Laporan Agustus 2021

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<big><big><span style="font-weight: bold;">
LAPORAN UNIVERSAL POLI UMUM<br>
BULAN 01-08-2021 - 31-08-2021 </span></big></big>
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<table align='center'>
<tr>
<td>Total</td>
<td>:</td>
<td>178</td>
</tr>
</table>
<table align="center" width="98%" border="1">
<tr class="row1">
<td width='3%'>No</td>
<td width='6%'>Tanggal</td>
<td width='6%'>No RM</td>
<td width='10%'>Nama</td>
<td width='6%'>Desa</td>
<td width='5%'>Kecamatan</td>
<td width='5%'>Kabupaten</td>
<td width='6%'>Tgl Lahir</td>
<td width='6%'>Umur<br>Th</td>
<td width='2%'>L/P</td>
<td width='2%'>Hp</td>
<td width='7%'>Pekerjaan</td>
<td width='7%'>Ruangan</td>
<td width='7%'>Petugas</td>
<td width='4%'>Status</td>
<td>Kasus</td>
<td>Cara Bayar</td>
<td>Jenis BPJS</td>
<td>No BPJS</td>
<td>Kode Bridging</td>
<td>ICD-10</td>
<td>Diagnosa</td>
</tr>
<tr align="left" valign="top">

<td>1</td>
<td>02-08-2021</td>
<td>008550</td>
<td>PAWIT PURWANTO</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-10-1986</td>
<td>35</td>
<td>L</td>
<td>`</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. ANDRI PRADYAKSANTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBD)</td>
<td>0002729788918</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
Coronavirus infection, unspecified </td>
</tr>

<td>2</td>
<td>02-08-2021</td>
<td>008545</td>
<td>GALANG MAHENDRA</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>12-09-1998</td>
<td>23</td>
<td>L</td>
<td>`</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659969245</td>
<td></td>
<td align='center'>
Z02.0 </td>
<td align='center'>
Examination for admission to educational institution </td>
</tr>

<td>3</td>
<td>02-08-2021</td>
<td>001027</td>
<td>MESINAH</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-05-1970</td>
<td>52</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002642959822</td>
<td>131202020821Y000001</td>
<td align='center'>
H40.1 </td>
<td align='center'>
Primary open-angle glaucoma </td>
</tr>

<td>4</td>
<td>02-08-2021</td>
<td>007900</td>
<td>PURWANTO</td>
<td>SIDOMULYO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-01-1982</td>
<td>40</td>
<td>L</td>
<td>`087702200084</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002711220794</td>
<td>131202020821Y000002</td>
<td align='center'>
S42.01 </td>
<td align='center'>
Fracture of clavicle, open </td>
</tr>

<td>5</td>
<td>02-08-2021</td>
<td>008218</td>
<td>TRI WAHONO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>28-09-1996</td>
<td>25</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>6</td>
<td>02-08-2021</td>
<td>008528</td>
<td>RUSMALIANTO</td>
<td>SIDOMULYO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-05-1981</td>
<td>41</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002842396852</td>
<td>131202020821Y000005</td>
<td align='center'>
K61 </td>
<td align='center'>
Abscess of anal and rectal regions </td>
</tr>

<td>7</td>
<td>02-08-2021</td>
<td>001015</td>
<td>SARTUMI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-05-1968</td>
<td>54</td>
<td>P</td>
<td>`</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>0001854582783</td>
<td>131202020821Y000003</td>
<td align='center'>
I64 </td>
<td align='center'>
Stroke, not specified as haemorrhage or infarction </td>
</tr>

<td>8</td>
<td>02-08-2021</td>
<td>007161</td>
<td>SUNARTI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-03-1985</td>
<td>37</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>0002488556992</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>9</td>
<td>02-08-2021</td>
<td>003084</td>
<td>AGUNG CAHYONO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-09-1975</td>
<td>46</td>
<td>L</td>
<td>`</td>
<td>Perangkat Desa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>0002195266059</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>
<td>10</td>
<td>02-08-2021</td>
<td>000451</td>
<td>KARNI WITONO</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUSI SUNDARI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000010</td>
<td align='center'>
E11 </td>
<td align='center'>
Non-insulin-dependent diabetes mellitus </td>
</tr>

<td>11</td>
<td>02-08-2021</td>
<td>002069</td>
<td>PONATIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-11-1979</td>
<td>42</td>
<td>P</td>
<td>`081249462702</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002711221222</td>
<td>131202020821Y000006</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>12</td>
<td>02-08-2021</td>
<td>000461</td>
<td>KATMINEM</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>05-03-1971</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
Essential (primary) hypertension </td>
</tr>

<td>13</td>
<td>02-08-2021</td>
<td>008547</td>
<td>SAMBUDI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-04-1973</td>
<td>49</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F28 </td>
<td align='center'>
Other nonorganic psychotic disorders </td>
</tr>

<td>14</td>
<td>03-08-2021</td>
<td>008555</td>
<td>DWI HARIYANTO</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>01-05-1992</td>
<td>30</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000509707214</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
Examination and encounter for administrative purposes </td>
</tr>

