Data Kunjungan Sakit BL Nopember 2017

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DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
1 30/11/201 132117021117Y000657 0000726415165 YULISTIANA P PBI (APBN) Acute otitis externa, noninfective TIDAK
2 30/11/201 132117021117Y000654 0000726874266 SUNANIK P PBI (APBN) Unspecified acute lower respiratory TIDAK
3 30/11/201 132117021117Y000651 0000727637501 WILDAN AMRULOH L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
4 30/11/201 132117021117Y000658 0000727694559 SALEH L PBI (APBN) Nummular dermatitis TIDAK
5 30/11/201 132117021117Y000656 0000728204602 ZAENURI L PBI (APBN) Essential (primary) hypertension TIDAK
6 30/11/201 132117021117Y000652 0000728421107 NURLIKAH P PBI (APBN) Acute dilatation of stomach TIDAK
7 30/11/201 132117021117Y000643 0000728704484 M KRISTIAN PRATAMA L PBI (APBN) Fracture of shaft of humerus YA
8 30/11/201 132117021117Y000655 0000728729796 SURATIN P PBI (APBN) Acute larynpharyngitis TIDAK
9 30/11/201 132117021117Y000653 0001043991505 MULIATI . P PBI (APBN) Acute upper respiratory infection, TIDAK
10 30/11/201 132117021117Y000659 0001900475436 NATASYA MAULIDIA P PEKERJA MANDIRI Acute dilatation of stomach TIDAK
11 29/11/201 132117021117Y000637 0000727818917 SITI NUR KOMSIYAH P PBI (APBN) Prolonged pregnancy YA
12 29/11/201 132117021117Y000649 0000728547636 MOH ISBANDI L PBI (APBN) Cellulitis of finger and toe TIDAK
13 29/11/201 132117021117Y000650 0000729424293 MEGA FITRI AYUSARI P PBI (APBN) Typhoid fever TIDAK
14 29/11/201 132117021117Y000640 0001295765054 GIYAH P PEKERJA MANDIRI Tuberculosis of lung, without mention YA
15 29/11/201 132117021117Y000642 0001535804155 EKO HARIYONO L PEGAWAI SWASTA Cutaneous abscess, furuncle and YA
16 29/11/201 132117021117Y000648 0001903135195 odi dzaka andrian L PEKERJA MANDIRI Acute upper respiratory infection, TIDAK
17 29/11/201 132117021117Y000638 0002007441865 SUPIYAH P PBI (APBN) Calculus of ureter YA
18 29/11/201 132117021117Y000639 0002007463061 PONITI P PBI (APBN) Congestive heart failure YA
19 29/11/201 132117021117Y000635 0002007476728 KOMARI L PBI (APBN) Stroke, not specified as haemorrhage YA
20 29/11/201 132117021117Y000641 0002007480958 INDAH DIAH KUMALA SARI P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
21 29/11/201 132117021117Y000646 0002297963924 MISTIANI P PEKERJA MANDIRI Obstruction of bile duct YA
22 28/11/201 132117021117Y000591 0000094294596 SAUDAH P PENERIMA PENSIUN Tinnitus YA
23 28/11/201 132117021117Y000625 0000107818209 KASIANINGATI P PENERIMA PENSIUN TNI Acute larynpharyngitis TIDAK
24 28/11/201 132117021117Y000620 0000107947304 RUCHOIYAH P PENERIMA PENSIUN Acute dilatation of stomach TIDAK
25 28/11/201 132117021117Y000628 0000108799547 SULASTRI P PNS DAERAH Acute nasopharyngitis [common cold] TIDAK
26 28/11/201 132117021117Y000629 0000108835018 TURAH P PENERIMA PENSIUN Essential (primary) hypertension TIDAK
27 28/11/201 132117021117Y000614 0000109074734 PARMIATI P PNS DAERAH Acute nasopharyngitis [common cold] TIDAK
28 28/11/201 132117021117Y000594 0000109132536 SUTINI P PNS DAERAH Follow-up examination after other YA
29 28/11/201 132117021117Y000623 0000109132626 SULASTRI P PNS DAERAH Myalgia TIDAK
30 28/11/201 132117021117Y000603 0000109134922 MUHAMMAD RAFI SAIFUDIN L PNS DAERAH Other and unspecified infectious TIDAK
31 28/11/201 132117021117Y000596 0000109136092 WIDIYANTORO L PNS DAERAH Stroke, not specified as haemorrhage YA
32 28/11/201 132117021117Y000611 0000727661013 IKE SUSANTI P PBI (APBN) Acute larynpharyngitis TIDAK
33 28/11/201 132117021117Y000605 0000727670889 SHELA AYU DEA P PBI (APBN) Typhoid fever TIDAK
34 28/11/201 132117021117Y000609 0000727679103 ACHMAD BASOFI P L PBI (APBN) Typhoid fever TIDAK
35 28/11/201 132117021117Y000612 0000727732528 INDRIAWATI P PBI (APBN) Myalgia TIDAK
36 28/11/201 132117021117Y000631 0000727753342 BELLA AYU PUSPITA P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
37 28/11/201 132117021117Y000592 0000727759506 SUPARSI P PBI (APBN) Congestive heart failure YA
38 28/11/201 132117021117Y000619 0000727767358 KUSNUL AZIROH P PBI (APBN) Dizziness and giddiness TIDAK
39 28/11/201 132117021117Y000633 0000727814395 SUMIATIN P PBI (APBN) Asphyxiation TIDAK
40 28/11/201 132117021117Y000607 0000727823169 SRI RAHAYU P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
41 28/11/201 132117021117Y000622 0000727846795 MUSLIKAH P PBI (APBN) Cough TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
42 28/11/201 132117021117Y000604 0000728152323 SARIANAH P PBI (APBN) Essential (primary) hypertension TIDAK
43 28/11/201 132117021117Y000593 0000728311792 ANAM MA'RUF L PBI (APBN) Internal thrombosed haemorrhoids YA
44 28/11/201 132117021117Y000606 0000728379044 SARTIN P PBI (APBN) Acute dilatation of stomach TIDAK
45 28/11/201 132117021117Y000626 0000728380899 KHOIRUNNISA P PBI (APBN) Other and unspecified infectious TIDAK
46 28/11/201 132117021117Y000610 0000728396223 INTAN PUTRI AZ ZAHAARO P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
47 28/11/201 132117021117Y000632 0000728445622 M. ILHAM FEBRIAN L PBI (APBN) Other and unspecified infectious TIDAK
48 28/11/201 132117021117Y000613 0000728446307 SEPTIA RAMADANI P PBI (APBN) Typhoid fever TIDAK
49 28/11/201 132117021117Y000615 0000728460865 HARTIYANI P PBI (APBN) Acute dilatation of stomach TIDAK
50 28/11/201 132117021117Y000681 0000728548255 SITI ANIS NUR LAILA P PBI (APBN) Contraceptive management, TIDAK
51 28/11/201 132117021117Y000634 0000728603921 NURFAENI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
52 28/11/201 132117021117Y000618 0000728614539 MAHMUDI L PBI (APBN) Myalgia TIDAK
53 28/11/201 132117021117Y000624 0000728874639 SUNARTI P PBI (APBN) Myalgia TIDAK
54 28/11/201 132117021117Y000682 0000729364386 SITI ROSITA P PBI (APBN) Contraceptive management, TIDAK
55 28/11/201 132117021117Y000627 0001043973843 SUKOYO L PBI (APBN) Acute larynpharyngitis TIDAK
56 28/11/201 132117021117Y000617 0001043974798 SUPINAH P PBI (APBN) Myalgia TIDAK
57 28/11/201 132117021117Y000608 0001043974822 DARSI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
58 28/11/201 132117021117Y000630 0001043977735 YULI ASTUTIK P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
59 28/11/201 132117021117Y000616 0001864029947 MUHAMMAD ZIDAN L PEKERJA MANDIRI Acute nasopharyngitis [common cold] TIDAK
60 28/11/201 132117021117Y000597 0002007425856 SARBI L PBI (APBN) Malignant neoplasm of skin, YA
61 28/11/201 132117021117Y000660 0002007461992 HETIK IRAWATI P PBI (APBN) Contraceptive management, TIDAK
62 28/11/201 132117021117Y000621 0002007500051 RUBIAH P PBI (APBN) Myalgia TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
63 28/11/201 132117021117Y000602 0002060260964 TSANIA HIDAYATUL P PEKERJA MANDIRI Cough TIDAK
64 28/11/201 132117021117Y000595 0002062645143 HASAN BISRI L PEKERJA MANDIRI Cataract, unspecified YA
65 27/11/201 132117021117Y000577 0000727360694 WILANDA PUTRA REHAN L PBI (APBN) Acute dilatation of stomach TIDAK
66 27/11/201 132117021117Y000564 0000727448128 SUKARNI P PBI (APBN) Cellulitis YA
67 27/11/201 132117021117Y000644 0000727604829 AFIKA SARI P PBI (APBN) Supervision of pregnancy with history TIDAK
68 27/11/201 132117021117Y000566 0000727652283 MARZIANAH P PBI (APBN) Acute dilatation of stomach TIDAK
69 27/11/201 132117021117Y000570 0000727658932 ARIS DARWANTO L PBI (APBN) Tuberculosis of lung, confirmed by TIDAK
70 27/11/201 132117021117Y000645 0000727818917 SITI NUR KOMSIYAH P PBI (APBN) Supervision of pregnancy with history TIDAK
71 27/11/201 132117021117Y000590 0000727965797 AISYAH P PBI (APBN) Supervision of pregnancy with history TIDAK
72 27/11/201 132117021117Y000574 0000727967316 JAMILAH P PBI (APBN) Viral warts TIDAK
73 27/11/201 132117021117Y000679 0000728058611 IMROATUL HASANAH P PBI (APBN) Contraceptive management, TIDAK
74 27/11/201 132117021117Y000586 0000728080661 INDRA GUNAWAN L PBI (APBN) Other specified local infections of skin TIDAK
75 27/11/201 132117021117Y000579 0000728145156 SUYATMI P PBI (APBN) Essential (primary) hypertension TIDAK
76 27/11/201 132117021117Y000647 0000728171166 SANTI P PBI (APBN) Supervision of pregnancy with history TIDAK
77 27/11/201 132117021117Y000680 0000728196028 WIWIK INDRAWATI P PBI (APBN) Contraceptive management, TIDAK
78 27/11/201 132117021117Y000578 0000728231815 DESI WULANDARI P PBI (APBN) Herpesviral vesicular dermatitis TIDAK
79 27/11/201 132117021117Y000575 0000728332378 RIAYU P PBI (APBN) Essential (primary) hypertension TIDAK
80 27/11/201 132117021117Y000589 0000728364249 SIH AMINDARI P PBI (APBN) Dizziness and giddiness TIDAK
81 27/11/201 132117021117Y000573 0000728419375 RETNO KOIRUNAWATI P PBI (APBN) Prolonged pregnancy YA
82 27/11/201 132117021117Y000588 0000728454598 PANGESTU YOGA SAPUTRA L PBI (APBN) Local infection of skin and TIDAK
83 27/11/201 132117021117Y000571 0000728470473 MISTI P PBI (APBN) Essential (primary) hypertension TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
84 27/11/201 132117021117Y000572 0000728514336 AZZAM WIDAD RAMADHAN L PBI (APBN) Acute dilatation of stomach TIDAK
85 27/11/201 132117021117Y000585 0000729246633 FEBI IRWANTI P PBI (APBN) Other acute conjunctivitis TIDAK
86 27/11/201 132117021117Y000661 0001043972212 KARTIKANINGSIH P PBI (APBN) Contraceptive management, TIDAK
