LAPORAN PELAYANAN KESEHATAN RUJUKAN DI FKTP

PUSKESMAS SAMBIREJO
Jan-18

No Tanggal Nama Pasien Umur No BPJS Jenis Kelamin

1 Asriani 66 0002224317396 L
2 Sudirman 69 0000984097743 L
3 T.Dewi R 68 0000984097754 P
2-Jan-18
4 Aidil Azhari 44 0000247183773 L
5 Siti Maimunah 52 0000010023344 P
6 Rosidah 47 0000249366352 P
7 Sringena 50 0000007169589 P
8 Pardi 37 0002223074957 L
9 Rusnani 50 0000007331286 P
10 Mardiana Stp 49 0000007426067 P
11 Paidi 62 0002066409606 L
12 3-Jan-18 Legiyem 62 0002066412069 P
13 Anisa R 17 0000165890496 P
14 Dapot Nababan 62 0000007283395 L
15 Tri Suci R 21 0000010009247 P
16 Sulaiman 46 0002196125122 L
17 Ponimin 52 0000248060349 L
18 Sumini 62 0001261674573 P
19 Jumadi 59 0001314549044 L
20 Mariono 63 0000248548105 L
21 Hj Safrah 70 0001423885678 P
22 Siti Nurdiah 46 0000247752729 P
23 4-Jan-18 Neti Asdawati 91 0000007327923 P
24 Suryatati 47 0002305857194 P
25 NurSyafitri 39 0002291258632 P
26 Siti Maryam 54 0000249427067 P

27 Kusno 46 0002265910863 P
28 Sunggul P 53 0002248743958 P
29 M.Yusuf Hsb 65 0001822065456 L
30 Junaidi 40 0002038018342 L
31 Juleha 47 0002298190329 P
32 Baharudin Sbrg 42 0000007413568 L
5-Jan-18
33 Suparto 78 0000249677087 L
34 Sutratjio 69 0001396746718 L
35 Alfilio Boy 1 0002289724323 L
36 Zulkarnaen 37 0002293559223 L
37 Azanul 49 0002044782742 L
38 Barkah 59 0001262795905 P
39 Partini 20 0000249230349 P
40 Lidiawati 30 0000248546992 P
6-Jan-18
41 Gunawan 32 0000249278861 L
42 Alvin Khairi 17 0000248203631 L
 6-Jan-18

