257 LILIK HIDAYAH 1 I10 1
135 3262 FUSCHAH 1 J06 1
136 3261 ELLY PURNOMOWATI 1 I10 1
137 3258 HASYAKAYLA AURORA 1 B08,4 1
138 3252 SURITA DEWI 1 J02 1
139 3244 FIRMANTA MEITANA 1 R42 1
140 3239 ZAINATUL FARIDA 1 J06 1
141 3238 ANITA SAMSUL 1 K29 1
142 3237 DZAKIY HANIF 1 J06 1
143 3236 ERRY URIYANTI 1 J06 1
144 3235 MARVEL SANJAYA 1 B30 1
145 3232 SEKAR ARUM WIDAYAT 1 R50 1
146 3229 HIMATUL CHOIRIYAH 1 B30 1
147 3227 NAZAR BHAKTI 1 J06 1
148 3016 HANAN FATIH 1 A09 1
149 3281 IMELDA VERONIKA 1 N13 1
150 3270 LATIFA 1 I11 1
151 3298 SUPENOWATI 1 I11 1 JANTUNG
152 3288 KINANTAN ARGIYANTI LITUHAYU 1 F80 1
153 3230 SOCKHIFUL ARIF 1 1 A88 R11 1
154 3306 TAMI ATI 1 R18 1
155 3280 ENDANG DWITASARI 1 1 A90 1
156 3241 SUPIYAH 1 I10.E10 1
157 3290 BINTANG PUTRI ALFIANI 1 J06 1
158 3331 MUHARTI 1 H25 1
159 3336 YULIA FARIDA 1 H81,2 1
160 3286 ALMAZIDAH ZAM ZAM MUSNIDAR 1 J02 1
161 3285 RIZKY RAHMADIAN SHOLEH 1 J06 1
162 3339 ANIS SUDIBYO 1 H40 1
163 3284 AZZAM ALIM MUTTAQIN 1 J06 1
164 3282 NUR ALFIANI GHUFRON 1 J02 1
165 3276 MUHAMAD FIRDAUS 1 I11 1
166 3265 ROBI'A AL ADAWIYAH 1 M79,1 1
167 3275 AFINI ISMA HIDAYATI 1 J02 1
168 3332 M SAID 1 K30 1
169 3264 HAJAR CHINTYA 1 J06 1
170 3269 SITI CHAULAH 1 E10 1
171 3268 RISTYA DWI KINASIH 1 B00 1
172 3266 ARDIANTO 1 A09 1
173 3267 MUHAMMAD SYAFII 1 L20 1
174 3256 IIS SULEIWATI 1 K25 1
175 3255 FARIKHAHA 1 J06 1
176 3250 LILIK 1 M79.1 1
177 3242 MOHAMMAD FARDAN 1 R50 1
178 3354 HUSAINI 1 E11 1
179 3357 AL AMIN A 1 H52.5 1
180 3361 NIKEN INDAH TRILESTARI 1 K29 1
181 3356 MARTINI SUSIAWATY 1 R42 1
MUHAMMAD DZAKIRUL
182 3355 1 J06 1
MIKAIL
183 3347 PUPUT ARISKA P 1 B30 1
MAHREZ ZAFRAN AL
184 3353 1 L20 1
BAIHAQI
185 3352 1 J06 1
AQILAH PUTRI ASY-SYIFAH
MUHAMMAD AHDAN AL
186 3351 1 J06 1
ABQARY
187 3349 ADZKIA NISA DHAFITA 1 J02 1
188 3338 NIZAR AFIF FATIN 1 G44 1
189 3337 RISKY AZIZA 1 J02 1
MUHAMMAD NASHIHUL
190 3330 1 J06 1
AMIN
191 3309 N FITHRATUL U 1 J02 1
192 3283 PRAKTISIA DIVA A 1 L23.9 1
193 3144 DAMAR IMAN A 1 J06 1
194 3151 INARA FALISHA 1 J06 1
195 3274 SINDY FIRDA 1 H10 1
196 3335 YUNI SULISTYOWATI 1 H61.2 1
197 3346 RIVAN HASANAL 1 J02 1
198 3348 AZZAHRA AYU 1 R05 1
199 3350 YUSUF RITONAGA 1 J00 1
200 3364 SUKARSO 1 M79.1 1
201 3322 RAHMAT SUGIONO 1 M79.1 1
MUHAMMAD ZA'IM SYAHMI
202 3321 1 J06 1
FAIRUZ
203 3320 MUJAHIDA WIDYA ROSITA 1 J06 1
204 3319 INSYIRAH EMILY FILCA 1 J06 1
205 3323 indah rafa lyndy 1 H60 1
206 3289 MUHAMMAD NAZRIL NIZAM 1 J00 1
 DZAKY FAYYADH
207 3303 1 J06 1
AHZALUBAID
208 3304 NURAINI 1 K30 1
209 3302 TONO SUTIONO 1 J06 1
210 3301 RESHA ARIASANTI 1 J06 1
211 3300 RIA MARGARETHA 1 J06 1
212 3299 FAREL AKHMAL SUTIONO 1 J06 1
213 3295 DINA YULIASARI 1 T14 1
214 3293 MAGDALIA ELVA 1 M79.1 1
215 3292 IIS SAPTIAHAYATI 1 L20 1
216 3291 PUTRI NAJWA AMELIA 1 A09 1
217 3271/3272 INDAH SUSILOWATI 1 L50 1
218 3278 RYAN NUR I 1 J06, Z00 1
219 3277 MOH NASRININ 1 N39 1
220 3273 DIAN ARFAH F 1 J06 1
221 3279 ROMILDA SAFAMAURA 1 J02 1
222 3307 SALSABILA EBRYANTI 1 J06 1
223 3308 MARLINA 1 M79.1 1
224 3310 NURHIDAYAH 1 J02 1
225 3314 PUTRI SAHALA 1 K29 1
226 3316 SABRINA ALESHA 1 A09 1
227 3334 LAILY DWI F 1 R51 1
228 3333 ENNIS LISNIAWATI 1 H10 1
229 3329 FITA ELENTRI C 1 J06 1
230 3327 HERJUNO RAFKA 1 R05 1
231 3326 MUHAMMAD MARFADIE 1 M79.1 1
232 3325 LULUK RUFIANI 1 A09 1
233 3313 LAILATUL MUSHOFA 1 B86 1
234 3312 1 B86 1
FITRIANA DWI ANGGRAENI
235 3311 hadi wahyuarno 1 A09 1
236 3305 M.YUSUF 1 J06 1
237 3375 MIKHAYLA ANNASYA 1 J06 1
HAFIZUDDIN AZZAM
238 3374 1 L08 1
BRAMANTIO
ACHMAD FAKHRIE
239 3373 1 R05 1
ZHAFRAN KHAIRY
240 3372 1 J01 1
muhammad misbah alfarizki
241 3368 PRASETYO WIDODO 1 M79.1 1
242 3367 ALFI SUKRIATIN 1 E11 1
243 3366 NINUK SUKRISTIANI 1 M17 1
MUCHAMMAD AFIFUDDIN
244 3360 1 R50, J06 1
RACHMAN
245 3365 AISYIAH 1 M79.1 1
246 3363 SUYATNO 1 K30 1
TUBAGUS RAMADHAN
247 3359 1 R50, R05 1
PRATAMA
MUHAMMAD MIRZA EZIO
248 3358 1 R50, J06 1
AHZA IHSAN
249 3371 NISA'UL MARDLIYAH 1 M79.1 1
250 3381 NENY SUSANTI 1 H61.2 1
251 3384 NABILLAH RACHMAWATI 1 1 K27 1
252 3379 1 R50 1
ALMEERA KENIZHA RAFIFA
253 3378 INDRASARI YUNIASTUTIK 1 H61.2 1
254 3377 BANY SATRYAGUNG R 1 M75 1
255 3380 HENGKI BUDI SUSANTO 1 K30 1
256 3383 DAYAT SUDIARJAT 1 R50, R05 1
257 3385/3386SUMARDJITO 1 K29 1
258 3389 SITI MADRIYAH 1 H10 1
259 3388 AHMAD SYAMSUDIN 1 H66 1
260 3387 MIERA APRILLIA BALKHIS 1 K30 1
261
262 4 0 17 243 38 222
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
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 LAPORAN PELAYANAN RAWAT JAL
BULAN JUN
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3001 ESTIFENI 1 R50, J06 1

2 3015 AULIA SAFIRA 1 R11 1
3 3023 RINDY AURELIA 1 R50, A09 1
4 3022 KHODIP PRIANTO 1 K30 1
5 3032 NURJANNAH 1 K29 1
3036/3
6 1 M79.1 1
037 SANTOSO
7 3024 ALMAHYRA MARITZA MECCA 1 H10 1
8 3033 JUHRI BASTOMI 1 L20 1
9 3045 DJOKO HARYONO 1 K80 1 DALAM
10 3050 HIDAYATUL FATATIK 1 I10 1
3064/3
11 1 e10.7,j40 1 DALAM
067 SUPRIYADI
12 3063 SUWAJI 1 I25 1 JP
13 3066 NISFI ROMADHON 1 E11 1
14 3080 SRIANA WARDANI 1 N18.9 1 DALAM
15 3060 SHOFIATUL INAYAH 1 K30 1
16 3091 SAFAROTUL INDARI 1 E11 1
17 3108 ZUMROTUN NISA'AH 1 H28.0,E11.7 1 DALAM
18 3006 ANA LESTARI 1 H10 1
19 3088 TRI HADI PRASTIYO 1 R11 1
20 3061 BAKUH BUDI PRASETYO 1 A09 1
21 3078 AZZAHRA PUTRI N 1 J06 1
22 3062 SUTIA 1 M54.5 1
23 3047 MUHAMMAD NAZRIL ISHAQI 1 A09 1
24 3128 AINUR ROCHIM 1 H33 1 MATA
3142/3
25 1 E11 1
143 MUKTAMAROH
26 3136 MIRA AMINATUL FIRDAUSI 1 H52.5 1 MATA
27 3152 ELI NURDIANA 1 K27,E11 1 DALAM
MUHAMMAD KHAKIM
28 3125 ANDRIYANTO
1 K30 1
29 3158 SRIAH 1 K58 1 DALAM
30 3139 1 K30 1
31 3172 NOFI IRAWATI 1 g44 1
32 3170 AINA MARISSA QONITA 1 R50 1
MUH. AIMAN ZHAFRAN EL
33 3161 HAKIM
1 H10 1
34 3162 DURROTUN NAFISAH 1 M54.5 1
35 3153 AISATUN NIKMAH 1 J06 1
36 3150 DIRGANTARA ARIENDRA W 1 J06 1
37 3149 HAURA MECCA SHAHMIMA 1 J06 1
38 3135 BAMBANG TRIONO RAHARJO
1 J06 1
39 3132 MULYANTO 1 J06 1
40 3126 RAYYAN YUSUF AR RASYID 1 J06 1
41 3122 SABIKIN S.PD 1 I84 1
42 3058 ERLY AMAI SAGARMATHA 1 J06 1
43 3118 SITI MUTMAINAH 1 J06 1
44 3182 SUKAERI 1 H26 1 MATA
45 3181 RUSMI 1 H52.5 1 MATA
IPANK NICOLSE GIOVANI
46 3145 SETIA
1 J06 1
47 3116 JULIATI DEVITA HADI 1 H10 1
48 3117 AHMAD FAJAR ALFARIZI 1 J06 1
49 3090 KHASAN KHUSEN 1 R50 1
3121/3
50 1 J02 1
123 WAHID
3114/3
51 1 J02 1
131 SUNGKONO
52 3166 BAGUS SURYA PRATAMA 1 H10,J06 1
3156/3
53 1 L20 1
157 AGUS SUGIANTO