<td>15</td>
<td>03-08-2021</td>
<td>008557</td>
<td>KATAMSO</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>09-07-1971</td>
<td>51</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PEGAWAI SWASTA</td>
<td>0002887752892</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>16</td>
<td>03-08-2021</td>
<td>008558</td>
<td>SUKATNI</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>26-06-1976</td>
<td>46</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659200904</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>17</td>
<td>03-08-2021</td>
<td>001077</td>
<td>KATELAN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-11-1952</td>
<td>69</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002301272313</td>
<td>131202020821Y000007</td>
<td align='center'>
N40 </td>
<td align='center'>
Hyperplasia of prostate </td>
</tr>

<td>18</td>
<td>03-08-2021</td>
<td>000285</td>
<td>TULARMI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-08-1970</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PNS DAERAH</td>
<td>0000103957211</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>19</td>
<td>03-08-2021</td>
<td>008551</td>
<td>KATNI</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>02-06-1944</td>
<td>78</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>20</td>
<td>03-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000008</td>
<td align='center'>
E10.2 </td>
<td align='center'>
Insulin-dependent diabetes mellitus with renal complications
</td>
</tr>

<td>21</td>
<td>03-08-2021</td>
<td>001683</td>
<td>RETNO JUMINI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-03-1994</td>
<td>28</td>
<td>P</td>
<td>`</td>
<td>Karyawan Swasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658399263</td>
<td>131202020821Y000009</td>
<td align='center'>
F32.3 </td>
<td align='center'>
Severe depressive episode with psychotic symptoms </td>
</tr>

<td>22</td>
<td>03-08-2021</td>
<td>006282</td>
<td>HADI PRIYO SUJONO</td>
<td>KETRO</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>18-03-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>PNS DAERAH</td>
<td>0000104160521</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>23</td>
<td>03-08-2021</td>
<td>002480</td>
<td>SULATIN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-12-1973</td>
<td>48</td>
<td>P</td>
<td>`082139307753</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036278426</td>
<td></td>
<td align='center'>
R50 </td>
<td align='center'>
Fever of other and unknown origin </td>
</tr>

<td>24</td>
<td>03-08-2021</td>
<td>008556</td>
<td>RIO NANDA AL MUSTAQIROM</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>27-08-1995</td>
<td>26</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>25</td>
<td>04-08-2021</td>
<td>008561</td>
<td>HENI PURWATI</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>17-01-1954</td>
<td>68</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>0000104097429</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>26</td>
<td>04-08-2021</td>
<td>008567</td>
<td>MARSI</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>15-05-1977</td>
<td>45</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0001976147526</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>27</td>
<td>04-08-2021</td>
<td>003832</td>
<td>PUJIHATI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-06-1989</td>
<td>33</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000657521684</td>
<td>131202020821Y000012</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>28</td>
<td>04-08-2021</td>
<td>001039</td>
<td>MAHMUDI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-06-1948</td>
<td>74</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659226431</td>
<td>131202020821Y000013</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>29</td>
<td>04-08-2021</td>
<td>008560</td>
<td>PURWOTO</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>04-08-1955</td>
<td>66</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>30</td>
<td>04-08-2021</td>
<td>008564</td>
<td>SUBAKIR</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-04-1959</td>
<td>63</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>31</td>
<td>04-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000014</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>32</td>
<td>04-08-2021</td>
<td>008569</td>
<td>SUYATMI</td>
<td>PADI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>04-08-1961</td>
<td>60</td>
<td>P</td>
<td>`081325276574</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>33</td>
<td>04-08-2021</td>
<td>000797</td>
<td>BINTI LUTFIANA</td>
<td>BANGUNSARI</td>
<td>PACITAN</td>
<td>PACITAN</td>
<td>17-05-1979</td>
<td>43</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104160284</td>
<td>131202020821Y000017</td>
<td align='center'>
L23.1 </td>
<td align='center'>
Allergic contact dermatitis due to adhesives </td>
</tr>

<td>34</td>
<td>04-08-2021</td>
<td>000953</td>
<td>SUYATIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-01-1966</td>
<td>56</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104138403</td>
<td>131202020821Y000016</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>35</td>
<td>05-08-2021</td>
<td>007129</td>
<td>SUKARNI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-10-1940</td>
<td>81</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002632176066</td>
<td>131202020821Y000019</td>
<td align='center'>
K80 </td>
<td align='center'>
Cholelithiasis </td>
</tr>

<td>36</td>
<td>05-08-2021</td>
<td>001082</td>
<td>SOMINI</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>20-04-1981</td>
<td>41</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000660549699</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>37</td>
<td>05-08-2021</td>
<td>002609</td>
<td>ZAENAL ARIFIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-09-1987</td>
<td>34</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0000658577711</td>
<td></td>
<td align='center'>
A16 </td>
<td align='center'>
Respiratory tuberculosis, not confirmed bacteriologically or
histologically </td>
</tr>

<td>38</td>
<td>05-08-2021</td>
<td>008576</td>
<td>SOGINI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>08-02-1953</td>
<td>69</td>
<td>L</td>
<td>`087875489189</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
J06 </td>
<td align='center'>
Acute upper respiratory infections of multiple and unspecified sites
</td>
</tr>

<td>39</td>
<td>05-08-2021</td>
<td>007613</td>
<td>MUHAMMAD SAHID</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>28-08-1999</td>
<td>22</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>40</td>
<td>06-08-2021</td>
<td>008581</td>
<td>BOGI</td>
<td>JETAK</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>09-07-1969</td>
<td>53</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td>0001585040837</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>41</td>
<td>06-08-2021</td>
<td>008582</td>
<td>SUJARNO</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>01-08-1985</td>
<td>36</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0001036346512</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>42</td>
<td>06-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000027</td>
<td align='center'>
E10 </td>
<td align='center'>
Insulin-dependent diabetes mellitus </td>
</tr>

