Anda di halaman 1dari 41

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jdbhksjhskjhdkjshdkfhksjdfhksbjfhkshdkushbfbdkushhdsbfhsdkbskhfhkushdfbkhsbfsukbskhfhksduhfksbuh
dkfbsjdhfkjbshkdjfhdshfuskhdfkdbshfkjbdfbskjhbhskdhfkjshbdkhfsuebkshdfskdbfhkbsjdhfbskudhfksuhdf
kushdfkbhskdbfhskdhfkjbshkdfhskdhfbskudhfbskdhfbsufhbkushdkushdskhdkbfhksjbdhfskjhdf
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

HARJAWINANGUN RT 1 RW Pemeriksaan
1 ABAS 3328041806730002 53 2023000046430157 Terduga TBC SO 11/03/2023 Neg 11/03/2023 11/03/2023 11/03/2023 12/03/2023 Puskesmas Kalibakung
3 Diagnosis

Pemeriksaan
2 ABDUL AZIZ 3328010302990005 23 2023000046370096 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
3 ABDUL BASIT 1301010303890005 30 2023000046420034 Jalan Mustika Ratu Terduga TBC SO 11/01/2023 Rif Sen 11/01/2023 11/01/2023 20/01/2023 20/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
4 ABDUL MUKHLIS 3328012107830001 39 2023000046380030 PAKULAUT RT 6 RW 3 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
5 ABDUL MUTOPIK 3328040107730019 54 2023000046430119 BUKATEJA RT 2 RW 2 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

HARJAWINANGUN RT 2 RW Pemeriksaan
6 ABDUL ROHMAN 3328040107600161 58 2023000046430058 Terduga TBC SO 04/02/2023 Neg 04/02/2023 04/02/2023 04/02/2023 04/02/2023 Puskesmas Kalibakung
3 Diagnosis

Pemeriksaan
7 ABIYYAN HILLAL AZKA 3328100912100001 12 2023000046450185 DUKUHLO RT 4 RW 5 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Lebaksiu
Diagnosis

BALAPULANG WETAN RT 1 Pemeriksaan


8 ACHMAD NUR ILYAS 3328042107970004 25 2023000046420208 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Balapulang
RW 5 Diagnosis

JEMBAYAT RT 003 RW Pemeriksaan


9 ADE LESTARI 3328016203990002 23 2023000046370271 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
001 Diagnosis

Pemeriksaan
10 ADE SETIYAWATI 3328046608960003 26 2023000046430052 BANJARANYAR RT 7 RW 2 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 30/01/2023 30/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
11 AESYA ASFIATUR RIZQI 3328034908100002 12 2023000046450386 BUNIWAH RT 1 RW 3 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
12 AFANIN LUBNA MUMTAZ 3328134801090002 14 2023000046450391 PENGARASAN RT 8 RW 2 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
13 AFDEL MUAFFA 3328013108070004 15 2023000046370064 MARGASARI RT 1 RW 4 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
14 AFFAN MAULANA 3328011508090003 13 2023000046370065 JATILABA RT 2 RW 3 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

JL. JALI TIMUR RT 2 Pemeriksaan


15 AFIFAH ARTHANAMIDYA 3328156410100001 12 2023000046450396 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
RW 5 Diagnosis

Pemeriksaan
16 AGUS HERONI 3328010305630001 59 2023000046380005 PAKULAUT RT 3 RW 2 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 14/01/2023 Puskesmas Kesambi
Diagnosis

JL. JEND SUDIRMAN Pemeriksaan


17 AGUS HIKMAT 3202320310670001 55 2023000046450364 Terduga TBC SO 17/02/2023 Rif Sen 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Lebaksiu
NO.112 RT 1 RW 6 Diagnosis

Pemeriksaan
18 AGUS MULYANTO 3328042708730001 52 2023000046430062 BATUAGUNG RT 20 RW 4 Terduga TBC SO 06/02/2023 Neg 06/02/2023 06/02/2023 06/02/2023 06/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
19 AGUSTINA TASYA RAMADHANI 3328126508100001 12 2023000046450373 KEBASEN RT 7 RW 2 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 2 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

DUKUH TENGAH RT 3 RW Pemeriksaan


20 AHMAD AGUS 3328010107520286 70 2023000046380109 Terduga TBC SO 21/03/2023 Neg 21/03/2023 21/03/2023 24/03/2023 24/03/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
21 AHMAD FAUZI 3329162007050005 17 2023000046450448 KUBANGJATI RT 2 RW 2 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 02/03/2023 02/03/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
22 AHMAD MUBAROK 3328010310940004 28 2023000046370095 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT Pemeriksaan


23 AHMAD ROIP 3328040102720003 51 2020000112710848 Terduga TBC SO 07/03/2023 Neg 07/03/2023 07/03/2023 08/03/2023 08/03/2023 Puskesmas Balapulang
010 RW 004 Diagnosis

Pemeriksaan
24 AIDIN 3328062207670001 55 2023000046420112 DUREN SAWIT RT 5 RW 5 Terduga TBC SO 13/02/2023 Rif Sen 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
25 AJI GUNAWAN 3328012807920003 30 2023000046370327 MARGASARI RT 1 RW 10 Terduga TBC SO 29/03/2023 Neg 29/03/2023 29/03/2023 30/03/2023 30/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
26 AKHMAD ABDUROHMAN 3328010107930038 28 2023000046380016 PAKULAUT RT 4 RW 3 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 16/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
27 AKHMAD DARDIRI 3328013112470091 75 2023000046370269 JEMBAYAT RT 3 RW 1 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
28 AKHMAD FATORI 3328062705680004 54 2023000046450252 DUKUHLO RT 2 RW 1 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Lebaksiu
Diagnosis

DESA PAKULAUT RT 4 RW Pemeriksaan


29 AKHMAD SUHALLY 3328010510790001 43 2023000046380007 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
30 AKIL SAMSUL ARIFIN 3328042606890002 33 2023000046430024 KARANGJAMBU RT 1 RW 7 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 12/01/2023 12/01/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


31 AKROM 3328041605690003 53 2023000046420183 Terduga TBC SO 06/03/2023 Rif Sen 06/03/2023 06/03/2023 07/03/2023 07/03/2023 Puskesmas Balapulang
RW 9 Diagnosis

JL WALET I BLOK
Pemeriksaan
32 AKROM MAULANA ATARSYAH 3328010102120004 11 2023000046380088 E-26/8 PD SEJAHTERA Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis
RT 8 RW 10

Pemeriksaan
33 ALFUN NI'MAH 3328044906100008 12 2023000046450400 BANJARANYAR RT 3 RW 4 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
34 ALVIANA 3328066507050001 17 2023000046450039 KESUBEN RT 2 RW 10 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Lebaksiu
Diagnosis

HARJAWINANGUN RT 5 RW Pemeriksaan
35 ALYA NAJLA THUFAILAH 3328042307070004 15 2023000046430141 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Kalibakung
4 Diagnosis

Pemeriksaan
36 AMIN MUSTAKHIM 3305080409800001 42 2023000046370261 MARGA AYU RT 1 RW 2 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
37 AMIN SUGITO 3328012009590001 63 2023000046370300 MARGASARI RT 5 RW 2 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


38 AMINAH 3328015303730003 49 2023000046380081 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 09/03/2023 Puskesmas Kesambi
RW 7 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 3 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
39 AMINUDIN 3328010707770006 45 2023000046370126 MARGASARI RT 2 RW 4 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 17/02/2023 17/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
40 AMIROH ULPAH 3328040107850243 40 2023000046430164 CENGGINI RT 3 RW 4 Terduga TBC SO 14/03/2023 Neg 14/03/2023 14/03/2023 14/03/2023 14/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
41 ANGGI BUDIYARTI 3327024608000008 22 2023000046430023 KARANGJAMBU RT 1 RW 7 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 12/01/2023 12/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
42 ANI LUTFIYAH 3328047012970004 25 2023000046420224 DANAWARIH RT 3 RW 2 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 28/03/2023 28/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
43 ANISA FITRI AINUN FADILLA 3328065709100001 12 2023000046450283 DUKUHLO RT 3 RW 1 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
44 ANISSA DWI ARYANI 3328124101100001 13 2023000046450399 DESA PACUL RT 20 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK SELATAN RT 4 Pemeriksaan


45 ANTISAH 3328015407690006 53 2023000046380033 Terduga TBC RO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Kesambi
RW 4 Diagnosis

PRUPUK SELATAN RT 4 Pemeriksaan


46 ANTISAH 3328015407690006 53 2023000046380033 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kesambi
RW 4 Diagnosis

Pemeriksaan
47 ARDIANTORO ARSO 3328062202770005 45 2022000046450208 kajen 3/2 Terduga TBC SO 20/01/2023 Rif Sen 20/01/2023 20/01/2023 21/01/2023 21/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
48 ARIFIN 3328011911540001 68 2023000046380015 PAKULAUT RT 4 RW 3 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
49 ARIPIN 3328012506800001 42 2023000046370117 MARGASARI RT 2 RW 8 Terduga TBC SO 09/02/2023 Rif Sen 09/02/2023 09/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT Pemeriksaan


50 ARLINAH 3328045803670001 55 2021000109860362 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 07/03/2023 Puskesmas Balapulang
006 RW 004 KAB. TEGAL Diagnosis

Pemeriksaan
51 ARUM PANDANSARI 3328015508010007 21 2023000046370119 MARGA AYU RT 5 RW 1 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
52 ARY GUSTONI 3328060608730003 49 2023000046450410 DUREN SAWIT RT 3 RW 5 Terduga TBC SO 21/02/2023 Neg 22/02/2023 22/02/2023 24/02/2023 24/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
53 ARYA AJI PANGESTU 3328042208020003 20 2023000046430065 BUKATEJA RT 2 RW 2 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
54 ARZY WAHYU AMINULLOH 3328040312100001 12 2023000046430038 BANJARANYAR RT 6 RW 5 Terduga TBC SO 17/01/2023 Neg 17/01/2023 17/01/2023 18/01/2023 18/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
55 ASIILAH ZAHRA BASHIR 3328124806060003 16 2023000046450406 PASANGAN RT 11 RW 4 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
56 ASIKIN 3328012011650003 57 2023000046370187 JEMBAYAT RT 1 RW 1 Terduga TBC SO 23/02/2023 Neg 23/02/2023 23/02/2023 24/02/2023 24/02/2023 Puskesmas Margasari Tegal
Diagnosis

DK. WANAGOPA RT 1 RW Pemeriksaan


57 ASYA RAHMA DANIA 3328175509080002 14 2023000046450395 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
3 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 4 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
58 ATHAYA ARUMI SALSABILA 3328044811160005 6 2023000046430190 KALIBAKUNG RT 1 RW 3 Terduga TBC SO 30/03/2023 Neg 30/03/2023 30/03/2023 30/03/2023 30/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
59 AURA AINAN NYSA 3329154408090002 13 2023000046450377 SITANGGAL RT 7 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
60 AVIN NURLAILA 3328014606990004 23 2023000046370109 SULUSUBAN RT 28 RW 4 Terduga TBC RO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
61 AYU WULANDARI 3328036412030003 19 2023000046450405 BOJONG RT 8 RW 2 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


62 AYYA KHANZA ZAFIRA 3328046109120001 10 2023000046420066 Terduga TBC SO 03/02/2023 Neg 03/02/2023 03/02/2023 04/02/2023 04/02/2023 Puskesmas Balapulang
RW 9 Diagnosis

KETANGGUNGAN RT 6 RW Pemeriksaan
63 AZITA LAELA RAHMA 3328136201090001 14 2023000046450394 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
1 Diagnosis

Pemeriksaan
64 AZIZ ZAWAWI 3328040101740005 49 2023000046430030 KALIBAKUNG RT 2 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 16/01/2023 16/01/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 1 Pemeriksaan


65 AZMIL MUSTOFA 3328040107920093 32 2023000046420052 Terduga TBC RO 20/01/2023 Neg 20/01/2023 20/01/2023 21/01/2023 21/01/2023 Puskesmas Balapulang
RW 10 Diagnosis

Pemeriksaan
66 AZRIEL ARKAN PUTRA GHOZALI 3328010710090001 13 2023000046370066 KARANGDAWA RT 2 RW 1 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
67 BACHRI 3328042503530004 69 2023000046430078 KALIBAKUNG RT 5 RW 2 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
68 BAGAS ZAKIA MUNIR 3328010802090001 14 2023000046380060 DUKUHTENGAH RT 4 RW 4 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
69 BAMBANG MUROKHIM 3328061005620001 60 2022000046451272 KRAJAN 1 1/7 Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 11/01/2023 11/01/2023 RS Hawari Essa
Diagnosis

Pemeriksaan
70 BANAJI 3328011312620001 60 2023000112710552 KALISALAK RT 1 RW 1 Terduga TBC RO 09/03/2023 Rif Res 09/03/2023 09/03/2023 10/03/2023 10/03/2023 Puskesmas Margasari Tegal
Diagnosis

HARJAWINANGUN RT 5 RW Pemeriksaan
71 BAROKATUN ANNISA 3328044205140007 8 2023000046430070 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Kalibakung
4 Diagnosis

Pemeriksaan
72 BAWON 3328014506670005 54 2023000046370094 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
73 BEGI ADITIA PRATAMA 3328010308000004 22 2023000046380091 PAKULAUT RT 4 RW 2 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

DESA KARANGDAWA RT 3 Pemeriksaan


74 BETTY ROCHYANI 3328015707880005 34 2023000046370085 Terduga TBC SO 30/01/2023 Rif Sen 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Margasari Tegal
RW 8 Diagnosis

WRINGINJENGGOT RT 1 Pemeriksaan
75 BIAS KHAYATUN NUFUS 3328046707090003 13 2023000046450393 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
RW 3 Diagnosis

JL.LETJEN SUPRAPTO Pemeriksaan


76 BILQIS AULIYA RAMADYNI 3174094510071004 15 2023000046450392 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
NO.174/47 RT 1 RW 3 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 5 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
77 BUDIYANTI 3328014703790011 43 2023000046380028 PAKULAUT RT 1 RW 2 Terduga TBC RO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Kesambi
Diagnosis

HARJAWINANGUN RT 5 RW Pemeriksaan
78 BUNAIM 3328041212600023 62 2023000046430165 Terduga TBC SO 14/03/2023 Neg 14/03/2023 14/03/2023 14/03/2023 14/03/2023 Puskesmas Kalibakung
4 Diagnosis

Pemeriksaan
79 BUNGA ASA VERNANDA 3328047001090001 14 2023000046430108 PAGERWANGI RT 4 RW 1 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 24/02/2023 24/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
80 CANDRA SUWANDI 3328011310930003 29 2023000046380115 DUKUHTENGAH RT 1 RW 2 Terduga TBC SO 29/03/2023 Rif Sen 29/03/2023 29/03/2023 30/03/2023 30/03/2023 Puskesmas Kesambi
Diagnosis

HARJAWINANGUN RT 2 RW Pemeriksaan
81 CARKUM EDI S. 3328040812870001 35 2023000046430181 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 27/03/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
82 CARMUN 3328011404460002 76 2023000046370273 JEMBAYAT RT 1 RW 12 Terduga TBC SO 01/03/2023 Rif Sen 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
83 CASIH 3328016705720004 50 2023000046370265 JEMBAYAT RT 1 RW 12 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
84 CASIH 3328065008500011 72 2023000046450412 DUKUHLO 1/6 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 24/02/2023 24/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
85 CASMIRAH 3328016108840002 38 2023000046370288 JATILABA RT 2 RW 8 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 10/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
86 CASONAH 3328014808950005 27 2023000046370129 KARANGDAWA RT 2 RW 10 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Margasari Tegal
Diagnosis

DS.PRUPUK SELATAN RT Pemeriksaan


87 CAUM 3328011812790003 43 2023000046380022 Terduga TBC SO 17/01/2023 Neg 17/01/2023 17/01/2023 18/01/2023 18/01/2023 Puskesmas Kesambi
2 RW 6 Diagnosis

Pemeriksaan
88 CHANDRA PUTRA FEBRIAN 3328041502150001 8 2023000046430148 KALIBAKUNG RT 1 RW 1 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 06/03/2023 07/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
89 CHANIROH 3328045602810010 42 2023000046420150 PAMIRITAN RT 3 RW 1 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
Diagnosis

HARJAWINANGUN RT 6 RW Pemeriksaan
90 CHATTANA RIDHOKA 3328041604100002 12 2023000046430083 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Kalibakung
4 Diagnosis

