Laporan Oktober 2021

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<big><big><span style="font-weight: bold;">
LAPORAN UNIVERSAL POLI UMUM<br>
BULAN 01-10-2021 - 31-10-2021 </span></big></big>
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<table align='center'>
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<td>Total</td>
<td>:</td>
<td>216</td>
</tr>
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<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>01-10-2021</td>
<td>008877</td>
<td>TUKINAH</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-03-1968</td>
<td>54</td>
<td>P</td>
<td>`</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>dr.IRKHAMYUDHI PRIMASAKTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002642960057</td>
<td>131202021021Y000006</td>
<td align='center'>
K30 </td>
<td align='center'>
Dyspepsia </td>
</tr>

<td>2</td>
<td>01-10-2021</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>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>Dr. ANDRI PRADYAKSANTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202021021Y000001</td>
<td align='center'>
E11 </td>
<td align='center'>
Non-insulin-dependent diabetes mellitus </td>
</tr>

<td>3</td>
<td>01-10-2021</td>
<td>002857</td>
<td>SUTARMI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-07-1976</td>
<td>45</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>0001036278202</td>
<td>131202021021Y000008</td>
<td align='center'>
I10 </td>
<td align='center'>
Essential (primary) hypertension </td>
</tr>

<td>4</td>
<td>01-10-2021</td>
<td>001962</td>
<td>GUN SUPRIYONO</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-05-1969</td>
<td>53</td>
<td>L</td>
<td>`081289797752</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036278415</td>
<td>131202021021Y000002</td>
<td align='center'>
M79.2 </td>
<td align='center'>
Neuralgia and neuritis, unspecified </td>
</tr>

<td>5</td>
<td>01-10-2021</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 LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036278426</td>
<td>131202021021Y000005</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>6</td>
<td>01-10-2021</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>PEKERJA MANDIRI</td>
<td>0002874857073</td>
<td>131202021021Y000004</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>7</td>
<td>01-10-2021</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'>
S81.9 </td>
<td align='center'>
Open wound of lower leg, part unspecified </td>
</tr>

<td>8</td>
<td>01-10-2021</td>
<td>008840</td>
<td>SUMIRAH</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-05-1971</td>
<td>51</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'>
I10 </td>
<td align='center'>
</tr>

<td>9</td>
<td>01-10-2021</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>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659732106</td>
<td>131202021021Y000007</td>
<td align='center'>
N39 </td>
<td align='center'>
Other disorders of urinary system </td>
</tr>
<td>10</td>
<td>01-10-2021</td>
<td>008876</td>
<td>SUWARNO</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-06-1967</td>
<td>55</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'>
I10 </td>
<td align='center'>
</tr>

<td>11</td>
<td>01-10-2021</td>
<td>008858</td>
<td>SUTINI</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>18-05-1977</td>
<td>45</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
H65 </td>
<td align='center'>
Nonsuppurative otitis media </td>
</tr>

<td>12</td>
<td>01-10-2021</td>
<td>008878</td>
<td>SURANI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>15-04-1961</td>
<td>61</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'>
W49 </td>
<td align='center'>
Exposure to other and unspecified inanimate mechanical forces causing
accidental injury </td>
</tr>

<td>13</td>
<td>01-10-2021</td>
<td>001030</td>
<td>KATENO</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-09-1974</td>
<td>47</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'>
E11 </td>
<td align='center'>
</tr>

<td>14</td>
<td>01-10-2021</td>
<td>002092</td>
<td>TINI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-02-1960</td>
<td>62</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002642960529</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>15</td>
<td>02-10-2021</td>
<td>001305</td>
<td>MISWANTO</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>17-08-1978</td>
<td>43</td>
<td>L</td>
<td>`</td>
<td>Karyawan Swasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PEGAWAI SWASTA</td>
<td>0002155642097</td>
<td></td>
<td align='center'>
M13 </td>
<td align='center'>
Other arthritis </td>
</tr>

<td>16</td>
<td>02-10-2021</td>
<td>008110</td>
<td>KATIYEM</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>01-07-1965</td>
<td>57</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002647217913</td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>17</td>
<td>04-10-2021</td>
<td>008892</td>
<td>ARIS GUNARSO</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-09-2001</td>
<td>20</td>
<td>L</td>
<td>`</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658659925</td>
<td>131202021021Y000030</td>
<td align='center'>
K05.0 </td>
<td align='center'>
Acute gingivitis </td>
</tr>

<td>18</td>
<td>04-10-2021</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>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202021021Y000028</td>
<td align='center'>
E14 </td>
<td align='center'>
Unspecified diabetes mellitus </td>
</tr>

<td>19</td>
<td>04-10-2021</td>
<td>000893</td>
<td>MOHAMAD ZAINUDIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-11-1959</td>
<td>62</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002090633591</td>
<td>131202021021Y000027</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>20</td>
<td>04-10-2021</td>
<td>003743</td>
<td>SUCIPTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-07-1989</td>
<td>33</td>
<td>L</td>
<td>`082332000445</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002711221288</td>
<td></td>
<td align='center'>
J40 </td>
<td align='center'>
Bronchitis, not specified as acute or chronic </td>
</tr>

<td>21</td>
<td>04-10-2021</td>
<td>000808</td>
<td>SUMIATI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1969</td>
<td>53</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>0000658659554</td>
<td>131202021021Y000029</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>22</td>
<td>04-10-2021</td>
<td>000428</td>
<td>MOH WANTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-10-1969</td>
<td>52</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001829586767</td>
<td>131202021021Y000011</td>
<td align='center'>
Z09.8 </td>
<td align='center'>
Follow-up examination after other treatment for other conditions
</td>
</tr>

<td>23</td>
<td>04-10-2021</td>
<td>001135</td>
<td>SUKATMI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-12-1970</td>
<td>51</td>
<td>P</td>
<td>`085336510416</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001383424165</td>
<td>131202021021Y000012</td>
<td align='center'>
E11.4 </td>
<td align='center'>
Non-insulin-dependent diabetes mellitus with neurological complications
</td>
</tr>

<td>24</td>
<td>04-10-2021</td>
<td>000331</td>
<td>FITRI LESTARI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-06-1986</td>
<td>36</td>
<td>P</td>
<td>`085211891713</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001283406309</td>
<td>131202021021Y000013</td>
<td align='center'>
N18.5 </td>
<td align='center'>
Chronic kidney disease, stage 5 </td>
</tr>

