Evaluasi

LAPORAN PELAYANAN
RAWAT JALAN TINGKAT PERTAMA (RJTP)

BULAN FEBRUARI TAHUN 2014
NO TANGGAL NO KARTU PESERTA NAMA PESERTA

1 3-Feb-14 Mayor / NRP. 529201 R.N.Jaya,Tn
2 Kapten / NRP. 511529 Juli Purnomo,Tn
3 a/d Kopda Sunaryo M. Nortanio,An
4 i/d PNS Yan Rini Sularsih,Ny
5 Pelda / NRP. 516880 Henu,Tn
6 a/d Pelda Selvie / NRP. 516741 Christian Daniel,An
7 Peltu / NRP. 506067 Diyot Sriyono
8 i/d Pelda Ali Mashar / NRP. 510088 Siti Fatimah,Ny
9 PNS II D / NIP. 196701311998031002 Akh Mukibi
10 a/d Serma Ranjau / NRP. 512096 Tiara,An
11 Pelda /POM / NRP. 506205 Rachmad,Tn
12 Sertu / NRP. 520079 Didik Supriyadi,Tn
13 a/d Pelda Mujito / NRP. 506166 Ainul Abdilah,An
14 Lettu Sus / NRP. 515110 Iding S,Tn
15 4-Feb-14 i/d Sertu Sugiono Ririn Haryani
16 Peltu / NRP. 509944 Hamid Arifin,Tn
17 a/d PNS Suliono Dian,An
18 a/d Peltu Sumadi / NRP. 509883 Andhika B,An
19 a/d serma Mukri Nanda Putri A,Nn
20 a/d Sertu Sugiono E Alfi Rohmania,An
21 Serka / NRP. 515714 Pujianto,Tn
22 i/d Sertu Witono / NRP. 522119 Hesti,Ny
23 Sertu / POM / NRP. 520057 Wahyudi,Tn
24 a/d Serma Ranjau / NRP. 512096 Bima,An
25 Serma / NRP. 521117 Damis,Tn
26 a/d Serma Suwarno / NRP. 511140 Harum,Nn
27 PNS III D / NIP. 196806181996032001 Dwi Handini
28 5-Feb-14 i/d Kapt. Fauzi / NRP. 507272 Yuli Afianti,Ny
29 Serma / NRP. 523706 Suherman,Tn
30 a/d Pelda Yatimun Wibisono Bagas,An
31 a/d Mayor ADM Suryodi Sanali / NRP. 50 M. Hafid Khoryadi,An
32 a/d Lettu Kes I Gusti Ayu Putu / NRP. 537 Kayla,An
33 6-Feb-14 PNS III B / NIP. 19601128198303204 Cicilia,Ny
34 Serka Heri Wibowo,Tn
35 Mayor / NRP. 508163 Sudjayadi,Tn
36 i/d PNS Sutarno II D / NIP. 030226648 Kasiati,Ny
37 a/d Serma Agustin / NRP. 522632 Rangga Tora,An
38 Serma / NRP. 5226323 Agustin,Ny
39 a/d Serma Gipsaragi / NRP. 523598 Faza,An
40 Sertu POM / NRP. 515750 Haryono,Tn
41 Sertu / NRP. 517760 Ririf Yudianto,Tn
42 7-Feb-14 Peltu / 509944 Hamid A,Tn
43 PNS / NIP. 196912101996032002 Wi Dwi Miko,Ny
44 PNS / NIP. 0001108831511 Jatmiatun,Ny
45 a/d serma Mukri Nanda Putri A,Nn
46 Peltu / NRP. 512420 Saroni,Tn
47 i/d Peltu Saroni / NRP. 512420 Mistiastuti,Ny
48 Serma / NRP. 522432 M. Choirudin,Tn
49 i/d Serma Ichwan Rudianto / NRP. 525478Dwi Oktaviana
50 a/d Sermo Randjau / NRP. 512096 Bima S D,An
51 a/d Mayor Suhardin Putri B,An
52 a/d Pelda M. Andri / NRP. 505829 Yuan,An
53 a/d Peltu Mardi Utomo / NRP. 505829 Rifky,An
54 Serma / NRP. 509384 Tjantje,Tn
55 Mayor / NRP. 508163 Sudjayadi,Tn
56 a/d Pelda Bambang M. Wildan,An
57 10-Feb-14 Peltu / NRP. 507193 Ilmi sabililah,Tn
58 a/d Serma Agustin / NRP. 522632 Rangga,An
59 i/d Sertu Surana / NRP. 517830 Sutrisni,Ny
60 a/d Pelda Yusuf Alfian / NRP. 516896 Aura Isni Khairunisa,An
61 PNS II D / Dis OPS Sadi,Tn
62 i/d PNS II D Sadi Sri Utami,Ny
63 a/d PNS II D Sadi Imroatul,Nn
64 a/d Serma Agustin / NRP. 522632 Rengganis
65 i/d Pratu Agung Tri / NRP. 536883 Lely Yunus,Ny
66 Letda / NRP. 515137 Sudarna,Tn
67 Askes / 0000098045673 Achmad Badrun,Tn
KTP: 3515183112390001
No. Rujukan: 0095-02-14-1001
68 Kapten / NRP. 511529 Juli Purnomo,Tn
69 Serma / NRP. 523598 Gerhana Indra P,Tn
70 Peltu / NRP. 509133 Bambang,Tn
71 a/d Pelda Retno Fitri,An
72 11-Feb-14 Peltu / NRP. 509944 Hamid A,Tn
73 i/d Kapt. Harwoto / NRP. 509575 Diah Retno A,Ny
74 i/d Sertu Wiono / NRP. 522119 Hesti,Ny
76 Letda POM / NRP. 516207 Tarso.Tn
77 PNS III B / NIP. 19692101996032002 Wi Dwi Miko,Ny
78 Sertu / NRP. 535225 Agung Y H,Tn
79 Serma / NRP. 509327 Sigit W,Tn
80 Sertu / NRP. 517863 Khoirul Anam
81 12-Feb-14 Peltu / NRP. 509175 M. azhari,Tn
82 Sertu / NRP. 517760 Ririf Yudianto,Tn
83 Kapten / NRP. 513029 Untung Krismanto,Tn
84 a/d Serma Djaeno / NRP. 509308 Suci Bintari,An
85 i/d Pelda Ema,Ny
86 Peltu / NRP. 516010 Heri Susanto,Tn
87 Sertu / NRP. 521734 Zaenal Arifin,Tn
88 Mayor / NRP. 522882 Arwani,Tn
89 i/d PNS Yan S / NIP. 19690106199403100Rini Sularsih,Ny
90 a/d Serka Ade Didi Bontar Pamungkas
91 Serka / NRP. 515714 Pujianto,Tn
92 13-Feb-14 Peltu / 516010 Hery S,Tn
93 i/d Kapt. Fauzi / NRP. 507272 Yuli Afianti,Ny
94 a/d Pelda Syahroni Bela Rani P,Nn
95 a/d Peltu Hardimiarso / NRP. 506064 Bram S,Tn
96 Praka / NRP. 533213 Vivat,Tn
97 Mayor / NRP. 522882 Arwani,Tn
98 a/d Pelda Sudarno / NRP. 518191 Astri,Nn
99 Peltu / NRP. 506935 Suliadi,Tn
100 Mayor / NRP. 508025 R M Edi Indrianto,Tn
101 Serma / NRP. 507627 Sutopo,Tn
102 Kopda Sutiono,Tn
103 14-Feb-14 a/d Peltu Joko Suwarno / NRP. 513855 Salsabila Suwarno,Nn
104 a/d Kopda Sunaryo / NRP. 528248 M Rotanio Abi,An
105 a/d Kopda Sunaryo / NRP. 528248 M Nurtanio,An
106 a/d PNS III A Liana / NIP. 197402081998 Satria,An
107 Sertu / NRP. 514354 Kartono,Tn
108 Praka / NRP. 534805 Agus Susanto,Tn
109 a/d Mayor Kal Triyanto / NRP. 506351 Erika,Nn
110 PNS II C / NIP. 198212072003122003 Moch Zaki,Tn
111 Mayor Tek / NRP. 505064 Slamet,Tn
112 Sertu / NRP. 517863 Khoirul,Tn
113 a/d Kapten Kes dr. Lusia Arka,An
114 i/d Kapten Harwoto / NRP. 509575 Dyah Retno Ayu,Ny
115 17-Feb-14 Kapten / NRP. 531246 Fakgbus Astro,Tn
116 a/d Kapten Inta Gamma,Sdr
117 a/d Serma Mukri / NRP. 508541 M Risky N,Tn
118 a/d Serma Muhali / NRP. 518590 M Surya,An
119 i/d Kapten Mundir Umi Nadiroh,Ny
120 Serma / NRP. 510235 Suparjo,Tn
121 18-Feb-14 Kopda / NRP. 526701 Iwan Brahmana,Tn
122 Serka / NRP. 513609 Surono,Tn
123 Sertu / NRP. 510351 Suwito,Tn
124 Kapten / NRP. 506536 Parma,Tn
125 Letkol / NRP. 520750 Ninuk,Ny
126 i/d Sertu Johannes / NRP. 531899 Tio Marlina,Ny
127 i/d Kapt M Fauzi / NRP. 507272 Yuli Afianti,Ny
128 PNS II D / NIP. 196412201993001101 Ali Hasyim,Tn
129 Sertu / NRP. 534004 Dedy Agus,Tn
130 Pelda / NRP. 518263 Condro Widodo,Tn
131 Serma / NRP. 523598 Gerhana Indra P S,Tn
132 Askes / 0000101328221 Niken Isnarta,Nn
133 i/d Serma POM Gerhana Indra P S / NRP. Titik A,Ny
134 Kapt Tek / NRP. 511529 Juli Purnomo,Tn
135 i/d PNS Yan S / NIP. 19690106199403100Rini Sularsih,Ny
136 Serma POM Rachmad M,Tn
138 19-Feb-14 PNS / NIP. 197910082007122001 Tilmar Dili S,Ny
139 PNS / NIP. 198708152010121003 Brilian Dili Gudus,Tn
140 a/d Peltu Hendra / NRP. 514905 Elita A,Ny
141 a/d Praka Sunaryo / NRP. 528248 M Rotanio Abi,An
142 a/d Pratu Wawan / NRP. 537653 Raditya Devin,An
143 Kapten / NRP. 517279 Siswadi,Tn
144 Peltu / NRP. 516010 Heri Susanto,Tn
145 Serma / 523759 Afuad,Tn
146 a/d Peltu Hendra K / NRP. 514905 Elita Anindiya,Nn
147 Kapten / NRP. 533189 Yeni Fitriana,Ny
148 20-Feb-14 a/d Mayor Suhardin Putri B,An
149 i/d Mayor Suhardin Sri Rahayu,Ny
150 Askes / 0001078531367 Sri Fatimah,Ny
151 Askes / 0001078531378 Feny,Nn
152 a/d Serka Surono / NRP. 513609 Rifaudi,An
153 i/d Kapt Harwoto / NRP. 509575 Diah Retno A,Ny
154 a/d Mayor Suryadi / NRP. 508163 Hafid Khoryadi,Tn
155 Serka POM / NRP. 515714 Pujianto,Tn
156 21-Feb-14 PNS / NIP. 196001011983031014 Subakat,Tn
157 a/d Serma Mukri / NRP. 508541 Nanda Putri A,Nn
158 Sulkani,Tn
159 i/d Kopda Hermanto Umi Mahwiati,Ny
160 a/d Mayor Sos Eman S / NRP. 524422 Zaskia,An
161 i/d Peltu Arifin / NRP. 506488 Hartini,Ny
162 a/d Mayor Suhardin Putri Balqis,An
163 Sertu Muhali / NRP. 518590 Muhali,Tn
164 24-Feb-14 i/d Kapt Harwoto / NRP. 509575 Diah Retno A,Ny
165 a/d Kapt Harwoto / NRP. 509575 Dinar,Nn
166 Kapten / NRP. 5182889 IS Andrai Awan,Tn
167 Peltu / NRP. 506205 Rachmad,Tn
168 Mayor / NRP. 516756 drg. Margaretha
169 Askes / 0000101328221 Niken Isnarta,Nn
170 a/d Pelda Yunus / NRP. 516896 Raneyza,An
171 a/d Bambang Sutijarso / NRP. 511156 Amelia Putri,An
172 a/d Sertu Wahib A / NRP. 533856 Anindya N,An
173 i/d Pelda Setiyono / NRP. 507755 Lusi,Ny
174 i/d Serma Sumarno / NRP. 509318 Sumarni,Ny
175 Sertu / NRP. 517818 Sudarman,Tn
176 i/d Kapt Mundir / NRP. 510086 Umi Nadiroh,Ny
177 25-Feb-14 a/d letnan Putu / NRP. 537328 Putu Kayla N,An
178 Kopda / NRP. 526701 Iwan Brahmana,Tn
179 a/d Peltu Malek M Artha,An
180 Serma / NRP. 522358 M Abdul Khoiri,Tn
181 Serda / NRP. 525645 Ichwan Edy,Tn
182 Sertu / NRP. 515774 Ali,Tn
183 a/d Praka Anggun / NRP. 532138 Tiara Anggun,An
184 Koptu / NRP. 524792 Suprapto,Tn
185 Praka / NRP. 532138 Agung Sukmoko,Tn
186 a/d Honor Hakmun Maulina Riska Dwi,An
187 Praka / NRP. 530604 Edi Mardiono,Tn
188 a/d Pelda Retno / NRP. 514632 Rahmania S,An
189 26-Feb-14 Serda / NRP. 525645 Ichwan Edy,Tn
190 a/d Kapt Harwoto / NRP. 509575 Dhenok,An
191 a/d Serka Titus / NRP. 515498 Samuel,An
192 i/d Serma Sigit W / NRP. 509327 Rini Winarti,Ny
193 PNS / NIP. 196112011983032008 Kastutia,Ny
194 27-Feb-14 i/d PNS Yan S / NIP. 19690106199403100Rini Sularsih,Ny
195 Peltu / 506408 Arifin Bahrudin,Tn
196 Pelda / 517034 Wiyanto,Tn
197 a/d Sertu / NRP. 518636 Nada A,An
198 i/d Serma Sumarno / NRP. 509318 Minarni,Ny
199 a/d Pelda Hari S Nanda A P,Tn
200 PNS III A / NIP. 196901061994031007 Yan Suryono,Tn
201 Askes / 0000105022023 Suparmi,Ny
202 i/d Pelda Yatimun W / NRP. 516939 Rani Erediani Fajar,Ny
203 28-Feb-14 PNS III D / NIP. 196806181996032001 Dwi Handini,Ny
204 Kapt Kal / NRP. 510071 Mulyadi,Tn
205 Honorer Makmun,Tn
206 Kapt / NRP. 509201 Inta Isnaningrum,Ny
207 a/d Sertu Suryo / NRP. 518554 Rikwal,An
208 Sertu / NRP. 518554 Suryo,Tn
209 i/d Kapt Kes Fauzi Yuli,Ny
210 Pelda / NRP. 506205 Rachmad,Tn
211 i/d Kapt Tek Agus M / NRP. 514673 Fatchul Maida,Ny
212 Kopda / NRP. 527001 Supriyanto,Tn
213 a/d Sertu Muhally / NRP. 518590 M Surya Dwi R,An
214 Sama / NRP. 510241 Suriyatno,Tn
AYANAN
T PERTAMA (RJTP)
TAHUN 2014
DIAGNOSA DI RUJUK
Gingvitis o.k. over hanging
678 abses dan G.10 DM Tipe 1
Gingival abses
Pulpitis
Gingival abses
J.11 Influenza
J.11 Influenza
J.11 Influenza
K.29 Gastritis
A.09 Gea
I.10 Hipertensi dan J.11 Influenza
J.11 Influenza
J.02 Faringitis
J.11 Influenza
ED Rujuk RSAL
Hiperemie pulpae
Check up gigi mau tumbuh
Gangraena pulpae
Gingival abses
Persistensi
Hiperemie pulpae
Gangraena pulpae
J.11 Influenza
A.09 Gea
J.11 Influenza
Mens tidak berhenti ± 3 minggu Surat rujukan
I.10 Hipertensi ensensial
Hiperemie pulpae
J.11 Influenza
Check up mata
A.09 Gastroenteritis Surat rujukan

