Rsud Dr. Kanudjoso Djatiwibowo Provinsi Kalimantan Timur PDF

DAFTAR PESERTA PER SATUAN KERJA
Nama Satuan Kerja : RSUD DR. KANUDJOSO DJATIWIBOWO PROVINSI KALIMANTAN TIMUR
No. No. Kartu NIK NIP. Lama NIP. Baru Nama Hub. Keluarga Tgl. Lahir Nama Faskes
1 0000006017185 6409012507910002 1991072520130 HERy SUSANTO PESERTA 25/07/1991 BP PANACEA CLINIC
315
2 0000007174416 1205130902910002 120513090291000200 DODI SUHERMAN PESERTA 09/02/1991 BP KLINIK KIMIA FARMA 136
3 0000077187789 3311111803930001 1803199301032 ROCHMAT HARI LAGIYATMO PESERTA 18/03/1993 BP KLINIK DAN APOTEK RISKYTHA
015
4 0000090116504 3313081204920001 1204199201032 FAJAR APRIYANTO PESERTA 12/04/1992 dr. TIEN FATIMATUZZAHRA
015
5 0000094090678 3401036410920013 2410199201032 NURULATIFAH OKTAVIANI R D PESERTA 24/10/1992 BP KLINIK KORPRI
015
6 0000095173481 3403050602900001 0602199001032 AGUNG WAHYU NUGROHO PESERTA 06/02/1990 dr. LIS INDRAYATI
015
7 0000098495706 3516167108930002 351616710893000211 SOFI AMELIA PUTRI PESERTA 31/08/1993 KUPANG
8 0000103532578 3524030801930002 352403080193000200 AHMAD NEHRU RIZAL PESERTA 08/01/1993 KLINIK BORNMED
9 0000119872372 6402036306900001 1990062320101 YZSAURA ZETIRA PESERTA 23/06/1990 BP PANACEA CLINIC
201
10 0000119923683 6402135804910002 1991041820110 PITRI LESTARI PESERTA 18/04/1991 BP PANACEA CLINIC
9
11 0000120048208 6402135710900001 1990101720121 DWI MAULIDINA PESERTA 17/10/1990 BP PANACEA CLINIC
10
12 0001866240753 3516162504880001 1990101720121 ARISTA FIRSANTORO SUAMI 25/04/1988 KLINIK KIMIA FARMA MANGGAR
10
13 0002203234929 6402131101160001 1990101720121 ATHALLAH MUFLIH ANAK 11/01/2016 BP PANACEA CLINIC
10 FIRSANTORO
14 0000120218782 6408140510930001 0110199301032 NGADIO PESERTA 05/10/1993 dr. MERIAH YACOBI
015
15 0000120326916 6471056105910002 19650528199 NURFAUZIAH MAIzAROH PESERTA 21/05/1991 DAMAI
16 0000120327478 6471050803900004 0801199001032 SUHENDRA PESERTA 08/01/1990 BP KLINIK KORPRI
015
3/8/17 5:18 PM Page 1 of 58

17 0002085341771 7405025912930002 0801199001032 ANDI NURHANA SUAMI 19/12/1993 BP KLINIK KORPRI
015
18 0000120328075 6471033003930002 1993300306201 199330030620150003 TRI SUTRISNO PESERTA 30/03/1993 GN. SAMARINDA
500
19 0000120328299 6471045710930005 1993101720141 MELINDA PESERTA 17/10/1993 dr. TITANIA LESTARI A
20
20 0001140300156 6471050308910004 1993101720141 AGUS WAHYU HENDRAWAN SUAMI 03/08/1991 dr. syafaah
20
21 0001484470326 6471044210100002 1993101720141 NAZWA AULIA RAHMA ANAK 02/10/2010 dr. TITANIA LESTARI A
20 SYAFIQAH
22 0002199147186 6471041010160001 1993101720141 Javier Arkhan Mahendra ANAK 10/10/2016 dr. TITANIA LESTARI A
20
23 0000120328582 6471040803970002 647104080397000211 ALDYAN PESERTA 08/03/1997 GN. SARI ILIR
24 0000120761886 6472040305930002 647204030593000222 MUNIF SETYA UTAMA PESERTA 03/05/1993 SAMBUTAN
25 0000120763113 6472040504910008 647204050491000800 PRADANA SETYANTO PESERTA 05/04/1991 KLINIK BORNMED
26 0000120769042 6472014605910001 1991050620140 Ayu Syahria Fatriana Ulfah PESERTA 06/05/1991 BP PANACEA CLINIC
415
27 0000120799721 6471033005920002 1992053020130 RIDHA PRATAMA RAJASA PESERTA 30/05/1991 BP PANACEA CLINIC
30
28 0000120883689 6472020312920001 1992120320140 CHANDRA MAtika PESERTA 03/12/1992 KLINIK PERMATA BUNDA
415
29 0000120892871 6473024504910005 647302450491000500 IJI RAHAYU SUDIARTI PESERTA 05/04/1991 KLINIK BORNMED
30 0000121013021 6401091905930001 1905199301032 WAHYU TRI WIJAYANTO PESERTA 19/05/1993 KLINIK BORNMED
015
31 0000121034518 6401046606930004 640104660693000411 DINA JANUAR NUR PESERTA 26/06/1993 BP KLINIK DAN APOTEK RISKYTHA
32 0000121081173 6401010103880003 19880804208 RAHIM PESERTA 04/08/1988 BP KLINIK KIMIA FARMA KM. 5
33 0000121091275 6401091912890001 1989121920120 ANGGA STEVALI PESERTA 19/12/1989 BP PANACEA CLINIC
10
34 0001820974138 6471054308910006 1989121920120 EKA INDRA WATI ISTRI 03/08/1991 BP PANACEA CLINIC
10
3/8/17 5:18 PM Page 2 of 58

35 0001820974184 6471064707140001 1989121920120 Kira Aracellia Stevali ANAK 07/07/2014 BP PANACEA CLINIC
10
36 0000121113573 6401066311930001 640106631193000100 RATIH PRATIWI PESERTA 23/11/1993 KLINIK BORNMED
37 0000121114416 6401064801920001 640106480192000111 NURUL HUDA PESERTA 08/01/1992 LONG IKIS
38 0000121171353 6409015301900005 1990113201112 ARFIAH PESERTA 13/01/1990 GN. SAMARINDA
01
39 0000121177451 6409026910910001 1991102920140 RIA HASRIANA PESERTA 29/10/1991 BP PANACEA CLINIC
415
40 0000121354097 6471055907870001 1987071920130 VINIDYA CAHYANI UTAMI PESERTA 19/07/1987 BP KLINIK KORPRI
315
41 0001820292186 6471052112810002 1987071920130 HERI FIRMANSYAH SUAMI 21/12/1981 BP KLINIK KORPRI
315
42 0001820292614 6471051411100001 1987071920130 Athallah Al Ghazir F ANAK 14/11/2011 BP KLINIK KORPRI
315
43 0002195182034 6471057107160002 1987071920130 athaya maritza arsyila firmansyah ANAK 31/07/2016 BP KLINIK KORPRI
315
44 0000121453312 6471051206890001 1206198901062 YUDI HERMAWAN A PESERTA 12/06/1989 BP PANACEA CLINIC
015
45 0000121466169 6471024907920001 1992070920140 SITI MAYSAROH PESERTA 13/07/1992 BARU ILIR
415
46 0000121476442 6471030402910001 1991020420130 SUTRIYANTO PESERTA 04/02/1991 BP PANACEA CLINIC
31
47 0000121508199 6471035601950002 647103560195000211 RIFKA ANISA PESERTA 16/01/1995 KARANG JOANG
48 0000121510866 6471022705930001 2705199301032 ATHMA JUWARDHANA PESERTA 27/05/1993 dr. TIEN FATIMATUZZAHRA
015
49 0000121521273 6471042111860001 1986112120150 TEGUH WAHYUDI PESERTA 21/11/1986 KLINIK BORNMED
8
50 0001820751579 6471044707840005 1986112120150 ENNY YULIYANINGSIH ISTRI 07/07/1984 KLINIK BORNMED
8
51 0001820752132 6471045807040001 1986112120150 KHAILA ANGGITA MAHARANI ANAK 18/07/2004 KLINIK BORNMED
8
3/8/17 5:18 PM Page 3 of 58

52 0001820752637 6471047107070004 1986112120150 CASEY FEYRISHCA ANAK 31/07/2007 KLINIK BORNMED
8
53 0002049764499 6471044304160001 1986112120150 AISYAH SALSABILA ANAK 03/04/2016 KLINIK BORNMED
8
54 0000121564078 6471045108910004 1991081120150 NIDIANANDA AMELINA PUTRI PESERTA 11/08/1991 MEKAR SARI
12
55 0000121575396 6471036807910003 1991072820140 YULITA YESY MULYANTI PESERTA 27/07/1991 BP SUMBER MULIA
4
56 0000121579852 6471056708860006 1986082720121 MARISSA GUSTIN PESERTA 27/08/1986 PRAPATAN
10
57 0000121582348 6471013112900003 3112199001032 SUTAN PARENRENGI PESERTA 31/12/1990 dr. IDA ARYANI
015
58 0000121624211 6471034209890003 1989090220121 DINOK FITRIA TRIWIBOWO PESERTA 02/09/1989 dr. TIEN FATIMATUZZAHRA
101
59 0000121642503 6471042710890005 1989102720130 FENDIKA DWI YUDHA PESERTA 27/10/1989 KLINIK BORNMED
305
60 0001820522441 3517165303900001 1989102720130 Titis Kristianti ISTRI 13/03/1990 KLINIK BORNMED
305
61 0002072647798 6471044110140003 1989102720130 HUSNIYYAH SYAUQI ANAK 01/10/2014 KLINIK BORNMED
305 SYAHIDAH
62 0000121661741 6471034805910001 1991050820121 NENCY RISKI YOLANDA PESERTA 08/05/1991 dr. LIS INDRAYATI
101
63 0001820978987 6471030605880004 1991050820121 RIVQI MUZAKKI SUAMI 06/05/1988 dr. LIS INDRAYATI
101
64 0000121681991 6403095311920002 640309531192000200 NOVIA RIANI PUSPITA PESERTA 24/11/1992 KLINIK BORNMED
65 0000123035152 6472044810930001 0810199301032 KRISNAWATI PESERTA 08/10/1993 dr. MERIAH YACOBI
015
66 0000123110313 6408015706940001 640801570694000133 HESTI MELISAPURNAWIRATI PESERTA 17/06/1994 BP KLINIK DAN APOTEK RISKYTHA
67 0000123236392 6472054203940005 0203199401032 TIARA RAMADHA AZHARI PESERTA 02/03/1994 dr. ARNOLD WAYONG
015
68 0000123271007 6472036208900003 1990082220120 DWI KUSUMA WARDHANI PESERTA 22/08/1990 BP PANACEA CLINIC
10
3/8/17 5:18 PM Page 4 of 58

69 0001820978831 6472052710870007 1990082220120 DWI HENDRO PRASETYO SUAMI 27/10/1987 BP PANACEA CLINIC
10
70 0001851441862 6472030505150002 1990082220120 MUHAMMAD FAIQ PRASETYO ANAK 05/05/2015 BP PANACEA CLINIC
10
71 0000127676349 6471036701920004 1992012720140 JUWITA N.H PURBA PESERTA 27/01/1992 KLINIK BORNMED
51
72 0000163819225 6471044810890001 1989081020151 SANDI UTAMI PESERTA 08/10/1989 BP PANACEA CLINIC
4
73 0002225395089 6471011210160002 1989081020151 DINAR ASHYRAF QEISHAR ANAK 18/12/2012 BP PANACEA CLINIC
4
74 0000164943011 6401064910920002 1992100920141 RINDA WIDYANINGSIH PESERTA 09/10/1992 dr. TIEN FATIMATUZZAHRA
20
75 0000170430838 6471020705930001 1993050720141 RANGGA J PRAKOSO PESERTA 07/05/1993 MARGO MULYO
20
76 0000171041714 6471051301900003 1301199001062 ANTHONY GUNAWAN PESERTA 13/01/1990 KLINIK BORNMED
015
77 0000902497364 6471044612940008 647104461294000800 MARIA KUMALA SARI PESERTA 06/12/1994 MUARA RAPAK
78 0000976169294 6402110301930001 1993011320141 ILHAM ANSHARI PESERTA 13/01/1993 KLINIK BORNMED
00
79 0001078688766 6471056710940004 647105671094000400 DINAR OKTAVRIANA PESERTA 27/10/1994 KLINIK BORNMED
80 0001108075757 6471045004930002 647104500493000200 MARIA MAGDALENA PESERTA 10/04/1993 BP KLINIK KIMIA FARMA 136
HUTABARAT
81 0001124643892 6471021707900003 1707199001062 ANDRI BUDI PRATAMA PESERTA 17/07/1990 DR. MARIA MAGDALENA DANIK
015
82 0001125345791 6471044410880001 6471044410880 647104441088000100 DEA PUSPITA RINI PESERTA 04/10/1988 dr. INDAH PUSPITASARI
001
83 0001133486728 6471024105890002 1989050120140 NENTY SYARIFATURROHMAH PESERTA 01/05/1989 KLINIK FAJAR
615
84 0001885060596 6471050703850008 1989050120140 CHANDRA ADIWENA SUAMI 07/03/1985 KLINIK FAJAR
615
85 0001136806389 6471035302890003 1989021320140 ARIANI PESERTA 13/02/1989 DR. MARIA MAGDALENA DANIK
41
3/8/17 5:18 PM Page 5 of 58

86 0001146251068 6472010804900003 647201080490000300 ISMAIL PRAHENDRA PESERTA 08/04/1990 KLINIK BORNMED
87 0001198352384 6472046512910001 647201080490000300 IRA DESTYANI ISTRI 25/12/1991 SIDOMULYO
88 0001150886463 6471056403890001 1989032420140 PASKABRIANA MULYAPUTRI PESERTA 24/03/1989 dr. BALLERINA
415
89 0001150886485 3505114609890003 1989090620140 DWI RINDA SULISTIOWATI PESERTA 06/09/1989 KLINIK FAJAR
41
90 0001152366118 6473021508880004 1508198801032 BUSTAMIN PESERTA 15/08/1988 dr. KARUNIA RONIE NENTE
015
91 0001826358726 7322045808910002 1508198801032 SARTIKA ISTRI 18/08/1991 dr. KARUNIA RONIE NENTE
015
92 0001971809177 7322040304150001 1508198801032 muh. khaizan al dzakwan ANAK 03/04/2015 dr. KARUNIA RONIE NENTE
015
93 0001155642322 6471035004920002 1004199201032 RATIH BUDI APRIYANTI PESERTA 10/04/1992 BP KLINIK DAN APOTEK RISKYTHA
015
94 0001166000084 6471036103880001 1988032120110 MARDHINA ISNAINI NUR PESERTA 21/03/1988 BP PANACEA CLINIC
60
95 0001820976849 6471032608850004 1988032120110 EDO GUSTINOF SUAMI 26/08/1985 BP PANACEA CLINIC
60
96 0001820976963 6471035901130001 1988032120110 KHALIKA AYSHA DZAKIYAH ANAK 19/01/2013 BP PANACEA CLINIC
60
97 0001902683114 6471032107090040 1988032120110 QONITA AZZAHRA ANAK 10/11/2015 KLINIK BORNMED
60
98 0001166084054 6409042702930004 640904270293000400 MUHAMMAD FEBRIAN PESERTA 27/02/1993 KLINIK BORNMED
99 0001183588299 6402035508920002 640203550892000211 YULYANTI PALIMBUNGA PESERTA 15/08/1992 KLINIK BORNMED
100 0001186235605 6471054107950005 647105410795000500 RESKI MUSTAFA PUTRI PESERTA 01/07/1995 GN BAHAGIA
101 0001190264117 6471035711840003 000114760770611111 RANTI CATRIN PESERTA 17/11/1984 GN. SAMARINDA
WAHYUNINGSIH
102 0001190264128 6471031412830001 6471031412830 647103141283000100 BUDI HIDAYAT PESERTA 14/12/1983 dr. MERIAH YACOBI
001
103 0001195110933 6471035411920007 1411199201032 RICA YUWANDA PUTRI PESERTA 14/11/1992 BP KLINIK DAN APOTEK RISKYTHA
015
3/8/17 5:18 PM Page 6 of 58

104 0001197275466 6471054708820017 0708198201062 ANITA SARDEWI PESERTA 07/08/1982 dr. INDAH PUSPITASARI
015
105 0001149501644 6471052102810012 0708198201062 WANDHI SETIAWAN SUAMI 21/02/1981 dr. INDAH PUSPITASARI
015
106 0001255906989 6471046111870001 1987112120090 INDARI PALUPI PESERTA 21/11/1987 BP PANACEA CLINIC
501
107 0001265485645 6471052107920007 6471052107920 647105210792000700 DEDDY SUNANDAR PESERTA 21/07/1992 KLINIK BORNMED
007
108 0001463394789 6304026402920001 6471052107920 647105210792000700 DEWI PURNAMASARI ISTRI 24/02/1992 KLINIK BORNMED
007
109 0002068832158 6471021507150004 6471052107920 647105210792000700 earlyta arsyfa salsabila ANAK 29/06/2016 Klinik Hesti Wira Sakti
007
110 0001269474581 6471034207910004 1991070220130 GUSTIN AYU DYAH RETNO PESERTA 02/07/1991 BP PANACEA CLINIC
315
111 0001270518366 6471050208870001 400198 AGUS SOEPRYANTO PESERTA 02/08/1987 BP KLINIK KIMIA FARMA KM. 5
112 0001855510413 6471055201920007 400198 dwi suswinarti ISTRI 12/01/1992 BP KLINIK KIMIA FARMA KM. 5
113 0001961381114 6471030612150002 400198 HIRO SYANDANA ANAK 06/12/2015 BP KLINIK KIMIA FARMA KM. 5
114 0001270520774 7309072404900002 413519 YUSRAN PESERTA 24/04/1990 BP PANACEA CLINIC
115 0001885052103 7314075508890001 413519 SURYANTI ISTRI 15/08/1990 BP PANACEA CLINIC
116 0002073715896 6471011604160002 413519 andi muhammad fathir yusran ANAK 16/04/2016 BP PANACEA CLINIC
117 0001273225239 6409016705920003 1992052720140 MELINDA IKA KUMALASARI PESERTA 27/05/1992 BP PANACEA CLINIC
41
118 0001274404004 6471051703930005 1993031720150 WAHYU RACHMADAN PESERTA 17/03/1993 Klinik Hesti Wira Sakti
26 IRMAYADI
119 0001275774063 6471024212910003 774063 REGINA PESERTA 02/12/1991 MARGO MULYO
120 0001294183067 6471045803850001 1985031820070 NITA SARI, A. MD. KEP PESERTA 18/03/1985 BP KLINIK KIMIA FARMA KM. 5
401
121 0001155495677 6471031801770004 1985031820070 EDDY RUSMANTO SUAMI 18/01/1977 BP KLINIK KIMIA FARMA KM. 5
401
122 0001294183675 6471044712090001 1985031820070 SALSABILA SHAFA NUR ELYSA ANAK 07/12/2009 BP KLINIK KIMIA FARMA KM. 5
401
3/8/17 5:18 PM Page 7 of 58

