BCP PERAWAT GIGI AHLI (BUKTI CATATAN PRIBADI/ HARIAN)

Nama : Suci Rokhani, S.S.T.

NIP : 19610428 198107 2 001
Pangkat/ Gol : Pembina, IVa
Jabatan : Perawat Gigi Ahli Madya
Bulan : Juni 2019
Puskesmas : Mergangsan

NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

1 02-01-2020 25304 RAHAYU MULYONO 64 L L [K04.1/L] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

2 90708 ALYA NAFI UMMAH 6 L P [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

3 27843 RADITYA MUSYAFFA URDHA 10 L L [K02.2/B] Caries of cementum [558] TumpatanGlass Ionomer 1 1 1
3 3 1

4 03-01-2020 91030 AENUN ANISAH 22 B P [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 1 2

5 47560 SITI DJAMILAH 74 L P [K04.1/B] Necrosis of pulp [298] Premedikasi 1 1

2 2 1 1 2

6 04-01-2020 65468 SUCI ASTUTI FIRAMIDA 62 L P [K04.1/L] Necrosis of pulp [574] Selektif Grinding 1 1 1

7 71359 ZAHRA IZATI NAILA AL 6 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

8 6839 SUGENG PRIBADI 35 L L [K04.7/B] Periapical abscess [298] Premedikasi 1 1

9 7930 DALIYEM 55 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

10 151 TUMINI 64 L P [K08.3/K] Retained dental root [298] Premedikasi 1 1

11 1108 TARTUTIK EKOWATI 58 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

12 74406 RIRIN DAMAYANTI 24 L P [K04.7/L] Periapical abscess [298] Premedikasi 1 1

7 7 2
NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

13 06-01-2020 151 TUMINI 64 L P [K08.3/K] Retained dental root [566] Pencabutan Gigi Tetap Citoject 1 1 1 1

14 23698 MUHAMMAD SHOLEH 47 L L [K12/B] Stomatitis [298] Premedikasi 1 1

15 87892 NADYATUL HUMAIRAH 18 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

3 3 1 1

16 07-01-2020 3834 MASHIDAYATI 63 L P [K04.5/B] Chronic apical periodontitis [591] Konsultasi Dokter Gigi 1 1

17 28417 MUHAMMAD IKHSAN 34 L L [K01.1/B] Impacted teeth [591] Konsultasi Dokter Gigi 1 1
2 2

18 08-01-2020 87707 MIKHAELLA GRACIANNA 1 L P [K02.1/B] Caries of dentine [591] Konsultasi Dokter Gigi 1 1

19 89703 FARAH SUHAILAH 22 L P [K00.6/B] Disturbances in tooth eruption [298] Premedikasi 1 1

20 86574 HANNY SUSILO AMADEUS 59 L L [K05.6/B] Periodontal disease [298] Premedikasi 1 1

21 45800 ZASKIA AULIA PUTRI 8 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

22 28518 NURUL KHASANAH 40 L P [K12/B] Stomatitis [591] Konsultasi Dokter Gigi 1 1

23 75595 MERINA TRI CAHYANI 39 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1
6 6

24 10-01-2020 90961 FARHAN FADILLAH ZAELANI 8 L L [K00.6/B] Disturbances in tooth eruption [298] Premedikasi 1 1

25 46337 DEANY NURUL ANISA 27 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

26 91086 LAYA MACHALIA 26 B P [K03.6/B] Deposits [accretions] on teeth [595] Pembersihan Karang Gigi 1 1 1 1 2

27 58740 IRDA YUAN TRIANDA 33 L L [K07.5/B] Dentofacial functional abnormalities [289] Observasi 1 1
4 4 1 1 2

28 11-01-2020 71253 ANNASYA OKTAVIANI 7 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Topical 1 1 1

29 7210 GALEH RIZQI RIDHO 17 L L [K04.7/B] Periapical abscess without sinus [298] Premedikasi 1 1
NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

30 17023 ALENA RESTU WARDHANI 11 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

31 91088 ALIFIA ZAHRA PRAMESTI 18 B P [K01.0/B] Embedded teeth [289] Observasi 1 1 1

4 4 1 2

32 13-01-2020 75207 RATNA LISTYANINGSIH 50 L P [K04.1/L] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

33 8899 KUSTARI 50 L P [K04.1/L] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

34 54907 LAIRE ELANG ARNAWARNA 7 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