43 Ny.Sarifah 86 0000010107156 P
44 Dedi Satria 31 0000240544899 L
45 Albert Gtg 49 0000007181976 L
46 Nurakmal 54 0000007281639 L
47 Atika Maysaroh 5 0001873670196 P
48 Sutino 58 0001105169927 L
49 Rbh Simamora 52 0001850295115 P
50 Sakdiah Ar 69 0001889761954 P
51 8-Jan-18 Dulharik 75 0002090509569 L
52 Karya Atmaja 82 0002313944853 L
53 Sutarni HS 76 0002094594726 P
54 Keliani 56 0000248003482 P
55 Julianti 22 0002302816972 P
56 Rasmi 69 0000249648096 P
57 Susi Indah L 23 0001871252414 P
58 Dasikem 69 0000984094211 P
59 Haryati 55 0002204523832 P
60 9-Jan-19 Kurniawan S 29 0002327609305 L
61 Sakidjan Jaya 78 0001300008508 L
62 Bela Puspita 35 0000247744697 P
63 Lisa Tiara Lbs 27 0001839193222 P
64 Drs Sofyan B 66 0000009983002 L
10-Jan-18
65 Masnah 59 0001264123743 P
66 Juniawati 48 0002070539807 P
67 Rosliana 54 0002230915454 P
68 Siti Hajar 41 0000248623931 P
69 11-Jan-18 Sukono 70 0001396753481 L
70 Sumarni 53 0000010179404 P
71 Popy Yusmira 32 0001143202746 P
72 Saidatun A Nst 51 0000247150304 P
73 Sri Ramadani 26 0002318918387 P
74 12-Jan-18 Endang S 60 0002293942623 P
75 Dewi Novita 43 0000007181548 P
76 Zahra 42 0000007021956 P
77 Sartono 58 0000248604748 L
78 Suratman S 38 0002314770647 L
13-Jan-18
79 Sanem 53 0001845237183 P
80 Tukirah 64 0002232501693 P
81 Chandrawati 59 0000200532475 P
82 Sulistia N 30 0002321670712 P
83 Astuti 33 0002271195865 P
84 Zubaidah 53 0001907428263 P
85 Sumarni 63 0000225886432 P
15-Jan-18
86 Sujadiono 56 0001847779222 L
87 Eka Ramadan 25 0002070540303 L
88 Fujiaty A 53 0001810176873 P
89 M.Reza N 14 0000007282394 L
90 Saadah 51 0000010151357 P
 91 Utami Ulandari 27 0001611061558 P
92 Misdi 58 0001102227895 L
93 16-Jan-18 Suratik 48 0001082386416 P
94 Ramlah 73 0002044094343 P
95 Mujiatik 53 0001880925186 P
96 Mutira 22 0000249085541 P
97 Era Lestari 38 0000247418289 P
98 Suriana 62 0000249118661 P
17-Jan-18
99 Tumina 54 0001719571083 P
100 Mulianti 44 0002212209808 P
101 Herlinawati 45 0002269097469 P
102 Muliasan 43 0001322558662 L
103 M.Sueb 53 0000173237016 L
18-Jan-18
104 Ratna Ningsi 49 0000007480124 P
105 Thia Miranda 31 0000007480135 P
106 Zamah Sari 59 0001907941781 P
107 Samidi 66 0000984098766 L
108 Dedy Huraira P 43 0000198468999 P
109 M.Nabihan 1 0002225158481 L
110 19-Jan-18 Ibrahim 68 0002079323806 L
111 Mimin Winarsi 69 0000162740079 P
112 Wagiyun 61 0002085339115 L
113 Saginem 58 0002039448936 P
114 Siti Radijah 58 0000007447882 P
115 M.Saleh 33 0001310857604 L
116 20-Jan-18 Semi 69 0001396746202 P
117 Kartini 49 0000249376871 P
118 Liza Wati 54 0001964439325 P
119 Mularseh 59 0001964439325 L
120 Robert Gultom 55 0000010198765 L
121 Siti Aminah 74 0001309671865 P
122 Adiarto 53 0000249225478 L
123 Nurmiani 43 0001262070055 P
22-Jan-18
124 Ade Pradana 19 0001429110707 L
125 Samijo 58 0001829735662 L
126 Hartini 45 0002280217803 P
127 Nurliana 49 0002327815304 P
128 Asni 61 0001847232786 P
129 Dela Sabrina 10 0000247787741 P
130 Syarifudin 56 0000007278129 L
131 Saikun 69 0001478505786 L
132 Sudarminah 65 0000249322634 P
133 23-Jan-18 Juminah 62 0000248236637 P
134 Popi Yusmira 32 0001143202746 P
135 Ria Novita S 27 0001884005043 P
136 M.Andi 13 0002266123267 L
137 Maret Purba 57 0000007169591 L
138 Djunaidi H 74 0001262795512 L

24-Jan-18
139 Wiji 67 0002322225551 L
24-Jan-18
140 Sumidin 55 0002209722074 L
141 Turino Hadi 52 0000007484679 L
142 Wagisah 60 0000984095267 P
143 Hakim 64 0000249439781 L
144 Sunaryo 57 0002046217329 L
145 25-Jan-18 Andres 17 0000249169307 L
146 Patimah 60 0001396746257 P
147 Amran 58 0001490920615 L
148 Azizah 4 0002127645404 P
149 Darmayanti 44 0000248154039 P
150 26-Jan-18 Putri Alpida 19 0000249107771 P
151 Yatini 45 0000984091285 P
152 Yanti 43 0000248735733 P
153 Salindi 36 0002423115628 P
154 Lisa Afriani 24 0000249047469 P
155 Sarkawi 71 0000984097809 L
156 Ade Tasya 39 0001396751095 P
157 Legimin 66 0001382767727 L
158 29-Jan-18 Syukur 59 0002420242042 L
159 Rizcky 17 0001852680093 L
160 Siti Sarah 47 0000007249331 P
161 Arsen S 1 0002284560898 L
162 Fatimah 50 0002265447418 P
163 M.Nasrul 55 0001103855657 L
164 Siti Nuraini 13 0000249081377 P
165 Siti Hajar 38 0000248837488 P
166 Hartuti 54 0002043790233 P
167 Salamah 51 0000007281742 P
168 Rumini 58 0002419379032 P
169 30-Jan-18 Suyatni 38 0000248817442 P
170 Raja R Srg 44 0000007280998 L
171 Darmansyah 65 0001830708033 L
172 Masijam 78 0002323232943 P
173 Hj Salbiah 55 0002319393442 P
174 Saminah 43 0000249142836 P
175 Masliyah 59 0000249209594 P
176 Ernilam Srg 45 0001904466936 P
177 31-Jan-18 Mariani 61 0002224318476 P
178 Suhasti 62 0000007352572 P
179 Rendi Setiawan 17 0002236490987 L
 KESEHATAN RUJUKAN DI FKTP
MAS SAMBIREJO
Jan-18

