PASIEN JKN DESA LAMPISI BULAN JANUARI 2023

Tanggal no Nomor Nama Keluhan BB TB TD R N Kode Dx Diagnosa

1 2 3 4 5 6 7 8 9 10 11 12
1 0000301823212 WINDA KURNIATI SAKIT KEPALA 50 152 110/70 20 80 G34 MIGREN
2 0000301816631 ASMAWATI MATA MERAH, PEDIH 54 153 120/80 22 80 H10.9 KONJUNGTIVITIS
3 0000301822839 MIRNAWATI MUAL, NYERI ULU HATI 48 152 110/70 22 80 K29.7 GASTRITIS
4 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72 173 125/80 20 80 K04 PNY.PULPA & JRNGN PERIAPIKAL
5 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20 80 J10-J11 INFLUENZA
6 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80 18 80 J10-J11 INFLUENZA
7 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152 120/80 20 80 K29.7 GASTRITIS
8 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80 20 80 K29.7 GASTRITIS
9 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168 120/80 18 78 J06.9 ISPA
10 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124 26 88 J06.9 ISPA
11 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168 80/60 20 78 l95 HIPOTENSI
12 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167 110/70 18 80 K29.7 GASTRITIS
13 0002601683572 RUBYAN RUYO LEGOWO DEMAM, BATUK, PILEK 21 118 26 88 J06.9 ISPA
14 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20 80 J10-J11 INFLUENZA
 TERAPI LP No hp
13 14 15
ANTALGIN 79 082235126959
KLORAMFENICOL TTM 84 082235126959
ANTASIDA 84 082235126959
ASMEF, AMOXILLIN 84 082377675861
CTM, EFEDRIN 83 082292536689
CTM, EFEDRIN 80 082380569884
ANTASIDA 87 082235126959
ANTASIDA 84 082380569884
PCT, GG, CTM 82 082269007580
PCT, GG, CTM 40 082377675861
B.COM, PCT 80 082292536689
ANTASIDA 81 085267842598
PCT SYR, AMOX SYR, CTM 39 082380569884
CTM, EFEDRIN 83 082292536689
 PASIEN JKN BULAN FEBRUARI 2023

Tanggal no Nomor Nama Keluhan BB TB TD R N Kode Dx Diagnosa

1 2 3 4 5 6 7 8 9 10 11 12
1 0000301816631 ASMAWATI MATA MERAH, PEDIH 54 153 120/80 22 80 H10.9 KONJUNGTIVITIS
2 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124 26 88 J06.9 ISPA
3 0000301822839 MIRNAWATI MUAL, NYERI ULU HATI 48 152 110/70 22 80 K29.7 GASTRITIS
4 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72 173 125/80 20 80 K04PNY.PULPA & JRNGN PERIAPIKAL
5 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20 80 J10-J11 INFLUENZA
6 0002786438169 MASKUROH ALERGI, GATAL-GATAL DI BADAN 61 153 120/80 20 80 L30.9 DERMATITIS
7 0002786438158 WIRTA BERSIN, HIDUNG TERSUMBAT 65 168 110/70 20 80 J10-J11 INFLUENZA
8 0002786438182 INTAN RAMAH DANI DEMAM, BATUK, PILEK 42 147 24 86 J06.9 ISPA
9 0001684148095 ANDRE SETYA WARDANA DEMAM, BATUK, PILEK 46 152 90/70 20 80 J06.9 ISPA
10 0002608807735 UNUY GIGI BERLUBANG, NYERI BERDENYUT 52 152 110/70 18 78 K04PNY.PULPA & JRNGN PERIAPIKAL
11 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80 18 80 J10-J11 INFLUENZA
12 0001828617153 MULYONO SESAK NAFAS 55 155 120/80 16 78 J45 ASMA
13 0000301825978 SUKARIYANI PUSING 82 161 160/100 22 78 I10 HIPERTENSI
14 0000989342921 MASTAR NYERI SENDI 54 150 130/80 20 80 M13 ARTRITIS
15 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80 20 80 K29.7 GASTRITIS
16 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168 120/80 18 78 J06.9 ISPA
17 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168 80/60 20 78 l95 HIPOTENSI
18 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167 110/70 18 80 K29.7 GASTRITIS
19 0000301829275 SURWANTI DEMAM, BATUK, PILEK 55 155 110/70 20 80 J06.9 ISPA
20 0000301824022 ERMAYANA MUAL, NYERI ULU HATI 53 150 120/80 20 78 K29.7 GASTRITIS
21 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152 120/80 20 80 K29.7 GASTRITIS
22 0002603282681 NINDY AULIA FAIRUZ DEMAM, BATUK, PILEK 21 119 26 88 J06.9 ISPA
23 0002609237485 AZELIA AZAHRA DEMAM, BATUK, PILEK 25 123 26 88 J06.9 ISPA
24 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23 120 26 88 J03 TONSILITIS AKUT
25 0002594304944 RAHEL ARDIANSYAH NYERI MENELAN, DEMAM 26 121 26 84 J03 TONSILITIS AKUT
26 0002608761003 ZAKI PRASETYO DEMAM, BATUK, PILEK 18 100 26 88 J06.9 ISPA
27 0002786421688 SAMSIAR DEMAM, BATUK, PILEK 46 150 100/70 24 80 J06.9 ISPA
 TERAPI LP No hp
13 14 15
KLORAMFENICOL TTM 84 082235126959
PCT, GG, CTM 40 082377675861
ANTASIDA 84 082235126959
ASMEF, AMOXILLIN 84 082377675861
CTM, EFEDRIN 83 082292536689
CTM, DEXA 88 085279918535
CTM, EFEDRIN 79 085279918535
PCT, GG, CTM 62 085279918535
PCT, GG, CTM 78 082378231560
ASMEF, AMOXILLIN 80
CTM, EFEDRIN 80 082380569884
SALBUTAMOL, DEXA 80
CAPTOPRIL 92 082236550720
PIROXICAM 78 082380569884
ANTASIDA 84 082380569884
PCT, GG, CTM 82 082269007580
B.COM, PCT 80 082292536689
ANTASIDA 81 085267842598
PCT, GG, CTM 85
ANTASIDA 84
ANTASIDA 87
PCT SYR, AMOX SYR, CTM 42 085366544411
PCT SYR, AMOX SYR, CTM 41
PCT, AMOXILLIN, VIT C 41 085206585630
PCT, AMOXILLIN, VIT C 42
PCT SYR, AMOX SYR, CTM 41
PCT, GG, CTM 78
 PASIEN JKN BULAN APRIL 2023

