<table class='tabel' width='90%'>

<tr class="form">
<td align="center" colspan="9">
<big><big><span style="font-weight: bold;">
LAPORAN UNIVERSAL <br>
BULAN 01-03-2018 - 31-03-2018 </span></big></big>
</td>
</tr>
</table>
<table align='center'>
<tr>
<td>Total</td>
<td>:</td>
<td>6</td>
</tr>
</table>
<table align="center" width="98%" border="1">
<tr class="row1">
<td width='3%'>No</td>
<td width='6%'>Tanggal</td>
<td width='6%'>No RM</td>
<td width='10%'>Nama</td>
<td width='6%'>Desa</td>
<td width='5%'>Kecamatan</td>
<td width='5%'>Kabupaten</td>
<td width='6%'>Tgl Lahir</td>
<td width='6%'>Umur<br>Th</td>
<td width='2%'>L/P</td>
<td width='7%'>Pekerjaan</td>
<td width='7%'>Ruangan</td>
<td width='7%'>Petugas</td>
<td width='4%'>Status</td>
<td>Kasus</td>
<td>Cara Bayar</td>
<td>Jenis BPJS</td>
<td>No BPJS</td>
<td>Kode Bridging</td>
<td>Diagnosa</td>
</tr>

<tr align="left" valign="top">

<td>1</td>
<td>01-03-2018</td>
<td>010812</td>
<td>GIJONO</td>
<td>WAYUT</td>
<td>JIWAN</td>
<td>MADIUN</td>
<td>12-08-1955</td>
<td>62</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. THEOFILUS WIRAWAN S</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
 <td>0000739405967</td>
<td>019900020318Y00</td>
<td align='center'>
H25.9 </td>

</tr>

<tr align="left" valign="top">

<td>2</td>
<td>05-03-2018</td>
<td>000035</td>
<td>SUMIRAH</td>
<td>NGETREP</td>
<td>JIWAN</td>
<td>MADIUN</td>
<td>11-11-1957</td>
<td>60</td>
<td>P</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. THEOFILUS WIRAWAN S</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000739292872</td>
<td>019900020318Y00</td>
<td align='center'>
H25.9 </td>

</tr>

<tr align="left" valign="top">

<td>3</td>
<td>08-03-2018</td>
<td>004092</td>
<td>AMAT SETU</td>
<td>GROBOGAN</td>
<td>JIWAN</td>
<td>MADIUN</td>
<td>08-10-1941</td>
<td>76</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. THEOFILUS WIRAWAN S</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000738350864</td>
<td>019900020318Y00</td>
<td align='center'>
H25.9 </td>

</tr>

<tr align="left" valign="top">

<td>4</td>
 <td>13-03-2018</td>
<td>004951</td>
<td>DJAIMUN</td>
<td>KLAGEN SERUT</td>
<td>JIWAN</td>
<td>MADIUN</td>
<td>12-09-1953</td>
<td>64</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. THEOFILUS WIRAWAN S</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>0001456180446</td>
<td>019900020318Y00</td>
<td align='center'>
H25.9 </td>

</tr>

<tr align="left" valign="top">

<td>5</td>
<td>22-03-2018</td>
<td>009376</td>
<td>SUMIATI</td>
<td>WAYUT</td>
<td>JIWAN</td>
<td>MADIUN</td>
<td>16-05-1958</td>
<td>59</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>Dr. THEOFILUS WIRAWAN S</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>0002258174531</td>
<td>019900020318Y00</td>
<td align='center'>
H25.9 </td>

</tr>

<tr align="left" valign="top">

<td>6</td>
<td>28-03-2018</td>
<td>004550</td>
<td>BIBIT SUSANTO</td>
<td>KLAGEN SERUT</td>
<td>JIWAN</td>
<td>MADIUN</td>
<td>15-12-1950</td>
<td>67</td>
<td>L</td>
 <td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. THEOFILUS WIRAWAN S</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000737218012</td>
<td>019900020318Y000991</td>
<td align='center'>
H25.9 </td>

</tr>
</table>