54 3130 MOHAMMAD RESTU PRAYOGI 1 Z00 1

SITI ROHAYATI
55 3089 1 J02 1
3053/3
56 1 M19 1
054 NUR AFIYAH
3051/3
57 1 M19 1
052 MUHAMMAD CHUSNAN
3055/3
58 1 M19 1
056 MUHAMMAD AINUL YAQIN
3048/3
59 1 J06 1
049 SITI MASFUAH
60 3046 WAHYU PURBA TANGGARA 1 J02 1
IRMA WAHYUNINGTIYAS
61 3113 (T253699)
1 J06 1
62 3160 ANNISA ZAHRA WIDHI 1 J06 1
63 3146 HADE WIBAWA 1 J06 1
64 3190 SLAMET 1 I25,9 1 JANTUNG
65 3203 INTAN PERMATA SARI 1 R50 1
66 3202 EDY SUPRAYITNO 1 K30 1
DESI JUMA'ATI
67 3198 PRIYANTININGSIH 1 H52.5 1 MATA

68 3175 CALLISTA AZALIA 1 J40 1

69 3204 IMELDA V 1 T14 1
70 3211 HARI SUSKIONU 1 T14 1
71 3212 ROFIAH 1 E11.7,E78 1 DALAM
72 3218 SABRINA WAFIRAH ACHMAD 1 L30 1
73 3216 FARICH WAHYU KURNIAWAN
1 L02 1
74 3215 CRISTA LIANAWATI 1 J02 1
75 3214 DAFFA SEPTIAN HAFIDZ 1 J06 1
76 3195 AL ZAIDAN FAEYZA G 1 J06 1
77 3210 ARSYILA DINDA AZZAHRA 1 K30 1
78 3207 WAHYU ERNAWATI 1 L30 1
79 3201 AISYAH ALIF DHIAN A 1 K02 1
80 3200 ADE MUHAMMAD WILDAN 1 R11 1
81 3196 AYUMI RIZQIANA ARETHA 1 J06,T14 1
82 3197 RIZKA DWI PRISTYANINGSIH 1 K30 1
83 3191 MARTHA MAGDALENA 1 L30 1
84 3016 RENNY CHANDRA PUSPITA 1 J06 1
85 3188 KAYYIS SYARIF Y 1 J06 1
86 3184 FAILINA 1 J06 1
87 3180 SANDYA AGHETA VIDYAHASTI
1 R11 1
88 3178 SHANIKA SEVA AMORA 1 A09 1

89 3217 TANUDIRTA HANGGIAR LABIB 1 K59 1

3224/3
90 1 C62 1 URO
225 H. ROCHIM
3226/3
91 1 K29 1
228 SRIATUN
92 3237 RIZKY YAZID AKBAR 1 F80 1 ANAK
93 3242 NAFA DHILLA 1 E03 1 PARU
94 3222 ZAINUL ARIFIN 1 J02 1
95 3221 RETNO WULANDARI 1 N39 1
96 3246 ATHAYANO ALVARO 1 R50 1
97 3241 PRADIPTA KEENAN 1 A09 1
98 3251 RAMA HUSAIN 1 R50.9 1
99 3249 SHERIYANA JULIA 1 J02 1
100 3248 INDAH ANGGRAENI 1 K29 1
101 3245 NURUS SHOBAH 1 M79.1 1
102 3244 POPPY TSABITAH 1 J06 1
103 3243 RIRIN INDAYATI 1 H60 1
104 3236 EGGA WAHYU RISNANDA 1 J06 1
105 3238 1 J06 1
MUHAMMAD KEVIN HIDAYAT
106 3235 YOGI KUSUMA CHANDRA 1 J06 1
107 3234 MARIANI GALIB 1 M79,1 1
108 3233 MUHAMMAD SONIC 1 L20 1
109 3227 TUBAGUS RAMADHAN 1 R50 1
110 3252 FRIEDA DWI ASTUTY 1 K80 1 DALAM
3258/3
111 1 I11 1
259 AGUS PARTIYONO
112 3240 MISRI TRI 1 K30 1
113 3265 TARIDJAN JUPRI 1 R73 1 DALAM
114 3301 budi mustofa 1 I11 1
 PURMIASIH WAHYUNING
115 3292 1 D63 1 DALAM
UTAMI
116 3268 NOER WAHYUNI 1 I11 1
117 3313 MUHAMMAD IBNU FALIHI 1 D17 1 BEDAH
118 3311 RACHMAH HIDAYATI 1 B30 1
119 3308 virza adyuta ryan 1 j06 1
120 3307 ANAFATUN NINTYAS 1 R11 1
121 3306 SHOCHIB 1 M79.1 1
122 3291 LULUK ROBITHA 1 M79.1 1
123 3304 MUTROFIN 1 J03 1
124 3267 KEISYA PUTRI 1 J03 1
3295/3
125 1 J06 1
298 RUMYANI WIDJIASIH
3270/3
126 1 L20 1
276 SUDRIHARTO
3269/3
127 1 M79.1 1
274 WONDO SUDIBYO
128 3260 HAZIQ SYAMIL AL 1 R50 1
129 3261 SHOFIYAH 1 M79.1 1
130 3262 ABDULLAH QODIR 1 M79..1 1
131 3254 ANDRIAS RAHMAWAN 1 M79.1 1
132 3253 WASIATUR ROHMAH 1 G44 1
133 3263 PUTRI WULAN 1 K29 1
134 3316 AINUL INDAYANIM 1 J06 1
135 3315 HAFIZH ALTHAF 1 J06 1
136 3314 ANINDITA MUFIA 1 J06 1
137 3309 ZAINATUL FARIDA 1 A09 1
138 3340 AHMAD FAJAR ALFARIZI 1 H52.5 1 MATA
139 3336 HERI EKO PRASETYO 1 R73 1
140 3342 MUSIYAM 1 E10 1 DALAM
141 3355 SIADI PRAYITNO 1 E11 1 DALAM
142 3347 RIN MEI POEDJIASTOETIK 1 I10 1
143 3336 HARI EKO PRASETYO 1 R73 1 DALAM
144 3354 RAYHAN ADHAFI DZIKRA 1 M35.7 1 ANAK
145 3373 UMU SALAMAH 1 I25,9 1 JP
146 3312 FAJAR SAMHARIL 1 J02 1
147 3370 FATHONI 1 R73 1 DALAM
148 3382 Zabir Achmad Alamsyah 1 L28 1 KULIT
3328/3
149 1 A09, I10 1
29 RAYHAN ALIF ALGHIFARI
150 3327 RICKY UTAMA 1 J02 1
1513322/3325 ALVIN JANUAR ACHMAD 1 J06 1
152 3332 RAHMA AISYAH ARINDI 1 L01 1
1533264/3266 NUR HAYATI 1 A09 1
154 3340 ahmad fajar alfarizi 1 H52.1 1 MATA
155 3352 IRCHAM HADI 1 K30 1
MUHAMMAD ZHAFRAN
156 3351 1 J06 1
ARROYYAN
CALLISTA ADZKIYA
157 3247 1 R50 1
AZZAHRA
158 3341 1 H60 1
MOHAMMAD ZAINUL ABIDIN
CHARISSA RANDA
159 3331 1 J06 1
ZAHRATUSSITA
160 3335 DJURMAN 1 K30 1
161 3326 NISRINA MAHDIANI PUTRI 1 J06 1
162 3333 VINA AULIA FITRI 1 R50 1
163 3334 MUZAYYIN 1 M22 1
164 3310 ZIDNI EL FIRDAUS 1 J06 1
ARSYFA ANNASYA
165 3321 1 J02 1
ZHAFIRAH
166 3359 M.FATIH 1 M79.1 1
167 3353 TRI ULANDARI 1 J02 1
168 3348 RAAFQI ATHALLAH 1 J06 1
169 3346 SUNARKO 1 E11 1
HAFIDZAH SABRINA
1703374/3375 1 R50 1
RAMADHANI HIDAYAH
MUCHAMMAD NUR
1713366/3367 1 L50 1
HIDAYAH
172 3349 CALVIN BANGKA 1 R11, R06 1
1733364/3365 NADIAN ANNITA RIZKY 1 M79.1 1
1743360/3363WAHJUDI 1 K30 1
175 3392 A. ISMAIL AB 1 N40 1 URO
176 3378 ALEX WIJAYA 1 T14 1
177 3395 MUJIONO 1 J44 1 PARU
178 3394 MUSIYAM 1 H52.5 1 MATA
179 3343 SITI AIS MINURTIN 1 J06 1
1803344/3357PITTER GERET 1 J06 1
1813345/3358WINDY VARADITYA 1 J06 1
182 3391 NAGIYAH EL 1 J06 1
183 3390 DAFINAH ATHIFA 1 J06 1
184 3388 DEVRIEL VINCENZO 1 J06 1
185 3387 DEANDRA AZZALFA 1 J06 1
186 3384 WITONO 1 H81 1
187 3383 ANA ULFA 1 B35 1
188 3381 HANIFAH 1 H81 1
189 3377 ACHAMAD DHANI 1 K29 1
190 3376 AYUDYA MIKHAILA 1 J06 1
191 3369 TIWIK SETYORISMI 1 G44 1
1923397/3398 TITIE DWI JAYANTI 1 J06 1
193 3330 RAHMA FITRIYA 1 H10 1
194 3337 RENIES RIZKA 1 J06 1
195 3339 MUHAMMAD ADAM 1 J06 1
196 3368 ZHAFERA AILEEN 1 L20 1
197 3372 RAISHA MALAIKA 1 B08 1
1983361/3362 HAFIDZAH SAFFANA 1 R50 1
1993379/3380 SOERAT 1 H10 1
2003385/3386SRI MULYATI 1 J06 1
201 3411 M DIRGA 1 A09 1
202 3409 PUJI SUBAGIO 1 H10 1
203 3405 MORITA LISTYA 1 J06 1
204 3371 QURRATUL AINI 1 N39 1
205 3404 ANDRE HERMANSYAH 1 N39 1
206 3403 ABDOR 1 K30 1
207 3401 SUNARKO 1 M79.1 1
208 3399 SUGENG PURNOMO 1 E78,2 1
209 3396 CELYN GITHA 1 I88.9 1
210 3402 TESSA EGY 1 L20 1
2113407/3408 ELOK SURYANINGSIH 1 G44 1
212 3410 PURWANTO 1 J02 1
213 3412 BUDIONO 1 J06 1
214 3424 IRFAN AHMAD ALIF 1 R50.9 1
BAYI NYONYA DWI VEGA
215 3020 1 L23 1
MAYLORRI
216 3423 M RAFFA AL FARIDZI 1 L23 1
217 3422 SUMARSIH 1 K30 1
218 3415 VERAWATI 1 M79.1 1
219 3414 SINTA FEBRIANA 1G44, R50.9, K30 1
220 3413 ACHMAD ZUDI 1 B00.1 1
221 3393 TRI KUMORO 1 A09 1
2223420/3421 HJ. CHOMARIYAH 1 J45 1
2233418/3419 H. RACHMAD 1 L23 1
MUHAMMAD RAZKA
224 3425 SHAQUILANO
1 K30 1
225 3428 BIENDHA 1 I84 1
226 3427 IQBAL RAZIF 1 I84 1
227 3426 AYESHA DWI RAMADHANI 1 J06 1
REYHAN ZAVIER
228 3429 FRISDHITAMA
1 R50.9 1
229 14 214 34 194
230
231 3389 EVI KUSUMAWATI E11.8 1 BEDAH
232
233
234
235
236
237
238
239
240
241
242
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

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162 2 5 23 4 1 11 7 2 1 2 1

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 LAPORAN PELAYANAN RAWAT JAL
BULAN JUN
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3016 NEYSA KAULIKA AZZARINE 1 A09 1