Diagnosa Spesialis Tempat Rujukan

Hernia Bedah RS.Bidadari
Stroke Saraf RS.Bidadari
TB Paru Paru RS.Bidadari
HIV Asoka RS.Djulham
Polyneuropathy P.Dalam RS.Bidadari
Cetanous Furuncle Bedah RS.Sylvani
Urinary Calculus P.Dalam RS.Royal Prima
Skizofrenia Jiwa RS.Djulham
Thyroid Nodule Bedah RS.Bidadari
Presbiopia Mata RS.Bidadari
CHF P.Dalam RS.Bidadari
HHD + CHF P.Dalam RS.Bidadari
Myopia Mata RS.Bidadari
Hypermetropia Mata RS.Bidadari
Hypermetropia Mata RS.Bidadari
Fraktur Of Femur Ortopedi RS.Djulham
DM + TB Paru P.Dalam RS.Bidadari
Mamae Dysplasia Onkologi RS.Djulham
Parkinson Saraf RS.Bidadari
PPOK Paru RS.Bidadari
CHF Jantung RS.Bidadari
Stroke Saraf RS.Bidadari
Hypoglikemia P.Dalam RS.Bidadari
Varicella Saraf RS.Bidadari
CHF Jantung RS.Bidadari
Low Back Paint Saraf RS.Bidadari
CHF Jantung RS.Bidadari
Gagal Ginjal Kronis HD RS.MHC
BPH + Hypertensi P.Dalam P.Dalam
CHF Jantung RS.Bidadari
Endometriosis Obgyn RS.Bidadari
Urinary Calculus P.Dalam RS.Sylvani
Pseudopakia Mata RS.Bangkatan
HHD Jantung RS.Bidadari
Non allergic Asthma Anak RS.Djulham
Mononeuropathy Saraf RS.Djulham
CKD HD RS.Bangkatan
Epilepsy P.Dalam RS.Djulham
Peptic Ulcer P.Dalam RS.Bidadari
Lymphadenitis P.Dalam RS.Sylvani
CKD HD RS.Bidadari
Mocular Cornea Mata RS.Bidadari
Decompensasi Cordis Jantung RS.Bangkatan
Lipoma Bedah RS.Djulham
OMP THT RS.Bidadari
OMP THT RS.Kesrem
Nefrotic Syndrome Anak RS.Murni Teguh
Penyakit Jantung Koroner Jantung RS.Bidadari
CHF Jantung RS.Murni Teguh
HNP P.Dalam RS.Djulham
PPOK P.Dalam RS.Bidadari
Catarak Mata RS.Bidadari
Presbyopia Mata RS.Bidadari
Pneumonia Paru RS.Bangkatan
TB + Abdominal Pragnancy Obgyn RS.Sylvani
Catarak Mata RS.Bidadari
Epilepsy Saraf RS.Bidadari
Presbyopia Mata RS.Kesrem
Glaukoma Mata RS.Djulham
Corpus Alienum Mata RS.Bidadari
CHF HD RS.Bidadari
Psoriasis Kulit RS.Bidadari
Abortion Incomplate Obgyn RS.Sylvani
Catarak Mata RS.Kesrem
Presbyopia Mata RS.Bidadari
Cardiomegali Jantung RS.Bidadari
TB Paru Paru RS.Bidadari
Myoma Uteri Obgyn RS.Arta Medika
CHF Jantung RS.Bidadari
TB Paru Paru RS.Bidadari
Kista Ovarium Obgyn RS.Bidadari
Ca Ovarium Obgyn RS.Pirngadi
Lipoma Bedah RS.Bidadari
Dyspepsia P.Dalam RS.Bidadari
Myopia Mata RS.Bidadari
Pterigyum Mata RS.Bidadari
Neuropathy Saraf RS.Bidadari
Nefrotic Syndrome P.Dalam RS.Bidadari
CKD HD RS.Bidadari
CHF Jantung RS.Djulham
CHF P.Dalam RS.Djulham
Post Op Sexio Saecar Obgyn RS.Bidadari
Depresi Op Partus Jiwa RS.Bidadari
Myopia Mata RS.Bidadari
CKD HD RS.Bidadari
CKD HD RS.Bidadari
TB Paru Paru RS.Bidadari
Presbyopia Mata RS.Bidadari
DM Tipe 2 P.Dalam RS.Bidadari
CHF P.Dalam RS.Bidadari
Chalazion Mata RS.Bidadari