123 0001970430028 6471045401160004 1985031820070 NADINE AISYAH AZAHRA ANAK 14/01/2016 BP KLINIK KIMIA FARMA KM. 5
401
124 0001294540301 7310045807920001 1992071820141 KHUSNUN NADHIFAH PESERTA 18/07/1992 BP KLINIK DAN APOTEK RISKYTHA
20 SYAMSUDDIN
125 0001295263934 6471044109880001 543892 NURUL FAJRI PESERTA 01/09/1988 MEKAR SARI
126 0001308400198 6471042802930002 979529 ACHMAD ROMADHAN PESERTA 28/02/1993 MEKAR SARI
127 0001310835328 6471046208750004 9855162013 SRIRAHAYU PESERTA 22/08/1975 MEKAR SARI
128 0001314472792 6471024311920001 647102431192000100 NOOR BANIYAH PESERTA 03/11/1992 KLINIK BORNMED
129 0001315190373 6471056412920006 6471056412920 647105641292000600 GANIS NASTITI EKAS SALIM PESERTA 24/12/1992 KLINIK BORNMED
006
130 0001319677795 3505182807880002 350518280788000211 JULI TEGAR SUSANTO PESERTA 28/07/1988 dr. INDAH PUSPITASARI
131 0002052735355 3505224310900001 350518280788000211 Chandra Puspitasari ISTRI 03/01/1991 dr. INDAH PUSPITASARI
132 0002225396834 6471030601170006 350518280788000211 IZZATHA SADRA ABDILLAH ANAK 06/01/2017 dr. INDAH PUSPITASARI
133 0001323832836 6471052306830004 1983062320153 GIGIN GINANJAR PESERTA 23/06/1983 dr.Cokorda Ratih
9
134 0001145562254 6471046306830003 1983062320153 DWI ROHMADHANIYATI ISTRI 23/06/1983 dr. INDAH PUSPITASARI
9
135 0001324470475 3315042111950007 1995112120140 ANDIKA NOVIYANTO PESERTA 21/11/1995 MANGGAR BARU
80
136 0001327116576 6471055108880006 188471412605 SITI RUSYDIAH PESERTA 11/08/1988 GN. SAMARINDA
137 0001371544209 6471032910800004 647103291080000411 RONALD MANATHARY PESERTA 29/10/1980 SUMBER REJO
138 0001371544244 6471035507850005 647103291080000411 RIRIS HOTULINA HASIBUAN ISTRI 15/07/1985 SUMBER REJO
139 0001371544277 6471036403120004 647103291080000411 ALICIA GRACE YOURA ANAK 23/03/2012 SUMBER REJO
SIADARY
140 0001371544323 6471032909140001 647103291080000411 HANS NATHANAEL BENAYA ANAK 29/09/2014 SUMBER REJO
SIADARY
141 0001373422667 6471035912890002 1989121920121 DINI RUKMANA PESERTA 19/12/1989 POLIKLINIK IBNU SINA RAPAK
101
142 0001820117305 6471032403140001 1989121920121 Haikal Zikri Ardiwinata ANAK 24/03/2014 POLIKLINIK IBNU SINA RAPAK
101
3/8/17 5:18 PM Page 8 of 58
143 0001373998331 6471024402840003 1984020420050 DESSY PRAMUDIAWATI PESERTA 04/02/1984 BARU ULU
401
144 0001374233995 6409015608890005 1989081620110 MARYATI PESERTA 16/08/1989 KLINIK VENUS HEALTH
101
145 0002071742646 6409015301150002 1989081620110 AZKA HAFIZAH SAFFANAH ANAK 13/01/2015 KLINIK VENUS HEALTH
101
146 0001379604486 6402175711880003 000113556125211110 WIWIN INDAH FITRIANA PESERTA 17/11/1988 BP KLINIK MEDIKA UTAMA
147 0001135561252 6402171107870001 000113556125211110 HAMZAH SUAMI 11/07/1987 BP KLINIK MEDIKA UTAMA
148 0001379604521 6402171909120001 000113556125211110 MUHAMMAD HANIF NUR ANAK 19/09/2012 BP KLINIK MEDIKA UTAMA
KHOLID
149 0001379606793 6471043107870007 6471043107870 647104310787000700 AGRI ICHSANI FAUZAN PESERTA 31/07/1987 GN. SAMARINDA
007
150 0001379606949 3517025504880005 6471043107870 647104310787000700 LILIK TRI SULISTYO PRATIWI ISTRI 15/04/1988 GN. SAMARINDA
007
151 0001475584031 6471045609140002 6471043107870 647104310787000700 nusaibah ichsani tompok ANAK 16/09/2014 GN. SAMARINDA
007
152 0001387570779 6471031101960002 1996011120140 HENDRIANTO PESERTA 11/01/1996 BP PANACEA CLINIC
801
153 0001390530892 6401041803920001 021358 EKO KURNIAWAN PESERTA 18/03/1992 BP KLINIK KIMIA FARMA KM. 5
154 0001425302605 6471044112850003 1985120120111 TIARTA INDAWATY MALAU PESERTA 01/12/1985 dr. ANDI LAWANG
201
155 0001831212718 6471054901140003 1985120120111 Grace Romauli F H ANAK 09/01/2014 dr. ANDI LAWANG
201
156 0001429582318 6471050301890006 647105030189000611 SAPTA ADI WIJAYANTO PESERTA 03/01/1989 BP PANACEA CLINIC
157 0001863206998 6471055905150001 647105030189000611 KHANSA NADA TSURAYYA ANAK 19/05/2015 BP PANACEA CLINIC
158 0001431914141 6401062512920002 1992122520141 HENDRI SUPRAPTO PESERTA 25/12/1992 dr. TIEN FATIMATUZZAHRA
20
159 0001433102679 6471045206900001 732601550188000123 SRI HANDAYANI PESERTA 12/06/1990 BP SUMBER MULIA
160 0001437478143 6471054802910001 6471054802910 647105480291000100 SUSANTI AMELIA PESERTA 08/02/1991 BP KLINIK KIMIA FARMA KM. 5
001
3/8/17 5:18 PM Page 9 of 58

161 0001446029638 6472066710900003 1990102720141 AYU MULYANTI PESERTA 27/10/1990 BP KLINIK KIMIA FARMA KM. 5
001
162 0001448695629 6472056102910002 647205610291000200 IRMA SAVITRI PESERTA 21/02/1991 KLINIK BORNMED
163 0001449591759 7309147011850003 1984113004201 198411300420150036 NOVIANTI TASIK PESERTA 30/11/1985 BP KLINIK KIMIA FARMA KM. 5
500
164 0001449592255 6402141710820002 1984113004201 198411300420150036 SULEMAN RANTE ISTRI 17/10/1982 BP KLINIK KIMIA FARMA KM. 5
500
165 0001449592817 6402142404140001 1984113004201 198411300420150036 JECONIA ANDRIEL FIDEL ANAK 24/04/2014 BP KLINIK KIMIA FARMA KM. 5
500
166 0001453442804 6471045504940002 1994041520141 AYUNINGTYAS PUTRI PESERTA 15/04/1994 dr. INDAH PUSPITASARI
20
167 0001459830971 6471042806920001 647104280692000100 MUCHAMMAD IQBAL PESERTA 28/06/1992 POLIKLINIK IBNU SINA RAPAK
168 0001467088132 6471056312940005 647105631294000500 KARINA PESERTA 23/12/1994 KLINIK KIMIA FARMA KLANDASAN
169 0001475524721 6409034303920004 1992030320121 MIRNA ALFIYATIE PESERTA 03/03/1992 BP PANACEA CLINIC
101
170 0001477325259 6471055005840015 1984051020090 HETY LASMANAH PESERTA 10/05/1984 KLINIK FAJAR
701
171 0001477325158 6471050127900004 1984051020090 DIDI DARMAWAN SUAMI 10/12/1979 KLINIK KIMIA FARMA SEPINGGAN
701
172 0001477325338 6471056609100002 1984051020090 AFIFAH AYUDHIANOCK ANAK 26/09/2010 KLINIK KIMIA FARMA SEPINGGAN
701
173 0001477325373 6471056709110001 1984051020090 DHISSYA AYUDHIARAHMA ANAK 27/09/2011 KLINIK KIMIA FARMA SEPINGGAN
701
174 0001527053602 3374027101930001 337402710193000100 IRMA RIZQIANA PESERTA 31/01/1993 KLINIK DYAH MEDIKA I
175 0001544808126 6409015606840007 1984061620111 ELISMAWATI PESERTA 16/06/1984 dr. LIS INDRAYATI
20
176 0001544821345 6471021902870001 647102190287000100 ARI PRAMONO PESERTA 19/02/1987 BP KLINIK DAN APOTEK RISKYTHA
177 0001544821367 6471045101910002 647102190287000100 SRI BUDY UTAMI ISTRI 11/01/1991 BP KLINIK DAN APOTEK RISKYTHA
178 0001544821378 6471044709140001 647102190287000100 Kirana Adeeva Putri ANAK 07/09/2014 BP KLINIK DAN APOTEK RISKYTHA
179 0001544936635 6471046007790012 1979072021012 CAROLINE F ROMPAS PESERTA 20/07/1979 dr. KARUNIA RONIE NENTE
0
3/8/17 5:18 PM Page 10 of 58

180 0001544937434 6471042109080001 1979072021012 CASEY FRANOV IMMANUEL ANAK 21/09/2008 dr. KARUNIA RONIE NENTE
0
181 0001545049484 6409015002860005 1986021020110 RIA ANGRENY MARCUS PESERTA 10/02/1986 KLINIK DOKTER STEVEN
101 SATTU
182 0001866504093 6471041709140008 1986021020110 shylo odilia pasondong ANAK 23/06/2015 KLINIK DOKTER STEVEN
101
183 0001545093551 6471034412830001 1983120420101 DESI PURWANTI PESERTA 04/12/1983 BP KLINIK KIMIA FARMA KM. 5
201
184 0001545093461 6471041408800004 1983120420101 AGUS MULYOTO SUAMI 14/08/1980 BP KLINIK KIMIA FARMA KM. 5
201
185 0001545093652 6471045105070002 1983120420101 FITRI ANINDIA GUSYANTI ANAK 11/05/2007 BP KLINIK KIMIA FARMA KM. 5
201
186 0001545093663 6471046706110001 1983120420101 ERFIN DARYANTI ANAK 27/06/2011 BP KLINIK KIMIA FARMA KM. 5
201
187 0001827596305 6471041001130003 1983120420101 DEVA HIDAYAH TRYANTO ANAK 10/01/2013 BP KLINIK KIMIA FARMA KM. 5
201
188 0001545139934 6471034310870002 1987100320110 SYAHLIM FATIMATUS ZAHROH PESERTA 03/10/1987 KARANG JOANG
601
189 0001545146019 6471015765880004 1988051720111 NANIK FITRIANINGSIH PESERTA 17/05/1988 BP KLINIK KORPRI
201
190 0001546464249 6472054608860004 0608198601062 AVELINE PESERTA 06/08/1986 KLINIK BORNMED
015
191 0001546465779 6472031406910003 6472031406910 647203140691000300 ARISTU HADI PRANANDA PESERTA 14/06/1991 KLINIK BORNMED
003
192 0001546465915 6409014503930007 640901450393000711 ADRIANY PESERTA 05/03/1993 BP KLINIK KIMIA FARMA 136
193 0001546472441 6471026809850004 2809198501032 EKA SEPRINA RAHAYU PESERTA 28/09/1985 dr. LIS INDRAYATI
015
194 0001546600691 6402056311931003 640205631193100300 NOVITA WAHYUNI PESERTA 23/11/1993 KLINIK BORNMED
195 0001552090037 6401084910930001 640108491093000111 LIZA OKTAVIANA PESERTA 09/10/1993 LONG KALI
196 0001631396834 7309076012920002 2012199201032 ARFIKA PESERTA 20/12/1992 dr. BALLERINA
015
3/8/17 5:18 PM Page 11 of 58

197 0001639798839 6409011208920004 640901120892000400 ARIJAL IRANDA PESERTA 12/08/1992 KLINIK BORNMED
198 0001656107897 6471032007920002 647103200792000200 ANGGI NASUTION PESERTA 20/07/1992 POLIKLINIK IBNU SINA RAPAK
199 0001786103943 6471045308900003 103943 AGUSTINA NURJANAH PESERTA 13/08/1990 GN. SARI ILIR
200 0001786100736 6471021203840001 103943 HARIANTO SUAMI 12/03/1984 GN. SARI ILIR
201 0001819731093 6471042912140001 103943 SAFWAN AL KAAFI ANAK 29/12/2014 GN. SARI ILIR
202 0002198626615 6471040411160003 103943 ZHAFRAN AL KAAFI ANAK 04/11/2016 GN. SARI ILIR
203 0001789652013 6471054411910003 6471054411910 647105441191000300 NOVIA PRISKAWATI PESERTA 04/11/1991 BP KLINIK DAN APOTEK RISKYTHA
003
204 0001797872321 7373036501920001 2501199201032 ASMA SAMAD PESERTA 25/01/1992 dr. ENDANG DWI ESTI
015
205 0001799814903 1708041706870004 1281883241011 YODI HAPRISA PESERTA 17/06/1987 KLINIK KIMIA FARMA SEPINGGAN
1
206 0001281883241 6471055511870008 1281883241011 NURBAITI, S.KOM.I ISTRI 15/11/1987 KLINIK KIMIA FARMA SEPINGGAN
1
207 0001804755521 6471052402840003 1984022420150 FORDHA EXSTRADA PUTRA PESERTA 24/02/1984 BP PANACEA CLINIC
22
208 0001808715328 7371101404890014 737110140489001400 ANDI SUPRIADI PESERTA 14/04/1989 KLINIK BORNMED
209 0001815122529 6471041702810003 1981021720150 JEFRI TANDI PESERTA 17/02/1981 GN. SARI ILIR
11
210 0001816170309 6409015611890002 640901561189000200 PRISCA NOVIANTI,AMD.KEP PESERTA 16/11/1989 KLINIK BORNMED
211 0001544871058 6409011708870003 640901561189000200 AHMAD ERWIN SUAMI 17/08/1987 KLINIK BORNMED
212 0001845406089 6409021004160001 640901561189000200 Almair Ubay Abdillah ANAK 10/04/2015 KLINIK BORNMED
213 0001818997435 6471014403930002 647101440393000211 PIPI ROMAWATIK PESERTA 04/03/1993 dr. IDA ARYANI
214 0002080439076 6471010702900002 647101440393000211 PURWANTO SUAMI 07/02/1990 dr. IDA ARYANI
215 0002201666499 6471011703160009 647101440393000211 azka mauza satria ANAK 12/10/2016 dr. IDA ARYANI
216 0001819905669 6403047112920001 640304711292000100 HERLIN JUPRY PESERTA 31/12/1991 KLINIK BORNMED
217 0001819950028 6471055409830003 1983091420100 DENO MAYASARI PESERTA 14/09/1983 KLINIK KIMIA FARMA SEPINGGAN
120
3/8/17 5:18 PM Page 12 of 58

218 0001819967433 6471050705810009 1983091420100 Gusli SUAMI 07/05/1981 KLINIK KIMIA FARMA SEPINGGAN
120
219 0001827589173 6471051302150001 1983091420100 M DZAKIR KHAFADI PRATAMA ANAK 13/02/2015 KLINIK KIMIA FARMA SEPINGGAN
120
220 0001819964305 6471021811850001 1985111820101 RINTO PESERTA 18/11/1985 BARU ILIR
20
221 0001822281941 6471024109870003 1985111820101 TRI RIA HANDI YANTI ISTRI 01/09/1987 BARU ILIR
20
222 0001819966781 6471021711080003 1985111820101 Rasya Aldira Rahman ANAK 17/11/2008 BARU ILIR
20
223 0001884949626 6471024205150003 1985111820101 LAURA NUR FAIZAH ANAK 02/05/2015 BARU ILIR
20
224 0002205799097 6471022306090018 1985111820101 muhammad khalid arrasyid ANAK 03/12/2016 BARU ILIR
20
225 0001819989505 6471032110880006 1988102120111 Chandra Adhi Irawan PESERTA 31/10/1988 BP KLINIK KIMIA FARMA KM. 5
201
226 0001819998066 6402164811900001 1990110820121 NITA ASTUTI PESERTA 08/11/1990 BP PANACEA CLINIC
101
227 0001820010723 6471036807890006 1989072820121 Luisa Duma Cantika PESERTA 28/07/1989 BP SUMBER MULIA
10
228 0001820029544 7322102706900001 1990062720130 Abdul Wahab PESERTA 27/06/1990 dr. ANDI LAWANG
31
229 0001820034797 3521092310900002 1989052020100 Fatwa Achmad Octoba PESERTA 23/10/1990 BP PANACEA CLINIC
01
230 0001820041301 6472016005890002 1989052020100 Fitriani Herawati PESERTA 20/05/1989 BP PANACEA CLINIC
300
231 0001820050817 6409015906900006 1990061920120 Siti Hardianti PESERTA 19/06/1990 BP PANACEA CLINIC
60
232 0001820055712 6401054512900003 1990120520120 PUPUT ANDAYANI PESERTA 05/12/1990 BP PANACEA CLINIC
60
233 0001820057905 6471032805880003 1990120520120 Chandra Hadi Saputra SUAMI 28/05/1988 BP PANACEA CLINIC
60
3/8/17 5:18 PM Page 13 of 58

