DATA RUJUKAN POLIKLINIK

PUSKESMAS CIBADAK BULAN APRIL 2018

No Nama No.BPJS L/P Diagnosa Asuransi

1 AZNAS SUHADA 47276199 L Nonspecific lymphadenitis BPJS
2 WAHYUDIN 801631337 L Chronic viral hepatitis B without delta-agent BPJS
3 TURNI 1051556804 P Impacted teeth BPJS
4 SUHADA 1295162662 L Respiratory tuberculosis, bacteriologically and histologically confirmed BPJS
5 MULYANAH 801736593 P Cellulitis of other parts of limb BPJS
6 JAYADI 1598029086 L Other allergic rhinitis BPJS
7 MURDIAH 801526678 P Congestive heart failure BPJS
8 NURHAYAH 801886239 P Other chronic obstructive pulmonary disease BPJS
9 PARDI 802051198 L Other chronic suppurative otitis media BPJS

10 ARIYA MANGUN YUDHA 2206821137 L Acute and transient psychotic disorders BPJS
11 SAYUTI 2428482071 L Pleural effusion, not elsewhere classified BPJS

Other diseases of the blood and blood-forming organs and certain

disorders involving the immune mechanism complicating pregnancy,
12 METI 801282339 P childbirth and the puerperium BPJS
13 LENI 801907233 P Maternal care for other abnormalities of gravid uterus BPJS
14 AHMAD HASAN 802206371 L Gastric ulcer BPJS
15 IJUDIN 1255283357 P Other superficial keratitis without conjunctivitis BPJS
16 IAN PERMANA 1263147939 L Thalassaemia BPJS
17 SALAM 800754772 L Hyperplasia of prostate BPJS
18 SUMI 801305368 P Corneal ulcer BPJS
19 IKA YUMASRIYANI 801591434 P Nephrotic syndrome BPJS
20 SUKAENI 801622653 P Cutaneous abscess, furuncle and carbuncle of other sites (TACC) BPJS
21 MAMAN 801939666 L Congestive heart failure BPJS
22 AHMAD PITUNG 802125448 L Glaucoma BPJS
23 SANTI 802653208 P Maternal care for known or suspected abnormality of pelvic organs BPJS
24 SARYANI 1051559223 L Ascites BPJS
25 SUHADA 1295162662 L Senile cataract BPJS
26 ENON 1892287528 P Psoriasis BPJS
27 JUMADI 2227887955 L Impacted teeth BPJS
28 IYAH 801617286 P Pneumonia due to other infectious organisms, not elsewhere classified BPJS
29 UTING 1051568526 L Acquired haemolytic anaemia BPJS
30 TUENI 1051568673 P Congestive heart failure BPJS
31 MAMAH 1324666653 P Rheumatic mitral valve diseases BPJS
32 MUHAMAD RIDWAN 2249131195 L Melaena BPJS
33 SURYADI 46805411 L Myopia BPJS
34 ABDUL ROHIM 800813237 L Deaf mutism, not elsewhere classified BPJS
35 IRMAWATI 801666213 P Genital varices in pregnancy BPJS
36 JOHARIAH 1051549547 P Chronic kidney disease BPJS
MOHAMAD RIFQI
37 ADILA 1387577709 L Thalassaemia BPJS
38 MUSTAHMIDIN 2085096554 L Acute atopic conjunctivitis BPJS
39 RASTI 801741251 P Congestive heart failure BPJS

40 RIDWAN IHWANUDIN 801546851 L Other spondylosis with myelopathy, lumbosacral region BPJS
41 CUCU ANISA 801586089 P Unspecified renal colic BPJS
42 MARYATI 802226081 P Senile cataract BPJS
43 ENDA 802947879 L Dental caries BPJS
44 TUSKAEPANA 47005716 L Foreign body on external eye BPJS
45 ABDUL ROHIM 800813237 L Deaf mutism, not elsewhere classified BPJS

46 ESIH 801136124 P Other specified diabetes mellitus with peripheral circulatory complications BPJS
47 UDING 801374949 L Congestive heart failure BPJS
48 MIMIN 801568258 P Pre-eclampsia, unspecified BPJS
49 MARSITI 801742511 P Maternal care due to uterine scar from previous surgery BPJS
50 YULIANTI 802384165 P Maternal care due to uterine scar from previous surgery BPJS
51 ITOY 1607291515 L Dyspepsia BPJS
52 SARMINAH 2127812117 P Other symptoms and signs involving cognitive functions and awareness BPJS
53 ROHADI 2298785297 L Other chronic obstructive pulmonary disease BPJS
54 SUHENI 800861872 P Urinary tract infection, site not specified BPJS
55 AHMAD SAYUTI 801537063 L Neoplasm of uncertain or unknown behaviour, unspecified BPJS
56 NASRUDIN 801787577 P Dental caries BPJS
57 SULEHA 801789862 P Chronic viral hepatitis B with delta-agent BPJS
58 RASIM 801793326 L Other specified headache syndromes BPJS
59 SUKAESIH 801813699 P Prolonged pregnancy BPJS
60 SRI MULYATI 801968488 P Haemorrhage in early pregnancy, unspecified BPJS
61 DEDEH 802141345 P Keratoconjunctivitis (TACC) BPJS
62 ANISAH 802181766 P Maternal care due to uterine scar from previous surgery BPJS
63 AANG 802624735 L Schizophrenia BPJS
64 JOHARIAH 1051549547 P Chronic kidney disease BPJS
65 PAUDIN 1451402695 L Chronic laryngitis BPJS
66 JAYADI 1598029086 L Other allergic rhinitis BPJS
67 SAYUTI 2428482071 L Pleural effusion, not elsewhere classified BPJS
68 SULEHA 801789862 P Single delivery by caesarean section BPJS
Other respiratory tuberculosis, without mention of bacteriological or
69 SULASTRI 1769897968 P histological confirmation BPJS

