REGISTER KUNJUNGAN PE

UPT PUSKESMA
BULAN
UNIT LAYANAN

: FEBRUARI
: BP GIGI

NO

TGL

NO.NIK / SPM

1
2

02/02/2015

3529064304990001
3529060609810001

3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

02/02/2015
02/03/2015
02/04/2015
02/09/2012

02/10/2015

02/11/2015

02/12/2015
16/2/2015
21/2/2015
23/2/2015

24/2/2015
26/1/2015

3529064702910001
3529060107571161
3529061110910003
3529064107630258
3529062003040001
3529062506790002
3529064601870005
3509232604890001
3529066406130002
3529061909630001
3529062912040005
3529060501740001
3529066406840002
3529061202720004
3529065306990003
3529066206950009
3529066904070001
3529067007030002
3529060711550001
3529064101940005
3529066205070001
3529065412740001
3529060201740002
3513196602940001
3529060103630005
3529062809900002
3529066104720005
3529062607890001
3529064305950001
3529062107080002

NAMA PENDERITA

HIDAYATI
SUPARDI
ANAWATI
HASAN
JUNAIDI
MISRIYA
ROZI
HARIS
DEVI
ALFIAN
ATHIYANI
ATIPAMIYONO
SARI YANTO
SADRIMAN
B.SUS
P.MUN
SUCI RIADI
SULISTIKA
LALA
LAILATUL
DIMIN
DEVI
FARAH
NURYANI
P.SUBAIDI
WULANDARI
JIROMLI
IFAN
SITI
AHMAD S
SRIUMA
ALDI

32
40

30
45
33
47
15
36
13
7
41
39
29
40
40
40
29
10
5
6
50
7
6
31
60
19
60
6
21
34
48
7

V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V

UMUR
(TH)

NO

TGL

NO.NIK / SPM
JUMLAH

NAMA PENDERITA

UMUR
(TH)

EGISTER KUNJUNGAN PENDERITA RAWAT JALAN JAMKESDA

UPT PUSKESMAS SARONGGI TAHUN 2015

KODE
ALAMAT

DIAGNOSA
ICD X

KARCIS
MASUK

JULUK
JULUK

K02
K04

Rp7,500
Rp7,500
Rp7,500

BLUTO
KARANG CEMPAKA
SARONGGI
SARONGGI
LANGSAR
MUANGAN
SARONGGI
TALANG
BLUTO
BLUTO
KEDATIM
KAMBINGAN BARAT
SARONGGI
PAGAR BATU
KEDATIM
BLUTO
SARONGGI
TALANG
KAMBINGAN BARAT
SAROKA
AENGDAKE
NAMBAKOR
TALANG
TANJUNG
TANJUNG
PAGAR BATU
PAGAR BATU
KEDATIM
JULUK
TANJUNG

K04
K04
K04
K04
K04
K04
K00
K00
K04
K04
K04
K04
K02
K04
K04
K00
K00
K00
K04
K00
K00
K04
K04
K04
K02
K02
K02
K02
K03
K00

Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500

TINDAKAN
INJEKSI

kb

Rp1,000
Rp1,000
Rp1,000
Rp1,000
Rp1,000
Rp1,000
Rp1,000
Rp1,000

rawat luka

Rp15,000

Rp10,000
Rp10,000

Rp10,000
Rp10,000
Rp20,000
Rp20,000

Rp10,000

KODE
ALAMAT

DIAGNOSA
ICD X

KARCIS
MASUK
Rp240,000

TINDAKAN
INJEKSI

Rp7,000

kb

Rp90,000

rawat luka

AKAN

total
lain2

Rp100

Rp20,000

Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500

Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500

Rp20,000

Rp20,000
Rp20,000

KETERANGAN

PELAYANAN
RESEP OBAT
JADI

Rp1,500

Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500

Rp25,100
Rp10,000
Rp10,000
Rp10,000
Rp10,000
Rp10,000
Rp10,000
Rp9,000
Rp17,500
Rp17,500
Rp9,000
Rp9,000
Rp29,000
Rp9,000
Rp9,000
Rp9,000
Rp9,000
Rp17,500
Rp9,000
Rp17,500
Rp29,000
Rp27,500
Rp27,500
Rp29,000
Rp9,000
Rp29,000
Rp9,000
Rp9,000
Rp9,000
Rp9,000
Rp9,000
Rp17,500

sirkumsisi

UKS
UKS

RUJUK

2 ELEMEN
2 ELEMEN

UKS

AKAN

total
lain2

Rp80,100

PELAYANAN
RESEP OBAT
JADI

Rp37,500 Rp454,600

KETERANGAN
Rp454,600

REGISTER KUNJUNGAN PENDERIT

UPT PUSKESMAS SARO
BULAN
UNIT LAYANAN

:JANUARI
: BP GIGI

NO

TGL

NO.NIK / SPM

01/12/2014

3529065405040001

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

02/12/2014

04/12/2014

05/12/2014

06/12/2014
08/12/2014

10/12/2014
13/12/2014

16/12/2014

3529063005110024
3529061311070001
3529060105064979
3529060412080068
3529060710130005
3529060511080037
3529061102130001
3529060105064977
3529062505120007
3529062901090064
3529062912100036
3529061702090004
3529060704090011
3529060105064977
3529061802090005
3529061106120007
3529062712100014
3529060303090021
3529061108090017
3529060306090028
3529063012100008
3529060109100002
3529060505090008
3529062709130003
3529062407140001
3529060511080037
3529060902930002
3529061904840001
3529060906050003

