PPDM RESTU IBU PEJATEN

MULAI DIAGNOSA
NO NAMA PESERTA NO KARTU NO. RM ALAMAT NO. TELP
TERDAFTAR (DM/HT)

1 DWI SUPRIYANTO 0001739396046 16.22.83 Jl. Gunuk 2 Rt5/3 085880641838 DM

2 SULARSIH 0000037849972 08.24.24 Jl. Swadaya I Rt9/9 No.31 081808532402 DM
3 ETTY ROHANAH 0001880200462 01.42.98 Jl. Swadaya I Rt1/10 No.22 088291826848 DM
4 NY. ONI FATIMAH 0002263039514 08.95.55 Jl. Swadaya I Rt4/11 No.29 DM
5 JUMADI 0000367157946 12.36.31 Jl. Nangka VI Tj. Barat 081311043944 DM
6 DRS. WANA DJAJA 0000045874888 07.54.34 Jl. Muara Rt10/03 No.10 089686617410 DM
7 MERDEKAWATI 0000043384509 13.92.07 Jl. Swadaya Rt05/06 No.48 081281363435 DM
8 HASANAH 0002196954189 15.47.91 Jl. Poltangan Raya Rt01/04 No.15 081311486363 DM
9 SUGIYONO 0001212197578 15.23.79 Jl. Swadaya I Rt1/10 081398417265 DM
10 EMI NURDYATIN 0002305346332 07.27.68 Jl. Gunuk Rt02/003 No.3 DM
11 IR DJUNAIDI 0002072832039 16.83.20 Masjid Al.Makmur DM
12 M ZUHDI 0001421080119 07.30.65 Pejaten Timur Rt12/09 No.28 78839261 DM
13 MUNAWAROH 0001836983788 16.74.40 Jl. Swadaya I Rt12/10 No.56 DM
14 PARDJAN 0001212466419 08.62.19 Gunuk Rt05/9 no.16 081381655067 DM
15 NENI SHINTA 0001845605417 07.33.64 Poltangan Raya III No.32 DM
16 LALU SANUSI 0000145345241 15.13.59 Jl. Lebak sari No.10 DM
17 MARYATI 0000045222985 15.13.59 Jl. Swadaya II Rt2/5 No. 6 085780570184 DM
18 LUFI SEKAR 0001463206735 07.22.70 Jl. Gunuk IV Rt8/003 DM
19 NARDI 0001479052236 14.18.46 Jl. Swadaya I Rt11/10 No.91 08176663938 DM
20 ZAKI ALI 0001730876073 20.25.59 Jl. Swadaya I Rt9/9 No.33 08128947379 DM
21 SORAYA 0001730876084 19.81.58 Jl. Swadaya I Rt9/9 No.33A 081219774709 DM
22 LASIDI 0001436462559 16.57.98 Jl. Swadaya I Rt9/009 DM
23 TN SUKIRNO 0001229192638 07.56.80 Pejaten Timur Rt10/10 No.49 081310648609 DM
24 TN JULI 0001720990495 10.84.96 Gg. Langgar Kebagusan Rt03/003 081210923956 DM
25 DANUWAR 0001427130044 20.62.38 Jl. Masjid Al. Makmur Rt6/008 DM
26 RINA K 0001839645988 13'86.84 Jl. Jaidi Rt3/11 DM
27 SUGENG M 0001767146861 20.87.10 Pejaten Timur Rt12/007 No.29 082124466920 DM
28 WASIYEM 0001210731603 14.45.92 Jl. Sawadaya I Rt9/009 No.3B 08129987774 DM
29 TARMINAH 00012104110167 08.12.82
30 WAHYU HADI 0001374417314 20.77.51 Jl. H.M Yasin No.37 085810276122 DM