70 RIDWAN IHWANUDIN 801546851 L Spondylosis, unspecified, lumbosacral region BPJS

71 ASIH 802009449 P Keloid scar BPJS
72 BASRI 802034774 L Haematemesis BPJS
73 ARSYILA SHAFANA 2439544184 P Candidal stomatitis BPJS
74 RISKA MARSELA 801223931 P Fever, unspecified BPJS
75 JARIAH 802248434 P Chronic obstructive pulmonary disease, unspecified BPJS
76 IROH 802325013 P Prolonged pregnancy BPJS
77 ANDRIYANSAH 1051568504 L Gastroenteritis and colitis of unspecified origin BPJS
78 SUMINTA 2045713792 L Hemiplegia, unspecified BPJS
79 SUHAEMAH 2286564748 P Nephrotic syndrome, unspecified BPJS
80 IROT 2288768905 P Gastric ulcer, chronic or unspecified with perforation BPJS
81 SUTISNA 801463375 L Congestive heart failure BPJS
82 ADE PERMADI 801820089 L Bacterial meningitis, not elsewhere classified BPJS
83 IJAH 801857125 P Systemic lupus erythematosus BPJS
84 ITIK UPRIAH 1267374609 P Polyarthritis, unspecified BPJS
85 M. BAIS AL-FATHU 2081118903 L Epilepsy, unspecified BPJS
86 ARYANAH 47004221 P Neoplasm of uncertain or unknown behavior of thyroid gland BPJS
87 ROHYATI 801666167 P Nasal polyp BPJS
88 ROSNA AULIANA 801715757 L Chronic laryngitis BPJS
89 KALSIAH 802013477 P Abscess of tendon sheath, ankle and foot BPJS
90 LINA SURYANI 1377228115 P Haemorrhage in early pregnancy BPJS
91 JAYADI 1598029086 L Other allergic rhinitis BPJS
92 SITI HERAWATI 801851275 P Unspecified nonorganic psychosis BPJS
93 SULAESNI 1051561326 P Cervical root disorders, not elsewhere classified BPJS
94 MUHAMAD TIALI 1265607729 L Epilepsy BPJS
Examination for normal comparison and control in clinical research
95 IRFAN MAULANA 2229182987 L programme BPJS
96 HARYATI 801843434 P Other extrapyramidal and movement disorders BPJS
97 JANAH 802366918 P Congestive heart failure BPJS
98 SUMIYATI 803081428 P Abnormal uterine and vaginal bleeding, unspecified BPJS
99 SURWANTA 1383401441 L Lumbar and other intervertebral disc disorders with radiculopathy BPJS
100 SITI RODIAH 2080485753 P Disorders of multiple cranial nerves BPJS
101 JUMI 2315888818 P Other intervertebral disc disorders BPJS
102 ANA 801366974 P Dental caries BPJS
103 RAMLI 801479261 L Other chest pain BPJS

