Laporan Prolanis DM

STATUS
NO NAMA NO KARTU BPJS JENIS PESERTA TGL RUJUK BALIK JK

P/I/S/A
1 A M PRIYATNA 0000058940605 P PRB & PROLANIS L
2 AI TIN M 0000056393662 I PRB & PROLANIS 9/28/2018 P
3 ALI SUTANTO 0001313721549 P PRB & PROLANIS L
4/23/2018
4 AMRIZAL 0001265109772 P PRB & PROLANIS 4/23/2018 L
5 AMYLIA TJIPTO 0001310150834 I PRB & PROLANIS 4/23/2018 P
6 AWAN SUWANDI 0001258922305 P PRB & PROLANIS L
7 BARKAH GULATRO 0001807784897 meninggal PRB & PROLANIS L
8 DAYAT 0001459004038 P PRB & PROLANIS 9/28/2018 L
9 DEDY SURAPATI 0001258997308 P PRB & PROLANIS L
10 DJUDJU SUPARMAN 0001421856573 P PRB & PROLANIS 27-09-208 L
11 EDY HARYANTO 0001425902769 P PRB & PROLANIS L
12 EMIYATI 0001455072478 I PRB & PROLANIS P
9/26/2018
13 ENANG KUSMANA 0001301722007 P PRB & PROLANIS L
9/26/2018
13 ENANG KUSMANA 0001301722007 P PRB & PROLANIS L
9/26/2018
14 ETI KARTINAH 0001188015017 I PRB & PROLANIS L
15 EUIS HERYATI 0000053762962 I PRB & PROLANIS 8/16/2018 P
16 EUIS KURAESIN 0001421848214 I PRB & PROLANIS 4/19/2018 P
17 EUIS MUJIWATI 0001446323826 I PRB & PROLANIS P

9/27/2018
18 FRANCISCUS SULAEMAN 0001464246832 P PRB & PROLANIS L
19 HERLIN SUHARLINA 0001445105068 I PRB & PROLANIS P
20 HERIYANA 0001450763897 P PRB & PROLANIS L
21 HERLINA 0001183715504 P PRB & PROLANIS P
22 IMAS SAODAH 0001442461263 I PRB & PROLANIS 9/27/2018 P
23 JAJA JAELANI 0001288595147 P PRB & PROLANIS L
24 KULSUM SUMINARSIH 0000058940616 I PRB & PROLANIS 24/04/2018 P
25 KUSNANDAR 0000057982869 P PRB & PROLANIS 4/23/2018 L
26 KWEE HA LAN 0001875600178 I PRB & PROLANIS P
8/18/2018
27 LILIS SUMIATI 0001324558833 I PRB P
28 LIOE JIE NO 0001339395412 I PRB & PROLANIS P

29 LIZAN FAUZAN 0001830953889 P PRB & PROLANIS L
30 MAMAN SUPARMAN 0001454727712 P PRB & PROLANIS L
31 N ITING 0001856038138 P PRB & PROLANIS L

