DAFTAR RAWAT JALAN BPJS DI DALAM GEDUNG DAN LUAR GEDUNG

PUSTU / POLINDES : SEPARAH BULAN : juli TAHUN : 2019

PEMERIKSAAN FISIK
NO TGL/KUNJ NO KARTU NAMA PENDERITA KELUHAN DIAGNOSA THERAPI
KESADARAN TB BB TENSI RESP NADI

1 0000765742072 SALENA gatal-gatal composmentis 162 68 130/90 20 80 myalgia dexa, amox

2 0000765772345 DEKKIR pusing, kaku leher composmentis 154 64 170/100 18 80 hypertensi captop, ibup
3 0000765790299 MASRIYEH batuk, pilek, panas composmentis 130 34 90/60 18 80 ispa amox, ibuprof, dexa
4 0000765792742 ABDULLO batuk, pilek, panas composmentis 145 36 90/60 18 80 ispa amox, ibuprof, dexa
5 0000765797365 JURI batuk, pilek, panas composmentis 150 50 100/60 20 80 ispa amox, ibuprof, dexa
6 0000765810652 FATIMA batuk, pilek, panas composmentis 134 36 90/60 20 84 ispa amox, ibuprof, dexa
7 0000765905207 NADROH gatal-gatal composmentis 120 29 90/60 20 84 dermatitits dexa, amox
8 0000765924581 JURIYEH nyeri uluh hati composmentis 150 64 130/90 20 80 gastritis antasida, dexa
9 0000765864472 MAYA nyeri uluh hati composmentis 152 58 130/90 20 80 gastritis antasida, dexa
10 0000765890526 WAHAB batuk, pilek, panas composmentis 166 60 120/80 18 78 ispa amox, ibuprof, dexa
11 0000765897153 HUZAIMAH sakit gigi composmentis 171 61 120/80 18 78 salkit gigi amox, ibuprof, dexa
12 0000765903431 MIA linu-linu composmentis 154 62 140/90 20 78 myalgia ibuprof, b comp, dexa
13 0000765923321 KURNIA nyeri uluh hati composmentis 153 56 110/80 20 78 gastritis antasida, dexa
14 0000765978107 SOLIHIN nyeri uluh hati composmentis 162 62 110/80 20 78 gastritis antasida, dexa
15 0000766016256 RISKIYAH batuk, pilek, panas composmentis 130 34 90/60 18 80 ispa amox, ibuprof, dexa
16 0000766023884 ISRO batuk, pilek, panas composmentis 145 36 90/60 18 80 ispa amox, ibuprof, dexa
17 0000766028553 RAHMA batuk, pilek, panas composmentis 150 50 100/60 20 80 ispa amox, ibuprof, dexa
18 0000766037608 ALIYEH batuk, pilek, panas composmentis 134 36 90/60 20 84 ispa amox, ibuprof, dexa
19 0000766044549 FAJROH gatal-gatal composmentis 120 29 90/60 20 84 dermatitits dexa, amox
20 0000766048487 MISYATI batuk, pilek, panas composmentis 133 31 90/60 20 84 ispa amox, ibuprof, dexa
21 0000766061054 SITTI sakit gigi composmentis 160 67 130/90 20 80 salkit gigi amox, ibuprof, dexa
22 0000766082799 HAIRIYAH linu-linu composmentis 152 58 130/90 20 80 myalgia ibuprof, b comp, dexa
23 0000766084746 SANIYAH batuk, pilek, panas composmentis 166 60 120/80 18 78 ispa amox, ibuprof, dexa
24 0000766087288 NASIFAH sakit gigi composmentis 151 61 120/80 18 78 ispa amox, ibuprof, dexa
25 0000766097324 SARIPA batuk, pilek, panas composmentis 167 62 140/90 20 78 myalgia ibuprof, b comp, dexa
26 0000766099135 AMINA nyeri uluh hati composmentis 153 56 110/80 20 78 gastritis antasida, dexa
27 0000766102757 AGUS nyeri uluh hati composmentis 152 48 110/80 20 78 gastritis antasida, dexa
28 0000766109248 HOSIMAH linu-linu composmentis 165 57 120/80 20 80 myalgia ibuprof, b comp, dexa
29 0000766117438 HOSNIYEH batuk, pilek, panas composmentis 148 50 110/80 20 80 ispa amox, ibuprof, dexa
30 0000766125562 INDAH linu-linu composmentis 155 57 140/90 20 80 myalgia ibuprof, b comp, dexa
31 0000766133008 HANAFI gatal-gatal composmentis 145 45 120/80 20 80 dermatitits dexa, amox
32 0000766138061 TOMIMAH sakit mata composmentis 165 59 120/80 18 80 conjungtivitys amox, ibuprof, dexa
33 0000766148927 SULIHA pusing, kaku leher composmentis 146 60 180/100 18 80 hypertensi captop, ibup
34 0000766151921 SUKARNI pusing, kaku leher composmentis 154 64 170/100 18 80 hypertensi captop, ibup
35 0000766153427 ANGGI batuk, pilek, panas composmentis 150 48 90/60 18 80 ispa amox, ibuprof, dexa
36 0000766161641 SIRI nyeri uluh hati composmentis 145 49 90/60 18 80 gastritis antasida, dexa
37 0000766169548 RAMYAH batuk, pilek, panas composmentis 150 54 100/60 20 80 ispa amox, ibuprof, dexa
38 0000766221456 MAYUHA batuk, pilek, panas composmentis 154 46 90/60 20 84 ispa amox, ibuprof, dexa
39 0000766228083 LUTFIYAH gatal-gatal composmentis 49 53 90/60 20 84 dermatitits dexa, amox
40 0000766231929 RUMSIYAH batuk, pilek, panas composmentis 147 56 90/60 20 84 ispa amox, ibuprof, dexa
41 0000766237061 HOSEN batuk, pilek, panas composmentis 123 26 90/60 20 84 ispa amox, ibuprof, dexa
42 0000766238411 SUMRIYAH pusing, kaku leher composmentis 150 51 180/100 20 84 hypertensi captop, ibup
43 0000766242966 ROHANI batuk, pilek, panas composmentis 169 71 90/60 20 84 ispa amox, ibuprof, dexa
44 0000766248186 IKRIDAH nyeri uluh hati composmentis 156 62 110/80 20 80 gastritis antasida, dexa
45 0000766267986 MASTURAH nyeri uluh hati composmentis 153 49 90/60 20 80 gastritis antasida, dexa
46 0000766288089 FITRI AYU linu-linu composmentis 168 69 130/90 18 80 myalgia ibuprof, b comp, dexa
47 0000766306563 NOR AINI batuk, pilek, panas composmentis 169 72 120/80 18 80 ispa amox, ibuprof, dexa
48 0000766312762 ULIN linu-linu composmentis 152 58 140/90 24 88 myalgia ibuprof, b comp, dexa
49 0000766319027 HAMLIYAH gatal-gatal composmentis 151 55 140/90 20 80 dermatitits dexa, amox
50 0000766325463 YASID nyeri uluh hati composmentis 164 62 110/80 20 80 gastritis antasida, dexa
51 0000766406968 MULISA batuk, pilek, panas composmentis 152 49 120/80 18 80 ispa amox, ibuprof, dexa
Mengetahui Bangkalan,
Kepala Puskesmas Banjar Pj. Pelayanan Puskesmas Banjar
Kecamatan Galis Polindes Separah

