Rekapan Rujukan PKM Soreang 2022

LAPORAN KASUS RUJUKAN PUSKESMAS…………………………………….
BULAN :......................................
JENIS
BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG RS RUJUKAN DI LUAR KAB. BANDUNG
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Anemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Anxietas 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Appendicitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Arthrosis 0 0 0 5 0 5 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Arthritis 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Atresia of bile ducts 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Asma 0 1 0 7 0 8 0 1 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 BELL'S PALSY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Benign Neoplasma of Breast 0 1 4 6 1 8 0 1 3 6 0 0 1 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Benign Neoplasma of Soft
Tissue 0 0 1 4 0 4 0 0 1 3 0 0 0 1 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Benign Lypome 0 0 0 2 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Benos pada Axilla 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Blighted Ovum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Broncho Pneumonia 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 CAD 0 0 0 115 0 115 0 0 64 0 0 0 115 0 0 0 0 0 0 3 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Cardiomegali 0 0 0 5 0 5 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Chatarak 0 0 0 51 0 51 0 0 0 0 0 0 0 0 0 0 51 0 0 1 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Carpal Tunel Syndrome 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Cerebro Vascular 0 0 0 8 0 8 0 0 0 0 0 0 0 8 0 0 0 0 0 1 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Cervicitis 0 0 0 2 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Cholelithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 CHF 0 1 0 90 2 89 0 0 22 0 0 0 69 0 0 0 0 0 0 2 0 0 0 89 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Chalazion 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Chest Pain 0 0 0 4 0 4 0 0 2 0 0 0 2 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
26 Cirrhosis of Liver 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Carcinoma 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Congenital Deformitas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 Constipasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Corpus Alienum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Coronary Trombosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32 Chronik Apical Periodontis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Chlamydia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Cysta OVARIUM 0 0 0 6 0 6 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 Colic Abdomen 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Depression 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Dermatitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38 DHF 0 1 1 0 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 DM 0 0 0 137 1 136 0 0 137 3 0 0 0 0 0 0 0 0 0 1 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Disease of Hard Tissue of
teeth 0 0 1 21 0 22 0 0 2 0 0 0 0 0 0 0 0 20 0 0 0 0 0 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Disorder Lipoprotein
Matabolism 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Disorder of LacrimaI System 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Disorder of Conjungtiva 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Disorder of Refraction
/Gangguan Visus 0 0 19 75 0 94 0 0 0 0 0 0 0 0 0 0 94 0 0 0 0 0 0 94 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 Disorder of Invertebral Disc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Disorder of Cervical 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Disosder of Metabolic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
48 Dyspepsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Dyspnoea 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Dyspareunia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Effusi Pleura 0 0 0 3 0 3 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
52 End Stage Renal Disease 0 0 0 32 0 32 0 0 26 6 1 0 0 0 0 0 0 0 0 2 0 0 0 31 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Epilepsy 1 7 13 10 15 16 0 3 0 0 0 2 0 26 0 0 0 0 0 0 0 0 0 31 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 External haemorrhoids with