TTL DIAGNOSA NO TELP/HP NAMA OBAT SIGNA JUMLAH
METFORMIN 500MG 3X1 90

04/03/1947 DM + HT 081315909377
AMLODIPINE 5MG 1X1 30
ACARBOSE 50 MG 3X1 90
02/10/1953 DM + HT 081394443646
SIMVASTATIN 20MG 1X1 30
DIOVAN 80MG 1X1 30
26/04/1959 DM + HT 085100557654
ASPILET 80MG 1X1 30
GLIMEPIRIDE 2MG 1X1 30
29/11/1949 DM 087825673255
16/11/1943 DM 022 6031507
IRBESARTAN 150MG 1X1 30
022 GLIMEPIRIDE 2MG 1X1 30
28/06/1949 DM + HT 5421708/08121492840
5 SIMVASTATIN 20MG 1X1 30
ACETOSAL 100MG 1X1 30
meninggal DM + HT 081367420425 SIMVASTATIN 20MG 1X1 30
02286061875/0813228
14/08/1962 DM + HT RAMIPRIL 5MG 1X1/2 15
12832
30/12/1953 DM + HT 082128801322
LISINOPRIL 5MG 1X1 30
ACARBOSE 100MG 1X1 30
022
08/04/1939 DM + HT METFORMIN 500MG 3X1 90
5230036/0817434475
FENOFIBRATE 200 1X1 30
HARNAL0,4 1X1 30
0226019937/08132213 GLIMEPIRIDE 1MG 1X1 30
12/06/1947 DM + HT 3478 IRBESARTAN 150MG 1X1 30
03/03/1960 DM + HT 081809298949 AMLODIPINE 5MG 1X1 30
ASPILET 80MG 1X1 30
GLIBENCLAMIDE 5MG 1X1 30
01/05/1953 DM 085294588082
01/05/1953 DM 085294588082
10/01/1958 DM + HT 081223684474 METFORMIN 500MG 2X1 60
25/06/1953 DM + HT 08122115126 ACARABOSE100 MG 3X1 90
GLIBENCLAMIDE 5MG 2X1 60
05/11/1956 DM + HT 081214148154 RAMIPRIL 5MG 1x1 30
13/01/1959 DM 085624224474 SIMVASTATIN 20MG 1x1 30
CAPTOPRIL 25MG 2X1 60
11/3/1957 DM + HT 081223936990 GLIMEPIRIDE 1MG 1X1 30
03/08/1960 DM + HT GLIBENCLAMIDE 5MG 1X2 60
21/08/1975 DM 081809740900
15/04/1954 DM + HT 081321317779
02/03/1947 DM + HT 081320287163
CONCOR 2,5MG 1X1 30
20/08/1955 DM + HT 081310015399
ASPILET 80MG 1X1 30
21/03/1968 DM 08164209757
ISDN 5MG 1X1 30
08588888918/0821800 GLIMEPIRIDE 4MG 1X1 30
20/07/1965 DM + HT 087722492227
meninggal DM + HT 081572999628
meninggal DM + HT 087825262636
16/07/1966 DM + HT 082240898870
15/05/1967 DM + HT 081321751844
JENIS
NO KANTOR CABANG KODE KC NAMA PESERTA NO KARTU
KELAMIN
1 KCU BANDUNG A M PRIYATNA 0000058940605 L

2 KCU BANDUNG AI TIN M 0000056393662 P
3 KCU BANDUNG ALI SUTANTO 0001313721549 L
4 KCU BANDUNG AMRIZAL 0001265109772 L
5 KCU BANDUNG AMYLIA TJIPTO 0001310150834 P
6 KCU BANDUNG AWAN SUWANDI 0001258922305 L
7 KCU BANDUNG BARKAH GULATRO 0001807784897 L
8 KCU BANDUNG DAYAT 0001459004038 L
9 KCU BANDUNG DEDY SURAPATI 0001258997308 L
10 KCU BANDUNG DJUDJU SUPARMAN 0001421856573 L
11 KCU BANDUNG EDI HARYANTO 0001425902769 L
12 KCU BANDUNG EMIYATI 0001455072478 P
13 KCU BANDUNG ENANG KUSMANA 0001301722007 L
14 KCU BANDUNG ETI KARTINAH 0001188015017 L
15 KCU BANDUNG EUIS HERYATI 0000053762962 P
16 KCU BANDUNG EUIS KURAESIN 0001421848214 P
17 KCU BANDUNG EUIS MUJIWATI 0001446323826 P
18 KCU BANDUNG FRANCISCUS SULAEMAN 0001464246832 L
19 KCU BANDUNG HERLIN SUHARLINA 0001445105068 P
20 KCU BANDUNG HERIYANA 0001450763897 L
21 KCU BANDUNG HERLINA 0001183715504 P
22 KCU BANDUNG IMAS SAODAH 0001442461263 P
23 KCU BANDUNG JAJA JAELANI 0001288595147 L
24 KCU BANDUNG KULSUM SUMINARSIH 0000058940616 P
25 KCU BANDUNG KUSNANDAR 0000057982869 L
26 KCU BANDUNG KWEE HA LAN 0001875600178 P
27 KCU BANDUNG LILIS SUMIATI 0001324558833 P
28 KCU BANDUNG LIOE JIE NO 0001339395412 P
29 KCU BANDUNG MAMAN SUPARMAN 0001454727712 L
30 KCU BANDUNG N ITING 0001856038138 L
KODE FASKES BULAN MULAI DIAGNOSA
P / I / S/A NAMA FASKES PRIMER IMT
PRIMER TERDAFTAR
(Kg/m2)
P KLINIK AFIATI 0135U011 DM + HT

I KLINIK AFIATI 0135U011 DM + HT
P KLINIK AFIATI 0135U011 DM + HT 23.7954
P KLINIK AFIATI 0135U011 DM 19.0311
I KLINIK AFIATI 0135U011 DM
I KLINIK AFIATI 0135U011 DM + HT 36.6991
I KLINIK AFIATI 0135U011 DM
P KLINIK AFIATI 0135U011 DM
I KLINIK AFIATI 0135U011
P KLINIK AFIATI 0135U011 23.8751
Jan-18
HBA1C HBA1C CHOL CHOL