2 3020 AISYAH 1 J45 1
3 3019 AHMAD MUDJIONO 1 E11.7 1 DALAM
3023/3
4 1 E11.7 1
024 AGUS NURYANTO
3021/3
5 1 H60 1
022 SUNARDI SUBROTO
6 3018 DARSONO 1 K30 1
7 3017 M. MUNIF 1 K05 1
8 3015 1 J06 1
WAHYUDI RAHMAD SAFITRI
ADRIAN KEANU
9 3027 1 H52.5 1 MATA
PUNTADEWA
10 3031 ARIS MAULANA 1 J06 1
11 3030 SUSANTI 1 J06 1
12 3033 WIDODO 1 M79.1 1
13 3043 DWI NATAH 1 R50, A09 1
14 3040 PRASETYO 1 J06, K30 1
15 3037 IBRAHIM EFFENDI 1 K30 1
16 3034 AZKADINA EIKO 1 J06 1
3047/3
17 1 H52.5 1 MATA
048 SUDIHARTI
18 3061 MOH ARIF TIRTANA 1 M79.1 1
19 3045 WAHYU BAHARDIAN 1 R10 1
20 3044 KHAWLA SHAFA AMRAN 1 R05 1
21 3062 HANAN FATIH AR RAYYAN 1 R10 1
22 3063 NIDIYA 1 B01 1
23 3090 NIKMATUL CHASANAH 1 H10 1
24 3081 ABDURROHMAN ZAKKY 1 R50, A09 1
3057/3
25 1 E11, J06 1
058 AINI LUTFIYAH
26 3054 EKIN NAUFAL 1 J06 1
27 3053 1 J06 1
PRIMI INDAHSARI KUSUMA
28 3056 EKO HERA SETYO 1 J02 1
29 3092 RISKY WULANDARI 1 A09 1
30 3072 AIRLANGGA MAHARDIKA 1 J06 1
31 3071 WAHYU AGUNG S 1 J06 1
32 3070 NURKHAYATI 1 M79.1 1
33 3052 AHMAD FATHONI 1 H10 1
34 3049 HURUN IN 1 J30 1
35 3050 ALESHA NASYAWA 1 J06 1
36 3051 HASBI FAWWAZ A 1 J06 1
37 3069 KHUDEROTUL YATIMAH 1 R05 1
38 3068 MUHAMMAD ZHAFRAN A 1 A09 1
3100/3
39 1 H04 1
101 SUSMIATI
40 3075 HIDAYAT SANTOSO 1 J30 1
41 3074 DONI WIKAYARDI 1 A09 1
42 3076 ENIS SAFAUZIYAH 1 J06 1
43 3121 APRILIA RACHMAD DAYANTI 1 L28 1 KULIT
44 3039 KLAUDIAISYAH 1 R10 1 DALAM
45 3122 MUDZOFAR 1 T14 1
46 3078 DIAN AZKA V 1 J06, A09 1
47 3084 ABDUL MUIN 1 R07 1
48 3093 SRI LESTARI 1 E11 1
49 3115 1 H00 1
MUHAMMAD BAKHARUDIN F
FIRDHAUS GRESYA THEA
50 3140 1 K58.9 1 DALAM
WARDHANI
51 3139 KASIADI 1 T14 1
52 3135 MUKAROMAH 1 T14 1
3119/3
53 1 L30 1
120 NANIK ROFIATUN
54 3113 MOHAMMAD RAEZAL 1 Z00 1
55 3125 WAHYU WIJAYATI 1 I25 1
56 3038 SULAIMAH 1 E78.3 1
57 3104 LULUK MUFIDAH 1 M13 1
58 3116 NISAUL MARDLIYAH 1 A49 1
59 3109 AHMAD ISWANTO 1 T14 1
60 3112 LAILATUL FITRIA 1 A09 1
61 3111 1 J03 1
MUHAMMAD AKBAR WAHYU
62 3107 MUHAMMMAD DZAKIE F 1 H10 1
63 3106 NAISA MAULIDIA N 1 H10 1
64 3105 BAMBANG TRIONO R 1 K30 1
65 3094 DENIA FEBRIANTI 1 H60 1
66 3087 SHAREEN AQILA Z 1 J06 1
67 3086 ARISHA PUTRI R 1 J06 1
68 3080 BY NY ELLY I 1 J06 1
69 3132 ANNISA IMANI'AH 1 E05 1 DALAM
3153/3
70 SRI MULATININGSIH 1 I10, E11 1
158
3152/3
71 1 E11 1
157 H. SUDJITO
72 3143 MUKAROMAH 1 I10 1
73 3151 SUFI AULIA 1 L50, J06 1
3155/3
74 1 E10.8 1 DALAM
160 SRI MEYDATI
75 3150 TASYABANIA AGUSTIN 1 H52.5 1 MATA
76 3149 SITI ROCHMAH 1 K30 1
77 3148 KHAYLA AMIRA 1 J06, R11 1
MUHAMMAD ZULFAN
78 3146 1 J06 1
AZHAR
79 3134 nur vika arrisqy 1 J02 1
80 3133 DESTRI 1 K30 1
81 3130 ZAQIAH ALISYAH KIRANI 1 J06 1
82 3131 SITI AMINAH MONALISA 1 J06 1
83 3127 DEVY RIZQI AMALIA 1 G56 1
84 3126 ABD MALIK 1 M61.9 1
85 3123 Dzakiy Hanif Darmawan 1 H66 1
86 3108 IRFAN AHMAD ALIF 1 R50 1
3029/3
87 1 M79.1 1
039 MARIANI GALIB
88 3091 MUHAMMAD KEENAN A 1 J06 1
MUHAMMAD REVANO
89 3082 1 J06 1
AZZAFAR
90 3168 HERI SUSILO 1 J06 1
91 3165 1 J06 1
KIKANDRYA CHARMARAIZA
92 3164 TRU AFRIANA H 1 J02 1
93 3163 LERRA KANDHITA 1 J06, R11 1
94 3185 SUNTINI 1 A09 1
95 3202 UMU SHOLICHA 1 S62.4 1 ORTHO
96 3199 MUHAMMAD FAISHAL ARIF 1 S62.4 1 ORTHO
97 3172 ISTIQOMAH 1 K80 1 DALAM
98 3180 ITA MARYUANINGTYAS 1 J06 1
99 3179 RACHEL TAHTA 1 J02 1
100 3178 Izzah Saida 1 H10 1
101 3177 BY NYONYA ISTINING 1 B86 1
102 3176 ISTINING RAHMAWATI 1 B86 1
103 3200 MACHMUD 1 J44 1 PARU
104 3201 RINI NOVITASARI 1 J02 1
105 3203 SHAFA KAYLA A 1 J06 1
106 3204 RANIA SHEZA A 1 A09 1
107 3208 ANIKTRI EKONINGSIH 1 E11 1
108 3205 SHABIRA ARKADEWI 1 R11 1
3193/3
109 1 T14 1
194 MULYONO
3189/3
110 1 I10 1
190 SUARNO
3188/3
111 1 I10 1
191 KISTRI INDRIATI
112 3174 RIYANTO 1 Z00 1
113 3184 RETNO WULANDARI 1 E78.4 1
114 3186 ZAINUL ARIFIN 1 E78.9 1
115 3035 BAMBANG HERMANTO 1 E78.4 1
116 3169 TRISYWAFI A 1 K30 1
117 3073 RIZKI AULIA R 1 E78.4 1
3166/3
118 1 R05 1
167 NINIK HARIANI
119 3161 SUGIATI 1 R51 1
3154/3
120 1 M79.1 1
159 PRIYO SUKOCO
3218/3
121 1 H10 1
219 DIMAMIK FORLINA
122 3214 MUFLICHAH 1 K30 1
123 3213 RIDWAN ISMAIL 1 I84 1
124 3215 OKTAVIANA NUR H 1 N94 1
MUHAMMAD ZAKY
125 3230 1 L30 1
IRFANSYAH
126 3226 DIAFITA 1 K30 1
MUHAMMAD AKMAL RIZQI
127 3225 1 B01 1
MAULUDDIN
128 3223 1 R10 1
SALSABILA NUR KHADIJAH
DEWI PARAMITHA
129 3231 1 J30 1
RAHARJA
130 3235 SUPARNO 1 M79,1 1
131 3232 1 T14 1
CHRISTIAN ISAAC NATHANIEL
MUHAMMAD SHODIFA
132 3195 MAULANA RIZQI 1 T14 1

133 3242 MUDJAH 1 I25.9 1 JP

134 3239 DIANA M 1 I25 1 JP
135 3230 MUHAMMAD ZAKY IRFANSYAH
1 L30 1
MOCHAMMAD ATHAYA
136 3223 GHAISAN
1 R10 1
MUHAMMAD AKMAL RIZQI
137 3225 MAULIDDIN
1 B01 1
138 3226 DIAFITA 1 K30 1
139 3238 MINARNI 1 E11 1
140 3244 MUHAMMAD RICI ROMADHONI
1 G44 1
141 3065 WIWIK RAHAYU 1 M13 1
142 3236 MUHAMMAD RAISA NAUFAL W
1 H10 1
143 3233 SIAMAH 1 M13,E79 1
144 3234 SUMARNO 1 M13 1
145 3245 CEISYA CHALONDRA 1 R50 1
146 3225 MUHAMMAD AKMAL R 1 B01 1
147 3247 MUCHAMMAD ROFI'UDDIN 1 R50 1
148 3251 NUR LAILY QUR'ANI (TP87150)
1 A09 1
149 3253 ARYA HAFIZH WASKITO 1 A56 1 ORT
150 3252 EKO SURYANTO 1 B18.0 1 DALAM
151 3254 ENIK NUR AINI 1 H10 1
152 3257 ANISSA NOVIANA 1 K30 1
153 3262 LUSI ANDRIANING 1 J06 1
154 3025 MIYATUL FADILAH 1 M79.1 1
155 3026 ABDUL JALAL 1 M79.1 1
1563060/3059 EDY BAHTIAR, SE 1 R73 1
1573259/3260 LENY RAKHMAWATI, SSI 1 H81 1
WARDAH ILMIYATUR
158 3240 1 H52.5 1 MATA
ROFIAH
159 3263 Sumiati 1 C50.2 1 BEDAH ONK
160 3043 ADI P 1 A09 1
MUHAMMAD FURQAN
161 3280 1 A15.0 1 PARU
APRIANDA
162 3295 AGUNG BUDIONO 1 i10 1
163 3284 NANIK ERNAMAH 1 I10 1
164 3271 TOPAN HADI 1 J06 1
165 3270 NUNUK NURJIYATI 1 I84 1
166 3269 FARAH RISKY OKINAWATI 1 H65 1
MUHAMMAD ALRAFAEYZA
167 3267 1 J06 1
FACHRESYI
168 3258 AGUSTIN DWI HANDAYANI 1 H10 1
169 3103 SONARNI 1 E11.7 1 DALAM
170 3265 ROSA DWI SASQIA PUTRI 1 A09 1
171 3264 cinta rizkya aisyah najib 1 J06 1
MUHAMMAD ERVIN
172 3279 1 H10 1
YUDIANSYAH
173 3285 FIFIN WIDYA NINGSIH 1 H10 1
174 3276 YOFITA WAHYU ASTUTI 1 M79.1 1
175 3275 HONI NUR WIJAYA 1 J06 1
1763197/3198WITOMO 1 M79.1 1
177 3289 suci rohmaningsih 1 G44 1
178 3288 1 J06 1
muhammad roikhan nawawi
AFKAR NURDIANSYAH
179 3287 1 J06 1
PRADIPTA
180 3283 FARISYA ALYA ZHAFIRA 1 J06 1
181 3282 BACHTIAR EFFENDI 1 T14 1
182 3315 MUHAMMAD MISMARUDDINI 1 j02 1
183 3302 DJUMIATI (GA0740.71) 1 g44 1
184 3300 shulhatul m 1 r50 1

