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Lampiran 1.

Laporan Kunjungan Rujukan Bulan Desember 2021


Nama FKTP : PUSKESMAS BALISOAN

Nomor JKN-KIS Terdaftar di Spesialisasi RS Tujuan


No Tanggal Nama Peserta Diagnosa Rujuk
Peserta FKTP tersebut Tujuan Rujukan Rujukan

1 1/3/2021 Caterina Yuliana Dangsa 140583688 Ispa 1 0


2 1/3/2021 Evita Yuilia Janis 140587637 Ispa 1 0
3 1/3/2021 Rosina Lesa 140603488 Ispa 1 0
4 1/3/2021 Timothius Derek Garpenassay 140639758 Hipertensi 1 0
5 1/3/2021 Stepanus Laha 973573784 Myalgia 1 0
6 1/3/2021 Novelia Santika Gam 1566363925 Ispa 1 0
7 1/3/2021 Henok Aky Kalamu 1566423077 Dm 1 0
8 1/3/2021 Gabriel Khenzo Latumaerissa 1585601144 Ispa 1 0
9 1/3/2021 Jeremia Cleo Alfrino Legu 2461453806 Ispa 1 0
10 1/3/2021 Gabriella Juniar Bangowa 2762235865 Ispa 1 0
11 1/3/2021 Anace Parmino 140580099 OA 1 0
12 1/3/2021 Amstrong Ngamon 140505164 Ispa 1 0
13 2/3/2021 Esra Ama 973574482 Comond Cold 1 0
14 3/3/2021 Marselina Pedeke 1109609572 Comond Cold 1 0
15 5/3/2021 Marileen Christina Bangala 1872976522 OA 1 0
16 5/3/2021 Hermanus Molle 1872976509 DM 1 0
17 5/3/2021 Anace Parmino 140580099 DM 1 0
18 8/3/2021 LYDIA MARIA TJANA BAIKOLE 1959973143 OA 1 0
19 8/3/2021 PETRUS GAM 193432116 Ispa 1 0
20 8/3/2021 BASTHIANA AWA 140583069 OA 1 0
21 9/3/2021 CRISTIANTY BASSAY 2859143646 Hipertensi 1 0
22 9/3/2021 TIRSA UY 1566364577 Myalgia 1 0
23 9/3/2021 DORCE LANTEMONA 973142886 Myalgia 1 0
24 9/3/2021 MARLINA GAM 973055889 Hipertensi 1 0
25 10/3/2021 KEYNA ALEYSIA PITTA BUKA 2932640886 Ispa 1 0
26 10/3/2021 YULIANA TORIMTUBUN 1891342192 Supervision of normal pregnancy 1 0
27 10/3/2021 DORKAS MALA 1566363969 Supervision of normal pregnancy 1 0
28 10/3/2021 BALANDINA BUNGA 972496383 Supervision of normal pregnancy 1 0
29 10/3/2021 FEBRIANI BUTUE 140616022 Supervision of normal pregnancy 1 0
30 13 / 03 / 2021 CHATERINA NGAMON 1797649841 gout 1 0
31 13 / 03 / 2021 ALEXANDER DRIK BATHO 1797572711 Ispa 1 0
32 13 / 03 / 2021 THEIDAS LALU 140369275 Gastritis 1 0
33 15 / 03 / 2021 Devarly Botty 2859155752 ispa 1 0
34 17/03/2021 Nofri Lenge Ngama 2859154659 Ispa 1 0
35 17/03/2021 Julio Stenrik Baramin 2454148901 Ispa 1 0
36 17/03/2021 Felecia Agusviani Lona 973512281 Ispa 1 0
37 17/03/2021 Salomi Yabu 140326896 oa 1 0
38 18/03/2021 Nona Patricia Hodja 1857352195 Epilepsy 1 0
39 18/03/2021 Yudas Djiko 1566441718 Myalgia 1 0
40 18/03/2021 Oey Sian Moy 1566423088 Ispa 1 0
41 18/03/2021 Gevvin Bassay 200185378 Ispa 1 0
42 20/03/2021 Anggi Greselia R. Lena 1899036955 Ispa 1 0
43 20/03/2021 Durceana Mangensihi 1852554352 Ispa 1 0
44 20/03/2021 Setia Boki 973451878 oa 1 0
45 20/03/2021 Salomi Yabu 140326896 Myalgia 1 0
46 22/03/2021 Efraim Bessy 1566274296 Asthma 1 0
47 22/03/2021 Fransiska Nathalia 1109609583 Dental caries 1 0
48 25/03/2021 Naftali Baykoli 1566362474 DM 1 0
49 30/03/2021 Maria Butuan 973033288 oA 1 0
50 30/03/2021 Rosina Lesa 140603488 Myalgia 1 0
Lampiran 2

Laporan Kunjungan Rujukan Bulan Maret 2021


Kantor Cabang : Ternate

Bulan Februari 2021


Kode JUMLAH KUNJUNGAN SAKIT JUMLAH KUNJUNGAN SEHAT JUMLAH RUJUKAN
No Kantor Cabang Nama Kab/Kota Kode FKTP Nama FKTP Jenis FKTP
Kab/Kota PESERTA PESERTA TAK PESERTA PESERTA TAK PESERTA PESERTA TAK
TERDAFTAR TERDAFTAR TERDAFTAR TERDAFTAR TERDAFTAR TERDAFTAR
1 KC Ternate 0360 KAB. HALMAHERA BARAT 3601003 BALISOAN PUSKESMAS 50 0 109 0 0 0

Ket
Peserta Terdaftar Peserta yang terdaftar di FKTP tersebut
Peserta Tak Terdaftar Peserta yang terdaftar di FKTP lain

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