TB BB GDP GDPP GDS (IFCC) (NGSP) KREATIN LDL HDL
IN
60
164 64 114 151

170 55 138 177
153 72 246 228

170 100 88 114
155 55 143 170
170 68 96 96
153 59 106 162
168 58 112 172
142 74 119 96
168 76 150 262
152 53 129 161
160 55 239 224
150 49 191 181
157 76 223 323

168 72 99 242
160 78 95 90
160 58 93 88
165 60 133 134
165 65 180 234

Feb-18
TEK. DARAH
IMT HBA1C
TRIGLISE TB BB GDP GDPP GDS
(Kg/m 2)
(IFCC)
RIDA SISTOLE DIASTOL
E
120 80
25.6837 145 54 269 379
23.7954 164 64 105 149
120 80 20.7612 170 60 140 147
24.6904 161 64 163 196
110 80 31.6118 153 74 260 229
140 100
130 80 25.8065 155 62 166 187
140 90
100 60 25.204 153 59 124 209
120 80 20.1956 168 57 86 80
140 90
140 80 26.5731 168 75 164 155
130 80 23.3726 152 54 150 152
160 90
130 80
130 80
120 80 25.5102 168 72 110 132
130 80 30.4688 160 78 88 80

110 80 23.0469 160 59 83 84
110 70 22.0386 165 60 120 133
31.3912 145 66 144 204
Feb-18
TEK. DARAH
HBA1C CHOL CHOL TRIGLISE IMT
(NGSP) KREATIN TB BB
LDL HDL (Kg/m 2)
IN RIDA SISTOLE DIASTOL
E
22.6563 160 58
170 100 26.1593 145 55
130 80 23.7954 164 64
110 80 20.0692 170 58
130 100 24.6904 161 64
150 110
34.9481 170 101
130 80
23.5294 170 68
100 70 25.204 153 59
150 100 20.1956 168 57
36.6991 142 74
130 90 26.5731 168 75
110 80 23.8054 152 55
20.202 165 55
21.6333 172 64
120 80 25.5102 168 72

29.5525 155 71
110 80 0 160
120 80 22.6563 160 58
100 80 23.1405 165 63
120 80 33.2937 145 70
Mar-18
TEK. DARAH
HBA1C HBA1C CHOL CHOL TRIGLISE
GDP GDPP GDS (IFCC) (NGSP) KREATIN LDL HDL
IN RIDA SISTOLE
94 115 110
213 263 130
109 145 120
118 136 110
193 231 140
105 105 120
97 95 160
112 165 110
84 127 140
128 154 120
127 174 120
132 152 110
126 132 110

97 123 110
111 148
225 364
97 77 110
115 146 100
188 195 120
Apr-18
TEK. DARAH
IMT HBA1C HBA1C
TB BB GDP GDPP GDS
DIASTOL (Kg/m 2)
(IFCC) (NGSP) KREATIN
IN
E
70
80 26.1593 145 55 188 374
80 24.539 164 66 75 143 5.8 40
70 20.0692 170 58 110 192 8 64
80 24.6904 161 64 133 123
30.7574 153 72 171 253
80 35.2941 170 102 72 88
25.8065 155 62 89 131
100 23.5294 170 68
70 26.9127 153 63 127 174 6.9 52
80 20.1956 168 57
80 36.6991 142 74 101 120
80 26.2188 168 74 163 235 6.9 52
80 23.3726 152 54 117 156 7.4 57
22.6563 160 58 293 318
21.7778 150 49 98 188
80 19.8347 165 54 167 211
70
30.8329 157 76 184 208
25.5102 168 72 121 141
29.5525 155 71 225 364
34.6021 153 81 307 223
70 22.2656 160 57 78 94 6.4 46

70 22.4059 165 61 112 156 6.7 50
80 33.7693 145 71 146 212
24.2568 145 51 210 362
27.8488 148 61 134 207