185 3296 SABIAN ALGHIFARY MAKSUM 1 J06 1

186 3297 AZKA 1 J06 1

187 3294 HANDAYANI 1 R73 1
MUHAMMAD DIMAS
188 3286 1 J06 1
SATRIYO
189 3293 ALLENA ALIFIA AZZAHRA 1 H10 1
190 3292 DINA RAHMADANI 1 J06 1
191 3299 MUHAMMAD ALVARONIZAM Z
1 J06 1
192 3291 FATIN AYU ABDILLAH 1 J06,A09 1
193 3298 WINDA ASTARI 1 J02 1
194 3308 FATHIMAH 1 C50.2 1 BEDAH ONK
195 3274 KOICHI HIRATA 1 R50 1
196 3266 AKHMAD QUSYAIRI 1 T14 1
197 3268 SUPARDI 1 1 K30,R11 1
1983272/3273 1 R11,K30 1
DAYINTA ANNISA SYAIFUL
199 3282 BACHTIAR EFFENDI 1 T14 1
KUS RETNANI WIDYATI
200 3316 1 H52.5 1 mata
PARAMITA
201 3321 1 t14 1
202 3317 AHMAD TAOFIK 1 T14 1
203 3290 MUJIONO 1 R60 1
204 3311 IKHWANI MUFIDAH, ST 1 A09,K30 1
205 3307 ABDUL HADI 1 J06 1
206 3306 EDI SANTOSO 1 M79.1 1
207 3301 SHAFIYA NISRINA 1 L30 1
GHAISANI INTAN
208 3319 1 J06,K30 1
MARTIKASARI FAJRIN
MUHAMMAD RIZQI
209 3318 1 K30 1
RIDWANSYACH
210 3320 SARWITONO 1 I10 1
211 3309 ANGGA KURNIAWAN 1 L30,M13 1
212 3326 SRIANI 1 K29 1
213 3314 HERRY SOEWANDI 1 I84 1
214 3304 RUSNITA 1 K29 1
MUHAMMAD IZZUDDIN
215 3323 1 J06 1
ARFAN BARIER
MUHAMMAD WAZIR AKMAL
216 3322 1 R50 1
ALBANA
GWEN SYAREEFA AZZAHRA
217 3303 RAMADHANI
1 J06 1
218 3292 DINA RAHMADANI 1 J06 1
219 3293 ALLENA ALIFIA AZZAHRA 1 H10 1
220 3338 NOER ATY ROSYITA 1 J00, H10 1
221 3337 YULIET VIRGINIA LIVERY 1 J02 1
222 3336 1 R50.9 1
SALSABILA ALISA LESTARI
223 3335 NUR KHOIRIYAH 1 G44 1
MUHAMMAD SYAUQI ASY
224 3334 1 L23 1
SYATHIR
225 3333 UYUN NAIILUFAR 1 M79.1 1
ADNI MAHIRAH TSANIYAH
226 3332 1 K30, R50.9 1
MUDDOFFAR
227 3327 ISKANDAR 1 M79.1 1
228 3325 DIDIK SUJIANTO 1 M79.1 1
229 3324 IRFIANAWATI MUFRIDAH 1 J06 1
ALFARABI ZUHRYAN AINUR
2303345/3346 RAHMAN 1 J06 1
2313343/3344JULAIMAH 1 E11.7 1
2323341/3342 LUTFIAH NUR MASYITHAH 1 L23 1
233 3340 PURNOMO ADI KUSUMA 1 J02 1
234 3339 ABA YAZID 1 G44 1
235 3347 ACHMAD ADITYA NAFAN 1 R50.9 1
236
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ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

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RL 13/06/2022
RL 13/06/2022

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 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3017 TOYIBAH 1 M79.1 1

SHAFIRA MAULIDA
2 3014 1 R50.9 1
AZZAHRA
3026/3
3 1 J06 1
027 WIWIK WAHYUNI
4 3025 AHMAD MARZUQI 1 M79.1 1
5 3023 IQBAL RAZIF 1 M79.1, K30 1
6 3021 YUSRATUL JANNAH 1 M35.0 1
7 3032 LINDA SILFIA 1 D24 1
8 3031 1 J02 1
DIAN RAKHMANU YUWANA
9 3043 ARMAN ARROI'SI IRAWAN 1 H10 1
10 3041 1 J06 1
MUHAMMAD NAZRIL ISHAQI
11 3046 WASIATUR ROHMAH K27 1 DALAM
12 3055 LAKSONO WAHYUDI 1 E11.7 1 DALAM
MUHAMMAD ALMAIR
13 3034 1 h52.5 1 MATA
MOUSSA
14 3064 NANY WIJAYA 1 I25 1 JP
15 3021 YUSRATUL JANNAH 1 R73 1
16 3041 MUHAMMAD NAZRIL ISHAQI 1 J06 1
ARMAN ARROISI IRAWAN
17 3043 (GA0818.24)
1 H10 1
18 3074 VINITA ARIANI 1 L10 1 KK
ARMAN ARROISI IRAWAN
19 3043 (GA0818.24)
1 H10 1
20 3072 AVRILIA RAISTY GARDENA 1 J06 1
21 3063 HANIFA FATMANINGTYAS 1 J06 1
22 3039 ANDREW AGUSTINUS 1 J02 1
23 3061 MUH RAFA AZKA PUTRA 1 J06 1
MUHAMMAD ATHAYA ZAIDAN
24 3059 AMMAR
1 J06 1
25 3058 MISNAN SAPUTRA 1 J06 1
FELICIA AMIRAH LASHIRA
26 3057 1 R50 1
27 3051 HAMIZAN OMAR RABBANI 1 R50 1
 HAIKAL ARDHANA PUTRA
28 3049 DIGDYANTO
1 R50 1
RR TRIATY SH
29 3053 1 T14 1
30 3077 BAGUS ADITA 1 I10,E11 1
3067/3
31 1 T14 1
068 DEWI ASTUTIK
32 3076 ALFARIZI A 1 J06 1
33 3082 aisyah humaira winardi 1 B08.4 1 ANAK
34 3081 SALSABILA AIRA WINARDI 1 B08.4 1 ANAK
35 3084 BASUNI 1 N90 1 PARU
36 3085 1 J44 1 ANAK
NAUFAL AHMAD ALFAREZA
37 3088 1 R73 1 DALAM
NAUFAL AHMAD ALFAREZA
38 3096 ABDULLAH FAKIH 1 I10 1
39 3098 NURUL JALALAH 1 I10 1
TIARA RAHINA
40 3091 1 J06 1
TUNGGADEWI
41 3089 AISYAH NUR AQILAH 1 J06 1
42 3083 LUHUR UDOYONO 1 J02 1
43 3094 ABDUL ALIM 1 I25 1 JP
44 3102 SUTRIYANI 1 K27.0 1 DALAM
45 3092 PARTI RAHAYU, Dra. 1 R50, M79.1 1
46 3107 ABDUL ROZAK 1 K30 1
47 3099 CANDRA SUSENO 1 N20 1 URO
48 3100 IDAYATI 1 E05 1 DALAM
49 3115 MOCH. ILYAS ADNAN 1 I25 1 JP
50 3116 RUPIAH 1 I63 1 SARAF
51 3123 CHUN CHUN WIDJAJA 1 K80,A18 1 DALAM
52 3117 IDAYU SATRIYO 1 I10 1
FAKHRI AL FARIZI HUSAIN ( BY
53 3104 NY FAQIHA R )
1 J06 1
54 3079 MUHIBBIN 1 R50 1
55 3030 LULUK MUFIDAH 1 M13 1
ZHANANDA BAGUS
56 3144 1 T14 1
PRAMUDYATIRTA A
57 36147 SUWARTI 1 I25 1 JP
58 3148 RISNIA FEBRI 1 T14 1
59 3155 NURIA ANINDITA PUTRI 1 T14 1
60 3154 MUSTAQIMAH 1 H81 1
61 3136 ATIKA PUTRI DAMAYANTI 1 K27 1 DALAM
62 3132 CINTA ARZETTY REVANI 1 I10 1
63 3143 HAYKAL B 1 H10 1
64 3142 GADING R 1 H61.2 1
3165/3
65 1 N20 1 URO
166 AHMAD HASAN BASRI
66 3137 ISNAH 1 K30 1
 FETI CHASIATIN NUR
67 3158 FADILLAH
1 j06 1
68 3126 NINDA AYU BISTANOVA SARI 1 Z00 1
3122/3
69 1 M79.1 1
124 IDA MAHCMUDAH
70 3109 LIESA ARDIANY 1 E63.1 1
3101/3
71 1 Z00 1
103 MIFTAH FARID
72 3065 HERI S 1 R50 1
73 3056 A JAVIER 1 K21 1
74 3054 RUHANIK (GA0787.11) 1 R42 1
3050/3
75 1 L30 1
052 SUMI INDARWATI, DRA
3047/3
76 1 J06 1
048 MUHAMMAD ZAINI
77 3127 ZUHROTUL MAFULA 1 H10 1
78 3073 ADINDA RANI FAMELA 1 H00 1
79 3042 NOVI SUJATMIKO 1 J06 1
80 3147 SUWARTI 1 I25 1 JP
81 3157 ULIFATUN WIKHAYA 1 G44 1
82 3152 ALLISA RATNASARI 1 H81 1
83 3150 KUSWATI  1 E78 1
84 3145 NAJMA MAULIDA AZKA KAMILA
1 H10 1
85 3141 ABDULLAH YAZID 1 J06 1
86 3173 NENY SUSANTI 1 H66 1
87 3138 MOCHAMMAD LUFFY AWWALA
1 J06 1
88 3139 ANGELI ARISTA PUTRI 1 H10 1
ABIDAH MA'RIFATILLAH
89 3134 TSANIATIL ULA
1 H10,R50 1
90 3130 RAISHA HANINDA AZZALEA 1 R50,A09 1
SANDYA HALWA AZZURA
91 3125 AHMAD
1 J06 1
92 311 LAILATUL KHOIRO 1 K30 1
93 3110 MUHAMMAD ISTIQOM 1 G44 1
94 3030 LULUK MUFIDAH 1 J06 1
ARIQAH DZAKIYAH NUR
95 3170 TALITA
1 R11 1
96 3149 GRESICHA TITALYANDA R 1 L25.9 1
97 3161 IKA RIZQI FEBRIYANTI, S.H 1 K30 1
98 3151 BETTY HANDAYANI 1 M19 1
99 3153 SUTRISNO 1 R42 1
100 3192 ATHA RASYID SABILUL 1 J06 1
101 3190 ABRISAM FAZAL GUINANDRA
1 J06 1
102 3191 RAJA RAHMAD K 1 L25.9 1
103 3188 1 J06 1
104 3182 RIYOHADI 1 J06 1
105 3201 MOH ERIK IRLIANTA 1 s83.1 1 ort
3015/3
106 1 N40 1 URO
016 SUHERIADI
107 3202 AMARENDRA ATI NIRMALA 1 B86 1
108 3200 ANDI RASHATI 1 M79.1 1
109 3194 SUKARSIH (GA1022.71) 1 B86 1
110 3193 PARLIN  1 M79.1 1
111 3205 MUHAMAD RIFAS MURGAN 1 Z00 1
112 3207 1 J45 1 ANAK
ALESHA NASYWA FARZANA
113 3206 AHMAD FATHONI 1 J00 1
114 3203 ZAYBA NAQIYYA AZALIA 1 J06 1
115 3205 MUHAMMAD RIFAS M 1 Z00 1
116 3222 bernardius soewandie 1 I10, E11 1
117 3213 MAHMUDI 1 I10 1
118 3214 KHOIRUN NISAK 1 E11, I10 1
119 3218 MISBAKHUL KHAFIDZ 1 T14 1
120 3219 AHMAD FATHONI 1 H10 1
121 3209 HIDAYAD BAHARDIAN 1 J06 1
122 3210 MUHAMAD KAFI K 1 J06 1
123 3212 AKHMAD KHOIRUN 1 J06 1
124 3216 SALSABILA RAHMA I 1 J02 1
125 3227 MUHAMMAD WIDIANTO 1 G44 1
126 3226 FERRY ARDIANSYAH 1 J06 1
127 3220 HIDAYATUL UMAH 1 G44 1
128 3221 DEWI AISYAH 1 E78.4 1
129 3231 ZAFIN RIZQIYA A 1 J06, R11 1
130 3229 ZAKIYAH RIZKY R 1 J02 1
131 3236 NAJMUL RIZQI 1 H52.5 1 MATA
132 3241 DIDIK SUPRAYITNO 1 K30 1
133 3240 IS YULIARTI 1 G44 1
3237/3
134 SITI HAJAR 1 K30 1
238
135 3233 NAURA YASMIN A 1 J06 1
136 3228 1 R50 1
DY RETTA MERSLYTHALIA
IDHAM AHMAD
137 3232 1 R11, R50 1
FERDIANSYAH
138 3244 SUBAGYO 1 E11 1
139 3239 HARTIK AGUSTINI 1 K29 1
GRENIA FREYA PUTRI
140 3250 1 H52.5 1 MATA
NUGROHO
141 3255 MOH ADNAN 1 T14 1
142 3253 ADE MUHAMMAD WILDAN 1 K29 1
MUHAMMAD HENDRA
143 3252 1 B35 1
GUNAWAN
144 3248 RAFIF ALI A 1 J02 1
145 3242 KUSWATI  1 L50 1
146 3234 SUDJAIYAH 1 G44 1
147 3243 ISYUDIN 1 J06 1
148 3257 KULAIFAH 1 I10 1
149 3269 ESTU AGUNG 1 M79.1 1
MUHAMMAD RIFKY
150 3274 1 A01 1
ALFARIEDHO AFLAH
151 3273 RIFAN DWI PRASETIYO 1 J02 1
152 3268 NUR KHASANAH 1 K29 1
153 3260 OKTAVELINA 1 K29 1
154 3295 SHABRINA SALSABILA 1 H00.1 1 MATA
155 3290 MUHAMMAD DAMAR W 1 R06, R07 1
156 3306 MURHAFLINA 1 G54, M54.5 1 SARAF
157 3324 RUSLAN SANAY 1 I11, K76 1 DALAM
158 3292 ARUMI SEA NALADHIPA 1 L20 1
159 3308 RAISA NAWLA S 1 J02, K30 1
160 3322 NUR NOVIANTI 1 O21.9 1
EARLYTA ARSYFA
161 3314 1 L01 1
SALSABILA
162 3275 KEVIN EDNA 1 R50 1
163 3297 RISKA NURUL 1 J06 1
1643302/3303 MUNANDAR 1 M79.1 1
165 3311 HERU JANUARDI 1 K30 1
166 3265 MUHAMMAD ZAIDI 1 M79.1 1
167 3258 KEANU ADAM SISWANTO 1 J06 1
168 3256 TIKA APRILIA 1 A09 1
169 3257 KULAIFAH 1 I10 1
170 3267 1 J06 1
CANTIKA PUTRI MAHARANI
171 3279 DEBBY TUTUR E 1 L20 1
172 3335 SHOCHIB 1 C11 1 BEDAH ONK
173 3341 BANY SATRIYAGUNG 1 J45 1
174 3343 INDRASARI YUNIASTUTIK 1 H61.2 1
1753342/3344 NUR MUHAMMAD Q 1 J06 1
176 3345 DICKY EKO SUSILO 1 K01 1
177 3339 MARYAM SHANUM 1 H10 1
178 3340 LATIFATUL ROCHIMAH 1 H10 1
179 3321 MAULIDA BILQIS 1 J06, R50 1
180 3310 AHMAS SHODIQ 1 B35 1
181 3312 MUTIARA ILMA 1 J06 1
182 3315 MUH ABRISAMI 1 R05 1
183 3313 HAIKAL ILMI D 1 J06 1
184 3316 EVI SUSANTI 1 B86 1
185 3317 SAUFA ZAKSIA K 1 B86 1
186 3323 AUDREY DWI M 1 R50,A09 1
187 3325 DEWI AYU 1 K30, J02 1
188 3327 ARISKA DEVI 1 K30 1
189 3326 M FAHMI AMMAR 1 H10 1
190 3334 INDAH AGUSTINE W 1 R05 1
191 3330 BAMBANG AJI 1 L60 1
192 3338 SUTOPO MOKODOMPIT 1 H60 1
1933270/3271 MUHAMMAD ASRI 1 Z00 1
194 3280 GABRIELLA BELINDA 1 L25.4 1
1953262/3263 HARIYANTO 1 H04 1
1963259/3261SATRIYO 1 J06 1
197 3254 AIDAH HALIMATUS S 1 K30 1
198 3249 OMOCH RIZAL R 1 H10 1
1993245/3246 LIA ROHMAWATI 1 K30 1
200 3272 RACHMAD DENY D 1 J02 1
201 3277 ALYA FAUZIYATUL 1 A09 1
202 3276 REVA KHANSANIA A 1 T14 1
203 3305 MOCH NAUFAL CHANDRA 1 L50 1
204 3230 ALFIYAH 1 K27 1
205 3304 MUHAMMAD SOLAHUDDIN 1 J02 1
206 3301 MAULANA MUHAMMAD IBRAHIM
1 J06 1
207 3300 FARIDATUL AINI 1 J02 1
208 3299 RINDY AURELLIA W 1 J06, K30 1
209 3296 SHINTA DEWI 1 K04 1
210 3282 AISYAH QYRANI 1 K29 1
211 3291 LAILATUL MUSHOFA 1 B02 1
212 3289 NISA ELINA KAMIA 1 K30 1
213 3288 VINA AULIA F 1 A09 1
214 3286 AFINI ISMA H 1 J06 1
215 3285 REYNAND PRADIPTHA 1 J06 1
216 3281 BY NY LAILIA DWI 1 R50 1
217 3278 MUHAMMAD HAFIDZ 1 A09 1
2183328/3329 EDY SUHARTO 1 K30 1
2193336/3337 AGUS SANTOSO 1 R50 1
220 3333 YUNITA AFSARI 1 H61.2 1
2213293/3292 SAKUAT 1 R50 1
222 3331 AYANDRA SADAWIRA 1 R50 1
223 3349 KAYYIS SYARIF 1 J06 1
224 3348 ABDUL QODIR 1 H10 1
225 3351 RACHMAD MULYONO 1 T14 1
226 3350 JAJUK RESMIATI 1 M79,1 1
227 3307 FARIDAH NURHAYATI 1 1 G44 1
228 9 216 0 30 197 0
229
230
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
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BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