Ns.H.MOH.TOHA.S.Kep.MM.Kes RISKA AMELIA

NIP. 19670525 198903 1 008
 DAFTAR RAWAT JALAN BPJS DI DALAM GEDUNG DAN LUAR GEDUNG

PUSTU / POLINDES : SEPARAH BULAN : FEBRUARI TAHUN : 2017

PEMERIKSAAN FISIK
NO TGL/KUNJ NO KARTU NAMA PENDERITA KELUHAN DIAGNOSA THERAPI
KESADARAN TB BB TENSI RESP NADI

1 0000765743253 SYAFIIH linu-linu composmentis 168 70 130/90 20 80 myalgia ibuprof, b comp, dexa
2 0000765743747 SUTIAH linu-linu composmentis 170 68 130/90 20 80 myalgia ibuprof, b comp, dexa
3 0000765744254 SAYADI batuk, pilek, panas composmentis 150 60 120/80 18 78 ispa amox, ibuprof, dexa
4 0000765745007 SNIWAN sakit gigi composmentis 154 61 120/80 18 78 salkit gigi amox, ibuprof, dexa
5 0000765750879 SAMIAN linu-linu composmentis 167 72 140/90 20 78 myalgia ibuprof, b comp, dexa
6 0000765751476 FATIMA nyeri uluh hati composmentis 166 70 110/80 20 78 gastritis antasida, dexa
7 0000765751746 FARIHAH nyeri uluh hati composmentis 149 55 110/80 20 78 gastritis antasida, dexa
8 0000765776204 SALINA linu-linu composmentis 163 67 120/80 20 80 myalgia ibuprof, b comp, dexa
9 0000765777137 ROMLAH batuk, pilek, panas composmentis 148 58 110/80 20 80 ispa amox, ibuprof, dexa
10 0000765777161 YAIMAN linu-linu composmentis 150 57 140/90 20 80 myalgia ibuprof, b comp, dexa
11 0000765777251 WIDATUL HASANAH gatal-gatal composmentis 165 15 120/80 20 80 dermatitits dexa, amox
12 0000765777519 MUSLIM sakit mata composmentis 151 55 120/80 18 80 conjungtivitys amox, ibuprof, dexa
13 0000765782392 MOH SAID pusing, kaku leher composmentis 166 68 180/100 18 80 hypertensi captop, ibup
14 0000765782482 ROSIDEH pusing, kaku leher composmentis 154 64 170/100 18 80 hypertensi captop, ibup
15 0000765782752 SULIHA batuk, pilek, panas composmentis 130 34 90/60 18 80 ispa amox, ibuprof, dexa
16 0000765783167 FARIDEH batuk, pilek, panas composmentis 145 36 90/60 18 80 ispa amox, ibuprof, dexa
17 0000765784236 MUNASSEH batuk, pilek, panas composmentis 150 50 100/60 20 80 ispa amox, ibuprof, dexa
18 0000765785259 SAMSUL batuk, pilek, panas composmentis 134 36 90/60 20 84 ispa amox, ibuprof, dexa
19 0000765785384 ABDUSSALAM gatal-gatal composmentis 120 29 90/60 20 84 dermatitits dexa, amox
20 0000765785529 ST AISA batuk, pilek, panas composmentis 133 31 90/60 20 84 ispa amox, ibuprof, dexa
21 0000765785845 FARIYAH sakit gigi composmentis 160 67 130/90 20 80 salkit gigi amox, ibuprof, dexa
22 0000765797635 RASMANI linu-linu composmentis 152 58 130/90 20 80 myalgia ibuprof, b comp, dexa
23 0000765806275 MOH AMIN batuk, pilek, panas composmentis 166 60 120/80 18 78 ispa amox, ibuprof, dexa
24 0000765822194 MUSTOFA sakit gigi composmentis 151 61 120/80 18 78 ispa amox, ibuprof, dexa
25 0000765822227 LUTFIYAH batuk, pilek, panas composmentis 167 62 140/90 20 78 myalgia ibuprof, b comp, dexa