87 27/11/201 132117021117Y000568 0001043991505 MULIATI . P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
88 27/11/201 132117021117Y000563 0001300612443 SULIKAN L PEKERJA MANDIRI Malignant neoplasm of brain, YA
89 27/11/201 132117021117Y000580 0001705484248 KHUSAIRI L PBI (APBD) Essential (primary) hypertension TIDAK
90 27/11/201 132117021117Y000569 0002007464174 ISTIANAH P PBI (APBN) Essential (primary) hypertension TIDAK
91 27/11/201 132117021117Y000576 0002007479204 SUNARTI P PBI (APBN) Cough TIDAK
92 27/11/201 132117021117Y000567 0002007516014 KHOLIFAH L PBI (APBN) Joint disorder, unspecified TIDAK
93 27/11/201 132117021117Y000582 0002020123348 FIQRI AKBAR SYAWALUDIN L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
94 27/11/201 132117021117Y000581 0002044373567 SITI SAFAATIN FATILLAH P PEKERJA MANDIRI Acute nasopharyngitis [common cold] TIDAK
95 27/11/201 132117021117Y000565 0002297963924 MISTIANI P PEKERJA MANDIRI Other acute viral hepatitis YA
96 25/11/201 132117021117Y000524 0000108201497 SITI ASIJAH P PENERIMA PENSIUN Local infection of skin and TIDAK
97 25/11/201 132117021117Y000553 0000108835018 TURAH P PENERIMA PENSIUN Essential (primary) hypertension TIDAK
98 25/11/201 132117021117Y000530 0000727448128 SUKARNI P PBI (APBN) Dizziness and giddiness TIDAK
99 25/11/201 132117021117Y000517 0000727516326 MOCH.AMIRUDIN L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
100 25/11/201 132117021117Y000507 0000727565668 SUBAKRI L PBI (APBN) Local infection of skin and TIDAK
101 25/11/201 132117021117Y000636 0000727585301 ANI MULYATI P PBI (APBN) Contraceptive management, TIDAK
102 25/11/201 132117021117Y000539 0000727586987 SUISNADI L PBI (APBN) Myalgia TIDAK
103 25/11/201 132117021117Y000538 0000727588067 ADIT MUSTOFA L PBI (APBN) Acute larynpharyngitis TIDAK
104 25/11/201 132117021117Y000598 0000727627206 ROFI'AH P PBI (APBN) Acute dilatation of stomach TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
105 25/11/201 132117021117Y000558 0000727729031 NUR HIDAYAH P PBI (APBN) Cough TIDAK
106 25/11/201 132117021117Y000527 0000727736231 KUSTIANI P PBI (APBN) Myalgia TIDAK
107 25/11/201 132117021117Y000532 0000727742553 PONIMAH P PBI (APBN) Local infection of skin and TIDAK
108 25/11/201 132117021117Y000599 0000727757526 MUJIATI P PBI (APBN) Other and unspecified infectious TIDAK
109 25/11/201 132117021117Y000521 0000727760327 VIMAYA INTAN PUSPITA P PBI (APBN) Supervision of pregnancy with history TIDAK
110 25/11/201 132117021117Y000540 0000727775965 SAMIATI P PBI (APBN) Myalgia TIDAK
111 25/11/201 132117021117Y000541 0000727776674 MUHAMAD TRIFANANI L PBI (APBN) Myalgia TIDAK
112 25/11/201 132117021117Y000515 0000727800028 PAISIN P PBI (APBN) Acute upper respiratory infection, TIDAK
113 25/11/201 132117021117Y000506 0000727811087 AGUS NURCAHYONO L PBI (APBN) Non-insulin-dependent diabetes YA
114 25/11/201 132117021117Y000513 0000727823046 ZUMAROH P PBI (APBN) Contraceptive management, TIDAK
115 25/11/201 132117021117Y000528 0000727863917 SUWADI L PBI (APBN) Myalgia TIDAK
116 25/11/201 132117021117Y000509 0000727895474 MISTIAH P PBI (APBN) Local infection of skin and TIDAK
117 25/11/201 132117021117Y000522 0000728029451 SUPARTI P PBI (APBN) Acute dilatation of stomach TIDAK
118 25/11/201 132117021117Y000678 0000728064696 DWI INDRAWATI P PBI (APBN) Contraceptive management, TIDAK
119 25/11/201 132117021117Y000526 0000728157846 SUKARNI P PBI (APBN) Essential (primary) hypertension TIDAK
120 25/11/201 132117021117Y000559 0000728170773 ARI DIAN PAMUNGKAS L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
121 25/11/201 132117021117Y000543 0000728180021 SUWOYO L PBI (APBN) Acute dilatation of stomach TIDAK
122 25/11/201 132117021117Y000560 0000728437792 RASMINI P PBI (APBN) Myalgia TIDAK
123 25/11/201 132117021117Y000545 0000728444867 PURWANTI P PBI (APBN) Myalgia TIDAK
124 25/11/201 132117021117Y000520 0000728547636 MOH ISBANDI L PBI (APBN) Local infection of skin and TIDAK
125 25/11/201 132117021117Y000537 0000728592704 SUNDARI P PBI (APBN) Essential (primary) hypertension TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
126 25/11/201 132117021117Y000518 0000728603921 NURFAENI P PBI (APBN) Acute dilatation of stomach TIDAK
127 25/11/201 132117021117Y000525 0000728716004 UUT DAYANTI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
128 25/11/201 132117021117Y000512 0000729086242 RUKANI P PBI (APBN) Joint disorder, unspecified TIDAK
129 25/11/201 132117021117Y000514 0000729180022 SITI NAPIAH P PBI (APBN) Epilepsy, unspecified TIDAK
130 25/11/201 132117021117Y000529 0000729294265 SUBARI L PBI (APBN) Tuberculosis of lung, confirmed by TIDAK
131 25/11/201 132117021117Y000511 0001043974697 AGUSTIN P PBI (APBN) Contraceptive management, TIDAK
132 25/11/201 132117021117Y000689 0001043974697 AGUSTIN P PBI (APBN) Contraceptive management, TIDAK
133 25/11/201 132117021117Y000561 0001043974978 MUTTO'INAH P PBI (APBN) Acute dilatation of stomach TIDAK
134 25/11/201 132117021117Y000600 0001043976126 WIJIONO L PBI (APBN) Non-insulin-dependent diabetes TIDAK
135 25/11/201 132117021117Y000535 0001043976475 SUPARMI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
136 25/11/201 132117021117Y000523 0001338251321 SAMPURNO L PEKERJA MANDIRI Acute nasopharyngitis [common cold] TIDAK
137 25/11/201 132117021117Y000508 0001705485126 SUHARTATIK P PBI (APBD) Asphyxiation TIDAK
138 25/11/201 132117021117Y000516 0001705485249 CERITO DULMANAN L PBI (APBD) Myalgia TIDAK
139 25/11/201 132117021117Y000542 0001963863167 sukinah P PNS DAERAH Myalgia TIDAK
140 25/11/201 132117021117Y000510 0001985091131 SUPIRAH P PBI (APBN) Essential (primary) hypertension TIDAK
141 25/11/201 132117021117Y000601 0002007462251 SITI MUHAYANAH P PBI (APBN) Essential (primary) hypertension TIDAK
142 25/11/201 132117021117Y000531 0002007463522 TUNING P PBI (APBN) Myalgia TIDAK
143 25/11/201 132117021117Y000533 0002007477448 RUM P PBI (APBN) Acute dilatation of stomach TIDAK
144 25/11/201 132117021117Y000519 0002007499702 DIAN KURNIA SARI P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
145 25/11/201 132117021117Y000557 0002060260626 M FAJAR MU'AFFA L PEKERJA MANDIRI Acute larynpharyngitis TIDAK
146 25/11/201 132117021117Y000562 0002290595422 NUNIK JULAIKAH P PEKERJA MANDIRI Acute larynpharyngitis TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
147 25/11/201 132117021117Y000536 0002293209911 azzahra nur sa'diyah P PBI (APBN) Other otitis externa TIDAK
148 24/11/201 132117021117Y000554 0000726386444 FATKUR ROCHMAH L PBI (APBN) Tuberculosis of lung, confirmed by TIDAK
149 24/11/201 132117021117Y000548 0000727645285 KASERI L PBI (APBN) Essential (primary) hypertension TIDAK
150 24/11/201 132117021117Y000504 0000727703313 AMILAH P PBI (APBN) Cataract, unspecified YA
151 24/11/201 132117021117Y000544 0000727740112 HANDI WAHYUDI L PBI (APBN) Joint disorder, unspecified TIDAK
152 24/11/201 132117021117Y000546 0000727775133 SITI ASIYAH P PBI (APBN) Dental caries, unspecified TIDAK
153 24/11/201 132117021117Y000549 0000728204602 ZAENURI L PBI (APBN) Essential (primary) hypertension TIDAK
154 24/11/201 132117021117Y000503 0000728265227 DESVITA AIDHA RISTANTI P PBI (APBN) Acute upper respiratory infection, YA
155 24/11/201 132117021117Y000550 0000728326923 M RIZAL L PBI (APBN) Acute upper respiratory infection, TIDAK
156 24/11/201 132117021117Y000534 0000728519106 ROSIDA HABIBAH P PBI (APBN) Nummular dermatitis TIDAK
157 24/11/201 132117021117Y000552 0000729246374 FERDI IRWANTO L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
158 24/11/201 132117021117Y000505 0000729493749 ISTIANAH P PBI (APBN) Antenatal screening, unspecified YA
159 24/11/201 132117021117Y000556 0001043993204 RINDA MARTANDI P PBI (APBN) Acute upper respiratory infection, TIDAK
160 24/11/201 132117021117Y000502 0001283792499 PARNI P PEKERJA MANDIRI Myopia YA
161 24/11/201 132117021117Y000555 0002019598424 THOMAS ANDREAS L PBI (APBN) Acute upper respiratory infection, TIDAK
162 24/11/201 132117021117Y000551 0002020553684 AISYAH MADINATUL P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
163 24/11/201 132117021117Y000547 0002285826658 marisa anindya fauziyah P PBI (APBN) Acute upper respiratory infection, TIDAK
164 23/11/201 132117021117Y000495 0000100767082 MOELJONO P VETERAN Acute nasopharyngitis [common cold] TIDAK
165 23/11/201 132117021117Y000499 0000107945965 MULJANINGSIH L PENERIMA PENSIUN Myalgia TIDAK
166 23/11/201 132117021117Y000497 0000727547499 SUPRIYATIN P PBI (APBN) Myalgia TIDAK
167 23/11/201 132117021117Y000476 0000727600307 YULISTIYOWATI P PBI (APBN) Acute dilatation of stomach TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
168 23/11/201 132117021117Y000491 0000727604482 KUSTIN P PBI (APBN) Acute larynpharyngitis TIDAK
169 23/11/201 132117021117Y000501 0000727633721 SUPRIHATIN P PBI (APBN) Acute larynpharyngitis TIDAK
170 23/11/201 132117021117Y000466 0000727634068 LUTFI MAULDIA P PBI (APBN) Contraceptive management, TIDAK
171 23/11/201 132117021117Y000474 0000727643507 SRI UTAMI P PBI (APBN) Myalgia TIDAK
172 23/11/201 132117021117Y000489 0000727710748 VENA PUTRI ZEREMIA P PBI (APBN) Acute larynpharyngitis TIDAK
173 23/11/201 132117021117Y000463 0000727729031 NUR HIDAYAH P PBI (APBN) Contraceptive management, TIDAK