Damentia Saraf RS.Djulham
Hypermetropia Mata RS.Kesrem
Pseudopakia Mata RS.Bidadari
Catarak Mata RS.SMEC
FAM Bedah RS.Bidadari
Myopia Mata RS.Bangkatan
Presbyopia Mata RS.Bangkatan
Ca Cerviks Obgyn RS.Bidadari
Headache Syndrome Saraf RS.Bidadari
Presbyopia Mata RS.Bidadari
CKD HD RS.Djulham
Stroke Saraf RS.Djulham
Stroke Saraf RS.Bidadari
Myopia Mata RS.Bidadari
Fatty Livar P.Dalam RS.Bidadari
Emphysema Paru RS.Bangkatan
Impacted Teeth Gigi RS.Bangkatan
TB Primer Anak RS.Sylvani
CHF P.Dalam RS.Djulham
Low Back Paint Saraf RS.Bidadari
CHF P.Dalam RS.Tj Pura
Low Back Paint Saraf RS.Bidadari
HHD + DM Tipe 2 P.Dalam RS.Djulham
Skin Ulcer kulit RS.Djulham
Presbyopia Mata RS.Kesrem
Kista Ovarium Obgyn RS.Bidadari
Nefrotic Syndrome P.Dalam RS.Sylvani
Pterigyum Mata RS.Djulham
Trauma Thorax Paru RS.Djulham
Pseudopakia Mata RS.Bangkatan
Otitis Media THT RS.Bidadari
CKD HD RS.Djulham
Hypermetropia Mata RS.Bidadari
Sinusitis THT RS.Bidadari
Depresi Jiwa RS.Djulham
Penyakit Jantung Koroner Jantung RS.Delia
TB Paru Paru RS.Bidadari
Steven Jonson Kulitr RS.Djulham
Incontinance Urinary Urologi RS.Djulham
CHF P.Dalam RS.Bidadari
Low Back Paint Saraf RS.Bangkatan
CKD + CHF + HHD Jantung RS.Bidadari
Pulpitis Gigi RS.Bangkatan
Myopia Mata RS.Bangkatan
Mumps P.Dalam RS.Bidadari
DM + PJK P.Dalam RS.Bangkatan
CHF P.Dalam RS.Bidadari
Stroke Saraf RS.Delia
CHF Jantung RS.Bidadari
Pterigyum Mata RS.Bidadari
Catarak Mata RS.Kesrem
Haemoptysis Paru RS.Djulham
Struma Nodul Non Toxic P.Dalam RS.Bidadari
Syndrome Nefrotic P.Dalam RS.Bangkatan
CHF P.Dalam RS.Bidadari
Arthropatic Psoriasis Kulit RS.Bidadari
Defness THT RS.Bidadari
Presbyopia Mata RS.Djulham
Abortion Incomplate Obgyn RS.Kesrem
Low Back Paint Saraf RS.Bidadari
Presbyopia Mata RS.Djulham
Conjungtiva Injury Mata RS.Bidadari
Hypermetropia Mata RS.Bidadari
Lipoma Bedah RS.Bangkatan
Myopia Mata RS.Bidadari
CHF P.Dalam RS.Bidadari
Anemia Aplastic P.Dalam RS.Bidadari
TB Paru Paru RS.Bidadari
Myopathy Saraf RS.Bidadari
Interstitial Pneumonia Anak RS.Sylavni
CKD HD RS.Bidadari
Depresi Jiwa RS.Bidadari
Glaukoma Mata RS.Bidadari
Myopia Mata RS.Bidadari
Prolaps Uteri Obgyn RS.Bidadari
Lipoma Mamae Bedah RS.Bidadari
CHF P.Dalam RS.Bidadari
Hypermetropia Mata RS.Bidadari
Batu Saluran Kemih Bedah RS.Bidadari
CHF Jantung RS.Bidadari
Metastasme Paru Obgyn RS.Bidadari
Low Back Paint P.Dalam RS.Bidadari
Irreguler Menstruasi Obgyn RS.Bidadari
Stroke Saraf Saraf
SOL Saraf Saraf
CHF Jantung Jantung
Hypermetropia Mata Mata
OMSK THT THT

Sambirejo, 05 Februari 2018

Ka. UPT Puskesmas Sambirejo

ARLINA PRIHHESTI, SKM

NIP. 19650820 198801 2 001