<td>43</td>
<td>06-08-2021</td>
<td>000797</td>
<td>BINTI LUTFIANA</td>
<td>BANGUNSARI</td>
<td>PACITAN</td>
<td>PACITAN</td>
<td>17-05-1979</td>
<td>43</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104160284</td>
<td>131202020821Y000025</td>
<td align='center'>
R11 </td>
<td align='center'>
Nausea and vomiting </td>
</tr>

<td>44</td>
<td>06-08-2021</td>
<td>001355</td>
<td>SURADI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-07-1966</td>
<td>56</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104046671</td>
<td>131202020821Y000024</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>45</td>
<td>06-08-2021</td>
<td>000357</td>
<td>RIDWAN CAHYONO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-03-1994</td>
<td>28</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002063738531</td>
<td>131202020821Y000026</td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>46</td>
<td>06-08-2021</td>
<td>000568</td>
<td>SUMARTI</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>05-12-1971</td>
<td>50</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000204314343</td>
<td>131202020821Y000023</td>
<td align='center'>
K29 </td>
<td align='center'>
Gastritis and duodenitis </td>
</tr>

<td>47</td>
<td>06-08-2021</td>
<td>008585</td>
<td>SITI SAREH</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-09-1978</td>
<td>43</td>
<td>P</td>
<td>`087759827511</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
J06 </td>
<td align='center'>
</td>
</tr>

<td>48</td>
<td>07-08-2021</td>
<td>008591</td>
<td>IMAM SUKEMI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-10-1953</td>
<td>68</td>
<td>L</td>
<td>`081946008811</td>
<td>pns</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td>PNS DAERAH</td>
<td>0000104045995</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>49</td>
<td>07-08-2021</td>
<td>001473</td>
<td>YUNI PRIYANTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-07-1983</td>
<td>39</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659015381</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>50</td>
<td>08-08-2021</td>
<td>005778</td>
<td>POERWOTO</td>
<td>PADI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>31-12-1941</td>
<td>80</td>
<td>L</td>
<td>`</td>
<td>Pensiunan</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0000104237605</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>51</td>
<td>10-08-2021</td>
<td>006155</td>
<td>SURATIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-06-1975</td>
<td>47</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002063738158</td>
<td>131202020821Y000033</td>
<td align='center'>
L03 </td>
<td align='center'>
Cellulitis </td>
</tr>
<td>52</td>
<td>10-08-2021</td>
<td>004726</td>
<td>GINEN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002214857542</td>
<td>131202020821P000031</td>
<td align='center'>
E11.4 </td>
<td align='center'>
Non-insulin-dependent diabetes mellitus with neurological complications
</td>
</tr>

<td>53</td>
<td>10-08-2021</td>
<td>000308</td>
<td>MARYONO</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1955</td>
<td>67</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002312326664</td>
<td>131202020821P000032</td>
<td align='center'>
Z09.8 </td>
<td align='center'>
Follow-up examination after other treatment for other conditions
</td>
</tr>

<td>54</td>
<td>10-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000034</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>55</td>
<td>11-08-2021</td>
<td>000709</td>
<td>SUPARTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-12-1966</td>
<td>55</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>VINA WAHYUNINGTYAS</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658560813</td>
<td>131202020821Y000036</td>
<td align='center'>
W19 </td>
<td align='center'>
Unspecified fall causing accidental injury </td>
</tr>

<td>56</td>
<td>12-08-2021</td>
<td>008610</td>
<td>SUCI MERLYANA SARI</td>
<td>CIGANJUR</td>
<td>JAGAKARSA</td>
<td>JAKARTA SELATAN</td>
<td>27-11-2000</td>
<td>21</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
Z02.1 </td>
<td align='center'>
Pre-employment examination </td>
</tr>

<td>57</td>
<td>12-08-2021</td>
<td>004280</td>
<td>YOGI PERMANA KURNIAWAN</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-06-1994</td>
<td>28</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002642961183</td>
<td></td>
<td align='center'>
K29 </td>
<td align='center'>
</tr>

<td>58</td>
<td>12-08-2021</td>
<td>004274</td>
<td>SLAMET RIYANTO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-03-1980</td>
<td>42</td>
<td>L</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002273797372</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>59</td>
<td>12-08-2021</td>
<td>005883</td>
<td>RETNO WIDIASTUTI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-11-1999</td>
<td>22</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002463829097</td>
<td>131202020821Y000090</td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>60</td>
<td>12-08-2021</td>
<td>008611</td>
<td>EKO BAYU KUNCORO</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-05-1997</td>
<td>25</td>
<td>L</td>
<td>`081945550281</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
L02 </td>
<td align='center'>
Cutaneous abscess, furuncle and carbuncle </td>
</tr>

<td>61</td>
<td>12-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000089</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>62</td>
<td>12-08-2021</td>
<td>007462</td>
<td>SARTIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-04-1971</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
K29 </td>
<td align='center'>
</tr>

<td>63</td>
<td>13-08-2021</td>
<td>005518</td>
<td>IBNU SUNARYO</td>
<td>JETAK</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-02-1997</td>
<td>25</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659932198</td>
<td></td>
<td align='center'>
Z02.1 </td>
<td align='center'>
Pre-employment examination </td>
</tr>