other complications 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
56 Fibro Adenoma Mammae 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Foreign Body in Ear 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Fracture 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Gastritis Ulcer 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Gastroentestinal
Haemorrahage 0 0 0 2 0 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
61 GERD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Hamil dengan TB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
63 High Risk Pregnancy 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Hematuria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Heamorhoids 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Headache Syndrom 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Head Injuri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
68 Hearing Loss 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Hernia 0 0 1 3 0 4 0 0 0 4 0 0 0 0 0 0 0 0 0 1 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 Hirsprung Diseases 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Hordeolum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Hyperplasia Prostat 0 0 0 4 0 4 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Hyperthiroid 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Hypermetrophy of Tonsil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Hypertensive heart disease
without (congestive) heart 0 0 0 60 0 60 0 0 60 0 0 0 0 0 0 0 0 0 0 0 0 0 0 60 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
failure
76 Hypospedia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Impacted teeth 0 0 2 10 0 12 0 0 0 0 0 0 0 0 0 0 0 12 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Incomplete Uterria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
79 ISK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
80 Irregular Menstruation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Irritable Bowel Syndrome 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
82 IUFD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
83 Keloid 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
84 Keratitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
85 Kista Baker's 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
86 Lithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
87 Lymphadenitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
88 Lypoma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Lymphangioma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Low Back Pain 0 0 0 23 0 23 0 0 1 0 0 0 10 12 0 0 0 0 0 1 0 0 0 22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Lumbar and Other Interverbal
Disc Disorder with Mielopathy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
92 Lumbal Radikulopati 0 0 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
93 Malignant Neoplasm 0 0 1 26 0 27 0 0 0 24 0 0 0 0 0 0 0 0 0 1 0 0 0 26 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
94 Mal union 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
95 Melanocytis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Maternal Care for Breech
Presentation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Mole Hydatidosa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
98 Mytral Stenosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Nontoxic Goitre 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100 Ovulation Bleeding 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
101 Otitis Media Kronis 1 0 0 2 0 3 0 0 0 0 0 0 0 0 0 3 0 0 0 1 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
102 Ottalgia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
103 Otitis Externa in Mycoses 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
104 Other Specified Surgical States
(Post Op) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
105 Other Cholelithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
106 other infective Bursitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Pain in thoracis spine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
108 Parkinson 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Peptic ulcer, unspecified as
acute or chronic, without 0 0 0 3 0 3 0 0 1 0 0 0 0 0 0 0 0 2 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
haemorrhage or perforation
110 Periapical abcess with sinus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