26 0000765822374 MUZAYYANAH nyeri uluh hati composmentis 153 56 110/80 20 78 gastritis antasida, dexa
27 0000765828167 SUKDI nyeri uluh hati composmentis 152 48 110/80 20 78 gastritis antasida, dexa
28 0000765829372 JUMI linu-linu composmentis 165 57 120/80 20 80 myalgia ibuprof, b comp, dexa
29 0000765829416 SULFIA batuk, pilek, panas composmentis 148 50 110/80 20 80 ispa amox, ibuprof, dexa
30 0000765832059 SODIK linu-linu composmentis 155 57 140/90 20 80 myalgia ibuprof, b comp, dexa
31 0000765832689 FARHAN gatal-gatal composmentis 145 45 120/80 20 80 dermatitits dexa, amox
32 0000765833319 TIPAH sakit mata composmentis 165 59 120/80 18 80 conjungtivitys amox, ibuprof, dexa
33 0000765833804 IDA pusing, kaku leher composmentis 146 60 180/100 18 80 hypertensi captop, ibup
34 0000765835659 MUHID pusing, kaku leher composmentis 154 64 170/100 18 80 hypertensi captop, ibup
35 0000765836324 SLIYA batuk, pilek, panas composmentis 150 48 90/60 18 80 ispa amox, ibuprof, dexa
36 0000765837843 SENNA nyeri uluh hati composmentis 145 49 90/60 18 80 gastritis antasida, dexa
37 0000765838765 NAKIDEH batuk, pilek, panas composmentis 150 54 100/60 20 80 ispa amox, ibuprof, dexa
38 0000765849284 ABDUS SHOMAD batuk, pilek, panas composmentis 154 46 90/60 20 84 ispa amox, ibuprof, dexa
39 0000765849339 MISNATI gatal-gatal composmentis 49 53 90/60 20 84 dermatitits dexa, amox
40 0000766084926 ABDUL KAMAR batuk, pilek, panas composmentis 147 56 90/60 20 84 ispa amox, ibuprof, dexa
41 0000766084994 MANIYAH batuk, pilek, panas composmentis 123 26 90/60 20 84 ispa amox, ibuprof, dexa
42 0000766092532 MUHYI pusing, kaku leher composmentis 150 51 180/100 20 84 hypertensi captop, ibup
43 0000766092824 SULIHA batuk, pilek, panas composmentis 169 71 90/60 20 84 ispa amox, ibuprof, dexa
44 0000766093059 ARIS nyeri uluh hati composmentis 156 62 110/80 20 80 gastritis antasida, dexa
45 0000766093353 SAFIIH nyeri uluh hati composmentis 153 49 90/60 20 80 gastritis antasida, dexa
46 0000766093735 ZEMMIL linu-linu composmentis 168 69 130/90 18 80 myalgia ibuprof, b comp, dexa
47 0000766107775 SUKRI H batuk, pilek, panas composmentis 169 72 120/80 18 80 ispa amox, ibuprof, dexa
48 0000766107865 ROHIMAH linu-linu composmentis 152 58 140/90 24 88 myalgia ibuprof, b comp, dexa
49 0000766107909 MARHAMAH gatal-gatal composmentis 151 55 140/90 20 80 dermatitits dexa, amox
50 0000766107966 ANIS nyeri uluh hati composmentis 164 62 110/80 20 80 gastritis antasida, dexa
51 0000765908065 MUNAK IM batuk, pilek, panas composmentis 152 49 120/80 18 80 ispa amox, ibuprof, dexa

Mengetahui Bangkalan,
Kepala Puskesmas Banjar Pj. Pelayanan Puskesmas Banjar
Kecamatan Galis Polindes Separah