<td>25</td>
<td>04-10-2021</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>SUYATNO</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>26</td>
<td>04-10-2021</td>
<td>000589</td>
<td>SARMI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-09-1969</td>
<td>52</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td></td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658639473</td>
<td>131202021021Y000025</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>27</td>
<td>04-10-2021</td>
<td>007600</td>
<td>FAUZI PRIYANGGA</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-07-1996</td>
<td>26</td>
<td>L</td>
<td>`082334898022</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0001085923462</td>
<td>131202021021Y000018</td>
<td align='center'>
H52.5 </td>
<td align='center'>
Disorders of accommodation </td>
</tr>

<td>28</td>
<td>04-10-2021</td>
<td>000720</td>
<td>LINARWATI</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-07-1986</td>
<td>36</td>
<td>P</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002321985666</td>
<td>131202021021Y000017</td>
<td align='center'>
J84.9 </td>
<td align='center'>
Interstitial pulmonary disease, unspecified </td>
</tr>

<td>29</td>
<td>05-10-2021</td>
<td>008899</td>
<td>MISWAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-03-1969</td>
<td>53</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659134732</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>30</td>
<td>05-10-2021</td>
<td>008901</td>
<td>SULIATIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-10-1951</td>
<td>70</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PENERIMA PENSIUN PNS</td>
<td>0000104122089</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>
<td>31</td>
<td>05-10-2021</td>
<td>005996</td>
<td>MUKAMAD </td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-01-1993</td>
<td>29</td>
<td>L</td>
<td>`082235304507</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002480720365</td>
<td>131202021021Y000024</td>
<td align='center'>
S82.20 </td>
<td align='center'>
Fracture of shaft of tibia, closed </td>
</tr>

<td>32</td>
<td>05-10-2021</td>
<td>000254</td>
<td>MARTINI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-07-1972</td>
<td>50</td>
<td>P</td>
<td>`082235030539</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002642961317</td>
<td>131202021021P000022</td>
<td align='center'>
I64 </td>
<td align='center'>
Stroke, not specified as haemorrhage or infarction </td>
</tr>

<td>33</td>
<td>05-10-2021</td>
<td>001092</td>
<td>SUMARTI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-06-1967</td>
<td>55</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002436036467</td>
<td>131202021021Y000023</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>34</td>
<td>05-10-2021</td>
<td>008849</td>
<td>PARTONO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-07-1940</td>
<td>82</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000657520931</td>
<td></td>
<td align='center'>
A30 </td>
<td align='center'>
Leprosy [Hansen disease] </td>
</tr>

<td>35</td>
<td>05-10-2021</td>
<td>008898</td>
<td>SUJARNO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-01-1968</td>
<td>54</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'>
I10 </td>
<td align='center'>
</tr>

<td>36</td>
<td>05-10-2021</td>
<td>002807</td>
<td>WIDWIASTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-08-1982</td>
<td>39</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659012736</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>37</td>
<td>05-10-2021</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>131202021021P000031</td>
<td align='center'>
J44 </td>
<td align='center'>
Other chronic obstructive pulmonary disease </td>
</tr>

<td>38</td>
<td>05-10-2021</td>
<td>000108</td>
<td>SURIYAH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-06-1971</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658619504</td>
<td>131202021021P000032</td>
<td align='center'>
I11 </td>
<td align='center'>
Hypertensive heart disease </td>
</tr>

<td>39</td>
<td>06-10-2021</td>
<td>000156</td>
<td>MUHAMMAD YUNIARDI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-02-1983</td>
<td>39</td>
<td>L</td>
<td>`</td>
<td>Pedagang</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001850963376</td>
<td>131202021021Y000033</td>
<td align='center'>
B20.8 </td>
<td align='center'>
HIV disease resulting in other infectious and parasitic diseases
</td>
</tr>

<td>40</td>
<td>06-10-2021</td>
<td>000020</td>
<td>DWI HANDAYANI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>25-01-1990</td>
<td>32</td>
<td>P</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0001850964355</td>
<td>131202021021Y000034</td>
<td align='center'>
B20.8 </td>
<td align='center'>
HIV disease resulting in other infectious and parasitic diseases
</td>
</tr>

<td>41</td>
<td>08-10-2021</td>
<td>002369</td>
<td>SAYITNO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-03-1985</td>
<td>37</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0001163244666</td>
<td>131202021021Y000037</td>
<td align='center'>
W49.1 </td>
<td align='center'>
Exposure to other and unspecified inanimate mechanical forces,
Residential Institution </td>
</tr>

<td>42</td>
<td>08-10-2021</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>Pegawai Negeri Sipil</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103987348</td>
<td>131202021021Y000038</td>
<td align='center'>
S52.0 </td>
<td align='center'>
Fracture of upper end of ulna </td>
</tr>

<td>43</td>
<td>08-10-2021</td>
<td>003436</td>
<td>SOKIMIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-03-1946</td>
<td>76</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>0002454298108</td>
<td>131202021021Y000042</td>
<td align='center'>
E10.3 </td>
<td align='center'>
Insulin-dependent diabetes mellitus with ophthalmic complications
</td>
</tr>

<td>44</td>
<td>08-10-2021</td>
<td>004982</td>
<td>BOMAN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-11-1950</td>
<td>71</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002320789421</td>
<td>131202021021Y000041</td>
<td align='center'>
S52.1 </td>
<td align='center'>
Fracture of upper end of radius </td>
</tr>

<td>45</td>
<td>11-10-2021</td>
<td>008965</td>
<td>KADIRAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-04-1952</td>
<td>70</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002711221031</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>46</td>
<td>11-10-2021</td>
<td>008960</td>
<td>RIYADI</td>
<td>WORAWARI</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>22-01-1995</td>
<td>27</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>0000658880482</td>
<td>131202021021Y000043</td>
<td align='center'>
S82.10 </td>
<td align='center'>
Fracture of upper end of tibia, closed </td>
</tr>

<td>47</td>
<td>11-10-2021</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>131202021021Y000048</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>48</td>
<td>11-10-2021</td>
<td>006807</td>
<td>DIAN WULANDARI</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-10-2001</td>
<td>20</td>
<td>P</td>
<td>`085334958810</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659051954</td>
<td>131202021021Y000049</td>
<td align='center'>
I20 </td>
<td align='center'>
Angina pectoris </td>
</tr>

<td>49</td>
<td>11-10-2021</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>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001854582783</td>
<td>131202021021Y000044</td>
<td align='center'>
H40.0 </td>
<td align='center'>
Glaucoma suspect </td>
</tr>