Tanggal no Nomor Nama Keluhan BB TB TD R N Kode Dx

1 2 3 4 5 6 7 8 9
1 0002609237485 AZELIA AZAHRA DEMAM, BATUK, PILEK 25 123 26 88 J06.9
2 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23 120 26 88 J03
3 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80 20 80 K29.7
4 0002608761003 ZAKI PRASETYO DEMAM, BATUK, PILEK 18 100 26 88 J06.9
5 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80 18 80 J10-J11
6 0002601683572 RUBYAN RUYO LEGOWO DEMAM, BATUK, PILEK 21 118 26 88 J06.9
7 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20 80 J10-J11
8 0001684148117 TUGIYO GIGI BERLUBANG, NYERI BERDENYUT 67 157 110/70 18 80 K04
9 0000989342921 MASTAR NYERI SENDI 54 150 130/80 20 80 M13
10 0000301828656 LAMIDI DEMAM, BATUK, PILEK 72 173 120/80 18 80 J06.9
11 0000301979553 AYU DIANA WATI MUAL, NYERI ULU HATI 52 154 110/80 18 78 K29.7
12 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124 26 88 J06.9
13 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167 110/70 18 80 K29.7
14 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23 120 26 88 J03
15 0002786421688 SAMSIAR DEMAM, BATUK, PILEK 46 150 100/70 24 80 J06.9
16 0002786438169 MASKUROH ALERGI, GATAL-GATAL DI BADAN 61 153 120/80 20 80 L30.9
17 0002786438158 WIRTA BERSIN, HIDUNG TERSUMBAT 65 168 110/70 20 80 J10-J11
18 0000301982264 GUNANTI ISPA 32 132 24 84 J06.9
19 0000301963217 ASIYAH MUAL, NYERI ULU HATI 48 149 110/70 24 78 K29.7
20 0001684148095 ANDRE SETYA WARDANA DEMAM, BATUK, PILEK 46 152 90/70 20 80 J06.9
21 0002786438182 INTAN RAMAH DANI DEMAM, BATUK, PILEK 42 147 24 86 J06.9
 Diagnosa TERAPI LP No hp
10 11 15
ISPA PCT SYR, AMOX SYR, CTM 41 082235126959
TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41 085206585630
GASTRITIS ANTASIDA 88 082380569884
ISPA PCT SYR, AMOX SYR, CTM 41 082328454611
INFLUENZA CTM, EFEDRIN 80 082380569884
ISPA PCT SYR, AMOX SYR, CTM 39 082380569884
INFLUENZA CTM, EFEDRIN 83 082292536689
PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 79
ARTRITIS PIROXICAM 77
ISPA PCT, GG, CTM 83
GASTRITIS ANTASIDA 84
ISPA PCT, GG, CTM 41
GASTRITIS ANTASIDA 80
TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41
ISPA PCT, GG, CTM 78
DERMATITIS CTM, DEXA 88
INFLUENZA CTM, EFEDRIN 79
ISPA PCT, GG, CTM 58
GASTRITIS ANTASIDA 78
ISPA PCT, GG, CTM 78
ISPA PCT, GG, CTM 62
 PASIEN JKN DESA LAMPISI BULAN MARET 2023

