<table width=1200><tr><th colspan=15>REGISTER PUSKESMAS Watukumpul PER TANGGAL 02-

05-2023 </th></tr><tr>
<th>NO</th>
<th>NO RM</th>
<th>NAMA</th>
<th>NAMA KK</th>
<th>TGL LAHIR</th>
<th>JK</th>
<th>ALAMAT</th>
<th>RT</th>
<th>RW</th>
<th>CARA BAYAR</th>
<th>NO JAMINAN</th>
<th>POLI</th>
<th>PELAYANAN</th>
<th>DIAGNOSA</th>
<th>THERAPI</th>
</tr><tr><td valign=top>1</td><td valign=top>3330</td><td valign=top>EFAN
ARDIANTO</td><td valign=top>WIYANTO</td>
<td valign=top>2019-04-14</td><td valign=top>L</td><td valign=top>BADAK</td><td
valign=top>4</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[] </td><td>- KLORAMFENIKOL TETES TELINGA
(RECO) 1, 3x3 tetes, <br/>- SIPROFLOKSASIN TABLET 500 MG 5, 3x1/2 tablet, <br/>-
PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br/></tr><tr><td valign=top>2</td><td
valign=top>3331</td><td valign=top>ABDU NAELUN NABHAN</td><td valign=top>ILHAM</td>
<td valign=top>2015-04-11</td><td valign=top>L</td><td valign=top>TLAGASANA</td><td
valign=top>14</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br/>- AMBROKSOL TABLET
5, 3x1/2 tablet, <br/>- AMOKSISILLIN SIRUP KERING 125 MG/ML 1, 3x1 sendok makan,
<br/></tr><tr><td valign=top>3</td><td valign=top>3332</td><td
valign=top>SUMARNI</td><td valign=top>WARSIDI</td>
<td valign=top>1965-05-02</td><td valign=top>P</td><td
valign=top>GUNUNGJAYA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[I10] Essential (primary)
hypertension</td><td>- NIFEDIPIN TABLET 10 MG 5, 1x1 tablet, <br/>- NATRIUM
DIKLOFENAK TABLET 50 MG 6, 2x1 tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10,
3x1 tablet, <br/></tr><tr><td valign=top>4</td><td valign=top>3333</td><td
valign=top>WARSIDI</td><td valign=top>WARSIDI</td>
<td valign=top>1958-05-02</td><td valign=top>L</td><td
valign=top>GUNUNGJAYA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>-
NATRIUM DIKLOFENAK TABLET 50 MG 6, 2x1 tablet, <br/>- PIROXICAM TABLET 20 MG 6, 2x1
tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1 tablet, <br/></tr><tr><td
valign=top>5</td><td valign=top>3334</td><td valign=top>ABDU NAELUN NABHAN</td><td
valign=top>ILHAM</td>
<td valign=top>1960-07-01</td><td valign=top>L</td><td valign=top>TLAGASANA</td><td
valign=top>14</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N39.9] Disorder of urinary system,
unspecified</td><td>- ASAM MEFENAMAT 500 MG 10, 2x1 tablet, <br/>- PIROXICAM TABLET
20 MG 6, 2x1 tablet, <br/>- VITAMIN B KOMPLEKS TABLET 10, 2x1 tablet,
<br/></tr><tr><td valign=top>6</td><td valign=top>3335</td><td valign=top>ABDU
NAELUN NABHAN</td><td valign=top>ILHAM</td>
<td valign=top>1969-07-07</td><td valign=top>L</td><td valign=top>TLAGASANA</td><td
valign=top>14</td><td valign=top>5</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J06.9] Acute upper respiratory infection,
unspecified</td><td>- AMBROKSOL TABLET 10, 3x1 tablet, <br/>- PARASETAMOL TABLET
500 MG 10, 3x1 tablet, <br/>- PIRIDOKSIN HCL ( VIT B6 ) TABLET 10 MG 10, 3x1
tablet, <br/></tr><tr><td valign=top>7</td><td valign=top>3336</td><td
valign=top>TARDI</td><td valign=top>TARDI</td>
<td valign=top>1960-02-07</td><td valign=top>L</td><td valign=top>JOJOGAN</td><td
valign=top>11</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0002800950884</td><td valign=top>POLI UMUM</td><td
valign=top>Dirujuk</td><td valign=top>-[H59.9] Postprocedural disorder of eye and
adnexa, unspecified</td><td></tr><tr><td valign=top>8</td><td
valign=top>3337</td><td valign=top>DAHIRIN</td><td valign=top>DAHIRIN</td>
<td valign=top>1972-05-02</td><td valign=top>L</td><td valign=top>TUNDAGAN</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N34.2] Other urethritis</td><td>-
SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- ASAM MEFENAMAT 500 MG 10, 3x1
tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet,
<br/></tr><tr><td valign=top>9</td><td valign=top>3338</td><td valign=top>AMELIA
KHUROTUN IFADAH</td><td valign=top>YUSUF</td>
<td valign=top>2020-06-04</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[] </td><td>- OKSITETRASIKLIN SALEP KULIT
1, 3x1, <br/>- AMOKSISILLIN SIRUP KERING 125 MG/ML 1, 3x1 sendok makan, <br/>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 4, 3x1/3 tablet, <br/>- ASAM ASKORBAT
( VIT C ) TABLET 50 MG 4, 3x1/3 tablet, <br/></tr><tr><td valign=top>10</td><td
valign=top>3339</td><td valign=top>SUROYO</td><td valign=top>SUROYO</td>
<td valign=top>1960-09-10</td><td valign=top>L</td><td valign=top>MAJAKERTA</td><td
valign=top>9</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000619862049</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[Z71.0] Person consulting on behalf of
another person</td><td>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- ASAM
MEFENAMAT 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG
(RAMVIT-C) 10, 3x1 tablet, <br/></tr><tr><td valign=top>11</td><td
valign=top>3340</td><td valign=top>CASMIAH</td><td valign=top>SOBIRIN</td>
<td valign=top>1978-05-02</td><td valign=top>P</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>8</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[J06.9] Acute upper
respiratory infection, unspecified</td><td>- AMBROKSOL TABLET 10, 3x1 tablet,
<br/>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C )
TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet, <br/></tr><tr><td valign=top>12</td><td
valign=top>3341</td><td valign=top>NANIK LUTFIAH</td><td valign=top>MUHAMMAD
NUROZAK</td>
<td valign=top>1998-01-05</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>9</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0001695307184</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N30.9] Cystitis, unspecified</td><td>-
ASAM MEFENAMAT 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG
(RAMVIT-C) 5, 1x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet,
<br/></tr><tr><td valign=top>13</td><td valign=top>3342</td><td
valign=top>YULIANA</td><td valign=top>JOHAN PRASETYO</td>
<td valign=top>2002-09-24</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>6</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI Konseling</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>14</td><td
valign=top>3343</td><td valign=top>BADRIYAH</td><td valign=top>RIYANTO</td>
<td valign=top>1976-12-26</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>5</td><td valign=top>4</td><td
valign=top>BPJS NonPBI</td><td valign=top>0001871826895</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[L20.8] Other atopic
dermatitis</td><td>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- PARASETAMOL
TABLET 500 MG 10, 3x1 tablet, <br/>- KLORAMFENIKOL SALEP KULIT 2% (BUFACETINE) 1, 2
kali oles, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet,
<br/></tr><tr><td valign=top>15</td><td valign=top>3344</td><td valign=top>RISTYADI