<td>50</td>
<td>11-10-2021</td>
<td>004022</td>
<td>SLAMET SURURI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-07-1955</td>
<td>67</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002491380314</td>
<td>131202021021Y000051</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>51</td>
<td>11-10-2021</td>
<td>000994</td>
<td>SUTINI BINTI MISMO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-01-1959</td>
<td>63</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>0000658980101</td>
<td>131202021021Y000046</td>
<td align='center'>
F41.1 </td>
<td align='center'>
Generalized anxiety disorder </td>
</tr>

<td>52</td>
<td>11-10-2021</td>
<td>001196</td>
<td>ISWIYATI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>28-07-1962</td>
<td>59</td>
<td>P</td>
<td>`</td>
<td>Pedagang</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104008476</td>
<td>131202021021Y000045</td>
<td align='center'>
I11 </td>
<td align='center'>
</tr>

<td>53</td>
<td>11-10-2021</td>
<td>002001</td>
<td>SUGITO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-03-1969</td>
<td>53</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>0002711366065</td>
<td>131202021021Y000052</td>
<td align='center'>
R50 </td>
<td align='center'>
Fever of other and unknown origin </td>
</tr>
<td>54</td>
<td>11-10-2021</td>
<td>008964</td>
<td>SOGINEM</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-12-1967</td>
<td>54</td>
<td>P</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'>
I10 </td>
<td align='center'>
</tr>

<td>55</td>
<td>11-10-2021</td>
<td>002369</td>
<td>SAYITNO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-03-1985</td>
<td>37</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001163244666</td>
<td>131202021021Y000050</td>
<td align='center'>
V20 </td>
<td align='center'>
Motorcycle rider injured in collision with pedestrian or animal
</td>
</tr>

<td>56</td>
<td>12-10-2021</td>
<td>008967</td>
<td>DINA SRI HANDAYANI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-05-1992</td>
<td>30</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>0002223781132</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>57</td>
<td>12-10-2021</td>
<td>008968</td>
<td>WINARTI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-12-1979</td>
<td>42</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'>
J06 </td>
<td align='center'>
Acute upper respiratory infections of multiple and unspecified sites
</td>
</tr>

<td>58</td>
<td>12-10-2021</td>
<td>002422</td>
<td>VILLIPO INZAGHI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-12-1999</td>
<td>22</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'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>59</td>
<td>12-10-2021</td>
<td>000767</td>
<td>SOINEM</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>05-03-1942</td>
<td>80</td>
<td>P</td>
<td>`</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658380519</td>
<td>131202021021Y000057</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>60</td>
<td>12-10-2021</td>
<td>005103</td>
<td>VIVIN ENDAH LESTARI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-01-1993</td>
<td>29</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>0000658380622</td>
<td>131202021021Y000055</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>61</td>
<td>12-10-2021</td>
<td>003340</td>
<td>DWI SEPTIYANA</td>
<td>BENDAN</td>
<td>BANYUDONO</td>
<td>BOYOLALI</td>
<td>24-03-1988</td>
<td>34</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PNS DAERAH</td>
<td>0000200352159</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
Examination and encounter for administrative purposes </td>
</tr>

<td>62</td>
<td>12-10-2021</td>
<td>006769</td>
<td>ANDRI PRADYAKSANTI</td>
<td>GEMAHARJO</td>
<td>TEGALOMBO</td>
<td>PACITAN</td>
<td>10-03-1982</td>
<td>40</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>PNS DAERAH</td>
<td>0000103962058</td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>63</td>
<td>12-10-2021</td>
<td>006821</td>
<td>WIJI</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>13-06-1960</td>
<td>62</td>
<td>P</td>
<td>`083853005314</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
Z02 </td>
<td align='center'>
</tr>

<td>64</td>
<td>12-10-2021</td>
<td>008972</td>
<td>RUSMA SIMANJUTAK</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-12-1986</td>
<td>35</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>PBI (APBD)</td>
<td>0001422687251</td>
<td></td>
<td align='center'>
K29.1 </td>
<td align='center'>
Other acute gastritis </td>
</tr>

<td>65</td>
<td>12-10-2021</td>
<td>008973</td>
<td>KATMUJI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-08-1982</td>
<td>39</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>66</td>
<td>12-10-2021</td>
<td>001958</td>
<td>DUDIK HARIANTO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>05-08-1976</td>
<td>45</td>
<td>L</td>
<td>`</td>
<td>GURU</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103942078</td>
<td>131202021021Y000054</td>
<td align='center'>
E11.3 </td>
<td align='center'>
Non-insulin-dependent diabetes mellitus with ophthalmic complications
</td>
</tr>

<td>67</td>
<td>12-10-2021</td>
<td>007178</td>
<td>DENY EDY PURNOMO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-03-1998</td>
<td>24</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>0000658657089</td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>68</td>
<td>13-10-2021</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>RITA AGUSTINA FITRI, Amd.Keb</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202021021Y000062</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>69</td>
<td>13-10-2021</td>
<td>000254</td>
<td>MARTINI</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-07-1972</td>
<td>50</td>
<td>P</td>
<td>`082235030539</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002642961317</td>
<td>131202021021Y000063</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>70</td>
<td>13-10-2021</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>131202021021Y000060</td>
<td align='center'>
Z09.8 </td>
<td align='center'>
Follow-up examination after other treatment for other conditions
</td>
</tr>

<td>71</td>
<td>13-10-2021</td>
<td>003821</td>
<td>SUKARDI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-06-1975</td>
<td>47</td>
<td>L</td>
<td>`081234141300</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>0000103954241</td>
<td>131202021021P000061</td>
<td align='center'>
I11.9 </td>
<td align='center'>
Hypertensive heart disease without (congestive) heart failure
</td>
</tr>

<td>72</td>
<td>13-10-2021</td>
<td>002750</td>
<td>SUPARTIN</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>11-03-1960</td>
<td>62</td>
<td>P</td>
<td>`081330808578</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002760297052</td>
<td>131202021021Y000059</td>
<td align='center'>
I63.9 </td>
<td align='center'>
Cerebral infarction, unspecified </td>
</tr>

<td>73</td>
<td>13-10-2021</td>
<td>008979</td>
<td>BOKAT</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-01-1958</td>
<td>64</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'>
R50 </td>
<td align='center'>
Fever of other and unknown origin </td>
</tr>

<td>74</td>
<td>13-10-2021</td>
<td>008981</td>
<td>MISWAN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1957</td>
<td>65</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'>
O87.2 </td>
<td align='center'>
Haemorrhoids in the puerperium </td>
</tr>

<td>75</td>
<td>13-10-2021</td>
<td>002175</td>
<td>AGUNG CAHYONO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-03-1996</td>
<td>26</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002219713571</td>
<td></td>
<td align='center'>
J33 </td>
<td align='center'>
Nasal polyp </td>
</tr>