Tanggal no Nomor Nama Keluhan BB TB TD R N Kode Dx

1 2 3 4 5 6 7 8 9 10 11
1 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20 80 J10-J11
2 0000301816631 ASMAWATI MATA MERAH, PEDIH 54 153 120/80 22 80 H10.9
3 0000301822839 MIRNAWATI MUAL, NYERI ULU HATI 48 152 110/70 22 80 K29.7
4 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72 173 125/80 20 80 K04
5 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20 80 J10-J11
6 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80 18 80 J10-J11
7 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152 120/80 20 80 K29.7
8 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80 20 80 K29.7
9 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168 120/80 18 78 J06.9
10 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124 26 88 J06.9
11 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168 80/60 20 78 l95
12 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167 110/70 18 80 K29.7
13 0002601683572 RUBYAN RUYO LEGOWO DEMAM, BATUK, PILEK 21 118 26 88 J06.9
14 0000301823212 WINDA KURNIATI SAKIT KEPALA 50 152 110/70 20 80 G34
 Diagnosa TERAPI LP No hp
12 13 14 15
INFLUENZA CTM, EFEDRIN 83 082292536689
KONJUNGTIVITIS KLORAMFENICOL TTM 84 082235126959
GASTRITIS ANTASIDA 84 082235126959
PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 84 082377675861
INFLUENZA CTM, EFEDRIN 83 082292536689
INFLUENZA CTM, EFEDRIN 80 082380569884
GASTRITIS ANTASIDA 87 082235126959
GASTRITIS ANTASIDA 84 082380569884
ISPA PCT, GG, CTM 82 082269007580
ISPA PCT, GG, CTM 40 082377675861
HIPOTENSI B.COM, PCT 80 082292536689
GASTRITIS ANTASIDA 81 085267842598
ISPA PCT SYR, AMOX SYR, CTM 39 082380569884
MIGREN ANTALGIN 79 082235126959
 PASIEN JKN BULAN MEI 2022

Tanggal no Nomor Nama Keluhan BB TB TD R N Kode Dx Diagnosa TERAPI LP

1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 0002832915317 IVO NUR FAIDAH MUAL, NYERI ULU HATI 53 154 110/70 18 78 K29.7 GASTRITIS ANTASIDA 79
2 0002832911493AHMAD MUHASIM DEMAM, BATUK, PILEK 60 159 120/80 18 78 J06.9 ISPA PCT, GG, CTM 80
3 0002627409363 ANISAH MUAL, NYERI ULU HATI 58 155 120/80 20 80 K29.7 GASTRITIS ANTASIDA 81
4 0002609162717 ROSDAN MUAL, NYERI ULU HATI 67 162 120/80 20 80 K29.7 GASTRITIS ANTASIDA 79
5 0002608297479
DZAKIRA AZ-ZAHRA
ALERGI, GATAL-GATAL DI BADAN
32 126 26 86 L30.9 DERMATITIS CTM, DEXA 46
6 0002609523977 RASMAN
GIGI BERLUBANG, NYERI BERDENYUT
71 161 120/80 20 78 K04 ASMEF, AMOXILLIN80
PNY.PULPA & JRNGN PERIAPIKAL
7 0002601872087 PONINGSIH BERSIN, HIDUNG TERSUMBAT52 153 110/70 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 79
8 0000301829275 SURWANTI DEMAM, BATUK, PILEK 55 155 110/70 20 80 J06.9 ISPA PCT, GG, CTM 85
9 0000301829883 ROMIATI MUAL, NYERI ULU HATI 55 156 110/70 18 78 K29.7 GASTRITIS ANTASIDA 87
10 0000301979406 NASIRON
GIGI BERLUBANG, NYERI BERDENYUT
72 173 125/80 20 80 K04 ASMEF, AMOXILLIN84
PNY.PULPA & JRNGN PERIAPIKAL
11 0000301783959NURUL KOMARIAH
BERSIN, HIDUNG TERSUMBAT55 156 120/80 20 80 J10-J11 INFLUENZA CTM, EFEDRIN 83
12 0000301824022 ERMAYANA MUAL, NYERI ULU HATI 53 150 120/80 20 78 K29.7 GASTRITIS ANTASIDA 84
13 0002608807735 UNUYGIGI BERLUBANG, NYERI BERDENYUT
52 152 110/70 18 78 K04 ASMEF, AMOXILLIN80
PNY.PULPA & JRNGN PERIAPIKAL
14 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT61 156 120/80 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80
 PASIEN JKN BULAN JUNI 2022 DESA LAMPISI