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P PROKES K
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TGL KONTROL
ADMED
TINDAKAN
LAIN

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PRB
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RL 14/06/22
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3
 LAPORAN PELAYANAN RAWAT JA
BULAN JU
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3354 TITIN MARDIANA 1 K05 1

2 3353 ACHMAD DIKI ARIVALDI 1 J06 1
3 3014 SANGAT PRIHATNO 1 L93 1 DALAM
4 3018 MACFUD 1 A88 1
3015/3
5 1 K30 1
016 SRI AMAH
6 3013 PALUPI IDA SETIANINGSIH 1 E10 1
3006/3
7 1 J06 1
007 DJUNAIDI
8 3005 MOHAMMAD FAROCHAN 1 A09 1
9 3003 NUR KUMALA 1 K30 1
10 3023 NOVA RIDA 1 R50 1
11 3020 LAILATUL FITRIYAH 1 K30 1
12 3029 NELI WULANSARI 1 H10 1
13 3026 RIZA MAHENDRA 1 H10 1
14 3021 NURKHAYATI 1 M79.1 1
15 3035 ROESDIANTO 1 E11 1
3032/3
16 1 I25 1 JP
034 SRININGSIH
3031/3
17 1 I25 1 JP
033 WAHYU BUDIONO
18 3055 AGUS PRASETYO 1 I25 1 JP
19 3056 ROHMAT MAHMUDI 1 M10 1
20 3043 NUR FAIQOH 1 B35 1
21 3063 SUPRIYONO 1 E11 1
22 3077 ALI FAUZI 1 N40 1 URO
23 3017 YUNUS FORQONI 1 M22 1 ORTO
24 3083 ACHMAD BASUKI 1 I11 1
25 3082 NUR CAHYO 1 I11 1 JP
26 3090 SRI INDARJATI 1 S42 1 ORTO
3036/3
27 1 1 R50, LEUKOSITOPENIA 1
034 DAYINTA ANNISA
3114/3
28 1 D63.8 1 DALAM
115 AULIA RAHMA DINIAR
29 3108 NUR FITRIA HANDAYANI 1 O02, Z30.5 1 OBGYN
3121/3
30 1 H52.5 1 MATA
112 TIWUL WIJI ASTUTI
31 3125 SHEZA ZAHEEN ADENA CAHYANI 1 H10, H52.5 1 MATA
32 3083 ACHMAD BASUKI 1 I10 1
33 3075 SURAJI 1 E11 1
34 3110 ROHMAT MAHMUDI 1 G44 1
35 3130 FATIMAH GHANIA ACHMAD 1 T14 1
36 3136 FAUJUL DWI ANGGRAINI 1 H52.5 1 MATA
BAYI NYONYA ELISA
37 3128 1 P07 1 ANAK
HANDAYANI
38 3131 SANUSI RACHMAN 1 E11 1 DALAM
39 3134 ENDANG TRISNOWATI 1 E11 1
40 3135 SATRIA TIRTA AR R 1 T14 1
3123/3
41 1 M79.1 1
124 IKHSAN
42 3106 RAHMAH 1 H10 1
43 3103 IRFAN JAINURI 1 J06 1
3098/3
44 1 R05 1
092 DJOKO SUPRIJANTO
45 3095 BUDI PRABOWO 1 J06 1
SHEZA KAMALIYAH
46 3079 1 J06 1
SALSABILA
47 3078 SUKIMIN 1 J06, M79.1 1
48 3072 DWI IMAM UTOMO 1 J06 1
3059/3
49 1 J06 1
060 IFFAN AL BAIHAQI
3057/3
50 1 J06 1
056 ERNI SULISTIANINGSIH
51 3107 REVA SABRINA NABILA 1 J06 1
52 3105 SOEHARNI 1 M79.1 1
53 3104 SALAMAH  1 I84 1
54 3009 ROSARI DEWI 1 Z00 1
55 3102 SUFI AULIA NURHAYATI 1 J02 1
56 3100 MOH. KHOIRUL ANAM 1 J02 1
57 3092 NABILAH RAZAN 1 J06 1
HENY RAMBU KATARINA
58 3094 1 T14 1
LAWA JATI
59 3089 FATKHUR SHODIKIN 1 A54 1
60 3088 ENI MUSLIMAH 1 L30 1
61 3087 RIZKY HASBY DZAKY 1 J06 1
62 3085 SUNARKO 1 M10 1
63 3084 HEKSARI 1 A09 1
SHAFIRA MAULIDA
64 3041 1 B08.4 1
AZZAHRA
65 3074 MUHAMMAD AKBAR FAIZIN 1 H10 1
66 3065 IMAM MA'MURI 1 A88.1 1
67 3062 SRI SULASTRI 1 K30 1
68 3061 GEDE ARDIASA 1 J02 1

