Laporan Universal

<table class='tabel' width='90%'>
<tr class="form">
<td align="center" colspan="9">
<big><big>
LAPORAN UNIVERSAL 
BULAN 01-07-2023 - 31-07-2023 </big></big>
</td>
</tr>
</table>
<table align='center'>
<tr>
<td>Total</td>
<td>:</td>
<td>169</td>
</tr>
</table>
<table align="center" width="98%" border="1">
<tr class="row1">
<td width='3%'>No</td>
<td width='6%'>Tanggal</td>
<td width='6%'>PKM</td>
<td width='6%'>No RM</td>
<td width='10%'>Nama</td>
<td width='10%'>NIK</td>
<td width='10%'>Alamat</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 Th</td>
<td width='2%'>L/P</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>01-07-2023</td>
<td>PUSKESMAS GANDUSARI</td>
<td>020306</td>
<td>ARSYA ABIDZAR AL-GHIFFARI,AN</td>
<td>'3503103107170001-337212</td>
<td>DSN KRAJAN, RT : 18,RW :8 </td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>31-07-2017</td>
<td>6</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.SEFY AKBARINA IRASARI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
Disturbances in tooth eruption </td>
</tr>

<td>2</td>
<td>01-07-2023</td>
<td>001150</td>
<td>PURWATI,NY</td>
<td>'</td>
<td>24/8</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>12-09-1989</td>
<td>33</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
Deposits [accretions] on teeth </td>
</tr>

<td>3</td>
<td>01-07-2023</td>
<td>011636</td>
<td>OCHA MAULIDIA ANDRIANI,NN</td>
<td>'</td>
<td>5/2</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-05-2005</td>
<td>18</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
Acute periodontitis </td>
</tr>

<td>4</td>
<td>01-07-2023</td>
<td>020313</td>
<td>YUSUF ARIFIN</td>
<td>'</td>
<td>4/2</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-12-2001</td>
<td>21</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664619951</td>
<td>131509010723Y000014</td>
<td align='center'>
K04.7 </td>
<td align='center'>
Periapical abscess without sinus </td>
</tr>

<td>5</td>
<td>03-07-2023</td>
<td>020325</td>
<td>CHAYRA DWI ATMARINI NADHIFA</td>
<td>'3503106207170003</td>
<td>DSN POJOK, RT : 10,RW :4 </td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>22-07-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>6</td>
<td>03-07-2023</td>
<td>000597</td>
<td>DWI BAROROH BARIDAH</td>
<td>'</td>
<td>11/6</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>05-10-1991</td>
<td>31</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>7</td>
<td>03-07-2023</td>
<td>020326</td>
<td>ASMYA RAESHA RAMADANI,AN</td>
<td>'</td>
<td>7/2</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>15-06-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>8</td>
<td>03-07-2023</td>
<td>020327</td>
<td>RAISA SALSABILA,AN</td>
<td>'3503104205170001</td>
<td>DSN KACANGAN, RT : 30,RW :14 </td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>02-05-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>9</td>
<td>03-07-2023</td>
<td>011512</td>
<td>ZAFRAN HAFIDZ ALFARIZI.AN</td>
<td>'3503102101160001</td>
<td>DSN DUREN, RT : 16,RW :5 </td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-01-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>10</td>
<td>03-07-2023</td>
<td>020322</td>
<td>OVILIA DOMISARI,NY</td>
<td>'3503104510950002</td>
<td>DSN NGLANCOR, RT : 25,RW :8 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>05-10-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>11</td>
<td>03-07-2023</td>
<td>001010</td>
<td>KAYLA VALERINA ASGA</td>
<td>'3503104105170001</td>
<td>RT51/16</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-05-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002246157764</td>
<td>131509010723Y000090</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>12</td>
<td>03-07-2023</td>
<td>012026</td>
<td>SHERIL ALLECIA SISWANTO PUTRI, AN</td>
<td>'</td>
<td>2/1</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>30-12-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>13</td>
<td>03-07-2023</td>
<td>020328</td>
<td>RISKA SUKAWATI,NY</td>
<td>'</td>
<td>3/2</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>18-12-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>14</td>
<td>03-07-2023</td>
<td>017785</td>
<td>DESY SETYOWATI,NY</td>
<td>'3503106912970003</td>
<td>22/07</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>29-12-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>15</td>
<td>03-07-2023</td>
<td>002199</td>
<td>IMA FITRI ASTUTIK,NY</td>
<td>'</td>
<td>36/17</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>15-11-1992</td>
<td>30</td>
<td>P</td>
<td>Guru</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>16</td>
<td>04-07-2023</td>
<td>008736</td>
<td>IMAM WARAS,TN</td>
<td>'3503100403770001</td>
<td>DSN GENENG SANAN, RT : 60,RW :27 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-03-1977</td>
<td>46</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>17</td>
<td>04-07-2023</td>
<td>020351</td>
<td>KAMSARI,TN</td>
<td>'3503103112500018</td>
<td>DSN MANGGIS, RT : 16,RW :6 </td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>31-12-1950</td>
<td>72</td>
<td>L</td>
<td>Perdagangan</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002749358237</td>
<td>131509010723Y000155</td>
<td align='center'>
K04.5 </td>
<td align='center'>
Chronic apical periodontitis </td>
</tr>