234 0001820058614 6471036210130001 1990120520120 Nadia Azzahra Casandra ANAK 22/10/2013 BP PANACEA CLINIC
60
235 0001820064712 6371046607900003 1990072620140 YULIANA PESERTA 26/07/1990 BP KLINIK KIMIA FARMA KM. 5
41
236 0002203228168 6471036904160003 1990072620140 KHALYSA PUTRI AZAHRA ANAK 29/04/2016 BP KLINIK KIMIA FARMA KM. 5
41
237 0001820077874 6402082502930001 1993022520141 Abdul Ghafur PESERTA 25/02/1993 KLINIK BORNMED
00
238 0001820098179 6401050504910004 1991040520121 Fery Apriadi PESERTA 05/04/1991 BP PANACEA CLINIC
101
239 0001820102769 6471037110890003 1989103120140 INDRA WIASTUTI PESERTA 31/10/1989 BP PANACEA CLINIC
415
240 0001820102872 6472026706890003 1989062720110 Erlia Susanti PESERTA 27/06/1989 BP PANACEA CLINIC
21
241 0001820107214 6471041708820009 1982081720100 Alimudin PESERTA 17/08/1982 BP PANACEA CLINIC
415
242 0001820108441 6471041310090035 1982081720100 Rahmatia ISTRI 05/07/1983 BP PANACEA CLINIC
415
243 0001820109082 6471046702070002 1982081720100 Fatimah Zahra ANAK 27/02/2007 BP PANACEA CLINIC
415
244 0001820110048 6471042911100002 1982081720100 Haidar Ali ANAK 29/11/2010 BP PANACEA CLINIC
415
245 0001820107618 6471031409890002 1989091420111 ACHMAD SYAFAR PESERTA 14/09/1989 BP PANACEA CLINIC
20
246 0002072643592 6409034701940002 1989091420111 MELLY HANDAYANI ISTRI 07/01/1994 BP PANACEA CLINIC
20
247 0002204262336 6471032811160002 1989091420111 husein habibie achmad ANAK 28/11/2016 BP PANACEA CLINIC
20
248 0001820149637 6471036111870002 1987112120150 Siti Nursanti PESERTA 21/11/1987 BP PANACEA CLINIC
13
249 0001820150684 6471031703060001 1987112120150 DAMAR JUSAN SAPUTRA ANAK 17/03/2006 BP PANACEA CLINIC
13
3/8/17 5:18 PM Page 14 of 58

250 0001890512223 6471032809150001 1987112120150 aditya naufal dary abbiyu ANAK 28/09/2015 BP KLINIK CAYA HEALTH CARE
13
251 0001820152732 6471045112860003 1986121120150 indah puspita sari PESERTA 11/12/1986 BP PANACEA CLINIC
14
252 0001820164353 6471041707910002 1991071720150 Koes Zailani Aryanto PESERTA 17/07/1991 BP PANACEA CLINIC
17
253 0001820165488 6471056910910007 1991071720150 OKTaVIANA ISTRI 29/10/1991 BP PANACEA CLINIC
17
254 0001821505432 6471041110110001 1991071720150 RUKHY iZZAT ARYANTO ANAK 11/10/2011 BP PANACEA CLINIC
17
255 0001820174027 6471034906910002 1991060920130 Analis Seda PESERTA 09/06/1991 BP PANACEA CLINIC
315
256 0001820180147 6471014906940002 1994060920140 Dini Eka Saputri PESERTA 09/06/1994 KLINIK PERMATA BUNDA
801
257 0001820194841 6471032509850002 1985092520120 dr Nur Robbi Kunsantri PESERTA 25/09/1985 BP KLINIK KIMIA FARMA KM. 5
41
258 0001820195447 3515184108870001 1985092520120 dr Dewi Susanti ISTRI 18/08/1988 BP KLINIK KIMIA FARMA KM. 5
41
259 0001820197629 7316047008880001 1988080320140 Rahmi Razak PESERTA 30/08/1988 BP PANACEA CLINIC
41
260 0001820203119 6471041211920001 1992111220110 Recky Tria Novario PESERTA 12/11/1982 dr. LIS INDRAYATI
501
261 0001820205718 6474025612880003 1988121620110 Merry Natalia Sihombing PESERTA 16/12/1988 BP PANACEA CLINIC
21
262 0001820208734 6402134507890002 1989070520110 DEWI TRIYANI PESERTA 05/07/1989 BP PANACEA CLINIC
21
263 0001820210949 6472044402900002 1984042920070 NURUL AZMI eka RINIE PESERTA 04/02/1990 BP PANACEA CLINIC
80
264 0001820214292 6409012904840008 1984042920070 DAVIT HARI SETIYOKO PESERTA 29/04/1984 BP KLINIK KORPRI
8
265 0001549931837 6401065952890002 1984042920070 ANIS HIDAYATI ISTRI 19/02/1989 BP KLINIK KORPRI
8
3/8/17 5:18 PM Page 15 of 58

266 0002064726718 6401066708150001 1984042920070 SYAKILA HUSNA ANAK 27/08/2015 BP KLINIK KORPRI
8 ALTHAFUNNISA
267 0001820214538 6471044908900001 1989080920150 NUR HASANAH ISNAINI PESERTA 09/08/1990 BP PANACEA CLINIC
2
268 0002075858155 6471040408160001 1989080920150 MUHAMMAD YAZID HARAHAP ANAK 04/08/2016 BP PANACEA CLINIC
2
269 0001820216272 6401080510930000 1993100520130 RUSDY PESERTA 05/10/1993 BP KLINIK KIMIA FARMA KM. 5
801
270 0002072645043 6471031403160012 1993100520130 ratna dewi ISTRI 26/03/1996 BP KLINIK KIMIA FARMA KM. 5
801
271 0002079070975 6471031706160002 1993100520130 AHMAD JIBRIL RAMADHAN ANAK 17/06/2016 BP KLINIK KIMIA FARMA KM. 5
801
272 0001820217003 6471046204810005 1981042220152 nurlingga PESERTA 22/04/1981 BP KLINIK KIMIA FARMA KM. 5
7
273 0001820217789 6471051101810007 1981042220152 Bambang Eko Setiawan SUAMI 11/01/1981 BP KLINIK KIMIA FARMA KM. 5
7
274 0001820218329 6471054810100002 1981042220152 Anindia Almira Setiawan ANAK 08/10/2010 BP KLINIK KIMIA FARMA KM. 5
7
275 0001820218691 6471054708120004 1981042220152 Nadinda Zhafira Setiawan ANAK 07/08/2012 BP KLINIK KIMIA FARMA KM. 5
7
276 0001820223584 6471035610920001 1992101620140 Sri Reni Nurhayani PESERTA 16/10/1992 BP PANACEA CLINIC
615
277 0001820223977 6471051011880001 1992101620140 PANDI SAPUTRA SUAMI 10/11/1988 BP PANACEA CLINIC
615
278 0001820224405 6471034203140004 1992101620140 KHANZA ZAKIYYA SAPUTRI ANAK 02/03/2014 BP PANACEA CLINIC
615
279 0001820225597 6409036005890002 1989052020120 Siti Mei Munah PESERTA 20/05/1989 BATU AMPAR
60
280 0001820227858 6471046808790001 1979082820070 Fitri Irmawati I K PESERTA 28/08/1979 BP KLINIK KIMIA FARMA KM. 5
8
281 0001900614306 6471031808150005 1979082820070 SALMAN AYYUB ANAK 18/08/2015 BP KLINIK KIMIA FARMA KM. 5
8
3/8/17 5:18 PM Page 16 of 58

282 0001820228084 6471036205930003 1993051220140 Devita Indrawati PESERTA 12/05/1993 BP KLINIK KIMIA FARMA KM. 5
615
283 0001820231987 6471020806860002 1986060820140 Helly Anggara Suwignyo PESERTA 08/06/1996 BP PANACEA CLINIC
615
284 0001820244082 6471030703130008 1987111120140 Hersanti Taufiqi PESERTA 11/11/1987 BP KLINIK KIMIA FARMA KM. 5
41
285 0001820244745 3618171904880003 1987111120140 M Shokhib S P d SUAMI 19/04/1988 BP KLINIK KIMIA FARMA KM. 5
41
286 0002072650522 6471030212150003 1987111120140 MUHAMMAD NIZAM ARSSYA ANAK 02/12/2015 BP KLINIK KIMIA FARMA KM. 5
41 SHOSAN
287 0001820248198 6409016004880003 1988042020110 Rahmadani PESERTA 19/08/1987 KLINIK KIMIA FARMA KLANDASAN
1
288 0001820248672 6409011908870004 1988042020110 Heru Prasetyo SUAMI 20/04/1988 KLINIK KIMIA FARMA KLANDASAN
1
289 0001843374227 6409014704160001 1988042020110 ZHAFIRAH KHANzA ANINDYA ANAK 07/04/2015 KLINIK KIMIA FARMA KLANDASAN
1 Prasetyo
290 0002209645833 6409012012160003 1988042020110 fathul tsaqib alfariza prasetyo ANAK 20/12/2016 KLINIK KIMIA FARMA KLANDASAN
1
291 0001820249111 6401046811890004 1989112820120 Layli Rohmah Muji Lismiati PESERTA 28/11/1989 KLINIK BORNMED
601
292 0001820252125 6471016106880002 1988062120130 HASNAH PESERTA 21/06/1988 KLINIK KIMIA FARMA SEPINGGAN
315
293 0001820254961 6472026906890002 1989062920110 IDA SUSANTI PESERTA 29/06/1989 BP PANACEA CLINIC
601
294 0001820257402 6471035904900004 1990041920121 Yuke Priswandika PESERTA 19/04/1990 KLINIK KIMIA FARMA KLANDASAN
10
295 0001820261373 6471036702890001 1989022720121 Irwana Kumalasary PESERTA 27/02/1989 BP KLINIK KIMIA FARMA KM. 5
101
296 0001820264657 6471054305890001 1989050320140 Dr Noor Ramadhaniah PESERTA 03/05/1989 KLINIK KIMIA FARMA SEPINGGAN
40
297 0001820265131 6471010911820001 1982110920110 Heri Susanto PESERTA 09/11/1982 dr.Cokorda Ratih
501
3/8/17 5:18 PM Page 17 of 58

298 0001820265772 6471054612840001 1982110920110 Siti Komariyah ISTRI 06/12/1984 dr.Cokorda Ratih
501
299 0001820266121 6471051204120005 1982110920110 Waldan Raqilla Dzahwan ANAK 12/04/2012 dr.Cokorda Ratih
501
300 0001820267223 6471022602720001 1972022620100 Sudarmujiono PESERTA 26/02/1972 dr. MERIAH YACOBI
10
301 0001820267842 6471026209760001 1972022620100 Hanipah ISTRI 22/09/1976 dr. MERIAH YACOBI
10
302 0001820270766 6471026710010001 1972022620100 Dea Oktavia Ningrum ANAK 27/10/2001 dr. MERIAH YACOBI
10
303 0001820274344 6471020509100004 1972022620100 Diva Aulia Safira ANAK 25/09/2010 dr. MERIAH YACOBI
10
304 0002077225683 6471030908160002 1972022620100 Diaz Rangga Saputra ANAK 09/08/2016 dr. MERIAH YACOBI
10
305 0001820269563 6471055303830003 1983031320153 Mutirah PESERTA 13/03/1983 dr.Cokorda Ratih
7
306 0001820271148 6471050905090006 1983031320153 Andika Akhmad Ghaisan ANAK 09/05/2009 dr.Cokorda Ratih
7
307 0001820271587 6471055101110008 1983031320153 Riska Putri Salsabila ANAK 11/01/2011 dr.Cokorda Ratih
7
308 0001820274041 7602074505870001 1987050520140 NIRMAWATI PESERTA 05/05/1987 dr. LIS INDRAYATI
415
309 0001820277718 6471030711730005 1972022620100 Sugeng Suriyanto PESERTA 07/11/1973 BP KLINIK KIMIA FARMA KM. 5
100
310 0001820278574 6471034602800001 1972022620100 Endang Pertiningsih ISTRI 06/02/1980 BP KLINIK KIMIA FARMA KM. 5
100
311 0001820279125 6471036211990002 1972022620100 Eka Wahyuni ANAK 22/11/1999 BP KLINIK KIMIA FARMA KM. 5
100
312 0001820279597 6471034205050002 1972022620100 Dwi Utami ANAK 02/05/2005 BP KLINIK KIMIA FARMA KM. 5
100
313 0002073710215 6471032203160002 1972022620100 RAYHAN SATYA ANAK 22/03/2016 BP KLINIK KIMIA FARMA KM. 5
100
3/8/17 5:18 PM Page 18 of 58

314 0001820282218 6471052704810005 1975050220100 Sukardi PESERTA 27/04/1981 SEPINGGAN
32
315 0001820285886 6471066705120001 1975050220100 Ghazkiyah Nurul ANAK 27/05/2012 SEPINGGAN
32
316 0001820286281 6471064807130002 1975050220100 Ghizka Ghaffarina ANAK 08/07/2013 SEPINGGAN
32
317 0001820289205 6471050205750010 1975050220100 Mujiono PESERTA 02/05/1975 BP KLINIK KIMIA FARMA KM. 5
30
318 0001820289701 6471054810760003 1975050220100 Sulistiani ISTRI 08/10/1976 BP KLINIK KIMIA FARMA KM. 5
30
319 0001820290241 6471050310040001 1975050220100 Muklis Ramadhani ANAK 03/10/2004 BP KLINIK KIMIA FARMA KM. 5
30
320 0001820290656 6471030401090001 1975050220100 Miranda Dwi Jayanti ANAK 04/01/2009 BP KLINIK KIMIA FARMA KM. 5
30
321 0001820293705 6471050706800001 1975050220100 M Aris PESERTA 07/06/1980 BP PANACEA CLINIC
01
322 0001831213901 7315035612910001 1975050220100 AGUSTINA ISTRI 16/12/1991 BP PANACEA CLINIC
01
323 0001891774427 6471062209150001 1975050220100 muhammad sahlan ANAK 22/09/2015 BP KLINIK CAYA HEALTH CARE
01
324 0001820296214 6471032810760003 1976102820110 Bambang Hihmawan PESERTA 28/10/1976 BP PANACEA CLINIC
50
325 0001820296754 6471046710720001 1976102820110 Liesna Niah ISTRI 27/10/1972 BP PANACEA CLINIC
50
326 0001820297316 6471032510070001 1976102820110 M Ghalib Arsyad ANAK 25/10/2007 BP PANACEA CLINIC
50
327 0001820302266 3519135404900003 1990041420140 Dewi Suryani PESERTA 14/04/1990 BP KLINIK KIMIA FARMA KM. 5
415
328 0001820304314 6471030306780004 1993061920130 Toto Hartoyo PESERTA 03/06/1978 BP PANACEA CLINIC
80
329 0001820304764 6471035508860001 1993061920130 Endang Rinowati ISTRI 15/08/1986 BP PANACEA CLINIC
80
3/8/17 5:18 PM Page 19 of 58

330 0001820307598 6471031906930001 1993061920130 Shaleh PESERTA 19/06/1993 BP PANACEA CLINIC
8
331 0001820310772 6471016401860001 1986012420154 Sulastri PESERTA 24/01/1986 KLINIK PERMATA BUNDA
2
332 0001820313584 6471032008880002 1988082020130 Syahrani PESERTA 20/08/1988 BP PANACEA CLINIC
80
333 0001820315597 6471035010890006 1989101020140 Rina Oktavia Saputri PESERTA 10/10/1989 BP PANACEA CLINIC
615
334 0001820316734 6471045212840007 1984121220101 Triana Susanti PESERTA 12/12/1984 dr. TITANIA LESTARI A
20
335 0001820318624 6471041307090001 1984121220101 M Rossi R ANAK 13/07/2009 dr. TITANIA LESTARI A
20
336 0001820319142 6471045211120002 1984121220101 Syifa Jamilah ANAK 12/11/2012 dr. TITANIA LESTARI A
20
337 0001820320672 6409015310880008 1988101320111 Isnawati PESERTA 13/10/1988 BP PANACEA CLINIC
201
338 0001820321256 6409020701870002 1988101320111 NUR ALIMi SUAMI 07/01/1987 BP PANACEA CLINIC
201
339 0001831213394 6409014608140001 1988101320111 shafiya nur afifa ANAK 06/08/2014 BP PANACEA CLINIC
201
340 0002214119597 6409021711090001 1988101320111 syafik nur Arsyad ANAK 07/01/2017 BP PANACEA CLINIC
201
341 0001820346322 3510191707890002 1989071720121 Yus Imron PESERTA 17/07/1989 dr. MERIAH YACOBI
10
342 0001820348695 6471022408700001 1970082420130 Agus Surianto PESERTA 24/08/1970 BP PANACEA CLINIC
80
343 0001820351226 6471046306880004 1988062320154 LINDA FATIMAH PESERTA 23/06/1988 BP PANACEA CLINIC
7
344 0001820351687 6471052904860000 1988062320154 SUHADA SUAMI 29/04/1986 BP PANACEA CLINIC
7
345 0001820352339 6471046904140001 1988062320154 Nazwa Faiha Zhahira ANAK 29/04/2014 BP PANACEA CLINIC
7
3/8/17 5:18 PM Page 20 of 58

346 0001820355118 6471054304900003 1990040320121 YUNIARTI EKA AMARI PESERTA 03/04/1990 KLINIK KIMIA FARMA SEPINGGAN
101
347 0001820360147 6471056604910003 1991042620140 Yashintya Rhamadani PESERTA 26/04/1991 dr. ENDANG DWI ESTI
70
348 0001820362228 6471026108870001 1987082120155 Widya Wahyu Firmawati PESERTA 21/08/1987 BATU AMPAR
0
349 0001820362871 6471025010090001 1987082120155 Sausan Zakiya Salsabila ANAK 10/10/2009 BATU AMPAR
0
350 0001820363758 6471055702880004 1988021720101 Farida Trisnawati PESERTA 17/02/1988 dr. ENDANG DWI ESTI
20
351 0001820365672 6471013103890003 1989033120130 Asdar Astriadi Amd Kep PESERTA 31/03/1989 KLINIK BORNMED
315
352 0001820368315 6471054609770008 1977090620130 Ani Rahmadani PESERTA 06/09/1977 KLINIK BORNMED
80
353 0001820368653 6471052008820004 1977090620130 Hendri Yusmanto SUAMI 20/08/1982 KLINIK BORNMED
80
354 0001820369068 6471055901040003 1977090620130 Kurnia Indriani ANAK 19/01/2004 KLINIK BORNMED
80
355 0001820369406 6471051709050003 1977090620130 M Raffi Alfatih ANAK 17/09/2005 KLINIK BORNMED
80
356 0001820372455 6402132511910001 1991112520121 Hari Sunandar PESERTA 25/11/1991 BP KLINIK KIMIA FARMA KM. 5
101
357 0001820374571 6471020808790005 1979080820130 Surip Suyadi PESERTA 08/08/1979 BP PANACEA CLINIC
80
358 0001820377776 6471046806840001 1984062820130 RIKA FITRIA MEGASARI PESERTA 28/06/1984 BP PANACEA CLINIC
80
359 0001820379497 6471045212080002 1984062820130 Aura Sasikirana ANAK 12/12/2008 BP PANACEA CLINIC
80
360 0002072648722 6471042912150001 1984062820130 ZHAFIF ATREYA ABIMANTRA ANAK 29/12/2015 BP PANACEA CLINIC
80
361 0001820381376 6471030906830005 1983060920090 Herdian Edi Asrianto PESERTA 09/06/1983 BP PANACEA CLINIC
50
3/8/17 5:18 PM Page 21 of 58