69 3144 MUHAMMAD FARDHANA 1 J06 1

ATHALLAH ANDREANSYAH
70 3143 1 J02 1
ATAYA FIKRIEZA RIZQULAH
BAYI NYONYA SHINTA
71 3139 1 J06 1
AISYIYAH
 RAFARDHAN ATALLAH
72 3137 1 R50 1
PUTRA
73 3127 NAYLA PUTRI ALIZA 1 L30 1
74 3126 MAULIDATUL IZZAH 1 A88.1 1
75 3120 IMAM WAHYUDI 1 K30 1
76 3117 KHUSNI MUBAROK 1 J06 1
77 3116 maisarah nafsyah salimah 1 H10 1
78 3138 SHINTA AISYIYAH 1 J06 1
3118/3
79 1 R05, J06 1
119 RR TRIATY SH
80 3153 MOHAMMAD SALEH 1 M79.1, I10 1
81 3159 ANGGORO ANDI 1 T14 1
3140/3
82 1 J02 1
141 NAZAR BHAKTI
MUHAMMAD NABIL
83 3157 1 J06 1
SYABANI RAFFASYA
84 3162 TAMINAH 1 I25 1
KHANZA INARA MARYAM
85 3150 1 J06 1
SETYABUDI
MOHAMMAD KEVIN RIDLO
86 3158 1 J02 1
MAHBUBY
muhammad azka dzikri
87 3132 1 J06 1
alkholifi
88 3049 ANDI RASHATI 1 E78.4 1
89 3142 JESSICA GRACE 1 J02 1
3166/3
90 1 E11 1
167 WARSITO
3160/3
91 1 J02 1
161 SUHARTONO
3154/3 DIAMONICA NATALIEANO
92 1 R42 1
155 KORE
93 3152 DELPHI MELENIA 1 Z00 1
94 3151 SURYATI NINGSIH 1 I25 1
3147/3
95 1 M79.1 1
148 ERNIK ZUMRIYAH
96 3093 MUNIROH MAHMUDAH 1 E78.4 1
3163/3
97 1 M79.1 1
164 ADI ARIYANTI
98 3146 FATHAN NUR RAFIF 1 J06 1
99 3145 LOITA DATU N 1 J06 1
100 3109 CITRA PUTRI KARUNA 1 J06 1
101 3012 1 J06 1
RENNY CHANDRA PUSPITA
102 3165 NUR AINI 1 B00 1
103 3156 NURJANNAH 1 K92.1 1 DALAM
104 3170 MOH. MAKHIN 1 E11.7 , I64 1 DALAM
105 3171 EMBUN TANISHA ERINA 1 J06 1
106 3168 VERAWATI 1 F20 1
107 3174 AZKA FATIMAH 1 L20 1
108 3173 NUR VIKA A 1 J06 1
109 3172 WININGSIH 1 J02 1
110 3149 NUR ALIYAH Y 1 A01 1
111 3177 KINANTI QIANDRA 1 J06 1
112 3178 ACHMAD QEYLAN R 1 J02 1
113 3179 YUNI ASTUTI 1 T14 1
114 3086 SUPARMAN 1 E11 1
3183/3
115 1 R06.0, K30 1
184 RR TRIATY SH
116 3182 BUNGA SALSABILA 1 M25.2 1 ORTHO
117 3187 1 M79 1
3185/3
118 1 G44 1
186 GIYANTI
MUHAMMAD ATHAFARID
119 3189 1 R11 1
RADEA ALFARIZKY
3180/3
120 1 Z00 1
181 PUTRI RAHMANDA
121 3190 RIZKY ARDYANSYAH 1 R50, K30 1
122 3175 SULASTRI 1 K29 1
123 3234 SUNATUS SHOLIKHA 1 H61.2 1
3241/3
124 1 A09 1
242 MOH ZHAFI HAMIZAN RABBANI
125 3233 ALIF HIDAYATI 1 J06 1
126 3232 HALWA AZKADINA SHAFA 1 J02 1
127 3231 APRILIA WULANDARI 1 H10 1
3229/3
128 1 K30 1
230 RUMYANI WIDJIASIH
IBRAHIM NAZRIL AL
129 3228 1 A09 1
GIFFARI
MUHAMMAD SYAHREZA
130 3227 1 J02 1
ZUHRI
3225/3
131 1 K30 1
226 DARSONO
MUHAMMAD MUZAKKY
132 3208 RAHMAN
1 M54.5 1
133 3199 SOENARJATI 1 I11 G20 1 JP
134 3251 Rafka Akmalil Fuad 1 F80 1 ANAK
135 3195 PUJI LAILATHUL HIKMAH 1 R50, A09 1
136 3193 SALHAM RIADI 1 H39 1
137 3192 SAMSUL EFENDI 1 J02 1
138 3191 AYUDYA MIKHAILA AZZANI 1 R05 1
139 3194 HAIDAR SUTA NUGRAHA 1 R50, J06 1
140 3198 DEWI ZULAICHAH 1 J06 1
141 3197 ABDULLAH WASIAN 1 J06 1
142 3196 RIZKI RAHMAWAN 1 H10 1
143 3224 METHALIA RISKAWATI 1 J02 1
AISYAH PUTRI HUMAIRAH
144 3223 1 J06 1
ZUHRI
RAYYAN AKHYAR LABIB AGEL
145 3222 P
1 J02 1
146 3221 ELIS INDRA 1 J02 1
147 3220 MUBLIKAH 1 M79.1 1
148 3219 NURUL ROCHMA YUNITA 1 L20 1
149 3217 HUSNA DARLIANA SPD 1 A88.1 1
150 3215/3216INAWATI 1 J45 1
151 3213/3214 MUHAMMAD ZAMRONI 1 J02 1
MUHAMMAD VIKHO
152 3212 1 J02 1
ROMADHONI
153 3211 1 H61.2 1
DENIA FEBRIANTI LESTARI
154 3243 SUPIIN 1 H52.5 1 MATA
MUHAMMAD HENDRY
155 3209 1 J06 1
BAGUS DWI HARDIANTO
156 3207 DODY ALFAYED 1 L20 1
157 3206 NUR HAYATI 1 J45, K29 1
158 3205 1 R50, K30 1
AISYAH SYAFAATUR ROHMA
159 3203/3204 YAHYA SADOLI 1 I11 1
160 3202 HARIYONO 1 J02 1
161 3200/3201 SUHARNO 1 J40 1
162 3176 1 J06 1
MUHAMMAD IHSAN MUZAKI
163 3252 DJAALAH 1 I10 1
MUHAMMAD NASHIHUL
164 3249 1 J06 1
AMIN
165 3250 RIZKA RAHMAWATI 1 H10 1
166 3248 YOFITA WAHYU ASTUTI 1 T14 1
LAILIYAH RAHMAWATI
167 3253 1 J06 1
ASROR
ANINDYA SHAKILA AZ
168 3247 1 J06, K30 1
ZAHRA
169 3244 VERDIAN INTAN SOFYANI 1 J02 1
170 3256 DHIKA RAMADHANNY PUTRA 1 E78, E79 1
171 3240 MOHAMMAD MIFTAH 1 J06 1
172 3239 LAILATUL QOMARIYAH 1 J02 1
173 3245 M IQBAL AL AYUBI 1 L50 1
174 3238 VELLANIKA SARASATI 1 J06 1
MOHAMMAD RIZA
175 3237 1 J06 1
KURNIAWAN
176 3236 MELLISA TIRTAYANA 1 J02 1
177 3235 MUHAMMAD ARDANI RIZQI 1 J06 1
178 3271 NANANG MAKRUF 1 k27 1
179 3261 DITO RAKHADITA SAPUTRA 1 f20.0 1 KJ
180 3210 NASIKA 1 I11, M79.1 1
181 3259 NUR SHOLIHAH 1 K29 1
182 3260 RULLY SUSANTO 1 A09 1
183 3257 MUTAROFAH 1 R10 1
LILIK SETYOWATI
184 3254 1 J02 1
185 3265 LIES SRIANANINGSIH 1 I10 1
186 3262 LUBABAH HIDAYATI NURO 1 R11, A09 1
187 3263 GALUH AJENG GUMPITASARI
1 J06 1
188 3264 TRI DIDIK P 1 M79 1
189 3255 1 J06 1
190 3266 MUJIONO 1 M79 1
MUHAMMAD HAFTSANI
191 3267 1 R50 1
MUSLIM
192 3268 RIFQY SOVIARIN PUTRI 1 H10 1
193 3269/3270 CHALIMATUS SA'DIYAH 1 A09 1
194 3272 NASTAINUL FIRDAUS ZAMZAMI
1 A09 1
195 3273 AKBAR BAGOES MARDWIKA 1 L50.9 1
196 3274 MOH NOVAL MAULUDIN 1 J02 1
197 3278/3280 SUJITNO 1 J02 1
198 3276 FETI FEBRIANI 1 H40 1 MATA
199 3302 SYIFA BRYNA 1 R10 1
200 3283 ELSHA RONA 1 J06 1
201 3284 ANNISA ZAHRA 1 R50 J06 1
202 3285 ISMAILAH 1 H10 1
203 3289 IQBAL HANIF 1 R50 1
204 3309 AZRA ANINDYA 1 E10 1
205 3287 MUH RAFA AZKA 1 H10 1
206 3311/3312 KAMILA AZZAHRA 1 R50 1
207 3307 LAILATUZ ZAKIYAH 1 K29 1
208 3306 ALYA RAMADHANI 1 J06 1
209 3304 BAGUS ADITA 1 J06 1
210 3303 AISYAH ALEXANDRA 1 J06 1
211 3301 CALLISTA AZZAHRA 1 J06 1
212 3300 NUR ALFAH 1 J02 1
213 3297/3299 RETNO UNRARINI 1 M79.1 1
214 3295/3296 IFAN PRIJANA 1 J02 1
215 3294 SITI AISYAH 1 M79.1 1
216 3317 KHADIJAH ZAHROTUS 1 R50 1
217 3316 MUQBILLA SYAHRIAH 1 K29 1
218 3314 PUTUT PRIO TAMTOMO 1 J02 1
219 3313 IDA YANI 1 I11 1
220 3315 ARIF PRABOWO 1 K30 1
221 3310 VITAHUR ROHMAH 1 K29 1
222 14 207 0 23 198 0
223
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
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287 1 1
288 1 1
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294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
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BULAN JUNI 2022

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B PG ANPER ASURANSI LAIN

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 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3308 ENI WINDRIASTUTI 1 I11 1 JP