Ma
TEK. DARAH
CHOL CHOL TRIGLISE IMT
TB BB GDP GDPP
LDL HDL (Kg/m 2)
E
19.5313 160 50 96 179
130 80 26.1593 145 55 186 254
130 80 24.3865 162 64 81 79
110 70 20.4152 170 59 117 107
150 80 #DIV/0!
130 80 32 150 72 170 214
120 80 #DIV/0!
130 80 #DIV/0!
140 80 22.5306 175 69 97 107
130 80 26.9127 153 63 133 208
23.7387 168 67
120 80 #DIV/0!
130 80 26.2188 168 74 130 135
120 80 22.9398 152 53 114 111
160 80 22.6563 160 58 316 346
120 80 23.5556 150 53 101 152
120 80 #DIV/0!
21.2953 172 63 94 95
120 80 30.4272 157 75 172 279
140 90 #DIV/0!
120 80 #DIV/0!
140 90 #DIV/0!
30.0781 160 77 103 99
120 80 22.2656 160 57 118 112
120 80 22.0386 165 60 130 123
120 80 #DIV/0!
#DIV/0!
140 90 #DIV/0!
23.8751 165 65 428 415
130 80 #DIV/0!
May-18
TEK. DARAH
HBA1C HBA1C CHOL CHOL TRIGLISE IMT
GDS (IFCC) (NGSP) KREATIN LDL HDL (Kg/m2)
E
120 80 19.5313
140 80
130 90 23.8751
130 90 14.8789
130 80
140 90 22.5306
130 80 23.1405
120 80 27.0993
120 80 21.2279
130 90
120 80
110 70 26.6389
120 80
140 80
120 80 22.6563
110 70 22.0386
24.2215
120 80 23.8751
Jun-18

IN
160 50 105 182
165 65 96 83
170 43 111 143
175 69 101 99
165 63 73 189
163 72 194 398

155 51 133 179
168 58
155 64
160 58 110 152

165 60 119 167
170 70 221 282
165 65 151 185

Jul-18
TEK. DARAH
IMT HBA1C
(Kg/m 2)
(IFCC)
E
130 80 19.5313 160 50 107 149
24.7325 145 52 63
120 80 23.5078 165 64 60
90 60 14.8789 170 43 113
24.6904 161 64 122
31.1111 150 70 229 365
25.8065 155 62 160

120 80 22.5306 175 69 94 92
120 80 23.1405 165 63 150
20.1956 168 57 92
130 90 27.852 163 74 143

120 80 21.2279 155 51 145
20.5499 168 58 413
26.2222 150 59 94
130 90 26.6389 155 64 100 123

29.6158 157 73 173
23.7387 168 67 115
29.5525 155 71 230 354
30.0781 160 77 96
110 80 22.6563 160 58 123 183
110 70 22.0386 165 60 134
120 80 24.2215 170 70 214
130 80
Jul-18
TEK. DARAH
LDL HDL (Kg/m2)
E
120 80 20 150 45
140 90 25.7885 142 52
120 80 23.5078 165 64
100 80 14.8789 170 43
100 80 28.4444 150 64
100 80 31.1111 150 70
130 80 25.8065 155 62

120 80 22.5306 175 69
120 80 19.4674 165 53
110 80 20.1956 168 57
37.195 142 75
120 80 27.852 163 74
130 80 21.2279 155 51
120 80 20.5499 168 58
110 80 26.2222 150 59
110 80
120 80
110 80
130 80
34.6021 153 81
130 80
120 80 22.6563 160 58
100 80 22.4059 165 61
120 80 33.7693 145 71
28.3053 148 62
Aug-18
TEK. DARAH
IN RIDA SISTOLE
100 120
111 140
93 150
111 150
205 120
208 140
157 120
97 140
179 120
101 120
112 140
172 110
141 120
310 130
177 150
240 150
116 120
123 120
192 120
123 120
Sep-18
TEK. DARAH
IMT HBA1C HBA1C
TB BB GDP GDPP GDS
DIASTOL (Kg/m 2)
IN
E
80 20 150 45 40 5.8 1.11
90 25.7885 142 52 79 9.4 0.78
90 25.3906 160 65 43 6.1 0.9
100 14.8789 170 43 57 7.4 0.69
80
90 31.1111 150 70 105 11.8 1.35
80 25.8065 155 62 80 9.5 1.06

90 22.5306 175 69 40 5.8 3.5
80 19.4674 165 53 66 8.2 1
90 20.1956 168 57 54 7.1 1.22
90 37.195 142 75 54 7.1 0.54
80 27.852 163 74 74 8.9 1.1
90 21.2279 155 51 53 7 0.7
90 20.5499 168 58 76 9.1 0.57
90 25.7778 150 58 60 7.6 1.05
19.8347 165 54 76 9.1 0.6
90 34.6021 153 81 75 9 0.85
80 22.6563 160 58 53 7 0.6