Ns.H.MOH.TOHA.S.Kep.MM.Kes SITI JUHAIRIYAH

NIP. 19670525 198903 1 008
 DAFTAR RAWAT JALAN BPJS DI DALAM GEDUNG DAN LUAR GEDUNG

PUSTU / POLINDES : SEPARAH BULAN : MARET TAHUN : 2017

PEMERIKSAAN FISIK
NO TGL/KUNJ NO KARTU NAMA PENDERITA KELUHAN DIAGNOSA THERAPI
KESADARAN TB BB TENSI RESP NADI

1 0000766824164 AMYAH batuk, pilek, panas composmentis 134 76 90/60 20 84 ispa amox, ibuprof, dexa
2 0000766835728 NAWATI linu-linu composmentis 150 48 90/60 18 80 myalgia ibuprof, b comp, dexa
3 0000766842862 MATROMLI batuk, pilek, panas composmentis 134 26 90/60 20 84 ispa amox, ibuprof, dexa
4 0000766843784 JUNIF batuk, pilek, panas composmentis 123 26 90/60 20 84 ispa amox, ibuprof, dexa
5 0000767190429 SATTIMA pusing, kaku leher composmentis 150 51 180/100 20 84 hypertensi captop, ibup
6 0000767194222 HARIYANTO batuk, pilek, panas composmentis 133 31 90/60 20 84 ispa amox, ibuprof, dexa
7 0000767200612 MANIRAH nyeri uluh hati composmentis 156 62 110/80 20 80 gastritis antasida, dexa
8 0000767202333 MUSEYYENA nyeri uluh hati composmentis 134 29 90/60 20 80 gastritis antasida, dexa
9 0000767217025 SAMSUKDIN linu-linu composmentis 168 69 130/90 18 80 myalgia ibuprof, b comp, dexa
10 0000767230266 ANISA batuk, pilek, panas composmentis 152 49 120/80 18 80 ispa amox, ibuprof, dexa
11 0000767235104 KALIMAH linu-linu composmentis 164 60 140/90 18 80 myalgia ibuprof, b comp, dexa
12 0000767240695 SISEH gatal-gatal composmentis 151 55 140/90 20 80 dermatitits dexa, amox
13 0000767244137 ZAINAB linu-linu composmentis 162 68 130/90 20 80 myalgia ibuprof, b comp, dexa
14 0000767264365 UMMI HANI nyeri uluh hati composmentis 162 62 110/80 20 78 gastritis antasida, dexa
15 0000767268696 FAISEH batuk, pilek, panas composmentis 130 34 90/60 18 80 ispa amox, ibuprof, dexa
16 0000767273106 MUZAI batuk, pilek, panas composmentis 145 36 90/60 18 80 ispa amox, ibuprof, dexa
17 0000765736503 MUNIR batuk, pilek, panas composmentis 150 50 100/60 20 80 ispa amox, ibuprof, dexa
18 0000765737021 AHMAD batuk, pilek, panas composmentis 134 36 90/60 20 84 ispa amox, ibuprof, dexa
19 0000765741868 HANIFAH gatal-gatal composmentis 120 29 90/60 20 84 dermatitits dexa, amox
20 0000765746065 ABDUL KOMAR batuk, pilek, panas composmentis 133 31 90/60 20 84 ispa amox, ibuprof, dexa
21 0000765761826 SAIR sakit gigi composmentis 160 67 130/90 20 80 salkit gigi amox, ibuprof, dexa
22 0000765764526 NURHASANAH linu-linu composmentis 152 58 130/90 20 80 myalgia ibuprof, b comp, dexa
23 0000765765325 HOSNA batuk, pilek, panas composmentis 166 60 120/80 18 78 ispa amox, ibuprof, dexa
24 0000765772312 SAMSIYAH sakit gigi composmentis 151 61 120/80 18 78 ispa amox, ibuprof, dexa
25 0000765774202 SALIMA batuk, pilek, panas composmentis 167 62 140/90 20 78 myalgia ibuprof, b comp, dexa
26 0000765776079 FERI nyeri uluh hati composmentis 153 56 110/80 20 78 gastritis antasida, dexa
27 0000765791111 HABIBEH nyeri uluh hati composmentis 152 48 110/80 20 78 gastritis antasida, dexa
28 0000765792088 BEDRIH linu-linu composmentis 165 57 120/80 20 80 myalgia ibuprof, b comp, dexa
29 0000765793495 HOIRI batuk, pilek, panas composmentis 148 50 110/80 20 80 ispa amox, ibuprof, dexa
30 0000765748607 TAUFIQ linu-linu composmentis 155 57 140/90 20 80 myalgia ibuprof, b comp, dexa
31 0000765750306 ANGGA gatal-gatal composmentis 145 45 120/80 20 80 dermatitits dexa, amox
32 0000765755561 MUKRITI sakit mata composmentis 165 59 120/80 18 80 conjungtivitys amox, ibuprof, dexa
33 0000765764234 ALFIYAH pusing, kaku leher composmentis 146 60 180/100 18 80 hypertensi captop, ibup
34 0000765765178 TIYAH linu-linu composmentis 167 57 140/90 20 80 myalgia ibuprof, b comp, dexa
35 0000765771726 SUPIYAH gatal-gatal composmentis 145 45 120/80 20 80 dermatitits dexa, amox
36 0000765772817 HOIRI sakit mata composmentis 151 55 120/80 18 80 conjungtivitys amox, ibuprof, dexa
37 0000765776046 IRA pusing, kaku leher composmentis 166 68 180/100 18 80 hypertensi captop, ibup
38 0000765787127 MAIMUNA pusing, kaku leher composmentis 154 64 170/100 18 80 hypertensi captop, ibup
39 0000765790266 SONHAJI linu-linu composmentis 150 48 90/60 18 80 myalgia ibuprof, b comp, dexa
40 0000765790299 MASRIYEH batuk, pilek, panas composmentis 145 36 90/60 18 80 ispa amox, ibuprof, dexa
41 0000765791526 MOH FARHAH batuk, pilek, panas composmentis 170 74 100/60 20 80 ispa amox, ibuprof, dexa
42 0000765792742 ABDULLO batuk, pilek, panas composmentis 154 46 90/60 20 84 ispa amox, ibuprof, dexa
43 0000765794439 HENDRI gatal-gatal composmentis 120 29 90/60 20 84 dermatitits dexa, amox
44 0000765795205 AHMADI batuk, pilek, panas composmentis 147 56 90/60 20 84 ispa amox, ibuprof, dexa
45 0000765796149 SULIS batuk, pilek, panas composmentis 123 26 90/60 20 84 ispa amox, ibuprof, dexa
46 0000765803384 AMSORI pusing, kaku leher composmentis 150 51 180/100 20 84 hypertensi captop, ibup
47 0000765794621 UMMI batuk, pilek, panas composmentis 133 31 90/60 20 84 ispa amox, ibuprof, dexa
48 0000765797332 SULAIMAN nyeri uluh hati composmentis 156 62 110/80 20 80 gastritis antasida, dexa
49 0000765802631 MALIYAH nyeri uluh hati composmentis 153 49 90/60 20 80 gastritis antasida, dexa