J.11 Influenza
J.11 Influenza
A.09 Gastroenteritis
J.11 Influenza
J.11 Influenza
J.02 Faringitis
Gangraena pulpae
Gangraena pulpae
Hiperemie pulpae
Gangraena pulpae
Gangraena pulpae
Gingival abses
Post OPS Orto Surat rujukan
Post OPS Urologi Surat rujukan
K.29 Gastritis
Post OPS Orto Surat rujukan
A.09 Diare
J.02 Tonsilopati akut
H.04 Mata kering
J.02 Pharingitis akut
J.11 Influenza
J.11 Influenza
J.11 Influenza
J.11 Influenza
H.00 Hordeolum Surat rujukan
J.11 Influenza
J.11 Influenza
J.11 Influenza
J.11 Influenza
J.11 Influenza
Paratiroid Surat rujukan
G.45 Gangguan Somatoform
J.11 Influenza
J.11 Influenza
J.11 Influenza
Persistensi
Gangraena pulpae
Gangraena pulpae
Gangraena pulpae
Gangraena pulpae
K.29 Gastritis
COR Surat Rujukan
Syncope
I.10 Hipertensi
J.11 Influenza
J.11 Influenza
I.10 Hipertensi
J.11 Influenza
I.10 Hipertensi
J.11 Influenza
J.11 Influenza
J.11 Influenza
Hiperemie pulpae
Hiperemie pulpae
Hiperemie pulpae
Gingival abses
Hiperemie pulpae
Operculitis
Hiperemie pulpae
G.44 Tension Headache
L.20 Alergi
L.20 Dermatitis
PPOK
A.09 Gastroenteritis
J.11 Influenza
I.10 Hipertensi
A.09 Diare
J.11 Influenza
J.11 Influenza
L.20 Dermatitis
J.11 Influenza
Sembelit
J.11 Influenza
L.20 Dermatitis
J.11 Influenza
A.01 Thypoid Rujuk IGD
J.11 Influenza
Gingival abses
N.39 ISK
Gingivitis Marginalis
Persistensi
Hiperemie pulpae
Periodontitis akut
Post KLL Surat rujukan
J.11 Influenza
J.11 Influenza
Kontrol Poli Jantung Surat rujukan
Surat rujukan
G.43 Migrain
A.01 Demam tifoid
G.10 DM tipe 1
J.11 Influenza
Kontrol Fisioterapi Surat rujukan
J.11 Influenza
Benjolan di leher Surat rujukan
J.11 Influenza
L.20 Dermatitis
Pulpitis
Gangraena Pulpae
Hiperemie pulpae
Hiperemie pulpae
A.09 Diare
J.11 Influenza
J.11 Influenza
I.10 Hipertensi
J.11 Influenza
J.11 Influenza
J.11 Influenza
A.09 Diare
K.29 Gastritis
J.11 Influenza
J.11 Influenza
J.11 Influenza
Gingival abses
Kontrol Post extractie
Hiperemie pulpae
Gangraena Radia
Gangraena Pulpae
Gangraena Radia
K.29 Gastritis
J.11 Influenza
Y.02 Osteo Artritis
A.09 Diare
G.43 Migrain
J.11 Influenza
Post Craniotomi Surat rujukan
K.29 Gastritis
Hypertiroid Surat rujukan

J.11 Influenza
J.03 Tonsilitis
J.11 Influenza
Hiperemie pulpae
Gangraena pulpae
Hiperemie pulpae
Hiperemie pulpae
J.11 Influenza
J.11 Influenza
J.11 Influenza
Konsultasi
J.11 Influenza
J.11 Influenza
H.00 Hordeolum
Telinga Berdengung Surat rujukan
J.11 Influenza
K.29 Gastritis
J.11 Influenza
Colic abdomen Surat rujukan
J.11 Influenza
J.11 Influenza
T.00 Vulnus laceratum
Gangraena pulpae
Pulpitis
Gangraena pulpae
Persistensi
Perawatan Luka Jahitan post Mow
T.00 Vulnus laceratum
K.29 Gastritis
I.10 Hipertensi
A.09 Diare
I.10 Hipertensi
HNP Surat rujukan
J.11 Influenza
Ganti ukuran kacamata Surat rujukan
J.11 Influenza
J.11 Influenza
G.47 Insomnia
E.56 Defisiensi vitamin
Post KLL Surat rujukan
Gangraena pulpae
Persistensi
Gingivitis
LAPORAN PELAYANAN
BULAN MARET TAHUN 2014
Nama Faskes : PPK I Lanud Mulyono

Alamat : Surabaya
NO TANGGAL NO KARTU PESERTA NAMA PESERTA DIAGNOSA

1 3-Mar-14 Kapten / 510581 Tn Dodi Jasmiko COPD
2 Praka/ 526701 Tn Iwan J.11 Influenza
3 a/d serka Agustina/522632 An Rengganis E.56 Defisiensi vitamin
4 a/d Pelda Mardi/505829 An Berliani J.11 Influenza
5 4-Mar-14 PNS/197409151998032003 Ny Yohana H.82 Vertigo
6 i/d sertu Hadi/533971 Ny Eka Nur Hidayati Z.34 Kehamilan normal
7 a/d sertu Hadi/533971 an Najma Zakia J.11 Influenza
8 Peltu/ 514824 Tn Abdul Manaf N.39 Infeksi saluran kemih
9 a/d Sertu Rohadi? 522206 An Muhamad Azzam J.11 Influenza
10 PNS /196912101996032002 Ny Widwi Mico J.11 Influenza
11 5-Mar-14 Serka / 510115 Tn Sunarko J.11 Influenza
12 Sertu/ 518590 Tn Muhali J.11 Influenza
13 PNS/19620020219842003 Ny Untari J.11 Influenza

14 5-Mar-14 a/d Pelda Abdul Malik an M Artha J.11 Influenza
15 Peltu/ 514632 Ny Retno J.11 Influenza
16 i/d Kapten Harwoto/509575 Ny Diah Retno A.09 Diare
17 i/d PNS Subakat Ny Anggit Andayani Back Pain
18 Pelda / 506205 Tn Rachmad E.56 Defisisensi vitamin
19 a/d sertu Hendriyanto an Satria akbar saputra Imunisasi

531847
20 Praka/ 532138 Tn agung kontrol ulang THT
21 PNS /196806181996 ny Dwi handini I.10 Hipertensi esential
22 a/d pelda sudarno an A satria D persistensi
23 6-Mar-14 Serda Tn Rudi L.25 Reaksi gigitan serangga
24 i/d serda Zainal Ny Hamsiah J.11 Influenza
25 i/d Pelda Syahroni/512750 Ny Mistiastuti J.11 Inluenza
26 6-Mar-14 Letkol/520750 Ny Ninuk Herlina E.10 Diabetes Mellitus
27 i/d serka Subekti/510110 Ny Farida Gangren pulpa
28 i/d pelda arifin/500408 Ny Hartini Periodontitis
29 pelda/506408 Tn Arifin Gangren Pulpa
30 a/d peltu Hendra/514905 NN Elita Pericoronitis
31 7-Mar-14 askes 00000988808636 Tn Abdul Jalil J.11 Influenza
32 a/d Mayor Eman/524422 An Adam Fauzan J.03 Tonsilitis
33 Peltu/509694 Tn Agus Suyono E.56 Defisisensi vitamin
34 1267713955 NY Tutik Suciatiningsih Hiperemi pulpa
35 1267714631 Nn Afina Truly Hiperemi Pulpa
36 Serma/509384 Tn Yantje Bawangun Hiperemi pulpa
37 a/d pelda retno/514632 An Rahmania safitri Persistensi
38 10-Mar-14 PNS/030207374 Tn Sukimin E.10 Diabetes mellitus

39 10-Mar-14 a/d serda Rudi/525599 An Renaldo J.11 Influenza
40 i/d kaprten Is andrai/513889 Ny Peni Budi kontrol ca
41 Kapten lek/513889 Tn Is andrai awan post opp craniotomi
42 i/d serda iwan Ny Juriah L.50 Urtikaria akut

43 Peltu/507193 Tn Iumi sabilah Parathyroid
44 a/d Pelda Syahroni/512420 Nn Bellarani Ginggivitis marginalis khronis
45 Peltu/509944 Tn Hamid Arifin Gangren pulpa
46 PNS/196001011983031014 Tn Subakat Gangren Radix
47 11-Mar-14 Serka/523759 Tn Afuad J.11 Influenza
48 Sertu/518590 Tn Muhali G.43 Migrain
49 a/d serma randjau/5512096 An Bima observasi febris
50 Serma Suwarno/511140 Tn Suwarno Post stroke
51 12-Mar-14 Peltu/ 506683 Tn Moch Nafik A.09 Diare

52 12-Mar-14 Kapten/513029 Tn Untung Krismantoro J.11 Influenza
53 Mayor Sus/524430 Tn Sariffudin Tarigan Nyeri sendi
54 Peltu/509133 Tn Bambang Julianto J.11 Influenza
55 i/d mayor sus sarifudin/524430 Ny Syarmiati Nyeri sendi
56 13-Mar-14 a/d sertu Ali/515774 An M reyfan Nyeri sendi
57 a/d mayor kal Triyanto/506351 Nn Erika Tiara L.20 Dermatitis
58 i/d serma sigit/509327 Ny Rini Winarti Rawat luka KLL
59 Peltu/506408 Tn Arifin Bahrudin Gangren Pulpa
60 a/d serka Hadi/506064 An Bram Satriawan Gangren Pulpa
61 14-Mar-14 Serka/527807 Tn Yusuf wibisono J.11 Influenza
62 Serma/522632 Ny agustina J.11 Influenza
63 a/d serka Bambang/511156 An Pandu Satria W J.11 Inluenza
64 Mayor/508163 Tn Sudjayadi B.02 Herpes Zoster

65 14-Mar-14 a/d peltu Hendra /514905 An Prabu Dewa L J.11 Influenza
66 i/d peltu Hendra/514905 Ny Munafiah konsultasi kulit
67 i/d lettu bambang/511253 Ny Rini Yudawati J.04 Laringitis
68 i/d serma jantje/509384 Ny Ritatik J.11 Influenza
69 a/d serma jantje/509384 An Angel F J.11 Infuenza
70 Serka/530884 Tn Widodo Kurniawan J.11 Influenza
71 i/d Kolonel Toni/505518 Ny Novarita gangren Radix
72 a/d peltu Sumadi/509883 an. Andhika gingival abses
73 pelda / 516896 Tn. Yunus alfian gangraena pulpa
74 17-Mar-14 mayor/507983 Tn Syaiful bachri T.00 vulnus
75 Sertu/535225 Tn Agung Y.H J.11 Influenza
76 a/d Mayor Eman/524422 An Adam Fauzan J.11 Influenza
77 Kapten/506536 Tn Parma kontrol poli jantung

78 i/d sertu/513029 Ny Marthalusi K.29 Gastritis
79 sertu/518554 Tn Suryo K.29 Gastritis
80 Kapten/513029 Tn Untung Krismantoro J.11 Influenza
81 PNS/195910281983032003 Ny Tuni K.29 Gastritis
82 a/d serka bambang/511156 an pandu satria J.11 Influenza
83 i/d Tn khamim/507011 Ny dyah S J.11 Inluenza
84 a/d kapten Khamim/507011 An Riskaning J.11 Influenza
85 Peltu/509944 Tn hamid A nekrosis pulpa
86 18-Mar-14 Askes/0000098808636 Tn Abdul jalil Periodontitis
87 i/d pelda Sudarno/518791 Ny Retno Y Gangraena pulpa
88 BPJS/0001267713955 Ny Tutik S Gangraena radix

89 BPJS/0001267714631 Nn Afina truli gangraena pulpa
90 i/d sertu M toiron/518636 Ny ratna winarti Hyperemi pulpa

91 18-Mar-14 sertu/518636 Tn M Toiron j.11 influenza
92 a/d pelda irfai/ 517382 nn. Carla j. 11 influenza
93 i/d pelda irfai/517382 ny. Eva i. 10 hipertensi
94 Mayor / 505090 tn. Hari padnanto j.11 influenza
95 pelda / 517323 Tn. Heriyanto j. 11 influenza
96 askes /0000098808636 Tn. Abdul jalil periodontitis
97 i/d pelda Sudarno/ 518791 Ny. Retno Y gangraena pulpa
98 BPJS / 0001267713955 Ny. Tutik S gangraena radix
99 BPJS/ 0001267714631 Nn Afina Truli Gangraena pulpa
100 i/d sertu M Thoiron/518636 Ny Ratna Winarti Hyperemi pulpa
101 19-Mar-14 Peltu/509133 Tn bambang Julianto J.11 Influenza
102 Mayor/511490 Tn Sudjoko Susanto J.11 Influenza
103 i/d serma Djainal/509308 Ny Legiati Handajani back pain

104 19-Mar-14 a/d Kapten Wulan An Bima J.11 Influenza
105 a/d praka sukma/530000 An Haydan Wicaksana J.11 Influenza
106 a/d kapten kamim/507011 Nn Riskaning Ayu J.11 Influenza
107 PNS/196806181996032001 Ny Dwi handini I.10 Hipertensi
108 a/d serma sigit/509327 Tn Abdanis Muslimin Gangraena pulpa
109 Koptu/523320 Tn Sablan Ginggivitis
110 20-Mar-14 PNS/196410261998032001 Ny Sri Sunaningsih G.44 Tension Headache
111 Peltu/506408 Tn Arifin Asam Urat
112 a/d mayor Eman/524422 An Adam Fauzan J.11 Influenza

113 a/d Mayor Eman/524422 An Zaskia J.11 Influenza
114 i/d Mayor Eman/524422 Ny Weny Sri J.11 Influenza
115 a/d Praka Sunaryo/518248 An M Nurtanio J.11 Influenza
116 a/d praka Sunaryo?528248 An Rotanio J.11 Influenza

117 20-Mar-14 i/d Kapten Edy Ny Nuryuni Myalgia
118 i/d Kapten Hari Padnanto Ny Hermin J.11 Influenza
119 Lettu/515110 Tn Iding J.11 Influenza
120 Peltu/506408 Tn Arifin Bahrudin Gangraena Radix
121 i/d PNS Yan Suryono Ny Rini S Pulpitis
122 a/d Serka Hadi/506064 Tn Bram Satriawan Pulpitis
123 21-Mar-14 Serma/510235 Tn Suparjo H.15 Episkleretis
124 24-Mar-14 Peltu/509944 Tn Hamid Arifin E.56 Defisiensi Vitamin
125 Mayor/505064 Tn Slamet J.11 Influenza
126 Mayor/506294 Tn Hery S J.11 Influenza
127 Kapten/514673 Tn Agus Suheri J.11 Influenza
128 a/d serma Sigit/509327 An Apdanis Muslimin D.17 Lipoma
129 Serma/523671 Tn Dhani Endro N.39 ISK

130 24-Mar-14 Askes/0000098808636 Tn Abdul Jalil I.10 Hypertensi
131 i/d Pelda Arifin/506488 Ny Hartini J.11 Influenza
132 Lettu Tn Iding Soemantri J.11 Influenza
133 PNS/19620202198403002 Ny Untari J.11 Influenza
134 PNS/197909152008122001 Ny Retno J.11 Influenza
135 Mayor/508163 Tn Sujayadi Rawat luka

136 PNS/198009302002122002 Ny Kusumastuti J.11 Influenza
137 Sertu/518590 Tn Muhali Rawat luka
138 a/d sertu Zaenal/509308 An Suci J.11 Influenza
139 Letkol /520750 Ny Ninuk J.11 Influenza
140 i/d serka Subekti/510110 Ny Farida Gangraena pulpa
141 Serka/508573 Tn Riyaman Ginggival abses
142 Peltu/509944 Tn Hamid Ginggival abses

143 25-Mar-14 a/d serma sigit/509327 Tn Abdanis Gangren pulpa
144 askes Ny E Suhartini Ginggival abses
145 i/d serda zainal/521734 Ny Hamsiah Pulpitis
146 a/d Kapten Lusia/535933 An Arka Yusiawan ISK
147 Kapten/535933 Ny Lusia A ISK
148 i/dserma jantje/509384 Ny Ritatik Rawat luka post KLL
149 Serma/509384 Tn Jantje J.11 Influenza
150 a/d Mayor Suhardin An Putri A.09 Diare
151 i/d sertu Hadi /533971 Ny Eka Nur Hidayati Z34 kehamilan normal
152 26-Mar-14 i/d serma Catur S/521204 Ny Rodiatun GIIIP2 nyeri perut
153 Serka/525212 Tn Tanto R Hyperemi Pulpa
154 Kopda/5529035 Tn Pungki Hyperemi pulpa
155 Serma /521295 Tn.heri wibowo j.11 influenza

156 a/d kapt. Rofik / 510092 Nn. Raras H
157 Serka / 530942 Tn. Andy t N .39 ISK
158 Serka/ 525212 Tn Tanto R Hiperemie pulpa
159 Kopda / 529035 Tn. Pungki S Hiperemie pulpa

160 27-Mar-14 Serka/ 508573 Tn Riaman gangraena pulpa
161 i/d serka said/ 516572 ny. Tumini pulpitis
162 Mayor / 523349 Tn Windhu Katawa Post Sincop
163 Serka/ 530136 Tn Evan j.11 influenza
164 i/d Praka Yani 531534 Ny Retno Myalgia
165 i/dPeltu Sudjoko / 513855 Ny. Eko Wahyuni kontrol post op fam
166 Serma / 523671 tn. Dhani endro N. 39 ISK
167 serka/538976 ny. Kurnia dewi L. 20 dermatitis Kontak
168 28-Mar-14 Peltu/509944 Tn Hamid Gangren Pulpa