174 23/11/201 132117021117Y000482 0000727734521 AMINAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
175 23/11/201 132117021117Y000478 0000727767819 MOHAMAD SA'ID L PBI (APBN) Acute upper respiratory infection, TIDAK
176 23/11/201 132117021117Y000479 0000727846659 NURUL MA'RIFAH P PBI (APBN) Epistaxis TIDAK
177 23/11/201 132117021117Y000480 0000727864424 SUPARMI P PBI (APBN) Acute dilatation of stomach TIDAK
178 23/11/201 132117021117Y000483 0000728152659 YAYANG ADI PRASETIYA L PBI (APBN) Ocular pain TIDAK
179 23/11/201 132117021117Y000457 0000728181551 SAUDI L PBI (APBN) Non-insulin-dependent diabetes YA
180 23/11/201 132117021117Y000490 0000728263585 MEGA SILVIA P PBI (APBN) Cough TIDAK
181 23/11/201 132117021117Y000472 0000728285488 SRI UTAMI P PBI (APBN) Nonallergic asthma TIDAK
182 23/11/201 132117021117Y000469 0000728445429 SATIAH P PBI (APBN) Myalgia TIDAK
183 23/11/201 132117021117Y000462 0000728467222 INDAH MARITA ASTUTIK P PBI (APBN) Acute larynpharyngitis TIDAK
184 23/11/201 132117021117Y000498 0000728489272 SULIKAH P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
185 23/11/201 132117021117Y000488 0000728594368 SUHARTO L PBI (APBN) Acute dilatation of stomach TIDAK
186 23/11/201 132117021117Y000487 0000728615867 NAIDA NUR JANNAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
187 23/11/201 132117021117Y000464 0000728617094 YULI RAHMAWATI P PBI (APBN) Contraceptive management, TIDAK
188 23/11/201 132117021117Y000484 0000728828763 NGATOMO L PBI (APBN) Asphyxiation TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
189 23/11/201 132117021117Y000486 0000728845931 UMI KULSUM P PBI (APBN) Essential (primary) hypertension TIDAK
190 23/11/201 132117021117Y000485 0000728863029 DELLA INTAN SEKAR P PBI (APBN) Acute larynpharyngitis TIDAK
191 23/11/201 132117021117Y000494 0000729187154 ALFIAN NURHIDAYAT L PBI (APBN) Myalgia TIDAK
192 23/11/201 132117021117Y000473 0001043974978 MUTTO'INAH P PBI (APBN) Essential (primary) hypertension TIDAK
193 23/11/201 132117021117Y000468 0001043976475 SUPARMI P PBI (APBN) Myalgia TIDAK
194 23/11/201 132117021117Y000496 0001089153437 FIA SUMIATI P VETERAN Myalgia TIDAK
195 23/11/201 132117021117Y000500 0001291914224 LILIK SETYOWATI P TNI ANGKATAN DARAT Cough TIDAK
196 23/11/201 132117021117Y000459 0001484532101 TRI MULYANINGSIH P PEGAWAI SWASTA Myopia YA
197 23/11/201 132117021117Y000460 0001531513708 GRACELLA NATHANIA P PEGAWAI SWASTA Acute nasopharyngitis [common cold] TIDAK
198 23/11/201 132117021117Y000475 0001963863167 sukinah P PNS DAERAH Cough TIDAK
199 23/11/201 132117021117Y000465 0001964925178 NUR ANAWIYAH P PEKERJA MANDIRI Contraceptive management, TIDAK
200 23/11/201 132117021117Y000458 0002007462519 SUPIYAR L PBI (APBN) Pneumonia, unspecified YA
201 23/11/201 132117021117Y000467 0002007462958 KHUSTIANI P PBI (APBN) Contraceptive management, TIDAK
202 23/11/201 132117021117Y000477 0002007477448 RUM P PBI (APBN) Acute dilatation of stomach TIDAK
203 23/11/201 132117021117Y000481 0002007479204 SUNARTI P PBI (APBN) Acute upper respiratory infection, TIDAK
204 23/11/201 132117021117Y000493 0002007479676 LINDI SWANDANI P PBI (APBN) Local infection of skin and TIDAK
205 23/11/201 132117021117Y000461 0002007500354 SUMARSIH P PBI (APBN) Dizziness and giddiness TIDAK
206 23/11/201 132117021117Y000492 0002253648519 ADELLA PUTRI RIMADANI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
207 23/11/201 132117021117Y000470 0002269886635 SRI WAHYUNING ASTUTIK P PEKERJA MANDIRI Joint disorder, unspecified TIDAK
208 23/11/201 132117021117Y000471 0002293209911 azzahra nur sa'diyah P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
209 22/11/201 132117021117Y000676 0000727428238 BATINAH . P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
210 22/11/201 132117021117Y000456 0000727623527 YUNANI P PBI (APBN) Uterovaginal prolapse, unspecified YA
211 22/11/201 132117021117Y000677 0000727817894 ANIK FITRIANI P PBI (APBN) Contraceptive management, TIDAK
212 22/11/201 132117021117Y000688 0000728617094 YULI RAHMAWATI P PBI (APBN) Contraceptive management, TIDAK
213 22/11/201 132117021117Y000455 0001230162682 SAHADI L PENERIMA PENSIUN Unspecified diabetes mellitus with YA
214 22/11/201 132117021117Y000454 0001971226282 DIAN NOVITA DEVI P PEKERJA MANDIRI Staphylococcal arthritis and YA
215 21/11/201 132117021117Y000451 0000727645285 KASERI L PBI (APBN) Essential (primary) hypertension TIDAK
216 21/11/201 132117021117Y000675 0000727745949 SITI NUR KHOLIS P PBI (APBN) Contraceptive management, TIDAK
217 21/11/201 132117021117Y000448 0000728717782 TINA P PBI (APBN) Paranoid schizophrenia YA
218 21/11/201 132117021117Y000449 0000728811461 RUPIATON P PBI (APBN) Congestive heart failure YA
219 21/11/201 132117021117Y000452 0002007425856 SARBI L PBI (APBN) Malignant neoplasm of skin, YA
220 21/11/201 132117021117Y000450 0002007477977 HERU L PBI (APBN) Cataract, unspecified YA
221 20/11/201 132117021117Y000414 0000094290131 M. AMINAN L PENERIMA PENSIUN Congestive heart failure YA
222 20/11/201 132117021117Y000399 0000108775809 NIKEN DWI TRISNANINGATI P PNS DAERAH Acute lymphadenitis, unspecified YA
223 20/11/201 132117021117Y000424 0000109186661 NIKMATUS SHOLIKAH P PNS DAERAH Non-insulin-dependent diabetes YA
224 20/11/201 132117021117Y000405 0000162672006 SITI KOFSAH P PNS DAERAH Tuberculosis of lung, without mention YA
225 20/11/201 132117021117Y000400 0000726411058 SUJONO L PBI (APBN) Cataract, unspecified YA
226 20/11/201 132117021117Y000442 0000726874266 SUNANIK P PBI (APBN) Acute dilatation of stomach TIDAK
227 20/11/201 132117021117Y000429 0000727491532 CAKRA SURYA DINATA L PBI (APBN) Other specified local infections of skin TIDAK
228 20/11/201 132117021117Y000419 0000727516102 YULIATIN P PBI (APBN) Typhoid fever TIDAK
229 20/11/201 132117021117Y000435 0000727565668 SUBAKRI L PBI (APBN) Local infection of skin and TIDAK
230 20/11/201 132117021117Y000417 0000727631919 PURI RAHAYU P PBI (APBN) Supervision of high-risk pregnancy, YA

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
231 20/11/201 132117021117Y000437 0000727652441 SUTRISMI P PBI (APBN) Acute dilatation of stomach TIDAK
232 20/11/201 132117021117Y000453 0000727676234 NINGSIH P PBI (APBN) Contraceptive management, TIDAK
233 20/11/201 132117021117Y000432 0000727708004 SRI ASTUTIK P PBI (APBN) Supervision of pregnancy with history TIDAK
234 20/11/201 132117021117Y000402 0000727783852 RIKA NURHAYATI P PBI (APBN) Non-insulin-dependent diabetes YA
235 20/11/201 132117021117Y000416 0000727792266 SUHARTINI P PBI (APBN) Unspecified diabetes mellitus with YA
236 20/11/201 132117021117Y000441 0000727823169 SRI RAHAYU P PBI (APBN) Myalgia TIDAK
237 20/11/201 132117021117Y000408 0000727828389 DANI PRASETIONO L PBI (APBN) Contracture of muscle, upper arm YA
238 20/11/201 132117021117Y000430 0000728157846 SUKARNI P PBI (APBN) Contraceptive management, TIDAK
239 20/11/201 132117021117Y000436 0000728237261 SUPARDI L PBI (APBN) Fall on same level involving ice and TIDAK
240 20/11/201 132117021117Y000444 0000728287738 SUHERNI P PBI (APBN) Cough TIDAK
241 20/11/201 132117021117Y000438 0000728336711 KHAMIMAH P PBI (APBN) Joint disorder, unspecified TIDAK
242 20/11/201 132117021117Y000410 0000728520647 SUWARNO L PBI (APBN) Cataract, unspecified YA
243 20/11/201 132117021117Y000434 0000728599476 SUDARMI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
244 20/11/201 132117021117Y000431 0000728599814 SITI NUR ASIYAH P PBI (APBN) Supervision of pregnancy with history TIDAK
245 20/11/201 132117021117Y000440 0000728612651 SUKARTI P PBI (APBN) Acute dilatation of stomach TIDAK
246 20/11/201 132117021117Y000418 0000728729796 SURATIN P PBI (APBN) Nonallergic asthma TIDAK
247 20/11/201 132117021117Y000411 0000729082563 SUTIKNO L PBI (APBN) Benign lipomatous neoplasm YA
248 20/11/201 132117021117Y000425 0000729531099 SITI SUSIANINGSIH P PBI (APBN) Dizziness and giddiness TIDAK
249 20/11/201 132117021117Y000433 0001043973235 SUWATIK P PBI (APBN) Acute dilatation of stomach TIDAK
250 20/11/201 132117021117Y000423 0001043974394 MURIANI P PBI (APBN) Dizziness and giddiness TIDAK
251 20/11/201 132117021117Y000443 0001043975553 LOSINAH P PBI (APBN) Myalgia TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
252 20/11/201 132117021117Y000439 0001043975621 FHATANAH P PBI (APBN) Myalgia TIDAK
253 20/11/201 132117021117Y000415 0001319290558 KASIATI P PEKERJA MANDIRI Follow-up examination after other TIDAK
254 20/11/201 132117021117Y000427 0001815659278 GIOVANI EKA PUTRA L PEGAWAI SWASTA Typhoid and paratyphoid fevers TIDAK
255 20/11/201 132117021117Y000407 0002007439841 JAYUS L PBI (APBN) Iron deficiency anaemia, unspecified YA
256 20/11/201 132117021117Y000420 0002007452766 KASAN TRIMO JOYO L PBI (APBN) Gastritis, unspecified YA
257 20/11/201 132117021117Y000428 0002007464174 ISTIANAH P PBI (APBN) Essential (primary) hypertension TIDAK
258 20/11/201 132117021117Y000421 0002007477876 ASTIANI P PBI (APBN) Myalgia TIDAK
259 20/11/201 132117021117Y000447 0002007478258 BASORI L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
260 20/11/201 132117021117Y000409 0002007499746 SUWARNI P PBI (APBN) Irregular menstruation, unspecified YA