<td>64</td>
<td>13-08-2021</td>
<td>002305</td>
<td>SOEKOJO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-06-1936</td>
<td>86</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0000104238459</td>
<td>131202020821Y000038</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>65</td>
<td>13-08-2021</td>
<td>000836</td>
<td>MISRANTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-09-1985</td>
<td>36</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002249346385</td>
<td></td>
<td align='center'>
J06 </td>
<td align='center'>
</td>
</tr>

<td>66</td>
<td>13-08-2021</td>
<td>000638</td>
<td>SRI NURYANI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-12-1989</td>
<td>32</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>67</td>
<td>13-08-2021</td>
<td>001142</td>
<td>SARMITNU</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-08-1958</td>
<td>63</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002729796873</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
Necrosis of pulp </td>
</tr>

<td>68</td>
<td>13-08-2021</td>
<td>000063</td>
<td>MISINEM</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-11-1968</td>
<td>53</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002227532602</td>
<td>131202020821Y000039</td>
<td align='center'>
C50 </td>
<td align='center'>
Malignant neoplasm of breast </td>
</tr>

<td>69</td>
<td>13-08-2021</td>
<td>000659</td>
<td>WENTI ANGGRAINI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-12-1988</td>
<td>33</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659489793</td>
<td>131202020821Y000040</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>70</td>
<td>13-08-2021</td>
<td>000260</td>
<td>MERI INSYAFIATI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-02-1995</td>
<td>27</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002860437587</td>
<td>131202020821Y000041</td>
<td align='center'>
L23.1 </td>
<td align='center'>
Allergic contact dermatitis due to adhesives </td>
</tr>

<td>71</td>
<td>13-08-2021</td>
<td>006155</td>
<td>SURATIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-06-1975</td>
<td>47</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002063738158</td>
<td>131202020821Y000042</td>
<td align='center'>
L03.9 </td>
<td align='center'>
Cellulitis, unspecified </td>
</tr>

<td>72</td>
<td>14-08-2021</td>
<td>008619</td>
<td>WAKIMIN</td>
<td>NGILE</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1934</td>
<td>88</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000660657284</td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>
<td>73</td>
<td>14-08-2021</td>
<td>005933</td>
<td>PUJIONO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-03-1993</td>
<td>29</td>
<td>L</td>
<td>`081231884098</td>
<td>POLI UMUM</td>
<td>NINIK HARUM SETIYAWATI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659199958</td>
<td>131202020821Y000043</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>74</td>
<td>14-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000044</td>
<td align='center'>
E10 </td>
<td align='center'>
Insulin-dependent diabetes mellitus </td>
</tr>

<td>75</td>
<td>16-08-2021</td>
<td>008626</td>
<td>LINDA SETIYANI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-01-1993</td>
<td>29</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002081172778</td>
<td>131202020821P000045</td>
<td align='center'>
D24 </td>
<td align='center'>
Benign neoplasm of breast </td>
</tr>

<td>76</td>
<td>16-08-2021</td>
<td>008459</td>
<td>SUYATMI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-04-1968</td>
<td>54</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002695801983</td>
<td>131202020821Y000091</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>77</td>
<td>16-08-2021</td>
<td>000812</td>
<td>SUPINI </td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-08-1988</td>
<td>33</td>
<td>P</td>
<td>`082257867922</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659687319</td>
<td>131202020821Y000046</td>
<td align='center'>
Q21.1 </td>
<td align='center'>
Atrial septal defect </td>
</tr>

<td>78</td>
<td>16-08-2021</td>
<td>007585</td>
<td>SLAMET RIYADI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-06-1970</td>
<td>52</td>
<td>L</td>
<td>`081932702228</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002521234146</td>
<td>131202020821Y000047</td>
<td align='center'>
J44 </td>
<td align='center'>
Other chronic obstructive pulmonary disease </td>
</tr>

<td>79</td>
<td>16-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000048</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>80</td>
<td>16-08-2021</td>
<td>008633</td>
<td>SUJARMI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-08-1973</td>
<td>48</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>81</td>
<td>18-08-2021</td>
<td>008636</td>
<td>WASDI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-06-1965</td>
<td>57</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>0002732295925</td>
<td>131202020821Y000054</td>
<td align='center'>
R50 </td>
<td align='center'>
</tr>

<td>82</td>
<td>18-08-2021</td>
<td>001361</td>
<td>TUGINEN</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-01-1950</td>
<td>72</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036275682</td>
<td>131202020821Y000050</td>
<td align='center'>
M13 </td>
<td align='center'>
Other arthritis </td>
</tr>

<td>83</td>
<td>18-08-2021</td>
<td>001521</td>
<td>IIN NUR LAILA</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-01-1995</td>
<td>27</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td>JIWA</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>84</td>
<td>18-08-2021</td>
<td>001246</td>
<td>SRI HIDAYAH</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>22-09-1971</td>
<td>50</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104260353</td>
<td>131202020821Y000051</td>
<td align='center'>
F20.0 </td>
<td align='center'>
Paranoid schizophrenia </td>
</tr>