169 Askes/0000098808636 Tn Abdul Jalil Periodontitis
170 i/d Serka Said/516572 Ny Tumini Gangren Pulpa
171 PNS/195910281983032003 Ny Tuni A.01 Thyphoid
172 a/d Mayor Komari Nn Estiwi J.11 Influenza
173 a/d mayor An Sahratu Gastritis
LAPORAN PELAYANAN
(RJTP)
DIAGNOSA DI RUJUK TTD PASIEN

Surat Rujukan
siensi vitamin
amilan normal
ksi saluran kemih
Surat rujukan
sisensi vitamin
surat rujukan
surat rujukan
rtensi esential
si gigitan serangga
etes Mellitus
sisensi vitamin
etes mellitus
rujuk
rujuk
rujuk
s marginalis khronis
rujuk
Rujuk
Rujuk
Rujuk
rujukan
rujuk
sion Headache
siensi Vitamin
milan normal
rujuk
Rujuk
rujuk
rujuk
matitis Kontak
LAPORAN PELAYANAN
BULAN APRIL 2014

Alamat : Surabaya

1 1-Apr-14 Peltu / 509944 Tn. Hamid arifin nekrose pulpa
2 i/d peltu m. Ashari/ 509175 ny. Heni .h gangren pulpa
3 i/d pns a.y r Ny. Partini aminorhea
4 i/d sertu muhally/518590 ny. Endan maisari kontrol kehamilan
5 i/d serka / 531092 ny. Winanti kontrol kehamilan
6 serma /509327 tn. Sigit w I. 10 hipertensi
7 a/d serma agustin/522632 an. Rangga tora L.24 Dermatitis
8 peltu/ 509175 Tn. M ashari K.29 gastritis
9 kopda/529520 Tn. Vellyps u J. 11 influ nza
10 PNS / 196806181996032001 Ny. Dwi handini I. 10 Hipertensi
11 i/d kopka Sugiyo Ny. Tri ikayani R.79 dislipidemia
12 i/d pelda arifin/ 506488 Ny. Hartini J.11 influenza
13 i/d peltu heri s /516010 Ny. Susi puji J.11 influenza
LAPORAN PELAYANAN
BULAN April TAHUN 2014

Alamat : Surabaya
NO TANGGAL NAMA PESERTA DIAGNOSA

14 A/D PELTU HERI S /516010 an. M.n safri J.11 influensa
15 a/d peltu heri s /516010 an. Syabil z J.11 influenza
16 PNS / 196710081999031003 Tn. Sukimin L.24 dermatitis
17 a/d serma danu /523616 an carissa L.24 Dermatitis
18 2-Apr-14 i/d peltu hendra /514905 Ny. Munafiah Gangraena pulpa
19 PNS / 196912101996032002 Ny. Miko Gangraena pulpa
20 kopka/ 517692 Tn. Heri p gangraena Pulpa
21 Serma/523671 Tn Dhani Endro N.39 ISK
22 a/d serka titus/515498 An Daniel Tio J.11 Influenza
23 3-Apr-14 a/d Pelda Nanang An Nizar J.11 Influenza
24 a/d Kapt Agus M/514673 An M.Izhar L.20 Dermatitis
25 a/d Kapt Agus M/514673 An Kaizen J.11 Influenza
26 Peltu/506205 Tn Rachmad J.11 Influenza

LAPORAN PELAYANAN
BULAN APRIL TAHUN 2014

Alamat : Surabaya

27 3-Apr-14 a/d serda Hardi/525001 An Zisya Mahar J.11 Influenza
28 a/d serda Hardi/525001 An Zasya Mahar J.11 Influenza
29 sertu/515750 Tn Haryono Gangraena pulpa
30 a/d mayor Suhardin/527055 An Askin S Gangraena pulpa
31 sertu/513204 Tn Hasim Gangraena pulpa
32 a/d sertu Saharudin/521610 An Salsabila persistensi

33 Peltu/511912 Mukowanto Gangraena pulpa
34 4-Apr-14 serma/525212 Tn Tanto R Hyperemi pulpa
35 sertu/535225 Tn Agung Y H L.20 dermatitis
36 a/d kapt M mundhir/510086 Kholid Fauzi H.15 Episkleretis
37 i/d PNS Subakat Ny Anggit Andayani Fisioterapi rutin
38 Lettu/515137 Tn Sudarna E.10 DM
LAPORAN PELAYANAN

Alamat : Surabaya

39 7-Apr-14 pelda/519550 Tn Oney Hyperemi pulpa
40 sertu/513204 Tn Hasim Gangraena pulpa
41 a/d G IP saragih/523598 An Faza Operculitis
42 Serma/510285 Tn Totok M Gangraena radix
43 i/d serma saraki/523598 Ny Titik Suntik Depo
44 i/d pratu krisdiono/539760 Ny Ika Yanuar kontrol kehamilan
45 Kapten/511529 Tn Juli Purnomo E.10 DM
46 i/d pelda Abdul M/506241 Ny. Ema s J.11 Influenza
47 a/d pelda nanang/ 517922 An. Nizar H. 67 Otitis media Akut
48 pelda / 519550 Tn onny p J.11 influenza
49 8-Apr-14 PNS?196702131993011001 Tn Suparno J.11 Influenza
50 PNS /196806181996032001 Ny Dwi Handini I.10 HT

51 a/d PNS Dwi Handini Nn Safira J.11 Influenza
LAPORAN PELAYANAN

Alamat : Surabaya

52 8-Apr-14 a/d serma Bambang/513356 An amelia H.10 Konjungtivitis
52 Letkol/523349 Tn Windu B.02 Herpes zoster
53 a/u peltu Heru/516010 An Syabil Zunnurin J.11 Influenza
54 PNS/19809022009121003 Tn M Juan Frisdianto Post trauma
55 i/d koptu M Yusuf Ny Siti Kusmiyati L.24 Dermatitis
56 peltu/509944 Tn Hamid A Gingival abses
57 peltu/511912 Tn Mukowanto Gangren pulpa
58 i/d pelda heri Ny S Puji Astuti Gazngren pulpa
59 10-Apr-14 i/d pelda syahroni Ny Misti Astuti Hyperemi Pulpa
60 a/d pelda gugus/516208 An Balqis persistensi
61 a/d PNS Dwi handini An Savira Gangren pulpa
62 i/d kopda Pungki/529035 Ny Renny Hyperemi pulpa
63 Pelda/507685 Tniono Sud J.11 Influenza

LAPORAN PELAYANAN

Alamat : Surabaya

64 10-Apr-14 ASKES/0000101328221 Nn Niken isnarta kontrol post opp
65 a/d sertu Suadi/521622 Tn Agus mardianto kontrol telinga
66 Prada/542819 Tn Wawan Suryawan J.11 influenza
67 prada/535656 Tn Ahmad Anton j.11 Influenza
68 i/d kapt Yuli Purnomo/511529 Ny Suparti kolik abdomen
69 i/d serma Catur Ny Rodiatun kontroll kehamilan
70 11-Apr-14 mayor /524319 Tn Soeksmo adi J.11 Influenza
71 Serma/507627 Tn Sutopo HNP
72 pratu/539900 Tn Dadang Indra B.02 Herpes
73 a/d serma andri/517310 An Yuan H.04 Mata kering
74 a/d peltu Mardi/505829 An Mutiarani J.11 Influenza
75 serma/525212 Tn Tanto hyperemi pulpa
76 sertu/515750 Tn Haryono gangren pulpa

LAPORAN PELAYANAN

Alamat : Surabaya

77 11-Apr-14 serma/513609 Tn Surono Hyperemi pulpa
78 a/d pelda hendra/514905 an syahratu persistensi
79 a/d mayor suhardin an Askin gangren pulpa
80 a/d kapt Khamim/507011 Nn Riskaning hyperemi pulpa
81 14-Apr-14 sertu/520559 Tn Niswan Hyperemi pulpa
82 sertu/513204 Tn Hasim T Gangren pulpa

83 mayor/507983 Tn Syaiful Osteoarthritis
84 a/d mayor harwoto/509575 An Denok J.11 Influenza
85 serma/509327 tn. Sigit I .20 Hipertensi
87 a/d kopda sunaryo/528248 an. M. Nortanio J.02 Pharingitis akut
88 a/d G. Saragih/523598 an. Nadea J.11 influenza
89 sertu Tn hasyim DM
90 PNS III/D Ny. Sri s J. 11 influenza

LAPORAN PELAYANAN

Alamat : Surabaya

91 a/d PNS sri s nn. Nabila J.11 influenza
92 a/d sertu muhally/ 518590 An. M surya d J.11 influenza
93 15-Apr-14 peltu/509944 Tn Hamid gangren pulpa
94 a/d serma Budi/509305 Tn Dwi budianto ginggivitis marginalis
95 serka/531899 Tn Johanes Observasi febris
96 sertu/518636 Tn Toiron J.11 Influenza
97 Praka/530732 Tn wiwit J.11 Influenza
98 i/d pelda ali/510088 Ny siti fatimah J.11 Influenza
99 a/d pelda ali/510088 Nn miftahul J J.11 influenza
100 peltu/506250 Tn rachmad H.15 episkleretis
101 a/d lettu yudi/514959 Dhistira agung I.84 haemoroid

102 a/d serka sutopo/507627 An halid L.24 dermatitis
103 PNS Ny retno J.11 influenza

LAPORAN PELAYANAN

Alamat : Surabaya

104 15-Apr-14 A/d PNS Untari An Marsyah J.11 Influenza
105 a/d serka suyatno/530977 An arsena J.11 influenza
106 a/d sertu saharudin/521610 An Salsabila persistensi
107 a/d peltu gugus/516208 an balqis persistensi
108 i/d kol Toni/505518 Ny Novarita Gangren pulpa
109 16-Apr-14 a/d Kapt Lusia/535933 An Arka Yusiawan A.09 febris
110 Kapten/510581 Tn Dody kontrol RSAL
111 Kaptren/533189 Ny Yeni Fitriana J.11 Influenza
112 Sertu Tn Hardi J.11 Influenza
113 Askes 0000098808636 Tn Abdul Jalil E.56 Defisiensi vitamin
114 Dokter RSAU Dr dorvalda A.09 Diare
115 a/d Kopda Hermanto?529486 An Dava hilmi B.02 Herpes
116 a/d serma/523598 An Faza J.11 influenza

LAPORAN PELAYANAN

Alamat : Surabaya
117 16-Apr-14 a/d Sertu Saharudin/521610 An Salsabila Persistensi
118 a/d peltu Gugus/516208 An Balqis persistensi
119 i/d kol Toni/505518 Ny Novarita Gangren pulpa
120 17-Apr-14 Peltu/517117 Tn Totok J.11 influenza
121 i/d Kopka Heri Ny Nanik Minarni K.29 Gastritis
122 i/d Mayor Arwani/522882 An Maulida Rahmawati J.03 Tonsilitis
123 Sertu/518554 Tn Suryo A J.20 Bronchitis Akut
124 a/d sertu Toiron/518636 Ny Ratna Winarti A.09 Diare
125 Peltu/507193 Tn Ilmi Sabilah kontrol RSAL
126 Serma/521259 Tn Yudhi Firmansyah J.11 influenza
127 Honorer Tn Syaiful L.20 Dermatitis
128 Praka/535859 Tn Subadi agus hyperemi pulpa
129 i/d peltu hendra/514905 Ny Munafiah Gangren Pulpa

LAPORAN PELAYANAN

Alamat : Surabaya

130 21-Apr-14 PNS/198609182010122008 Ny Isrofatul Hyperemi pulpa
132 a/d PNS suparno Nn Febri K Ginggivitis marginalis
133 Pelda/507740 Tn Efendi J.11 influenza
134 Sertu/518554 Tn Suryo J.11 Influenza
135 a/d PNS Kusuma An M Alfa L.20 Dermatitis

136 a/d PNS Kusuma An Atika L.20 Dermatitis
137 a/d serma Haris/517028 An Chelsea B.08 Other Viral infection
138 Mayor/506294 Tn Hery Santoso J.11 Influenza
139 Serda/526862 Tn Rudi Hermawan HNP
140 Peltu/509133 TN Bambang julianto K.29 Gastritis
141 22-Apr-14 a/d PNS Kusuma An M Alfa L.20 Dermatitis
142 i/d Kapten Yuli/511529 Ny Suparti N.76 Vaginosis Bakterialis
143 a/d Pelda Budi/505247 An Rama Artha N.67 Otitis Media Akut
LAPORAN PELAYANAN

Alamat : Surabaya

144 22-Apr-14 Kapten/511529 Tn Juli purnomo E.10 DM
145 Serma/523616 Tn Danu Wiryawan A.09 Diare
146 i/d Serma/522632 Ny Agustin J.11 Influenza
147 a/d Serma Agustin/522632 An Rengganis J.11 Influenza
148 i/d Lettu bambang/511253 Ny Rini J.11 Influenza
149 Kapten /509021 Ny Inta Isnaningrum J.11 Influenza
150 Peltu/509944 Tn Hamid gangren Pulpa
151 23-Apr-14 PNS Ny Iri titi Ginggivitis marginalis
152 Serka/52803 Ny Meylani Ginggivitis marginalis
153 a/d Mayor Nasron An Rifky M Persistensi
154 Honorer Tn syaiful J.11 Influenza

155 i/d peltu Joko/513855 Ny Eko wahyuni L.20 Dermatitis
156 a/d Pelda Eswan/513870 An Andri wirawan L.20 Dermatitis

LAPORAN PELAYANAN

Alamat : Surabaya

157 23-Apr-14 PNS/196912101996032002 Ny Wi Dwi Miko J.11 Influenza
158 Pelda/517995 Tn Muh Syamsudin J.11 Influenza
159 24-Apr-14 Serka/518590 Tn Muhali J.02 Faringitis
160 honorer Tn M syaiful Observasi febris
161 25-Apr-14 Serka Tn Rudi J.11 Influenza
162 Peltu/506886 Tn Siswono fatique
163 Serka/521117 Tn Damis fatique
164 Sertu/515276 Tn Hendro S Gangraena Radix
165 Serma/525404 Tn Ari Widodo Hyperemi pulpa
166 PNS Brilliant dilly Hyperemi pulpa
167 28-Apr-14 Serma Tn Tjantje Gangraena pulpa
168 PNS/196706261998031004 Tn Sadi J.11 influenza
169 Pelda/5188263 Tn Condro W Kontrol fisioterapi

LAPORAN PELAYANAN

Alamat : Surabaya
170 28-Apr-14 Kopka/517692 Tn Heri P B.07 Veruka vulgaris
171 Peltu/506022 Tn Widianto N.39 ISK
172 Letkol/520750 Ny Ninuk J.11 Influenza
173 a/d Pelda Budi Laksana An Rama Artha B.26 Parotitis
174 Pelda/505247 Tn Budi Laksana H.52 Miopia
175 i/d Serda Hardi/525001 Ny Marthalusi J.11 Influenza
176 a/d Serda Hardi/525001 An Zixy J.11 Influenza
177 Pelda/506205 Tn Rachmad Fatique
178 Kapten/513029 Tn Untung N.39 suspect ISK
179 a/d serma Randjau/512096 An Rama J.11 Influenza
180 Kapten/514673 Tn Agus Madiyanto L.20 Dermatitis
181 Serka/515482 Tn Andi Heri G.44 Tension Headache
182 a/d Serma Zainal/509308 An Suci Bintari L.20 Dermatitis

LAPORAN PELAYANAN

Alamat : Surabaya

183 29-Apr-14 i/d PNS Suyitno Ny Sugiami J.11 Influenza
184 Lettu/514959 Tn Yudi Cahyono T.00 Vulnus laseratum
185 Kapten/511529 Tn Juli Purnomo L.20 Dermatitis
186 BPJS 0001109711237 An Alexander J.11 Influenza
187 Peltu/509133 Tn Bambang Julianto Fatique

188 Kapten/513029 Tn Untung is N.39 Suspect ISK
189 Serma/509327 Tn Sigit I.10 Hypertensi
190 PNS/196806181996032001 Ny Dwi Handini I.10 Hypertensi
191 a/d sertu F Rian/513616 An Diva Surya Observasi Febris
192 Kopka Tn Sugiyo J.11 Influenza
193 PNS/19690110619940310007 Tn Yan Suryono H.82 Vertigo
194 Sertu/513204 Tn Hasyim E.10 DM
195 a/d Pelda Ridwan/507741 An Putra A.K K.29 Gastritids

LAPORAN PELAYANAN

Alamat : Surabaya

196 i/d Mayor Hartowo/509575 Ny Diah Retno J.11 Influenza
197 Mayor/524318 Tn Soekmono Adi L.20 Dermatitis
198 30-Apr-14 a/d sertu Suadi/521622 An Muhammad alfatih J.11 Influenza
199 i/d sertu Suadi/521622 Ny Dwi Sarinda J.11 Influenza
200 Honorer Tn Yono Observasi Febris
201 i/d peltu Mardi/505829 Ny Jatmiatun L.20 Dermatitis
202 a/d Peltu Rachmad/506205 Nn Widya P Observasi Febris
203 a/d serma Munaji Tn Destyan Ginggivitis marginalis
204 i/d Pelda Syahroni Ny Mistiati Ginggival abses