<td>18</td>
<td>04-07-2023</td>
<td>020352</td>
<td>SUYATNO,TN</td>
<td>'3503100107530010</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-07-1953</td>
<td>70</td>
<td>L</td>
<td>Petani/Pekebun</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.5 </td>
<td align='center'>
</tr>

<td>19</td>
<td>04-07-2023</td>
<td>013802</td>
<td>MIRZA ALIYANA ZABRAN SUPRAPTO</td>
<td>'3503101610150002</td>
<td>DSN KREBET, RT : 26,RW :10 </td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>16-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>20</td>
<td>04-07-2023</td>
<td>020353</td>
<td>FERIDA EKA WAHYUNINGTIAS,NY</td>
<td>'3503105007950004</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>10-07-1995</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
Necrosis of pulp </td>
</tr>

<td>21</td>
<td>04-07-2023</td>
<td>009564</td>
<td>DWI LUTINA SARI,NY</td>
<td>'3503106508930001</td>
<td>14/06</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>25-08-1993</td>
<td>29</td>
<td>P</td>
<td>Guru</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666156767</td>
<td>Konseling</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>22</td>
<td>04-07-2023</td>
<td>004076</td>
<td>BINTAR SUCI RAHAYU</td>
<td>'</td>
<td>28/13</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-01-2006</td>
<td>17</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666196525</td>
<td>131509010723Y000154</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>23</td>
<td>04-07-2023</td>
<td>003578</td>
<td>AMURWA PRATYA INDRASWARI</td>
<td>'</td>
<td>33/10</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-04-1999</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0002762325821</td>
<td>131509010723Y000156</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>24</td>
<td>04-07-2023</td>
<td>001423</td>
<td>NOVA AYU WULANDARI</td>
<td>'</td>
<td>RT 11/4</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-11-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002231726747</td>
<td>131509010723Y000152</td>
<td align='center'>
K05.3 </td>
<td align='center'>
Chronic periodontitis </td>
</tr>

<td>25</td>
<td>04-07-2023</td>
<td>020359</td>
<td>IKA PUSPITASARI,NY</td>
<td>'3503104811910001</td>
<td>DSN SAMPANG, RT : 26,RW :8 </td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>08-11-1991</td>
<td>31</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>26</td>
<td>04-07-2023</td>
<td>003509</td>
<td>VAAISYAH NURA</td>
<td>'</td>
<td>33/10</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>25-08-2007</td>
<td>15</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002762325584</td>
<td>131509010723Y000153</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>27</td>
<td>04-07-2023</td>
<td>020313</td>
<td>YUSUF ARIFIN</td>
<td>'</td>
<td>4/2</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-12-2001</td>
<td>21</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664619951</td>
<td>131509010723Y000151</td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>28</td>
<td>04-07-2023</td>
<td>020356</td>
<td>SYARA MIA NURLIANA,NY</td>
<td>'</td>
<td>1/1</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>28-07-1995</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>29</td>
<td>04-07-2023</td>
<td>011027</td>
<td>ARSYFA KHAIRA WIDA,AN</td>
<td>'9999999999999999-327857</td>
<td>DSN. BANDUNG, RT : 11,RW :6 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>15-03-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>30</td>
<td>04-07-2023</td>
<td>016648</td>
<td>KHAIRINNISA AIDA ZAHRANI</td>
<td>'</td>
<td></td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-04-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>31</td>
<td>04-07-2023</td>
<td>007431</td>
<td>ALFARO YUDHISTIRA PRISTIADI</td>
<td>'3503100806160001</td>
<td>DSN KEDEKAN, RT : 10,RW :4 </td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>08-06-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>32</td>
<td>05-07-2023</td>
<td>015091</td>
<td>RANI PUTRI UTARI</td>
<td>'3503106306950001</td>
<td>DSN GANDUSARI, RT : 1,RW :1 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-06-1995</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000106525822</td>
<td>131509010723Y000205</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>33</td>
<td>05-07-2023</td>
<td>007760</td>
<td>RENI YULIANINGSIH</td>
<td>'3503074204940001</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>02-06-1994</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>34</td>
<td>05-07-2023</td>
<td>020383</td>
<td>MUHAMMAD JUSTIN FARZANA</td>
<td>'3503101112160002</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>11-12-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>35</td>
<td>05-07-2023</td>
<td>002527</td>
<td>ARISKIYA FITRI ANDINI</td>
<td>'</td>
<td>23/11</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>10-09-2009</td>
<td>13</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>36</td>
<td>05-07-2023</td>
<td>018896</td>
<td>AINUL LAELIYAWATI,NY</td>
<td>' </td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>09-10-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001036930994</td>
<td>131509010723Y000707</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>37</td>
<td>06-07-2023</td>
<td>020391</td>
<td>QUEENZINO HARSCHEL M,AN</td>
<td>'</td>
<td>01/01</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-12-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>38</td>
<td>06-07-2023</td>
<td>020393</td>
<td>ZIDAN FEBRIAN AZKA NUGRAHA</td>
<td>'</td>
<td>03/01</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-02-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002927929048</td>
<td>131509010723Y000232</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>39</td>
<td>06-07-2023</td>
<td>020395</td>
<td>ALULA FARZANA FITROHA</td>
<td>'3503105105170001</td>
<td>DSN PUNDENSARI, RT : 6,RW :2 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>11-05-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
Pulpitis </td>
</tr>