Tanggal no Nomor Nama Keluhan BB TB TD R N Kode Dx

1 2 3 4 5 6 7 8 9 10 11
1 0002609523977 RASMAN
GIGI BERLUBANG, NYERI BERDENYUT
71 161 120/80 20 78 K04
2 0002601872087 PONINGSIH BERSIN, HIDUNG TERSUMBAT 52 153 110/70 18 80 J10-J11
3 0002605156018
DHAKA RAMADANIDEMAM, BATUK, PILEK 29 122 26 86 J06.9
4 0000301823212WINDA KURNIATI SAKIT KEPALA 50 152 110/70 20 80 G34
5 0000301815674FADILLA AZIZATINYERI MENELAN, DEMAM 29 130 26 86 J03
6 0000301826698 NUR HIKMAHPUSING, TIDAK NAFSU MAKAN57 157 80/60 18 78 I95
7 0000301826103 SUCIPTO MATA MERAH, PEDIH 55 158 110/70 20 80 H10.9
8 0000301824472
MARSYA SHESILLIADEMAM, BATUK, PILEK 34 135 26 86 J06.9
9 0002628508072 SAFITRI DEMAM, BATUK, PILEK 30 132 26 82 J06.9
10 0002603282681
NINDY AULIA FAIRUZDEMAM, BATUK, PILEK 21 119 26 84 J06.9
11 0002609237485AZELIA AZAHRA DEMAM, BATUK, PILEK 25 123 26 82 J06.9
12 0001684154351 SUHARIANUM SAKIT KEPALA 54 153 125/80 18 80 G34
13 0001684154327
ADITYA RAMADHAN
NYERI MENELAN, DEMAM 21 118 26 84 J03
14 0001684154349 SUNARDI
GIGI BERLUBANG, NYERI BERDENYUT
71 171 120/80 18 80 K04
15 0001684148128 SUNIYAH DEMAM, BATUK, PILEK 78 154 120/80 18 78 J06.9
16 0001684148117 TUGIYO
GIGI BERLUBANG, NYERI BERDENYUT
67 157 110/70 18 80 K04
17 0002603007224
MARWAH NOVIANA
NYERI MENELAN, DEMAM 23 120 26 86 J03
18 0002608602952 RUSMIAH SAKIT KEPALA 56 151 120/80 20 78 G34
19 0002594304944
RAHEL ARDIANSYAH
NYERI MENELAN, DEMAM 26 121 26 86 J03
20 0002608761003ZAKI PRASETYO
ALERGI, GATAL-GATAL DI BADAN
18 100 26 84 L30.9
21 0002608807735 UNUY MUAL, NYERI ULU HATI 52 152 110/70 18 78 K29.7
22 0002607468546 MAHYO MATA MERAH, SAKIT 61 156 120/80 18 78 H10.9
23 0002601683572
RUBYAN RUYO LEGOWO
DEMAM, BATUK, PILEK 21 118 26 88 J06.9
AMPISI

Diagnosa TERAPI LP
12 13 14
PNY.PULPA & JRNGN PERIAPIKAL
ASMEF, AMOXILLIN 83
INFLUENZA CTM, EFEDRIN 79
ISPA 45
PCT SYR, AMOX SYR, CTM
MIGREN ANTALGIN 78
TONSILITIS AKUT PCT, AMOXILLIN, VIT C43
HIPOTENSI B.COM, PCT 82
KONJUNGTIVITIS KLORAMFENICOL TTM81
ISPA PCT, GG, CTM 46
ISPA 46
PCT SYR, AMOX SYR, CTM
ISPA 50
PCT SYR, AMOX SYR, CTM
ISPA 52
PCT SYR, AMOX SYR, CTM
MIGREN ANTALGIN 84
TONSILITIS AKUT PCT, AMOXILLIN, VIT C39
ASMEF, AMOXILLIN 80
PNY.PULPA & JRNGN PERIAPIKAL
ISPA PCT, GG, CTM 88
ASMEF, AMOXILLIN 79
PNY.PULPA & JRNGN PERIAPIKAL
TONSILITIS AKUT PCT, AMOXILLIN, VIT C42
MIGREN ANTALGIN 81
TONSILITIS AKUT PCT, AMOXILLIN, VIT C43
DERMATITIS CTM, DEXA 41
GASTRITIS ANTASIDA 79
KONJUNGTIVITIS KLORAMFENICOL TTM81
ISPA 44
PCT SYR, AMOX SYR, CTM
 PASIEN JKN BULAN JULI 2021