2 3321 MUKHLIS 1 H60 1
3 3320 TRI TEDI SETIAWAN 1 R50 1
4 3322 MUHAMMAD CALIEF 1 J06 1
3318/3
5 1 K29 1
319 PUTHUT TRI WIDODO
6 3004 SIROJ MUNIRUZ 1 J02 1
7 3003 MUHLISHOTUL 1 R50 1
8 3002 USMAN KHOLIM 1 H10 1
9 3001 RISCA MARDIANA 1 M79.1 1
3016/3
10 1 I11 1
017 SUNYOTO
11 3018 SITI NURJANAH 1 I11 1
12 3021 CHORIYAH 1 J06 1
3023/3
13 1 E10 1
022 SUDIHARTI
14 3019 ANISA RAHMA 1 L20 1
3014/3
15 1 H10 1
015 SRI HARTINI
16 3013 ARIF RACHMAN 1 A09 1
3011/3
17 1 B35.6 1
012 WIWIK SOEPENI
3009/3
18 1 I11 1
010 IMAM SJAFI I
3006/3
19 1 E10 1
007 WIWIK JULIATI
3005/3
20 MUHAMMAD AFFANDI 1 E10 1
008
21 3038 DJATMIKO 1 E11.7 1 DALAM
22 3039 ANIYAH 1 E11 1
23 3049 SULISTIYOWATI 1 E11 1
24 3063 TUTIK SRIANI 1 E11 1
25 3061 NURUL HIBATULLAH 1 K30, J06 1
26 3062 DIZZY NINDYA PRISWARI 1 J02 1
27 3060 SHANIKA SEVA AMORA 1 J06 1
 CINDY WIDYA PARAMITA
28 3058 1 J06 1
SOSELISA
29 3057 ARYANTI 1 H10 1
30 3056 ENDAH KUSUMAWATI 1 H10 1
31 3053 GARRY GERALDY 1 J06, K30 1
LIENTJE LINNETE
32 3052 1 G44 1
DOENGGIO
33 3033 SITI ANIFAH 1 I11 1
34 3037 AIMAR KEENAN RAFFASYA 1 R50.9 1
35 3047 TRI WAHJOENI 1 J06 1
36 3046 NOFITA SARI 1 J06 1
37 3045 1 J06 1
AHMAD DAFIT NURIL RIZKY
38 3041 KALAMUN 1 A09, K30 1
AR SAKHA GHAISAN
39 2024 1 J06 1
MUHAMMAD THOLIB
AL FATIH GIBRAN
40 3025 1 J06 1
MUHAMMAD THOLIB
41 3035 1 E04 1
AYU ANITA DIANARA ARINI .
MUHAMMAD NASIR AL
42 3030 1 H00 1
MUHAIMIN
43 3044 TSANIYAH NUR FAJRIA 1 J06 1
44 3048 MUHAMMAD DANIAL AZIZI 1 J06, M54.5 1
45 3040 SAIFUL HARIS 1 B02.9 1
3042/3
46 1 I10 1
043 DJOKO SANTOSO
3080/3
47 1 N60.9 1 B. ONK
081 SRI HARYATI
48 3083 MARISA 1 J02 1
49 3082 1 A09 1
AQILLA MASHEL RAFAILAH
50 3075 SITI AISYAH 1 D64.9 1
51 3029 ALFI MASRUROH 1 R50 1
52 3028 ABDULLAH 1 J45 1
MUHAMMAD RAFA EL
53 3078 1 B86 1
FARABI
54 3077 1 M54.5 1
NUR AFIFAHTUL ISLAMIYAH
MOH. AGUS BADRUZ
55 3076 1 I84 1
ZAMAN
56 3074 SRI MARTINI 1 H10 1
57 3059 MUTAROFAH 1 N39 1
MOHAMMAD ILHAM WAHYU
58 3072 1 H61.2 1
PRAYOGI
59 3071 1 H60 1
AULIA KUSUMA RAMADHANI
60 3070 ENDAH KUSUMAWATI 1 J00 1
DENNY NATALIA
61 3094 1 O20 1 OBGYN
62 3088 AHMAD FATHIR ALFATH 1 R50.9 1
63 3086 ADE MUHAMMAD WILDAN 1 K30 1
64 3085 HERU SETYAWAN 1 H10 1
65 3084 NURUS SOBAH. 1 K30, J06 1
66 3068 MARIYAM 1 G44, A88.1 1
KHARISMA AISYAH
67 3067 1 J06 1
RAMADHANI
68 3093 NABILAH SALMA K 1 R50 1
3091/3
69 1 J06 1
092 ELLY SUBIYANTO
70 3096 Renny Feriwanti 1 I45, I50.9 1 JP
71 3095 Djoko Sri Widodo 1 I25, I11.9 1 JP
72 3089 JOVI ARYAGUNA CAHAYA 1 J06 1
73 3090 1 J06 1
DWI ANGGUN KRISNA WATI
74 3087 FEBBY ZAHRUL FIRDAUS 1 H10 1
MUHAMMAD FAIQ MIRZA ULUL
75 3064 AZMI
1 J06 1
3054/3
76 1 G44 1
055 EVI NURUL HIDAYATI
ETIKA ARTINING TYAS
77 3101 (GA1015.42)
1 Z00 1
78 3107 MOH. MUNIR 1 I25 1 JP
79 3106 1 R50 1
ILHAM TIYANTO SAPUTRO
3104/3
80 1 M79.1 1
105 SRI ERI SUNARTI
3102/3 MUHAMMAD HAFIZ
81 1 L08.0 1
103 OKTARISKY
MUHAMMAD KEVIN
82 3099 ELVARETTA 1 R50.9, K30 1
BALAPRADHANA FIGO
HAIKAL ARDHANA PUTRA
83 3098 1 R50.9 1
DIGDYANTO
84 3100 DANDUNG KASIATNO 1 H10, J06 1
85 3097 ROHMAT MAHMUDI 1 S90 1
86 3108 AFIIF PERDANA PUTRA 1 L23 1
87 3110 ANDREW AGUSTINUS 1 J05.1 1 DALAM
88 3114 ERNI PUDJIWATI 1 K27, G54.2 1 DALAM
89 3112 SHAFA AMEERA LAFATUNNISA
1 K30, J06 1
90 3113 YUHARTO 1 G61.0 1
91 3117 MOH ABDUL ROZAK 1 M79.1 1
92 3116 YULIASTUTI 1 G56.0 1
93 3115 ACHMAD YUSUF 1 H10 1
94 3119 BAMBANG AJI 1 M67.4 1 BEDAH
95 3125 AMIN TOHARI 1 I63 1 SARAF
96 3121 NATHISA IXORA J 1 J06 1
97 3118 LEO HAIDAR D 1 J06 1
98 3122 MUTHIAH ANPHALIS J 1 J06 1
99 3120 SUTOMO TIKABRATA 1 J06 1
100 3123 FITYAH AMARYLLIS J 1 J06 1
3126/3
101 1 R05 1
127 MUHAMMAD IRCHAM M
102 3124 M AFIFUDIN N 1 R50 1
103 3128 MUHAMMAD FARIS H 1 J06 1
NAAZNEEN FARZANA
104 3129 1 J06 1
ORNELLA
105 3133 AINUR RAHMAH, S.AK 1 J30 1
AYU KUSUMA NOVIANTI
106 3134 1 J06 1
RACHMAWINAS
AYSHILA QANITA AULIA
107 3132 1 J30 1
RAHMAH
108 3135 TUKIRAN 1 R11 1
3130/3
109 1 J06 1
131 NAZAR BHAKTI
MUHAMMAD ADSA
110 3140 1 J06, R50 1
ALFIANSYAH
111 3136 EKO AGUS PURWANTO 1 L20 1
112 3141 MAS BUDIANTO 1 J06 1
113 3138 DEVI MANDASARI 1 H10 1
114 3139 RAISSA KIRANA 1 K04 1
115 3143 ARIF RACHMAN 1 E11 1
116 3159 aldizar muhammad 1 T14 1
117 3158 ASHABALQORYATI 1 M79.1 1
118 3156 MUHAMMAD SALMAN 1 R50.9 1
119 3155 BONAR SIMON S 1 J06 1
120 3160 NATASYA TRI C 1 B08.4 1
121 3161 MUHAMMAS AFFAN A 1 J06 1
122 3150 DWI REDI S 1 T14 1
123 3162 MOCH. ZAINULR A 1 R50 1
124 3166 salma idzni m 1 r07.4 1
125 3168 LILIK HANDAYANI 1 R05 1
126 3169 NOVIA RIZKY R 1 J06 1
127 3167 LUKMAN HAKIM 1 Z00 1
128 3170 ACHMAD FADIL S 1 J06, R50 1
129 3147 M SAID 1 J06, M79.1 1
130 3145 PUTRI ELISA R 1 R50 1
131 3142 FAHRUL AZIZ 1 J06 1
132 3144 MUHAMMAD GHILBY A 1 J45 1
133 3178 M NURHAN AFKAR F 1 J32 1 ANAK
134 3154 ZAKI AHMAD KHALFA 1 J02 1
 3173/3
135 1 I10 1
174 FARIDA HANUM
3171/3
136 1 E11 1
172 HERY CAHYONO
137 3175 1 J02 1
SHALIHUDDIN BAHARSYAH
138 3176 1 J06 1
GRACECIA DWI OKTAVIANI
139 3177 1 H10 1
MUHAMMAD ALFIN ALFAHRI
VIZCARRA MUSTIKA PUTRI
140 3179 1 G44 1
APRILIA
141 3180 ZUHROTUN NISA 1 J06, H10 1
142 3181 AINUL INDAYANIM 1 J06 1
143 3182 MUHAMMAD ALI K 1 J02 1
144 3189 RISWANDI 1 h90.3 1 THT
145 3184 WAHYU TRIWIYOKO 1 J06 1
146 3185 HERJUNO RAFKA 1 J06 1
147 3186 ALFIAN BAGASTIO 1 J06 1
148 3183 ZEHA AYESHA 1 R50, J30 1
149 3193 FATKHUR ROZI 1 L20 1
150 3190 MUHAMMAD ANDIESA P 1 K04 1
151 3109 MUSTIKA TRIA W 1 1 R42 1
152 3212 WIDYA RAHMAWATI 1 F00 1 JIWA
MUHAMMAD RAIHAN
153 3211 1 F90 1 JIWA
FAYYADI ARIGA
1543199/3200 NINING ROFIQOH 1 J06 1
155 3197 AZKA SYHATIR 1 R11, A09 1
156 3196 MAULIDA TRYATAMA 1 J06 1
157 3195 MAS WAFIKA W 1 J06 1
158 3194 MARIYATIS 1 G44 1
MUHAMMAD GHUFRAN
159 3216 1 H52.5 1 MATA
RAMDHANI
160 3213 SIGIT PRAYITNO 1 J06 1
161 3214 REIHAN BAYU SATRIA 1 M79.1 1
162 3195 ANDIK SUPRIYONO 1 J06 1
163 3217 MUHAMMAD AZHIIMI ROFI 1 B35.4 1
164 3208 RETNO AYU P 1 R50 1
MEISYIFA AULIA
165 3210 1 R50 1
DWIANTORO
166 3203 CAHYA NAYYARA 1 R50 1
1673201/3202RAFI MUHARRAM 1 J06 1
168 3220 CUT TITIEN KEMALASARI 1 I10 1
169 3218 HENDRY HERMAWAN 1 J02 1
170 3221 EMILDA ROCHANA 1 I10 1
171 3219 SUMI 1 G44 1
172 3204 ESTI AULIA P 1 J02 1
173 3209 MUHAMMAD FADHIL 1 J02 1
174 3215 MUHAMMAD AZZAM F 1 H10 1
175 3223 AGUNG PRIHANTO 1 H81 1
176 3222 AZKA SATRIA 1 J06 1
177 3224 NANDA DWI RAHMAWATI 1 A09 1
178 3226 SITI MUFAIDAH 1 J06 1
179 3225 PUTRI DELIA 1 J06 1
180 6 173 0 16 163 0
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
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258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
PELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
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1
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RACHMI 1
1
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0 114 0 5 5 19 2 0 0 0 0 1 19 2 0 8 0 0 2 0 0 0 1
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N
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TINDAKAN
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PRB
PRB
PRB
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IRIGASI TELINGA
 INJ

SKS

1 SOLISI MEDIKA

INJ
EKSTRASI KUKU
16/06/2022

PRB
RL 12/06/2022

INJ
MRS DG AMBULANCE KEHORISON
GRAHU

INJ

PRB

INJ
 APS MRS

1
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 3062 VITA HURROHMAN 1 K29 1