SISWANTO</td><td valign=top>RISTYADI SISWANTO</td>
<td valign=top>1965-12-08</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>4</td><td valign=top>1</td><td
valign=top>BPJS PBI</td><td valign=top>0000078936928</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis
[common cold]</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>-
NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1 tablet, <br/></tr><tr><td
valign=top>16</td><td valign=top>3345</td><td valign=top>SAHWAN</td><td
valign=top>SAHWAN</td>
<td valign=top>1963-07-01</td><td valign=top>L</td><td valign=top>GAPURA</td><td
valign=top>11</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[M19.0] Primary arthrosis of other
joints</td><td>- PIROXICAM TABLET 20 MG 10, 2x1 tablet, <br/>- ALLOPURINOL TABLET
300 MG 10, 2x1 tablet, <br/>- VITAMIN B KOMPLEKS TABLET 10, 2x1 tablet,
<br/></tr><tr><td valign=top>17</td><td valign=top>3346</td><td
valign=top>MUTAROH</td><td valign=top>MUTAROH</td>
<td valign=top>1966-05-04</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>2</td><td valign=top>3</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>-
SALBUTAMOL TABLET 2 MG 6, 1x1 tablet, <br/>- PIROXICAM TABLET 20 MG 10, 2x1 tablet,
<br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1 tablet, <br/></tr><tr><td
valign=top>18</td><td valign=top>3347</td><td valign=top>SENDI NIRFAN</td><td
valign=top>RIDO</td>
<td valign=top>2006-02-13</td><td valign=top>L</td><td valign=top>MAJALANGU</td><td
valign=top>5</td><td valign=top>6</td><td valign=top>BPJS PBI</td><td
valign=top>0000617219932</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>19</td><td
valign=top>3348</td><td valign=top>ARI SUPRIYADI</td><td valign=top>ARI
SUPRIYADI</td>
<td valign=top>1989-05-06</td><td valign=top>L</td><td valign=top>GAPURA</td><td
valign=top>6</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000618971411</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[R04.2] Haemoptysis</td><td>- AMBROKSOL
TABLET 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 5,
1x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/></tr><tr><td
valign=top>20</td><td valign=top>3349</td><td valign=top>SUDIN</td><td
valign=top>SUDIN</td>
<td valign=top>1964-01-13</td><td valign=top>L</td><td valign=top>MAJALANGU</td><td
valign=top>5</td><td valign=top>6</td><td valign=top>BPJS PBI</td><td
valign=top>0000618302801</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[K29.1] Other acute
gastritis</td><td></tr><tr><td valign=top>21</td><td valign=top>3350</td><td
valign=top>KHASANAH</td><td valign=top>DARISMAN</td>
<td valign=top>1982-12-28</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>5</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[E07.9] Disorder of thyroid,
unspecified</td><td>- PROPANOLOL HCL TABLET 40 MG 10, 2x1 tablet, <br/>-
NEUROTROPIC KAPLET (PEHAVRAL) 6, 1x1 tablet, <br/></tr><tr><td
valign=top>22</td><td valign=top>3351</td><td valign=top>ADAM SAPUTRA</td><td
valign=top>SUTARJO</td>
<td valign=top>2010-06-15</td><td valign=top>L</td><td valign=top>MAJALANGU</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000617316309</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[] </td><td>- SIPROFLOKSASIN TABLET 500 MG
10, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 2x1 tablet,
<br/>- PARASETAMOL TABLET 500 MG 10, 2x1 tablet, <br/></tr><tr><td
valign=top>23</td><td valign=top>3352</td><td valign=top>MARYATI</td><td
valign=top>SUTIKLAN</td>
<td valign=top>1981-03-17</td><td valign=top>P</td><td valign=top>CIKADU</td><td
valign=top>4</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT
( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG
6, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 6, 2x1 tablet,
<br/></tr><tr><td valign=top>24</td><td valign=top>3353</td><td
valign=top>CASLIRI</td><td valign=top>CASLIRI</td>
<td valign=top>1969-12-30</td><td valign=top>L</td><td valign=top>BODAS</td><td
valign=top>7</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000618097241</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N34.2] Other urethritis</td><td>-
SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- ASAM MEFENAMAT 500 MG 10, 3x1
tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet,
<br/></tr><tr><td valign=top>25</td><td valign=top>3354</td><td
valign=top>DARISMAN</td><td valign=top>DARISMAN</td>
<td valign=top>1946-11-10</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>1</td><td valign=top>3</td><td
valign=top>BPJS PBI</td><td valign=top>0001029940648</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[A15.2] Tuberculosis of lung,
confirmed histologically</td><td>- SALBUTAMOL TABLET 2 MG 10, 1x1tablet, <br/>- OAT
KATEGORI I 28, 1x2 tablet, <br/>- AMBROKSOL TABLET 15, 3x1tablet, <br/>- VITAMIN B
KOMPLEKS TABLET 20, 1x1tablet, <br/></tr><tr><td valign=top>26</td><td
valign=top>3355</td><td valign=top>YUMNA KHOIRUNNISA</td><td valign=top>MAUN</td>
<td valign=top>2018-07-30</td><td valign=top>P</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>7</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[] </td><td>- AMOKSISILLIN SIRUP
KERING 125 MG/ML 1, 3x1 sendok makan, <br/>- PARASETAMOL SIRUP 120 MG/5 ML 1, 3x1
sendok makan, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 4, 3x1/4 tablet,
<br/>- KLORAMFENIKOL SALEP KULIT 2% (BUFACETINE) 1, 3x1, <br/></tr><tr><td
valign=top>27</td><td valign=top>3356</td><td valign=top>KUNI SYA'ADAH</td><td
valign=top>DED SUKENDAR</td>
<td valign=top>1992-05-01</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>4</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000619031665</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[] </td><td>- ETABION 10, 1x1 tablet,
<br/>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C )
TABLET 500 MG (RAMVIT-C) 10, 1x1 tablet, <br/></tr><tr><td valign=top>28</td><td
valign=top>3357</td><td valign=top>KIANA NAFISA SALMA</td><td valign=top>URIP
JUWENI</td>
<td valign=top>2023-09-15</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>5</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis
[common cold]</td><td>- PARASETAMOL SIRUP 120 MG/5 ML 1, 3x1 sendok makan, <br/>-
SALISIL BEDAK RAMA 1, 3x1 , <br/>- MULTIVITAMIN SIRUP (LYTACUR) 1, 1x1 sendok
makan, <br/></tr><tr><td valign=top>29</td><td valign=top>3358</td><td
valign=top>CASNIAH</td><td valign=top>SURATNO</td>
<td valign=top>1970-07-01</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>1</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000619618511</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>- NATRIUM
DIKLOFENAK TABLET 50 MG 6, 2x1 tablet, <br/>- AMBROKSOL TABLET 10, 3x1 tablet,
<br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet,