<td>85</td>
<td>18-08-2021</td>
<td>001039</td>
<td>MAHMUDI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-06-1948</td>
<td>74</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659226431</td>
<td>131202020821Y000052</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>86</td>
<td>18-08-2021</td>
<td>004880</td>
<td>JOKO PURMANTO</td>
<td>SIDOHARJO</td>
<td>PACITAN</td>
<td>PACITAN</td>
<td>15-08-1975</td>
<td>46</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103964657</td>
<td>131202020821Y000053</td>
<td align='center'>
K21.0 </td>
<td align='center'>
Gastro-oesophageal reflux disease with oesophagitis </td>
</tr>

<td>87</td>
<td>18-08-2021</td>
<td>000617</td>
<td>PARLAN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-10-1968</td>
<td>53</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>NINIK HARUM SETIYAWATI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
A15 </td>
<td align='center'>
Respiratory tuberculosis, bacteriologically and histologically
confirmed </td>
</tr>

<td>88</td>
<td>19-08-2021</td>
<td>000146</td>
<td>ARIS MUNANDAR</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-01-1998</td>
<td>24</td>
<td>L</td>
<td>`</td>
<td>lmm</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659347119</td>
<td>131202020821Y000062</td>
<td align='center'>
L23.0 </td>
<td align='center'>
Allergic contact dermatitis due to metals </td>
</tr>

<td>89</td>
<td>19-08-2021</td>
<td>007145</td>
<td>TUIYEM</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-06-1970</td>
<td>52</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658709943</td>
<td>131202020821Y000063</td>
<td align='center'>
K29.0 </td>
<td align='center'>
Acute haemorrhagic gastritis </td>
</tr>

<td>90</td>
<td>19-08-2021</td>
<td>007683</td>
<td>NUR ARIFIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-04-1995</td>
<td>27</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0003078191283</td>
<td>131202020821Y000060</td>
<td align='center'>
M54.5 </td>
<td align='center'>
Low back pain </td>
</tr>

<td>91</td>
<td>19-08-2021</td>
<td>006048</td>
<td>MISIYEM</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-07-1955</td>
<td>67</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>0003061602347</td>
<td>131202020821Y000064</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>92</td>
<td>19-08-2021</td>
<td>008646</td>
<td>TUMINGAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-03-1966</td>
<td>56</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>93</td>
<td>19-08-2021</td>
<td>008647</td>
<td>JUMINTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-12-1966</td>
<td>55</td>
<td>L</td>
<td>`081944999475</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>
<td>94</td>
<td>19-08-2021</td>
<td>004986</td>
<td>SUJONO</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>03-07-1949</td>
<td>73</td>
<td>L</td>
<td>`</td>
<td>Pensiunan</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0000104238922</td>
<td>131202020821P000061</td>
<td align='center'>
I48 </td>
<td align='center'>
Atrial fibrillation and flutter </td>
</tr>

<td>95</td>
<td>19-08-2021</td>
<td>008650</td>
<td>TRI WIBOWO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-04-1972</td>
<td>50</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>96</td>
<td>20-08-2021</td>
<td>008654</td>
<td>SUPARTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-01-1976</td>
<td>46</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>0001826983091</td>
<td></td>
<td align='center'>
W49 </td>
<td align='center'>
Exposure to other and unspecified inanimate mechanical forces causing
accidental injury </td>
</tr>

<td>97</td>
<td>20-08-2021</td>
<td>007129</td>
<td>SUKARNI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-10-1940</td>
<td>81</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002632176066</td>
<td>131202020821Y000065</td>
<td align='center'>
R33 </td>
<td align='center'>
Retention of urine </td>
</tr>

<td>98</td>
<td>20-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000067</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>99</td>
<td>20-08-2021</td>
<td>001193</td>
<td>TRI UNTORO</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>28-08-1988</td>
<td>33</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001249965268</td>
<td>131202020821Y000066</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>100</td>
<td>20-08-2021</td>
<td>008632</td>
<td>FAJAR CAHYONO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-06-1995</td>
<td>27</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>101</td>
<td>20-08-2021</td>
<td>008634</td>
<td>RUSMINI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-05-1973</td>
<td>49</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>102</td>
<td>20-08-2021</td>
<td>008653</td>
<td>TUTIK RAHAYU</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-03-1986</td>
<td>36</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>103</td>
<td>20-08-2021</td>
<td>003084</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-09-1975</td>
<td>46</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002195266059</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>104</td>
<td>20-08-2021</td>
<td>000383</td>
<td>SUPRAPTI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>31-01-1981</td>
<td>41</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002291585455</td>
<td>131202020821Y000068</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>105</td>
<td>20-08-2021</td>
<td>008655</td>
<td>ARIS EKO WIDYARTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>22-06-1995</td>
<td>27</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F20.4 </td>
<td align='center'>
Post-schizophrenic depression </td>
</tr>

<td>106</td>
<td>20-08-2021</td>
<td>000707</td>
<td>SUWITO</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-09-1940</td>
<td>81</td>
<td>L</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659732106</td>
<td>131202020821Y000086</td>
<td align='center'>
R33 </td>
<td align='center'>
</tr>

<td>107</td>
<td>21-08-2021</td>
<td>007613</td>
<td>MUHAMMAD SAHID</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>28-08-1999</td>
<td>22</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>108</td>
<td>21-08-2021</td>
<td>005812</td>
<td>DIDIK ISNAWAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-01-1981</td>
<td>41</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>109</td>
<td>21-08-2021</td>
<td>008652</td>
<td>SOINEM</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1955</td>
<td>67</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659104547</td>
<td>131202020821Y000074</td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>110</td>
<td>23-08-2021</td>
<td>008668</td>
<td>ENY SUSIANA</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>05-01-1987</td>
<td>35</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>0002867838478</td>
<td></td>
<td align='center'>
J06 </td>
<td align='center'>
</td>
</tr>