2 3041 DEWANTORO 1 J06 1
3 3071 EMY TRIANA 1 G44 1
4 3095 HAWWA KHANSA 1 K29 1
5 3151 MUHAMMAD IZZUDDIN 1 R50 1
6 3150 CAHYO ADHI HERYONO 1 K25 1
7 3149 ABDULLAH YAZID 1 J06 1
3153/3
8 1 T14 1
154 MURNI
9 3158 HIDAYATI 1 T14 1
3165/3
10 1 I11 1
166 SITI CHULAFAH
11 3162 MUKHAMAD SYAIKU 1 K40 1
3159/3
12 1 K30 1
160 WINARTI
13 3157 CHOLIDZ 1 I25 1 JP
14 3156 DJUMAIYAH 1 R73 1 DALAM
15 3173 SAMI AN 1 H52,2 1
3168/3
16 1 H81,1 1
169 WASITO
17 3170 DIAN RAKHMANU 1 J02 1
18 3189 LUTFI 1 C11.9 1 THT
19 3284 LITA ERISANTI 1 H52.5 1 MATA
20 3329 HENNY NILAWATI 1 J45, J44 1 PARU
21 3336 SUPI AH 1 G44 1
3327/3
22 1 H52.5 1 MATA
328 UNTUNG HARSONOTO
23 3319 YAZID 1 H52.5 1 MATA
24 3321 SHOFIYAH 1 H52.5 1 MATA
25 3312 FIANDO ZACKY ARDHANI 1 F80 1 ANAK
26 3318 MUKAROMAH 1 T30 1
27 3259 MEGA SURYANINGSIH 1 O00.0 1
28 3357 KALAMUN 1 K27.0 1 DALAM
29 3359 MASLI'AH 1 A15.0, J18.9 1 PARU
 3410/3
30 1 E11.7 1 DALAM
411 PRAPTI ANDAYANI
31 3393 SULIANAH 1 K27.0 1 DALAM
32 3391 SUMADI 1 H52.5 1 MATA
33 3392 1 H52.5 1 MATA
AIDA TASYA RAHMADHANIA
34 3396 1 H52.5 1 MATA
NIMAS FARAH WULANDARI
35 3424 Sri Suwarti 1 C50 1 B. ONK
36 3418 ANEST SUPARNO 1 e10.7, i11 1 DALAM
37 3430 AKHMAD KHUSAERI 1 I10, L23 1
SULTAN RAKHA AL
38 3388 1 J06, K30 1
SYAHBANI
39 3390 NELLY OCTAVIANTI 1 J06, E78 1
40 3369 PRATAMA AKBAR 1 K30 1
41 3371 SURAIFAYANTI 1 H52.5, I10 1
CLAUDIA TRI RAHMAWATI
42 3354 1 K30 1
PUSPANINGRUM
43 3353 FATIMAH ELMIRA RAIHANA 1 J06 1
AS'AD SYAUQY FIRDAUS
44 3355 1 J06 1
EL-TSANY
AMSYAR RIZQI
45 3283 1 R50.9 1
NURHAMIZAN
46 3332 AHMAD FATHIR ALFATH 1 R50.9 1
47 3333 ASTRI HANDARINI 1 R50.9 1
48 3426 WAHYU ULIL AZMI 1 K04.0 1
49 3376 SAMSUL EFENDI 1 J06 1
50 3375 ROHMAT MAHMUDI 1 S90 1
51 3322 ALFIYAH DRA 1 E78.4 1
52 3347 MUHAMMAD ULIN NUHA 1 M79.1 1
53 3367 ARIF MASRUR ROSADI 1 J06 1
54 3360 DHEFIN EL FATIH 1 J06 1
55 3358 OMEGA KEYTA ARTI 1 H10.3 1
56 3348 MIRZA NUR ZAKIRA 1 J06 1
57 3344 1 J02 1
NIA NUR IKA NAILATUL IZZA
58 3326 YUSUF BATHIK 1 J02 1
59 3324 ANNISA JIHAN ZAHIRA 1 J06 1
60 3323 NUR WACHIDA 1 J02 1
61 3313 ASMAUL CHUSNA 1 M79.1 1
SHAYNALA AZQIARA
62 3300 1 J00 1
ELSHANUM
63 3297 REIGA YUSRA ATTAQI 1 J00 1
YULIANA
64 3265 1 J02 1
ROKHMAYANTINingrum
65 3273 KHOIRUN NADHORI 1 M19.9 1
66 3262 ILHAM BAYU S. 1 T14 1
 DAVINA GENDISSYIA CITRA
67 3247 1 J06 1
PRAYOGa
68 3248 1 J02 1
ERWIN NANANG PRAYOGO
3314/3
69 1 G54.2 1 ORTH
315 EKA PENADI
70 3325 SUHERI 1 R11 1
NATASYAH RIZQI AMALIAH
71 3316 1 S94 1
SU'UDI
72 3302 FAIRUS SHALEH FAHRURI 1 J06 1
73 3301 ISTIE YULIAN ANGGRAENY 1 M10 1
74 3320 RODLIFATUL LAILIYAH 1 L50 1
75 3305 AFIF MUSSABIQ 1 J02 1
3298/3
76 1 J45 1
299 SRI MULYANI
77 3293 NENY BUDIARTI 1 M19 1
3252/3
78 1 G54.2 1
254 KUSTI HARTINI
79 3250 SUNARLI 1 M79.1, K30 1
80 3229 DELISHA FARZANA AZZAHRA 1 J02, R11 1
81 3191 DENNY RESDIANA 1 R50, M79.1 1
82 3222 SJAIFUL CHAQ 1 H25 1
83 3217 RAIN HAJJAR AR RASYID 1 H10 1
3180/3
84 1 S00 1
181 TRI YULIANI
85 3241 HAMIZAN OMAR RABBANI 1 R50 1
86 3261 PRASETYO 1 K30 1
87 3260 ELYYS SUSWATI 1 L23 1
88 3255 TUTIK FARIDAH 1 K30 1
89 3253 MUHAMMAD JAWARI 1 K30 1
DHIANITA
90 3234 1 J00 1
SULISTIYONINGRUM
91 3233 AULIA EMBUN AZZAHRA 1 J06 1
MARITZA RAMADHANI
92 3220 1 J00 1
PUTRI PRASETIYO
MUHAMMAD ZHAFRAN
93 3219 1 A09 1
ALHABIB
94 3209 SUTARNO 1 S20 1
95 3207 IS YULIARTI 1 G44, I10 1
MUHAMMAD RAFA AR
96 3206 1 J02 1
RAYYAN
97 3190 ARIF KURNIAWAN 1 M79.1 1
KENJIRO ASYAM
98 3186 1 J00 1
HIDAYATULLAH
MOHAMMAD AZKA
99 3185 1 J06, K30 1
MARCELLO GHALIBIE
100 3184 EKA WISNOE BOEDI 1 H10 1
 MAULANA YAHYA HAFIDZI
101 3182 1 J06 1
BASSAM
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
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1
1
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1
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RSMG 1
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RSGH 1
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RSML 1
RSGH 1
RSPG 1
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1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN

MRS/RSGH/AMBULANCE

INJ

RL
INJ
SENTANA ADIDAYA
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN
 LAPORAN PELAYANAN RAWAT JALAN
BULAN JUNI 2
Nama Faskes : Klinik Satelit Kalimantan

Alamat : Jl. Kalimantan No. 29-31 GKB Gresik

UNIT DI RUJUK

UGD
M
P TUJUAN
NO NO REG NAMA PESERTA R DX
J M O RUJUK
S YA TDK
K E L
K D I

1 1 1
2 1 1
3 1 1
4 1 1
5 1 1
6 1 1
7 1 1
8 1 1
9 1 1
10 1 1
11 1 1
12 1 1
13 1 1
14 1 1
15 1 1
16 1 1
17 1 1
18 1 1
19 1 1
20 1 1
21 1 1
22 1 1
23 1 1
24 1 1
25 1 1
26 1 1
27 1 1
28 1 1
29 1 1
30 1 1
31 1 1
32 1 1
33 1 1
34 1 1
35 1 1
36 1 1
37 1 1
38 1 1
39 1 1
40 1 1
41 1 1
42 1 1
43 1 1
44 1 1
45 1 1
46 1 1
47 1 1
48 1 1
49 1 1
50 1 1
51 1 1
52 1 1
53 1 1
54 1 1
55 1 1
56 1 1
57 1 1
58 1 1
59 1 1
60 1 1
61 1 1
62 1 1
63 1 1
64 1 1
65 1 1
66 1 1
67 1 1
68 1 1
69 1 1
70 1 1
71 1 1
72 1 1
73 1 1
74 1 1
75 1 1
76 1 1
77 1 1
78 1 1
79 1 1
80 1 1
81 1 1
82 1 1
83 1 1
84 1 1
85 1 1
86 1 1
87 1 1
88 1 1
89 1 1
90 1 1
91 1 1
92 1 1
93 1 1
94 1 1
95 1 1
96 1 1
97 1 1
98 1 1
99 1 1
100 1 1
101 1 1
102 1 1
103 1 1
104 1 1
105 1 1
106 1 1
107 1 1
108 1 1
109 1 1
110 1 1
111 1 1
112 1 1
113 1 1
114 1 1
115 1 1
116 1 1
117 1 1
118 1 1
119 1 1
120 1 1
121 1 1
122 1 1
123 1 1
124 1 1
125 1 1
126 1 1
127 1 1
128 1 1
129 1 1
130 1 1
131 1 1
132 1 1
133 1 1
134 1 1
135 1 1
136 1 1
137 1 1
138 1 1
139 1 1
140 1 1
141 1 1
142 1 1
143 1 1
144 1 1
145 1 1
146 1 1
147 1 1
148 1 1
149 1 1
150 1 1
151 1 1
152 1 1
153 1 1
154 1 1
155 1 1
156 1 1
157 1 1
158 1 1
159 1 1
160 1 1
161 1 1
162 1 1
163 1 1
164 1 1
165 1 1
166 1 1
167 1 1
168 1 1
169 1 1
170 1 1
171 1 1
172 1 1
173 1 1
174 1 1
175 1 1
176 1 1
177 1 1
178 1 1
179 1 1
180 1 1
181 1 1
182 1 1
183 1 1
184 1 1
185 1 1
186 1 1
187 1 1
188 1 1
189 1 1
190 1 1
191 1 1
192 1 1
193 1 1
194 1 1
195 1 1
196 1 1
197 1 1
198 1 1
199 1 1
200 1 1
201 1 1
202 1 1
203 1 1
204 1 1
205 1 1
206 1 1
207 1 1
208 1 1
209 1 1
210 1 1
211 1 1
212 1 1
213 1 1
214 1 1
215 1 1
216 1 1
217 1 1
218 1 1
219 1 1
220 1 1
221 1 1
222 1 1
223 1 1
224 1 1
225 1 1
226 1 1
227 1 1
228 1 1
229 1 1
230 1 1
231 1 1
232 1 1
233 1 1
234 1 1
235 1 1
236 1 1
237 1 1
238 1 1
239 1 1
240 1 1
241 1 1
242 1 1
243 1 1
244 1 1
245 1 1
246 1 1
247 1 1
248 1 1
249 1 1
250 1 1
251 1 1
252 1 1
253 1 1
254 1 1
255 1 1
256 1 1
257 1 1
258 1 1
259 1 1
260 1 1
261 1 1
262 1 1
263 1 1
264 1 1
265 1 1
266 1 1
267 1 1
268 1 1
269 1 1
270 1 1
271 1 1
272 1 1
273 1 1
274 1 1
275 1 1
276 1 1
277 1 1
278 1 1
279 1 1
280 1 1
281 1 1
282 1 1
283 1 1
284 1 1
285 1 1
286 1 1
287 1 1
288 1 1
289 1 1
290 1 1
291 1 1
292 1 1
293 1 1
294 1 1
295 1 1
296 1 1
297 1 1
298 1 1
299 1 1
300 1 1
ELAYANAN RAWAT JALAN TINGKAT PERTAMA (RJTP)
BULAN JUNI 2022

JENIS JAMINAN

B PG ANPER ASURANSI LAIN

P
KET P U
P PROKES K
RUJUK J P K P G M P T W I
K 3 S C SURI PER
S KRY KLG S Y N S U J E I MM N PJB
B.PR PLAV D P M M G TANI LAIN
K K G A L L H
G

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
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 KET./
N
TGL KONTROL
ADMED
TINDAKAN
LAIN