Tanggal no Nomor Nama Keluhan BB TB TD R

1 2 3 4 5 6 7 8 9
1 0000301823921 SUPARDI MATA MERAH, PEDIH 80 170 120/80 20
2 0000301823212 WINDA KURNIATI SAKIT KEPALA 50 152 110/70 20
3 0000301825978 SUKARIYANI PUSING 82 161 160/100 22
4 0000989342921 MASTAR NYERI SENDI 54 150 130/80 20
5 0000301816631 ASMAWATI MATA MERAH, PEDIH 54 153 120/80 22
6 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80 20
7 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168 120/80 18
8 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124 26
9 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168 80/60 20
10 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167 110/70 18
11 0000301822839 MIRNAWATI MUAL, NYERI ULU HATI 48 152 110/70 22
12 0000301829275 SURWANTI DEMAM, BATUK, PILEK 55 155 110/70 20
13 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72 173 125/80 20
14 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80 20
15 0000301824022 ERMAYANA MUAL, NYERI ULU HATI 53 150 120/80 20
16 0002608807735 UNUY GIGI BERLUBANG, NYERI BERDENYUT 52 152 110/70 18
17 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80 18
18 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152 120/80 20
19 0001828617153 MULYONO SESAK NAFAS 55 155 120/80 16
20 0002603282681 NINDY AULIA FAIRUZ DEMAM, BATUK, PILEK 21 119 26
21 0002609237485 AZELIA AZAHRA DEMAM, BATUK, PILEK 25 123 26
22 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23 120 26
23 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80 20
24 0002594304944 RAHEL ARDIANSYAH NYERI MENELAN, DEMAM 26 121 26
25 0002608761003 ZAKI PRASETYO DEMAM, BATUK, PILEK 18 100 26
26 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80 18
27 0002601683572 RUBYAN RUYO LEGOWO DEMAM, BATUK, PILEK 21 118 26
29 0002786421688 SAMSIAR DEMAM, BATUK, PILEK 46 150 100/70 24
30 0002786438169 MASKUROH ALERGI, GATAL-GATAL DI BADAN 61 153 120/80 20
31 0002786438158 WIRTA BERSIN, HIDUNG TERSUMBAT 65 168 110/70 20
32 0002786438182 INTAN RAMAH DANI DEMAM, BATUK, PILEK 42 147 24
33 0001684148095 ANDRE SETYA WARDANA DEMAM, BATUK, PILEK 46 152 90/70 20
JULI 2021

N Kode Dx Diagnosa TERAPI lingkar perut No hp

10 11 12 13 14 15
80 H10.9 KONJUNGTIVITIS KLORAMFENICOL TTM 83
80 G34 MIGREN ANTALGIN 79
78 I10 HIPERTENSI CAPTOPRIL 92 082236550720
80 M13 ARTRITIS PIROXICAM 78 82380569884
80 H10.9 KONJUNGTIVITIS KLORAMFENICOL TTM 84
80 K29.7 GASTRITIS ANTASIDA 84 082380569884
78 J06.9 ISPA PCT, GG, CTM 82 082269007580
88 J06.9 ISPA PCT, GG, CTM 40 082377675861
78 l95 HIPOTENSI B.COM, PCT 80 082292536689
80 K29.7 GASTRITIS ANTASIDA 81 085267842598
80 K29.7 GASTRITIS ANTASIDA 84
80 J06.9 ISPA PCT, GG, CTM 85
80 K04 PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 84 082377675861
80 J10-J11 INFLUENZA CTM, EFEDRIN 83 082292536689
78 K29.7 GASTRITIS ANTASIDA 84
78 K04 PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 80
80 J10-J11 INFLUENZA CTM, EFEDRIN 80 082380569884
80 K29.7 GASTRITIS ANTASIDA 87
78 J45 ASMA SALBUTAMOL, DEXA 80
88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 42 085366544411
88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41
88 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41 085206585630
80 K29.7 GASTRITIS ANTASIDA 88
84 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 42
88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41
80 J10-J11 INFLUENZA CTM, EFEDRIN 80 082380569884
88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 39 082380569884
80 J06.9 ISPA PCT, GG, CTM 78
80 L30.9 DERMATITIS CTM, DEXA 88 085279918535
80 J10-J11 INFLUENZA CTM, EFEDRIN 79 085279918535
86 J06.9 ISPA PCT, GG, CTM 62 085279918535
80 J06.9 ISPA PCT, GG, CTM 78 082378231560
 PASIEN JKN BULAN AGUSTUS 2022