LAPORAN PELAYANAN

MA (RJTP)
dirujuk
MA (RJTP)
4

rujuk
MA (RJTP)
14

rujuk
rujuk
MA (RJTP)
14
rujuk
tis media Akut

MA (RJTP)
14

rujuk
rujuk
MA (RJTP)
14

rujuk
rujuk
rujuk
MA (RJTP)
14

MA (RJTP)
14
s marginalis
MA (RJTP)
14
Rujuk
siensi vitamin
MA (RJTP)
14
surat rujukan
MA (RJTP)
14
s marginalis
er Viral infection
nosis Bakterialis
s Media Akut surat rujukan
MA (RJTP)
14
s marginalis
s marginalis
MA (RJTP)
14
rujukan
MA (RJTP)
14
rujukan
sion Headache
MA (RJTP)
14
us laseratum
surat rujukan
surat rujukan
MA (RJTP)
14
s marginalis
MA (RJTP)
14
LAPORAN PELAYANAN
BULAN MEI TAHUN 2014

Alamat : Surabaya
NO TANGGAL IDENTITAS NAMA PESERTA

1 2-May-14 Serma/510268 Tn Surotin
2 Mayor/506294 Tn Hery Santoso
3 Serma/512096 Tn Randjau
4 Serma/523598 Tn Gerhana Saragih
5 i/d Peltu Rachmad/506205 Ny Endang
6 a/d sertu M Toiron/518636 An Nahda Aurista
7 a/d PNS Juan F An Shaquila Aysel
8 a/d serma Agustin An Rangga
9 Pelda/507741 Tn Ridwan
10 Kapten/514673 Tn Agus
11 Serda/526862 Tn Rudi Hermawan
12 a/d Pelda Triyonoi An Fadilah
13 i/d Pelda Syahroni Ny Mismiati
14 BPJS/000110971012 Ny Hartini
15 a/d serka surono/513609 Tn Ronaldo
16 Sema/509384r Tn Tjanje
17 BPJS/0001103628036 Tn M Aminin
18 BPJS/0001272403168 Tn Guntur K
19 5-May-14 Sertu/514354 Tn Kartono
20 a/d Serma Gerhana/523598 An Nadhea
21 i/d serma gerhana/5235898 Ny. Titin
22 peltu/506241 Tn. Abdul malik
23 i/d serma sardiyanto Ny.hartiasih
24 a/d peltu iswan/ 513870 An Andri Wirawan
25 a/d PNS A Mukibi An M Ulul Azmi
LAPORAN PELAYANAN

Alamat : Surabaya

26 5-May-14 Kapten/515110 Tn Iding S
27 i/d serda Zainal/521734 Ny Hamsiah
28 a/d Mayor Sus Eman/524422 An adm Fauzan
29 a/d Abd Khoiri/522356 An Ryan Saputra
30 Serma/509384 Tn Tjanje
31 6-May-14 a/d Sertu Zainal/521734 An Rizky
32 i/d sertu zainal/521734 Ny Hamsiah
33 serma Tn Zainal
34 i/d PNS Sukimin Ny Tamirah
35 a/d Serma Randjau/512096 An Bima
36 Sertu/515750 Tn Haryono
37 a/d serma Suwarno/517117 Nn Harum P
38 Peltu/517117 Tn Totok Suyono
39 7-May i/d serda Zainal/521734 Ny Hamsiah
40 Letda/511206 Ny Susi
41 BPJS/0001109711237 An Alexander
42 a/d pelda Retno An R Safitri
43 Pelda/508912 Tn M Sulkani
44 Sertu Tn F Rian
45 Kapten/517279 Tn Siswadi
46 a/d Pelda Saifudin/508610 An Qururin
47 Pelda/507708 Tn Mudjito
48 Pelda/518150 Tn Heru Kusprapto
49 i/d PNS Subakat Ny Anggit Andayani
50 Serda/542622 Nn Diah ayu
LAPORAN PELAYANAN

Alamat : Surabaya

51 7-May-14 i/d pelda Muslimin/519504 Ny Sumaiyah
52 8-May-14 Sertu/521622 Tn Suwadi
53 Kapten/510698 Tn Nurhadi
54 PNS IIIA Ny Kusumastuti
55 a/d Mayor kes Firman/511369 An Teddy Setiawan
56 Kapten/513029 Tn Untung
57 a/d serka Hadi/525001 An Zasya mahar N
58 Lettu Tn Tarso
59 Pelda/517323 Tn Heriyanto
60 Sertu/518554 Tn Suryo
61 PNS IIIA Ny Isrofatul
62 Kapten/520057 Tn Nurhadi
63 Sertu/510698 Tn Wahyudi
64 9-May a/d PNS Dwi handini An Savira
65 Peltu Tn Totok Suyono
66 i/d Kapten Fauzi Ny Yuli A
67 Serka/523671 Tn Dhani endro
68 Kapten/505090 Tn Hari padnanto
69 a/d Kapten Agus/514673 An Moch Izhar
70 PNS IIIB Ny Enny suryowati
71 a/d peltu Hendra/514905 An Prabu Dewa
72 PNS IIIB NY Wi Dwi Miko
73 i/d Kapten Khamim/507011 Ny Diyah
74 a/d kapten Khamim/507011 An Riskaning
75 Lettu/514959 Tn Yudi Cahyono
LAPORAN PELAYANAN

Alamat : Surabaya

76 12-May-14 Serka/515268 Tn Ipung
77 a/d serma Randjau/512096 Nn Rara Intan
78 Pelda/516741 Ny Selvy Debora
79 Kapten /513029 Tn Untung
80 a/d serma Zainal/509308 An Dian N
81 i/d sertu Zaenal/521734 Ny Hamsiah
83 Pelda/505801 Tn Winarko
84 13-May-14 Serma/50984 Tn Tjantje
85 Mayor/508163 Tn Suryadi S
86 Koptu/526062 Tn Hartono
87 14-May-14 i/d pelda Mardi/505829 Ny Jatmiatun
88 Sertu/521622 Tn Suwadi
89 Pelda/506205 Tn Rachmad
90 a/d serda Hardi/525001 An Zasya Mahar
91 Kapten Tn Juli Purnomo
92 i/d peltu Iswan/5136870 Ny Suci
93 i/d Serma Sutopo/507627 Ny Sri Hartini
94 Sertu/513204 Tn Hasim T
95 Serma/525212 Tn Tanto R
96 Serma/521043 Tn Agus Riyadi
97 BPJS 0001109711237 An Alexander K
98 BPJS 0001109701012 Ny Hartini
99 a/d peltu Hendra An Prabu Dewa
100 i/d peltu Hendra Ny Murtafiah
LAPORAN PELAYANAN

Alamat : Surabaya

101 14-May-14 a/d serma Tjante An Evangelist
102 16-May-14 a/d PNS dwi Handini An Savira
103 PNS Ny Dwi handini
104 i/d Kapten Edi Ny Ninik
105 Tn Totok S
106 Tn Zainul A
107 Tn Dhani Endro
108 PNS IIID Ny Dwi handini
109 Serka/510115 Tn Suwarno
110 Sertu/521734 Tn Zaenal Arifin
111 a/d serma randjau/512096 Rama manggala
112 a/d peltu retno/514632 An Raahmania
113 Peltu/514632 Ny Retno Imbajanti
114 Serma/521117 Tn Damis
115 Pelda/507193 Tn Ilmi Sabian
116 Serda/526862 Tn Rudi Hermawan
117 a/d serka Gipsaragih/523598 An Nadhea
118 i/d serka Gipsaragih/523598 Ny Titik
119 i/d serma Randjau/512095 Ny Rohmah Maulida
120 19-May-14 Kapten/510581 Tn Dody
121 Pratu7496/53 Tn Wawan Efendi
122 i/d Kapten Tek Agus/514673 Ny Fatechulmaida
123 Serma/511140 Tn Suwarno
124 i/d kapten suyatno/509142 Ny Siti Juariah
125 Sertu/518590 Tn Muhali
LAPORAN PELAYANAN

Alamat : Surabaya

126 19-May-14 Serma/509327 Tn Sigit
127 a/d sertu Sugianto/523000 An Sulthon aziz
128 Sertu/520079 Tn Didik Supriyadi
129 Serka/515268 Tn Ipung Sudarmanto
130 Kapten/513029 Tn Untung K
132 Serma/523833 Tn Christian S
133 20-May-14 a/d PNS Untari An M chessa
134 i/d serma ngadiyana/512095 Ny Fitri Rachmawati
135 Peltu/509944 Tn Hamid
136 Serma/508541 Tn Mukri
137 Mayor/529201 Tn RN Jaya
138 Kapten/506536 Tn Ipung Sudarmanto
139 a/d sertu iro An Felisa
140 i/d Lettu kes bambang/511253 Ny Rini Yudawati
141 a/d pelda Irfai/517382 Nn carla
142 a/d pelda rifai/517382 An Cleon
143 a/d praka Yani An Gadis shafir
144 i/dsyahroni pelda Ny Mistiastuti
145 Pratu/537496 Tnndi Wawan efe
146 21-May-14 Serma Tn Bambang
147 i/d Kapten Harwoto/509575 Ny Dyah retno
148 i/d Lettu kes bambang/511253 Ny Rini Yudawati
149 Kapten/505678 Tn Hariyanto
150 a/d serka seritoyo An Hafiz
LAPORAN PELAYANAN

Alamat : Surabaya

151 21-May-14 Serma/510235 Tn Supardjo
152 Sertma/509384 Tn Tjantje
153 a/d PNS Dwi handini An Savira
154 a/d Pelda Marlina An galang S
155 22-May-14 BPJS 0001109711237 An Alexander
156 BPJS 0001109701012 Ny Hartini
157 i/d peltu hendra Ny Munafiah
158 a/d Randjau/512096 An Rara Intan
159 i/d serma Sardjianto Ny Hartiasih
160 Serma/523598 Tn Gerhana Indra
161 Pratu/535656 Tn Ahmad Anton
162 23-May-14 a/d Pelda Bambang/518196 Nn Anisa Dian R
163 a/d serma Haribowo/510287 An Citra Sukma Pratiwi
164 PNS NY kusetyorini
165 a/d peltu triyono/518988 An Fadhilah
166 i/d peltu Triyono/518988 Ny Yenni Apriani
LAPORAN PELAYANAN
BULAN JUNI TAHUN 2014

Alamat : Surabaya

1 2-Jun-14 Mayor/508163 Tn suryadi Sanali
2 Kapten/513029 Tn Untung Krismantoro
3 a/d Kopda Sunbaryo/528248 An M Nurtanio
4 a/d Sertu Catur/531907 An Siti Khaila
5 a/d Sermagustina/522632 An Rangga
6 ASKES 0001272956771 Nn Putu theda
7 Mayor/529201 Tn R.N Jaya
8 Lettu/514959 Tn Yudi Cahyono
9 3-Jun-14 Mayor Tn Suryadi

10 Kapten Tn M Djafar
11 a/d PNS Dwi handini An Syavira
12 PNS/030225820 Ny Tatik
13 a/d Serka Suana An Zahra Putri
14 Peltu/5066205 Tn Rachmad
15 a/d Pelda Naning/518398 An Fikri
16 Serma/521117 Tn Damis
17 4-Jun-14 Mayor/524430 Tn Sarifudin Tarigan

18 Serma/509327 Tn Sigit W
19 i/d Serma Hadi M Ny Yatini
20 i/d Serma Mukri Ny Rida Pristiwati
21 a/d PNS Ririska An M Nur Furqon
22 Prada/541452 Tn Yulianto Sudaryono
23 Serka/530136 Tn Evan
24 Letda/511206 Ny Susi
25 5-Jun-14 Kopda/529432 Tn Agung M

26 i/d Sertu Suana Ny Sutrisni
27 a/d Sertu Suana An Zahra
28 6-Jun-14 a/d Praka Yani/531534 An Gadis Shafira

29 i/d pelda Iswan/513870 Ny Suci
30 ASKES 0000105022023 Ny Suparmi
31 a/d Kapten Kamim/507011 Nn Riskaning
32 Sertu/521734 Tn Zaenal Arifin
33 i/d Serda Hardi/525001 Ny Martha Lusi
34 9-Jun-14 ASKES 0000097920696 Ny Tituk Sujati

35 a/d pelda andri An Andrew Billy
36 ASKES 0001103346854 Tn Muhalli
37 i/d Kopda Hermanto/529486 Ny Ummy M
38 a/d Serka Suyatno/530977 An Arsena Rafindra
39 Pelda/508912 Tn Mochammad Sulkan
40 Serka/515268 Tn Ipung
41 10-Jun-14 Letda/515137 Tn Sudarna

42 PNS Ny Dwi Handini
43 a/d Serka Iro An Felisa Cahya
44 askes 0001103445382 Tn M Jafar
45 askes 0001103617866 Tn Tjanje
46 askes 0001103388208 Ny Susi
47 askes 0001285192798 Ny Atik
48 11-Jun-14 askes 0001287609006 Ny Ninik

49 a/d Sertu S Efendi/523000 An Alfi Rahmania
50 askes 0001103129831 Tn Yudi Cahyono
51 a/d Mayor R.N Jaya an M Fikri
52 i/d Sertu Mansyur/521614 Ny Siti Nursaadah
53 i/d PNS Subakat Ny Anggit Andayani
54 a/d Serma Danu/523616 An Carissa
55 12-Jun-14 Serma/bpjs 0001103396567 Tn Surotin

56 i/d kapt harwoto/509575 Ny Diah retno
57 Kopka/514498 Tn Sugiyo
58 Kapten /509142 Tn Suyatno
59 Askes 0001109711237 An Alexander
60 Askes 001109701012 Ny Hartini
61 Askes 0001103205508 Ny Inge imelda
62 Askes 0001103205508 Tn Evan B
63 Askes 0001103899833 Tn Agung Mashuri
64 13-Jun-14 i/d Mayor Triyanto Ny Rianti

65 Pratu6/535656 Tn Ahmad Anton
66 a/d Mayor Eman/524422 An Adam Fauzan
67 a/i Mayor Trianto/506351 Nn Erika
68 16-Jun-14 Serka/515268 Tn Ipung S

69 askes 0000097920696 Ny Tituk Sujati
70 askes0001103333782 Tn Adi Wahyu
72 Mayor/522882 Tn Arwani
73 Kopka/514498 Tn Sugiyo
74 i/d Serma Sigit/509327 Ny Rini Winarti
75 i/d Pelda Iswan/513870 Ny Suci Atiningsih
76 Kapten/506536 Tn Parma
77 i/d Serka Gipsaragi Ny Legiati Handayani
78 a/d Pelda Syaifudin Nn Novian
79 Serka/530941 Tn Adi W P
80 a/d Pelda Naning/518398 An Fikri
81 PNS Ny Untari
82 17-Jun-14 a/d Pelda Eswan/503870 An Bima

83 Serma/523613 Tn Dedy
84 Serda/539254 Tn M Alieffian
85 18-Jun-14 Askes 0001103617866 Tn Tjanje

86 Serma Tn Sutopo
87 i/d Mayor Suryadi/508163 Ny Sri Suswanti
88 a/d Peltu Arifin/506408 An Alexander
89 Prada/542819 Tn Wawan Suryawan
90 19-Jun-14 a/d Serma Agustina/522632 An Rangga Tora

91 a/d Kapten Lusia An Arka
92 askes 0001103333782 Adi Wahyu
93 a/d Mayor R.N Jaya/529201 An R.Fikri
94 Mayor sus/524479 Tn Muchidin
95 20-Jun-14 Kapten kal/510698 Tn Nurhadi

96 Kapten kal/514673 Tn Agus M
97 a/d peltu irvai Nn Carla
98 a/d peltu Syahroni/512420 Nn Bella
99 kapten / 5110092 tn. Ropig
100 23-Jun-14 a/d serma Suwarno Nn. Retno dyah

101 a/d mayor R.N jaya/529201 An. R. Fikri
102 i/d Peltu eswan /513870 Ny. Suci
103 a/d pelda syaifudin/508610 Nn Novian
104 Serda/526973 Tn M Lidi
105 An Faza
106 Kapten/505678 Tn Hariyanto
107 PNS IIID Ny Dwi Handini
109 Kopka/506057 Tn Sugito
110 Peltu/506057 Tn Diyot sriyono
111 Mayor/529201 Tn R.N Jaya
112 24-Jun-14 Peltu/506057 Tn Diyot sriyono

113 Peltu/509133 Tn Bambang
114 i/d Mayor Harwoto/509575 Ny Diah
115 Kopda/526701 Tn Iwan
116 Letda/517414 Ny Kusmawati
117 Serma/511140 Tn Suwarno
118 Pelda/507741 Tn Ridwan
119 bpjs 0001285192798 Ny Atik Yulia
120 a/d serka triyono/518988 An Fadilah
121 i/d mayor Suhardin Ny sri rahayu
122 25-Jun-14 bpjs 0001103619227 Tn Sutopo