35 49862 ALAKEY PUTRA LISTYADARM 8 L L [K00.6/K] Disturbances in tooth eruption [564] Pencabutan Anestesi Lokal 1 1 1

36 17613 STEPHANIE DEWI PADMASARI 41 L P [K03.6/B] Deposits [accretions] on teeth [591] Konsultasi Dokter Gigi 1 1
5 5 2

37 15-01-2020 30464 BUDI SUPRIHATIN 35 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

38 6963 FEBRICA BILLY NUR 23 L P [K01.1/B] Impacted teeth [298] Premedikasi 1 1

39 16034 DIAN TRISNASARI 56 L P [K08.3/B] Retained dental root [591] Konsultasi Dokter Gigi 1 1

40 8924 TAUFIX IBNU BATHARA 24 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1
4 4 1

41 16-01-2020 63876 SYHAILENDRA ARZHYI 6 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

42 87030 ANISA HUSNUL KHOTIMAH 22 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

43 87892 NADYATUL HUMAIRAH 18 L P [K04/L] Penyakit pulpa [591] Konsultasi Dokter Gigi 1 1
3 3 1

44 17-01-2020 1605 BAMBANG HADI P 50 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

45 2665 SYAMSUL BAHRI 59 L L [K04.1/B] Necrosis of pulp [298] Premedikasi 1 1

46 57641 RAHMAT KURNIAWAN 15 L L [K03.6/B] Deposits [accretions] on teeth [298] Premedikasi 1 1

47 59371 RENGGA MAHENDRA 24 L L [K01.1/L] Impacted teeth [298] Premedikasi 1 1

NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

48 72515 RUDY GIVALDO 24 L L [K04.5/L] Chronic apical periodontitis [591] Konsultasi Dokter Gigi 1 1
5 5

49 18-01-2020 90607 RISMA ADI TRIAS RINI 16 L P [K03.6/L] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

50 41158 THASYA KAYLA 9 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

51 26187 DESSY RESPATININGRUM 39 L P [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

52 55729 WURYANTO 69 L L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

53 0.42925 RAFA ABIYU SETIAWAN 9 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

54 1984 TUSIDI KARYONO 50 L L [K04.1/L] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

55 74570 SAPTA MUGIHARJONO 58 L L [K04.5/L] Chronic apical periodontitis [298] Premedikasi 1 1

56 151 TUMINI 64 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

8 8 2 2

57 20-01-2020 87878 WAGIYEM SUNANDI 63 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

58 19460 KUSTATI 67 L P [K02.1/B] Caries of dentine [553] Tumpatan Sementara 1 1 1

59 66915 ANINDITA NIRMALA 6 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

60 82374 LOVYLA AZZALIA 9 L P [K00.6/B] Disturbances in tooth eruption [298] Premedikasi 1 1

4 4 2

61 22-01-2020 88604 MUHAMMAD AMIR 59 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

62 83815 RIZKA PURWANDHARI 20 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

63 35529 MEISYA RACHMA 9 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1
3 3 2

64 23-01-2020 26952 DANANG SUJARWO, DRS 53 L L [K04.7/B] Periapical abscess [298] Premedikasi 1 1

65 57270 SITI KHOTIJAH/NY.NGATIJO 57 L P [K06.0/B] Gingival recession [298] Premedikasi 1 1

NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

66 73535 NAFISA PUTRI NUR AISYAH 5 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

67 91165 ADDIN MAHMUDI 36 B L [K04.1/B] Necrosis of pulp [302] Surat Rujukan Dokter 1 1 1

68 64771 MARTINUS RIMO 28 L L [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

69 84587 MUHAMMAD ARKAN 6 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

70 5759 VENTA MARSA 26 L P [K05/B] Penyakit gusi [298] Premedikasi 1 1

71 91167 RIKA IRAWATI 23 B P [K00/B] Gg pertumbuhan Gigi dan Erupsi [298] Premedikasi 1 1 1

72 15820 GABRIELA MAYANGSASI 23 L P [K00/B] Gg pertumbuhan Gigi dan Erupsi [298] Premedikasi 1 1
9 9 2 3 2

73 24-01-2020 30139 SUGIYANTI 41 L P [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

74 91174 RAHMA REZA AZIZAH 14 B P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1 1

75 78685 YUNINGSIH SULISTYOWATI 16 L P [K02.2/B] Caries of cementum [552] Perawatan Kaping Pulpa 1 1 1

76 13571 MARYUNANI 79 L P [K05.2/B] Acute periodontitis [298] Premedikasi 1 1

77 54709 NABIL SHOFAREISY SYAFIQ 6 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