HARJAWINANGUN RT 6 RW Pemeriksaan
91 CHODIDJAH 3328046412520001 70 2023000046430133 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 04/03/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
92 CHOERUNISA 3174075509881001 33 2023000046420202 CIBUNAR 1/5 Terduga TBC SO 07/03/2023 Neg 07/03/2023 07/03/2023 08/03/2023 08/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
93 CICI NUR SAFITRI 3328015512990008 23 2023000046370136 DUKUHTENGAH RT 1 RW 5 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
94 DAENAH 3328066510660002 56 2023000046450449 SEMPUMAJA RT 5 RW 2 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 02/03/2023 02/03/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
95 DAIRAH 3328044708560001 66 2023000046430111 CENGGINI RT 4 RW 1 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 27/02/2023 27/02/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 6 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
96 DAIROH 3328014504910003 31 2023000046370113 JATILABA RT 1 RW 7 Terduga TBC SO 08/02/2023 Rif Sen 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
97 DAKRUN 3328040705520002 62 2023000046430160 DANAREJA RT 5 RW 3 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 13/03/2023 13/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
98 DAKUM A DARKUM 3328011212590007 63 2023000046370060 KARANGDAWA RT 4 RW 5 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 5 Pemeriksaan


99 DAMO 3328010107490025 73 2023000046380067 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
100 DAMU 3328040503530004 70 2023000046430159 BATUAGUNG RT 6 RW 1 Terduga TBC RO 11/03/2023 Neg 11/03/2023 11/03/2023 11/03/2023 12/03/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT Pemeriksaan


101 DANIL FAIZAL AMRI 3328043010000007 22 2023000046420090 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Balapulang
10 RW 8 Diagnosis

Pemeriksaan
102 DANINGSIH 3328044101850003 40 2023000046430174 DANAREJA RT 6 RW 3 Terduga TBC SO 17/03/2023 Neg 17/03/2023 17/03/2023 17/03/2023 18/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
103 DARJO 3328012604670002 55 2023000046370152 MARGASARI RT 4 RW 9 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 28/03/2023 28/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
104 DARJO 3328031812720001 50 2023000046430120 KALIBAKUNG RT 3 RW 3 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

JL. MASJID ASSYAKUR Pemeriksaan


105 DARMANTO 3674050510870008 35 2023000046420119 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Balapulang
BANJARANYAR RT 2 RW 3 Diagnosis

Pemeriksaan
106 DARMI 3328016802830002 39 2023000046370037 JEMBAYAT RT 1 RW 12 Terduga TBC RO 10/01/2023 Neg 10/01/2023 10/01/2023 11/01/2023 11/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
107 DARNINGSIH 3328015408890010 33 2023000046430094 BATUAGUNG RT 24 RW 4 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 2 Pemeriksaan


108 DARNO 3328012504470004 75 2023000046380049 Terduga TBC SO 15/02/2023 Rif Sen 15/02/2023 15/02/2023 17/02/2023 17/02/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
109 DARSO 3328010108490002 73 2023000046380105 PRUPUK UTARA 7/2 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
110 DARSONI 3328040102710004 52 2023000046430066 BATUAGUNG RT 16 RW 3 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
111 DARSONO 3328010107740103 48 2022000046370035 MARGA AYU 1/3 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Margasari Tegal
Diagnosis

KARANG JAMBU RT 3 RW Pemeriksaan


112 DARSONO 3328041210510001 71 2023000046430140 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Kalibakung
3 Diagnosis

Pemeriksaan
113 DARYATI 3328017011790001 43 2023000046370134 JATILABA RT 4 RW 6 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
114 DARYO 3328010308630005 59 2023000046370057 JEMBAYAT RT 3 RW 12 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 7 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
115 DARYO 3328012512470002 75 2023000046370058 JEMBAYAT RT 1 RW 12 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
116 DASRI 3328016201730002 49 2023000046370052 JEMBAYAT RT 2 RW 10 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
117 DEA APRILIAN 3205025404920002 30 2023000153040085 Lebaksiu Lor Terduga TBC SO 04/02/2023 Rif Sen 04/02/2023 04/02/2023 07/02/2023 07/02/2023 RS Hawari Essa
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


118 DEDE ILMI AMALIYAH 3328014201080001 15 2023000046380048 Terduga TBC SO 15/02/2023 Rif Sen 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
119 DEPI RAMANSYAH 3328044212940001 28 2023000046430042 KALIBAKUNG RT 4 RW 2 Terduga TBC SO 20/01/2023 Neg 20/01/2023 20/01/2023 20/01/2023 20/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
120 DESI DIANA SARI 3328016812140002 8 2023000046370072 MARGAAYU RT 2 RW 2 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
121 DEVI MAESANTI 3328045608010005 22 2023000046430106 BANJARANYAR RT 3 RW 3 Terduga TBC SO 23/02/2023 Rif Sen 23/02/2023 23/02/2023 23/02/2023 23/02/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


122 DEWI ANGGRAENI 3328014701810003 42 2023000046380064 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 7 Diagnosis

DK. TEGAL KUBUR RT 5 Pemeriksaan


123 DEWI ATIKOH 3328066909870002 35 2023000046450038 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Lebaksiu
RW 7 Diagnosis

Pemeriksaan
124 DEWI PURWANTI 3328045001910010 32 2023000046420149 KALIWUNGU RT 3 RW 2 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
125 DIAH 3328014104630002 59 2023000046370061 KARANGDAWA RT 4 RW 5 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 18/01/2023 18/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 3 Pemeriksaan


126 DIAN ASTUTI 3328015208950006 27 2023000046380029 Terduga TBC SO 01/02/2023 Rif Sen 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Kesambi
RW 7 Diagnosis

BALAPULANG WETAN RT 1 Pemeriksaan


127 DIMAS ADITYA ALIFIANTO 3328101008980005 24 2023000046420120 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Balapulang
RW 2 Diagnosis

Pemeriksaan
128 DINAR AYU PRAMESTI 3328016804090005 13 2023000046370073 JATILABA RT 3 RW 3 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
129 DINI PIDIYAH ELIYANTI 3328044101900018 33 2023000046430014 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 09/01/2023 09/01/2023 Puskesmas Kalibakung
1 Diagnosis

Pemeriksaan
130 DIRAH 3328014107530044 69 2020000046380020 prupuk selatan 5/3 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
131 DISKA AMELIA 3328045412010001 21 2023000046430168 BUKATEJA RT 8 RW 2 Terduga TBC SO 15/03/2023 Neg 15/03/2023 15/03/2023 15/03/2023 15/03/2023 Puskesmas Kalibakung
Diagnosis

KARANG JAMBU RT 1 RW Pemeriksaan


132 DITA NURJANAH 3328045205020003 20 2023000046430171 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 16/03/2023 16/03/2023 Puskesmas Kalibakung
6 Diagnosis

Pemeriksaan
133 DITA NAJUNDASARI 3328046611010005 21 2023000046420216 KALIWUNGU RT 4 RW 1 Terduga TBC SO 20/03/2023 Neg 20/03/2023 20/03/2023 24/03/2023 24/03/2023 Puskesmas Balapulang
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 8 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
134 DJAMALUDIN 3328040502580002 65 2023000046420093 KALIWUNGU RT 2 RW 1 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 13/02/2023 13/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
135 DOHIROH 3328046405810003 41 2023000046430072 BATUAGUNG RT 17 RW 3 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 11/02/2023 11/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
136 DRAJAT 3328041501620006 61 2023000046420079 CIBUNAR RT 1 RW 5 Terduga TBC SO 06/02/2023 Rif Sen 06/02/2023 06/02/2023 07/02/2023 07/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
137 DUL HALIM 3328041507530008 69 2022000046430201 KARANGJAMBU RT 1 RW 4 Terduga TBC SO 10/03/2023 Neg 10/03/2023 10/03/2023 10/03/2023 11/03/2023 Puskesmas Kalibakung
Diagnosis

DUKUH TENGAH RT 1 RW Pemeriksaan


138 DWI ASTUTININGSIH 3328016901900009 32 2023000046380003 Terduga TBC SO 09/01/2023 Rif Sen 09/01/2023 09/01/2023 10/01/2023 10/01/2023 Puskesmas Kesambi
6 Diagnosis

Pemeriksaan
139 DYAH FAUZIYATI 3328065609930003 29 2023000046450202 KESUBEN RT 2 RW 12 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 27/01/2023 27/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
140 EDLYN QISYA AZARIA 3328107001140002 9 2023000046450452 SLAWI KULON RT 3 RW 9 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 02/03/2023 02/03/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
141 EKA AYU MAULIDDIA 3173045707970002 25 2023000046430069 BANJARANYAR RT 5 RW 2 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Kalibakung
Diagnosis

DUKUH TENGAH RT 1 RW Pemeriksaan


142 EKA YULIA ADE NINGRUM 3328014607050005 17 2023000046380043 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
1 Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


143 ELSA NUR FADILAH 3328014112060009 16 2023000046380079 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 10/03/2023 Puskesmas Kesambi
RW 7 Diagnosis

BALAPULANG WETAN RT 2 Pemeriksaan


144 ELVA NUR HIDAYAH 3328044903020002 20 2023000046420083 Terduga TBC SO 08/02/2023 Rif Sen 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Balapulang
RW 10 Diagnosis

DESA DANAREJA RT 3 RW Pemeriksaan


145 ENCUM SUMARNI 3328044904690002 53 2023000046430128 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 04/03/2023 Puskesmas Kalibakung
2 Diagnosis

BALAPULANG WETAN RT 5 Pemeriksaan


146 ENDANG MUTIARI 3328046403640001 58 2023000046420065 Terduga TBC SO 03/02/2023 Neg 03/02/2023 03/02/2023 04/02/2023 04/02/2023 Puskesmas Balapulang
RW 4 Diagnosis

Pemeriksaan
147 ERLINAWATI 3328044405810002 41 2023000046430169 BUKATEJA RT 8 RW 2 Terduga TBC SO 15/03/2023 Neg 15/03/2023 15/03/2023 15/03/2023 15/03/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 9 Pemeriksaan


148 ESTIKA KURNIA PRATIWI 3328045405040001 18 2023000046420122 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Balapulang
RW 4 Diagnosis

LEBAKSIU LOR RT 1 RW Pemeriksaan


149 ETI KUSMIYATI 3604155509790004 43 2023000046450361 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
8 Diagnosis

Pemeriksaan
150 EVA DWI ROSIANA 3328046411930004 29 2023000046430013 BATUAGUNG RT 18 RW 3 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 09/01/2023 09/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
151 EVAN ETENIA SANDY 3328040303040001 18 2022000046380215 WANASARI RT 4 RW 3 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Kesambi
Diagnosis

PRUPUK SELATAN RT 4 Pemeriksaan


152 EVI SRIYANTI 3328014204840007 38 2023000046380036 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 11/02/2023 11/02/2023 Puskesmas Kesambi
RW 5 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 9 dari 41
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
153 FACHRI RAHMADANI 3328040205090003 13 2023000046430087 BATUAGUNG RT 13 RW 3 Terduga TBC SO 15/02/2023 Rif Sen 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
154 FADLI AHMAD 3328041401150004 7 2023000046430018 CENGGINI RT 1 RW 2 Terduga TBC SO 09/01/2023 Rif Sen 09/01/2023 09/01/2023 10/01/2023 10/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
155 FAIZAR AL GHAZALI 3328011110150001 7 2023000046370125 KARANGDAWA RT 4 RW 8 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
156 FAIZATUL AMILA 3328045605120001 10 2023000046430020 BUKATEJA RT 2 RW 1 Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 10/01/2023 10/01/2023 Puskesmas Kalibakung
Diagnosis

DS. TEMBONGWAH RT 3 Pemeriksaan


157 FAIZIN 3328041202730001 50 2023000046430162 Terduga TBC SO 13/03/2023 Rif Sen 13/03/2023 13/03/2023 13/03/2023 13/03/2023 Puskesmas Kalibakung
RW 4 Diagnosis

PRUPUK UTARA RT 6 RW Pemeriksaan


158 FAJAR SIDIK RIYADI 3328011005070006 15 2023000046380026 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 27/01/2023 27/01/2023 Puskesmas Kesambi
3 Diagnosis

DUKUH TENGAH RT 2 RW Pemeriksaan


159 FAJRIAN 3328011304030007 19 2023000046380116 Terduga TBC SO 29/03/2023 Rif Sen 29/03/2023 29/03/2023 30/03/2023 30/03/2023 Puskesmas Kesambi
4 Diagnosis

BALAPULANG KULON RT 7 Pemeriksaan


160 FARIDA MULYATI 3328046003810002 41 2023000046420121 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
161 FATIKHA 3328044204650001 57 2023000046420001 DK.KASERAN RT 4 RW 1 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
162 FATIMAH 3328014809610006 61 2023000046370062 JEMBAYAT RT 1 RW 10 Terduga TBC SO 18/01/2023 Neg 18/01/2023 18/01/2023 19/01/2023 19/01/2023 Puskesmas Margasari Tegal
Diagnosis

DESA BANJARANYAR RT 4 Pemeriksaan


163 FATKHUROJI 3328042407730002 49 2023000046430105 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 Puskesmas Kalibakung
RW 5 Diagnosis

Pemeriksaan
164 FATLUROH 3328066808870005 35 2023000046450010 KESUBEN RT 4 RW 9 Terduga TBC SO 05/01/2023 Neg 05/01/2023 05/01/2023 07/01/2023 07/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
165 FATONI 3328040705560001 66 2023000046420152 DANAWARIH RT 1 RW 1 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
166 FAZARI KHARIZA 3328066612020001 20 2023000046450280 DK. YOMANI RT 5 RW 3 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
167 FIDEA MIRANTIKA 3328066009960003 26 2023000046450314 DURENSAWIT RT 1 RW 5 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK UTARA RT 7 RW Pemeriksaan


168 FINA SEPTIANA ANGGRAINI 3328015909860004 36 2023000046380038 Terduga TBC SO 13/02/2023 Rif Sen 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Kesambi
3 Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


169 FIRDA TRI RAKHMAWATI 3328015208080003 14 2023000046380042 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
170 FIRLY IRNAENI 3328146402090001 13 2023000046450376 SETU RT 4 RW 1 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK SELATAN Pemeriksaan


171 FITRI SETIOWATI 3328015612010010 21 2023000046380076 Terduga TBC SO 07/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 10/03/2023 Puskesmas Kesambi
005/003 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 10 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
172 FITRIYANI 3328065404910006 31 2023000046450129 KAJEN RT 3 RW 8 Terduga TBC SO 17/01/2023 Neg 17/01/2023 17/01/2023 18/01/2023 18/01/2023 Puskesmas Lebaksiu
Diagnosis

LEBAKSIU LOR RT 2 RW Pemeriksaan


173 FITRIYANINGSIH 3328064202960002 27 2023000046450365 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Lebaksiu
4 Diagnosis

JL. BISMA NO. 82 Pemeriksaan


174 GUNAWATI 3328016201640003 59 2023000112740209 Terduga TBC SO 10/03/2023 Rif Sen 10/03/2023 10/03/2023 11/03/2023 12/03/2023 Puskesmas Margasari Tegal
MARGASARI RT 1 RW 1 Diagnosis

Pemeriksaan
175 GURITNO AGUS PURNOMO 3328011808720005 50 2023000046380111 PRUPUKUTARA RT 3 RW 1 Terduga TBC RO 28/03/2023 Neg 28/03/2023 28/03/2023 29/03/2023 29/03/2023 Puskesmas Kesambi
Diagnosis

TANGGUNGSARI RT 2 RW Pemeriksaan
176 HABIL SATYA ABDILAH 3329161004090002 13 2023000046370067 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
1 Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


177 HALIM HAKIM 3328040902920003 30 2023000046420111 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Balapulang
RW 9 Diagnosis

Pemeriksaan
178 HARIRI 3328060409490001 73 2023000046450366 KESUBEN RT 5 RW 10 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
179 HARSONO 3328041512550005 67 2023000046430137 KALIBAKUNG RT 6 RW 2 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 6 Pemeriksaan


180 HARTONO 3328042403590002 63 2023000046420159 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
RW 4 Diagnosis

Pemeriksaan
181 HARTONO 3328042406750007 47 2023000046430155 BATUAGUNG RT 23 RW 4 Terduga TBC SO 10/03/2023 Neg 10/03/2023 10/03/2023 10/03/2023 11/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
182 HASNA NADA FITRIA 3328125009100004 12 2023000046450380 CANGKRING RT 5 RW 2 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

KP. CIBUBUAY RT 4 RW Pemeriksaan


183 HAYATI 3328045805830001 39 2023000046420145 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
1 Diagnosis

Pemeriksaan
184 HENA ALEYDA SUTISNA 3328045510030004 19 2023000046430006 KALIBAKUNG RT 4 RW 1 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Kalibakung
Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
185 HENDRIK MAULANA 3328040105850002 37 2023000046430187 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 28/03/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
186 HERI PURNOMO 3328010610980004 24 2023000046370013 JEMBAYAT RT 3 RW 12 Terduga TBC SO 05/01/2023 Neg 05/01/2023 05/01/2023 06/01/2023 06/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
187 HESTI SUPRIYATIN 3328047006090002 13 2023000046430154 BANJARANYAR RT 7 RW 1 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 09/03/2023 09/03/2023 Puskesmas Kalibakung
Diagnosis