123 Peltu/506205 Tn Rachmad
124 Kapten/511529 Tn Juli purnomo
125 Serka/517863 Tn Khoirul anam
126 26-May-14 Serma/523616 Tn Danu

127 Serka/510115 Tn Sumarno
128 Sertu/514354 Tn Kartono
129 bpjs 0000098121892 Ny een Suhartini
130 28-May-14 Serka/515714 Tn Pujianto

131 Peltu/517117 Tn Totok S
132 Serka/523671 Tn Dhani endro
133 Mayor sus/524430 Tn Sarifudin
134 bpjs 0000098024387 Tn Ribut
135 i/d lettu bambang/511253 Ny Rini Yudawati
136 a/d sertu Hadi /533971 An Ajwah Djakaria
137 Kapten/510086 Tn M. Mundhir
138 30-May-14 PNS IID Tn Sadi

139 Peltu/509944 Tn Hamid arifin
140 i/d serma gerhana/523598 Ny Titik A
141 Serma/509327 Tn Sigit
142 i/d Serka Sardjianto Ny Hartiasih
143 Letnan/537328 Ny Gusti putu
144 i/d sertu Surana/517830 Ny Sutrisni
145 a/d Sertu surana An Surya Budi
146 i/d kaptren edi Ny Ninik
147 bpjs 0001109711237 An alexander
148 a/d serma sardiyanto Tn hariyanto
AYANAN
PERTAMA (RJTP)
HUN 2014

J.11 Influenza
J.11 Influenza
J.11 Influenza
J.11 Influenza
Observasi febris
A.09 GEA
J.11 Influenza
J.11 influenmza
LBP
L.20 Dermatitis
J.11 Influenza
Persistensi
Gangraena Pulpa
Periodontitis akut
Ginggivitis marginalis
Gangren pulpa
Hyperemi pulpa
L.20 Dermatitis
J.11 Influenza
j.02 Pharingitis akut
kontrol poli jantung rujukan
carpus alenium rujukan
j.02 Pharingitis akut
Serumen prop rujukan
AYANAN
PERTAMA (RJTP)
HUN 2014

K.29 Gastritis
Ginggival abses
Persistensi
Gangren pulpa
J.11 Influenza
L.20 dermatitis
B.02 Herpes
A.01 Thyphoid
J.11 Influenza
Gangren pulpa
Periodontitis akut
Hyperemi pulpa
Gangren pulpa
Gangren pulpa
Persistensi
J.11 Influenza
J.11 Influenza
J.11 Influenza
Observasi febris
J.11 Influenza
Observasi febris
Kontrol fisioterapi rujukan
A.01 Thyphoid
AYANAN
PERTAMA (RJTP)
HUN 2014

Pembengkakan lambung Rujukan
Pro ekstraksi kuku rujukan
J.11 Influenza
J.11 Influenza
Miopia rujukan
N.39 ISK
A.09 Diare
K.29 Gastritis
L.08 Folikulitis
J.02 Faringitis
Hyperemi pulpa
Hyperemi pulpa
Gangren pulpa
Periodontitis akut
Gangren pulpa
Hyperemi pulpa
J.11 Influenza
J.11 Influenza
Commond cold
J.11 Influenza
Kontrol orthopedi rujukan
J.11 Influenza
J.11 Influenza
L.20 Dermatitis
AYANAN
PERTAMA (RJTP)
HUN 2014

J.11 Influenza
J.11 Influenza
J.11 Influenza
kontrol jahitan
Gangren pulpa
Periodontitis
Periodontitis
Gangren pulpa
Hyperemi pulpa
K.29 gastritis
A.09 Diare
A.09 Diare
Gangguan Neurotropi
Nyeri pada ginggiva
J.11 Influenza
Osteoarthritis
J.11 Influenza
Gangren pulpa
Hyperemi pulpa
Gangren pulpa
Gangren pulpa
Persistensi
Hyperemi pulpa
AYANAN
PERTAMA (RJTP)
HUN 2014

Persistensi
Gangren pulpa
Hyperemi pulpa
Hypertemi pulpa
Gangren pulpa
Hyperemi pulpa
Hyperemi pulpa
I.10 Hypertensi
I.10 Hypertensi
kontrol kulit rujukan
J.11 Influenza
J.11 Influenza
J.11 Influenza
Kontrol poli endokrin Rujukan
J.11 Influenza
J.11 Influenza
J.11 Influenza
Myalgia
Kontrol poli jantung Rujukan
Kontrol poli jantung Rujukan
cephalgia
Kontrol poli syaraf rujukan
J.11 Influenza
cephalgia
AYANAN
PERTAMA (RJTP)
HUN 2014

I.10 Hypertensi
H.15 Episkleretis
J.11 Influenza
J.11 Influenza
Gangren radix
Gangren Radix
Gangren pulpa
Hyperemi pulpa
Gangren Radix
Gangren pulpa
Hyperemi pulpa
J.11 Influenza
F.29 Gastritis
L.20 Alergi
cephalgia
observasi febris
F.29 Gastritis
kontrol poli urologi rujukan
chest pain rujukan
J.11 Influenza
cephalgia
H.00 Hordeolum
J.11 Influenza
L.20 Dermatitis
AYANAN
PERTAMA (RJTP)
HUN 2014

I.10 Hypertensi
Gangren pulpa
Gangren pulpa
Persistensi
Gangren pulpa
Gangren pulpa
Gangren pulpa
L.20 Dermatitis
F.29 Gastritis
J.11 Influenza
L.20 Dermatitis
L.20 Dermatitis
H.60 Otitis externa
Hyperemi pulpa
Persistensi
Gangren pulpa
AYANAN
PERTAMA (RJTP)
HUN 2014

J.11 Influenza
I.10 Hypertensi
Nyeri telinga rujukan
Observasi vomiting
J.11 Influenza
Gangren pulpa
Gangren pulpa
Hyperemi pulpa
Hyperemi pulpa
Hyperemi pulpa
Gangren pulpa
G.43 Migraine
L.20 Dermatitis
I.10 Hypertensi
A.09 Diare
L.20 Dermatitis
ISK
I.10 Hypertensi
Trigger Finger
I.10 Hypertensi
J.11 Influenza
Kontrol fisioterapi rujukan
Hyperemi pulpa
Ginggival abses
Hyperemi pulpa
J.11 Influenza
J.11 Influenza
B.26 Parotitis
Osteoarthritis
I.10 Hypertensi
K.29 Gastritis
J.11 Influenza
Hyperemi pulpa
Persistensi
Hyperemi pulpa
H.10 Konjungtivitis
pro imunisasi rujukan
L.20 Dermatitis
H.10 Konjungtivitis
E.10 Diabetes Mellitus

I.10 Hypertensi
L.20 Dermatitis
Hyperemi pulpa
Gangren pulpa
Gangren pulpa
Hyperemi pulpa
Hyperemi pulpa
persistensi
Hyperemi pulpa
Gangren pulpa
L.20 Dermatitis
Kontrol fisiotherapi Rujukan
J.11 Influenza
kontrol saraf rujukan

G.43 Migrain
J.02 Faringitis
K.29 Dyspepsia
Gangren pulpa
Periodontitis
Hyperemi pulpa
Hyperemi pulpa
Hyperemi pulpa
T.00 vulnus laseratum
J.03 Tonsilitis
K.29 Gastritis
Hyperemi pulpa
Hyperemi pulpa
Gangren pulpa
I.10 Hypertensi
J.11 Influenza
B.00 Herpes simplex
Tensiom Headache
Osteoartritis
Kontrol jantung Rujukan
Tension Headache
L.24 Dermatitis kontak
L.24 Dermatitis kontak
Tension Headache
J.11 Influenza
J.02 Pharyngitis akut
J.02 Pharyngitis akut
Gangren pulpa
Ginggival abses
J.11 Influenza
J.11 Influenza
L.20 Dermatitis
pro imunisasi rujukan

J.11 Influenza
Ginggival abses
Gangren pulpa
E.11 DM
A.09 Diare
A.09 Diare
J.11 Influenza
J.11 Influenza
A.01 Thypoid rujukan
gingivitis marginalis
gingival abses
osteoarthritis
Observasi febris
K.29 Dyspepsia
A.09 Diare
J.11 Influenza
I/10 Hypertensi
I.10 Hypertensi
B.15 Hepatitis
K.29 Dyspepsia
J.11 Influenza
A.09 Diare
J.11 Influenza
J.11 Influenza
J.11 Influenza
K.29 Dyspepsia
Kontrol rutin RSAL rujukan
K.29 Dyspepsia
Hyperemi pulpa
Persistensi
Hyperemi pulpa
Periodontitis
A.09 Diare
E.10 DM
Nyeri telinga kiri rujukan
L.20 Dermatitis
A.09 Diare
L.20 Dermatitis
Gangren pulpa
Gangren pulpa
Gangren pulpa
Hyperemi pulpa
N.39 ISK
Anoreksia
J.11 Influenza
Kontrol post partus
L.20 Dermatitis
J.11 Influenza
J.11 Influenza
A.09 Diare
I.10 Hypertensi
F.29 Gastritis
Observasi febris
H.00 Hordeolum
Observasi febris
Gangren pulpa
Gangren pulpa
Gangren radix
LAPORAN PELAYANAN
BULAN JULI TAHUN 2014
Nama Faskes :
Alamat :

1 26-Jun-14 bpjs 0001289137735 An Aurifaringga
2 sertu/521655 Tn zainul arifin
3 i/d serma Zaenal M Ny sholichah
4 Letkol/520750 Ny Ninuk H
5 a/d mayor Komari An Estiwi M
6 PNS IIC Ny Ririska A
7 Sertu/531907 Tn Catur Sugeng
8 Serda Tn Iro Sungkono
9 a/d Serka Sardjianto An Reza
10 27-Jun-14 Letda/516207 Tn Tarso
11 Pelda/516010 Tn Heri S
12 Serma/523613 Tn Dedy
13 i/d mayor Hari/505090 Ny Hermin
14 a/d kapten Yuli/511529 Nn Anjelita
15 Pelda/506886 Tn Siswono
16 Serma/510323 Tn Kasmidi
17 30-Jun-14 a/d Sertu Suadi An Muhammad Alfatih
18 Peltu/509175 Tn M Ashari
19 Koptu/522136 Tn M Yusuf
20 Pelda/541452 Tn Yulianto
22 bpjs 0001289317779 An Nabila
23 a/d mayor R.N Jaya An R Fikri Saleh
24 1-Jul-14 a/d Tn Suryo Atmojo/518554 An Lazwardian
25 i/d serma Bambang/513356 Ny Tuti Mulyati
26 Sertu/522206 Tn Rohadi
27 Lettu/516207 Tn Tarso
28 bpjs 0001288734557 Tn Reza Ibnu
29 bpjs 0001285192798 Ny Atik Yulia
30 i/d Mayor Suhardin Ny Sri Rahayu
31 2-Jul-14 i/d Kolonel Toni/505518 Ny Novarita
32 Pelda/506205 Tn Rachmad
33 3-Jul-14 Serma/510060 Tn Yaiduri
34 kapten/510741 Tn Dody Abdulrachman
35 Kapten/507134 Tn Matheus
36 Mayor/506294 Tn Hery Santoso
37 i/d Lettu Bambang/511253 Ny Rini Yudawati
38 a/d Pelda Irfai/517382 Nn Carla
39 bpjs/0001288724825 An Balqis gusti
40 bpjs 0001287618581 Ny Rini S
41 bpjs 000110351081 Ny Sudarno
42 bpjs 0001287605428 An Albert Samuel
43 4-Jul-14 Mayor/524430 Tn Sarifuddin Tarigan
44 Serka/531092 Ny Winantrtri
45 a/d Sertu Suryo/518554 An Lazwardian Ramadan
46 a/d Pelda Irfai/517382 An Cigon
47 Prada/541452 Tn Yulianto Sudaryono
48 a/d serka Suyatno/530977 An Arsena
49 bpjs 0001103212326 Tn Heri S
50 a/d kapten Harwoto An Dheno Arsita
51 bpjs 0001288734557 Tn Reza Ibnu
52 a/d sertu Sugianto/523000 An Alfi R
53 bpjs 000188152562 An Keysha
55 bpjs 0001103212574 Ny Iva Susanti
56 7-Jul-14 bpjs 0001108975421 Ny Titik Arijanti
57 bpjs 0001103211753 Tn Khoirul anam
58 i/d praka Sunaryo/528248 Ny Ely karmila
59 i/d sertu Sugianto/523000 Ny Ririn karsani
60 a/d sertu Sugianto/523000 An alfi Rahmaniah
61 Peltu/506057 Tn Diot Sriyono
62 a/d pelda m sahid/516572 An Devinta
63 bpjs 0001103655317 Tn M Muklis
64 bpjs 0001287608218 Tn Andri wirawan
65 bpjs 0001103346854 Tn Muhalli
66 Ny Sri Soerianingsih
67 8-Jul-14 Tn Heri Susanto
68 bpjs 0001103142846 Tn vivat putra adi
69 bpjs 0001103273616 Tn hamid Arifin
70 a/d serka Teguh/527723 An Alvaro Danish F
71 a/d sertu suryo/518554 An Lazwadian ramadhan
72 a/d peltu Mardi/505829 An Berliani
73 bpjs 0001288171451 Fikri dewa afif
74 Purn Mayor pnb Tn Djasman
75 bpjs 0001284743147 Emilia Windawati
76 bpjs 0001284755545 Ny Nila Mutiara
77 a/d mayor S Tarigan/524430 An Syachreza El hakim
78 10-Jul-14 bpjs 0001103211753 Tn Khoirul anam
79 bpjs 0001103355955 Ny Kastutik
80 bpjs 0001108975421 Ny Titik Arijanti
81 a/d serrma Saragih/523598 An Nadia
82 bpjs 0001103167686 Tn Untung Krismantoro
83 bpjs 0001108770759 Ny Diah Retno Ayu
84 bpjs 0001103678954 Tn Sugiyo
85 bpjs 0001103522139 Ny Estu Rahayu
86 Serka/531907 Tn Catur Sugeng
87 bpjs 0001297335879 An Rr Riskaning Ayu
88 Kapten sus/533189 Ny Yeni fitriani
89 Letda kes/518302 Tn Sugeng Nurdiyanto
90 bpjs 0001285811166 An Galang Sukma
92 bpjs 0001226946363 n Cheryl E
93 bpjs 0001103212574 Ny Iva Susanti
94 a/d mayor RN Jaya/529201 An R Fikri Saleh
95 11-Jul-14 bpjs 0001288734557 Tn reza Ibnu
96 bpjs 0001288157409 An daniel Tio
97 bpjs 001287618581 Ny Rini Sularsih
98 bpjs 0001103121156 Tn Masduki
99 bpjs 0001103399482 Tn Dhani E kardiyanto
101 a/d Kapten Fakgous/531246 By Arya
102 i/d kapten fakgous/531246 Ny Rani
103 bpjs 0001286373104 An Rachmania savitri
104 i/d peltu Bambang/509133 Ny Sri Handayani
105 14-Jul-14 bpjs 0001103400358 Tn Bakti Hasmoko
106 bpjs 0001103521702 Ny Kusumastuti
107 bpjs 0001103592262 Tn Condro widodo
108 nik 351517051230001 Agustina evi irawati
109 bpjs 0001103359487 Tn Misnanto
110 bpjs 0001103126141 Tn Sigit W
111 bpjs 0001267713955 Ny Tutik S
112 15-Jul-14 bpjs 0001108831961 Ny Yatini
113 bpjs 0001103243264 Tn Wawan efendi
114 a/d pelda nuril/511612 Wanda joko
115 bpjs 0001103408256 Tn Totok sutono
116 a/d peltu Ali M/510028 Miftahul Jannah
117 bpjs 0001288158467 An Arsena Rafiiandra
118 bpjs 0001103170781 Tn Catur Sugeng
119 16-Jul-14 bpjs 0001103396567 Tn surotin
120 bpjs 0001103631952 Ny Ilomi Sabilah
121 17-Jul-14 bpjs 0001103231711 Tn Bambang Julianto
122 bpjs 0001103221528 Tn Siswono
123 bpjs 0001301710961 Ny Retno yuliastuti
124 bpjs 0001301711488 Astry darmayanti
125 bpjs 0001289348471 An Salsabila almas
126 bpjs 000118901373 Ny Suci Atiningsih
127 bpjs 0001108870986 Ny Endang Maisari
128 bpjs 0001108858702 Ny Farida
129 bpjs 0001103447193 Tn Matheus
130 bpjs 0001108915514 Ny Hesti
131 18-Jul-14 PNS Ny Dwi Handini
132 a/d serka Gipsaragih/523598 An Nadia
133 Kapten/506536 Tn Parma
134 bpjs 0001289201264 An Felisa cahya
135 bpjs 0001103221607 Tn Suliadi
136 bpjs 0001103368656 Tn Fandi Arif
137 bpjs 0001103196611 Tn Wahyu widjayanti
138 21-Jul-14 bpjs 0001103355865 Tn Subakat
139 Mayor/522758 Tn Wahyudi
140 bpjs 0001103346854 Tn Muhalli
141 Kopda/528309 Tn Imron Rosidi
144 a/d lettu yeni/517424 An Rafa
145 bpjs 0001288144315 Ny Hermi siswati
146 bpjs 0001103346854 Tn Muhalli
147 bpjs 0001103633829 Tn Mudjito
148 bpjs 0001103383214 Tn Rachmad Muhasan
149 22-Jul-14 bpjs 0001103212326 Tn Heri S
150 bpjs 0001108831961 Ny Yatini
151 a/d kapten agus/514673 an.Kaizen s
152 bpjs 0001288738833 an. M Alfatih
153 bpjs 0001103212326 Tn. Heri s
154 kopda/526862 tn. Rudi hermawan
155 kapten/ 513889 tn. Is andrai
156 i/d serda m ali/515774 Ny. Siti m
157 bpjs 0001286377288 an. Zixy m
158 bpjs 0001286377479 an Zisya m
159 a/d g.i.p saragih/523589 an. Faza
160 a/d g.i.p saragih/523589 an.nadea
161 23-Jul-14 bpjs 0001286354417 An.Elsa p
162 bpjs 0001226946374 ny. Yeni
163 bpjs 0001103383214 tn Racmad m
164 a/d serma randjau/512096 an Bima
165 bpjs 0001103378848 tn ranjau
166 bpjs 0001108973204 ny. Nursaadah
167 kopda/526701 tn iwan
168 24-Jul-14 bpjs 0001288728246 an adinda t
169 bpjs 0001226946363 an cheryl
170 bpjs 0001227405982 an aurel c
171 a/d serma agustina/ 5222632 an rangga tora
172 25-Jul-14 bpjs 0001286354417 an Elsa p
173 pns/ 196410261998032001 ny. Sri s
174 a/d peltu heri /516020 an syadyil n
175 serma/ 509327 tn.sigit
176 bpjs 0001103385431 tn moh toiron
LAPORAN PELAYANAN
BULAN AGUSTUS 2014
Nama Faskes :
Alamat :
NO
AYANAN
T PERTAMA (RJTP)
HUN 2014