<td>40</td>
<td>06-07-2023</td>
<td>013965</td>
<td>BINTANG ARSENA PUTRI,NN</td>
<td>'3503105203070001</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>14-03-2007</td>
<td>16</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
Caries of dentine </td>
</tr>

<td>41</td>
<td>06-07-2023</td>
<td>020399</td>
<td>DINDA WAHYU NUR AZIZAH,AN</td>
<td>'</td>
<td>10/05</td>
<td>WONOCOYO</td>
<td>POGALAN</td>
<td>TRENGGALEK</td>
<td>31-03-2018</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>42</td>
<td>06-07-2023</td>
<td>010144</td>
<td>SHIDQIYA NASYWA,AN</td>
<td>'</td>
<td>25/07</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>12-06-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>43</td>
<td>06-07-2023</td>
<td>018388</td>
<td>EGEN ADERIAU APRIYANZO,AN</td>
<td>'</td>
<td>23/10</td>
<td>SUGIHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>23-04-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003505156121</td>
<td>131509010723Y000643</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>44</td>
<td>06-07-2023</td>
<td>020402</td>
<td>ALBI ZAINUS ALFAHRO</td>
<td>'3503072501150001</td>
<td>DUSUN NGIMER, RT : 23,RW :10 </td>
<td>SUGIHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>25-01-2015</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>45</td>
<td>06-07-2023</td>
<td>009544</td>
<td>AZKA SATRIA GIONINO,AN</td>
<td>'3503102008150001</td>
<td>DSN KARANGREJO, RT : 30,RW :10 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-08-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>46</td>
<td>06-07-2023</td>
<td>018129</td>
<td>FATHAN AGUNG WIJAYA,AN</td>
<td>'9999999999999999-327723</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>27-12-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>47</td>
<td>07-07-2023</td>
<td>020419</td>
<td>VIVI MEI JAMILA,NY</td>
<td>'3503104205870003</td>
<td>01/01</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>05-05-1987</td>
<td>36</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>48</td>
<td>07-07-2023</td>
<td>000041</td>
<td>YULI MUKAROMAH</td>
<td>'</td>
<td>22/10</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-07-1984</td>
<td>39</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665034028</td>
<td>131509010723Y000631</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>
<td>49</td>
<td>07-07-2023</td>
<td>017280</td>
<td>SITI ROMELAH</td>
<td>' </td>
<td>DSN KEBON, RT : 5,RW :2 </td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-04-2000</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665430783</td>
<td>131509010723Y000632</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>50</td>
<td>08-07-2023</td>
<td>014939</td>
<td>TINTIN SUHARTI</td>
<td>'</td>
<td>29/14</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>15-05-1966</td>
<td>57</td>
<td>P</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106891986</td>
<td>Konseling</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>51</td>
<td>10-07-2023</td>
<td>012840</td>
<td>NAURA KHANZA AZZAHRA,AN</td>
<td>'3503104912140001</td>
<td>1/1</td>
<td>MELIS</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>09-12-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002608231656</td>
<td>131509010723Y000359</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>52</td>
<td>10-07-2023</td>
<td>020448</td>
<td>RATNA SUKESI,NN</td>
<td>'3503104303060003</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>03-03-2006</td>
<td>17</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003236363436</td>
<td>131509010723Y000364</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>53</td>
<td>10-07-2023</td>
<td>012321</td>
<td>ANUNGGITA DWASTA ARIMURTI,AN</td>
<td>'3503101712150001</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-12-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>54</td>
<td>10-07-2023</td>
<td>002290</td>
<td>SHAFA ZUBI CARABELLA,AN</td>
<td>'</td>
<td>21/8</td>
<td>WIDORO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>30-03-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>55</td>
<td>10-07-2023</td>
<td>020455</td>
<td>SALSABILA DWI AYU,AN</td>
<td>'</td>
<td>07/02</td>
<td>PAKEL</td>
<td>WATULIMO</td>
<td>TRENGGALEK</td>
<td>22-05-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>56</td>
<td>10-07-2023</td>
<td>016730</td>
<td>MUHAMMAD MAULANA PRADIPTA</td>
<td>'3503102512160002</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>25-12-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>57</td>
<td>10-07-2023</td>
<td>020459</td>
<td>RAFIF ATHAFURRAHMAN</td>
<td>'3503100508170001</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>05-08-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>58</td>
<td>10-07-2023</td>
<td>020451</td>
<td>ADINDA SABERINA K,AN</td>
<td>'</td>
<td>9/5</td>
<td>SUGIHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>16-09-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>59</td>
<td>11-07-2023</td>
<td>000850</td>
<td>SHABIRA BINAR RINASTITI SUGHULIN</td>
<td>'</td>
<td>5/3</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>06-06-2007</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000148391008</td>
<td>131509010723Y000428</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>60</td>
<td>11-07-2023</td>
<td>009010</td>
<td>ZEVINA DWI ANDINI,NN</td>
<td>'3503106401040005</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>24-01-2004</td>
<td>19</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>61</td>
<td>11-07-2023</td>
<td>014891</td>
<td>ANITA PUSPITA DEWI,NN</td>
<td>'3503104801970001</td>
<td>28/13</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>08-01-1997</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003106801023</td>
<td>131509010723Y000429</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>62</td>
<td>11-07-2023</td>
<td>018020</td>
<td>NUFIN KHOIRIYAH,NY</td>
<td>'3503105911770002</td>
<td>DUSUN TUGU, RT : 27,RW :13 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>19-11-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>63</td>
<td>11-07-2023</td>
<td>010725</td>
<td>TIARA MARGANIA SAPUTRI</td>
<td>'3503105603090001</td>
<td>DSN GENENG SANAN SUKOREJO, RT : 38,RW :18 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>16-03-2009</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802836507</td>
<td>131509010723Y000430</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>64</td>
<td>11-07-2023</td>
<td>002331</td>
<td>MARDI BUNYAMIN</td>
<td>'3503102001610001</td>
<td>TUGU, RT : 25,RW :12 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-01-1961</td>
<td>62</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106817185</td>
<td>131509010723Y000431</td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>65</td>
<td>11-07-2023</td>
<td>013219</td>
<td>FA`ADHILA ZULFA</td>
<td>'3503105411960001</td>
<td>23/9</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>14-11-1996</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>66</td>
<td>12-07-2023</td>
<td>004763</td>
<td>ARSHA RIFKI RAMADHAN</td>
<td>'</td>
<td>28/13</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-05-2020</td>
<td>3</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012971692</td>
<td>131509010723Y000456</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>67</td>
<td>12-07-2023</td>
<td>020483</td>
<td>DEGISHA PUTRI AQILA,AN</td>
<td>'</td>
<td>54/25</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>24-06-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>68</td>
<td>12-07-2023</td>
<td>015594</td>
<td>ALNAIRA KHAILA NAWANG ARUM</td>
<td>'3503104301170001</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>03-01-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>69</td>
<td>12-07-2023</td>
<td>011661</td>
<td>ZALFA AIMANU IZZUDDIN</td>
<td>'3503103005150001</td>
<td>DSN PUCUNG, RT : 11,RW :4 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>30-05-2015</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>70</td>
<td>12-07-2023</td>
<td>014939</td>
<td>TINTIN SUHARTI</td>
<td>'</td>
<td>29/14</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>15-05-1966</td>
<td>57</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106891986</td>
<td>131509010723Y000466</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>71</td>
<td>12-07-2023</td>
<td>000205</td>
<td>RUSMINI</td>
<td>'</td>
<td>RT5/2</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-03-1959</td>
<td>64</td>
<td>P</td>
<td>Petani / Pekebun</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000113498368</td>
<td>Konseling</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>72</td>
<td>12-07-2023</td>
<td>013207</td>
<td>TITIN TRIANA,NY</td>
<td>'</td>
<td>23/11</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>10-01-1974</td>
<td>49</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000174135273</td>
<td>Konseling</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>73</td>
<td>12-07-2023</td>
<td>009405</td>
<td>TITIS HARDIATIN,NY</td>
<td>'3503105903010002</td>
<td>JATI, RT : 16,RW :6 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>19-03-1991</td>
<td>32</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002087119359</td>
<td>Konseling</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>74</td>
<td>12-07-2023</td>
<td>012823</td>
<td>PATONAH,NY</td>
<td>'3503106303710002</td>
<td>DSN KREBET, RT : 23,RW :9 </td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-03-1971</td>
<td>52</td>
<td>P</td>
<td>Pedagang</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002260741386</td>
<td>131509010723Y000470</td>
<td align='center'>
K02.0 </td>
<td align='center'>
Caries limited to enamel </td>
</tr>