<td>76</td>
<td>13-10-2021</td>
<td>008983</td>
<td>SUKARMAN</td>
<td>GASANG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>26-02-1955</td>
<td>67</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'>
E11 </td>
<td align='center'>
</tr>
<td>77</td>
<td>14-10-2021</td>
<td>008984</td>
<td>MARYONO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-05-1950</td>
<td>72</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'>
K05.1 </td>
<td align='center'>
Chronic gingivitis </td>
</tr>

<td>78</td>
<td>14-10-2021</td>
<td>006807</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-10-2001</td>
<td>20</td>
<td>P</td>
<td>`085334958810</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659051954</td>
<td>131202021021Y000121</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>79</td>
<td>14-10-2021</td>
<td>000021</td>
<td>SUPIYAH</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-01-1971</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td></td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658706049</td>
<td></td>
<td align='center'>
L23 </td>
<td align='center'>
Allergic contact dermatitis </td>
</tr>

<td>80</td>
<td>14-10-2021</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></td>
<td>BPJS</td>
<td>0000103954375</td>
<td></td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>81</td>
<td>14-10-2021</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>131202021021Y000066</td>
<td align='center'>
I25.1 </td>
<td align='center'>
Atherosclerotic heart disease </td>
</tr>

<td>82</td>
<td>14-10-2021</td>
<td>007991</td>
<td>MARYATIN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-05-1975</td>
<td>47</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001295465319</td>
<td></td>
<td align='center'>
H52 </td>
<td align='center'>
Disorders of refraction and accommodation </td>
</tr>

<td>83</td>
<td>14-10-2021</td>
<td>000829</td>
<td>TRI SANTOSO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-03-1994</td>
<td>28</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658453588</td>
<td>131202021021Y000122</td>
<td align='center'>
G40.1 </td>
<td align='center'>
Localization-related (focal) (partial) symptomatic epilepsy and
epileptic syndromes with simple partial seizures </td>
</tr>

<td>84</td>
<td>14-10-2021</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></td>
<td>BPJS</td>
<td>0002214857542</td>
<td></td>
<td align='center'>
E11.1 </td>
<td align='center'>
Non-insulin-dependent diabetes mellitus with ketoacidosis </td>
</tr>

<td>85</td>
<td>14-10-2021</td>
<td>009003</td>
<td>SARJONO</td>
<td>JATIGUNUNG</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>25-03-1948</td>
<td>74</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>0001916353179</td>
<td></td>
<td align='center'>
K29.0 </td>
<td align='center'>
Acute haemorrhagic gastritis </td>
</tr>

<td>86</td>
<td>14-10-2021</td>
<td>009002</td>
<td>SUPARMIATI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>15-04-1977</td>
<td>45</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'>
A09 </td>
<td align='center'>
Diarrhoea and gastroenteritis of presumed infectious origin </td>
</tr>

<td>87</td>
<td>15-10-2021</td>
<td>009004</td>
<td>SUYONO</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-01-1983</td>
<td>39</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0001163250134</td>
<td>131202021021Y000072</td>
<td align='center'>
L13.0 </td>
<td align='center'>
Dermatitis herpetiformis </td>
</tr>

<td>88</td>
<td>15-10-2021</td>
<td>009012</td>
<td>SADIR</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-03-1971</td>
<td>51</td>
<td>L</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>0000659190633</td>
<td>131202021021Y000069</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>89</td>
<td>15-10-2021</td>
<td>002517</td>
<td>MARIYAH</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>16-08-1958</td>
<td>63</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0000104239427</td>
<td>131202021021Y000067</td>
<td align='center'>
F20.0 </td>
<td align='center'>
Paranoid schizophrenia </td>
</tr>

<td>90</td>
<td>15-10-2021</td>
<td>003552</td>
<td>ENDANG SULASTRI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>22-11-1972</td>
<td>49</td>
<td>P</td>
<td>`085233060614</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0003059722315</td>
<td>131202021021Y000120</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>91</td>
<td>15-10-2021</td>
<td>003436</td>
<td>SOKIMIN</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-03-1946</td>
<td>76</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>0002454298108</td>
<td>131202021021Y000070</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>92</td>
<td>15-10-2021</td>
<td>000088</td>
<td>RATNA WATI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-02-1990</td>
<td>32</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658570421</td>
<td>131202021021Y000071</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>93</td>
<td>15-10-2021</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 LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103987348</td>
<td>131202021021Y000068</td>
<td align='center'>
S52.0 </td>
<td align='center'>
</tr>

<td>94</td>
<td>15-10-2021</td>
<td>008972</td>
<td>RUSMA SIMANJUTAK</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-12-1986</td>
<td>35</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>0001422687251</td>
<td></td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>95</td>
<td>15-10-2021</td>
<td>002171</td>
<td>ENIK SUSILOWATI</td>
<td>WIDORO</td>
<td>PACITAN</td>
<td>PACITAN</td>
<td>21-03-1977</td>
<td>45</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103987293</td>
<td>131202021021Y000073</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>96</td>
<td>15-10-2021</td>
<td>009010</td>
<td>MUCHLIS</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>18-09-1962</td>
<td>59</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td></td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
N39.0 </td>
<td align='center'>
Urinary tract infection, site not specified </td>
</tr>

<td>97</td>
<td>15-10-2021</td>
<td>002668</td>
<td>SRI WAHYUNI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-12-1993</td>
<td>28</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td>JIWA</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>98</td>
<td>16-10-2021</td>
<td>009013</td>
<td>MISNATIN</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-10-1970</td>
<td>51</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>0002772345014</td>
<td></td>
<td align='center'>
N94 </td>
<td align='center'>
Pain and other conditions associated with female genital organs and
menstrual cycle </td>
</tr>

<td>99</td>
<td>16-10-2021</td>
<td>009014</td>
<td>TIARA TRISNAWATI</td>
<td>BANGUNSARI</td>
<td>PACITAN</td>
<td>PACITAN</td>
<td>26-01-1994</td>
<td>28</td>
<td>P</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002641811062</td>
<td></td>
<td align='center'>
R53 </td>
<td align='center'>
Malaise and fatigue </td>
</tr>
<td>100</td>
<td>16-10-2021</td>
<td>007246</td>
<td>MISIYAH</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>27-04-1963</td>
<td>59</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>0002611873383</td>
<td></td>
<td align='center'>
J45.0 </td>
<td align='center'>
Predominantly allergic asthma </td>
</tr>