<br/></tr><tr><td valign=top>30</td><td valign=top>3359</td><td
valign=top>MUTMAINAH</td><td valign=top>ABDUL KODIR</td>
<td valign=top>1971-07-01</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>3</td><td valign=top>9</td><td valign=top>BPJS PBI</td><td
valign=top>0001029932829</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- PARASETAMOL TABLET
500 MG 10, 3x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1
tablet, <br/></tr><tr><td valign=top>31</td><td valign=top>3360</td><td
valign=top>ANA ANJARWATI</td><td valign=top></td>
<td valign=top>2003-07-17</td><td valign=top>P</td><td valign=top>DANASARI</td><td
valign=top>3</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[Z71.0] Person consulting on behalf of
another person</td><td></tr><tr><td valign=top>32</td><td valign=top>3361</td><td
valign=top>TAMUN</td><td valign=top>TAMUN</td>
<td valign=top>1966-07-06</td><td valign=top>L</td><td valign=top>GAPURA</td><td
valign=top>7</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000618971692</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J45.8] Mixed asthma</td><td>- SALBUTAMOL
TABLET 2 MG 10, 2x1 tablet, <br/>- AMBROKSOL TABLET 10, 3x1 tablet, <br/>-
PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET
500 MG (RAMVIT-C) 5, 1x1 tablet, <br/></tr><tr><td valign=top>33</td><td
valign=top>3362</td><td valign=top>NANANG ANDRIYANSAH</td><td valign=top>SALIM</td>
<td valign=top>2009-12-25</td><td valign=top>L</td><td valign=top>BADAK</td><td
valign=top>5</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000618212439</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- AMBROKSOL TABLET 6, 2x1 tablet, <br/>- SIPROFLOKSASIN TABLET 500 MG
6, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 6, 2x1 tablet,
<br/>- KLORAMFENIKOL SALEP KULIT 2% (BUFACETINE) 1, 3x1, <br/></tr><tr><td
valign=top>34</td><td valign=top>3363</td><td valign=top> M IBNU HIBAN</td><td
valign=top>KARDI</td>
<td valign=top>2022-09-16</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>5</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis
[common cold]</td><td>- AMOKSISILLIN SIRUP KERING 125 MG/ML 1, 3x1, <br/>-
AMBROKSOL TABLET 4, 3x1/3 tablet, <br/>- PARASETAMOL SIRUP 120 MG/5 ML 1, 3x1
sendok makan, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 4, 3x1/3 tablet,
<br/></tr><tr><td valign=top>35</td><td valign=top>3364</td><td
valign=top>PONADI</td><td valign=top>PONADI</td>
<td valign=top>1940-03-04</td><td valign=top>L</td><td valign=top>MAJAKERTA</td><td
valign=top>3</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000078793356</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>- NIFEDIPIN TABLET
10 MG 5, 1x1 tablet, <br/>- NATRIUM DIKLOFENAK TABLET 50 MG 10, 2x1 tablet, <br/>-
ALLOPURINOL TABLET 300 MG 10, 2x1 tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5,
1x1 tablet, <br/></tr><tr><td valign=top>36</td><td valign=top>3365</td><td
valign=top>RETNO TITIN MURNIASIH</td><td valign=top>SISWO KISWORO</td>
<td valign=top>1983-03-23</td><td valign=top>P</td><td valign=top>GAPURA</td><td
valign=top>14</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001900342664</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N92.0] Excessive and frequent menstruation
with regular cycle</td><td>- TABLET TAMBAH DARAH 10, 1x1 tablet, <br/>- ASAM
ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet, <br/></tr><tr><td
valign=top>37</td><td valign=top>3366</td><td valign=top>TRI LISTIYA
NINGRUM</td><td valign=top>MUSTIYO</td>
<td valign=top>1992-12-15</td><td valign=top>P</td><td valign=top>GAPURA</td><td
valign=top>5</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002017764797</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N39.9] Disorder of urinary system,
unspecified</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ASAM
ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet, <br/></tr><tr><td
valign=top>38</td><td valign=top>3367</td><td valign=top>JUNARI</td><td
valign=top>JUNARI</td>
<td valign=top>1990-07-18</td><td valign=top>L</td><td valign=top>WISNU</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002870452866</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[D17.9] Benign lipomatous neoplasm,
unspecified</td><td>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- ASAM
MEFENAMAT 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG
(RAMVIT-C) 5, 1x1 tablet, <br/></tr><tr><td valign=top>39</td><td
valign=top>3368</td><td valign=top>RINA SETYA PERTIWI</td><td valign=top>SOIM
MUHAJIR</td>
<td valign=top>1987-10-21</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>4</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[] </td><td>- ETABION 10, 1x1 tablet,
<br/>- ASAM FOLAT TABLET 0,4 MG (ANELAT) 10, 1x1 tablet, <br/>- PIRIDOKSIN HCL
( VIT B6 ) TABLET 10 MG 10, 1x1 tablet, <br/></tr><tr><td valign=top>40</td><td
valign=top>3369</td><td valign=top>RUSMI</td><td valign=top>RUSMI</td>
<td valign=top>1953-12-01</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>6</td><td valign=top>4</td><td
valign=top>BPJS PBI</td><td valign=top>0000618612129</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>- ASAM
MEFENAMAT 500 MG 10, 3x1 tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1
tablet, <br/>- BIONICOM ZINC 10, 1x1 tablet, <br/></tr><tr><td
valign=top>41</td><td valign=top>3370</td><td valign=top>FAHMINA MUZAEN</td><td
valign=top>RAKLAN</td>
<td valign=top>2009-05-08</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>1</td><td
valign=top>BPJS PBI</td><td valign=top>0002128542221</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis
[common cold]</td><td>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1 tablet, <br/>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br/>- PARASETAMOL TABLET
500 MG 10, 3x1 tablet, <br/></tr><tr><td valign=top>42</td><td
valign=top>3371</td><td valign=top>WIWIN PRAYOGO</td><td valign=top>WIWIN
PRAYOGO</td>
<td valign=top>1992-09-20</td><td valign=top>L</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>-
SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET
4 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 50 MG 10, 3x1 tablet,
<br/></tr><tr><td valign=top>43</td><td valign=top>3372</td><td valign=top>ERA
KUSWATI</td><td valign=top>WIWIN PRAYOGA</td>
<td valign=top>1994-04-13</td><td valign=top>P</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>-
SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET
4 MG 10, 3x1 tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1 tablet, <br/>-
PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/></tr><tr><td valign=top>44</td><td
valign=top>3373</td><td valign=top>YOGA ASRAF ALHANI</td><td valign=top>WIWIN
PRAYOGA</td>