<td>75</td>
<td>12-07-2023</td>
<td>002579</td>
<td>DZAKIRA BALQIS AFTANI</td>
<td>'9999999999999999-334567</td>
<td>DSN DAWUHAN PULE, RT : 3,RW :2 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-08-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>76</td>
<td>12-07-2023</td>
<td>014773</td>
<td>LINDA ULFATUN AZIZAH</td>
<td>'3503105310000001</td>
<td>DSN PLAGEN, RT : 7,RW :3 </td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>13-10-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>77</td>
<td>13-07-2023</td>
<td>020448</td>
<td>RATNA SUKESI,NN</td>
<td>'3503104303060003</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>03-03-2006</td>
<td>17</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003236363436</td>
<td>131509010723Y000519</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>78</td>
<td>13-07-2023</td>
<td>003798</td>
<td>NABILA AZ-ZAHRA KHAIRANI</td>
<td>'3503076509130001</td>
<td>DUSUN WATES, RT : 9,RW :5 </td>
<td>SUGIHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>25-09-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>79</td>
<td>13-07-2023</td>
<td>020519</td>
<td>UTAMI,NY</td>
<td>'</td>
<td>11/04</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>06-07-1988</td>
<td>35</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>80</td>
<td>13-07-2023</td>
<td>003537</td>
<td>HAMDAN TSANI PRASETYO</td>
<td>'3503102810020002</td>
<td>DSN BANDUNG, RT : 13,RW :6 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>28-10-2002</td>
<td>20</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001036936315</td>
<td>131509010723Y000525</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>81</td>
<td>13-07-2023</td>
<td>005638</td>
<td>KIANA ELVARETA DANASTRI</td>
<td>'</td>
<td>19/9</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-02-2014</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>82</td>
<td>13-07-2023</td>
<td>017758</td>
<td>YAYUK TRI RATNAWATI,NY</td>
<td>'3503104807700003</td>
<td>4/2</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>08-07-1970</td>
<td>53</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001132368175</td>
<td>131509010723Y000526</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>83</td>
<td>13-07-2023</td>
<td>008783</td>
<td>KERIN NURDIANA ASLYN</td>
<td>'3503106312010006</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-12-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>84</td>
<td>13-07-2023</td>
<td>015778</td>
<td>ADINDA NIMAS SEKAR PRAMESWARI</td>
<td>'3503104802170002</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>08-02-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>85</td>
<td>13-07-2023</td>
<td>016649</td>
<td>MYSHA HAYU AGISTA,AN</td>
<td>'3503106808160001</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>28-08-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>86</td>
<td>13-07-2023</td>
<td>020526</td>
<td>ENDAH FEBRI SULISTIANI,NY</td>
<td>'</td>
<td>57/26</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>03-02-2000</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>87</td>
<td>13-07-2023</td>
<td>008469</td>
<td>ALPIPATUS SHOLIKAH.NN</td>
<td>'</td>
<td>33/16</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-05-1999</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665601096</td>
<td>Konseling</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>88</td>
<td>14-07-2023</td>
<td>009071</td>
<td>RAFAN SHAVIQ ANWAR,AN</td>
<td>'</td>
<td>30/14</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-12-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>89</td>
<td>14-07-2023</td>
<td>020542</td>
<td>PARYONO,TN</td>
<td>'3503101007800006</td>
<td>DSN BELIK, RT : 17,RW :5 </td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>10-07-1980</td>
<td>43</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002860468558</td>
<td>131509010723Y000600</td>
<td align='center'>
K01.1 </td>
<td align='center'>
Impacted teeth </td>
</tr>