111 Polip of nasal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Polyhydramnion 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Polymyalgia Rhematica 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Polyneurophathy 0 0 0 3 0 3 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Polyarthritis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Post Traumatic Joint 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
117 PPOK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Preeclamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
119 Presbycusis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Presbiopia 0 0 1 12 0 13 0 0 0 0 0 0 0 0 0 0 13 0 0 0 0 0 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Pterygium 0 0 0 2 0 2 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Presence of Cardiac and
Vascular Implant and Graft 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Prolaps Uteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
124 Prolonged Pregnancy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Psikosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
126 Psoriasis Vulgaris 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Penyakit Pulpa dan Jaringan
periapikal 0 0 1 8 0 5 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
128 Radiculopathy 0 0 0 20 0 20 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 5 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Rematisme 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Renal Colic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Retention Urine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Salphingitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia 0 0 0 83 0 82 1 0 0 0 0 83 0 0 0 0 0 0 0 0 0 0 8 75 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
134 Sinusitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 SLE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Spondylosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Sprain & strain shoulder 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Sequelae OF Stroke 0 0 0 10 0 10 0 0 0 0 0 2 8 0 0 0 0 0 0 0 0 0 2 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
139 Stroke 0 0 0 32 0 32 0 0 15 0 0 2 0 15 0 0 0 0 0 1 0 0 2 29 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
140 Struma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
141 Superficial Mycosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
142 Superficial Insurgent 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
143 Susp Kista Odortogenik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
144 Susp Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
145 Susp TB MDR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
146 Susp Thalasemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
147 Susp IUGR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Tubercukosis paru-paru 0 1 0 2 0 3 0 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Tubercukosis ekstra paru 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
150 TBC Meninitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
151 Trigger Finger 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
152 Tetraplegia, unspecified 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
153 Tinnitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
154 Tonsilitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
155 Ulcus Ventri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
156 Urolithiasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
157 Vertigo 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
158 Vesicovaginal fistula 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
159 Ventricular Septal Defect 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
160 PENYAKIT LAIN 1 3 12 61 1 77 0 4 38 7 6 1 4 2 0 0 0 1 0 0 1 0 0 77 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
RS RUJUKAN KAB. BANDUNG
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
RS RUJUKAN DI LUAR KAB. BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
7 Atresia of bile ducts
8 Asma
9 BELL'S PALSY
10 Benign Neoplasma of Breast
Tissue
12 Benign Lypome
13 Benos pada Axilla
14 Blighted Ovum
15 Broncho Pneumonia
16 CAD
17 Cardiomegali
18 Chatarak
19 Carpal Tunel Syndrome
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
26 Cirrhosis of Liver
27 Carcinoma
28 Congenital Deformitas
29 Constipasi
30 Corpus Alienum
31 Coronary Trombosis
32 Chronik Apical Periodontis
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
42 Disorder of LacrimaI System
43 Disorder of Conjungtiva
/Gangguan Visus
45 Disorder of Invertebral Disc
46 Disorder of Cervical
47 Disosder of Metabolic
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
52 End Stage Renal Disease
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
56 Fibro Adenoma Mammae
57 Foreign Body in Ear
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
63 High Risk Pregnancy
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
70 Hirsprung Diseases
71 Hordeolum
72 Hyperplasia Prostat
73 Hyperthiroid
74 Hypermetrophy of Tonsil
without (congestive) heart
failure
76 Hypospedia
77 Impacted teeth
78 Incomplete Uterria
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
80 Irregular Menstruation
81 Irritable Bowel Syndrome
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
Disc Disorder with Mielopathy
92 Lumbal Radikulopati
93 Malignant Neoplasm
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
100 Ovulation Bleeding
101 Otitis Media Kronis
102 Ottalgia
103 Otitis Externa in Mycoses
(Post Op)
105 Other Cholelithiasis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
106 other infective Bursitis
107 Pain in thoracis spine
108 Parkinson
acute or chronic, without
110 Periapical abcess with sinus