<td valign=top>2014-11-23</td><td valign=top>L</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>-
PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br/>- AMOKSISILLIN SIRUP KERING 125
MG/ML 1, 3X2 SENDOK, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 5, 3x1/2
tablet, <br/></tr><tr><td valign=top>45</td><td valign=top>3374</td><td
valign=top>ALWI MISBAHUL ANFUSI</td><td valign=top>WIWIN P</td>
<td valign=top>2020-02-24</td><td valign=top>L</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[] </td><td>- AMOKSISILLIN SIRUP
KERING 125 MG/ML 1, 3x1 sendok makan, <br/>- PARASETAMOL SIRUP 120 MG/5 ML 1, 3x1
sendok makan, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 50 MG 5, 3x1/2 tablet, <br/>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 5, 3x1/3 tablet, <br/></tr><tr><td
valign=top>46</td><td valign=top>3375</td><td valign=top>HERI PAMUNGKAS</td><td
valign=top>WAHYAT</td>
<td valign=top>1984-06-27</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>4</td><td
valign=top>BPJS PBI</td><td valign=top>0000618365891</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[F20.5] Residual
schizophrenia</td><td>- THP TRIHEXIFENIDIL TABLET 2 MG 30, 1x1 tablet, <br/>-
KLORPROMAZIN HCl TABLET SALUT 100 MG 30, 1x1 tablet, <br/>- HALOPERIDOL TABLET 5 MG
30, 1x1 tablet, <br/></tr><tr><td valign=top>47</td><td valign=top>3376</td><td
valign=top>SALIM</td><td valign=top>SALIM</td>
<td valign=top>1965-01-01</td><td valign=top>L</td><td valign=top>BADAK</td><td
valign=top>5</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>- NATRIUM
DIKLOFENAK TABLET 50 MG 10, 2x1 tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10,
3x1 tablet, <br/>- BIONICOM ZINC 5, 1x1 tablet, <br/></tr><tr><td
valign=top>48</td><td valign=top>3377</td><td valign=top>ALWI MISBAHUL
ANFUSI</td><td valign=top>WIWIN P</td>
<td valign=top>1958-07-01</td><td valign=top>L</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[J40] Bronchitis, not
specified as acute or chronic</td><td>- KAPTOPRIL TABLET 25 MG 10, 2x1 tablet,
<br/>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- AMBROKSOL TABLET 10, 3x1
tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet,
<br/></tr><tr><td valign=top>49</td><td valign=top>3378</td><td
valign=top>WISRI</td><td valign=top>WISRI</td>
<td valign=top>1984-12-19</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>3</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000617136186</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[L20.8] Other atopic dermatitis</td><td>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT
C ) TABLET 50 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet,
<br/>- KLORAMFENIKOL SALEP KULIT 2% (BUFACETINE) 1, 2 kali oles, <br/></tr><tr><td
valign=top>50</td><td valign=top>3379</td><td valign=top>ANANG SAPUTRA</td><td
valign=top>NUR FATHURI</td>
<td valign=top>2008-03-18</td><td valign=top>L</td><td valign=top>BADAK</td><td
valign=top>3</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>- SEFADROKSIL KAPSUL
500 MG 6, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 6, 2x1
tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 6, 1x1 tablet,
<br/></tr><tr><td valign=top>51</td><td valign=top>3380</td><td
valign=top>IMRON</td><td valign=top>IMRON</td>
<td valign=top>1957-02-19</td><td valign=top>L</td><td valign=top>MAJALANGU</td><td
valign=top>3</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002800939454</td><td valign=top>POLI UMUM</td><td
valign=top>Dirujuk</td><td valign=top>-[L51.9] Erythema multiforme,
unspecified</td><td></tr><tr><td valign=top>52</td><td valign=top>3381</td><td
valign=top>ESTI SRI SURYANI</td><td valign=top></td>
<td valign=top>1999-11-04</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>203</td><td valign=top>0</td><td valign=top>BPJS PBI</td><td
valign=top>0000617295835</td><td valign=top>POLI UMUM</td><td
valign=top>Dirujuk</td><td valign=top>-[A15.2] Tuberculosis of lung, confirmed
histologically</td><td></tr><tr><td valign=top>53</td><td valign=top>3382</td><td
valign=top>RIZQY FADILLAH</td><td valign=top></td>
<td valign=top>2020-04-07</td><td valign=top>L</td><td valign=top>JOJOGAN</td><td
valign=top>6</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002929955297</td><td valign=top>POLI K I A</td><td
valign=top>Dirujuk</td><td valign=top>-[G40.9] Epilepsy,
unspecified</td><td></tr><tr><td valign=top>54</td><td valign=top>3383</td><td
valign=top>ANINDITA FAUZIAH</td><td valign=top>TEGUH</td>
<td valign=top>2015-10-15</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>4</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- ANTASIDA DOEN I TABLET KOMBINASI 5, 3x1/2 tablet, <br/>-
PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br/>- AMOKSISILLIN SIRUP KERING 125
MG/ML 1, 3x2 sendok, <br/></tr><tr><td valign=top>55</td><td
valign=top>3384</td><td valign=top>RIKA AGUSTIN</td><td valign=top>ROMADHON
SAPUTRA</td>
<td valign=top>2003-08-03</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>1</td><td valign=top>6</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002916306369</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[Z36.9] Antenatal screening,
unspecified</td><td>- ETABION 10, 1x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET
500 MG (RAMVIT-C) 10, 1x1 tablet, <br/></tr><tr><td valign=top>56</td><td
valign=top>3385</td><td valign=top>NABILA YASMIN PUTRI</td><td
valign=top>RATIM</td>
<td valign=top>2004-07-20</td><td valign=top>P</td><td valign=top>BODAS</td><td
valign=top>8</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- KOTRIMOXAZOLE TABLET 480 MG 6, 2x1 tablet, <br/>- AMBROKSOL TABLET
5, 3x1/2 tablet, <br/>- PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet,
<br/></tr><tr><td valign=top>57</td><td valign=top>3386</td><td valign=top>DISA
PUTRI FAZAIRA</td><td valign=top>ARYADIKA PANGESTU</td>
<td valign=top>2020-11-14</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>5</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- AMBROKSOL TABLET 3, 3x1/3 tablet, <br/>- PARASETAMOL SIRUP 120 MG/5
ML 3, 3x1 sendok teh, <br/>- AMOKSISILLIN SIRUP KERING 125 MG/ML 3, 3x1 sendok teh,
<br/>- HIDROKORTISON KRIM 2.5 % 1, 3x, <br/></tr><tr><td valign=top>58</td><td
valign=top>3387</td><td valign=top>SUZANA FALASIFA AZHARI</td><td
valign=top>TARCHIM</td>
<td valign=top>2003-06-24</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>7</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J40] Bronchitis, not specified as acute or
chronic</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- AMBROKSOL TABLET
10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1
tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1 tablet, <br/></tr><tr><td
valign=top>59</td><td valign=top>3388</td><td valign=top>fajar muzaini</td><td