persistensi
Hyperemi pulpa
Hyperemi pulpa
J.11 Inluenza
Dismenorhea
L.25 Reaksi gigitan serangga
I.10 Hypertensi
H.67 otitis media akut
K.29 Dyspepsia
G.44 Tension headache
konstipasi rujuk
J.11 Inluenza
Observasi febris
Observasi febris
K.29 Dyspepsia
J.11 Inluenza
J.11 Inluenza
I.10 Hypertensi
HNP
I.10 Hypertensi
persistensi
Ginggival abses
rawat luka
J.11 Inluenza
J.11 Inluenza
K.29 Dyspepsia
Gangraena pulpa
Hyperemi pulpa
Gangraena radix
Low back pain
Trigger finger
A.09 Diare
H.04
Rujukan
J.11 Influenza
L.24 Dermatitis kontak iritan
J.11 Influenza
Persistensi
Hyperemi pulpa
Hyperemi pulpa
Hyperemi pulpa
J.11 Influenza
Observasi febris
T.00 Vulnus Laseratum
Observasi febris
Kontrol fisioterapi rujuk
kontrol imunisasi rujuk
Gangren pulpa
Persistensi
Gangren pulpa
Persistensi
Persistensi
Gangren pulpa
Hyperemi pulpa
J.02 Faringitis akut
F.45 Gangguan stomatoform
K.21 Refluks Gastroesofagus
J.11 Influenza
A.09 Diarhoea
A.01 Demam tifoid
A.01 Demam tifoid
H.10 Konjungtivitis
B.00 Herpes simpleks
Hyperemi pulpa
Eruption difficult rujuk
K.29 gastritis
F.45 Gangguan somatoform
T.00 Vulnus Laseratum
J.11 Influenza
Observasi febris
F.45 Gangguan somatoform
K.29 gastritis
S.09 kekerasan tumpul
A.01 Thyphoid fever
E.79 Hyperurisemia
J.11 Influenza
J.11 Influenza
G.44 Tension headache rujuk
H.10 Konjungtivitis
K.29 gastritis
I.84 Haemoroid rujuk
kontrol mata rujuk
periksa ECHO rujuk
Persistensi
Gangren pulpa
Hyperemi pulpa
Hyperemi pulpa
Gangren pulpa
Gangren pulpa
Persistensi
Hyperemi pulpa
H.61 Serumen prop rujuk
J.11 Influenza
I.10 Hypertensi
Imunisasi BCG
J.11 Influenza
Konsultasi infertilitas
B.369 Superficial mycosis
kontrol fisioterapi rujuk
J.4590 Astma bronchiale
Gangren pulpa
K.021 Hyperemi pulpa
I.341 mitral valve prolapse rujuk
J.351 Tonsio faringitis
J.11 Influenza
J.11 Influenza
L.208 Dermatitis atopic
I.843 Eksternal haemoroid
K.052 Periodontitis akut
E.100 DM
J.11 Influenza
J.11 Influenza
J.11 Influenza
vulnus apertum
OA Genu
J.11 Influenza
K.052 Periodontitis akut
Ginggival abses
Gastritis
J.11 Influenza
Aterosklerosis rujuk
J.11 Influenza
J.11 Influenza
Vomiting rujuk
J.11 Influenza
Gangren pulpa
Hyperemi pulpa
Lymphadenitis
kontrol NICU rujuk
J.11 Influenza
gangguan somatoform
J.11 Influenza
J.11 Influenza
Angkat jahitan post OD
Hyperemi pulpa
ulkus mulut
filariasis
influenza
influenza
pharingitis
rujuk
ISPA
ISPA
ISPA
ISPA
periodontitis acute
gingivitis chronis
influenza
influenza
influenza
influenza
influenza
persistensi
hiperemi pulpa
hiperemi pulpa
influenza
periodontitis acute
gingivitis chronis
influenza
hipertensi
influenza
LAPORAN PELAYANAN
BULAN AGUSTUS TAHUN 2014

Alamat : Surabaya
NO TANGGAL IDENTITAS NAMA PESERTA DIAGNOSA

1 1-Aug-14 a/d PNS Dwi Handini An Savira Hyperemi pulpa
2 bpjs 0001103387321 Tn Suyatno Hyperemi pulpa
3 PNS Tn Sulkani Ginggivitis khronis
4 Pelda/517176 Tn M Hanafi Hyperemi pulpa
5 bpjs 0001286354417 An Elsa Periodontitis akut
6 Peltu/509866 Tn Suyatno dermatitis
7 Sertu/510351 Tn Suwito dermatitis
8 a/d Pelda Malik An M Artha Diare akut dg dehidrasi ring
9 Kapten/510086 Tn M Mundhir Influenza
10 a/d PNS Dwi An Ratna Influenza
11 bpjs 0001103231711 Tn Bambang J Dyspepsia
12 Kopda/523182 Tn Hari S Influenza
13 Lettu/517279 Tn Siswadi Influenza
14 bpjs 0001108773426 Ny Yuniarti Influenza
15 bpjs 0001103216861 Tn M Lidei Influenza
16 4-Aug-14 a/d pelda Muslimin /519504 An Octavian gagah
17 a/d Serma Agustina/522632 An Rangga Tora Gavin Vomitting
18 i/d Kopda Puyngky/529035 Ny Renny D Hyperemi pulpa
20 5-Aug-14 bpjs 0001103121303 Tn wahyudi Hyperemi pulpa
21 bpjs 0001103355865 Tn Subakat Gangren pulpa
22 bpjs 0001103394306 Tn Tanto R Hyperemi pulpa
23 a/d Mayor Nasron An Rifky M Persistensi
24 bpjs 0001108920126 Ny Ema Influenza
25 Kopda/526062 Hartono Hematokezia
26 Sertu/518590 Tn Muhali Influenza
27 i/d Serda Iwan/525646 Ny Zuritah Faringitis
28 a/d serda Iwan/525646 An Safira valensia Influenza
29 bpjs 0001284725542 An Dhenok Nursinta Influenza
30 bpjs 0001288738833 Tn M Ali fatih Influenza
31 bpjs 0001108913897 Dwi Sarwinda Influenza
32 6-Aug-14 bpjs 0001103126016 Tn Sumardi Influenza
33 bpjs 0001103221528 Tn Siswono Hypertensi
34 bpjs 0001103440858 an Zasia mahar GEADS
35 bpjs 0001103386105 Tn Sudjoko Otitis
36 Pelda Tn Heriyanto Fatique
37 7-Aug-14 bpjs 0001103309381 Ny Achuritasari Hyperemi pulpa
39 8-Aug-14 bpjs 0001103521328 Tn Supardi ISPA
40 Pelda/508912 Tn M Sulkan Dermatofitosis
41 bpjs 0001288728246 An Adinda Tiara Persistensi
42 i/d Serma Suwono/511140 Ny Sumarmi Hyperemi pulpa
43 a/d Mayor Suryadi/508163 Tn M Hafid Ginggivitis khronis
44 a/d Serka Saragih An Nadhea Rampan karies
45 11-Aug-14 bpjs 0001103620421 Tn Eswan Gangren pulpa
46 bpjs 0001103355865 Tn Subakat Gangren pulpa
47 523616 Tn Danu Wiryanto Gangren pulpa
48 bpjs 0001103126016 Tn Sumardi Influenza
49 bpjs 0001103223925 Tn M Abd Koiri Corpus alienum di mata
50 Sertu/514354 Tn Kartono GEA
51 i/d Pelda Setiyono/507755 Ny Lusi DA
52 Serma/509327 Tn Sigit Hypertensi
53 bpjs 0001108850861 Ny Elly Karmila Psikosomatis
54 bpjs 0001103152871 Tn Rohadi Influenza
55 Kapten/514673 Tn Agus Mardianto DA
56 12-Aug-14 a/d Kopda Sugiyo/514498 An Yopin Varicella
57 bpjs 0001103370175 Tn Ahmad Anton Harun Cravus
58 PNS Ny Dwi Miko Influenza
59 a/d Sertu Surana An Zahra Putri Influenza
60 i/d serma sigit/509327 ny. Rini winarti vulnus apertum
61 bpjs 0001109066264 ny. Sri hartini Influenza
62 bpjs 0001288738833 an. Muh al fatih
63 serma /521271 tn. Jacky influenza
64 bpjs 0001278728008 ny. Purwati influenza
65 bpjs 0001103408482 tn. Irfai influenza
66 a/d pelda syahroni/512420 nn. Bella r operculitis
67 serma/ 521271 tn. Jacky periodontitis acute
68 bpjs 0001103381111 tn. Mashudi h hiperemi pulpa
69 serma /519550 tn. Oney p hiperemi pulpa
70 i/d Kopda pungki / 529035 ny. Renny d gangraena pulpa
71 13-Aug-14 bpjs 0001103273616 tn. Hamid arifin conjungtivitis
72 kapten / 513029 tn. Untung k hipertensi + influensa
73 bpjs /0001103488446 tn. Erie nur cephalgia
74 bpjs 0001103216861 tn. M lidi herpez zooster
75 bpjs 0001103189027 tn. Heru ariyanto influenza
76 mayor / 524479 tn. Muchidin cek GDA
77 a/d serma randjau/ 512096 an bima s influenza
78 prada/ 542813 tn. Fendi tri vulnus apertum
79 14-Aug-14 bpjs / 0001103168215 tn. Siswadi gangraena pulpa
80 bpjs / 9171017112720008 ny. Syarmiati periodontitis acute
81 bpjs 0001284743439 tn. Nanda influenza
82 i/d honor makmun ny. Eni G II P 1+ influenza
83 bpjs 0001103671686 tn. Sunaryo influenza
84 bpjs 0001103652472 tn. Yani i heat stroke
85 pns IIId/196806181996032001 ny. Dwi h influenza+hipertensi
86 15-Aug-14 bpjs 0001288734557 tn. Reza ibnu gangraena pulpa
87 bpjs 0001108901373 ny. Suciatiningsih Osteo atritis
88 bpjs 0001103231711 tn. Bambang j influenza
89 18-Aug-14 bpjs 0001103433399 tn. Sunarto hiperemi pulpa
90 purn. PNB tn. Jasman hiperemi pulpa
91 bpjs 0001288731273 tn. Rama m hiperemi pulpa
92 bpjs 0001103355865 tn. Subakat gangraena pulpa
93 bpjs 0001103431511 ririn dewi m fatique
94 bpjs 0001106366771 ny. Subiyana h broncitis
95 bpjs 0001103278858 tn. Arwani myalgia
96 i/d peltu a . Mashar/ 510088 ny. Siti fatimah dyslipidema
97 a/d sertu an. Riqwal an. Riqwal miopi
98 serma /511140 tn. Suwarno post CVA
99 a/d serma sigit/509327 an. Mustika abdominal discomfort
100 19-Aug-14 bpjs 0001103212326 tn. Heri susanto gingival abses
101 purn. PNB tn. Jasman pulpitis
102 a/d pelda syahroni/512420 nn. Bella r eruption difficult
103 mayor/ 508163 tn. Suryadi hiperemi pulpa
104 bpjs 0001109064521 ny. Soemirah gangraena pulpa
105 bpjs 0001108887849 ny. Tutik m hiperemi pulpa
106 bpjs 0001109064521 ny. soemirah myalgia
107 bpjs 0001103385431 tn. Moh thoiron influenza
108 kapten / 513029 tn. Untung k influenza + hipertensi
109 serda / 524961 tn. Muklis myalgia
110 bpjs 0001103062116 tn. Parma kontrol rutin
111 20-Aug-14 bpjs 0001103168215 tn. siswadi hiperemi pulpa
112 a/d pelda m.andri/517310 an andrew bill yuan hiperemi pulpa
113 bpjs 0001108973384 ny. Ririn h gingival abses
114 bpjs 0001286356285 ardyansyah a influenza
115 bpjs 0001103408256 tn. Suyono influenza
116 pelda / 506205 tn. Racmad influnza
117 pelda / 517310 tn. Sunarno hipertensi
118 bpjs 0001286354417 an.elsa influenza
119 i/d serma hadi ny. Yatini influenza
120 pelda /517028 tn. Hari s hipertensi + vomoting
121 21-Aug-14 pelda / 517034 tn. Wiyanto influenza
122 bpjs 001103385431 an. Dita a influenza
123 bpjs 0001103385431 tn moh thoiron broncitis
124 bpjs 0001102381514 tn. Sariffudin pharingitis
125 pelda/ 516654 tn. Djoko p hipertensi
126 bpjs 0001423125797 tn. Putra a influenza
127 serka /508573 tn. Riaman hipertensi
128 a/d myor sariffudin /524430 an. Sandrina rujuk
129 a/d mayor suhardin/ 527055 an. Askin influenza
130 bpjs 0001284771442 An. Ardhiya r pro vaksinasi hep
131 bpjs 0001284770891 Ny. Utami pro vaksinasi hep
132 bpjs 0001284771262 an. Agie k pro vaksinasi hep
133 prada/ 542819 tn. Wawan s hordenum OD
134 22-Aug-14 purn. PNB tn. Jasman pulpitis
135 bpjs 0001103280704 tn. Evan b hiperemi pulpa
136 bpjs 0001289201264 an. Felisa persistensi
137 bpjs 0001289205404 ny. Siti maryam B.20 suspect
138 bpjs 00011036848861 tn. Hartono B.20
139 bpjs 0001108972326 ny. Sudjiati influenza
140 bpjs 0001106366771 ny. Subyana h influenza
141 i/d kapten dodik/510581 ny. Nanik abses
144 bpjs 0001284748547 an. Atikah dwi GEA + vomiting
145 25-Aug-14 bpjs 0001103419462 Tn Petrus Pardede Hyperemi pulpa
146 bpjs 0001109064521 Ny Soemirah periodontitis acute
147 dedxZZZZ
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
NAN
RTAMA (RJTP)
UN 2014

