PEMERINTAH KABUPATEN KAYONG UTARA

DINAS KESEHATAN DAN KELUARGA BERENCA

PUSKESMAS SUKADANA
Alamat : Jln. Bhayangkara. No: 31 Kabupaten Kayong Utara

LAPORAN RUJUKAN

POLI : KIA KB
BULAN : FEBRUARI 2023

JENIS PEMBIAYAAN
TERDAFTAR BPJS BELUM
NO NAMA UMUR DIAGNOSA TERDAFTA
PBI NON PBI R
L P L P L
1 2 3 4 5 6 7 8 9

1 Nuryanti 37 th Serotinus √

2 Agus Mayani 31 th Amenorrhea, unspicifed √

Maternal care for malpresentation of √

3 Siti Supriyadi 27 th
fetus, unspeficied

4 Ayu Safitri 28 th Anemia Complication √

5 Eka Pebriyanti 25 th Anemia Complication √

Varices Veins of other specified √

6 Imbun 40 th
sites

7 Winda sari 37 th Serotinus √

Female pelvic inflammatory disease,

8 Rohana 39 th √
uncspecified

9 Beti Maryanti 29 th Hipertensi Kronik √

10 Ratnawati 32 th Fetal Takikardi √

11 Riska 22 th Supervision of normal pregnancy √

12 Yuliana Anggraini 22 th Supervision of normal pregnancy √

13 Junia Ratih 22 th Prolonged pregnancy √

 Follow up eximination after other √
14 Tengku Salawati 25 th
treatment for other cinditions

15 Yumna 36 th Supervision of normal pregnancy √

16 Eti Andriani 28 th Preterm labour and delivery √

Follow up eximination after other √

17 Hosniah 38 th
treatment for other cinditions

18 Halimah 35 th Supervision of normal pregnancy √

19 Ega Fitriani 31 th Supervision of normal pregnancy √

20 Woniti 32 th Oligohidramnion √

21 Niti pipah 25 th Supervision of high risk pregnancy √

22 Nabila 33 th Preterm labour and delivery √

23 Siti Aminah 23 th Supervision of high risk pregnancy √

24 Surida 34 th Preterm labour and delivery √

26 Mita 26 th Prolonged pregnancy √

27 Winda Sari 30 th Prolonged pregnancy √

28 Misnawati 41 th Pre Eklampsia √

29 Herni dewi 35 th Other and specified ovarian cysts √

30 Rindu Suci 17 th Supervision of high risk pregnancy √

31 Neti Susanti 26 th Supervision of high risk pregnancy √

32 Safitri 18 th Prolonged pregnancy √

AYONG UTARA
ARGA BERENCANA
ADANA
Kayong Utara

MBIAYAAN
BELUM
TERDAFTA PERMAT RS. M
R A AGUSDJAM FATIMA DJAMAL
P BUNDA UDIN
10 11 12 13 15

√
NON PBI = 4

√
PBI = 28

√
√

√
 PEMERINTAH KABUPATEN KAYONG UTARA
DINAS KESEHATAN DAN KELUARGA BERENCAN
PUSKESMAS SUKADANA
Alamat : Jln. Bhayangkara. No: 31 Kabupaten Kayong Utara

LAPORAN RUJUKAN

POLI : KIA KB
BULAN : MARET 2023

JENIS PEMBIAYAAN
TERDAFTAR BPJS BELUM
NO NAMA UMUR DIAGNOSA TERDAFTA
PBI NON PBI R
L P L P L P
1 2 3 4 5 6 7 8 9 10
Surveilance of (intruterine) √
1 Fitriani 28 th
contaceptive device

2 Sumarni 36 th Supervision of high risk pregnancy √

3 Jannati 33 th Supervision of high risk pregnancy √

4 Pitri Sandi 22 th Supervision of high risk pregnancy √

5 Eka Widiawati 30 th Supervision of high risk pregnancy √

6 Nia Kartina 27 th Oligohidramnion √

7 Machfuzah S 39 th Threatened Abortin √

8 Syarifah Nurhalimah 30 th Supervision of high risk pregnancy √

Follow up eximination after other

9 Rahmawati 25 th √
treatment for other cinditions

10 Siti Marniah 37 th Prolonged pregnancy √

11 Susriyanti 39 th Supervision of high risk pregnancy √

12 Parida 31 th Supervision of normal pregnancy √

13 Jeni Rustina 26 th Supervision of normal pregnancy √

14 Sri Anggraeni 30 th Supervision of normal pregnancy √

15 Arlana 39 th Supervision of normal pregnancy √

16 Reniati 25 th Prolonged pregnancy √

17 Yulianti 29 th Antenatal Sreening, Unspesied √

18 Natmatul Muhimah 24 th Supervision of normal pregnancy √

19 Rapita 20 th Supervision of normal pregnancy √

20 Eli Susanti 24 th Supervision of normal pregnancy √

Anemia complicating Pregnancy, √

21 Elvi Ni"matul. S 24 th
childbirth and the puerperium

22 Wiwinawati 24 th Supervision of high risk pregnancy √

23 Asmah 28 th Supervision of high risk pregnancy √

24 Nurhasimah 38 th Supervision of high risk pregnancy √

26 Nurfadiah 41 th Supervision of high risk pregnancy √

27 Parini 34 th Supervision of high risk pregnancy √

NG UTARA
A BERENCANA
NA
Utara

PERMAT RS. M
A AGUSDJAM FATIMA DJAMAL
BUNDA UDIN
11 12 13 15

√
NON PBI = 4

√
PBI = 28

√
√