90 22.4059 165 61 52 6.9 1.06
80 31.3912 145 66 76 9.1 0.54
90
Oct-18
TEK. DARAH
CHOL CHOL CHOL TRIGLISE IMT
TB BB GDP
LDL HDL TOTAL (Kg/m2)
E
129 51 190 123 130 80 20 150 45 109
140 140 220 225 140 80 26.2845 142 53 256
102 43 151 68 140 100 25.3906 160 65 101
111 56 170 85 100 80 14.8789 170 43 133
28.8889 150 65 213
156 43 232 270 120 80 31.1111 150 70 194
171 38 231 235 130 90 24.5578 155 59 110

95 37 143 135 130 90 22.5306 175 69 109
102 54 180 216 120 80 19.4674 165 53 140
107 47 149 43 100 70 20.5499 168 58 125
231 48 294 146 170 110 37.195 142 75
126 45 178 140 130 90 27.852 163 74 224
112 83 198 94 120 80 21.2279 155 51
132 47 207 227 120 80 20.5499 168 58 158
203 72 280 155 130 80 25.7778 150 58 198
160 56 225 150 130 80 19.4674 165 53 150
74
190 50 263 210 140 90 34.6021 153 81
94 81 176 73 110 80 22.6563 160 58 127

145 51 195 74 120 80 22.0386 165 60 127
98 55 175 203 120 80 33.2937 145 70 190
Oct-18 Nov-18
TEK. DARAH TEK. DARAH
GDPP GDS IMT TB BB GDP
SISTOLE DIASTOL (KG/M2) SISTOLE DIASTOL
E E
26.2222 150 59 89 130 80
120 90 26.2845 142 53 367 120 90
120 80 25.7813 160 66 85 140 80
110 80
130 80 28.8889 150 65 149 130 80
130 80 31.1111 150 70 167 130 80
130 80
150 90 22.5306 175 69 92 150 90
130 80 23.5078 165 64 174 120 80
110 70 20.5499 168 58 90 120 90
27.852 163 74 159 120 80

20.8117 155 50 92 110 80
110 80 20.5499 168 58 141 110 80
120 80 25.7778 150 58 160 120 80
130 80
21.6441 155 52 110 110 80
26.2188 168 74 91 130 80
22.6563 160 58 92 130 90

110 80 22.3081 164 60 125 100 80
120 80 33.2937 145 70 189 120 80
22.4059 165 61 187

27.8488 148 61 131
Dec-18
TEK. DARAH
IMT
TB BB GDP GDPP
(Kg/m2) SISTOLE DIASTOL
E
26.2845 142 53 148 140 80

25.7813 160 66 122 120 80
15.5709 170 45 114 110 80
28.8889 150 65 164 120 80
32 150 72 173 150 80
24.5578 155 59 129 130 80

22.5306 175 69 140 90
23.5078 165 64 135 120 90
19.487 168 55 106 100 70
25.2363 158 63 158 110 70

20.8117 155 50 127 110 70
23.03 168 65 227 140 80
23.5556 150 53 150 130 80
26.2227 155 63 130 80

24.4898 175 75 194 120 80
26.2188 168 74 112 130 90
22.8928 155 55 120 80

22.3081 164 60 124 110 70
33.2937 145 70 169 130 80
JENIS
NO KANTOR CABANG KODE KC NAMA PESERTA NO KARTU
KELAMIN
1 KCU BANDUNG A M PRIYATNA 0000058940605 L

2 KCU BANDUNG AI TIN M 0000056393662 P
3 KCU BANDUNG ALI SUTANTO 0001313721549 L
4 KCU BANDUNG AMRIZAL 0001265109772 L
5 KCU BANDUNG AMYLIA TJIPTO 0001310150834 P
6 KCU BANDUNG AWAN SUWANDI 0001258922305 L
7 KCU BANDUNG DAYAT 0001459004038 L
8 KCU BANDUNG DEDY SURAPATI 0001258997308 L
9 KCU BANDUNG DJUDJU SUPARMAN 0001421856573 L
10 KCU BANDUNG EDI HARYANTO 0001425902769 L
11 KCU BANDUNG EMIYATI 0001455072478 P
12 KCU BANDUNG ENANG KUSMANA 0001301722007 L
13 KCU BANDUNG ETI KARTINAH 0001188015017 L
14 KCU BANDUNG EUIS HERYATI 0000053762962 P
15 KCU BANDUNG EUIS KURAESIN 0001421848214 P
16 KCU BANDUNG EUIS MUJIWATI 0001446323826 P
17 KCU BANDUNG FRANCISCUS SULAEMAN 0001464246832 L
18 KCU BANDUNG HERLIN SUHARLINA 0001445105068 P
19 KCU BANDUNG HERIYANA 0001450763897 L
20 KCU BANDUNG HERLINA 0001183715504 P
21 KCU BANDUNG IMAS SAODAH 0001442461263 P
22 KCU BANDUNG JAJA JAELANI 0001288595147 L
23 KCU BANDUNG KULSUM SUMINARSIH 0000058940616 P
24 KCU BANDUNG KUSNANDAR 0000057982869 L
25 KCU BANDUNG KWEE HA LAN 0001875600178 P
26 KCU BANDUNG LILIS SUMIATI 0001324558833 P
27 KCU BANDUNG LIOE JIE NO 0001339395412 P
28 KCU BANDUNG MAMAN SUPARMAN 0001454727712 L
29 KCU BANDUNG N ITING 0001856038138 L
Jan
KODE FASKES BULAN MULAI DIAGNOSA
P / I / S/A NAMA FASKES PRIMER IMT
PRIMER TERDAFTAR
(Kg/m2)