valign=top>ZAENAL ARIFIN</td>
<td valign=top>1995-05-30</td><td valign=top>L</td><td valign=top>GAPURA</td><td
valign=top>4</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001820682999</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[F20.0] Paranoid schizophrenia</td><td>-
DIAZEPAM TABLET 5 MG 10, 2x1 tablet, <br/></tr><tr><td valign=top>60</td><td
valign=top>3389</td><td valign=top>M. HUSEN</td><td valign=top>M. HUSEN</td>
<td valign=top>1991-05-29</td><td valign=top>L</td><td valign=top>JOJOGAN</td><td
valign=top>5</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002695265932</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[H65.1] Other acute nonsuppurative otitis
media</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT
( VIT C ) TABLET 500 MG (RAMVIT-C) 5, 1x1 tablet, <br/>- KLORAMFENIKOL TETES
TELINGA (RECO) 1, 1x2 tetes, <br/></tr><tr><td valign=top>61</td><td
valign=top>3390</td><td valign=top>RINA FATMAWATI</td><td valign=top>AMIN</td>
<td valign=top>1991-09-30</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>4</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0002870445892</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[Z36.9] Antenatal screening,
unspecified</td><td>- PIRIDOKSIN HCL ( VIT B6 ) TABLET 10 MG 10, 2x1 tablet, <br/>-
ETABION 10, 1x1 tablet, <br/>- ASAM FOLAT TABLET 0,4 MG (ANELAT) 10, 1x1 tablet,
<br/></tr><tr><td valign=top>62</td><td valign=top>3391</td><td valign=top>LELI
PUJI PRIHATIN</td><td valign=top>AEMI</td>
<td valign=top>1990-12-24</td><td valign=top>P</td><td valign=top>BODAS</td><td
valign=top>4</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K04.1] Necrosis of pulp</td><td>- ASAM
MEFENAMAT 500 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 10, 2x1 tablet,
<br/></tr><tr><td valign=top>63</td><td valign=top>3392</td><td valign=top>SALIS
SIFA NUR ISTIKOMAH</td><td valign=top>FALALI</td>
<td valign=top>2017-08-20</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>8</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K00.6] Disturbances in tooth
eruption</td><td>- PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br/></tr><tr><td
valign=top>64</td><td valign=top>3393</td><td valign=top>RUDIANTO</td><td
valign=top>RUDIANTO</td>
<td valign=top>1999-05-28</td><td valign=top>L</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>9</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[A09] Diarrhoea and
gastroenteritis of presumed infectious origin</td><td>- SEFADROKSIL KAPSUL 500 MG
6, 2x1 tablet, <br/>- ATTAPULGIT TABLET (NEW ANTIDES) 10, 3x1 tablet, <br/>-
BIONICOM ZINC 10, 1x1 tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1
tablet, <br/></tr><tr><td valign=top>65</td><td valign=top>3394</td><td
valign=top>LAELATUL MUGIARTI</td><td valign=top>M. MUSBITUL KHAMDI</td>
<td valign=top>1996-11-10</td><td valign=top>P</td><td valign=top>CIKADU</td><td
valign=top>10</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- NATRIUM DIKLOFENAK TABLET 50 MG 6, 2x1 tablet, <br/>- NEUROTROPIC
KAPLET (PEHAVRAL) 5, 1x1 tablet, <br/>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet,
<br/></tr><tr><td valign=top>66</td><td valign=top>3395</td><td valign=top>FATMA
NUR SHAQEENA</td><td valign=top>M MUSBITUL KHAMDI</td>
<td valign=top>2022-07-05</td><td valign=top>P</td><td valign=top>CIKADU</td><td
valign=top>10</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOKSISILLIN SIRUP KERING 125 MG/ML 1, 3x1 sendok teh, <br/>-
PARASETAMOL SIRUP 120 MG/5 ML 1, 3x1 sendok teh, <br/>- AMBROKSOL TABLET 3, 3x1/4
tablet, <br/>- VITAMIN B KOMPLEKS TABLET 3, 3x1/4 tablet, <br/></tr><tr><td
valign=top>67</td><td valign=top>3396</td><td valign=top>GALANG OKI SUKRIA</td><td
valign=top>AHMAD</td>
<td valign=top>2010-10-30</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis
[common cold]</td><td>- KOTRIMOXAZOLE TABLET 480 MG 12, 2x2 tablet, <br/>-
PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- AMBROKSOL TABLET 10, 3x1 tablet,
<br/>- VITAMIN B KOMPLEKS TABLET 10, 3x1 tablet, <br/></tr><tr><td
valign=top>68</td><td valign=top>3397</td><td valign=top>NUR KHASANAH</td><td
valign=top>AHMAD</td>
<td valign=top>1976-05-25</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>2</td><td
valign=top>BPJS NonPBI</td><td valign=top>0002461511687</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[I10] Essential (primary)
hypertension</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- KAPTOPRIL
TABLET 25 MG 10, 2x1 tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1 tablet,
<br/></tr><tr><td valign=top>69</td><td valign=top>3398</td><td valign=top>NURUL
KHAYATUN</td><td valign=top>LUTFI MUBAROK</td>
<td valign=top>1989-08-13</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>5</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000618592487</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[P59.1] Inspissated bile syndrome</td><td>-
ATTAPULGIT TABLET (NEW ANTIDES) 10, 3x1 tablet, <br/>- ANTASIDA DOEN I TABLET
KOMBINASI 10, 3x1 tablet, <br/>- MULTIVITAMIN TABLET (CURCUMA FORCE) 10, 3x1
tablet, <br/></tr><tr><td valign=top>70</td><td valign=top>3399</td><td
valign=top>TASRIAH</td><td valign=top>TASRIAH</td>
<td valign=top>1963-03-23</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>4</td><td
valign=top>BPJS PBI</td><td valign=top>0000619545172</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[I10] Essential (primary)
hypertension</td><td>- NIFEDIPIN TABLET 10 MG 10, 2x1 tablet, <br/>- PARASETAMOL
TABLET 500 MG 10, 3x1 tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1 tablet,
<br/></tr><tr><td valign=top>71</td><td valign=top>3400</td><td
valign=top>MAEMATUN</td><td valign=top></td>
<td valign=top>1956-10-10</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>1</td><td valign=top>7</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078587234</td><td valign=top>POLI UMUM</td><td
valign=top>Dirujuk</td><td valign=top>-[E11.2] Non-insulin-dependent diabetes
mellitus with renal complications</td><td></tr><tr><td valign=top>72</td><td
valign=top>3401</td><td valign=top>HANIYAH</td><td valign=top>TARSO</td>
<td valign=top>1995-12-29</td><td valign=top>P</td><td valign=top>TAMBI</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0002800923243</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[Z36.9] Antenatal screening,
unspecified</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- MULTIVITAMIN
TABLET (CURCUMA FORCE) 10, 1x1 tablet, <br/>- ASAM FOLAT TABLET 0,4 MG (ANELAT) 10,
1x1 tablet, <br/></tr><tr><td valign=top>73</td><td valign=top>3402</td><td
valign=top>KHOERU RAHMAWATI</td><td valign=top>DIKIN</td>
<td valign=top>2015-10-02</td><td valign=top>P</td><td valign=top>KUTA</td><td