31
32
33
 PEMERIKSAAN NOVEMBER 2023
NAMA OBAT GDP TEKANAN DARAH TB BB
SISTOLE DIASTOLE
METFORMIN 500 MG, GLIMEPIRIDE 2 MG
METFORMIN 500 MG, SIMVASTATIN 10 MG, GLIMEPIRIDE 1 MG 92 139 70 155 70
GLIMEPIRIDE 2 MG, METFORMIN 500 MG, AMLODIPIN 5 MG, CANDERSATAN 8 MG, SIMVASTATIN 20 MG 105 140 90 155 65
LANTUS 20 UNIT, NOVORAPID 15 U, AMLODIPINE 10MG, VALSARTAN 80MY, SIMVASTATIN 20MG 124 130 86 160 82
AMLODIPIN 10MG, METFORMIN 850MG
METFORMIN 500MG, SIMVASTATIN 10MG, AMLODIPIN 5MG 200 160 90 170 80
AMLODIPIN 10MG, VALSARTAN 80MG, METFORMIN 500MG, SIMVASTATIN 20MG 220 140 80 152 53
AMLODIPINE 5MG, SIMVASTATIN 20 MG 105 120 80 158 58
METFORMINE 500MG, GLIMEPIRID 3MG, SIMVASTATIN 20MG 101 139 70 165 65
METFORMIN 500MG, AMLODIPINE 5 MG, ALLOPURINOL 100 MG 95 140 80 165 65
GLIMEPIRIDE
CONCOR 5MG,
2.5MG, METFORMINE
RAMIPRIL 2.5MG,500MG, SIMVASTATIN
CLOPIDOGREL 75MG, 10MG
SIMVASTATIN 20MG, ISDN 10MG, ACARBOSE 50MG, GLICIAZIDE 80MG, 86 140 80 167 74
GABAPENTIN 300MG 101 140 80 160 65
GLIMEPIRID 3MG, CANDESARTAN 8MG, METFORMIN500MG, GLIMEPIRID 4MF, ALLUPURINOL 100MG, AMLODIPIN 10 MG 214 185 95 165 69
METFORMIN 850MG, GLIMEPIRID 1MG, RAMIPRIL 5MG, AMLODIPINE 10MG, SIMVASTATIN 20MG 119 120 80 160 67
METFORMINE 500MG, GLIMEPIRID 2MG 100 127 80 169 62
DIAMICRON 60MG, METFORMIN 500MG, ACARBOSE 100MG, AMLODIPIN 10MG, SIMVASTATIN 20MG 121 130 80 170 62
GLIMEPIRIDE 3MG, METFORMINE 500MG 120 128 78 154 52
MINIASPI 80MG, BISOPROLOL 5MG, CPG 75MG, RAMIPRIL 10MG, SIMVASTATIN 20 MG 110 129 80 157 70
METFORMIN 500MG, AMLODIPINE 5 MG, ALLOPURINOL 100 MG 101 129 80 157 70
METFORMIN 500MG
METFORMIN 500MG 125 130 80 157 85
METFORMIN 500MG, GLIBENCLAMIDE 120 130 80 160 54
METFORMIN 500MG, BISOPROLOL 2.5MG, GLIBENCLAMIDE 5MG
LANTUS 20 UNIT, AMLODPINE 5MG, METFORMIN 500MG
METFORMIN 500MG 102 130 70 169 69
METFORMIN 500MG, GLIBENCLAMIDE 112 120 75 170 75
METFORMIN 500MG, GLIMEPIRIDE 2MG 120 117 80 165 69
METFORMIN 850MG, GLIMEPIRID 1MG, RAMIPRIL 5MG, AMLODIPINE 10MG, SIMVASTATIN 20MG 125 128 75 159 55
METFORMIN 500MG, GLIMEPIRIDE 2MG 109 119 75 163 63
OVEMBER 2023 PEMERIKSAAN DESEMBER 2023
LP Tanggal Pemeriksaan PEMERIKSAAN KIMIA DARAH TEKANAN DARAH
GDP TB
CHOLES TOTALTRIGLESERIDE HDL LDL UREUM CREATININ HBA1C SISTOLE DIASTOLE