Mengetahui Bangkalan,
Kepala Puskesmas Banjar Pj. Pelayanan Puskesmas Banjar
Kecamatan Galis Polindes Separah

Ns.H.MOH.TOHA.S.Kep.MM.Kes SITI JUHAIRIYAH

NIP. 19670525 198903 1 008
 DAFTAR RAWAT JALAN BPJS DI DALAM GEDUNG DAN LUAR GEDUNG

PUSTU / POLINDES : SEPARAH BULAN : juli TAHUN : 2019

PEMERIKSAAN FISIK
NO TGL/KUNJ NO KARTU NAMA PENDERITA KELUHAN DIAGNOSA
KESADARAN TB BB TENSI RESPNADI
1 0000765784236 MUNASSEH gatal-gatal composmentis 162 68 130/90 20 80 -
2 0000765785259 SAMSUL pusing, kaku leher composmentis 154 64 170/100 18 80
3 0000767268832 ACH MUHEDI batuk, pilek, panas composmentis 130 34 90/60 18 80
4 0000767268325 MOH HOLIL batuk, pilek, panas composmentis 145 36 90/60 18 80
5 0000767265153 FADLILLA batuk, pilek, panas composmentis 150 50 100/60 20 80
6 0000767264422 ALHAM DANI batuk, pilek, panas composmentis 134 36 90/60 20 84
7 0000767263217 ASISEH HJ gatal-gatal composmentis 120 29 90/60 20 84
8 0000767242113 MUHYI nyeri uluh hati composmentis 150 64 130/90 20 80
9 0000767242056 BEDRIH nyeri uluh hati composmentis 152 58 130/90 20 80
10 0000767240392 MINAL batuk, pilek, panas composmentis 166 60 120/80 18 78
11 0000767235756 SITI sakit gigi composmentis 171 61 120/80 18 78
12 0000767233168 HARYATI linu-linu composmentis 154 62 140/90 20 78
13 0000765753219 MADDULLA nyeri uluh hati composmentis 153 56 110/80 20 78
14 0000765756191 AGUS nyeri uluh hati composmentis 162 62 110/80 20 78
15 0000765764234 ALFIYAH batuk, pilek, panas composmentis 130 34 90/60 18 80
16 0000767286922 SATIMA batuk, pilek, panas composmentis 145 36 90/60 18 80
17 0000767269912 LUKMAN batuk, pilek, panas composmentis 150 50 100/60 20 80
18 0000767272443 KARRAM batuk, pilek, panas composmentis 134 36 90/60 20 84
19 0000767268663 NUR CHOLIS gatal-gatal composmentis 120 29 90/60 20 84
20 0000767265737 MASRIDEH batuk, pilek, panas composmentis 133 31 90/60 20 84
21 0000767264422 ALHAM DANI sakit gigi composmentis 160 67 130/90 20 80
22 0000767242113 MUHYI linu-linu composmentis 152 58 130/90 20 80
23 0000767235497 SOLEH batuk, pilek, panas composmentis 166 60 120/80 18 78
24 0000767230266 ANISA sakit gigi composmentis 151 61 120/80 18 78
25 0000767229254 MAIMUN batuk, pilek, panas composmentis 167 62 140/90 20 78
26 0000767216226 MISYAT nyeri uluh hati composmentis 153 56 110/80 20 78
27 0000767201354 ROHIM nyeri uluh hati composmentis 152 48 110/80 20 78
28 0000767200612 MANIRAH linu-linu composmentis 165 57 120/80 20 80
29 0000767194222 HARIYANTO batuk, pilek, panas composmentis 148 50 110/80 20 80
30 0000767193636 NUR AMINA linu-linu composmentis 155 57 140/90 20 80
31 0000766842963 TOYYIBAH gatal-gatal composmentis 145 45 120/80 20 80
32 0000767189057 MUHAIMIN sakit mata composmentis 165 59 120/80 18 80
33 0000766843029 IIS pusing, kaku leher composmentis 146 60 180/100 18 80
34 0000766815399 MARYAM pusing, kaku leher composmentis 154 64 170/100 18 80
35 0000766807661 MASAMAH batuk, pilek, panas composmentis 150 48 90/60 18 80
36 0000766805321 SUADEH HJ nyeri uluh hati composmentis 145 49 90/60 18 80
37 0000766783012 ROHMAT batuk, pilek, panas composmentis 150 54 100/60 20 80
38 0000766780604 SITI AMINA batuk, pilek, panas composmentis 154 46 90/60 20 84
39 0000766782977 RUSMIATI gatal-gatal composmentis 145 53 130/90 20 84
40 0000766805916 HASANAH batuk, pilek, panas composmentis 147 56 90/60 20 84
41 0000766750678 SAFIYAH batuk, pilek, panas composmentis 132 26 90/60 20 84
42 0000766761535 SEHRO pusing, kaku leher composmentis 150 51 180/100 20 84
43 0000766746516 AININ NAJIB batuk, pilek, panas composmentis 160 59 90/60 20 84
44 0000766735288 RONI nyeri uluh hati composmentis 156 62 110/80 20 80
45 0000766729203 RIPIN nyeri uluh hati composmentis 153 49 90/60 20 80
46 0000766698355 MUHHER linu-linu composmentis 168 69 130/90 18 80
47 0000766696364 MUSRIFAH batuk, pilek, panas composmentis 155 50 120/80 18 80
48 0000766693967 SALEH linu-linu composmentis 152 58 140/90 24 88
49 0000766668442 ASMA gatal-gatal composmentis 151 55 140/90 20 80
50 0000766668251 SAED nyeri uluh hati composmentis 164 62 110/80 20 80