Hyperemi pulpa
Hyperemi pulpa
Ginggivitis khronis
Hyperemi pulpa
Periodontitis akut
dermatitis
dermatitis
Diare akut dg dehidrasi ringan
Rujukan
Hyperemi pulpa
Hyperemi pulpa
Hyperemi pulpa
Gangren pulpa
Hyperemi pulpa
Persistensi
Hematokezia Rujukan
Hypertensi
Rujukan
Rujukan
Hyperemi pulpa
Hyperemi pulpa
Dermatofitosis
Persistensi
Hyperemi pulpa
Ginggivitis khronis
Rampan karies
Gangren pulpa
Gangren pulpa
Gangren pulpa
Corpus alienum di mata Rujukan
Hypertensi
Psikosomatis
vulnus apertum
rujuk
operculitis
periodontitis acute
hiperemi pulpa
hiperemi pulpa
gangraena pulpa
conjungtivitis
hipertensi + influensa
herpez zooster
vulnus apertum
gangraena pulpa
periodontitis acute
G II P 1+ influenza
heat stroke
influenza+hipertensi
gangraena pulpa
Osteo atritis
hiperemi pulpa
hiperemi pulpa
hiperemi pulpa
gangraena pulpa
dyslipidema
rujuk
rujuk
abdominal discomfort
gingival abses
eruption difficult
hiperemi pulpa
gangraena pulpa
hiperemi pulpa
influenza + hipertensi
kontrol rutin rujuk

hiperemi pulpa
hiperemi pulpa
gingival abses
hipertensi
hipertensi + vomoting rujuk
pharingitis
pro vaksinasi hep rujuk
hordenum OD
hiperemi pulpa
persistensi
B.20 suspect rujuk
rujuk
GEA + vomiting
Hyperemi pulpa
periodontitis acute
rujuk
LAPORAN PELAYANAN
BULAN AGUSTUS TAHUN 2014

Alamat : Surabaya

1 25-Aug-14 bpjs 0001103419462 Tn. Petrus pardede
2 bpjs 0001109064521 Ny. Soemirah
3 sertu / 514354 tn. Kartono
4 Serma / 509327 tn. Sigit
5 bpjs 0001286368086 an. M reifan
6 kapten / 511529 tn. Juli purnomo
7 bpjs 0001103532164 tn. Eko herry p
8 bpjs 0001289345758 an. Jovanka
9 mayor / 524479 tn. Muchidin
10 bpjs 0001103301099 ny. Mamik catur wulan
11 serma /525348 tn. Witoyo
12 26-Aug-14 bpjs 0001103433399 tn. Sunarto
13 bpjs 0001103387321 tn. Suyatno
14 bpjs 0001103521702 ny. Kusuma astuti
15 bpjs 0001289200364 an. M. Surya
16 bpjs 0001103426256 tn. Pungki
17 bpjs 0001103408256 tn. Totok suyono
18 bpjs 0001108893161 rr.diah s
19 PNS II/D 1964122019931001101 tn. Ali hasyim
20 sertu / 518590 tn. Muhalli
21 bpjs 0001335641725 tn. Rifki a
22 askes 0000097920685 tn. Pardjono
23 a/d pelda andri /517310 an andrew bill yuan
24 PNS / 196912101996032002 ny. Widwi miko
25 27-Aug-14 a/d pelda budi / 505247 tn. Candra d
26 bpjs 0001103640737 tn. Budi laksana
27 bpjs000128144315 ny. Hermi s
28 askes 0000097920685 tn. Pardjono
29 a/d pelda syaifudin nn. Novian
30 pelda/ 517310 tn. Andri
31 bpjs 0001108831443 ny. Tutik s
31 28-Aug-14 bpjs 0001103597065 tn. Suriyatno
32 a/d kapten Matheus/507134 an. Edlyn
33 bpjs 0001103419462 Tn. Petrus pardede
34 bpjs 0001103510709 ny. Tutik s
35 bpjs 0001103120234 tn. M sutiono
36 bpjs 0001103443413 tn. Iding s
37 29-Aug-14 mayor / 508163 tn. Suryadi
38 Serma / 509327 tn. Sigit w
39 bpjs 0001103221528 tn. Siswono
40 bpjs 0001108919665 ny. Yophita
41 bpjs 0001288157433 an samuel d
42 1-Sep-14 bpjs 0001103272907 tn. Suyato
43 bpjs 0001108973384 ny. Ririn h
44 a/d sertu sugianto/ 523000 an. Alfi r
45 bpjs 0001103387321 tn. suyatno
46 bpjs 0001103617866 tn. Janje
47 peltu / 506806 tn. Siswono
48 serda / 522599 tn. Rudi
49 lettu / 515137 tn. Sudarna
50 a/d serma saragih/ 523598 an. Nadea
51 bpjs 0001108975421 ny. Titik a
52 sertu muhalli
53 lettu i putu
54 bpjs 0001103511262 ny. Yohana
55 2-Sep-14 bpjs 0001103212326 tn. Heri susanto
56 purn PNB tn. Jasman
57 bpjs 0001103479749 tn. Yulianto
58 bpjs 0001428494501 an. Anindita kirana
59 bpjs 0001103304892 ny. Eka puspita
60 prada / 542813 tn. Fendi
61 jamsostek 12012226879001 tn.erwin a
62 pelda / 516654 tn. Joko pranowo
63 3-Sep-14 serrma / 510285 tn. Totok m
64 bpjs 0001109064521 Ny. Soemirah
65 bpjs 0001103426256 tn. Pongki
66 bpjs 0001103630769 tn M. Ashari
67 bpjs 0001103167686 tn. Untung
68 a/d praka yani / 531534 an. Gadis
69 sertu / 518590 tn. muhalli
70 4-Sep-14 askes 0000097920685 tn. Pardjono
71 a/d pelda andri /517310 an. Andrew bill yuan
72 bpjs 0001109076614 ny. Susi
73 bpjs 0001108973384 ny. Ririn h
74 bpjs 0001103597065 tn. Suriyatno
75 5-Sep-14 a/d PNS untari nn. Minggit d
76 iti bpjs 0001103684861 tn. Hartono
77 i/dsertu hasyim / 513204 ny. Rini
78 i/d koptu hartono ny. Siti m
79 bpjs 0001109701012 ny. Hartini
80 PNS ny. Dwi handini
81 i/d mayor suhardin/ 527055 ny. Sri rahayu
83 bpjs 0001103383214 tn. Rahmad muhasan
84 8-Sep-14 a/d pratu eri an. Agam abrisan
85 bpjs 0001106366771 ny. Subiyana
86 i/d serma kasmidi/ 510323 ny. Khumayah
87 bpjs 000110870672 ny. Sri wilujeng
88 serma / 514020 tn. Bambang
89 serma /509384 tn. Jantje
90 9-Sep-14 a/d PNS untari nn. Minggit d
91 a/d pelda syaifudin / 508610 nn. Novian
92 bpjs 0001103217693 tn. Suryadi s
93 bpjs 0001103636575 tn. Abdul malik
94 bpjs 0001103510709 tn. Achmad yuniar
95 bpjs 0001106366771 ny. Subiyana
96 koptu / 522136 tn. M. Yusuf
97 10-Sep-14 bpjs 0001108972326 ny. Sudjiati
98 bpjs 0001103208557 tn. Joesdi
99 a/d kopda agung / 529432 an. Bunga a
100 bpjs 0001109064521 ny. soemirah
101 bpjs 0001103528643 tn. Dudy a
102 serma /509384 tn. Jantje
103 11-Sep-14 bpjs 0001103280704 tn. Evan b
104 bpjs 0001109076614 ny. Susi p
105 letkol / 520750 ny. Ninuk h
106 bpjs 0001288144315 ny. Hermi s
107 bpjs 0001289200364 an. M surya
108 bpjs 0001103387321 tn. suyatno
109 bpjs 0001316012196 tn. Rangga p
110 bpjs 0001103285924 ny. Yeni f
111 an. Zaskia
112 peldA /517310 tn. andri
113 bpjs 0001103408256 tn. Totok suyono
114 bpjs 0001103383214 tn. Rahmad muhasan
115 bpjs 0001288738596 an. Maverix
116 12-Sep-14 a/d kopda agung / 529432 an. Bunga a
117 bpjs 0001103631952 tn. Ilmi s
118 bpjs 0001103426256 tn. pongki
119 bpjs 0001289202693 ny. Rina
120 bpjs 0001289203615 by. Renaldo
121 bpjs 0001284743992 an. Chelsea
122 bpjs 0001284743177 ny. Emilia
123 bpjs 0001103479749 tn. Yulianto
124 bpjs 0001103652472 tn. Yani i
125 serka /509327 tn. Sigit w
126 bpjs 0001103631952 tn. Ilmi s
127 15-Sep-14 bpjs 0001284767886 tn. Bagus a
128 bpjs 0001103208557 tn. Joesdi
129 bpjs 0001103394306 tn. Tanto
130 kopka/ 509217 tn. Kasan hadi
131 bpjs 0001103115824 tn. M. Sulkan
132 bpjs 0001103445382 an . M jafar
133 bpjs 0001103401045 tn. Gerhana i.p
134 koptu/ 517692 tn. Heri pujiono
135 sertu / 517692 tn. Iro s
136 koptu / 524792 tn. Suprapto
137 bpjs 0001103635056 tn. Agus i
138 bpjs 0001287025929 an. Alexandria
139 NRP 516939 tn. Moh runako
140 16-Sep bpjs 0001103433399 tn. sunarto
141 bpjs 0001287618581 ny. Rini s
142 bpjs 001103333782 tn. Adi wahyu
143 bpjs 0001103602228 tn. Tarso s
144 bpjs 0001103522499 tn. Yan suryono
145 bpjs 0001103285920 ny. Yeni.f
146 bpjs 0001109701012 ny. Hartini
147 serma / 517323 tn. Heriyanto
148 bpjs 0001272383728 an. M idhandi
149 bpjs 0001278728008 ny. Purwanti
150 PNS 19610504198332004 ny. Subaidah
151 17-Sep-14 a/d kopda agung / 529432 an. Bunga a
152 bpjs 0001289201264 an. Felisa c
153 a/d pelda syaifudin / 508610 nn. Novian
154 bpjs 00012863987321 an. Nalini
155 bpjs 0001108971303 ny. Anies w
156 a/d serma agustin /522632 an. Rangga tora
157 bpjs 0001103387321 tn. suyatno
158 18-Sep-14 bpjs 0001288144315 ny. Hermi s
159 i/d pelda muslimin ny. Sumaiyah
160 bpjs 0001103062116 tn. Parma
161 a/d serka rofik nn. Windara
162 bpjs 0001103167686 tn. Untung
163 NRP 517830 an. Zahra
164 bpjs 0001288167221 an. M nortanio
165 bpjs 0001288167513 an. M rotanio
166 bpjs 0001286387919 ny. Rini y
167 bpjs 0001103567005 tn. Fandi
168 bpjs 0003567005 tn. Sugianto e
169 19-Sep-14 bpjs 00012844315 ny. Hermi s
170 a/d pelda andri /517310 an. Andrew bill yuan
171 bpjs 0001103617866 tn. Janje
172 bpjs 0001108975421 ny. Titik a
173 sertu / 521465 tn. Iro s
174 bpjs 0001109066782 ny. Lusye
175 bpjs 0001285810716 an. Wahyu s
176 a/d kapten harianto an. Nayla
177 a/d serka yanto / 521792 tn.ovan
178 22-Sep-14 bpjs 0001109064521 ny. soemirah
179 a/d kopda agung / 529432 an. Bunga a
180 bpjs 000142167884 an. Aprilia
181 bpjs 0001103339248 ny. Kinanti ayu
182 a/d PNS kinanti an. Aisha
183 pelda/ 507195 tn. Heru
184 pelda / 516208 tn. Gugus
185 bpjs 0001103405736 tn. Nanang
186 bpjs 0001103437776 tn. Arifin
187 bpjs 0001108901373 ny. sudjiati
188 bpjs 0001109066782 ny. Lusye
189 i/d serma suwarno ny. Sumarmi
190 23-Sep-14 a/d PNS dwi h an. Savira
191 bpjs 0001108972326 ny. Sudjiati
192 bpjs 0001103208557 tn. Joesdhi
193 bpjs 0001273133081 an. Ardelia n
194 serma / 518396 ny. Yuyun
195 PNS 196806181996003201 ny. Dwi handini
196 bpjs 0001109062427 ny. Siti m
197 serda /542622 nn. Diah ayu
198 a/d serma randjau/512096 an. Bima
199 24-Sep-14 bpjs 0001103136344 tn. Budiono
200 bpjs 0001103146042 tn. Komari
201 a/d serma saragih/ 523598 an. nadea
202 bpjs 0001287610931 ny. Khoirul
203 bpjs 0001297611109 an. Aurinda
204 bpjs 0001103494015 tn. Sugiyanto
205 kapten / 532025 drg. Elisabeth
206 25-Sep-14 bpjs 0001103361041 ny. Untari
AYANAN
PERTAMA (RJTP)
TAHUN 2014
DIAGNOSA DIRUJUK
hiperemi pulpa
periodontitis acute
DKI RSAU
hipertensi
pharingitis acute
IBP
consio muscolorum
obs. Febris RSAU
DM
influenza
influenza
hiperemi pulpa
hiperemi pulpa
gingival abses
persistensi
hiperemi pulpa
influenza
influenza
DM
ISPA
impaksi
gangraena pulpa
hiperemi pulpa
gangraena pulpa
ekstraksi kuku RSAU
visus RSAU
rhinitis alergi
hipertensi RSAU
suspect SLE RSAU
hipertensi
MCU RSAU
hiperemi pulpa
persistensi
hiperemi pulpa
MCU RSAU
influenza
influenza
gingivitis chronis
HT + influenza
hipertensi
influenza
influenza
hiperemi pulpa
gingival abses
persistensi
hiperemi pulpa
hiperemi pulpa
hipertensi
ISPA
ISPA
ISPA
gastritis
ISPA
obs febris
rujuk RSAU
gingival abses
hiperemi pulpa
dirujuk RSAL
dirujuk RSAU
dirujuk RSAU
rawat luka
KLL
diare
hiperemi pulpa
gangraena pulpa
hiperemi pulpa
diare
ISPA
ISPA
ISPA
gangraena pulpa
hiperemi pulpa
hiperemi pulpa
gingival abses
hiperemi pulpa
gingival abses
dirujuk RS siti hajar
post KLL
dirujuk RS siti hajar
hipertensi
hipertensi
ISPA
LBP
ISPA
ISPA
ISK
hipertensi
hipertensi
ISPA
gingival abses
ISPA
fatique
dirujuk RSAU
ISPA
dirujuk RSAU
ISPA
gangraena pulpa
gangraena pulpa
gangraena pulpa
gangraena pulpa
ISPA
ISPA
hiperemi pulpa
hiperemi pulpa
hiperemi pulpa
hiperemi pulpa
persistensi
ISPA
ISPA
ISPA
kontrol
ISPA
presbiopi
LBP
ISPA
nekrose pulpa
periodontitis chronis
gingivitis chronis
ISPA
ISPA
ISPA
ISPA
diare
ISPA
hipertensi
di rujuk RSAL
over bite RSAL
gingival abses
hiperemi pulpa
gangraena pulpa
ISPA
ISPA
GEA
ISPA
hipertensi
ISPA
obs. Febris
ISPA
di rujuk RSAU
hiperemi pulpa
hiperemi pulpa
dyspepsia
influenza
dirujuk RSAL
thypoid
influenza
influenza
influenza
influenza
dirujuk RSAU
gingival abses
pharingitis
SLE + abd discomfort
stomatitis
hipertensi
dirujuk RSAU
influenza
hiperemi pulpa
influenza
dirujuk RSAL
dirujuk RSAU
influenza
influenza
influenza
influenza
hiperuresemia
influenza
influenza
hiperemi pulpa
hiperemi pulpa
gangraena pulpa
influenza
hipertensi
dyspepsia
obs. Febris
KLL
GEA
gangraena pulpa
gangraena pulpa
influenza
influenza
influenza
alergi
influenza
influenza
trauma RSAU
influenza
dermatitis
haemoroid .
gangraena pulpa
gangraena pulpa
gangraena pulpa
pharingitis
influenza
hipertensi
dirujuk RSAL
diare
influenza
influenza
dirujuk RSAU
tonsilitis
RICE
fluor albus
influenza
influenza
LAPORAN PELAYANAN
BULAN SEPTEMBER TAHUN 2014