I KLINIK AFIATI 0135U011 DM 28.8889
P KLINIK AFIATI 0135U011 DM + HT 32
I KLINIK AFIATI 0135U011 DM + HT #DIV/0!
I KLINIK AFIATI 0135U011 DM #DIV/0!
P KLINIK AFIATI 0135U011 DM + HT #DIV/0!
P KLINIK AFIATI 0135U011 DM #DIV/0!
I KLINIK AFIATI 0135U011 #DIV/0!
P KLINIK AFIATI 0135U011 23.8751
Jan-19 Feb-19
IMT
TB BB GDP TB BB GDP
SISTOLE DIASTOLE (Kg/m2) SISTOLE
150 59 98 120 80 26.6667 150 60 98 110

142 53 266 120 80 26.7804 142 54 234 120
160 66 97 120 80 26.1719 160 67 123 110
170 45 101 100 60 15.5709 170 45 122 110
150 65 168 110 80 28.8889 150 65 160 120
150 72 155 120 80 32 150 72 177 120
155 59 186 130 80 #DIV/0!
175 69 104 120 80 22.5306 175 69 93 130
165 64 131 120 80 23.5078 165 64 193 140
168 55 38 110 80 19.487 168 55 106 120
#DIV/0!
158 63 193 120 80 25.2363 158 63 411 120
155 50 114 120 80 21.2279 155 51 127 100
168 65 218 120 80 20.5499 168 58 286 150
150 53 115 120 80 24.4444 150 55 147 140
#DIV/0!
#DIV/0!
31.6337 155 76 182 130
168 74 106 120 80 26.9274 168 76 124 120
22.8928 155 55 253 120
#DIV/0!
#DIV/0!
155 55 103 100 80 22.8928 155 55 98 120
164 60 132 110 70 22.3081 164 60 147 110
145 70 185 130 80 33.2937 145 70 220 120
#DIV/0!
#DIV/0!
165 65 294 130 80 23.8751 165 65 267 130
25.8065 155 62 105 120
Mar-19
TEK. DARAH
IMT HBA1C HBA1C
TB BB GDP GDPP GDS
DIASTOL (Kg/m 2)
IN
E
80
80
80
80
80
80
90
90
80
80
80
90
70
80
80
80
80
80
80
80
80
Ap
TEK. DARAH
TB BB GDP GDPP
LDL HDL (Kg/m 2)
E
Apr-19
TEK. DARAH
HBA1C HBA1C CHOL CHOL TRIGLISE IMT
GDS (IFCC) (NGSP) KREATIN LDL HDL (Kg/m 2)
E
May-19