DK.KRAJAN 11 RT 003 Pemeriksaan


188 HIDAYATUL MUSTAPIDAH 3328046909930001 29 2022000112710924 Terduga TBC RO 27/02/2023 Neg 27/02/2023 27/02/2023 27/02/2023 27/02/2023 Puskesmas Kalibakung
RW 005 Diagnosis

Pemeriksaan
189 HIMATUL ATQIYA 3328035506050003 17 2023000153040093 KEDAWUNG RT 2 RW 3 Terduga TBC SO 27/02/2023 Rif Sen 27/02/2023 27/02/2023 28/02/2023 28/02/2023 RS Hawari Essa
Diagnosis

Pemeriksaan
190 IDA ROYANI 3328014805960008 26 2023000046370092 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 11 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
191 IKA ALIYA AZIZAH 3328016802970004 26 2023000046370264 JEMBAYAT RT 2 RW 12 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
192 IKA AULYA NAFISYAH 3328047008940001 28 2023000046430017 BANJARANYAR RT 2 RW 1 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 10/01/2023 10/01/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 2 Pemeriksaan


193 IKA SETIAWATI 3328015406930007 29 2023000046380072 Terduga TBC SO 07/03/2023 Neg 07/03/2023 07/03/2023 08/03/2023 08/03/2023 Puskesmas Kesambi
RW 8 Diagnosis

Pemeriksaan
194 IKE KOMALA DEWI 3328044112980006 24 2023000046430107 BANJARANYAR RT 3 RW 4 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 24/02/2023 24/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
195 IMA HELIANINGSIH 3328045502910003 32 2023000046430100 CENGGINI RT 1 RW 4 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
196 IMAM WAHYUDO 3328062712890007 33 2023000046450001 DUKUHLO RT 3 RW 4 Terduga TBC SO 03/01/2023 Rif Sen 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Lebaksiu
Diagnosis

DK. KARANGWUNI RT 5 Pemeriksaan


197 INDI SYIFA 3328174806100003 12 2023000046450387 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
RW 3 Diagnosis

Pemeriksaan
198 INDRA YULIANTO 3928060805840007 27 2023000046450253 KESUBEN 4/1 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
199 INDRAGANDI 3328105103850005 37 2022000046450941 Dukuh lo 5/5 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
Diagnosis

HARJAWINANGUN RT 2 RW Pemeriksaan
200 INTAN AMELIA KHUSNA 3328046507990010 23 2023000046430073 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 11/02/2023 11/02/2023 Puskesmas Kalibakung
3 Diagnosis

Pemeriksaan
201 IRAWATI DWI ANDAYANI 3328046908930003 29 2023000046420219 KALIWUNGU RT 1 RW 2 Terduga TBC SO 21/03/2023 Neg 21/03/2023 21/03/2023 24/03/2023 24/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
202 IRFINA NURLAILA 3328016501010004 22 2021000046370072 marga ayu 2/1 Terduga TBC RO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
203 IRPAN SUJADI 3328042501680002 54 2023000046420035 KALIWUNGU RT 2 RW 1 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
204 IRPAN SUJADI 3328042501680002 54 2023000046420035 KALIWUNGU RT 2 RW 1 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
205 ISHMATUL ZULFA 3328066501030005 19 2023000046450011 KESUBEN RT 1 RW 9 Terduga TBC SO 05/01/2023 Rif Sen 05/01/2023 05/01/2023 07/01/2023 07/01/2023 Puskesmas Lebaksiu
Diagnosis

LEBAKSIU KIDUL RT 5 Pemeriksaan


206 ISNA FAUZIAH 3328066211000002 22 2023000046450003 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Lebaksiu
RW 5 Diagnosis

Pemeriksaan
207 ISNI NURUL HIDAYAH 3328135104100002 12 2023000046450397 KEPANDEAN RT 1 RW 6 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

HARJOWINANGUN RT 4 RW Pemeriksaan
208 ISRO 3328045711530001 61 2023000046430122 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
3 Diagnosis

Pemeriksaan
209 ITA MUNDIARTI 3328045006970008 25 2023000046430178 CILONGOK RT 2 RW 1 Terduga TBC SO 20/03/2023 Rif Sen 20/03/2023 20/03/2023 20/03/2023 20/03/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 12 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
210 JACHJA 3328040107370125 84 2023000046430134 KARANGJAMBU RT 2 RW 1 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
211 JAETUN 3328044107520104 70 2023000046430132 TEMBONGWAH RT 4 RW 4 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
212 JAHRO 3328045207620006 60 2023000046420154 DARAWARIH RT 1 RW 1 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
213 JAMALUDIN 3328040107910125 32 2023000046420220 SANGKANJAYA RT 3 RW 1 Terduga TBC SO 24/03/2023 Rif Sen 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
214 JAMARI 3328060107500118 72 2023000046450352 TIMBANGREJA RT 1 RW 7 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
Diagnosis

DESA TEMBONGWAH RT 6 Pemeriksaan


215 JAMJURI 3328040808530002 69 2023000046430004 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 05/01/2023 04/01/2023 Puskesmas Kalibakung
RW 1 Diagnosis

PRUPUK UTARA RT 3 RW Pemeriksaan


216 JAROTIN 3328016506700004 52 2023000046380073 Terduga TBC SO 07/03/2023 Neg 07/03/2023 07/03/2023 08/03/2023 08/03/2023 Puskesmas Kesambi
2 Diagnosis

BALAPULANG WETAN RT 7 Pemeriksaan


217 JARWOTO 3328041512830001 39 2023000046420158 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
RW 9 Diagnosis

Pemeriksaan
218 JESSICA PUTRI NAILAH 3328114512050004 17 2023000046450390 KALIWADAS RT 3 RW 1 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK UTARA RT 3 RW Pemeriksaan


219 JOLEHA 3328014402660002 57 2023000046380074 Terduga TBC SO 07/03/2023 Rif Sen 07/03/2023 07/03/2023 08/03/2023 08/03/2023 Puskesmas Kesambi
4 Diagnosis

DK. TEGALKUBUR RT 3 Pemeriksaan


220 JUMADI 3328062002720003 51 2023000046450368 Terduga TBC SO 20/02/2023 Rif Sen 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Lebaksiu
RW 8 Diagnosis

Pemeriksaan
221 JUMAROH 3328016908690002 53 2023000046370266 JEMBAYAT RT 2 RW 12 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Margasari Tegal
Diagnosis

BANJAR ANYAR RT 1 RW Pemeriksaan


222 JUMRIAH 3328045204800006 42 2023000046430188 Terduga TBC SO 29/03/2023 Neg 29/03/2023 29/03/2023 29/03/2023 29/03/2023 Puskesmas Kalibakung
4 Diagnosis

Pemeriksaan
223 JUNAEDI 3328060303660005 56 2022000046450847 Kesuben 5/3 Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 11/01/2023 11/01/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK UTARA RT 6 RW Pemeriksaan


224 JUNIA ARI WIDAYANTI 3328014906010004 22 2023000046380110 Terduga TBC SO 21/03/2023 Neg 21/03/2023 21/03/2023 24/03/2023 24/03/2023 Puskesmas Kesambi
1 Diagnosis

Pemeriksaan
225 JUPRI 3328010112650008 57 2023000046370093 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
226 JUWAHIR 3328010507840001 38 2023000046370275 JEMBAYAT RT 3 RW 3 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
227 K. UNTUNG 3328040107550095 67 2023000046430015 KALIBAKUNG RT 6 RW 1 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 09/01/2023 09/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
228 KADORI 3328011207520006 70 2023000046370005 KALISALAK RT 2 RW 10 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Margasari Tegal
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 13 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
229 KAMALI 3328060701550001 68 2023000046450409 DK. WINONG RT 2 RW 4 Terduga TBC SO 21/02/2023 Rif Sen 22/02/2023 22/02/2023 24/02/2023 24/02/2023 Puskesmas Lebaksiu
Diagnosis

BALAPULANG KULON RT 5 Pemeriksaan


230 KAMILAH 3328044105420001 80 2023000046420156 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

Pemeriksaan
231 KAMPLIS 3328010604600001 62 2023000046370047 KARANGDAWA RT 4 RW 5 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK UTARA RT 6 RW Pemeriksaan


232 KANINGSIH 3328014711790005 43 2023000046380055 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 20/02/2023 20/02/2023 Puskesmas Kesambi
2 Diagnosis

JL. K SOLIKIM RT 3 RW Pemeriksaan


233 KARMAN 3671111112540004 68 2023000046370086 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Margasari Tegal
3 Diagnosis

DESA PRUPUK UTARA RT Pemeriksaan


234 KARNO 3328010409710002 51 2023000046380004 Terduga TBC SO 11/01/2023 Rif Sen 11/01/2023 11/01/2023 12/01/2023 12/01/2023 Puskesmas Kesambi
2 RW 1 Diagnosis

Pemeriksaan
235 KARNOTO 3328060903740001 48 2023000046450362 DESA KAJEN RT 2 RW 9 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
236 KARTO 3328041202670003 56 2023000046430096 BANJARANYAR RT 4 RW 3 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
237 KARYONO 3328011209770003 45 2023000046370128 MARGASARI RT 2 RW 4 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 17/02/2023 17/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
238 KASMINAH 3328045301600001 63 2023000046430142 BANJARANYAR RT 5 RW 2 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK UTARA RT 5 RW Pemeriksaan


239 KASMUDI 3328011306540001 68 2023000046380106 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
240 KASNARI 3328060304520003 70 2023000046450277 YAMANSARI RT 4 RW 1 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Lebaksiu
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


241 KASNAWI 3172040101620024 61 2023000046380020 Terduga TBC SO 16/01/2023 Rif Sen 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kesambi
4 Diagnosis

Pemeriksaan
242 KASWINAH 3328015908660001 56 2023000046370306 JEMBAYAT RT 2 RW 4 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 18/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
243 KAYANA MIKHAELLIA BILQISTY 3328045112130001 9 2023000046430163 KARANGJAMBU RT 2 RW 1 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 13/03/2023 13/03/2023 Puskesmas Kalibakung
Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
244 KEISHA ANINDITA 3328045704160004 6 2023000046430189 Terduga TBC SO 29/03/2023 Neg 29/03/2023 29/03/2023 29/03/2023 29/03/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
245 KENDAR 3328013108300002 92 2023000046370305 DANARAJA RT 4 RW 4 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 18/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
246 KESIH 3328015103470001 75 2023000046370185 DUKUHTENGAH RT 1 RW 5 Terduga TBC SO 23/02/2023 Neg 23/02/2023 23/02/2023 24/02/2023 24/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
247 KHAIDIR AKBAR HIDAYATULLAH 3328041604010001 21 2023000046430061 BANJARANYAR RT 3 RW 4 Terduga TBC SO 06/02/2023 Neg 06/02/2023 06/02/2023 06/02/2023 06/02/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 14 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
248 KHALIMI 1301010909580001 68 2023000046420153 DARAWARIH RT 1 RW 1 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
249 KHAMILAH 3328015212770009 45 2023000046370319 KARANGDAWA RT 4 RW 3 Terduga TBC SO 25/03/2023 Neg 25/03/2023 25/03/2023 27/03/2023 27/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
250 KHAMIM 3328012005990009 25 2023000046370091 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
251 KHAMIROH 3328067112620047 60 2023000046450359 DURENSAWIT RT 3 RW 5 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
252 KHAPIDIN 3328042306850005 37 2023000046430129 TEMBONGWAH RT 2 RW 4 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
253 KHERUDIN 3328040308900005 32 2023000046430033 CENGGINI RT 5 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 2 Pemeriksaan


254 KHILMI AZI MARRUSDI 3328042203010002 22 2023000046420221 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 27/03/2023 27/03/2023 Puskesmas Balapulang
RW 9 Diagnosis

Pemeriksaan
255 KHOIRUL MAUJUDIN 3328041210660003 56 2023000046430144 BANJARANYAR RT 4 RW 2 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 06/03/2023 07/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
256 KHOPIFAH 3328014602550004 67 2023000046370071 KALISALAK RT 1 RW 5 Terduga TBC SO 19/01/2023 Rif Sen 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
257 KHOTIAH 3328065207550002 67 2023000046450134 KAJEN RT 2 RW 1 Terduga TBC SO 17/01/2023 Neg 17/01/2023 17/01/2023 18/01/2023 18/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
258 KHUMIDAH 3328014107500201 72 2023000046370292 KARANGDAWA RT 3 RW 9 Terduga TBC SO 10/03/2023 Neg 10/03/2023 10/03/2023 11/03/2023 13/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
259 KHUNIMAH 3328016107670003 55 2023000046370272 JEMBAYAT RT 1 RW 12 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
260 KHURAEROTUN 3328015708660001 56 2023000046370301 MARGASARI RT 5 RW 2 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG KULON RT 1 Pemeriksaan


261 KHUSNUL KHOTIMAH 3328046704840001 38 2023000046420146 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
262 KHUZAEMAH NAZWA SAFITRI 3328045108130002 9 2023000046430177 CENGGINI RT 1 RW 3 Terduga TBC SO 20/03/2023 Neg 20/03/2023 20/03/2023 20/03/2023 20/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
263 KOMISAH 3328014304730005 49 2022000046370126 KALISALAK 1/7 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
264 KOTIM 3328016207680004 54 2023000046370016 JEMBAYAT RT 3 RW 12 Terduga TBC SO 05/01/2023 Neg 05/01/2023 05/01/2023 06/01/2023 06/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
265 KUMPUL 3328047112670010 55 2023000046430099 TEMBONGWAH RT 1 RW 1 Terduga TBC SO 20/02/2023 Rif Sen 20/02/2023 20/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
266 KUMYENI 3328045212480005 74 2023000046430124 KARANGJAMBU RT 3 RW 3 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 15 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
267 KUNYATI 3328015703550001 67 2023000046370089 KARANGDAWA RT 3 RW 8 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
268 KURNIASIH 3328015101740002 49 2023000046380045 DUKUHTENGAH RT 2 RW 2 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
269 KUSMANTO 3328012701750002 48 2023000046380112 PAKULAUT RT 1 RW 4 Terduga TBC SO 28/03/2023 Rif Sen 28/03/2023 28/03/2023 29/03/2023 29/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
270 KUSNO 3328011812770002 48 2023000046370315 JEMBAYAT RT 3 RW 12 Terduga TBC SO 24/03/2023 Rif Sen 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
271 KUSRIN MARJOKO 3328041308690001 53 2023000046430118 DANAREJA RT 10 RW 4 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
272 LAELATUL MAGHFIROH 3328065711030004 19 2023000046450348 KESUBEN RT 3 RW 10 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
273 LARAS TRIANA 3328015010960002 26 2023000046380061 WANASARI RT 4 RW 2 Terduga TBC SO 24/02/2023 Rif Sen 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Kesambi
Diagnosis

DESA DUKUHLO RT 3 RW Pemeriksaan


274 LARAS WENINGATI 3328065404020004 20 2023000046450284 Terduga TBC SO 08/02/2023 Rif Sen 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Lebaksiu
5 Diagnosis

BANJAR ANYAR RT 5 RW Pemeriksaan


275 LILIS HERYAWATI 3328045409860003 36 2023000046430076 Terduga TBC SO 11/02/2023 Rif Sen 11/02/2023 11/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
5 Diagnosis

Pemeriksaan
276 LINA AMALIA 3328016201980003 25 2023000046370278 JEMBAYAT RT 4 RW 13 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Margasari Tegal
Diagnosis

TIMBANG REJA RT 3 RW Pemeriksaan


277 LINDA ASTUTI 3328064808980004 22 2023000046450350 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
2 Diagnosis

Pemeriksaan
278 LUKMAN ISMAIL 3328011808850012 37 2023000046370053 KARANG DAWA RT 4 RW 5 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
279 LUKMAN ISMAIL 3328011808850012 37 2023000046370053 KARANG DAWA RT 4 RW 5 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
280 LUTFIYANA ZAHRA 3328114104090003 13 2023000046450374 PESAREAN RT 31 RW 7 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
281 M. ALEK MUNAJIB 3328043004960002 26 2023000046430027 PAGERWANGI RT 1 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 16/01/2023 16/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
282 M. HUSNA 3328012505000009 22 2023000046370039 JEMBAYAT RT 1 RW 12 Terduga TBC SO 10/01/2023 Rif Sen 10/01/2023 10/01/2023 11/01/2023 11/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
283 M. RIDWAN 3328041010840016 38 2022000046420228 PAMIRITAN 2/4 Terduga TBC SO 31/01/2023 Neg 31/01/2023 31/01/2023 01/02/2023 01/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
284 M. RIZAL AMINUDIN 3328010108930004 29 2023000046370106 JEMBAYAT RT 1 RW 11 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
285 M. SAKHI ARKAN AL-KARM 3328041410160002 6 2021000112740633 DK. PETIR RT 2 RW 4 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Balapulang
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 16 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
286 M. TOBIIN 3328041510740004 48 2023000046420164 DANAWARIH RT 2 RW 3 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
Diagnosis