90 11/11/2023
98 11/11/2023 202 * 126 50 129 * 22 0.66 9.9 * 155 CM
96 11/11/2023

78 11/11/2023 177 167 * 50 102 * 52 * 1.08 7.3 * 170 CM

75 11/11/2023 150 CM
49 11/11/2023 268 206 * 52 178 * 32 0.82 5.9 *
85 11/11/2023 150 CM
85 11/11/2023
89 11/11/2023 160 CM
85 11/11/2023
86 11/11/2023 160 217 * 42 80 30 1.55 * 8.5 * 160 CM
90 11/11/2023 253 107 48 182 * 22 0.95 7.7 *
84 11/11/2023 232 * 374 * 34 * 134 * 42 1.03 9.3 * 165 CM
96 11/11/2023 184 109 39 * 123 * 25 1.43 * 7.9 *
89 11/11/2023 206 * 157 * 41 131 * 81 * 1.9 * 7.7 * 154 CM
92 11/11/2023 139 451 * 28 42 31 0.81 * 8.8 *
94 11/11/2023 163 277 * 33 * 89 30 1.06 6.5
184 90 45 123 * 30 0.7 6.1 * 157 CM
99 11/11/2023 221 * 86 59 128 27 0.69 6.2 * 179 CM
85 11/11/2023 178 125 51 106 * 28 0.93 7.6 * 157 CM
166 CM
160 CM
90 11/11/2023 162 CM
100 11/11/2023
85 11/11/2023
80 11/11/2023
86 11/11/2023
188 121 55 109 * 24 1.04 5.5
BB LP Tanggal Pemeriksaan
PPHT RESTU IBU PEJATEN