362 0001820381782 6471036203830004 1983060920090 Wiwin Endah S ISTRI 22/03/1983 BP PANACEA CLINIC
50
363 0001820382006 6471031311060001 1983060920090 M Naufal F H ANAK 13/11/2006 BP PANACEA CLINIC
50
364 0001820382467 6471031702120005 1983060920090 M Raafi Dzaki H ANAK 17/02/2012 BP PANACEA CLINIC
50
365 0001839793781 6471032403150002 1983060920090 MUHAMMAD ALFAREZA ANAK 24/03/2015 BP PANACEA CLINIC
50 FATHAN HERWINDO
366 0001820384188 6471042901900005 1990012920120 M Nur Fadli PESERTA 29/01/1990 KLINIK PERMATA BUNDA
60
367 0001820384976 6401086805910001 1991052820110 RIANA SUMAWARDHANI PESERTA 28/05/1991 GN. SAMARINDA
601
368 0001820387834 6401085403140001 1991052820110 NAJWA ABDILLA ZANIDAH ANAK 14/03/2014 GN. SAMARINDA
601
369 0001820386089 6471031808760002 1976081820050 Ari Yusuf PESERTA 18/08/1976 BP PANACEA CLINIC
30
370 0001820386539 6471035911750002 1976081820050 Sujaini ISTRI 19/11/1975 BP PANACEA CLINIC
30
371 0001820386899 6471031709010001 1976081820050 Ilham Yogo W ANAK 17/09/2001 BP PANACEA CLINIC
30
372 0001820387204 6471032701080001 1976081820050 Fadhli Rahman ANAK 27/01/2008 BP PANACEA CLINIC
30
373 0001820388969 6471032709810003 1981092720070 Henri Gunawan PESERTA 27/09/1981 BP PANACEA CLINIC
40
374 0001820389184 6471034110830002 1981092720070 Tira Ustaziyah Yunus ISTRI 01/10/1983 BP PANACEA CLINIC
40
375 0001820389511 6471030402080001 1981092720070 M Zlatan I ANAK 04/02/2008 BP PANACEA CLINIC
40
376 0001820389871 6471031509120001 1981092720070 M Mesut Ozil ANAK 15/09/2012 BP PANACEA CLINIC
40
377 0001861385523 6471030905150004 1981092720070 UWAIS AL-QORNY ANAK 09/05/2015 BP PANACEA CLINIC
40
3/8/17 5:18 PM Page 22 of 58

378 0001820391456 6409014301900006 1990010320110 MARDIANA PESERTA 03/01/1990 BP PANACEA CLINIC
601
379 0001152471069 6471012606890005 1990010320110 SYAMSUL HIDAYAT SUAMI 26/06/1989 BP PANACEA CLINIC
601
380 0002072637178 6409016908150002 1990010320110 KHAIRA NADHIFA SHIDQIA ANAK 29/08/2015 BP PANACEA CLINIC
601
381 0001820392367 6471051605830006 1986021020110 Rosyid Prasetyoadi PESERTA 16/05/1983 BP KLINIK KORPRI
11
382 0001821102028 6471036706830005 1986021020110 sitti nurkhaerani ISTRI 27/06/1983 BP KLINIK KORPRI
11
383 0001821102748 6471052709090002 1986021020110 aditya putra prasetiawan ANAK 27/09/2009 BP KLINIK KORPRI
11
384 0001821103187 6471051201140001 1986021020110 kevin aldan khairon ANAK 12/01/2014 BP KLINIK KORPRI
11
385 0001820395991 6409015202890004 1989021220110 JAYA MANTI PESERTA 12/02/1989 BP PANACEA CLINIC
101
386 0001820396632 6409012111130008 1989021220110 untung waluyo SUAMI 30/12/1988 BP PANACEA CLINIC
101
387 0001820396889 6409014808140001 1989021220110 NAILA ABYAdHI ZAHRA ANAK 08/08/2014 BP PANACEA CLINIC
101
388 0001820397587 3521092208890002 1989082220130 Antoni Ray Vivaldi PESERTA 22/08/1989 BP PANACEA CLINIC
30
389 0001820397835 6401064202910003 1989082220130 Mega Ratna Puspitasari ISTRI 02/02/1991 BP PANACEA CLINIC
30
390 0002052562364 6471032803130012 1989082220130 dirgayara satria vivaldi ANAK 18/04/2016 BP PANACEA CLINIC
30
391 0001820398454 6471045105920003 1992051120140 Siti Hani Amd Kep PESERTA 11/05/1992 BP PANACEA CLINIC
415
392 0001820398994 6471026309780002 1978092320050 Noormila PESERTA 23/09/1978 BP PANACEA CLINIC
50
393 0001820400197 6471022404090001 1978092320050 Rafif Habibie ANAK 24/04/2009 BP PANACEA CLINIC
50
3/8/17 5:18 PM Page 23 of 58

394 0001820400489 6471024110120002 1978092320050 Jihan Afifah ANAK 01/10/2012 BP PANACEA CLINIC
50
395 0001820399826 6471046110920004 1992102120140 Rachmayani Octora Jamal PESERTA 21/10/1992 BP PANACEA CLINIC
415
396 0001820402256 6471043010810004 Hendyansyah PESERTA 30/10/1981 BP PANACEA CLINIC
1981103020100
1
397 0001820402414 6471036205810001 Meilina Novi Anita ISTRI 22/05/1981 BP PANACEA CLINIC
1981103020100
1
398 0001820402583 6471044906090002 Almira Rahayu ANAK 09/06/2009 BP PANACEA CLINIC
1981103020100
1
399 0001820402807 6471032808120005 Aryo Hendy Putra ANAK 25/08/2012 BP PANACEA CLINIC
1981103020100
1
400 0001820403516 6472045504890002 1989041520110 firliani PESERTA 15/04/1989 BP PANACEA CLINIC
214
401 0001820404462 6409014807890002 1989070820110 Indra Yuli Yanti PESERTA 08/07/1989 BP PANACEA CLINIC
101
402 0001820404631 7307032511850001 1989070820110 Rusman SUAMI 25/11/1985 BP PANACEA CLINIC
101
403 0001885050314 6409012206150003 1989070820110 ABID ADYA RAMADHAN ANAK 22/08/2015 BP PANACEA CLINIC
101
404 0001820404754 6471050604850001 1985040620070 Hadiyanto PESERTA 06/04/1985 BP KLINIK KIMIA FARMA KM. 5
40
405 0001820405867 6471035804860001 1986041820090 EKA APRIYANA PESERTA 18/04/1986 BP PANACEA CLINIC
10
406 0001820406251 6471042810870003 1986041820090 Bayu Effendy Putra SUAMI 28/10/1987 BP PANACEA CLINIC
10
407 0001820406418 6471035811110004 1986041820090 Azzahra S E ANAK 18/11/2011 BP PANACEA CLINIC
10
408 0001858628261 6471031707120054 1986041820090 zildjian tama effendy ANAK 28/05/2015 BP PANACEA CLINIC
3/8/17 5:18 PM Page 24 of 58

10
409 0001820407522 6409015004890004 1989041020110 Afsnur Diyanariyah PESERTA 10/04/1989 BP PANACEA CLINIC
10
410 0001820409939 6471022003840003 1984032020140 SAFRI PESERTA 20/03/1984 BP PANACEA CLINIC
415
411 0002073696445 7317144707880006 1984032020140 ST. NURMIATI ISTRI 07/07/1988 BELOPA UTARA
415
412 0002228072409 6471030409140013 1984032020140 bayi ny. st. nurmiati ANAK 25/02/2017 BELOPA UTARA
415
413 0001820410119 6471035905850002 1985051920070 Siti Aswidah Amin PESERTA 19/05/1985 BP KLINIK KORPRI
40
414 0001820410378 6471040408850001 1985051920070 Faldy Widiaputra SUAMI 04/08/1985 BP KLINIK KORPRI
40
415 0001820410571 6471036211120007 1985051920070 Aisyah Malika ANAK 22/11/2012 BP KLINIK KORPRI
40
416 0001820410806 6409015603900007 1990031620156 IFA KRISTINAWATI PESERTA 16/03/1990 BP PANACEA CLINIC
6
417 0002072646584 3510041206880001 1990031620156 ERIK JUNIARDI SUAMI 12/06/1988 BP PANACEA CLINIC
6
418 0001820411493 6471035803870002 1987031820100 Dwi Utami Ningsih PESERTA 18/03/1987 BP PANACEA CLINIC
70
419 0001820411728 6471031012860004 1987031820100 Guntur Tata Laksono SUAMI 10/12/1986 BP PANACEA CLINIC
70
420 0001820411919 6471034605120002 1987031820100 Raihanah Gaitsha K ANAK 06/05/2012 BP PANACEA CLINIC
70
421 0002225392659 6471030307160002 1987031820100 SAFARAZ AKMA SHAHEEN ANAK 03/07/2016 BP PANACEA CLINIC
70
422 0001820411908 6401066310900002 1991092320140 Susilowati PESERTA 23/09/1991 BP PANACEA CLINIC
415
423 0001820412707 7605065111880001 1988111120140 NURDIANA PESERTA 11/11/1988 BP KLINIK KIMIA FARMA KM. 5
415
424 0001820412955 6471056004840012 1984042020090 Nur Fadianita PESERTA 01/10/1979 KLINIK KIMIA FARMA KLANDASAN
70
3/8/17 5:18 PM Page 25 of 58
425 0001820413102 6471050110790010 1984042020090 Kusnanto SUAMI 20/04/1984 KLINIK KIMIA FARMA KLANDASAN
70
426 0001820413236 6471050902080005 1984042020090 Aryo Rizqy K ANAK 09/02/2008 KLINIK KIMIA FARMA KLANDASAN
70
427 0001820413427 6471050902080007 1984042020090 Alfian Rifqy K ANAK 09/02/2008 KLINIK KIMIA FARMA KLANDASAN
70
428 0001820413438 6471046608900001 1990082620121 GUSTIN RAHAYU PESERTA 26/08/1990 dr. LIS INDRAYATI
101
429 0001820414441 6471040911830001 1983110920130 YUDHI HARIADI PESERTA 09/11/1983 BP PANACEA CLINIC
801
430 0001820414665 6471044112910002 1983110920130 NINING WIDYA NINGSIH ISTRI 01/12/1991 BP PANACEA CLINIC
801
431 0001820415036 6471041103110011 1983110920130 ZULFAN ZULTAN ZA'KKY ANAK 11/03/2011 BP PANACEA CLINIC
801
432 0001820415958 6471044503140001 1983110920130 Zaskya Zhafira Zalsabila ANAK 05/04/2014 BP PANACEA CLINIC
801
433 0001820424014 6471042609860003 Ricky Sulistiawan PESERTA 26/09/1986 BP SUMBER MULIA
1986092920080
5
434 0001820424183 6472065605900005 Ayu Widhi Yanti ISTRI 16/05/1990 BP SUMBER MULIA
1986092920080
5
435 0002216276267 6471042506140005 ABIDALLAH PRATAMA ANAK 14/01/2017 BP SUMBER MULIA
1986092920080
5
436 0001820424701 6471044612770002 1977120620110 NOOR LAELA PESERTA 06/12/1977 BP KLINIK KIMIA FARMA KM. 5
40
437 0001820424802 6471040107780008 1977120620110 JULI SUTRISNO SUAMI 01/07/1978 BP KLINIK KIMIA FARMA KM. 5
40
438 0001820424925 6471042911070006 1977120620110 RIDWAN HAKIM ANAK 29/11/2007 BP KLINIK KIMIA FARMA KM. 5
40
439 0001820424982 6471042908090004 1977120620110 RAFLY RAMADHAN ANAK 29/08/2009 BP KLINIK KIMIA FARMA KM. 5
40
3/8/17 5:18 PM Page 26 of 58

440 0001820425048 6471041711100001 1977120620110 MUHAMMAD SAPUTRA ANAK 17/11/2010 BP KLINIK KIMIA FARMA KM. 5
40
441 0001820425724 6471042112870003 1987122120157 WAHYU REZKI PESERTA 21/12/1987 BP PANACEA CLINIC
1
442 0001820425836 6471054610850004 1987122120157 TIA ARYANTI ISTRI 06/10/1985 BP PANACEA CLINIC
1
443 0001820425882 6471056208090002 1987122120157 'AIENA RIZQI RAMADHANI ANAK 22/08/2009 BP PANACEA CLINIC
1
444 0001820426005 6471062301140003 1987122120157 Choirul Azzam Alfarizqi ANAK 23/01/2014 BP PANACEA CLINIC
1
445 0002073698695 6471064807160002 1987122120157 alifah rizqi azzahra ANAK 08/07/2016 BP PANACEA CLINIC
1
446 0001820426501 6471045703860005 1986031720100 NUR ATIKA, S.Far,Apt PESERTA 17/03/1986 BP PANACEA CLINIC
614
447 0001820426578 6471040508850010 1986031720100 MUHAMMAD NASRUDIN, SUAMI 05/08/1985 BP PANACEA CLINIC
614 S.FAR, APT
448 0001820426635 6471045909120004 1986031720100 AILANI NUR TABINA ANAK 19/09/2012 BP PANACEA CLINIC
614
449 0001820426657 6471052911720003 1972112920100 RAHMAT KARIM PESERTA 29/11/1972 BP PANACEA CLINIC
20
450 0001820426815 6471036112880002 1988122120121 DENNIS DWI CAHYA, PESERTA 21/12/1988 BP PANACEA CLINIC
101 A.MD.KEB
451 0001820426872 6471044105120001 1988122120121 RIEVANIYA CHIRCHA ANAK 01/05/2012 BP PANACEA CLINIC
101 ANGGORO
452 0001885053532 6471040104150002 1988122120121 REGIANATAN CHIANO ANAK 01/04/2015 BP PANACEA CLINIC
101 ALFAREZQI A
453 0001820456346 6471032609770002 19770926201 FIRMANSYAH PESERTA 26/09/1977 dr. ARNOLD WAYONG
454 0001820456368 6471036906810002 19770926201 TIARA WULANDARI ISTRI 29/06/1981 dr. ARNOLD WAYONG
455 0001820456425 6471036906000004 19770926201 AFIRRA ZALLSHA MAULIDA ANAK 29/06/2000 dr. ARNOLD WAYONG
456 0001820456458 6471035606020004 19770926201 ADINDA ZAHARA MAHARANI ANAK 16/06/2002 dr. ARNOLD WAYONG
457 0001820458157 6471044810820007 1982100820070 TITIEN OKTARIANY PESERTA 08/10/1982 BP PANACEA CLINIC
101
3/8/17 5:18 PM Page 27 of 58
458 0001820517568 6471031006830009 1983061020130 HERU TRI HARWOKO PESERTA 10/06/1983 BP KLINIK DAN APOTEK RISKYTHA
30
459 0001820518661 6471032712100005 1983061020130 Faiza Muthmainna ANAK 27/12/2010 KLINIK PERTAMINA PANORAMA
30
460 0001820519324 6471032205140005 1983061020130 Muhammmad Hanif Al Muzakky ANAK 22/05/2014 KLINIK PERTAMINA PANORAMA
30
461 0001820521225 6471052008850010 1985082020130 ANANG FITRIONO AMD KEP PESERTA 20/08/1985 BP PANACEA CLINIC
315
462 0001820522597 7371116609880007 1985082020130 Sukma H N ISTRI 26/09/1988 BP PANACEA CLINIC
315
463 0001885054972 6471030505140006 1985082020130 MUHAMMAD ARIFFIN ANAK 05/05/2014 BP PANACEA CLINIC
315 FITRIANO
464 0001820525073 6471040712910004 1991120720140 Mulyono PESERTA 07/12/1991 BP PANACEA CLINIC
515
465 0001820526491 6471041602820003 Nur Ifansyah PESERTA 16/02/1982 dr. TITANIA LESTARI A
1982021620101
466 0001820526952 6471046608820003 Ika Prasetyawati ISTRI 26/08/1982 Klinik GMC Health Center
1982021620101
467 0001820527435 6471042012070005 Vaka Danendra F ANAK 20/12/2007 dr. TITANIA LESTARI A
1982021620101
468 0001820527929 6471042807090002 Vino Alifath Putra ANAK 28/07/2009 dr. TITANIA LESTARI A
1982021620101
469 0001820527356 6407076408880001 1988082420121 Dewi Rosita PESERTA 24/08/1988 KLINIK KIMIA FARMA SEPINGGAN
101
470 0001820533869 6471034109900002 1990090120120 Nur Halimah Tusadiyah PESERTA 01/09/1990 dr. ARNOLD WAYONG
601
471 0001820535579 6471034301830001 1983010320050 Bety Lesmana PESERTA 03/01/1983 BP PANACEA CLINIC
401
472 0001820537201 6471036309120006 1983010320050 Myiesha Nafeeza Ayu ANAK 23/09/2012 BP PANACEA CLINIC
401
473 0001820540529 6471042512920002 Rio Tri sulistiawan PESERTA 25/12/1992 BP PANACEA CLINIC
1992122520101
3/8/17 5:18 PM Page 28 of 58

474 0001820542059 6471056511880005 1988112520111 Nur Fajrin PESERTA 25/11/1988 dr. KARUNIA RONIE NENTE
101
475 0001820542678 6471010502850002 1988112520111 TESAR SUAMI 05/02/1985 dr. KARUNIA RONIE NENTE
101
476 0001820543051 6471013008100002 1988112520111 Saddam Thierry Al Hafidz ANAK 30/08/2010 dr. KARUNIA RONIE NENTE
101
477 0002074350835 6471052907160006 1988112520111 TSAQIF RIZIEQ ABQARY ANAK 29/07/2016 dr. KARUNIA RONIE NENTE
101
478 0001820543286 6471035306860003 1986061320111 Dwi Ernawati PESERTA 13/06/1986 BP PANACEA CLINIC
2
479 0001820546223 6471031610840002 1986061320111 Sugiarto SUAMI 14/10/1984 BP PANACEA CLINIC
2
480 0001831209715 6471031107130002 1986061320111 UWAIS ARFAKHSYAD ANAK 11/07/2013 BP PANACEA CLINIC
2
481 0001820547077 6471046309840003 1984092320158 Rahmayanah PESERTA 23/09/1984 BP SUMBER MULIA
5
482 0001820547483 6471021209810001 1984092320158 Edi Setiawan SUAMI 12/09/1981 BP SUMBER MULIA
5
483 0001820547854 6471042506070002 1984092320158 Muhammad Javier Ibnu Setiawan ANAK 25/06/2007 BP SUMBER MULIA
5
484 0001820548315 6471036007130003 1984092320158 Ersya Adistya Ramadhani ANAK 20/07/2013 BP SUMBER MULIA
5
485 0001820548495 6402072002930001 1993022020140 M Alansyah PESERTA 20/02/1993 BP PANACEA CLINIC
8
486 0001820551779 6471024103850002 1985030120121 WIDIANINGSIH PESERTA 01/03/1985 BP SUMBER MULIA
001
487 0001820552872 6471040207820002 1985030120121 HASAN SUAMI 02/07/1982 BP SUMBER MULIA
001
488 0001820553287 6471022712090001 1985030120121 Candra Alfiano Ananda ANAK 27/12/2009 BP SUMBER MULIA
001
489 0001820554569 6471030209920002 1992090220101 RUDI SEPTIAWAN PESERTA 02/09/1992 BP KLINIK KIMIA FARMA KM. 5
2
3/8/17 5:18 PM Page 29 of 58