M. UNTUNG MANTEP DWI BALAPULANG KULON RT 2 Pemeriksaan


287 3328042209050005 17 2023000046420061 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Balapulang
SAPUTRA RW 4 Diagnosis

DK. KRAJAN I RT 3 RW Pemeriksaan


288 M. WIDADO 3328060107650314 49 2023000046420226 Terduga TBC SO 27/03/2023 Rif Sen 27/03/2023 27/03/2023 28/03/2023 29/03/2023 Puskesmas Balapulang
7 Diagnosis

Pemeriksaan
289 MA'MUROH 3328046102590001 63 2023000046430095 PAGERWANGI RT 1 RW 1 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


290 MADUNI 3603181805720002 50 2023000046380071 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 06/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
291 MAEMUNAH 3328045204800002 42 2023000046420163 DANAWARIH RT 2 RW 3 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
292 MAENATUL KHASANAH 3328026204040001 18 2023000046450403 CEMPAKA RT 2 RW 2 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
293 MAESAROH 3328064107600125 62 2022000046450755 TIMBANG REJA 1/4 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
294 MAHYANI 3328010107500247 70 2023000046370307 JEMBAYAT RT 2 RW 4 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
295 MALIYAH 3328145212920003 30 2023000046420085 CIBUNAR RT 2 RW 6 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
296 MAPTUHA 3328064811800002 42 2021000046450026 Yamansari 5/9 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 02/03/2023 02/03/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
297 MARINI 3276034205820003 40 2023000046430060 KALIBAKUNG RT 3 RW 3 Terduga TBC SO 04/02/2023 Neg 04/02/2023 04/02/2023 04/02/2023 04/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
298 MARJUKI 3328010107550196 67 2023000046370123 JEMBAYAT RT 1 RW 1 Terduga TBC SO 10/02/2023 Rif Sen 10/02/2023 10/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT 4 Pemeriksaan


299 MARPOEAH 3328047001570001 79 2023000046420161 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
RW 6 Diagnosis

Pemeriksaan
300 MARYAM 3328015008570002 65 2023000046370115 KARANGDAWA RT 4 RW 3 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 21/02/2023 21/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
301 MASHUDI 3328041008850011 37 2023000046420031 KALIWUNGU RT 3 RW 1 Terduga TBC SO 09/01/2023 Rif Sen 09/01/2023 09/01/2023 10/01/2023 10/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
302 MASITOH 3328044107590076 63 2023000046430121 PAGERWANGI RT 2 RW 2 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
303 MASLAH 3328044107550054 67 2023000046430045 BUKATEJA RT 2 RW 1 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 26/01/2023 26/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
304 MASLIKHA 3328045801500004 72 2023000046430005 BANJARANYAR RT 5 RW 5 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 17 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

LEBAKSIU KIDUL RT 2 Pemeriksaan


305 MASRIKHAH 3328066612720004 50 2023000046450367 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Lebaksiu
RW 4 Diagnosis

Pemeriksaan
306 MASRIYAH 3328045501770001 45 2023000046430025 PAGERWANGI RT 4 RW 1 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
307 MAULA ZULFA 3328024703060002 16 2023000046450398 SOKATENGAH RT 5 RW 1 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
308 MEGA WATI 3328044211990009 23 2023000046430085 KALIBAKUNG RT 1 RW 1 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 6 Pemeriksaan


309 MEI LISDIANSARI 3328046605950005 27 2023000046420127 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Balapulang
RW 8 Diagnosis

DK. SARANG RT 04/01


DS. CENGGINI KEC. Pemeriksaan
310 MENAH 3328044107600173 62 2023000046420209 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Balapulang
BALAPULANG KAB. TEGAL Diagnosis
RT 4 RW 1

PRUPUK SELATAN RT 4 Pemeriksaan


311 MERAH SURYA 3328011708660003 56 2023000046380062 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kesambi
RW 4 Diagnosis

Pemeriksaan
312 MISTI LAELI 3328064410800007 42 2021000046450011 lebaksiu lor 3/3 Terduga TBC RO 21/02/2023 Neg 22/02/2023 22/02/2023 24/02/2023 24/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
313 MITA DWI SARI 3328016306020002 20 2023000046380096 KALIGAYAM RT 4 RW 2 Terduga TBC SO 10/03/2023 Neg 10/03/2023 10/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
314 MOH. BAGUS INDRA RIZKI 3328040802040003 19 2023000046430116 BATUAGUNG RT 14 RW 3 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT Pemeriksaan


315 MOH. SOLEH 3328042212700004 52 2022000112711780 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Balapulang
009 RW 003 Diagnosis

Pemeriksaan
316 MOHAMAD CHUMAEDI ABDILAH 3322041012780002 44 2023000046420151 Balapulang Kulon 2/4 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
317 MOHAMAD FAHRUDIN 3328062705760006 46 2023000046450281 YAMANSARI RT 2 RW 2 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Lebaksiu
Diagnosis

BALAPULANG WETAN RT 2 Pemeriksaan


318 MOHAMAD MISBAH 3328040110860002 36 2023000046420082 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Balapulang
RW 9 Diagnosis

Pemeriksaan
319 MOHAMAD WAHYUDIN 3328010506930001 29 2023000046370326 KARANGDAWA RT 4 RW 1 Terduga TBC SO 29/03/2023 Neg 29/03/2023 29/03/2023 30/03/2023 30/03/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG KULON RT 4 Pemeriksaan


320 MUDRIKAH 3328044107650030 60 2023000046420157 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


321 MUDRIKAH 3328046907640002 58 2023000046420056 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
322 MUFRIYADI 3328061804660004 56 2020000046450135 kesuben 1/3 Terduga TBC RO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Lebaksiu
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 18 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
323 MUHAEMIN 3328010705620004 60 2023000046370299 JEMBAYAT RT 1 RW 1 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
324 MUHAMAD FAJAR SETIAWAN 3328011109080001 14 2023000046370068 JATILABA RT 2 RW 3 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
325 MUHAMAD IZAZI 3328043108830002 39 2023000046430019 KALIWUNGU RT 1 RW 1 Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 10/01/2023 10/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
326 MUHAMMAD ABDUL MUIS 3328010112050011 18 2023000046370097 KARANGDAWA 02/03 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
327 MUHAMMAD ANDI KURNIAWAN 3328060608920004 30 2021000046450041 kajen 2/9 Terduga TBC SO 27/01/2023 Neg 27/01/2023 27/01/2023 28/01/2023 30/01/2023 RS Hawari Essa
Diagnosis

Pemeriksaan
328 MUHAMMAD ARZAN FAHREZI 3328010701180001 5 2022000046370213 KARANGDAWA 01/05 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 17/02/2023 17/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
329 MUHAMMAD DRAJAT 3328040702770001 43 2023000046420228 BATURGEDONG RT 2 RW 1 Terduga TBC SO 28/03/2023 Neg 28/03/2023 28/03/2023 29/03/2023 29/03/2023 Puskesmas Balapulang
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


330 MUHAMMAD KASDUKI AS 3328011708480002 75 2023000046380065 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 5 Diagnosis

Pemeriksaan
331 MUHAMMAD KHAFID ARDIANSYAH 3328011606090002 13 2023000046370070 JEMBAYAT RT 1 RW 10 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
332 MUHAMMAD SAIF ALI MUZAKI 3328010401010005 22 2023000046370038 JEMBAYAT RT 1 RW 12 Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 11/01/2023 11/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
333 MUHAMMAD ZAIN AL FATIH 3328062505160002 6 2023000046450355 YAMANSARI RT 4 RW 4 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
334 MUHIROH 3328044203760003 46 2023000046420058 DK.MALANG RT 1 RW 5 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
335 MUJAENI 3328041106710001 51 2023000046430056 TEMBONGWAH RT 3 RW 4 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
336 MUJIANAH 3328046810700001 52 2023000046420218 KALIWUNGU RT 1 RW 2 Terduga TBC SO 21/03/2023 Neg 21/03/2023 21/03/2023 24/03/2023 28/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
337 MUJIARTI 3328016311790001 43 2023000046380095 PAKULAUT RT 5 RW 1 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

WRINGINJENGGOT RT 1 Pemeriksaan
338 MUJIHARTI 3328044504560001 66 2023000046420155 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
RW 4 Diagnosis

Pemeriksaan
339 MUKHAMAD AFDI ARDIANSYAH 3328040110010009 21 2023000046420126 KALIWUNGU RT 1 RW 3 Terduga TBC SO 23/02/2023 Neg 23/02/2023 23/02/2023 24/02/2023 24/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
340 MUKRONI 3328013112590118 63 2023000046370276 KALISALAK RT 2 RW 7 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
341 MULYADI 3328063112650012 57 2023000046430156 SEMPUMAJA RT 1 RW 1 Terduga TBC SO 11/03/2023 Neg 11/03/2023 11/03/2023 11/03/2023 12/03/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 19 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

HARJAWINANGUN RT 6 RW Pemeriksaan
342 MULYANI 3328046010740002 48 2023000046430151 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 08/03/2023 08/03/2023 Puskesmas Kalibakung
4 Diagnosis

BALAPULANG WETAN RT 2 Pemeriksaan


343 MULYATI 3328044107680008 54 2023000046420080 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Balapulang
RW 8 Diagnosis

Pemeriksaan
344 MUNAJI 3328043112550006 67 2023000046420059 DANAWARIH RT 5 RW 5 Terduga TBC SO 31/01/2023 Rif Sen 31/01/2023 31/01/2023 01/02/2023 01/02/2023 Puskesmas Balapulang
Diagnosis

PRUPUK SELATAN RT 6 Pemeriksaan


345 MUNAWAROH 3328015907810007 41 2023000046380027 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Kesambi
RW 4 Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


346 MUNFARICHA 3328046009590001 63 2023000046420223 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 28/03/2023 28/03/2023 Puskesmas Balapulang
RW 10 Diagnosis

LEBAKSIU KIDUL RT 2 Pemeriksaan


347 MUNJILAH 3328064411710001 51 2023000153040001 Terduga TBC SO 04/01/2023 Rif Sen 04/01/2023 04/01/2023 05/01/2023 05/01/2023 RS Hawari Essa
RW 4 Diagnosis

Pemeriksaan
348 MURNIASIH 3328046104920006 30 2023000046430166 BANJARANYAR RT 2 RW 1 Terduga TBC SO 14/03/2023 Neg 14/03/2023 14/03/2023 14/03/2023 14/03/2023 Puskesmas Kalibakung
Diagnosis

DK. KRAJAN I RT 2 RW Pemeriksaan


349 MURYATI 3328045105560001 66 2023000046420182 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 09/03/2023 09/03/2023 Puskesmas Balapulang
5 Diagnosis

DK. KRAJAN I RT 2 RW Pemeriksaan


350 MURYATI 3328045105560001 66 2023000046420182 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 09/03/2023 16/03/2023 Puskesmas Balapulang
5 Diagnosis

Pemeriksaan
351 MURYATNI 3328065301740002 49 2023000046450382 YAMANSARI RT 5 RW 3 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Lebaksiu
Diagnosis

BALAPULANG WETAN RT 5 Pemeriksaan


352 MUSLIH 3328041005840007 38 2023000046420087 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Balapulang
RW 8 Diagnosis

Pemeriksaan
353 MUSLIHA 3328044604700002 54 2023000046430117 DANAREJA RT 10 RW 4 Terduga TBC SO 02/03/2023 Neg 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
354 MUSTAKIM 3328011506950007 27 2023000046370277 JATILABA RT 2 RW 11 Terduga TBC SO 01/03/2023 Rif Sen 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
355 MUSTOFA 3328010305810005 41 2023000046370329 KARANGDAWA RT 4 RW 2 Terduga TBC SO 29/03/2023 Neg 29/03/2023 29/03/2023 30/03/2023 30/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
356 MUTIA RIZKI MAFTUKHA 3329076611070002 15 2023000046450372 KEBOGADUNG RT 2 RW 4 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

LEBAKSIU LOR RT 1 RW Pemeriksaan


357 NABIL ZURAFA AL MAJID 3328062402110002 11 2023000046450346 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
5 Diagnosis

Pemeriksaan
358 NADIA KHASANAH 3329054206040002 18 2023000046420148 PONPES DI DANAWARIH Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
Diagnosis

LEBAKSIU KIDUL RT 4 Pemeriksaan


359 NADIA PUTRI OKTAVIANI 3328066210030001 19 2023000046450363 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Lebaksiu
RW 3 Diagnosis

Pemeriksaan
360 NADIROH 3328045408770002 45 2023000046430035 PAGERWANGI RT 3 RW 2 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 20 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

DUREN SAWIT KESUBEN Pemeriksaan


361 NADIROH 3328065808550005 67 2023000046450351 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
RT 5 RW 1 Diagnosis

DK. KARANG MONCOL 2 Pemeriksaan


362 NADYA AZZAH AFIFAH 3171084211090002 13 2023000046450371 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
RT 1 RW 4 Diagnosis

Pemeriksaan
363 NAELA FADILAH 3328044807030003 19 2023000046420123 DK. MALANG RT 4 RW 3 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
364 NAILUL FALAKHI 3328040901020003 21 2020000112711211 CIBUNAR RT 002 RW 001 Terduga TBC SO 11/03/2023 Rif Sen 11/03/2023 11/03/2023 11/03/2023 13/03/2023 Puskesmas Balapulang
Diagnosis

DK. RANCAKAKI RT 1 RW Pemeriksaan


365 NANDANI 3328045807940003 28 2023000046420089 Terduga TBC SO 09/02/2023 Rif Sen 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Balapulang
2 Diagnosis

BALAPULANG KULON RT 7 Pemeriksaan


366 NANI PURWANINGSIH 3328046004780002 44 2023000046420060 Terduga TBC SO 31/01/2023 Neg 31/01/2023 31/01/2023 01/02/2023 01/02/2023 Puskesmas Balapulang
RW 3 Diagnosis

BALAPULANG KULON RT 7 Pemeriksaan


367 NANI PURWANINGSIH 3328046004780002 44 2023000046420060 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
368 NASICHATUN 3328017112680091 54 2023000046370088 KARANGDAWA RT 3 RW 8 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
369 NASIROH 3328014107570575 65 2023000046370284 KARANGDAWA RT 2 RW 3 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 07/03/2023 07/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
370 NAYLA FATIH HAMSYAR 3328015406070007 15 2023000046370122 MARGASARI RT 1 RW 5 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 2 Pemeriksaan


371 NENI NUR AENI 3329066405000003 22 2023000046380024 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
372 NIHAYATUL MIRZAH 3328016408000003 22 2023000046370087 KARANGDAWA RT 3 RW 8 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
373 NILNA MAZYA 3315027103100002 12 2023000046450388 TALANG RT 4 RW 1 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
374 NINDI ELISA 3328016607900006 32 2023000046370133 MARGA AYU RT 3 RW 1 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
375 NINING ERLINAH 3328014601860004 37 2023000046380017 PAKU LAUT RT 1 RW 3 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

DUKUH TENGAH RT 5 RW Pemeriksaan


376 NINING ERTANTI 3328017003600005 61 2023000046380068 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
2 Diagnosis

Pemeriksaan
377 NIRWASITA ZAHWA OKTAVIANI 3328064410130001 9 2023000046450002 KAJEN RT 3 RW 8 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
378 NISSA AGUSTINA 3328047008840001 38 2022000046420479 DANAWARIH 4/1 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
379 NOK HARNITI 3328015401770003 46 2023000046370059 PAKULAUT RT 5 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 21 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
380 NOK WININGSIH 3328014507800008 42 2023000046370296 MARGASARI RT 5 RW 1 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Margasari Tegal
Diagnosis

JEMBAYAT RT 002 RW Pemeriksaan


381 NOPIYAH 3328015003910007 31 2022000046370256 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 10/03/2023 10/03/2023 Puskesmas Margasari Tegal
004 Diagnosis

Kalisalak Rt 001 Rw Pemeriksaan


382 NOVI INDAH TRIYANA 3328016307000009 22 2023000153040019 Terduga TBC SO 13/01/2023 Rif Sen 13/01/2023 13/01/2023 14/01/2023 14/01/2023 RS Hawari Essa
002 Diagnosis

PRUPUK SELATAN RT 3 Pemeriksaan


383 NUR AENI 3328017008820007 40 2022000046380214 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Kesambi
RW 7 Diagnosis

Pemeriksaan
384 NUR AMAN 3328041605700003 52 2023000046430101 BANJARANYAR RT 3 RW 4 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
385 NUR AZIZAH 3328014410930012 29 2022000046370212 KARANGDAWA 01/05 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 18/02/2023 18/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
386 NUR ILMIYATI NAIMAH 3328064507010004 21 2023000046450349 KESUBEN RT 2 RW 7 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
Diagnosis