MULAI DIAGNOSA
NO NAMA PESERTA NO KARTU TERDAFTAR NO. RM ALAMAT NO. TELP (DM/HT)

1 KARNO 0000043249206 10.76.96 Jl. Swadaya I Rt16/09 HT

2 TATI ROHAYATI 0001210532084 15.19.44 Jl. Swadaya I Rt8/009 No.29 0217810630 HT
3 IRMA SANANTI 0001228096168 14.70.21 Jl. Pagujaten Rt07/007 No.07 HT
4 NURHELINDA 0001457640595 13.36.72 Jl. Swadaya I Rt07/10 085289485820 HT
5 JAMILAH 0001624752786 15.18.04 Jl. Poltangan 5 Rt3/10 No.29 B 085880403301 HT
6 SITI MAKSUDAH 0000043249217 13.66.67 Kp. Jawa Rt06/009 78830639 HT
7 HJ. SUNARTI 0001131226885 10.49.57 Gg. Delima Rt03/004 No.70 HT
8 WATIYEM 0002035213986 08.01.02 Jl. Swadaya I Rt16/009 No.50 HT
9 HJ. SUPRIYATI 0001896846827 15.53.91 Kp. Jawa Rt12/10 085780648313 HT
10 RUMINI 0000042226187 07.53.56 Jl. Swadaya I Rt9/009 No.30 c HT
11 MASITAH ARBI 0002047847321 15.05.06 Jl. Swadaya 2 A Rt2/005 HT
12 ZURAIDAH ARBI 0000037405271 14.69.77 Jl. Swadaya 2A Rt02/05 No.1 085289793427 HT
13 TUGIMAN 0002066181658 13.43.00 Jl. Jaidi Rt02/11 HT
14 RATNI HERMAN 0000210068717 14.03.07 Jl. Poltangan Rt02/10 No.17 78843839 HT
15 DRS. H OESMAN MAR 0000043273811 11.48.55 Jl. Swadaya I Rt9/009 No.40 HT
16 DJUNARTI 0001212845308 15.97.73 Pejaten Timur Rt9/009 No.33 081316791282 HT
17 SYAMSUDIN BANTO 0000043309563 12.07.08 Pejaten Timur Rt6/9 No.22 HT
18 IR. SUROTO 0001228656374 12.04.71 Poltangan Rt01/11 No.4 HT
19 SITI MARIYAM 0001633618348 14.98.89 Jl. Angsana I Rt03/006 No. 50 HT
20 MODESTA BR SIMAMORA 0001630264904 15.22.50 Jl. Swadaya Gg. Rawa Rt05/11 No.87 081294227234 HT
21 SUMIHAR DOLOK 0000043005802 .11.05.98 Jl. Swadaya 2 Rt1/005 No.18 HT
22 MUHAMAD ALI 0000043265946 14.80.95 Gg. Langgar 2 Rt7/10 No.23 E HT
23 SRI NURYANI 0001228663539 07.98.02 Gg. Langgar 3 Rt14/008 No.34 A 081219119538 HT
24 TOMI HERMANTO 0001620626692 10.81.27 Jl. Gunuk Rt07/003 No.36 HT
25 ELLINDA OTHMAL 0001860654655 14.89.76 Jl. Swadaya Rt01/005 No.59 A 78833619 HT
26 SALHA 0001212119943 08.20.52 Jl.Swadya I Rt05/009 HT
27 BURHANUDDIN 0001832532614 16.77.23 Pejaten Timur Rt04/008 No.6 087775545271 HT
28 TRISULA K 0001309404486 09.80.06 Jl. Gunuk II /16A-B Rt05/003 081381002213 HT
29 DRS SUPRIADI 0001259736647 14.20.38 Tj. Barat Rt09/001 HT
30 SUSI YENI 0001261862436 07.21.27 Jl. Gunuk I Rt03/0011No.23 F 7812073 HT
31 DAMIRI 0002092552211 12.47.32 Tanjung Barat 081296889169 HT
32 TONY SAPUTRA 0002141035481 11.38.27 Jl. Swadaya I Rt9/009 No.21 B 081219484552 HT
33 BONG SAK MOY 0001795242868 14.95.01 Jl. Gunuk 2 No.33 7820458 HT
34 ENI SYAMSIAH 0001210796335 11.96.26 Jl. Swadaya I Rt9/10 No.17 HT
35 BUDIONO 0002698594604 07.39.99 Jl. Swadaya I Rt4/11 No.43 HT
36 YETTI WIDIASTUTI 0001458118664 07.99.36 Jl. Swadaya I Rt03/009 No.7 HT
37 SOEKOYO 0000063110452 07.99.91 Jl. Swadaya I Rt02/009 No.9 HT
38 RR DEWI HENDRIATI 0002256843453 09.61.16 Tb. Simatupang Rt10/003 No.99 HT
39 AINUN 0001434417682 07.31.22 Pejaten Timur Rt12/008 No.64 HT
40 HERAWATI 0000030859402 13.02.16 Poltangan III No.38 081315056600 HT
41 ANTON HABIB 0002042604191 20.20.31 Jl. Anggrek Rt10/004 HT
42 MA'MUM NAWAWI 0001634136333 19.84.00 Tj. Barat Rt03/002 No.21 HT
43 SRI PURWATI 0001199703903 07.43.90 Jl. Swadaya I Rt05/009 No.16 A HT
44 HAPOSAN 0001905977147 14.09.46 Jl. Swadaya I No.12 081385938000 HT
45 MAHRI MAULANA 0001459801822 20.19.55 Jl. H. Zen Sarmili 087845634427 HT
46 IR TEGUH 0001738604092 20.47.33 Poltangan Baru No.6 HT
47 RIANTO 0001128827428 13.98.64 Jl. Swadaya I Rt05/009 085282741516 HT
48 SYAIFUL 0001211880262 15.05.24 Tanjung Barat Rt09/001 No.6 HT
49 STEFANUS AVRY DWI 0002456491994 20.80.50 Jl. Muara Rt12/005 No.18 081808208825 HT
50 RIDWAN 0001341274882 07.51.77 Jl. Swadaya II Rt07/005 No.43 HT
51 HANIMAH 0001459880076 07.20.29 Jl. Swadaya II Rt03/005 No.61 HT
52 SURYATI 0000041808565 12.21.00 Jl. Gunuk Rt6/005 No.35 HT
53 SRI HASTUTI 0001338175348 14.00.70 Jl. Swadaya II A Rt2/005 No.49 HT
54 WAWAN SUWANDA 0001285513626 17.52.60 Jl. Gunuk Ciliwung Rt9/005 HT
55 SUMIHARTO RAJI 0001374707013 08.76.67 Jl. Gunuk Raya Rt8/003 No. 94 081383707620 HT
56 BUDI HARTINI 0000041795087 07.19.04 Jl. Swadaya I Rt9/009 No.27 HT
57 NUHARMEN 00000414178482 HT
58 RIDWAN 0001341274882 07.51.77 Jl. Swadaya II Rt07/005 No.43 HT
59 WAHYU HADI 0001374417314 20.77.51 Jl. H.M Yasin No.37 085810276122 DM
60 HERMANSYAH 0000038078919 15.30.68 Poltangan Gg. Delima I Rt1/005 081380099203 HT, DM
61 YOHANA 00018549594888 20.91.19 Jl. Jaidi Rt8/11 No.65 085265536890 HT
62 SITI MASUROH 0001725103989
63 ROHANA 0001656017403
 PEMERIKSAAN NOVEMBER 2023
PROLANIS
AKTIF/TIDAK SAJA / TEKANAN DARAH
NAMA OBAT AKTIF PRB+PROLAN TB
IS SISTOLE DIASTOLE