<td>111</td>
<td>23-08-2021</td>
<td>008669</td>
<td>FARIDH SALAMAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-12-1972</td>
<td>49</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659288867</td>
<td>131202020821Y000075</td>
<td align='center'>
K29 </td>
<td align='center'>
</tr>

<td>112</td>
<td>23-08-2021</td>
<td>008672</td>
<td>SAMSUHARI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-08-1987</td>
<td>34</td>
<td>L</td>
<td>`083845849459</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000658635063</td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>113</td>
<td>23-08-2021</td>
<td>002130</td>
<td>PAERAH</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-03-1966</td>
<td>56</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002883338638</td>
<td>131202020821Y000070</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>114</td>
<td>23-08-2021</td>
<td>004665</td>
<td>SARMINI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-01-1967</td>
<td>55</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002198966444</td>
<td>131202020821Y000071</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>
<td>115</td>
<td>23-08-2021</td>
<td>002190</td>
<td>AMINI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-05-1971</td>
<td>51</td>
<td>P</td>
<td>`083850763018</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659097696</td>
<td>131202020821Y000069</td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>116</td>
<td>23-08-2021</td>
<td>003333</td>
<td>JUMATUN</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-03-1979</td>
<td>43</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659581852</td>
<td></td>
<td align='center'>
J06 </td>
<td align='center'>
</td>
</tr>

<td>117</td>
<td>23-08-2021</td>
<td>004611</td>
<td>IIN RUSTIANA</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-09-1986</td>
<td>35</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>118</td>
<td>23-08-2021</td>
<td>004280</td>
<td>YOGI PERMANA KURNIAWAN</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-06-1994</td>
<td>28</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002642961183</td>
<td>131202020821Y000072</td>
<td align='center'>
K29.1 </td>
<td align='center'>
Other acute gastritis </td>
</tr>

<td>119</td>
<td>23-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000073</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>120</td>
<td>23-08-2021</td>
<td>008547</td>
<td>SAMBUDI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-04-1973</td>
<td>49</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>121</td>
<td>23-08-2021</td>
<td>008670</td>
<td>HENDRO PUSPITO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-11-1995</td>
<td>26</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
L23 </td>
<td align='center'>
Allergic contact dermatitis </td>
</tr>

<td>122</td>
<td>23-08-2021</td>
<td>002019</td>
<td>SUJARNO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-07-1966</td>
<td>55</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002267701828</td>
<td>131202020821P000078</td>
<td align='center'>
Z49.1 </td>
<td align='center'>
Extracorporeal dialysis </td>
</tr>

<td>123</td>
<td>23-08-2021</td>
<td>008673</td>
<td>MISBAKHUL HUDA</td>
<td>GEMAHARJO</td>
<td>TEGALOMBO</td>
<td>PACITAN</td>
<td>01-06-1975</td>
<td>47</td>
<td>L</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PNS DAERAH</td>
<td>0000196522569</td>
<td></td>
<td align='center'>
I84.3 </td>
<td align='center'>
External thrombosed haemorrhoids </td>
</tr>

<td>124</td>
<td>23-08-2021</td>
<td>001710</td>
<td>YOGA NUR WAKHIDAH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-03-1993</td>
<td>29</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0001843774683</td>
<td>131202020821Y000085</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>125</td>
<td>23-08-2021</td>
<td>008629</td>
<td>ZULI WINARTI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-03-1984</td>
<td>38</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002014178455</td>
<td>131202020821Y000088</td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>126</td>
<td>24-08-2021</td>
<td>008674</td>
<td>SUMARTI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-06-1976</td>
<td>46</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0000658670624</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>127</td>
<td>24-08-2021</td>
<td>003084</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-09-1975</td>
<td>46</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002195266059</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>128</td>
<td>24-08-2021</td>
<td>004367</td>
<td>TUKINAH</td>
<td>JETAK</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1952</td>
<td>70</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002873693801</td>
<td>131202020821Y000098</td>
<td align='center'>
I25.1 </td>
<td align='center'>
Atherosclerotic heart disease </td>
</tr>

<td>129</td>
<td>24-08-2021</td>
<td>007978</td>
<td>SUMARDI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-03-1963</td>
<td>59</td>
<td>L</td>
<td>`</td>
<td>Pensiunan</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0000103954375</td>
<td>131202020821Y000101</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>130</td>
<td>24-08-2021</td>
<td>006681</td>
<td>NURLAILA</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-06-1971</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103987348</td>
<td>131202020821Y000107</td>
<td align='center'>
V20 </td>
<td align='center'>
Motorcycle rider injured in collision with pedestrian or animal
</td>
</tr>

<td>131</td>
<td>25-08-2021</td>
<td>008687</td>
<td>SARMI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>15-06-1953</td>
<td>69</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659367832</td>
<td>131202020821Y000130</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>132</td>
<td>25-08-2021</td>
<td>000965</td>
<td>SUNARTI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-07-1980</td>
<td>42</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002322461351</td>
<td>131202020821Y000105</td>
<td align='center'>
B20 </td>
<td align='center'>
Human immunodeficiency virus [HIV] disease resulting in infectious and
parasitic diseases </td>
</tr>