HARJAWINANGUN RT 2 RW Pemeriksaan
387 NUR JANAH 3328046710860003 36 2023000046430074 Terduga TBC SO 11/02/2023 Neg 11/02/2023 11/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
3 Diagnosis

KARANG DAWA-MARGASARI Pemeriksaan


388 NUR KHAFID MAULANA 3328012507000016 22 2023000046370036 Terduga TBC SO 06/01/2023 Rif Sen 06/01/2023 06/01/2023 09/01/2023 09/01/2023 Puskesmas Margasari Tegal
RT 2 RW 4 Diagnosis

Pemeriksaan
389 NUR KHIKMAH 3328045111850003 37 2023000046430158 CENGGINI RT 2 RW 2 Terduga TBC SO 11/03/2023 Neg 11/03/2023 11/03/2023 11/03/2023 12/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
390 NUR LAELAH 3328015001780004 45 2023000046370107 MARGA AYU RT 2 RW 1 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
391 NUR MAELISA 3328016307960012 26 2023000046370127 PAKULAUT RT 2 RW 3 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 17/02/2023 17/02/2023 Puskesmas Margasari Tegal
Diagnosis

DK. PESAWAHAN RT 5 RW Pemeriksaan


392 NUR TRESNOWATI 3328065603910007 31 2023000046450036 Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 11/01/2023 11/01/2023 Puskesmas Lebaksiu
5 Diagnosis

PRUPUK UTARA RT 4 RW Pemeriksaan


393 NURASIYAH 3328015312520002 70 2023000046380034 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 11/02/2023 11/02/2023 Puskesmas Kesambi
4 Diagnosis

Pemeriksaan
394 NURHARDI WIYONO 3328010810990002 23 2023000046380093 PAKULAUT RT 5 RW 1 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 12/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
395 NURHIDAYATI 3328044411750001 47 2023000046430071 BATUAGUNG RT 13 RW 3 Terduga TBC SO 10/02/2023 Rif Sen 10/02/2023 10/02/2023 11/02/2023 11/02/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 2 Pemeriksaan


396 NURKHAYATUN 3328045009800003 42 2023000046420114 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Balapulang
RW 10 Diagnosis

PRUPUK SELATAN RT 004 Pemeriksaan


397 NURKHOLIS 3328011009760006 46 2021000112710710 Terduga TBC RO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Kesambi
RW 002 Diagnosis

Pemeriksaan
398 NURKHOTIMAH 3328025605770001 45 2022000046430267 BUMIJAWA RT 5 RW 2 Terduga TBC SO 14/03/2023 Neg 14/03/2023 14/03/2023 14/03/2023 14/03/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 22 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
399 NURSIDIK 3328012708870003 35 2023000046370002 KALISALAK RT 1 RW 8 Terduga TBC SO 02/01/2023 Rif Sen 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Margasari Tegal
Diagnosis

JL H TAIMAN UJUNG RT Pemeriksaan


400 NURUL ISNAENI 3328045205000003 22 2023000046430167 Terduga TBC SO 15/03/2023 Neg 15/03/2023 15/03/2023 15/03/2023 15/03/2023 Puskesmas Kalibakung
8 RW 7 Diagnosis

Pemeriksaan
401 OMISAH 3328064801890001 33 2023000046450279 KESUBEN RT 3 RW 10 Terduga TBC SO 07/02/2023 Rif Sen 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
402 PAKUWATI 3328017112520129 70 2023000046370083 JATILABA RT 2 RW 5 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
403 PANDU EKA PRASETYA 3328042004070005 15 2023000046430046 BUKATEJA RT 4 RW 1 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 26/01/2023 26/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
404 PARYATI 3328015211650009 57 2023000046370322 MARGASARI RT 1 RW 4 Terduga TBC SO 25/03/2023 Neg 25/03/2023 25/03/2023 27/03/2023 27/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
405 PASIKHA 3328015803620001 60 2023000046370302 JEMBAYAT RT 2 RW 2 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
406 PATONAH 3328045203480002 74 2023000046430126 KARANGJAMBU RT 4 RW 4 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
407 PRITA 3328014704070005 15 2023000112740396 Bintara RT 02/05 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
408 PUJI ASTUTI 3328045209960001 26 2023000046430003 BATUAGUNG RT 8 RW 2 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
409 QOMARUDIN 3328041211800006 42 2023000046430016 TEMBONGWAH RT 1 RW 1 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 09/01/2023 09/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
410 QONITATUL HILMI AHMAD 3328035408080001 14 2023000046370074 BOJONG RT 3 RW 1 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG KULON RT 1 Pemeriksaan


411 RAHARJO 3328041902620001 61 2023000046420130 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
412 RAHAYU 3328067011580002 64 2023000046450278 DURENSAWIT RT 5 RW 3 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
413 RAHMA ALFIANNA RISQI 3328034108100002 12 2023000046450401 BUNIWAH RT 3 RW 3 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
414 RAHMAT MAULANA 3328041705130001 9 2023000046430079 KALIBAKUNG RT 4 RW 2 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
Diagnosis

DK KRAJAN LOR RT 7 RW Pemeriksaan


415 RAHMAWATI 3329035308070005 15 2023000046370075 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
2 Diagnosis

BALAPULANG WETAN RT 5 Pemeriksaan


416 RAIS 3328040706560003 66 2022000046420077 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Balapulang
RW 9 Diagnosis

Pemeriksaan
417 RAISYA NADZIRA SAKILA 3329095209110002 11 2023000046430091 CILONGOK RT 2 RW 3 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 23 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
418 RAJIYONO 3328010405610008 61 2023000046370304 MARGASARI RT 4 RW 6 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 18/03/2023 18/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
419 RAMLAH 3328040701490002 74 2023000046430093 TEMBONGWAH RT 1 RW 4 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
420 RANI 3328016008930004 29 2023000046380047 WANASARI RT 1 RW 2 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
421 RANI DEWI ASTUTI 3328044401040003 19 2023000046430051 BUKATEJA RT 2 RW 1 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 30/01/2023 30/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
422 RAPIASIH 3328015705980009 24 2023000046370011 MARGAAYU RT 3 RW 3 Terduga TBC RO 04/01/2023 Neg 04/01/2023 04/01/2023 05/01/2023 05/01/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT 4 Pemeriksaan


423 RASIDI 3276061612620002 60 2023000046420117 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Balapulang
RW 1 Diagnosis

Pemeriksaan
424 RASMUN 3328040107470077 75 2023000046430131 TEMBONGWAH RT 4 RW 4 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
425 RASTINAH 3328014107470417 75 2023000046370132 MARGAAYU 03/01 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
426 RASTO 3328010107640073 58 2023000046370081 JATILABA RT 1 RW 7 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
427 RATAM 3328013112520076 70 2023000046380014 PAKULAUT RT 1 RW 3 Terduga TBC SO 12/01/2023 Rif Sen 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
428 RATINAH 3328046409650002 57 2023000046420064 DANAWARIH RT 3 RW 1 Terduga TBC SO 03/02/2023 Neg 03/02/2023 03/02/2023 04/02/2023 04/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
429 RATNI 3328014801740003 49 2023000046370121 KARANGDAWA RT 5 RW 6 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
Diagnosis

BANJAR ANYAR RT 1 RW Pemeriksaan


430 RATNI 3328045512600002 70 2023000046430053 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 30/01/2023 30/01/2023 Puskesmas Kalibakung
5 Diagnosis

DESA JATILABA RT 3 RW Pemeriksaan


431 RATNO 3328013112550103 67 2023000046370135 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 Puskesmas Margasari Tegal
6 Diagnosis

Pemeriksaan
432 REZA ARDILA 3276064708000003 22 2023000046370295 KARANGDAWA RT 4 RW 7 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
433 RIA YULIANINGSIH 3328065707970001 25 2023000046450135 KAJEN RT 3 RW 2 Terduga TBC SO 17/01/2023 Rif Sen 17/01/2023 17/01/2023 18/01/2023 18/01/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK UTARA RT 6 RW Pemeriksaan


434 RICKY AGUSTI PRADANA 3328011208980007 24 2023000046380100 Terduga TBC SO 14/03/2023 Neg 14/03/2023 14/03/2023 15/03/2023 15/03/2023 Puskesmas Kesambi
2 Diagnosis

HARJAWINANGUN RT 6 RW Pemeriksaan
435 RIDHO RAHARJO 3313122411730001 49 2023000046430113 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 27/02/2023 27/02/2023 Puskesmas Kalibakung
1 Diagnosis

PRUPUK UTARA RT 4 RW Pemeriksaan


436 RIESTYA ADI WIBOWO 3321061103820005 41 2023000046380108 Terduga TBC SO 21/03/2023 Neg 21/03/2023 21/03/2023 24/03/2023 24/03/2023 Puskesmas Kesambi
1 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 24 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
437 RIFA EQI PRATAMA 3328011812060001 16 2023000046380031 PAKULAUT RT 6 RW 3 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
438 RIKHAYATI 3328016507890001 33 2022000046370124 KARANGDAWA 1/3 Terduga TBC RO 16/01/2023 Rif Res 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
439 RIKHMAYATI 3328014708710003 51 2023000046370279 MARGASARI RT 4 RW 8 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 06/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
440 RIYA RANITA 3328016003050003 18 2023000046380087 PAKULAUT RT 5 RW 6 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
441 RIYANTI AULIA SAFITRI 3328015705100001 12 2023000046380099 PAKULAUT RT 5 RW 6 Terduga TBC SO 09/03/2023 Neg 10/03/2023 10/03/2023 11/03/2023 13/03/2023 Puskesmas Kesambi
Diagnosis

PRUPUK UTARA RT 7 RW Pemeriksaan


442 RIYANTO 3328011705610001 61 2023000046380107 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
443 RIZIQ KURAISI 3328061310970011 25 2023000046450251 TIMBANGREJA RT 3 RW 3 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
444 ROCHATI 3328015712660003 56 2023000046380010 PAKULAUT RT 8 RW 3 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

DUKUH KALIBANTENG RT Pemeriksaan


445 ROCHMI 3172025312740001 48 2023000046420055 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 27/01/2023 27/01/2023 Puskesmas Balapulang
2 RW 3 Diagnosis

Pemeriksaan
446 RODIYAH 3328015102670004 55 2022000046370538 KALISALAK 02/08 Terduga TBC SO 11/01/2023 Neg 11/01/2023 11/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

DESA MARGASARI RT 2 Pemeriksaan


447 RODIYAH 3328016205740003 48 2023000046370118 Terduga TBC RO 09/02/2023 Neg 09/02/2023 09/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
RW 9 Diagnosis

Pemeriksaan
448 RODIYAH 3328017112590148 63 2023000046370283 MARGAAYU RT 3 RW 1 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 07/03/2023 07/03/2023 Puskesmas Margasari Tegal
Diagnosis

DS. CILONGOK RT 3 RW Pemeriksaan


449 ROHATI 3328044212610001 61 2023000046430049 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 30/01/2023 30/01/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
450 ROHMAH 3328015303640001 59 2023000046370303 MARGASARI RT 4 RW 6 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
451 ROIS 3328042808740009 48 2023000046430026 KARANGJAMBU RT 2 RW 2 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
452 ROISAH 3328015111780001 47 2023000046370045 KARANGDAWA RT 4 RW 5 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
453 ROISAH 3328015111780001 47 2023000046370045 KARANGDAWA RT 4 RW 5 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 17/02/2023 18/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
454 ROISAH 3328016505870005 35 2023000046380082 PAKULAUT RT 5 RW 6 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
455 ROJALI 3172030311750009 47 2023000046380059 DUKUHTENGAH RT 4 RW 4 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Kesambi
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 25 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
456 ROJIKHI 3328012012730002 49 2023000046380114 KALIGAYAM RT 1 RW 1 Terduga TBC SO 28/03/2023 Neg 28/03/2023 28/03/2023 29/03/2023 29/03/2023 Puskesmas Kesambi
Diagnosis

CENGGINI BALONG RT 1 Pemeriksaan


457 ROKHANAH 3328044306750001 50 2023000046430139 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Kalibakung
RW 2 Diagnosis

Pemeriksaan
458 ROLIYAH 3328044107620181 60 2023000046430001 KARANGJAMBU RT 5 RW 5 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 02/01/2023 02/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
459 RONI 3174040709730009 49 2023000046370289 KARANGDAWA RT 1 RW 2 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 10/03/2023 10/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
460 ROSID 3328013112600076 62 2023000046370003 JEMBAYAT RT 4 RW 10 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
461 ROSYIDI 3328012707630003 59 2023000046370320 MARGASARI RT 1 RW 9 Terduga TBC SO 25/03/2023 Neg 25/03/2023 25/03/2023 27/03/2023 27/03/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK UTARA RT 2 RW Pemeriksaan


462 ROTIAH 3328014107520351 70 2023000046380097 Terduga TBC SO 10/03/2023 Neg 10/03/2023 10/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
463 ROUDHATUL JANAH 3328014808960006 26 2023000046370079 KARANGDAWA RT 2 RW 1 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
464 ROUP 3328013112580141 64 2023000046370270 JEMBAYAT RT 3 RW 1 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
465 ROYANAH 3328014805660003 56 2023000046380101 PAKULAUT RT 9 RW 3 Terduga TBC RO 15/03/2023 Neg 15/03/2023 15/03/2023 16/03/2023 16/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
466 ROYANAH 3328044712800001 42 2023000046430055 BANJARANYAR RT 6 RW 5 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
467 RUKILAH 3328044107570243 65 2023000046430022 TEMBONGWAH RT 7 RW 1 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 12/01/2023 12/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
468 RUMINAH 3328014107460041 76 2023000046370082 JATILABA 02/05 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
469 RUMINAH 3328014107500292 72 2023000046380103 dukuhtengah 1/2 Terduga TBC SO 17/03/2023 Rif Sen 17/03/2023 17/03/2023 18/03/2023 18/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
470 RUPIAH 3328044107720020 62 2023000046430145 BATUAGUNG RT 24 RW 4 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 06/03/2023 07/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
471 RUPIAH 3328046309540001 60 2023000046420091 SESEPAN RT 1 RW 2 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 11/02/2023 11/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
472 RUPINAH 3328016801710002 52 2023000046380046 WANASARI RT 2 RW 3 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
473 RUSDI 3328011312510002 71 2023000046370051 KARANGDAWA RT 1 RW 2 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
474 RUSMINAH 3328015102540001 64 2023000046370313 KARANGDAWA RT 2 RW 5 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Margasari Tegal
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 26 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
475 RUSMIYATI 3328045905600001 62 2023000046420115 BANJARANYAR RT 2 RW 1 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Balapulang
Diagnosis

BALAPULANG KULON RT 5 Pemeriksaan


476 SA'ID 3328041608480002 74 2023000046420166 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

Pemeriksaan
477 SAADAH 3328015509760001 46 2023000046370311 JENBAYAT RT 2 RW 4 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
478 SAAT KHATAMAN 3328042509630005 59 2023000046430185 BANJARANYAR RT 1 RW 2 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 27/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
479 SABILA NAJAH 3328065205010003 17 2023000046450404 PAMIRITAN RT 3 RW 3 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
480 SADIKIN AL ASIKIN 3328013112360041 86 2023000046370297 MARGASARI RT 2 RW 11 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
481 SAEFUL KHANIF 3328040108000010 22 2023000046420204 PAMIRITAN RT 1 RW 2 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 09/03/2023 Puskesmas Balapulang
Diagnosis

LEBAKSIU LOR RT 3 RW Pemeriksaan


482 SAHDA HANUN AZALIA 3328065710110001 11 2023000046450354 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Lebaksiu
2 Diagnosis

Pemeriksaan
483 SAHURI 3328010711510002 71 2023000153040087 PUPUK UTARA RT 3 RW 1 Terduga TBC SO 15/02/2023 Rif Sen 15/02/2023 15/02/2023 16/02/2023 16/02/2023 RS Hawari Essa
Diagnosis

Pemeriksaan
484 SAIRAH 3328014107670384 55 2023000046370120 MARGAAYU RT 4 RW 1 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 14/02/2023 14/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
485 SAIRAH 3328045108610001 61 2023000046420054 CIBUNAR RT 2 RW 1 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 27/01/2023 27/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
486 SAIRAN 3328121510770007 45 2023000046430036 BANJARANYAR RT 2 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
487 SAIRIN 3328011004740003 49 2023000046370291 JEMBAYAT RT 2 RW 3 Terduga TBC SO 10/03/2023 Neg 10/03/2023 10/03/2023 11/03/2023 12/03/2023 Puskesmas Margasari Tegal
Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
488 SAIROH 3328044303730003 49 2023000046430089 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
489 SAIROH 3328045209720004 50 2023000046430153 BANJARANYAR RT 7 RW 1 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 09/03/2023 09/03/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