261 20/11/201 132117021117Y000426 0002020123348 FIQRI AKBAR SYAWALUDIN L PBI (APBN) Typhoid fever TIDAK
262 20/11/201 132117021117Y000445 0002020536009 YAHYA HAFIZALWIANSYAH P PBI (APBN) Cough TIDAK
263 20/11/201 132117021117Y000412 0002021177957 MOCH SANDY SYARIF L PBI (APBN) Foreign body in ear YA
264 20/11/201 132117021117Y000404 0002021231621 RAHMAD UBAIDILLAH L PBI (APBN) Constipation YA
265 20/11/201 132117021117Y000422 0002024903237 MUHAMMAD RAMADANA L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
266 20/11/201 132117021117Y000446 0002025577348 MUHAMMAD AWINNULOH L PBI (APBN) Acute larynpharyngitis TIDAK
267 20/11/201 132117021117Y000403 0002232687813 TRI BUDI SETYOWATI P PENERIMA PENSIUN Calculus of bile duct with cholangitis YA
268 20/11/201 132117021117Y000401 0002297963924 MISTIANI P PEKERJA MANDIRI Abnormal uterine and vaginal bleeding, YA
269 20/11/201 132117021117Y000406 0002302377377 LAYLATUL HIKMAH P PEKERJA MANDIRI Leiomyoma of uterus YA
270 20/11/201 132117021117Y000413 0002302378738 KARSIDIN L PEKERJA MANDIRI Cataract, unspecified YA
271 18/11/201 132117021117Y000380 0000726843363 SOMO L PBI (APBN) Acute dilatation of stomach TIDAK
272 18/11/201 132117021117Y000369 0000726874266 SUNANIK P PBI (APBN) Acute dilatation of stomach TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
273 18/11/201 132117021117Y000365 0000727726702 ABDUL ROCHIM L PBI (APBN) Non-insulin-dependent diabetes TIDAK
274 18/11/201 132117021117Y000381 0000728080661 INDRA GUNAWAN L PBI (APBN) Other specified local infections of skin TIDAK
275 18/11/201 132117021117Y000377 0000728160592 NABIL MAULANA L PBI (APBN) Thyrotoxicosis, unspecified YA
276 18/11/201 132117021117Y000372 0000728184486 SA'ADAH P PBI (APBN) Other bacterial pneumonia YA
277 18/11/201 132117021117Y000378 0000728204602 ZAENURI L PBI (APBN) Essential (primary) hypertension TIDAK
278 18/11/201 132117021117Y000368 0000729135652 MULYONO L PBI (APBN) Asthma, unspecified TIDAK
279 18/11/201 132117021117Y000385 0001043974067 SUMIATI P PBI (APBN) Secondary hypertension, unspecified YA
280 18/11/201 132117021117Y000674 0001043995252 MUJI ISDANANING P PBI (APBN) Contraceptive management, TIDAK
281 18/11/201 132117021117Y000375 0001320111865 MUJAYANAH P PEKERJA MANDIRI Arthrosis, unspecified, multiple sites YA
282 18/11/201 132117021117Y000386 0002007480069 YULIADI L PBI (APBN) Cataract, unspecified YA
283 18/11/201 132117021117Y000382 0002007514574 KASTAMAH P PBI (APBN) Essential (primary) hypertension TIDAK
284 17/11/201 132117021117Y000672 0000728013521 SRI UTAMI P PBI (APBN) Contraceptive management, TIDAK
285 17/11/201 132117021117Y000673 0001043994205 SITI KHOLIKIYAH P PBI (APBN) Contraceptive management, TIDAK
286 16/11/201 132117021117Y000363 0000109183678 MASITHOH RORO P PNS DAERAH Acute larynpharyngitis TIDAK
287 16/11/201 132117021117Y000394 0000727448128 SUKARNI P PBI (APBN) Myalgia TIDAK
288 16/11/201 132117021117Y000357 0000727504839 LILIK HANDAYANI P PBI (APBN) Other antenatal screening YA
289 16/11/201 132117021117Y000387 0000727516326 MOCH.AMIRUDIN L PBI (APBN) Acute upper respiratory infection, TIDAK
290 16/11/201 132117021117Y000354 0000727555746 SITI MASLAHAH P PBI (APBN) Follow-up examination after surgery YA
291 16/11/201 132117021117Y000361 0000727698982 SULAIMAN JUWAHIR L PBI (APBN) Myalgia TIDAK
292 16/11/201 132117021117Y000360 0000727699026 SITI MUTROFIN P PBI (APBN) Cough TIDAK
293 16/11/201 132117021117Y000687 0000727753072 KADARWATI P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
294 16/11/201 132117021117Y000353 0000727766403 VIVIN ERNAWATI P PBI (APBN) Follow-up examination after surgery YA
295 16/11/201 132117021117Y000392 0000727956955 TUMINI P PBI (APBN) Dizziness and giddiness TIDAK
296 16/11/201 132117021117Y000391 0000728196028 WIWIK INDRAWATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
297 16/11/201 132117021117Y000395 0000728620446 SUWADI L PBI (APBN) Myalgia TIDAK
298 16/11/201 132117021117Y000390 0000728713359 ARLINAH P PBI (APBN) Myalgia TIDAK
299 16/11/201 132117021117Y000389 0000728716004 UUT DAYANTI P PBI (APBN) Acute upper respiratory infection, TIDAK
300 16/11/201 132117021117Y000359 0000728828763 NGATOMO L PBI (APBN) Asphyxiation TIDAK
301 16/11/201 132117021117Y000364 0001043973235 SUWATIK P PBI (APBN) Acute dilatation of stomach TIDAK
302 16/11/201 132117021117Y000355 0001043977375 IRFAN WIBISONO L PBI (APBN) Acute polymorphic psychotic disorder YA
303 16/11/201 132117021117Y000393 0001043991718 NUR CHAMIDAH P PBI (APBN) Acute upper respiratory infection, TIDAK
304 16/11/201 132117021117Y000362 0001801292894 SULAS SETIO NINGSIH P PNS DAERAH Cough TIDAK
305 16/11/201 132117021117Y000388 0001822611892 abdillah rizki choirufie L PEKERJA MANDIRI Acute dilatation of stomach TIDAK
306 16/11/201 132117021117Y000356 0002007474502 SUTIK P PBI (APBN) Other specified cardiac arrhythmias YA
307 16/11/201 132117021117Y000358 0002035258435 fiqih izam kusuma L PEKERJA MANDIRI Acute larynpharyngitis TIDAK
308 15/11/201 132117021117Y000341 0000107947304 RUCHOIYAH P PENERIMA PENSIUN Gastric diverticulum TIDAK
309 15/11/201 132117021117Y000351 0000108921082 DR. HJ. RR TYAS P PNS DAERAH Unspecified diabetes mellitus without TIDAK
310 15/11/201 132117021117Y000327 0000108924941 SRI AMBARWATI P PNS DAERAH Haemarthrosis TIDAK
311 15/11/201 132117021117Y000350 0000108930969 IDA DWI PANTI ARINI P PNS DAERAH Gastric diverticulum TIDAK
312 15/11/201 132117021117Y000323 0000727378108 THOIB L PBI (APBN) Congestive heart failure YA
313 15/11/201 132117021117Y000352 0000727565196 SITI MAUDU'AH P PBI (APBN) Gastric diverticulum TIDAK
314 15/11/201 132117021117Y000347 0000727612929 SAROPAH P PBI (APBN) Unspecified diabetes mellitus without TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
315 15/11/201 132117021117Y000398 0000727636184 TATIK MUAFIAH P PBI (APBN) Joint disorder, unspecified TIDAK
316 15/11/201 132117021117Y000397 0000727637501 WILDAN AMRULOH L PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
317 15/11/201 132117021117Y000329 0000727770767 YATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
318 15/11/201 132117021117Y000322 0000727783852 RIKA NURHAYATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
319 15/11/201 132117021117Y000321 0000727829458 PITONO L PBI (APBN) Unspecified diabetes mellitus without YA
320 15/11/201 132117021117Y000383 0000727831956 SUSIANAH P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
321 15/11/201 132117021117Y000342 0000727846413 SRIANAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
322 15/11/201 132117021117Y000333 0000727865109 MUNAWAROH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
323 15/11/201 132117021117Y000328 0000727871387 SULASTRI P PBI (APBN) Acute dilatation of stomach TIDAK
324 15/11/201 132117021117Y000319 0000727871848 MOH KURNIAWAN L PBI (APBN) Fever, unspecified YA
325 15/11/201 132117021117Y000334 0000728009638 RUPIAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
326 15/11/201 132117021117Y000338 0000728131948 MUKIYAH P PBI (APBN) Unspecified diabetes mellitus without TIDAK
327 15/11/201 132117021117Y000332 0000728271077 TITIN AGUSTINAH P PBI (APBN) Essential (primary) hypertension TIDAK
328 15/11/201 132117021117Y000335 0000728328262 SYAFA,AH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
329 15/11/201 132117021117Y000318 0000728354013 RISMA AGUSTINA P PBI (APBN) Injury of blood vessels of head, not YA
330 15/11/201 132117021117Y000379 0000728418161 SUMIYATI P PBI (APBN) General counselling and advice on TIDAK
331 15/11/201 132117021117Y000320 0000728524089 SUYANIK P PBI (APBN) Acute lymphadenitis of face, head and YA
332 15/11/201 132117021117Y000343 0000728544688 SITI.MAIMUNAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
333 15/11/201 132117021117Y000337 0000728896522 MUSIATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
334 15/11/201 132117021117Y000345 0000729067678 NUR ROIFATIN P PBI (APBN) Gastric diverticulum TIDAK
335 15/11/201 132117021117Y000324 0000729212365 SUGATI P PBI (APBN) Unspecified diabetes mellitus without TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
336 15/11/201 132117021117Y000325 0000729625307 KARMUAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
337 15/11/201 132117021117Y000344 0001043991639 SAMIRAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
338 15/11/201 132117021117Y000376 0001043993338 SUKARSIH P PBI (APBN) Anaemia complicating pregnancy, TIDAK
339 15/11/201 132117021117Y000348 0001082355535 KAMINI P PENERIMA PENSIUN TNI Gastric diverticulum TIDAK
340 15/11/201 132117021117Y000330 0001427001028 sri rahayu P PEKERJA MANDIRI Gastric diverticulum TIDAK
341 15/11/201 132117021117Y000339 0001450313526 WARSINI P PEKERJA MANDIRI Haemarthrosis TIDAK
342 15/11/201 132117021117Y000349 0001705664463 WAGIATIN P PBI (APBD) Unspecified diabetes mellitus without TIDAK
343 15/11/201 132117021117Y000384 0001811757519 setyaningsih P PEKERJA MANDIRI Essential (primary) hypertension TIDAK
344 15/11/201 132117021117Y000331 0002007461924 WIJIATI P PBI (APBN) Haemarthrosis TIDAK
345 15/11/201 132117021117Y000336 0002007502457 SRI INDAYATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
346 15/11/201 132117021117Y000346 0002092744811 SAMAH P PEKERJA MANDIRI Unspecified diabetes mellitus without TIDAK