IN
Jun-19
TEK. DARAH
IMT HBA1C
(Kg/m 2)
(IFCC)
E
Jun-19
TEK. DARAH
LDL HDL (Kg/m 2)
E
Jul-19
TEK. DARAH
IN RIDA SISTOLE
Aug-19
TEK. DARAH
IMT HBA1C HBA1C
TB BB GDP GDPP GDS
DIASTOL (Kg/m 2)
IN
E
TEK. DARAH
TB BB GDP GDPP
LDL HDL (Kg/m 2)
E
Sep-19
TEK. DARAH
HBA1C HBA1C CHOL CHOL CHOL TRIGLISE
GDS (IFCC) (NGSP) KREATIN LDL HDL TOTAL
E
Oct-19 Nov-19
TEK. DARAH
IMT
TB BB GDP GDPP GDS IMT TB
(Kg/m2) SISTOLE DIASTOL (KG/M2)
E
Nov-19 Dec-19
IMT
BB GDP TB BB GDP GDPP
SISTOLE DIASTOL (Kg/m 2)
SISTOLE
E
TEK. DARAH
DIASTOL
E
BULAN TEK. DARAH
NAMA PESERTA NO KARTU MULAI DIAGNOSA TTD HADIR TTD OBAT
TERDAFTAR TB BB GDP GDPP
SISTOLE DIASTOL
E
A M PRIYATNA 0000058940605 DM + HT
AI TIN M 0000056393662 DM + HT
ALI SUTANTO 0001313721549 DM + HT
AMRIZAL 0001265109772 DM
AMYLIA TJIPTO 0001310150834 DM
AWAN SUWANDI 0001258922305 DM + HT
BARKAH GULATRO 0001807784897 DM + HT
DAYAT 0001459004038 DM + HT
DEDY SURAPATI 0001258997308 DM + HT
DJUDJU SUPARMAN 0001421856573 DM + HT
EDI HARYANTO 0001425902769 DM + HT
EMIYATI 0001455072478 DM + HT
ENANG KUSMANA 0001301722007 DM
ETI KARTINAH 0001188015017 DM + HT
EUIS HERYATI 0000053762962 DM + HT
EUIS KURAESIN 0001421848214 DM + HT
EUIS MUJIWATI 0001446323826 DM
FRANCISCUS SULAEMAN 0001464246832 DM + HT
HERLIN SUHARLINA 0001445105068 DM + HT
HERIYANA 0001450763897 DM + HT
HERLINA 0001183715504 DM
IMAS SAODAH 0001442461263 DM + HT
JAJA JAELANI 0001288595147 DM + HT
KULSUM SUMINARSIH 0000058940616 DM + HT
KUSNANDAR 0000057982869 DM
KWEE HA LAN 0001875600178 DM + HT
LILIS SUMIATI 0001324558833 DM + HT
LIOE JIE NO 0001339395412
MAMAN SUPARMAN 0001454727712
N ITING 0001856038138 DM + HT
Kegiatan Kelompok Resiko Tinggi
Nama FKTP
Nama Klub : DM SEHAT AFIATI
Tempat Kegiatan : Klinik afiat
dr./FKTP Pembina : dr. Resta Yuniar
No. Telp / Hp : 022 5232291
Tgl Terbentuk : Aug-14
KEGIATAN JUMLAH TT
NO BULAN
JENIS TGL YG HADIR PEMBINA
1 Senam
2 Edukasi
1 Jan-19 18/01/2019 19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
2 Feb-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
3 Mar-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
4 Apr-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
5 May-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
6 Jun-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
7 Jul-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
8 Aug-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
9 Sep-19
9 Sep-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
10 Oct-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
11 Nov-19
3 Pemeriksaan
4 pembagian obat
1 Senam
2 Edukasi
12 Dec-19
3 Pemeriksaan
4 pembagian obat
REKAP KEGIATAN PROLAN
NAMA FKTP : Klinik afiat

NAMA DOKTER : dr. Resta Yuniar
No Tanggal Kegiatan Jenis Kegiatan Nama Klub Rist
1 18/01/2019 PENYULUHAN DM SEHAT AFIATI I
Cat:
Format ini disertakan pada saat pertanggungjawaban kegiatan prolanis.
REKAP KEGIATAN PROLANIS 2019
Peserta
Materi Edukasi Rist Pemberi Materi Terdaftar
GOUT ARTHRITIS DR. RESTA YUNIAR 29
giatan prolanis.
Hadir Honor Konsumsi dll Total Biaya
19 -
Dec-18
JENIS TTD TTD OBAT
NO NAMA PESERTA NO KARTU KELAMIN P / I / S/A DIAGNOSA TEK. DARAH HADIR
TB BB
SISTOLE DIASTOL
1 A M PRIYATNA 0000058940605 L P DM + HT E
2 AI TIN M 0000056393662 P I DM + HT
3 ALI SUTANTO 0001313721549 L P DM + HT
4 AMRIZAL 0001265109772 L P DM
5 AMYLIA TJIPTO 0001310150834 P I DM
6 AWAN SUWANDI 0001258922305 L P DM + HT
7 BARKAH GULATRO 0001807784897 L P DM + HT
8 DAYAT 0001459004038 L P DM + HT
9 DEDY SURAPATI 0001258997308 L P DM + HT
10 DJUDJU SUPARMAN 0001421856573 L P DM + HT
11 EDI HARYANTO 0001425902769 L P DM + HT
12 EMIYATI 0001455072478 P I DM + HT
13 ENANG KUSMANA 0001301722007 L P DM
14 ETI KARTINAH 0001188015017 L I DM + HT
15 EUIS HERYATI 0000053762962 P I DM + HT
16 EUIS KURAESIN 0001421848214 P I DM + HT
17 EUIS MUJIWATI 0001446323826 P I DM
18 FRANCISCUS SULAEMAN 0001464246832 L P DM + HT
19 HERLIN SUHARLINA 0001445105068 P I DM + HT
20 HERIYANA 0001450763897 L P DM + HT
21 HERLINA 0001183715504 P P DM
22 IMAS SAODAH 0001442461263 P I DM + HT
23 JAJA JAELANI 0001288595147 L P DM + HT
24 KULSUM SUMINARSIH 0000058940616 P I DM + HT
25 KUSNANDAR 0000057982869 L P DM
26 KWEE HA LAN 0001875600178 P I DM + HT
27 LILIS SUMIATI 0001324558833 P I DM + HT
28 LIOE JIE NO 0001339395412 P I
29 MAMAN SUPARMAN 0001454727712 L P
30 N ITING 0001856038138 L P DM + HT