51 0000766648168 SAWATI batuk, pilek, panas composmentis 152 49 120/80 18 80
52 0000765742072 SALENA gatal-gatal composmentis 162 68 130/90 20 80
53 0000765772345 DEKKIR pusing, kaku leher composmentis 154 64 170/100 18 80
54 0000765790299 MASRIYEH batuk, pilek, panas composmentis 130 34 90/60 18 80
55 0000765792742 ABDULLO batuk, pilek, panas composmentis 145 36 90/60 18 80
56 0000765797365 JURI batuk, pilek, panas composmentis 150 50 100/60 20 80
57 0000765810652 FATIMA batuk, pilek, panas composmentis 134 36 90/60 20 84
58 0000765905207 NADROH gatal-gatal composmentis 120 29 90/60 20 84
59 0000765924581 JURIYEH nyeri uluh hati composmentis 150 64 130/90 20 80
60 0000765864472 MAYA nyeri uluh hati composmentis 152 58 130/90 20 80
61 0000765890526 WAHAB batuk, pilek, panas composmentis 166 60 120/80 18 78
62 0000765897153 HUZAIMAH sakit gigi composmentis 171 61 120/80 18 78
63 0000765903431 MIA linu-linu composmentis 154 62 140/90 20 78
64 0000765923321 KURNIA nyeri uluh hati composmentis 153 56 110/80 20 78
65 0000765978107 SOLIHIN nyeri uluh hati composmentis 162 62 110/80 20 78
66 0000766016256 RISKIYAH batuk, pilek, panas composmentis 130 34 90/60 18 80
67 0000766023884 ISRO batuk, pilek, panas composmentis 145 36 90/60 18 80
68 0000766028553 RAHMA batuk, pilek, panas composmentis 150 50 100/60 20 80
69 0000766037608 ALIYEH batuk, pilek, panas composmentis 134 36 90/60 20 84
70 0000766044549 FAJROH gatal-gatal composmentis 120 29 90/60 20 84
71 0000766048487 MISYATI batuk, pilek, panas composmentis 133 31 90/60 20 84
72 0000766061054 SITTI sakit gigi composmentis 160 67 130/90 20 80
73 0000766082799 HAIRIYAH linu-linu composmentis 152 58 130/90 20 80
74 0000766084746 SANIYAH batuk, pilek, panas composmentis 166 60 120/80 18 78
75 0000766087288 NASIFAH sakit gigi composmentis 151 61 120/80 18 78
76 0000766097324 SARIPA batuk, pilek, panas composmentis 167 62 140/90 20 78
77 0000766099135 AMINA nyeri uluh hati composmentis 153 56 110/80 20 78
78 0000766102757 AGUS nyeri uluh hati composmentis 152 48 110/80 20 78
79 0000766109248 HOSIMAH linu-linu composmentis 165 57 120/80 20 80
80 0000766117438 HOSNIYEH batuk, pilek, panas composmentis 148 50 110/80 20 80
81 0000766125562 INDAH linu-linu composmentis 155 57 140/90 20 80
82 0000766133008 HANAFI gatal-gatal composmentis 145 45 120/80 20 80
83 0000766138061 TOMIMAH sakit mata composmentis 165 59 120/80 18 80
84 0000766148927 SULIHA pusing, kaku leher composmentis 146 60 180/100 18 80
85 0000766151921 SUKARNI pusing, kaku leher composmentis 154 64 170/100 18 80
86 0000766153427 ANGGI batuk, pilek, panas composmentis 150 48 90/60 18 80
87 0000766161641 SIRI nyeri uluh hati composmentis 145 49 90/60 18 80
88 0000766169548 RAMYAH batuk, pilek, panas composmentis 150 54 100/60 20 80
89 0000766221456 MAYUHA batuk, pilek, panas composmentis 154 46 90/60 20 84
90 0000766228083 LUTFIYAH gatal-gatal composmentis 49 53 90/60 20 84
91 0000766231929 RUMSIYAH batuk, pilek, panas composmentis 147 56 90/60 20 84
92 0000766237061 HOSEN batuk, pilek, panas composmentis 123 26 90/60 20 84
93 0000766238411 SUMRIYAH pusing, kaku leher composmentis 150 51 180/100 20 84
94 0000766242966 ROHANI batuk, pilek, panas composmentis 169 71 90/60 20 84
95 0000766248186 IKRIDAH nyeri uluh hati composmentis 156 62 110/80 20 80
96 0000766267986 MASTURAH nyeri uluh hati composmentis 153 49 90/60 20 80
97 0000766288089 FITRI AYU linu-linu composmentis 168 69 130/90 18 80
98 0000766306563 NOR AINI batuk, pilek, panas composmentis 169 72 120/80 18 80
99 0000766312762 ULIN linu-linu composmentis 152 58 140/90 24 88
100 0000766319027 HAMLIYAH gatal-gatal composmentis 151 55 140/90 20 80
101 0000766325463 YASID nyeri uluh hati composmentis 164 62 110/80 20 80
102 0000766406968 MULISA batuk, pilek, panas composmentis 152 49 120/80 18 80
103 0000765749204 JUHAIRI sakit gigi composmentis 151 61 120/80 18 78
104 0000765749226 MARSITI batuk, pilek, panas composmentis 167 62 140/90 20 78
105 0000765749272 RENO nyeri uluh hati composmentis 153 56 110/80 20 78