347 15/11/201 132117021117Y000326 0002265995632 SUMARNI P PEKERJA MANDIRI Other primary narthrosis YA
348 15/11/201 132117021117Y000340 0002272886965 BADRIATI P PEKERJA MANDIRI Gastric diverticulum TIDAK
349 15/11/201 132117021117Y000396 0002289141358 vino rafa aska putra L PBI (APBN) Acute upper respiratory infection, TIDAK
350 14/11/201 132117021117Y000312 0000107818323 NGADERI L VETERAN Unspecified diabetes mellitus with YA
351 14/11/201 132117021117Y000313 0000727842407 ROHANI P PBI (APBN) Unspecified diabetes mellitus without YA
352 14/11/201 132117021117Y000316 0000727882457 DWI RETNO ANGGRAINI P PBI (APBN) Retention of urine YA
353 14/11/201 132117021117Y000671 0000728013521 SRI UTAMI P PBI (APBN) Contraceptive management, TIDAK
354 14/11/201 132117021117Y000311 0000729261674 ROMLI L PBI (APBN) Ganglion YA
355 14/11/201 132117021117Y000317 0001043972368 ASMAUL HUSNAH P PBI (APBN) Contusion of other parts of wrist and YA
356 14/11/201 132117021117Y000670 0002007419488 RIZQIA MUSTAINAH P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
357 13/11/201 132117021117Y000293 0000108835018 TURAH P PENERIMA PENSIUN Essential (primary) hypertension TIDAK
358 13/11/201 132117021117Y000288 0000108835301 HARIS SUKMO HANTORO L PEKERJA MANDIRI Chronic renal failure, unspecified TIDAK
359 13/11/201 132117021117Y000292 0000727327866 BAJI L PBI (APBN) Acute dilatation of stomach TIDAK
360 13/11/201 132117021117Y000277 0000727448128 SUKARNI P PBI (APBN) Cellulitis of finger and toe TIDAK
361 13/11/201 132117021117Y000309 0000727586291 AHMAD KHARIS MAULANA L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
362 13/11/201 132117021117Y000284 0000727595212 SRI ANAHWATI P PBI (APBN) Contraceptive management, TIDAK
363 13/11/201 132117021117Y000290 0000727616373 ALVIAN ARSANDI PUTRA L PBI (APBN) Acute larynpharyngitis TIDAK
364 13/11/201 132117021117Y000266 0000727619523 SUYONO L PBI (APBN) Unspecified nephritic syndrome, other YA
365 13/11/201 132117021117Y000287 0000727661496 REGITSA DWI AKBAR L PBI (APBN) Typhoid fever TIDAK
366 13/11/201 132117021117Y000310 0000727678697 RUBIATIN P PBI (APBN) Acute dilatation of stomach TIDAK
367 13/11/201 132117021117Y000305 0000727708105 FILION BAGUS SETIAWAN L PBI (APBN) Local infection of skin and TIDAK
368 13/11/201 132117021117Y000294 0000727742169 ACHMAD L PBI (APBN) Acute dilatation of stomach TIDAK
369 13/11/201 132117021117Y000304 0000727755467 MUHAMMAD THORIQUL L PBI (APBN) Acute larynpharyngitis TIDAK
370 13/11/201 132117021117Y000286 0000727768225 SAMPINI P PBI (APBN) Essential (primary) hypertension TIDAK
371 13/11/201 132117021117Y000272 0000727824835 NURUL AZKA P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
372 13/11/201 132117021117Y000271 0000727847065 TOHADI L PBI (APBN) Calculus of prostate YA
373 13/11/201 132117021117Y000300 0000727860014 KASIANI P PBI (APBN) Acute larynpharyngitis TIDAK
374 13/11/201 132117021117Y000301 0000727860082 SRI WILUJENG P PBI (APBN) Acute larynpharyngitis TIDAK
375 13/11/201 132117021117Y000267 0000727909053 HERMIN P PBI (APBN) Low back pain YA
376 13/11/201 132117021117Y000281 0000728225875 REVALINA DEWI SURYA P PBI (APBN) Acute upper respiratory infection, TIDAK
377 13/11/201 132117021117Y000299 0000728379044 SARTIN P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
378 13/11/201 132117021117Y000285 0000728380899 KHOIRUNNISA P PBI (APBN) Contraceptive management, TIDAK
379 13/11/201 132117021117Y000279 0000728421107 NURLIKAH P PBI (APBN) Disease of stomach and duodenum, TIDAK
380 13/11/201 132117021117Y000302 0000728446307 SEPTIA RAMADANI P PBI (APBN) Acute larynpharyngitis TIDAK
381 13/11/201 132117021117Y000269 0000728502603 MAHMUD MIFTAH L PBI (APBN) Non-insulin-dependent diabetes YA
382 13/11/201 132117021117Y000275 0000728606902 AULIA QUIN VANESSA P PBI (APBN) Acute upper respiratory infection, TIDAK
383 13/11/201 132117021117Y000298 0000728614798 SRI SUKAMTI P PBI (APBN) Acute dilatation of stomach TIDAK
384 13/11/201 132117021117Y000314 0000728621098 NURUL MANIA P PBI (APBN) Contraceptive management, TIDAK
385 13/11/201 132117021117Y000265 0000728716746 SUTIKNO L PBI (APBN) End-stage renal disease YA
386 13/11/201 132117021117Y000274 0000729135652 MULYONO L PBI (APBN) Asthma, unspecified TIDAK
387 13/11/201 132117021117Y000303 0000729197054 PONISIH P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
388 13/11/201 132117021117Y000283 0000729526959 YANAH P PBI (APBN) Other and unspecified infectious TIDAK
389 13/11/201 132117021117Y000306 0001043973663 MUHAMMAD CATUR L PBI (APBN) Acute larynpharyngitis TIDAK
390 13/11/201 132117021117Y000307 0001043973696 NINIK HARIATI P PBI (APBN) Asphyxiation TIDAK
391 13/11/201 132117021117Y000308 0001043975968 SUTRI P PBI (APBN) Local infection of skin and TIDAK
392 13/11/201 132117021117Y000297 0001291914224 LILIK SETYOWATI P TNI ANGKATAN DARAT Diarrhoea and gastroenteritis of TIDAK
393 13/11/201 132117021117Y000273 0001705484248 KHUSAIRI L PBI (APBD) Other and unspecified infectious TIDAK
394 13/11/201 132117021117Y000315 0002007461643 NUR FADILAH P PBI (APBN) Contraceptive management, TIDAK
395 13/11/201 132117021117Y000296 0002007477448 RUM P PBI (APBN) Acute dilatation of stomach TIDAK
396 13/11/201 132117021117Y000270 0002007479204 SUNARTI P PBI (APBN) Bronchitis, not specified as acute or TIDAK
397 13/11/201 132117021117Y000280 0002007481061 JOKO PURNOMO L PBI (APBN) Unspecified diabetes mellitus without TIDAK
398 13/11/201 132117021117Y000282 0002007502222 NUR KHASANAH P PBI (APBN) Unilateral or unspecified femoral TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
399 13/11/201 132117021117Y000264 0002007502727 RUBI'AH P PBI (APBN) Cataract, unspecified YA
400 13/11/201 132117021117Y000295 0002022438262 SRI WILUJENG P PBI (APBN) Local infection of skin and TIDAK
401 13/11/201 132117021117Y000289 0002023544902 FAHMIHUDA L PBI (APBN) Cough TIDAK
402 13/11/201 132117021117Y000268 0002092744811 SAMAH P PEKERJA MANDIRI Non-insulin-dependent diabetes YA
403 13/11/201 132117021117Y000291 0002254525435 MUSLIKAH P PEKERJA MANDIRI Acute myocardial infarction, YA
404 13/11/201 132117021117Y000276 0002263761011 NUR SAADIYAH P PEKERJA MANDIRI Prolonged pregnancy YA
405 13/11/201 132117021117Y000278 0002269456378 SIHKANTI SUMAJANI P PEKERJA MANDIRI Unspecified diabetes mellitus with YA
406 11/11/201 132117021117Y000258 0000108835301 HARIS SUKMO HANTORO L PEKERJA MANDIRI Cushing's syndrome, unspecified TIDAK
407 11/11/201 132117021117Y000669 0000726401485 SUGIARTI P PBI (APBN) Contraceptive management, TIDAK
408 11/11/201 132117021117Y000260 0000727708105 FILION BAGUS SETIAWAN L PBI (APBN) Atopic dermatitis, unspecified YA
409 11/11/201 132117021117Y000261 0000727846413 SRIANAH P PBI (APBN) Headache TIDAK
410 11/11/201 132117021117Y000686 0000728380899 KHOIRUNNISA P PBI (APBN) Contraceptive management, TIDAK
411 11/11/201 132117021117Y000668 0000729610018 YULI SUSANTI P PBI (APBN) Contraceptive management, TIDAK
412 11/11/201 132117021117Y000259 0001078566737 ALI ERFAN L PNS DAERAH Pterygium YA
413 11/11/201 132117021117Y000263 0002007479204 SUNARTI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
414 11/11/201 132117021117Y000262 0002007516014 KHOLIFAH L PBI (APBN) Essential (primary) hypertension TIDAK
415 10/11/201 132117021117Y000250 0000098792469 SUNTINAH P VETERAN Chronic gastritis, unspecified YA
416 10/11/201 132117021117Y000256 0000108930969 IDA DWI PANTI ARINI P PNS DAERAH Unspecified diabetes mellitus without YA
417 10/11/201 132117021117Y000255 0000727732506 KUSWATININGSIH P PBI (APBN) Thyrotoxicosis, unspecified YA
418 10/11/201 132117021117Y000685 0000727904079 MUSLIKATIN P PBI (APBN) Contraceptive management, TIDAK
419 10/11/201 132117021117Y000253 0000728449042 KARTONO L PBI (APBN) Iron deficiency anaemia, unspecified YA

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
420 10/11/201 132117021117Y000254 0000729368572 LILIS FARIDA P PBI (APBN) End-stage renal disease YA
421 10/11/201 132117021117Y000251 0000729409421 SUTRAMI P PBI (APBN) Low back pain YA
422 10/11/201 132117021117Y000252 0001535808802 ADI SUWANTO L PEGAWAI SWASTA Stroke, not specified as haemorrhage YA
423 10/11/201 132117021117Y000257 0002087525193 MUCHAMMAD OKTA L PBI (APBN) Epilepsy, unspecified YA
424 09/11/201 132117021117Y000233 0000109074734 PARMIATI P PNS DAERAH Myalgia TIDAK
425 09/11/201 132117021117Y000235 0000109183678 MASITHOH RORO P PNS DAERAH Cough TIDAK
426 09/11/201 132117021117Y000245 0000727516102 YULIATIN P PBI (APBN) Local infection of skin and TIDAK
427 09/11/201 132117021117Y000232 0000727604482 KUSTIN P PBI (APBN) Acute larynpharyngitis TIDAK
428 09/11/201 132117021117Y000231 0000727685627 ENI IFTITAH P PBI (APBN) Contraceptive management, TIDAK
429 09/11/201 132117021117Y000230 0000727720165 WIWIK INDAH SARI P PBI (APBN) Contraceptive management, TIDAK
430 09/11/201 132117021117Y000247 0000727745455 JEBEN WINARTI P PBI (APBN) Local infection of skin and TIDAK
431 09/11/201 132117021117Y000248 0000727755996 SRI GANTI P PBI (APBN) Acute dilatation of stomach TIDAK
432 09/11/201 132117021117Y000229 0000727783852 RIKA NURHAYATI P PBI (APBN) Benign neoplasm of stomach YA