111 Polip of nasal
112 Polyhydramnion
113 Polymyalgia Rhematica
114 Polyneurophathy
115 Polyarthritis
116 Post Traumatic Joint
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
Vascular Implant and Graft
123 Prolaps Uteri
124 Prolonged Pregnancy
125 Psikosis
126 Psoriasis Vulgaris
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
137 Sprain & strain shoulder
138 Sequelae OF Stroke
139 Stroke
140 Struma
141 Superficial Mycosis
142 Superficial Insurgent
143 Susp Kista Odortogenik
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
148 Tubercukosis paru-paru
149 Tubercukosis ekstra paru
150 TBC Meninitis
151 Trigger Finger
152 Tetraplegia, unspecified
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
158 Vesicovaginal fistula
159 Ventricular Septal Defect
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
LAPORAN KASUS RUJUKAN PUSKESMAS SOREANG
BULAN : SEPTEMBER 2018
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma 2 2 2 2
9 BELL'S PALSY
10 Benign Neoplasma of Breast 1 1 2 1 1 1 3 4
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD 41 41 41 3 38
17 Cardiomegali
18 Chatarak 6 6 6 1 5
20 Cerebro Vascular 8 8 8 1 7
21 Cervicitis 2 2 2 1 1
22 Cholelithiasis
23 CHF 11 11 11 2 9
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM 35 1 34 35 1 34
teeth
Matabolism
/Gangguan Visus
3 3 3 3
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
52 End Stage Renal Disease 5 5 5 2 3
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy 1 5 6 1 5 6
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia 2 2 2 1 1
71 Hordeolum
72 Hyperplasia Prostat 4 4 4 4
73 Hyperthiroid
failure
24 24 24 24
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain 9 9 9 1 8
93 Malignant Neoplasm 4 4 4 1 3
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson
acute or chronic, without 2 2 2
2
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia 1 3 4 4 4
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy 2 2 2 2
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia 15 14 1 15 15
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke 15 15 15 1 14
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN : AGUSTUS 2018
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas 1 1 1 1
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue 1 1
1
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak 4 4 4 4
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 5 1 4 5 5
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM 6 6 6 6
teeth 2 2
2 2
Matabolism
/Gangguan Visus
1 2 3 3 3
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura 3 3 3 3
52 End Stage Renal Disease 6 6 6 6
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy 2 2 2 2
other complications 1 1
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
2 2 2 2
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain 1 1 1 1
92 Lumbal Radikulopati 1 1 1 1
93 Malignant Neoplasm 3 3 3
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
101 Otitis Media Kronis 1 2 3 3 1 2
102 Ottalgia
103 Otitis Externa in Mycoses 1 1 1 1
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy 1 1 1 1
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia 6 6 6 6
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
1 4 1 5 5
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia 5 5 5 5
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN 5 8 13 13 13
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
TAHUN 2022
JENIS
Gol Umur BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG
RUJUKAN
CICALENGKA
KANDUNGAN
MAJALAYA
SULAIMAN
NO KASUS RUJUKAN
SOREANG
AL ISLAM
JANTUNG
AL IHSAN
5 - 18 th
KHUSUS
SYARAF
1 - 5 th
DALAM
BEDAH
> 18 th
UMUM
KULIT
SKTM
MATA
< 1 th
ANAK
JIWA
BPJS
AMC
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis 5 5 5 5
6 Arthritis 1 1 1 1
8 Asma 1 4 5 1 4 5
9 BELL'S PALSY
10 Benign Neoplasma of 3 4 7 6 1 7
Breast
Benign Neoplasma of Soft
11 1 2 3 2 1
Tissue 3
12 Benign Lypome 2 2 2 2
14 Blighted Ovum
15 Broncho Pneumonia 1 1 1 1
16 CAD 64 64 64 64 64
17 Cardiomegali 5 5 5 5
18 Chatarak 40 40 40 40
Carpal Tunel Syndrome
19
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 69 69 16 53 69
24 Chalazion
25 Chest Pain 4 4 2 2 4
27 Carcinoma 1 1 1 1
Congenital Deformitas
28
29 Constipasi
30 Corpus Alienum
Chronik Apical Periodontis
32
33 Chlamydia
34 Cysta OVARIUM 5 5 5 5
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF 1 1 2 2 2
39 DM 88 88 88 3 85
Disease of Hard Tissue of
40 teeth 13 13
13 13
Disorder Lipoprotein
41 Matabolism
42 Disorder of LacrimaI
43 System
Disorder of Conjungtiva 1 1 1 1
Disorder of Refraction
44 /Gangguan Visus
17 66 83 83 83
Disorder of Invertebral
45
Disc
Disosder of Metabolic
47
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
End Stage Renal Disease
52
20 20 20 20
53 Endometriosis
54 Epilepsy 1 6 8 15 15 15
JENIS
RUJUKAN
CICALENGKA
KANDUNGAN
MAJALAYA
SULAIMAN
NO KASUS RUJUKAN
SOREANG
AL ISLAM
JANTUNG
AL IHSAN
5 - 18 th
KHUSUS
SYARAF
1 - 5 th
DALAM
BEDAH
> 18 th
UMUM
KULIT
SKTM
MATA
< 1 th
ANAK
JIWA
BPJS
AMC
GIGI
THT
External haemorrhoids
55 with other complications
Fibro Adenoma Mammae