NAMA PENDERITA

SRI
Sudaryo
AUFA
SUTINA
SURIYANTO
ALVI
IBNO
MARYAMI
SUTO
MOH. RISKI
MOH
SAWI
BOSIWANA
SADIYAH
SUTO
RAHMANI
TINI
IQBAL
HARUN
SADALI
AFANDI
MOH RISKI
MARSUWATUN
JUMAATI
IDA ROYANI
HASIYA
IBNO
FEBIYA
BURAWI
M. ZEN

V
v
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V

NO

31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67

TGL

17/12/2014

18/12/2014

20/12/2014

22/12/2014

23/12/2014

24/12/2014

29/12/2014

30/12/2014

NO.NIK / SPM

3529061309740001
3529064901970003
3529060907731154
3529061202990002
3529062312540001
6306057012110001
3529065006970002
3529061010040003
3529064311020001
3529065206740004
3529065509750005
3529067006600071
3529062312540001
3529064310010001
3529064604010003
3529065008980005
3529055912300001
3529060903730002
3529065108830003
3529061002620004
3529065006970002
3529064707820002
3529062406080002
3529065405550001
3529066105960001
3529067006660024
3529066106640001
3529067006560016
3529061103990002
3529061510790001
3529060309100001
3529061008470001
3529064307070001
3529066812070002
3529064510600001
3529062107080002
3529061012810002

NAMA PENDERITA

WAHA
MASTURIYA
ADAR
FARISI
SULAM
HASANAH
HOLIDA
NURIL
NIA
RINA
JUMAATI
MASRUMI
SULAM
DEWI
FINA
IRIYANTI
SUMADIYA
SUSANTO
SAHWIYANI
SALAM
HOLIDA
ROFNAN
SAKTI
HIYA
SITI
H. SADIYA
SUHRIYA
NASIYA
YUDI
SUMIRI
DAFID
SAHRAWI
AUNIS
ANGGUN
JUMAIYA
ALDI
MUDU

V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V

NO

68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101

TGL

31/12/2014
02/01/2015
06/01/2015

07/01/2015

NO.NIK / SPM

3529060611810003
3529061505090003
3529063004063306
3529062302090011
3529061908080030
3529061211130002
3529061810100003
3529062104090009

3529061202090154
3529062803140002
3529063006090009
08/01/2015
3529062601090029
12/01/2015
3529060102090043
13/1/2015
3529062312080006
3529060902090048
13/1/2015
3529061501090071
3529062403080001
3529060301090006
3529060701090012
3529061906090047
14/1/2015
3529060906080004
3529062402090016
15/1/2015
3529061204100002
3529061611100005
17/1/2015
3529060105064528
19/1/2015
3529060402140001
3529061409100023
3529060205060617
3529063012100064
3529062502090006
21/1/2015
3529061810100003
21/1/2015
3529061909140005
22/1/2015
3529062010140001
3529061202090154
JUMLAH

NAMA PENDERITA

MASROFI
TOLA
LINDA
MASTARIYA
MADANI
FAMILINAN
INAYATUL
HADIYATUL
NUR LAILA
SITI NURHASANAH
SIRAUP
IMAM BUHARI
HENDRI
DWI DINDA
ASMI
RISCONU
SUHARTINI
ATUN
MOH SAHLAN
AHMAD
SULAM
SANIYA
RAHMAD
SATUN
SISKA
IRWAN
JESIKA
SAGINO
RAHMANI
SRI
INAYATUL
SRI WAHYUNI
PUTRI
NUR LAILA

V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V

REGISTER KUNJUNGAN PENDERITA RAWAT JALAN JAMKESDA

UPT PUSKESMAS SARONGGI TAHUN 2015

KODE

ALAMAT

TANJUNG
aengtongtong
TANJUNG
MUANGAN
NAMBAKOR
KARANGANYAR
aengtongtong
KEBUNDADAP BARAT
MUANGAN
TANAH MERAH
TALANG
TANAH MERAH
KEBUNDADAP BARAT
SAROKA
MUANGAN
PAGAR BATU
SAROKA
KAMBINGAN TIMUR
JULUK
JULUK
aengtongtong
LANGSAR
KEBUNDADAP BARAT
SAROKA
TALANG
KEBUNDADAP BARAT
aengtongtong
TANJUNG
BLUTO
TANAH MERAH