<td>101</td>
<td>17-10-2021</td>
<td>000906</td>
<td>BOWO SUGIANTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>23-03-1995</td>
<td>27</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002647184308</td>
<td>131202021021Y000074</td>
<td align='center'>
W49.0 </td>
<td align='center'>
Exposure to other and unspecified inanimate mechanical forces, Home
</td>
</tr>

<td>102</td>
<td>18-10-2021</td>
<td>009016</td>
<td>SITI ROFI`AH</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-02-1973</td>
<td>49</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>0001443734796</td>
<td></td>
<td align='center'>
T17.2 </td>
<td align='center'>
Foreign body in pharynx </td>
</tr>

<td>103</td>
<td>18-10-2021</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>131202021021Y000079</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>104</td>
<td>18-10-2021</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>131202021021Y000076</td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>105</td>
<td>18-10-2021</td>
<td>002104</td>
<td>SARMINI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-04-1978</td>
<td>44</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'>
K29.0 </td>
<td align='center'>
</tr>

<td>106</td>
<td>18-10-2021</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>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>107</td>
<td>18-10-2021</td>
<td>003593</td>
<td>AHMAD SAIFUDIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-07-2000</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'>
J02 </td>
<td align='center'>
Acute pharyngitis </td>
</tr>

<td>108</td>
<td>18-10-2021</td>
<td>007228</td>
<td>DARMO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-03-1954</td>
<td>68</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>0003017754707</td>
<td></td>
<td align='center'>
A30 </td>
<td align='center'>
Leprosy [Hansen disease] </td>
</tr>

<td>109</td>
<td>18-10-2021</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>131202021021Y000077</td>
<td align='center'>
N39.0 </td>
<td align='center'>
Urinary tract infection, site not specified </td>
</tr>

<td>110</td>
<td>18-10-2021</td>
<td>008978</td>
<td>SARTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-01-1966</td>
<td>56</td>
<td>P</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'>
I10 </td>
<td align='center'>
</tr>

<td>111</td>
<td>18-10-2021</td>
<td>006807</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-10-2001</td>
<td>20</td>
<td>P</td>
<td>`085334958810</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659051954</td>
<td>131202021021Y000075</td>
<td align='center'>
R00.2 </td>
<td align='center'>
Palpitations </td>
</tr>

<td>112</td>
<td>18-10-2021</td>
<td>009017</td>
<td>YULI INDRIYANI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-10-1989</td>
<td>32</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'>
L23.0 </td>
<td align='center'>
Allergic contact dermatitis due to metals </td>
</tr>

<td>113</td>
<td>18-10-2021</td>
<td>008065</td>
<td>NING RIZA HUMAIROH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-02-1992</td>
<td>30</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>0002265597156</td>
<td>131202021021Y000078</td>
<td align='center'>
I95.9 </td>
<td align='center'>
Hypotension, unspecified </td>
</tr>

<td>114</td>
<td>18-10-2021</td>
<td>009018</td>
<td>TAMIRAH</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-10-1974</td>
<td>47</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'>
L23 </td>
<td align='center'>
</tr>

<td>115</td>
<td>18-10-2021</td>
<td>002192</td>
<td>SAIFUL AFANDI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-12-1968</td>
<td>53</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td>JIWA</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>116</td>
<td>18-10-2021</td>
<td>009019</td>
<td>KOMSIYAH</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>12-05-1969</td>
<td>53</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'>
K29.7 </td>
<td align='center'>
Gastritis, unspecified </td>
</tr>

<td>117</td>
<td>19-10-2021</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 LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103987348</td>
<td>131202021021Y000080</td>
<td align='center'>
S52.0 </td>
<td align='center'>
</tr>

<td>118</td>
<td>19-10-2021</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>119</td>
<td>19-10-2021</td>
<td>000604</td>
<td>SUPRIYATI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1961</td>
<td>61</td>
<td>P</td>
<td>`085335271977</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>120</td>
<td>19-10-2021</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>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001826983091</td>
<td></td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>121</td>
<td>19-10-2021</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>122</td>
<td>19-10-2021</td>
<td>000414</td>
<td>ERIKA YULIANA PRASTIWI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-04-1990</td>
<td>32</td>
<td>P</td>
<td>`082332004703</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002300306771</td>
<td>131202021021Y000085</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>123</td>
<td>20-10-2021</td>
<td>009024</td>
<td>SUDIRNO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-07-1970</td>
<td>52</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002447729752</td>
<td>131202021021Y000081</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>124</td>
<td>20-10-2021</td>
<td>008902</td>
<td>MISNATIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-07-1974</td>
<td>48</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>0002842395052</td>
<td>131202021021Y000082</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>125</td>
<td>20-10-2021</td>
<td>002487</td>
<td>NANIK MARIYANA</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>02-01-1980</td>
<td>42</td>
<td>P</td>
<td>`085330317141</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659051706</td>
<td>131202021021Y000083</td>
<td align='center'>
J02 </td>
<td align='center'>
</tr>

<td>126</td>
<td>21-10-2021</td>
<td>009032</td>
<td>SUMI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-05-1960</td>
<td>62</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000658151436</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>127</td>
<td>21-10-2021</td>
<td>001030</td>
<td>KATENO</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-09-1974</td>
<td>47</td>
<td>L</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'>
E11 </td>
<td align='center'>
</tr>

<td>128</td>
<td>21-10-2021</td>
<td>000871</td>
<td>HENDRA SETIAWAN</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-04-2000</td>
<td>22</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>0002882383255</td>
<td>131202021021Y000086</td>
<td align='center'>
F20.0 </td>
<td align='center'>
Paranoid schizophrenia </td>
</tr>

<td>129</td>
<td>21-10-2021</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>131202021021Y000091</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>130</td>
<td>21-10-2021</td>
<td>001201</td>
<td>HARTINI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-05-1995</td>
<td>27</td>
<td>P</td>
<td>`085204536326</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001297963528</td>
<td>131202021021Y000088</td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>131</td>
<td>21-10-2021</td>
<td>002673</td>
<td>WIJI PURWANI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-04-1969</td>
<td>53</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104264381</td>
<td>131202021021Y000089</td>
<td align='center'>
I61.1 </td>
<td align='center'>
Intracerebral haemorrhage in hemisphere, cortical </td>
</tr>

<td>132</td>
<td>21-10-2021</td>
<td>001995</td>
<td>DWIYANTI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-11-1971</td>
<td>50</td>
<td>P</td>
<td>`085235858222</td>
<td>POLI UMUM</td>
<td>ROZI SULISTYO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000104059405</td>
<td>131202021021Y000119</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>133</td>
<td>21-10-2021</td>
<td>001474</td>
<td>SUPRIHATIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-07-1975</td>
<td>47</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>ROZI SULISTYO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001249962153</td>
<td>131202021021Y000090</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>134</td>
<td>21-10-2021</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>131202021021Y000092</td>
<td align='center'>
G40 </td>
<td align='center'>
Epilepsy </td>
</tr>