490 0002086925591 6471031302160004 1992090220101 ACHMAD AGAM AL MUBARAK ANAK 13/02/2016 BP KLINIK KIMIA FARMA KM. 5
2
491 0001820555919 6471042904860002 1986042920158 Edi Suwito PESERTA 29/04/1986 DR. ESTHER VONNY KRISTIANTY
7
492 0001820556461 6471045402900001 1986042920158 Puspita Sari ISTRI 14/02/1990 DR. ESTHER VONNY KRISTIANTY
7
493 0001820556876 6471042910120001 1986042920158 Muhammad Khairul Azam ANAK 29/10/2012 DR. ESTHER VONNY KRISTIANTY
7
494 0001820556549 7307052711910001 Andi Wira Purnawan PESERTA 27/11/1991 KLINIK BORNMED
1991112720140
495 0001820558709 6471025211720001 1972111220050 Endang Nursita PESERTA 12/11/1972 BP KLINIK KIMIA FARMA KM. 5
6
496 0001820561016 6471041103870008 1987031120110 Toufi Hadi PESERTA 11/03/1987 BP PANACEA CLINIC
6
497 0001820561589 6471036210870002 1987031120110 Sandy Sarah N ISTRI 22/10/1987 BP PANACEA CLINIC
6
498 0001820562074 6471035006120004 1987031120110 Fatawa S Putri ANAK 20/06/2012 BP PANACEA CLINIC
6
499 0001820562682 6408031211010001 1987031120110 Atalarik F ANAK 02/11/2001 BP PANACEA CLINIC
6
500 0002065267473 6471032603120010 1987031120110 faiza kula nazma ANAK 08/10/2015 BP PANACEA CLINIC
6
501 0001820563817 6471050107850004 1986112720130 Samiun Basir PESERTA 27/11/1985 KLINIK KIMIA FARMA SEPINGGAN
801
502 0001820564493 6471057112910018 1986112720130 Wa ampe ISTRI 31/12/1991 KLINIK KIMIA FARMA SEPINGGAN
801
503 0001820565077 6471053010100020 1986112720130 Raziq Khairullah Ainun Basyir ANAK 30/10/2010 KLINIK KIMIA FARMA SEPINGGAN
801
504 0001820565549 6471051110130002 1986112720130 Razaq Khalifah Basir ANAK 11/10/2013 KLINIK KIMIA FARMA SEPINGGAN
801
505 0001820564976 6471041801830002 1983011820100 Rudy Sulistiawan PESERTA 18/01/1983 BP PANACEA CLINIC
10
3/8/17 5:18 PM Page 30 of 58

506 0001820565516 6471045107840002 1983011820100 Ani Handayani ISTRI 11/07/1984 BP PANACEA CLINIC
10
507 0001820566034 6471040409040005 1983011820100 Aditya S P ANAK 04/09/2004 BP PANACEA CLINIC
10
508 0001820566629 6471045010090201 1983011820100 AMANDA ANAK 10/10/2009 BP PANACEA CLINIC
10
509 0002077363855 6471041108160001 1983011820100 rifqi tri setiawan ANAK 11/08/2016 BP PANACEA CLINIC
10
510 0001820574044 6401065411870001 1987111420110 Ummi Uswati Musthofa PESERTA 14/11/1987 BP PANACEA CLINIC
60
511 0001820576305 6409032701910005 Edi Siswanto PESERTA 27/01/1991 BP PANACEA CLINIC
1991012720121
10
512 0001820578476 6402136911860001 1988112720120 Hartiningsih PESERTA 29/11/1986 KLINIK KIMIA FARMA SEPINGGAN
60
513 0001820579174 6471045210890005 1989101220158 LUCY HARIYATI PESERTA 12/10/1989 BP PANACEA CLINIC
9
514 0002079072854 6471041503870001 1989101220158 SUHENDROABI PRASETYO SUAMI 15/03/1987 BP PANACEA CLINIC
9
515 0001820580671 6471056711880005 1988112720120 Sudaryanti PESERTA 27/11/1988 BP KLINIK KORPRI
6
516 0001820581694 6409014401900004 1990010420110 Paridah PESERTA 04/01/1990 dr.Cokorda Ratih
214
517 0001820583145 6471033003870002 1987033020100 Mardi PESERTA 30/03/1987 BP KLINIK KIMIA FARMA KM. 5
1
518 0001820585294 6471055000187000 1987011020090 Isna Dewi Auliya PESERTA 10/01/1987 BP KLINIK KORPRI
7
519 0001820587386 6409024108890007 1989080120140 Anna Rosiana PESERTA 01/08/1989 BP PANACEA CLINIC
4
520 0001820592641 6472035701910003 1991011720140 Antonia Yudistira PESERTA 17/01/1991 KLINIK BORNMED
4
521 0001820595036 6471044311910001 1991110320121 Sulastri PESERTA 03/11/1991 BP PANACEA CLINIC
1
3/8/17 5:18 PM Page 31 of 58

522 0001820598445 6471045310910002 1991101320140 Dini Mustika Anggraini PESERTA 13/10/1991 BP PANACEA CLINIC
4
523 0001820600897 6471020411650001 1965110420090 BASRANSYAH PESERTA 04/11/1965 BP SUMBER MULIA
103
524 0001820603608 6471024103710002 1965110420090 Minarni ISTRI 01/03/1971 BP SUMBER MULIA
103
525 0001820603992 1751014209060001 1965110420090 Cahya Kirana Anugrah ANAK 02/09/2006 BP SUMBER MULIA
103
526 0001820606398 6471052607820004 1982072620159 Rahmat Julianto PESERTA 26/07/1982 dr. MERIAH YACOBI
5
527 0001820607074 6471095611840008 1982072620159 Dwi Astuti Novianti ISTRI 16/11/1984 dr. MERIAH YACOBI
5
528 0002072640431 6471030608120036 1982072620159 afnan yusuf fausto saadan ANAK 06/06/2015 dr. MERIAH YACOBI
5
529 0001820607849 6471055411850001 19901210201 Dwi Setiyani Rahayu PESERTA 14/11/1985 KLINIK KIMIA FARMA KLANDASAN
530 0001820609021 6471064807130001 19901210201 Aulia Putri Ramadhani ANAK 08/07/2013 KLINIK KIMIA FARMA KLANDASAN
531 0001820609212 6471011505890005 1989051520140 Akbar PESERTA 15/05/1989 KLINIK KIMIA FARMA SEPINGGAN
415
532 0001820611719 6472036104910003 1991042120140 Salmiah PESERTA 21/04/1991 dr. MERIAH YACOBI
415
533 0001820613756 6471026312810002 1981122220110 Yusnita PESERTA 22/12/1981 BP PANACEA CLINIC
101
534 0001820614623 6472060304810005 1981122220110 Taufiqurrohman SUAMI 03/04/1981 BP PANACEA CLINIC
101
535 0001820615152 6471026004050004 1981122220110 Khoirunnisa Nur Fadila ANAK 20/04/2005 BP PANACEA CLINIC
101
536 0001832825226 6471021011130001 1981122220110 m moviqo asri fatkhurrahman ANAK 10/11/2013 BP PANACEA CLINIC
101
537 0001820613778 7306070806880004 1988060820130 Asnan Multifikar PESERTA 08/06/1988 KLINIK KIMIA FARMA SEPINGGAN
538 0001820615973 7306011302920004 1992021320130 Nurul Fahmi PESERTA 13/02/1992 KLINIK KIMIA FARMA SEPINGGAN
3
3/8/17 5:18 PM Page 32 of 58

539 0001820619437 6471030907740002 1974070920100 JUNIAR PURWANTO PESERTA 09/07/1974 BP KLINIK KIMIA FARMA KM. 5
104
540 0001820620293 6471034605760006 1974070920100 Wiwik Sulastini ISTRI 06/05/1976 BP KLINIK KIMIA FARMA KM. 5
104
541 0001820620888 6471036706000001 1974070920100 Alifah Rizky Rahayu ANAK 27/06/2000 BP KLINIK KIMIA FARMA KM. 5
104
542 0001820621518 6471036507040001 1974070920100 Aqillah Mumtaazah ANAK 25/07/2004 BP KLINIK KIMIA FARMA KM. 5
104
543 0001820622227 6471036507040002 1974070920100 Athifah Mumtaazah ANAK 25/07/2004 BP KLINIK KIMIA FARMA KM. 5
104
544 0001820622677 6401046210880001 1988102220130 Wina Andriani PESERTA 22/10/1988 BP KLINIK KIMIA FARMA KM. 5
3
545 0001820623342 6473031907880002 1988102220130 Akbar Amiruddin SUAMI 19/07/1988 BP KLINIK KIMIA FARMA KM. 5
3
546 0001872549933 6471036104150004 1988102220130 KAISA SAHIRA AKBAR ANAK 21/04/2015 BP KLINIK KIMIA FARMA KM. 5
3
547 0001820624512 6471030909860011 1986090920110 PUPUT SETIAWAN PESERTA 09/09/1986 BP PANACEA CLINIC
501
548 0001148467408 6471055810870001 1986090920110 INING SUYANTI ISTRI 18/10/1987 dr. ENDANG DWI ESTI
501
549 0002223517364 6471031602150013 1986090920110 naifa nur asifah ANAK 09/02/2017 BP PANACEA CLINIC
501
550 0001820626446 6471052201920001 1992012220130 Arisman Hady PESERTA 22/01/1992 KLINIK KIMIA FARMA SEPINGGAN
801
551 0001820628426 6471032504890002 1989042520100 Sumarman PESERTA 25/04/1989 BP PANACEA CLINIC
104
552 0001820632959 6471053112870049 1987123120130 Muhammad Tahir PESERTA 31/12/1987 KLINIK KIMIA FARMA SEPINGGAN
3
553 0001820634208 6471056701850009 1987123120130 Hasnawati ISTRI 27/01/1985 KLINIK KIMIA FARMA SEPINGGAN
3
554 0001820634592 6471056412090005 1987123120130 Fauzia Muthmainah ANAK 24/12/2009 KLINIK KIMIA FARMA SEPINGGAN
3
3/8/17 5:18 PM Page 33 of 58

555 0002067962657 6471051032001000 1987123120130 muhammad dzakwan padu ANAK 25/06/2016 KLINIK KIMIA FARMA SEPINGGAN
3
556 0001820637382 6471041104910002 1991041120130 CANDRA DWI SAPUTRA PESERTA 11/04/1991 BP PANACEA CLINIC
3
557 0002091074332 6471014408160003 1991041120130 qiana latif qotrunnada ANAK 04/08/2016 BP PANACEA CLINIC
3
558 0001820637584 6471022301890003 1989012320110 Sembodo Enggar Dono PESERTA 23/01/1989 BP PANACEA CLINIC
501
559 0001820642736 6409024911890004 1989110920120 Nurul Jumaidah PESERTA 19/11/1989 BP PANACEA CLINIC
60
560 0001820643311 6401040906850002 1989110920120 Andi Jusman SUAMI 09/06/1985 BP PANACEA CLINIC
60
561 0002091073522 6409020108130001 1989110920120 m yasin ramadhan ANAK 01/08/2013 BP PANACEA CLINIC
60
562 0001820660646 6409015501900006 1990011520111 SHERLI PURWANTI PESERTA 15/01/1990 BP PANACEA CLINIC
20
563 0001900505979 6471030111150005 1990011520111 ARZAKA MULTIFAKAR ANAK 01/11/2015 BP PANACEA CLINIC
20
564 0001900506238 6471030111150004 1990011520111 ARZIKI MULTIFAKAR ANAK 01/11/2015 BP PANACEA CLINIC
20
565 0001820665844 6401036003880001 1988080420110 Sutini PESERTA 20/03/1988 BP KLINIK KIMIA FARMA KM. 5
10
566 0001820668331 6710512018500003 1985011220130 Ajis Mulyono PESERTA 12/01/1985 dr.Cokorda Ratih
80
567 0001820668893 3520044711850003 1985011220130 Nur Hartanti ISTRI 07/11/1985 dr.Cokorda Ratih
80
568 0001820737912 6471040706820006 1982060720090 SYARIFUDIN PESERTA 07/06/1982 BP PANACEA CLINIC
50
569 0001820742401 6471045602840002 1982060720090 HADJIDJAH ISTRI 16/02/1984 BP PANACEA CLINIC
50
570 0001820742917 6471046803100002 1982060720090 KAYLA AZ-ZAHRA SHALIHA ANAK 28/03/2010 BP PANACEA CLINIC
50 PUTRI
3/8/17 5:18 PM Page 34 of 58

571 0002065282536 6471036907150001 1982060720090 khairunisa zainab salsabila ANAK 29/07/2015 BP PANACEA CLINIC
50
572 0001820745314 6471040205880004 1988050220100 RUSLIN HUSEIN PESERTA 02/05/1988 BP KLINIK KIMIA FARMA KM. 5
104
573 0001820746067 6471054710900004 1988050220100 SATRIANI ISTRI 07/10/1990 BP KLINIK KIMIA FARMA KM. 5
104
574 0001820746967 6409046203110003 1988050220100 Nazhifah Inayah Putri ANAK 22/03/2011 BP KLINIK KIMIA FARMA KM. 5
104
575 0001820747283 6471031312120001 1988050220100 Muhammad Zinedin Zidan ANAK 13/12/2012 BP KLINIK KIMIA FARMA KM. 5
104
576 0001820752828 6471045410720004 17892111220 Erlina Indriasari PESERTA 14/10/1972 BP PANACEA CLINIC
577 0001820753561 6471041204070006 17892111220 M SYAFIQ PUTRA ANTOLI N S ANAK 12/04/2007 BP PANACEA CLINIC
578 0001820754483 6471052708860008 1986082720110 HABIEL PRAMUKTI PESERTA 27/08/1986 BP KLINIK KIMIA FARMA KM. 5
501
579 0001820755811 6471016310840002 1992111220140 Rahmatiyah PESERTA 23/10/1984 KLINIK KIMIA FARMA SEPINGGAN
22
580 0001820756035 6471032709860001 1986092720110 SARJU PESERTA 27/09/1986 BP KLINIK KIMIA FARMA KM. 5
501
581 0001820757104 6471010411830002 1983110420100 ADI WIBOWO PESERTA 04/11/1983 BP PANACEA CLINIC
104
582 0001820759229 6471016503110001 1983110420100 Naila Nuramelia Wibowo ANAK 25/03/2011 BP PANACEA CLINIC
104
583 0001856597139 6471010802150002 1983110420100 ZILDAN ALFAHRI WIBOWO ANAK 08/02/2015 BP PANACEA CLINIC
104
584 0001820759106 6471034902820002 1992111220140 Nur Hasanah PESERTA 09/02/1982 BP PANACEA CLINIC
72
585 0001820759488 6471051309840012 1992111220140 Havid Zakaria Iskandarlam SUAMI 13/09/1984 BP PANACEA CLINIC
72
586 0001820759782 6471031807120001 1992111220140 Muhammad Razqa Putra Z ANAK 18/07/2012 BP PANACEA CLINIC
72
587 0001820760197 6471031005140001 1992111220140 Muhammad Yazid Maulana Z ANAK 10/05/2014 BP PANACEA CLINIC
72
3/8/17 5:18 PM Page 35 of 58

588 0001820760761 6471032204780001 1978042220100 MADI PESERTA 22/04/1978 BP PANACEA CLINIC
104
589 0001820762155 6471026001840003 1978042220100 Sripurwanti ISTRI 20/01/1984 BP PANACEA CLINIC
104
590 0001820766554 6471025504090002 1978042220100 Pradita Aprilia ANAK 15/04/2009 BP PANACEA CLINIC
104
591 0001820763292 6471052403730006 1965052819970 Budi Raharjo PESERTA 24/03/1973 BP PANACEA CLINIC
7
592 0001820764168 6471034204740006 1965052819970 Herlina Eka Shanti ISTRI 02/04/1974 BP PANACEA CLINIC
7
593 0001820764642 6471051711090005 1965052819970 Pandu Rafa Abimanyu ANAK 17/11/2009 BP PANACEA CLINIC
7
594 0001820765079 6471063009130002 1965052819970 Bagas Aryo Wibisono ANAK 30/09/2013 BP PANACEA CLINIC
7
595 0001820766936 6471041912920002 1992121920140 Abdul Rauf PESERTA 19/12/1992 BP SUMBER MULIA
51
596 0001820768973 6471044606920006 1992060620121 Yuni Suryanti PESERTA 06/06/1992 BP PANACEA CLINIC
001
597 0001820769074 6471031108920002 1992081120140 Dita Eko Purnawijaya PESERTA 11/08/1992 BP KLINIK KIMIA FARMA KM. 5
51
598 0001820769603 6471026805920004 1992081120140 Tanti Komariyah SUAMI 28/05/1992 BP KLINIK KIMIA FARMA KM. 5
51
599 0001840756994 6471032002150006 1992081120140 nauval tandi wijaya ANAK 20/02/2015 BP KLINIK KIMIA FARMA KM. 5
51
600 0001820772819 6471030910870001 1987100920100 BENI OKTARISA PESERTA 09/10/1987 BP PANACEA CLINIC
80
601 0001820774665 6471043105850004 1991051120122 Hari Wisnu Wijaya PESERTA 31/05/1985 BP KLINIK MEDIKA UTAMA
602 0001820774957 6471044104870003 1991051120122 Elga Astria Wijaya ISTRI 01/04/1987 BP KLINIK MEDIKA UTAMA
603 0001846617917 6471016710140001 1991051120122 kanaya abdithalia devanka ANAK 27/10/2014 BP KLINIK MEDIKA UTAMA
604 0001820776577 6471050201780005 1978010220100 ADI ERAWAN PESERTA 02/01/1978 KLINIK KIMIA FARMA SEPINGGAN
415
3/8/17 5:18 PM Page 36 of 58