<td>133</td>
<td>25-08-2021</td>
<td>000964</td>
<td>SANTOSO</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-08-1967</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002322461237</td>
<td>131202020821Y000104</td>
<td align='center'>
B20 </td>
<td align='center'>
Human immunodeficiency virus [HIV] disease resulting in infectious and
parasitic diseases </td>
</tr>

<td>134</td>
<td>25-08-2021</td>
<td>008685</td>
<td>JUWAIR</td>
<td>PAGEREJO</td>
<td>NGADIROJO</td>
<td>PACITAN</td>
<td>09-10-1948</td>
<td>73</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
H61.2 </td>
<td align='center'>
Impacted cerumen </td>
</tr>

<td>135</td>
<td>25-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUSI SUNDARI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000106</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>136</td>
<td>25-08-2021</td>
<td>000291</td>
<td>TUGINEM</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-03-1979</td>
<td>43</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0002842396492</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>137</td>
<td>25-08-2021</td>
<td>008686</td>
<td>SRI PAINI</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>14-12-1988</td>
<td>33</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
V20 </td>
<td align='center'>
Motorcycle rider injured in collision with pedestrian or animal
</td>
</tr>
<td>138</td>
<td>25-08-2021</td>
<td>000617</td>
<td>PARLAN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-10-1968</td>
<td>53</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
A16 </td>
<td align='center'>
Respiratory tuberculosis, not confirmed bacteriologically or
histologically </td>
</tr>

<td>139</td>
<td>25-08-2021</td>
<td>008689</td>
<td>KABUL</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>21-08-1973</td>
<td>48</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000658859073</td>
<td></td>
<td align='center'>
J44 </td>
<td align='center'>
</tr>

<td>140</td>
<td>26-08-2021</td>
<td>008692</td>
<td>DWI ANA EFRANDI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-05-1996</td>
<td>26</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002884258596</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>141</td>
<td>26-08-2021</td>
<td>008693</td>
<td>WIJI SUSANTI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-03-1998</td>
<td>24</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0002647206224</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>142</td>
<td>26-08-2021</td>
<td>008690</td>
<td>INDRA PRASTIKA</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>22-02-2001</td>
<td>21</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>143</td>
<td>26-08-2021</td>
<td>008669</td>
<td>FARIDH SALAMAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-12-1972</td>
<td>49</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659288867</td>
<td>131202020821Y000108</td>
<td align='center'>
K29 </td>
<td align='center'>
</tr>

<td>144</td>
<td>26-08-2021</td>
<td>000828</td>
<td>SUYITNO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-09-1961</td>
<td>60</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>0003005187344</td>
<td></td>
<td align='center'>
G43 </td>
<td align='center'>
Migraine </td>
</tr>

<td>145</td>
<td>26-08-2021</td>
<td>008694</td>
<td>LATININGSIH</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>15-06-1982</td>
<td>40</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
K29.0 </td>
<td align='center'>
Acute haemorrhagic gastritis </td>
</tr>

<td>146</td>
<td>26-08-2021</td>
<td>002480</td>
<td>SULATIN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-12-1973</td>
<td>48</td>
<td>P</td>
<td>`082139307753</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036278426</td>
<td>131202020821Y000111</td>
<td align='center'>
J40 </td>
<td align='center'>
Bronchitis, not specified as acute or chronic </td>
</tr>

<td>147</td>
<td>27-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000112</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>148</td>
<td>27-08-2021</td>
<td>008646</td>
<td>TUMINGAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-03-1966</td>
<td>56</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>149</td>
<td>28-08-2021</td>
<td>008699</td>
<td>NUR NOVIA RAHAYU</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-11-1997</td>
<td>24</td>
<td>P</td>
<td>`081232423520</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000657804126</td>
<td></td>
<td align='center'>
R11 </td>
<td align='center'>
Nausea and vomiting </td>
</tr>

<td>150</td>
<td>28-08-2021</td>
<td>008701</td>
<td>KOSIM</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1952</td>
<td>70</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000660606153</td>
<td>131202020821Y000117</td>
<td align='center'>
R33 </td>
<td align='center'>
</tr>

<td>151</td>
<td>28-08-2021</td>
<td>002532</td>
<td>TUMARNI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-01-1960</td>
<td>62</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658860186</td>
<td>131202020821Y000116</td>
<td align='center'>
K29 </td>
<td align='center'>
</tr>

<td>152</td>
<td>28-08-2021</td>
<td>008700</td>
<td>BOINAH</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>01-09-1958</td>
<td>63</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>153</td>
<td>30-08-2021</td>
<td>002130</td>
<td>PAERAH</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-03-1966</td>
<td>56</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002883338638</td>
<td>131202020821Y000119</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>154</td>
<td>30-08-2021</td>
<td>007129</td>
<td>SUKARNI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-10-1940</td>
<td>81</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002632176066</td>
<td>131202020821Y000118</td>
<td align='center'>
R33 </td>
<td align='center'>
</tr>

<td>155</td>
<td>30-08-2021</td>
<td>000385</td>
<td>TUGINEN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-05-1971</td>
<td>51</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000657522865</td>
<td>131202020821Y000121</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>156</td>
<td>30-08-2021</td>
<td>000451</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1968</td>
<td>54</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202020821Y000122</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>157</td>
<td>30-08-2021</td>
<td>001577</td>
<td>RIYANTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-05-1959</td>
<td>63</td>
<td>L</td>
<td>`085330402973</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658998472</td>
<td>131202020821P000123</td>
<td align='center'>
J44 </td>
<td align='center'>
</tr>