<td>90</td>
<td>14-07-2023</td>
<td>011513</td>
<td>MUSTOFA,TN</td>
<td>'</td>
<td>36/10</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>06-11-1963</td>
<td>59</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002681714889</td>
<td>131509010723Y000607</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>91</td>
<td>14-07-2023</td>
<td>011473</td>
<td>SITI MARYATUN</td>
<td>'</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-01-1959</td>
<td>64</td>
<td>P</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002249364734</td>
<td>131509010723Y000608</td>
<td align='center'>
K04.5 </td>
<td align='center'>
</tr>

<td>92</td>
<td>14-07-2023</td>
<td>000205</td>
<td>RUSMINI</td>
<td>'</td>
<td>RT5/2</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-03-1959</td>
<td>64</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000113498368</td>
<td>131509010723Y000612</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>93</td>
<td>14-07-2023</td>
<td>013207</td>
<td>TITIN TRIANA,NY</td>
<td>'</td>
<td>23/11</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>10-01-1974</td>
<td>49</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000174135273</td>
<td>131509010723Y000615</td>
<td align='center'>
K04.5 </td>
<td align='center'>
</tr>

<td>94</td>
<td>14-07-2023</td>
<td>020543</td>
<td>NIVA KARUNIASARI,NY</td>
<td>'</td>
<td>06/02</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-10-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>95</td>
<td>14-07-2023</td>
<td>000856</td>
<td>MALIK</td>
<td>'</td>
<td>9/3</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-09-1955</td>
<td>67</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665254517</td>
<td>131509010723Y000617</td>
<td align='center'>
K04.5 </td>
<td align='center'>
</tr>

<td>96</td>
<td>14-07-2023</td>
<td>014269</td>
<td>FIDYA ULFA FARADIKMA</td>
<td>'3503106909960001</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>27-09-1996</td>
<td>26</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665159883</td>
<td>131509010723Y000592</td>
<td align='center'>
K01.1 </td>
<td align='center'>
Impacted teeth </td>
</tr>