605 0001820777793 6472055211820007 1978010220100 Susilowati ISTRI 12/11/1982 KLINIK KIMIA FARMA SEPINGGAN
415
606 0001884946342 6471056210020001 1978010220100 divka andini sabina erawan ANAK 22/10/2002 KLINIK KIMIA FARMA SEPINGGAN
415
607 0001884947264 6471051802070001 1978010220100 andika zera erawan ANAK 18/02/2007 KLINIK KIMIA FARMA SEPINGGAN
415
608 0001884947949 6472051303070003 1978010220100 muhammad ancel prinata ANAK 13/03/2007 KLINIK KIMIA FARMA SEPINGGAN
415
609 0001820776689 6471055105910001 Jihan Amanda Meiretha PESERTA 11/05/1991 KLINIK BORNMED
1991051120130
30
610 0001820780572 6471020512790001 1979120520151 Erpiansyah PESERTA 05/12/1979 BP KLINIK KIMIA FARMA KM. 5
6
611 0001820780908 6471024108820001 1979120520151 Endah Retno ISTRI 01/08/1982 BP KLINIK KIMIA FARMA KM. 5
6
612 0001820781235 6471022212000001 1979120520151 Dicky Putra Pratama ANAK 22/12/2000 BP KLINIK KIMIA FARMA KM. 5
6
613 0001820781606 6471020907060003 1979120520151 Dzaki Sulthan Alwi ANAK 09/07/2006 BP KLINIK KIMIA FARMA KM. 5
6
614 0001820781933 6471025709100013 1979120520151 Halimah Fatmawati ANAK 17/09/2010 BP KLINIK KIMIA FARMA KM. 5
6
615 0001820783755 6471031704800002 1980041720151 IKHWAN PESERTA 17/04/1980 BP PANACEA CLINIC
7
616 0001820784734 6471036037700003 1980041720151 Supiyah ISTRI 25/03/1977 BP PANACEA CLINIC
7
617 0001820785307 6471032903050001 1980041720151 Muhammad Ikhsan Hakim ANAK 29/03/2005 BP PANACEA CLINIC
7
618 0001820785656 6471035207080003 1980041720151 Zakia Sholehatunnisa ANAK 12/07/2008 BP PANACEA CLINIC
7
619 0001820785577 6417034103760001 1976030120070 Dewi Herdinawati Marlina PESERTA 01/03/1976 BP PANACEA CLINIC
10
620 0001820787344 6471012301870001 1987012320080 ARI FEBRIANTO PESERTA 23/01/1987 KLINIK PERMATA BUNDA
514
3/8/17 5:18 PM Page 37 of 58

621 0001820788097 6401047009870002 1987012320080 Rima Milawati ISTRI 30/09/1987 KLINIK PERMATA BUNDA
514
622 0001820788345 6471014811130002 1987012320080 Naura Putri Aqilla ANAK 08/11/2013 KLINIK PERMATA BUNDA
514
623 0001820788042 6471032902800004 1980022920100 Agus Setiyawan PESERTA 29/02/1980 BP KLINIK KIMIA FARMA KM. 5
10
624 0001820788435 6471045804810004 1980022920100 Awiwik Apriani ISTRI 18/04/1981 BP KLINIK KIMIA FARMA KM. 5
10
625 0001820788964 6471042503090004 1980022920100 Althaf Ghani ANAK 25/03/2009 BP KLINIK KIMIA FARMA KM. 5
10
626 0001820789414 6471044401130001 1980022920100 Afiqah Ghaziah ANAK 04/01/2013 BP KLINIK KIMIA FARMA KM. 5
10
627 0001882815208 6471030309150005 1980022920100 AMMAR GHAISAN ANAK 03/09/2015 BP KLINIK KIMIA FARMA KM. 5
10
628 0001820790843 6471056507850001 1985072520120 NOOR ISMI, DR PESERTA 25/07/1985 KLINIK KIMIA FARMA SEPINGGAN
801
629 0001820791517 6471052802820007 1985072520120 Deni Eri Zulfirman SUAMI 28/02/1982 GN BAHAGIA
801
630 0001820791934 6471055811120001 1985072520120 Aneera Denizz Zayani ANAK 18/11/2012 KLINIK KIMIA FARMA SEPINGGAN
801
631 0001820792283 6471050208140001 1985072520120 Muhammad Abidzar Al Ghifary ANAK 02/08/2014 KLINIK KIMIA FARMA SEPINGGAN
801 Zulfirman
632 0001820791574 6471021008740004 1974081020090 Tovik Hendrayana PESERTA 10/08/1974 KLINIK FAJAR
50
633 0001820793971 6471031108740006 1974081120100 Alinur PESERTA 11/08/1974 BP PANACEA CLINIC
301
634 0001820794318 6471034204740005 1974081120100 Bahria ISTRI 02/04/1974 BP PANACEA CLINIC
301
635 0001820794601 6471035907030003 1974081120100 Maghfirah Afifah Putri Noer ANAK 19/07/2003 BP PANACEA CLINIC
301
636 0001820794871 6471032903050004 1974081120100 Muhammad Rozan Rifdah Putri ANAK 29/03/2005 BP PANACEA CLINIC
301 Noer
3/8/17 5:18 PM Page 38 of 58

637 0001820795117 6471033007120003 1974081120100 Muhammad Riziq Raihan Putra ANAK 30/07/2012 BP PANACEA CLINIC
301 Noer
638 0001820796603 6471055411760005 1976111420100 Dwi Wahyuni PESERTA 14/11/1976 BP PANACEA CLINIC
10
639 0001820798144 6471052604020005 1976111420100 Muhamad Ridho ANAK 26/04/2002 BP PANACEA CLINIC
10
640 0001820798561 6471052605080001 1976111420100 Khoirul Ikrom ANAK 26/05/2008 BP PANACEA CLINIC
10
641 0001820797288 6471051208830006 1983081220152 DWI AGUS SATRIO PESERTA 12/08/1983 BP KLINIK DAN APOTEK RISKYTHA
1
642 0001820797852 6471044906840001 1983081220152 Marliana ISTRI 09/06/1984 BP KLINIK DAN APOTEK RISKYTHA
1
643 0001820798133 6471051603070003 1983081220152 Maryo Rakha Satya ANAK 16/03/2007 BP KLINIK DAN APOTEK RISKYTHA
1
644 0001820798458 6471055107100002 1983081220152 Dealova Maura Citra ANAK 11/07/2010 BP KLINIK DAN APOTEK RISKYTHA
1
645 0001965446649 6471033112150003 1983081220152 SYAHZAM ANAK 31/12/2015 BP KLINIK DAN APOTEK RISKYTHA
1
646 0001820801079 6471041210830003 1983110122015 SAMAD PESERTA 12/10/1983 dr. TITANIA LESTARI A
22
647 0001820801845 6471045208850004 1983110122015 Emmy Agustina ISTRI 12/08/1985 dr. TITANIA LESTARI A
22
648 0001820802598 6471040207080002 1983110122015 Shabda Andi Ar Razzan ANAK 02/07/2008 dr. TITANIA LESTARI A
22
649 0001820803151 6471042612100003 1983110122015 Fathir Akram Andi Ar Razzan ANAK 26/12/2010 dr. TITANIA LESTARI A
22
650 0001820801968 6471041805830005 1983051820050 Robiyanto PESERTA 18/05/1983 BP PANACEA CLINIC
30
651 0001820803724 6472027105910004 1991053020121 Maya Andalia PESERTA 31/05/1991 BP PANACEA CLINIC
10
652 0001820805851 6471014711780006 1978110720060 DR TRI WAHYUNI PESERTA 07/11/1978 KLINIK KIMIA FARMA SEPINGGAN
80
3/8/17 5:18 PM Page 39 of 58

653 0001820806492 6471010511060002 1978110720060 Rafi Pratama Risanto ANAK 05/11/2006 KLINIK KIMIA FARMA SEPINGGAN
80
654 0001820809135 6471035407860001 1986071420130 Mardiana Lestari PESERTA 14/07/1986 BP PANACEA CLINIC
80
655 0001820812296 6471057005880004 1988053020130 Titin Dede Safitri PESERTA 30/05/1988 BP KLINIK KIMIA FARMA KM. 5
305
656 0001820813049 6471046305730001 1973052320090 Sumiati PESERTA 23/05/1973 BP PANACEA CLINIC
10
657 0001820813499 6471040909590002 1973052320090 Sutarno SUAMI 09/09/1959 BP PANACEA CLINIC
10
658 0001820813962 6471042004060002 1973052320090 Andhika Vikry Arisandhi ANAK 20/04/2006 BP PANACEA CLINIC
10
659 0001820814311 6471043001080004 1973052320090 Edgar Tryasa Ar Rasyid ANAK 30/01/2008 BP PANACEA CLINIC
10
660 0001820813782 6205020604890001 1989040620130 Decky Nurhadi Sopyan PESERTA 06/04/1989 BP PANACEA CLINIC
315
661 0001820815863 6471051506830012 1983061520120 EKO WAHYONO PESERTA 15/06/1983 dr. syafaah
601
662 0001820816763 6471052305830012 1983061520120 Sri Sugistiyati ISTRI 23/05/1983 dr. syafaah
601
663 0001820817213 6471050810090008 1983061520120 Muhammad Alif Nur Fakhri ANAK 08/10/2009 dr. syafaah
601
664 0001820816313 6471025107890001 1989071120130 Qori Konio PESERTA 11/07/1989 BP PANACEA CLINIC
80
665 0001820816728 6471022812800005 1989071120130 Fadli SUAMI 28/12/1980 BP PANACEA CLINIC
80
666 0001820819722 6471052210840008 1984102220101 MUHAMMAD BAMBANG PESERTA 22/10/1984 BP PANACEA CLINIC
20
667 0001820820161 6471055906830006 1984102220101 Supartiningsih ISTRI 19/06/1983 BP PANACEA CLINIC
20
668 0001820820554 6471054610090004 1984102220101 okta fitriana eka rachelianingsih ANAK 06/10/2009 BP PANACEA CLINIC
20
3/8/17 5:18 PM Page 40 of 58

669 0002073707109 6471011708150001 1984102220101 BAGAS DWI PAMUNGKAS ANAK 17/08/2015 BP PANACEA CLINIC
20
670 0001820820958 6471042907860001 1986072920152 Fajrun Ismail PESERTA 29/07/1986 BP PANACEA CLINIC
7
671 0001820821307 6471056310890002 1986072920152 Asrahmah ISTRI 23/10/1989 BP PANACEA CLINIC
7
672 0001820821702 6471045610100003 1986072920152 NADIRA NUR HAFIDZAH ANAK 16/10/2010 BP PANACEA CLINIC
7
673 0002065264593 6471041507100025 1986072920152 muzdalifah Nur dzakkiyah ANAK 24/09/2015 BP PANACEA CLINIC
7
674 0001820822523 6409040704910003 1991040720140 ANDRIE BUDIYANTO PESERTA 07/04/1991 BP PANACEA CLINIC
515
675 0000170530312 6471046211900002 1991040720140 DEWI CHOIRANI ISTRI 22/11/1990 BP PANACEA CLINIC
515
676 0001831215339 6471041101100004 1991040720140 raditya saputra ANAK 11/01/2010 BP PANACEA CLINIC
515
677 0001820823366 6409040601920005 1992010620121 Bangkit Nugraha PESERTA 06/01/1992 BP KLINIK KIMIA FARMA KM. 5
101
678 0001820825019 6471030409930001 1993090420140 BIMO BAYU KAMAN DHANU PESERTA 04/09/1993 BP KLINIK DAN APOTEK RISKYTHA
51
679 0002073700664 6471035111130004 1993090420140 fairuz ilona blandina azahra ANAK 11/11/2013 BP KLINIK DAN APOTEK RISKYTHA
51
680 0001820826898 6471032309890001 1989092320140 Mochamad Rudy Suzanto PESERTA 23/09/1989 dr. ARNOLD WAYONG
51
681 0001820828463 6471030806850005 1985060820140 Aris Darmawan PESERTA 08/06/1985 BP PANACEA CLINIC
51
682 0001820831826 6471052002930002 1993022020140 Fitriansyah PESERTA 20/02/1993 dr. syafaah
51
683 0001820832298 6409036002930002 1993022020140 Erlian PESERTA 20/02/1993 BP PANACEA CLINIC
41
684 0001820833492 7304094912920001 1992120920140 Rina Alfiana Natsir PESERTA 09/12/1992 BP PANACEA CLINIC
51
3/8/17 5:18 PM Page 41 of 58

685 0001820834559 6471045006880003 1988061020120 RETNO INDAH DUWI UTAMI PESERTA 10/06/1988 KLINIK BORNMED
60
686 0001820835876 6471030312890001 1989120320120 Friza Servile Vianto PESERTA 03/12/1989 BP KLINIK KIMIA FARMA KM. 5
10
687 0001820836269 6471036006890004 1989120320120 Ika Hayun Yuniawati S Pd ISTRI 20/06/1989 BP KLINIK KIMIA FARMA KM. 5
10
688 0001820836708 6471030509130001 1989120320120 Gestalt giga servile ANAK 05/09/2013 BP KLINIK KIMIA FARMA KM. 5
10
689 0002088211162 6471030907120039 1989120320120 dara yotta servile ANAK 25/09/2016 BP KLINIK KIMIA FARMA KM. 5
10
690 0002088211724 6471030907120000 1989120320120 dera tera servile ANAK 25/09/2016 BP KLINIK KIMIA FARMA KM. 5
10
691 0001820836855 6471026102870004 1987022120152 Eka Safitriyani PESERTA 21/02/1987 BP PANACEA CLINIC
7
692 0001820838835 6471040704820040 1982040720130 DWI SUSANTO PESERTA 07/04/1982 BP PANACEA CLINIC
80
693 0000120358877 6472035006920007 1982040720130 DINA JUNITA SARI ISTRI 10/06/1992 BP PANACEA CLINIC
80
694 0001820840951 6471037011880006 1988113020100 NURLINA PESERTA 30/11/1988 BP PANACEA CLINIC
30
695 0002079072213 6471040412870002 1988113020100 EDWIN DESTIYAWARMAN SUAMI 04/12/1987 BP PANACEA CLINIC
30
696 0002225183938 6471040108160014 1988113020100 OZIL MUHAMMAD QOLBY ANAK 12/02/2017 BP PANACEA CLINIC
30
697 0001820841581 6471032202910002 1991022220111 DICKY FIRMANSYAH PESERTA 22/02/1991 BP PANACEA CLINIC
001
698 0000100591705 6471055602920001 1991022220111 LUPITA CHINTYA DEWI ISTRI 16/02/1992 BP PANACEA CLINIC
001
699 0002060082696 6471060306140005 1991022220111 khanza tanzeela syaffira ANAK 13/05/2016 BP PANACEA CLINIC
001
700 0001820842806 6471054511900001 1990110520130 Bitha Dwita Novarena PESERTA 05/11/1990 KLINIK BORNMED
31
3/8/17 5:18 PM Page 42 of 58

701 0001820851874 6471030104740002 1974040120130 Abdul Wahab PESERTA 01/04/1974 dr. MERIAH YACOBI
801
702 0001820853336 6471035304790002 1974040120130 Halimah ISTRI 13/04/1979 dr. MERIAH YACOBI
801
703 0001820853696 6471031110980001 1974040120130 abdul wahid ANAK 11/10/1998 dr. MERIAH YACOBI
801
704 0001820854023 6471035410020001 1974040120130 Sitti Nur Hasanah ANAK 14/10/2002 dr. MERIAH YACOBI
801
705 0001820854495 6471032506040002 1974040120130 MUHAMMAD AKBAR ANAK 04/10/2004 dr. MERIAH YACOBI
801
706 0001820857072 6471042512730009 1973122520061 NARIS PRASMAWAN PESERTA 25/12/1973 BP PANACEA CLINIC
225
707 0001820858692 6471045909850004 1973122520061 Dwi Sucendah ISTRI 19/09/1985 BP PANACEA CLINIC
225
708 0001820859074 6471041712100007 1973122520061 Arya Wijayakusuma ANAK 17/12/2010 BP PANACEA CLINIC
225
709 0001820859399 6471035801130006 1973122520061 Rania Kusumadewi ANAK 18/01/2013 BP PANACEA CLINIC
225
710 0001820869121 6471031907880002 1988071920121 Misbahul Anam Ahmadi PESERTA 19/07/1988 KLINIK AVICENNA
1
711 0001820869367 3322177010910001 1988071920121 Oktaviana Windu ISTRI 30/10/1991 KLINIK AVICENNA
1
712 0001846616319 6471036002150003 1988071920121 talitha maysa aqilla ANAK 20/02/2015 KLINIK AVICENNA
1
713 0001820911419 6401066206890007 1989062220110 MISTUTI PESERTA 22/06/1989 BP PANACEA CLINIC
21
714 0001820913625 6471012205880001 1988052220110 AKHMAD BASIT PESERTA 22/05/1988 BP PANACEA CLINIC
21
715 0001820914108 6471016409890001 1988052220110 HENI WAHYUNI ISTRI 24/09/1989 BP PANACEA CLINIC
21
716 0001820914301 6471016304130002 1988052220110 AILA KALILA RIFDA ANAK 23/04/2013 BP PANACEA CLINIC
21
3/8/17 5:18 PM Page 43 of 58

717 0001820915515 6471037110890002 1989103120100 RAHAYU SRI WULANDARI PESERTA 31/10/1989 BP PANACEA CLINIC
104
718 0001964841838 6471036812150001 1989103120100 SEKAR ARUM WULANDARI ANAK 28/12/2015 dr. TITANIA LESTARI A
104
719 0001820916066 6471031210840005 1984101220110 Arie Kurnianto PESERTA 12/10/1984 BP PANACEA CLINIC
2
720 0001820916314 6409015705900003 1984101220110 Ismiati ISTRI 17/05/1990 BP PANACEA CLINIC
2
721 0002091070732 6409014206160003 1984101220110 RIZKY ZHAFIRA KURNIA ANAK 02/06/2016 BP PANACEA CLINIC
2 NAFIZAH
722 0001820916606 6471030204820001 1982040220050 SUDIRNO PESERTA 02/04/1982 KLINIK PERMATA BUNDA
301
723 0001820916843 6471014412870001 1982040220050 HELMAYANTI ISTRI 04/12/1987 KLINIK PERMATA BUNDA
301
724 0001820917798 6471034801110002 1982040220050 SYARFILAH SADINA FHARIZKY ANAK 08/01/2011 KLINIK PERMATA BUNDA
301
725 0001820917247 3509214707890012 1989070720130 WULAN YULIA KUMALASARI PESERTA 07/07/1989 PRAPATAN
30
726 0001820917618 6471051202850005 1989070720130 Amyah Subekti SUAMI 12/02/1985 PRAPATAN
30
727 0001903547529 6471052101130036 1989070720130 ALARIC XAVIER MUHAMMAD ANAK 14/01/2015 PRAPATAN
30 SUBEKTI
728 0002199146319 3509216901100001 1989070720130 Chesya Salsabillah Putri ANAK 29/01/2010 PRAPATAN
30
729 0001820919352 6471055112860004 1986121120130 Purwandari PESERTA 11/12/1986 dr. KARUNIA RONIE NENTE
30
730 0001820919486 6471050510810018 1986121120130 Dani Handoko SUAMI 05/10/1981 dr. KARUNIA RONIE NENTE
30
731 0001820919666 6471050506120007 1986121120130 Rais Syam Handoko ANAK 05/06/2012 dr. KARUNIA RONIE NENTE
30
732 0001820919565 6472036303900005 1990032320120 MARIATUL KIPTIAH PESERTA 23/03/1990 BP PANACEA CLINIC
601
3/8/17 5:18 PM Page 44 of 58