Alamat : Surabaya

1 26-Sep-14 kapten dr. Lusia
2 serma / 509327 tn. Sigit
3 a/d serma sardianto/ 509253 tn. Novian
4 sertu / 521465 tn. Iro
5 bpjs 0001289200871 an. Farisah cahya
6 27-Sep-14 serka tn. Mugiono
7 serka /523598 tn. Saragih
8 bpjs 0001287613168 an. Risqi a
9 29-Sep-14 bpjs 0001103628971 tn. Mardi utomo
10 bpjs 0001108831511 ny. Jatmiatun
11 serma / 518398 ny. Naning
12 a/d serma sargih / 523598 an. Nadea
13 bpjs 00011035556352 ny. Kusumastuti
14 a/d serka catur/531907 an. Siti z
15 bpjs 0001103266315 tn. Pongki
16 bpjs 0001276172414 ny. Suparti s
17 bpjs 0001285809377 an. M hafis f
18 peltu / 514824 tn. Abdul manaf
19 30-Sep-14 bpjs 0001103208557 tn. Joesdhi h
20 mayor / 524479 tn. Muchidin
21 bpjs 0001108770759 ny. Diah retno
22 bpjs 0001284725542 an dhenok n
23 bpjs 0001108893662 ny. Yuli a
24 bpjs 00014221678845 an. Aprilia
25 bpjs 0001108975421 ny. Titik
26 bpjs 0001109023029 ny. Sri s
27 a/d serma saragih/523598 an. Faza
28 bpjs 0001103217693 tn. Suryadi sanali
29 bpjs 0001428979498 an. Askin
30 PNS 196011281983032004 ny. Cicilia
31 1-Oct-14 bpjs 0001103384755 tn. L syahroni
32 bpjs 0001103437563 tn. Jacky
33 bpjs 0001103166887 tn. Ida bagus
34 bpjs 0001288167513 an. Rotanio
35 bpjs 0001103408256 tn. Totok s
36 NRP 519562 tn. Samsul
37 2-Oct-14 bpjs 0001103146042 tn. Komari
38 bpjs 0001108773426 ny. Yuniati
39 serma / 521259 tn. Yudhi f
40 bpjs 0001103596424 tn. Saifudin j
41 bpjs 0001103655317 tn. M muklis
42 sertu / 521465 tn. iro
43 3-Oct-14 bpjs 0001103061789 tn. Budi s
44 letda / 517414 ny. Kusmawati
45 prada / 541452 tn. Yulianto
46 a/d 534004 an. Devano
47 i/d 534004 ny. Linda
48 bpjs 0001109066736 ny. Sri rahayu
49 PNS Tn Sukimin
50 Pelda 509382 Tn Sumardi
51 6-Oct-14 NRP 540677 Tn Wahyu
52 NRP 510088 Ny Siti fatimah
53 i/d Serma Sigit/509327 Ny Rini Winarti
54 a/d Serma Sigit/509327 Tn Iman Bachtiar
55 bpjs 0001285809118 Tn Tegar Faridz
56 bpjs 0001285809377 M Hafiz Fajar N
57 bpjs 0001297335879 An Riskaning Ayu tri
58 bpjs 0001108901373 Ny Suciatiningsih
60 bpjs 0001284725542 An Deno
61 bpjs 0001287617365 An Dian P.S
62 7-Oct-14 a/d PNS Dwi Handini An Savira
63 a/d Pelda Andi/517310 An Audrey
64 bpjs 0001287019359 Nn Carla Virenabia
65 8-Oct-14 bpjs 0001103273616 Tn Hamid Arifin
66 PNS Ny Tatik
67 Ny Aini
68 bpjs 0001289345758 An Jovanca
69 bpjs 0001102493092 Tn Juli purnomo
70 bpjs 0001108972326 Ny Sudjiati
71 bpjs 0001103396422 Tn Kasmidi
72 9-Oct-14 NRP 504909 Tn Budi S
73 i/d Marnado s/533524 Ny Sulastri Marpaung
74 10-Oct-14 bpjs 0001103211753 Tn Khoirul anam
75 NRP 509327 Tn Sigit W
76 NRP 514020 Tn Bambang
77 PNS Ny Dwi Handini
78 NRP 517279/0001103168215 Tn Siswadi
79 bpjs 0001108915514 Ny Hesti Palupi W
80 bpjs 0001109064521 Ny Soemirah
81 bpjs 0001275529961 An Dio Cahya
82 bpjs 0001103399482 Tn Dhani Endro
83 bpjs 000128747783 An M Alfathoni
84 13-Oct-14 Askes 0000097920685 Tn Pardjono
85 NRP 506886 Tn Siswono
86 NRP 504909 Tn Budi S
87 bpjs 0001103378848 Tn Randjau Siswo
88 NRP 506057 Tn Diyot sriyono
89 bpjs 0001297335879 an RR Riskaning
90 NRP 523230 Tn Ahmad Sobirin
91 PNS Ny Endri
92 Pelda Tn Sudarno
93 bpjs 0001103304892 Ny Eka
94 14-Oct-14 NRP 509382 Tn Sumardi
95 bpjs 0001103108534 Tn Agung Yuliastono
96 bpjs 0001103146042 tn. komari
97 bpjs 0001103494015 tn. Sugiyanto
98 bpjs 0001103636575 Tn Abdul Malik
99 bpjs 0001103109579 Tn Iro Sungkono
100 bpjs 0001289201264 An Felisa Cahya Maulidah
101 bpjs 0001103592262 Tn Condro Widodo
102 NRP 506351 Tn Trianto teguh
103 NRP 521215 Tn Tri Mariyanto
104 bpjs 0001109069425 Ny Heny hidayah
105 NRP 529201 TR.N Jaya
106 bpjs 0001275529961 An Dio Cahya
107 bpjs 0001275522794 Ny Jenny J
108 15-Oct-14 bpjs 0000101186054 Ny Sukatmi
109 bpjs 0001103598336 Tn Hermanto
110 bpjs 0001288143551 Tn Mohammad ichsan
111 Purn PNB Tn Jasman
112 bpjs 0001284738423 An Zaky
113 bpjs 0001103618643 Ny Meylani
114 bpjs 0001103356416 Ny Cicilia
115 bpjs 0001286396741 An Nalini
116 bpjs 0001103617866 Tn Tjantje
117 16-Oct-14 Mayor Tn Aziz
118 bpjs 0001109064521 Ny Soemirah
119 a/d serka Suyatno/530977 An Arsena rafi andra
120 bpjs 0001287048598 An Ahmad Auliyaurrahman
121 bpjs 0001103684861 Tn Hartino
122 NRP 506057 Tn Diot sriyono
123 17-Oct-14 NRP 506536 Tn Parma
124 bpjs 0001299780854 Tn M idris Nasution
125 bpjs 0001284765491 An Rama Aji Kusuma
126 NRP 506517 Ny Susi Indrawati
127 bpjs 0001284755545 Ny Nila Mutiara H
128 bpjs 0001226913906 Ny Wulandari
129 20-Oct-14 NRP 509327 Tn Sigit T N
130 NRP 511140 Tn Suwarno
131 bpjs 0001103631952 Tn Ilmi Sabilah
132 NRP 509327 An Mustika
133 NRP 514905/Pelda Sumardi Ny Munafi'ah
134 21-Oct-14 NRP 515110 Tn Iding
135 PNS Ny Dwi handini
136 22-Oct NRP 523759 Tn Achmad Fuad
137 bpjs 0001103109579 Tn Iro sungkono
138 bpjs 0001421604033 drg dyna
139 bpjs 0001284738423 An Zaky
140 bpjs 0001286354417 An Elsa P B
141 bpjs 0001284747783 An M Alfathoni
142 23-Oct-14 Serma Tn Totok M
143 bpjs 0001421865641 An Marsya
144 bpjs 0001288136812 An Nyoman Gilang
145 bpjs 0001103370175 Tn Pratu Rosyid
146 bpjs 0001103630769 Tn Mohammad Ashari
147 i/d peltu Ashari/509175 Ny Heny
148 bpjs 0001286387919 Ny Rini Yudawati
149 i/d Koptu Hartono/506062 Ny Siti maryam
150 24-Oct-14 bpjs 0001108972326 Ny Sudjiati
AYANAN
PERTAMA (RJTP)
TAHUN 2014
DIAGNOSA DIRUJUK
hiperemi pulpa
hipertensi
pharingitis
hipertensi
influenza
influenza
influenza
persistensi
gastritis
influenza
influenza
influenza
myalgia
KLL
influenza
influenza
dirujuk RSAU
influenza
gangraena pulpa
influenza
influenza
influenza
influenza
influenza
influenza
influenza
influenza
influenza
influenza
influenza
pulpitis
gingivitis chronis
hiperemi pulpa
influenza
influenza
influenza
influenza
dirujuk RSAU
influenza
influenza
influenza
hipertensi
impaksi
diare
dirujuk RSAL
influenza
influenza
influenza
Influenza
KLL
Ginggivitis khronis
ISPA
Cephal;gia
Limphadenitis
ISPA
Asma Rujuk
KLL
Dermatitis
gangraena pulpa
Persistensi
Persistensi
gangraena pulpa
Faringitis
Dyspepsia
ISPA
ISPA
ISPA
Varicella
ISPA
gangraena pulpa
Ginggivitis khronis
KLL
GIII P-2-2 post SC Rujuk
Hepatitis A Kontrol RSAU
Hypertensi
Hypertensi
Hypertensi
ISPA
Cephalgia
gangraena pulpa
Persistensi
Hyperemi pulpa
gangraena pulpa
gangraena pulpa
Hypertensi
Kontrol luka
ISPA
ISPA
kontrol
ISPA
Kontrol Kebidanan
ISPA
ISPA
ISPA
influenza
LBP
LBP
DM
Hypertensi
ISPA
Kontrol Fisioterapi Rujuk
GEA
Dermatitis
Amenorhea Rujuk
gangraena pulpa
Persistensi
Ginggivitis khronis
Hypertensi
Dermatitis insect
ISPA
Ginggivitis khronis
Hyperemi pulpa
gangraena pulpa
Hyperemi pulpa
Persistensi
gangraena pulpa
Ginggivitis khronis
gangraena pulpa
Imunisasi HIB rujuk
Bronchitis
B20 rujuk
ISPA
Iskemia myocard rujuk
Kontrol Poli THT Esnawan
Dyspepsia
Hypertensi
metromenorhagi
Hyperemi pulpa
Hypertensi
kontrol rutin RSAL Poli syaraf
DM RSAL Poli endokrin
kontrol KLL RSAU radiologi
Hypertensi
GEA
Hypertensi
Chal;azion pulp susp os rujuk
Hypertensi
Myalgia
Hyperemi pulpa
Persistensi
Gangren radix
Gangren pulpa
Persistensi
Hyperemi pulpa
Gangren pulpa
ISPA
ISPA
Susp OA
Tinnitus rujuk
Gangren pulpa
LAPORAN PELAYANAN
BULAN OKTOBER TAHUN 2014

Alamat : Surabaya

1 27-Oct-14 bpjs 0001287613168 An Rizqi
2 bpjs 0001287615407 ny. Siska y
3 bpjs 0001287610165 ny. Munafiah
4 bpjs 0001287610255 nn. Elita
5 bpjs 0001430879207 nn. Bella
6 bpjs 0001103671686 tn. Sunaryo
7 bpjs 0001108975375 ny. Solichah
8 28-Oct-14 bpjs 0001103280704 tn. Evan b
9 bpjs 0001103619227 tn. Sutopo
10 i/d serma suwarno ny. Sumarmi
11 bpjs 0001103391527 tn. Mudiyono
12 serma / 522362 ny. Agustin
13 serma / 523616 tn. Danu w
14 pelda / 506886 tn. Siswono
15 bpjs 00011288153539 ny. Ervin m
16 bpjs 0001103634707 tn. Rianto
17 bpjs 0001103619227 tn. Sutopo
18 bpjs 0001109046014 ny. Tri ikayani
19 bpjs 0001103333409 tn. Wahyudi
20 bpjs 0001103335075 tn. Suprayitno u
21 bpjs 0001103511262 ny. Yohana
22 serma / 507693 tn. Suprayitno
23 29-Oct-14 bpjs 0001108831511 ny. Jatmi
24 bpjs 0001103463088 tn. Hasim t
25 bpjs 000128836812 an. Nyoman gilang
26 bpjs 0001103370175 tn. A. Rosyid
27 pelda / 518196 tn. Bambang
28 letkol / 520750 ny. Ninuk h
29 serka / 523671 tn. Dhani
30 bpjs 0001287617365 an. Dian p
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AYANAN
PERTAMA (RJTP)
TAHUN 2014
DIAGNOSA DIRUJUK
Pesitensi
Influenza
hipertensi
Influenza
haemoroid
ISPA
gastritis
hiperemi pulpa
periodontitis chronis
gangraena pulpa
impaksi
nyeri perut
myalgia
ISPA
appendix dirujuk
benjolan telinga dirujuk
furunkel aurikola
dermatitis
dirujuk
gastritis
gastritis
gingivitis
hiperemi pulpa
gangraena pulpa
hiperemi pulpa
hiperemi pulpa
gangraena pulpa
hiperemi pulpa
hiperemi pulpa
persistensi
LAPORAN PELAYANAN
BULAN DESEMBER TAHUN 2014

Alamat : Surabaya

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AYANAN
PERTAMA (RJTP)
TAHUN 2014
de
DIAGNOSA DIRUJUK

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LAPORAN PELAYANAN

RAWAT JALAN TINGKAT PERTAMA (RJTP)

NO TANGGAL NO KARTU PESERTA NAMA PESERTA

A.09 Gastroenteritis Surat rujukan

Hypertiroid Surat rujukan

Nama Faskes : PPK I Lanud Mulyono

NO TANGGAL NO KARTU PESERTA NAMA PESERTA DIAGNOSA

3 a/d serka Agustina/522632 An Rengganis E.56 Defisiensi vitamin

4 a/d Pelda Mardi/505829 An Berliani J.11 Influenza

5 4-Mar-14 PNS/197409151998032003 Ny Yohana H.82 Vertigo

6 i/d sertu Hadi/533971 Ny Eka Nur Hidayati Z.34 Kehamilan normal

7 a/d sertu Hadi/533971 an Najma Zakia J.11 Influenza

8 Peltu/ 514824 Tn Abdul Manaf N.39 Infeksi saluran kemih

9 a/d Sertu Rohadi? 522206 An Muhamad Azzam J.11 Influenza

10 PNS /196912101996032002 Ny Widwi Mico J.11 Influenza

11 5-Mar-14 Serka / 510115 Tn Sunarko J.11 Influenza

12 Sertu/ 518590 Tn Muhali J.11 Influenza

13 PNS/19620020219842003 Ny Untari J.11 Influenza

15 Peltu/ 514632 Ny Retno J.11 Influenza

16 i/d Kapten Harwoto/509575 Ny Diah Retno A.09 Diare

17 i/d PNS Subakat Ny Anggit Andayani Back Pain

18 Pelda / 506205 Tn Rachmad E.56 Defisisensi vitamin

19 a/d sertu Hendriyanto an Satria akbar saputra Imunisasi

21 PNS /196806181996 ny Dwi handini I.10 Hipertensi esential

22 a/d pelda sudarno an A satria D persistensi

23 6-Mar-14 Serda Tn Rudi L.25 Reaksi gigitan serangga

24 i/d serda Zainal Ny Hamsiah J.11 Influenza

25 i/d Pelda Syahroni/512750 Ny Mistiastuti J.11 Inluenza

26 6-Mar-14 Letkol/520750 Ny Ninuk Herlina E.10 Diabetes Mellitus

27 i/d serka Subekti/510110 Ny Farida Gangren pulpa

28 i/d pelda arifin/500408 Ny Hartini Periodontitis

29 pelda/506408 Tn Arifin Gangren Pulpa

30 a/d peltu Hendra/514905 NN Elita Pericoronitis

31 7-Mar-14 askes 00000988808636 Tn Abdul Jalil J.11 Influenza

32 a/d Mayor Eman/524422 An Adam Fauzan J.03 Tonsilitis

33 Peltu/509694 Tn Agus Suyono E.56 Defisisensi vitamin

34 1267713955 NY Tutik Suciatiningsih Hiperemi pulpa

35 1267714631 Nn Afina Truly Hiperemi Pulpa

36 Serma/509384 Tn Yantje Bawangun Hiperemi pulpa

37 a/d pelda retno/514632 An Rahmania safitri Persistensi

38 10-Mar-14 PNS/030207374 Tn Sukimin E.10 Diabetes mellitus

40 i/d kaprten Is andrai/513889 Ny Peni Budi kontrol ca

41 Kapten lek/513889 Tn Is andrai awan post opp craniotomi

42 i/d serda iwan Ny Juriah L.50 Urtikaria akut

44 a/d Pelda Syahroni/512420 Nn Bellarani Ginggivitis marginalis khronis

45 Peltu/509944 Tn Hamid Arifin Gangren pulpa

46 PNS/196001011983031014 Tn Subakat Gangren Radix

47 11-Mar-14 Serka/523759 Tn Afuad J.11 Influenza

48 Sertu/518590 Tn Muhali G.43 Migrain

49 a/d serma randjau/5512096 An Bima observasi febris

50 Serma Suwarno/511140 Tn Suwarno Post stroke

51 12-Mar-14 Peltu/ 506683 Tn Moch Nafik A.09 Diare

53 Mayor Sus/524430 Tn Sariffudin Tarigan Nyeri sendi

54 Peltu/509133 Tn Bambang Julianto J.11 Influenza

55 i/d mayor sus sarifudin/524430 Ny Syarmiati Nyeri sendi

56 13-Mar-14 a/d sertu Ali/515774 An M reyfan Nyeri sendi

57 a/d mayor kal Triyanto/506351 Nn Erika Tiara L.20 Dermatitis

58 i/d serma sigit/509327 Ny Rini Winarti Rawat luka KLL

59 Peltu/506408 Tn Arifin Bahrudin Gangren Pulpa

60 a/d serka Hadi/506064 An Bram Satriawan Gangren Pulpa

61 14-Mar-14 Serka/527807 Tn Yusuf wibisono J.11 Influenza

62 Serma/522632 Ny agustina J.11 Influenza