490 SAIROH 3328047112670018 55 2023000046420081 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Balapulang
RW 5 Diagnosis

Pemeriksaan
491 SALISA AULADINA 3328075802080002 15 2022000046470937 CERIH RT 13/ RW 1 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
492 SALSA FEBRIAN AROHMAH 3329176702070005 15 2023000046430057 BUKATEJA RT 1 RW 2 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 02/02/2023 02/02/2023 Puskesmas Kalibakung
Diagnosis

DESA BERSOLE RT 8 RW Pemeriksaan


493 SALSABILA PUTRI 3328115906090002 13 2023000046450383 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
2 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 27 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
494 SAMILAH 3328014107550273 67 2023000046370012 KARANGDAWA RT 1 RW 2 Terduga TBC SO 04/01/2023 Rif Sen 04/01/2023 04/01/2023 05/01/2023 05/01/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG KULON RT 4 Pemeriksaan


495 SAMSUDIN 3328041003680003 55 2023000046420225 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 28/03/2023 29/03/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
496 SAMUD 3328013001590002 58 2023000046370188 KARANGDAWA 04/03 Terduga TBC SO 23/02/2023 Neg 23/02/2023 23/02/2023 24/02/2023 24/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
497 SANEP 3328013112720113 50 2023000046370262 JEMBAYAT 02/12 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
498 SANIPAH 3328044703650004 57 2023000046420095 CIBUNAR RT 1 RW 5 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 13/02/2023 13/02/2023 Puskesmas Balapulang
Diagnosis

JL. WERKUDORO NO. 211 Pemeriksaan


499 SARAH FADHILATIL ATQIYA 3376024312090002 13 2023000046450369 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
RT 1 RW 6 Diagnosis

Pemeriksaan
500 SARIPUDIN 3328012009830005 39 2022000046370369 KARANGDAWA 02/03 Terduga TBC RO 02/02/2023 Rif Sen 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
501 SARNO 3328010107340007 88 2023000046380094 PAKULAUT RT 5 RW 1 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
502 SAROH 3328016811650001 57 2023000046370015 JEMBAYAT RT 3 RW 12 Terduga TBC SO 05/01/2023 Neg 05/01/2023 05/01/2023 06/01/2023 06/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 3 Pemeriksaan


503 SAROPAH 3328014504880012 34 2023000046380104 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
504 SARTINI 3328056711670001 55 2023000046420036 SEMBOJA RT 3 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Balapulang
Diagnosis

PRUPUK UTARA RT 6 RW Pemeriksaan


505 SARTONO 3328011311790012 43 2023000046380039 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Kesambi
1 Diagnosis

Pemeriksaan
506 SARTONO 3328040107630077 63 2023000046430043 TEMBONGHWAH RT 3 RW 1 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 24/01/2023 24/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
507 SATRIA PUTRA PRATAMA 3376030505080004 14 2023000046430082 KARANGJAMBU RT 1/2 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
508 SATRIO BAGUS SAPUTRA 3328010207150002 7 2023000046380083 PAKULAUT RT 5 RW 6 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


509 SAUNI 3328014107550319 67 2023000046380040 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
510 SAUNI 3328014107620187 60 2023000046370274 JEMBAYAT RT 3 RW 3 Terduga TBC SO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


511 SEKAR SHAFA MAULIDA 3328017101110001 12 2023000046380080 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 09/03/2023 Puskesmas Kesambi
RW 7 Diagnosis

Pemeriksaan
512 SEMI 3328014107150252 107 2023000046380018 PAKULAUT RT 4 RW 3 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 28 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
513 SEPTI NURLAELA 3328015609030003 19 2023000046370108 MARGA AYU RT 2 RW 1 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Margasari Tegal
Diagnosis

DESA DANAREJA RT 3 RW Pemeriksaan


514 SEPUDIN 3328040201680004 55 2023000046430127 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
515 SEPUL MUJAB 3328032707810006 36 2023000046430182 CILONGOK RT 2 RW 1 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 27/03/2023 Puskesmas Kalibakung
Diagnosis

DK. TEGALKUBUR RT 3 Pemeriksaan


516 SERLI NINGSIH 3328066108920002 30 2023000046450454 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 01/03/2023 01/03/2023 Puskesmas Lebaksiu
RW 7 Diagnosis

Pemeriksaan
517 SHINTA NURRIYAH ASSYARI 3328166212040005 18 2023000046450389 SURADADI RT 2 RW 3 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
518 SILVA RUGAYAH 3328045006970005 25 2023000046420094 DANAWARIH RT 2 RW 2 Terduga TBC SO 10/02/2023 Rif Sen 10/02/2023 10/02/2023 13/02/2023 13/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
519 SINGGIH NURDIYANTI 3328014202060004 16 2023000046380009 PAKULAUT RT 7 RW 2 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 16/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
520 SISCA MULIA PRATAMI 3328096006100004 12 2023000046450378 JL. MANGGA RT 4 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
521 SISWANTO 3328042109790002 43 2023000046430031 CILONGOK RT 2 RW 4 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
Diagnosis

LEBAKSIU KIDUL RT 4 Pemeriksaan


522 SITI AISAH 3328067107730003 49 2023000046450358 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
RW 4 Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
523 SITI ALIA ROSALI 3328046605050001 17 2023000046430170 Terduga TBC SO 15/03/2023 Neg 15/03/2023 15/03/2023 15/03/2023 15/03/2023 Puskesmas Kalibakung
4 Diagnosis

Pemeriksaan
524 SITI AMELIA 3328045110020002 20 2023000046430097 TEMBONGWAH RT 4 RW 4 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


525 SITI AMINAH 3328015212630005 59 2023000046380077 Terduga TBC SO 07/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 10/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
526 SITI AMINAH 3328064207870002 33 2023000046450411 YAMANSARI RT 1 RW 1 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 24/02/2023 24/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
527 SITI AMIROH 3328045205830012 47 2023000046430175 BUKATEJA RT 3 RW 1 Terduga TBC SO 17/03/2023 Neg 17/03/2023 17/03/2023 17/03/2023 18/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
528 SITI BADRIYAH 3328016210690002 53 2023000046370298 JEMBAYAT RT 1 RW 1 Terduga TBC SO 16/03/2023 Neg 16/03/2023 16/03/2023 17/03/2023 17/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
529 SITI BAROYAH 3328016212870006 35 2023000046430010 KALIBAKUNG RT 1 RW 1 Terduga TBC SO 04/01/2023 Rif Sen 04/01/2023 04/01/2023 04/01/2023 04/01/2023 Puskesmas Kalibakung
Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
530 SITI DAROJAH 3328045506940001 28 2023000046430186 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 27/03/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
531 SITI FATIMAH TUJJAHRO 3328044711940002 28 2023000046430090 BATUAGUNG RT 2 RW 1 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 29 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
532 SITI HAPSOH RAMADHANI 3328164309080001 14 2023000046450408 SURADADI RT 2 RW 3 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
533 SITI HIKMAWATI 3328044107780059 44 2023000046430098 BANJARANYAR RT 3 RW 5 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


534 SITI JANATUN 3328014602760003 47 2023000046380070 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
535 SITI JAROKHA 3328045207850004 37 2023000046430088 PAGERWANGI RT 2 RW 2 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
Diagnosis

HARJAWINANGUN RT 6 RW Pemeriksaan
536 SITI KEYSA ANIQ 3328045105100001 12 2023000046450381 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
2 Diagnosis

Pemeriksaan
537 SITI KHUMAIROH 3275015005080009 14 2023000046370049 JEMBAYAT RT 3 RW 12 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
538 SITI LUTIFAH 3328046605800002 42 2023000046430075 BUKATEJA RT 1 RW 2 Terduga TBC SO 11/02/2023 Neg 11/02/2023 11/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


539 SITI MALICHA 3328014304860008 36 2023000046380050 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
540 SITI MASRUROH 3328014608820004 40 2023000046370186 JEMBAYAT RT 1 RW 1 Terduga TBC SO 23/02/2023 Neg 23/02/2023 23/02/2023 24/02/2023 24/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
541 SITI MUTMAINAH 3328045204500006 72 2023000046420203 JL. MERAK RT 7 RW 1 Terduga TBC SO 07/03/2023 Neg 07/03/2023 07/03/2023 08/03/2023 08/03/2023 Puskesmas Balapulang
Diagnosis

DUKUH MANGIR RT 2 RW Pemeriksaan


542 SITI NASRI 3328045101600004 63 2023000046420162 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
4 Diagnosis

BALAPULANG WETAN RT 5 Pemeriksaan


543 SITI NUR EFA YUNINGSIH 3328046102830001 39 2023000046420110 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Balapulang
RW 5 Diagnosis

Pemeriksaan
544 SITI NURAMALIYAH 3328047108020003 20 2023000046430114 KALIBAKUNG RT 1 RW 1 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 27/02/2023 27/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
545 SITI NURHAYATI 3328045811660001 56 2023000046430077 BATUAGUNG RT 24 RW 4 Terduga TBC SO 11/02/2023 Neg 11/02/2023 11/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
546 SITI PATIMAH 3328046501790002 44 2023000046430081 BANJARANYAR RT 3 RW 4 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
547 SITI RETNO JOHARIYAH 3328014901700001 53 2023000046380006 PAKULAUT RT 3 RW 2 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
548 SITI ROATUN 3328065506690006 53 2021000046450258 Lebaksiu lor 2/6 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
Diagnosis

JL.VETERAN BALAPULANG Pemeriksaan


549 SITI ROHYATI 3328046712730001 49 2021000046420588 Terduga TBC SO 20/02/2023 Neg 20/02/2023 20/02/2023 21/02/2023 21/02/2023 Puskesmas Balapulang
KULON RT 1/ RW 3 Diagnosis

JL.VETERAN BALAPULANG Pemeriksaan


550 SITI ROHYATI 3328046712730001 49 2021000046420588 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
KULON RT 1/ RW 3 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 30 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
551 SITI ROKHMAH 3328045107580005 64 2023000046420053 KALIWUNGU RT 2 RW 2 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Balapulang
Diagnosis

DUKUH TENGAH RT 1 RW Pemeriksaan


552 SITI SOPIYAH 3328016703670003 55 2023000046370078 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
3 Diagnosis

LEBAKSIU KIDUL RT 2 Pemeriksaan


553 SITI SUNARTI 3328064307670009 55 2023000046450357 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
RW 1 Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


554 SITI URIPAH 3328044506560003 66 2021000112711589 Terduga TBC SO 15/03/2023 Neg 15/03/2023 15/03/2023 16/03/2023 16/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

Pemeriksaan
555 SLAMET 3328017012790007 43 2023000046370050 KARANGDAWA RT 4 RW 5 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT 2 Pemeriksaan


556 SLAMET 3328040107710044 50 2023000046420032 Terduga TBC SO 11/01/2023 Neg 11/01/2023 11/01/2023 12/01/2023 12/01/2023 Puskesmas Balapulang
RW 10 Diagnosis

Pemeriksaan
557 SOBARI 3328062912530002 69 2023000046450254 KAJEN RT 4 RW 1 Terduga TBC SO 02/02/2023 Neg 02/02/2023 02/02/2023 03/02/2023 03/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
558 SOBICHA 3328045210530003 69 2023000046430059 BATUAGUNG RT 10 RW 2 Terduga TBC SO 04/02/2023 Neg 04/02/2023 04/02/2023 04/02/2023 04/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
559 SOBIKHA 3328044204710001 51 2023000046430149 CENGGINI RT 4 RW 3 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 06/03/2023 07/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
560 SOBIRIN 3328023101900001 32 2023000153040060 BATUNYANA RT 6 RW 1 Terduga TBC SO 28/01/2023 Neg 28/01/2023 28/01/2023 28/01/2023 30/01/2023 RS Hawari Essa
Diagnosis

WRINGIN JENGGOT RT 3 Pemeriksaan


561 SOBIRIN 3328040808780004 44 2023000046420213 Terduga TBC SO 17/03/2023 Neg 17/03/2023 17/03/2023 18/03/2023 18/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

Pemeriksaan
562 SOBIRIN 3328043012690007 53 2023000046430176 BANJARANYAR RT 4 RW 3 Terduga TBC SO 17/03/2023 Neg 17/03/2023 17/03/2023 17/03/2023 18/03/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 3 Pemeriksaan


563 SODIKIN 3328012807560001 66 2023000046380066 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 5 Diagnosis

Pemeriksaan
564 SOHIBI 3328011209740001 48 2023000046370318 JATILABA RT 1 RW 4 Terduga TBC SO 25/03/2023 Rif Sen 25/03/2023 25/03/2023 27/03/2023 27/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
565 SOLICHIN 3328041212530027 76 2023000046430123 KARANGJAMBU RT 3 RW 3 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
566 SOLIKHIN 3328022003790001 40 2022000046542143 SIGEDONG RT 10 RW 4 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 RS Hawari Essa
Diagnosis

Pemeriksaan
567 SOLIYAH 3328044107740080 48 2023000046430044 TEMBONGWAH RT 5 RW 2 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 25/01/2023 25/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
568 SOPAN JAMALI 3328010506700006 52 2023000188200016 KARANGDAWA RT 1 RW 1 Terduga TBC SO 02/03/2023 Rif Sen 02/03/2023 02/03/2023 03/03/2023 03/03/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG KULON RT 6 Pemeriksaan


569 SOPANAWATI 3328046910660002 56 2023000046420062 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Balapulang
RW 1 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 31 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

JEMBAYAT RT 003 RW Pemeriksaan


570 SOPIAH 3172024501740002 49 2022000112711258 Terduga TBC RO 01/03/2023 Neg 01/03/2023 01/03/2023 02/03/2023 02/03/2023 Puskesmas Margasari Tegal
001 Diagnosis

Pemeriksaan
571 SRI HARTATI 3328044107790026 44 2023000046430152 TEMBONGWAH RT 1 RW 3 Terduga TBC SO 08/03/2023 Neg 08/03/2023 08/03/2023 08/03/2023 08/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
572 SRI HERI SUSANTO 3328040203780005 44 2023000046430037 BATUAGUNG RT 1 RW 1 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 1 Pemeriksaan


573 SRI HIDUP 3328045402850009 38 2023000046420147 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
574 SRI JAETIN 3328045504680002 54 2023000046430136 KALIBAKUNG RT 5 RW 2 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
575 SRI MULYANI 3328045001880003 35 2023000046420033 DANAWARIH RT 3 RW 1 Terduga TBC SO 11/01/2023 Neg 11/01/2023 11/01/2023 12/01/2023 12/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
576 SRI MUSTIKA ASIH 3328044402800008 43 2023000046430086 BUKATEJA RT 6 RW 1 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
577 SRI PUJI PURWATI 3328046010750001 47 2023000046420113 DANAWARIH RT 4 RW 4 Terduga TBC SO 14/02/2023 Neg 14/02/2023 14/02/2023 15/02/2023 15/02/2023 Puskesmas Balapulang
Diagnosis

BALAPULANG KULON RT 2 Pemeriksaan


578 SRI WAHYUNINGSIH 3328040610840003 38 2023000046420116 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Balapulang
RW 3 Diagnosis

Pemeriksaan
579 SRIYATI 3328045902950001 27 2023000046420086 PAMIRITAN RT 1 RW 3 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
580 ST. DJOLECHA 3328044107470085 75 2023000046430180 KALIBAKUNG RT 1 RW 2 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 24/03/2023 24/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
581 SUALI 3328010107600102 63 2023000046370290 JEMBAYAT RT 3 RW 3 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 10/03/2023 11/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
582 SUCIATI 3174105603781001 44 2023000046430040 KP BARU IV RT 5 RW 2 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 19/01/2023 19/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
583 SUDIRMAN 3328011606790005 43 2023000046370063 JATILABA RT 4 RW 14 Terduga TBC SO 18/01/2023 Rif Sen 18/01/2023 18/01/2023 19/01/2023 19/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
584 SUDIRNO 3329152201940002 29 2023000046380089 PAKULAUT RT 5 RW 6 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

BALAPULANG WETAN RT 4 Pemeriksaan


585 SUGENG 3328040605620001 60 2023000046420222 Terduga TBC SO 27/03/2023 Rif Sen 27/03/2023 27/03/2023 28/03/2023 28/03/2023 Puskesmas Balapulang
RW 5 Diagnosis

Pemeriksaan
586 SUGIARTO 3328010304740006 48 2023000188200021 MARGASARI RT 4 RW 8 Terduga TBC SO 24/03/2023 Rif Sen 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK UTARA RT 5 RW Pemeriksaan


587 SUGIARTO 3328010610940004 28 2023000046380057 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
1 Diagnosis

Pemeriksaan
588 SUGINAH 3328016409870012 35 2023000046370282 JEMBAYAT RT 2 RW 12 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 07/03/2023 07/03/2023 Puskesmas Margasari Tegal
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 32 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