56
58 Fracture
59 Gastritis Ulcer
Gastroentestinal
60 1 1 1
Haemorrahage 1
61 GERD
62 Hamil dengan TB
63 High Risk Pregnancy 1 1 1 1
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
Hypermetrophy of Tonsil
74
Hypertensive heart disease
75 failure
30 30 30 30
76 Hypospedia
77 Impacted teeth 2 10 12 12 12
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain 10 10 10 10
Lumbar and Other
Interverbal Disc Disorder
91 with Mielopathy
93 Malignant Neoplasm 1 15 16 16 16
94 Mal union
95 Melanocytis
Maternal Care for Breech
96
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
Otitis Externa in Mycoses
103
Other Specified Surgical
104 States (Post Op)

other infective Bursitis
106
Pain in thoracis spine
107
JENIS
RUJUKAN
CICALENGKA
KANDUNGAN
MAJALAYA
SULAIMAN
NO KASUS RUJUKAN
SOREANG
AL ISLAM
JANTUNG
AL IHSAN
5 - 18 th
KHUSUS
SYARAF
1 - 5 th
DALAM
BEDAH
> 18 th
UMUM
KULIT
SKTM
MATA
< 1 th
ANAK
JIWA
BPJS
AMC
GIGI
THT
108 Parkinson
Peptic ulcer, unspecified
109 as acute or chronic,
without haemorrhage or
perforation
110 Periapical abcess with
111 sinus
Polip of nasal
112 Polyhydramnion
Polymyalgia Rhematica
113
114 Polyneurophathy 1 1 1 1
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia 3 3 3 3
121 Pterygium 2 2 2 2
Presence of Cardiac and
122 Vascular Implant and
Graft
123 Prolaps Uteri
Prolonged Pregnancy
124
125 Psikosis
Penyakit Pulpa dan
127
Jaringan periapikal 4 4 4
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
134 Sinusitis
135 SLE
136 Spondylosis
Sprain & strain shoulder
137
138 Sequelae OF Stroke 8 8 8 8
139 Stroke 15 15 15 15
140 Struma
Superficial Insurgent
142
Susp Kista Odortogenik
143
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
Tubercukosis paru-paru
148
Tubercukosis ekstra paru
149
150 TBC Meninitis
151 Trigger Finger
Tetraplegia, unspecified
152
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
Ventricular Septal Defect
159
160 PENYAKIT LAIN 1 2 7 40 1 50 3 21 4 5 1 4 1 1 1 50
JUMLAH
TAHUN 2022
N KASUS RUJUKAN PUSKESMAS SOREANG
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA
ATMA
HERMINA
IMANUEL
KASIH
BUNDA
MITRA
KASIH
MUHAMADIY
AH
PINDAD
SANTOSA
KOPO
SARTIKA
ASIH
SANTO
YUSUP
ROTINSULU
RS LAIN
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA
ATMA
HERMINA
IMANUEL
KASIH
BUNDA
MITRA
KASIH
MUHAMADIY
AH
PINDAD
SANTOSA
KOPO
SARTIKA
ASIH
SANTO
YUSUP
ROTINSULU
RS LAIN
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
KLINIS KES.
GRAHA
ATMA
HERMINA
IMANUEL
KASIH
BUNDA
MITRA
KASIH
MUHAMADIY
AH
PINDAD
SANTOSA
KOPO
SARTIKA
ASIH
SANTO
YUSUP
ROTINSULU
RS LAIN
BULAN :......................................
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
53 Endometriosis
54 Epilepsy
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
MAJALAYA
SULAIMAN
BANDUNG
PUSK DTP
SOREANG
JANTUNG
HUMANA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
CISARUA
DUSTIRA
AVISENA
BBKKPM
CIBABAT
SADIKIN
ASTANA
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
HASAN
PONED
ANYAR
BEDAH
1 - 5 th
HABIBI
> 18 th
PRIMA
MATA
ANAK
SKTM
KULIT
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui
Ka Puskesmas
NO
KASUS RUJUKAN
< 1 th
1 - 5 th
5 - 18 th
Gol Umur
> 18 th
UMUM
BPJS