Tanggal no Nomor Nama Keluhan BB TB

1 2 3 4 5
1 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167
2 0002601872087 PONINGSIH BERSIN, HIDUNG TERSUMBAT 52 153
3 0001684148128 SUNIYAH DEMAM, BATUK, PILEK 78 154
4 0002786437135 SUWARNO DEMAM, BATUK, PILEK 60 158
5 0000301815674 FADILLA AZIZATI NYERI MENELAN, DEMAM 29 130
6 0002601683572 RUBYAN RUYO LEGOWO DEMAM, BATUK, PILEK 21 118
7 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152
8 0002628508072 SAFITRI DEMAM, BATUK, PILEK 30 132
9 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23 120
10 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72 173
11 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168

Tanggal no Nomor Nama Keluhan BB TB

1 2 3 4 5 6 7
30-8-2021 1 0000301825978 SUKARIYANI PUSING 82 161
2 0000989342921 MASTAR NYERI SENDI 54 150
3 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151
4 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168
5 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124
6 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168
7 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167
N BULAN AGUSTUS 2022

TD R N Kode Dx Diagnosa TERAPI LP

6 7 8 9 10 11
110/70 18 80 K29.7 GASTRITIS ANTASIDA 81
110/70 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 79
120/80 18 78 J06.9 ISPA PCT, GG, CTM 88
110/70 20 80 J06.9 ISPA PCT, GUAIFENESIN, CTM 81
26 86 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 49
26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 44
120/80 20 80 K29.7 GASTRITIS ANTASIDA 87
26 84 J06.9 ISPA PCT, Guafenisin, CTM 39
26 88 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41
125/80 20 80 K04 PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 84
80/60 20 78 l95 HIPOTENSI B.COM, PCT 80

TD R N Kode Dx Diagnosa TERAPI lingkar perut

8 9 10 11 12 13 14
160/100 22 78 I10 HIPERTENSI CAPTOPRIL 92
130/80 20 80 M13 ARTRITIS PIROXICAM 78
120/80 20 80 K29.7 GASTRITIS ANTASIDA 84
120/80 18 78 J06.9 ISPA PCT, GG, CTM 82
26 88 J06.9 ISPA PCT, GG, CTM 40
80/60 20 78 l95 HIPOTENSI B.COM, PCT 80
110/70 18 80 K29.7 GASTRITIS ANTASIDA 81
 no hp
11
085267842598
085366544411
082378231560
082328454611
085267842598
082380569884
082235126959
082235126959
085206585630
082377675861
082292536689

No hp
15
082236550720
82380569884
082380569884
082269007580
082377675861
082292536689
085267842598
 PASIEN JKN BULAN SEPTEMBER 2022

Tanggal no Nomor Nama Keluhan BB

1 2 3 4 5 6
1 0000301825978 SUKARIYANI PUSING 82
2 0000989342921 MASTAR NYERI SENDI 54
3 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56
4 0000301972577 MISNO DEMAM, BATUK, PILEK 64
5 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26
6 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67
7 0000301814346 DARMIN MUAL, NYERI ULU HATI 69
8 0000301823212 WINDA KURNIATI SAKIT KEPALA 50
9 0000301816631 ASMAWATI MATA MERAH, PEDIH 54
10 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26
11 0000301822839 MIRNAWATI MUAL, NYERI ULU HATI 48
12 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72
13 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55
14 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61
15 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61
16 0002603282681 NINDY AULIA FAIRUZ DEMAM, BATUK, PILEK 21
17 0002609237485 AZELIA AZAHRA DEMAM, BATUK, PILEK 25
18 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23
19 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56
20 0002608761003 ZAKI PRASETYO DEMAM, BATUK, PILEK 18
21 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61
22 0002601683572 RUBYAN RUYO LEGOWO DEMAM, BATUK, PILEK 21
23 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55
KN BULAN SEPTEMBER 2022