<td>97</td>
<td>14-07-2023</td>
<td>020557</td>
<td>TAHTA TAHLILAN</td>
<td>'</td>
<td>13/05</td>
<td>KARANGANYAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>16-10-2008</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS PUSAT</td>
<td>'0000165909069</td>
<td>131509010723Y000619</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>98</td>
<td>14-07-2023</td>
<td>012368</td>
<td>HAIDAR RIYAN UBAIDILLAH AN.</td>
<td>'</td>
<td>4/1</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>06-04-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>99</td>
<td>15-07-2023</td>
<td>020567</td>
<td>KEISHA AZZAHRA,AN</td>
<td>'</td>
<td>9/3</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-05-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>100</td>
<td>17-07-2023</td>
<td>020611</td>
<td>MUHAMMAD THAARIQUL HUDA</td>
<td>'</td>
<td>19/09</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-10-2010</td>
<td>12</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>101</td>
<td>17-07-2023</td>
<td>020391</td>
<td>QUEENZINO HARSCHEL M,AN</td>
<td>'</td>
<td>01/01</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-12-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>102</td>
<td>17-07-2023</td>
<td>020615</td>
<td>ADITYA FAHMI GUMILANG,SDR</td>
<td>'3503101110040002</td>
<td>27/13</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>11-10-2004</td>
<td>18</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>103</td>
<td>17-07-2023</td>
<td>018819</td>
<td>MUHAMMAD FARIZ RAZKA</td>
<td>'</td>
<td>23/11</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>16-09-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>104</td>
<td>18-07-2023</td>
<td>008523</td>
<td>HARI SUSIANIK</td>
<td>'3503126810710001</td>
<td>3/1</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>28-10-1971</td>
<td>51</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106845557</td>
<td>131509010723Y000933</td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>105</td>
<td>18-07-2023</td>
<td>002165</td>
<td>FAJARIATUL MASRUROH</td>
<td>'</td>
<td>RT 31 RW 15</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>24-04-1998</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000666347635</td>
<td>131509010723Y000934</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>106</td>
<td>18-07-2023</td>
<td>020638</td>
<td>FEBRIANSYAH IKO RISMANA</td>
<td>'</td>
<td>22/08</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-02-2003</td>
<td>20</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002284491431</td>
<td>131509010723Y000932</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>107</td>
<td>18-07-2023</td>
<td>016627</td>
<td>HARYANI</td>
<td>'3503125303670002</td>
<td>RT 030 RW 013 DUSUN GONDANGREJO NGADIRENGGO POGALAN, RT : 30,RW :13
</td>
<td>NGADIRENGGO</td>
<td>POGALAN</td>
<td>TRENGGALEK</td>
<td>13-03-1967</td>
<td>56</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106524731</td>
<td>131509010723Y000935</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>
<td>108</td>
<td>20-07-2023</td>
<td>001602</td>
<td>MUSRINGATUN</td>
<td>'3503104507560002</td>
<td>DSN. DAWUHAN PULE, RT : 21,RW :10 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>05-07-1956</td>
<td>67</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000106636757</td>
<td>131509010723Y001990</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>109</td>
<td>20-07-2023</td>
<td>018316</td>
<td>ERVIANA FEBRI PUTRI LESTARI</td>
<td>'3503105402080001</td>
<td>DSN SETRI, RT : 1,RW :1 </td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>14-02-2008</td>
<td>15</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802858996</td>
<td>131509010723Y001989</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>110</td>
<td>20-07-2023</td>
<td>010673</td>
<td>ELVINA SYEILA YUANITA,AN</td>
<td>'</td>
<td>53/16</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-09-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>111</td>
<td>21-07-2023</td>
<td>019026</td>
<td>INTI BING SLAMET,NY</td>
<td>'</td>
<td>NURYANI,TN</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-08-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000667478957</td>
<td>131509010723Y001032</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>112</td>
<td>21-07-2023</td>
<td>020665</td>
<td>FARREL DIMAS ANDANA,AN</td>
<td>'</td>
<td>19/07</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>31-08-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>113</td>
<td>21-07-2023</td>
<td>000465</td>
<td>FAHMI SAHAD BUKHORI</td>
<td>'</td>
<td>RT 10/03</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-07-2018</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>114</td>
<td>21-07-2023</td>
<td>011166</td>
<td>RAFAEL MARCELINO TIAR ALDIANSYAH,AN</td>
<td>'3503103110130002</td>
<td>24/04</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>31-10-2013</td>
<td>9</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>115</td>
<td>21-07-2023</td>
<td>020670</td>
<td>ARKAN KINZA RAVINDRA</td>
<td>'</td>
<td>12</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>22-07-2018</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002475557054</td>
<td>Konseling</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>116</td>
<td>21-07-2023</td>
<td>015536</td>
<td>WAHYU NURROHMAWATI</td>
<td>'3503106303000005</td>
<td>18/1</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-06-2000</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000665769431</td>
<td>131509010723Y001037</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>117</td>
<td>21-07-2023</td>
<td>019437</td>
<td>ASFIATUL NIKMAH</td>
<td>'3503104404170001</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-04-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012972873</td>
<td>131509010723Y001041</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>118</td>
<td>21-07-2023</td>
<td>016922</td>
<td>SITI NURHAYATI</td>
<td>'3503106708670001</td>
<td>19/7</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>27-08-1967</td>
<td>55</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002681713438</td>
<td>131509010723Y001045</td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>119</td>
<td>21-07-2023</td>
<td>020674</td>
<td>ATIK NURKHOLIPAH,NY</td>
<td>'</td>
<td>3/2</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>30-05-1989</td>
<td>34</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>120</td>
<td>22-07-2023</td>
<td>020678</td>
<td>RHAKA ALFARIZKI,AN</td>
<td>'</td>
<td>4/2</td>
<td>SUGIHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>06-06-2013</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>121</td>
<td>22-07-2023</td>
<td>017693</td>
<td>NOPATU MAWADOH,NY</td>
<td>'3503114111990002</td>
<td>9/4</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>01-11-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>122</td>
<td>22-07-2023</td>
<td>005740</td>
<td>FAZILA HASYA MAYODA</td>
<td>'3503076004170001</td>
<td>5/2</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-04-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002243439685</td>
<td>131509010723Y001782</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>123</td>
<td>22-07-2023</td>
<td>008841</td>
<td>NOVAN RIDA AHMANDA,AN</td>
<td>'3503100911140001</td>
<td>12/05</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>09-11-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>124</td>
<td>24-07-2023</td>
<td>000463</td>
<td>MARIA ANDRIANA</td>
<td>'</td>
<td>RT 2 RW 1</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-07-1987</td>
<td>36</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002681656031</td>
<td>Konseling</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>125</td>
<td>24-07-2023</td>
<td>013174</td>
<td>ADELA ADRIANA AGATHA,AN</td>
<td>'3503105711150001</td>
<td>DSN PUCUNG, RT : 11,RW :4 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-11-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>126</td>
<td>24-07-2023</td>
<td>010673</td>
<td>'</td>
<td>53/16</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-09-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>127</td>
<td>24-07-2023</td>
<td>016831</td>
<td>AMANDA NAIZA ALMAHYRA REIGA</td>
<td>'3503100802160001</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>08-02-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>128</td>
<td>24-07-2023</td>
<td>020139</td>
<td>AHYAN NAFI R,AN</td>
<td>'</td>
<td>10/03 GANDUSARI</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>25-02-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>129</td>
<td>25-07-2023</td>
<td>020737</td>
<td>IDZA`AN MIKHAEL YUNANDA W</td>
<td>'</td>
<td>24/11</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>31-12-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
Caries limited to enamel </td>
</tr>