JENIS
RUJUKAN
SKTM
ANAK
DALAM
BEDAH
KANDUNGAN
JIWA
JANTUNG
SYARAF
KULIT
BAGIAN RUJUKAN
THT
MATA
GIGI
KHUSUS
AL IHSAN
AMC
MAJALAYA
AL ISLAM
SOREANG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN : JANUARI 2019
JENIS
BAGIAN RUJUKAN RS RUJUKAN KAB. BANDUNG
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
MAJALAYA
SOREANG
JANTUNG
AL ISLAM
AL IHSAN
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
BEDAH
1 - 5 th
> 18 th
MATA
ANAK
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma 1 1 1 1
9 BELL'S PALSY
Tissue 1 1 1
1
12 Benign Lypome
14 Blighted Ovum
16 CAD 10 10 10 10
17 Cardiomegali
18 Chatarak 1 1 1 1
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF 1 5 1 5 6 6
24 Chalazion
25 Chest Pain
27 Carcinoma
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM 1 1 1 1
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM 8 8 8 8
teeth 1 6 7
7 7
Matabolism
/Gangguan Visus
1 4 5 5 5
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
MAJALAYA
SOREANG
JANTUNG
AL ISLAM
AL IHSAN
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
BEDAH
1 - 5 th
> 18 th
MATA
ANAK
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
52 End Stage Renal Disease 1 1 1 1 2
53 Endometriosis 1 1
54 Epilepsy 1 4 3 8 2 6 8
other complications
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage 1 1 1
1
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids 1 1 1 1
66 Headache Syndrom 1 1 1 1
67 Head Injuri
68 Hearing Loss
69 Hernia 1 1 2 2 2
71 Hordeolum
73 Hyperthiroid
failure
4 4 4 4
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain 3 3 3 3
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
MAJALAYA
SOREANG
JANTUNG
AL ISLAM
AL IHSAN
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
BEDAH
1 - 5 th
> 18 th
MATA
ANAK
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
93 Malignant Neoplasm 4 4 4 4
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
103 Otitis Externa in Mycoses 1 1 1 1
(Post Op)
108 Parkinson
acute or chronic, without 1 1 1
1
111 Polip of nasal
112 Polyhydramnion
114 Polyneurophathy 1 1 1
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
134 Sinusitis
135 SLE
136 Spondylosis
138 Sequelae OF Stroke 2 2 2 2
JENIS
Gol Umur RUJUKAN
KANDUNGAN
NO KASUS RUJUKAN
MAJALAYA
SOREANG
JANTUNG
AL ISLAM
AL IHSAN
KHUSUS
5 - 18 th
SYARAF
DALAM
UMUM
BEDAH
1 - 5 th
> 18 th
MATA
ANAK
SKTM
KULIT
< 1 th
JIWA
AMC
BPJS
GIGI
THT
139 Stroke 2 2 2 2
140 Struma
144 Susp Difteri
145 Susp TB MDR
146 Susp Thalasemia
147 Susp IUGR
148 Tubercukosis paru-paru 1 2 3 1 2 3
150 TBC Meninitis
151 Trigger Finger 1 1 1 1
152 Tetraplegia, unspecified 1 1 1 1
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
159 Ventricular Septal Defect 1 1 1 1
160 PENYAKIT LAIN 1 13 14 1 4 3 1 1 14
JUMLAH
Mengetahui
Ka Puskesmas
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
1
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
SULAIMAN
CICALENGKA
PONED
PUSK DTP
ASTANA
ANYAR
AVISENA
BINA SEHAT
BBKKPM
CIBADAK
CISARUA
CIBABAT
CICENDO
DUSTIRA
HASAN
SADIKIN
HUMANA
PRIMA
HABIBI
KOTA
BANDUNG
BULAN :......................................
JENIS
Gol Umur RUJUKAN
MUHAMADIYA
SANTO YUSUP
KASIH BUNDA
GRAHA ATMA
SARTIKA ASIH
KANDUNGAN