TB TD R N Kode Dx Diagnosa TERAPI lingkar perut

7 8 9 10 11 12 13 14
161 160/100 22 78 I10 HIPERTENSI CAPTOPRIL 92
150 130/80 20 80 M13 ARTRITIS PIROXICAM 78
151 120/80 20 80 K29.7 GASTRITIS ANTASIDA 84
168 120/80 18 78 J06.9 ISPA PCT, GG, CTM 82
124 26 88 J06.9 ISPA PCT, GG, CTM 40
168 80/60 20 78 l95 HIPOTENSI B.COM, PCT 80
167 110/70 18 80 K29.7 GASTRITIS ANTASIDA 81
152 110/70 20 80 G34 MIGREN ANTALGIN 79
153 120/80 22 80 H10.9 KONJUNGTIVITIS KLORAMFENICOL TTM 84
124 26 88 J06.9 ISPA PCT, GG, CTM 40
152 110/70 22 80 K29.7 GASTRITIS ANTASIDA 84
173 125/80 20 80 K04 PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 84
156 120/80 20 80 J10-J11 INFLUENZA CTM, EFEDRIN 83
156 120/80 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80
152 120/80 20 80 K29.7 GASTRITIS ANTASIDA 87
119 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 42
123 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41
120 26 88 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41
151 120/80 20 80 K29.7 GASTRITIS ANTASIDA 88
100 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41
156 120/80 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80
118 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 39
156 120/80 20 80 J10-J11 INFLUENZA CTM, EFEDRIN 83
 No hp
15
082236550720
082380569884
082380569884
082269007580
082377675861
082292536689
085267842598
082235126959
082235126959
082377675861
082235126959
082377675861
082292536689
082380569884
082235126959
085366544411
082235126959
085206585630
082380569884
082328454611
082380569884
082380569884
082292536689
 PASIEN JKN DESA LAMPISI BULAN OKTOBER 2022

Tanggal no Nomor Nama Keluhan BB TB TD

1 2 3 4 5 6 7 8
1 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80
2 0000301825978 SUKARIYANI PUSING 82 161 160/100
3 0000989342921 MASTAR NYERI SENDI 54 150 130/80
4 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80
5 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168 120/80
6 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124
7 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168 80/60
8 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167 110/70
9 0000301823212 WINDA KURNIATI SAKIT KEPALA 50 152 110/70
10 0000301816631 ASMAWATI MATA MERAH, PEDIH 54 153 120/80
11 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156 120/80
12 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156 120/80
13 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152 120/80
14 0002603282681 NINDY AULIA FAIRUZ DEMAM, BATUK, PILEK 21 119
15 0002609237485 AZELIA AZAHRA DEMAM, BATUK, PILEK 25 123
16 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23 120
17 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151 120/80
18 0002608761003 ZAKI PRASETYO DEMAM, BATUK, PILEK 18 100
LAN OKTOBER 2022

R N Kode Dx Diagnosa TERAPI lingkar perut No hp

9 10 11 12 13 14 15
18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80 082380569884
22 78 I10 HIPERTENSI CAPTOPRIL 92 082236550720
20 80 M13 ARTRITIS PIROXICAM 78 082380569884
20 80 K29.7 GASTRITIS ANTASIDA 84 082380569884
18 78 J06.9 ISPA PCT, GG, CTM 82 082269007580
26 88 J06.9 ISPA PCT, GG, CTM 40 082377675861
20 78 l95 HIPOTENSI B.COM, PCT 80 082292536689
18 80 K29.7 GASTRITIS ANTASIDA 81 085267842598
20 80 G34 MIGREN ANTALGIN 79 082235126959
22 80 H10.9 KONJUNGTIVITIS KLORAMFENICOL TTM 84 082235126959
20 80 J10-J11 INFLUENZA CTM, EFEDRIN 83 082292536689
18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80 082380569884
20 80 K29.7 GASTRITIS ANTASIDA 87 082235126959
26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 42 085366544411
26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41 082235126959
26 88 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41 085206585630
20 80 K29.7 GASTRITIS ANTASIDA 88 082380569884
26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41 082328454611
 PASIEN JKN DESA LAMPISI BULAN NOVEMBER 2022

Tanggal no Nomor Nama Keluhan BB TB

1 2 3 4 5 6 7
1 0000301825978 SUKARIYANI PUSING 82 161
2 0000989342921 MASTAR NYERI SENDI 54 150
3 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56 151
4 0000301972577 MISNO DEMAM, BATUK, PILEK 64 168
5 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26 124
6 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67 168
7 0000301814346 DARMIN MUAL, NYERI ULU HATI 69 167
8 0000301823212 WINDA KURNIATI SAKIT KEPALA 50 152
9 0000301816631 ASMAWATI MATA MERAH, PEDIH 54 153
10 0000301822839 MIRNAWATI MUAL, NYERI ULU HATI 48 152
11 0000301979406 NASIRON GIGI BERLUBANG, NYERI BERDENYUT 72 173
12 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55 156
13 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61 156
14 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61 152
BULAN NOVEMBER 2022