UMUR
(TH)

DIAGNOSA
ICD X

KARCIS

MASUK

K00

Rp7,500
Rp7,500

37
11
50
32
6
47
66
51
9
8
22
25
74
51
55
75
12
69
50
9
6
27
40
40
51
47
7
45
55

k04
K00
K04
K04
K00
K04
K04
K04
K00
K00
K04
K04
K04
K04
K04
K04
K00
K04
K04
K00
K00
K04
K04
K04
K04
K04
taa
K04
K04

Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500

TINDAKAN

EKSTRAKSI GIGI
SULUNG DG
INJEKSI

EKSTRAKSI GIGI
SULUNG TANPA
INJEKSI

Rp10,000

Rp15,000

KODE

ALAMAT

UMUR
(TH)

DIAGNOSA
ICD X

KARCIS

MASUK

KEBUNDADAP BARAT
KARANGANYAR
LOBUK
TALANG
NAMBAKOR
KEBUNDADAP BARAT
BLUTO
TALANG

25
67
45
7
60
7
20
7

K04
K04
K04
K00
K02
K00
K04
K00

Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500

BLUTO
TALANG
SAROKA
TALANG
NAMBAKOR
TANAH MERAH
KEBUNDADAP TIMUR
SERA TIMUR
SARONGGI
MUANGAN
JULUK
NAMBAKOR
BLUTO
TALANG
KEBUNDADAP BARAT
TALANG
TANJUNG
SAROKA
TALANG
KEBUNDADAP BARAT
TANAH MERAH
JULUK
PAGAR BATU
MUANGAN
TANAH MERAH
KEBUNDADAP TIMUR
NAMBAKOR
TANJUNG
KEBUNDADAP TIMUR

9
38
40
50
60
9
18
21
40
40
55
60
20
41
6
50
19
70
54
55
20
45
11
70
11
7
48
7
69

K00
K04
K04
K04
K04
K00
K04
K04
K04
K04
K04
K04
K04
K04
K00
K02
K03
K02
K04
K04
K04
K02
K00
K04
K00
K00
K04
K00
K04

Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500

TINDAKAN

EKSTRAKSI GIGI
SULUNG DG
INJEKSI

EKSTRAKSI GIGI
SULUNG TANPA
INJEKSI

KODE

ALAMAT

UMUR
(TH)

DIAGNOSA
ICD X

KARCIS

MASUK

TINDAKAN

EKSTRAKSI GIGI
SULUNG DG
INJEKSI

KEBUNDADAP TIMUR
JULUK
SARONGGI
KARANGANYAR
LENTENG
LENTENG
JULUK
JULUK

36
23
30
67
10
21
7
7

K04
K04
K04
K04
K02
K02
K00
K00

Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500 Rp10,000
Rp7,500 Rp10,000

TALANG
LOBUK
LOBUK
TALANG
KAPEDI
SAROKA
TALANG
LOBUK
SARONGGI
TALANG
AENGDAKE
TANAH MERAH
NAMBAKOR
KEBUNDADAP TIMUR
TANAH MERAH
LOBUK
KEBUNDADAP TIMUR
LANGSAR
JULUK
KAMBINGAN TIMUR
TANAH MERAH
KEBUNDADAP TIMUR
JULUK
KEBUNDADAP TIMUR
TALANG
TALANG

7
31
56
32
31
11
35
17
25
65
38
39
66
48
43
40
15
29
7
40
44
40
7
35
9
9

K00
K04
K02
K04
K04
K00
K04
K04
K04
K04
K04
K01
K04
K04
K04
K04
K00
K04
K00
K04
K04
K04
K00
K04
K00
K00

Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500
Rp7,500 Rp10,000
Rp7,500
Rp7,500 Rp10,000
Rp7,500 Rp10,000
Rp757,500
Rp50,000

EKSTRAKSI GIGI
SULUNG TANPA
INJEKSI

Rp0

TINDAKAN

EKSTRAKSI GIGI
PERMANEN
(NORMAL)

PELAYANAN
RESEP OBAT
JADI

Rp20,000

Rp1,500

KETERANGAN

TINDAKAN

EKSTRAKSI GIGI
PERMANEN
(NORMAL)

PELAYANAN
RESEP OBAT
JADI

KETERANGAN

TINDAKAN

EKSTRAKSI GIGI
PERMANEN
(NORMAL)

PELAYANAN
RESEP OBAT
JADI

KETERANGAN

Rp1,500
Rp1,500
UKS
UKS
Rp1,500
RUJUK
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
RUJUK
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
Rp1,500
UKS
Rp1,500

Rp0

UKS
UKS
Rp28,500 Rp836,000