valign=top>35</td><td valign=top>8</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[B65.3] Cercarial dermatitis</td><td>-
KOTRIMOXAZOLE TABLET 480 MG 6, 2x1/2 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM )
TABLET 4 MG 5, 3x1/2 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 50 MG 5, 3x1/2
tablet, <br/>- HIDROKORTISON KRIM 2.5 % 1, 3x, <br/></tr><tr><td
valign=top>74</td><td valign=top>3403</td><td valign=top>RAFA MALIKAL HIKAM</td><td
valign=top>TUROHMAN</td>
<td valign=top>2015-11-17</td><td valign=top>L</td><td valign=top>KUTA</td><td
valign=top>33</td><td valign=top>8</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- PARASETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br/>- KOTRIMOXAZOLE
TABLET 480 MG 6, 2x1 tablet, <br/>- AMBROKSOL TABLET 3, 3x1/2 tablet,
<br/></tr><tr><td valign=top>75</td><td valign=top>3404</td><td
valign=top>TRININGSIH</td><td valign=top>RATIM</td>
<td valign=top>1984-08-12</td><td valign=top>P</td><td valign=top>BODAS</td><td
valign=top>8</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000618167136</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[L20.8] Other atopic dermatitis</td><td>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT
C ) TABLET 50 MG 10, 3x1 tablet, <br/>- OKSITETRASIKLIN SALEP KULIT 1, 2 kali
oles, <br/></tr><tr><td valign=top>76</td><td valign=top>3406</td><td
valign=top>JAFAR UMAR</td><td valign=top></td>
<td valign=top>2002-03-24</td><td valign=top>L</td><td valign=top>JOJOGAN</td><td
valign=top>6</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000619170862</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>- KLORFENIRAMIN
MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET
500 MG (RAMVIT-C) 5, 1x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet,
<br/>- KLORAMFENIKOL SALEP KULIT 2% (BUFACETINE) 1, 2 kali oles, <br/></tr><tr><td
valign=top>77</td><td valign=top>3407</td><td valign=top>KHANSA ANIQ FIKRIA</td><td
valign=top>FAJAR ADE F</td>
<td valign=top>2017-08-11</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>3</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- KOTRIMOXAZOLE TABLET 480 MG 6, 2x1 tablet, <br/>- PARASETAMOL
TABLET 500 MG 5, 3x1/2 tablet, <br/>- AMBROKSOL TABLET 3, 3x1/2 tablet, <br/>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 3, 3x1/2 tablet, <br/></tr><tr><td
valign=top>78</td><td valign=top>3408</td><td valign=top>ESTI WIDIASTUTI</td><td
valign=top>ARIS</td>
<td valign=top>2005-04-16</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>3</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[R59.0] Localized enlarged lymph
nodes</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL
500 MG 6, 2x1 tablet, <br/>- BIONICOM ZINC 5, 1x1 tablet, <br/></tr><tr><td
valign=top>79</td><td valign=top>3409</td><td valign=top>RIPAI</td><td
valign=top>RIPAI</td>
<td valign=top>1971-08-09</td><td valign=top>L</td><td valign=top>MAJAKERTA</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[J06.9] Acute upper respiratory infection,
unspecified</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- AMBROKSOL
TABLET 10, 3x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1
tablet, <br/>- VITAMIN B KOMPLEKS TABLET 10, 2x1 tablet, <br/></tr><tr><td
valign=top>80</td><td valign=top>3410</td><td valign=top>YANI SAFITRI</td><td
valign=top>WARYADI</td>
<td valign=top>2008-02-27</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>1</td><td valign=top>5</td><td valign=top>BPJS PBI</td><td
valign=top>0002800914963</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[J00] Acute nasopharyngitis [common
cold]</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- AMBROKSOL TABLET
10, 3x1 tablet, <br/>- SIPROFLOKSASIN TABLET 500 MG 6, 2x1 tablet,
<br/></tr><tr><td valign=top>81</td><td valign=top>3411</td><td valign=top>HANAFI
SAPUTRA</td><td valign=top>WARYADI</td>
<td valign=top>2016-10-10</td><td valign=top>L</td><td valign=top>MAJAKERTA</td><td
valign=top>1</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[] </td><td>- KOTRIMOXAZOLE TABLET 480 MG
6, 2x1 tablet, <br/>- AMBROKSOL TABLET 6, 3x1/2 tablet, <br/>- PARASETAMOL TABLET
500 MG 5, 3x1/2 tablet, <br/></tr><tr><td valign=top>82</td><td
valign=top>3412</td><td valign=top>ANNASYA NAIRA PUTRI</td><td
valign=top>KASMO</td>
<td valign=top>2017-10-02</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>2</td><td valign=top>6</td><td valign=top>BPJS PBI</td><td
valign=top>0003149539661</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K00.6] Disturbances in tooth
eruption</td><td></tr><tr><td valign=top>83</td><td valign=top>3413</td><td
valign=top>MUHAMMAD FAUZAN </td><td valign=top>WAHRI</td>
<td valign=top>2016-05-17</td><td valign=top>L</td><td valign=top>KUTA</td><td
valign=top>27</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K00.6] Disturbances in tooth
eruption</td><td></tr><tr><td valign=top>84</td><td valign=top>3414</td><td
valign=top>ADITYA RIFKI HAMIZAN</td><td valign=top>NUROHIM</td>
<td valign=top>2015-04-13</td><td valign=top>L</td><td valign=top>KUTA</td><td
valign=top>27</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K00.6] Disturbances in tooth
eruption</td><td></tr><tr><td valign=top>85</td><td valign=top>3415</td><td
valign=top>KRISTIANTI</td><td valign=top>BUDI</td>
<td valign=top>1978-03-17</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>4</td><td
valign=top>BPJS NonPBI</td><td valign=top>0003001968854</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>-
PIROXICAM TABLET 20 MG 5, 1x1 tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1
tablet, <br/>- METFORMIN 500 MG 10, 1x1 tablet, <br/></tr><tr><td
valign=top>86</td><td valign=top>3416</td><td valign=top>UMI AZKIYAH</td><td
valign=top>KHAUTSAR</td>
<td valign=top>1990-12-29</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>3</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0001029933134</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K04.0] Pulpitis</td><td>- ASAM MEFENAMAT
500 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 6, 2x1 tablet,
<br/></tr><tr><td valign=top>87</td><td valign=top>3417</td><td valign=top>RINA
WIJAWATI</td><td valign=top>KOIMAN</td>
<td valign=top>1993-08-02</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>5</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0002597624032</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K04.1] Necrosis of pulp</td><td>- ASAM
MEFENAMAT 500 MG 10, 3x1 tablet, <br/></tr><tr><td valign=top>88</td><td
valign=top>3418</td><td valign=top>SITI WAHYU NIKMAH</td><td valign=top>ENDRO
UTOMO</td>
<td valign=top>1966-10-24</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>3</td><td valign=top>9</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078380379</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[N93.0] Postcoital and contact
