Data Offline Surveilans PTM berbasis FKTP

IDENTITA
S
Tanggal
No No Rekam Jenis
Pemeriksaan * No KTP * Nama Pasien *
Medis Kelamin *

1 18 May 2018 3278014505820021 Rita Sandriant P

2 18 May 2018 3278014202720020 Aan Kurniasih P
3 18 May 2018 3278016504970014 Sinta Apriyani P
4 18 May 2018 3278017003760003 Tika Surtka P
5 19 May 2018 3278015504670010 Ihah Solihah P
6 19 May 2018 3278015209980001 Haryatn P
7 19 May 2018 3278014702890018 Reji L
8 19 May 2018 3278015910930013 Ami Oktaviani P
9 19 May 2018 3210234107450101 Hj. Emah P
10 19 May 2018 3278074602990003 Evi Latfah P
11 19 May 2018 3278016812590005 Karmanah P
12 19 May 2018 3278016303870008 Neni Nuraeni P
13 19 May 2018 3209055706920002 Fitria Purnamasari P
14 19 May 2018 3278015612560006 Neneng Sopiah P
15 19 May 2018 3278015505740008 Hasanah P
16 21 May 2018 3278081470474013 Yuyun Yuningsih P
17 21 May 2018 3278015405870017 Evi Fitriani Dewi P
18 21 May 2018 3278015310750005 Erni Susana P
19 22 May 2018 3278015006460006 Een P
20 22 May 2018 3278015112920006 Ida Yuliani P
21 22 May 2018 3278015310650008 Enok Suarsih P
22 22 May 2018 3278017010850010 Yanah Setanah P
23 22 May 2018 3278015308860008 Sani Sri Rahayu P
24 22 May 2018 3278015208560008 Piah P
25 23 May 2018 3278015906520001 Sumiat P
26 23 May 2018 3278014704820022 Laela Komariah P
27 23 May 2018 3278016605800005 Reni Nuraeni P
28 23 May 2018 3278015802400601 Mamah P
29 23 May 2018 3278014102580007 Ade Halimah P
30 23 May 2018 3278015006780051 Didah Mardiah P
31 04 June 2018 3278015311960010 Fitri Widiastut P
32 30 May 2018 3278015505650009 Uum P
33 16 May 2018 3278016205860001 Mia Sri Nuryat P
34 05 June 2018 3278016812540004 Ani Heryani P
35 05 June 2018 3278016502730012 Ani Sulastni P
36 07 June 2018 3278010600567013 Aep Saepudin L
37 07 June 2018 3278016205860001 Nenden Handayani P
38 09 June 2018 3278012110720003 Yani Lukman P
39 09 June 2018 3278015201700010 Imas Masrikah P
40 09 June 2018 3278011504760006 Undang S L
41 09 June 2018 3278011302510004 Bambang Suwarno L
 42 09 June 2018 3278014811780007 Net Herawat P
43 09 June 2018 3278014912770004 Yayan L
44 09 June 2018 3278015910930012 Ovi Yanda Rohyanita P
45 09 June 2018 3278016310860002 Ita Rosita P
46 09 June 2018 3278016109960011 Sit Sarah P
47
48
49
50
xxx xxx xxx xxx xxx xxx
Tempat Lahir Tanggal Lahir * Alamat Lengkap * No HP

05 May 1982 Argasari 2/1

02 February 1972 Cilembang 3/9
26 April 1997 Cilembang 5/14
30 March 1976 Argasari 7/8
15 April 1967 Argasari 4/1
01 September 1998 Argasari 3/7
07 February 1989 Cilembang 3/14
19 October 1993 Argasari 2/6
01 July 1945 Cilembang 8/15
06 February 1999 Cilembang 1/2
28 December 1959 Cilembang 8/15
23 March 1987 Argasari 4/2
17 June 1992 Argasari 3/8
16 December 1956 Argasari 5/2
11 March 1975 Argasari 2/2
07 April 1974 Argasari 1/2
14 May 1987 Cilembang 1/15
13 October 1975 Cilembang 3/7
10 June 1946 Cilembang 4/4
11 December 1992 Argasari 6/6
13 October 1965 Argasari
30 October 1985 Argasari 5/4
13 August 1986 Argasari 7/2
12 August 1956 Yudanegara 5/4
19 June 1952 Argasari 8/1
07 April 1982 Cilembang 4/13
27 June 1983 Cilembang 3/6
18 February 1940 Clembang 3/5
01 February 1958 Argasari 4/2
10 June 1978 Cilembang 5/15
13 November 1996 Cilembang 5/5
15 May 1966 Argasari 5/5
22 May 1986 Yudanegara 3/2
26 December 1954 Cilembang 5/13
25 February 1973 Argasari 1/3
06 May 1967 Argasari 5/6
22 May 1986 Argasari 1/2
21 October 1972 Cilembang 5/3
12 January 1970 Cilembang 6/9
15 April 1976 Cilembang 2/15
13 February 1951 Cilembang
 08 November 1978 Argasari 4/7
09 December 1977 Argasari 5/4
19 October 1993 Cilembang 3/4
23 October 1986 Argasari 6/6
21 September 1996 Argasari 3/7