433 09/11/201 132117021117Y000238 0000728160017 MUHAMMAD ARIKI L PBI (APBN) Acute dilatation of stomach TIDAK
434 09/11/201 132117021117Y000240 0000728186466 MUHAMMAD DIAN L PBI (APBN) Acute larynpharyngitis TIDAK
435 09/11/201 132117021117Y000237 0000728270201 AHMAD SAIKU L PBI (APBN) Acute larynpharyngitis TIDAK
436 09/11/201 132117021117Y000234 0000728599476 SUDARMI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
437 09/11/201 132117021117Y000242 0000728599814 SITI NUR ASIYAH P PBI (APBN) Supervision of pregnancy with history TIDAK
438 09/11/201 132117021117Y000228 0000728715194 mega oktavia saputri P PBI (APBN) Trichomoniasis, unspecified YA
439 09/11/201 132117021117Y000244 0000728845931 UMI KULSUM P PBI (APBN) Essential (primary) hypertension TIDAK
440 09/11/201 132117021117Y000239 0001043973685 EDI SUHARMONO L PBI (APBN) Cough TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
441 09/11/201 132117021117Y000249 0001043977566 WIJI UTAMI P PBI (APBN) Cough TIDAK
442 09/11/201 132117021117Y000241 0001705485126 SUHARTATIK P PBI (APBD) Asphyxiation TIDAK
443 09/11/201 132117021117Y000236 0001801292894 SULAS SETIO NINGSIH P PNS DAERAH Acute larynpharyngitis TIDAK
444 09/11/201 132117021117Y000243 0001963863167 sukinah P PNS DAERAH Cough TIDAK
445 09/11/201 132117021117Y000246 0001964515476 SIH SAYEKTI P PEKERJA MANDIRI Non-insulin-dependent diabetes TIDAK
446 09/11/201 132117021117Y000226 0002007480982 SITI RUBAIYAH P PBI (APBN) Glaucoma, unspecified YA
447 09/11/201 132117021117Y000227 0002007499735 SAMIONO L PBI (APBN) Unspecified diabetes mellitus without YA
448 08/11/201 132117021117Y000215 0000108246598 MAMNUN L PNS DAERAH Joint disorder, unspecified TIDAK
449 08/11/201 132117021117Y000208 0000108808211 SUMARLIK P PNS DAERAH Congestive heart failure YA
450 08/11/201 132117021117Y000202 0000109132132 KRISTANTINE EDI P PNS DAERAH Hypermetropia YA
451 08/11/201 132117021117Y000223 0000109135855 TJIPTO ADI L PNS DAERAH Non-insulin-dependent diabetes YA
452 08/11/201 132117021117Y000221 0000109176693 GINI SUSANTI P PNS DAERAH Dizziness and giddiness TIDAK
453 08/11/201 132117021117Y000225 0000109176704 DHAMAR WAHYU HIDAYAT L PNS DAERAH Other specified local infections of skin TIDAK
454 08/11/201 132117021117Y000210 0000110111038 MUAWANAH JD M. GUFRON, P PENERIMA PENSIUN Cataract, unspecified YA
455 08/11/201 132117021117Y000224 0000207371968 kairul lianah P PNS DAERAH Stroke, not specified as haemorrhage YA
456 08/11/201 132117021117Y000683 0000727720165 WIWIK INDAH SARI P PBI (APBN) Contraceptive management, TIDAK
457 08/11/201 132117021117Y000217 0000728204602 ZAENURI L PBI (APBN) Essential (primary) hypertension TIDAK
458 08/11/201 132117021117Y000666 0000728522335 SRI WILUJENG P PBI (APBN) Surveillance of (intrauterine) TIDAK
459 08/11/201 132117021117Y000216 0000728728929 CHICA PUTRI SUGIANTI P PBI (APBN) Fibroadenosis of breast YA
460 08/11/201 132117021117Y000213 0000729135652 MULYONO L PBI (APBN) Asthma, unspecified TIDAK
461 08/11/201 132117021117Y000667 0000729265252 RENI WAHYUNI P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
462 08/11/201 132117021117Y000218 0000729609524 M SUMALI L PBI (APBN) Acute dilatation of stomach TIDAK
463 08/11/201 132117021117Y000200 0001316094952 HADI SUWONO L PEKERJA MANDIRI Other and unspecified cirrhosis of liver YA
464 08/11/201 132117021117Y000219 0001705484259 MA'RUFAN P PBI (APBD) Asthma, unspecified TIDAK
465 08/11/201 132117021117Y000220 0001705485609 INDAYAH P PBI (APBD) Acute upper respiratory infection, TIDAK
466 08/11/201 132117021117Y000222 0002007443564 SITI SAADAH P PBI (APBN) Hypertensive heart disease with YA
467 08/11/201 132117021117Y000214 0002007500534 SUWATI P PBI (APBN) Cough TIDAK
468 08/11/201 132117021117Y000197 0002059516912 ACHMAD SUBADI L PEKERJA MANDIRI Low back pain YA
469 08/11/201 132117021117Y000198 0002059517744 TINI SAIDAH P PEKERJA MANDIRI Hypertensive heart disease with YA
470 07/11/201 132117021117Y000190 0000108775809 NIKEN DWI TRISNANINGATI P PNS DAERAH Acute upper respiratory infection, TIDAK
471 07/11/201 132117021117Y000184 0000109130826 CHABIBULLOH L PNS DAERAH Urinary calculus, unspecified YA
472 07/11/201 132117021117Y000189 0000109234607 SUHARTONO L PNS DAERAH Unspecified renal colic YA
473 07/11/201 132117021117Y000370 0000727607452 SUMINTARSIH P PBI (APBN) Myalgia TIDAK
474 07/11/201 132117021117Y000684 0000727685627 ENI IFTITAH P PBI (APBN) Contraceptive management, TIDAK
475 07/11/201 132117021117Y000188 0000727792806 SRI HERMIATI P PBI (APBN) Asthma, unspecified TIDAK
476 07/11/201 132117021117Y000187 0000728152727 ELIN NADILA ANJELITA P PBI (APBN) Localization-related (focal) (partial) TIDAK
477 07/11/201 132117021117Y000181 0000728153763 MUHAMMAD SYAIFUDDIN L PBI (APBN) Acute tonsillitis, unspecified YA
478 07/11/201 132117021117Y000180 0000728215018 SALAMAH P PBI (APBN) Stroke, not specified as haemorrhage YA
479 07/11/201 132117021117Y000194 0000728311792 ANAM MA'RUF L PBI (APBN) Essential (primary) hypertension TIDAK
480 07/11/201 132117021117Y000191 0000728344056 SUPRIATEN P PBI (APBN) Non-insulin-dependent diabetes TIDAK
481 07/11/201 132117021117Y000374 0000728488247 SIANIK P PBI (APBN) Stiffness of joint, not elsewhere TIDAK
482 07/11/201 132117021117Y000665 0000728549414 JAYANTI PURNANING TYAS P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
483 07/11/201 132117021117Y000373 0000728679126 SRIGATI P PBI (APBN) Other acute gastritis TIDAK
484 07/11/201 132117021117Y000195 0000729294265 SUBARI L PBI (APBN) Tuberculosis of lung, confirmed by TIDAK
485 07/11/201 132117021117Y000182 0000729338051 MOHAMMAD FERNANDO L PBI (APBN) Fracture of lower leg, part unspecified YA
486 07/11/201 132117021117Y000664 0001043992754 ANI TRISNAWATI P PBI (APBN) Contraceptive management, TIDAK
487 07/11/201 132117021117Y000199 0001043992754 ANI TRISNAWATI P PBI (APBN) Contraceptive management, TIDAK
488 07/11/201 132117021117Y000371 0001043993529 SRI MULYATI P PBI (APBN) Essential (primary) hypertension TIDAK
489 07/11/201 132117021117Y000183 0001432839431 lumunturingsih P PEKERJA MANDIRI Unspecified diabetes mellitus with YA
490 07/11/201 132117021117Y000192 0001705484248 KHUSAIRI L PBI (APBD) Essential (primary) hypertension TIDAK
491 07/11/201 132117021117Y000193 0001811757519 setyaningsih P PEKERJA MANDIRI Essential (primary) hypertension TIDAK
492 07/11/201 132117021117Y000196 0001971226282 DIAN NOVITA DEVI P PEKERJA MANDIRI Myalgia TIDAK
493 07/11/201 132117021117Y000185 0002007463037 SODIK L PBI (APBN) Low back pain YA
494 07/11/201 132117021117Y000201 0002007465276 SRI ISWIDAYATI P PBI (APBN) Idiopathic ut TIDAK
495 07/11/201 132117021117Y000186 0002007479204 SUNARTI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
496 07/11/201 132117021117Y000663 0002007501985 ZULI NURFARICHAH P PBI (APBN) Contraceptive management, TIDAK
497 06/11/201 132117021117Y000145 0000108800144 SUPI HANDAYANIK P PNS DAERAH Acute larynpharyngitis TIDAK
498 06/11/201 132117021117Y000137 0000108807568 NYOTO ROHADI L PNS DAERAH Other peripheral verti YA
499 06/11/201 132117021117Y000155 0000109176704 DHAMAR WAHYU HIDAYAT L PNS DAERAH Other specified local infections of skin TIDAK
500 06/11/201 132117021117Y000587 0000195165786 SITI NUR ABIDAH P PNS PUSAT Contraceptive management, TIDAK
501 06/11/201 132117021117Y000134 0000726411058 SUJONO L PBI (APBN) Cataract, unspecified YA
502 06/11/201 132117021117Y000205 0000726431635 NARISAH P PBI (APBN) Acute dilatation of stomach TIDAK
503 06/11/201 132117021117Y000162 0000727448128 SUKARNI P PBI (APBN) Acute dilatation of stomach TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
504 06/11/201 132117021117Y000125 0000727491047 SULAIMAN L PBI (APBN) Injury, unspecified YA
505 06/11/201 132117021117Y000166 0000727529297 SAPTO PRIJONO P PBI (APBN) Myalgia TIDAK
506 06/11/201 132117021117Y000178 0000727661496 REGITSA DWI AKBAR L PBI (APBN) Typhoid fever TIDAK
507 06/11/201 132117021117Y000130 0000727663623 ZUNAIDAH P PBI (APBN) Unspecified diabetes mellitus without YA
508 06/11/201 132117021117Y000207 0000727725879 ABID AMIRUDDIN L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
509 06/11/201 132117021117Y000153 0000727753072 KADARWATI P PBI (APBN) Acute dilatation of stomach TIDAK
510 06/11/201 132117021117Y000143 0000727760327 VIMAYA INTAN PUSPITA P PBI (APBN) Supervision of high-risk pregnancy, TIDAK
511 06/11/201 132117021117Y000172 0000727768225 SAMPINI P PBI (APBN) Acute dilatation of stomach TIDAK
512 06/11/201 132117021117Y000170 0000727846413 SRIANAH P PBI (APBN) Essential (primary) hypertension TIDAK
513 06/11/201 132117021117Y000584 0000727852937 RISMA ANDRIANI P PBI (APBN) Contraceptive management, TIDAK
514 06/11/201 132117021117Y000211 0000727865109 MUNAWAROH P PBI (APBN) Non-insulin-dependent diabetes TIDAK
515 06/11/201 132117021117Y000146 0000727867664 KUSNADI L PBI (APBN) Chest pain, unspecified YA
516 06/11/201 132117021117Y000156 0000727895474 MISTIAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
517 06/11/201 132117021117Y000212 0000728009638 RUPIAH P PBI (APBN) Essential (primary) hypertension TIDAK
518 06/11/201 132117021117Y000149 0000728058611 IMROATUL HASANAH P PBI (APBN) Candidiasis of vulva and vagina TIDAK
519 06/11/201 132117021117Y000148 0000728133243 ISWANTO L PBI (APBN) Myalgia TIDAK