MITRA KASIH
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
ROTINSULU
KLINIS KES.
MAJALAYA
SULAIMAN
BANDUNG
IMANUEL
SOREANG
HERMINA
PUSK DTP
JANTUNG
HUMANA
SANTOSA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
AVISENA
CISARUA
DUSTIRA
CIBABAT
BBKKPM
ASTANA
SADIKIN
KHUSUS
5 - 18 th
PINDAD
SYARAF
RS LAIN
DALAM
UMUM
PONED
HASAN
ANYAR
BEDAH
HABIBI
1 - 5 th
PRIMA
> 18 th
MATA
ANAK
KOPO
KULIT
SKTM
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
H
1 Adnexa
2 Anemia
3 Anxietas
4 Appendicitis
5 Arthrosis
6 Arthritis
8 Asma
9 BELL'S PALSY
Tissue
12 Benign Lypome
14 Blighted Ovum
16 CAD
17 Cardiomegali
18 Chatarak
20 Cerebro Vascular
21 Cervicitis
22 Cholelithiasis
23 CHF
24 Chalazion
25 Chest Pain
27 Carcinoma
JENIS
Gol Umur RUJUKAN
MUHAMADIYA
SANTO YUSUP
KASIH BUNDA
GRAHA ATMA
SARTIKA ASIH
KANDUNGAN
MITRA KASIH
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
ROTINSULU
KLINIS KES.
MAJALAYA
SULAIMAN
BANDUNG
IMANUEL
SOREANG
HERMINA
PUSK DTP
JANTUNG
HUMANA
SANTOSA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
AVISENA
CISARUA
DUSTIRA
CIBABAT
BBKKPM
ASTANA
SADIKIN
KHUSUS
5 - 18 th
PINDAD
SYARAF
RS LAIN
DALAM
UMUM
PONED
HASAN
ANYAR
BEDAH
HABIBI
1 - 5 th
PRIMA
> 18 th
MATA
ANAK
KOPO
KULIT
SKTM
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
H
29 Constipasi
30 Corpus Alienum
33 Chlamydia
34 Cysta OVARIUM
35 Colic Abdomen
36 Depression
37 Dermatitis
38 DHF
39 DM
teeth
Matabolism
/Gangguan Visus
48 Dyspepsia
49 Dyspnoea
50 Dyspareunia
51 Effusi Pleura
53 Endometriosis
54 Epilepsy
other complications
JENIS
Gol Umur RUJUKAN
MUHAMADIYA
SANTO YUSUP
KASIH BUNDA
GRAHA ATMA
SARTIKA ASIH
KANDUNGAN
MITRA KASIH
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
ROTINSULU
KLINIS KES.
MAJALAYA
SULAIMAN
BANDUNG
IMANUEL
SOREANG
HERMINA
PUSK DTP
JANTUNG
HUMANA
SANTOSA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
AVISENA
CISARUA
DUSTIRA
CIBABAT
BBKKPM
ASTANA
SADIKIN
KHUSUS
5 - 18 th
PINDAD
SYARAF
RS LAIN
DALAM
UMUM
PONED
HASAN
ANYAR
BEDAH
HABIBI
1 - 5 th
PRIMA
> 18 th
MATA
ANAK
KOPO
KULIT
SKTM
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
H
58 Fracture
59 Gastritis Ulcer
60 Gastroentestinal
Haemorrahage
61 GERD
62 Hamil dengan TB
64 Hematuria
65 Heamorhoids
66 Headache Syndrom
67 Head Injuri
68 Hearing Loss
69 Hernia
71 Hordeolum
73 Hyperthiroid
failure
76 Hypospedia
77 Impacted teeth
79 ISK
82 IUFD
83 Keloid
84 Keratitis
85 Kista Baker's
86 Lithiasis
JENIS
Gol Umur RUJUKAN
MUHAMADIYA
SANTO YUSUP
KASIH BUNDA
GRAHA ATMA
SARTIKA ASIH
KANDUNGAN
MITRA KASIH
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
ROTINSULU
KLINIS KES.
MAJALAYA
SULAIMAN
BANDUNG
IMANUEL
SOREANG
HERMINA
PUSK DTP
JANTUNG
HUMANA
SANTOSA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
AVISENA
CISARUA
DUSTIRA
CIBABAT
BBKKPM
ASTANA
SADIKIN
KHUSUS
5 - 18 th
PINDAD
SYARAF
RS LAIN
DALAM
UMUM
PONED
HASAN
ANYAR
BEDAH
HABIBI
1 - 5 th
PRIMA
> 18 th
MATA
ANAK
KOPO
KULIT
SKTM
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
H
87 Lymphadenitis
88 Lypoma
89 Lymphangioma
90 Low Back Pain
94 Mal union
95 Melanocytis
Presentation
97 Mole Hydatidosa
98 Mytral Stenosis
99 Nontoxic Goitre
102 Ottalgia
(Post Op)
108 Parkinson