<td>135</td>
<td>21-10-2021</td>
<td>009038</td>
<td>SLAMET HARYANTO</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>10-11-1979</td>
<td>42</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>DIAH WAHYU MENTARI,Amd.Keb</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'>
</tr>

<td>136</td>
<td>22-10-2021</td>
<td>009043</td>
<td>NARIS FEBRI FLAMBOYAN</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>26-02-2000</td>
<td>22</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002677948233</td>
<td>131202021021Y000097</td>
<td align='center'>
Z02.0 </td>
<td align='center'>
Examination for admission to educational institution </td>
</tr>

<td>137</td>
<td>22-10-2021</td>
<td>005121</td>
<td>SUKATNI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-05-1955</td>
<td>67</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658574324</td>
<td>131202021021Y000093</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>138</td>
<td>22-10-2021</td>
<td>006547</td>
<td>SUYANTO</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-12-1957</td>
<td>64</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002874630295</td>
<td>131202021021Y000095</td>
<td align='center'>
N18 </td>
<td align='center'>
Chronic kidney disease </td>
</tr>

<td>139</td>
<td>22-10-2021</td>
<td>001906</td>
<td>PAWITRI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-05-1966</td>
<td>56</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>
<td>140</td>
<td>22-10-2021</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 LAMA</td>
<td>BPJS</td>
<td>0001843774683</td>
<td>131202021021Y000096</td>
<td align='center'>
H40.0 </td>
<td align='center'>
Glaucoma suspect </td>
</tr>

<td>141</td>
<td>22-10-2021</td>
<td>001195</td>
<td>ERVI SEPTIANINGSIH</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>23-09-1990</td>
<td>31</td>
<td>P</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'>
J02 </td>
<td align='center'>
</tr>

<td>142</td>
<td>22-10-2021</td>
<td>007246</td>
<td>MISIYAH</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>27-04-1963</td>
<td>59</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002611873383</td>
<td></td>
<td align='center'>
J45 </td>
<td align='center'>
Asthma </td>
</tr>

<td>143</td>
<td>22-10-2021</td>
<td>008067</td>
<td>ALFIN DWI ERFANA</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>20-05-1998</td>
<td>24</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002252228231</td>
<td></td>
<td align='center'>
Z02.0 </td>
<td align='center'>
Examination for admission to educational institution </td>
</tr>

<td>144</td>
<td>22-10-2021</td>
<td>008978</td>
<td>SARTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-01-1966</td>
<td>56</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>145</td>
<td>23-10-2021</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></td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001282634122</td>
<td>131202021021Y000098</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>146</td>
<td>23-10-2021</td>
<td>000297</td>
<td>JURIYAH</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-06-1960</td>
<td>62</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td></td>
<td>UMUM</td>
<td></td>
<td>JIWA</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>147</td>
<td>23-10-2021</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>LAMA</td>
<td></td>
<td>GRATIS</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>148</td>
<td>23-10-2021</td>
<td>009051</td>
<td>JUREMI</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1950</td>
<td>72</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td></td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000660255186</td>
<td></td>
<td align='center'>
W49.1 </td>
<td align='center'>
</tr>

<td>149</td>
<td>25-10-2021</td>
<td>009052</td>
<td>SULANTAR</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-05-1958</td>
<td>64</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>0001036279708</td>
<td>131202021021Y000102</td>
<td align='center'>
H40.1 </td>
<td align='center'>
Primary open-angle glaucoma </td>
</tr>

<td>150</td>
<td>25-10-2021</td>
<td>009056</td>
<td>TUMIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-01-1940</td>
<td>82</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000659009687</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>151</td>
<td>25-10-2021</td>
<td>009064</td>
<td>SARINEM</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-03-1964</td>
<td>58</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002641156345</td>
<td>131202021021Y000117</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>152</td>
<td>25-10-2021</td>
<td>007170</td>
<td>DUKUT</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-10-1952</td>
<td>69</td>
<td>L</td>
<td>`085334205515</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0003001422104</td>
<td>131202021021Y000099</td>
<td align='center'>
H40.1 </td>
<td align='center'>
Primary open-angle glaucoma </td>
</tr>

<td>153</td>
<td>25-10-2021</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>131202021021Y000103</td>
<td align='center'>
E10 </td>
<td align='center'>
Insulin-dependent diabetes mellitus </td>
</tr>

<td>154</td>
<td>25-10-2021</td>
<td>000588</td>
<td>KATIRAN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-08-1963</td>
<td>58</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>0000658671096</td>
<td>131202021021Y000118</td>
<td align='center'>
K29.1 </td>
<td align='center'>
</tr>

<td>155</td>
<td>25-10-2021</td>
<td>000239</td>
<td>SUPARTIN</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>25-02-1956</td>
<td>66</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002617981402</td>
<td>131202021021Y000100</td>
<td align='center'>
F41.1 </td>
<td align='center'>
</tr>

<td>156</td>
<td>25-10-2021</td>
<td>001559</td>
<td>SUCIPTO</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>09-03-1969</td>
<td>53</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>0002262653335</td>
<td>131202021021Y000101</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>157</td>
<td>25-10-2021</td>
<td>008967</td>
<td>DINA SRI HANDAYANI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-05-1992</td>
<td>30</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>GRATIS</td>
<td>0002223781132</td>
<td></td>
<td align='center'>
F20 </td>
<td align='center'>
Schizophrenia </td>
</tr>

<td>158</td>
<td>25-10-2021</td>
<td>009055</td>
<td>AHMAD FAHRUDIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>29-04-1998</td>
<td>24</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td></td>
<td></td>
<td align='center'>
J06.0 </td>
<td align='center'>
Acute larynpharyngitis </td>
</tr>

<td>159</td>
<td>25-10-2021</td>
<td>004527</td>
<td>EKA NOVIYANTI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-05-1995</td>
<td>27</td>
<td>P</td>
<td>`082310582196</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658444601</td>
<td>131202021021Y000116</td>
<td align='center'>
R51 </td>
<td align='center'>
Headache </td>
</tr>

<td>160</td>
<td>25-10-2021</td>
<td>006598</td>
<td>RISNA APRILIA</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>10-04-1998</td>
<td>24</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PEGAWAI BUMN</td>
<td>0002136891914</td>
<td></td>
<td align='center'>
K29.1 </td>
<td align='center'>
</tr>