733 0001820920465 6471040510870003 1987100520090 Budi Kiswanto PESERTA 05/10/1987 BP PANACEA CLINIC
10
734 0001820921837 6471045208890009 1989081220140 MURNI PESERTA 12/08/1989 BP PANACEA CLINIC
415
735 0001820921905 6471046501940001 1993022820121 BONITA SARI PESERTA 25/01/1994 DR. ESTHER VONNY KRISTIANTY
0
736 0002072649745 6471051011840002 1993022820121 HADIANSYAH SUAMI 10/11/1984 DR. ESTHER VONNY KRISTIANTY
0
737 0002208054058 6471051901160031 1993022820121 maulid athailla haufanzza ANAK 14/12/2016 DR. ESTHER VONNY KRISTIANTY
0
738 0001820922546 6408032410920002 1992102420140 FAJAR FAISAL PESERTA 24/10/1992 BP PANACEA CLINIC
415
739 0001820922772 6471034306910002 1991060320100 Yoeni Rahmanita PESERTA 03/06/1991 BP PANACEA CLINIC
1
740 0001820923086 6471056001890002 1989012020140 DEBORA BUAS PESERTA 20/01/1989 BP PANACEA CLINIC
415
741 0001820923468 5206044511940003 1994110520140 NOVIA RAHMAWATI PESERTA 05/11/1994 BP KLINIK KORPRI
5
742 0001124927998 6471033001920003 1994110520140 DWI PRASTYO SUAMI 30/01/1992 BP KLINIK KORPRI
5
743 0001820924649 6471025709900003 1990091720130 EASDHA ERMANDIA PUTRIE PESERTA 17/09/1990 BP PANACEA CLINIC
315
744 0001820925112 6471052411900005 1990112420130 YAHYA CAHYADI PESERTA 24/11/1990 BP PANACEA CLINIC
315
745 0001820926967 6420131908910001 1991081920130 Agus Supandi PESERTA 19/08/1991 BP PANACEA CLINIC
315
746 0001820928622 6471042810870002 1987102820110 ANGGA PRATIKA OKTAFIAN PESERTA 28/10/1987 BP PANACEA CLINIC
601
747 0001820937486 6402135507890001 1989071520110 RATNA YULIANA PESERTA 15/07/1989 BP KLINIK KIMIA FARMA KM. 5
21
748 0001820937532 6402131608860004 1989071520110 AIDIL IDHAM SUAMI 16/08/1986 BP KLINIK KIMIA FARMA KM. 5
21
3/8/17 5:18 PM Page 45 of 58

749 0001820937598 6402135905130004 1989071520110 NADILA AFIFAH IDHAM ANAK 19/05/2013 BP KLINIK KIMIA FARMA KM. 5
21
750 0002203229215 6402133003160004 1989071520110 NADIF ARKHAN AL FATH ANAK 30/03/2016 BP KLINIK KIMIA FARMA KM. 5
21
751 0001820937857 6471035101870001 1987011120080 RINA DEPITA AYU JAYANTI PESERTA 11/01/1987 BP PANACEA CLINIC
514
752 0001820938127 6471051212100001 1987011120080 HILAL ABIYU YASYKUR ANAK 12/12/2010 BP PANACEA CLINIC
514 IRAWAN
753 0001820938173 6471035105130002 1987011120080 MUKHBITA ABIDAH SAKHI ANAK 11/05/2013 BP PANACEA CLINIC
514 IRAWAN
754 0001820938588 6471046709820003 1982092720060 WIDIYASTUTI PESERTA 27/09/1982 BP PANACEA CLINIC
101
755 0001820938915 6471046809070001 1982092720060 HANISSA RAMADHANI ANAK 28/09/2007 BP PANACEA CLINIC
101
756 0001820938972 6471045603130001 1982092720060 ADNI A'ISYAH FADHILLA ANAK 16/03/2013 BP PANACEA CLINIC
101
757 0001820973789 7372026204900003 1990042220130 ASNIATI, AMD.KEB PESERTA 22/04/1990 dr. DR. ISDIAWATI
31
758 0001820973791 6409016202920003 1992022220101 SITI KOMARIAH PESERTA 22/02/1992 BP KLINIK KIMIA FARMA KM. 5
201
759 0001820973892 6471036508940003 1994082520130 YULIANTI AGUSTINAH PESERTA 25/08/1994 BP KLINIK KIMIA FARMA KM. 5
31
760 0001820973903 8204081704900001 1990041720130 ALIF SAPUTRA PESERTA 17/04/1990 KLINIK KIMIA FARMA SEPINGGAN
30
761 0002082447562 6471030109160004 1990041720130 fahreza fatih pratama ANAK 01/09/2016 KLINIK KIMIA FARMA SEPINGGAN
30
762 0001820973969 6471024501940001 SITI AISAH PESERTA 05/01/1994 BP PANACEA CLINIC
1994010520140
51
763 0001820974026 6471020212850002 1985120220070 MUHAMMAD ATHO PESERTA 02/12/1985 BP PANACEA CLINIC
40
764 0001820974048 6471022710920004 1985120220070 Dewi Riana Sari ISTRI 17/01/1992 BP PANACEA CLINIC
40
3/8/17 5:18 PM Page 46 of 58

765 0001820974072 6471022508120001 1985120220070 MUHAMMAD RAFA AIDIL ANAK 25/08/2012 BP PANACEA CLINIC
40 FAQIH
766 0001820974353 6471041007810010 1981071020130 NASIKHUN PESERTA 10/07/1981 BP PANACEA CLINIC
801
767 0001820974566 6409016305900002 1990052320121 SRI LESTARI PESERTA 23/05/1990 BP PANACEA CLINIC
101
768 0001820974871 6471045505880003 1988051520100 ANASTASIA ANITA MANULANG PESERTA 15/05/1988 BP PANACEA CLINIC
301
769 0001887614346 6471042307150103 1988051520100 BRODY ELO BANUNAEK ANAK 18/09/2015 BP KLINIK CAYA HEALTH CARE
301
770 0001820974972 6471046704870003 1987042720110 WURI HANDAYANI PESERTA 27/04/1987 BP PANACEA CLINIC
601
771 0001820975409 6471031609100006 1987042720110 DEANDRA NARYAMA HABIBI ANAK 16/09/2010 BP PANACEA CLINIC
601
772 0001820975556 6471031602130003 1987042720110 SADDAM SAYYID HABIBI ANAK 16/02/2013 BP PANACEA CLINIC
601
773 0001820975084 6409016707890005 1989072720121 NAHRIA PESERTA 27/07/1989 BP PANACEA CLINIC
10
774 0001820975275 6471042711840001 1984112720100 MUHAMAD ADI PUTRA PESERTA 27/11/1984 BP PANACEA CLINIC
80
775 0001552888743 6401086102900001 1984112720100 NOORHAYATI ISTRI 21/02/1990 BP PANACEA CLINIC
80
776 0001820975545 6303142805900003 1990052820140 IMAM TAUFIK PESERTA 28/05/1990 BP KLINIK KORPRI
41
777 0002068906961 6303044107940218 1990052820140 LISNAWATI ISTRI 17/03/1994 BP KLINIK KORPRI
41
778 0002083029254 6471050708140030 1990052820140 septia rahmawati ANAK 05/09/2016 BP KLINIK KORPRI
41
779 0002199148031 6471054509160006 1990052820140 Elvina Adinda Taufik ANAK 05/09/2016 BP KLINIK KORPRI
41
780 0001820975769 6471030501850009 1985010520120 HARTONO PESERTA 05/01/1985 BP PANACEA CLINIC
10
3/8/17 5:18 PM Page 47 of 58

781 0001820975837 6471037108900002 1985010520120 RIMA MARANTIKA ISTRI 31/08/1990 BP PANACEA CLINIC
10
782 0001820975949 6471034403110008 1985010520120 Haiva Zarra Nur Cantika ANAK 04/03/2011 BP PANACEA CLINIC
10
783 0001820976052 6471032105140002 1985010520120 Akmal Zayyan Ar Raksi ANAK 21/05/2014 BP PANACEA CLINIC
10
784 0001820975771 6471046910870002 1987102920090 EMI OKTIYAWATI PESERTA 29/10/1987 KLINIK BORNMED
701
785 0001820975872 6471045106130001 1987102920090 KEYSHA AQILAH PUTRI ANAK 11/06/2013 KLINIK BORNMED
701 FIRDAUS
786 0001820977492 6471054305860002 1986050320100 DIAN PRATIWI PESERTA 03/05/1986 KLINIK KIMIA FARMA SEPINGGAN
61
787 0001820977514 6471032802920002 1992022820130 REDO RUSANDY PESERTA 28/02/1992 BP PANACEA CLINIC
31
788 0001820977986 6471036210070006 1987102220130 Dahlia Wardani PESERTA 22/10/1987 KLINIK BORNMED
31
789 0001820978234 6471025907880003 YULIA ANANDA PUTRI PESERTA 19/07/1988 BP PANACEA CLINIC
1988071920111
00
790 0001820979235 7306024212890002 1989120220140 WARNINDAR PESERTA 02/12/1989 BP PANACEA CLINIC
51
791 0001820979933 6471035110910004 1991101120140 DEVI OKTAVIA PESERTA 11/10/1991 BP PANACEA CLINIC
51
792 0001820980348 6471034101900004 1990010120130 AMELIA PUSPITA PESERTA 01/01/1990 BP PANACEA CLINIC
30
793 0002091072756 6402080505870001 1990010120130 muhammad arifin SUAMI 27/05/1987 BP PANACEA CLINIC
30
794 0001820980888 6471044907840001 1984070920101 YULIA SAPITRI PESERTA 09/07/1984 BP PANACEA CLINIC
20
795 0001820981079 6471042304050001 1984070920101 RIZKY JALU ATHAYA ANAK 23/04/2005 BP PANACEA CLINIC
20
796 0001820981171 6471030505130002 1984070920101 RIZKY AUFA ACHMAD EZAR ANAK 05/05/2013 BP PANACEA CLINIC
20
3/8/17 5:18 PM Page 48 of 58

797 0002225398645 6471036604150002 1984070920101 ALYA NURUL DZIHNI ANAK 26/04/2015 BP PANACEA CLINIC
20
798 0001820981621 6471055807840005 1984071820090 DIANA KUSUMAWARDHANI PESERTA 18/07/1984 BP PANACEA CLINIC
20
799 0001820981777 6409035803910006 1991031820121 FIDIAWATI PESERTA 18/03/1991 BP KLINIK KIMIA FARMA KM. 5
101
800 0001820982227 6471055306830001 1983061320050 VIVI INTA ISNURAHMA PESERTA 13/06/1983 BP PANACEA CLINIC
50
801 0001820982352 6471021104740004 1983061320050 YUSRI. H SUAMI 11/04/1974 BP PANACEA CLINIC
50
802 0001820982464 6471054204100005 1983061320050 ALVINA ABIANE AZZAHRO ANAK 02/04/2010 BP PANACEA CLINIC
50
803 0001820982701 6471061203140002 1983061320050 Jonnav Galaxy Abdillah ANAK 12/03/2014 BP PANACEA CLINIC
50
804 0001820982262 6401064906900003 1990060920121 BAIQ RIZA YURLAILI PESERTA 09/06/1990 BP KLINIK KIMIA FARMA KM. 5
101
805 0001820982666 6471035611910005 1991111620130 DERINA ARMEDITA PESERTA 16/11/1991 BP PANACEA CLINIC
315
806 0001820983149 6471035607840003 1984071620121 YULIANA PESERTA 16/07/1984 BP KLINIK KIMIA FARMA KM. 5
001
807 0001820983443 6471052310810008 1984071620121 LULUK DEWANTORO SUAMI 23/10/1981 BP KLINIK KIMIA FARMA KM. 5
001
808 0001820983882 6471032601120001 1984071620121 ALLEHANDRO ANGLING ANAK 26/01/2012 BP KLINIK KIMIA FARMA KM. 5
001 KUSUMA DEWA
809 0002064721713 6471030906160005 1984071620121 ARKHAN runako arsenio ANAK 09/06/2016 BP KLINIK KIMIA FARMA KM. 5
001
810 0001820983217 6409040412800001 1980120420130 DARMAWAN SUBU PESERTA 04/12/1980 BARU TENGAH
315
811 0001820983342 6409045208820002 1980120420130 AGUSTINA ISTRI 02/08/1982 BARU TENGAH
315
812 0001820983601 6409046306070002 1980120420130 ASTY DAMAYANTI ANAK 23/06/2007 BARU TENGAH
315
3/8/17 5:18 PM Page 49 of 58

813 0001820983667 6409042410120002 1980120420130 ASYRAFUL ANAM DARMAWAN ANAK 24/10/2012 BARU TENGAH
315
814 0002072642534 6471023009140008 1980120420130 asryfa sahara darmawan ANAK 02/12/2015 BARU TENGAH
315
815 0001820984163 6471022208830002 1983082220090 CATUR ADI SANTOSO PESERTA 22/08/1983 BP PANACEA CLINIC
10
816 0001820984308 6471026309860001 1983082220090 RULLY SEPRIYANTI.H ISTRI 23/09/1986 BP PANACEA CLINIC
10
817 0001820984556 6471031902100004 1983082220090 Akhdan Jidan Sabilillah ANAK 19/02/2010 BP PANACEA CLINIC
10
818 0002072635255 6471022051500004 1983082220090 arkan jameel sabian ANAK 22/05/2015 BP PANACEA CLINIC
10
819 0001820984736 6471035106910003 1991061120130 METTY YUNIK SAWITRI PESERTA 11/06/1991 BP KLINIK KIMIA FARMA KM. 5
315
820 0001820985118 6471050104840006 1984040120130 MAMBA'UL HUDA PESERTA 01/04/1984 BP KLINIK KIMIA FARMA KM. 5
30
821 0001820985377 6471044905840003 1984050920090 PUSFITA ANGGRIANY PESERTA 09/05/1984 BP PANACEA CLINIC
103
822 0001820985748 6471042212830001 1984050920090 EDVINO JAYA SUAMI 22/12/1983 BP PANACEA CLINIC
103
823 0001820987651 6471041808090005 1984050920090 Ibrahim Royan Angjaya ANAK 18/08/2009 BP PANACEA CLINIC
103
824 0001837374592 6471042803070005 1984050920090 nadhira thafana angjaya ANAK 19/03/2015 BP PANACEA CLINIC
103
825 0001820987335 6409046002920001 1992022020121 KHUSNUL KHOTIMAH PESERTA 20/02/1992 BP PANACEA CLINIC
10
826 0001845524698 6409042001150003 1992022020121 nadira ANAK 14/04/2015 BP PANACEA CLINIC
10
827 0001820990079 6471042804890003 1989042820110 Nugraha Assay Saputra PESERTA 28/04/1989 KLINIK PERMATA BUNDA
601
828 0001820990902 6471034106890002 1989042820110 FRAGITA AZ ZAHRA ISTRI 01/06/1989 KLINIK PERMATA BUNDA
601 RIYANNURLINA
3/8/17 5:18 PM Page 50 of 58

829 0001820991565 6471044801130001 1989042820110 Queensha Ayra Azzahra ANAK 08/01/2013 KLINIK PERMATA BUNDA
601
830 0001821103288 6471021902840001 1984031220150 FABRIANSYAH PESERTA 19/02/1984 BP SUMBER MULIA
0
831 0001821104087 6471025010800009 1984031220150 rusdiana erviana ISTRI 10/10/1980 BP SUMBER MULIA
0
832 0001821128409 6471026712100002 1984031220150 maharani aulia saron ANAK 27/12/2010 BP SUMBER MULIA
0
833 0001821107261 6471050908800009 1980080920150 eko siswanto PESERTA 09/08/1980 BP SUMBER MULIA
1
834 0001821108036 6471055503850017 1980080920150 ririn triyanawati ISTRI 15/03/1985 BP SUMBER MULIA
1
835 0001821126047 6471066210130002 1980080920150 ratu khanza alana ANAK 22/10/2013 BP SUMBER MULIA
1
836 0001822275393 6471050311100004 1980080920150 SULTAN HAFIZH MAULANA ANAK 03/11/2010 BP SUMBER MULIA
1
837 0001821117699 6409016604860001 25874698574 DIAN FATAYATI PESERTA 26/04/1986 KLINIK OBLIQUE HEALTH
838 0001821119005 6409011003850009 25874698574 eko wahyu aji SUAMI 10/03/1985 KLINIK OBLIQUE HEALTH
839 0001821120164 6409018303120001 25874698574 callysta aqilah ayudya ANAK 23/03/2012 KLINIK OBLIQUE HEALTH
840 0001821120952 6409010111130003 25874698574 elysia safa ayudya ANAK 21/11/2013 KLINIK OBLIQUE HEALTH
841 0001821119793 6471034506890001 1988060520150 YUNITA PESERTA 05/06/1989 BP SUMBER MULIA
2
842 0001821121209 6471032108840003 1988060520150 MUHAMAD ASWAR SUAMI 21/08/1984 BP SUMBER MULIA
2
843 0001831211381 6471030608140008 1988060520150 Rayyan Azwar ANAK 06/08/2014 BP SUMBER MULIA
2
844 0002048554776 6471036903160004 1988060520150 ADEEVA TRIZZLA AZWAR ANAK 29/03/2016 BP SUMBER MULIA
2
845 0001821124337 6471045207680004 1884014067528 sudikasih PESERTA 12/07/1969 KLINIK OBLIQUE HEALTH
7
846 0001821131908 3518070406950001 23587468791 muhammad sulton PESERTA 04/06/1995 BP SUMBER MULIA
3/8/17 5:18 PM Page 51 of 58

847 0001822779911 6471024802830003 Lusiana PESERTA 08/02/1983 KLINIK MITRA SEHAT
1983020820100
30
848 0001822780315 6471030206800003 Lukman Hakim SUAMI 02/06/1980 KLINIK MITRA SEHAT
1983020820100
30
849 0001822780732 6471024510080001 Salwa Salsabila Hakim ANAK 05/10/2008 KLINIK MITRA SEHAT
1983020820100
30
850 0001822781024 6471037004130006 KHANZA ALIFa HAKIM ANAK 30/04/2013 KLINIK MITRA SEHAT
1983020820100
30
851 0001832725642 3521093009920002 1992122420150 TEGUH KURNIANTO PESERTA 30/09/1992 BP KLINIK DAN APOTEK RISKYTHA
10
852 0001833750281 6471054405940002 000183375028111111 MADYA SALIRAN PUTIH PESERTA 04/05/1994 BP KLINIK MEDIKA UTAMA
853 0001841825654 6471034905930001 0504199301042 Feny Mulyawati PESERTA 05/04/1993 BP KLINIK DAN APOTEK RISKYTHA
015
854 0001841827037 6401064606910004 0406199101032 Dina Saliyana PESERTA 04/06/1991 dr. TIEN FATIMATUZZAHRA
015
855 0001841827443 6401084901940001 0901199401032 Hermah PESERTA 09/01/1994 KLINIK BORNMED
015
856 0001841831458 7317207103890001 31031989 Ika Sri Jum'ati PESERTA 31/03/1989 dr. LIS INDRAYATI
857 0001841832077 6472036001940001 2001199401032 Elta Sandria Azida PESERTA 20/01/1994 dr. MERIAH YACOBI
015
858 0001841834362 6409016812910002 2812199101032 Nurul Andriani PESERTA 28/12/1991 KLINIK BORNMED
015
859 0001841835543 6409035009920003 1009199201032 Devi Puspita Sari PESERTA 10/09/1992 KLINIK BORNMED
015
860 0001841837714 6409014807930003 0807199301032 Enik Zubaidah PESERTA 08/07/1993 KLINIK BORNMED
015
861 0001841839233 6402174107910008 0701199101032 Ari Wulandari PESERTA 07/01/1991 KLINIK BORNMED
015
3/8/17 5:18 PM Page 52 of 58