520 06/11/201 132117021117Y000151 0000728152727 ELIN NADILA ANJELITA P PBI (APBN) Acute larynpharyngitis TIDAK
521 06/11/201 132117021117Y000176 0000728157161 SITI RUQOIYAH P PBI (APBN) Acute dilatation of stomach TIDAK
522 06/11/201 132117021117Y000136 0000728175947 SUMIRAH P PBI (APBN) Contraceptive management, TIDAK
523 06/11/201 132117021117Y000128 0000728215018 SALAMAH P PBI (APBN) Stroke, not specified as haemorrhage YA
524 06/11/201 132117021117Y000583 0000728406988 RODIYAH P PBI (APBN) Contraceptive management, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
525 06/11/201 132117021117Y000158 0000728416427 FADELI L PBI (APBN) Asphyxiation TIDAK
526 06/11/201 132117021117Y000174 0000728496549 SUMARNI P PBI (APBN) Essential (primary) hypertension TIDAK
527 06/11/201 132117021117Y000132 0000728526532 NGATILAH P PBI (APBN) Hypertensive heart disease with YA
528 06/11/201 132117021117Y000169 0000728527375 SUWITO L PBI (APBN) Myalgia TIDAK
529 06/11/201 132117021117Y000147 0000728599476 SUDARMI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
530 06/11/201 132117021117Y000144 0000728599814 SITI NUR ASIYAH P PBI (APBN) Supervision of pregnancy with history TIDAK
531 06/11/201 132117021117Y000168 0000728602661 LILIS NURAINI P PBI (APBN) Myalgia TIDAK
532 06/11/201 132117021117Y000152 0000728603436 AGUNG ELLY SANTOSO L PBI (APBN) Cough TIDAK
533 06/11/201 132117021117Y000150 0000728603921 NURFAENI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
534 06/11/201 132117021117Y000126 0000728721821 lasmi P PBI (APBN) Unspecified diabetes mellitus with YA
535 06/11/201 132117021117Y000160 0000728845931 UMI KULSUM P PBI (APBN) Essential (primary) hypertension TIDAK
536 06/11/201 132117021117Y000206 0000729178773 JUNIA BINTANG NURIL P PBI (APBN) Other specified local infections of skin TIDAK
537 06/11/201 132117021117Y000157 0000729261933 SAMIONO L PBI (APBN) Essential (primary) hypertension TIDAK
538 06/11/201 132117021117Y000203 0000729294265 SUBARI L PBI (APBN) Cough TIDAK
539 06/11/201 132117021117Y000161 0000729344463 SARPUK P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
540 06/11/201 132117021117Y000179 0001043976475 SUPARMI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
541 06/11/201 132117021117Y000133 0001043976622 AFRIAN YUDI FERNANDA L PBI (APBN) Hebephrenic schizophrenia YA
542 06/11/201 132117021117Y000163 0001043976655 SITI MURIPAH P PBI (APBN) Essential (primary) hypertension TIDAK
543 06/11/201 132117021117Y000164 0001043977566 WIJI UTAMI P PBI (APBN) Myalgia TIDAK
544 06/11/201 132117021117Y000209 0001043991639 SAMIRAH P PBI (APBN) Essential (primary) hypertension TIDAK
545 06/11/201 132117021117Y000367 0001043993529 SRI MULYATI P PBI (APBN) General counselling and advice on TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
546 06/11/201 132117021117Y000124 0001283792499 PARNI P PEKERJA MANDIRI Bell's palsy YA
547 06/11/201 132117021117Y000171 0001291914224 LILIK SETYOWATI P TNI ANGKATAN DARAT Acute larynpharyngitis TIDAK
548 06/11/201 132117021117Y000154 0001297863009 SAI'IN L PEKERJA MANDIRI Joint disorder, unspecified TIDAK
549 06/11/201 132117021117Y000135 0001301545146 dewangga ardhiana habibi L PEKERJA MANDIRI Tuberculosis of lung, without mention YA
550 06/11/201 132117021117Y000129 0001438790141 FITRIA RIZQI NERAZZURI P PEKERJA MANDIRI Acute upper respiratory infection, YA
551 06/11/201 132117021117Y000131 0001445438316 HENDI SAPUTRA L PEKERJA MANDIRI Status epilepticus, unspecified YA
552 06/11/201 132117021117Y000366 0001478918136 devan imanuel L PNS DAERAH Acute nasopharyngitis [common cold] TIDAK
553 06/11/201 132117021117Y000159 0001540943796 SITI CHOIRUN NISAK P PEGAWAI SWASTA Acute nasopharyngitis [common cold] TIDAK
554 06/11/201 132117021117Y000175 0001964926473 ERWIN DESY ARINDA P PEKERJA MANDIRI Acute larynpharyngitis TIDAK
555 06/11/201 132117021117Y000142 0002007426666 YULIANA MURDANING RUM P PBI (APBN) Other and unspecified ovarian cysts YA
556 06/11/201 132117021117Y000123 0002007461777 MARDIYAH P PEKERJA MANDIRI Acute cholecystitis YA
557 06/11/201 132117021117Y000127 0002007463026 MUSLICHAH P PBI (APBN) Thyrotoxicosis, unspecified YA
558 06/11/201 132117021117Y000167 0002007475661 INDAH SUSANTO P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
559 06/11/201 132117021117Y000177 0002007477584 ZULAIKAH P PBI (APBN) Local infection of skin and TIDAK
560 06/11/201 132117021117Y000173 0002007497259 NURUL FATIHATUS. S L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
561 06/11/201 132117021117Y000165 0002007501849 SIANTI P PBI (APBN) Pure hypercholesterolaemia TIDAK
562 06/11/201 132117021117Y000138 0002060259862 SOLIKIN L PEKERJA MANDIRI Intracerebral haemorrhage, unspecified YA
563 06/11/201 132117021117Y000204 0002290528787 WIWIN NURUSSOBA P PEKERJA MANDIRI Acute nasopharyngitis [common cold] TIDAK
564 04/11/201 132117021117Y000141 0000107918109 MOCH. BISRIE L PENERIMA PENSIUN Acute nasopharyngitis [common cold] TIDAK
565 04/11/201 132117021117Y000096 0000110088944 SALASAH JD.SAIMIN P VETERAN Chronic obstructive pulmonary disease, YA
566 04/11/201 132117021117Y000102 0000726388986 SITI ALIYAH P PBI (APBN) Essential (primary) hypertension TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
567 04/11/201 132117021117Y000122 0000727512614 BIBIT RINA OFTANTI P PBI (APBN) Myalgia TIDAK
568 04/11/201 132117021117Y000121 0000727679103 ACHMAD BASOFI P L PBI (APBN) Acute dilatation of stomach TIDAK
569 04/11/201 132117021117Y000120 0000727685627 ENI IFTITAH P PBI (APBN) Acute dilatation of stomach TIDAK
570 04/11/201 132117021117Y000114 0000727697305 GINTEN P PBI (APBN) Essential (primary) hypertension TIDAK
571 04/11/201 132117021117Y000140 0000727710985 SULIANAH P PBI (APBN) Myalgia TIDAK
572 04/11/201 132117021117Y000107 0000727752205 LESTARI NURHANA P PBI (APBN) Myalgia TIDAK
573 04/11/201 132117021117Y000092 0000727754725 SISWATI P PBI (APBN) Epistaxis TIDAK
574 04/11/201 132117021117Y000119 0000727762871 SRI ENDAH WAHYUNINGSIH P PBI (APBN) Local infection of skin and TIDAK
575 04/11/201 132117021117Y000117 0000727783852 RIKA NURHAYATI P PBI (APBN) Myalgia TIDAK
576 04/11/201 132117021117Y000109 0000727823169 SRI RAHAYU P PBI (APBN) Essential (primary) hypertension TIDAK
577 04/11/201 132117021117Y000139 0000727846795 MUSLIKAH P PBI (APBN) Myalgia TIDAK
578 04/11/201 132117021117Y000115 0000727867664 KUSNADI L PBI (APBN) Essential (primary) hypertension TIDAK
579 04/11/201 132117021117Y000098 0000727903258 NUR KHASANAH P PBI (APBN) Contraceptive management, TIDAK
580 04/11/201 132117021117Y000099 0000728075698 SUNTINAH P PBI (APBN) Essential (primary) hypertension TIDAK
581 04/11/201 132117021117Y000104 0000728146089 YANTI P PBI (APBN) Contraceptive management, TIDAK
582 04/11/201 132117021117Y000111 0000728514369 MEIRISKA DWI KHARISMA P PBI (APBN) Acute larynpharyngitis TIDAK
583 04/11/201 132117021117Y000112 0000728594368 SUHARTO L PBI (APBN) Acute dilatation of stomach TIDAK
584 04/11/201 132117021117Y000108 0000728856369 ZULAIKAH P PBI (APBN) Acute dilatation of stomach TIDAK
585 04/11/201 132117021117Y000105 0000729590951 SUJIATI P PBI (APBN) Essential (primary) hypertension TIDAK
586 04/11/201 132117021117Y000101 0000729647537 SUPARTI P PBI (APBN) Essential (primary) hypertension TIDAK
587 04/11/201 132117021117Y000116 0001043977566 WIJI UTAMI P PBI (APBN) Non-insulin-dependent diabetes TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
588 04/11/201 132117021117Y000088 0001851288175 SIH NIYATI P PEKERJA MANDIRI Congestive heart failure YA
589 04/11/201 132117021117Y000091 0001907528354 nadira maulidia agustin P PEKERJA MANDIRI Acute upper respiratory infection, YA
590 04/11/201 132117021117Y000103 0002007475593 ALIYAH P PBI (APBN) Essential (primary) hypertension TIDAK
591 04/11/201 132117021117Y000118 0002007477448 RUM P PBI (APBN) Acute dilatation of stomach TIDAK
592 04/11/201 132117021117Y000113 0002007477516 MARYUNAH P PBI (APBN) Myalgia TIDAK
593 04/11/201 132117021117Y000100 0002007478877 SUGIATI WANINGSIH P PBI (APBN) Contraceptive management, TIDAK
594 04/11/201 132117021117Y000662 0002007499522 SRI WAHYUNI P PBI (APBN) Contraceptive management, TIDAK
595 04/11/201 132117021117Y000110 0002021231621 RAHMAD UBAIDILLAH L PBI (APBN) Acute dilatation of stomach TIDAK
596 04/11/201 132117021117Y000106 0002092744811 SAMAH P PEKERJA MANDIRI Essential (primary) hypertension TIDAK
597 04/11/201 132117021117Y000097 0002195257331 SARIONO L PEGAWAI SWASTA Essential (primary) hypertension TIDAK
598 03/11/201 132117021117Y000094 0000107903013 SUTARTI P PENERIMA PENSIUN Other acute gastritis TIDAK
599 03/11/201 132117021117Y000087 0000109127619 RINA EKO HENDRIANI P PNS DAERAH Congestive heart failure YA
600 03/11/201 132117021117Y000084 0000728060657 IMAH P PBI (APBN) Acute dilatation of stomach TIDAK
601 03/11/201 132117021117Y000083 0002007515621 MULYONO L PBI (APBN) Epilepsy, unspecified YA
602 03/11/201 132117021117Y000085 0002020089925 SUYITNO L PBI (APBN) Stroke, not specified as haemorrhage YA
603 03/11/201 132117021117Y000086 0002285826658 marisa anindya fauziyah P PBI (APBN) Congenital deformity of feet, YA
604 02/11/201 132117021117Y000072 0000108800144 SUPI HANDAYANIK P PNS DAERAH Myalgia TIDAK