<td>161</td>
<td>25-10-2021</td>
<td>001565</td>
<td>WINARNO</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-02-1969</td>
<td>53</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>0000103957222</td>
<td>131202021021Y000115</td>
<td align='center'>
K29.1 </td>
<td align='center'>
</tr>

<td>162</td>
<td>25-10-2021</td>
<td>009057</td>
<td>SRI UTAMI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1959</td>
<td>63</td>
<td>P</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'>
I10 </td>
<td align='center'>
</tr>

<td>163</td>
<td>25-10-2021</td>
<td>003669</td>
<td>JUMINEM</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1952</td>
<td>70</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>0002729796759</td>
<td>131202021021Y000114</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>164</td>
<td>25-10-2021</td>
<td>009066</td>
<td>TUMINAH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-02-1952</td>
<td>70</td>
<td>P</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'>
I10 </td>
<td align='center'>
</tr>

<td>165</td>
<td>25-10-2021</td>
<td>009067</td>
<td>RITA HANDAYANI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-03-1987</td>
<td>35</td>
<td>P</td>
<td>`082132802007</td>
<td>POLI UMUM</td>
<td>SUYATNO</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>166</td>
<td>25-10-2021</td>
<td>000604</td>
<td>SUPRIYATI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1961</td>
<td>61</td>
<td>P</td>
<td>`085335271977</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'>
</tr>

<td>167</td>
<td>25-10-2021</td>
<td>009068</td>
<td>SOLIKIN</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>26-11-1965</td>
<td>56</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'>
R50.9 </td>
<td align='center'>
Fever, unspecified </td>
</tr>

<td>168</td>
<td>25-10-2021</td>
<td>009069</td>
<td>SUJARMI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-09-1977</td>
<td>44</td>
<td>P</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'>
I10 </td>
<td align='center'>
</tr>

<td>169</td>
<td>26-10-2021</td>
<td>009070</td>
<td>JUMANGIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-06-1983</td>
<td>39</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>0002643162434</td>
<td></td>
<td align='center'>
K29.0 </td>
<td align='center'>
</tr>

<td>170</td>
<td>26-10-2021</td>
<td>009072</td>
<td>NGALI REJO</td>
<td>NGLARAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>11-05-1930</td>
<td>92</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>0000659941525</td>
<td></td>
<td align='center'>
W45.9 </td>
<td align='center'>
Foreign body or object entering through skin, Unspecified Place
</td>
</tr>

<td>171</td>
<td>26-10-2021</td>
<td>000405</td>
<td>SUPRIHATIN</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>16-12-1992</td>
<td>29</td>
<td>P</td>
<td>`085232873869</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>0002729796939</td>
<td>131202021021Y000124</td>
<td align='center'>
K29 </td>
<td align='center'>
Gastritis and duodenitis </td>
</tr>

<td>172</td>
<td>26-10-2021</td>
<td>009051</td>
<td>JUREMI</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>30-06-1950</td>
<td>72</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0000660255186</td>
<td></td>
<td align='center'>
W45.9 </td>
<td align='center'>
Foreign body or object entering through skin, Unspecified Place
</td>
</tr>

<td>173</td>
<td>26-10-2021</td>
<td>000627</td>
<td>MULYANINGSIH</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-09-1967</td>
<td>54</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td>KADER</td>
<td></td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>174</td>
<td>26-10-2021</td>
<td>009071</td>
<td>SARJITO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-03-1964</td>
<td>58</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'>
Z00 </td>
<td align='center'>
General examination and investigation of persons without complaint and
reported diagnosis </td>
</tr>

<td>175</td>
<td>26-10-2021</td>
<td>006654</td>
<td>SUMIYEM</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>23-03-1967</td>
<td>55</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002312324223</td>
<td>131202021021Y000127</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>176</td>
<td>26-10-2021</td>
<td>006656</td>
<td>KATNI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>04-03-1959</td>
<td>63</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>0002312323301</td>
<td>131202021021Y000126</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>177</td>
<td>26-10-2021</td>
<td>004333</td>
<td>SULIKAH</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-10-1979</td>
<td>42</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002647183757</td>
<td>131202021021Y000128</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>178</td>
<td>26-10-2021</td>
<td>003141</td>
<td>SUYATNI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>01-03-1968</td>
<td>54</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>0000659693777</td>
<td>131202021021Y000129</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>179</td>
<td>26-10-2021</td>
<td>008978</td>
<td>SARTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>03-01-1966</td>
<td>56</td>
<td>P</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'>
J45 </td>
<td align='center'>
Asthma </td>
</tr>

<td>180</td>
<td>26-10-2021</td>
<td>008758</td>
<td>SUMINI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-02-1967</td>
<td>55</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>181</td>
<td>26-10-2021</td>
<td>001117</td>
<td>SINTYA NOVITASARI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>02-11-1997</td>
<td>24</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'>
J06 </td>
<td align='center'>
</td>
</tr>
<td>182</td>
<td>26-10-2021</td>
<td>009073</td>
<td>JANIAS MANDALINI</td>
<td>WONOANTI</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>05-01-1994</td>
<td>28</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'>
R50.0 </td>
<td align='center'>
Fever with chills </td>
</tr>

<td>183</td>
<td>26-10-2021</td>
<td>002948</td>
<td>SYAHRI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-02-1969</td>
<td>53</td>
<td>L</td>
<td>`</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0000103968088</td>
<td>131202021021Y000125</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>184</td>
<td>27-10-2021</td>
<td>009080</td>
<td>ASTUTIK</td>
<td>BUBAKAN</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>06-02-1983</td>
<td>39</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002860444271</td>
<td></td>
<td align='center'>
W49.0 </td>
<td align='center'>
Exposure to other and unspecified inanimate mechanical forces, Home
</td>
</tr>

<td>185</td>
<td>27-10-2021</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>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0001036275682</td>
<td>131202021021Y000131</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>186</td>
<td>27-10-2021</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>187</td>
<td>27-10-2021</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>131202021021Y000132</td>
<td align='center'>
M13 </td>
<td align='center'>
</tr>

<td>188</td>
<td>27-10-2021</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>131202021021Y000133</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>189</td>
<td>27-10-2021</td>
<td>004230</td>
<td>YAMTI DIAN SARI</td>
<td>PAGUTAN</td>
<td>ARJOSARI</td>
<td>PACITAN</td>
<td>09-02-1999</td>
<td>23</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBD)</td>
<td>0002732355843</td>
<td></td>
<td align='center'>
J06 </td>
<td align='center'>
</td>
</tr>