bleeding</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- VITAMIN B
KOMPLEKS TABLET 10, 2x1 tablet, <br/></tr><tr><td valign=top>89</td><td
valign=top>3419</td><td valign=top>TRININGSIH</td><td valign=top>RATIM</td>
<td valign=top>1953-01-01</td><td valign=top>P</td><td valign=top>BODAS</td><td
valign=top>8</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000618167136</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[I63.9] Cerebral infarction,
unspecified</td><td></tr><tr><td valign=top>90</td><td valign=top>3420</td><td
valign=top>MUHAMMAD HASHIF BUNYANUDDIN</td><td valign=top>HERU SETIAWAN</td>
<td valign=top>2016-12-19</td><td valign=top>L</td><td valign=top>MAJAKERTA</td><td
valign=top>1</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003072913176</td><td valign=top>POLI GIGI</td><td
valign=top>Dilayani</td><td valign=top>-[K02.1] Caries of
dentine</td><td></tr><tr><td valign=top>91</td><td valign=top>3421</td><td
valign=top>ROKHANI</td><td valign=top>KOHAR</td>
<td valign=top>2017-12-15</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>1</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000618659133</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[L13.0] Dermatitis
herpetiformis</td><td>- KOTRIMOXAZOLE TABLET 480 MG 6, 2x1 tablet, <br/>-
PARASETAMOL TABLET 500 MG 3, 3x1/2 tablet, <br/>- AMBROKSOL TABLET 3, 3x1/2 tablet,
<br/>- KETOKONAZOL SALEP 1, 3x, <br/></tr><tr><td valign=top>92</td><td
valign=top>3422</td><td valign=top>LUTFIYANI</td><td valign=top>RUKHADI</td>
<td valign=top>2001-05-01</td><td valign=top>P</td><td valign=top>JOJOGAN</td><td
valign=top>20</td><td valign=top>5</td><td valign=top>BPJS PBI</td><td
valign=top>0000619395006</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[A15.2] Tuberculosis of lung, confirmed
histologically</td><td>- AMBROKSOL TABLET 10, 3x1 tablet, <br/>- NEUROTROPIC
KAPLET (PEHAVRAL) 6, 1x1 tablet, <br/>- OAT KATEGORI I 28, 1x2tablet,
<br/></tr><tr><td valign=top>93</td><td valign=top>3423</td><td
valign=top>RUINAH</td><td valign=top>USMAN</td>
<td valign=top>1977-08-15</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>7</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001735468007</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia</td><td>- PIROXICAM TABLET
20 MG 5, 1x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1
tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1 tablet, <br/>- AMBROKSOL
TABLET 10, 3x1 tablet, <br/>- VITAMIN B KOMPLEKS TABLET 6, 2x1 tablet,
<br/></tr><tr><td valign=top>94</td><td valign=top>3424</td><td valign=top>MULYONO
MULYOHARDJONO</td><td valign=top>MULYONO MULYOHARDJONO</td>
<td valign=top>1931-03-17</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>2</td><td valign=top>1</td><td
valign=top>BPJS NonPBI</td><td valign=top>0000078792625</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[N34.1] Nonspecific
urethritis</td><td>- FUROSEMID TABLET 40 MG 10, 1x1 tablet, <br/>- VITAMIN B
KOMPLEKS TABLET 10, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 8,
3x1 tablet, <br/></tr><tr><td valign=top>95</td><td valign=top>3425</td><td
valign=top>DIAN SAFITRI</td><td valign=top>ADITYA ABDUL </td>
<td valign=top>2005-05-15</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>6</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[Z36.8] Other antenatal
screening</td><td>- ETABION 10, 1x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET
50 MG 10, 1x1 tablet, <br/></tr><tr><td valign=top>96</td><td
valign=top>3426</td><td valign=top>ZAIMATUS ZAKIYAH</td><td
valign=top>HANIFUDIN</td>
<td valign=top>2002-11-30</td><td valign=top>P</td><td valign=top>TAMBI</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0000617310292</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>97</td><td
valign=top>3427</td><td valign=top>IBNU JAOSAK</td><td valign=top></td>
<td valign=top>1999-02-26</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>1</td><td valign=top>4</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[L02.8] Cutaneous abscess,
furuncle and carbuncle of other sites</td><td>- ASAM MEFENAMAT 500 MG 10, 3x1
tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br/>-
SEFADROKSIL KAPSUL 500 MG 10, 2x1 tablet, <br/>- OKSITETRASIKLIN SALEP KULIT 1, 2x1
tablet, <br/></tr><tr><td valign=top>98</td><td valign=top>3428</td><td
valign=top>GAMPANG MUSILO</td><td valign=top>GAMPANG MUSILO</td>
<td valign=top>1964-06-01</td><td valign=top>L</td><td
valign=top>WATUKUMPUL</td><td valign=top>4</td><td valign=top>4</td><td
valign=top>BPJS NonPBI</td><td valign=top>0001817532729</td><td valign=top>POLI
UMUM</td><td valign=top>Dilayani</td><td valign=top>-[J45.9] Asthma,
unspecified</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- AMBROKSOL
TABLET 10, 3x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1
tablet, <br/>- SALBUTAMOL TABLET 2 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL 500
MG 6, 2x1 tablet, <br/></tr><tr><td valign=top>99</td><td valign=top>3429</td><td
valign=top>ENI FATMAWATI</td><td valign=top>RASMONO</td>
<td valign=top>1990-08-31</td><td valign=top>P</td><td valign=top>BODAS</td><td
valign=top>6</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000618537958</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[R59.1] Generalized enlarged lymph
nodes</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL
500 MG 6, 2x1 tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1 tablet,
<br/>- VITAMIN B KOMPLEKS TABLET 10, 2x1 tablet, <br/></tr><tr><td
valign=top>100</td><td valign=top>3430</td><td valign=top>ALIMAN</td><td
valign=top>SAEFUDIN</td>
<td valign=top>1997-03-15</td><td valign=top>L</td><td valign=top>BADAK</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[A01.0] Typhoid fever</td><td>- PARASETAMOL
TABLET 500 MG 10, 3x1 tablet, <br/>- ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1
tablet, <br/>- AMBROKSOL TABLET 10, 3x1 tablet, <br/>- VITAMIN B KOMPLEKS TABLET 6,
2x1 tablet, <br/></tr><tr><td valign=top>101</td><td valign=top>3431</td><td
valign=top>WINDI ASTUTI</td><td valign=top>SAEFUDIN</td>
<td valign=top>2004-01-21</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[O02.1] Missed abortion</td><td>-
PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- VITAMIN B KOMPLEKS TABLET 10, 3x1
tablet, <br/>- NEUROTROPIC KAPLET (PEHAVRAL) 5, 1x1 tablet, <br/></tr><tr><td
valign=top>102</td><td valign=top>3432</td><td valign=top>TURIMAN</td><td
valign=top>TURIMAN</td>
<td valign=top>1974-05-06</td><td valign=top>L</td><td valign=top>MAJALANGU</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000618239259</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[M79.1] Myalgia<br> -[R50.9] Fever,