104 RIDWAN IHWANUDIN 801546851 L Spondylosis, unspecified, lumbar region BPJS

105 SUKANDI 801638199 L Congestive heart failure BPJS

106 MILA AMALIA SIREGAR 1597955365 P Other congenital malformations of heart BPJS
107 JAYADI 1598029086 L Typhoid fever (TACC) BPJS
108 HARIMAN SIREGAR 2242391782 L Malignant neoplasm of colon BPJS
109 NUNUNG 2428977238 P Dyspepsia BPJS
110 INDAR YULIATI 2442394304 P Nasal polyp BPJS
111 NAMI 800650089 P Other specified heart block BPJS
112 AHMAD SAYUTI 801537063 L Neoplasm of uncertain or unknown behavior of other specified sites BPJS
113 DURIAH 801592187 P Other diseases of anus and rectum BPJS
114 SUKAENI 801622653 P Abscess of tendon sheath, lower leg BPJS
115 IRMAWATI 801666213 P Varicose veins of lower extremity in pregnancy BPJS
116 KAMDAH 801875924 P Other chronic obstructive pulmonary disease BPJS
117 SAMSIAH 801988953 P Other specified diabetes mellitus with neurological complications BPJS
118 BASRI 802034774 L Essential (primary) hypertension (TACC) BPJS
119 ARNI 802072394 P Vascular syndromes of brain in cerebrovascular diseases BPJS
120 LIRAWATI 802273364 P Dental caries BPJS
121 ENAH 1483458478 P Vertiginous syndromes in diseases classified elsewhere BPJS
122 HENI HANDAYANI 2274939292 P Other chronic nonsuppurative otitis media BPJS
123 SUHENAH 801630639 P Other chronic cystitis BPJS
124 IDA RUSTIANA 1051548557 P Embedded and impacted teeth BPJS
125 ASIH TRI MULYANI 1176016904 P Severe depressive episode with psychotic symptoms BPJS
126 ENAH 1483458478 P Vertiginous syndromes in diseases classified elsewhere BPJS
127 DEDE 1786155715 L Paranoid schizophrenia BPJS
128 MASAMAH 2128585915 P Maternal care due to uterine scar from previous surgery BPJS
129 DARSO'AH 2314949411 P Hypertensive heart disease BPJS
130 NUNUNG 2428977238 P Congestive heart failure BPJS
131 PADRI 47002937 L Dysphasia and aphasia BPJS
132 ABDUL ROHIM 800813237 L Disorders of initiating and maintaining sleep [insomnias] (TACC) BPJS
133 KOSIN 801728728 L Urinary tract infection, site not specified (TACC) BPJS
134 MARSITI 801742511 P Maternal care for other conditions predominantly related to pregnancy BPJS
135 AAN 802081877 P Other specified diabetes mellitus with other specified complications BPJS
136 ANAH 802235439 P Senile cataract BPJS
137 MARNI 803003591 P Senile cataract BPJS
138 IPHAN HADIYANTI 1266715089 L Thalassaemia BPJS
139 SURWANTA 1383401441 L Other intervertebral disc disorders BPJS
140 LILIS 1598031178 P Neoplasm of uncertain or unknown behavior of thyroid gland BPJS
Other respiratory tuberculosis, without mention of bacteriological or
141 SULASTRI 1769897968 P histological confirmation BPJS
142 ENON 1892287528 P Psoriasis BPJS
143 RUMSI 2209911647 P Unspecified haematuria BPJS
144 AZKIYA 2293756479 P Pneumonia, organism unspecified BPJS
145 JUMI 2315888818 P Other intervertebral disc disorders BPJS
146 SAYUTI 2428482071 L Pleural effusion, not elsewhere classified BPJS
UMUM
147 RATNAWATI P Susp. TB paru (sktm)
UMUM
148 SITI MASITOH P Limfadenopati Kronis (sktm)
149 JAYADI L Rhinitis Alergi UMUM
150 ARYAMAN L Neoplasm of hyroid UMUM
UMUM
(JAMPERSA
151 JUBAEDAH P G6P5A0 H 40 minggu Hipertensi Kronis L)
152 JUMI L Susp fraktur reg Pedis UMUM
UMUM
153 EMI P SNNT (sktm)
 DATA RUJUKAN IGD
PUSKESMAS CIBADAK BULAN APRIL 2018

No. Tanggal Nama Diagnosa Asuransi

1 4/5/2018 Siti Amelia. 13th Prolonged febris, susp. SSJ umum
2 4/16/2018 Pipit, 2 th Prolonged febris, penurunan kesadaran umum
 DATA RUJUKAN PERSALINAN
PUSKESMAS CIBADAK BULAN APRIL 2018

No. Tanggal Nama Diagnosa BPJS/KIS Umum Jampersal

1 4/14/2018 Ny Amnah G5P4A0 H 38 minggu letak obliq 0002441870469
2 4/21/2018 Ny Uriah G3P2Ao H aterm Kala I fase laten + KPD BPJS
3 4/23/2018 Ny Mamah G2P1A0 Ab. Inkomplit 0001051562597
4 4/9/2018 Ny Arsonah G2P1A0 H 42 minggu + oligohidramnion jampersal
5 4/20/2018 Ny Nurheti G2P1A0 H 30 minggu + KPD + PPI jampersal
6 4/18/2018 Ny Wawat G6 P5 A0 H aterm kala I fase laten + KPD jampersal
7 4/25/2018 Ny Dewi G1P0A0 H aerm kala II lama 0002265069655
 CAKUPAN PELAYANAN KESEHATAN RUJUKAN
PUSKESMAS CIBADAK BULAN APRIL 2018

STATUS KEPESERTAAN RINGKASAN

NO UNIT TOTAL KASUS KASUS
UMUM JKN JAMPERSAL RUJUKAN
1 BP Umum 7 146 - 153
2 IGD 2 - - 2
3 Persalinan - 4 3 7
TOTAL 162

Cibadak, Mei 2018

Pengelola Rujukan Kepala Puskesmas Cibadak

dr.Nida Nurhanifah H.Uun Sunarya, SKM

NIP.196310051985011002