Mengetahui Bangkalan,
Kepala Puskesmas Banjar Pj. Pelayanan Puskesmas Banjar
Kecamatan Galis Polindes Separah

Ns.H.MOH.TOHA.S.Kep.MM.Kes RISKA AMELIA

NIP. 19670525 198903 1 008
THERAPI
 Bangkalan,
. Pelayanan Puskesmas Banjar
Polindes Separah

RISKA AMELIA
 DAFTAR RAWAT JALAN BPJS DI DALAM GED

PUSTU / POLINDES : SEPARAH

NO TGL/KUNJ NO KARTU NAMA PENDERITA KELUHAN

1 1.4.17 0000767271723 ERRU gatal-gatal

2 0000767269776 HOTIJA pusing, kaku leher
3 0000767268832 ACH MUHEDI batuk, pilek, panas
4 2.4.17 0000767268325 MOH HOLIL batuk, pilek, panas
5 0000767265153 FADLILLA batuk, pilek, panas
6 0000767264422 ALHAM DANI batuk, pilek, panas
7 0000767263217 ASISEH HJ gatal-gatal
8 0000767242113 MUHYI nyeri uluh hati
9 0000767242056 BEDRIH nyeri uluh hati
10 4.4.17 0000767240392 MINAL batuk, pilek, panas
11 5.4.17 0000767235756 SITI sakit gigi
12 0000767233168 HARYATI linu-linu
13 0000765753219 MADDULLA nyeri uluh hati
14 7.4.17 0000765756191 AGUS nyeri uluh hati
15 8.4.17 0000765764234 ALFIYAH batuk, pilek, panas
16 0000767286922 SATIMA batuk, pilek, panas
17 0000767269912 LUKMAN batuk, pilek, panas
18 0000767272443 KARRAM batuk, pilek, panas
19 0000767268663 NUR CHOLIS gatal-gatal
20 9.4.17 0000767265737 MASRIDEH batuk, pilek, panas
21 0000767264422 ALHAM DANI sakit gigi
22 0000767242113 MUHYI linu-linu
23 0000767235497 SOLEH batuk, pilek, panas
24 0000767230266 ANISA sakit gigi
25 0000767229254 MAIMUN batuk, pilek, panas
26 10.4.17 0000767216226 MISYAT nyeri uluh hati
27 11.4.17 0000767201354 ROHIM nyeri uluh hati
28 0000767200612 MANIRAH linu-linu
29 12.4.17 0000767194222 HARIYANTO batuk, pilek, panas
30 0000767193636 NUR AMINA linu-linu
31 0000766842963 TOYYIBAH gatal-gatal
32 0000767189057 MUHAIMIN sakit mata
33 13.4.17 0000766843029 IIS pusing, kaku leher
34 0000766815399 MARYAM pusing, kaku leher
35 0000766807661 MASAMAH batuk, pilek, panas
36 14.4.17 0000766805321 SUADEH HJ nyeri uluh hati
37 16.4.17 0000766783012 ROHMAT batuk, pilek, panas
38 0000766780604 SITI AMINA batuk, pilek, panas
39 0000766782977 RUSMIATI gatal-gatal
40 17.4.17 0000766805916 HASANAH batuk, pilek, panas
41 0000766750678 SAFIYAH batuk, pilek, panas
42 18.4.17 0000766761535 SEHRO pusing, kaku leher
43 0000766746516 AININ NAJIB batuk, pilek, panas
44 0000766735288 RONI nyeri uluh hati
45 0000766729203 RIPIN nyeri uluh hati
46 0000766698355 MUHHER linu-linu
47 0000766696364 MUSRIFAH batuk, pilek, panas
48 19.4.14 0000766693967 SALEH linu-linu
49 20.4.17 0000766668442 ASMA gatal-gatal
50 0000766668251 SAED nyeri uluh hati
51 0000766648168 SAWATI batuk, pilek, panas
Mengetahui
Kepala Puskesmas Banjar
Kecamatan Galis