78 41929 SRI YUNIARTI 30 L P [K04.1/K] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1
6 6 1 2

79 27-01-2020 90607 RISMA ADI TRIAS RINI 16 L P [K02.2/B] Caries of cementum [558] Tumpatan Glass Ionomer 1 1 1

80 55369 ITA KUSUMANINGRUM 27 L P [K04.7/L] Periapical abscess [298] Premedikasi 1 1

81 1166 YAKIRAH 60 L P [K08.3/B] Retained dental root [298] Premedikasi 1 1

82 71217 SUMARMIYATI 49 L P [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

83 91187 LAILA NURUL HIMMAH 29 B P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1 1

84 38565 WIJI LESTARI 37 L P [K05.2/B] Acute periodontitis [298] Premedikasi 1 1

85 19460 KUSTATI 67 L P [K02.2/K] Caries of cementum [552] Perawatan Kaping Pulpa 1 1 1

7 7 1 3 2
NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

86 28-01-2020 88604 MUHAMMAD AMIR 59 L L [K04.5/B] Chronic apical periodontitis [289] Observasi 1 1

87 52451 NURZAMMI,dr 41 L P [K02.2/B] Caries of cementum [558] Tumpatan Glass Ionomer 1 1 1

88 83716 DEWI KRISTIANI 42 L P [K06.9/B] Disorder of gingiva [289] Observasi 1 1

89 67941 YOVITA ANGGRAENI 54 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

90 79724 ARIF INSANI 24 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

91 88131 RADEN SUTOTO 62 L L [K05.2/B] Acute periodontitis [298] Premedikasi 1 1

92 60684 SUMIJATI 71 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

93 68350 ZIDNI PUSPITA DEWI 6 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1
8 8 2

94 29-01-2020 77675 ADE IRAWANTO 23 L L [K02.2/B] Caries of cementum [557] Tumpatan Glass Ionomer 1 1 1

95 66774 MUKIYEM 62 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

96 78797 ARDO REYNAND PRATAMA 3 L L [K04.7/B] Periapical abscess [298] Premedikasi 1 1

97 66342 TRI WAHYUNINGSIH 52 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

98 90961 FARHAN FADILLAH ZAELANI 8 L L [K00.6/B] Disturbances in tooth eruption [563] Pencabutan Anestesi Lokal 1 1 1

99 33957 SITI FATIMAH 23 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

100 39667 SITI YULAEKAH 56 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

101 17613 STEPHANIE DEWI PADMASARI 41 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

102 13831 TRI RAHAYU 54 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

103 9477 HESTI SUNARSIYAM 37 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

104 77939 DENICIA SIMPONI 3 L P [K04.7/B] Periapical abscess [289] Observasi 1 1

105 84813 VIONA FEBRIANA DEWI 7 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

106 91201 RIZQI HIKMAYATI 22 B P [K00/B] Gg pertumbuhan Gigi [298] Premedikasi 1 1 1

107 67313 AL HAFIDZ CANDRA 6 L L [K04.1/B] Necrosis of pulp [289] Observasi 1 1

14 14 1 2
NO TGL PERIKSA RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
6a 6b 6c 7a1 9a 9c 14b

108 30-01-2020 41939 IKA YUNIYANTI 34 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

109 38335 JATI WIDAYAT 39 L L [K01.1/B] Impacted teeth [298] Premedikasi 1 1

110 65113 CS SRI PRAMENG 68 L P [K02.9/B] Dental caries [289] Observasi 1 1

111 82066 FORLAN DAIDULLAH 9 L L [K04.7/B] Periapical abscess [298] Premedikasi 1 1

112 82855 BERNADUS HANDRI LUKITO 41 L L [K01.1/B] Impacted teeth [298] Premedikasi 1 1

113 7429 ARENDRA ARDHAN K 13 L L [K04.7/B] Periapical abscess [298] Premedikasi 1 1

114 91209 NAUFAL HABIBROCHMAN 12 B L [K04.5/B] Chronic apical period [298] Premedikasi 1 1 1

115 90216 KARTIKA SIMBOLON 21 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

8 8 1

Yogyakarta, 30 Juni 2020

Mengetahui
Kepala Puskesmas Mergangsan Pelaksana

drg. Risa Dhiana Permanasari Suci Rokhani, S.S.T.

NIP. 19740310 200604 2 003 NIP. 19610428 198107 2 001