Miniaspi, tanapres,concor 2.5mg.nitrokaf,simvastatin

adalat oros,concor,valsartan
amlodipine 5mg, simvastatin 20mg
amlodipine 5mg, simvastatin 20mg, concor 1.25mg
amlodipine 5mg, captopril 12.5mg, simvastatin 20mg
amlodipine 10mg, valsartan 80mg
bisoprolol 5mg
amlodipine 5mg, lisinopril 10mg, concor 2.5mg
concor 2.5mg,candersatan 8mg, simvastatin 20mg
amlodipine 10mg, simvastatin 20mg
metformin 500mg,diltiazem,concor,nitrokaf,cpg,simvas
metformin 500mg, candesartan 16mg,v-block,amlo 10mg
amlodipine 10mg, simvastatin 20mg
adalat oros, simvastatin 20mg
amlodipine 10mg
amlodpine 5mg
kendaron 200mcg
aspilet 80mg, clonidine, amlodipine 5mg, candesartan
candesartab 16mg, concor, adalat oros
amlodipine 5mg, ramipril 10mg, simvastatin 20mg
amlodipine 10mg, miniaspi, candesartan, nittrokaf 2.5mg
candesartab 16mg, concor, adalat oros
ramipril 10mg, amlodipine 10mg,simvastatin
aspilet 80mg, corcor, nitrokaf, isdn
candesartan 8mg, nitrokaf 2.5mg, simvastatin
adalat oros, candesartan 16mg, bisoprolol 5mg
amlodipine 10mg, miniaspi, concor 2.5mg
adalat oros 30mg, ramipril, simvastatin 20mg
amlodipine 10mg, simvastatin 20mg
ramipril 10mg, amlodipine 10mg,simvastatin,bisoprolol
amlodipine 5mg, miniaspi, bisoprolol,candesartan
candesartan, amlodipine 10mg, isdn, bisoprolol
amlodipine 10mg, bisoprolol 1.25mg, candesartan
diltiazem, candesartan 8mg, concor 10mg
cpg 75mg, spironolacton 25mg, ramipril 5mg, miniaspi
amlodipine 5mg, tanapres 10mg, bisoprolol 5mg
amlodipine 10mg, candesartan 16mg
amlodipine 10mg
candesartan 8mg, nitrokaf 2.5mg, simvastatin, kendaron
amlodipine 5mg, aspilet, ramipril 5mg, bisoprolol 5mg
miniaspi, bisoprolol 5mg, cpg, ramipril 5mg, simvastatin
aspilet 80mg, bisoprolol 5mg, fenofibrate
miniaspi 80mg, bisoprolol 5mg, nitrokaf
amlodipine 10mg, bisprolol 2.5mg
amlodpine 5mg, bisoprolol 2.5mg
amlodipine 10mg
miniaspi 80mg, candesattan 16mg, bisoprolol, nitrokaf
amlodipine 10mg, bisoprolol 5mg
amlodipine 5mg, candesartan 16mg
amlodipine 10mg, valsartan 80mg
amlodipine, nitrokaf, bisoprolol
amlodipine 10mg
amlodipine 10mg
amlodipine 5mg
AMLODIPIN 10MG, METFORMIN 500MG, CONCOR 2,5MG, SIMVASTATIN 10MG
BISOPROLOL 5MG, GLIMEPIRID 2MG, ALLOPURINOL 100MG, SIMVASTATIN 20MG, CANDESARTAN 10MG, CLONIDIN

amlodpine 5mg, valasrtan 5mg

candesartan 16mg, adalat oros 30mg. Amlodipine 5mg
KSAAN NOVEMBER 2023 PEMERIKSAAN DESEMBER 2023
KIMIA DARAH TEKANAN DARAH
BB LP CHOLES TB BB LP
TOTAL TRIGLESERIDE HDL LDL UREUM CREATININ SISTOLE DIASTOLE

225 * 104 55 147 * 18 0.66

191 145 50 119 * 17 0.51

267 * 114 68 186 * 27 0.65

188 89 61 110 * 35 0.72
209 * 111 58 129 * 30 0.59
230 * 137 60 145 * 30 0.86

164 80 65 86 27 0.79

191 135 57 115 * 23 0.83

182 58 57 112 * 28 1*

197
163 65 43 104 * 25 0.8
169 69 54 97 21 0.84

238 * 94 63 153 * 31 0.72

258 * 185 * 49 178 * 44 0.99 *

219 * 101 60 135 * 29 0.96 *

191 173 * 37 * 116 33 0.97 *

176 94 50 110 * 32 1.03
 194 56 70 110 * 36 0.99 *
193 84 52 125 * 43 1.47
215 104 * 74 121 * 23 0.6

230 * 112 46 162 * 33 1.01

205 * 132 47 130 * 66 * 2.78 *

202 * 155 * 45 126 * 19 0.89

244 179 * 48 167 * 17 0.73

190 152 * 49 116 * 24 0.97 *

166 167 * 37 * 103 * 17 1.09

193 146 * 50 112 65 * 1.42 *
171 115 47 98 65 * 2.02 *