Ns.H.MOH.TOHA.S.Kep.MM.Kes
NIP. 19670525 198903 1 008
WAT JALAN BPJS DI DALAM GEDUNG DAN LUAR GEDUNG

BULAN : APRIL TAHUN : 2017

PEMERIKSAAN FISIK
DIAGNOSA
KESADARAN TB BB TENSI RESP NADI
composmentis 162 68 130/90 20 80 myalgia
composmentis 154 64 170/100 18 80 hypertensi
composmentis 130 34 90/60 18 80 ispa
composmentis 145 36 90/60 18 80 ispa
composmentis 150 50 100/60 20 80 ispa
composmentis 134 36 90/60 20 84 ispa
composmentis 120 29 90/60 20 84 dermatitits
composmentis 150 64 130/90 20 80 gastritis
composmentis 152 58 130/90 20 80 gastritis
composmentis 166 60 120/80 18 78 ispa
composmentis 171 61 120/80 18 78 salkit gigi
composmentis 154 62 140/90 20 78 myalgia
composmentis 153 56 110/80 20 78 gastritis
composmentis 162 62 110/80 20 78 gastritis
composmentis 130 34 90/60 18 80 ispa
composmentis 145 36 90/60 18 80 ispa
composmentis 150 50 100/60 20 80 ispa
composmentis 134 36 90/60 20 84 ispa
composmentis 120 29 90/60 20 84 dermatitits
composmentis 133 31 90/60 20 84 ispa
composmentis 160 67 130/90 20 80 salkit gigi
composmentis 152 58 130/90 20 80 myalgia
composmentis 166 60 120/80 18 78 ispa
composmentis 151 61 120/80 18 78 ispa
composmentis 167 62 140/90 20 78 myalgia
composmentis 153 56 110/80 20 78 gastritis
composmentis 152 48 110/80 20 78 gastritis
composmentis 165 57 120/80 20 80 myalgia
composmentis 148 50 110/80 20 80 ispa
composmentis 155 57 140/90 20 80 myalgia
composmentis 145 45 120/80 20 80 dermatitits
composmentis 165 59 120/80 18 80 conjungtivitys
composmentis 146 60 180/100 18 80 hypertensi
composmentis 154 64 170/100 18 80 hypertensi
composmentis 150 48 90/60 18 80 ispa
composmentis 145 49 90/60 18 80 gastritis
composmentis 150 54 100/60 20 80 ispa
composmentis 154 46 90/60 20 84 ispa
composmentis 145 53 130/90 20 84 dermatitits
composmentis 147 56 90/60 20 84 ispa
composmentis 132 26 90/60 20 84 ispa
composmentis 150 51 180/100 20 84 hypertensi
composmentis 160 59 90/60 20 84 ispa
composmentis 156 62 110/80 20 80 gastritis
composmentis 153 49 90/60 20 80 gastritis
composmentis 168 69 130/90 18 80 myalgia
composmentis 155 50 120/80 18 80 ispa
composmentis 152 58 140/90 24 88 myalgia
composmentis 151 55 140/90 20 80 dermatitits
composmentis 164 62 110/80 20 80 gastritis
composmentis 152 49 120/80 18 80 ispa
Bangkalan,
Pj. Pelayanan Puskesmas Banjar
Polindes Separah

RISKA AMELIA
 THERAPI

dexa, amox
captop, ibup
amox, ibuprof, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
dexa, amox
antasida, dexa
antasida, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
ibuprof, b comp, dexa
antasida, dexa
antasida, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
dexa, amox
amox, ibuprof, dexa
amox, ibuprof, dexa
ibuprof, b comp, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
ibuprof, b comp, dexa
antasida, dexa
antasida, dexa
ibuprof, b comp, dexa
amox, ibuprof, dexa
ibuprof, b comp, dexa
dexa, amox
amox, ibuprof, dexa
captop, ibup
captop, ibup
amox, ibuprof, dexa
antasida, dexa
amox, ibuprof, dexa
amox, ibuprof, dexa
dexa, amox
amox, ibuprof, dexa
 amox, ibuprof, dexa
captop, ibup
amox, ibuprof, dexa
antasida, dexa
antasida, dexa
ibuprof, b comp, dexa
amox, ibuprof, dexa
ibuprof, b comp, dexa
dexa, amox
antasida, dexa
amox, ibuprof, dexa
angkalan,
ayanan Puskesmas Banjar
Polindes Separah

RISKA AMELIA