unspecified</td><td>- PARASETAMOL TABLET 500 MG 10, 3x1 tablet, <br/>- ANTASIDA
DOEN I TABLET KOMBINASI 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL 500 MG 6, 2x1
tablet, <br/>- VITAMIN B KOMPLEKS TABLET 6, 2x1 tablet, <br/></tr><tr><td
valign=top>103</td><td valign=top>3433</td><td valign=top>ROSWATI</td><td
valign=top>ASEP</td>
<td valign=top>1979-07-31</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>4</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000618817533</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[L20.8] Other atopic dermatitis</td><td>-
KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br/>- SEFADROKSIL KAPSUL
500 MG 6, 2x1 tablet, <br/>- KLORAMFENIKOL SALEP KULIT 2% (BUFACETINE) 1, 2 kali
oles, <br/></tr><tr><td valign=top>104</td><td valign=top>3434</td><td
valign=top>WINDI ASTUTI</td><td valign=top>SAEFUDIN</td>
<td valign=top>1966-06-04</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td
valign=top>Dilayani</td><td valign=top>-[A42.1] Abdominal actinomycosis</td><td>-
ANTASIDA DOEN I TABLET KOMBINASI 10, 3x1 tablet, <br/>- RANITIDINE TABLET 150 MG 6,
3x1 tablet, <br/>- VITAMIN B KOMPLEKS TABLET 6, 2x1 tablet, <br/>- PARASETAMOL
TABLET 500 MG 10, 3x1 tablet, <br/></tr><tr><td valign=top>105</td><td
valign=top>3435</td><td valign=top>TARMINAH</td><td valign=top>TARMIDI</td>
<td valign=top>1945-07-01</td><td valign=top>P</td><td valign=top>MAJAKERTA</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0000620085442</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td>- PARASETAMOL TABLET 500 MG 10, 3x1
tablet, <br/></tr><tr><td valign=top>106</td><td valign=top>3436</td><td
valign=top>ALDI SAPUTRA</td><td valign=top>KARSO</td>
<td valign=top>2009-05-20</td><td valign=top>L</td><td valign=top>MAJALANGU</td><td
valign=top>4</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0000618393666</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>- KOTRIMOXAZOLE
TABLET 480 MG 6, 2x1 tablet, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 6,
3x1/2 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 50 MG 6, 3x1/2 tablet,
<br/></tr><tr><td valign=top>107</td><td valign=top>3437</td><td
valign=top>WAMINI</td><td valign=top>KARSO</td>
<td valign=top>1982-11-05</td><td valign=top>P</td><td valign=top>MAJALANGU</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000618391383</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>108</td><td
valign=top>3438</td><td valign=top>AENI HINDRIYANI</td><td valign=top>ANTON</td>
<td valign=top>1988-03-09</td><td valign=top>P</td><td valign=top>JOJOGAN</td><td
valign=top>9</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001813192086</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[Z30.8] Other contraceptive
management</td><td>- ASAM MEFENAMAT 500 MG 10, 3x1 tablet, <br/>- SIPROFLOKSASIN
TABLET 500 MG 6, 2x1 tablet, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 50 MG 6, 3x1
tablet, <br/></tr><tr><td valign=top>109</td><td valign=top>3439</td><td
valign=top>ARINA</td><td valign=top>ARTO SETIAWAN</td>
<td valign=top>1985-05-19</td><td valign=top>P</td><td
valign=top>GUNUNGJAYA</td><td valign=top>2</td><td valign=top>7</td><td
valign=top>BPJS NonPBI</td><td valign=top>0001460460418</td><td valign=top>POLI
UMUM</td><td valign=top>Belum Dilayani</td><td valign=top>-[] </td><td></tr><tr><td
valign=top>110</td><td valign=top>3440</td><td valign=top>roisah</td><td
valign=top>YATIM</td>
<td valign=top>1969-09-04</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>3</td><td valign=top>1</td><td
valign=top>Umum</td><td valign=top>0001872485897</td><td valign=top>POLI
UMUM</td><td valign=top>Belum Dilayani</td><td valign=top>-[] </td><td></tr><tr><td
valign=top>111</td><td valign=top>3441</td><td valign=top>SUISAH</td><td
valign=top>DANURI</td>
<td valign=top>1975-03-20</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>4</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000618653362</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>112</td><td
valign=top>3442</td><td valign=top>AGHNIA ANAHDA</td><td valign=top>M ABDULOH
SAFII</td>
<td valign=top>2023-01-17</td><td valign=top>P</td><td
valign=top>WATUKUMPUL</td><td valign=top>4</td><td valign=top>1</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI K I
A</td><td valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>-
AMOKSISILLIN SIRUP KERING 125 MG/ML 1, 3x1/2 sendok teh, <br/>- KLORFENIRAMIN
MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br/>- ASAM ASKORBAT ( VIT C ) TABLET
50 MG 2, @ 10, 3x1 bgks, <br/></tr><tr><td valign=top>113</td><td
valign=top>3443</td><td valign=top>KUSNAENI</td><td valign=top>DARSONO</td>
<td valign=top>1997-09-21</td><td valign=top>P</td><td valign=top>TAMBI</td><td
valign=top>3</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0000617186687</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>114</td><td
valign=top>3444</td><td valign=top>ELSA SAFIRA</td><td valign=top>DARSONO</td>
<td valign=top>2015-03-05</td><td valign=top>P</td><td valign=top>TAMBI</td><td
valign=top>3</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[B86] Scabies</td><td>- KLORFENIRAMIN
MALEAT ( CTM ) TABLET 4 MG 5, 3x1/2 tablet, <br/>- GRISEOFULVIN TABLET 125 MG 5,
3x1/2 tablet, <br/>- AMOKSISILLIN SIRUP KERING 125 MG/ML 5, 3x 1 1/2 tablet,
<br/></tr><tr><td valign=top>115</td><td valign=top>3445</td><td valign=top>RAHMAT
ZAKARIA</td><td valign=top>SAHRUL</td>
<td valign=top>2021-04-30</td><td valign=top>L</td><td valign=top>BADAK</td><td
valign=top>2</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[H11.3] Conjunctival haemorrhage</td><td>-
KLORAMFENIKOL SALEP MATA (RECO) 1, 3x, <br/>- AMOKSISILLIN SIRUP KERING 125 MG/ML
1, 3x1 sendok teh, <br/>- KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG 3, 3x1/3 sendok
teh, <br/>- ASAM ASKORBAT ( VIT C ) TABLET 50 MG 3, 3x1/3 sendok teh,
<br/></tr><tr><td valign=top>116</td><td valign=top>3446</td><td
valign=top>MUNIROH</td><td valign=top>DARYADI</td>
<td valign=top>1973-07-01</td><td valign=top>P</td><td valign=top>BADAK</td><td
valign=top>3</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI UMUM</td><td valign=top>Belum
Dilayani</td><td valign=top>-[] </td><td></tr><tr><td valign=top>117</td><td
valign=top>3447</td><td valign=top>NUR KUAT RAMADANI</td><td valign=top>DARJAT</td>
<td valign=top>2015-07-11</td><td valign=top>L</td><td valign=top>WISNU</td><td
valign=top>3</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI K I A</td><td
valign=top>Dilayani</td><td valign=top>-[R50.9] Fever, unspecified</td><td>-
KOTRIMOXAZOLE TABLET 480 MG 5, 2x1 tablet, <br/>- PARASETAMOL SIRUP 120 MG/5 ML 5,
3x1/2 tablet, <br/>- EKSTRAK PLACENTA NEOMYCIN JELLY (NEOCENTA JEL) 1, 3x,
<br/></tr>