xxx xxx xxx xxx

 WAWANC

Golongan
No Telp. Rumah Status Pekerjaan Keterangan Merokok
Darah

Tidak
Tidak
Tidak
Tidak
xxx xxx xxx xxx xxx xxx
 WAWANCARA IMT Tekanan Darah Gula Darah

Kurang Kurang Konsumsi Tinggi Berat Lingkar Gula Darah Gula Darah
Aktivitas Makan Sistol Diastol
Alkohol Badan Badan Perut Sewaktu Puasa
Fisik Sayur

Ya 150 39 90 70
Ya 152 53 110 90
Ya 151 44 110 70
Ya 150 43 120 80
143 55 120 80
158 41 110 80
160 85 120 80
147 52 100 70
150 62 140 90
145 41 110 70
157 75 110 70
154 56 110 80
150 45 110 80
156 59 120 80
157 80 120 80
150 67 120 80
160 64 110 70
150 45 110 70
147 53 120 70
151 39 100 70
156 70 110 70
153 48 90 70
159 51 110 80
160 65 170 110
150 48 120 80
153 48 100 70
148 57 100 80
151 52 140 100
147 49 100 70
156 70 110 80
150 48 90 70
143 42 120 80
153 55 90 70
146 49 150 100 211
150 55 140 80
153 45 130 80 127
153 55 90 70
173 46 100 60
162 64 140 80
172 52 100 60
160 58 140 80
 150 58 120 80
150 62 110 80
157 66 110 80
150 57 90 70
142 41 100 70

xxx xxx xxx xxx xxx xxx xxx xxx xxx xxx
 Kolesterol

Arus Kadar Tes Benjolan

Kolesterol Puncak
Trigliserida LDL HDL Alkohol Amfetamin Abnormal Pap Smear
Total Ekspirasi Pernafasan Urin Payudara
(APE)
xxx xxx xxx xxx xxx xxx xxx xxx xxx
 DIAGNOSA