BALAPULANG KULON RT 5 Pemeriksaan


589 SUGIYANTI 3328044101650015 58 2023000046420160 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 06/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

PRUPUK UTARA RT 5 RW Pemeriksaan


590 SUGIYANTO 3328010803840008 38 2023000046380052 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
2 Diagnosis

Pemeriksaan
591 SUHARDI 3328040702910004 32 2023000046420214 KALIWUNGU RT 3 RW 3 Terduga TBC SO 17/03/2023 Rif Sen 17/03/2023 17/03/2023 18/03/2023 18/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
592 SUHARJO 3328013112570020 65 2023000046370130 MARGA AYU RT 4 RW 1 Terduga TBC SO 17/02/2023 Rif Res 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
593 SUHERMANTO 3328062606870007 35 2023000046430011 BUKATEJA RT 5 RW 1 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 09/01/2023 09/01/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT Pemeriksaan


594 SUHERNI 3328046611850001 41 2021000112711539 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Balapulang
003 RW 007 Diagnosis

DUKUH TENGAH RT 1 RW Pemeriksaan


595 SUINAH 3328014506780005 45 2023000046380019 Terduga TBC RO 16/01/2023 Rif Res 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
596 SUJA'I 3328010605600001 62 2023000046380113 KALIGAYAM RT 2 RW 1 Terduga TBC SO 28/03/2023 Neg 28/03/2023 28/03/2023 29/03/2023 29/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
597 SUKAR 3328041206770004 45 2023000046430183 CILONGOK RT 02 RW 01 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 27/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
598 SUKI 3328014110490002 73 2023000046370014 JEMBAYAT 03/12 Terduga TBC SO 05/01/2023 Neg 05/01/2023 05/01/2023 06/01/2023 06/01/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


599 SUKIRMAN 3328040503570001 65 2021000046420470 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 02/02/2023 02/02/2023 Puskesmas Balapulang
RW 2 Diagnosis

Pemeriksaan
600 SUKIRNO 3328060507720008 50 2021000046450060 Dukuh lo 1/5 Terduga TBC RO 05/01/2023 Rif Sen 05/01/2023 05/01/2023 07/01/2023 07/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
601 SUKRIB 3328041107490001 74 2022000046430162 BANJARANYAR RT 7 RW 2 Terduga TBC SO 11/03/2023 Rif Sen 11/03/2023 11/03/2023 11/03/2023 13/03/2023 Puskesmas Balapulang
Diagnosis

BBALAPULANG KULON RT Pemeriksaan


602 SULAMI 3328044512550007 67 2023000046420084 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Balapulang
7 RW 3 Diagnosis

Pemeriksaan
603 SULASTRI 3328067112540034 68 2023000046450184 KESUBEN RT 4 RW 6 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
604 SULEMI 3328016308820003 40 2023000046370084 DUKUHTENGAH RT 4 RW 4 Terduga TBC SO 27/01/2023 Rif Sen 27/01/2023 27/01/2023 28/01/2023 30/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
605 SULENI 3328016505980009 24 2023000046370312 KALISALAK RT 2 RW 5 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
606 SULISTIA 3328047011950008 27 2023000046420088 BANJARANYAR RT 3 RW 1 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 11/02/2023 Puskesmas Balapulang
Diagnosis

DESA TEMBONG WAH


Pemeriksaan
607 SULWI 3328047112480014 74 2023000046430041 JL.BULUH PAYUNG RT 5 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 19/01/2023 19/01/2023 Puskesmas Kalibakung
Diagnosis
RW 3

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 33 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

HARJAWINANGUN RT 3 RW Pemeriksaan
608 SUMARNI 3328045212630006 59 2023000046430021 Terduga TBC SO 11/01/2023 Neg 11/01/2023 11/01/2023 12/01/2023 12/01/2023 Puskesmas Kalibakung
3 Diagnosis

DESA BANJARANYAR JL. Pemeriksaan


609 SUMARTI 3328044107500129 72 2023000046430103 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 21/02/2023 21/02/2023 Puskesmas Kalibakung
SERUT RT 4 RW 3 Diagnosis

Pemeriksaan
610 SUMIATI 3328044707740001 48 2023000046420206 PAMIRITAN RT 4 RW 4 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
611 SUMIROH 3328017101620002 60 2023000046370056 JEMBAYAT RT 3 RW 12 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
612 SUMYATI 3328015509720006 52 2023000046380085 PAKULAUT RT 8 RW 3 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
613 SUNADI 3328010511420001 80 2023000046370131 MARGASARI RT 2 RW 9 Terduga TBC SO 17/02/2023 Neg 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Margasari Tegal
Diagnosis

KARANG JAMBU RT 2 RW Pemeriksaan


614 SUNANTI 3328044107620180 61 2023000046430084 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 15/02/2023 15/02/2023 Puskesmas Kalibakung
2 Diagnosis

Pemeriksaan
615 SUNARTI 3328045012560001 66 2023000046430138 KALIBAKUNG RT 1 RW 1 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


616 SUNARYO 3328012002590001 63 2023000046380021 Terduga TBC SO 16/01/2023 Rif Sen 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kesambi
6 Diagnosis

Pemeriksaan
617 SUNARYO 3328061711880001 34 2023000046450414 DURENSAWIT RT 3 RW 2 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
618 SUNASID 3328012402680002 54 2023000046380051 WANASARI RT 2 RW 3 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
Diagnosis

BALAPULANG WETAN RT 4 Pemeriksaan


619 SUNASIH 3328046011530001 69 2023000046420205 Terduga TBC SO 13/03/2023 Rif Sen 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Balapulang
RW 1 Diagnosis

Pemeriksaan
620 SUNIPAH 3328044107610069 61 2023000046430130 TEMBONGWAH RT 2 RW 4 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
621 SUNITI 3328047112630021 59 2023000046430039 CENGGINI RT 5 RW 2 Terduga TBC SO 18/01/2023 Neg 18/01/2023 18/01/2023 18/01/2023 18/01/2023 Puskesmas Kalibakung
Diagnosis

DK. SEMPUMAJA RT 3 RW Pemeriksaan


622 SUNITI 3328066207760002 46 2023000046450360 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
2 Diagnosis

Pemeriksaan
623 SUNOTO 3328040107670076 55 2023000046430067 CENGGINI RT 1 RW 3 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
624 SUPARJO 3328012803660002 56 2023000046370080 KALISALAK RT 3 RW 12 Terduga TBC SO 25/01/2023 Neg 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 5 Pemeriksaan


625 SUPARNO 3328012002680001 55 2023000046380075 Terduga TBC SO 07/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 09/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
626 SUPARYATI 3328064107730131 56 2023000046450453 YAMANSARI RT 3 RW 7 Terduga TBC RO 28/02/2023 Rif Sen 28/02/2023 28/02/2023 01/03/2023 01/03/2023 Puskesmas Lebaksiu
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 34 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

BALAPULANG KULON RT 5 Pemeriksaan


627 SUPRAPTI 3328044102530006 70 2023000046420167 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 04/03/2023 07/03/2023 Puskesmas Balapulang
RW 2 Diagnosis

BALAPULANG WETAN RT 1 Pemeriksaan


628 SUPRATIN 3328045112650001 57 2023000046420165 Terduga TBC SO 04/03/2023 Neg 04/03/2023 04/03/2023 06/03/2023 06/03/2023 Puskesmas Balapulang
RW 10 Diagnosis

KARANGMONCOL 1 RT 1 Pemeriksaan
629 SUPRIYATIN 3328065212630022 59 2023000046450315 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
RW 3 Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


630 SURATMI 3328014107450229 77 2023000046380069 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

PRUPUK UTARA RT 2 RW Pemeriksaan


631 SURATNO 3328011407660002 56 2023000046380053 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

KARANG JAMBU Pemeriksaan


632 SUTANTI 3328044709790002 43 2023000046430029 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 16/01/2023 16/01/2023 Puskesmas Kalibakung
BALAPULANG RT 3 RW 2 Diagnosis

Pemeriksaan
633 SUTARJO 3328021505650009 57 2023000153040059 SOKATENGAH RT 5 RW 4 Terduga TBC SO 28/01/2023 Neg 28/01/2023 28/01/2023 28/01/2023 30/01/2023 RS Hawari Essa
Diagnosis

BALAPULANG WETAN RT 9 Pemeriksaan


634 SUTARMO 3328041107580001 64 2023000153040042 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 RS Hawari Essa
RW 4 Diagnosis

Pemeriksaan
635 SUTIJAH 3328044310650001 57 2023000046430109 KARANGJAMBU RT 4 RW 7 Terduga TBC SO 25/02/2023 Neg 25/02/2023 25/02/2023 25/02/2023 27/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
636 SUTIRAH 3328016212900004 32 2023000046370044 PAKULAUT RT 6 RW 2 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Margasari Tegal
Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


637 SUWARNO 3328041212580012 64 2023000046420129 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 28/02/2023 28/02/2023 Puskesmas Balapulang
RW 5 Diagnosis

PRUPUK UTARA RT 7 RW Pemeriksaan


638 SUWARTO 3328010506430002 79 2023000046380037 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 14/02/2023 14/02/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
639 SUWITNO 3328010708760002 46 2023000046370309 DANARAJA RT 3 RW 3 Terduga TBC SO 18/03/2023 Rif Sen 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
640 SUWITO 3328011705560003 66 2023000046370114 KARANGDAWA RT 4 RW 3 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Margasari Tegal
Diagnosis

DESA KARANG DAWA RT 1 Pemeriksaan


641 SUYA 3328010107570354 65 2023000046370046 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Margasari Tegal
RW 2 Diagnosis

Pemeriksaan
642 SUYATINI 3328064607580003 64 2020000046450074 kajen 1/4 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK SELATAN RT 2 Pemeriksaan


643 SYAHRINI INDAH PERMATASARI 3328015111140004 8 2023000046380023 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Kesambi
RW 3 Diagnosis

Pemeriksaan
644 SYAIPUDIN 3328042810590002 63 2023000046420217 KALIWUNGU RT 1 RW 2 Terduga TBC SO 21/03/2023 Neg 21/03/2023 21/03/2023 24/03/2023 24/03/2023 Puskesmas Balapulang
Diagnosis

KARJAWINANGUN RT 1 RW Pemeriksaan
645 TAHRUDIN 3328040105540008 68 2022000046430236 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 10/03/2023 10/03/2023 Puskesmas Kalibakung
2 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 35 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
646 TAHYUDIN 3328040102630001 60 2023000046420184 SESEPAN RT 2 RW 4 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 07/03/2023 07/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
647 TAJUDIN 3328042206750002 47 2023000046420131 DK.MALANG RT 1 RW 3 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
648 TALITA NURJIYANA 3328015408090002 13 2023000046370076 KARANGDAWA RT 2 RW 3 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
649 TAPSILAH 3328044207540004 66 2022000046430057 CILONGOK 4/3 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 30/01/2023 30/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
650 TARDJUKI 3328041012530009 69 2023000046430161 BANJARANYAR RT 3 RW 5 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 13/03/2023 13/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
651 TARHADI 3328040107150028 62 2022000112712424 PAMIRITAN RT 1 RW 4 Terduga TBC SO 06/02/2023 Neg 06/02/2023 06/02/2023 07/02/2023 07/02/2023 Puskesmas Balapulang
Diagnosis

KARANG JAMBU RT 3 RW Pemeriksaan


652 TARIMAH 3328046201470001 76 2023000046430064 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Kalibakung
1 Diagnosis

LEBAKSIU LOR RT 4 RW Pemeriksaan


653 TARINAH 3328064107520325 70 2023000046450347 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Lebaksiu
7 Diagnosis

Pemeriksaan
654 TARINI 3328044607570004 65 2023000046420215 KALIWUNGU RT 6 RW 2 Terduga TBC SO 18/03/2023 Neg 18/03/2023 18/03/2023 20/03/2023 20/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
655 TARINI 3328064304430001 79 2023000046450186 RT 0 RW 0 Terduga TBC SO 25/01/2023 Rif Sen 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
656 TARJI 3328010611550001 79 2023000046370314 JEMBAYAT RT 3 RW 12 Terduga TBC SO 24/03/2023 Neg 24/03/2023 24/03/2023 25/03/2023 25/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
657 TARJUNAEDI 3328041409660002 56 2023000046430135 KALIBAKUNG RT 5 RW 2 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 03/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
658 TARMO 3328010312630002 59 2023000046380001 WANASARI RT 1 RW 1 Terduga TBC SO 04/01/2023 Rif Sen 04/01/2023 04/01/2023 05/01/2023 05/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
659 TARSONO 3328013112600157 62 2020000046370105 karang dawa1/1 Terduga TBC RO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
660 TARUNI 3328046006640001 58 2023000046430002 CILONGOK RT 2 RW 3 Terduga TBC SO 02/01/2023 Neg 02/01/2023 02/01/2023 02/01/2023 02/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
661 TARWADI 3328010712550005 67 2023000046380012 PAKULAUT RT 4 RW 3 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 16/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

DUKUH TENGAH RT. 4 / Pemeriksaan


662 TASAMAH 3328015406720003 50 2022000135642343 Terduga TBC RO 03/03/2023 Neg 03/03/2023 03/03/2023 04/03/2023 06/03/2023 Puskesmas Kesambi
4 MARGASARI Diagnosis

Pemeriksaan
663 TASJAD 3328010107510085 71 2023000153040041 KARANGDAWA RT 6 RW 7 Terduga TBC SO 21/01/2023 Neg 21/01/2023 21/01/2023 21/01/2023 21/01/2023 RS Hawari Essa
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


664 TASORI 3328013012700010 52 2020000112711191 Terduga TBC RO 21/02/2023 Rif Sen 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Kesambi
3 Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 36 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

LEBAKSIU KIDUL RT 7 Pemeriksaan


665 TASORI 3328060103500005 72 2023000188200002 Terduga TBC SO 25/01/2023 Rif Sen 25/01/2023 25/01/2023 26/01/2023 26/01/2023 Puskesmas Lebaksiu
RW 4 Diagnosis

Pemeriksaan
666 TASRIPAH 3328014911710004 51 2023000046370054 KARANGDAWA RT 4 RW 3 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
667 TASWI 3328014107550274 67 2023000046370048 KARANGDAWA RT 1 RW 2 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
668 TAZKIYATUL AMALIA 3328045712090003 13 2023000046450402 KASERAN RT 5 RW 1 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
669 THOHIDIN 3328040107740090 48 2023000046420227 DK.KASERAN RT 4 RW 1 Terduga TBC SO 28/03/2023 Rif Sen 28/03/2023 28/03/2023 29/03/2023 29/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
670 TIARA ANINDYA SALSABILA 3328045403120002 10 2023000046430063 KALIBAKUNG RT 3 RW 3 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 5 Pemeriksaan


671 TJARTA 3328043112390007 83 2023000046420128 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 27/02/2023 Puskesmas Balapulang
RW 10 Diagnosis

CENGGINI 04/02 Pemeriksaan


672 TOBRONI 3328040106500003 72 2022000112740362 Terduga TBC RO 10/02/2023 Neg 10/02/2023 10/02/2023 13/02/2023 13/02/2023 Puskesmas Balapulang
BALAPULANG Diagnosis

Pemeriksaan
673 TOHIR 3328040107670165 55 2023000046430050 TEMBONGWAH RT 4 RW 2 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 30/01/2023 30/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
674 TOIPAH 3328044802700002 52 2023000046430028 BATUAGUNG RT 18 RW 3 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 16/01/2023 16/01/2023 Puskesmas Kalibakung
Diagnosis

HARJAWINANGUN RT 2 RW Pemeriksaan
675 TONIAH 3328044604650003 57 2023000046430147 Terduga TBC SO 06/03/2023 Neg 06/03/2023 06/03/2023 06/03/2023 07/03/2023 Puskesmas Kalibakung
1 Diagnosis

Pemeriksaan
676 TUMINAH 3328044901550001 68 2023000046430102 BANJARANYAR RT 3 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 21/02/2023 21/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
677 TUMINAH 3329144203930011 30 2023000046420207 PAMIRITAN RT 1 RW 2 Terduga TBC SO 13/03/2023 Neg 13/03/2023 13/03/2023 14/03/2023 14/03/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
678 TURAH 3328044112600008 62 2020000046420215 BANJARANYAR 1/1 Terduga TBC SO 11/02/2023 Neg 11/02/2023 11/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
Diagnosis

perum Griya satria Pemeriksaan


679 UCU SAHRONI 3215191010880005 34 2023000153040002 Terduga TBC SO 10/01/2023 Rif Sen 10/01/2023 10/01/2023 11/01/2023 11/01/2023 RS Hawari Essa
kajen , Lebaksiu Diagnosis