862 0001841846016 6409016112920005 2112199201032 Raudhatun Nisa PESERTA 21/12/1992 dr. MERIAH YACOBI
015
863 0001841847434 6402024404930003 0404199301032 Yanti Agustina PESERTA 04/04/1993 dr. ARNOLD WAYONG
015
864 0001841849741 6472025212920006 1212199201032 Widia Sari Rasyid PESERTA 12/12/1992 dr. ARNOLD WAYONG
015
865 0001841851361 6471052909860002 2909198601032 Alfianus Kongle PESERTA 29/09/1986 BP KLINIK KORPRI
015
866 0001841859628 6401037108930002 3108199301032 Dwi Susanti PESERTA 31/08/1993 dr. TIEN FATIMATUZZAHRA
015
867 0001841861507 6471021711900001 1711199001032 Rusdi PESERTA 17/11/1990 dr. TIEN FATIMATUZZAHRA
015
868 0001841863566 6401094101930002 0101199301032 Yeni Monalisa PESERTA 01/01/1993 dr. TIEN FATIMATUZZAHRA
015
869 0001841865175 6409032708930003 2708199301032 Budi Sartria Rahmatullah PESERTA 27/08/1993 KLINIK BORNMED
015
870 0001841890724 6409010407900003 0407199001032 Rudi Harjanto PESERTA 04/07/1990 dr. TIEN FATIMATUZZAHRA
015
871 0001841892399 6409022501900003 2501199001032 M. Hasbullah PESERTA 25/01/1990 dr. TIEN FATIMATUZZAHRA
015
872 0001841913459 6409042104940002 2104199401032 Helda Devalen Nor Erviansyah PESERTA 21/04/1994 dr. TIEN FATIMATUZZAHRA
015
873 0001841916824 6409021409910002 1409199101032 Robin Hidayat PESERTA 14/09/1991 KLINIK BORNMED
015
874 0001841918354 3518170802960002 0802199601032 Ahmad Rizqi Yaqub PESERTA 08/02/1996 BP KLINIK DAN APOTEK RISKYTHA
015
875 0001841921774 6471014102890009 0102198901032 Ayu Listianie PESERTA 01/02/1989 dr. MERIAH YACOBI
015
876 0001841922898 6471035508130003 0102198901032 Shazia Qaireen Anjea ANAK 15/08/2013 dr. MERIAH YACOBI
015
877 0001841928423 6403052909870001 2909198701032 KAHAR PESERTA 29/09/1987 dr. TIEN FATIMATUZZAHRA
015
3/8/17 5:18 PM Page 53 of 58

878 0001841934609 3304031212920003 1212199001032 Diyan Prasetyo Triwibowo PESERTA 12/12/1992 dr. TIEN FATIMATUZZAHRA
015
879 0001841939177 3320080912900002 0912199001032 Nurwanto PESERTA 09/12/1990 BP KLINIK DAN APOTEK RISKYTHA
015
880 0001841942272 1508075507930001 1506199301032 Ayu Ningtias Munawaroh PESERTA 15/06/1993 KLINIK PERMATA BUNDA
015
881 0001841944814 3309171901930004 1901199301032 Dhonik Sutopo PESERTA 19/01/1993 BP KLINIK DAN APOTEK RISKYTHA
015
882 0001841948627 3372044501930010 0501199301032 Galuh Pitaloka PESERTA 05/01/1993 BP KLINIK KORPRI
015
883 0001841989735 6471030104960003 0104199601032 Fadil Irsyal Hafisni PESERTA 01/04/1996 BP KLINIK DAN APOTEK RISKYTHA
015
884 0001841995978 6471041911910004 1911199101032 Deny Utoyo PESERTA 19/11/1991 SUMBER REJO
015
885 0001841998329 7316105608950001 1608199501032 Selmiati PESERTA 16/08/1995 KLINIK BORNMED
015
886 0001842988959 6471054503880001 6471054503880 647105450388000100 KENZY PAULA MARISKA PESERTA 05/03/1988 KLINIK FAJAR
001 RAWIS
887 0001847224787 7371095512880009 7371095512880 737109551288000900 GLORIANI ARRUAN, S PESERTA 15/12/1988 BP KLINIK DAN APOTEK RISKYTHA
009
888 0001861210451 6471054702840001 0702198401062 NURUL JANNAH PESERTA 07/02/1984 dr. ANDI SRI JULIARTI
015
889 0002225393526 6471064706150004 0702198401062 NAISHA NIFIRA GEETA ANAK 07/06/2015 dr. ANDI SRI JULIARTI
015
890 0001861468165 6471040209830004 0209198301062 AGUS SUTANTO PESERTA 02/09/1983 dr. INDAH PUSPITASARI
015
891 0001861488156 6471045304880002 1304198801062 DINAR PRADIPTA, A.MD.KEP PESERTA 13/04/1988 dr. LIS INDRAYATI
015
892 0001861488707 6471031804850002 1304198801062 MOCHAMAD REDY SAPUTRO SUAMI 18/04/1985 dr. LIS INDRAYATI
015
893 0001861489304 6471031307110001 1304198801062 NARENDRA SATYA SADEWO ANAK 13/07/2011 dr. LIS INDRAYATI
015
3/8/17 5:18 PM Page 54 of 58

894 0002060329746 6471037103150001 1304198801062 SABRINA FAIZA REDITA ANAK 31/03/2015 dr. LIS INDRAYATI
015
895 0001861492555 6471055904860007 1904198601062 MARISSA APRILYA PESERTA 19/04/1986 KLINIK KIMIA FARMA SEPINGGAN
015
896 0001861496212 6471025007800002 1007198001062 SITI NASATUL HOIRIYAH PESERTA 10/07/1980 dr. TIEN FATIMATUZZAHRA
015
897 0001861518914 3524082707850002 1007198001062 NURUDDIN KAFY EL- RIDLO SUAMI 27/07/1985 dr. TIEN FATIMATUZZAHRA
015
898 0002225397407 6471025205150002 1007198001062 ADIVA MAHIRAH KAFIYAH ANAK 12/05/2015 dr. TIEN FATIMATUZZAHRA
015
899 0001861520589 6471035509880003 1509198601062 HENDI GALIH SEFTIKA. AMD PESERTA 15/09/1988 dr. LIS INDRAYATI
015 KEB
900 0001861524999 6471047312870005 3012198701062 IKAWATI CAHYONO PUTRI PESERTA 30/12/1987 dr. TITANIA LESTARI A
015
901 0000120330347 6471040512890003 3012198701062 DEO ANGGA ISTRI 05/12/1989 dr. TITANIA LESTARI A
015 SUKMAWARDANA
902 0001861526812 6471045502120001 3012198701062 Sheirlyza Virly Putri Wardana ANAK 15/02/2012 dr. TITANIA LESTARI A
015
903 0001861530884 6471044206920001 1992060206201 199206020620150001 FEMI DANIYANTI PESERTA 02/06/1992 GN. SARI ILIR
500 SIMANUNGKALIT
904 0001861543067 6471056611880005 2611198801062 NOVA RAGILIA MANDASARI PESERTA 26/11/1988 KLINIK BORNMED
015
905 0001861543833 6401040801930001 0801199301062 RIZAL KURNIAWAN PESERTA 08/01/1993 BP KLINIK DAN APOTEK RISKYTHA
015
906 0001861571215 6471044912940001 1994091206201 199409120620150004 MUHINI PESERTA 09/12/1993 dr. ANDI SRI JULIARTI
500
907 0001861607698 6471040902920004 0902199201062 Randi Ansori PESERTA 09/02/1992 dr. ANDI SRI JULIARTI
015
908 0001871302803 3521126409890012 352112640989000211 NENI SUKARSI PESERTA 24/09/1989 dr. KARUNIA RONIE NENTE
909 0001872440133 3371030911830001 1983091106201 198309110620150003 William Sugandhi PESERTA 09/11/1983 dr.Cokorda Ratih
500
910 0001891601932 1751046412880003 1988241210201 198824121020150001 MICHELIA IUSTIANA DEVI PESERTA 24/12/1988 KLINIK BORNMED
3/8/17 5:18 PM Page 55 of 58

500 PALLUPI
911 0001922975021 6472035805950001 647203580595000100 ANNISA KUMALA SARI PESERTA 18/05/1995 KLINIK BORNMED
912 0002046819723 6409010203950004 6409010203950 FITRIYANTO PESERTA 02/03/1995 KLINIK BORNMED
004
913 0002052074575 7315110104880004 731511010488000411 MUHammad TAHIR PESERTA 01/04/1988 BP KLINIK DAN APOTEK RISKYTHA
914 0002052117775 6403051802900002 640305180290000211 EDY GUNAWAN PESERTA 18/02/1990 BP KLINIK DAN APOTEK RISKYTHA
915 0002052120598 6401045805910001 640104580591000111 Enny Zahratunnisa PESERTA 18/05/1991 BP KLINIK DAN APOTEK RISKYTHA
916 0002052122376 6409012010900001 640901201090000111 Paul Kalva PESERTA 20/10/1990 BP KLINIK DAN APOTEK RISKYTHA
917 0002052660137 6472052103880003 647205210388000311 MARDI HALIM PESERTA 21/03/1988 BP KLINIK DAN APOTEK RISKYTHA
918 0002052662894 6471022706930003 647102270693000311 RISWAN TAKDIR PESERTA 27/06/1993 BP KLINIK DAN APOTEK RISKYTHA
919 0002052665739 6471025811890002 647102581189000211 DIAN CATUR LESTARI PESERTA 18/11/1989 BP KLINIK DAN APOTEK RISKYTHA
920 0002052685451 7311012804880002 731101280488000211 IWAN BIN ARMAN PESERTA 28/04/1988 dr. LIS INDRAYATI
921 0002052693696 7308024404910002 730802440491000233 MARHUMIA, A.Md.Kep PESERTA 04/04/1991 BP KLINIK DAN APOTEK RISKYTHA
922 0002052707139 6402032402910002 640203240291000211 Manikal Febrio Radjid PESERTA 24/02/1991 BP KLINIK DAN APOTEK RISKYTHA
923 0002052732543 7404255911880001 740425591188000111 ERMILA BAA PESERTA 19/01/1988 dr. LIS INDRAYATI
924 0002052737447 6403096507900002 640309650790000211 Inna Amaliatul Solikah PESERTA 25/07/1990 dr. IDA ARYANI
925 0002052737796 6471013003840002 640309650790000211 Wawan Sugianto SUAMI 30/04/1984 dr. IDA ARYANI
926 0002052740564 6401092703910001 640109270391000122 Awal Ramadhan PESERTA 27/03/1991 BP KLINIK DAN APOTEK RISKYTHA
927 0002052740867 6408101503920002 640810150392000211 AHMAD PURWANTO PESERTA 15/03/1992 BP KLINIK DAN APOTEK RISKYTHA
928 0002052771175 7326016004900001 732601600490000122 APRIANY PITHER KARANGAN PESERTA 20/04/1990 BP KLINIK DAN APOTEK RISKYTHA
929 0002052774549 7308075207920001 730807520792000122 Mardiana PESERTA 12/07/1992 BP KLINIK DAN APOTEK RISKYTHA
930 0002052775596 6471045703900001 647104570390000122 LIDIYA MARISA INGAI PESERTA 17/03/1990 BP KLINIK KIMIA FARMA 136
931 0002052776643 3520104306900003 352010430690000322 Ayu Yulaika PESERTA 03/06/1990 BP KLINIK DAN APOTEK RISKYTHA
932 0002052777519 6472015404980001 647201540498000111 Afris Yusmita PESERTA 14/04/1993 BP KLINIK DAN APOTEK RISKYTHA
933 0002052780377 6471045403880001 647104540388000111 Marasi Banurea PESERTA 14/03/1988 BP KLINIK DAN APOTEK RISKYTHA
3/8/17 5:18 PM Page 56 of 58

934 0002052780827 6409011707870003 640901170787000311 Iqbal Goval PESERTA 17/07/1987 BP KLINIK DAN APOTEK RISKYTHA
935 0002052781334 3510086606880004 640901170787000311 Eka Lusiana ISTRI 26/06/1988 BP KLINIK DAN APOTEK RISKYTHA
936 0002052781863 6409014412130004 640901170787000311 Carine Goval ANAK 04/12/2013 BP KLINIK DAN APOTEK RISKYTHA
937 0002052782155 6471051708870010 647105170887001011 NANDA SUSYADI PESERTA 17/08/1987 BP KLINIK DAN APOTEK RISKYTHA
938 0002196280732 6471052708110005 647105170887001011 MUHAMMAD VIERLY NAFISHA ANAK 27/08/2011 BP KLINIK DAN APOTEK RISKYTHA
PRATAMA
939 0002052785439 7326015501880001 732601550188000133 Elim Sirupa PESERTA 15/01/1988 BP KLINIK DAN APOTEK RISKYTHA
940 0002052787465 6472026406920002 647202640692000222 Veny Pironika PESERTA 24/06/1992 BP KLINIK DAN APOTEK RISKYTHA
941 0002052789164 6472056804940002 647205680494000211 Ayu Nur Handayani PESERTA 28/04/1994 BP KLINIK DAN APOTEK RISKYTHA
942 0002052790334 6471056712930001 647105671293000122 DESTIYAN BISMALA DEWI PESERTA 27/12/1993 BP KLINIK DAN APOTEK RISKYTHA
943 0002052977771 6472026109930003 647202610993000311 Anddini Dwy Nurdin PESERTA 21/09/1993 BP KLINIK DAN APOTEK RISKYTHA
944 0002053006727 7302025702930004 730202570293000422 Andi Magfirawanti PESERTA 17/02/1993 BP KLINIK DAN APOTEK RISKYTHA
945 0002053009124 6471042601920006 647104260192000633 Muhammad Yusuf PESERTA 26/01/1992 BP KLINIK DAN APOTEK RISKYTHA
946 0002053013005 6471040507810001 647104050781000111 James Charles Oroh PESERTA 05/07/1981 BP KLINIK DAN APOTEK RISKYTHA
947 0002080433046 5171014707890001 517101470789000111 FLORESTIA SAIULIMA BORU PESERTA 07/07/1989 KLINIK FAJAR
MUNTHE
948 0002080433463 6474031810880002 517101470789000111 ANDRIAN SITOMPUL SUAMI 18/10/1988 KLINIK FAJAR
949 0002080434431 6471052601840008 647105260184000811 ANDITA ROHMAT, DR PESERTA 26/01/1984 KLINIK KIMIA FARMA SEPINGGAN
950 0002083107161 3404065640191000 647105260184000811 onie puspa ISTRI 24/01/1991 KLINIK KIMIA FARMA SEPINGGAN
951 0002083107947 6471054710140003 647105260184000811 KHALISA MECCA ANAK 07/10/2014 KLINIK KIMIA FARMA SEPINGGAN
952 0002091818968 6471051010160003 647105260184000811 MEHDI ARAFAT ANAK 10/10/2016 KLINIK KIMIA FARMA SEPINGGAN
953 0002080438075 1751041704910001 175104170491000111 fitria arestu PESERTA 17/04/1991 KLINIK BORNMED
954 0002080443429 1751050508900005 175105050890000511 LYNDON DARWIN PESERTA 05/08/1990 KLINIK BORNMED
955 0002080444465 6471020510930001 647102051093000111 DONI AJI KURNIAWAN PESERTA 05/10/1993 KLINIK BORNMED
956 0002080446581 6408012307910002 640801230791000211 DODDY JULIAWAN PESERTA 23/07/1991 KLINIK BORNMED
957 0002080448133 6471042311820001 647104231182000111 NOVRIYAN DANA SAPUTRA PESERTA 23/11/1982 KLINIK BORNMED
3/8/17 5:18 PM Page 57 of 58

958 0002080448662 6471044204840003 647104231182000111 EKA PUJIATI ISTRI 02/04/1984 KLINIK BORNMED
959 0002080449246 6471041209010002 647104231182000111 ALIEF RAFI AL FIANSYACH ANAK 12/09/2001 KLINIK BORNMED
960 0002080449573 6471040810100001 647104231182000111 FHATIR REVAN NURSHABITD ANAK 08/10/2010 KLINIK BORNMED
961 0002080483852 3674064612920009 367406461292000911 hanum khalimatus sadiah PESERTA 05/12/1992 KLINIK BORNMED
962 0002080489509 6472042410930002 647204241093000222 MUHAMMAD KAHFI PESERTA 24/10/1993 KLINIK BORNMED
RIZKIANSYAH
963 0002080490589 6471035504950001 647103550495000111 DINA DWI APRIANA PESERTA 15/04/1995 KLINIK BORNMED
964 0002199271037 6471026511880001 6471026511880 647102651188000100 NEVI ASTIKA PESERTA 25/11/1988 BP SUMBER MULIA
001
965 0002209023977 7315055204930001 731505520493000100 YUSRI KASANG PESERTA 12/04/1993 KLINIK BORNMED
966 0002209046613 6401040412910003 640104041291000300 NABAUL MUARIF PESERTA 04/12/1991 KLINIK BORNMED
967 0002209049313 7307050806910001 730705080691000100 MUSDAR PESERTA 08/06/1991 KLINIK BORNMED
968 0002209100117 7302090409920003 730209040992000300 YUSRIZAL SUTONG, A.MD.KEP PESERTA 04/09/1992 KLINIK BORNMED
969 0002209100995 3503061809910002 350306180991000200 BUDI PURWIYANTO PESERTA 18/09/1991 KLINIK BORNMED
970 0002209102929 6472060602900005 647206060290000500 DAFIT HIDAYAT PESERTA 06/02/1990 KLINIK BORNMED
971 0002209122044 6471015606940003 647101560694000300 SUBAIDAH PESERTA 16/06/1994 KLINIK PERMATA BUNDA
972 0002209126015 7308182209910002 730818220991000200 ANDI KURNIAWAN PESERTA 22/09/1991 dr. IDA ARYANI
973 0002209126814 6471034912940001 647103491294000100 KHAIRUNNISA PESERTA 09/12/1994 KLINIK BORNMED
974 0002209442736 7308244205910002 730824420591000200 ROSELLAH PESERTA 02/05/1991 KLINIK BORNMED
3/8/17 5:18 PM Page 58 of 58

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