Hasil
Periksa Krioterapi Diagnosa 1 Diagnosa 2 Diagnosa 3 Diagnosa 4
IVA

Obesitas

Obesitas

Obesitas

Hipertensi

Hipertensi

Hipertensi Diabetes Militus Tipe 2

Diabetes Militus Tipe 2

xxx xxx xxx xxx xxx xxx
 Pemeriksaan Penunjang

Urin Rutin
Darah &
Diagnosa 5 EKG Radiologi Lengkap Mikroskop Dirujuk
ik
xxx xxx xxx xxx xxx xxx
 tgl_periksa rekam_medis nik nama tgl_lahir alamat gender
2018-05-18 3278014505820021 Rita Sandriant 1982-05-05 Argasari 2/1 P
2018-05-18 3278014202720020 Aan Kurniasih 1972-02-02 Cilembang 3/9 P
2018-05-18 3278016504970014 Sinta Apriyani 1997-04-26 Cilembang 5/14 P
2018-05-18 3278017003760003 Tika Surtka 1976-03-30 Argasari 7/8 P
2018-05-19 3278015504670010 Ihah Solihah 1967-04-15 Argasari 4/1 P
2018-05-19 3278015209980001 Haryatn 1998-09-01 Argasari 3/7 P
2018-05-19 3278014702890018 Reji 1989-02-07 Cilembang 3/14 L
2018-05-19 3278015910930013 Ami Oktaviani 1993-10-19 Argasari 2/6 P
2018-05-19 3210234107450101 Hj. Emah 1945-07-01 Cilembang 8/15 P
2018-05-19 3278074602990003 Evi Latfah 1999-02-06 Cilembang 1/2 P
2018-05-19 3278016812590005 Karmanah 1959-12-28 Cilembang 8/15 P
2018-05-19 3278016303870008 Neni Nuraeni 1987-03-23 Argasari 4/2 P
2018-05-19 3209055706920002 Fitria Purnamasari 1992-06-17 Argasari 3/8 P
2018-05-19 3278015612560006 Neneng Sopiah 1956-12-16 Argasari 5/2 P
2018-05-19 3278015505740008 Hasanah 1975-03-11 Argasari 2/2 P
2018-05-21 3278081470474013 Yuyun Yuningsih 1974-04-07 Argasari 1/2 P
2018-05-21 3278015405870017 Evi Fitriani Dewi 1987-05-14 Cilembang 1/15 Err:509
2018-05-21 3278015310750005 Erni Susana 1975-10-13 Cilembang 3/7 P
2018-05-22 3278015006460006 Een 1946-06-10 Cilembang 4/4 P
2018-05-22 3278015112920006 Ida Yuliani 1992-12-11 Argasari 6/6 P
2018-05-22 3278015310650008 Enok Suarsih 1965-10-13 Argasari P
2018-05-22 3278017010850010 Yanah Setanah 1985-10-30 Argasari 5/4 P
2018-05-22 3278015308860008 Sani Sri Rahayu 1986-08-13 Argasari 7/2 P
2018-05-22 3278015208560008 Piah 1956-08-12 Yudanegara 5/4 P
2018-05-23 3278015906520001 Sumiat 1952-06-19 Argasari 8/1 P
2018-05-23 3278014704820022 Laela Komariah 1982-04-07 Cilembang 4/13 P
2018-05-23 3278016605800005 Reni Nuraeni 1983-06-27 Cilembang 3/6 P
2018-05-23 3278015802400601 Mamah 1940-02-18 Clembang 3/5 P
2018-05-23 3278014102580007 Ade Halimah 1958-02-01 Argasari 4/2 P
2018-05-23 3278015006780051 Didah Mardiah 1978-06-10 Cilembang 5/15 P
2018-06-04 3278015311960010 Fitri Widiastut 1996-11-13 Cilembang 5/5 P
2018-05-30 3278015505650009 Uum 1966-05-15 Argasari 5/5 P
2018-05-16 3278016205860001 Mia Sri Nuryat 1986-05-22 Yudanegara 3/2 P
2018-06-05 3278016812540004 Ani Heryani 1954-12-26 Cilembang 5/13 P
2018-06-05 3278016502730012 Ani Sulastni 1973-02-25 Argasari 1/3 P
2018-06-07 3278010600567013 Aep Saepudin 1967-05-06 Argasari 5/6 L
2018-06-07 3278016205860001 Nenden Handayani 1986-05-22 Argasari 1/2 P
2018-06-09 3278012110720003 Yani Lukman 1972-10-21 Cilembang 5/3 P
2018-06-09 3278015201700010 Imas Masrikah 1970-01-12 Cilembang 6/9 P
2018-06-09 3278011504760006 Undang S 1976-04-15 Cilembang 2/15 L
2018-06-09 3278011302510004 Bambang Suwarno 1951-02-13 Cilembang L
2018-06-09 3278014811780007 Net Herawat 1978-11-08 Argasari 4/7 P
2018-06-09 3278014912770004 Yayan 1977-12-09 Argasari 5/4 L
2018-06-09 3278015910930012 Ovi Yanda Rohyanita 1993-10-19 Cilembang 3/4 P
2018-06-09 3278016310860002 Ita Rosita 1986-10-23 Argasari 6/6 P
2018-06-09 3278016109960011 Sit Sarah 1996-09-21 Argasari 3/7 P
telp diagnosa1 diagnosa2 diagnosa3 diagnosa4 diagnosa5 merokok kurang_aktfitas
kurang_sayur
2 1
2 1
2 1
2 1

4 2

2
konsumsi_alkohol tb bb lp sistol diastol gds gdp
150 39 90 70
152 53 110 90
151 44 110 70
150 43 120 80
143 55 120 80
158 41 110 80
160 85 120 80
147 52 100 70
150 62 140 90
145 41 110 70
157 75 110 70
154 56 110 80
150 45 110 80
156 59 120 80
157 80 120 80
150 67 120 80
160 64 110 70
150 45 110 70
147 53 120 70
151 39 100 70
156 70 110 70
153 48 90 70
159 51 110 80
160 65 170 110
150 48 120 80
153 48 100 70
148 57 100 80
151 52 140 100
147 49 100 70
156 70 110 80
150 48 90 70
143 42 120 80
153 55 90 70
146 49 150 100 211
150 55 140 80
153 45 130 80 127
153 55 90 70
173 46 100 60
162 64 140 80
172 52 100 60
160 58 140 80
150 58 120 80
150 62 110 80
157 66 110 80
150 57 90 70
142 41 100 70
apebenjolan_payudara
positf_iva krioterapi papsmear tempat_lahirno_telprum golongan_dastatus
suku pekerjaan keterangan kolesterol_totrigliserida ldl hdl kadar_alko
tesamfetamekg radiologi darah_lengurin_rutn dirujuk
2 fktp