<td>130</td>
<td>25-07-2023</td>
<td>020734</td>
<td>FITRIANA,NY</td>
<td>'</td>
<td>11/06</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>19-08-1990</td>
<td>32</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>131</td>
<td>25-07-2023</td>
<td>017228</td>
<td>ARSY HASNA PRAMUDYA,AN</td>
<td>'</td>
<td>18/07</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>15-09-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002085624066</td>
<td>131509010723Y001246</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>132</td>
<td>25-07-2023</td>
<td>011092</td>
<td>PADMIATUN</td>
<td>'</td>
<td>BANDUNG 14/7</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>25-05-1971</td>
<td>52</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802843786</td>
<td>131509010723Y001245</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>133</td>
<td>25-07-2023</td>
<td>016618</td>
<td>SUSI WAHYUNINGSIH</td>
<td>'3504184905020002</td>
<td>6/3</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>09-05-2002</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000667009348</td>
<td>Konseling</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>134</td>
<td>25-07-2023</td>
<td>008475</td>
<td>BERTHA DOMINICA MAHESWARI,AN</td>
<td>'</td>
<td>14/04</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>05-02-2014</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681699376</td>
<td>131509010723Y001247</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>135</td>
<td>25-07-2023</td>
<td>013709</td>
<td>DIAJENG NUR A,AN</td>
<td>'</td>
<td>19/07</td>
<td>WONOANTI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-04-2018</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>136</td>
<td>26-07-2023</td>
<td>020744</td>
<td>AMBARWATI,NY</td>
<td>'</td>
<td>9/4</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>16-05-1997</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>137</td>
<td>26-07-2023</td>
<td>018565</td>
<td>AYU RISKA FIRNANDA,AN</td>
<td>'</td>
<td>21/06</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>13-03-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>138</td>
<td>26-07-2023</td>
<td>010812</td>
<td>HELEN APRILIA SAYEKTI,AN</td>
<td>'</td>
<td>16/08</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>18-04-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681707961</td>
<td>131509010723Y001295</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>139</td>
<td>26-07-2023</td>
<td>020749</td>
<td>CHOIRIYATIN,NY</td>
<td>'</td>
<td>14/04</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-05-1989</td>
<td>34</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>140</td>
<td>26-07-2023</td>
<td>003500</td>
<td>ALVARENDRA ATHAZAKY RULKA NABIHAN</td>
<td>'</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>26-07-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002269577081</td>
<td>Konseling</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>141</td>
<td>26-07-2023</td>
<td>020395</td>
<td>ALULA FARZANA FITROHA</td>
<td>'3503105105170001</td>
<td>DSN PUNDENSARI, RT : 6,RW :2 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>11-05-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>142</td>
<td>26-07-2023</td>
<td>011306</td>
<td>MUHAMMAD ABIL HASAN,AN</td>
<td>'3503102901170001</td>
<td>DSN TUGU, RT : 28,RW :13 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>19-02-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>143</td>
<td>26-07-2023</td>
<td>020046</td>
<td>USWATUN HASANAH</td>
<td>'3503065906950001</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>19-06-1995</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663869439</td>
<td>Konseling</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>144</td>
<td>26-07-2023</td>
<td>009979</td>
<td>MONA KAYSA,AN</td>
<td>'</td>
<td>41</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>30-04-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>145</td>
<td>26-07-2023</td>
<td>018976</td>
<td>DYAH WINDA SEPTYANA,NY</td>
<td>'3503104409980004</td>
<td>30/14</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-09-1997</td>
<td>25</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>146</td>
<td>26-07-2023</td>
<td>020756</td>
<td>ANIQOTUS SADIYAH,NY</td>
<td>'</td>
<td>50/16</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>24-08-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>147</td>
<td>26-07-2023</td>
<td>012605</td>
<td>SITI NURKHASANAH</td>
<td>'3503094409960001</td>
<td>1/1</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-09-1996</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002598205342</td>
<td>131509010723Y001326</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>148</td>
<td>27-07-2023</td>
<td>018956</td>
<td>FITRA AZKA,AN</td>
<td>'</td>
<td>14/04</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>13-06-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>149</td>
<td>27-07-2023</td>
<td>020761</td>
<td>LELADIAH WULANDARI,NY</td>
<td>'</td>
<td>15/04</td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-06-2003</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>150</td>
<td>27-07-2023</td>
<td>010955</td>
<td>KHANZA ADRIANA K,AN</td>
<td>'</td>
<td>36/17</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-09-2011</td>
<td>11</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>151</td>
<td>27-07-2023</td>
<td>000576</td>
<td>SUHARNI</td>
<td>'3503124712820001</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>07-12-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001707002436</td>
<td>131509010723Y001740</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>152</td>
<td>27-07-2023</td>
<td>010001</td>
<td>BANGKIT HIKMAWAN ANHARI,AN</td>
<td>'9999999999999999-326855</td>
<td>DSN NGLAYUR, RT : 50,RW :24 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>31-05-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>153</td>
<td>28-07-2023</td>
<td>006633</td>
<td>SANIYAH</td>
<td>'3503076206750001</td>
<td>DUSUN KRAJAN, RT : 4,RW :2 </td>
<td>TIMAHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>22-06-1975</td>
<td>48</td>
<td>P</td>
<td>Petani/Pekebun</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>154</td>
<td>28-07-2023</td>
<td>010115</td>
<td>MUJIYAH,NY</td>
<td>'</td>
<td>56/16</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>26-03-1976</td>
<td>47</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666051399</td>
<td>131509010723Y001723</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>155</td>
<td>28-07-2023</td>
<td>020771</td>
<td>SETU,TN</td>
<td>'</td>
<td>01/01</td>
<td>NGRAYUNG</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>06-11-1953</td>
<td>69</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666188965</td>
<td>131509010723Y001724</td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>156</td>
<td>28-07-2023</td>
<td>017418</td>
<td>ELSA HANIFARA</td>
<td>'3503106103170002</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>21-03-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>157</td>
<td>28-07-2023</td>
<td>010673</td>
<td>'</td>
<td>53/16</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>17-09-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>158</td>
<td>29-07-2023</td>
<td>019323</td>
<td>MACKENZO YASIN ZIDAN,TN</td>
<td>'</td>
<td>34/16</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>20-05-2015</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>159</td>
<td>29-07-2023</td>
<td>003714</td>
<td>RAFA RIZQI FAIZ RAMADHANI</td>
<td>'3503101007130001</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>10-07-2013</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>160</td>
<td>29-07-2023</td>
<td>018356</td>
<td>MUHAMMAD KHADIQUN NUHA,SDR</td>
<td>'3503102406040002</td>
<td>DSN. NGLAYUR, RT : 46,RW :22 </td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>04-06-2004</td>
<td>19</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003525442042</td>
<td>131509010723Y001708</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>161</td>
<td>29-07-2023</td>
<td>020678</td>
<td>RHAKA ALFARIZKI,AN</td>
<td>'</td>
<td>4/2</td>
<td>SUGIHAN</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>06-06-2013</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>162</td>
<td>31-07-2023</td>
<td>007212</td>
<td>SEPTI AYU PUJI LESTARI</td>
<td>' </td>
<td>DSN KEBON, RT : 4,RW :2 </td>
<td>JAJAR</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>24-09-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665172167</td>
<td>131509010723Y001941</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>163</td>
<td>31-07-2023</td>
<td>018018</td>
<td>SANIA RESTININGRAT,NN</td>
<td>'</td>
<td>35/11</td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>02-04-2002</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>'0002474250851</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>164</td>
<td>31-07-2023</td>
<td>000469</td>
<td>JUSTIANO DANIEL PUTRA SYAHREZA</td>
<td>'</td>
<td>RT 13/04</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>23-11-2019</td>
<td>3</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002907888884</td>
<td>131509010723Y001935</td>
<td align='center'>
K04.7 </td>
<td align='center'>
</tr>