TD R N Kode Dx Diagnosa TERAPI lingkar perut No hp

8 9 10 11 12 13 14 15
160/100 22 78 I10 HIPERTENSI CAPTOPRIL 92 082236550720
130/80 20 80 M13 ARTRITIS PIROXICAM 78 082380569884
120/80 20 80 K29.7 GASTRITIS ANTASIDA 84 082380569884
120/80 18 78 J06.9 ISPA PCT, GG, CTM 82 082269007580
26 88 J06.9 ISPA PCT, GG, CTM 40 082377675861
80/60 20 78 l95 HIPOTENSI B.COM, PCT 80 082292536689
110/70 18 80 K29.7 GASTRITIS ANTASIDA 81 085267842598
110/70 20 80 G34 MIGREN ANTALGIN 79 082235126959
120/80 22 80 H10.9 KONJUNGTIVITIS KLORAMFENICOL TTM 84 082235126959
110/70 22 80 K29.7 GASTRITIS ANTASIDA 84 082235126959
125/80 20 80 K04 PNY.PULPA & JRNGN PERIAPIKAL ASMEF, AMOXILLIN 84 082377675861
120/80 20 80 J10-J11 INFLUENZA CTM, EFEDRIN 83 082292536689
120/80 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80 082380569884
120/80 20 80 K29.7 GASTRITIS ANTASIDA 87 082235126959
 PASIEN JKN DESA LAMPISI BULAN DESEMBE

Tanggal no Nomor Nama Keluhan BB

1 2 3 4 5 6
2 0000301825978 SUKARIYANI PUSING 82
3 0000989342921 MASTAR NYERI SENDI 54
4 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56
5 0000301972577 MISNO DEMAM, BATUK, PILEK 64
6 0000301980486 REVAN JULIANSYAH DEMAM, BATUK, PILEK 26
7 0000301783724 HASAN PUSING, TIDAK NAFSU MAKAN 67
8 0000301814346 DARMIN MUAL, NYERI ULU HATI 69
9 0000301823212 WINDA KURNIATI SAKIT KEPALA 50
10 0000301816631 ASMAWATI MATA MERAH, PEDIH 54
11 0000301783959 NURUL KOMARIAH BERSIN, HIDUNG TERSUMBAT 55
12 0002607468546 MAHYO BERSIN, HIDUNG TERSUMBAT 61
13 0001684153473 NURHAYATI MUAL, NYERI ULU HATI 61
14 0002603282681 NINDY AULIA FAIRUZ DEMAM, BATUK, PILEK 21
15 0002609237485 AZELIA AZAHRA DEMAM, BATUK, PILEK 25
16 0002603007224 MARWAH NOVIANA NYERI MENELAN, DEMAM 23
17 0002608602952 RUSMIAH MUAL, NYERI ULU HATI 56
18 0002608761003 ZAKI PRASETYO DEMAM, BATUK, PILEK 18
A LAMPISI BULAN DESEMBER 2022

TB TD R N Kode Dx Diagnosa TERAPI lingkar perut

7 8 9 10 11 12 13 14
161 160/100 22 78 I10 HIPERTENSI CAPTOPRIL 92
150 130/80 20 80 M13 ARTRITIS PIROXICAM 78
151 120/80 20 80 K29.7 GASTRITIS ANTASIDA 84
168 120/80 18 78 J06.9 ISPA PCT, GG, CTM 82
124 26 88 J06.9 ISPA PCT, GG, CTM 40
168 80/60 20 78 l95 HIPOTENSI B.COM, PCT 80
167 110/70 18 80 K29.7 GASTRITIS ANTASIDA 81
152 110/70 20 80 G34 MIGREN ANTALGIN 79
153 120/80 22 80 H10.9 KONJUNGTIVITIS KLORAMFENICOL TTM 84
156 120/80 20 80 J10-J11 INFLUENZA CTM, EFEDRIN 83
156 120/80 18 80 J10-J11 INFLUENZA CTM, EFEDRIN 80
152 120/80 20 80 K29.7 GASTRITIS ANTASIDA 87
119 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 42
123 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41
120 26 88 J03 TONSILITIS AKUT PCT, AMOXILLIN, VIT C 41
151 120/80 20 80 K29.7 GASTRITIS ANTASIDA 88
100 26 88 J06.9 ISPA PCT SYR, AMOX SYR, CTM 41
 No hp
15
082236550720
082380569884
082380569884
082269007580
082377675861
082292536689
085267842598
082235126959
082235126959
082292536689
082380569884
082235126959
085366544411
082235126959
085206585630
082380569884
082328454611