Pemeriksaan
680 UKHFIDUN NAFSI 3328045301020001 21 2023000046430184 BUKATEJA RT 2 RW 1 Terduga TBC SO 27/03/2023 Neg 27/03/2023 27/03/2023 27/03/2023 28/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
681 UMAYAH 3328045506900003 32 2023000046430150 DANAREJA RT 5 RW 3 Terduga TBC RO 06/03/2023 Rif Res 06/03/2023 06/03/2023 06/03/2023 07/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
682 UMI HANI 3328045005840004 38 2023000046420057 DANAWARIH RT 4 RW 3 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Balapulang
Diagnosis

Pemeriksaan
683 UMU HABIBAH 3301194507930003 29 2023000046430034 PAGERWANGI RT 1 RW 2 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 37 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

BALAPULANG WETAN RT Pemeriksaan


684 UNTUNG PRAYITNO 3328042302740001 43 2023000046420125 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 Puskesmas Balapulang
10 RW 8 Diagnosis

Pemeriksaan
685 URIPAH 3328044709550001 67 2023000046430092 BATUAGUNG RT 9 RW 2 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 20/02/2023 20/02/2023 Puskesmas Kalibakung
Diagnosis

VALYA TALATHOFA ANNADA Pemeriksaan


686 3328014202000009 22 2021000046370080 MARGASARI Terduga TBC SO 10/01/2023 Neg 10/01/2023 10/01/2023 11/01/2023 11/01/2023 Puskesmas Margasari Tegal
SHOFIE AL FANY Diagnosis

Pemeriksaan
687 VANI ANGGI RAMADANI 3328066509060006 16 2023000046450356 YAMANSARI RT 5 RW 3 Terduga TBC SO 16/02/2023 Neg 16/02/2023 16/02/2023 17/02/2023 17/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
688 VANI ANGGI RAMADANI 3328066509060006 16 2023000046450356 YAMANSARI RT 5 RW 3 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 RS Hawari Essa
Diagnosis

LEBAKSIU LOR RT 3 RW Pemeriksaan


689 VIA ANGGUN WIBAWATI 3328064204860001 36 2023000046450353 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Lebaksiu
2 Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


690 VIOLA AZZAHRA AULIA RAHMA 3328015709170005 5 2023000046380078 Terduga TBC SO 07/03/2023 Neg 08/03/2023 08/03/2023 09/03/2023 09/03/2023 Puskesmas Kesambi
RW 3 Diagnosis

BALAPULANG WETAN RT 4 Pemeriksaan


691 WA'AD 3328043005530001 69 2023000046420063 Terduga TBC SO 03/02/2023 Neg 03/02/2023 03/02/2023 04/02/2023 04/02/2023 Puskesmas Balapulang
RW 6 Diagnosis

Pemeriksaan
692 WAEBAH 3328044202610002 62 2023000046430068 BATUAGUNG RT 2 RW 1 Terduga TBC SO 09/02/2023 Neg 09/02/2023 09/02/2023 10/02/2023 10/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
693 WAGE 3328040107690089 53 2023000046430047 TEMBONGWAH RT 5 RW 2 Terduga TBC SO 28/01/2023 Neg 28/01/2023 28/01/2023 28/01/2023 30/01/2023 Puskesmas Kalibakung
Diagnosis

PRUPUK SELATAN RT 2 Pemeriksaan


694 WAGIMAN 3328010701620003 61 2023000188200003 Terduga TBC SO 03/02/2023 Neg 03/02/2023 03/02/2023 04/02/2023 04/02/2023 Puskesmas Kesambi
RW 1 Diagnosis

PRUPUK UTARA RT 3 RW Pemeriksaan


695 WAHUD 3328013112480126 74 2023000046380035 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 11/02/2023 11/02/2023 Puskesmas Kesambi
4 Diagnosis

Pemeriksaan
696 WAHYU AGUNG AMILAH 3328013110970002 25 2023000046380013 PAKULAUT RT 1 RW 3 Terduga TBC SO 30/01/2023 Neg 30/01/2023 30/01/2023 31/01/2023 31/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
697 WAHYU MULYANI 3328015107980001 25 2023000046380090 PAKULAUT RT 5 RW 6 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
698 WAHYUDI 3328010608890002 33 2022000046370477 KARANGDAWA 04/02 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 13/01/2023 13/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 5 Pemeriksaan


699 WAIDIN 3328013112890025 33 2023000046380032 Terduga TBC RO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Kesambi
RW 3 Diagnosis

PRUPUK UTARA RT 6 RW Pemeriksaan


700 WAINAH 3328014903540002 68 2023000046380056 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
2 Diagnosis

Pemeriksaan
701 WAINAH 3328064107590245 63 2023000046450451 KESUBEN RT 4 RW 1 Terduga TBC SO 28/02/2023 Neg 28/02/2023 28/02/2023 02/03/2023 02/03/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
702 WAKRONI 3328011010690009 54 2023000046380084 PAKULAUT RT 8 RW 3 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 11/03/2023 Puskesmas Kesambi
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 38 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
703 WALIKHA 3328025107640003 58 2023000046430054 JEJEG RT 4 RW 2 Terduga TBC SO 01/02/2023 Neg 01/02/2023 01/02/2023 01/02/2023 01/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
704 WANIROH 3328014709600001 42 2023000046380102 PAKULAUT 8/2 Terduga TBC SO 17/03/2023 Rif Sen 17/03/2023 17/03/2023 18/03/2023 18/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
705 WARDAH RAMADHANI ZAHFA 3328125909090003 13 2023000046450375 TEGALWANGI RT 13 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 23/02/2023 23/02/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK UTARA RT 2 RW Pemeriksaan


706 WARHEMI 3328016108620003 65 2023000046380054 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
707 WARISEM 3328016001730003 50 2023000046370124 DANARAJA RT 1 RW 3 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 15/02/2023 15/02/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
708 WARKONAH 3328014809670001 55 2023000046370263 JEMBAYAT RT 1 RW 12 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 28/02/2023 28/02/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK UTARA RT 5 RW Pemeriksaan


709 WARMI 3328014605700009 52 2023000046380058 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 20/02/2023 20/02/2023 Puskesmas Kesambi
2 Diagnosis

Pemeriksaan
710 WARPUAH 3328044508590003 63 2023000046430012 PAGERWANGI RT 3 RW 1 Terduga TBC SO 09/01/2023 Neg 09/01/2023 09/01/2023 09/01/2023 09/01/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
711 WARSIYANTI 3328016401760002 47 2023000046380025 PAKULAUT RT 6 RW 5 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Kesambi
Diagnosis

BALAPULANG WETAN RT 4 Pemeriksaan


712 WARSO 3328042703620002 60 2022000046420014 Terduga TBC SO 07/02/2023 Neg 07/02/2023 07/02/2023 08/02/2023 08/02/2023 Puskesmas Balapulang
RW 10 Diagnosis

HARJAWINANGUN RT 1 RW Pemeriksaan
713 WARTONI 3328040101770019 46 2023000046430032 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kalibakung
2 Diagnosis

KARANG DAWA RT 001 RW Pemeriksaan


714 WARTONO 3328010605890010 33 2021000112710222 Terduga TBC RO 17/02/2023 Rif Sen 17/02/2023 17/02/2023 20/02/2023 20/02/2023 Puskesmas Margasari Tegal
009 Diagnosis

Pemeriksaan
715 WASHADI 3328010810750004 47 2023000046380011 PAKULAUT RT 7 RW 2 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 16/01/2023 16/01/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
716 WASHORI 3328010412910007 31 2023000153040017 KALIGAYAM RT 1 RW 2 Terduga TBC SO 13/01/2023 Neg 13/01/2023 13/01/2023 14/01/2023 14/01/2023 RS Hawari Essa
Diagnosis

Pemeriksaan
717 WASIHATUN 3203154602900005 29 2023000046370055 KARANGDAWA RT 4 RW 3 Terduga TBC SO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Margasari Tegal
Diagnosis

PRUPUK SELATAN RT 1 Pemeriksaan


718 WASITAH 3328015207450003 77 2023000046380063 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 01/03/2023 01/03/2023 Puskesmas Kesambi
RW 6 Diagnosis

Pemeriksaan
719 WASRIPAH 3328014305710003 51 2023000046370321 MARGASARI RT 4 RW 9 Terduga TBC SO 25/03/2023 Neg 25/03/2023 25/03/2023 27/03/2023 27/03/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
720 WATA 3328040108470001 75 2023000046430125 KARANGJAMBU RT 4 RW 4 Terduga TBC SO 03/03/2023 Neg 03/03/2023 03/03/2023 03/03/2023 04/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
721 WATIFA 3328016703940006 28 2023000153040086 MARGA AYU RT 3 RW 1 Terduga TBC SO 10/02/2023 Neg 10/02/2023 10/02/2023 11/02/2023 11/02/2023 RS Hawari Essa
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 39 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

HARJOWINANGUN RT 3 RW Pemeriksaan
722 WATRIAH 3328044703710002 49 2023000046430112 Terduga TBC SO 27/02/2023 Neg 27/02/2023 27/02/2023 27/02/2023 27/02/2023 Puskesmas Kalibakung
4 Diagnosis

TIMBANGREJA RT 001 RW Pemeriksaan


723 WAWAN HERMAWAN 3328061010810004 41 2022000112712041 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 27/01/2023 27/01/2023 Puskesmas Lebaksiu
003 Diagnosis

Desa Prupuk Selatan Pemeriksaan


724 WIDARSIH 3328014108670002 55 2020000046380084 Terduga TBC RO 16/01/2023 Neg 16/01/2023 16/01/2023 17/01/2023 17/01/2023 Puskesmas Kesambi
RT 2 RW 8 Diagnosis

LEBAKSIU KIDUL RT 2 Pemeriksaan


725 WIHARTI 3328065906720009 51 2023000046450282 Terduga TBC SO 08/02/2023 Neg 08/02/2023 08/02/2023 09/02/2023 09/02/2023 Puskesmas Lebaksiu
RW 4 Diagnosis

Pemeriksaan
726 WINAH 3328014104690001 53 2023000046370006 KALISALAK RT 2 RW 8 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Margasari Tegal
Diagnosis

DK. SAIMBANG RT 4 RW Pemeriksaan


727 WINARSIH 3328065405840004 38 2023000046450413 Terduga TBC SO 24/02/2023 Neg 24/02/2023 24/02/2023 25/02/2023 25/02/2023 Puskesmas Lebaksiu
6 Diagnosis

Pemeriksaan
728 WIWIN AMELIA 3328047007010001 21 2023000046430104 CENGGINI RT 2 RW 2 Terduga TBC SO 22/02/2023 Neg 22/02/2023 22/02/2023 23/02/2023 23/02/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
729 WIWIN ROSMIYATI 3328045007850003 37 2023000046430080 BANJARANYAR RT 9 RW 2 Terduga TBC SO 13/02/2023 Neg 13/02/2023 13/02/2023 13/02/2023 13/02/2023 Puskesmas Kalibakung
Diagnosis

DK. WANAGOPA RT 3 RW Pemeriksaan


730 WULANDARI 3328174906080001 14 2023000046450385 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
4 Diagnosis

Pemeriksaan
731 WUTUH 3328046003670001 55 2023000046430048 KARANGJAMBU RT 2 RW 5 Terduga TBC SO 28/01/2023 Neg 28/01/2023 28/01/2023 28/01/2023 30/01/2023 Puskesmas Kalibakung
Diagnosis

BALAPULANG WETAN RT 3 Pemeriksaan


732 WUTUH NUR AMAH 3328045006740005 49 2023000046420002 Terduga TBC RO 02/01/2023 Rif Sen 02/01/2023 02/01/2023 03/01/2023 03/01/2023 Puskesmas Balapulang
RW 6 Diagnosis

Pemeriksaan
733 YETI OKTRIYANA 3328015610990004 23 2023000046380092 PAKULAUT RT 4 RW 2 Terduga TBC SO 09/03/2023 Neg 09/03/2023 09/03/2023 11/03/2023 12/03/2023 Puskesmas Kesambi
Diagnosis

Pemeriksaan
734 YUANA AWANTI 3328066002920002 30 2022000046451156 YAMANSARI 2/5 Terduga TBC SO 26/01/2023 Neg 26/01/2023 26/01/2023 27/01/2023 27/01/2023 Puskesmas Lebaksiu
Diagnosis

PRUPUK UTARA RT 7 RW Pemeriksaan


735 YULIA ADHAENI 3671136207880001 34 2023000046380117 Terduga TBC SO 29/03/2023 Neg 29/03/2023 29/03/2023 30/03/2023 30/03/2023 Puskesmas Kesambi
1 Diagnosis

Pemeriksaan
736 YULIYADI 3328010512700007 52 2023000046380044 DUKUHTENGAH RT 2 RW 2 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
Diagnosis

DESA PAKULAUT RT 4 RW Pemeriksaan


737 YUNI MUTMAINAH 3328015706810005 41 2023000046380008 Terduga TBC SO 12/01/2023 Neg 12/01/2023 12/01/2023 14/01/2023 16/01/2023 Puskesmas Kesambi
3 Diagnosis

Pemeriksaan
738 ZAETUN 3328016507660004 56 2023000046370004 JEMBAYAT RT 3 RW 7 Terduga TBC SO 03/01/2023 Neg 03/01/2023 03/01/2023 04/01/2023 04/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
739 ZAHRA LAILUL MI'RAJ 3603305907090001 13 2023000046450370 KP. BAYUR RT 6 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
740 ZAHRATUN NISA 3329124803100004 12 2023000046450384 PENGABEAN RT 8 RW 5 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

HASIL PEMERIKSAAN XPERT (TCM) YANG DIAJUKAN KLAIM OLEH Puskesmas Kalibakung PADA TANGGAL 01 April 2023
Hal 40 dari
Jumlah
Laboratorium : Puskesmas Kalibakung Tujuan Klaim : Dinas Kesehatan Kabupaten Tegal : 747

Periode Hasil Pemeriksaan : Januari - Maret 2023 Jenis Pemeriksaan : Xpert (TCM) Status Klaim : Pengajuan klaim

Tgl Hasil Tgl Tgl Contoh


Alasan Kriteria Tgl Contoh Tgl Hasil
No Nama Terduga / Pasien NIK Umur Kode barcode SITB Alamat Pasien Permohonan Pemeriksaan Pengambilan Uji diterima Fasyankes Pengirim
pemeriksaan Terduga Uji Dikirim dilaporkan
Lab TCM Contoh Uji Lab

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

Pemeriksaan
741 ZAIDA ERNIYANTI 3173015006920005 30 2023000046430146 KALIBAKUNG RT 2 RW 2 Terduga TBC SO 06/03/2023 Rif Indet 06/03/2023 06/03/2023 07/03/2023 07/03/2023 Puskesmas Kalibakung
Diagnosis

Pemeriksaan
742 ZAIDA ERNIYANTI 3173015006920005 30 2023000046430146 KALIBAKUNG RT 2 RW 2 Terduga TBC SO 06/03/2023 Rif Sen 06/03/2023 06/03/2023 07/03/2023 13/03/2023 Puskesmas Kalibakung
Diagnosis

DUSUN ANGGAMAYA RT 1 Pemeriksaan


743 ZAKARIA NUR IMANI PRAYITNO 3329152002100005 12 2023000046370069 Terduga TBC SO 19/01/2023 Neg 19/01/2023 19/01/2023 20/01/2023 20/01/2023 Puskesmas Margasari Tegal
RW 5 Diagnosis

Pemeriksaan
744 ZAKIYATUL MAHBUBAH 3328124306100001 12 2023000046450379 BENGLE RT 9 RW 2 Terduga TBC SO 21/02/2023 Neg 21/02/2023 21/02/2023 22/02/2023 22/02/2023 Puskesmas Lebaksiu
Diagnosis

Pemeriksaan
745 ZALFAA AZIZAH 3328015605090005 13 2023000046370077 PAKULAUT RT 6 RW 1 Terduga TBC SO 24/01/2023 Neg 24/01/2023 24/01/2023 25/01/2023 25/01/2023 Puskesmas Margasari Tegal
Diagnosis

Pemeriksaan
746 ZASKIA WULANDARI 3328014310130002 9 2023000046370324 JEMBAYAT RT 2 RW 12 Terduga TBC SO 28/03/2023 Neg 28/03/2023 28/03/2023 28/03/2023 28/03/2023 Puskesmas Margasari Tegal
Diagnosis

DUKUH TENGAH RT 3 RW Pemeriksaan


747 ZIDAN KHAIRUL HAKIM 3328010811150003 7 2023000046380041 Terduga TBC SO 15/02/2023 Neg 15/02/2023 15/02/2023 16/02/2023 16/02/2023 Puskesmas Kesambi
3 Diagnosis

TAGIHAN PENGAJUAN KLAIM PEMERIKSAAN XPERT (TCM): Puskesmas Kalibakung (01 April 2023)
Hal 41 dari

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