<td>158</td>
<td>30-08-2021</td>
<td>002334</td>
<td>SUYATI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>15-03-1946</td>
<td>76</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002088444914</td>
<td>131202020821P000124</td>
<td align='center'>
Z09.8 </td>
<td align='center'>
Follow-up examination after other treatment for other conditions
</td>
</tr>
<td>159</td>
<td>30-08-2021</td>
<td>008674</td>
<td>SUMARTI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-06-1976</td>
<td>46</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0000658670624</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>160</td>
<td>30-08-2021</td>
<td>006783</td>
<td>EVA RAHMADI NINGSIH</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-02-1997</td>
<td>25</td>
<td>P</td>
<td>`085156077032</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002906971964</td>
<td>131202020821Y000125</td>
<td align='center'>
K02 </td>
<td align='center'>
Dental caries </td>
</tr>

<td>161</td>
<td>30-08-2021</td>
<td>005448</td>
<td>AJI SATOTO</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-10-1999</td>
<td>22</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td>0002473304207</td>
<td></td>
<td align='center'>
R50 </td>
<td align='center'>
</tr>

<td>162</td>
<td>30-08-2021</td>
<td>000900</td>
<td>SUNYOTO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>05-02-1974</td>
<td>48</td>
<td>L</td>
<td>`082337790586</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002874857073</td>
<td>131202020821Y000129</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>163</td>
<td>30-08-2021</td>
<td>006945</td>
<td>SULATIN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-05-1975</td>
<td>47</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036278426</td>
<td>131202020821Y000128</td>
<td align='center'>
J40 </td>
<td align='center'>
Bronchitis, not specified as acute or chronic </td>
</tr>

<td>164</td>
<td>31-08-2021</td>
<td>008710</td>
<td>EDY SUPRIYATI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-07-1963</td>
<td>59</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0001994359983</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>165</td>
<td>31-08-2021</td>
<td>008711</td>
<td>SARINO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-12-1961</td>
<td>60</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0002000432081</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>166</td>
<td>31-08-2021</td>
<td>008713</td>
<td>SARNI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1970</td>
<td>52</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002275308944</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>167</td>
<td>31-08-2021</td>
<td>008708</td>
<td>SURTINI</td>
<td>SIDOMULYO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-11-1980</td>
<td>41</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>168</td>
<td>31-08-2021</td>
<td>001089</td>
<td>FERI BIN MISPON</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-03-1991</td>
<td>31</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002198967467</td>
<td>131202020821Y000131</td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>169</td>
<td>31-08-2021</td>
<td>004665</td>
<td>SARMINI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-01-1967</td>
<td>55</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002198966444</td>
<td>131202020821Y000133</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>170</td>
<td>31-08-2021</td>
<td>006298</td>
<td>MISPON</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-10-1960</td>
<td>61</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002198964497</td>
<td>131202020821Y000134</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>171</td>
<td>31-08-2021</td>
<td>000384</td>
<td>IRFAN MAMENI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-08-1977</td>
<td>44</td>
<td>L</td>
<td>`082331707679</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002624601609</td>
<td>131202020821Y000132</td>
<td align='center'>
Q21.0 </td>
<td align='center'>
Ventricular septal defect </td>
</tr>

<td>172</td>
<td>31-08-2021</td>
<td>007161</td>
<td>SUNARTI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-03-1985</td>
<td>37</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>0002488556992</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>173</td>
<td>31-08-2021</td>
<td>008712</td>
<td>JUMIANTO</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-02-1969</td>
<td>53</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>174</td>
<td>31-08-2021</td>
<td>008692</td>
<td>DWI ANA EFRANDI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-05-1996</td>
<td>26</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002884258596</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>175</td>
<td>31-08-2021</td>
<td>008693</td>
<td>WIJI SUSANTI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-03-1998</td>
<td>24</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PBI (APBN)</td>
<td>0002647206224</td>
<td></td>
<td align='center'>
B34.2 </td>
<td align='center'>
</tr>

<td>176</td>
<td>31-08-2021</td>
<td>008570</td>
<td>BANDI NERSANDI</td>
<td>MUNJULJAYA</td>
<td>PURWAKARTA</td>
<td>PURWAKARTA</td>
<td>28-03-1988</td>
<td>34</td>
<td>L</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBD)</td>
<td>0003042524485</td>
<td></td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>177</td>
<td>31-08-2021</td>
<td>005933</td>
<td>PUJIONO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-03-1993</td>
<td>29</td>
<td>L</td>
<td>`081231884098</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659199958</td>
<td>131202020821Y000135</td>
<td align='center'>
S40 </td>
<td align='center'>
Superficial injury of shoulder and upper arm </td>
</tr>
<td>178</td>
<td>31-08-2021</td>
<td>002699</td>
<td>SUGIARTO</td>
<td>BORANG</td>
<td>ARJOSARI</td>
<td>PACITAN</td>
<td>14-10-1983</td>
<td>38</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
W49 </td>
<td align='center'>
Exposure to other and unspecified inanimate mechanical forces causing
accidental injury </td>
</tr>
</table>

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