605 02/11/201 132117021117Y000039 0000109132569 MUKHAMAD FARHAN SY L PNS DAERAH Other atopic dermatitis YA
606 02/11/201 132117021117Y000076 0000109183678 MASITHOH RORO P PNS DAERAH Cough TIDAK
607 02/11/201 132117021117Y000093 0000727365205 TRI DIYAH AMBAR WATI P PBI (APBN) Essential (primary) hypertension TIDAK
608 02/11/201 132117021117Y000078 0000727538995 UKHIBBATUN UKHTIYAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
609 02/11/201 132117021117Y000070 0000727632156 SUPRAPTI P PBI (APBN) Non-insulin-dependent diabetes TIDAK
610 02/11/201 132117021117Y000049 0000727683309 WARAS UMAR L PBI (APBN) Acute dilatation of stomach TIDAK
611 02/11/201 132117021117Y000066 0000727707791 ABDUL ROKIM L PBI (APBN) Acute dilatation of stomach TIDAK
612 02/11/201 132117021117Y000082 0000727710985 SULIANAH P PBI (APBN) Myalgia TIDAK
613 02/11/201 132117021117Y000077 0000727713731 SARMO L PBI (APBN) Asphyxiation TIDAK
614 02/11/201 132117021117Y000040 0000727716159 RETI P PBI (APBN) Cataract, unspecified YA
615 02/11/201 132117021117Y000062 0000727754725 SISWATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
616 02/11/201 132117021117Y000038 0000727784144 MARMAN L PBI (APBN) Chronic obstructive pulmonary disease, YA
617 02/11/201 132117021117Y000050 0000727800311 PATOAH P PBI (APBN) Essential (primary) hypertension TIDAK
618 02/11/201 132117021117Y000058 0000727821819 SITI ZULAIKAH P PBI (APBN) Multiple valve disease, unspecified TIDAK
619 02/11/201 132117021117Y000054 0000727840258 ISMIATI P PBI (APBN) Contraceptive management, TIDAK
620 02/11/201 132117021117Y000063 0000727860014 KASIANI P PBI (APBN) Cough TIDAK
621 02/11/201 132117021117Y000065 0000727895474 MISTIAH P PBI (APBN) Myalgia TIDAK
622 02/11/201 132117021117Y000090 0000728223298 WIJI SRI WAHYUNI P PBI (APBN) Myalgia TIDAK
623 02/11/201 132117021117Y000075 0000728460865 HARTIYANI P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
624 02/11/201 132117021117Y000064 0000728602841 NOVI DWI LESTARI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
625 02/11/201 132117021117Y000046 0000729135652 MULYONO L PBI (APBN) Asthma, unspecified TIDAK
626 02/11/201 132117021117Y000073 0000729506395 WIWIK PUJI ASTUTIK P PBI (APBN) Acute upper respiratory infection, TIDAK
627 02/11/201 132117021117Y000067 0000729570666 WARSI P PBI (APBN) Myalgia TIDAK
628 02/11/201 132117021117Y000047 0001043992282 RIDWAN SYAHIDA L PBI (APBN) Typhoid fever TIDAK
629 02/11/201 132117021117Y000079 0001428873579 RIANI P PEKERJA MANDIRI Acute dilatation of stomach TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
630 02/11/201 132117021117Y000080 0001452263051 SHOLIKHAH P PENERIMA PENSIUN Acute dilatation of stomach TIDAK
631 02/11/201 132117021117Y000048 0001705484248 KHUSAIRI L PBI (APBD) Essential (primary) hypertension TIDAK
632 02/11/201 132117021117Y000060 0001864029947 MUHAMMAD ZIDAN L PEKERJA MANDIRI Acute nasopharyngitis [common cold] TIDAK
633 02/11/201 132117021117Y000061 0001963863167 sukinah P PNS DAERAH Acute dilatation of stomach TIDAK
634 02/11/201 132117021117Y000051 0002007437297 MASDJUDI L PBI (APBN) Idiopathic ut TIDAK
635 02/11/201 132117021117Y000068 0002007462251 SITI MUHAYANAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
636 02/11/201 132117021117Y000069 0002007462429 SITI MUASOMAH P PBI (APBN) Myalgia TIDAK
637 02/11/201 132117021117Y000081 0002007464578 ARIK CHUSNUL S. P PBI (APBN) Acute dilatation of stomach TIDAK
638 02/11/201 132117021117Y000052 0002007478214 VIKY MAULANA ARIFUDIN L PBI (APBN) Cough TIDAK
639 02/11/201 132117021117Y000045 0002007478473 SUNARSIH P PBI (APBN) Cataract, unspecified YA
640 02/11/201 132117021117Y000071 0002007479744 SUPARMI P PBI (APBN) Myalgia TIDAK
641 02/11/201 132117021117Y000042 0002007479799 SULASTRI P PBI (APBN) Cataract, unspecified YA
642 02/11/201 132117021117Y000041 0002007496708 KARIYONO L PBI (APBN) Congestive heart failure YA
643 02/11/201 132117021117Y000074 0002021231621 RAHMAD UBAIDILLAH L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
644 02/11/201 132117021117Y000059 0002236158011 ALEXANDER JUANDRA L PEKERJA MANDIRI Acute nasopharyngitis [common cold] TIDAK
645 01/11/201 132117021117Y000057 0000107946584 PAIDIN L PENERIMA PENSIUN Myalgia TIDAK
646 01/11/201 132117021117Y000012 0000726377646 LULUK FARIDA P PBI (APBN) Myalgia TIDAK
647 01/11/201 132117021117Y000013 0000726404984 MUKHAYATIN. P PBI (APBN) Acute dilatation of stomach TIDAK
648 01/11/201 132117021117Y000014 0000726406143 NURUL AVITA P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
649 01/11/201 132117021117Y000015 0000726407864 KARNIATI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
650 01/11/201 132117021117Y000016 0000726408213 LUTFIA ZAKIA P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
651 01/11/201 132117021117Y000018 0000726410799 SITI FATIMAH P PBI (APBN) Acute upper respiratory infection, TIDAK
652 01/11/201 132117021117Y000019 0000726411014 DESI RATNASARI P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
653 01/11/201 132117021117Y000021 0000726411464 SRIATI P PBI (APBN) Myalgia TIDAK
654 01/11/201 132117021117Y000022 0000726412037 NURUL KALAMIYAH P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
655 01/11/201 132117021117Y000024 0000726414704 MUSRIATIN P PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
656 01/11/201 132117021117Y000003 0000726843363 SOMO L PBI (APBN) Disease of stomach and duodenum, TIDAK
657 01/11/201 132117021117Y000044 0000727632156 SUPRAPTI P PBI (APBN) Respiratory tuberculosis unspecified, TIDAK
658 01/11/201 132117021117Y000029 0000727697305 GINTEN P PBI (APBN) Non-insulin-dependent diabetes TIDAK
659 01/11/201 132117021117Y000028 0000727718613 DARTIK YUNIATI L PBI (APBN) Myalgia TIDAK
660 01/11/201 132117021117Y000010 0000727729918 PAINO L PBI (APBN) Tuberculosis of lung, without mention YA
661 01/11/201 132117021117Y000031 0000727755996 SRI GANTI P PBI (APBN) Essential (primary) hypertension TIDAK
662 01/11/201 132117021117Y000043 0000727813934 LENI ZAKIYATUL FUADAH P PBI (APBN) Disease of stomach and duodenum, TIDAK
663 01/11/201 132117021117Y000027 0000727822517 PUJI TRIASIH P PBI (APBN) Essential (primary) hypertension TIDAK
664 01/11/201 132117021117Y000011 0000727957102 ELHAM EDIWANTO L PBI (APBN) Other and unspecified infectious TIDAK
665 01/11/201 132117021117Y000025 0000728152727 ELIN NADILA ANJELITA P PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
666 01/11/201 132117021117Y000095 0000728223298 WIJI SRI WAHYUNI P PBI (APBN) Myalgia TIDAK
667 01/11/201 132117021117Y000053 0000728233907 M BELLEN SUDIJAYA L PBI (APBN) Acute upper respiratory infection, TIDAK
668 01/11/201 132117021117Y000020 0000728382543 M MANSYUR L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
669 01/11/201 132117021117Y000017 0000728511783 SUHARTI P PBI (APBN) Essential (primary) hypertension TIDAK
670 01/11/201 132117021117Y000089 0000728526385 SUGIARTI P PBI (APBN) Other acute gastritis TIDAK
671 01/11/201 132117021117Y000005 0000728597079 MOHAMMAD ARSHI ILHAM L PBI (APBN) Acute upper respiratory infection, TIDAK

05/12/2017 03.21.28
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO (1307)


FKTP : KESAMBEN NGORO (13211702)

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK
672 01/11/201 132117021117Y000034 0000728828763 NGATOMO L PBI (APBN) Asphyxiation TIDAK
673 01/11/201 132117021117Y000035 0000728849182 DEA AVITASARI P PBI (APBN) Cough TIDAK
674 01/11/201 132117021117Y000006 0000729409421 SUTRAMI P PBI (APBN) Essential (primary) hypertension TIDAK
675 01/11/201 132117021117Y000033 0001043974822 DARSI P PBI (APBN) Asphyxiation TIDAK
676 01/11/201 132117021117Y000023 0001043976161 WAHYUNI SUCI UTAMI P PBI (APBN) Ocular pain TIDAK
677 01/11/201 132117021117Y000007 0001043994576 SUTRISNO L PBI (APBN) Diarrhoea and gastroenteritis of TIDAK
678 01/11/201 132117021117Y000001 0001315145316 RINA PURWATI P PEKERJA MANDIRI Undifferentiated schizophrenia YA
679 01/11/201 132117021117Y000030 0001320111865 MUJAYANAH P PEKERJA MANDIRI Myalgia TIDAK
680 01/11/201 132117021117Y000002 0001380239616 ENDIT LUGITO L PEKERJA MANDIRI Chronic obstructive pulmonary disease, YA
681 01/11/201 132117021117Y000036 0001452263051 SHOLIKHAH P PENERIMA PENSIUN Essential (primary) hypertension TIDAK
682 01/11/201 132117021117Y000009 0001705485148 ATIK PURWANING TYAS P PBI (APBD) Acute dilatation of stomach TIDAK
683 01/11/201 132117021117Y000037 0001963863167 sukinah P PNS DAERAH Acute dilatation of stomach TIDAK
684 01/11/201 132117021117Y000008 0002007480306 MARLULUK P PBI (APBN) Acute dilatation of stomach TIDAK
685 01/11/201 132117021117Y000004 0002007502143 JAMILAH P PBI (APBN) Unspecified acute lower respiratory TIDAK
686 01/11/201 132117021117Y000055 0002020123348 FIQRI AKBAR SYAWALUDIN L PBI (APBN) Acute upper respiratory infection, TIDAK
687 01/11/201 132117021117Y000032 0002023141217 SILFA AZZAHRA P PBI (APBN) Local infection of skin and TIDAK
688 01/11/201 132117021117Y000026 0002023544902 FAHMIHUDA L PBI (APBN) Acute nasopharyngitis [common cold] TIDAK
689 01/11/201 132117021117Y000056 0002236171217 SARIANI NATSIR ASSA P PEKERJA MANDIRI Dental caries, unspecified TIDAK

05/12/2017 03.21.28

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