<td>165</td>
<td>31-07-2023</td>
<td>014592</td>
<td>SEPTIANDRA DESTA AL PRIZMA</td>
<td>'</td>
<td>45</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>28-09-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>166</td>
<td>31-07-2023</td>
<td>009403</td>
<td>INAYA ASMI ATIFA,AN</td>
<td>'</td>
<td>57/26</td>
<td>SUKOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>30-07-2015</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003089590064</td>
<td>131509010723Y001943</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>167</td>
<td>31-07-2023</td>
<td>020804</td>
<td>SISKA IKA APRILIA</td>
<td>'3503105104950002</td>
<td>DSN GANDU, RT : 5,RW :2 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>11-04-1995</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>168</td>
<td>31-07-2023</td>
<td>020805</td>
<td>SULURIN.NY</td>
<td>'3503105804830001</td>
<td>DSN JATIREJO, RT : 14,RW :5 </td>
<td>GANDUSARI</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>18-04-1983</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>169</td>
<td>31-07-2023</td>
<td>016020</td>
<td>EKA DWI PUTRI IMROAH,NY</td>
<td>'3503106202000001</td>
<td>WONOREJO</td>
<td>GANDUSARI</td>
<td>TRENGGALEK</td>
<td>22-02-2000</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>
</table>

Laporan Universal

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Laporan Universal

Uploaded by

Copyright:

Available Formats

<table class='tabel' width='90%'>

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">

<tr align="left" valign="top">