<td>190</td>
<td>27-10-2021</td>
<td>009076</td>
<td>MARKUM</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-09-1968</td>
<td>53</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'>
M13 </td>
<td align='center'>
</tr>

<td>191</td>
<td>27-10-2021</td>
<td>001826</td>
<td>SUTIRAH</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>21-07-1967</td>
<td>54</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0002206950524</td>
<td>131202021021Y000130</td>
<td align='center'>
F41.1 </td>
<td align='center'>
</tr>

<td>192</td>
<td>27-10-2021</td>
<td>009081</td>
<td>IMAM SUKEMI</td>
<td>KALIKUNING</td>
<td>TULAKAN</td>
<td>PACITAN</td>
<td>27-10-1966</td>
<td>55</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'>
W49.1 </td>
<td align='center'>
</tr>

<td>193</td>
<td>27-10-2021</td>
<td>009082</td>
<td>MARJUKI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-10-1966</td>
<td>55</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'>
E11 </td>
<td align='center'>
</tr>

<td>194</td>
<td>27-10-2021</td>
<td>009084</td>
<td>SUMINI</td>
<td>WONOGONDO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>31-12-1964</td>
<td>57</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>195</td>
<td>28-10-2021</td>
<td>009088</td>
<td>SUMINI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>07-08-1952</td>
<td>69</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000658634927</td>
<td>131202021021Y000137</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>196</td>
<td>28-10-2021</td>
<td>009089</td>
<td>HARDI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>06-02-1967</td>
<td>55</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0002643161433</td>
<td></td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>197</td>
<td>28-10-2021</td>
<td>008902</td>
<td>MISNATIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>12-07-1974</td>
<td>48</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>0002842395052</td>
<td>131202021021Y000140</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>198</td>
<td>28-10-2021</td>
<td>007603</td>
<td>SUMINEM</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-06-1965</td>
<td>57</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>0002647184332</td>
<td>131202021021Y000134</td>
<td align='center'>
C07 </td>
<td align='center'>
Malignant neoplasm of parotid gland </td>
</tr>

<td>199</td>
<td>28-10-2021</td>
<td>002944</td>
<td>USMAN</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>27-09-1971</td>
<td>50</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002632569884</td>
<td>131202021021Y000139</td>
<td align='center'>
E11 </td>
<td align='center'>
</tr>

<td>200</td>
<td>28-10-2021</td>
<td>003595</td>
<td>MESIYAH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1970</td>
<td>52</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>SUYATNO</td>
<td>BARU</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659166254</td>
<td>131202021021Y000138</td>
<td align='center'>
I10 </td>
<td align='center'>
</tr>

<td>201</td>
<td>28-10-2021</td>
<td>009087</td>
<td>MESENI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-06-1976</td>
<td>46</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'>
E11 </td>
<td align='center'>
</tr>

<td>202</td>
<td>28-10-2021</td>
<td>009090</td>
<td>SUMINI</td>
<td>GEMBUK</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>19-05-1964</td>
<td>58</td>
<td>P</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'>
I10 </td>
<td align='center'>
</tr>

<td>203</td>
<td>28-10-2021</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>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0002711221222</td>
<td>131202021021Y000135</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>204</td>
<td>28-10-2021</td>
<td>000184</td>
<td>PONIMIN</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>20-03-1966</td>
<td>56</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>0000659225171</td>
<td>131202021021Y000136</td>
<td align='center'>
E10.4 </td>
<td align='center'>
Insulin-dependent diabetes mellitus with neurological complications
</td>
</tr>
<td>205</td>
<td>28-10-2021</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'>
A15 </td>
<td align='center'>
Respiratory tuberculosis, bacteriologically and histologically
confirmed </td>
</tr>

<td>206</td>
<td>29-10-2021</td>
<td>009096</td>
<td>SUMARTO</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>14-05-1947</td>
<td>75</td>
<td>L</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>0002039520521</td>
<td></td>
<td align='center'>
L23.0 </td>
<td align='center'>
Allergic contact dermatitis due to metals </td>
</tr>

<td>207</td>
<td>29-10-2021</td>
<td>009098</td>
<td>MESIYAH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>08-08-1963</td>
<td>58</td>
<td>P</td>
<td>`</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>0001249961938</td>
<td></td>
<td align='center'>
J40 </td>
<td align='center'>
Bronchitis, not specified as acute or chronic </td>
</tr>

<td>208</td>
<td>29-10-2021</td>
<td>004363</td>
<td>PARTI</td>
<td>KETEPUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>04-03-1965</td>
<td>57</td>
<td>P</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'>
K29.7 </td>
<td align='center'>
Gastritis, unspecified </td>
</tr>

<td>209</td>
<td>29-10-2021</td>
<td>009071</td>
<td>SARJITO</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>24-03-1964</td>
<td>58</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'>
Z04.1 </td>
<td align='center'>
Examination and observation following transport accident </td>
</tr>

<td>210</td>
<td>29-10-2021</td>
<td>005464</td>
<td>MUHAMMAD SYAHRONI</td>
<td>SANGGRAHAN</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-05-1997</td>
<td>25</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'>
Z00.0 </td>
<td align='center'>
General medical examination </td>
</tr>

<td>211</td>
<td>29-10-2021</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>131202021021Y000143</td>
<td align='center'>
E10 </td>
<td align='center'>
Insulin-dependent diabetes mellitus </td>
</tr>

<td>212</td>
<td>29-10-2021</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>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>0001854582783</td>
<td>131202021021Y000142</td>
<td align='center'>
I64 </td>
<td align='center'>
</tr>

<td>213</td>
<td>29-10-2021</td>
<td>001030</td>
<td>KATENO</td>
<td>PUNJUNG</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-09-1974</td>
<td>47</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'>
E11 </td>
<td align='center'>
</tr>

<td>214</td>
<td>29-10-2021</td>
<td>009097</td>
<td>SINAR</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>30-06-1945</td>
<td>77</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'>
I11 </td>
<td align='center'>
</tr>

<td>215</td>
<td>29-10-2021</td>
<td>003252</td>
<td>TUKIRAH</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>13-06-1953</td>
<td>69</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'>
I10 </td>
<td align='center'>
</tr>

<td>216</td>
<td>29-10-2021</td>
<td>009099</td>
<td>SUKARTI</td>
<td>KETRO</td>
<td>KEBONAGUNG</td>
<td>PACITAN</td>
<td>17-05-1941</td>
<td>81</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'>
I10 </td>
<td align='center'>
</tr>
</table>

Laporan Oktober 2021

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