111 Polip of nasal
112 Polyhydramnion
JENIS
Gol Umur RUJUKAN
MUHAMADIYA
SANTO YUSUP
KASIH BUNDA
GRAHA ATMA
SARTIKA ASIH
KANDUNGAN
MITRA KASIH
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
ROTINSULU
KLINIS KES.
MAJALAYA
SULAIMAN
BANDUNG
IMANUEL
SOREANG
HERMINA
PUSK DTP
JANTUNG
HUMANA
SANTOSA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
AVISENA
CISARUA
DUSTIRA
CIBABAT
BBKKPM
ASTANA
SADIKIN
KHUSUS
5 - 18 th
PINDAD
SYARAF
RS LAIN
DALAM
UMUM
PONED
HASAN
ANYAR
BEDAH
HABIBI
1 - 5 th
PRIMA
> 18 th
MATA
ANAK
KOPO
KULIT
SKTM
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
H
114 Polyneurophathy
115 Polyarthritis
117 PPOK
118 Preeclamsia
119 Presbycusis
120 Presbiopia
121 Pterygium
123 Prolaps Uteri
125 Psikosis
periapikal
128 Radiculopathy
129 Rematisme
130 Renal Colic
131 Retention Urine
132 Salphingitis
133 Schizoprenia
134 Sinusitis
135 SLE
136 Spondylosis
139 Stroke
140 Struma
144 Susp Difteri
145 Susp TB MDR
JENIS
Gol Umur RUJUKAN
MUHAMADIYA
SANTO YUSUP
KASIH BUNDA
GRAHA ATMA
SARTIKA ASIH
KANDUNGAN
MITRA KASIH
NO KASUS RUJUKAN
CICALENGKA
BINA SEHAT
ROTINSULU
KLINIS KES.
MAJALAYA
SULAIMAN
BANDUNG
IMANUEL
SOREANG
HERMINA
PUSK DTP
JANTUNG
HUMANA
SANTOSA
AL ISLAM
AL IHSAN
CICENDO
CIBADAK
AVISENA
CISARUA
DUSTIRA
CIBABAT
BBKKPM
ASTANA
SADIKIN
KHUSUS
5 - 18 th
PINDAD
SYARAF
RS LAIN
DALAM
UMUM
PONED
HASAN
ANYAR
BEDAH
HABIBI
1 - 5 th
PRIMA
> 18 th
MATA
ANAK
KOPO
KULIT
SKTM
< 1 th
KOTA
JIWA
AMC
BPJS
GIGI
THT
H
146 Susp Thalasemia
147 Susp IUGR
150 TBC Meninitis
151 Trigger Finger
153 Tinnitus
154 Tonsilitis
155 Ulcus Ventri
156 Urolithiasis
157 Vertigo
160 PENYAKIT LAIN
JUMLAH
Mengetahui ……………………..
Ka Puskesmas Pembuat Laporan

Rekapan Rujukan PKM Soreang 2022

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Rekapan Rujukan PKM Soreang 2022

Uploaded by

Copyright:

Available Formats

LAPORAN KASUS RUJUKAN PUSKESMAS…………………………………….

110 Periapical abcess with sinus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

110 Periapical abcess with sinus

110 Periapical abcess with sinus

110 Periapical abcess with sinus

110 Periapical abcess with sinus

110 Periapical abcess with sinus

110 Periapical abcess with sinus

110 Periapical abcess with sinus

110 Periapical abcess with sinus

Fibro Adenoma Mammae

105 Other Cholelithiasis

110 Periapical abcess with sinus

110 Periapical abcess with sinus

You might also like