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STATUS

NO NAMA NO KARTU BPJS JENIS PESERTA TGL RUJUK BALIK JK

1 A M PRIYATNA 0000058940605 P PRB & PROLANIS L

2 AI TIN M 0000056393662 I PRB & PROLANIS 9/28/2018 P

3 ALI SUTANTO 0001313721549 P PRB & PROLANIS L

5 AMYLIA TJIPTO 0001310150834 I PRB & PROLANIS 4/23/2018 P

6 AWAN SUWANDI 0001258922305 P PRB & PROLANIS L

7 BARKAH GULATRO 0001807784897 meninggal PRB & PROLANIS L

8 DAYAT 0001459004038 P PRB & PROLANIS 9/28/2018 L

9 DEDY SURAPATI 0001258997308 P PRB & PROLANIS L

10 DJUDJU SUPARMAN 0001421856573 P PRB & PROLANIS 27-09-208 L

11 EDY HARYANTO 0001425902769 P PRB & PROLANIS L

12 EMIYATI 0001455072478 I PRB & PROLANIS P

15 EUIS HERYATI 0000053762962 I PRB & PROLANIS 8/16/2018 P

16 EUIS KURAESIN 0001421848214 I PRB & PROLANIS 4/19/2018 P

17 EUIS MUJIWATI 0001446323826 I PRB & PROLANIS P

18 FRANCISCUS SULAEMAN 0001464246832 P PRB & PROLANIS L

19 HERLIN SUHARLINA 0001445105068 I PRB & PROLANIS P

20 HERIYANA 0001450763897 P PRB & PROLANIS L

21 HERLINA 0001183715504 P PRB & PROLANIS P

22 IMAS SAODAH 0001442461263 I PRB & PROLANIS 9/27/2018 P

23 JAJA JAELANI 0001288595147 P PRB & PROLANIS L

24 KULSUM SUMINARSIH 0000058940616 I PRB & PROLANIS 24/04/2018 P

25 KUSNANDAR 0000057982869 P PRB & PROLANIS 4/23/2018 L

26 KWEE HA LAN 0001875600178 I PRB & PROLANIS P

28 LIOE JIE NO 0001339395412 I PRB & PROLANIS P

31 N ITING 0001856038138 P PRB & PROLANIS L

METFORMIN 500MG 3X1 90

1 KCU BANDUNG A M PRIYATNA 0000058940605 L

P KLINIK AFIATI 0135U011 DM + HT

HBA1C HBA1C CHOL CHOL

164 64 114 151

153 72 246 228

157 76 223 323

165 65 180 234

130 80 30.4688 160 78 88 80

120 80 25.5102 168 72

105 105 120

126 132 110

70 22.2656 160 57 78 94 6.4 46

24.2568 145 51 210 362

27.8488 148 61 134 207

HBA1C HBA1C CHOL CHOL

163 72 194 398

160 58 110 152

165 65 151 185

25.8065 155 62 160

130 90 27.852 163 74 143

130 90 26.6389 155 64 100 123

130 80 25.8065 155 62

80 25.8065 155 62 80 9.5 1.06

90 34.6021 153 81 75 9 0.85

80 22.6563 160 58 53 7 0.6

171 38 231 235 130 90 24.5578 155 59 110

190 50 263 210 140 90 34.6021 153 81

94 81 176 73 110 80 22.6563 160 58 127

27.852 163 74 159 120 80

26.2188 168 74 91 130 80

22.6563 160 58 92 130 90

22.4059 165 61 187

26.2845 142 53 148 140 80

24.5578 155 59 129 130 80